Distinct forebrain regions define a dichotomous astrocytic profile in multiple system atrophy

The growing recognition of a dichotomous role of astrocytes in neurodegenerative processes has heightened the need for unraveling distinct astrocytic subtypes in neurological disorders. In multiple system atrophy (MSA), a rare, rapidly progressing atypical Parkinsonian disease characterized by increased astrocyte reactivity. However the specific contribution of astrocyte subtypes to neuropathology remains elusive. Hence, we first set out to profile glial fibrillary acidic protein levels in astrocytes across the human post mortem motor cortex, putamen, and substantia nigra of MSA patients and observed an overall profound astrocytic response. Matching the post mortem human findings, a similar astrocytic phenotype was present in a transgenic MSA mouse model. Notably, MSA mice exhibited a decreased expression of the glutamate transporter 1 and glutamate aspartate transporter in the basal ganglia, but not the motor cortex. We developed an optimized astrocyte isolation protocol based on magnetic-activated cell sorting via ATPase Na+/K+ transporting subunit beta 2 and profiled the transcriptomic landscape of striatal and cortical astrocytes in transgenic MSA mice. The gene expression profile of astrocytes in the motor cortex displayed an anti-inflammatory signature with increased oligodendroglial and pro-myelinogenic expression pattern. In contrast, striatal astrocytes were defined by elevated pro-inflammatory transcripts accompanied by dysregulated genes involved in homeostatic functions for lipid and calcium metabolism. These findings provide new insights into a region-dependent, dichotomous astrocytic response-potentially beneficial in the cortex and harmful in the striatum-in MSA suggesting a differential role of astrocytes in MSA-related neurodegenerative processes.

Enzymatic Activity of HPGD in Treg Cells Suppresses Tconv Cells to Maintain Adipose Tissue Homeostasis and Prevent Metabolic Dysfunction

Regulatory T cells (Treg cells) are important for preventing autoimmunity and maintaining tissue homeostasis, but whether Treg cells can adopt tissue- or immune-context-specific suppressive mechanisms is unclear. Here, we found that the enzyme hydroxyprostaglandin dehydrogenase (HPGD), which catabolizes prostaglandin E₂ (PGE₂) into the metabolite 15-keto PGE₂, was highly expressed in Treg cells, particularly those in visceral adipose tissue (VAT). Nuclear receptor peroxisome proliferator-activated receptor-γ (PPARγ)-induced HPGD expression in VAT Treg cells, and consequential Treg-cell-mediated generation of 15-keto PGE₂ suppressed conventional T cell activation and proliferation. Conditional deletion of Hpgd in mouse Treg cells resulted in the accumulation of functionally impaired Treg cells specifically in VAT, causing local inflammation and systemic insulin resistance. Consistent with this mechanism, humans with type 2 diabetes showed decreased HPGD expression in Treg cells. These data indicate that HPGD-mediated suppression is a tissue- and context-dependent suppressive mechanism used by Treg cells to maintain adipose tissue homeostasis.

Cellular Differentiation of Human Monocytes Is Regulated by Time-Dependent Interleukin-4 Signaling and the Transcriptional Regulator NCOR2

Human in vitro generated monocyte-derived dendritic cells (moDCs) and macrophages are used clinically, e.g., to induce immunity against cancer. However, their physiological counterparts, ontogeny, transcriptional regulation, and heterogeneity remains largely unknown, hampering their clinical use. High-dimensional techniques were used to elucidate transcriptional, phenotypic, and functional differences between human in vivo and in vitro generated mononuclear phagocytes to facilitate their full potential in the clinic. We demonstrate that monocytes differentiated by macrophage colony-stimulating factor (M-CSF) or granulocyte macrophage colony-stimulating factor (GM-CSF) resembled in vivo inflammatory macrophages, while moDCs resembled in vivo inflammatory DCs. Moreover, differentiated monocytes presented with profound transcriptomic, phenotypic, and functional differences. Monocytes integrated GM-CSF and IL-4 stimulation combinatorically and temporally, resulting in a mode- and time-dependent differentiation relying on NCOR2. Finally, moDCs are phenotypically heterogeneous and therefore necessitate the use of high-dimensional phenotyping to open new possibilities for better clinical tailoring of these cellular therapies.

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In vitro monocyte cultures model in vivo inflammatory dendritic cells and macrophages

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Monocyte-derived dendritic cells integrate interleukin-4 signaling time dependently

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NCOR2 controls differentiation of in vitro generated monocyte-derived dendritic cells

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In vitro generated monocyte-derived cells are phenotypically heterogeneous

The transcriptional regulator network of human inflammatory macrophages is defined by open chromatin

Differentiation of inflammatory macrophages from monocytes is characterized by an orderly integration of epigenetic and transcriptional regulatory mechanisms guided by lineage-determining transcription factors such as PU.1. Further activation of macrophages leads to a stimulus- or microenvironment-specific signal integration with subsequent transcriptional control established by the action of tissue- or signal-associated transcription factors. Here, we assess four histone modifications during human macrophage activation and integrate this information with the gene expression data from 28 different macrophage activation conditions in combination with GM-CSF. Bioinformatically, for inflammatory macrophages we define a unique network of transcriptional and epigenetic regulators (TRs), which was characterized by accessible promoters independent of the activation signal. In contrast to the general accessibility of promoters of TRs, mRNA expression of central TRs belonging to the TR network displayed stimulus-specific expression patterns, indicating a second level of transcriptional regulation beyond epigenetic chromatin changes. In contrast, stringent integration of epigenetic and transcriptional regulation was observed in networks of TRs established from somatic tissues and tissue macrophages. In these networks, clusters of TRs with permissive histone marks were associated with high gene expression whereas clusters with repressive chromatin marks were associated with absent gene expression. Collectively, these results support that macrophage activation during inflammation in contrast to lineage determination is mainly regulated transcriptionally by a pre-defined TR network.

ATF3 Is a Key Regulator of Macrophage IFN Responses

Cytokines and IFNs downstream of innate immune pathways are critical for mounting an appropriate immune response to microbial infection. However, the expression of these inflammatory mediators is tightly regulated, as uncontrolled production can result in tissue damage and lead to chronic inflammatory conditions and autoimmune diseases. Activating transcription factor 3 (ATF3) is an important transcriptional modulator that limits the inflammatory response by controlling the expression of a number of cytokines and chemokines. However, its role in modulating IFN responses remains poorly defined. In this study, we demonstrate that ATF3 expression in macrophages is necessary for governing basal IFN-β expression, as well as the magnitude of IFN-β cytokine production following activation of innate immune receptors. We found that ATF3 acted as a transcriptional repressor and regulated IFN-β via direct binding to a previously unidentified specific regulatory site distal to the Ifnb1 promoter. Additionally, we observed that ATF3 itself is a type I IFN-inducible gene, and that ATF3 further modulates the expression of a subset of inflammatory genes downstream of IFN signaling, suggesting it constitutes a key component of an IFN negative feedback loop. Consistent with this, macrophages deficient in Atf3 showed enhanced viral clearance in lymphocytic choriomeningitis virus and vesicular stomatitis virus infection models. Our study therefore demonstrates an important role for ATF3 in modulating IFN responses in macrophages by controlling basal and inducible levels of IFNβ, as well as the expression of genes downstream of IFN signaling.

Optimization of transcription factor binding map accuracy utilizing knockout-mouse models

Genome-wide assessment of protein-DNA interaction by chromatin immunoprecipitation followed by massive parallel sequencing (ChIP-seq) is a key technology for studying transcription factor (TF) localization and regulation of gene expression. Signal-to-noise-ratio and signal specificity in ChIP-seq studies depend on many variables, including antibody affinity and specificity. Thus far, efforts to improve antibody reagents for ChIP-seq experiments have focused mainly on generating higher quality antibodies. Here we introduce KOIN (knockout implemented normalization) as a novel strategy to increase signal specificity and reduce noise by using TF knockout mice as a critical control for ChIP-seq data experiments. Additionally, KOIN can identify 'hyper ChIPable regions' as another source of false-positive signals. As the use of the KOIN algorithm reduces false-positive results and thereby prevents misinterpretation of ChIP-seq data, it should be considered as the gold standard for future ChIP-seq analyses, particularly when developing ChIP-assays with novel antibody reagents.

Transcriptome-based network analysis reveals a spectrum model of human macrophage activation

Macrophage activation is associated with profound transcriptional reprogramming. Although much progress has been made in the understanding of macrophage activation, polarization, and function, the transcriptional programs regulating these processes remain poorly characterized. We stimulated human macrophages with diverse activation signals, acquiring a data set of 299 macrophage transcriptomes. Analysis of this data set revealed a spectrum of macrophage activation states extending the current M1 versus M2-polarization model. Network analyses identified central transcriptional regulators associated with all macrophage activation complemented by regulators related to stimulus-specific programs. Applying these transcriptional programs to human alveolar macrophages from smokers and patients with chronic obstructive pulmonary disease (COPD) revealed an unexpected loss of inflammatory signatures in COPD patients. Finally, by integrating murine data from the ImmGen project we propose a refined, activation-independent core signature for human and murine macrophages. This resource serves as a framework for future research into regulation of macrophage activation in health and disease.

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Macrophages react with specific transcriptional programming upon distinct signals

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Activation by TNF, PGE₂, and P3C activates a STAT4-associated transcriptional program

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NFKB1, JUNB, and CREB1 are central transcription factors of macrophage activation

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Inflammatory signatures are lost in alveolar macrophages from COPD patients

High-density lipoprotein mediates anti-inflammatory reprogramming of macrophages via the transcriptional regulator ATF3

High Density Lipoprotein (HDL) mediates reverse cholesterol transport and it is known to be protective against atherosclerosis. In addition, HDL has potent anti-inflammatory properties that may be critical for protection against other inflammatory diseases. The molecular mechanisms of how HDL can modulate inflammation, particularly in immune cells such as macrophages, remain poorly understood. Here we identify the transcriptional repressor ATF3, as an HDL-inducible target gene in macrophages that down-regulates the expression of Toll-like receptor (TLR)-induced pro-inflammatory cytokines. The protective effects of HDL against TLR-induced inflammation were fully dependent on ATF3 in vitro and in vivo. Our findings may explain the broad anti-inflammatory and metabolic actions of HDL and provide the basis for predicting the success of novel HDL-based therapies.

High-resolution transcriptome of human macrophages

Macrophages are dynamic cells integrating signals from their microenvironment to develop specific functional responses. Although, microarray-based transcriptional profiling has established transcriptional reprogramming as an important mechanism for signal integration and cell function of macrophages, current knowledge on transcriptional regulation of human macrophages is far from complete. To discover novel marker genes, an area of great need particularly in human macrophage biology but also to generate a much more thorough transcriptome of human M1- and M1-like macrophages, we performed RNA sequencing (RNA-seq) of human macrophages. Using this approach we can now provide a high-resolution transcriptome profile of human macrophages under classical (M1-like) and alternative (M2-like) polarization conditions and demonstrate a dynamic range exceeding observations obtained by previous technologies, resulting in a more comprehensive understanding of the transcriptome of human macrophages. Using this approach, we identify important gene clusters so far not appreciated by standard microarray techniques. In addition, we were able to detect differential promoter usage, alternative transcription start sites, and different coding sequences for 57 gene loci in human macrophages. Moreover, this approach led to the identification of novel M1-associated (CD120b, TLR2, SLAMF7) as well as M2-associated (CD1a, CD1b, CD93, CD226) cell surface markers. Taken together, these data support that high-resolution transcriptome profiling of human macrophages by RNA-seq leads to a better understanding of macrophage function and will form the basis for a better characterization of macrophages in human health and disease.

Lack of PPARγ in myeloid cells confers resistance to Listeria monocytogenes infection

The peroxisomal proliferator-activated receptor γ (PPARγ) is a nuclear receptor that controls inflammation and immunity. Innate immune defense against bacterial infection appears to be compromised by PPARγ. The relevance of PPARγ in myeloid cells, that organize anti-bacterial immunity, for the outcome of immune responses against intracellular bacteria such as Listeria monocytogenes in vivo is unknown. We found that Listeria monocytogenes infection of macrophages rapidly led to increased expression of PPARγ. This prompted us to investigate whether PPARγ in myeloid cells influences innate immunity against Listeria monocytogenes infection by using transgenic mice with myeloid-cell specific ablation of PPARγ (LysMCre×PPARγ(flox/flox)). Loss of PPARγ in myeloid cells results in enhanced innate immune defense against Listeria monocytogenes infection both, in vitro and in vivo. This increased resistance against infection was characterized by augmented levels of bactericidal factors and inflammatory cytokines: ROS, NO, IFNγ TNF IL-6 and IL-12. Moreover, myeloid cell-specific loss of PPARγ enhanced chemokine and adhesion molecule expression leading to improved recruitment of inflammatory Ly6C(hi) monocytes to sites of infection. Importantly, increased resistance against Listeria infection in the absence of PPARγ was not accompanied by enhanced immunopathology. Our results elucidate a yet unknown regulatory network in myeloid cells that is governed by PPARγ and restrains both listeriocidal activity and recruitment of inflammatory monocytes during Listeria infection, which may contribute to bacterial immune escape. Pharmacological interference with PPARγ activity in myeloid cells might represent a novel strategy to overcome intracellular bacterial infection.

Repression of the genome organizer SATB1 in regulatory T cells is required for suppressive function and inhibition of effector differentiation

Regulatory T cells (T(reg) cells) are essential for self-tolerance and immune homeostasis. Lack of effector T cell (T(eff) cell) function and gain of suppressive activity by T(reg) cells are dependent on the transcriptional program induced by Foxp3. Here we report that repression of SATB1, a genome organizer that regulates chromatin structure and gene expression, was crucial for the phenotype and function of T(reg) cells. Foxp3, acting as a transcriptional repressor, directly suppressed the SATB1 locus and indirectly suppressed it through the induction of microRNAs that bound the SATB1 3' untranslated region. Release of SATB1 from the control of Foxp3 in T(reg) cells caused loss of suppressive function, establishment of transcriptional T(eff) cell programs and induction of T(eff) cell cytokines. Our data support the proposal that inhibition of SATB1-mediated modulation of global chromatin remodeling is pivotal for maintaining T(reg) cell functionality.

A Retinal Prosthesis Technology Based on CMOS Microelectronics and Microwire Glass Electrodes

A very large format neural stimulator device, to be used in future retinal prosthesis experiments, has been designed, fabricated, and tested. The device was designed to be positioned against a human retina for short periods in an operating room environment. Demonstrating a very large format, parallel interface between a 2-D microelectronic stimulator array and neural tissue would be an important step in proving the feasibility of high resolution retinal prosthesis for the blind. The architecture of the test device combines several novel components, including microwire glass, a microelectronic multiplexer, and a microcable connector. The array format is 80 times 40 array pixels with approximately 20 microwire electrodes per pixel. The custom assembly techniques involve indium bump bonding, ribbon bonding, and encapsulation. The design, fabrication, and testing of the device has resolved several important issues regarding the feasibility of high-resolution retinal prosthesis, namely, that the combination of conventional CMOS electronics and microwire glass provides a viable approach for a high resolution retinal prosthesis device. Temperature change from power dissipation within the device and maximum electrical output current levels suggest that the device is acceptable for acute human tests.

The status of structural genomics defined through the analysis of current targets and structures

Structural genomics--large-scale macromolecular 3-dimenional structure determination--is unique in that major participants report scientific progress on a weekly basis. The target database (TargetDB) maintained by the Protein Data Bank (http://targetdb.pdb.org) reports this progress through the status of each protein sequence (target) under consideration by the major structural genomics centers worldwide. Hence, TargetDB provides a unique opportunity to analyze the potential impact that this major initiative provides to scientists interested in the sequence-structure-function-disease paradigm. Here we report such an analysis with a focus on: (i) temporal characteristics--how is the project doing and what can we expect in the future? (ii) target characteristics--what are the predicted functions of the proteins targeted by structural genomics and how biased is the target set when compared to the PDB and to predictions across complete genomes? (iii) structures solved--what are the characteristics of structures solved thus far and what do they contribute? The analysis required a more extensive database of structure predictions using different methods integrated with data from other sources. This database, associated tools and related data sources are available from http://spam.sdsc.edu.

Three-dimensional reconstructions of normal and aneurysmatic left ventricles in vivo using transesophageal echocardiography

OBJECTIVE

To perform three-dimensional surface reconstructions to provide spatial delineations of a normal and an aneurysmatic left ventricle, using transesophageal echocardiography.

DESIGN

Prospective study.

SETTING

University hospital.

PARTICIPANTS

Eight patients in cardiogenic shock admitted to the intensive care unit and two patients undergoing surgery with general anesthesia.

INTERVENTIONS

Using a multiplane transesophageal echocardiography probe, nine echocardiographic cross-sectional images of the heart at approximately 20 degrees angular increments were obtained from midesophageal level in each patient for three-dimensional surface reconstructions. Multiple determinations of cardiac output using the thermodilution principle were also made in each patient to verify the accuracy of three-dimensional data sets.

MEASUREMENTS AND MAIN RESULTS

End-diastolic and end-systolic volumes were determined from three-dimensional data sets using the disc-summation method. Stroke volume was derived as the difference between end-diastolic and end-systolic volumes. Stroke volume was also calculated from thermodilution cardiac output measurements and heart rate. Correlation and limits of agreement between stroke volumes derived by the two methods were determined. Three-dimensional wire-frame models of a normal and an aneurysmatic left ventricle at end-systole were constructed from the nine echocardiographic cross-sectional images. Correlation coefficient between stroke volume derived from three-dimensional data sets using the disc-summation method and that measured by the thermodilution method was 0.91 (p < 0.001). Wire-frame models reveal a normal symmetric cavity and an aneurysmal cavity in sharp relief.

CONCLUSIONS

Three-dimensional surface reconstruction can be performed from multiple cross-sectional images obtained using an unmodified commercially available multiplane transesophageal echocardiography probe, to reveal the left ventricular cavity in sharp relief. High correlation between stroke volume calculated from three-dimensional data sets and that measured by the thermodilution method attests to the accuracy of the three-dimensional data sets.

Na+ translocation by the NADH:ubiquinone oxidoreductase (complex I) from Klebsiella pneumoniae

Complex I is the site for electrons entering the respiratory chain and therefore of prime importance for the conservation of cell energy. It is generally accepted that the complex I-catalysed oxidation of NADH by ubiquinone is coupled specifically to proton translocation across the membrane. In variance to this view, we show here that complex I of Klebsiella pneumoniae operates as a primary Na+ pump. Membranes from Klebsiella pneumoniae catalysed Na+-stimulated electron transfer from NADH or deaminoNADH to ubiquinone-1 (0.1-0.2 micromol min-1 mg-1). Upon NADH or deaminoNADH oxidation, Na+ ions were transported into the lumen of inverted membrane vesicles. Rate and extent of Na+ transport were significantly enhanced by the uncoupler carbonylcyanide-m-chlorophenylhydrazone (CCCP) to values of approximately 0.2 micromol min-1 mg-1 protein. This characterizes the responsible enzyme as a primary Na+ pump. The uptake of sodium ions was severely inhibited by the complex I-specific inhibitor rotenone with deaminoNADH or NADH as substrate. N-terminal amino acid sequence analyses of the partially purified Na+-stimulated NADH:ubiquinone oxidoreductase from K. pneumoniae revealed that two polypeptides were highly similar to the NuoF and NuoG subunits from the H+-translocating NADH:ubiquinone oxidoreductases from enterobacteria.

A membrane-bound NAD(P)+-reducing hydrogenase provides reduced pyridine nucleotides during citrate fermentation by Klebsiella pneumoniae

During anaerobic growth of Klebsiella pneumoniae on citrate, 9.4 mmol of H2/mol of citrate (4-kPa partial pressure) was formed at the end of growth besides acetate, formate, and CO2. Upon addition of NiCl2 (36 microM) to the growth medium, hydrogen formation increased about 36% to 14.8 mmol/mol of citrate (6 kPa), and the cell yield increased about 15%. Cells that had been harvested and washed under anoxic conditions exhibited an H2-dependent formation of NAD(P)H in vivo. The reduction of internal NAD(P)+ was also achieved by the addition of formate. In crude extracts, the H2:NAD+ oxidoreductase activity was 0.13 micromol min-1 mg-1, and 76% of this activity was found in the washed membrane fraction. The highest specific activities of the membrane fraction were observed in 50 mM potassium phosphate, with 1.6 micromol of NADPH formed min-1 mg-1 at pH 7.0 and 1.7 micromol of NADH formed min-1 mg-1 at pH 9.5. In the presence of the protonophore carbonyl cyanide m-chlorophenylhydrazone and the Na+/H+ antiporter monensin, the H2-dependent reduction of NAD+ by membrane vesicles decreased only slightly (about 16%). The NADP+- or NAD+-reducing hydrogenases were solubilized from the membranes with the detergent lauryldimethylamine-N-oxide or Triton X-100. NAD(P)H formation with H2 as electron donor, therefore, does not depend on an energized state of the membrane. It is proposed that hydrogen which is formed by K. pneumoniae during citrate fermentation is recaptured by a novel membrane-bound, oxygen-sensitive H2:NAD(P)+ oxidoreductase that provides reducing equivalents for the synthesis of cell material.

Three-dimensional echocardiographic determination of left ventricular volumes and function by multiplane transesophageal transducer: dynamic in vitro validation and in vivo comparison with angiography and thermodilution

The goal of this study was to validate 3-dimensional echocardiography by multiplane transesophageal transducer for the determination of left ventricular volumes and ejection fraction in an in vitro experiment and to compare the method in vivo with biplane angiography and the continuous thermodilution method. In the dynamic in vitro experiment, we scanned rubber balloons in a water tank by using a pulsatile flow model. Twenty-nine measurements of volumes and ejection fractions were performed at increasing heart rates. Three-dimensional echocardiography showed a very high accuracy for volume measurements and ejection fraction calculation (correlation coefficient, standard error of estimate, and mean difference for end-diastolic volume 0.998, 2.3 mL, and 0.1 mL; for end-systolic volume 0.996, 2.7 mL, and 0.5 mL; and for ejection fraction 0.995, 1.0%, and -0.4%, respectively). However, with increasing heart rate there was progressive underestimation of ejection fraction calculation (percent error for heart rate below and above 100 bpm 0.59% and -8.6%, P < .001). In the in vivo study, left ventricular volumes and ejection fraction of 24 patients with symmetric and distorted left ventricular shape were compared with angiography results. There was good agreement for the subgroup of patients with normal left ventricular shape (mean difference +/-95% confidence interval for end-diastolic volume 5.2+/-6.7 mL, P < .05; for end-systolic volume -0.5+/-8.4 mL, P = not significant; for ejection fraction 2.4%+/-7.2%, P = not significant) and significantly more variability in the patients with left ventricular aneurysms (end-diastolic volume 23.1+/-56.4 mL, P < .01; end-systolic volume 5.6+/-41.0 mL, P = not significant; ejection fraction 4.9%+/-16.0%, P < .05). Additionally, in 20 critically ill, ventilated patients, stroke volume and cardiac output measurements were compared with measurement from continuous thermodilution. Stroke volume as well as cardiac output correlated well to thermodilution (r = 0.89 and 0.84, respectively, P < .001), although both parameters were significantly underestimated by 3-dimensional echocardiography (mean difference +/-95% confidence interval = -6.4+/-16.0 mL and -0.6+/-1.6 L/min, respectively, P < .005).

A database of macromolecular motions

We describe a database of macromolecular motions meant to be of general use to the structural community. The database, which is accessible on the World Wide Web with an entry point at http://bioinfo.mbb.yale.edu/MolMovDB , attempts to systematize all instances of protein and nucleic acid movement for which there is at least some structural information. At present it contains >120 motions, most of which are of proteins. Protein motions are further classified hierarchically into a limited number of categories, first on the basis of size (distinguishing between fragment, domain and subunit motions) and then on the basis of packing. Our packing classification divides motions into various categories (shear, hinge, other) depending on whether or not they involve sliding over a continuously maintained and tightly packed interface. In addition, the database provides some indication about the evidence behind each motion (i.e. the type of experimental information or whether the motion is inferred based on structural similarity) and attempts to describe many aspects of a motion in terms of a standardized nomenclature (e.g. the maximum rotation, the residue selection of a fixed core, etc.). Currently, we use a standard relational design to implement the database. However, the complexity and heterogeneity of the information kept in the database makes it an ideal application for an object-relational approach, and we are moving it in this direction. Specifically, in terms of storing complex information, the database contains plausible representations for motion pathways, derived from restrained 3D interpolation between known endpoint conformations. These pathways can be viewed in a variety of movie formats, and the database is associated with a server that can automatically generate these movies from submitted coordinates.

Evaluation of regional systolic function in hypertrophic cardiomyopathy and hypertensive heart disease: a three-dimensional echocardiographic study

Assessment of regional left ventricular (LV) function in patients with asymmetric LV hypertrophy is difficult with two-dimensional echocardiography mainly because of factors such as LV geometry, structure, regional wall stress, and ischemia. Multiplane transesophageal echocardiography with three-dimensional reconstruction of cross-sectional images was used for quantitative evaluation of regional wall thickness and fractional thickening. Fifteen patients (56 +/- 13 years old) with hypertrophic cardiomyopathy (LV ejection fraction 71% +/- 4%), 15 (62 +/- 13 years) with hypertensive heart disease (ejection fraction 66% +/- 8%) and 15 (53 +/- 11 years) healthy control subjects (ejection fraction 61% +/- 5%) were included in the analysis. Regional function was studied in four parallel equidistant short-axis cross sections from base to apex of the reconstructed left ventricle. In 15 degree intervals, 24 wall thickness measurements in each cross section were made at end-diastole and end-systole after endocardial and epicardial border tracing. A total of 192 measurements were obtained in each patient, and absolute wall thickening and fractional thickening were calculated. Absolute and fractional wall thickening showed a significant inverse relation to end-diastolic wall thickness in all heart conditions (r = 0.71, p < 0.0001). Regions of normal wall thickness in diseased patients were not hyperdynamic when compared with normal control subjects. Significant impairment in fractional thickening at identical end-diastolic thickness was observed in the septum compared with the lateral free wall in both hypertrophic cardiomyopathy and hypertensive heart disease. Thus regional systolic function is inversely related to end-diastolic wall thickness. The decrease in regional systolic function with increasing LV hypertrophy was similar in idiopathic and hypertensive cardiomyopathy. In both types of hypertrophy, significant differences in systolic function were observed in septal and lateral wall segments of similar wall thickness. This indicates that factors other than end-diastolic wall thickness influence myocardial thickening in patients with hypertrophy and preserved global function.

Disturbed intracoronary hemodynamics in myocardial bridging: early normalization by intracoronary stent placement

BACKGROUND

The purpose of this study was to evaluate the hemodynamic mechanisms leading to myocardial ischemia in patients with myocardial bridging. Myocardial bridging is known to induce angina and even severe myocardial ischemia.

METHODS AND RESULTS

In 12 symptomatic patients with myocardial bridges, quantitative coronary angiography was performed to obtain systolic/diastolic vessel diameters within the bridged segments. Coronary flow velocities, flow reserve, and pressures were determined with a 0.014-in Doppler and a 0.014-in pressure microtransducer. In 3 symptomatic patients, coronary stents were implanted and hemodynamic measurements were repeated immediately and after 7 weeks. An in vitro validation of the pressure measurements was performed. Angiography revealed a systolic diameter reduction of 80.6+/-9.2% and a persistent diastolic reduction of 35.3+/-11% within the bridged segment. Diastolic flow velocities (cm/s) were increased (31.5+/-14.3 within versus 17.3+/-5.7 proximal and 15.2+/-6.3 distal, P<.001). Coronary flow reserve distal to the bridge was 2.5+/-0.5. There was an increased peak systolic pressure within the bridged segment (171+/-48 versus 113+/-10 mm Hg proximal, P<.001). Stent placement abolished the phasic lumen compression, the diastolic flow abnormalities, the intracoronary peak systolic pressure, and clinical symptoms. Coronary flow reserve improved to 3.8+/-0.3.

CONCLUSIONS

Coronary hemodynamics in myocardial bridges are characterized by a phasic systolic vessel compression with a localized peak pressure, persistent diastolic diameter reduction, increased blood flow velocities, retrograde flow, and a reduced flow reserve. These alterations may explain the occurrence of symptoms and ischemia in these patients. Intracoronary stent placement abolished all hemodynamic abnormalities and may improve clinical symptoms in otherwise unsuccessfully treated patients with myocardial bridges.

The Na+-translocating NADH:ubiquinone oxidoreductase from Vibrio alginolyticus--redox states of the FAD prosthetic group and mechanism of Ag+ inhibition

The FAD prosthetic group of the Na+-motive NADH:ubiquinone oxidoreductase (Na+-NQR) from Vibrio alginolyticus was investigated by ultraviolet-visible and fluorescence spectroscopy. The reduction of Na+-NQR by excess NADH in the presence of 6-13 microM O2 resulted in the formation of the blue flavosemiquinone radical. If the concentration of dioxygen was further reduced to 0.1 microM O2, neither the reduction of Na+-NQR by NADH nor its reoxidation with ubiquinone-1 (Q-1) yielded a stable flavosemiquinone in equilibrium with reductant or oxidant, respectively, but the fully reduced (Fl(red)H2) or oxidized flavin (Fl(ox)) prevailed. During reoxidation of Fl(red)H2 with Q-1, the intermediate formation of an absorbance band around 800 nm was observed, which was tentatively assigned as the Fl(red)H(-)-NAD+ charge-transfer complex. Complete reoxidation of Fl(red)H2 in Na+-NQR was achieved by a fivefold excess of Q-1 over NADH. These results indicated that only a small fraction of FAD was in the flavosemiquinone redox state during turnover to mediate the electron transfer between the hydride donor, NADH, and the one-electron acceptor [2Fe-2S]. The titration of Na+-NQR with Ag+, a specific inhibitor, was followed by the fluorescence emission spectra of FAD (Fl(ox)). The addition of Ag+ resulted in a marked increase of the flavin fluorescence (16% at 200 nM Ag+), with half-maximal saturation at approximately 50 nM Ag+, indicating dissociation of FAD from the enzyme. The increase in fluorescence intensity correlated with the loss of enzyme activity. Gel filtration of the Ag+-treated Na+-NQR confirmed that FAD had been displaced from the holo-enzyme.

[3-D echocardiography: technical toy in search of a clinical application or logical evolution of diagnostic equipment?]

In recent years, 3D echocardiographic reconstruction and real time 3D echocardiography have been developed. Reconstruction techniques are based on one of two principles: acoustic or electromagnetic location devices that identify the spatial position of the transducer during imaging, or transducers that image from a fixed position varying the sector orientation in a predefined way. Animated, dynamic reconstructions of cardiac structures are possible, and the 3D data set can be sliced and viewed in any desired way after acquisition. The mitral annulus and congenital malformations of the heart have been imaged and studied successfully by 3D echo. Mass and volume calculations based on 3D data sets have been shown to be extraordinarily accurate by several investigators working with different techniques. Since the 3D data set is more comprehensive than any set of 2D images, such calculations are fundamentally superior to 2D or M-mode derived parameters. Color Doppler data can also be reconstructed into 3D data sets, with possible applications to proximal convergence zone calculations. However, broad implementation of 3D echo in clinical practice is hampered to date by cumbersome manual tracing to derive quantitative parameters and sometimes by insufficient image quality. Nevertheless, the rapid technical evolution, now including real-time 3D echo, ensures an important role for 3D echo in future echocardiography.

Determination of left ventricular mass and circumferential wall thickness by three-dimensional reconstruction: in vitro validation of a new method that uses a multiplane transesophageal transducer

Elevated left ventricular mass and increased wall thickness have important prognostic implications in clinical medicine. However, these parameters have been incompletely characterized by one- and two-dimensional echocardiography. Therefore this study was performed to validate in vitro measurement of left ventricular mass and circumferential wall thickness with a multiplane transesophageal transducer and three-dimensional reconstruction. Results for mass measurements were also compared with a standard method for the determination of left ventricular mass, the Penn convention. Fourteen necropsied left ventricles were scanned in a water bath by a volume-rendering, three-dimensional reconstruction system. There was an excellent correlation and high agreement for determination of three-dimensional left ventricular mass (r = 0.98; standard error of the estimate [SEE] = 9.6 gm; y = 1.02x + 0.46) and wall thickness (r = 0.93; SEE = 1.4 mm; y = 0.95x + 1.64) compared with anatomic measurements. Left ventricular mass by a simulated Penn convention revealed a lower correlation and larger error compared with three-dimensional measurements (r = 0.72; SEE = 42.8 gm; y = 1.01x + 9.61). Therefore determination of left ventricular mass by three-dimensional reconstruction was validated in vitro and was superior to one-dimensional echocardiographic methods.

Functional characteristics of myocardial bridging. A combined angiographic and intracoronary Doppler flow study

AIMS

Combined quantitative coronary angiography and intracoronary Doppler flow velocity measurements were performed to study the underlying haemodynamic mechanisms leading to myocardial ischaemia in patients with myocardial bridging in the absence of coronary artery disease.

METHODS AND RESULTS

In 42 symptomatic patients with myocardial bridging of the left anterior descending coronary artery, quantitative coronary angiography was used to measure absolute and relative vessel diameters during systole and diastole. In 14 patients, serial frame-by-frame diameter quantification during a complete cardiac cycle was performed. Intracoronary blood flow velocities were determined using a 0.014 inch Doppler flow guide wire proximal, within, and distal to myocardial bridges, and coronary flow reserve was calculated. Quantitative coronary angiography revealed a maximal systolic lumen diameter reduction of 71 +/- 16% with a persistent diameter reduction of 35 +/- 13% during mid-diastole. Flow velocities revealed increased average diastolic peak flow velocities within myocardial bridges of 38.6 +/- 19 cm.s-1 vs 22.4 +/- 7.7 cm.s-1 proximal and 18.6 +/- 4.6 cm.s-1 distal (P < 0.001), which increased during rapid pacing (64.7 +/- 25 cm.s-1, P < 0.001 vs baseline). Coronary flow reserve distal to myocardial bridges was 2.3 +/- 0.9 (vs 2.9 +/- 0.9 proximal, P < 0.05). There was a characteristic Doppler flow profile within myocardial bridges with an early diastolic overshoot, which was further augmented during rapid pacing.

CONCLUSION

Myocardial bridging is characterized by a delay in diastolic lumen gain and a concomitant increase in diastolic intracoronary Doppler flow velocities, which are enhanced by rapid pacing. In combination with a reduced coronary flow reserve and anginal symptoms these findings support the concept of a haemodynamically significant obstruction to coronary flow due to myocardial bridging in a selected subset of patients.

Left ventricular volume calculations using a multiplanar transoesophageal echoprobe; in vitro validation and comparison with biplane angiography

BACKGROUND

Biplane angiographic and transthoracic echocardiographic volume calculations have shown to be sufficiently reliable in symmetric hearts; however, they are unreliable in the presence of aneurysmatic distortions. Multiplane transoesophageal echocardiography offers unobstructed cross-sectional views of the heart from one stable transducer position with the potential of imaging irregular cavity forms more accurately. It was the purpose of this in vitro study to compare the precision of multiplanar transoesophageal echocardiography to that of biplane angiography in determining left ventricular volumes, especially in aneurysmatic models.

METHODS

Seven silicon rubber models of the left ventricle from post-mortem specimens (four with aneurysms) were filled with 30 different volumes (range 153-256 ml, 197 +/- 30 ml). Echocardiographic cross-sections (20 degree rotational steps) were obtained from different transducer positions, utilizing a multiplanar probe with a central rotational axis. Volumes were calculated using the disc-summation method. For comparison the same volumes were determined by standard biplane angiography. The minimum number of echo cross-section necessary to optimize precision was analysed by calculating volumes for each increasing equidistant rotational step.

RESULTS

Linear correlation between measured volume using a multiplanar transoesophageal echoprobe and true volume was high (r = 0.97) and significantly better than for biplane angiography (r = 0.88; P < 0.001). Measurement bias and imprecision were also significantly lower with multiplanar echocardiography than with biplane angiography (3.9 +/- 7.1% vs 11.1 +/- 15.4%, and 2.0 +/- 3.7% vs 5.9 +/- 8.3%; P < 0.001). Precision of biplane angiographic volume measurements was significantly influenced by the presence of aneurysmatic distortions. Multiplanar echo volumes, however, were not influenced by left ventricular geometry and transducer positions. Nine echo cross-sections provided optimal precision.

CONCLUSIONS

Three-dimensional echocardiographic volume calculations using a multiplanar transoesophageal echoprobe and the disc-summation method provide precise measurements unaffected by left ventricular geometry and transducer position in an in vitro setting. Standard biplane angiography is significantly less precise.

Functional, angiographic and intracoronary Doppler flow characteristics in symptomatic patients with myocardial bridging: effect of short-term intravenous beta-blocker medication

OBJECTIVES

We sought to define the effects of short-term beta-adrenergic blocking medication on intracoronary flow characteristics, clinical symptoms and angiographic diameter changes in patients with severe myocardial bridging of the left anterior descending coronary artery.

BACKGROUND

Controversy exists regarding the pathophysiology, clinical relevance and optimal therapy in symptomatic patients with myocardial bridges because antianginal drugs have not been systematically tested.

METHODS

In 15 symptomatic patients with myocardial bridging of the left anterior descending coronary artery, maximal lumen diameter reductions were evaluated by quantitative coronary angiography. There were no angiographic signs of coronary artery disease. Coronary blood flow velocities (using a 0.014-in. [0.035 cm] Doppler guide wire) were measured at rest, during atrial pacing and during intravenous administration of a short-acting beta-blocker (esmolol, 50 to 500 micrograms/kg body weight per min) with continuous atrial pacing.

RESULTS

The maximal angiographic systolic lumen diameter reduction within the myocardial bridges was 83 +/- 9% at rest, with a persistent diastolic diameter reduction of 41 +/- 11% (mean +/- SD). Short-term intravenous beta-blocker therapy decreased the diameter reduction during both systole (from 83 +/- 9% to 62 +/- 11%) and diastole (from 41 +/- 11% to 30 +/- 9%, both p < 0.001). The average diastolic peak flow velocity was higher within the myocardial bridges (33 +/- 13 cm/s) than the proximal (26 +/- 13 cm/s) and distal bridges (17 +/- 4 cm/s, both p < 0.001). During tachypacing, average diastolic peak flow velocity increased within the bridged segments to 63 +/- 21 cm/s versus 29 +/- 12 cm/s in the proximal and 20 +/- 4 cm/s in the distal bridges (both p < 0.001). Beta-receptor blockade produced a return to baseline values (average diastolic peak flow velocity within bridge 35 +/- 16 cm/s, p < 0.001). ST segment changes and symptoms were abolished with beta-blocker administration.

CONCLUSIONS

In patients with myocardial bridges, administration of short-acting beta-blockers during atrial pacing alleviates anginal symptoms and signs of ischemia. This effect was mediated by a reduction of vascular compression and maximal flow velocities within the bridged coronary artery segment.

[Three-dimensional reconstruction of heart valves]

The reconstruction of three-dimensional data sets from two-dimensional echocardiographic images offers several fundamental advantages: 1. more complete data than present in the few standard 2D-view; 2. off-line generation of any desired plane, cut, or perspective after the data set has been acquired; 3. access to quantitative parameters like surface areas (e.g., of valve leaflets or portions of leaflets), volumes, and others, without geometric assumptions. The mitral valve has been the focus of several studies using various techniques of reconstruction of transthoracic or transesophageal images. These studies have shown the mitral annulus to be a non-planar, "saddle-shaped" structure, with an average distance of highest to lowest points of 14 mm in normals. This recognition of mitral annular non-planarity has led to a more stringent echocardiographic definition of mitral valve prolapse. Further studies have shown systolic shrinkage of mitral annular area by about 30% and systolic apico-basal translation of the annulus by approximately 1 cm in normals. In patients with dilated cardiomyopathy, the annulus is flattened, and both cyclic change in annular area and apico-basal translation are significantly reduced. 3D-studies of the left ventricular outflow tract in hypertrophic obstructive cardiomyopathy allow measurement of outflow tract and leaflet surface areas and dynamic spatial visualization of systolic anterior motion of the anterior mitral leaflet. Automated techniques to reconstruct the full grey value data set from a high number of parallel or rotational transesophageal planes allow impressive visualization of normal and diseased mitral and aortic valves or valve prostheses, with special emphasis on generating "surgical" views and perspectives, which cannot be obtained by conventional tomographic imaging.(ABSTRACT TRUNCATED AT 250 WORDS)

[3-dimensional reconstruction of multiplanar transesophageal echocardiography images: a methodologic report with case examples]

First experience with the dynamic three-dimensional reconstruction of transesophageal echocardiographic images in more than 100 patients with various cardiac diseases are reported. Ninety different two-dimensional image planes were acquired for each reconstruction using a conventional multiplanar transducer, connected to a stepper motor and controlled by a computer-based image acquisition system with special software. Acquisition time for one data set was 2.3 +/- 0.9 min, and calculation time to achieve three-dimensional images was 20-45 min. Several cardiac structures were reconstructed and analyzed qualitatively and quantitatively (measurements of distances and areas, volume calculation by Simpson's rule). Image sequences showing three-dimensional depth by gray scale modification were generated. After image acquisition one can select any desired cut plane to achieve perspectives that cannot be obtained by two-dimensional technique. Advantages of three-dimensional echocardiography are the display and potential quantification of pathomorphology of the left ventricle and mitral valve, atrial septal defects, intracardiac masses (i.e., myxomas, vegetations), and direct spatial imaging of complex congenital heart diseases. In principle, three-dimensional data sets have advantages for the quantitative evaluation of irregular formed cardiac structures, since the three-dimensional data set is more complete than cross-sections used in conventional two-dimensional echocardiography. Currently, however, these advantages are limited by the necessity of human interaction to segment the structures of interest.

Three-dimensional reconstruction of cardiac structures from transesophageal echocardiography

Although tomographic imaging has been very successful in cardiology,the quantitation of volumes, surfaces, and masses,as well as understanding of complex morphologies would improve by three-dimensional imaging. This review focuses on approaches to 3-D reconstruction from transesophageal echocardiography. In the past, several attempts using either stepwise parallel translation or stepwise rotation of the transducer have been made. In vitro and, to a limited extent, in vivo studies have confirmed high accuracy in calculating left ventricular volumes in such manner. Complex cardiac structures and their motion, such as the mitral annulus, mitral leaflets, atrial septal defects, and others have been reconstructed from patient studies. Although potentially a powerful tool for cardiac imaging with promising quantitation capabilities, progress is needed in particular in the field of border detection to make 3-D imaging practical enough for clinical use.

Moving the retina: choroidal modulation of refractive state

The chick eye is able to change its refractive state by as much as 7 D by pushing the retina forward or pulling it back; this is effected by changes in the thickness of the choroid, the vascular tissue behind the retina and pigment epithelium. Chick eyes first made myopic by wearing diffusers and then permitted unrestricted vision developed choroids several times thicker than normal within days, thereby speeding recovery from deprivation myopia. Choroidal expansion does not occur when visual cues are reduced by dim illumination during the period of unrestricted vision. Furthermore, in chick eyes presented with myopic or hyperopic defocus by means of spectacle lenses, the choroid expands or thins, respectively, in compensation for the specific defocus imposed. Consequently, when the lenses are removed, the eye finds its refractive error suddenly of opposite sign, and the choroidal thickness again compensates by changing in the opposite direction. If a local region of the eye is made myopic by a partial diffuser and then given unrestricted vision, the choroid expands only in the myopic region. Although the mechanism of choroidal expansion is unknown, it might involve either a increased routing of aqueous humor into the uveoscleral outflow or osmotically generated water movement into the choroid. The latter is compatible with the increased choroidal proteoglycan synthesis either when eyes wear positive lenses or after diffuser removal.

[Results of occupational rehabilitation of patients with severe vision impairment]

The authors had interviewed 134 former students of the Thuringian low vision school, of Weimar, concerning the course and outcomes of their vocational training as well as their current occupational situation at the study time, i.e. May/June 1990. The findings show a picture of largely successful vocational rehabilitation within the then-existing societal conditions.

[Rehabilitation of blind patients exemplified by the Weimar special school. A retrospective study]

The beginning of this century saw the establishment of the first special school for people with poor vision; nowadays, in contrast, there is a trend to integrate such people into mainstream education. In the former GDR (now the new federal länder), however, the traditional special school system survived until 1990, which provides a unique opportunity of assessing the positive value of this type of education with a view to obtaining insights that will help in the future integration of people who have poor vision or are blind. Probands: A total of 134 former pupils (older than 18) of the former special school in Weimar were traced and asked about their development between leaving school and the present.

RESULTS

We analysed factors of medical, occupational and cultural rehabilitation, of rehabilitation in their families (e.g. 10th class exams = 84.3%; completed vocational training = 84.3%; marriage/permanent relationship = 47.8%; own flat = 67.2%) but also such problems as contrasts between hoped for occupation and training, later changes of job, availability of aids to vision at places of work.

CONCLUSIONS

Advantages of special schools should be taken into account. Vocational training, applications of aids to vision and after-care are all capable of improvement.

Evaluation of segmental elastic properties of the aorta in normotensive and medically treated hypertensive patients by intravascular ultrasound

DESIGN AND METHODS

Local elastic properties of the descending aorta at different levels were evaluated by means of intravascular ultrasound images and pressure measurements. For this purpose, 30 normotensive patients and 30 age-matched medically treated patients with essential hypertension, all undergoing diagnostic cardiac catheterization, were studied.

RESULTS

Hypertension was well controlled in the essential hypertensives (137.1 +/- 6.79/74.5 +/- 2.65 mmHg). Systolic but not diastolic blood pressure in the hypertensive patients was significantly different from that of the normotensives (118.8 +/- 4.38/69.7 +/- 1.65 mmHg). The continuous loss of volume compliance with increasing distance from the heart was significantly higher in the hypertensives than in the normotensive patients [normotensives (1.45 +/- 0.19) x 10(-10) m5/N at the thoracic aorta, (0.08 +/- 0.05) x 10(-10) m5/N at the external iliac artery; hypertensives (0.81 +/- 0.09) x 10(-10) and (0.05 +/- 0.01) x 10(-10) m5/N at the corresponding sites]. Similarly, the hypertensives had an elevated elastic modulus proximal to the aortic bifurcation compared with the normotensives (244.47 +/- 44.06 versus 108.10 +/- 17.76 m/s, respectively). The decrease in buffering function of the vessel at this site is presumably caused by a turbulent flow pattern. Compared with the normotensives, the treated hypertensives had a significantly higher elastic modulus at each site where this was measured, whereas volume compliance and sectional compliance were lower.

CONCLUSION

The differences in elastic modulus and compliance between hypertensive and normotensive patients seem disproportionate to the difference in systolic blood pressure (within the normal range in both the treated hypertensives and the normotensives). Therefore, normalization of high blood pressure by long-term antihypertensive treatment may not fully reverse changes, caused by arterial hypertension, in the viscoelastic properties of the arterial wall.

[Initial clinical trial of a multi-planar transesophageal echoscope]

The prototype of a multiplanar transesophageal echocardiographic transducer was evaluated clinically. This 5 MHz, phased array, 64-element transducer allows to continuously rotate the imaging plane from the transverse (0 degree) position to a maximal 180 degrees position, thus encompassing transverse, longitudinal, and every intermediate position. The transducer is incorporated in the echoscope tip measuring 16 by 11 by 40 mm. The shaft of the instrument is 110-cm long and has a 9-mm diameter. The instrument has pulsed wave, continuous wave, and color Doppler capabilities. 176 clinical patients were examined with the multiplane transducer. No complications occurred. Advantages of this transducer included: 1) comprehensive scanning of the whole mitral circumference and mitral valve; 2) quick and precise alignment of aortic valve long and short axis views, including long axis views of the ascending aorta, with a mean visualized length of 6 cm; 3) improved imaging and evaluation of transvalvular and paravalvular regurgitant jets in mitral and aortic valve prostheses; 4) complete evaluation of all left ventricular segments using multiple planes from transgastric and transesophageal transducer positions. An important potential application is three-dimensional reconstruction of cardiac structures and color Doppler jets.

Radiation retinopathy: electron microscopy of retina and optic nerve

A 4 1/2 year old female was treated for embryonal rhabdomyosarcoma of the left orbit in 1975 with radiation (59.5 Gy in 5 weeks), followed by chemotherapy. An electroretinogram (ERG) in March, 1988 revealed cone responses 3% of normal and no rod responses in the left eye, and normal responses in the right eye. The eye was enucleated in April 1988. In the fovea no choroidocapillaris was seen at the intact Bruch's membrane, and the pigment epithelium was preserved only in small patches. No photoreceptor cells were seen in the areas devoid of pigment epithelial cells. The parafoveal and peripheral (30 degrees eccentricity) retina was better preserved. The thickness of the layer of rods and cones and of Henle's fiber layer was reduced. Very few outer segments were present. Macrophages had invaded the retinal tissue in moderate numbers. The retinal vessels were ensheathed by several layers of collagen fibrils. The spatial densities of pigment epithelial, cone, rod, and bipolar cells had been reduced. The optic nerve contained a total number of 1,022,000 nerve fibers.

Anaplastic carcinoma of the lacrimal gland presenting with recurrent subconjunctival hemorrhages and displaying incipient sebaceous differentiation

Primary adenocarcinomas of the lacrimal gland rarely display sebaceous differentiation. An anaplastic lacrimal gland neoplasm manifesting this feature was excised from a 64-year-old man who initially appeared with recurrent painless subconjunctival hemorrhages. Globe displacement and tumor-induced hyperopia were later findings. Electron microscopic studies performed on the widely excised tumor documented prominent lipid vacuoles, desmosomes, scattered cytoplasmic filaments, and linear segments of basement membrane material. The patient refused radical surgery and instead opted for 6,000 rads of adjuvant radiotherapy. Eleven months postoperatively liver and bone metastases developed, but he was free of local orbital recurrence. Twenty-two months postoperatively he died from complications of his metastatic disease. This most unusual lacrimal neoplasm is discussed in terms of its initial signs and symptoms and its histopathology. When the current case is analyzed in combination with three earlier reports, there is evidence that primary lacrimal gland sebaceous carcinoma is probably among the most malignant orbital tumors due to its uniform early fatality.

Romberg's progressive hemifacial atrophy: an association with scleral melting

We report the unusual case of a 43-year-old woman who presented with Romberg's progressive facial hemiatrophy and spontaneous scleral perforation in the ipsilateral eye, for which scleral grafting was performed. Histologic and ultrastructural examination of the scleral specimen revealed a noninflammatory lytic process. The location of the scleral loss, exactly on the line of the "en coup de sabre" atrophy, as well as the light microscopy and ultrastructural histopathologic findings suggest that the scleral destruction was a late manifestation of Romberg's disease.

Survival and synapse formation of transplanted rat rods

Isolated rods enzymatically removed from normal adult rat retina have been transplanted to the subretinal space of adult rats with a retinal dystrophy which has destroyed almost all the photoreceptors. These transplanted rods survive for months after transplantation during which time they form synapses with other retinal cells. Rod spherules with large amounts of synaptic vesicles and synaptic ribbons are found forming discreet contacts with pre- and post-synaptic densities in arrangements closely resembling those seen in the normal retina.

Effect of accelerated iron ions on the retina

The eyes of rats were exposed to doses of 0.1 and 2.5 Gy of 450-MeV/amu 56Fe particles (LET approximately 195 keV/microns). The beam axes were oriented perpendicular to the central retina of the animals. Retinas were harvested immediately (less than 10 min), 24 h, 15 days, 136 days, and 186 days after the experiment. The retinas of animals of equivalent ages were sampled at the same intervals. By Day 15, the spatial densities of the pigment epithelial, photoreceptor, and bipolar cells in retinas irradiated with 2.5 Gy were 15 to 20% lower than those of the controls. The cellular density of the pigment epithelium returned to the control level by Day 186 while photoreceptor and bipolar cell numbers remained depressed. One and fifteen days after irradiation, the choroidal vessels showed signs of radiation damage. Exposure to 0.1 Gy did not affect the cellular density within the retina at the interval examined (186 days). None of the retinas showed evidence of track-specific injury that could be interpreted as microlesions or tunnel lesions.

The fiber system of the choroidocapillaris

In the central choroid of three cynomolgus monkeys (Macaca irus) and a baboon (Papio anubis) the shape of the choroidocapillary sinus is determined by a system of interstitial collagen fibers, the "fiber system of the choroidocapillaris". The inner leaflet of this system is Bruch's membrane. The outer leaflet consists of interwoven collagen bundles, covering the roof of the capillary sinus. Straight bundles of collagen fibers passing through connective tissue columns in the choroidocapillary sinus connect both leaflets. Forces created by changes in the arterial tone in the vascular stroma may be transmitted by the choroidocapillary fiber system to the elastic layer of Bruch's membrane.