Subfoveal choroidal thickness in patients with diabetic retinopathy and diabetic macular oedema.

PurposeTo investigate the relationship between subfoveal choroidal thickness, severity of diabetic retinopathy (DR), and the presence of diabetic macular oedema (DMO) using enhanced depth imaging spectral domain optical coherence tomography (EDI-OCT) in patients with type 2 diabetes.MethodsA retrospective study of 145 eyes from untreated, type 2 diabetic patients who attended clinic at the Oxford Eye Hospital between January 2012 and February 2013, and underwent fundus photography and EDI-OCT imaging. Eyes were divided into two groups based on the presence or absence of foveal involving DMO and classified according to retinopathy grade: R1 (mild non-proliferative diabetic retinopathy (NPDR), R2 (moderate-severe NPDR), and R3 (proliferative diabetic retinopathy (PDR). Subfoveal choroidal thickness was measured on the EDI-OCT images and statistically analysed using Student's t-test.ResultsIn mild NPDR (n=87), the mean subfoveal choroidal thickness was 217.7 microns. In moderate-severe NPDR (n=37), the mean subfoveal choroidal thickness was 221.7 microns. In PDR (n=21), the mean subfoveal choroidal thickness was 242.1 microns. There was a statistically significant increase in choroidal thickness in PDR when compared with the mild NPDR group, P=0.027. DMO was associated with a non-statistically significant increase in choroidal thickness (225.4 microns) compared with eyes without DMO (209.3 microns), P=0.13.ConclusionSubfoveal choroidal thickness increased with the severity of diabetic retinopathy but showed no statistically significant association with the presence of DMO. This suggests that the choroidal layer is responsive to retinal vascular changes.

Parabrachial nucleus modulates cardiovascular responses to blood loss.

The goal of this study was to determine the role of the pontine lateral parabrachial nucleus (LPBN) in the compensatory responses to blood loss. Conscious unrestrained rats with complete, partial, or sham bilateral ibotenic acid lesions of the LPBN were subjected to a hypotensive 16-ml/kg blood withdrawal via arterial catheter. Complete lesions (LPBNx) encompassed the entire LPBN and extended into the ventrolateral parabrachial region to encroach on the Kolliker-Fuse nucleus. Partial lesions were restricted to the body of the LPBN and spared the outer rim of the external lateral subnucleus of the LPBN. In all three groups, serum corticosterone concentration and plasma renin activity increased four- to fivefold after hemorrhage (P < 0.01), and immunocytochemistry demonstrated numerous Fos-positive neurons in the hypothalamic supraoptic nucleus. However, the cardiovascular responses to hypotensive blood loss differed for complete and partial lesions. Blood pressure failed to recover in LPBNx rats and was significantly lower in LPBNx (66 +/- 4 mmHg) than in rats with partial or sham lesions (98 +/- 4 and 85 +/- 5 mmHg, respectively) at 40 min posthemorrhage. In contrast, rats with partial lesions had a significant attenuation of the posthemorrhage bradycardia. This implies that a population of neurons within the body of the LPBN is essential for full expression of the bradycardia that accompanies hemorrhagic hypotension, whereas the ventrolateral parabrachial region is essential for normal restoration of arterial pressure after hypotensive hemorrhage.

Effect of N(G)-nitro-L-arginine methyl ester on autonomic modulation of heart rate variability during hypovolemic shock.

OBJECTIVE: To study the changes in neuroautonomic regulation of heart rate and the effects of N(G)-nitro-L-arginine methyl ester (L-NAME), a competitive inhibitor of nitric oxide synthase, on efferent sympathetic cardiac activity and blood pressure during hypovolemic shock. Hypotension during hypovolemic shock may be attributable, in part, to the failure of neuroautonomic regulation of heart rate and blood pressure. In addition, the release of nitric oxide may contribute to hypotension through vasodilation and inhibition of efferent sympathetic activity. DESIGN: Prospective, controlled trial. SETTING: Experimental laboratory in a university hospital. SUBJECTS: Seventeen anesthetized adult male New Zealand White rabbits. INTERVENTIONS: The rabbits were divided into four groups: control (n = 3), control plus L-NAME (n = 5), hypovolemic (n = 4), and hypovolemic plus L-NAME (n = 5). Hypovolemic rabbits were bled of 10% of their circulating blood volume (85 mL/kg) every 10 mins until 30% cumulative hypovolemia was reached. Rabbits received either three doses of saline 1 mL/kg every 10 mins or L-NAME 10 mg/kg in 1 mL/kg of saline solution administered after each hemorrhage for a total of three doses. Changes in heart rate, respiratory rate, mean arterial pressure, plasma catecholamine levels, and heart rate power spectra were recorded every 10 mins during serial hypovolemia and during a 30-min recovery period. MEASUREMENTS AND MAIN RESULTS: During hypovolemic shock there was a decrease in log low-frequency heart rate power (p = .001) and in systolic (p = .003), diastolic (p < .001), and mean (p < .001) blood pressures compared with control rabbits. Treatment with L-NAME during hypovolemia resulted in increased log low-frequency heart rate power (p = .03) and systolic (p = .01), diastolic (p = .007), and mean (p = .009) blood pressures compared with hypovolemic rabbits who received saline placebo. CONCLUSIONS: We found that treatment with L-NAME increased efferent sympathetic cardiac activity and mean arterial pressure during hypovolemic shock compared with control rabbits. We conclude that L-NAME may blunt hypotension during hypovolemic shock by inhibiting nitric oxide synthase and may act to restore neuroautonomic cardiovascular reactivity. Spectral analysis of heart rate variability may allow for insights into the pathophysiology of shock and provide a means of monitoring the neuroautonomic cardiovascular response to therapy.

Role of paraventricular nucleus parvicellular neurons in the compensatory responses to graded hemorrhage.

The goal of this study was to determine the role of the parvicellular component of the paraventricular hypothalamic nucleus (PVH) in the compensatory responses to blood loss. Male Sprague-Dawley rats were prepared with bilateral ibotenate lesions of the parvicellular PVH (PVHx; n = 5) or with sham lesions (Sham; n = 8). After >10 days recovery, hemorrhage was performed by gradual withdrawal of 16 ml/kg blood over 34 min via an indwelling femoral arterial catheter while the rats were conscious and unrestrained. Basal serum corticosterone levels, plasma renin concentration (PRC), mean arterial pressure, and heart rate did not differ between PVHx and Sham, whereas basal hematocrit was lower in PVHx than Sham (40 +/- 1 vs. 44 +/- 1; P < 0.05). After hemorrhage, corticosterone increased fourfold in Sham (P < 0.001) but did not increase significantly in PVHx. However, the blood pressure, heart rate, PRC, and hemodilution responses to hemorrhage were the same in Sham and PVHx during both the normotensive (7-13 ml/kg blood loss) and hypotensive (16 ml/kg blood loss) phases. In conclusion, the parvicellular PVH is essential for the corticosterone response, but not for the cardiovascular or renin responses to blood loss.

Role of the hypothalamic paraventricular nucleus in cardiovascular regulation.

1. The paraventricular hypothalamic nucleus (PVH) is a complex structure with both neuroendocrine and autonomic functions. It is a major source of vasopressin and the primary source of corticotropin-releasing factor. In addition, parvicellular PVH neurons have reciprocal connections with brainstem autonomic centres and directly innervate sympathetic preganglionic neurons. Evidence is reviewed which indicates that in conscious rats PVH activation increases blood pressure, heart rate, renal nerve activity and plasma renin activity. 2. In conscious rats, a non-hypotensive haemorrhage (13 mL/kg blood loss over 24 min) results in increased numbers of Fos-immunoreactive cell nuclei within both magnocellular and parvicellular PVH neurons, including the ventral medial parvicellular regions known to contain neuronal projections to brainstem autonomic centres and spinal cord sympathetic preganglionic neurons. 3. Cell-selective ibotenate lesions of the parvicellular PVH significantly blunt the corticosterone response but do not alter blood pressure, heart rate or plasma renin concentration response to non-hypotensive or hypotensive haemorrhage. This and earlier studies indicate that, while the PVH is necessary for the corticosterone response and contributes to increased vasopressin release during blood loss, it does not play an important role in the sympathetic nervous system and renin-angiotensin responses to hypovolaemia and hypotension. 4. There is evidence to indicate that the parvicellular PVH serves as a necessary relay for cardiovascular and renin responses to certain behavioural stressors. We propose that cardiovascular information relayed to parvicellular PVH autonomic regions may be used to modulate behavioural, rather than homeostatic, effects on haemodynamics and renin release.