Correlation of visual recovery with macular height in macula-off retinal detachments.

OBJECTIVES: To determine the relationship between the preoperative macular height of a macular detachment and visual outcome of the post retinal reattachment. METHODS: Prospective case series of 26 patients who presented to the Wolverhampton Eye Infirmary with a primary rhegmatogenous macula-off retinal detachment. Macular detachment height was assessed by B-scan ultrasound (10 Mhz) in the seated and supine postures before surgery. Age, gender, duration of the detachment, type of surgery, preoperative (pre-op) and postoperative (post-op) visual acuities at 3 and 6 months and status of the fellow eye were noted. RESULTS: A total of 26 eyes of 26 patients (mean age: 61.4 years+/-15.56 SD) were recruited. The mean logMAR pre- and post-op visual acuities at 3 and 6 months were 1.5+/-1.1 SD (range: 0.2-3), 0.38+/-0.23 SD (range: 0-0.84), and at 6 months 0.29+/-0.22 SD (range: 0-1.0). The median period of the macular detachment was 4.5 days (95% CI: 2-8 days). There was no significant difference between the mean macular heights while seated 2.42 mm+/-1.2 or supine 2.39 mm+/-1.0 (t-test, P=0.9). Correlation showed that the pre-op macular height is a statistical predictor of post-op visual acuity in our group of patients with macula-off retinal detachments. CONCLUSIONS: The shallower the macular detachment the greater the likelihood of a good visual outcome.

Sleep loss reduces diurnal rhythm amplitude of leptin in healthy men.

The aim of the current study was to investigate the effects of sleep loss on the diurnal rhythm of circulating leptin levels. An indwelling forearm catheter was used to sample blood at 90-min intervals for a total of 120 h, which included 88 h of sustained sleeplessness, in 10 healthy men. The diurnal amplitude of leptin was reduced during total sleep deprivation and returned toward normal during the period of recovery sleep. This finding provides evidence that sleep influences the nocturnal leptin profile, and may have implications for the understanding of the role of sleep in metabolic regulation and the aetiologies of obesity and the night eating syndrome.

Caffeine eliminates psychomotor vigilance deficits from sleep inertia.

STUDY OBJECTIVES: This study sought to establish the effects of caffeine on sleep inertia, which is the ubiquitous phenomenon of cognitive performance impairment, grogginess and tendency to return to sleep immediately after awakening. DESIGN: 28 normal adult volunteers were administered sustained low-dose caffeine or placebo (randomized double-blind) during the last 66 hours of an 88-hour period of extended wakefulness that included seven 2-hour naps during which polysomnographical recordings were made. Every 2 hours of wakefulness, and immediately after abrupt awakening from the naps, psychomotor vigilance performance was tested. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In the placebo condition, sleep inertia was manifested as significantly impaired psychomotor vigilance upon awakening from the naps. This impairment was absent in the caffeine condition. Caffeine had only modest effects on nap sleep. CONCLUSIONS: Caffeine was efficacious in overcoming sleep inertia. This suggests a reason for the popularity of caffeine-containing beverages after awakening. Caffeine's main mechanism of action on the central nervous system is antagonism of adenosine receptors. Thus, increased adenosine in the brain upon awakening may be the cause of sleep inertia.

Soluble TNF-alpha receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight.

BACKGROUND: The extent to which sleep loss may predispose astronauts to a state of altered immunity during extended space travel prompts evaluation with ground-based models. OBJECTIVE: We sought to measure plasma levels of selected cytokines and their receptors, including the putative sleep-regulation proteins soluble TNF-alpha receptor (sTNF-alpha R) I and IL-6, in human subjects undergoing 2 types of sleep deprivation during environmental confinement with performance demands. METHODS: Healthy adult men (n = 42) were randomized to schedules that varied in severity of sleep loss: 4 days (88 hours) of partial sleep deprivation (PSD) involving two 2-hour naps per day or 4 days of total sleep deprivation (TSD). Plasma samples were obtained every 6 hours across 5 days and analyzed by using enzyme-linked immunoassays for sTNF-alpha RI, sTNF-alpha RII, IL-6, soluble IL-2 receptor, IL-10, and TNF-alpha. RESULTS: Interactions between the effects of time and sleep deprivation level were detected for sTNF-alpha RI and IL-6 but not for sTNF-alpha RII, soluble IL-2 receptor, IL-10, and TNF-alpha. Relative to the PSD condition, subjects in the TSD condition had elevated plasma levels of sTNF-alpha RI on day 2 (P =.04), day 3 (P =.01), and across days 2 to 4 of sleep loss (P =.01) and elevated levels of IL-6 on day 4 (P =.04). CONCLUSIONS: Total sleep loss produced significant increases in plasma levels of sTNF-alpha RI and IL-6, messengers that connect the nervous, endocrine, and immune systems. These changes appeared to reflect elevations of the homeostatic drive for sleep because they occurred in TSD but not PSD, suggesting that naps may serve as the basis for a countermeasures approach to prolonged spaceflight.

High yield of Methylophilus methylotrophus cytochrome c by coexpression with cytochrome c maturation gene cluster from Escherichia coli.

Heterologous expression of c-type cytochromes in the periplasm of Escherichia coli often results in low soluble product yield, apoprotein formation, or protein degradation. We have expressed cytochrome c from Methylophilus methylotrophus in E. coli by coexpression of the gene encoding the cytochrome (cycA) with the host-specific cytochrome c maturation elements, within the ccmA-H gene cluster. Aerobic cultures produced up to 10 mg holoprotein per liter after induction with IPTG. In the absence of the maturation factors E. coli failed to produce a stable haem protein. Cytochrome c" isolated from the natural host was compared with the recombinant protein. No structural differences were detected using SDS-PAGE, UV-Visible spectroscopy, differential scanning calorimetry, and (1)H-NMR spectroscopy. The success in expressing the mature cytochrome c in E. coli allows the engineering of the cycA gene by site-directed mutagenesis thereby providing an ideal method for producing mutant protein for studying the structure/function relationship.

Cloning and sequence analysis of the gene encoding Methylophilus methylotrophus cytochrome c", a unique protein with a perpendicular orientation of the histidinyl ligands.

Cytochrome c" from Methylophilus methylotrophus is an unusual monohaem protein that undergoes a major redox-linked spin-state transition: one of the two axial histidines bound to the iron in the oxidised form is detached upon reduction and a proton is taken up. A 3.5-kb DNA fragment, containing the gene encoding cytochrome c" (cycA), has been cloned and sequenced. The cytochrome c" gene codes for a pre-protein with a typical prokaryotic 20-residue signal sequence, suggesting that the protein is synthesised as a precursor which is processed during its secretion into the periplasm. The C-terminus of cytochrome c" has homology with the corresponding region of an oxygen-binding haem protein (SHP) from phototrophically grown Rhodobacter sphaeroides. SHP is similar in size and in the location of its haem-binding site. Immediately downstream from cytochrome c" a second open reading frame (ORF) codes for a 23-kDa protein with similarity to the cytochrome b-type subunit of Ni-Fe hydrogenase. The possibility of coordinated expression of cycA and this ORF is discussed.

Simultaneous posterior chamber intraocular lens implant combined with vitreoretinal surgery for intraocular foreign body injuries.

UNLABELLED: To evaluate the safety of simultaneous posterior chamber intraocular lens (IOL) implant combined with complex vitreoretinal surgery for ocular trauma due to intraocular foreign body (IOFB). METHODS: We undertook a retrospective analysis of 10 patients who had undergone simultaneous cataract extraction, vitreoretinal surgery, removal of IOFB and posterior chamber IOL implant, for ocular trauma due to IOFB. The visual outcome and complications were noted. The surgical procedure is described. RESULTS: Ten young, male patients were followed for 5-30 months post-operatively. The post-operative visual acuity in the operated eye remained the same or improved as compared with their pre-operative vision. Eight patients had a visual acuity of 6/9 or better. One patient developed post-operative infective endophthalmitis. Three patients had retinal detachment post-operatively. The IOL was stable in all patients. CONCLUSIONS: Simultaneous posterior chamber IOL implant with vitreoretinal surgery is safe in selected cases of severe ocular trauma due to IOFB. It allows early visual rehabilitation of young, working patients.

Synovial hemangioma of the knee.

Hemangioma of the knee is a cause of pain and recurrent hemarthroses in the pediatric age group, often seen as an internal derangement of the knee. Historically, long delays in diagnosis have occurred. Conventional radiographic techniques can miss the presence of the lesion. However, magnetic resonance imaging (MRI) is a noninvasive and frequently diagnostic investigative modality. Five cases of diffuse synovial hemangioma of the knee are presented. Diffuse lesions are difficult to excise arthroscopically, and open wide excision is recommended after MRI and arthroscopic assessment.

Ablepharon macrostomia syndrome.

The association of congenital ablepharon with the absence of eyelashes and eyebrows, a wide mouth (macrostomia), and auricular, nasal, genital, and other systemic anomalies has been termed the ablepharon macrostomia syndrome. One such case is reported which illustrates the importance of immediate postnatal ocular management to minimise severe visual loss.

Ptosis following cataract and trabeculectomy surgery.

A prospective study was carried out to estimate the incidence and severity of ptosis following cataract extraction and trabeculectomy. A postoperative ptosis of 2 mm or more was found in 6.2% of all cases. In this series the incidence of ptosis following surgery under local anaesthesia was greater than that under general anaesthesia. The aetiology and management of this complication are discussed.

Neural processes involved in directing attention.

Neural processes associated with two aspects of visual-spatial attention were investigated with event-related potential (ERPs): those that direct spatial attention to a given point in space and those that modulate the processing of sensory input after attention has been directed. The subjects were 6- to 9-year-old children (51 boys and 35 girls). An arrow cue directed attention from the central to peripheral visual field; targets were then flashed in the attended or ignored visual field 600 msec after the cue. The directing of attention to the left vs. right visual field was associated with hemispheric differences in slow potentials prior to the presentation of the targets. The earliest potential, which started about 200 msec after the cue and was negative over the hemisphere contralateral to the direction of attention, was greatest over the parietal area and appeared to reflect processes directing attention per se. The last potential, which peaked 60 msec after the target and was positive over the hemisphere contralateral to the direction of attention, was greatest over the occipital-parietal region. It appeared to reflect the modulation of cortical excitability in the regions receiving input from the relevant and irrelevant visual fields. The effects of spatial attention on P1, N1, and P3 ERP components following the targets replicated previous results. Boys appeared more aroused (as indicated by CNVs) and reflected faster and greater selective processing (as indicated by reaction time, and N1-P1 latency and amplitude) than girls.