Attenuation of ketamine-induced impairment in verbal learning and memory in healthy volunteers by the AMPA receptor potentiator PF-04958242.

There is a need to develop treatments for cognitive impairment associated with schizophrenia (CIAS). The significant role played by N-methyl-d-aspartate receptors (NMDARs) in both the pathophysiology of schizophrenia and in neuronal plasticity suggests that facilitation of NMDAR function might ameliorate CIAS. One strategy to correct NMDAR hypofunction is to stimulate α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) as AMPAR and NMDAR functioning are coupled and interdependent. In rats and nonhuman primates (NHP), AMPAR potentiators reduce spatial working memory deficits caused by the nonselective NMDAR antagonist ketamine. The current study assessed whether the AMPAR potentiator PF-04958242 would attenuate ketamine-induced deficits in verbal learning and memory in humans. Healthy male subjects (n=29) participated in two randomized treatment periods of daily placebo or PF-04958242 for 5 days separated by a washout period. On day 5 of each treatment period, subjects underwent a ketamine infusion for 75 min during which the effects of PF-04958242/placebo were assessed on ketamine-induced: (1) impairments in verbal learning and recall measured by the Hopkins Verbal Learning Test; (2) impairments in working memory on a CogState battery; and (3) psychotomimetic effects measured by the Positive and Negative Syndrome Scale and Clinician-Administered Dissociative Symptoms Scale. PF-04958242 significantly reduced ketamine-induced impairments in immediate recall and the 2-Back and spatial working memory tasks (CogState Battery), without significantly attenuating ketamine-induced psychotomimetic effects. There were no pharmacokinetic interactions between PF-04958242 and ketamine. Furthermore, PF-04958242 was well tolerated. 'High-impact' AMPAR potentiators like PF-04958242 may have a role in the treatment of the cognitive symptoms, but not the positive or negative symptoms, associated with schizophrenia. The excellent concordance between the preclinical (rat, NHP) and human studies with PF-04958242, and in silico modeling of AMPAR-NMDAR interactions in the hippocampus, highlights the translational value of this study.

Large outbreak of Legionnaires' disease and Pontiac fever at a military base.

We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2-22·0] and 5·5 (95% CI 2·1-14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.

Diagnostic exome sequencing identifies two novel IQSEC2 mutations associated with X-linked intellectual disability with seizures: implications for genetic counseling and clinical diagnosis.

Intellectual disability is a heterogeneous disorder with a wide phenotypic spectrum. Over 1,700 OMIM genes have been associated with this condition, many of which reside on the X-chromosome. The IQSEC2 gene is located on chromosome Xp11.22 and is known to play a significant role in the maintenance and homeostasis of the brain. Mutations in IQSEC2 have been historically associated with nonsyndromic X-linked intellectual disability. Case reports of affected probands show phenotypic overlap with conditions associated with pathogenic MECP2, FOXG1, CDKL5, and MEF2C gene mutations. Affected individuals, however, have also been identified as presenting with additional clinical features including seizures, autistic-behavior, psychiatric problems, and delayed language skills. To our knowledge, only 5 deleterious mutations and 2 intragenic duplications have been previously reported in IQSEC2. Here we report two novel IQSEC2 de novo truncating mutations identified through diagnostic exome sequencing in two severely affected unrelated male probands manifesting developmental delay, seizures, hypotonia, plagiocephaly, and abnormal MRI findings. Overall, diagnostic exome sequencing established a molecular diagnosis for two patients in whom traditional testing methods were uninformative while expanding on the mutational and phenotypic spectrum. In addition, our data suggests that IQSEC2 may be more common than previously appreciated, accounting for approximately 9 % (2/22) of positive findings among patients with seizures referred for diagnostic exome sequencing. Further, these data supports recently published data suggesting that IQSEC2 plays a more significant role in the development of X-linked intellectual disability with seizures than previously anticipated.

Transcriptome profiling of hippocampal CA1 after early-life seizure-induced preconditioning may elucidate new genetic therapies for epilepsy.

Injury of the CA1 subregion induced by a single injection of kainic acid (1 × KA) in juvenile animals (P20) is attenuated in animals with two prior sustained neonatal seizures on P6 and P9. To identify gene candidates involved in the spatially protective effects produced by early-life conditioning seizures we profiled and compared the transcriptomes of CA1 subregions from control, 1 × KA- and 3 × KA-treated animals. More genes were regulated following 3 × KA (9.6%) than after 1 × KA (7.1%). Following 1 × KA, genes supporting oxidative stress, growth, development, inflammation and neurotransmission were upregulated (e.g. Cacng1, Nadsyn1, Kcng1, Aven, S100a4, GFAP, Vim, Hrsp12 and Grik1). After 3 × KA, protective genes were differentially over-expressed [e.g. Cat, Gpx7, Gad1, Hspa12A, Foxn1, adenosine A1 receptor, Ca(2+) adaptor and homeostasis proteins, Cacnb4, Atp2b2, anti-apoptotic Bcl-2 gene members, intracellular trafficking protein, Grasp and suppressor of cytokine signaling (Socs3)]. Distinct anti-inflammatory interleukins (ILs) not observed in adult tissues [e.g. IL-6 transducer, IL-23 and IL-33 or their receptors (IL-F2 )] were also over-expressed. Several transcripts were validated by real-time polymerase chain reaction (QPCR) and immunohistochemistry. QPCR showed that casp 6 was increased after 1 × KA but reduced after 3 × KA; the pro-inflammatory gene Cox1 was either upregulated or unchanged after 1 × KA but reduced by ~70% after 3 × KA. Enhanced GFAP immunostaining following 1 × KA was selectively attenuated in the CA1 subregion after 3 × KA. The observed differential transcriptional responses may contribute to early-life seizure-induced pre-conditioning and neuroprotection by reducing glutamate receptor-mediated Ca(2+) permeability of the hippocampus and redirecting inflammatory and apoptotic pathways. These changes could lead to new genetic therapies for epilepsy.

Combined two-photon luminescence microscopy and OCT for macrophage detection in the hypercholesterolemic rabbit aorta using plasmonic gold nanorose.

BACKGROUND AND OBJECTIVES: The macrophage is an important early cellular marker related to risk of future rupture of atherosclerotic plaques. Two-channel two-photon luminescence (TPL) microscopy combined with optical coherence tomography (OCT) was used to detect, and further characterize the distribution of aorta-based macrophages using plasmonic gold nanorose as an imaging contrast agent. STUDY DESIGN/MATERIALS AND METHODS: Nanorose uptake by macrophages was identified by TPL microscopy in macrophage cell culture. Ex vivo aorta segments (8 × 8 × 2 mm(3) ) rich in macrophages from a rabbit model of aorta inflammation were imaged by TPL microscopy in combination with OCT. Aorta histological sections (5 µm in thickness) were also imaged by TPL microscopy. RESULTS: Merged two-channel TPL images showed the lateral and depth distribution of nanorose-loaded macrophages (confirmed by RAM-11 stain) and other aorta components (e.g., elastin fiber and lipid droplet), suggesting that nanorose-loaded macrophages are diffusively distributed and mostly detected superficially within 20 µm from the luminal surface of the aorta. Moreover, OCT images depicted detailed surface structure of the diseased aorta. CONCLUSIONS: Results suggest that TPL microscopy combined with OCT can simultaneously reveal macrophage distribution with respect to aorta surface structure, which has the potential to detect vulnerable plaques and monitor plaque-based macrophages overtime during cardiovascular interventions.

SARS-CoV-2 and Plasmodium falciparum common immunodominant regions may explain low COVID-19 incidence in the malaria-endemic belt.

Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality and new cases are on the rise globally, yet malaria-endemic areas report statistically significant lower incidences. We identified potential shared targets for an immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by immune determinants' shared identities with P. falciparum using the Immune Epitope Database and Analysis Resource Immune 9.0 browser tool. Probable cross-reactivity is suggested through HLA-A∗02:01 and subsequent CD8+ T-cell activation. The apparent immunodominant epitope conservation between SARS-CoV-2 (N and open reading frame (ORF) 1ab) and P. falciparum thrombospondin-related anonymous protein (TRAP) may underlie the low COVID-19 incidence in the malaria-endemic zone by providing immunity against virus infection to those previously infected with Plasmodium. Additionally, we hypothesize that the shared epitopes which lie within antigens that aid in the establishment of the P. falciparum erythrocyte invasion may be an alternative route for SARS-CoV-2 via the erythrocyte CD147 receptor, although this remains to be proven.

Detection of macrophages in atherosclerotic tissue using magnetic nanoparticles and differential phase optical coherence tomography.

We demonstrate the detection of iron oxide nanoparticles taken up by macrophages in atherosclerotic plaque with differential phase optical coherence tomography (DP-OCT). Magneto mechanical detection of nanoparticles is demonstrated in hyperlipidemic Watanabe and balloon-injured fat-fed New Zealand white rabbits injected with monocrystalline iron oxide nanoparticles (MIONs) of < 40 nm diam. MIONs taken up by macrophages was excited by an oscillating magnetic flux density and resulting nanometer tissue surface displacement was detected by DP-OCT. Frequency response of tissue surface displacement in response to an externally applied magnetic flux density was twice the stimulus frequency as expected from the equations of motion for the nanoparticle cluster.

Thorough QT study with recommended and supratherapeutic doses of tolterodine.

The objective of our study was to determine the QTc effects of tolterodine. A crossover-design thorough QT study of recommended (2 mg twice daily) and supratherapeutic (4 mg twice daily) doses of tolterodine, moxifloxacin (400 mg once daily), and placebo was performed. Electrocardiograms (ECGs) and pharmacokinetic samples were obtained on days 1-4; time-matched baseline ECGs were taken on day 0. Mean placebo-subtracted change from baseline Fridericia-corrected QT (QTcF) during peak drug exposure on day 4 was the primary end point. Mean QTcF prolongation of moxifloxacin was 8.9 ms (machine-read) and 19.3 ms (manual-read). At recommended and supratherapeutic tolterodine doses, mean QTcF prolongation was 1.2 and 5.6 ms (machine-read), respectively, and 5.0 and 11.8 ms (manual-read), respectively. The QTc effect of tolterodine was lower than moxifloxacin. No subject receiving tolterodine exceeded the clinically relevant thresholds of 500 ms absolute QTc or 60 ms change from baseline. In conclusion, tolterodine does not have a clinically significant effect on QT interval.

Macrophages and intravascular OCT bright spots: a quantitative study.

OBJECTIVES: This study hypothesized that bright spots in intravascular optical coherence tomography (IVOCT) images may originate by colocalization of plaque materials of differing indexes of refraction. To quantitatively identify bright spots, we developed an algorithm that accounts for factors including tissue depth, distance from light source, and signal-to-noise ratio. We used this algorithm to perform a bright spot analysis of IVOCT images and compared these results with histological examination of matching tissue sections. BACKGROUND: Bright spots are thought to represent macrophages in IVOCT images, and studies of alternative etiologies have not been reported. METHODS: Fresh human coronary arteries (n = 14 from 10 hearts) were imaged with IVOCT in a mock catheterization laboratory and then processed for histological analysis. The quantitative bright spot algorithm was applied to all images. RESULTS: Results are reported for 1,599 IVOCT images co-registered with histology. Macrophages alone were responsible for only 23% of the bright spot-positive regions, although they were present in 57% of bright spot-positive regions (as determined by histology). Additional etiologies for bright spots included cellular fibrous tissue (8%), interfaces between calcium and fibrous tissue (10%), calcium and lipids (5%), and fibrous cap and lipid pool (3%). Additionally, we showed that large pools of macrophages in CD68(+) histology sections corresponded to dark regions in comparative IVOCT images; this is due to the fact that a pool of lipid-rich macrophages will have the same index of refraction as a pool of lipid and thus will not cause bright spots. CONCLUSIONS: Bright spots in IVOCT images were correlated with a variety of plaque components that cause sharp changes in the index of refraction. Algorithms that incorporate these correlations may be developed to improve the identification of some types of vulnerable plaque and allow standardization of IVOCT image interpretation.

Narcolepsy, cataplexy, heart rate, and blood pressure.

Seven narcoleptic patients had serial measurements of blood pressure taken during nocturnal sleep over a period of 2 or 3 successive nights. Blood pressure was measured using a Doppler system with a cuff that automatically inflates every 15 min. There was no difference in the blood pressure measurements throughout the night compared with normal control subjects. Blood pressure followed the patterns of normal nocturnal variation; there was a nonsignificant increase in REM sleep compared with stage 3-4 NREM sleep. Studies of heart rate immediately preceding cataplectic attacks were inconclusive in identifying cardiovascular changes preceding muscle weakness.

Viloxazine hydrochloride in narcolepsy: a preliminary report.

Twenty-three narcoleptic subjects participated in a single-blind drug study with placebo-viloxazine hydrochloride (100 mg/day). One woman discontinued the study because of nausea and headaches during the treatment period. The remaining 22 subjects were polygraphically monitored during baseline, The remaining 22 subjects were polygraphically monitored during baseline, placebo intake, viloxazine treatment, and placebo intake following 48 h of drug withdrawal. Symptoms and side effects were evaluated subjectively and objectively. Except for the subject who discontinued the study, viloxazine was well tolerated, particularly in elderly subjects. The drug had an inhibitory effect on REM sleep, cataplexy, and other auxiliary symptoms. While there is no objective evidence that it heightens alertness, patients reported fewer sleep attacks.

Applications of the PM3 semi-empirical method to the study of triethylenediamine.

Charcoal filters impregnated with triethylenediamine (TEDA) are known to be efficient for the collection of volatile methyl iodide, which may be released under a hypothetical loss-of-coolant accident in a nuclear generating station. The structure and thermodynamic stability of the products of the TEDA-methyl iodide reaction have thus been studied using semi-empirical techniques. The reaction of TEDA with two molecules of methyl iodide leads to a quaternization reaction at each of the nitrogens. Moreover, it is shown that substitution of the hydrogens on TEDA with electron-donating groups can lead to enhanced stability of the quaternary ammonium reaction products. The semi-empirical method PM3 (Parametric Method 3) was used as the basis for all calculations. Molecular systems and simulations were constructed using HyperChem 4.5 for Silicon Graphics workstations. Enthalpy determination and geometry optimization were some of the calculations performed on a system.

Iron-accelerated cumene hydroperoxide decomposition in hexadecane and trilaurin emulsions.

Free radicals arising from lipid peroxides accelerate the oxidative deterioration of foods. To elucidate how lipid peroxides impact oxidative reactions in food emulsions, the stability of cumene hydroperoxide was studied in hexadecane or trilaurin emulsions stabilized by anionic (sodium dodecyl sulfate; SDS), nonionic (Tween 20), and cationic (dodecyltrimethylammonium bromide; DTAB) surfactants. Fe(2+) rapidly (within 10 min) decomposed between 10 and 31% of the cumene hydroperoxide in Tween 20- and DTAB-stabilized emulsions at pH 3.0 and 7.0 and in the SDS-stabilized emulsion at pH 7.0 with no further decomposition of peroxides occurring for up to 3 h. In SDS-stabilized emulsions at pH 3.0, Fe(2+) decreased peroxides by 90% after 3 h. Decomposition of peroxides in the absence of added iron and by Fe(3+) was observed only in SDS-stabilized emulsions at pH 3.0. These results suggest that peroxide decomposition by iron redox cycling occurs when iron emulsion droplet interactions are high.

The effects of surfactant type, pH, and chelators on the oxidation of salmon oil-in-water emulsions.

Lipid oxidation in emulsions is influenced by the ability of transition metals to associate with emulsion droplets. The oxidative stability of 5% salmon oil-in-water emulsion was influenced by surfactant type, with oxidation rates being greatest in emulsions stabilized by anionic sodium dodecyl sulfate (SDS) followed by nonionic Tween 20 and cationic dodecyltrimethylammonium bromide (DTAB). EDTA inhibited lipid oxidation in all the emulsions, and apo-transferrin inhibited oxidation in the Tween 20-stabilized emulsions at pH 7.0, suggesting that continuous-phase iron was an active prooxidant. Iron associated with Tween-20 stabilized hexadecane emulsion droplets could be partitioned into the continuous phase by lowering the pH to

Ability of iron to promote surfactant peroxide decomposition and oxidize alpha-tocopherol.

Peroxides are an important factor in oxidative reactions in foods because their decomposition can result in formation of highly reactive free radicals. Emulsifiers such as the Brijs, Tweens, and lecithin were found to contain 4-35 micromol of peroxides/g of surfactant. Peroxide concentrations in Tween 20 micelles increased in the presence of low iron concentrations but decreased when iron concentrations were high, suggesting that iron was capable of promoting both peroxide formation and decomposition. Oxidation of alpha-tocopherol was observed in micelles high in peroxides (Tween 20) but not in micelles where peroxide concentrations were low (Brij). Transition metals accelerated the oxidation of alpha-tocopherol in Tween 20 micelles, whereas EDTA stabilized alpha-tocopherol in the presence of added Fe(2+). These results suggest that surfactant peroxides could decrease the oxidative stability of food emulsions by acting as a source of free radicals, especially in the presence of transition metals.

Complications of foot surgery. Laser surgery.

The carbon dioxide laser, when used surgically, is a possible source of complications. Knowledge of laser physics, tissue effects, and target tissue anatomy are of the utmost importance for minimizing complications. This article seeks to elucidate the factors involved in laser beam physics and the effect of these factors on target tissue, based on specific tissue anatomy. Common tissue complications and specific procedure-oriented complications that may arise as a result of laser surgery will be discussed and reviewed.

Carbon dioxide laser treatment of pedal verrucae.

Physicians always are pursuing improved results. In the case of pedal verrucae, the varying treatment modalities that have evolved are the product of a search, so far less than successful, for one that is virtually 100% effective. HPV is an extremely resilient and elusive organism, possessing the capabilities of lying dormant and suddenly springing to the surface of the skin. Although no single treatment modality has been shown to be a panacea, the authors believe that, among the various treatment alternatives available, the CO2 laser offers the best surgical prospect for eliminating the verruca and minimizing the sequelae of recurrence and postoperative pain.

Laser's use in bone and joint surgery.

The use of various lasers in medicine and surgery has progressed considerably. Obviously, the sheer number of lasers being used both clinically and experimentally indicates a great potential for further advancement and refinement in technique and surgical outcomes. Although the medical field has come very far accepting and using the laser, there is still a long way to go.

Diagnosis, pathophysiology, and treatment of plantar verruca.

The diagnosis and treatment of plantar verrucae have always been a dilemma to medical practitioners. Treatment modalities and their success rates vary. This article documents the wide array of treatment options available to today's practitioner.

Intravascular optical coherence tomography light scattering artifacts: merry-go-rounding, blooming, and ghost struts.

We sought to elucidate the mechanisms underlying two common intravascular optical coherence tomography (IV-OCT) artifacts that occur when imaging metallic stents: "merry-go-rounding" (MGR), which is an increase in strut arc length (SAL), and "blooming," which is an increase in the strut reflection thickness (blooming thickness). Due to uncontrollable variables that occur in vivo, we performed an in vitro assessment of MGR and blooming in stented vessel phantoms. Using Xience V and Driver stents, we examined the effects of catheter offset, intimal strut coverage, and residual blood on SAL and blooming thickness in IV-OCT images. Catheter offset and strut coverage both caused minor MGR, while the greatest MGR effect resulted from light scattering by residual blood in the vessel lumen, with 1% hematocrit (Hct) causing a more than fourfold increase in SAL compared with saline (p<0.001 ). Residual blood also resulted in blooming, with blooming thickness more than doubling when imaged in 0.5% Hct compared with saline (p<0.001 ). We demonstrate that a previously undescribed mechanism, light scattering by residual blood in the imaging field, is the predominant cause of MGR. Light scattering also results in blooming, and a newly described artifact, three-dimensional-MGR, which results in "ghost struts" in B-scans.