Recurrent Fevers and Neuro-ophthalmic Disorders in a Mathematical Genius.

Horner's syndrome coexisting with an ipsilateral fourth cranial nerve palsy is a rare occurrence and likely localises to pathology in the cavernous sinus. One such case may have occurred in the 18th century affecting the renowned mathematician Leonhard Euler. A review of his biographies, eulogies, and three finely detailed facial portraits suggest that these two neuro-ophthalmic conditions, along with visual loss and a decades-long intermittent febrile illness, may have been the result of an orbital cellulitis and septic cavernous sinus thrombosis, from an underlying chronic brucellosis infection.

A Comparison of Readings from Thermoluminescent Dosimeter Ring Badges Worn in Different Positions.

Our purpose was to evaluate whether the position of a thermoluminescent dosimeter (TLD) crystal results in different exposure readings. Methods: Nine subjects wore 2 TLD badges (one facing inward, toward the palm, and one facing outward) for 2 mo. Both TLDs were worn on the middle finger of the dominant hand, with the inward-facing TLD placed at the bottom and the outward-facing TLD at the top. At the end of the first month, these TLDs were replaced with new ones for another month. Combined results from the badges for the 2 mo were recorded in millisieverts. A paired t test with 2-sample means was performed to compare the 2 positions in general nuclear medicine and PET/CT subjects, with an α of 0.05. Results: For all subjects and for the general nuclear medicine and PET/CT groups, mean exposure was greater for the inward-facing TLD. Conclusion: For a TLD worn on the dominant hand, extremity-exposure readings are maximized when the TLD faces inward.

Changes in peripapillary blood vessel density in Graves' orbitopathy after orbital decompression surgery as measured by optical coherence tomography angiography.

The purpose is to evaluate the utility of optical coherence tomography (OCT) angiography in the evaluation of Graves' orbitopathy (GO) and response to orbital decompression in patients with and without dysthyroid optic neuropathy (DON). This was a single-center, prospective case series in a cohort of 12 patients (24 orbits) with GO and ±DON, (6 orbits) who underwent bilateral orbital decompression. All patients underwent pre- and postoperative OCT angiography of the peripapillary area. Vessel density indices were calculated in a 4.5 mm × 4.5 mm ellipsoid centered on the optic disk using split-spectrum amplitude decorrelation angiography algorithm, producing the vessel density measurements. Mean change in vessel density indices was compared between pre- and postoperative sessions and between patients with and without DON. Patient 1, a 34-year-old male with GO and unilateral DON OD, showed a significant reduction in blood vessel density indices oculus dexter (OD) (DON eye) after decompression while a more modest reduction was found oculus sinister (OS) with the greatest change noted intrapapillary. Patient 2, a 50-year-old male with DON OU, showed worsening neuropathy following decompression OD that was confirmed by angiographic density indices. Patient 3, a 55-year-female with DON, showed a reduction in blood vessel density OD and increased density OS. Patients without DON showed overall less impressive changes in indices as compared to those with DON. Using OCT angiography, response to surgical treatment in GO orbits, more so in orbits with DON, can be demonstrated and quantified using vessel density indices with reproducibility.

Microbiological Investigations of ReNu Plastic Bottles and the 2004 to 2006 ReNu With MoistureLoc-Related Worldwide Fusarium Keratitis Event.

PURPOSES: The purposes of this study were to determine whether the contact lens solution RevitaLens Ocutec (containing the antimicrobial agents alexidine and polyquaternium-1) would inhibit Fusarium organisms when heated in ReNu plastic bottles; whether alexidine would inhibit Fusarium organisms when heated in non-ReNu plastic bottles; and whether an alexidine-neutralizing compound leaches from heated ReNu bottles. METHODS: RevitaLens and an alexidine solution (0.00045%), previously stored in ReNu bottles at room temperature (RT) and 56°C, were incubated with 7 different Fusarium organisms. The alexidine solution was similarly stored in seven non-ReNu plastic bottles and incubated with these same organisms. To determine if an alexidine-neutralizing compound might be leaching from heated ReNu bottles, phosphate-buffered saline (PBS) was incubated at RT and 56°C in ReNu bottles, combined with alexidine, and then tested for anti-Fusarium capability. RESULTS: After being heated in ReNu bottles, RevitaLens retained its anti-Fusarium capability, whereas the alexidine solution did not. The alexidine solution heated in seven non-ReNu plastic bottles retained its anti-Fusarium capability. The alexidine solution retained its anti-Fusarium capability when incubated with a PBS solution that had been heated in ReNu bottles, indicating, microbiologically, that an alexidine-neutralizing compound did not leach from the heated ReNu bottle. CONCLUSIONS: Alexidine uniquely fails to inhibit Fusarium organisms when heated in a plastic ReNu bottle, but not in seven other plastic bottles, whereas the anti-Fusarium capability of RevitaLens (containing the antimicrobial agents alexidine and polyquaternium-1) is unaffected by heating in a ReNu bottle. There does not seem to be an alexidine-neutralizing compound leaching from heated ReNu bottles. An interaction between alexidine and its heated ReNu bottle may have been a critical factor in the worldwide ReNu with MoistureLoc-related Fusarium keratitis event of 2004 to 2006.

Synthesis, characterization, and electrochemical studies of PPh(3-n)(dipp)(n) (dipp = 2,6-diisopropylphenyl): steric and electronic effects on the chemical and electrochemical oxidation of a homologous series of triarylphosphines and the reactivities of the corresponding phosphoniumyl radical cations.

Activation barriers to the electrochemical oxidation for the series PPh3-n(dipp)n (dipp = 2,6-diisopropylphenyl) in CH2Cl2/Bu4NPF6 were measured using large amplitude FT ac voltammetry. Increasing substitution across this series, which offers the widest range of steric requirements across any analogous series of triarylphosphines reported to date, increases the energetic barrier to electron transfer; values of 18, 24, and 25 kJ mol(-1) were found for compounds with n = 1, 2, and 3, respectively. These values are significantly greater than those calculated for outer sphere activation barriers, with deviations between observed and calculated values increasing with the number of dipp ligands. This suggests that the steric congestion afforded by these bulky substituents imposes significant reorganizational energy on the electron transfer processes. This is the first investigation of the effect of sterics on the kinetics of heterogeneous electron transfer across a structurally homologous series. Increased alkyl substitution across the series also increases the chemical reversibility of the oxidations and decreases the oxidation peak potentials. As the compounds for which n = 1 and 2 are novel, the synthetic strategies employed in their preparation are described, along with their full spectroscopic, physical, and crystallographic characterization. Optimal synthesis when n = 1 is via a Grignard reagent, whereas when n = 2 an aryl copper reagent must be employed, as use of a Grignard results in reductive coupling. Chemical oxidation studies were performed to augment the electrochemical work; the O, S, and Se oxidation products for the parent triarylphosphines for which n = 1 and 2 were isolated and characterized.

Pan-antimicrobial failure of alexidine as a contact lens disinfectant when heated in Bausch & Lomb plastic containers: implications for the worldwide Fusarium keratitis epidemic of 2004 to 2006.

OBJECTIVE: ReNu with MoistureLoc (ReNuML), containing the antimicrobial agent alexidine 0.00045%, was associated with the Fusarium keratitis epidemic of 2004 to 2006. Although a single-point source contamination was ruled out, only Fusarium organisms were reported during the outbreak. This study investigated whether the reported loss of antimicrobial effectiveness toward Fusarium of ReNuML after exposure to heat in high-density polyethylene (HDPE) plastic containers could also be demonstrated with other common fungal and bacterial agents of keratitis. METHODS: A buffered solution of alexidine 0.00045% was incubated in glass and ReNu HDPE plastic containers at room temperature (RT) and 56°C for 4 weeks, serially diluted, and tested for its ability to inhibit the growth of 20 bacterial isolates, 12 non-Fusarium fungal isolates, and 7 Fusarium isolates originally involved in the keratitis epidemic. RESULTS: A statistically significant loss of antimicrobial capability was seen with all fungi, all gram-positive bacteria, and all isolates of Klebsiella when alexidine 0.00045% was incubated at 56°C in ReNu HDPE containers compared with RT or glass incubation (P≤0.0001). CONCLUSIONS: Heating of an alexidine solution in ReNu HDPE plastic (but not glass) containers results in the same loss of anti-Fusarium activity as reported when testing the original ReNuML solution. This loss of inhibitory activity is not specific to Fusarium and occurs with other fungi and bacteria that cause keratitis. The reasons for the lack of reports of bacterial and/or non-Fusarium fungal keratitis during the original Fusarium keratitis epidemic remain unclear at this time.

A formulation strategy for gamma secretase inhibitor ELND006, a BCS class II compound: development of a nanosuspension formulation with improved oral bioavailability and reduced food effects in dogs.

ELND006 is a novel gamma secretase inhibitor previously under investigation for the oral treatment of Alzheimer's disease. ELND006 shows poor solubility and has moderate to high permeability, suggesting it is a Biopharmaceutics Classification System Class II compound. The poor absolute oral bioavailability of the compound in fasted dogs (F ∼11%) is attributed to poor aqueous solubility. In addition, inhibiting amyloid precursor protein but not Notch cleavage is an important goal for gamma secretase inhibitors; therefore, significant variation in bioavailability resulting from food consumption is a potential liability for this class of compounds. The objective of the present study was to determine if an ELND006 nanocrystalline formulation would offer improved and predictable pharmacokinetics. ELND006 was formulated as a nanosuspension with a mean particle size of less than 200 nm, which was stable in particle size and crystallinity for over 1 year. In addition, ELND006 nanosuspension exhibited rapid dissolution in comparison with reference active pharmaceutical ingredient (API). The in vivo performance of the ELND006 nanosuspension was tested in fed and fasted beagle dogs and compared with a gelatin capsule containing reference API. The results show that nanosizing ELND006 profoundly improved the oral bioavailability and virtually eliminated variation resulting from food intake.

Human polymorphisms in the glutathione transferase zeta 1/maleylacetoacetate isomerase gene influence the toxicokinetics of dichloroacetate.

Dichloroacetate (DCA), a chemical relevant to environmental science and allopathic medicine, is dehalogenated by the bifunctional enzyme glutathione transferase zeta (GSTz1)/maleylacetoacetate isomerase (MAAI), the penultimate enzyme in the phenylalanine/tyrosine catabolic pathway. The authors postulated that polymorphisms in GSTz1/MAAI modify the toxicokinetics of DCA. GSTz1/MAAI haplotype significantly affected the kinetics and biotransformation of 1,2-¹³C-DCA when it was administered at either environmentally (µg/kg/d) or clinically (mg/kg/d) relevant doses. GSTz1/MAAI haplotype also influenced the urinary accumulation of potentially toxic tyrosine metabolites. Atomic modeling revealed that GSTz1/MAAI variants associated with the slowest rates of DCA metabolism induced structural changes in the enzyme homodimer, predicting protein instability or abnormal protein-protein interactions. Knowledge of the GSTz1/MAAI haplotype can be used prospectively to identify individuals at potential risk of DCA's adverse side effects from environmental or clinical exposure or who may exhibit aberrant amino acid metabolism in response to dietary protein.

Henry B. Stallard, MD: The 1924 Paris Olympics, and Chariots of Fire.

Hyla Bristow Stallard was one of the greatest middle-distance runners in British athletic history. While an English medical student, he won the bronze medal in the 1500-meter run at the 1924 Paris Olympics, immortalized in the critically acclaimed 1981 epic British film, Chariots of Fire. He later became one of the most famous ophthalmologists in the world for his pioneering work in radiation therapy of malignant eye disease. He was an inspiring role model for both athletes and physicians. As a gifted individual who enjoyed two international careers, he is worthy of great admiration and emulation.

Activation parameters derived from a temperature dependent large amplitude ac voltammetric study of the electrode kinetics of the Cp2M(0/+) redox couples (M = Fe, Co) at a glassy carbon electrode.

Heterogeneous charge transfer rate constants (k°) for the oxidation of ferrocene, Fc (k° = 0.21 cm s(-1) at 20 °C), and the reduction of the cobaltocenium cation, Cc(+) (k° = 0.12 cm s(-1) at 18 °C), in CH(2)Cl(2) (0.5 M Bu(4)NPF(6)) at a glassy carbon (GC) electrode were determined as a function of temperature using the higher harmonic components available in Fourier transformed large amplitude ac voltammetry. The measured k° values lie at the upper end of the analytically useful range available for the acquisition of meaningful kinetic data for these very fast (i.e., close to reversible) processes. Measurements of the kinetics are facilitated by the ac technique because contributions resulting from uncompensated resistance and slow electrode kinetics, both of which also vary with temperature, can be distinguished via their different contributions to individual harmonics. Values of k° measured over the temperature range of -18 to +20 °C for the Fc(0/+) and Cc(+/0) processes gave linear Arrhenius plots yielding free energies of activation (ΔG(‡)) estimates of 17.0 and 18.0 kJ mol(-1), respectively, in excellent agreement with theoretical values derived from Marcus theory. An analogous temperature dependence is indicated in a study of the Fc(0/+) process in acetonitrile (0.1 M Bu(4)NPF(6)), but the greater k° value evident makes the temperature dependence of these parameters more difficult to quantify as departures from reversibility are minimal, even in the higher harmonics.

Effects of time, temperature, and storage container on the growth of Fusarium species: implications for the worldwide Fusarium keratitis epidemic of 2004-2006.

OBJECTIVE: To demonstrate the effects of time, temperature, and container properties on the ability of ReNu with MoistureLoc (ReNuML; contains the antimicrobial agent alexidine) to inhibit growth of Fusarium species. METHODS: ReNu with MoistureLoc was stored in its Bausch & Lomb (Rochester, New York) plastic or similarly sized glass containers for 1 and 4 weeks at room temperature, 42°C, and 56°C, and then tested for its ability to inhibit growth of 7 Fusarium isolates. RESULTS: ReNu with MoistureLoc stored in glass containers for 1 or 4 weeks at all 3 temperatures demonstrated no significant fungistatic deterioration. However, ReNuML stored at 56°C in its Bausch & Lomb plastic container demonstrated a statistically significant fungistatic deterioration compared with room temperature storage in its original plastic container or with glass container storage at any temperature. CONCLUSION: When exposed to elevated storage temperature, it appears that an interaction between ReNuML and its Bausch & Lomb plastic container adversely affects the fungistatic properties of ReNuML, which could have contributed to the Fusarium keratitis epidemic of 2004 through 2006.

Effects of coupled homogeneous chemical reactions on the response of large-amplitude AC voltammetry: extraction of kinetic and mechanistic information by Fourier transform analysis of higher harmonic data.

Large-amplitude ac voltammograms contain a wealth of kinetic information concerning electrode processes and can provide unique mechanistic insights compared to other techniques. This paper describes the effects homogeneous chemical processes have on ac voltammetry in general and provides experimental examples using two well-known chemical systems: one simple and one complex. Oxidation of [Cp*Fe(CO)(2)](2) (Cp* = η(5)-pentamethylcyclopentadienyl) in noncoordinating media is a reversible one-electron process; in the presence of nucleophiles, however, the resulting ligand-induced disproportionation changes the process to a multiple step regeneration. The chemical kinetic parameters of the regeneration mechanism were discerned via analysis of the third and higher harmonics of Fourier-transformed ac voltammetry data. Comparison of experimental data to digital simulations provides clear evidence that the reaction proceeds via a rapid pre-equilibrium between the electrogenerated monocation and the coordinating ligand; simultaneous fitting of the first nine harmonics indicates that k(f) = 7500 M(-1) s(-1) and k(r) = 100 s(-1), and that the unimolecular decomposition of the corresponding intermediate occurs with a rate constant of 2.2 s(-1). The rapid cis(+) → trans(+) isomerization of the electrogenerated cis-[W(CO)(2)(dpe)(2)](+), where dpe = 1,2-diphenylphosphinoethane, was examined to illustrate the effects of a simpler EC mechanism on the higher harmonics; a rate constant of 280 s(-1) was determined. These results not only shed new light on the chemistry of these systems, but provide a clear demonstration that the higher harmonics of ac voltammetry provide mechanistic insights into coupled homogeneous processes far more detailed than those that are readily accessible with dc techniques.

A retrospective statistical analysis of the Fusarium keratitis epidemic of 2004-2006.

PURPOSE: A retrospective statistical analysis of the Fusarium keratitis epidemic of 2004-2006 was performed. METHODS: Poisson and binomial probability distributions were performed in conjunction with statistical data reported from Singapore's Fusarium keratitis outbreak in order to identify the earliest theoretical point in time that this outbreak and its cause could have been recognized. RESULTS: The outbreak in Singapore could, theoretically, have been recognized after only three months (three cases), P = 0.0067. The cause of the Singapore outbreak could, theoretically, have been determined after only four months (five cases), P = 0.0024. CONCLUSIONS: The worldwide Fusarium keratitis epidemic of 2004-2006 could, theoretically, have been recognized much earlier by the application of basic statistical methods to the outbreak in Singapore. The lessons learned from this analysis may help prevent future epidemics.

Yes, but what's the mechanism? (don't expect an easy answer).

Psychologists increasingly recommend experimental analysis of mediation. This is a step in the right direction because mediation analyses based on nonexperimental data are likely to be biased and because experiments, in principle, provide a sound basis for causal inference. But even experiments cannot overcome certain threats to inference that arise chiefly or exclusively in the context of mediation analysis-threats that have received little attention in psychology. The authors describe 3 of these threats and suggest ways to improve the exposition and design of mediation tests. Their conclusion is that inference about mediators is far more difficult than previous research suggests and is best tackled by an experimental research program that is specifically designed to address the challenges of mediation analysis.