The relationship between physical activity, structural deformity, and spinal mobility in adolescent idiopathic scoliosis patients.

PURPOSE: Adolescent idiopathic scoliosis (AIS) patients experience structural spinal deformity, but the impact of AIS on physical activity is not widely studied. Reports of physical activity levels between children with AIS and their peers are mixed. This study sought to characterize the relationship between spinal deformity, spinal range of motion, and self-reported physical activity in AIS patients. METHODS: Patients aged 11-21 completed self-reported measures of physical activity using the HSS Pedi-FABS and PROMIS Physical Activity questionnaires. Radiographic measures were obtained from standing biplanar radiographic imaging. Surface topographic (ST) imaging data was obtained using a whole-body ST scanning system. Hierarchical linear regression models analyzed the relationship between physical activity, ST, and radiographic deformity while controlling for age and BMI. RESULTS: 149 patients with AIS (mean age 14.5 ± 2.0 years, mean Cobb angle 39.7° ± 18.9°) were included. In the hierarchical regression predicting physical activity from Cobb angle, no factors were significant predictors of physical activity. When predicting physical activity from ST ROM measurements, age and BMI served as covariates. No covariates or ST ROM measurements were significant predictors of physical activity levels for either activity measure. CONCLUSIONS: Physical activity levels of patients with AIS were not predicted by levels of radiographic deformity or surface topographic range of motion. Although patients may experience severe structural deformity and range of motion limitations, these factors do not appear to be associated with decreased physical activity level utilizing validated patient activity questionnaires. LEVEL OF EVIDENCE: Level II.

Localization of synaptic and nonsynaptic nicotinic-acetylcholine receptors in the goldfish retina.

The localization of nicotinic-cholinergic receptors in the inner plexiform layer (IPL) of goldfish retina was studied by electron microscopic analysis of the binding pattern of a conjugate or horseradish peroxidase and alpha bungarotoxin (HRP-alpha BTx). Specific HRP reaction product (blockade by 1mM curare) was found at both synaptic and nonsynaptic sites. Synaptic binding sites for HRP-alpha BTx, which accounted for only 16% of the total specific reaction product sites, always involved an amacrine process as the presynaptic element, whereas amacrine, ganglion, and bipolar cells could be post-synaptic elements at labeled synapses. Only 17.5% of the total number of amacrine synapses were labeled by HRP-alpha BTx. Labeled synapses showed the same distribution in the IPL as unlabeled synapses: bimodal for amacrine-to-bipolar synapses with peak concentrations at the 20% and 80% layers and unimodal for amacrine-to-nonbipolar synapses with a peak concentration at the 60% layer. Nonsynaptic binding sites for HRP-alpha BTx (84% of total) were seen on the dendrites of ganglion, amacrine, and bipolar cells. The distribution of the nonsynaptic sites in the IPL largely accounts for the trilaminar binding pattern of 125I-alpha BTx as observed in light microscopic autoradiographs. If, as appears likely, the distribution of synapses is the relevant variable in determining the sites of neuronal interaction for a given transmitter system, then this study further illustrates the importance of distinguishing synaptic from nonsynaptic binding when using receptor-ligand probes to localize sites of chemical synaptic transmission.

Gamma-aminobutyric acidA receptors on a bistratified amacrine cell type in the rabbit retina.

Gamma-Aminobutyric acid (GABA) is considered to be a major inhibitory neurotransmitter in the inner plexiform layer of the retinas of all vertebrate species. It is contained in and released from nearly 40% of the amacrine cells and is known to play a major role in many aspects of visual processing. By using well-characterized antibodies to several subunits of the GABA(A) receptor, we have analyzed their localization on the cell bodies and dendritic trees of two amacrine cell populations in the rabbit retina, which have been either filled intracellularly with Lucifer yellow or stained immunohistochemically. Both populations are selectively stained by intravitreal injection of the fluorescent nuclear dye 4',6-diaminidin-2-phenylindoldihydrochloride (DAPI). We have found that the most significant concentration of the alpha1 and beta2/3 GABA(A) receptor subunits is localized to the DAPI-3 type amacrine cell. The perikarya of the DAPI-3 cells are found in the proximal inner nuclear layer and send their processes into two sublayers in sublaminae a and b of the inner plexiform layer. These processes abut but do not directly overlap those of the two mirror-symmetric populations of starburst amacrine cells. Because the cell bodies of the DAPI-3 cells are the only ones in the inner nuclear layer that stain strongly for either the alpha1 or beta2/3 subunits, such staining is a diagnostic feature of these cells. Their processes also constitute the most strongly staining ones found within the inner plexiform layer. The dendritic trees of DAPI-3 cells, which range from about 150 microm up to about 300 microm, exhibit recurvate looping processes reminiscent of those described for directionally selective ganglion cells. In contrast to the DAPI-3 cell, we have also shown that the starburst amacrine cells exhibit no immunoreactivity for the alpha1 GABA(A) receptor subunit and very little for the beta2/3 subunit. Thus, we have shown that the DAPI-3 cells contain the highest concentrations of the alpha1 and beta2/3 GABA(A) receptor subunits in the rabbit retina. These cells, which costratify near the processes of both the starburst amacrine cells and the ON-OFF directionally selective ganglion cells, thus, are situated both anatomically and by virtue of their receptor content to potentially interact.

Neurotoxic action of kainic acid in the isolated toad and goldfish retina: I. Description of effects.

The neurotoxic action of kainic acid (KA) was investigated by histological methods in the isolated retina of toads and goldfish. Particular attention was paid to the earliest and most sensitive response to KA in the outer plexiform layer (OPL). KA caused vacuolization of proximal and distal segments of horizontal cell dendrites in the OPL as well as perikaryal vacuolization and/or chromatin clumping in selected classes of neurons in the inner nuclear layer. Further, KA caused vacuolization and swelling in the inner plexiform layer. These effects were very similar in the retinae of goldfish and toad. The extent of vacuolization in the OPL was graded with KA concentration and with length of incubation. For 15-minute incubations, half-maximal vacuolization was found at 10-20 microM KA. At 25 microM KA, OPL vacuolization was evident within 1-2 minutes of application of KA. In goldfish, but not in toad, rod-connecting dendrites were less sensitive to KA than cone-connecting dendrites.

Neurotoxic action of kainic acid in the isolated toad and goldfish retina: II. Mechanism of action.

The specificity and mechanism of the neurotoxic action of kainic acid (KA) was investigated by histological methods in the isolated retina of toads and goldfish. Particular attention was paid to the earliest and most sensitive response to KA in the outer plexiform layer (OPL). Of 21 compounds tested as potential mimics of KA neurotoxicity in the OPL, only the enantiomers of glutamate and aspartate mimicked KA, inducing a low-level neurotoxic effect at concentrations 5,000-10,000-fold higher than concentrations of KA giving comparable effects. Further, of 22 compounds tested as potential blockers of KA neurotoxicity in the OPL, only D-gamma-glutamylglycine, D,L-alpha-amino pimelic acid, sodium pentobarbital, D,L-alpha-amino adipic acid, L-glutamate, and L-aspartate blocked KA neurotoxicity (IC50 values of 0.1, 0.3, 0.3, 2, 5, and 15 mM, respectively). In ionic substitution experiments, KA-induced vacuolization was found to require sodium and chloride ions but not calcium ions in the extracellular medium. These findings support the hypothesis that KA combines with specific receptors in the membrane of susceptible neurons in the retinal OPL, leading to prolonged opening of membrane channels permeable to sodium and potassium ions. An accompanying equilibrating chloride influx may result in intracellular ion excess, leading to osmotic swelling and vacuolization. The membrane receptors involved in mediating the action of KA in the OPL are likely to be a class of postsynaptic or extrasynaptic glutamate receptor.

Synaptic organization of substance P-like immunoreactive amacrine cells in goldfish retina.

A class of amacrine cells in the goldfish retina displays substance P-like immunoreactivity (SPIR). We studied the synaptic organization of SPIR amacrine cells by electron microscopical immunocytochemistry. Amacrine cells showing SPIR have processes which ramify in a very narrow band in layer 3 of the inner plexiform layer. SPIR is restricted to large dense-cored vesicles (DCVs), which are distributed throughout the dendrites. Processes labeled with SPIR contain a mixture of DCVs and numerous small agranular vesicles. Of 88 synaptic contracts analyzed, SPIR processes occurred as the presynaptic element 57 times and as the postsynaptic element 31 times. SPIR processes made synapses upon amacrine and ganglion cell dendrites with equal frequency and received synaptic input from both amacrine and bipolar cells. The stratification of SPIR amacrine cells in proximal sublamina a suggests that their synaptic interactions are restricted to "off" and "on-off" neurons. However, this is in contrast to published electrophysiological data. Possible explanations for this discrepancy are discussed in detail.

Comparison of fixation and penetration enhancement techniques for use in ultrastructural immunocytochemistry.

Electron microscopic immunohistochemistry, although generally providing good localization, has often failed to produce satisfying ultrastructural preservation. Techniques that result in well-preserved tissue ultrastructure often hinder penetration of immunological reagents or render antigens non-immunoreactive. These are particularly serious limitations in studies of central nervous system and retina. We have evaluated several fixatives, including picric acid, high pH paraformaldehyde, and glutaraldehyde with subsequent sodium borohydride treatment, and penetration enhancement techniques, including buffered-ethanolic treatment and freeze--thaw, for their applicability in the retina. Our best fixation was achieved with 1 hr in 4% paraformaldehyde and 0.2% glutaraldehyde (pH 7.4) followed by overnight fixation in 4% paraformaldehyde (pH 10.4). Treatment with sodium borohydride after glutaraldehyde fixation restores much of the immunoreactivity that would otherwise be undetectable. The penetration of immunological reagents can be greatly increased by using either a buffered-ethanolic series or by freezing the tissue after careful cryoprotection. Using these methods we have been able to achieve specific immunological staining throughout the full thickness of retinal slices, up to 500 microns across, while preserving good ultrastructure. The methods should prove useful in the immunocytochemical localization of many different antigens in a variety of tissues.

Prone and supine positioning effects on energy expenditure and behavior of low birth weight neonates.

The effect of body position (supine v prone) on energy expenditure and behavior of 42 healthy low birth weight (920 to 1,760 g) infants was evaluated in 66 studies. Each infant was randomly assigned to the supine or prone position for the first three-hour epoch; the position was reversed for the second three-hour epoch. The difference in energy expenditure and the percentage of time in active sleep, quiet sleep, and wakefulness between the two positions was computed. The median difference (supine minus prone) in overall energy expenditure between positions was +3.1 kcal/kg/d (interquartile range 0.6 to 6.5; P less than .001). When only periods of active sleep were analyzed, the median difference in energy expenditure remained significant, the supine position being higher than prone by +2.6 kcal/kg/d (interquartile range 0.1 to 4.8; P less than .001). In the supine position, the time awake was 5.7% higher (interquartile range 1.8 to 17.4; P less than .001) than in the prone position. The percentage of time in active sleep was not significantly different between the positions, hence quiet sleep decreased in the supine position. In summary, when low birth weight infants are changed from the supine to the prone position, energy expenditure decreases, time spent in quiet sleep increases, and time spent awake decreases. These data suggest that prone is the position of choice for the low birth weight infant.

Protein quality in feeding low birth weight infants: a comparison of whey-predominant versus casein-predominant formulas.

Growth (delta weight, delta length, delta head circumference, and delta skinfold thickness), nitrogen retention, and chemical indices of metabolic tolerance (BUN concentration and acid-base status; plasma amino acid concentrations including free and bound cyst(e)ine; urinary excretion of sulfur amino acids) were determined serially in low birth weight infants (900 to 1,750 g) fed formulas differing only in protein quality. One contained unmodified bovine milk protein (a ratio of whey proteins to caseins of 18:82); the other contained modified bovine milk protein (a ratio of whey proteins to caseins of 60:40). Both provided protein and energy intakes, respectively, of approximately 3.4 g/kg/d and 120 kcal/kg/d. Neither weight gain nor the rate of increase in length, head circumference, and skinfold thickness differed between the two groups. Nitrogen retention of the two groups also did not differ. Although BUN concentration and blood acid-base status did not differ, there were differences in the plasma concentrations of some amino acids. Plasma tyrosine concentration was higher in infants fed the casein-predominant protein, and plasma threonine concentration was higher in infants fed the whey-predominant protein. Neither plasma-free nor bound cyst(e)ine concentration differed between the two groups, but the greater cyst(e)ine intake of the whey-predominant group resulted in greater cyst(e)ine retention; this was accompanied by greater urinary taurine excretion, a reflection of greater taurine stores.

Heterogeneity of receptor immunoreactivity at synapses of glycine-utilizing neurons.

Neurons often contain, and probably release, more than one neuroactive substance that may have diverse or opposite actions on the postsynaptic cell. It remains unexplained how these neurons utilize their multiple neuroactive substances while maintaining appropriate resolution of neurotransmitter functions. Here, we have examined the ultrastructural localization of glycine receptors by using a monoclonal antibody directed to the intracellular domain of the strychnine-sensitive glycine receptor. We have found that glycine receptors are only localized to 56% of the synapses made by presumed 'glycinergic' (more accurately, glycine-utilizing) amacrine cells in the turtle retina. The remaining synapses made by these same boutons show no evidence of glycine receptors. As there is no evidence to suggest the presence of a second type of glycine receptor, these data indicate that only a portion of the postsynaptic sites contacted by the glycine-utilizing neurons can respond to glycine. They also suggest that a neuron containing multiple neuroactive substances can selectively affect postsynaptic elements by means of heterogeneous receptor localization.

Molecular monitoring of the immunosuppressive effects of cyclosporine in renal transplant patients by using a quantitative polymerase chain reaction.

We have developed a rapid (24 hours) quantitative PCR assay to measure the direct effect of cyclosporine on IL-2 mRNA production by activated PBMC cultures from renal transplant patients. The PBMCs were purified from normal laboratory volunteers (group A, n = 26), CsA-treated renal transplant patients with good renal function, tested between 3 and 8 weeks (group B, n = 14) or between 2 and 8 years (group C, n = 15) after surgery, and stimulated with PHA in media supplemented with either patient serum or pooled commercially obtained AB serum. The mRNA was then isolated and, using semiquantitative PCR or quantitative PCR with a competitive inhibitor, the relative levels or exact levels of IL-2 mRNA (in attomoles) could be measured. A 3-day confirmatory lymphoproliferation assay of [3H]thymidine incorporation was also performed on the samples. Kinetic analysis of the data from group A showed that the peak level of IL-2 transcription into mRNA occurred at 6 hours after mitogen stimulation. Increasing in vitro concentrations of CsA in this group resulted in lower IL-2 mRNA levels and a shift in the peak time to 12-24 hours. In the transplant recipients, there was no correlation between individual CsA blood levels and proliferation responses. However, some correlation was found between CsA blood levels and IL-2 mRNA levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Longitudinal induced IL-2 mRNA monitoring in renal transplant patients immunosuppressed with cyclosporine and in unmodified canine renal transplant rejection.

Immune monitoring of transplant patients to define optimal immunosuppression continues to be important, as rejection occurs despite adjustment of dosaging of CsA or even FK506 to achieve "therapeutic-range" blood levels. Because CsA is known to inhibit upregulation of IL-2 mRNA transcription, we prospectively sequentially measured (induced) IL-2 mRNA in PHA-stimulated PBMC cultures from transplant recipients of kidneys from living-related donors (n = 15) using a quantitative PCR assay, with a potential 24-hour turnaround time, to define immunologic events in real time. Reproducible individual patient sensitivity or refractoriness to CsA was determined pretransplant, by adding a range of CsA concentrations to the PBMC cultures and constructing induced IL-2 mRNA regression inhibition curves. However, this was not predictive of rejection episodes, but did correlate well with individual differences in IL-2 mRNA levels posttransplant, despite similar maintenance trough blood concentrations of CsA between patients. In this prospective study, seven patients experienced rejection episodes despite therapeutic CsA trough levels. Three of these, plus one not receiving CsA therapy, who happened to be prospectively tested at the time that rejection was clinically diagnosed, had a decrease in induced IL-2 mRNA before treatment was instituted. As a correlation to this observation in patients, induced IL-2 mRNA levels in unmodified rejection were sequentially measured in PBMC cultures in autologous vs allogeneic canine renal transplants and IL-2, IL-10, TNF-alpha, and IFN-gamma mRNA were also measured in kidney biopsies. Sequential PHA lymphoproliferation assays of [3H] thymidine incorporation on patient and dog PBMC cultures were also performed. Similar to the observations in patients, unmodified rejection in the canine renal allograft model also was accompanied by a decline of PHA-induced IL-2 mRNA in PBMCs as the serum creatinine concentrations became elevated. In the dog kidney biopsies at later phases of rejection, IL-10 mRNA levels were also significantly elevated (p = 0.032).

Correlations between cholinergic neurons and muscarinic m2 receptors in the rat retina.

Acetylcholine is well established as the neurotransmitter of starburst amacrine cells in the vertebrate retina but their function is poorly understood. We compared the distribution of muscarinic m2 receptors in the rat retina with the localization of the starburst cell processes. mAChR2 immunoreactivity appeared in a central band in the inner plexiform layer, which did not co-localize with the processes of the cholinergic amacrine cells. We found co-labelling of VAChT and ChAT making it highly unlikely that there are undetected cholinergic neurons in rat retina. Most mAChR2 receptors were located far from the cholinergic neurons, suggesting that most of them are unlikely to be associated with conventional cholinergic synapses.

Two types of pyriform Ab amacrine cells in the goldfish retina: an EM analysis of [3H]GABA uptake and somatostatin-like immunoreactivity.

Pyriform Ab amacrine cells in the goldfish retina take up [3H]GABA and show somatostatin-like immunoreactivity (SLIR), leading to the question of whether these two markers are labeling the same or different types of Ab amacrine cells. We used a double-label radio/immuno-technique at the electron microscopical level to visualize the comparative location of [3H]GABA uptake and SLIR in Ab amacrine cells and their processes. SLIR was restricted to large dense-cored vesicles in processes of Ab amacrine cells. In no case were processes labeled with SLIR observed to take up [3H]GABA. Thus, there are at least two types of pyriform Ab amacrine cells: one that takes up [3H]GABA and one that shows SLIR. These may correspond to the two types of Ab amacrine cells described by Cajal in his classic studies on the retina.

Non-correspondence of [3H]GABA uptake and GAD localization in goldfish amacrine cells.

Ultrastructural analysis of the inner synaptic layer of goldfish retina, using a double-label technique, showed that [3H]GABA uptake and glutamic acid decarboxylase (GAD)-immunoreactivity (IR) occurred in different neuronal processes in most cases. Many [3H]GABA-accumulating processes were found surrounding GAD-IR processes, though not necessarily in a postsynaptic relationship. Co-localization of [3H]GABA uptake and GAD-IR occurred only when one GAD-IR process was juxtaposed to another GAD-IR process. This study suggests that [3H]GABA uptake may be a poor marker for GABA releasing neurons.

Azaserine: further evidence for DNA damage in Escherichia coli.

Azaserine causes DNA damage in stationary-phase cells. In our investigation of this damage, we used strains of Escherichia coli differing in repair capabilities to study azaserine-induced DNA damage, detected as DNA strand breaks by sucrose gradient sedimentation techniques. Reduced sedimentation in alkaline and neutral sucrose gradients indicated the presence of both alkali-labile sites and in situ strand breaks. Azaserine induced DNA single-strand breaks (SSBs) abundantly in all but the recA strain, in which SSBs were greatly reduced. Treatment of purified DNA with azaserine from bacteriophages T4 and PM2 produced no detectable SSBs. Several other studies also failed to detect DNA damage induced directly by azaserine. Increased levels of beta-galactosidase were induced in an E. coli strain possessing a rec::lac fusion, providing further evidence for azaserine induction of the recA gene product. In addition, azaserine induced adaptation against killing but not against mutagenesis in wild-type E. coli strain.

Localization of gephyrin and glycine receptor subunit immunoreactivity in the rabbit retina.

Being utilized by over 40% of the amacrine cells, glycine is considered to be a major inhibitory neurotransmitter in the retinas of all vertebrate species examined. Localization of gephyrin, which is a 93-kD peripheral membrane glycine receptor-associated anchoring protein, has been used in several studies to identify the sites of glycinergic interactions in the retina and other regions of the central nervous system. Recent studies have shown that gephyrin colocalizes with GABA(A) receptors which, like those for glycine, are also inhibitory amino acid receptors usually associated with a chloride channel. In the present study, we have used two antibodies which recognize either gephyrin (mAb7a), or the alpha and beta subunits of the glycine receptor (mAb4a) in order to determine to what extent gephyrin is associated with glycine receptors in the mammalian retina. Single-label studies showed extensive punctate staining throughout most of the inner plexiform layer with each antibody. Double labeling showed that nearly 90% of the glycine receptor sites were also immunoreactive for gephyrin. However, nearly 60% of the total punctae immunoreactive for gephyrin were not stained for glycine receptors. This distinction was most pronounced in the most proximal inner plexiform layer where only 24% of the gephyrin-immunoreactive sites were glycine receptor positive. This study suggests that although most glycine receptors in the rabbit retina colocalize with the anchoring protein gephyrin, a significant proportion of the gephyrin-labeled sites are not associated with glycine receptors. In light of studies showing gephyrin association with GABA(A) receptor subunits, the localization of gephyrin may be indicative of chloride-mediated inhibitory amino acid transmission in general and not solely that of glycinergic. Given several studies which show that bipolar cells express glycine receptors and respond to glycine but do not express gephyrin, the 10% of glycine receptors not colocalized with gephyrin shown in the present study may represent a subtype of glycine receptors found on bipolar cells which do not require gephyrin for the functional clustering of receptor subunits.

Synaptic organization of dopaminergic interplexiform cells in the goldfish retina.

The synaptic organization of dopaminergic interplexiform cells (DA-IPC) in the goldfish retina was studied by a combined double-label electron-microscopical (EM) immunocytochemical/autoradiographical study. DA-IPCs were labeled with antisera against tyrosine hydroxylase. The possibility of synaptic contact with GABAergic amacrine cells in the proximal inner plexiform layer (IPL) was studied by using 3H-GABA uptake. Most synaptic input and output from DA-IPC processes involved amacrine cell processes. In addition, synaptic interactions were observed between DA-IPC processes and bipolar cell terminals, other DA-IPC processes, very small dendrites in the IPL, ganglion cell and optic fiber layers (OFL), and cell bodies in the ganglion cell layer (GCL). Input and output synapses with GABAergic amacrine processes also were observed. Two-thirds of the DA-IPC boutons in the proximal IPL were involved in "junctional appositions," that is, the junctions appeared to be specialized but they were different than classical chemical synapses. The synaptic organization of DA-IPCs in the goldfish IPL appears to be far more complex than previously thought. Although earlier studies have attempted to explain the action of dopamine in terms of interaction only with amacrine cells, the present study shows that effects involving bipolar cells, other DA-IPCs, unidentified processes and cell bodies in the GCL and OFL must be considered as well.