Noninvasive saliva collection for DNA analyses from free-ranging Tibetan macaques (Macaca thibetana).

Cryptic and endangered fauna, including many primate taxa, pose challenges for noninvasive collection of biomaterials. As a result, application of noninvasive genotyping to primates has been limited to the use of samples such as feces and hair for the extraction of PCR-amplifiable DNA. We present a method for noninvasive collection of saliva from habituated, free-ranging monkeys. The method utilizes a low-cost apparatus that controls for contamination and is usable with individual, free-ranging primates. Saliva samples were collected from 18 individuals in a population of Tibetan macaques (Macaca thibetana) in the Valley of Wild Monkeys in Huangshan, People's Republic of China. DNA was extracted from these samples and PCR-amplified for both mitochondrial and nuclear genes, Cytochrome B and MHC-DR Beta 1, respectively. These results indicate this is an effective technique for the noninvasive collection of saliva across age and sex class, and dominance rank in a free-ranging, terrestrial primate species. This device could have wide application for obtaining high-quality saliva samples from free-ranging primate populations for use in epidemiological studies, hormonal analyses of HPA axis function, pathogen screening, noninvasive genotyping, and behavioral genetics.

Social connectivity among female Tibetan macaques (Macaca thibetana) increases the speed of collective movements.

Social network analysis provides insights into patterns of group movements in primates, but fewer studies to date have focused on the dynamics of how such movements occur. In this study, we proposed and tested two hypotheses about the influence of sex on social connectivity and group movement in Tibetan macaques (Macaca thibetana): (1) adult females are socially more connected than are adult males and (2) social connectivity facilitates the speed of collective decision-making. We collected data from 128 successful collective movements (≥ 2 individuals followed an initiator within 5 min) over a 2-month period in a group of adult Tibetan macaques at Mt. Huangshan, China. Although high-ranking individuals of both sexes in our dataset were more central in their social network than were low-ranking individuals, our results show that affiliations between females were stronger, with more preferred associations than those between males. Groups with more females reached collective decisions faster than groups with fewer females. We conclude that female Tibetan macaques use their social networks to enhance the speed of collective decision-making, which may have associated fitness benefits.

Marked variation between winter and spring gut microbiota in free-ranging Tibetan Macaques (Macaca thibetana).

Variation in the availability and distribution of food resources is a strong selective pressure on wild primates. We explored variation in Tibetan macaque gut microbiota composition during winter and spring seasons. Our results showed that gut microbial composition and diversity varied by season. In winter, the genus Succinivibrio, which promotes the digestion of cellulose and hemicellulose, was significantly increased. In spring, the abundance of the genus Prevotella, which is associated with digestion of carbohydrates and simple sugars, was significantly increased. PICRUSt analysis revealed that the predicted metagenomes related to the glycan biosynthesis and metabolic pathway was significantly increased in winter samples, which would aid in the digestion of glycan extracted from cellulose and hemicellulose. The predicted metagenomes related to carbohydrate and energy metabolic pathways were significantly increased in spring samples, which could facilitate a monkey's recovery from acute energy loss experienced during winter. We propose that shifts in the composition and function of the gut microbiota provide a buffer against seasonal fluctuations in energy and nutrient intake, thus enabling these primates to adapt to variations in food supply and quality.

Aicardi syndrome in one dizygotic twin.

The Aicardi syndrome consists of infantile spasms, defects of the corpus callosum, dorsal vertebral anomalies, and chorioretinal lacunar defects. The etiology is, as yet, unknown. The most likely cause, however, is an X-linked mutational event that is lethal in males. The first case of the Aicardi syndrome known to occur in one twin is reported. The patient was female and her unaffected sibling was male. This provides strong evidence to support the theory of an X-linked mutational event as the cause of this condition. The typical chorioretinal defects, often difficult to document because these children die at an early age, are clearly illustrated in this report.

Developmental aspects in the assessment of visual function in young children.

The developmental aspects in the assessment of visual acuity in the preverbal child have been reviewed. Several investigative techniques indicate that visual acuity of infants increases significantly between birth and age 6 months. Transient oculomotor deviation in infancy must be differentiated from pathologic ocular conditions. Changes in refraction of the developing eye that occur normally and as a result of an ocular disorder must be recognized and managed early in the infant's life.

The sit-up test: an alternate clinical test for evaluating pediatric torticollis.

The sit-up test, a new evaluation method for differentiating between ocular and orthopaedic torticollis, was evaluated against the monocular occlusion test, using results of three-step testing for standardization. The study group consisted of 31 patients with torticollis between the ages of 4 and 12.5 years. Subjects were selected based only on their ability to cooperate with three-step testing. Three-step testing identified 27 of the 31 patients as having ocular torticollis, with the remaining 4 having an orthopaedic etiology. Sit-up testing correctly identified all 27 ocular torticollis patients, with no false positives or false negatives. Monocular occlusion testing detected at best 22 (81.4%) of the ocular torticollis patients, with no false positives.

Activation of thromboxane A2 receptors alters lipopolysaccharide-induced adherence of THP-1 cells.

U46619, a thromboxane A2 (TXA2) mimetic, inhibits human monocyte chemotactic responses, suggesting that TXA2, an arachidonic acid metabolite, may alter monocyte adhesion. We tested the hypothesis that TXA2 alters Lipopolysaccharide (LPS)-induced adhesion of THP-1 cells, a human monocytic leukemia cell line. Salmonella enteritidis endotoxin (1 microgram/mL) induced a significant (p < .05; n = 6) increase in the adherence of THP-1 cells (basal, 5.7 +/- 1.8 micrograms/well; LPS, 78.8 +/- 4.9 micrograms/well). Treatment of THP-1 cells with indomethacin or TXA2 receptor antagonists before LPS stimulation significantly (p < .05) enhanced adhesion, suggesting that endogenously produced TXA2 or prostaglandins alter LPS-induced THP-1 cell adhesion. TXA2 mimetics significantly decreased (p < .05; n = 5 and n = 3, respectively) LPS-induced THP-1 cell adhesion. This effect was blocked by three structurally dissimilar TXA2 receptor antagonists. These results support the hypothesis that TXA2 alters LPS-induced adhesion of THP-1 cells.

Spasmus nutans. A benign clinical entity?

Spasmus nutans occurs in early childhood and consists of a triad of symptoms as follows: small-amplitude, rapid, horizontal nystagmus in one or both eyes asymmetrically; head nodding; and anomalous head position. Once thought to be a benign clinical entity, there are an increasing number of reports linking spasmus nutans to optic nerve and chiasmal gliomas. We describe 14 patients with spasmus nutans, none of whom were found to have a tumor with computed tomographic scanning. One patient, however, had an arachnoid cyst and an empty sella and another patient had a porencephalic cyst. The diagnosis of spasmus nutans, its implications, and its management are discussed.

High hyperopia in Leber's congenital amaurosis.

Few studies comment on the type of refractive errors found in patients with Leber's congenital amaurosis. The association of an uncomplicated infantile form of this condition with high hyperopia but without systemic complications has been suggested. In a retrospective study, we identified 11 patients who satisfied the criteria for the diagnosis of this subtype of Leber's congenital amaurosis. All of our cases were found to have at least +6.00 diopters of hyperopia on cycloplegic refraction. No systemic abnormalities were found in any of these children. We suggest that high hyperopia be included in the diagnostic criteria of this specific form of Leber's congenital amaurosis.

Ocular torticollis.

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Abnormal head position for ocular reasons is usually assumed in order to maintain binocularity and/or to optimize visual acuity. A variety of conditions may be responsible. The sensory organ of position sense, the labyrinth, lies within the inner ear and it relates to eye movement in both a dynamic and static fashion. The Bielschowsky head tilt test is based on the functioning of the otolithic apparatus and is the primary test in evaluating abnormal head position. Treatment is usually surgical, with extent and location dependent upon on the underlying cause. While corrective surgery has usually been done on an elective basis for cosmetic purposes, there is evidence that uncorrected torticollis can cause musculoskeletal problems. This review describes the physiological bases for ocular torticollis and the diagnosis and treatment of its various underlying causes.

Duane's retraction syndrome.

Duane's retraction syndrome (DRS) has been a recognized clinical entity for nearly a century. It is a clinically well described ocular disorder consisting of retraction of the globe with narrowing of the lid fissure in attempted adduction, frequent abduction deficiency with variable limitation to adduction, and upshoot and/or downshoot of the affected eye on adduction. Among strabismus patients the incidence of DRS is probably not more than 5%. Most cases are sporadic, but familial cases have been estimated at 10% by most authors. Numerous theories concerning the etiology and pathogenesis of DRS have been proposed, including agenesis of the abducens nucleus, but the majority of investigators concur that the characteristic findings are best explained by a paradoxical innervation of the lateral rectus muscle, which subsequently causes a cocontraction of the horizontal rectus muscles. The frequent association of DRS with other congenital anomalies suggests a teratogenic event occurring between the fourth to eighth week of gestation as an etiological factor. In this review historical aspects and theories of the syndrome are studied and statistical data are compiled and analyzed. Clinical features, differential diagnoses and variants of the syndrome are examined. Testing and treatment objectives are discussed.

Congenital esotropia.

Congenital esotropia represents the most common type of strabismus. Its pathogenesis, however, remains uncertain. It is typically characterized as a large angle, constant esotropia with onset during the first six months of life. Associated clinical findings include normal refractive errors for age, amblyopia, dissociated vertical deviation, inferior oblique muscle overaction and nystagmus. It must be distinguished from Duane's retraction syndrome, Moebius syndrome, nystagmus blockage syndrome, and early onset accommodative esotropia, as well as other causes of esotropia in infancy. The surgical management may involve recession of both medial recti muscles, unilateral recession of a medial rectus muscle and a resection of a lateral rectus muscle or three or four muscle surgery.

Results of a survey of children with acute bacterial conjunctivitis treated with trimethoprim-polymyxin B ophthalmic solution.

Acute conjunctivitis, one of the most frequently seen eye diseases in infants and children, is associated with a shorter duration of clinical disease when antimicrobial agents are used. Although viruses often are implicated as causative agents, Haemophilus influenzae and Streptococcus pneumoniae are the most commonly isolated bacterial pathogens. Empiric therapy of acute conjunctivitis therefore should include agents with both gram-positive and gram-negative antimicrobial activity. Trimethoprim-polymyxin B is a broad-spectrum antimicrobial agent available as an ophthalmic solution. We conducted a patient outcomes study to evaluate the subjective response to treatment with trimethoprim-polymyxin B of children with presumed acute bacterial conjunctivitis. Questionnaires were distributed to more than 100 pediatricians who assessed outcome measures in 472 children with acute bacterial conjunctivitis for whom they prescribed trimethoprim-polymyxin B. The parameters evaluated were clinical outcome, overall efficacy, and comfort provided by the medication regimen. The physicians reported that 95% of the infected eyes were cured or improved within 7 days. In addition, the overall efficacy trimethoprim-polymyxin B was rated as excellent or good in 76% and 20% of cases, respectively. With regard to patient comfort, patients or their caregivers reported that patients were very comfortable or moderately comfortable in 62% and 27% of cases, respectively. Four adverse events were reported; all were transient and of mild-to-moderate intensity. The survey results support clinical research findings on the comparative efficacy and safety of trimethoprim-polymyxin B ophthalmic solution compared with other ophthalmic antimicrobial agents. The pediatricians in our survey who prescribed trimethoprim-polymyxin B ophthalmic solution for children with presumed acute bacterial conjunctivitis reported that this medication was effective and well tolerated.

Glaucoma in children.

Glaucoma in children is a relatively rare but frequently debilitating disorder. Pediatricians must be aware of the association of glaucoma with certain systemic diseases and congenital ocular abnormalities. Recognition of the signs of infantile glaucoma allows the physician to refer patients for definitive care. Timely therapy is critical to the successful management of children affected with glaucoma.

Allergic and immunologic pediatric disorders of the eye.

Numerous allergic and immunologic disorders occur in the eyes and frequently present to nonophthalmologists. This article presents a review of ocular immunology, as well as the specific ocular and systemic disorders that are frequently seen. Also included is a discussion of some of the more common ocular disorders in the differential diagnosis of conjunctival inflammation. The treatment of these disorders is presented.

Anterior segment ischemia and retinal detachment after vertical rectus muscle surgery.

PURPOSE: The authors describe the clinical course of a woman who developed two complications following vertical strabismus repair: anterior segment ischemia (ASI) and retinal detachment. METHODS: A 62 year-old woman is described. She presented with new onset proptosis and left hypertropia with significant diplopia in all fields of gaze. This presentation, her 15 year history of thyroid disease, and preoperative computed tomography (CT) of the orbits were consistent with Graves' ophthalmopathy. Vertical strabismus repair was carried out by recessing the left superior rectus muscle and resecting the left inferior rectus muscle. RESULTS: The diplopia was eliminated. The patient developed significant postoperative ASI and iatrogenic rhegmatogenous retinal detachment in the left eye due to unsuspected globe perforation. She was treated with systemic corticosteroids and radial scleral buckling. CONCLUSIONS: Severe ASI following strabismus surgery is a well recognized complication, with age, thyroid ophthalmopathy, and manipulation of the vertical rectus muscles as risk factors. The retinal detachment soon after strabismus surgery was difficult to detect, possibly due to diminished visualization of the posterior segment as a result of ASI.

Down syndrome. Clinical review of ocular features.

A total of 187 medical records of Down syndrome individuals over a 10-year period were reviewed retrospectively for strabismus, myopia, hyperopia, astigmatism, nystagmus, cataract, glaucoma, and other significant eye findings. This study showed that a higher proportion of these individuals than reported in previous studies had strabismus (57%). Refractive errors of myopia (22.5%), hyperopia (20.9%) and astigmatism (22%) were common. The primary care physician needs to be aware of the specific eye problems of Down syndrome individuals so that he or she may initiate or refer the patient for appropriate ophthalmologic care, because most of the eye findings in Down syndrome are treatable. Significant visual loss, a usually avoidable event in Down syndrome, should occur rarely.

Long-term results: botulinum for sixth nerve palsy.

Eight patients with intracranial malignancies or vascular lesions and sixth nerve palsies were treated with botulinum toxin chemodenervation of the antagonist medial rectus muscle. Primary deviation ranged from 20 to 75 prism diopters (pd) of esotropia. Six were treated acutely (within 3 months of onset) and two, which demonstrated partial recovery of lateral rectus function but with residual esotropia and diplopia, were treated after 6 months. After a mean follow-up of 20.6 months, seven were diplopia-free with excellent rotations. Five had complete resolution of the esotropia and diplopia, with near complete recovery of abduction. One had 6 pd residual esotropia, while another, whose sixth nerve had been resected, required a modified Jensen procedure, resulting in full rotations. The single case of bilateral sixth nerve palsy had a functional improvement but was lost to follow-up. One patient had a vertical strabismus induced with the injection and had a gradual return of the esotropia.

The impact of blood glucose monitoring on depression and distress in insulin-naïve patients with type 2 diabetes.

OBJECTIVE: To test whether a structured self-monitoring of blood glucose (SMBG) protocol reduces depressive symptoms and diabetes distress. RESEARCH DESIGN AND METHODS: A 12-month, cluster-randomised, clinical trial compared patients who received a collaborative, structured SMBG, physician/patient intervention with an active control. Studied were 483 insulin naïve type 2 diabetes patients (experimental = 256, control = 227) (≥ 7.5% HbA1c) from 34 primary care practices (experimental = 21, control = 13). Experimental patients used a paper tool to record a 7-point SMBG profile on each of three consecutive days prior to their quarterly physician visit. Patients and physicians interpreted SMBG results to make medication and lifestyle changes. CLINICAL TRIAL REGISTRATION: NIH Trial Registry Number: NCT00674986. MAIN OUTCOME MEASURES: Depressive symptoms (Patient Health Questionnaire: PHQ-8), diabetes-related distress (Diabetes Distress Scale: DDS). HbA1c and SMBG frequency were assessed quarterly; data were analysed using Linear Mixed Models (LMM) for intent-to-treat (ITT) and per protocol (PP) analyses. RESULTS: ITT analyses showed significant improvement in depression and disease-related distress among experimental and control patients from baseline to 12 months (p < 0.01 in both cases) with no between-group differences. Experimental patients displayed significantly greater reductions in distress related to regimen adherence than controls. Also, experimental patients with elevated diabetes distress or depressive symptoms at baseline showed significantly greater reductions in distress and depressive symptoms than control patients at 12 months. The greater improvement in mood in the experimental than control group was independent of improvements in glycaemic control and changes in SMBG frequency. CONCLUSIONS: Using well standardised measures, collaborative, structured SMBG leads to reductions, not increases, in depressive symptoms and diabetes distress over time, for the large number of moderately depressed or distressed type 2 patients in poor glycaemic control. Changes in affective status are independent of improvements in glycaemic control and changes in SMBG frequency for these patients.