Diagnosis and Treatment of Posteromedial Elbow Impingement in the Throwing Athlete.

PURPOSE OF REVIEW: Posteromedial elbow impingement is a common pathological entity in the throwing athlete. The posteromedial articulation of the elbow is a significant stabilizer to medial elbow forces and valgus stress noted during repetitive throwing. This current review investigates recent literature regarding the relevant anatomy, diagnosis, and treatment of posteromedial impingement in the thrower. RECENT FINDINGS: Improvements in advanced imaging have provided accurate and detailed diagnostic capability for the assessment of the throwers' elbow. After failure of conservative measures, arthroscopic treatment of posteromedial elbow impingement with posteromedial osteophyte removal has demonstrated excellent outcomes with a reliable return to play in the competitive thrower. In addition to a thorough history and physical examination, MRI, MR arthrogram, CT, and dynamic ultrasound imaging modalities are useful in the assessment of a presumed diagnosis of posteromedial impingement. Arthroscopic decompression with posteromedial osteophyte removal provides effective clinical results and return to play. The surgeon should be careful to avoid creating medial ulnar collateral instability by means of over-resection of the posteromedial olecranon.

Complementary Metagenomic Approaches Improve Reconstruction of Microbial Diversity in a Forest Soil.

Soil ecosystems harbor diverse microorganisms and yet remain only partially characterized as neither single-cell sequencing nor whole-community sequencing offers a complete picture of these complex communities. Thus, the genetic and metabolic potential of this "uncultivated majority" remains underexplored. To address these challenges, we applied a pooled-cell-sorting-based mini-metagenomics approach and compared the results to bulk metagenomics. Informatic binning of these data produced 200 mini-metagenome assembled genomes (sorted-MAGs) and 29 bulk metagenome assembled genomes (MAGs). The sorted and bulk MAGs increased the known phylogenetic diversity of soil taxa by 7.2% with respect to the Joint Genome Institute IMG/M database and showed clade-specific sequence recruitment patterns across diverse terrestrial soil metagenomes. Additionally, sorted-MAGs expanded the rare biosphere not captured through MAGs from bulk sequences, exemplified through phylogenetic and functional analyses of members of the phylum Bacteroidetes Analysis of 67 Bacteroidetes sorted-MAGs showed conserved patterns of carbon metabolism across four clades. These results indicate that mini-metagenomics enables genome-resolved investigation of predicted metabolism and demonstrates the utility of combining metagenomics methods to tap into the diversity of heterogeneous microbial assemblages.IMPORTANCE Microbial ecologists have historically used cultivation-based approaches as well as amplicon sequencing and shotgun metagenomics to characterize microbial diversity in soil. However, challenges persist in the study of microbial diversity, including the recalcitrance of the majority of microorganisms to laboratory cultivation and limited sequence assembly from highly complex samples. The uncultivated majority thus remains a reservoir of untapped genetic diversity. To address some of the challenges associated with bulk metagenomics as well as low throughput of single-cell genomics, we applied flow cytometry-enabled mini-metagenomics to capture expanded microbial diversity from forest soil and compare it to soil bulk metagenomics. Our resulting data from this pooled-cell sorting approach combined with bulk metagenomics revealed increased phylogenetic diversity through novel soil taxa and rare biosphere members. In-depth analysis of genomes within the highly represented Bacteroidetes phylum provided insights into conserved and clade-specific patterns of carbon metabolism.

The effect of temperature, farm density and foot-and-mouth disease restrictions on the 2007 UK bluetongue outbreak.

In 2006, bluetongue (BT), a disease of ruminants, was introduced into northern Europe for the first time and more than two thousand farms across five countries were affected. In 2007, BT affected more than 35,000 farms in France and Germany alone. By contrast, the UK outbreak beginning in 2007 was relatively small, with only 135 farms in southeast England affected. We use a model to investigate the effects of three factors on the scale of BT outbreaks in the UK: (1) place of introduction; (2) temperature; and (3) animal movement restrictions. Our results suggest that the UK outbreak could have been much larger had the infection been introduced into the west of England either directly or as a result of the movement of infected animals from southeast England before the first case was detected. The fact that air temperatures in the UK in 2007 were marginally lower than average probably contributed to the UK outbreak being relatively small. Finally, our results indicate that BT movement restrictions are effective at controlling the spread of infection. However, foot-and-mouth disease restrictions in place before the detection and control of BT in 2007 almost certainly helped to limit BT spread prior to its detection.

A network model of E. coli O157 transmission within a typical UK dairy herd: the effect of heterogeneity and clustering on the prevalence of infection.

Cattle are considered to be the main reservoir for Vero cytotoxin-producing Escherichia coli (VTEC) O157, a cause of food-poisoning (and even death) in humans. Here, the transmission of E. coli O157 within a typical UK dairy herd is modelled using a semi-stochastic network model. The model incorporates demographic as well as infection processes. Indirect transmission is modelled homogeneously, while direct transmission is modelled via a dynamic contact network. The aim was to investigate the effects of heterogeneity and clustering on the prevalence of infection within the herd and discover whether, particularly in terms of choosing an intervention strategy, it is necessary to include heterogeneity in direct contacts when modelling this sort of system. Results show that heterogeneity in direct contacts can make it more difficult for the pathogen to persist, particularly when the average number of contacts (per animal) in each group is small. They also show that the relationship between clustering and prevalence is not simple. For example, increasing the average number of contacts can increase clustering and prevalence. However, when the average number of contacts in each group is sufficiently high, higher clustering leads to lower prevalence. It would seem that clustering can aid the flow of infection under certain circumstances, but hinder it under others (probably by preventing wider dissemination). Further results show that indirect transmission (as it is modelled here) effectively removes the effect of heterogeneity in direct contacts. In terms of investigating proposed interventions, the results suggest that a network model would only be required if there was evidence to suggest that direct transmission was the major source of infection.

Methylprednisolone prevention of increased lung vascular permeability following endotoxemia in sheep.

To see whether methylprednisolone would affect the pulmonary vascular response to endotoxemia, we studied responses to endotoxemia in the presence and absence of methylprednisolone in the same chronically instrumented, unanesthetized sheep. Infusion of Escherichia coli endotoxin (0.70-1.33 mug/kg) caused an initial period of marked pulmonary hypertension followed several hours later by a long period of increased vascular permeability when pulmonary vascular pressures were near base line (base-line pulmonary artery pressure (PPa) = 21+/-1 cm H(2)O SE, left atrial pressure (Pla) = 1+/-3; experimental PPa = 20+/-3, Pla = 3+/-4; P = NS), lung lymph flow ( Qlym) was high (base-line Qlym = 7.2+/-0.2 ml/h; experimental Qlym = 23.2+/-1.0; P < 0.05) and lymph/plasma protein concentration (L/P) was high (base-line L/P = 0.65+/-0.04; experimental L/P = 0.79+/-0.05; P < 0.05). When methylprednisolone (1.0 g + 0.5 g/h i.v.) was begun 30 min before the same dose of endotoxin was infused, the initial pulmonary hypertension was less and the late phase increase in lung vascular permeability was prevented (experimental PPa = 24+/-1, Pla = 1+/-1, Qlym = 10.0+/-0.4; L/P = 0.56+/-0.03). Qlym and L/P were significantly (P < 0.05) lower than with endotoxin alone. Methylprednisolone began during the initial pulmonary hypertensive response to endotoxin also prevented the late phase increase in lung vascular permeability, but the drug had no effect once vascular permeability was increased. We conclude that large doses of methylprednisolone given before or soon after endotoxemia prevent the increase in lung vascular permeability that endotoxin causes, but do not reverse the abnormality once it occurs.

Effects of antihistamines on the lung vascular response to histamine in unanesthetized sheep. Diphenhydramine prevention of pulmonary edema and increased permeability.

To see whether antihistamines could prevent and reverse histamine-induced pulmonary edema and increased lung vascular permeability, we compared the effects of a 4-h intravenous infusion of 4 mug/kg per min histamine phosphate on pulmonary hemodynamics, lung lymph flow, lymph and plasma protein content, arterial blood gases, hematocrit, and lung water with the effects of an identical histamine infusion given during an infusion of diphenhydramine or metiamide on the same variables in unanesthetized sheep. Histamine caused lymph flow to increase from 6.0+/-0.5 to 27.0+/-5.5 (SEM) ml/h (P less than 0.05), lymph; plasma globulin concentration ratio to increase from 0.62+/-0.01 to 0.67+/-0.02 (P less than 0.05), left atrial pressure to fall from 1+/-1 to -3+/-1 cm H2O (P less than 0.05), and lung lymph clearance of eight protein fractions ranging from 36 to 96 A molecular radius to increase significantly. Histamine also caused increases in lung water, pulmonary vascular resistance, arterial PCO2, pH, and hematocrit, and decreases in cardiac output and arterial PO2. Diphenhydramine (3 mg/kg before histamine followed by 1.5 mg/kg per h intravenous infusion) completely prevented the histamine effect on hematocrit, lung lymph flow, lymph protein clearance, and lung water content, and reduced histamine effects on arterial blood gases and pH. 6 mg/kg diphenhydramine given at the peak histamine response caused lymph flow and lymph: plasma protein concentration ratios to fall. Metiamide (10 mg/kg per h) did not affect the histamine lymph response. We conclude that diphenhydramine can prevent histamine-induced pulmonary edema and can prevent and reverse increased lung vascular permeability caused by histamine, and that histamine effects on lung vascular permeability are H1 actions.

Pulmonary vascular effects of fat emulsion infusion in unanesthetized sheep. Prevention by indomethacin.

Pulmonary diffusing capacity and arterial blood Po(2) decrease in humans when 10% fat emulsion is infused. To study its effects on the pulmonary circulation and lung fluid balance, we infused 0.25 g/kg x h of a 10% fat emulsion (Intralipid, Cutter Laboratories, Inc., Berkeley, Calif.) into an awake sheep lung lymph preparation. The emulsion caused a sustained increase in pulmonary artery pressure to approximately twice base line with little change in left atrial pressure. Pa(O2) decreased an average 13 torr and lung lymph flow increased two- to threefold. Lymph/plasma total protein concentration fell as lymph flow increased; the magnitude of the lymph/plasma protein decrease was similar to that reported previously when lung vascular pressures were mechanically elevated. Heparin infusion (loading dose = 4,000 U, maintenance dose = 2,000 U/h) cleared the serum of triglycerides but did not alter the response to fat emulsion. Indomethacin infusion (loading dose = 5 mg/kg, maintenance dose = 3 mg/kg x h) blocked the rise in pulmonary artery pressure, the increase in lung lymph flow, and the fall in Pa(O2). Neither extravascular lung water nor [(14)C]urea lung vascular permeability surface area products were altered by fat emulsion infusion. We conclude that fat emulsion infusion in sheep increases lung microvascular filtration by increasing vascular pressures, but has no effect on vascular permeability. Since the effects are blocked by indomethacin, they may be prostaglandin mediated.

Effects of prostaglandin cyclic endoperoxides on the lung circulation of unanesthetized sheep.

Although prostaglandins E(2) and F(2alpha) have been suggested as mediators of the pulmonary hypertension seen after endotoxin infusion or during alveolar hypoxia, their precursors, the endoperoxides (prostaglandins G(2) and H(2)) are much more potent vasoconstrictors in vitro. In this study we compared the effects of prostaglandin (PG)H(2), a stable 9-methylene ether analogue of PGH(2) (PGH(2)-A), PGE(2), and PGF(2alpha) on pulmonary hemodynamics in awake sheep. The animals were prepared to allow for measurement of (a) lung lymph flow; (b) plasma and lymph protein concentration; (c) systemic and pulmonary vascular pressures; and (d) cardiac output. We also determined the effect of prolonged PGH(2)-A infusions on lung fluid balance and vascular permeability by indicator dilution methods, and by assessing the response of lung lymph. Both PGH(2) and PGH(2)-A caused a dose-related increase in pulmonary artery pressure: 0.25 mug/kg x min tripled pulmonary vascular resistance without substantially affecting systemic pressures. Both were 100 times more potent than PGE(2) or PGF(2alpha) in this preparation. PGH(2)-A, as our analysis of lung lymph and indicator dilution measurements show, does not increase the permeability of exchanging vessels in the lung to fluid and protein. It does, however, augment lung fluid transport by increasing hydrostatic pressure in the pulmonary circulation. We conclude: (a) that PGH(2) is likely to be an important mediator of pulmonary vasoconstriction; (b) its effects are probably not a result of its metabolites PGE(2) or PGF(2alpha).

A semi-stochastic model for Salmonella infection in a multi-group herd.

A multi-group semi-stochastic model is formulated to identify possible causes of why different strains of Salmonella develop so much variation in their infection dynamics in UK dairy herds. The model includes demography (managed populations) and various types of transmission: direct, pseudovertical and indirect (via free-living infectious units in the environment). The effects of herd size and epidemiological parameters on mean prevalence of infection and mean time until fade out are investigated. Numerical simulation shows that higher pathogen-induced mortality, shorter infectious period, more persistent immune response and more rapid removal of faeces result in a lower mean prevalence of infection, a shorter mean time until fade out, and a greater probability of fade out of infection within 600 days. Combining these results and those for the deterministic counterpart could explain differences in observed epidemiological patterns and help to identify the factors inducing the decline in reported cases of epidemic strains such as DT104 in cattle. We further investigate the effect of group structure on the probability of a major outbreak by using the stochastic threshold theory in homogeneous populations and that in heterogeneous populations. Numerical studies suggest that group structure makes major outbreaks less likely than would be the case in a homogeneous population with the same basic reproduction number. Moreover, some control strategies are suggested by investigating the effect of epidemiological parameters on the probability of an epidemic.

Function of galanin in the anterior pituitary of estrogen-treated Fischer 344 rats: autocrine and paracrine regulation of prolactin secretion.

Estrogen is a robust stimulator of galanin synthesis and secretion in the anterior pituitary. Galanin is colocalized in lactotrophs in the estrogen-treated anterior pituitary, and its roles in lactotroph function are still being elucidated. In the present studies, we quantified the phenotypes of estrogen-treated Fischer 344 rat anterior pituitary cells expressing the galanin gene by dual in situ hybridization. The total population of galanin-positive pituitary cells increased from undetectable levels to 16% of all cells after 2 weeks of estrogen treatment. More than 90% of the galanin-positive cells coexpressed PRL messenger RNA, and one-third of the lactotrophs expressed galanin messenger RNA. We hypothesized that galanin in the anterior pituitary may contribute to the heterogeneous secretion of PRL, and that one of the functions of galanin is to regulate PRL secretion in an autocrine/paracrine manner. To test this hypothesis, we performed the reverse hemolytic plaque assay combined with in situ hybridization to measure PRL secretion and galanin gene expression within the same individual cells. PRL secretion from galanin-positive lactotrophs was significantly greater than that from galanin-negative lactotrophs. Moreover, treatment with galanin antiserum significantly attenuated PRL secretion from galanin-positive cells, and treatment with galanin significantly enhanced PRL secretion from galanin-negative lactotrophs. In conclusion, these data provide direct evidence that galanin derived from the estrogen-treated anterior pituitary stimulates PRL secretion in both autocrine and paracrine manners.

Brainstem melanocortin 3/4 receptor stimulation increases uncoupling protein gene expression in brown fat.

Central administration of melanocortin 3 and 4 receptor (MC3/4-R) agonists increases energy expenditure, with the hypothalamus commonly held as the primary site of action. It is also clear, however, that MC4-R are expressed in caudal brainstem structures of relevance to the control of energy expenditure. Three experiments investigated whether hindbrain MC-R contribute to the energy expenditure effects of central MC3/4-R agonist treatments; in each, we examined the effect of fourth intracerebroventricular (i.c.v.) administration of a MC3/4-R agonist, MTII (three injections, each separated by 12 h), on uncoupling protein 1 (UCP-1) gene expression in brown adipose tissue (BAT). First, we compared the effects of fourth and third i.c.v. administration of MTII and found that the hindbrain and forebrain treatments were equally effective at elevating UCP-1 mRNA expression in BAT compared with the respective vehicle-treated group results. A second experiment demonstrated that the fourth i.c.v. MTII-induced rise in UCP-1 expression was mediated by sympathetic outflow to BAT by showing that this response was abolished by surgical denervation of BAT. In the third experiment, we showed that chronic decerebrate rats, like their neurologically intact controls, elevated UCP-1 mRNA expression in response to fourth i.c.v. MTII administration. Taken together, the results indicate that: 1) there is an independent caudal brainstem MC3/4-R trigger for a sympathetically stimulated elevation in BAT UCP-1 gene expression, and 2) the MTII-induced rise in UCP-1 expression can be mediated by circuitry intrinsic to the caudal brainstem and spinal cord.

Neurotoxicity in conscious rats following intraventricular SNAP, a nitric oxide donor.

A solution containing S-nitroso-N-acetylpenicillamine (SNAP), a nitric oxide (NO.-releasing compound, was microinjected in doses of 0.25-2 mumol into a lateral ventricle of conscious rats. SNAP produced dose-dependent convulsions similar to those associated with limbic stimulation, such as tonic extension of the hindlimbs and tail, and dystonia of the forepaws. At 2 mumol, SNAP evoked hyperventilation (arterial hypocapnia), arterial hyperglycemia and caused necrotic lesions of periventricular gray (e.g. lateral septal nucleus) and white matter structures. In the caudate nucleus and lateral septal nucleus ipsilateral to injection, SNAP elicited a bipolar metabolic pattern of low glucose metabolism proximal to the ventricle with higher values occurring more distally. In control studies, we proved that the residue of SNAP decomposition, N-acetylpenicillamine disulfide injected intraventricularly (2 mumol), was without physiological, behavioral, or histological effects. Ventricular pretreatment with methylene blue (2 nmol), a putative inhibitor of guanylate cyclase and superoxide generator, suppressed several of the behavioral manifestations of 1 mumol SNAP, such as the forepaw dystonia, squinting, and facial clonus, but was ineffective on the physiological and histological variables affected by the 2 mumol SNAP dose. Another NO. donor, sodium nitroprusside (2 mumol), produced fewer behavioral and cytotoxic effects over a 55-min observation period, but caused more intense and widely distributed metabolic stimulation, especially in commissural and projection white matter tracts. The results are the basis for a conscious rat model using intraventricular injection of nitrocompounds to examine the physiological, behavioral, metabolic and cytotoxic properties of NO. in the brain.

The basic depression ratio of the host: the evolution of host resistance to microparasites.

The basic reproduction ratio R0 occupies a central position in the theory of host pathogen interactions. However, this quantity stresses the role of the pathogen. This paper proposes an additional, more host-centred char acterization using the basic depression ratio D0. This quantity is the number of host individuals per infected by which the infected host population is depressed below its uninfected level. This paper shows that a baseline criterion for the evolution of host resistance to microparasites is that resistance evolves to minimize D0. This parallels the result for pathogen virulence where R0 is maximized. The tension between these two criteria is noted. The framework established allows a discussion of trade-offs between aspects of the pathogen-free host biology and the host pathogen interaction. For certain linear and convex trade-offs it is shown that the strain with the lowest transmission parameter beta wins (despite the fact that it has the lowest intrinsic birth rate a). For corresponding concave trade-offs, either the strain with minimum beta and a or the strain with maximum beta and a wins. Finally the connection with the techniques of adaptive dynamics is made. Evolutionary singular points are shown to occur at extrema of D0. The evolutionary attainment of the results is discussed.

Host-pathogen systems in a spatially patchy environment.

A discrete model for a host-pathogen system is developed and is used to represent the dynamics in each patch within a landscape of n x n patches. These patches are linked by between-generation dispersal to neighbouring patches. Important results (compared to similar 'coupled map lattice' studies) include an increase in the likelihood of metapopulation extinction if the natural loss of pathogen particles is low, and the observation of a radial wave pattern (not previously reported) where the wavefront propagates uniformly from a central focus. This result has additional significance in that it permits the system to exhibit 'intermittency' between two quasi-stable spatial patterns: spirals and radial waves. With intermittent behaviour, the dynamics may look consistent when viewed at one time scale, but over a longer time scale they can alter dramatically and repeatedly between the two patterns. There is also evidence of clear links between spatial structure and temporal metapopulation behaviour in both the intermittent and 'pure' regions, verified by results from an algorithmic complexity measure and a spectral analysis of the temporal dynamics.

Life-history trade-offs and the evolution of pathogen resistance: competition between host strains.

The dynamics of a 'resistant' and a 'susceptible' strain of a self-regulated host species, in the presence of a directly transmitted pathogen, is investigated. The two strains trade off differences in pathogen transmissibility (as an aspect of pathogen resistance) against differences in birth rate and/or resistance to crowding. Depending on parameter values, either strain may be eliminated, or the two may coexist (along with the pathogen). Coexistence (polymorphism), unsurprisingly, requires an appropriate balance between the different advantages possessed by the two strains. The probability of coexistence through such a balance, however, varies nonlinearly with the degree of difference between the strains: coexistence is least likely between two very similar strains. Resistance is most likely to evolve in hosts with the characteristics of many insect pests. Moreover, with highly pathogenic pathogens, a 'susceptible' strain may exclude a 'resistant' strain because its higher growth rate is more effective against the pathogen than reduced transmissibility. 'Resistance' can reside in parameters other than those directly associated with the pathogen. Although no cycles arise and no chaotic behaviour is found, an oscillatory approach to equilibrium is commonly observed, signalling the possibility of observable oscillations in strain frequency in the (more variable) real world.

Kinetics of HIV-1 replication and intracellular accumulation of particles in HTLV-I-transformed cells.

The replication kinetics of HIV were examined in HTLV-I-transformed MT-2 cells. The duration of the initial replication cycle was 20 hours, determined by the first detection of infectious progeny virus, development of syncytia, and production of viral RNA and protein. A phase of exponential virus production followed until 62 h postinfection. Cell death occurred in the final phase of infection during which infectious virus production remained constant even though viral RNA and protein production increased at an exponential rate. Accumulations of HIV particles were observed within cytoplasmic vacuoles of infected MT-2 cells. Although cell lysates contained high titers of infectious virus, our data show that an increasing proportion of particles produced late in infection were not infectious.

The location of middle mediastinal pheochromocytomas.

Eight middle mediastinal pheochromocytomas were located by means of 131I- meta- iodobenzylguanidine scintigraphy. The exact anatomic location of the lesions was confirmed by means of dynamic computed tomographic scanning following bolus injection of contrast medium. In all but one case the lesion had not been detected prior to scintigraphy despite extensive investigations including arteriography, venography with sampling, computed tomography with infusion of contrast medium, and in some cases surgical exploration of the abdomen and chest. Accurate anatomic location of the lesion permitted resection of five lesions from the cardiac atria and one from the aortopulmonary window. A sixth case in which an atrial pheochromocytoma was found by coronary angiography was not cured by resection of the primary tumor, and 131I- meta- iodobenzylguanidine scintigraphy revealed extensive metastases. Thus 131I- meta- iodobenzylguanidine scintigraphy has been of considerable value in the location of pheochromocytomas of the middle mediastinum, which may be a more frequent site than previously recognized.

Studies of the ocular compatibility of hydrogels. A review of the clinical manifestations of spoilation.

The range and nature of the various clinical manifestations of hydrogel contact lens spoilations are considered. An indication of the present view of the occurrence, chemical composition and potential aetiology for discrete elevated deposits, organic and inorganic surface films, plaques and granular deposits, microbial spoilation, lens discoloration and other extrinsic factors is provided. The literature is principally concerned with the clinical manifestations of spoilation and most observations have been made on lenses that have become so severely spoiled as to be unwearable. No serious attempt has yet been made to identify those tear species responsible for the development of the various types of deposits or of the effects of variations in the bulk and lens chemistry, and also wear protocols on the formation of deposits.

Studies of the ocular compatibility of hydrogels. White spot deposits--incidence of occurrence, location and gross morphology.

Light and scanning electron microscopical techniques have been employed to determine the morphology, geographical location and incidence of occurrence of discrete elevated deposits on a variety of commercial lenses of differing bulk and surface chemistries and also wear protocols. Spoilt lenses were derived from controlled lens wear trials and additional clinical sources. This type of elevated deposit displays a complex morphology and is composed of three distinctive yet interactive sub-layers. It is apparent that alterations in lens surface properties, wear protocol, and application of the device are not significant in determining deposit morphology. The rate of deposit formation is however, a function of the lens chemistry, wear protocol and the individual patient. These findings promote the belief that some common biological interface conversion event, or events, occur which reduce the biocompatibility of these materials with their ocular environment.

Studies of the ocular compatibility of hydrogels. White spot deposits--chemical composition and geological arrangement of components.

Light, SEM and histochemical techniques were used to determine the architecture and composition of elevated deposits on a variety of commercial lenses of differing bulk and surface chemistries and wear protocols. Spoilt lenses were derived from controlled lens wear trials and additional clinical sources. Elevated deposits display a complex multilayered structure, unaffected by variations in wear protocol or bulk and surface chemistries. These deposits are predominantly composed of tear-derived lipids laid down in a well-defined fashion. The primary layer is composed of unsaturated lipids, whilst the secondary and tertiary layers are dominated by cholesterol and cholesterol esters. The composition and location of deposit components is unaffected by variations in, wear protocol, chemistry of the lens matrix, or tear composition of lens wearers. These findings suggest that unsaturated lipids are responsible for the biological interfacial conversion of hydrogel lenses, reducing their compatibility with the ocular environment.