bluuebunny/crossref_metadata_2025 huggingface dataset:
Family‐based studies indicate association of Engrailed 2 gene with autism in an Indian population
Authors: Sen B. , Surindro Singh A. , Sinha S. , Chatterjee A. , Ahmed S. , Ghosh S. , Usha R.
Published: November 2009

Engrailed 2 (EN2) is a homeobox transcription factor involved in the patterning of cerebellum during brain development. Linkage analysis and studies on knockout mice support EN2, located on chromosome 7q36.3, as a potential risk locus for autism. Candidate gene approach also suggested association of EN2 with autism spectrum disorder (ASD) in various populations. Here, we have investigated the association of five markers [rs3735653 (C/T) in exon 1; rs34808376 (GC/‐) and rs6150410 (CGCATCCCC/‐) in promoter region; rs1861972 (A/G) and rs1861973 (C/T) in the intron] of the gene with autism and ASD in Indian population using family‐based approach. Probands have been recruited using Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM‐IV) diagnostic criteria. Genotypic distributions conform to Hardy–Weinberg equilibrium. Genotyping analysis showed that the intronic single nucleotide polymorphisms (SNPs) are in complete linkage disequilibrium showing A‐C and corresponding G‐T allelic association. We observed significant preferential transmission of C allele of rs1861973 from the parents to affected offspring [transmission disequilibrium test (TDT): narrow diagnosis likelihood ratio statistics (LRS) = 6.63, P = 0.006; broad diagnosis LRS = 4.47, P = 0.05]. Interestingly, gender‐based investigations showed significant transmission of C allele to the affected females [TDT: LRS = 7.36, P = 0.0025; haplotype‐based haplotype relative risk (HHRR): LRS = 7.16, P = 0.02]. A maternal overtransmission for these alleles was also noted (TDT: LRS = 3.65, P = 0.036; HHRR: LRS = 2.81, P = 0.036). Bioinformatic analysis using TFSearch showed generation of Sp1 binding site in the presence of C allele. While Del‐T haplotype formed from rs34808376‐rs1861973 markers showed increased non‐transmission, the Ins‐C showed significant transmission suggesting protective effect and risk, respectively, conferred by these haplotypes in autism etiology. These results suggest positive genetic correlation of EN2 with autism in the Indian population.
Spatial analysis of oblique photo‐point images for quantifying spatio‐temporal changes in plant communities
Authors: Michel P. , Mathieu R. , Mark A.F.
Published: November 2009

Question: Can spatial analytical techniques be used to extract quantitative measurements of vegetation communities from ground‐based permanent photo‐point images?

Location: Mount Aspiring National Park, south‐western South Island, New Zealand.

Methods: Sets of ground‐based photographs representing two contrasting vegetation types were selected to test two spatial analytical techniques. In the grid technique, a grid was superimposed onto the photographs and the frequency of species presence in each grid‐square was calculated to estimate species abundance/cover over the defined area. In the object‐oriented technique, the photographs were segmented into meaningful objects, based on the colour of the pixels and the textural patterns of the images, and the area occupied by an object in the image was used to derive species abundance/cover over the area.

Results: Both techniques allow quick and easy classification of digital elements into ecologically relevant categories of vegetation components. The grid technique appeared more robust, being quick and efficient, accommodating all image types and providing presence/absence matrices for multivariate analysis. Fewer classes were identified using the object‐oriented technique, in particular for the forest interior site and for small individual plants such as Astelia spp.

Conclusions: Both techniques showed potential for the objective quantitative analysis of long‐term vegetation monitoring of cover and changes of several component species, using repeat ground‐based photographs more specifically for grassland habitats. However, both rely to various degrees on manual classification. Corrective factors and strict protocols for taking the photographs are necessary to account for variation in view angles and to compute values more representative of absolute species abundance.
The 10 mL syringe is useful in generating the recommended standard of 40 mmHg intrathoracic pressure for the Valsalva manoeuvre
Authors: Smith Gavin , Boyle Malcolm J
Published: November 2009

Objective:  The Valsalva manoeuvre (VM) continues to be first‐line management for haemodynamically stable supraventricular tachycardia in the acute setting. 40 mmHg of intrathoracic pressure is seen as an essential component of the VM. Anecdotally, blowing into a 10 mL syringe to move the plunger is one method of pressure generation; however, to date its effectiveness has not been tested. The objective of the present study was to assess if blowing into a syringe sufficient to move the plunger could produce the required 40 mmHg of pressure.

Methods:  A two‐part experimental study tested the pressure required to move the plunger, and sustain that movement for 15 s, in a Terumo syringe. Part one tested a range of syringe sizes. Part two, a repeated measures study, tested the syringe to ascertain if a pressure reduction occurred after repeated use. A sphygmomanometer was attached to the syringe via a 10 cm length of tubing with another length of tubing attached to the sphygmomanometer enabling an investigator to blow into the syringe.

Results:  In part one, the 10 mL syringe was the only size noted to provide the required 40 mmHg pressure to move the plunger. In part two, the mean for each of the three tests per syringe varied between 37.0 mmHg (95% CI 34.2–39.8) and 40.2 mmHg (95% CI 37.5–43.0). There was no statistically significant fall noted over three uses of the same syringe.

Conclusion:  The present study has demonstrated that blowing into a 10 mL Terumo syringe, to move the plunger, generated 40 mmHg intrathoracic pressure, thereby meeting the recommended intrathoracic pressure for optimum VM performance.
Current level of training, experience and perceptions of emergency physicians as expert witnesses: A pilot study
Authors: Cunningham Nicola Y , Weiland Tracey J
Published: November 2009

The objective of the present study was to determine emergency physicians' training, experience and perceptions as expert witnesses. Emergency physicians of an adult tertiary referral and teaching hospital participated in a pilot survey regarding their experiences in report writing and in court as expert witnesses. The 28‐item survey also examined the amount of formalized forensic medical teaching that emergency physicians had received during their training. Of the participants, 41% (95% CI 21.6–64.1; 7/17) had never received any undergraduate or postgraduate training in forensic medicine, 11/17 (65%, 95% CI 41.2–82.8) had provided a written expert opinion for court, and 12/17 (71%, 95% CI 46.6–87.0) had attended court as an expert witness. All participants considered themselves ‘skilled in attending an emergency resuscitation’, whereas 3/13 (23%, 95% CI 7.5–50.9) considered themselves ‘skilled in attending a courtroom trial’. Nearly 90% (95% CI 64.7–98.0; 15/17) thought that medical evidence training should be a requirement of emergency speciality training. The most commonly preferred forms of medical evidence training were mock court sessions (76%, 95% CI 52.2–91.0; 13/17) and forensic workshops (76%, 95% CI 52.2–91.0; 13/17). From 10 non‐technical skills required of an EP, ‘appearing in court as an expert witness’ was perceived to be the second most difficult skill by most respondents. Emergency physicians in this pilot study have limited training for the role of expert witness and see it as one of the most difficult non‐technical skills they have to perform. Further research is required regarding the current and future scope of forensic training.
Emergency physicians as expert witnesses: ‘From frontline wise to courtroom woes’
Authors: Cunningham Nicola Y
Published: November 2009

A ‘Medical Expert’ witness is one who has been accepted by the court as having special knowledge of the subject about which they are testifying and as a result is allowed to give evidence of their medical opinion. In contrast, ordinary witnesses can only give evidence regarding facts that they have observed. Emergency medicine is one of a few speciality areas of medicine more likely to be involved in legal proceedings. Preparing the emergency physician to be an expert witness is an invaluable part of their training. Education in this area should concentrate on the purpose of the evidence, the legal framework in which it is delivered and the specific skill requirements of medical expert witnesses.
Short‐term risk of adverse outcome is significantly higher in patients returning an abnormal troponin result when tested in the emergency department
Authors: Flindell Jade A , Finn Judith C , Gibson Nicholas P , Jacobs Ian G
Published: November 2009

Objective:  Describe short‐term mortality and hospitalization outcomes in patients undergoing troponin testing in Western Australia tertiary public hospital ED.

Methods:  Retrospective cohort study of adults presenting to urban tertiary ED between July 2000 and December 2004, and undergoing troponin inhibitory or tropomyosin binding testing. Patient data relating to ED attendance, troponins, hospitalization and death were linked using probabilistic data linkage. Troponin results were dichotomized (normal/abnormal) according to hospitals' cut‐offs across various time periods. Presentations undergoing ED troponin testing, provided that it was not within 28 days of a previous discharge involving ED troponin testing, met study inclusion criteria. Logistical regression analyses quantified risk of subsequent hospitalization and death.

Results:  A total of 119 646 troponin tests were performed during 83 635 ED presentations involving 54 214 patients. For the 73 965 ED presentations meeting the study criteria, 6779 (9.2%) recorded an abnormal peak troponin level and 168 (2.5%) of these presentations were discharged directly from ED. After adjusting for covariates, those discharged directly from ED with abnormal troponin results were significantly more likely to die within 2 days (OR 60.4, 95% CI 31.9–114.2), 7 days (OR 31.2, 95% CI 17.9–54.3) and 28 days (OR 19.4, 95% CI 12.5–30.1) of discharge, compared with those with normal troponin results. Adjusted odds of subsequent hospital admission within 28 days following discharge from ED were 3.3 (95% CI 2.4–4.5) times greater for presentations with abnormal versus normal troponin results.

Conclusion:  An abnormal ED troponin result appears to be associated with increased risk of subsequent hospitalization and death within 28 days of discharge.
The Association Between Sexual Satisfaction and Body Image in Women
Authors: Pujols Yasisca , Meston Cindy M. , Seal Brooke N.
Published: November 2009

Introduction

Although sexual functioning has been linked to sexual satisfaction, it only partially explains the degree to which women report being sexually satisfied. Other factors include quality of life, relational variables, and individual factors such as body image. Of the few studies that have investigated the link between body image and sexual satisfaction, most have considered body image to be a single construct and have shown mixed results.

Aim

The present study assessed multiple body image variables in order to better understand which aspects of body image influence multiple domains of sexual satisfaction, including sexual communication, compatibility, contentment, personal concern, and relational concern in a community sample of women.

Methods

Women between the ages of 18 and 49 years in sexual relationships (N = 154) participated in an Internet survey that assessed sexual functioning, five domains of sexual satisfaction, and several body image variables.

Main Outcome Measures

Body image variables included the sexual attractiveness, weight concern, and physical condition subscales of the Body Esteem Scale, the appearance-based subscale of the Cognitive Distractions During Sexual Activity Scale, and body mass index. Total score of the Sexual Satisfaction Scale for Women was the main outcome measure. Sexual functioning was measured by a modified Female Sexual Function Index.

Results

Consistent with expectations, correlations indicated significant positive relationships between sexual functioning, sexual satisfaction, and all body image variables. A multiple regression analysis revealed that sexual satisfaction was predicted by high body esteem and low frequency of appearance-based distracting thoughts during sexual activity, even after controlling for sexual functioning status.

Conclusion

Several aspects of body image, including weight concern, physical condition, sexual attractiveness, and thoughts about the body during sexual activity predict sexual satisfaction in women. The findings suggest that women who experience low sexual satisfaction may benefit from treatments that target these specific aspects of body image.
Association Analysis of Endothelial Nitric Oxide Synthase G894T Gene Polymorphism and Erectile Dysfunction Complaints in a Population-Based Survey
Authors: Andersen Monica L. , Guindalini Camila , Santos-Silva Rogerio , Bittencourt Lia Rita A. , Tufik Sergio
Published: November 2009

Introduction

Erectile dysfunction (ED) is a common disorder leading to a serious, negative impact on the quality of the patient’s life. The gene encoding endothelial nitric oxide synthase (eNOS) is an interesting candidate gene for understanding the physiopathology of ED, as it is involved in the catalytic production of nitric oxide (NO), the neurotransmitter that plays a critical role in penile tumescence and erection.

Aim

To evaluate a potential association between the G894T polymorphism in the eNOS gene and ED complaints in a population-based sample in São Paulo, Brazil.

Main Outcome Measures

The prevalence of ED complaints was estimated according to the answer to the question “How would you describe your ability to get and keep an erection that is adequate for satisfactory intercourse?” ED was considered to be present if the response was “sometimes” or “never.”

Methods

A total of 449 men were enrolled in the study and answered an eight-item questionnaire to ascertain sexual performance/ED and satisfaction. The eNOS G894T polymorphism was genotyped using a standard polymerase chain reaction method.

Results

Univariate analysis demonstrated that ED was associated with diabetes, hypertension, sleep apnea severity, increasing age and body mass index, as well as testosterone levels (P <0.05). Forward multiple regression models indicated that age was the only independent factor associated with ED in this population (odds ratio=1.09; 95% CI 1.06–1.11; P <0.0001). Genotypic and allelic analyses provided no evidence for an association between this polymorphism and the risk for ED complaints in this sample. Population stratification did not affect the association test results.

Conclusions

This is the first study to examine the effect of polymorphisms in the eNOS gene and the risk for ED utilizing a case-control approach in the Brazilian population. Our results do not support a major role for eNOS gene polymorphisms in ED in this population.
EFFECTS OF EXTRUSION TREATMENT ON ENZYMATIC HYDROLYSIS PROPERTIES OF WHEAT GLUTEN
Authors: CUI CHUN , ZHAO HAIFENG , ZHAO MOUMING , CHAI HUA
Published: November 2009

Degree of hydrolysis (DH), protein recovery (PR), Fourier transform infrared spectroscopy (FTIR), molecular weight distribution and amino acid composition were examined to investigate effects of extrusion treatment on Pancreatin‐induced hydrolysis properties of wheat gluten in the present study. Results showed that extrusion treatment had significant impacts on enzymatic hydrolysis properties of wheat gluten. It not only resulted in significant increases of 19.2% in DH after 36 h of hydrolysis and 13.4% in PR after 60 h of hydrolysis, but also changed considerably FTIR spectroscopy, molecular weight distribution and amino acid composition of wheat gluten hydrolysates. The conformational changes and structural rearrangements of wheat gluten treated with extrusion might modify the catalytic sites of proteases and be responsible for the improvement of enzymatic hydrolysis efficiency of wheat gluten.

PRACTICAL APPLICATIONS

There were increasing interests in expanding the usage fields of wheat gluten, as it is available in large amounts and at relatively low cost. However, its usage was limited due to lack of some desirable functional properties. Although enzymatic hydrolysis is able to improve the solubility and develop the emulsifying and foaming properties of wheat gluten, the low enzymatic hydrolysis efficiency remains one of the major problems present in the industrial scale production. Therefore, increasing enzymatic hydrolysis efficiency of wheat gluten gets more important. Our results clearly showed that enzymatic hydrolysis efficiency of extruded wheat gluten was increased significantly. Results from this preliminary study will provide a better understanding on enzymatic hydrolysis mechanisms of extruded wheat gluten and allow the screening of pretreatment method to improve the enzymatic hydrolysis efficiency during the industrial scale wheat gluten hydrolysates production.
Familial pain syndromes from mutations of the Nav1.7 sodium channel
Authors: Fischer Tanya Z. , Waxman Stephen G.
Published: November 2009

The literature currently suggests that voltage‐gated sodium channels play a major role in the pathogenesis of neuropathic pain. Alterations in the expression and targeting of specific sodium channels within injured dorsal root ganglia neurons appear to predispose the neurons to abnormal firing properties, allowing for the development of neuropathic pain. Mutations of one particular sodium channel (Nav1.7) have been shown to cause inherited neuropathic pain in humans, specifically in erythromelalgia and paroxysmal extreme pain disorder. Inherited erythromelalgia is the first human pain syndrome to be understood at a molecular level, having been linked to gain‐of‐function mutations of Nav1.7. Conversely, a loss‐of‐function of the Nav1.7 channel can produce channelopathy‐associated insensitivity to pain. Therefore, the Nav1.7 channel may provide a unique target for the pharmacotherapy of pain in humans. In this review article we summarize current knowledge regarding several different disease manifestations arising from changes within the Nav1.7 channel.
Vertebrobasilar dilatative arteriopathy (dolichoectasia)
Authors: Lou Min , Caplan Louis R.
Published: November 2009

Dolichoectasia (dilatative arteriopathy) describes marked elongation, widening, and tortuosity of arteries. The intracranial vertebral and basilar arteries are preferentially involved. Dolichoectatic arteries usually have an abnormally large external diameter and a thin arterial wall, with degeneration of the internal elastic lamina, multiple gaps in the internal elastica, thinning of the media secondary to reticular fiber deficiency, and smooth muscle atrophy. The most important clinical presentations of dilatative arteriopathy include acute brain ischemia; a progressive course related to compression of cranial nerves, the brain stem, or the third ventricle; and catastrophic outcome caused by vascular rupture. Flow in dilated arteries can become bidirectional, resulting in reduced antegrade flow and thrombus formation. Elongation and angulation of arteries can stretch and distort the orifices of arterial branches, leading to decreased blood flow, especially in penetrating branches.
REM sleep behavior disorder
Authors: Boeve Bradley F.
Published: November 2009

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. The polysomnographic features of RBD include increased electromyographic tone +/− dream enactment behavior during REM sleep. Management with counseling and pharmacologic measures is usually straightforward and effective. In this review, the terminology, clinical and polysomnographic features, demographic and epidemiologic features, diagnostic criteria, differential diagnosis, and management strategies are discussed. Recent data on the suspected pathophysiologic mechanisms of RBD are also reviewed. The literature and our institutional experience on RBD are next discussed, with an emphasis on the RBD–neurodegenerative disease association and particularly the RBD‐synucleinopathy association. Several issues relating to evolving concepts, controversies, and future directions are then reviewed, with an emphasis on idiopathic RBD representing an early feature of a neurodegenerative disease and particularly an evolving synucleinopathy. Planning for future therapies that impact patients with idiopathic RBD is reviewed in detail.
Congenital heart disease and brain development
Authors: McQuillen Patrick S. , Miller Steven P.
Published: November 2009

Brain and heart development occur simultaneously in the human fetus. Given the depth and complexity of these shared morphogenetic programs, it is perhaps not surprising that disruption of organogenesis in one organ will impact the development of the other. Newborns with congenital heart disease show a high frequency of acquired focal brain injury on sensitive magnetic resonance imaging studies in the perioperative period. The surprisingly high incidence of white matter injury in these term newborns suggests a unique vulnerability and may be related to a delay in brain development. These abnormalities in brain development identified with MRI in newborns with congenital heart disease might reflect abnormalities in cerebral blood flow while in utero. A complete understanding of the mechanisms of white matter injury in the term newborn with congenital heart disease will require further investigation of the timing, extent, and causes of delayed fetal brain development in the presence of congenital heart disease.
The tuberous sclerosis complex
Authors: Orlova Ksenia A. , Crino Peter B.
Published: November 2009

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder that results from mutations in the TSC1 or TSC2 genes and is associated with hamartoma formation in multiple organ systems. The neurological manifestations of TSC are particularly challenging and include infantile spasms, intractable epilepsy, cognitive disabilities, and autism. Progress over the past 15 years has demonstrated that the TSC1 or TSC2 encoded proteins modulate cell function via the mTOR signaling cascade and serve as keystones in regulating cell growth and proliferation. The mTOR pathway provides an intersection for an intricate network of protein cascades that respond to cellular nutrition, energy levels, and growth‐factor stimulation. In the brain, TSC1 and TSC2 have been implicated in cell body size, dendritic arborization, axonal outgrowth and targeting, neuronal migration, cortical lamination, and spine formation. Antagonism of the mTOR pathway with rapamycin and related compounds may provide new therapeutic options for TSC patients.
Dermatomyositis and polymyositis
Authors: Mammen Andrew L.
Published: November 2009

Dermatomyositis (DM) and polymyositis (PM) are autoimmune myopathies characterized clinically by proximal muscle weakness, muscle inflammation, extramuscular manifestations, and frequently, the presence of autoantibodies. Although there is some overlap, DM and PM are separate diseases with different pathophysiological mechanisms. Furthermore, unique clinical phenotypes are associated with each of the myositis‐specific autoantibodies (MSAs) associated with these disorders. This review will focus on the clinical features, pathology, and immunogenetics of PM and DM with an emphasis on the importance of autoantibodies in defining unique phenotypes and, perhaps, as clues to help elucidate the mechanisms of disease.
Depressive Symptoms and Economic Outcomes of Low‐Income Women: A Review of the Social Causation, Social Selection, and Interactionist Hypotheses
Authors: Gupta Anjali E. , Huston Aletha C.
Published: November 2009

We review research that connects depression and depressive symptoms to employment and economic factors for low‐income women. Women who have low incomes and are unemployed or underemployed are vulnerable to mental health distress. The strain of balancing work and family life can be exacerbated by poor psychological health or nonsufficient economic resources. Research on the barriers that impede self‐sufficiency can lead to policies that improve the economic and psychological health of low‐income populations.

The discussion is framed by contrasting evidence for three theoretical perspectives: the social causation, social selection, and interactionist (bidirectional) hypotheses. The only causal relation reported is an effect of increased income on reduced depressive symptoms. Yet strong associations are found among psychological distress, earnings, employment stability, income, and job characteristics. The effects of programs to increase employment and the benefits of (and barriers to) depression treatment are also discussed. A bidirectional or interactionist perspective best conceptualizes the relationship between depression and economic factors. The reported negative effects of both poor mental well‐being and low‐quality employment suggest the need for stronger policies in the areas of mental health and work supports. We present policy recommendations addressing mental health treatment and outreach, employment placement, and workplace flexibility.
Frequent STAT3 activation is associated with Mcl‐1 expression in nasal NK‐cell lymphoma
Authors: TSUTSUI M. , YASUDA H. , SUTO H. , IMAI H. , ISOBE Y. , SASAKI M. , KOJIMA Y. , OSHIMI K. , SUGIMOTO K.
Published: November 2009

Nasal natural killer (NK)‐cell lymphoma was resistant to various antitumor agents. Although high expression of p‐glycoprotein has been reported, other molecular mechanism of the chemo‐resistance is largely unknown. Activation of STAT3 and expression of major apoptosis‐related proteins Bcl‐2, Bcl‐x, and Mcl‐1 were analyzed by immunohistochemistry. Effects of STAT3 inhibitor AG490 on NK‐YS cell line were analyzed by Western blotting and flow cytometric apoptosis assay. STAT3 was activated in six of the nine nasal NK‐cell lymphomas (67%). In contrast, STAT3 activation was detected in 35% of diffuse large B‐cell lymphoma (DLBCL) and in 10% of follicular lymphoma (FL). Frequent activation of STAT3 was significantly correlated with Mcl‐1 expression in nasal NK‐cell lymphoma, i.e., Mcl‐1 was positive in five of six STAT3‐active cases and negative in all three STAT3‐inactive ones. In DLBCL, not only six out of seven STAT3‐active cases (86%) but also eight out of thirteen STAT3‐inactive cases (62%) were positive for Mcl‐1 expression. Latent membrane protein‐1 was positive in four nasal NK‐cell lymphomas, among which three cases showed intermediate STAT3 activation. Inhibition of STAT3 activation by JAK inhibitor AG490 decreased Mcl‐1 expression and induced apoptosis in STAT3‐active NK‐YS cells. Serum starvation rather increased the Mcl‐1 level in NK‐YS cells, and this effect was also canceled by AG490. These results suggest that activation of STAT3‐Mcl‐1 axis may play a role in the chemotherapy resistance of nasal NK‐cell lymphoma. The pathway may be one of the future therapeutic targets of this intractable disease.
Natural gas markets: how sensitive are they to crude oil price changes?
Authors: Onour Ibrahim A.
Published: November 2009

This paper investigates sensitivity of US natural gas price with crude oil price changes, using time‐varying coefficient models. Identification of the range of variation of the sensitivity of natural gas price to oil price change allows more accurate assessment of upper and minimum risk levels that can be utilised in pricing natural gas derivatives such as gas futures and option contracts, and gas storage facility contracts.
European Union Clinical Trials Directives
Authors: DANIELSON L
Published: November 2009

Abstract not provided
Automatic estimation of the arteriolar‐to‐venular diameter ratio (AVR) in retinal images
Authors: RUGGERI A , TRAMONTAN L , GRISAN E
Published: November 2009

Purpose The Arteriolar‐to‐Venular diameter Ratio (AVR), a parameter derived from vessel caliber measurements in a specific region of retinal images, is used as a descriptor of generalized arteriolar narrowing. We developed a computerized system to compute AVR in a totally automatic way.

Methods Images are at first enhanced to highlight the vessel network, which is then traced by a vessel tracking algorithm. From the detected vessel structure, the position of the optic disc is derived and the region inside which the AVR data are to be measured is determined. Vessels within this region are classified as either arteries or veins, their caliber estimated and the AVR parameter is eventually computed. Results provided by the system have been compared with manually derived AVR values on 20 eye fundus images.

Results Mean and SD values from the two sets of measurements are the same, and automatic/manual ratios have an average value of 1 and 95% confidence interval of (0.98‐1.02). The correlation coefficient between the two methods is 0.88. In only two images the ratio is appreciably different from unity, 1.14 and 0.89 respectively. A detailed analysis of these cases revealed that in each image the wrong classification of one vessel only was the cause for these unsatisfactory results. When these misclassifications are manually corrected, e.g. with a quick editing tool that can be easily made available to the user, the ratios become 0.95 and 0.99, respectively, and the overall correlation coefficient becomes 0.97.

Conclusion Additional evaluation on a larger set of images, acquired from subjects exhibiting wide variations of AVR, will be performed in order to fully assess the reliability and clinical applicability of this automatic procedure.
Choroidal neovascularization management in uveitic patients – our experience
Authors: URBANCIC M , KRAUT A
Published: November 2009

Purpose Choroidal neovascularization (CNV) is well documented complication of posteroir uveitis which can lead to severe visual loss. There are varying management options for this condition. We present our experience in managing CNV in uveitic patients.

Methods Retrospective study of uveitic patients with CNV treated in our hospital during last eight years. Data collected were: gender and age of patient, type of uveitis, CNV localization, visual acuity at the time of diagnosis, visual acuity at the last follow‐up visit, management of condition.

Results 38 patients with posterior uveitis developed CNV in one or both eyes (12 males, 26 females). Average age at the time of diagnosis was 41,7 years. Management of CNV depended on clinical presentation. Treatment options that were used: laser photocoagulation, photodynamic therapy, corticosteroids, vitreoretinal procedure and anti‐VEGF therapy. Different treatment options were combined in some patients. Some patients were only observed. Follow‐up period ranged from one to eight years. Visual acuity improved in 19 eyes and remained stable in 9 eyes.

Conclusion The results of varying management options for CNV in uveitic patients are limited. Individual approach in the management decision is necessary because of various clinical presentations. Additional clinical trials are needed to define an optimal approach.
Expression of galectin molecules in intraocular tissue and inflammation
Authors: YAMAKI K , AMANO M
Published: November 2009

Purpose To study the role of Galectin molecules in intraocular tissue. We examined the expression of Galectin molecules in intraocular tissues in normal and inflammatory conditions.

Methods Lewis rats eye ball and cultured human retinal pigment epithelial cells were used for experiment. Expression levels of Galectin – 1, 3, and 9 were examined with immune staining for the proteins and in situ hybridization for the mRNAs in normal and inflammatory conditions. Expression levels of the mRNA from established retinal pigment epithelium (RPE) derived cells of ARPE‐19 and hTERT were also examined with real time PCR

Results Galectin ‐ 1in normal condition: the protein expression was detected in ciliary body, RPE, retinal outer and inner segments. In inflammatory condition, expression levels were not changed dramatically. Galectin – 3 in normal and inflammatory condition: ubiquitous expression was detected in almost all tissues of the eye (ciliary body, RPE and neural retinal layers). Galectin – 9 in normal condition: a little amount of expression was detected in ciliary body, choroid RPE, and some layers of neural retina. In inflammatory condition, expression levels increased in the above tissues. In cultured RPE cells expressed galectin molecules in normal conditions. When the cells were stimulated by proinflammatory cytokines, only expression of Galectin – 9 increased.

Conclusion Recently It is reported that Galectin – 9 and Tim – 3 bind and negatively regulates Th1 immunity. In intraocular tissue,Galectin – 9 also may play important roles for modulating intraocular immune responses.
Analysis of corneal epithelial cells with confocal microscopy after lamellar keratoplasty
Authors: GAUJOUX T , TOUZEAU O , KOPITO R , LAROCHE L , BORDERIE VM
Published: November 2009

Purpose the purpose of this study was to analyze morphometry of corneal epithelial cells in normal eyes and after anterior lamellar keratoplasty using confocal microscopy.

Methods The combination of the Heidelberg Retina Tomograph II and the Rostock Cornea Module (HRT II/RCM) was used to evaluate the corneal epithelium of 10 eyes of patients who had undergone anterior lamellar keratoplasty (ALK group) and 10 normal eyes (control group). Three epithelial layers per cornea were examined: superficial cell layer, wing cell layer, and basal cell layer. A morphometric analysis software was used to determine area, perimeter, circularity, and Feret diameter of the corneal epithelial cells.

Results The mean basal cell area in the central zone was significantly higher (p< 0.001) after ALK than in the control group. After ALK, the mean basal cell area decreased with post‐operative time (rS = ‐ 0.42; p = 0.039) but it did not return to normal 24 months after transplantation. Comparison of both groups showed significant differences in cell perimeter, circularity, and Feret diameter of basal cells (p< 0.001). Similar differences were found in wing cell layer. Only few superficial cells could be analyzed on corneal graft (no statistical analysis could be done).

Conclusion This study imaged the living human basal epithelium of lamellar grafts, analyzed its structure and highlighted changes in epithelial cells density and morphology. We found an increase in basal cell density between 12 and 30 months. This could be explained by reinnervation of the cornea. Indeed, corneal nerves provide important protective and trophic functions. The basal cell area seems to be a relevant morphometric parameter to assess the corneal epithelium.
Infectious crystalline keratopathy and its management
Authors: DUA HS , SAID DG
Published: November 2009

Purpose Infectious crystalline keratopathy (ICK) is defined as microbial infection of the cornea in the absence of the host inflammatory response. It presents as slowly progressive crystalline opacities resembling needles, snowflakes or ferns and are filamentous or branching in pattern within the cornea stroma.

Methods Pathogenesis: Streptococcus viridans is the most common cause of ICK but a range of fungi and bacteria have been isolated from cases of ICK. They are located within the corneal stroma within the interlamellar planes. The pattern of spread of bacteria within corneal tissue is determined by the compactness of the corneal stroma. Another common feature is reduced corneal sensation, abrogating the triple response reflex at the limbus and hence the lack of the host response. The diagnosis of ICK is made on history and examination as microbiological diagnosis by culture of scrapes is difficult. Histology of biopsy specimen confirms diagnosis.

Results Medical treatment with broad spectrum topical anti‐microbial agents is initiated. Any concomitant use of topical steroids should be discontinued. If no resolution of infection occurs, surgery in the form of lamellar or penetrating keratoplasty or superficial keratectomy is required. The successful use of excimer laser therapeutic keratectomy and Nd:YAG laser in the treatment of ICK has been demonstrated in single case reports but these techniques need further evaluation.

Conclusion The diagnosis of ICK is largely clinical. It is difficult to treat medically often requiring surgical intervention. Poor corenal sensation and steroid use are important predisposing factors.
Assessment of macular pigment optical density (MPOD) among patients with wet age‐related macular degenaration (AMD) in one eye and the dry form in the fellow eye
Authors: TSIKA CI , KONTADAKIS GA , MAKRIDAKI M , PLAINIS S , MOSCHANDREAS J , TSILIMBARIS MK
Published: November 2009

Purpose To estimate the Macular Pigment Optical Density (MPOD) in patients with unilateral wet Age‐Related Macular Degenaration (AMD), not taking any carotenoid supplements.

Methods The MPOD was measured in 20 patients (73.7±5.32 years) and in 20 healthy‐retina subjects (71.6± 5.19 years) using Heterochromatic Flicker Photometry. Independent‐samples t test was performed between patients’ eye with dry AMD and controls’ right eye.

Results No significant difference (mean difference: 0.01 (p=0.845)) was observed between the Macular Pigment Optical Density (MPOD) of the fellow dry AMD eye of patients with unilateral wet AMD (mean MPOD: 0.51 ± 0.16) and the eyes of age‐matched control subjects (mean MPOD: 0.52 ± 0.15).

Conclusion Patients with unilateral wet AMD were not found to have less Macular Pigment than healthy subjects of same age. This finding suggests that MPOD might not be useful as prognostic factor for the progression of the disease at this high‐risked group of patients.
Perioperative bevacizumab injection: clinical and histological results
Authors: ROMANO MR , GIBRAN SK , WONG D , HISCOTT P , HEIMANN H
Published: November 2009

Purpose To evaluate the safety and efficacy of Intravitreal Bevacizumab (IVB) injection as an adjuvant in the management of proliferative diabetic retinopathy (PDR) before or after planned vitrectomy.

Methods Prospective, interventional, consecutive case series of 58 eyes of 55 patients with PDR. The patients were divided in two groups: Group A (28 eyes) had IVB within 10 days before the surgery; Group B (30 eyes) had the IVB at the end of the surgery. A dose of IVB was of 2.5mg in 0.1 ml and was given under aseptic conditions. The specimens obtained from the both groups were evaluated by histological examination.

Results In Group A, 3 of 28 eyes (12%) had no significant reduction of neovascularisation; 8 of 28 eyes (28%) had a significant reduction in leakage and regression of tractional retinal detachment (TRD) with parallel improvement in visual acuity. Four (50%) of these 8 patients had recurrence of PDR within 10 weeks after the injection. In 2 patients, worsening of TRD was noted. In 11 patients, vitrectomy, delamination and endolaser laser were performed within 10 days. Post‐operative bleeding was not noted in this group. In Group B, 7 out of 30 eyes (23%) had a re‐bleeding within one month from the surgery. No difference in morphology was observed between the specimens of the two groups. An analogous staining pattern was observed between two groups when comparing markers for apoptosis (caspase), hypoxia (HIF1 and HIF2) and VEGF.

Conclusion IVB seems to be efficacious as an adjuvant treatment, if injected pre‐operatively rather than post‐operatively, for the management of PDR. IVB does not appear to cause any change in the light microscopic appearance or in the immunohistochemically‐detectable expression of hypoxia or apoptosis markers.
The ophthalmological approach
Authors: SPILEERS W
Published: November 2009

Purpose Patients with unvoluntary eye movements frequently consult an ophthalmologist. A correct diagnosis of the type and etiology is important.

Methods A clinical approach with selected technical examinations is mandatory for a correct diagnostic approach.

Results Isolated ophthalmological and combined neurological elements can be identified to guide the further approach.

Conclusion A practical work‐up of a patient presenting with nystagmus will be presented. Frequently the collaboration with the neurologist is important.
First results in repeated functional testing in low vision patients with retinitis pigmentosa
Authors: GEORGI T , IVASTINOVIC D , HORNIG R , KOCH M , VELIKAY‐PAREL M
Published: November 2009

Purpose We created a visual function test, the Graz mobility (GM) test to document visual progress in artificial vision. In previous studies our low vision test adequately graded the low vision of patients with retinitis pigmentosa (RP). However in repeated testing the learning effect could contaminate the visual results after implantation. The aim of this study was to investigate the constancy of the performance and to record behavioural changes in repeated testing in low vision RP patients.

Methods 8 low vision RP‐patients with a visual acuity from hand motion to 20/800 were tested repeatedly in 1, 2, 3 and 6 months time intervals. The GM test consisted of four different, structurally similar mazes with 11 obstacles. The subjects passed through each course several times. A people tracking system with an integrated trajectory projection system was established to record horizontal and vertical scanning movements of people during the test. Passage time, walking speed, number of contacts, frequency of scanning movements and average scanning angle were recorded.

Results In repeated testing significant changes of the passage time were observed once the patients became familiar with the mobility test. The maximum learning effect was achieved within the first test session and was never exceeded in the following sessions. However further changes in the remaining parameters were observed in each patient, displaying behavioural changes correlating to the level of comfort during the task performance.

Conclusion The GM proves to be reliable for repeated testing in low vision patients and the learning effect will not contaminate the results of visual function changes. Furthermore behavioural changes can be objectively assessed.
Effect of VEGF blockade on corneal graft neovascularization and rejection in rats
Authors: ROCHER N , BEHAR‐COHEN F , RENARD G , BOURGES JL
Published: November 2009

Purpose To evaluate the effect of anti‐vascular endothelial growth factor antibodies directed at VEGF 164, 120, 121 and 165, administered by subconjunctival injections (SC), on neovascularization and rejection after penetrating keratoplasty (PK) in rats

Methods Twelve Lewis rats were grafted with corneal buttons from Brown Norway rats and were divided in 2 treatment groups (G) just after surgery (day 0). G1 received saline SC injections (0.02ml/inj, n=6) every 3 days from D0 to D21 and G2 received SC injections of anti‐VEGF (0.02ml/inj, 10µg/ml), with the same regimen. Rejection clinical scores were based on corneal oedema (0 to 3) and transparency (0 to 4). Surface and extension of neovascularization were scored clinically (0 to 4) and then quantified using lectin immunostaining on flat‐mounted buttons

Results At D21, the mean rejection scores were significantly higher in G1 compared to G2. Rejection rates were 83% in G1 vs. 50% in G2 (p<0.05). Neovessels scores were 4±0 in G1 vs. 2.5±0.54 in G2 (p<0.001). On flat‐mounted corneas the mean ratio of vessels area/clear cornea was 58% in G1 vs. 36% in G2 (p=0,003).

Conclusion The sub conjunctival administration of anti‐VEGF antibodies not only reduces neovessels growth but also prevent rejection after PK.
Signaling pathways in innate immunity
Authors: SALMINEN A
Published: November 2009

Inflammation has a key role in the pathogenesis of AMD. This lecture will review the recent progress in understanding the different host‐defence mechanisms against pathogens and self‐based danger signals involved in the activation of innate immunity. The innate defence system utilizes pattern recognition receptors (PRR) to respond to a variety of pathogen‐associated (PAMP) and danger‐associated (DAMP) molecular structures. Along with the well‐known complement and scavenger receptor systems, Toll‐like receptors (TLR) and NOD‐like receptors (NLR) have also a crucial part in host‐defence and these receptor systems can be activated both by PAMPs and DAMPs. Pattern recognition receptors are located either in cell surface, such as TLR2 and TLR4, or in intracellular locations, e.g. TLR3, TLR9 and all NLRs. PRRs show some specificity to ligands and also in downstream they activate different signaling pathways, most common of which are NF‐kB and IRF‐dependent pathways inducing inflammatory responses. Retinal pigment epithelial cells (RPE) have an important role in eye host‐defence, both at apical and basolateral surfaces. Most of the TLRs are expressed in RPE cells, especially TLR3 and TLR4, and they can participate in photoreceptor outer segment recognition. TLR3 can also suppress angiogenesis. The functions of NLRs, e.g. those forming inflammasomes, are still unknown, although the danger‐type of activation signals, such as oxidative stress and potassium efflux, are present in retinal pigment epithelium. It seems that the activation of innate immunity system via DAMPs and PRRs may have a central role in the pathogenesis of AMD.
Evaluation of contrast sensitivity on monocularly ‐ deprived subjects
Authors: GIANNAKOPOULOU T , PLAINIS S , PALLIKARIS IG , TSILIMBARIS MK
Published: November 2009

Purpose It is widely accepted that monocular deprivation results to improved visual performance of the non‐pathological eye. The aim of the study was to investigate the effect of monocular deprivation on the contrast sensitivity performance of the fellow eye.

Methods Sixteen subjects (mean age: 28.0 ± 7.9) with monocular deprivation volunteered to participate in the study. Eleven more subjects (mean age: 28.1 ± 3.6) served as the control group. Best‐corrected visual acuity was ‐0.15 ± 0.09 and ‐0.16 ± 0.08 logMAR, correspondingly. Best‐corrected contrast sensitivity was evaluated using vertical sinusoidal gratings (2 Hz square‐wave reversal) displayed on a Sony GDM F‐520 CRT display at 200cm distance, by means of a VSG2/5 stimulus generator card (CRS, Rochester, UK). Seven spatial frequencies (1, 2, 4, 8, 12, 16 and 24 c/deg) were tested. The average of three thresholds was taken. Performance of the control group was tested both monocularly (dominant eye) and binocularly.

Results Binocular viewing improves contrast sensitivity by about 3.5 dB in control subjects. Contrast sensitivity was found to be higher (4.6 dB on average) for monocularly‐deprived subjects, compared with the dominant eye of the control group. However, the effect was spatial frequency‐dependent: the difference was more pronounced for low and high spatial frequencies.

Conclusion Monocularly‐deprived subjects show higher contrast sensitivity compared to monocular values of normal young subjects. The improved performance of the non‐pathological eye of patients with monocular deprivation may be a result of the neuronal synaptic plasticity of the visual cortex.