Axonal loss in the retinal nerve fiber layer in patients with multiple sclerosis

OBJECTIVE: To quantify axonal loss in the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS), with and without a history of optic neuritis, by means of ocular imaging technologies. METHODS: This cross-sectional study enrolled 50 patients with MS and 25 age- and sex-matched healthy controls. All patients underwent neurologic assessment and a complete ophthalmic examination that included visual acuity, visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (GDx) and visual evoked potentials (VEPs). Visual parameters and RNFL measurements were evaluated in MS eyes with a prior optic neuritis episode (MS-ON), with no prior episode (MS-NON) and control subjects. RESULTS: There were significant differences (p < 0.05, analysis of variance) between MS-ON (n = 25 eyes) and healthy eyes (n = 25 eyes) for all RNFL parameters measured by OCT and GDx. Significant differences between MS-NON (n = 75 eyes) and healthy eyes were also found for most of these parameters. RNFL thickness in the temporal quadrant was the parameter with the greatest differences between groups (71.79 microm in healthy eyes, 60.29 microm in MS-NON and 53.92 microm in MS-ON, p < 0.0005). Although there was a highly significant but moderate correlation between RNFL thickness and duration of the disease, no correlation was observed between RNFL thickness and neurologic impairment (Expanded Disability Status Scale). CONCLUSIONS: Axonal loss was detected not only in MS eyes with a previous acute optic neuritis, but also in MS eyes with no known optic neuritis episode. Structural abnormalities correlate with functional assessments of the optic nerve.     

Choroidal Thickness in Multiple Sclerosis: An Optical Coherence Tomography Study

Background and PurposeTo identify changes in the choroidal thickness (CT) in multiple sclerosis (MS) patients with and without optic neuritis (ON) using enhanced-depth-imaging optical coherence tomography (EDI-OCT).MethodsThis cross-sectional study included 96 eyes with MS and 28 eyes of healthy controls. All participants underwent an ophthalmologic examination and EDI-OCT scanning (Spectralis, Heidelberg Engineering, Germany) to assess the CT and the retinal nerve fiber layer (RNFL) thickness. MS patients were divided into two groups: 1) with and 2) without a history of ON. The CT was evaluated in the fovea and at six horizontal and six vertical points at 500, 1,000, and 1,500 µm from the fovea. Paired t-tests were used to compare the groups, and p-value<0.05 was considered as significant.ResultsAt all 13 measurements points, the CT was thicker in MS patients than in the healthy controls and was thinner in eyes with ON than in the contralateral eyes, but these differences were not statistically significant. However, the CT was always larger in all points in eyes with a history of ON than in the control eyes. The RNFL was significantly thinner (p<0.05) in both MS and ON eyes than in the control eyes.ConclusionsThe CT did not differ between MS and control eyes, but it was significantly larger in patients with a history of ON, in whom the RNFL was thinner. Further studies are necessary to establish the possible role of the choroid in MS.     

Reduced retinal nerve fiber layer and macular thickness in patients with multiple sclerosis with no history of optic neuritis identified by the use of spectral domain high-definition optical coherence tomography

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS), with both inflammatory and degenerative components. The visual system is frequently involved, often in the form of visual loss from optic neuritis (ON). Retinal nerve fiber layer (RNFL) loss has been demonstrated in individuals with MS, not only in those with previous ON but also in absence of historical evidence of previous acute inflammation/demyelination of the optic nerve. Peripapillary RNFL measurements of all quadrants, central macular thickness, and average macular thickness were performed in 32 eyes of healthy volunteers and 60 eyes of individuals with a diagnosis of relapsing remitting MS using high definition spectral domain optical coherence tomography (HD-OCT). Both the Macular Cube 512 × 128 scan and RNFL measurement by the Optic Disc Cube 200 × 200 protocol were performed on all eyes. Eyes of individuals with MS with no previous ON had significantly decreased overall RNFL thickness (89.1 μm) compared to controls (98.0 μm) (p < 0.05). MS mainly affected the temporal quadrant (56.6 μm versus [vs.] 67.8 μm) (p < 0.05), and inferior quadrant (117.9 μm vs. 132.1 μm) (p < 0.05), respectively. Also, the patients with MS demonstrated significantly decreased average macular thickness (280 μm) compared to the control group (287 μm) (p < 0.05). A significant correlation between RNFL and average macular thickness was also found in eyes of patients with MS (r = 0.69, p < 0.01). HD-OCT is a quick, inexpensive and promising tool to detect subclinical changes in RNFL and macular thickness in individuals with MS. Longitudinal studies should be encouraged to examine disease progression over time in individuals with MS.     

Reduced retinal nerve fiber layer (RNFL) thickness in ALS patients: a window to disease progression

Objectives

To assess RNFL thickness in ALS patients and compare it to healthy controls, and to detect possible correlations between RNFL thickness in ALS patients and disease severity and duration.

Methods

Study population consisted of ALS patients and age- and sex-matched controls. We used the revised ALS functional rating scale (ALSFRS-R) as a measure of disease severity. RNFL thickness in the four quadrants were measured with a spectral domain OCT (Topcon 3D, 2015).

Results

We evaluated 20 ALS patients (40 eyes) and 25 healthy matched controls. Average RNFL thickness in ALS patients was significantly reduced compared to controls (102.57?±?13.46 compared to 97.11?±?10.76, p 0.04). There was a significant positive correlation between the functional abilities of the patients based on the ALSFRS-R and average RNFL thickness and also RNFL thickness in most quadrants. A linear regression analysis proved that this correlation was independent of age. In ALS patients, RNFL thickness in the nasal quadrant of the left eyes was significantly reduced compared to the corresponding quadrant in the right eyes even after adjustment for multiplicity (85.80?±?23.20 compared to 96.80?±?16.96, p?=?0.008).

Conclusion

RNFL thickness in ALS patients is reduced compared to healthy controls. OCT probably could serve as a marker of neurodegeneration and progression of the disease in ALS patients. RNFL thickness is different among the right and left eyes of ALS patients pointing to the fact that asymmetric CNS involvement in ALS is not confined to the motor system.

     

Optical coherence tomography in multiple sclerosis

BACKGROUND : Axonal distribution within the retinal nerve fiber layer (RNFL) measured by optical coherence tomography (OCT) correlates with axonal viability and integrity. OBJECTIVE : To investigate correlations between RNFL and MRI measures of axonal loss in MS patients. METHODS : Fifty one remitting-relapsing MS patients, 20 with a history of optic neuritis (MS-ON), 31 without optic neuritis (MS N-ON), and 12 healthy control subjects (HC) were included in the study. RNFL was measured by OCT and brain atrophy was assessed by MRI. RESULTS : The average RNFL in the affected eye (AE) in the MS-ON group was significantly lower than the RNFL in the MS N-ON (p = 0.01) and in HC (p = 0.01). The average RNFL in the unaffected eye (UE) and RNFL in MS N-ON were also lower than HC, but this value did not achieve significance. In MS N-ON a lower average RNFL was associated with an increased T1 lesion volume (p = 0.03) and T2-lesion volume (p = 0.001). The RNFL in MS N-ON was also associated with a reduction of BPF and %gm fraction (p = 0.01, p = 0.02 respectively). In MS-ON there was a much weaker, non-significant correlation between RNFL thickness and T1, T2 volume, BPF, %gm and %wm fractions that might have resulted from a pronounced post-inflammatory local optic nerve atrophy in AE. CONCLUSION : The RNFL measured by OCT may be useful as a surrogate marker for assessment of brain atrophy in MS.     

A comparison of health-related quality of life in autonomic disorders: postural tachycardia syndrome versus vasovagal syncope

Purpose

Postural tachycardia syndrome (POTS) and vasovagal syncope (VVS) are two disorders of orthostatic intolerance which are often misdiagnosed as the other. In each case, patients experience a reduced health-related quality of life (HRQoL) compared to healthy populations. This study was conducted to test the hypothesis that HRQoL is worse in POTS.

Methods

POTS patients were recruited from the Dysautonomia International Annual Patient and Caregiver Conference. VVS patient data came from those enrolled in the Second Prevention of Syncope Trial. Participants aged?≥?18 years (177 POTS and 72 VVS) completed the RAND 36-Item Health Survey, a generic and coherent health-related quality of life survey.

Results

POTS patients reported reduced HRQoL compared to VVS patients in physical functioning (42.5?±?1.7 vs. 76.5?±?2.9, p?<?0.001), role limitations due to physical health (11.4?±?1.9 vs. 33.0?±?5.0, p?<?0.001), energy and fatigue (27.2?±?1.3 vs. 50.7?±?2.6, p?<?0.001), social functioning (45.2?±?1.8 vs. 71.2?±?2.9, p?<?0.001), pain (48.8?±?1.9 vs. 67.7?±?2.9, p?<?0.001), and general health (31.2?±?1.5 vs. 60.5?±?2.6, p?<?0.001) domains. Scores did not differ significantly in the role limitations due to emotional health (p?=?0.052) and emotional well-being (p?=?0.271) domains. Physical and general health composite scores were lower in the POTS population, while mental health composite scores were not different.

Conclusion

Differences in HRQoL exist between these patient populations. POTS patients report lower scores in physical and general health domains than VVS patients, but emotional health domains do not differ significantly. Targeting physical functioning in these patients may help improve quality of life.

     

Optical coherence tomography in optic neuritis and multiple sclerosis: a review

Optical coherence tomography (OCT) is a new noninvasive high-resolution method that measures the retinal nerve fiber layer (RNFL) thickness. An overview of the use in optic neuritis (ON) and multiple sclerosis (MS) is presented. Literature survey of PubMed was carried out. RNFL thickness in eyes of healthy control subjects was 102.9–111.11  μ m, in eyes affected by ON 59.79–85  μ m, and in fellow eyes 82.73–99.8  μ m. All studies found a significant reduction in RNFL in eyes affected by ON compared with fellow eyes and eyes of healthy controls. Two out of three studies found a significant reduction in RNFL in fellow eyes compared with control eyes. RNFL thickness correlated with visual acuity, visual field, low-contrast letter acuity, contrast sensitivity, and color vision. Correlations were also found with the optic nerve area evaluated by magnetic resonance imaging, neurologic impairment score, and increasing disease duration. One of two studies found a significant correlation with amplitudes of visual evoked potentials, neither correlated with latencies. OCT is a promising new tool for evaluating atrophy in patients with ON and MS.     

The association between retinal nerve fibre layer thickness and corpus callosum index in different clinical subtypes of multiple sclerosis

The objective of this paper is to evaluate the association between physical disability in multiple sclerosis (MS) patients, the thickness of the retinal nerve fibre layer (RNFL) and corpus callosum volumes, as expressed by the corpus callosum index (CCI). This study was based on a cohort of 212 MS patients and 52 healthy control subjects, who were age and gender matched. The MS patients included 144 women and 177 relapsing-remitting MS (RRMS) patients. Peripapillary and volumetric optical coherence tomography (OCT) scans of the macula were performed using spectral-domain OCT technology. All magnetic resonance imaging (MRI) scans were performed using 1.5-T systems. CCI and RNFL were lower in MS than healthy control subjects (0.341 versus 0.386, p < 0.01 and 92.1 versus 105.0, p < 0.01). In addition, CCI correlated with RNFL (r = 0.464, p < 0.01). This was also true for the subgroup of patients with no history of optic neuritis (ON). There is a correlation between the thickness of the RNFL and CCI values in MS patients with no history of ON, which suggests that OCT might be a suitable marker for neurodegeneration in MS clinical trials.     

Cognitive and physical disability in Egyptian patients with multiple sclerosis: genetic and optical coherence tomography study

ABSTRACT

Objectives: The aim of this study was to explore the relationship between cognitive dysfunction, neurodegeneration, and genetic factors among multiple sclerosis (MS) patients.

Methods: Fifty patients of definite MS were included. Physical disability was assessed by expanded disability status scale (EDSS). Cognitive functions were assessed by using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). For each eye, optical coherence tomography (OCT) was used to track thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), respecting the previous history of optic neuritis (ON). All patients were genotyped for glutamate N-methyl-D-aspartate receptors (NMDARs).

Results: A statistically significant negative correlation was found between scores of EDSS and each of neuropsychological tests scores and thickness of both RNFL and GCC. The predictor for progressive disability assessed by EDSS was Symbol Digit Modalities Test (SDMT) (P = 0.021), that is dependent on the educational level of the patients (P = 0.016). A statistically significant positive correlation was found between scores of all neuropsychological tests and the thickness of both RNFL and GCC. Eighty-three percent of MS patients with CC genotype reported previous attacks of ON with significant thinning in RNFL and GCC despite their higher cognitive performance in comparison to other genotypes.

Discussion: Deficit in information processing speed measured by SDMT is a predictor of early progressive disability in MS patients. Thinning of RNFL and GCC is a potential biomarker for cognitive and physical disability in MS. The CC genotype of glutamate NMDAR gene has a divergent effect on visual and cognitive functions.     

Childhood traumas in euthymic bipolar disorder patients in Eastern Turkey and its relations with suicide risk and aggression

Abstract

Purpose: The aim of this study was to determine the relationship between childhood trauma and aggression-suicidal behavior in patients with bipolar disorder.

Material and Methods: A total of 112 outpatients diagnosed with bipolar disorder in remission in the province of Siirt on the east coast of Turkey were included in this study carried out between January and June 2018. Personal Information Form, Childhood Trauma Questionnaire (CTQ), Buss–Perry Aggression Scale (BPAS) and Suicide Probability Scale (SPS) were used for data acquisition.

Results: It was determined that patients with bipolar disorder have 89.3% of physical neglect, 74.1% of emotional neglect, 75.9% of physical abuse, 79.5% of emotional abuse and 40.2% of sexual abuse. The mean score of CTQ was 66.8?±?19.2, the total score of BPAS was 94.6?±?28.8 and the total score of SPS was 85.3?±?17.9. A statistically significant and positive correlation was determined between CTQ, BPAS and SPS (p?<?0.05).

There was a weak and positive relationship between BPAS, CTQ (r?=?0.325**; p?<?0.05) and subscales of CTQ which are emotional abuse (r?=?0.350**; p?<?0.05), physical abuse (r?=?0.354**; p?<?0.01), physical neglect (r?=?0.313**; p?<?0.01) and emotional neglect (r?=?0.316**; p?<?0.01). A statistically significant difference was observed between the regular use of drugs, violence against others and total score of CTQ, BPAS and SPS (p?<?0.05).

Conclusion: It is suggested that patients diagnosed with bipolar disorder should be evaluated with regards to childhood trauma history by taking into consideration sociodemographic characteristics and psychiatric support in order to prevent their aggression and suicide attempts.     

Evaluation of the retinal changes in patients with chronic migraine

The aim of this study was to investigate retinal nerve fiber layer (RNFL) thickness and macular changes (central subfield thickness, cube average thickness, cube volume) in patients with chronic migraine (CM) without visual impairment using spectral-domain optical coherence tomography (SD-OCT) and to compare the results to healthy controls. A total of 80 subjects, including 40 CM patients (18 females, 12 males, at 19–36 years of age) with no migraine prophylactic treatment and 40 healthy controls (16 females, 14 males, at 20–40 years of age) were enrolled. Both eyes of patients with CM and controls were imaged using Cirrus HD SD-OCT (Carl Zeiss Meditec, Dublin, CA, USA). The average RNFL thickness was not significantly thinner in patients with CM. The mean average RNFL thickness was 83 ± 10.5 μm in CM patients and 85 ± 9.6 μm in healthy controls (p = 0.648), but superior quadrant RNFL thickness in the CM patients was significantly lower than healthy controls. The mean superior RNFL thickness was 86 ± 6.7 μm in CM patients and 108 ± 7.3 μm in controls (p < 0.001). Illness duration and frequency of the attacks were not affected by RNFL thickness. No significant differences were detected in macular changes between CM patients and healthy controls. In our study, the thickness of superior RNFL was found to be thinner in CM patients. This implies that longitudinal follow-up is needed to clarify whether RNFL thinning, in migraine patients, is related to a progressive loss of axons and retinal ganglion cells.     

Disruption of the network between Onuf’s nucleus and myenteric ganglia,and developing Hirschsprung-like disease following spinal subarachnoid haemorrhage: an experimental study

Abstract

Purpose/Aim of the study: Auerbach/Meissner network of lower abdominopelvic organs managed by parasympathetic nerve fibres of lumbosacral roots arising from Onuf’s nucleus located in conus medullaris. Aim of this study is to evaluate if there is any relationship between Onuf’s nucleus ischemia and Auerbach/Meissner network degeneration following spinal subarachnoid haemorrhage (SAH).

Materials and Methods: Study was conducted on 24 male rabbits included control (Group I, n?=?5), serum saline-SHAM (Group II, n?=?5), and spinal SAH (Group III, n?=?14) groups. Spinal SAH performed by injecting homologous blood into subarachnoid space at Th₁₂–L₄ level and followed three weeks. Live and degenerated neuron densities of Onuf’s nucleus, Auerbach and Meissner ganglia (n/mm³) were determined by Stereological methods.

Results: The mean degenerated neuron density of Onuf’s nucleus was significantly higher in Group III than in Groups I–II (152?±?26, 2?±?1 and 5?±?2/mm³ respectively, p?<?0.005). The degenerated neuron density of Auerbach’s ganglia was significantly higher in Group III than in Groups I–II (365?±?112, 3?±?1 and 9?±?3/mm³ respectively, p?<?0.005). The degenerated neuron density of Meissner’s ganglia was significantly higher in Group III than in Groups I–II (413?±?132, 2?±?1 and 11?±?4/mm³ respectively, p?<?0.005).

Conclusions: Onuf’s nucleus pathologies should be considered as Auerbach/Meissner ganglia degeneration and also related Hirschsprung-like diseases in the future.     

Retinal atrophy using optical coherence tomography (OCT) in 15 patients with multiple sclerosis and comparison with healthy subjects

INTRODUCTION: Multiple sclerosis is a common disabling progressive neurological disorder. Axonal loss is thought to be a likely cause of persistent disability after a multiple sclerosis relapse. Retinal nerve fiber layer (RNFL) imaging by optical coherence tomography (OCT) seems to be a non-invasive way of detecting optical axonal loss following optic neuritis. OBJECTIVE: To determine whether multiple sclerosis affects retinal nerve fiber layer measurements obtained with optical coherence tomography (OCT3-Carl Zeiss Meditec, Dublin, California, USA). MATERIAL AND METHODS: Diagnosis of MS was based on the MacDonald criteria. The cohort was divided into two groups based on their clinical course (multiple sclerosis with [n=8; 16 eyes] or without [n=7; 14 eyes] optic neuritis antecedents). The disease-free controls were matched for age and gender (n=15; 30 eyes). Retinal nerve fiber layer thickness was measured using optical coherence tomography (OCT; fastRNFL and RNFL thickness software protocol). Visual acuity, visual field, color vision were also noted. RESULTS: There were highly significant reductions (p<0.001) of retinal nerve fiber layer thickness in affected patients (with or without optic neuritis antecedents) compared with control eyes (fastRNFL and RNFL procedures). Visual acuity, visual field and color vision were globally less altered than OCT. There were no significant relationships among RNFL thickness and visual acuity, visual field, or color vision. CONCLUSION: This study has demonstrated the anatomic changes of the retinal nerve fiber layer of patients with multiple sclerosis with optic neuritis antecedents. Thus axonal loss following optic neuritis can be detected with OCT. But the retinal nerve fiber layer of patients without optic neuritis is also thinner than disease-free controls so that chronic optic axonal loss can be frequent in multiple sclerosis. Additionally, OCT was more sensitive than the common ophthalmological explorations to detect optical nerve impairment during multiple sclerosis. Finally, we demonstrated that two procedures fastRNFL and RNFL could be used to detect optic nerve impairment.     

Clinical characteristics of myelin oligodendrocyte glycoprotein seropositive optic neuritis: a cohort study in Shanghai,China

Qualitative and quantitative visual outcomes of Asian optic neuritis (ON) patients with seropositive myelin oligodendrocyte glycoprotein (MOG) antibodies remain unknown. We retrospectively evaluated a cohort of new-onset ON patients in Shanghai, China between January 2015 and December 2016. Serum MOG and aquaporin-4 (AQP4) antibodies were detected using cell-based assays, and patients were followed-up for at least 6 months. The clinical characteristics and optical coherence tomography (OCT) results were evaluated in the MOG-seropositive optic neuritis (MOG-ON), AQP4-seropositive (AQP4-ON), and double seronegative (Seronegative-ON) patients. Best-corrected visual acuity (BCVA) and peripapillary retinal nerve fiber layer (RNFL) thickness after 6 months of follow-up were compared. Among MOG-ON (n = 49, 64 eyes), AQP4-ON (n = 76, 102 eyes), and Seronegative-ON patients (n = 100, 116 eyes), the percentages of BCVAs better than 0.8 (20/25) at the 6-month visit were 67.19, 19.60, and 72.41%, respectively, which showed no statistical difference between MOG-ON and Seronegative-ON patients (p = 0.198), but were better than the AQP4-ON patients (P = 0.001). The average peripapillary RNFLs measured 6 months after the attack were 58.03 ± 8.73, 64.34 ± 12.88, and 78.12 ± 13.34 μm for the MOG-ON, AQP4-ON, and Seronegative-ON patients, respectively. There was no statistical difference between MOG-ON and AQP4-ON patients (P = 0.089), but both were thinner than Seronegative-ON patients (P = 0.001). The visual acuity in MOG-ON patients was as good as Seronegative-ON patients, whereas the RNFL of the optic nerve head showed a significant thinning as in the AQP4-ON patients.     

Does metabolic status affect serum levels of BDNF and MMP-9 in patients with schizophrenia?

Abstract

The purpose of the article: Brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) are involved in the processes of neurogenesis, synaptic plasticity, learning and memory. Growing number of studies shows a relationship between BDNF or MMP-9 and schizophrenia. Also, BDNF and MMP-9 levels may be affected by metabolic parameters, such as obesity or dyslipidemia. Our hypothesis is that alterations of BDNF or MMP-9 levels in schizophrenia might be secondary to metabolic abnormalities, often found among schizophrenia patients.

Materials and methods: We have compared BDNF and MMP-9 between patients with schizophrenia (n?=?64, age 49?±?8.2?y) and healthy controls (n?=?32, age 51?±?8.9?y) in the context of cardio-metabolic parameters. Serum levels of BDNF and MMP-9 were measured using ELISA test, body composition parameters were determined using bioelectric impedance analysis.

Results and conclusions: Our results showed significantly lowered serum BDNF concentration in the schizophrenia group (schizophrenia: 23.8?±?7.83?ng/mL, control: 27.69?±?8.11?ng/mL, p?=?0.03). Serum MMP-9 concentration in schizophrenia group did not differ compared with the control group (schizophrenia: 456.8?±?278.4?ng/mL, control: 341.5?±?162.4?ng/mL, p?=?0.07). After adjusting for age, all anthropometric parameters, body composition and laboratory tests BDNF were still significantly lower in the schizophrenia group. However, MMP-9 became significantly elevated in the schizophrenia group after adjusting for several anthropometric and body composition covariates. Our results confirmed reduced serum BDNF concentration in patients with schizophrenia. Also, this reduction seems to be independent of metabolic abnormalities. On the other hand, our hypothesis that MMP-9 level in schizophrenia is altered due to metabolic abnormalities might be true.     

Cardiovascular adjustments to cold pressor test in postmenopausal women and the impact of α1-adrenergic blockade

Purpose

We investigate the impact of menopause on cardiovascular adjustments to the cold pressor test (CPT) and the role of the α1-adrenergic receptor.

Methods

Ten young women (YW) and nine postmenopausal women (MW) underwent 1 min of CPT in control and α1-blockade conditions (0.03 mg?kg^?1 of oral prazosin).

Results

CPT increased heart rate (HR) (YW: ?20?±?3 bpm; MW: ?13?±?2 bpm) and stroke volume (SV; YW: ?15?±?8 ml; MW: ?9?±?6 ml; p?=?0.01 for time) and evoked a greater increase in cardiac output (CO) in YW (YW: ?2.1?±?0.2 l?m^?1; MW: ?1.3?±?0.5 l?m^?1; p?=?0.01). α1-Blockade increased baseline HR and did not change HR, SV, and CO responses to CPT. MW presented an exaggerated systolic blood pressure (BP) response (YW: ?38?±?9 mmHg; MW: ?56?±?24 mmHg; p?=?0.03). The α1-blockade did not change baseline BP while blunting its response. Total vascular resistance (TVR) was similar between groups at baseline and increased during CPT only in MW (YW: ?2.3?±?1.4 mmHg?L^?1?min; MW:?6.8?±?5.9 mmHg?L^?1?min). Under α1-blockade, the TVR increase during CPT was attenuated in MW and abolished in YW (YW: ?0.3?±?1.2 mmHg?L^?1?min and MW: ?3.0?±?2.0 mmHg?L^?1?min). CPT did not change femoral vascular conductance (FVC) in either group before the blockade (YW: ??0.3?±?4.0 ml?min^?1?mmHg^?1; MW: ??0.2?±?0.8 ml?min^?1?mmHg^?1); however, FVC tended to increase in young women (YW: ?1.3?±?1.0 ml?min^?1?mmHg^?1; MW: ?0.1?±?1.5 ml?min^?1?mmHg^?1; p?=?0.06) after the α1-blockade.

Conclusion

In postmenopausal women, the cardiac ability to adjust to CPT is blunted and α1-adrenergic receptor stimulation is important for the increase in stroke volume. In addition, the peripheral effect of α1-adrenergic receptor stimulation seems to be increased in postmenopausal women.

     

Imaging of the optic disc and retinal nerve fiber layer in acute optic neuritis

PURPOSE: To demonstrate whether optical coherence tomography (OCT-3) and scanning laser ophthalmoscopy (HRT-2) can be used to measure changes of the optic disc and peripapillary retinal nerve fiber layer (RNFL) in eyes with acute retrobulbar optic neuritis that have no clinically apparent optic disc swelling. To correlate these findings with presentation magnetic resonance imaging (MRI) of the affected optic nerve. METHODS: Eight consecutive patients with acute retrobulbar optic neuritis, who had no prior optic neuritis in either eye, were prospectively investigated at presentation and at between 1 and 3 months with clinical examination, OCT-3, HRT-2. At presentation, MRI of the optic nerves were performed in 7/8 patients. RESULTS: Compared to unaffected eyes, affected eyes without clinically seen optic disc swelling at baseline, there was a non-significant trend to increased thickness in the total RNFL, superior and nasal measurements. Baseline HRT in affected eyes showed smaller mean cup to disc ratio (p=0.003) and a smaller cup area (p=0.002) compared with the unaffected eye. The MRI-demonstrated optic nerve lesion did not correlate with OCT RNFL thickening or HRT decrease of the physiological cup. Follow-up imaging of the affected eyes showed normalization of HRT cup size parameters and OCT RNFL thickness (p<0.04). At follow-up, the temporal RNFL had thinning in 7/8 affected eyes (46.8 mum, p=0.021) compared with fellow unaffected eyes (57.8 mum), which did not change. CONCLUSION: OCT-3 and HRT demonstrate mild RNFL thickening or optic disc swelling in acute optic neuritis, even when swelling is not seen clinically. OCT-3 appears to reveal measurable RNFL thinning in the temporal quadrant after retrobulbar optic neuritis, even though vision improves. RNFL imaging may be useful in future studies of residual injury after optic neuritis.     

Levels of C-reactive protein (CRP) in elderly patients with unipolar depression – case control analysis

Aim: C-reactive protein (CRP) is the major acute-phase plasma protein. Studies show that patients with depression have elevated levels of CRP. The aim of the study was to determine differences in CRP serum level in elderly patients with unipolar depression (DEP) compared with non-depressed elderly patients (nonDEP) using case-control analysis.

Methods: Serum level of CRP was measured in 404 (DEP: n?=?202, nonDEP: n?=?202) Caucasian inpatients aged ≥60 (350 women, 86.7%; mean age?=?76.7 years).

Results: Mean CRP level in the study groups was: DEP 2.67?±?2.56?mg/dL, nonDEP 2.41?±?2.19?mg/dL, the difference was not significant (p?=?0.96). The overall rate of being above the high level of CRP (set at 3.0?mg/L) was 33.2% for DEP and 29.2% for nonDEP groups (p?=?0.39). It was also found that, in the whole study group, CRP level was not correlated with age (p?=?0.10).

Conclusions: Elderly patients with depression have no increased CRP levels. A high percentage (～30%) of all subjects had a CRP level >3?mg/L, which is the cut-off point for increased cardiovascular risk.     

Effect of pulmonary vein isolation on the relationship between left atrial reverse remodeling and sympathetic nerve activity in patients with atrial fibrillation

Purpose

Catheter ablation (CA) to isolate the pulmonary vein, which is an established treatment for atrial fibrillation (AF), is associated with left atrium reverse remodeling (LARR). The intrinsic cardiac autonomic nervous system includes the ganglion plexi adjacent to the pulmonary vein in the left atrium (LA). However, little is known about the effect of CA on the relationship between LARR and sympathetic nerve activity in patients with AF.

Methods

This study enrolled 22 AF patients with a normal left ventricular ejection fraction (LVEF) aged 64.6?±?12.9 years who were scheduled for CA. Sympathetic nerve activity was evaluated by direct recording of muscle sympathetic nerve activity (MSNA) before and 12 weeks after CA. Blood pressure, heart rate (HR), HR variability, and echocardiography were also measured.

Results

The heart rate increased significantly after CA (63?±?10.9 vs. 70.6?±?7.7 beats/min, p?<?0.01), but blood pressure did not change. A high frequency (HF) and low frequency (LF) of HR variability decreased significantly after ablation, but no significant change in LF/HF was observed. CA significantly decreased MSNA (38.9?±?9.9 vs. 28?±?9.1 bursts/min, p?<?0.01). Moreover, regression analysis revealed a positive correlation between the percentage change in MSNA and the LA volume index (r?=?0.442, p?<?0.05).

Conclusions

Our results show that CA for AF reduced MSNA and the decrease was associated with the LA volume index in AF patients with a normal LVEF. These findings suggest that LARR induced by CA for AF decrease sympathetic nerve activity.