Characterization of beta amyloid assemblies in drusen: the deposits associated with aging and age-related macular degeneration

PURPOSE: Recent studies strongly suggest that drusen, the extracellular deposits associated with age-related macular degeneration (AMD), are a manifestation of local inflammatory events. New evidence indicates that substructural elements within drusen contain activated complement components as well as amyloid beta (Abeta), a major pro-inflammatory component of Alzheimer's disease plaques. We characterized the ultrastructural organization and histochemical staining properties of these Abeta-containing elements in order to further assess their significance in drusen formation and AMD pathogenesis. METHODS: We used differential interference contrast optics, laser scanning confocal immunofluorescence, and immunogold electron microscopy to characterize the structural properties and molecular composition of Abeta-containing elements in drusen. We obtained estimates of their frequency from montages of electron micrographs gathered from 152 human donor eyes ranging from 9 to 91 years of age. RESULTS: Spherical Abeta-containing elements, which are typically organized as concentric ring-like structures, are common substructural components of drusen. They stain with thioflavin T, but are not stained by Congo red; nor do they bind cationic, lipophilic, or nucleic acid-binding fluorescent dyes. Ultrastructurally, they are composed of a central core, one or more concentric inner rings with intervening electron lucent layers, and an electron dense outer shell. Immunogold labeling indicates that most Abeta immunoreactivity is associated with the outer layers that consist of densely-packed spherical subunits. No longitudinally-oriented fibril arrays, characteristic of aggregated amyloid fibrils in the brain, are evident. Other prominent drusen-associated proteins including the terminal complement complex C5b-9, vitronectin, apolipoprotein E, serum amyloid P component, and ubiquitin are excluded from the spheres.Conclusions. These structures embedded in drusen appear to represent a new type of macromolecular assembly that contains Abeta as well as activated complement components. The presence of Abeta in these extracellular deposits is an additional indication that some of the pathogenic pathways that give rise to drusen and AMD may be shared with other neurodegenerative diseases characterized by misfolded protein deposition and aggregation.     

Retrospective and Current Risks of Mercury to Panthers in the Florida Everglades

Florida panthers are an endangered species inhabiting south Florida. Hg has been suggested as a causative factor for low populations and some reported panther deaths, but a quantitative assessment of risks has never been performed. This study quantitatively evaluated retrospective (pre-1992) and current (2002) risks of chronic dietary Hg exposures to panthers in the Florida Everglades. A probabilistic assessment of Hg risks was performed using a dietary exposure model and Latin Hypercube sampling that incorporated the variability and uncertainty in ingestion rate, diet, body weight, and mercury exposure of panthers. Hazard quotients (HQs) for retrospective risks ranged from less than 0.1-20, with a 46% probability of exceeding chronic dietary thresholds for methylmercury. Retrospective risks of developing clinical symptoms, including ataxia and convulsions, had an HQ range of <0.1-5.4 with a 17% probability of exceeding an HQ of 1. Current risks were substantially lower (4% probability of exceedences; HQ range <0.1-3.5) because of an estimated 70-90% decline in Hg exposure to panthers over the last decade. Under worst case conditions of panthers consuming only raccoons from the most contaminated area of the Everglades, current risks of developing clinical symptoms that may lead to death was 4.6%. Current risks of mercury poisoning of panthers with a diversified diet was 0.1% (HQ range of <0.1-1.4). The results of this assessment indicate that past Hg exposures likely adversely affected panthers in the Everglades, but current risks of Hg are low.     

Right ventricular myocardial responses to chronic pulmonary regurgitation in lambs: disturbances of activation and conduction

Patients after repair of tetralogy of Fallot are at increased risk of arrhythmic death. Clinical data suggest that pulmonary regurgitation predisposes to these arrhythmias, although the cellular electrophysiologic effects of pulmonary regurgitation are unknown. We induced pulmonary regurgitation in lambs, and 3 mo later, having quantified the pulmonary regurgitant (PR) fraction, studied right ventricular mechanical and electrophysiologic properties in vivo and in vitro. The PR fraction was greater in PR (75 +/- 10%) than in sham-operated animals (8 +/- 4%; p < 0.01). In vivo, monophasic action potential duration and activation time, at rest and during acute right ventricular stretch, were similar in both groups. However, the dispersion of activation time was greater in PR animals at rest (13 +/- 1.1 versus 8 +/- 1.1 ms; p < 0.05). Furthermore, the dispersion of activation increased during right ventricular stretch in PR, but not in sham-operated animals. In vitro, myocardial force-frequency responses were similar in both groups, indicating preserved systolic performance, but mechanical restitution studies showed a prolonged refractory period (447 +/- 22 versus 370 +/- 26 ms; p < 0.05) and a decreased recovery time constant (184 +/- 19 versus 265 +/- 20 ms; p < 0.001) in PR animals, indicating altered calcium cycling. Furthermore, the myocardial conduction velocity was reduced in PR animals (31 +/- 3.58 versus 47.9 +/- 5.1 cm/s; p < 0.01), resulting from a 2-fold increase in intracellular resistance (437.25 +/- 125.93 versus 194 +/- 43.27 Omega. cm; p = 0.025). Chronic PR leads to inhomogeneity of right ventricular activation, alters myocardial calcium cycling, reduces conduction velocity, and increases intracellular resistivity. These may contribute to the development of arrhythmias associated with PR, including those in patients after tetralogy repair.     

Predictors of door-to-balloon delay in primary angioplasty

In the treatment of acute myocardial infarction, delayed reperfusion therapy is associated with increased mortality. Predictors of delay have been described for fibrinolysis but not for primary percutaneous transluminal coronary angioplasty (pPTCA). Therefore, we studied 40,017 consecutive patients with acute myocardial infarction who underwent pPTCA in the National Registry of Myocardial Infarction between June 1994 and April 2000. Median door-to-balloon times were calculated, and factors independently associated with a delay of >120 minutes were determined by logistic regression. The median door-to-balloon time among all patients was 111 minutes (interquartile range 84 to 152). The proportion of patients with a delay of >2 hours was greater among those aged > or = 65 years (49% vs 41%), women (50% vs 42%), patients with contraindications to fibrinolysis (60% vs 41%), and those without chest pain on admission (61% vs 43%, all p <0.0001). Delay was also more common with transfer from another hospital (87% vs 38%), with presentation outside the hours of 8 A.M. to 4 P.M. (51% vs 38%), and in hospitals performing <49 pPTCAs/year (47% vs 41%, all p <0.0001). The strongest independent predictor of delay was hospital transfer, along with non-daytime presentation and low-volume centers. Older age, female sex, and non-white race were weaker predictors. Both patient and hospital factors are associated with delay in pPTCA after presentation. These findings may help design treatment algorithms to minimize delay, thus improving the survival benefit of pPTCA. These results may also help design trials of combination reperfusion strategies.     

Photoenhanced toxicity of aqueous phase and chemically dispersed weathered Alaska North Slope crude oil to Pacific herring eggs and larvae

The photoenhanced toxicity of weathered Alaska North Slope crude oil (ANS) was investigated in the eggs and larvae of Pacific herring (Clupea pallasi) with and without the chemical dispersant Corexit 9527. Oil alone was acutely toxic to larvae at aqueous concentrations below 50 microg/L total polycyclic aromatic hydrocarbons (tPAH), and median lethal (LC50s) and effective concentrations (EC50s) decreased with time after initial oil exposure. Brief exposure to sunlight (approximately 2.5 h/d for 2 d) significantly increased toxicity 1.5- to 48-fold over control lighting. Photoenhanced toxicity only occurred when oil was present in larval tissue and increased with increasing tPAH concentration in tissue. Ultraviolet radiation A (UVA) treatments were less potent than natural sunlight, and UVA + sunlight caused greater toxicity than sunlight alone. The toxicity of chemically dispersed oil was similar to oil alone in control and UVA treatments, but oil + dispersant was significantly more toxic in the sunlight treatments. The chemical dispersant appeared to accelerate PAH dissolution into the aqueous phase, resulting in more rapid toxicity. In oil + dispersant exposures, the 96-h no-observed-effect concentrations in the UVA + sunlight treatment were 0.2 microg/L tPAH and 0.01 microg/g tPAH. Exposure of herring eggs to oil caused yolk sac edema, but eggs were not exposed to sun and UVA treatment did not cause phototoxicity. These results are consistent with the hypothesis that weathered ANS is phototoxic and that UV can be a significant and causative factor in the mortality of early life stages of herring exposed to oil and chemically dispersed oil.     

Local cooling alters neural mechanisms producing changes in peripheral blood flow by spinal cord stimulation

This study was performed to investigate the respective role of sensory afferent and sympathetic fibers in peripheral vasodilatation induced by spinal cord stimulation at different hindpaw skin temperatures. Cooling the skin was used as a strategy to enhance sympathetic activity [Am. J. Physiol.: Heart Circ. Physiol. 263 (1992) H1197]. Cutaneous blood flow in the footpad of anesthetized rats was recorded using laser Doppler flowmetry. Local cooling (<25 degrees C) or moderate local cooling (25-28 degrees C) of the hindpaw was produced with a cooling copper coil. Spinal cord stimulation delivered at clinically relevant parameters and with 30%, 60%, and 90% of motor threshold induced the early phase of vasodilatation in the cooled and the moderately cooled hindpaw. In addition, spinal cord stimulation at 90% of motor threshold produced the late phase of vasodilatation only in the cooled hindpaw, which was possible to block by the autonomic ganglion-blocking agent, hexamethonium. The early responses to spinal cord stimulation in the moderately cooled hindpaw were not affected by hexamethonium. In contrast, both the early and the late phase responses were eliminated by CGRP (8-37), an antagonist of the calcitonin gene-related peptide receptor. After dorsal rhizotomy, spinal cord stimulation at 90% of motor threshold elicited hexamethonium-sensitive vasodilatation in the cooled hindpaw (late phase). These results suggest that spinal cord stimulation-induced vasodilatation in the cooled hindpaw (<25 degrees C) is mediated via both the sensory afferent (early phase of vasodilatation) and via suppression of the sympathetic efferent activity (late phase) although the threshold for vasodilatation via the sympathetic efferent fibers is higher than that via sensory nerves. In contrast, vasodilatation via sensory afferent fibers may predominate with moderate temperatures (25-28 degrees C). Thus, two complementary mechanisms for spinal cord stimulation-induced vasodilatation may exist depending on the basal sympathetic tone.     

A model for public health workforce development using the National Public Health Performance Standards Program.

Workforce development programs in public health should link improvements in workers' performance with improvements in their agencies' performance. The "ten essential services" of public health provide criteria for measuring both individual worker training (as in workforce competency standards) and agency performance (as in the Centers for Disease Control and Prevention's National Public Health Performance Standards Program). This shared foundation was the basis for a model strategic training program developed for use in a 500-employee urban county health department. Full implementation of this model as a foundation for assessment, curriculum development, and evaluation requires careful attention to management issues, confidentiality of employee records, and evaluation methodologies.