Effect of hydrodissection on intraoperative performance: randomized study

PURPOSE: To evaluate the effect of hydrodissection on intraoperative performance during phacoemulsification of age-related nuclear cataracts. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: In a prospective study, 86 eyes were randomly assigned to have multiquadrant hydrodissection (+HD, n = 48) or no hydrodissection (-HD, n = 38) during phacoemulsification of a grade 1 to 3 nuclear cataract. Excluded were patients with grade 4 or 5 nuclear sclerosis, a poorly dilating pupil, or associated ocular/systemic disease. Parameters assessed were nucleus and cortex removal time, the amount of fluid used for cortex removal, and the total amount of fluid used. The ease of nucleus rotation and cortical cleanup was also evaluated and graded subjectively as very easy, difficult, or very difficult. Data were analyzed using the Student t test and the chi-square test. RESULTS: The mean nucleus removal time was 355 seconds +/- 237 (SD) and 474 +/- 212 seconds in the +HD and -HD groups, respectively (P =.09). The mean cortex removal time was significantly less in the +HD group than in the -HD group (79 +/- 51 seconds and 220 +/- 222 seconds, respectively) (P =.007). Significantly less fluid (43%) was used for cortex removal in the +HD group than in the -HD group (mean 70 +/- 45 mL and 123 +/- 82 mL, respectively) (P =.013), and significantly less total fluid (35%) was used in the +HD group (312 +/- 132 mL and 422 +/- 80 mL, respectively) (P =.002). Nucleus rotation was easy in all eyes in the +HD group; 68.43% of eyes in the -HD group failed to achieve rotation (P =.001). Cortex removal was very easy in 52.08% of eyes in the +HD group and easy in 47.90%; it was easy in 52.63% in the -HD group, difficult in 36.84%, and very difficult in 10.52%. CONCLUSION: The use of multiquadrant cortical-cleaving hydrodissection made removal of the lens nucleus and cortex easier and faster during phacoemulsification of age-related nuclear cataracts.     

Permanent blue discoloration of a hydrogel intraocular lens by intraoperative trypan blue

A 79-year-old white man had cataract surgery in the right eye with implantation of an Acqua intraocular lens (IOL) (Mediphacos). Trypan blue 0.1% was used during surgery to stain the anterior capsule and enhance the contrast during capsulorhexis. Seven days after surgery, the patient presented with "dark and double" vision (monocular diplopia). The IOL was decentered superiorly and appeared dark blue. The lens was explanted 2 months after surgery and sent for gross and microscopic analyses in a dry state and after hydration. The same analyses were performed on 2 unused lenses of the same design that had been immersed in diluted trypan blue solutions (0.01% and 0.001%). On the explanted lens, the dark blue staining was denser in the optic, especially in its periphery. The blue discoloration could not be removed after 24 hours of lens immersion in a balanced salt solution at 37 degrees C. Permanent staining of the unused lenses was also obtained after immersion in the trypan blue solutions.     

Novel cyclic templates of alpha-MSH give highly selective and potent antagonists/agonists for human melanocortin-3/4 receptors

In an effort to develop highly selective and potent agonists and/or antagonists for the hMC3 and hMC4 receptors, a new approach involving the use of linker arms and a backbone to side chain cyclization strategy was employed. Three key analogues were identified to have the required selectivity and potency at the hMC3 or hMC4 receptors, implicated to play pivotal roles in energy homeostasis and other biological effects. The novel cyclic peptide (O)C-CH(2)-CH(2)-C(O)-c-[His(6)-D-Phe(7)-Arg(8)-Trp(9)-Lys(10)]-NH(2) (1) was found to be a highly selective and potent agonist of the hMC4 receptor. Structure-activity studies have shown that replacing the succinyl linker arm of 1 by an o-phthalic acid group and substituting a D-Nal(2')(7) residue in place of D-Phe(7) results in a potent antagonist 7 at the hMC4 receptor. Furthermore, increasing the 23-membered lactam ring of 1 by one carbon atom (succinyl --> glutaric acid linker) gives a highly selective and potent antagonist 9 for the hMC3 receptor. Analogues 1, 7, and 9 therefore represent the first examples of a class of cyclic melanotropin ligands with high selectivity and defined biological activities at the physiologically important hMC3 and hMC4 receptors.     

Exploring the site of anorectic action of peripherally administered synthetic melanocortin peptide MT-II in rats

Melanotan-II (MT-II), a cyclic heptapeptide, is a potent, non-selective melanocortinergic agonist. When administered centrally or systemically, MT-II elicited a profound inhibitory effect on food intake in rodents, presumably via activation of melanocortin-4-receptor (MC4R). In this study, we sought to investigate whether penetration of MT-II and iodo-MT-II into brain parenchyma is required for the anorectic effect following intravenous (IV) administration. Firstly, both MT-II and iodo-MT-II were effective at suppressing appetite in rats following their IV administration. We next surveyed by in vitro autoradiographic studies the distribution of selective (125)I-MT-II binding sites in multiple brain regions including areas important for feeding regulation such as the hypothalamus and caudal brainstem. Upon IV administration of (125)I-MT-II, significant radioactivity could not be detected in various brain regions by autoradiography except for a group of circumventricular organs (CVOs), which are anatomically situated outside the blood-brain barrier (BBB). The most intensely labeled CVOs include the subfornical organ, median eminence, area postrema and choroid plexus, and accumulation of radioactivity at these sites can be blocked by co-injection of excess unlabeled MT-II. Direct measurement of MT-II in the brain and plasma by LC-MS-MS following IV injection confirmed that the degree of MT-II penetration into the brain is negligible. Furthermore, when given peripherally under conditions that suppressed food intake, MT-II did not result in a detectable induction of c-Fos-like immunoreactivity in brain regions where a significantly elevated c-Fos expression was observed following intracerebroventricular injection of this peptide. Our results indicate that MT-II has a very limited brain penetration capability, and its effect on feeding behavior following systemic administration may be mediated by either the brain regions in close proximity to the CVOs or sites outside of the BBB, including CVOs or other peripheral systems.     

Vitamin E and carotene status in pre-eclamptic pregnant women from India

BACKGROUND:The imbalance between oxidative stress and the protective antioxidant system of the body enhanced the free radical mediated membrane lipid peroxidation and possibly the vascular endothelial damage due to peroxidation plays a major role in the aetiology of pre-eclampsia. With present day awareness on micronutrient antioxidants, we did investigate vitamin E and carotene status in Indian pre-eclamptic pregnant and full term normotensive pregnant women. Fresh vegetables and oils are considered to be good sources of vitamin E and carotene. The subjects were used to have good intake of fresh vegetable and oil as per Indian standard prescribed by Indian council of Medical research (ICMR) for this sub-continent. METHODS: The blood samples were processed for RBC vitamin E, serum carotene and serum cholesterol analysis. Routine laboratory tests like hemogram, serum urea, urate, malonyldialdehyde, urine sugar and albumin were performed. RESULTS: All pregnant subjects, both cases and control were maternal and gestational age matched. Routine check up showed no significant differences in means of white blood cell count, Hb/hematocrit and platelets. Serum urate and malonyldialdehyde were significantly raised in pre-eclamptic cases. The severely affected pre-eclamptic cases (diastolic BP >100 mmHg with proteinuria 2+ and more) showed markedly low levels of vitamin E and carotene whereas their levels were comparable between mild cases (diastolic BP <100 mmHg with+/-trace albuminuria) and normotensive pregnant control. CONCLUSIONS: The study concluded that the levels of vitamin E and carotene were markedly lowered in severe pre-eclamptic pregnant women from India. The mild pre-eclamptic cases did not show noticeable changes from that of control pregnant women. Further studies are needed to verify their therapeutic and prophylatic roles against pre-eclamptic complication suring pregnancy.     

SH2D1A expression in Burkitt lymphoma cells is restricted to EBV positive group I lines and is downregulated in parallel with immunoblastic transformation

The SH2 domain containing SH2D1A protein has been characterized in relation to the X-linked lymphoproliferative disease (XLP), a primary immunodeficiency that leads to serious clinical conditions after Epstein-Barr virus (EBV) infection. The SH2D1A gene is mutated in the majority of XLP patients. We previously detected SH2D1A in activated T and NK cells, but not in B lymphocytes. We have found SH2D1A protein in Burkitt lymphoma (BL) lines, but only in those that carried EBV and had a Group I (germinal center) phenotype. All the EBV-carrying Group III (immunoblastic) and the EBV-negative BL lines tested were SH2D1A-negative. Motivated by these differences, we studied the impact of EBV and the cellular phenotype on SH2D1A expression. We approached the former question with BL sublines after both the loss of the virus and subsequent reinfection. We also tested original EBV-negative BL lines carrying transfected EBV genes, such as EBNA1, EBNA2, EBNA6, EBER1, 2 and LMP1, respectively. In our experiments, no direct relationship could be seen between EBV and SH2D1A expression. We modified the phenotype of the Group I BL cells by LMP1 transfection or CD40 ligation. The phenotypic changes, indicated by expression of immunoblastic markers, e.g., SLAM, were accompanied by downregulation of SH2D1A. It seems, therefore, that the presence of EBV and the phenotype of the cell together regulate SH2D1A expression in the BL cells. It is possible that SH2D1A is expressed in a narrow window of B cell development represented by germinal center cells.     

Asymptomatic spontaneous rupture of suprasellar dermoid cyst: a case report

Suprasellar dermoid cysts are uncommon intracranial lesions. CT and MRI findings in a rare case of asymptomatic rupture of suprasellar dermoid cyst with subarachnoid dissemination is described.