A safety and feasibility study of the use of 670 nm red light in premature neonates.

OBJECTIVE: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina affecting extremely preterm or low birth weight infants The aim of this study was to assess the feasibility and safety of 670 nm red light use in a neonatal intensive care unit. STUDY DESIGN: Neonates <30 weeks gestation and <1150 g were enrolled within 48 h of birth. Data collected included cause of preterm delivery, Apgar scores and birthweight. 670 nm red light was administered for 15 min per day from a distance of 25 cm, delivering 9 J cm(-)(2), from the time of inclusion in the study until 34 weeks postmenstrual age. Infants were assessed daily for the presence of any skin burns or other adverse signs. RESULT: Twenty-eight neonates were enrolled, seven 24 to 26 weeks and twenty-one 27 to 29 weeks gestation. The most common cause for preterm delivery was preterm labor (14/28) with five of these having evidence of chorioamnionitis. There were no skin burns or other documented adverse events. Entry into the study was readily achieved and treatment was well accepted by parents and nursing staff. CONCLUSION: 670 nm red light appears to be a safe and feasible treatment for further research in respect to ROP.

Electroretinogram changes associated with retinal upregulation of trophic factors: observations following optic nerve section.

The purpose of the present work was to assess whether upregulation of trophic factors and protection from damage induced in the retina by optic nerve section are associated with changes in the flash electroretinogram (ERG). We have examined the ERG in adult pigmented rat at different survival times over a period of 3 months following section of the optic nerve. The a-wave was analyzed using the Lamb-Pugh model and the parameters of best fit were estimated in control animals and at successive survival times. The amplitudes of the a- and b-waves were reduced over the first 7 days after nerve section. The a-wave recovered its relative amplitude by 21 days, but the b-wave remained depressed 5 weeks following nerve section. Analysis of the a-wave indicated a 20-30% reduction in the dark current of sectioned eyes at 7 days survival. A significant reduction of the amplification constant was observed in both nerve-sectioned and nerve-intact eyes, relative to normal and sham-operated controls. This reduction persisted to the longest survival time examined. The reduction of the a-wave at 7 days after nerve section coincides with a period of upregulation of ciliary nerve trophic factor. The amplification factor is influenced over a longer time course, which corresponds with a period of up-regulation of basic fibroblast growth factor. These changes in growth factor expression and ERG parameters are in turn associated with protection of photoreceptors against light damage. Present results suggest that the sensitivity of the retina to light may be regulated by mechanisms which protect photoreceptors against stress.

Evaluation of sporadic cases of odontogenic keratocysts in multicentric study.

The aim of this retrospective study was to report frequency of sporadic odontogenic keratocysts (sOKC) according to the age and gender, as well as location (mandible, maxilla, soft tissues, and maxillary sinus). Four hundred and twenty nine sOKC confirmed pathohistologically in a period from 1965-1998 were included in this study. The average age of patients with sOKC was 43.11 (age range 10-91), in males 42.06 and in females 44.72 years. More frequently sOKC were found in males (60.61%) in comparison to the females (39.39%). Therefore, ratio between males and females was 1.5:1. Diagnosis of sOKC is usually established in patients aged 21-30 (18.88%), in males usually aged between 21-30 (23.46%), and in females aged between 11-20 (18.93%). sOKC are more frequent in males according to the age groups, except between age 61-70 where sOKC were more frequent in females. Most frequently, sOKC occurred in the mandible 70.16%, 12.35% of sOKC were found in the maxilla, 12.82% in soft tissues and 4.66% in the maxillary sinuses.

Cellular and subcellular patterns of expression of bFGF and CNTF in the normal and light stressed adult rat retina.

This study compared the distributions in the normal and light stressed rat retina of the neuroprotective factors bFGF (basic fibroblast growth factor) and CNTF (ciliary neurotrophic factor). Albino Sprague-Dawley rats were raised in cyclic light and some were exposed to bright continuous light for 48 hr, to induce light damage of photoreceptors. Their retinas were prepared as cryosections, immunolabelled with antibodies to bFGF and CNTF and analysed by confocal microscopy. Both factors were prominent in macroglial cells (astrocytes, Müller cells) and the retinal pigment epithelium (RPE). In the somas of these cells the distributions of the two factors were complementary, with bFGF concentrated in the nuclei and CNTF in the cytoplasm. Both factors were distributed along the processes of macroglial cells, in granular form. CNTF was not detected in neurones, but bFGF was consistently present in the cytoplasm of ganglion cell somas and, in regions of retina subject to stress, in the cytoplasm of photoreceptors. bFGF was not detected in the nuclei or processes of neurones. In retina stressed by light exposure or proximity to the anterior edge of the retina, the levels of bFGF and CNTF were up-regulated, without major changes in localization. Macroglial cells (Müller cells, astrocytes) play a major role in distributing bFGF and CNTF throughout the retina. The different localizations of the two factors within the somas of macroglial, RPE and photoreceptor cells, suggest that their protective actions are exerted by distinctive mechanisms.

Effects of oxygen and bFGF on the vulnerability of photoreceptors to light damage.

PURPOSE: To test whether tissue oxygen levels affect the vulnerability of photoreceptors to damage by bright continuous light (BCL). METHODS: Albino rats were raised in standard conditions of cyclic light (12-hour light, 12-hour darkness) with the light level at 5 to 10 lux or 40 to 65 lux. They were then exposed to BCL (1000-1400 lux), either continuously for 48 hours or for the day or night components of the 48-hour period. During BCL, some rats were kept in room air (normoxia, 21% oxygen), some in hypoxia (10%), and some in hyperoxia (70%). Their retinas were examined for cell death, for the expression of basic fibroblast growth factor (bFGF), and for response to light (electroretinogram, ERG). RESULTS: The death of retinal cells induced by BCL was confined to photoreceptors. Within the retina, the severity of death was inversely related to the level of bFGF immunolabeling in the somas of the outer nuclear layer (ONL) before exposure. The death of photoreceptors was accompanied by an upregulation of bFGF protein levels in the ONL and by a decline in the ERG. Both hypoxia and hyperoxia during BCL reduced the photoreceptor death, bFGF upregulation, and ERG decline caused by BCL. The protective effects of hyperoxia and hypoxia were evident during both the day and night halves of the daily cycle. Hypoxia or hyperoxia alone did not upregulate bFGF or ciliary neurotrophic factor (CNTF) expression in the retina. CONCLUSIONS: Photoreceptors are protected from light damage by hypoxia and hyperoxia during exposure. The protection provided by oxygen levels operates during both day and night. The protection is not mediated by an upregulation of bFGF or CNTF.

The impact of basic fibroblast growth factor on photoreceptor function and morphology.

PURPOSE: To assess the impact of basic fibroblast growth factor (bFGF) on photoreceptor function and morphology. METHODS: Impact was assessed in two models. In one, the endogenous expression of bFGF in photoreceptors was raised by sectioning one optic nerve of rats 3 to 4 weeks before study. In the other, bFGF was injected into the vitreous chamber in rats and cats. Retinal function was assessed from the electroretinogram (ERG), and retinal morphology was studied using DNA dyes, immunolabeling, and in situ hybridization. RESULTS: In both models of bFGF upregulation, the ERG b-wave was suppressed over a wide stimulus range and in light- and dark-adapted conditions. The a-wave was not suppressed by either procedure and at the brightest intensities was enhanced by both procedures. In nerve-sectioned eyes, outer retina appeared normal histologically, but levels of bFGF protein in the inner and outer nuclear layers were raised, whereas bFGF mRNA levels remained unchanged. In both models, levels of synaptophysin in the outer plexiform layer and of cytochrome oxidase in inner segments were raised in association with increases in bFGF protein levels. CONCLUSIONS: bFGF increased the ability of photoreceptors to respond to light but attenuated the transmission of this response to inner retinal cells, presumably by blocking the photoreceptor-bipolar synapse. If the expression of bFGF protein is upregulated in human photoreceptor dystrophies, it may contribute a reversible component to the loss of vision. The relationship between these actions of bFGF and its ability to protect photoreceptors from stress remains to be established.

Limiting photoreceptor death and deconstruction during experimental retinal detachment: the value of oxygen supplementation.

PURPOSE: To assess the role of hypoxia in causing the death and deconstruction of photoreceptors in detached retinas and the effectiveness of supplemental oxygen in limiting such damage. METHODS: Retinal detachment was induced surgically in the right eye of each of 10 cats. The cats were allowed to survive surgery for 3 days. Two were kept for these 3 days in normoxia (room air, 21% oxygen) and eight in hyperoxia (70% oxygen). The retinas were examined for cell death by use of labels for normal and fragmenting DNA, with antibodies and a cone sheath-specific lectin to demonstrate the status of their inner and outer segments, the synaptic structures of the outer plexiform layer, and the distribution of basic fibroblast growth factor (bFGF) and with in situ hybridization to demonstrate bFGF mRNA. RESULTS: Retinal detachment without oxygen supplementation caused the death of some photoreceptors; the loss of cytochrome oxidase from the inner segments and the collapse of the outer segments of surviving photoreceptors; the loss of synaptophysin profiles from the outer plexiform layer; and the loss of bFGF protein from retinal neurons and neuroglia but not from retinal vessels. Oxygen supplementation (hyperoxia) during detachment mitigated all these changes, reducing photoreceptor death, maintaining the specialized structures of surviving photoreceptors, and stabilizing the bFGF within the retina. CONCLUSIONS: In experimental retinal detachment, hypoxia caused by the separation of outer retina from its normal source of nutrients is a factor in inducing the death and deconstruction of photoreceptors as well as in the loss of bFGF from the detached retina. Hyperoxia offered to human patients between diagnosis of retinal detachment and surgery may enhance the function of the reattached retina.

Limiting the proliferation and reactivity of retinal Müller cells during experimental retinal detachment: the value of oxygen supplementation.

PURPOSE: To assess the role of hypoxia in inducing the proliferation, hypertrophy, and dysfunction of Muller cells in detached retina and the effectiveness of supplemental oxygen in limiting these reactions. METHODS: Retinal detachments were produced in the right eye of each of 13 cats; the cats survived surgery for 3 days, during which six were kept in normoxia (room air, 21%) and seven in hyperoxia (70% oxygen). Retinas were labeled for proliferation with an antibody (MIB-1) to a cell cycle protein (Ki-67), for evidence of hypertrophy employing antibodies to the intermediate filament protein glial fibrillary acidic protein (GFAP) and to beta-tubulin and for disturbance of glutamate neurochemistry employing antibodies to glutamate to a glutamate receptor (GluR-2) and to glutamine synthetase. RESULTS: Results from the two animals kept in normoxia after retinal detachment confirmed previous reports that detachment caused the proliferation of Muller cells, the hypertrophy of Muller cell processes, and the disruption of glutamate recycling by Muller cells. Oxygen supplementation during detachment reduced Muller cell proliferation and hypertrophy and reduced the abnormalities in the distributions of glutamate, GluR-2, and glutamine synthetase. CONCLUSIONS: Oxygen supplementation reduced the reaction of retinal Muller cells to retinal detachment, limiting their proliferation and helping to maintain their normal structure and function. In the clinical setting, oxygen supplementation between diagnosis and reattachment surgery may reduce the incidence and severity of glial-based complications, such as proliferative vitreoretinopathy.

Photoreceptor dystrophy in the RCS rat: roles of oxygen, debris, and bFGF.

PURPOSE: To examine the roles of oxygen, basic fibroblast growth factor (bFGF), and photoreceptor debris in the photoreceptor dystrophy of the Royal College of Surgeons (RCS) rat. METHODS: Pups were exposed during the critical period of their development (postnatal day [P] 16-24) and for some days thereafter to hypoxia and hyperoxia. The effects of these exposures on photoreceptor death, debris accumulation in the subretinal space, and the expression of bFGF protein and mRNA by surviving cells were studied. RESULTS: During the critical period hyperoxia slowed photoreceptor death in a dose-related fashion and decreased bFGF protein levels, whereas hypoxia accelerated death and increased bFGF levels. At the edges of the retina, where photoreceptors survive longest in normoxia, hypoxia had little effect on either photoreceptor death or bFGF protein levels. Oxygen-induced modulation of rates of death could not be related to the accumulation of debris in the subretinal space. After P27, the relationship between oxygen and photoreceptor death changed markedly, hyperoxia no longer delaying and hypoxia no longer accelerating death. CONCLUSIONS: The death of RCS rat photoreceptors in the period P16 to P27 is precipitated by hypoxia that may result from the accumulation of photoreceptor debris in the subretinal space. This debris, the result of the phagocytotic failure of the retinal pigment epithelium in this strain, lies in the normal pathway of oxygen diffusing to the photoreceptors from the choriocapillaris. During this period the retina responds to hypoxia by increasing expression of a potentially protective protein (bFGF), but hypoxia-induced damage overwhelms any protection provided by this or other mechanisms. Later stages of the dystrophy may not be hypoxia-induced.

Tissue oxygen during a critical developmental period controls the death and survival of photoreceptors.

PURPOSE: To study the death of photoreceptors in normally developing and dystrophic retina and to test the role of hypoxia in causing that death. METHODS: Death of photoreceptors was detected in the albino, hooded, and Royal College of Surgeons (RCS) strains of rat, and in the rabbit and cat, using the TUNEL technique. Retinas of selected ages from animals raised normally and those from rat pups raised for periods in hyperoxia (75% oxygen) or hypoxia (10% oxygen) were studied. RESULTS: In all species and strains examined, a naturally occurring wave of photoreceptor death was detected during the last stages of retinal development. In the albino rat, this wave, which began approximately at postnatal day 15 (P15) and peaked at P22, was reduced by hyperoxia and was intensified by hypoxia, producing a "hypoxic dystrophy" of photoreceptors. In the RCS rat, photoreceptor death also commenced at approximately P15 and then proceeded to exhaustion. This degeneration was greatly reduced by hyperoxia. In the RCS rat, hyperoxia was effective in photoreceptor rescue only during a discrete period, from P16 to P22. In the albino rat, the effectiveness of hypoxia in inducing photoreceptor death was much greater between P15 and P21 than at earlier ages, or in the adult. CONCLUSIONS: During a critical period extending approximately from P15 to P22, tissue oxygen levels strongly influence photoreceptor death and survival in dystrophic and normally developing strains of rat. This period is evident in normal development as a period of naturally occurring photoreceptor death and is evident experimentally as a period during which hyperoxia is effective in rescuing dying photoreceptors and during which hypoxia is effective in inducing death of otherwise viable photoreceptors.

Metabolism of difebarbamate in man.

The metabolism of 1,3-bis(3-butoxy-2-carbamoyloxypropyl)-5-ethyl-5-phenyl- (1H,3H,5H)-pyrimidine-2,4,6-trione (difebarbamate) in man was studied. Human volunteers received a single oral dose of 25 mg/kg difebarbamate. Urine was extracted with Amberlite XAD-2 resin and the extracts were separated by preparative HPLC after enzymatic hydrolysis. Four major metabolites were isolated and their structures were determined using NMR and mass spectrometry. The oxygen dealkylation led to the formation of two metabolites: 1-(3-butoxy-2-carbamoyloxypropyl)-3-(2-carbamoyloxy-3-hydrox ypropyl)-5-ethyl-5- phenyl-(1H, 3H, 5H)-pyrimidine-2,4,6,-trione and 1,3-bis(2-carbamoyloxy-3-hydroxypropyl)-5-ethyl-5-phenyl-(1H,3H,5H )- pyrimidine-2,4,6,-trione. The hydrolysis of the carbamoyloxy group with the oxygen dealkylation led to the formation of 1-(2-carbamoyloxy-3-hydroxypropyl)-3-(2,3-dihydroxypropyl)-5-ethyl - 5-phenyl-(1H,3H,5H)-pyrimidine-2,4,6,-tione, whereas the 4-hydroxylation of the benzene ring together with the oxygen dealkylation led to the formation of 1,3-bis(2-carbamoyloxy-3-hydroxypropyl)-5-ethyl-5-(4-hydroxyphenyl )-(1H,3H,5H)- pyrimidine-2,4,6,-trione. No traces of the parent drug were found.

Metabolism of pheneturide in the rat and in man.

The biotransformation of pheneturide was studied in humans and in the rat. Human volunteers received a single oral dose of 10 mg/kg of pheneturide and the rats were given repeated doses of 250 mg/kg. Urine from both study groups was extracted with Amberlite XAD-2 and the extracts were separated by preparative HPLC after enzymatic hydrolysis. Five metabolites were isolated in man and their structures were determined using NMR and mass spectrometry. The hydrolysis of the ureide function and the 4-hydroxylation of the benzene ring led to the formation of two major metabolites: 2-(4-hydroxyphenyl)-butyroylurea (37.5%) and 2-phenylbutyric acid (40.6%), and to one minor metabolite: 2-(4-hydroxyphenyl)-butyric acid (11.9%). Seven metabolites were isolated in the rat. The 4-hydroxylation of the benzene ring and the C 3 hydroxylation of the aliphatic chain led to the formation of two major metabolites: 2-(4-hydroxyphenyl)-butyroylurea (70.5%) and 3-hydroxy-2-phenyl-butyroylurea (19.6%), whereas the hydrolysis of the ureide function was less important. Only traces of the parent drug were found in humans as well as in the rat.

Febarbamate: metabolism in man.

The biotransformation of 1-(3-butoxy-2-carbamoyloxypropyl)-5-ethyl-5-phenyl-(1H,3H,5H)-pyrimidine-2,4,6-trione (febarbamate) has been investigated in man. Human volunteers received a single oral dose of 15 mg/kg febarbamate. Twenty two metabolites found in urine were separated and purified by means of an extraction with Amberlite XAD-2 and the high performance liquid chromatography. Their chemical structures were established with the help of mass and NMR spectral data and by comparison with known standards. The oxygen dealkylation, the penultimate hydroxylation of the n-butyl chain with consecutive oxidation to the ketone and C 4 hydroxylation of the benzene ring lead to the formation of four major metabolites: 1-(2-carbamoyloxy-3-hydroxypropyl)-5-ethyl-5-phenyl-(1H,3H,5H)-pyrimidine-2,4, 6-trione (41.4%), 1-[3-(3-hydroxybutoxy)-2-carbamoyloxypropyl]-5-ethyl-5-phenyl-(1H,3H,5H)-pyrimidine-2,4,6-trione (20.2%), 1-[3-(3-oxobutoxy)-2-carbamoyloxypropyl]-5-ethyl-5-phenyl-(1H,3H,5H)-pyrimidine-2,4,6-trione (11.1%) and 1-(2-carbamoyloxy-3-hydroxypropyl)-5-ethyl-5-(4-hydroxyphenyl)-(1H,3H,5H)-pyrimidine-2,4,6-trione (9.2%). Hydrolysis of the carbamoyloxy group was insignificant, the pyrimidine ring opening and the oxidation of the 5-ethyl group were not observed. Only traces of the parent drug were found.

[Investigation of magnesium and calcium in ischemic changes in the human myocardium]. / Vysetrováníní magnézia a kalcia pri ischemických zmenách v lidském myokardu.

The results are presented of tests for magnesium and calcium and their ratio in the human myocardium affected by ischemia in correlation with macroreaction to dehydrogenases. The cases were examined in the shortest possible time after death, observing strict criteria. Even some of the relatively early postmortem changes were found to block the practical diagnostic uses of the changes of magnestium and calcium metabolism in postmortem material.

[Studies of potassium and sodium in ischemic changes of the human myocardium]. / Vysetrování kalia a natria pri ischemických zmenách v lidském myokardu

The results are presented of investigations concerning the potassium-sodium ratio in the human myocardium under ischaemia in correlation with macroreaction to dehydrogenases. The values found, though approaching those of the familiar experimental results, can hardly be regarded as reliable in diagnosing early ischaemic changes in autopsy material since they are affected by post-mortem changes.