PURPOSE. To use the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) to evaluate vision-related quality of life (VR-QOL) in patients with pituitary adenoma who undergo transsphenoidal surgery. METHODS. The VFQ-25 was self-administered by 74 patients with pituitary adenoma before and 3 months after surgery. Pre- and postoperative clinical data were collected, including age, sex, tumor type and size, logarithm of minimum angle of resolution best corrected visual acuity (logMAR BCVA), critical flicker fusion frequency, static perimetry scores (mean deviation [MD] and corrected pattern SD [CPSD]), duration of ocular symptoms, and number of systemic comorbidities. RESULTS. Seventy-four patients with a mean age of 48.2 years were studied. Transsphenoidal surgery for pituitary adenoma significantly improved logMAR BCVA and critical fusion flicker frequency in the worse-seeing eye and MD and CPSD scores in both the better- and worse-seeing eyes (P < 0.001). The VFQ-25 composite score and all subscale scores, except those for the general health and color vision subscales, improved significantly (P < 0.05). A multivariate regression analysis revealed that the preoperative VFQ-25 composite score and the preoperative MD and CPSD scores in the better-seeing eye were related to the postoperative VFQ-25 composite score (P < 0.05). CONCLUSIONS. This study quantitatively demonstrated that transsphenoidal surgery can dramatically improve VR-QOL in pituitary adenoma and that the preoperative VFQ-25 composite score and visual field disturbance in the better-seeing eye are particularly important predictors associated with the postoperative VR-QOL. The use of VFQ-25 provides a more comprehensive overview of the effectiveness of transsphenoidal surgery.

BACKGROUND

Bifidobacterium longum 105-A produces markedly high amounts of capsular polysaccharides (CPS) and exopolysaccharides (EPS) that should play distinct roles in bacterial-host interactions. To identify the biological function of B. longum 105-A CPS/EPS, we carried out an informatics survey of the genome and identified the EPS-encoding genetic locus of B. longum 105-A that is responsible for the production of CPS/EPS. The role of CPS/EPS in the adaptation to gut tract environment and bacteria-gut cell interactions was investigated using the ΔcpsD mutant.

RESULTS

A putative B. longum 105-A CPS/EPS gene cluster was shown to consist of 24 putative genes encoding a priming glycosyltransferase (cpsD), 7 glycosyltransferases, 4 CPS/EPS synthesis machinery proteins, and 3 dTDP-L-rhamnose synthesis enzymes. These enzymes should form a complex system that is involved in the biogenesis of CPS and/or EPS. To confirm this, we constructed a knockout mutant (ΔcpsD) by a double cross-over homologous recombination. Compared to wild-type, the ∆cpsD mutant showed a similar growth rate. However, it showed quicker sedimentation and formation of cell clusters in liquid culture. EPS was secreted by the ∆cpsD mutant, but had altered monosaccharide composition and molecular weight. Comparison of the morphology of B. longum 105-A wild-type and ∆cpsD by negative staining in light and electron microscopy revealed that the formation of fimbriae is drastically enhanced in the ∆cpsD mutant while the B. longum 105-A wild-type was coated by a thick capsule. The fimbriae expression in the ∆cpsD was closely associated with the disappearance of the CPS layer. The wild-type showed low pH tolerance, adaptation, and bile salt tolerance, but the ∆cpsD mutant had lost this survivability in gastric and duodenal environments. The ∆cpsD mutant was extensively able to bind to the human colon carcinoma Caco-2 cell line and was phagocytosed by murine macrophage RAW 264.7, whereas the wild-type did not bind to epithelial cells and totally resisted internalization by macrophages.

CONCLUSIONS

Our results suggest that CPS/EPS production and fimbriae formation are negatively correlated and play key roles in the survival, attachment, and colonization of B. longum 105-A in the gut.

The authors have studied the efficacy of an association of DHA, vitamin E and vitamin B complex (TROFINERV) in glaucomatous patients. The parameters evaluated were computerized visual field (CVF) and retinal contrast sensitivity (RCS). Thirty chronic simple glaucoma patients in good tensional compensation with local therapy were given TROFINERV oral therapy. The results show significant differences after 90 days of treatment both in the perimetric indices (MD, SF, CPSD; p < 0.05) and in the RCS frequency values (p < 0.05). In the light of the results obtained, the authors consider the use of such association to be a useful support in glaucomatous patient therapy for preventing or delaying the progress of damage.

The authors assess the efficacy of flunarizine in improving blood flow and perimetric indices in low-tension glaucoma (LTG). A group of 20 patients with LTG well-compensated by medical treatment underwent Color Doppler Imaging (CDI) of the ophthalmic artery and posterior ciliary arteries with peak systolic velocity (PSV) and Purcelot's index (PI) evaluation. Computerized perimetry was also performed to assess MD, SF and CPSD. The parameters were measured before and after three months' therapy with flunarizine. Data before and after flunarizine treatment were: Ophthalmic artery- PSV 33.261 +/- 1.628 cm/sec vs 35.746 +/- 0.800 cm/sec (p < 0.001); PI 0.697 +/- 0.017 vs 0.627 +/- 0.031 (p < 0.001); Posterior ciliary arteries- PSV 9.385 +/- 0.751 cm/sec vs 10.738 +/- 1.566 cm/sec (p < 0.005); PI 0.673 +/- 0.056 vs 0.589 +/- 0.023 (p < 0.001). The perimetric indices were modified as follows: MD -11.002 +/- 6.574 vs -6.604 +/- 6.426 (p < 0.006); SF 5.05 +/- 5.717 vs 2.937 +/- 1.780 (p < 0.193); CPSD 10.198 +/- 13.392 vs 3.445 +/- 2.709 (p < 0.093). Oral administration of flunarizine, a calcium channel-blocker which acts at a vascular and neuronal level, improves the blood flow indices for the optic nerve, improving thereby the perimetric indices in LTG.

The relationship between visual acuity, the level of visual field impairment, visual functioning, and the quality of life was evaluated in Korean patients with glaucoma. Forty-three consecutive glaucoma patients from the glaucoma service at Severance Eye and Ear Hospital were included in this study. Each subject underwent a vision-specific functional status questionnaire (VF-14), a modified VF-14 (VF'-14) and general quality-of-life questionnaires of the Medical Outcomes Study 36-Items Short Form Health Survey (SF-36). The visual acuity and visual field measurements with a Humphrey automated perimeter were taken within one month of the initial visit. The mean age of the subjects was 57.9 +/- 17.8. Among these patients, there were 23 males and 20 females. The mean deviation (MD) and the corrected pattern standard deviation (CPSD) by the automated perimeter in the eye with the better visual acuity were -5.87 +/- 5.16 dB and 3.92 +/- 2.74 dB respectively. The VF-14 and SF-36 scores were 41.28 +/- 14.56 and 52.39 +/- 6.61 respectively. There were significant correlations between the VF-14, VF'-14, and the MD of the better eye (p < 0.05). In Korean patients with glaucoma, the VF-14 and VF'-14 have significant relationship with the MD of the better eye in the visual field.

OBJECTIVE

To examine the relation between perfusion of the optic nerve head and visual field defects in glaucomatous patients.

METHODS

A study was performed on 94 patients affected with primary open-angle glaucoma. The optic nerve head blood flow was measured by means of a scanning laser Doppler flowmeter (Heidelberg Retina Flowmeter). Blood volume, flow and velocity were analysed in two areas of the rim and in one area of the lamina cribrosa. The visual field was tested with the 30-2 full threshold white-on-white program and mean deviation (MD) and corrected pattern standard deviation (CPSD) were considered as parameters of visual field defects.

RESULTS

The interindividual analysis showed that the vascular parameters of the neuroretinal rim circulation were not significantly correlated with visual field parameters. The blood volume, flow and velocity of lamina cribrosa correlated significantly with both MD (R=0.519, R=0.549 and R=0.531, respectively; P<0.001) and CPSD (R=-0.496, R=-0.363 and R=-0.363, respectively; P<0.001). The intraindividual correlations (right-left differences of parameters) showed that the side differences of MD and CPSD correlated significantly with the side differences of blood volume (R=0.511 and R=-0.477, respectively), flow (R=0.554 and R=-0.390, respectively) and velocity (R=0.541 and R=-0.372, respectively) in lamina cribrosa.

CONCLUSIONS

These findings suggest that in glaucoma patients the perfusion parameters of lamina cribrosa are significantly correlated with visual field defects.

OBJECTIVE

To estimate the deterioration rates of visual field loss in Japanese normal-tension glaucoma (NTG) patients under either topical nipradilol or timolol, and to explore intergroup differences in the treatment results.

METHODS

A total of 146 NTG patients with mild to moderate damage were randomized to either nipradilol or timolol and followed for 3 years with a periodic comprehensive ophthalmological visual field examination (30-2 Humphrey perimeter program) every 6 months (the Nipradilol-Timolol Study). The time course of mean deviation (MD), the average total deviation (TD(mean)) in four subfields, and the corrected pattern standard deviation (CPSD) were compared between the two groups using regression analysis with a linear mixed effect model.

RESULTS

The estimated slope for MD (dB/year) was -0.03 in the nipradilol and -0.05 in the timolol group (P>> 0.4). In both groups, TD(mean) in the superior-central subfield and <em>CPSD</em> showed significant changes (-0.3 and 0.2-0.3, P <or= 0.001). In the patients with early visual field loss or those younger than 40 years, deterioration of some visual field parameters tended to be slower in the nipradilol group than in the timolol group.

CONCLUSIONS

During 3 years of monotherapy with either nipradilol or timolol in NTG patients, only TD(mean) in the superior-central subfield and the CPSD changed significantly without any intergroup differences.

OBJECTIVE

In a previous study we demonstrated that the progression of the disease retinitis pigmentosa (RP) can be readily monitored by the mean deviation (MD) measured by Humphrey central 10-2 perimetry, which assesses the sensitivity distribution in the macular area in eyes affected by RP. In the present study, we investigated whether the 10 degrees perimetric results could predict the time of declining visual acuity in eyes with RP in a cross-sectional study.

METHODS

Humphrey 10-2 perimetry results and visual acuity were studied in the right eyes of 69 patients with typical RP. Patients whose eyes had cataract, glaucoma, cystoid macular edema, or other complications affecting vision were excluded.

RESULTS

Eyes with an MD of -15 dB or greater had almost normal visual acuity. Various degrees of visual acuity loss were observed in eyes with an MD of less than -15 dB. In the 35 eyes with an MD of less than -15 dB, visual acuity correlated well with the corrected pattern standard deviation (CPSD), which is the measure of the degree to which the shape of the measured field departs from the age-corrected normal reference field.

CONCLUSIONS

In the absence of complications, many eyes with RP may experience acuity loss after the field constriction reaches an MD of less than -15 dB. The CPSD may be used as an indicator of acuity because eyes showing a lower CPSD tend to have greater loss of acuity among eyes with an equivalent MD value.

Over the past decade, Streptococcus pneumoniae (the pneumococcus) has gained prominence as a model for studying the bacterial cell cycle. This important human pathogen possesses a characteristic diplo-ovococcal cell shape and produces a protective polysaccharide capsule required for virulence, and it has been used to investigate natural genetic transformation. Recent advances have demonstrated that the pneumococcus has evolved phosphorylation-dependent regulatory mechanisms dedicated to controlling cell division and ensuring the concealment of the newborn cells by the capsule. In this review, I survey the role of the only two serine/threonine- (StkP) and tyrosine-kinases (CpsD) of the pneumococcus and discuss the existence of interconnected phosphorylation networks coordinating cell division and morphogenesis with key aspects of the cell cycle.

OBJECTIVE

This study examined how FASTPAC, a fast strategy for the Humphrey Field Analyzer (HFA), compares to the standard 4/2-dB full threshold strategy in patients with glaucoma.

METHODS

The author tested one eye each of 50 patients with glaucoma (23 with only relative defects, 27 with at least one absolute defect; age range, 25 to 79 years; median age, 61.5 years) with both strategies using program 30-2 of the HFA (stimulus size III). Global visual field indices as calculated by Statpac, unweighted mean sensitivity, and examination time were compared. In addition, a point by point analysis of the sensitivity values was performed.

RESULTS

Between the two strategies, no significant differences were found for indices directly related to the sensitivity values (mean sensitivity [MS], mean deviation [MD]) or for the actual thresholds. For the entire population, FASTPAC showed higher mean short-term fluctuation (SF; P = 0.018), lower mean pattern standard deviation (PSD; P = 0.006), and mean corrected PSD (CPSD; P < 0.001) values and a time reduction of more than 30% (P < 0.001) compared to the standard strategy. These differences between the strategies were found to be independent of the amount of field loss, except for PSD (P = 0.001). No age influence was present. Statistically significant linear regression (r>> 0.70, P < 0.001) was found between the FASTPAC values of MS, MD, PSD, CPSD, and the corresponding values determined with the standard strategy. No correlation exists for SF (r < 0.46, P>> 0.030).

CONCLUSIONS

FASTPAC provides a considerable time reduction at the cost of higher threshold fluctuation. This may lead to problems in detecting relative defects or changes in differential light threshold in follow-up examinations.

OBJECTIVE

To investigate the correlation between a disc hemorrhage and peripapillary atrophy in glaucoma patients with a unilateral disc hemorrhage.

METHODS

The 44 glaucoma patients (7 with primary open-angle glaucoma and 37 with normal-tension glaucoma) with a unilateral disc hemorrhage from June 1997 to November 2002 were selected randomly and included sequentially. The topographic measurements were performed using Heidelberg Retina Tomograph (HRT) within 3 months of detecting the disc hemorrhage. The zone beta parameters of the peripapillary atrophy were analyzed by the Atrophy Zone Analysis software. The intraocular pressure, refractive error, visual field parameters, and optic disc parameters were compared between both eyes. Univariate and multivariate regression analysis were performed.

RESULTS

The area, angular and radial extent of the zone beta, and the ratio of the zone beta area to the disc area were significantly greater in the hemorrhagic eyes than in the contralateral eyes (P < 0.001). The prevalence of peripapillary atrophy was significantly higher in the hemorrhagic eyes (84%) than in the contralateral eyes (66%) (P = 0.034, chi2 test). The rim area and the rim volume of the hemorrhagic eyes were significantly smaller than those of the contralateral eyes (P = 0.02, < 0.001, respectively). In multivariate regression analysis, the peripapillary atrophy area was the independent significant factor associated with disc hemorrhage (P = 0.03, Odds Ratio = 1.51). The refractive error, intraocular pressure, Mean Deviation (MD), and Corrected Pattern Standard Deviation (CPSD) of the visual fields in both eyes were similar.

CONCLUSIONS

The area and extent of the peripapillary atrophy was significantly greater and more prevalent in the eyes with a disc hemorrhage than in the contralateral control eyes. Peripapillary atrophy is closely associated with a disc hemorrhage in glaucoma patients irrespective of small neuroretinal rim area and volume.

OBJECTIVE

To evaluate the visual field changes in smokers.

METHODS

In 24 healthy, chronic, heavy cigarette smokers and 16 age and sex-matched healthy non-smokers, central 30-2 threshold tests were evaluated. The quantitative perimetric indices as objective retinal sensitivity measures were recorded in both eyes, but only those from the second eye were chosen for analysis. The visual field defects were also assessed.

RESULTS

All subjects had normal visual acuity. The central visual fields in smokers showed relative to absolute scotomas in 20 degrees to 30 degrees. Quantitative perimetric indices including total threshold dB with red and white target, MD, PSD, and CPSD values were significantly different (p<0.05) between the groups. Smokers showed both diffuse and localised retinal sensitivity decrease. SF showed no significant difference (p>0.05) between the groups.

CONCLUSIONS

In healthy, chronic, heavy cigarette smokers, retinal sensitivity was found to be decreased although central vision was not affected. This is possibly due to a cumulative effect of chronic smoking onto the retinal and/or optic nerve functions without clinically evident optic neuropathy.

Group B streptococcus (GBS) capsular polysaccharide is one of the major virulence factors underlying invasive GBS disease and a component of forthcoming vaccines. Serotype classification of GBS is based on the capsule polysaccharide of which ten variants are known to exist (Ia, Ib, II-IX). Current methods for GBS serotype assignment rely on latex agglutination or PCR while more recently a whole genome sequencing method was reported. In this study, three distinct algorithms for serotype assignment from genomic data were assessed using a panel of 790 clinical isolates.

The first approach utilised the entire capsular locus coupled with a mapping methodology. The second approach continues from the first and utilised a SNP-based methodology across the conserved cpsD-G region to differentiate serotypes Ia-VII and IX. Finally the third approach used the variable cpsG -K region coupled with a mapping methodology. All three approaches were assessed for typeability (percentage of isolates assigned a serotype) and concordance to the latex agglutination methodology.

Following comparisons, the third approach using the variable cpsG-K region demonstrated the best performance with 99.9% typeability and 86.7% concordance. Overall, of the 105 discordant isolates, 71 were resolved following retesting of latex agglutination and whole genome sequencing, 20 failed to assign a serotype using latex agglutination and only 14 were found to be truly discordant on re-testing. Comparison of this final approach with the previously described assembly-based approach returned identical results.

These results demonstrated that molecular capsular typing using whole genome sequencing and a mapping-based approach is a viable alternative to the traditional, latex agglutination-based serotyping method and can be implemented in a public health microbiology setting.

OBJECTIVE

The development and evaluation of a sensitive and specific TaqMan real-time polymerase chain reaction (PCR) for the detection and identification of Pantoea stewartii on maize.

RESULTS

A TaqMan-based real-time PCR assay targeting the cpsD gene enabling specific detection of P. stewartii in maize leaves and seeds was developed. Under optimal conditions, the selected primers and probe were specific for the detection of all 14 reference P. stewartii strains by real-time PCR. The 32 non-Panteoa and eight other Pantoea strains tested negative. The TaqMan PCR assay detected 1 pg of purified DNA and 10(4)P. stewartii colony forming units per millilitre (10 cells per reaction) in pure cultures consisting of 92.0% intact (viable) cells. Direct processing of leaf lesions and seeds by the real-time PCR detected 10 and 50 P. stewartii cells per reaction respectively. TaqMan real-time PCR results were validated by dilution plating of macerates and PCR-based subcloning followed by DNA sequencing.

CONCLUSIONS

The real-time PCR assay described is a rapid, reliable and more sensitive tool for the detection of P. stewartii.

CONCLUSIONS

This real-time PCR assay would avoid false-negative results and reduce the time required for certifying maize seed shipments.

OBJECTIVE

To compare the effects of topical nipradilol and timolol on the visual field in Japanese normal-tension glaucoma (NTG) patients.

METHODS

We enrolled 146 NTG patients. At baseline, age, intraocular pressure (IOP), and mean deviation (MD) by the Humphrey field analyzer were 47.6 (SD 8.5), 14.2 (1.7) mmHg, and -4.5 (3.0) dB. Seventy-two patients were randomly assigned to the 0.25% nipradilol group and 74 patients to the 0.5% timolol ophthalmic solution group twice daily for the 3-year study period. The Humphrey full-threshold 30-2 visual field test was performed every 6 months. The primary end point was the nonparametric O'Brien summary score (sum of the ranks of six slopes calculated from the average of the total deviation in each cluster) in each patient. The secondary analyses were differences in the MD slope, average of the total deviation in each cluster, the corrected pattern standard deviation (CPSD), and the time course of IOP.

RESULTS

No significant intergroup differences were found in baseline characteristics, or in the parameters of the primary and secondary analyses. In both groups, central superior clusters showed negative slopes and IOP decreased by about 1 mmHg from baseline.

CONCLUSIONS

No significant difference in visual field performance or IOP reduction was seen between the nipradilol and timolol groups.

The production of capsular polysaccharides (CPS) or secreted exopolysaccharides is ubiquitous in bacteria, and the Wzy pathway constitutes a prototypical mechanism to produce these structures. Despite the differences in polysaccharide composition among species, a group of proteins involved in this pathway is well conserved. Streptococcus agalactiae (group B Streptococcus; GBS) produces a CPS that represents the main virulence factor of the bacterium and is a prime target in current vaccine development. We used this human pathogen to investigate the roles and potential interdependencies of the conserved proteins CpsABCD encoded in the cps operon, by developing knock-out and functional mutant strains. The mutant strains were examined for CPS quantity, size, and attachment to the cell surface as well as CpsD phosphorylation. We observed that CpsB, -C, and -D compose a phosphoregulatory system where the CpsD autokinase phosphorylates its C-terminal tyrosines in a CpsC-dependent manner. These Tyr residues are also the target of the cognate CpsB phosphatase. An interaction between CpsD and CpsC was observed, and the phosphorylation state of CpsD influenced the subsequent action of CpsC. The CpsC extracellular domain appeared necessary for the production of high molecular weight polysaccharides by influencing CpsA-mediated attachment of the CPS to the bacterial cell surface. In conclusion, although having no impact on cps transcription or the synthesis of the basal repeating unit, we suggest that these proteins are fine-tuning the last steps of CPS biosynthesis (i.e. the balance between polymerization and attachment to the cell wall).

BACKGROUND

To correlate the findings of optical coherence tomography (OCT) evaluation of retinal nerve fiber layer (RNFL) thickness with visual field changes in glaucomatous, ocular hypertensive and normal eyes.

METHODS

Thirty consecutive normal, 30 consecutive ocular hypertensive and 30 consecutive glaucomatous eyes underwent a complete ophthalmic examination, including applanation tonometry, disc evaluation, (30-2) Humphrey field analyzer white on white (W/W) perimetry and short- wavelength automated perimetry. Thickness of the RNFL around the optic disc was determined with 3.4 mm diameter-wide OCT scans. Average and segmental RNFL thickness values were compared among all groups. A correlation was sought between global indices of perimetry and RNFL thickness.

RESULTS

Of the 90 eyes enrolled (mean age of patients 52.32+/-10.11 years), the mean RNFL thickness was significantly less in ocular hypertensive (82.87+/-17.21 mm; P =0.008 and glaucomatous eyes (52.95+/-31.10 microm; P < 0.001), than in normals (94.26+/-12.36 microm). The RNFL was significantly thinner inferiorly in glaucomatous eyes (64.41+/-43.68 microm; P<0.001). than in normals (120.15+/-14.32 microm) and ocular hypertensives (107.87+/-25.79 microm; P<0.001). Ocular hypertensives had thinner RNFL in the nasal, inferior and temporal quadrants (P<0.001) when compared to normals. Global indices in ocular hypertensives on SWAP showed Mean Deviation (MD) of 5.32+/-4.49, Pattern Standard Deviation (PSD) 3.83+/-1.59 and Corrected Pattern Standard Deviation (CPSD) 2.84+/-1.85. The RNFL thickness could not be significantly correlated with global indices of visual fields in ocular hypertensives.

CONCLUSIONS

Optical coherence tomography is capable of detecting changes at the level of RNFL in ocular hypertensive eyes with normal appearance of discs and W/W perimetry fields.

OBJECTIVE

To determine whether the use of pattern standard deviation instead of corrected pattern standard deviation, as part of Anderson's criteria, makes a difference in categorizing a single field printout using the full threshold strategy on the Humphrey's Field Analyzer.

METHODS

Forty-eight patients with glaucomatous field defects of varying severity underwent full threshold perimetry on the Humphrey's Field Analyzer. The third field of one eye was used for the study. The agreement between CPSD and PSD alone was determined. Each field was then categorized using Anderson's criteria first using CPSD and then PSD. The kappa statistic was used to determine agreement in both situations.

RESULTS

The agreement between CPSD and PSD alone, as determined by kappa, was 0.77. The kappa statistic for categorization using Anderson's criteria was 0.82; the weighted kappa was 0.92.

CONCLUSIONS

There was almost perfect agreement using the PSD instead of CPSD as part of Anderson's criteria. This substitution seems valid for the spectrum of field defects used in this series, at least for the full threshold programs.

OBJECTIVE

To evaluate the vision-related quality of life (VR-QOL) in patients with pituitary adenoma.

METHODS

Prospective, consecutive, comparative case series.

METHODS

A VR-QOL questionnaire was distributed to 154 patients with pituitary adenoma and 81 normal controls. These were presurgical patients. VR-QOL was measured using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25). The influence of various factors on VFQ-25 score was assessed, including age, logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), critical flicker fusion frequency, Humphrey static perimetry scores, and the duration of ocular symptoms.

RESULTS

The VFQ-25 composite score was significantly lower in patients with pituitary adenoma than in the normal controls (P < .001), with significant differences in all subscales except for color vision. The VFQ-25 composite score in patients with pituitary adenoma was significantly correlated with logMAR BCVA, mean deviation (MD) and corrected pattern standard deviation (CPSD) of Humphrey perimetry, critical flicker fusion frequency, and the duration of ocular symptoms. Stepwise multiple regression analysis revealed that MD score in the better-seeing eye (r = 0.69; P < .001) and the duration of ocular symptoms associated with pituitary adenoma (r = -0.36; P < .001) were significantly related to the VFQ-25 composite score.

CONCLUSIONS

The VR-QOL is significantly deteriorated in patients with pituitary adenoma. The degree of visual field defect in the better-seeing eye and duration of ocular symptoms were found to be significantly related to the decline of VR-QOL in these patients.

Streptococcus iniae causes severe septicemia and meningitis in farmed fish and is also occasionally zoonotic. Vaccination against S. iniae is problematic, with frequent breakdown of protection in vaccinated fish. The major protective antigens in S. iniae are the polysaccharides of the capsule, which are essential for virulence. Capsular biosynthesis is driven and regulated by a 21-kb operon comprising up to 20 genes. In a long-term study, we have sequenced the capsular operon of strains that have been used in autogenous vaccines across Australia and compared it with the capsular operon sequences of strains subsequently isolated from infected vaccinated fish. Intriguingly, strains isolated from vaccinated fish that subsequently become infected have coding mutations that are confined to a limited number of genes in the cps operon, with the remainder of the genes in the operon remaining stable. Mutations in strains in diseased vaccinated fish occur in key genes in the capsular operon that are associated with polysaccharide configuration (cpsG) and with regulation of biosynthesis (cpsD and cpsE). This, along with high ratios of nonsynonymous to synonymous mutations within the cps genes, suggests that immune response directed predominantly against capsular polysaccharide may be driving evolution in a very specific set of genes in the operon. From these data, it may be possible to design a simple polyvalent vaccine with a greater operational life span than the current monovalent killed bacterins.

The makers of the Humphrey perimeter have developed a rapid thresholding program, FASTPAC, to address the problems of fatigue and poor test performance associated with prolonged perimetry. The performance of FASTPAC was compared with the standard threshold program of the Humphrey visual field analyser (program 24-2) in 44 glaucoma patients. FASTPAC reduced the mean test time by 35% (from 12.6 to 8.2 minutes), owing to a reduction in the number of stimulus presentations. FASTPAC underestimated the mean deviation (MD) (Wilcoxon, p = 0.007) and corrected pattern standard deviation (CPSD) (Wilcoxon, p = 0.005). The sum of the differences between FASTPAC and the standard program was -1.19 (SD 2.37) dB for MD and 0.97 (2.14) dB for CPSD. The measured difference between the two methods was independent of the value of either MD or CPSD, indicating that the measurement error was just as likely to occur with either early or advanced visual field loss. No difference was noted in short term fluctuation or in the reliability indices of test performance. These results indicate that FASTPAC, while considerably faster, is not as accurate as the standard threshold program at measuring retinal sensitivity in glaucoma. This inaccuracy may be offset in practical terms by greater patient acceptability and by increasing the number of patients capable of performing reliable threshold perimetry because of the reduction in duration of the FASTPAC program.

OBJECTIVE

To evaluate the effect of acute elevation of intraocular pressure (IOP) during laser in situ keratomileusis (LASIK) on the visual field in myopic eyes.

METHODS

Istanbul University, Cerrahpassa Medical Faculty, Istanbul, Turkey.

METHODS

Thirty-seven eyes of 37 patients were included in the study. The LASIK procedure was performed using the Hansatome microkeratome (Bausch & Lomb) and the Summit SVS Apex Plus 193 nm argon-fluoride excimer laser. Visual field testing was performed twice before LASIK and 1 day and 24 months after LASIK. Seventy-six points, 6 degrees apart, in the central visual field (Central 30-2) were tested for threshold sensitivity (Humphrey). The mean threshold sensitivity of baseline and post-LASIK visual field examinations was calculated in each patient. Seventy-six points of the Central 30-2 test were divided into 21 clusters corresponding to perimetric nerve-fiber bundles derived from Peridata software version 6.2a (Interzaag AG). The mean threshold sensitivity of each cluster and the visual field indices (mean deviation [MD] and corrected pattern standard deviation [CPSD]) in baseline and follow-up visual fields were compared using analysis of variance.

RESULTS

The mean age of the 23 men and 14 women was 31.04 years +/- 6.55 (SD). The mean spherical equivalent refraction was -4.21 +/- 1.66 diopters (D) (range -2.25 to -6.75 D). The mean duration of suction was 42.29 +/- 29.06 seconds. The mean visual field sensitivity at baseline and the 2 follow-up examinations was 25.97 +/- 2.04 dB, 25.70 +/- 1.99 dB, and 27.17 +/- 1.68 dB, respectively (P =.181). There was no difference between preoperative and postoperative visual field clusters except in area 13. In area 13, threshold sensitivity was decreased at 1 day (P =.039) and at the preoperative level at 24 months. The MD of the visual fields was -3.53 +/- 1.67 dB, -3.61 +/- 2.91 dB, and -2.61 +/- 1.66 dB at the preoperative and 2 postoperative examinations, respectively (P =.495). The mean CPSD of the visual fields was 1.76 +/- 1.24 dB, 1.42 +/- 0.85 dB, and 1.74 +/- 0.86 dB, respectively (P =.680).

CONCLUSIONS

Laser in situ keratomileusis did not cause visual field defects in mild to moderate myopic patients who had no risk factors that might render the optic nerve more vulnerable to damage.

BACKGROUND

Individuals with social phobia (SP) represent a large group with elevated rates of cigarette smoking and cessation rates lower than that of individuals without psychopathology. For individuals with SP, cigarette smoking may be used to reduce social anxiety in anticipation of and during social situations. However, no study to date has experimentally examined this association. The aim of the current study was to experimentally examine the relationship between cigarette smoking and SP as a function of induced social stress.

METHODS

We recruited daily smokers ages 18-21 who scored in either a clinical or normative range on the Social Interaction Anxiety Scale (SIAS). Participants included 54 smokers (42.6% female, 77.8% White, age M(SD)=19.65(1.18), CPSD M(SD)=7.67(4.36), 46.30% high SP) who attended two sessions: one social stress session and one neutral session.

RESULTS

Results indicated that high SP smokers experienced significant decreases in negative affect (NA) following smoking a cigarette when experiencing social stress. This effect was specific to high SP smokers under social stress and was not observed among individuals' average in SP or when examining changes in positive affect.

CONCLUSIONS

For individuals with SP, cigarette smoking may be maintained due to changes in NA associated with smoking specifically in the context of social stress. These results speak to the importance of targeted cessation interventions that address the nature of smoking for individuals with SP.

Carbamyl phosphate synthetase I deficiency (CPSD) is an autosomal recessive disorder of ureagenesis characterized by hyperammonemic coma in the neonatal period. To study the genetic basis of CPSD we have performed a molecular analysis of the CPS I genes in CPSD patients from six unrelated families. Using a cDNA probe for the human CPS I gene and restriction endonuclease mapping techniques, we observed no abnormality in the number of size of the hybridizing DNA fragments from the seven affected individuals examined. These findings suggest that no gross alteration affected the CPS I genes. We did detect a frequent restriction fragment length polymorphism (RFLP) at the CPS I locus which we employed as a linkage marker. Our results suggest the polymorphic CPS I restriction fragments cosegregate with the CPSD phenotype, and that linkage disequilibrium exists between the CPSI RFLPs studied and the affected alleles. The RFLPs described may enable prenatal detection of CPSD in families where the coupling phases between CPSD alleles and RFLPs can be determined.