Comparison of non-mydriatic retinal photography with ophthalmoscopy in 2159 patients: mobile retinal camera study.

OBJECTIVE--To determine whether non-mydriatic Polaroid retinal photography was comparable to ophthalmoscopy with mydriasis in routine clinic screening for early, treatable diabetic retinopathy. DESIGN--Prospective study of ophthalmoscopic findings according to retinal camera screening and ophthalmoscopy and outcome of referral to ophthalmologist. SETTING--Outpatient diabetic clinics of three teaching hospitals and three district general hospitals. PATIENTS--2159 Adults selected randomly from the diabetic clinics, excluding only those registered as blind or those in wheelchairs and unable to enter the screening vehicle. MAIN OUTCOME MEASURES--Numbers of patients and eyes correctly identified by each technique as requiring referral with potentially treatable retinopathy (new vessel formation and maculopathy) and congruence in numbers of microaneurysms, haemorrhages, and exudates reported. RESULTS--Camera screening missed two cases of new vessel formation and did not identify a further 12 but indicated a need for referral. Ophthalmoscopy missed five cases of new vessel formation and indicated a need for referral in another four for other reasons. Maculopathy was reported in 147 eyes with camera screening alone and 95 eyes by ophthalmoscopy only (chi 2 = 11.2; p less than 0.001), in 66 and 29 of which respectively maculopathy was subsequently confirmed. Overall, 38 eyes received laser treatment for maculopathy after detection by camera screening compared with 17 after ophthalmoscopic detection (chi 2 = 8.0; p less than 0.01). Camera screening underestimated numbers of microaneurysms (chi 2 = 12.9; p less than 0.001) and haemorrhages (chi 2 = 7.4; p less than 0.01) and ophthalmoscopy underestimated hard exudates (chi 2 = 48.2; p less than 0.001). CONCLUSIONS--Non-mydriatic Polaroid retinal photography is at least as good as ophthalmoscopy with mydriasis in routine diabetic clinics in identifying new vessel formation and absence of retinopathy and is significantly better in detecting exudative maculopathy.     

Fatty acid metabolism in hepatocytes cultured with hypolipidaemic drugs. Role of carnitine.

The kinetic features of the changes in the cytosolic free Ca2+ concentration, [Ca2+]i, following stimulation by thyrotropin releasing hormone (TRH) were analysed in single cells of a pituitary line (GH3B6) by dual excitation microfluorimetry [Tsien, Rink & Poenie (1985) Cell Calcium 6, 145-157], using fura 2 as intracellular Ca2+ probe. Two phases were observed: initially, [Ca2+]i is raised in a single rapid transient to a maximum averaging 8.0 microM, and in a second phase TRH causes a series of rapid [Ca2+]i oscillations with maxima around 1.0 microM, which are probably due to the enhanced firing of action potentials. TRH triggers both phases independently, i.e. it can elicit either the first or the second phase exclusively. This is also the case in those cells in which [Ca2+]i undergoes rhythmic oscillations due to the firing of spontaneous action potentials [Schlegel, Winiger, Mollard, Vacher, Wuarin, Zahnd, Wolheim & Dufy (1987) Nature (London) 329, 719-721]. The sudden onset of the first phase of TRH action on [Ca2+]i shows that Ca2+ mobilization due to enhanced production of inositol phosphate may occur as rapidly as the firing of action potentials, i.e. in the ms time range. Due to a marked response type heterogeneity and to the randomness of the rapid events, previous monitoring of [Ca2+]i in cell populations had misleadingly suggested small and maintained changes due to TRH. It is concluded that stimulatory regulation of secretion is provided by the generation of rapid [Ca2+]i transients, the frequency of which determines secretory rate. Furthermore, it is demonstrated that the regulation of [Ca2+]i by hormones and neurotransmitters in pituitary and many other cell types will have to be studied at the single cell level in order to appreciate its role in cell activation.     

Internal fertilization in a meiobenthic priapulid worm:Tubiluchus philippinensis (Tubiluchidae,Priapulidia)

Summary Internal fertilization is demonstrated in the priapulid wormTubiluchus philippinensis by the electron microscopic observation of sperm in the urogenital duct of female animals. This finding is of interest in that all other members of this group thus far examined have exhibited external fertilization.     

The fine structure of the lateral eyes ofNeocarus texanus Chamberlin and Mulaik, 1942 (Opilioacarida,Acari, Arachnida,Chelicerata)

Summary Neocarus texanus, a primitive mite, bears two pairs of eyes, which are principally similar in ultrastructure. Each eye is covered externally by a cuticular cornea. It is underlain by flat sheath cells which send extensive processes into the retina. The retina is composed of distal and proximal cells. The 20 distal cells of the anterior eye are inversely orientated and form 10 disc-like rhabdoms. They represent typical retinula cells. Each rhabdom encloses the dendritic process of a neuron, the perikaryon of which is located outside the retina (proximal cells). The significance of this cell is not known. The retina is underlain by a crystalline tapetum. In the posterior eye 14 retinula cells form 7 rhabdoms in an arrangement similar to the anterior eye. The eyes of one side of the body are located within a capsule of pigment cells. Together the axons of the distal and proximal cells form the two optic nerves, one on each side of the body. The optic nerves leave the eyes anteriorly and terminate in two optic neuropils located in the brain.From structural evidence it is concluded, that the resolution of the eyes must be rather low.The peculiar proximal cells have not been observed previously in Acari. They probably resemble at best the eccentric cells and arhabdomeric cells of xiphosurans, scorpions, whip-scorpions and opilionids. Also, inverse retinae and tapeta of the present type have not been found in Acari until now, but are present in other Arachnida. Thus the eyes ofNeocarus texanus evidently represent a unique type within the Acari.     

The Nutrimentary Egg Development of the Mite,Varroa jacobsoni (Acari,Arachnida), an Ectoparasite of Honey Bees

The fine structure of the female gonad of Varroa jacobsoni is described. There are two components: the ovary proper and the so-called lyrate organ. The ovary is the place where oocytes mature, embedded in a supporting tissue composed of two cell types: somacells 1 and somacells 2. The lyrate organ has a nutrimentary function and is comprised of two components: supporting cells and nutritive tissue. The supporting cells are similar to the somacells 2 in that they contain abundant microtubules. The nutritive tissue is an extensive syncytium. It is connected with the oocytes via intercellular bridges, the nutritive cords. Oocytes and nutritive tissue are thought to have derived from common stem cells. From fine structural evidence it is concluded that ribosomes are one of the most important components to be transported via the nutritive cords into the oocytes. However, an increase in number of mitochondria in the middle-stage oocytes may also be a consequence of transport of these organelles from the nutritive tissue into the oocytes. Further characteristics make plausible that the interdependences of oocytes and nutritive tissue are comparable to those found in meroistic ovarioles of insects. The somatic components do not seem to be as important as the follicle cells of insects, however. It is assumed that the evolution of a nutrimentary oogenesis speeds up embryogenesis. Thus, the differentiation of the female gonad of Varroa jacobsoni may have facilitated the species' adaptation to a development completed in a short and limited time within the shelter of the covered brood cell of the bee.     

Regulation of flux through pyruvate dehydrogenase and pyruvate carboxylase in rat hepatocytes. Effects of fatty acids and glucagon

The regulation of flux through pyruvate dehydrogenase (PDH) and pyruvate carboxylase (PC) by fatty acids and glucagon was studied in situ, in intact hepatocyte suspensions. The rate of pyruvate metabolized by carboxylation plus decarboxylation was determined from the incorporation of [1-14C]pyruvate into 14CO2 plus [14C]glucose. The flux through PDH was determined from the rate of formation of 14CO2 from [1-14C]pyruvate corrected for other decarboxylation reactions (citrate cycle, phosphoenolpyruvate carboxykinase and malic enzyme), and the flux through PC was determined by subtracting the flux through PDH from the total pyruvate metabolized. With 0.5 mM pyruvate as substrate the ratio of flux through PDH/PC was 1.9 in hepatocytes from fed rats and 1.4 in hepatocytes from 24 h-starved rats. In hepatocytes from fed rats, octanoate (0.8 mM) and palmitate (0.5 mM) increased the flux through PDH (59-76%) and PC (80-83%) without altering the PDH/PC flux ratios. Glucagon did not affect the flux through PDH but it increased the flux through PC twofold, thereby decreasing the PDH/PC flux ratio to the value of hepatocytes from starved rats. In hepatocytes from starved rats, fatty acids had similar effects on pyruvate metabolism as in hepatocytes from fed rats, however glucagon did not increase the flux through PC. 2[5(4-Chlorophenyl)pentyl]oxirane-2-carboxylate (100 microM) an inhibitor of carnitine palmitoyl transferase I, reversed the palmitate-stimulated but not the octanoate-stimulated flux through PDH, in cells from fed rats, indicating that the effects of fatty acids on PDH are secondary to the beta-oxidation of fatty acids. This inhibitor also reversed the stimulatory effect of palmitate on PC and partially inhibited the flux through PC in the presence of octanoate suggesting an effect of POCA independent of fatty acid oxidation. It is concluded that the effects of fatty acids on pyruvate metabolism are probably secondary to increased pyruvate uptake by mitochondria in exchange for acetoacetate. Glucagon favours the partitioning of pyruvate towards carboxylation, by increasing the flux through pyruvate carboxylase, without directly inhibiting the flux through PDH.     

Regulation of ketogenesis, gluconeogenesis and the mitochondrial redox state by dexamethasone in hepatocyte monolayer cultures.

The effects of the glucocorticoid dexamethasone on fatty acid and pyruvate metabolism were studied in rat hepatocyte cultures. Parenchymal hepatocytes were cultured for 24 h with nanomolar concentrations of dexamethasone in either the absence or the presence of insulin (10 nM) or dibutyryl cyclic AMP (1 microM BcAMP). Dexamethasone (1-100 nM) increased the rate of formation of ketone bodies from 0.5 mM-palmitate in both the absence and the presence of BcAMP, but inhibited ketogenesis in the presence of insulin. Dexamethasone increased the proportion of the palmitate metabolized that was partitioned towards oxidation to ketone bodies, and decreased the cellular [glycerol 3-phosphate]. The latter suggests that the increased partitioning of palmitate to ketone bodies may be associated with decreased esterification to glycerolipid. The Vmax. of carnitine palmitoyltransferase (CPT) and the affinity of CPT for palmitoyl-CoA were not affected by dexamethasone, indicating that the increased ketogenesis was not due to an increase in enzymic capacity for long-chain acylcarnitine formation. Dexamethasone and BcAMP, separately and in combination, increased gluconeogenesis. In the presence of insulin, however, dexamethasone inhibited gluconeogenesis. Changes in gluconeogenesis thus paralleled changes in ketogenesis. Dexamethasone decreased the [3-hydroxybutyrate]/[acetoacetate] ratio, despite increasing the rate of ketogenesis and presumably the mitochondrial production of reducing equivalents. The more oxidized mitochondrial NADH/NAD+ redox couple with dexamethasone is probably due either to an increased rate of electron transport or to increased transfer of mitochondrial reducing equivalents to the cytoplasm.     

Metabolic abnormalities in children of non-insulin dependent diabetics.

Non-insulin dependent diabetes appears to be an inherited condition. A study of young offspring of non-insulin dependent diabetics was conducted to determine whether metabolic abnormalities could be found at a young age before clinical diabetes developed. Thirteen patients with non-insulin dependent diabetes were selected who fulfilled the following criteria: they had a sibling who also had non-insulin dependent diabetes, their spouse was non-diabetic, and the offspring were aged between 12 and 45 years, not diabetic, and available for study. All 32 offspring had a 75 g oral glucose tolerance test, and results in 13 of them, one randomly selected from each family, were compared with 13 controls of similar age, sex, and weight. The offspring had significantly higher fasting concentrations of glucose, higher proportions of haemoglobin A1, and higher concentrations of insulin, C peptide, and glucagon. After glucose challenge the increases in both glucose and C peptide concentrations were significantly greater in the offspring. These differences were maintained in all 32 offspring when compared with 18 controls of similar age, sex, and weight; seven of the 32 offspring had impaired glucose tolerance. These results indicate that young offspring of selected non-insulin dependent diabetics can show extensive metabolic changes including impaired glucose tolerance. These changes are associated with hyperinsulinaemia and hyperglucagonaemia.