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Gymnasts' bone mineral characteristics are generally not known before starting their sport. Prepubertal females who enrolled in beginning artistic gymnastics (n = 65) had lower bone mineral than controls (n = 78). However, 2 years of gymnastics participation versus no participation led to a significantly greater accrual of forearm bone area and lumbar spine areal BMD. Introduction: The skeletal response to exercise in children compared with adults is heightened because of the high bone turnover rate and the ability of bone to change its size and shape. Whereas child gymnasts generally have greater rates of bone mineral accrual compared with nongymnasts, it is unknown if some of these skeletal advantages are present before the onset of training or are caused entirely by training. Materials and Methods: Changes in bone area (BA; cm2), BMC (g), and areal BMD (aBMD; g/cm2) over 24 months were examined in prepubertal females, 4–8 years of age, who selected to perform recreational gymnastics (GYM; n = 65), nongymnastic activities, or no organized activity (CON; n = 78). Participants had essentially no lifetime history of organized athletic participation (

Leptin is secreted by adipose tissue and thought to regulate appetite at the central level. Several studies have explored the central nervous system (CNS) entry of this peptide across the blood-brain and blood-cerebrospinal fluid (CSF) barriers in parallel, but this is the first to explore the transport kinetics of leptin across the choroid plexus (blood-CSF barrier) in isolation from the blood-brain barrier (BBB). This is important as the presence of both barriers can lead to ambiguous results from transport studies. The model used was the isolated Ringer perfused sheep choroid plexus. The steady-state extraction of [(125)I]leptin (7.5 pmol l(-1)) at the blood face of the choroid plexus was 21.1+/-5.7%, which was greater than extraction of the extracellular marker, giving a net cellular uptake for [(125)I]leptin (14.0+/-3.7%). In addition, trichloroacetic acid precipitable [(125)I] was detected in newly formed CSF, indicating intact protein transfer across the blood-CSF barrier. Human plasma concentrations of leptin are reported to be 0.5 nM. Experiments using 0.5 nM leptin in the Ringer produced a concentration of leptin in the CSF of 12 pM (similar to that measured in humans). [(125)I]Leptin uptake at the blood-plexus interface using the single-circulation paired tracer dilution technique (uptake in60 s) indicated the presence of a saturable transport system, which followed Michaelis-Menten-type kinetics (K(m)=16.3+/-1.8 nM, V(max)=41.2+/-1.4 pmol min(-1) g(-1)), and a non-saturable component (K(d)=0.065+/-0.002 ml min(-1) g(-1)). In addition, secretion of new CSF by the choroid plexuses was significantly decreased with leptin present. This study indicates that leptin transport at the blood-CSF barrier is via saturable and non-saturable mechanisms and that the choroid plexus is involved in the regulation of leptin availability to the brain.

A prospective, randomized, double-masked, and placebo-controlled study was performed to evaluate the effects of a localized and sustained release of mitomycin on the success of glaucoma filtration surgery in rabbits. A bioerodible polymer was used as the drug carrier. Full-thickness filtration surgeries were performed and data from 22 rabbits were collected. One eye received a polymer impregnated with mitomycin (0.02 mg or 0.06 mg), while the fellow eye received a drug-free polymer. Intraocular pressure, bleb survival, and postoperative complications were investigated. Intraocular pressures remained lower for a longer period of time (P less than 0.004) and filtration blebs lasted longer (P less than 0.05) in experimental eyes than in control eyes. Conjunctivitis and sectorial corneal haze occurred more frequently in eyes treated with the higher dosage mitomycin compared with control eyes. The use of mitomycin-C in a polymer delivery system appeared to promote the success of glaucoma filtration surgery in rabbits. With the lower dosage of mitomycin, clinically significant ocular toxicity was not noted.

PURPOSE: To evaluate the safety and efficacy of the Ahmed glaucoma valve implant in patients with glaucoma as a result of Sturge-Weber syndrome. METHODS: Eleven eyes (10 patients) with glaucoma resulting from Sturge-Weber syndrome had placement of an Ahmed glaucoma valve implant from May 1993 to June 1996 at the Jules Stein Eye Institute. Success was defined by intraocular pressure at the last two consecutive visits of less than 21 mm Hg, no additional glaucoma surgery, no expulsive choroidal hemorrhage, and no retinal detachment. RESULTS: Mean intraocular pressure on the first postoperative day was 14.0 mm Hg (SD ± 6.7). The cumulative probability of success was 79% (95% confidence interval [CI], 52% to 100%) at 24 months, 59% (95% CI, 20% to 98%) at 42 months, and 30% (95% CI, 0% to 75%) at 60 months. CONCLUSIONS: On the basis of limited follow-up, the Ahmed glaucoma valve implant appears to be a relatively useful drainage device in eyes with glaucoma resulting from Sturge-Weber syndrome.

Background: Evidence suggests that adults and adolescents throughout the United States are at risk of poor vitamin D status. However, vitamin D concentrations in young American children have not been assessed. Objective: The relations between serum 25-hydroxyvitamin D [25(OH)D] and bone were examined in prepubertal girls. Design: In the present cross-sectional study, serum 25(OH)D concentrationwasassessedin168prepubertalgirlsaged4–8ylivingin the southeastern United States with the use of radioimmunoassay. Bone area, bone mineral content, and areal bone mineral density were measured from total body, lumbar spine, proximal femur, and forearm with dual-energy X-ray absorptiometry. Data were analyzed with analysis of variance, analysis of covariance, stepwise multiple regression, and partial correlations. Results:Themean(SD)serum25(OH)Dwas93.828.1nmol/L (range: 31.1–181.4 nmol/L). In a multiple regression analysis, race and season were the strongest predictors of vitamin D status. The black girls had lower mean 25(OH)D values than did the white girls (P 0.01), and 25(OH)D values were significantly different in the total sample between the seasons (P 0.001), ranging from 74.4 nmol/Lduringthewintermonthsto107nmol/Lduringthesummer. After adjustment for season, age, race, and body mass index, 25(OH)Dvalueswerenegativelycorrelatedwithforearmbonemineral content (r 0.18; P 0.02). Conclusions:Unlikepriorreportsofadultsandadolescentslivingin the southeastern United States, vitamin D status was adequate in the children of the present study. 25(OH)D concentrations were not positively associated with higher bone mineral. Am J Clin Nutr 2006;83:75–81.

The patient's perspective of his or her own health status as it relates to functioning and well-being is referred to as health-related quality of life. Various generic and ophthalmology-specific survey instruments have been used to gain an understanding of patient-oriented health status in patients with cataract or with glaucoma. Improvement in vision-targeted quality of life has been shown following cataract surgery; however, an improvement in self-perceived overall health status following cataract surgery has not been established. Increasing severity of glaucoma has been shown to be negatively related to vision-targeted quality of life; the relationship between increasing severity of glaucoma and overall self-perceived health status is inconclusive. Integration of the concepts of health-related quality of life into clinical practice will require the development of better measurement instruments that can demonstrate notable outcome advantages for patients.

Poor foetal and neonatal nutrition may impair normal pancreatic β -cell development and predispose to diabetes in later life. We investigate here the nature of the pancreatic β -cell dysfunction in sucrose-fed adult offspring malnourished during the foetal-neonatal period and examine glucose metabolism and the generation of signals involved in the secretory mechanism. In islets from sucrose-fed previously malnourished rats, rates of glucose utilisation (production of 3 H 2 O) and oxidation (production of 14 CO 2 ), at 2, 6 and 10 mM glucose, were not lower than those of controls. ATP concentrations in islets from previously malnourished rats fed sucrose at 2 and 10 mM glucose were similar to those of controls. Glucose-stimulated insulin release was impaired (by 49–55%) in islets from these animals as was the response to keto-isocaproate (by 70%) and tolbutamide (by 70%). Under conditions in which ATP-sensitive K + channels were clamped open (40 mM K + and diazoxide), glucose-stimulated insulin release in islets from previously malnourished rats fed sucrose was reduced. These findings show that defects in insulin secretion in islets isolated from previously malnourished animals are located in both ATP-sensitive K + channel dependent and independent pathways. They do not involve alterations in the early steps of glucose handling in the β -cell, including glucose metabolism and ATP generation.

To test the hypothesis that poor foetal–neonatal nutrition predisposes adult animals to impaired glucose tolerance or diabetes, pregnant and lactating rats were fed a low (5%) protein diet and glucose tolerance and pancreatic islet function then assessed in the adult offspring. To expose any underlying defects the offspring were allowed access to a sucrose supplement (35%) or fed a high fat diet. Offspring born to low protein-fed females had significantly lower body weights than controls. In islets from previously malnourished rats, insulin release in batch incubations or perifusion was not significantly different to controls. In islets from previously malnourished animals fed sucrose, glucose-stimulated insulin release was reduced in perifusion by 66% (PPPPP Journal of Endocrinology (1997) 154, 177–185

We fed normal rats a high sucrose diet in order to test the hypothesis that mild hyperglycemia can induce defects in pancreatic beta-cell function and impair glucose-stimulated insulin release. Rats provided with free access to a sucrose solution (35%) voluntarily consumed 50% more carbohydrate than control per day. After 7 days of sucrose feeding, glucose tolerance was significantly impaired; the area under the glucose tolerance test curve (GTT) was 683 +/- 61 mmol/120 min compared with 472 +/- 56 mmol/120 min in controls (P0.05). Impaired glucose tolerance was still present after a further 12 days (area under the GTT: 749 +/- 99 mmol/120 min). Sucrose-fed rats were significantly (P0.05) hyperglycemic by 1.5 mmol/l over controls. When insulin secretion was assessed in vivo and in vitro in control and sucrose-fed rats, no significant differences were apparent in plasma samples collected over a 1-h period or in statically incubated or perifused isolated pancreatic islets. In addition, the rates of glucose utilisation and oxidation were normal in islets from sucrose-fed rats. These data do not support the hypothesis that minimal hyperglycemia is sufficient to impair glucose-stimulated insulin release.

1104 Background: First-line surgical options for early stage breast cancer include breast-conserving surgery (BCS) or mastectomy. We analyzed factors that influence the receipt of mastectomy and re...

A prospective, randomized, double-masked, and placebo controlled study was performed to examine the effects of topically applied mitomycin on the success of full thickness filtration surgery in 23 rabbits. Both eyes of each rabbit had surgery by the same surgeon. After surgery, the experimental eye received a single subconjunctival injection of mitomycin (0.2 mg), and 50 microliters of a 0.2 mg/cc solution of mitomycin topically four time daily. The fellow control eyes were treated with sterile water. The mean intraocular pressure reduction from baseline exhibited by the experimental eyes was greater than that observed for the control eyes. The difference in intraocular pressure reduction between the two groups was statistically significant from post-operative day three through day 21 (p less than .05). With survival analysis, fewer failures were noted in the experimental eyes compared to control eyes for each time period throughout the study (p less than .005). The experimental eyes also demonstrated a longer time to bleb failure although this difference did not achieve statistical significance (p less than .10). An additional five rabbits were treated with the experimental drop in one eye and sterile water in the fellow eye but underwent no surgery. No differences between eyes were noted with regard to intraocular pressure change or anterior segment pathology. These data demonstrated the efficacy of mitomycin in promoting filtration surgical success in rabbits.

Objective To develop a brief symptom survey specific for persons with glaucoma, the Glaucoma Symptom Scale (GSS). Design Cross-sectional study of symptoms, functional impairment, and vision-targeted health-related quality of life among persons with glaucoma. Patients A sample of 147 persons with glaucoma among a broad range of treatment categories from 4 tertiary care glaucoma centers and 44 persons without eye disease enrolled from the same 4 centers. Main Outcome Measures Participants completed a modified version of the Ocular Hypertension Treatment Study 10-item symptom checklist. Participants also completed 2 vision-specific measures, the National Eye Institute Visual Function Questionnaire and the VF-14. Participants underwent a clinical evaluation, including ocular and medical history, dilated ophthalmic examination, and Humphrey 24-2 automated visual field testing. Results The GSS has 2 underlying domains that demonstrate sufficient internal consistency reliability for between-group comparisons. The GSS discriminates well between persons with and without glaucoma. Additionally, tests of association with clinical markers of glaucoma severity support the clinical validity of the measure and tests of association with established vision-targeted measures provide evidence of construct validity. Conclusion The simplicity, brevity, and psychometric properties of the GSS support its use in clinical practice and research to quantify symptoms in patients with glaucoma and to assist in investigations concerning the effect of glaucoma and treatments.

Objective: To evaluate the Ahmed Glaucoma Valve implant, an aqueous shunting device with a unidirectional valve mechanism, in patients younger than 18 years. Design: Prospective case series. Setting: Tertiary care hospital. Patients: Twenty-one consecutive patients younger than 18 years. The median age of patients was 4.8 years (range, 0.23-17.9 years). Intervention: Placement of an Ahmed Glaucoma Valve implant between April 1992 and April 1994. Main Outcome Measure: Time after surgery without failure. Success was defined as an average intraocular pressure less than 22 mm Hg for the last 2 follow-ups in eyes with preoperative intraocular pressure greater than 22 mm Hg, or an intraocular pressure that was lowered by at least 20% from preoperative values in eyes with pre-operative intraocular pressure less than 22 mm Hg, and no additional glaucoma surgeries or visually devastating complications. Results: Cumulative probabilities of success at 12 and 24 months were 77.9%±8.8% and 60.6%±13.7%, respectively. One eye had a flat anterior chamber and suprachoroidal hemorrhage on the first postoperative day. No other eyes had flat or shallow anterior chambers that required reformation. In 3 eyes the implant extruded from underneath the conjunctiva and was removed. In 2 other eyes the average intraocular pressure for the last 2 follow-ups was greater than 22 mm Hg. In 1 eye with an intraocular pressure less than 22 mm Hg preoperatively, the intraocular pressure was not reduced by at least 20%, although the number of antiglaucoma medications was reduced. Conclusion: The 12- and 24-month success rates of the Ahmed Glaucoma Valve implant are similar to those of other implants when used in a pediatric population.

• We studied the toxic effects of sulfur hexafluoride and perfluoropropane in comparison with air, balanced salt solution, hyaluronate sodium, and aqueous humor in a rabbit model. Sixty normal pigmented rabbits were studied during a period of 4 weeks. The variables studied were slit-lamp biomicroscopic examination of the anterior segment, intraocular pressure as measured by pneumotonometry, corneal thickness and endothelial cell count as measured by specular microscopy, lens opacity by Scheimpflug photography, and light and transmission electron microscopy. All three gases were more toxic to the cornea and lens than were balanced salt solution, hyaluronate, and aqueous humor. However, 15% perfluoropropane and 50% sulfur hexafluoride were no more toxic to the eye than air was. Therefore, this study suggests that nonexpansile mixtures of perfluoropropane and sulfur hexafluoride may be beneficial and relatively safe in re-forming persistently flat anterior chambers in situations where the use of air is being considered.

We observed 48 patients for 7-21 months (mean, 18 months) after pterygium excision and 2 weeks of placebo or mitomycin topical therapy to evaluate whether or not the short-term efficacy of mitomycin in preventing pterygium recurrence would be reflected in long-lasting efficacy as well. Placebo-treated pterygia showed a 73% recurrence rate. One of 58 (1.7%) mitomycin-treated pterygia recurred (p less than 0.05). We also performed a pilot study comparing pterygia treated with excision followed by 0.4 mg/ml of mitomycin to pterygia treated with excision coupled with conjunctival autograft transplantation to estimate the number of patients required for a randomized clinical trial comparing these two treatment modalities and thereby to decide whether or not such a study would be justified. Thirteen primary and two recurrent pterygia were treated with mitomycin, while 14 primary and one recurrent pterygia were treated with conjunctival autograft transplantation. With mean follow-up times of 4 and 6 months, respectively, no recurrences were noted in the mitomycin-treated group, while the conjunctival autograft transplantation group had one recurrence (6.6%). We estimate that 400 patients would be required for a properly designed clinical trial comparing these two effective therapies for prevention of recurrent pterygia. We conclude that such a study is unjustified, and further conclude that the vastly less expensive, simple therapy of mitomycin eye drops is the more appropriate treatment.

To determine whether magnetic resonance (MR) imaging can demonstrate the early stages of osteonecrosis that are not detectable radiographically, the authors compared radiologic findings with histologic results in seven patients at high risk for osteonecrosis of the femoral head. Radiography and MR imaging were performed, and proximal femoral intramedullary pressures were measured in all patients, even if results from imaging studies were normal. If the pressures were elevated, core decompression with biopsy was performed. Seven patients had elevated pressures in 11 hips. Of 11 hips from which biopsy specimens were taken, all had histologic evidence of osteonecrosis. However, in only five were the MR imaging findings consistent with osteonecrosis. In the remaining six hips with osteonecrosis, MR imaging findings were normal. Sensitivity of MR imaging in detection of osteonecrosis was 46%. The authors conclude that normal MR imaging results in high-risk patients do not rule out the presence of osteonecrosis.

Animals sensitized by intratracheal administration of particulate Micropolyspora faeni antigen and subsequently challenged with the antigen intratracheally developed lesions of hypersensitivity pneumonitis histologically similar to those observed in man wih this disease. Animals sensitized with antigen but depleted of complement with cobra venom factor prior to challenge with the antigen manifested a significant reduction in mean lesion indices when compared to a group of control animals that were not complement-depleted. These data indicate that complement is necessary for the development of pulmonary lesions of experimental hypersensitivity pneumonitis in the rabbit.

The authors used an antineoplastic-antibiotic agent, mitomycin, in the form of eye drops as adjunctive treatment for primary and recurrent pterygia after surgical excision. Sixteen primary and four recurrent pterygia were treated with 1.0 mg/ml mitomycin eye drops, 14 primary and 10 recurrent pterygia were treated with 0.4 mg/ml mitomycin eye drops, and 18 primary pterygia were treated with placebo eye drops. Postoperative follow-up for the eyes treated with mitomycin eye drops ranged from 3 to 34 weeks (mean, 23 weeks). One of 44 pterygia treated with mitomycin recurred after 5 months (recurrence rate, 2.3%), whereas 16 of 18 primary pterygia treated with placebo eye drops developed postoperative granulomas and recurrent pterygia with a mean postoperative period of 6 weeks (recurrence rate, 88.9%). Topical mitomycin (1.0 mg/ml) caused conjunctival irritation, excessive lacrimation, and mild superficial punctate keratitis. These topical side effects were minimized with the 0.4 mg/ml mitomycin dosage. No systemic toxicity was noted with either dosage. The authors believe that mitomycin eye drops is a safe and effective adjunct to surgical excision in the treatment of primary or recurrent pterygia, or both.

• In a case-control study using an exploratory health questionnaire, we examined the relationship between primary open angle glaucoma (POAG) and a variety of personal characteristics and potential toxic exposures in patients in a general eye service. There were 83 patients with definite POAG, 121 POAG suspects, and 237 controls. Using multiple logistic regression analysis for simultaneous evaluation of potential risk factors, we found that black race (rate ratio = 6.8; 95% confidence interval [CI] = 2.8 to 16.0) and untreated systolic hypertension (rate ratio = 5.8; 95% CI = 2.2 to 15) were the most important risk factors. Current cigarette smoking was also associated with glaucoma (rate ratio = 2.9; 95% CI = 1.3 to 6.6). Suggestive associations were found with family history of glaucoma, definite or borderline diabetes, and myopia. The effects of many of these personal characteristics and exposures as risk factors were also noted for the glaucoma suspect group, though not as strongly as for the definite glaucoma cases.

EEG and autonomic habituation were studied during sleep stages 2 and REM. and during awake. Repeated presentations of the same stimulus to the same subjects within sleep stages and when awake permitted evaluation of habituation between tone sets within stag 2, REM, and awake, and from sleep to awake. Forty-six subjects were exposed to 800 Hz. 75 dB, 1- or 2-sec tones, presented in sets of 20 tones. During steep, there was no habituation of the EEC response. Habituation occurred for both FPR and HRR during stage 2, with no evidence of within-stage. between tone set habituation. No significant habituation occurred during REM for HRR or FPR. Evoked skin resistance responses were rare during both stage 2 and RKM. In the awake state, HRR was unresponsive but all other variables showed habituation. Tones presented during the night had no effect on the awake response.

Unique hypertrophic apocrine sweat glands are described in the neck, perineal and inguinal skin of mink kits. These glands enlarge after birth, only to regress rapidly and become vestigal by weaning. No similar phenomenon has been recognized before in mammals. Behavioral studies indicate a possible role for the glandular secretion in maternal recognition of the young.

In snouts of pigs from 5 of 8 piggeries in New South Wales examined, there was evidence of severe atrophic rhinitis. In 220 pigs examined from one piggery there was no correlation between the severity of atrophic rhinitis and growth rate or back-fat thickness. There was also no correlation between the extent of lung pathology and back-fat thickness. Pleurisy or pericarditis did cause a significant reduction in growth rate.