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BackgroundA bioinformatics approach identified antitumor effects of tricyclic antidepressants (TCAs) in small cell lung cancer (SCLC) and other high-grade neuroendocrine carcinomas (grade 3 neuroendocrine carcinomas) (G3NEC) that was subsequently validated in preclinical models with a putative mechanism of action via inhibition of neuroendocrine signaling pathways. This study was undertaken to reposition the candidate TCA desipramine in a clinical trial in SCLC and G3NEC.MethodsIn this prospective, phase IIa intrapatient dose escalation clinical trial, patients were required to have failed at least one prior chemotherapy for metastatic SCLC or G3NEC. Treatment with desipramine began at 75 mg nightly with escalation in increments of 75 mg weekly to a maximum of 450 mg daily.ResultsSix patients were enrolled, 3 with SCLC, and 3 with G3NEC (lung, rectal, and pancreas). Tolerability of desipramine was worse than predicted. Of the 6 patients enrolled: 1 patient achieved 300 mg daily, 2 patients reached 150 mg daily, 1 patient reached 75 mg daily, and 2 patients were unable to tolerate any stable dose. Reasons for discontinuation included drug-related grade 3 colon pseudo-obstruction, unrelated GI bleed, and grade 1-2 neurocognitive adverse events. Median clinical or radiographic progression free survival was 1.2 months (range 0.2-3.3) and median overall survival from study entry was 2.7 months (range 1.3-5.6).ConclusionsNo clinical or radiographic benefit was observed using desipramine to treat SCLC and G3NEC, so this trial was terminated. Intolerable low and medium grade neurocognitive side effects led to intermittent treatment and early discontinuation in most patients; given this limitation, doses achieved may be inadequate compared to the preclinical studies.MicroabstractA bioinformatics approach previously identified a potential antitumor effect of tricyclic antidepressants (TCAs) in small cell lung cancer (SCLC) and other high-grade neuroendocrine carcinomas (grade 3 neuroendocrine carcinoma) (G3NEC), which was validated in preclinical models. In this prospective, phase IIa clinical trial, patients were required to have failed at least one prior chemotherapy for metastatic SCLC or G3NEC (Ki-67 ≥ 20% or ≥ 20 mitoses/10 HPF). Treatment with desipramine began at 75 mg nightly with escalation by 75 mg weekly to a maximum dose of 450 mg daily. Six patients were enrolled on this clinical trial, 3 with SCLC, and 3 with G3NEC (lung, rectal, and pancreatic). Tolerability of desipramine was worse than predicted. In the 6 patients enrolled: 1 patient achieved 300 mg daily, 2 patients reached 150 mg daily, 1 patient reached 75 mg daily, and 2 patients were unable to tolerate any stable dose. Reasons for discontinuation included drug-related grade 3 colon pseudo-obstruction, unrelated GI bleed, and grade 1-2 drug related dizziness, confusion, and somnolence. Though numbers are small, median clinical or radiographic progression free survival was 1.2 months (range 0.2-3.3) and median overall survival from study entry was 2.7 months (range 1.3-5.6). Although preclinical evidence was promising, no clinical or radiographic benefit was observed using desipramine to treat SCLC and G3NEC, so this trial was terminated.

Many hepatitis B infections in newborns can be prevented with appropriate screening during pregnancy, treatment after birth, and follow-up with the infant's pediatrician. Pregnant women infected with hepatitis C (HCV) appear to be at minimal risk of transmitting the virus to their fetus unless they also have HIV. There does not appear to be any benefit associated with treating infants exposed to HCV.

Hepatitis B (HBV) virus does not appear to spread easily among children attending daycare centers. Twenty-one Seattle daycare centers were evaluated. Sites selected because there was a known carrier attending (3 sites) or because many children attending came from Asian background, an ethnic group at high risk for HBV infection, and because 50% or more of the parents agreed that their children could participate. Blood samples of children, their families (if positive), and staff were tested for HBV antibodies. Six of 98 staff members had HBV antibodies. All were Asian. Four agreed to a follow-up blood test, and none were carriers. Eight of 496 children not already known to be carriers had been infected with HBV. Only one did not have any family members with HBV antibodies. The other seven children were all Asian and had family members with markers of prior infection.

The sheer complexity of the brain has complicated our ability to understand the cellular and molecular mechanisms underlying its function in health and disease. Genome-wide association studies have uncovered genetic variants associated with specific neurological phenotypes and diseases. In addition, single-cell transcriptomics have provided molecular descriptions of specific brain cell types and the changes they undergo during disease. Although these approaches provide a giant leap forward towards understanding how genetic variation can lead to functional changes in the brain, they do not establish molecular mechanisms. To address this need, we developed a 3D co-culture system termed iAssembloids (induced multi-lineage assembloids) that enables the rapid generation of homogenous neuron-glia spheroids. We characterize these iAssembloids with immunohistochemistry and single-cell transcriptomics and combine them with large-scale CRISPRi-based screens. In our first application, we ask how glial and neuronal cells interact to control neuronal death and survival. Our CRISPRi-based screens identified that GSK3β inhibits the protective NRF2-mediated oxidative stress response in the presence of reactive oxygen species elicited by high neuronal activity, which was not previously found in 2D monoculture neuron screens. We also apply the platform to investigate the role of APOE- ε 4, a risk variant for Alzheimer's Disease, in its effect on neuronal survival. We find that APOE- ε 4-expressing astrocytes may promote more neuronal activity as compared to APOE- ε 3-expressing astrocytes. This platform expands the toolbox for the unbiased identification of mechanisms of cell-cell interactions in brain health and disease.

Background: Cirrhosis causes an imbalance in the coagulation pathway and leads to a tendency for both bleeding and clotting. SARS-CoV-2 has been reported to be associated with a hypercoagulable state. This study examines SARS-CoV-2's impact on hemostasis in compensated patients with cirrhosis., Methods: We analyzed the US Collaborative Network, which comprises 63 HCOs in the U.S.A. Compensated cirrhosis patients were split into two groups: SARS-CoV-2-positive and -negative. Patients' baseline characteristics were used in a 1:1 propensity score-matched module to create comparable cohorts. We compared the risk of portal vein thrombosis (PVT), deep venous thrombosis (DVT), and pulmonary embolism (PE) at 6 months, and 1 and 3 years., Results: Of 330,521 patients, 27% tested positive and 73% remained negative. After PSM, both cohorts included 74,738 patients. Patients with SARS-CoV-2 had a higher rate of PVT compared to those without at 6 months (0.63% vs 0.5%, p < 0.05), 1 year (0.8% vs 0.6%, p < 0.05), and 3 years (1% vs. 0.7%, p < 0.05), a higher rate of DVT at 6 months (0.8% vs. 0.4%, p < 0.05), 1 year (1% vs. 0.5%, p < 0.05), and 3 years (1.4% vs. 0.8%, p < 0.05), and a higher rate of PE at 6 months (0.6% vs. 0.3%, p < 0.05), 1 year (0.7% vs. 0.4%, p < 0.05), and 3 years (1% vs. 0.6%, p < 0.05)., Conclusions: The presence of SARS-CoV-2 infection in patients with compensated cirrhosis was associated with a higher rate of PVT, DVT, and PE at 6 months, and 1 and 3 years., Competing Interests: The authors declare no conflicts of interest.

Background Within the cardiovascular system, sinus tachycardia has been a noted finding in patients with post-COVID-19 syndrome (symptoms persisting beyond 12 weeks post-infection). To better understand post-COVID-19 tachycardia, we examined the prevalence of sinus tachycardia 12-16 weeks after diagnosis of SARS-COV-2 infection and its correlation with intensive care utilization, ventilator use, and mortality in vaccinated and unvaccinated patients. Methods We identified adult patients in the TriNetX COVID-19 Research Network with confirmed SARS-COV-2 diagnosis from January 20th, 2020, to February 14th, 2022, and sinus tachycardia 12-16 weeks after diagnosis. Two cohorts were created: patients who developed tachycardia 12 weeks after initial diagnosis and patients without tachycardia. The tachycardia cohort was divided further based on vaccination status. Results Of 1,363,907 patients included, 30,705 (2.2%) developed tachycardia. The patients with tachycardia had more comorbidities. Using propensity score matching (PSM), two cohorts of 30,702 were created. The SARS-COV-2 tachycardic cohort had higher mortality (5.1% vs 2.1%, p<0.001), critical care utilization (5.8% vs 2.2%, p<0.001), and ventilator use (1.8% vs 0.5%, p<0.001). Out of 22,878 patients with persistent tachycardia and recorded vaccination status, 14,840 (65%) were not vaccinated. Mortality (5.9% vs 2.3%, p<0.001), critical care utilization (8.3% vs 3.6%, p<0.001), and ventilator use (3.8% vs 0.6%, p<0.001) were higher in the non-vaccinated patients compared with the vaccinated patients after PSM.  Conclusion The prevalence of persistent tachycardia after SARS-COV-2 infection is notable at 2.2%. Patients with persistent tachycardia have higher mortality rates and demonstrate greater healthcare utilization at one year compared to patients without persistent tachycardia, particularly if unvaccinated., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2024, Amir-Kabirian et al.)

Mutations in the human progranulin (GRN) gene are a leading cause of frontotemporal lobar degeneration (FTLD). While previous studies implicate aberrant microglial activation as a disease-driving factor in neurodegeneration in the thalamocortical circuit in Grn-/- mice, the exact mechanism for neurodegeneration in FTLD-GRN remains unclear. By performing comparative single-cell transcriptomics in the thalamus and frontal cortex of Grn-/- mice and patients with FTLD-GRN, we have uncovered a highly conserved astroglial pathology characterized by upregulation of gap junction protein GJA1, water channel AQP4, and lipid-binding protein APOE, and downregulation of glutamate transporter SLC1A2 that promoted profound synaptic degeneration across the two species. This astroglial toxicity could be recapitulated in mouse astrocyte-neuron cocultures and by transplanting induced pluripotent stem cell-derived astrocytes to cortical organoids, where progranulin-deficient astrocytes promoted synaptic degeneration, neuronal stress, and TDP-43 proteinopathy. Together, these results reveal a previously unappreciated astroglial pathology as a potential key mechanism in neurodegeneration in FTLD-GRN.

Loss of function (LoF) of TAR-DNA binding protein 43 (TDP-43) and mis-localization, together with TDP-43-positive and hyperphosphorylated inclusions, are found in post-mortem tissue of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) patients, including those carrying LoF variants in the progranulin gene (GRN). Modeling TDP-43 pathology has been challenging in vivo and in vitro. We present a three-dimensional induced pluripotent stem cell (iPSC)-derived paradigm-mature brain organoids (mbOrg)-composed of cortical-like-astrocytes (iA) and neurons. When devoid of GRN, mbOrgs spontaneously recapitulate TDP-43 mis-localization, hyperphosphorylation, and LoF phenotypes. Mixing and matching genotypes in mbOrgs showed that GRN -/- iA are drivers for TDP-43 pathology. Finally, we rescued TDP-43 LoF by adding exogenous progranulin, demonstrating a link between TDP-43 LoF and progranulin expression. In conclusion, we present an iPSC-derived platform that shows striking features of human TDP-43 proteinopathy and provides a tool for the mechanistic modeling of TDP-43 pathology and patient-tailored therapeutic screening for FTD and ALS., Competing Interests: Conflict of interests M.dM. and M.Koontz are full-time employees and equity holders of Synapticure Inc. E.M.U. is an equity holder of Synapticure Inc. M. Kampmann is an inventor on U.S. Patent 11,254,933 related to CRISPRi and CRISPRa screening, serves on the Scientific Advisory Boards of Engine Biosciences, Casma Therapeutics, Cajal Neuroscience, and Alector, and is an advisor to Modulo Bio and Recursion Therapeutics. J.R.K. is a shareholder of Faze Medicines and QurAlis, and is an author on patent that describes surfaces for the long-term culture of pluripotent cells (U.S. patent 8,648,170) as well as a patent application that describes methods and compositions for restoring STMN2 levels (U.S. patent application 20,220,133,848). M.Kurnellas is a full-time employee and has equity interest in Alector, Inc. N.M.Dräger is a full time employee at Modulo Bio, Inc. All other authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Astrocytes become reactive in response to insults to the central nervous system by adopting context-specific cellular signatures and outputs, but a systematic understanding of the underlying molecular mechanisms is lacking. In this study, we developed CRISPR interference screening in human induced pluripotent stem cell-derived astrocytes coupled to single-cell transcriptomics to systematically interrogate cytokine-induced inflammatory astrocyte reactivity. We found that autocrine-paracrine IL-6 and interferon signaling downstream of canonical NF-κB activation drove two distinct inflammatory reactive signatures, one promoted by STAT3 and the other inhibited by STAT3. These signatures overlapped with those observed in other experimental contexts, including mouse models, and their markers were upregulated in human brains in Alzheimer's disease and hypoxic-ischemic encephalopathy. Furthermore, we validated that markers of these signatures were regulated by STAT3 in vivo using a mouse model of neuroinflammation. These results and the platform that we established have the potential to guide the development of therapeutics to selectively modulate different aspects of inflammatory astrocyte reactivity., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) readily infects a variety of cell types impacting the function of vital organ systems, with particularly severe impact on respiratory function. Neurological symptoms, which range in severity, accompany as many as one-third of COVID-19 cases, indicating a potential vulnerability of neural cell types. To assess whether human cortical cells can be directly infected by SARS-CoV-2, we utilized stem-cell-derived cortical organoids as well as primary human cortical tissue, both from developmental and adult stages. We find significant and predominant infection in cortical astrocytes in both primary tissue and organoid cultures, with minimal infection of other cortical populations. Infected and bystander astrocytes have a corresponding increase in inflammatory gene expression, reactivity characteristics, increased cytokine and growth factor signaling, and cellular stress. Although human cortical cells, particularly astrocytes, have no observable ACE2 expression, we find high levels of coronavirus coreceptors in infected astrocytes, including CD147 and DPP4. Decreasing coreceptor abundance and activity reduces overall infection rate, and increasing expression is sufficient to promote infection. Thus, we find tropism of SARS-CoV-2 for human astrocytes resulting in inflammatory gliosis-type injury that is dependent on coronavirus coreceptors.

Limited access to medications and devices relevant to the care of low-risk childbearing families acts as a barrier to the successful integration of high-quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community-based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state-licensed midwives. These professionals are the primary health care providers offering community-based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community-based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement. Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence-based care. Policy makers can improve health, health equity, consumer choice, and access to evidence-based care by using ideal legal language for midwifery practice authority., (© 2021 by the American College of Nurse-Midwives.)

Human astrocytes provide trophic as well as structural support to the surrounding brain cells. Furthermore, they have been implicated in many physiological processes important for central nervous system function. Traditionally astrocytes have been considered to be a homogeneous class of cells, however, it has increasingly become more evident that astrocytes can have very different characteristics in different regions of the brain, or even within the same region. In this review we will discuss the features of human astrocytes, their heterogeneity, and their generation during neurodevelopment and the extraordinary progress that has been made to model these fascinating cells in vitro, mainly from induced pluripotent stem cells. Astrocytes' role in disease will also be discussed with a particular focus on their role in neurodegenerative disorders. As outlined here, astrocytes are important for the homeostasis of the central nervous system and understanding their regional specificity is a priority to elucidate the complexity of the human brain., (© 2020 Wiley Periodicals, Inc.)

Background: Long non-coding RNAs (lncRNAs) exhibit highly cell type-specific expression and function, making this class of transcript attractive for targeted cancer therapy. However, the vast majority of lncRNAs have not been tested as potential therapeutic targets, particularly in the context of currently used cancer treatments. Malignant glioma is rapidly fatal, and ionizing radiation is part of the current standard-of-care used to slow tumor growth in both adult and pediatric patients., Results: We use CRISPR interference (CRISPRi) to screen 5689 lncRNA loci in human glioblastoma (GBM) cells, identifying 467 hits that modify cell growth in the presence of clinically relevant doses of fractionated radiation. Thirty-three of these lncRNA hits sensitize cells to radiation, and based on their expression in adult and pediatric gliomas, nine of these hits are prioritized as lncRNA Glioma Radiation Sensitizers (lncGRS). Knockdown of lncGRS-1, a primate-conserved, nuclear-enriched lncRNA, inhibits the growth and proliferation of primary adult and pediatric glioma cells, but not the viability of normal brain cells. Using human brain organoids comprised of mature neural cell types as a three-dimensional tissue substrate to model the invasive growth of glioma, we find that antisense oligonucleotides targeting lncGRS-1 selectively decrease tumor growth and sensitize glioma cells to radiation therapy., Conclusions: These studies identify lncGRS-1 as a glioma-specific therapeutic target and establish a generalizable approach to rapidly identify novel therapeutic targets in the vast non-coding genome to enhance radiation therapy.

This research presents the initial results of the effects of hydrological restoration on forested wetlands in the Mississippi alluvial plain near Memphis, Tennessee. Measurements were carried out in a secondary channel, the Loosahatchie Chute, in which rock dikes were constructed in the 1960s to keep most flow in the main navigation channel. In 2008-2009, the dikes were notched to allow more flow into the secondary channel. Study sites were established based on relative distance downstream of the notched dikes. Additionally, a reference site was established north of the Loosahatchie Chute where the dikes remained unnotched. We compared various components of vegetation composition and productivity at sites in the riparian wetlands for two years. Salix nigra had the highest Importance Value at every site. Species with minor Importance Values were Celtis laevigata, Acer rubrum, and Plantanus occidentalis. Productivity increased more following the introduction of river water in affected sites compared to the reference. Aboveground net primary productivity was highest at the reference site (2926 ± 458.1 g·m(-2)·year(-1)), the intact site; however, there were greater increase at the sites in the Loosahatchie Chute, where measurements ranged from 1197.7 ± 160.0 g m(-2)·year(-1)·to 2874.2 ± 794.0 g·m(-2)·year(-1). The site furthest from the notching was the most affected. Pulsed inputs into these wetlands may enhance forested wetland productivity. Continued monitoring will quantify impacts of restored channel hydrology along the Mississippi River.

Purpose: The Dixon techniques provide uniform water-fat separation but require multiple image sets, which extend the overall acquisition time. Here, an alternative rapid single acquisition method, lipid elimination with an echo-shifting N/2-ghost acquisition (LEENA), was introduced., Methods: The LEENA method utilized a fast imaging with steady-state free precession sequence to obtain a single k-space dataset in which successive k-space lines are acquired to allow the fat magnetization to precess 180°. The LEENA data were then unghosted using either image-domain (LEENA-S) or k-space domain (LEENA-G) parallel imaging techniques to reconstruct water-only and fat-only images. An off-resonance correction technique was incorporated to improve the uniformity of the water-fat separation., Results: Uniform water-fat separation was achieved for both the LEENA-S and LEENA-G methods for phantom and human body and leg imaging applications at 1.5T and 3T. The resultant water and fat images were qualitatively similar to conventional 2-point Dixon and fat-suppressed images., Conclusion: The LEENA-S and LEENA-G methods provide uniform water and fat images from a single MRI acquisition. These straightforward methods can be adapted to 1.5T and 3T clinical MRI scanners and provide comparable fat/water separation with conventional 2-point Dixon and fat-suppression techniques., (© 2014 Wiley Periodicals, Inc.)

Computer modeling of aggregate exposure provides the capability to estimate the range of doses that can occur from product use and to understand the relative importance of different routes of exposure. This paper presents an assessment of aggregate occupational exposure to two glycol ethers used as solvents in floor maintenance products for industrial and institutional facilities, using a simulation tool named PROMISE. Three commercial floor-care products were assumed to be applied in sequence--a floor stripper, then a floor cleaner, and lastly a protective coating. The glycol ethers modeled were ethylene glycol butyl ether (EGBE) in the floor stripper and in the floor cleaner, and dipropylene glycol methyl ether (DPGME) in the coating. Modeling uncertainty was assessed through a comparison of the PROMISE inhalation exposure estimates with those from an independent model (MCCEM), and parameter uncertainty was investigated using PROMISE software's Monte Carlo simulation capabilities. Modeling results indicated that inhalation is the dominant exposure route. The predicted average air concentration and inhalation dose from PROMISE agreed with the second model (MCCEM) within 10%. Monte Carlo simulation indicated that the upper end of the aggregate-dose distribution for the scenario was more than 50% higher than the value of the point estimate. The modeled 8-h TWA concentrations for EGBE and DPGME were lower than the corresponding permissible exposure limits American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLV) by at least a factor of 20, indicating that under the assumed conditions workplace exposures to glycol ethers are below levels of concern.

House depressurization occurs when household equipment such as a kitchen or bathroom fan or a fireplace exhausts air from the house and lowers the pressure indoors with respect to the outside. The operation of air handlers for forced-air heating or cooling systems also can have a depressurization effect. This depressurization can hinder the natural draft from vented combustion appliances and lead to backdrafting, which in turn can result in combustion gases spilling into the indoor airspace. Extensive spillage can cause elevated indoor levels of combustion products such as carbon dioxide (CO2) and water vapor, as well as contaminants such as carbon monoxide (CO) and nitrogen dioxide (NO2). The focus of this paper is to review studies on depressurization-induced backdrafting and spillage from gas-fired, drafthood equipped furnaces and domestic hot water heaters. Qualitative and quantitative techniques that were used in depressurization and backdrafting studies conducted in Canada, Europe, and the United States are analyzed. These studies have shown that exhaust fans operated simultaneously with fireplaces depressurize houses by 3 to 8 Pa on average. The CO indoor concentrations due to spillage, as reported in these studies, generally have been lower than 5 ppm. However, such low CO concentrations do not necessarily imply that a potential problem associated with backdrafting does not exist. Other combustion products, such as NO2, rarely have been measured in prior backdrafting studies. It can be concluded from the literature review that causes of house depressurization are well understood. However, more comprehensive research is needed to better understand the frequency, duration, and severity of depressurization-induced spillage in a broad cross section of houses. Efforts in this direction have begun recently in the United States through a workshop to define research issues, pilot studies to develop comprehensive measurement protocols, and consensus standard development activities to prepare standardized methods and protocols.

Range gas consumption in households tends to follow an annual cycle resembling a sinusoid, with peak consumption during the winter. When outdoor NO2 concentrations have a constant or small impact, the resulting indoor NO2 concentrations also tend to resemble an annual sinusoid. Optimal monitoring strategies can be designed to take advantage of this knowledge to obtain a better estimate of the true annual average gas consumption or indoor NO2 concentration. Gas consumption data, together with measured outdoor concentrations, house volumes, sampled emission rates, air exchange rates, and NO2 decay rates, are used to model weekly indoor NO2 concentrations throughout the year. Based on the modeling results, various monitoring strategies are evaluated for their accuracy in estimating the annual mean. Analysis of the results indicates that greater accuracy is attained using samples equally spaced throughout the year. In addition, the expected error for various monitoring strategies and various numbers of equally spaced samples is quantified, and their ability to classify homes into correct concentration categories is assessed.

GABA-immunoreactive displaced amacrines were previously shown to make synapses onto neuronal profiles in the ganglion cell layer (GCL) of macaque monkey retina [Koontz, Hendrickson and Ryan (1989) Visual Neuroscience, 2, 19-25]. These postsynaptic elements have been investigated further using postembedding immunogold methods for electron microscopy. This paper provides ultrastructural evidence that GABA-immunoreactive profiles are presynaptic to the ganglion cell soma, axon hillock, and axon initial segment in the GCL and its border with the nerve fiber layer (NFL). Some axonal profiles have a dense undercoat and fasciculated microtubules, features that are characteristic of the axon initial segment in many neurons of both central and peripheral nervous systems. These features are confined to small- and medium-diameter (0.2-0.6 microns) axon profiles located near the GCL/NFL border and are not found on axonal profiles lying deep in the NFL, suggesting that the dense-coated region does not extend far along the axon and that the dense-coated region may be narrower than the distal part of the axon. The dense-coated region may correspond to the ganglion cell "narrow segment" recently described in a variety of species using light microscopic methods. The results presented here strengthen our previous hypothesis that GABA-immunoreactive neurons in the GCL provide direct synaptic input to ganglion cells near the site of action potential initiation.

Recent studies have varied widely in the percentages of GABA- and glycine-immunoreactive (GABA+, GLY+) amacrines reported for primate retina. We compared the distributions of GABA+ and GLY+ amacrines and displaced amacrines at seven locations along the horizontal meridian of macaque retina using postembedding immunogold labeling with silver intensification. The percentage of GABA+ amacrine profiles was higher in central retina (50-55%) than peripheral retina (30-40%), whereas the percentage of GLY+ amacrine profiles did not vary much with eccentricity (52-57%). GABA and glycine were colocalized in 5-20% of amacrines, depending on the eccentricity, whereas 5-30% of amacrines were not immunoreactive for either neurotransmitter. GABA+ amacrines were slightly larger than GLY+ amacrines or Müller cells. In the ganglion cell layer, 5-20% of neurons were labeled for either GABA or glycine and were identified as displaced amacrines. Of these, 53% were GABA+ only, 11% were GLY+ only, and 37% were double-labeled. A few large, very lightly labeled GABA+ cells were identified as ganglion cells. Other features that varied with eccentricity included the linear density of GABA+ and GLY+ amacrines, and the ratio of amacrines to Müller cells.

The distributions of the two synaptic vesicle proteins p65 [Matthew et al. (1981) J. Cell Biol., 91:257-269] and synapsin I [De Camilli et al. (1983) J. Cell Biol., 96:1337-1354] were compared in macaque monkey retina using pre-embedding immunocytochemistry for both light and electron microscopy. The monoclonal antibody AB-48 against p65 labeled ribbon-containing synaptic terminals of cone, rod, and bipolar cells as well as many conventional synapses of amacrine cells. In contrast, a polyclonal antiserum against synapsin I (SYN I) labeled many amacrine conventional synapses but no photoreceptor or bipolar ribbon synaptic terminals. Horizontal cell pre- and post-synaptic profiles in the outer plexiform layer were not labeled by either antibody. At the light microscopic level, the banding patterns in the inner plexiform layer also differed for the two antibodies, with four bands of AB-48 immunoreactivity in sublayers S1, S2, S4, and S5 but only three bands of SYN I immunoreactivity in S1, S3, and S5. SYN I also labeled varicose fibers in both the inner nuclear layer and the outer plexiform layer that are probably processes of dopaminergic and GABAergic interplexiform cells. Varicose fibers in the ganglion cell layer were labeled by both antibodies. These results provide the first electron microscopic immunocytochemical labeling for AB-48 and SYN I in intact retina and confirm that AB-48 labels both ribbon and conventional synaptic terminals, whereas SYN I labels only conventional synapses.

Part II of this article continues the discussion of group process in a reality-based, ego-supportive therapeutic group for mothers of incest victims that was co-led for 2 years by the authors. Strategies are discussed that fostered development of a therapeutic group. Recurrent themes that emerged in the group are identified. Interventions that provided opportunities for corrective interpersonal experiences are described, as are therapeutic values and beneficial outcomes.

Reality-based, ego-supportive group therapy is an intervention with mothers of children who were sexually abused by a father, stepfather, or man in the paternal role. Structure and process of a mothers' group that was co-led by the authors and met weekly for 2 years are described in this two part article. In Part I of this article, the structure of the Mothers' Group is described: setting and referral sources, purpose and goals, format, and group composition. Also discussed are the influence of leader attributes on group process, therapeutic interventions related to these attributes, and strategies to handle the potential for counter-transference and minimize its antitherapeutic effects.

The distribution patterns of GABA immunoreactive (+) and immunonegative (-) amacrine cell synapses and profiles in the inner plexiform layer (IPL) were analyzed in three macaque monkey retinas using postembedding electron-microscopic (EM) immunogold cytochemistry. Synapses and profiles were counted at 5% intervals throughout the IPL depth in three EM montages (total area = 6509 microns 2), with 0% depth at the inner nuclear layer/IPL border. Nearly 70% of all amacrine synapses were GABA+, and they contacted all major classes of neurons that arborize in the IPL: bipolars (45%), ganglion cells (25%), and GABA+ (20%) and GABA- (10%) amacrines. A major relationship was seen between GABA+ amacrine processes and bipolar terminals: 76% of all amacrine-to-bipolar synapses were GABA+, and 82% of bipolar output dyads contained at least one GABA+ amacrine. GABA+ amacrine profiles (N = 2455) were concentrated in three wide bands at IPL depths of 0-25%, 40-60%, and 75-100%, corresponding to the dense bands seen with light-microscopic immunocytochemistry. In contrast, GABA+ amacrine synapses (N = 1081) were distributed evenly throughout the IPL depth, rather than being confined to the three dense bands. GABA- amacrine synapses (N = 516) were concentrated at 40% and 60% depths. Each category of amacrine output synapses had a characteristic pattern of stratification in the IPL. GABA+ amacrine-to-bipolar synapses occurred throughout the IPL but were most frequent at 20% and 80% IPL depths, where the dendrites of midget cone bipolars arborize (Polyak, 1941). In contrast, GABA+ amacrine-to-ganglion cell synapses were concentrated at 30% and 70% IPL depths, near the dendritic arborizations of parasol ganglion cells (Watanabe & Rodieck, 1989). GABA+ synapses onto bipolars and amacrines were also concentrated at the level of rod bipolar terminals. GABA+ amacrines must play significant but different roles in ON and OFF midget and parasol pathways as well as the rod pathway.