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The whitespotted eagle ray Aetobatus narinari is a tropical to warm-temperate benthopelagic batoid that ranges widely throughout the western Atlantic Ocean. Despite conservation concerns for the species, its vertical habitat use and diving behaviour remain unknown. Patterns and drivers in the depth distribution of A. narinari were investigated at two separate locations, the western North Atlantic (Islands of Bermuda) and the eastern Gulf of Mexico (Sarasota, Florida, U.S.A.). Between 2010 and 2014, seven pop-up satellite archival tags were attached to A. narinari using three methods: a through-tail suture, an external tail-band and through-wing attachment. Retention time ranged from 0 to 180 days, with tags attached via the through-tail method retained longest. Tagged rays spent the majority of time (82.85 ± 12.17% S.D.) within the upper 10 m of the water column and, with one exception, no rays travelled deeper than ~26 m. One Bermuda ray recorded a maximum depth of 50.5 m, suggesting that these animals make excursions off the fore-reef slope of the Bermuda Platform. Individuals occupied deeper depths (7.42 ± 3.99 m S.D.) during the day versus night (4.90 ± 2.89 m S.D.), which may be explained by foraging and/or predator avoidance. Each individual experienced a significant difference in depth and temperature distributions over the diel cycle. There was evidence that mean hourly depth was best described by location and individual variation using a generalized additive mixed model approach. This is the first study to compare depth distributions of A. narinari from different locations and describe the thermal habitat for this species. Our study highlights the importance of region in describing A. narinari depth use, which may be relevant when developing management plans, whilst demonstrating that diel patterns appear to hold across individuals., (© 2020 Fisheries Society of the British Isles.)

Occupational exposure to hypobaria (low atmospheric pressure) is a risk factor for reduced white matter integrity, increased white matter hyperintensive burden, and decline in cognitive function. We tested the hypothesis that a discrete hypobaric exposure will have a transient impact on cerebral physiology. Cerebral blood flow, fractional anisotropy of water diffusion in cerebral white matter, white matter hyperintensity volume, and concentrations of neurochemicals were measured at baseline and 24 hr and 72 hr postexposure in N = 64 healthy aircrew undergoing standard US Air Force altitude chamber training and compared to N = 60 controls not exposed to hypobaria. We observed that hypobaric exposure led to a significant rise in white matter cerebral blood flow (CBF) 24 hr postexposure that remained elevated, albeit not significantly, at 72 hr. No significant changes were observed in structural measurements or gray matter CBF. Subjects with higher baseline concentrations of neurochemicals associated with neuroprotection and maintenance of normal white matter physiology (glutathione, N-acetylaspartate, glutamate/glutamine) showed proportionally less white matter CBF changes. Our findings suggest that discrete hypobaric exposure may provide a model to study white matter injury associated with occupational hypobaric exposure., (© 2019 Wiley Periodicals, Inc.)

Background: Neuroscience research in brain development and disorders can benefit from an in vivo animal model that portrays normal white matter (WM) development trajectories and has a sufficiently large cerebrum for imaging with human MRI scanners and protocols., New Method: Twelve three-month-old Sinclair™ miniature pigs (Sus scrofa domestica) were longitudinally evaluated during adolescent development using advanced diffusion weighted imaging (DWI) focused on cerebral WM. Animals had three MRI scans every 23.95 ± 3.73 days using a 3-T scanner. The DWI imaging protocol closely modeled advanced human structural protocols and consisted of fifteen b-shells (b = 0-3500 s/mm 2 ) with 32-directions/shell. DWI data were analyzed using diffusion kurtosis and bi-exponential modeling that provided measurements that included fractional anisotropy (FA), radial kurtosis, kurtosis anisotropy (KA), axial kurtosis, tortuosity, and permeability-diffusivity index (PDI)., Results: Significant longitudinal effects of brain development were observed for whole-brain average FA, KA, and PDI (all p < 0.001). There were expected regional differences in trends, with corpus callosum fibers showing the highest rate of change., Comparison With Existing Method(s): Pigs have a large, gyrencephalic brain that can be studied using clinical MRI scanners/protocols. Pigs are less complex than non-human primates thus satisfying the "replacement" principle of animal research., Conclusions: Longitudinal effects were observed for whole-brain and regional diffusion measurements. The changes in diffusion measurements were interepreted as evidence for ongoing myelination and maturation of cerebral WM. Corpus callosum and superficial cortical WM showed the expected higher rates of change, mirroring results in humans., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: Quantitative longitudinal magnetic resonance imaging and spectroscopy (MRI/S) is used to assess progress of brain disorders and treatment effects. Understanding the significance of MRI/S changes requires knowledge of the inherent technical and physiological consistency of these measurements. This longitudinal study examined the variance and reproducibility of commonly used quantitative MRI/S measurements in healthy subjects while controlling physiological and technical parameters., Methods: Twenty-five subjects were imaged three times over 5 days on a Siemens 3T Verio scanner equipped with a 32-channel phase array coil. Structural (T1, T2-weighted, and diffusion-weighted imaging) and physiological (pseudocontinuous arterial spin labeling, proton magnetic resonance spectroscopy) data were collected. Consistency of repeated images was evaluated with mean relative difference, mean coefficient of variation, and intraclass correlation (ICC). Finally, a "reproducibility rating" was calculated based on the number of subjects needed for a 3% and 10% difference., Results: Structural measurements generally demonstrated excellent reproducibility (ICCs 0.872-0.998) with a few exceptions. Moderate-to-low reproducibility was observed for fractional anisotropy measurements in fornix and corticospinal tracts, for cortical gray matter thickness in the entorhinal, insula, and medial orbitofrontal regions, and for the count of the periependymal hyperintensive white matter regions. The reproducibility of physiological measurements ranged from excellent for most of the magnetic resonance spectroscopy measurements to moderate for permeability-diffusivity coefficients in cingulate gray matter to low for regional blood flow in gray and white matter., Discussion: This study demonstrates a high degree of longitudinal consistency across structural and physiological measurements in healthy subjects, defining the inherent variability in these commonly used sequences. Additionally, this study identifies those areas where caution should be exercised in interpretation. Understanding this variability can serve as the basis for interpretation of MRI/S data in the assessment of neurological disorders and treatment effects.

Background: Repetitive hypobaric exposure in humans induces subcortical white matter change, observable on magnetic resonance imaging (MRI) and associated with cognitive impairment. Similar findings occur in traumatic brain injury (TBI). We are developing a swine MRI-driven model to understand the pathophysiology and to develop treatment interventions., Methods: Five miniature pigs (Sus scrofa domestica) were repetitively exposed to nonhypoxic hypobaria (30,000 feet/FIO 2 100%/transcutaneous PO 2 >90%) while under general anesthesia. Three pigs served as controls. Pre-exposure and postexposure MRIs were obtained that included structural sequences, dynamic contrast perfusion, and diffusion tensor quantification. Statistical comparison of individual subject and group change was performed utilizing a two-tailed t test., Findings: No structural imaging change was noted on T2-weighted or three-dimensional fluid-attenuated inversion recovery imaging between MRI 1 and MRI 2. No absolute difference in dynamic contrast perfusion was observed. A trend (p = 0.084) toward increase in interstitial extra-axonal fluid was noted. When individual subjects were examined, this trend toward increased extra-axonal fluid paralleled a decrease in contrast perfusion rate., Discussion/impact/recommendations: This study demonstrates high reproducibility of quantitative noninvasive MRI, suggesting MRI is an appropriate assessment tool for TBI and hypobaric-induced injury research in swine. The lack of fluid-attenuated inversion recovery change may be multifactorial and requires further investigation. A trend toward increased extra-axonal water content that negatively correlates with dynamic contrast perfusion implies generalized axonal injury was induced. This study suggests this is a potential model for hypobaric-induced injury as well as potentially other axonal injuries such as TBI in which similar subcortical white matter change occurs. Further development of this model is necessary., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Background: In preparation for longitudinal analyses of white matter development in youths with family histories of substance use disorders (FH+) or without such histories (FH-), we examined the reproducibility and reliability of global and regional measures of fractional anisotropy (FA) values, measured using the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA)-diffusion tensor imaging (DTI) protocol. Highly reliable measures are necessary to detect any subtle differences in brain development., Methods: First, we analyzed reproducibility data in a sample of 12 healthy young adults (ages 20-28) imaged three times within a week. Next, we calculated the same metrics in data collected 1-year apart in the sample of 68 FH+ and 21 FH- adolescents. This is a timeframe where within subject changes in white matter microstructure are small compared to between subject variance. Reproducibility was estimated by examining mean coefficients of variation (MCV), mean absolute differences (MAD), and intraclass correlations (ICC) for global and tract-specific FA values., Results: We found excellent reproducibility for whole-brain DTI-FA values and most of the white matter tracts, except for the corticospinal tract and the fornix in both adults and youths. There was no significant effect of FH-group on reproducibility ( p  =   .4). Reproducibility metrics were not significantly different between adolescents and adults (all p  > .2). In post hoc analyses, the reproducibility metrics for regional FA values showed a strong positive correlation ( r  = .6) with the regional FA heritability measures previously reported by ENIGMA-DTI., Conclusion: Overall, this study demonstrated an excellent reproducibility of ENIGMA-DTI FA, positing it as viable analysis tools for longitudinal studies and other protocols that repeatedly assess white matter microstructure.

Introduction: Nonhypoxic hypobaric (low atmospheric pressure) occupational exposure, such as experienced by U.S. Air Force U-2 pilots and safety personnel operating inside altitude chambers, is associated with increased subcortical white matter hyperintensity (WMH) burden. The pathophysiological mechanisms underlying this discrete WMH change remain unknown. The objectives of this study were to demonstrate that occupational exposure to nonhypoxic hypobaria is associated with altered white matter integrity as quantified by fractional anisotropy (FA) measured using diffusion tensor imaging and relate these findings to WMH burden and neurocognitive ability., Methods: There were 102 U-2 pilots and 114 age- and gender-controlled, health-matched controls who underwent magnetic resonance imaging. All pilots performed neurocognitive assessment. Whole-brain and tract-wise average FA values were compared between pilots and controls, followed by comparison within pilots separated into high and low WMH burden groups. Neurocognitive measurements were used to help interpret group difference in FA values., Results: Pilots had significantly lower average FA values than controls (0.489/0.500, respectively). Regionally, pilots had higher FA values in the fronto-occipital tract where FA values positively correlated with visual-spatial performance scores (0.603/0.586, respectively). There was a trend for high burden pilots to have lower FA values than low burden pilots., Discussion: Nonhypoxic hypobaric exposure is associated with significantly lower average FA in young, healthy U-2 pilots. This suggests that recurrent hypobaric exposure causes diffuse axonal injury in addition to focal white matter changes.McGuire SA, Boone GRE, Sherman PM, Tate DF, Wood JD, Patel B, Eskandar G, Wijtenburg SA, Rowland LM, Clarke GD, Grogan PM, Sladky JH, Kochunov PV. White matter integrity in high-altitude pilots exposed to hypobaria. Aerosp Med Hum Perform. 2016; 87(12):983-988.

Objective: Demonstrate that occupational exposure to nonhypoxic hypobaria is associated with subcortical white matter hyperintensities (WMHs) on fluid-attenuated inversion recovery magnetic resonance imaging (MRI)., Methods: Eighty-three altitude chamber personnel (PHY), 105 U-2 pilots (U2P), and 148 age- controlled and health-matched doctorate degree controls (DOC) underwent high-resolution MRI. Subcortical WMH burden was quantified as count and volume of subcortical WMH lesions after transformation of images to the Talairach atlas-based stereotactic frame., Results: Subcortical WMHs were more prevalent in PHY (volume p = 0.011/count p = 0.019) and U2P (volume p < 0.001/count p < 0.001) when compared to DOC, whereas PHY were not significantly different than U2P., Interpretation: This study provides strong evidence that nonhypoxic hypobaric exposure may induce subcortical WMHs in a young, healthy population lacking other risk factors for WMHs and adds this occupational exposure to other environmentally related potential causes of WMHs. Ann Neurol 2014;76:719-726., (© 2014 American Neurological Association.)

Objective: Determine whether United States Air Force (USAF) U-2 pilots (U2Ps) with occupational exposure to repeated hypobaria had lower neurocognitive performance compared to pilots without repeated hypobaric exposure and whether U2P neurocognitive performance correlated with white matter hyperintensity (WMH) burden., Methods: We collected Multidimensional Aptitude Battery-II (MAB-II) and MicroCog: Assessment of Cognitive Functioning (MicroCog) neurocognitive data on USAF U2Ps with a history of repeated occupational exposure to hypobaria and compared these with control data collected from USAF pilots (AFPs) without repeated hypobaric exposure (U2Ps/AFPs MAB-II 87/83; MicroCog 93/80). Additional comparisons were performed between U2Ps with high vs low WMH burden., Results: U2Ps with repeated hypobaric exposure had significantly lower scores than control pilots on reasoning/calculation (U2Ps/AFPs 99.4/106.5), memory (105.5/110.9), information processing accuracy (102.1/105.8), and general cognitive functioning (103.5/108.5). In addition, U2Ps with high whole-brain WMH count showed significantly lower scores on reasoning/calculation (high/low 96.8/104.1), memory (102.9/110.2), general cognitive functioning (101.5/107.2), and general cognitive proficiency (103.6/108.8) than U2Ps with low WMH burden (high/low WMH mean volume 0.213/0.003 cm(3) and mean count 14.2/0.4)., Conclusion: In these otherwise healthy, highly functioning individuals, pilots with occupational exposure to repeated hypobaria demonstrated lower neurocognitive performance, albeit demonstrable on only some tests, than pilots without repeated exposure. Furthermore, within the U2P population, higher WMH burden was associated with lower neurocognitive test performance. Hypobaric exposure may be a risk factor for subtle changes in neurocognition., (© 2014 American Academy of Neurology.)

Fractional anisotropy (FA) of water diffusion in cerebral white matter (WM), derived from diffusion tensor imaging (DTI), is a sensitive index of microscopic WM integrity. Physiological and metabolic factors that explain intersubject variability in FA values were evaluated in two cohorts of healthy adults of different age spans (N=65, range: 28-50years; and N=25, age=66.6±6.2, range: 57-80years). Single voxel magnetic resonance spectroscopy (MRS) was used to measure N-acetylaspartate (NAA), total choline-containing compounds, and total creatine, bilaterally in an associative WM tract: anterior corona radiata (ACR). FA values were calculated for the underlying, proximal and two distal WM regions. Two-stage regression analysis was used to calculate the proportion of variability in FA values explained by spectroscopy measurements, at the first stage, and subject's age, at the second stage. WM NAA concentration explained 23% and 66% of intersubject variability (p<0.001) in the FA of the underlying WM in the younger and older cohorts, respectively. WM NAA concentration also explained a significant proportion of variability in FA of the genu of corpus callosum (CC), a proximal WM tract where some of the fibers contained within the spectroscopic voxel decussate. NAA concentrations also explained a significant proportion of variability in the FA values in the splenium of CC, a distal WM tract that also carries associative fibers, in both cohorts. These results suggest that MRS measurements explained a significant proportion of variability in FA values in both proximal and distal WM tracts that carry similar fiber-types., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Virtual twins (VTs) are same-age unrelated siblings reared together from early infancy. These unique sibling sets replicate twinship, but without the genetic link. The first VT pair was identified and studied at the University of Minnesota in 1990, launching the development of the Fullerton Virtual Twin Study at California State University, Fullerton (CSUF) in 1991. The registry currently includes 151 pairs, mostly children, with new pairs identified on a continuous basis. Research with VTs includes studies of general intelligence, body size, interpersonal trust, social coordination, social networks, and parenting. In some cases, VTs have been studied in conjunction with pairs of monozygotic twins, dizygotic twins, full siblings, and friends as part of TAPS (Twins, Adoptees, Peers and Siblings), a collaborative project conducted between CSUF and the University of San Francisco, 2002-2006. VTs will also serve as a comparison group for epigenetic analyses of young Chinese twins reared apart and together.

Introduction: Neurologic decompression sickness (NDCS) can affect high-altitude pilots, causing variable central nervous system symptoms. Five recent severe episodes prompted further investigation., Methods: We report the hyperintense white matter (HWM) lesion imaging findings in 50 U-2 pilot volunteers, and compare 12 U-2 pilots who experienced clinical NDCS to 38 U-2 pilots who did not. The imaging data were collected using a 3T magnetic resonance imaging scanner and high-resolution (1-mm isotropic) three-dimensional fluid-attenuated inversion recovery sequence. Whole-brain and regional lesion volume and number were compared between groups., Results: The NDCS group had significantly increased whole brain and insular volumes of HWM lesions. The intergroup difference in lesion numbers was not significant., Conclusion: A clinical episode of NDCS was associated with a significant increase in HWM lesion volume, especially in the insula. We postulate this to be due to hypobaric exposure rather than hypoxia since all pilots were maintained on 100% oxygen throughout the flight. Further studies will be necessary to better understand the pathophysiology underlying these lesions.

The Fullerton Virtual Twin Study has been assessing the behaviors of an unusual sibship since 1982. Virtual twins (VTs) are same-age, unrelated siblings reared together since infancy. They replicate the rearing situation of twins but without the genetic link, enabling direct assessment of shared environmental effects on behavior. An updated analysis of IQ data, based on an increased sample of 142 VT pairs (7.87 years, SD=8.22), is presented. Intraclass correlations of .28 (IQ) and .11 (subtest profile) indicated modest shared environmental influences on intelligence. Findings from the Twins, Adoptees, Peers and Siblings (TAPS) project that studies virtual twins and other kinships are described.

Introduction: Traumatic brain injury (TBI) is common in young adults and therefore of significant concern to an aircrew population. This paper reports the occurrences of seizures in U.S. Air Force (USAF) aircrew following receipt of an aeromedical waiver for TBI., Methods: Using both an aeromedical waiver tracking system database and medical records, we identified surrogate seizure markers such as all episodes of subsequent TBI, seizure, loss of consciousness, or prescription of anticonvulsant medications from the time of initial TBI until the last medical visit or entry recorded in either the database or medical records for our study population., Results: The seizure rate for aircrew who met USAF waiver criteria was 24.53/100,000 person-years. One pilot experienced a major motor seizure 14.9 yr following a severe TBI for an incidence of 308.64/100,000 person-years., Discussion: The USAF waiver process following TBI was sufficiently effective in removing aircrew with elevated risk for seizure following TBI. While our rates of post-traumatic seizure appear to be lower than previously published civilian population rates, direct comparison cannot be made secondary to differences in study design and selection criteria. Further areas of study could involve a more detailed analysis of aircrew neurocognitive status following TBI for subtle changes, crosschecking USAF Safety Center data for changes in accident rates among post-TBI aircrew, and analysis of lost aircrew flying time as a result of TBI and the degree of burden that loss places on the flying mission., Conclusion: Application of these stringent criteria is sufficient to fulfill aeromedical safety standards, but costs remain undetermined.

Virtual twins (VTs) are same-age unrelated siblings reared together from infancy who replicate twinship, but without the genetic relatedness. A 2005 report from the ongoing Fullerton Virtual Twin Study found an IQ intraclass correlation of .26 (p < .01, n = 113 pairs) and a within-pair difference of 13.22 IQ points. The average age of VTs in that study was 8.10 years (SD = 8.56, range: 4.01-54.84 years). An opportunity to retest members of 43 VT pairs, 1.70-8.96 years after their time 1 assessment, allowed additional analyses of genetic and environmental influences underlying general intellectual development. A decrease in the VT IQ correlation and an increase in the within-pair difference were indicated, consistent with increasing genetic and/or non-shared environmental influences and decreasing shared environmental influence on general intellectual development throughout childhood.

The patterns of infection of American eels Anguilla rostrata, with the introduced swimbladder nematode Anguillicola crassus, in tributaries of middle and upper Chesapeake Bay are described. A total of 423 subadult eels was collected from 8 Bay tributaries from spring 1998 to fall 1999. Also, 30 elvers were collected from Ocean City, Maryland, in spring 1998. The numbers of juvenile and adult specimens of A. crassus in the swimbladder wall and lumen were counted. No elvers were infected. In subadult eels, prevalence of adult and juvenile stages combined ranged from 13% to 82%; mean intensity ranged from 2.6 to 9.0 worms per eel. Infection levels were highest for Susquehanna River eels (northernmost river) and lowest in the southernmost sites: St. Jerome's Creek and the Pocomoke River. Although eels from these 2 localities were larger, the low infection rates there are most likely due to reduced transmission in higher salinity water and not to eel size. Eels with both adult and juvenile stages of A. crassus were more common than expected by chance. This might be explained by inhibition of juveniles migrating into the swimbladder lumen when adults are already present there.

We studied whether there was an association between nerve conduction studies (NCS), CSF, and CD4-T lymphocyte parameters in a large cohort of HIV positive individuals. Two hundred and twenty-eight HIV positive individuals underwent motor and sensory nerve conduction studies, CSF evaluation, peripheral CD4-T lymphocyte count, and neurologic evaluation to determine the presence or absence of peripheral neuropathy. We compared NCS of HIV positive subjects with and without abnormal CSF parameters in the entire cohort. We also compared CSF parameters in a subset of CD4-matched patients with and without neuropathy. CSF abnormalities (in excess of laboratory norms) occurred frequently in the entire study group. There was no statistically significant relationship between NCS and CSF parameters. In addition, there was no significant difference in the CSF findings in the group of patients with clinical neuropathy compared to the group without neuropathy. However, there was an association (p < 0.05) between lower CD4 counts and NCS parameters. In general, abnormal CSF findings are not associated with deteriorating peripheral nerve function in HIV infected patients and are just as likely to be found in an HIV positive patient whether or not a peripheral neuropathy is present.

We studied patterns of mothers' and fathers' differential treatment of firstborn (average age 10.5 years) and secondborn (average age 8 years) school-age siblings, and we examined the links between parents' differential treatment and children's well-being and dyadic family relationships. Mothers, fathers, and both siblings in 110 families were interviewed in their homes. For each dimension of parental behavior that we assessed (i.e., differential affection and discipline) we created groups of families that reflected mothers' and fathers' levels of differential treatment (e.g., discipline the firstborn more, equal treatment, discipline the secondborn more). Although we detected substantial correspondence between the 2 parents' differential treatment, we found a sizable group of families in which parents' reports were incongruent (i.e., 1 parent reported equal and the other differential treatment). Parental patterns were linked to differences between the siblings' well-being and both sibling and parent-child relationships, with younger siblings exhibiting greater vulnerability to differential treatment. Incongruence in differential warmth was associated with marital distress.

Monocytes and brain macrophage-microglial cells are thought to play a crucial role in the neurologic dysfunction associated with HIV-1 disease. Since neopterin is produced by monocytes-macrophages, we asked whether cerebrospinal fluid (CSF) neopterin levels increase before the onset of HIV-1 neurologic disease and whether they correlate with other CSF and peripheral blood immunologic parameters. In this study, CSF neopterin levels from 159 neurologically asymptomatic HIV-positive persons were found to increase as the blood CD4+ T-cell count decreased and as CSF IgG, IgG synthesis, IgG index, and beta 2-microglobulin increased. Neopterin levels in the CSF exceeded those in the serum in 32% of patients, while 25% had CSF levels > 13.5 nmol/liter. CSF neopterin levels vary with immune status, may reflect intrathecal production, and can be elevated in asymptomatic HIV-positive patients with normal neurologic examinations. Long-term follow-up of this patient population should be able to define the clinical correlation between CSF neopterin levels during the asymptomatic phase of HIV-1 disease and the risk of subsequent neurologic disease.

Objective: In individuals who were infected with the human immunodeficiency virus (HIV) we determined the prevalence of peripheral neuropathies (PNs) and explored the relationship between immunologic competence and nerve function., Design: Cohort survey., Setting: US Air Force medical center., Patients: Population based. Seven hundred ninety-eight of 817 HIV-positive personnel identified by US Air Force HIV screening program from 1985 to 1989. Average age of cohort was 29.2 years. The majority were male with early-stage HIV disease., Main Outcome Measures: Neurologists examined all subjects for symptoms and signs of PN. We grouped patients by CD4 T-lymphocyte count. We further studied 300 HIV-infected volunteers without clinical evidene of PN by nervex

An autosomal recessive disorder which mimics Duchenne muscular dystrophy has long been suspected as a cause of muscular dystrophy in karyotypically normal girls and in both boys and girls with consanguineous parents. Analysis of dystrophin now allows confirmation of the existence of this disorder. We report the results of this analysis in a brother and sister who have the typical clinical features of Duchenne muscular dystrophy, but no demonstrable abnormality in dystrophin or its gene.

Beta 2-microglobulin levels were measured in the cerebrospinal fluid (CSF) and serum of 163 human immunodeficiency virus-positive (HIV+) persons with normal neurologic physical examinations. None were on antiretroviral therapy. Only 3% had a positive CSF HIV p24 antigen test. The CSF beta 2-microglobulin levels increased as the CD4+ T cell count decreased. Intrathecal production of beta 2-microglobulin was suggested by finding CSF concentrations greater than serum concentrations in 15% of patients. The CSF beta 2-microglobulin levels rose as in vitro T helper cell function deteriorated, independent of CD4+ T cell count. CSF beta 2-microglobulin levels paralleled CSF IgG, IgG index, and IgG synthesis. Higher CSF beta 2-microglobulin levels were found in persons with positive CSF oligoclonal bands. CSF beta 2-microglobulin concentration may serve as a marker for subclinical neurologic damage due to HIV. If this is established, defining the effect of anti-HIV interventions on CSF beta 2-microglobulin would be warranted.

The neurotoxicity of vincristine sulfate, a commonly used antineoplastic agent, has been well described. A literature review failed to reveal any absolute contraindications to the initial use of vincristine. We describe two patients with nodular sclerosing Hodgkin's disease in whom a rapidly progressive, but reversible, severe polyneuropathy developed when they were given a total of 4 mg of vincristine sulfate. Each was later shown to have the demyelinating form of Charcot-Marie-Tooth syndrome. This association suggests that the use of vincristine is contraindicated in patients with the demyelinating form of Charcot-Marie-Tooth syndrome.

Acute vincristine neurotoxicity leading to a severe motor and sensory neuropathy has been noted in patients with hereditary motor and sensory neuropathy type I (HMSN-I). The case of a 2-year-old boy with acute lymphocytic leukemia and HMSN-I is reported, and additional cases from the literature are reviewed. Severe vincristine neurotoxicity in patients with HMSN-I may be secondary to impairment of both slow and- fast axonal transport. Vincristine should be used with caution in patients with a family history of polyneuropathy.

To determine which method of surgical therapy might be optimal for patients with anomalous left coronary artery from the pulmonary artery (ALCAPA), a follow-up study was performed. Twenty-nine teenagers and adults who had ALCAPA diagnosed during life at age 13 years or older were identified mainly by literature search. Recent follow-up was obtained on all. Thirteen treated by ALCAPA ligation alone (Group A), were followed a mean of 9.2 years postoperately (range 1 to 15 years). There was no operative mortality. Three Group A patients died suddenly; a mean of five years (range 2 to 7 years) postoperatively. Sixteen patients treated by simultaneous ALCAPA ligation and saphenous vein graft (SVG) from aorta to left coronary artery (Group B) were followed a mean of five years (range 0 to 11 years) with one intraoperative death and no late mortality. Using the generalized Wilcoxon test for single censored samples, there was no significant difference in survival at any postoperative year when comparing both Groups A and B. The late appearance of sudden death in three Group A patients and no late deaths in Group B patients suggests that ligation and SVG, or its equivalent, may be the therapy of choice.

We describe a family with classic features of continuous muscle fiber activity (Isaacs-Mertens syndrome) appearing in an autosomal dominant pattern. Both a mother and her son had muscle stiffness and rigidity in early childhood. Because the mother's condition was not immediately apparent, we recommend a thorough examination of family members.