Variability of the relative afferent pupillary defect.

PURPOSE: Afferent asymmetry of visual function is detectable in both normal and pathologic conditions. With a computerized test, we assessed the variability in measuring afferent asymmetry of the pupillary light reflex, that is, the relative afferent pupillary defect. METHODS: In ten normal subjects, pupillary responses to an alternating light stimulus were recorded with computerized infrared pupillography. The relative afferent pupillary defect for each test was determined by using a new computer analysis. The 95% confidence interval of each determination of relative afferent pupillary defect was used to represent the short-term fluctuation in its measurement. To optimize the test for clinical use, we studied the influence of stimulus intensity, duration, and number on the variability of the relative afferent pupillary defect. RESULTS: When the relative afferent pupillary defect was based on only a few light alternations (stimulus pairs), there was excessive variability in its measurement (95% confidence interval > 0.5 log units). With approximately 200 stimulus pairs, the 95% confidence interval was reduced to less than 0.1 log unit (relative afferent pupillary defect +/- 0.05 log unit). Also, there was less variability when the dark interval between alternating light stimulation was less than one second. CONCLUSIONS: Computerized infrared pupillography can standardize the alternating light test and minimize the error in quantifying a relative afferent pupillary defect. A reproducible relative afferent pupillary defect measurement is desirable for defining afferent injury and following the course of disease.

Effect of the September 11, 2001 terrorist attack on a state highway patrol trooper's heart rate variability

BACKGROUND: On September 11, 2001, terrorists attacked the United States. By coincidence, a North Carolina highway patrol trooper was wearing an ambulatory ECG Holter monitor at this time as part of an air pollution study. METHODS: Heart rate variability parameters were analyzed: standard deviation of normal to normal beat intervals (SDNN) and percentage of interval differences >50 ms (PNN50). RESULTS: The trooper's heart rate variability changed immediately after learning about the terrorist attacks. Heart rate increased and PNN50 decreased, while SDNN increased strongly. CONCLUSIONS: These changes suggest strong emotional sympathetic stress associated with parasympathetic withdrawal in response to the news about the terrorist attack. [Authors]

Respiratory variability in mechanically ventilated patients. Critical Care 2011

Introduction: Increased respiratory pattern variability is associated with improved oxygenation. Pressure support (PS) is a widely used partial-assist mechanical ventilation (MV) mode, in which each breathing cycle is initiated by flow or pressure variation at the airway due to patient inspiratory effort. Neurally adjusted ventilatory assist (NAVA) is relatively new and uses the electrical activity of the diaphragm (Eadi) to deliver ventilatory support proportional to the patient's inspiratory demand. We hypothesize that respiratory variability should be greater with NAVA compared with PS.Methods: Twenty-two patients underwent 20 minutes of PS followed by 20 minutes of NAVA. Flow and Eadi curves were used to obtain tidal volume (Vt) and ∫Eadi for 300 to 400 breaths in each patient. Patient-specific cumulative distribution functions (CDF) show the percentage Vt and ∫Eadi within a clinically defined (±10%) variability band for each patient. Values are normalized to patient-specific medians for direct comparison. Variability in Vt (outcome) is thus expressed in terms of variability in ∫Eadi (demand) on the same plot.Results: Variability in Vt relative to variability in ∫Eadi is significantly greater for NAVA than PS (P = 0.00012). Hence, greater variability in outcome Vt is obtained for a given demand in ∫Eadi, under NAVA, as illustrated in Figure 1 for a typical patient. A Fisher 2 × 2 contingency analysis showed that 45% of patients under NAVA had a Vt variability in equal proportion to ∫Eadi variability, versus 0% for PS (P < 0.05).Conclusions: NAVA yields greater variability in tidal volume, relative to ∫Eadi demand, and a better match between Vt and ∫Eadi. These results indicate that NAVA could achieve improved oxygenation compared with PS when sufficient underlying variability in ∫Eadi is present, due to its ability to achieve higher tidal volume variability from a given variability in ∫Eadi.

Partitioning of genetic (Rapd) variability among sexes and populations of the Barn Owl (Tyto alba) in Europe

The white Barn Owl subspecies (Tyto alba alba) is found in southern Europe and the reddish-brown subspecies (T a. guttata) in northern and eastern Europe. In central Europe, the two subspecies interbreed producing a large range of phenotypic variants. Because of the different ratios of the subspecies in different geographic regions, we predict that genetic variation should be greater in Switzerland than in Hungary. We tested this hypothesis by measuring genetic variation with the RAPD method. As predicted, the genetic differentiation within a Swiss population of Barn Owls was significantly greater than the variation within a Hungarian population. This suggests that gene flow is greater in central Europe than at the eastern limit of the Barn Owl distribution in Hungary. In both countries genetic variation was more pronounced in females than in males. As in other birds, this is probably because female Barn Owls are less philopatric than males. The number of migrants between Hungary and Switzerland is ca. 1 individual per generation; if calculated separately for the sexes, then 0.525 for males and ca. I for females (Nm values). The difference in the number of migrants between genders again is likely a consequence of higher male philopatry. The sexual differentiation is greater in the Swiss population than in the Hungarian and the genetic substructuring of the populations of the species is substantial. The reason for the considerable population substructuring could be the nonmigratory behavior and socially monogamous pairing of the species, as well as the geographical barriers (Alps) between the populations examined.

Relationship between imatinib population pharmacokinetics and alpha-1-acid glycoprotein

Objectives: Considering the large inter-individual differences in the function of the systems involved in imatinib disposition, exposure to this drug can be expected to vary widely among patients. Among those known systems is alpha-1-acid glycoprotein (AGP), a circulating protein that strongly binds imatinib. This observational study aimed to explore the influence of plasma AGP on imatinib pharmacokinetics. Methods: A population pharmacokinetic analysis was performed using NONMEM based on 278 plasma samples from 51 oncologic patients, for whom both total imatinib and AGP plasma concentrations were measured. The influence of this biological covariate on oral clearance and volume of distribution was examined. Results: A one-compartment model with first-order absorption appropriately described the data. A hyperbolic relationship between plasma AGP levels and oral clearance, as well as volume of distribution was observed. A mechanistic approach was built up, postulating that only the unbound imatinib concentration was able to undergo first-order elimination through an unbound clearance process, and integrating the dissociation constant as a parameter in the model. This approach allowed determining an average (± SEM) free clearance of 1310 (± 172) L/h and a volume of distribution of 301 (± 23) L. By comparison, the total clearance previously determined was 14 (± 1) L/h. Free clearance was affected by body weight and pathology diagnosis. Moreover, this model provided consistent estimates of the association constant between imatinib and AGP (5.5?106 L/mol) and of the average in vivo free fraction of imatinib (1.1%). The variability observed (17% for free clearance and 66% for volume of distribution) was less than the one previously reported without considering AGP impact. AGP explained indeed about one half of the variability observed in total imatinib disposition. Conclusion: Such findings clarify in part the in vivo impact of protein binding on imatinib disposition and might raise again the question whether high levels of AGP could represent a resistance factor to imatinib. This remains however questionable, as it is not expected to affect free drug concentrations. On the other hand, would imatinib be demonstrated as a drug requiring therapeutic drug monitoring, either the measurement of free concentration or the correction of the total concentration by the actual AGP plasma levels should be considered for accurate interpretation of the results.

Main results of the Monte Carlo studies carried out for nuclear medicine practices within the ORAMED project

The aim of ORAMED work package 4 was the optimization of the medical practices in nuclear medicine during the preparation of radiopharmaceuticals and their administration to the patient. During the project a wide campaign of measurements was performed in the nuclear medicine departments of the collaborating hospitals. Such data were intrinsically characterized by a large variability that depended on the procedure, the employed techniques and the operator's habits. That variability could easily hide some important parameter, for example, the effectiveness of the adopted shielding (for syringe and vial) or the effect of the distances from the source. This information is necessary for a valuable optimization purpose of radiation protection. To this end a sensitivity analysis was carried out through Monte Carlo simulations employing voxel models, representing operator's hand during the considered practices. Such analysis allowed understanding at what extent the range of personal dose equivalent evaluated during measurements can be considered intrinsically related to the procedures. Furthermore, with the Monte Carlo simulations it was possible to study the appropriateness of the shielding usually utilized in these practices.

The dermatophyte species Arthroderma benhamiae: intraspecies variability and mating behaviour.

Arthroderma benhamiae is a zoophilic dermatophyte belonging to the Trichophyton mentagrophytes species complex. Here, a population of A. benhamiae wild strains from the same geographical area (Switzerland) was studied by comparing their morphology, assessing their molecular variability using internal transcribed spacer (ITS) and 28S rRNA gene sequencing, and evaluating their interfertility. Sequencing of the ITS region and of part of the 28S rRNA gene revealed the existence of two infraspecific groups with markedly different colony phenotypes: white (group I) and yellow (group II), respectively. For all strains, the results of mating type identification by PCR, using HMG (high-mobility group) and α-box genes in the mating type locus as targets, were in total accordance with the results of mating type identification by strain confrontation experiments. White-phenotype strains were of mating type + (mt+) or mating type - (mt-), whilst yellow-phenotype strains were all mt-. White and yellow strains were found to produce fertile cleistothecia after mating with A. benhamiae reference tester strains, which belonged to a third group intermediate between groups I and II. However, no interfertility was observed between yellow strains and white strains of mt+. A significant result was that white strains of mt- were able to mate and produce fertile cleistothecia with the white A. benhamiae strain CBS 112371 (mt+), the genome of which has recently been sequenced and annotated. This finding should offer new tools for investigating the biology and genetics of dermatophytes using wild-type strains.

Social rationality and scales of action: inter-ethnic relations in cockfighting and game-fishing, Raiatea, French Polynesia

This article challenges the notion of economic rationality as a criterion for explaining ethnic boundary maintenance. It offers an ethnographic analysis of inter-ethnic relations in the context of games (cockfights and game-fishing contests) in the island of Raiatea (French Polynesia). Although all players engage in the same basic gambling practices, money is differentially scaled and mobilized by the Tahitian and Chinese participants. Building on recent pragmatic approaches to rationality, it is shown that the players' rationalities differ not from the point of view of economic maximization, but only in so far as they participate in social relations at different scales.

The variability of peridotite composition across a mantle shear zone (Lanzo massif, Italy): interplay of melt focusing and deformation

In this paper we present new data on the spatial variability of peridotite composition across a kilometer-scale mantle shear zone within the Lanzo massif (Western Alps, Italy). The shear zone separates the central from the northern part of the massif. Plagioclase peridotite shows gradually increasing deformation towards the shear zone, from porphyroclastic to mylonitic textures in the central body, while the northern body is composed of porphyroclastic rocks. The peridotite displays a large range of compositions, from fertile peridotite to refractory harzburgite and dunite. Deformed peridotites (proto-mylonite and mylonites) tend to be compositionally more homogeneous and fertile than weakly deformed peridotites. The composition of most plagioclase peridotites show rather high and constant (Ce/Yb) (N) ratios, and Yb (N) that cannot be explained by any simple melting model. Instead, refertilization modeling, consisting of melt increments from spinel peridotite sources, particularly with E-MORB melt, reasonably reproduces the plagioclase peridotite whole rock composition. Combined with constraints from Ce-Nb and Ce-Th systematics, we speculate that peridotites such as those from Lanzo record pervasive refertilization processes in the thermal boundary layer. In this scenario, mantle shear zones might act as important areas of melt focusing in the upper mantle that separates the thermal boundary layer from the conductively cooled mantle.

Variability of radioiodine measurements in the thyroid.

Monte Carlo simulations were carried out to study the response of a thyroid monitor for measuring intake activities of (125)I and (131)I. The aim of the study was 3-fold: to cross-validate the Monte Carlo simulation programs, to study the response of the detector using different phantoms and to study the effects of anatomical variations. Simulations were performed using the Swiss reference phantom and several voxelised phantoms. Determining the position of the thyroid is crucial for an accurate determination of radiological risks. The detector response using the Swiss reference phantom was in fairly good agreement with the response obtained using adult voxelised phantoms for (131)I, but should be revised for a better calibration for (125)I and for any measurements taken on paediatric patients.

High genetic variability and low local diversity in a population of arbuscular mycorrhizal fungi.

Arbuscular mycorrhizal fungi (AMF) are ecologically important root symbionts of most terrestrial plants. Ecological studies of AMF have concentrated on differences between species; largely assuming little variability within AMF species. Although AMF are clonal, they have evolved to contain a surprisingly high within-species genetic variability, and genetically different nuclei can coexist within individual spores. These traits could potentially lead to within-population genetic variation, causing differences in physiology and symbiotic function in AMF populations, a consequence that has been largely neglected. We found highly significant genetic and phenotypic variation among isolates of a population of Glomus intraradices but relatively low total observed genetic diversity. Because we maintained the isolated population in a constant environment, phenotypic variation can be considered as variation in quantitative genetic traits. In view of the large genetic differences among isolates by randomly sampling two individual spores, <50% of the total observed population genetic diversity is represented. Adding an isolate from a distant population did not increase total observed genetic diversity. Genetic variation exceeded variation in quantitative genetic traits, indicating that selection acted on the population to retain similar traits, which might be because of the multigenomic nature of AMF, where considerable genetic redundancy could buffer the effects of changes in the genetic content of phenotypic traits. These results have direct implications for ecological research and for studying AMF genes, improving commercial AMF inoculum, and understanding evolutionary mechanisms in multigenomic organisms.

Pharmacokinetic and pharmacogenetic factors influencing plasma and cellular antiretroviral drug disposition

Abstract: The improvement in antiretroviral drug therapy has transformed HIV infection into a chronic disease. However, treatment failure and drug toxicity are frequent. Inadequate response to treatment is clearly multifactorial and, therefore, dosage individualisation based on demographic factors, genetic markers and measurement of cellular and plasma drug level may enhance both drug efficacy and tolerability. At present, antiretroviral drugs levels are monitored in plasma, whereas only drugs penetrating into cells are able to exert an antiviral activity, suggesting that cellular drug determination may more confidently reflect drug exposure at the site of pharmacological action. The overall objective of this thesis is to provide a better understanding of the Pharmacokinetic and pharmacogenetic factors influencing the plasma and cellular disposition of antiretroviral drugs. To that endeavour, analytical methods for the measurements of plasma and cellular drug levels have been developed and validated using liquid chromatography methods coupled with ultraviolet and tandem mass spectrometry detection, respectively. Correlations between plasma and cellular exposures were assessed during observational and experimental studies. Cytochrome (CYP) 2B6, efflux transporters (ABCB1, ABCC1, ABCC2 and ABCG2) and orosomucoid (ORM) polymorphisms were determined and were related to plasma and cellular exposures, as well as toxicity of antiretroviral drugs. A Pharmacokinetic population model was developed to characterise inter- and intra-patient variability of atazanavir pharmacokinetics, and to identify covariates influencing drug disposition. In that context, a Pharmacokinetic interaction study between atazanavir and lopinavir, both boosted with ritonavir, has beén conducted to assess the safety and pharmacokinetics of this boosted double-protease inhibitors regimen. Well to moderately-correlated cellular and plasma drug levels are .observed or protease inhibitors, whereas for efavirenz and nevirapine these correlations are weak. Cellular exposure, and CYP2B6 genotype (516G>T) are predictors of efavirenz neuropsychological toxicity. Nevirapine plasma exposure is also influenced by CYPZB6 polymorphism. Nelfinavir cellular exposure appears to be significantly associated only with ABCB1 genotype (3435C>T and intron 26 + 80T>C). Indinavir and lopinavir clearance and lopinavir cellular/plasma exposure ratio are influenced by the concentration of the variant S of ORM, suggesting-a specific binding of these drugs to this variant. Nelfinavir and efavirenz are not influenced by ORM concentration and phenotype. The Pharmacokinetic parameters of atazanavir are adequately described by our population model. The atazanavir-lopinavir interaction study indicates no influence on plasma and cellular atazanavir pharmacokinetics, while limited decrease in lopinavir concentrations was observed after atazanavir addition. The residual variability unexplained by the considered variables suggests that other covariates either uncontrolled at present or remaining to be identified, such as genetic and environmental factors influence antiretroviral drug pharmacokinetics, with substantial impact on treatment efficacy and tolerability. In that context, a comprehensive approach taking into account drug pharmacokinetics and patient genetic background is expected to contribute to increase treatment success, and to reduce the occurrence of adverse drug reactions by stratifying patients in an individualised antiretroviral therapy approach. Résumé Facteurs pharmacocinétiques et pharmacogénétiques influençant l'exposition plasmatique et cellulaire des antirétroviraux Les progrès de la thérapie antirétrovirale ont transformé l'infection par le VIH d'une affection mortelle à une maladie chronique. En dépit de ce succès, l'échec thérapeutique et la toxicité médicamenteuse restent fréquents. Une réponse inadéquate au traitement est clairement multifactorielle et une individualisation de la posologie des médicaments qui se baserait sur les facteurs démographiques et génétiques des patients et sur les taux sanguins des médicaments pourrait améliorer à la fois l'efficacité et la tolérance de la thérapie. Par ailleurs, seules les concentrations plasmatiques sont actuellement considérées pour le suivi thérapeutique des médicaments, alors que les taux cellulaires pourraient mieux refléter l'activité de ses médicaments qui agissent au niveau intracellulaire. L'objectif global de cette thèse était de mieux comprendre les facteurs pharmacocinétiques et pharmacocénétiques influençant l'exposition plasmatique et cellulaire des médicaments antirétroviraux. A cet effet, des méthodes pour quantifier les concentrations plasmatiques et cellulaires des antirétroviraux ont été développées et validées en utilisant la chromatographie liquide couplée à la détection ultraviolette et la spectrométrie de masse en tandem, respectivement. La corrélation entre l'exposition cellulaire et plasmatique de ces médicaments a été étudiée lors d'études observationnelles et expérimentales. Les polymorphismes du cytochrome (CYP) 2B6, ainsi que des transporteurs d'efflux (ABCB1, ABCC1, ABCC2 et ABCG2) et de l'orosomucoïde (ORM) ont été déterminés et corrélés avec l'exposition plasmatique et cellulaire des antirétroviraux, ainsi qu'à leur toxicité. Un modèle de pharmacocinétique de population a été établi afin de caractériser la variabilité inter- et intra-individuelle de l'atazanavir, et d'identifier les covariables pouvant influencer le devenir de ce médicament. Dans ce contexte, une étude d'interaction entre l'atazanavir et le lopinavir a été effectuée afin de déterminer la sécurité et le profil pharmacocinétique de ce régime thérapeutique. Des corrélations modérées à bonnes ont été observées entre les taux cellulaires et plasmatiques des inhibiteurs de protéase, alors que pour l'efavirenz et la névirapine ces corrélations sont faibles. L'exposition cellulaire, ainsi que le génotype du CYP2B6 (516G>T) sont des indices de la toxicité neuropsychologique de l'efavirenz. L'exposition plasmatique de la névirapine est également influencée par le polymorphisme du CYPZB6. L'exposition cellulaire du nelfinavir est significativement associée au génotype du ABCB1 (3435C>T et intron 26 + 80T>C). La clairance de l'indinavir et du lopinavir, ainsi que le rapport entre exposition cellulaire et plasmatique du lopinavir sont influencés par la concentration du variant S de l'ORM, suggérant une liaison spécifique de ces médicaments à ce variant. La clairance du nelfinavir et de l'efavirenz n'est pas influencée ni par la concentration ni par le phénotype de l'ORM. Les paramètres pharmacocinétiques de l'atazanavir ont été décrits de façon adéquate par le modèle de population proposé. De plus, le lopinavir n'influence pas les concentrations plasmatiques et cellulaires de l'atazanavir; alors que celui-ci conduit à une baisse limitée des taux de lopinavir. L'importante variabilité pharmacocinétique des antirétroviraux suggère que d'autres facteurs génétiques et environnementaux -qui restent encore à découvrir- influencent également leur disponibilité. Dans un proche futur, une prise en charge qui tienne. compte de la pharmacocinétique des médicaments et des caractéristiques génétiques du patient devrait permettre d'individualiser le traitement, contribuant certainement à une amélioration de la réponse thérapeutique et à une diminution de la toxicité. Résumé grand public Facteurs pharmacocinétiques et pharmacogénétiques influençant l'exposition plasmatique et cellulaire des antirétroviraux Les progrès effectués dans le traitement de l'infection par le virus de l'immunodéficience humaine acquise (VIH), ont permis de transformer une maladie avec un pronostic sombre, en une maladie chronique traitable avec des médicaments de plus en plus efficaces. Malgré ce succès, de nombreux patients ne répondent pas de façon optimale à leur traitement et/ou souffrent d'effets indésirables médicamenteux entraînant fréquemment une modification de leur thérapie. Actuellement, le suivi de la réponse au traitement s'effectue par la mesure chez les patients de la quantité de virus et du nombre des cellules immunitaires dans le sang, ainsi que par la concentration sanguine des médicaments administrés. Cependant, comme le virus se réplique à l'intérieur de la cellule, la mesure des concentrations médicamenteuses au niveau intracellulaire pourrait mieux refléter l'activité pharmacologique au site d'action. De plus, il a été possible de mettre en évidence la grande variabilité des concentrations plasmatiques de médicaments chez des patients prenant pourtant la même dose de médicament. Comme cette variabilité est notamment due à des facteurs génétiques qui sont susceptibles d'influencer la réponse au traitement antirétroviral, des analyses génétiques ont été également effectuées chez ces patients. Cette thèse a eu pour objectif de mieux comprendre les facteurs pharmacologiques et génétiques influençant l'activité et la toxicité des médicaments antirétroviraux afin de réduire la variabilité de la réponse thérapeutique. A cet effet, une méthode de dosage permettant la quantification des médicaments anti-HIV au niveau intracellulaire a été développée. Par ailleurs, nos études ont également porté .sur les variations génétiques influençant la quantité et l'activité des protéines impliquées dans le métabolisme et dans le transport des médicaments antirétroviraux. Enfin, les conséquences de ces variations sur la réponse clinique et la toxicité du traitement ont été évaluées. Nos études ont mis en évidence des associations significatives entre les variations génétiques considérées et la concentration sanguine, cellulaire et la toxicité de quelques médicaments antirétroviraux. La complémentarité des connaissances pharmacologiques, génétiques et virales pourrait aboutir à une stratégie globale permettant d'individualiser le traitement et la dose administrée, en fonction des caractéristiques propres de chaque patient. Cette approche pourrait contribuer à une optimisation du traitement antirétroviral dans la perspective d'une meilleure- efficacité thérapeutique à long terme et d'une diminution des effets indésirables rencontrés.