A Novel Anticancer Agent, 8-Methoxypyrimido4 `,5 `: 4,5]thieno(2,3-b) Quinoline-4(3H)-One Induces Neuro 2a Neuroblastoma Cell Death through p53-Dependent, Caspase-Dependent and Independent Apoptotic Pathways

Neuroblastoma is the most common cancer in infants and fourth most common cancer in children. Despite recent advances in cancer treatments, the prognosis of stage-IV neuroblastoma patients continues to be dismal which warrant new pharmacotherapy. A novel tetracyclic condensed quinoline compound, 8-methoxypyrimido 4 `,5 `: 4,5] thieno(2,3-b) quinoline-4(3H)-one (MPTQ) is a structural analogue of an anticancer drug ellipticine and has been reported to posses anticancer property. Study on MPTQ on neuroblastoma cells is very limited and mechanisms related to its cytotoxicity on neuroblastoma cells are completely unknown. Here, we evaluated the anticancer property of MPTQ on mouse neuro 2a and human SH-SY5Y neuroblastoma cells and investigated the mechanisms underlying MPTQ-mediated neuro 2a cell death. MPTQ-mediated neuro 2a and SH-SY5Y cell deaths were found to be dose and time dependent. Moreover, MPTQ induced cell death reached approximately 99.8% and 90% in neuro 2a and SH-SY5Y cells respectively. Nuclear oligonucleosomal DNA fragmentation and Terminal dUTP Nick End Labelling assays indicated MPTQ-mediated neuro 2a cell death involved apoptosis. MPTQ-mediated apoptosis is associated with increased phosphorylation of p53 at Ser15 and Ser20 which correlates with the hyperphosphorylation of Ataxia-Telangiectasia mutated protein (ATM). Immunocytochemical analysis demonstrated the increased level of Bax protein in MPTQ treated neuro 2a cells. MPTQ-mediated apoptosis is also associated with increased activation of caspase-9, -3 and -7 but not caspase-2 and -8. Furthermore, increased level of caspase-3 and cleaved Poly ( ADP Ribose) polymerase were observed in the nucleus of MPTQ treated neuro 2a cells, suggesting the involvement of caspase-dependent intrinsic but not extrinsic apoptotic pathway. Increased nuclear translocation of apoptosis inducing factor suggests additional involvement of caspase-independent apoptosis pathway in MPTQ treated neuro 2a cells. Collectively, MPTQ-induced neuro 2a cell death is mediated by ATM and p53 activation, and Bax-mediated activation of caspase-dependent and caspase-independent mitochondrial apoptosis pathways.

Cytotoxic T lymphocytes raised against Japanese encephalitis virus: effector cell phenotype, target specificity and in vitro virus clearance.

Several H-2 defined cell lines were examined for their ability to support infection and replication of Japanese encephalitis virus (JEV) before their use in in vitro and in vivo stimulation protocols for generating cytotoxic T lymphocytes (CTLs) against JEV. Among II different cell lines tested, two H-2(d) macrophage tumour lines (P388D1, RAW 264.7), an H-2(d) hybridoma (Sp2/0), an H-2K(k)D(d) neuroblastoma (Neuro 2a), and H-2(k) fibroblast cell line (L929) were found to support JEV infection and replication. These cell lines were used to generate anti-JEV CTLs by using in vivo immunization followed by in vitro stimulation of BALB/c mice. We observed that not only syngeneic and allogeneic infected cells but also JEV-infected xenogeneic cells could prime BALB/c mice for the generation of JEV-specific CTLs upon subsequent in vitro stimulation of splenocytes with JEV-infected syngeneic cells. Although infected xenogeneic cells were used for immunization, the anti-JEV effecters that were generated lysed infected syngeneic targets but not JEV-infected xenogeneic or allogeneic target cells in a 5h Cr-51 release assay. These anti-JEV effecters recognized syngeneic target cells infected with West Nile virus to a lesser extent and were shown to be Lyt-2.2(+) T cells. The results of unlabelled cold target competition studies suggested alterations in the cell surface expression of viral antigenic determinants recognized by these CTLs. We further demonstrate that the JEV-specific CTLs generated could virtually block the release of infectious virus particles from infected P388D1 and Neuro 2a cells in vitro.

Japanese encephalitis virus infection of mouse cell lines: ability to prime mice for generation of virus specific cytotoxic T lymphocytes and differences in CTL recognisable viral determinants

Ten different mouse cell lines were examined for Japanese encephalitis virus (JEV) infection in vitro and then tested for their ability to generate virus specific cytotoxic T lymphocytes (CTL). Among all cell lines examined, Neuro La (a neuroblastoma) was readily infected with JEV as examined by immunofluorescence and viral replication. Among other cells, P388D1, RAW 264.7 (Macrophage origin), Sp2/0 (B-cell Hybridoma), YAC-1 (T-cell lymphoma), and L929 (Fibroblast) were semipermissive to JEV infection. The cytopathic effects caused by progressive JEV infection varied from cell line to cell line. In the case of YAC-1 cells long-term viral antigen expression was observed without significant alterations in cell viability. Intermediate degrees of cytopathicity are seen in RAW 264.7 and L929 cells while infection of PS, Neuro 2a, P388D1 and Sp2/0 caused major viability losses. All infected cell lines were able to prime adult BALB/c (H-2(d)) mice for the generation of secondary JEV specific CTL. In contrast to YAC-1, the permissive neuroblastoma cell line Neuro 2a (H-2K(k)D(d)) was found to be least efficient in its ability to stimulate anti-viral CTL generation. Cold target competition studies demonstrated that both Neuro 2a and YAC-1 (H-2K(k)D(d)) cells expressed similar viral determinants that are recognised by CTL, suggesting that the reason for the lower ability of Neuro 2a to stimulate anti-viral CTL was not due to lack of viral CTL determinants. These findings demonstrate that a variety of mouse cell lines can be infected with Japanese encephalitis virus, and that these infected cells could be utilised to generate virus specific CTL in BALB/c mice.

钠离子通道类毒素的细胞毒性和检测方法的研究

赤潮毒素广泛存在于各种赤潮藻和各类海洋生物中，不仅对渔业、养殖业危害甚大，而且还直接威胁着人类的生存健康。其中，离子通道类毒素是一类毒性较高的毒素。除一些赤潮藻可以产生此类毒素之外，海洋中还存在某些生物也能够产生离子通道类毒素。为进一步阐明钠离子通道类毒素对细胞的毒性效应机制，本文选取一株小鼠神经母细胞瘤（Neuro-2a）作为受试对象，研究了四种钠离子通道类毒素STX、GTX1,4、GTX2,3、TTX对Neuro-2a细胞的毒性影响机制，并利用STX和TTX，建立了钠离子通道类毒素的细胞毒性检测方法，且应用此方法检测了贝体内、藻体内的毒素含量，进一步与小鼠法和HPLC法进行了比较。 研究表明：STX、GTX1,4、GTX2,3、TTX四种钠离子通道类毒素在长时间内均会对Neuro-2a细胞的增殖产生不利影响。在短时间（24h）内，以上各毒素均没有抑制Neuro-2a细胞的增殖，但是48h后，以上各毒素对Neuro-2a细胞的增殖均产生了抑制作用，且随着各毒素剂量的增加，细胞增殖受抑制程度也表现出一定程度的增高，二者呈剂量-反应关系。STX、GTX1,4、GTX2,3、TTX对Neuro-2a细胞的48h半数抑制浓度（IC50）分别为：250ng/ml、1000ng/ml、1300ng/ml、700ng/ml。本论文还首次研究了STX、GTX1,4、GTX2,3、TTX四种钠离子通道类毒素对Neuro-2a细胞内酶活性的影响。研究发现，STX、GTX1,4、GTX2,3、TTX四种钠离子通道阻断剂类毒素均能够影响Neuro-2a细胞内Na+-K+-ATP酶和乙酰胆碱酯酶TChE的活性。当各毒素作用24h后，Neuro-2a细胞内Na+-K+-ATP酶和乙酰胆碱酯酶TChE的活力均会受到抑制，并且随着各毒素剂量的增加，两种酶的活性也逐渐降低。可见，钠离子通道阻断剂类毒素能对细胞内酶的功能产生一定的影响，此影响连同阻断细胞膜钠离子通道，造成离子流的失衡作用，进一步对细胞产生毒性效应。在对细胞膜通透性的研究中发现，上述四种钠离子通道阻断剂类毒素各剂量组细胞培养液乳酸脱氢酶LDH的漏出率与对照组相比均无显著差异，它们均未引起Neuro-2a细胞膜内LDH的改变，看来钠离子通道阻断剂类毒素不会通过影响细胞膜的通透性而对细胞引起毒性效应。 本研究还利用STX和TTX两种钠离子通道标准毒素以及乌苯苷、藜芦定两种生物毒素，参照Jellett（1992）方法，建立了STX和TTX两种钠离子通道类毒素的细胞毒性检测的标准曲线，分别为：Y=0.266X+51.184和 Y=1.6068X+47.186。检出限分别为5ng/ml和0.8ng/ml。并且利用已建立的细胞毒性检测方法检测了来自浙江舟山和连云港赣榆市的19个织纹螺样品和5株实验室培养的亚历山大藻，得到的实验结果与小鼠生物测试和HPLC检测的结果存在较好的相关关系。鉴于该方法具有高通量、省时、检出限低等优点，因此更具有在沿海环境检测中推广应用的潜力。

DSP等赤潮藻毒素对哺乳类细胞的毒性效应及机制研究

本文研究了腹泻性贝毒的主要组分大田软海绵酸以及几株重要赤潮藻的提取物对四株哺乳类细胞的毒性效应，并探讨了应用细胞毒性检测方法作为赤潮藻毒素毒性检测常规方法的可能性。 结果发现：OA和利玛原甲藻提取物显著地抑制四株细胞的增殖并诱导四株细胞发生凋亡；四株细胞对毒素的敏感性存在一定的差异，人肝癌细胞和小鼠神经瘤细胞较敏感，其次分别为人肝细胞和小鼠皮肤细胞。 小鼠神经瘤细胞对OA反应敏感，细胞毒性检测指标及检测方法灵敏、快速，应用小鼠神经瘤细胞Neuro-2a进行的DSP毒素细胞毒性测试方法具有发展为该类毒素毒性监测常规方法的潜能。 米氏凯伦藻内存在抑制细胞增殖的毒性物质，且该物质是一种具有一定极性的脂溶性物质；该物质能够导致细胞肿胀、破裂，并诱导细胞发生脂质过氧化，导致脂质过氧化产物丙二醛(MDA)的积累。 相关亚历山大藻的去藻过滤液内存在抑制细胞增殖和诱导细胞凋亡的毒性物质，该毒性物质的分子量＞5K，这与本实验室以往的研究结果一致。 　　总之，通过我们的研究发现：DSP等赤潮藻毒素或毒性物质对哺乳类细胞存在毒性影响，且不同毒素的危害机制存在差异，赤潮藻毒素或赤潮藻产生的一些毒性物质威胁人类的健康，应引起我们的高度关注。

Jararhagin, a snake venom metalloprotease-disintegrin, activates the Rac1 GTPase and stimulates neurite outgrowth in neuroblastoma cells

It has been shown previously that the snake venom metalloprotease-disintegrin jararhagin stimulates cell migration and cytoskeletal rearrangement, independently of its effects on cellular adhesion but possibly associated with the activation of small GTP-binding proteins from the Rho family [Costa, E.P., Santos, M.F., 2004. Toxicon 44(8), 861-870.] Here we show that jararhagin stimulates spreading, actin dynamics and neurite outgrowth in neuroblastoma cells, and that this effect is accompanied by the translocation of the Rac1 small GTPase to the membrane fraction, suggesting its activation. Stimulation of neurite outgrowth was observed within minutes and was dependent on the proteolytic activity of the toxin. These results suggest that jararhagin may stimulate neuronal differentiation, being potential tool for neuronal regeneration studies. (C) 2008 Elsevier Ltd. All rights reserved.

Pluronics F-127/L-81 Binary Hydrogels as Drug-Delivery Systems: Influence of Physicochemical Aspects on Release Kinetics and Cytotoxicity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Inhibition of hypoxia-inducible factor 1 activity by nitric oxide donors in hypoxia

Nitric oxide (NO) is known to have various biologic and pathophysiologic effects on organisms. The molecular mechanisms by which NO exerts harmful effects are unknown, although various O2 radicals and ions that result from reactivity of NO are presumed to be involved. Here we report that adaptive cellular response controlled by the transcription factor hypoxia-inducible factor 1 (HIF-1) in hypoxia is suppressed by NO. Induction of erythropoietin and glycolytic aldolase A mRNAs in hypoxically cultured Hep3B cells, a human hepatoma cell line, was completely and partially inhibited, respectively, by the addition of sodium nitroprusside (SNP), which spontaneously releases NO. A reporter plasmid carrying four hypoxia-response element sequences connected to the luciferase structural gene was constructed and transfected into Hep3B cells. Inducibly expressed luciferase activity in hypoxia was inhibited by the addition of SNP and two other structurally different NO donors, S-nitroso-l-glutathione and 3-morpholinosydnonimine, giving IC50 values of 7.8, 211, and 490 μM, respectively. Inhibition by SNP was also observed in Neuro 2A and HeLa cells, indicating that the inhibition was not cell-type-specific. The vascular endothelial growth factor promoter activity that is controlled by HIF-1 was also inhibited by SNP (IC50 = 6.6 μM). Induction generated by the addition of cobalt ion (this treatment mimics hypoxia) was also inhibited by SNP (IC50 = 2.5 μM). Increased luciferase activity expressed by cotransfection of effector plasmids for HIF-1α or HIF-1α-like factor in hypoxia was also inhibited by the NO donor. We also showed that the inhibition was performed by blocking an activation step of HIF-1α to a DNA-binding form.

A 9-nt segment of a cellular mRNA can function as an internal ribosome entry site (IRES) and when present in linked multiple copies greatly enhances IRES activity

This study addresses the properties of a newly identified internal ribosome entry site (IRES) contained within the mRNA of the homeodomain protein Gtx. Sequential deletions of the 5′ untranslated region (UTR) from either end did not define distinct IRES boundaries; when five nonoverlapping UTR fragments were tested, four had IRES activity. These observations are consistent with other cellular IRES analyses suggesting that some cellular IRESes are composed of segments (IRES modules) that independently and combinatorially contribute to overall IRES activity. We characterize a 9-nt IRES module from the Gtx 5′ UTR that is 100% complementary to the 18S rRNA at nucleotides 1132–1124. In previous work, we demonstrated that this mRNA segment could be crosslinked to its complement within intact 40S subunits. Here we show that increasing the number of copies of this IRES module in the intercistronic region of a dicistronic mRNA strongly enhances IRES activity in various cell lines. Ten linked copies increased IRES activity up to 570-fold in Neuro 2a cells. This level of IRES activity is up to 63-fold greater than that obtained by using the well characterized encephalomyocarditis virus IRES when tested in the same assay system. When the number of nucleotides between two of the 9-nt Gtx IRES modules was increased, the synergy between them decreased. In light of these findings, we discuss possible mechanisms of ribosome recruitment by cellular mRNAs, address the proposed role of higher order RNA structures on cellular IRES activity, and suggest parallels between IRES modules and transcriptional enhancer elements.

Implication of the 5-HT(2A) and 5-HT(2C) (but not 5HT(1A)) receptors located within the periaqueductal gray in the elevated plus-maze test-retest paradigm in mice

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The neuro-muscular and musculo-skeletal characterization of children with joint hypermobility

In children, joint hypermobility (typified by structural instability of joints) manifests clinically as neuro-muscular and musculo-skeletal conditions and conditions associated with development and organization of control of posture and gait (Finkelstein, 1916; Jahss, 1919; Sobel, 1926; Larsson, Mudholkar, Baum and Srivastava, 1995; Murray and Woo, 2001; Hakim and Grahame, 2003; Adib, Davies, Grahame, Woo and Murray, 2005:). The process of control of the relative proportions of joint mobility and stability, whilst maintaining equilibrium in standing posture and gait, is dependent upon the complex interrelationship between skeletal, muscular and neurological function (Massion, 1998; Gurfinkel, Ivanenko, Levik and Babakova, 1995; Shumway-Cook and Woollacott, 1995). The efficiency of this relies upon the integrity of neuro-muscular and musculo-skeletal components (ligaments, muscles, nerves), and the Central Nervous System’s capacity to interpret, process and integrate sensory information from visual, vestibular and proprioceptive sources (Crotts, Thompson, Nahom, Ryan and Newton, 1996; Riemann, Guskiewicz and Shields, 1999; Schmitz and Arnold, 1998) and development and incorporation of this into a representational scheme (postural reference frame) of body orientation with respect to internal and external environments (Gurfinkel et al., 1995; Roll and Roll, 1988). Sensory information from the base of support (feet) makes significant contribution to the development of reference frameworks (Kavounoudias, Roll and Roll, 1998). Problems with the structure and/ or function of any one, or combination of these components or systems, may result in partial loss of equilibrium and, therefore ineffectiveness or significant reduction in the capacity to interact with the environment, which may result in disability and/ or injury (Crotts et al., 1996; Rozzi, Lephart, Sterner and Kuligowski, 1999b). Whilst literature focusing upon clinical associations between joint hypermobility and conditions requiring therapeutic intervention has been abundant (Crego and Ford, 1952; Powell and Cantab, 1983; Dockery, in Jay, 1999; Grahame, 1971; Childs, 1986; Barton, Bird, Lindsay, Newton and Wright, 1995a; Rozzi, et al., 1999b; Kerr, Macmillan, Uttley and Luqmani, 2000; Grahame, 2001), there has been a deficit in controlled studies in which the neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility have been quantified and considered within the context of organization of postural control in standing balance and gait. This was the aim of this project, undertaken as three studies. The major study (Study One) compared the fundamental neuro-muscular and musculo-skeletal characteristics of 15 children with joint hypermobility, and 15 age (8 and 9 years), gender, height and weight matched non-hypermobile controls. Significant differences were identified between previously undiagnosed hypermobile (n=15) and non-hypermobile children (n=15) in passive joint ranges of motion of the lower limbs and lumbar spine, muscle tone of the lower leg and foot, barefoot CoP displacement and in parameters of barefoot gait. Clinically relevant differences were also noted in barefoot single leg balance time. There were no differences between groups in isometric muscle strength in ankle dorsiflexion, knee flexion or extension. The second comparative study investigated foot morphology in non-weight bearing and weight bearing load conditions of the same children with and without joint hypermobility using three dimensional images (plaster casts) of their feet. The preliminary phase of this study evaluated the casting technique against direct measures of foot length, forefoot width, RCSP and forefoot to rearfoot angle. Results indicated accurate representation of elementary foot morphology within the plaster images. The comparative study examined the between and within group differences in measures of foot length and width, and in measures above the support surface (heel inclination angle, forefoot to rearfoot angle, normalized arch height, height of the widest point of the heel) in the two load conditions. Results of measures from plaster images identified that hypermobile children have different barefoot weight bearing foot morphology above the support surface than non-hypermobile children, despite no differences in measures of foot length or width. Based upon the differences in components of control of posture and gait in the hypermobile group, identified in Study One and Study Two, the final study (Study Three), using the same subjects, tested the immediate effect of specifically designed custom-made foot orthoses upon balance and gait of hypermobile children. The design of the orthoses was evaluated against the direct measures and the measures from plaster images of the feet. This ascertained the differences in morphology of the modified casts used to mould the orthoses and the original image of the foot. The orthoses were fitted into standardized running shoes. The effect of the shoe alone was tested upon the non-hypermobile children as the non-therapeutic equivalent condition. Immediate improvement in balance was noted in single leg stance and CoP displacement in the hypermobile group together with significant immediate improvement in the percentage of gait phases and in the percentage of the gait cycle at which maximum plantar flexion of the ankle occurred in gait. The neuro-muscular and musculo-skeletal characteristics of children with joint hypermobility are different from those of non-hypermobile children. The Beighton, Solomon and Soskolne (1973) screening criteria successfully classified joint hypermobility in children. As a result of this study joint hypermobility has been identified as a variable which must be controlled in studies of foot morphology and function in children. The outcomes of this study provide a basis upon which to further explore the association between joint hypermobility and neuro-muscular and musculo-skeletal conditions, and, have relevance for the physical education of children with joint hypermobility, for footwear and orthotic design processes, and, in particular, for clinical identification and treatment of children with joint hypermobility.

Multi-step ahead direct prediction for the machine condition prognosis using regression trees and neuro-fuzzy systems

This paper presents an approach to predict the operating conditions of machine based on classification and regression trees (CART) and adaptive neuro-fuzzy inference system (ANFIS) in association with direct prediction strategy for multi-step ahead prediction of time series techniques. In this study, the number of available observations and the number of predicted steps are initially determined by using false nearest neighbor method and auto mutual information technique, respectively. These values are subsequently utilized as inputs for prediction models to forecast the future values of the machines’ operating conditions. The performance of the proposed approach is then evaluated by using real trending data of low methane compressor. A comparative study of the predicted results obtained from CART and ANFIS models is also carried out to appraise the prediction capability of these models. The results show that the ANFIS prediction model can track the change in machine conditions and has the potential for using as a tool to machine fault prognosis.

Fault diagnosis of induction motor based on decision trees and adaptive neuro-fuzzy inference

This paper presents a fault diagnosis method based on adaptive neuro-fuzzy inference system (ANFIS) in combination with decision trees. Classification and regression tree (CART) which is one of the decision tree methods is used as a feature selection procedure to select pertinent features from data set. The crisp rules obtained from the decision tree are then converted to fuzzy if-then rules that are employed to identify the structure of ANFIS classifier. The hybrid of back-propagation and least squares algorithm are utilized to tune the parameters of the membership functions. In order to evaluate the proposed algorithm, the data sets obtained from vibration signals and current signals of the induction motors are used. The results indicate that the CART–ANFIS model has potential for fault diagnosis of induction motors.

Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy : a systematic review

Background: Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors' knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes. Methods: Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway. Results: The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN. Conclusions: This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.

Prediction of driving safety in individuals with homonymous hemianopia and quadrantanopia from clinical neuro-imaging

BACKGROUND: The objective of this study was to determine whether it is possible to predict driving safety in individuals with homonymous hemianopia or quadrantanopia based upon a clinical review of neuro-images that are routinely available in clinical practice. METHODS: Two experienced neuro-ophthalmologists viewed a summary report of the CT/MRI scans of 16 participants with homonymous hemianopic or quadrantanopic field defects which provided information regarding the site and extent of the lesion and made predictions regarding whether they would be safe/unsafe to drive. Driving safety was defined using two independent measures: (1) The potential for safe driving was defined based upon whether the participant was rated as having the potential for safe driving, determined through a standardized on-road driving assessment by a certified driving rehabilitation specialist conducted just prior and (2) state recorded motor vehicle crashes (all crashes and at-fault). Driving safety was independently defined at the time of the study by state recorded motor vehicle crashes (all crashes and at-fault) recorded over the previous 5 years, as well as whether the participant was rated as having the potential for safe driving, determined through a standardized on-road driving assessment by a certified driving rehabilitation specialist. RESULTS: The ability to predict driving safety was highly variable regardless of the driving outcome measure, ranging from 31% to 63% (kappa levels ranged from -0.29 to 0.04). The level of agreement between the neuro-ophthalmologists was also only fair (kappa =0.28). CONCLUSIONS: The findings suggest that clinical evaluation of summary reports currently available neuro-images by neuro-ophthalmologists is not predictive of driving safety. Future research should be directed at identifying and/or developing alternative tests or strategies to better enable clinicians to make these predictions.