This study is the first case series of torpedo maculopathy in the paediatric population. Contrary to previous reports of two distinct types of lesion on OCT representing different stages of the same disease, our case series indicates that Type 1 and Type 2 lesions are in fact different phenotypic entities both of which can occur at a young age. We also present the associated risk of choroidal neovascular membrane formation which is an important consideration for long term follow-up.

Understanding the health consequences of chronic disruption of circadian rhythms can contribute to improving prevention strategies for shift workers. Chronic circadian disruption in shift work has been linked to a higher risk of stroke. Dysregulated immune responses are also linked to circadian disruption and may be a factor in stroke outcomes in shift workers. In this study, we test the hypotheses that specific schedules of circadian disruption exacerbate inflammatory responses in the brain, causing an increase in infarct size after experimentally induced ischemic stroke. Mice were exposed to 1 of 5 different lighting schedules followed by a 30-min middle cerebral artery occlusion, then reperfusion and 3-day recovery. A history of weekly phase advances resulted in an increased infarct volume versus the control lighting schedule. These effects were shift-direction specific, nonpermanent, and required multiple shifts to occur. In a separate cohort, stereotaxic injections of lipopolysaccharide were given bilaterally after exposure to 1 of 3 different lighting schedules. Ratios of pro- to anti-inflammatory cytokine expression show dysregulated responses after a history of phase advances. We conclude that chronic circadian disruption leads to worsened stroke outcome in a direction- and schedule-specific manner likely because of priming of the inflammatory response in the brain. These pieces of evidence suggest that the health impacts of shift work may be improved by targeting shift work scheduling, inflammatory mediators, or both.

Non-traditional work schedules, such as shift work, have been associated with numerous health issues including cardiovascular and metabolic disease. These work schedules can chronically misalign environmental timing cues with internal circadian clock systems in the brain and in peripheral organs, leading to dysfunction of those systems and their associated biological processes. Environmental circadian disruption in the kidney may be an important factor in the increased incidence of hypertension and adverse health outcomes in human shift workers. The relationship between renal rhythmicity and injury resilience is not well understood, especially in the context of environmental, rather than genetic manipulations of the circadian system. We conducted a longitudinal study to determine whether chronic shifting of the light cycle that mimics shift work schedules would disrupt output rhythms of the kidney and accelerate kidney injury in salt-loaded male spontaneously hypertensive, stroke-prone rats. We observed that chronic shifting of the light-dark (LD) cycle misaligned and decreased the amplitude of urinary volume rhythms as the kidney phase-shifted to match each new lighting cycle. This schedule also accelerated glomerular and tubular injury marker excretion, as quantified by nephrin and KIM-1 compared with rats kept in a static LD cycle. These data suggest that disrupted rhythms in the kidney may decrease resilience and contribute to disease development in systems dependent on renal and cardiovascular functions.

Shift work, performed by approximately 21 million Americans, is irregular or unusual work schedule hours occurring after 6:00 pm. Shift work has been shown to disrupt circadian rhythms and is associated with several adverse health outcomes and chronic diseases such as cancer, gastrointestinal and psychiatric diseases and disorders. It is unclear if shift work influences the complications associated with certain infectious agents, such as pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility resulting from genital chlamydial infection. We used an Environmental circadian disruption (ECD) model mimicking circadian disruption occurring during shift work, where mice had a 6-h advance in the normal light/dark cycle (LD) every week for a month. Control group mice were housed under normal 12/12 LD cycle. Our hypothesis was that compared to controls, mice that had their circadian rhythms disrupted in this ECD model will have a higher Chlamydia load, more pathology and decreased fertility rate following Chlamydia infection. Results showed that, compared to controls, mice that had their circadian rhythms disrupted (ECD) had higher Chlamydia loads, more tissue alterations or lesions, and lower fertility rate associated with chlamydial infection. Also, infected ECD mice elicited higher proinflammatory cytokines compared to mice under normal 12/12 LD cycle. These results imply that there might be an association between shift work and the increased likelihood of developing more severe disease from Chlamydia infection.

BackgroundDiffuse unilateral subacute neuroretinitis (DUSN) is a rare cause of posterior uveitis in the United Kingdom. It typically presents unilaterally in children and young adults but rarely bilateral cases have been reported. It is also rare to have multiple worms in the same eye causing the clinical picture. In this article, we present a challenging case of DUSN in a young girl unresponsive to conventional treatments suggesting the possibility of multiple worms being present in the same eye.Case PresentationAn 8-year-old girl presented with a 2-month history of headaches. On occasions the headaches were associated with redness and watering of her left eye. She denied any visual loss or visual symptoms. Her visual acuity was reduced to 6/30 in her left eye. Fundal examination revealed a unilateral chorioretinitis. Investigation did not reveal a specific cause for the chorioretinitis. Over 15 months her visual acuity improved to 6/9 but the fundal appearance changed and a diagnosis of DUSN was made. She was treated with focal laser, systemic anti-helminthic and immunosuppressive treatments but continued to develop new, active areas of chorioretinitis, raising the possibility of multiple worms in the sub-retinal space. There is also a concern as to other central nervous system (CNS) involvement given her significant and ongoing headaches.ConclusionWe present a challenging case of DUSN in a young girl; a condition that remains rare in the UK. She was unresponsive to both focal laser and systemic anti-helminthic and immunosuppressive treatments suggesting the possibility of multiple worms being present in the sub-retinal space. This case highlights the difficulties often encountered in the treatment of DUSN, even when a worm can be identified. Her visual prognosis is poor as there was ongoing recurrence of active chorioretinitis.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Environmental cues such as light and timing of food intake influence molecular clocks that produce circadian rhythmicity of many biological functions. The master circadian clock is entrained by light input and synchronizes to peripheral clocks in every organ. Careers that require rotating shift work schedules predispose workers to a constant desynchronization of biological clocks and are associated with increased risk of cardiovascular disease. We utilized a stroke-prone spontaneously hypertensive rat model exposed to a known biological desynchronizer, chronic environmental circadian disruption (ECD), and hypothesized that it would accelerate time to stroke onset. We investigated whether time-restricted feeding could delay stroke onset and evaluated its usefulness as a countermeasure when combined with the disruption of the light cycle. We found that a phase advancing schedule accelerated stroke onset. Restricting food access time to 5 hours/day regardless of lighting delayed stroke onset in both standard 12:12 light:dark or ECD lighting conditions compared with ad-lib feeding, but acceleration by ECD versus control lighting conditions was still observed. Since hypertension is a precursor to stroke in this model, we assessed blood pressure in a small cohort longitudinally using telemetry. Daily systolic and diastolic blood pressure was increased in both control and ECD conditions, thus hypertension was not accelerated to cause earlier strokes. We observed intermittent dampening of rhythms after each shift of the light cycle reminiscent of a relapsing-remitting non-dipping state. Our results suggest that constant ECD rhythms may be associated with increased risk of cardiovascular complications in the presence of cardiovascular risk factors.

The circadian clock regulates Na+ transport with a necessary diurnal variation for optimal health. The clock gene, Bmal1, is known to regulate mitochondrial O2 consumption, but whether or how this occurs in the kidney has not been established. An estimated 95% of O2 consumption in the kidney is linked to sodium transport. We developed and used a novel Bmal1 knockout rat on a Sprague Dawley background. Male Bmal1 -/- rats do not have the typical night-day difference in Na+ excretion, while female rats maintain this pattern. We recently observed that ADP-dependent O2 consumption in permeabilized kidney tissue was significantly higher in both sexes of Bmal1 -/- rats but only during the active/dark period. We also observed a significant increase in cytochrome c oxidase activity in Bmal1 -/- rats during the dark vs. light period (164 ± 40 vs. 306 ± 40 pmol/s·mg; p=0.0031, t-test). Since these effects were observed in both male and female rats, these changes in mitochondrial activity cannot explain the difference in diurnal sodium excretion. Since mitochondrial morphology can impact oxidative phosphorylation and energy availability, we hypothesized that Bmal1 regulates mitochondrial morphology in the kidney. Male and female global Bmal1 +/+ and Bmal1 -/- rats at 12-14 weeks of age were maintained in regular 12:12 LD cycles. Outer renal medullary tissue was dissected and prepared for mRNA expression and transmission electron microscopy (EM). For EM, tissues were obtained at light (ZT2-4) or dark (ZT14-16) periods to correspond with the minimum and maximum whole-body energy consumption and peak and trough Bmal1 protein expression. Digital droplet PCR mRNA expression was conducted from tissue collected at 4hr intervals over 24hrs. EM images appear to show an elongation of mitochondrial morphology in females but not male Bmal1 -/- during the active time of day. Mitofusion1 (Mfn1) and fission 1 (Fis1) are genes that regulate mitochondrial structural dynamics. Mfn1 and Fis1 mRNA expression over 24hrs showed a significant interaction between genotype and time of day in male rats (p=0.004 and p=0.020, respectively, 2way ANOVA). In contrast, there were no significant differences in overall Mfn1 or Fis1 expression between female Bmal1 +/+ and Bmal1 -/- rats. Our findings demonstrate that Bmal1 is crucial in maintaining mitochondrial respiration coupling and ATP generation in the kidney. Furthermore, we suggest that female Bmal1 -/- rats can better compensate for impaired respiration by mitochondrial morphological changes when the molecular clock is dysfunctional. We further propose that the rhythmicity of Na+ excretion in females, but not male, Bmal1 -/- rats is due to adjustments in mitochondrial morphology. T32 HL007457, P01HL136267, AHA 908953 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.