New insights into the role of zinc in the respiratory epithelium

Over the past 30 years, many researchers have demonstrated the critical role of zinc (Zn), a group IIb metal, in diverse physiological processes, such as growth and development, maintenance and priming of the immune system, and tissue repair. This review will discuss aspects of Zn physiology and its possible beneficial role in the respiratory epithelium. Here we have detailed the mechanisms by which Zn diversely acts as: (i) an anti-oxidant; (ii) an organelle stabilizer; (iii) an anti-apopototic agent; (iv) an important cofactor for DNA synthesis; (v) a vital component for wound healing; and (vi) an anti-inflammatory agent. This paper will also review studies from the authors' laboratory concerning the first attempts to map Zn in the respiratory epithelium and to elucidate its role in regulating caspase-3 activated apoptosis. We propose that Zn, being a major dietary anti-oxidant has a protective role for the airway epithelium against oxyradicals and other noxious agents. Zn may therefore have important implications for asthma and other inflammatory diseases where the physical barrier is vulnerable and compromised.

Evaluation of liquid Bacillus thuringiensis var. israelensis products for control of Australian Aedes arbovirus vectors

Laboratory bioassay studies were conducted in southeast Queensland, Australia, on the efficacy of Teknar, VectoBac 12AS, and Cybate (active ingredient: 1,200 international toxic units Bacillus thuringiensis var. israelensis [Bti]) against 3rd instars of the arbovirus vectors Aedes aegypti, Ae. notoscriptus, Ae. vigilax, and Ae. camptorhynchus. Probit analyses were then used to determine LD50 (median lethal dose), LD50, and lethal dose ratios (LDR). Aedes aegypti and Ae. notoscriptus, both container-habitat species, tolerated the highest Bti concentrations compared with saltmarsh Ae. vigilax and Ae. camptorhynchus. For example, the LDR for Ae. vigilax versus Ae. notoscriptus exposed to Cybate was 0.14 (95% confidence limit [CL] 0.03-0.61). Similarly, the Cybate LDR for Ae. camptorhynchus versus Ae. notoscriptus was 0.22 (95% CL 0.07-0.70). Teknar produced similar results with an LDR of 0.21 (95% CL 0.04-1.10) for Aedes vigilax versus Aedes notoscriptus. Differences in product efficacy were found when tested against the 2 container-breeding species. Cybate was less effective than Teknar with LDRs of 1.55 (95% CL 0.65-3.67) and 1.87 (95% CL 0.68-5.15) for Aedes aegypti and Ae. notoscriptus, respectively. The significant differences in susceptibility between mosquito species and varying efficacy between products highlight the importance of evaluating concentration-response data prior to contracting with distributors of mosquito control products. This information is crucial to resistance management strategies.

Pneumocystis carinii cytochrome b mutations are associated with atovaquone exposure in patients with AIDS

This retrospective cohort study was conducted to determine whether Pneumocystis carinii cytochrome b gene mutations in patients with AIDS and P. carinii pneumonia (PCP) are associated with atovaquone exposure. Portions of the P. carinii cytochrome b genes that were obtained from 60 patients with AIDS and PCP from 6 medical centers between 1995 and 1999 were amplified and sequenced by using polymerase chain reaction. Fifteen patients with previous atovaquone prophylaxis or treatment exposure were matched with 45 patients with no atovaquone exposure. Cytochrome b coenzyme Q binding site mutations were observed in 33% of isolates from patients exposed to atovaquone, compared with 6% from those who were not (P=.018). There was no difference in survival 1 month after treatment between patients with or without cytochrome b mutations (P=.14). Thus, cytochrome b mutations are significantly more common in patients with AIDS and PCP with atovaquone exposure, but the clinical significance of these mutations remains unknown.

Cholinergic deficits contribute to behavioral disturbance in patients with dementia

BACKGROUND

Noncognitive behavioral changes such as depression, aggressive behavior, psychosis, and overactivity occur frequently in patients with dementia, in addition to cognitive impairment, and often determine the need for institutionalization. The biochemical basis of such changes is poorly understood. Clinical trial data indicate that cholinomimetics improve noncognitive behaviors. This study investigated the relationship between markers of the cholinergic and dopaminergic neurotransmitter systems and noncognitive behavioral symptoms assessed during the course of dementing illness.

METHOD

Brains from 46 patients with dementia (36 with AD and 10 with mixed or other dementias using Consortium to Establish a Registry for AD criteria) were examined together with 32 normal controls. The patients with dementia had been evaluated every 4 months, often over several years, for cognitive performance (Mini-Mental State Examination) and behavior (Present Behavioral Examination). Concentrations of dopamine (DA) and major metabolites, choline acetyltransferase activity (ChAT), and density (Bmax) of DA D1 receptors in frontal and temporal cortex were studied by radioligand binding protocols. None of the patients was receiving cholinomimetic drugs.

RESULTS

ChAT activity, but no other neurochemical markers, was reduced in AD compared with controls. Loss of ChAT activity correlated with cognitive impairment. Lowered ChAT activity also correlated with increasing overactivity in patients with dementia in both frontal and temporal cortex whereas ChAT:DA and ChAT:D1 ratios in temporal cortex correlated negatively with aggressive behavior.

CONCLUSIONS

Disturbance of the cholinergic system may underlie both cognitive and some noncognitive behavioral changes in dementia, providing a basis for rational therapy.-1467

An experience with transvaginal sonography in gynaecologic tumour surveillance

Surveillance of gynaecologic cancer patients treated with a curative intent involves frequent presentations by the patient for a targeted history, detailed general and pelvic examination, including Pap smear. One of the aims of such surveillance is to detect potentially curable recurrences early to allow the initiation of further therapy, hopefully to attain eradication of the recurrent tumour. Six cases are presented where the prudent use of transvaginal sonography (TVS) was found to be useful in the exclusion of recurrent tumour in patients with symptoms; early diagnosis in patients who were asymptomatic; confirmation of disease in those with symptoms; to evaluate patients with obliterated upper vaginas due to therapy, and follow-up of those with confirmed recurrence as a form of disease marker.

Family support for stroke: a randomised controlled trial

BACKGROUND

Attention is currently focused on family care of stroke survivors, but the effectiveness of support services is unclear. We did a single-blind, randomised, controlled trial to assess the impact of family support on stroke patients and their carers.

METHODS

Patients with acute stroke admitted to hospitals in Oxford, UK, were assigned family support or normal care within 6 weeks of stroke. After 6 months, we assessed, for carers, knowledge about stroke, Frenchay activities index, general health questionnaire-28 scores, caregiver strain index, Dartmouth co-op charts, short form 36 (SF-36), and satisfaction scores, and, for patients, knowledge about stroke and use of services, Barthel index, Rivermead mobility index, Frenchay activities index, London handicap scale, hospital anxiety and depression scales, Dartmouth co-op charts, and satisfaction.

FINDINGS

323 patients and 267 carers were followed up. Carers in the intervention group had significantly better Frenchay activities indices (p=0.03), SF-36 scores (energy p=0.02, mental health p=0.004, pain p=0.03, physical function p=0.025, and general health perception p=0.02), quality of life on the Dartmouth co-op chart (p=0.01), and satisfaction with understanding of stroke (82 vs 71%, p=0.04) than those in the control group. Patients' knowledge about stroke, disability, handicap, quality of life, and satisfaction with services and understanding of stroke did not differ between groups. Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge (44 vs 56%, p=0.04), but use of other services was similar.

INTERPRETATION

Family support significantly increased social activities and improved quality of life for carers, with no significant effects on patients.

Inter-rater reliability of the Frenchay activities index in patients with stroke and their careers

OBJECTIVE

To measure the inter-rater reliability of the interview-administered version of the Frenchay Activities Index (FAI).

DESIGN

Comparison of FAI score on the same person when administered by two raters (mean time between interviews 15.2 days).

SUBJECTS

Fifty-nine Oxfordshire residents who either had had a stroke (n = 35) or were the main carer (n = 24).

RESULTS

The 95% limits of agreement for the FAI totals were -9.9 to +8.4. The kappa statistic for nine of the 15 items showed a good level of agreement between the two research interviews (0.64-0.80). The other six items showed fair or moderate strength of agreement (0.26-0.52). Three items showed significant differences between the two raters p < 0.05 (Wilcoxon's sign paired rank sum test). The mean difference between the total scores was -0.76 (95% confidence interval from -1.98 to 0.46). Spearman's rho correlation coefficient for FAI totals of rater B against A was r(59) = 0.93 (p < 0.001).

CONCLUSION

The FAI is a reliable tool for measuring outcome following stroke. Suggestions are made to strengthen the reliability, and consequently the validity of the measure.

Autozygosity mapping of a seckel syndrome locus to chromosome 3q22. 1-q24

Seckel syndrome (MIM 210600) is an autosomal recessive disorder of low birth weight, severe microcephaly, and dysmorphic facial appearance with receding forehead, prominent nose, and micrognathia. We have performed a genomic screen in two consanguineous families of Pakistani origin and found that the disorder segregates with markers between loci D3S1316 and D3S3710, which map to chromosome 3q22.1-q24. Analysis using HOMOZ/MAPMAKER gave a maximum LOD score of 8.72. All five affected individuals were homozygous for the same allele, for two adjacent polymorphic markers within the region segregating with the disease, narrowing the region to 12 cM.

Pulmonary chemokine and mutagenic responses in rats after subchronic inhalation of amorphous and crystalline silica

Chronic inhalation of crystalline silica can produce lung tumors in rats whereas this has not been shown for amorphous silica. At present the mechanisms underlying this rat lung tumor response are unknown, although a significant role for chronic inflammation and cell proliferation has been postulated. To examine the processes that may contribute to the development of rat lung tumors after silica exposure, we characterized the effects of subchronic inhalation of amorphous and crystalline silica in rats. Rats were exposed for 6 h/day, on 5 days/week, for up to 13 weeks to 3 mg/m(3) crystalline or 50 mg/m(3) amorphous silica. The effects on the lung were characterized after 6.5 and 13 weeks of exposure as well as after 3 and 8 months of recovery. Exposure concentrations were selected to induce high pulmonary inflammatory-cell responses by both compounds. Endpoints characterized after silica exposure included mutation in the HPRT gene of isolated alveolar cells in an ex vivo assay, changes in bronchoalveolar lavage fluid markers of cellular and biochemical lung injury and inflammation, expression of mRNA for the chemokine MIP-2, and detection of oxidative DNA damage. Lung burdens of silica were also determined. After 13 weeks of exposure, lavage neutrophils were increased from 0.26% (controls) to 47 and 55% of total lavaged cells for crystalline and amorphous silica, with significantly greater lavage neutrophil numbers after amorphous silica (9.3 x 10(7) PMNs) compared to crystalline silica (6.5 x 10(7) PMNs). Lung burdens were 819 and 882 microg for crystalline and amorphous silica, respectively. BAL fluid levels of LDH as an indicator of cytotoxicity were twice as high for amorphous silica compared to those of crystalline silica, at the end of exposure. All parameters remained increased for crystalline silica and decreased rapidly for amorphous silica in the 8-month recovery period. Increased MIP-2 expression was observed at the end of the exposure period for both amorphous and crystalline silica. After 8 months of recovery, those markers remained elevated in crystalline silica-exposed rats, whereas amorphous silica-exposed rats were not significantly different from controls. A significant increase in HPRT mutation frequency in alveolar epithelial cells was detected immediately after 13 weeks of exposure to crystalline, but not to amorphous silica. A significant increase in TUNEL staining was detected in macrophages and terminal bronchiolar epithelial cells of amorphous silica-exposed rats at the end of the exposure period; however, crystalline silica produced far less staining. The observation that genotoxic effects in alveolar epithelial cells occurred only after crystalline but not amorphous silica exposure, despite a high degree of inflammatory-cell response after subchronic exposure to both types of silica, suggests that in addition to an inflammatory response, particle biopersistence, solubility, and direct or indirect epithelial cell cytotoxicity may be key factors for the induction of either mutagenic events or target cell death.

Cognitive function in UK community-dwelling African Caribbean and white elders: a pilot study

In recent years there has been interest in risk of cognitive impairment and dementia in populations of African origin. Little is known about this risk in older African Caribbean residents in the UK. One difficulty is lack of consensus over an adequate cognitive test battery for this community. Forty-five African Caribbean and 45 age and gender matched white community residents were recruited by household enumeration of an inner London electoral ward. These participants were administered the MMSE during a screening interview. Where possible, this was followed up by tests from the CERAD and CAMCOG neuropsychological batteries, a medical examination, and a structured interview with an informant. Based on these data, a psychiatrist blind to ethnicity independently rated 86 of these participants (41 of the African Caribbeans, all 45 of the whites) as cognitively normal, cognitively impaired, or demented. Of 41 African Caribbeans, 18 (44%) were rated as cognitively normal, 9 (22%) were rated as cognitively impaired, and 14 (34%) were rated as demented. Of the 45 whites, 39 (87%) were rated as cognitively normal, 4 (9%) were rated as cognitively impaired, and 2 (4%) were rated as demented. African Caribbeans scored significantly lower than whites in most cognitive test scores, which was not accounted for by their lower educational and occupational attainment, or their higher frequency of cardiovascular risk factors. African Caribbean elders in the UK appear to be at high risk of cognitive impairment and dementia. However, the influence of potential confounding factors such as socio-economic position and ill-health, and the effect of cultural test bias, cannot be ruled out.

Thermal lattice boltzmann simulation for multispecies fluid equilibration

The equilibration rate for multispecies fluids is examined using thermal lattice Boltzmann simulations. Two-dimensional free-decay simulations are performed for effects of velocity shear layer turbulence on sharp temperature profiles. In particular, parameters are so chosen that the lighter species is turbulent while the heavier species is laminar-and so its vorticity layers would simply decay and diffuse in time. With species coupling, however, there is velocity equilibration followed by the final relaxation to one large co- and one large counter-rotating vortex. The temperature equilibration proceeds on a slower time scale and is in good agreement with the theoretical order of magnitude estimate of Morse [Phys. Fluids 6, 1420 (1963)].

Prion protein immunoreactivity in brain samples from an unselected autopsy population: findings in 200 consecutive cases

Immunostaining for prion protein (PrP) using the KG9 monoclonal antibody was undertaken on brain sections from an unselected group of 200 post-mortem cases. One case of clinically diagnosed vCJD was confirmed and showed widespread abundant PrP immunostaining with KG9 and somewhat less abundant PrP with another monoclonal antibody, 3F4. PrP immunostaining seen with KG9 was insensitive to proteinase K pretreatment in sections from this case of vCJD. Among the remaining 199 cases, sections from 84 (42%) showed small amounts of PrP immunoreactivity with the KG9 antibody, mainly localized to neurones, neural processes and argyrophilic plaques of the type seen in ageing and Alzheimer's disease. Purkinje cells, swollen (ischaemic) axons, macrophages and microglials cells were also occasionally labelled with this antibody in non-CJD cases. Pre-treatment of adjacent sections from non-CJD cases with positive KG9 staining abolished this staining, indicating that it represented the cellular form of PrP. There were differences in age, sex and cause of death in non-CJD cases with some PrP immunostaining patterns compared with cases lacking any staining. Specifically, a younger mean age, more females and fewer cardiac deaths were found among those with neuronal PrP staining patterns. Staining of some features was also significantly associated. These findings need to be taken into account when PrP immunostaining is used to diagnose prion diseases. They may indicate that cellular PrP is increased in the human brain under some circumstances and provide insight into the handling of this protein by human brain cells.

Aggressive endometriosis: report of a case

A 54-year-old premenopausal woman presented with abdominal pain, constipation, and raised serum CA-125 levels during routine follow-up of a low-grade endometrial stromal sarcoma with prominent sex cord-like features, which had been treated by vaginal hysterectomy 4 years previously. The findings at laparotomy included: a 100-mm unilocular thick-walled right ovarian cyst, a solid 25-mm nodule in the left meso-ovarium, and a phlegmonous mass in the wall of the sigmoid colon, which proved to be a pericolic abscess due to diverticular disease. The ovarian cyst was a histologically benign endometrioid cystadenoma with stromal luteinization in the wall. Small islands of morphologically benign endometrial tissue were present in vessels of the meso-ovarium. The left adnexal nodule exhibited florid morphologically benign endometriosis, much of which was within and occluding large vascular spaces, and of apparently recent onset. No lesions resembled, in any way, the original stromal sarcoma. There was no evidence of endometriosis elsewhere in the pelvis or abdomen. The patient has made an uneventful recovery and is being monitored, as before, by tumor markers only. The discordance in morphology between the uterine sarcoma and the subsequent pelvic lesions was so complete as to raise doubts about any pathogenetic relationship between them. We propose the use of the term aggressive endometriosis to describe the changes observed.

Primary, nonsyndromic vesicoureteric reflux and its nephropathy is genetically heterogeneous, with a locus on chromosome 1

Primary vesicoureteric reflux (VUR) affects 1%-2% of whites, and reflux nephropathy (RN) causes up to 15% of end-stage renal failure in children and adults. There is a 30-50-fold increased incidence of VUR in first-degree relatives of probands, compared with the general population. We report the results of the first genomewide search of VUR and RN; we studied seven European families whose members exhibit apparently dominant inheritance. We initially typed 387 polymorphic markers spaced, on average, at 10 cM throughout the genome; we used the GENEHUNTER program to provide parametric and nonparametric linkage analyses of affected individuals. The most positive locus spanned 20 cM on 1p13 between GATA176C01 and D1S1653 and had a nonparametric LOD score (NPL) of 5.76 (P=.0002) and a parametric LOD score of 3.16. Saturation with markers at 1-cM intervals increased the NPL to 5.94 (P=.00009). Hence, VUR maps to a locus on chromosome 1. There was evidence of genetic heterogeneity at the chromosome 1 locus, and 12 additional loci were identified genomewide, with P<.05. No significant linkage was found to 6p, where a renal and ureteric malformation locus has been reported, or to PAX2, mutations of which cause VUR in renal-coloboma syndrome. Our results support the hypothesis that VUR is a genetic disorder.

The London handicap scale: a re-evaluation of its validity using standard scoring and simple summation

OBJECTIVE

To assess the validity of the London handicap scale (LHS) using a simple unweighted scoring system compared with traditional weighted scoring

METHODS

323 patients admitted to hospital with acute stroke were followed up by interview 6 months after their stroke as part of a trial looking at the impact of a family support organiser. Outcome measures included the six item LHS, the Dartmouth COOP charts, the Frenchay activities index, the Barthel index, and the hospital anxiety and depression scale. Patients' handicap score was calculated both using the standard procedure (with weighting) for the LHS, and using a simple summation procedure without weighting (U-LHS). Construct validity of both LHS and U-LHS was assessed by testing their correlations with the other outcome measures.

RESULTS

Cronbach's alpha for the LHS was 0.83. The U-LHS was highly correlated with the LHS (r=0.98). Correlation of U-LHS with the other outcome measures gave very similar results to correlation of LHS with these measures.

CONCLUSION

Simple summation scoring of the LHS does not lead to any change in the measurement properties of the instrument compared with standard weighted scoring. Unweighted scores are easier to calculate and interpret, so it is recommended that these are used.

Surgery and post-operative radiotherapy for early stage cervical cancer

The use of post-operative radiotherapy in the treatment of cervical cancer is controversial. The aim of this study was to document the results and toxicity of adjuvant irradiation in patients with Stage 1B and 2A cervical cancer. We performed a retrospective review of all patients treated with post-operative radiotherapy at Royal Prince Alfred Hospital between 1986 and 1993. Patient, tumour and treatment factors and late toxicity were recorded. Relapse-free and overall survival were calculated. Eighty-one patients form the study population. The median follow-up was 6.1 years. Fifty-eight patients (72%) had stage 1B cervical cancer and 23 (28%) stage 2A. The 5 year relapse-free and overall survival were 78% and 80% respectively. Six patients (7%) had late toxicity requiring inpatient medical treatment and 6 patients (7%) required surgery. The survival was comparable to other series reported in the literature. There was an incidence of 14% late toxicity requiring medical or surgical intervention which is greater than with hysterectomy or pelvic irradiation alone. Clinical prognostic factors should be used to select patients for either surgery or radiotherapy alone to minimise the increased toxicities associated with a combination of surgery and radiotherapy.