Illness and injury to students on a school excursion to Peru

BACKGROUND

School-organized travels abroad provide an opportunity for students to undertake supervised travel that reinforces scholastic study of various geographical locations under the direction and protection of experienced tour leaders and health professional support. Little is known concerning the nature of illnesses and injuries occurring on overseas school excursions. This study was designed to investigate the prevalence of injury and illness suffered by older teenagers on a school excursion to South America.

METHODS

In 2010, the school's tour physician (EH) diagnosed and recorded all illnesses and injuries among 29 school girls and 6 accompanying adults on a school excursion to Peru. Information recorded included age, sex, the nature of the presenting illness, number of days into the tour, the assessment of the condition, and the treatment employed during the excursion's field phase of 21 days.

RESULTS

A total of 32 (91%) travelers sought medical advice at least once for a total of 371 consultations, resulting in 153 separate diagnoses. The mean age of the students was 16 years with six adults accompanying the students being significantly older. Primary illnesses diagnosed were related to the following systems and conditions: gastrointestinal (58, 37%), respiratory (25, 16%), altitude sickness (19, 12%), genitourinary (8, 5%), dermatological (10, 7%), trauma (7, 5%), neurological (7, 5%), anxiety or psychological adjustment (7, 5%), adverse drug reactions (4, 3%), and musculoskeletal (5, 3%). The most commonly used medications were antidiarrheal and antiemetic medication. There were six accidents during the journey resulting in minor soft-tissue injuries. There were no deaths or other major accidents requiring emergency evacuation or hospitalization.

CONCLUSIONS

On this school excursion, the health problems encountered were consistent with those reported for other specialized tours, including expeditions and premium tours, although altitude illness needs to be carefully planned for in tours to higher elevation destinations as in South America. As well as being part of the service provided to the school students, the inclusion of a physician with appropriate medical supplies for this tour increased the independence of the travel group. A proposed medical kit for such an excursion is presented.

The shoulder and elbow joints and right and left sides demonstrate similar joint position sense

Proper orientation of the shoulder and elbow is necessary for accurate and precise positioning of the hand. The authors' goal was to compare these joints with an active joint position sense task, while also taking into account the effects of joint flexion angle and arm dominance. Fifteen healthy subjects were asked to replicate presented joint angles with a single degree of freedom active positioning protocol. There were no significant differences in angular joint position sense errors with respect to joint (shoulder vs. elbow) and side (left vs. right). However, when considering linear positioning, errors were lower for the elbow, due to a shorter lever arm. Also, as flexion angles increased toward 90°, there was a consistent pattern of lower errors for both joints.

Tracking an imploding cylinder with photonic Doppler velocimetry

Cylindrical implosion offers a path to extreme material states, reaching considerably higher pressures than planar geometry. However, diagnosing compressed material in cylindrical geometry is challenging. Time-resolved velocimetry, a standard technique in planar compression, is difficult to incorporate into cylindrical experiments. This paper describes the use of photonic Doppler velocimetry (PDV) in magnetically driven cylindrical compression experiments at the Sandia Z machine. With this diagnostic, it is possible to track the interior of an imploding cylinder beyond 20 km/s. A "leapfrog" implementation is described to support velocities well above the bandwidth limits of standard PDV measurements.

Neuroimaging of frontal-limbic dysfunction in schizophrenia and epilepsy-related psychosis: toward a convergent neurobiology

Psychosis is a devastating, prevalent condition considered to involve dysfunction of frontal and medial temporal limbic brain regions as key nodes in distributed brain networks involved in emotional regulation. The psychoses of epilepsy represent an important, though understudied, model relevant to understanding the pathophysiology of psychosis in general. In this review, we (1) discuss the classification of epilepsy-related psychoses and relevant neuroimaging and other studies; (2) review structural and functional neuroimaging studies of schizophrenia focusing on evidence of frontal-limbic dysfunction; (3) report our laboratory's PET, fMRI, and electrophysiological findings; (4) describe a theoretical framework in which frontal hypoactivity and intermittent medial temporal hyperactivity play a critical role in the etiopathology of psychosis both associated and unassociated with epilepsy; and (5) suggest avenues for future research.

Morbidity in former sawmill workers exposed to pentachlorophenol (PCP): a cross-sectional study in New Zealand

BACKGROUND

From 1950 to 1990 pentachlorophenol (PCP) was used widely in the New Zealand sawmill industry, and persistent claims of long-term health effects have been made.

METHODS

We surveyed surviving members of a cohort enumerated to study mortality in sawmill workers employed from 1970 to 1990. Estimates of historical exposure were based on job titles held, using the results of a PCP biomonitoring survey conducted in the 1980s. The survey involved interviews and clinical examinations, with interviewers and examiners blinded to exposure status.

RESULTS

Of the 293 participants 177 had not been exposed, and of the 116 exposed all but 10% had low or short-term PCP exposure. Nevertheless, a number of significant associations between PCP exposure and the prevalence of various symptoms were observed including associations between: (i) exposure levels and self-reported tuberculosis, pleurisy or pneumonia (P < 0.01) and a deficit in cranial nerve function (P = 0.04); (ii) duration of employment and thyroid disorders (P = 0.04), and neuropsychological symptoms including often going back to check things (P = 0.04), low libido (P = 0.02) and heart palpitations (P = 0.02), and a strong dose-response trend for frequent mood changes without cause (P < 0.01); and (iii) cumulative exposure and frequent mood changes without cause (P = 0.02), low libido (P = 0.04), and in the overall number of neuropsychological symptoms reported (P = 0.03).

CONCLUSIONS

PCP exposure was associated with a number of physical and neuropsychological health effects that persisted long after exposure had ceased.

Suitability of forced expiratory volume in 1 second/forced vital capacity vs percentage of predicted forced expiratory volume in 1 second for the classification of asthma severity in adolescents

OBJECTIVE

To determine whether lung function alters asthma severity based on symptom history in asthmatic adolescents.

DESIGN

Data on asthma symptoms and lung function were collected from adolescents randomly selected from the general population.

SETTING

Five schools from the central Wellington, New Zealand, area during 2003 to 2005.

PARTICIPANTS

Two hundred twenty-four secondary school students aged 13 to 17 years (asthmatic, 118; nonasthmatic, 106).

MAIN EXPOSURES

Asthma questionnaire and lung function testing.

MAIN OUTCOME MEASURES

Distribution of asthmatic adolescents in each severity class based on symptoms, lung function, or a combination of both.

RESULTS

Median values for all spirometric parameters for asthmatic adolescents, apart from forced expiratory volume in the first second of expiration (FEV(1))/forced vital capacity (FVC), were in the normal range. Distribution of severity (based on symptoms and beta(2)-agonist use with adjustment for regular inhaled corticosteroid use) was 48.3%, mild; 28.8%, moderate; and 22.9%, severe asthma. For severity based on percentages of predicted FEV(1) and predicted forced expiratory flow, midexpiratory phase (FEF(25%-75%)) and FEV(1)/FVC, the percentages were 89.8%, 86.4%, and 63.5%, mild; 9.3%, 10.2%, and 18.6%, moderate; and 0.9%, 3.4%, and 17.8%, severe asthma, respectively. When percentages of predicted FEV(1) or predicted FEF(25%-75%) or FEV(1)/FVC were added to symptom severity, 6.8%, 5.1%, and 16.9% of asthmatic adolescents were reclassified into another severity group, respectively.

CONCLUSIONS

The majority of asthmatic adolescents have normal lung function despite experiencing significant asthma symptoms. Adding FEV(1)/FVC to symptom history changes the distribution of severity; however, both percentages of predicted FEV(1) and FEF(25%-75%) have little added effect in assessing asthma severity in adolescents.

Direct measurement of the 7Be solar neutrino flux with 192 days of borexino data

We report the direct measurement of the 7Be solar neutrino signal rate performed with the Borexino detector at the Laboratori Nazionali del Gran Sasso. The interaction rate of the 0.862 MeV 7Be neutrinos is 49+/-3stat+/-4syst counts/(day.100 ton). The hypothesis of no oscillation for 7Be solar neutrinos is inconsistent with our measurement at the 4sigma C.L. Our result is the first direct measurement of the survival probability for solar nu(e) in the transition region between matter-enhanced and vacuum-driven oscillations. The measurement improves the experimental determination of the flux of 7Be, pp, and CNO solar nu(e), and the limit on the effective neutrino magnetic moment using solar neutrinos.

Asthma control in a random sample of New Zealand adolescent asthmatics

Asthma control, defined by asthma symptoms and lung function, and asthma medication use, was assessed in 123 adolescent asthmatics. Sputum eosinophilia (>or= 2.5% eosinophils) and bronchial hyperresponsiveness (BHR) to hypertonic saline were also measured to assess whether these additional objective parameters might aid in determining asthma control; 54.5% of subjects had adequately controlled asthma; 50.4% of all subjects reported inhaled corticosteroid use in the preceding 12 months; however, only 22.3% reported regular use. Although BHR and median eosinophil numbers were significantly higher in the inadequately controlled asthmatics, BHR and sputum eosinophilia had poor sensitivity for detecting inadequate asthma control.

The l2 minor capsid protein of low-risk human papillomavirus type 11 interacts with host nuclear import receptors and viral DNA

Analysis of the interactions of low-risk human papillomavirus type 11 (HPV11) L2 with karyopherin beta (Kap beta) nuclear import receptors revealed that L2 interacted with Kap beta 1, Kap beta 2, and Kap beta 3 and formed a complex with the Kap alpha 2 beta 1 heterodimer. HPV11 L2 contains two nuclear localization signals (NLSs)-in the N terminus and the C terminus-that could mediate its nuclear import via a classical pathway. Each NLS was functional in vivo, and deletion of both of them abolished L2 nuclear localization. Both NLSs interacted with the viral DNA. Thus, HPV11 L2 can interact with several karyopherins and the viral DNA and may enter the nucleus via multiple pathways.

Comparison of minimal inhibitory and mutant prevention drug concentrations of 4 fluoroquinolones against clinical isolates of methicillin-susceptible and -resistant Staphylococcus aureus

Staphylococcus aureus remains an important human pathogen affecting both outpatients and those hospitalized. Increasing antimicrobial resistance is global but prevalence rates are variable for different geographical areas. Fluoroquinolones have been used to treat S. aureus infections and the newer quinolones have enhanced in vitro activity against this organism. The mutant prevention concentration (MPC) defines the antimicrobial drug concentration threshold that would require an organism to simultaneously possess two mutations for growth in the presence of the drug. We tested clinical isolates of methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) S. aureus by minimum inhibitory concentration (MIC) and MPC against gatifloxacin, gemifloxacin, levofloxacin and moxifloxacin. For MSSA strains, the rank order of potency based on MIC(90) values were gemifloxacin (0.063 mg/l) = moxifloxacin (0.063 mg/l) > gatifloxacin (0.05 mg/l) = levofloxacin (0.25 mg/l) and by MPC values moxifloxacin (0.25 mg/l) > gemifloxacin (0.5 mg/l) > gatifloxacin (1 mg/l) = levofloxacin (1mg/l). For 87% of the isolates the MPC value was 0.5 mg/l for gatifloxacin. The rank order of potency based on the time the serum drug concentration exceeded the MPC(90), was as follows: moxifloxacin (>24 h) > levofloxacin (>18 h) > gatifloxacin (12 h) > gemifloxacin (9 h). Serum drug concentration remained in excess of the MPC(87) for 24 h for gatifloxacin. Both MIC(90) and MPC(90) values were higher against MRSA strains and the time above the MPC(90) was significantly shorter for all agents.

The sacroiliac joints: evaluation using nuclear scintigraphy. Part 1: The normal horse

REASONS FOR PERFORMING STUDY

Sacroiliac (SI) disease is recognised as a cause of poor hindlimb action but differential diagnosis is often difficult.

HYPOTHESES

That in clinically normal horses there would be a significant difference in the ratio of radiopharmaceutical uptake (RU) between the fifth lumbar vertebra (L5) and each tuber sacrale (TS) and between L5 and each SI joint; and that these ratios would alter with age, but ratios would be bilaterally symmetrical.

METHODS

Dorsal scintigraphic images of the SI region of 15 horses, selected randomly from the clinic database, were analysed by 2 of the authors, comparing noncorrected and motion-corrected images. To determine scintigraphic anatomy, the scintigraphic images of 10 Thoroughbred horses were superimposed over a ventrodorsal radiographic image of an isolated pelvis. Dorsal scintigraphic images of 40 clinically normal horses age 3-16 years were evaluated using subjective examination, profile analysis and quantification using regions of interest.

RESULTS

The tubera sacrale were seen as 2 well-defined oval regions immediately to the left and right of the midline, abaxial to which were larger, approximately oval areas with less RU, representing uptake in the SI joints. The definition between the SI region and the TS was more obvious in younger horses. Nonmotion-corrected images were often not of diagnostic quality or could be misinterpreted as abnormal. There were significant differences in RU between the TS and SI joints compared to L5, and decreased RU in the tubera sacrale with increasing age, but no change of uptake in the SI joint region and no effect of gender on RU. There was a high degree of left-right symmetry of the TS and SI joint regions.

CONCLUSIONS AND POTENTIAL RELEVANCE

The scintigraphic images of horses with suspected sacroiliac joint disease should be compared with images of normal horses of comparable age. In normal horses, there was a high degree of symmetry; therefore, marked left-right asymmetry is likely to be abnormal.

The sacroiliac joints: evaluation using nuclear scintigraphy. Part 2: Lame horses

REASONS FOR PERFORMING STUDY

Sacroiliac (SI) joint disease is difficult to diagnose definitively on clinical grounds.

HYPOTHESES

Lameness not attributable to SI joint pain may result in asymmetrical uptake of radiopharmaceutical in the tubera sacrale and SI joints; and that horses with clinical signs suggestive of sacroiliac joint disease would have differences in the ratios of radiopharmaceutical uptake between the fifth lumbar vertebra (L5) and either the tubera sacrale or SI joints compared with normal horses.

OBJECTIVES

To determine whether differences in radiopharmaceutical activity could identify individuals with presumed SI joint region pain.

METHODS

The scintigraphic appearance of the pelvic region of 234 horses (Group I) with lameness unrelated to the SI joints was compared with that for 40 normal horses (Group N) in full work and that for 41 horses with suspected SI joint disease (Group II). The effect of age, sex, lame limb and discipline were assessed in Group I. Motion-corrected scintigraphic images were assessed grossly, using profile analysis and by comparing ratios of uptake of mean count per pixel between L5 and each of the left (L) tuber sacrale (TS), right (R) TS, LSI and RSI joints. Left-right symmetry was compared.

RESULTS

Lame horses (Group I) had greater asymmetry of radiopharmaceutical uptake in the tubera sacrale compared with normal horses. Horses with right hindlimb lameness had a larger RSI/LSI ratio compared to normal horses. In Group I L5/LTS, L5/RTS and L5/RSI increased with age, and there was a trend for L5/LSI to increase with age. In horses with presumed sacroiliac joint disease (Group II), L5/LTS, L5/RTS and L5/RSI were all greater compared with normal horses. Detection of marked left-right asymmetry by quantitative analysis or profile analysis was helpful in discriminating between those horses with clinical signs compatible with SI joint disease and either normal horses or those lame due to another cause.

CONCLUSIONS AND POTENTIAL RELEVANCE

Scintigraphic evaluation of the SI region is useful to identify SI joint disease in combination with other clinical signs supportive of the diagnosis. However, diagnosis should not be based on this alone because of some degree of overlap in the range of radiopharmaceutical uptake between horses with SI joint disease and both normal horses and those with other causes of lameness.

Low level viremia and high CD4% predict normal survival in a cohort of HIV type-2-infected villagers

A community-based study of human immunodeficiency virus type 2 (HIV-2) infection was conducted in a rural village in northern Guinea Bissau, West Africa to assess the relationship between plasma HIV-2 RNA levels, CD4 lymphocyte percentage, and survival over an 8-year period. The cohort of 133 HIV-2-infected individuals and 160 HIV-uninfected controls enrolled in 1991 were followed up at home until 1998. Thirty-one (23%) HIV-2-infected and 24 (16%) HIV-uninfected individuals died over the follow-up period (mortality hazard ratio 1.7, 95% CI 1.0, 2.9; p= 0.06). In HIV-2-infected individuals, the median HIV-2 RNA level was 347 copies/ml and the mean CD4% was 28.6. Both plasma viremia and CD4% were independent predictors of survival, with hazard ratios increasing by 1.6 (95% CI, 1.1, 2.3) for each log(10) increase of plasma viremia and 1.7 (1.1, 2.6) for each 10% decrease of CD4%. Infected subjects with a plasma viral load >or= the median (347 copies/ml) and a CD4% <or= the mean (28.6%) had a mortality hazard ratio of 3.1 (95% CI 1.7, 5.8) compared to uninfected controls, whereas the remaining infected subjects had a mortality rate similar to uninfected controls, the mortality hazard ratio being 1.0 (95% CI, 0.5, 2.1.) In those who survived between 1991 and 1996, HIV-2 RNA levels were unchanged overall and CD4 lymphocyte counts remained high. In conclusion, baseline HIV-2 RNA levels predicted a normal survival for the majority, with low and stable levels of plasma viremia characterizing HIV-2 infections in this rural West African community.

Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia

OBJECTIVE

To assess and compare the mortality rates of patients with HIV-1, HIV-2 or both infections (HIV-D) in the same population.

DESIGN

Clinic-based cohort study.

METHODS

HIV-seropositive patients aged 15 years and older who attended the Medical Research Council clinics in Fajara between May 1986 and September 1997 were recruited. Clinical assessment using the Karnofsky score, CDC cell staging, WHO staging, and CD4 cell counts was performed at baseline. Patients attended clinic every 3 months; if they did not attend, they were visited at home by field workers to ascertain survival status. No patient was on antiretroviral therapy during the study period.

RESULTS

Data from 1519 HIV-positive adult patients were analysed. A total of 746 patients had HIV-1, 666 HIV-2, and 107 patients had HIV-D. A total of 828 patients (55%) died, and 161 (11%) were lost to follow-up. The median follow-up was 12 months (range 0-128). CD4 cell counts were available for 894 patients. Compared with HIV-1, the adjusted hazards ratio for mortality in the CD4 cell count category 500 cells/microl or greater was 0.50 for HIV-2 (95% CI 0.28-0.88) and 1.27 (95% CI 0.51-3.7) for HIV-D. Among those with CD4 cell counts less than 500 cells/microl the mortality rates in HIV-2 and HIV-D were similar to those in HIV-1.

DISCUSSION

HIV-2-infected patients with CD4 cell counts of 500 cells/microl and greater had a significantly lower mortality rate than HIV-1-infected patients. HIV-2-infected patients with advanced disease had the same poor prognosis as patients with HIV-1. Dually infected patients had mortality rates similar to HIV-1.

Increased prevalence of HTLV-1 among HIV-2-infected women but not HIV-2-infected men in rural Guinea-Bissau

OBJECTIVE

To assess the prevalence of HTLV infection and its association with HIV and other potential risk factors.

DESIGN AND SETTING

A cross-sectional survey and a case-control study in a rural community in Guinea-Bissau.

METHODS

A total of 2770 people were included in an HIV and HTLV seroepidemiologic survey. Three hundred of these participants were selected for a case-control study on HIV-2. Sera from both studies were tested for HTLV.

RESULTS

In all, 2501 and 298 subjects in the survey and case-control study, respectively, were tested for HTLV. Overall HTLV-1 prevalence was 5.2% and it was higher in women (odds ratio [OR], 1.36; confidence interval [CI], 0.92-2.02). Apart from an infected spouse, no significant risk factors could be identified for men. In women, HIV-2 infection (adjusted OR, 5.58; CI, 3.09-10.1), having an infected spouse, and area of residence were significantly associated with HTLV-1 infection. The association between HTLV-1 and HIV-2 was significantly different for men and women (test of interaction, p =.002).

CONCLUSIONS

In women, the most important determinant of HTLV-1 seropositivity was HIV-2 infection. Because the pattern was significantly different for men and women, common sexual risk factors may not be sufficient to explain the co-occurrence of HIV-2 and HTLV-1 in women. These observations may have implications in geographic areas where both types of retroviruses are prevalent.

HIV-2 does not protect against HIV-1 infection in a rural community in Guinea-Bissau

OBJECTIVE

To examine the putative protective effect of HIV-2 infection against subsequent HIV-1 infection.

DESIGN

Retrospective analysis of data from two cross-sectional surveys in the same community.

METHODS

Two surveys between 1989 and 1998 in a rural area in northwestern Guinea-Bissau provided data from residents aged 15-59 years. HIV testing was done in the first survey. In the second survey, tests were made for both HIV and syphilis, and data on sociodemographic factors and sexual behaviour, including commercial sex work, were gathered. Qualitative polymerase chain reaction amplification of HIV-1 and HIV-2 viral DNA was performed on serologically dually reactive samples.

RESULTS

Of the 2276 eligible adult villagers initially tested, 60% (1360) provided a second sample. Of 110 HIV-2-infected subjects, 17 became additionally infected with HIV-1 [incidence rate (IR), 26.3/1000 person-years observation]. Of the 1250 HIV-seronegative subjects, 24 became infected with HIV-1 (IR, 2.8/1000 person-years observation). The incidence rate ratio (IRR), comparing the incidence rate in HIV-2-infected people with the rate in HIV-seronegative subjects, was > 1 in all three "risk groups": men, female commercial sex workers, and other women. The overall estimate of the IRR, adjusted for age group and risk group, was 3.24 (confidence interval, 1.5-7.1).

CONCLUSIONS

There was no protective effect of HIV-2 in this population. HIV-2 cannot be regarded as a vaccine, but, instead, may be a risk factor for HIV-1 infection.

Characterization and functional significance of calcium transients in the 2-cell mouse embryo induced by an autocrine growth factor

Growth of preimplantation embryos is influenced by autocrine trophic factors that need to act by the 2-cell stage, but their mode of action is not yet described. This report shows that late zygote and 2-cell stage mouse embryos responded to embryo-derived platelet-activating factor (PAF) with transient increases in intracellular calcium concentration ([Ca(2+)](i)). [Ca(2+)](i) transients were single global events and were specifically induced by embryo-derived PAF. They were blocked by inhibition of phospholipase C (U 73122) and an inositol trisphosphate (IP(3)) receptor antagonist (xestospongin C), indicating the release of calcium from IP(3)-sensitive intracellular stores. Transients were also inhibited by the absence of calcium from extracellular medium and partially inhibited by treatment with dihydropyridine (nifedipine, 10 micrometer), but not pimozide (an inhibitor of an embryonic T-type calcium channel). (+/-)BAY K8644 (an L-type channel agonist) induced [Ca(2+)](i) transients, yet these were completely inhibited by nifedipine (10 micrometer). The complete inhibition of BAY K8644, but only partial inhibition of PAF by nifedipine shows that L-type channels were only partly responsible for the calcium influx. Depolarization of 2-cell embryos by 50 mm K(+) did not inhibit PAF-induced calcium transients, showing that the influx channels were not voltage-dependent. Depletion of intracellular calcium stores by thapsigargin revealed the presence of store-operated channels. The interdependent requirement for IP(3)-sensitive internal calcium stores and extracellular calcium in the generation of PAF-induced transients may be explained by a requirement for capacitative calcium entry via store-operated channels. A functionally important role for the PAF-induced transients is supported by the observation that inhibition of [Ca(2+)](i) transients by a PAF-antagonist (WEB 2086) or an intracellular calcium chelator (1,2-bis(2-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid tetrakis-acetoxymethyl ester; BAPTA-AM) caused marked inhibition of early embryo development. Growth inhibition by BAPTA-AM was relieved by addition of exogenous PAF.

Maternal HIV-1 and HIV-2 infection and child survival in The Gambia

OBJECTIVE

To compare the survival of children born to HIV-1 or HIV-2 seropositive mothers with that of children born to HIV-seronegative mothers and to evaluate risk factors for mortality.

DESIGN

Physician-blinded prospective study.

METHODS

One hundred and one HIV-1-seropositive, 243 HIV-2-seropositive pregnant women, and 468 HIV-seronegative women (control group) matched by age, parity, and health centre, were followed up in a study of mother-to-child transmission of HIV. Mothers and children were seen at 2 and 6 months of age and subsequently followed at 3-monthly intervals up to 18 months of age. HIV infection in children was diagnosed by polymerase chain reaction at 2, 9 or 18 months and by antibody assays at 18 months.

RESULTS

Fifteen per cent of children born to HIV-1-infected mothers died compared with 7% of children born to HIV-2-infected mothers [hazard ratio, 2.3; 95% confidence interval (CI), 1.1-4.7; P = 0.02], and 6% of HIV-seronegative mothers (hazard ratio, 2.6; 95% CI, 1.4-5.0; P = 0.003). Six of the 17 children known to be HIV-1 infected died compared with none among the eight HIV-2-infected children (P = 0.13). High proviral load in the babies, high antenatal maternal RNA plasma viral load, and maternal death increased child mortality significantly.

CONCLUSIONS

More children born to HIV-1-infected mothers died in comparison with those born to HIV-2-infected mothers or to mothers from the control group. This effect was due to excess death in HIV-1-infected infants which was associated with a high viral load in the affected mother and child.

Matrix Metalloproteinases Generate Angiostatin: Effects on Neovascularization

Angiostatin, a cleavage product of plasminogen, has been shown to inhibit endothelial cell proliferation and metastatic tumor cell growth. Recently, the production of angiostatin has been correlated with tumor-associated macrophage production of elastolytic metalloproteinases in a murine model of Lewis lung cell carcinoma. In this report we demonstrate that purified murine and human matrix metalloproteinases generate biologically functional angiostatin from plasminogen. Macrophage elastase (MMP-12 or MME) proved to be the most efficient angiostatin-producing MMP. MME was followed by gelatinases and then the stomelysins in catalytic efficiency; interstitial collagenases had little capacity to generate angiostatin. Both recombinant angiostatin and angiostatin generated from recombinant MME-treated plasminogen inhibited human microvascular endothelial cell proliferation and differentiation in vitro. Finally, employing macrophages isolated from MME-deficient mice and their wild-type littermates, we demonstrate that MME is required for the generation of angiostatin that inhibits the proliferation of human microvascular endothelial cells.

Matrix metalloproteinases generate angiostatin: effects on neovascularization

Angiostatin, a cleavage product of plasminogen, has been shown to inhibit endothelial cell proliferation and metastatic tumor cell growth. Recently, the production of angiostatin has been correlated with tumor-associated macrophage production of elastolytic metalloproteinases in a murine model of Lewis lung cell carcinoma. In this report we demonstrate that purified murine and human matrix metalloproteinases generate biologically functional angiostatin from plasminogen. Macrophage elastase (MMP-12 or MME) proved to be the most efficient angiostatin-producing MMP. MME was followed by gelatinases and then the stomelysins in catalytic efficiency; interstitial collagenases had little capacity to generate angiostatin. Both recombinant angiostatin and angiostatin generated from recombinant MME-treated plasminogen inhibited human microvascular endothelial cell proliferation and differentiation in vitro. Finally, employing macrophages isolated from MME-deficient mice and their wild-type littermates, we demonstrate that MME is required for the generation of angiostatin that inhibits the proliferation of human microvascular endothelial cells.

Factors associated with smoking and the reasons for stopping in Maori and Europeans: a comparative study

AIM

To compare the prevalence of smoking, factors associated with smoking, ex-smokers and reasons for stopping in Maori and Europeans aged 10 years and older.

METHODS

Demographic and smoking data were obtained by personal interview using a standard questionnaire and assisted by Maori health carers. Report-back meetings were held.

RESULTS

The smoking status in 713 subjects (Maori 52.5%, Europeans 47.5%) was: current smokers (Maori 48.1%, Europeans 19.8%); never smoked (Maori 28.1%, Europeans 47.5%); ex-smokers (Maori 23.8%, Europeans 32.7%). Of Maori smokers, 66.1% were women whereas of European smokers 47.8% were women. Significantly more Maori aged 10 to 29 years smoked than Europeans (p = 0.0002). Nineteen percent of smokers smoked < 5 cigarette equivalents per day, 68.8% smoked 5 to 20, and 12.2% smoked > 20 cigarettes per day. There was no gender difference in cigarette consumption. Maoridom (p = 0.00001), a less skilled occupation (p = 0.0008), lower income (< or = $15,000 p = 0.002) and alcohol consumption (p = 0.00001) were significantly associated with current smoking. Reasons for giving up smoking were health (majority), awareness of risks (Europeans), financial (Maori men), pregnancy (Maori women), social unacceptability (European women), on advice of medical practitioner (minority).

CONCLUSIONS

Smoking remains a major problem in New Zealand, particularly in Maori. Stricter anti-tobacco measures than already exist, greater input from medical practitioners and particularly ongoing participation by Maori health carers should lead to a further decline in smoking.