Chronic renal failure in Jamaican children--an update (2001-2006)

OBJECTIVE

This study evaluated the incidence, epidemiology, aetiology and outcome of chronic renal failure (CRF) in Jamaican children < 12 years old between 2001 and 2006.

METHODS

The required data on all children who fulfilled inclusion criteria were obtained from their medical records at the University Hospital of the West Indies, Bustamante Hospital for Children and from practitioners in hospitals serving children islandwide.

RESULTS

Eighteen new children (72.2% male) presented with CRF. The cumulative annual incidence was 4.61/million child population under age 12 years or 1.14/million total population. Congenital urological disease (44.5%) was the commonest cause of CRF, followed by glomerulonephritis (33.3%). Half of the cases of glomerulonephritis were secondary to HIV-associated nephropathy. Although all children with posterior urethral valves were diagnosed before age 6 months and promptly treated, renal failure present at birth proved irreversible. The mean age at diagnosis of CRF was 6.72 years. Ten children (55.6%) were already in CRF at first presentation with renal disease. Of these, the five with non-urological disease were already in End Stage Renal Disease (ESRD). Mortality was 44.4%. Five children died in ESRD without the benefit of dialysis.

CONCLUSION

The incidence of CRF has increased from the 1985-2000 local study and is mainly due to urological pathology which progresses despite early diagnosis and treatment. Non-urological renal disease is presenting too late for therapeutic intervention. Greater public awareness of symptoms of renal disease is needed. Children's access to dialysis is unpredictable. A paediatric dialysis and transplantation programme is needed.

Molecular analysis of sleep: wake cycles in Drosophila

Sleep is controlled by two major regulatory systems: a circadian system that drives it with a 24-hour periodicity and a home-ostatic system that ensures that adequate amounts of sleep are obtained. We are using the fruit fly Drosophila melanogaster to understand both types of regulation. With respect to circadian control, we have identified molecular mechanisms that are critical for the generation of a clock. Our recent efforts have focused on the analysis of posttranslational mechanisms, specifically the action of different phosphatases that control the phosphorylation and thereby the stability and/or nuclear localization of circadian clock proteins period (PER) and timeless (TIM). Resetting the clock in response to light is also mediated through posttranslational events that target TIM for degradation by the proteasome pathway; a recently identified ubiquitin ligase, jet lag (JET), is required for this response. Our understanding of the homeostatic control of sleep is in its early stages. We have found that mushroom bodies, which are a site of synaptic plasticity in the fly brain, are important for the regulation of sleep. In addition, through analysis of genes expressed under different behavioral states, we have identified some that are up-regulated during sleep deprivation. Thus, the Drosophila model allows the use of cellular and molecular approaches that should ultimately lead to a better understanding of sleep biology.

Self-focused ZnO transducers for ultrasonic biomicroscopy

A simple fabrication technique was developed to produce high frequency (100 MHz) self-focused single element transducers with sputtered zinc oxide (ZnO) crystal films. This technique requires the sputtering of a ZnO film directly onto a curved backing substrate. Transducers were fabricated by sputtering an 18 mum thick ZnO layer on 2 mm diameter aluminum rods with ends shaped and polished to produce a 2 mm focus or f-number equal to one. The aluminum rod served a dual purpose as the backing layer and positive electrode for the resultant transducers. A 4 mum Parylene matching layer was deposited on the transducers after housing and interconnect. This matching layer was used to protect the substrate and condition the transfer of acoustic energy between the ZnO film and the load medium. The pulse-echo response for a representative transducer was centered at 101 MHz with a -6 dB bandwidth of 49%. The measured two way insertion loss was 44 dB. A tungsten wire phantom and an adult zebrafish eye were imaged to show the capability of these transducers.

Pharmacokinetics/genotype associations for major cytochrome P450 enzymes in native and first- and third-generation Japanese populations: comparison with Korean, Chinese, and Caucasian populations

Application of foreign clinical data across geographic regions can accelerate drug development. Drug disposition can be variable, and identification of factors influencing responsible pharmacokinetic/pharmacogenomic approaches could facilitate the universal application of foreign data and reduce the total amount of phase III clinical trials evaluating risks in different populations. Our objective was to establish and compare genotype (major cytochrome P450 (CYP) enzymes)/phenotype associations for Japanese (native and first- and third-generation Japanese living abroad), Caucasian, Chinese, and Korean populations using a standard drug panel. The mean metabolic ratios (MRs) for the four ethnic groups were similar except for a lower activity of CYP2D6 in Caucasians and CYP2C19 in Asians. Genotype, not ethnicity, impacted the MR for CYP2C9, CYP2C19, and CYP2D6; neither affected CYP1A2, CYP2E1, and CYP3A4/5 activities. We conclude that equivalent plasma drug concentrations and metabolic profiles can be expected for native Japanese, first- and third-generation Japanese, Koreans, and Chinese for compounds handled through these six CYP enzymes.

Self-focused ZnO transducers for ultrasonic biomicroscopy

A simple fabrication technique was developed to produce high frequency (100 MHz) self-focused single element transducers with sputtered zinc oxide (ZnO) crystal films. This technique requires the sputtering of a ZnO film directly onto a curved backing substrate. Transducers were fabricated by sputtering an 18 μm thick ZnO layer on 2 mm diameter aluminum rods with ends shaped and polished to produce a 2 mm focus or f-number equal to one. The aluminum rod served a dual purpose as the backing layer and positive electrode for the resultant transducers. A 4 μm Parylene matching layer was deposited on the transducers after housing and interconnect. This matching layer was used to protect the substrate and condition the transfer of acoustic energy between the ZnO film and the load medium. The pulse-echo response for a representative transducer was centered at 101 MHz with a -6 dB bandwidth of 49%. The measured two way insertion loss was 44 dB. A tungsten wire phantom and an adult zebrafish eye were imaged to show the capability of these transducers.

Origin and evolution of high throughput screening

This article reviews the origin and evolution of high throughput screening (HTS) through the experience of an individual pharmaceutical company, revealing some of the mysteries of the early stages of drug discovery to the wider pharmacology audience. HTS in this company (Pfizer, Groton, USA) had its origin in natural products screening in 1986, by substituting fermentation broths with dimethyl sulphoxide solutions of synthetic compounds, using 96-well plates and reduced assay volumes of 50-100 microl. A nominal 30 mM source compound concentration provided high microM assay concentrations. Starting at 800 compounds each week, the process reached a steady state of 7200 compounds per week by 1989. Screening in the Applied Biotechnology and Screening Group was centralized with screens operating in lock-step to maximize efficiency. Initial screens were full files run in triplicate. Autoradiography and image analysis were introduced for (125)I receptor ligand screens. Reverse transcriptase (RT) coupled with quantitative PCR and multiplexing addressed several targets in a single assay. By 1992 HTS produced 'hits' as starting matter for approximately 40% of the Discovery portfolio. In 1995, the HTS methodology was expanded to include ADMET targets. ADME targets required each compound to be physically detected leading to the development of automated high throughput LC-MS. In 1996, 90 compounds/week were screened in microsomal, protein binding and serum stability assays. Subsequently, the mutagenic Ames assay was adapted to a 96-well plate liquid assay and novel algorithms permitted automated image analysis of the micronucleus assay. By 1999 ADME HTS was fully integrated into the discovery cycle.

Uptake of fluoride ions by the glass component of glass ionomer cement

OBJECTIVES

The uptake of F(-) ions by glass ionomer cement (GIC) has been extensively studied but the precise location of the F(-) ion in the GIC structure has not been reported. The aim of this study is to use model materials to elucidate the possible locations. GIC consists of residual particles of aluminosilicate glass surrounded by depleted glass in an ionically crosslinked polymeric matrix. This study evaluates uptake by both unreacted glass particles (RAW) and particles acid-treated to produce a depleted glass surface (DEPLETED).

METHOD

Three glasses, previously studied as cements, were tested at the particle size used in GICs. LG30 contained Al, Ca, O, P, and Si; LG26 also contained F and AH2 contained Na as well. To produce depleted surfaces they were immersed in acetic acid washed and dried at room temperature. Test samples (N=5) were immersed in KF solution (900ppm F). Control solutions without glass were used. Both were stored at 37C for 48h. F concentrations were measured using ISE with TISAB IV.

RESULTS

Uptake was Control-test expressed in micromol/g glass. RAW LG30=56 (16); LG26=35(17); AH2=17(31). DEPLETED LG30=285(41); LG26=431(42); AH2=286(50). The levels of F uptake by DEPLETED were comparable to those found with GICs formed with these glasses.

CONCLUSIONS

The glass particles of GIC, and particularly the depleted zones surrounding them, can account for an appreciable amount of the F uptake observed with cements but do not show the same relation between F content and F uptake previously observed with cements.

Ion processes in glass ionomer cements

Ion processes are involved in many aspects of glass-ionomer cements. The ions released from the glass take part in the formation of the cement matrix. Although this process has been investigated, particularly using model cement systems, no study provides a complete matrix composition. Combining results from different studies enables an approximate composition to be derived. The importance of Phosphorous in controlling ion release from the glass surface has been identified in a number of studies. The release of ions from the set cement into water (and other aqueous liquids) has been much reported, particularly for fluoride. Over most of the release periods studied (i.e. from >7 days up to 3 years), release of F ion is related to t1/2 indicating a diffusion-controlled process. Other ions, except possibly Na+ also show this relationship. The amount of cumulative F release whilst maintaining this relationship indicates that more F than is in the matrix is involved. Ion chromatography would probably elucidate the precise form of the ionic species released. Glass-ionomer cements take up ions from solutions in which they are immersed. The levels are much higher than required to produce as internal/external equilibrium. Studies using dynamic SIMS and XPS give some information on ion location and elemental association. It is suggested that ToF SIMS would elucidate these further. Re-release of uptaken ions can vary considerably for different cements and ion species. Surface disruption of glass ionomers is caused by both F ion and monofluorophosphate ion and occurs much more readily in F containing cements than in F free ones. The mechanism of this process has not been elucidated. Analysis of the ions released from the cement as disruption occurs should provide an indication of the site of attack.

The Action of Lubricants in Metal Cutting

One important way in which cutting lubricants operate is by reducing the degree of adhesion between the tool rake-face and the freshly formed chip surface. It is suggested that processes of molecular transport within a network of interfacial capillaries play a dominant role in controlling the effectiveness of cutting fluids, providing that they are capable of reaction with, or adsorption into, the metal surfaces.

The Photo-Activated Antibacterial Action of Toluidine Blue O in a Collagen Matrix and in Carious Dentine

The main aim of this study was to determine the susceptibility to photo-activated disinfection (PAD) of Streptococcus mutans when the organism was present in a collagen matrix--an environment similar to that which would exist within a carious tooth. In addition, the susceptibility to PAD of bacteria present in carious human teeth was also determined. Light was delivered to the collagen and teeth using a system comprising a 0.8-mm diameter isotropic tip emitting light at 633 +/- 2 nm. A single concentration of TBO (10 microg/ml) was used with both collagen and dentine. Two contact times, 30 and 180 s, were evaluated in intact collagen and additionally, for 180 s only, in collagen partially disrupted by shredding. The effect of energy doses from 1.8 to 14.4 J on the kills attained was assessed by determining the number of surviving viable bacteria. In carious dentine, two contact times, 30 and 60 s and one energy dose, 4.8 J, were used. Antibacterial effects were less than those obtained using planktonic suspensions with a maximum mean log reduction of 1.4 in shredded collagen and dentine. Increasing contact time increased the antibacterial effectiveness in both substrates although this was not always of statistical significance. Shredding the collagen resulted in significantly increased bacterial kills compared to those obtained in intact collagen for the 30-second contact time. The collagen matrix appeared to be a suitable model for carious dentine with advantages of availability and reproducibility. The results of this study have shown that PAD can achieve appreciable kills of oral bacteria, including S. mutans, when the organisms are embedded in a collagen gel or are present in carious teeth.

Glass ionomer cement: evidence pointing to fluorine release in the form of monofluorophosphate in addition to fluoride ion

The fluoride ion released from glass ionomer cements into water is reportedly, in part, complexed with other elements present in the cement. When measured using ion selective electrode potentiometry (ISE) a decomplexant TISAB IV (T) is used to convert all fluoride to F- ion which the ISE can detect. In this study, an additional decomplexing procedure (H) designed to hydrolyse fluorine covalently bonded to phosphorus in the monofluorophosphate (MFP) ion into F- was also used. The soluble products from three glass ionomers were analysed by both techniques (H & T). Five 1 x 10 mm discs were each immersed in 10 ml of de-ionised water. This was changed and 4 ml analysed by T and 4 ml by H at 1, 2, 3, 6, 10, 13, 17, 21, 24, 28, and 31 days. H was greater than T for 161 of the 165 pairs ( chi2=74.7, p=<0.001 ). The total cumulative F release H (in micromol/g cement) at 31 days for AH2 was 122.3, s.d. 30.8; LG26 44.0, s.d. 1.55; LG30 10.0, s.d. 3.15 as compared T results of 100.1, s.d. 31.1; 30.3, s.d. 1.92; 3.7, s.d. 1.36, respectively. In all three cases the H was significantly greater than T (matched pair 't' test with p=0.01 or less). H-T was show to have a very strong associative relationship with t1/2 (R2=0.98 or greater p<0.001 ). Evaluating the ratio of P:F in the cements in comparison with the ratio of additional F measured by H to that measured by T produced a relationship log[(H-T)/T]=0.28 x log[P/F]-0.45 with R2=0.999. It is concluded that glass ionomers release more fluorine than is detected by ISE using TISAB IV. If this F is in the form of MFP this may be released more completely into saliva than F as F-, release of which is substantially reduced by Ca2+, since calcium monofluorophosphate is more soluble than CaF2.

The effect of variable energy input from a novel light source on the photoactivated bactericidal action of toluidine blue O on Streptococcus Mutans

Although the combination of toluidine blue O (TBO) dye and laser light at a wavelength of 633 nm has a bactericidal effect, light from laboratory lasers can only be directed externally at a bacterial colony or suspension. In this study a novel delivery system guided the laser light to an 800-micrometer diameter spherical tip (an isotropic tip) from which light radiated producing a uniform sphere of light within the colony or suspension. The system was highly effective in killing TBO-treated Streptococcus mutans NCTC 10449 in stirred planktonic suspension, killing at least 10(9 )cfu/ml. Antibacterial action increased as the delivered energy dose increased. Energy doses of 1.8 J or more produced 100% kills and log reductions of 8-10 cfu/ml. Neither TBO dye nor light alone had a significant antibacterial effect under the experimental conditions used. The existence of a threshold energy, i.e. a minimum energy required before bactericidal action occurred, could not be demonstrated.

Primary cultures of prostate cells and their ability to activate carcinogens

Differences in the incidence of prostate cancer (CaP) amongst different migrant populations point to causative agents of dietary and/or environmental origin. Prostate tissues were obtained following transurethral resection of the prostate (TURP) or radical retropubic prostatectomy. After surgery, TURP-derived or tumour-adjacent tissue fragments were minced in warm PFMR-4A medium (37 degrees C) and suspensions pipetted into collagen-coated petri dishes. Non-adherent material was removed by washing with fresh medium after 12 h. Adhered cells subsequently reacted positively with monoclonal antibodies to prostate specific antigen (PSA). PSA was also detected in the medium. The genotoxicities of the chemical carcinogens 2-amino-1-methyl-6-phenylimidazo[4,5-b] pyridine (PhIP), its N-hydroxy metabolite (N-OH-PhIP) and benzo[a]pyrene (B[a]P) in adherent cell populations from different donors (n=8) were examined. Cells were treated in suspension for 30 min at 37 degrees C in the presence of the DNA repair inhibitors hydroxyurea (HU) and cytosine arabinoside (ara-C). DNA single-strand breaks were detected in cells by the alkaline single cell-gel electrophoresis ('Comet') assay and quantified by measuring comet tail length (CTL) in microm. All three carcinogens induced dose-related increases in CTLs (P<0.0001) in cells from four donors 24 h post-seeding. However, in cells from a further two donors the genotoxic effects of PhIP, N-OH-PhIP and B[a]P were much less apparent after 48 h than after 24 h in culture. After 96 h in culture, cells from these donors appeared to be resistant to the comet-forming activity of the compounds. However, B[a]P-DNA adducts were still measurable by (32)P-postlabelling for up to 14 days following a 24-h exposure to 50 microM B[a]P in adhered cells from another two donors. This study shows that primary cultures of cells derived from the prostate can activate members of two classes of chemical carcinogens. Further development may provide a robust model system in which to investigate the aetiology of CaP.

The effects of adding fluoride compounds to a fluoride-free glass ionomer cement on subsequent fluoride and sodium release

Studies have shown that ions in a glass ionomer matrix are 1-10% of the amounts present in the original glass. To measure more precisely the release from a cement matrix, known amounts of ions were added to LG30 glass which was fluoride and sodium-free. Cement without additions acted as the control. 1.4-1.6% of each of sodium, calcium and aluminum fluorides were added to three portions of control blend. The sodium and fluoride release into deionised water from five discs of each cements blend was measured for 8 months. This represented complete release for sodium but not for fluoride. Traces of fluoride and sodium in the glass produced low but measurable amounts indicating about a third of the fluoride and substantially all sodium present in LG30 was released. The addition of calcium fluoride had no significant effect on sodium or fluoride release and aluminium fluoride minimal effects. Adding sodium fluoride significantly enhanced release of both ions although fluoride release was less than from a glass containing 5% fluoride. Only small proportions of the additions, 2-5% of the fluoride and 13% of sodium, were released. Sodium and fluoride appeared to be released independently. For LG30 cements additives were poor at supplying extra ions.

Chronic renal failure in Jamaican children

In order to document the incidence, aetiology and outcome of chronic renal failure in Jamaican children, paediatric surgeons and hospital based paediatricians island-wide were contacted, and the nephrology records at the island's paediatric nephrology centres searched for data on children < 12-year-old with chronic renal failure diagnosed for the first time between January 1985 and December 2000. Thirty-four children were identified, 21 were male. The cumulative annual incidence of chronic renal failure was 3.2 per million children aged < 12 years. The incidence is likely underestimated, as some children may have been undiagnosed and/or not referred. Glomerulonephritis was the commonest cause of chronic renal failure (50%) followed by obstructive uropathy, reflux nephropathy, renal dysplasia and chronic pyelonephritis (41.2%). Five children (14.7%) had reflux nephropathy (post obstructive in four). Half the children were already in chronic renal failure at time of presentation. Mortality was 65%. In Jamaica, childhood chronic renal failure is due mainly to potentially treatable diseases. Local physicians should be more aware of potentially progressive renal diseases and their prevention. Earlier referral of difficult cases for nephrological consultation is recommended. A paediatric dialysis/transplant programme is needed.

Fractionated stereotactic radiotherapy for acoustic neuromas

BACKGROUND

When compared to radiosurgery, fractionated stereotactic radiotherapy (FSR) for acoustic neuroma (AN) offers escalation of tumor dose (Gy) and potential sparing of auditory and facial nerve functions.

METHOD

Over the past 6.5 years 287 consecutive patients have received FSR for AN. One hundred fifty patients have follow up greater than 1 year and comprise this report. Non-invasive, repeat-fixation mask allowed simulation via spiral CT. Differential collimation and beam weighting achieved conformality. Three distinct schedules for total dose and fractionation were used. For AN<3.0 cm diameter (mean volume 1.5+/-0.2 cc), > or =3.0 and < or =3.9 cm (mean volume 8.7+/-1.0 cc) and > or =4.0 cm (mean volume 28.3 cc (one case) doses of 5 Gy given in 5 consecutive daily fractions (25 Gy total) (131 patient), 10 fractions of 3 Gy (30 Gy total) (18 pts), or 20 fractions of 2 Gy (1 patient) were given. All treatments were prescribed to the 80% isodose and given via the dedicated 10 MeV accelerator.

FINDINGS

The percentage decreases in tumor size were 14+/-1 (range: 0-100), 15+/-3 (range 0-38) and 8 for the 25, 30 and 40 Gy regimens, respectively. No patient had growth of AN or developed facial weakness. Two patients developed transient decrease in facial sensation. Rates of hearing preservation were similar for both the larger and smaller tumors.

INTERPRETATION

Fractionated stereotactic radiotherapy may preserve normal function and control both small and large acoustic neuromas.

Evaluation of the Digene Hybrid Capture II Assay with the Rapid Capture System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae

Screening for chlamydial and gonococcal infection has been strongly recommended for all sexually active women under the age of 26. Advances in the ability to detect infection by nucleic acid detection techniques have improved access to screening methods in routine clinical practices. To meet the increasing demand for testing, a high-throughput system is desirable. We evaluated the performance of the Hybrid Capture 2 CT/GC (HC2) assay with the Digene Rapid Capture System (HC2-RCS). The results of HC2-RCS for endocervical samples from 330 women were compared to those of culture and the COBAS Amplicor PCR. For detection of chlamydial infection, HC2-RCS had a sensitivity and a specificity similar to those of PCR (P > 0.5) and an improved sensitivity compared to that of culture (P = 0.007). For identification of gonococcal infections, all assays performed similarly (P > 0.5). The performance of HC2-RCS was also compared to that of the manual HC2 format (HC2-M) with these samples and with 911 endocervical samples collected previously. The performance of HC2-RCS was equivalent to that of HC2-M; the overall concordance rates for the detection of chlamydia and gonorrhea were 99.7% (kappa = 0.97) and 99.8% (kappa = 0.97), respectively. When the HC2 assay was performed with a semiautomated system application designed for high throughput, it demonstrated high sensitivity and a high specificity for detection of both Chlamydia trachomatis and Neisseria gonorrhoeae.

C-reactive protein is elevated in symptomatic compared with asymptomatic patients with carotid artery disease

OBJECTIVES

to investigate the level of inflammatory markers between symptomatic and asymptomatic carotid stenosis patients.

DESIGN

cross-sectional study.

MATERIALS AND METHODS

a prospective study of 137 consecutive patients, admitted electively for carotid endarterectomy during 1997-2000, was conducted. 125 patients had cerebrovascular symptoms: either stroke (neurological deficit >24 h), Transient ischaemic attack (neurological deficit<24 h) or amaurosis fugax. Twelve patients were asymptomatic. A medical history and a fasting venous blood sample were taken from each patient around 6 weeks before surgery. The plasma concentrations of cholesterol and of inflammatory markers; (high sensitivity C-reactive protein (hs-CRP), sICAM-1, sVCAM-1, sE-selectin) were determined.

RESULTS

the concentration of hs-CRP in the symptomatic group (3.9 mg/L) was significantly higher than in the asymptomatic group (2.1 mg/L; p = 0.04). These concentrations were within normal range (<10 mg/L). sICAM-1, sVCAM-1, sE-selectin and total cholesterol concentrations were not different between the two groups.

CONCLUSION

plasma hs-CRP was elevated in symptomatic compared to asymptomatic patients with carotid artery disease. High sensitivity C-reactive protein has been shown to be of prognostic value in a number of cardiovascular conditions and this study suggests it may be of value to identify patient at high risk of developing neurological deficits.

The glass ionomer cement: the sources of soluble fluoride

This study aimed to investigate certain processes of fluoride production which enable glass ionomer cements to leach fluoride. Two fluoroaluminosilicate glasses, G338 and LG26 were used. The free and total fluoride which could be dissolved from the glasses was measured, before and after acetic acid washing. Both glasses contained appreciable amounts of soluble fluoride prior to any acid treatment. The latter process reduced the amount to some 75% of the original levels. Replacing the customary polymeric acid with propionic acid produced a cement which disintegrated in water allowing the amount of fluoride generated by the cement forming process to be measured. Cement production increased soluble fluoride by a further 3%. Both glasses behaved similarly when undergoing the various processes. G338 produced significantly greater quantities of fluoride, of the order of 10, compared with LG26 although containing only three times the amount of fluoride in the glass formula. A substantial proportion, over half, of the total fluoride was complexed especially after contact with cement and when G338 was used. During the period of the experiment, 21 days, total fluoride release did not seem to depend on the square root of time.