Pre-oxygenation in healthy volunteers: a comparison of the supine and 45° seated positions*

Pre-oxygenation in the seated (sitting) position has been associated with better oxygenation. This randomised, cross over study compared oxygenation in the supine position with that in the 45° seated position in 40 young, healthy volunteers. Oxygen was administered through a circle system and tight fitting facemask. Transcutaneous P(O)₂ levels were recorded at 10-s intervals from two measurement points during 4 min of oxygenation in the two positions. The mean (SD) values of 12 measurements taken between the third and fourth minute were recorded. There was no difference in the increase in tissue oxygenation when comparing the supine and seated positions (32.7 (7.3) vs 32.6 (6.7) kPa, respectively). We conclude that there is no evidence that pre-oxygenation in the 45° seated position improves tissue oxygenation in young healthy volunteers compared with the supine position.

Urine catecholamine levels as diagnostic markers for neuroblastoma in a defined population: implications for ophthalmic practice

PURPOSE

although elevated urinary catecholamine levels have been reported in 90-95% of patients with neuroblastoma, more recent studies of pediatric Horner syndrome caused by an underling neuroblastoma have reported normal values at presentation. The purpose of this population-based study is to report the percentage of cases of neuroblastoma with elevated urinary catecholamine levels at presentation and to suggest a recommended work-up for cases of idiopathic pediatric Horner syndrome.

METHODS

the medical records of all pediatric (<19 years) residents of Olmsted County, Minnesota diagnosed with neuroblastoma from 1 January 1969 through 31 December 2008 were retrospectively reviewed.

RESULTS

a total of 14 patients <19 years of age were diagnosed with neuroblastoma as residents of Olmsted County, Minnesota, during the 40-year study period. A total of 10 (71%) of the 14 cases manifested elevated urinary catecholamine metabolites at the initial presentation. Urinary vanillylmandelic acid (VMA) levels were greater than twice the upper limit of normal in eight (57%) of 14 cases, whereas homovanillic acid (HVA) levels were greater than two times the upper limit of normal in 10 (71%) of the 14 cases. Three (75%) of the four cases without significantly elevated urinary VMA or HVA levels were diagnosed with stage IV disease, whereas one (25%) had stage II neuroblastoma.

CONCLUSION

urinary catecholamine levels were significantly elevated at presentation in 10 (71%) of the 14 neuroblastoma cases during the 40-year study period, suggesting that greater emphasis be placed on performing a thorough physical examination and obtaining warranted imaging studies in cases of idiopathic pediatric Horner syndrome.

Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?

BACKGROUND

Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy.

METHODS

The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery).

RESULTS

There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8).

CONCLUSION

Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.

Circulating IgG autoanti-IgE antibodies in atopic patients block the binding of IgE to its low affinity receptor (CD23)

Aims-To investigate the ability of circulating IgG autoanti-IgE antibodies from atopic rhinitis patients to block the binding of IgE to its low affinity receptor (FcepsilonRII), also termed CD23.Methods-This involved the use of a well validated flow cytometric method to detect inhibition of FITC labelled IgE binding to human B cells expressing CD23 (RPMI 8866 cell line).Results-Taking inhibition values greater than 20% as being significant, 15 out of 20 IgG anti-IgE containing sera inhibited the binding of IgE-FITC to the RPMI 8866 cells. The inhibitory effect was recoverable in the IgG fraction of serum, but was not related to the titre of either IgG1 anti-IgE or IgG4 anti-IgE, thus suggesting that it might be related to epitope specificity. No such inhibition was demonstrable with rheumatoid sera containing autoanti-IgG (that is, rheumatoid factor), but lacking autoanti-IgE.Conclusions-The capacity of anti-IgE to block the binding of IgE to CD23 has important implications, particularly in terms of upregulation of IgE synthesis and the consequent perpetuation of the inflammatory response.

Circulating human IgG autoanti-IgE antibodies in asthma patients block the binding of IgE to its high affinity receptor

Aims-To investigate the ability of circulating human IgG autoanti-IgE antibodies from asthma patients to block the binding of IgE to the alpha chain of the high affinity receptor (FcepsilonRI).Methods-This involved the use of a well validated flow cytometric method to detect inhibition of FITC labelled IgE binding to a fibroblast cell line (CHK1E1) transfected with the alpha chain of FcepsilonRI.Results-IgG autoanti-IgE-containing sera blocked the binding of IgE-FITC to the CHK1E1 cells. No such inhibition was demonstrable with rheumatoid sera containing autoanti-IgG (that is, rheumatoid factor) but lacking autoanti-IgE. Percentage inhibition (up to 50%) of IgE binding to the CHK1E1 cells was directly related to the titre of IgG1, but not IgG4, autoanti-IgE in the sera tested (correlation coefficient 0.66, probability 0.003).Conclusions-The capacity of anti-IgE to block the binding of IgE to FcepsilonRI has important clinical implications, particularly in terms of downregulation of allergic reactions.

The role of ultrasound-indicated cerclage in triplets

OBJECTIVES

Preterm delivery is the leading cause of major perinatal morbidity and mortality associated with triplet pregnancies. The objective of this study was to evaluate the efficacy of ultrasound-indicated cervical cerclage in triplet pregnancies that are diagnosed with cervical shortening on biweekly transvaginal sonography (TVS).

METHODS

A retrospective review of all triplets who were followed with biweekly TVS for measurement of cervical length was conducted. Cervical shortening was defined as cervical length <or= 2.5 cm. Outcomes of interest included cervical cerclage placement, gestational age at delivery and birth weight.

RESULTS

In our population of 24 triplet pregnancies, 13 had cervical shortening. Of these, 54% underwent cervical cerclage at a mean gestational age of 20 weeks. Overall, patients without cervical shortening delivered on average 17 days later than those with cervical shortening (32 + 2 weeks vs. 29 + 6 weeks, P = 0.034). Moreover, infants of patients without cervical shortening weighed on average 456 g more at birth than did those with cervical shortening (1751 g vs. 1295 g, P = 0.039) and had a lower percentage of very low birth weight infants (30.3% vs. 69.2%, P = 0.002). Within the subset of patients with cervical shortening, there was no statistical difference in any of the outcomes studied between patients who underwent cervical cerclage and those who did not.

CONCLUSIONS

Triplet pregnancies complicated by cervical shortening diagnosed on biweekly TVS surveillance do not appear to benefit from placement of cervical cerclage, based on assessment of gestational age at delivery, birth weight and incidence of very low birth weight infants.

[Endocarditis due to Aggregatibacter (formerly: Actinobacillus) actinomycetemcomitans, a bacterium that grows in characteristic star-shaped colonies]

A 72-year-old man, having had an artificial valve for almost 20 years now, presented with tiredness that had persisted for several weeks and reported weight loss of 5 kg. In more recent days he experienced fever and cold shivers, and an associated dry cough. Bearing in mind the potential for endocarditis, blood cultures were grown. In this, we identified a small, Gram-negative rod with a small, smooth, raised colony that grew slowly. We considered a micro-organism from the 'HACEK group', which is a group of micro-organisms including Haemophilus aphrophilus, Haemophilus paraphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae and Aggregatibacter (formerly: Actinobacillus) actinomycetemcomitans. More careful observation revealed that the bacteria formed star-shaped colonies, proving that A. actinomycetemcomitans was the cause of this non-acute endocarditis. The patient received antibiotic treatment. Because non-acute endocarditis is often caused by hidden abnormalities in the mouth or teeth and A. actinomycetemcomitans plays an important role in severe cases of peridontitis, a dental surgeon was consulted. The dental surgeon diagnosed multifocal peridontitis and treated the patient, who was able to leave the hospital after 6 weeks of antibiotic treatment.

The triggering of astrocytic calcium waves by NMDA-induced neuronal activation

It has been well established that astrocytes possess functional receptors for the excitatory neurotransmitter glutamate and respond to physiological concentrations of this substance with oscillations in cytoplasmic Ca2+ concentrations and spatially propagating Ca2+ waves. These findings strongly suggest that glutamate released during synaptic transmission triggers such phenomena within the perisynaptic astrocyte in situ. We test this hypothesis in two preparations, the organotypic hippocampal slice and hippocampal neuron-astrocyte co-cultures, using the Ca2+ indicator fluo-3 and confocal laser microscopy. An agonist for the N-methyl-D-aspartate (NMDA)-preferring glutamate receptor is employed to stimulate neuronal populations specifically, leaving the astrocytic population unaffected as these cells appear to lack this glutamate receptor subtype. Such pharmacological stimulation initially elicits large Ca2+ transients within the neuronal populations, followed by Ca2+ spikes in surrounding astrocytes, presumably as the result of neuronal glutamate release. During continuous neuronal stimulation, the astrocyte's Ca2+ response becomes oscillatory, with a period averaging 33 s and ranging from 15 to 50 s at 21 degrees C. These findings establish another form of communication within the brain, that between neurons and astrocytes, which perhaps acts to couple astrocytic regulatory responses to neuronal activity.

Home safety education and provision of safety equipment for injury prevention

BACKGROUND

In industrialised countries injuries are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home, but there is little meta-analytic evidence that child home safety interventions improve a range of safety practices or reduce injury rates and little evidence on their effect by social group.

OBJECTIVES

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment in increasing home safety practices or reducing child injury rates and whether the effect varied by social group.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, DARE, ASSIA, Psychinfo and Web of Science, plus a range of relevant web sites, conference proceedings and bibliographies. We contacted authors of included studies and surveyed a range of organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, which reported safety practices, possession of safety equipment or injury.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneoulsy combined in meta-regressions by social and demographic variables.

MAIN RESULTS

Eighty studies were included; 37 of which were included in at least one meta-analysis. Twenty-three (62%) were RCTs and 12 (32%) included in the meta-analysis provided IPD. Home safety education was effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.35, 95% CI 1.01 to 180), functional smoke alarms (OR 1.85, 95% CI 1.24 to 2.75), storing medicines (OR 1.58, 95% CI 1.18 to 2.13) and cleaning products (OR 1.63, 95% CI 1.22 to 2.17) out of reach, syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) and poison control centre numbers accessible (OR 3.66, 95% CI 1.84 to 7.27), fitted stair gates (1.26, 95% CI 1.05 to 1.51), socket covers on unused sockets (OR 3.73, 95% CI 1.48 to 9.39) and storing sharp objects out of reach (OR 1.52, 95% CI 1.01 to 2.29). There was a lack of evidence that interventions reduced rates of thermal injuries, poisoning or a range of injuries. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS

Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment is effective in increasing a range of safety practices. There is a lack of evidence regarding its impact on child injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment was less effective in those at greater risk of injury.

Phosphodiesterase 7A: a new therapeutic target for alleviating chronic inflammation?

Over the last fifteen years there has been much excitement in the idea that targeting phosphodiesterase (PDE) 4 with small molecule inhibitors could lead to the discovery of novel, steroid-sparing compounds with utility in treating a multitude of diseases associated with chronic inflammation. However, dose-limiting side effects, of which nausea and vomiting are the most common are worrisome, have hampered their clinical development. Indeed, a fundamental obstacle that still is to be overcome by the pharmaceutical industry is to make compounds that dissociate beneficial from the adverse events. Unfortunately, both of these activities of PDE4 inhibitors represents an extension of their pharmacology and improving the therapeutic ratio has proved to be a major challenge. Several strategies have been considered, with some degree of success, but compounds with an optimal pharmacophore still have not been reported. An alternative approach to targeting PDE4 is to inhibit other cAMP PDE families that are also expressed in immune and pro-inflammatory cells in the hope that the beneficial activity can be retained at the expense of side effects. One such candidate is PDE7A. In this article we review the literature on PDE7A and explore the possibility that selective small molecule inhibitors of this enzyme family could provide a novel approach to alleviate the inflammation that is associated with many inflammatory diseases including asthma, chronic obstructive pulmonary disease, atopic dermatitis, psoriasis, lupus, rheumatoid arthritis and multiple sclerosis.

Protective immune responses induced by different recombinant vaccine regimes to Rift Valley fever

The glycoprotein (GP) and nucleocapsid (NC) genes of Rift Valley fever virus (RVFV) were expressed in different expression systems and were evaluated for their ability to protect mice from virulent challenge using a prime-boost regime. Mice vaccinated with a lumpy skin disease virus-vectored recombinant vaccine (rLSDV-RVFV) expressing the two RVFV glycoproteins (G1 and G2) developed neutralising antibodies and were fully protected when challenged, as were those vaccinated with a crude extract of truncated G2 glycoprotein (tG2). By contrast mice vaccinated with a DNA vaccine expressing G1 and G2 did not sero-convert with only 20% of them surviving challenge. Mice vaccinated with the DNA vaccine and boosted with rLSDV-RVFV also failed to sero-convert but 40% survived challenge. Surprisingly, although none of the mice immunised with the purified NC protein sero-converted, 60% of them survived virulent challenge. The rLSDV-RVFV construct was then further evaluated in sheep for its dual protective abilities against RVFV and sheeppox virus (SPV). Vaccinated sheep sero-converted for both viruses and were protected against RVFV challenge, however, neither the immunised or negative control animals showed any significant reactions to the virulent SPV challenge.

Inhibitory effect of p38 mitogen-activated protein kinase inhibitors on cytokine release from human macrophages

BACKGROUND AND PURPOSE

Macrophages release cytokines that may contribute to pulmonary inflammation in conditions such as chronic obstructive pulmonary disease. Thus, inhibition of macrophage cytokine production may have therapeutic benefit. p38 MAPK may regulate cytokine production, therefore, the effect of two p38 MAPK inhibitors, SB239063 and SD-282, on the release of TNF-alpha, GM-CSF and IL-8 from human macrophages was investigated.

EXPERIMENTAL APPROACH

Cytokine release was measured by ELISA. Immunoblots and mRNA expression studies were performed to confirm p38 MAPK isoform expression and activity. Macrophages were isolated from lung tissue of current smokers, ex-smokers and emphysema patients and exposed to lipopolysaccharide. These cells then released cytokines in a concentration-dependent manner.

KEY RESULTS

SB239063 only inhibited TNF-alpha release (EC50 0.3 +/- 0.1 microM). Disease status had no effect on the efficacy of SB239063. SD-282 inhibited both TNF-alpha and GM-CSF release from macrophages (EC50 6.1 +/- 1.4 nM and 1.8 +/- 0.6 microM respectively) but had no effect on IL-8 release. In contrast, both inhibitors suppressed cytokine production in monocytes.

CONCLUSIONS AND IMPLICATIONS

The differential effects of p38 MAPK inhibitors between macrophages and monocytes could not be explained by differences in p38 MAPK isoform expression or activity. However, the stability of TNF-alpha mRNA was significantly increased in macrophages compared to monocytes. These data suggest a differential involvement for p38 MAPK in macrophage cytokine production compared with monocytes. These effects are not due to lack of p38 activation or p38alpha expression in macrophages but may reflect differential effects on the stability of cytokine mRNA.

Lateral medullary syndrome caused by penetrating head injury

Herein, we report a rare case of a patient surviving penetrating trauma to the brainstem. Low velocity penetrating head injuries may be occult and are associated with a high incidence of vascular injury.

Environmental and dietary risk factors for infantile atopic eczema among a Slovak birth cohort

Infantile atopic eczema (AE) is a risk marker for future asthma. This study assesses the contribution of modifiable exposures to infantile AE. If modifiable exposures contribute substantially to infantile AE, its prevention might be a sensible approach to asthma prevention. Pregnant women (n = 1978) were systematically recruited from maternity hospitals of the Slovak Republic; their birthed cohort of 1990 children were prospectively followed for 1 yr. Children's exposures to selected environmental and dietary factors were assessed via maternal questionnaires administered at delivery and 1 yr of age. A child was considered to have AE, based on physical examination (SCORAD index >2) or mother's report of a previous physician diagnosis. Multivariate logistic regression was used to calculate adjusted odds ratios and percent total regression scores (TRS) for each variable. At 1 yr of age 1326 (67%) of the children remained in the cohort and 207 (15.6%) developed AE. Various modifiable environmental and dietary exposures increased the likelihood of AE (ownership of cats; consumption of infant formula, eggs, and fish) while others decreased the likelihood of AE (ownership of livestock; exclusive breast feeding for > or =4 months). Overall, modifiable exposures contributed less to the TRS than did non-modifiable exposures (38% vs. 62%, respectively). The modifiable exposure category that contributed most to the TRS was infant feeding practices (27.5% TRS). Modifiable exposures -- especially those related to infant feeding practices -- significantly contribute to infantile AE, although modifiable factors contribute less overall than do non-modifiable exposures.

EEG abnormalities in frontotemporal lobar degeneration

The EEG appearances in patients with frontotemporal lobar degeneration (FTLD) were compared with those in patients with Alzheimer disease (AD). EEG abnormalities were found in 61% of FTLD patients, with the degree of EEG abnormality increasing with dementia severity. There was no significant difference in the severity of EEG abnormality between the FTLD and AD patient groups. These data suggest a need for reappraisal of the role of the EEG in the diagnostic differentiation of FTLD from AD.

Resonance Raman scattering of cytochrome P450 BM3 and effect of imidazole inhibitors

Resonance Raman scattering from cytochrome P450 BM3 is obtained with a Raman microprobe using 406-nm excitation with an accumulation time of a few seconds. The small sample size and rapid measurement time make the routine characterization of P450 systems by resonance Raman spectroscopy easier. Addition of imidazole and imidazole derivatives as inhibitors causes the appearance of additional peaks due to vinyl modes, increases the relative intensity of symmetric modes that would be A(1g) in D(4h) symmetry, and causes a large drop in the intensity of nu(11). This information indicates that the ligation of imidazoles to the heme iron causes the alignment of the vinyl modes with the plane of the heme ring and reduces the out of plane distortion of the ring. The effect of both inhibitors is similar but there is a subtle difference in the extent of the reduction in the intensity of nu(11), which suggests that steric effects within the pocket are having some effect.

C-reactive protein concentration and concentrations of blood vitamins, carotenoids, and selenium among United States adults

OBJECTIVE

To examine the relationships between circulating concentrations of C-reactive protein and concentrations of retinol, retinyl esters, vitamin C, vitamin E, carotenoids, and selenium.

DESIGN

Cross-sectional study using National Health and Nutrition Examination Survey III (1988-1994) data.

SETTING

United States population.

SUBJECTS

Up to 14 519 US noninstitutionalized civilian men and women aged > or=20 y.

RESULTS

C-reactive protein concentration (dichotomized at the sex-specific 85th percentile) was inversely and significantly associated with concentrations of retinol, retinyl esters, vitamin C, alpha-carotene, beta-carotene, cryptoxanthin, lutein/zeaxanthin, lycopene, and selenium after adjustment for age, sex, race or ethnicity, education, cotinine concentration, body mass index, leisure-time physical activity, and aspirin use.

CONCLUSIONS

These results suggest that the inflammatory process, through the production of reactive oxygen species, may deplete stores of antioxidants. Whether increased consumption of foods rich in antioxidants or supplementation with antioxidants can provide health benefits to people characterized by elevated C-reactive protein concentrations may be worthy of further study.

Brain imaging: how stable are synaptic connections?

Cortical circuits can undergo experience-dependent remodeling, while retaining the capacity for long-term information storage. The stability of individual synaptic connections is fundamental to both processes, but poorly understood; two studies using new in vivo imaging techniques have finally shed some light on this important issue.

Indirect enzyme-linked immunosorbent assay for the detection of antibody against Rift Valley fever virus in domestic and wild ruminant sera

An indirect enzyme-linked immunosorbent assay (I-ELISA) for the detection of specific IgG immunoglobulins against Rift Valley fever virus (RVFV) was validated in-house. A total of 3055 sera from sheep (n = 1159), goats (n = 636), cattle (n = 203), African buffalo (n = 928), and other wild ruminants (n = 129), including eland, kudu, and black wildebeest, was used. Sera from domestic ruminants were collected in West (n = 10), South (n = 1654) and East Africa (n = 334), and sera from wild ruminants (n = 1064) were collected in South Africa. In addition, 136 sera from eight experimentally RVFV-infected sheep, taken during a period of 28 days post infection (dpi), were used to study the kinetics of RVFV antibody production. Field sera were tested by the serum neutralization (VN) test and experimental sera by VN and haemagglutination-inhibition (HI) test. Based on VN test results, negative sera were regarded as reference controls from RVFV-free, and positive sera were regarded as reference controls from RVFV-infected subpopulations of animals. ELISA data were expressed as the percentage positivity (PP) of an internal high positive control. The two-graph receiver operating characteristics approach was used for the selection and optimization of I-ELISA cut-offs including the misclassification costs term and Youden index (J). In addition, cut-off values were determined as the mean plus two-fold standard deviation of the result observed with the RVFV-free subpopulations. Established optimal cut-offs were different for each of the data sets analyzed, and ranged from 1.65 PP (buffalo) to 9.1 PP (goats). At the cut-off giving the highest estimate of combined measure of diagnostic accuracy (highest J value), the I-ELISA test parameters were determined as follows: (1) Diagnostic sensitivity (%): cattle--84.31, buffalo--94.44, sheep--98.91, goats--99.18. (2) Diagnostic specificity (%): cattle--99.34, buffalo--98.28, sheep--99.16, goats--99.23 and other game ruminants--99.26. In the group of RVFV-experimentally infected sheep, seroconversion In all individuals was detected by VN on 4-6 dpi, by HI on 5-7 dpi, and by I-ELISA on 6-7 dpi. All tests showed the same kinetic pattern of immunological response. Antibody levels were low for a very short period before increasing to high titres, after which it was easily detectable by all tests. Compared to traditional tests, the lower sensitivity of I-ELISA in the detection of the earliest stage of immunological response may be practically insignificant, particularily when this assay is used in population-based, disease-surveillance programmes. The high sensitivity and specificity of I-ELISA established in this study, especially for the statistically more representative subpopulations of animals tested, seem to support this prediction. Test parameters determined in this study should, however, be regarded as in-house diagnostic decision limits, for which further updating is recommended, particularly for specimens from other countries, and preferably by applying a standardized method for sampling of new subpopulations of animals to be targeted by the assay.

Lower abdominal pressure versus external bladder stimulation to aid bladder emptying in multiple sclerosis: a randomized controlled study

OBJECTIVE

To investigate the change in post-void residual bladder volumes (PVR) with 'abdominal vibration' using a percutaneous bladder stimulator in multiple sclerosis (MS) patients compared with either 'no treatment' or 'abdominal pressure'.

DESIGN

Randomized controlled cross-over study.

SETTING

Regional neurorehabilitation clinics.

SUBJECTS

Twenty-eight MS patients with urinary symptoms and PVR > 100 ml. Twelve patients had urinary incontinence.

METHODS

MS patients with voiding dysfunction and elevated PVR of 100-500 ml on BVI-3000 Ultrasound Scanner were randomized to either 'abdominal pressure' or 'vibration' by a portable, percutaneous, vibrating device (Queen Square Bladder Stimulator; Malem Medical) or to 'no treatment'. PVR was assessed at the end of each two-week phase.

OUTCOME MEASURE

PVR reduction by greater than 100 ml.

RESULTS

The 28 patients ranged in age from 29 to 71 years with a mean age of 49 years and a mean duration of MS of 12 years (range 1-37 years). The PVR decreased from 231 (SD 119) ml during no treatment to 191 (SD 132) ml with abdominal pressure (p = 0.242). Using suprapubic vibration the PVR reduced further to 126 (SD 121) ml, which was highly significant (p = 0.002) compared with no treatment. The difference between abdominal pressure and vibration just failed to reach significance (p = 0.059). There was no significant reduction in either the frequency of micturition or episodes of incontinence. The device was well-tolerated by patients.

CONCLUSION

Abdominal vibration is an effective method of reducing PVR in MS patients and appears more effective than abdominal pressure alone.

Sputum T lymphocytes in asthma, COPD and healthy subjects have the phenotype of activated intraepithelial T cells (CD69+ CD103+)

BACKGROUND

T cells of intraepithelial phenotype have previously been detected in bronchoalveolar lavage (BAL) fluid in a range of lung diseases; these cells express the adhesion molecule alpha(E)beta(7) integrin, CD103, the ligand for epithelial cell E-cadherin. In subjects with asthma CD4+ lymphocytes are the predominant T cell subtype found in bronchial biopsy specimens and in BAL fluid, whereas CD8+ lymphocytes have been shown to predominate in subjects with chronic obstructive pulmonary disease (COPD). The aim of this study was to analyse the expression of CD103, activation markers (CD25 and CD69), and chemokine receptors (CXCR3, CCR5 and CCR3) on CD4+ and CD8+ lymphocytes from sputum and peripheral blood of subjects with asthma, COPD, and healthy controls.

METHODS

T cell surface markers were assessed by immunofluorescence labelling and flow cytometry of gated lymphocytes among CD45+ leucocytes in sputum cell suspensions.

RESULTS

Sputum lymphocytes expressed higher levels of CD103 and CD69 than blood lymphocytes in all subject groups, with CD103 expressed at higher levels on CD8+ than on CD4+ cells. There were no detectable differences in numbers of CD4+ and CD8+ T cells between subjects with asthma, COPD and controls. The percentage of sputum lymphocytes expressing CXCR3 was lower in subjects with asthma or COPD than in healthy controls; CCR3 was not detectable on sputum or blood lymphocytes.

CONCLUSIONS

Sputum T lymphocytes are predominantly of activated intraepithelial phenotype (CD103+ CD69+), and normal numbers of CD4+ and CD8+ T cell populations are found in the sputum of patients with asthma and COPD.

Dexamethasone inhibits maturation, cytokine production and Fc epsilon RI expression of human cord blood-derived mast cells

BACKGROUND

Mast cells are responsible for eliciting the early phase and for contributing to the development of the late phase of allergic reactions, through the release of cytokines and other inflammatory mediators.

OBJECTIVE

To assess whether the glucocorticoid dexamethasone has a direct effect on mast cell progenitor maturation and on mature cord blood-derived mast cell properties.

METHODS

Mast cells were obtained by culturing human umbilical cord blood mononuclear cells with stem cell factor, IL-6 and prostaglandin E2. Mast cell numbers were assessed by Toluidine Blue staining and immunocytochemistry of tryptase positive cells. The expression of Fc epsilon RI, CD49d and c-kit was assessed by flow cytometry. Histamine release was determined by a radioenzymatic assay. Cys-LT, GM-CSF and TNF-alpha production and release were determined by ELISA.

RESULTS

Dexamethasone (10(-6) M-10(-9) M) time- and dose-dependently inhibited the maturation of the mast cell progenitors. Dexamethasone did not affect the basal expression of Fc epsilon RI, CD49d and c-kit, but it inhibited the IgE-dependent enhanced expression of Fc epsilon RI. Dexamethasone (10(-6) M-10(-9) M) had no significant effect on Fc epsilon RI-dependent histamine release or the synthesis and release of Cys-LT from the mature mast cells. However, pre-incubation of the mast cell cultures with dexamethasone for 1 h, prior to cross-linking of Fc epsilon RI, dose-dependently inhibited the production and secretion of both GM-CSF and TNF-alpha.

CONCLUSIONS

From these in vitro data we propose that glucocorticosteroids are effective drugs in the management of allergic inflammation due to their capacity to inhibit mast cell development, IgE-dependent Fc epsilon RI expression and mast cell production of GM-CSF and TNF-alpha.

Measurement of absolute cross sections for excitation of the 3s(2)3p(5) 2P(o)(3/2)- 3s(2)3p(5) 2P(o)(1/2) fine-structure transition in Fe9+

Experimental cross sections are reported for the 3s(2)3p(5) 2P(o)(3/2)- 3s(2)3p(5) 2P(o)(1/2) transition in Fe9+ located at 1.945 eV. The center-of-mass interaction energies are in the range of 1.72 eV (below threshold) through threshold, to 5.6 eV (2.9 x threshold). Data are compared with results of a 49-state Breit-Pauli R-matrix theory. The experiment detects structures at 3.5 and 4.6 eV corresponding to enhancement of the direct excitation via many narrow, closely spaced resonances about these energies calculated by the theory. Iron is present in practically every astrophysical object, as well as being an impurity in fusion plasmas. Present data are the first electron-energy-loss measurements on a highly charged iron ion.