A complex network of factors with overlapping affinities represses splicing through intronic elements

To better understand splicing regulation, we used a cell-based screen to identify ten diverse motifs that inhibit splicing from intron. Each motif was validated in another human cell type and gene context, and their presence correlated with in vivo splicing changes. All motifs exhibited exonic splicing enhancer or silencer activity, and grouping these motifs based on their distributions yielded clusters with distinct patterns of context-dependent activity. Candidate regulatory factors associated with each motif were identified, recovering 24 known and novel splicing regulators. Specific domains in selected factors were sufficient to confer ISS activity. Many factors bound multiple distinct motifs with similar affinity, and all motifs were recognized by multiple factors, revealing a complex, overlapping network of protein:RNA interactions. This arrangement enables individual cis-element to function differently in distinct cellular contexts depending on the spectrum of regulatory factors present.

Paclitaxel and CYC3, an aurora kinase A inhibitor, synergise in pancreatic cancer cells but not bone marrow precursor cells

BACKGROUND

Amplification of aurora kinase A (AK-A) overrides the mitotic spindle assembly checkpoint, inducing resistance to taxanes. RNA interference targeting AK-A in human pancreatic cancer cell lines enhanced taxane chemosensitivity. In this study, a novel AK-A inhibitor, CYC3, was investigated in pancreatic cancer cell lines, in combination with paclitaxel.

METHODS

Western blot, flow cytometry and immunostaining were used to investigate the specificity of CYC3. Sulforhodamine B staining, time-lapse microscopy and colony-formation assays were employed to evaluate the cytotoxic effect of CYC3 and paclitaxel. Human colony-forming unit of granulocyte and macrophage (CFU-GM) cells were used to compare the effect in tumour and normal tissue.

RESULTS

CYC3 was shown to be a specific AK-A inhibitor. Three nanomolar paclitaxel (growth inhibition 50% (GI(50)) 3 nM in PANC-1, 5.1 nM in MIA PaCa-2) in combination with 1 μM CYC3 (GI(50) 1.1 μM in MIA PaCa2 and 2 μM in PANC-1) was synergistic in inhibiting pancreatic cell growth and causing mitotic arrest, achieving similar effects to 10-fold higher concentrations of paclitaxel (30 nM). In CFU-GM cells, the effect of the combination was simply additive, displaying significantly less myelotoxicity compared with high concentrations of paclitaxel (30 nM; 60-70% vs 100% inhibition).

CONCLUSION

The combination of lower doses of paclitaxel and CYC3 merits further investigation with the potential for an improved therapeutic index in vivo.

A 5-item prediction rule to identify severe renal dysfunction in patients with acute stroke

BACKGROUND AND PURPOSE

Although patients with severe renal dysfunction who receive iodinated contrast are at high risk of CIN, contrast-enhanced CT scans are often obtained without prior knowledge of kidney function in patients with acute stroke. We aimed to develop a tool to identify patients with acute stroke at a high risk of CIN in the absence of a recent GFR.

MATERIALS AND METHODS

We used the RCSN (9872 patients) and OSA (2544 patients) for our derivation and validation cohort, respectively. A multivariable logistic regression model was performed to develop a predictive tool to identify severe renal dysfunction (defined as a GFR < 30 mL/min/1.73 m(2)).

RESULTS

The overall prevalence of severe renal dysfunction was 4.9% and 5.2% in the derivation and validation cohort, respectively. The prediction rule was designed as follows: (age in years) + (5 points for women) + (5 points for history of diabetes mellitus) + (15 points for preadmission insulin use) + (10 points for history of hypertension). The prevalence of severe renal dysfunction is negligible in patients with a total score of ≤70 (≤0.005%-0.7%) but increases with higher Renal Risk Scores (eg, scores 71-80: 2.1%-2.2%; scores 91-100: 6.6%-7.1%; scores 111-120: 15.9%-28.1%).

CONCLUSIONS

The Renal Risk Score is a validated tool that helps clinicians select which patients with stroke can safely proceed to contrast-enhanced brain imaging without waiting for laboratory evidence of good renal function.

Incompatible ABO-plasma exchange and its impact on patient selection in paediatric cardiac transplantation

OBJECTIVES

A decade ago, the first series of ABO-incompatible heart transplants was published, with surprising and extremely promising results; drastically reduced waiting list mortalities of infants listed for heart transplantation. Essential to the procedure was the process of plasma exchange transfusion, required to reduce isohaemagglutinin titres and facilitate the crossing of ABO blood group boundaries. Since then, Great Ormond Street Hospital, London has offered ABO-incompatible heart transplants to infants who potentially would die waiting for a suitable organ. We report the results of a decade of evolving plasma exchange experience and its impact upon patient selection.

METHODS

A retrospective analysis was undertaken of all elective ABO-incompatible heart transplants at Great Ormond Street Children's Hospital from January 2001 until January 2011. Data were sought on underlying conditions and demographics of the patients, the isohaemagglutinin titre before and after plasma exchange and survival figures to date.

RESULTS

Twenty-one patients underwent ABO-incompatible heart transplantation, ranging from 3 to 44 months, with preoperative isohaemagglutinin titres ranging from 0 to 1:32. All patients underwent a "3 times" plasma exchange before transplantation, requiring exchange volumes of up to 3209 mL. Postoperative isohaemagglutinin titres ranged from 0 to 1:16. One patient died of causes unrelated to organ rejection.

CONCLUSIONS

Our data showed that eight patients (38.1%) were older than the previously suggested 12-month cut-off age. Using a combination of adult reservoir/paediatric oxygenator and extracorporeal circuit, ABO-incompatible plasma exchange transfusions can be undertaken safely using a simplified '3 times' method, reducing the circulating levels of isohaemagglutinins whilst providing minimal circuit size. This allows ABO-incompatible heart transplantation in a broader patient population than previously reported.

PP162. sFlt-1 controlled by CPAP in a pregnant patient with chronic hypertension

INTRODUCTION

Preeclampsia is recognised as the leading cause of perinatal mortality and morbidity worldwide. Interest has been increasing recently as to the possible impact of sleep disordered breathing (SDB) on the mechanisms of preeclampsia, possibly by augmenting placental hypoxia during sleep. A biomarker of preeclampsia, sFlt-1, has also come to prominence in recent years and is postulated to be a good predictor of preeclampsia as well as a strong indicator of the severity of the disease.

OBJECTIVES

The aim of this study was to investigate the effect of CPAP treatment for SDB on sFlt-1 concentrations during pregnancy.

METHODS

Patients were recruited from the outpatients' clinic in Campbelltown Hospital, Campbelltown, NSW in the first half of 2011. The levels of sFlt-1 in four pregnant women, with or without hypertensive disorders of pregnancy, and with or without SDB were measured using ELISA.

RESULTS

Women with SDB and chronic hypertension or preeclampsia had higher levels of sFlt-1 and a greater percentage increase of this marker, and CPAP treatment appeared to attenuate the rise of sFlt-1 as shown in the table below.

CONCLUSION

Elevated sFlt-1 was associated with untreated SDB in those with chronic hypertension. This study provides feasibility for a larger scale study to occur, to further examine the validity of the hypothesis that CPAP treatment has a beneficial effect on sFLt-1 levels and therefore, may lower the risk and severity of preeclampsia.

PP154. Relationship between recorded and reported snoring during pregnancy: Objective measurement versus questionnaire responses

INTRODUCTION

Snoring is a common symptom of sleep disordered breathing (SDB), a condition that is present in 4% of the general population. SDB is identified by snoring and repetitive cessation of breathing during sleep accompanied by repetitive hypoxia and has been found to be associated with hypertension, stroke and heart attack. There is not depth of knowledge examining the association between SDB and pregnancy outcomes.

OBJECTIVES

To examine the prevalence of self reported snoring in pregnancy and the potential association between self reported snoring and the development of Hypertensive Disorders of Pregnancy (HDP) within a larger cohort from a prevalence of SDB in pregnancy study.

METHODS

Questionnaires were administered to pregnant women attending an outpatient's antenatal clinic. The self reported snoring is a component of the Epworth scale. Pregnancy progression and outcome data were collected on all participants and analyse by IBM SPSS v.20™ utilising Chi-square analysis, Student T test and logistic regression analysis. HDP diagnoses were in alignment with the SOMANZ (2009) diagnostic criteria.

RESULTS

Questionnaires were administered and outcomes collected on 2023 pregnancies. Snoring was reported by 49.2% of women. HDP affected 10.1% of the cohort, 3.3% of whom were preeclamptic. Of the pregnancies affected by HDP self reported snoring occurred in 57.7% in comparison to 43.3% who do not report snoring (p<0.001).

CONCLUSION

This would indicate that there is an association between self reported snoring and the development of HDP. Further analysis will be undertaken to model the effect of other potential risk factors such as maternal age, parity, pre-pregnancy BMI and other co morbidities.

Demineralization of enamel in primary second molars related to properties of the enamel

Enamel structure is of importance in demineralization. Differences in porosity in enamel effect the rate of demineralization, seen between permanent and deciduous teeth. Individual differences have been shown in the mean mineral concentration values in enamel, the role of this in demineralization is not thoroughly investigated. The aim of this study was to study variations of depths of artificial lesions of demineralization and to analyze the depth in relation to variations in the chemical and mineral composition of the enamel. A demineralized lesion was created in second primary molars from 18 individuals. Depths of lesions were then related to individual chemical content of the enamel. Enamel responded to demineralization with different lesion depths and this was correlated to the chemical composition. The carbon content in sound enamel was shown to be higher where lesions developed deeper. The lesion was deeper when the degree of porosity of the enamel was higher.

Carious lesions and caries risk predictors in a group of Swedish children 2 to 3 years of age. One year observation

AIM

Identification of potential carious risk criteria, retrospectively at 2 years of age, for developing carious lesions at 3 years of age. Study design Longitudinal observations from 2 until 3 years of age. Cross-sectional observations of two cohorts of 3- year-olds with different approaches.

MATERIALS AND METHODS

The study group consisted of 78 three- year- olds from a previous study at age 2 years. Clinical examination, diet history, questions regarding breastfeeding and salivary sampling for mutans streptococci (MS) were performed at both ages. The previous study on 124 three-year-olds was used as a control group for comparison of the 3-year-olds in the longitudinal study group.

RESULTS

The examinations suggested the following risk predictors: carious lesions, frequent intake of selected sugar-containing products, breastfeeding at night and MS, which covered all children with lesions at 3 years of age, resulting in a positive predictive value of 32% and a negative predictive value of 100%. The only statistically significant difference between the two groups of 3-year-olds was the reported intake of sugar-containing items. Statistics Student's t-test and chi square test, completed by Fischer's exact test.

CONCLUSION

The combination of the suggested risk criteria was predictive of carious lesions. In spite of individual parental information, new lesions developed after one year. Based on observations, a more structured and monitored preventive approach is suggested.

Successful ABO-incompatible kidney transplantation with antibody removal and standard immunosuppression

ABO-incompatible (ABOi) kidney transplantation is an established therapy, though its implementation to date has been in part limited by the requirement for additional immunosuppression. Here, we describe the outcomes of 37 patients undergoing ABOi kidney transplantation utilizing perioperative antibody depletion and receiving an identical tacrolimus-based immunosuppressive regimen to contemporaneous ABO-compatible (ABOc) recipients, with the exception that mycophenolate was commenced earlier (7-14 days pretransplant). Antibody depletion was scheduled according to baseline anti-ABO antibody titer (tube IAT method: median 1:128, range 1:8 to 1:4096). Patient and graft survival for the 37 ABOi recipients was 100% after a median 26 months (interquartile range [IQR] 18-32). Eight rejection episodes (two antibody-mediated and six cellular) in ABOi recipients were successfully treated with biopsy-proven resolution. Latest median eGFR is 50 mL/min × 1.73 m² (IQR 40-64) for ABOi patients and 54 mL/min × 1.73 m² (IQR 44-66) in the ABOc patients (p = 0.25). We conclude that ABOi transplantation can be performed successfully with perioperative antibody removal and conventional immunosuppression. This suggests that access to ABOi transplantation can include a broader range of end-stage kidney disease patients.

Reducing inter-rater variability in the assessment of nuchal translucency image quality

INTRODUCTION

Standardization of first-trimester nuchal translucency (NT) image acquisition is crucial to the success of screening for Down syndrome. Rigorous audit of operator performance and constructive feedback from assessors maintain standards. This process relies on good inter-rater agreement on image assessment. We describe the Australian approach to NT image assessment and evaluate the impact of a targeted intervention on inter-rater agreement.

METHODS

Between 2002 and 2008 a group of experienced practitioners met nine times to compare their assessment of a series of NT images. Each assessor had previously scored the images according to a system described in 2002. Inter-rater agreement was evaluated before and after an intervention where the assessors were required to refer to a detailed resource manual designed to reduce the subjectivity inherent in image assessment.

RESULTS

There was a statistical improvement in inter-rater agreement for all elements of image assessment (original scores and individual component scores) after the intervention, apart from horizontal fetal position. However, even after the intervention, inter-rater agreement levels generally remained moderate (kappa range: 0.14-0.58).

CONCLUSIONS

This study has shown that provision of detailed resource documentation to experienced assessors can significantly improve inter-rater agreement in all facets of NT image assessment. It also highlights areas of image assessment that require critical review. It is recommended that all audit bodies regularly review their inter-rater agreement to ensure consistent feedback to operators who submit images for expert peer review.

Decreasing the cost of flexible ureterorenoscopic procedures

OBJECTIVE

To treat calculus disease, perform diagnostic procedures, for endoscopic management of upper tract tumours and in selected cases for laser guided endopyelotomy there is an increase in the use of Flexible Ureterorenoscopy (FURS).

METHODS

We wanted to prospectively audit the cost of flexible ureterorenoscopic procedures undertaken in our department between March 2009 and March 2010.

RESULTS

Based on our business model, the cost of diagnostic FURS is £131 (equivalent to €157 or $196.50), FURS and lasertripsy for stones is between £296 and £429 (€355-€515 or $444-$644), and that for endoscopic management of upper tract transitional cell carcinomas is between £148 and £225 (€178-€270 or $222-$338).

CONCLUSION

Our model shows a cost-efficient way of performing FURS procedures. As the cost of FURS comes down, more trainees will build hands-on experience in these procedures.

RHEED Intensity Oscillation Studies of the Kinetics of GaAs Deposition During Chemical Beam Epitaxy(CBE)

Recently we have reported the measurement of RHEED intensity oscillations during Chemical Beam Epitaxy(CBE) of GaAs using triethylgallium(TEG) and As2 derived from an arsine cracker(Appl. Phys. Lett. 50(19), May 11,1987). The existence of RHEED intensity oscillations during CBE growth of GaAs indicates that over the range of conditions studied, growth proceeds via nucleation of islands which grow two-dimensionally as opposed to a vicinal step propagation mechanism. In the same study we observed a significant variation of the GaAs growth rate with substrate temperature at constant flux. In addition, the variation of growth rate with incident flux at constant temperature was found to be non-linear below approximately 500°C and linear above 500'C for incident fluxes yielding maximum growth rates between.2 and 1.8 monolayers/sec. Additional measurements of the dependence of the damping of RHEED intensity oscillations on V/11 ratio have indicated much less sensitivity of the growth front morphology to group V flux in CBE. This behavior is thought to reflect the role of highly mobile, partially saturated ethyl-gallium radicals in epitaxial growth by CBE. Measurements of As2 arrival rate limited intensity oscillations on gallium rich surfaces prepared by pyrolyzing TEG in the absence of As2 have shown that the pyrolysis of TEG is not self-limiting at 500°C and that excess gallium can be deposited on gallium rich surfaces. This paper also describes a simple model of the surface pyrolysis of TEG which is consistent with the above experimental observation.

Electron paramagnetic resonance investigation of purified catalyst-free single-walled carbon nanotubes

Electron paramagnetic resonance of single-walled carbon nanotubes (SWCNTs) has been bedevilled by the presence of paramagnetic impurities. To address this, SWCNTs produced by laser ablation with a nonmagnetic PtRhRe catalyst were purified through a multiple step centrifugation process in order to remove amorphous carbon and catalyst impurities. Centrifugation of a SWCNT solution resulted in sedimentation of carbon nanotube bundles containing clusters of catalyst particles, while isolated nanotubes with reduced catalyst particle content remained in the supernatant. Further ultracentrifugation resulted in highly purified SWCNT samples with a narrow diameter distribution and almost no detectable catalyst particles. Electron paramagnetic resonance (EPR) signals were detected only for samples which contained catalyst particles, with the ultracentrifuged SWCNTs showing no EPR signal at X-band (9.4 GHz) and fields < 0.4 T.

High-performance field effect transistors from solution processed carbon nanotubes

Nanoelectronic field effect transistors (FETs) are produced using solution processed individual carbon nanotubes (CNTs), synthesized by both arc discharge and laser ablation methods. We show that the performance of solution processed FETs approaches that of CVD-grown FETs if the nanotubes have minimal lattice defects and are free from surface contamination. This is achieved by treating the nanotubes to a high-temperature vacuum annealing process and using 1,2-dichloroethane for dispersion. We present CNT FETs with mobilities of up to 3546 cm(2)/(V s), transconductance of 4.22 μS, on-state conductance of 9.35 μS and on/off ratios as high as 10(6). High-resolution transmission electron microscopy is used to examine the presence of catalyst particles and amorphous carbon on the surface and Raman spectroscopy is used to examine the lattice defects, both of which lead to reduced device performance.

Women and Sport

Women have historically taken part in sports for many centuries. The first recorded female game competitions were the Herean Games in approximately 1,000 BC, named after the Goddess Hera. Held at Olympia in Greece, these games were for women alone and were thought to have originated as part of ancient fertility rights.

Historically there is evidence of sporting activities involving women, but nothing of significance until after the 1948 summer Olympic Games, when 385 female athletes participated. Over the last six decades there has been a noted rise in the number of female athletes, reaching its maximum with the 2008 Beijing Olympics, where over 42% of the 11,028 athletes were women.

Similarly in 2006, at the Turin Winter Olympics in Italy, 40% of the 2,500 athletes were females. In the 2012 Olympics, the Olympic Committee anticipates that approximately 44% of all athletes participating will be female.

Despite there being a significant rise in the number of elite athletes in the UK, there appears to be an overall decrease in the amount and intensity of physical exercise undertaken by teenage girls. This is considered to be due to the fact that physical education is no longer an integral part of the school curriculum in the UK. There is, however, a small but significant group of elite athletes who start to train at a very early age (9-10 years old) especially in gymnastics, skating, swimming and athletics.

Gender differences in carotid imaging and revascularization following stroke

BACKGROUND

Carotid endarterectomy is performed less often in women than in men, but it is unknown whether this reflects differences in screening rates, disease prevalence, or other factors.

METHODS

This was a cohort study of consecutive patients with acute stroke or TIA admitted to 11 Ontario stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003, and September 30, 2007. We compared rates of carotid imaging, the severity of carotid stenosis, and rates of carotid endarterectomy or angioplasty within 6 months of the index event in women vs men.

RESULTS

We studied 6,389 patients (48% women) with ischemic stroke or TIA. Women were less likely than men to undergo carotid imaging (81% vs 86%, p < 0.0001); however, when the analysis was limited to patients without apparent contraindications to surgery, 92% received carotid imaging, with no difference between women and men. Women were less likely than men to have severe carotid stenosis (7.4% vs 11.5%, p < 0.0001). Women were half as likely as men to undergo carotid revascularization within 6 months of the index event (odds ratio 0.51, 95% confidence interval 0.37 to 0.70), but this gender difference was no longer significant in the subgroup with severe carotid stenosis (odds ratio 0.75, 95% confidence interval 0.49 to 1.15).

CONCLUSIONS

Although women with ischemic stroke or TIA are less likely than men to undergo carotid screening and revascularization, this difference is largely explained by potential contraindications to surgery and by sex differences in the severity of carotid disease.

The reliability and accuracy of digital templating in total knee replacement

We aimed to determine the reliability, accuracy and the clinical role of digital templating in the pre-operative work-up for total knee replacement.

Initially a sample of ten pre-operative digital radiographs were templated by four independent observers to determine the inter- and intra-observer reliability of the process. Digital templating was then performed on the radiographs of 40 consecutive patients undergoing total knee replacement by a consultant surgeon not involved with the operation, who was blinded to the size of the implant inserted. The Press Fit Condylar Sigma Knee system was used in all the patients. The size of the implant as judged by templating was then compared to that of the size used.

Good inter- and intra-observer agreement was demonstrated for both femoral and tibial templating. However, the correct size of the implant was predicted in only 48% of the femoral and 55% of the tibial components. Albeit reproducible, digital templating does not currently predict the correct size of component often enough to be of clinical benefit.

Inclusive K(S);(0)K(S);(0) resonance production in ep collisions at HERA

Inclusive K_{S};{0}K_{S};{0} production in ep collisions at the DESY ep collider HERA was studied with the ZEUS detector using an integrated luminosity of 0.5 fb;{-1}. Enhancements in the mass spectrum were observed and are attributed to the production of f_{2}(1270)/a_{2};{0}(1320), f_{2};{'}(1525) and f_{0}(1710). Masses and widths were obtained using a fit which takes into account theoretical predictions based on SU(3) symmetry arguments, and are consistent with the Particle Data Group values. The f_{0}(1710) state, which has a mass consistent with a glueball candidate, was observed with a statistical significance of 5 standard deviations. However, if this state is the same as that seen in gammagamma-->K_{S};{0}K_{S};{0}, it is unlikely to be a pure glueball state.

Effects of long-range electrostatic forces on simulated protein folding kinetics

Molecular dynamics simulations are a useful tool for characterizing protein folding pathways. There are several methods of treating electrostatic forces in these simulations with varying degrees of physical fidelity and computational efficiency. In this article, we compare the reaction field (RF) algorithm, particle-mesh Ewald (PME), and tapered cutoffs with increasing cutoff radii to address the impact of the electrostatics method employed on the folding kinetics. We quantitatively compare different methods by a correlation of quantitative measures of protein folding kinetics. The results of these comparisons show that for protein folding kinetics, the RF algorithm can quantitatively reproduce the kinetics of the more costly PME algorithm. These results not only assist the selection of appropriate algorithms for future simulations, but also give insight on the role that long-range electrostatic forces have in protein folding.

Large cystic tumour at the chest wall mimicking an echinococcosis: a case report

The authors report an atypical late onset of a big axillary lymphatic malformation in a 41-year-old male. Considering the patient's history and clinical findings at first presentation, the swelling was highly suspicious for malignancy or cystic echinococcosis. A consequent CT showed non infiltrative growth with inhomogeneous density but remained non conclusive regarding diagnosis. Subsequently incision biopsy revealed lymphatic tissue and raised suspicion for lymphatic malformation. The tumour was excised completely and showed no recurrence in a 1-year follow up. Late onset lymphatic malformations can mimic malignant tumours or other rare conditions such as echinococcosis which has to be taken into consideration as differential diagnosis especially in known areas of hydatid diseases.

Protein restriction for diabetic renal disease

BACKGROUND

Diabetic renal disease (diabetic nephropathy) is a leading cause of end-stage renal failure. Once the process has started, it cannot be reversed by glycaemic control, but progression might be slowed by control of blood pressure and protein restriction.

OBJECTIVES

To assess the effects of dietary protein restriction on the progression of diabetic nephropathy in patients with diabetes.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, ISI Proceedings, Science Citation Index Expanded and bibliographies of included studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and before and after studies of the effects of a modified or restricted protein diet on diabetic renal function in people with type 1 or type 2 diabetes following diet for at least four months were considered.

DATA COLLECTION AND ANALYSIS

Two reviewers performed data extraction and evaluation of quality independently. Pooling of results was done by means of random-effects model.

MAIN RESULTS

Twelve studies were included, nine RCTs and three before and after studies. Only one study explored all-cause mortality and end-stage renal disease (ESRD) as endpoints. The relative risk (RR) of ESRD or death was 0.23 (95% confidence interval (CI) 0.07 to 0.72) for patients assigned to a low protein diet (LPD). Pooling of the seven RCTs in patients with type 1 diabetes resulted in a non-significant reduction in the decline of glomerular filtration rate (GFR) of 0.1 ml/min/month (95% CI -0.1 to 0.3) in the LPD group. For type 2 diabetes, one trial showed a small insignificant improvement in the rate of decline of GFR in the protein-restricted group and a second found a similar decline in both the intervention and control groups. Actual protein intake in the intervention groups ranged from 0.7 to 1.1 g/kg/day. One study noted malnutrition in the LPD group. We found no data on the effects of LPDs on health-related quality of life and costs.

AUTHORS' CONCLUSIONS

The results show that reducing protein intake appears to slightly slow progression to renal failure but not statistically significantly so. However, questions concerning the level of protein intake and compliance remain. Further longer-term research on large representative groups of patients with both type 1 and type 2 diabetes mellitus is necessary. Because of the variability amongst patients, there might perhaps be a six month therapeutic trial of protein restriction in all individuals, with continuation only in those who responded best. Trials are required of different types of protein.

rhBMP-6 stimulated osteoprogenitor cells enhance posterolateral spinal fusion in the New Zealand white rabbit

BACKGROUND CONTEXT

The nonunion rate after posterolateral spinal fusion can be as high as 35%. This has stimulated interest in the development of techniques for enhancing new bone formation, including the addition of bioactive peptides or the use of cell-based therapies, including genetically modified cells. In previous studies we have demonstrated that exposing autologous, marrow-derived osteoprogenitor cells to a recombinant human bone morphogenetic protein-6 (rhBMP-6) containing extracellular matrix induces osteoblastic differentiation, and that these cells are capable of increasing new bone formation. Growth of autologous cells on a synthetic rhBMP-6 containing matrix yields a population of stimulated osteoprogenitor cells, without the expense of adding large amounts of rhBMP-6 directly, or the risks inherent in the use of genetically altered cells.

PURPOSE

This study was performed to evaluate the potential of rhBMP-6 stimulated osteoprogenitor cells (stOPC) to enhance the rate and strength of posterolateral spinal fusion.

STUDY DESIGN

Prospective in vivo animal study

OUTCOME MEASURES

Radiographic evidence of spinal fusion, biomechanical testing of explanted spines, histological analysis of new bone formation

METHODS

Single-level posterolateral spinal arthrodeses were performed in 69 New Zealand white rabbits. Autologous marrow stem cells were concentrated and then plated on an rhBMP-6-rich extracellular matrix synthesized by genetically engineered mouse C3H10T1/2 cells. Animals in Groups I (n=18) and II (n=18) received autografts of 30M and 60M rhBMP-6 stOPCs in guanidine extracted demineralized bone matrix (gDBM), respectively, whereas those in Group III (n=13) received iliac crest bone graft (ICBG). Those in Group IV (n=10) received gDBM, and those in Group V (n=10) underwent decortication only. Assessment of fusion was made with serial radiographs, manual palpation of the explanted spines, and biomechanical testing. The fusion masses from two animals each in Groups I, II, and IV were evaluated histologically.

RESULTS

Fifty-three animals were available for analysis at the conclusion of the study. In these animals, the arthrodesis rate was significantly higher after treatment with rhBMP-6 stOPCs (77% for both Groups I and II by palpation) than ICBG, gDBM, or decortication alone (Group III=55%, IV=20% and V=0%, respectively). Similarly, the peak loads to failure of the fusion masses in Groups I and II (212.5+/-37.8 N and 234.6+/-45.7 N) were significantly greater than the corresponding values in the other groups (Group III=155.9+/-36.4N, Group IV=132.7+/-59.9N, and Group V=92.8+/-18.4N), though when only the fused specimens in Groups I, II, and III were compared, only Group II was significantly different than Group III (234.6+/-45.7N and 155.9+/-36.4N, respectively). The fusion masses in the rhBMP-6 stOPC-treated animals were typified by a thin, fusiform cortical shell, newly formed trabecular bone emanating from the decorticated transverse processes, and residual unremodeled gDBM carrier particles. The fusion masses in the gDBM treated bones were morphologically similar, though they contained less newly formed bone.

CONCLUSIONS

The use of rhBMP-6 stOPCs in a carrier of gDBM significantly enhanced the rate and strength of single-level posterolateral spinal arthrodeses in the New Zealand white rabbit, compared with ICBG, gDBM, and decortication alone. Our results confirm that the stimulation of marrow-derived osteoprogenitor cells by growing them on a rhBMP-6 containing extracellular matrix is feasible. Further investigation is warranted to determine the relative contribution of rhBMP-6 stimulation and the number of cells implanted, as well as strategies for optimizing the technique for clinical application.

The psychological impact of genital anomalies on the parents of affected children

BACKGROUND

There is scarce information on how parents cope with children with genital anomalies. Participants & methods: Twenty-six parents of 25 children with a median age of 0.5 years (r, 5 days-10.8 years) were recruited through the Scottish Genital Anomaly Network and had a quantitative assessment of parenting stress and coping patterns; a qualitative assessment by a semi-structured interview was also performed in19 parents.

RESULTS

In five parents, the total stress score was above the 85th centile, denoting clinical levels of stress. Three parents showed reduced coping pattern scores for social support, self-esteem and psychological stability and three showed a reduction in utilization of communication with medical professionals. The scores did not correlate with each other or the extent of genital anomaly in the child. Semi-structured interview analysis revealed parents' need for more knowledge about the imminent surgery, post-operative care and their desire for written information that could complement the time-restricted contact with the clinical team.

CONCLUSION

In the majority of cases, parents did not display abnormal levels of stress or coping on quantitative assessment. The semi-structured interview provided further information about the parents' level of coping and potential for stress and highlighted the need for more effective exchange of clinical information at a critical period of the parent-child relationship.

Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial

OBJECTIVE

To evaluate the efficacy of Homeopathic Arnica in reducing the morbidity following tonsillectomy.

METHODS

Randomised double blind, placebo controlled trial at a tertiary referral centre. 190 patients over the age of 18 undergoing tonsillectomy were randomised into intervention and control groups receiving either Arnica 30c or identical placebo, 2 tablets 6 times in the first post-operative day and then 2 tablets twice a day for the next 7 days. The primary outcome measure was the change in pain scores (visual analogue scale) recorded by the patient on a questionnaire over 14 days post-operatively; Secondary outcome measures were: analgesia consumption, visits to the GP or hospital, antibiotic usage, the day on which their swallowing returned to normal and the day on which they returned to work.

RESULTS

111 (58.4%) completed questionnaires were available for analysis. The Arnica group had a significantly larger drop in pain score from day 1 to day 14 (28.3) compared to the placebo group (23.8) with p < 0.05. The two groups did not differ significantly on analgesic consumption or any of the other secondary outcome measures (number of post-operative visits to GP, use of antibiotics and secondary haemorrhage readmissions).

CONCLUSION

The results of this trial suggest that Arnica montana given after tonsillectomy provides a small, but statistically significant, decrease in pain scores compared to placebo.