Sexually transmitted disease/HIV health-care policy and service provision in Britain

The objective of this paper was to discusses historical developments of sexually transmitted disease (STD)/HIV sexual health policies in Britain, principally from the 19th to the 21st century. Repeating trends were identified and a consideration of how history addresses today's urgent need for better management of sexual health is discussed. In January 1747, the first venereal disease (VD) treatment was established at Lock Hospital, London. As the 19th century passed, sexuality emerged from a conspiracy of silence and became part of social consciousness. In Victorian times, prostitution was regarded with revulsion. Renewed medical interest in VD was brought about by improvements in medical knowledge from 1900-10. In the period 1913-17, there was a significant change in sexual health policy. From 1918, treatment centres increasingly recognized the difficulties in persuading attendees to return for a complete course of treatment. AIDS in Britain wrecked havoc in the period 1981-86 with incidences of infection in several widely differing groups and public alarm fuelled by the media. In conclusion, education, advertising and public health counselling need to be moulded effectively so that the public recognize the real risks associated with unprotected sexual intercourse.

The effects of orally administered crude alcohol and aqueous extracts of African potato (Hypoxis hemerocallidea) corm on the morphometry of viscera of suckling rats

The litter from six Sprague-Dawley rats was used to study the short-term effects of African potato (AP) corm extracts in suckling rats. Ten days after birth, the pups in each litter were assigned to treatment groups and received alcohol (AL) or aqueous (AQ) extracts of AP (50 mg kg(-1) b.w. in 0.9% saline, 10 ml kg(-1) b.w., and a high dose 200 mg kg(-1) b.w. in 0.9% saline, 10 ml kg(-1) b.w.) via a stomach tube, for 5 consecutive days. A fifth group (control) received 0.9% saline (10 ml kg(-1) b.w.). Between gavage, the pups were kept with their dams. The pups were then killed and the viscera removed for gross and microscopic morphometric measurements. The low dose of AQ and AL extracts of AP significantly increased (P<0.01, ANOVA) the mean weight gain. The high dose of AQ significantly increased (P<0.05, ANOVA) the weight of the caeca whilst the low dose of the AL extract reduced pancreas weight compared to the control and low dose AQ groups. All other morphometric parameters of the viscera measured did not differ significantly between the groups. The small intestinal villi and crypts did not reveal any signs of pathology.

Tumour necrosis factor-alpha single nucleotide polymorphisms are not independent of HLA class I in UK Caucasians with adult onset idiopathic inflammatory myopathies

OBJECTIVE

To investigate haplotype tagging single nucleotide polymorphisms (SNPs) in the tumour necrosis factor alpha (TNF-alpha) gene, in UK Caucasian idiopathic inflammatory myopathy (IIM) patients.

METHODS

A cross-sectional, case-control study of four TNF-alpha SNPs was undertaken, comparing cases of polymyositis (PM) (n = 121), dermatomyositis (DM) (n = 109) and myositis overlapping with other connective tissue diseases (CTD-overlap) (n = 73) with normal subjects (n = 177). Subgroup analyses were undertaken after stratifying for myositis specific/associated antibodies.

RESULTS

The TNF-308A allele demonstrated a strong association with each myositis disease subgroup vs controls [PM, odds ratio (OR) 2.8, 95% confidence interval 1.9-4.3; DM, OR 2.5, 1.6-3.8; CTD-overlap, OR 3.3, 2.1-5.1]. The TNF-308GA/AA genotype frequency was significantly increased vs controls (PM, OR 3.7, 2.1-6.3; DM, OR 3.2, 1.8-5.5; CTD-overlap, OR 5.0, 2.6-9.6) suggesting a dominant model. The association was strongest in patients possessing anti-aminoacyl transfer RNA synthetase (anti-synthetase) (OR 5.1, 3.3-8.0) or -PM-Scl (OR 5.0, 2.7-8.9) antibodies. The -1031T allele was also a significant risk factor in DM (OR 2.2, 1.4-3.6), anti-synthetase (OR 2.9, 1.6-5.3) and -PM-Scl (OR 5.6, 1.9-6.4) antibody positive patients. The TNF-308A association was lost after adjusting for HLA-B*08, but remained independent of HLA-DQB1*02 (both are alleles forming part of the common ancestral haplotype). The HLA-B*08/TNF-308A/DRB1*03/DQA1*05/DQB1*02 haplotype was a risk factor in all myositis subgroups vs controls (OR 3.0, 1.8-5.3).

CONCLUSIONS

TNF-308A and -1031T alleles are significant risk factors in the IIMs. In the IIMs, the TNF-308A allele is part of the common ancestral haplotype, but is not independent of HLA-B*08.

First finding of libyostrongylosis in farm-reared ostriches (Struthio camelus) in Croatia: Unusual histopathological finding in the brain of two ostriches, naturally infected with Libyostrongylus douglasi

In the present work, the very first finding of Libyostrongylus douglasi in farm-reared ostriches in Croatia, was described, not only as the main cause of the death, but also as the cause of persistent infection. The results of histopathological examination of almost all parenchymatous organs in two routinely necropsied ostriches were presented, including atypical histopathological finding in the brain and the result of the L. douglasi scanning electron microscopical (SEM) examination. In order to determine the parasite species to which the larval form found in the brain belonged, polymerase chain reaction (PCR) was performed. Total DNA was isolated from fresh L. douglasi, and from archival formalin-fixed and paraffin-embedded brain section. Additionally, the smears of the proventricular mucosal lining were cytologically examined. Virological examination for newcastle disease virus (NDV) was also performed. As there was very limited information concerned ostrich's health status in Croatian farms, a preliminary evaluation of the parasite infestation level in the Croatian ostrich population over the period 2001-2002 was also done, and an attempt at characterising individual parasite species, was made.

Thysanoptera infestation on skin and periorbital cellulitis in ostriches (Struthio camelus) aged 14 months

AIM

To report the infestation of Thysanoptera (Limothrips denticornis) on ostriches (Struthio camelus) and to determine their relative density.

METHODS

A farm in Poland was studied on which ostriches aged 14 months were severely infested with L. denticornis (thrips). Thrips were collected and their density on the neck, torso and legs (10 cm2) of 85 ostriches determined at 0600, 1200 and 1800 h, respectively, over 7 days. At the same times, apparent densities of thrips/m2 were determined in adjacent grassy areas (120 m2) on a muslin cloth impregnated with permethrin. Thrips were mounted onto slides in Hoyer's medium, for identification.

RESULTS

The apparent density of thrips was greatest at 1200 h, and was greater on the neck than the torso and legs (p=0.03). In adjacent surroundings, densities were also highest at 1200 h (mean 199 (SE 9.3) thrips/m2) and were similar to the maximum densities recorded on the necks of ostriches at that time (mean 205 (SE 6.4) thrips/m2). Ostriches engaged in excessive preening and attempted to scratch their head/neck with their feet. Numerous small, pale red papules were observed on the skin. Observations of periorbital cellulitis, conjunctivitis, blepharitis, watery discharge, inflammation, and sclerotic discolouration were noted in 65 ostriches.

CONCLUSION

Observations were commensurate with L. denticornis infestation.

CLINICAL RELEVANCE

Infestation may exacerbate stress levels and subsequently lead to a reduction in feed intake and performance. The infestation and subsequent irritation from thrips impacts negatively on the general health of ostriches by damaging skin and irritating eyes.

Differences in stride between healthy ostriches (Struthio camelus) and those affected by tibiotarsal rotation : research note

Twenty healthy ostriches (ten cocks and ten hens), and twenty birds with tibiotarsal rotation (nine cocks and 11 hens) (14 months old) were isolated, hooded and weighed. A run (50m x 2.5 m) was divided into sections marked 5m, 10m, 15m and 20 m. Time taken for each bird to pass these points was recorded and speed computed. The degree of tibiotarsal rotation in the right foot was mean + SEM, 156 + 2.69°. Comparisons between left and right foot length in healthy birds showed no significant differences. Foot length was significantly lower in tibiotarsal rotation (P=0.03). The right foot in tibiotarsal rotation was significantly shorter than the left foot. The number of strides per each 5 m division were significantly (P 0.05) greater in tibiotarsal rotation by comparison with healthy birds. At 20 m, healthy cocks had more strides than hens. The stride length in hens was significantly (P 0.05) greater than cocks at 5, 10 and 15 m, respectively, but lower throughout in tibiotarsal rotation (P = 0.001). The speed of hens was significantly (P 0.05) greater than cocks. Tibiotarsal rotation resulted in significantly (P 0.05) reduced speeds. Hens may be able to escape danger faster than cocks. The occurrence of tibiotarsal rotation necessitates consideration of genetics, management, sex, nutrition and growth rates.

Interferon-gamma and interleukin-4 gene polymorphisms in Caucasian idiopathic inflammatory myopathy patients in UK

OBJECTIVE

To determine whether interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) genes confer susceptibility for the idiopathic inflammatory myopathies (IIMs).

METHODS

A large cross-sectional study of UK caucasian adults with polymyositis (PM, n = 101), dermatomyositis (DM, n = 94) and myositis overlapping with a connective tissue disease (myositis/CTD-overlap, n = 70) was completed. 177 ethnically matched controls were available for comparison. Single-nucleotide polymorphisms (SNPs) within intronic regions coding for IL-4, IFN-gamma and a microsatellite marker within intron 1 of the IFN-gamma gene were typed.

RESULTS

Strong linkage disequilibrium was present between SNPs in each gene. In the IFN-gamma gene, a weak allelic association was observed in PM versus controls at rs1861493 (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.03 to 2.4). The microsatellite IFN-gamma CA(14) allele was associated with risk for IIMs overall (OR 3.3, 95% CI 1.4 to 7.8), the strongest association being observed within the anti-U1-ribonucleoprotein (RNP) group (OR 6.0, 95% CI 1.5 to 23.1), and persisting after adjustment for known myositis human leucocyte antigen (HLA) class II associations.

CONCLUSIONS

Genetic markers in the IFN-gamma gene demonstrate significant allelic associations with the IIMs in a UK Caucasian population. The SNPs tested in this study within the region coding for IL-4 fail to show significant associations with susceptibility to IIM disease.

The diagnostic utility of myositis autoantibody testing for predicting the risk of cancer-associated myositis

OBJECTIVES

There is a known association between myositis and cancer. The risk is greater in dermatomyositis (DM) than polymyositis (PM), although reliable methods to predict cancer risk in specific patients with myositis are not presently available. This study was undertaken to determine whether risk of developing cancer in myositis can be predicted by antibody profiling.

METHODS

A cross-sectional study of UK Caucasian adults with PM (n = 109), DM (n = 103) and connective tissue disease overlap (myositis/CTD-overlap, n = 70). Patients were tested for a comprehensive range of myositis-specific/associated autoantibodies. Sensitivity and specificity analyses were performed for the optimal identification of cancer risk.

RESULTS

Sixteen patients had cancer-associated myositis (CAM) (15 DM, 1 myositis/CTD-overlap). CAM patients were older at disease onset, and patients without myositis-specific/associated autoantibodies on "routine" laboratory testing (negative for anti-Jo-1, anti-PM-Scl, anti-U1-RNP, anti-U3-RNP, anti-Ku antibodies) had a significantly increased risk of CAM. Possession of the antibody against 155 kDa and 140 kDa protein specificities (anti-155/140 antibody) represented a significant risk factor for CAM, and was found exclusively in DM. A positive anti-155/140 antibody result proved highly specific, moderately sensitive, with high negative predictive value for CAM. A "negative routine myositis antibody panel" result was highly sensitive, with high negative predictive value for CAM. The combination of these two approaches was 94% sensitive, detecting 15 of 16 CAM, with 100% sensitivity and negative predictive value in DM.

CONCLUSIONS

These results may help clinicians predict which patients with myositis are at greater risk of developing cancer, thus identifying those requiring aggressive diagnostic evaluation and intensive cancer surveillance at myositis onset and follow-up.

In adult onset myositis, the presence of interstitial lung disease and myositis specific/associated antibodies are governed by HLA class II haplotype, rather than by myositis subtype

The aim of this study was to investigate HLA class II associations in polymyositis (PM) and dermatomyositis (DM), and to determine how these associations influence clinical and serological differences. DNA samples were obtained from 225 UK Caucasian idiopathic inflammatory myopathy patients (PM = 117, DM = 108) and compared with 537 randomly selected UK Caucasian controls. All cases had also been assessed for the presence of related malignancy and interstitial lung disease (ILD), and a number of myositis-specific/myositis-associated antibodies (MSAs/MAAs). Subjects were genotyped for HLA-DRB1, DQA1 and DQB1. HLA-DRB1*03, DQA1*05 and DQB1*02 were associated with an increased risk for both PM and DM. The HLA-DRB1*03-DQA1*05-DQB1*02 haplotype demonstrated strong association with ILD, irrespective of myositis subtype or presence of anti-aminoacyl-transfer RNA synthetase antibodies. The HLA-DRB1*07-DQA1*02-DQB1*02 haplotype was associated with risk for anti-Mi-2 antibodies, and discriminated PM from DM (odds ratio 0.3, 95% confidence interval 0.1-0.6), even in anti-Mi-2 negative patients. Other MSA/MAAs showed specific associations with other HLA class II haplotypes, irrespective of myositis subtype. There were no genotype, haplotype or serological associations with malignancy. The HLA-DRB1*03-DQA1*05-DQB1*02 haplotype associations appear to not only govern disease susceptibility in Caucasian PM/DM patients, but also phenotypic features common to PM/DM. Though strongly associated with anti-Mi-2 antibodies, the HLA-DRB1*07-DQA1*02-DQB1*02 haplotype shows differential associations with PM/DM disease susceptibility. In conclusion, these findings support the notion that myositis patients with differing myositis serology have different immunogenetic profiles, and that these profiles may define specific myositis subtypes.

Monocyte chemotactic protein-1 single nucleotide polymorphisms do not confer susceptibility for the development of adult onset polymyositis/dermatomyositis in UK Caucasians

OBJECTIVES

Polymyositis (PM) and dermatomyositis (DM) form part of the idiopathic inflammatory myopathies (IIMs). The chemokine monocyte chemotactic protein-1 (MCP-1) is expressed at sites of the T cell inflammatory response in the IIMs. We thus investigate whether genetic markers in the MCP-1 gene confer disease susceptibility for the development of PM and DM.

METHODS

DNA samples were analysed from a group of 195 UK Caucasian IIM patients, comprising 103 PM and 92 DM. Their results were compared with those of 162 ethnically matched controls. The polymorphic positions of three single nucleotide polymorphisms (SNPs) and one insertion-deletion sequence within regions coding for MCP-1 were tested. The SNPs examined were located in intron 1 (rs2857657, C/G), exon 2 (rs4586, A/G) and the 3 ' untranslated region (rs13900, C/T). The insertion-deletion sequence was located in intron 1 (rs3917887, AGCTCCTCCTTCTC/-). Each SNP was tested for Hardy-Weinberg equilibrium and allelic/genotypic associations. Haplotype frequencies were estimated using the Expectation/Maximization algorithm.

RESULTS

There was strong linkage disequilibrium present between three out of these four markers. The majority of controls were in Hardy Weinberg equilibrium. No allelic, genotypic or haplotypic associations were detected when comparing PM or DM cases to controls, or when PM and DM were compared with each other.

CONCLUSIONS

Genetic markers in the MCP-1 gene do not demonstrate significant genetic associations with the IIMs, and do not discriminate PM from DM in a UK Caucasian population.

The presence of quill mites (Gabucinia bicaudata) and lice (Struthiolipeurus struthionis) in ostrich wing feathers

Quill mites (Gabucinia bicaudata) and lice (Struthiolipeurus struthionis) may infest ostrich feathers, resulting in skin damage, pruritus and excessive feather preening and loss. Four different feather types (prime white, femina extra wide, femina class 1, and femina short; n = 10) were collected. The quill mites and lice were removed with fine forceps, studied using a photographic optical microscope and counted microscopically at x 100 magnification following collection by sedimentation. They were placed in separate Petri dishes containing lactophenol solution and examined (x40 magnification). Anatomical features are described. The density of quill mites in all feather types of both wings was higher than that of the lice. There was no significant difference between the counts of both arthropods on the left wing and the right wing, respectively, except for the femina class 1 quill mites (P = 0.01). The femina extra wide feathers were a preferred habitat in both wings. Large standard deviations (quill mites left wing: 73 +/- 8; quill mites right wing: 69 +/- 7) suggested variations in the degree of migration between feather shafts or as a response to escape preening. It is recommended that ostriches be treated with an oral preparation of Ivermectin administered per os at a dosage rate of 0.2 mg/kg at 30-day intervals for quill mites, and with a 1-5 % Malathion dust at 14-day intervals for lice.

Voluntary activation failure is detectable in some myositis patients with persisting quadriceps femoris weakness: an observational study

This cross-sectional, observational study was undertaken to examine whether voluntary activation failure could contribute to the persisting weakness observed in some patients with treated idiopathic inflammatory myositis. In 20 patients with myositis of more than six months' duration (5 males, 15 females; mean [± 1 SD] age 53 [11] years) and 102 normal subjects (44 males, 58 females; mean age 32 [8] years), isometric maximum voluntary contractions (MVCs) of the dominant quadriceps femoris (QF) were quantified. Absolute MVC results of normal subjects and patients were then normalised with respect to lean body mass (force per units of lean body mass), giving a result in Newtons per kilogram. Based on mass-normalised force data of normal subjects, patients were arbitrarily stratified into "weak" and "not weak" subgroups. During further MVC attempts, the "twitch interpolation" technique was used to assess whether the QF voluntary activation of patients was complete. This technique relies on the fact that, because muscle activation is incomplete during submaximal voluntary contractions, electrical stimulation of the muscle can induce force increments superimposed on the submaximal voluntary force being generated. No between-gender differences were seen in the mass-normalised MVC results of healthy subjects, so the gender-combined results of 6.6 (1.5) N/kg were used for patient stratification. No between-gender difference was found for mass-normalised MVCs in patients: males 5.4 (3.2) and females 3.0 (1.7) N/kg (p > 0.05). Mass-normalised MVCs of male patients were as great as those of normal subjects (p > 0.05), but mass-normalised MVCs of female patients were significantly smaller than those of the normal subjects (p < 0.001). Only one of the six "not weak" patients exhibited interpolated twitches during electrical stimulation, but six of the 14 "weak" patients did, the biggest twitches being seen in the weakest patient. That interpolated twitches can be induced in some myositis patients with ongoing QF weakness during supposed MVCs clearly suggests that voluntary activation failure does contribute to QF weakness in those patients.

Ostrich nutrition: a review from a Zimbabwean perspective

The ostrich is an important animal in many livestock industries and, in the developing world, the export of meat and skins is a valuable source of foreign currency. As the successful growth and reproductive performance of ostriches depends on good nutrition it is extremely important to provide the correct diet. Some researchers have incorrectly assumed that poultry diets are useful for ostriches, but the vitamin and mineral requirements of these birds are unique and their diets should never be substituted with poultry or other livestock feeds. Producers should be knowledgeable about how different ingredients provide the essential nutrients for growth and development. Adequate nutrition is key to good flock performance and more research into ostrich nutrition is required. In Zimbabwe, one of the greatest costs involved in the keep of ostrich breeder birds is purchased feed, which can cost approximately US$ 4,555 for every 10 birds per annum. In order to cover these costs, the producer needs to ensure an adequate supply of birds for slaughter.

Have recent immunogenetic investigations increased our understanding of disease mechanisms in the idiopathic inflammatory myopathies?

PURPOSE OF REVIEW

The idiopathic inflammatory myopathies (IIM) continue to provide a challenge given the variable effectiveness of the available treatments, and immunogenetic studies are ongoing to further elucidate IIM disease mechanisms. This review examines how recent research has improved our understanding of the mechanisms that lead to IIM.

RECENT FINDINGS

HLA-DRB1 studies in a large homogenous cohort of UK Caucasian patients have confirmed that polymyositis (PM) and dermatomyositis (DM) are not genetically identical diseases while other studies have shown that tumor necrosis factor alpha is genetically implicated in disease susceptibility. Some remarkable results from an international collaboration, correlating gene-environment interactions, clearly suggest that ultraviolet light is capable of modulating both clinical and immunologic features of IIMs. Studies on microchimerism are unraveling interesting associations in juvenile DM patients, and bolstering the hypothesis that myositis may be an 'allo-immune' disease. mRNA gene expression profiling is helping to increase our understanding of myositis pathogenesis, whilst animal models have provided new information on the roles of Th1 responses and nitric oxide synthase in muscle disease. New candidate genes have been examined in inclusion body myositis (IBM), and a novel gene transfer experiment has been conducted, which led to significant changes in expression of the IBM phenotype.

SUMMARY

Improving the understanding of the immunogenetics and immunopathogenesis of the IIMs may in the future provide novel therapeutic targets, and thus improve outcomes in these difficult diseases.

Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined "adverse" fiber-type composition

STUDY DESIGN

Investigative case control study.

OBJECTIVES

To determine whether excessive paraspinal muscle fatigue in chronic low back pain results from a paucity of muscle type I fiber content.

SUMMARY OF BACKGROUND DATA

Paraspinal muscle function is vital for spinal protection. Prospective studies suggest that excessive paraspinal muscle fatigability may increase risk of first-time low back pain. As contractile performance of the paraspinal muscles is governed by their constitutionally determined fiber composition, the question arises whether a constitutionally determined "adverse" composition could predispose to low back pain through impaired spinal protection.

METHODS

Thirty-five male patients with chronic low back pain were compared with 32 male control patients of similar age and anthropometry. During Sorensen and 60% of maximum voluntary isometric contraction fatigue tests, median frequency declines in the paraspinal muscle surface electromyograph signal were monitored and correlated with muscle histomorphometry.

RESULTS

Patients were weaker than controls during maximum voluntary isometric contractions (84.47 [28.44]vs. 98.74 [18.11] kg, respectively; P = 0.02) and more fatigable during their Sorensen tests (endurance time 105.29 [28.53]vs. 137.50 [40.38] sec, respectively; P < 0.01). There were no between-group differences in median frequency declines during the Sorensen (-0.37 [0.16]vs. -0.36 [0.12]%.sec) or 60% maximum voluntary isometric contraction (-0.42 [0.31]vs. -0.51 [0.29]%.sec) tests, for patients and controls, respectively. There were no between-group differences in the percent number of paraspinal muscle type I fibers (64 [11]vs. 64 [9]%) or the percent area occupied by type I fibers (67 [11]vs. 69 [9]%), for patients and controls, respectively. Type I and II muscle fiber narrow diameters were similar for both groups.

CONCLUSION

In the patients with chronic low back pain tested, their associated paraspinal muscle dysfunction was not the result of a constitutionally determined "adverse" fiber type composition.

Between-days reliability of electromyographic measures of paraspinal muscle fatigue at 40, 50 and 60% levels of maximal voluntary contractile force

OBJECTIVE

To ascertain which percentage of maximal voluntary contractile force of the paraspinal muscles, when tested in a functional position, is most reliable for assessing electromyographic (EMG) fatigue changes.

SUBJECTS

Ten healthy volunteers with no history of low back pain (six males).

MAIN OUTCOME MEASURES

The surface EMG signal during 60-second isometric contractions of the paraspinal muscles at 40, 50 and 60% levels of maximal voluntary contractile force was captured and analysed. Each contraction level was assessed on two occasions, at least three days apart. The initial median frequency, the decline in median frequency slope and the increase in root mean square values were assessed for between-days reliability, using intraclass correlation coefficients (ICCs) and standard errors of measurements (SEM). Normalized median frequency and root mean square values were also assessed.

RESULTS

At 40% of maximal voluntary contraction, little or no EMG fatigue changes occurred in any of the observed parameters. At 50% maximal voluntary contraction the initial mean frequency and root mean square changes proved highly reliable, with ICCs ranging from 0.74 to 0.86 and 0.75 to 1.00 respectively. Normalizing the root mean square data reduced the reliability, but this was still acceptable with ICCs 0.70-0.83. The median frequency decline slope proved less reliable with ICCs 0.24-0.74 for raw and 0.26-0.77 for normalized data. At 60% maximal voluntary contraction the initial mean frequency proved as reliable as initial median frequency at 50% with ICCs 0.70-0.89. The raw and normalized root mean squares (ICCs 0.43-0.89 and 0.30-0.87 respectively) and raw and normalized median frequency (ICCs 0.27-0.51 and 0.24-0.53 respectively) changes were less reliable than at 50% MVC. Overall, the reliability is better at the L4/5 than at the L2/3 level.

CONCLUSION

Outcome measures taken at 50% maximal voluntary contraction are the most reliable in functional testing the paraspinal muscles of healthy volunteers. With initial median frequency and root mean square values being more reliable parameters than median frequency decline. At the L4/5 level, however, all parameters were acceptably reliable at 50% of maximum effort. However the between-subject variability of the median frequency decline and root mean square incline slopes suggest that these parameters are not yet fully suitable for monitoring fatigue changes during prolonged isometric contraction.

Quarts out of pint pots -- expanding the pint. Clinical budgeting in practice

Clinical budgeting is the process whereby clinical users are charged for the resources they use. A system for recharging users for the costs of tests was introduced at the Northern General Hospital, Sheffield, in 1995, and has been in operation since. The system has allowed pathology to maintain budgetary balance, has automatically compensated for workload increases, has allowed the introduction of new tests, and has encouraged clinical users to include pathology costs in their bids for funding for clinical developments. The system works according to rules agreed between pathology and its users at the outset, but once set up takes a minimal amount of work to operate and maintain.

Euglycemic hyperinsulinemia augments the cytokine and endocrine responses to endotoxin in humans

Type 2 diabetes is associated with biochemical evidence of low-grade inflammation, and experimental studies have suggested that both insulin and glucose affect inflammatory responses. To determine the effect of in vivo changes in glucose availability and plasma insulin concentrations in humans, we administered 20 U/kg Escherichia coli lipopolysaccharide (LPS) or saline (control) to 14 subjects during a euglycemic hyperinsulinemic clamp (n = 6) or an infusion of sterile saline (n = 8). Parallel in vitro studies on human whole blood were undertaken to determine whether there was a direct effect of glucose, insulin, and leptin on proinflammatory cytokine production. Infusion of glucose and insulin significantly amplified and/or prolonged the cardiovascular, plasma interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and counterregulatory hormone responses to LPS, whereas the effects on fever, plasma norepinephrine concentrations, and oxygen consumption were unaffected. In vitro studies showed no modulation of LPS-stimulated IL-6 or TNF-alpha production by glucose, insulin, or leptin at physiologically relevant concentrations. Hyperinsulinemia indirectly enhances key components of the systemic inflammatory and stress responses in this human model of infection.

Synthesis of novel cationic lipids: effect of structural modification on the efficiency of gene transfer

A series of novel cationic lipids was designed and synthesized in an effort to understand the importance of the various structural features with respect to transfection efficiency. Particular attention has been paid to the hydrophobic domain and the cationic headgroup. An efficient method of synthesizing asymmetric diether lipids is described, using alkyl chains ranging from C(12) to C(18) and the unsaturated oleyl group. The ternary formulations including the diether lipid 3beta-[N-(N',N'-dimethylaminoethyl)carbamoyl]cholesterol (DC-Chol) and dioleoyl phosphatidylethanolamine (DOPE) were up to 10-fold more efficacious in in vitro assays than the DC-Chol/DOPE control. The shorter and most asymmetric diether lipids performed the best. The chemical nature and basicity of the headgroups have been varied by the coupling of the four naturally occurring amino acids with cationic side chains-arginine, histidine, lysine, and tryptophan. Transfection efficiency was highest for arginine/lysine derivatives, with binary formulations containing the amino acid derivative alone and DOPE proving superior.

Paraspinal muscle EMG fatigue testing with two methods in healthy volunteers. Reliability in the context of clinical applications

OBJECTIVE

Comparison of the accuracy of surface electromyogram for back muscle endurance assessment with two different tests.

DESIGN

Test-retest measurements in 16 healthy volunteers on two separate occasions for each test under controlled conditions.

BACKGROUND

Back muscle endurance is considered important in low back pain rehabilitation. Reliability of paraspinal muscle endurance assessment is a pre-requisite for accurate and meaningful clinical applications of the technique.

METHODS

All participants performed each test twice. A direct comparison was made between two popular fatigue testing methods, the modified Biering-Sørensen and a 60% maximum voluntary isometric contraction in the upright position during which time fatigue was assessed from the electromyogram spectral and amplitude analysis.

RESULTS

Reproducibility of initial median frequency was excellent for both tests. Normalised median frequency slope values were more reliable with the 60% maximum voluntary contraction upright test. The clinical applicability of these measures in detecting significant differences after patient rehabilitation is recommended. Root mean square had very large between-day error for both tests.

Effects of ethanol on plasma chloroquine, arginine vasopressin (AVP) concentrations and renal hydro-electrolyte handling in the rat

Current evidence in literature suggests that acute effects of either chloroquine or ethanol on kidney function partly depend on influencing plasma concentrations of arginine vasopressin (AVP). Therefore, the goal of the current study was to explore the effects of chloroquine and/or various doses of ethanol on plasma AVP levels and associated effects on renal hydro-electrolyte handling. Separate groups of male anaesthetized Sprague-Dawley rats were placed on a continuous jugular infusion of 0.077 M NaCl at 150 microL/min(-1). After 3 h equilibration period, consecutive 20 min urine collections were made over the subsequent 4 h of 1 h control, 1 h 20 min treatment and 1 h 40 min postequilibration periods for measurements of urine flow and Na+ and K+ excretion rates. Chloroquine (0.06 microg/min(-1)) and/or ethanol at either 2.4, 6, 18 or 24 microg/min(-1) were added to the infusate during the treatment period. Trunk blood was collected after the treatment period from parallel groups for AVP, ethanol and chloroquine measurements. Vehicle infused animals acted as control animals. Infusion of ethanol at low rate of 2.4 microg/min(-1) increased Na+ excretion rates, but high rates (6-24 microg/min(-1)) did not elicit such effects. Plasma ethanol concentrations were undetectable following administration of ethanol alone at 2.4 or 6 microg/min(-1). However, ethanols were measurable following co-infusion of chloroquine and ethanol at 6 microg/min(-1) (6+/-1 mg/dL(-1)). Concurrent chloroquine and ethanol (24 microg/min(-1)) administration elevated plasma ethanol concentrations by 26% by comparison with that of ethanol alone at the same dose. Chloroquine and ethanol infusion at all doses significantly (p < 0.01) increased plasma chloroquine concentrations. Intravenous infusion of ethanol increased plasma AVP concentrations in a dose-dependent manner. The observations of this study suggest that acute ethanol increases plasma AVP levels in a dose-dependent manner to affect hydro-electrolyte balance.

Effects of ethanol on the changes in renal fluid and electrolyte handling and kidney morphology induced by long-term chloroquine administration to rats

This study investigated the effects of long-term chloroquine and ethanol administration on renal fluid and electrolyte handling and kidney structure. Male Sprague-Dawley rats were orally administered with chloroquine diphosphate (20 microg kg(-1) bw) and/or ethanol (1.6 g kg(-1) bw) every third consecutive day for 4 weeks. Urine volume and total urinary outputs of Na+ and K+ were determined from 24-h samples. For detailed renal studies, rats were subsequently anaesthetised and challenged with a continuous jugular infusion of 0.077 M NaCl at 150 microl min(-1) 24 h after the last treatment. After a 3-h equilibration period, urine flow, Na+ and K+ excretion rates were determined over a 4-h period. Plasma concentrations of AVP and aldosterone were measured in unanaesthetised rats and in anaesthetised rats after hypotonic saline infusion. In separate groups, the rats were anaesthetised with an overdose of ether after 4 weeks of treatment and part of the right kidney was quickly collected and routinely processed for light microscopy. Chloroquine decreased Na+ excretion and increased plasma aldosterone concentrations in anaesthetised rats. Ethanol alone did not alter urinary Na+ outputs or aldosterone levels. Combined chloroquine and ethanol increased renal Na+ excretion, but did not affect plasma aldosterone levels. In unanaesthetised animals all treatments increased aldosterone levels by comparison with control rats. Urinary Na+ excretion was decreased by separate administration of either chloroquine or ethanol, but increased by combined treatment. Microscopic studies showed that concurrent chloroquine and ethanol administration induced extensive damage of the proximal tubule and collecting ducts cells. The results of this study suggest that alcohol consumption and chloroquine administration could result in diminished renal function possibly due to alteration of renally active hormones or kidney morphology.

Amelioration of established collagen induced arthritis by systemic IL-10 gene delivery

A novel formulation of cationic liposomes containing the novel cytofectin ACHx was used for delivery of an anti-inflammatory cytokine gene, IL-10, to mice with established collagen induced arthritis. A single intraperitoneal injection of human IL-10 expression plasmid complexed with liposomes 2 to 4 days after the onset of arthritis was sufficient to give significant and prolonged amelioration of arthritis for 30 days. Preliminary experiments suggested that the therapeutic effect was IL-10 dose-dependent. The distribution of the human IL-10 DNA after injection was widespread, including the inflamed paws. Human IL-10 mRNA was also detected in the paws 24 h after injection. IL-10 protein was below the level of detection in paws and serum but was detected in some tissues up to 10 days after injection. The target cell of transfection was demonstrated to be the macrophage. These results suggest that systemic therapy with plasmid DNA complexed with cationic liposomes merits further development as an alternative method for anti-inflammatory treatment of arthritis.

Renal electrolyte and fluid handling in the rat following chloroquine and/or ethanol administration

We postulated that chloroquine and/or ethanol affect plasma arginine vasopressin (AVP) concentrations to alter renal function. Therefore, we studied the effects of chloroquine and/or ethanol on plasma AVP concentrations and fluid, urinary Na(+) and K(+) outputs in separate groups of anaesthetized Sprague-Dawley (SD) rats challenged with a continuous jugular infusion of 0.077 M NaCl at 150 microl.min(-1). After a 3-h equilibration period, vehicle, chloroquine (0.06 microg. min(-1)), ethanol (2.4 or 24 microg.min(-1)) or both chloroquine and ethanol were added to the infusate after 1 h (control) for 1 h 20 min (treatment). The animals were switched back to the infusate alone for the final 1 h 40 min recovery periods. Urine flow Na(+) and K(+) excretion rates were determined at 20-min intervals over the subsequent 4-h postequilibration period. Blood was collected from separate groups of animals at the end of treatment period or equivalent time for control animals for measurement of plasma aldosterone and AVP concentrations by radioimmunoassay. Simultaneous chloroquine and ethanol infusion significantly (p < 0.01) increased plasma chloroquine concentrations in an ethanol dose-dependent manner by comparison with animals administered chloroquine alone. Chloroquine infusion alone (0.06 microg.min(-1)) and/or ethanol (2.4 or 24 microg.min(-1)) elevated plasma AVP concentrations from 9.73 +/- 1.64 fmol.l(-1) in control rats to 15.65 +/- 2.49 fmol.l(-1), 17. 39 +/- 4.21 fmol.l(-1), and 33.87 +/- 6.18 fmol.l(-1), respectively. Separate administration of chloroquine or ethanol at low dose rates increased urinary Na(+) excretion rates. We conclude that the impairment of renal electrolyte handling associated with chloroquine administration may be exacerbated by ethanol.

Cell delivery, intracellular trafficking and expression of an integrin-mediated gene transfer vector in tracheal epithelial cells

The mechanism of cell entry and intracellular fate of a gene transfer vector composed of a receptor-targeting, DNA-condensing peptide, RGD-oligolysine, a luciferase encoding plasmid DNA (pDNA) and a cationic liposome was examined. We demonstrate by confocal microscopy, electron microscopy and subcellular fractionation that the major mechanism of entry of the vector is endocytic. The vector complex rapidly (5 min) internalizes into early endosomes, then late endosomes and lysosomes. Entry involves, at least in part, clathrin-coated pit-mediated endocytosis since different conditions or drugs known to influence this pathway modify both uptake of pDNA and its expression. The observed increase in expression with addition of a lip some correlated with an increase in the rate of transfer of the pDNA to lysosomes, a decrease in intracellular recycling and exocytosis of the pDNA and an increase in the amount of pDNA in the nuclear fraction. Trafficking within the cell involved endosome fusion and the acid environment of the endosomes-lysosomes was beneficial for expression. After 30 min both the peptide and pDNA localized to the nucleus and the amount of intact pDNA in the nuclear fraction was highest with liposome and peptide. A better understanding of the cellular mechanisms by which vectors transfer to and traffic in cells should help design improved vectors.

Recent developments in gene-directed enzyme prodrug therapy (GDEPT) for cancer

Gene-directed enzyme prodrug therapy (GDEPT) is a promising two-step treatment for solid malignant tumors. In the first step, the gene for a foreign enzyme is administered and directed to the tumor, where it may be expressed using specific transcriptional elements. In the second step, prodrugs are administered and activated by the foreign enzyme expressed at the tumor. This review focuses on the progress from the end of 1997 to date. Important issues, such as viral and non-viral vectors, new enzyme/prodrug systems, new strategies, advances in the understanding of the bystander effects, the comparison of different systems used in GDEPT and clinical trials are outlined.

Prediction of maximal back muscle strength from indices of body mass and fat-free body mass

OBJECTIVES

The purpose of this study was to examine, in healthy volunteers, the relationship between back extensor muscle strength and body size.

METHODS

The maximal voluntary isometric back extensor strength of 456 volunteers, aged 18-42 yr and with no history of low back pain, was measured in a standing, slightly flexed forward posture. This was then correlated with two indices of body size: body mass and fat-free body mass.

RESULTS

Significant linear relationships were observed between back muscle strength and each of the two indices of body size. There was a gender difference in both the slope and the intercept of the regression equations describing the relationships. There was no independent influence of age within the range studied.

CONCLUSION

It was possible to establish predictive equations for back extensor strength based on body size which could be used to quantify strength 'deficits', for instance in patients with low back pain, and to prescribe submaximal target forces for use in endurance training and testing.

Predicting 'normal' grip strength for rheumatoid arthritis patients

OBJECTIVE

An ability to predict accurately 'normal' grip strength in rheumatoid arthritis (RA) patients would facilitate a more accurate assessment of the degree of their functional loss. This, in turn, would allow the setting of more meaningful treatment goals aimed at restoring hand function towards normal. This study carefully measures three modalities of hand grip strength and their correlation with multiple simple anthropometric parameters in normal subjects. We aim to determine which of these parameters are best correlated to grip strength, and whether this correlation is strong enough to allow the accurate prediction of what normal grip strength should be in RA patients.

METHODS

In 81 normal subjects (67 female), power, pinch and tripod grip strength measurements were made using an MIE digital pinch grip analyser. These strength data were correlated with specific local forearm anthropometric measurements: forearm circumference, forearm length, forearm volume, hand circumference, hand length, hand volume, hand and forearm volume, and various general anthropometric parameters (weight, height and age). These normal subjects had been chosen so as to be age and sex matched with 83 RA patients (67 female) in whom the same strength and anthropometric parameters were assessed and correlated. In patients, the grip strength results were additionally correlated with two markers of disease activity: a modified Ritchie Articular Index local to the hand and forearm (mRAI) and a visual analogue scale (VAS) assessing subjective pain severity.

RESULTS

In normal subjects, clear correlations were demonstrated between hand grip strengths and all specific anthropometric variables, the strongest correlation being with forearm and hand volume (r = 0.729 and 0.638 for dominant and non-dominant hands, respectively; P < 0.01 for both). The patients were considerably weaker than normal subjects. Markers of disease activity showed a negative correlation with grip strength. In normal subjects, the dominant hand was significantly stronger than the non-dominant hand, and on average by 8%, while the opposite was true in patients, who were 20% weaker on the dominant side.

CONCLUSION

Simple anthropometric measurements, and forearm and hand volume in particular, would be useful at baseline for predicting 'normal' hand grip strength in RA patients, both in the clinical setting and in research trials aimed at improving grip strength and hand function.

Serine and tyrosine phosphorylations cooperate in Raf-1, but not B-Raf activation

The Raf family of serine/threonine protein kinases couple growth factor receptor stimulation to mitogen activated protein kinase activation, but their own regulation is poorly understood. Using phospho-specific antisera, we show that activated Raf-1 is phosphorylated on S338 and Y341. Expression of Raf-1 with oncogenic Ras gives predominantly S338 phosphorylation, whereas activated Src gives predominantly Y341 phosphorylation. Phosphorylation at both sites is maximal only when both oncogenic Ras and activated Src are present. Raf-1 that cannot interact with Ras-GTP is not phosphorylated, showing that phosphorylation is Ras dependent, presumably occurring at the plasma membrane. Mutations which prevent phosphorylation at either site block Raf-1 activation and maximal activity is seen only when both are phosphorylated. Mutations at S339 or Y340 do not block Raf-1 activation. While B-Raf lacks a tyrosine phosphorylation site equivalent to Y341 of Raf-1, S445 of B-Raf is equivalent to S338 of Raf-1. Phosphorylation of S445 is constitutive and is not stimulated by oncogenic Ras. However, S445 phosphorylation still contributes to B-Raf activation by elevating basal and consequently Ras-stimulated activity. Thus, there are considerable differences between the activation of the Raf proteins; Ras-GTP mediates two phosphorylation events required for Raf-1 activation but does not regulate such events for B-Raf.

Cationic liposome-mediated DNA transfection in organotypic explant cultures of the ventral mesencephalon

We have examined the potential of cationic liposomes as a tool for approaches to gene therapy in the CNS. Our previous work has shown that cationic liposomes formulated from 3 beta-[N-(N',N'-dimethylaminoethane)carbamoyl] cholesterol (DC-Chol) and dioleoyl-L-alpha-phosphatidylethanolamine (DOPE) could achieve high transfection levels in a neuronal cell line (McQuillin et al. Neuroreport 1997; 8: 1481-1484). We therefore wished to assess transfection efficiencies in organotypic cultures from the brain with a reporter plasmid expressing E. coli beta-galactosidase in order to mimic an in vivo model. Explant cultures were generated according to the method of Stoppini et al (J Neurosci Meth 1991; 37: 173-182) with slight modifications. Brain slices were maintained on transparent porous membranes and were observed to maintain their intrinsic connectivity and cytoarchitecture to a large degree over periods of up to 6 weeks in culture. CNS tissue was obtained from rats at birth or 5 days after birth. After transfection beta-galactosidase expression was detected in cells of both neuronal and non-neuronal morphology. Control cultures were exposed to liposome alone and a plasmid that had the beta-galactosidase gene insert removed. Only low levels of endogenous beta-galactosidase reactivity were seen in these control cultures. DC-Chol/DOPE-mediated transfection was confirmed using a RT-PCR protocol capable of differentiating between untranscribed plasmid DNA and RNA generated from the transfected vector. These results suggest that cationic liposomes, particularly DC-Chol/DOPE liposomes, will be useful as delivery agents for gene transfer to CNS cells in vitro and possibly in vivo.

Liposomes enhance delivery and expression of an RGD-oligolysine gene transfer vector in human tracheal cells

Nonviral gene delivery systems consist predominantly of lipoplexes or receptor-targeting and nontargeting polyplexes. We examined integrin-mediated gene delivery using an Arg-Gly-Asp/oligo-L-lysine ([K]16RGD) cyclic peptide and investigated its gene transfer efficiency when associated with a cationic liposome. We demonstrated that human cystic fibrosis and noncystic fibrosis tracheal epithelial cells in culture express integrins that recognise the RGD integrin-binding motif. We found a 10-fold (P < 0.01) increased expression of a luciferase encoding plasmid in these cells when complexing the plasmid to the [K]16RGD peptide as compared with plasmid alone. This increase was specific to the [K]16RGD peptide since neither a [K]16RGE nor a [K]16 peptide gave a comparable increase. Expression was further enhanced 30-fold (P < 0.01) with lipofectamine and the ratio of DNA/peptide/lipofectamine was critical for specificity and expression. Fluorescence and radioactive labelling of the complex showed that the [K]16RGD peptide increased the endocytic uptake of DNA into cells. The cell association of both DNA and peptide increased even further with lipofectamine. Confocal microscopy showed that the [K]16RGD peptide and the DNA internalised together within 30 min and localised to vesicles in the perinuclear region. These results show that an integrin-binding ligand can deliver genetic material to airway cells and that a cationic liposome can enhance the efficacy of this nonviral vector system.

Electrical stimulation of human tibialis anterior: (A) contractile properties are stable over a range of submaximal voltages; (B) high- and low-frequency fatigue are inducible and reliably assessable at submaximal voltages

OBJECTIVES

To investigate the validity and reliability of submaximal voltage stimulation for assessing the 'fresh' contractile properties of human tibialis anterior muscle (TA) and the efficacy of such stimulation in inducing and assessing high- and low-frequency fatigue.

INTERVENTIONS

(A) Contractile properties of fresh TA were assessed in six normal volunteers using multifrequency stimulation trains (comprising 2 seconds at each of 10, 20 and 50 Hz, arranged contiguously) over a range of submaximal voltages. (B) On three separate occasions, fatigue was induced in the TA of 10 normal volunteers by means of a 3-minute unbroken sequence of the described multifrequency stimulation trains, delivered at a 'standardized' submaximal voltage. This fatiguing protocol was preceded by discrete multifrequency stimulation trains, at the same standardized voltage, but followed by discrete multifrequency trains delivered over a range of submaximal voltages (which included the standardized voltage).

OUTCOME MEASURES

In experiment A the 10:50 Hz and 20:50 Hz force ratios were analysed for between-voltages variability using coefficients of variation (CVs), and for trends using Friedman tests and post-hoc Wilcoxon tests. In experiment B low-frequency fatigue was detected using 10:50 Hz and 20:50 Hz force ratios derived from the discrete multifrequency trains. High-frequency fatigue was calculated from the decline in high-frequency force which occurred during the fatiguing protocol itself. Each parameter was assessed for between-days repeatability using CVs.

RESULTS

In experiment A the 'fresh' 10:50 Hz force ratio was clearly unreliable at voltages which generated <10% of maximal voluntary contractile force (MVC) (CV< or =29.7%), but was reasonably reliable at voltages which generated 20-30% of MVC (CV < or = 11.5%; p = 0.847). The 'fresh' 20:50 Hz force ratio was,in contrast, extremely reliable throughout the tested voltage range (CV< or =5.8%; p = 0.636) in fresh muscle. In experiment B paired t-tests indicated that the fatiguing protocol induced significant high-frequency fatigue (p <0.0037) and low-frequency fatigue (p <0.0008 for 'fresh' versus 'fatigued' 10:50 Hz force ratio; p <0.0001 for 'fresh' versus 'fatigued' 20:50 Hz force ratio). In muscle thus fatigued, the 20:50 Hz force ratio was extremely reliable in the 20-33% of MVC range (CV < or =7.3%; p = 0.847). Between-days repeatability was poor for the 10:50 Hz force ratio in both fresh and fatigued muscle (CV < or =23.8 and 44.4% respectively), but was highly acceptable for both voluntary and stimulated fatigue indices and for the 20:50 Hz force ratio, the latter in both fresh and fatigued muscle.

CONCLUSIONS

These results confirm the validity and reliability of submaximal voltages in assessing contractile properties (including low-frequency fatiguability) and inducing fatigue of human TA.

Enhanced in vitro and in vivo gene delivery using cationic agent complexed retrovirus vectors

Retroviruses are, at present, the most efficient integrative vectors available for gene delivery. However, these viruses are still limited by relatively low titres. Although several protocols exist to improve virus titre most of them are time-consuming and unable to provide sufficient virus for in vivo applications. Virus titre can be enhanced by polybrene and other cationic agents. By investigating a broad range of cationic agents for their ability to enhance virus infectivity we found that both ecotropic and amphotropic retrovirus infection could be increased. In particular, the lipopolyamine dioctadecylamidoglycylspermine (DOGS) gave up to one order of magnitude enhancement above polybrene-mediated infection without cytotoxicity. To increase virus infectivity further we combined the enhancing effect of DOGS on virus infectivity with concentration of virus particles by ultrafiltration to reach titres of 1 x 10(9) IU/ml. The in vivo transduction of regenerating rat liver, by an amphotropic retrovirus was increased approximately five-fold by the addition of DOGS compared with virus alone. There was no animal toxicity observed following the administration of DOGS. The improved transduction efficiency seen both in vitro and in vivo following the co-administration of DOGS/virus complexes may be useful for future gene therapy applications.

Endothelial cell transfection with cationic liposomes and herpes simplex-thymidine kinase mediated killing

Endothelial cells are a promising target for cancer gene therapy because neoangiogenesis is vital for the supply of oxygen and nutrients to solid tumours. However, endothelial cells have been reported to be difficult to transfect. We demonstrate high rates of transfection with the reporter gene pSV40 beta gal using DC-Chol/DOPE cationic liposomes and lower rates with the novel polyamine cationic liposomes ACHx/DC-Chol/DOPE and ACO/DC-Chol/DOPE. Endothelial cells transfected with HSV-thymidine kinase using DC-Chol/DOPE demonstrated 3 log10 increased cytotoxicity compared with controls when exposed to the prodrug ganciclovir, thereby demonstrating significant biological effect.

An RGD-oligolysine peptide: a prototype construct for integrin-mediated gene delivery

We have synthesized a linear, bifunctional peptide that comprises an integrin-targeting domain containing an arginine-glycine-aspartic acid tripeptide motif and a DNA-binding moiety consisting of a short stretch of 16 lysine residues. This peptide can form distinctive, condensed complexes with DNA and is capable of mediating its delivery and expression in a variety of mammalian cells in culture. Internalization is mediated by cell surface integrin receptors via a mechanism that is known to be phagocytic. We have analyzed the relationship between DNA and peptide and have investigated the conditions suitable for optimal gene delivery. The formation of condensed peptide DNA complexes leads to resistance to nuclease degradation. The level of reporter gene expression obtained is dependent on the peptide-to-DNA ratio and is enhanced in the presence of the endosomal buffer chloroquine, polyethyleneimine, and deactivated adenovirus during gene delivery. Under optimal conditions the levels of reporter gene expression obtained approach or even exceed those obtained with DNA delivered with the commercial liposome Lipofectamine. The ability to produce an efficient gene delivery system using small, easily modified, and well-defined constructs that have no constraint of particle size demonstrates the advantages of integrin-targeting peptides for gene transfer.

The influence of muscle fiber size and type distribution on electromyographic measures of back muscle fatigability

STUDY DESIGN

This was a cross-sectional study carried out on a group of 31 healthy, consenting volunteers with no history of low back pain (17 men, 14 women).

OBJECTIVES

To evaluate the relationship between electromyographic measures of erector spinae fatigability and the muscle's fiber type characteristics.

SUMMARY OF BACKGROUND DATA

Using electromyographic techniques, a pronounced fatigability of the muscles of patients with low back pain has been identified. It has been postulated that this is the result of an unfavorable back muscle fiber type distribution, although an association between electromyographic measures of fatigue and the muscle's fiber type characteristics has never been established.

METHODS

Two tests of back extensor fatigability were performed (on separate days), each to the limit of endurance: 1) maintenance of 60% total maximum voluntary contraction of the back extensors, and 2) performance of the Biering-Sørensen test. Pairs of surface electrodes were attached to the skin overlying the belly of the erector spinae, bilaterally, at T10 and L3. The median frequency was computed from the electromyographic power spectrum, and fatigability was given by the slope of the linear regression of median frequency on time (MFgrad; %.s-1). One week later, two percutaneous erector spinae muscle biopsy samples were obtained from the same sites described for electromyography (left side only). Samples were prepared for histochemistry for the identification of muscle fiber types. Fiber sizes (cross-sectional areas) were quantified using computerized image analysis.

RESULTS

The mean fiber size at each erector spinae region showed a significant correlation with maximum back extensor strength. In the thoracic region, the relative area of the muscle occupied by Type I fibers (which accounts for the relative size and distribution of the fiber types) showed a significant relationship with MFgrad recorded during each fatigue test. A similar relationship was observed for the lumbar region, but for the Biering-Sørensen test only.

CONCLUSIONS

The electromyographic changes recorded in back muscles during fatigue appear to be related to the underlying muscle fiber type area distribution. This confirms the usefulness of electromyography in reflecting such muscle characteristics in a noninvasive manner, when monitoring changes in function consequent to the development of, or rehabilitation from, low back pain.

Urinary excretion of albumin and retinol binding protein in systemic lupus erythematosus

We have measured the urinary excretion of total protein, albumin and retinol binding protein (RBP) in random urine specimens obtained from 40 female patients with systemic lupus erythematosus (SLE). Thirty-three of these patients had no clinical evidence of any renal impairment (non-renal SLE); seven had overt renal disease (renal SLE). RBP:creatinine ratios were significantly higher in non-renal SLE patients compared with female controls (P = 0.002). There was no significant difference between urine total protein concentrations, albumin:creatinine or total protein:creatinine ratios in non-renal SLE patients when compared with controls, despite approximately 20% of these patients having elevated excretion of total protein or albumin. All seven renal SLE patients had elevated albumin:creatinine ratios but only four of them had an increased RBP:creatinine ratio. Of 29 non-renal SLE patients who had urinary total protein concentrations below 0.2 g/L, (i.e. approximating to a negative protein dipstick), 14 had increases in either albumin or RBP:creatinine ratios. Only two patients had increases in both. In the absence of clinical evidence of renal disease, increases in urinary albumin or RBP excretion could indicate subclinical nephropathy and measurements may have a role in the early diagnosis and subsequent monitoring of renal disease in SLE.