The role of inflammatory bowel disease susceptibility loci in multiple sclerosis and systemic lupus erythematosus

To date, three loci have been validated to confer susceptibility to inflammatory bowel disease (IBD): the CARD15/NOD2 gene, the discs large homolog 5 gene (DLG5), and the IBD5 locus on 5q31 (IBD5). We have explored the possibility that these loci may also be associated with susceptibility to two other chronic inflammatory diseases, multiple sclerosis (MS) and systemic lupus erythematosus (SLE). As the CARD15 risk alleles had previously been assessed in our collection of 496 MS trios, we focused our efforts on the DLG5 risk allele and the IBD5(risk) haplotype (IBD5(risk)) for MS. While there is no evidence of association within our MS sample with either of these polymorphisms, screening of 1027 subjects with SLE suggests that IBD5(risk) may have a modest contribution to disease risk in the subset of SLE subjects without lupus nephritis. In addition, a pooled analysis of existing published and unpublished data in 1305 cases of SLE genotyped for the CARD15 risk alleles suggests that only the CARD15(908R) IBD risk allele may have a strong effect on risk of SLE. Our data, therefore, suggest that both the CARD15 gene and the IBD5 locus may have a role as general susceptibility loci for certain common, genetically complex inflammatory diseases.

Determining 'need' for a Removable Partial Denture: a qualitative study of factors that influence dentist provision and patient use

OBJECTIVE

To identify factors that influence Removable Partial Denture (RPD) provision, and patient use of RPDs in the UK.

DESIGN

Exploratory qualitative interview study.

SUBJECTS AND METHODS

SUBJECTS

There were two sample groups. A purposive sample of 16 male and female dentists was categorised in terms of level of RPD provision, experience, and practice characteristics. A purposive sample of 17 male and female partially dentate patients was categorised in terms of RPD use and demographic characteristics.

DATA COLLECTION

Semi-structured in-depth interviews.

RESULTS

For dentists, RPD provision was indicated by patient demand and physical function of the remaining teeth, but was mediated by NHS fee structures and professional satisfaction. For patients, RPD use was influenced by the trade-off between improved appearance and the unpalatable presence of an RPD in their mouth. The location of the gap(s) was important, but other issues were relevant such as ability to "manage" without the RPD.

CONCLUSION

When defining "need" for an RPD, dentists focused on physical function of the teeth whereas patients focused on social meanings of the mouth. These differing priorities may improve understandings of patient non-compliance in RPD use. Further research on the relationship between denture use and social identity could be beneficial.

Échographie pédiatrique ostéo-articulaire

Ultrasound examination is often the most effective and sometimes the only practical means of examining children with soft tissue, tendon and joint diseases. This review will cover the important application of diagnostic ultrasound in children musculoskeletal disorders. We will consider topics where ultrasound is the only sensible means of examination such as developmental dysplasia of the hip, where it is the best choice of several possible methods such as painful hip and when it provides an alternative or adjunct to other imaging such as the examination of soft tissue masses.

One year results of the Middlesbrough early revascularisation to limit infarction (MERLIN) trial

OBJECTIVE

To report one year results of the MERLIN (Middlesbrough early revascularisation to limit infarction) trial, a prospective randomised trial comparing the strategy of coronary angiography and urgent revascularisation with conservative treatment in patients with failed fibrinolysis complicating ST segment elevation myocardial infarction (STEMI). The 30 day results have recently been published. At the planning stage of the trial, it was determined that follow up of trial patients would continue annually to three years to determine whether late benefit occurred.

SUBJECTS

307 patients who received a fibrinolytic for STEMI but failed to reperfuse early according to previously described ECG criteria and did not develop cardiogenic shock.

METHODS

Patients were randomly assigned to receive either emergency coronary angiography with a view to proceeding to urgent revascularisation (rescue percutaneous coronary intervention (rPCI) arm) or continued medical treatment (conservative arm). The primary end point was all cause mortality at 30 days. The secondary end points included the composite end point of death, reinfarction, stroke, unplanned revascularisation, or heart failure at 30 days. The same end points were evaluated at one year and these results are presented.

RESULTS

All cause mortality at one year was similar in the conservative arm and the rPCI arm (13.0% v 14.4%, p = 0.7, risk difference (RD) -1.4%, 95% confidence interval (CI) -9.3 to 6.4). The incidence of the composite secondary end point of death, reinfarction, stroke, unplanned revascularisation, or heart failure was significantly higher in the conservative arm (57.8% v 43.1%, p = 0.01, RD 14.7%, 95% CI 3.5% to 25.5%). This was driven almost exclusively by a significantly higher incidence of subsequent unplanned revascularisation in the conservative arm (29.9% v 12.4%, p < 0.001, RD 17.5%, 95% CI 8.5% to 26.4%). Reinfarction and clinical heart failure were numerically, but not statistically, more common in the conservative arm (14.3% v 10.5%, p = 0.3, RD 3.8%, 95% CI -3.7 to 11.4, and 31.2% v 26.1%, p = 0.3, RD 5.0%, 95% CI -5.1 to 15.1). There was a strong trend towards fewer strokes in the conservative arm (1.3% v 5.2%, p = 0.06, RD -3.9%, 95% CI -8.9 to 0.06).

CONCLUSION

At one year of follow up, there was no survival advantage in the rPCI arm compared with the conservative arm. The incidence of the composite secondary end point was significantly lower in the rPCI arm, but this was driven almost entirely by a highly significant reduction in the incidence of further revascularisation.

Exact results for one-dimensional disordered bosons with strong repulsion

We study one-dimensional disordered bosons with strong repulsive interactions. A Bose-Fermi mapping expresses this problem in terms of noninteracting Anderson-localized fermions, whereby known results for the distribution function of the local density of states, the spectral statistics, and density-density correlations can be transferred to this new domain of applicability. We show that disorder destroys bosonic quasi-long-range order by calculating the momentum distribution, and comment on the experimental observability of these predictions in ultracold atomic gases.

Bioprocess development for the production of a recombinant MUC1 fusion protein expressed by CHO-K1 cells in protein-free medium

The mucin MUC1 is a candidate for use in specific immunotherapy against breast cancer, but this requires the large-scale production of a MUC1 antigen. In this study, a bioprocess for the expression of a recombinant MUC1 fusion protein with a cancer associated glycosylation in CHO-K1 cells has been developed. Cells permanently expressing parts of the extracellular portion of MUC1 fused to IgG Fc were directly transferred from adherent growth in serum-containing medium to suspension culture in the protein-free ProCHO4-CDM culture medium. Using the Cellferm-pro system, optimal culture parameter as pH and pO(2) were determined in parallel spinner flask batch cultures. A pH of 6.8-7.0 and a pO(2) of 40% of air saturation was found to give best cell growth and productivity of secreted recombinant protein. Specific productivity strongly depended the pO(2) and correlated with the online monitored oxygen uptake rate (OUR) of the cells, which indicates a positive influence of the rate of oxidative phosphorylation on productivity. The optimised conditions were applied to continuous perfusion culture which gave very high cell densities and space time yields of the recombinant MUC1 fusion protein, allowing production at gram scale. The product degradation was much lower in supernatants from continuous perfusion culture compared to batch mode. Antibodies reacting with cancer associated MUC1 glycoforms strongly bound to the fusion protein, indicating that the desired glycoforms were obtained and suggesting that the recombinant MUC1 protein could be tested for use in immunotherapy.

Interference of atomic levels and superfluid-Mott insulator phase transitions in a two-component Bose-Einstein condensate

The superfluid-Mott insulator phase transition in a Bose-Einstein condensate of neutral atoms with doubly degenerate internal ground states in an optical lattice is theoretically investigated. The optical lattice is created by two counterpropagating linearly polarized laser beams with the angle theta between the polarization vectors (lin-angle-lin configuration). The phase diagram of the system and the critical values of the parameters are worked out. It is shown that the sign of the detuning plays an important role and that there is a strong suppression of the Mott transition in the case of blue detuning. Varying the laser intensity and/or the angle theta one can manipulate the Mott insulator to superfluid quantum phase transition as well as prepare the condensate in physically distinguishable "ferromagnetic" and "antiferromagnetic" superfluid states.

Haematologic determinants of left atrial spontaneous echo contrast in mitral stenosis

OBJECTIVES

To determine if a relationship exists in mitral stenosis, in patients with either sinus rhythm or atrial fibrillation, between left atrial spontaneous echo contrast and the haematologic indices haematocrit, red cell concentration, mean corpuscular volume, platelet count and volume.

METHODS

Left atrial spontaneous echo contrast severity was graded on a scale of 0-4 in 163 patients with symptomatic mitral stenosis (84 patients in sinus rhythm, 79 patients in atrial fibrillation) undergoing transesophageal echocardiography, cardiac catheterization and full blood examination as part of assessment prior to balloon mitral valvuloplasty.

RESULTS

In sinus rhythm, spontaneous echo contrast grade was negatively correlated with cardiac index (r=-0.33), mitral valve area (r=-0.25) and mitral regurgitation grade (r=-0.22) and positively correlated with haematocrit (r=0.24) and red cell concentration (r=0.25). Spontaneous echo contrast grade was not correlated with left atrial diameter or mean corpuscular volume. In atrial fibrillation, spontaneous echo contrast grade was also negatively correlated with mitral valve area (r=-0.25) and mitral regurgitation (r=-0.36) but was positively correlated with left atrial diameter (r=0.34) and was not correlated with cardiac index, haematocrit or red cell concentration. There was no correlation between spontaneous echo contrast grade and platelet variables in either group.

CONCLUSIONS

Natural variation in red cell concentration in patients with symptomatic mitral stenosis was an independent predictor of the severity of left atrial spontaneous echo contrast in sinus rhythm, but no relationship between red cell concentration and spontaneous echo contrast grade was evident in atrial fibrillation.

Multilocation trial of ceftiofur for treatment of postpartum cows with fever

OBJECTIVE

To evaluate the effect of ceftiofur for treatment of postpartum cows with fever.

DESIGN

Multilocation randomized complete block design trial.

ANIMALS

330 cows.

PROCEDURE

Cows with rectal temperature > or = 39.5 C (103.1 F) during the first 10 postpartum days were randomly assigned to a treatment (ceftiofur; 1 mg/kg [0.45 mg/lb] of body weight daily for 3 days) or untreated control group. Cure (no additional or alternative antimicrobial treatment used, rectal temperature < 39.5 C, and no other concurrent clinical signs of disease when evaluated at 9 or 10 days after enrollment), milk production, and rectal temperature were evaluated.

RESULTS

Ceftiofur-treated cows were significantly more likely to be cured than control cows (56.0 vs 28.9%, respectively), with an odds ratio of 3.14 when vaginal discharge (a factor with moderate interaction with treatment) was present at enrollment. Among cows that had an abnormal calving (a significant interaction factor), treated cows had first milking yield 2.27 kg (5 lb) greater than control cows. Treated cows had a significantly greater reduction in rectal temperature (1.19 C [2.14 Fl), compared with control cows (1.04 C [1.87 F]).

CONCLUSIONS AND CLINICAL RELEVANCE

Parenteral administration of ceftiofur significantly improved cure rate, milk yield, and rectal temperature in postpartum cows with fever and vaginal discharge or dystocia. These findings provide information to determine appropriate treatment for postpartum cows, which for years has been debated in the dairy industry.

A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy

BACKGROUND

Current management of extraperitoneal rectal injuries involves a laparotomy and diversion of the fecal stream. In this study, we review our experience with laparoscopy and diverting loop sigmoid colostomy without laparotomy in the management of these injuries.

METHODS

All patients admitted to the trauma unit at Groote Schuur Hospital between January 1995 and May 2000 with a rectal injury were evaluated. The presence of a rectal injury was confirmed by rectal examination and proctosigmoidoscopy. Intraperitoneal injuries were excluded by laparoscopy. Only patients who did not have intraperitoneal injuries were included in the study. The patients were then managed with a diverting loop sigmoid colostomy created through an abdominal wall trephine without laparotomy.

RESULTS

Ten patients were included in the study. In eight patients, laparoscopy excluded intraperitoneal injuries. All 10 patients had a diverting loop sigmoid colostomy fashioned. There were no complications related to either the rectal injury or colostomy. Nine stomas have since been closed.

CONCLUSION

In patients with isolated extraperitoneal rectal injuries, laparoscopic exclusion of intraperitoneal injuries, followed by a diverting loop sigmoid colostomy, is a feasible option.

Dissociating the neural correlates of item and context memory: an ERP study of face recognition

We investigated the neural correlates of item and context retrieval using event-related potentials (ERPs). Participants studied unfamiliar faces with happy or neutral expressions, and at test, they decided whether test faces were studied in the same or in a different expression, or were new. The parietal ERP effect, which is hypothesized to indirectly reflect medial-temporal lobe (MTL) function, was sensitive to item retrieval, whereas the frontal ERP effect, which is thought to reflect prefrontal cortex (PFC) function, was sensitive to context retrieval. Converging with lesion, functional neuroimaging (PET and fMRI), and ERP evidence, these results support the notion that item retrieval is primarily associated with MTL function whereas context retrieval is primarily associated by PFC function.

Bisphosphonates--mechanisms of action in multiple myeloma

Bisphosphonates are a class of anti-resorptive drugs, which are effective in the treatment of osteoclast-mediated bone disease, including the osteolytic bone disease. which is a major clinical feature of patients with multiple myeloma. Recently, increases in survival following treatment with pamidronate have been observed in some patients with multiple myeloma, raising the possibility that bisphosphonates may also have an anti-tumour effect. We have demonstrated that bisphosphonates can have an anti-tumour effect in human myeloma cell in vitro, and that these anti-tumour effects induced by potent nitrogen-containing bisphosphonates are a result of inhibition of enzymes of the mevalonate pathway. However, we and others have been unable to demonstrate an anti-tumour effect of the potent bisphosphonate ibandronate in vivo, using murine models of multiple myeloma. It is therefore likely that only by studying patients receiving bisphosphonates will we be able to determine whether these compounds have a clinically important anti-tumour effect.

Event-related potentials of recognizing happy and neutral faces

In event-related potentials (ERPs) studies, recognition memory is associated with two positivities: one over parietal regions, and one over frontal regions. With nameable neutral stimuli, such as words or common objects, the parietal effect is usually left lateralized, and the frontal effect is usually right lateralized. We investigated the lateralization of these effects for nonnameable emotional stimuli: unfamiliar faces with happy and neutral expressions. The parietal effect was bilateral, suggesting that the left lateralization of this effect in studies using nameable stimuli reflected verbal processing. The frontal effect was left lateralized for happy faces, but right lateralized for neutral faces. This finding is consistent with the valence hypothesis, which posits that processing of pleasant emotions is lateralized to the left hemisphere.