Hepatic capillariasis in a Cape ground squirrel (Xerus inaurus)

We report, for the first time, an incidental finding of Calodium hepaticum infestation in a sub-adult female Cape ground squirrel (Xerus inaurus). Post mortem examination of the squirrel revealed severe haemoperitoneum, splenomegaly and hepatomegaly with miliary white spots distributed diffusely throughout the hepatic parenchyma. Histologically the portal tracts in the liver showed granulomatous inflammation with fibrosis and numerous giant cells. Occasional adult worms were identified and there were multiple C. hepaticum eggs distributed diffusely throughout the portal tracts and the parenchyma. The spleen also contained C. hepaticum eggs. The genus Rattus is the primary host and reservoir of C. hepaticum, but C. hepaticum infections have been reported previously in other Sciuridae. Based on our findings, people should be cautious of the zoonotic potential of C. hepaticum, when they come into contact with the Cape ground squirrel.

Resibufogenin prevents the manifestations of preeclampsia in an animal model of the syndrome

BACKGROUND AND OBJECTIVES

We have developed a rat model of preeclampsia which is based upon excessive volume expansion and includes hypertension, proteinuria and intrauterine growth restriction. In this model, the urinary excretion of the circulating steroid inhibitor of Na +/ K+ ATPase, marinobufagenin, is increased prior to the development of hypertension and proteinuria. An analogue of marinobufagenin, resibufogenin, successfully treats the hypertension and proteinuria.

METHODS

We administered resibufogenin early in pregnancy in this model, prior to the development of the syndrome.

RESULTS

We found that resibufogenin not only prevented the advent of hypertension and proteinuria, but also the development of intrauterine growth restriction.

DISCUSSION

These results may have relevance to the human condition.

The contractile deceleration point: an important physiologic landmark on oesophageal pressure topography

BACKGROUND

This study aimed to correlate oesophageal bolus transit with features of oesophageal pressure topography (OPT) plots and establish OPT metrics for accurately measuring peristaltic velocity.

METHODS

About 18 subjects underwent concurrent OPT and fluoroscopy studies. The deglutitive Contractile Front Velocity (CFV) in OPT plots was subdivided into an initial fast phase (CFV(fast)) and subsequent slow phase (CFV(slow)) separated by a user-defined deceleration point (CDP). Fluoroscopy studies were analyzed for the transition from the initial rapidly propagated luminal closure associated with peristalsis to slow bolus clearance characteristic of phrenic ampullary emptying and to identify the pressure sensors at the closure front and at the hiatus. Oesophageal pressure topography measures were correlated with fluoroscopic milestones of bolus transit. Oesophageal pressure topography studies from another 68 volunteers were utilized to develop normative ranges for CFV(fast) and CFV(slow).

KEY RESULTS

A distinct change in velocity could be determined in all 36 barium swallows with the fast and slow contractile segments having a median velocity of 4.2 cm s(-1) and 1.0 cm s(-1), respectively. The CDP noted on OPT correlated closely with formation of the phrenic ampulla making CFV(fast) (mean 5.1 cm s(-1)) correspond closely to peristaltic propagation and CFV(slow) (mean 1.7 cm s(-1)) to ampullary emptying.

CONCLUSIONS & INFERENCES

The deceleration point in the CFV on OPT plots accurately demarcated the early region in which the CFV reflects peristaltic velocity (CFV(fast)) from the later region where it reflects the progression of ampullary emptying (CFV(slow)). These distinctions should help objectify definitions of disordered peristalsis, especially spasm, and improve understanding of impaired bolus transit across the oesophagogastric junction.

Factors influencing Australian community pharmacists' willingness to participate in research projects - an exploratory study

Objective

To identify the factors influencing Australian community pharmacists' willingness to participate in research projects and their attitudes towards research.

Method

A mixed-method survey instrument comprising demographics, previous participation in research, and perceptions about participation in research was mailed to 267 community pharmacists in New South Wales and the Australian Capital Territory. An analysis of variance test was used to identify similarities and differences between research- and non-research-active respondents. Bivariate correlations and partial least squares (PLS) regression analyses were used to identify barriers and facilitators to research participation.

Key findings

The overall response rate to the survey was 40%. Of these, 70% were classified as previous research participants (PRP), and 30% were classified as non-previous research participants (NPRP). Both groups had mostly favourable attitudes towards research; however, the results revealed several differences between the PRP and NPRP groups. Three items were identified as key facilitators to participation in research for both PRP and NPRP groups - having an interest in the research topic; believing that the research will benefit the customer; and a belief that community pharmacy research is important. Lack of time, either real or perceived, was identified as a key barrier to participation in research for both the PRP and NPRP groups.

Conclusion

Researchers should take into account pharmacists' previous research experience when recruiting pharmacists into research projects. In the case of pharmacists with research experience, emphasis should be on promoting factors that facilitate participation. In the case of pharmacists with little research experience, emphasis should be on reducing barriers to participation.

Incidence Rates of Invasive Breast Cancer in Postmenopausal Women with and without a Family History of Breast Cancer and Stratified by Breast Cancer Risk Score

Background: Health care professionals often consider family history the most important indicator of invasive breast cancer (IBC) risk and may assume women without a family history of breast cancer (FHBC) are at low risk for IBC. This analysis compared the incidence of IBC in postmenopausal women (PMW) with and without FHBC who were enrolled in the placebo arms of 2 clinical trials.Materials and Methods: The study population for this analysis was PMW with osteoporosis or women with or at high risk for coronary artery disease (CAD). The breast cancer risk (BCR) score [or absolute risk] was calculated using the breast cancer risk assessment (BCRA) tool from the National Cancer Institute (NCI). Descriptive statistics (eg, mean age, BCR score) were calculated for women with or without FHBC. The BCR score was binned into unit intervals and, within each unit, the number of patients, number of IBC cases, and the IBC incidence rates were calculated.Results: Of the 6322 patients included in this analysis (excluding patients ≥86 years old, or with a history of ductal carcinoma in situ or lobular carcinoma in situ), 92 developed IBC (Table 1). For PMW with FHBC [164;12.9%], the mean (±SD) age was 71.3±6.9, the mean BCR score (%) was 3.65±1.09, and all 164 (100%) had a BCR score ≥1.66%, which is consistent with the NSABP Breast Cancer Prevention Trial's definition of “high risk.” For women without FHBC, the mean age was 70.8±6.7, the mean BCR score was 1.74±0.44 and 598 (55.1%) women belonged to the high risk group. For women with or at high risk for CAD and FHBC [443; 8.8%], the mean age was 68.9±6.8, the mean BCR score was 3.52±1.25, and 441 (99.5%) were in the high-risk group. Among women without FHBC (n=4589), the mean age was 67.3±6.6, the mean BCR score was 1.54±0.40, and 1605 (35.0%) were at high risk for IBC. The incidence rate of IBC increased as the absolute risk of breast cancer increased or if FHBC was present, more IBC cases were recorded in women with a lower absolute risk of breast cancer or without a FHBC (Figure 1).Discussion: In general, incidence rates of IBC correlated with BCR estimates and incidence rates were higher as BCR scores increased. However, the majority of women who developed breast cancer had scores between 1% and 2% and did not have FHBC (76/92; 82.6%); many women with IBC (40/92; 43.5%) had BCR scores below the defined high risk cutoff of 1.66%.Total number of all patients, IBC cases and incidence rates grouped by unit BCRA tool score intervalsBCRA Tool Score (%)No. PatientsNo. IBC CasesIBC Incidence Rate(0,1]36610.52(1,2]4602602.61(2,3]881163.74(3,4]369116.28(4,5]35  (5,6]27215.81(6,7]21  (7,8]18222.9(8,9]1  (9,10]1  (10,11]   (11,12]1  Total632292  Figure 1: Invasive breast cancer cases and incidence rate by unit BCRA tool risk intervals. The number of cases represented by the black and gray bars are stacked and not additive.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6066.

The endocannabinoid anandamide inhibits cholangiocarcinoma growth via activation of the noncanonical Wnt signaling pathway

Cholangiocarcinomas are cancers that have poor prognosis and limited treatment options. The noncanonical Wnt pathway is mediated predominantly by Wnt 5a, which activates a Ca(2+)-dependent pathway involving protein kinase C, or a Ca(2+)-independent pathway involving the orphan receptor Ror2 and subsequent activation of Jun NH(2)-terminal kinase (JNK). This pathway is associated with growth-suppressing effects in numerous cell types. We have shown that anandamide decreases cholangiocarcinoma growth in vitro. Therefore, we determined the effects of anandamide on cholangiocarcinoma tumor growth in vivo using a xenograft model and evaluated the effects of anandamide on the noncanonical Wnt signaling pathways. Chronic administration of anandamide decreased tumor growth and was associated with increased Wnt 5a expression in vitro and in vivo. Treatment of cholangiocarcinoma cells with recombinant Wnt 5a decreased cell proliferation in vitro. Neither anandamide nor Wnt 5a affected intracellular calcium release, but both increased the JNK phosphorylation. Stable knockdown of Wnt 5a or Ror2 expression in cholangiocarcinoma cells abolished the effects of anandamide on cell proliferation and JNK activation. Modulation of the endocannabinoid system may be important in cholangiocarcinoma treatment. The antiproliferative actions of the noncanonical Wnt signaling pathway warrants further investigation to dissect the mechanism by which this may occur.

Regional-scale models for relating land cover to basin surface-water quality using remotely sensed data in a GIS

Plant-based management systems implementing deep-rooted, perennial vegetation have been identified as important in mitigating the spread of secondary dryland salinity due to its capacity to influence water table depth. The Glenelg Hopkins catchment is a highly modified watershed in the southwest region of Victoria, where dryland salinity management has been identified as a priority. Empirical relationships between the proportion of native vegetation and in-stream salinity were examined in the Glenelg Hopkins catchment using a linear regression approach. Whilst investigations of these relationships are not unique, this is the first comprehensive attempt to establish a link between land use and in-stream salinity in the study area. The results indicate that higher percentage land cover with native vegetation was negatively correlated with elevated in-stream salinity. This inverse correlation was consistent across the 3 years examined (1980, 1995, and 2002). Recognising the potential for erroneously inferring causal relationships, the methodology outlined here was both a time and cost-effective tool to inform management strategies at a regional scale, particularly in areas where processes may be operating at scales not easily addressed with on-site studies.

Behavioural, histological and cytokine responses during hyperalgesia induced by carrageenan injection in the rat tail

We produced experimental inflammatory hyperalgesia by injecting carrageenan into the tail of Sprague-Dawley rats. We compared the rats' voluntary running wheel activity following carrageenan injection into the tail to that after carrageenan injection into the hind paw, the conventional site of inflammation, to identify whether the site of inflammatory-induced hyperalgesia altered voluntary activity. We also measured voluntary running before and after injection of carrageenan or saline into the tail or hind paw, and in separate groups of rats we measured the nociceptive response and the associated pro-inflammatory cytokine profiles following a carrageenan injection into the tail. Female rats were injected intradermally with either 2 mg carrageenan or saline into the dorsal surface of the tail. Withdrawal responses to noxious heat (49 degrees C water), and punctate mechanical (electronic anaesthesiometer) challenges were recorded in 12 rats for 3 days before and 1 h to 48 h after injection. In a separate group of rats, interleukin (IL)-1beta, IL-6, tumour necrosis factor-alpha (TNF-alpha) and cytokine-induced neutrophil chemoattractant (CINC-1) concentrations were measured in plasma and tail tissue samples taken at the site of injection, 3 h, 6 h and 24 h after injections. Voluntary wheel running was reduced significantly following carrageenan injection into the hind paw compared to that after saline injection into the hind paw. Carrageenan injection into the tail did not result in significant reduction in wheel running compared to that after saline injection into the tail. Both thermal and mechanical hyperalgesia were present after carrageenan injection into the tail (P<0.01, ANOVA). The hyperalgesia at the site coincided with significant increases in TNF-alpha, IL-1beta, IL-6 and CINC-1 tissue concentrations, peaking 6 h after carrageenan injection (P<0.01, ANOVA). We conclude that carrageenan injection into the tail produces inflammatory hyperalgesia with underlying pro-inflammatory cytokine release, but does not affect voluntary running wheel activity in rats.

A phase I trial of AVN944 in patients with advanced hematologic malignancies

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Background: AVN-944 is an inhibitor of inosine monophosphate dehydrogenase (IMPDH), an enzyme that catalyzes the rate- limiting step in guanine nucleotide synthesis, and induces apoptosis in malignant hematopoietic cell lines in vitro. Methods: This phase I study employed open-label dose escalations in patients (pts) with relapsed, refractory hematologic cancers with safety, pharmacokinetic (PK), pharmacodynamic, & efficacy endpoints. Between 12/05 and 1/07 a total of 70 cycles of AVN944 at 25 (7pts), 50 (6pts), 75 (7pts), 100 (7pts) or 125 mg (3pts) b.i.d. orally X 21d every 28d were administered to 30 pts with AML (12), ALL (2), CLL (3), and multiple myeloma (13). Peripheral blood mononuclear cell (PBMC) or leukemic blast samples were obtained from all pts pre and post-receiving AVN944 to determine effects on GTP pools, IMPDH activity, and to correlate these changes to response in a 32-gene set that relates directly to cellular pathways dependent upon guanine nucleotide biosynthesis. Results: Pharmacokinetics were dose proportional with mean Tmax=1 hour, T1/2=1.5 hours, Cmax=2800 ng/ml and AUC=7228 hr.ng/ml at the 100 mg b.i.d. dose. Toxicities were generally mild-moderate and/or not attributed to AVN944. Twelve serious adverse events (SAEs) occurred in 8 pts; 7 of 8 had AML. No SAEs was attributed to AVN944. DLT was not seen. No protocol defined responses were seen. Twelve of 24 assessable pts had stable disease of 2 to 10 months duration. Changes in the gene expression set correlated with disease stability. Conclusions: AVN944 is well tolerated with oral b.i.d. dosing. Stabilization of disease was observed in half of the pts. Gene expression correlated with stable versus progressive disease.

[Table: see text]

The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia

AIM

To assess the impact of a community pharmacy diabetes service model on patient outcomes in Type 2 diabetes.

METHODS

The study utilized a multisite, control vs. intervention, repeated-measures design within four states in Australia. Fifty-six community pharmacies, 28 intervention and 28 control, were randomly selected from a representative sample of urban and rural areas. Intervention pharmacies delivered a diabetes service to patients with Type 2 diabetes, which comprised an ongoing cycle of assessment, management and review, provided at regular intervals over 6 months in the pharmacy. These services included support for self monitoring of blood glucose, education, adherence support, and reminders of checks for diabetes complications. Control pharmacists assessed patients at 0 and 6 months and delivered no intervention.

RESULTS

A total of 289 subjects (149 intervention and 140 control) completed the study. For the intervention subjects, the mean blood glucose level decreased over the 6-month study from 9.4 to 8.5 mmol/l (P < 0.01). Furthermore, significantly greater improvements in glycaemic control were seen in the intervention group compared with the control: the mean reduction in HbA(1c) in the intervention group was -0.97% (95% CI: -0.8, -1.14) compared with -0.27% (95% CI: -0.15, -0.39) in the control group. Improvements were also seen in blood pressure control and quality of life in the intervention group.

CONCLUSION

A pharmacy diabetes service model resulted in significant improvements in clinical and humanistic outcomes. Thus, community pharmacists can contribute significantly to improving care and health outcomes for patients with Type 2 diabetes. Future research should focus on clarifying the most effective elements of the service model.

Pharmacy diabetes care program: analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy

OBJECTIVE

To compare the efficacy and cost-effectiveness of two methods of screening for undiagnosed type 2 diabetes in Australian community pharmacy.

METHODS

A random sample of 30 pharmacies were allocated into two groups: (i) tick test only (TTO); or (ii) sequential screening (SS) method. Both methods used the same initial risk assessment for type 2 diabetes. Subjects with one or more risk factors in the TTO group were offered a referral to their general practitioner (GP). Under the SS method, patients with risk factors were offered a capillary blood glucose test and those identified as being at risk referred to a GP. The effectiveness and cost-effectiveness of these approaches was assessed.

RESULTS

A total of 1286 people were screened over a period of 3 months. The rate of diagnosis of diabetes was significantly higher for SS compared with the TTO method (1.7% versus 0.2%; p=0.008). The SS method resulted in fewer referrals to the GP and a higher uptake of referrals than the TTO method and so was the more cost-effective screening method.

CONCLUSIONS

SS is the superior method from a cost and efficacy perspective. It should be considered as the preferred option for screening by community based pharmacists in Australia.