The efficacy of donepezil hydrochloride on memory functioning in three adolescents with severe traumatic brain injury

OBJECTIVE

To explore efficacy of donepezil on memory in adolescents with severe traumatic brain injury (TBI).

DESIGN

Single subject, unblinded, multiple baseline design.

METHODS AND PROCEDURES

Memory functioning was examined in three adolescents with TBI on and off medication (5 and 10 mg) using the Selective Reminding Test. Four variables were examined: Total recall (TR) = number of words total words recalled, Long Term Storage (LTS) = words recalled on two trials in a row, Consistency of Long Term Retrieval (CLTR) = words continuously recalled, Delay = number of words recalled after delay.

RESULTS

On medication, three out of three participants demonstrated better memory. Two showed greatest improvement on 10 mg. All participants demonstrated improvement in TR and LTS. Two participants demonstrated improved CLTR. No participants displayed improvement in Delay. No adverse side effects were reported.

CONCLUSIONS

Results suggests that donepezil may be effective in improving memory in adolescents with severe TBI and warrant further examination.

Molecular bases for sensitivity to figitumumab (CP-751,871) in NSCLC

8091

Background: Signaling of Insulin like Growth Factors (IGFs) through the IGF type 1 receptor (IGF-IR) induces tumor resistance to cancer therapy. Bioavailability of IGFs is regulated by IGF-binding proteins (IGFBP), of which IGFBP3 is the most abundant. Figitumumab (F) (CP-751,871), a specific IGF-IR inhibitor, has shown phase 2 activity in NSCLC in some histologies (i.e., squamous cell and adenocarcinoma) but not others (i.e, large cell or NOS tumors). Methods: Protein expression of members of the IGF-IR pathway, EGFR and differentiation markers was determined in core biopsies from 230 NSCLC pts, including 52 pts enrolled in F trials. Plasma concentration of IGF-1 and related proteins was determined in 159 NSCLC pts in F trials. Gene expression profiling was conducted in 35 NSCLC cell lines treated with F. Results: Squamous NSCLC had the highest IGF-IR expression (p=0.057). An association with better outcome was seen for E-cadherin expression (HR =0.62, 0.46–0.82 95% CI, p=0.005) and clustering by E-cadherin levels revealed a strong correlation between IGF-IR and EGFR expression in the high E-cadherin group (p<0.001). This subset included 73% of the squamous cell tumors investigated (N=44). Plasma levels of free IGF-1 (fIGF-1) were low and not predictive of response in squamous cell. In contrast, pts with adenocarcinoma had high plasma fIGF-1 levels (p=0.06) that correlated with vimentin expression (Rho=0.732, p=0.06), and both fIGF-1 and vimentin were predictive of F clinical benefit (p=0.03). Large cell/NOS NSCLC expressed the highest levels of vimentin (p<0.001) but had low E-cadherin and IGF-IR expression and low fIGF-1 plasma levels. Analysis of anchorage independent growth in NSCLC cell lines confirmed that F activity is independently associated to IGF-IR overexpression (p=0.02) and IGFBP3 under-expression (p=0.009). Conclusions: IGF-IR overexpression and increased free IGFs/low IGFBP are key independent mechanisms of sensitivity to F in NSCLC of squamous and adenocarcinoma cell histologies.

[Table: see text]

[Table: see text]

Chemical contamination assessment of Gulf of Mexico oysters in response to hurricanes Katrina and Rita

Hurricane Katrina made landfall on August 29, 2005 and caused widespread devastation along the central Gulf Coast states. Less than a month later Hurricane Rita followed a similar track slightly west of Katrina's. A coordinated multi-agency response followed to collect water, sediment and tissue samples for a variety of chemical, biological and toxicological indicators. The National Oceanic and Atmospheric Administration's National Status and Trends Program (NS&T) participated in this effort by measuring chemical contamination in sediment and oyster tissue as part of the Mussel Watch Program, a long-term monitoring program to assess spatial and temporal trends in a wide range of coastal pollutants. This paper describes results for contaminants measured in oyster tissue collected between September 29 and October 10, 2005 and discusses the results in the context of Mussel Watch and its 20-year record of chemical contamination in the region and the nation. In general, levels of metals in oyster tissue were higher then pre- hurricane levels while organic contaminants were at or near record lows. No contaminant reported here exceeded the FDA action level for food safety.

185 THE PORCINE EPIBLAST AND NOT THE INNER CELL MASS HAS DEVELOPED CONVENTIONAL PATHWAYS FOR REGULATION OF PLURIPOTENCY

Pluripotency in mice and human embryonic stem cells is regulated by a number of transcription factors, notably including Oct-4, Sox-2, and Nanog. However, in the pig, previous research indicates that Oct-4 protein and mRNA is not specifically localized to the inner cell mass (ICM) of the zona-intact (ZI) blastocyst. Levels of expression of Nanog mRNA, on the other hand, appear to be low in the ZI blastocyst, and protein has not been detected. Similarly, Sox-2 expression in the ZI blastocyst is relatively low and not specific to the ICM. In this study, we investigated the mRNA expression of Oct-4, Sox-2, and Nanog in D6/D7-derived ZI porcine in vivo-derived blastocysts compared with epiblasts mechanically isolated from hatched D10/D11 in vivo-derived blastocysts. We then investigated components involved in pathways important for regulating pluripotency, including JAK/STAT (i.e. gp130, LIFr), FGF (i.e. bFGF, FGFr1, FGFr2), and BMP (bmp4, smad4) signaling pathways and their downstream targets, stat3, c-myc, c-fos, by using RT-PCR. Sows were artificially inseminated, and embryos were flushed from uteri following slaughter. Single D6/D7 blastocysts (n = 3), single mechanically isolated D10/D11 epiblasts (n = 3), endometrium, and oviduct total RNA was isolated using the RNeasy Micro Kit (Qiagen, Valencia, CA, USA). Total RNA from the blastocysts and epiblasts was then amplified to form cDNA using the QuantiTect Whole Transcriptome kit (Qiagen). Positive control tissues (oviduct and endometrium) were reverse transcribed using the RevertAid First Strand cDNA synthesis kit (Fermentas, Burlington, Ontario, Canada). Primers were designed to span introns in highly homologous sequences to human mRNA. Primers were tested in both oviduct and endometrium tissue, and products were sequenced to confirm specificity. PCR was performed at 55°C for 35 cycles. Results indicate that D6/D7 blastocysts only expressed Oct-4 and not Nanog and Sox-2. In contrast, all 3 transcripts were expressed in D10/D11 epiblasts. The D10/D11 epiblasts also expressed LIFr, bFGF, FGFr1, FGFr2, bmp4, smad4, stat3, c-myc, and c-fos. The cytokine receptor gp130 was only weakly expressed in a single epiblast. In contrast, the earlier stage D6/D7 blastocysts failed to express these messengers with the exception of weak expression of gp130 in all 3 blastocysts, and only a single blastocyst expressed LIFr, smad4, c-myc, and c-fos. In conclusion, this study indicates that the ICM of the porcine D6/D7 ZI blastocyst has not developed pluripotency signaling as observed in mice and humans at this developmental stage. Furthermore, without expression of gp130, the JAK/STAT pathway is unlikely to play a role in regulating pluripotency in the epiblast. It is likely that the later stage epiblast may be more amenable for the derivation of porcine embryonic stem cells.

Regulation of stem cell differentiation by histone methyltransferases and demethylases

The generation of different cell types from stem cells containing identical genetic information and their organization into tissues and organs during development is a highly complex process that requires defined transcriptional programs. Maintenance of such programs is epigenetically regulated and the factors involved in these processes are often essential for development. The activities required for cell-fate decisions are frequently deregulated in human tumors, and the elucidation of the molecular mechanisms that regulate these processes is therefore important for understanding both developmental processes and tumorigenesis.

New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury

Traumatic brain injury (TBI) constitutes a major source of psychiatric morbidity and disability. This study examines new onset of obsessions and compulsions (OCS) within 1 year of severe pediatric TBI. Eighty children and adolescents ages 6-18 years with severe TBI were interviewed by a child psychiatrist using the Diagnostic Interview for Children and Adolescents-Revised to diagnose OCS and comorbidities. A brain magnetic resonance imaging used a 1.5 T scanner 3 months after injury with a T1-weighted spoiled gradient-recalled-echo sequence to provide high spatial resolution and T1- and T2(*)-contrast sensitivity. Race, sex, socioeconomic status, psychosocial adversity, and injury severity were used to predict new onset OCS. Psychiatric comorbidities and brain lesion volumes in orbitofrontal, mesial prefrontal, temporal lobe, basal ganglia, and thalamus were examined in relation to new onset OCS. Twenty-one children (21/72, 29.2%) had OCS after TBI. Most common were worries about disease, cleanliness, and inappropriate actions as well as excessive cleaning, doing things a certain way and ordering. Anxiety disorders, mania, dysthymia, depressive symptoms, and posttraumatic stress disorder were significantly associated with new onset OCS. Injury severity was not associated with new onset OCS. Greater psychosocial adversity (P=0.009), and being female (P=0.005) were associated with OCS while mesial prefrontal and temporal lobe lesions were associated with new onset obsessions (P<0.05). OCS are common after severe pediatric TBI and are associated with greater comorbidities. New onset obsessions are associated with female sex, psychosocial adversity, and mesial prefrontal and temporal lesions.

Theory of resonant acoustic transmission through subwavelength apertures

A complete landscape is presented of the acoustic transmission properties of subwavelength apertures (slits and holes). First, we study the emergence of Fabry-Perot resonances in single apertures. When these apertures are placed in a periodic fashion, a new type of transmission resonance appears in the spectrum. We demonstrate that this resonance stems from the excitation of an acoustic guided wave that runs along the plate, which hybridizes strongly with the Fabry-Perot resonances associated with waveguide modes in single apertures. A detailed discussion of the similarities and differences with the electromagnetic case is also given.

Risk for contralateral breast cancer among carriers of the CHEK2*1100delC mutation in the WECARE Study

The protein encoded by the CHEK2 gene is involved in cellular repair of DNA damage. The truncating mutation, CHEK2^*1100delC, seems to increase the risk for breast cancer. We investigated whether the CHEK2^*1100delC mutation carrier status increases the risk for asynchronous contralateral breast cancer (CBC) and whether it interacts with radiation therapy (RT) or chemotherapy in regard to CBC risk. The germline mutation frequency was assessed in 708 women with CBC and 1395 women with unilateral breast cancer (UBC) in the Women's Environment, Cancer and Radiation Epidemiology (WECARE) Study whose first primary breast cancer was diagnosed before age 55 years and during 1985–1999. Seven women with CBC (1.0%) and 10 women with UBC (0.7%) were CHEK2^*1100delC variant carriers (rate ratio (RR)=1.8, 95% confidence interval (CI)=0.6–5.4 for CBC vs UBC). Carriers who received RT for their first breast cancer, compared with non-carriers not treated with RT, had an RR of developing CBC of 2.6 (95% CI=0.8–8.7). We found no significant associations between the CHEK2^*1100delC mutation and CBC overall or among those treated with RT. However, the sampling variability was such that modest increases in risk could not be excluded. Nonetheless, because this is a rare mutation, it is unlikely to explain a major fraction of CBC in the population.

Induction of apoptosis of myeloid leukemia with CSC17.1, a unique monoclonal antibody targeting CD45RA

3030

Background: Blast crisis from myeloid leukemia is may be responsive to chemotherapy, but a majority of patients die from their disease. Relapse may be due to persistence of cancer stem cells (CSC). A monoclonal antibody (mAb) that targets myeloid blast cells including the CSC without targeting the hematopoietic stem cell (HSC: CD34+90+) may be of value. CSC phenotype of CML-BC (CD34+38+123+45RA+) and AML (CD34+38–90-) have been defined. Method: We developed a biologically based mAb platform with 2 important steps after generating the mAb library: i) mAb must not bind the HSC (SS; safety screen); and ii) must bind the target cells (RxS; therapeutic screen). HSC for the SS were from G-CSF mobilized blood; cells for RxS was patient specimens of CML-BC and AML. After screens, the target was indentified, in vitro and in vivo functional assays are performed. Results: 5 of 400 mAb passed the SS and RxS. CSC17.1, an IgG2b isotype binding a unique, linear, 12 amino acid sequence of CD45RA has been selected. CML (Kasumi4), AML (Kasumi3 and KG1a), ALL (MOLT3) and NHL (Pfeiffer) cel lines express high levels of CD45RA. Five of 5 CML-BC and 3 of 3 AML patient specimens express CD45RA in high levels. Kausmi4 and Pfeiffer cell lines and patient specimens of CML-BC and AML undergo apoptosis in a dose and time dependent manner after exposure to CSC17.1 (>80% apoptosis at 1ug/ml@8h). KG1a is refractory to apoptosis despite high levels of target on the cell surface (15% apoptosis at 1ug/ml@8h). Normal T,B and NK cells express high levels of CD45RA, but do not undergo apoptosis or activation when exposed to CSC17.1. CSC17.1 causes capping and patching, but not internalization of CD45RA in cell lines and CD8+ normal cells. Commercially available antibodies to CD45RA do not inhibit binding of CSC17.1 to CD45RA, do not cause apoptosis, do not cause patching and capping, but do undergo internalization. In vivo murine models with cell lines and patient specimens of CML-BC and AML are underway. Conclusions: 1) CSC17.1 binds a previously undefined epitope of CD45RA that causes apoptosis of selected hematopoietic tumor cell lines and patient specimens of CML-BC and AML; 2) apoptosis, is a unique function of CSC17.1 compared to other mAb against CD45RA; 3) CML-BC and AML CSC include the CD45RA antigen suggesting CSC17.1 will target these cells.

No significant financial relationships to disclose.

Phase I Clinical and Pharmacodynamic Evaluation of Oral CI-1033 in Patients with Refractory Cancer

PURPOSE

To determine the tolerability and pharmacokinetics of CI-1033 given daily for 7 days of a 21-day cycle. Tumor response and changes in erbB receptor tyrosine kinase activity in tumor and skin tissue were examined, and modulation of potential biomarkers in plasma was explored.

DESIGN

This was a dose-finding phase I study in patients with advanced solid malignancies. Patients were evaluated for safety, pharmacokinetics, and tumor response. Pharmacodynamic markers, such as Ki67, p27, and erbB receptor status, were assessed in tumor and skin tissue using immunohistochemical and immunoprecipitation methodologies. Plasma biomarkers HER2, vascular endothelial growth factor, interleukin-8, and matrix metalloproteinase-9 were evaluated using immunologic techniques.

RESULTS

Fifty-three patients were enrolled in the study. Dose-limiting toxicity (emesis, persistent rash, and mouth ulcer) was observed at 750 mg. The maximum tolerated dose was 650 mg. There were no confirmed objective responses. CI-1033 treatment showed down-regulation of epidermal growth factor receptor, HER2, and Ki67 in a variety of tumor tissues and up regulation of p27 in skin tissue. Plasma HER2 was reduced following CI-1033 administration, but no consistent change in vascular endothelial growth factor, interleukin-8, or matrix metalloproteinase-9 was noted. CI-1033 plasma concentrations were proportional to dose.

CONCLUSION

The safety and pharmacokinetic profile of CI-1033 was favorable for multidose oral administration. Evidence of modulation of erbB receptor activity in tumor and skin tissue was accompanied by changes in markers of proliferation and cell cycle inhibition. Additional clinical trials are warranted in defining the role of CI-1033 in the treatment of cancer and further assessing the utility of antitumor markers.

Factors influencing the prevalence of Salmonella spp. in swine farms: a meta-analysis approach

A systematic review and meta-analysis was conducted to identify study-level variables that could explain the variation in apparent Salmonella spp. prevalence estimates. Electronic and non-electronic literature searches from 1990 until 2005 were carried out to identify all studies related to the prevalence of subclinical Salmonella infection in swine. The searches were restricted to studies published in English, Spanish, and French. Clinical trials or any other study where an intervention was evaluated were excluded from this analysis. A template was designed to retrieve the most relevant variables and data abstraction was performed in duplicate. A total of 98 papers containing 82 animal-level and 156 farm-level studies were used in the analyses. The median farm-level and animal-level prevalences were 59% and 17%, respectively. Meta-regression analyses were carried out on both farm and animal-level data. Diagnostic procedure, sample size, and country where study was conducted were the three most important predictors in explaining the differences in Salmonella prevalences between studies. When compared to a farm with a apparent prevalence of 50% determined by the blood ELISA, prevalences based on culture of fecal samples were 39% lower and prevalences based on cecum and tissue cultures were 16% and 19% lower, respectively. Similar to farm-level models, animal-level models did not show any difference among serological tests and prevalence values based culture procedures were, on average, 9% lower than those from serological tests. Sample size was negatively associated with prevalence estimates. In conclusion, the methodology was useful for identifying and quantifying sources of variation in Salmonella apparent prevalence among studies and for establishing prevalence distributions that could be used as input parameters in risk assessment and decision models. The analysis provides some guidelines when interpreting and comparing apparent Salmonella prevalence results from studies using different study designs.

Danish Stable Schools for Experiential Common Learning in Groups of Organic Dairy Farmers

The farmer field school (FFS) is a concept for farmers' learning, knowledge exchange, and empowerment that has been developed and used in developing countries. In Denmark, a research project focusing on explicit non-antibiotic strategies involves farmers who have actively expressed an interest in phasing out antibiotics from their herds through promotion of animal health. One way of reaching this goal was to form participatory focused farmer groups in an FFS approach, which was adapted to Danish conditions and named "stable schools." Four stable schools were established and went through a 1-yr cycle with 2 visits at each of the 5 or 6 farms connected to each group. A facilitator was connected to each group whose role was to write the meeting agenda together with the host farmer, direct the meeting, and write the minutes to send to the group members after the meeting. Through group focus interviews and individual semistructured qualitative interviews of all participants, the approach of the farmers' goal-directed work toward a common goal was judged to be very valuable and fruitful and based on a common learning process. Complex farming situations were the focus of all groups and in this context, problems were identified and solutions proposed based on each farmer's individual goals. In this article, we describe the experiences of 4 stable school groups (each comprising farmers and a facilitator), and the common process of building a concept that is suitable for Danish organic dairy farming.

Cost-effectiveness of grass allergen tablet (GRAZAX�) for the prevention of seasonal grass pollen induced rhinoconjunctivitis ? a Northern European perspective

BACKGROUND

The prevalence of allergic rhinoconjunctivitis has increased dramatically. Seventeen million people in the United Kingdom, Germany, the Netherlands, Sweden, Denmark, Norway and Finland suffer from grass pollen induced allergic rhinitis. Symptomatic therapy with antihistamines and topical steroids is partially effective but allergen-specific immunotherapy by injection or sublingual routes is superior. The grass allergen tablet (GRAZAX) is a new allergen-specific immunotherapy for home administration.

OBJECTIVE

To assess the cost-effectiveness of the grass allergen tablet compared with symptomatic medication in seven Northern European countries.

METHODS

A prospective pharmacoeconomic analysis was carried out alongside a multinational clinical trial. Pooled data on resource use and health outcomes were collected. A societal perspective was adopted, and the analysis had a 9-year time horizon. The outcome measure was Quality Adjusted Life Years (QALYs).

RESULTS

The grass allergen tablet was clinically superior to symptomatic treatment, producing statistically significant differences for all efficacy end-points, including the number of QALYs gained - 0.976 vs. 0.947 QALYs gained. There was a significantly higher usage of the rescue medications loratadine and budesonide, and more hours missed from work (production loss), in the symptomatic treatment group. The cost per QALY gained in the grass allergen tablet group was similar in the seven countries (euro 12,930 to euro 18,263 for an annual cost of the grass allergen tablet of euro 1500). The analysis showed that the grass allergen tablet was cost-effective for all countries for an annual treatment cost below euro 2200.

CONCLUSION

The pharmacoeconomic analysis illustrated that allergen-specific immunotherapy with the grass allergen tablet is a cost-effective intervention for the prevention of grass pollen induced rhinoconjunctivitis in Northern European countries, for a tablet price below euro 6. In Germany for example the price of the tablet is euro 2.95 corresponding to a yearly treatment cost of euro 358 - based on a 9-year time horizon.

MET amplification leads to gefitinib resistance in lung cancer by activating ERBB3 signaling

The epidermal growth factor receptor (EGFR) kinase inhibitors gefitinib and erlotinib are effective treatments for lung cancers with EGFR activating mutations, but these tumors invariably develop drug resistance. Here, we describe a gefitinib-sensitive lung cancer cell line that developed resistance to gefitinib as a result of focal amplification of the MET proto-oncogene. inhibition of MET signaling in these cells restored their sensitivity to gefitinib. MET amplification was detected in 4 of 18 (22%) lung cancer specimens that had developed resistance to gefitinib or erlotinib. We find that amplification of MET causes gefitinib resistance by driving ERBB3 (HER3)-dependent activation of PI3K, a pathway thought to be specific to EGFR/ERBB family receptors. Thus, we propose that MET amplification may promote drug resistance in other ERBB-driven cancers as well.

The effect of discontinued use of antimicrobial growth promoters on the risk of therapeutic antibiotic treatment in Danish farrow-to-finish pig farms

This study estimated the effect of discontinued use of antimicrobial growth promoters (duAGPs) on the risk of antibiotic treatment for diarrhoea, arthritis, pneumonia, unthriving and miscellaneous disorders in Danish pig farms. The estimation was done in a case-crossover study comparing: (1) the proportion of days per farm where treatment was performed (PDT) and (2) the proportion of pigs treated per day per farm at days where treatment was performed (PPT) before and after duAGPs at 68 farrow-to-finish farms. The farms were selected using a two-stage (veterinarian/farm) convenience sampling. On average, during the first year after duAGPs there was a significant increase in the risk of antibiotic treatment for diarrhoea (PDT: OR 2.5, 95% CI 1.7-3.8; PPT: OR 1.6, 95% CI 1.1-2.2). However, the effect varied among farms--some farms experienced substantial problems, while others experienced few problems after duAGPs. No effect was identified for the risk of treatment for other diseases.

Neuropsychological profile following suicide attempt by hanging: two adolescent case reports

Hippocampal damage and amnesia following hypoxia and ischemia are described in the few published adult cases of suicide attempt by hanging. However, a recent review (Caine & Watson, 2000) suggests a variable pattern of brain involvement and neuropsychological impairments following hypoxic-ischemic injury that may or may not involve amnesia. To help clarify the impact of hanging on the developing brain, we examined neuropsychological functioning in two adolescents who survived suicide attempt by hanging. Despite differences in Glasgow Coma Scale (GCS), coma duration, and structural imaging findings, both patients had similar IQ (VIQ>PIQ) and presented with various combinations of deficits in expressive/receptive language, visual-constructional and perceptual ability, processing speed, attention, working memory, and/or executive functioning shortly after injury. In spite of their similarities, only one of the patients presented with classic amnesia symptoms in his early recovery. This patient was evaluated 1 year postinjury, and persistent deficits in processing speed and memory encoding were noted. Several hanging-related variables, including longer estimated hanging duration, greater weight, and severe airway edema, were thought to place this patient at increased risk for cognitive deficits. Clinical MRI scans of this patient obtained 6 weeks postinjury revealed mild volume loss as well as abnormalities in bilateral superior cortex. However, CT and MRI scans obtained throughout early recovery did not reveal overt evidence of injury to specific memory-related structures. Comprehensive neuropsychological evaluation of all adolescent survivors of suicide attempt by hanging is recommended, as a variety of postacute cognitive deficits were observed in these patients despite relatively short (<or=15 minutes) estimated hanging durations.

Pilot study to determine the hemodynamic safety and feasibility of magnesium sulfate infusion in children with severe traumatic brain injury

OBJECTIVE

Magnesium sulfate is neuroprotective in preclinical models, but there are limited safety data regarding its clinical use for pediatric traumatic brain injury. We conducted a pilot study in children with severe traumatic brain injury to a) examine if magnesium sulfate decreases mean arterial pressure, decreases cerebral perfusion pressure, increases intracranial pressure, or adversely effects cardiac conduction; and b) determine the feasibility of a multiple-center trial of magnesium sulfate.

DESIGN

Double-blinded, placebo-controlled, randomized pilot trial with repeated measurement of hemodynamic variables.

SETTING

Two pediatric trauma centers.

PATIENTS

Six children (3 months to 18 yrs) with severe traumatic brain injury.

INTERVENTIONS

: Magnesium sulfate (50 mg/kg) bolus followed by (8.3 mg/kg/hr) infusion for 24 hr vs. equivolume placebo.

MEASUREMENTS AND MAIN RESULTS

We screened 96 patients with severe traumatic brain injury during 24 months; 20 were eligible for enrollment, six provided informed consent, four received magnesium sulfate, and two received placebo. Before and after study drug infusion, we repeatedly measured blood ionized magnesium concentration, mean arterial pressure, cerebral perfusion pressure, intracranial pressure, heart rate, and corrected QT interval. Mean age (7.9 yrs), mean highest Glasgow Coma Scale score (6), gender (33% boys), inflicted injury rate (17%), and case mortality rate (17%) did not differ between those enrolled and those not enrolled. Compared with baseline, magnesium sulfate did not change cerebral perfusion pressure, intracranial pressure, heart rate, or corrected QT interval. Mean arterial pressure was unchanged until the late phase of magnesium sulfate infusion, when mean arterial pressure rose (82 +/- 5 vs. 93 +/- 6 mm Hg, p < .05). Sixty-four percent of corrected QT interval determinations obtained in the first 6 days after injury exceeded 440 msecs; 12% were >600 msecs.

CONCLUSIONS

In children with severe traumatic brain injury, magnesium sulfate administration did not decrease mean arterial pressure or cerebral perfusion pressure or adversely effect cardiac conduction. Our data suggest that enrollment of brain-injured children in a therapeutic trial remains challenging. These results provide information important for clinical trials of magnesium sulfate in children with severe traumatic brain injury.

Gamma-hydroxybutyrate--a drug of abuse

Gamma-hydroxybutyrate (GHB) is a drug of abuse that causes euphoria, anxiolysis, and hypnosis. The recent rise in the recreational intake of GHB, as well as its association with 'drug rape', has turned the attention to GHB in acute hospital settings. Acutely admitted GHB intoxicated patients may display various levels of sedation or coma, but may also show paradoxical agitation, combativeness, or self-injurious behaviors. The symptoms can be nonspecific and the definite diagnosis therefore normally relies on the detection of GHB in blood or body fluids, which is an analysis that may not be promptly available. As a basis for understanding the clinical features of GHB intoxication and abuse, we here review the pharmacological and neurophysiological knowledge about GHB, which stems from decades of clinical and basic GHB research. In addition, we discuss the latest discoveries in the quest for distinct GHB receptors in the brain, and their possible implications for future therapies of GHB abuse.

Folate intake, alcohol and risk of breast cancer among postmenopausal women in Denmark

OBJECTIVE

There is consistent evidence that alcohol increases the risk of breast cancer. It has been suggested that the increased risk associated with alcohol intake may be reduced by adequate intake of folate. Since many women consume alcohol, detection of a risk-reducing mechanism would have major public health implications.

DESIGN

We therefore evaluated the possible interaction between alcohol and folate in a paired nested case-control study among postmenopausal women.

SETTING

A total of 24 697 postmenopausal women were included in the 'Diet, Cancer and Health' follow-up study between December 1993 and May 1997. The cohort was followed until December 2000. The study included 388 cases of breast cancer and 388 randomly selected controls were used to estimate the breast cancer incidence rate ratio (IRR) in conditional logistic regression analysis.

RESULTS

A previously established association between alcohol intake and risk of breast cancer was present mainly among women with low folate intake. An IRR of 1.19 (95% CI: 0.99-1.42) per 10 g average daily alcohol intake was found for women with a daily folate intake below 300 mug, while among women with a folate intake higher than 350 mug, we could not show an association between the alcohol intake and the breast cancer incidence rate (e.g. folate intake >400 mug; IRR of 1.01 (95% CI: 0.85-1.20)).

CONCLUSION

The findings support the evidence that adequate folate intake may attenuate the risk of breast cancer associated with high alcohol intake.

SPONSORSHIP

The Danish Cancer Society.

Visceral hypersensitivity in irritable bowel syndrome: a summary review

We examined published reports from 1970 to the present to evaluate the theory that abnormal visceral sensitivity characterizes the irritable bowel syndrome. Evidence to support claims that abnormal visceral sensitivity defines the irritable bowel syndrome falls short because of cognitive deficits in gastrointestinal neurobiology, limitations in experimental design and execution, and the interpretation of results.

Inhibition of the met receptor in mesothelioma

BACKGROUND

Expression of the Met receptor and its ligand, hepatocyte growth factor (HGF), has been observed in 74% to 100% and 40% to 85% of malignant pleural mesothelioma (MPM) specimens, respectively. HGF stimulation has been shown to enhance MPM cell proliferation, migration, cell scattering, and invasiveness.

EXPERIMENTAL DESIGN

To investigate a potential therapeutic role for the Met receptor in MPM, we examined the effects of PHA-665752, a specific small-molecule inhibitor of the Met receptor tyrosine kinase, in a panel of 10 MPM cell lines.

RESULTS

Two of the cell lines, H2461 and JMN-1B, exhibited autocrine HGF production as measured by ELISA (3.9 and 10.5 ng/mL, respectively, versus <0.05 ng/mL in other cell lines). Evaluation of PHA-665752 across the 10 MPM cell lines indicated that despite Met expression in all cell lines, only in cell lines that exhibited a Met/HGF autocrine loop, H2461 and JMN-1B, did PHA-665752 inhibit growth with an IC(50) of 1 and 2 micromol/L, respectively. No activating mutations in Met were detected in any of the cell lines. Consistent with observed growth inhibition, PHA-665752 caused cell cycle arrest at G(1)-S boundary accompanied by a dose-dependent decrease in phosphorylation of Met, p70S6K, Akt, and extracellular signal-regulated kinase 1/2. Growth of H2461 cells was also inhibited by neutralizing antibodies to HGF and by RNA interference knockdown of the Met receptor, confirming that growth inhibition observed was through a Met-dependent mechanism. PHA-665752 also reduced MPM in vitro cell migration and invasion.

CONCLUSIONS

Taken together, these findings suggest that inhibition of the Met receptor may be an effective therapeutic strategy for patients with MPM and provides a mechanism, the presence of a HGF/Met autocrine loop, by which to select patients for PHA-665752 treatment.

Characteristics of auditory agnosia in a child with severe traumatic brain injury: a case report

We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully characterize auditory agnosia in a single individual.

Neuroimaging correlates of anxiety after pediatric traumatic brain injury

BACKGROUND

Anxiety disorders are common after traumatic brain injury (TBI). Data on the neural correlates of these conditions are lacking. This study examines the relationship between brain damage, particularly to the orbitofrontal cortex (OFC) and temporal lobe, and anxiety symptoms and disorders.

METHODS

Ninety-five children and adolescents were followed for one year postinjury. Preinjury and one-year postinjury anxiety status were obtained from the parent. Magnetic resonance imaging was performed to evaluate brain lesions. The primary analysis used regression models to determine relationships between brain lesions and anxiety outcomes. As a secondary analysis, previously reported posttraumatic stress disorder (PTSD) data were reanalyzed using similar methods for purposes of comparison.

RESULTS

The primary analysis showed that greater volume and number of OFC lesions correlated with decreased risk for anxiety, whereas lesions in other brain areas did not correlate with anxiety. Consistent with prior data, the secondary analysis showed an inverse correlation between OFC damage and PTSD; temporal lobe damage was positively correlated with PTSD.

CONCLUSIONS

After pediatric TBI, greater damage to the OFC is associated with decreased risk for anxiety outcomes. Similar to adult data, these findings implicate OFC dysfunction in childhood anxiety. Temporal lobe damage did not correlate with anxiety, in contrast to the findings for PTSD.

State-related changes in cerebral white matter may underlie psychosis exacerbation

Previous reports have described accelerated loss of cerebral white matter in schizophrenia. Others have reported changes of ventricle volumes in schizophrenic patients, with greatest increases following remission of psychotic symptoms. In this study changes in cerebral white matter volumes and psychotic symptoms were measured in 16 recently decompensated schizophrenic patients from neuroleptic-free baseline to 4 weeks later during treatment with antipsychotics. Serial white matter assessments were also performed in eight controls at similar intervals. Thirteen of 16 patients showed reduction of psychotic symptoms (reduction of SAPS scores by 24.4+/-12.6) during treatment. Three patients failed to respond (increase of SAPS scores by 15.7+/-13.8). Serial volumetric studies of cerebral white matter during the 4-week period showed a decrease of white matter volume in the responders by 8.2+/-8.2 cm(3) (P=0.003). Patients who failed to respond showed a non-significant increase in white matter during the same period by 11.4+/-11.7 cm(3). Absolute and percentage changes change in white matter volumes during the 4-week period were positively correlated with changes in SAPS scores (both P<0.01). Cerebral white matter, composed of myelin-containing oligodendrocytes, is highly sensitive to excitotoxicity. Swelling of myelin and of white matter, associated interference with the speed of neurotransmission through myelinated axons, and dyssynchrony of information processing by subcortical and cortical networks may be associated with psychosis exacerbation. Partial remission of symptoms may mark temporary reduction of an active, toxic process that interferes with information processing.

c-Met: structure, functions and potential for therapeutic inhibition

Studies on signal transduction pathways have generated various promising molecular targets for therapeutic inhibition in cancer therapy. Receptor tyrosine kinases represent an important class of such therapeutic targets. c-Met is a receptor tyrosine kinase that has been shown to be overexpressed and/or mutated in a variety of malignancies. A number of c-Met activating mutations, many of which are located in the tyrosine kinase domain, have been detected in various solid tumors and have been implicated in invasion and metastasis of tumor cells. It is known that stimulation of c-Met via its natural ligand, hepatocyte growth factor (also known as scatter factor, HGF/SF) results in a plethora of biological and biochemical effects in the cell. Activation of c-Met signaling can lead to scattering, angiogenesis, proliferation, enhanced cell motility, invasion, and eventual metastasis. In this review, the role of c-Met dysregulation in tumor progression and metastasis is discussed in detail with particular emphasis on c-Met mutations. Moreover, we summarize current knowledge on various pathways of c-Met signal transduction, highlighting the central role in the cytoskeletal functions. In this summary is included recent data in our laboratory indicating that phosphorylation of focal adhesion proteins, such as paxillin, p125FAK, and PYK2, occurs in response to c-Met stimulation in lung cancer cells. Most importantly, current data on c-Met suggest that when mutated or overexpressed in malignant cells, c-Met would serve as an important therapeutic target.

Comparability of venous and capillary glucose measurements in blood

AIM

Diabetes and glucose intolerance are diagnosed by measurement of glucose in blood. Glucose is usually measured as venous plasma or capillary whole blood and diagnostic criteria frequently provide equivalence estimates for these two methods. This study examined the relationship between glucose measured in capillary and venous samples collected at random, fasting and 2 h after oral glucose.

METHODS

Simultaneous measurements of venous plasma and capillary blood glucose were performed on random samples in 609 people, fasting samples in 685 people, and 2 h after oral glucose samples in 463 people. Separate capillary and venous samples were collected each time. A variance component model was used to construct conversion algorithms between venous and capillary results.

RESULTS

The relationship between venous and capillary glucose values varied, with venous plasma being higher than capillary blood for random and fasting samples but lower for sampling 2 h after oral glucose. Discrepancies were observed between measured capillary blood values and the published WHO capillary blood equivalence values for venous plasma values for all except a fasting venous value of 7.0 mmol/l. For example, for a fasting venous plasma glucose of 6.1 mmol/l the WHO equivalent value is 5.6 mmol/l, while the measured value was 5.2 mmol/l, and for a 2-h venous plasma glucose of 11.1 mmol/l the WHO value is 11.1 mmol/l, while the measured result was 11.7 mmol/l.

CONCLUSIONS

These results highlight the difficulty in equating glucose levels from one sampling and measuring procedure to another, and raise uncertainties about current published equivalence values which could lead to misclassifications in glucose tolerance status.

Front-face fluorescence spectroscopy and chemometrics in analysis of yogurt: rapid analysis of riboflavin

The present study demonstrates the use of front-face fluorescence spectroscopy and chemometrics for monitoring light-induced changes in plain yogurt during storage. Fluorescence analysis is suggested as a new rapid method for measuring riboflavin content in yogurt. Fluorescence landscapes with excitation wavelengths from 270 to 550 nm and emission wavelengths in the range 310 to 590 nm were obtained from front-face fluorescence measurements directly on yogurt samples during two storage experiments over a period of 5 wk at 4 degrees C. Yogurts were stored in two different packaging materials (polylactate and polystyrene) and under fluorescent light (3500 lux) or in darkness. Principal Component Analysis of unfolded fluorescence emission spectra revealed systematic changes in fluorescence signal throughout the storage period, strongly related to the storage conditions, i.e. storage time and differences in packaging materials. Correlation between fluorescence spectra and riboflavin content determined by the standard AOAC fluorometric method was evaluated using a Partial Least Square Regression model. The regression model showed a good ability to predict riboflavin in plain yogurt with a high correlation (R = 0.99) and a prediction error of 0.092 microgram riboflavin/g. Thus, it is concluded that nondestructive fluorescence spectroscopy can be used to monitor riboflavin content in yogurt, and that the suggested rapid method has the potential to substitute the standard method for analysis of riboflavin in yogurt.