Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors

Disruptive behaviour disorders (DBDs), including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) are chronic disorders with significant overlap in aetiology and presentation. An integrative examination of environmental risk factors is lacking. Six literature searches of web-based bibliographic databases were completed to identify literature on DBDs in general and five disorders in particular: CD, ODD, ADHD, deficits of attention, motor control and perception, and reactive attachment disorder. Searches were filtered to focus on studies including diagnostic assessment, focussing on environmental risk and protective factors in the first 4 years of life. The database searches generated 9806 papers of which 47 were reviewed after filters had been applied. The evidence suggests links between a number of early life risk factors and DBDs, including prenatal cigarette smoking and alcohol use, prenatal viral illness, maternal stress and anxiety, low birthweight, peri-partum and early neonatal complications, parental stress and parenting styles in infancy, early deprivation, adoption and separation. Despite the understanding that there is sharing of risk factors between the DBDs, there has been a disproportionate focus on the role of certain risk factors at the expense of others and the field is weakened by difficulties in controlling for all potential confounding variables.

Matching parenting support needs to service provision in a universal 13-month child health surveillance visit

BACKGROUND

The Glasgow Parenting Support Framework is an intervention to support families with preschool children. It provides structured support through universal and targeted interventions. Two routine family visits by health visitors have been piloted, one involving a home assessment when the child is 13 months old.

AIMS

To establish the need for parenting support in the population at 13 months and whether or not the home assessment improved the match of service provision to need.

METHODS

Health visitors were asked to collect data on existing problems and service provision to families, the mental state of the child's principal carer, an observation of the parent-child relationship and details of management plans. Data from the Child Health Surveillance System were also used.

RESULTS

Data were obtained for 549 families. Nine families were noted to have problems in the parent-child relationship. Carers in these families had poorer mental health. In all, 20% of families had a revisit scheduled: they were also more likely to have poor mental health. All families with possible problems in the relationship had a revisit scheduled. Depression scores measured during the pilot were a significant predictor of revisiting and referral, with an odds ratio of 1.37 for every one point increase in score on the Adult Wellbeing Scale depression subscale.

CONCLUSIONS

Current service provision matches need to some extent but routine visits focused on parenting difficulties at 13 months, particularly parental depression, may help to identify families needing support who would not otherwise have received it.

Quantum dynamics of a Bose superfluid vortex

We derive a fully quantum-mechanical equation of motion for a vortex in a 2-dimensional Bose superfluid in the temperature regime where the normal fluid density ρ(n)(T) is small. The coupling between the vortex "zero mode" and the quasiparticles has no term linear in the quasiparticle variables--the lowest-order coupling is quadratic. We find that as a function of the dimensionless frequency Ω=ℏΩ/k(B)T, the standard Hall-Vinen-Iordanskii equations are valid when Ω≪1 (the "classical regime"), but elsewhere, the equations of motion become highly retarded, with significant experimental implications when Ω≳1.

CD73: an emerging target for cancer immunotherapy (66.7)

CD73 is over-expressed in many types of human and mouse cancers, and is implicated in the control of tumor progression. However, the exact contribution of tumor and host CD73 expression to tumor growth remains unknown to date. We here show that host CD73 promotes tumor growth in a T cell-dependent manner, and that the optimal anti-tumor effect of CD73 blockade required inhibiting both tumor and host CD73. Notably, CD73 on bone marrow (BM)-derived cells (CD4+CD25+ T regulatory cells), but not on nonhematopoietic cells, inhibited systemic anti-tumor T cell expansion and effector function. On the other hand, CD73 on non BM-derived cells (presumably endothelial cells) limited anti-tumor T cell homing to local tumors. Thus, CD73 has distinct roles in hematopoietic and nonhematopoietic cells in regulating anti-tumor T cell responses. In addition, pharmacological blockade of CD73 using its selective inhibitor α,β-methylene adenosine 5′-diphosphate or an anti-CD73 monoclonal antibody, inhibited tumor growth and completely restored efficacy of adoptive T cell therapy. These findings suggest that both tumor and host CD73 cooperatively protects tumors from incoming anti-tumor T cells, and point to a novel cancer immunotherapy strategy by targeting CD73.

Recipient CD73-generated adenosine plays a preventive role in graft-versus-host disease by regulating allogeneic T cell activation (169.16)

Graft-versus-host disease (GvHD) is a systemic disease in which donor T cells attack the allogeneic recipient. Here we investigated the role of CD73 in GvHD induced by transplantation of BALB/c bone marrow and spleen cells into lethally irradiated C57BL/6 recipients. CD73 is an enzyme that generates extracellular adenosine, a nucleoside with anti-inflammatory and immunosuppressive activity mediated by adenosine receptors. Survival curves showed more severe GvHD in CD73-/- → CD73-/- transplants than in CD73+/+ → CD73+/+ transplants and serum IFNγ and IL-6 were higher in CD73-/- recipient mice. CD4+ and CD8+ T cells from CD73-/- donors proliferated more in vivo than those from CD73+/+ donors as assessed by CFSE dye dilution and cell numbers in spleens. However, irradiation-induced activation of dendritic cells as assessed by CD86 up regulation was similar in CD73+/+ and CD73-/- mice. In vivo anti-C57BL/6 CTL activity was higher in CD73-/- transplant recipients than in CD73+/+ recipients. Additional CD73-/- → CD73+/+ and CD73+/+ → CD73-/- transplants revealed that more severe GvHD is caused primarily by a lack of CD73 in recipients. The adenosine receptor antagonist caffeine exacerbated GvHD in CD73+/+ recipients, consistent with the idea that the protective effect of CD73 depends upon its adenosine-generating activity. In conclusion, recipient CD73 plays a primary preventive role in GvHD by regulating allogeneic donor T cell activation in an adenosine-dependent manner.

Targeting CD73 to improves tumor immunotherapy (131.23)

During tumor progression, tumor cells foster a tolerant microenvironment and the activation of many immunosuppressive mechanisms that act in concert to counteract effective immune responses. Therefore, to accomplish cancer immune eradication, tumor-induced immunosuppression must be overcome. We demonstrate that CD73 is widely expressed on many tumor cell lines and upregulated in cancerous tissues with active enzymatic activity. Notably, CD73 expression in malignant cancer patients is closely associated with poor immune status of tumor infiltrating effector T cells. Because CD73 catalyzes AMP breakdown to immunosuppressive adenosine, we propose that CD73-generated adenosine prevents tumor destruction by inhibiting antitumor immunity. We confirmed this hypothesis by showing that inhibition of CD73 by selective inhibitor APCP slowed tumor growth and increased mice survival, and more importantly, augmented CTL therapy of cancer. Using genetic ablation of CD73 on tumor cells by siRNA and CD73 deficient mice, we found that both tumor and host CD73 synergistically controlled tumor progression by impairing antitumor T cell immunity. Thus, counteracting adenosinergic effects of CD73 in the tumor microenvironment represents a novel and feasible strategy of cancer treatment and is complementary to other approaches directed at improving the immune function of antitumor T cells such as adoptive T cell therapy or dendritic cell vaccines.

TEMPO EC for the enumeration of Escherichia coli in foods: collaborative study

The automated method for enumeration of Escherichia coli, TEMPO EC, in foods uses a dehydrated culture medium and enumeration card containing 48 wells across three different dilutions for the automatic determination of the most probable number (MPN). The alternative method was compared in a multilaboratory collaborative study to AOAC Official Method 966.24. Six food types were artificially contaminated with E. coli: raw ground beef, bagged lettuce, cooked chicken, pasteurized crabmeat, frozen green beans, and pasteurized whole milk. All foods were analyzed for E. coli counts by 11 collaborating laboratories throughout the United States. Test portions from the six food types each contaminated at four different contamination levels were evaluated. The study demonstrated that the TEMPO EC method is a reliable, automated assay for the enumeration of E. coli in foods.

Flow cytometric evaluation of boar semen by the sperm chromatin structure assay as related to cryopreservation and fertility

Boar semen from a heterospermic mating trial and semen cryopreserved by various methods were evaluated by the flow cytometric sperm chromatin structure assay (SCSA), which measures the susceptibility of sperm nuclear DNA to acid-induced denaturation in situ. Spermatozoa were treated with a pH 1.4 buffer and then stained with the metachromatic dye acridine orange. Acridine orange intercalated into double-stranded DNA (native) fluoresces green while single-stranded DNA (denatured) fluoresces red when excited with 488 nm light. The ratio of red to total fluorescence provides an index of normality/abnormality. The SCSA data on neat boar semen or semen in either Kiev-Merck or Pursel-Johnson extender and frozen directly on dry ice blocks or plunged into LN2 did not differ within individual boars. Therefore, chromatin structure, as measured by the SCSA, was not influenced differently by these 2 methods of semen cryopreservation. When semen from 6 boars was mixed in equal sperm numbers in six 3-way combinations and inseminated into at least 3 Duroc gilts per combination, 4 of the 6 combinations yielded 2 litters, while the remaining 2 combinations yielded 3 litters. The SCSA correctly predicted both the high and low fertility boars based on a ratio of offspring as deviated from the theoretical percentage. Thus, the SCSA was found to be a valuable adjunct method for evaluating boar semen quality.

Easy-to-use rapid test for direct detection of Campylobacter spp. in chicken feces

Human campylobacteriosis is the leading cause of acute bacterial gastroenteritis in developed countries. One important source of infection is poultry. Results from the Dutch Campylobacter Risk Management and Assessment project indicate that meat from broiler flocks shedding >or=7 log CFU Campylobacter per g of feces poses the greatest risk of transmitting campylobacteriosis. The objective of this study was to develop a simple and rapid test that would identify chicken flocks shedding high numbers of Campylobacter. We used lateral flow technology as the alternative test method, and selected the culture method according to International Organization for Standardization guidelines. To evaluate the test under field conditions, we sampled either chicken droppings at farms or cecal contents at the slaughterhouse. PCR was used to confirm presumptive Campylobacter spp. colonies. Under laboratory conditions, chicken feces containing >or=6.7 log CFU/g Campylobacter jejuni or >or=7.1 log CFU/g Campylobacter coli were identified by the lateral flow test. Overall, 3 (33%) of 10, and 29 (85%) of 34 C. jejuni- or C. coli-positive chicken flocks were identified at farms and slaughterhouses, respectively, by using the lateral flow test. Fecal samples containing >or=7.3 log of C. jejuni or C. coli CFU/g as determined by plating were always positive when using the lateral flow test. A single person testing seven flocks at a time could obtain test results within 2 h of sampling. This simple and rapid lateral flow test may contribute significantly to the identification of chicken flocks shedding high numbers of Campylobacter.

Wide beam reconstruction "quarter-time" gated myocardial perfusion SPECT functional imaging: a comparison to "full-time" ordered subset expectation maximum

BACKGROUND

Previously we reported that compared to iterative reconstruction with ordered subset expectation maximum (OSEM), wide beam reconstruction (WBR), which incorporates resolution recovery and controls noise during reconstruction without applying a post-processing filter, allows half-time SPECT acquisition with preserved diagnostic quality. We now postulate that with further Poisson noise treatment, quarter-time acquisition is possible.

METHODS

The half-time WBR algorithm was optimized for quarter-time acquisition based upon anthropomorphic cardiac phantom data and a pilot group of 48 patients (pts). Then using the modified algorithm, 209 pts (91 men, 118 women, mean chest circumference = 40 in) were imaged at rest (R) and stress (S) (9/32 mCi (99m)Tc-sestamibi) full-time with OSEM, and again quarter-time with the modified WBR algorithm. The 180 degrees , 64-stop, full-time single-day rest (R) (25 second-per-stop, sps) and 8-frame per cardiac cycle post-stress (S) (20 sps) gated SPECT, and then quarter-time R (6 sps) and post-S (4 sps) gated SPECT were acquired. Blinded observers graded scan quality (1 = poor to 5 = excellent) based on myocardial uniformity, endocardial/epicardial edge definition, and background noise. Perfusion defects were scored using a 17-segment model. Using three commercially available software methods, end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were calculated.

RESULTS

For the 209 prospective pts, mean image quality for R full-time OSEM and quarter-time WBR were similar (3.5 +/- 0.9 vs 3.6 +/- 0.7, p NS). For S, quarter-time WBR quality was superior to full-time OSEM (4.3 +/- 0.7 vs 3.9 +/- 0.7) (P = 1.78 x 10(-17)). In 35 pts with chest circumferences >44 inches a longer, 10 sps WBR acquisition improved resting image quality. Of 48 pts with abnormal scans (SSSs > 2 by OSEM) mean summed stress scores, summed rest scores, and summed difference scores were not significantly different with quarter-time WBR vs full-time OSEM (11.2 vs 10.9), (9.1 vs 9.0), (2.0 vs 1.9) (P NS). For the three software methods, there was a good correlation of LVEF, EDV, and ESV determined by WBR vs OSEM (all r > 0.92). ESVs were generally higher with WBR, primarily due to better delineation of the valve plane at end-systole, whereas EDVs were similar. Thus, EFs were significantly lower with WBR.

CONCLUSIONS

For perfusion SPECT quarter-time WBR affords image quality, defect characterization, and functional assessment equivalent to full-time OSEM.

Paediatricians' perceptions on referrals to paediatric palliative care

Children have traditionally been referred to palliative care when curative treatments were exhausted. Recently, experts have suggested that children could benefit from palliative care early in their courses of illness. Using survey data from 303 paediatricians in Florida and California, this study assesses if paediatricians would refer children to palliative care early in their course of illness. Results showed that more years in practice were associated with decreased odds of referring children to palliative care. Academic practice setting and more Medicaid patients were associated with greater odds of referral prior to the end of life. Hispanic paediatricians, those with more experience and those who practice in a hospital setting were associated with decreased odds of referral prior to the end of life. Results suggest that health planners who wish to implement or refine integrated paediatric palliative care programs should consider outreach strategies targeted at paediatricians with specific characteristics.

CD73-generated Adenosine Regulates Thrombomodulin Expression (94.29)

Thrombomodulin (TM), as a thrombin modulator, plays a role in anti-coagulation. TM also plays an important role in regulating inflammation and vascular permeability. As TM expression levels are regulated by cAMP, and adenosine receptors (AR) modulate intracellular cAMP levels, we investigated whether TM expression can be regulated by AR signaling triggered by CD73-generated adenosine. Mouse endothelial cells were treated with either the general AR agonist NECA, or agonists specific for different AR subtypes, and TM expression levels were measured. Protein levels increased 2-fold in response to NECA; mRNA levels increased 4-fold. TM protein and mRNA levels also increased in response to A2AAR and A2BAR agonists, but not to A1AR or A3AR agonists. TM protein and mRNA levels also increased after AMP treatment and these increases were abrogated by a CD73 inhibitor. TM mRNA levels increased 4- to 6-fold in lung, heart, and liver of mice treated with NECA; protein levels increased 2-fold. Wild type and CD73-/- mice were treated with LPS and TM expression levels were measured in lung tissues. TM mRNA levels decreased further in lung tissue of CD73-/- mice than in wild-type mice after LPS treatment. These data suggest that AR signaling can modulate TM expression and that CD73-generated adenosine can be very important in regulating TM mRNA levels in vivo during an inflammatory response.

This work is funded by NIH grants AI18220 and P20RR016904.

I did not save for my retirement and will have to work until I drop

I can relate to Connie Amaning (features February 4), who at 65 is still working to save for her retirement. I cannot afford to retire and will have to work until I drop.

Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea

STUDY OBJECTIVES

To compare a clinical pathway using portable monitoring (PM) for diagnosis and unattended autotitrating positive airway pressure (APAP) for selecting an effective continuous positive airway pressure (CPAP) with another pathway using polysomnography (PSG) for diagnosis and treatment of obstructive sleep apnea (OSA).

DESIGN

Randomized parallel group

SETTING

Veterans Administration Medical Center

PATIENTS

106 patients with daytime sleepiness and a high likelihood of having OSA MEASUREMENTS AND RESULTS: The AHI in the PM-APAP group was 29.2 +/- 2.3/h and in the PSG group was 36.8 +/- 4.8/h (P= NS). Patients with an AHI > or = 5 were offered CPAP treatment. Those accepting treatment (PM-APAP 45, PSG 43) were begun on CPAP using identical devices at similar mean pressures (11.2 +/- 0.4 versus 10.9 +/- 0.5 cm H2O). At a clinic visit 6 weeks after starting CPAP, 40 patients in the PM-APAP group (78.4% of those with OSA and 88.8% started on CPAP) and 39 in the PSG arm (81.2% of those with OSA and 90.6% of those started on CPAP) were using CPAP treatment (P = NS). The mean nightly adherence (PM-APAP: 5.20 +/- 0.28 versus PSG: 5.25 +/- 0.38 h/night), decrease in Epworth Sleepiness Scale score (-6.50 +/- 0.71 versus -6.97 +/- 0.73), improvement in the global Functional Outcome of Sleep Questionnaire score (3.10 +/- 0.05 versus 3.31 +/- 0.52), and CPAP satisfaction did not differ between the groups.

CONCLUSIONS

A clinical pathway utilizing PM and APAP titration resulted in CPAP adherence and clinical outcomes similar to one using PSG.