Cytokines and neutrophils responses in influenza pneumonia

This case report shows a striking correlation of remarkable brief high levels of pro- and anti-inflammatory cytokines coupled with increased neutrophil activation, followed by a sharp decrease in cytokine levels and increased neutrophil apoptosis associated with the favorable clinical outcomes of a patient with severe influenza infection. The host response examined in our case is not complete, given it did not assess the full spectrum of host response. The brief neutrophil and cytokine response seen in our case in the absence of antiviral therapy and in the presence of methotrexate immunosuppressive therapy rise the question as to whether the latter optimally modulated the macrophage function, resulting in a favorable outcome of severe influenza viral infection.

Towards the determination of an optimal scale for stormwater quality management: micropollutants in a small residential catchment

Stormwater and atmospheric deposits were collected on a small residential urban catchment (0.8 ha) near Paris in order to determine the levels of certain micropollutants (using a preliminary scan of 69 contaminants, followed by a more detailed quantification of PAHs, PCBs, alkylphenols and metals). Atmospheric inputs accounted for only 10%-38% of the stormwater contamination (except for PCBs), thus indicating substantial release within the catchment. On this small upstream catchment however, stormwater contamination is significantly lower than that observed downstream in storm sewers on larger adjacent urban catchments with similar land uses. These results likely stem from cross-contamination activity during transfers inside the sewer system and underscore the advantages of runoff management strategies at the source for controlling stormwater pollutant loads. Moreover, it has been shown that both contamination levels and contaminant speciation evolve with the scale of the catchment, in correlation with a large fraction of dissolved contaminants in upstream runoff, which differs from what has been traditionally assumed for stormwater. Consequently, the choice of treatment device/protocol must be adapted to the management scale as well as to the targeted type of contaminant.

Molecular epidemiology of Malassezia globosa and Malassezia restricta in Sudanese patients with pityriasis versicolor

Pityriasis versicolor is a superficial infection of the stratum corneum caused by Malassezia yeasts. The cutaneous Malassezia globosa and Malassezia restricta in Sudanese patients with pityriasis versicolor were elucidated using a molecular-based, culture-independent method and compared with that in healthy individuals. Scale samples were collected by applying an Opsite™ transparent dressing to lesional and non-lesional sites on 29 Sudanese patients with pityriasis versicolor and 54 healthy individuals. Malassezia DNA was extracted directly from the samples. The overall level of colonization by Malassezia globosa and Malassezia restricta was analyzed by real-time PCR using a TaqMan probe. The overall level of colonization by Malassezia at the lesional sites was higher than that at the non-lesional sites for all body sites, including the face, neck, cheeks, and trunk (2.7- to 6.0-fold increase). Both M. globosa and M. restricta were detected in patients and healthy individuals. However, M. globosa predominated at lesional sites, whereas the level of colonization by both species was similar in healthy individuals.

Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia

BACKGROUND

Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza.

OBJECTIVE

To evaluate the role of CAP severity scores as predictors of mortality.

METHODS

This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality.

RESULTS

Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality.

CONCLUSIONS

The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.

Zn and Pb emissions from roofing materials--modelling and mass balance attempt at the scale of a small urban catchment

Many studies have shown that roofing materials are an important source of metals in urban runoff. Today, in the context of the European Water Directive (2000/60 CE), the quantification of these emissions is necessary, and thus the development of assessment tools is needed. This study focuses on a small urban catchment (drained by a separative sewer system). Atmospheric fallout, road runoff, roof runoff and total runoff at the outlet of the catchment were sampled. The aim is (1) to verify the contribution of roofing materials to metallic flows of Zn and Pb at the catchment scale and (2) to try to model emissions using some models previously developed at the test-bed scale. These models have to be tested at different spatial scales. Results obtained confirm the strong contribution of roofing materials to Zn and Pb flows at the catchment scale. For Zn, models tested were successfully transposed and validated at the roof and the catchment scales, permitting a good quantification of Zn emissions. For Pb, the use of the models highlights some difficulties, especially concerning the identification and the quantification of lead surface areas implemented.

13-14-week fetal anatomy scan: a 5-year prospective study

OBJECTIVES

To assess the potential value of an early (first-trimester) ultrasound examination in depicting fetal anomalies by transabdominal (TAS) and transvaginal (TVS) sonography, to compare it with the traditional mid-trimester anomaly ultrasound examination and to evaluate the degree of patient acceptance of early sonography by the transvaginal route.

METHODS

In this prospective study over a 5-year period (January 2002 to January 2007) 2876 pregnant women underwent a 13-14-week ultrasound examination. The scan was performed by TAS at first and then, if a full fetal anatomical survey was not achieved, by TVS. A mid-trimester fetal anatomy scan was then performed in patients who had not dropped out, miscarried or undergone pregnancy termination (n = 2834).

RESULTS

In the early scan, analyzable data for 2876 TAS and 1357 TVS examinations showed that TVS was significantly better in visualizing the cranium, spine, stomach, kidneys, bladder and upper and lower limbs (P < 0.001). Complete fetal anatomical surveys were achieved by TAS in 64% of cases versus 82% of the cases in which it was attempted by TVS (P < 0.001). Patient body mass index significantly affected the ability of the sonographer to achieve a complete anatomical survey by both TAS and TVS (P < 0.001 and P = 0.004, respectively). The duration of the scan was significantly longer using TVS. The heart and kidneys were not properly visualized in 42% and 27% of cases, respectively, at the 13-week scan compared with 1.6% and 0% at the mid-trimester scan. The total number of cases in which anomalies were detected was 31. At the first-trimester scan, anomalies were detected in 21 fetuses and in 14 of these cases the parents chose pregnancy termination. At the second-trimester scan, anomalies were detected in 17 fetuses: 10 new anomalous cases along with seven cases already detected in the first-trimester scan.

CONCLUSION

Besides its importance in screening for chromosomal abnormalities, the early scan has great potential in visualizing with precision fetal anatomy. TVS can be used to compliment difficult TAS examinations; however, patients do not always agree to undergo TVS. The mid-trimester scan remains crucial for detailed fetal anatomical survey.

Annual metallic flows in roof runoff from different materials: test-bed scale in Paris conurbation

A substantial database of annual metal runoff loads, obtained from a 14-month field exposure campaign on 12 different metal roofing materials at two sites within Paris conurbation, is presented herein. Thirteen metallic species have been considered. A comparison among the various roofing materials yields a ranking of their runoff pollution potential, which highlights that aluminum, coated products, and stainless steel display the lower emission levels, before zinc and copper materials. Lead materials appear to release more metallic species, and tend to do so in quite large quantities. Whatever the material family considered, older materials apparently release more metallic species with higher levels of emission. In considering zinc emissions from zinc-based materials, it is clear that surface coatings significantly reduce zinc emissions (40% less for the Zn3(PO4)2 surface-treated Anthra zinc, compared to natural zinc; and 99% less for prepainted galvanized steel compared to standard galvanized steel). In the case of Anthra zinc however, surface treatment induces the release of Ni into the runoff, and Ni constitutes a priority pollutant in the European Water Framework Directive (2000/60 CE). A high level of consistency with literature data has been found for Zn runoff when considering runoff rates reported at the same inclination.

Adherence to anti retroviral therapy (ART) during Muslim Ramadan fasting

Annual fasting during the month of Ramadan is observed in Muslim countries, some of which have widespread HIV infection. We studied treatment adherence and customary practices among 142 fasting 'FT' and 101 non-fasting 'NFT' patients on anti-retroviral therapy (ART) in Nigeria. Adherence on ART among FT and NFT patients was similar during Ramadan, 96% and 98%, and ever since commencement of ART, 80% and 88%, respectively. FT patients altered their typical daily behaviors by advancing morning and delaying evening doses thereby prolonging dosing intervals, eating heavier meals pre-dawn and on breakfast at sunset (78%), and changing or reducing their sleeping and waking times (40%). This preliminary study suggests that adherence and drug taking frequency appear uncompromised in FT HIV infected patients on ARVs.

Inflammatory mechanisms in the lung

Inflammation is the body's response to insults, which include infection, trauma, and hypersensitivity. The inflammatory response is complex and involves a variety of mechanisms to defend against pathogens and repair tissue. In the lung, inflammation is usually caused by pathogens or by exposure to toxins, pollutants, irritants, and allergens. During inflammation, numerous types of inflammatory cells are activated. Each releases cytokines and mediators to modify activities of other inflammatory cells. Orchestration of these cells and molecules leads to progression of inflammation. Clinically, acute inflammation is seen in pneumonia and acute respiratory distress syndrome (ARDS), whereas chronic inflammation is represented by asthma and chronic obstructive pulmonary disease (COPD). Because the lung is a vital organ for gas exchange, excessive inflammation can be life threatening. Because the lung is constantly exposed to harmful pathogens, an immediate and intense defense action (mainly inflammation) is required to eliminate the invaders as early as possible. A delicate balance between inflammation and anti-inflammation is essential for lung homeostasis. A full understanding of the underlying mechanisms is vital in the treatment of patients with lung inflammation. This review focuses on cellular and molecular aspects of lung inflammation during acute and chronic inflammatory states.

Sterols: a tracer of organic matter in combined sewers

The important organic pollution of combined wet weather flows (WWF), its acute impact on receiving waters have been widely demonstrated. The main three possibly origins for this organic pollution are: runoff water (streets and roofs), wastewater and erosion of sewer sediments in combined sewer system. This work, for tracing the origin of organic particles bound in combined sewer system, has been focused on the innovative use of sterols. So, eight sterols have been selected and analysed for each kind of sample. Results are represented in contents of sterols (microg g(-1)) and in sterol profiles (%). The comparison of contents and profiles leads the separation between two groups: runoff water, characterized by the total absence of coprostanol, epicoprostanol and coprostanone, and the group of sewer deposits (gross bed sediment (GBS), organic layer (OL), biofilms) and wastewater. Moreover, sewer deposits and wastewater can be distinguished by their sterol contents and profiles. To evaluate their contribution to WWF a comparison between sterol signatures is done which shows that these effluents have a strong similarity in profiles and in contents of sterols to the organic layer.

Settling velocity of particulate pollutants from combined sewer wet weather discharges

Settling velocities of TSS and of particulate pollutants (COP, PDCO, PTKN, PCu, PPb, PZn, PPAH) measured on a wide range of wet weather flow (WWF) samples collected at different levels of the Parisian combined sewer system are reported. The recorded V30 (0.01 to 0.1 mm s(-1)) and V50 (0.09 to 0.6 mm s(-1)) values exceed by a factor 10 those of dry weather sewage and also exceed the values measured for pavement runoff. These values lie however often below the 0.28 mm s(-1) reference value considered in France for the design of WWF settling facilities. A decrease in settleability is observed between a small upstream catchment and larger scaled downstream catchments. The settling behaviour of particulate pollutants varies depending on the considered parameter and can differ significantly from the TSS behaviour, due to a non homogeneous distribution of micropolluants over the different classes of particles. PZn and PTKN appear far less settleable than TSS, whereas PPAH show higher settleability.

Use of a tissue expander and a polyglactic acid (Vicryl) mesh to reduce radiation enteritis: case report and literature review

Management of stage IV rhabdomyosarcoma comprises systemic chemotherapy with local control by conservative surgery and radiotherapy. Abdominal radiotherapy may lead to radiation enteritis causing such serious morbidity as malabsorption, fistulae or stricture formation. The risk increases with the dose of radiation and length of bowel involved. Various methods have been utilised to displace the bowel from the radiation field. Usually these are applied in patients requiring pelvic irradiation. We report a case of metastatic alveolar rhabdomyosarcoma requiring radiotherapy to the right renal bed. Effective displacement of small bowel from the tumour site was achieved by a combined use of a tissue expander and Vicryl mesh. There were no complications from the surgery. This is the first report discussing combined use of a tissue expander and Vicryl mesh to aid radiotherapy to the renal fossa in a paediatric patient.

The secondary dyslipidemia and deranged serum phosphate concentration in thyroid disorders

Hyperlipidemia is a secondary disorder associated with many metabolic disorders including hypothyroidism. The occurrence of dyslipidemia in subclinical hypothyroidism is controversial. Hyperphosphatemia may accompany the dyslipidemia in some metabolic disorders. Both hyperlipidemia and hyperphosphatemia are considered to be risk factors for the coronary heart diseases. In the present study, we investigated the occurrence of dyslipidemia and altered serum phosphate concentrations in patients with thyroid disorders. The results indicated a significantly elevated serum cholesterol and triglyceride concentrations in the hypothyroid patients. The dyslipidemia was accompanied with significantly elevated serum phosphate level. On the other hand, no significant difference was evident in the serum lipid or phosphate concentrations of subclinical hypothyroid patients compared to euthyroid subjects. A significantly reduced serum phosphate level was shown in hyperthyroid patients with unaltered serum lipid levels. Significant correlations were evident between TSH and T(4) levels as independent parameters and the serum concentrations of triglyceride, cholesterol and phosphate. The results indicate in hypothyroidism that a secondary hyperphosphatemia may aggravate myocardial and arterial abnormalities induced by the secondary hyperlipidemia, which may need correction.

Automatic analysis and classification of surface electromyography

In this paper, parametric modeling of surface electromyography (EMG) algorithms that facilitates automatic SEMG feature extraction and artificial neural networks (ANN) are combined for providing an integrated system for the automatic analysis and diagnosis of myopathic disorders. Three paradigms of ANN were investigated: the multilayer backpropagation algorithm, the self-organizing feature map algorithm and a probabilistic neural network model. The performance of the three classifiers was compared with that of the old Fisher linear discriminant (FLD) classifiers. The results have shown that the three ANN models give higher performance. The percentage of correct classification reaches 90%. Poorer diagnostic performance was obtained from the FLD classifier. The system presented here indicates that surface EMG, when properly processed, can be used to provide the physician with a diagnostic assist device.

T cell activity correlates with oligomeric peptide-major histocompatibility complex binding on T cell surface

Recognition of virally infected cells by CD8+ T cells requires differentiation between self and nonself peptide-class I major histocompatibility complexes (pMHC). Recognition of foreign pMHC by host T cells is a major factor in the rejection of transplanted organs from the same species (allotransplant) or different species (xenotransplant). AHIII12.2 is a murine T cell clone that recognizes the xenogeneic (human) class I MHC HLA-A2.1 molecule (A2) and the syngeneic murine class I MHC H-2 D(b) molecule (D(b)). Recognition of both A2 and D(b) are peptide-dependent, and the sequences of the peptides recognized have been determined. Alterations in the antigenic peptides bound to A2 cause large changes in AHIII12.2 T cell responsiveness. Crystal structures of three representative peptides (agonist, null, and antagonist) bound to A2 partially explain the changes in AHIII12.2 responsiveness. Using class I pMHC octamers, a strong correlation is seen between T cell activity and the affinity of pMHC complexes for the T cell receptor. However, contrary to previous studies, we see similar half-lives for the pMHC multimers bound to the AHIII12.2 cell surface.

Evaluation of circulating Fasciola antigens in specific diagnosis of fascioliasis

Ninety-eight individuals were included in this study, 60 of them were passing Fasciola eggs, 20 were infected with other parasites but not Fasciola (infected control group) and 18 individuals were free from parasite infection (normal control group). Circulating Fasciola antigens (CFAg) and anti-Fasciola IgG were estimated by ELISA technique among all groups. Highly significant increased level of CFAg was observed among Fasciola-infected cases when compared with normal control group. The percentage positivity of CFAg was 95% among Fasciola-infected cases. Solid specificity was observed by the test. Moreover, a highly significant increase in the antigen level was detected among moderately infected patients compared with lightly infected group. The level of CFAg was significantly higher in the hepatomegalic cases than those without organomegaly. Anti-Fasciola IgG antibodies were detected in only 35% of Fasciola infected cases, which indicates much lower sensitivity of the antibody detection than antigens. No correlation between the level of the circulating antibodies and either the intensity of infection or the clinical presentations was observed.

Contribution of different sources to the pollution of wet weather flows in combined sewers

Experiments performed on "Marais" catchment, in central Paris, aimed to follow up the quality of wet weather flows from the entry to the exit of a combined sewer network. SS, VSS, COD, BOD5, Cd, Cu, Pb, Zn concentrations were measured for an important number of rain events in roof, yard, street runoff, as well as in dry and wet weather flows at the catchment outlet. Mass entry-exit totals, at the scale of the catchment, were calculated over 31 rain events in order to evaluate the contribution of different types of runoff, of sanitary sewage and of sewer sediments to the total wet weather pollutant loads at the catchment outlet. The erosion of in-sewer pollutant stocks was found to be the main source of particles and of organic matter in wet weather flows, whereas heavy metal loads mainly originated from roof runoff, due to the corrosion of metallic roofs. Particles eroded inside the sewer during rain events were found to be quite different from the particles constituting the main part of sewer sediments: they are organic and biodegradable, with rather important settling velocities and seem to accumulate during dry weather periods. A change of the chemical form of heavy metals was noticed during the transport in the sewer and it is suspected that a fraction of the dissolved metals from the runoff is adsorbed on sewer sediments.

Usefulness of the response of flow velocity in the left anterior descending coronary artery to the cold pressor test for evaluating endothelium-dependent vascular relaxation in the coronary microvasculature by transesophageal echocardiography in subjects with angiographically normal coronary arteries

Measurement of flow velocity in the left anterior descending coronary artery by transesophageal echocardiography in subjects without risk factors for coronary artery disease (group 1) and in subjects with normal coronary arteries but conditions associated with endothelial dysfunction (group 2) revealed that there was a significantly impaired coronary flow velocity response to the cold pressor test in group 2 subjects. Thus, transesophageal echocardiography provides a minimally invasive tool for the functional assessment of endothelium and can be valuable in evaluating endothelial dysfunction and recovery in a variety of disease states.

Mutations in NEUROD1 are associated with the development of type 2 diabetes mellitus

The helix-loop-helix (HLH) protein NEUROD1 (also known as BETA2) functions as a regulatory switch for endocrine pancreatic development. In mice homozygous for a targeted disruption of Neurod, pancreatic islet morphogenesis is abnormal and overt diabetes develops due in part to inadequate expression of the insulin gene (Ins2). NEUROD1, following its heterodimerization with the ubiquitous HLH protein E47, regulates insulin gene (INS) expression by binding to a critical E-box motif on the INS promoter. Here we describe two mutations in NEUROD1, which are associated with the development of type 2 diabetes in the heterozygous state. The first, a missense mutation at Arg 111 in the DNA-binding domain, abolishes E-box binding activity of NEUROD1. The second mutation gives rise to a truncated polypeptide lacking the carboxy-terminal trans-activation domain, a region that associates with the co-activators CBP and p300 (refs 3,4). The clinical profile of patients with the truncated NEUROD1 polypeptide is more severe than that of patients with the Arg 111 mutation. Our findings suggest that deficient binding of NEUROD1 or binding of a transcriptionally inactive NEUROD1 polypeptide to target promoters in pancreatic islets leads to the development of type 2 diabetes in humans.

NACOB presentation to ASB Young Scientist Award: Postdoctoral. The impact of boundary conditions and mesh size on the accuracy of cancellous bone tissue modulus determination using large-scale finite-element modeling. North American Congress on Biomechanics

The apparent properties of cancellous bone are determined by a combination of both hard tissue properties and microstructural organization. A method is desired to extract the underlying hard tissue properties from simple mechanical tests, free from the complications of microstructure. It has been suggested that microCT voxel-based large-scale finite element models could be employed to accomplish this goal (van Rietbergen et al., 1995, Journal of Biomechanics, 28, 69-81). This approach has recently been implemented and it is becoming increasingly popular as finite element models increase in size and sophistication (Fyhrie et al., 1997, Proceedings of the 43rd Annual Meeting of the Orthopaedic Research Society, San Francisco, CA, p. 815; van Rietbergen et al., 1997, Proceedings of the 43rd Annual Meeting of the Orthopaedic Research Society, San Francisco, CA, p. 62). However, no direct quantitative measurements of the accuracy of this method applied to porous structures such as cancellous bone have been made. This project demonstrates the feasibility of this approach by quantifying its best-case accuracy in determining the trabecular hard tissue modulus of analogues fabricated of a material with known material properties determined independently by direct testing. In addition we were able to assess the impact of mesh size and boundary conditions on accuracy. We found that the assumption of a frictionless boundary condition in the parallel plate compression loading configuration was a significant source of error that could be overcome with the use of rigid end-caps similar to those used by Keaveny et al. (1997 Journal of Orthopaedic Research, 15(1), 101-110). In conclusion, we found that this approach is an effective method for determining the average trabecular hard tissue properties of human cancellous bone with an expected practical accuracy level better than 5%.

Distribution of cholinergic neurons in cell group K of the rabbit brainstem

The cell bodies of efferent neurons supplying the masseter and digastric muscles of the rabbit are located in two brainstem nuclei: the trigeminal motor nucleus and cell group k. The latter also contains neurons innervating muscles of the middle ear and Eustachian tube, as well as neurons that project to the cerebellum and the oculomotor complex. As part of an attempt to identify the functional subpopulations within the three cell divisions (kl-k3) that make up cell group k, we have investigated the distribution of neurons containing choline acetyltransferase, because these are likely to be motoneurons. Five rabbits anaesthetized with sodium pentobarbital (90 mg/kg, i.v.) were used in this study. They were perfused with 4% paraformaldehyde and 0.1% glutaraldehyde in phosphate buffer (0.1 M, pH 7.4). Two animals were used for preliminary studies. In the other three cases, serial Vibratome coronal sections of the brainstem were cut at 50 microm and two series of alternating sections were collected. The first was stained with a monoclonal antibody (code AB8, Incstar) directed against choline acetyltransferase, using the avidin-biotin-peroxidase method. The other was stained with Cresyl Violet. Cell counts and three-dimensional reconstructions were made for both series to determine positions and ratios of cholinergic and non-cholinergic neurons within the trigeminal motor nucleus and the subdivisions of cell group k. The results showed that the numbers of choline acetyltransferase- and Nissl-stained neurons within the trigeminal motor nucleus were almost identical. In cell group k, significantly fewer choline acetyltransferase-stained cells were counted in all three animals (ratios of choline acetyltransferase/Nissl=0.53-0.71). In addition, the distribution of cholinergic neurons was not uniform throughout cell group k. Subdivisions kl and k3 contained proportionately fewer choline acetyltransferase-positive cells (ratios of choline acetyltransferase/Nissl=0.23-0.64) than did k2 (ratios choline acetyltransferase/ Nissl=0.75-0.88). Within each subdivision, there were significant differences in the spatial coordinates of Nissl- and choline acetyltransferase-positive neurons. We conclude that cell group k contains at least two populations of neurons which are unevenly distributed between and within the three subdivisions. While the majority of neurons in subgroup k2 contain choline acetyltransferase and thus are likely to be motoneurons, more than half of the neurons in subgroups k1 and k3 are not cholinergic. It remains to be determined whether these are the neurons that project to the cerebellum and to other CNS regions.

Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study

CONTEXT

Exercise training is associated with improved insulin sensitivity (SI), but the potential impact of habitual, nonvigorous activity is uncertain.

OBJECTIVE

To determine whether habitual, nonvigorous physical activity, as well as vigorous and overall activity, is associated with better SI.

DESIGN

A multicultural epidemiologic study.

SETTING

The Insulin Resistance Atherosclerosis Study, conducted in Oakland, Calif; Los Angeles, Calif; the San Luis Valley, Colo; and San Antonio, Tex.

PARTICIPANTS

A total of 1467 men and women of African American, Hispanic, and non-Hispanic white ethnicity, aged 40 to 69 years, with glucose tolerance ranging from normal to mild non-insulin-dependent diabetes mellitus.

MAIN OUTCOME MEASURE

Insulin sensitivity as measured by an intravenous glucose tolerance test.

RESULTS

The mean SI for individuals who participated in vigorous activity 5 or more times per week was 1.59 min(-1) x microU(-1) x mL(-1) x 10(-4) (95% confidence interval [CI], 1.39-1.79) compared with 0.90 (95% CI, 0.83-0.97) for those who rarely or never participated in vigorous activity, after adjusting for potential confounders (P<.001). When habitual physical activity (estimated energy expenditure [EEE]) was assessed by 1-year recall of activities, the correlation coefficient between SI and total EEE was 0.14 (P<.001). After adjustment for confounders, vigorous and nonvigorous levels of EEE (metabolic equivalent levels > or = 6.0 and <6.0, respectively) were each positively and independently associated with SI (P< or =.01 for each). The association was attenuated after adjustment for the potential mediators, body mass index (a measure of weight in kilograms divided by the square of the height in meters), and waist-to-hip ratio. Results were similar for subgroups of sex, ethnicity, and diabetes.

CONCLUSIONS

Increased participation in nonvigorous as well as overall and vigorous physical activity was associated with significantly higher SI. These findings lend further support to current public health recommendations for increased moderate-intensity physical activity on most days.

Anatomical organization of efferent neurons innervating various regions of the rabbit masseter muscle

Previous studies have shown that the masseter muscle is supplied by motoneurons located in the anterodorsal region of the trigeminal motor nucleus and by an additional group of efferent neurons located in cell group k. The present experiments were performed on nine rabbits and were designed to establish the locations of neurons innervating the different regions of this muscle. Retrograde labeling with two fluorescent tracers (FluoroGold and Fast Blue) was applied to the central ends of cut branches of the masseter nerve. Serial coronal sections of the brainstem were viewed with fluorescence microscopy. The labeled cells were counted in all animals, and three-dimensional reconstructions of their distribution were made in five cases. In each successful experiment, labeled neurons were seen in the anterodorsal region of the trigeminal motor nucleus and in the two dorsal cell columns of cell group k (k1 and k3). Within-animal comparisons of the median position of populations innervating two distinct muscle regions in five rabbits showed that there were no significant differences in either the dorsoventral or rostrocaudal axes. However, in each case, there was a small but significant difference (83-173 microm) in the mediolateral axis within the motor nucleus but not within cell group k. Even in this axis, there was a 94-99% overlap of the two populations. Comparisons of the neuronal cross-sectional area showed that the deep regions were innervated by a larger proportion of small neurons from both nuclei than were the superficial and intermediate regions. Our results suggest that there is no simple topographical arrangement of motoneurons that corresponds to the peripheral pattern of nerve supply to the different regions of the masseter muscle.

Study of neuromyopathy in amyloid kidney transplant patients

Neuromuscular status of amyloid and control groups of kidney transplant recipients was assessed through complete neurological examination, assay for serum levels of muscle enzymes (CPK and LDH), electromyography and nerve conduction velocity studies. Neuromyopathic findings were detected in both groups but without severe disabling clinical manifestations. These findings were more prominent in the amyloid group, evidenced by a more significant increase in polyphasicity detected by electromyography and longer prolongation of terminal latency measured in the median nerve. From this study, we concluded that amyloid kidney transplant recipients are more prone to neuromyopathy than the general kidney transplant population, which is mostly due to the amyloidosis itself and/or the colchicine therapy.

Effect of age, comorbidity and type of surgery on perioperative complications and mortality of prostatectomy

OBJECTIVE

To study the effect of age, type of surgery and comorbidities (cardiovascular diseases, chronic lung diseases, diabetes mellitus and renal impairment) on the peri-operative complications and mortality of prostatectomy.

PATIENTS AND METHODS

A series of 236 consecutive patients who underwent prostatectomy (171 by transurethral resection, TUR, and 65 by open procedure) were reviewed. Ninety patients at risk with one or more of the comorbidities were grouped together and compared with the remaining 146 fit patients. Also, 148 patients aged < or = 70 years were compared with 88 patients aged > 70 years. The peri-operative morbidity variables compared were haemorrhage, > or = 3 units of blood transfusion, bacteriuria, orchitis, pyrexia, uraemia and bed-stay.

RESULTS

Mean post-operative bed-stay for patients at risk was significantly longer than that for fit patients (12 +/- 7 and 9.7 +/- 6 days, respectively). Mortality and the other morbidity variables, apart from post-operative bacteriuria which was more frequent in diabetics, were not significantly different between the groups. Similarly, comparing age groups revealed no significant differences. However, open surgery was associated with more haemorrhage, blood transfusion, post-operative pyrexia and a longer bed-stay.

CONCLUSION

The comorbidities studied and age did not significantly influence the complications and mortality of prostatectomy. However, comorbidities prolonged post-operative bed-stay. Open surgery was associated with more bleeding and pyrexia and a longer bed-stay than TUR.

Causes and consequences of esterase 6 enzyme activity variation in pre-adult Drosophila melanogaster

We report heritable threefold differences in both larval and pupal esterase 6 activity among 17 isoallelic lines of D. melanogaster extracted from a natural population. The activity differences in the two stages are only weakly correlated with each other or with previously determined values for esterase 6 activity in adults of these lines. The pre-adult activity variation is also unrelated to polymorphisms among the lines for six esterase 6 allozymes and six restriction sites in a region encompassing the esterase 6 coding DNA and the first kbp of 5' flanking DNA. However, two insertions, of 8.0 and 6.8 kbp, located about 1.4 kbp 5' of the esterase 6 coding region are associated with low activity in larvae and, to a lesser extent, in pupae, albeit not in adults. Restriction mapping reveals similarity between the 8.0 kbp insert and the 7.4 kbp retrotransposon 17.6. The differences in larval activity among lines are positively correlated with fitness as assessed from assays of pre-adult viability and development time but no significant associations between pupal esterase 6 activity and these measures are detected. Some effects of esterase 6 allozyme differences are also found for viability and development time but these effects could be explained by linkage disequilibrium between the 8.0 kbp insert and the EST6-9 allozyme.

Acute variceal hemorrhage: the persistent bleeder. A plea for management

A group of 1910 patients with acutely bleeding esophagogastric varices were managed in the Kasr El Aini sclerotherapy project; 458 of the patients (24%) were lost to follow-up. The remaining patients were studied in five groups: group I (294/401 patients), rigid versus flexible sclerotherapy; group II (254/336 patients), intravariceal versus paravariceal sclerotherapy; group III (174/227 patients), timing of initial sclerotherapy and the optimum frequency of sclerotherapy sessions; group IV (80/99 patients), splenectomy devascularization operation alone versus combined surgery with sclerotherapy; group V (650/847 patients), management of failures of and recurrences after sclerotherapy. The mean period of follow-up was 72 months. Rigid sclerotherapy was significantly superior to flexible sclerotherapy for emergency control of acute bleeding but was associated with significantly more morbidity. Paravariceal injection achieved insignificantly better initial control of bleeding and had more morbidity than intravariceal injection, which obliterated the varices in a significantly larger proportion of patients. Emergency injection of the acute bleeder should be carried out soon after admission, with sclerotherapy sessions repeated every 2 weeks. Combined sclerotherapy with splenectomy and devascularization was significantly more effective for controlling bleeding than surgery alone. Surgery should be done without delay for continued bleeding after the second attempt of sclerotherapy and in patients who rebleed after their third sclerotherapy session. Survival, however, was not significantly improved by the different modalities of sclerotherapy.

Associations of esterase 6 allozyme and activity variation with reproductive fitness in Drosophila melanogaster

Previous studies have shown that the esterase 6 (EST6) enzyme of D. melanogaster is mainly produced in the sperm ejaculatory duct of the adult male and comparisons of wild-type males with laboratory null mutants have suggested that the enzyme plays a role in reproductive fitness. In this study we have compared 18 field-derived lines each isoallelic for Est6 for differences in five components of male reproductive fitness. No consistent fitness differences were found among lines differing in respect of the two major allozyme classes EST6-F and EST6-S, despite other evidence that these two classes are not selectively equivalent in the field. However, differences in reproductive fitness were found among lines differing in the minor mobility variants that segregate within EST6-F and EST6-S. A failure to distinguish among these minor forms may explain the discrepancies in previous studies on the effects of the major EST6 allozymes on reproductive fitness. The most significant associations we have found between EST6 and reproductive fitness were due to variation in EST6 activity levels. Male EST6 activity levels were found to be positively correlated with their time to first mating, negatively correlated with the numbers of eggs laid and progeny produced by their mates, and negatively correlated with the frequency with which their mates remate. We conclude that some EST6 variants differ in components of male reproductive fitness operative in laboratory cultures. However, the evidence for fitness differences is stronger for variants affecting the amount, rather than the structure of the enzyme, and the direction of the differences varies between some of the fitness components tested.

[Risk of dislocation and cataract formation in 240 IOGEL lenses. 4 years experiences]

Following planned extracapsular cataract extractions we implanted 240 IOGEL lenses into the capsular bag and noticed 5 dislocations into the vitreous cavity, 2 after an Nd-YAG capsulotomy, 4 postoperatively and 1 after surgical repositioning. Postoperatively, one lens was subluxated into the anterior chamber. Thirty-three patients required a 4- to 5-mm Nd-YAG capsulotomy because of a fibrotic or regenerative secondary cataract. Two lenses dislocated 2 and 6 weeks after the YAG capsulotomy into the vitreous cavity; the capsulotomy was performed 5 and 6 months, respectively, after the implantation. In 4 patients the IOGEL lens dislocated 3 times within the first 3 days and once within the first 3 months after implantation. Primary stable placement in the bag could be achieved, however. One patient required repositioning of the lens because of decentration 3 months after implantation. The lens dislocated on the following day. Late dislocation of the flexible and soft IOGEL lens can be due to the fact that the lenses do not adhere to the capsular sheets. Furthermore, postoperative capsular shrinkage enlarging a posterior capsular opening leads to lens dislocation. Eight patients underwent a secondary anterior chamber lens implantation. In three patients the IOGEL lens was explanted, in two of them without and in one of them with serious complications. The other five patients still have their IOGEL lens deep in the vitreous without complications. We suggest that if a YAG capsulotomy is necessary, it should not be performed before the 6th postoperative month. It should also not exceed 4 mm in diameter and no IOGEL lens should be implanted if a capsular rupture occurs intraoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Schistosoma mansoni nephropathy in Syrian golden hamsters: effect of dose and duration of infection

In this work, 180 golden hamsters were infected with Schistosoma mansoni and 30 hamsters matched for age and sex served as controls. According to the number of injected cercariae, infected hamsters were divided into six main groups (20, 50, 100, 150, 200 and 250 cercariae). Each group was divided into five subgroups, according to the duration of infection after which animals were sacrificed (4, 6, 8, 12 and 24 weeks). Control and infected hamsters were subjected to laboratory evaluations (serum creatinine, blood urea nitrogen, cholesterol, albumin, total protein and urine protein concentration) and histopathologic examinations of kidney and liver tissues. A significant proteinuria, hypoalbuminemia and hypercholesterolemia was observed in schistosome infected (50 cercariae or more) but not in the controls and the group infected with 20 cercariae. There was significant correlation between these changes and duration of infection and the number of adult worm recovered from the mesenteric circulation at the end of the experiments. Histopathologic evaluation showed appearance of the circulating schistosome antigens, circulating anodic antigen (CAA) and circulating cathodic antigen (CCA), and of IgG glomerular deposits by the 6th week following infection; mesangial hypercellularity appeared early after infection (6-8 weeks), renal amyloid deposition appeared later (8-12 weeks). Egg antigens were not detected in the renal glomeruli. There was a significant correlation between the pathologic changes and duration of infection and the number of recovered adult worms from the mesenteric circulation. No histopathologic lesions were detected in controls and the group injected with 20 cercariae. A significant correlation was found between hepatic periportal fibrosis, amyloidosis and immune complex, deposition in the renal glomeruli. Hamsters did not tolerate infection with 150 cercariae or more for more than 12 weeks, and 20 cercariae caused no detectable glomerular disease. From this study, we concluded that S. mansoni infection causes nephropathy in the Syrian golden hamster. The disease became biochemically and histopathologically manifest by the 6th week following infection. Both immune complex deposition and renal amyloidosis stand as major pathogenic mechanisms. CAA and CCA are the major responsible antigens. Hepatic disease has an impact on the kidney lesion. 50 cercariae are the best dose to produce disease without early death of the animal. There is a significant correlation between the kidney disease and the duration and the load of S. mansoni infection.