Effect of Gender and Device Mouthpiece Shape on Bolus Insulin Aerosol Delivery Using the AERxPulmonary Delivery System

PURPOSE

A study was designed to compare differences in insulin aerosol deposition profiles in healthy male and female subjects, as well as examine the effect of mouthpiece cross-sectional shape, volume, and taper on deposition profiles using a developmental AERx pulmonary delivery system.

METHODS

Six mouthpieces were screened in the laboratory, and three were selected for clinical investigation: a cylindrical mouthpiece with constant-cross-sectional area, an elliptical mouthpiece with constant-cross-sectional area, and a tapered elliptical mouthpiece with an exit cross-sectional area equal to one half the entrance cross-sectional area.

RESULTS

There was no significant difference in the lung dose or in the deposition pattern between males and females (p > 0.05, by ANOVA). The cross-sectional shape of the mouthpiece had no significant effect on the clinical lung dose or the deposition pattern (p > 0.05, by ANOVA), although in vitro testing showed lower emitted dose values with the tapered elliptical mouthpiece (by ANOVA and Duncan's multiple range test, alpha = 0.05). Using the tapered mouthpiece in the clinic resulted in significantly more deposition on the mouthpiece itself when compared to the nontapered mouthpieces.

CONCLUSION

Inhalation of insulin using the AERx system was insensitive to differences in male and female respiratory tract geometry across all mouthpiece designs examined.

Trauma-induced cutaneous pigmentation from tetracycline: a case report

Tetracycline is well known to cause pigmentation of various body tissues, such as teeth, bone, lunulae, conjunctivae, and lymph nodes. It has not been reported to cause discoloration of the skin, unlike its semisynthetic derivative, minocycline. We report an 18-year-old girl who developed lower extremity pigmentation in areas of trauma during treatment with tetracycline.

Measuring quality of life of persons with spinal cord injury: external and structural validity

STUDY DESIGN

Measurement evaluation of the external and structural components of validity.

OBJECTIVES

To examine the relationships between quality of life (QOL) as measured by the spinal cord injury (SCI) version of the Ferrans and Powers Quality of Life Index (QLI) and other constructs represented within the model of disablement; and to examine the domains and scoring model of the QLI by exploring item and overall score/section score relationships.

SETTING

Community, Alberta, Canada.

METHODS

A convenience sample of 98 individuals with SCI living in the community completed the QLI and measures representing the model of disablement including the ASIA motor index, Functional Independence Measure, Reintegration to Normal Living index, Rosenberg's Self-Esteem Scale and Rotter's Internal-External Locus of Control scale.

RESULTS

Four of the five a priori hypotheses were supported. Locus of control was not significantly related to QOL as expected. Factor analysis resulted in a five-factor structure that differed from the four-domain model of the original QLI. Scoring relationships indicated that both the satisfaction and importance ratings contribute to the overall score, although not equally.

CONCLUSION

There is support for the external component of validity although further examination regarding locus of control for persons with SCI is warranted. The structural component of validity requires further investigation to elucidate the domains of the SCI version of the QLI and the contribution of the importance scores.

Gamma scintigraphic evaluation of a novel budesonide dry powder inhaler using a validated radiolabeling technique

A scintigraphic study was carried out to compare the lung deposition of budesonide delivered via Clickhaler and Turbuhaler dry powder inhalers in healthy volunteers. Validation of Technetium-99m ((99m)Tc) radiolabeling of the budesonide/lactose blend used in the Clickhaler and excipient-free budesonide used in the Turbuhaler was carried out using a multistage liquid impinger, and compared with reference unlabeled devices. Budesonide was quantified using high-performance liquid chromatography and (99m)Tc by scintillation counting. The percentages (SD) of fine particles (<5.5 microm diameter) from radiolabeled and unlabeled devices were not significantly different (p > 0.05). Mean values for drug and radiolabel, respectively, were 34.6% (2.5) and 31.6% (3.8) for the Clickhaler, and 29.8% (5.5) and 31.4% (5 6) for the Turbuhaler. Fifteen healthy male volunteers received a single dose (2 x 200 microg actuations) from both devices in a double-blinded, double dummy, crossover study. During dosing, each inhalation maneuver was recorded using a computer-linked pressure transducer. To permit accurate determination of radiolabeled drug deposition, the lung margins of each volunteer were determined by Krypton-81m ((81m)Kr) gas imaging. Mean [SD] lung deposition for the Clickhaler (26.8% [6.8], RSD 25.2) was significantly greater (p < 0.001) than for the Turbuhaler (15.8% [6.6], RSD 42.2). Inspiratory flow rate parameters were similar for both devices with peak and mean values of 73 and 51 L/min for the Clickhaler, and 73 and 47 L/min for the Turbuhaler, respectively. These results indicate that, in healthy volunteers, budesonide lung deposition was higher and more consistent with the Clickhaler than with the Turbuhaler.

Measuring quality of life of persons with spinal cord injury: substantive and structural validation

The purpose of this study was to evaluate the substantive and structural validity of an existing measure of quality of life (QOL), the spinal cord injury (SCI) version of the Ferrans and Powers quality of life index (QLI). To evaluate substantive validity, 11 individuals with a SCI participated in 'think aloud' interviews to determine meaningfulness of the QLI items and to identify areas requiring modification. Free sort and ranking exercises of the items were used to evaluate the structural validity of the domains and scoring rubric. Content analysis of the interview comments resulted in the addition of two items and wording revision to three items. The free sort exercise revealed that the domains as perceived by the participants differed somewhat from those of the test developer. The contribution of the satisfaction and importance sections proposed by the scoring model was not completely supported by the data from the ranking exercise. It is concluded that the modified version of the QLI reflects the perspectives of persons with SCI spinal cord injury as represented by the participants of this study. The structural validity evaluation has implications for the use of domain subscores and weighted vs. section scores. Further evaluation of the modified version is necessary before widespread use with this patient population.

Tenascin-C aptamers are generated using tumor cells and purified protein

Tenascin-C (TN-C) is an extracellular matrix protein that is overexpressed during tissue remodeling processes, including tumor growth. To identify an aptamer for testing as a tumor-selective ligand, SELEX (systematic evolution of ligands by exponential enrichment) procedures were performed using both TN-C and TN-C-expressing U251 glioblastoma cells. The different selection techniques yielded TN-C aptamers that are related in sequence. In addition, a crossover procedure that switched from tumor cell to purified protein selections was effective in isolating two high-affinity TN-C aptamers. When targeting tumor cells in vitro, the observed propensity of naive oligonucleotide pools to evolve TN-C aptamers may be due to the abundance of this protein. In vivo, TN-C abundance may also be well suited for aptamer accumulation in the tumor milieu. A size-minimized and nuclease-stabilized aptamer, TTA1, binds to the fibrinogen-like domain of TN-C with an equilibrium dissociation constant (K(d)) of 5 x 10(-9) m. At 13 kDa, this aptamer is intermediate in size between peptides and single chain antibody fragments, both of which are superior to antibodies for tumor targeting because of their smaller size. TTA1 defines a new class of ligands that are intended for targeted delivery of radioisotopes or chemical agents to diseased tissues.

Innovative dementia care: functional status over time of persons with Alzheimer disease in a residential care centre compared to special care units

Residential care centres (RCCs) for persons with Alzheimer disease are increasing worldwide, but there are few studies that compare the functional outcomes of RCC residents to residents of other types of continuing care settings. This study compared residents of the first Canadian RCC on physical, cognitive, behavioural and emotional functioning 6, 12 and 18 months after admission to residents of special care units (SCUs) operated by the same continuing care provider. SCU residents were initially functioning lower than RCC residents on most outcome measures and these differences persisted over time. Resident functioning declined over time regardless of care setting and, when the initial status was controlled for, the rates of decline were similar. However, RCC residents experienced greater independence/freedom of choice, fewer physical or psychotropic medication restraints and were more active, which may have enhanced their quality of life.

A comparative assessment of Boise, Idaho, ambient air fine particle samples using the plate and microsuspension Salmonella mutagenicity assays

The primary objective of this study is to characterize the genotoxic potential of the ambient air aerosols collected within an air shed impacted primarily by wood smoke and automotive emissions. The study also examines the relative merits of a microsuspension assay and the standard plate assay for monitoring the presence of airborne particle-bound mutagens. Wintertime ambient air particulate samples collected from Boise, Idaho, USA, were shown to contain extractable organic matter that is mutagenic in the Salmonella typhimurium microsuspension and plate-incorporation assays. Differences in the results from the primary sites, auxiliary sites and the background site demonstrate that the particle-bound mutagens are not evenly distributed within the air shed and are more associated with the location of sampling than with the time of sampling or the type of bioassay used to evaluate the samples. This study also demonstrates that the bioassay protocol used in such studies should depend upon the characteristics of the air shed's mutagens and the purpose of the study. For example, the microsuspension assay gave somewhat more variable results between samples but was approximately threefold more sensitive than the plate assay. When strain TA98 was used in the microsuspension assay, the mutagenic response was greater without an exogenous activation system. The reverse was true for the plate assay in which the use of an exogenous activation system increased the mutagenicity response. TA100 in the microsuspension assay provided results comparable to those with TA98. This is important because TA100 can also be used to bioassay semivolatile and volatile organics associated with ambient air mutagenicity. This, in turn, allows a comparison of the mutagenicity of organics collected by differing methods due to their volatility. Future studies should be directed toward correlation of mutagenicity results with other analytical results in order to further develop methods for better characterization of the genotoxicity of ambient air.

Methods for the spiral Salmonella mutagenicity assay including specialized applications

An automated approach to bacterial mutagenicity testing - the spiral Salmonella assay - was developed to simplify testing and to reduce the labor and materials required to generate dose-responsive mutagenicity information. This document provides the reader with an overview of the spiral assay and a discussion of its application for examining the mutagenic potential of pure compounds, complex environmental mixtures, and interactive effects. Guidelines for performing a routine spiral assay are presented, and alternative test methods intended to overcome a variety of technical difficulties (such as restricted sample availability, sample viscosity or volatility, etc.) are recommended. Methods for the computerized analysis of data and the interpretation of results are discussed.

Genetic susceptibility to MS: a second stage analysis in Canadian MS families

Four published genome screens have identified a number of markers with increased sharing in multiple sclerosis (MS) families, although none has reached statistical significance. One hundred and five markers previously identified as showing increased sharing in Canadian, British, Finnish, and American genome screens were genotyped in 219 sibling pairs ascertained from the database of the Canadian Collaborative Project on Genetic Susceptibility to MS (CCPGSMS). No markers examined met criteria for significant linkage. Markers located at 5p14 and 17q22 were analyzed in a total of 333 sibling pairs and attained mlod scores of 2.27 and 1.14, respectively. The known HLA Class II DRB1 association with MS was confirmed (P<0.0001). Significant transmission disequilibrium was also observed for D17S789 at 17q22 (P=0.0015). This study highlights the difficulty of searching for genes with only mild-to-moderate effects on susceptibility, although large effects of specific loci may still be present in individual families. Future progress in the genetics of this complex trait may be helped by (1) focussing on more ethnically homogeneous samples, (2) using an increased number of MS families, and (3) using transmission disequilibrium analysis in candidate regions rather than the affected relative pair linkage analysis.

Arthroscopic mosaic arthroplasty in the equine third carpal bone

OBJECTIVE

To investigate survival and function of autogenous heterotopic osteochondral grafts in a site where injuries are common.

STUDY DESIGN

Three osteochondral grafts were harvested arthroscopically from the femoropatellar joint and transplanted to the third carpal bone (C(3)). Nine months later, histologic, histomorphometric, and biochemical comparisons were made between the transplanted grafts in C(3) and tissue adjacent to the recipient site, the opposing radial carpal bone (C(r)), the donor site in the femoropatellar joint, and the sham-operated contralateral C(3).

ANIMALS

One mixed-breed pony and 5 Standardbred horses aged 3 to 8 years old.

METHODS

Using instruments modified for equine use, four 4.5-mm-diameter osteochondral grafts were harvested arthroscopically from the distal aspect of the lateral trochlea of the right femur and inserted into the radial facet of the right third carpal bone. The fourth graft was kept as a donor-site control sample. Three months later, regular exercise was started and at 6 months, repeat arthroscopy was conducted to evaluate healing. The horses were euthanatized 9 months after transplantation, and comparisons were made between the grafts, opposing radial carpal bone, and contralateral third carpal bone. The assessment criteria included paravital staining, a modified Mankin scoring system, and biochemical analyses for collagen type, total collagen content, and sulfated glycosaminoglycan concentration.

RESULTS

All horses were sound 21 days' postoperatively. At 6 months, all 18 grafts were intact but somewhat soft and opaque compared with surrounding carpal cartilage. Nine months' postoperatively, the bony portions of the grafts were well integrated with the recipient sites, but 6 grafts had histologic evidence of cartilage degeneration. From biochemical analysis of grafts, there was little or no new repair tissue invading the experimental sites, but sulfated glycosaminoglycan (proteoglycan) loss from the transplanted cartilage was marked.

CONCLUSIONS

Heterotopic transfer of osteochondral grafts from the distal aspect of the lateral femoral trochlea to the third carpal bone is feasible with minor modifications of human mosaic arthroplasty instruments. The bony portion of the osteochondral grafts was quickly remodeled to provide subchondral support to the transplanted articular cartilage. The loss of proteoglycan from the transplanted cartilage indicates that the grafts might have been injured during harvesting or insertion, or, more likely, did not remodel to meet the demands of a new biomechanical environment.

CLINICAL RELEVANCE

These findings suggest that arthroscopic resurfacing of focal osteoarticular defects will not be successful in the long term unless donor and recipient sites can be matched with respect to cartilage thickness, biochemical constituents, and physical properties. Mosaic arthroplasty may be indicated in selected cases in which no other options exist to create a confluent cartilage-covered surface.

Propagation of fluorescent light

BACKGROUND AND OBJECTIVE

In general, the remitted fluorescence spectrum is affected by the scattering and absorption properties of tissue. Other important factors are boundary conditions, geometry of the tissue sample, and the quantum yield of tissue fluorophores. Each of these factors is examined through a series of Monte Carlo simulations.

STUDY DESIGN/MATERIALS AND METHODS

Monte Carlo modeling is used to simulate the propagation of excitation light and the resulting fluorescence. Remitted fluorescence is determined for semi-infinite single and multiple layer geometries and for cubic geometries representing small tissue samples. Monte Carlo results are compared to approximations obtained with a heuristic model.

RESULTS

Remitted fluorescence as a function of (1) the depth of fluorescence generation and (2) radial escape position is presented for semi-infinite single and multiple layer geometries. Fluorescence from a small tissue sample is simulated in terms of a cubic geometry, and losses from the sides and bottom are presented as a function of cube dimensions in terms of optical depth of the excitation wavelength. Monte Carlo results for a homogeneous semi-infinite layer are compared to a simple, fast heuristic model.

CONCLUSION

Both Monte Carlo simulations and the heuristic model clearly detail the volume of tissue interrogated by fluorescence. Since approximately 35-40% of the remitted fluorescence is due to photons originally directed away from the surface, distal layers affect the remitted fluorescence. Fluorescence spectra from small biopsy samples may not produce the correct line shape owing to wavelength dependent losses.

The effect of vitamin E exposure on cadmium toxicity in mouse embryo cells in vitro

Heavy metals such as cadmium pose a number of environmental problems in addition to being detrimental to human health. Cadmium is known to be embryotoxic in animal models and to cause brain, limb and craniofacial malformations. Among numerous mechanisms proposed for cadmium toxicity are oxidative stress and lipid peroxidation. Vitamin E has been found to have antioxidant and cytoprotective properties in cultured cells but its effect on cadmium embryonic toxicity has not yet been determined. Epithelial-like cells derived from day-8 whole-mouse embryos were used as a model embryonic tissue. Cadmium toxicity in these cultured cells was found to be both time and concentration dependent. Prior exposure to 50 microM alpha-tocopherol or 25 or 50 microM alpha-tocopherol acetate resulted in a marked reduction in the toxicity of 5 microM CdCl2. The apparent cytoprotective effects may be partly non-specific, however, as a general growth enhancement was observed after vitamin E exposure in the absence of cadmium.

Latent learning in medial temporal amnesia: evidence for disrupted representational but preserved attentional processes

Damage to the hippocampus and medial temporal (MT) structures can lead to anterograde amnesia and may also impair latent learning, in which prior exposure to cues affects their subsequent associability. Normally, latent learning may reflect both representational and attentional mechanisms. Prior work has suggested that individuals with MT amnesia have specific deficits in representational processing; thus, latent learning that invokes primarily representational mechanisms might be especially impaired in MT amnesia. The current results provide preliminary confirmation of this prediction. In Experiment 1, a latent learning paradigm expected to invoke representational mechanisms was impaired in individuals with MT amnesia, whereas in Experiment 2, a paradigm expected to invoke other attentional mechanisms was spared in individuals with MT amnesia. This suggests the representational and attentional components of latent learning are dissociable and differentially affected in anterograde amnesia.

Quality of life of stroke survivors

Adaptation to stroke requires complex, long-term change in stroke survivors' lives. This study aimed at identifying those factors that influence quality of life (QOL) of geriatric stroke survivors 1-3 years post-discharge. The objectives were: to describe the overall quality of life of stroke survivors; to examine the relationships between sociodemographic variables, neurological variables, functional status, social support, perceived health status, depression, and overall QOL; and to determine the best predictors of QOL. Data were collected on 50 stroke survivors using a cross-sectional design and standardized questionnaires, including the Quality of Life Index, the Functional Independence Measure, the Social Support Inventory for Stroke Survivors and the Centre for Epidemiologic Studies Depression Scale. The overall quality of life of the study participants was low. The most important predictors of QOL were depression, marital status, quality of social support, and functional status. Depression was the strongest predictor of QOL. By employing a multi-dimensional perspective, this study confirmed that adaptation to stroke involves much more than physical function. Thus, rehabilitation programs for this group would be more effective if they are based upon a holistic approach.

Genotoxicity of bioremediated soils from the Reilly Tar site, St. Louis Park, Minnesota

An in vitro approach was used to measure the genotoxicity of creosote-contaminated soil before and after four bioremediation processes. The soil was taken from the Reilly Tar site, a closed Superfund site in Saint Louis Park, Minnesota. The creosote soil was bioremediated in bioslurry, biopile, compost, and land treatment, which were optimized for effective treatment. Mutagenicity profiles of dichloromethane extracts of the five soils were determined in the Spiral technique of the Salmonella assay with seven tester strains. Quantitative mutagenic responses in the plate incorporation technique were then determined in the most sensitive strains, YG1041 and YG1042. Mutagenic potency (revertants per microgram extract) in YG1041 suggested that compost, land treatment, and untreated creosote soil extracts were moderately mutagenic with Arochlor-induced rat liver (S9) but were nonmutagenic without S9. However, the bioslurry extract was strongly mutagenic and the biopile extract was moderately mutagenic either with or without S9. A similar trend was obtained in strain YG1042. The strong mutagenic activity in the bioslurry extract was reduced by 50% in TA98NR, which suggested the presence of mutagenic nitrohydrocarbons. Variation in reproducibility was 15% or less for the bioassay and extraction procedures. Bioavailability of mutagens in the biopile soil was determined with six solvents; water-soluble mutagens accounted for 40% of the total mutagenic activity and they were stable at room temperature. The mutagenic activity in the bioslurry and biopsile samples was due to either the processes themselves or to the added sludge/manure amendments. The in vitro approach was effective in monitoring bioremediated soils for genotoxicity and will be useful in future laboratory and in situ studies.

Deficient cancellation of the vestibular ocular reflex in schizophrenia

Schizophrenia has long been associated with difficulties in visual tracking of a moving object. Deficits are most notable in tracking tasks that require inhibition of saccades during active smooth pursuit. In order to assess whether there is a more global problem in inhibition of other eye movement systems while the smooth pursuit system is active, this study examined cancellation of the vestibular ocular reflex (VOR). Cancellation of the VOR occurs in a task in which the subject is rotated while looking at a target that is also being rotated. This requires the subject to use the pursuit system to override the VOR, maintain the eye at a stable location within the orbit, and thus retain visual gaze upon the target. Thirteen individuals with schizophrenia and 15 normals were assessed during clockwise rotation at 60 degrees s-1. Schizophrenic subjects had a significant increase in counterclockwise slow velocity eye movements, suggesting an impaired ability to cancel the VOR. Cancellation of the VOR is thus another example of a breakthrough of an alternative eye movement system while the smooth pursuit system is active. Because of the simplicity of the VOR and its suitability for animal modeling, investigation of this phenomenon may delineate more precisely the mechanisms of visual tracking dysfunction in schizophrenia.

Visual form of Alzheimer's disease and its response to anticholinesterase therapy

In a 60-year-old woman with the visual variant of Alzheimer's disease, single photon emission computed tomography abnormalities were most marked in the parieto-occipital regions of the brain. After treatment with donepezil, improvement is noted on neuropsychological testing and on brain SPECT, including increased perfusion (metabolism) in the occipital lobes.

Preschoolers face moral dilemmas: a longitudinal study of acknowledging and resolving internal conflict

Following on from research that indicated significant moral internalisations by age 3, using a play narrative approach in which children were asked to complete story stems describing a range of moral dilemmas, the purpose of this study was to replicate the results, extend them with longitudinal information and assess the child's developing capacities to acknowledge both sides of moral dilemmas and resolve them in a prosocial way. Fifty-one children were presented with three enacted story stems describing moral dilemmas as they might occur in everyday life. Story completions were obtained from children at ages 3, 4, and 5 and were coded for the level of acknowledgement of the dilemmas and the degree of prosocialness involved in story resolution. Results included the following: firstly, some children acknowledged the dilemmas and resolved them prosocially as early as age 3; secondly, the ability to acknowledge dilemmas and resolve them improved with age; and thirdly, children showed a greater capacity to acknowledge dilemmas with support from an examiner. The implications of these findings for our understanding early moral development are discussed, along with questions pointing to new research.

Interaction between cortisol and tumour necrosis factor with concurrent resistance and endurance training

OBJECTIVE

To determine the effect of concurrent resistance and endurance training on tumor necrosis factor alpha (TNF alpha), urinary free cortisol, strength [one-repetition maximum (1 RM)], and maximal oxygen consumption (Vo2max).

DESIGN

Randomized control trial of 12 weeks' duration.

SETTING

University of Alberta, Edmonton, Alberta, Canada.

PARTICIPANTS

Forty-five healthy female (n = 18) and male (n = 27) subjects who had not formally trained for at least 6 months prior to the study but were physically active. The mean +/- SD age, height, and body mass for all subjects were 22.3 +/- 3.3 years, 1.76 +/- 9.32 m, and 73.4 +/- 11.6 kg, respectively.

INTERVENTION

The subjects were randomly assigned to four groups: strength training only (S), n = 10; endurance training only (E), n = 11; combined strength and endurance training (SE), n = 13; and a control group (C), n = 10. The S and E groups performed progressively overloaded training sessions three times per week for 12 weeks. The SE group completed the same strength and endurance training programs on different days (i.e., 6 days/week) for 12 weeks.

MAIN OUTCOME MEASURES

Serum levels of TNF alpha, urinary free cortisol, 1 RM, and Vo2max were measured before and after 6 and 12 weeks of training.

RESULTS

Significant increases in leg press and knee extension 1 RM occurred after training in both S and SE groups, but the relative gains in knee extension 1 RM were greater in the S group. Similar increases in Vo2max were observed in groups E and SE (p < 0.05). Cortisol was significantly increased in the SE group for women and decreased in the E group for men after training. TNF alpha was significantly elevated in the women of group E after training. No correlation was observed between urinary free cortisol and TNF alpha with training.

CONCLUSION

These results indicate that a partial interference effect of compromised strength gains in unilateral knee extension of the men occurred after concurrent strength and endurance training that could not be attributed to an interaction between cortisol and TNF alpha in response to this type of exercise.

Emotion regulation in mother-child narrative co-construction: associations with children's narratives and adaptation

The associations were studied between early mother-child co-construction of a separation-reunion narrative and children's concurrent and later (a) emotion narratives and (b) behavior problems. Fifty-one children and their mothers were observed during a co-construction task when the children were age 4 1/2. At ages 4 1/2 and 5 1/2, children's narratives were elicited using the MacArthur Story-Stem Battery (MSSB), and mothers completed the Child Behavior Checklist. Results showed that children who were more emotionally coherent during the co-constructions had MSSB narratives that were more coherent, had more prosocial themes, and had fewer aggressive themes at ages 4 1/2 and 5 1/2. Moreover, such children had fewer behavior problems at both ages. The relations between narrative processes and emotion regulation are discussed.

Proximal tubular reabsorption of growth hormone and sodium/fluid in normo- and microalbuminuric insulin-dependent diabetes mellitus

Proximal tubular dysfunction may be implicated in the pathogenesis of diabetic nephropathy. An investigation of proximal tubular function was carried out by assessing proximal tubular sodium-reabsorption and low molecular weight protein excretion in a group of patients with type 1 diabetes mellitus. Normoalbuminuric [group A, n = 6, albumin excretion rate (AER) mean (range) 4 (0-10) micrograms/min], and microalbuminuric [group B, n = 6, AER 88 (35-198) micrograms/min] patients with type 1 diabetes were compared with matched controls. Simultaneous lithium and growth hormone (GH) clearance and urinary beta 2-microglobulin excretion were assessed. Fasting plasma glucose at the start of the study was [median (range)] 13 (10.2-15.1), 9.3 (5.9-15) and 4.1 (4.0-5.0) mmol/l in groups A, B and controls, respectively, with a mean coefficient of variation during the study of 3.9% (group A) and 5.2% (group B). There was no significant difference in plasma glucose levels between patients in groups A and B. Urinary GH excretion was raised in the patients with microalbuminuria (group B; P < 0.05), although there was no difference in serum GH clearance rate between the patient groups and controls. Urinary GH correlated with B 2-microglobulin in the diabetic subjects (r = 0.665, P < 0.05) and with the degree of microalbuminuria in group B patients (r = 1, P < 0.01). Urinary GH was also greater than 10 microU, the median value observed in the controls, in 5 of 6 (83%) patients in group A. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) measured by constant infusion of 51Cr-ethylene diamine tetra-acetic acid (EDTA) and I125-para-amino hippuric acid (PAH), respectively, showed relative hyperfiltration in the normoalbumiruric group compared with controls (P < 0.05) and group B (P < 0.05). Absolute proximal reabsorption of sodium and of water (APRNa and APRH2O) was significantly higher in group A patients (P < 0.05). Although GFR was significantly higher in group A patients, no differences were found in fractional proximal reabsorption of sodium and water (FPRNa+H2O) or end proximal delivery between the patient groups and controls. Therefore, the measurement of protein reabsorptive capacity provides a more sensitive marker of renal tubular impairment in type 1 diabetes than sodium/fluid reabsorptive capacity. In patients with microalbuminuria, both glomerular and tubular damage may coexist. Our results stress the usefulness of markers of renal tubular function in monitoring the course of diabetic nephropathy. This study also shows that assessment of GH clearance has promise as a marker of renal tubular protein reabsorptive capacity.

Emotion regulation in mother-child narrative co-construction: associations with children's narratives and adaptation

The associations were studied between early mother-child co-construction of a separation-reunion narrative and children's concurrent and later (a) emotion narratives and (b) behavior problems. Fifty-one children and their mothers were observed during a co-construction task when the children were age 4 1/2. At ages 4 1/2 and 5 1/2, children's narratives were elicited using the MacArthur Story-Stem Battery (MSSB), and mothers completed the Child Behavior Checklist. Results showed that children who were more emotionally coherent during the co-constructions had MSSB narratives that were more coherent, had more prosocial themes, and had fewer aggressive themes at ages 4 1/2 and 5 1/2. Moreover, such children had fewer behavior problems at both ages. The relations between narrative processes and emotion regulation are discussed.

Children's narrative representations of mothers: their development and associations with child and mother adaptation

We investigated associations between children's representations of mothers in their play narrative and measures of children's and mothers' socioemotional adaptation, and explored the development of these representations between the ages of 4 and 5 years. Fifty-one children were interviewed using the MacArthur Story-Stem Battery to obtain their narrative representations of mothers. Positive, Negative, and Disciplinary representation composites were generated. Children who had more Positive and Disciplinary representations and fewer Negative representations had fewer behavior problems and their mothers reported less psychological distress. In addition, 5-year-olds had more Positive and Disciplinary representations and fewer Negative representations than did 4-year-olds, and there was moderate stability in individual differences in children's representations of mothers across the 2 ages. The results add an important dimension to research on parent-child relationships--that of children's perspectives on these relationships.

A full genome search in multiple sclerosis

The aetiology of multiple sclerosis (MS) is uncertain. There is strong circumstantial evidence to indicate it is an autoimmune complex trait. Risks for first degree relatives are increased some 20 fold over the general population. Twin studies have shown monozygotic concordance rates of 25-30% compared to 4% for dizygotic twins and siblings. Studies of adoptees and half sibs show that familial risk is determined by genes, but environmental factors strongly influence observed geographic differences. Studies of candidate genes have been largely unrewarding. We report a genome search using 257 microsatellite markers with average spacing of 15.2 cM in 100 sibling pairs (Table 1, data set 1 - DS1). A locus of lambda>3 was excluded from 88% of the genome. Five loci with maximum lod scores (MLS) of >1 were identified on chromosomes 2, 3, 5, 11 and X. Two additional data sets containing 44 (Table 1, DS2) and 78 sib pairs (Table 1, DS3) respectively, were used to further evaluate the HLA region on 6p21 and a locus on chromosome 5 with an MLS of 4.24. Markers within 6p21 gave MLS of 0.65 (non-significant, NS). However, D6S461, just outside the HLA region, showed significant evidence for linkage disequilibrium by the transmission disequilibrium test (TDT), in all three data sets (for DS1 chi2 = 10.8, adjusted P < 0.01)(DS2 and DS3 chi2 = 10.9, P < 0.0005), suggesting a modest susceptibility locus in this region. On chromosome 5p results from all three data sets (222 sib pairs) yielded a multipoint MLS of 1.6. The results support genetic epidemiological evidence that several genes interact epistatically to determine heritable susceptibility.

The neurological mouse mutations jittery and hesitant are allelic and map to the region of mouse chromosome 10 homologous to 19p13.3

Jittery (ji) is a recessive mouse mutation on Chromosome 10 characterized by progressive ataxic gait, dystonic movements, spontaneus seizures, and death by dehydration/starvation before fertility. Recently, a viable neurological recessive mutation, hesitant, was discovered. It is characterized by hesitant, unco-ordinated movements, exaggerated stepping of the hind limbs, and reduced fertility in males. In a complementation test and by genetic mapping we have shown here that hesitant and jittery are allelic. Using several large intersubspecific backcrosses and intercrosses we have genetically mapped ji near the marker Amh and microsatellite markers D10Mit7, D10Mit21, and D10Mit23. The linked region of mouse Chromosome 10 is homologous to human 19p13.3, to which several human ataxia loci have recently been mapped. By excluding genes that map to human 21q22.3 (Pfkl) and 12q23 (Nfyb), we conclude that jittery is not likely to be a genetic mouse model for human Unverricht-Lundborg progressive myoclonus epilepsy (EPM1) on 21q22.3 nor for spinocerebellar ataxia II (SCA2) on 12q22-q24. The closely linked markers presented here will facilitate positional cloning of the ji gene.

Costimulation enhances the active immunotherapy effect of recombinant anticancer vaccines

Activation of T lymphocytes in the absence of a costimulatory signal can result in anergy or apoptotic cell death. Two molecules capable of providing a costimulatory signal, B7-1 (CD80) and B7-2 (CD86), have been shown to augment the immunogenicity of whole-tumor cell vaccines. To explore a potential role for costimulation in the design of recombinant anticancer vaccines, we used lacZ-transduced CT26 as an experimental tumor and beta-galactosidase (beta-gal) as the model tumor antigen. Attempts to augment the function of a recombinant vaccinia virus (rVV) expressing beta-gal by admixture with rVV expressing murine B7-1 were unsuccessful. However, a double recombinant vaccinia virus engineered to express both B7-1 and the model antigen beta-gal was capable of significantly reducing the number of pulmonary metastases when administered to mice bearing tumors established for 3 or 6 days. Most important, the double recombinant vaccinia virus prolonged the survival of tumor-bearing mice. These effects were antigen specific. The related costimulatory molecule B7-2 was found to have a similar, although less impressive enhancing effect on the function of a rVV expressing beta-gal. Thus, the addition of B7-1 and, to a lesser extent, B7-2 to a rVV encoding a model antigen significantly enhanced the therapeutic antitumor effects of these poxvirus-based, therapeutic anticancer vaccines.

Use of standardized SCID-hu Thy/Liv mouse model for preclinical efficacy testing of anti-human immunodeficiency virus type 1 compounds

We have developed standardized procedures and practices for infection of SCID-hu Thy/Liv mice with human immunodeficiency virus type 1 for the prophylactic administration of antiviral compounds and for evaluation of the antiviral effect in vivo. Endpoint analyses included quantitation of viral load by intracellular p24 enzyme-linked immunosorbent assay, DNA PCR for the presence of proviral genomes, flow cytometry to measure the representation of CD4+ and CD8+ cells, and cocultivation for the isolation of virus. Efficacy tests in this model are demonstrated with the nucleoside analogs zidovudine and dideoxyinosine and with the nonnucleoside reverse transcriptase inhibitor nevirapine. This small-animal model should be particularly useful in the preclinical prioritization of lead compounds within a common chemical class, in the evaluation of alternative in vivo dosing regimens, and in the determination of appropriate combination therapy in vivo.

Antiviral efficacy in vivo of the anti-human immunodeficiency virus bicyclam SDZ SID 791 (JM 3100), an inhibitor of infectious cell entry

SID 791, a bicyclam inhibiting human immunodeficiency virus (HIV) replication in vitro by blocking virus entry into cells, is an effective inhibitor of virus production and of depletion of human CD4+ T cells in HIV type 1-infected SCID-hu Thy/Liv mice. Steady levels of 100 ng of SID 791 or higher per ml in plasma resulted in statistically significant inhibition of p24 antigen formation. Daily injections of SID 791 caused a dose-dependent decrease in viremia, and this inhibition could be potentiated by coadministration of zidovudine or didanose. The present study suggests that SID 791 alone or in combination with licensed antiviral agents may decrease the virus load in HIV-infected patients and, by extension, that the infectious cell entry step is a valid target for antiviral chemotherapy of HIV disease. The SCID-hu Thy/Liv model in effect provides a rapid means of assessing the potential of compounds with novel modes of antiviral action, as well as the potential of antiviral drug combinations.

Parental ancestry and risk of multiple sclerosis in Alberta, Canada

Self-reported population ancestry data for the 19 census divisions (CDs) of Alberta, Canada, were correlated with multiple sclerosis (MS) prevalence rates in those divisions, for men and women separately; and parental ancestry was compared between a group of MS patients and controls attending the University of Alberta MS Clinic. At the CD level, there was a positive correlation between single Scandinavian ancestry and MS prevalence in men, but this was not confirmed in the case-control comparison. The case-control comparison indicated an excess risk of MS associated with single non-specific European as opposed to British ancestry in men only. When paternal versus maternal ancestry was considered separately, there was an excess risk of MS associated with non-specific European as opposed to British ancestry for both men and women, but on the father's side only. Aboriginal ancestry was negatively associated with MS prevalence at the CD level in both men and women; and no MS patients with aboriginal origin were among cases assembled through the MS clinic.

Embryo brain kinase: a novel gene of the eph/elk receptor tyrosine kinase family

A new gene belonging to the Eph/Eck/Elk receptor tyrosine kinase family has been cloned from mouse brain. The gene maps to mouse chromosome 4. In the adult brain it is expressed exclusively and abundantly in the hippocampus. We propose to name it Ebk (embryo brain kinase), as in situ hybridisation shows expression in many parts of the developing mouse brain. The most abundant expression is in the subcommissural organ, and the earliest expression is in the forebrain neural folds, in rhombomeres 2-6, and in somites and heart. Other regions positive at various stages include the cochlear duct, trigeminal ganglion, lung, first branchial arch, and tooth primordia. Also positive are areas of mesenchyme underlying various epithelia during morphogenesis, especially in the mouth and nose, as well as in the eyelids and toes. We compare these patterns with the available data on the 12 other known members of this gene family. Most of them, like Ebk, are expressed in brain (especially adult hippocampus and embryonic rhombomeres) and in organs rich in epithelia (especially lung), although the spatial and temporal patterns differ. We suggest that combinatorial patterns of these receptors act as labels for the regional identity of neurons and epithelia, and could mediate fine control of neurite pathfinding and epithelial morphogenesis.

Combined ultrasound and fluorescence spectroscopy for physico-chemical imaging of atherosclerosis

This paper describes a combined ultrasonic and spectroscopic system for remotely obtaining physico-chemical images of normal arterial tissue and atherosclerotic plaque. Despite variations in detector-tissue separation, R, fluorescence powers corresponding to pixels in the image are converted to the same set of calibrated units using distance estimations from A-mode ultrasound reflection times. An empirical model, validated by Monte Carlo simulations of light propagation in tissue, is used to describe changes in fluorescence power as a function of R. Fluorescence spectra of normal and atherosclerotic human aorta obtained with this system are presented as a function of R. To compensate for changes in fluorescence power with R, the empirical model was used in each case to calculate the fluorescence power at a constant reference value of R(Rref = 1.67 mm). Prior to compensation, tissue fluorescence power decreased more than a factor of two as R was increased from 2.5 to 5 mm. Following compensation, the fluorescence power varied less than +/- 10% of the average compensated peak. The chemical composition of each sample was determined by fitting its fluorescence spectrum (in calibrated units) to a model of tissue fluorescence incorporating structural protein and ceroid fluorescence, as well as structural protein and hemoglobin attenuation. Parameters of the fit were used to classify tissue type. Without compensation for distance variation, classification of tissue type was frequently incorrect; however, with compensation, predictive value was high. A 1-D chemical image of a section of human aorta containing both normal and atherosclerotic regions obtained with this system is also presented. After compensation for detector-sample separation, tissue classifications along the cross-section closely resemble those obtained from histology. Regions of elevated ceroid concentration and intimal thickening are clearly observable in the resultant chemical image. The potential value of this type of system in the diagnosis and treatment of coronary artery disease is discussed.

Traumatic head and spinal cord injuries in Alaska (1991-1993)

Traumatic head and spinal cord injuries (SCI) are serious events, often leading to severe disability or death. Because these injuries are experienced most often by younger, more active people, they are associated with some of the most enduring physical, emotional, and financial costs. In order to describe several demographic and epidemiologic characteristics of traumatic head and spinal cord injuries in Alaska, a retrospective study was conducted using information collected from the Alaska Trauma Registry (ATR) for hospital trauma admissions in 1991 through 1993. Hospitalized traumatic head injury were identified in 2178 cases, for an average annual incidence rate of 129.5 per 100,000 population. For hospitalized traumatic SCI, 139 cases were identified, for an average annual incidence rate of 8.3 per 100,000 population. To analyze and assess the incidence of these injuries in Alaska, the following injury characteristics were explored through the Alaska Trauma Registry: demographics, mechanism of injury, work relatedness, use of safety equipment, involvement of alcohol, and discharge status.

In vivo diagnosis of cervical intraepithelial neoplasia using 337-nm-excited laser-induced fluorescence

Laser-induced fluorescence at 337-nm excitation was used in vivo to differentiate neoplastic [cervical intraepithelial neoplasia (CIN)], nonneoplastic abnormal (inflammation and human papilloma viral infection), and normal cervical tissues. A colposcope (low-magnification microscope used to view the cervix with reflected light) was used to identify 66 normal and 49 abnormal (5 inflammation, 21 human papilloma virus infection, and 23 CIN) sites on the cervix in 28 patients. These sites were then interrogated spectroscopically. A two-stage algorithm was developed to diagnose CIN. The first stage differentiated histologically abnormal tissues from colposcopically normal tissues with a sensitivity, specificity, and positive predictive value of 92%, 90%, and 88%, respectively. The second stage differentiated preneoplastic and neoplastic tissues from nonneoplastic abnormal tissues with a sensitivity, specificity, and positive predictive value of 87%, 73%, and 74%, respectively. Spectroscopic differences were consistent with a decrease in the absolute contribution of collagen fluorescence, an increase in the absolute contribution of oxyhemoglobin attenuation, and an increase in the relative contribution of reduced nicotinamide dinucleotide phosphate [NAD(P)H] fluorescence as tissue progresses from normal to abnormal in the same patient. These results suggest that in vivo fluorescence spectroscopy of the cervix can be used to diagnose CIN at colposcopy.

Ultrastructure of the macaque ciliary ganglion

The primate ciliary ganglion is an obligatory relay in the pathways that control the lens and pupil for the near response and the light reflex, two functions which have been the target of increasing inquiry in behavioural physiology paradigms. This investigation provides a comprehensive description of the ultrastructure of the ciliary ganglion in the rhesus monkey (Macaca mulatta). The results indicate that the ciliary ganglion contains a heterogeneous population of neurons in terms of somatic size, cytoplasmic contents and somatodendritic distribution of terminals. Variations in the clear and dense-cored vesicle content of the synaptic profiles present in the ganglion suggest that the synaptic inputs are also heterogeneous and may mediate separate functions. Several characteristic ultrastructural features of the macaque ciliary ganglion are noteworthy. Despite the large size of the neuronal somata, most cells do not exhibit contacts directly onto the somatic membrane. However, the few somata that do receive direct input often display several axosomatic contacts. The vast majority of synaptic interactions occur in the perisomatic neuropil, where the postsynaptic elements consist of simple and complex somatic appendages, as well as dendrites with their appendages. There is little neuropil independent of these immediately perisomatic regions. In some cases, axonal terminals form the central element of complex glomeruli, in which they are presynaptic to numerous spine-like profiles. In other cases, axon terminals and their postsynaptic targets are found within shallow depressions in the somatic membrane or, occasionally, deeply embedded within the borders of the postganglionic neuron. The somata and all the non-myelinated neuronal elements are surrounded by interdigitating, electron-dense processes of satellite cells. These glial cells are sometimes found in shallow recesses, or deeply embedded within the borders of the neuronal somata. The complexity of the ultrastructure of the ciliary ganglion in the macaque suggests that this ganglion may not be a simple relay in the parasympathetic outflow to the eye, but may instead be the site of neuronal processing of the preganglionic input.

Prevalence, incidence, and characteristics of multiple sclerosis in Westlock County, Alberta, Canada

We report a prevalence study of multiple sclerosis (MS) in the town of Westlock and surrounding county of Westlock, in Alberta, Canada. The prevalence rate for clinically definite MS on January 1, 1991, was 200/100,000. The average annual incidence rates for patients living in the area at onset were 1.91/100,000 for 1950-1959, 2.85/100,000 for 1960-1969, 3.82/100,000 for 1970-1979, and 7.26/100,000 for 1980-1989. Forty-eight percent of the patients were relapsing-remitting. Sixty percent were still walking without assistance. The female-to-male ratio was 1.4:1. Mean current age was 47, age at onset 30, and duration of illness 18 years. The majority of patients (40%) experienced multiple symptom onset. Forty percent were of single ethnic origin (primarily British); the remainder were predominantly north European combinations. Twenty-four percent of patients reported another MS relative, six first-degree and one second-degree relative.

Emergence of vancomycin-resistant enterococci in New York City

Enterococci, a common cause of nosocomial infection, are intrinsically resistant to most antimicrobials and readily acquire additional resistance. Vancomycin-resistant enterococci (VRE) have caused clusters of nosocomial infections since 1988. In April, 1991, the New York City Department of Health asked all city laboratories to submit suspected VRE isolates for confirmation. Clinical and epidemiological characteristics of the first 100 patients with VRE were identified, and antimicrobial susceptibility testing, restriction enzyme analysis, and DNA-DNA hybridisation with the vanA gene probe were done. From September, 1989, to October, 1991, 361 patients with VRE were identified at 38 hospitals. The number of hospitals reporting VRE increased from 1 in 1989 to 38 by October, 1991. 98% of 100 VRE infections were nosocomially acquired and 83% patients had received vancomycin and/or a cephalosporin in the 30 days before isolation of VRE. Of 23 isolates from 21 of the first 100 patients, 19 (83%) were resistant to all available antimicrobials. Four vanA probing patterns were noted, and restriction enzyme analysis of the 23 isolates revealed 14 strains. VRE have emerged rapidly in New York City. Molecular analyses suggest that a highly mobile genetic element--eg, a transposon--is responsible for the rapid spread of vancomycin resistance.

N-acetyl-L-cysteine protects endothelial cells but not L929 tumor cells from tumor necrosis factor-alpha-mediated cytotoxicity

The effect of N-acetyl-L-cysteine on the cytotoxicity of tumor necrosis factor-alpha was investigated in cultured bovine pulmonary artery endothelial cells and L929 mouse tumor cells. In endothelial cells, a 72-h incubation with tumor necrosis factor-alpha (100 ng/ml) reduced the number of viable cells to 27% of control. Simultaneous incubation with N-acetyl-L-cysteine (0.5-5 mmol/l) protected endothelial cells from tumor necrosis factor-alpha-mediated cytotoxicity and increased viability in a concentration-dependent fashion to 69% of control. Under the same conditions, a 72-h incubation with tumor necrosis factor-alpha (100 ng/ml) reduced the number of viable L929 tumor cells to 31% of control. However, this cytotoxic response remained unaltered in the presence of N-acetyl-L-cysteine (0.5-5 mmol/l). Similar results were obtained when using a lower concentration of tumor necrosis factor-alpha (50 ng/ml). These findings demonstrate protection from tumor necrosis factor-alpha-mediated toxicity by N-acetyl-L-cysteine in endothelial cells but not in a tumor cell line. It is concluded that N-acetyl-L-cysteine might serve as a therapeutic agent to limit the vascular toxicity of tumor necrosis factor-alpha without affecting its antineoplastic activity.

The role of iron in the cytotoxicity of tumor necrosis factor

The effect of iron on the cytotoxicity of tumour necrosis factor-alpha (TNF, cachectin) was examined in L929 cells, which are killed by TNF at low concentrations. In L929 cells, the addition of iron (FeNTA) either prior to or concurrent with the addition of TNF markedly augmented the cytotoxicity of TNF over a wide range of TNF concentrations. Iron alone was not cytotoxic to the cells and did not inhibit protein synthesis. The iron chelator deferoxamine was able to protect against TNF cytotoxicity in L929 cells. Iron chelators also protected L929 cells from the cytotoxicity of TNF plus cycloheximide, suggesting that iron plays a role in this mode of TNF killing as well. TNF did not induce the synthesis of ferritin heavy chain in L929 cells. These experiments demonstrate that cellular iron status affects the ability of TNF to kill sensitive target cells.

A population-based study of multiple sclerosis in twins: update

This study is a 7.5-year follow-up of a population-based series of twins with multiple sclerosis (MS) whose mean age now exceeds 50 years. The twin pairs were identified through the Canadian nationwide system of MS clinics and were drawn from a population of 5,463 patients. After 7.5 years, the monozygotic concordance rate increased from 25.9 to 30.8% and the dizygotic-like sex concordance rate from 2.4 to 4.7%. These results are very similar to those of other population-based studies and to our own modified replication twin data reported here. We interpret the data to mean that MS susceptibility is genetically influenced, and a single dominant or even a single recessive gene is unlikely to account for this effect. The difference in concordance rates suggests that at least two or more genes are operative. These data also have important implications for the nature of the environmental effect(s) in MS susceptibility. Most monozygotic twins are discordant even after a correction for age and magnetic resonance imaging findings. This unambiguously demonstrates the powerful effect of nonheritable factors.