Status of ionization by radial electron neat adaptation ion source research and development for SPIRAL2 and EURISOL-DS

To take up the challenging issue of supplying a plasma ion source able to produce radioactive beams under extreme SPIRAL2 and EURISOL irradiation conditions, a research and development program has been initiated to work out ionization by radial electron neat adaptation (IRENA) ion source. Based on the electron beam generated plasma concept, the ion source is specifically adapted for thick target exploitation under intense irradiation. A validation prototype has been designed, constructed, and tested. First results obtained will be presented and commented. IRENA potential will be discussed, particularly in the framework of multimegawatt EURISOL.

Maturation of oral feeding skills in preterm infants

AIM

Safe and successful oral feeding requires proper maturation of sucking, swallowing and respiration. We hypothesized that oral feeding difficulties result from different temporal development of the musculatures implicated in these functions.

METHODS

Sixteen medically stable preterm infants (26 to 29 weeks gestation, GA) were recruited. Specific feeding skills were monitored as indirect markers for the maturational process of oral feeding musculatures: rate of milk intake (mL/min); percent milk leakage (lip seal); sucking stage, rate (#/s) and suction/expression ratio; suction amplitude (mmHg), rate and slope (mmHg/s); sucking/swallowing ratio; percent occurrence of swallows at specific phases of respiration. Coefficients of variation (COV) were used as indices of functional stability. Infants, born at 26/27- and 28/29-week GA, were at similar postmenstrual ages (PMA) when taking 1-2 and 6-8 oral feedings per day.

RESULTS

Over time, feeding efficiency and several skills improved, some decreased and others remained unchanged. Differences in COVs between the two GA groups demonstrated that, despite similar oral feeding outcomes, maturation levels of certain skills differed.

CONCLUSIONS

Components of sucking, swallowing, respiration and their coordinated activity matured at different times and rates. Differences in functional stability of particular outcomes confirm that maturation levels depend on infants' gestational rather than PMA.

Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants

OBJECTIVE

(1) To compare maternal characteristics and psychological stress profile among African-American, Caucasian and Hispanic mothers who delivered very low birthweight infants. (2) To investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume.

STUDY DESIGN

Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected.

RESULT

Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU) and positively with infant birthweight and STS. Milk volume correlated negatively with depression and positively with milk expression frequency and STS.

CONCLUSION

Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS.

Relative validity of a food frequency questionnaire used in the Inter99 study

OBJECTIVE

To evaluate the validity of the Inter99 food frequency questionnaire (FFQ) compared with a 28-days' diet history and biomarkers.

SUBJECTS

A random sample of 13 016 individuals were drawn from a general population and invited for a health screening programme. Participation rate was 52.5%. All high-risk individuals were re-invited for assessment after 1 and 3 years and completed a 198-item FFQ at all three occasions. Participants attending for 3 years follow-up were invited to participate in the validation study, including a 28-days' diet history, a 24-h urine collection and a fasting blood sample. Overall, 264 subjects participated.

RESULTS

Spearman's rank correlation coefficients between the two dietary methods ranged from 0.31(beta-carotene) to 0.64 (fruits) in men and from 0.31 (polyunsaturated fat and sodium) to 0.64 (fruits) for women. The proportion of individuals classified in the same or adjacent quintiles were, on average, 72% for men and 69% for women. Gross misclassification was found on average in 2%. The correlation coefficients of the residuals ranged from 0.27 (sodium) to 0.61 (fruits) for men and from 0.21 (sodium) to 0.62 (B12-vitamin) for women. Correlation coefficients between fruit and vegetable intake and carotenoids ranged from -0.08 (lycopene) to 0.44 (alpha-carotene). For the residuals the correlation coefficients ranged from -0.004 (lycopene) to 0.47 (alpha-carotene).

CONCLUSION

The Inter99 FFQ and the residuals of the intake provide acceptable classification of individuals according to their dietary intakes and the FFQ gives a good quantitative measurement of key dietary components.

Image registration in myocardial perfusion MRI

In clinical first-pass myocardial perfusion studies, physiological and patient motions are inevitable. Such motions impair the sensitivity and reliability in assessing myocardial perfusion abnormalities. The current study aims to correct the misregistration of myocardium during first-pass perfusion imaging by using a normalized mutual information approach. Multi-slice registrations were performed in 15 sets of clinical data sets. The proposed registration procedure was found to be fairly robust. With such registration, ROI time courses from normal myocardium and infarcted myocardium were improved, offering potential to quantify myocardial perfusion parameters in a more reliable manner.

Development of an inductively coupled epiretinal vision prosthesis

Electrical stimulation of the retina elicits visual perception in patients with retinitis pigmentosa. Using the potentials of microsystem technology, neural prostheses to restore vision become feasible that are completely implantable in the eye. In this paper, we describe the development of an inductively coupled epiretinal vision prosthesis. Microelectronic chips for data encoding and stimulation were assembled on flexible substrates with an integrated electrode array. The system was encapsulated with parylene C and silicone rubber. The receiver part was placed into an artificial intraocular lens. Microcables led to the stimulation array in the macula region. This prototype elicited spatio-temporal patterns in the visual cortex after electrical stimulation of the retina in the cat.

Prolonged function of macrophage, von Willebrand factor-deficient porcine pulmonary xenografts

Porcine von Willebrand factor (vWF) activates human and primate platelets. Having determined the importance of pulmonary intravascular macrophages (PIMs) in pulmonary xenotransplantation, we evaluated whether, in the absence of PIMs, vWF might play a role in pulmonary xenograft dysfunction. Utilizing a left single-lung transplant model, baboons depleted of anti-alphaGal antibodies received lungs from either vWF-deficient (n = 2); MCP-expressing (n = 5); MCP PIM-depleted (n = 5); or vWF-deficient PIM-depleted swine (n = 3). Two out of three of the PIM-depleted, pvWF deficient grafts survived longer than any previously reported pulmonary xenografts, including PIM-depleted xenografts expressing human complement regulatory proteins. Depletion of PIM's from vWF-deficient lungs, like depletion of PIM's from hMCP lungs, resulted in abrogation of the coagulopathy associated with pulmonary xenotransplantation. Thus, in terms of pulmonary graft survival, control of adverse reactions involving pvWF appears to be equally or even more important than is complement regulation using hMCP expression. However, based on the rapid failure of PIM-sufficient, pvWF-deficient pulmonary xenografts, pVWF-deficient pulmonary xenografts appear to be particularly sensitive to macrophage-mediated damage. These data provide initial evidence that vWF plays a role in the 'delayed' (24 h) dysfunction observed in pulmonary xenotransplantation using PIM depleted hMCP organs.

The Dietary Quality Score: validation and association with cardiovascular risk factors: the Inter99 study

OBJECTIVE

To develop and assess the validity of the Dietary Quality Score (DQS) and investigate the association with cardiovascular risk factors.

DESIGN

Cross-sectional population-based study.

SETTING

Copenhagen County, Glostrup, Denmark.

SUBJECTS

A random sample of 12,934 men and women aged 30-60 years were invited to a health examination. A total of 6542 participants were included in the statistical analysis.

METHODS

The DQS was developed using eight questions from a 48-item food frequency questionnaire (FFQ) and validated using a 198-item FFQ. Associations between the DQS and fasting serum lipids, homocysteine, blood pressure and the absolute risk of ischaemic heart disease (IHD) were explored.

RESULTS

A higher DQS was shown to be associated with higher dietary quality in general, including a low intake of fat, especially saturated fat; a high intake of fibre; various vitamins and minerals; and fruit, fish, vegetables and whole-grain products. A higher score according to the DQS was significantly negatively associated with total cholesterol (P=0.0031), triglyceride (P=0.0406), low-density lipoprotein-cholesterol (P=0.0071), homocysteine (P<0.0001) and the absolute risk of IHD (P<0.0001), adjusted for sex, age, smoking habits and physical activity level.

CONCLUSIONS

The DQS is a simple, valid and quick tool to make a rough classification of individuals into groups with high, average and low dietary quality. The DQS is negatively associated with serum lipids, homocysteine and the absolute risk of IHD.

SPONSORSHIP

The Inter99 study is supported economically by The Danish Medical Research Council, The Danish Centre for Evaluation and Health Technology Assessment, Novo Nordisk, Copenhagen County, The Danish Heart Foundation, The Danish Pharmaceutical Association, Augustinus Foundation, Ib Henriksen Foundation and Becket Foundation, Copenhagen County.

The development of a prediction tool for chemotherapy-induced anemia in patients with advanced non-small cell lung cancer (NSCLC) palliative receiving chemotherapy

8600

Background: Anemia remains a common complication in patients with advanced NSCLC on palliative chemotherapy. Many oncologists believe that anemia is unpredictable, acting on a low hemoglobin value once the patient is anemic (i.e. reactively). However, patient care could be substantially improved if severe anemia could be accurately predicted by validated mathematical models. The development and validation of our cycle-based prediction model for severe anemia (hemoglobin ≤ 100 g/L) is described. Methods: Data on 536 European patients receiving palliative chemotherapy was prospectively collected as part of the European Cancer Anemia Survey (Ludwig et al, 2004), including information on clinical and biochemistry parameters that could potentially be associated with anemia. The sample was randomly divided into a 2/3 model derivation and 1/3 validation sample. Multivariable logistic regression techniques were applied for the initial model. A risk scoring system based on regression parameters was created, from 0 to 15. Finally a receiver operating characteristic curve (ROC) analysis was undertaken to measure predictive accuracy of the validation sample. Results: Precycle hemoglobin, low body surface area, advanced age, poor performance status, recurrent/persistent disease and platinum or gemcitabine-based chemotherapy were identified as being important predictors for severe anemia. The ROC analysis on the derivation and internal validation datasets had areas under the ROC curve of 0.80 (95%CI: 0.74 - 0.85) and 0.86 (95%CI: 0.83 - 0.89). A risk score of ≥ 8 to < 10 was identified as being the optimal cut-off to maximize sensitivity (83.1%) and specificity (67.8%) of the prediction tool. Patients with a score of ≥ 8 would be considered at high risk for developing severe anemia following a particular cycle of chemotherapy. Conclusions: This study outlines the development of an accurate anemia prediction tool for NSCLC patients receiving chemotherapy. The application and planned continued refinement of this prediction tool will be an important source of patient specific risk information for the practicing oncologist and can enhance patient care by utilizing anemia therapies earlier and pro-actively.

[Table: see text]

A phase I study of sunitinib malate (SU11248) in combination with gefitinib in patients with metastatic renal cell carcinoma (mRCC)

4537

Background: Sunitinib malate (SU11248) is an oral multitargeted tyrosine kinase inhibitor of VEGF and PDGF receptors. Two phase II trials with sunitinib given as second line therapy in patients with mRCC showed a ≥40% response rate (JCO 2006;24:16–24; Proc ASCO 23,380s). Combining sunitinib and gefitinib (an EGFR inhibitor) may enhance antitumor activity by providing a broader spectrum of tyrosine kinase inhibition. The maximum tolerated dose (MTD) of sunitinib in combination with gefitinib was assessed in this Phase I trial. Methods: Patients with mRCC previously treated with cytokine therapy were enrolled in the study. Cohorts of 4–6 patients received escalating doses of sunitinib and a fixed dose of gefitinib. Dose levels of sunitinib were 37.5 mg and 50 mg. Dose limiting toxicity (DLT) was defined as Grade 4 hematologic toxicity, Grade 3 nonhematologic toxicity of ≥7 days or a Grade 2 cardiac toxicity. Six-week treatment cycles comprised of sunitinib daily for 4 weeks followed by 2 weeks off and continuous gefitinib at 250 mg daily except in Cycle 1 where gefitinib was begun on Day 10. Results: In the first dose level (n=4, 37.5 mg of sunitinib and 250 mg of gefitinib), no DLTs were observed. In the second dose level (50 mg of sunitinib and 250 mg of gefitinib), there were 7 patients enrolled, but 1 patient had dose reduction for hypertension during the sunitinib monotherapy part of the study and was not included in the cohort defining MTD. 2 of 6 patients experienced a DLT (Grade 2 decline in ejection fraction, persistent Grade 3 fatigue) and the MTD was determined as 37.5 mg of sunitinib with 250 mg of gefitinib. Grade 3 adverse events included: diarrhea (n = 2) and hand/foot syndrome (n = 2). Laboratory abnormalities included grade 4 neutropenia (n = 1), grade 3 neutropenia (n = 2), and grade 3 thrombocytopenia (n = 2). Overall, 5 of 11 patients demonstrated a partial response and patient accrual to the phase 2 portion of the study is underway. Conclusions: The combination of sunitinib and gefitinib in mRCC patients was well tolerated and MTD was determined. The efficacy and toxicity of this combination is being assessed in a phase II component of this trial.

[Table: see text]

Increased use of selective serotonin reuptake inhibitors in patients admitted with gastrointestinal haemorrhage: a multicentre retrospective analysis

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) can adversely affect platelet function and impair haemostasis. Various bleeding complications have been reported in persons taking SSRIs including an increased risk of gastrointestinal haemorrhage (GIH).

AIM

To evaluate SSRI use in patients hospitalized with GIH compared with controls.

METHODS

A retrospective, multicentre case-control study determined use of SSRIs, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, clopidogrel, coumadin and enoxaparin in patients admitted with GIH and age- and sex-matched controls. Exclusion criteria included liver disease, portal hypertension or bleeding diathesis.

RESULTS

A total of 579 cases were matched with 1000 controls. SSRI use was 19.2% in cases and 13.6% in controls [OR (95% CI) = 1.5 (1.2-2.0); P = 0.003]. NSAIDs were used by 7.3% of cases and 3.8% of controls [OR = 2.0 (1.3-3.1); P = 0.003]. SSRI use was more strongly associated with lower [1.8 (1.2-2.8)] rather than upper [1.3 (0.83-1.9)] GIH. Significant interactions existed for SSRI use with NSAIDs and aspirin.

CONCLUSIONS

Patients admitted with GIH gastrointestinal bleeding were more likely to be taking SSRIs than controls. This association exists for lower as well as upper GIH. Physicians should be aware of this risk particularly in patients already using medications that increase GIH risk.

Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis

OBJECTIVES

To assess the efficacy of the administration of magnesium as a method for the prevention of postoperative atrial fibrillation (AF) and to evaluate its influence on hospital length of stay (LOS) and mortality.

METHODS

Literature search and meta-analysis of the randomised control studies published since 1966.

RESULTS

20 randomised trials were identified, enrolling a total of 2490 patients. Study sample size varied between 20 and 400 patients. Magnesium administration decreased the proportion of patients developing postoperative AF from 28% in the control group to 18% in the treatment group (odds ratio 0.54, 95% confidence interval (CI) 0.38 to 0.75). Data on LOS were available from seven trials (1227 patients). Magnesium did not significantly affect LOS (weighted mean difference -0.07 days of stay, 95% CI -0.66 to 0.53). The overall mortality was low (0.7%) and was not affected by magnesium administration (odds ratio 1.22, 95% CI 0.39 to 3.77).

CONCLUSION

Magnesium administration is an effective prophylactic measure for the prevention of postoperative AF. It does not significantly alter LOS or in-hospital mortality.

Effect of an oral stimulation program on sucking skill maturation of preterm infants

This study assessed the effect of an oral stimulation program on the maturation of sucking skills of preterm infants. Thirty-two preterm infants (13 males, 19 females), appropriate size for gestational age (gestational age at birth 28 wks, SD 1.2wks; birthweight 1002g, SD 251g), were randomly placed into experimental and control groups. The experimental group received a daily 15-minute oral stimulation program, consisting of stroking the peri- and intra-oral structures, for 10 days before the start of oral feedings. Sucking measures were monitored with a specially-designed nipple-bottle apparatus. Results indicate that the experimental group achieved full oral feedings 7 days sooner than the control group, and demonstrated greater overall intake (%), rate of milk transfer (mL/min), and amplitude of the expression component of sucking (mmHg). There was no difference in sucking stage maturation, sucking frequency, and amplitude of the suction component of sucking. Endurance, defined as ability to sustain the same sucking stage, sucking burst duration, and suction and expression amplitudes throughout a feeding session, was not significantly different between the two groups. The stimulation program enhanced the expression component of sucking, resulting in better oral feeding performance.

Animal models for the study of the effect of prolonged stress on lactation in rats

The suppressive effect of stress on lactation is well acknowledged. Animal models used to study this problem have used primarily acute stressors. As such, they are not adequate for the study of the effect of prolonged stress on lactation. This study aimed at developing a paradigm(s) in rats for the study of the effect on lactation of prolonged exposure to a stressful situation. Two models were examined. The first consisted of a separation paradigm whereby dams had 1, 2, 4, or 6 contacts per day with their pups, but only for a total of 4 h per day. The second model implicated the introduction of a male intruder into the home cage during the 12-h light period. Both protocols were implemented for four consecutive days beginning on Days 10/11 postpartum. Milk release was measured on Day 13/14 postpartum. For both models, milk release was significantly reduced following the preexposure period. During the assessment of milk release, maternal behavior of the experimental and control animals was similar at all times. It is advanced that these two rat models of stress are appropriate for the study of lactation following a prolonged exposure to stress.

Prognostic significance of serum vascular endothelial growth factor and endostatin in patients with hepatocellular carcinoma

BACKGROUND

Vascular endothelial growth factor (VEGF) and endostatin stimulate and inhibit tumour angiogenesis respectively. Recent studies have demonstrated the prognostic value of serum levels of both VEGF and endostatin in patients with various types of cancer. Their significance in patients with hepatocellular carcinoma (HCC) remains unclear.

METHODS

Serum VEGF and endostatin levels were measured by enzyme immunoassay in 108 patients with HCC before surgical resection and in 20 healthy controls. Preoperative serum VEGF and endostatin levels were correlated with clinicopathological features and long-term survival.

RESULTS

Serum VEGF levels in patients with HCC were significantly higher than those in controls, but serum levels of endostatin were similar in the two groups. High serum levels of VEGF, but not endostatin, were significantly associated with venous invasion and advanced tumour stage. Patients with a serum VEGF level higher than median (over 245.0 pg/ml) had significantly worse overall and disease-free survival than those with a lower level (P = 0.012 and P = 0.022 respectively). On multivariate analysis, serum VEGF level was an independent prognostic factor (hazard ratio 1.86 (95 per cent confidence interval 1.10 to 3.92); P = 0.032). Serum endostatin levels did not have significant prognostic influence on overall or disease-free survival.

CONCLUSION

A high serum level of VEGF is a predictor of poor outcome after resection of HCC. Serum VEGF, but not endostatin, may be a useful prognostic marker in patients with HCC.

Test offering, not additional information, may increase HIV testing uptake in a knowledgeable population

OBJECTIVES

To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informational handout on HIV testing propensity.

DESIGN

Cross sectional, descriptive techniques were employed to assess demographics, HIV knowledge and HIV testing experience. A randomized controlled trial was performed to determine if an HIV/AIDS information sheet influenced testing propensity.

SETTING

Blantyre Adventist Hospital Outpatient Clinic.

SUBJECTS

Non-emergency patients over 18 years old attending during consulting hours.

INTERVENTIONS

All subjects answered a questionnaire. For the randomized controlled trial component, half received an HIV information handout.

MAIN OUTCOME MEASURES

Proportions were calculated to evaluate testing experience. Logistic regression was used to assess impact of written information and demographics on HIV testing propensity.

RESULTS

490 participants were recruited, of whom 57% had never been tested for HIV. Of the untested, 88% had never been offered an HIV test. Of those that had never been offered a test, 46% desired one. The sample was highly knowledgeable about HIV. Reading an information sheet had no impact on HIV knowledge (p=0.736 to 0.788) or desire for testing (p=0.387). However, age (OR=0.97, 95%CI (0.95,0.99)) and gender (OR=1.85, 95%CI (1.06, 3.23)) significantly correlated with testing propensity.

CONCLUSIONS

A large percentage of patients who have never been offered HIV testing desire testing. More frequent HIV test offering by clinicians could improve testing rates. Clinician education programmes should be developed to increase test offering. Furthermore, written health information in a setting of high HIV/AIDS knowledge may not change behaviour. Alternative methods should be employed to encourage HIV testing uptake.

A survey of attitudes to Traditional Chinese Medicine in Hong Kong pharmacy students

OBJECTIVES

To study the attitudes and personal experiences with Traditional Chinese Medicine (TCM) use in pharmacy students.

DESIGN

Prospective cross-sectional study.

SETTING

University School of Pharmacy.

METHODS

Pharmacy students were asked 17 questions according to an anonymous survey questionnaire.

RESULTS

All 91 students (46% males) participated in the survey. The attitude toward TCM use was positive in 40%, neutral in 59% and negative in only 1%. On scales from 0 to 10, the mean (SD) scores for the adequacy of the current curriculum in TCM training and state of TCM knowledge were 3.2 (2.0) and 3.6 (1.6), respectively. Of the 35 participants who had used TCM in the past year, nearly half did so without any TCM practitioner consultation. Seventy-four percent reported that they had not been told of any side effects of TCM. When comparing the third year with first or second year students, there was no significant difference between any of these findings.

CONCLUSION

The training in TCM within this 3-year pharmacy curriculum appears inadequate. Most students are not aware of any possible side effects in TCM. The attitude and practice do not appear to vary significantly between successive year of pharmacy students.

Lack of evidence for intergenerational reproductive effects due to prenatal and postnatal undernutrition in the female CD-1 mouse

The impacts of adverse environments during the prenatal and/or early postnatal periods may be manifested as functional deficits that occur later in life. Epidemiological studies have shown an association of sub-optimal pregnancy outcomes in one generation with similar events in the following one, a phenomenon termed the "intergenerational effect". Data indicate that the incidence of adverse pregnancy outcomes and/or low birth weight infants is more closely correlated with the mother's perinatal environment than with that during her pregnancy. However, epidemiological studies are inherently limited given the variability of lifestyles, ethnicity, nutritional status, and exposures to environmental factors. An appropriate animal model would permit control of parameters that may be impossible to evaluate in human populations. The current studies investigated the mouse as a possible animal model. Pregnant CD-1 mice were placed on an ad libitum or food-restricted diet (50% normal) throughout gestation to generate control (CON) and intrauterine growth retarded (IUGR) litters. At birth (postnatal day (PD) 1) pups (F1) were cross-fostered to control dams in litters of either 8 (CON) or 16 (postnatal food restriction (FR)). The experimental groups thus generated represented adequate nutrition (CON-CON) and undernutrition during the prenatal (IUGR-CON), or postnatal periods (CON-FR), or both (IUGR-FR). Pups of dams on a restricted diet during gestation had significant IUGR (P<0.001) as compared to controls (birth weights of 1.32 g versus 1.63 g). At weaning, the average weight of the pups was dependent on postnatal litter size and the difference in birth weights between IUGR and CON animals was not a significant factor. CON-CON pup weight was 24.1g and IUGR-CON was 22.2 g as compared to the CON-FR (17.0 g) and IUGR-FR (17.3 g) groups. The difference in weaning pup weights between the FR and CON groups was significant (P<0.01). The F1 FR females did not reach CON female weights at any time point through 11 months after weaning. At PD60, a single breeding period for all groups of females with CON males began and continued for 75 days with 17 opportunities for breeding. Animals that became pregnant during this time were removed and allowed to litter. No significant differences were noted in average F2 litter size or average pup weight at birth: (CON-CON 12.2/1.62 g; IUGR-CON 11.9/1.6 2 g; CON-FR 10.9/1.70 g; IUGR-FR 11.3/1.61 g). We conclude that body weight at birth in the CD-1 mouse is not correlated with growth through the period of weaning (PD28). We did not find any evidence for an intergenerational reproductive effect after developmental undernutrition.