Long term effects of periconceptional multivitamin supplements for prevention of neural tube defects: a seven to 10 year follow up

Periconceptional supplementation with Pregnavite Forte F was offered to women who presented consecutively to the Oxford genetic counselling service in the early 1980s who had previously had one or more pregnancies complicated by a neural tube defect. The first 100 children born alive to these women are the subject of this study. Birth weight, gestation, and congenital abnormalities were recorded. At age 2-5 years all 96 children remaining in the United Kingdom were assessed clinically and developmentally and behavioural information was obtained by questionnaire. At age 7-10 years, follow up of 91 children by telephone and postal questionnaire yielded further information about growth, general health, vision, hearing, and educational and behavioural status. Entry criteria excluded single mothers but the social class distribution of the sample was otherwise representative of the Oxfordshire population. There were no recurrences of neural tube defects. One child had radiological evidence of spina bifida occulta affecting only the fifth lumbar vertebra. One had an autosomal recessive disorder. Eight had random minor congenital anomalies. Birth weight for gestational age was significantly greater than for the local population and at age 7-10 years the girls were considerably taller than expected. Health, auditory, visual, and developmental status were no different from the general population. None of the children had special educational needs. None showed a major behaviour disorder but worries, fussiness, and fearfulness were highly significantly over represented.

"X Lite": a protective shield for skin grafts on the back

"X Lite", a thermoplastic material was used in eight patients as a splint for protecting split skin grafts on the back. After an average stay of 4.3 days patients were discharged with no incidence of graft failure. The patients involved felt comfortable whilst remaining supine. We believe time saved by adequate protection leading to successful grafts makes this method economically useful.

Direct detection of Molluscum contagiosum virus in clinical specimens by in situ hybridization using biotinylated probe

Molluscum contagiosum virus (MCV) is an unclassified poxvirus which has recently become recognized as causing a major sexually transmitted disease. At present no assay is available for specific detection of MCV because the virus cannot be serially propagated in cell culture. Since MCV produces an abortive, limited growth with some cytopathic effect in certain cell lines, we were able to develop an in situ hybridization assay for detection of MCV genome in clinical specimens. Human fetal diploid lung cell monolayers were infected with clinical specimens, and after proper incubation and fixation in paraformaldehyde, hybridization was performed under full stringency conditions with a molecularly cloned biotinylated probe. Only MCV infected cells showed homology to the MCV probe with a purple-brown cytoplasmic staining. Additionally, we have described an in situ hybridization assay for direct detection of MCV genome in formalin-fixed, paraffin-embedded biopsies. Characteristic intracytoplasmic Molluscum bodies (Henderson-Paterson bodies) were detected in stratum spinosum cells of the epidermis. Striking staining similarities have been observed between in situ hybridization and haematoxylin-eosin cytostaining. These procedures are the first successful identification of MCV genome in clinical samples by molecular hybridization, with sensitivity and specificity equal to or greater than electron microscopy.

Host range and physiologic specialisation of Macrophomina phaseolina isolated from field peas in South Australia

Macrophomina phaseolina is reported as a pathogen of field peas, causing leaf, stem, and petiole lesions characteristic of ascochyta infection. Alternative hosts were found to include Vigna mungo, Medicago littoralis, Medicago scutellata, and Lens culinaris. Twenty-one isolates of M. phaseolina were differentiated into 15 pathotypes. Adequate sources of resistance were identified against all pathotypes. Breeding for specific resistance to M. phaseolina in field peas is discussed.

Sleep related upper airway obstruction in a cohort with Down's syndrome

The prevalence of sleep related upper airway obstruction (UAO) was studied in a cohort of 34 children with Down's syndrome from a geographically defined area. Thirty two (94%) of the children, ranging in age between 0.1 and 4.9 years (median 1.4), underwent full clinical assessment for UAO including parental questionnaires and overnight tape recordings of chest wall movements and arterial oxygen saturation (SaO2). Compared with controls, children with Down's syndrome had (a) an increased incidence of stridor and chest wall recession during sleep, (b) an increased frequency of a pattern on inspiration indicating increased upper airway resistance, (c) a reduced baseline oxygen saturation (having excluded recordings on four children with potential for right to left intracardiac shunting), and (d) an increased number of episodes with SaO2 less than or equal to 90% despite continued chest wall movements. At their initial assessment seven children (22%) had evidence of UAO. The 18 youngest children (less than or equal to 1.7 years) underwent repeated recordings and clinical assessment until they had all reached 2 years of age. A further three were found to have developed UAO. Sleep related UAO is a common problem in children with Down's syndrome, occurring in 10 of 32 (31%) of this population based sample.

Constitutive expression and secretion of proteases in non-metastatic SP1 mammary carcinoma cells and its metastatic sublines

Malignant tumors are generally characterized by extensive local tissue invasion and destruction of ECM which may be due to increased constitutive expression and activity of secreted proteases. Moreover, a large number of diverse protease activities may be constitutively over-expressed in a simultaneous or co-ordinated fashion, thereby significantly increasing cellular invasive potential of the cells. To explore this relationship, we have measured steady-state levels of mRNA coding for urokinase plasminogen activator (uPA), tissue plasminogen activator (tPA), transin and tissue-specific inhibitor of metalloproteinases (TIMP); as well as gelatinolytic, caseinolytic and plasminogen activator activities secreted by SPI, a non-metastatic mouse mammary carcinoma cell line and 4 metastatic sublines derived from it. mRNA encoding metalloproteinase transin was increased 15- to 20-fold, while TIMP transcripts were decreased 3-fold in the metastatic sublines compared to parental SPI tumor cells. Metastatic sublines secreted higher levels of gelatinase (i.e., 92 kDa and 64 kDa) as well as proteases with caseinolytic activity (i.e., 115 kDa and 57 kDa) when compared with SPI cells. Moreover, these enzymes were identified as neutral metalloproteinases. Although the amount of uPA mRNA appeared to be the same in SPI and the metastatic sublines, the latter secreted 1.5-3 times more uPA activity into the culture supernatants. Metastatic competence in the SPI tumor model is therefore associated with increased secretion of several metalloproteinase activities and uPA, as well as decreased TIMP expression, consistent with a more invasive phenotype.

Acid-base status at birth and neurodevelopmental outcome at four and one-half years

Two hundred thirty term infants with measured acid-base status in umbilical arterial blood at birth were selected from 1210 consecutive deliveries for detailed neurodevelopmental follow-up at age 4 1/2 years; 203 were examined. Cutoff points approximately 1 SD from the mean (pH less than or equal to 7.10; base deficit greater than 12 mmol/L) were used to define acidosis. No statistically significant associations between acidosis and developmental outcome were found. The highest proportion of unimpaired children was found among those who were most severely acidotic at birth (pH less than or equal to 7.04; 2 SD below mean), but this finding was not statistically significant. These findings suggest that the ability of the fetus to produce an acidosis in response to the stress of labor may be beneficial to long-term outcome. The 10 nonacidotic babies with 1-minute Apgar scores of less than or equal to 3 showed statistically significant deficits in some areas. Coincident acidosis was not associated with a worse outcome for infants with low Apgar scores.

Characteristics of males at a public health department contraceptive service

To effectively confront teenage pregnancy, the characteristics, attitudes, and behaviors of males, along with females, need to be better understood. This pilot study examined young males who visited the family planning clinic of a public health department to obtain free condoms. Questionnaires were distributed over a 4-week period. Nearly 30% of males reported having sex 11+ times a month. However, an equal proportion reported having sex three or fewer times in the same interval. Most males reported using condoms during sex, although one quarter reported use as "seldom." The health department was a major source of condoms and was positively evaluated because condoms were free and there were "no questions asked." Only one third of the males reported using another method of contraception. Results suggest a major role of the health department in condom availability and the potential need for contraceptive services for males.

Psychiatric disorder among children with tuberous sclerosis

The psychiatric status of 90 children with tuberous sclerosis was investigated. Over 50 per cent of the sample showed psychotic behaviour, 59 per cent were hyperkinetic and 13 per cent severely aggressive. 57 per cent of the children who had infantile spasms were autistic, as opposed to 13 per cent in a Finnish study of children who had infantile spasms from all causes. The very high incidence of psychiatric disturbance has implications for the advice doctors should give on the management of children diagnosed to have tuberous sclerosis and for the special educational methods that may be needed.

Regulation of renal sulfoglycolipid biosynthesis

The in vitro activity of the renal galactolipid sulfotransferase and the level of sulfated glycolipids in the rat kidney have been correlated as a function of age. The galactolipid sulfotransferase was found to be greatly reduced in the young as compared with the adult animal. The relatively minor changes in the sulfated glycolipid content of the kidney with age suggests that an increase in sulfoglycolipid turnover occurs during growth. An inhibitory activity was detected in the homogenate supernate of the young animal capable of reducing the in vitro sulfotransferase activity of the adult. Assay of the human renal galactolipid sulfotransferase showed that this enzyme activity is deleted in samples of the blastematous form of Wilm's renal tumor. The results suggest that the rate of synthesis of renal sulfoglycolipids may prove a marker of renal development, perhaps by post translational regulation.

Prolonged use of nitrazepam for epilepsy in children with tuberous sclerosis

A case note study of 90 children with tuberous sclerosis showed that 56 had taken nitrazepam for seizures for from one month to 13 years. In 38 children nitrazepam was withdrawn but only two had immediate major seizures. Given that sleepiness, deterioration in motor skills, or ataxia seems to be associated in some children with treatment with nitrazepam, doctors may wish to review their long term prescriptions of this drug in children with tuberous sclerosis.

Different patterns of lectin binding and cell surface sialylation detected on related high- and low-metastatic tumor lines

We have analyzed cell surface-bound carbohydrates in two different model systems for metastasis composed of closely related tumor cell lines with differing metastatic potential. The first system studied was that of the DBA/2-derived T-lymphoma lines (Eb/ESb) and some recently established sublines of ESb with altered metastatic behavior (ESb-M and ESb-MR). The second system consisted of the highly metastatic MDAY-D2 cells, a wheat germ agglutinin-resistant low metastatic subline MDW40, and two metastatic revertants from the latter. The cells were stained with fluorescein isothiocyanate-conjugated lectins and analyzed by flow cytofluorography. All low-metastatic tumor lines expressed receptor sites for the lectins soybean agglutinin (SBA) and Vicia villosa (VV). The metastatic lines had the respective lectin binding sites blocked by sialic acid (SA). A good correlation was found within the cell lineages Eb leads to ESb leads to ESb-M leads to ESb-MR and MDAY-D2 leads to MDW40 leads to MDW40M1 between reactivity of SBA and VV and metastatic potential. The amount of neuraminidase-accessible SA was similar for all cell types (except MDW40) indicating differences in the positioning of SA. For high-metastatic ESb cells, the sialylation of SBA and VV receptor sites was paralleled by a relative decrease of SA associated with receptor sites for peanut agglutinin. Low-metastatic Eb cells, in contrast, had their peanut agglutinin receptor sites sialylated but expressed asialylated SBA and VV receptor sites. Eb cells were also found to have 2-fold higher activities in galactose-specific sialyltransferases. It is proposed that the differences in positioning of SA on the cell surface leading to masking or unmasking of terminal sugars could influence the metastatic potential of tumor cells.

Comparison of direct immunofluorescence and direct immunoperoxidase procedures for detection of herpes simplex virus antigen in lesion specimens

Direct immunofluorescence and direct immunoperoxidase staining were equally sensitive and specific for detection of herpes simplex virus antigen in lesion specimens, and each method showed 82% agreement with virus isolation results.

Very early neonatal seizure rate: a possible epidemiological indicator of the quality of perinatal care

The most frequently cited objective of perinatal care is the prevention of mortality and morbidity; but there is no general agreement about the indices which should be used to assess the extent to which this broad objective is being achieved. As mortality and morbidity observed during the perinatal period may reflect pathological processes originating earlier in pregnancy, putative indices of perinatal care should ideally be evaluated in clinical experiments comparing different modes of practice. Also, because perinatal practice can affect mortality and morbidity in a reciprocal manner, it is important to define indices of both mortality and morbidity. Morbidity indices should preferably be based on neonatal clinical signs which are both unambiguous and strongly predictive of later morbidity. We propose that the frequency of neonatal seizures beginning within 48 h of birth should be considered as an index which may meet these criteria in respect of full-term babies.

Apparent reversion of stable in vitro genetic markers detected in tumour cells from spontaneous metastases

The evolution towards more aggressive and autonomous behaviour of many cancerous tumours, often referred to as tumour progression, is thought to stem from the development of heterogeneity within the tumour cell population, combined with the continuous selection of progressively more malignant cellular phenotypes. During the course of the disease, the tumour cells show multiple phenotypic changes in a stepwise, but apparently random fashion, becoming more anaplastic, increasingly independent of growth controls and more metastatic. Several laboratories, including our own, have analysed aspects of tumour heterogeneity and cancer metastasis by selecting and studying the properties of lectin-resistant (LecR) membrane mutant tumour sublines; in a few cases, such variants have been claimed to be less tumorigenic or metastatic than the parental cells from which they were derived. We have attempted to study the factors involved in the reestablishment of tumour heterogeneity by monitoring the stability in vivo of LecR phenotypes of metastatic tumour cells after injection of cloned LecR tumour cells. We now report that spontaneous metastases arising after a subcutaneous (s.c.) injection of cells from variant tumour lines selected from a highly metastatic DBA/2 mouse tumour known as MDAY-D2, and which are stably resistant in tissue culture to wheat germ agglutinin (WGA), no longer carry the WGA-resistant (WGAR) phenotype. The results demonstrate that WGAR tumour cells do not metastasize, but rather, 'revertants' for the WGAR phenotype, which presumably were generated in vivo after injection, were the cells actually capable of metastatic growth.