An Ab Initio Study of the Excited States, Isomerization Energy Profiles and Conical Intersections of a Chiral Cyclohexylidene Derivative

The excited valence and Rydberg states of the chiral (4-methylcyclohexylidene) fluoromethane (4MCF) have been investigated using multiconfigurational CASSCF and CASPT2, and coupled-cluster methods (RI-CC2). A 3s Rydberg state is predicted below the valence (1)pipi* state. To gain insight into the photophysics of the cis-trans isomerization of this olefin, potential energy profiles for the valence (10pipi* state along the twisting and pyramidalization reaction coordinates have been computed using variational methods (CASSCF and multireference configuration interaction with singles and doubles (MR-CISD)). Starting from geometries with energies close to degeneracy in the valence and ground-state curves, three minima on the crossing seam that can be correlated with the conical intersections known for fluoroethylene, have been found. On the basis of these features, the photochemistry of 4MCF is discussed.

Screens using RNAi and cDNA expression as surrogates for genetics in mammalian tissue culture cells

We have developed methods for the automation of transfection-grade DNA preparation, high-throughput retroviral preparation, and highly parallel phenotypic screens to establish approaches that will allow investigators to examine in an unbiased manner the roles of proteins in mammalian cells. These methods have been used to raise or lower the levels of individual kinases in individual micro-well cultures either by cDNA or short hairpin RNA expression and will allow investigators to treat mammalian cells in culture in manners that are analogous to genetic screens in yeast. Our proof-of-principle experiments have been performed in human cells using repositories that represent over 75% of the protein, nucleotide, carbohydrate, lipid, and amino acid kinases in the human genome. These initial experiments have demonstrated the feasibility of two general types of screens. We have performed phenotypic screens to identify proteins with specific roles in a chosen function and genetic interaction screens to establish epistatic relations between different proteins. The results suggest that any phenotype that can be scored by a robust assay in tissue culture is amenable to these types of screens and that interactions between mammalian proteins can be established. These results point to the near-term goal of establishing comprehensive, unbiased screens that will allow queries on the roles of all human proteins.

On the Location of Conical Intersections in CH2BrCl Using MS-CASPT2 Methods

Multiconfigurational second-order perturbation theory has been employed to calculate two-dimensional potential energy surfaces for the lowest low-lying singlet electronic states of CH2BrCl as a function of the two carbon-halogen bonds. The photochemistry of the system is controlled by a nonadiabatic crossing occurring between the A and B bands, attributed to the b1A' and c1A' states, which are found almost degenerate and forming a near-degeneracy line of almost equidistant C-Br and C-Cl bonds. A crossing point in the near-degeneracy line is identified as a conical intersection in this reduced two-dimensional space. The positions of the conical intersection located at CASSCF, single-state (SS)-CASPT2, and multistate (MS)-CASPT2 levels of theory are compared, also paying attention to the nonorthogonality problem of perturbative approaches. To validate the presence of the conical intersection versus an avoided crossing, the geometrical phase effect has been checked using the multiconfigurational MS-CASPT2 wave function.

Six years experience in intracoronary brachytherapy procedures: patient doses from fluoroscopy

Typical patient dose levels during intracoronary brachytherapy (ICB) procedures using beta sources were determined across a sample of 221 treatments. Dose-area product values, fluoroscopy time and number of frames per procedure, with median values of 62 Gy cm2, 17.0 min and 1493 images, respectively, resulted in a 20% to 50% increase in the values measured for percutaneous transluminal coronary angioplasty procedures in the same medical centre (median values 41 Gy cm2, 14.3 min and 1078 images). Likely reasons for this increase include the additional complexity of ICB, the need for recording and reporting every step of the treatment, getting the essential parameters for the volume determination of the lesion and therapeutic radiation dose calculation and, finally, the learning curve for this kind of procedure. A high concentration skin dose distribution during ICB procedures was measured and in 12% of the patients peak skin doses higher than 1.5 Gy were confirmed. 10 patients were submitted to clinical follow-up and skin injuries were not identified.

Microvascular injury and blood-brain barrier leakage in Alzheimer's disease

Thinning and discontinuities within the vascular basement membrane (VBM) are associated with leakage of the plasma protein prothrombin across the blood-brain barrier (BBB) in Alzheimer's disease (AD). Prothrombin immunohistochemistry and ELISA assays were performed on prefrontal cortex. In severe AD, prothrombin was localized within the wall and neuropil surrounding microvessels. Factor VIII staining in severe AD patients indicated that prothrombin leakage was associated with shrinkage of endothelial cells. ELISA revealed elevated prothrombin levels in prefrontal cortex AD cases that increased with the Braak stage (Control=1.39, I-II=1.76, III-IV=2.28, and V-VI=3.11 ng prothrombin/mg total protein). Comparing these four groups, there was a significant difference between control and Braak V-VI (p=0.0095) and also between Braak stages I-II and V-VI (p=0.0048). There was no significant difference in mean prothrombin levels when cases with versus without cerebral amyloid angiopathy (CAA) were compared (p-value=0.3627). When comparing AD patients by APOE genotype (ApoE3,3=2.00, ApoE3,4=2.49, and ApoE4,4=2.96 ng prothrombin/mg total protein) an analysis of variance indicated a difference between genotypes at the 10% significance level (p=0.0705). Tukey's test indicated a difference between the 3,3 and 4,4 groups (p=0.0607). These studies provide evidence that in advanced AD (Braak stage V-VI), plasma proteins like prothrombin can be found within the microvessel wall and surrounding neuropil, and that leakage of the blood-brain barrier may be more common in patients with at least one APOE4 allele.

2-D native-PAGE/SDS-PAGE visualization of an oligomer's subunits: Application to the analysis of IgG

A 2-D native-PAGE/SDS-PAGE method for detecting the subunit components of protein oligomers at low picomole sensitivity is presented. IgG was electrophoresed in a native acidic polyacrylamide gel in amounts ranging from 51 pmol to 60 fmol. Silver-staining (native fast silver stain, ammoniacal silver stain, permanganate silver stain), Coomassie-staining (R-250, G-250), metal ion-reverse-staining (zinc, copper), and fluorescent chromophore-staining (SYPRO Ruby) methods were used to visualize the IgG oligomers. The protein zones were then excised, separated by SDS-PAGE, and subunits visualized with a permanganate silver stain. The Coomassie R-250/permanganate silver-staining combination detected IgG subunits using 2 pmol of sample. Coomassie G-250 and native fast silver staining in the first-dimensional gel produced detectable subunits in the second-dimensional separation at 3 and 13 pmol, respectively. Staining with silver (ammoniacal, permanganate), copper, zinc, or SYPRO Ruby in the first-dimensional gel did not produce discernible subunits in the second-dimensional gels due to protein streaking or protein immobilization in the native gel. When using a 2-D native-PAGE/SDS-PAGE system, Coomassie staining of the first-dimensional native gel combined with permanganate silver staining of the second-dimensional denaturing gel provides the most sensitive method (2-3 pmol) for visualizing constituent subunits from their oligomeric assemblies.

Occupational radiation doses in interventional cardiology: a 15-year follow-up

This report describes occupational radiation doses of interventional cardiologists over 15 years and assesses action undertaken to optimize radiation protection. Personal dosimetry records of nine staff cardiologists and eight interventional cardiology fellows were recorded using personal dosemeters worn over and under their lead aprons. The hospital in which this study was conducted currently performs 5000 cardiology procedures per year. The hospital has improved its facilities since 1989, when it had two old-fashioned theatres, to include four rooms with more advanced and safer equipment. Intensive radiation protection training was also implemented since 1989. Initially, some individual dose values in the range of 100-300 mSv month(-1), which risked exceeding some regulatory dose limits, were measured over the lead apron. Several doses in the range of 5-11 mSv month(-1) were recorded under the apron (mean = 10.2 mSv year(-1)). During the last 5 years of the study, after the implementation of the radiation protection actions and a programme of patient-dose optimization, the mean dose under the apron was reduced to 1.2 mSv year(-1). Current mean occupational doses recorded under the lead apron are 14% of those recorded during 1989-1992 and those recorded over the apron are 14-fold less than those recorded during 1989-1992. The regulatory dose limits and the threshold for lens injuries might have been exceeded if radiation protection facilities had not been used systematically. The most effective actions involved in reducing the radiation risk were training in radiation protection, a programme of patient-dose reduction and the systematic use of radiation protection facilities, specifically ceiling-suspended protective screens.

Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology

Patient and staff dose values in an interventional cardiology laboratory for different operational modes and several patient thicknesses (from 16 to 28 cm, simulated using polymethylmethacrylate) are presented. When increasing patient thicknesses and depending on fluoroscopy and cine modes, occupational doses can increase >30 times the baseline level. Scatter dose rates at the cardiologist's position with no radiation protective tools ranged from 1 to 14 mSv h(-1) for fluoroscopy, and from 10 to 47 mSv h(-1) during cine acquisition. Patient entrance surface air kerma rates increased by nearly 3 and staff dose rates by up to 2.6 when fluoroscopy was moved from the low to the high mode, for a typical 20 cm thickness. The respective increase factors were 6 and 4.2 when patient thickness rose from 16 to 28 cm, and by 10 and 8.3, when comparing cine acquisition with the low fluoroscopy mode. The knowledge of typical dose rates for each X-ray system in use in catheterisation laboratories is essential in order to optimise protection of patients and staff.

Separation of proteins with a molecular mass difference of 2 kDa utilizing preparative double-inverted gradient polyacrylamide gel electrophoresis under nonreducing conditions: Application to the isolation of 24 kDa human growth hormone

A method for separating proteins with a molecular mass difference of 2 kDa using SDS-PAGE under nonreducing conditions is presented. A sample mixture containing several human growth hormone (hGH) isoforms was initially separated on a weak anion-exchange column. Fractions rich in 24 kDa hGH as determined by analytical SDS-PAGE were pooled and further separated by cation-exchange chromatography. The fractions pooled from the cation-exchange chromatography contained two hGH isoforms with a 2 kDa molecular mass difference according to SDS-PAGE analysis, 22 and 24 kDa hGH. The 22 and 24 kDa hGH were separated using continuous-elution preparative double-inverted gradient PAGE (PDG-PAGE) under nonreducing conditions. The preparative electrophoresis gel was composed of three stacked tubular polyacrylamide matrices, a 4% stacking gel, a 13-18% linear gradient gel, and a 15-10% linear inverted gradient gel. Fractions containing purified 24 kDa hGH were pooled and Western blot analysis displayed immunoreactivity to antihGH antibodies. PDG-PAGE provides researchers with an electrophoretic technique to preparatively purify proteins under nonreducing conditions with molecular mass differences of 2 kDa.

An influx of macrophages is the predominant local immune response in ovine pulmonary adenocarcinoma

Infection with a retrovirus, Jaagsiekte sheep retrovirus (JSRV), causes ovine pulmonary adenocarcinoma (OPA). The excess production of surfactant proteins by alveolar tumour cells results in increased production of pulmonary fluid, which is characteristically expelled through the nostrils of affected sheep. The immune response to JSRV and the tumour is poorly understood: no JSRV-specific circulating antibodies or T cells have been detected to date. The aim of the present study was to obtain phenotypic evidence for a local immune response in OPA lungs. Specific-pathogen free lambs were infected intratracheally with JSRV. When clinical signs of OPA were apparent, the lungs were removed at necropsy and immunohistochemistry (IHC) was performed on lung sections using a panel of mouse anti-sheep mAbs. No influx of dendritic cells, B cells, CD4, CD8 or gammadelta T cells was seen in the neoplastic nodules or in their periphery. MHC Class II-positive cells were found intratumourally, peritumourally and in the surrounding alveolar lumina. In the tumours, many of these cells were shown to be fibroblasts and the remainder were likely to be mature macrophages. In the alveolar lumen, the MHC Class II-positive cells were CD14-positive and expressed high levels of IFN-gamma. They appeared to be immature monocytes or macrophages which then differentiated to become CD14-negative as they reached the periphery of the tumours. A high level of MHC Class I expression was detected on a range of cells in the OPA lungs but the tumour nodules themselves contained no MHC Class I-positive cells. On the basis of these findings, it is proposed that the lack of an effective immune response in OPA could result from a mechanism of peripheral tolerance in which the activity of the invading macrophages is suppressed by the local environment, possibly as a consequence of the inhibitory properties of the surfactant proteins.

Systematic review and meta-analysis: proton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics in Helicobacter pylori eradication

OBJECTIVE

To systematically review the Helicobacter pylori eradication efficacy with ranitidine bismuth citrate (RBC) and two antibiotics, and to conduct a meta-analysis of randomized clinical trials comparing the efficacy of proton pump inhibitor (PPI) vs. RBC with two antibiotics for 1 week.

SELECTION OF STUDIES

Studies evaluating RBC plus two antibiotics were considered. For the meta-analysis, randomized controlled trials comparing PPI vs. RBC plus two antibiotics for 1 week were included.

SEARCH STRATEGY

Electronic and manual bibliographical searches. Assessment of study quality and data extraction: Independently done by two reviewers.

DATA SYNTHESIS

'Intention-to-treat' eradication rate. Meta-analysis was performed, combining the odds ratios (OR) of the individual studies. Subanalysis: Depending on the type of antibiotics and the quality of the studies.

RESULTS

Mean H. pylori eradication with 7-day RBC-clarithromycin-amoxicillin, RBC-clarithromycin-nitroimidazole, and RBC-amoxicillin-nitroimidazole was 83%, 86%, and 71%, respectively. The meta-analysis showed comparable efficacy with RBC and PPI when they were combined with clarithromycin and amoxicillin (OR = 1.11; 95% CI = 0.88-1.40), or with amoxicillin and metronidazole (OR = 0.92; 95%CI = 0.60-1.41). However, when comparing PPI vs. RBC plus clarithromycin and a nitroimidazole, higher cure rates with RBC than with PPI were demonstrated (OR = 1.65; 95% CI = 1.15-2.37).

CONCLUSION

The efficacy of RBC and PPI-based triple regimens were comparable when using the clarithromycin-amoxicillin or the amoxicillin-metronidazole combination. However, RBC seems to have a higher efficacy than PPI when clarithromycin and a nitroimidazole are the antibiotics prescribed. Therefore, if one prefers to use the clarithromycin-nitroimidazole regimen, RBC should be used instead of a PPI.

Accreditation in radiation protection for cardiologists and interventionalists

Training in radiation protection is widely recognised as one of the basic components of optimisation programmes for medical exposures. Occupational and patient radiation risks in interventional radiology can be quite high and international bodies have shown concern on this item. Following recommendations of the International Commission on Radiological Protection and in accordance with the European Directive on medical exposures, some initiatives for training in radiation protection took place in Spain and Luxembourg. These provided practitioners of interventional radiology adequate theoretical and practical training in radiation protection. The main outcome of the pilot courses organised to this end is discussed, concluding its suitability to implement the European Directive in practice.

Patient dosimetry and image quality in digital radiology from online audit of the X-ray system

The present work describes an online patient dosimetry and an image quality system in digital radiology. For the patient dosimetry audit, current mean values of entrance surface dose (ESD) were compared with local and national reference values (RVs) for the specific examination type evaluated. Mean values exceeding the RV trigger an alarm signal and then an evaluation of the technical parameters, operational practice and image quality was begun, using data available in the DICOM header to derive any abnormal settings or performance to obtain the image. The X-ray tube output for different kVp values is measured periodically, to allow for the automatic calculation of ESD. The system allows also for image audit, linking the dose imparted, the image quality and the alarm condition, if produced. Results and the benefits derived from this online quality control are discussed here.

Evaluation of risk of deterministic effects in fluoroscopically guided procedures

A methodology for the evaluation of skin dose distribution and possible skin injuries on patients undergoing interventional procedures has been developed as part of the European DIMOND programme. Relevant dosimetric data from the procedures are recorded and other specific measurements for skin dose evaluation (slow films for therapy, radiochromic films, thermoluminescence dosemeters and optically stimulated luminescence dosemeters) have been carried out. For non-cardiac and for some cardiac procedures, dose-area product values of 200 and 300 Gy cm2 were proposed, respectively, as a trigger level for further detailed skin dose investigation and possible clinical follow-up. Results from a survey of 191 selected complex procedures are reported. Out of all the patients included in the trial, 16% received skin doses > or =1.5 Gy. No skin injuries were found in any of the patients followed.

Cell-type specific modification of PII is involved in the regulation of nitrogen metabolism in the cyanobacterium Anabaena PCC 7120

In the heterocystous cyanobacterium Anabaena PCC 7120, the modification state of the signalling PII protein is regulated according to the nitrogen regime of the cells, as already observed in some unicellular cyanobacteria. However, during the adaptation to diazotrophic growth conditions, PII is phosphorylated in vegetative cells while unphosphorylated in heterocysts. Isolation of mutants affected on PII modification state and analysis of their phenotypes allow us to show the implication of PII in the regulation of molecular nitrogen assimilation and more specifically, the requirement of unmodified state of PII in the formation of polar nodules of cyanophycin in heterocysts.

Reference level for patient dose in dental skull lateral teleradiography

The present work describes an experiment to obtain a local reference dose value in lateral skull teleradiography for dental applications. The reference value was based on patient measurements in seven dental X-ray units, using thermoluminescent chips, and measurements on a rubber globe filled with water at another 78 installations. Dosemeters were located initially in the head and neck of a human phantom to select the most suitable locations, and on the cephalostat of the X-ray unit at two appropriate locations, which did not interfere with the patient or with the usual imaging routine. The skin projection of the Porion point was considered the best position. 523 patients were monitored in the seven units; then patient doses and dose values from measurements on rubber balloons were compared to normalize and combine the data. The provisional reference value proposed is 400 microGy.