Influence of a collapsed coastal landfill on metal levels in sediments and biota--a portent for the future?

In May 2008 a coastal landslide deposited landfill debris onto the shore near Lyme Regis, UK. Six months later, intertidal sediments and biota from the area were sampled to determine whether the landslip had affected distribution and bioavailability of metals in the area and if there were any biological effects. Highest sediment concentrations for the majority of metals occurred near the landslip zone and in several cases exceeded Threshold Effects or Probable Effects Levels (As, Cu, Hg, Ni, Pb, Zn). The 1 M HCl-extractable fraction of Cd, Pb and Zn in sediments also increased near the landslip. Metal bioaccumulation by intertidal biota showed variability between different species and metals, but there were several instances of increased accumulation near the landslip through increased availability from seawater, sediment and dietary sources. In most cases, metal concentrations in molluscs exceeded Oslo and Paris Commission (OSPAR) background concentrations (BCs) together with background assessment concentrations (BACs) at some sites. Kidney tissues in winkles (Littorina littorea) were measured for evidence of oxidative stress using the Total Oxyradical Scavenging Capacity (TOSC) assay. Responses to peroxynitrite, peroxyl and hydroxyl radicals suggested raised levels of TOSC in animals from the sites close to or east of the landfill waste. There have been very few studies of direct impact of landfills on the marine environment and this study could serve as a practical model for similar events driven by sea level rise.

[IgG4-related tubulointerstitial nephritis presented with multiple renal nodular lesions]

A 66-year-old man presented with multiple bilateral renal nodular lesions demonstrated by enhanced computed tomographic scan. He had a history of autoimmune pancreatitis and renal cell carcinoma, which had been treated with partial nephrectomy. We performed renal biopsy under ultrasound guidance. Pathological examination revealed plasma cell infiltration to the renal interstitium. Serum IgG4 level was high and we diagnosed as IgG4-related tubulointerstitial nephritis. After one month of oral steroid therapy the multiple nodular lesions disappeared.

Regulation of connexin 43 by basic fibroblast growth factor in the bladder: transcriptional and behavioral implications

PURPOSE

Basic fibroblast growth factor is a candidate causative factor of detrusor overactivity in bladder outlet obstruction cases through up-regulation of the gap junction protein connexin 43. We addressed the transcriptional and behavioral implications of this axis.

MATERIALS AND METHODS

Cx43 and Cx45 mRNA expression was assessed by real-time reverse transcriptase-polymerase chain reaction in the bladder of a rat bladder outlet obstruction model and in cultured rat bladder smooth muscle cells with and without basic fibroblast growth factor treatment. Involvement of the extracellular signal regulated kinase 1/2-activator protein-1 pathway was evaluated by immunofluorescence study and a promoter-reporter assay in bladder smooth muscle cells. The effect of basic fibroblast growth factor on micturition behavior was measured in unrestrained rats under a 12-hour light/dark cycle using a controlled release system from gelatin hydrogels fixed on the bladder. The expression of extracellular signal regulated kinase 1/2 and connexin 43 protein was assessed by Western blotting of rat bladder protein.

RESULTS

Cx43 but not Cx45 mRNA expression was increased in the bladder of the obstruction model and in bladder smooth muscle cells treated with basic fibroblast growth factor. The mitogen-activated and extracellular signal-regulated kinase kinase inhibitor PD98059 blocked the stimulatory effect of basic fibroblast growth factor on connexin 43 protein expression and promoter activity, which was also decreased by mutation or deletion of an activator protein-1 cis-element of the connexin 43 promoter. In vivo application of basic fibroblast growth factor on the bladder increased urinary frequency during the latter half of the dark phase, ie the late active phase of rats (F = 5.1, 2-way ANOVA p <0.05). The expression of phospho-extracellular signal regulated kinase 1/2 and connexin 43 protein was increased in the bladder.

CONCLUSIONS

The extracellular signal regulated kinase 1/2-activator protein-1-connexin 43 axis could be a potential therapeutic target for increased urinary frequency.

[Pseudohypoaldosteronism type 1 in an infant with bilateral primary obstructive megaureter : a case report]

A 35-day-old male infant was referred to our hospital for bilateral hydroureteronephrosis on postnatal ultrasonography. He was born at 37 weeks and 2 days of gestation, weighing 2,765 g. He was diagnosed with bilateral primary obstructive megaureter. During observation, at 3 months and 2 weeks of age, he presented with dehydration and showed hyponatremia and hyperkalemia. An endocrinological examination led to a diagnosis of pseudohypoaldosteronism type 1 (PHA1). After bilateral percutaneous nephrostomy, PHA1 resolved. He underwent bilateral ureteral tapering and ureteroneocystostomy at 5 months and 3 weeks of age. Since PHA1 recurred after removal of urethral catheter, urethral catheter and bilateral double-J-stent was kept until 8 months old. He was followed-up until 3 years old with no signs of PHA1 recurrence. For an infant with obstructive uropathy or vesicoureteral reflux showing hyponatremia and hyperkalemia, PHA1 should be considered.

Bioactive bone cement with a low content of titania particles without postsilanization: effect of filler content on osteoconductivity, mechanical properties, and handling characteristics

In this study, we developed three types of polymethylmethacrylate (PMMA)-based composite cement with low contents of nonsilanized titania particles (5, 10, and 20 wt % TiO(2), respectively: designated T5, T10, and T20). The osteoconductivity, mechanical properties, and handling characteristics of these cements were compared with those of commercially available PMMA cement (PMMAc). The cement was inserted into rat tibiae and solidified in situ. After 6 and 12 weeks, tibiae were removed for evaluation of osteoconductivity using Stevenel's Blue and Van Gieson's picrofuchsin staining. The affinity indices reflecting the osteoconductivity of T10 and T20 were 33.4 ± 12.8 and 56.5 ± 14.1 at 6 weeks, and 67.0 ± 18.0 and 65.0 ± 51.7 at 12 weeks, respectively, and were significantly higher than for PMMAc (p < 0.01). The compressive and flexural strengths of T5, T10, and T20 exceeded those of PMMAc, whereas the elasticity did not differ significantly. Scanning electron microscopy and energy-dispersive X-ray microanalysis showed that the micron-sized and spherical titania particles were well dispersed in T20 and were exposed on the surface of the cement that made direct contact with bone. These results show that T20 is a promising bioactive bone cement for use in prosthesis fixation.

Detection of disease-associated prion protein in the posterior portion of the small intestine involving the continuous Peyer's patch in cattle orally infected with bovine spongiform encephalopathy agent

Twenty-eight calves were exposed to 5 g of homogenized brainstems confirmed as bovine spongiform encephalopathy (BSE) agents. Two to five animals were sequentially killed for post-mortem analyses 20 months post-inoculation (MPI) at intervals of 6 or 12 months. Samples from animals challenged orally with BSE agents were examined by Western blot and immunohistochemical analyses. Immunolabelled, disease-associated prion protein (PrPsc) was detected in a small portion of follicles in the continuous Peyer's patch from the posterior portion of the small intestine involving the entire ileum and the posterior jejunum but not in the discrete Peyer's patches in the remaining jejunum in preclinical animals at 20, 36, and 48 MPI. The PrPsc-positive cells corresponded to tingible body macrophages on double immunofluorescence labelling. In addition, PrPsc accumulated in 7 of 14 animals in the central nervous system (CNS) after 34 MPI, and five of them developed clinical signs and were killed at 34, 46, 58, and 66 MPI. Two preclinical animals killed at 36 and 48 MPI presented the earliest detectable and smallest deposition of immunolabelled PrPsc in the dorsal motor nucleus of the vagus nerve, the spinal trigeminal nucleus of the medulla oblongata at the obex region, and/or the intermediolateral nucleus of the 13th thoracic segment of the spinal cord. Based on serial killing, no PrPsc was detectable in the CNS, including the medulla oblongata at the obex level, before 30 MPI, by Western blot and immunohistochemical analyses. These results are important for understanding the pathogenesis of BSE.

Factors contributing to cure in T2 pancreatic cancer

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Background: It is crucial to determine whether cancer therapy achieves cure or merely prolongs time to death from cancer (failure time). Unfortunately, conventional survival tests such as log-rank test and Cox regression fail to distinguish between cure and prolonged failure time, both making a great difference in survival benefit. In 1994, Gamel extended the Boag model to three regressions, allowing us to study whether prognostic factors have significant effect on cure rate or failure time. Using the Gamel-Boag regressions, we study curative effects of clinicopathological factors in pancreatic cancer.

Methods: Follow-up data from 452 patients who underwent pancreatectomy for T2 ductal cell cancer were analyzed. The prognostic factors to be studied were converted to binary variables, which include sex, age (<=60 or >60 years), tumor size (<=2 or >2 cm) lymphnode metastasis, and six types of invasions, i.e., serosal, retroperitoneal, portal vain, common bile duct and duodenal invasions. By calculating coefficients of the three regressions and their confidence intervals, we evaluated whether each (or combinations) of these variables are associated with increased cure rate or prolonged failure time.

Results: Tthere were 11 relapse-free 5-year survivors. Except for tumor size (TS) and lymphnode metastasis (N), no factors were significantly associated with increased cure rate or prolonged failure time. The only factor found to significantly affect cure was TS; the estimated cure rate being 44% for patients with TS <= 2 cm and 4% otherwise (p=0.0001). This effect was not influenced by N and other factors. Only N significantly accelerated failure time; the median failure time being 11.9 months when N was negative and 6.7 months otherwise (p<0.0001). Thus, both TS and N affected the prognosis significantly but in different ways. By contrast the Cox regression showed that both TS and N were significantly associated with hazard reduction (p=0.003 and p<0.001, respectively), which, however, did no reveal a qualitative difference in survival outcome between TS and N.

Conclusions: In T2 pancreatic cancer, a highly significant increase in cure rate is found when TS≤2 cm. This increase is not affected by N or tumor extension to nonpancreatic tissues.

No significant financial relationships to disclose.

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

OBJECTIVES

To assess the clinical effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence (SUI) through systematic review and economic modelling.

DATA SOURCES

The Cochrane Incontinence Group Specialised Register, electronic databases and the websites of relevant professional organisations and manufacturers, and the following databases: CINAHL, EMBASE, BIOSIS, Science Citation Index and Social Science Citation Index, Current Controlled Trials, ClinicalTrials.gov and the UKCRN Portfolio Database.

STUDY SELECTION

The study comprised three distinct elements. (1) A survey of 188 women with SUI to identify outcomes of importance to them (activities of daily living; sex, hygiene and lifestyle issues; emotional health; and the availability of services). (2) A systematic review and meta-analysis of non-surgical treatments for SUI to find out which are most effective by comparing results of trials (direct pairwise comparisons) and by modelling results (mixed-treatment comparisons - MTCs). A total of 88 randomised controlled trials (RCTs) and quasi-RCTs reporting data from 9721 women were identified, considering five generic interventions [pelvic floor muscle training (PFMT), electrical stimulation (ES), vaginal cones (VCs), bladder training (BT) and serotonin-noradrenaline reuptake inhibitor (SNRI) medications], in many variations and combinations. Data were available for 37 interventions and 68 treatment comparisons by direct pairwise assessment. Mixed-treatment comparison models compared 14 interventions, using data from 55 trials (6608 women). (3) Economic modelling, using a Markov model, to find out which combinations of treatments (treatment pathways) are most cost-effective for SUI.

DATA EXTRACTION

Titles and abstracts identified were assessed by one reviewer and full-text copies of all potentially relevant reports independently assessed by two reviewers. Any disagreements were resolved by consensus or arbitration by a third person.

RESULTS

Direct pairwise comparison and MTC analysis showed that the treatments were more effective than no treatment. Delivering PFMT in a more intense fashion, either through extra sessions or with biofeedback (BF), appeared to be the most effective treatment [PFMT extra sessions vs no treatment (NT) odds ratio (OR) 10.7, 95% credible interval (CrI) 5.03 to 26.2; PFMT + BF vs NT OR 12.3, 95% CrI 5.35 to 32.7]. Only when success was measured in terms of improvement was there evidence that basic PFMT was better than no treatment (PFMT basic vs NT OR 4.47, 95% CrI 2.03 to 11.9). Analysis of cost-effectiveness showed that for cure rates, the strategy using lifestyle changes and PFMT with extra sessions followed by tension-free vaginal tape (TVT) (lifestyle advice-PFMT extra sessions-TVT) had a probability of greater than 70% of being considered cost-effective for all threshold values for willingness to pay for a QALY up to 50,000 pounds. For improvement rates, lifestyle advice-PFMT extra sessions-TVT had a probability of greater than 50% of being considered cost-effective when society's willingness to pay for an additional QALY was more than 10,000 pounds. The results were most sensitive to changes in the long-term performance of PFMT and also in the relative effectiveness of basic PFMT and PFMT with extra sessions.

LIMITATIONS

Although a large number of studies were identified, few data were available for most comparisons and long-term data were sparse. Challenges for evidence synthesis were the lack of consensus on the most appropriate method for assessing incontinence and intervention protocols that were complex and varied considerably across studies.

CONCLUSIONS

More intensive forms of PFMT appear worthwhile, but further research is required to define an optimal form of more intensive therapy that is feasible and efficient for the NHS to provide, along with further definitive evidence from large, well-designed studies.

Experimental transmission of h-type bovine spongiform encephalopathy to bovinized transgenic mice

To characterize the biological and biochemical properties of H-type bovine spongiform encephalopathy (BSE), a transmission study with a Canadian H-type isolate was performed with bovinized transgenic mice (TgBoPrP), which were inoculated intracerebrally with brain homogenate from cattle with H-type BSE. All mice exhibited characteristic neurologic signs, and the subsequent passage showed a shortened incubation period. The distribution of disease-associated prion protein (PrP(Sc)) was determined by immunohistochemistry, Western blot, and paraffin-embedded tissue (PET) blot. Biochemical properties and higher molecular weight of the glycoform pattern were well conserved within mice. Immunolabeled granular PrP(Sc), aggregates, and/or plaque-like deposits were mainly detected in the following brain locations: septal nuclei, subcallosal regions, hypothalamus, paraventricular nucleus of the thalamus, interstitial nucleus of the stria terminalis, and the reticular formation of the midbrain. Weak reactivity was detected by immunohistochemistry and PET blot in the cerebral cortex, most thalamic nuclei, the hippocampus, medulla oblongata, and cerebellum. These findings indicate that the H-type BSE prion has biological and biochemical properties distinct from those of C-type and L-type BSE in TgBoPrP mice, which suggests that TgBoPrP mice constitute a useful animal model to distinguish isolates from BSE-infected cattle.

Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen

Although bacterial infection is a major cause of death even after reduced-intensity conditioning (RIC) for allogeneic stem cell transplantation (SCT), little is known about the epidemiology and risk factors. The incidence of bacterial infection in 43 patients who received allogeneic bone marrow transplantation (BMT) using a RIC regimen was compared with that in 68 patients who received BMT using a myeloablative conditioning regimen, and risk factors for bacterial infection were identified. Before engraftment, incidences of febrile neutropenia (FN) and documented infections (DI) were significantly decreased in RIC patients (FN: 59.5% vs. 89.6%, P<0.01, DI: 4.8% vs. 17.9%, P<0.01). However, incidence of bacterial infection was significantly increased in RIC patients in the post-engraftment phase (53.8% vs. 11.1%, log-rank, P<0.01). Blood stream was the most frequent focus of infection in both groups. In multivariate analysis, RIC and acute graft-versus-host disease were revealed to be significant risk factors for bacterial infection in this phase. In summary, risk of bacterial infection after engraftment was significantly higher in RIC patients, although infection was decreased before engraftment, and we need to develop a RIC-specific strategy against bacterial infection after RIC SCT.

Myocardin-dependent activation of the CArG box-rich smooth muscle gamma-actin gene: preferential utilization of a single CArG element through functional association with the NKX3.1 homeodomain protein

Serum response factor (SRF) is a ubiquitously expressed transcription factor that binds a 10-bp element known as the CArG box, located in the proximal regulatory region of hundreds of target genes. SRF activates target genes in a cell- and context-dependent manner by assembling unique combinations of cofactors over CArG elements. One particularly strong SRF cofactor, myocardin (MYOCD), acts as a component of a molecular switch for smooth muscle cell (SMC) differentiation by activating cytoskeletal and contractile genes harboring SRF-binding CArG elements. Here we report that the human ACTG2 promoter, containing four conserved CArG elements, displays SMC-specific basal activity and is highly induced in the presence of MYOCD. Stable transfection of a non-SMC cell type with Myocd elicits elevations in endogenous Actg2 mRNA. Gel shift and luciferase assays reveal a strong bias for MYOCD-dependent transactivation through CArG2 of the human ACTG2 promoter. Substitution of CArG2 with other CArGs, including a consensus CArG element, fails to reconstitute full MYOCD-dependent ACTG2 promoter stimulation. Mutation of an adjacent binding site for NKX3.1 reduces MYOCD-dependent transactivation of the ACTG2 promoter. Co-immunoprecipitation, glutathione S-transferase pulldown, and luciferase assays show a physical and functional association between MYOCD and NKX3.1; no such functional relationship is evident with the related NKX2.5 transcription factor despite its interaction with MYOCD. These results demonstrate the ability of MYOCD to discriminate among several juxtaposed CArG elements, presumably through its novel partnership with NKX3.1, to optimally transactivate the human ACTG2 promoter.

Basic fibroblast growth factor causes urinary bladder overactivity through gap junction generation in the smooth muscle

Overactive bladder is a highly prevalent clinical condition that is often caused by bladder outlet obstruction (BOO). Increased coupling of bladder smooth muscle cells (BSMC) via gap junctions has been hypothesized as a mechanism for myogenic bladder overactivity in BOO, although little is known about the regulatory system underlying such changes. Here, we report the involvement of basic fibroblast growth factor (bFGF) and connexin 43, a bladder gap junction protein, in bladder overactivity. BOO created by urethral constriction in rats resulted in elevated bFGF and connexin 43 levels in the bladder urothelium and muscle layer, respectively, and muscle strips from these bladders were more sensitive than those from sham-operated controls to a cholinergic agonist. In vitro bFGF treatment increased connexin 43 expression in cultured rat BSMC via the ERK 1/2 pathway. This finding was supported by another in vivo model, where bFGF released from gelatin hydrogels fixed on rat bladder walls caused connexin 43 upregulation and gap junction formation in the muscle layer. Bladder muscle strips in this model showed increased sensitivity to a cholinergic agonist that was blocked by inhibition of gap junction function with alpha-glycyrrhetinic acid. Cystometric analyses of this model showed typical features of detrusor overactivity such as significantly increased micturition frequency and decreased bladder capacity. These findings suggest that bFGF from the urothelium could induce bladder hypersensitivity to acetylcholine via gap junction generation in the smooth muscle, thereby contributing to the myogenic overactivity of obstructed bladders.

[A case of penile metastasis of malignant melanoma with priapism]

A metastatic penile tumor of malignant melanoma is very rare. The patient had priapism caused by metastatic penile tumor and the primary cancer was in the end stage. However, in this case, we could relieve the dysuria and pain by percutaneous cystostomy and partial penectomy. The corpus spongiosumcorpus cavernosum shunt could not relieve the priapism and might have accelerated the metastasis.

Adipogenic differentiation of adipo-stromal cells incubated with basic fibroblast growth factor in solution and coated form

Human adipo-stromal cells were incubated in culture medium containing basic fibroblast growth factor (bFGF) or in a cell-culture dish coated with bFGF. The effect of the two existence modes of bFGF on cell attachment and differentiation was evaluated. The morphology and number of cells were similar for both the bFGF modes. However, the extracellular signal-regulated kinase 1 and 2 (ERK1/2) activation of cells incubated with bFGF in the medium was stronger and lasted for a longer time period than that of bFGF in the coated form. When adipo-stromal cells were incubated in an adipogenic differentiation medium, irrespective of the mode of bFGF added, the mRNA expression of peroxisome proliferator-activated receptor gamma2 (PPRAgamma2) and fatty acid binding protein 2 (aP2), the glycerol-3-phosphate dehydrogenase (GPDH) activity and the cell accumulation of oil lipids were all suppressed. bFGF in the solution form inhibited the PPARgamma2 expression to a high extent compared with that in the coated form. It is possible that bFGF-induced ERK1/2 activation consequently inhibited the adipogenic differentiation of adipo-stromal cells.