Comprehensive clinical assessment improves the accuracy of predicting cirrhosis in chronic hepatitis C

BACKGROUND

The diagnosis of cirrhosis in chronic hepatitis C (CHC) is important but difficult in those who are unable to undergo liver biopsy. Thus, the aims of the present study were to compare separately and in combination, clinical markers of liver disease, the discriminant score (DS) and serum hyaluronic acid (HA) for their ability to predict cirrhosis in CHC.

METHODS

Two groups of consecutive patients (groups 1 and 2) with CHC were analyzed. Clinical data and routine laboratory results at the time of liver biopsy were collected, and serum HA levels were assayed. A clinical examination score (CES) was constructed using the sum of clinical markers of liver disease in group 1 and was validated in group 2, the DS was calculated, and a serum HA score (HAS) was produced. Combination scores were constructed using the sum of the CES, DS and HAS. Histological analysis of liver biopsies was performed by hepatopathologists blinded to clinical results.

RESULTS

One hundred and fifty-one patients with CHC (group 1, n = 47; group 2, n = 104) including 27 with cirrhosis were assessed. Serum HA was more accurate than either CES or DS in the prediction of cirrhosis. The combination of CES, DS and HAS enabled the most accurate prediction of cirrhosis with a sensitivity and specificity of 78% and 93%, and a positive predictive value and negative predictive value of 75% and 94%, respectively.

CONCLUSIONS

A comprehensive clinical assessment utilizing clinical and laboratory data more accurately predicts the presence and absence of cirrhosis in CHC than individual markers.

Survival in hepatocellular carcinoma: impact of screening and etiology of liver disease

BACKGROUND AND AIMS

As the merits of screening at-risk populations for hepatocellular carcinoma (HCC) remain unclear, we compared the clinico-pathologic features and survival of patients with cirrhosis and HCC detected by screening (Group A) to that in non-screened cases (Group B).

METHODS

We studied cirrhotics who developed HCC between 1994 and 2002. During this period, cirrhotics managed by the Gastroenterology Unit were regularly screened at 6-12 monthly intervals while those managed by other hospital units were not. Demographic data, tumor details, treatment received and survival were recorded and compared according to screening status.

RESULTS

There were 96 cases identified; 41 by screening (group A) and 55 by non-screening methods (Group B). HCC in Group A were smaller (P < 0.01), more likely unilobar (P < 0.01), at an early stage (P < 0.0005) and before vascular invasion (P < 0.005) than Group B cases. The frequency of hepatic surgery and/or local ablation was higher in Group A than Group B (P = 0.001). Overall median survival of Group A was 882 days versus 99 days in Group B (P < 0.0001). One- and 3-year probabilities of survival in Group A were 89% and 38%, versus 33% and 19% in Group B (P < 0.001). Independent predictors of survival included screening, Child-Pugh score, creatinine, tumor stage and absence of alcohol as the etiology.

CONCLUSIONS

Screening for HCC in cirrhosis identifies tumors at an earlier stage, results in a higher chance of receiving curative treatment and possibly improves patient survival. The absence of alcoholic liver disease impacts favorably on survival.

High central venous pressure is associated with prolonged mechanical ventilation and increased mortality after lung transplantation

BACKGROUND

Poor oxygenation might occur in transplanted lungs as a result of reperfusion injury and lack of lymphatic drainage. Low central venous and pulmonary capillary wedge pressures are advocated to reduce pulmonary edema and maximize oxygenation but might adversely affect cardiac index, circulation, and renal function.

METHODS

Histories, intensive care unit charts, and donor data on 118 lung transplantations performed between 1999 and 2002 were retrospectively assessed. Multiple logistic regression analysis was performed on donor, recipient, operative, and intensive care unit parameters to determine the relationship of filling pressure (central venous and pulmonary capillary wedge pressures) to prolonged mechanical ventilation and outcome. The mean central venous pressure was used to divide patients into high and low central venous pressure groups, which were then compared to determine differences in outcome and complication rates.

RESULTS

A high central venous pressure was found to be associated with prolonged mechanical ventilation (odds ratio, 1.57; 95% confidence interval, 1.13-2.20; P = .008). After removing the effect of poor myocardial function by excluding patients with low cardiac index (< 2.2 L x min -1 x m(-2) ) and high inotrope requirement (> 10 microg/min), central venous pressure remained associated with prolonged mechanical ventilation (odds ratio, 2.31; 95% confidence interval, 1.31-4.07; P = .004). Duration of ventilation (P < .001), intensive care unit mortality (P = .02), hospital mortality (P = .09), and 2-month mortality (P = .02) were higher in patients with central venous pressures of greater than 7 mm Hg. There was no evidence of complications caused by hypovolemia in the low (< or = 7 mm Hg) central venous pressure group, who had lower inotrope requirements (P = .02) and lower creatinine levels (P = .013). Conclusions A high central venous pressure was associated with adverse outcomes after lung transplantation.

Outcomes, cost and long term survival of patients referred to a regional weaning centre

BACKGROUND

Regional weaning centres provide cost effective care for patients who have undergone prolonged mechanical ventilation. There are few published European data on outcomes in these patients.

METHODS

Patients admitted for weaning to the Lane Fox Respiratory Unit (LFU) between January 1997 and December 2000 were identified. The proportion weaned from mechanical ventilation, in-hospital mortality, and subsequent survival after discharge were examined.

RESULTS

A total of 153 patients had been ventilated for a median of 26 days before transfer. The daily cost per patient stay was 1350. Fifty eight patients (38%) were fully weaned, 42 (27%) died, and 53 (35%) required ventilatory support at discharge from hospital of whom 36 (24%) required only nocturnal ventilation. Univariate analysis showed increasing age (OR 1.06, p<0.001), length of ICU stay (OR 1.02, p = 0.001), APACHE II predicted risk of death score (OR 1.02, p = 0.05), and a surgical cause for admission (OR 4.04) were associated with mortality. Neuromuscular/chest wall conditions were associated with low mortality (OR 0.36) but low likelihood of weaning from ventilation (OR 0.28). Female sex (OR 2.13, p = 0.03) and COPD (OR 2.81) were associated with successful weaning. Overall survival at 3 years from admission was 47%. Long term survival was lowest in patients with COPD.

CONCLUSIONS

Most patients survived to leave hospital, the majority having been liberated from ventilatory support. Survivors were younger and spent less time ventilated in the referring ICU. The underlying diagnosis determined success of weaning, hospital survival, and long term outcome.

A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study

Effect of continuous passive motion (CPM) protocols on outcomes after total knee arthroplasty. In this prospective randomized controlled study, 147 patients were assigned to 1 of 3 treatment groups: CPM from 0 degrees to 40 degrees and increased by 10 degrees per day, CPM from 90 degrees to 50 degrees (early flexion) and gradually progressed into full extension over a 3-day period, and a no-CPM group. The CPM was administered twice a day for 3 hours over a 5-day period. All patients participated in the same postoperative physiotherapy program. Patients were assessed preoperatively, day 5, 3 months, and 1 year postoperatively. The early flexion group had significantly more range of flexion than both the standard and control groups at day 5. There was no significant difference between the groups for any other variable tested at any time frame. Key words: total knee arthroplasty, CPM, rehabilitation, outcomes.

Rapid prototyping to create vascular replicas from CT scan data: Making tools to teach, rehearse, and choose treatment strategies

Our goal was to develop and prove the accuracy of a system that would allow us to re-create live patient arterial pathology. Anatomically accurate replicas of blood vessels could allow physicians to teach and practice dangerous interventional techniques and might also be used to gather basic physiologic information. The preparation of replicas has, until now, depended on acquisition of fresh cadaver material. Using rapid prototyping, it should be able to replicate vascular pathology in a live patient. We obtained CT angiographic scan data from two patients with known arterial abnormalities. We took such data and, using proprietary software, created a 3D replica using a commercially available rapid prototyping machine. From the prototypes, using a lost wax technique, we created vessel replicas, placed those replicas in the CT scanner, then compared those images with the original scans. Comparison of the images made directly from the patient and from the replica showed that with each step, the relationships were maintained, remaining within 3% of the original, but some smoothing occurred in the final computer manipulation. From routinely obtainable CT angiographic data, it is possible to create accurate replicas of human vascular pathology with the aid of commercially available stereolithography equipment. Visual analysis of the images appeared to be as important as the measurements. With 64 and 128 slice detector scanners becoming available, acquisition times fall enough that we should be able to model rapidly moving structures such as the aortic root.

Melanopsin expression in the chick retina and pineal gland

The chick retina and pineal gland exhibit circadian oscillations in biochemical and physiological processes in vivo and in vitro and entrain to 24 h LD cycles. However, the phototransductive mechanisms responsible for entrainment are largely unknown. Experiments utilizing mice lacking functional rods and cones reveal normal circadian responses to light. These studies also implicate a subset of photoresponsive cells in the ganglion cell layer (GCL) which express melanopsin (opn4). The current study investigates opn4 mRNA distribution and regulation in the chick. Opn4 mRNA is widespread in the central nervous system and peripheral tissues, with highest levels of transcript abundance in the pineal gland and retina. Opn4 mRNA is also regulated on a circadian basis in the pineal gland, reaching peak values of accumulation in the late subjective night. In the retina, opn4 is not robustly regulated at the transcriptional level, exhibiting a slight increase in mRNA abundance during subjective night. In situ hybridization (ISH) revealed opn4 mRNA in areas associated with phototransduction and the visual system, including the pineal gland and optic tectum of the brain, along with GCL, inner nuclear layer (INL), and photoreceptor layer (PL) of the retina. Opn4 is also present in cerebellum. Our results present an opsin-like gene located in two circadian oscillators associated with circadian phototransduction and melatonin biosynthesis that may play a role in entrainment of these tissues' clocks.

Transcriptional Profiling of Circadian Patterns of mRNA Expression in the Chick Retina

Previous transcriptome analyses have identified candidate molecular components of the avian pineal clock, and herein we employ high density cDNA microarrays of pineal gland transcripts to determine oscillating transcripts in the chick retina under daily and constant darkness conditions. Subsequent comparative transcriptome analysis of the pineal and retinal oscillators distinguished several transcriptional similarities between the two as well as significant differences. Rhythmic retinal transcripts were classified according to functional categories including phototransductive elements, transcription/translation factors, carrier proteins, cell signaling molecules, and stress response genes. Candidate retinal clock transcripts were also organized relative to time of day mRNA abundance, revealing groups accumulating peak mRNA levels across the circadian day but primarily reaching peak values at subjective dawn or subjective dusk. Comparison of the chick retina transcriptome to the pineal transcriptome under constant conditions yields an interesting group of conserved genes. This group includes putative clock elements cry1 and per3 in addition to several previously unidentified and uninvestigated genes exhibiting profiles of mRNA abundance that varied markedly under daily and constant conditions. In contrast, many transcripts were differentially regulated, including those believed to be involved in both melatonin biosynthesis and circadian clock mechanisms. Our results indicate an intimate transcriptional relationship between the avian pineal and retina in addition to providing previously uncharacterized molecular elements that we hypothesize to be involved in circadian rhythm generation.

Development and validation of the medication regimen complexity index

BACKGROUND

Medication regimen attributes, such as the number of drugs, dosage frequency, administration instructions, and the prescribed dosage forms, have been shown to influence patient outcomes. No single tool for quantifying the complexity of general medication regimens has been published in the medical literature.

OBJECTIVE

To develop and validate a tool to quantify the complexity of prescribed medication regimens.

METHODS

Literature findings and the expertise of the authors were used for developing the tool. Eight pharmacy researchers helped in establishing the tool's face and content validity. The new tool was tested on 134 medication regimens from patients with moderate to severe chronic obstructive pulmonary disease. Six regimens with a spread of scores on the tool were presented to a 5-member expert panel that subjectively ranked these regimens to confirm the tool's criterion-related validity. The relationships between scores on the tool and various independent variables were tested to judge the tool's construct validity. Two raters scored 25 regimens using the tool to test its inter-rater and test-retest reliabilities.

RESULTS

A 65-item Medication Regimen Complexity Index (MRCI) was developed. The expert panel had strong agreement (Kendall's W = 0.8; p = 0.001) on their individual rankings of the 6 regimens. The panel's consensus ranking had perfect correlation with the MRCI ranking. The total MRCI score had significant correlation with the number of drugs in the regimen (Spearman's Rho = 0.9; p < 0.0001), but not with the age and gender of the patients. Inter-rater and test-retest reliabilities for the total score and scores for individual sections on the MRCI were > or = 0.9.

CONCLUSIONS

The MRCI is a reliable and valid tool for quantifying drug regimen complexity with potential applications in both practice and research.

How well do doctors know their patients with severe asthma?

BACKGROUND

Rates of asthma mortality have fallen in Australia since the commencement of the National Asthma Campaign and promotion of the Australian asthma management plan. New strategies are now needed to further reduce mortality.

AIM

To examine agreement about key features between asthma patients and their general practitioners (GPs).

METHODS

We interviewed: (i) the next of kin of 56 asthma deaths, (ii) 91 asthma patients presenting to emergency departments with acute severe asthma and (iii) 147 of their GPs.

RESULTS

Agreement was substantial for usage of oral symptomatic medication, but poor for inhaled symptomatic and preventive medications. There was moderate agreement regarding hospital admissions within the last 12 months among the cases, but little about other markers of severity. There was moderate agreement where the presenting or fatal attack was triggered by an upper respiratory-tract infection or aspirin. The next of kin and GPs agreed about family problems, but not about other psychosocial issues. They also agreed about which cases had been given action plans or verbal instructions, but few other aspects of asthma management. There was also moderate agreement regarding the use of peak flow meters by the controls.

CONCLUSIONS

Doctors often have relatively poor insights into self-management practices, social background or trigger factors, even in high-risk patients. This should be considered when planning future campaigns to improve asthma management and further reduce mortality.

Opsin photoisomerases in the chick retina and pineal gland: characterization, localization, and circadian regulation

PURPOSE

The chick retina and pineal gland exhibit circadian oscillations in biochemical and physiological processes in vivo and in vitro, which entrain to 24-hour light-dark cycles. However, the phototransduction mechanisms responsible for entrainment are largely unknown. The present study characterizes two candidate opsinlike genes that may play a role in entrainment of the clocks in these tissues.

METHODS

Bioinformatics, cladistic techniques, and in situ hybridization and Northern blot analyses were conducted to characterize, localize, and determine the circadian expression of the candidate opsinlike genes in the retina and pineal gland.

RESULTS

Two candidate photosensors and/or photoisomerases were predominantly distributed within the pineal gland and retina: the retinal pigmented epithelium-derived rhodopsin homologue (peropsin, gRrh) and retinal G-protein-coupled receptor opsin (RGR opsin, gRgr). Northern blot and in situ analyses revealed mRNA expression for both opsins in the pineal gland, retina, and brain tissue. The mRNA for both genes within the pineal gland and retina is regulated on a circadian basis such that they are highest in late subjective day. Digoxigenin in situ analyses showed retinal gRgr message within the inner nuclear layer (INL) and retinal ganglion cell layer (RGL), whereas gRrh message was distributed predominantly in the RGL. In the pineal gland, gRgr message was sparsely distributed among pinealocytes in follicles, but not within the follicles themselves, whereas gRrh was localized in interstitial areas indicative of astrocytic and/or endothelial origin.

CONCLUSIONS

The presence of two putative photoisomerases within the pineal gland and in retinal layers associated with biological clock function provides two candidate opsinlike genes that may serve in the visual cycle regulation of the circadian clock.

Population dynamics and gene transfer in genetically modified bacteria in a model microcosm

The horizontal transfer and effects on host fitness of a neutral gene cassette inserted into three different genomic loci of a plant-colonizing pseudomonad was assessed in a model ecosystem. The KX reporter cassette (kanamycin resistance, aph, and catechol 2, 3, dioxygenase, xylE) was introduced on the disarmed transposon mini-Tn5 into: (I) the chromosome of a spontaneous rifampicin resistant mutant Pseudomonas fluorescens SBW25R; (II) the chromosome of SBW25R in the presence of a naturally occurring lysogenic-phage (phage Phi101); and (III) a naturally occurring plasmid pQBR11 (330 kbp, tra+, Hgr) introduced into SBW25R. These bacteria were applied to Stellaria media (chickweed) plants as seed dressings [c. 5 x 104 colony-forming units (cfu)/seed] and the seedlings planted in 16 microcosm chambers containing model plant and animal communities. Gene transfer to pseudomonads in the phyllosphere and rhizosphere was found only in the plasmid treatment (III). Bacteria in the phage treatment (II) initially declined in density and free phage was detected, but populations partly recovered as the plants matured. Surprisingly, bacteria in the chromosome insertion treatment (I) consistently achieved higher population densities than the unmanipulated control and other treatments. Plasmids were acquired from indigenous bacterial populations in the control and chromosome insertion treatments. Plasmid acquisition, plasmid transfer from inocula and selection for plasmid carrying inocula coincided with plant maturation.

Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI).

DESIGN

Retrospective, 3-year, case series.

SETTING

Tertiary medical unit specializing in SCI rehabilitation.

PARTICIPANTS

Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included.

INTERVENTION

Chart review.

MAIN OUTCOME MEASURES

Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI.

RESULTS

Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days.

CONCLUSIONS

Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.

Lung Volume Reduction Surgery in Australia and New Zealand

BACKGROUND

Lung volume reduction surgery (LVRS) has been shown to improve lung function, exercise performance, and quality of life in highly selected individuals with severe emphysema; however, major questions regarding the efficacy and long-term outcomes of LVRS still remain unanswered. Pending the results of large randomized controlled trials (RCTs), the Australian and New Zealand LVRS Database was created to audit local clinical practice and patient outcomes.

AIMS

To review patient selection, surgical activity, and patient outcomes related to LVRS in Australia and New Zealand.

METHODS

Prospective data were voluntarily submitted by hospitals performing LVRS in Australia and New Zealand. Preoperative, surgical, perioperative, and follow-up variables were analyzed.

RESULTS

Data were collected from 15 hospitals regarding 529 patients. Mean age (+/- SD) at surgery was 63 +/- 7 years. Preoperatively, FEV(1) was 29 +/- 9% predicted, total lung capacity (TLC) was 138 +/- 20% predicted, residual volume (RV) was 250 +/- 64% predicted, and 6-min walk (6MW) distance was 327 +/- 111 m. There has been a reduction in the overall number of cases and hospitals performing LVRS since 1999. Improvements in lung function following LVRS (ie, FEV(1) increase of 38%, RV decrease of 27%, TLC decrease of 17%) and exercise capacity (ie, 6MW distance increase of 24%) appear to be maintained for approximately 3 years.

CONCLUSIONS

LVRS continues to be performed in Australia and New Zealand, predominantly in large tertiary teaching hospitals with similar outcomes to those described in the literature. It remains difficult to capture long-term lung function and survival outcomes in this population. Ongoing audit and RCTs are both required to resolve the confusion that still shrouds this procedure.

Transcriptional profiling of the chick pineal gland, a photoreceptive circadian oscillator and pacemaker

The avian pineal gland contains both circadian oscillators and photoreceptors to produce rhythms in biosynthesis of the hormone melatonin in vivo and in vitro. The molecular mechanisms for melatonin biosynthesis are largely understood, but the mechanisms driving the rhythm itself or the photoreceptive processes that entrain the rhythm are unknown. We have produced cDNA microarrays of pineal gland transcripts under light-dark and constant darkness conditions. Rhythmic transcripts were classified according to function, representing diverse functional groups, including phototransduction pathways, transcription/translation factors, ion channel proteins, cell signaling molecules, and immune function genes. These were also organized relative to time of day mRNA abundance in light-dark and constant darkness. The transcriptional profile of the chick pineal gland reveals a more complex form of gene regulation than one might expect from a gland whose sole apparent function is the rhythmic biosynthesis of melatonin. The mRNAs encoding melatonin biosynthesis are rhythmic as are many orthologs of mammalian "clock genes." However, the oscillation of phototransductive, immune, stress response, hormone binding, and other important processes in the transcriptome of the pineal gland, raises new questions regarding the role of the pineal gland in circadian rhythm generation, organization, and avian physiology.

Efficient cellulase production by Trichoderma reesei in continuous cultivation on lactose medium with a computer-controlled feeding strategy

A low-foaming hydrophobin II deletant of the Trichoderma reesei strain Rut-C30 was used for production of cellulases by continuous cultivation on lactose medium in a laboratory fermenter. The control paradigm of the addition of new medium to the continuous process was based on the growth dynamics of the fungus. A decrease in the rate of base addition to the cultivation for pH-minimum control was used as an indicator of imminent exhaustion of carbon source for growth and enzyme induction. When the amount of base added per 5 min computation cycle decreased below a given value, new medium was added to the fermenter. When base addition for pH control thereafter increased above the criterion value, due to increased growth, the medium feed was discontinued or decreased. The medium feeding protocol employed was successful in locking the fungus in the stage of imminent, but not actual, exhaustion of carbon source. According to the results of a batch cultivation of the same strain on the same medium, this is the phase of maximal enzyme productivity. The medium addition protocol used in this work resulted in a very stable continuous process, in which cellulase productivity was maintained for several hundred hours at the maximum level observed in a batch cultivation for only about 10 h. Despite a major technical disturbance after about 420 h, the process was restored to stability. When the cultivation was terminated after 650 h, the level of enzyme production was still maximal, with no signs of instability of the process.

Structure and evolution of the luciferin-regenerating enzyme (LRE) gene from the firefly Photinus pyralis

To study the structural features of genes for the luciferin-regenerating enzyme (LRE), the entire gene along with 524 bp of upstream sequence was determined from Photinus pyralis (Coleoptera: Lampyridae). The LRE gene revealed an open reading frame composed of five exons divided by four introns ranging in size from 47 to 904 bp. The deduced LRE amino acid sequence showed identity to senescence marker protein-30 (SMP30) from a number of insects and mammals including four putative SMP30 sequences from Anopheles gambiae. Gene structure comparisons showed some intron/exon site conservation with A. gambiae and mammalian SMP30 proteins but not Drosophila. LRE and luciferase sequence comparisons revealed two conserved putative luciferin-binding sites. The evolution of LRE was discussed in relation to its function.

The rate of gastroenteritis in a large city before and after chlorination

There is conflicting evidence about the contribution of drinking water to endemic community gastroenteritis in water supplies which meet conventional microbiological standards with some studies reporting associations between drinking water and endemic disease and others finding no evidence that water is implicated in disease. This study reports the results of an ecological study investigating the effect on community gastroenteritis of chlorinating a city of over 3 million people in the mid 1970s. Prior to chlorination faecal coliforms were regularly identified in the water. Admissions for gastroenteritis and attendances to the Emergency Department of the Royal Children's Hospital, Melbourne's major children's hospital, were measured between 1974 and 1980 inclusive and the influence of chlorination on rates of gastroenteritis was examined. No statistically significant difference was found in the number of admissions or emergency department visits before and after chlorination of the water supply. The study highlights the need for caution when interpreting the relationships between drinking water and gastroenteritis. The result suggests that water was not a dominant contributor to the burden of gastrointestinal disease in the community despite faecal coliforms being present in the water supply. It indicates the need for caution when attributing significant illness to drinking water when there have been only small changes in water quality without first stringently reviewing the studies methodology and understanding their limitations.

A valid food frequency questionnaire for measuring dietary fish intake

There is considerable interest in the potentially protective effects of high fish consumption on many chronic diseases. Many epidemiological studies use food frequency questionnaires (FFQ) to quantify usual dietary fish intake, so it is important to validate this assessment against objective markers. The objective of this study was to determine the relationship between plasma percentage fatty acids and dietary fish intake as assessed by a FFQ. A semiquantitative FFQ was completed by 174 adults from the community (aged 26-49 years) who also had venous blood analysed for plasma percentage fatty acids. Following linear regression modelling, total non-fried fish intake was a significant predictor of n-3 (regression coefficient, B = 0.94; 95% CI = 0.60-1.28), docosahexaenoic acid (DHA; B = 0.73; 95% CI = 0.47-0.99) and the ratio of n-6: n-3 fatty acids (B = -1.0; 95% CI = - 1.35- -0.65). Steamed, grilled or baked fish was a small but significant predictor of eicosapentaenoic acid (EPA) levels (B = 0.13; 95% CI = 0.05-0.21) while total fish intake was a predictor of n-6 fatty acids (B = -0.88; 95% CI = -1.41- -0.36). This semiquantitative FFQ could be useful for ranking subjects according to their likely plasma n-3, DHA, and n-6 fatty acid intake and the ratio of n-6: n-3 fatty acids, when the available resources may simply not permit biological markers to be used.

beta-Actin and GAPDH housekeeping gene expression in asthmatic airways is variable and not suitable for normalising mRNA levels

BACKGROUND

The use of reverse transcription-polymerase chain reaction (RT-PCR) to measure mRNA levels has led to the common use of beta-actin and GAPDH housekeeping genes as denominators for comparison of samples. Expression of these genes is assumed to remain constant, so normalising for variations in processing and signal quantitation. However, it is well documented that beta-actin and GAPDH expression is upregulated with proliferation, activation, and differentiation. We hypothesised that airway samples which differ in their cellular profiles and activation status have different levels of expression of GAPDH and beta-actin.

METHODS

The mRNA for beta-actin, GAPDH, and interleukin (IL)-2 was measured in bronchoalveolar lavage (BAL) fluid cells and endobronchial biopsy tissue by competitive RT-PCR in a cross sectional study of 26 normal controls and 92 asthmatic subjects.

RESULTS

For both BAL fluid cells and biopsy tissue, asthmatics overall had reduced expression of GAPDH and beta-actin mRNA. In asthmatic subjects not using inhaled corticosteroids (ICS), GAPDH mRNA levels in both BAL fluid and biopsy tissue, and beta-actin mRNA in BAL fluid cells were 10 times lower than samples from both normal controls and from asthmatic subjects using ICS. beta-Actin mRNA in biopsy specimens showed the same pattern of expression, but asthmatic subjects not using ICS were not significantly different from those receiving ICS treatment. IL-2 mRNA levels did not differ between the subject or treatment groups but, when expressed as a ratio with beta-actin, significant differences were seen.

CONCLUSIONS

beta-Actin and GAPDH used as denominators of gene expression quantitation in asthma research can cause confounding. Housekeeping genes need careful validation before their use in such quantitative mRNA assays.

Nontraumatic spinal cord injury: demographic characteristics and complications

OBJECTIVES

To investigate the demographic characteristics and complications of nontraumatic spinal cord injury (NT/SCI), to compare patients who were admitted for initial rehabilitation with readmission rehabilitation patients, to compare our findings with those of other studies, and to develop a model to predict the length of stay (LOS).

DESIGN

Retrospective, 3-year, case series.

SETTING

Tertiary medical unit specializing in SCI rehabilitation in Australia.

PARTICIPANTS

Consecutive sample of 134 adult referred inpatients with NT/SCI (58% women; median age, 61y). Patients requiring initial rehabilitation or readmission were included.

INTERVENTION

Chart review.

MAIN OUTCOMES MEASURES

Demographic characteristics, neurologic injury, etiology, comorbidities, and complications of NT/SCI.

RESULTS

The most common cause of NT/SCI was tumor (20.1%), but there were many different etiologies. Tetraplegia occurred in 32.8% of patients, and 56% had motor incomplete injuries. Most patients (63%) had at least 1 complication, including urinary tract infection (32.8%), pressure ulcer (31.5%), and pain (18.7%). Initial rehabilitation patients were significantly older (initial median, 69y vs readmission median, 54y; P=.0001). A multivariate model for LOS was able to predict 52% of the variance.

CONCLUSIONS

NT/SCI rehabilitation patients have a different demographic profile compared with traumatic SCI (T/SCI) patients and a lower prevalence of many of the complications that affect T/SCI patients. There are differences between initial and readmission patients.

Process technological effects of deletion and amplification of hydrophobins I and II in transformants of Trichoderma reesei

Transformants of the Trichoderma reeseistrains QM9414 and Rut-C30 were constructed in which the genes for the two major hydrophobin proteins, hydrophobins I (HFBI) and II (HFBII), were deleted or amplified by molecular biological techniques. Growth parameters and foam production of the transformant strains were compared with the corresponding properties of the parent strains by cultivation in laboratory bioreactors under conditions of catabolite repression (glucose medium) or induction of cellulolytic enzymes and other secondary metabolites (cellulose and lactose media). All the transformed strains exhibited vegetative growth properties similar to those of their parent. The Delta hfb2 (but not the Delta hfb1) transformant showed reduced tendency to foam, whereas both strains overproducing hydrophobins foamed extensively, particularly in the case of HFBII. Enzyme production on cellulose medium was unaltered in the Delta hfb2 transformant VTT D-99676, but both the Delta hfb2 and HFBII-overproducing transformants exhibited somewhat decreased enzyme production properties on lactose medium. Production of HFBI by the multi-copy transformant VTT D-98692 was almost 3-fold that of the parent strain QM9414. Overproduction of HFBII by the transformant VTT D-99745, obtained by transformation with three additional copies of the hfb2 gene under the cbh1 promoter, was over 5-fold compared to production by the parent strain Rut-C30. The Delta hfb2transformant VTT D-99676 produced a greatly increased number of spores on lactose medium compared with the parent strain, whereas the HFBII-overproducing transformant VTT D-99745 produced fewer spores.

Substrate-regulated cyanide hydratase (chy) gene expression in Fusarium solani: the potential of a transcription-based assay for monitoring the biotransformation of cyanide complexes

The fungus Fusarium solani detoxifies cyanide through induction of the cyanide hydratase gene activity (chy) in the presence of either KCN or the metal-complexed cyanides, K2Ni(CN)4 or K4Fe(CN)6, at pH 7.0 and 4.0 respectively. Sequence analysis of the chy gene identified primers for reverse transcriptase-polymerase chain reaction (RT-PCR)-directed analysis of mRNA transcripts, which demonstrated that activity correlated to the substrate-specific induction of gene expression. chy transcription was initiated 30-60 min after exposure of F. solani cultures to cyanide complexes. Maximum expression was detected within 4.5 h, after which chy mRNA synthesis declined below the limits of detection within 26 h. A lag period of approximately 2 h, following initial transcription, was recorded before cyanide complexes were converted to formamide. mRNA transcripts of chy were not detected in the absence of cyanide or cyanide complexes. The presence of introns within the gene resulted in a difference in size of 100 bp for DNA compared with mRNA of the corresponding 5' region. This size difference facilitated PCR detection of gene and transcript respectively. Comparisons of the predicted amino acid sequence of the F. solani chy gene and those of Gloeocerospora sorghi, Fusarium lateritium and Leptosphaeria maculans demonstrate that cyanide hydratase genes are highly conserved and of a similar evolutionary origin. These data predict that the functional assay described here to monitor the induction of chy gene expression and, potentially, cyanide degradation would be applicable to a variety of polluted environments.