Optimal tissue types in the thoracic electrical impedance model for thoracic electrical bioimpedance (TEB) studies

In this study we have identified the tissues required to be included in the thoracic electrical impedance model for studies relating to impedance cardiography. This is a useful finding, as it expedites and simplifies the segmentation process when employed to construct digital human models from a set of magnetic resonance or computed tomography images. Laplace equations with inhomogeneous boundary conditions were solved within an anatomically accurate thorax model. When the number of tissue types in the model was reduced to only 7 (i.e. blood, fat, liver, lung, muscle, skin and bone) the calculations indicated a 3.6% error in the result. Addition of internal air reduced the error to as small as 1.3%. Further reductions in the number of tissue types introduced larger errors in the measurement. It was therefore concluded that 8 tissue types are essential to acceptably preserve the computational accuracy while facilitating a simplification of the segmentation process.

The use of herbal medicines by people with cancer in the UK: a systematic review of the literature

BACKGROUND AND AIM

Little is known about the use of herbal medicines by people living with cancer in the UK. This systematic review aimed to estimate the prevalence of herbal medicine use by this group, the characteristics of users, factors motivating use, and attitudes towards herbal remedies.

DESIGN AND METHODS

Fifteen electronic databases were searched. People who were research-active in the field were contacted and asked about further published or unpublished work. All studies identified as relevant to the purpose of the review were assessed. Searches were not restricted by publication type or date.

RESULTS

Of 1288 unique references identified, 11 met the eligibility criteria. Studies were excluded where research had been conducted outside the UK; where information on herbal medicine use was not differentiated from that relating to complementary and alternative therapies more broadly, and where neither prevalence of use nor information on user characteristics was included. Prevalence estimates ranged from 3.1 to 24.9%. Most studies did not obtain information specifically on herbal medicines and only one examined the characteristics and motivations of users of herbal medicines as distinct from complementary and alternative therapies in general.

CONCLUSION

The high degree of heterogeneity of methodology, sample selection and characteristics, and research design resulted in a wide range of estimates of prevalence. Well-designed research is needed to define the evidence base about the herbal medicines taken by people with cancer in the UK, the reasons for use, knowledge about possible effects and potential risks, and where people seek information.

Computational modelling of blood-flow-induced changes in blood electrical conductivity and its contribution to the impedance cardiogram

Studies have shown that blood-flow-induced change in electrical conductivity is of equal importance in assessment of the impedance cardiogram (ICG) as are volumetric changes attributed to the motion of heart, lungs and blood vessels. To better understand the sole effect of time-varying blood conductivity on the spatiotemporal distribution of trans-thoracic electric fields (i.e. ICG), this paper presents a segmented high-resolution (1 mm(3)) thoracic cardiovascular system, in which the time-varying pressures, flows and electrical conductivities of blood in different vessels are evaluated using a set of coupled nonlinear differential equations, red blood cell orientation and cardiac cycle functions. Electric field and voltage simulations are performed using two and four electrode configurations delivering a small alternating electric current to an anatomically realistic and electrically accurate model of modelled human torso. The simulations provide a three-dimensional electric field distribution and show that the time-varying blood conductivity alters the voltage potential difference between the electrodes by a maximum of 0.28% for a cardiac output of about 5 L min(-1). As part of a larger study, it is hoped that this initial model will be useful in providing improved insights into blood-flow-related spatiotemporal electric field variations and assist in the optimal placement of electrodes in impedance cardiography experiments.

Quantifying genetic (co)variation and effects of genetic selection on tibial bone morphology and quality in 37 lines of broiler, layer and traditional chickens

1. Tibial bone morphology and quality was assessed at 6, 8 and 10 weeks of age in 12 broiler, 12 layer and 13 traditional lines of chickens. 2. High intraclass correlations (0.65-0.96) were estimated for tibial weight, length, width, strength, stiffness, stress radiodensity, plateau angle but not for cortical width and tibial torsion at 6 and 10 weeks of age and for weight, length, width, strength radiodensity and plateau angle at 8 weeks of age. Lower intraclass correlations (0.4-0.8) were estimated within category (broiler, layer and traditional) for weight, length, width at 6, 8 and 10 weeks, and for stiffness, stress and radiodensity at 6 and 10 weeks, and were lower (<0.33) at 8 weeks of age. Intraclass correlations for tibial torsion angles were low (< or =0.4) at all ages. 3. Tibia from layers and traditional lines were similar suggesting that intensive genetic selection for high rates of egg laying has not changed bone size, shape or quality. Tibia from broilers, as expected, were heavier and larger and the differences were greatest at 6 weeks of age suggesting that the broilers were earlier maturing than layers and traditional lines. Broiler tibiae were more radiodense, stronger and stiffer and had lower stress values than bones from layers and traditional lines. Plateau angles were higher in broilers and torsion angles had higher external rotation compared with layers and traditional lines.

General practitioners' attitudes to assessment of genetic risk of common disorders in routine primary care

In 2003, the UK Department of Health set out the genetics white paper, a plan for action and investment with particular emphasis on integration of genetic health care into primary care. Since the delivery of the genetics white paper, there has been little exploration of UK primary care doctors' attitudes towards extending their role to include provision of routine genetics services. We explored explore general practitioners' (GPs) attitudes towards provision of genetic health care including routine family history screening and familial risk assessment for common disorders in primary care using a quantitative, evaluative postal survey. Only 25% (797 of 3160) of the GPs returned a completed questionnaire. Although 32% of GPs supported collection of family history information and 41.5% familial risk assessment, 18% were not willing to offer these services even if training is provided. Of the GPs, 50% stated they recognized when referral to genetics services is appropriate, although 43% felt unprepared to collect family history or assess familial risk. Lack of training within the last 3 years was a significant predictor of feeling unprepared to undertake these activities (OR = 2.53,p = 0.012). A substantial group of GPs remain unprepared or unwilling to provide genetic health care. GPs' attitudes to delivery of genetic health care are significantly influenced by factors such as a lack of evidence of the direct benefits to patients, local guidelines and specialist services. These factors need addressing if delivery of genetic health care is to be incorporated into routine primary care.

Reducing the economic impact of carpal tunnel surgery

A nurse-led carpal tunnel service was started in Leicester in 1999. Many developments in the service have been patient-driven. A large proportion of our patients are not salaried and many had expressed concerns about the amount of time taken off work after surgery. This therefore prompted us to encourage immediate hand function after surgery. Subsequently, in 494 patients studied prospectively, we have seen 93% of patients return to work by 2 weeks and 99% by 4 weeks. This has obvious benefits in terms of reducing loss of income. Furthermore there is potential for considerable economic savings.

Bone sarcomas arising in patients with neurofibromatosis type 1

We identified eight patients of 2900 with a primary malignant bone tumour who had coexisting neurofibromatosis type 1. This was a much higher incidence than would be expected by chance. The patients had a mean age of 22.4 years (9 to 54): five were male. Two patients subsequently developed a second bone sarcoma, one of which was radiation induced. Four of the primary tumours were osteosarcomas, four were spindle-cell sarcomas and one a Ewing's sarcoma. All the patients were treated with chemotherapy and surgery: six of the eight appear to be cured. This study suggests a possible relationship between neurofibromatosis type 1 and the development of a bone sarcoma, the increased risk being estimated at eight times that of the normal population. We recommend that further research into this possible link should be considered.

Factors affecting attitudes toward colorectal cancer screening in the primary care population

Background:

Colorectal cancer (CRC) is a major cause of death in the United Kingdom. Regular screening could significantly reduce CRC-related morbidity and mortality. However, screening programmes in the United Kingdom have to date seen uptake rates of less than 60%. Attitudes towards screening are the primary factors determining patient uptake.

Methods:

A questionnaire was sent to people aged 50–69 years who were registered with general practices in the West Midlands. A total of 11 355 people (53%) completed the questionnaire. Multivariable logistic regression analyses were performed to identify those factors (gender, age, ethnicity, deprivation, number of symptoms, and their duration) that most strongly contributed to negative/positive attitudes in the primary care population.

Results:

Fourteen percent of respondents had a negative attitude towards screening. Men, older people, and those with Indian ethnic backgrounds were more likely to have negative attitudes toward screening, whereas people with Black-Caribbean ethnic background, people with multiple symptoms and those reporting abdominal pain, bleeding, and tiredness were more likely to have a positive attitude.

Conclusion:

Culturally relevant screening strategies should aim to increase knowledge of the symptoms and signs related to bowel cancer among South Asian ethnic groups in the United Kingdom. It is also important to find ways to increase the acceptability of screening among asymptomatic patients.

Hepatosplenomegaly associated with chronic malaria exposure: evidence for a pro-inflammatory mechanism exacerbated by schistosomiasis

In sub-Saharan Africa, chronic hepatosplenomegaly, with palpable firm/hard organ consistency, is common, particularly among school-aged children. This morbidity can be caused by long-term exposure to malaria, or by Schistosoma mansoni, and it is exacerbated when these two occur together. Although immunological mechanisms probably underlie the pathogenic process, these mechanisms have not been identified, nor is it known whether the two parasites augment the same mechanisms or induce unrelated processes that nonetheless have additive or synergistic effects. Kenyan primary schoolchildren, living in a malaria/schistosomiasis co-transmission area, participated in cross-sectional parasitological and clinical studies in which circulating immune modulator levels were also measured. Plasma IL-12p70, sTNF-RII, IL-10 and IL-13 levels correlated with relative exposure to malaria, and with hepatosplenomegaly. Soluble-TNF-RII and IL-10 were higher in children infected withS. mansoniHepatosplenomegaly caused by chronic exposure to malaria was clearly associated with increased circulating levels of pro-inflammatory mediators, with higher levels of regulatory modulators, and with tissue repair cytokines, perhaps being required to control the inflammatory response. The higher levels of regulatory modulators amongstS. mansoniinfected children, compared to those without detectableS. mansoni and malarial infections, but exposed to malaria, suggest thatS. mansoniinfection may augment the underlying inflammatory reaction.

The effect of a bisphosphonate on bone volume and eggshell structure in the hen

Bisphosphonates, used in the prevention and treatment of osteoporosis, in man, can prevent bone loss in experimental models of osteoporosis in mammals. In egg-laying hens there is a high incidence of bone fractures which are due to osteoporosis. Alendronate, a bisphosphonate, was given to three groups of hens in mid-lay. Different doses of alendronate were given to each group and group 4 was a control. The birds were killed after 2 weeks of treatment. The hens receiving the highest dosage of alendronate (1 mg/kg every 2nd day) ceased laying and had reduced serum calcium concentrations. Lower dosages of alendronate (0.1 and 0.01 mg/kg every 2nd day) resulted in normal egg production and serum calcium concentrations. Egg shells with ultra-structural features indicative of reduced shell quality were produced by hens on the two higher dosages, but the egg shells from the controls and from the hens on the lowest dosage were considered normal. When alendronate was administered to hens in mid-lay there was no effect on trabecular bone volumes, but there was a reduction in mean medullary bone volume in some groups. In a second experiment, pullets were treated with alendronate (0.01 mg/kg twice a week) before the onset of lay. The pullets were killed after laying their first egg. In the pullets treated with alendronate, this protocol resulted in a significantly greater volume of trabecular (structural) bone at the onset of lay.

Completed Audit Cycle on Lithium Monitoring on Older Adults in Northumbria Healthcare NHS Trust, UK

Aims:

The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.

Methods:

During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.

Results:

22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.

Conclusions:

The re-audit encouragingly showed significant improvement in practise.

179 INTERNAL CONTROL GENES FOR QUANTITATIVE PCR OF PORCINE MESENCHYMAL STEM CELLS DURING ADIPOGENIC AND OSTEOGENIC DIFFERENTIATION IN VITRO

Uncovering transcriptomic adaptation of porcine adult stem cells during differentiation in vitro towards a target tissue can provide important information for human adult stem cell therapeutic applications. High-throughput microarrays allow the parallel analysis of thousands of genes simultaneously. However, quantitative RT-PCR (qPCR) remains the chosen method for high-precision mRNA abundance analysis and microarray data verification. Essential for qPCR reliability is data normalization using appropriate internal control genes (ICG). The objective of this study was to find reliable ICG for normalization of qPCR data for porcine adult mesenchymal stem cells induced to differentiate toward adipogenic and osteogenic lineages. Mesenchymal stem cells were harvested from porcine adipose tissue and bone marrow and cultured in vitro with specific differentiation media for up to 3 weeks. The experiment was analyzed by a porcine 13 000-oligo microarray, and data were mined to uncover highly stable genes. Statistical analysis was performed using PROC MIXED of SAS (SAS Institute Inc., Cary, NC, USA). The model included fixed effect of time, cell type, differentiation, and all interaction between them. Pig (n = 3) was considered a random variable. Initial microarray analysis revealed 27 genes with high stability across all samples (sample/reference = 1 ± 0.2). Gene network analysis identified 20 genes without known co-regulation (i.e. common up-stream regulators). Among those genes, we could design high-quality primers (i.e. absence of primer-dimer, single amplicon) only for 10 of them (BANF1, DAK, DPH3, GTF2H3, PRR3, NSUN5, NUBP, SSU72, TIMM17B, and VPS4A), and qPCR using a standard curve was run. Stability of those genes was assessed using pairwise comparison of expression ratios. All genes examined were highly stable with TIMM17B, NSUN5, and VPS4A as the most stable. All the potential ICG tested had significant time, tissue × differentiation, and tissue × time effects. For the 3 most stable genes, we did not observe additional effects, while other ICG were significantly affected by differentiation. The analysis also indicated calculation of the normalization factor using the 3 most stable genes (NF3) as highly reliable; however, the use of 7 genes (NF7) would provide the best reliability. To assess the effect of normalization, we ran qPCR for DBI and COL1A1, genes specific of adipogenic and osteogenic differentiation, respectively. The effect on qPCR data normalization was highly apparent for the adipogenic differentiation and less apparent for the osteogenic differentiation. No differences were observed when qPCR data were normalized by NF3 or NF7. The combination of microarray data and pairwise analysis uncovered novel and high reliable ICG for qPCR normalization in adult porcine stem cells induced into adipogenic and osteogenic lineages. This work was supported by the Illinois Regenerative Medicine Institute.

282 ADIPOGENIC DIFFERENTIATION IN VITRO OF PORCINE ADULT MESENCHYMAL STEM CELLS

The quantity and accessibility of subcutaneous adipose tissue in humans make it an attractive alternative to bone marrow as a source of adult stem cells for therapeutic purposes. However, before such a cell source substitution can be proposed, the properties of stem cells derived from adipose tissue (ADSC) and bone marrow (BMSC), and their differentiated progeny must be compared in an animal model, such as swine, that adequately simulates the structure and physiology of humans. The objective of this work was to induce adult porcine stem cells isolated from subcutaneous adipose tissue and bone marrow to differentiate in vitro along the adipogenic lineage and to compare their transcript profile properties. ADSC and BMSC were isolated from subcutaneous adipose tissue and femurs of adult pigs, respectively, and differentiated along the adipogenic lineage using specific inducing medium. Cells were incubated up to 4 weeks with medium replaced every 3 days. Histological staining with Oil Red O was performed at 0, 2, 4, 7, 14, 21, 28 days of differentiation (dd) to confirm the adipogenic differentiation. RNA was also extracted at these time points. qPCR was performed on PPARG, DBI, ACSL1, CD36, CEBPA, DGAT2, ADFP, ADIPOQ, SCD. The geometrical mean of GTF2H3, NUBP, and PPP2CB was used as an internal control. Gene expression was analyzed using a mixed model of SAS with repeated time. The adipogenic differentiation of both ADSC and BMSC was confirmed by the Oil Red O positive staining. The relative mRNA abundance of all the genes at dd0 was similar between the ADSC and BMSC. The relative mRNA abundance of most of the genes was also similar between ADSC and BMSC throughout the adipogenic differentiation. ACSL1 and ADIPOQ had analogous expression patterns among the cell types. ACSL1 had relatively large mRNA abundance before differentiation, but ADIPOQ was barely detectable. As a consequence of differentiation, ACSL1 increased in relative mRNA abundance about 10-fold, whereas ADIPOQ mRNA increased about 1000-fold. Temporal expression patterns of SCD, DGAT2, and ADFP were similar. The increase in gene expression was >800% for SCD, >500% for ADFP, and >50 000% for DGAT2 after 7dd. ADSC had significantly higher expression of those genes compared to BMSC at 14 and 28dd. Both ADIPOQ and DGAT2 were almost undetectable prior to differentiation. mRNA expression of CD36 and DBI was similar with a significantly larger increase in expression of ADSC compared with BMSC. Relative mRNA abundance of CEBPA and PPARG was also larger in ADSC compared with BMSC; however, BMSC had a remarkable increase in temporal expression of those genes throughout adipogenic differentiation. These results suggest both cell types can differentiate towards the adipogenic lineage but with quantitatively different gene expression patterns. More investigation is needed before the ADSC can be considered a practical alternative source for stem cells in future human clinical applications. This research was supported by the Illinois Regenerative Medicine Institute.

Changes in undergraduate clinical psychiatry teaching in Scotland since "Tomorrow's doctors"

This paper reviews the factors which have driven changes in undergraduate education in psychiatry since the 1993 publication of "Tomorrow's Doctors",' after which it describes current undergraduate curricula in the four Scottish medical schools teaching clinical psychiatry. Reasons underlying the differences between curricula are discussed. The authors suggest that research in medical education, alongside communication and debate between medical schools and across specialties, would lead to more uniform and evidence-based curricula.

Identifying symptoms of ovarian cancer: a qualitative and quantitative study

Introduction

Symptoms of ovarian cancer are often vague and consequently a high proportion of women with ovarian cancer are not referred to the appropriate clinic.

Objective

To identify diagnostic factors for ovarian cancer.

Design

A qualitative and quantitative study.

Setting

Four UK hospitals.

Sample

One hundred and twenty-four women referred to hospital with suspected ovarian malignancy.

Methods

Women were interviewed prior to diagnosis (n = 63), or soon after. A thematic analysis was conducted. Emergent symptoms were quantitatively analysed to identify distinguishing features of ovarian cancer.

Main outcomes

Symptoms in women with and without ovarian cancer.

Results

Diagnoses comprised 44 malignancies, 59 benign gynaecological pathologies and 21 normal findings. Of the malignancies, 25 women had stage III or more disease, with an average age of 59 years. The benign/normal cohort was significantly younger (48 years). Multivariate analysis revealed persistent abdominal distension (OR 5.2, 95% CI 1.3–20.5), postmenopausal bleeding (OR 9.2, 95% CI 1.1–76.1), appetite loss (OR 3.2, 95% CI 1.1–9.2), early satiety (OR 5.0, 95% CI 1.6–15.7) and progressive symptoms (OR 3.6, 95% CI 1.3–9.8) as independent, statistically significant variables associated with ovarian cancer. Fluctuating distension was not associated with ovarian cancer (OR 0.4, 95% CI 0–4.1). Women frequently used the term bloating, but this represented two distinct events: persistent abdominal distension and fluctuating distension/discomfort.

Conclusions

Ovarian cancer is not a silent killer. Clinicians should distinguish between persistent and fluctuating distension. Recognition of the significance of symptoms described by women could lead to earlier and more appropriate referral.

Please cite this paper as: Bankhead C, Collins C, Stokes-Lampard H, Rose P, Wilson S, Clements A, Mant D, Kehoe S, Austoker J. Identifying symptoms of ovarian cancer: a qualitative and quantitative study. BJOG 2008;115:1008–1014.

Purification, thermal stability, and antigenicity of the immunodominant soybean allergen P34 in soy cultivars, ingredients, and products

Protein P34 (Gly m Bd 30K) is the immunodominant allergen in soybean (Glycine max L.). The objectives of this study were (1) to study the effect of thermal treatment on P34 antigenicity and secondary structure after isolation and purification of P34 from soybean by chromatographic techniques; (2) to identify the variability of P34 allergen within 138 accessions from a diverse USDA soybean germplasm collection by ELISA; and (3) to quantify P34 immunoreactivity in various commercial soy ingredients and products. Thermal processing decreased P34 antigenicity. Soybean accessions with the highest P34 content were ancestral (12 mg/g defatted flour) followed by modern (10 mg/g defatted flour) and exotic (8 mg/g defatted flour). The cultivar that emerged as the lowest-expressing P34 accession was PI548657 (2.3 mg/g defatted flour). Among commercial soy ingredients, soy flour yielded the highest P34 antigenicity (32 mg/g extracted protein) followed by soy protein isolate (29 mg/g extracted protein) and soy protein concentrate (24 mg/g extracted protein). Among soy consumer products, soymilk presented the highest P34 antigenicity, ranging from 7 to 23 mg/g extracted protein, followed by tempeh (8 mg/g extracted protein), soy infant formula (3.4 mg/g extracted protein), soy powder (2 mg/g extracted protein), and soy cheese products (0.50 mg/g extracted protein). Korean miso, soy sauce, soy chili mix, soy nuts, soy cream cheese, soy meat patty, texturized soy protein, and soy cereal exhibited undetectable P34 antigenicity (detection limit = 0.45 ng). Selecting soybean varieties with low levels of this allergen, or via processing, could potentially make soybean products less antigenic.

Thiadiazolopiperazinyl ureas as inhibitors of fatty acid amide hydrolase

A series of thiadiazolopiperazinyl aryl urea fatty acid amide hydrolase (FAAH) inhibitors is described. The molecules were found to inhibit the enzyme by acting as mechanism-based substrates, forming a covalent bond with Ser241. SAR and PK properties are presented.

Developing a Generic Risk Assessment Simulation Modelling Software Tool for Assessing the Risk of Foot and Mouth Virus Introduction

Foot and Mouth disease (FMD) is a highly contagious viral disease that affects all cloven-hoofed animals. Because of its devastating effects on the agricultural industry, many countries take measures to stop the introduction of FMD virus into their countries. Decision makers at multiple levels of the United States Department of Agriculture (USDA) use Risk Assessments (RAs) (both quantitative and qualitative) to make better and more informed scientifically based decisions to prevent the accidental or intentional introduction of the disease. There is a need for a generic RA that can be applied to any country (whether FMD free or non-FMD free) and for any product (FMD infected animals and animal products). We developed a user-friendly generic RA tool (software) that can be used to conduct and examine different scenarios of quantitative/qualitative risk assessments for the different countries with their varying FMD statuses in relation to reintroduction of FMD virus into the USA. The program was written in Microsoft Visual Basic 6.0 (Microsoft Corporation, Redmond, Washington, USA). The @Risk 6.1 Developer Kit (RDK) and @Risk 6.1 Best Fit Kit library (Palisade Corporation, Newfield, NY.USA) was used to build Monte Carlo simulation models. Microsoft Access 2000 (Microsoft Corporation, Redmond, Washington, USA) was used and SQL to query the data. Different input probability distributions can be selected for the nodes in the scenario tree and different output for each end-state of the simulation is given in different graphical formats and statistical values are used in describing the likelihood of FMD virus introduction. Sensitivity Analysis in determining which input factor has more effect on the total risk outputs is also given. The developed generic RA tools can be eventually extended and modified to conduct RAs for other animal diseases and animal products.

Relative contributions of TRPA1 and TRPV1 channels in the activation of vagal bronchopulmonary C-fibres by the endogenous autacoid 4-oxononenal

Transient receptor potential (TRP) A1 channels are cation channels found preferentially on nociceptive sensory neurones, including capsaicin-sensitive TRPV1-expressing vagal bronchopulmonary C-fibres, and are activated by electrophilic compounds such as mustard oil and cinnamaldehyde. Oxidative stress, a pathological feature of many respiratory diseases, causes the endogenous formation of a number of reactive electrophilic alkenals via lipid peroxidation. One such alkenal, 4-hydroxynonenal (4HNE), activates TRPA1 in cultured sensory neurones. However, our data demonstrate that 100 microm 4HNE was unable to evoke significant action potential discharge or tachykinin release from bronchopulmonary C-fibre terminals. Instead, another endogenously produced alkenal, 4-oxononenal (4ONE, 10 microm), which is far more electrophilic than 4HNE, caused substantial action potential discharge and tachykinin release from bronchopulmonary C-fibre terminals. The activation of mouse bronchopulmonary C-fibre terminals by 4ONE (10-100 microm) was mediated entirely by TRPA1 channels, based on the absence of responses in C-fibre terminals from TRPA1 knockout mice. Interestingly, although the robust increases in calcium caused by 4ONE (0.1-10 microm) in dissociated vagal neurones were essentially abolished in TRPA1 knockout mice, at 100 microm 4ONE caused a large TRPV1-dependent response. Furthermore, 4ONE (100 microm) was shown to activate TRPV1 channel-expressing HEK cells. In conclusion, the data support the hypothesis that 4-ONE is a relevant endogenous activator of vagal C-fibres via an interaction with TRPA1, and at less relevant concentrations, it may activate nerves via TRPV1.

The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomised controlled trial

While it seems intuitively appealing to promote participation in regular exercise in the management of irritable bowel syndrome, limited randomised controlled trial evidence exists to support this recommendation. We examined the feasibility and effects of an exercise intervention upon quality of life and irritable bowel symptoms using a randomised controlled trial methodology. Patients with a clinically confirmed diagnosis of irritable bowel syndrome according to Rome II criteria were randomised to either an exercise consultation intervention or usual care for 12 weeks. Outcomes included irritable bowel specific quality of life, symptoms (total symptoms, constipation, diarrhoea and pain) and exercise participation. The recruitment rate of eligible patients identified from hospital records was 18.3% (56/305). Analyses revealed no differences in quality life scores between groups at 12-week follow-up. The exercise group reported significantly improved symptoms of constipation (mean difference=10.9, 95 % CI= -20.1, -1.6) compared to usual care at follow-up. The intervention group participated in significantly more exercise than usual care at follow-up (mean difference=21.6, 95% CI=9.4, 33.8). Recruitment of eligible patients into this study was possible but rates were low. Findings highlight the possibility that exercise may be an effective intervention for symptom management in patients with irritable bowel syndrome; this may be particularly the case for constipation predominant patients.

The use of prolotherapy in the sacroiliac joint

OBJECTIVE

In this study the effectiveness of prolotherapy in the treatment of deficient load transfer of the sacroiliac joint (SIJ) was determined.

DESIGN

A prospective descriptive study.

SETTING

Authors' private practice.

PARTICIPANTS

25 patients who consented to treatment and attended for at least one follow-up visit and assessment.

STUDY PERIOD

From April 2004 to July 2007.

INTERVENTION

Three injections of hypertonic dextrose solution into the dorsal interosseous ligament of the affected SIJ, under CT control, 6 weeks apart.

MAIN OUTCOME MEASURES

Quebec Back Pain Disability Scale, Roland-Morris 24, Roland-Morris 24 Multiform questionnaires and clinical examination by two authors independently.

RESULTS

All patients included in this study attended at least one follow-up visit at 3, 12 or 24 months.. The number of patients at follow-up decreased at 12 and 24 months. Functional questionnaires demonstrated significant improvements for those followed-up at 3, 12 and 24 months (p<0.05). Clinical scores showed significant improvement from commencement to 3, 12 and 24 months (p<0.001).

CONCLUSIONS

This descriptive study of prolotherapy in private practice has shown positive clinical outcomes for the 76% of patients who attended the 3-month follow-up visit (76% at 12 months and 32% at 24 months). Similar results were found in the questionnaires (Quebec Back Pain Disability Scale, Roland-Morris 24 and Roland-Morris 24 Multiform questionnaires) at 3, 12 and 24 months.

182 OSTEOPONTIN GENE EXPRESSION IN IMMATURE AND MATURE SWINE CUMULUS CELLS AND OOCYTES

Osteopontin (OPN) is an acidic single-chain phosphorylated glycoprotein found in both the female and the male reproductive tract that is believed to facilitate reproduction. It was recently reported in swine that OPN improves in vitro fertilization (Hao et al. 2006 Biol. Reprod. 75, 726–733). In bovine, OPN improves the efficiency of in vitro embryo production, and it has been detected on the zona pellucida (ZP) of immature and mature oocytes (Monaco et al. 2007 J. Anim. Sci. 85, 529 abst). This study was designed to evaluate the gene expression of OPN (SPP1) in immature and mature swine cumulus cells and oocytes. Ovaries from a local slaughterhouse were collected on three different days. Half of the immature cumulus–oocyte complexes (COCs) from each day were vortexed in 1 mL TCM-199 HEPES containing 10 mg mL–1 hyaluronidase to separate immature cumulus cells, while the other half of the COCs were maturated for 40-42 h and then the cumulus cells were separated. RNA from cumulus cells and oocytes was extracted and genomic DNA was removed by DNase treatment. cDNA was synthesized using 100 ng of RNA and diluted 50% with DNase–RNase-free water. The RT-PCR product from cumulus cells and oocytes was run in a 2% agarose gel stained with ethidium bromide to verify the presence of SPP1. Relative mRNA abundance between immature and mature cumulus cells was assessed by SYBR green real-time RT–PCR run in triplicate using a 6-point twofold dilution standard curve. GAPDH was used as internal control. Primers for SPP1 and GAPDH were designed spanning an exon/exon junction. The presence of a single and specific PCR product was assessed by gel electrophoresis (a single band was expected at 100 and 90 bp, respectively, for SPP1 and GAPDH), dissociation curve, and sequencing. A t-test was used to assess differences between immature (n = 3) and mature (n = 3) cumulus cells. SPP1 was detected in agarose gel in both immature and mature oocytes and cumulus cells. Cumulus cells presented a Ct for SPP1 ranging from 20 (immature) to 29 (mature). Immature cumulus cells showed a 32-fold larger mRNA abundance compared to the mature cumulus cells (P < 0.05) when data were transformed using a standard curve. Results showed expression of SPP1 in porcine oocytes and cumulus cells. However, maturation significantly decreased the expression of SPP1 in cumulus cells. The presence of SPP1 mRNA in oocytes and cumulus cells and the larger mRNA abundance before maturation may suggest a role of this protein prior to maturation of oocytes. Additional studies will be required to determine the specific role of SPP1 in oocyte maturation in the pig.

286 OSTEOGENIC DIFFERENTIATION IN VITRO OF PORCINE ADULT MESENCHYMAL STEM CELLS

The quantity and accessibility of subcutaneous adipose tissue in humans make it an attractive alternative to bone marrow as a source of adult stem cells for therapeutic purposes. However, before such a cell source substitution can be proposed, the properties of stem cells derived from adipose (ADSCs) and bone marrow (MSCs) and their differentiated progeny must be compared in an animal model that adequately simulates the structure and physiology of humans. The objective of this work was to induce adult porcine stem cells isolated from subcutaneous adipose tissue and bone marrow to differentiate in vitro along the osteoblastic lineage and to compare their morphological, phenotypic, and genotypic properties. MSCs and ADSCs were isolated respectively from femurs and subcutaneous adipose tissue of adult pigs and cultured in vitro using DMEM supplemented with 10% fetal bovine serum (FBS), 1% penicillin G-streptomycin, and 5.6 mg L–1 amphotericin B. After 3 passages, cells were differentiated along the osteogenic lineage using lineage-specific inducing medium. Osteogenic medium contained 100 nm dexamethasone, 10 mm β-glycerophosphate, and 0.005 mm ascorbic acid-2-phosphate. Osteogenic cultures were incubated for 4 weeks in 95% air and 5% CO2 at 39�C. Spent medium was replaced with fresh medium every 3 days. Histological staining with alkaline phosphatase, Von Kossa, and alizarin red S were performed at 0, 2, 4, 7, 14, 21, and 28 days of differentiation (dd). At the same time points, RNA was extracted. qPCR was performed on COL1A1, BGLAP, SPARC, and SPP1. As internal control, the geometrical mean of GTF2H, NUBP, and PPP2C was used. Relative mRNA abundance between cell types was calculated using 1/efficiencydCT. The osteogenic differentiation of both MSCs and ADScs was confirmed by the organization of the cells in nodules and by alkaline phosphatase-, Von Kossa-, and alizarin red S-positive staining. The percent relative abundance of the 4 genes in both cell types was COL1A1 (ca. 50) > SPARC (ca. 45) > SPP1 (ca. 5) > BGLAP ( < 0.1). Cell types showed similar mRNA abundance for COL1A1 and SPARC while SPP1 and BGLAP were, respectively, 10- and 19-fold higher in MSCs than in ADSCs. All of the genes had the same pattern among tissues during differentiation except for SPP1, which showed a >10-fold increase at 14 v. 0 dd only for MSCs. Adipose-derived stem cells demonstrated a clear osteogenic differentiation and similar expression and pattern of the two osteogenic genes most abundant in MSCs (COL1A1 and SPARC). However, the higher abundance of SPP1 and BGLAP and the different behavior of SPP1 in MSCs suggest a different transcription profile between the two cell types. From these preliminary results, adipose tissue can be a practical alternative source for stem cells in future human clinical applications.

Encapsulation of moxifloxacin within poly(butyl cyanoacrylate) nanoparticles enhances efficacy against intracellular Mycobacterium tuberculosis

Macrophages in the lungs are the most important cell type supporting replication of Mycobacterium tuberculosis in humans. The objective of this study was to investigate whether the effect of moxifloxacin against M. tuberculosis residing in macrophages could be improved by encapsulation of the drug in the biodegradable nanoparticles, which are known to accumulate in macrophages upon intravenous administration. To accomplish this, moxifloxacin was encapsulated in poly(butyl cyanoacrylate) (PBCA) nanoparticles. Encapsulated moxifloxacin accumulated in macrophages approximately three-fold times more efficiently than the free drug, and was detected in the cells for at least six times longer than free moxifloxacin at the same extracellular concentration. Inhibition of intracellular M. tuberculosis growth with encapsulated moxifloxacin was achieved at the concentration of 0.1microg/ml, whereas the same effect with free MX required a concentration of 1microg/ml. Nanoparticles observed within the macrophage cytoplasm were distributed throughout the cytoplasm, sometimes in the vicinity of intracellular bacteria.

Elevated serum matrix metalloproteinase 9 (MMP-9) concentration predicts the presence of colorectal neoplasia in symptomatic patients

Early detection of polyps or colorectal carcinoma can reduce colorectal carcinoma-associated deaths. Previous studies have demonstrated raised serum levels of matrix metalloproteinase 9 (sMMP-9) in a range of cancers. The aim of this study was to investigate the role of sMMP-9 levels in identifying colorectal neoplasia. Consenting patients donated a blood sample and were assessed by proforma-led history and physical examination. Samples were analysed for sMMP-9 concentration (enzyme-linked immuno-sorbant assay) and compared to final diagnoses. Logistic regression modelling determined independent factors associated with neoplasia. A total of 365 patients were recruited of whom 300 were analysed, including 46 normal controls. A total of 27 significant adenomas and 63 malignancies were identified. The median sMMP-9 concentration was 443ng ml⁻¹ (IQR: 219–782; mean: 546). Patients with neoplasia had significantly elevated sMMP-9 levels (P<0.001). Logistic regression modelling identified elevated log(sMMP-9) as the most significant predictor of neoplasia (χ²=38.33, P<0.001). Other significant factors were age, sex, smoking history, abdominal pain and weight loss. The model accurately predicted neoplasia in 77.3% of cases. Sensitivity and specificity were 77.9 and 77.1%. sMMP-9 estimation can accurately stratify patient to low- or high-risk cohorts. Serum sampling is a potential means of avoiding unnecessary colonoscopy and reducing patient anxiety, iatrogenic morbidity and mortality, and cost.