Global inter-rater reliability, scale validity, and local perception: Panss ratings and reactions from 4 Countries

Introduction/objectives/aims

We compared cohorts of raters from different countries who received training on the PANSS. We attempted to determine if there was any consistent by-country impact on specific items, factors, or subscales. We also queried raters about their perceptions of the instrument they were asked to use vis-à-vis their local patient population.

Methods

The data set comes from standardized rater training events involving raters from four countries: India (n = 83), Russia (n = 59), the US (n = 63), and Romania (n = 76). Raters scored interviews of schizophrenic patients using the PANSS. Scores were compared and intra-class correlation coefficients (ICCs) and rater agreement with “gold standard” scores were evaluated. The results were viewed against raters’ responses to questions about how well the PANSS items correlated to the presentation of symptoms.

Results

Raters from the US and Russia demonstrated a higher level of inter-rater consistency with ICCs of 0.883 and 0.835, respectively. For eight PANSS items, all raters demonstrated at least 80% agreement with the gold standard scores. For ten PANSS items, there was at least one country whose raters scored below 60% agreement. The PANSS items with the lower inter-rater reliability were the same items raters indicated as problematic in local settings.

Conclusion

The differences in rater performance indicate that standardized rater training is broadly effective but that there are some important differences in the way in which different groups conceptualize symptomatology and corresponding PANSS items. This suggests a need to tailor training to ensure reliability and validity in the use of this instrument.

Adverse antiepileptic drug effects in new-onset seizures: a case-control study

OBJECTIVE

Adverse effects (AEs) are a major concern when starting antiepileptic drug (AED) treatment. This study quantified the extent to which AE reporting in people with new-onset seizures started on AEDs is attributable to the medication per se, and investigated variables contributing to AE reporting.

METHODS

We pooled data from 2 large prospective studies, the Multicenter Study of Early Epilepsy and Single Seizures and the Northern Manhattan Study of incident unprovoked seizures, and compared adverse event profile (AEP) total and factor scores between adult cases prescribed AEDs for new-onset seizures and untreated controls, adjusting for several demographic and clinical variables. Differences in AEP scores were also tested across different AED monotherapies and controls, and between cases and controls grouped by number of seizures.

RESULTS

A total of 212 cases and 206 controls were identified. Most cases (94.2%) were taking low AED doses. AEP scores did not differ significantly between the 2 groups. Depression, female gender, symptomatic etiology, younger seizure onset age, ≥2 seizures, and history of febrile seizures were associated with higher AEP scores. There were no significant differences in AEP scores across different monotherapies and controls. AEP scores increased in both cases and controls with increasing number of seizures, the increment being more pronounced in cases.

CONCLUSIONS

When AED treatment is started at low doses following new-onset seizures, AE reporting does not differ from untreated individuals. Targeting specific factors affecting AE reporting could lead to improved tolerability of epilepsy treatment.

A guide to defining and implementing protocols for the welfare assessment of laboratory animals: eleventh report of the BVAAWF/FRAME/RSPCA/UFAW Joint Working Group on Refinement

The refinement of husbandry and procedures to reduce animal suffering and improve welfare is an essential component of humane science. Successful refinement depends upon the ability to assess animal welfare effectively, and detect any signs of pain or distress as rapidly as possible, so that any suffering can be alleviated. This document provides practical guidance on setting up and operating effective protocols for the welfare assessment of animals used in research and testing. It sets out general principles for more objective observation of animals, recognizing and assessing indicators of pain or distress and tailoring these to individual projects. Systems for recording indicators, including score sheets, are reviewed and guidance is set out on determining practical monitoring regimes that are more likely to detect any signs of suffering. This guidance is intended for all staff required to assess or monitor animal welfare, including animal technologists and care staff, veterinarians and scientists. It will also be of use to members of ethics or animal care and use committees. A longer version of this document, with further background information and extra topics including training and information sharing, is available on the Laboratory Animals website.

Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting

BACKGROUND

Multimorbidity is defined as two or more co-existing chronic conditions in an individual and is common in general practice. It is associated with poorer outcomes for patients. This study aimed to establish the prevalence of multimorbidity in patients with chronic respiratory disease in general practice and to describe its impact on health service use.

METHODS

Cross-sectional study based in general practice in Dublin. Drug and disease code searches were performed to identify adult patients with a diagnosis of chronic respiratory disease. Medical records were reviewed for chronic respiratory diagnosis, other chronic conditions, demographic characteristics, General Practitioner (GP) and practice nurse utilisation rates, and numbers of medications.

RESULTS

In a general practice population of 16,946 patients 3.9% had chronic respiratory disease and 60% of these had one or more co-existing chronic condition(s). GP and practice nurse utilisation rates, and number of medications were significantly higher among those with multimorbidity compared with those with respiratory disease alone. Multivariate analysis showed that increasing age and low socio-economic status were significantly associated with multimorbidity.

CONCLUSION

The majority of patients with chronic respiratory disease have multimorbidity. Clinical guidelines based on single disease entities and outcomes are not as easy to implement and may not be as effective in this group.

Cardiac Safety Data for Casopitant, a Neurokinin-1 Receptor Antagonist, Given with Anthracycline

Objectives: The NK-1 receptor antagonist casopitant is a promising agent for the prevention of chemotherapy-related and postoperative nausea and vomiting. However, findings suggestive of cardiac damage were noted in animal studies of long-term administration of casopitant at supratherapeutic doses. Cardiac evaluation of the concomitant use of casopitant with anthracyclines was therefore of particular interest due to myocyte loss associated with anthracycline use.Methods: Chemotherapy-naïve patients receiving anthracyclines as part of a Phase III moderately emetogenic chemotherapy study regimen were randomized to receive ondansetron and dexamethasone plus one of the following casopitant regimens: single-dose 150-mg oral casopitant (ORAL1); 3-day IV/oral casopitant (90 mg IV/50 mg oral/50 mg oral) (IV/ORAL); 3-day oral casopitant (150/50/50 mg) (ORAL3); or placebo. Serial cardiac troponin (cTnI) levels were measured using the Beckman assay. Although this assay is generally considered reliable within the range of 0.04-0.5 ng/mL, levels below the limit of quantitation (LOQ) (<0.04 ng/mL) were also evaluated in an attempt to identify patterns of change below LOQ. Further cardiac assessment consisting of left ventricular ejection fraction (LVEF) monitoring was conducted in patients with cTnI levels ³0.12 ng/mL.Results: In total, 611 patients were evaluated: 155 ORAL1, 145 IV/ORAL, 159 ORAL3, and 152 placebo; no risk factor variation between groups was observed. Adverse events were balanced across treatment groups. Cardiovascular adverse events occurred in 3% of patients in each of the placebo, ORAL1, and ORAL/IV groups and in 2% of the ORAL3 group. Three patients (0.5%) had cTnI >0.12 ng/mL (1 each IV/ORAL, ORAL3, and placebo); all LVEF determinations were normal at follow-up, with the exception of 1 patient with mitral regurgitation but normal ejection fraction. A total of 59 patients (9.7%) had median cTnI 0.04-0.12 ng/mL. Of the remaining patients with cTnI below LOQ, median baseline levels across groups were similar (ORAL1 and IV/ORAL 0.008 ng/mL; ORAL3 0.01 ng/mL; placebo 0.009 ng/mL). After 4 cycles of anthracycline, median cTnI increased to 0.02 ng/mL in all groups, with no difference noted between casopitant and placebo groups.Conclusions: Thorough monitoring of cardiac-related toxicities including cardiac (S)AEs, ECG, and ejection fraction data showed no evidence of increased risk of cardiac damage in the casopitant groups compared with control. Subclinical elevations in cTnI occurred in patients receiving anthracyclines but were not considered to be related to or accentuated by simultaneous administration of casopitant. cTnI elevations were similar across treatment groups and were well below rates reported in the literature for a patient population receiving higher doses of anthracycline. Use of appropriate cardiac biomarkers in ranges below those commonly used to detect infarction may be valuable to detect or exclude subclinical toxicity of potentially cardiotoxic agents used in combination. Additional analysis is ongoing.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1118.

Hyperglycaemia as a predictor of outcome during non-invasive ventilation in decompensated COPD

RATIONALE

Hyperglycaemia predicts a poor outcome in Intensive Care Unit (ICU) patients. Whether this is true for respiratory failure necessitating non-invasive ventilation (NIV) is not known.

OBJECTIVES

To determine whether hyperglycaemia within 24 h of admission independently predicts outcome of NIV during acute decompensated ventilatory failure complicating chronic obstructive pulmonary disease (COPD) exacerbations.

METHODS

Patients with COPD presenting with acute hypercapnic respiratory failure at University Hospital Aintree between June 2006 and September 2007 and receiving NIV within 24 h of admission were studied prospectively. Random blood glucose levels were measured before NIV administration.

RESULTS

88 patients (mean baseline pH 7.25, PaCO(2) 10.20 kPa, and PaO(2) 8.19 kPa) met the inclusion criteria, with NIV normalising arterial pH off therapy in 79 (90%). After multivariate logistic regression, the following predicted outcome: baseline respiratory rate (OR 0.91; 95% CI 0.84 to 0.99), random glucose > or = 7 mmol/l (OR 0.07; 95% CI 0.007 to 0.63) and admission APACHE II (Acute Physiology and Chronic Health Evaluation II) score (OR 0.75; 95% CI 0.62 to 0.90). The combination of baseline respiratory rate (RR) <30 breaths/min and random glucose <7 mmol/l increased prediction of NIV success to 97%, whilst use of all three factors was 100% predictive.

CONCLUSIONS

In acute decompensated ventilatory failure complicating COPD, hyperglycaemia upon presentation was associated with a poor outcome. Baseline RR and hyperglycaemia are as good at predicting clinical outcomes as the APACHE II score. Combining these variables increases predictive accuracy, providing a simple method of early risk stratification.

Designing for the future

The lifecycles of many medical devices are extremely complex, as is their design process, which requires a great investment in time and expert procedures at all stages. This article highlights the critical issues to consider when embarking on a design project and how to reduce the risks involved in long life cycles.

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.

311 RISK ANALYSIS OF ALPHA-LACTALBUMIN TRANSGENE TRANSFER TO NON-TRANSGENIC CONTROL ANIMALS DURING REARING AND BREEDING

Assessment of general risk posed from transgenic (T) animals is important to their future contributions to society. Identification of potentially harmful properties of transgenic livestock is the initial step in a risk assessment. Direct and indirect impacts of potential harmful properties of T livestock need to be evaluated at 3 levels, namely (1) characterization of how the transgene, its product, and the T livestock behave in their immediate environment, that is, in their barn or pen; (2) determination of possible impacts of large-scale release of T livestock, that is, if they were to be integrated into the larger population of food animal livestock; and (3) determination of the more complex environmental and safety consequences of their release into livestock populations. We previously developed and characterized transgenic swine containing a mammary-specific transgene (bovine α-lactalbumin, bALAC) that results in increased milk production in sows. We currently are determining whether bALAC is expressed in tissues of T swine other than the lactating mammary gland and whether the transgene DNA (Tg) crosses into non-transgenic control (C) swine under various physiological and physical conditions. The specific aims addressed in the present study were to determine: (1) whether the Tg can be transferred directly from T animals to C animals by physical association or contact and (2) whether the Tg can be transferred directly from an adult T animal to an adult C animal via mating. The T animals utilized in these studies are in at least generation 10 and have stable incorporation of the Tg. Comparable age- and weight-matched animals, T and C, were housed together allowing for general contact that is normal within swine production, for either 180, 220, or 250 d of age after weaning. Swine due to their behavior ingest saliva, regurgitated food, and stool or urinary products, as well as other bodily fluids and cells during normal housing. In a second study, vaginal, cervical, uterine, oviductal, and ovarian tissues from C females on 2, 7, or 90 d after mating to T males and penis, bulbourethral gland, urethra, testis, and epididymis tissues from C males on 2 or 7 days after mating to Tg females were collected. The presence of Tg in tissues from all C animals was tested via PCR. We have analyzed for the presence of the Tg in various tissues [including mammary gland, salivary gland, skin (sebaceous gland), muscle, lung, liver, kidney, brain, ovary, oviduct, uterus, cervix, vagina, penis, bulbourethral gland, urethra, testis, epididymis, and intestine]. Results indicate no presence of the Tg in tissues of C animals (n = 28) after co-habitation for 180, 220, or 250 d (n = 305 samples analyzed) or at 2 (n = 5), 7(n = 14), or 90 (n = 2) d post-mating (n = 60, 174, or 24 samples analyzed, respectively). The present results suggest that there is no horizontal Tg transmission between T and C pigs due to rearing or mating. This work provides a critical step toward providing rigorous scientific data for risk assessment of transgenic livestock. This project supported by the USDA BRAG Project #2005-03799.

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.

Variation of immunological response in methotrexate-induced pneumonitis

OBJECTIVES

To assess the variation of peripheral blood and bronchoalveolar lavage (BAL) inflammatory cell counts and lung biopsy findings with the degree of exposure to MTX therapy.

METHODS

Fifty-six (16 males; 40 females) reported cases of MTX-induced pneumonitis (MTX-P) on low-dose MTX (5-30 mg) were identified from a literature search and classified using Searles and McKendry's criteria. The median cumulative dose was 300 mg and this was used to categorize patients into low and high MTX-exposure groups and 6 months was used to divide patients into early- and late-onset MTX-P groups.

RESULTS

Neutrophil counts in the peripheral blood and BAL were significantly raised in the low MTX-exposure group compared with the high MTX-exposure group (P = 0.018 and 0.038, respectively). There were similar findings when early-onset was compared with late-onset group. Lymphocytes in BAL were significantly higher in the high MTX-exposure group compared with low-dose cumulative group (P = 0.007). There were 6 (11%) recorded deaths and all were in the low MTX-exposure group. Early-onset/low MTX-exposure groups had a high prevalence of lung fibrosis.

CONCLUSIONS

This is the first study to describe the variation of immunological responses in MTX-P with the degree of exposure to MTX. Our findings suggest that MTX-P can be divided into two groups: type 1 MTX-P that occurs early, predominated by neutrophils, lung fibrosis and has a high mortality; and type 2 MTX-P that occurs late, predominated by lymphocytes, has less lung fibrosis and low mortality.

Does the position of restraint of disturbed psychiatric patients have any association with staff and patient injuries?

The aim of this study was to examine the risk of injury among patients and staff following involvement in a restraint episode in relation to restraint position (standing, supine or prone) and other aspects of the pre-incident behaviour including perceived causation. Mixed effects logistic regression was used to estimate the relative odds of injury to staff or patient in a series of 680 restraint episodes involving 260 patients in an adult mental health service in England between 1999 and 2001. There was no statistically significant association between patient injury and restraint position in this sample, but a prone restraint position was weakly associated with staff injury. Staff injury was most likely when an actual assault had occurred prior to the incident. Patient injury was more likely when the patient had self-harmed, had been abusing substances and had used a weapon prior to the incident, and less likely when the patient was showing signs of frustration with their environment. The use of prone restraint may be weakly associated with an increased risk of injury to staff. However, other aspects of the incident are stronger predictors and should be considered when planning training for front line staff.

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.

Expression of the uptake drug transporter hOCT1 is an important clinical determinant of the response to imatinib in chronic myeloid leukemia

Some chronic myeloid leukemia (CML) patients do not respond to imatinib, whereas others lose an initial response. To identify potential imatinib failures, we investigated the expression of imatinib uptake transporter (human organic cation transporter 1; hOCT1) and efflux transporters (ATP-binding cassette transporters ABCB1, ABCG2, and ABCC1) using real-time quantitative reverse transcription-polymerase chain reaction in 70 CML patients. Patients with high pretreatment hOCT1 expression had superior complete cytogenetic response (CCR) rates (P=0.008), progression-free and overall survival (P=0.01 and 0.004). Pretreatment ABCB1, ABCG2, and ABCC1 levels did not correlate with treatment outcome. Regression analysis demonstrated that pretreatment hOCT1 expression was the most powerful predictor of CCR achievement at 6 months (P=0.002). Imatinib uptake into a CML cell line with high hOCT1 expression was greater than into those with modest or low expression (P=0.002). The expression of hOCT1, but not efflux transporters, is important in determining the clinical response to imatinib.

Monitoring obstetricians’ performance with statistical process control charts

OBJECTIVE

The main objective of this study was to pave the way towards proactive, continuous assessment of individuals and hospitals by demonstrating the application of evidence-based competency standards in maternity care using statistical performance monitoring.

DESIGN

Retrospective study using data routinely collected by a large maternity hospital.

SETTING

A large teaching hospital.

POPULATION

Clinicians who routinely perform either amniocentesis or ventouse deliveries.

METHOD

As a 'proof of principle', we have used statistical process control (SPC) charts to compare the observed complication rates for amniocentesis and ventouse delivery with the expected complication rates based on published data.

MAIN OUTCOME MEASURES

The recorded complication rates for amniocentesis and ventouse delivery.

RESULTS

The SPC charts identified significant variation in complication rates within the team and showed the ways in which prospective data can be used to provide continuous feedback to individuals on their performance.

CONCLUSION

The study shows that statistical performance monitoring and, in particular, the use of control charts can be a valuable tool in the continuous assessment of individuals and the healthcare service being provided. The control charts provide a more immediate indication of current performance and provide an alternative to performance-based league tables for the presentation of yearly performance data.

202 IN VITRO DIFFERENTIATION OF ADULT PORCINE ADIPOSE-DERIVED STEM CELLS AFTER LABELING WITH PKH26 AND FLOW CYTOMETRY

The purpose of this study was to investigate the possible effects of the fluorescent dye PKH26 and flow cytometry on adult porcine adipose-derived stem cells (ADSCs) after exposing them to adipogenic and osteogenic differentiation conditions. Adipose tissue was isolated from swine (11 months of age) and digested with 0.075% collagenase at 37�C for 90 min. The digested adipose tissue was centrifuged at 200g for 10 min to obtain a cell pellet. The pellet was re-suspended with DMEM, and the ADSCs were plated onto 75 cm2 flasks (5000-10 000 cells per cm2) and cultured in DMEM supplemented with 10% fetal bovine serum (FBS) and 1% gentamicin. Passage 3 cells were labeled with fluorescent dye (PKH26 red fluorescent cell linker kit; Sigma Chemical, St. Louis, MO, USA) and sorted by flow cytometry. After labeling and sorting, the sorted and unsorted (control group) cells were replated and exposed to adipogenic (1 �M dexamethasone, 0.5 mM isobutylmethylxantine, 10 �M insulin and 200�M indomethacin) and osteogenic (0.1 �M dexamethasone, 10 mM �-glycerophosphate, and 50�M ascorbic acid) differentiation conditions when the cells were 90% confluent. Cells were evaluated based on morphology and specific staining properties. Adipogenic differentiation was confirmed by oil red O-positive staining of large lipid vacuoles, and osteogenic differentiation by Von Kossa staining 2 weeks after initiation of differentiation. The frequency of oil red O-positive colonies in both sorted and unsorted group was similar (15.0% vs. 13.2%, respectively). The number of osteogenic nodules, confirmed by the presence of calcium by Von Kossa staining, in the sorted and unsorted group was 17 and 184 per flask, respectively. In conclusion, this study demonstrates that adult porcine adipose-derived stem cells maintain their differentiation potential after labeling with fluorescent dye and sorting by flow cytometry. This should allow for more rapid evaluation of the differentiation potential of ADSCs in vitro. This work was partially supported by the Council for Food and Agricultural Research (C-FAR) Sentinel Program, University of Illinois and CNPq, Brazil (M. Mello).

125 ISOLATION OF MULTILINEAGE STEM CELLS FROM THE PORCINE MAMMARY FAT PAD

Porcine mammary tissue is a dynamic system that undergoes multiple cycles of growth, differentiation, and regression during the life cycle of a female; however, the mechanisms of mammary morphogenesis are not fully understood. The current hypothesis suggests that epithelial stem cells in the terminal end buds interact with surrounding epithelial and stromal cells during mammary tissue development and regeneration. Because the mammary gland of the virgin animal consists largely of a pad of adipose tissue, we propose that adipose-derived stem cells from the mammary fat pad (MFP) may also play a role in the regeneration process. Therefore, the objective of this experiment was to determine whether multilineage stem cells are present in the MFP of gilts. Adipose tissue from the MFP and back fat (BF) from the loin region were harvested from six nulliparous, cycling Yorkshire gilts, approximately 16 mo of age. Methods for isolation of adipose-derived stem cells were modified from those of Malusky and Wheeler (2004; International Society for Stem Cell Research, Proceedings 2nd Annual Meeting, abstr. 248:124). Presumptive stem cells isolated from each tissue type were maintained in vitro in DMEM supplemented with either 10% newborn calf serum (NCS; Rep 1 and 2) or 10% fetal calf serum (Rep 3). BF and MFP cell types formed colonies of fibroblast-like cells within 3 to 5 d. Growth characteristics are shown in Table 1. When the cells were 80% confluent, they were trypsinized and reseeded into 75-cm2 flasks. When cultured in the presence of NCS, both cell types had a progressive decrease in viability, and these cultures could not be maintained past Passage 4. Differentiation of both cell types (Passage 1) into adipogenic, myogenic, and osteogenic lineages are currently underway. Based on morphological evaluations, both cell types are able to differentiate into the aforementioned lineages; however, differentiation of MFP-derived cells occurred at a slower rate and was less pronounced than that of BF-derived cells. These preliminary findings suggest that the MFP likely contains a population of multipotent stem cells; however, at this time, it is not possible to make meaningful statistical comparisons. Further experiments are needed to fully characterize these cells and determine their role in mammary gland morphogenesis. Table 1. Growth of porcine adipose-derived stem cells obtained from the BF or from the MFP This study was partially supported by the Council for Food and Agricultural Research (C-FAR) Sentinel Program and USDA Multistate Project (W-1171).