Cytotoxicity induced by grape seed proanthocyanidins: role of nitric oxide

Grape seed proanthocyanidin extract (GPSE) at high doses has been shown to exhibit cytotoxicity that is associated with increased apoptotic cell death. Nitric oxide (NO), being a regulator of apoptosis, can be increased in production by the administration of GSPE. In a chick cardiomyocyte study, we demonstrated that high-dose (500 microg/ml) GSPE produces a significantly high level of NO that contributes to increased apoptotic cell death detected by propidium iodide and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining. It is also associated with the depletion of intracellular glutathione (GSH), probably due to increased consumption by NO with the formation of S-nitrosoglutathione. Co-treatment with L-NAME, a NO synthase inhibitor, results in reduction of NO and apoptotic cell death. The decline in reduced GSH/oxidized GSH (GSSG) ratio is also reversed. N-Acetylcysteine, a thiol compound that reacts directly with NO, can reduce the increased NO generation and reverse the decreased GSH/GSSG ratio, thereby attenuating the cytotoxicity induced by high-dose GSPE. Taken together, these results suggest that endogenous NO synthase (NOS) activation and excessive NO production play a key role in the pathogenesis of high-dose GSPE-induced cytotoxicity.

Manufacture and acoustical characterisation of a high-frequency contrast agent for targeting applications

The aim of this study was to develop and acoustically to optimise an ultrasonic contrast agent for research imaging applications at 40 MHz. A range of liposomal dispersions were manufactured and the mean backscatter power was measured using a Boston Scientific ClearView Ultra intravascular scanner with a 40 MHz, 2.5 Fr Atlantis SR Plus catheter. The scanner had been modified to allow access to the unprocessed ultrasound data, which were digitised, and the mean backscatter power was calculated over a region-of-interest centred at 2 mm from the transducer. Mean backscatter power was normalised to the data collected from a water-air interface. The effects of sonication and rapid shaking on six liposomal samples were also studied and this indicated that both techniques significantly reduced the size of the liposomes within the dispersions. Maximum mean backscatter power was measured for sonicated liposomal dispersions with 60% by weight of phosphatidylethanolamine. Moreover, this dispersion had greater mean backscatter power than sheep blood at 40 MHz.

Sex change strategy and the aromatase genes

Sequential hermaphroditism is a common reproductive strategy in many teleosts. Steroid production is known to mediate both the natural and induced sex change, yet beyond this the physiology directing this process has received little attention. Cytochrome P450 aromatase is a key enzyme in the hormonal pathway catalysing the conversion of sex steroids, androgens to oestrogens, and thus is highly relevant to the process of sex change. This study reports the isolation of cDNA sequences for aromatase isoforms CYP19A1 and CYP19A2 from teleost species representing three forms of sexual hermaphroditism: Lates calcarifer (protandry), Cromileptes altivelis (protogyny), and Gobiodon histrio (bi-directional). Deduced amino acid analysis of these isoforms with other reported isoforms from gonochoristic (single sex) teleosts revealed 56-95% identity within the same isoform while only 48-65% identity between isoforms irrespective of species and sexual strategy. Phylogenetic analysis supported this result separating sequences into isoform exclusive clades in spite of species apparent evolutionary distance. Furthermore, this study isolates 5' flanking regions of all above genes and describes putative cis-acting elements therein. Elements identified include steroidogenic factor 1 binding site (SF-1), oestrogen response element (ERE), progesterone response element (PRE), androgen response element (ARE), glucocorticoid response elements (GRE), peroxisome proliferator-activated receptor alpha/retinoid X receptor alpha heterodimer responsive element (PPARalpha/RXRalpha), nuclear factor kappabeta (NF-kappabeta), SOX 5, SOX 9, and Wilms tumor suppressor (WTI). A hypothetical in vivo model was constructed for both isoforms highlighting potential roles of these putative cis-acting elements with reference to normal function and sexual hermaphroditism.

Dental treatment in Medieval England

Medieval (12th-14th century) medical literature suggests that care of the teeth was largely limited to non-invasive treatment. Cures, mainly for toothache and "tooth worm" were based on herbal remedies, charms and amulets. Bloodletting was advised for certain types of toothache. There is also documentary evidence for powders to clean teeth and attempts at filling carious cavities. Surgical intervention for oral cancer and facial fracture is also known. Post-operative infection and abscess formation can be identified and early forms of false teeth are mentioned.

Dental treatment in Anglo-Saxon England

Anglo-Saxon medical literature suggests that care of the teeth was largely limited to non-invasive treatment. Cures, mainly for toothache, were based on herbal remedies, charms and amulets. Herbal potions also treated oral problems as diverse as caries and facial deformities. However, surgical intervention for cleft lip is mentioned in the later documents. Skeletal evidence confirms that cleft lip and palate was definitely known to the Anglo-Saxons. A possible dentist's grave has been identified.

Bulk glasses and ultrahard nanoceramics based on alumina and rare-earth oxides

Although often regarded as a network-former in conventional silicate glasses, Al(2)O(3) alone cannot be obtained as a bulk glass. Until now, glasses comprising continuously linked [AlO(x)] polyhedra have been prepared in only a few systems under very fast cooling conditions, which limits their dimensions to a few millimetres. Yet it is desirable to prepare bulk, or monolithic, alumina-rich glasses, with the prospect of superior mechanical, chemical and optical properties. Here we report a novel process for preparing very-high-alumina glasses and nanoscale glass-ceramics. Fully dense bulk articles in net shape are obtained through viscous sintering of glass microbeads. Additional heat treatment of the consolidated glasses leads to fully crystallized transparent glass-converted nanoceramics with a hardness similar to that of alumina. This method avoids the impracticably high applied pressures (more than 1 GPa) that have been required in most cases to prepare nanocrystalline ceramics by sintering, owing to the concurrent nature of densification and grain growth under pressureless conditions. The reported techniques can be extended to form glasses and nanoceramics in other oxide systems that do not include a conventional glass-forming component.

An unusual medieval mandibular pathology

A medieval mandible with an unusual bilateral periosteal reaction, probably related to chronic inflammation or infection, is presented.

Peak mean myocardial velocities and velocity gradients measured by color M-mode tissue Doppler imaging in healthy cats

We sought to assess the feasibility of recording the myocardial velocity gradients (MVGs) and mean myocardial velocities (MMVs) measured by color M-mode tissue Doppler imaging (TDI) in the free wall of unsedated normal cats (n = 18) with a 7.4-MHz probe equipped to record TDI images. The peak MVG and MMV values during the different phases of the cardiac cycle corresponded to certain color velocity patterns occurring in the left ventricular free wall (LVFW). Biphasic shifts were recorded in the tracings of both the MVG and MMV during early diastole (E1 and E2) as well as during the isovolumic relaxation (IVR) and isovolumic contraction (IVC) phases. Stepwise regression analysis showed that age was the only significant predictor for the peak MVG values during the 2nd phase of early diastole (E2) (r = -0.79, r2 = 0.63, and P < .001). The peak late diastolic MVG values were associated positively with age (r = 0.50, r2 = 0.25, and P < .05). The peak MMV values showed a negative association with age during E2 (r = -0.71, r2 = 0.50, and P < .001) as well as during early systole (Se) (r = -0.55, r2 = 0.30, and P < .05) and late systole (SI) (r = -0.62, r2 = 0.39, and P < .01). A positive association was found between age and the peak MMV values during late diastole (r = 0.54, r2 =- 0.29, and P < .05). The MVG values showed cyclic variations consistent with wall thickness changes. The accuracy of velocity determination and the spatial resolution of the system used were validated with a phantom. To our knowledge, this study is the 1st report of the application of this technique to the myocardium of cats,providing insights into the physiology of myocardial motion. It provides reference ranges of the peak MVG and MMV values for future studies of feline myocardial diseases.

Human factors engineering design demonstrations can enlighten your RCA team

A case study is presented, based on the experience of the US Veterans Affairs health system, which shows the benefits of healthcare personnel understanding human factors engineering (HFE) and how it relates to patient safety. After HFE training, personnel are better able to use a systems-oriented approach during adverse event analysis. Without some appreciation of HFE, the focus of adverse event analyses (e.g. root cause analysis (RCA)) is often misguided towards policies or an individual's shortcomings, leading to ineffective solutions. The case study followed the investigation by an RCA team of a retained sponge following cardiac surgery. The team began with a focus on the specific failings of the surgical nurse and outdated policies. HFE design demonstrations were used to redirect the team's focus to more systems-oriented issues, which could be uncovered even when events appeared to be related to policy or training, and to point them towards examining the design of systems that contributed to the event. The team was thus able to identify design flaws and make improvements to the design of the forms and computer systems that were key to preventing such events from recurring.

PROGRAMMABLE DIELECTROPHORETIC μTAS SAMPLE HANDLING

We present the concept of a general-purpose sample analysis platform (GSAP) based on dielectrophoretic methods. The platform architecture comprises integrated functional blocks that can be programmed to perform a diverse range of analysis steps, including the on-device preparation of real world samples.

Selected Soybean Plant Introductions with Partial Resistance to Sclerotinia sclerotiorum

Sclerotinia stem rot, caused by Sclerotinia sclerotiorum, is a major soybean (Glycine max) disease in north-central regions of the United States and throughout the world. Current sources of resistance to Sclerotinia stem rot express partial resistance, and are limited in number within soybean germ plasm. A total of 6,520 maturity group (MG) 0 to IV plant introductions (PIs) were evaluated for Sclerotinia stem rot resistance in the United States and Canada in small plots or in the greenhouse from 1995 to 1997. Selected PIs with the most resistance were evaluated for resistance in the United States and Canada in replicated large plots from 1998 to 2000. The PIs in the MG I to III tests in Urbana, IL were evaluated for agronomic traits from 1998 to 2000. The selected PIs also were evaluated with an excised leaf inoculation and petiole inoculation technique. After the 1995 to 1997 evaluations, all but 68 PIs were eliminated because of their susceptibility to Sclerotinia stem rot. In field tests in Urbana, higher disease severity in selected MG I to III PIs was significantly (P< 0.05) associated with taller plant heights and greater canopy closure. All other agronomic traits evaluated were not associated or were inconsistently associated with disease severity. MG I to III PIs 153.282, 189.931, 196.157, 398.637, 417.201, 423.818, and 561.331 had high levels of resistance and had canopies similar to the resistant checks. The resistance ratings from the petiole inoculation technique had a high and significant (P< 0.01) correlation with disease severity in the MG I and II field tests. The partially resistant PIs identified in this study can be valuable in incorporating Sclerotinia stem rot resistance into elite germ plasm.

Documentary and artistic evidence for conjoined twins from sixteenth century England

Our knowledge of disease in earlier Britain is largely based on the study of skeletal remains. However, a series of sixteenth century illustrative ballads provides the first proof for conjoined twins from late medieval England. The dearth of archaeological cases may be due to lack of definite skeletal changes or as a result of the remains being denied burial within consecrated ground. Other cases may exist, but documentary evidence is biased to the later medieval period, when such birth defects were recorded solely as a warning against immorality. The famous Biddenden Maids, no doubt, are remembered because of their association with a bequest of land and distribution to the poor.

Minor long-term changes in weight have beneficial effects on insulin sensitivity and beta-cell function in obese subjects

AIM

To evaluate the long-term effect of changes in body composition induced by weight loss on insulin sensitivity (SI), non-insulin mediated glucose disposal, glucose effectiveness (SG)and beta-cell function.

DESIGN

Glucose metabolism was evaluated before and after participation in a two-year weight loss trial of Orlistat vs. placebo, combined with an energy and fat restricted diet.

SUBJECTS

Twelve obese patients (11 women, 1 man), age 45.8 +/- 10.5 years, body weight (BW) 99.7 +/- 13.3 kg, BMI 35.3 +/- 2.8 kg/m(2).

MEASUREMENTS

At inclusion and 2 years later an oral glucose tolerance test (OGTT) and a frequently sampled intravenous glucose tolerance test (FSIGT) were performed. Body composition was estimated by a dual-energy X-ray absorptiometry (DXA) whole body scanning.

RESULTS

The patients obtained varying changes in BW ranging from a weight loss of 17.8 kg to a weight gain of 6.0 kg. Corresponding changes in fat mass (FM) varied from a 40% reduction to a19% increase. A significant decrease in both fasting (p = 0.038) and 2 h (p = 0.047) blood glucose at OGTT was found. The improvement in insulin sensitivity (SI) estimated by means of Bergmans Minimal Model, was significantly and linearly correlated to change in total FM (r = - 0.83,p = 0.0026). A multiple regression analysis showed that changes in truncal FM was the strongest predictor of change in S(I) explaining 67% of the variation. First phase insulin response (AIRg)remained unchanged whereas insulin disposition index increased significantly (p = 0.044). At inclusion five patients had impaired glucose tolerance of which four, who lost weight, were normalized at the retest 2 years later.

CONCLUSION

In obese subjects long-term minimal or moderate changes in weight were found to be linearly associated with changes in insulin sensitivity. In obese subjects with impaired glucose tolerance even a minor weight loss was able to normalize glucose tolerance.

An in vitro system for the study of ultrasound contrast agents using a commercial imaging system

An in vitro system for the investigation of the behaviour of contrast microbubbles in an ultrasound field, that provides a full diagnostic range of settings, is yet to be presented in the literature. The evaluation of a good compromise of such a system is presented in this paper. It is based on (a) an HD13000 ATL scanner (Bothell, WA, USA) externally controlled by a PC and (b) on the use of well-defined reference materials. The suspensions of the reference ultrasonic scattering material are placed in an anechoic tank. The pulse length ranges from 2 to 10 cycles, the acoustic pressure from 0.08 to 1.8 MPa, the transmit frequency from 1 to 4.3 MHz, and the receive frequency from 1 to 8 MHz. The collection of 256 samples of RF data, at an offset distance from the transducer face, was performed at 20 MHz digitization rate, which corresponds to approximately 1 cm depth in water. Two particle suspensions are also presented for use as reference scatterers for contrast studies: (a) a suspension of Orgasol (ELF Atochem, Paris, France) particles (approximately 5 microm mean diameter) and (b) a suspension of Eccosphere (New Metals & Chemicals Ltd, Essex, UK) particles (approximately 50 microm mean diameter). A preliminary experiment with the contrast agent Definity (DuPont Pharmaceutical Co, Waltham, MA) showed that the above two materials are suitable for use as a reference for contrast backscatter.

A practice-based approach for converting from proton pump inhibitors to less costly therapy

CONTEXT

Projected cost for lansoprazole, the formulary proton pump inhibitor (PPI) at our institution, was $1.8 million in 1999. While some patients require PPI therapy, many could control their symptoms with a histamine H2-receptor antagonist blocker (H2 blocker) at a much lower cost.

OBJECTIVE

To evaluate a practice-based approach to converting patients from PPIs to H2 blockers.

DESIGN

Before-after study.

SETTING

Portland Veterans Affairs Primary Care Clinics.

INTERVENTION

We developed guidelines and educated clinicians about the use of PPIs and H2 blockers. To help physicians convert appropriate patients from PPIs to H2 blockers, we gave them a list of their patients receiving PPIs, form letters for patients explaining the conversion, and structured prescription forms. Patient lists and e-mail reminders, as well as feedback on institutional performance, were sent to clinicians during the intervention period.

OUTCOME MEASURES

Number of PPI and H2 prescriptions per enrollee and pharmacy costs.

RESULTS

The average number of PPI prescriptions per enrollee at our institution decreased from 0.39 in the 9 months before the intervention to 0.27 in the 9 months after the intervention. The associated pharmacy costs decreased from an average of $43 to $28 per enrollee per quarter, a difference of $15 or a savings of $80,000 per quarter. Accounting for the decrease in medication prices during the study, this difference was $11 per patient per quarter, corresponding to a savings of about $60,000 per quarter. With respect to the conversion process, more than 70% of clinicians felt the intervention had a big impact on how they prescribed PPIs and H2 blockers. Eighty-two percent of clinicians converted patients from PPIs to H2 blockers during clinic time; 56% did so during administrative time. Overall, more clinicians considered the intervention to be helpful rather than a hassle.

CONCLUSIONS

The number of PPI prescriptions decreased during the intervention and was sustained at least three quarters afterward. This low-intensity, practice-based intervention may serve as a model for other health care systems.