Altered phenotype of dextran sulfate sodium colitis in interferon regulatory factor-1 knock-out mice

BACKGROUND AND AIMS

Interferon regulatory factor-1 (IRF-1) is a transcription factor with antiviral, proinflammatory and tumor suppressor properties. We examined the role of IRF-1 in dextran sulfate sodium colitis, a murine model of inflammatory bowel disease, to determine if absence of the gene would protect against colitis.

METHODS

C57BL/6J mice with a targeted disruption of IRF-1 and wild-type C57BL/6J controls received five 7-day cycles of 2% dextran sulfate sodium alternating with five 7-day cycles of water. Colonic tissue was formalin fixed for histological analysis and total RNA extracted for gene chip and SYBR green real-time polymerase chain reaction (PCR) analysis.

RESULTS

Histological analysis revealed increased distortion of crypt architecture in the dextran sulfate sodium-treated, IRF-1 -/- animals as compared to dextran sulfate sodium-treated wild-type animals. Five of 15 dextran sulfate sodium-treated IRF-1 -/- mice, but only one of 14 dextran sulfate sodium-treated wild-type mice, developed colonic dysplasia. Microarray analysis comparing colonic gene expression in IRF-1 -/- and wild-type animals revealed decreased expression of caspases, genes involved in antigen presentation, and tumor suppressor genes in the IRF-1 -/- animals. Increased expression of genes involved in carcinogenesis and immunoglobulin and complement genes was also noted in the knock-out animals.

CONCLUSIONS

Absence of IRF-1 is not protective in dextran sulfate sodium colitis.

Modeling mental navigation in scenes with multiple objects

Various lines of evidence indicate that animals process spatial information regarding object locations differently from spatial information regarding environmental boundaries or landmarks. Following Wang and Spelke's (2002) observation that spatial updating of egocentric representations appears to lie at the heart of many navigational tasks in many species, including humans, we postulate a neural circuit that can support this computation in parietal cortex, assuming that egocentric representations of multiple objects can be maintained in prefrontal cortex in spatial working memory (not simulated here). Our method is a generalization of an earlier model by Droulez and Berthoz (1991), with extensions to support observer rotation. We can thereby simulate perspective transformation of working memory representations of object coordinates based on an egomotion signal presumed to be generated via mental navigation. This biologically plausible transformation would allow a subject to recall the locations of previously viewed objects from novel viewpoints reached via imagined, discontinuous, or disoriented displacement. Finally, we discuss how this model can account for a wide range of experimental findings regarding memory for object locations, and we present several predictions made by the model.

The evaluation and treatment of female urinary incontinence--a comparison of clinical practice in the Republic of Ireland with the recommendations of the International Continence Society

In 1998 the International Continence Society (ICS) developed a set of recommendations for the diagnostic evaluation and treatment of urinary incontinence. The aim of this study was to determine to what extent current clinical practice in the Republic of Ireland correlated with the ICS recommendations. We personally interviewed 100 gynaecologists at units around Ireland. Participants were presented with two clinical scenarios, one described a patient with predominantly genuine stress incontinence, the other described a patient with an overactive bladder. Ninety-five (95%) requested a midstream urine sample for culture and sensitivity, and 74 (74%) considered urodynamics an appropriate initial investigation for a woman with stress incontinence. Physiotherapy was recommended as a first line treatment for stress incontinence by 76 (76%). Burch colposuspension, chosen by 55 (55%), was the most common first line surgical procedure. Other first line surgical procedures were TVT [31(31%)] Marshall-Marchetti-Krants procedure [5(5%)], anterior colporrhaphy [4 (4%)] and a variety of other procedures [5 (5%)]. When considering the initial investigation for a woman with an overactive bladder, 95 (95%) asked for a midstream urine sample for culture and sensitivity and 85 (85%) requested urodynamic investigations. Initial management of this condition included anticholinergic therapy alone [57 (57%)], anticholinergic therapy combined with bladder retraining [36 (36%)], bladder retraining alone [5 (5%)], and cystoscopy and bladder distension 2 (2%). Seventy-six (76%) felt that cystoscopy was an appropriate investigation for a woman with symptoms of an overactive bladder who has failed to respond to initial therapy. The study reveals a significant degree of diversity in the evaluation and management of patients who present with symptoms of urinary incontinence. It also highlights a number of areas where current clinical practice deviates from the recommendations of the ICS. In particular, there is a high and inappropriate use of urodynamics in the initial management of these patients.

Persistent Blurred Vision After Blepharoplasty and Ptosis Repair

BACKGROUND

Visual disturbance after upper (eyelid) blepharoplasty is a relatively common postoperative complaint. Recent ophthalmology literature has demonstrated alternations of corneal curvature after procedures that reposition the upper eyelid using corneal topography. Astigmatic changes induced by eyelid repositioning may be a cause of persistent blurred vision after upper eyelid procedures. This observation has not been reported in the facial plastic literature.

OBJECTIVE

To determine the incidence of persistent visual disturbance after upper blepharoplasty.

METHODS

A retrospective review of upper blepharoplasty by 1 facial plastic surgeon and 2 oculoplastic surgeons during the year 2000. Patient interviews were conducted via telephone.

RESULTS

A total of 146 patients were identified, and 106 of them responded to the study request. Six patients (5.7%) had subjective visual acuity changes 1 year after upper blepharoplasty, and 4 of the 6 patients had combined blepharoplasty and ptosis repair. Three patients had worse vision, 2 had improved vision, and 1 was unable to wear rigid contact lenses because of fogging.

CONCLUSIONS

Prior studies have shown that most patients have measurable astigmatic changes 3 months after blepharoplasty and ptosis repair. We found that only a small percentage of them have persistent subjective symptoms 1 year postoperatively. It is important for facial plastic surgeons to properly advise patients, especially those with combined procedures, that upper eyelid repositioning procedures may induce long-term vision changes. Patients may need to obtain new prescription spectacles and contact lenses postoperatively.

Variability in position of the subthalamic nucleus targeted by magnetic resonance imaging and microelectrode recordings as compared to atlas co-ordinates

BACKGROUND

Traditional methods for localisation of target nuclei for deep brain stimulation (DBS) have used brain atlas co-ordinates for initial targeting. It is now possible to visualise the subthalamic nucleus (STN) on magnetic resonance imaging (MRI) and determine the individual variability of its position.

METHODS

The present study was performed in patients undergoing STN DBS for Parkinson's disease. The STN was directly targeted from axially obtained MRI and verified with microelectrode recordings. Postoperatively, the most effective contact was identified for each patient, and its position was calculated.

RESULTS

Fifty electrodes were inserted in 25 patients. The target position varied considerably in relation to the mid-commissural point. The mean effective contact position lies just dorsal to the location of the STN in a standard brain atlas.

CONCLUSION

The STN varies in position, and can be accurately targeted from MRI alone.

Audit of thromboprophylaxis in women undergoing caesarean section

Thromboembolism is a major cause of maternal mortality. Pregnancy is associated with an increased risk of thromboembolic diseases, with an even greater risk in women undergoing caesarean section. Since the introduction of the RCOG guidelines in 1995 on thromboprophylaxis for women undergoing caesarean section, there has been a significant reduction in the number of women dying from pulmonary embolism in the UK. The aims of our study was to conduct an audit cycle to assess our compliance with RCOG guidelines for thromboprophylaxis in women undergoing caesarean section to introduce changes in practice based on the observations of this audit, and to re-audit our practice to assess the effect of the changes. A retrospective audit of 100 women undergoing caesarean section was done in the Rotunda Hospital in June 2001. Changes in practice were introduced based on the findings of this audit. Obstetricians were asked to complete a checklist pre-operatively and to assign the patients a risk category-low, moderate or high. Prophylaxis was prescribed based on this risk assessment. Following the introduction of this change in practice, we re-audited 100 women delivered by caesarean section in June 2002. In the first audit, risk assessment was as follows: 20 low, 75 moderate and 5 high. Twenty-one of 75 (28%) of moderate risk patients in the first audit received appropriate prophylaxis. In the re-audit, risk assessment was as follows: 33 low, 66 moderate and 1 high. Following the introduction of new clinical practice, 45 of 66 (68%) of those in the moderate risk group received appropriate prophylaxis. All women in the low risk groups received appropriate prophylaxis in both audits. Our audit cycle of thromboprophylaxis in women undergoing caesarean section has demonstrated that the introduction of new clinical practice resulted in greater compliance with the RCOG guidelines, but further improvement could be achieved. These observations are discussed and recommendations are made to further improve compliance with RCOG guidelines.

Use of the NeuroMate Stereotactic Robot in a Frameless Mode for Movement Disorder Surgery

BACKGROUND/AIMS

To evaluate the use of the NeuroMate stereotactic robot with a novel ultrasound registration system for movement disorder surgery (MDS).

METHODS

Using the robot in a frameless mode, 51 patients underwent MDS. Surgical planning was carried out using MRI data obtained more than 24 h before surgery.

RESULTS

37 out of 50 targets in the subthalamic nucleus were satisfactorily identified with a single microelectrode trajectory and the final electrode positions were at a mean distance of 1.7 mm from the calculated target. There was a significant improvement in motor scores of the Unified Parkinson's Disease Rating Scale III (off medication) at 6 (43%) and 18 months (51.7%) compared to pre-operative scores (p < 0.05).

CONCLUSIONS

The frameless robot using only MRI data can be used for MDS. The temporal separation of imaging from the surgical procedure provides additional time for detailed image analysis and planning.

Deep brain stimulation of the subthalamic nucleus: effectiveness in advanced Parkinson's disease patients previously reliant on apomorphine

OBJECTIVES

To assess the efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with advanced Parkinson's disease previously reliant on apomorphine as their main antiparkinsonian medication.

METHODS

Seven patients with motor fluctuations despite optimal medical treatment given as predominantly apomorphine infusion (n=6), or intermittent apomorphine injections (n=1) underwent bilateral STN DBS using frameless stereotactic surgery. Standard assessments of parkinsonism and motor fluctuations, using Unified Parkinson's Disease Rating Scale (UPDRS) were performed before and six months after surgery. Assessments were performed both on and off medication, and postoperative with the stimulators switched on and off.

RESULTS

Bilateral STN DBS improved motor scores (UPDRS III) by 61% when off medication (p<0.05). Clinical fluctuations (UPDRS IV items 36-39) were reduced by 46.2% (p<0.05). Total daily apomorphine dose was reduced by 68.9% (p<0.05) and apomorphine infusion via a pump was no longer required in four patients. There were no operative complications. Two patients required treatment for hallucinations postoperatively but there was no significant change in mini-mental state examination.

CONCLUSIONS

In patients with advanced Parkinson's disease, previously reliant on apomorphine, bilateral STN DBS is an effective treatment to reduce motor fluctuations and enable a reduction in apomorphine use.

A new predictor of cephalopelvic disproportion?

Cephalopelvic disproportion (CPD) is a recognised obstetric problem with potential risk to both mother and infant. Identification of those mothers at risk of CPD is difficult and has concentrated in the past on such measurements as maternal shoe size and height. Our objective in this study was to examine new anthropomorphic parameters as indicators of CPD. This was a case controlled study of sixty consecutive women, and their partners, who had caesarean section performed for CPD and 60 case matched controls. Measurements included maternal and paternal head circumference, height, shoe-size, body mass index (BMI), infant weight and head circumference. Parity, gestation at delivery, and mode of onset of labour were recorded. Data were analysed using Stata Release 6. Prognostic factors were tested for association with CPD using conditional logic regression. The most important anthropomorphic risk factors for CPD were maternal head circumference in relation of height (P < 0.001), and paternal head to height ratio (P = 0.017). Head to height ratio is taken as the head circumference in centimeters divided by the height in metres. Body mass index was higher in CPD cases (maternal case mean = 27.1, control mean = 25.5; paternal case mean = 27.2, control mean = 26.2). Infant head circumference was not a predictor. Primiparity was an important independent predictor (P<0.001), regardless of the mode of onset of labour. Maternal or paternal shoe-size, induction of labour and gestation at delivery were not predictors. The risk profile for CPD which emerges is one of a tall father where both mother and father have large head-to-height ratios.

Pathways to care in children at risk of attention-deficit hyperactivity disorder

BACKGROUND

There is underdiagnosis of and low use of specialist services for attention-deficit hyperactivity disorder (ADHD).

AIMS

To quantify the filters in the help-seeking pathway through primary care and to investigate factors influencing progress for children at risk of ADHD.

METHOD

A total of 127 children (5-11 years old) with pervasive hyperactivity who passed each filter (primary care attendance and general practitioner (GP) recognition of disorder) were compared with those who had not.

RESULTS

Primary care attendance was only associated with parental perception of the behaviour as problematic (OR 2.11; 95% CI 1.11-4.03). However, GP recognition was related to both parent and child factors - parental request for referral (OR 20.83; 95% CI 3.05-142.08) and conduct problems (OR 1.48; 95% CI 1.04-2.12). GP non-recognition was the main barrier in the pathway to care; following recognition, most children were referred.

CONCLUSIONS

Parents can be regarded as the main gatekeepers for access to specialist services.

Pharmacological salvage of a combined distal bypass and free flap with catheter-directed thrombolysis

With recent improvements in microvascular techniques, the use of combined distal bypass and free-flap transfer has been advocated for salvaging the critically ischaemic limb in extreme conditions. Distal bypass, however, carries an inherent risk of graft failure due to thrombosis, and this may threaten the viability of the free flap and, indeed, the lower limb. We present the case of a 66-year-old man with acute-on-chronic ischaemia of his left leg and rectus abdominis free flap. Despite a prolonged ischaemic time of 72 h, both were successfully salvaged using catheter-directed recombinant tissue plasminogen activator. This is previously unreported in the literature.

Chimerism Analysis in Sex-Mismatched Murine Transplantation Using Quantitative Real-Time PCR

Murine experimental stem cell transplantations require the accurate discrimination and quantification of donor cells from host cells. A Y-chromosome-specific, quantitative real-time PCR (kinetic PCR) protocol for blood-derived DNA was developed. The assay sensitivity was extremely high with accurate detection of only 10 pg (six copies of Y target DNA) in a variable background of female DNA background ranging from 2.5 to 50 ng. The dynamic range of the assay provided accurate results ranging from 2.2 × 10−2% to 100% of male DNA in female background. The kinetic PCR assay can be used in all mouse strains, and a sample size as low as 2.5 ng total DNA is sufficient for analysis. Therefore, kinetic PCR allows engraftment kinetic studies on repeated blood draws of individual animals with no need for sacrifice. Compared to conventional PCR, the assay is much simplified, as neither the accurate adjustment of sample DNA concentration nor a post-reaction analysis procedure is required. The procedure is simple, free of radioactivity, and permits a throughput of 500–600 reactions per day.

Chimerism analysis in sex-mismatched murine transplantation using quantitative real-time PCR

Marine experimental stem cell transplantations require the accurate discrimination and quantification of donor cells from host cells. A Y-chromosome-specific, quantitative real-time PCR (kinetic PCR) protocol for blood-derived DNA was developed. The assay sensitivity was extremely high with accurate detection of only 10 pg (six copies of Y target DNA) in a variable background of female DNA background ranging from 2.5 to 50 ng. The dynamic range of the assay provided accurate results ranging from 2.2 x 10(-2)% to 100% of male DNA in female background. The kinetic PCR assay can be used in all mouse strains, and a sample size as low as 2.5 ng total DNA is sufficient for analysis. Therefore, kinetic PCR allows engraftment kinetic studies on repeated blood draws of individual animals with no need for sacrifice. Compared to conventional PCR, the assay is much simplified, as neither the accurate adjustment of sample DNA concentration nor a post-reaction analysis procedure is required. The procedure is simple, free of radioactivity, and permits a throughput of 500-600 reactions per day.

Perinatal outcome in unbooked women at the Rotunda Hospital

To determine the incidence and outcome of unbooked pregnancies in women at the Rotunda Hospital Retrospective case control study. All unbooked deliveries in the Rotunda Hospital over a two year period were identified and matched with a control. Control patients were selected as the next delivery after each case and were regular antenatal attenders. Demographic and obstetric data was collected from each case and control and compared using the Chi-square test. There were 101 unbooked women in the study, during this time there were 11522 deliveries giving an incidence of unbooked pregnancies of 0.88%. Unbooked women were found to be young, multiparous, unemployed and unmarried. They were more likely to deliver by spontaneous vaginal delivery to preterm, low birth weight infants and were at greater risk of a stillbirth and neonatal death. Unbooked pregnancies account for a small proportion of our antenatal population. However, perinatal outcome is significantly worse in unbooked patients compared to those who are regular antenatal attenders.

The effects of antiretroviral therapy on HIV-1 RNA loads in seminal plasma in HIV-positive patients with and without urethritis

BACKGROUND

High seminal plasma HIV-1 RNA loads (SVL) have been reported during gonococcal, non-gonococcal and chlamydial urethritis in patients not taking antiretroviral therapy.

OBJECTIVE

To examine if urethritis leads to increased SVL in HIV-positive patients taking antiretroviral therapy.

METHODS

Men who had been taking therapy for at least 3 months were recruited: 24 had urethitis (PWU) and 16 were without urethritis (controls). At three visits, 1 week apart, blood plasma viral load (BVL) and SVL were assayed by quantitative polymerase chain reaction or the NASBA assay.

RESULTS

Most subjects had undetectable SVL (18 PWU, 13 controls). Among those with undetectable BVL prior to first study visit, virus was undetectable in semen in 5/5 episodes of chlamydial urethritis, 6/7 episodes of non-gonococcal urethritis and 4/5 cases of gonococcal urethritis. Two PWU with undetectable BVL just prior to the first study visit had low to moderate SVL, which became undetectable by visit 2 following treatment. Of nine subjects with detectable SVL, eight had detectable BVL (3/3 controls and 5/6 PWU). Of these, 1/3 controls and 4/5 PWU (all with gonococcal urethritis) had poorly controlled BVL just prior to the first study visit. These four PWU had high SVL and one had higher levels in semen than in blood. This patient's SVL was reduced more than 20-fold following treatment for gonococcal urethritis.

CONCLUSIONS

Effective antiretroviral therapy appeared to limit the effect of urethritis on SVL. When BVL was poorly controlled by antiretroviral therapy, high SVL occurred during gonococcal urethritis, increasing the potential risk of transmitting both wild type and drug resistant strains of HIV-1.

Importance of radiotherapy in the outcome of patients with primary CNS lymphoma: an analysis of the CHOD/BVAM regimen followed by two different radiotherapy treatments

PURPOSE

To assess the effect of a reduced dose of radiotherapy (RT) in patients with primary CNS lymphoma (PCNSL) responding to the cyclophosphamide, doxorubicin, vincristine, and dexamethasone (CHOD)/carmustine, vincristine, methotrexate, and cytarabine (BVAM) regimen.

PATIENTS AND METHODS

Patients received one cycle of CHOD and two of BVAM. In the first trial, all 31 patients received 45-Gy whole-brain RT (CHOD/BVAM I). In the second, with 26 patients, RT dose was reduced to 30.6 Gy if there was a complete response (CR) after chemotherapy (CHOD/BVAM II).

RESULTS

Age, performance status, and chemotherapy received were similar in both protocols. CR rate at the end of all treatment was 68% for CHOD/BVAM I and 77% and for CHOD/BVAM II. Treatment modality was the only predictor of relapse, with 3-year relapse risks of 29% and 70% for CHOD/BVAM I and II, respectively. This was specifically important in the 25 patients less than 60 years old (3-year relapse risk, 25% v 83%; P =.01). The 5-year overall survival (OS) was 36%. Age (< 60 v > or = 60 years) was the only predictor for OS in the multivariate analysis (relative risk, 2.1; 95% confidence interval, 1.4 to 2.8). RT dose was the only predictor of OS in patients younger than 60 years old who achieved CR at the end of all treatment (3-year OS, 92% v 60% for patients receiving 45 or 30.6 Gy, respectively; P =.04).

CONCLUSION

Reduction of the RT dose from 45 Gy to 30.6 Gy in patients younger than 60 years old with PCNSL who achieved CR resulted in an increased risk of relapse and lower OS.

A new device for the measurement of disease severity in patients with intermittent claudication

OBJECTIVES

To assess a new method of determining functional impairment in patients with intermittent claudication, the Double Physiological Walking Test (DPWT) using the PADHOC (Peripheral Arterial Disease Holter Control) device, against a standard treadmill test.

DESIGN

Patients with intermittent claudication presenting to the department were considered for both the DPWT and a standard treadmill test.

METHODS

initial claudicating distance, maximal walking distance and speed of walking were determined for both parts of the DPWT. Initial claudicating distance and maximal walking distance were determined from the treadmill test. Comparisons were made between the treadmill test and the DPWT.

RESULTS

The treadmill test was unable to be performed in 22% of patients due to defined contraindications. There were strong correlations in both walking distances and disease severity when comparing the DPWT and the treadmill test. Patients in whom the treadmill test was contraindicated had significantly shorter walking distances on the DPWT than those who were able to complete a treadmill walking test.

CONCLUSIONS

The DPWT correlates strongly with walking distances obtained from a standard treadmill test. However, the PADHOC can be used in a number of differing locations and settings as well as in patients in whom a treadmill test is contraindicated. It therefore has a role to play in the initial assessment of patients presenting with intermittent claudication.

Identification of gene clusters differentially expressed during the cellular injury responses (CIR) to cisplatin

The goal of this study was to identify changes in mRNA levels in tumour cells after a toxic exposure to cisplatin (IC(99)dose). Using suppression-subtractive hybridization (SSH) 2 cDNA libraries were created, an UP library (202 cDNA fragments) and a DOWN library (153 cDNA fragments). Using reversed Northern hybridization 16 and 30 fragments were truly differentially expressed in the UP and DOWN libraries, respectively. Most prominent in the UP library were the mitochondrial and injury response clusters and in the DOWN library the cytoskeletal, protein synthesis and signalling clusters. These distinct clusters potentially represent an expression profile of the cisplatin-induced cellular injury response.