Maternal and foetal activin A levels: associations with normal and abnormal labour

In pregnancy the feto-placental unit is the major source of activin A. However, the role(s) of activin A in late pregnancy remain uncertain and controversial. In particular, whether activin A levels alter in association with labour is unclear. In a cross-sectional cohort study, maternal serum samples were collected from women at term prior to elective Caesarean section (n=11), during labour prior to a spontaneous vaginal delivery (n=31), an instrumental vaginal delivery (n=16) or an emergent Caesarean section (n=7). Umbilical artery blood samples were collected from 75 pregnancies, after an elective Caesarean section (n=9), a normal vaginal delivery (n=37), an instrumental vaginal delivery (n=15) or an emergent Caesarean section (n=14). Levels of activin A were measured and compared according to modes of delivery. Maternal, but not foetal, serum activin A was increased significantly in women who were delivered by an intrapartum Caesarean section compared to other modes of delivery. Foetal, but not maternal, serum activin A was significantly correlated with umbilical artery pH. Maternal serum activin A is increased in women undergoing an intrapartum Caesarean section compared to either a vaginal delivery or an elective Caesarean section. The mechanism(s) underlying this observation are not clear.

Management of spinal trauma in 69 cats

This study sought to evaluate a series of clinical and radiological findings on spinal trauma in cats and the outcome that emerged from conservative or surgical treatment using 2 types of spinal stapling: stabilization using a Steinmann pin and coated polypropylene. Case records were reviewed for their diagnostic approaches on the basis of physical and neurological conditions, and concurrent disorders in addition to spinal trauma. Radiological examinations of the vertebral column were carried out using survey radiography, myelography and epidurography. All cases were classified according to etiopathogenesis of the disease. Surgical treatment consisted of decompression (laminectomy, hemilaminectomy and durotomy), or decompression with stabilization which was performed by one of two methods. The first one was the employment of translaminar stapling at the base of a spinous process and the other involved spinal stapling at the spinous process. The spinal lesions were identified as cervical (n = 2), thoracic (n = 35), lumbar (n = 22), sacral and caudal (n = 10). While 19 out of 30 conservatively managed cases recovered, the rest had persistent residual paresis and ataxia. Complete recovery was seen in 4 cats that underwent hemilaminectomy and 3 subjected to laminectomy. Partial recovery was observed in 5 cases involving laminectomy; however, there was no improvement observed in another 2 cases. Each animal was followed for at least a 3-month period to evaluate the clinical assessment of the results following treatment. The results of conservative and operative management of spinal trauma indicated that the type and degree of spinal cord degradation strongly influenced any prognosis. The results emerging from decompressive procedures seemed satisfactory for those cases where instability was not an issue. Both stabilization techniques were not ideal in terms of their methodological versatility or regarding weaknesses of bone structure observed in intra- and postoperative periods. However, translaminar stapling at the base of a spinous process was deemed to be the superior technique.

Dosimetric validation for multileaf collimator-based intensity-modulated radiotherapy: a review

The creation of intricate dose distributions produced by intensity-modulated radiotherapy (IMRT) depends on complex planning systems and specialized mechanical devices. The many possible sources of inaccuracy and the complexity of the dose maps themselves require that a substantial effort be made to ensure that calculated and delivered dose distributions agree. This review provides an overview of the current status of the validation of dose predictions of IMRT planning systems by comparisons with measurements. Emphasis is placed on multileaf collimator- (MLC) based IMRT. Discrepancies between calculations and measurements may be due to any of 3 causes: errors and uncertainties in the dose calculation algorithm, in measurements, or in beam delivery by the accelerator/MLC combination. Some of the factors affecting dosimetry include: the technique employed for modulating the fluence, the dose calculation algorithm and other aspects of the planning system, mechanical limitations of the MLC hardware, dosimetric characteristics of the MLC, such as MLC leakage and rounded leaf ends, the choice of dosimeter, and the measurement geometry and technique. The advantages and drawbacks of various dosimeters including film, ion chambers, thermoluminescent dosimetry, and electronic portal imaging devices are discussed. The steps involved in validating dosimetrically a planning system are outlined, including the various fields that need to be measured, the phantoms that may be used, and measurement techniques. The achievable accuracy of dosimetry for IMRT is discussed.

Serum vitamin A concentrations and growth in children and adolescents in Gansu Province, China

The association between serum vitamin A concentration and growth was assessed in a random sample of 650 children aged 0-14 years and 143 adolescents aged 15-19 years from the four prefectures of Jiayuguan, Linxia, Lanzhou and Tianshui in Gansu Province, China. Serum vitamin A concentrations were measured using a high performance liquid chromatograph. Height and weight were measured with standard methods. The results show that serum vitamin A concentration appeared to be the lowest in the age group 5-9 years which was only 0.28 mg/mL (95% confidence interval [CI]: 0.27-0.30) in males and 0.30 mg/mL (95% CI: 0.28-0.32) in females; and then it gradually increased with age. There was no statistically significant difference between males and females in any of the age groups. There were statistically significant correlations between vitamin A and weight (r = 0.37; P <0.001) and body mass index (r = 0.26; P < 0.001). This study suggests that serum vitamin A concentrations in children and adolescents may affect child growth. Concerted efforts to improve vitamin A status from a very early age become increasingly important if vitamin A has a genuine impact on child growth.

Myopathy with lobulated muscle fibers: evidence for heterogeneous etiology and clinical presentation

The clinico-pathological features of 17 patients displaying a myopathy with lobulated (trabeculated) fibers are reported. All these patients had a limb girdle phenotype and at least 20% of lobulated fibers in their muscle biopsies. There were ten females and seven males. The onset of symptoms ranged from 2 to 55 years (mean 24). The average age at the time of muscle biopsy was 39 (range 3-63). Interestingly, in six patients, high prevalence of lobulated fibers was observed at the second biopsy only, performed on average 11 years after the first or in another muscle. Six patients had a suggestively positive family history. Facial weakness was noted in two patients (genetic study confirmed FSH dystrophy). The course and the severity of weakness varied from one patient to another. Immunohistochemistry and Western blot analyses revealed one Duchenne carrier, one alpha-sarcoglycanopathy, no dysferlinopathy and four calpain deficiencies (including one patient with FSH dystrophy), but SSCP revealed mutation in the calpain gene in only one of the patients. These results show that (1) myopathies with lobulated fibers are clinically and genetically heterogeneous, (2) lack of calpain expression by Western blot analysis is not always associated with null mutation, (3) a molecular diagnosis is made in less than 40% of myopathy with lobulated fibers, (4) when observed, lobulated fibers are most prominent in proximal muscles and require time to appear.

Available space and extracellular transport of macromolecules: effects of pore size and connectedness

Molecular exclusion in tumor tissues is one of the limiting factors for drug delivery to tumor cells. It can be quantified by the available volume fraction of solutes (K(AV)). We found in a previous study that K(AV) of dextran in tumor tissues decreased sharply when the molecular weight (MW) of dextran was increased from 40,000 to 70,000. Outside this range, K(AV) was less sensitive to the MW of dextran. To understand the mechanisms of the MW dependence of K(AV), we investigated K(AV) in tissue phantoms composed of tumor cells in 1% agarose gels, and performed numerical simulations of the available volume fraction in pore networks. We found that the MW dependence of K(AV) in tissue phantoms was similar to that in tumor tissues when the volume fraction of cells in the former was approximately 30%. Our numerical simulations revealed that the sharp decrease in K(AV) required two necessary conditions: (i) the existence of at least two populations of pores and (ii) the lack of connectedness of available pores in the interstitial space. Furthermore, results in this study suggest that it is important to consider not only the local structures of pores but also their connectedness in analyses of molecular transport in tissues.

Determinants of smoking and cessation during and after pregnancy

Smoking during pregnancy is harmful to both the foetus and the woman herself. However, in spite of educational efforts, a substantial proportion of pregnant women continue to smoke and many women who do stop smoking during pregnancy resume smoking following childbirth. To foster successful maternal smoking cessation, public health professionals need to focus on the major determinants of smoking and cessation during and after pregnancy, and then to address these with their intervention efforts. It is important to review contemporary epidemiological evidence on this significant public health issue. We have identified nine cohort studies, published in international peer-reviewed journals, that have examined determinants of smoking and cessation in pregnant women. The results indicate that the determinants of pregnant smoking and cessation include maternal age, dose and duration of smoking, partner's smoking habit, socioeconomic status, level of education, age to start smoking, level of addiction, parity and passive smoking. However, many other psychosocial factors, which may affect smoking status among pregnant women, remain to be identified. Evidence reviewed here suggests that a more focused, integrated approach and a more comprehensive assessment of major determinants of smoking and cessation during pregnancy will be required as part of any future intervention effort.

Climate variation and incidence of Ross river virus in Cairns, Australia: a time-series analysis

In this study we assessed the impact of climate variability on the Ross River virus (RRv) transmission and validated an epidemic-forecasting model in Cairns, Australia. Data on the RRv cases recorded between 1985 and 1996 were obtained from the Queensland Department of Health. Climate and population data were supplied by the Australian Bureau of Meteorology and the Australian Bureau of Statistics, respectively. The cross-correlation function (CCF) showed that maximum temperature in the current month and rainfall and relative humidity at a lag of 2 months were positively and significantly associated with the monthly incidence of RRv, whereas relative humidity at a lag of 5 months was inversely associated with the RRv transmission. We developed autoregressive integrated moving average (ARIMA) models on the data collected between 1985 to 1994, and then validated the models using the data collected between 1995 and 1996. The results show that the relative humidity at a lag of 5 months (p < 0.001) and the rainfall at a lag of 2 months (p < 0.05) appeared to play significant roles in the transmission of RRv disease in Cairns. Furthermore, the regressive forecast curves were consistent with the pattern of actual values.

A short sequence within domain C of duck carboxypeptidase D is critical for duck hepatitis B virus binding and determines host specificity

Virus-cell surface receptor interactions are of major interest. Hepadnaviruses are a family of partially double-stranded DNA viruses with liver tropism and a narrow host range of susceptibility to infection. At least in the case of duck hepatitis B virus (DHBV), host specificity seems controlled partly at the receptor level. The middle portion in the pre-S region of the viral large envelope protein binds specifically to duck carboxypeptidase D (DCPD) but not to its human or chicken homologue. Although domain C of DCPD is implicated in ligand binding, the exact pre-S contact site remains to be determined. We prepared and tested a panel of chimeric constructs consisting of DCPD and human carboxypeptidase D (HCPD). Our results indicate that a short region at the N terminus of domain C (residues 920 to 949) is critical to DHBV binding and is a major determinant for the host specificity of DHBV infection. Replacing this region of the DCPD molecule with its human homologue abolished the DHBV interaction, whereas introducing this DCPD sequence into HCPD conferred efficient DHBV binding. Extensive analysis of site-directed mutants revealed that both conserved and nonconserved residues were important for the pre-S interaction. There were primary sequence variations and secondary structural differences that contributed to the inability of HCPD to bind the DHBV pre-S domain.

The discovery of sulfonylated dipeptides as potent VLA-4 antagonists

Directed screening of a carboxylic acid-containing combinatorial library led to the discovery of potent inhibitors of the integrin VLA-4. Subsequent optimization by solid-phase synthesis afforded a series of sulfonylated dipeptide inhibitors with structural components that when combined in a single hybrid molecule gave a sub-nanomolar inhibitor as a lead for medicinal chemistry. Preliminary metabolic studies led to the discovery of substituted biphenyl derivatives with low picomolar activities. SAR and pharmacokinetic characterization of this series are presented.

Geographic variation of notified Ross River virus infections in Queensland, Australia, 1985-1996

The spatial and temporal variations of Ross River virus infections reported in Queensland, Australia, between 1985 and 1996 were studied by using the Geographic Information System. The notified cases of Ross River virus infection came from 489 localities between 1985 and 1988, 805 between 1989 and 1992, and 1,157 between 1993 and 1996 (chi2(df = 2) = 680.9; P < 0.001). There was a marked increase in the number of localities where the cases were reported by 65 percent for the period of 1989-1992 and 137 percent for 1993-1996, compared with that for 1985-1988. The geographic distribution of the notified Ross River virus cases has expanded in Queensland over recent years. As Ross River virus disease has impacted considerably on tourism and industry, as well as on residents of affected areas, more research is required to explore the causes of the geographic expansion of the notified Ross River virus infections.

[Membranous nephropathy after allogeneic peripheral blood hematopoietic stem cell transplantation--clinicopathologic manifestations of a rare chronic GVHD]

OBJECTIVE

To investigate the clinicopathologic characteristics of renal chronic graft versus host disease (GVHD) after allogeneic peripheral blood hematopoietic transplantation(HSCT).

METHODS

Clinical and pathological data from a patient with post-BMT GVHD were analysed with a related references review.

RESULTS

The patient developed nephrotic syndrome (NS) 8 months after allogeneic HSCT. Renal biopsy revealed irregular thickening of glomerular basement membrane with granular deposits of IgG along it. Electronic microscopy showed electron dense deposits with increased mesangial matrix and cells in subepithelial and mesangial area.

CONCLUSION

NS occurred after HSCT might be an autoimmune glomerulonephritis. Immune suppressor could reduce the incidence of NS in the HSCT patients. Cell-cept had a good efficacy in the treatment and renal biopsy played an important role in the diagnosis and prognosis of renal cGVHD.

Removal of ECG interference from the EEG recordings in small animals using independent component analysis

In experiments involving small animals, the electroencephalogram (EEG) recorded during severe injury and accompanying resuscitation exhibit the strong presence of electrocardiogram (ECG). For improved quantitative EEG (qEEG) analysis, it is therefore imperative to remove ECG interference from EEG. In this paper, we validate the use of independent component analysis (ICA) to effectively suppress the interference of ECG from EEG recordings during normal activity, asphyxia and recovery following asphyxia. Two channels of EEG from five rats were recorded continuously for 2 h. Simultaneous recording of one channel ECG was also made. Epochs of 4 s and 1 min were selected from baseline, asphyxia and recovery (every 10 min) and their independent components and power spectra were calculated. The improvement in normalized power spectrum of EEG obtained for all animals was 7.71+/-3.63 db at the 3rd minute of recovery and dropped to 1.15+/-0.60 db at 63rd minute. The application of ICA has been particularly useful when the power of EEG is low, such as that observed during early brain hypoxic-asphyxic injury. The method is also useful in situations where accurate indications of EEG signal power and frequency content are needed.

Acceleration of dose calculations for intensity-modulated radiotherapy

The requirements and trade-offs between accuracy and speed for radiotherapy dose computations have been discussed for decades. Inverse planning used for intensity-modulated radiotherapy (IMRT) optimization imposes additional demands on dose calculation since it is an iterative process in which dose calculations might be repeated many (10's to 1000's) of times. This work discusses the accuracy and speed issues as related to IMRT dose calculations. A hybrid dose calculation method which accelerates the optimization process is proposed and applied in which a fast-pencil beam (PB) model is used for initial optimization iterations, followed by superposition/convolution (SC) calculations. Optimization dose results are compared for pure PB optimization, pure SC optimization, and PB optimization followed by SC optimization. Plans were evaluated in terms of isodose coverage, dose-volume histograms, and total dose calculation time for five head and neck cases with diverse locations, sizes, and shapes for tumors and critical structures. Patient plans were designed for nine equispaced beams. For one patient, an additional five-beam configuration was tested. We found that gross features of intensity distributions resulting from all schemes were similar, however there were differences in the fine detail. Differences were small between composite dose distributions optimized with PB and SC methods, yet differences in individual beam dose distributions were quite significant. When the SC method was used to compute dose following optimization with PB method, dose differences were reduced significantly both for composite plans and for individual beams. Substantial overall timesavings were observed, allowing IMRT dose planning to become a more interactive activity.

A practical approach to inverse planning for high-precision dose escalated conformal prostate radiotherapy

The problem of choosing the best gantry angles and beam weights for dose-escalated conformal prostate treatment planning is formulated using a mixed-integer linear programming approach, to account for tumour dose homogeneity and dose-volume constraints. The formulation allows the number of beams to be restricted and for some of the beams to be compulsory. The present planning algorithm interfaces with and utilizes the three-dimensional planning capabilities of a commercial treatment planning system. A case study is illustrated, which represents a particularly challenging planning problem due to a large planning target volume and an unusually small bladder. Treatment plans with different numbers of beams are generated to compare with each other and with the standard six-field plan. Significant improvement is shown in the reduction of hot regions within the femoral heads and rectal wall, while not unduly compromising homogeneity constraints for the tumour.

The use of echocardiographic colour kinetic wall motion to differentiate broad complex tachycardia

Discrimination between supraventricular tachycardia (SVT) with aberrant conduction from ventricular tachycardia (VT) is vital for the safe and effective management of both conditions. Electrocardiographic algorithms for the differentiation of broad complex tachycardia are complex and difficult to implement in the acute setting, with misdiagnosis occurring in up to 40% of acute presentations. This case study shows the potential for echocardiographic colour kinesis (eck) to support electrocardiographic differentiation. A 74-year old man in sinus rhythm with left bundle branch block (lbbb), a history of myocardial infarction and recurrent sustained VT underwent eck analysis of wall motion propagation during a programmed electrical ventricular stimulation study. Sequential 40 ms time frames of echocardiographic colour coded endocardial wall motion velocity were recorded on video during both induced VT of lbbb configuration and near isochronic atrially paced tachycardia in lbbb. During VT there was initial eck propagation of ventricular septal wall motion from the apex to the atria secondary to electrical depolarisation. During atrially paced tachycardia initial eck motion developed in the interatrial septum and atrial wall followed by propagation in the ventricular endocardial septal wall motion from the atria toward the ventricular apex. This eck technique potentially could be used to support the electrocardiographic diagnosis of a broad complex tachycardia.

Dynamic changes of interleukin-1, interleukin-6 and tumor necrosis factor in intermingled skin graft in burned rats

OBJECTIVE

To compare the dynamic changes of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF) in intermingled skin graft with those in other types of skin grafts in rats.

METHODS

A 10%-15% third-degree burn was created in 180 Sprague-Dawley (SD) rats. After removing the scar, skin grafts were performed on the open wounds immediately with autoskin (aus, n=54), alloskin (als, n=54) and intermingled skin (n=36). That is to say, in the intermingled skin graft, a big piece of alloskin (mals) was grafted first, and 3 days later, small pieces of autoskin (maus) wer e embedded in the alloskin. The rest 36 rats were taken as the controls. And the biological activities of IL-1, IL-6 and TNF in graft sheets in each group were detected after skin graft.

RESULTS

The levels of IL-1, IL-6 and TNF in the aus group decreased steadily after their initial elevations, whereas in the als group they increased significantly and kept on the peak level in the later phases. In the in termingled group, there appeared a lowest IL-1 level in the mals and a highest one in the maus simultaneously at 7 (4) days (The number out of parenthesis is t he days after transplanting with alloskin sheets, and the number in parenthesis is the days after embedding autoskin sheets in the intermingled skin graft. Similarly hereinafter.) after skin graft (P<0.01), and the high level in the maus abruptly decreased at 14 (11) days after skin graft. At exactly the same phase on day 7 (4), a prominent peaked IL-6 in the mals occurred. In the later phases, the levels of TNF remained relatively low both in the m als and in the maus. From day 7 (4) on, each cytokine fluctuation in the mals synchronized with that in the maus. The longer the post transplantation period lasted, the more the positive cytokine correlated between the mals and the maus.

CONCLUSIONS

The low levels of IL-1 and TNF may be important f actors to lighten the intensity of local rejection in the intermingled skin graft. The temporarily peaked IL-6 is both an inducer which induces the production of local IL-1 receptor antagonists and soluble TNF receptors and a signal which indicates a local enhancement of Th(2) cells. The mild rejection process and th e synchronized cytokine level during the later phases suggest a possible chimerism between the mals and the maus.

Three membrane-proximal amino acids in the human parainfluenza type 2 (HPIV 2) F protein are critical for fusogenic activity

In this study, we investigated the role of the membrane-proximal region of the human parainfluenza virus type 2 (HPIV2) F protein by mutational analysis, including deletion, insertion, and substitution. Deletion or replacement of the entire 12 amino acid region (aa 474-485) of the HPIV2 F protein completely abolished its fusion activity when coexpressed with the HPIV2 HN protein. Deletion of groups of four of aa 478-485, single alanine, or other amino acid substitutions among aa 478-485 had minimal or limited effects on HPIV2 F/HN-induced cell fusion. However, a significant reduction in, or complete inhibition of, fusion activity was observed when aa 474-477 were deleted, or the N475, F476, or F477 residues were singly substituted with alanine. In addition, insertions of four amino acids at this region or deletion of eight or more amino acids significantly reduced F protein fusion activity. The oligomerization patterns and levels of cell surface expression of the mutant F proteins were compared to those of the wild-type HPIV2 F protein. The mutant HPIV2 F proteins defective in fusion were also found to be unable to initiate hemifusion, indicating that there is a specific requirement for three specific amino acids as well as the spacing in this region for initiating lipid mixing.

Numerical simulations of angiogenesis in the cornea

Angiogenesis plays important roles in many physiologic and pathologic processes in the body. To understand mechanisms of angiogenesis, we developed a mathematical model for quantitative analysis of various biological events involved in angiogenesis. Our model was focused on two-dimensional angiogenesis in the cornea. The model considered diffusion of angiogenic factors, uptake of these factors by endothelial cells, and randomness in the rate of sprout formation and the direction of sprout growth. Our simulation results indicated that redistribution and uptake of angiogenic factors during angiogenesis had significant effects on the structure of vascular networks. A decrease in the uptake rate resulted in increases in vessel density, self-loop formation, and front migration speed of vascular networks. The randomness in the direction of sprout formation determined the curvature of vessels, whereas the probability of sprout formation from a vessel segment had a significant effect on the total number of vessels in vascular networks. The vascular networks generated in numerical simulations were similar to those observed experimentally. The mathematical model developed in this study can be used to evaluate effects of individual factors on angiogenesis, understand mechanisms of interactions among different factors during angiogenesis, and generate experimentally testable hypotheses.

Antioxidant properties of carvedilol and metoprolol in heart failure: a double-blind randomized controlled trial

Animal and human studies have shown that carvedilol has significant antioxidant properties compared with other beta-blockers. The objective of this study was to determine if these antioxidant effects are detectable in patients with heart failure and to compare carvedilol with the selective beta-blocker metoprolol. Twenty-four patients with chronic heart failure were randomly assigned to receive either carvedilol or metoprolol in a double-blind control trial for 12 weeks in a University teaching hospital clinic. Blood pressure, heart rate, exercise tolerance, left ventricular ejection fraction, plasma total antioxidant status, erythrocyte superoxide dismutase, and glutathione peroxidase activities were determined at baseline and every 4 weeks up to 12 weeks. The results showed that erythrocyte superoxide dismutase and glutathione peroxidase were significantly reduced in carvedilol treated patients after 12 weeks of therapy, whereas metoprolol had no significant effect, although the clinical improvement over the short-term was similar with both drugs. Thus carvedilol, in addition to improving symptoms in heart failure, also possesses significant antioxidant properties. Whether this additional action influences long-term outcome is at present unknown.