Endogenous excess cortisol production and diabetes mellitus as predisposing factors for pulmonary cryptococcosis: a case report and literature review

Pulmonary cryptococcosis usually occurs as an opportunistic infection in immunocompromised patients. Endogenous Cushing's syndrome is associated with cortisol excess and can predispose to development of cryptococcal infections. We report a case of diabetic patient with ACTH secreting pituitary tumour who developed a cavitating lung mass. Computed tomography-guided biopsy of the lesion revealed mucicarminophilic budding forms of cryptococcus. Broncheoalveolar lavage culture grew Cryptococcus neoformans. There was radiological response to treatment with liposomal Amphotericin, but patient ultimately succumbed to septicemia and multiorgan failure. Opportunistic infections with organisms like Cryptococcus neoformans, should be considered in patients with endogenous Cushing's syndrome and a pulmonary infiltrate.

Do flowers wave to attract pollinators? A case study with Silene maritima

To answer the question whether flowers wave to attract pollinators, we determine: (1) the heritability of floral mobility; (2) whether wavy flowers attract more insects; (3) does the duration of pollination affect seed set; and (4) the relationship between seed set and floral mobility. The pollination ecology of Silene maritima was investigated. Flowers on stalks of different waviness were used to investigate the effect of floral movement on pollinator visits. There is heritable variation in both direct and indirect estimates of floral mobility. The highest insect total visitation times were associated with medium length thin stalks that were visited more frequently and by more insect species. Although mean individual visit durations were less than those of less mobile flowers, this was compensated for by increased visits. Observations of controlled pollinations show that when the visit times are low, so is seed set and therefore low and high mobility flowers might suffer from reduced fitness. Combining these observations provides a mechanism that could be driving stabilizing selection for flower stalk traits, with a trade-off applying between waving to attract pollinators and not being too mobile as to prevent effective pollination. Further evidence for stabilizing selection is provided by the relationship observed in the field between seed set and floral mobility where the highest levels of fitness was associated with intermediate levels of floral waving.

EuPA achieves visibility - an activity report on the first three years

Plans for the European Proteomics Association (EuPA) were conceived and established during 2004 and 2005, and culminated in the formal inception of the organisation during the 4th HUPO World Congress held in Munich in 2005. The mission from the outset has been three-tiered and is to: i) strengthen the national Proteomics organizations in their efforts; ii) to co-ordinate and provide educational programs, and iii) to advance the networking of scientists through meetings, workshops and student exchange. Linked to the mission were objectives to emphasise the benefits and contributions of Proteomics to biological and industrial researchers, the general public and science policy makers in Europe. In addition, the EuPA set out to promote scientific exchange for all applications and technology development related to Proteomics, and coordinate joint activities of national Proteomics societies at the European level. To achieve these tasks an organisational structure was conceived whereby four Activity Committees (Conferences/Communications, Education, EuPA-HUPO-Interactions and Funding) were implemented and a General Council consisting of all member countries. The remarkable rise and progress the EuPA has achieved in this small time frame is reported here.

Presence of corticotrophin-releasing factor and/or tyrosine hydroxylase in cells of a neural brain-testicular pathway that are labelled by a transganglionic tracer

Our laboratory has shown that male testosterone levels are not solely controlled by the release of hypothalamic gonadotrophin-releasing hormone and pituitary luteinising hormone, but are also regulated by a multisynaptic pathway connecting the brain and the testis that interferes with the testosterone response to gonadotrophins. This pathway, which is independent of the pituitary gland, is activated by an i.c.v. injection of either the stress-related peptide corticotrophin-releasing factor (CRF) or of beta-adrenoceptor agonists, both of which alter androgen release and decrease levels of the peripheral-type benzodiazepine receptor and the steroidogenic acute regulatory protein within Leydig cells. Our original studies used the retrograde transganglionic tracer pseudorabies virus (PRV) to map progression of the virus from the testes to upper brain levels. The present study aimed to extend this work by identifying the regions where CRF and catecholamine neurones represented components of the stress-activated, brain-testicular pathway that prevents testosterone increases. To this end, anaesthetised adult male rats received an intra-testicular injection of PRV. Using immunofluorescence, we identified co-labelling of PRV and either CRF or tyrosine hydroxylase (TH), the enzyme responsible for biogenic amine synthesis. Co-labelling of PRV and CRF was found in the bed nucleus of the stria terminalis, the paraventricular nucleus of the hypothalamus (PVN) and the central amygdala. Co-labelling of PRV and TH was found in the PVN, substantia nigra, A7/Kölliker-Fuse area, area of A5, locus coeruleus, nucleus of solitary tract, area of C3, area of C2 and the area of C1/A1. These results indicate that most cell groups of the ventral noradrenergic pathway have neurones that are a part of the brain-testicular pathway. This suggests that the stress hormones CRF and catecholamines may act as neurotransmitters that signal the pathway to inhibit increases in plasma testosterone levels.

The effect of exercise on von Willebrand factor and ADAMTS-13 in individuals with type 1 and type 2B von Willebrand disease

BACKGROUND

The effect of exercise on von Willebrand factor (VWF) and ADAMTS-13 levels in individuals with von Willebrand disease (VWD) has never been reported.

OBJECTIVES

The aim was to quantify the effect of a standardized exercise protocol on individuals with type 1 and type 2B VWD.

PATIENTS/METHODS

Thirty individuals from three groups (10 controls, 11 with type 1 VWD and 9 with type 2B VWD) completed the Standard Bruce Protocol Treadmill Test. A bleeding questionnaire was administered and blood tests were performed pre- and immediately postexercise. The groups were well matched for age, gender and body mass index (BMI).

RESULTS

There was a correlation in all groups between the metabolic equivalents (METS) achieved and the degree of change of VWF and FVIII:C levels (P < 0.002, Pearson's correlation). There was a significant postexercise increase in VWF:Ag, VWF:RCo, FVIII:C and activated VWF levels in both the control group and in the type 2B VWD group, but not in the type 1 VWD group. Specific to the type 2B VWD group was an increase in the percentage of high molecular weight multimers (P = 0.022), a decrease in the mean platelet count compared with the other groups (P < 0.001) and an increase in the ADAMTS-13 level (P = 0.001).

CONCLUSIONS

There are significant differences in the effects of exercise on individuals with type 1 and type 2B VWD compared with controls. Further clinical studies are necessary to evaluate exercise as a therapeutic option in VWD.

Regulamentação das cadeias de fornecedores para proteger a saúde e segurança de trabalhadores vulneráveis

Um grande número de pesquisas recentes evidencia que as estratégias de subcontratação de serviços e produtos e a contratação de trabalhadores contingentes, nas chamadas cadeias de fornecedores, afetam os processos de planejamento e tomada de decisão de maneira a solapar seriamente a Segurança e Saúde dos Trabalhadores (SST). Complexas cadeias de fornecedores apresentam um desafio para a ação de regulamentação, pois a responsabilidade legal pela SST está difusa dentre um maior espectro de atores sociais, com mais dificuldades para focalizar os principais tomadores de decisão, e as agências de governo encontram maiores dificuldades logísticas na tentativa de proteger legalmente os trabalhadores contingentes, como os temporários e terceirizados. Em certo número de indústrias, esses problemas têm instigado novas formas de intervenção regulamentadora, incluindo mecanismos para alocar a responsabilidade legal no topo das cadeias de fornecedores, dispositivos de acompanhamento contratual e crescente envolvimento da indústria, dos sindicatos e da comunidade na fiscalização do cumprimento da lei. Depois de descrever os problemas acima referidos, este artigo examina recentes esforços para regulamentar as cadeias de fornecedores para salvaguardar a SST no Reino Unido e na Austrália.

Ultrasound localisation and removal of non-palpable Implanon implants

BACKGROUND

Implanon is the trade name for a contraceptive implant that releases etonogestrel over a 3-year period. The rod is inserted into the subdermis of the upper arm. The implant should be palpable and easily removed through a small incision.

AIMS

To determine whether ultrasound is an accurate means of localising and guiding removal of non-palpable Implanon implants.

METHODS

All patients referred to The Northern Hospital, between March 2002 and October 2005, for localisation and/or removal of their non-palpable Implanon implants were included in this study. Ultrasound was used to locate the implants, the implant was considered localised when a linear echogenic rod with posterior acoustic shadowing was identified. When removal of the implant was requested and the implant was clear of neurovascular structures, blunt dissection was performed under ultrasound control and the implant was extracted. If the implant was considered too close to major neurovascular structures, the position of the implant was marked and the patient was referred for surgical removal.

RESULTS

Thirty-four women were included in the study. In 33 patients the implant was identified. In one patient no implant was found and its absence was confirmed by serum assay. Twenty-four patients were referred for implant removal. In 20 patients the implant was successfully removed under ultrasound guidance. In the other four patients the implant was close to neurovascular structures. The position of the implants was marked and surgical removal was successfully performed.

CONCLUSION

Ultrasound is highly accurate at localising and guiding removal of non-palpable Implanon implants.

Analysis of a sub-proteome which co-purifies with and is phosphorylated by the Golgi casein kinase

In an attempt to gain information about the identity of the Golgi apparatus casein kinase(s) (G-CK), responsible for the phosphorylation of caseins in lactating mammary gland, the proteins present in fractions enriched in G-CK activity eluted from DEAE-Sepharose and heparin-Sepharose columns were resolved by two-dimensional electrophoresis and analyzed by mass spectrometry. This led to the identification of 47 proteins altogether, none of which is a bona fide protein kinase. At least 9 of the identified proteins however, are readily phosphorylated by co-purifying G-CK activity, and 7 are physically associated with it to give supramolecular complex(es) of about 500 kDa as judged from Superdex S200 gel fitration and glycerol gradient ultracentrifugation experiments. In contrast, the apparent molecular weight of G-CK estimated from an in gel activity assay after SDSPAGE and renaturation is about 41 kDa. Many of the proteins phosphorylated by and/or associated with G-CK belong to the category of chaperonines, including HSP90, GRP-94 and -78, and various isoforms of protein disulfide isomerases, suggesting a global role of this kinase in the modulation of protein folding.

Conjugated Linoleic Acid Impairs Endothelial Function

OBJECTIVE

To determine the effect of dietary supplementation with conjugated linoleic acid (CLA) on body mass index (BMI), body fat distribution, endothelial function, and markers of cardiovascular risk.

METHODS AND RESULTS

Forty healthy volunteers with BMI >27 kg/m2 were randomized to receive a CLA isomeric mixture or olive oil in a 12-week double-blind study. Subcutaneous body fat and abdominal/hepatic fat content were assessed using skin-fold thicknesses and computed tomography scanning, respectively. Endothelial function was assessed by brachial artery flow-mediated dilatation (FMD). Plasma isoprostanes were measured as an index of oxidative stress. CLA supplementation did not result in a significant change in BMI index or total body fat. There was a significant decrease in limb (-7.8 mm, P<0.001), but not torso skin-fold thicknesses or abdominal or liver fat content. Brachial artery FMD declined (-1.3%, P=0.013), and plasma F2-isoprostanes increased (+91 pg/mL, P=0.042).

CONCLUSIONS

A CLA isomeric mixture had at most modest effects on adiposity and worsened endothelial function. On the basis of these results, the use of the isomeric mixture of CLA as an aid to weight loss cannot be recommended.

The value of genetic testing for type 2B Von Willebrand disease

Von Willebrand disease (VWD) is an inherited bleeding disorder that may be associated with significant morbidity, but is often a diagnostic challenge. While an appropriate clinical bleeding history suggests the condition, current laboratory screening investigations lack the sensitivity and specificity to confirm the diagnosis in many cases. Recently, much work has gone into characterizing the genetic mutations associated with the various subtypes of VWD. We report a case in which the diagnosis of VWD type 2B was made via genetic testing, illustrating its value as a useful diagnostic tool.

The annual incidence of diabetic complications in a population of patients with Type 1 and Type 2 diabetes

AIM

The DARTS diabetes register was used to determine incidence rates of diabetes and related complications in 1997.

METHODS

The diabetes register records detailed clinical information for all patients diagnosed with diabetes in Tayside, Scotland. The study population included patients who were alive and registered with a Tayside GP for the duration of 1997 or who died in Tayside during this time. Patients who had diabetes prior to 1997, those who developed diabetes in 1997, and those who developed diabetic complications in 1997, were identified.

RESULTS

In the Tayside population of 385 774 at the start of 1997, there were 942 and 6632 patients with Type 1 and Type 2 diabetes, with a further 29 and 744 patients diagnosed in 1997. The incidence rates (with 95% confidence intervals) of diabetic complications per 1000 patients with Type 1 and Type 2 diabetes, respectively, were: angina 8.8 (4.5-17.3) and 38.4 (33.4-44.2); myocardial infarction 8.6 (4.4-16.9) and 21.9 (18.4-25.9); cerebrovascular accident 1.1 (0.3-6.0) and 14.2 (11.6-17.5); lower extremity amputation 3.2 (1.2-9.4) and 3.1 (2.1-4.8); peripheral vascular disease 5.5 (2.4-12.8) and 13.6 (11.0-16.8); registered blindness 1.1 (0.3-5.9) and 1.6 (0.9-2.9); end-stage renal failure 6.4 (3.0-13.8) and 5.0 (3.6-7.0). Mortality was 14.6 per 1000 (9.6-25.7) in Type 1 diabetes and 50.0 per 1000 (45.1-55.3) in Type 2 diabetes.

CONCLUSION

This study provides baseline figures for rates of diabetic complications for Type 1 and Type 2 diabetes, and confirms the increased burden of macrovascular disease in Type 2 diabetes.

Treatment gap in the use of lipid-lowering drug therapy in diabetes: a population-based study

BACKGROUND

Lowering cholesterol is highly effective in reducing morbidity and mortality in high-risk people with prevalent cardiovascular disease.

AIMS

To investigate lipid-lowering therapy use for secondary prevention of coronary heart disease in all diabetic patients in Tayside, Scotland.

METHODS

Among the 385,500 Tayside residents on 31 March 2001, the DARTS database identified all people with Types 1 and 2 diabetes with prevalent macrovascular disease, defined as a history of angina or coronary heart disease. The uptake of lipid-lowering drug was ascertained from MEMO's database of prescriptions dispensed at Tayside pharmacies.

RESULTS

Among the 1128 Type 1 patients, 11.3% had prevalent macrovascular disease and 7.9% used lipid-lowering therapy with 42.2% for patients with macrovascular disease. Current/former smokers (OR 2.40, 95% CI: 1.15-5.03) and those with a history of coronary heart disease (OR 2.26, 95% CI: 1.04-4.90) were more likely to use lipid-lowering therapy. Among the 8686 Type 2 patients, 38.8% had prevalent macrovascular disease and 18.3% used lipid-lowering therapy, with 26.7% for patients with macrovascular disease. Current/former smokers (OR 1.37; 95% CI 1.17-1.61) and those with a history of coronary heart disease (OR 2.07, 95% CI 1.66-2.59) or angina (OR 1.30, CI 1.03-1.63) were more likely to use lipid-lowering therapy. A duration of 4 years or less from the first macrovascular event was associated with increased use (OR 1.27; 95% CI 1.05-1.54). Age > 70 years reduced the likelihood (OR 0.51, CI 0.44-0.60).

CONCLUSION

A clear gap exists between those requiring lipid-lowering drug therapy and those who are actually receiving it in Tayside.

Development of sustainability indicators by communities in China: a case study of Chongming County, Shanghai

Public participation as a means of identifying sustainability indicators for Chongming County, Shanghai, China was evaluated by an international group drawing on established best practice. An initial 'long list' of 86 sustainability indicators, based on previous indicator systems developed in China, was identified. This 'long list' was reduced via consultations with local academics and local-government officers from Shanghai City and Chongming County to a 'short list' of 17 indicators. This short-list was subjected to further community consultation involving 159 local-government officers, teachers, students (aged 12-14 years), farmers and workers. Data from the consultations indicated differences in the understanding of sustainable development among the different sectors. By combining the data from the different sectors it was possible to identify a consensus around 4 core and 7 additional indicators. These are proposed as indicators which could be used to steer local activities directed towards sustainable development. The list of indicators produced by the people of Chongming Island was compared to local indicator systems in Europe. In comparison with European lists the Chongming list was found to have a greater emphasis on economic development but a similar level of concern for environmental matters. This study has special significance as it reports on the implementation of a process involving local resident participation in the process of sustainable development in China.

Evolution of the Shanghai city region 1978-1998: an analysis of indicators

Building on a description of the present situation in Shanghai, a series of ten regionally relevant indicators are identified and described. Using data from 1978-1998, relationships between these economic, social and environmental indicators are explored using correlation and regression analysis. The analysis indicated that, in Shanghai, conflict between economy and environment existed throughout the research period and the evolution of the city region system seems to lack regularity. The key elements affecting trends in the development of the Shanghai city region are Gross Domestic Product, Total Investment and Urban Living Area per Head. The city region system seemed more sustainable, indicated by an improvement in environmental quality and relative lower investment growth rate, when the annual change rate of Gross Domestic Product was less than 7-8%.