A worldwide multicentre comparison of assays for cerebrospinal fluid biomarkers in Alzheimer's disease

BACKGROUND

Different cerebrospinal fluid (CSF) amyloid-beta 1-42 (Abeta(1-42)), total Tau (Tau) and Tau phosphorylated at threonine 181 (P-Tau) levels are reported, but currently there is a lack of quality control programmes. The aim of this study was to compare the measurements of these CSF biomarkers, between and within centres.

METHODS

Three CSF-pool samples were distributed to 13 laboratories in 2004 and the same samples were again distributed to 18 laboratories in 2008. In 2004 six laboratories measured Abeta(1-42), Tau and P-Tau and seven laboratories measured one or two of these marker(s) by enzyme-linked immunosorbent assays (ELISAs). In 2008, 12 laboratories measured all three markers, three laboratories measured one or two marker(s) by ELISAs and three laboratories measured the markers by Luminex.

RESULTS

In 2004, the ELISA intercentre coefficients of variance (interCV) were 31%, 21% and 13% for Abeta(1-42), Tau and P-Tau, respectively. These were 37%, 16% and 15%, respectively, in 2008. When we restricted the analysis to the Innotest (N = 13) for Abeta(1-42), lower interCV were calculated (22%). The centres that participated in both years (N = 9) showed interCVs of 21%, 15% and 9% and intra-centre coefficients (intraCV) of variance of 25%,18% and 7% in 2008.

CONCLUSIONS

The highest variability was found for Abeta(1-42). The variabilities for Tau and P-Tau were lower in both years. The centres that participated in both years showed a high intraCV comparable to their interCV, indicating that there is not only a high variation between but also within centres. Besides a uniform standardization of (pre)analytical procedures, the same assay should be used to decrease the inter/intracentre variation.

Epithelial stem/progenitor cells in lung postnatal growth, maintenance, and repair

The adult lung consists of a trachea leading into a system of branched airways ending in millions of alveolar sacs. It contains many different epithelial cell types arranged in precise patterns along the proximodistal axis. Each region of the lung has the capacity to repair through the proliferation of different epithelial cell types. However, the precise identity of the cells mediating repair is not fully resolved. To address this problem, we are using genetic lineage-labeling techniques in the mouse. The tools we have made will also be useful for understanding how progenitor cell behavior is regulated under normal and pathological conditions.

Irritable bowel syndrome: a practical approach

Irritable bowel syndrome accounts for approximately 2.7 million physician office visits yearly, although only 10%-30% of affected patients seek treatment. The disease is predominantly found in women 20-50 years of age. The etiology of irritable bowel syndrome is likely multifactorial: environmental factors, genetics, gut flora alterations, nervous system alterations (visceral hypersensitivity and motility abnormalities), and psychosocial stressors are thought to contribute. Treatment options are also quite diverse, including both pharmacologic and nonpharmacologic modalities. This article summarizes the proposed pathophysiology of and treatment options for irritable bowel syndrome.

Cultural identity, clothing and common mental disorder: a prospective school-based study of white British and Bangladeshi adolescents

OBJECTIVE

Cultural integration is the healthiest outcome for young people living in multicultural societies. This paper investigates the influence of different cultural identities on the risk of common mental disorders among Bangladeshi and white British pupils.

DESIGN

The cultural identity of 11-14-year-old school pupils was assessed by their preferences for friends and clothes of their own or other cultural groups; using this information pupils were classified into traditional, integrated, assimilated or marginalised groups. We undertook prospective analyses of cultural identity and its impacts on the later mental health of young people.

SETTING

East London.

PARTICIPANTS

In 2001, white British (573) and Bangladeshi (682) school pupils from a representative sample of schools completed a self-report questionnaire that assessed their cultural, social and health characteristics. In 2003, 383 white British and 517 Bangladeshi pupils were resurveyed and completed measures of mental health.

MAIN OUTCOME MEASURE

Strengths and difficulties questionnaire.

RESULTS

Bangladeshi pupils preferring clothes from their own cultural group (traditional clothing) were less likely to have later mental health problems when compared with Bangladeshi pupils showing an equal preference for clothing from their own and other cultures (integrated clothing; odds ratio (OR) 0.3, 95% CI 0.1 to 0.9). In gender-specific analyses, this finding was sustained only among Bangladeshi girls (OR 0.1, 95% CI 0.1 to 0.7). Integrated clothing choices were least risky only for white British adolescents. Friendship choices showed no prospective associations with later mental health problems.

CONCLUSIONS

Cultural identity, expressed by clothing preferences, influences mental health; the effects differ by gender and ethnic group.

Labioplasty in girls under 18 years of age: an unethical procedure?

Labioplasty is a surgical procedure performed to alter the size and shape of the labia minora. The reasons for women requesting this procedure remain largely unknown and recently girls and young women under the age of 18 years have been requesting this type of surgery. This paper examines the ethical acceptability of performing this procedure on under 18s. We will first discuss whether labioplasty can be considered to be a therapeutic technique. We will claim that, while it is difficult to offer a definitive definition of what constitutes a therapeutic technique, in our view labioplasty cannot be considered as such. This conclusion has relevance for the ethical acceptability of the procedure, its legal status in regard to the Female Genital Mutilation Act and the debates over who can give consent for it. It will be concluded that in our current state of knowledge, the benefits of labioplasty are far from clear, whereas the harms are demonstrable and therefore this procedure should not be offered to those aged under 18 years.

Survey of pigs' kidneys with lesions consistent with PMWS and PDNS and ochratoxicosis. Part 1: concentrations and prevalence of ochratoxin A

One thousand condemned pigs' kidneys were collected in February 2002 from two pig abattoirs in England to assess the possible contribution of ochratoxicosis to postweaning multisystemic wasting syndrome (PMWS) and porcine dermatitis and nephropathy syndrome (PDNS); 250 of the kidneys with macroscopic lesions consistent with nephrosis/nephritis (pale or white cortical lesions) were selected, and the concentration of ochratoxin A was measured in samples of renal cortex by high-performance liquid chromatography (HPLC). Low concentrations were detected in 230 (92 per cent) of the kidneys tested, and in 41 (16.4 per cent) of them the concentration was below the limit of quantification of 0.2 microg/kg. In 187 (74.8 per cent) of the kidneys, the concentration was more than 0.2 microg/kg, and the highest concentration detected was 2.3 microg/kg. The mean (sd) concentration was 0.31 (0.33) microg/kg. The identification of ochratoxin A was confirmed by mass spectrometry. The concentrations of ochratoxin A did not exceed the threshold assessed by the Food Standards Agency to be safe for human food.

Survey of pigs' kidneys with lesions consistent with PMWS and PDNS and ochratoxicosis. Part 2: pathological and histological findings

One thousand condemned pigs' kidneys were collected in February 2002 from two pig abattoirs in England to assess the lesions due to postweaning multisystemic wasting syndrome (pmws) and porcine dermatitis and nephropathy syndrome (pdns) and the possible contribution of ochratoxicosis; 174 of the kidneys were pale, 295 were swollen and 81 were abnormally firm with the gross appearance of fibrosis. The main macroscopic finding was the presence of multifocal pale cortical lesions, observed in 446 of the kidneys, and there were large cysts in 266 of them. Histopathological lesions of non-suppurative tubulointerstitial nephritis, with degeneration and fibrosis of renal tubules, were identified in 213 of 250 (85.2 per cent) of the kidneys examined. These lesions were consistent with those reported in cases of pmws and pdns. The tubular degeneration and fibrosis were also consistent with ochratoxicosis. A higher mean concentration of ochratoxin A was significantly (P=0.020) associated with the presence of multifocal pale cortical lesions consistent with ochratoxicosis, but a causal relationship was not confirmed because histochemistry was not used to detect ochratoxin in the lesions directly. There was no significant correlation between the microscopic lesions and the concentration of ochratoxin. The degenerative lesions may have been caused by previous exposure to ochratoxin that had subsequently been excreted, but the microscopic lesions also included non-suppurative interstitial nephritis, which was unlikely to have been caused by ochratoxicosis.

The impact of the physical and urban environment on mental well-being

OBJECTIVES

To examine the strength of association between physical and social factors in the built environment and mental well-being, and to determine which factors are the most important.

STUDY DESIGN

A postal survey based on a theoretical model of domains that might link the physical and urban environment with mental well-being was sent to 2696 adults aged 18 years or over, in four areas of Greenwich, London. Mental health was measured using the SF36 subscales for mental health (MH) and vitality (V). Additional household and area level data were appended for each respondent from a range of sources.

RESULTS

1012 questionnaires were returned (38% response rate). At the univariate level significant confounders that were associated with poorer mental well-being were being female, 85+ years, unemployed or retired, on housing benefit, council tenant, two or more children, and having requested re-housing Better mental well-being was associated with being aged 65 years to 84 years (better MH and V). Within domain analysis, adjusting for each of the confounding factors, resulted in the following factors being significantly associated with being in the lowest quartile for MH score: (i) control over the internal environment (damp), (ii) design and maintenance (not liking the look of the estate/road, (iii) noise (neighbour noise), (iv) density and escape (feeling over-crowded in the home, being dissatisfied with green spaces, dissatisfied with social and entertainment facilities) being dissatisfied with community facilities (such as libraries and community centres) was only significant for vitality, (v) fear of crime and harassment (feeling unsafe to go out in the day, feeling unsafe to go out at night, agreeing that needles and syringes left lying around are a problem) (vi) social participation (not enough events to get people together, not enough places to stop and chat). When these 12 factors were entered into a single model with the significant confounders five remained significantly associated with being in the lowest quartile for MH or V: neighbour noise MH OR 2.71 [95% CI 1.48, 4.98]; feeling over-crowded in the home MH OR 2.22 [1.42, 3.48]; being dissatisfied with access to green open spaces MH OR 1.69 [1.05, 2.74]; access to community facilities V OR 1.92, [1.24, 3.00]; feeling unsafe to go out in the day MH OR 1.64 [1.02, 2.64]; V OR 1.58 [1.00, 2.49].

CONCLUSIONS

This study confirms an association between the physical environment and mental well-being across a range of domains. The most important factors that operate independently are neighbour noise, sense of over-crowding in the home and escape facilities such as green spaces and community facilities, and fear of crime. This study highlights the need to intervene on both design and social features of residential areas to promote mental well-being.

Molecular epidemiology of tuberculosis after declining incidence, New York City, 2001-2003

Tuberculosis incidence in New York City (NYC) declined between 1992 and 2000 from 51.1 to 16.6 cases per 100,000 population. In January 2001, universal real-time genotyping of TB cases was implemented in NYC. Isolates from culture-confirmed tuberculosis cases from 2001 to 2003 were genotyped using IS6110 and spoligotype to describe the extent and factors associated with genotype clustering after declining TB incidence. Of 2408 (91.8%) genotyped case isolates, 873 (36.2%) had a pattern indistinguishable from that of another study period case, forming 212 clusters; 248 (28.4%) of the clustered cases had strains believed to have been widely transmitted during the epidemic years in the early 1990s in NYC. An estimated 27.4% (873 minus 212) of the 2408 cases were due to recent infection that progressed to active disease during the study period. Younger age, birth in the United States, homelessness, substance abuse and presence of TB symptoms were independently associated with greater odds of clustering.

Concurrent end-phase boost high-dose radiation therapy for non-small-cell lung cancer with or without cisplatin chemotherapy

The aim of this study was to audit the results of a high-dose, combined-modality prospective protocol for non-small-cell lung cancer in terms of survival, disease-specific survival and toxicity. One hundred and twenty-one patients with non-small-cell lung cancer were treated with a concurrent, end-phase, boost, high-dose radiotherapy protocol with 65 Gy in 35 fractions for more than 5 weeks. Sixty-six patients received radiotherapy alone (group 1), 29 received concurrent chemoradiation (group 2) and 26 received neoadjuvant and concurrent chemotherapy (group 3). Thirty-four patients had stage I disease, six had stage II and 81 had stage III. Overall median survival was 23 months: 75% at 1 year and 23% at 5 years. Median survivals for patients with stage I and stages II and III disease were 43 and 19 months, respectively. For stages II and III patients by groups 1-3, median survivals were 18, 25 and 18 months, respectively, and 2-year survivals were 36, 52 and 38%, respectively. Toxicity was acceptable. Overall, 9% had symptomatic pneumonitis and 7% had grades 3 and 4 oesophagitis. For those who had the mediastinum included in the volume, grade > or = 3 oesophagitis occurred in 0, 11 and 22% (n = 110, P = 0.001), respectively, for treatment groups 1-3. Overall treatment-related mortality was 3%, consisting of two septic deaths, one pneumonitis and possibly one late cardiac event, all occurring in patients who had chemotherapy (7% of 55 patients). Treatment-related mortality declined over the study period. Accelerated radiotherapy was well tolerated, with only moderate increased acute toxicity when combined with concurrent platinum chemotherapy. Toxicity was enhanced by induction chemotherapy. Overall survival outcomes were excellent for this condition. Continued use of this radiotherapy schedule is recommended as the platform for assessment of other chemotherapy schedules.

Drinking histories of self-identified lifetime abstainers and occasional drinkers: findings from the 1958 British Birth Cohort Study

AIMS

To investigate the validity of retrospective items used to distinguish people who have rarely or never consumed alcohol.

METHODS

The 1958 British Birth Cohort Study has followed 9377 individuals until age 45. Previous drinking (at 16, 23, 33 and 42 years) was investigated for two groups of 45-year-old non-drinkers, those reporting never having consumed alcohol ('never drinkers', n = 143, 1.5%), and having only consumed very infrequently ('occasional-only drinkers', n = 1149, 12.3%).

RESULTS

67% of never drinkers previously reported drinking, 25% were past weekly/daily drinkers; 56% of occasional-only drinkers reported weekly/daily consumption. The validity of the retrospective items was progressively questionable when presumed to cover longer time periods.

CONCLUSIONS

Substantial measurement error was evident when identifying 'occasional-only' and 'never' drinkers using retrospective items covering the lifecourse. Researchers investigating potential health benefits associated with moderate drinking need to incorporate more sophisticated methods when identifying sub-groups of non-drinkers.

Noise exposure and children's blood pressure and heart rate: the RANCH project

BACKGROUND

Conclusions that can be drawn from earlier studies on noise and children's blood pressure are limited due to inconsistent results, methodological problems, and the focus on school noise exposure.

OBJECTIVES

To investigate the effects of aircraft and road traffic noise exposure on children's blood pressure and heart rate.

METHODS

Participants were 1283 children (age 9-11 years) attending 62 primary schools around two European airports. Data were pooled and analysed using multilevel modelling. Adjustments were made for a range of socioeconomic and lifestyle factors.

RESULTS

After pooling the data, aircraft noise exposure at school was related to a statistically non-significant increase in blood pressure and heart rate. Aircraft noise exposure at home was related to a statistically significant increase in blood pressure. Aircraft noise exposure during the night at home was positively and significantly associated with blood pressure. The findings differed between the Dutch and British samples. Negative associations were found between road traffic noise exposure and blood pressure, which cannot be explained.

CONCLUSION

On the basis of this study and previous scientific literature, no unequivocal conclusions can be drawn about the relationship between community noise and children's blood pressure.

Annexin II binds progastrin and gastrin-like peptides, and mediates growth factor effects of autocrine and exogenous gastrins on colon cancer and intestinal epithelial cells

We and others have reported the presence of novel progastrin (PG)/gastrin receptors on normal and cancerous intestinal cells. We had earlier reported the presence of 33-36 kDa gastrin-binding proteins on cellular membranes of colon cancer cells. The goal of the current study was to identify the protein(s) in the 33-36 kDa band, and analyse its functional significance. A carbodiimide crosslinker was used for crosslinking radio-labeled gastrins to membrane proteins from gastrin/PG responsive cell lines. Native membrane proteins, crosslinked to the ligand, were solubulized and enriched by >1000-fold, and analysed by surface-enhanced laser desorption/ionization-time of flight-mass spectrometry. The peptide masses were researched against the NCBInr database using the ProFound search engine. Annexin II (ANX II) was identified, and confirmed by matrix-assisted laser desorption/ionization-time of flight-mass spectrometry. As HCT-116 cells express autocrine PG, the in situ association of PG with ANX II was demonstrated in pulldown assays. Direct binding of PG with ANX II was confirmed in an in vitro binding assay. In order to confirm a functional importance of these observations, sense and anti-sense (AS) ANX II RNA-expressing clones of intestinal epithelial (IEC-18) and human colon cancer (HCT-116) cell lines were generated. AS clones demonstrated a significant loss in the growth response to exogenous (IEC-18) and autocrine (HCT-116) PG. We have thus discovered that membrane-associated ANX II binds PG/gastrins, and partially mediates growth factor effects of the peptides.