Using kangaroo care in a clinical setting with fullterm infants having breastfeeding difficulties

Usually Kangaroo Care (KC) or skin-to-skin holding care is done with preterm infants. This article, however, documents clinical experiences with three mothers and their fullterm infants who were having latching/breastfeeding difficulties. In each case the nurse placed the fullterm infant in KC for approximately 1 hour prior to and continuing into the next breastfeeding session. Although no recommendations can be made based on case studies, these clinical experiences suggest that KC is a worthwhile intervention to try when a mother and her fullterm infant are struggling to achieve successful breastfeeding.

Successful incorporation of the Severe Head Injury Guidelines into a phased-outcome clinical pathway

Clinical pathways have been proven to be valuable tools in improving outcomes in patients with neurological diagnoses. However, their use with trauma populations has been limited. The unpredictable nature of trauma makes it difficult to develop a day-by-day plan of care that would be applicable to all patients with the same trauma diagnosis. Nevertheless, a severe traumatic brain injury (TBI) clinical pathway was developed and implemented at a Level 1 Trauma Center with significant reductions in length of stay and number of ventilator days. With the publication of the Guidelines for the Management of Severe Head Injury, this pathway was refashioned into a severe TBI phased-outcome pathway. Rather than a day-by-day plan of care, this clinical pathway consists of four phases of care: (a) admission to the intensive care unit, (b) acute critical care, (c) mobility and weaning, and (d) pre-rehabilitation. After 12 months, the improvements accomplished by the original pathway have been maintained or exceeded.

A comparison of the dynamic pedobarograph and EMED systems for measuring dynamic foot pressures

The purpose of this study was to compare the peak pressure and peak force values obtained from two pressure assessment systems, the Dynamic Pedobarograph and the EMED SF. Twenty-one individuals with a mean age of 31.6 years walked barefoot over both systems using a two-step data collection protocol. Peak plantar pressures and peak vertical force values were measured under the heel, central forefoot, hallux, and entire foot for both systems. The results of this study demonstrated that the EMED SF system produced larger peak pressures under the central forefoot and hallux. The Pedobarograph, on the other hand, produced greater pressures under the heel and entire foot. With respect to peak vertical forces, the Pedobarograph showed significantly greater values under the heel and central forefoot compared with the EMED SF, but were significantly lower under the hallux and entire foot.

Detection of P24 protein in human breast cancer: influence of receptor status and oestrogen exposure

The expression of oestrogen regulated protein, P24, was investigated in 69 breast cancers. At initial evaluation P24 protein was detected significantly more frequently and was present in significantly higher concentration in oestrogen receptor positive than in receptor negative tumours. There was, however, no correlation between P24 staining and progesterone receptor, tumour ploidy or proliferative index. Nineteen patients received a short course of treatment with diethylstilboestrol. Following treatment with oestrogen, P24 staining became positive in 7/13 tumours previously negative for P24, including six tumours which were oestrogen receptor negative. Oestrogen administration also caused an increase of the proliferation index in 12/19 tumours, including 5/7 that were oestrogen receptor positive and 7/12 that were oestrogen receptor negative. In some instances oestrogenic stimulation of proliferation occurred together with increased P24 expression; in other instances proliferation index increased without induction of P24 synthesis. The in vivo effects of oestrogen in clinical breast cancer thus appear to show dissociation between enhancement of protein synthesis and cellular proliferation.

Sequential hydrolysis of hyaluronate by beta-glucuronidase and beta-N-acetylhexosaminidase

1. Hyaluronate extracted from rooster comb was digested by a mixture of beta-N-acetylhexosaminidase and beta-glucuronidase with simultaneous dialysis for 96 h. 2. The produjct, yielding 99.6% of a mixture of mono- and oligo-saccharides, was purified by gel chromatography and analysed for glucuronic acid, N-acetylglucosamine and other sugars. 3. The oligosaccharide portion was chromatographed on DEAE-cellulose, and the effluent fractions were analysed for glucuronic acid and N-acetylglucosamine, reduced with NaBH4, digested by beta-N-acetylhexosaminidase and subjected to acid hydrolysis and glucosamine determination. 4. GlcNAc-GlcA-GlcNAc, GlcA-GlcA-GlcNAc and GlcA-GlcA-GlcA-GlcNAc were the oligosaccharides obtained, which resulted from the transferase activity of the enzymes and represented 57% of the digestion products. The results demonstrate that this hyaluronate is an unbranched polymer of approximatey equal amounts of glucuronic acid and N-acetylglucosamine. The data also indicate that if this glycosaminoglycan contains any of the neutral sugars for which it was analysed, their concentration must be less than 0.020% of the sum of the known components.

Fibrinolysis and acquired alpha-2 plasmin inhibitor deficiency in amyloidosis

A patient with plasma cell myeloma and amyloidosis presented with a severe bleeding disorder. There was laboratory evidence of fibrinolysis and severe deficiency of alpha-2 plasmin inhibitor. Treatment with epsilon aminocaproic acid was associated with diminished bleeding and marked increase in the plasmin inhibitor level. This is the first report of acquired alpha-2 plasmin inhibitor deficiency in the fibrinolytic state associated with amyloidosis.

Domain-based assays of individual antibody concentrations in an oligoclonal combination targeting a single protein

Quantitation of individual monoclonal antibodies (mAbs) within a combined antibody drug product is required for preclinical and clinical drug development, including pharmacokinetic (PK), toxicology, stability, and biochemical characterization studies of such drugs. We have developed an antitoxin, XOMA 3AB, consisting of three recombinant mAbs that potently neutralize the known subtypes of type A botulinum neurotoxin (BoNT/A). The three mAbs bind nonoverlapping BoNT/A epitopes with high affinity. XOMA 3AB is being developed as a treatment for botulism resulting from BoNT/A. To develop antibody-specific assays, we cloned, expressed, and purified BoNT/A domains from Escherichia coli. Each mAb bound only to its specific domain with affinity comparable to the binding to holotoxin. mAb-specific domains were used to develop an enzyme-linked immunosorbent assay (ELISA) for characterization of the integrity and binding activity of the three mAbs in the drug product. An electrochemiluminescence bridging assay that is robust to interference from components in serum was also developed, and we demonstrate that it can be used for PK assays. This type of antigen engineering to generate mAb-specific domains is a general method allowing quantitation and characterization of individual mAbs in a mAb cocktail that binds the same protein and is superior to anti-idiotype approaches.

Species differences in induction of hepatic enzymes by BM 17.0744, an activator of peroxisome proliferator-activated receptor alpha (PPARalpha)

BM 17.0744, a new anti-diabetic and lipid-lowering agent, leads also to strong hepatomegaly and carnitine acetyl transferase (CAT) increase in the liver of rats, a phenomenon known from fibrates. For information on the relevance of changes in liver of rats to other species, we investigated the effects of BM 17.0744 on lipids and selected marker enzymes related to beta-oxidation in rats, dogs and guinea-pigs, so-called high and low responders to peroxisome proliferators. To examine selectivity other enzymes were also determined, e.g. esterase, urate oxidase (UOX) and cytochrome c oxidase (CYT.C.OX.). Lowering of triglycerides and cholesterol in blood serum and/or liver was observed in pharmacological dose range in the three species tested. In dogs and guinea-pigs, liver and kidney weights were unaffected even in dogs in medium and high dose groups with high systemic exposure and severe toxicity. In male Sprague-Dawley rats treatment with 1.5, 3, 6 and 12.5 mg/kg per day BM 17.0744 selectively elevated the activities of CAT and acyl-CoA oxidase (AOX) by < or =200 and 20-fold, respectively. Administration of BM 17.0744 to Beagle dogs (1.5, 4, 12 mg/kg per day) and guinea-pigs (3 and 12 mg/kg per day) enhanced the activities of CAT and AOX dose-dependently by a factor of two to three only. Immunoblotting revealed a drug-specific enhancement of the amount of beta-oxidation enzymes in rats, which is in accord with the rapid and coordinated transcriptional activation shown in Northern dot blot analysis. Nuclear run-on assays demonstrated a real transcriptional activation. BM 17.0744 activates peroxisome proliferator-activated receptor alpha (PPARalpha), which could be shown by transactivation assays. The stimulation of PPARalpha by BM 17.0744 was stronger than that of the known ligands WY 14.643 and ETYA. Activation of PPARgamma can be excluded. Taken collectively, the data demonstrate an enhancement of the beta-oxidation system by BM 17.0744 paralleled by lipid-lowering in all species investigated. The activation of the nuclear factor PPARalpha may explain the changes in liver and the metabolic effects on the molecular level. The lack of an increase in liver and kidney weights and the relatively moderate enhancement of activities of beta-oxidation-related enzymes in dogs and guinea-pigs indicate that the excessive response observed in rats is not applicable to other, predominantly non-rodent, species. On the basis of these data and the experience with fibrates a specific risk for humans is not expected.

Induction of SIV capsid-specific CTL and mucosal sIgA in mice immunized with a recombinant S. typhimurium aroA mutant

We have developed a new expression system based on the E. coli groEL promoter. The suicide vector constructed (called APC vector) allows simultaneous attenuation of a Salmonella strain by disruption of the coding sequence for aroA and stable integration of a gene into the bacterial chromosome. High-level expression of antigen is achieved after Salmonella is taken up by macrophages, a major antigen processing cell of the host. The chloramphenicol acetyltransferase (CAT) and the simian immunodeficiency virus capsid (p27gag) genes were cloned downstream of the groEL promoter and expressed within S. typhimurium. By measuring CAT activity, we showed that the groEL promoter was up-regulated during infection of the J774 macrophage line. The immune response to SIV capsid was assessed in Balb/c mice given one oral dose of vaccine. A local mucosal secretory IgA response against SIV capsid was detected but no systemic antibody response to the same antigen. A systemic CTL response was detected as early as 28 days to as late as 70 days post-immunization. CTL activity was MHC restricted (H-2d) and was mediated by CD3+, CD8+, CD4- T-lymphocytes. These results indicate that with only one oral dose of recombinant Salmonella using the APC vector, a systemic CTL response and a mucosal secretory response against the SIV capsid antigen are elicited in a mouse model.

Effects of exercise training program on functional capacity and quality of life in patients with peripheral arterial occlusive disease. Evaluation of a pilot project

BACKGROUND

In patients with peripheral arterial occlusive disease (PAOD) stage II, exercise training seems to be important to reduce symptoms and improve functional capacity. We evaluated the effects of an out-patient treatment program on walking distance (standardized treadmill testing), training exercise capacity, and disease specific quality of life (PAVK-86 questionnaire).

METHODS AND RESULTS

Thirty-one patients aged 70 +/- 2 with intermittent claudicatio in stage IIa/IIb according to Fontaine (n = 18/13) underwent a supervised 12 week exercise training and education outpatient program. During course of intervention, patients demonstrated improvements in pain-free training walking distance (p < 0.001) and repetitions of tiptoe standing (p < 0.05). In standardized treadmill testing, pain-free walking distance was improved by 182% (129 +/- 19 m-->364 +/- 53 m; p < 0.001), and maximum walking distance by 76% (311 +/- 42 m-->546 +/- 63 m; p < 0.01). Before training, mean subscale scores of the PAVK-86 demonstrated distinct impairments concerning pain and functional status. After 12 weeks of intervention, with exception of the subscale complaints, all dimensions of quality of life assessed have improved significantly. The highest effect size was observed for the subscales pain, mood, and functional status. Improvement in the subscale anxiety and pain-free walking distance (treadmill test) correlated significantly (r = 0.46) as well as improvement in the subscale mood and maximum walking distance (r = 0.45).

CONCLUSION

In patients with PAOD stage II considerable effects on functional capacity and important dimensions of quality of life can be achieved by a short exercise and education program.

Estimation of additive maternal and cytoplasmic genetic variances in animal models

Two pathways for maternal genetic effects to act on production traits are additive maternal and cytoplasmic. Estimation of these variances have generally assumed that the correct maternal pathway is known. A method is described that allows simultaneous estimation of additive maternal and cytoplasmic genetic variances as well as additive direct genetic variances and error variances using an animal model. Data were simulated assuming an additive maternal model, cytoplasmic model, or both. The method was tested by analyzing the data under the true or incorrect maternal model using REML with an animal model that accounted for additive genetic relationships. Additive direct, additive maternal, cytoplasmic, and error variances were correctly partitioned when estimated under the true model. However, when additive maternal or cytoplasmic genetic effects were ignored in the model used for analysis, estimates of additive direct variance were significantly inflated. Also, under an additive maternal genetic model, a small cytoplasmic variance was estimated although none was present in the data.

The Association between Objectively Measured Physical Activity and the Gut Microbiome among Older Community Dwelling Men

OBJECTIVES

To determine the relationship between objectively measured physical activity (PA) and the gut microbiome among community-dwelling older men.

DESIGN

Cross-sectional study.

SETTING

Osteoporotic Fractures in Men (MrOS) cohort participants at Visit 4 (2014-16).

PARTICIPANTS

Eligible men (n=373, mean age 84 y) included participants with 5-day activity assessment with at least 90% wear time and analyzed stool samples.

MEASUREMENTS

PA was measured with the SenseWear Pro3 Armband and stool samples analyzed for 16S v4 rRNA marker genes using Illumina MiSeq technology. Armband data together with sex, height, and weight were used to estimate total steps, total energy expenditure, and level of activity. 16S data was analyzed using standard UPARSE workflow. Shannon and Inverse Simpson indices were measures of (within-participant) α-diversity. Weighted and unweighted Unifrac were measures of (between-participant) β-diversity. We used linear regression analysis, principal coordinate analysis, zero-inflated Gaussian models to assess association between PA and α-diversity, β-diversity, and specific taxa, respectively, with adjustments for age, race, BMI, clinical center, library size, and number of chronic conditions.

RESULTS

PA was not associated with α-diversity. There was a slight association between PA and β-diversity (in particular the second principal coordinate). Compared to those who were less active, those who had higher step counts had higher relative abundance of Cetobacterium and lower relative abundance of taxa from the genera Coprobacillus, Adlercreutzia, Erysipelotrichaceae CC-115 after multivariable adjustment including age, BMI, and chronic conditions. There was no consistent pattern by phylum.

CONCLUSION

There was a modest association between levels of PA and specific gut microbes among community-dwelling older men. The observed associations are consistent with the hypothesis that underlying health status and composition of the host microbiome are related.

Analysing quantitative parent-of-origin effects with examples from ultrasonic measures of body composition In Australian beef cattle

Parent-of-origin effects arise when an individual's genes are modified during gametogenesis. Commonly known as imprinting, affected genes may be completely, or partially, suppressed. Individual loci in mice, human and sheep are known to be imprinted, and the quantitative effects of imprinted loci have been found for many carcass traits in cattle and pigs. Differentiating between five types of loci - direct additive loci and partially and completely imprinted loci by sires and dams - is not possible as their effects are confounded such that only three of seven parameters can be estimated. An analysis of Australian Hereford and Angus heifers and bulls for four ultrasonic measures of body composition - eye muscle area, rib fat, rump fat and intramuscular fat per cent - found parent-of-origin effects for both parents in most trait-gender data sets and that they were an average of 28% of the total genetic variance. No parent-of-origin effects were found for Hereford bull intramuscular fat per cent and the maternal parent-of-origin effects were not significant for Angus Heifer eye muscle area.

Advances in methodology for random regression analyses

Random regression analyses have become standard methodology for the analysis of traits with repeated records that are thought of as representing points on a trajectory. Modelling curves as a regression on functions of a continuous covariable, such as time, for each individual, random regression models are readily implemented in standard, linear mixed model analyses. Early applications have made extensive use of regressions on orthogonal polynomials. Recently, spline functions have been considered as an alternative. The use of a particular type of spline function, the so-called B-splines, as basis functions for random regression analyses is outlined, emphasising the local influence of individual observations and low degree of polynomials employed. While such analyses are likely to involve more regression coefficients than polynomial models, it is demonstrated that reduced rank estimation via the leading principal components is feasible and likely to yield more parsimonious models and more stable estimates than full rank analyses. The combined application of B-spline basis function and reduced rank estimation is illustrated for a small set of data for beef cattle.

Peptide-based Interaction Proteomics

Protein-protein interactions are often mediated by short linear motifs (SLiMs) that are located in intrinsically disordered regions (IDRs) of proteins. Interactions mediated by SLiMs are notoriously difficult to study, and many functionally relevant interactions likely remain to be uncovered. Recently, pull-downs with synthetic peptides in combination with quantitative mass spectrometry emerged as a powerful screening approach to study protein-protein interactions mediated by SLiMs. Specifically, arrays of synthetic peptides immobilized on cellulose membranes provide a scalable means to identify the interaction partners of many peptides in parallel. In this minireview we briefly highlight the relevance of SLiMs for protein-protein interactions, outline existing screening technologies, discuss unique advantages of peptide-based interaction screens and provide practical suggestions for setting up such peptide-based screens.