Long-Chain Omega-3 Fatty Acid Intake Is Associated with Age but not Cognitive Performance in an Older Australian Sample

BACKGROUND

Long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFA) are essential nutrients and may be capable of delaying age-related cognitive decline. However, previous studies indicate that Australians are not meeting recommendations for LCn-3 PUFA intake. The current study therefore examined LCn-3 PUFA intake in an older Australia sample, as well as associations between LCn-3 PUFA intake and cognitive function.

METHODS

Cross-sectional data were collected from 90 adults aged 50 to 80 years. LCn-3 PUFA intake was assessed using a food frequency questionnaire and red blood cell fatty acid profiles were used to calculate the Omega-3 Index (RBC n-3 index). Cognitive function was measured using Addenbrooke's Cognitive Examination-III.

RESULTS

Positive associations were observed between age and RBC n-3 index (b=0.06, 95% CI: 0.01 - 0.10, P=0.01), and age and LCn-3 PUFA intake from fish oil capsules (b=17.5, 95% CI: 2.4 - 32.5 mg/day, P=0.02). When adjusting for LCn-3 PUFA from fish oil capsules, the association between age and RBC n-3 index was no longer significant. No associations were observed between LCn-3 PUFA intake and cognitive function.

CONCLUSION

LCn-3 PUFA and fish oil consumption increased with age in this sample of older Australians, particularly due to supplement intake. However, LCn-3 PUFA intake was not associated with cognitive function.

Combined spinal/caudal catheter anesthesia: extending the boundaries of regional anesthesia for complex pediatric urological surgery

BACKGROUND

Spinal anesthesia (SA) is an established anesthetic technique for short outpatient pediatric urological cases. To avoid general anesthesia (GA) and expand regional anesthetics to longer and more complex pediatric surgeries, the authors began a program using a combined spinal/caudal catheter (SCC) technique.

STUDY DESIGN

The authors retrospectively reviewed the charts of all patients scheduled for surgery under SCC between December 2016 and April 2018 and recorded age, gender, diagnosis, procedure, conversion to GA/airway intervention, operative time, neuraxial and intravenous medications administered, complications, and outcomes. The SCC technique typically involved an initial intrathecal injection of 0.5% isobaric bupivacaine followed by placement of a caudal epidural catheter. At the discretion of the anesthesiologist, patients received 0.5 mg per kilogram of oral midazolam approximately 30 min prior to entering the operating room. One hour after the intrathecal injection, 3% chloroprocaine was administered via the caudal catheter to prolong the duration of surgical block. Intra-operative management included either continuous infusion or bolus dosing of dexmedetomidine, as needed, for patient comfort and to optimize surgical conditions. Prior to removal of caudal catheter in the post-anesthesia care unit, a supplemental bolus dose of local anesthesia was given through the catheter to provide prolonged post-operative analgesia.

RESULTS

Overall, 23 children underwent attempted SCC. SA was unsuccessful in three patients, and surgery was performed under GA. The remaining 20 children all had successful SCC placement. There were 11 girls and nine boys, with a mean age of 16.5 months (3.3-43.8). Surgeries performed under SCC included seven ureteral reimplantations, two ureterocele excisions/reimplantations, two megaureter repairs, four first-stage hypospadias repairs, one distal hypospadias repair, one second-stage hypospadias repair, two feminizing genitoplasties, and one open pyeloplasty. Average length of surgery was 109 min (range 63-172 min). Pre-operative midazolam was given in 13/20 (65%). All SCC patients were spontaneously breathing room air during the operation, and there were no airway interventions. Only one SCC patient received opioids intra-operatively. There were no intra-operative or perioperative complications.

DISCUSSION

This pilot study shows that the technique of SCC allows one to do more complex urologic surgery under regional anesthesia than what would be possible under pure SA alone. The main limitations of the study include the relatively small number of patients and the small median length of the operative procedures. As a proof of concept, however, this does show that complex genital surgery bladder level procedures such as ureteral reimplantation can be performed under regional anesthesia.

CONCLUSION

SCC allows for more complex surgeries to be performed exclusively under regional anesthesia, thus obviating the need for airway intervention, minimizing or eliminating the use of opioids, and thus avoiding known and potential risks associated with GA. The latter is of particular importance given current concerns regarding hypothetical neurocognitive effects of GA on children aged below 3 years.

Preclinical modeling of myelodysplastic syndromes

Myelodysplastic syndromes (MDS) represent a heterogeneous group of hematological clonal disorders. Here, we have tested the bone marrow (BM) cells from 38 MDS patients covering all risk groups in two immunodeficient mouse models: NSG and NSG-S. Our data show comparable level of engraftment in both models. The level of engraftment was patient specific with no correlation to any specific MDS risk group. Furthermore, the co-injection of mesenchymal stromal cells (MSCs) did not improve the level of engraftment. Finally, we have developed an in vitro two-dimensional co-culture system as an alternative tool to in vivo. Using our in vitro system, we have been able to co-culture CD34+ cells from MDS patient BM on auto- and/or allogeneic MSCs over 4 weeks with a fold expansion of up to 600 times. More importantly, these expanded cells conserved their MDS clonal architecture as well as genomic integrity.

Cognitive deficits associated with a high-fat diet and insulin resistance are potentiated by overexpression of ecto-nucleotide pyrophosphatase phosphodiesterase-1

There is growing evidence that over consumption of high-fat foods and insulin resistance may alter hippocampal-dependent cognitive function. To study the individual contributions of diet and peripheral insulin resistance to learning and memory, we used a transgenic mouse line that overexpresses ecto-nucleotide pyrophosphatase phosphodiesterase-1 in adipocytes, which inhibits the insulin receptor. Here, we demonstrate that a model of peripheral insulin resistance exacerbates high-fat diet induced deficits in performance on the Morris Water Maze task. This finding was then reviewed in the context of the greater literature to explore potential mechanisms including triglyceride storage, adiponectin, lipid composition, insulin signaling, oxidative stress, and hippocampal signaling. Together, these findings further our understanding of the complex relationship among peripheral insulin resistance, diet and memory.

The relationship of TP53 R72P polymorphism to disease outcome and TP53 mutation in myelodysplastic syndromes

Nonsynonymous TP53 exon 4 single-nucleotide polymorphism (SNP), R72P, is linked to cancer and mutagen susceptibility. R72P associations with specific cancer risk, particularly hematological malignancies, have been conflicting. Myelodysplastic syndrome (MDS) with chromosome 5q deletion is characterized by erythroid hypoplasia arising from lineage-specific p53 accumulation resulting from ribosomal insufficiency. We hypothesized that apoptotically diminished R72P C-allele may influence predisposition to del(5q) MDS. Bone marrow and blood DNA was sequenced from 705 MDS cases (333 del(5q), 372 non-del(5q)) and 157 controls. Genotype distribution did not significantly differ between del(5q) cases (12.6% CC, 38.1% CG, 49.2% GG), non-del(5q) cases (9.7% CC, 44.6% CG, 45.7% GG) and controls (7.6% CC, 37.6% CG, 54.8% GG) (P=0.13). Allele frequency did not differ between non-del(5q) and del(5q) cases (P=0.91) but trended towards increased C-allele frequency comparing non-del(5q) (P=0.08) and del(5q) (P=0.10) cases with controls. Median lenalidomide response duration increased proportionate to C-allele dosage in del(5q) patients (2.2 (CC), 1.3 (CG) and 0.89 years (GG)). Furthermore, C-allele homozygosity in del(5q) was associated with prolonged overall and progression-free survival and non-terminal interstitial deletions that excluded 5q34, whereas G-allele homozygozity was associated with inferior outcome and terminal deletions involving 5q34 (P=0.05). These findings comprise the largest MDS R72P SNP analysis.

Ergolytic/ergogenic effects of creatine on aerobic power

This study evaluated the effects of creatine (Cr) loading and sex differences on aerobic running performance. 27 men (mean±SD; age: 22.2±3.1 years, ht: 179.5±8.7 cm, wt: 78.0±9.8 kg) and 28 women (age: 21.2±2.1 years, ht: 166.0±5.8 cm, wt: 63.4±8.9 kg) were randomly assigned to either creatine (Cr, di-creatine citrate; n=27) or a placebo (PL; n=28) group, ingesting 1 packet 4 times daily (total of 20 g/day) for 5 days. Aerobic power (maximal oxygen consumption: VO2max) was assessed before and after supplementation using open circuit spirometry (Parvo-Medics) during graded exercise tests on a treadmill. 4 high-speed runs to exhaustion were conducted at 110, 105, 100, and 90% of peak velocity to determine critical velocity (CV). Distances achieved were plotted over times-to-exhaustion and linear regression was used to determine the slopes (critical velocity, CV) assessing aerobic performance. The results indicated that Cr loading did not positively or negatively influence VO2max, CV, time to exhaustion or body mass (p>0.05). These results suggest Cr supplementation may be used in aerobic running activities without detriments to performance.

GM1 structure determines SV40-induced membrane invagination and infection

Incoming simian virus 40 (SV40) particles enter tight-fitting plasma membrane invaginations after binding to the carbohydrate moiety of GM1 gangliosides in the host cell plasma membrane through pentameric VP1 capsid proteins. This is followed by activation of cellular signalling pathways, endocytic internalization and transport of the virus via the endoplasmic reticulum to the nucleus. Here we show that the association of SV40 (as well as isolated pentameric VP1) with GM1 is itself sufficient to induce dramatic membrane curvature that leads to the formation of deep invaginations and tubules not only in the plasma membrane of cells, but also in giant unilamellar vesicles (GUVs). Unlike native GM1 molecules with long acyl chains, GM1 molecular species with short hydrocarbon chains failed to support such invagination, and endocytosis and infection did not occur. To conceptualize the experimental data, a physical model was derived based on energetic considerations. Taken together, our analysis indicates that SV40, other polyoma viruses and some bacterial toxins (Shiga and cholera) use glycosphingolipids and a common pentameric protein scaffold to induce plasma membrane curvature, thus directly promoting their endocytic uptake into cells.

Age-dependent increase in desmosterol restores DRM formation and membrane-related functions in cholesterol-free DHCR24-/- mice

Cholesterol is a prominent modulator of the integrity and functional activity of physiological membranes and the most abundant sterol in the mammalian brain. DHCR24-knock-out mice lack cholesterol and accumulate desmosterol with age. Here we demonstrate that brain cholesterol deficiency in 3-week-old DHCR24^−/− mice was associated with altered membrane composition including disrupted detergent-resistant membrane domain (DRM) structure. Furthermore, membrane-related functions differed extensively in the brains of these mice, resulting in lower plasmin activity, decreased β-secretase activity and diminished Aβ generation. Age-dependent accumulation and integration of desmosterol in brain membranes of 16-week-old DHCR24^−/− mice led to the formation of desmosterol-containing DRMs and rescued the observed membrane-related functional deficits. Our data provide evidence that an alternate sterol, desmosterol, can facilitate processes that are normally cholesterol-dependent including formation of DRMs from mouse brain extracts, membrane receptor ligand binding and activation, and regulation of membrane protein proteolytic activity. These data indicate that desmosterol can replace cholesterol in membrane-related functions in the DHCR24^−/− mouse.

Acute effects of passive stretching vs vibration on the neuromuscular function of the plantar flexors

This study examined the acute effects of passive stretching (PS) vs prolonged vibration (VIB) on voluntary peak torque (PT), percent voluntary activation (%VA), peak twitch torque (PTT), passive range of motion (PROM), musculotendinous stiffness (MTS), and surface electromyographic (EMG) and mechanomyographic (MMG) amplitude of the medial gastrocnemius (MG) and soleus (SOL) muscles during isometric maximal voluntary contractions (MVCs) of the plantar flexors. Fifteen healthy men performed the isometric MVCs and PROM assessments before and after 20 min of PS, VIB, and a control (CON) conditions. There were 10% and 5% decreases in voluntary PT, non-significant 3% and 2% decreases in %VA, 9-23% decreases in EMG amplitude of the MG and SOL after the PS and VIB, respectively, with no changes after the CON. PROM increased by 19% and MTS decreased by 38% after the PS, but neither changed after the VIB or CON conditions. Both PS and VIB elicited similar neural deficits (i.e., gamma loop impairment) that may have been responsible for the strength losses. However, mechanical factors related to PROM and MTS cannot be ruled out as contributors to the stretching-induced force deficit.

Effects of creatine supplementation on the onset of neuromuscular fatigue threshold and muscle strength in elderly men and women (64 - 86 years)

OBJECTIVES

This study examined the effects of 14 days of creatine supplementation on the physical working capacity at fatigue threshold (PWCFT), maximal isometric grip strength (GRIP), sit-to-stand (STS), and body weight (BW) in elderly men and women.

DESIGN

Using a double blind cross-over design, fifteen men (n = 7) and women (n = 8) (age +/- SD = 74.5 +/- 6.4 yrs) were randomly assigned to either the creatine (CR) (20g.d-1 during week 1 decreasing to 10g.d-1 at week 2) or Placebo (PL) group. After a 4 to 6 week washout period, the subjects were assigned the other treatment. Before (pre) and after (post) the supplementation period, participants performed a discontinuous, cycle ergometry test to determine the PWCFT. In addition, subjects performed STS, GRIP, BW test prior to and post treatment.

SETTING

Southeastern part of the United States.

RESULTS

Significant increases in GRIP (6.7%) and PWCFT (15.6%) from pre- to post-supplementation were found for the CR (p < 0.05) treatment, but no change for the PL treatment was observed. However, no significant change (p superior 0.05) was noted for STS or BW for either treatment.

CONCLUSION

These findings suggest that 14 days of CR supplementation may increase upper body grip strength and increase physical working capacity by delaying neuromuscular fatigue in the elderly men and women in this study. While more research is needed, CR supplementation may improve upper body grip strength and lower body muscle endurance which may be important for maintaining health and independent living in elderly men and women.

Label-free optical detection and tracking of single virions bound to their receptors in supported membrane bilayers

We apply an interferometric optical detection scheme to image and track unlabeled single virions. Individual simian virus 40 virions and uninfectious virus-like particles were imaged on a glass substrate and on a supported membrane bilayer. Moreover, single unlabeled virions were tracked when bound to supported membrane bilayers via the viral receptor, the glycolipid GM1. The technology presented here promises to be generally applicable to studying the motion of unlabeled macromolecules on membranes.

GST CYP and PON1 polymorphisms in farmers attributing ill health to organophosphate-containing sheep dip

Previously we reported that in sheep dippers exposed to organophosphates the frequency of paraoxonase (PON1) polymorphisms differed between those with or without self-reported ill health. We have now examined whether polymorphisms in other genes involved in xenobiotic metabolism alter disease risk in this population. There were elevated but non-significant risks associated with the CYP2D6 WT genotype (odds ratio (OR) 1.47, 95% CI 0.83-2.60), or a GSTP1*B or *C allele (OR 1.37, 95% CI 0.88-2.01) or being GSTM1*2/GSTT1*2 homozygous (OR 1.61, 95% CI 0.74-3.48). Similar results were generally obtained after the exclusion of subjects to obtain a more homogenous case-referent population: for double null GSTM1 and GSTT1 homozygotes the OR was 2.06 (95% CI 0.85-2.04). In those also likely to have been exposed to diazinon, risks associated with a GSTP1*B or *C allele (OR 1.82, 95% CI 0.92-3.63) or a GSTM1*2/GSTT1*2 homozygous (OR 2.60, 95% CI 0.72-10.42) were elevated but not to a significant extent. Risk associated with PON1 genotype and phenotype varied with CYP2D6 and GSTP1 genotype but not consistently with a priori hypotheses. Further work is necessary to delineate more clearly pathways of organophosphate activation and non-PON1 pathways of detoxification and to confirm whether CYP and GST polymorphisms alter disease risk in populations exposed to organophosphates.

Paraoxonase polymorphisms and self-reported chronic ill-health in farmers dipping sheep

BACKGROUND

Serum paraoxonase (PON1) provides protection against organophosphate induced toxicity. Recently we reported that the frequency of paraoxonase polymorphisms in sheep dippers with self-reported chronic ill-health differed from that in dippers with a similar dipping history but no ill-health. As these analyses may have included subjects with conditions unrelated to organophosphate exposure, the aim of this study was to examine whether the risk associated with PON1 polymorphisms varied using a more homogenous case and referent population.

METHODS

Each subject completed a detailed symptom questionnaire and their general practitioner was asked whether there was any history of neurological disease that could be confused with the effects of organophosphate poisoning. Subjects were then excluded both on clinical grounds and where identified as atypical on discriminant analysis.

RESULTS

Risk associated with the PON1 192 and 55 genotypes altered little with these changes in the population.

CONCLUSIONS

These findings are consistent with the hypothesis that organophosphates contribute to the self-reported ill-health of sheep dippers.

Single-particle tracking of murine polyoma virus-like particles on live cells and artificial membranes

The lateral mobility of individual murine polyoma virus-like particles (VLPs) bound to live cells and artificial lipid bilayers was studied by single fluorescent particle tracking using total internal reflection fluorescence microscopy. The particle trajectories were analyzed in terms of diffusion rates and modes of motion as described by the moment scaling spectrum. Although VLPs bound to their ganglioside receptor in lipid bilayers exhibited only free diffusion, analysis of trajectories on live 3T6 mouse fibroblasts revealed three distinct modes of mobility: rapid random motion, confined movement in small zones (30-60 nm in diameter), and confined movement in zones with a slow drift. After binding to the cell surface, particles typically underwent free diffusion for 5-10 s, and then they were confined in an actin filament-dependent manner without involvement of clathrin-coated pits or caveolae. Depletion of cholesterol dramatically reduced mobility of VLPs independently of actin, whereas inhibition of tyrosine kinases had no effect on confinement. The results suggested that clustering of ganglioside molecules by the multivalent VLPs induced transmembrane coupling that led to confinement of the virus/receptor complex by cortical actin filaments.

How viruses enter animal cells

Viruses replicate within living cells and use the cellular machinery for the synthesis of their genome and other components. To gain access, they have evolved a variety of elegant mechanisms to deliver their genes and accessory proteins into the host cell. Many animal viruses take advantage of endocytic pathways and rely on the cell to guide them through a complex entry and uncoating program. In the dialogue between the cell and the intruder, the cell provides critical cues that allow the virus to undergo molecular transformations that lead to successful internalization, intra-cellular transport, and uncoating.

Ganglioside-dependent cell attachment and endocytosis of murine polyomavirus-like particles

For murine polyomavirus (Py), previous studies suggest the cellular target is a terminal alpha2,3-linked sialic acid. Here, we investigate the binding and uptake of mouse polyomavirus-like particles (PyVLP) derived from bacterially expressed VP1. We find that in fibroblast 3T6 cells, binding of PyVLP was substantially reduced by sialidase treatment, but only moderately affected by protease treatment, suggesting glycolipids such as the sialic acid-containing gangliosides mediate cell attachment. We further tested the entry requirement of PyVLP using the ganglioside-deficient GM95 murine cell line, and find PyVLP binding and entry were reduced in these cells. Finally, we find that addition of gangliosides G(M1), G(D1a), and G(T1b) to GM95 cells restored cellular PyVLP binding and uptake. Taken together, results indicate that gangliosides function in PyVLP cell attachment and endocytosis.

Gene therapy progress and prospects: gene therapy of lysosomal storage disorders

Despite disappointments with early clinical studies, there is continued interest in the development of gene therapy for the group of metabolic diseases referred to as lysosomal storage disorders (LSDs). The LSDs are monogenic and several small and large, representative animal models of the human diseases are available. Further, the successful reconstitution of only low and unregulated tissue levels of the affected lysosomal enzymes are expected to be sufficient to correct the disease at least in the case of some of the LSDs. For these reasons, they are perceived as good models for the evaluation of different gene delivery vectors and of different strategies for treating chronic genetic diseases by gene transfer. In this review, we will highlight the progress that has been made over the past 2 years in preclinical research for this group of disorders and speculate on future prospects.

Evaluation of inherent performance of intelligent medical decision support systems: utilising neural networks as an example

Researchers who design intelligent systems for medical decision support, are aware of the need for response to real clinical issues, in particular the need to address the specific ethical problems that the medical domain has in using black boxes. This means such intelligent systems have to be thoroughly evaluated, for acceptability. Attempts at compliance, however, are hampered by lack of guidelines. This paper addresses the issue of inherent performance evaluation, which researchers have addressed in part, but a Medline search, using neural networks as an example of intelligent systems, indicated that only about 12.5% evaluated inherent performance adequately. This paper aims to address this issue by concentrating on the possible evaluation methodology, giving a framework and specific suggestions for each type of classification problem. This should allow the developers of intelligent systems to produce evidence of a sufficiency of output performance evaluation.

Implementation of intelligent decision support systems in health care

The full implementation of any intelligent system in health care, which is designed for decision support, has several stages, from initial problem identification through development and, finally, cost-benefit analysis. Central to this is formal objectivist evaluation with its core component of inherent performance of the outputs from these systems. A Medline survey of one type of intelligent system is presented, which demonstrates that this issue is not being addressed adequately. Lack of criteria for dealing with the outputs from these "black box" systems to prescribe adequate levels of inherent performance may be preventing their being accepted by those in the health-care domain and, thus, their being applied widely in the field.

Npap60/Nup50 is a tri-stable switch that stimulates importin-alpha:beta-mediated nuclear protein import

Many nuclear-targeted proteins are transported through the nuclear pore complex (NPC) by the importin-alpha:beta receptor. We now show that Npap60 (also called Nup50), a protein previously believed to be a structural component of the NPC, is a Ran binding protein and a cofactor for importin-alpha:beta-mediated import. Npap60 is a tri-stable switch that alternates between binding modes. The C terminus binds importin-beta through RanGTP. The N terminus binds the C terminus of importin-alpha, while a central domain binds importin-beta. Npap60:importin-alpha:beta binds cargo and can stimulate nuclear import. Endogenous Npap60 can shuttle and is accessible from the cytoplasmic side of the nuclear envelope. These results identify Npap60 as a cofactor for importin-alpha:beta nuclear import and as a previously unidentified subunit of the importin complex.

Systems analysis of Ran transport

The separate components of nucleocytoplasmic transport have been well characterized, including the key regulatory role of Ran, a guanine nucleotide triphosphatase. However, the overall system behavior in intact cells is difficult to analyze because the dynamics of these components are interdependent. We used a combined experimental and computational approach to study Ran transport in vivo. The resulting model provides the first quantitative picture of Ran flux between the nuclear and cytoplasmic compartments in eukaryotic cells. The model predicts that the Ran exchange factor RCC1, and not the flux capacity of the nuclear pore complex (NPC), is the crucial regulator of steady-state flux across the NPC. Moreover, it provides the first estimate of the total in vivo flux (520 molecules per NPC per second and predicts that the transport system is robust.

Performance evaluation of artificial intelligence classifiers for the medical domain

The application of artificial intelligence systems is still not widespread in the medical field, however there is an increasing necessity for these to handle the surfeit of information available. One drawback to their implementation is the lack of criteria or guidelines for the evaluation of these systems. This is the primary issue in their acceptability to clinicians, who require them for decision support and therefore need evidence that these systems meet the special safety-critical requirements of the domain. This paper shows evidence that the most prevalent form of intelligent system, neural networks, is generally not being evaluated rigorously regarding classification precision. A taxonomy of the types of evaluation tests that can be carried out, to gauge inherent performance of the outputs of intelligent systems has been assembled, and the results of this presented in a clear and concise form, which should be applicable to all intelligent classifiers for medicine.

The pigmented "black" neuroendocrine tumor of the pancreas: a question of origin

BACKGROUND

Pigmented neoplasms are extremely rare in the pancreas, and, when black pigment is identified, it often suggests the diagnosis of metastatic melanoma. The authors describe two patients with pigmented "black" neuroendocrine tumors of the pancreas. One patient had an incidental (0.5 cm) finding, and the second patient had a well-demarcated, 4.5-cm mass identified by computerized tomography that was consistent with an islet cell tumor.

METHODS

The two neoplasms were resected surgically and studied by light microscopy using hematoxylin and eosin (H&E), Fontana-Masson, and iron stains. The neoplasms were examined immunohistochemically, and ultrastructural analysis was performed.

RESULTS

H&E stains revealed nests of well-differentiated cells with small, round, centrally placed nuclei. The cytoplasm of the neoplastic cells was pink and granular and contained abundant brown-black pigment. Angiolymphatic and perineural invasion were identified in the larger neoplasm. Both neoplasms demonstrated a positive reaction with a Fontana-Masson stain, which was susceptible to bleaching, and a negative reaction to an iron stain. Immunohistochemical stains showed that neoplastic cells expressed chromogranin and synaptophysin but did not express HMB-45, S-100 protein, glucagon, or insulin. Ultrastructural examination revealed regular neurosecretory granules (100-150 nm) and large, irregularly shaped, electron-dense granules with small lipid inclusions consistent with lipofuscin.

CONCLUSIONS

These pigmented pancreatic neoplasms are similar histologically and radiographically to the "black adenoma" of the adrenal gland. It is important to recognize these tumors, because they may mimic metastatic melanoma.

Sorption and mobility of dithiopyr in golf course greens rooting medium

Sorption and mobility of dithiopyr in golf course greens rooting medium (RM) were studied. The sorption increased from 20 to 27 degrees C at 24 h after treatment (HAT) and reached equilibrium in 48 HAT at 20 degrees C. The sorption isotherms had Freundlich values (KF) of 1122, 27.44 to 35.16, and 0.053 to 0.168 for peat moss, the RM, and quartz sand, respectively, and solid to aqueous phase partition coefficients (Kd) of 470 to 1706 L/kg, 14.61 to 84.4 L/kg, and 0.07 to 0.29 L/kg for peat moss, RM, and quartz sand, respectively. Generally, higher dithiopyr concentration in the aqueous solution and the reduced pH of the solution corresponded to the higher Kd values. The average values for dispersion (D, cm2/min), retardation coefficient (R), beta, and omega parameters for solute transport in the RM lysimeter; obtained from CXTFIT curve fitting of Br- breakthrough curves; were 0.95, 1.01, 1, and 93.89, respectively. After elutriation by 18 L of aqueous KNO3 (10 mM), greater than 90% of the added dithiopyr remained in the top 10 cm of the RM lysimeter and no detectable dithiopyr was present at depths beyond 35 cm. The lysimeter effluent contained dithiopyr at concentrations less than 3.5 microg/L. The R value obtained from CXFIT curve fitting is 38.5. Results from both sorption and mobility experiments indicated that dithiopyr is quite immobile in golf course greens RM and has minimal potential for movement into surface water drainage or ground water.

Aerosol and lobar administration of a recombinant adenovirus to individuals with cystic fibrosis. II. Transfection efficiency in airway epithelium

A phase I clinical trial was conducted in which recombinant adenovirus containing the cystic fibrosis trans-membrane regulator (CFTR) (Ad2/CFTR) was administered by bronchoscopic instillation or aerosolization to the lungs of cystic fibrosis (CF) patients. In this paper, we evaluate the efficiency of Ad2/CFTR-mediated transduction of bronchial airway cells. The ability of an Ad2/CFTR vector to transduce airway cells was first evaluated in patients to whom the vector was administered by bronchoscopic instillation. Cells at the administration site were collected 2 days after treatment by bronchoscopic brushing. Ad2-specific CFTR DNA was detected in four of five individuals by PCR, and Ad2-specific CFTR RNA was detected in three of five individuals by RT-PCR. Ad2/CFTR-mediated transduction of airway epithelial cells was then determined in CF individuals receiving this vector by aerosol inhalation. Ad2-specific CFTR DNA was detected in 13 of 13 individuals 2 days after aerosolization, and in 3 of 5 individuals 7 days after aerosolization. Ad2-specific RNA was detected in 4 of 13 individuals on day 2, but was not detected in the 5 individuals tested on day 7. The percentage of airway epithelial cells containing nuclear-localized vector DNA was < or =2.4% as determined by fluorescence in situ hybridization (FISH). However, in some cases, a high percentage of nonepithelial mononuclear cells or squamous metaplastic epithelial cells was infected with the adenoviral vector. In conclusion, aerosol administration is a feasible means to distribute adenoviral vectors throughout the conducting airways, but improvements in adenovirus-mediated transduction of airway epithelial cells are necessary before gene therapy for CF will be effective.

Aerosol and lobar administration of a recombinant adenovirus to individuals with cystic fibrosis. I. Methods, safety, and clinical implications

Cystic fibrosis (CF), an autosomal recessive disorder resulting from mutations in the cystic fibrosis trans-membrane conductance regulator (CFTR) gene, is the most common lethal genetic illness in the Caucasian population. Gene transfer to airway epithelium, using adenoviruses containing normal CFTR cDNA, leads to transient production of CFTR mRNA and, in some studies, to correction of the airway epithelial ion transport defect caused by dysfunctional CFTR. Inflammatory responses to the adenoviral vector have been reported, particularly at high viral titers. We evaluated the effects of adenovirus-mediated CFTR gene transfer to airway epithelium in 36 subjects with CF (34 individuals, 2 of whom received two separate doses of vector), 20 by lobar instillation and 16 by aerosol administration. Doses ranged from 8 x 10(6) to 2.5 x 10(10) infective units (IU), in 0.5-log increments. After lobar administration of low doses there were occasional reports of cough, low-grade temperature, and myalgias. At the highest lobar dose (2.5 x 10(9) IU) two of three patients had transient myalgias, fever, and increased sputum production with obvious infiltrates on CT scan. After aerosol administration there were no significant systemic symptoms until the 2.5 x 10(10) IU dose, when both patients experienced myalgias and fever that resolved within 24 hr. There were no infiltrates seen on chest CT scans in any of the patients in the aerosol administration group. There were no consistent changes in pulmonary function tests or any significant rise in serum IgG or neutralizing antibodies in patients from either group. Serum, sputum, and nasal cytokines, measured before and after vector administration, showed no correlation with adenoviral dose. Gene transfer to lung cells was inefficient and expression was transient. Cells infected with the vector included mononuclear inflammatory cells as well as cuboidal and columnar epithelial cells. In summary, we found no consistent immune response, no evidence of viral shedding, and no consistent change in pulmonary function in response to adenovirus-mediated CFTR gene transfer. At higher doses there was a mild, nonspecific inflammatory response, as evidenced by fevers and myalgias. Overall, vector administration was tolerated but transfer of CFTR cDNA was inefficient and transgene expression was transient for the doses and method of administration used here.

Characterization of the zinc sites in cobalamin-independent and cobalamin-dependent methionine synthase using zinc and selenium X-ray absorption spectroscopy

X-ray absorption spectroscopy has been used to investigate binding of selenohomocysteine to cobalamin-independent (MetE) and cobalamin-dependent (MetH) methionine synthase enzymes of Escherichia coli. We have shown previously [Peariso et al. (1998) J. Am. Chem. Soc. 120, 8410-8416] that the Zn sites in both enzymes show an increase in the number of sulfur ligands when homocysteine binds. The present data provide direct evidence that this change is due to coordination of the substrate to the Zn. Addition of L-selenohomocysteine to either MetE or the N-terminal fragment of MetH, MetH(2-649), causes changes in the zinc X-ray absorption near-edge structure that are remarkably similar to those observed following the addition of L-homocysteine. Zinc EXAFS spectra show that the addition of L-selenohomocysteine changes the coordination environment of the zinc in MetE from 2S + 2(N/O) to 2S + 1(N/O) + 1Se and in MetH(2-649) from 3S + 1(N/O) to 3S + 1Se. The Zn-S, Zn-Se, and Se-S bond distances determined from the zinc and selenium EXAFS data indicate that the zinc sites in substrate-bound MetE and MetH(2-649) both have an approximately tetrahedral geometry. The selenium edge energy for selenohomocysteine shifts to higher energy when binding to either methionine synthase enzyme, suggesting that there is a slight decrease in the effective charge of the selenium. Increases in the Zn-Cys bond distances upon selenohomocysteine binding together with identical magnitudes of the shifts to higher energy in the Se XANES spectra of MetE and MetH(2-649) suggest that the Lewis acidity of the Zn sites in these enzymes appears the same to the substrate and is electronically buffered by the Zn-Cys interaction.

Protonation state of methyltetrahydrofolate in a binary complex with cobalamin-dependent methionine synthase

N5-Methyltetrahydrofolate (CH(3)-H(4)folate) donates a methyl group to the cob(I)alamin cofactor in the reaction catalyzed by cobalamin-dependent methionine synthase (MetH, EC 2.1.1.3). Nucleophilic displacement of a methyl group attached to a tertiary amine is a reaction without an obvious precedent in bioorganic chemistry. Activation of CH(3)-H(4)folate by protonation prior to transfer of the methyl group has been the favored mechanism. Protonation at N5 would lead to formation of an aminium cation, and quaternary amines such as 5,5-dimethyltetrahydropterin have been shown to transfer methyl groups to cob(I)alamin. Because CH(3)-H(4)folate is an enamine, protonation could occur either at N5 to form an aminium cation or on a conjugated carbon with formation of an iminium cation. We used (13)C distortionless enhancement by polarization transfer (DEPT) NMR spectroscopy to infer that CH(3)-H(4)folate in aqueous solution protonates at N5, not on carbon. CH(3)-H(4)folate must eventually protonate at N5 to form the product H(4)folate; however, this protonation could occur either upon formation of the binary enzyme-CH(3)-H(4)folate complex or later in the reaction mechanism. Protonation at N5 is accompanied by substantial changes in the visible absorbance spectrum of CH(3)-H(4)folate. We have measured the spectral changes associated with binding of CH(3)-H(4)folate to a catalytically competent fragment of MetH over the pH range from 5.5 to 8.5. These studies indicate that CH(3)-H(4)folate is bound in the unprotonated form throughout this pH range and that protonated CH(3)-H(4)folate does not bind to the enzyme. Our observations are rationalized by sequence homologies between the folate-binding region of MetH and dihydropteroate synthase, which suggest that the pterin ring is bound in the hydrophobic core of an alpha(8)beta(8) barrel in both enzymes. The results from these studies are difficult to reconcile with an S(N)2 mechanism for methyl transfer and suggest that the presence of the cobalamin cofactor is important for CH(3)-H(4)folate activation. We propose that protonation of N5 occurs after carbon-nitrogen bond cleavage, and we invoke a mechanism involving oxidative addition of Co(1+) to the N5-methyl bond to rationalize our results.

L-Selenohomocysteine: one-step synthesis from L-selenomethionine and kinetic analysis as substrate for methionine synthases

A single-step convenient synthesis of L-selenohomocysteine (SeHcy) from L-selenomethionine (SeMet) using sodium in liquid ammonia is described. Methionine synthases convert SeHcy to SeMet at rates comparable to their rates of conversion of L-homocysteine (Hcy) to L-methionine (Met). This study suggests that SeHcy generated from SeMet metabolism can be efficiently recycled to SeMet in mammals.

The importance of local data in unintended pregnancy prevention programming

OBJECTIVE

Lack of local data on pregnancy intendedness poses a serious problem for those responsible for regional program development and evaluation. This article demonstrates how the Boulder County Health Department addressed this problem by conducting its own assessment. The information gathered served as the basis for collaborative population-based programming and policy development aimed at decreasing unintended pregnancy in the county.

METHODS

A random-digit-dial telephone survey of 300 men and 300 women was conducted to estimate the prevalence of unintended pregnancy and establish groups at highest risk. Qualitative data regarding the psychosocial and contextual factors associated with unintended pregnancy were gathered in six focus groups conducted with 46 males and females aged 18-28 who had experienced an unintended pregnancy.

RESULTS

The prevention strategies identified by the focus group participants lead to the development of locally relevant interventions among specific high-risk populations identified in the telephone survey. Programmatic and policy initiatives included raising awareness among key service providers and the community at large, creative means of bringing information and resources to those at risk, strengthening the delivery of clinical services, and promoting school involvement in unintended pregnancy prevention.

CONCLUSION

Maternal and child health authorities should encourage the collection and use of pregnancy intendedness data at the local level.

The mechanical properties of Saccharomyces cerevisiae

Cell-wall mechanical properties play an integral part in the growth and form of Saccharomyces cerevisiae. In contrast to the tremendous knowledge on the genetics of S. cerevisiae, almost nothing is known about its mechanical properties. We have developed a micromanipulation technique to measure the force required to burst single cells and have recently established a mathematical model to extract the mechanical properties of the cell wall from such data. Here we determine the average surface modulus of the S. cerevisiae cell wall to be 11.1 +/- 0.6 N/m and 12.9 +/- 0.7 N/m in exponential and stationary phases, respectively, giving corresponding Young's moduli of 112 +/- 6 MPa and 107 +/- 6 MPa. This result demonstrates that yeast cell populations strengthen as they enter stationary phase by increasing wall thickness and hence the surface modulus, without altering the average elastic properties of the cell-wall material. We also determined the average breaking strain of the cell wall to be 82% +/- 3% in exponential phase and 80% +/- 3% in stationary phase. This finding provides a failure criterion that can be used to predict when applied stresses (e.g., because of fluid flow) will lead to wall rupture. This work analyzes yeast compression experiments in different growth phases by using engineering methodology.

Review of the Bethesda System atlas does not improve reproducibility or accuracy in the classification of atypical squamous cells of undetermined significance smears

BACKGROUND

The Bethesda System (TBS) and its accompanying atlas were developed to promote uniform diagnosis and reporting of cervical and vaginal cytology, especially with respect to borderline abnormal smears. The authors assessed whether group study of TBS atlas improves the reproducibility and accuracy of the cytopathologic diagnosis of equivocal Papanicolaou smears.

METHODS

One hundred "atypical" smears were divided into pretest and posttest sets containing equal numbers of negative, atypical squamous cells of undetermined significance (ASCUS), and squamous intraepithelial lesion (SIL) diagnoses based on a five-member panel review. Two comparable teams of four pathologists from George Washington University Medical Center (Washington, DC) and Kaiser Permanente (Portland, OR), each comprised of two more experienced cytopathologists and two less experienced pathologists, independently reviewed the 50 pretest slides and classified the slides according to TBS as negative, ASCUS, or SIL. The teams then conducted group study sessions using TBS atlas. After the review, the pathologists independently classified the 50 posttest slides in a similar manner.

RESULTS

Pretest, pair-wise interobserver agreement ranged from 30% to 66% compared with 34-62% for posttest agreement. Absolute percent agreement of reviewers' diagnoses with a previously developed consensus diagnosis based on opinions of a five-expert panel (cytopathologic certainty scale) ranged from 44% to 62% for the pretest set and from 40% to 60% for the posttest set. Comparison of the detection of oncogenic human papilloma virus (HPV) DNA by hybrid capture tube test with smears classified as negative, ASCUS, or SIL revealed that seven of eight reviewers did not demonstrate a stronger association between HPV detection and cytologic diagnosis in the posttest set.

CONCLUSIONS

Review of TBS atlas by itself does not appear to improve the reproducibility or accuracy of cytologic diagnoses. The lack of improvement was similar among the pathologists involved regardless of experience level or whether they had a close working relation. Cancer (Cancer Cytopathol)

Perceived knowledge and training needs in adolescent pregnancy prevention: results from a multidisciplinary survey

OBJECTIVES

To examine health care professionals' knowledge and interest in training in adolescent pregnancy prevention and whether an association exists between perceived knowledge and interest in training.

DESIGN

A cross-sectional mailed survey.

PARTICIPANTS

Random, stratified sample design that identified 800 psychologists, 800 social workers, 1,000 nurses, and 400 pediatricians from national professional membership lists. Response rate to the mailed survey was 51%. After removing respondents who did not currently work with adolescents, 1,242 surveys (41%) were available for analyses.

MAIN OUTCOME MEASURES

Descriptive analyses were conducted on self-report data concerning perceived knowledge and interest in training about adolescent pregnancy prevention separately for each of the 4 disciplines. Within disciplines, perceived knowledge and interest in training were correlated for each of 3 content areas (ie, sex education and contraceptive counseling, adolescent pregnancy, and counseling after a negative pregnancy test) and for a summary measure of the content areas.

RESULTS

Less than half of the nursing, pediatrics, psychology, and social work professionals reported high perceived knowledge in the 3 content areas. Psychologists and social workers reported the lowest perceived knowledge. However, with the exception of psychologists, more than two thirds of the other respondents reported moderate or high interest in training in the 3 content areas. Interest in training was not strongly correlated with perceived knowledge within any discipline.

CONCLUSIONS

The need to integrate psychosocial components into adolescent health care is a core assumption in the field, yet these data indicate that psychologists and social workers perceive low levels of knowledge and interest in training. These disciplines may benefit from more targeted professional training about their role in preventing adolescent pregnancy.

Prevalence of home pregnancy testing among adolescents

OBJECTIVES

This study estimated the prevalence of home pregnancy testing among adolescents.

METHODS

A survey was administered in 11 urban clinics to 600 females aged 13 to 19 years.

RESULTS

The prevalence of home pregnancy test use was 34% among 474 sexually experienced youths; 77% of the users had received at least 1 negative pregnancy test result, and 48% took no further action for confirmation. Compared with those who had never used such tests, users were older, younger at sexual debut, less likely to consistently use effective birth control, and more likely to have ever been pregnant.

CONCLUSIONS

Health care clinics are important sources for pregnancy prevention, but clinics may have limited opportunity to intervene with some youths who use home pregnancy tests.

Vascular embolization of benign granulosa cells

OBJECTIVE(S)

Most conditions involving sex cord-stromal cells can be diagnosed on morphologic criteria alone. We describe a case of vascular embolization of benign granulosa cells in which immunohistochemistry was of value as a diagnostic tool.

METHODS

We reviewed the clinical history and gross pathologic findings from a 48-year-old patient who presented with abdominal pain and fullness. Formalin-fixed paraffin-embedded sections were examined by routine H&E and immunohistochemical stains.

RESULTS

Histologic examination of a grossly enlarged and cystic ovary revealed nests of cells within angiolymphatic spaces. Although the cells were cohesive and atypical, they were morphologically similar to the nearby graafian follicle. Immunohistochemistry showed positive labeling with antibodies to inhibin-alpha and cytokeratin in a pattern consistent with benign granulosa cells.

CONCLUSION(S)

Immunohistochemical stains for inhibin-alpha and cytokeratin are useful tools to help confirm granulosa cell origin, as demonstrated in this case involving an atypical histomorphologic picture of "embolization."

Domiciliary visits to the old and the mentally ill: how valuable?

In the early days of the British National Health Service, domiciliary visits were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patient's home. The nature of domiciliary visits, which still attract a special fee, has since changed. We analysed the effectiveness of all domiciliary visits undertaken in a NHS trust providing primary care, mental health and elderly care services to a population of 470,000. Data were obtained from domiciliary visit claim forms and from questionnaires completed by the consultant, the referring GP and consultant peer reviewers. The largest number of visits (total 234) was in geriatric medicine 48.9%, followed by old-age psychiatry 44.9%. Geriatric medicine was more likely than psychiatry to admit patients to hospital (19%) after a visit. All domiciliary visits in old-age psychiatry were done during the day (9 am to 5 pm). Only 2% of GPs stated that they attended any of the domiciliary visits; almost all thought that the outcome of domiciliary visits was of value. Old-age-psychiatry peer reviewers believed that all visits in that specialty were appropriate; in geriatric medicine this figure was 77% and in other psychiatric specialties 65%. The findings indicate that domiciliary visits were not being used routinely as a pathway to hospital admission, though they were often used to expedite admission or gain a quick consultant opinion; the visits were valued by GPs. The practice of domiciliary visits differs greatly from the definition in NHS terms and conditions of service. One or other should be altered.

Bone mineral and geometric changes through the femur with immobilization due to spinal cord injury

This cross-sectional study describes bone mineral and geometric properties of the midshaft and distal femur in a control population and examines effects of immobilization due to spinal cord injury (SCI) at these skeletal sites. The subject populations were comprised of 118 ambulatory adults (59 men and 59 women) and 246 individuals with SCI (239 men and 7 women); 30 of these were considered to have acute injury (SCI duration <1 year). Bone mineral density (BMD) was assessed at the femoral neck, and midshaft and distal femur by dual energy absorptiometry. Geometric properties, specifically cortical area, polar moment of inertia, and polar section modulus, were estimated at the midshaft from cortical dimensions obtained by concurrent radiography. Reduction in BMD was noted in all femoral regions (27%, 25%, and 43% for femoral neck, midshaft, and distal femur, respectively) compared with controls. In contrast, although endosteal diameter was enlarged, geometric properties were not significantly reduced in the midshaft attributable to the age-related increase in periosteal diameter. These results suggest that simultaneous assessment of bone mineral and geometric properties may improve clinically relevant evaluation of skeletal status.

Genetic alterations in urinary bladder carcinosarcoma: evidence of a common clonal origin

The cellular origin of carcinosarcoma of the bladder is unknown. We addressed this issue by using microsatellite analysis for loss of heterozygosity (LOH) in both the carcinomatous and sarcomatous components of 6 bladder tumors. We tested 40 microsatellite markers from 19 human chromosomes and compared the genetic alterations between the two separately isolated components. The potential relevance of the E-cadherin pathway was also evaluated by immunohistochemistry. All 6 cases revealed identical LOH on chromosomal arms 9p, 9q, 8p, and 8q, corresponding to relatively early events in bladder carcinogenesis. Discordant losses between two alleles in the remaining chromosomes, associated with progression, were seen in all tumors with a trend toward a higher incidence in the more advanced tumors (N1M1 and N1Mx). E-cadherin was strongly expressed in the carcinomatous components (5 of 6), whereas most of sarcomatous elements displayed absence of the protein product (4 of 6). These results indicate that both the carcinomatous and sarcomatous components of carcinosarcoma are derived from a common stem cell. Downregulation of E-cadherin may define one of the pathways responsible for conversion of epithelial cells to the sarcomatous phenotype.

Do self-fulfilling prophecies accumulate, dissipate, or remain stable over time?

The authors examined whether self-fulfilling prophecies accumulate, dissipate, or remain stable over time by using data from more than 500 6th- through 12th-grade students in public school math classes. The authors used multiple regression analyses to assess the extent to which teacher perceptions predicted students' final math marks and standardized math-test scores from 6th through 12th grade. Control variables included 5 measures of student motivation and 2 measures of previous achievement. The results were consistent with both the dissipation and stability hypotheses. Implications for understanding the extent to which social perception creates social reality and the role of expectations in social problems are discussed.