Benefits of isochoric freezing for carrot juice preservation

Isochoric freezing (IF) at -5°C/77 and -10°C/100 MPa was used to preserve carrot juice for 12 weeks. The juice qualities were compared to those using heat treatment (HT) at 95°C for 15 s followed by cold storage at 4°C. The native population of total aerobic bacteria, yeasts, and molds in isochoric frozen juice remained below the detection limit for 12 weeks. In comparison, microbes started to grow in heat-treated juices after 3 weeks of refrigeration. The color of isochoric frozen juice appeared more deep orange than the fresh juice due to an increase in carotenoid extractability. IF was not effective in reducing the activities of peroxidase, polyphenol oxidase, and pectin methyl esterase compared with HT. However, the isochoric samples showed higher carotenoid content, polyphenol content, and antioxidant capacity compared to the fresh and heat-treated juices. PRACTICAL APPLICATION: Isochoric freezing was used to produce carrot juice with extended shelf life. Isochoric freezing could be a beneficial alternative to conventional heat treatment for carrot juice processing as the applied pressures reached total inactivation levels of spoilage microorganisms. Moreover, the low processing temperatures better retained desirable compounds and quality attributes of fresh juice throughout its shelf life.

Oral dydrogesterone versus micronized vaginal progesterone for luteal phase support: a double-blind crossover study investigating pharmacokinetics and impact on the endometrium

STUDY QUESTION

How do plasma progesterone (P) and dydrogesterone (D) concentrations together with endometrial histology, transcriptomic signatures, and immune cell composition differ when oral dydrogesterone (O-DYD) or micronized vaginal progesterone (MVP) is used for luteal phase support (LPS)?

SUMMARY ANSWER

Although after O-DYD intake, even at steady-state, plasma D and 20αdihydrodydrogesterone (DHD) concentrations spiked in comparison to P concentrations, a similar endometrial signature was observed by histological and transcriptomic analysis of the endometrium.

WHAT IS KNOWN ALREADY

O-DYD for LPS has been proven to be noninferior compared to MVP in two phase III randomized controlled trials. Additionally, a combined individual participant data and aggregate data meta-analysis indicated that a higher pregnancy rate and live birth rate may be obtained in women receiving O-DYD versus MVP for LPS in fresh IVF/ICSI cycles. Little data are available on the pharmacokinetic (PK) profiles of O-DYD versus MVP and their potential molecular differences at the level of the reproductive organs, particularly at the endometrial level.

STUDY DESIGN, SIZE, DURATION

Thirty oocyte donors were planned to undergo two ovarian stimulation (OS) cycles with dual triggering (1.000 IU hCG + 0.2 mg triptorelin), each followed by 1 week of LPS: O-DYD or MVP, in a randomized, cross-over, double-blind, double-dummy fashion. On both the first and eighth days of LPS, serial blood samples upon first dosing were harvested for plasma D, DHD, and P concentration analyses. On Day 8 of LPS, an endometrial biopsy was collected for histologic examination, transcriptomics, and immune cell analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All oocyte donors were <35 years old, had regular menstrual cycles, no intrauterine contraceptive device, anti-Müllerian hormone within normal range and a BMI ≤29 kg/m2. OS was performed on a GnRH antagonist protocol followed by dual triggering (1.000 IU hCG + 0.2 mg triptorelin) as soon as ≥3 follicles of 20 mm were present. Following oocyte retrieval, subjects initiated LPS consisting of MVP 200 mg or O-DYD 10 mg, both three times daily. D, DHD, and P plasma levels were measured using liquid chromatography-tandem mass spectrometry. Histological assessment was carried out using the Noyes criteria. Endometrial RNA-sequencing was performed for individual biopsies and differential gene expression was analyzed. Endometrial single-cell suspensions were created followed by flow cytometry for immune cell typing.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 21 women completed the entire study protocol. Subjects and stimulation characteristics were found to be similar between groups. Following the first dose of O-DYD, the average observed maximal plasma concentrations (Cmax) for D and DHD were 2.9 and 77 ng/ml, respectively. The Cmax for D and DHD was reached after 1.5 and 1.6 h (=Tmax), respectively. On the eighth day of LPS, the first administration of that day gave rise to a Cmax of 3.6 and 88 ng/ml for D and DHD, respectively. For both, the observed Tmax was 1.5 h. Following the first dose of MVP, the Cmax for P was 16 ng/ml with a Tmax of 4.2 h. On the eighth day of LPS, the first administration of that day showed a Cmax for P of 21 ng/ml with a Tmax of 7.3 h. All 42 biopsies showed endometrium in the secretory phase. The mean cycle day was 23.9 (±1.2) in the O-DYD group versus 24.0 (±1.3) in the MVP group. RNA-sequencing did not reveal significantly differentially expressed genes between samples of both study groups. The average Euclidean distance between samples following O-DYD was significantly lower than following MVP (respectively 12.1 versus 18.8, Mann-Whitney P = 6.98e-14). Immune cell profiling showed a decrease of CD3 T-cell, γδ T-cell, and B-cell frequencies after MVP treatment compared to O-DYD, while the frequency of natural killer (NK) cells was significantly increased.

LIMITATIONS, REASONS FOR CAUTION

The main reason for caution is the small sample size, given the basic research nature of the project. The plasma concentrations are best estimates as this was not a formal PK study. Whole tissue bulk RNA-sequencing has been performed not correcting for bias caused by different tissue compositions across biopsies.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first study comparing O-DYD/MVP, head-to-head, in a randomized design on a molecular level in IVF/ICSI. Plasma serum concentrations suggest that administration frequency is important, in addition to dose, specifically for O-DYD showing a rapid clearance. The molecular endometrial data are overall comparable and thus support the previously reported noninferior reproductive outcomes for O-DYD as compared to MVP. Further research is needed to explore the smaller intersample distance following O-DYD and the subtle changes detected in endometrial immune cells.

STUDY FUNDING/COMPETING INTEREST(S)

Not related to this work, C.Bl. has received honoraria for lectures, presentations, manuscript writing, educational events, or scientific advice from Abbott, Ferring, Organon, Cooper Surgical, Gedeon-Richter, IBSA, and Merck. H.T. has received honoraria for lectures, presentations, manuscript writing, educational events, or scientific advice from Abbott, Ferring, Cooper Surgical, Gedeon-Richter, Cook, and Goodlife. S.M. has received honoraria for lectures, presentations, educational events, or scientific advice from Abbott, Cooper Surgical, Gedeon-Richter, IBSA, and Merck and Oxolife. G.G. has received honoraria for lectures, presentations, educational events, or scientific advice from Merck, MSD, Organon, Ferring, Theramex, Gedeon-Richter, Abbott, Biosilu, ReprodWissen, Obseva, PregLem, Guerbet, Cooper, Igyxos, and OxoLife. S.V.-S. is listed as inventor on two patents (WO2019115755A1 and WO2022073973A1), which are not related to this work.

TRIAL REGISTRATION NUMBER

EUDRACT 2018-000105-23.

O-254 Oral dydrogesterone (OD) versus micronized vaginal progesterone (MVP) for luteal phase support (LPS): impact on endometrium and genital tract microbiota

Study question

Is there a difference in the endometrial transcriptome and/or reproductive tract microbiota composition when OD versus MVP is used as LPS for fresh embryo transfer?

Summary answer

Endometrial transcriptome signatures and microbiota composition at the vaginal, cervical or intra-uterine site presented no significant differences following OD versus MVP.

What is known already

Adequate LPS is crucial to achieve a successful pregnancy following ovarian stimulation (OS) and fresh embryo transfer. OD has been proven to be non-inferior compared to MVP in two phase III clinical RCTs. Additionally, a combined individual participant data and aggregate data meta-analysis showed an odds ratio in favor of OD for live birth. Little information is available on the potential differences at the molecular level of the reproductive organs following the administration of either LPS strategies. Given the potential immunomodulating properties of OD, of main interest is the endometrial functionality and microbiota composition of the female genital tract.

Study design, size, duration

Thirty oocyte donors were planned to have two OS-cycles followed by one week of LPS (OD or MVP) in a randomized, cross-over, double-blind, double-dummy fashion. An endometrial biopsy, as well as vaginal/cervical/intra-uterine samples were collected. Endometrial RNA-sequencing was performed, raw reads were processed using STAR/htseq-count, differential gene expression was evaluated with EdgeR. Microbiota profiles were obtained by 16S-rRNA-sequencing using the DADA2-pipeline with RDP-classifier. Comparative analysis of genera relative abundances was performed in R.

Participants/materials, setting, methods

All oocyte donors were &lt;35 years old, had regular menstrual cycles, no intra-uterine contraceptive device, AMH within normal range and BMI≤ 29 kg/m2. OS was performed in a GnRH antagonist protocol followed by dual triggering (1000U hCG + 0.2mg triptorelin) as soon as ≥ 3 follicles of 20mm were present. Following oocyte retrieval, subjects initiated LPS consisting of MVP 200 mg (Utrogestan®) or OD 10 mg (Duphaston®), both three times daily.

Main results and the role of chance

Subject and stimulation characteristics were comparable between the groups. For endometrial RNA-sequencing, 21 pairs (n = 42 biopsies) were available with the same oocyte donor having a biopsy after OD as well as after MVP (the remaining 9 subjects were excluded due to late follicular progesterone elevation/drop-out after one cycle). After correction for multiple hypothesis testing, no differentially expressed genes could be withheld and the principal component analysis plot showed one mixed OD/MVP cluster (PCA1 25% variance, PCA2 16% variance). The average Euclidean distance between samples of the OD group was significantly lower than for the MVP group (respectively 12.1 vs 18.8, comparison of the two-group wise Euclidean distributions results in p = 6.98e-14 using the Mann-Whitney test).

Microbiota profiling was performed before and after OD/MVP (4 collections per subject). Samples with insufficient high-quality reads were excluded, resulting in 42 intra-uterine samplings, 82 cervical and 84 vaginal swabs used for analysis. No difference was seen at any site of the female reproductive tract following OD versus MVP in microbiota diversity, richness, genera abundances (delta contrasts [Mann–Whitney U test], padj &gt; 0.1), nor community composition (dbRDA genus-level Euclidean distances in vagina [R2= 0.22%, padj=0.26], cervix [R2= 0.36%, padj=0.20], uterus [R2= -0.06%, padj=0.45]).

Limitations, reasons for caution

Sample size was limited. Whole tissue endometrial transcriptomics was performed on individual biopsies without accounting for the potential bias of different tissue compartment compositions among biopsies. As it was a double blind, double dummy study design, the impact of not administering medication via the vaginal route could not be evaluated.

Wider implications of the findings

This is the first molecular study comparing OD/MVP. Results show that there is no difference between OD/MVP’s ability to give rise to the receptive state, which corresponds with the clinical trial data. As the inter-sample distance of RNA-profiles was smaller following OD, interindividual variations could be lower for this approach.

Trial registration number

EUDRACT 2018-000105-23

P-409 The endometrial transcriptome of infertile women with and without recurrent implantation failure

Study question

Does the endometrial transcriptome profile differ between infertile women with or without a recurrent implantation failure (RIF)?

Summary answer

Although two different clusters emerged from the endometrial transcriptome data, these were not associated with clinical phenotype (RIF vs non-RIF).

What is known already

Despite the transfer of morphologically ‘good-quality’ embryos in IVF/ICSI, implantation failure often occurs, which may be explained by impaired endometrial receptivity. In order to guide prognosis and use effective therapeutic interventions, identifying a gene expression profile predictive of endometrial receptivity as well as implantation failure, would be of great value. Additionally, transcriptome analysis may also shed light on alterations in biological processes responsible for the implantation failure. Thousands of potential biomarkers for endometrial receptivity have already been identified by transcriptomic approach, however due to differences in study methodology, there is little overlap of markers between studies.

Study design, size, duration

Endometrial tissue was obtained from a cohort of 141 infertile women undergoing endometrial scratching within a randomised controlled trial (RCT) (SCRaTCH trial, NL5193/NTR5342). Briefly, women aged 18-44 years with failed implantation after one full IVF/ICSI cycle and planning a subsequent IVF/ICSI cycle, were eligible. Participants were followed-up until 12 months after randomisation, with the primary outcome being live birth, defined as the delivery of at least one live foetus after 24 weeks of gestation.

Participants/materials, setting, methods

Endometrial tissue was obtained with an endometrial biopsy catheter in the midluteal phase of a natural cycle preceding subsequent IVF/ICSI. Biopsies were snap-frozen and stored at -80 °C until use. After thawing, total RNA isolation, library preparation and paired-end RNA-sequencing were performed. Raw data was preprocessed and mapped to GRCh38. Reads (counts per million) were normalised using library size. Differential gene expression (DGE) analysis was conducted using the EdgeR package with significance threshold FDR &lt;0.05.

Main results and the role of chance

Out of 141 endometrium samples, 107 were included in the RNA-sequencing based on RNA quality. For DGE analysis, data of two groups were compared: the ‘fertile’ group, women with a live birth after ≤3 good quality embryo(s) transfers (n = 23), and the RIF group, women with no live birth after ≥3 good quality embryo(s) transfers (n = 23). Two clusters were visible in the principle component analysis (PCA) plot showing transcriptome data of the fertile and RIF samples (cluster 1, n = 29; cluster 2, n = 10), which was not explained by clinical phenotype, as both clusters contained samples of both the fertile and RIF group. DGE analysis between the fertile and RIF group resulted in respectively 3 significantly upregulated and 0 significantly downregulated genes, whereas DGE analysis between the two clusters resulted in 2,235 significantly upregulated and 2,162 significantly downregulated genes. Enrichment analysis of differentially expressed genes between both clusters demonstrated upregulation of enriched terms mainly annotated to cell migration and downregulation of enriched terms mainly annotated to lipid and mitochondrial metabolism.

Limitations, reasons for caution

A strength of the study is the large number of samples included. Bulk RNA-sequencing was conducted and there was a variation in LH-based timing of the biopsies (5-8 days after LH surge) for which adjustments of the transcriptome data for tissue cellular composition and menstrual cycle were performed.

Wider implications of the findings

Future studies investigating underlying biological mechanisms in the endometrium in (in)fertility by a (multi-)omics analysis approach with standardised methodology are required to obtain consistencies in relevant biomarkers/pathways, and in due course create possibilities to improve and personalise care for infertile couples.

Trial registration number

NL5193/NTR5342

P-087 Transcriptomic differences between fibrotic and non-fibrotic testicular tissue reveal possible key players in Klinefelter syndrome-related testicular fibrosis

Study question

Which genes are differentially expressed between patients with and without testicular fibrosis?

Summary answer

This study revealed three X-related genes MXRA5, DCX and VC3BX, which may be involved in Klinefelter-related testicular fibrosis.

What is known already

Klinefelter syndrome (KS; 47,XXY) affects 1-2 in 1000 males. Most KS men suffer from azoospermia due to a loss of spermatogonial stem cells. Additionally, testicular fibrosis is detected from puberty onwards. However, mechanisms responsible for fibrosis and germ cell loss remain unknown. Previous genomics studies on KS tissue focused on germ cell loss, however, differential gene expression analyses focused on testicular fibrosis have not been performed before.

This study aimed to identify factors involved in the fibrotic remodeling of KS testes by analyzing the transcriptome of (non-)fibrotic testicular tissue.

Study design, size, duration

Transcriptome analysis on extracted RNA from testicular biopsies was performed. RNA scope analysis and immunohistochemistry were performed as validation for the findings of the transcriptomics study.

Participants/materials, setting, methods

RNA sequencing was performed to compare the genetic profile of testicular biopsies from patients with (KS and testis atrophy) and without (Sertoli cell-only syndrome and fertile controls) testicular fibrosis (n = 5, each). Next, differentially expressed genes (DEGs) between KS and testis atrophy samples were compared. To gain insight in potential functions of DEGs (significant when p &lt; 0.01 and log2FC &gt; 2), gene-ontology and KEGG analyses were performed. To validate the gene expression results, immunohistochemistry and RNA scope were performed.

Main results and the role of chance

A first transcriptomic analysis of fibrotic versus non-fibrotic testis tissue resulted in 734 significant DEGs (167 up- and 567 downregulated), of which 26 were X-linked. In the top upregulated biological functions, DEGs involved in the extracellular structure organization were found, including vascular cell adhesion molecule 1 (VCAM1). KEGG analysis showed an upregulation of genes involved in the TGF-β pathway.

The second analysis of KS versus testis atrophy samples resulted in 539 significant DEGs (59 up- and 480 downregulated). One of the biological functions found though gene ontology analysis was the chronic inflammatory response. When looking at the overlap of DEGs on the X-chromosome from the first and second analysis, three genes were found: matrix-remodeling associated 5 (MXRA5), doublecortin (DCX) and variable charge X-Linked 3B (VCX3B).

Through validation by immunohistochemistry and RNA scope, an overexpression of VCAM1, MXRA5 and DCX was found within the fibrotic group compared to the non-fibrotic group.

Limitations, reasons for caution

The study included fresh testis tissue from adult KS patients, however these are quite scarce, resulting in a low number of included patients per group (n = 5).

Wider implications of the findings

This study revealed genes which may play a role in testicular fibrosis, including VCAM1. In addition, fibrotic genes on the X-chromosome were revealed: MXRA5, DCX and VCX3B. Up- or downregulation of these genes may prevent testicular fibrosis and thus enhance the chances at retrieving spermatozoa from KS patients.

Trial registration number

NA

P-552 Analysis of the genomewide BAF profiles of selected SNPs allows reliable aneuploidy detection in preimplantation embryos, independent of haplotyping

Study question

Can we reliably detect aneuploidy in trophectoderm samples using SNP array data, independent of haplotyping?

Summary answer

We identified all chromosomes with meiotic copy number gains and non-mosaic copy number losses larger than 5Mb that had been detected with Karyomapping.

What is known already

Currently, generic methods such as Karyomapping (Vitrolife) and OnePGT (Agilent), are commonly used for preimplantation genetic testing of monogenic disorders (PGT-M). The genome-wide approach has the advantage that also aneuploidy can be detected by visualizing the haplotypes, the raw B-allele frequency (BAF) and the copynumber (CN) or Log2 ratio (Log2R) values. However, these haplotyping methods have considerable shortcomings for PGT-A including the need of reference DNA samples from both sides of the family and the long time required to access all haplotype information. We aimed to circumvent these shortcomings with our own proprietary method.

Study design, size, duration

We retrospectively re-analyzed the available raw SNP array data from 359 embryos with trophectoderm biopsy between September 1 2015 and December 31 2017 that were diagnosed with Karyomapping (Vitrolife) as being not genetically transferable. The local ethical committee approved this study under number B.U.N. 143201731745. Written informed consent was available. We intended to identify anomalies &gt;5Mb that are detectable by haplotyping.

Participants/materials, setting, methods

SNPs were categorized based on the parental SNP genotypes. Next, the BAF values for each category of SNPs (cBAF) were extracted from the raw SNP array data and visualized on genomewide plots. The obtained cBAF plots were analyzed for the presence of aneuploidy together with raw BAF and Log2R SNP data. The results from the interpretation of these profiles were compared with the findings previously obtained with Karyomapping (Log2R, raw BAF and haplotype profiles).

Main results and the role of chance

A low level maternal contamination was observed in 5 embryos by analysis of cBAF profiles that had not been detected using Karyomapping. In five other embryos, an abnormal ploidy was observed with both methods. In the remaining 8027 chromosomes from 349 embryos, all 70 chromosomes with both parental homolog (BPH) anomalies larger than 5Mb detected with Karyomapping were identified by analysis of cBAF profiles. In 68 chromosomes the type (segmental or whole chromosome) and the copy number (+1 or + 2 copies) of the detected BPH anomaly was identical with both methods. All 93 chromosomes with a copy number loss larger than 5Mb detected with Karyomapping were identified by analysis of cBAF profiles. For 92 out of 93 chromosomes the type of non-mosaic copy number loss was identical (segmental or whole chromosome). Out of 17 single parental homolog (SPH) copy number gains interpreted as non-mosaic by Karyomapping, 16 were interpreted as non-mosaic based on cBAF profiles. In one instance, the SPH copy number detected with Karyomapping was interpreted as a mosaic SPH trisomy using cBAF. Two chromosomes with mosaic anomalies and one chromosome without diagnosis with Karyomapping were interpreted as non-mosaic anomalies using cBAF.

Limitations, reasons for caution

In case of consanguinity aneuploidy may be more difficult to detect. The limit of detection for the size of segmental anomalies remains to be determined.

Wider implications of the findings

By analyzing the cBAF profiles we were able to detect all types of chromosome anomaly that are detectable by haplotyping. We were able to identify meiotic BPH copy number gains and determine the parent of origin for all anomalies without haplotyping and hence without the need for DNA from familymembers.

Trial registration number

not applicable

Inpatient comparison of wireless and wired pulse oximetry in neonates

BACKGROUND

To compare oxygen saturation (SpO2) and heart rate (HR) recorded by a reference wired pulse oximeter to a wireless pulse oximeter in inpatient neonates.

METHODS

Term infants born≥37 + 0 weeks and preterm infants born≤35 + 0 weeks gestation were enrolled and time-matched data pairs were obtained. The primary outcome was intraclass correlation coefficient and r-values between the two oximeters for heart rate and oxygen saturation.

RESULTS

Thirty term and 20 preterm neonates were enrolled. There was a high degree of correlation between the two oximeters for HR (r = 0.926) among all 50 infants, and excellent interclass correlation (ICC = 0.961), but there were no bradycardia episodes in either term or preterm infants. There was a lesser degree of correlation for SpO2 values in the term and preterm groups (r = 0.242; 0.521, respectively) along with moderate interclass correlation (ICC = 0.719) but few episodes of hypoxemia≤90% occurred in enrolled subjects.

CONCLUSIONS

There were no significant differences between the wireless and reference wired oximeters for assessing HR. There was less correlation between the two oximeters for monitoring SpO2 in both the term and preterm group. Wireless pulse oximetry may have practical advantages for use in inpatient neonates, but additional studies are needed that include bradycardia and desaturation events to delineate this question.

Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell"

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.

Development of an e-learning programme to improve knowledge of interprofessional education

Evidence has highlighted the importance of interprofessional education in relation to the promotion of collaborative team working and the ultimate reduction in communication errors between health professionals. The establishment of interprofessional education in undergraduate healthcare programmes prepares students for interprofessional collaboration, which is vital to the delivery of safe patient care. Using a logic model approach an interprofessional education e-learning programme was developed and made available to healthcare students to undertake during their clinical practice experiences. This article describes how a logic model process was used to develop and implement this interprofessional education e-learning programme for use by undergraduate healthcare students.

Evaluating the association of allergies with multiple sclerosis susceptibility risk and disease activity in a pediatric population

BACKGROUND

Multiple sclerosis (MS) and allergies are both considered to be related to imbalanced Th1 and Th2 immune responses. Previous studies evaluating the relationship between MS and allergies provide conflicting results.

OBJECTIVE

To assess allergies and asthma as risk factors for MS and as predictors of MS relapses in a pediatric cohort.

METHODS

The environment and genetic risk factors for pediatric MS study is a national case-control project with 16 participating US sites. An environmental questionnaire is used that includes history of allergies in the first five years of life. Case-control data are entered in the pediatric MS Network database and cases at 12 of the 16 sites enter relapse data prospectively. Annualized relapse rate was calculated for patients with follow-up and adjusted for age at disease onset, gender, race, ethnicity, and use of disease-modifying therapy (DMT).

RESULTS

We included 271 cases (mean age at disease onset of 15.7years and 62% female) and 418 controls. Relapse data were available for 193 cases. There was no difference in prevalence of allergies or asthma between cases and controls. Patients with food allergies had fewer relapses compared to patients without food allergies (0.14 vs 0.48, p=0.01).

CONCLUSIONS

While allergies and asthma are not associated with pediatric MS, cases with food allergies have fewer relapses compared to those without food allergies.

The clinical utility of anthropometric measures to assess adiposity in a cohort of prematurely born infants: Correlations with MRI fat quantification

OBJECTIVE

To correlate magnetic resonance imaging (MRI) of body fat in preterm infants at the time of hospital discharge with same-day anthropometric measures, and to assess the clinical utility of body mass index (BMI), waist circumference (WC), and WC/length ratio as indicators of visceral fat.

STUDY DESIGN

MRI performed prior to NICU discharge in 25 infants born preterm at <32 weeks gestation. Total body fat and visceral fat were quantified using a commercial software program. The Pearson correlation coefficient (r, 95% C.I.) was used to describe strength of association between MRI fat and anthropometric measures.

RESULTS

BMI and weight at discharge were strongly correlated with total body fat (r = 0.95 and 0.89 respectively; p < 0.001). Total body fat as a % of body weight was moderately correlated with weight (r = 0.53), WC (r = 0.52), and BMI (r = 0.47). Weight, BMI, and ponderal index all were found to correlate with total visceral fat (r = 0.65, 0.64, 0.55 respectively) but WC did not (r = 0.28). WC/length ratio was not correlated with any MRI fat measurements.

CONCLUSIONS

BMI and weight at discharge both correlate with MRI fat measurements. Our findings do not support the usefulness of measuring WC or WC/length ratio in preterm infants at term-equivalent age.

Increased mortality for pregnancy-associated melanoma: systematic review and meta-analysis

Among women, pregnancy-associated melanomas may have a poorer prognosis than other melanomas, but evidence is inconsistent. We conducted a systematic review and meta-analysis to assess the effect on melanoma outcome of a coinciding pregnancy. The objective of the study was to conduct a systematic review and meta-analysis of risk of death from, or recurrence of, pregnancy-associated melanomas compared with other melanomas in women of reproductive age. Cochrane (1996-2013), MEDLINE (1950-2013), EMBASE (1966-2013), CINAHL (1982-2013), and PUBMED (1951-2013) databases were searched for studies assessing the risk of death and recurrence in pregnancy-associated melanomas. Eligible studies investigated melanoma outcomes in women with pregnancy-associated melanomas (diagnosed during pregnancy or in 12 months following pregnancy), included a comparison group and reported measures of risk of melanoma death or disease-free survival. Eligible study designs were cohort studies of women of childbearing age with confirmed diagnoses of cutaneous melanoma. Individual study effect estimates were pooled using the weighted average method. Studies that did not report a quantitative estimate were summarized narratively. Of 304 citations identified, 14 studies met the inclusion criteria, with assessed outcomes being melanoma death (7), recurrence (3), or both (4). Pooled estimates of mortality risk from four studies showed increased risk of melanoma death after adjustment for patient age and stage of melanoma (pHR 1.56, 95% CI 1.23-1.99) for pregnancy-associated melanoma compared with other melanomas. Based on limited quantitative evidence, pregnancy-associated melanomas appear to have poorer outcomes than other melanomas.

Apple, carrot, and hibiscus edible films containing the plant antimicrobials carvacrol and cinnamaldehyde inactivate Salmonella Newport on organic leafy greens in sealed plastic bags

The objective of this study was to investigate the antimicrobial effects of carvacrol and cinnamaldehyde incorporated into apple, carrot, and hibiscus-based edible films against Salmonella Newport in bagged organic leafy greens. The leafy greens tested included organic Romaine and Iceberg lettuce, and mature and baby spinach. Each leafy green sample was washed, dip inoculated with S. Newport (10⁷ CFU/mL), and dried. Each sample was put into a Ziploc® bag. Edible films pieces were put into the Ziploc bag and mixed well. The bags were sealed and stored at 4 °C. Samples were taken at days 0, 3, and 7 for enumeration of survivors. On all leafy greens, 3% carvacrol films showed the best bactericidal effects against Salmonella. All 3 types of 3% carvacrol films reduced the Salmonella population by 5 log₁₀ CFU/g at day 0 and 1.5% carvacrol films reduced Salmonella by 1 to 4 log₁₀ CFU/g at day 7. The films with 3% cinnamaldehyde showed 0.5 to 3 log reductions on different leafy greens at day 7. The films with 0.5% and 1.5% cinnamaldehyde and 0.5% carvacrol also showed varied reductions on different types of leafy greens. Edible films were the most effective against Salmonella on Iceberg lettuce. This study demonstrates the potential of edible films incorporated with carvacrol and cinnamaldehyde to inactivate S. Newport on organic leafy greens.

Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide

BACKGROUND

Cognitive therapy has been found to be effective in decreasing the recurrence of suicide attempts. A theoretical aim of cognitive therapy is to improve problem-solving skills so that suicide no longer remains the only available option. This study examined the differential rate of change in problem-solving appraisal following suicide attempts among individuals who participated in a randomized controlled trial for the prevention of suicide.

METHOD

Changes in problem-solving appraisal from pre- to 6-months post-treatment in individuals with a recent suicide attempt, randomized to either cognitive therapy (n = 60) or a control condition (n = 60), were assessed by using the Social Problem-Solving Inventory-Revised, Short Form.

RESULTS

Improvements in problem-solving appraisal were similarly observed for both groups within the 6-month follow-up. However, during this period, individuals assigned to the cognitive therapy condition demonstrated a significantly faster rate of improvement in negative problem orientation and impulsivity/carelessness. More specifically, individuals receiving cognitive therapy were significantly less likely to report a negative view toward life problems and impulsive/carelessness problem-solving style.

CONCLUSIONS

Cognitive therapy for the prevention of suicide provides rapid changes within 6 months on negative problem orientation and impulsivity/carelessness problem-solving style. Given that individuals are at the greatest risk for suicide within 6 months of their last suicide attempt, the current study demonstrates that a brief cognitive intervention produces a rapid rate of improvement in two important domains of problem-solving appraisal during this sensitive period.

Inactivation of Listeria monocytogenes on ham and bologna using pectin-based apple, carrot, and hibiscus edible films containing carvacrol and cinnamaldehyde

Edible films can be used as wrapping material on food products to reduce surface contamination. The incorporation of antimicrobials into edible films could serve as an additional barrier against pathogenic and spoilage microorganisms that contaminate food surfaces. The objective of this study was to investigate the antimicrobial effects of carvacrol and cinnamaldehyde, incorporated into apple, carrot, and hibiscus-based edible films against Listeria monocytogenes on contaminated ham and bologna. Ham or bologna samples were inoculated with L. monocytogenes and dried for 30 min, then surface wrapped with edible films containing the antimicrobials at various concentrations. The inoculated, film-wrapped samples were stored at 4 °C. Samples were taken at day 0, 3, and 7 for enumeration of surviving L. monocytogenes by plating on appropriate media. Carvacrol films showed better antimicrobial activity than cinnamaldehyde films. Compared to control films without antimicrobials, films with 3% carvacrol induced 1 to 3, 2 to 3, and 2 to 3 log CFU/g reductions on ham and bologna at day 0, 3, and 7, respectively. Corresponding reductions with 1.5% carvacrol were 0.5 to 1, 1 to 1.5, and 1 to 2 logs, respectively. At day 7, films with 3% cinnamaldehyde reduced L. monocytogenes population by 0.5 to 1.5 and 0.5 to 1.0 logs on ham and bologna, respectively. Inactivation by apple films was greater than that by carrot or hibiscus films. Apple films containing 3% carvacrol reduced L. monocytogenes population on ham by 3 logs CFU/g on day 0 which was 1 to 2 logs greater than that by carrot and hibiscus films. Films were more effective on ham than on bologna. The food industry and consumers could use these films to control surface contamination by pathogenic microorganisms.

PRACTICAL APPLICATION

Antimicrobial edible, food-compatible film wraps prepared from apples, carrots, and hibiscus calyces can be used by the food industry to inactivate Listeria monocytogenes on widely consumed ready to eat meat products such as bologna and ham. This study provides a scientific basis for large-scale application of edible fruit- and vegetable-based antimicrobial films on foods to improve microbial food safety.

Molecular background of RH in Bastiaan, the RH:-31,-34 index case, and two novel RHD alleles

Anti-hr(B) (-RH31) and anti-Hr(B) (-RH34) were found nearly 40 years ago in the serum of a South African woman. The anti-hr(B) was revealed after adsorption with DcE/DcE red blod cells (RCBs). Numerous anti-hr(B), in the absence of anti-Hr(B), have since been identified. We obtained a sample of blood from this index case (Bastiaan) and report the molecular basis of her D+C-E-c+e+/-, V-VS+Hr+hr(S)+hr(B)-Hr(B)- phenotype as well as results of testing her RBCs using currently available regents. We tested a cohort of African Americans to estimate the frequency of the RHCE*ce 48C,733G,1006T allele, and in addition found two novel RHD alleles. Hemagglutination tests and DNA analyses were performed by standard methods. Analyses revealed homozygosity for RHCE*ce 48C,733G,1006T in Bastiaan. RBCs from Bastiaan were strongly agglutinated by three commercial anti-e reagents. Testing RBCs from people homozygous for RHCE*ce 48C,733G,1006T showed that anti-e MS16, MS17, and MS63 were weakly reactive or non reactive, MS21 was strongly reactive, and HIRO38, HIRO41, and HIRO43 were non reactive. Results show that Bastiaan has RHD*DIIIa150C and RHD*DIIIa-CE(4-7)-D. Tests on 605 samples from random African Americans revealed a frequency of 0.036 for RHCE*ce 48C,733G,1006T and revealed two novel alleles: RHD*186T and RHD*DIIIa150C. The Bastiaan phenotype is encoded by RHD*DIIIa150C-RHCE*ce 48C,733G,1006T and RHD*DIIIa-CE(4-7)-D-RHCE*ce 48C,733G,1006T ; thus, this genotype is the gold standard for the hr(B)-Hr(B)-phenotype. The r'(s) complex encodes VS, which explains why most hr(B)-RCBs are VS+.

Structure of nitrilotriacetate monooxygenase component B from Mycobacterium thermoresistibile

Mycobacterium tuberculosis belongs to a large family of soil bacteria which can degrade a remarkably broad range of organic compounds and utilize them as carbon, nitrogen and energy sources. It has been proposed that a variety of mycobacteria can subsist on alternative carbon sources during latency within an infected human host, with the help of enzymes such as nitrilotriacetate monooxygenase (NTA-Mo). NTA-Mo is a member of a class of enzymes which consist of two components: A and B. While component A has monooxygenase activity and is responsible for the oxidation of the substrate, component B consumes cofactor to generate reduced flavin mononucleotide, which is required for component A activity. NTA-MoB from M. thermoresistibile, a rare but infectious close relative of M. tuberculosis which can thrive at elevated temperatures, has been expressed, purified and crystallized. The 1.6 Å resolution crystal structure of component B of NTA-Mo presented here is one of the first crystal structures determined from the organism M. thermoresistibile. The NTA-MoB crystal structure reveals a homodimer with the characteristic split-barrel motif typical of flavin reductases. Surprisingly, NTA-MoB from M. thermoresistibile contains a C-terminal tail that is highly conserved among mycobacterial orthologs and resides in the active site of the other protomer. Based on the structure, the C-terminal tail may modulate NTA-MoB activity in mycobacteria by blocking the binding of flavins and NADH.

Electron paramagnetic resonance in irradiated fingernails: variability of dose dependence and possibilities of initial dose assessment

The results of electron paramagnetic resonance (EPR) measurements in irradiated fingernails are presented. In total, 83 samples of different fingernails were studied. Five different groups of samples were selected based on the collection time of fingernail samples, their level of mechanical stress, and the number and size of clippings: (1) recently (<24 h) cut, irradiated and measured with EPR without any treatment of samples, and with rigorous control of size and number of clippings (stressed-fresh, controlled); (2) recently (<24 h) cut, irradiated and measured with EPR after application of a special treatment (10 min of water soaking, 5 min of drying time) to reduce the mechanical stress caused by cutting the samples, and with rigorous control of size and number of clippings (unstressed-fresh, controlled); (3) previously (>24 h) cut, stored at room temperature, additionally cut into small pieces immediately prior to study, irradiated and measured with EPR without any treatment of samples, and with rigorous control of size and number of clippings (stressed-old, controlled); (4) previously (>24 h) cut, stored at room temperature, additionally cut into small pieces immediately prior to the study, irradiated and measured with EPR after application of a special treatment to reduce mechanical stress caused by cut, and with rigorous control of size and number of clippings (unstressed-old, controlled); and (5) recently (<24 h) cut, irradiated and measured with EPR after application of a special treatment to reduce the mechanical stress caused by cut, and without rigorous control of size and number of clippings (unstressed-fresh, uncontrolled). Except for the fifth selected group, variability of the dose dependence inside all groups was found to be not statistically significant, although the variability among the different groups was significant. Comparison of the mean dose dependences obtained for each group allowed selection of key factors responsible for radiation sensitivity (dose response per unit of mass and dose) and the shape of dose dependence in fingernails. The major factor responsible for radiation sensitivity of fingernails was identified as their water content, which can affect radiation sensitivity up to 35%. The major factor responsible for the shape of the radiation sensitivity was identified as the mechanical stress. At a significant level of mechanical stress, the shape of the dose dependence is linear in the studied dose range (<20 Gy), and in lesser-stressed samples it is of an exponential growth including saturation, which depends on the degree of mechanical stress. In view of the findings, recommendations are discussed and presented for the appropriate protocol for EPR dose measurements in fingernails.

SWOG S0342 and S0536: Expression of EGFR protein and markers of epithelial-mesenchymal transformation (EMT) in cetuximab/chemotherapy-treated non-small cell lung cancer (NSCLC)

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Background: High EGFR gene copy number is associated with efficacy in NSCLC patients (pts) receiving combined chemotherapy and cetuximab (S0342). EGFR protein is typically overexpressed in tumors with high copy number but no consistent association has yet been demonstrated between EGFR protein expression and outcome in pts treated with chemotherapy plus cetuximab. EMT is associated with aggressive biological behavior and resistance to anti-EGFR TKI therapy in NSCLC. Our objective was to identify any association between EGFR protein and EMT and to correlate findings with pt outcomes from cetuximab/chemotherapy in SWOG trials S0342 (paclitaxel [P]-carboplatin [CB] plus sequential or concurrent cetuximab [CX]) and S0536 (P-CB-CX + bevacizumab). Methods: Paraffin sections were stained by immunoperoxidase methods using monoclonal antibodies against EGFR and the EMT markers vimentin, E-cadherin and Zeb1. Sections were scored on continuous scale ranging from 0–300 based on the H score (sum of % positive at each intensity from 0–3). Results were compared to outcome by Kaplan-Meier plot. Results: 79 samples from S0342 were evaluated for EGFR and EMT markers. 67 samples from S0536 were assessed for EGFR only. Mean EGFR H score was 153 and 137 for S0342 and S0536 respectively. At all cut points tested (scores 0, <100, <300) no association between EGFR H score and response or progression-free survival (PFS) was detected in either trial. There was a trend for overall survival and EGFR level at each cutpoint in S0536 but the results did not achieve statistical significance (15 vs 11 mos, p=0.14; 15 vs 11 mos, p=0.20 and 14 mos vs not reached, p=0.10, respectively). Vimentin (6 positive pts) was associated with a shorter PFS, HR=2.60 (1.10–6.14), p=0.03. ECAD and Vimentin were significantly inversely correlated with one another (Spearman p-value<0.01) Conclusions: EGFR protein level by IHC does not significantly correlate with efficacy parameters in chemotherapy/cetuximab-treated NSCLC pts. Patients with vimentin producing tumors (and possible other EMT markers) had shorter PFS, suggesting possible relative resistance to EGFR blockade from cetuximab.

[Table: see text]

The effect of glycerol on the lacrate metabolism in the perfused tat liver

The effect of glycerol on the lactate metabolism was studied on the perfused rat liver. Addition of glycerol to the perfusion medium caused a significant output of lactate and uptake of pyruvate. The lactate/pyruvate- and beta-hydroxybutyrate/acetoacetate ratios rose indicating an effect of glycerol on the cytoplasmic and mitochondrial redox potentials which became more reduced. The output of lactate by the liver may be a result of the reduction in the redox level induced by the oxidation of glycerol.

KRAS mutation analysis in patients (pts) with locally advanced pancreatic cancer (LAPC) treated with gefitinib and chemoradiation therapy (CT-RT) in a phase I trial

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Background: Correlative studies that incorporate biomarkers to rapidly analyze response to new agents are needed. Unique to pancreatic cancer is the high incidence of KRAS mutations (over 90%). This pilot study evaluated plasma KRAS mutations for disease monitoring in LAPC pts treated on a Phase I trial combining CT-RT with the EGFR inhibitor, gefitinib. Methods: DNA was extracted from plasma of 11 pts collected at 3 timepoints: pre-gefitinib, pre-CT-RT, and post-gefitinib+CT-RT. Matched tissue DNA was obtained from 4 pts with available paraffin blocks. KRAS codon 12 mutations were detected using a two-stage RFLP-PCR assay. Cell line controls: Calu-1 (mutant KRAS) and LNCaP (wild-type KRAS). Mutations were confirmed by direct DNA sequencing. Results were related to pt clinical data. Results: KRAS mutations were detected in the pre-gefitinib plasma of 5/11 pts, and in the matched tumor tissue of 3/4 pts. Of the 5 pts with plasma KRAS mutations, 2 pts with no detectable mutant KRAS in the plasma post-gefitinib+CT-RT had overall survival of 8 and 21 months, whereas 2 pts who retained mutant KRAS had overall survival of only 2 and 5 months, and one pt withdrew early. Of the 3 tumor tissues containing mutant KRAS, the mutations were also detectable in the matched plasma in 2 pts (67%). KRAS codon 12 mutations spectrum: 4 GGT→GAT, 2 GGT→GTT and 1 GGT→AGT. Conclusions: Plasma KRAS mutations are readily detectable in LAPC pts, and the clearance or persistence of plasma KRAS mutations after treatments reflected the clinical course in some cases. The use of plasma KRAS mutation as a marker of survival and response will be further assessed in a recently approved phase I trial using a proteasome inhibitor with chemoradiation at the University of Colorado.

No significant financial relationships to disclose.

Surveillance of transcriptomes in basic military trainees with normal, febrile respiratory illness, and convalescent phenotypes

Gene expression profiles permit analysis of host immune response at the transcriptome level. We used the Pax gene Blood RNA (PAX) System and Affymetrix microarrays (HG-U133A&B) to survey profiles in basic military trainees and to classify them as healthy, febrile respiratory illness (FRI) without adenovirus, FRI with adenovirus, and convalescent from FRI with adenovirus. We assessed quality metrics of RNA processing for microarrays. Class prediction analysis discovered nested sets of transcripts that could categorize the phenotypes with optimized accuracy of 99% (nonfebrile vs febrile, P<0.0005), 87% (healthy vs convalescent, P=0.001), and 91% (febrile without vs with adenovirus, P<0.0005). The discovered set for classification of nonfebrile vs febrile patients consisted of 40 transcripts with functions related to interferon induced genes, complement cascades, and TNF and IL1 signaling. The set of seven transcripts for distinguishing healthy vs convalescent individuals included those associated with ribosomal structure, humoral immunity, and cell adhesion. The set of 10 transcripts for distinguishing FRI without vs with adenovirus had functions related to interferon induced genes, IL1 receptor accessory protein, and cell interactions. These results are the first in vivo demonstration of classification of infectious diseases via host signature transcripts and move us towards using the transcriptome in bio-surveillance.

Estrogen-like properties of brominated analogs of bisphenol A in the MCF-7 human breast cancer cell line

Tetrabromobisphenol A (TeBBPA) is a four-meta-brominated variant of bisphenol A (BPA) and is one of the most commonly used brominated flame retardants worldwide. We compared the estrogenic potency of TeBBPA, BPA and the brominated analogs mono- (MBBPA), di- (DBBPA), and tribromobisphenol A (TrBBPA) in the estrogen-dependent human breast cancer cell line MCF-7. All of the compounds competed with 17beta-estradiol for binding to the estrogen receptor, although the affinity of the test chemicals to the estrogen receptor was much lower than that of 17beta-estradiol. TrBBPA and TeBBPA showed a considerably lower access to the estrogen receptors within intact MCF-7 cells incubated in 100% serum compared to incubation in serum-free medium, indicating a strong binding to serum proteins. BPA, MBBPA, and DBBPA showed only a slightly reduced access to the receptors. All of the test compounds induced proliferation in MCF-7 cells, the potential decreasing with increasing number of bromo-substitutions. TeBBPA did not induce maximal cell growth, indicating cytotoxic effects at high concentrations. BPA and the brominated analogs, except TeBBPA, induced progesterone receptor and pS2 to the same extent as 17beta-estradiol, although at much higher concentrations. Our studies demonstrate that compared to 17beta-estradiol, BPA and the brominated analogs have much lower estrogenic potencies for all of the endpoints tested, TeBBPA being the least estrogenic compound.

A longitudinal study of the biometric and refractive changes in full-term infants during the first year of life

Changes in ocular axial dimensions and refraction were followed longitudinally, using ultrasonography and retinoscopy, during the first year of life (mean ages 4-53 weeks) of a group of 20 full-term infants (10 male, 10 female). Using a mixed-model regression analysis, axial length changes as a function of time were found to be best described by a quadratic expression (AL=17.190+0.128x-0.0013x(2), where AL is the axial length in mm and x is the age in weeks), while anterior chamber depth changed linearly (ACD=2.619+0.018x, where ACD is the anterior chamber depth in mm): lens thickness was essentially constant. Spherical equivalent refraction through most of the first year showed a steady reduction in hypermetropia (SER=2.982-0.032x, where SER is the spherical equivalent refraction in dioptres): astigmatism also tended to diminish. Mean hyperopic refractive errors through the year were negatively correlated with corresponding axial lengths (SER=12.583-0.541AL), but some individual subjects showed marked departures from this pattern. These results are discussed in relation to concepts of emmetropization.

Ergogenic supplements and health risk behaviors

OBJECTIVE

Our goals were to determine the prevalence of ergogenic supplement use in a young healthy population and to examine the extent to which supplement use is associated with specific health risk behaviors.

STUDY DESIGN

We performed a cross-sectional survey.

POPULATION

Individuals entering military service for enlisted training were included.

OUTCOMES MEASURED

We recorded previous use of any nutritional ergogenic supplements and self-reported health risk behaviors.

RESULTS

Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P &lt.001). There were no differences in patterns of supplement use according to age or body mass index.

CONCLUSIONS

Our study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.

Conservative management of an intruded immature maxillary permanent central incisor with healing complication of pulp bone

Traumatic intrusion injury of permanent teeth is serious with multiple complications possible associated with the pulp, periodontal ligament, alveolar bone and Hertwig's epithelial root sheath. The optimal treatment for the management of an intrusion injury has not yet been determined. A case is presented involving the conservative management of an immature maxillary permanent central incisor intrusively luxated by allowing for re-eruption and orthodontic extrusion two weeks later. After a follow-up period of ten months, the intruded tooth continued to show a mobility of grade one, without metallic percussion tone or infra-occlusion, which confirmed periodontal ligament healing. Although the intruded tooth failed to respond to dry ice testing, no other signs of pulp necrosis were evident and the colour of the intruded tooth was within normal limits throughout the follow-up period. However, complications of healing of Hertwig's epithelial root sheath occurred, causing in-growth of bone and periodontal ligament into the root canal.

3-Nitropropionic acid: an astrocyte-sparing neurotoxin in vitro

3-Nitropropionic acid (NPA), an inhibitor of succinate dehydrogenase, is dietary neurotoxin. It is not known if neurons and astrocytes differ in their vulnerability to NPA, therefore, we investigated its toxicity in primary cultures of cerebellar granule cells and astrocytes. NPA inhibited succinate dehydrogenase and tricarboxylic acid cycle activity to the same degree in neurons and astrocytes. Even so NPA acid was 16 times more toxic to neurons than to astrocytes (LC50: 0.7 and 11 mM, respectively). The neurotoxicity of NPA was mediated by NMDA-receptor activation, calcium influx, and formation of reactive oxygen species, as revealed by the protective effect of NMDA-receptor blockade, the accumulation of 45Ca, and the protective effect of N-t-butyl-alpha-phenylnitron (PBN), a scavenger of reactive oxygen species. Cytotoxic concentrations of NPA caused a reduction in the intracellular level of glutathione, which probably contributed to the oxidative damage in both neurons and astrocytes. The relative resistance of astrocytes to NPA appeared to be related to their low tricarboxylic acid cycle activity (5%-10% of that in neurons) and to the inability of NPA to cause astrocytic calcium overload. We conclude that NPA acid predominantly is an astrocyte-sparing neurotoxin.

Bone loss after hip fracture is correlated to the postoperative degree of mobilisation

This study quantifies changes in bone mineral density (BMD) in the opposite hip and in both proximal tibiae and the correlation with the use of walking aids for patients with two types of hip fracture during the 1st year after surgery. In all, 26 women and 15 men aged 42-88 years (median 71 years) were included. Twenty-one patients had an intracapsular hip fracture (ICF) and 20 had an intertrochanteric fracture (ITF). All patients were treated with a dynamic hip screw. BMD was measured by dual X-ray absorptiometry (DXA; LUNAR, Wisconsin) within the 1st week after surgery and after 3, 6 and 12 months. Initial BMD of the non-fractured hip was significantly lower for both fracture groups compared with reference material. For both fracture types there was a significant decrease in BMD of the non-fractured hip and proximal tibia of the fractured leg during the first 3 months, which still persisted a year after surgery. Improved mobilisation between two examinations was positively correlated with changes in BMD of the proximal tibia of the fractured leg and the non-fractured hip.

Changes in bone mineral density adjacent to two biomechanically different types of cementless femoral stems in total hip arthroplasty

We have compared the differences in bone mineral density (BMD) adjacent to two biomechanically different cementless femoral stems used for total hip arthroplasty. Measurements were performed 12 to 38 months after surgery in a cross sectional study of 29 patients. Of these, 15 had arthroplasties using an "off the shelf" type cementless femoral stem (Spotorno), while 14 had a custom made cementless stem (Evolution-K). Dual X-ray absorptiometry (DXA) measurements revealed that the patients who had a Spotorno stem had a significantly lower BMD in the operated leg compared to the non-operated side in both Gruen zones 1 and 7, whereas no significant differences were found in these areas in the Evolution-K group. For both types of prosthesis there was a significant and similar decrease in BMD of the proximal tibia on the operated side.

Can a hydrophilic guidewire be resterilized?

The Glidewire (Microvasive, Natick, MA) or Terumo wire (Terumo, Japan) is constructed with a hydrophilic polymer surface that enables easier passage through narrowed lumens in the urinary tract. This study examined the effects of gas sterilization on Glidewire surface structure, slipperiness, and ability to support bacterial growth. Light microscopy at 100x and 400x and scanning electron microscopy at 100 to 1300x were used to compare the surface tips of five new 0.038-inch Glidewires with those resterilized one or three times. The tips were immersed in water prior to standard gas sterilization for operating room equipment. Subjective evaluation of slipperiness involved asking 10 blinded urologists to assess the nature of new and resterilized wires by feel. Support of bacterial growth was assessed by comparing cultures performed on new wires (control) with those of wires incubated with Bacillus stearothermophilus. Microscopy, reviewed by a pathologist, revealed no perceivable surface differences after one and three gas sterilizations. Eight of the urologists noted similar or improved slipperiness of resterilized wires compared with new wires. Bacterial cultures of intentionally infected wire segments showed no growth after standard gas sterilization in all cases. In this study, gas sterilization did not adversely affect the lubricious nature or the surface coating of the hydrophilic coating of Glidewires. Also, gas resterilization was bactericidal to new and used wires that had been infected with a heat-tolerant organism.