P-433 Comparative analysis of serum obtained in early pregnancy using Fourier transform-infrared spectroscopy to predict tubal ectopic pregnancy and miscarriage

Study question

Can Fourier transform-infrared (FT-IR) spectroscopy be used to discriminate adverse early pregnancy outcomes such as tubal ectopic pregnancy and miscarriage from live normally-sited pregnancies?

Summary answer

Biochemical information acquired from serum samples using FT-IR spectroscopy does not discriminate adverse early pregnancy outcomes from live normally-sited pregnancies.

What is known already

Ectopic pregnancy and miscarriage are associated with maternal morbidity and mortality. Current management of pregnancy of unknown location and viability may involve serial blood human chorionic gonadotrophin-beta measurements and several ultrasound scans. Multiple interventions and length of time to diagnosis are costly and have a profound psychological impact on women. Vibrational spectroscopic methods such as Fourier transform-infrared (FT-IR) spectroscopy have been increasingly shown to discriminate disease states such as cancer from controls utilising the ‘metabolomic signature’ of molecules within a biological sample. It is hypothesised that this signature will differ between live normally-sited pregnancies, and tubal ectopic pregnancy and miscarriage.

Study design, size, duration

A total of 380 women were recruited to the prospective cohort study, Ectopic Pregnancy Diagnosis sTudy (ExPeDITe) between November 2018 and November 2021. Inclusion criteria comprised pregnant women ≥18 years presenting with pain and/or bleeding at < 10 weeks of gestation. A sample of blood and demographic data were collected at the time of consent, and a full history was taken. Early pregnancy outcomes were collected and classified according to ESHRE guidance.

Participants/materials, setting, methods

Serum samples prepared from collected blood (n = 340) were diluted 1:4 to prevent oversaturation of spectra and quality controls were created from the pooled diluted serum. Samples were transferred to silicon plates and dried at 37.5 °C. Samples were subjected to FT-IR spectroscopy and spectral data were submitted to baseline correction, smoothing, and vector normalisation prior to multivariate statistical analysis including Principal Component Analysis (PCA) and Partial Least Squares – Discriminant Analysis (PLS-DA).

Main results and the role of chance

Infrared spectral data collected from live normally-sited pregnancies, tubal ectopic pregnancies, pregnancies of unknown location, and miscarriages displayed similar infrared signatures, exhibiting bands associated to vibrational modes related to the main molecular constituents commonly found in most biological samples such as proteins, lipids, nucleic acids, and carbohydrates. Spectral data were used as inputs to PCA and PLS-DA models as clustering algorithms in order to classify the different pregnancy outcomes. The output obtained by the classification model generated with PLS-DA shows two distributions; a ‘real’ and ‘null/random’ model. These models displayed poor correct classification rates, indicating no differences in the infrared signatures between the different pregnancy outcomes. Similar findings were also observed in the PCA results as no clustering pattern indicating correct classification between the experimental groups was observed in the scores plot. Although infrared spectroscopy has been well demonstrated as an analytical tool to discriminate several disorders from healthy/control samples including cancer, diabetes and many others, these findings indicate that the information about the overall biochemistry probed by infrared spectroscopy acquired from serum samples currently lacks accuracy/sensitivity to discriminate different pregnancy outcomes.

Limitations, reasons for caution

Proteins were not removed from samples prior to analysis, which may mask discreet changes in small molecule metabolites. As FT-IR spectra multivariate in nature power calculations are not possible. If this study had shown case-control separation then these findings would have been validated with a second set of samples.

Wider implications of the findings

The findings of this study suggest that FT-IR spectroscopy of serum may not be discriminatory to identify important early pregnancy outcomes, but further analytical techniques should be utilised to confirm if metabolomic analysis of blood or other biofluids would provide a novel diagnostic test.

Trial registration number

REC 17/NW/0646

Genomic characterization of orthobunyavirus of veterinary importance in America

During 2013, in Argentina, three new isolates of serogroup Bunyamwera virus (genus Orthobunyavirus, family Peribunyaviridae) were recovered from two horses with encephalitis, and from an aborted equine fetus. In the present study, we report the complete genome sequence, genetic characterization, and phylogenetic analysis of three new strains isolated in Argentina to clarifying their relationship within the Bunyamwera serogroup virus and to investigate the evolutionary history of viruses with segmented genomes.

Comparative analysis of the transcriptome of the Amazonian fish species Colossoma macropomum (tambaqui) and hybrid tambacu by next generation sequencing

Background

The C. macropomum is a characiform fish from the Amazon basin that has been hybridized with other pacu species to produce commercial hybrids, such as the tambacu. However, little is known of the functional genomics of the parental species or these hybrid forms. The transcriptome of C. macropomum and tambacu were sequenced using 454 Roche platform (pyrosequencing) techniques to characterize the domains of Gene Ontology (GO) and to evaluate the levels of gene expression in the two organisms.

Results

The 8,188,945 reads were assembled into 400,845 contigs. A total of 58,322 contigs were annotated with a predominance of biological processes for both organisms, as determined by Gene Ontology (GO). Similar numbers of metabolic pathways were identified in both the C. macropomum and the tambacu, with the metabolism category presenting the largest number of transcripts. The BUSCO analysis indicated that our assembly was more than 40% complete. We identified 21,986 genes for the two fishes. The P and Log2FC values indicated significant differences in the levels of gene expression, with a total of 600 up-regulated genes.

Conclusion

In spite of the lack of a reference genome, the functional annotation was successful, and confirmed a considerable difference in the specificity and levels of gene expression between the two organisms. This report provides a comprehensive baseline for the genetic management of these commercially important fishes, in particular for the identification of specific genes that may represent markers involved in the immunity, growth, and fertility of these organisms, with potential practical applications in aquaculture management.

De novo transcriptome based on next-generation sequencing reveals candidate genes with sex-specific expression in Arapaima gigas (Schinz, 1822), an ancient Amazonian freshwater fish

Background

The Arapaima (Arapaima gigas) is one of the world's largest freshwater bony fish, and is found in the rivers of the Amazon basin. This species is a potential aquaculture resource, although reproductive management in captivity is limited in particular due to the lack of external sexual dimorphism. In this study, using the 454 Roche platform (pyrosequencing) techniques, we evaluated a major portion of the transcriptome of this important Amazonian species.

Results

Four libraries obtained from the liver and skin tissue of juvenile specimens (representing males and females separately) were sequenced, yielding 5,453,919 high-quality reads. The de novo transcriptome assembly resulted in 175,792 contigs, with 51,057 significant blast hits. A total of 38,586 transcripts were mapped by Gene Ontology using Blast2GO. We identified 20,219 genes in the total transcriptome (9,551 in the liver and 16,818 in the skin). The gene expression analyses indicated 105 genes in the liver and 204 in the skin with differentiated expression profiles, with 95 being over-expressed in the females and 214 in the males. The log2 Fold Change and heatmap based on Reads Per Kilobase per Million mapped reads (RPKM) revealed that the gene expression in the skin is highly differentiated between male and female arapaima, while the levels of expression in the liver are similar between the sexes.

Conclusion

Transcriptome analysis based on pyrosequencing proved to be a reliable tool for the identification of genes with differentiated expression profiles between male and female arapaima. These results provide useful insights into the molecular pathways of sexual dimorphism in this important Amazonian species, and for comparative analyses with other teleosts.

Variability of the obturator artery with its surgical implications

The vascular anatomy of the pelvis has in the retro pubic space one the most dangerous artery variations for the surgical approach. The aim of this study was to evaluate arise from obturator artery and its implications. Eleven specimens were bisected pelvic an adult cadaver. The iliac artery and femoral artery were identified and divided in their branches. The anomalous origin was noted in 22.72% with an anastomotic branch between the external iliac or inferior epigastric vessels found in 13.69%. The right side showed a greater variation than left side with 27.27% versus 18.18%. Our data suggest that retro pubic space has critical vascular variations of the obturator artery with many probabilities of the lesions.

Study of worker's exposure to Tantalum-bearing particles in a mining and metallurgical plant

The objective of this study was to assess worker exposure to mineral dust particles, and a metabolic model, based on the model adopted by ICRP, was applied to assess human exposure to Ta, and predicted values of Ta concentrations in excreta. The occupational exposure to Th, U, Nb, and Ta-bearing particles during routine tasks to obtain Fe-Nb alloys was estimated using air samplers and excreta samples. Ta concentrations in food samples and in drinking water were also determined. The results support that workers were occupationally exposed to Ta-bearing particles, and also indicate that a source of Ta exposure for both workers and the control group was the ingestion of drinking water containing soluble compounds of Ta. Therefore, some Ta compounds should be considered soluble compounds in gastrointestinal tract. Consequently, the metabolic model based on ICRP metabolic model and/or the transfer factor f ₁ for Ta should be reviewed and the solubility of Ta compounds in gastrointestinal should be determined.

Viabilidade da técnica de transposição uretral pré-púbica mediante secção peniana em cadáveres de cães

RESUMO Descreve-se a viabilidade da técnica cirúrgica de transposição uretral pré-púbica em cadáveres de cães machos, adultos, advindos de um hospital veterinário, a fim de se avaliar a manutenção da luz uretral a partir de um desvio uretral pré-púbico, descrevendo-se detalhadamente a abordagem e as estruturas anatômicas envolvidas. A técnica consistiu inicialmente da orquiectomia, seguida de celiotomia retroumbilical, tração vesical cranial, secção transversa da uretra membranosa a 1cm caudal à próstata, espatulação e reparo da borda livre. A seguir, divulsão e secção do pênis 1,5cm caudal ao osso peniano, espatulação da borda uretral peniana e transposição desta em direção à cavidade abdominal, fazendo-se anastomose por meio de sutura interrompida simples à uretra membranosa. Foi mensurado o comprimento uretral desde o meato externo até o início da uretra prostática em dois momentos: pré e pós-transposição. Ao final, avaliou-se, por meio de uretrografia retrógrada de contraste positivo, o diâmetro e o selamento na anastomose uretral e o fluxo do contraste até a bexiga. A transposição uretral pré-púbica é uma técnica cirúrgica exequível, anatomicamente compatível com a espécie canina e capaz de manter o diâmetro uretral e o fluxo do contraste de forma satisfatória, com manutenção estética externa idêntica a um cão macho orquiectomizado.

Quality of Life of Children and Youngsters who Attended the Psycho-Educational Program “+ Familia” (+family)

The program “+ Família” part of the activities promoted by CLDS + from Paredes de Coura in 2015, has enabled to act at the level of strategy development for qualifying families. The perceived quality of life of children and youngsters was evaluated in 2 moments: at the beginning (n = 23) and in the end (n = 11). We used the scale kidscreen-10, translated and measured for the Portuguese population. At the first moment, the sample consisted of 65% of women and 35% man; 87% aged between 6 and 10 years old and 13% aged between 11 and 15 years old; 74% attended the 1st cycle of studies and 13% had some type of disability. Based on 4 of the questions, the perception of quality of life has improved, between the beginning and the end of the program implementation. So for the remaining 6 questions, quality of life was perceived in a more negative way in the same period. An intra subject analysis would have to be made in order to measure the results’ bias due to the absence of 12 subjects in the final evaluation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The reality of domestic violence in the US

According to the United States department of justice, domestic violence is defined as “a pattern of abusive behaviours in any relationship that are used by one partner to gain or maintain power and control over another intimate partner”. It involves a pattern of coercive behaviour in intimate relationships whereby the behaviour is controlled through humiliation, intimidation, fear, and often intentional physical, emotional or sexual injury. Domestic violence crosses all ethnic, socioeconomic and age groups, and is also prevalent in same sex relationships.

Over six million children are severely assaulted by family members every year in the United States; a man beats a woman every twelve seconds; women who leave their batterer are at 75% greater risk of being killed by their batterer than those who stay; and one third of police time is spending on answering domestic violence calls.

In domestic violence situations the intervention is frequently in crisis, where the victims “fight” for survival, and it is necessary to give proper answers according to the victim's needs. The professionals that work directly with domestic violence assume that there is a strong bond connecting the domestic violence with mental health. In the United States 90% of domestic violence survivors report extreme emotional distress; 47.5% report having been diagnosed with post-traumatic stress disorder; 14.7% report anxiety; 20% depression. Mental illnesses are frequently observed in domestic violence survivors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Impact of Psychopedagogical Intervention on Quality of Life in Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) Treated with Psychostimulant Medication

Several studies have shown that ADHD has a significant negative impact on multiple domains of quality of life of children and adolescents, particularly in terms of behavioral, emotional and psychosocial quality of life. The psychopedagogical intervention can be therapeutic, preventive and promote educational inclusion. Moreover, it aims to address the learning process, how it is developed and how the individual relates himself to learning, both in the cognitive, social and emotional domains. Our purpose was to understand whether the psychopedagogical intervention influences the quality of life of adolescents with ADHD considering their pharmacological plans. The aim of this study was to evaluate the impact of a psychopedagogical intervention on quality of life of a sample of adolescents with ADHD taking into account their pharmacological plans (rubifen, ritalin, and concerta). We used quantitative and qualitative assessment measures: the KIDSCREEN-10, to measure the quality of life of these adolescents, and a semi-structured interview to assess the impact of a psychopedagogical intervention in the lives of these adolescents and their parents, respectively. The results showed that psychopedagogical intervention has a positive impact on the quality of life of adolescents with ADHD, as well as in the family dynamics. Due to the demands of school work (homework) and their negative impact on the family dynamics and consequently in the quality of life, the results corroborate the relevance of a psychopedagogical intervention to improve these areas. Thus, it appears that this type of intervention is very useful for adolescents with ADHD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Guide for adults in the children's therapeutic tale: “I conquered my fears”

The book “I conquered my fears” was created as a result of the clinical experience of the author. It is a therapeutic tale, which is valid as a resource to be used by health workers and parents so as to help children overcome their fears at bedtime.

Because experience is important for an adult so as to better reflect on the theme, the book also includes an appendix to help accordingly.

The adult is invited to express what he/she likes to hear the most and the least, when waking from a sleepless night, and is also invited to dynamically interact with the book, give answers and create hypothesis, with no fear of making mistakes.

The parents, after reading the book, refer a better stress management capacity at critical moments experienced with the children at bedtime.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

PTSD And Quality of Life Among Firefighters and Municipal Police Forces

Research has shown that PTSD is prevalent among firefighters and police forces and that Quality of Life (QoL) is seriously compromised in individuals suffering from PTSD. However, QoL studies with these professionals are scarce. This study results from a screening program held by the Portuguese Red Cross (PRC) aiming to analyze predictors of QoL. Participants were 95 firefighters and municipal police officers. They answered the Posttraumatic Stress Disorder Checklist (PCL-5) in order to evaluate the prevalence of PTSD symptoms, as well as measures of social support (3-Item Oslo Social Support Scale) and QoL (EUROHIS-QOL-8). From the results, there were no group differences regarding total PTSD, social support or QoL and 10% of participants reported enough symptoms to PTSD diagnostic. Social Support and PTSD explained 25% of QoL variance, PTSD symptoms explaining 10% (negative beta) and, in the second step, social support explained 15%. The results suggest that it would be important to include QoL as an outcome measure in clinical and research work in these populations, with special attention to PTSD and social support.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Neural Correlates of Borderline Personality Disorder - A Review

Introduction

The Borderline Personality (BP) disorder is defined as a limit state between neurosis and psychosis. The symptomatology observed in such disorder seems to be correlated with the dysfunction of specific areas of the human brain, such as cortical and sub-cortical ones.

Objectives

This report aims to review the state of the art in order to better understand the correlation between the functional anatomy of the brain and the BP disorder, and its relevance to the symptomatic manifestation of this psychopathology.

Background

The stress response of patients with BP disorder seems to be associated with a low-responsive pituitary gland. The frontolimbic abnormalities observed in recent studies seems associated with the difficulty in the emotional management and impulsivity. The findings suggest a reduction of parietal cortex metabolism which appears to be associated to lack of insight and easy hypnotic induction. The disfunction of the amygdala, hippocampus and prefrontal cortex was found to be lateralized on the left hemisphere, whether the structures with increased activation on the right hemisphere were the temporal lobe, ventrolateral prefrontal cortex and posterior parietal lobe. Finally, the aggressive and impulsive behavior of such patients seems to be related with low levels of cortical serotonin.

Conclusions

To our knowledge, some of the neurofunctional findings didn’t match the symptomatic pattern of the BP disorder. From all the relations found, the fronto-limbic deficit is the one with a more relevant influence for the consequent emotional disturbance, a major symptom of this disorder.

Humoral and cellular immune responses after influenza vaccination in kidney transplant recipients

It has been speculated that influenza vaccination of renal allograft recipients could be associated with de novo production and/or increased titers of anti-HLA antibodies (HLA-Ab). To directly address this issue, we recruited 66 stable renal transplant recipients and 19 healthy volunteers during the 2005-2006 vaccination campaign. At day 0 and day 30 following vaccination, HLA-Ab were screened and in parallel influenza-specific antibody and T-cell responses were assessed. Humoral postvaccinal responses to A/H1N1 and A/H3N2 strains, but not B strain, were less frequent in transplanted patients than in control subjects. Significant expansion of influenza-specific IFN-gamma-producing T cells was observed at similar frequencies in patients and controls. There was no correlation between cellular and humoral postvaccinal responses. No impact of sex, age or immunosuppressive regimen could be evidenced. Vaccination was not associated with any significant change in preexisting or de novo anti-HLA sensitization. No episode of allograft rejection was recorded in any of the patients. Our results suggest that flu vaccination is safe in stable renal transplanted patients. Larger studies are needed for definitive statistical proof of the safety and effectiveness, with regard to the quality of the immune response, of yearly influenza vaccination in immunosuppressed patients.

Interference of methysergide, a specific 5-hydroxytryptamine receptor antagonist, with airway chronic allergic inflammation and remodelling in a murine model of asthma

BACKGROUND

Airway remodelling encompasses the structural changes observed in asthmatic airways. Mast cells, through the release of histamine and 5-hydroxytryptamine (serotonin), are implicated in early asthmatic reactions, bronchoconstriction and mucosal oedema, and in the development of bronchial hyperresponsiveness. However, the association between serotonin and remodelling processes in murine model of airways inflammation remains to be elucidated.

OBJECTIVE

As serotonin is released by murine mast cells upon antigen challenge, we tested the hypothesis of its involvement in the development of inflammatory and remodelling processes in a murine model of chronic airway inflammation following prolonged allergen challenge. Methods BALB/c mice were exposed to aerosolized ovalbumin for 20 min 2 days a week, for 4 consecutive weeks. Two hours before each challenge, they were treated with methysergide (intranasally, 40 microg/kg). Forty-eight hours after the last aerosol challenge, bronchoalveolar lavage (BAL) and lung tissue were collected for analysis.

RESULTS

Methysergide inhibited the allergen-induced increase in airway eosinophilia, reduced T helper type 2 (Th2) cytokines in lung, spleen or thoracic lymph nodes, and specific IgE levels. The extravasation of plasma and fibronectin production in the lung, and collagen deposition in the lung were also inhibited after methysergide treatment. Although methysergide treatment induced an increase in IFN-gamma levels, experiments with neutralizing antibody suggest that this is not responsible for inhibition. In addition, instillation of serotonin to immunized mice induced eosinophil recruitment to BAL, Th2 cytokine production and fibronectin release in lung as well as collagen deposition.

CONCLUSION

Serotonin may contribute to the development and maintenance of remodelling through the release of cytokines and of fibrogenic mediators. Serotonin should therefore be considered as relevant for the development and maintenance of airway remodelling.

Regulation of gene expression in mouse trophoblast cells by interferon-gamma

We have previously shown that interferon-gamma (IFN-gamma) activates phagocytosis and induces nitric oxide production in cultured mouse trophoblast cells. In the present study we examined the effect of this cytokine on ectoplacental cone and gene expression in trophoblast cells. Ectoplacental cones were obtained during the postimplantation period on gestational day 7.5 from CD-1 mice and exposed to 100U/mL IFN-gamma. Ectoplacental cone morphology, cell proliferation and death were also determined upon IFN-gamma treatment. Complementary DNA macroarray and semiquantitative RT-PCR were used to analyze gene expression. IFN-gamma treatment did not alter ectoplacental cone morphology, trophoblast cell proliferation or death. However, using gene array technology, we observed that IFN-gamma affected the developing trophoblast, altering the level of mRNA expression, which resulted in upregulation of 35 genes and downregulation of seven others. The upregulation of transcription factors and immune response-associated genes suggests that IFN-gamma is involved in processes beyond immunological homeostasis and plays an important role in placental development and function.

Immunosuppresive role of principal toxin (crotoxin) of Crotalus durissus terrificus venom

The composition of the crotalic venom and the immunochemistry and/or pathophysiological characterization and main components were well studied. However, few studies have been carried out to investigate the effect of toxins of this venom on the development of the immune response. The objective of this work was to find out if venom or crotoxin of Crotalus durissus terrificus was able to modulate the immune response through its ability to change the mediators involved in the immune response by an unrelated antigen. We observed in the murine model, that venom as well as crotoxin have inhibitory effect on splenic cells proliferation induced by Con-A. Moreover, CB did not inhibit the proliferative response, suggesting that the integrity of crotoxin complex is necessary for the development of this phenomenon. Moreover, we showed that the effect on cellular proliferation was unrelated to cytotoxicity activity. We also observed that venom or crotoxin inhibited cytokine release induced in HSA immunised mice, mainly IL-2, IL-4 and IL-10, however, crotoxin did not inhibit the release of IFN-gamma. The involvement of T or B cells in the suppressive effect of venom was evaluated through the transference of purified splenic cells from venom-mice to normal mice that also produced low IgG1 anti-HSA levels, indicating the participation of these cells in this process. Mechanism of action of the crotalic venom on development of immune response to an unrelated antigen is much more complex, therefore it must not only involve the interaction of distinct cellular populations, but activation or inhibition of signalling proteins, need to be further investigated.

A comparative study of biological activities of crotoxin and CB fraction of venoms from Crotalus durissus terrificus, Crotalus durissus cascavella and Crotalus durissus collilineatus

In Brazil, the Crotalus durissus terrificus subspecie is the most studied, particularly concerning its crotoxin. Crotoxin is the major toxic component of the South American rattlesnake Crotalus durissus venom. It is composed of two different subunits, CA called crotapotin and CB weakly toxic phospholipase A2 with high enzymatic activity. In this paper, we decided to make a study of the main toxic characteristics of crotoxin (CTX) and CB fraction from the other subspecies, Crotalus durissus cascavella and of Crotalus durissus collilineatus, in comparison with those of C. d. terrificus. Ours results have shown that the venoms presented similar chromatographic profiles and the purified fractions were free of contaminants. Regarding the toxic activities, the DL50 of the crotoxins showed no significant differences between the subspecies. The smaller toxicity of CB indicated that the toxicity of the crotoxin complex depends on the interaction between CA and CB. CTX and fraction CB of the three species of Crotalus showed negligible proteolytic activity. C. d. terrificus CTX presented higher PLA2 activity when compared with the others two subspecies. The oedema induced by CB developed later than the CTX and reached its peak 3 h after the injection. The myotoxic activity was determined by assaying serum CK levels. Mice injected with CTX of C. d. terrificus presented greater myotoxic activity compared to the others. The myotoxic activity of CB from the three subspecies was lower than the activity of the crotoxin, reinforcing the idea that the fraction CA increases the toxicity of CB.

Eosinophilic inflammation and airway hyper-responsiveness are profoundly inhibited by a helminth (Ascaris suum) extract in a murine model of asthma

BACKGROUND

The increase of atopic disorders in developed countries has been associated with the decline of infectious diseases, including helminthic infections. We have already demonstrated that adult worm extracts from Ascaris suum (ASC) suppress the IgE antibody production against unrelated antigens.

OBJECTIVE

Here we investigated the influence of ASC on the development of pulmonary eosinophilic inflammation in a murine model of asthma.

METHODS

Heat-coagulated egg white alone (EWI) or mixed with ASC (EWI + ASC) was implanted subcutaneously in B10.A or C57BL/6 mice, and 14 days later they were challenged intratracheally with OVA or exposed to aerosolized OVA for 4 days.

RESULTS

The suppressive effect of ASC was demonstrated on the accumulation of cells into airways, with reduction of eosinophil numbers and of eosinophil peroxidase activity in EWI + ASC-immunized mice. This effect correlated with a marked reduction of IL-5 and IL-4 levels in the BAL from C57BL/6 and B10. A mice, respectively, and of eotaxin in BAL and lung tissue from both strains. OVA-specific IgG1 and IgE levels were also impaired in serum and BAL from these mice. Airway hyper-reactivity to methacholine was obtained in B10. A mice sensitized with EWI, but the respiratory mechanical parameters returned to normal levels in EWI + ASC-immunized mice.

CONCLUSION

These results indicate that ASC has a profound inhibitory effect on lung inflammation and hyper-responsiveness and that suppression of IL-5 or IL-4 and of eotaxin contributes to this effect.

Prevalence of spondyloarthritis in Terceira, Azores: a population based study

OBJECTIVE

To determine the prevalence of spondyloarthritis (SpA) in the Caucasian population of Terceira Island, Azores.

METHODS

Study subjects were recruited from people over the age of 50 years from one half of the island of Terceira (n=24 561). Seventy eight men and 78 women from each five year age group were selected, giving a total of 468 men and 468 women available for study, of whom 490 agreed to take part. These subjects were assessed by dorsal, lumbar, and pelvic radiography. Radiological sacroiliitis was identified in eight patients on whom sacroiliac computed tomography scans were performed. HLA class I typing by polymerase chain reaction with sequence-specific primers was carried out in seven cases.

RESULTS

SpA was present in eight subjects (1.6%, 95% CI 0.8 to 2.7%), including seven men (2.7%) and one woman (0.4%). Three (1.2% ) male patients with definite ankylosing spondylitis were HLA-B27 positive. Only one person had a previous diagnosis of SpA.

CONCLUSION

These data complement previous studies in European countries on SpA prevalence and establish an estimate of the overall prevalence of SpA in a southern European population.

Progressive myoclonic ataxia and JC virus encephalitis in an AIDS patient

A case of progressive myoclonic ataxia in an AIDS patient is described, which evolved over a 13 month period. The ataxia persisted as the only clinical finding for several months before the appearance of a severe tetraparesis and cachexia. Throughout the clinical progression, magnetic resonance imaging (MRI) revealed the presence of bilateral, progressive, isolated, and symmetrical lesions involving the red nuclei, subthalami, thalami, lenticular nuclei, and primary motor cortices. Neuropathological examination, supplemented by in situ hybridisation for JC virus DNA, confirmed that the lesions were those of progressive multifocal leucoencephalopathy (PML). The exceptional clinical presentation of PML in this case is the first report of progressive myoclonic ataxia caused by PML. The selective nature of the lesions confirms the role of the dentato-rubral-thalamo-cortical tract in the pathogenesis of progressive myoclonic ataxia. The atypical MRI findings further emphasise the need for expanded diagnostic criteria for PML in AIDS patients and support the use of more aggressive diagnostic methods as new treatments become available.

Peritonitis per patient and year: a basic index

For the past 15 years, the appropriate treatment of end stage renal failure has included both continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis. In some circumstances CAPD has been indicated as a more adequate option. However, the main handicap for CAPD patients is peritoneal infection [1], ranking as the main cause of hospital admission and transfer to haemodialysis [2]. Peritonitis represents the third highest cause of death in CAPD patients [3]. It also produces a 15–19% deterioration of peritoneal membrane function.

Safety and pharmacokinetics of an intraocular fluocinolone acetonide sustained delivery device

PURPOSE

To determine the safety and pharmacokinetics of an intraocular fluocinolone acetonide sustained drug delivery device.

METHODS

Nonbiodegradable drug delivery devices containing 2 or 15 mg of a synthetic corticosteroid, fluocinolone acetonide, were constructed. The long-term in vitro release rates of these devices were determined in protein-free buffer or buffer containing 50% plasma protein. Fifteen-milligram devices were also implanted into the vitreous cavities of rabbit eyes. Intravitreal drug levels, the amount of drug remaining in explanted devices, and the release rate of explanted devices were determined over a 1-year time period. Drug toxicity was assessed over this same time period by slit lamp examination, indirect ophthalmoscopy, electroretinography, and histologic examination.

RESULTS

The drug release rates for the 2-mg device, 1.9 +/- 0.25 microg/d, and for the 15-mg device, 2.2 +/- 0.6 microg/d, remained linear over the 6-month and 45-day testing period, respectively. The release rate increased by approximately 20% when devices were transferred from protein-free buffer to buffer that contained protein (P: < 0.0001). Vitreous levels remained fairly constant (0.10-0.21 microg/ml) over a 1-year period. No drug was present in the aqueous humor during this time period. Based on the device release rates, the predicted life span of the 2- and 15-mg devices are 2.7 and 18.6 years, respectively. There was no evidence of drug toxicity by clinical examination, electroretinography, or histologic examination.

CONCLUSIONS

It is feasible to construct a nontoxic fluocinolone acetonide drug delivery device that reproducibly releases fluocinolone acetonide in a linear manner over an extended period. These devices show great promise in the treatment of ocular diseases such as uveitis, which are often managed with chronic corticosteroid therapy.

Trypanosoma cruzi surface mucins with exposed variant epitopes

The protozoan parasite Trypanosoma cruzi, the agent of Chagas disease, has a large number of mucin molecules on its surface, whose expression is regulated during the life cycle. These mucins are the main acceptors of sialic acid, a monosaccharide that is required by the parasite to infect and survive in the mammalian host. A large mucin-like gene family named TcMUC containing about 500 members has been identified previously in T. cruzi. TcMUC can be divided into two subfamilies according to the presence or absence of tandem repeats in the central region of the genes. In this work, T. cruzi parasites were transfected with one tagged member of each subfamily. Only the product from the gene with repeats was highly O-glycosylated in vivo. The O-linked oligosaccharides consisted mainly of beta-d-Galp(1-->4)GlcNAc and beta-d-Galp(1-->4)[beta-d-Galp(1-->6)]-d-GlcNAc. The same glycosyl moieties were found in endogenous mucins. The mature product was anchored by glycosylphosphatidylinositol to the plasma membrane and exposed to the medium. Sera from infected mice recognized the recombinant product of one repeats-containing gene thus showing that they are expressed during the infection. TcMUC genes encode a hypervariable region at the N terminus. We now show that the hypervariable region is indeed present in the exposed mature N termini of the mucins because sera from infected hosts recognized peptides having sequences from this region. The results are discussed in comparison with the mucins from the insect stages of the parasite (Di Noia, J. M., D'Orso, I., Sánchez, D. O., and Frasch, A. C. C. (2000) J. Biol. Chem. 275, 10218-10227) which do not have variable regions.

Separation of Galfbeta1-->XGlcNAc and Galpbeta1-->XGlcNAc (X = 3, 4, and 6) as the alditols by high-pH anion-exchange chromatography and thin-layer chromatography: characterization of mucins from Trypanosoma cruzi

The O-linked N-acetylglucosamine oligosaccharides in the mucins of Trypanosoma cruzi may contain galactofuranose or galactopyranose, depending on the strain, one of the components being the disaccharide. Since galactofuranose is a site for antibody recognition, it is desirable to have a sensitive method for the detection of the galactofuranosyl structures. In this paper, we present procedures for the separation of Galfbeta1-->XGlcNAc and Galpbeta1-->XGlcNAc (X = 3, 4, and 6) as the corresponding alditols by high-pH anion-exchange chromatography with pulse amperometric detection. All the isomeric disaccharides could be resolved on a CarboPac PA-10 column, the galactofuranose-containing disaccharides being more retained in the column. GlcNAcol and Galfbeta1-->4(Galpbeta1-->6)GlcNAcol could be analyzed in the same run. The compounds could also be separated by thin-layer chromatography on silica gel 60, a convenient method for analysis of the radiolabeled alditols obtained by reductive beta-elimination in the presence of NaB(3)H(4). Both methods were applied for the analysis of the O-linked sugars in the mucins of T. cruzi CL 14 and revealed that they contained only N-acetylglucosamine and the disaccharide Galpbeta1-->4GlcNAc.

Meningoencephalic herniation into the middle ear

Meningoencephalic herniation into the middle ear (MHME) is a rare condition. It can result from ear surgery, infection, head trauma or can be spontaneous. Diagnosis requires a high degree of clinical suspicion. The presentation may suggest the condition, but sometimes the intraoperative discovery of an occult meningoencephalic herniation may be a frightening situation. Treatment planning must avoid intra-cranial complications. Transmastoid (TM) and middle cranial fossa (MCF) are alternative or complementary approaches, determined by several factors, including the size and the site of the bony defect and the presence or absence of middle ear infection. Three case reports are presented and a review of the literature is performed, to explain some aspects related to MHME, including aetiopathogenesis, clinical presentation, histopathology, diagnosis and treatment.

Building the road map for a performance-driven organization

The strategic importance of performance improvement (PI) in healthcare is being recognized across the country. Organizations that recognize PI's importance and support PI will be better prepared for a healthcare future that mandates measurable value. Building the foundation for success is neither a simple task nor a cheap one. It requires a total systems perspective on improving processes and systems, a commitment to continual learning, and recognition of what other industries have already learned--to succeed, you must constantly innovate and improve. This article discusses one organization's approach to building the foundation for a performance-driven 21st-century healthcare system.