Cardiometabolic Risk in First Episode Psychosis Patients

Previous research in patients with schizophrenia in European and USA population groups has demonstrated a high prevalence of metabolic syndrome and disease progression (~35%-40%) and increased risk for cardiovascular disease and long-term mortality. Limited research has determined the prevalence of existing cardiometabolic risk factors at onset of a first episode psychosis. This cross-sectional study presents a clinical overview of the cardiometabolic risk profile in young people with first episode psychosis in the UK. Forty-six participants (72% male) clinically diagnosed with first episode psychosis (n = 25), schizophrenia (n = 13), bipolar disorder (n = 4), unspecified non-organic psychosis (n = 2) or acute psychotic episode (n = 2) with < 6 months Duration of Untreated Psychosis (DUP; mean 33.4 ± 37.2 days) were assessed for anthropometric, health risk behaviors and clinical measurements including resting heart rate, blood pressure, blood lipids, glycated hemoglobin, and prolactin. Overall, participants (aged 18-37 years) had a high prevalence of cardiometabolic risk factors due to: elevated values for BMI (73%) and abdominal adiposity (50%), blood pressure (47% prehypertensive; 23% hypertensive), resting heart rate (43%); hypercholesterolemia (32%); suboptimal HDL-C levels (36%); and hypertriglyceridemia (40%). Participants also self-reported poor health risk habits including smoking (55%), alcohol use (39%), substance use (18%), poor diet (52%), and sedentary behavior (29%). Young people with psychosis are at increased risk for cardiometabolic disorders due to elevated clinical markers and health risk behaviors. Physical health interventions (including health behavior advice) are needed early in the treatment process to address this increased risk for cardiometabolic disorders in individuals recently diagnosed with psychosis.

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care

AIM

Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK.

METHODS

Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months.

RESULTS

Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence.

CONCLUSIONS

The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.

Transport and potential attenuation of nitrogen in shallow groundwaters in the lower Rangitikei catchment, New Zealand

Intensive agricultural activities are generally associated with nitrogen leaching from agricultural soils, and this nitrogen has the potential to percolate and contaminate groundwater and surface waters. We assessed surface water and groundwater interactions, and nitrogen leaching and its potential attenuation in shallow groundwater in the lower Rangitikei River catchment (832km²), New Zealand. We combined regional- and local-scale field surveys and experiments, nutrient budget modelling, and hydraulic and geochemical methods, to gain an insight into leaching, transformation and transport of nitrogen via groundwaters to the river in the study area. Concurrent river flow gaugings (in January 2015) and a piezometric map, developed from measured depths to groundwater in 110 bores (in October 2014), suggest groundwater discharges to the Rangitikei River in the upper parts of the study area, while there is groundwater recharge near the coast. The groundwater redox characterisation, based on sampling and analysis of 15 mostly shallow bores (<30m below ground level (bgl)), suggests groundwater across the lower Rangitikei catchment in general is under anoxic/reduced conditions. The groundwater typically has low dissolved oxygen (DO) concentrations (<1mg/L), suggesting the subsurface environment is conducive to potential attenuation by 'denitrification' of NO₃-N in groundwater. We further measured NO₃-N attenuation in shallow groundwater piezometers (3-6mbgl) using single-well push-pull tests. We found generally low levels (<0.5mg/L) of NO₃-N in shallow groundwater piezometers (>5mbgl), despite being installed under intensive land uses, such as dairying and cropping. Our in-field push-pull tests showed NO₃-N reduction at four shallow groundwater piezometers, with the rates of reduction varying from 0.04mgNL^-1h^-1 to 1.57mgNL^-1h^-1. This highlights the importance of a sound understanding of not only the sources, but also transport and transformation, or fate, of nutrients leached from farms, to mitigate the likely impacts of land use on water quality and ecosystem health in agricultural catchments.

Temporal and spatial water use on irrigated and nonirrigated pasture-based dairy farms

Robust information for water use on pasture-based dairy farms is critical to farmers' attempts to use water more efficiently and the improved allocation of freshwater resources to dairy farmers. To quantify the water requirements of dairy farms across regions in a practicable manner, it will be necessary to develop predictive models. The objectives of this study were to compare water use on a group of irrigated and nonirrigated farms, validate existing water use models using the data measured on the group of nonirrigated farms, and modify the model so that it can be used to predict water use on irrigated dairy farms. Water use data were collected on a group of irrigated dairy farms located in the Canterbury, New Zealand, region with the largest area under irrigation. The nonirrigated farms were located in the Manawatu region. The amount of water used for irrigation was almost 52-fold greater than the amount of all other forms of water use combined. There were large differences in measured milking parlor water use, stock drinking water, and leakage rates between the irrigated and nonirrigated farms. As expected, stock drinking water was lower on irrigated dairy farms. Irrigation lowers the dry matter percentage of pasture, ensuring that the amount of water ingested from pasture remains high throughout the year, thereby reducing the demand for drinking water. Leakage rates were different between the 2 groups of farms; 47% of stock drinking water was lost as leakage on nonirrigated farms, whereas leakage on the irrigated farms equated to only 13% of stock drinking water. These differences in leakage were thought to be related to regional differences rather than differences in irrigated versus nonirrigated farms. Existing models developed to predict milking parlor, corrected stock drinking water, and total water use on nonirrigated pasture-based dairy farms in a previous related study were tested on the data measured in the present research. As expected, these models performed well for nonirrigated dairy farms but provided poor predictive power for irrigated farms. Partial least squares regression models were developed specifically to simulate corrected stock drinking water, milking parlor water, and total water use on irrigated dairy farms.

Effect of Trisodium Citrate on Rheological and Physical Properties and Microstructure of Yogurt

The effect of trisodium citrate (TSC) on the rheological and physical properties and microstructure of yogurt was investigated. Reconstituted skim milk was heated at 85 degrees C for 30 min, and various concentrations (5 to 40 mM) of TSC were added to the milk, which was then readjusted to pH 6.50. Milk was inoculated with 2% yogurt culture and incubated at 42 degrees C until pH was 4.6. Acid-base titration was used to determine changes in the state of colloidal calcium phosphate (CCP) in milk. Total and soluble Ca contents of the milk were determined. The storage modulus (G') and loss tangent (LT) values of yogurts were measured as a function of pH using dynamic oscillatory rheology. Large deformation rheological properties were also measured. Microstructure of yogurt was observed using confocal scanning laser microscopy, and whey separation was also determined. Addition of TSC reduced casein-bound Ca and increased the solubilization of CCP. The G' value of gels significantly increased with addition of low levels of TSC, and highest G' values were observed in samples with 10 to 20 mM TSC; higher (> 20 mM) TSC concentrations resulted in a large decrease in G' values. The LT of yogurts increased after gelation to attain a maximum at pH approximately 5.1, but no maximum was observed in yogurts made with > or = 25 mM of TSC because CCP was completely dissolved prior to gelation. Partial removal of CCP resulted in an increase in the LT value at pH 5.1. At low TSC levels, the removal of CCP crosslinks may have facilitated greater rearrangement and molecular mobility of the micelle structure, which may have helped to increase G' and LT values of gels by increasing the formation of crosslinks between strands. At high TSC concentrations the micelles were completely disrupted and CCP crosslinks were dissolved, both of which resulted in very weak yogurt gels with large pores obvious in confocal micrographs. Gelation pH and yield stress significantly decreased with the use of high TSC levels. Lowest whey separation levels were observed in yogurt made with 20 mM TSC, and whey separation greatly increased at > 25 mM TSC. In conclusion, low concentrations of TSC improved several important yogurt characteristics, whereas the use of levels that disrupted casein micelles resulted in poor gel properties. We also conclude that the LT maximum observed in yogurts made from heated milk is due to the presence of CCP because the modification of the CCP content altered this peak and the removal of CCP eliminates this feature in the LT profiles.

In vitro uptake of SCH 27899 (evernimicin) by rat alveolar macrophages

The in vitro uptake of [(14)C]evernimicin ([(14)C]SCH 27899) by primary cultures of rat alveolar macrophages and hepatocytes was determined. Both cell populations exhibited linear rates of uptake. However, the initial rate of drug uptake by alveolar macrophages was about threefold higher than that by hepatocytes. These findings demonstrate that [(14)C]evernimicin is taken up by rat alveolar macrophages, supporting the likelihood that the drug is able to reach sites of infection.

The preparation of copper-oxidized LDL for the measurement of oxidized LDL antibodies by EIA

In the present study we try to define the optimal conditions for preparation of copper-oxidized low-density lipoprotein (oxLDL) to be used for the assay of oxLDL antibodies by enzyme immunoassay (EIA). Oxidation of LDL was monitored by measuring the formation of conjugated dienes at 234 nm and the generation of fluorescent products with emission at 430 nm when excitation is performed at 360 nm. The generation of immunogenic epitopes was evaluated by testing the reactivity of aliquots collected at different times during the oxidation process with human sera with high oxLDL antibody levels and with a purified human oxLDL antibody. The values of fluorescence emission at 430 nm correlated best with reactivity with oxLDL antibodies; strong reactivity was usually associated with values greater than 1.1 U. The time needed for fluorescence emission to reach maximum levels varied between 6 and 14 h for most LDL, but it was considerably longer in a few LDL preparations. The maximal reactivity of oxLDL with oxLDL antibodies was observed when the LDL oxidation reaction was stopped 4 or more hours after the fluorescence readings reached their peak. At this stage of the oxidation reaction, apolipoprotein B fragmentation and aggregation were observed as shown by Western blot analysis. The CV for 13 EIA runs of two reference oxLDL antibodies reacting with four different pools of standardized oxLDL prepared according to the stated guidelines was 14.5 and 3.9%, confirming the reproducibility of our oxidation conditions.

Elevated maternal serum alpha-fetoprotein with low unconjugated estriol and the risk for lethal perinatal outcome

OBJECTIVE

To determine whether a combination of elevated maternal serum alpha-fetoprotein (MSAFP) and low unconjugated estriol (E3) concentration identifies pregnancies at particularly high risk for fetal abnormality or poor outcome.

METHODS

Pregnancy outcomes were reviewed for women with elevated MSAFP (> or =2.0 MoM) from our database of 50,315 women who had received triple marker testing from 1993-1998. Outcomes for those with low E3 (< or =0.7 MoM) were compared with those with normal E3 (>0.7 MoM). The incidences of fetal death, neural tube defects, chromosome abnormalities, congenital abnormalities, preterm birth, small-for-gestational age (SGA), twins, and inaccurate dates were compared in the two groups using Fisher's exact test with P < 0.05 considered significant.

RESULTS

Of the 50,315 women screened, 1,435 (2.85%) had an elevated MSAFP. Pregnancy outcomes were obtained in 94% of those with elevated MSAFP and 70% of all patients screened. Neural tube defects were present in 57 fetuses/infants (21 anencephalic, 29 spina bifida, 7 encephalocele) of which 46 (81%) had an elevated MSAFP. Of the 1,435 women with an elevated MSAFP, 199 (14%) had a low E3. Compared to those women with elevated MSAFP but normal E3, women with elevated MSAFP and low E3 were at significantly increased risk for fetal death (20.6% vs. 2.8%, relative risk (RR) 8.9), anencephaly (9.0% vs. 0.1%, RR 122.8) and chromosome abnormality (2.5% vs. 0.6%, RR 4.0).

CONCLUSIONS

Pregnancies complicated by elevated second trimester MSAFP and low E3 are at a particularly high risk (32%) for lethal perinatal outcomes. Twins, while a common cause of elevated MSAFP, are rarely found when an elevated MSAFP is associated with low E3.

Autolysis and cell wall degradation in a choline-independent strain of Streptococcus pneumoniae

Streptococcus pneumoniae has an auxotrophic requirement for choline, and choline residues that incorporate into the wall and membrane teichoic acids are intimately involved with the control of autolytic phenomena of this bacterium. We report here the re-examination of the role of choline in autolytic cell wall degradation using the choline-independent S. pneumoniae strain R6Cho- recovered from a heterologous cross with DNA from Streptococcus oralis. S pneumoniae Cho- cultured in choline-free medium grew with normal generation time but formed long chains, failed to undergo stationary-phase autolysis, and was also resistant to lysis induced by deoxycholate or penicillin. Cell walls produced under these conditions had reduced phosphorus content, contained no choline residues detectable by nuclear magnetic resonance, and had reduced binding capacity for the pneumococcal autolytic amidase, and complete hydrolysis of such walls by the amidase required prolonged incubation with high concentrations of the enzyme. Addition of choline to the growth medium reversed at these phenomena. High-performance liquid chromatography analysis of amidase digests of cell walls prepared from strain R6Cho- grown with or without choline produced identical stem peptide profiles, which were also similar to that of the parental S. pneumoniae strain R6. Peptidoglycans prepared by hydrofluoric extraction of cell walls from Cho- growth with or without choline or from the parental strain R6 were uniformly susceptible to the autolytic amidase and were fully degraded to the normal family of stem peptides, indicating that, in sharp contrast to the case of cell walls, the amidase degradation of teichoic acid-free peptidoglycan did not require the presence of choline residues in the substrate.

Maternal serum screening for fetal trisomy 18: a comparison of fixed cutoff and patient-specific risk protocols

OBJECTIVE

To compare the effectiveness of two widely used protocols for second-trimester screening for fetal trisomy 18.

METHODS

Second-trimester screening results for 41,565 women were reviewed to determine whether pregnancies could be considered to be at high risk for trisomy 18. The screening test was considered positive if either maternal serum concentrations of alpha-fetoprotein (MSAFP), hCG, and unconjugated estriol (E3) fell below defined levels, or the second-trimester patient-specific risk (based on maternal age and serum analytes) was greater than 1:100. Detection rates, false-positive rates, and pregnancy outcomes for the two protocols were compared.

RESULTS

The fixed-cutoff method showed a 23% detection rate and a 0.19% false-positive rate for trisomy 18. These low rates were in close agreement with a theoretical expectation for fixed-cutoff trisomy 18 screening. The risk-based approach resulted in a 69% detection rate and a 0.45% false-positive rate. Both methods identified pregnancies with other fetal anomalies.

CONCLUSION

Overall, the risk-based method is more effective than the fixed-cutoff approach to trisomy 18 screening.

Role of Streptococcus thermophilus MR-1C capsular exopolysaccharide in cheese moisture retention

Recent work by our group has shown that an exopolysaccharide (EPS)-producing starter pair, Streptococcus thermophilus MR-1C and Lactobacillus delbrueckii subsp. bulgaricus MR-1R, can significantly increase moisture retention in low-fat mozzarella (D. B. Perry, D. J. McMahon, and C. J. Oberg, J. Dairy Sci. 80:799-805, 1997). The objectives of this study were to determine whether MR-1C, MR-1R, or both of these strains are required for enhanced moisture retention and to establish the role of EPS in this phenomenon. Analysis of low-fat mozzarella made with different combinations of MR-1C, MR-1R, and the non-EPS-producing starter culture strains S. thermophilus TA061 and Lactobacillus helveticus LH100 showed that S. thermophilus MR-1C was responsible for the increased cheese moisture level. To investigate the role of the S. thermophilus MR-1C EPS in cheese moisture retention, the epsE gene in this bacterium was inactivated by gene replacement. Low-fat mozzarella made with L. helveticus LH100 plus the non-EPS-producing mutant S. thermophilus DM10 had a significantly lower moisture content than did cheese made with strains LH100 and MR-1C, which confirmed that the MR-1C capsular EPS was responsible for the water-binding properties of this bacterium in cheese. Chemical analysis of the S. thermophilus MR-1C EPS indicated that the polymer has a novel basic repeating unit composed of D-galactose, L-rhamnose, and L-fucose in a ratio of 5:2:1.

Hepatitis B immunization in a low-incidence province of Canada: comparing alternative strategies

This study provides a comparative cost-effectiveness analysis of three universal immunization programs for hepatitis B virus (HBV). Using three theoretical cohorts of infants, 10-year-olds, and 12-year-olds, a universal immunization program was compared with a prenatal screening/newborn immunization program involving testing of prepartum women and immunization of newborns of HBsAg-positive mothers. A Markov long-term outcome model used Manitoba data to estimate costs and health outcomes across the lifespan. The model was based on an HBV incidence rate of 19/100,000 and a discount rate of 5% and incorporated the most recent treatment advances (interferon therapy). Cost-effectiveness was calculated as the ratio of dollars spent per year of life saved, with costs determined from the perspective of a third-party payer. The universal infant-immunization program, although not cost-saving, was associated with a low, economically attractive cost-effectiveness ratio of $15,900 (Canadian) per year of life saved, a figure substantially lower than the ratios of $97,600 and $184,800 (Canadian) associated with the universal programs for 10- and 12-year-olds, respectively. Cost-effectiveness ratios were found to be sensitive to changes in immunization costs, HBV incidence rates, and the rate at which protective antibody levels are lost over time: If these variables move in the directions suggested by current trends, the authors anticipate an increasing economic appeal of universal programs well into the future. A universal program of HBV immunization for infants appears to be economically practical in regions where HBV infection rates are low and stable.

Down syndrome and neural tube defect screening: the value of using gestational age by ultrasonography

OBJECTIVE

Our goal was to determine whether gestational age should be based on ultrasonographic evaluation or last menstrual period data in the interpretation of second-trimester maternal serum screening for Down syndrome and open neural tube defects.

STUDY DESIGN

Initial and revised screen-positive rates and detection rates were reviewed for women undergoing triple-marker testing (maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol). The study population consisted of > 24,000 women at 15.0 to 21.9 weeks' gestation with approximately 60% of test interpretations based on ultrasonographic evaluation of gestational age. Gestational age and screening results were compared for 24 Down syndrome pregnancies in which both ultrasonography and last menstrual period dating were available.

RESULTS

Both initial and revised screen-positive rates for Down syndrome were significantly lower when ultrasonographic data were used compared with last menstrual period dating. The detection rate for Down syndrome appeared to be higher with ultrasonographic dating (approximately 76% vs 60% for last menstrual period dating). Down syndrome fetuses had a significantly shorter gestational age when evaluated by ultrasonography (relative to last menstrual period dating), but a similar trend was also seen in control pregnancies. Initial and revised screen-positive rates for open neural tube defects were higher for women who had received an ultrasonographic examination compared with the rates for those women referred with only last menstrual period data. The detection rates for open neural tube defects were similar for both methods of pregnancy dating.

CONCLUSION

By use of ultrasonographic measurement of gestational age, the number of amniocenteses performed to detect Down syndrome can be substantially reduced while detection rates are maintained or improved.

Maternal serum screening for birth defects: results of a Connecticut regional program

Second trimester maternal serum screening provides a method to identify pregnancies at high risk for fetal Down's syndrome, trisomy 18, open neural tube defects, and a variety of other chromosomal and nonchromosomal fetal anomalies. Results are presented for a regional program to identify high-risk pregnancies using alpha feto-protein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) analyses (triple marker testing). A total of 27,140 women received screening. Using a midtrimester Down's syndrome risk of 1:270 to define the high-risk group, 5.26% of women of all ages were screen-positive for Down's syndrome resulting in the eventual detection of approximately 72% of the affected fetuses. The detection rate for patients under 35 at estimated date of delivery was 61% and for women 35, or older, the detection rate was 100%. A separate protocol to screen for trisomy 18 identified 0.2% of pregnancies, with 38% of the trisomy 18 cases present in this group. Over 3% of women screen-positive for Down's syndrome or trisomy 18 had a serious fetal chromosome anomaly. In addition, 2.89% of women had an elevated AFP (greater or equal to 2.0 multiples of median). This component of the screening resulted in the identification of 86% of the neural tube defects, 75% of the ventral wall defects, and also some of the other various fetal anomalies present in the screened population. Since both laboratory and clinical data are combined to generate patient-specific risks, there is a need for quality control elements that go beyond that normally required for a clinical laboratory alone. We stress the need for comprehensive follow-up programs to evaluate screening programs and maintain high quality.

Elevated second-trimester maternal serum hCG alone or in combination with elevated alpha-fetoprotein

OBJECTIVE

To evaluate the clinical significance of a second-trimester elevated maternal serum hCG in women carrying singleton, chromosomally normal fetuses.

METHODS

The results of second-trimester maternal serum screening (alpha-fetoprotein [MSAFP], hCG, and unconjugated estriol) for 25,438 women were reviewed, and those with hCG values exceeding 3.0 multiples of the median (MoM) were identified. A control population was selected only on the basis of samples accessioned by the laboratory at the same time as the study group. Follow-up information was collected from physicians' offices for both groups. Incidence of fetal or neonatal loss (spontaneous abortion, fetal death, and neonatal death combined), preterm birth (before 37 weeks' gestation), small for gestational age, and preeclampsia were compared.

RESULTS

Three hundred twenty-two women (1.3%) had hCG levels exceeding 3.0 MoM. In addition to chromosomal abnormalities and fetal death at the time of testing, this group showed a significantly higher incidence of fetal or neonatal death, preterm birth, low birth weight, and preeclampsia than did controls. For patients with elevated second-trimester hCG, many of the preterm deliveries occurred before 34 weeks' gestation. Logistic regression analysis indicated that hCG, MSAFP, and race were significant independent factors in predicting risk for adverse outcome.

CONCLUSIONS

Similar to elevated AFP, elevated hCG is associated with poor pregnancy outcome. By combining the results of the two tests, it may be possible to improve substantially the identification of patients at very high risk for adverse outcomes.

An assessment of sulphide oxidation in abandoned base-metal tailings, Te Aroha, New Zealand

Tailings from the Tui base-metal mine were characterized using a variety of techniques including scanning electron microscopy (SEM) and flame atomic absorption spectroscopy (FAAS), to assess their potential for use as a plant growth medium. With the notable exception of Pb (10 568 mg kg(-1)), 'total' metal concentrations in the surface tailings (0-200mm) were relatively low (Cu, 113; Fe, 3660; Zn, 486 mg kg(-1)). The theoretical acid generating potential (TAGP) and 'total' concentrations of Cu, Fe and Zn of the tailings, were found to increase greatly with depth, reflecting an increase in the abundance of chalcopyrite (CuFeS(2)), pyrite (FeS(2)) and sphalerite (ZnS), as detected by X-ray diffraction (XRD) analysis. SEM micrographs indicate that the distribution of sulphide minerals in the tailings was originally uniform with depth. The depletion of Cu, Fe and Zn in the surface tailings is considered to be a result of sulphide oxidation, as evidenced by the craggy and highly irregular morphology of the sulphide particles and the high hydrogen ion activity (pH 2.3-4.0) in this zone. The persistence of high concentrations of acid-generating sulphide minerals between 200 and 600 mm has important implications in determining strategies for revegetating the tailings.

The need for acute hospitals to provide counselling following motor vehicle accidents

This paper examines the need for a systematic way of detecting individuals likely to encounter moderate to severe psychological sequelae after being injured in a motor vehicle accident. It presents the findings of assessments of consecutive adult admissions during a six-month period to the Accident and Emergency Department of Royal Melbourne Hospital, a major acute hospital in Melbourne, within two days of being injured in a motor vehicle accident. Seventy of the 250 subjects surveyed completed the General Health Questionnaire 12 and the Impact of Event Scale questionnaire, with 77 per cent found likely to have had a psychiatric disorder. Seventy-four per cent had at least moderate levels of intrusion or avoidance phenomena. Forty-four per cent had severe levels of one or the other. Prevalence of these psychological sequelae was greater than that found in several recent studies on the effects of motor vehicle accidents. A small number (11-15 per cent) sought or received professional counselling within the first three months. This group did not differ, according to levels of intrusion, avoidance, or scores on the GHQ 12, to subjects who did not seek or receive such assistance. Results identify the necessity of investigating and implementing methods of detecting and treating the many who apparently sustain significant psychological sequelae following injury in a motor vehicle accident.

Juvenile dermatomyositis in a child infected with human parvovirus B19

We report a case of juvenile dermatomyositis in which clinical onset occurred soon after infection with human parvovirus B19. To the best of our knowledge an association between juvenile dermatomyositis and human parvovirus B19 has not been previously reported. Parvovirus infection has been associated with several autoimmune diseases, and the findings in the case we describe raise the possibility that parvovirus may induce juvenile dermatomyositis, although we could not demonstrate a causal relationship.

Prenatal diagnosis of diverse chromosome abnormalities in a population of patients identified by triple-marker testing as screen positive for Down syndrome

OBJECTIVE

Our purpose was to determine the incidence of all types of chromosome abnormalities (i.e., trisomy 21 and other abnormalities) in women receiving prenatal chromosome analysis after a Down syndrome screen-positive result by maternal serum triple-marker testing (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol analyses).

STUDY DESIGN

A total of 11,434 patients between 15.0 and 21.9 weeks' gestation received second-trimester Down syndrome risk evaluation by triple-marker testing. By use of a 1:270 midtrimester Down syndrome risk cutoff value, and after ultrasonographic confirmation of gestational age, 677 patients were screen positive for Down syndrome (corrected screen-positive rate 5.92%). Karyotypes were reviewed for 468 (69%) of these patients who received prenatal chromosome analysis.

RESULTS

In addition to 12 cases of Down syndrome, 12 other fetal chromosome abnormalities were found (i.e., 5.13% had a chromosome abnormality of some type). Expressed as a proportion of all patients with a corrected Down syndrome screen-positive result, at least 3.69% had a chromosome abnormality. The overall spectrum of abnormal karyotypes (approximately 50% autosomal trisomy, 25% structural and 25% sex chromosome abnormality) appears to be comparable to that seen in patients undergoing amniocentesis because of advanced maternal age.

CONCLUSIONS

As is the case for women of advanced maternal age, preamniocentesis counseling for patients with positive triple-marker testing results should reflect the relatively high probability that an abnormality other than Down syndrome may be identified.

Hepatitis E in a Canadian traveller

Hepatitis E is clinically indistinguishable from hepatitis A and is caused by an enterically transmitted rna virus that is endemic in developing countries of Asia, Africa, the Middle East and North America. This report describes a Canadian traveller to Nepal, Thailand and India with one of the first confirmed cases of hepatitis E reported in Canada. Although this disease is usually self-limited with no known sequelae, it may produce fulminant hepatitis with a high case fatality rate in pregnancy. Diagnosis can be confirmed by serological tests. Apart from strict food and beverage hygiene, there are presently no prophylactic measures against this disease, and pregnant women in the third trimester should avoid travel to endemic areas.

Antibody-dependent enhancement of respiratory syncytial virus infection by sera from young infants

Respiratory syncytial virus (RSV) convalescent-phase sera and control sera from both infants ( < 6 months) and older individuals (1.5 to 90 years) were assayed for RSV-specific antibodies by neutralization, in vitro enhancing activity, and immunoprecipitation. Enhancement of RSV infection in U937 cells was demonstrated with convalescent-phase sera and was shown to be dependent on Fc receptors by blocking with human immunoglobulin G (P < 0.01). Convalescent-phase sera from infants enhanced infection at concentrations closer to physiological ones (10(-1) to 10(-3) dilutions of serum), while convalescent-phase sera from older individuals enhanced infection only at much lower concentrations (10(-3) to 10(-6) dilutions of serum; P < 0.01). To our knowledge, this is the first report of RSV-enhancing antibody activity in the sera of infants. The observed enhancing activity and the low neutralizing antibody levels are confined mostly to convalescent-phase sera from infants aged 0 to 6 months, suggesting that these factors may contribute to the increased severity of RSV disease frequently encountered in young infants.

Conformational and functional analysis of the C-terminal globular head of the reovirus cell attachment protein

We have been investigating structure-function relationships in the reovirus cell attachment protein sigma 1 using various deletion mutants and protease analysis. In the present study, a series of deletion mutants were constructed which lacked 90, 44, 30, 12, or 4 amino acids from the C-terminus of the 455-amino acid-long reovirus type 3 (T3) sigma 1 protein. The full-length and truncated sigma 1 proteins were expressed in an in vitro transcription/translation system and assayed for L cell binding activity. It was found that the removal of as few as four amino acids from the C-terminus drastically affected the cell binding function of the sigma 1 protein. The C-terminal-truncated proteins were further characterized using trypsin, chymotrypsin, and monoclonal and polyclonal antibodies. Our results indicated that the C-terminal portions of the mutant proteins were misfolded, leading to a loss in cell binding function. The N-terminal fibrous tail of the proteins was unaffected by the deletions as was sigma 1 oligomerization, further illustrating the discrete structural and functional roles of the N- and C-terminal domains of sigma 1. In an attempt to identify smaller, functional peptides, full-length sigma 1 expressed in vitro was digested with trypsin and subsequently with chymotrypsin under various conditions. The results clearly demonstrated the highly stable nature of the C-terminal globular head of sigma 1, even when separated from the N-terminal fibrous tail. We concluded that: (1) the C-terminal globular head of sigma 1 exists as a compact, protease-resistant oligomeric structure; (2) an intact C-terminus is required for proper head folding and generation of the conformationally dependent cell binding domain.

Incidental carcinoma of prostate, Long-term follow-up

Stage A1 carcinoma of the prostate because of its small volume and low grade has been regarded as clinically insignificant and requiring no treatment. Recent long-term studies of the untreated natural history of this disease suggests otherwise. Review of our long-term follow-up of untreated incidental carcinoma of the prostate diagnosed between 1966 and 1975 has demonstrated a 16 percent progression rate requiring therapy. This finding suggests Stage A1 prostate carcinoma is not a dismissible diagnosis but demands accurate staging, closer follow-up to uncover progression, and consideration of definitive therapy following diagnosis.

Identification of conserved domains in the cell attachment proteins of the three serotypes of reovirus

Sequence analysis of reovirus serotype 1 (ST1) and 2 (ST2) S1 genome segment cDNAs identified several differences from previously reported versions of their sequences. The sequences reported here comprise 1463 and 1440 base pairs, respectively; for comparison, the ST3 S1 genome segment is 1416 nucleotides long. The serotype 1 and 2 sigma 1 proteins are predicted to contain 470 and 462 amino acids, respectively; the ST3 sigma 1 protein is 455 amino acids long. As previously observed, the ST1 and ST2 sigma 1 proteins are much more closely related to each other than to that of ST3 (about 48 and 25% similarity, respectively, using a computer program that finds about 14% similarity among unrelated proteins). The sequences of the three S1 genome segments have diverged very extensively in all three codon positions, in some cases almost to the extent of randomness. Despite this, not only function but also shape and configuration have been retained (since the three sigma 1 proteins can be incorporated efficiently into completely heterologous capsids). Seventy-nine amino acid residues are conserved among all three serotypes, many of them clustered into five regions in which one-third or more of the residues are triply conserved. These regions may represent functionally conserved domains involved in oligomerization, cell attachment, and hemagglutination.

Varicocele as the presenting sign of an abdominal mass

A patient with a varicocele on the right side as the presenting sign of intra-abdominal Burkitt's lymphoma is reported. The incidence and etiology of varicocele are discussed.

Development of an imaging flow cytometer

A cell analyzer that combines the characteristics of image cytometry and flow cytometry is being designed and constructed at the University of Sydney. This paper describes the image acquisition and processing components and some preliminary applications. Cells stained by a fluorescent dye and suspended in a liquid medium are conveyed by a hydraulic system to a flow channel assembly, where they are detected and illuminated by a laser beam. A two-dimensional charge-coupled device is used to acquire the cell images. Image processing and classification is to be carried out by a special-purpose computer comprising an array of four conventional microprocessors and a highly parallel processor consisting of an array of 32 X 32 processing elements. The analyzer will be capable of using morphologic, immunologic and biochemical information to classify and sort up to 500 cells per second. Because of its unique characteristics, the instrument will be of particular use in tumor heterogeneity studies.

Breast arteritis in polymyalgia rheumatica

A 79-year-old woman with the clinical presentation of polymyalgia rheumatica (PMR) also had breast cancer. Histopathologic evidence of arteritis was found in mastectomy tissue and in a temporal artery, neither of which had produced symptoms before surgery. Previously reported cases are reviewed in the context that breast vasculitis may be more common than in generally recognized in patients with PMR.

Cecal dilatation and volvulus in dairy cows: 84 cases (1977-1983)

The records of 84 cows with cecal dilatation or cecal volvulus were reviewed. The diagnosis was made by exploratory laparotomy or necropsy in 21 cows with cecal dilatation, and in 45 cows with cecal volvulus. Eighteen of the cows with cecal dilatation responded to medical management and the diagnosis was made by physical examination alone. The most useful criteria for determining that surgery was necessary were the presence of a high heart rate, apparent abdominal pain, scant or absence of feces, and the apex of the cecum rotated cranially on rectal examination. The prognosis for cattle with cecal dilatation and volvulus was good following medical therapy or decompression at surgery unless there was severe vascular compromise of the cecum. There was a 10% recurrence rate, and in these cows a partial typhlectomy was performed.