Strategies to improve the home care of periodontal disease in dogs: A systematic review

The expected contribution of this study is to have a complete view of the available products used in the prevention of periodontal disease in dogs. The related studies in databases including Web of Science, Science Direct, and Scopus, from 1992 to 2021, were retrieved, and 36 studies were used in the systematic review. Among the continents researched, North America proved to have the most developed research relating to the subject. The active ingredients researched, isolated, or compared to each other, were polyphosphates > phytogenics > chlorhexidine > enzymes > vitamin C > xylitol = adelmidrol = and probiotics. The form of use of active products was chewable > solution via water = via food > biscuits > paste and gels > mucoadhesive. Gingivitis index was the most studied parameter used to assess oral health. According to the evidence recovered in the systematic review was possible to conclude that products with different active agents and forms of use demonstrated positive effects in the prevention of periodontal diseases. The results of this study summarize the most frequently used active ingredients and application forms for cleaning dogs' teeth and provide a roadmap for future research on the maintenance of oral health in dogs.

P-105 A UNIQUE AND MULTIDISCIPLINARY APPROACH TO ABDOMINAL DEFECT CORRECTION AFTER TRAM FLAP

Aim

The Transverse Rectus Myocutaneous (TRAM) flap is a valid option in autologous breast reconstruction with acceptable aesthetic results, but the absence of the rectus muscle can be responsible for the discomfort and functional lost caused be the asymmetry of the abdominal wall with a slight bulge. It's also described that incisional hernias can develop following TRAM, and the management is often challenging. We want to present a case of a multidisciplinary surgery with immediate correction of the abdominal defect after the TRAM flap.

Material and Methods

We describe a case of a woman who, at the same surgical time, underwent skin-sparing mastectomy with immediate reconstruction with a TRAM flap and correction of the muscle defect of the abdominal wall with transverse abdominis release (TAR) with placement of a wide, macroporous polypropylene mesh with 48mg/m2 density in a retromuscular position.

Results

The association of the TAR with the placement of a wide mesh retromuscular allows a greater containment of intraabdominal force, with less bulging and better aesthetic results at the muscle donor site.

Conclusion

The correction of the muscle defect should be considered at the same time of the TRAM flap. The multidisciplinary approach in these cases can reduce the patient's surgical morbidity and allow better aesthetic and functional outcomes.

Note: we use a DIPROMED®, BULEVB5050 mesh

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Subcutaneous vacuoles with suppuration and granulomas: a histological clue to atypical mycobacterial infection

An 83-year-old woman was referred to the Dermatology department with a papular eruption on her left arm, occurring below the scar site of a malignant melanoma in situ, which had been excised 6 months previously. On physical examination, multiple, tender, violaceous papules and nodules inferior to the scar were noted, with central pustules in some of the lesions.

A systematic review on resource allocation in public health

Background

Research in resource allocation is a need arising from State interference by the allocative function, which seeks to promote resource adjustments with the provision of certain goods and public services (Musgrave, 1974; Musgrave & Musgrave, 1980, Longo & Troster, 1993). In this perspective, a research question arises: how has international literature on the field of Business, Management and Accounting been approaching resource allocation in public health?

Methods

Systematic Literature Review through the Scopus Database. keywords: “public health” and “resource allocation”. The types were Article and Review. Language: English, since it is internationally accepted in scientific articles, and Portuguese, in order to include Brazilian research. Search period: from 1976 to 2017. Areas: “Business, Management and Accounting”. The performed analysis technique was qualitative meta-synthesis and by using the MAXQDA Analytics Pro 18 software.

Results

The first identified study was in 2000 Sweden, pulished in Health Care Management Science. The most recente in 2017 Brazil, published in Evaluation and Program Planning. Among the countries that presented the largest production, the United States is highlighted (4). Dispersion of publication among reviews was noted. Generally, publications are grouped in four perspectives: adequate allocation, resource management and effective cost; resource allocation for treating specific diseases; resource allocation for decision-making; and health evaluation and the need of informing resource allocation. The prevailing lack of theoretical grounding must be highlighted.

Conclusions

Can be inferred that this production is recent, that it does not possess a specific focus or outline, as there is a variety of approaches, most of them being geared towards healthcare and disease control, such as cancer, diabetes, overweight, rabies, malaria and infectious diseases.

Key messages

International literature indicates that the theme is yet unexplored in the field of Business, Management e Accounting and most studies are geared towards healthcare and disease control. Allocation in the public-health policy as a function of the role of the State in providing the necessary budget for financial availability and not cost-wise, suggests lack of research.

Applied health communication training as active methodologies in undergraduate medical

Background

Health education plays a fundamental role in the formation of critical and reflective health professionals, preparing them to transcend theories and experience challenging practices. For the educator, it is unique to guide the way that can transform a gap in the undergraduate medical education into a possibility of positive action. It was in this sense that the health communication training was developed, supported by theory of neurolinguistics and techniques of emotional intelligence. Teachers of the Communication, Leadership and Management Skills (speech therapist, psychologist, nurse, doctor, dentist) programmed a training to work with students, all from the second year of the undergraduate medical course, to stimulate verbal communication. and nonverbal. Six experiential activities were used in the classroom, detailing: Activity 1 - Assertive Communication;. Activity 2 - Consensus Groups. Activity 3 - Nonverbal Communication. Activity 4 - Body Shapes. Activity 5 - Perception of the Other.

Objective

This qualitative descriptive study aimed to report the experience of a trainning on the topic of health communication held in an institution of the public higher education system in Brazil with the purpose of promoting innovation in the education of medical students.

Results

Faced with activities like this, we realize that students go through a process of breaking paradigms, which significantly influences their way of thinking. Initial training should provide adequate support to students from the perspective of the knowledge spiral. From the generalist content, with the evolution of the undergraduate years, the student perfects and deepens his reflections, in a continuous process of meanings.

Conclusions

The training of verbal and nonverbal communication with medical students satisfactorily developed skills in personal interaction, behavioral, empathy, self-perception.

Key messages

This work represents a breakthrough in the field of health education towards producing technology for health professionals. Among the challenges of the 21st century is the use of new teaching methodologies that address the demands of world health problems.

Persistent inflammation, immunosuppression and catabolism syndrome (PICS) in critically ill children is associated with clinical outcomes: a prospective longitudinal study

BACKGROUND

Persistent inflammation, immunosuppression and catabolism syndrome (PICS) has been described in critically ill adults and may contribute to unfavourable outcomes. The present study aimed to describe and characterise PICS in critically ill children (PICS-ped) and to verify its association with clinical outcomes.

METHODS

A prospective longitudinal study was conducted in a paediatric intensive care unit (PICU) with children aged between 3 months and 15 years. PICS-ped, based on adult definition, was described. PICS-ped was defined as PICU length of stay >14 days; C-reactive protein > 10.0 mg L^-1 ; lymphocytes <25%; and any reduction of mid-upper arm circumference Z-score. Clinical, demographic, nutritional status, nutrition therapy parameters and clinical outcomes were assessed. Statistical analysis comprised Mann-Whitney and Fisher's chi-squared tests, as well as logistic and Cox regression. P < 0.05 was considered statistically significant.

RESULTS

In total, 153 children were included, with a median age of 51.7 months (interquartile range 15.6-123.4 months), and 60.8% male. The mortality rate was 10.5%. The prevalence of PICS-ped was 4.6%. Days using vasoactive drugs and days using antibiotics were associated with PICS-ped. PICS-ped was associated with mortality in crude (odds ratio = 6.67; P = 0.013) and adjusted analysis (odds ratio = 7.14; P = 0.017). PICS-ped was also associated with PICU and hospital length of stay, as well as duration of mechanical ventilation. Similar results were found in a subset of critically ill children who required mechanical ventilation for more than 48 h.

CONCLUSIONS

Children with PICS-ped required antibiotics or vasoactive drugs for a longer period. PICS-ped was associated with poor clinical outcomes in critically ill children. More studies are needed to properly define PICS-ped for this population.

European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

Intestinal failure (IF) is a debilitating condition of inadequate nutrition due to an anatomical and/or physiological deficit of the intestine. Surgical management of patients with acute and chronic IF requires expertise to deal with technical challenges and make correct decisions. Dedicated IF units have expertise in patient selection, operative risk assessment and multidisciplinary support such as nutritional input and interventional radiology, which dramatically improve the morbidity and mortality of this complex condition and can beneficially affect the continuing dependence on parenteral nutritional support. Currently there is little guidance to bridge the gap between general surgeons and specialist IF surgeons. Fifteen European experts took part in a consensus process to develop guidance to support surgeons in the management of patients with IF. Based on a systematic literature review, statements were prepared for a modified Delphi process. The evidence for each statement was graded using Oxford Centre for Evidence-Based Medicine Levels of Evidence. The current paper contains the statements reflecting the position and practice of leading European experts in IF encompassing the general definition of IF surgery and organization of an IF unit, strategies to prevent IF, management of acute IF, management of wound, fistula and stoma, rehabilitation, intestinal and abdominal reconstruction, criteria for referral to a specialist unit and intestinal transplantation.

PANNOTATOR: an automated tool for annotation of pan-genomes

Due to next-generation sequence technologies, sequencing of bacterial genomes is no longer one of the main bottlenecks in bacterial research and the number of new genomes deposited in public databases continues to increase at an accelerating rate. Among these new genomes, several belong to the same species and were generated for pan-genomic studies. A pan-genomic study allows investigation of strain phenotypic differences based on genotypic differences. Along with a need for good assembly quality, it is also fundamental to guarantee good functional genome annotation of the different strains. In order to ensure quality and standards for functional genome annotation among different strains, we developed and made available PANNOTATOR (http://bnet.egr.vcu.edu/iioab/agenote.php), a web-based automated pipeline for the annotation of closely related and well-suited genomes for pan-genome studies, aiming at reducing the manual work to generate reports and corrections of various genome strains. PANNOTATOR achieved 98 and 76% of correctness for gene name and function, respectively, as result of an annotation transfer, with a similarity cut-off of 70%, compared with a gold standard annotation for the same species. These results surpassed the RAST and BASys softwares by 41 and 21% and 66 and 17% for gene name and function annotation, respectively, when there were reliable genome annotations of closely related species. PANNOTATOR provides fast and reliable pan-genome annotation; thereby allowing us to maintain the research focus on the main genotype differences between strains.

Expression of Gene Trios as Predictive Markers of Response to Doxorubicin Based Primary Chemotherapy in Breast Cancer Patients

Some studies have been carried out to identify a gene expression profile predictive of drug response in breast cancer patients and assessed the reproducibility of the model in an independent group of patients. In common, these studies have used the same technique already used to identify the panel of genes in a training set, to verify accuracy of the model in a validation set. We have previously identified through cDNA microarray technology gene trios whose expression was capable of predicting response to neoadjuvant chemotherapy based in doxorubicin and cyclophosphamide in breast cancer patients. We have now evaluated whether expression of these genes analyzed by real time RT-PCR, which represents a more accessible technique, would reproduce cDNA microarray results in separating responsive from non-responsive patients. Twenty eight samples, already studied by cDNA microarray, were analyzed as a technical validation group and subsequently, another 14 samples were evaluated, as a biological validation group. Expression of nine genes (defining five trio combinations, previously identified) was evaluated by RT-PCR in samples from the technical validation group, to define the separating plane, using linear discriminant analysis. Among the five trios, the best separation of tumors was conferred by RPL37A, XLHSRF-1 based trios (with NOTCH1 or NUP210, as third genes), which correctly classified 86% of samples from the technical validation group and 82% in a cross-validation analysis (leave-one-out). Next, samples from the biological validation group were spatially distributed using the pre-established features from these two trios, resulting in 71% correct classification. Additionally, other gene combinations were searched for a higher accuracy in discriminating response and expression of a new trio, RPL37A, SMYD2 and MTSS1, correctly classified 86% and 79% of samples from the technical validation (leave-one-out cross-validation) and the biological validation groups, respectively. Expression values evaluated by cDNA microarray and RT-PCR are reproducible, however they are not exactly the same as these methods are based on different technical principles and normalization approaches. Our data indicate that care should be taken when substituting techniques in an attempt to reproduce a model. In conclusion, expression of the gene trio RPL37A, SMYD2, MTSS1, as evaluated by RT-PCR, is a potential candidate as predictive marker of response to neoadjuvant chemotherapy in breast cancer patients.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2040.

The G6055A (G2019S) mutation in LRRK2 is frequent in both early and late onset Parkinson's disease and originates from a common ancestor

BACKGROUND

Mutations in the gene Leucine-Rich Repeat Kinase 2 (LRRK2) were recently identified as the cause of PARK8 linked autosomal dominant Parkinson's disease.

OBJECTIVE

To study recurrent LRRK2 mutations in a large sample of patients from Italy, including early (<50 years) and late onset familial and sporadic Parkinson's disease.

RESULTS

Among 629 probands, 13 (2.1%) were heterozygous carriers of the G2019S mutation. The mutation frequency was higher among familial (5.1%, 9/177) than among sporadic probands (0.9%, 4/452) (p<0.002), and highest among probands with one affected parent (8.7%, 6/69) (p<0.001). There was no difference in the frequency of the G2019S mutation in probands with early v late onset disease. Among 600 probands, one heterozygous R1441C but no R1441G or Y1699C mutations were detected. None of the four mutations was found in Italian controls. Haplotype analysis in families from five countries suggested that the G2019S mutation originated from a single ancient founder. The G2019S mutation was associated with the classical Parkinson's disease phenotype and a broad range of onset age (34 to 73 years).

CONCLUSIONS

G2019S is the most common genetic determinant of Parkinson's disease identified so far. It is especially frequent among cases with familial Parkinson's disease of both early and late onset, but less common among sporadic cases. These findings have important implications for diagnosis and genetic counselling in Parkinson's disease.

Early-onset parkinsonism associated with PINK1 mutations: frequency, genotypes, and phenotypes

OBJECTIVE

To assess the prevalence, nature, and associated phenotypes of PINK1 gene mutations in a large series of patients with early-onset (<50 years) parkinsonism.

METHODS

The authors studied 134 patients (116 sporadic and 18 familial; 77% Italian) and 90 Italian controls. The whole PINK1 coding region was sequenced from genomic DNA; cDNA was analyzed in selected cases.

RESULTS

Homozygous pathogenic mutations were identified in 4 of 90 Italian sporadic cases, including the novel Gln456Stop mutation; single heterozygous truncating or missense mutations were found in another 4 Italian sporadic cases, including two novel mutations, Pro196Leu and Gln456Stop. Pathogenic mutations were not identified in the familial cases. Novel (Gln115Leu) and known polymorphisms were identified with similar frequency in cases and controls. In cases carrying single heterozygous mutation, cDNA analysis detected no additional mutations, and revealed a major pathogenic effect at mRNA level for the mutant C1366T/Gln456Stop allele. All patients with homozygous mutations had very early disease onset, slow progression, and excellent response to l-dopa, including, in some, symmetric onset, dystonia at onset, and sleep benefit, resembling parkin-related disease. Phenotype in patients with single heterozygous mutation was similar, but onset was later.

CONCLUSIONS

PINK1 homozygous mutations are a relevant cause of disease among Italian sporadic patients with early-onset parkinsonism. The role of mutations found in single heterozygous state is difficult to interpret. Our study suggests that, at least in some patients, these mutations are disease causing, in combination with additional, still unknown factors.

Characterization of fibroblast cytoplasmic proteins that bind to the 3' UTR of human catalase mRNA

The excessive expression of catalase protein and its activity in cultured skin fibroblast from Zellweger Syndrome (ZS), a disorder of peroxisomal biogenesis, was found to be regulated at the translational level (J. Neurochem. 67: 2373-2378, 1996). Overall there is a considerable increase in the association of catalase mRNA with polysomes in ZS cell lines as compared to control indicating translational upregulation. To investigate the possibility that RNA-protein interactions are involved in the mediation of this increase in translation, the interaction between 3' untranslated region of human catalase mRNA and human fibroblast cytoplasmic proteins were investigated by RNA gel shift assay technique. Competition experiments demonstrated that all the 600 bases of 3' UTR (of human catalase gene) was required for efficient binding. Catalase RNA- protein interaction was sensitive to the altered redox state in these in vitro assays and this RNA-protein interaction could be enhanced by the addition of beta-mercaptoethanol in cytoplasm from control fibroblast but not in cytoplasm from ZS fibroblast. UV cross linked RNA-protein complexes on SDS polyacrylamide gel electrophoresis revealed the presence of at least four protein bands with approximate molecular masses of 38 kDa, 50 kDa, 66 kDa and 80 kDa. The potential role of these mRNA binding proteins in the regulation of catalase gene expression is discussed.

Lovastatin therapy for X-linked adrenoleukodystrophy: clinical and biochemical observations on 12 patients

X-linked adrenoleukodystrophy (X-ALD) is a progressive demyelinating disorder whose neurological signs and symptoms can manifest in childhood as cerebral ALD or in adulthood in the form of a progressive myelopathy (AMN). The consistent metabolic abnormality in all forms of X-ALD is an inherited defect in the peroxisomal beta-oxidation of very long chain (VLC) fatty acids (>C(22:0)) which may in turn lead to a neuroinflammatory process associated with demyelination of the cerebral white matter. The current treatment for X-ALD with Lorenzo's oil aims to lower the excessive quantities of VLC fatty acids that accumulate in the patients' plasma and tissues, but does not directly address the inflammatory process in X-ALD. We have previously demonstrated that lovastatin and other 3-HMG-CoA reductase inhibitors are capable of normalizing VLC fatty acid levels in primary skin fibroblasts derived from X-ALD patients. Lovastatin can block the induction of inducible nitric oxide synthase and proinflammatory cytokines in astrocytes, microglia, and macrophages in vitro. In a preliminary report, we demonstrated that lovastatin therapy can normalize VLC fatty acids in the plasma of patients with X-ALD. Here we report our clinical and biochemical observations on 12 patients with X-ALD who were treated with lovastatin for up to 12 months. Our results show that the high plasma levels of hexacosanoic acid (C(26:0)) showed a decline from pretreatment values within 1 to 3 months of starting therapy with 40 mg of lovastatin per day and stabilized at various levels during a period of observation up to 12 months. The percentage decline from pretreatment values varied and did not correlate with the type of ALD gene mutation (point mutation versus gene deletion). In 6 patients, in whom red cell membrane fatty acid composition was studied, a mean correction of 50% of the excess C(26:0) was observed after 6 months of therapy suggesting sustained benefit. In a few patients who discontinued lovastatin therapy plasma C(26:0) levels reverted to pretreatment values suggesting a cause and effect relationship between these events. Two patients dropped out of the study claiming no clinical benefit, 1 was withdrawn due to adverse effects, and an adult patient with cerebral involvement died during the study. A 10-year-old boy with severe cerebral involvement showed worsening of his neurological status. All patients with AMN remained neurologically stable or showed modest subjective improvement. All patients who did not have Addison's disease at the time of enrollment maintained normal adrenal function throughout the study. The implications of our findings for developing an effective therapy for X-ALD are discussed.

Involvement of sulfated proteoglycans in embryonic brain expansion at earliest stages of development in rat embryos

The expansive force generated by the positive pressure of the neural tube fluid confined inside the brain vesicles has been shown to be a key factor during the earliest stages of brain morphogenesis and development of chick embryos. In a previous study, we demonstrated the existence of an intracavity extracellular matrix rich in condroitin sulfate in this species, which could be involved in the regulation of the expansive process. In this report, scanning electron microscopy and immunohistochemistry show that, after neurulation, a similar extracellular matrix rich in chondroitin sulfate is present inside the brain vesicles of rat embryos during early enlargement of the brain anlage. In vitro treatment of rat embryos with beta-D-xyloside (a chemical compound which disrupts chondroitin sulfate synthesis) shows that changes in intralumen chondroitin sulfate concentration are accompanied by significant changes in brain anlage growth. These results support the hypothesis that intracerebral chondroitin sulfate plays a relevant role in the regulation of the expansive process of the brain anlage of rat embryos, and could represent a general mechanism in the early brain development of avian and mammalian embryos.

The use of hypothermia: a role in the treatment of neonatal asphyxia?

Perinatal asphyxia remains one of the most devastating neurologic processes. Although the understanding of the pathophysiology after perinatal asphyxia is extensive, there are few therapeutic interventions available to prevent or even mitigate the devastating process that unfolds after injury. The search for a safe and efficacious therapy has prompted scientists and clinicians to consider various promising therapies. One such therapy is therapeutic hypothermia. On the basis of adult, pediatric, and animal research, there is increasing evidence to suggest that therapeutic hypothermia may be an effective intervention to lessen the secondary neuronal injury that ensues after a hypoxic-ischemic insult. In this article the historic and modern-day uses of therapeutic hypothermia are first reviewed. The pathophysiology of neonatal asphyxia is examined next, with emphasis on the changes that occur when therapeutic hypothermia is implemented. Potential side-effects of the therapy in the neonate and the debate over systemic vs selective hypothermia are discussed. Lastly, although hypothermia as a potential treatment modality for neonates with hypoxic-ischemic encephalopathy is supported by numerous studies, the need for well-designed multicenter trials with detailed patient entry criteria and therapeutic conditions is emphasized.

Use of the pediatric symptom checklist in the pediatric neurology population

The purpose of this study was to evaluate the effectiveness of the Pediatric Symptom Checklist (PSC) as a mental health screening instrument in a busy pediatric neurology population in comparison with more lengthy, time-consuming assessment methods. One hundred two children were screened using the PSC. PSC results were compared with scores on the Child Behavior Checklist (CBCL), results from structured interviews, and ratings of adaptive functioning using the Children's Global Assessment Scale (CGAS). Thirty-nine of the patients (38%) scored 63 or above on the CBCL, indicating psychosocial impairment. Using a cutoff score of 22, the PSC correctly identified 35 of these 39 positive cases (sensitivity 89.7) and 48 of the 63 children with CBCL scores below 63 (specificity 76.2). CGAS scores were significantly negatively correlated with PSC scores (r = -0.60, P < 0.05). The PSC correctly identified 85.9% of children who scored 70 or below on the CGAS. Among the 53 children with psychiatric diagnoses on the basis of the interview, 41 scored above the cutoff of 22 on the PSC. Results suggest that the PSC is an efficient and accurate screen for identification of mental health problems in the pediatric neurology population.

Pilot study with a glutamine-supplemented enteral formula in critically ill infants

Seriously ill infants often display protein-calorie malnutrition due to the metabolic demands of sepsis and respiratory failure. Glutamine has been classified as a conditionally essential amino acid, with special usefulness in critical patients. Immunomodulation, gut protection, and prevention of protein depletion are mentioned among its positive effects in such circumstances. With the intent of evaluating the tolerance and clinical impact of a glutamine supplement in seriously ill infants, a prospective randomized study was done with nine patients. Anthropometric and biochemical determinations were made, and length of stay in the intensive care unit (ICU), in the hospital, and under artificial ventilation, and septic morbidity and mortality were tabulated. Infants in the treatment group (n = 5) were enterally administered 0.3 g/kg of glutamine, whereas controls received 0.3 g/kg of casein during a standard period of five days. Septic complications occurred in 75% of the controls (3/4) versus 20% of the glutamine-treated group (1/5, p < or = 0.10), and two patients in the control group died of bacterial infections (50% vs. 0%, p < or = 0.10). Days in the ICU, in the hospital, and with ventilation numerically favored glutamine therapy, although without statistical significance. The supplements were usually well tolerated, and no patient required discontinuation of the program. The conclusion was that glutamine supplementation was safe and tended to be associated with less infectious morbidity and mortality in this high-risk population.

Disruption of proteoglycans in neural tube fluid by beta-D-xyloside alters brain enlargement in chick embryos

Following neurulation, the anterior end of the neural tube undergoes a dramatic increase in size due mainly to the enlarging of the brain cavity. This cavity is filled with so-called neural tube fluid (NTF), whose positive pressure has been shown to play a key role in brain morphogenesis. This fluid contains a water-soluble matrix, rich in chondroitin sulfate (CS), which has been proposed as an osmotic regulator of NTF pressure genesis. The purpose of the present study is to observe the influence of CS on NTF osmolality and its relation to NTF hydrostatic pressure and brain expansion. NTF was obtained by means of microaspiration from the mesencephalic cavity of chick embryos. The osmolality of NTF between H.H. stages 20 and 29 was measured on the basis of its cryoscopic point. CS synthesis was disrupted by using beta-D-xyloside and the induced variations in brain volume were measured by means of morphometry. We also measured the variations in NTF osmolality, hydrostatic pressure, and the concentration of CS and sodium induced by means of beta-D-xyloside. Our data reveal that, at the earliest stages of development analyzed, variations in NTF osmolality show a characteristic pattern that coincides with the developmental changes in the previously described fluid pressure. Chick embryos treated with beta-D-xyloside, a chemical that disrupts CS synthesis, displayed a notable increase in brain volume but no other apparent developmental alterations. Morphometric analysis revealed that this increase was due to hyperenlargement of the brain cavity. Beta-D-xyloside brings about specific changes in the biochemical composition of NTF, which entails a large increase in CS concentration, mainly in the form of free chains, and in that of sodium. As a result, the fluid's osmolality and brain intraluminal pressure increased, which could account for the increase in size of the brain anlage. These data support the hypothesis that the intraluminal pressure involved in embryonic brain enlargement is directly dependent on NTF osmolality, and that the concentrations of CS and its associated microions could play a key role in the regulation of this process.

Restoration of phytanic acid oxidation in Refsum disease fibroblasts from patients with mutations in the phytanoyl-CoA hydroxylase gene

Refsum disease (RD) is biochemically characterized by the excessive accumulation of phytanic acid in tissues and body fluids due to deficiency of phytanoyl-CoA hydroxylase (PAHX). In this study, we screened three RD patients and identified a novel deletion (88 amino acids), and a missense mutation (Arg275Trp) in the previously reported PAHX cDNA (Jansen et al., 1997; Mihalik et al., 1997). Moreover, transfection of skin fibroblasts from two RD patients with wild-type PAHX gene restored the activity for alpha-oxidation of phytanic acid. Southern analysis on a somatic cell hybrid panel detected the PAHX gene on chromosome 10, corroborating radiation hybrid and homozygosity mapping data (Mihalik et al., 1997; Nadal et al., 1995).

Abnormality in catalase import into peroxisomes leads to severe neurological disorder

Peroxisomal disorders are lethal inherited diseases caused by either defects in peroxisome assembly or dysfunction of single or multiple enzymatic function(s). The peroxisomal matrix proteins are targeted to peroxisomes via the interaction of peroxisomal targeting signal sequences 1 and 2 (PTS1 or PTS2) with their respective cytosolic receptors. We have studied human skin fibroblast cell lines that have multiple peroxisomal dysfunctions with normal packaging of PTS1 and PTS2 signal-containing proteins but lack catalase in peroxisomes. To understand the defect in targeting of catalase to peroxisomes and the loss of multiple enzyme activities, we transfected the mutant cells with normal catalase modified to contain either PTS1 or PTS2 signal sequence. We demonstrate the integrity of these pathways by targeting catalase into peroxisomes via PTS1 or PTS2 pathways. Furthermore, restoration of peroxisomal functions by targeting catalase-SKL protein (a catalase fused to the PTS1 sequence) to peroxisomes indicates that loss of multiple functions may be due to their inactivation by H2O2 or other oxygen species in these catalase-negative peroxisomes. In addition to enzyme activities, targeting of catalase-SKL chimera to peroxisomes also corrected the in situ levels of fatty acids and plasmalogens in these mutant cell lines. In normal fibroblasts treated with aminotriazole to inhibit catalase, we found that peroxisomal functions were inhibited to the level found in mutant cells, an observation that supports the conclusion that multiple peroxisomal enzyme defects in these patients are caused by H2O2 toxicity in catalase-negative peroxisomes. Moreover, targeting of catalase to peroxisomes via PTS1 and PTS2 pathways in these mutant cell lines suggests that there is another pathway for catalase import into peroxisomes and that an abnormality in this pathway manifests as a peroxisomal disease.

Local increase level of chondroitin sulfate induces changes in the rhombencephalic neural crest migration

Numerous studies suggest that chondroitin sulfate proteoglycan (CSPG) inhibits neural crest cells (NCC) migration at the trunk level. However, its action on the cephalic neural crest is not clear. To determine this action, we have microinjected 0.5 nl of different concentrations of chondroitin sulfate (CS) at the anterior rhombencephalon level in 9 stage chick embryos, as well as subgerminally administering beta-D-xyloside to 8 stage chick embryos. Beta-D-xyloside disrupts CSPG synthesis, producing an increase in CS free chains in several embryonal anlages. Chondroitin sulfate microinjected embryos and beta-D xyloside treated embryos were reincubated until attaining 12 stage. Results obtained for both experimental groups were similar. Immunoreactivity with HNK-1 antibody revealed that NCC did not migrate, remaining near the rhombencephalon dorsal wall; in addition, several NCC did not separate from the neural fold, becoming invaginated towards the rhombencephalon cavity. Our findings indicate that an increase in CS free chains in cephalic neural crest migratory routes not only disrupts their migration, but also impedes delamination and detachment of the rhombencephalic neuroepithelium NCC. These data suggest that the inhibitory action upon the neural crest migration attributed to CSPG may rest on its glycosaminoglycan (GAG). We cannot, however, rule out the possibility that increases in other GAGs apart from CS, may produce similar effects on neural crest migration.

Major co-localization of the extracellular-matrix degradative enzymes heparanase and gelatinase in tertiary granules of human neutrophils

The expression of cell-surface adhesion proteins and the release of extracellular-matrix degradative enzymes constitute crucial processes for the attachment of neutrophils to the endothelium and for the subsequent extravasation of these cells through the endothelial layer. We have analysed in resting human neutrophils the subcellular localization of heparanase, a heparan-sulphate-degrading endoglycosidase that can degrade basement-membrane components, thereby facilitating neutrophil passage into the tissue during an inflammatory reaction. By subcellular fractionation of postnuclear supernatants from resting human neutrophils on continuous sucrose gradients, we have found that heparanase activity was mainly located in gelatinase-containing tertiary granules. Using a specific antibody, the 96-kDa heparanase protein was further located in the gelatinase-rich subcellular fractions. Following immunoblotting and immunoprecipitation analysis in the distinct subcellular fractions, we also found co-localization of heparanase and Mo1 (CD11b/CD18), a leucocyte integrin involved in the attachment of neutrophils to the endothelium, in the fractions enriched in gelatinase-containing tertiary granules. Treatment of human neutrophils with tumour necrosis factor or granulocyte/macrophage colony-stimulating factor induced an increase in the CD11b/CD18 cell-surface expression, as well as the release of both gelatinase (matrix metalloproteinase-9) and heparanase, but not of other granule markers, indicating a major co-localization of gelatinase, heparanase and CD11b/CD18 in the same organelle. Furthermore, confocal laser scanning microscopy using specific antibodies against gelatinase and heparanase revealed a major co-localization of both enzymes in intracellular cytoplasmic granules. The major localization of heparanase and CD11b/CD18 in the gelatinase-containing tertiary granule supports the notion that mobilization of this organelle can regulate extravasation of human neutrophils.

Molecular cloning and sequencing of human palmitoyl-CoA ligase and its tissue specific expression

A complimentary DNA clone encoding the entire human palmitoyl-CoA ligase has been isolated from a liver cDNA library and sequenced in it's entirety. The predicted product is a 699 amino acid protein. Southern analysis utilizing the human palmitoyl-CoA ligase gene as a probe revealed varying degrees of similarity amongst various mammalian species. The palmitoyl-CoA ligase gene is highly expressed in liver, heart, skeletal muscle and kidney, and to a lesser extent in brain, lung, placenta and pancreas. The expression of palmitoyl-CoA ligase in various tissue parallels the function of this enzyme in the metabolism of fatty acids in these tissues.

Genetic and biochemical normalization in female carriers of Duchenne muscular dystrophy: evidence for failure of dystrophin production in dystrophin-competent myonuclei

We studied 19 symptomatic female carriers of the Duchenne muscular dystrophy (DMD) gene. Most of these dystrophinopathy patients had had an erroneous or ambiguous diagnosis prior to dystrophin immunofluorescence testing. We assessed clinical severity by a standardized protocol, measured X-chromosome inactivation patterns in blood and muscle DNA, and quantitated the dystrophin protein content of muscle. We found that patients could be separated into two groups: those showing equal numbers of normal and mutant dystrophin genes in peripheral blood DNA ("random" X-inactivation), and those showing preferential use of the mutant dystrophin gene ("skewed" X-inactivation). In the random X-inactivation carriers, the clinical phenotype ranged from asymptomatic to mild disability, the dystrophin content of muscle was > 60% of normal, and there were only minor histopathologic changes. In the skewed X-inactivation patients, clinical manifestations ranged from mild to severe, but the patients with mild disease were young (5 to 10 years old). The low levels of dystrophin (< 30% on average) and the severe symptoms of the older patients suggested a poor prognosis for those with skewed X-inactivation, and they all showed morphologic changes of dystrophy. The random inactivation patients showed evidence of biochemical "normalization," with higher dystrophin content in muscle than predicted by the number of normal dystrophin genes. Seventy-nine percent of skewed X-inactivation patients (11/14) showed genetic "normalization," with proportionally more dystrophin-positive nuclei in muscle than in blood. In 65% of the skewed X-inactivation patients, dystrophin was not produced by dystrophin-positive nuclei; an average of 20% of myofiber nuclei were genetically dystrophin-positive but did not produce stable dystrophin. Biochemical normalization seems to be the main mechanism for rescue of fibers from dystrophin deficiency in the random X-inactivation patients. In the skewed X-inactivation patients, genetic normalization is active, but production failure of dystrophin by dystrophin-normal nuclei may counteract any effect of biochemical normalization. In the skewed X-inactivation patients, the remodeling of the muscle through cycles of degeneration and regeneration led to threefold increase in the number of dystrophin-competent nuclei in muscle myofibers (3.3 +/- 4.6), while dystrophin content was on the average 1.5-fold less then expected (-1.54 +/- 3.38). Our results permit more accurate prognistic assessment of isolated female dystrophinopathy patients and provide important data with which to estimate the potential effect of gene delivery (gene therapy) in DMD.

Calpain expression in lymphoid cells. Increased mRNA and protein levels after cell activation

Although calpain is ubiquitously present in human tissues and is thought to play a role in demyelination, its activity is very low in resting normal lymphocytes. To determine the nature of calpain expression at the mRNA and protein levels in human lymphoid cells, we studied human T lymphocytic, B lymphocytic, and monocytic lines as well as peripheral blood mononuclear cells. Stimulation of cells with the phorbol ester phorbol myristate acetate and the calcium ionophore A23187 resulted in increased calpain mRNA and protein expression. Calpain mRNA expression is also increased in human T cells stimulated with anti-CD3. A dissociation between the increases of RNA and protein suggested that calpain could be released from the cells; the subsequent experiments showed its presence in the extracellular environment. 5,6-Dichloro-1b-D-ribofuranosylbenzimidazole, a reversible inhibitor of mRNA synthesis, reduced calpain mRNA levels by 50-67% and protein levels by 72-91%. Its removal resulted in resumption of both calpain mRNA and protein synthesis. Cycloheximide, a translational inhibitor, reduced calpain protein levels by 77-81% and calpain mRNA levels by 96% in activated THP-1 cells. Interferon-gamma induced calpain mRNA and protein in U-937 and THP-1 cells. Dexamethasone increased mRNA expression in THP-1 cells. Our results indicate that activation of lymphoid cells results in de novo synthesis and secretion of calpain.

Refsum disease: a defect in the alpha-oxidation of phytanic acid in peroxisomes

The oxidation of phytanic acid to pristanic acid was previously demonstrated to be deficient in monolayer cultures of skin fibroblasts (Herndon et al. 1969. J. Clin. Invest. 48: 1017-1032). However, identification of subcellular organelle with deficient enzyme activity has not been established. To define the subcellular organelle with deficient enzyme activity in the catabolism of phytanic acid, we measured the oxidation of [1-14C] phytanic acid to 14CO2 and pristanic acid in different subcellular organelles isolated from cultured skin fibroblasts from control and Refsum patients. The rates of oxidation of phytanic acid in peroxisomes, mitochondria, and endoplasmic reticulum were 37.1 +/- 2.65, 1.9 +/- 0.3, and 0.4 +/- 0.07 pmol/h per mg protein, respectively, from control fibroblasts. The phytanic acid oxidation activity in mitochondria (2.04 +/- 0.7 pmol/h per mg protein) and endoplasmic reticulum (0.43 +/- 0.2 pmol/h per mg protein) from Refsum fibroblasts was similar to control fibroblasts. However, phytanic acid oxidation in peroxisomes from Refsum fibroblasts was not detected at all the protein concentrations tested. On the other hand, the peroxisomes from Refsum fibroblasts had normal rates of activation and oxidation of palmitic and lignoceric acids, suggesting that the peroxisomes isolated from Refsum fibroblasts were metabolically active. The phytanoyl-CoA ligase, the first enzyme in the alpha-oxidation pathway, had activity similar to that in peroxisomes from control (9.86 +/- 0.09 nmol/h per mg protein) and Refsum (10.25 +/- 0.31 nmol/h per mg protein) fibroblasts. The data described here clearly demonstrate that pathognomonic accumulation of phytanic acid in patients with Refsum disease is due to the deficient activity of peroxisomal alpha-oxidation enzyme system.

Retinoic acid induces changes in the rhombencephalic neural crest cells migration and extracellular matrix composition in chick embryos

Chick embryos at 9-10 stages (Hamburger and Hamilton: J Morphol 88:49-82, 1951) have been treated with all-trans retinoid acid (RA) (0.5 microgram, 1.5 micrograms, and 2.5 micrograms) to determine the pattern and mechanism of RA-induced effects on early cephalic development. We found that while 0.5 microgram RA did not produce any significant dysmorphogenesis, 2.5 micrograms RA elicited wide malformation of both cephalic and trunk regions. However, 1.5 micrograms RA produced selective and specific changes at the cephalic level, which consisted of morphological alterations, changes in neural crest cells (NCC) migration and extracellular matrix (ECM) composition. Morphological alterations included hypoplasia of the first three branchial arches, swelling of either anterior cardinal veins or dorsal aortae, and atrophy of branchial arch arteries. Concurrently NCC did not migrate away, remaining clustered on the dorsal surface of the rhombencephalon, and in some cases they shifted into the neural tube cavity. Accordingly, the second branchial arch showed a reduction of the mesenchymal cellular population. The extracellular matrix in RA-injected embryos showed changes in glycosaminoglycans (GAGs) concentration as compared with controls, that is, an increase in the non-sulphated GAGs, stained with alcian blue 8GX at 2.5 pH, and a decrease in the sulphated GAGs stained with alcian blue 8GX at 1 pH. These quantitative changes reflected alterations in the pattern of distribution and composition of the GAGs within the cephalic ECM, which specifically consisted in an increase of the hyaluronic acid and a decrease of the chondroitin sulphate. Our findings indicate that RA is involved in abnormal cephalic development, suggesting that RA may effect neural crest cell migration via changes in the GAGs of the ECM.

Morphological study by scanning electron microscopy of the lingual papillae in the common European bat (Pipistrellus pipistrellus)

There are many accounts of the tongues of mammals observed with scanning electron microscopy (SEM), but apparently only one article about the tongue of the Chiroptera. In the present study the tongue surface (after removing extracellular material) of the European common bat (Pipistrellus pipstrellus) was examined. The tongue is covered with papillae and has an elevation between its medial and posterior half. There are three types of papillae: filiform, fungiform and circumvallate, and the filiform can be classified as strictly filiform, conical and crown-like. The shapes and disposition of these papillae are related to function, which is principally to retain captured food during flight. At higher magnification the surface of the filiform papillae has many pores and microridges, which may serve for the production and distribution of mucus over the papillary surface.