Constructing an ELISA for Detection of Anti-Borrelia in Wildlife and Agricultural Animals

Zoonotic diseases have major impacts on human and animal health, as well as being ecologically significant. Lyme Borreliosis or Lyme disease, caused by infection by pathogenic members of the Borrelia genus, is among these zoonotic diseases. Serology is one of the most accessible means for indirect surveillance of pathogen presence by monitoring the presence, abundance, and type of immune response to the pathogen or pathogen-associated epitopes. Serological surveillance of wild animals is important as wild animals are the primary reservoirs of many zoonotic diseases. Similarly, serological surveillance of agricultural animals is important due to their economic importance, in addition to animal welfare concerns. However, serology in any non-model animal such as wildlife or agricultural animals is difficult because serology necessarily relies on blood samples from the animals being tested. While companion or laboratory animals are generally sufficiently accustomed to humans that blood samples can be obtained, obtaining blood samples from wild or agricultural animals is more challenging. This initial challenge is compounded by the absence of validated serological tools to evaluate antibody titres in the sera. In this chapter, we provide methods for constructing an ELISA for the detection of anti-Borrelia antibodies in non-model animals, using studies on horses and cows as a proof of principle. The methods focus on the problems specific to non-model animals including obtaining sera, options for determining positive and negative controls without the ability to perform controlled infections, and methods for test optimization and validation.

Spinach latent virus Infecting Tomato in Virginia, United States

Plants in a single field of commercial tomato (Solanum lycopersicum) of unidentified cultivars in Virginia in July, 2012, were observed showing stunting, leaf distortion, twisting and thickening, discoloration, and color streaking and ringspots on fruits. Serological tests were negative for Cucumber mosaic virus, Groundnut ringspot virus, Tomato spotted wilt virus, Tomato chlorotic spot virus, Impatiens necrotic spot virus, Tobacco mosaic virus, and Tomato bushy stunt virus (Agdia, Inc., Elkhart, IN). Using a membrane-based macroarray (3), hybridization was observed to 8 of 9 70-mer oligonucleotide probes of Spinach latent virus (SpLV; genus Ilarvirus, family Bromoviridae). To confirm the hybridization results, complementary DNA (cDNA) was synthesized using random hexamers and MMLV reverse transcriptase (Promega, Madison, WI), followed by PCR amplification using ilarvirus degenerate primers (4). Fragments of approximately 380 bp were amplified and directly sequenced (GenBank Accession KC_466090); a BLAST search showed a 99% identity to the SpLV RNA 2 reference genome (NC_003809). Primers for SpLV RNA1 (SpLVRNA1f-GGTGTCACCATGCAAACTGG, SpLVRNA1r-AGCTCTTCGTAATAGGCCTGC) and SpLV RNA3 (SpLVCPf-GAAGTCTTTCCCAGGTGAGCA, SpLVCPr-AGGTGGGCATATGGACTTGG) were designed and cDNA was amplified using the IQ supermix (Biorad, Hercules, CA) with thermocycling of 94°C for 4 min, 35× (94°C 45 s, 55°C 45 s, 72°C 45 s), and 72°C for 10 min. The resulting fragments of 538 bp for RNA1 (KC_466088) and 661 bp for RNA3 (KC_466089) showed 100% identity to reference genome sequences for SpLV (NC_003808 and NC_003810, respectively). To demonstrate virus transmissibility, Chenopodium quinoa plants were mechanically inoculated using tomato leaf material (same source described above) ground in 30 mM Na₂HPO₄ buffer, pH 7.0. Necrotic spots developed on the inoculated leaves 10 dpi. Younger, non-inoculated leaves showed yellow mottling and tested positive for SpLV by RT-PCR (two of two plants tested). The detection of SpLV is rarely reported, with only one record from the United States (2). Although SpLV is described as a latent virus, it has been found associated with tomato fruit symptoms in New Zealand (1). It is not known if the fruit ringspot and other symptoms on the Virginia samples were due to virus infection. Since SpLV is seed-transmissible and seed production takes place in different parts of the world, it has the potential to spread with germplasm and become more widespread in North America. References: (1) B. S. M. Lebas et al. Plant Dis. 91:228, 2007. (2) H. Y. Liu and J. E. Duffus. Phytopathology 76:1087, 1986. (3) K. L. Perry and X. Lu. Phytopathology 100:S100, 2010. (4) M. Untiveros, et al. J. Virol. Methods 165:97, 2010.

First Report of Puccinia emaculata Infection on Switchgrass in Virginia

During the spring of 2007, approximately 2,000 switchgrass plants, representing 168 core switchgrass germplasm, were established in a field nursery at the Virginia Tech Kentland Farm Research Center in Montgomery County, VA. These germplasms were originally obtained from the USDA Plant Genetic Resources Conservation Unit (Griffin, GA) and included both lowland and upland ecotypes. After planting, the switchgrass plants were allowed to establish for 3 years. In the summers of 2009, 2010, and 2011, a substantial infection of a foliar rust pathogen was observed on more than 90% of switchgrass lines in the field. The infected leaves had dark brown pustules that were arranged in a linear fashion between the veins and mainly located on the adaxial surface of the leaf. We observed the infected leaf samples under a microscope and isolated the urediniospores. The urediniospores were brown, round, and averaged 26.08 ± 1.67 μm long and 24.65 ± 1.66 μm wide. Teliospores were observed late in the summers of 2009 and 2010. The teliospores were two-celled, oblong to ellipsoid in shape, and averaged 32.23 ± 3.07 μm in length. The apical cell width averaged 17.6 ± 1.83 μm and the basal cell width averaged 15.08 ± 1.75 μm. The morphology of both the urediniospores and teliospores were similar to Puccinia emaculata Schw. (P. emaculata) (2,3). Using previously established rust disease scoring methods (1), the infected switchgrass lines were evaluated and scored for infection severity on a 0 to 9 scale based on the percentage of leaf area infected, with 0 being either highly resistant or escaping infection and 9 being highly susceptible. The majority of upland switchgrass cultivars, including Caddo, Cave-in-rock, Blackwell, Sunburst, Pathfinder, and Dacotah, were moderately to highly susceptible to this rust pathogen and on average, scored between 7 and 8. However, the majority of lowland switchgrass cultivars, including Alamo, Kanlow, TEM-SEC, TEM-SLC, and TEM-LoDorm, were moderately to highly resistant and scored on average between 3 and 4. This result is consistent with previous reports that show that lowland ecotypes are more resistant to rust diseases (1). To further validate the identity of the rust pathogen, we designed two primers (5'-CCAGTAACGGCGAGTGAAGAG-3' and 5'-CGACTTCCATGGCCACCGTGCGGCTGTCT-3') based on the 18S rDNA sequence of P. emaculata (3). DNA was extracted from bulk infected leaf material for PCR amplification. The 1.2 kb PCR product was isolated and sent for DNA sequencing. The DNA sequence was 98% identical to the 18S rDNA sequence of P. emaculata (EU915294.1). To our knowledge, this study represents the first report of rust on a wide range of various switchgrass cultivars in Virginia. References: (1) D. M. Gustafson et al. Crop Sci. 43:755, 2003. (2) R. L. Hirsch et al. Plant Dis. 94:381, 2010. (3) J. Zale et al. Plant Dis. 92:1710, 2008.

An evaluation of scrapie surveillance in the United States

Animal health surveillance systems should reflect national disease control priorities and promote the best use of public resources by maximizing effectiveness and efficiency. A surveillance system should be routinely evaluated to assess the degree to which the system accomplishes these goals, fulfills its stated objectives, and meets accepted surveillance standards. In the United States, there are a number of disparate endemic disease surveillance and eradication programs. The National Animal Health Surveillance System is a federal initiative designed to combine animal health surveillance and monitoring activities into a comprehensive and coordinated system. A protocol has been developed to facilitate the evaluation of animal health surveillance systems and investigate opportunities for coordination between the different surveillance and eradication programs. The evaluation protocol was based largely on protocols developed for public health but adapted for the specific needs and goals of animal health surveillance. The evaluation process was designed to identify program strengths and areas for improvement and facilitate the system's adaptability to changing situations. The evaluation protocol was applied to the scrapie surveillance system in the United States; scrapie surveillance was found to be an important part of surveillance for transmissible spongiform encephalopathies. Results from the evaluation of sensitivity, sampling methods and representativeness are presented.

Application of broken-line analysis to assess floor space requirements of nursery and grower-finisher pigs expressed on an allometric basis1

Few issues in swine production are as complex as floor space allowances. One method for pork producers to calculate floor space allowance (A) is to convert BW into a 2-dimensional concept yielding an expression of A = k * BW(0.667). Data on ADG, ADFI, and G:F were obtained from published peer-reviewed studies. Five data sets were created: A = grower-finisher pigs, fully slatted floors, and consistent group size; B = grower-finisher pigs and fully slatted floors (group size did not need to be consistent); C = grower-finisher pigs, partially slatted floors, and consistent group size; D = grower-finisher pigs, partially slatted floors (group size did not need to be consistent); and E = nursery pigs, fully slatted or woven wire floors (group size did not need to be consistent). Each data set was analyzed using a broken-line analysis and a linear regression. For the broken-line analyses, the critical k value, below which a decrease in ADG occurred, varied from 0.0317 to 0.0348. In all cases the effect of space allowance on ADG was significant (P < 0.05). Using the linear analyses based on data with k values of < 0.030, the critical k values for the 4 grower-finisher data sets did not differ from those obtained using the broken-line analysis (0.0358 vs. 0.0336, respectively; P > 0.10); however, none of the linear regressions explained a significant proportion of the variation in ADG. The slopes for the nonplateau portion of the broken-line analyses based on percent values varied among data sets. For every 0.001 decrease in k (approximately 3% of the critical k value), ADG decreased by 0.56 to 1.41%, with an average value of 0.98% for the 5%-based analyses. The use of an allometric approach to express space allowance and broken-line analysis to establish space requirements seem to be useful tools for pig production. The critical k value at which crowding becomes detrimental to the growth of the pig is similar in full- and partial-slat systems and in nursery and grower-finisher stages. The critical point for crowding determined in these analyses approximated current recommendations to ensure the welfare of pigs.

Insulin-sensitizing effect of rosiglitazone (BRL-49653) by regulation of glucose transporters in muscle and fat of Zucker rats

Thiazolidinediones (TZDs), a class of antidiabetic agents, are specific agonists of peroxisome proliferator activator receptor (PPARgamma). However, their mechanisms of action, and the in vivo target tissues that mediate insulin sensitization are not well understood. The aim of this study was to investigate the role of glucose transporters (GLUT-1 and GLUT-4) in the TZD insulin-sensitizer action. The effects of rosiglitazone treatment were studied using Zucker (fa/fa) rats after 7 days of oral dosing (3.6 mg/kg/d). Rosiglitazone lowered (approximate 80%) basal plasma insulin levels in obese rats and substantially corrected (approximately 50%) insulin resistance based upon results from hyperinsulinemic euglycemic clamp studies. GLUT-4 protein levels were reduced (approximately 75%) in adipose tissue of obese rats and treatment with rosiglitazone normalized them. Interestingly, GLUT-1 protein content was increased in adipose tissue ( thick approximate 150%) and skeletal muscle (approximately 50%) of obese rats and treatment with rosiglitazone increased it even more by 5.5-fold in fat and by 2.5-fold in muscle. Consistent with these results, basal (GLUT-1-mediated) transport rate of 3-O-methyl-D-glucose into isolated epitrochlearis muscle was elevated in response to rosiglitazone. Incubation of fully differentiated 3T3-L1 adipocytes with the drug for 7 days increased the levels of GLUT-1 protein, but did not affect GLUT-4 levels. In conclusion, rosiglitazone may improve insulin resistance in vivo by normalizing GLUT-4 protein content in adipose tissue and increasing GLUT-1 in skeletal muscle and fat. While the drug has a direct effect on GLUT-1 protein expression in vitro without a direct effect on GLUT-4 suggests that direct and indirect effects of rosiglitazone on glucose transporters may have an important role in improving insulin resistance in vivo.

The use of human touch to improve the well-being of older adults. A holistic nursing intervention

Touch and massage are viable nursing modalities that are both underutilized and understudied. This underuse of touch is especially noted in settings aimed at improving the well-being of older adults. A number of studies suggest that the appropriate use of touch by nurses has the potential to significantly improve the health status of older adults. In particular, touch can be useful with cognitively impaired, institutionalized, or hospitalized older adults. Likewise, touch can be useful for improving comfort and communication among terminally ill older adults and their loved ones. This article synthesizes some of the available literature on the subject while suggesting avenues for nursing practice and education aimed at using touch as a viable and cost-effective holistic gerontological nursing intervention.

Psychological and physiological factors associated with tilt table testing for neurally mediated syncopal syndromes

This study investigated psychological and physiological factors in two groups of patients who had tilt table testing for autonomic dysfunction. The first group of 61 patients completed assessments of depression, anxiety, and symptom effects on lifestyle. The 25 patients identified as tilt positive were younger (30.5 years) and had higher mean depression scores (7.6) compared to the tilt-negative response group (n = 36); the latter averaged 40 years of age and had mean depression scores of 4.6. These differences were statistically significant. Women testing tilt positive were significantly more depressed than tilt-negative women (P = 0.02). More severe depressive symptoms were associated with lower blood pressure (BP) (P < 0.05). A second group of 52 patients was monitored during tilt for BP, heart rate (HR), skin temperature (TEMP), skin conductance level (SCL), and forehead muscle tension (EMG). Twenty-seven tested positive and 23 were negative. There were statistically significant group differences in systolic BP and diastolic BP (P < 0.05). There was a significant interaction between tilt status (positive or negative) and time (P = 0.03) in HR. TEMP increased 2 degrees over time in both groups (P < 0.05). The decrease in SCL from 13.7 to 10.4 mu omega in the tilt-positive response group compared to the slight increase in the tilt-negative group was significantly different (P < 0.05). Identification of psychological factors correlated with BP and physiological changes that accompany decreases in BP in tilt-positive response patients could guide management of patients with autonomic dysfunction.

CC chemokine receptor 2 is required for macrophage infiltration and vascular hypertrophy in angiotensin II-induced hypertension

Recent studies have identified the presence of macrophages in the arterial wall of hypertensive animals and suggested that as is the case in atherosclerosis, macrophage products may be important mediators of the adaptive response of the arterial wall. In support of this, we have previously shown that the expression of monocyte chemoattractant protein-1 is upregulated in the arteries of hypertensive animals. We hypothesized that macrophage recruitment is a critical step in the pathogenesis of hypertension. To obtain insights into this potential mechanism, we made use of mice deficient in the CC chemokine receptor 2 (CCR2), the receptor for monocyte chemoattractant protein-1. Hypertension was induced with the subcutaneous administration of angiotensin II (0.75 mg. kg(-1). d(-1)) for 7 days. Using in situ hybridization with a probe for c-fms to identify macrophages, we found that hypertension-induced macrophage infiltration of the arterial wall was virtually eliminated in CCR2-deficient mice. In addition, vascular hypertrophy was reduced by approximately 65% compared with wild-type animals. These data demonstrate that CCR2 is essential for the recruitment of macrophages into the arterial wall in the setting of hypertension. Furthermore, the decreased hypertrophic response suggests that vascular hypertrophy occurs in part as a consequence of macrophage infiltration. In angiotensin II-induced hypertension, CCR2-mediated responses are critical to the process of macrophage recruitment and vascular hypertrophy and may represent one mechanism by which at least some forms of hypertension may lead to the development of atherosclerosis.

A human capecitabine excretion balance and pharmacokinetic study after administration of a single oral dose of 14C-labelled drug

An excretion balance and pharmacokinetic study was conducted in cancer patients with solid tumors who received a single oral dose of capecitabine of 2000 mg including 50 microCi of 14C-radiolabelled capecitabine. Blood, urine and fecal samples were collected until radioactive counts had fallen to below 50 dpm/mL in urine, and levels of intact drug and its metabolites were measured in plasma and urine by LC/MS-MS (mass spectrometry) and 19F-NMR (nuclear magnetic resonance) respectively. Based on the results of the 6 eligible patients enrolled, the dose was almost completely recovered in the urine (mean 95.5%, range 86-104% based on radioactivity measurements) over a period of 7 days after drug administration. Of this, 84% (range 71-95) was recovered in the first 12 hours. Over this time period, 2.64% (0.69-7.0) was collected in the feces. Over a collection period of 24-48 h, a total of 84.2% (range 80-95) was recovered in the urine as the sum of the parent drug and measured metabolites (5'-DFCR, 5'-DFUR, 5-FU, FUH2, FUPA, FBAL). Based on the radioactivity measurements of drug-related material, absorption is rapid (tmax 0.25-1.5 hours) followed by a rapid biphasic decline. The parent drug is rapidly converted to 5-FU, which is present in low levels due to the rapid metabolism to FBAL, which has the longest half-life. There is a good correlation between the levels of radioactivity in the plasma and the levels of intact drug and the metabolites, suggesting that these represent the most abundant metabolites of capecitabine. The absorption of capecitabine is rapid and almost complete. The excretion of the intact drug and its metabolites is rapid and almost exclusively in the urine.

Bioequivalence of two tablet formulations of capecitabine and exploration of age, gender, body surface area, and creatinine clearance as factors influencing systemic exposure in cancer patients

PURPOSE

The objective of the study was to assess the bioequivalence of two tablet formulations of capecitabine and to explore the effect of age, gender, body surface area and creatinine clearance on the systemic exposure to capecitabine and its metabolites.

METHODS

The study was designed as an open, randomized two-way crossover trial. A single oral dose of 2000 mg capecitabine was administered on two separate days to 25 patients with solid tumors. On one day, the patients received four 500-mg tablets of formulation B (test formulation) and on the other day, four 500-mg tablets of formulation A (reference formulation). The washout period between the two administrations was between 2 and 8 days. After each administration, serial blood and urine samples were collected for up to 12 and 24 h, respectively. Unchanged capecitabine and its metabolites were determined in plasma using LC/MS-MS and in urine by NMRS.

RESULTS

Based on the primary pharmacokinetic parameter, AUC(0-infinity) of 5'-DFUR, equivalence was concluded for the two formulations, since the 90% confidence interval of the estimate of formulation B relative to formulation A of 97% to 107% was within the acceptance region 80% to 125%. There was no clinically significant difference between the t(max) for the two formulations (median 2.1 versus 2.0 h). The estimate for C(max) was 111% for formulation B compared to formulation A and the 90% confidence interval of 95% to 136% was within the reference region 70% to 143%. Overall, these results suggest no relevant difference between the two formulations regarding the extent to which 5'-DFUR reached the systemic circulation and the rate at which 5'-DFUR appeared in the systemic circulation. The overall urinary excretions were 86.0% and 86.5% of the dose, respectively, and the proportion recovered as each metabolite was similar for the two formulations. The majority of the dose was excreted as FBAL (61.5% and 60.3%), all other chemical species making a minor contribution. Univariate and multivariate regression analysis to explore the influence of age, gender, body surface area and creatinine clearance on the log-transformed pharmacokinetic parameters AUC(0-infinity) and C(max) of capecitabine and its metabolites revealed no clinically significant effects. The only statistically significant results were obtained for AUC(0-infinity) and C(max) of intact drug and for C(max) of FBAL, which were higher in females than in males.

CONCLUSION

The bioavailability of 5'-DFUR in the systemic circulation was practically identical after administration of the two tablet formulations. Therefore, the two formulations can be regarded as bioequivalent. The variables investigated (age, gender, body surface area, and creatinine clearance) had no clinically significant effect on the pharmacokinetics of capecitabine or its metabolites.

Hearing our voices: assessing HIV prevention needs among Asian and Pacific Islander women

The purpose of this study was to (a) assess the impact of HIV/AIDS on the Asian-Pacific Islander (API) community and changes in their behavior due to AIDS, (b) identify perception of risk, HIV risk behaviors, factors contributing to those behaviors, barriers to HIV prevention, and the types of prevention programs that would benefit their community, and (c) describe culturally appropriate considerations when designing HIV prevention strategies for API women. Thirty API adults participated in three different groups. Focus group interviewing methods were used, guided by the Health Belief Model. The women had numerous concerns about HIV that placed them at risk for infection, such as their inability to talk with their sexual partners about condom use due to the cultural and taboo nature of sexual topics. All groups concluded that for HIV prevention interventions to be successful, they must be tailored to the cultural and specific needs of API women.

Seroprevalence of Trichinella infection in domestic swine based on the National Animal Health Monitoring System's 1990 and 1995 swine surveys

Swine sera collected by the US Department of Agriculture's Center for Animal Health Monitoring during 1990 and 1995 was tested for antibodies to Trichinella spiralis using an enzyme immunoassay. From a total of 3048 sera collected from lactating sows in 1990, five sera tested positive for a prevalence of 0.16%. From a total of 7987 sera collected from both finishing pigs and gestating sows in 1995, one serum was positive for a prevalence of 0.013%. Responses to questionnaires administered at the time of serum collection showed that seropositive farms had management variables consistent with known risk factors for exposure to trichinae.

Practice what we preach? HIV knowledge, beliefs, and behaviors of adolescents and adolescent peer educators

The purpose of this article is to (a) describe the knowledge, beliefs, and sexual behaviors of urban adolescents and adolescent peer educators, and (b) identify elements needed to design effective HIV/AIDS prevention programs for out-of-school youth. Thirty-three predominantly African American adolescents (female = 14; male = 19) between the ages of 14 and 24 in a large urban city including adolescent (n = 18) and adolescent peer educators (n = 15) participated. Paper-and-pencil questionnaire and focus-group interviewing methods were used. Adolescents and adolescent peer educators had a moderately high level of HIV knowledge, confidence in their ability to use condoms, and beliefs that condom use would not decrease sexual pleasure or imply infidelity. Both groups reported low perceptions of susceptibility of HIV infection. Engagement in sexual risk behavior was low, but was significantly higher among males. Although adolescent male peer educators engaged in a higher frequency of risk behaviors over time, they had a lower frequency of sexual risk behaviors in the past 2 months compared with male adolescents. Study findings showed that HIV prevention interventions need to include information about specific risk behaviors, such as using condoms for oral sex, and cleaning drug paraphernalia. Community-based and church programs, visible HIV prevention messages, specifically those aimed at increasing perceptions of HIV risk, and the development of condom-use skills were identified by adolescents and adolescent peer educators as relevant approaches to reduce HIV infection among this population.

Preadolescent suicidal behavior: the role of cognitive functioning

The recent suicidal behavior of fifty-three hospitalized preadolescents was assessed in interviews with children and their parents. Children described by their parents as more suicidal scored higher on measures of verbal intelligence and language production than their less suicidal counterparts, with unique variance predicted only by language production ability. The results suggest that parents of preadolescents with better language production skills may be more aware of their youngsters' suicidal thoughts than parents of children with poorer language production ability.

Plasma kinetics of vitamin A in humans after a single oral dose of [8,9,19-13C]retinyl palmitate

The kinetics of vitamin A and its major metabolites were investigated in humans. Eleven healthy male subjects ingested 105 mumol (100,000 IU) of [8,9,19-13C]retinyl palmitate in an oily solution. Twenty-seven blood samples were collected during the 1-week study. Plasma samples were analyzed for retinyl esters and for [12C]- and [8,9,19-13C]retinol. Retinol isotopes were quantified using a newly developed GC-MS method. Total retinyl esters peaked at about 4.45 mumol/L from 3.5 to 12 h after dosing. As a result of the perturbation of the tracee system, the plasma concentration of [12C]retinol increased and then decreased as the concentration of [8,9,19-13C]retinol increased, indicating rapid distribution kinetics. A broad single peak (1.16 +/- 0.32 mumol/L) was observed for [8,9,19-13C]retinol at about 10 to 24 h postdose; this likely reflects hepatic secretion of [8,9,19-13C]retinol associated with retinol-binding protein. Then, declining levels of the tracer and increasing levels of the tracee were observed. At its peak, the ingested [8,9,19-13C]retinol reached about 51% of the observed total plasma retinol concentration. This percentage dropped to 13.4% on day 7 indicating slow final elimination from plasma. Our data support the concept that the liver follows the principle "last in/first out' in maintaining vitamin A homeostasis.

Inhibition and kinetics of cytochrome P4503A activity in microsomes from rat, human, and cdna-expressed human cytochrome P450

Midazolam (MDZ) is metabolized in human liver microsomes by the cytochrome P450 (CYP) 3A subfamily to 1'-hydroxy (1'-OH) and 4-hydroxy (4-OH) metabolites. MDZ is metabolized in the rat primarily to 4-OH MDZ, 1'-OH MDZ, and 1',4-dihydroxy (1',4-diOH) MDZ. The kinetics of 4-OH and 1'-OH metabolite formation were determined using hepatic microsomes from control, Ro 23-7637 and dexamethasone-treated male rats. KM values for the major metabolite, 4-OH MDZ, were 24.5, 43.1, and 32.8 microM, and the corresponding Vmax values were 5.9, 28.9, and 13 nmol/mg/min for the control, DEX, and Ro 23-7637-treated animals, respectively KM values for 1'-hydroxylation of MDZ (the major metabolite) after incubation with human liver microsomes from three individuals were 5.57, 2.50, and 3.56 microM, and the corresponding Vmax values were 4.38, 0.49, and 0.19 nmol/mg/min, respectively. In parallel studies using cDNA-expressed human CYP3A4 microsomes, the KM for 1'-OH formation was 1.56 microM, and the corresponding Vmax was 0.16 nmol/mg/min. MDZ was not metabolized by cDNA-expressed human CYP2D6, CYP2E1, or CYP1A2, thus confirming that these isoforms were not responsible for its biotransformation. The formation of 1',4-diOH metabolite in rat and 1'-OH formation in cDNA-expressed human CYP3A4 microsomes showed a decrease in velocity at high substrate concentrations. Inhibition studies showed that MDZ hydroxylation was strongly inhibited by ketoconazole and Ro 23-7637 in rat, human, and cDNA-expressed human CYP3A4 microsomes. alpha-Naphthoflavone stimulated 1'-OH metabolite formation in human and cDNA-expressed human CYP3A4 microsomes at low concentration (10 microM). Naringenin, a flavonoid present in grapefruit juice, also inhibited MDZ metabolism in human liver microsomes. Immunoinhibition studies revealed that polyclonal anti-rat CYP3A2 antibody inhibited MDZ metabolism 80-90% in rat, human, and cDNA-expressed human CYP3A4 microsomes, thus suggesting that members of the CYP3A4 subfamily were involved in the metabolism.

Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study

Several new studies have indicated that an active approach to patients with chronic disabling low back pain (LBP) seems effective. Some of these studies emphasize the importance of dealing with the patient's total situation in comprehensive multidisciplinary programs--the bio-psycho-social model. However, these programs are expensive. The aim of this study was to evaluate the rehabilitation outcome from three different active programs in terms of: (1) return-to-work rate, (2) days of sick leave, (3) health-care contacts, (4) pain and disability scores, and (5) staying physically active. The subjects included 132 patients randomized to the study, of whom 123 started one of the treatment programs. They had all had at least 6 months of chronic LBP. The patients were randomized into one of three programs: group 1--a full-time, intensive 3-week multidisciplinary program, including active physical and ergonomic training and psychological pain management, followed by 1 day weekly for the subsequent 3 weeks; group 2--active physical training, twice a week for 6 weeks, for a total of 24h; group 3--psychological pain management combined with active physical training, twice a week for 6 weeks, also for a total of 24h. The results presented here are based on data collected 4 months following treatment, which shows an 86% response rate. The initial examination and the follow-up evaluation were performed by a blinded observer. The results show that 4 months after treatment, the intensive multidisciplinary program is superior to the less intensive programs in terms of return-to-work rate, health-care contacts, pain and disability scores, and staying physically active.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of suicidal behavior among preadolescent children who are psychiatric inpatients

The prevalence of suicidal behavior displayed by preadolescent children hospitalized on inpatient psychiatric units is estimated to range between 18% and 80% of the population. The current study provides an independent estimate of the prevalence of this problem. A semistructured interview was used to assess suicidal behavior displayed by 61 admissions to a child psychiatric inpatient unit between April 1988 and September 1989. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 63% of the sample engaged in some form of suicidal behavior. Preadolescents and their parents reported similar rates of suicidal thoughts, threats and attempts. The dangerousness of recent suicidal behavior was not found to differ by age, sex, legal custody status or socioeconomic status.

The psychosocial climate of families with suicidal pre-adolescent children

A structured interview measure of suicidal behavior and a questionnaire measure of family psychosocial climate were administered to 43 pre-adolescent psychiatric inpatients and their parents. Results showed that suicidal behavior tended to be associated with greater family conflict and with less family organization, cohesion, and achievement orientation.

Effect of formulation adjuvants on gastrointestinal absorption of leuprolide acetate

Leuprolide acetate, [D-Leu6-desGly10]LH-RH ethylamide, a highly potent superagonist of luteinizing hormone-releasing hormone (LH-RH), was administered by intraduodenal (ID) injection to male castrate rats in a saline solution. Absorption was low, approximately 0.01% and 0.08% by oral (PO) and ID administration respectively, compared with intravenous (i.v.) controls. An aqueous formulation and a water in oil emulsion of a lipophilic salt, a decane sulfonic acid derivative of [D-Leu6-desGly10]LH-RH ethylamide gave ID bioavailabilities of approximately 0.2% and 1%, respectively. Evaluation of formulation effects on the oral absorption of leuprolide showed that lipophilicity, surfactant and vehicle properties significantly affected ID absorption of leuprolide. Absolute bioavailability of the drug in typical emulsion systems ranged from approximately 3 to 10% and represent an improvement of about 100 fold in gastrointestinal bioavailability of this peptide. The implications of these findings relative to the effect of formula adjuvants on oral absorption of leuprolide and other peptides following ID administration are discussed.

Determination of transcription factor isoelectric point by two-dimensional native isoelectric focusing and electrophoretic mobility shift analysis

A rapid, sensitive, and inexpensive assay is described for the determination of isoelectric points of native transcription factors derived from cell nuclei. This assay depends on a transcription factors' ability to bind DNA with high specificity and obviates the need for specific antisera or additional detection methods in identifying a particular protein following isoelectric focusing. This method has been applied to two ubiquitous proteins, the octamer transcription factor, Oct-1, and the multisubunit CCAAT box factor, NF-Y. Isoelectric points have been determined under native conditions using conventional isoelectric focusing in the first dimension, followed by binding to a specific oligonucleotide DNA probe, and separation of specific DNA/protein complexes from unbound DNA in the second dimension using native polyacrylamide gel electrophoresis. Oct-1 from HeLa cell nuclei was shown to have a pI of 9.6, while NF-Y was shown to have a pI of 4.5. This method is applicable to any transcription factor which binds DNA specifically and may be used to identify changes in surface charge characteristics which occur as a result of alternative splicing events and/or following transcription factor post-translational modification(s).

The relationship of suicidality and psychiatric diagnosis in hospitalized pre-adolescent children

Two structured interview measures of suicidal behavior were administered to 43 child psychiatric inpatients between the ages of 7 and 11 and their parents. DSM-III-R diagnoses were assigned to the children, with twenty-six Axis I and Axis II diagnostic categories represented. Generally, the interview measures of suicidal behavior were found to be unrelated to psychiatric diagnosis. The results suggest that to better understand pre-adolescent suicidal behaviors, it may be more useful to examine associations between these behaviors and the biopsychosocial dimensions that underlie the diagnostic categories.

[High-frequency ventilation. I. Distribution of alveolar pressure amplitudes during high frequency oscillation in the lung model]

The pattern of intrapulmonary pressure distribution was studied during high-frequency ventilation in order to explain the inconsistent results reported in the literature. Methods. Pressure and flow velocity (hot-wire anemometry) were measured in different lung compartments: 1. In transalveolar chambers sealed to the perforated pleural surfaces of dried pig lungs; 2. In emphysema-simulating airbags sealed to the isolated bronchial trees of dried pig lungs; and 3. In transalveolar chambers sealed to the perforated pleural surfaces of freshly excised pig lungs. Results. 1. The pressure amplitudes change from one area to another and depending on the exciting frequency. 2. High-frequency oscillation is associated with an increase in pressure amplitude when the exciting frequency rises, whereas with conventional high-frequency jet ventilation the pressure amplitude is more likely to decrease with frequency. 3. During high-frequency jet ventilation the local pressure amplitude changes with the position of the tube in the trachea rather than with the exciting frequency. 4. When the volume of the measuring chamber is doubled the resulting pressure amplitude falls to half the control value. 5. The pressure amplitude and mean pressure measured in the transalveolar chamber vary more or less independently from the peak flow velocity. High-frequency ventilation is thus seen to be a frequency-dependant, inhomogeneous mode of ventilation that can essentially be homogenized by systematically changing the exciting frequency. The frequency-dependant response to different lung areas to excitation is likely to result from an intrabronchially-localized aerodynamic effect rather than the mechanical properties of the lung parenchyma.

Mammographic microcalcifications: detection with xerography, screen-film, and digitized film display

Pulverized bone specks and aluminum oxide specks were measured by hand into sizes ranging from 0.2 mm to 1.0 mm and then arranged in clusters. These clusters were superimposed on a human breast tissue phantom, and xeromammograms and screen-film mammograms of the clusters were made. The screen-film mammograms were digitized using a high-resolution laser scanner and then displayed on cathode ray tube (CRT) monitors. Six radiologists independently counted the microcalcifications on the xeromammograms, the screen-film mammograms, and the digitized-film mammograms. The xeromammograms were examined with a magnifying glass; the screen-film images were examined with a magnifying glass and by hot light; and the digitized-film images were examined by electronic magnification and image processing. The bone speck size that corresponded to a mean 50% detectability level for each technique was as follows: xeromammography, 0.550 mm; digitized film, 0.573 mm; and screen-film, 0.661 mm. We postulate that electronic magnification and image processing with edge enhancement can improve the capability of screen-film mammography to enhance the detection of microcalcifications.

Short-term effects of chest physiotherapy on pulmonary function in children with cystic fibrosis

In a short-term controlled study of 20 patients with cystic fibrosis and chronic sputum production, chest physiotherapy resulted in a significantly improved peak flow over a whole day, with no significant difference in other forced expiratory flows, when compared to a control day. This suggests that physiotherapy may be effective in enhancing clearance of sputum from central large airways, but it has little obvious effect on more peripheral airways. A bronchodilator given before physiotherapy had no added effects. It is important that we examine ways of improving physiotherapy to aid clearance of secretions from the more peripheral airways.