Innovative Approaches for Improving the Quality and Resilience of Spring Barley Seeds: The Role of Nanotechnology and Phytopathological Analysis

This study emphasizes the importance of seed quality in the context of yield formation. Based on the research data, this paper emphasizes the role of proper diagnosis of seed-borne pathogens in ensuring high and stable grain yields. Particular attention is paid to the study of the effect of the treatment of mother plants with fullerenol-based nanopreparations on the qualitative characteristics of spring barley seeds. The results showed that such treatment contributes to the increase in varietal purity, weight of 1000 grains as well as to the increase of nutrient and moisture reserves in seeds. Phytopathological analysis confirmed the presence of various diseases such as Alternaria, helminthosporiosis, fusarium, mold and mildew on the seeds. However, some samples showed a high resistance to pathogens, presumably due to the use of carbon nanopreparations. These results open new perspectives for the development of strategies to improve barley yield and disease resistance through seed optimization.

Distinct differences in gut microbial composition and functional potential from lean to morbidly obese subjects

INTRODUCTION

The gut microbiome may contribute to the development of obesity. So far, the extent of microbiome variation in people with obesity has not been determined in large cohorts and for a wide range of body mass index (BMI). Here, we aimed to investigate whether the faecal microbial metagenome can explain the variance in several clinical phenotypes associated with morbid obesity.

METHODS

Caucasian subjects were recruited at our hospital. Blood pressure and anthropometric measurements were taken. Dietary intake was determined using questionnaires. Shotgun metagenomic sequencing was performed on faecal samples from 177 subjects.

RESULTS

Subjects without obesity (n = 82, BMI 24.7 ± 2.9 kg m^-2 ) and subjects with obesity (n = 95, BMI 38.6 ± 5.1 kg m^-2 ) could be clearly distinguished based on microbial composition and microbial metabolic pathways. A total number of 52 bacterial species differed significantly in people with and without obesity. Independent of dietary intake, we found that microbial pathways involved in biosynthesis of amino acids were enriched in subjects with obesity, whereas pathways involved in the degradation of amino acids were depleted. Machine learning models showed that more than half of the variance in body fat composition followed by BMI could be explained by the gut microbiome, composition and microbial metabolic pathways, compared with 6% of variation explained in triglycerides and 9% in HDL.

CONCLUSION

Based on the faecal microbiota composition, we were able to separate subjects with and without obesity. In addition, we found strong associations between gut microbial amino acid metabolism and specific microbial species in relation to clinical features of obesity.

P1755Plasma proteomics in healthy individuals predict myocardial infarction

Background

Currently used models to predict cardiovascular event risk have limited value. It has been shown repetitively that the addition of single biomarkers has modest impact. Recently we observed that a model consisting of a larger array of plasma proteins performed very well in predicting the presence of vulnerable plaques in primary prevention patients. However, the validation of this protein panel in predicting cardiovascular outcomes remains to be established.

Purpose

This study investigated the ability of a 384 preselected protein biomarkers to predict acute myocardial infarction, using state-of-the-art machine learning techniques. Secondly, we compared the performance of this multi-protein risk model to traditional risk engines.

Methods

We selected 822 subjects from the EPIC-Norfolk prospective cohort study, of whom 411 suffered a myocardial infarction during follow-up (median 15 years) compared to 411 controls who remained event-free (median follow-up 20 years). The 384 proteins were measured using proximity extension assay technology. Machine learning algorithms (random forests) were used for the prediction of acute myocardial infarction (ICD code I21–22). Performance of the model was tested against and on top of traditional risk factors for cardiovascular disease (refit Framingham). All performance measurements were averaged over several stability selection routines.

Results

Prediction of myocardial infarction using a machine-learning model consisting of 50 plasma proteins resulted in a ROC AUC of 0.74±0.14, in comparison to 0.69±0.17 using traditional risk factors (refit Framingham. Combining the proteins and refit Framingham resulted in a ROC AUC of 0.74±0.15. Focussing on events occurring within 3 years after baseline blood withdrawal, the ROC AUC increased to 0.80±0.09 using 50 plasma proteins, as opposed to 0.67±0.22 using refit Framingham (figure). Combining the protein model with refit Framingham resulted in a ROC AUC of 0.82±0.11 for these events.

Diagnostic performance events <3yrs

Conclusion

High-throughput proteomics outperforms traditional risk factors in prediction of acute myocardial infarction. Prediction of myocardial infarction occurring within 3 years after inclusion showed highest performance. Availability of affordable proteomic approaches and developed machine learning pave the path for clinical implementation of these models in cardiovascular risk prediction.

Acknowledgement/Funding

This study was funded by an ERA-CVD grant (JTC2017) and EU Horizon 2020 grant (REPROGRAM, 667837)

Dominant effect of relative tropical Atlantic warming on major hurricane occurrence

Here we explore factors potentially linked to the enhanced major hurricane activity in the Atlantic Ocean during 2017. Using a suite of high-resolution model experiments, we show that the increase in 2017 major hurricanes was not primarily caused by La Niña conditions in the Pacific Ocean but rather triggered mainly by pronounced warm sea surface conditions in the tropical North Atlantic. Further, we superimpose a similar pattern of North Atlantic surface warming on data for long-term increasing sea surface temperature (a product of increases in greenhouse gas concentrations and decreases in aerosols) to show that this warming trend will likely lead to even higher numbers of major hurricanes in the future. The key factor controlling Atlantic major hurricane activity appears to be the degree to which the tropical Atlantic warms relative to the rest of the global ocean.

Reversal of visceral hypersensitivity in rat by Menthacarin® , a proprietary combination of essential oils from peppermint and caraway, coincides with mycobiome modulation

BACKGROUND

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder associated with altered gastrointestinal microflora and increased nociception to colonic distension. This visceral hypersensitivity can be reversed in our rat maternal separation model by fungicides. Menthacarin^® is a proprietary combination of essential oils from Mentha x piperita L. and Carum carvi. Because these oils exhibit antifungal and antibacterial properties, we investigated whether Menthacarin^® can reverse existing visceral hypersensitivity in maternally separated rats.

METHODS

In non-handled and maternally separated rats, we used the visceromotor responses to colorectal distension as measure for visceral sensitivity. We evaluated this response before and 24 hours after water-avoidance stress and after 7 days treatment with Menthacarin^® or control. The pre- and post-treatment mycobiome and microbiome were characterized by sequencing of fungal internal transcribed spacer 1 (ITS-1) and bacterial 16s rDNA regions. In vitro antifungal and antimicrobial properties of Menthacarin^® were studied with radial diffusion assay.

KEY RESULTS

Menthacarin^® inhibited in vitro growth of yeast and bacteria. Water-avoidance caused visceral hypersensitivity in maternally separated rats, and this was reversed by treatment. Multivariate analyses of ITS-1 and 16S high throughput data showed that maternal separation, induced changes in the myco- and microbiome. Menthacarin^® treatment of non-handled and maternally separated rats shifted the mycobiomes to more similar compositions.

CONCLUSIONS & INFERENCES

The development of visceral hypersensitivity in maternally separated rats and the Menthacarin^® -mediated reversal of hypersensitivity is associated with changes in the mycobiome. Therefore, Menthacarin^® may be a safe and effective treatment option that should be tested for IBS.

Hawkmoths use nectar sugar to reduce oxidative damage from flight

Nectar-feeding animals have among the highest recorded metabolic rates. High aerobic performance is linked to oxidative damage in muscles. Antioxidants in nectar are scarce to nonexistent. We propose that nectarivores use nectar sugar to mitigate the oxidative damage caused by the muscular demands of flight. We found that sugar-fed moths had lower oxidative damage to their flight muscle membranes than unfed moths. Using respirometry coupled with δ¹³C analyses, we showed that moths generate antioxidant potential by shunting nectar glucose to the pentose phosphate pathway (PPP), resulting in a reduction in oxidative damage to the flight muscles. We suggest that nectar feeding, the use of PPP, and intense exercise are causally linked and have allowed the evolution of powerful fliers that feed on nectar.

An investigation of red blood cell concentrate quality during storage in paediatric-sized polyvinylchloride bags plasticized with alternatives to di-2-ethylhexyl phthalate (DEHP)

BACKGROUND AND OBJECTIVES

Di-2-ethylhexyl phthalate (DEHP) is a blood bag plasticizer. It is also a toxin, raising concerns for vulnerable populations, for example, neonates and infants. Here, the in vitro quality of red cell concentrates (RCC) stored in paediatric bags formulated with alternative plasticizers to DEHP was compared.

MATERIALS AND METHODS

RCC were pooled and split into polyvinylchloride (PVC)/DEHP, PVC/1,2-cyclohexanedicarboxylic acid diisononyl ester (DINCH) or PVC/butyryl trihexyl citrate (BTHC) bags. Quality was assessed on storage days 5, 21, 35 and 43.

RESULTS

Metabolism differed among the bags: pCO2 levels were lowest and pO2 were highest in BTHC bags. Glucose consumption and lactate production suggested higher metabolic rates in BTHC bags. ATP levels were best maintained in DINCH bags (day 43 mean level: 2·86 ± 0·29 μmol/g Hb). RCC in BTHC bags had the greatest potassium release (54·6 ± 3·0 mm on day 43). From day 21, haemolysis was higher in BTHC bags (P < 0·01) and by day 43 had exceeded 0·8% (0·85 ± 0·10%). RCC in BTHC bags showed more microparticle formation than RCC in DEHP or DINCH bags.

CONCLUSION

The results suggest that the BTHC formulation used was detrimental to RBC quality. DINCH bags could be a viable alternative to DEHP: they outperformed DEHP bags energetically, with better maintenance of ATP levels.

Quinazoline-based tricyclic compounds that regulate programmed cell death, induce neuronal differentiation, and are curative in animal models for excitotoxicity and hereditary brain disease

Expanding on a quinazoline scaffold, we developed tricyclic compounds with biological activity. These compounds bind to the 18 kDa translocator protein (TSPO) and protect U118MG (glioblastoma cell line of glial origin) cells from glutamate-induced cell death. Fascinating, they can induce neuronal differentiation of PC12 cells (cell line of pheochromocytoma origin with neuronal characteristics) known to display neuronal characteristics, including outgrowth of neurites, tubulin expression, and NeuN (antigen known as 'neuronal nuclei', also known as Rbfox3) expression. As part of the neurodifferentiation process, they can amplify cell death induced by glutamate. Interestingly, the compound 2-phenylquinazolin-4-yl dimethylcarbamate (MGV-1) can induce expansive neurite sprouting on its own and also in synergy with nerve growth factor and with glutamate. Glycine is not required, indicating that N-methyl-D-aspartate receptors are not involved in this activity. These diverse effects on cells of glial origin and on cells with neuronal characteristics induced in culture by this one compound, MGV-1, as reported in this article, mimic the diverse events that take place during embryonic development of the brain (maintenance of glial integrity, differentiation of progenitor cells to mature neurons, and weeding out of non-differentiating progenitor cells). Such mechanisms are also important for protective, curative, and restorative processes that occur during and after brain injury and brain disease. Indeed, we found in a rat model of systemic kainic acid injection that MGV-1 can prevent seizures, counteract the process of ongoing brain damage, including edema, and restore behavior defects to normal patterns. Furthermore, in the R6-2 (transgenic mouse model for Huntington disease; Strain name: B6CBA-Tg(HDexon1)62Gpb/3J) transgenic mouse model for Huntington disease, derivatives of MGV-1 can increase lifespan by >20% and reduce incidence of abnormal movements. Also in vitro, these derivatives were more effective than MGV-1.

Standardization of CD62P measurement: results of an international comparative study

BACKGROUND AND OBJECTIVES

Despite long being a mainstay in describing platelet activation via degranulation, interlaboratory variation remains an issue in measurement of membrane CD62P by flow cytometry. Our objective was to identify actions that may minimize this variation.

MATERIALS AND METHODS

Sixteen laboratories participated in an international comparative study. Two sets of platelet samples were prepared in one laboratory. Set 1 was stained and fixed; set 2 was fixed and required staining at participating laboratories. A single-staining method was used, and platelet populations were selected based on forward scatter/side scatter characteristics. Calibration beads were used to standardize measurement across different instruments.

RESULTS

There was a large discrepancy in reported CD62P values among study sites [interlaboratory coefficient of variance (CV): 36-78%]. When electronic data were re-analysed by a single analyst using a consistent gating strategy and a stable reference point, variation decreased markedly (CV < 12%), indicating a problem with isotype control samples, possibly related to sample fixation or shipment.

CONCLUSION

Consensus regarding gating strategies and use of a reliable reference point would greatly improve agreement in interlaboratory CD62P measurement.

Impact of sample volume and handling time during analysis on the in vitro quality measurements of platelet concentrates held in syringes

INTRODUCTION

The determination of quality parameters is a necessity for monitoring the efficacy of platelet concentrates. During consolidated quality control studies, there may be a large number of samples to be analyzed at the same time. This common workflow setup triggered the question whether there is an influence of the number of samples to be analyzed on the accuracy of the test results.

METHODS

Two different sample volumes of platelet concentrates, 1 ml and 50 ml, were analyzed for a set of standard in vitro parameters including pCO(2), pO(2), pH, glucose, and lactate as well as platelet activation via CD62P expression and responsiveness to adinosine diphosphate in an extent-of-shape-change assay. To assess apoptotic mechanisms triggered by the hold time, changes in the phosphatidylserine exposure were monitored.

RESULTS

In total, eleven time points were assessed over a 3-h period as well as an overnight point for assay evaluation. Except for pCO(2) and pO(2), all in vitro parameters analyzed were unaffected by a sample hold time of up to 3-h.

CONCLUSION

Sampling for pO(2) determination should be carried out in small volumes and assessed within 30 min of collection to obtain reliable and comparable results.

Extra-Nuclear Estrogen Receptors: Functions in Breast Cancer

Pools of classical estrogen receptors alpha and beta exist in various cellular locations including the nucleus, plasma membrane, and in cytoplasmic organelles (e.g.-mitochondria). The roles and importance of the extra-nuclear receptors are under investigation but in some women with breast cancer, membrane ERalpha greatly exceeds the nuclear ER pool. To understand how these receptors traffic to the plasma membrane and function, we took a proteomic approach that identified Heat Shock Protein 27 (Hsp27) as an important promoter of membrane ER localization. Hsp27 physically interacts with the ERalpha monomer, promoting palmitoylation of the sex steroid receptor, leading to enhanced association with caveolin-1 in cytoplasm and subsequent trafficking to the membrane. Using RNAi for Hsp27, this protein was shown to be necessary for ERalpha to localize to the membrane and signal through ERK and PI3 kinase, accounting for about 50% of total cell proliferation induced by estradiol. Membrane ERalpha and not nuclear ERalpha also blocks DNA repair signaling through ATR and ATM kinases in both normal breast epithelial cells and breast cancer cells (Mol Biol Cell 20:3374,2009).This occurs in the setting of radiation or chemotherapy-induced cell damage, in-vitro. Inhibiting kinase signaling leads to loss of cell cycle checkpoints, delay of DNA repair, inhibition of p53 function, and enhanced chromosomal damage upon exposing cells to gamma radiation. As for ERbeta, we find that this receptor exists mainly in extra-nuclear, mitochondrial locations in breast cancer cell lines. There is evidence that the cytoplasmic ERbeta 2 isoform correlates to a poor prognosis in women with breast cancer (Clin Canc Res, 2008). We found that mitochondrial ERbeta regulates reactive oxygen species formation. This function importantly participates in the response to tamoxifen, sensitivity (apoptosis) versus resistance (survival and growth), in several breast cancer cell lines. Mechanisms involved will be explored at the meeting. In summary, new and potentially important functions of extra-nuclear ERalpha and ERbeta could contribute to breast pathobiology.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr BS2-1.

Gluon saturation effects on J / psi production in heavy ion collisions

We consider a novel mechanism for J / psi production in nuclear collisions arising due to the high density of gluons. The resulting J / psi production cross section is evaluated as a function of rapidity and centrality. We compute the nuclear modification factor and show that the rapidity distribution of the produced J / psi's is significantly more narrow in AA collisions due to the gluon saturation effects. Our results indicate that gluon saturation in the colliding nuclei is a significant source of J / psi suppression and can explain the experimentally observed rapidity and centrality dependencies of the effect.

Development of a new measure of health-related quality of life for people with dementia: DEMQOL

BACKGROUND

We identified the need to develop a scientifically rigorous measure of health-related quality of life (HRQL) in dementia that would be appropriate for use at all stages of dementia severity and would be available in both self- and proxy-report versions.

METHOD

We used standard psychometric methods to eliminate items with poor psychometric properties (item-reduction field test) and to assess the acceptability, reliability and validity of the item-reduced instruments (psychometric evaluation field test). We developed and validated two versions of DEMQOL: a 28-item interviewer-administered questionnaire that is self-reported by the person with dementia (DEMQOL) and a 31-item interviewer-administered questionnaire that is proxy-reported by a caregiver (DEMQOL-Proxy).

RESULTS

DEMQOL shows high reliability (internal consistency and test-retest) and moderate validity in people with mild/moderate dementia. DEMQOL-Proxy shows good acceptability and internal consistency and moderate evidence of validity in people with mild/moderate and severe dementia. Test-retest reliability and performance in people with severe dementia need further testing.

CONCLUSIONS

DEMQOL and DEMQOL-Proxy show psychometric properties that are comparable with the best available dementia-specific measures of HRQL. We recommend that DEMQOL and DEMQOL-Proxy are used together. Reliability and validity need to be confirmed in independent samples and responsiveness needs to be evaluated.

Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia

OBJECTIVES

To explore the extent to which commonly used measures of specific outcomes in dementia are an appropriate proxy for quality of life in dementia.

METHODS

This was a cross sectional study set in communities in London and Nottingham, comprising 101 people with dementia and their 99 main family caregivers. The main outcome measures were health related quality of life in dementia (measured by the DEMQOL-Proxy), cognition (Mini Mental State Examination), functional impairment (Barthel Index), behavioural and psychological symptoms in dementia (Neuropsychiatric Inventory; NPI), and carer mental health (General Health Questionnaire).

RESULTS

On univariate analysis, decreased quality of life was statistically significantly correlated with higher levels of behavioural and psychological disturbance (NPI total score and its agitation, depression, anxiety, disinhibition, and irritability subscales); younger age of the person with dementia; and poorer mental health of the carer. Quality of life was not statistically significantly associated with cognition or carer age. In a multivariate model, psychological and behavioural disturbance and patient age remained statistically significantly associated with quality of life. Carer mental health was no longer statistically significantly associated, and cognition and functional limitation remained statistically insignificant.

CONCLUSIONS

These data suggest that quality of life in dementia is complex, and that simple proxy substitutions of discrete measures such as cognition or function are likely to miss important factors.

Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology

OBJECTIVES

To develop and validate a psychometrically rigorous measure of health-related quality of life (HRQoL) for people with dementia: DEMQOL.

DATA SOURCES

Literature review. Expert opinion. Interviews and questionnaires.

REVIEW METHODS

Gold standard psychometric techniques were used to develop DEMQOL and DEMQOL-Proxy. A conceptual framework was generated from a review of the literature, qualitative interviews with people with dementia and their carers, expert opinion and team discussion. Items for each component of the conceptual framework were drafted and piloted to produce questionnaires for the person with dementia (DEMQOL) and carer (DEMQOL-Proxy). An extensive two-stage field-testing was then undertaken of both measures in large samples of people with dementia (n = 130) and their carers (n = 126) representing a range of severity and care arrangements. In the first field test, items with poor psychometric performance were eliminated separately for DEMQOL and DEMQOL-Proxy to produce two shorter, more scientifically robust instruments. In the second field test, the item-reduced questionnaires were evaluated along with other validating measures (n = 101 people with dementia, n = 99 carers) to assess acceptability, reliability and validity.

RESULTS

Rigorous evaluation in two-stage field testing with 241 people with dementia and 225 carers demonstrated that in psychometric terms: (1) DEMQOL is comparable to the best available dementia-specific HRQoL measures in mild to moderate dementia, but is not appropriate for use in severe dementia [Mini Mental State Examination (MMSE) <10]; and (2) DEMQOL-Proxy is comparable to the best available proxy measure in mild to moderate dementia, and shows promise in severe dementia. In addition, the DEMQOL system has been validated in the UK in a large sample of people with dementia and their carers, and it provides separate measures for self-report and proxy report, which allows outcomes assessment across a wide range of severity in dementia.

CONCLUSIONS

The 28-item DEMQOL and 31-item DEMQOL-Proxy provide a method for evaluating HRQoL in dementia. The new measures show comparable psychometric properties to the best available dementia-specific measures, provide both self- and proxy-report versions for people with dementia and their carers, are appropriate for use in mild/moderate dementia (MMSE >/= 10) and are suitable for use in the UK. DEMQOL-Proxy also shows promise in severe dementia. As DEMQOL and DEMQOL-Proxy give different but complementary perspectives on quality of life in dementia, the use of both measures together is recommended. In severe dementia, only DEMQOL-Proxy should be used. Further research with DEMQOL is needed to confirm these findings in an independent sample, evaluate responsiveness, investigate the feasibility of use in specific subgroups and in economic evaluation, and develop population norms. Additional research is needed to address the psychometric challenges of self-report in dementia and validating new dementia-specific HRQoL measures.

Miscarriage in the first trimester according to the presence or absence of the progesterone-induced blocking factor at three to five weeks from conception in progesterone supplemented women

PURPOSE

To determine if the failure to detect the immonomodulatory protein progesterone induced blocking factor (PIBF) at three to five weeks of seemingly normal pregnancies in women supplemented by extra progesterone is associated with a higher miscarriage rate.

METHODS

Progesterone-induced blocking factor expression by lymphocytes was measured by an immunocytochemistry technique. The serum beta human chorionic gonadotropin (hCG) and/or ultrasound were also deemed appropriate so that by these criteria there was no evidence of a poor pregnancy. The minimum progesterone dosage was 200 mg twice daily vaginal suppositories.

RESULTS

Progesterone-induced blocking factor was detected in 17/39 (43.5%) of pregnant patients at this early time. There were three miscarriages by 12 weeks in this group (17.6%). The miscarriage rate was 6/21 (28.5%) in those where it was not detected.

CONCLUSIONS

There was insufficient power to show significance. However there seems to be a trend for higher rates of miscarriage when PIBF is absent so these preliminary data encourage continuation of the study.

Effect of treating antibody-coated sperm with chymotrypsin on pregnancy rates following IUI as compared to outcome of IVF/ICSI

Males with 100% of their sperm coated by antisperm antibody have a very small chance of achieving a pregnancy by intercourse or conventional intrauterine insemination (IUI). A previous study found that treatment of the sperm with the protein digestive enzyme chymotrypsin improved the efficacy of IUI. The present study was designed to corroborate or refute this previous study and compare efficacy to IVF with ICSI. This time the subjects were an even more difficult group with 100% of the sperm coated by autoantibodies.

[Detection of anti-Borrelia antibodies by immunoblotting in Lyme borreliosis]

IgM and IgG were detected in the sera from 25 Russian patients with Lyme disease by immunoblotting test with Immunetics kit (USA). Early stage of the disease was diagnosed in 12 patients and late stage in 13. Specific protein lines were detected in virtually all patients but their number and combination in the sera were different. Eleven (43%) sera were regarded as positive according to the American criteria of seropositive test, 3 of them by IgM and 10 by IgG. In patients with short disease serum reaction was either negative or confined to 1-2 lines per strip. Patients with late stage showed a more manifest extensive reaction, which was the most pronounced in patients with a long lasting disease and articular involvement; the reaction was similar to that characteristic of chronic Lyme arthritis. Parallel testing of IgG antibodies in 25 sera from American patients with Lyme disease (confirmed by direct isolation of the agent) showed notable similarity of reactions of both American and Russian sera. More essential differences were observed only for low molecular weight proteins (p28, p23, p21).

Hepatitis B vaccination: long-term follow-up of the immune response of preterm infants and comparison of two vaccination protocols

BACKGROUND

We conducted a 3-year follow-up study of long-term antibody persistence following vaccination of low-risk preterm infants with recombinant hepatitis B vaccine (HBV). Two three-dose protocols were compared: vaccination beginning within 24 h of birth to initial vaccination delayed until a weight of 2,000 g was reached.

SUBJECTS AND METHODS

The study population included 136 children, divided into three groups: children born prematurely (< or = 35 weeks, n = 57), children born at term (> or = 37 weeks, n = 39), both groups receiving the first dose of HBV within 24 h of birth, and children born prematurely (< or = 35 weeks, n = 40), who received the first dose of HBV when a weight of 2,000 g was reached. All infants received the second hepatitis vaccination 1 month after the first, and the third dose 6 months after the first. Hepatitis B surface antibody (AntiHBs) was measured at an age of 3-3.5 years (at least 2.5 years after completion of the three-dose HBV series). An AntiHBs level of > or = 10 IU/l was considered positive.

RESULTS

At 3-3.5 years of age, a higher percentage of the premature-delayed vaccination group had a positive AntiHBs level (92.5%) compared to both the premature (54.4%, p < 0.001) and full-term groups (71.8%, p < 0.05) vaccinated soon after birth. The premature-delayed vaccination group also had a significantly higher geometric mean concentration (GMC) (119 vs 14.2 IU/l, p < 0.001 and 119 vs 32.7 IU/l, p < 0.005, respectively).

CONCLUSION

Delaying vaccination of premature infants against hepatitis B until a weight of 2,000 g was reached resulted in both a significantly higher percentage of children with positive antibody levels and a significantly higher GMC at 3-3.5 years of age as compared to early-vaccinated preterm and full-term infants. The known short-term advantage of delayed vaccination of preterm infants was shown to persist for at least the first 3 years of life.

Deposition of whole blood platelets on extracellular matrix under flow conditions in preterm infants

BACKGROUND

A previous study showed greater adhesion by platelets of healthy full term infants to subendothelial extracellular matrix (ECM) under flow conditions compared with healthy adult platelets.

AIM

To investigate the adhesion and aggregation of platelets from preterm infants on ECM under defined shear conditions.

METHODS

In vitro platelet function was investigated in 106 preterm infants, 74 full term infants, and 26 healthy adults. Blood samples were obtained from all infants within 24 hours of birth, and weekly until discharge from preterm infants only. Citrated whole blood was placed in ECM precoated tissue culture plates and subjected to shear stress (1300 s-1) for two minutes using a rotating Teflon cone. Platelet adhesion (surface coverage) and aggregation (average size) to ECM were assayed using an image analyser. Assays for von Willebrand factor (vWF) antigen, ristocetin cofactor, and vWF collagen-binding activity were performed on samples from an additional 70 preterm infants, 23 healthy full term infants, and 24 healthy adults. Preterm infants with hyaline membrane disease (HMD) were analysed separately in both cohorts.

RESULTS

Platelets from preterm infants displayed significantly less platelet adhesion than those from full term infants but similar aggregation and levels of vWF antigen, ristocetin cofactor, and collagen binding activity. Mean surface coverage was 22.0 (8.4)% for preterm infants with HMD, 28.7 (8.0)% for healthy preterm infants, and 35.7 (7.9)% for full term infants. Surface coverage in the preterm infants correlated with gestational age during the first 24 hours only, and did not reach full term levels during 10 weeks of follow up.

CONCLUSION

Platelet adhesion to ECM is significantly poorer in preterm than in full term infants, and poorer in preterm infants with HMD than in healthy preterm infants. Intrinsic platelet properties rather than the concentration or activity of vWF may be responsible for this difference.

Depression and the response of residential homes to physical health needs

OBJECTIVE

To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response and the prevalence of depression.

DESIGN AND SAMPLE

Post hoc analysis of data collected for a cross-sectional survey of homes chosen to represent "excellent" and "standard" care; resident sample sufficient to detect difference between 20% and 40% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed.

SETTING

Seventeen residential homes in different areas of England.

METHODS

Data were collected about aspects of the care provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems.

RESULTS

Seventy-nine per cent of the sample were suffering from dementia; 40% of 194 residents who could be assessed for depression were depressed. Of residents assessed by research nurses, 72% had problems with mobility, 67% with stability, 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents.

DISCUSSION

The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of care provision might reduce depression and thus improve quality of life.

Patterns of medication use before and after bone densitometry: factors associated with appropriate treatment

OBJECTIVE

We examined the medications used by women before and after bone densitometry to determine whether patient or physician factors were associated with appropriate osteoporosis therapy.

METHODS

Appropriate osteoporosis treatment was defined as alendronate, etidronate, calcitonin, or hormone replacement therapy (HRT) for women with any bone mineral density (BMD) t score < -2.5 or no osteoporosis therapy, except HRT, for women with t scores > -1.0. We observed a cohort of women who underwent bone densitometry at one outpatient osteoporosis clinic. Medical history, medication use, and demographic data were collected at the time of bone densitometry. A followup questionnaire assessed the medication use patterns since bone densitometry and attitudes about osteoporosis therapy.

RESULTS

We recruited 553 women who underwent bone densitometry in 1996. Their mean age was 62 years and 95% were postmenopausal. Prior to bone density scans, 27% of patients used HRT, 15% used bisphosphonates, and 6% used calcitonin. Scan results and surveys revealed that 40% of patients had BMD below a t score of -2.5 at any site. Of women with osteoporosis 78% reported taking an appropriate medication after their scans. Patients most likely to receive appropriate treatment were those who understood their bone densitometry results (odds ratio, OR, 2.5; 95% confidence interval, CI, 1.3 to 4.8) and patients who were taking an osteoporosis medication (OR 1.9; 95% CI 1.0 to 3.6). Neither the specialty of the referring physician nor patients' medical history was associated with use of appropriate osteoporosis therapy.

CONCLUSION

Of women with osteoporosis who underwent bone densitometry 78% received appropriate therapy after this test. Patient factors were associated with the likelihood that they received appropriate therapy, suggesting that strategies aimed at educating patients may improve the use of osteoporosis medications.

Outcome of referral to social services departments for people with cognitive impairment

The objective of this study was to determine how the entry into long term care of people assessed by their local social services department (SSD) under the National Health Service and Community Care Act 1990 is predicted by the severity of their cognitive impairment, care provided by family members, and the receipt of community care services. The design involved a cohort study of people over one and a half years following referral (min-max: 1-2 years) from three SSDs (county council, metropolitan and inner London boroughs). Consecutive recruitment of 141 people with cognitive impairment aged 65 and over took place over a 4 month period. The main outcome measure was survival analysis of time taken from referral to entering long term care at follow-up. The receipt and intensity of community care services increased the probability of remaining at home. People with mild or moderate cognitive impairment were more likely to remain at home if they had a spouse or daughter carer. Analysis of the interaction between three main effects predicting entry to long term care (severity of cognitive impairment, access to a carer, and the receipt of home care or day care) suggests that while carers are central in determining whether older people with cognitive impairment are able to remain living in the community, there are limits to the care they can provide.