Tamoxifen triggers the in vitro release of neutrophil extracellular traps in healthy horses

Neutrophils display an array of biological functions including the formation of neutrophil extracellular traps (NETs), web-like structures specialized in trapping, neutralizing, killing and preventing microbial dissemination within the host. However, NETs contribute to a number of inflammatory pathologies, including severe equine asthma. Tamoxifen (TX) is a selective estrogen receptor modulator which belongs to the triphenylethyllenes group of molecules, and which is used as a treatment in all stages of estrogen-positive human breast cancer. Our previous results suggest that tamoxifen can modulate neutrophil functionality and promote resolution of inflammation; this would partly explain the clinical beneficial effect of this drug in horses with airway inflammation. Enhanced NETs production has been reported with tamoxifen use in humans, but minimal data exists regarding the drug's effect on NETs in horses. The aim of this study is to assess the in vitro effect of TX on NETs formation from peripheral blood of healthy horses. Five clinically healthy mixed-breed adult horses were enrolled in the study. For this, cellular free DNA quantification, immunofluorescence for the visualization of NETs, assessment of different types of NETs, and detection of mitochondrial superoxide. TX induced NETs formation at a concentration of 10 uM. Our results show that only two types of NETs were induced by TX: 95% spread NETs (sprNETs) and 5% aggregated NETs (aggNETs). Furthermore, induction of these NETs could be influenced by mitochondrial ROS. Future research should involve an In vivo study of horses with severe asthma and TX treatment, to evaluate BALF neutrophil NET formation. In conclusion, this in vitro study suggests that the resolution of inflammation by TX in horses with airway inflammation is due to inhibition of other neutrophilic functions but not to NET formation.

Post-inflammatory polyps burden as a prognostic marker of disease-outcome in patients with inflammatory bowel disease

INTRODUCTION AND AIM

Post-inflammatory polyps (PIPs) are considered as indicators of previous episodes of severe inflammation and mucosal ulceration. Inflammatory bowel disease (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), exhibit a perpetuating, relapsing, and remitting pattern and PIPs is a frequent sequela of chronicity. The aim of this study was to determine whether a high PIPs burden is associated with a more severe disease course in patients with IBD.

METHODS

This was a multinational, multicentre, retrospective study. IBD patients previously diagnosed with PIPs were retrieved from the endoscopic database of each centre. PIPs burden was evaluated and associated with demographic and clinical data as well as factors indicating a more unfavorable disease course.

RESULTS

A total of 504 IBD patients with PIPs were recruited (male: 61.9%). The mean age at IBD diagnosis was 36.9 (±16.8) years. Most patients (74.8%) were diagnosed with UC. A high PIPs burden was present in 53.4% of patients. On multivariable Cox regression analysis, high PIPs burden was independently associated with treatment escalation (HR 1.35, 95% CI 1.04-1.75; P=0.024), hospitalization (HR 1.90; 95% CI 1.24 - 2.90; P=0.003), need for surgery (HR 2.28; 95% CI 1.17-4.44, P=0.02) and younger age at diagnosis (HR 0.99, 95% CI 0.98-0,99; p=0.003).

CONCLUSION

PIPs burden was associated with a more severe outcome. Future prospective studies should focus on the characterisation of PIPs burden as to further risk stratify this patient cohort.

Metabolomics analysis of bronchoalveolar lavage fluid samples in horses with naturally-occurring asthma and experimentally-induced airway inflammation

The present work characterized the metabolomic profile of bronchoalveolar lavage fluid (BALF) in healthy horses, experimentally-induced airway inflammation by lipopolysaccharide (LPS) nebulization, and naturally-occurring asthma (n = 3 in each group). All animals underwent clinical and upper airway endoscopic examinations, and bronchoalveolar lavage. BALF supernatant samples were subjected to metabolic analysis based on gas chromatography-mass spectrometry (GC-MS). Overall, 67 peaks were obtained from BALF GC-MS analysis, corresponding to 53 metabolites which were categorized according to chemical class, such as organic acids, fatty acids, nucleosides or their derivatives, amino acids, peptides or their derivatives, carbohydrates, and other compounds. Our results showed that the airway inflammation induction model with LPS produced the same pattern of metabolite changes as in horses with naturally occurring asthma. Metabolic pathway analysis was done by means of Fisher's exact test, for detection of metabolites over-represented in asthma affected-horses and LPS-induced airway inflammation as compared with healthy horses. The most significant altered metabolic pathways were fatty acid biosynthesis, galactose metabolism and citrate cycle. These results suggest that the airway inflammation induction model with LPS is a good study model for asthma-affected horses, due to the similarity of the profile of inflammatory cells (specifically neutrophils) and similar metabolic alterations found in BALF that occur during the inflammatory process of the airways. Further research may increase understanding of metabolomics disturbances and their significance in the pathogenesis of equine asthma.

Equine Asthma: Current Understanding and Future Directions

The 2019 Havemeyer Workshop brought together researchers and clinicians to discuss the latest information on Equine Asthma and provide future research directions. Current clinical and molecular asthma phenotypes and endotypes in humans were discussed and compared to asthma phenotypes in horses. The role of infectious and non-infectious causes of equine asthma, genetic factors and proposed disease pathophysiology were reviewed. Diagnostic limitations were evident by the limited number of tests and biomarkers available to field practitioners. The participants emphasized the need for more accessible, standardized diagnostics that would help identify specific phenotypes and endotypes in order to create more targeted treatments or management strategies. One important outcome of the workshop was the creation of the Equine Asthma Group that will facilitate communication between veterinary practice and research communities through published and easily accessible guidelines and foster research collaboration.

Tamoxifen and its metabolites induce mitochondrial membrane depolarization and caspase-3 activation in equine neutrophils

Neutrophils participate in innate immunity as the first line of host defence against microorganisms. However, persistent neutrophil activity and delayed apoptosis can be harmful to surrounding tissues; this problem occurs in diverse inflammatory diseases, including asthma‐affected horses. Previous studies in horses with acute lung inflammation indicated that treatment with tamoxifen (TX), a selective oestrogen receptor modulator, produces a significant decrease in bronchoalveolar lavage fluid (BALF) neutrophil content. The aim of this study was to investigate the effect of tamoxifen and its metabolites (N‐desmethyltamoxifen and endoxifen) on the mitochondrial membrane potential assay by flow cytometry, and the activation of effector caspase‐3 through immunoblotting, in peripheral blood neutrophils obtained from healthy horses (n = 5). Results show that tamoxifen, N‐desmethyltamoxifen and endoxifen depolarize the mitochondrial membrane and activate caspase‐3 in healthy equine neutrophils in vitro. These findings suggest that tamoxifen and its metabolites may activate the intrinsic apoptotic pathway in equine neutrophils. However, more studies are necessary to further explore the signalling pathways of these drugs in the induction of apoptosis.

Microsurgical Anatomy of the Central Retinal Artery

BACKGROUND

The central retinal artery (CRA) has been described as one of the first branches of the ophthalmic artery.It arises medial to the ciliary ganglion and after a sinuous path within the orbital cavity it penetrates the lower surface of the dura mater that covers the optic nerve, approximately 1 cm behind the eyeball. However, the numerous anatomic descriptions that were made of the CRA have been insufficient or unclear in relation to certain characteristics that are analyzed in the present study.

METHODS

An electronic literature search was made in the PubMed database and a cadaver dissection was performed on 11 orbits fixed in formaldehyde.

RESULTS

Results were obtained regarding the source, collateral branches, curves, direction, length of the optic nerve, dural perforation site, distance, path and relations, diameter, and area of the central artery of the retina.

CONCLUSIONS

Our anatomic study innovates in 2 aspects of the CRA: area and curves. Not only was there a simple count of the number of curves, but it also analyzed the angle presented by each of the curves based on photos obtained in high definition, with a digital program to reduce the margin of error. These curvatures of the CRA were classified according to their spatial disposition within the orbital cavity based on a pattern that was easy to understand. Data were obtained from the area of the CRA on the penetration of the CRA into the dural sheath of the optic nerve.

Equine bone marrow mesenchymal stromal cells inhibit reactive oxygen species production by neutrophils without affecting other important microbicidal functions

Neutrophils (PMN) are the largest leukocyte population in the blood of most mammals including horses, playing an important defensive role in many infectious diseases. However, the mechanisms that increase PMN as one of the main cellular subsets in the defense against pathogens, could also be involved in the pathophysiology of dysregulated inflammatory conditions. Mesenchymal stem/stromal cells (MSCs) are a heterogeneous population with a modulatory potential on the inflammatory response, and are known to interact with nearly all cells of the immune system including PMN. In this study, we investigate the in vitro modulation of equine bone marrow-derived MSCs on phagocytosis, ROS production, and NETs generation from equine PMN. We found that in co-culture with MSCs, unstimulated PMN produces less ROS (2.88% ± 1.43) than PMN in single culture (5.89% ± 2.63); interestingly, co-cultured PMN remains conditioned to produce fewer ROS after PMA stimulation in comparison to PMN not cultured with MSCs. We also found that inhibition of ROS production by co-cultured PMN occurred not only after prolonged PMN-MSC co-incubation (4 hours), but also when MSC were present in the culture at the moment of adding the stimuli (30% less than control), suggesting that MSCs don’t only modulate PMN functions prior to their arrival to the inflammatory site, but also at the inflammatory niche itself. Additionally, we found that incubation with MSC supernatant strongly inhibited ROS production (83% ± 6.35 less than control) without affecting phagocytosis or capacity for NETosis. These results support the potential use of MSCs in equine inflammatory conditions where neutrophils are the main effector inflammatory cells

Tamoxifen inhibits chemokinesis in equine neutrophils

Neutrophils are terminally differentiated innate effector cells at the first line of host defense. Neutrophil migration within tissues is complex and involves several steps, during which these cells must be able to interpret a variety of chemical and physical signals. Exacerbated neutrophil activity can be harmful to surrounding tissues; this is important in a range of diseases, including equine asthma. Tamoxifen (TX) is a non-steroidal estrogen receptor modulator with effects on cell growth and survival. Previous studies showed that TX treatment in horses with induced acute pulmonary inflammation promoted early apoptosis of blood and bronchoalveolar lavage fluid (BALF) neutrophils, reduction of BALF neutrophil content, and improvement in animals’ clinical status. Further, TX dampens chemotactic index and respiratory burst production in vitro. The aim of this study was to provide information on the effect of TX on chemokinesis in peripheral blood neutrophils from five healthy horses. Results showed that neutrophils increased migration and travelled distance in response to IL-8; but in the presence of TX, IL-8 did not produce neutrophil migration. This suggests that TX has an inhibitory effect on the kinesis of equine peripheral blood neutrophils stimulated with IL-8. However, further studies are required to fully understand the signaling pathways of TX on neutrophil chemokinesis.

Tamoxifen induces apoptosis and inhibits respiratory burst in equine neutrophils independently of estrogen receptors

Neutrophils play an important role in the exacerbation and maintenance of severe equine asthma; persistent neutrophil activity and delayed apoptosis can be harmful to surrounding tissues. Tamoxifen (TX) is a nonsteroidal estrogen receptor modulator with immunomodulatory effects and induces early apoptosis of blood and bronchoalveolar lavage neutrophils from horses with acute lung inflammation. This study investigated if the in vitro effects of tamoxifen are produced by its action on nuclear (α and β) and membrane (GPR30) estrogen receptors in healthy equine neutrophils. Results showed that TX inhibits neutrophil respiratory burst induced by opsonized zymosan in a dose-dependent manner. Nuclear (17-β-Estradiol) and GPR30 cell membrane (G1) estrogen receptor agonists and their antagonists (ICI 182,780 and G15, respectively) do not block or reproduce the effect of TX. Therefore, TX does not inhibit respiratory burst through estrogen receptors. TX (8.5 μM) also increased phosphatidylserine translocation, a marker of early apoptosis, which did not occur with any of the estrogen receptor agonists or antagonists. Thus, tamoxifen generates dose-dependent inhibition of respiratory burst and increased early apoptosis in healthy equine neutrophils, independently of nuclear or membrane estrogen receptors. Further studies are necessary to explore the signaling pathways of tamoxifen-induced ROS inhibition and phosphatidylserine translocation.

Tamoxifen induces apoptotic neutrophil efferocytosis in horses

Macrophages and neutrophils are important cellular components in the process of acute inflammation and its subsequent resolution, and evidence increasingly suggests that they play important functions during the resolution of chronic, adaptive inflammatory processes. Exacerbated neutrophil activity can be harmful to surrounding tissues; this is important in a range of diseases, including allergic asthma and chronic obstructive pulmonary disease in humans, and equine asthma (also known as recurrent airway obstruction (RAO). Tamoxifen (TX) is a non-steroidal estrogen receptor modulator with effects on cell growth and survival. Previous studies showed that TX treatment in horses with induced acute pulmonary inflammation promoted early apoptosis of blood and BALF neutrophils, reduction of BALF neutrophils, and improvement in animals' clinical status. The aim of this study was to describe if TX induces in vitro efferocytosis of neutrophils by alveolar macrophages. Efferocytosis assay, myeloperoxidase (MPO) detection and translocation phosphatidylserine (PS) were performed on neutrophils isolated from peripheral blood samples from five healthy horses. In in vitro samples from heathy horses, TX treatment increases the phenomenon of efferocytosis of peripheral neutrophils by alveolar macrophages. Similar increases in supernatant MPO concentration and PS translocation were observed in TX-treated neutrophils, compared to control cells. In conclusion, these results confirm that tamoxifen has a direct effect on equine peripheral blood neutrophils, through stimulation of the engulfment of apoptotic neutrophils by alveolar macrophages.

In Vitro effects of tamoxifen on equine neutrophils

Neutrophils participate in innate immunity as the first line of host defense against microorganisms. However, exacerbated neutrophil activity can be harmful to surrounding tissues; this is important in a range of diseases, including allergic asthma and chronic obstructive pulmonary disease in humans, and equine asthma (also known as recurrent airway obstruction (RAO). Tamoxifen (TX) is a non-steroidal estrogen receptor modulator with effects on cell growth and survival. Previous preliminary studies showed that TX treatment in horses with induced acute pulmonary inflammation promoted early apoptosis of blood and BALF neutrophils, reduction of BALF neutrophils, and improvement in animals' clinical status. The aim of this study was to evaluate the in vitro effect of TX on functional tests in equine peripheral blood neutrophils. Chemotaxis, respiratory burst production and phagocytosis assays were performed on neutrophils isolated from peripheral blood samples from 10 healthy horses. Results showed that IL-8 stimulated cells decrease their chemotactic index when treated with TX (1 and 10μM). Respiratory burst production was also dampened after treatment with TX. In conclusion, these results confirm that tamoxifen has a direct action on equine peripheral blood neutrophils. However, more in vivo and in vitro studies are required to fully understand the mechanisms of action of TX on neutrophils, in order to elucidate if it can be used as treatment in disorders such as allergic asthma in humans and horses.

Scatter to volume registration for model-free respiratory motion estimation from dynamic MRIs

Respiratory motion is one major complicating factor in many image acquisition applications and image-guided interventions. Existing respiratory motion estimation and compensation methods typically rely on breathing motion models learned from certain training data, and therefore may not be able to effectively handle intra-subject and/or inter-subject variations of respiratory motion. In this paper, we propose a respiratory motion compensation framework that directly recovers motion fields from sparsely spaced and efficiently acquired dynamic 2-D MRIs without using a learned respiratory motion model. We present a scatter-to-volume deformable registration algorithm to register dynamic 2-D MRIs with a static 3-D MRI to recover dense deformation fields. Practical considerations and approximations are provided to solve the scatter-to-volume registration problem efficiently. The performance of the proposed method was investigated on both synthetic and real MRI datasets, and the results showed significant improvements over the state-of-art respiratory motion modeling methods. We also demonstrated a potential application of the proposed method on MRI-based motion corrected PET imaging using hybrid PET/MRI.

Safety assessment of a novel active ingredient, acetyl aspartic acid, according to the EU Cosmetics Regulation and the Scientific Committee on Consumer Safety guidelines

OBJECTIVE

Acetyl aspartic acid (A-A-A) was proposed as a new novel active ingredient for use in cosmetics. The safety of A-A-A was assessed by following an in-house-developed 'New Ingredient Testing Strategy', which was designed in accordance with the Scientific Committee on Consumer Safety (SCCS) notes of guidance and the requirements of Annex I of the EU Cosmetics Regulation. The aim of the project was to determine whether A-A-A was safe for use in cosmetics and to determine a maximum permitted safe level in the formulations.

METHODS

A literature review was conducted, consulting over 40 different information sources. This highlighted a number of gaps which required testing data. A-A-A was tested for phototoxicity according to OECD test guideline 432, skin irritation according to OECD test guideline 439 and eye irritation according to OECD test guideline 437. Dermal absorption of A-A-A was measured according to OECD test guideline 428 and was used to calculate the margin of safety (MoS). Finally, A-A-A was tested in a human repeat insult patch test (HRIPT) and a 14-day in-use tolerance study.

RESULTS

A-A-A was non-phototoxic and was non-irritating to skin and eyes in in vitro testing. Dermal absorption was calculated to be 5%. The MoS for A-A-A was 351, at a level of 5%, for all cosmetic product types, indicating no systemic safety toxicity concern. A-A-A at 5% under occlusive patch on a panel of 50 adult volunteers induced no skin irritation or allergic reaction in the HRIPT study. Finally, repeated application of A-A-A to the periocular area, twice per day for 14 days, in 21 female volunteers, demonstrated that 1% A-A-A was well tolerated following dermatological and ophthalmological assessment in a cosmetic formulation.

CONCLUSION

A-A-A was assessed as safe by the cosmetic safety assessor for use in cosmetics at a level of 5% in all cosmetic product types, in line with the requirements of the EU Cosmetics Regulation and in accordance with the SCCS notes of guidance.

The role of visceral and subcutaneous adipose tissue fatty acid composition in liver pathophysiology associated with NAFLD

Visceral adiposity is associated with type-2-diabetes, inflammation, dyslipidemia and non-alcoholic fatty liver disease (NAFLD), whereas subcutaneous adiposity is not. We hypothesized that the link between visceral adiposity and liver pathophysiology involves inherent or diet-derived differences between visceral and subcutaneous adipose tissue to store and mobilize saturated fatty acids. The goal of the present study was to characterize the fatty acid composition of adipose tissue triglyceride and portal vein fatty acids in relation to indices of liver dysregulation. For 8 weeks rats had free access to control (CON; 12.9% corn/safflower oil; 3.6 Kcal/g), high saturated fat (SAT; 45.2% cocoa butter; 4.5 Kcal/g) or high polyunsaturated fat (PUFA; 45.2% safflower oil; 4.5 Kcal/g) diets. Outcome measures included glucose tolerance, visceral and subcutaneous adipose tissue triglyceride, liver phospholipids and plasma (portal and systemic) free fatty acid composition, indices of inflammation and endoplasmic reticulum stress in the liver and adipose tissue depots and circulating adipo/cytokines. Hepatic triglycerides were significantly increased in both high fat diet groups compared to control and were significantly higher in PUFA compared to SAT. Although glucose tolerance was not different among diet groups, SAT increased markers of inflammation and ER stress in the liver and both adipose tissue depots. Fatty acid composition did not differ among adipose depots or portal blood in any dietary group. Overall, these data suggest that diets enriched in saturated fatty acids are associated with liver inflammation, ER stress and injury, but that any link between visceral adipose tissue and these liver indices does not involve selective changes to fatty acid composition in this depot or the portal vein.

Change in Atypical Maternal Behavior Predicts Change in Attachment Disorganization From 12 to 24 Months in a High-Risk Sample

This longitudinal study examined links between disorganization and atypical maternal behavior at 12 and 24 months in 71 adolescent mother-child dyads. Organized attachment and maternal not disrupted behavior were more stable than disorganization and disrupted behavior, respectively. At both ages, disorganization and maternal disrupted behavior were significantly correlated. Change in atypical maternal behavior predicted change in disorganization across time. The results provide substantial support for extant theories linking anomalous maternal behavior to the development of disorganized attachment. The Interesting-but-Scary paradigm, introduced in this study, promises to be a useful tool for assessing attachment and maternal behavior in toddlerhood.

A role for bioelectric effects in the induction of bystander signals by ionizing radiation?

The induction of "bystander effects" i.e. effects in cells which have not received an ionizing radiation track, is now accepted but the mechanisms are not completely clear. Bystander effects following high and low LET radiation exposure are accepted but mechanisms are still not understood. There is some evidence for a physical component to the signal. This paper tests the hypothesis that bioelectric or biomagnetic phenomena are involved. Human immortalized skin keratinocytes and primary explants of mouse bladder and fish skin, were exposed directly to ionizing radiation or treated in a variety of bystander protocols. Exposure of cells was conducted by shielding one group of flasks using lead, to reduce the dose below the threshold of 2mGy (60)Cobalt gamma rays established for the bystander effect. The endpoint for the bystander effect in the reporter system used was reduction in cloning efficiency (RCE). The magnitude of the RCE was similar in shielded and unshielded flasks. When cells were placed in a Faraday cage the magnitude of the RCE was less but not eliminated. The results suggest that liquid media or cell-cell contact transmission of bystander factors may be only part of the bystander mechanism. Bioelectric or bio magnetic fields may have a role to play. To test this further, cells were placed in a Magnetic Resonance Imaging (MRI) machine for 10 min using a typical head scan protocol. This treatment also induced a bystander response. Apart from the obvious clinical relevance, the MRI results further suggest that bystander effects may be produced by non-ionizing exposures. It is concluded that bioelectric or magnetic effects may be involved in producing bystander signaling cascades commonly seen following ionizing radiation exposure.

Impact of Insertions in the HIV-1 P6 Ptapp Region on the Virological Response to Amprenavir

We evaluated the impact of genetic changes within p6Gag gene on the virological response (VR, mean decrease in plasma viral load at week 12) to unboosted amprenavir (APV). Gag-protease fragments, including gag p2, p7, p1, p6 regions and whole protease (PR) were sequenced from baseline plasma specimens of 84 highly pre-treated but APV-naive patients included in the NARVAL (ANRS 088) trial. The correlation between baseline p6Gag polymorphism, PR mutations, baseline characteristics and VR to APV was analysed in univariate analysis. Insertions (P459Ins) within p6 protein, leading to partial or complete duplication of the PTAPP motif, were significantly associated with a decreased VR (P459Ins versus wild-type; –0.3 ±0.8 vs –1.1 ±1.2 log copies/ml, P=0.007) and were more frequent when the V82A/F/T/S PR mutation was present ( P=0.020). In multivariate analysis, after adjustment on the predictive factors of the VR in the NARVAL trial and on the PR mutations linked with response, there was a strong trend to an association ( P=0.058) between the presence of P459Ins and an altered VR. In conclusion, these results suggest that insertions in the p6 region of HIV-1 gag gene may affect the VR, in highly pre-treated patients receiving an unboosted APV-containing regimen.

The similarity of siblings' attachments to their mother

Do siblings develop similar attachment relationships with their mother? Attachment theory suggests that brothers and sisters growing up in the same family are likely to relate in similar ways to their parents, at least when parental attachment representations and interactive styles remain stable across time. In the current study, sibling attachment data from three research groups (from Pennsylvania State University, Leiden University, and the University of Western Ontario) have been pooled to assemble a sufficiently large sample of observations (N = 138 sibling pairs) for a detailed comparison of sibling attachment relationships. Spacing between the births, differences in maternal sensitivity, and gender of siblings were examined as possible sources of concordance of nonconcordance. Attachment security (including disorganized attachment) of each sibling was assessed with the Strange Situation procedure between 12 and 14 months after birth. Maternal sensitivity was observed with the same rating scale in a laboratory play session in one of the studies and in home observations in the others. Sibling relationships were found to be significantly concordant when classified as secure/nonsecure (62% concordance, p < .01, 1-tailed, intraclass correlation = .23) but not when further subcategorized. Maternal insensitivity to both siblings (shared environment) was associated with concordance of sibling nonsecurity. Siblings of the same gender were more likely to form concordant relationships with their mother (68%; p < .01, 1-tailed, intraclass correlation = .37) than those of opposite gender. Same-sex sibling concordance was comparable to the concordance found for monozygotic twins in earlier studies. Genetic factors may, therefore, play a relatively small role in the development of attachment.

Ainsworth revisited: an empirical analysis of interactive behavior in the home

Naturalistic assessment of maternal and infant interactive behavior using q-sorts has typically focused on rationally derived variables, such as maternal sensitivity and infant security. In the current study, behavior profiles characteristic of groups of young and adult mothers and their infants were derived empirically through q-factor analysis of the Maternal Behavior Q-sort (Version 3.0) and the Attachment Q-sort (Version 3.0). A three-factor solution best described the behavior profiles characteristic of young mothers. The identified factors were labeled: 'ignoring/neglecting versus interacting', 'accepting versus hostile/rejecting', and 'interfering'. The behavior of adult mothers was less variable and was described with only one factor, which corresponded to the 'accepting versus hostile/rejecting' factor. The factor solutions for infants of young and adult mothers were similar, with four identified factors, or behavioral profiles, discriminating between groups of infants with similar patterns of behavior: 'secure with mother', 'prefers visitor', 'socially withdrawn' and 'demanding with mother'. Infants of young and adult mothers differed with regard to their mean values on the first two identified factors. Results provide support for the relevance of rationally derived domains and criterion sorts in populations of both adult and young mothers, and suggest ways of progressing beyond the currently used, rationally derived variables in assessments of maternal and infant behavior in high- and low-risk populations.

Maternal attachment representations, maternal sensitivity, and the infant-mother attachment relationship

The role of maternal sensitivity as a mediator accounting for the robust association between maternal attachment representations and the quality of the infant-mother attachment relationship was examined. Sixty mother-infant dyads were observed at home and in the Strange Situation at 13 months, and mothers participated in the Adult Attachment Interview (AAI) within the next 6 months. A strong association was found between AAI and Strange Situation classifications, and autonomous mothers were more sensitive at home than were nonautonomous mothers. Mothers in secure relationships were more sensitive at home than mothers in nonsecure relationships. Likewise, infants in secure relationships were more secure as assessed by the Waters' Attachment Q sort than infants in nonsecure relationships. A test of the mediational model revealed that maternal sensitivity accounted for 17% of the relation between AAI and Strange Situation classifications.

Maternal attachment representations, maternal sensitivity, and the infant-mother attachment relationship

The role of maternal sensitivity as a mediator accounting for the robust association between maternal attachment representations and the quality of the infant-mother attachment relationship was examined. Sixty mother-infant dyads were observed at home and in the Strange Situation at 13 months, and mothers participated in the Adult Attachment Interview (AAI) within the next 6 months. A strong association was found between AAI and Strange Situation classifications, and autonomous mothers were more sensitive at home than were nonautonomous mothers. Mothers in secure relationships were more sensitive at home than mothers in nonsecure relationships. Likewise, infants in secure relationships were more secure as assessed by the Waters' Attachment Q sort than infants in nonsecure relationships. A test of the mediational model revealed that maternal sensitivity accounted for 17% of the relation between AAI and Strange Situation classifications.

NMR relaxation studies of porous sol-gel glasses

2H relaxation times T1, T1 rho and T2 for D2O in silica sol-gels are used to monitor porosity and surface interactions within the silica framework as a function of aging. Tetramethoxysilane gels are compared with composites containing low levels of poly(vinyl alcohol) (PVA) prepared under acidic conditions. Non-exponential decay of magnetisation in T1 rho and T2 experiments is attributed to the fractal nature of the pore structure.

Predictors of psychosocial adjustment in patients with implantable cardioverter defibrillators

Predictors of psychological distress/adjustment were examined in 25 patients following placement of ICDs. Patients completed a demographic questionnaire and a standardized questionnaire of psychological symptoms (i.e., Symptom Checklist-90 Revised; SCL-90-R). The number of discharges categorized by the patient as inappropriate and appropriate were also ascertained. The number of ICD discharges categorized as inappropriate and diminished levels of physical activity (r = 0.53 and 0.63, P < 0.01, respectively) did significantly relate to overall psychological distress. In addition, after controlling for age and prior psychiatric and physical health status through a stepwise multiple regression analysis, the occurrence of ICD discharges categorized as inappropriate and diminished physical activity continued to significantly predict overall psychological distress (R2 = 0.41, P < 0.01). However, the number of ICD discharges categorized as appropriate did not significantly predict overall psychological distress. The results of this investigation suggest that further refinement of the ICD could reduce the risk of exposure to potential psychological distress, and an analysis of prior and anticipated patient physical activity levels should be a factor when calibrating minimum ICD discharge threshold levels.

Molecular and phenotypic analysis of Candida dubliniensis: a recently identified species linked with oral candidosis in HIV-infected and AIDS patients

The discovery and characterisation of a novel species of Candida, termed Candida dubliniensis, associated with oral candidosis in HIV-infected individuals is described. These organisms share several phenotypic characteristics in common with Candida albicans and Candida stellatoidea, including the ability to produce germ tubes and chlamydospores. However, in contrast to these latter two species, C. dubliniensis isolates produce abundant chlamydospores, which are often arranged in contiguous pairs, triplets and other multiples suspended from a single suspensor cell. They belong to C. albicans serotype A and exhibit atypical substrate assimilation profiles. Genomic DNA fingerprinting analysis with the C. albicans-specific probe 27A and five different oligonucleotide probes consisting of short repeat sequence-containing motifs, demonstrated that C. dubliniensis has a distinct genomic organisation relative to C. albicans and C. stellatoidea. This was confirmed by karyotype analysis and random amplified polymorphic DNA (RAPD) analysis. Comparison of 500 bp of the V3 variable region of the large ribosomal subunit genes from 14 separate C. dubliniensis isolates and the corresponding sequences from C. albicans, C. stellatoidea, C. tropicalis, C. glabrata, C. parapsilosis, C. kefyr and C. krusei demonstrated that the C. dubliniensis isolates formed a homogenous cluster (100% similarity), representing a discrete taxon within the genus Candida that was significantly different from the other species analysed.

Hostility predicts restenosis after percutaneous transluminal coronary angioplasty

OBJECTIVE

To investigate the "toxic" total (potential for) hostility component of the type A behavior pattern (assessed by means of the structured interview) as it relates to prediction of restenosis after percutaneous transluminal coronary angioplasty (PTCA).

DESIGN

Patients with single vessel or multivessel coronary artery disease in whom PTCA had been scheduled or done were administered the structured interview by one trained interviewer prospectively or retrospectively (blinded to angiographic endpoints).

MATERIAL AND METHODS

A total of 41 patients underwent 53 initial balloon dilations on native arteries by 1 of 5 participating cardiologists. Inclusion criteria for this study were a successful initial PTCA and post-PTCA recatheterization if a patient complained of ischemic symptoms possibly related to restenosis.

RESULTS

Of the 41 patients, 15 (36.6%) had restenoses at a total of 18 previous angioplasty sites. Patients with high total (potential for) hostility ratings were almost 2.5 times more likely to have restenosis than those with low total (potential for) hostility scores (95% confidence interval = 1.03 to 5.32). Logistic regression revealed that total (potential for) hostility scores predicted post-PTCA restenosis overall as well as when adjusted for gender and race. Total (potential for) hostility scores were also positively associated with the number of arteries restenosed (P = 0.01).

CONCLUSION

This is the first report of type A total (potential for) hostility behavior conferring an increased risk for restenosis after PTCA. Its modification may be effective in reducing recurrent cardiac events. A coronary-prone behavior modification program for patients with persistent, same-site restenosis after PTCA has been initiated.

Persistence, replacement, and microevolution of Cryptococcus neoformans strains in recurrent meningitis in AIDS patients

Six separate human immunodeficiency virus-positive patients with cryptococcal meningitis were each found to have been infected with a unique strain of Cryptococcus neoformans on the basis of genomic DNA finger-printing analysis with the microsatellite sequence-containing oligonucleotide probe (GGAT)4 and by random amplification of polymorphic DNA. Two patients (A and B) experienced a recurrent episode of infection. Between 12 and 16 single-colony isolates recovered from primary isolation media (> 50% of C. neoformans colonies recovered) from cerebrospinal fluid specimens were fingerprinted from both patients during each episode. The fingerprints of both isolate collections from patient B were very similar, although minor polymorphisms were evident in both sets of profiles. The fingerprints of the isolate collection from the initial episode of infection in patient A were also identical to each other, apart from minor polymorphisms, but they were clearly different from the corresponding profiles of the isolate collection from the recurrent episode, the latter of which were completely identical, apart from minor polymorphisms in a single isolate. Furthermore, prolonged storage and in vitro subculture of the isolates did not alter the fingerprint profiles. These results provided convincing evidence that patients A and B were each infected with a single C. neoformans strain during each episode of infection and that in patient B, the same strain persisted and caused both episodes, while in patient A, a different strain was responsible for each episode. The prevalence of polymorphisms in multiple single-colony isolates from both patients also suggested that C. neoformans populations may undergo microevolution.

Expressions of the attachment relationship outside of the strange situation

41 preterm infants and 38 full-term infants and their mothers were observed at home at 8 and 12 months of age and in the Strange Situation at 18 months in order to compare expressions of attachment relationships in these 2 settings. There was 84% concordance in the distinctions between secure and nonsecure classifications of the mother-infant relationship made at home at 12 months and in the Strange Situation. Classifications of avoidant relationships also displayed high concordance, but only 6 of the 15 dyads classified at home as ambivalent were classified in the same way in the Strange Situation. Mothers in secure relationships as assessed in the Strange Situation were rated as more sensitive at both 8 and 12 months than mothers in either avoidant or ambivalent relationships, whereas the sensitivity of mothers in these two nonsecure relationships did not differ significantly. Infants in secure relationships in the Strange Situation were characterized by more effective secure base behavior and more affective sharing and enjoyment of physical contact, and they were less fussy or difficult during the 12-month home observations.

Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use

The bacteriology of cutaneous or subcutaneous abscesses (86 specimens) among intravenous drug users (IVDUs) was compared with the bacteriology of abscesses (74 specimens) in patients with no history of intravenous drug use (non-IVDUs). The IVDU abscesses yielded 173 aerobes and 131 anaerobes. Staphylococcus aureus was the most common aerobe isolated (50% of specimens yielded this isolate), followed by "Streptococcus milleri" (46%). The commonly encountered anaerobes were Fusobacterium nucleatum (17%), pigmented Prevotella species (22%), Peptostreptococcus micros (17%), Actinomyces odontolyticus (15%), and Veillonella species (13%). The non-IVDU isolates included 116 aerobes and 106 anaerobes. S. aureus was isolated from 53% of these specimens, followed by coagulase-negative staphylococci (19%), "S. milleri" (19%), and Streptococcus pyogenes (16%). The main groups of anaerobes were Peptostreptococcus species (35%), Bacteroides species (19%), and gram-positive bacilli (31%). Overall, 67% of the IVDU isolates were of oral origin, compared with 25% of the non-IVDU isolates. Of the specimens from IVDUs and non-IVDUs, 48% and 67%, respectively, yielded only aerobes, and 2% and 4%, respectively, yielded only anaerobes. Sixty-four percent of the patients had one or more beta-lactamase-producing organisms.

Measuring the ghost in the nursery: an empirical study of the relation between parents' mental representations of childhood experiences and their infants' security of attachment

This paper presents a summary of the Anna Freud Centre-University College London, Parent-Child Project. Its most important finding was that the security of the infants' relationship with both parents at 12 and 18 months could be predicted on the basis of qualitative aspects of the parents' accounts of their own childhoods collected before the birth of the child. This confirmed Selma Fraiberg's observations concerning the reemergence of childhood conflicts at early stages of childbearing. Possible mechanisms mediating this link are explored with particular reference to the role of the parents' accurate mental representations of the infants' mental world.

Effect of the cyanobacterial (blue-green algal) toxins from Microcystis aeruginosa on isolated enterocytes from the chicken small intestine

Livestock deaths, and clinical reports of human injury, follow the consumption of toxic blue-green algae. The experiments described show that isolated intestinal enterocytes from chicks are both deformed and killed by exposure to Microcystis toxins, in a dose-dependent and time-dependent manner. The enterocytes were protected from toxicity by deoxycholate, bromosulphothalein and rifampicin. It was concluded that the gastroenteritis clinically associated with accidental Microcystis ingestion is likely to reflect enterocyte injury by Microcystis toxins, and that the therapeutic use of bile acids or transport inhibitors may be of value in treatment.

A controlled study of psychoanalytic treatment of brittle diabetes

The study compared two equivalent groups of 11 diabetic children with grossly abnormal blood glucose profiles necessitating repeated admissions to a hospital. Patients in the treatment group were offered an intensive inpatient treatment program including psychoanalytic psychotherapy three to four times a week, which took place on the hospital ward and lasted an average of 15 weeks. The intervention was highly effective in improving the diabetic control of the children, and this was maintained at a 1 year follow-up. Patients in the comparison group, who were offered only inpatient medical intervention, returned to their prehospitalization level of metabolic control within a period of 3 months from discharge.

Reflections on the aim of child analysis

Childhood disturbances can best be studied in a developmental frame of reference. Following Anna Freud, the authors distinguish between outcome aims and intermediary aims. They present the analyses of a child and an adolescent to demonstrate how these aims affect the nature and progression of treatment.