Help-Seeking After Intimate Partner or Sexual Violence: Exploring the Experiences of International Student Women in Australia

Research suggests that many international students experience intimate partner violence (IPV) or sexual violence (SV) whilst attending tertiary institutions. Yet, little is known about how they engage in help-seeking and what types of support they need following IPV/SV. In this paper, we present findings from a qualitative analysis of 30 in-depth interviews with international student women who experienced SV/IPV while studying in Australia. The findings highlight how isolation and structural factors can create significant barriers to help-seeking for international student women. Yet, the findings also highlight the agency and resourcefulness of international student women in overcoming challenges. The provision of culturally and linguistically appropriate and tailored support for international students is crucial in order to help reduce the harms of SV/IPV.

SPADE4: Sparsity and Delay Embedding Based Forecasting of Epidemics

Predicting the evolution of diseases is challenging, especially when the data availability is scarce and incomplete. The most popular tools for modelling and predicting infectious disease epidemics are compartmental models. They stratify the population into compartments according to health status and model the dynamics of these compartments using dynamical systems. However, these predefined systems may not capture the true dynamics of the epidemic due to the complexity of the disease transmission and human interactions. In order to overcome this drawback, we propose Sparsity and Delay Embedding based Forecasting (SPADE4) for predicting epidemics. SPADE4 predicts the future trajectory of an observable variable without the knowledge of the other variables or the underlying system. We use random features model with sparse regression to handle the data scarcity issue and employ Takens' delay embedding theorem to capture the nature of the underlying system from the observed variable. We show that our approach outperforms compartmental models when applied to both simulated and real data.

POS1269 THE UTILITY OF ULTRASOUND TO PREDICT PATIENT OUTCOMES IN SHOULDER PAIN: A PROSPECTIVE OBSERVATIONAL STUDY OF 500 PATIENTS

Background:

Shoulder pain is common and persistent, with a large socioeconomic burden. Ultrasound (US) scans are used for diagnosing and managing shoulder pain, but the extent to which it informs management and improves outcomes is unknown. A recent retrospective study identified groups with different patterns of US pathologies.

Objectives:

To confirm the existence of US-based groups of shoulder pain and determine if US-detected pathology (grouped or individual) predicts outcomes in the context of usual care. Response to local steroid injection was also evaluated.

Methods:

This was a 6 month, prospective, single centred, community based, observational cohort study. Inclusion: shoulder pain, ≥18 years, first shoulder US. Exclusion: shoulder surgery, inflammatory arthritis, steroid/physiotherapy in prior 6 weeks. Standardised reporting for 10 US pathologies was employed. Latent class analysis (LCA) identified pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and 6-month Shoulder Pain and Disability Index (SPADI). Growth mixture modelling (GMM) identified groups with common trajectories of change.

Results:

Of 500 patients (mean age 53.6; 52% female), 330 completed follow-up. LCA identified 4 groups: bursitis without acromioclavicular joint degeneration (ACJD) (group 1), bursitis with ACJD (group 2), rotator cuff tear (group 3), no bursitis/tear (group 4). SPADI was higher at baseline for tears (55.1 vs. 49.7-51.3) (overall p=0.005), but groups did not differ at 6 months (p=0.379) (Table 1). No individual pathologies predicted 6-month outcomes. Response to baseline injection at week 2 did not differ between groups (p=0.423). GMM found 4 trajectories; the majority of patients followed trajectory 1 (little change), irrespective of US pathology group (79%, 77%, 87%, 70% of US groups 1-4 respectively) (Figure 1).

Conclusion:

This is the largest prospective study involving US of symptomatic shoulders, and the first to investigate groups with distinct patterns of US pathologies in predicting outcome. US-based classification of pathology (as groups or individually) did not predict 6-month outcomes with current treatments and there were no differences in short-term response to steroids between groups. The role of routine diagnostic US for shoulder pain needs consideration; it may be useful if evidence-based therapies for specific pathologies are established.

Table 1.

Predictors of SPADI score at 6 months

Baseline characteristicCoefficient* (95% CI), p-valuePathology group:Bursitis w/o ACJ degeneration (group 1)ReferenceBursitis with ACJ degeneration (group 2)0.08 (-5.15, 5.32), p=0.975RC tear (group 3)5.01 (-1.48, 11.50), p=0.130No bursitis, no RC tear (group 4)1.98 (-4.00, 7.96), p=0.516Injection at scan4.87 (0.40, 9.34), p=0.033Age, years-0.01 (-0.17, 0.15), p=0.898Female-1.51 (-5.42, 2.40), p=0.448Symptom duration, months0.00 (-0.04, 0.05), p=0.879Uses arms to rise from chair2.65 (-1.50, 6.81), p=0.210Physiotherapy before baseline-0.23 (-4.78, 4.31), p=0.9201 injection before baseline2.35 (-2.87, 7.56), p=0.377≥2 injections before baseline6.53 (-2.50, 15.57), p=0.156Total SPADI0.62 (0.35, 0.89), p<0.001Shoulder activity score-0.59 (-1.15, -0.04), p=0.037P-SEQ score-0.20 (-0.46, 0.07), p=0.141Brief IPQ score0.19 (-0.16, 0.54), p=0.298HADS score0.01 (-0.38, 0.41), p=0.947Constant**35.44 (29.50, 41.38), p<0.001

*Interpreted as unit difference in Rasch-transformed SPADI score per 1 additional unit of the independent variable **Estimated SPADI at 26 weeks in patients in the reference category for all categorical variables and with mean values for continuous covariates. ACJ=acromioclavicular joint; HADS=hospital anxiety and depression scale; IPQ=illness perception questionnaire; P-SEQ=pain self-efficacy questionnaire; RC=rotator cuff; SPADI=shoulder pain and disability index

Figure 1.

Trajectories of total SPADI over time by the pathology groups found and response to injections

Acknowledgements:

This research was funded by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) and by a NIHR Doctoral Research Fellowship (GT; DRF-2016-09-159). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also part-funded through the Arthritis Research UK Leeds Experimental Osteoarthritis Treatment Centre (20083).

Disclosure of Interests:

None declared

Activation of naive CD4+CD25+FOXP3+Treg by specific autoantigen and Th2 cytokines IL-4 and IL-5 induces autoantigen specific Treg that inhibit EAE

CD4+CD25+FOXP3+Treg (tTreg) protect against induction of autoimmunity, but fresh naïve or ex vivo expanded tTreg have limited ability to control established autoimmunity. We have examined pathways of naïve tTreg activation by antigen and Th2 cytokines IL-4 and IL-5. First, IL-4 and antigen induce Ts2 cells that express IL-5Ralpha. In a second step, IL-5, not IL-4, and antigen induce Ts2 cells to Th2-like Treg.

EAE was induced in Lewis rats by immunization with myelin basic protein (MBP) in Freund’s complete adjuvant. Naïve CD4+CD25+Treg cultured with MBP and IL-4 for 4d produced Ts2 cells. To produce Th2-like Treg, Ts2 cells were cultured with IL-5 and MBP for 4d. Cells were assessed by FACS, RT-PCR and ability to suppress EAE.

5×106 Ts2 or 1×106 Th2-like Treg were given ivi 9d post-immunization. Ts2 cells activated by MBP, but not those activated by renal tubular antigen, suppressed EAE between 11 and 16d post-immunization. Clinical score: 0.1±0.5(n=6) in treated vs 1.5±2.7(n=13) in controls at 12d (p&lt;0.01); 1.3±0.7 vs 2.5±0.8 at 13d (p&lt;0.001). Onset of EAE was delayed, peak disease score reduced, as was weight loss. Naïve tTreg had no effect on EAE.

Th2-like Treg had no effect on the onset until 14d when there was rapid recovery with no weakness from 15–21d. Controls did not recover until 22d.

The Ts2 and Th2-like Treg were 99% CD4+, 98% CD25+ and 70–80% FOXP3+. Naïve tTreg expressed no il5ra whereas Ts2 and Th2-like Treg expressed Il5ra. Th2-like Treg had higher Foxp3, irf4 and gata3.

Ex vivo culture of naïve tTreg with IL-4 and autoantigen induces antigen-specific Treg that can control established autoimmune responses. These Ts2 cells further activated by culture with IL-5 and MBP also control autoimmunity. Both cells may have therapeutic potential.

Th2 cytokines and specific donor alloantigen activated CD4+CD25+T cells reverse chronic rejection: role of IL-4 and IL-5 in promoting antigen-specific Treg

Naïve CD4+CD25+Foxp3+T regulatory cells (tTreg) activated by specific alloantigen (Ag) and IL-4 express IL-5Ralpha. We examined if IL-5 treatment activated alloAg specific Treg to prevent chronic rejection in F344 rats grafted with Lewis hearts. 5000units rIL-5 (rIL-5Rx) was given daily from 7d after grafting when rejection had started. Changes in CD4+CD25+T cells were assessed by FACS, RT-PCR of Il5ra and response to alloAg in MLC.

Sham Rx rats fully rejected their grafts by 28d while IL-5Rx for 10d reversed rejection and grafts survived 60d (p&lt;0.01). There were rejection episodes after stopping IL-5 but continued IL-5Rx reduced this. Pre-treatment with anti-CD25 or anti-IL-4 mAb abolished the benefit of rIL-5Rx, all grafts rejected by 28d. IL-5 treated hosts had increased CD4+CD25+T cells, 6–8% vs 3–4% in controls. After 10d of rIL-5Rx, host CD4+CD25+T cells responded to Lewis but not to F344 or third-party PVG alloAg in MLC, showing activation of alloAg-specific Treg. CD4+CD25+T cells from rats treated for 50d with rIL-5 had more il5ra, remained FOXP3+ and in MLC rIL-5 enhanced responses to Lewis but not other alloAg. These findings are consistent with IL-4 and alloAg activating tTreg to induce Ag-specific Treg that suppress rejection.

To demonstrate rIL-4 and specific alloantigen activated naïve tTreg to suppress rejection, these cells were prepared ex vivo. 5×106 of these IL-4 alloAg activated tTreg, given after rejection commenced, reversed rejection. 5×106 fresh naïve tTreg or 5×106 tTreg activated by third-party PVG alloAg had no effect on rejection.

IL-5 prevented heart graft rejection through hosts’ CD25+Treg that had been activated by alloAg and IL-4. IL-5 therapy may have potential to prevent chronic allograft rejection.

Recently alloactivated CD4+CD8−CD25+T regulatory cells express CD8alpha and are potent suppressor cells

Therapy with antigen-specific CD4+CD25+ T regulatory cells (Treg) for induction of transplant tolerance is desirable, as naïve thymic Treg (tTreg) are non-antigen specific and weak suppressor cells. Naïve tTreg from DA rats cultured with fully allogeneic PVG stimulator cells and IL-2 express IFN-gamma receptor (IFNGR) and IL-12 receptor beta2 (IL-12Rb2) and are more potent alloantigen-specific regulators that we call Ts1 cells.

This study examined other markers that could identify the activated alloantigen-specific Treg as a subpopulation within the CD4+CD25+Foxp3+Treg. After culture of naïve DA CD4+CD8−CD25+T cells with rIL-2 and PVG alloantigen, CD8a was expressed on 10–20% and CD8b on &lt;5% of these cells. RT-PCR showed the CD8+ cells had increased Ifngr that characterizes Ts1 cells as well was Irf4, a transcription factor induced by TCR activation. Proliferation induced by re-culture with rIL-12 and alloantigen was greater with CD4+CD8+CD25+Treg consistent with the CD8a+ cells expressing IL-12R. In MLC, the CD8+ fraction had greater suppression than the mixed Ts1 population, whereas the CD4+CD8−CD25+T cells had less suppression. In an adoptive transfer assay, rIL-2 and alloantigen activated Treg suppress rejection at a ratio of 1:10 with naïve effector cells, whereas alloantigen and rIL-2 activated tTreg depleted of the CD8a cells did not prevent rejection.

This study showed the expression of CD8alpha by rIL-2 and alloantigen activation of CD4+CD8−CD25+Foxp3+T cells was a marker of alloantigen-specific Treg and may be of use to enrich alloantigen-specific Treg.

A Brain-Derived Neurotrophic Factor-Based p75NTR Peptide Mimetic Ameliorates Experimental Autoimmune Neuritis Induced Axonal Pathology and Demyelination

Axonal damage and demyelination are major determinants of disability in patients with peripheral demyelinating neuropathies. The neurotrophin family of growth factors are essential for the normal development and myelination of the peripheral nervous system (PNS), and as such are potential therapeutic candidates for ameliorating axonal and myelin damage. In particular, BDNF promotes peripheral nerve myelination via p75 neurotrophin receptor (p75NTR) receptors. Here, we investigated the therapeutic efficacy of a small structural mimetic of the region of BDNF that binds to p75NTR (cyclo-dPAKKR) in experimental autoimmune neuritis (EAN), an established animal model of peripheral demyelinating neuropathy. Examination of rodents induced with EAN revealed that p75NTR is abundantly expressed in affected peripheral nerves. We found that systemic administration of cyclo-dPAKKR ameliorates EAN disease severity and accelerates recovery. Animals treated with cyclo-dPAKKR displayed significantly better motor performance compared to control animals. Histological assessment revealed that cyclo-dPAKKR administration limits the extent of inflammatory demyelination and axonal damage, and protects against the disruption of nodal architecture in affected peripheral nerves. In contrast, a structural control peptide of cyclo-dPAKKR exerted no influence. Moreover, all the beneficial effects of cyclo-dPAKKR in EAN are abrogated in p75NTR heterozygous mice, strongly suggesting a p75NTR-dependent effect. Taken together, our data demonstrate that cyclo-dPAKKR ameliorates functional and pathological defects of EAN in a p75NTR-dependant manner, suggesting that p75NTR is a therapeutic target to consider for future treatment of peripheral demyelinating diseases and targeting of p75NTR is a strategy worthy of further investigation.

Experimental Investigation of the Collective Raman Scattering of Multiple Laser Beams in Inhomogeneous Plasmas

Experiments have been performed evidencing significant stimulated Raman sidescattering (SRS) at large angles from the density gradient. This was achieved in long scale-length high-temperature plasmas in which two beams couple to the same scattered electromagnetic wave further demonstrating for the first time this multiple-beam collective SRS interaction. The collective nature of the coupling and the amplification at large angles from the density gradient increase the global SRS losses and produce light scattered in novel directions out of the planes of incidence of the beams. These findings obtained in plasmas conditions relevant of inertial confinement fusion experiments similarly apply to the more complex geometry of these experiments where anomalously large levels of SRS were measured.

Fiber Orientation and Compartment Parameter Estimation From Multi-Shell Diffusion Imaging

Diffusion MRI offers the unique opportunity of assessing the structural connections of human brains in vivo. With the advance of diffusion MRI technology, multi-shell imaging methods are becoming increasingly practical for large scale studies and clinical application. In this work, we propose a novel method for the analysis of multi-shell diffusion imaging data by incorporating compartment models into a spherical deconvolution framework for fiber orientation distribution (FOD) reconstruction. For numerical implementation, we develop an adaptively constrained energy minimization approach to efficiently compute the solution. On simulated and real data from Human Connectome Project (HCP), we show that our method not only reconstructs sharp and clean FODs for the modeling of fiber crossings, but also generates reliable estimation of compartment parameters with great potential for clinical research of neurological diseases. In comparisons with publicly available DSI-Studio and BEDPOSTX of FSL, we demonstrate that our method reconstructs sharper FODs with more precise estimation of fiber directions. By applying probabilistic tractography to the FODs computed by our method, we show that more complete reconstruction of the corpus callosum bundle can be achieved. On a clinical, two-shell diffusion imaging data, we also demonstrate the feasibility of our method in analyzing white matter lesions.

Defect-Tolerant Aligned Dipoles within Two-Dimensional Plastic Lattices

Carboranethiol molecules self-assemble into upright molecular monolayers on Au{111} with aligned dipoles in two dimensions. The positions and offsets of each molecule's geometric apex and local dipole moment are measured and correlated with sub-Ångström precision. Juxtaposing simultaneously acquired images, we observe monodirectional offsets between the molecular apexes and dipole extrema. We determine dipole orientations using efficient new image analysis techniques and find aligned dipoles to be highly defect tolerant, crossing molecular domain boundaries and substrate step edges. The alignment observed, consistent with Monte Carlo simulations, forms through favorable intermolecular dipole-dipole interactions.

Fast local trust region technique for diffusion tensor registration using exact reorientation and regularization

Diffusion tensor imaging is widely used in brain connectivity research. As more and more studies recruit large numbers of subjects, it is important to design registration methods which are not only theoretically rigorous, but also computationally efficient. However, the requirement of reorienting diffusion tensors complicates and considerably slows down registration procedures, due to the correlated impacts of registration forces at adjacent voxel locations. Based on the diffeomorphic Demons algorithm (Vercauteren , 2009), we propose a fast local trust region algorithm for handling inseparable registration forces for quadratic energy functions. The method guarantees that, at any time and at any voxel location, the velocity is always within its local trust region. This local regularization allows efficient calculation of the transformation update with numeric integration instead of completely solving a large linear system at every iteration. It is able to incorporate exact reorientation and regularization into the velocity optimization, and preserve the linear complexity of the diffeomorphic Demons algorithm. In an experiment with 84 diffusion tensor images involving both pair-wise and group-wise registrations, the proposed algorithm achieves better registration in comparison with other methods solving large linear systems (Yeo , 2009). At the same time, this algorithm reduces the computation time and memory demand tenfold.

Handling of missing data to improve the mining of large feed databases

Feed databases often have missing data. Despite their potentially major effect on data analysis (e.g., as a source of biased results and loss of statistical power), database managers and nutrition researchers have paid little attention to missing data. This study evaluated various methods of handling missing data using mining outputs from a database containing data on chemical composition and nutritive value for 18,864 alfalfa samples. A complete reference dataset was obtained comprising the 2,303 cases with no missing data for the attributes CP, crude fiber (CF), NDF, ADF and ADL. This dataset was used to simulate 2 types of missing data (at random and not at random), each with 2 loss intensities (33 and 66%), thus yielding a total of 4 incomplete datasets. Missing data from these datasets were handled using 2 deletion methods and 4 imputation methods, and outputs in terms of the identification and typing of alfalfa (using ANOVA and descriptive statistics) and of correlations between attributes (using regressions) were compared with outputs from the complete dataset. Imputation methods, particularly model-based versions, were found to perform better than deletion methods in terms of maximizing information use and minimizing bias although the extent of differences between methods depended on the type of missing data. The best approximation to the uncertainty value was provided by multiple imputation methods. It was concluded that the choice of the most suitable method for handling missing data depended both on the type of missing data and on the purpose of data analysis.

The spectrum of central nervous system infections in an adult referral hospital in Hanoi, Vietnam

Objectives

To determine prospectively the causative pathogens of central nervous system (CNS) infections in patients admitted to a tertiary referral hospital in Hanoi, Vietnam.

Methods

From May 2007 to December 2008, cerebrospinal fluid (CSF) samples from 352 adults with suspected meningitis or encephalitis underwent routine testing, staining (Gram, Ziehl-Nielsen, India ink), bacterial culture and polymerase chain reaction targeting Neisseria meningitidis, Streptococcus pneumoniae, S. suis, Haemophilus influenzae type b, Herpes simplex virus (HSV), Varicella Zoster virus (VZV), enterovirus, and 16S ribosomal RNA. Blood cultures and clinically indicated radiology were also performed. Patients were classified as having confirmed or suspected bacterial (BM), tuberculous (TBM), cryptococcal (CRM), eosinophilic (EOM) meningitis, aseptic encephalitis/meningitis (AEM), neurocysticercosis and others.

Results

352 (male: 66%) patients were recruited: median age 34 years (range 13–85). 95/352 (27.3%) diagnoses were laboratory confirmed and one by cranial radiology: BM (n = 62), TBM (n = 9), AEM (n = 19), CRM (n = 5), and neurocysticercosis (n = 1, cranial radiology). S. suis predominated as the cause of BM [48/62 (77.4%)]; Listeria monocytogenese (n = 1), S. pasteurianus (n = 1) and N. meningitidis (n = 2) were infrequent. AEM viruses were: HSV (n = 12), VZV (n = 5) and enterovirus (n = 2). 5 patients had EOM. Of 262/352 (74.4%) patients with full clinical data, 209 (79.8%) were hospital referrals and 186 (71%) had been on antimicrobials. 21 (8%) patients died: TBM (15.2%), AEM (10%), and BM (2.8%).

Conclusions

Most infections lacked microbiological confirmation. S. suis was the most common cause of BM in this setting. Improved diagnostics are needed for meningoencephalitic syndromes to inform treatment and prevention strategies.

Fast diffusion tensor registration with exact reorientation and regularization

Diffusion tensor imaging is widely used in brain connectivity study. As more and more group studies recruit a large number of subjects, it is important to design registration methods that are not only theoretically rigorous, but also computationally efficient, for processing large data sets. However, the requirement of reorienting diffusion tensors complicates and slows down the registration, especially for those methods whose scalar-image versions have linear complexity, for example, the Demons algorithm. In this paper, we propose an extension of the Demons algorithm that incorporates exact reorientation and regularization into the calculation of deforming velocity, yet preserving its linear complexity. This method restores the computational efficiency of the Demons algorithm to diffusion images, but does not sacrifice registration goodness. In our experiments, the new algorithm achieved state-of-art performance at a ten-fold decrease of computational time.

Alloantigen specific T regulatory cells in transplant tolerance

CD4(+)CD25(+)Foxp3(+)T cells are regulatory/suppressor cells (Treg) that include non-antigen(Ag)-specific as well as Ag-specific Tregs. How non-Ag-specific naïve CD4(+)CD25(+)Treg develop into specific Tregs is unknown. We have studied DA rats tolerant to fully allogeneic PVG cardiac grafts that survived with out immunosuppression for over 100 days and identified the cellular basis of alloantigen specific tolerance. Key observations from our studies will be reviewed including how CD4(+)CD25(+)Tregs were first identified and the cytokine dependence of CD4(+)T cells that transfer alloantigen specific transplant tolerance which died in culture unless stimulated with both cytokine rich ConA supernatant and specific donor alloantigen. Both the tolerant CD4(+)CD25(+) and CD4(+)CD25(-) T cell populations are required to transfer tolerance, yet alone the CD4(+)CD25(-) T cell effect rejection. Tolerance transfer occurs with a low ratio of CD4(+)CD25(+)T cells (<1:10), whereas to induce tolerance with naive CD4(+)CD25(+)T cells requires both a ratio of >1:1 and is not alloantigen specific. Recent findings on how naïve CD4(+)CD25(+)T cells developed into two separated pathways of alloantigen specific Tregs, by culturing them with alloAg with either IL-2 or IL-4 and donor alloantigen are described. IL-2 enhances IFN-gammaR and IL-5 mRNA while IL-4 induced a reciprocal profile with de novo IL-5Ralpha and increased IFN-gamma mRNA expression. Both IL-2 and IL-4 alloactivated CD4(+)CD25(+)Tregs within 3-4 days of culture can induce alloantigen specific tolerance at ratios of 1:10. Long term, CD4(+)CD25(+)T cells from tolerant hosts given IL-2 cultured cells have increased IL-5 and IFN-gammaR mRNA; whereas hosts given IL-4 cultured cells had enhanced IL-5Ralpha mRNA expression and IL-5 enhanced their proliferation to donor but not third party alloAg. These findings suggest that Th1 and Th2 responses activate two pathways of alloantigen specific Tregs that can mediate transplant tolerance but are dependent upon cytokines produced by ongoing Th1 and/or Th2 immune responses.

Il-4 therapy prevents the development of proteinuria in active Heymann nephritis by inhibition of Tc1 cells

The role of IL-4, a key Th2 cytokine, in promoting or inhibiting active Heymann nephritis (HN) was examined. HN is induced by immunization with Fx1A in CFA, and proteinuria in HN is associated with subepithelial IgG and C3 deposition and infiltration of CD8(+) T-cytotoxic 1 (Tc1) cells and macrophages into glomeruli, as well as induction of Abs to Crry. Treatment with rIL-4 from the time of Fx1A/CFA immunization stimulated an earlier IgG1 response to Fx1A, induced anti-Crry Abs, and up-regulated IL-4 mRNA in lymphoid tissue, but did not alter proteinuria. Treatment with MRCOx-81, an IL-4-blocking mAb, resulted in greater proteinuria, which suggests endogenous IL-4 regulated the autoimmune response. Delay of rIL-4 treatment until 4 wk post-Fx1A/CFA immunization and just before the onset of proteinuria prevented the development of proteinuria and reduced Tc1 cell infiltrate in glomeruli. Delayed treatment with IL-4 had no effect on titer or isotype of Abs to Fx1A or on Ig, C3, and C9 accumulation in glomeruli. Treatment with rIL-13, a cytokine that alters macrophage function such as rIL-4, but has no direct effect on T or B cell function, reduced glomerular macrophage infiltrate, but did not prevent proteinuria or CD8+ T cell infiltrate. Anti-Crry Abs were paradoxically only induced with rIL-4 therapy, not in HN controls with proteinuria. It was concluded that the rIL-4 effect was probably by inhibition of Tc1 cells, which normally mediate the glomerular injury that results in proteinuria.

Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool

BACKGROUND AND GOAL

Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status.

METHODS

Every patient over 60 years of age, scheduled for elective surgery, was seen in anaesthesiology consultation and was submitted to the MNA. The MNA is a clinical score consisting of four additive items: 'Anthropometric assessment' based on BMI, mid-arm and calf circumferences, weight loss; global evaluation; dietetic assessment, and subjective assessment - these last three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies patients in the following categories: well-nourished (24 </= MNA </= 30), at risk of malnutrition (17 </= MNA < 23.5), and undernutrition (MNA < 17). Also recorded were: age, gender, type of scheduled operation, and the American Society of Anesthesiologists (ASA) physical status score. Results are given as median (extremes).

RESULTS

Four hundred and nineteen patients (50.4% women) were seen between January and October 1996. The mean age was 72 years (range, 60-98 years); BMI: 25.2 (12.8-40.4) kg m(-2). The MNA score was recorded in 408 patients, ranging from 1.5 to 30 (median: 26). According to the score, the patients were stratified in: well-nourished, 276 patients (67.6%), at risk, 104 patients (25. 5%) and suffering from overt malnutrition, 28 patients (6.9%). According to the ASA score, 290 patients were found to be at low or mild risk for anaesthesia and surgery (ASA 1 and 2), and 72 patients (24.8%) were stratified as being at least at risk of malnutrition. One hundred and eighteen other patients were found to be at a higher risk (ASA 3 and 4), and 58 (49.2%) were not well-nourished (MNA < 24).

CONCLUSION

The MNA was found to be well-suited for the preoperative assessment during anaesthesia consultation because it required no biological marker. It showed that approximately one-third of all the examined patients, and half of the ASA 3-4 patients, were not well-nourished. The ASA score could not predict poor nutritional status. The results suggested that nutritional assessment should be routinely performed in ASA 3-4 patients over 60 years of age.

Pharmacokinetics, metabolism and bioavailability of the new anti-allergic drug BM 113. Part III: Pharmacokinetics, metabolism, dose dependency and gender effect after single or repeated administration to human healthy volunteers

A new anti-allergic drug, BM 113 (1-(benzhydryloxyethyl)piperidino-4- ethylacetate, CAS 115313-90-1; BM 113 maleate: CAS 115313-91-2), with a piperidinic structure, showing anti-histaminic properties was studied after administration to healthy human volunteers. The focus was on the pharmacokinetics, the metabolism, the dose dependency and gender differences of the pharmacokinetic parameters of BM 113 and its main desacetylated metabolite, BM 212. Unchanged BM 113 was not recovered in plasma or in urine. The elimination of the radioactivity was essentially urinary with about 81% recovered within 24 h. The elimination was completed with 97% of the administered dose recovered after 120 h. HPLC dosage of BM 212, using a specific method, showed that BM 212 represented 62% of the urine radioactivity. The plasma profile of radioactivity was characterized by two decreasing phases with respective half-lives of 3.71 +/- 0.66 h and 24.67 +/- 25.01 h. A dose dependency study realised with 20, 40, 60 and 80 mg oral doses administered to 8 healthy volunteers has proven the linearity of the pharmacokinetics of BM 212 in the studied range. BM 212 disposition after single and repeated BM 113 oral doses in a 14-day study did not vary and permitted to conclude that no auto-induction or auto-inhibition phenomenon was involved. No significant difference between men and women was observed. The concentration profile was mono or biexponential, depending on the subject but whatever the gender. An inter-individual variability appeared for both sexes and caused some variations in the pharmacokinetic parameters.

Pharmacokinetics, metabolism and bioavailability of the new anti-allergic drug BM 113. Part II: Pharmacokinetics in primates after repeated oral or single intravenous administration

The pharmacokinetics of BM 113 (1-(benzhydryloxyethyl)piperidino-4-ethylacetate, CAS 115313-90-1; BM 113 maleate: CAS 115313-91-2) was studied using 3H-BM 113 in the Cynomolgus primate. Oral repeated administration of 0.75 mg/kg was performed on 8 days. 40 days after the oral treatment, a single intravenous administration of 0.4 mg/kg was done. Whatever the administration route, the radioactivity excretion was essentially urinary (about 60%) and most of the radioactivity was excreted within the first 24 h. The faecal elimination was low, about 10% of the administered dose. 40 days after the treatment, some radioactivity was already present in the urine. For this reason, the excretion balance ranged from 70 to 83% of the dose. The elimination half-life of 3H-BM 113 was long, about 80 h.

Pharmacokinetics, metabolism and bioavailability of the new anti-allergic drug BM 113. Part I: Pharmacokinetics and tissular distribution in Sprague-Dawley rats

A new anti-allergic drug, BM 113 (1-(benzhydryloxyethyl)piperidino-4-ethylacetate, CAS 115313-90-1; BM 113 maleate: CAS 115313-91-2) with a piperidinic structure, showing antihistaminic properties was studied in male and female Sprague-Dawley rats after i.v. or p.o. administrations of 0.750 mg/kg 3H-BM 113. This product presented a rapid faecal elimination after i.v. and oral administration. The total recovery of the dose was obtained after 144 h. Biliary elimination was very fast: 54% of the intravenous dose were biliarily eliminated within 2 h, essentially as a conjugated form. For both i.v. and p.o. routes, the blood kinetics were biexponential. Intravenous administration led to elimination half-lives of 1.36 h and 0.75 h for the first phase and 38.6 h and 56.5 h for the second one for males and females, respectively. After oral administration, rebounds corresponding to the presence of enterohepatic cycle or metabolites were observed. Thus, the determination of half-lives was not possible. Slight but significant differences of some pharmacokinetic parameters were observed between genders. The results obtained during the protein binding study corresponded to the BM 113 metabolite known as BM 212. The free fraction corresponded to 55.5%. Tissular concentrations showed a rapid distribution of 3H-BM 113 followed by a slow elimination. In most of the tissues, the decrease was biexponential. The organs containing most of the radioactivity were those of the intestinal tract and the liver. Other tissues presented concentrations close to those of plasma. Lipidic tissues, showing low BM 113 concentrations, presented a slower elimination, probably related to the high lipophilicity of molecule.

Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: comparative study with i.v. PCA morphine

We have compared the quality of three regimens of postoperative analgesia (continuous epidural administration of ropivacaine (Ropi. group), epidural ropivacaine and patient-controlled analgesia (PCA) with i.v. morphine (Ropi. + PCA group) and PCA morphine alone (PCA group)) during the first postoperative 24 h in a multicentre, randomized, prospective study. Postoperative analgesia was studied in 130 patients after major abdominal surgery performed under general anaesthesia. The ropivacaine groups received 20 ml of epidural bolus ropivacaine 2 mg ml-1 via the epidural route at the end of surgery, followed by continuous infusion of 10 ml h-1 for 24 h. The Ropi. + PCA group also had access to i.v. PCA morphine 1 mg, with a 5-min lockout. The PCA group received morphine as the sole postoperative pain treatment. The two ropivacaine groups had lower pain scores (P < 0.01) than the PCA group. Morphine consumption was higher in the PCA group (P < 0.05) than in the two ropivacaine groups. The quality of pain relief was rated as good or excellent in 79-85% of patients in the three groups. The percentage of patients without motor block increased between 4 and 24 h from 61% to 89% in the Ropi. group, and from 51% to 71% in the Ropi. + PCA group.

Treatment with interleukin-4 prolongs allogeneic neonatal heart graft survival by inducing T helper 2 responses

BACKGROUND

The T helper (Th) 2 cytokine interleukin (IL)-4 has been implicated as a major regulatory cytokine for the induction of transplant tolerance, but few studies have examined the capacity of IL-4 to induce tolerance. The effect of IL-4 therapy alone or with low doses of anti-CD4 monoclonal antibody (mAb) therapy on survival of fully allogeneic PVG neonatal heart graft in adult DA rats was examined.

METHODS

Rat recombinant (r) IL-4 was given at 30 microg (10(4) U)/kg daily intraperitoneally for 10 days and MRC OX35 (anti-CD4, nondepleting) or MRC OX81 (anti-IL-4) was given intraperitoneally on days 0, 3, 7, and 10. Semiquantitative reverse transcriptase-polymerase chain reaction was used to assay mRNA for cytokine in the graft, regional node and spleen and fluorescence-activated cell sorting was used to assay alloantibody Ig isotypes.

RESULTS

Grafts in rIL-4-treated rats survived a median period of 39 days (range, 28-52 days), significantly longer than in both untreated and nontransfected Chinese hamster ovary-K1 supernatant-treated controls (median, 14 days; range, 10-16 days, P=0.009). rIL-4 treatment with a suboptimal dose of anti-CD4 mAb prolonged median survival to 70 days (range, 63-80 days), which was longer than rIL-4 treatment alone or anti-CD4 mAb alone (median, 36 days; range, 30-55 days; P<0.0045). Combining MRC OX81 with MRC OX35 therapy led to earlier rejection at a median period of 26 days (range, 20-28 days); MRC OX81 alone had no effect on graft survival. Alloantibody titers, especially IgG1, were higher in rIL-4-treated animals and lower in anti-CD4 mAb-treated animals than in animals with normal rejection (P<0.05). IL-4 mRNA was increased in regional lymph nodes and spleen of the rIL-4-treated groups compared with all other groups, but there were no differences for IL-2, interferon-gamma, or IL-10.

CONCLUSIONS

rIL-4 therapy markedly prolonged neonatal cardiac allograft survival, and, with anti-CD4 therapy, it further prolonged survival. It induced IL-4 mRNA in lymphoid tissues and enhanced alloantibody production, especially IgG1, which demonstrated enhanced Th2 responses, but did not affect Th1 cytokines.

Effects of muscimol or homotaurine on sleep-wake states in alcohol-dependent rats during withdrawal

Sleep-wake states were studied following withdrawal in 36 adult male wistar alcohol-dependent rats, after chronic administration of ethanol (10 g/kg/24 h) for 13 days. In the light phase of the withdrawal day, 12 alcohol-dependent rats received muscimol (0.25 mg/kg), 12 received homotaurine (140 mg/kg), and 12 received 0.9% physiological saline (10 ml/kg). The results have been compared with a control group of 36 rats that received water during the treatment phase of the experiment, and the 14th day received intraperitoneal muscimol or homotaurine. Muscimol significantly improves the alterations of sleep-wake states in alcohol-withdrawn rats, decreasing the percentage of active wakefulness and increasing the percentage of REMS, but without any action on the latency of appearance of REMS, which remains shortened. The effects of homotaurine are less important on the wakefulness, but it also increases the percentage of REMS without influencing its latency of appearance. The influence of these GABA(A) agonists is not identical during the whole period of survey in the light phase, as there are important differences in the temporal sequences for each of them. We conclude that the stimulation of GABA(A) receptors, of which the activity is decreased during alcohol withdrawal, significantly improves the disturbances in the sleep-wake states in the alcohol-dependent rats, in a time-related manner, and there are significant pharmacodynamic differences between muscimol and homotaurine.

New benzocycloalkylpiperazines, potent and selective 5-HT1A receptor ligands

A series of 1-(benzocycloalkyl)-4-(benzamidolkyl)piperazine derivatives was prepared in order to obtain compounds with a high affinity and selectivity for 5-HT1A receptors. The modifications of aromatic substituents, the length of the alkyl chain, and the size of the ring were explored. Most of N-(1,2,3,4-tetrahydronaphthyl)-N'-(benzamidoethyl)piperazines (32-37) were bound to 5-HT1A receptors in a nanomolar range and presented a high degree of selectivity. After resolution, levorotatory enantiomers showed affinity and selectivity higher than those of dextrorotory ones for 5-HT1A sites. The agonist type activity of selected derivatives was also confirmed in vitro on the inhibition of the activation of adenylate cyclase induced by forskolin and, in vivo, on the induction of the lower lip retraction in rats.

[Characteristics of the audiogenic convulsive crisis in mice made sensitive by magnesium deficiency]

Mice of the OF1, C57BL/6, AKR, C3H/He, DBA/2, BALB/C, B6D2F1 and CBA strains are susceptible to audiogenic seizures after 40 or 20 days of acute magnesium deficiency. The duration of the various phases of the audiogenic seizure response (at 100 dBA) (wild running latency period, convulsions latency period and the clonic and tonic convulsions) among these mice was measured. Using the Kruskall-Wallis test, no difference was recorded using these measurements and those obtained for genetically audio-susceptible animals. This shows that acute magnesium deficiency-induced audiogenic seizures develop in exactly the same way as in genetically audio-susceptible animals (21-days-old DBA/2 mice). Lower intensity (60 and 80 dBA) produced only audiogenic seizures in magnesium deficient mice. Repeated auditory stimulation caused an increase in the number of lethal seizures. Sound-induced seizures in magnesium deficient mice provide a sensitive screening test for anti convulsive drug, and for drugs use in magnesium depletion.

Evaluation of the Clinitek 200 urinary test-strip reader in the analysis of dog and rat urines in pre-clinical toxicology studies

The performance of a clinical urinary test-strip reader Clinitek 200 was evaluated for dog and rat urines, in the context of pre-clinical toxicology studies. No major discrepancies were found between data generated by visual estimation or automatic measurement. Analysis of spiked samples showed good agreement between actual concentrations and Clinitek 200 responses for ketone bodies and glucose although a lack of sensitivity was found for the latter. Results for proteins showed over- or underestimation in dog and rat urines respectively at low concentrations, and overestimation at high concentrations in both species. Reproducibility of responses was excellent for ketone bodies, glucose and proteins but was weaker for haemoglobin and bilirubin. High bilirubin concentrations were found to interfere with the haemoglobin reaction. The pH measurements were found to be accurate only around pH 7. Specific gravity measurements were unreliable. Overall, the Clinitek 200 as a screening tool proved sufficiently reliable in the measurement of all parameters tested, with the exception of specific gravity.

Effect of an antihypertensive hydrazine derivative on Ca2+ current of single frog cardiac cells

The effects of MP 518, an acylated 2-chlorobenzylidene hydrazidone derivative with antihypertensive properties were investigated on the Ca current, ICa, recorded under whole-cell patch-clamp in single frog ventricular cells. MP 518 (1-100 microM) had no effect on ICa under control conditions. However, at 10 microM it significantly increased the beta-adrenergic stimulated ICa, an effect similar to that of isobutylmethyl-xanthine (IBMX), a non-specific phosphodiesterase inhibitor. The effects of MP 518 and IBMX were not, however, additive. This positive effect was also observed with both compounds, MP 518 and IMBX, when a submaximal dose of cyclic AMP was intracellularly perfused. In the presence of IBMX or at a high concentration (100 microM), MP 518 had a negative effect on beta-adrenergic stimulated ICa. It was thus considered that the main effect of MP 518 is an antiphosphodiesterase activity, since the increase in ICa induced by low concentrations of MP 518 could be related to inhibition of cAMP degradation; however, at higher concentrations, MP 518 antagonizes beta-adrenergic stimulation, possibly at several levels. Such an antiphosphodiesterase activity can account for the vasorelaxant effects as well as the tachycardic effects of MP 518.

Acamprosate modulates synaptosomal GABA transmission in chronically alcoholised rats

Male Sprague-Dawley rats were pulmonary alcoholised for 30 days. Six were treated with acamprosate (400 mg/kg/day, PO) during alcoholisation. The control nonalcoholised group also received acamprosate (400 mg/kg/day, PO) during the 30 days. At the end of the experiment, brains areas (cortex, hippocampus, thalamus, striatum, and olfactory bulbs) were dissected for the study of synaptosomal 3H-GABA uptake. In another experiment, GABA levels were determined in the same areas using HPLC with electrochemical detection. Blood ethanol levels were also measured during alcoholisation. Acamprosate treatment did not modify blood ethanol levels. In cortex and olfactory bulbs, alcoholisation increased 3H-GABA uptake (Vmax) with an increase in the affinity (Km). 3H-GABA uptake was not affected by alcoholisation in other brain areas. In hippocampus and thalamus, acamprosate treatment enhanced 3H-GABA uptake (Vmax) only in alcoholised rats. Moreover, in thalamus, alcoholisation enhanced GABA levels. The effect of alcohol and acamprosate on GABA presynaptic events is discussed and it is concluded that the action of ethanol and acamprosate on GABA transport could be, in part, responsible for the modulation by acamprosate treatment of ethanol behaviour.

Effects of alcohol dependence on shock-induced fighting: action of muscimol and homotaurine

We have applied the electroshock-induced fighting behavior to the study of experimental alcohol dependence. Adult Wistar rats were intoxicated chronically with ethanol (10 g/kg/24 h) for 13 days. Electroshock-induced fighting behavior was studied during chronic intoxication and withdrawal in comparison with normal rats receiving a water-carbohydrate solution isocaloric to ethanol. Rats were divided into groups receiving respectively muscimol (0.25 mg/kg), a GABAA agonist; homotaurine (140 mg/kg) a GABA mimetic; and physiological saline (10 ml/kg), intraperitoneally. During chronic intoxication, rats showed an increase in defensive-fighting behavior. Withdrawal accentuated the aggressive behavior and muscimol and homotaurine inhibited it. These results confirm the relevance of the electroshock-induced defensive fighting behavior test in chronic intoxication with alcohol, but to show the involvement of GABAergic transmission in the behavioral effects of alcohol withdrawal, additional experiments with other GABA mimetics and with GABA antagonists should be considered.

Circadian variations in vigilance states in the alcohol-dependent rat

Waking and sleep states were studied in the alcohol-dependent rat after administration of ethanol (416 mg/kg/hr) by indwelling intragastric catheter (IGC) for 13 days. Electropolygraphic recordings performed for a total of 24 hr from the start of withdrawal were compared with those of control rats receiving water by IGC and showed 1) that rapid eye movement sleep was the most sensitive of the four vigilance states studied. A decrease was noted both for the total duration of recording and for the light period; 2) that nonactive wakefulness was the only vigilance state to show an inversion of percentages between the light and dark period; 3) that the light period was the best time for studying changes in vigilance states. Changes included increased percentages of active and nonactive wakefulness and decreased percentages of slow-wave and rapid eye movement sleep. This was due to a change in the number of episodes rather to a change in their mean duration. No significant change occurred during the dark period.

Acamprosate appears to decrease alcohol intake in weaned alcoholics

Five hundred and sixty-nine alcoholics were included in a double-blind placebo-controlled randomized multicenter study of the effects of Acamprosate (calcium acetylhomotaurinate (CA), 1.3 g/day) on indicators of alcoholic relapse after withdrawal. One hundred and eighty-one patients in the CA group versus 175 in the placebo group completed the three-month study. The major efficacy criterion was plasma gamma-glutamyl transpeptidase (GGT), as an indicator of recent alcohol ingestion. This analysis was completed by criteria concordance analysis on a number of indicators of alcohol intake. Patients in both groups were similar initially. After 3 months of treatment, the patients in the CA group had significantly lower GGT (1.4 +/- 1.56 versus 2.0 +/- 3.19 times normal, P = 0.016). All significant differences (P less than 0.05) or trends (0.10 greater than P greater than 0.05) were in favor of a superior effect of CA over placebo. The major side-effect of CA was diarrhea (present in 13% of CA patients versus 7% of placebo, P = 0.04). CA proved superior to placebo on the evolution of markers of alcohol ingestion at three months, in this large-scale multicenter study. It could be a new modality in the drug therapy of alcoholism, not involving an antabuse effect, an antidepressant action, or conditioning.

Clinical pharmacology of gallium chloride after oral administration in lung cancer patients

Pharmacokinetic parameters were determined in 18 lung cancer patients after a single administration of 800 mg/24 h of GaCl3: Cmax = 123 +/- 61 mu/l; Tmax = 5.2 +/- 5.5 h; AUCO-96h = 4690 +/- 3358 micrograms.l-1.h; AUCO - infinity = 6394 +/- 5352 micrograms.l-1.h; T 1/2 beta = 43 +/- 19 h. Serum Ga concentrations at the steady-state (Css) were then determined in these patients after a daily oral administration of 800 mg/24 h of GaCl3 for 15 days: Css = 274 +/- 167 micrograms/l. No correlation was found between Css and the previous pharmacokinetic parameters in each patient. Various doses of GaCl3 were administered daily to 45 patients to correlate Css and dosage. Serum Ga concentrations increased with dosage from 100 to 400 mg/24 h (p less than 0.05), but not with further dosages up to 1400 mg/24 h. The optimal daily dose of GaCl3 in lung cancer patients seems to be 400 mg/24 h. In 2 patients, Ga was assayed after death in tissues. Ga concentrations were more than 10 micrograms/g in metastases, 3.6 +/- 2.9 micrograms/g in the primary tumor and 2.3 +/- 0.9 micrograms/g in the kidney. Due to the lack of renal and hematological toxicities and the significant uptake of Ga by the tumor, GaCl3 can be used orally in conjunction with other cytotoxic agents. We intend to evaluate its efficacy according to a randomized study comparing chemotherapy versus chemotherapy plus 400 mg/24 h of GaCl3.