Unsettled science on longer-run effects of early education

More rigorous research is needed on how to design programs.

Patient and family perceptions of a discharge bedside board

Objective

To explore patient and family perspectives of a discharge bedside board for supporting engagement in patient care and discharge planning to inform tool revision.

Methods

This qualitative descriptive study included 45 semi-structured interviews with a purposeful sample of English-speaking patients (n = 44; mean age 58.5 years) and their family members (n = 5) across seven adult inpatient units at a tertiary acute care hospital in mid-western Canada. Thematic (interviews), content (board, organization procedure document), and framework-guided integrated (all data) analyses were performed.

Results

Four themes were generated from interview data: understanding the board, included essential information to guide care, balancing information on the board, and maintaining a sense of connection. Despite application inconsistencies, documented standard procedures aligned with recommended board (re)orientation, timely patient-friendly content, attention to privacy, and patient-provider engagement strategies.

Conclusion

Findings indicate the tool supported consultation and some involvement level engagement in patient care and discharge. Board information was usually valued, however, perceived procedural gaps in tool education, privacy, and the quality of tool-related communication offer opportunities to strengthen patients' and families' tool experience.

Innovation

Novel application of a continuum engagement framework in the exploration of multiple data sources generated significant insights to guide tool revision.

Unconditional Cash and Family Investments in Infants: Evidence from a Large-Scale Cash Transfer Experiment in the U.S

Economists have limited causal evidence on how families receiving unconditional income would spend those funds. We examine financial and time investments in infants among families living in poverty from a large-scale, multi-site randomized controlled study of monthly unconditional cash. We find increased spending on child-specific goods and mothers' early-learning activities with their infants. The marginal propensity to consume child-focused items from the cash transfer exceeded that from other income, consistent with the behavioral cues in the design. We find no statistically detectable offsets in household earnings or impacts on pre-registered outcomes related to expenditures, labor supply, childcare or subjective well-being.

Antidepressants Trial in Parkinson's Disease (ADepT-PD): protocol for a randomised placebo-controlled trial on the effectiveness of escitalopram and nortriptyline on depressive symptoms in Parkinson's disease

BACKGROUND

Depressive symptoms are common in patients with Parkinson's disease and depression is a significant predictor of functional impairment, reduced quality of life and general well-being in Parkinson's disease. Despite the high prevalence of depression, evidence on the effectiveness and tolerability of antidepressants in this population is limited. The primary aim of this trial is to establish the clinical and cost effectiveness of escitalopram and nortriptyline for the treatment of depression in Parkinson's disease.

METHODS

This is a multi-centre, double-blind, randomised placebo-controlled trial in 408 people with Parkinson's disease with subsyndromal depression, major depressive disorder or persistent depressive disorder and a Beck Depression Inventory-II (BDI-II) score of 14 or above. Participants will be randomised into one of three groups, receiving either escitalopram, nortriptyline or placebo for 12 months. Trial participation is face-to-face, hybrid or remote. The primary outcome measure is the BDI-II score following 8 weeks of treatment. Secondary outcomes will be collected at baseline, 8, 26 and 52 weeks and following withdrawal, including severity of anxiety and depression scores as well as Parkinson's disease motor severity, and ratings of non-motor symptoms, cognitive function, health-related quality of life, levodopa-equivalence dose, changes in medication, overall clinical effectiveness, capability, health and social care resource use, carer health-related quality of life, adverse effects and number of dropouts.

DISCUSSION

This trial aims to determine the effectiveness of escitalopram and nortriptyline for reducing depressive symptoms in Parkinson's disease over 8 weeks, to provide information on the effect of these medications on anxiety and other non-motor symptoms in PD and on impact on patients and caregivers, and to examine their effect on change in motor severity.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03652870 Date of registration - 29^th August 2018.

Principles And Policies To Strengthen Child And Adolescent Health And Well-Being

Four recent reports from the National Academies of Sciences, Engineering, and Medicine framed around the issues of poverty; mental, emotional, and behavioral health; adolescence; and young family health and education build on extensive recent evidence of what can be done to improve the health and well-being of children, youth, and families. We describe the process of generating the reports, briefly summarize each report's content, and identify crosscutting themes and recommendations. We also note how the coronavirus disease 2019 (COVID-19) pandemic highlights major disparities and systemic problems addressed in the reports and heightens the relevance of their policy recommendations. The reports issue a unified, urgent call for measures with the potential to change the trajectory and outcomes for children and youth. Among these are basic income supports, other family supports, universal health care structured to meet family needs, and a broad national policy that prioritizes children and youth.

Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature

AIM

The best treatment for tailgut cysts has not been firmly established. We report a systematic review of the cases in the available literature in order to provide an evidence base for treatment.

METHOD

A systematic search of articles wholly or partly in English was made of PubMed, Embase and Google Scholar; additional studies were discovered by searching reference lists and contacting authors directly. Search terms 'tailgut cyst', 'tail gut cyst', 'retrorectal hamartoma' and 'retrorectal tumour' were used for case reports or case series; no publication date restrictions were imposed. Only studies with histological confirmation of diagnosis and reporting the age and gender of patients were included. Papers were excluded by consensus between the first two authors.

RESULTS

A total of 196 individual cases were analysed in detail including 51 cases of neoplasia. The overall rate of neoplastic transformation was 26.6%. Although the male:female cyst incidence ratio was 1:4, men over 18 had a significantly greater relative risk of neoplasm at 1.94 (P = 0.0055). Radiological evidence of nodular thickening of the cyst wall significantly increased the relative risk of the presence of cancer (P = 0.0023).

CONCLUSIONS

Current orthodoxy that these are not dangerous embryological remnants is unfounded and may be false. The available data suggest the risk of malignant transformation is high and will apply to any residual tissue after excision. The same rationale behind total mesorectal excision in rectal cancer applies to tailgut cysts. Consequently they should be resected with similar oncological margins.

A Universal Child Allowance: A Plan to Reduce Poverty and Income Instability Among Children in the United States

To reduce child poverty and income instability, and eliminate extreme poverty among families with children in the United States, we propose converting the Child Tax Credit and child tax exemption into a universal, monthly child allowance. Our proposal is based on principles we argue should undergird the design of such policies: universality, accessibility, adequate payment levels, and more generous support for young children. Whether benefits should decline with additional children to reflect economies of scale is a question policymakers should consider. Analyzing 2015 Current Population Survey data, we estimate our proposed child allowance would reduce child poverty by about 40 percent, deep child poverty by nearly half, and would effectively eliminate extreme child poverty. Annual net cost estimates range from $66 billion to $105 billion.

Evidence-based anatomical review areas derived from systematic analysis of cases from a radiological departmental discrepancy meeting

AIM

To produce short checklists of specific anatomical review sites for different regions of the body based on the frequency of radiological errors reviewed at radiology discrepancy meetings, thereby creating "evidence-based" review areas for radiology reporting.

MATERIALS AND METHODS

A single centre discrepancy database was retrospectively reviewed from a 5-year period. All errors were classified by type, modality, body system, and specific anatomical location. Errors were assigned to one of four body regions: chest, abdominopelvic, central nervous system (CNS), and musculoskeletal (MSK). Frequencies of errors in anatomical locations were then analysed.

RESULTS

There were 561 errors in 477 examinations; 290 (46%) errors occurred in the abdomen/pelvis, 99 (15.7%) in the chest, 117 (18.5%) in the CNS, and 125 (19.9%) in the MSK system. In each body system, the five most common location were chest: lung bases on computed tomography (CT), apices on radiography, pulmonary vasculature, bones, and mediastinum; abdominopelvic: vasculature, colon, kidneys, liver, and pancreas; CNS: intracranial vasculature, peripheral cerebral grey matter, bone, parafalcine, and the frontotemporal lobes surrounding the Sylvian fissure; and MSK: calvarium, sacrum, pelvis, chest, and spine.

CONCLUSION

The five listed locations accounted for >50% of all perceptual errors suggesting an avenue for focused review at the end of reporting.

Neighborhood deprivation and depression in adult twins: genetics and gene×environment interaction

BACKGROUND

Depression is a significant problem and it is vital to understand its underlying causes and related policy implications. Neighborhood characteristics are implicated in depression but the nature of this association is unclear. Unobserved or unmeasured factors may confound the relationship. This study addresses confounding in a twin study investigating neighborhood-level effects on depression controlling for genetics, common environment, and gene×environment (G × E) interactions.

METHOD

Data on neighborhood deprivation and depression were gathered from 3155 monozygotic twin pairs and 1275 dizygotic pairs (65.7% female) between 2006 and 2013. The variance for both depression and neighborhood deprivation was decomposed into three components: additive genetic variance (A); shared environmental variance (C); and non-shared environmental variance (E). Depression was then regressed on neighborhood deprivation to test the direct association and whether that association was confounded. We also tested for a G × E interaction in which the heritability of depression was modified by the level of neighborhood deprivation.

RESULTS

Depression and neighborhood deprivation showed evidence of significant A (21.8% and 15.9%, respectively) and C (13.9% and 32.7%, respectively) variance. Depression increased with increasing neighborhood deprivation across all twins (p = 0.009), but this regression was not significant after controlling for A and C variance common to both phenotypes (p = 0.615). The G × E model showed genetic influences on depression increasing with increasing neighborhood deprivation (p < 0.001).

CONCLUSIONS

Neighborhood deprivation is an important contributor to depression via increasing the genetic risk. Modifiable pathways that link neighborhoods to depression have been proposed and should serve as targets for intervention and research.

Early School Adjustment and Educational Attainment

Although school attainment is a cumulative process combining mastery of both academic and behavioral skills, most studies have offered only a piecemeal view of the associations between middle childhood capacities and subsequent schooling outcomes. Using a 20-year longitudinal dataset, this study estimates the association between children's academic skills, anti-social behaviors and attention problems, all averaged across middle childhood, and their long-term educational outcomes. After adjusting for family and individual background measures, we find that high average levels of math and reading achievement, and low average levels of anti-social behavior problems, are positively associated with later attainment. Associations between attention problems and attainment are small. Associations are attenuated somewhat when sibling differences in these skills and behaviors are related to sibling differences in attainment outcomes.

Gait analysis: a step in the right direction

Tri-axial accelerometery has recently been shown to produce reliable gait parameters in normal subjects. This study reports the use of this device in patients with pathological gait. Thirty-three patients with a variety of mobility-limiting disorders were studied. All patients were independently mobile with or without a walking aid. Gait was recorded by attaching the tri-axial accelerometer over the patient's sacrum with the patient walking at their usual pace along a 6m path. Gait speed was measured in all 33 patients and ranged from 0.11 m/s to 0.82m/s. Gait parameters could not be calculated in eight patients. In the remaining 25 patients, gait cycle time, cadence, stride length and mean right and left step times could be calculated. Interobserver variation was 2%. Comparison of right and left step times enabled lateralization of the gait abnormality. This portable technique allows rapid qualitative and quantitative assessment of gait within a normal ward environment.

Adolescent Reproductive Knowledge, Attitudes, and Beliefs and Future Fatherhood

PURPOSE

With a growing focus on the importance of men's reproductive health, including preconception health, the ways in which young men's knowledge, attitudes, and beliefs (KAB) predict their reproductive paths are understudied. To determine if reproductive KAB predicts fatherhood status, timing and residency (living with child or not).

METHODS

Reproductive KAB and fatherhood outcomes were analyzed from the National Longitudinal Study of Adolescent Health, a 20-year, nationally representative study of individuals from adolescence into adulthood. Four measures of reproductive KAB were assessed during adolescence in waves I and II. A generalized linear latent and mixed model predicted future fatherhood status (nonfather, resident/nonresident father, adolescent father) and timing while controlling for other socio-demographic variables.

RESULTS

Of the 10,253 men, 3,425 were fathers (686 nonresident/2,739 resident) by wave IV. Higher risky sexual behavior scores significantly increased the odds of becoming nonresident father (odds ratio [OR], 1.30; p < .0001), resident father (OR, 1.07; p = .007), and adolescent father (OR, 1.71; p < .0001); higher pregnancy attitudes scores significantly increased the odds of becoming a nonresident father (OR, 1.20; p < .0001) and resident father (OR, 1.11; p < .0001); higher birth control self-efficacy scores significantly decreased the odds of becoming a nonresident father (OR, .72; p < .0001) and adolescent father (OR, .56; p = .01).

CONCLUSIONS

Young men's KAB in adolescence predicts their future fatherhood and residency status. Strategies that address adolescent males' reproductive KAB are needed in the prevention of unintended reproductive consequences such as early and nonresident fatherhood.

Intervention fidelity for a complex behaviour change intervention in community pharmacy addressing cardiovascular disease risk

Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.

Peer Influence, Genetic Propensity, and Binge Drinking: A Natural Experiment and a Replication

The authors draw data from the College Roommate Study (ROOM) and the National Longitudinal Study of Adolescent Health to investigate gene-environment interaction effects on youth binge drinking. In ROOM, the environmental influence was measured by the precollege drinking behavior of randomly assigned roommates. Random assignment safeguards against friend selection and removes the threat of gene-environment correlation that makes gene-environment interaction effects difficult to interpret. On average, being randomly assigned a drinking peer as opposed to a nondrinking peer increased college binge drinking by 0.5-1.0 episodes per month, or 20%-40% the average amount of binge drinking. However, this peer influence was found only among youths with a medium level of genetic propensity for alcohol use; those with either a low or high genetic propensity were not influenced by peer drinking. A replication of the findings is provided in data drawn from Add Health. The study shows that gene-environment interaction analysis can uncover social-contextual effects likely to be missed by traditional sociological approaches.

Longitudinal Study of Body Mass Index in Young Males and the Transition to Fatherhood

Despite a growing understanding that the social determinants of health have an impact on body mass index (BMI), the role of fatherhood on young men's BMI is understudied. This longitudinal study examines BMI in young men over time as they transition from adolescence into fatherhood in a nationally representative sample. Data from all four waves of the National Longitudinal Study of Adolescent Health supported a 20-year longitudinal analysis of 10,253 men beginning in 1994. A "fatherhood-year" data set was created and changes in BMI were examined based on fatherhood status (nonfather, nonresident father, resident father), fatherhood years, and covariates. Though age is positively associated with BMI over all years for all men, comparing nonresident and resident fathers with nonfathers reveals different trajectories based on fatherhood status. Entrance into fatherhood is associated with an increase in BMI trajectory for both nonresident and resident fathers, while nonfathers exhibit a decrease over the same period. In this longitudinal, population-based study, fatherhood and residence status play a role in men's BMI. Designing obesity prevention interventions for young men that begin in adolescence and carry through young adulthood should target the distinctive needs of these populations, potentially improving their health outcomes.

Post-operative bilateral adrenal haemorrhage: A case report

•

An unusual complication of intra-abdominal sepsis.

•

A demonstration of diagnostic difficulty in the post-operative patient.

•

A variation from the normal electrolyte profile observed in adrenal insufficiency.

•

Highlights the clinical importance of a high index of suspicion for further investigation of ‘on-ward’ electrolyte abnormalities.

INTRODUCTION

Bilateral adrenal haemorrhage is a rare, but serious, illness carrying an estimated 15% mortality.^1,2 The majority of cases occur in patients with acute, stressful illness, however the exact mechanism underlying adrenal haemorrhage remains unclear. This medical emergency carries significant diagnostic difficulty⁴ with non-specific clinical symptoms and variations in electrolyte abnormalities. Timely treatment is important as it prevents both the acute and long-term sequelae of adrenal failure.

PRESENTATION OF CASE

This report describes a medical emergency in a surgical patient following emergency surgery for intra-abdominal sepsis. The patient reported non-specific symptoms of confusion, mild pyrexia and vague abdominal pain during the post-operative phase, with subtle electrolyte abnormalities and a low serum cortisol suggestive of adrenal crisis. Timely medical treatment, with intravenous hydrocortisone and intensive monitoring, and appropriate medical follow-up with addition of long-term fludrocortisone resulted in a satisfactory outcome.

DISCUSSION

This report describes a potentially life-threatening complication of intra-abdominal sepsis with adrenal crisis secondary to bilateral adrenal haemorrhage. In particular, this case highlights the diagnostic difficulty in such surgical patients due to vague symptoms and, in this case, the presence of a presentation variant with acute hyponatraemia and normal potassium.

CONCLUSION

This case highlights the importance of awareness of both the symptoms and signs and variation in electrolyte profile when assessing surgical patients post-operatively. In addition, this case highlights the benefit of early recognition and initiation of treatment and the importance of follow-up as long-term medical management is often required to prevent further relapse.

A longitudinal study of paternal mental health during transition to fatherhood as young adults

BACKGROUND AND OBJECTIVE

Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors.

METHODS

We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a "fatherhood-year" data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals.

RESULTS

Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = -0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%.

CONCLUSIONS

In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during children's key attachment years of 0-5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.

Promoting the Positive Development of Boys in High-Poverty Neighborhoods: Evidence From Four Anti-Poverty Experiments

This study uses geocoded address data and information about parent's economic behavior and children's development from four random-assignment welfare and anti-poverty experiments conducted during the 1990s. We find that the impacts of these welfare and anti-poverty programs on boys' and girls' developmental outcomes during the transition to early adolescence differ as a function of neighborhood poverty levels. The strongest positive impacts of these programs are among boys who lived in high-poverty neighborhoods at the time their parents enrolled in the studies, with smaller or non-statistically significant effects for boys in lower poverty neighborhoods and for girls across all neighborhoods. This research informs our understanding of how neighborhood context and child gender may interact with employment-based policies to affect children's well-being.

In vivo RAF signal transduction as a potential biomarker for sorafenib efficacy in patients with neuroendocrine tumours

BACKGROUND

Targeted therapies elicit anticancer activity by exerting pharmacodynamic effects on specific molecular targets. Currently, there is limited use of pharmacodynamic assessment to guide drug administration in the routine oncology setting.

METHODS

We developed a phosphoshift (pShift) flow cytometry-based test that measures RAF signal transduction capacity in peripheral blood cells, and evaluated it in a phase II clinical trial of oral sorafenib plus low-dose cyclophosphamide in patients with advanced neuroendocrine tumours (NETs), in order to predict clinical course and/or guide individual dose-titration.

RESULTS

Twenty-two patients were enrolled. Median progression-free survival (PFS) was 3 months (95% CI 2-10.7), and one patient had a partial response. PFS was longer among five patients who demonstrated an increase in pShift after 7 days of sorafenib compared with those who did not (14.9 months vs 2.8 months; P=0.047). However, pShift did not add value to toxicity-based dose-titration.

CONCLUSION

The pharmacodynamic assessment of RAF transduction may identify selected patients with advanced NETs most likely to benefit from the combination of sorafenib plus cyclophosphamide. Further investigation of this test as a potential biomarker is warranted.

A virtual practice environment to develop communication skills in pharmacy students

OBJECTIVE

To develop communication skills in second-year pharmacy students using a virtual practice environment (VPE) and to assess students' and tutors' (instructors') experiences.

DESIGN

A VPE capable of displaying life-sized photographic and video images and representing a pharmacy setting was constructed. Students viewed prescriptions and practiced role-playing with each other and explored the use of nonverbal communication in patient-pharmacist interactions. The VPE experiences were complemented with lectures, reflective journaling, language and learning support, and objective structured clinical examinations (OSCEs).

ASSESSMENT

Most students believed the VPE was a useful teaching resource (87%) and agreed that the video component enabled them to contextualize patient problems (73%). While 45% of students questioned the usefulness of watching the role plays between students after they were video recorded, most (90%) identified improvement in their own communication as a result of participating in the tutorials. Most tutors felt comfortable using the technology. Focus group participants found the modified tutorials more engaging and aesthetically positive than in their previous experience.

CONCLUSION

The VPE provided an effective context for communication skills development classes.

Knowledge, attitudes and practices of private sector providers of tuberculosis care: a scoping review

SETTING

The past decade has seen a significant increase in private sector provision of tuberculosis (TB)care. While patients often seek and select treatment from private providers at significant out-of-pocket expense,treatment outcomes remain largely unknown.

OBJECTIVE

To investigate the knowledge, attitudes and practices of private sector TB care providers in high burden countries.

METHODS

Medline, PubMed, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using Medical Subject Headings terms,Emtree terms and key words. Searches were limited to the English language and published between 1998 and week 2 of November 2009. Studies were included if they reported the knowledge, attitudes or practice behaviours of private health care providers working in one of 22 high-TB-burden countries. Each included study was critically assessed using a structured data extraction tool. Data extracted included the study setting, objective, design, sample, response rate, outcomes and limitations.

RESULTS

The 34 studies that met review inclusion criteriaen compassed diverse study methods and designs.All categories of TB care providers lacked comprehensive knowledge of national treatment guidelines. Procedures for referral, treatment monitoring, record keeping and case holding were not systematically implemented.However, there was a high degree of willingness to collaborate with national TB programmes.

CONCLUSION

Research using standardised data collection methods may assist in identifying gaps in knowledge and practice among all providers of TB care. Further studies in developing and evaluating needs-based interventions should be undertaken; systematic reviews of such studies may then assist in strategic decision making in public-private mix DOTS expansion.

The interaction between caveolin-1 and Rho-GTPases promotes metastasis by controlling the expression of alpha5-integrin and the activation of Src, Ras and Erk

Proteins containing a caveolin-binding domain (CBD), such as the Rho-GTPases, can interact with caveolin-1 (Cav1) through its caveolin scaffold domain. Rho-GTPases are important regulators of p130(Cas), which is crucial for both normal cell migration and Src kinase-mediated metastasis of cancer cells. However, although Rho-GTPases (particularly RhoC) and Cav1 have been linked to cancer progression and metastasis, the underlying molecular mechanisms are largely unknown. To investigate the function of Cav1-Rho-GTPase interaction in metastasis, we disrupted Cav1-Rho-GTPase binding in melanoma and mammary epithelial tumor cells by overexpressing CBD, and examined the loss-of-function of RhoC in metastatic cancer cells. Cancer cells overexpressing CBD or lacking RhoC had reduced p130(Cas) phosphorylation and Rac1 activation, resulting in an inhibition of migration and invasion in vitro. The activity of Src and the activation of its downstream targets FAK, Pyk2, Ras and extracellular signal-regulated kinase (Erk)1/2 were also impaired. A reduction in α5-integrin expression, which is required for binding to fibronectin and thus cell migration and survival, was observed in CBD-expressing cells and cells lacking RhoC. As a result of these defects, CBD-expressing melanoma cells had a reduced ability to metastasize in recipient mice, and impaired extravasation and survival in secondary sites in chicken embryos. Our data indicate that interaction between Cav1 and Rho-GTPases (most likely RhoC but not RhoA) promotes metastasis by stimulating α5-integrin expression and regulating the Src-dependent activation of p130(Cas)/Rac1, FAK/Pyk2 and Ras/Erk1/2 signaling cascades.

Improved hatchability and posthatch performance in turkey poults receiving a dextrin-iodinated casein solution in ovo

Two experiments were conducted with a commercial turkey company using a commercial egg injection system to investigate the effect of a dextrin-iodinated casein solution injected in ovo at 25 d of incubation on turkey poult hatchability, hatch weight, and growth (6 or 7 d posthatch). In experiment 1, a total of 3,900 turkey eggs (1,300 per group) were injected at 25 d of incubation with either 200 μL of a control (physiological saline) solution or a dextrin solution (18% maltodextrin and 10% potato starch dextrin) with 75 or 375 μg/mL of iodinated casein (DexIC75 or DexIC375, where Dex and IC refer to dextrin and iodinated casein, respectively). Two hundred poults from each group were neck-tagged, weighed (hatch weight), placed in a commercial turkey house within a single brooder ring, and weighed again (7 d posthatch). In experiment 2, a total of 5,200 eggs (2,600 per group) were injected with the control or DexIC75 solution. A total of 600 poults (300 per group) were neck-tagged and hatch weights were obtained, followed by placement in a single brooder ring in a commercial house and a second weighing (6 d posthatch). Eggs in experiments 1 and 2 were obtained from hen flocks that were 33 and 5 wk into the laying cycle, respectively. In experiment 1, the DexIC75 injection resulted in a 1.8% increase (P = 0.03) in hatch weight. In experiment 2, the DexIC75 treatment resulted in a 2.4% increase in hatchability (P = 0.01), a 4.3% increase in hatch weight (P < 0.001), and a 1.8% increase in 6-d poult weights (P < 0.03) compared with controls. Results of this study indicate that a solution containing dextrin and 75 μg/mL of iodinated casein injected into turkey eggs at 25 d of incubation may be used to improve early poult weights, hatchability, or both in commercial turkey production.

Comparison of conventional metered dose inhaler and breath actuated inhaler in elderly patients

Elderly patients frequently fail to achieve or to retain a competent inhaler technique using a conventional metered dose inhaler. In a prospective, randomised, crossover study of 44 subjects aged 64–94 (mean 78) years, we compared a metered dose inhaler (MDI) with a breath actuated inhaler (BAI) in terms of inhaler technique, ease of teaching and patient acceptability. Patients were stratified according to physical, functional or cognitive impairment before randomisation. Structured tuition was provided at the start of treatments, and technique was graded weekly and retaught if deficient. At the start of the treatment periods satisfactory technique was observed in 14 of 35 patients (six impaired, eight unimpaired) using the MDI and in 14 of 35 patients (three impaired, 11 unimpaired) using the BAI (P = 1.0). At the end of the four-week treatment periods satisfactory technique was observed in 19 of 30 patients (seven impaired, 12 unimpaired) using the MDI and in 27 patients (11 impaired, 16 unimpaired) using the BAI (P = 0.01). Mean weekly teaching times (minutes) were similar (MDI 7.0, BAI 6.5, P = 0.41) and there was no difference in terms of patient acceptability (P = 0.38). A breath actuated inhaler may be the preferred device for elderly patients as a greater proportion were able to retain satisfactory inhaler technique.

A tetravalent RGD ligand for integrin-mediated cell adhesion

Monovalent RGD (arginine-glycine-aspartic acid) peptides or polymers furnished with RGD in random distributions are employed as cell-scaffolds and gene delivery vehicles. However, integrin binding to RGD is dependent on the spatial distribution (clustering) of the ligand and intrinsic integrin affinity via conformational changes (avidity). Here we have designed and expressed a polypeptide consisting of a tetrameric coiled coil and spacer facilitating polyvalent (clustered) display of integrin ligands; the RGD motif was used as proof of principle. Size-exclusion chromatography and circular dichroism showed that the polypeptide self assembled as a tetramer in solution with a defined secondary structure. Cell adhesion to surfaces coated with the polypeptide was up to 3-fold greater than that for (monovalent) RGDS peptide at equivalent concentrations. Moreover, the polypeptide in solution at concentrations ≥1μM inhibited cell adhesion to fibronectin-coated surfaces, while RGDS peptide in solution at concentrations up to 500μM did not. These cell data demonstrate that the polypeptide bound integrin receptors in a polyvalent manner. The polypeptide will therefore be of use in the engineering of tissue-culture scaffolds with increased cell adhesion activity, or to targeted gene delivery vehicles, and could incorporate protein ligands in place of the RGD motif.

Balancing inflammatory, lipid, and xenobiotic signaling pathways by VSL#3, a biotherapeutic agent, in the treatment of inflammatory bowel disease

BACKGROUND

The interleukin 10 knockout mouse (IL10-KO) is a model of human inflammatory bowel disease (IBD) used to study host microbial interactions and the action of potential therapeutics. Using Affymetrix data analysis, important signaling pathways and transcription factors relevant to gut inflammation and antiinflammatory probiotics were identified.

METHODS

Affymetrix microarray analysis on both wildtype (WT) and IL10-KO mice orally administered with and without the probiotic VSL#3 was performed and the results validated by real-time polymerase chain reaction (PCR), immunocytochemistry, proteomics, and histopathology. Changes in metabolically active bacteria were assessed with denaturing gradient gel electrophoresis (DGGE).

RESULTS

Inflammation in IL10-KO mice was characterized by differential regulation of inflammatory, nuclear receptor, lipid, and xenobiotic signaling pathways. Probiotic intervention resulted in downregulation of CXCL9 (fold change [FC] = -3.98, false discovery rate [FDR] = 0.019), CXCL10 (FC = -4.83, FDR = 0.0008), CCL5 (FC = -3.47, FDR = 0.017), T-cell activation (Itgal [FC = -4.72, FDR = 0.00009], Itgae [FC = -2.54 FDR = 0.0044]) and the autophagy gene IRGM (FC = -1.94, FDR = 0.01), a recently identified susceptibility gene in human IBD. Consistent with a marked reduction in integrins, probiotic treatment decreased the number of CCL5+ CD3+ double-positive T cells and upregulated galectin2, which triggers apoptosis of activated T cells. Importantly, genes associated with lipid and PPAR signaling (PPARalpha [FC = 2.36, FDR = 0.043], PPARGC1alpha [FC = 2.58, FDR = 0.016], Nr1d2 [FC = 3.11, FDR = 0.0067]) were also upregulated. Altered microbial diversity was noted in probiotic-treated mice.

CONCLUSIONS

Bioinformatics analysis revealed important immune response, phagocytic and inflammatory pathways dominated by elevation of T-helper cell 1 type (TH1) transcription factors in IL10-KO mice. Probiotic intervention resulted in a site-specific reduction of these pathways but importantly upregulated PPAR, xenobiotic, and lipid signaling genes, potential antagonists of NF-kappaB inflammatory pathways.

A graded forceps crush spinal cord injury model in mice

Given the rising availability and use of genetically modified animals in basic science research, it has become increasingly important to develop clinically relevant models for spinal cord injury (SCI) for use in mice. We developed a graded forceps crush model of SCI in mice that uses three different forceps with spacers of 0.25, 0.4, and 0.55 mm, to produce severe, moderate, and mild injuries, respectively. Briefly, each mouse was subjected to laminectomy of T5-T7, 15-second spinal cord crush using one of those forceps, behavioral assessments, and post-mortem neuroanatomical analyses. There were significant differences among the three injury severity groups on behavioral measures (Basso Mouse Score, footprint, and ladder analyses), demonstrating an increase in neurological deficits for groups with greater injury severity. Quantitative analysis of the lesion demonstrated that as injury severity increased, lesion size and GFAP negative area increased, and spared tissue, spinal cord cross-sectional area, spared grey matter and spared white matter decreased. These measures strongly correlated with the behavioral outcomes. Similar to other studies of SCI in mice, we report a dense laminin and fibronectin positive extracellular matrix in the lesion sites of injured mice, but unlike those previous studies, we also report the presence of numerous p75 positive Schwann cells in and around the lesion epicenter. These results provide evidence that the graded forceps crush model is an attractive alternative for the study of SCI and related therapeutic interventions. Because of its demonstrated consistency, ease of use, low cost, and clinical relevance, this graded forceps crush is an attractive alternative to the other mouse models of SCI currently available.

Calcium and the physiology of cataract

Calcium has long been known to play a role in cataract formation but techniques have only recently become available for investigating the physiological mechanisms. Previous studies showed that lens membrane permeability alters when the external calcium concentration falls below 1 mM, so it was interesting that values for human aqueous from cataract patients ranged from 0.45 to 2.0 mM. The mean value for the aqueous was one half that for the plasma. The calcium concentration in cataractous lenses ranged from 0.1 to 64 mM and lenses with a high calcium concentration also had a high sodium content. In lenses with near normal sodium content the highest calcium concentrations were associated with highly localized opacities, while nuclear cataracts had a low calcium content. The relationship between calcium and transparency was investigated in a rat lens system using ion-sensitive microelectrodes. The distribution of free calcium in the lens varied with age and was correlated with a change in the sensitivity of the lens to cold cataract and a change in lens birefringence. The highest free calcium levels were obtained from lenses incubated in 10 mM-calcium in the absence of glucose and these lenses showed most light scattering. Ion-sensitive microelectrode techniques applied to human lenses yielded calcium levels of 0.1 microM-2 mM. In lenses with dense, highly localized opacities the calcium distribution was not uniform and was highest in regions that scattered most light. The movement of calcium through individual membrane channels was investigated using patch clamp techniques. Three types of ionic channels have been identified in the lens. The smallest appears to be a calcium channel; the larger current fluctuations are associated with sodium and potassium movements. In organ culture studies of the bovine lens, a marked decrease in protein synthesis and net leakage of proteins was associated more strongly with an increase in calcium than with an increase in sodium. The stability of the lens protein gel thus seems to depend on maintaining a low internal level of calcium ions.