Urban parks provide ecosystem services by retaining metals and nutrients in soils

Urban greenspaces provide ecosystem services like more natural ecosystems do. For instance, vegetation modifies soil properties, including pH and soil organic matter content, yet little is known about its effect on metals. We investigated whether the accumulation and mobility of heavy metals, nutrients and carbon is affected by plant functional types (evergreen or deciduous trees, lawns) in urban parks of varying ages in southern Finland. Plant types modified soil physico-chemical parameters differently, resulting in diverging accumulation and mobility of metals and other elements in park soils. However, the effects of plant functional type depended on park age: lawns in parks of ca. 50 y old had the highest contents of Cr, Cu, Fe, Mn, Ni, and Zn, and in these, and older parks (>100 y old), contents of most metals were lowest under evergreen trees. The mobility of metals and other elements was influenced by the amount of water leached through the soils, highlighting the importance of vegetation on hydrology. Soils under evergreen trees in young parks and lawns in intermediately-aged parks were most permeable to water, and thus had high loads of Ca, Cr, Cu, Fe, Ni, tot-P and tot-N. The loads/concentrations of elements in the leachates was not clearly reflected by their content/concentration in the soil, alluding to the storage capacity of these elements in urban park soils. Our results suggest that in urban systems with a high proportion of impermeable surfaces, park soil has the potential to store nutrients and metals and provide an important ecosystem service particularly in polluted cities.

Dysregulated STAT1-SOCS1 control of JAK2 promotes mammary luminal progenitor cell survival and drives ERα(+) tumorigenesis

We previously reported that STAT1 expression is frequently abrogated in human estrogen receptor-α-positive (ERα(+)) breast cancers and mice lacking STAT1 spontaneously develop ERα(+) mammary tumors. However, the precise mechanism by which STAT1 suppresses mammary gland tumorigenesis has not been fully elucidated. Here we show that STAT1-deficient mammary epithelial cells (MECs) display persistent prolactin receptor (PrlR) signaling, resulting in activation of JAK2, STAT3 and STAT5A/5B, expansion of CD61(+) luminal progenitor cells and development of ERα(+) mammary tumors. A failure to upregulate SOCS1, a STAT1-induced inhibitor of JAK2, leads to unopposed oncogenic PrlR signaling in STAT1(-/-) MECs. Prophylactic use of a pharmacological JAK2 inhibitor restrains the proportion of luminal progenitors and prevents disease induction. Systemic inhibition of activated JAK2 induces tumor cell death and produces therapeutic regression of pre-existing endocrine-sensitive and refractory mammary tumors. Thus, STAT1 suppresses tumor formation in mammary glands by preventing the natural developmental function of a growth factor signaling pathway from becoming pro-oncogenic. In addition, targeted inhibition of JAK2 may have significant therapeutic potential in controlling ERα(+) breast cancer in humans.

Neuro-ophthalmological Complications of Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) can lead to prominent nerve hypertrophy, which can mimic other forms of neuropathy radiologically. Neuro-ophthalmological complications can also occur in CIDP, either at presentation or chronically in the disorder. This can also cause diagnostic difficulties. We report three cases of neuro-ophthalmological complications of CIDP: two cases of papilloedema and one case of proptosis. In all three cases cranial nerve hypertrophy was present. CIDP should be considered in neuro-ophthalmological presentations associated with cranial/spinal nerve root hypertrophy.

Schizophrenia risk gene CAV1 is both pro-psychotic and required for atypical antipsychotic drug actions in vivo

Caveolin-1 (Cav-1) is a scaffolding protein important for regulating receptor signaling cascades by partitioning signaling molecules into membrane microdomains. Disruption of the CAV1 gene has recently been identified as a rare structural variant associated with schizophrenia. Although Cav-1 knockout (KO) mice displayed no baseline behavioral disruptions, Cav-1 KO mice, similar to schizophrenic individuals, exhibited increased sensitivity to the psychotomimetic N-methyl-D-aspartate receptor antagonist phencyclidine (PCP). Thus, PCP disruption of prepulse inhibition (PPI) and PCP-induced mouse locomotor activity were both enhanced by genetic deletion of Cav-1. Interestingly, genetic deletion of Cav-1 rendered the atypical antipsychotics clozapine and olanzapine and the 5-HT(2A)-selective antagonist M100907 ineffective at normalizing PCP-induced disruption of PPI. We also discovered that genetic deletion of Cav-1 attenuated 5-HT(2A)-induced c-Fos and egr-1 expression in mouse frontal cortex and also reduced 5-HT(2A)-mediated Ca(2+) mobilization in primary cortical neuronal cultures. The behavioral effects of the 5-HT(2A) agonist (2,5-dimethoxy-4-iodoamphetamine) including head twitch responses and disruption of PPI were also attenuated by genetic deletion of Cav-1, indicating that Cav-1 is required for both inverse agonist (that is, atypical antipsychotic drug) and agonist actions at 5-HT(2A) receptors. This study demonstrates that disruption of the CAV1 gene--a rare structural variant associated with schizophrenia--is not only pro-psychotic but also attenuates atypical antipsychotic drug actions.

Workers' exposure to dust, endotoxin and β-(1-3) glucan at four large-scale composting facilities

OBJECTIVES

To characterise compost workers' exposure to dust, endotoxin and β-(1-3) glucan during various operational practices and investigate whether dust concentrations are a useful indicator of endotoxin exposure in compost workers.

METHODS

This study assessed inhalable dust fractions, bacterial endotoxin and β-(1-3) glucan in 117 personal samples and 88 ambient samples from four large-scale composting facilities.

RESULTS

Employees' exposures to inhalable dust, endotoxin and β-(1-3) glucan exhibited a large range. Inhalable dust was found to be generally low (GM 0.99 mg/m(3), GSD 2.99 mg/m(3)). Analysis of the biological component of the dust showed that employees' exposures to endotoxin were elevated (GM 35.10 EU/m(3), GSD 9.97 EU/m(3)). Employees' exposure to β-(1-3) glucan was low (GM 0.98 ng/m(3), GSD 13.39 ng/m(3)). Dust levels were elevated during manual sorting and screening of waste and high levels of endotoxin and β-(1-3) glucan were observed during all practices involving the movement of waste. A significant correlation was observed between the personal dust levels and personal endotoxin concentrations (r=0.783, p<0.05) and that personal inhalable dust concentration may be a valuable predictor for personal endotoxin concentration in the sites studied.

CONCLUSIONS

Workers at composting sites are exposed to high levels of bacterial endotoxin consistent with adverse respiratory outcomes even though in most cases, their personal dust exposure is below the suggested regulatory levels. Dose-response data for the biological components present in the dust encountered at composting sites are not well established at this time and site operators should adopt precautionary measures when assessing and managing these potential risks.

The effect of antidiuretic hormone on human sweating

1. Changes in insensible perspiration and sweating were followed in normal subjects by continuously monitoring total body weight loss in environmental temperatures of 18, 29 and 37 degrees C.2. Pharmacological doses of ADH had no effect on cutaneous water loss at 18 degrees C.3. Pharmacological doses of ADH are capable of increasing the rate of cutaneous water loss in human subjects who are close to or above the thermal sweating threshold.4. Physiological doses of ADH had no effect on cutaneous water loss in either cool or hot environments.5. At normal rates of secretion in the body, ADH probably does not influence human sweat secretion.

Elevated multidrug resistance-associated protein 4 (MRP4) expression in localized prostate cancer—A potential androgen regulated protein

20022

Background: MRP4 is an ATP-binding cassette transporter and amphipathic anion efflux pump which transports prostaglandins, nucleoside analogues, glutamate and phosphate analogues. High MRP4 expression is prognostic of poor outcome in neuroblastoma and also correlates with MYCN amplification, suggesting regulation by this oncogene. Although MRP4 is known to be expressed in normal prostate epithelium, its expression in prostate cancer (PC) is undefined. This study aimed to define the pattern of expression of MRP4 in normal and malignant prostate tissue and assess the association with androgen exposure. Methods: 84 radical prostatectomy specimens from patients with clinically localized PC (22 neoadjuvant androgen ablation therapy, 62 no neoadjuvant treatment), 42 specimens of hyperplasia adjacent to PC and 16 cases of advanced PC were assessed for MRP4 expression using in situ hybridisation and immunohistochemistry. PC cell lines were assessed by immunoblotting. Results: There were significantly higher levels of MRP4 mRNA and protein expression in localized PC compared to hyperplasia (p=0.006). Conversely, MRP4 protein levels were significantly decreased in PCs treated with neoadjuvant androgen ablation therapy compared to cancers exposed to normal testosterone levels (p < 0.0001). There was also a trend towards decreased MRP4 expression in advanced PCs. Furthermore, immunoblotting revealed that MRP4 protein was more highly expressed in androgen-dependent (LNCaP) compared to androgen-independent (PC3/DU145) cell lines. In addition, in a panel of 14 normal human tissues only kidney and prostate tissue expressed MRP4 protein suggesting limited expression of MRP4 in human tissues. Discussion: Elevated MRP4 expression is found in malignant compared to benign prostate tissue while lower MRP4 expression is seen after androgen ablation suggesting that MRP4 may be an androgen-regulated gene. In addition, there is relatively little expression of MRP4 in normal tissues. These data suggest that MRP4 is important in the progression to PC and that it may be a potential therapeutic target.

No significant financial relationships to disclose.

Incomplete sexual isolation in sympatry between subspecies of the butterfly Danaus chrysippus (L.) and the creation of a hybrid zone

Subspecies chrysippus, dorippus and alcippus of the butterfly Danaus chrysippus differ at three biallelic colour gene loci. They have partially vicariant distributions, but their ranges overlap over a substantial part of central and East Africa, where hybridism is commonplace. We now report that the West African subspecies alcippus differs from other subspecies, not only in nuclear genotype but also in mitochondrial haplotype in both allopatry and sympatry. The maintenance of concordant nuclear and cytoplasmic genetic differences in sympatry, and in the face of hybridisation, is prima facie evidence for sexual isolation. Other evidence that suggests alcippus may be isolated from chrysippus and dorippus include differences in sex ratio (SR), heterozygote deficiency at one site and deduced differences in patterns of migration. We suggest that, within the hybrid zone, differential infection of subspecies by a male-killing Spiroplasma bacterium causes SR differences that restrict female choice, triggering rounds of heterotypic mating and consequent heterozygote excess that is largely confined to females. The absence of these phenomena from hybrid populations that test negative for Spiroplasma supports the hypothesis. The incomplete sexual isolation and partial vicariance of alcippus suggests that it is a nascent species.

Use of questionnaire screening for vibration white finger in a high risk industrial population

OBJECTIVES

To compare the results of questionnaire screening with those of objective testing in the identification of vibration white finger (VWF) in a high risk population.

METHODS

Three groups of men (79 riveters, 52 healthy controls and 79 compensation claimants) were assessed for VWF by a detailed questionnaire covering occupational and general medical history and incorporating specific questions related to the presence or absence of relevant symptoms in their hands. Each then underwent provocative cold testing under controlled conditions using established protocols. The presence or absence of digital vasospasm following cooling was determined by finger systolic pressure measurements using laser Doppler flowmetry. The test protocols used have been evaluated in patients with a clear clinical diagnosis of non-occupational Raynaud's syndrome.

RESULTS

6.3% of the riveters and 83.5% of the claimants reported specific Raynaud's syndrome symptoms but 30.4% of the riveters and only 19% of the claimants tested positive for vasospasm after middle phalangeal cooling to 10 degrees C for 5 min. Using a more severe cooling protocol provoked vasospasm in 46.8% of the claimants. Lack of sensitivity or specificity of the objective testing could not explain the large discrepancies between the findings in the riveters and in the claimants.

CONCLUSIONS

Questionnaire responses concerning VWF symptoms can be influenced by the context in which they are recorded. It is important to employ more objective methods in assessing all workers at risk of developing VWF.

Digital vascular responses and serum endothelin-1 concentrations in primary and secondary Raynaud's phenomenon

OBJECTIVE

To determine circulating endothelin-1 levels (ET-1) in patients with primary or secondary associated Raynaud's phenomenon (RP) under resting conditions and in response to cold provocation.

METHODS

Patients were categorised as primary RP (18) or scleroderma associated RP (14). Finger blood flow was measured by venous occlusion plethysmography at finger temperatures of 32 degrees C and 24 degrees C. Vasospasm was detected as a finger systolic pressure of 0 mm Hg after standardised provocative cooling. Severity of vasospasm was assessed by the level of cooling required to provoke spasm. Plasma ET-1 levels were measured in antecubital blood withdrawn under baseline conditions (finger 32 degrees C) and at the point of vasospasm. Measurements were also made in 19 matched control subjects.

RESULTS

Finger blood flow was lower in patients with RP than in controls, with no difference between the two RP groups. Vasospasm occurred in all patients with RP but not in any control subjects and a grading system of severity was established. Baseline plasma ET-1 levels were similar in patients with RP and controls. Increases in ET-1 levels at the point of vasospasm in patients or corresponding timepoint in controls were also similar. There was no significant difference between the ET-1 levels in the two RP subgroups when the fingers were warm or when vasospasm was present.

CONCLUSIONS

These results do not support the hypothesis that ET-1 plays a part in the pathogenesis of RP. Objective testing is a useful adjunct to the clinical diagnosis of RP and allows assignment of a severity grade.

Unemployment, depression, and health: a look at the African-American community

OBJECTIVES

While the unemployment rate of African-American people is more than twice that of the white population, the research on the impact of unemployment on the health of this population is scarce. This study analysed the impact of unemployment on depression and well being among African-American people, and the factors associated with well being.

METHODS

Logistic and multiple regression models were used to analyse panel data collected in the National Survey of Families and Households 1987-1992. African-American (1369) and white (6660) respondents were analysed separately. Outcome variables included an index of depression and self reported health status.

MAIN FINDINGS

Differences between employment and unemployment groups were less significant for African-Americans than for the white population in predicting depression and well being. Health enhancing factors such as education and wealth were significantly associated with better health and lower depression indices among the white population but not consistently so among African-Americans. Satisfaction with personal relationships was the strongest predictor of well being for both groups.

CONCLUSION

Research should focus on the special needs and circumstances of African-Americans, because protective factors may not have the same impact in different groups of the population.

Autonomic function in patients on continuous ambulatory peritoneal dialysis

OBJECTIVE

To investigate sympathetic function in the peripheries of patients on chronic ambulatory peritoneal dialysis (CAPD) using noninvasive techniques.

DESIGN

Comparison of peripheral blood flow responses in sympathetic vasoconstrictor reflexes in CAPD patients and matched control subjects.

SETTING

Tertiary care hospital and research institution.

PATIENTS

Twenty-three clinically stable CAPD patients and 23 control subjects matched for age, sex, and drug therapy.

MAIN OUTCOME MEASURES

Sympathetic activity assessed from the reductions in hand and foot blood flow induced by a deep breath and by body surface cooling. Cardiac autonomic activity measured by the changes in heart rate produced by deep breathing, a Valsalva maneuver, and standing from lying.

RESULTS

A deep breath induced mean decreases in hand blood flow of 65.1% in the patients and 82.8% in their matched controls. Corresponding reductions in the foot were 46.0% and 70.0%. Body surface cooling reduced mean hand blood flow by 50.3% in the patients and 71.8% in the control subjects. Corresponding values in the foot were 26.7% and 43.6%. The differences in response between the patients and their matched control subjects were all significant (p < 0.01). Cardiac autonomic function assessed by standard tests of heart rate variability was significantly impaired in the patients compared with the control subjects in two of the three tests used (p < 0.001).

CONCLUSIONS

Cardiovascular autonomic impairment can affect the peripheral circulation as well as the heart in patients on dialysis, and this may have implications for cardiovascular homeostasis.

Acute effects of vibration on peripheral blood flow in healthy subjects

OBJECTIVES

The main objective was to study the acute vascular effects in the hands of normal healthy subjects of a complex vibration spectrum similar to that generated by many industrial hand held tools. The effects of repeated bouts of vibrations and alterations in the intensity of vibration were also studied.

METHODS

Blood flow was measured by venous occlusion plethysmography with strain gauges. Vibration across a frequency range of 0.4 to > 4000 Hz was generated by a pneumatic chisel and applied to the right hand. Blood flow was measured in both middle fingers, both big toes, or both forearms before, during, and after a two minute period of vibration. Systolic pressure of a finger and heart rate were also measured.

RESULTS

Vibration was associated with a significant bilateral reduction in finger and toe blood flow (P < 0.01 and P < 0.03) and a significant increase in heart rate (P < 0.05) but had no effect on forearm blood flow. The finger response was not abolished by repeated bouts of the vibration but was initially most notable during the first minute of vibration. Increasing the intensity of vibration delayed recovery.

CONCLUSIONS

Hand vibration causes a generalised increase in sympathetic tone in the heart and extremities. This may be a factor in the development of vasospastic disease in habitual users of hand held industrial vibrating tools.

Hydrostatic pressure has different effects on the assembly of tubulin, actin, myosin II, vinculin, talin, vimentin, and cytokeratin in mammalian tissue cells

Hydrostatic pressures in the range of hundreds of atmospheres are known to disrupt cytoskeletal organization in tissue culture cells, with profound changes in cell shape. The molecular mechanisms of these effects are poorly understood. To determine the effect of pressure on the cytoskeleton, and thus to provide better indicators of the molecular mechanisms, we used fluorescent antibody staining to compare the organizations of seven different cytoskeletal proteins in HeLa cells and rat osteosarcoma cells (ROS-17/2.8) subjected to different pressures up to 400 atm. Pressures of 300 atm or more caused cells of both lines to "round up" and to withdraw their lamellar extensions. However, this response varied within a population of cells, with some cells remaining spread at pressures that caused their neighbors to round up. The most resistant to rounding were those cells touching other cells, and the occasional giant cells. As expected, the rounded cells showed disruption of actin stress fibers and of vinculin and talin at focal contacts. The unrounded cells showed less disruption in the organization of these same proteins. Microtubules and myosin II filaments appeared resistant to 400 atm pressure in both cell types, whether rounded or unrounded. However, in HeLa cells, the intermediate filaments, vimentin and cytokeratin, depolymerized and formed small vesicles when pressures exceeded 200 atm, and this occurred in rounded as well as unrounded cells. In osteosarcoma cells, which do not have cytokeratin, vimentin did not depolymerize. We discuss different mechanisms that might explain these responses to pressure, including direct effects on the equilibria of protein polymerization and less direct effects on regulatory mechanisms, such as phosphorylation pathways, that control cytoskeletal organization. The later type of explanation seems more consistent with both the variability of response within cell populations and the difference in vimentin's response in one cell line compared with the other.

Genotoxicity testing of pidotimod in vitro and in vivo

The mutagenic potential of pidotimod ((R)-3-[(S)-(5-oxo-2- pyrrolidinyl)carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was assessed in a series of five assays designed to measure gene mutation, chromosomal damage and primary DNA damage. All tests were carried out in accordance with appropriate EEC and OECD Guidelines. No indications of mutagenic potential were observed in any of the assays.

Peripheral autonomic impairment in patients newly diagnosed with type II diabetes

OBJECTIVE

To measure both peripheral and central autonomic function in patients newly diagnosed with type II diabetes.

RESEARCH DESIGN AND METHODS

Measurements were made on 49 diabetic patients (8 with long-standing diabetes and neuropathic complications, 41 with newly diagnosed type II diabetes) and on 49 healthy, age- and sex-matched, control subjects. Five of the 41 newly diagnosed type II diabetic patients had retinopathy, and 4 had clinical evidence of neuropathy. No patient or control subject had significant vascular disease. Cardiac autonomic function was investigated by using standard cardiovascular reflex tests. The digital vasoconstrictor responses to deep breathing and body cooling were measured using venous occlusion plethysmography.

RESULTS

The vasoconstrictor responses to a deep breath and body cooling were significantly reduced (P < 0.001) in the fingers and toes of the neuropathic patients compared with their matched control subjects, as were the heart rate responses (P < 0.02). The vasoconstrictor responses were significantly reduced in the toes (P < 0.001) and fingers (P < 0.05, P < 0.01) of the newly diagnosed patients compared with the corresponding responses in the control subjects. There was no significant difference in the heart rate or blood pressure responses of these patients and control subjects during standard tests of cardiac autonomic function.

CONCLUSIONS

Patients with type II diabetes may have impaired peripheral autonomic function at diagnosis.

Vascular responses in chain saw operators

The intensive use of chain saws is associated with development of the hand-arm vibration syndrome (vibration white finger). Objective testing for cold induced vasospasm was carried out on the fingers of 12 chain saw operators and 12 matched control men from a similar working environment. Two of the chain saw operators tested positive for vasospasm in the laboratory and another three had an abnormal result. All of the control subjects tested negative. Measurements of finger blood flow at different temperatures and during vibration of the hand were similar in the chain saw operators and controls. Use of the chain saw did not cause significant alterations in the plasma concentrations of von Willebrand factor antigen in either the long or the short term.

Evaluation of the mutagenicity of a-dihydroergocryptine in vitro and in vivo

The mutagenic potential of the ergot alkaloid a-dihydroergocryptine (a-DEC, CAS 14271-05-7) was assessed in a series of 5 assays designed to measure gene mutation, chromosomal damage and primary DNA damage. All tests were carried out in accordance with appropriate EEC and OECD Guidelines. No indications of mutagenic potential were observed in any of the assays.

'Strawberry gums'--a case of Wegener's granulomatosis

We report a case of Wegener's granulomatosis (WG), localised to the upper aerodigestive tract, which presented as an unusual form of hyperplastic gingivitis in a 36-year-old female. The clinical, serological and histopathological findings are described. The resemblance of the affected gums to over-ripe strawberries is emphasised, in order to draw attention to this characteristic oral manifestation of a rare and potentially life-threatening condition. The response to co-trimoxazole as sole therapy is noted.

Strawberry gums: a clinicopathological manifestation diagnostic of Wegener's granulomatosis?

AIMS

To highlight an uncommon but characteristic gingival lesion associated with Wegener's granulomatosis, emphasising the presence of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells; and the paucity of the currently accepted histopathological criteria of Wegener's granulomatosis--namely necrosis, vasculitis, and granulomata.

METHODS

The histopathological features of a gingival biopsy specimen from a case of Wegener's granulomatosis limited to the upper aerodigestive tract in a 36 year old woman were compared with those of 14 similar reported cases.

RESULTS

Pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells were recorded as present in almost all cases of gingival Wegener's granulomatosis. Necrosis, vasculitis, and granuloma formation were present in only a few cases.

CONCLUSIONS

The combination of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells in a gingival biopsy specimen from erythematous, swollen gums, clinically resembling over-ripe strawberries, in a patient with a severe systemic upset, is so typical of Wegener's granulomatosis as to be virtually diagnostic. Recognition of this characteristic lesion may aid early diagnosis and treatment in cases where other diagnostic variables are absent.

Early cystic/necrotic changes after hyperfractionated radiation therapy in children with brain stem gliomas. Data from the Childrens Cancer Group

BACKGROUND

A higher total dose of radiation therapy administered in fractionated lower individual doses twice daily (hyperfractionated radiation therapy) has been reported to improve survival for children with brain stem gliomas. However, this higher dose of radiation therapy may cause more sequelae.

METHOD

Eighty-eight children with brain stem gliomas were treated with 100 cGy twice daily to a total dose of 7200 cGy. Patients were carefully followed up for treatment-related clinical or radiographic worsening.

RESULTS

Thirteen (15%) had intralesional cystic/necrotic changes within 8 weeks of completion of treatment. Children with these changes had a variable clinical course, including steady deterioration in one child; initial improvement, followed by progressive deterioration in three; and initial improvement, followed by deterioration, with subsequent improvement or prolonged stabilization of condition without additional antineoplastic treatment in nine.

CONCLUSION

This latter "triphasic" course suggests that "early" worsening after hyperfractionated radiation therapy at 7200 cGy may be a sequelae of therapy, rather than a symptom of progressive tumor growth. This has substantial implications for patient care and evaluation of the efficacy of treatment.

Autonomic reflexes in patients with cardioinhibitory carotid sinus syncope

Autonomic reflexes were investigated in patients with the cardioinhibitory carotid sinus syndrome. Heart rate, blood pressure and forearm blood flow responses were recorded during prolonged head-up tilt, the Valsalva manoeuvre, lower body negative pressure and sequential respiratory cycles in ten patients and nine age-matched controls. The mean maximum R-R interval prolongation during carotid sinus massage was 4.4 s. Three patients had syncope during prolonged head-up tilt. Heart rate and blood pressure responses were similar for patients and controls who completed tilt. Responses to lower body negative pressure and Valsalva manoeuvre were similar for both groups. Respiratory sinus arrhythmia was significantly less marked in patients, 7 bpm (0 to 20 bpm) versus 15 bpm (6 to 35 bpm; p = 0.05). Therefore, neck massage and deep breathing produce abnormal cardiac vagal responses, whereas other reflexes, including response to lower body negative pressure and the Valsalva manoeuvre are within the normal range in cardioinhibitory carotid sinus syndrome.

An investigation into the acute vascular effects of riveting

Measurements were made on 46 pairs of riveters and matched control subjects before and after a morning's work. Before starting work, the mean resting finger systolic pressure was 112 (SEM 3.3) mm Hg in the riveters, similar to 117 (1.7) in the control subjects. After cooling the middle phalanx to 10 degrees C for five minutes, 16 riveters but only one control subject exhibited digital vasospasm and these numbers were unaltered after a morning's work. A subgroup of riveters whose role was always to provide counter pressure to the rivet gun showed a higher incidence (45%) of cold induced vasospasm than did riveters who invariably held the gun (10%) or rotated between both roles (27%). Plasma levels of three markers of vascular activity, endothelin-1 (ET-1), von Willebrand factor antigen (vWFAg), and angiotensin converting enzyme (ACE), were measured in non-smoking riveters and control subjects. Before work, ET-1 concentrations were slightly lower (p < 0.05) in the riveters, but vWFAg concentration and ACE activity were similar in riveters and control subjects. Riveting for a morning did not alter ET-1 concentration or ACE activity but did induce a small increase (p < 0.05) in vWFAg concentration, which may indicate damage to the endothelium. This type of vascular assessment may be helpful in assessing vasospastic complications in workers exposed to vibration.

Autonomic function in neuropathic diabetic patients with foot ulceration

OBJECTIVE

The aim of this study was to compare peripheral autonomic function in neuropathic diabetic subjects with and without foot ulceration.

RESEARCH DESIGN AND METHODS

Measurements were made on 57 diabetic subjects; 35 subjects had evidence of peripheral neuropathy, 14 of these had a history of foot ulceration, and 22 subjects had no evidence of peripheral neuropathy. No patient had peripheral vascular disease. Measurements were made of motor and sensory nerve conduction. Autonomic function was investigated by using standard cardiovascular reflex tests and by measuring blood flow variability in the foot. The vasoconstrictor responses to deep breathing and body cooling were measured by using venous occlusion plethysmography.

RESULTS

Peripheral sympathetic function was significantly worse in the DU group. The vasoconstrictor response to deep breathing in the DU group was significantly smaller than the response in the DN group (15.3 +/- 2.7 vs. 38 +/- 4%, P < 0.001). The response to body cooling in the DU group was significantly smaller than the response in the DN group (6.2 +/- 3.1 vs. 20.8 +/- 3.5%, P < 0.01). Tests of cardiac autonomic function and measurements of motor and sensory nerve conduction were similar in both neuropathic groups.

CONCLUSIONS

Peripheral autonomic neuropathy is associated with the development of foot ulceration in diabetic subjects.

Demonstration of silicon in sites of connective-tissue disease in patients with silicone-gel breast implants

BACKGROUND AND DESIGN

Silica, Silastic, and silicone (any organic compound in which silicon replaces carbon) have been associated with a number of connective-tissue diseases, most commonly systemic sclerosis (scleroderma). Silicone is known to leak from breast implants and spread to surrounding tissues, including lymph nodes, but silicone's role in the origin and pathogenesis of the inflammation and fibrosis related to such conditions remains controversial. Synovial tissue, alveolar macrophages, and skin, each from three different patients with silicone-gel implants, plus the breast implant capsules from each of the three patients, were examined by light microscopy, transmission electron microscopy, and electron probe microanalysis for the presence of silicon-containing material.

RESULTS

Silicon was identified within the fibrous breast capsule of each case, associated with a chronic inflammatory cell infiltrate. Silicon was also identified within tissues involved by chronic inflammation and fibrosis, namely, synovium, skin, and alveolar macrophages, in association with clinical, serologic, and histologic evidence of connective tissue disease. All three patients improved after removal of the silicone-gel breast implants.

CONCLUSIONS

The presence of silicon-containing material within sites of connective-tissue disease supports a role for silicon in the origin or pathogenesis of such conditions in patients with silicone-gel breast implants. All patients with connective-tissue disease should be questioned about exposure to various forms of silicon. In those patients with known exposure, tissue specimens should be examined carefully for silicon-containing material and, if found, the source should be removed.

Objective testing for vasospasm in the hand-arm vibration syndrome

Since vibration white finger (VWF) became a prescribed industrial disease in 1985, objective testing for the diagnosis and grading of the severity of the condition has become desirable. Measurements have been made of finger blood flow and finger systolic pressure before and after cold challenge in 22 healthy control subjects and 34 men presenting for medical examination in connection with compensation claims for VWF. This type of testing has previously produced one false negative result in 35 patients with an established clinical diagnosis of Raynaud's syndrome and no false positives in 40 control subjects. Finger blood flow was not significantly different in the claimants and controls in either warm or cool environments at local finger temperatures from 32 degrees C down to 20 degrees C. Finger systolic pressure in the claimants was not significantly different from that in the controls when the fingers were warm at 32 degrees C. After five minutes middle phalangeal cooling to 15 or 10 degrees C, finger systolic pressure was 0 mm Hg in 22 of the claimants indicating that vasospasm had occurred. No vasospasm occurred in the remaining 12 claimants or in any of the 22 control subjects. By clinical assessment alone, 26 of the 34 claimants had been thought to have VWF and 21 (81%) of these exhibited vasospasm in the laboratory. Of the eight considered not to have VWF, only one exhibited vasospasm in the laboratory.

Absence of mutagenic activity in Salmonella and of clastogenic activity in CHO cells of Caramel Colours I, II, III and IV

A total of 15 caramel colours were examined for genotoxic activity using the Salmonella typhimurium plate incorporation assay (Ames test). Five bacterial strains, TA1535, TA1537, TA1538, TA98 and TA100 were used in all the plate incorporation tests. Caramel colours can be divided into four classes, classification depending on the preparative method used. In this study, representatives of all four classes of caramel colour were tested for genotoxic potential in the Ames test, some of the caramel colours being tested both with and without a pre-incubation stage. None of the 15 caramel colours tested exhibited genotoxic potential in any of the five bacterial tester strains. The last two caramel colours tested, in the series of 15 [203-23-4 (Class II) and 311 (Class III)] were also assessed for clastogenic potential. For this test, cultures of CHO cells were exposed to the two caramel colours and metaphase preparations from these cultures examined for evidence of chromosomal aberrations. No evidence of chromosome damaging activity was observed.

An objective test for the diagnosis and grading of vasospasm in patients with Raynaud's syndrome

1. Reliable objective tests for the diagnosis and grading of vasospasm would be helpful in the assessment of patients with Raynaud's syndrome. 2. Measurements of finger blood flow at local finger temperatures from 32 degrees C down to 20 degrees C did not reliably distinguish between patients with Raynaud's syndrome and matched control subjects. 3. Using laser Doppler flowmetry to detect blood cell flux in fingertip skin, there was no significant difference (Wilcoxon's signed rank test) in the finger systolic blood pressure of 28 patients with Raynaud's syndrome and their matched controls when the fingers were warm at 32 degrees C. 4. Absence of flux was considered to indicate complete vasospasm and the degree of cooling required to abolish flux indicated the severity of the vasospastic condition in an individual patient. 5. Finger cooling for 5 min did not significantly alter finger systolic blood pressure in the control subjects, but abolished blood cell flux in the fingertip skin of 27 of the 28 patients with Raynaud's syndrome. 6. A grading scale was derived from the flux measurements. There was a significant correlation (r = 0.75, P less than 0.001) between the grading of disease severity as judged by the flux test and the clinical grade as assessed before the laboratory visit. 7. There was one false-negative result in the 28 patients with Raynaud's syndrome tested and no false-positive results in 28 matched control subjects. 8. This type of testing may prove helpful in the diagnosis and grading of vasospastic disorders.

Assessment of the genotoxic potential of Caramel Colour I in four short-term tests

A battery of three short-term tests in vitro and one in vivo was used to determine the genotoxicity of Caramel Colour I. The results of the bacterial mutation assay, using five strains of Salmonella typhimurium, and the mouse micronucleus assay in vivo showed no evidence of genotoxic activity. Results from both the cytogenetics assay in vitro, using CHO cells, and the mouse lymphoma assay indicated that there was some genotoxic activity associated with Caramel Colour I but only in the absence of S-9 and at very high dose levels.

Treatment of newly diagnosed state D2 prostate cancer with leuprolide and flutamide or leuprolide alone, phase III, intergroup study 0036

In order to test the hypothesis of complete androgen blockade for advanced prostate cancer (D2CaP), an intergroup trial was instituted in 1985 comparing leuprolide (L) alone to the combination of L with flutamide (F). Eligibility requirements included previously untreated histologically confirmed stage D2CaP, measurable bone or soft tissue metastases, performance status (PS) of 3 or better, acceptable renal and hepatic function, no severe cardiac disease, and no prior or concomitant endocrine therapy. Stratification at entry was on the basis of PS and none or minimal disease (MD) versus severe degree (SD) of bone metastases. Six hundred and seventeen patients were entered into this study between March 1985 and April 1986. At the present time, there is a 3-month difference in the median progression-free survival (13.9 vs 16.9 months; P = 0.039) and a 7.1-month difference in survival (27.9 vs 35.01 months; P = 0.035) favoring L + F. In L + F-treated patients with good PS-MD, the median survival recently has been reached and is 51.9 months vs 39.6 months for L + P patients. The 107 black patients in the study had median survival of 26.4 months vs 33.3 months for whites. Discussions of racial differences in survival as well as other prognostic factors will be presented. The combination of L + F is superior to treatment with L alone. The benefits appear greatest in patients with minimal disease.

Autonomic function in Holmes Adie syndrome

Autonomic function was studied in a group of 11 patients with Holmes Adie Syndrome. Autonomic function was assessed by the measurement of cardiovascular reflexes. Heart rate responses to respiration, valsalva manoeuvre and standing were studied. The change in systolic blood pressure on moving from the lying to the standing position was measured. Abnormalities of parasympathetic function were found in three patients, compared with matched controls. Autonomic dysfunction in Holmes Adie Syndrome may be more widespread than previously suspected.

A comparison of peripheral vasoconstrictor responses and cardiovascular autonomic function tests in diabetic patients

Venous occlusion plethysmography has been used to measure sympathetic vasoconstrictor responses in the feet and hands to a deep breath and body cooling and to assess blood flow variability. Measurements were made in 14 non-diabetic control subjects and 52 diabetic patients, 30 of whom had evidence of peripheral neuropathy. All the measurements were significantly reduced in the feet of patients with neuropathy. Vasoconstrictor responses were not significantly impaired in the hands of these patients. Cardiovascular autonomic function was assessed in the same subjects by standard tests of reflex heart rate responses and compared to sympathetic vasoconstrictor function as determined by the response to a deep breath. Eighteen of the 30 diabetic patients with peripheral neuropathy had impairment of both cardiovascular and sympathetic vasoconstrictor function. Five had normal vasoconstrictor but impaired cardiovascular responses and two had normal cardiovascular but impaired vasoconstrictor function. It may therefore be important to assess both systems in diabetic patients.

Blood flow in diabetics with foot lesions due to 'small vessel disease'

Blood flow was measured in the feet and toes of 23 diabetics, 7 controls and 6 non-diabetic neuropathic controls, using venous occlusion plethysmography. All of the diabetics showed a characteristic flow abnormality with mild hyperperfusion of the foot at rest but impaired peak flow following arterial occlusion. When the diabetics were subdivided into those with 'small vessel disease', those with neuropathic ulceration and those with neuropathy but no ulceration, the groups had remarkably comparable blood flows, except that peak great toe blood flow was rather lower in small vessel disease. In small vessel disease, the combination of high resting blood flow and elevated foot venous oxygen saturation suggests that the hyperperfusion is due to arteriovenous shunting. It seems likely that the toe lesions ascribed to small vessel disease were in fact manifestations of severe diabetic neuropathy. The term small vessel disease should be avoided in the context of diabetic foot lesions.

Frequency-dependent selection by predators

Sometimes predators tend to concentrate on common varieties of prey and overlook rare ones. Within prey species, this could result in the fitness of each variety being inversely related to its frequency in the population. Such frequency-dependent or 'apostatic' selection by predators hunting by sight could maintain polymorphism for colour pattern, and much of the supporting evidence for this idea has come from work on birds and artificial prey. These and other studies have shown that the strength of the observed selection is affected by prey density, palatability, coloration and conspicuousness. When the prey density is very high, selection becomes 'anti-apostatic': predators preferentially remove rare prey. There is still much to be learned about frequency-dependent selection by predators on artificial prey: work on natural polymorphic prey has hardly begun.

Apostatic selection by humans searching for computer-generated images on a colour monitor

A computer program was used to generate "populations" of dimorphic "prey" on the screen of a colour monitor. Different subjects were presented with the prey at seven different frequencies and were asked to use a light pen to remove each prey they detected. They all received the same two types of prey but 70 had them presented against a matching background and 49 had them against a background that made them conspicuous. The results showed that apostatic selection occurred when the prey were inconspicuous but not when they were conspicuous. There is evidence that the apostatic selection was caused by some effect of the difficulty in detecting the prey when they were cryptic.

A plethysmograph for the measurement of digital blood flow

Venous occlusion plethysmography using a water-filled plethysmograph is an accurate and reliable method for the measurement of limb flow which has been used for many years. The technique has been adapted to produce a plethysmograph for the measurement of digital blood flow. The device is small, light, cheap, simple to use, and can be calibrated directly with the digit 'in situ'. It is especially suitable for the assessment of digital blood flow, since flow through a large portion of the whole digit is measured and the local temperature of the digit is accurately controlled.

Phase I study of carboplatin (CBDCA) in children with cancer

A phase I study of carboplatin (CBDCA) was performed in 40 children with advanced cancer. A single course of CBDCA consisted of 4 weekly 1-hour infusions followed by a 2-week rest. The starting dose of 100 mg/m2/week was 66% of the maximum tolerated dose in adults. Escalated dose levels given were: 125, 150, 175, and 210 mg/m2. Myelosuppression was dose limiting, with thrombocytopenia more pronounced than leukopenia. There was no evidence of cumulative toxicity. The maximum tolerated dose for children with solid tumors was 210 mg/m2/week X 4. Other side effects included transient nausea and vomiting at the higher dose levels and non-dose-related, reversible changes in creatinine clearance. One patient developed hives. No hepatic toxicity was seen. Among the 28 evaluable patients with solid tumors, one of ten with osteogenic sarcoma had complete disappearance of a lung nodule for 15+ months. Two of four patients with medulloblastoma had partial responses by clinical and computerized tomographic scan for 4 and 10 months. All three responders had received prior cisplatin therapy. CBDCA has major advantages over cisplatin in terms of reduced toxicity. Responses observed in patients previously treated with cisplatin are encouraging. The recommended phase II dose for children with solid tumors is 175 mg/m2/week X 4 with a 2-week rest.