Soil moisture controls the partitioning of carbon stocks across a managed boreal forest landscape

Boreal forests sequester and store vast carbon (C) pools that may be subject to significant feedback effects induced by climatic warming. The boreal landscape consists of a mosaic of forests and peatlands with wide variation in total C stocks, making it important to understand the factors controlling C pool sizes in different ecosystems. We therefore quantified the total C stocks in the organic layer, mineral soil, and tree biomass in 430 plots across a 68 km2 boreal catchment. The organic layer held the largest C pool, accounting for 39% of the total C storage; tree and mineral C pools accounted for 38% and 23%, respectively. The size of the soil C pool was positively related to modelled soil moisture conditions, especially in the organic soil layer (R2 = 0.50). Conversely, the tree C pool exhibited a unimodal relationship: storage was highest under intermediate wetness conditions. The magnitude and variation in the total soil C stocks observed in this work were comparable to those found at the national level in Sweden, suggesting that C accumulation in boreal landscapes is more sensitive to local variation resulting primarily from differences in soil moisture conditions than to regional differences in climate, nitrogen deposition, and parent material.

Impact of insufficient admission vitamin D serum concentrations on sepsis incidence and clinical outcomes in patients with thermal injury

INTRODUCTION

In burn patients, vitamin D has been studied primarily in the pediatric population and focused mainly on the correlation with bone marker measurements and incidence of fractures. There is an association between vitamin D deficiency and the development of sepsis in non-burn critically-ill patients. However, there is limited data on vitamin D concentrations and clinical outcomes in burn patients, such as sepsis. The objective of this study is to evaluate the impact of vitamin D concentrations on the incidence of sepsis in adult burn patients.

METHODS

This was a retrospective cohort of patients 18 years of age and older admitted between February 1, 2016 and February 28, 2018 to an American Burn Association (ABA) verified burn center with diagnosis of burn injury. The primary endpoint was incidence of sepsis using the ABA 2007 Sepsis Consensus Criteria between patients with adequate vitamin D concentrations (25[OH]D > 20 ng/mL) and insufficient vitamin D (25[OH]D < 20 ng/mL) concentrations measured on admission. Descriptive statistics were used for baseline demographics. Univariate analysis was conducted using Chi-square, Fisher's exact test or Mann-Whitney U test, as appropriate.

RESULTS

A total of 115 patients were screened and 107 patients were included in this study. Sixty three patients (58.9%) had insufficient vitamin D concentrations. Patient demographics were overall similar between groups. The median total body surface area burned was 14.6% in the insufficient vitamin D group, and 12.1% in the adequate vitamin D group (p = 0.2). There was a trend towards greater incidence of sepsis in the insufficient vitamin D group in the univariate analysis (15.9% vs. 4.5%, p = 0.07). The multivariable logistic regression analysis found that adequate vitamin D concentrations was associated with a reduction in the incidence of sepsis (OR 0.10, 95% CI 0.01-0.88). The insufficient vitamin D group had a longer median hospital LOS (19 [IQR 11-37] vs 11.5 [IQR 7-20] days, p < 0.05), longer intensive care unit LOS (17 [IQR 10-37] vs 5 [IQR 2-19.5] days, p < 0.05) and fewer ventilator free days (26 [IQR 18-28] vs 28 [IQR 27-28] days, p < 0.05). There was no difference in mortality between groups (p = 0.69).

CONCLUSIONS

Patients with adequate vitamin D concentrations on admission had a reduction in the incidence of sepsis as compared to patients with insufficient vitamin D concentrations. Insufficient vitamin D concentrations may contribute to other worsened clinical outcomes in burn patients. Our findings set the stage for future, multicenter studies to determine the role of vitamin D supplementation in burn patients.

Improving the detection of environmental enteric dysfunction: a lactulose, rhamnose assay of intestinal permeability in children aged under 5 years exposed to poor sanitation and hygiene

Background

Environmental enteric dysfunction (EED) is an asymptomatic intestinal disorder affecting populations living in conditions of poor sanitation and hygiene. The study tested intestinal barrier function in infants with EED.

Methods

We prospectively studied an advanced high-performance liquid chromatography mass spectrometry assay of urine collected after oral intake of the monosaccharide, L-rhamnose and the disaccharide, lactulose, in 112 children from three continents.

Findings

Compared to the US cohort (n=27), the cohorts of children from Peru (n=19) and Zambia (n=85) were older with evidence of growth impairment. The median (range) of age (months) was 8.0 (2.0 to 13.0), 27.0 (15.0 to 29.0) and 21.0 (12.0 to 36.0), respectively. The median (range) of height for age Z score was −0.1 (−1.8 to 2.4), −1.8 (−3.3 to −0.2) and −2.3 (−8.5 to 1.2), respectively. Among children with valid sugar data (n=22 USA, n=19 Peru, n=73 Zambia), there were no significant differences in the median rhamnose urine concentrations between the three groups. The median (range) lactulose concentration (µg/mL) was 6.78 (0.29 to 31.90), 47.60 (4.23 to 379.00) and 75.40 (0.67 to 873.00) in the US, Peruvian and Zambian cohorts, respectively (p<0.001). The lactulose/rhamnose ratio (LRR) was higher in cohorts from Peru (0.75, 0.15, 5.02) and Zambia (2.26, 0.08, 14.48) compared to the US (0.14, 0.06, 1.00) cohort (p<0.001). In a multivariate effect modification model, higher weight-for-age z scores were associated with lower post-dose lactulose when rhamnose excretion was constant (p=0.003).

Conclusions

This non-invasive two saccharide permeability protocol measures changes in intestinal permeability in children with EED and permits the identification of individuals for interventional trials.

A new solid state extractor pulser for the FNAL magnetron ion source

A new solid state extractor pulser has been installed on the Fermi National Accelerator Laboratory (FNAL) magnetron ion source, replacing a vacuum tube style pulser that was used for over 40 years. The required ion source extraction voltage is 35 kV for injection into the radio frequency quadrupole. At this voltage, the old pulser had a rise time of over 150 μs due to the current limit of the vacuum tube. The new solid state pulsers are capable of 50 kV, 100 A peak current pulses and have a rise time of 9 μs when installed in the operational system. This paper will discuss the pulser design and operational experience to date.

Hydrogel-Based Engineering of Beige Adipose Tissue

Brown and beige adipose tissues have a significant capacity for energy expenditure that may be exploited as a treatment for obesity and metabolic disease. However, the limited volumes of these tissues in adults hinders realization of this potential. Engineering beige adipose tissue may provide an alternative source of this tissue. In this paper we describe the preparation of poly(ethylene glycol) (PEGDA) hydrogels with mechanical properties similar to native adipose tissue. Adipose derived stem cells (ASC) were cultured in hydrogels without adhesive sequences or degradable monomers. Cells were able to differentiate, independent of scaffold properties and were maintained as a viable and functioning adipose tissue mass. The cells expressed their own basement membrane proteins consistent with the composition of adipose tissue. The ASCs could be induced to express uncoupling protein-1 (UCP-1) and cIDEA, makers of beige adipocytes with expression level varying with hydrogel stiffness. This hydrogel-based culture system serves as a first step in engineering beige adipose tissue.

A case-control study of childhood trauma in the development of irritable bowel syndrome

BACKGROUND

The etiology of irritable bowel syndrome (IBS) is not been fully elucidated, but childhood trauma may disturb the brain-gut axis and therefore be important. Thus, we conducted a family based case-control study of IBS cases and their relatives with the aims to (i) determine the frequency of childhood trauma among IBS cases and controls as well as their relatives, and (ii) assess childhood trauma among IBS cases with affected relatives (familial IBS).

METHODS

Outpatients with IBS, matched controls, and their first-degree relatives completed a self-report version of Bremner' Early Trauma Inventory. Percent of cases and controls with a family history were compared and odds ratios were computed using chi-squared test; recurrence risks to relatives were computed using logistic regression and generalized estimating equations.

KEY RESULTS

Data were collected from 409 cases, 415 controls, 825 case relatives, and 921 control relatives. IBS cases had a median age of 50 and 83% were women. Of IBS cases, 74% had experienced any general trauma compared to 59% among controls, yielding an odds ratio of 1.56 (95% CI: 1.13-2.15, p < 0.008). There were no statistical differences between IBS relatives and control relatives with regards to lifetime trauma.

CONCLUSIONS & INFERENCES

IBS is associated with childhood trauma, and these traumas often occur prior to onset of IBS symptoms. This provides further insight into how traumatic childhood events are associated with development of adult IBS.

Short-latency single unit processing in olfactory cortex

Abstract Single-unit recording of layer II-III cells in olfactory (piriform) cortex was performed on awake, unrestrained rats actively engaged in learning novel odors in an olfactory discrimination task. Five of the 67 cells tested had very brief monophasic action potentials and high spontaneous firing rates (30-80 Hz); it is suggested that these units were interneurons. The remainder of the neurons had broader spikes and did not discharge for prolonged periods. Thirty-nine percent of the broad spike cells responded to at least one and usually more of the odors presented to the rats during either of the first two trials on which that odor was present, but, in most cases, these responses occurred only very infrequently over the course of subsequent trials. Six percent of the broad-spike group, how ever, continued firing robustly to a single odor but not to others. From these results it appears that most cells in piriform cortex do not respond to most odors, i.e., coding is exceedingly sparse. A subgroup of the predominant broad-spike cell type does react to several odors but this response drops out with repeated exposure, perhaps because of training. However, a few members of this class (a small fraction of the total cell population) do go on responding to a particular odor, thus exhibiting a form of odor specificity. The results are discussed with regard to predictions from recently developed models of the olfactory cortex.

Barriers and motivators affecting tuberculosis infection control practices of Russian health care workers

SETTING

Five in-patient and out-patient tuberculosis (TB) care facilities in two regions of Russia.

OBJECTIVE

To identify barriers and motivators to the use of infection control measures among Russian TB health care workers.

DESIGN

In this qualitative study, a convenience sample of 96 health care workers (HCWs) was used to generate 15 homogeneous focus groups, consisting of physicians, nurses, and laboratory or support staff.

RESULTS

Barriers and motivators related to knowledge, attitudes and beliefs, and practices were identified. The three main barriers were 1) knowledge deficits, including the belief that TB was transmitted by dust, linens and eating utensils; 2) negative attitudes related to the discomfort of respirators; and 3) practices with respect to quality and care of respirators. Education and training, fear of infecting loved ones, and fear of punishment were the main motivators.

CONCLUSIONS

Our results point to the need for evaluation of current educational programs. Positive health promotion messages that appeal to fear might also be successful in promoting TB infection control. Individualized rewards based on personal motivators or group rewards that build on collectivist theory could be explored.

Nested case-control study of feline calicivirus viruria, oral carriage, and serum neutralizing antibodies in cats with idiopathic cystitis

BACKGROUND

The epidemiology of feline calicivirus (FCV) infection in cats with idiopathic cystitis (FIC) has not been investigated by contemporary molecular biologic methods.

OBJECTIVES

To determine the prevalence of and evaluate risk factors for FCV viruria, oral carriage, and virus neutralizing (VN) antibodies in cats with and without FIC.

ANIMALS

Cats with nonobstructive FIC (n = 47), obstructive FIC (n = 22), and FCV upper respiratory tract infection (URI; n = 25), and healthy client-owned (n = 18) and colony-housed (n = 24) cats.

METHODS

Oropharyngeal secretions and urine were evaluated with a FCV p30 gene-based real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay. Serum VN antibody titers were determined by a modified microtiter assay. Associations of risk factors with log-transformed antibody titers were determined by multivariable generalized linear regression.

RESULTS

FCV viruria was detected in 4 (6%) and 3 (12%) cats with FIC and URI, respectively. In 3 FIC cats, viruria was unassociated with detectable oral virus carriage. Oral FCV carriage was detected in 7 (10%) FIC cats. Median antibody titers were significantly higher in cats with obstructive FIC (1 :256), nonobstructive FIC (1:128), and URI (1:512) compared with healthy client-owned (1:16) and colony-housed (1:4) cats (P < .001). Other than disease, multivariate analysis did not identify any other explanatory variables for increased titers in cats with FIC or URI.

CONCLUSIONS AND CLINICAL IMPORTANCE

FCV viruria was detected in cats with FIC and URI, however, its etiologic significance is uncertain. Serologic results suggest increased FCV exposure in FIC cats compared with controls. Further investigations are needed to clarify the potential role of FCV in FIC.

Baseline serum estradiol and fracture reduction during treatment with hormone therapy: the Women's Health Initiative randomized trial

INTRODUCTION

The purpose of the study was to test the hypothesis that the reduction in fractures with hormone therapy (HT) is greater in women with lower estradiol levels.

METHODS

We conducted a nested case-control study within the Women's Health Initiative HT Trials. The sample included 231 hip fracture case-control pairs and a random sample of 519 all fracture case-control pairs. Cases and controls were matched for age, ethnicity, randomization date, fracture history, and hysterectomy status. Hormones were measured prior to randomization. Incident cases of fracture were identified over an average follow-up of 6.53 years.

RESULTS

There was no evidence that the effect of HT on fracture differed by baseline estradiol (E2) or sex hormone binding globulin (SHBG). Across all quartiles of E2 and SHBG, women randomized to HT had about a 50% lower risk of fracture, including hip fracture, compared to placebo.

CONCLUSION

The effect of HT on fracture reduction is independent of estradiol and SHBG levels.

Multiple Subtypes of HER-2/Neu-Positive Metastatic Breast Cancer

Background: Using IHC or FISH to select patients for trastuzumab-based therapy, only half of HER2-positive patients show evidence of response. In vitro data implicate HER2:HER3 heterodimers and p95HER2 (p95), the truncated 95-kilodalton C-terminal fragment of HER-2 lacking the trastuzumab binding site, as mediators of resistance to trastuzumab at the receptor level. We have previously reported that central FISH-positive patients with low HER2 protein expression by VeraTag had significantly reduced response to trastuzumab compared to patients who had FISH-positive tumors with high HER2 protein expression (Lipton, SABCS 2008). Adding quantitative measurements of HER3 and p95, we offer evidence for the existence of multiple sub-types of HER2-positive tumors that respond differently to trastuzumab.Methods: Using the VeraTag assay, quantitative protein measurements of HER2, HER3, and p95 were made in FFPE specimens from a cohort of patients with metastatic breast cancer (MBC) and correlated with time to progression (TTP) and overall survival (OS) following treatment with first-line trastuzumab using Kaplan-Meier (KM) and Cox proportional hazards regression analyses.Results: Measurements of HER2 (H2T), HER3 (H3T) and p95 were made in FFPE tumor samples from 95 patients treated with first-line trastuzumab for metastatic breast cancer. Within the group that overexpressed HER2 by the VeraTag Assay (n=60), a group with highly overexpressed HER2 (n=15) had shorter TTP and OS than those that had moderate HER2 overexpression (median TTP 4.6 vs. 12 mos, HR=2.1; p=0.011; median OS 29 vs. 40 mos, HR=2.0; p=0.047). Within the subgroup with moderate H2T overexpression (n=45), bivariate Cox analyses demonstrated that p95 and H3T were independent predictors of TTP (p95 HR=2.1; p=0.031; H3T HR=3.5; p=0.0037). For OS, p95 was significant and H3T showed a strong trend (p95 HR=2.5; p=0.025, H3T HR=2.2; p=0.089). Univariate KM analysis with the p95+ and H3T+ groups combined, gives the results in the table below. These data suggest that HER2-positive breast cancer patients can be classified into at least 4 sub-groups with different outcomes following trastuzumab treatment.Conclusions: These data suggest the existence of multiple subgroups of HER2-positive patients expressing varying HER2, p95, and HER3 levels that experience different clinical outcomes following treatment with trastuzumab. Furthermore, the association of HER3 and p95 overexpression with poor response to trastuzumab in otherwise HER2-positive tumors suggests possible treatment approaches with combinations of targeted therapies.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2030.

Technical note: a method to quantify prolamin proteins in corn that are negatively related to starch digestibility in ruminants

Compared with floury or high-moisture corns, dry corn with a greater percentage of vitreous endosperm has been demonstrated to be negatively related to starch digestibility and milk yield of lactating dairy cows. Starch granules in corn are encapsulated by hydrophobic prolamin proteins that are innately insoluble in the rumen environment. Corn prolamin proteins are named zein, and laboratory methods to quantify zein exist but are seldom employed in ruminant nutrition because of their arduous nature. In this study, advances in cereal chemistry were combined with rapid turbidimetric methods yielding a modified turbidimetric zein method (mTZM) to quantify zein in whole corn. Ten dry corns containing unique endosperms were evaluated using the mTZM. Corns with flint, dent, floury, or opaque endosperms were found to contain 19.3, 11.3, 5.8, and 4.9 g of zein/100 g of starch, respectively. The ability of mTZM to differentiate corn endosperm types as defined by least significant difference was 2.6 g of zein/100 g of starch. Ten high-moisture corns of varying moisture content were also evaluated using the mTZM. Zein content of high-moisture corns as defined by mTZM ranged from 8.3 to 2.8 g of zein/100 g of starch with a least significant difference of 1.2 g of zein/100 g of starch. The mTZM determined that zein contents of high-moisture, floury, and opaque corns were markedly less than those of flint and dent dry corns, indicating that mTZM has the ability to quantify starch granule encapsulation by hydrophobic prolamin proteins in whole corn.

A randomized controlled trial evaluating the effect of a support and education programme for spouses of people affected by stroke

Objective: To determine whether a nurse-led support and education programme for spouses of patients affected by stroke improved the psychological health of the spouses.

Design: A longitudinal, open, randomized controlled trial.

Sample: One hundred spouses of stroke patients were randomly assigned to either an intervention or a control group.

Setting: The study was conducted in a hospital setting.

Intervention: The intervention consisted of six group meetings during six months, with a follow-up after further six months. Comparison between the intervention and the control groups was made at baseline, after six and 12 months using analysis with repeated measures.

Main measures: The Comprehensive Psychopathological Rating Scale — Self-Affective for psychological health.

Results: No significant difference was found between the intervention and control groups concerning overall psychological health. However, a subanalysis revealed that those who participated more frequently in the group meetings (five or six times) had significantly stronger psychological health (P<0.05). Knowledge about stroke increased over time in both groups, but participants in the intervention group learned more (P = 0.041).

Conclusion: Encouraging participation in the group meetings of a support programme might have a positive effect on psychological health.

21 DEVELOPMENT OF A TIMED INSEMINATION PROGRAM IN DAIRY HEIFERS AS A PLATFORM TO DETERMINE IF FLUNIXIN MEGLUMINE IMPROVES PREGNANCY RATE AND EMBRYO SURVIVAL

The objectives of the present series of experiments were to develop a timed artificial insemination (TAI) program for dairy heifers and to utilize a TAI program to evaluate the effect of flunixin meglumine (Banamine�; Schering-Plough Animal Health Corp., Atlanta, GA, USA), a prostaglandin H synthase (PGHS)-2 inhibitor, on pregnancy rate and embryo survival. In Experiment 1, 247 heifers were assigned randomly to a prostaglandin F (PGF)/gonadotropin-releasing hormone (GnRH) TAI [i.e., 2 injections of Lutalyse� (25 mg, IM; Pfizer Animal Health Inc., Groton, CT, USA) given 14 days apart in the PM; 60 h after the 2nd Lutalyse injection, heifers received a GnRH injection (Cystorelin�; 100 µg, IM; Merial, Duluth, GA, USA) and were TAI] or a 5-day CIDR/Synch TAI [intravaginal insertion of a CIDR� device (Pfizer Animal Health Inc.) and an injection of GnRH in the AM; 5 days later in the AM, the CIDR insert was removed and Lutalyse was injected, followed by a 2nd injection of Lutalyse� 12 h later; heifers were TAI and injected with GnRH at 72 h after CIDR removal]. Blood samples for progesterone analyses were taken 7 days apart prior to initial PGF or CIDR insertion from the respective groups to determine cycling status. The CIDR/Synch TAI heifers tended to have greater Day 32 (53.1, >46.2%) ultrasound pregnancy rate (USPR) and Day 42 (50.8, >43.7%) rectal palpation (RPPR) than PGF/GnRH heifers (P = 0.10); 4/9 non-cycling heifers of the CIDR/Synch TAI group conceived v. 0/3 of the PGF/GnRH TAI group. In Experiment 2, 176 heifers underwent the CIDR/Synch TAI protocol. However, 2 injections of cloprostenol [500 µg AM/PM; Estrumate�, Schering-Plough Animal Health Corp.) were used to regress the CL at CIDR removal. Heifers at initiation of the CIDR/Synch TAI protocol were assigned randomly to receive injections of Banamine (400 mg IM) at Day 15.5 and at Day 16.0 or no injections (control). Banamine treatment failed to alter either Day 32 USPR (59.6% Banamine v. 59.8% control) or Day 46 RPPR (59.6% Banamine v. 58.6% control). Overall, 4/11 non-cycling heifers conceived. In Experiment 3, 147 heifers underwent a UsedCIDR/Synch TAI protocol utilizing cloprostenol as in Experiment 2. A 5-day used CIDR was employed. Heifers at initiation of the UsedCIDR/Synch TAI protocol were assigned randomly to receive injections of Banamine (400 mg IM) at Day 15.5 and at Day 16.0 or no injections (control). Banamine treatment failed to alter either Day 32 USPR (60.5% Banamine v. 62.0% control) or Day 46 RPPR (59.2% Banamine v. 60.6% control). Pooled overall analyses of pregnancy rates for dairy heifers receiving the CIDR/Synch TAI treatments (n = 451), adjusted for experiments, were 58.3% at Day 32 (USPR) and 57.6% at Day 46 (RPPR). In conclusion, Banamine failed to improve pregnancy rate and/or late embryo survival in dairy heifers, and a CIDR/Synch TAI program is very effective for optimizing the pregnancy rate in dairy heifers. This work was supported by the Florida-Georgia Milk Check-off program.

Vinorelbine-based salvage therapy for patients with aggressive leukemias and non-Hodgkin’s lymphomas

17563

Background: We treated 26 patients with aggressive lymphohematopoietic malignancies, including 3 chronic myeloid leukemia (CML) patients in blast crisis, 2 chronic lymphocytic leukemia (CLL) patients with rapidly progressive leukemia, 10 acute lymphoblastic leukemia (ALL) patients in therapy refractory relapse, and 11 non-Hodgkin’s lymhoma (NHL) patients (9 in relapse with progressive lymphoma) with vinorelbine-based outpatient salvage chemotherapy. Methods: Patients received vinorelbine-based salvage therapy regimens NND-I (Vinorelbine [Navelbine] 25 mg/m2 d1,d8, Mitoxantrone [Novantrone]10 mg/m2 d1, Dexamethasone [Decadron] 20 mg BID d1 through 7, or NND-II (Vinorelbine 25 mg/m2 d1, Mitoxantrone 10 mg/m2 d1, Dexamethasone 20 mg BID d1 through 7, Fludarabine 25 mg/m2 d1,d2,d3). Rituximab (Rituxan, 375 mg/m2 d1,8,15,29) was used in combination with chemotherapy in patients with CD20 antigen positive malignancies. Treatment responses were evaluated by peripheral blood and bone marrow examinations in patients with leukemia and CT/MRI-PET fusion imaging in patients with non-Hodgkin’s lymphoma using standard response criteria. Results: All patients completed their salvage therapy as an outpatient without infectious disease complications or hospitalizations. Of the 26 patients, 20 (77%) had objective responses, including 14 complete remissions (CR). All 3 CML patients and both CLL patients achieved a CR. Of the 10 ALL patients, 5 achieved a CR and one achieved a partial remission (PR). Of the 11 NHL patients, 4 achieved a CR and 5 achieved a PR. Conclusions: Taken together, these findings demonstrate that patients with high risk/poor prognosis leukemias and non-Hodgkin’s lymphomas can achieve meaningful objective responses in an outpatient setting using vinorelbine-based salvage regimens.

No significant financial relationships to disclose.

Survival outcome of metastatic adenocarcinoma patients after patient-tailored outpatient chemotherapy guided by fusion imaging

13145

Background: We treated 173 patients with metastatic Stage IV adenocarcinoma, including 65 patients with metastatic colorectal cancer (MCRC), 22 patients with metastatic pancreas cancer (MPC), and 86 patients with metastatic breast cancer (MBC) in an outpatient setting. The metastatic sites included liver (49% of patients), bone (39%), lung (36%), brain (16%), peritoneum (16%), lymph node (14%) and chest wall (8%). Methods: MCRC patients received multiple cycles of Xeloda-based empirical chemotherapy regimens: alone or in combination with Irinotecan, Oxaliplatin or Mitomycin. MPC patients were given cycles of Gemcitabine-based empirical chemotherapy regimens: alone or with Cisplatin, 5-FU or Xeloda. MBC patients received cycles of Taxol-based chemotherapy: alone or with Adriamycin, Carboplatin or Gemcitabine; Xeloda plus Taxotere or Vinorelbine; Gemcitabine plus Taxotere or Vinorelbine; and Adriamycin plus Taxotere. Anatomic imaging/fusion technology with combined anatomic and functional imaging (CT/MRI fused with whole body PET scans) plus serial cancer marker level measurements monitored response to therapy and in patients showing evidence of progression on a given regimen were switched to a different treatment regimen. Results: Kaplan Meier calculated median survival time for all 173 metastatic adenocarcinoma patients was 17 mo (95% CI 13–19 mo); for subgroups medians were 12 mo (9–16 mo), 16 (8–22 mo) and 22 mo (18–42 mo) for MCRC, MPC and MBC patients respectively. The probability of living at 1 yr after initiation of therapy was 61 ± 6% for all patients, 47 ± 6% for MCRC, 59 ± 10% for MPC and 72 ± 5% for MBC patients. Our results indicate that a significant portion of previously treated patients with MCRC, MPC and MBC with liver, lung, and/or brain metastases can achieve objective responses and long-term progression-free survival with an excellent quality of life on patient tailored outpatient treatments guided by fusion imaging. Conclusions: Fusion technology provides a powerful diagnostic tool for timely termination or modification of ineffective treatments. Empirical patient-tailored chemotherapy should be offered to metastatic adenocarcinoma patients as an alternative to the clinical trial and hospice options.

No significant financial relationships to disclose.

Clonal origin of recurrent meningiomas

Meningiomas are common intracranial and intraspinal tumors. They are treated primarily by surgical resection. Meningioma recurrence following surgery is frequent despite advances in microneurosurgery. However, it is not clear whether recurrent meningiomas, close or distant to the primary resection site, arise from incomplete resection, dissemination of tumor fragments or from independent tumor growth. In order to address the question of clonality in recurring meningiomas, we examined a series of five patients with a total of 14 tumors for X-chromosome inactivation in the tumor tissues. Four patients with a total of 11 meningiomas were informative for polymorphisms either in the PGK or the AR genes. All recurrent meningiomas were found to be clonal with respect to the primary lesions. This finding suggests a common molecular pathogenesis of primary meningioma and subsequent recurrences (p<0.01). In a sixth patient, we analyzed the NF2 gene for mutations in the primary and 5 recurrent meningiomas. All six lesions carried the identical NF2 mutation, strongly indicating a common origin for these tumors. We conclude that recurrent meningiomas usually arise from dissemination of tumor fragments, most likely at the time of the first surgical resection. Our data should alert to the potential of meningioma cells for seeding during surgical procedures.

Thalomid (Thalidomide) capsules: a review of the first 18 months of spontaneous postmarketing adverse event surveillance, including off-label prescribing

The sedative/hypnotic thalidomide was withdrawn from the worldwide market nearly 40 years ago, because of its teratogenic and neurotoxic effects. Thalidomide was later found to very effectively suppress erythema nodosum leprosum (ENL). The US Food and Drug Administration (FDA) has approved Thalomid (thalidomide) capsules for the acute treatment of the cutaneous manifestations of moderate to severe ENL. Thalidomide is currently under investigation for the treatment of a wide variety of diseases, including conditions thought to have an inflammatory or immune basis, malignancies and complications of infection with HIV. Interest in the potential anti-inflammatory, immunomodulatory and anti- angiogenic effects of thalidomide has resulted in off-label use of prescription thalidomide. During the first 18 months of spontaneous postmarketing adverse event surveillance for Thalomid, 1210 spontaneous postmarketing adverse event reports were received for patients treated with prescription thalidomide for all therapeutic indications, including off-label use. The most common adverse events spontaneously reported would have been expected on the basis of the current Thalomid labelling/product information. The current labelling/product information reflects what was known about the risks associated with thalidomide therapy in limited patient populations at the time of the approval of Thalomid. With the postmarketing use of thalidomide in populations other than patients with ENL, it becomes increasingly important to identify patient groups that may be particularly susceptible to specific adverse drug effects and to identify conditions under which specific adverse events may be more likely to occur. Oncology patients may represent a patient population with increased susceptibility to thalidomide-associated adverse effects, including thromboembolic events. Consideration of the spontaneous postmarketing safety surveillance data may help to identify and characterise factors associated with increased risk in this and other patient groups. Serious unexpected adverse events reported with sufficient frequency to signal previously undetected product-event associations for which there may potentially be plausible evidence to suggest a causal relationship have included seizures and Stevens-Johnson syndrome. The potential effects of thalidomide on wound healing are also being closely monitored. Premarketing human clinical trials of drug products are inherently limited in their ability to detect adverse events. Broader postmarketing experience with thalidomide in more varied patient populations and more experience in the setting of long term thalidomide use will increase our ability to detect rare adverse events and to identify signals that may need to be evaluated in more controlled settings.

Predictors of family members' satisfaction with hospice

This large, long-term study of families served by hospice found that nearly 95 percent said hospice had been helpful. Still, about 30 percent of family members said there was something they wish hospice had done differently. Those who had some complaint were more likely than those who had no complaints to be women, to report the patient had needed a great deal of care, to have a history of depression and greater levels of distress before and after the patient's death, and to be dissatisfied with the support they received from family members and friends.

Down-regulation of dendritic spine and glutamic acid decarboxylase 67 expressions in the reelin haploinsufficient heterozygous reeler mouse

Heterozygous reeler mice (HRM) haploinsufficient for reelin express approximately 50% of the brain reelin content of wild-type mice, but are phenotypically different from both wild-type mice and homozygous reeler mice. They exhibit, (i) a down-regulation of glutamic acid decarboxylase 67 (GAD(67))-positive neurons in some but not every cortical layer of frontoparietal cortex (FPC), (ii) an increase of neuronal packing density and a decrease of cortical thickness because of neuropil hypoplasia, (iii) a decrease of dendritic spine expression density on basal and apical dendritic branches of motor FPC layer III pyramidal neurons, and (iv) a similar decrease in dendritic spines expressed on the basal dendrite branches of CA1 pyramidal neurons of the hippocampus. To establish whether the defect of GAD(67) down-regulation observed in HRM is responsible for neuropil hypoplasia and decreased dendritic spine density, we studied heterozygous GAD(67) knockout mice (HG(67)M). These mice exhibited a down-regulation of GAD(67) mRNA expression in FPC (about 50%), but they expressed normal amounts of reelin and had no neuropil hypoplasia or down-regulation of dendritic spine expression. These findings, coupled with electron-microscopic observations that reelin colocalizes with integrin receptors on dendritic spines, suggest that reelin may be a factor in the dynamic expression of cortical dendritic spines perhaps by promoting integrin receptor clustering. These findings are interesting because the brain neurochemical and neuroanatomical phenotypic traits exhibited by the HRM are in several ways similar to those found in postmortem brains of psychotic patients.

Intracellular parasitism by the human granulocytic ehrlichiosis bacterium through the P-selectin ligand, PSGL-1

Human granulocytic ehrlichiosis (HGE) is a febrile tick-borne illness caused by a recently discovered intracellular bacterium remarkable for its tropism for professionally phagocytic neutrophils. Monoclonal antibodies against the P-selectin binding domain of the leukocyte P-selectin glycoprotein ligand, PSGL-1, prevented HGE cell binding and infection, as did enzymatic digestion of PSGL-1. Furthermore, simultaneous neoexpression in nonsusceptible cells of complementary DNAs for both PSGL-1 and its modifying alpha-(1,3) fucosyltransferase, Fuc-TVII, allowed binding and infection by HGE. Thus, the HGE bacterium specifically bound to fucosylated leukocyte PSGL-1. Selectin mimicry is likely central to the organism's unique ability to target and infect neutrophils.

Thyroid disease: a review for primary care

Manifestations of thyroid disease include hyperthyroidism and hypothyroidism. In the past, the diagnosis of thyroid disease has been perplexing due to the multisystemic effects of thyroid hormone and the lack of specificity in laboratory tests. New methods of measuring thyroid function have made screening and diagnosis of thyroid dysfunction both more accurate and cost-effective. Testing for thyroid stimulating hormone (TSH) is now a first-line diagnostic procedure and, in some cases, may be the only test indicated. The general pathophysiology of thyroid, the diagnosis and management of thyroid disease, and current screening recommendations are reviewed here.

Peripheral administration of a serine protease inhibitor blocks kindling

An inhibitor of tissue plasminogen activator (tPA) was tested for its effects on the rapid kindling induced by a series of afterdischarges (ADs) triggered in hippocampus over a 3-h period. Rats injected with vehicle prior to the session had prolonged ADs in tests carried out 10 days later. This was not the case for animals treated with the inhibitor. These findings support the hypothesis that activity-driven proteolysis contributes importantly to the production of long-lasting physiological changes.

Isolation of Neisseria gonorrhoeae mutants that show enhanced trafficking across polarized T84 epithelial monolayers

Initiation of a gonococcal infection involves attachment of Neisseria gonorrhoeae to the plasma membrane of an epithelial cell in the mucosal epithelium and its internalization, transepithelial trafficking, and exocytosis from the basal membrane. Piliation and expression of certain Opa proteins and the immunoglobulin A1 protease influence the transcytosis process. We are interested in identifying other genetic determinants of N. gonorrhoeae that play a role in transcellular trafficking. Using polarized T84 monolayers as a model epithelial barrier, we have assayed an N. gonorrhoeae FA1090 minitransposon (mTn) mutant bank for isolates that traverse the monolayer more quickly than the isogenic wild-type (WT) strain. From an initial screen, we isolated four mutants, defining three genetic loci, that traverse monolayers significantly more quickly than their WT parent strain. These mutants adhere to and invade cells normally and do not affect the integrity of the monolayer barrier. Backcrosses of the mutations into the WT FA1090 strain yielded mutants with a similar fast-trafficking phenotype. In two mutants, the mTns had inserted 370 bp apart into the same locus, which we have named fit, for fast intracellular trafficker. Backcrosses of one of these mutants into the MS11A genetic background also yielded a fast-trafficking mutant. The fit locus contains two overlapping open reading frames, fitA and fitB, whose deduced amino acid sequences have predicted molecular weights of 8.6 and 15.3, respectively. Neither protein contains a signal sequence. FitA has a potential helix-turn-helix motif, while the deduced sequence of FitB offers no clues to its function. fitA or fitB homologues are present in the genomes of Pseudomonas syringae and Rhizobium meliloti, but not Neisseria meningitidis. Replication of the MS11A fitA mutant in A431 and T84 cells is significantly accelerated compared to that of the isogenic WT strain. In contrast, growth of this mutant in liquid media is normal. Taken together, these results strongly suggest that traversal of N. gonorrhoeae across an epithelial barrier is linked to intracellular bacterial growth.

Explaining the gender difference in depressive symptoms

It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.

Explaining the gender difference in depressive symptoms

It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.

Alterations in synaptic transmission and long-term potentiation in hippocampal slices from young and aged PDAPP mice

Synaptic transmission and plasticity were studied in the CA1 field of hippocampal slices from young and aged transgenic mice over-expressing a mutant form of the human amyloid precursor protein (PDAPP mice). The transgenic mice at 4-5 months of age, prior to the formation of amyloid-beta peptide deposits in these animals, differed from non-transgenic control mice in three respects: (1) paired-pulse facilitation (PPF) was enhanced; (2) responses to high frequency stimulation bursts were distorted; (3) long-term potentiation (LTP) decayed more rapidly. More striking was the profound reduction in the size of synaptic responses and frequent loss of field potentials that were found in the transgenic mice at 27-29 months, an age at which they exhibit numerous amyloid plaques, neuritic dystrophy, and gliosis. Control mice at these ages did not show such dramatic effects. PPF was reduced in aged transgenic mice, compared to aged controls; however, LTP was still in evidence, although direct comparisons of its induction conditions in aged transgenic and control mice were compromised by the profound differences in field potentials between the two groups. These results point to two conclusions: (1) altered synaptic communication appears in PDAPP mice in advance of amyloid plaque formation and probably involves changes in presynaptic calcium kinetics; (2) the disturbances in synaptic transmission that appear when abundant plaques and Alzheimer's-like neuropathology are present in the transgenic mice are not necessarily accompanied by a disproportionate loss of long-term synaptic plasticity.

Mapping the pro-region of carboxypeptidase B by protein engineering. Cloning, overexpression, and mutagenesis of the porcine proenzyme

The proteolytic processing of pancreatic procarboxypeptidase B to a mature and functional enzyme is much faster than that of procarboxypeptidase A1. This different behavior has been proposed to depend on specific conformational features at the region that connects the globular domain of the pro-segment to the enzyme and at the contacting surfaces on both moieties. A cDNA coding for porcine procarboxypeptidase B was cloned, sequenced, and expressed at high yield (250 mg/liter) in the methylotrophic yeast Pichia pastoris. To test the previous hypothesis, different mutants of the pro-segment at the putative tryptic targets in its connecting region and at some of the residues contacting the active enzyme were obtained. Moreover, the complete connecting region was replaced by the homologous sequence in procarboxypeptidase A1. The detailed study of the tryptic processing of the mutants shows that limited proteolysis of procarboxypeptidase B is a very specific process, as Arg-95 is the only residue accessible to tryptic attack in the proenzyme. A fast destabilization of the connecting region after the first tryptic cut allows subsequent proteolytic processing and the expression of carboxypeptidase B activity. Although all pancreatic procarboxypeptidases have a preformed active site, only the A forms show intrinsic activity. Mutational substitution of Asp-41 in the globular activation domain, located at the interface with the enzyme moiety, as well as removal of the adjacent 310 helix allow the appearance of residual activity in the mutated procarboxypeptidase B, indicating that the interaction of both structural elements with the enzyme moiety prevents the binding of substrates and promotes enzyme inhibition. In addition, the poor heterologous expression of such mutants indicates that the mutated region is important for the folding of the whole proenzyme.

Activation of muscarinic M3-like receptors and beta-adrenoceptors, but not M2-like muscarinic receptors or alpha-adrenoceptors, directly modulates corticostriatal neurotransmission in vitro

The aim of this study was to characterize the modulation of synaptic transmission in the glutamatergic corticostriatal pathway by cholinergic and adrenergic receptors. In coronal slices of mouse brain, negative-going field potentials were recorded in the dorsal striatum in response to stimulation of the overlying white matter, and their susceptibility to various pharmacological manipulations was studied. The responses were mediated by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-type glutamate receptors, since they were augmented by aniracetam (0.5-1.5 mM), a positive modulator of AMPA-type glutamate receptors, and blocked by 6-cyano-7-nitroquinoxaline-2,3-dione (> or = 10 microM), a selective antagonist of AMPA receptors. Carbachol (10 microM), a muscarinic agonist, reduced the size of responses and abolished paired-pulse depression; these effects being consistent with previous studies indicating that muscarinic activation inhibits release of glutamate in the corticostriatal pathway. Muscarinic antagonists could block the effect of carbachol. Their rank order was: 10 microM scopolamine (a non-selective muscarinic antagonist) > or = 1 microM 4-diphenylacetoxy-N-methyl-piperidine (M3/M1 antagonist)>1 microM pirenzepine (M1 antagonist)>10 microM methoctramine (M2 antagonist). McN-A-343 (1-10 microM), an M1 muscarinic agonist, was ineffective in this preparation. In contrast, isoproterenol (10-30 microM), a beta-adrenergic agonist, slightly increased the synaptic responses, but it did not affect paired-pulse depression. None of alpha-adrenergic agents (30 nM-1.0 microM dexmedetomidine, an alpha2-adrenergic agonist, 0.3 microM atipamezole, an alpha2-adrenergic antagonist or 30 microM phenylephrine, an alpha1-adrenergic agonist) influenced the size of the responses; neither did these drugs alter paired-pulse depression. These results indicate that the activation of striatal M3-like muscarinic receptors and beta-adrenoceptors, but not M2-like muscarinic receptors and alpha-adrenoceptors, modulates directly corticostriatal glutamatergic neurotransmission.

Activation of NMDA receptors stimulates extracellular proteolysis of cell adhesion molecules in hippocampus

Recent work indicates that treatments which block adhesion receptors prevent the stabilization of long term potentiation (LTP). The experiments reported here show that brief stimulation of hippocampal NMDA receptors, a triggering event for LTP induction, results in the extracellular proteolysis of two or more members of the Cell Adhesion Molecule (CAM) family. This effect is rapid, occurs at a consensus serine protease site, and is selective to NMDA receptors. It is also found in vivo after kainic acid induced seizures. Cleavage of adhesive connections could be an early step in the formation of new synaptic configurations.

Making sense of loss and benefiting from the experience: two construals of meaning

Theoretical models of the adjustment process following loss and trauma have emphasized the critical role that finding meaning plays. Yet evidence in support of these models is meager, and definitions of meaning have been too broad to facilitate a clear understanding of the psychological process involved. Using a prospective and longitudinal study of people coping with the loss of a family member, we differentiate 2 construals of meaning--making sense of the event and finding benefit in the experience--and demonstrate that both independently play roles in the adjustment process following the loss. Results indicate that making sense of the loss is associated with less distress, but only in the 1st year postloss, whereas reports of benefit finding are most strongly associated with adjustment at interviews 13 and 18 months postloss.

Central nervous system tuberculoma: a case report

Pediatric cerebral tuberculoma is a disease rarely encountered in the United States. We report a case of central nervous system tuberculoma in a 6-month-old infant who presented to the emergency department with isolated right upper extremity paralysis. The discussion includes a brief review of central nervous system tuberculomas.

Making sense of loss and benefiting from the experience: two construals of meaning

Theoretical models of the adjustment process following loss and trauma have emphasized the critical role that finding meaning plays. Yet evidence in support of these models is meager, and definitions of meaning have been too broad to facilitate a clear understanding of the psychological process involved. Using a prospective and longitudinal study of people coping with the loss of a family member, we differentiate 2 construals of meaning--making sense of the event and finding benefit in the experience--and demonstrate that both independently play roles in the adjustment process following the loss. Results indicate that making sense of the loss is associated with less distress, but only in the 1st year postloss, whereas reports of benefit finding are most strongly associated with adjustment at interviews 13 and 18 months postloss.

Preserved induction of long-term potentiation in the stratum radiatum in the CA1 field of hippocampal slices from transgenic mice overexpressing ornithine decarboxylase and overproducing putrescine

The role of putrescine in synaptic neurotransmission and plasticity was studied using transgenic mice overexpressing ornithine decarboxylase (ODC), a polyamine-synthesizing enzyme. Transgenic mice were produced using the standard microinjection technique leading to elevated levels of putrescine in the periphery and in the brain. The experiments investigated whether or not ODC mice with elevated levels of putrescine show alterations in synaptic transmission and induction of long-term potentiation in the CA1 field of the hippocampus in vitro. Our results indicated that (1) putrescine levels in brain slices of the transgenic mice were more than ten times higher than those in fresh slices of control mice, although the absolute levels of putrescine and spermine decreased (by 15 and 40%, respectively) after 3-6 h incubation in vitro, while the levels of spermidine slightly increased (by 10%), (2) the excitatory synaptic response waveforms were wider (an increased half-width), and paired-pulse facilitation was somewhat reduced in ODC mice as compared to controls, and (3) potentiation of excitatory synaptic responses (measured 30-45 min after theta burst stimulation) did not differ between ODC and control mice. These results indicate that synaptic transmission is affected, but synaptic plasticity in the field CA1 assessed in vitro is not changed by elevated levels of intracellular putrescine.

The Neisseria type 2 IgA1 protease cleaves LAMP1 and promotes survival of bacteria within epithelial cells

Infection of human epithelial cells by Neisseria meningitidis (MC) and Neisseria gonorrhoeae (GC) increases the rate of degradation of LAMP1, a major integral membrane glycoprotein of late endosomes and lysosomes. Several lines of evidence indicate that the neisserial IgA1 protease is directly responsible for this LAMP1 degradation. LAMP1 contains an IgA1-like hinge region with potential cleavage sites for the neisserial type 1 and type 2 IgA1 proteases. Neisserial type 2 IgA1 protease cleaves purified LAMP1 in vitro. Unlike its wild-type isogenic parent, an iga mutant of N. gonorrhoeae cannot affect LAMP1 turnover and its growth in epithelial cells is dramatically reduced. Thus, IgA1 protease cleavage of LAMP1 promotes intracellular survival of pathogenic Neisseria spp.