Negative relationship between dry matter intake and the temperature-humidity index with increasing heat stress in cattle: a global meta-analysis

Changes in frequency and severity of heat waves due to climate change pose a considerable challenge to livestock production systems. Although it is well known that heat stress reduces feed intake in cattle, effects of heat stress vary between animal genotypes and climatic conditions and are context specific. To derive a generic global prediction that accounts for the effects of heat stress across genotypes, management and environments, we conducted a systematic literature review and a meta-analysis to assess the relationship between dry matter intake (DMI) and the temperature-humidity index (THI), two reliable variables for the measurement of feed intake and heat stress in cattle, respectively. We analysed this relationship accounting for covariation in countries, breeds, lactation stage and parity, as well as the efficacy of various physical cooling interventions. Our findings show a significant negative correlation (r =  - 0.82) between THI and DMI, with DMI reduced by 0.45 kg/day for every unit increase in THI. Although differences in the DMI-THI relationship between lactating and non-lactating cows were not significant, effects of THI on DMI varied between lactation stages. Physical cooling interventions (e.g. provision of animal shade or shelter) significantly alleviated heat stress and became increasingly important after THI 68, suggesting that this THI value could be viewed as a threshold for which cooling should be provided. Passive cooling (shading) was more effective at alleviating heat stress compared with active cooling interventions (sprinklers). Our results provide a high-level global equation for THI-DMI across studies, allowing next-users to predict effects of heat stress across environments and animal genotypes.

Predicting optimum crop designs using crop models and seasonal climate forecasts

Expected increases in food demand and the need to limit the incorporation of new lands into agriculture to curtail emissions, highlight the urgency to bridge productivity gaps, increase farmers profits and manage risks in dryland cropping. A way to bridge those gaps is to identify optimum combination of genetics (G), and agronomic managements (M) i.e. crop designs (GxM), for the prevailing and expected growing environment (E). Our understanding of crop stress physiology indicates that in hindsight, those optimum crop designs should be known, while the main problem is to predict relevant attributes of the E, at the time of sowing, so that optimum GxM combinations could be informed. Here we test our capacity to inform that "hindsight", by linking a tested crop model (APSIM) with a skillful seasonal climate forecasting system, to answer "What is the value of the skill in seasonal climate forecasting, to inform crop designs?" Results showed that the GCM POAMA-2 was reliable and skillful, and that when linked with APSIM, optimum crop designs could be informed. We conclude that reliable and skillful GCMs that are easily interfaced with crop simulation models, can be used to inform optimum crop designs, increase farmers profits and reduce risks.

Predicting optimum crop designs using crop models and seasonal climate forecasts

Expected increases in food demand and the need to limit the incorporation of new lands into agriculture to curtail emissions, highlight the urgency to bridge productivity gaps, increase farmers profits and manage risks in dryland cropping. A way to bridge those gaps is to identify optimum combination of genetics (G), and agronomic managements (M) i.e. crop designs (GxM), for the prevailing and expected growing environment (E). Our understanding of crop stress physiology indicates that in hindsight, those optimum crop designs should be known, while the main problem is to predict relevant attributes of the E, at the time of sowing, so that optimum GxM combinations could be informed. Here we test our capacity to inform that "hindsight", by linking a tested crop model (APSIM) with a skillful seasonal climate forecasting system, to answer "What is the value of the skill in seasonal climate forecasting, to inform crop designs?" Results showed that the GCM POAMA-2 was reliable and skillful, and that when linked with APSIM, optimum crop designs could be informed. We conclude that reliable and skillful GCMs that are easily interfaced with crop simulation models, can be used to inform optimum crop designs, increase farmers profits and reduce risks.

Review, evaluation, and discussion of the challenges of missing value imputation for mass spectrometry-based label-free global proteomics

In this review, we apply selected imputation strategies to label-free liquid chromatography-mass spectrometry (LC-MS) proteomics datasets to evaluate the accuracy with respect to metrics of variance and classification. We evaluate several commonly used imputation approaches for individual merits and discuss the caveats of each approach with respect to the example LC-MS proteomics data. In general, local similarity-based approaches, such as the regularized expectation maximization and least-squares adaptive algorithms, yield the best overall performances with respect to metrics of accuracy and robustness. However, no single algorithm consistently outperforms the remaining approaches, and in some cases, performing classification without imputation sometimes yielded the most accurate classification. Thus, because of the complex mechanisms of missing data in proteomics, which also vary from peptide to protein, no individual method is a single solution for imputation. On the basis of the observations in this review, the goal for imputation in the field of computational proteomics should be to develop new approaches that work generically for this data type and new strategies to guide users in the selection of the best imputation for their dataset and analysis objectives.

Changes in protein expression across laboratory and field experiments in Geobacter bemidjiensis

Bacterial extracellular metal respiration, as carried out by members of the genus Geobacter, is of interest for applications including microbial fuel cells and bioremediation. Geobacter bemidjiensis is the major species whose growth is stimulated during groundwater amendment with acetate. We have carried out label-free proteomics studies of G. bemidjiensis grown with acetate as the electron donor and either fumarate, ferric citrate, or one of two hydrous ferric oxide mineral types as electron acceptor. The major class of proteins whose expression changes across these conditions is c-type cytochromes, many of which are known to be involved in extracellular metal reduction in other, better-characterized Geobacter species. Some proteins with multiple homologues in G. bemidjiensis (OmcS, OmcB) had different expression patterns than observed for their G. sulfurreducens homologues under similar growth conditions. We also compared the proteome from our study to a prior proteomics study of biomass recovered from an aquifer in Colorado, where the microbial community was dominated by strains closely related to G. bemidjiensis. We detected an increased number of proteins with functions related to motility and chemotaxis in the Colorado field samples compared to the laboratory samples, suggesting the importance of motility for in situ extracellular metal respiration.

Protein and microRNA biomarkers from lavage, urine, and serum in military personnel evaluated for dyspnea

Background

We have identified candidate protein and microRNA (miRNA) biomarkers for dyspnea by studying serum, lavage fluid, and urine from military personnel who reported serious respiratory symptoms after they were deployed to Iraq or Afghanistan.

Methods

Forty-seven soldiers with the complaint of dyspnea who enrolled in the STudy of Active Duty Military Personnel for Environmental Dust Exposure (STAMPEDE) underwent comprehensive pulmonary evaluations at the San Antonio Military Medical Center. The evaluation included fiber-optic bronchoscopy with bronchoalveolar lavage. The clinical findings from the STAMPEDE subjects pointed to seven general underlying diagnoses or findings including airway hyperreactivity, asthma, low diffusivity of carbon monoxide, and abnormal cell counts. The largest category was undiagnosed. As an exploratory study, not a classification study, we profiled proteins or miRNAs in lavage fluid, serum, or urine in this group to look for any underlying molecular patterns that might lead to biomarkers. Proteins in lavage fluid and urine were identified by accurate mass tag (database-driven) proteomics methods while miRNAs were profiled by a hybridization assay applied to serum, urine, and lavage fluid.

Results

Over seventy differentially expressed proteins were reliably identified both from lavage and from urine in forty-eight dyspnea subjects compared to fifteen controls with no known lung disorder. Six of these proteins were detected both in urine and lavage. One group of subjects was distinguished from controls by expressing a characteristic group of proteins. A related group of dyspnea subjects expressed a unique group of miRNAs that included one miRNA that was differentially overexpressed in all three fluids studied. The levels of several miRNAs also showed modest but direct associations with several standard clinical measures of lung health such as forced vital capacity or gas exchange efficiency.

Conclusions

Candidate proteins and miRNAs associated with the general diagnosis of dyspnea have been identified in subjects with differing medical diagnoses. Since these markers can be measured in readily obtained clinical samples, further studies are possible that test the value of these findings in more formal classification or case–control studies in much larger cohorts of subjects with specific lung diseases such as asthma, emphysema, or some other well-defined lung disease.

Expediting SRM assay development for large-scale targeted proteomics experiments

Because of its high sensitivity and specificity, selected reaction monitoring (SRM)-based targeted proteomics has become increasingly popular for biological and translational applications. Selection of optimal transitions and optimization of collision energy (CE) are important assay development steps for achieving sensitive detection and accurate quantification; however, these steps can be labor-intensive, especially for large-scale applications. Herein, we explored several options for accelerating SRM assay development evaluated in the context of a relatively large set of 215 synthetic peptide targets. We first showed that HCD fragmentation is very similar to that of CID in triple quadrupole (QQQ) instrumentation and that by selection of the top 6 y fragment ions from HCD spectra, >86% of the top transitions optimized from direct infusion with QQQ instrumentation are covered. We also demonstrated that the CE calculated by existing prediction tools was less accurate for 3+ precursors and that a significant increase in intensity for transitions could be obtained using a new CE prediction equation constructed from the present experimental data. Overall, our study illustrated the feasibility of expediting the development of larger numbers of high-sensitivity SRM assays through automation of transition selection and accurate prediction of optimal CE to improve both SRM throughput and measurement quality.

Proteomic analysis of saliva in HIV-positive heroin addicts reveals proteins correlated with cognition

The prevalence of HIV-associated neurocognitive disorders (HAND) remains high despite effective antiretroviral therapies. Multiple etiologies have been proposed over the last several years to account for this phenomenon, including the neurotoxic effects of antiretrovirals and co-morbid substance abuse; however, no underlying molecular mechanism has been identified. Emerging evidence in several fields has linked the gut to brain diseases, but the effect of the gut on the brain during HIV infection has not been explored. Saliva is the most accessible gut biofluid, and is therefore of great scientific interest for diagnostic and prognostic purposes. This study presents a longitudinal, liquid chromatography-mass spectrometry-based quantitative proteomics study investigating saliva samples taken from 8 HIV-positive (HIV⁺), 11 −negative (HIV⁻) heroin addicts. In addition, saliva samples were investigated from 11 HIV⁻, non-heroin addicted healthy controls. In the HIV⁺ group, 58 proteins were identified that show significant correlations with cognitive scores, implicating disruption of protein quality control pathways by HIV. Notably, only one protein from the HIV⁻ heroin addict cohort showed a significant correlation with cognitive scores, and no proteins correlated with cognitive scores in the healthy control group. In addition, the majority of correlated proteins have been shown to be associated with exosomes, allowing us to propose that the salivary glands and/or oral epithelium may modulate brain function during HIV infection through the release of discrete packets of proteins in the form of exosomes.

A semiautomated framework for integrating expert knowledge into disease marker identification

BACKGROUND

The availability of large complex data sets generated by high throughput technologies has enabled the recent proliferation of disease biomarker studies. However, a recurring problem in deriving biological information from large data sets is how to best incorporate expert knowledge into the biomarker selection process.

OBJECTIVE

To develop a generalizable framework that can incorporate expert knowledge into data-driven processes in a semiautomated way while providing a metric for optimization in a biomarker selection scheme.

METHODS

The framework was implemented as a pipeline consisting of five components for the identification of signatures from integrated clustering (ISIC). Expert knowledge was integrated into the biomarker identification process using the combination of two distinct approaches; a distance-based clustering approach and an expert knowledge-driven functional selection.

RESULTS

The utility of the developed framework ISIC was demonstrated on proteomics data from a study of chronic obstructive pulmonary disease (COPD). Biomarker candidates were identified in a mouse model using ISIC and validated in a study of a human cohort.

CONCLUSIONS

Expert knowledge can be introduced into a biomarker discovery process in different ways to enhance the robustness of selected marker candidates. Developing strategies for extracting orthogonal and robust features from large data sets increases the chances of success in biomarker identification.

Approach to cerebrospinal fluid (CSF) biomarker discovery and evaluation in HIV infection

Central nervous system (CNS) infection is a nearly universal facet of systemic HIV infection that varies in character and neurological consequences. While clinical staging and neuropsychological test performance have been helpful in evaluating patients, cerebrospinal fluid (CSF) biomarkers present a valuable and objective approach to more accurate diagnosis, assessment of treatment effects and understanding of evolving pathobiology. We review some lessons from our recent experience with CSF biomarker studies. We have used two approaches to biomarker analysis: targeted, hypothesis-driven and non-targeted exploratory discovery methods. We illustrate the first with data from a cross-sectional study of defined subject groups across the spectrum of systemic and CNS disease progression and the second with a longitudinal study of the CSF proteome in subjects initiating antiretroviral treatment. Both approaches can be useful and, indeed, complementary. The first is helpful in assessing known or hypothesized biomarkers while the second can identify novel biomarkers and point to broad interactions in pathogenesis. Common to both is the need for well-defined samples and subjects that span a spectrum of biological activity and biomarker concentrations. Previously-defined guide biomarkers of CNS infection, inflammation and neural injury are useful in categorizing samples for analysis and providing critical biological context for biomarker discovery studies. CSF biomarkers represent an underutilized but valuable approach to understanding the interactions of HIV and the CNS and to more objective diagnosis and assessment of disease activity. Both hypothesis-based and discovery methods can be useful in advancing the definition and use of these biomarkers.

Evaluation of selected binding domains for the analysis of ubiquitinated proteomes

Ubiquitination is an abundant post-translational modification that consists of covalent attachment of ubiquitin to lysine residues or the N-terminus of proteins. Mono- and polyubiquitination have been shown to be involved in many critical eukaryotic cellular functions and are often disrupted by intracellular bacterial pathogens. Affinity enrichment of ubiquitinated proteins enables global analysis of this key modification. In this context, the use of ubiquitin-binding domains is a promising but relatively unexplored alternative to more broadly used immunoaffinity or tagged affinity enrichment methods. In this study, we evaluated the application of eight ubiquitin-binding domains that have differing affinities for ubiquitination states. Small-scale proteomics analysis identified ~200 ubiquitinated protein candidates per ubiquitin-binding domain pull-down experiment. Results from subsequent Western blot analyses that employed anti-ubiquitin or monoclonal antibodies against polyubiquitination at lysine 48 and 63 suggest that ubiquitin-binding domains from Dsk2 and ubiquilin-1 have the broadest specificity in that they captured most types of ubiquitination, whereas the binding domain from NBR1 was more selective to polyubiquitination. These data demonstrate that with optimized purification conditions, ubiquitin-binding domains can be an alternative tool for proteomic applications. This approach is especially promising for the analysis of tissues or cells resistant to transfection, of which the overexpression of tagged ubiquitin is a major hurdle.

A Multi-Omic View of Host-Pathogen-Commensal Interplay in Salmonella-Mediated Intestinal Infection

The potential for commensal microorganisms indigenous to a host (the ‘microbiome’ or ‘microbiota’) to alter infection outcome by influencing host-pathogen interplay is largely unknown. We used a multi-omics “systems” approach, incorporating proteomics, metabolomics, glycomics, and metagenomics, to explore the molecular interplay between the murine host, the pathogen Salmonella enterica serovar Typhimurium (S. Typhimurium), and commensal gut microorganisms during intestinal infection with S. Typhimurium. We find proteomic evidence that S. Typhimurium thrives within the infected 129/SvJ mouse gut without antibiotic pre-treatment, inducing inflammation and disrupting the intestinal microbiome (e.g., suppressing Bacteroidetes and Firmicutes while promoting growth of Salmonella and Enterococcus). Alteration of the host microbiome population structure was highly correlated with gut environmental changes, including the accumulation of metabolites normally consumed by commensal microbiota. Finally, the less characterized phase of S. Typhimurium’s lifecycle was investigated, and both proteomic and glycomic evidence suggests S. Typhimurium may take advantage of increased fucose moieties to metabolize fucose while growing in the gut. The application of multiple omics measurements to Salmonella-induced intestinal inflammation provides insights into complex molecular strategies employed during pathogenesis between host, pathogen, and the microbiome.

Trauma-associated human neutrophil alterations revealed by comparative proteomics profiling

PURPOSE

Polymorphonuclear neutrophils (PMNs) play an important role in mediating the innate immune response after severe traumatic injury; however, the cellular proteome response to traumatic condition is still largely unknown.

EXPERIMENTAL DESIGN

We applied 2D-LC-MS/MS-based shotgun proteomics to perform comparative proteome profiling of human PMNs from severe trauma patients and healthy controls.

RESULTS

A total of 197 out of ~2500 proteins (being identified with at least two peptides) were observed with significant abundance changes following the injury. The proteomics data were further compared with transcriptomics data for the same genes obtained from an independent patient cohort. The comparison showed that the protein abundance changes for the majority of proteins were consistent with the mRNA abundance changes in terms of directions of changes. Moreover, increased protein secretion was suggested as one of the mechanisms contributing to the observed discrepancy between protein and mRNA abundance changes. Functional analyses of the altered proteins showed that many of these proteins were involved in immune response, protein biosynthesis, protein transport, NRF2-mediated oxidative stress response, the ubiquitin-proteasome system, and apoptosis pathways.

CONCLUSIONS AND CLINICAL RELEVANCE

Our data suggest increased neutrophil activation and inhibited neutrophil apoptosis in response to trauma. The study not only reveals an overall picture of functional neutrophil response to trauma at the proteome level, but also provides a rich proteomics data resource of trauma-associated changes in the neutrophil that will be valuable for further studies of the functions of individual proteins in PMNs.

Suite of activity-based probes for cellulose-degrading enzymes

Microbial glycoside hydrolases play a dominant role in the biochemical conversion of cellulosic biomass to high-value biofuels. Anaerobic cellulolytic bacteria are capable of producing multicomplex catalytic subunits containing cell-adherent cellulases, hemicellulases, xylanases, and other glycoside hydrolases to facilitate the degradation of highly recalcitrant cellulose and other related plant cell wall polysaccharides. Clostridium thermocellum is a cellulosome-producing bacterium that couples rapid reproduction rates to highly efficient degradation of crystalline cellulose. Herein, we have developed and applied a suite of difluoromethylphenyl aglycone, N-halogenated glycosylamine, and 2-deoxy-2-fluoroglycoside activity-based protein profiling (ABPP) probes to the direct labeling of the C. thermocellum cellulosomal secretome. These activity-based probes (ABPs) were synthesized with alkynes to harness the utility and multimodal possibilities of click chemistry and to increase enzyme active site inclusion for liquid chromatography-mass spectrometry (LC-MS) analysis. We directly analyzed ABP-labeled and unlabeled global MS data, revealing ABP selectivity for glycoside hydrolase (GH) enzymes, in addition to a large collection of integral cellulosome-containing proteins. By identifying reactivity and selectivity profiles for each ABP, we demonstrate our ability to widely profile the functional cellulose-degrading machinery of the bacterium. Derivatization of the ABPs, including reactive groups, acetylation of the glycoside binding groups, and mono- and disaccharide binding groups, resulted in considerable variability in protein labeling. Our probe suite is applicable to aerobic and anaerobic microbial cellulose-degrading systems and facilitates a greater understanding of the organismal role associated with biofuel development.

A comparative analysis of computational approaches to relative protein quantification using peptide peak intensities in label-free LC-MS proteomics experiments

Liquid chromatography coupled with mass spectrometry (LC-MS) is widely used to identify and quantify peptides in complex biological samples. In particular, label-free shotgun proteomics is highly effective for the identification of peptides and subsequently obtaining a global protein profile of a sample. As a result, this approach is widely used for discovery studies. Typically, the objective of these discovery studies is to identify proteins that are affected by some condition of interest (e.g. disease, exposure). However, for complex biological samples, label-free LC-MS proteomics experiments measure peptides and do not directly yield protein quantities. Thus, protein quantification must be inferred from one or more measured peptides. In recent years, many computational approaches to relative protein quantification of label-free LC-MS data have been published. In this review, we examine the most commonly employed quantification approaches to relative protein abundance from peak intensity values, evaluate their individual merits, and discuss challenges in the use of the various computational approaches.

DanteR: an extensible R-based tool for quantitative analysis of -omics data

MOTIVATION

The size and complex nature of mass spectrometry-based proteomics datasets motivate development of specialized software for statistical data analysis and exploration. We present DanteR, a graphical R package that features extensive statistical and diagnostic functions for quantitative proteomics data analysis, including normalization, imputation, hypothesis testing, interactive visualization and peptide-to-protein rollup. More importantly, users can easily extend the existing functionality by including their own algorithms under the Add-On tab.

AVAILABILITY

DanteR and its associated user guide are available for download free of charge at http://omics.pnl.gov/software/. We have an updated binary source for the DanteR package up on our website together with a vignettes document. For Windows, a single click automatically installs DanteR along with the R programming environment. For Linux and Mac OS X, users must install R and then follow instructions on the DanteR website for package installation.

CONTACT

rds@pnnl.gov.

Morphine produces immunosuppressive effects in nonhuman primates at the proteomic and cellular levels

Morphine has long been known to have immunosuppressive properties in vivo, but the molecular and immunologic changes induced by it are incompletely understood. To explore how these changes interact with lentiviral infections in vivo, animals from two nonhuman primate species (African green monkeys and pigtailed macaques) were provided morphine and studied using a systems biology approach. Biological specimens were obtained from multiple sources (e.g. lymph node, colon, cerebrospinal fluid, and peripheral blood) before and after the administration of morphine (titrated up to a maximum dose of 5 mg/kg over a period of 20 days). Cellular immune, plasma cytokine, and proteome changes were measured and morphine-induced changes in these parameters were assessed on an interorgan, interindividual, and interspecies basis. In both species, morphine was associated with decreased levels of Ki-67(+) T-cell activation but with only minimal changes in overall T-cell counts, neutrophil counts, and NK cell counts. Although changes in T-cell maturation were observed, these varied across the various tissue/fluid compartments studied. Proteomic analysis revealed a morphine-induced suppressive effect in lymph nodes, with decreased abundance of protein mediators involved in the functional categories of energy metabolism, signaling, and maintenance of cell structure. These findings have direct relevance for understanding the impact of heroin addiction and the opioids used to treat addiction as well as on the potential interplay between opioid abuse and the immunological response to an infective agent.

Effect of influenza vaccination on international normalized ratio during chronic warfarin therapy

WHAT IS KNOWN AND OBJECTIVE

Warfarin is a widely used anticoagulant, well-known for its interactions with medications and foods. Vaccinations, particularly the influenza vaccine, have been thought to potentially interfere with anticoagulation response in those on chronic warfarin. Our objective was to systematically review the literature to assess the validity and clinical significance of this association.

METHODS

A primary literature search was performed using MEDLINE (1966 - June 2011) and EMBASE (1980 - June 2011). Additional studies were obtained by performing a manual bibliographical review of literature from the initial results and by searching The Cochrane Database of Systematic Reviews. All English-language, peer-reviewed publications identified were evaluated. Reviews, case studies and trials reporting anticoagulation response using an unconverted prothrombin time ratio were excluded.

RESULTS AND DISCUSSION

Thirty-one abstracts were initially reviewed, and seven studies were identified for inclusion in this review. Significant changes in mean INR post-vaccination between the study and comparator groups were documented in one trial. Through subgroup analysis, another study noted that elderly patients spent more time in the subtherapeutic range post-vaccination when compared with baseline INR levels. No other significant changes in mean INR levels were documented following influenza vaccination. Adverse bleeding events reported after immunization were limited and minor in nature.

WHAT IS NEW AND CONCLUSION

Overall, our review does not indicate a consistent, clinically relevant effect of influenza vaccines on INR of patients on chronic warfarin therapy. Isolated reports of variations in INR following influenza vaccination are likely due to other factors.

Process optimization of an auger pyrolyzer with heat carrier using response surface methodology

A 1 kg/h auger reactor utilizing mechanical mixing of steel shot heat carrier was used to pyrolyze red oak wood biomass. Response surface methodology was employed using a circumscribed central composite design of experiments to optimize the system. Factors investigated were: heat carrier inlet temperature and mass flow rate, rotational speed of screws in the reactor, and volumetric flow rate of sweep gas. Conditions for maximum bio-oil and minimum char yields were high flow rate of sweep gas (3.5 standard L/min), high heat carrier temperature (∼600 °C), high auger speeds (63 RPM) and high heat carrier mass flow rates (18 kg/h). Regression models for bio-oil and char yields are described including identification of a novel interaction effect between heat carrier mass flow rate and auger speed. Results suggest that auger reactors, which are rarely described in literature, are well suited for bio-oil production. The reactor achieved liquid yields greater than 73 wt.%.

Characterization of macaque pulmonary fluid proteome during monkeypox infection: dynamics of host response

Understanding viral pathogenesis is challenging because of confounding factors, including nonabrasive access to infected tissues and high abundance of inflammatory mediators that may mask mechanistic details. In diseases such as influenza and smallpox where the primary cause of mortality results from complications in the lung, the characterization of lung fluid offers a unique opportunity to study host-pathogen interactions with minimal effect on infected animals. This investigation characterizes the global proteome response in the pulmonary fluid, bronchoalveolar lavage fluid, of macaques during upper respiratory infection by monkeypox virus (MPXV), a close relative of the causative agent of smallpox, variola virus. These results are compared and contrasted against infections by vaccinia virus (VV), a low pathogenic relative of MPXV, and with extracellular fluid from MPXV-infected HeLa cells. To identify changes in the pulmonary protein compartment, macaque lung fluid was sampled twice prior to infection, serving as base line, and up to six times following intrabronchial infection with either MPXV or VV. Increased expression of inflammatory proteins was observed in response to both viruses. Although the increased expression resolved for a subset of proteins, such as C-reactive protein, S100A8, and S100A9, high expression levels persisted for other proteins, including vitamin D-binding protein and fibrinogen γ. Structural and metabolic proteins were substantially decreased in lung fluid exclusively during MPXV and not VV infection. Decreases in structural and metabolic proteins were similarly observed in the extracellular fluid of MPXV-infected HeLa cells. Results from this study suggest that the host inflammatory response may not be the only facilitator of viral pathogenesis, but rather maintaining pulmonary structural integrity could be a key factor influencing disease progression and mortality.

Extensive HIV-1 intra-host recombination is common in tissues with abnormal histopathology

There is evidence that immune-activated macrophages infected with the Human Immunodeficiency Virus (HIV) are associated with tissue damage and serve as a long-lived viral reservoir during therapy. In this study, we analyzed 780 HIV genetic sequences generated from 53 tissues displaying normal and abnormal histopathology. We found up to 50% of the sequences from abnormal lymphoid and macrophage rich non-lymphoid tissues were intra-host viral recombinants. The presence of extensive recombination, especially in non-lymphoid tissues, implies that HIV-1 infected macrophages may significantly contribute to the generation of elusive viral genotypes in vivo. Because recombination has been implicated in immune evasion, the acquisition of drug-resistance mutations, and alterations of viral co-receptor usage, any attempt towards the successful eradication of HIV-1 requires therapeutic approaches targeting tissue macrophages.

HIV-1 activates macrophages independent of Toll-like receptors

Background

Macrophages provide an interface between innate and adaptive immunity and are important long-lived reservoirs for Human Immunodeficiency Virus Type-1 (HIV-1). Multiple genetic networks involved in regulating signal transduction cascades and immune responses in macrophages are coordinately modulated by HIV-1 infection.

Methodology/Principal Findings

To evaluate complex interrelated processes and to assemble an integrated view of activated signaling networks, a systems biology strategy was applied to genomic and proteomic responses by primary human macrophages over the course of HIV-1 infection. Macrophage responses, including cell cycle, calcium, apoptosis, mitogen-activated protein kinases (MAPK), and cytokines/chemokines, to HIV-1 were temporally regulated, in the absence of cell proliferation. In contrast, Toll-like receptor (TLR) pathways remained unaltered by HIV-1, although TLRs 3, 4, 7, and 8 were expressed and responded to ligand stimulation in macrophages. HIV-1 failed to activate phosphorylation of IRAK-1 or IRF-3, modulate intracellular protein levels of Mx1, an interferon-stimulated gene, or stimulate secretion of TNF, IL-1β, or IL-6. Activation of pathways other than TLR was inadequate to stimulate, via cross-talk mechanisms through molecular hubs, the production of proinflammatory cytokines typical of a TLR response. HIV-1 sensitized macrophage responses to TLR ligands, and the magnitude of viral priming was related to virus replication.

Conclusions/Significance

HIV-1 induced a primed, proinflammatory state, M1_HIV, which increased the responsiveness of macrophages to TLR ligands. HIV-1 might passively evade pattern recognition, actively inhibit or suppress recognition and signaling, or require dynamic interactions between macrophages and other cells, such as lymphocytes or endothelial cells. HIV-1 evasion of TLR recognition and simultaneous priming of macrophages may represent a strategy for viral survival, contribute to immune pathogenesis, and provide important targets for therapeutic approaches.

Impact on genetic networks in human macrophages by a CCR5 strain of human immunodeficiency virus type 1

Human immunodeficiency virus type 1 (HIV-1) impacts multiple lineages of hematopoietic cells, including lymphocytes and macrophages, either by direct infection or indirectly by perturbations of cell networks, leading to generalized immune deficiency. We designed a study to discover, in primary human macrophages, sentinel genetic targets that are impacted during replication over the course of 7 days by a CCR5-using virus. Expression of mRNA and proteins in virus- or mock-treated macrophages from multiple donors was evaluated. Hierarchical agglomerative cluster analysis grouped into distinct temporal expression patterns >900 known human genes that were induced or repressed at least fourfold by virus. Expression of more than one-third of the genes was induced rapidly by day 2 of infection, while other genes were induced at intermediate (day 4) or late (day 7) time points. More than 200 genes were expressed exclusively in either virus- or mock-treated macrophage cultures, independent of the donor, providing an unequivocal basis to distinguish an effect by virus. HIV-1 altered levels of mRNA and/or protein for diverse cellular programs in macrophages, including multiple genes that can contribute to a transition in the cell cycle from G(1) to G(2)/M, in contrast to expression in mock-treated macrophages of genes that maintain G(0)/G(1). Virus treatment activated mediators of cell cycling, including PP2A, which is impacted by Vpr, as well as GADD45 and BRCA1, potentially novel targets for HIV-1. The results identify interrelated programs conducive to optimal HIV-1 replication and expression of genes that can contribute to macrophage dysfunction.

Optimal screw diameter for interference fixation in a bone tunnel: a porcine model

The study investigates the optimal interference screw dimensions required to secure a tendon graft in a bone tunnel. A standard 8 mm pig flexor-tendon graft was inserted into a standard open-ended 8 mm bone tunnel of a porcine distal femur and secured using either 7 mm, 8 mm or 9 mm diameter metal interference screws (Arthrex Inc, Naples, FL). The construct was tested to failure using a Shimadzu ASG 10KN Universal Material Testing Machine (Shimadzu, Tokyo, Japan). Load and mode of construct failure were recorded for 37 individual constructs. There was no significant difference in the load at failure between the 7 mm screw (192 N; range 151-232) and 8 mm screw (181 N; range 150-212) (p>0.05). There was a significant difference between the 7 mm screw and the 9 mm screw (109 N; range 67-151) (p=0.006) and between the 8 mm screw and the 9 mm screw (p=0.015). When using a 9 mm screw, 100% of the constructs failed by cut out of the graft at the tunnel opening. The 7 mm constructs failed by slippage of the tendon from the bone tunnel in 83% of cases, with only 17% failing by cut out at the tunnel opening. The 8 mm constructs demonstrated a mixture of failure modes, with slippage occurring in 58% of cases, cut out in 38% and failure of the graft substance in one case (4%). In this model, screw diameters equal to or 1 mm less than the tunnel/tendon diameter provides better fixation than using a screw 1 mm larger. The mode of failure differs for each of these screws.

Grade III acromioclavicular joint injury in Australian Rules Football

We have reviewed fourteen Australian Rules Football players who were seen consecutively by a single surgeon with grade III acromioclavicular joint injuries between January 1993-June 1997. After discussion at initial consultation eight players elected for non-operative management and six for operative management. Two players in the non-operative group subsequently underwent surgical reconstruction after failure of non-operative treatment. The mean return time to non-contact training was 2.4 weeks (range 1-4, S.D. 1.52) in the non-operative group and 6.3 weeks (range 3.5-10, S.D. 2.99) in the operative group. However return to sports specific training (contact training) was at a mean of 20.8 weeks (range 10-32. S.D. 8.56) in the non-operative group and 13.6 weeks (range 6-24. S.D. 7.06) in the operative group. Return to competitive football matches for the non-operative group was at a mean of 26.2 weeks (range 10-34,S.D. 8.84) and 18.8 weeks (9.5-28. S.D. 8.05) for those treated operatively. These results were not statistically significant. At final follow up the subjective scores for the current overall condition of the shoulder when compared to the uninjured side, were 72.5 (range 20-100, S:D.24.9) for the non operative group and 87.3 (range 75-100, S:D.10.61) for the operative group and this difference was also not statistically significant. Conclusions in this study are limited by small numbers and lack of statistically significant results. The results show a trend towards faster return to ARF and a more satisfactory outcome for patients undergoing surgery compared to their non operative cohorts.

The posteromedial impingement lesion of the ankle. A series of six cases

We report on a series of six cases of posteromedial impingement lesion of the ankle operated on during a 3-year period with excellent or good results and a return of the patients to preinjury levels of activity. This lesion occurs, on occasion, after a severe ankle-inversion injury in which the deep posterior fibers of the medial deltoid ligament become crushed between the medial wall of the talus and the medial malleolus. Initially, posteromedial symptoms do not predominate, compared with the symptoms of the lateral ligament disruption, and they usually resolve without specific treatment. Occasionally, however, thick, disorganized fibrotic scar tissue persists and impinges between the medial wall of the talus and the posterior margin of the medial malleolus. Clinically, the patient has persistent medial to posteromedial activity-related ankle pain after a severe inversion injury, despite a sound ankle rehabilitation program. There is deep soft tissue induration immediately behind the medial malleolus with localized tenderness and reproduction of symptomatic pain on provocative testing by palpating this site while moving the ankle into plantar flexion and inversion. The posteromedial impingement lesion has a distinct pathologic picture and can coexist with other ankle lesions that cause pain after lateral ligament injury.

Effect of transgenic GDNF expression on gentamicin-induced cochlear and vestibular toxicity

Gentamicin administration often results in cochlear and/or vestibular hair cell loss and hearing and balance impairment. It has been demonstrated that adenovirus-mediated overexpression of glial cell line-derived neurotrophic factor (GDNF) can protect cochlear hair cells against ototoxic injury. In this study, we evaluated the protective effects of adenovirus-mediated overexpression of GDNF against gentamicin ototoxicity. An adenovirus vector expressing the human GDNF gene (Ad.GDNF) was administered into the scala vestibuli as a rescue agent at the same time as gentamicin, or as a protective agent, 7 days before gentamicin administration. Animals in the Rescue group displayed hearing thresholds that were significantly better than those measured in the Gentamicin or Ad.LacZ/Gentamicin groups. In the Protection group, Ad.GDNF afforded significant preservation of utricular hair cells. The data demonstrated protection of the inner ear structure, and rescue of the inner ear structure and function against ototoxic insults. These experiments suggest that inner ear gene therapy may be developed as a clinical tool for protecting the ear against environmentally induced insults.

Shoulder pathology associated with symptomatic acromioclavicular joint degeneration

We report the incidence and nature of shoulder disease found in association with symptomatic degenerative change in the acromioclavicular joint in 218 shoulders. Coexisting pathologic conditions were present in 213 shoulders: rotator cuff degeneration in 176 shoulders (79 with complete thickness tears), labral tears in 72, glenohumeral degeneration in 31, and biceps tendon disease in 49. In 59 shoulders findings were unexpected. We looked specifically at 2 age groups: <50 years and > or =50 years. In the <50 years group labral tears were seen in 42% (30 of 71) and rotator cuff disease in 65% (46 of 71). Cuff tears tended to be incomplete. In the older age group only 14% (21 of 147) had an intact cuff, with 72 shoulders having a full-thickness tear. Labral tears were seen in 29% (42 of 147). We recommend that all patients undergo shoulder arthroscopy at the time of acromioclavicular surgery.

Herbicide spray drift odor: measurement and toxicological significance

The toxicological significance of exposure of members of the public to spray drift odors of four herbicide formulations (three 2, 4-dichlorophenoxyacetic [2,4-D] acid derivatives and one MCPA [4-methyl-2-chlorophenoxyacetic acid] derivative) has been studied using a combination of novel odor measurement and classic residue analysis techniques. The mean odor concentrations, generated during the spraying of the commercial herbicide formulations under simulated aerial application conditions, were about twofold higher for 2,4-D ethylhexyl ester (22,500 OU(c)/m(3)) and MCPA (30,100 OU(c)/m(3)) than for 2,4-D butyl ester (12,400 OU(c)/m(3)) and 2,4-D amine (11,800 OU(c)/m(3)). Detailed investigations determined that the odors are due to trace manufacturing impurities and additives in the commercial formulations, whereas the herbicide active ingredients are odorless. Measured airborne herbicide active ingredient concentrations under the simulated aerial application conditions were all below their respective occupational safety and health TLV-TWA values, indicating that exposures of toxicological significance as a result of spray drift are unlikely.

Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian rules football players

Australian Rules football (ARF) is a potentially violent, overhead, body-contact sport. We reviewed 56 shoulders in patients who sustained their initial traumatic anterior subluxation or dislocation during ARF and who underwent reconstructive surgery for traumatic anterior instability, whether by arthroscopic or by open techniques. Patients were followed up for a mean of 29.4 months after operation, and clinical evaluation was performed with the Rowe grading system. Three types of surgical procedures were performed: arthroscopic suture repair, arthroscopic Bankart repair with an absorbable polyglyconate tack, and open capsular shift with repair of the Bankart lesion. Shoulders treated with arthroscopic suture repair had a 70% rate of recurrent subluxation or dislocation on return to ARF Dislocations treated arthroscopically with the biodegradable tack had a 38% rate of recurrence of instability; three fourths of the recurrences were after minimal to moderate trauma. Shoulders treated with an open capsular shift and Bankart procedure had a 30% rate of recurrent instability, with half of the recurrences caused by violent trauma. In the open group there were no failures in patients who did not return to ARF. We suggest that arthroscopic repair in shoulders with anterior instability and recurrent dislocation does not adequately address the plastic deformation of the anterior capsule that may occur after repeated episodes of dislocation. We advocate open shoulder procedures in ARF athletes to address all areas of the capsulolabral pathologic condition and to provide the most secure repair possible with minimal chance of recurrence.

Plantar fascia release through a transverse plantar incision

A transverse plantar incision for plantar fascial release was assessed for pain relief, numbness, and subsequent heel pad symptoms. Twenty-seven feet in 26 patients who underwent plantar fascia release were reviewed with a minimum follow-up of 2 years after surgery (average, 37.6 months). Comprehensive data were obtained on 25 feet (24 patients) (93% response rate). The plantar fascia origin was completely transected in all cases. This led to complete resolution of symptoms in 19 feet and residual minor symptoms in six feet. After 2 years, four patients had developed recurrent symptoms, two in the area of surgery and two on the dorsum of the foot, in association with a pes planus foot. Two patients had some continued persistence of heel pain after surgery, although significantly less pain than preoperatively.Thus, 76% of patients had complete relieve of there symptoms, 12% of patients had mild symptoms not affecting daily activities, and 12% of patients had moderate symptoms that limited some activities. No patient suffered heel pad symptoms or numbness after surgery. It is concluded that plantar fascia release through a transverse plantar incision is a successful procedure for long-term relief of symptoms which avoids unnecessary heel pad numbness and scar morbidity. The benefits of a transverse incision include greater intraoperative vision, to ensure adequate release and spur excision, and an incision parallel to the medial calcaneal branches of the tibial nerve.

The early results of the Brunelli procedure for trapeziometacarpal instability

We report the results of Brunelli's abductor pollicis longus transfer for symptomatic instability of the trapeziometacarpal joint in 15 hands (14 patients) at a mean follow-up of 21 months. Patients were assessed subjectively, and objectively by an independent observer. All but one of the patients were very satisfied with the result of the operation, including the six patients who had significant degeneration of the carpometacarpal joint surface preoperatively. Four patients said they had no pain and the mean pain score overall on a visual analogue scale was 1.2 (out of a maximum of 10). Overall the outcome was rated good or excellent in 11 of the 15 thumbs.

Deliberate self-harm as a cause of persistent discharge from arthroscopic portals

Persistent discharge and bleeding from arthroscopy portals are rare complications. We report three cases which occurred as a result of deliberate self-harm. To our knowledge the occurrence of self-inflicted injury following arthroscopy has not been reported. Although suspicion of such activity may be delayed we consider it important to be aware of the possibility of this behaviour and to seek specialist help early in order to reduce the likelihood of further permanent physical damage.

Surgeon protection: early recognition of glove perforation using a green under glove

This paper reports the use of a double gloving system, which consists of a standard latex over glove and a green latex under glove, and aids recognition of intra-operative glove perforation during trauma surgery. Recognition of perforation is possible due to the colour of the under glove becoming more visable following ingress of fluid between the glove layers. The gloves were used in 40 consecutive operative procedures for lower limb fracture fixation. Glove perforations occurred in 48% of operations. The outer glove was perforated on 26 occasions and the under glove on two. There were no false positive colour changes but on one occasion no indication of perforation was visible. The rapidity and accuracy of colour change allowed identification of the cause of glove damage intra-operatively. This was most often due to powered instrumentation (58%).

A mechanism for entrapment of the tibialis posterior tendon in lateral subtalar dislocation

The entrapment of the tibialis posterior tendon causing a block to reduction of lateral subtalar dislocation is recognized. The mechanism which allows tendon excursion is less clearly understood. We present a case in which extensive tearing of the musculotendinous junction of the tibialis posterior muscle occurred during tendon displacement and entrapment in lateral subtalar dislocation. In view of this previously poorly recognized finding the two theories regarding entrapment are discussed. Recognition of the cause of the tendon lengthening with an intact flexor retinaculum allows appropriate early treatment.

The suspected scaphoid fracture and isotope bone imaging

Carpal trauma often results in scaphoid injury. A small group of patients have clinical evidence of scaphoid fracture but radiographs fail to demonstrate bony damage. Persistent pain warrants isotope bone scanning. This report reviews the results of 36 consecutive bone scans performed for the suspected scaphoid injury and reviews radiographs taken on presentation. In all, 18 diagnosed fractures: there were three of the scaphoid, six of the distal radius and nine of other carpal bones. It was possible, with hindsight, to see eight fractures on the original radiographs. In patients with continued pain over the radial side of the carpus, attention should be given to the other carpal bones and the distal radius and not just the scaphoid.

Age-related changes in cochlear vascular conductance in mice

Vascular changes contribute to age-related hearing loss but the mechanisms involved in microvascular reactivity, particularly in the aged ear, are still incompletely understood. In this study, possible age-related changes in cochlear blood flow (CBF) and vascular reactivity were studied in presbycusic mice (C57BL/6) and young, age-matched, and old controls (CBA/J) without presbycusis. Reactivity was monitored by laser Doppler flowmetry and assessed by change in cochlear vascular conductance (VC) (defined as the ratio of CBF to blood pressure) in response to round window-applied sodium nitroprusside, a vasodilating agent. Mean VC response of C57BL/6 mice differed from controls both in maximum response and in post-drug recovery time. In C57BL/6 mice, mean VC increased about 28%, in contrast to an increase of over 40% in young and age-matched CBA/J controls. A less elevated VC response, similar to that of the presbycusic mice, was shown by aged (20-21 month) controls. Also, VC response in C57BL/6 mice was sustained throughout the 60 min observation period, while response of most CBA/J controls recovered in 50 min or less. These changes suggest age-dependent, pathologically-related altered responsiveness in cochlear vascular reactivity.

Distal radial osteotomy for malunion of wrist fractures in young patients

Malunion after a fracture of the distal radius in a young patient causes a significant disturbance of wrist function. We have performed distal radial osteotomies in 11 patients to correct radial malunion. Surgery was indicated in young patients with functional disability in the wrist due to limited wrist motion and pain. Many had an unacceptable cosmetic appearance of the wrist. In all patients surgery consisted of opening wedge osteotomies to correct radial tilt and radial angle. In some instances it was not possible completely to restore radial length without a reduction in ulnar length. Post-operatively combined dorsal and volar flexion improved from a mean of 34 degrees to 72 degrees. Combined pronation and supination improved from a mean of 68 degrees to 106 degrees. Pain assessed on a simple four-point functional score was decreased from a mean of 3.3 to 1.3.

Cochlear flux motion and arterial pressure reduction in guinea pig

Vasomotion, as a fundamental phenomenon of microvessels, exists in the cochlea of guinea pig. In the current study, the vasomotion and its relation to arterial pressure reduction was studied in the guinea pig cochlea, using laser Doppler flowmetry (LDF). Blood pressure (BP) in 25 guinea pigs was manipulated by a mechanical occluder placed around the descending aorta or the inferior vena cava. Before thoracotomy and artificial respiration, BP was 55.5 +/- 10.9 mmHg and no flux motion occurred. Vasomotion became evident when BP was significantly lower (28.2 +/- 7.2 mmHg) than the mean BP after thoracotomy (37.3 +/- 8.3 mmHg) (t = 4.1536, p < 0.05). Vasomotion appeared during both continuous hypotension and brief BP decreases caused by mechanical occlusion. During periods of continuous flux motion, both increase and decrease in BP could weaken or abolish it. The pressure provoking the vasomotion was different for each animal but the pressure range for a given animal was relatively stable. Mean frequency and amplitude of flux motion were 3.8 +/- 0.6 cycles per min and 20.8 +/- 7.1% of the baseline. A negative linear relationship was found between amplitude and frequency. Oscillations of LDF signal indicate that there is a synchronization of contraction and relaxation of cochlear microvessels or of the larger supplying vessels to the cochlea. Manipulation of BP possibly initiates the fluctuating change in vascular tone by influencing the activity of pacemaker or feedback mechanisms of cochlear vascular smooth muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

An audit of prophylactic antibiotic prescribing patterns in orthopaedic practice

As part of the regular monthly audit of orthopaedic practice in Sheffield the prescribing patterns of orthopaedic surgeons were evaluated by questionnaire. Staff questioned were consultant orthopaedic surgeons and surgeons in training. The questionnaire depicted two areas of prophylactic antibiotic use: prescribing patterns in primary total hip replacement and in a number of procedures for closed fractures. The responses were anonymous. The results showed a range of treatment regimes were being used, although everyone prescribed an appropriate antibiotic at the time of surgery in primary joint replacement. The number of postoperative doses varied from none to treatment for 1 week. 78% continue intravenous therapy for 24 h. Prescribing patterns were not so clearly defined in surgery for closed fractures. 13% prescribe no prophylaxis in hip fracture fixation while 16% would prescribe intravenous therapy for 24 h after closed Kirshner wiring of a metacarpal fracture. The discussion of the findings has enabled the introduction of guidelines which should lead to optimal patient care and use of resources.

Autoregulation of cochlear blood flow in guinea pigs

Autoregulation of blood flow in the inner ear following uncontrolled changes in systemic blood pressure (BP), which was induced by the application of pharmacological agents that cause local and/or systemic vascular effects, has been reported in previous studies. In the current study, carotid BP was systematically manipulated without drugs, while the resulting cochlear blood flow (CBF) changes were measured using a laser Doppler flowmeter (LDF). Anesthesized guinea pigs were used, and the probe of a LDF was held against the ventral-posterior portion of the surgically exposed cochlea. A mechanical occluder was placed around the descending aorta or the inferior vena cava. BP could be elevated or lowered over a wide range and was held stable during 2-min occlusions. The mean level (+/- SD) of regulation (% delta CBF/% delta BP) for BP changes less than +/- 35% of preocclusion baseline was 0.24 +/- 0.2 (or 0.18 +/- 0.2 if BP is corrected by subtracting central venous pressure). Significant regulation occurred for BP between 20 and 70 mmHg. A demonstration of the cochlear origin of the regulatory response was obtained by "pharmacological blockade" following topical application of the vasodilator, sodium nitroprusside, to the cochlea. In this condition, CBF changed in nearly direct proportion to BP.

Osmotic pump implant for chronic infusion of drugs into the inner ear

Continuous long-term delivery of experimental drugs to the cochlea of a small animal, such as a young guinea pig, presents several technical problems. A method of placing and securing a cannula-osmotic pump system is described in this paper. Guinea pigs (225-410 g) were unilaterally implanted with an Alzet micro-pump and cannula for delivery of 20 mM tetrodotoxin (TTX) (six animals) or saline (three animals) for three days (1 microliter/h). Auditory brainstem responses (ABRs) were recorded under light anesthesia on post-implant day 1 and day 3 and compared with pre-implant baseline values. In all six cochleas infused with TTX, most frequencies showed a 30-60dB decrease in sensitivity within 24 h. Saline control animals showed little or no change from baseline sensitivity for most frequencies. In three TTX-infused animals, the cannula-pump unit was removed on day 3, and ABRs were followed during recovery. Most frequencies returned to, or near, pre-implant levels after pump removal but recovery times varied. By day 6, all animals had recovered post-surgical weight loss and showed a gain of 10-40 g. Brains and cochleas were removed and processed for sectioning. Assessment of the cochlear nucleus of non-recovery TTX-treated animals showed a deafness-related flattening of auditory nerve active zones on the treated side.

Acute soft tissue injuries of the cervical spine

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Isolated duodenal varices as a cause of massive gastrointestinal bleeding

Portal hypertension and the development of varices in areas of portosystemic venous anastomoses can lead to dramatic and life-threatening haemorrhage. Varices most commonly occur in the gastro-oesophageal region but ectopic varices can arise at other sites in the gastrointestinal tract. This report describes a patient with massive haemorrhage from duodenal varices. We believe the case highlights the importance of considering ectopic varices as a cause of gastro-intestinal haemorrhage especially when oesophageal varices are absent.

Apical hair cells and hearing

This study assessed the contribution of the apical hair cells to hearing. Guinea pigs, chinchillas and monkeys were behaviorally trained using positive reinforcement to respond to pure-tone stimuli. When a stable audiogram had been determined, each subject received one of three experimental treatments: ototoxic drug administration, low-frequency noise exposure, or the application of a cryoprobe to the bony wall of the cochlear apex. After post-treatment audiograms stabilized, subjects were euthanized and the percentage of hair cells remaining was assessed by light microscopy. Results indicate that a redundancy of encoding mechanisms exist in the mammalian cochlea for low-frequency stimuli. They also suggest that a very small percentage of apical hair cells are sufficient for some low-frequency hearing. Finally, data from this and other studies suggest that the low-frequency threshold shift caused by the loss of a certain percentage of apical hair cells is less pronounced than the high-frequency threshold shift caused by the loss of a comparable percentage of basal hair cells. These data agree with anatomical and electrophysiological evidence that functional as well as anatomical differences may exist between the apex and base of the cochlea.

Multiple sebaceous neoplasms and visceral carcinomas: Torre's syndrome

The association of sebaceous neoplasms with visceral carcinomas is recognized as Torre's syndrome. A classical example of this interesting syndrome is reported. The familial predisposition to colorectal carcinoma is emphasized.