Evidence of abnormality in glutathione metabolism in the airways of preterm born children with a history of bronchopulmonary dysplasia

Preterm-born children are at risk of long-term pulmonary deficits, including those who developed bronchopulmonary dysplasia (BPD) in infancy, however the underlying mechanisms remain poorly understood. We characterised the exhaled breath condensate (EBC) metabolome from preterm-born children, both with and without BPD. Following spirometry, EBC from children aged 7-12 years, from the Respiratory Health Outcomes in Neonates study, were analysed using Time-of-Flight Mass Spectrometry. Metabolite Set Enrichment Analysis (MSEA) linked significantly altered metabolites to biological processes. Linear regression models examined relationships between metabolites of interest and participant demographics. EBC was analysed from 214 children, 144 were born preterm, including 34 with BPD. 235 metabolites were detected, with 38 above the detection limit in every sample. Alanine and pyroglutamic acid were significantly reduced in the BPD group when compared to preterm controls. MSEA demonstrated a reduction in glutathione metabolism. Reduced quantities of alanine, ornithine and urea in the BPD group were linked with alteration of the urea cycle. Linear regression revealed significant associations with BPD when other characteristics were considered, but not with current lung function parameters. In this exploratory study of the airway metabolome, preterm-born children with a history of BPD had changes consistent with reduced antioxidant mechanisms suggesting oxidative stress.

Characterizing the urinary proteome of prematurity-associated lung disease in school-aged children

INTRODUCTION

Although different phenotypes of lung disease after preterm birth have recently been described, the underlying mechanisms associated with each phenotype are poorly understood. We, therefore, compared the urinary proteome for different spirometry phenotypes in preterm-born children with preterm- and term-born controls.

METHODS

Preterm and term-born children aged 7-12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) cohort, underwent spirometry and urine collection. Urine was analysed by Nano-LC Mass-Spectrometry with Tandem-Mass Tag labelling. The preterm-born children were classified into phenotypes of prematurity-associated preserved ratio impaired spirometry (pPRISm, FEV₁ < lower limit of normal (LLN), FEV₁/FVC ≥ LLN), prematurity-associated obstructive lung disease (POLD, FEV₁ < LLN, FEV₁/FVC < LLN) and preterm controls (FEV₁ ≥ LLN,). Biological relationships between significantly altered protein abundances were analysed using Ingenuity Pathways Analysis software, and receiver operator characteristic curves were calculated.

RESULTS

Urine was analysed from 160 preterm-born children and 44 term controls. 27 and 21 were classified into the pPRISm and POLD groups, respectively. A total of 785 proteins were detected. Compared to preterm-born controls, sixteen significantly altered proteins in the pPRISm group were linked to six biological processes related to upregulation of inflammation and T-cell biology. In contrast, four significantly altered proteins in the POLD group were linked with neutrophil accumulation. Four proteins (DNASE1, PGLYRP1, B2M, SERPINA3) in combination had an area under the curve of 0.73 for pPRISm and three combined proteins (S100A8, MMP9 and CTSC) had AUC of 0.76 for POLD.

CONCLUSIONS

In this exploratory study, we demonstrate differential associations of the urinary proteome with pPRISm and POLD.

TRIAL REGISTRATION

EudraCT: 2015-003712-20.

Multi-omic approach characterises the neuroprotective role of retromer in regulating lysosomal health

Retromer controls cellular homeostasis through regulating integral membrane protein sorting and transport and by controlling maturation of the endo-lysosomal network. Retromer dysfunction, which is linked to neurodegenerative disorders including Parkinson's and Alzheimer's diseases, manifests in complex cellular phenotypes, though the precise nature of this dysfunction, and its relation to neurodegeneration, remain unclear. Here, we perform an integrated multi-omics approach to provide precise insight into the impact of Retromer dysfunction on endo-lysosomal health and homeostasis within a human neuroglioma cell model. We quantify widespread changes to the lysosomal proteome, indicative of broad lysosomal dysfunction and inefficient autophagic lysosome reformation, coupled with a reconfigured cell surface proteome and secretome reflective of increased lysosomal exocytosis. Through this global proteomic approach and parallel transcriptomic analysis, we provide a holistic view of Retromer function in regulating lysosomal homeostasis and emphasise its role in neuroprotection.

Modulation of pulmonary desmosomes by inhaler therapy in preterm-born children with bronchopulmonary dysplasia

Despite evidence demonstrating persistent lung function deficits in preterm-born children, especially in those who had bronchopulmonary dysplasia (BPD) in infancy, the underlying biological mechanisms explaining these lung function deficits remain poorly understood. We characterised the exhaled breath condensate (EBC) proteome in preterm-born children, with and without BPD; and before and after inhaler treatment. EBC from children aged 7-12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) study, were analysed by Nano-LC Mass Spectrometry with Tandem Mass Tag labelling. Children with percent predicted forced expiratory volume in 1 second ≤ 85% were enrolled to a 12-week blinded randomised trial of inhaled corticosteroids alone (ICS) or with long-acting β₂-agonist (ICS/LABA) or placebo. EBC was analysed from 218 children at baseline, and 46 children received randomised inhaled therapy. 210 proteins were detected in total. For the 19 proteins present in every sample, the desmosome proteins: desmoglein-1, desmocollin-1 and plakoglobin were significantly decreased, and cytokeratin-6A was increased in preterm-born children with BPD when compared to preterm- and term-born controls. ICS/LABA treatment significantly increased abundance of desmoglein-1, desmocollin-1 and plakoglobin in the BPD group with low lung function, and significantly increased plakoglobin in those without BPD. No differences were noted after ICS treatment. Exploratory analyses of proteins not detected in all samples suggested decreased abundance of several antiproteases. This study provides proteomic evidence of ongoing pulmonary structural changes with decreased desmosomes in school-aged preterm-born children with BPD and low lung function, which was reversed with combined inhaled corticosteroids and long-acting β₂-agonists therapy.

Effect of cardioplegic arrest and reperfusion on left and right ventricular proteome/phosphoproteome in patients undergoing surgery for coronary or aortic valve disease

Our earlier work has shown inter‑disease and intra‑disease differences in the cardiac proteome between right (RV) and left (LV) ventricles of patients with aortic valve stenosis (AVS) or coronary artery disease (CAD). Whether disease remodeling also affects acute changes occuring in the proteome during surgical intervention is unknown. This study investigated the effects of cardioplegic arrest on cardiac proteins/phosphoproteins in LV and RV of CAD (n=6) and AVS (n=6) patients undergoing cardiac surgery. LV and RV biopsies were collected during surgery before ischemic cold blood cardioplegic arrest (pre) and 20 min after reperfusion (post). Tissues were snap frozen, proteins extracted, and the extracts were used for proteomic and phosphoproteomic analysis using Tandem Mass Tag (TMT) analysis. The results were analysed using QuickGO and Ingenuity Pathway Analysis softwares. For each comparision, our proteomic analysis identified more than 3,000 proteins which could be detected in both the pre and Post samples. Cardioplegic arrest and reperfusion were associated with significant differential expression of 24 (LV) and 120 (RV) proteins in the CAD patients, which were linked to mitochondrial function, inflammation and cardiac contraction. By contrast, AVS patients showed differential expression of only 3 LV proteins and 2 RV proteins, despite a significantly longer duration of ischaemic cardioplegic arrest. The relative expression of 41 phosphoproteins was significantly altered in CAD patients, with 18 phosphoproteins showing altered expression in AVS patients. Inflammatory pathways were implicated in the changes in phosphoprotein expression in both groups. Inter‑disease comparison for the same ventricular chamber at both timepoints revealed differences relating to inflammation and adrenergic and calcium signalling. In conclusion, the present study found that ischemic arrest and reperfusion trigger different changes in the proteomes and phosphoproteomes of LV and RV of CAD and AVS patients undergoing surgery, with markedly more changes in CAD patients despite a significantly shorter ischaemic period.

Safety and effectiveness of parent- or nurse-controlled analgesia in neonates: a systematic review

OBJECTIVE

The aim of this systematic review was to determine the safety and effectiveness of parent- or nurse-controlled analgesia on neonatal patient outcomes. More specifically, the objective was to determine the effect of parent- or nurse-controlled analgesia on neonatal pain scores, analgesic use, and incidence of iatrogenic withdrawal syndrome, as well as any opioid-associated adverse events.

INTRODUCTION

Despite recent innovations in neonatology leading to significant improvements in short- and long-term outcomes for newborns requiring intensive care, optimal management of pain and distress remains a challenge for the treating multidisciplinary team. The inability of neonates to communicate pain easily, inconsistent practice among health professionals, insufficient analgesic prescriptions, and delays in medical reviews all impact effective pain management. Exploring the effect of parent- or nurse-controlled analgesia may identify a modality that negates these concerns and improves the pharmacological management of pain in newborns.

INCLUSION CRITERIA

This review considered experimental and observational studies evaluating the safety and effectiveness of parent- or nurse-controlled analgesia that included babies born at 23 weeks' gestation to four weeks post-term. The interventions considered for inclusion were any type of analgesia delivered by an infusion pump that allowed bolus dosing or a continuous analgesic infusion with bolus dosing as required. Studies using algorithms and protocols to guide timing and dosage were eligible for inclusion. Comparators included the standard management of pain for neonates in the newborn intensive care unit. A modification to the a priori protocol was made to include all neonates nursed outside of a neonatal intensive care unit to ensure all studies that examined the use of parent- or nurse-controlled analgesia in the neonatal population were included in the review.

METHODS

An extensive search of six major databases was conducted (CINAHL, Cochrane Library, Embase, PubMed, PsycINFO, and Web of Science). Studies published from 1997 to 2020 in English were considered for inclusion in this review. Databases searched for unpublished studies included MedNar and ProQuest Dissertations and Theses.

RESULTS

Fourteen studies were included in this review: two randomized controlled trials, six quasi-experimental studies, one case-control study, and five case series. There was considerable heterogeneity in the interventions and study outcome measures within the studies, resulting in an inability to statistically pool results. The small sample sizes and inability to distinguish data specific to neonates in six of the studies resulted in low quality of evidence for the safety and effectiveness of parent- or nurse-controlled analgesia in neonates. However, studies reporting neonatal data demonstrated low pain scores and a trend in reduced opioid consumption when parent- or nurse-controlled analgesia was used.

CONCLUSIONS

The use of parent- or nurse-controlled analgesia in the neonatal population has shown some effect in reducing the amount of opioid analgesia required without compromising pain relief or increasing the risk of adverse events. Due to the paucity of evidence available, certainty of the results is compromised; therefore, larger trials exploring the use of parent- or nurse-controlled analgesia in neonates and the development of nurse-led models for analgesia delivery are needed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018114382.

Ribosome heterogeneity in Drosophila melanogaster gonads through paralog-switching

Ribosomes have long been thought of as homogeneous macromolecular machines, but recent evidence suggests they are heterogeneous and could be specialised to regulate translation. Here, we have characterised ribosomal protein heterogeneity across 4 tissues of Drosophila melanogaster. We find that testes and ovaries contain the most heterogeneous ribosome populations, which occurs through a combination of paralog-enrichment and paralog-switching. We have solved structures of ribosomes purified from in vivo tissues by cryo-EM, revealing differences in precise ribosomal arrangement for testis and ovary 80S ribosomes. Differences in the amino acid composition of paralog pairs and their localisation on the ribosome exterior indicate paralog-switching could alter the ribosome surface, enabling different proteins to regulate translation. One testis-specific paralog-switching pair is also found in humans, suggesting this is a conserved site of ribosome heterogeneity. Overall, this work allows us to propose that mRNA translation might be regulated in the gonads through ribosome heterogeneity, providing a potential means of ribosome specialisation.

SARS-CoV-2 vaccine ChAdOx1 nCoV-19 infection of human cell lines reveals low levels of viral backbone gene transcription alongside very high levels of SARS-CoV-2 S glycoprotein gene transcription

BACKGROUND

ChAdOx1 nCoV-19 is a recombinant adenovirus vaccine against SARS-CoV-2 that has passed phase III clinical trials and is now in use across the globe. Although replication-defective in normal cells, 28 kbp of adenovirus genes is delivered to the cell nucleus alongside the SARS-CoV-2 S glycoprotein gene.

METHODS

We used direct RNA sequencing to analyse transcript expression from the ChAdOx1 nCoV-19 genome in human MRC-5 and A549 cell lines that are non-permissive for vector replication alongside the replication permissive cell line, HEK293. In addition, we used quantitative proteomics to study over time the proteome and phosphoproteome of A549 and MRC5 cells infected with the ChAdOx1 nCoV-19 vaccine.

RESULTS

The expected SARS-CoV-2 S coding transcript dominated in all cell lines. We also detected rare S transcripts with aberrant splice patterns or polyadenylation site usage. Adenovirus vector transcripts were almost absent in MRC-5 cells, but in A549 cells, there was a broader repertoire of adenoviral gene expression at very low levels. Proteomically, in addition to S glycoprotein, we detected multiple adenovirus proteins in A549 cells compared to just one in MRC5 cells.

CONCLUSIONS

Overall, the ChAdOx1 nCoV-19 vaccine's transcriptomic and proteomic repertoire in cell culture is as expected. The combined transcriptomic and proteomics approaches provide a detailed insight into the behaviour of this important class of vaccine using state-of-the-art techniques and illustrate the potential of this technique to inform future viral vaccine vector design.

Characterisation of the transcriptome and proteome of SARS-CoV-2 reveals a cell passage induced in-frame deletion of the furin-like cleavage site from the spike glycoprotein

BACKGROUND

SARS-CoV-2 is a recently emerged respiratory pathogen that has significantly impacted global human health. We wanted to rapidly characterise the transcriptomic, proteomic and phosphoproteomic landscape of this novel coronavirus to provide a fundamental description of the virus's genomic and proteomic potential.

METHODS

We used direct RNA sequencing to determine the transcriptome of SARS-CoV-2 grown in Vero E6 cells which is widely used to propagate the novel coronavirus. The viral transcriptome was analysed using a recently developed ORF-centric pipeline. Allied to this, we used tandem mass spectrometry to investigate the proteome and phosphoproteome of the same virally infected cells.

RESULTS

Our integrated analysis revealed that the viral transcripts (i.e. subgenomic mRNAs) generally fitted the expected transcription model for coronaviruses. Importantly, a 24 nt in-frame deletion was detected in over half of the subgenomic mRNAs encoding the spike (S) glycoprotein and was predicted to remove a proposed furin cleavage site from the S glycoprotein. Tandem mass spectrometry identified over 500 viral peptides and 44 phosphopeptides in virus-infected cells, covering almost all proteins predicted to be encoded by the SARS-CoV-2 genome, including peptides unique to the deleted variant of the S glycoprotein.

CONCLUSIONS

Detection of an apparently viable deletion in the furin cleavage site of the S glycoprotein, a leading vaccine target, shows that this and other regions of SARS-CoV-2 proteins may readily mutate. The furin site directs cleavage of the S glycoprotein into functional subunits during virus entry or exit and likely contributes strongly to the pathogenesis and zoonosis of this virus. Our data emphasises that the viral genome sequence should be carefully monitored during the growth of viral stocks for research, animal challenge models and, potentially, in clinical samples. Such variations may result in different levels of virulence, morbidity and mortality.

The type 2 diabetes gene product STARD10 is a phosphoinositide-binding protein that controls insulin secretory granule biogenesis

OBJECTIVE

Risk alleles for type 2 diabetes at the STARD10 locus are associated with lowered STARD10 expression in the β-cell, impaired glucose-induced insulin secretion, and decreased circulating proinsulin:insulin ratios. Although likely to serve as a mediator of intracellular lipid transfer, the identity of the transported lipids and thus the pathways through which STARD10 regulates β-cell function are not understood. The aim of this study was to identify the lipids transported and affected by STARD10 in the β-cell and the role of the protein in controlling proinsulin processing and insulin granule biogenesis and maturation.

METHODS

We used isolated islets from mice deleted selectively in the β-cell for Stard10 (βStard10KO) and performed electron microscopy, pulse-chase, RNA sequencing, and lipidomic analyses. Proteomic analysis of STARD10 binding partners was executed in the INS1 (832/13) cell line. X-ray crystallography followed by molecular docking and lipid overlay assay was performed on purified STARD10 protein.

RESULTS

βStard10KO islets had a sharply altered dense core granule appearance, with a dramatic increase in the number of "rod-like" dense cores. Correspondingly, basal secretion of proinsulin was increased versus wild-type islets. The solution of the crystal structure of STARD10 to 2.3 Å resolution revealed a binding pocket capable of accommodating polyphosphoinositides, and STARD10 was shown to bind to inositides phosphorylated at the 3' position. Lipidomic analysis of βStard10KO islets demonstrated changes in phosphatidylinositol levels, and the inositol lipid kinase PIP4K2C was identified as a STARD10 binding partner. Also consistent with roles for STARD10 in phosphoinositide signalling, the phosphoinositide-binding proteins Pirt and Synaptotagmin 1 were amongst the differentially expressed genes in βStard10KO islets.

CONCLUSION

Our data indicate that STARD10 binds to, and may transport, phosphatidylinositides, influencing membrane lipid composition, insulin granule biosynthesis, and insulin processing.

Trends in intra-aortic balloon counterpulsation: Comparison of a 669 record Australian dataset with the multinational Benchmark Counterpulsation Outcomes Registry

The aim of this study was to review and describe indications for intraaortic balloon counterpulsation (IABP) use and identify the impact these have on outcomes at an Australian cardiothoracic tertiary referral hospital. A secondary aim was comparison of the Australian practice with a large multinational IABP data registry. Patient demographics, IABP indication, IABP complication rate and mortality in 662 patients treated with IABP at The Prince Charles Hospital (TPCH), Brisbane, between January 1994 and December 2004 inclusive were compared with The Benchmark Counterpulsation Outcomes Registry. Data were collected between 1994 and 2000 by retrospective patient record review and prospectively using the Benchmark database from 2001 to 2004. Statistical analysis was undertaken usingSAS (v8.2) software. The mean age of patients managed with IABP at TPCH (71.6% male) was 63.4 years (SD 12.4). In-hospital mortality rate was 22% and the complication rate was 10.3%. TPCH indications for IABP were: weaning from cardiopulmonary bypass (34.2%); cardiogenic shock (24.4%); preoperative support (13%); catheter laboratory support (10.6%); refractory ventricular failure (7.3%); ischaemia related to intractable ventricular arrhythmias (4.5%); unstable refractory angina (4%); mechanical complications due to acute myocardial infarction (1.2%) and other (0.4%) (0.4% not reported). In comparison to Benchmark, IABP at TPCH demonstrated a prejudice toward intraoperative use (34.2% versus 16.6%; P= <0.0001) and an aversion to catheter laboratory support (10.6% versus 19%; P= <0.0001). TPCH and Benchmark IABP outcomes demonstrated comparable mortality (22% versus 20.8%; P=ns) but increased TPCH complications (10.3% vs. 6.2%; P= <0.0001) owing to a 2% difference in observed insertion site bleeding.

High quality clinical grade human embryonic stem cell lines derived from fresh discarded embryos

BACKGROUND

Human embryonic stem cells (hESCs) hold tremendous promise for cell replacement therapies for a range of degenerative diseases. In order to provide cost-effective treatments affordable by public health systems, HLA-matched allogeneic tissue banks of the highest quality clinical-grade hESCs will be required. However only a small number of existing hESC lines are suitable for clinical use; they are limited by moral and ethical concerns and none of them apply Good Manufacturing Practice (GMP) standards to the earliest and critical stages of gamete and embryo procurement. We thus aimed to derive new clinical grade hESC lines of highest quality from fresh surplus GMP grade human embryos.

METHODS

A comprehensive screen was performed for suitable combinations of culture media with supporting feeder cells or feeder-free matrix, at different stages, to support expansion of the inner cell mass and to establish new hESC lines.

RESULTS

We developed a novel two-step and sequential media system of clinical-grade hESC derivation and successfully generated seven new hESC lines of widely varying HLA type, carefully screened for genetic health, from human embryos donated under the highest ethical and moral standards under an integrated GMP system which extends from hESC banking all the way back to gamete and embryo procurement.

CONCLUSIONS

The present study, for the first time, reports the successful derivation of highest-quality clinical-grade hESC lines from fresh poor-quality surplus human embryos generated in a GMP-grade IVF laboratory. The availability of hESC lines of this status represents an important step towards more widespread application of regenerative medicine therapies.

The N2-Src neuronal splice variant of C-Src has altered SH3 domain ligand specificity and a higher constitutive activity than N1-Src

N2-Src is a poorly understood neuronal splice variant of the ubiquitous C-Src tyrosine kinase, containing a 17 amino acid insert in its Src homology 3 (SH3) domain. To characterise the properties of N2-Src we directly compared its SH3 domain specificity and kinase activity with C- and N1-Src in vitro. N2- and N1-Src had a similar low affinity for the phosphorylation of substrates containing canonical C-Src SH3 ligands and synaptophysin, an established neuronal substrate for C-Src. N2-Src also had a higher basal kinase activity than N1- and C-Src in vitro and in cells, which could be explained by weakened intramolecular interactions. Therefore, N2-Src is a highly active kinase that is likely to phosphorylate alternative substrates to C-Src in the brain.

The impact of overnight consolidation upon memory for emotional and neutral encoding contexts

Sleep plays a role in the consolidation of declarative memories. Although this influence has attracted much attention at the level of behavioural performance, few reports have searched for neural correlates. Here, we studied the impact of sleep upon memory for the context in which stimuli were learned at both behavioural and neural levels. Participants retrieved the association between a presented foreground object and its encoding context following a 12-h retention interval including either wake only or wake plus a night of sleep. Since sleep has been shown to selectively enhance some forms of emotional memory, we examined both neutral and emotionally valenced contexts. Behaviourally, less forgetting was observed across retention intervals containing sleep than retention intervals containing only wakefulness, and this benefit was accompanied by stronger responses in hippocampus and superior parietal cortex. This sleep-related reduction in forgetting did not differ between neutral and negative contexts, but there was a clear interaction between sleep and context valence at the functional level, with left amygdala, right parahippocampus, and other components of the episodic memory system all responding more strongly during correct memory for emotional contexts post-sleep. Connectivity between right parahippocampus and bilateral amygdala/periamygdala was also enhanced during correct post-sleep attribution of emotional contexts. Because there was no interaction between sleep and valence in terms of context memory performance these functional results may be associated with memory for details about the emotional encoding context rather than for the link between that context and the foreground object. Overall, our data show that while context memory decays less across sleep than across an equivalent period of wake, the sleep-related protection of such associations is not influenced by context emotionality in the same way as direct recollection of emotional information.

ULCERATIVE TYPES AS DETERMINED BY INHERITANCE AND AS RELATED TO NATURAL RESISTANCE AGAINST TUBERCULOSIS: AN EXPERIMENTAL STUDY ON INBRED GUINEA PIGS

Five families of strictly inbred guinea pig whose general resistance to experimental tuberculosis had previously been determined by Wright and Lewis have now been studied with reference to the characteristics of the local lesion produced by intracutaneous inoculation with the tubercle bacillus. It is found that there are clearly recognizable familial types based on the size and quality of the nodular lesion, the ulcerative lesion consecutive to this and the general effectiveness of the healing process when in evidence. Family 39 which has the lowest general resistance forms an initial papule which does not differ appreciably from that formed by Family 35 which is the most resistant. In the ulcerative stage Family 39 shows an indolent excoriating process which exhibits none of the qualities which would be expected to make for healing. Family 35 exhibits a firm primary papule and nodule followed by an active healthy type of ulceration which is definitely restrained in comparison with that of the low resistance Family 13. Family 35 also presents the largest number of completely healed lesions in the later observation periods. Family 13 shows a larger, softer, primary papule and nodule than any of the others. The ulcer when formed is less restrained; that is, it is larger in proportion to the total size of the lesion. It is also more generally destructive. This family also shows a singular tendency to the formation of secondary ulcers along the lymphatic channels leading toward the adjacent lymph nodes. The adjacent lymph nodes are likewise more severely affected and frequently ulcerate through the skin giving rise to residual discharging sinuses. Families 2 and 32 are less definitely characterized. They are of the same order as 35 and 13 in that the ulcerations are active and healthy. Such similarities as are recognizable place Family 2 more nearly with 13 and Family 32 more nearly with 35. In general the qualities of lesion exhibited are such as to agree with the general resistance as previously determined and it is believed that the qualities underlying the tissue reaction may be safely considered to be among the influential factors in the make-up of the natural resistance against tuberculosis. The differences in reaction are in part manifested against agents causing simple inflammation also, and hence must be designated as non-specific with reference to the tubercle bacillus. There are definite indications of other "constitutional" differences in the character of the tissues and the general make-up of these families. The accumulated evidence from the study of the separate families and intercrosses between them is to the effect that the differences in question are transmitted by the blending type of inheritance and are therefore controlled by multiple unit characters. It is also suggested by the observations that certain of the significant characters are recessive in nature. It is of considerable interest that the observations agree very well with the older conception of an inherited, predisposing, constitutional diathesis as a significant factor in the incidence of tuberculosis.

THE FUNCTIONAL VALUE OF NEWLY FORMED CONNECTIVE TISSUE

1. A method has been revived which enables the connective tissue factor in wound healing to be studied quantitatively. 2. It has been found that the functional value of connective tissue formed in response to traumatism as represented by its tensile strength varies widely in different animals. 3. It is suggested that the method may find application in the study of extraneous influences which may affect wound healing either through local or systemic application. 4. It has been determined that there is no parallelism between an active connective tissue response to traumatism and natural resistance to inoculation tuberculosis in the rabbit.

THE DISTRIBUTION OF TRYPAN-RED TO THE TISSUES AND VESSELS OF THE EYE AS INFLUENCED BY CONGESTION AND EARLY INFLAMMATION

In as far as the observations reported have a bearing on the movements of fluid within the eye, they are, for the most part, in accord with views at present generally accepted. On the other hand, we know of no other way in which it may be so readily demonstrated that simple and even temporary local circulatory changes may profoundly alter the distribution of substances from the circulating blood to the extravascular fluids and tissues. In the light of these observations, it would seem that such changes might easily account for marked idiosyncrasies in the action of poisonous drugs, and as well probably for other factors in drug action.

ALLERGIC IRRITABILITY : II. ANAPHYLAXIS IN THE GUINEA PIG AS AFFECTED BY THE INHERITANCE

Inbred lines of guinea pig which have previously been observed to differ in their susceptibility to tuberculosis differ in their anaphylactic responses as well. The families that are relatively resistant to tuberculosis appear also to be somewhat more resistant to some one or more of the phases of the anaphylactic reaction complex.

ALLERGIC IRRITABILITY : THE FORMATION OF ANTI-SHEEP HEMOLYTIC AMBOCEPTOR IN THE NORMAL AND TUBERCULOUS GUINEA PIG

The guinea pig infected with virulent tubercle bacilli develops much more anti-sheep amboceptor than do controls when given like amounts of sheep red blood corpuscles. The curve of antibody production in the guinea pig when treated with sheep red blood corpuscles shows a departure from curves previously determined in other animals. These facts were ascertained as part of an effort to learn mbre of the functional nature of the inheritable factors controlling natural resistance to disease. The nature of some of the problems involved is outlined, and the limited bearing of the experiments on these is discussed.

ALLERGIC IRRITABILITY : IV. THE CAPACITY OF GUINEA PIGS TO PRODUCE ANTIBODIES AS AFFECTED BY THE INHERITANCE AND AS RELATED TO FAMILIAL RESISTANCE TO TUBERCULOSIS

The allergic irritability of closely inbred guinea pigs as represented by their capacity to produce hemolytic antibodies for beef and sheep corpuscles, and agglutinins for Bacillus typhosus and Bacillus abortus (Bang) differs by families and therefore is at least partly dependent on inherited characteristics. These differences show an imperfect but suggestive correlation with the differences in resistance of the same families to inoculation tuberculosis as previously determined by Wright and Lewis. The differences in antibody production also show an imperfect correlation with the differences in response in the anaphylactic reaction complex as previously determined by Lewis and Loomis. These studies suggest very strongly that the allergic irritability is one of the several inheritable characters which form a partial basis for the natural resistance to tuberculosis. The antibody-producing capacity is only satisfactorily defined when minimal or moderate amounts of antigen are used and this in single treatments. The irregularities in experimental result when repeated treatments or very large single treatments are used suggest that antibody production in the second or "acquired capacity" phase may rest on a somewhat different fundamental basis than the latent or potential natural capacity. There is some very slight evidence that production in the second phase may also be influenced by inherited qualities.

SWINE INFLUENZA : II. A HEMOPHILIC BACILLUS FROM THE RESPIRATORY TRACT OF INFECTED SWINE

1. A hemophilic bacillus has been regularly obtained in culture from the respiratory tract of a series of swine experimentally infected with swine influenza and from a small number of spontaneous field cases of the disease. It has not been observed in respiratory tract cultures from a group of swine free from influenza. 2. The cultural and morphological characters of the organism have been described and the name Hemophilus influenzas (variety suis) suggested. The organism exhibits marked serological diversity, since only two out of eight strains studied were serologically identical. It is usually non-pathogenic for rabbits and white rats, and irregularly pathogenic for white mice. One strain of the organism was pathogenic for guinea pigs while two others were not. 3. Eleven out of thirteen attempts to induce symptoms of disease in swine by intranasal inoculation with pure cultures of H. influenzae suis were entirely negative. The remaining two attempts which suggested a positive result have been discussed. 4. Attention has been called to the marked similarity which exists between non-indol-producing strains of H. influenzae and H. influenzae suis.

THE COMPLEMENT FIXATION REACTION AS APPLIED TO LEPROSY

By means of a method differing in important details from those of previous investigators it has been determined that the blood serum of cases of leprosy exhibits the ability to fix complement with a wide variety of antigens including to a greater or less extent those derived from any culture of the acid-fast group of bacteria available to us. This property of multiple fixation may sufficiently characterize the disease to be of diagnostic significance, although our experience is hardly sufficient to enable us to speak with complete assurance on this point. Certainly, control sera from normal individuals, from cases of tuberculosis, or from cases of syphilis as obtained in our locality have entirely failed to react with certain antigens, whereas serum from cases of leprosy have so reacted to the extent of over 93 per cent. The most characteristic fixation given by the leprosy sera is that with Bacillus lepræ (Clegg) used as antigen, either in the form of a bacterial emulsion or of an alcoholic extract of the dried culture. Antibody absorption may be demonstrated in the acid-fast group if the absorbing bacteria are removed by filtration. Otherwise the resulting fluid is strongly anticomplementary. Leper serum is not deprived of the complement-fixing body when so treated with either Bacillus tuberculosis or Bacillus lepræ (Clegg).

EXPERIMENTAL EPIDEMIC POLIOMYELITIS IN MONKEYS

The experimental study of poliomyelitis has yielded a large number of important facts relating to the spontaneous disease in man. The nature of the virus has been discovered, many of its properties have been ascertained, some of its immunity effects have been established, the clinical and pathological peculiarities of the disease have been elucidated, and a basis has been secured on which to develop measures of prevention.

THE STERILIZATION OF LIPOVACCINES

Pneumococcus lipovacdne confers a definite protection against pneumococcus infection in mice. The protective quality is not destroyed, and apparently is not greatly diminished, by heating to 130 degrees C. for 3 hours or 120 degrees C. for 12 hours. Typhoid lipovaccine gives rise to the formation of agglutinins in rabbits but to a lesser degree than saline suspensions. The antigenic qualities of the typhoid lipovaccine are greatly injured by heating to 130 degrees C. for 3 hours.

THE INDUCED SUSCEPTIBILITY OF THE GUINEA-PIG TO THE TOXIC ACTION OF THE BLOOD SERUM OF THE HORSE

Following the divisions before used, the results presented in the preceding pages may be briefly stated. I. The particular method of sensitization and the place where the test injection is made have an important bearing on the results obtained by various workers. Comparing the results obtained by the various methods, we may conclude that the incubation period of the hypersensitive reaction is not sharply limited, but that there is a progressive increase in sensitiveness from the sixth day, and presumably before that, extending over a period of several weeks. It seems very probable that the degree of hypersensitiveness attained where the sensitizing dose consists of a mixture of diphtheria toxin and serum is greater than when a single dose of the same small quantity of serum is given alone. II. Our early experiments, the first in this field, are in thorough agreement with those first reported by Otto, and shortly after him by Rosenau and Anderson. III. This hypersensitive reaction is transmissible from mother to offspring. The transmission is probably not equally effective in all cases, and individual young guinea-pigs probably vary greatly in the rate with which they lose their ability to react. As a result not all of the young of a hypersensitive mother react to a subcutaneous dose of five cubic centimeters of serum given when they are four or five weeks old. The reaction in the young animals differs quite markedly from that in those actively sensitized. These differences are such as to indicate that in the mother there is a considerable localization of the reaction in tissues and organs whose destruction does not cause sudden death. This local reaction is a protective factor and is not transmitted to the same degree as the factors involved in the fatal acute reaction. IV. The hypersensitive reaction to horse serum depends on the development of a special anti-body during the incubation period, which anti-body may be passively transferred to a fresh animal. If the dose of hypersensitive serum be sufficient, and the intoxicating injection be given directly into the circulation, this passive hypersensitiveness may be enough so that the animal will die when tested. There is also in the serum of hypersensitive guinea-pigs an uneliminated horse serum element or "rest," which is distinct from this antibody, and probably without influence on the course of the acute reaction. V. The anti-body on which the hypersensitive reaction depends may be entirely neutralized by horse serum without causing symptoms. The gradual introduction of increasing doses over a total period of twenty-four hours suffices for this. The animal is then, properly speaking, neither immune nor refractory, but is essentially in the condition of a normal animal which has recently had a large dose of horse serum. This rapid neutralization is made possible by the great binding power which the subcutaneous and other relatively unimportant tissues have for the toxic element of the serum. The so-called "Phenomenon of Arthus" is probably the same reaction for the rabbit that we have here dealt with in the guinea-pig. The fact that the manifestation is more prominently a local one depends on racial differences. I have encountered cases in the guinea-pig in which the conditions in the rabbit are closely simulated.

THE PHYSIOLOGY OF THE IMMEDIATE REACTION OF ANAPHYLAXIS IN THE GUINEA-PIG

1. By an immediate anaphylactic reaction we mean the chain of symptoms which occur in highly sensitized guinea-pigs shortly after an intravenous or intracardiac injection of the toxic dose and usually end in death. 2. Immediate anaphylactic death occurs three to five minutes after the toxic injection in highly sensitized guinea-pigs. 3. Immediate anaphylactic death in guinea-pigs is caused by asphyxia; cessation of respiration is secondary to this asphyxia. 4. This asphyxia is apparently produced by a tetanic contraction of the smooth muscles of the bronchioles, which occludes their lumen gradually, so that finally no air enters or leaves the lung, in spite of violent respiratory efforts; the animal is strangulated. 5. The stage of complete broncho-constriction is preceded by a short broncho-dilatation, if the bronchioles have been in a state of tonus previous to the injection of the toxic dose. 6. Anatomically, the lungs of these guinea-pigs are typical and may be used as an indicator of the immediate anaphylactic state when the animal has been immobilized by curarin or by pithing. 7. The lungs of a guinea-pig killed by immediate anaphylaxis are distended and in an inspiratory position so that the diaphragm is pushed down; no marked collapse occurs when the chest is opened and when the lungs are excised in toto; their color is a pale bluish-pink ; the surfaces and borders are smooth; no foam is in the trachea or large bronchi; pieces of lung cut off do not collapse, float lightly on water, and contain a good amount of air and little fluid which escapes on pressure. The blood in the lungs and heart is black when the autopsy is made at once after the cessation of respiration. 8. Section of the vagi in the neck, or curarin (artificial respiration) exerts no appreciable effect on the development of immediate anaphylaxis. 9. This immobilization of the lungs, which is due to a broncho-constriction, is of peripheral origin, for destruction of the spinal cord and medulla affects in no appreciable way the promptness and extent of the typical lung response to the injection of the toxic dose. Artificial respiration is, of course, necessary. At the present time we do not care to state whether the toxic dose exerts its effects upon the bronchial muscles alone or upon the vagus motor endings or upon both structures. 10. The blood pressure in immediate anaphylaxis first shows a rise, which may be considerable; a short maintenance of this high level and then a gradual drop to IO to 20 millimeters of mercury and even less, within ten minutes after injection of the toxic dose. 11. Shortly after injection of the toxic dose a heart block develops, so that auricles and ventricles may beat in a 3:I rhythm; the block is probably due to asphyxia. 12. The cardiac vagus gradually loses its irritability after injection of the toxic dose. 13. Cooling of the guinea-pig delays the reaction to the toxic injection.

THE SURVIVAL OF YELLOW FEVER VIRUS IN CULTURES

1. The virus of yellow fever has been found to survive in artificial culture media for at least 12 days at a temperature of 35°C. No visible growth has been present and no reproduction of the virus has been demonstrated. 2. Infections have been obtained in rhesus monkeys with two strains of virus in quantities as small as 0.00001 cc. of infectious blood, and with one strain in an amount probably as minute as 0.000001 cc.

THE HISTOLOGICAL EXPRESSION OF THE NATURAL RESISTANCE OF RABBITS TO INFECTION WITH HUMAN AND BOVINE TYPE TUBERCLE BACILLI

From the foregoing description it is evident that when rabbits are inoculated intravenously with equal amounts of tubercle bacilli of bovine and human type respectively, they are subject to an immediate reaction in the form of an interstitial pulmonary exudation, which, being of equal severity and character does not serve to distinguish the type. There is an hyperplasia of the lymphoid tissue which is much more pronounced in the bovine series and which may distinguish this type. Opinion on this point may well be reserved until other typical cultures are examined for this response. The two types are sharply distinguished by the behavior of the tubercle bacillus and by the progression of tubercle formation. Tubercles are formed by both types and for about I week after inoculation they are not distinguishable. Progressively thereafter those formed as a response to the bovine bacillus become more numerous; they caseate and become conglomerate, finally coming to occupy the major part of the pulmonary tissue and its associated lymph nodes. With the human type the tubercles do not progress to caseation, do not become more numerous after their first well defined formation, and finally tend to disappear. The human type bacillus does not multiply considerably, if at all, and disappears early. The bovine bacillus suffers little or no restraint in growth and finally multiplies enormously. It seems clear that so far as histologic evidence goes the fundamental difference in the reaction of the rabbit to the two types of tubercle bacilli is referable to the ability of the animal to restrain the growth of the human type or to the prevalence of conditions which permit a most vigorous multiplication of the bovine type. The initial cellular responses seem to be qualitatively of the same order and their quantitative distinctions are for the most part developed coincidently with the manifest growth of the bovine type bacillus. If we undertake to state the observed results in the terminology of immunity we can say only that the histologic picture discloses a difference in the rate of bacillary multiplication which suggests that a difference in the physiologic requirements for growth of the two types of bacilli is satisfied or unsatisfied, in the respective cases, by the rabbit as host; or on the other hand, that there is a positive growth-restraining action exerted with efficiency against bacilli of the human type. It is evident that the present observations furnish no points of discrimination between these alternatives. There is, however, an occasional result of the injection of human type bacilli into rabbits (not seen in this series) which offers a suggestion. When animals so injected are allowed to live for 2 or 3 months, the lungs at autopsy not infrequently present a few nodules of large size, often 1 cm. in diameter, which are found to be well encapsulated, soft, caseous masses. These often contain large numbers of tubercle bacilli. Since we know nothing of the particular conditions which give rise to these rather exceptional formations it is impossible to draw general conclusions from them, but they do suggest that the rabbit is not lacking in the food materials required by the human type bacillus; and that if the more usual suppression of this type is due to failure of its essential nutritives, it is rather a question of the distribution within the animal than an absence which is responsible. The usual result would then appear to be due to a positive growth-restraining action exerted against the human type bacillus. Certain other points of interest in the histologic picture described are worthy of comment. The lymphocytes do not appear as active cells in any preponderant way in either series and they are much less in evidence in the immune case (human type) than in the non-immune (bovine type). This might suggest that the activity of this cell type is a response to infection rather than that it furnished an effective preexisting barrier against infection in this particular case. If the lymphocytes were the most important agents in the immune reaction, it might be expected that they would show an immediate sharp response in the human series. The large mononuclear type of cell is clearly most closely related physically to the tubercle bacillus within the body of the rabbit and this without distinction as to bacillary type. Foci of these cells are the loci of the disappearing bacilli of human type, and in either the active or necrotic state similar cell collections are the site of the most vigorous multiplication of the bovine bacilli. These cells undoubtedly stand in a central position in any picture which can be drawn of experimental tuberculosis in the rabbit and deserve as a consequence all of the very considerable attention they have received at the hands of numerous observers in recent years. It has been quite usual of late to consider that the whole of the essential reaction of the animal against tubercle bacilli is carried by the cells of the mononuclear series, either lymphocytes or large mononuclears according to the predilections of the observer. We cannot, however, entirely overlook the presence in very large numbers of polymorphonuclear leucocytes, both amphophilic and eosinophilic, in this experimental series. They are much less prominent in the animals injected with the killed culture and hence can hardly be neglected on the assumption that they are merely a part of a reaction to an indifferent foreign body They are in large measure a reaction to the living organism: whether a primary and direct or a secondary, indirect consequence of its presence we are unable to decide. These cells are not massed in any regular relationship to the well formed tubercles or to the clusters of mononuclear cells initiating tubercle formation. They are also very much less abundant in the very severe late lesions of the bovine type where enormous numbers of bacilli are enclosed in the tubercles. It seems possible that the polymorphonuclears are a response to the living free tubercle bacilli as contrasted with either the dead bacilli or the living bacilli segregated in mononuclear cell clusters or in tubercles. They would appear also to be related to something apart from the bacillus itself, either a diffusion or disintegration product, since phagocytosis of bacilli, or the presence of bacilli in close physical relation to polymorphonuclear leucocytes, is so infrequent in general as not to have been observed in this series of experiments.

THE FUNCTION OF THE SPLEEN IN THE EXPERIMENTAL INFECTION OF ALBINO MICE WITH BACILLUS TUBERCULOSIS

Infection of rats and mice with Bacillus tuberculosis (bovine type) develops a splenic tumor as a typical lesion. Removal of the spleen from mice (albino) greatly increases their resistance to the infection. This increased resistance cannot be explained at present. The infection in the splenectomized mice tends to remain localized as contrasted with an almost septicemic type of disease which is usual in the normal animal. The animals of each group that live more than thirty days are apt to present typical exudative lesions. The removal of the spleen does not therefore grossly change what may be called the capacity of the body for exudation.

The precision of temporal judgement: milliseconds, many minutes, and beyond

The principle that the standard deviation of estimates scales with the mean estimate, commonly known as the scalar property, is one of the most broadly accepted fundamentals of interval timing. This property is measured using the coefficient of variation (CV) calculated as the ratio between the standard deviation and the mean. In 1997, John Gibbon suggested that different time measurement mechanisms may have different levels of absolute precision, and would therefore be associated with different CVs. Here, we test this proposal by examining the CVs produced by human subjects timing a broad range of intervals (68 ms to 16.7 min). Our data reveal no evidence for multiple mechanisms, but instead show a continuous logarithmic decrease in CV as timed intervals increase. This finding joins other recent reports in demonstrating a systematic violation of the scalar property in timing data. Interestingly, the estimated CV of circadian judgements fits onto the regression of decreasing CV, suggesting a link between short interval and circadian timing mechanisms.

Immunolocalization of myocilin protein in the anterior eye of normal and primary open-angle glaucomatous dogs

OBJECTIVE

The presence of myocilin was investigated in a colony of Beagles, a canine model for inherited primary open-angle glaucoma (POAG). The myocilin protein was localized in the normal and glaucomatous canine eyes by immunohistochemistry and immunocytochemistry.

METHODS

Paraffin- and plastic-embedded specimens from the anterior uveas of 10 Beagles with inherited glaucoma (3 months to 13 years old) and 6 age-matched normal dogs were sectioned, and were then incubated with primary antibody, rabbit polyclonal antihuman MYOC IgG, overnight at 4 degrees C. Specimens were incubated with secondary antibody with one of the following: biotinylated link followed by peroxidase-labeled streptavidin and then by substrate-chromogen for light microscopy; fluorescent marker Texas red; or 18 nm colloidal gold-labeled goat antirabbit IgG for transmission electron microscopy.

RESULTS

With normal, pre- and early glaucomatous canine specimens, cell membranes of smooth muscle cells of the iris and ciliary body stained positively, as well as most resident stromal and vascular endothelial cells. The cytoplasm of cells within the nonpigmented ciliary epithelium of the ciliary body processes stained intensely, being weaker along the pars plana. Trabecular meshwork (TM) cells and surrounding extracellular matrix labeled, as well as the sclera adjacent to the angular aqueous plexus. In specimens with moderate and advanced glaucoma, greater intensity of staining was observed within TM cells and adjacent sclera, and portions of the nonpigmented epithelium of the ciliary processes. Fibrinous material labeled intensely within the posterior chamber.

CONCLUSIONS

Myocilin in the normal and glaucomatous canine eye was successfully immunolocalized. These findings with regard to the normal eye are nearly identical to those previously reported in humans, and support the original hypothesis that there is an increase in both accumulation and localization of myocilin in glaucomatous canine eyes. It also supports the possibility that changes in the activity of myocilin within the aqueous humor outflow pathway of individuals with spontaneous glaucoma are associated with the rise of intraocular pressure and subsequent development of this disease, but may not be the primary event in the initial raise in intraocular pressure in POAG in the Beagle.

Cystic fibrosis mortality and survival in the UK: 1947-2003

Data up to 1995 on the survival of 3-yr cohorts of patients with cystic fibrosis (CF) born in the UK in the period 1968-1992 have previously been published. The present study reports survival data up to the end of 2003 together with a 2003 population estimate. All subjects with CF born in the UK in the period 1968-1992 were identified up to 1997 by active enquiry through recognised CF clinics and other hospital consultants. Information from the death certification authorities up to the end of 2003 was added. Death certificates that could not be matched with UK Cystic Fibrosis Survey records were investigated and the data reconciled. The observed survival up to 2003 of CF patients born in 1978 was 55% for males and 49% for females. For 1988 and 1992 the data were 91 and 88%, and 97 and 96%, respectively. The estimated 2003 mid-year CF population was 8,284. The continuing improvement in survival of cystic fibrosis patients in successive cohorts means that the previous prediction of median survival of >50 yrs of age for individuals born in 2000 continues to look realistic, even in the absence of proven effective therapy aimed at correcting the basic cystic fibrosis defect.

Neural correlates of processing valence and arousal in affective words

Psychological frameworks conceptualize emotion along 2 dimensions, "valence" and "arousal." Arousal invokes a single axis of intensity increasing from neutral to maximally arousing. Valence can be described variously as a bipolar continuum, as independent positive and negative dimensions, or as hedonic value (distance from neutral). In this study, we used functional magnetic resonance imaging to characterize neural activity correlating with arousal and with distinct models of valence during presentation of affective word stimuli. Our results extend observations in the chemosensory domain suggesting a double dissociation in which subregions of orbitofrontal cortex process valence, whereas amygdala preferentially processes arousal. In addition, our data support the physiological validity of descriptions of valence along independent axes or as absolute distance from neutral but fail to support the validity of descriptions of valence along a bipolar continuum.

A right hemispheric prefrontal system for cognitive time measurement

Despite a growing body of neuroimaging data, little consensus has been reached regarding the neural correlates of temporal processing in humans. This paper presents a reanalysis of two previously published neuroimaging experiments, which used two different cognitive timing tasks and examined both sub- and supra-second intervals. By processing these data in an identical manner, this reanalysis allows valid comparison and contrasting across studies. Conjunction of these studies using inclusive masking reveals shared activity in right hemispheric dorsolateral and ventrolateral prefrontal cortex and anterior insula, supporting a general-purpose system for cognitive time measurement in the right hemispheric prefrontal cortex. Consideration of the patterns of activity in each dataset with respect to the others, and taking task characteristics into account, provides insight into the possible role of dorsolateral prefrontal cortex in working memory and of posterior parietal cortex and anterior cingulate in attentional processing during cognitive time measurement tasks.

What factors influence functional ability in patients with rheumatoid arthritis. Do they alter over time?

OBJECTIVES

To describe the changes in functional ability (FA) taking place over 5 yr in patients with rheumatoid arthritis (RA) starting disease-modifying anti-rheumatic drug (DMARD) therapy, to investigate the factors having most influence upon FA and to compare these factors at baseline and after 5 yr of treatment.

METHODS

Three hundred and sixty-six patients with active RA were studied as part of a 5-yr randomized controlled study of DMARD therapy. FA was assessed by Health Assessment Questionnaire (HAQ) score every 6 months. Multiple linear regression was used to identify factors affecting FA at baseline and at 5 yr. The independent variables used were age, sex, visual analogue scale (VAS) pain, Ritchie articular index, C-reactive protein (CRP), Larsen score and log-transformed morning stiffness (EMS).

RESULTS

Mean HAQ score was 1.64 at baseline, improved by 21% at 1 yr and gradually returned towards baseline levels by 5 yr. At baseline only 34% of variance in HAQ score could be explained; the most significant explanatory variables were the Ritchie articular index and CRP. At 5 yr the variance explained was 60%. The Ritchie articular index remained the strongest factor followed by VAS pain, log(10) EMS and Larsen score.

CONCLUSIONS

Improvement in function did occur after commencement of the first DMARD therapy but was not maintained to 5 yr. The most consistent factor affecting function was joint tenderness. Global pain and duration of EMS were of lesser importance. Disease activity measures such as the CRP exerted an influence in the earlier, more active stages of disease: radiographic damage assumed greater importance as the arthritis progressed.

Brain mechanisms for mood congruent memory facilitation

Emotional information is better remembered when mood at the time of retrieval matches it in valence (positive mood, positive material). An associative memory model predicts that this 'mood congruent' facilitation is due to the mood-related reactivation at retrieval of emotional responses which were linked to valenced information at encoding. To test this model, we presented subjects with positive and negative words at study and manipulated their mood at test while using functional imaging to monitor brain activity. Subjective mood ratings and heart rate variability both indicated that the manipulation was effective, and memory performance showed a strong trend towards facilitation in congruent conditions. In the functional imaging data, valence-specific conjunctions between encoding activity predicting subsequent memory in a congruent mood and retrieval activity relating to mood congruent recollection revealed shared responses in subgenual cingulate for positive valence and posteriolateral orbitofrontal cortex for negative valence, thus supporting the associative model. To elucidate the mnemonic basis of facilitation, independent of valence, we examined the shared correlates of positive and negative congruence and found that parts of the episodic memory system were activated by congruence in correct rejection trials, but no part of this system was activated by congruence in correctly remembered trials. This pattern suggests that mood congruent facilitation occurs at the level of attempted recall rather than that of successful recollection.

Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study

A randomised controlled trial was conducted to assess whether a single intervention by a health visitor reduced the unplanned re-admission of elderly people discharged from geriatric wards. Two hundred and four consecutive discharges from geriatric wards were randomly allocated to receive either a single visit from the health visitor at 72 h in addition to normal follow-up services or to a control group receiving the normal follow-up services. The primary outcome measure was the unplanned re-admissions over the following 6 months. There were 40 cases and 43 control patients with unplanned re-admissions in the first 6 months. The total lengths of the unplanned re-admissions were 1237 days for cases and 1427 for controls, an average of 12.1 days for cases and 14.0 for controls (95% confidence interval -4.9 to 8.7 days, not significant). A visit by a health visitor to elderly patients after discharge from geriatric wards is unlikely to be of sufficient benefit to the patients for the service to be funded from a saving in unplanned re-admissions.

Inequalities in access to knee joint replacements for people in need

OBJECTIVES

To quantify the effects of socioeconomic deprivation and rurality on evidence of need for total knee joint replacement and the use of health services, after adjusting for age and sex.

METHODS

A random stratified sample of 15 000 people aged > or =65 years taken from central age/sex registers for the geographical areas covered by the previous Sheffield and Wiltshire Health Authorities. A self completion validated questionnaire was then mailed directly to subjects to assess need for knee joint replacement surgery and whether general practice and hospital services were being used. Subjects were followed up for 18 months to evaluate access to surgery.

RESULTS

The response rate was 78% after three mailings. In those aged 65 years and over (with and without comorbidity), the proportion with no comorbid factors and in need of knee replacement was 5.1%; the rate of need among subjects without comorbidity was 7.9%. There were inequalities in health and access to health related to age, sex, geography, and deprivation but not rurality. People who were more deprived had greater need. Older and deprived people were less likely to access health services. Only 6.4% of eligible people received knee replacement surgery after 18 months of follow up.

CONCLUSIONS

There is an important unmet need in older people, with significant age, sex, geographical, and deprivation inequalities in levels of need and access to services. The use of waiting list numbers as a performance indicator is perverse for this procedure. There is urgent need to expand orthopaedic services and training.

Inequalities in accessing hip joint replacement for people in need

OBJECTIVES

To quantify the effects of rurality and socio-economic disadvantage on prior evidence of need for total hip joint replacement and use of health services after adjusting for age and gender.

DESIGN

Self-completion validated questionnaire mailed directly to subjects.

SETTINGS

Geographical areas covered by Wiltshire and Sheffield Health Authorities in England.

PARTICIPANTS

Random stratified sample of 15,000 aged 65 years and over taken from the central age-sex registers.

MAIN OUTCOME MEASURE

Prior need for hip joint replacement surgery and whether general practice and hospital services were being used as assessed by the questionnaire.

RESULTS

The response rate was 78% after three mailings. Prevalence of need for total hip replacement in the over 64s was 3.4% (95% confidence interval is 3.0% to 3.8%) and in those without co-morbidity 5.4% (95% confidence interval is 4.8% to 6.0%). There were inequalities demonstrated due to age, geography, and deprivation, but not rurality in accessing general practice and hospital services. People who were poor had more need. Older people in need were less likely to be accessing health services.

CONCLUSIONS

There is an important unmet need for hip joint replacement in older people with marked inequalities in levels of need and use of services. The use of numbers of people waiting as a performance indicator is perverse for this procedure. We have urgently to expand orthopaedic services and the training of orthopaedic surgeons in England.

Comparative morphology of the tapetum lucidum (among selected species)

OBJECTIVES

The phenomenon of 'eye-shine' is seen in a variety of animal species, and is generally thought to be related to the presence of an intraocular reflecting structure, the tapetum lucidum. The tapetum lucidum is a biologic reflector system that is a common feature in the eyes of vertebrates. It normally functions to provide the light-sensitive retinal cells with a second opportunity for photon-photoreceptor stimulation, thereby enhancing visual sensitivity at low light levels. The tapetum lucidum is presented here according to a classification based on the location, as well as the composition, of this reflective layer. Finally, the physical and chemical properties, as well as the origins of the different tapeta lucida, are discussed and compared.

METHODS

The anatomic and biochemical aspects of the tapetum lucidum in various vertebrates are examined. Morphologic observations were made from paraffin and plastic embedded specimens. Specimens were treated with traditional stains and observed by light and transmission electron microscopy.

RESULTS

Some species (primates, squirrels, birds, red kangaroo and pig) do not have this structure and they usually are diurnal animals. In vertebrates, the tapetum lucidum exhibits diverse structure, organization and composition. Therefore, the retinal tapetum (teleosts, crocodilians, marsupials, fruit bat), the choroidal guanine tapetum (elasmobranchs), the choroidal tapetum cellulosum (carnivores, rodents, cetacea), and the choroidal tapetum fibrosum (cow, sheep, goat, horse) are described.

CONCLUSIONS

The tapetum lucidum represents a remarkable example of neural cell and tissue specialization as an adaptation to a dim light environment and, despite these differences, all tapetal variants act to increase retinal sensitivity by reflecting light back through the photoreceptor layer. These variations regarding both its location and structure, as well as the choice of reflective material, may represent selective visual adaptations associated with their feeding behavior, in response to the use of specific wavelengths and amount of reflectance required.

Brain activity correlates differentially with increasing temporal complexity of rhythms during initialisation, synchronisation, and continuation phases of paced finger tapping

Activity in parts of the human motor system has been shown to correlate with the complexity of performed motor sequences in terms of the number of limbs moved, number of movements, and number of trajectories. Here, we searched for activity correlating with temporal complexity, in terms of the number of different intervals produced in the sequence, using an overlearned tapping task. Our task was divided into three phases: movement selection and initiation (initiate), synchronisation of finger tapping with an external auditory cue (synchronise), and continued tapping in absence of the auditory pacer (continue). Comparisons between synchronisation and continuation showed a pattern in keeping with prior neuroimaging studies of paced finger tapping. Thus, activation of bilateral SMA and basal ganglia was greater in continuation tapping than in synchronisation tapping. Parametric analysis revealed activity correlating with temporal complexity during initiate in bilateral supplementary and pre-supplementary motor cortex (SMA and preSMA), rostral dorsal premotor cortex (PMC), basal ganglia, and dorsolateral prefrontal cortex (DLPFC), among other areas. During synchronise, correlated activity was observed in bilateral SMA, more caudal dorsal and ventral PMC, right DLPFC and right primary motor cortex. No correlated activity was observed during continue at P<0.01 (corrected, cluster level), though left angular gyrus was active at P<0.05. We suggest that the preSMA and rostral dorsal PMC activities during initiate may be associated with selection of timing parameters, while activation in centromedial prefrontal cortex during both initiate and synchronise may be associated with temporal error monitoring or correction. The absence of activity significantly correlated with temporal complexity during continue suggests that, once an overlearned timed movement sequence has been selected and initiated, there is no further adjustment of the timing control processes related to its continued production in absence of external cues.

Interval timing in mice does not rely upon the circadian pacemaker

The suprachiasmatic nucleus (SCN) of the hypothalamus is a precise timekeeper that controls and synchronizes the circadian period of countless physiological and behavioural functions and entrains them to the 24 h light/dark cycle. We examined the possibility that it is also indirectly involved in measurement of a briefer interval by observing the effects of lesions targeted at the SCN, and abolishing circadian rhythmicity, upon interval timing behaviour. Fourteen house mice (Mus musculus) were trained to estimate a 10 s interval using a modified peak procedure, and then underwent electrolytic lesions. Six individuals became behaviourally arrhythmic. Peak interval performance was then assessed in 12:12 light/dark conditions and in constant darkness. No significant change in peak characteristics was observed as a consequence of the lesion for either rhythmic or arrhythmic groups. These results show that the accurate measurement of 10 s requires neither a functioning circadian pacemaker nor entrained behavioural rhythmicity.

Brain activation patterns during measurement of sub- and supra-second intervals

The possibility that different neural systems are used to measure temporal durations at the sub-second and several second ranges has been supported by pharmacological manipulation, psychophysics, and neural network modelling. Here, we add to this literature by using fMRI to isolate differences between the brain networks which measure 0.6 and 3s in a temporal discrimination task with visual discrimination for control. We observe activity in bilateral insula and dorsolateral prefrontal cortex, and in right hemispheric pre-supplementary motor area, frontal pole, and inferior parietal cortex during measurement of both intervals, suggesting that these regions constitute a system used in temporal discrimination at both ranges. The frontal operculum, left cerebellar hemisphere and middle and superior temporal gyri, all show significantly greater activity during measurement of the shorter interval, supporting the hypotheses that the motor system is preferentially involved in the measurement of sub-second intervals, and that auditory imagery is preferentially used during measurement of the same. Only a few voxels, falling in the left posterior cingulate and inferior parietal lobe, are more active in the 3s condition. Overall, this study shows that although many brain regions are used for the measurement of both sub- and supra-second temporal durations, there are also differences in activation patterns, suggesting that distinct components are used for the two durations.

Localization of smooth muscle actin in the iridocorneal angle of normal and spontaneous glaucomatous beagle dogs

PURPOSE

To date, our knowledge of the canine trabecular meshwork (TM) with regard to contractility is incomplete. It is important to understand the potential contractile capability within the TM and possible changes associated with spontaneous hypertensive glaucoma. To that end we have examined the presence of actin, including smooth muscle (SM) actin, in the normal and glaucomatous canine iridocorneal angle (ICA) morphologically and immunohistochemically.

METHODS

Sections from the ICAs of 12 Beagles with inherited glaucoma (3 months to 6 years old) and age-matched normal Beagles were treated with target retrieval, protein and power blocked and sequentially incubated with the primary antibody (rat anticanine SM actin) and the secondary antibody (rabbit antirat immunoglobulin), followed by peroxidase labeled streptavidin and incubation with substrate-chromogen solution (AEC). Smooth muscle fibers that lined an artery within canine heart tissue were used as positive controls. Separate specimens were prepared for ultrastructual observation.

RESULTS

Ultrastructurally, cells within the inner, posterior region of the corneoscleral TM and outer, posterior region of the uveal TM contained many microfilaments, 6 nm in diameter (i.e. actin). Immunohistochemistry demonstrated that cells within these regions possessed SM actin, having been greatest posteriorly, but extended anteriorly to a lesser extent. In the preglaucomatous affected dog the localization pattern for SM actin was identical to that seen in the normal dogs. With the progression of the disease the pattern disappeared.

CONCLUSIONS

The interior presence of myofibroblastic cells within the canine ICA suggests that these cells and the smooth muscle cells of the ciliary body along the same plane of orientation function to facilitate the removal of aqueous humor and are likely to be influenced by vascular mediators. The contractile apparatus for the ICA in the dog with inherited glaucoma appeared identical to that of the normal dog prior to expression of the disease, but weakened as the disease progressed.

Cycloartanes, protolimonoids, a pregnane and a new ergostane from Trichilia reticulata

The new ergostane steroid ergosta-5,24(24')-diene-3beta,4beta,22R-triol (1), a pregnane, (E)-volkendusin, characterised as the diacetate (3), cycloartanes 4-6 and protolimonoids 7-9 were obtained from the leaves and twigs of Trichilia reticulata.

Expression of BRI-amyloid beta peptide fusion proteins: a novel method for specific high-level expression of amyloid beta peptides

In order to develop transgenic animal models that selectively overexpress various Abeta peptides, we have developed a novel expression system that selectively expresses Abeta40 or Abeta42 in the secretory pathway. This system utilizes fusion constructs in which the sequence encoding the 23-amino-acid ABri peptide at the carboxyl terminus of the 266-amino-acid type 2 transmembrane protein BRI is replaced with a sequence encoding either Abeta40 or Abeta42. Constitutive processing of the resultant BRI-Abeta fusion proteins in transfected cells results in high-level expression and secretion of the encoded Abeta peptide. Significantly, expression of Abeta42 from the BRI-Abeta42 construct resulted in no increase in secreted Abeta40, suggesting that the majority of Abeta42 is not trimmed by carboxypeptidase to Abeta40 in the secretory pathway.