Evaluation of the Safety of Drugs and Biological Products Used During Lactation: Workshop Summary

This report serves as a summary of a 2-day public workshop sponsored by the US Food and Drug Administration (FDA) to discuss the safety of drugs and biological products used during lactation. The aim of the workshop was to provide a forum to discuss the collection of data to inform the potential risks to breastfed infants with maternal use of medications during lactation. Discussions included the review of current approaches to collect data on medications used during lactation, and the considerations for future approaches to design and guide clinical lactation studies. This workshop is part of continuing efforts to raise the awareness of the public for women who choose to breastfeed their infants.

Reliable and developmentally appropriate study end points are needed to achieve drug development for treatment of pediatric pulmonary arterial hypertension

OBJECTIVE

To identify suitable end points and surrogates for pediatric pulmonary arterial hypertension (PAH) as the lack of developmentally appropriate end point and clinical trials contribute to the unmet medical need.

STUDY DESIGN

Reviewed the efficacy end points and surrogates for all trials (1995 to 2013) that were submitted to the Food and Drug Administration (FDA) to support the approval of PAH therapy and conducted literature search.

RESULTS

An increase in the 6 min walking distance (6MWD) was used as a primary end point in 8/9 adult PAH trials. This end point is not suitable for infants and young children because of performance limitations and lack of control data. One adult PAH trial used time to the first morbidity or mortality event as a primary end point, which could potentially be used in pediatric PAH trials. In the sildenafil pediatric PAH trial, the change in pulmonary vascular resistance index or mean pulmonary artery pressure was used as a surrogate for the 6MWD to assess exercise capacity. However, two deaths and three severe adverse events during the catheterizations made this an unacceptably high-risk surrogate. The INOmax persistent pulmonary hypertension of the newborn trial used a reduction in initiation of extracorporeal membrane oxygenation treatment as a primary end point, which is not feasible for other pediatric PAH trials. A Literature review revealed none of the existing noninvasive markers are fully validated as surrogates to assess PAH efficacy and long-term safety.

CONCLUSIONS

For pediatric PAH trials, clinical end points are acceptable, and novel validated surrogates would be helpful. FDA seeks collaboration with academia, industry and parents to develop other suitable and possibly more efficient efficacy end points to facilitate pediatric PAH drug development.

Optimization of drug-like properties of nonsteroidal glucocorticoid mimetics and identification of a clinical candidate

A series of nonsteroidal "dissociated" glucocorticoid receptor agonists was optimized for drug-like properties such as cytochrome P450 inhibition, metabolic stability, aqueous solubility, and hERG ion channel inhibition. This effort culminated in the identification of the clinical candidate compound ( R )-39.

Non-steroidal dissociated glucocorticoid agonists: indoles as A-ring mimetics and function-regulating pharmacophores

We report a SAR of non-steroidal glucocorticoid mimetics that utilize indoles as A-ring mimetics. Detailed SAR is discussed with a focus on improving PR and MR selectivity, GR agonism, and in vitro dissociation profile. SAR analysis led to compound (R)-33 which showed high PR and MR selectivity, potent agonist activity, and reduced transactivation activity in the MMTV and aromatase assays. The compound is equipotent to prednisolone in the LPS-TNF model of inflammation. In mouse CIA, at 30 mg/kg compound (R)-33 inhibited disease progression with an efficacy similar to the 3 mg/kg dose of prednisolone.

Nonsteroidal dissociated glucocorticoid agonists containing azaindoles as steroid A-ring mimetics

Syntheses and structure-activity relationships (SAR) of nonsteroidal glucocorticoid receptor (GR) agonists are described. These compounds contain azaindole moieties as A-ring mimetics and display various degrees of in vitro dissociation between gene transrepression and transactivation. Collagen induced arthritis studies in mouse have demonstrated that in vitro dissociated compounds (R)-16 and (R)-37 have steroid-like anti-inflammatory properties with improved metabolic side effect profiles, such as a reduced increase in body fat and serum insulin levels, compared to steroids.

Parental perception of time and decision-making in neonatal research

OBJECTIVE

To assess the impact of time on parental decision-making for research participation for neonates with congenital heart disease.

STUDY DESIGN

Interviews were conducted with 37 parents of 19 neonates with congenital heart disease who were eligible for three different studies: genetic etiology of congenital heart disease, heart rate variability (HRV) and structural and functional cranial magnetic resonance imaging (MRI). All parents were asked the same questions: (1) 'Did you have adequate time to make a decision about research?' and (2) 'Why?' Differences between groups (reporting adequate and inadequate time) were evaluated using Fisher's exact tests; central themes were examined using qualitative analysis.

RESULT

Of those parents who reported having adequate time to make their decision (22 of 37), the majority chose to participate when compared to those who reported inadequate time (genetics study, P<0.01; HRV, P=0.05; MRI, P<0.01). For the parents reporting inadequate time, consistent themes emerged: insufficient time to make an educated choice (n=10), consideration of study logistics (n=8), spouse not present at the time of decision (n=7) and insufficient time to discuss the studies (n=4).

CONCLUSION

Parental perception of adequate time to decide about research participation was associated with parental willingness to enroll the child in research. Despite any time limitations, parents were satisfied with the decisions they made. Optimizing the time available for the parental permission process could enhance research participation in the neonatal period.

The relationship between skin temperature and neuronal characteristics in the median, ulnar and radial nerves of non-impaired individuals

The purpose of this study was to evaluate the relationship between the nerve conduction characteristics in the median, ulnar and radial nerves and presenting skin temperature in non-impaired individuals as they were subjected to electrophysiological testing. Previous researchers artificially manipulated the skin temperature and demonstrated that there was a positive relationship between temperature and nerve conduction velocity and a negative correlation between distal latency and evoked motor action potential (EMAP). The sample population was 50 non-impaired individuals derived from a venue in the New York City and Long Island region. The independent variable was skin temperature. The dependent variables were: motor nerve conduction velocity, motor distal latency, EMAP of median and ulnar nerves, sensory distal latency and sensory nerve action potential (SNAP) of median, ulnar and radial nerves. The data were analyzed using descriptive statistics, the Bonferroni correction factor and correlation statistics. The study showed significant correlation in median motor distal latency, ulnar motor distal latency, ulnar sensory distal latency, median sensory amplitude, and ulnar sensory amplitude. The NCV, the distal latency and the amplitude of the median, ulnar and radial nerves were similar in values to other researchers' normal values.

Discovery and SAR study of novel dihydroquinoline-containing glucocorticoid receptor agonists

We have recently reported the discovery of a novel class of glucocorticoid receptor (GR) antagonists, exemplified by 3, containing a 1,2-dihydroquinoline molecular scaffold. Further SAR studies of these antagonists uncovered chemical modifications conveying agonist functional activity to this series. These agonists exhibit good GR binding affinity and are selective against other nuclear hormone receptors.

New modifications to the area of pyrazole-naphthyl urea based p38 MAP kinase inhibitors that bind to the adenine/ATP site

Discovery of the pyrazole-naphthyl urea class of p38 MAP kinase inhibitors typified by the clinical candidate BIRB 796 has encouraged further exploration of this particular scaffold. Modification to the part of the inhibitor that occupies the adenine/ATP binding site has resulted in a new way to obtain potent inhibitors that possess favorable in vitro and in vivo properties.

Surface composition of Hyperion

Hyperion, Saturn's eighth largest icy satellite, is a body of irregular shape in a state of chaotic rotation. The surface is segregated into two distinct units. A spatially dominant high-albedo unit having the strong signature of H2O ice contrasts with a unit that is about a factor of four lower in albedo and is found mostly in the bottoms of cup-like craters. Here we report observations of Hyperion's surface in the ultraviolet and near-infrared spectral regions with two optical remote sensing instruments on the Cassini spacecraft at closest approach during a fly-by on 25-26 September 2005. The close fly-by afforded us the opportunity to obtain separate reflectance spectra of the high- and low-albedo surface components. The low-albedo material has spectral similarities and compositional signatures that link it with the surface of Phoebe and a hemisphere-wide superficial coating on Iapetus.

Assay Optimization: A Statistical Design of Experiments Approach

With the transition from manual to robotic HTS in the last several years, assay optimization has become a significant bottleneck. Recent advances in robotic liquid handling have made it feasible to reduce assay optimization timelines with the application of statistically designed experiments. When implemented, they can efficiently optimize assays by rapidly identifying significant factors, complex interactions, and nonlinear responses. This article focuses on the use of statistically designed experiments in assay optimization.

Quinol-4-ones as Steroid A-Ring Mimetics in Nonsteroidal Dissociated Glucocorticoid Agonists

We report on the nuclear receptor binding affinities, cellular activities of transrepression and transactivation, and anti-inflammatory properties of a quinol-4-one and other A-ring mimetic containing nonsteroidal class of glucocorticoid agonists.

Three Mechanistically Distinct Kinase Assays Compared: Measurement of Intrinsic ATPase Activity Identified the Most Comprehensive Set of ITK Inhibitors

Numerous assay methods have been developed to identify small-molecule effectors of protein kinases, but no single method can be applied to all isolated kinases. The authors developed a set of 3 high-throughput screening (HTS)–compatible biochemical assays that can measure 3 mechanistically distinct properties of a kinase active site, with the goal that at least 1 of the 3 would be applicable to any kinase selected as a target for drug discovery efforts. Two assays measure catalytically active enzyme: A dissociation-enhanced lanthanide fluoroimmuno assay (DELFIA) uses an antibody to quantitate the generation of phosphorylated substrate; a second assay uses luciferase to measure the consumption of adenosine triphosphate (ATP) during either phosphoryl-transfer to a peptide substrate or to water (intrinsic ATPase activity). A third assay, which is not dependent on a catalytically active enzyme, measures the competition for binding to kinase between an inhibitor and a fluorescent ATP binding site probe. To evaluate the suitability of these assays for drug discovery, the authors compared their ability to identify inhibitors of a nonreceptor protein tyrosine kinase from the Tec family, interleukin-2-inducible T cell kinase (ITK). The 3 assays agreed on 57% of the combined confirmed hit set identified from screening a 10,208-compound library enriched with known kinase inhibitors and molecules that were structurally similar. Among the 3 assays, the one measuring intrinsic ATPase activity produced the largest number of unique hits, the fewest unique misses, and the most comprehensive hit set, missing only 2.7% of the confirmed inhibitors identified by the other 2 assays combined. Based on these data, all 3 assay formats are viable for screening and together provide greater options for assay design depending on the targeted kinase.

Composition and Physical Properties of Enceladus' Surface

Observations of Saturn's satellite Enceladus using Cassini's Visual and Infrared Mapping Spectrometer instrument were obtained during three flybys of Enceladus in 2005. Enceladus' surface is composed mostly of nearly pure water ice except near its south pole, where there are light organics, CO2, and amorphous and crystalline water ice, particularly in the region dubbed the "tiger stripes." An upper limit of 5 precipitable nanometers is derived for CO in the atmospheric column above Enceladus, and 2% for NH3 in global surface deposits. Upper limits of 140 kelvin (for a filled pixel) are derived for the temperatures in the tiger stripes.

Discovery and SAR study of novel dihydroquinoline containing glucocorticoid receptor ligands

We report the discovery of a novel class of glucocorticoid receptor (GR) ligands based on 1,2-dihydroquinoline molecular scaffold. The compounds exhibit good GR binding affinity and selectivity profile against other nuclear hormone receptors.

Trifluoromethyl group as a pharmacophore: Effect of replacing a CF3 group on binding and agonist activity of a glucocorticoid receptor ligand

Compound 1, a potent glucocorticoid receptor ligand, contains a quaternary carbon bearing trifluoromethyl and hydroxyl groups. This paper describes the effect of replacing the trifluoromethyl group on binding and agonist activity of the GR ligand 1. The results illustrate that replacing the CF3 group with a cyclohexylmethyl or benzyl group maintains the GR binding potency. These substitutions alter the functional behavior of the GR ligands from agonists to antagonists. Docking studies suggest that the benzyl analog 19 binds in a similar fashion as the GR antagonist, RU486. The central benzyl group of 19 and the C-11 dimethylaniline moiety of RU486 overlay. Binding of compound 19 is believed to force helix 12 to adopt an open conformation and this leads to the antagonist properties of the non-CF3 ligands carrying a large group at the center of the molecule.

Release of volatiles from a possible cryovolcano from near-infrared imaging of Titan

Titan is the only satellite in our Solar System with a dense atmosphere. The surface pressure is 1.5 bar (ref. 1) and, similar to the Earth, N2 is the main component of the atmosphere. Methane is the second most important component, but it is photodissociated on a timescale of 10(7) years (ref. 3). This short timescale has led to the suggestion that Titan may possess a surface or subsurface reservoir of hydrocarbons to replenish the atmosphere. Here we report near-infrared images of Titan obtained on 26 October 2004 by the Cassini spacecraft. The images show that a widespread methane ocean does not exist; subtle albedo variations instead suggest topographical variations, as would be expected for a more solid (perhaps icy) surface. We also find a circular structure approximately 30 km in diameter that does not resemble any features seen on other icy satellites. We propose that the structure is a dome formed by upwelling icy plumes that release methane into Titan's atmosphere.

What factors are important to parents making decisions about neonatal research?

BACKGROUND

Although parents of neonates with congenital heart disease are often asked permission for their neonates to participate in research studies, little is known about the factors parents consider when making these decisions.

OBJECTIVE

To determine the reasons for parents' decisions about participation in research studies.

METHODS

Qualitative analysis of the unsolicited comments of 34 parents regarding reasons for agreeing or declining to participate in research studies. Parents' comments were offered spontaneously during interviews about clinical care decisions for neonates with congenital heart disease.

RESULTS

Parents cited five types of reason for or against permitting their newborn to participate in research studies: societal benefit (n = 18), individual benefit for their infant (n = 16), risk of study participation (n = 10), perception that participation posed no harm (n = 9), and anti-experimentation views (n = 4).

CONCLUSION

Addressing parental decision making in the light of these reasons could enhance the parental permission process for parents of critically ill neonates.

Neuronal conduction studies of the median nerve in non-impaired humans: a comparison of accepted techniques

BACKGROUND AND PURPOSE

There are two commonly accepted techniques used for distal electro-stimulation placement when performing median motor nerve conduction studies. The purpose of this study was to compare latency using two commonly accepted sites of distal stimulation of the median nerve when performing motor nerve conduction studies on non-impaired adult humans.

PARTICIPANTS

The sample consisted of 36 non-impaired participants (15 female, 21 male) aged 20 to 40 years.

METHODS

Participants were randomly assigned to two groups and tested bilaterally for the median motor nerve. For distal stimulation of the median motor nerve, in the first group, 8 cm was measured from the center of the muscle diagonally to arrive at a point between the flexor carpi radialis and plamaris longus tendons. In the second group, 3.5 cm was measured from the distal wrist crease proximally along the median nerve for the distal stimulation of the median motor nerve. Distal latency of both techniques was obtained. Surface skin temperature of the palm was recorded throughout the procedures.

RESULTS

No significant differences were found between the 8 cm and 3.5 cm techniques at p < or = 0. 05 level.

COMMENT

Even though no differences were found between the two techniques, the 3.5-cm technique is recommended because of its consistency as an anatomical landmark reducing the potential for measurement error.

Comparison of motor unit action potentials using monopolar vs. concentric needle electrodes in the middle deltoid and abductor digiti minimi muscles

Electromyography readings are analyzed noting abnormalities in the parameters of amplitude, duration, and number of phases. Previous studies have demonstrated variability between monopolar needle electrodes (MNEs) and concentric needle electrodes (CNEs) in regard to the above parameters. We hypothesized that a difference in measured parameters would be observed due to the physical differences between the needles. Twenty-three subjects participated in this study. Five readings were recorded from the middle deltoid and the abductor digiti minimi muscles using the MNE, and five readings were recorded using the CNE. A minimal isometric contraction of the tested muscle in the subjects dominant arm was performed. A significant difference was found in amplitudes recorded by the MNE and CNE in both muscles. A significant difference was found in the ADM, and not in the deltoid, with regard to duration. The difference found in the number of phases was clinically insignificant.

DISCUSSION

The MNE detected larger amplitudes and durations because of its larger recording territory. The duration may also be affected by the distance between the active/reference electrodes.

Comparison of motor unit action potential characteristics and hand dominance using monopolar needle electrodes in the abductor pollicis brevis and abductor digiti minimi muscles

This study examined specific electrical characteristics of voluntary single motor unit action potentials (SMUAPs): amplitude, duration, phase change, and rate of rise. These characteristics, which were detected from two intrinsic muscles of the hand--the abductor pollicis brevis and the abductor digiti minimi--were compared to hand dominance. Forty subjects participated in the study. Five characteristics were detected from each muscle using the quadrant technique while the subject produced a minimal isometric contraction. Based on results of an ANOVA [two-factor with replication] test, our study revealed no significant difference between muscles in the dominant and non-dominant hands. Descriptive statistics for each muscle characteristic are presented. This study has identified parameters for SMUAP characteristics detected in non-impaired individuals ranging in age from 20 to 43 years. The normative parameters serve as a valuable base from which one may examine potential neuronal damage from cumulative trauma disorders.

Observations of comet 19P/Borrelly by the miniature integrated camera and spectrometer aboard Deep Space 1

The nucleus of the Jupiter-family comet 19P/Borrelly was closely observed by the Miniature Integrated Camera and Spectrometer aboard the Deep Space 1 spacecraft on 22 September 2001. The 8-kilometer-long body is highly variegated on a scale of 200 meters, exhibiting large albedo variations (0.01 to 0.03) and complex geologic relationships. Short-wavelength infrared spectra (1.3 to 2.6 micrometers) show a slope toward the red and a hot, dry surface (</=345 kelvin, with no trace of water ice or hydrated minerals), consistent with approximately 10% or less of the surface actively sublimating. Borrelly's coma exhibits two types of dust features: fans and highly collimated jets. At encounter, the near-nucleus coma was dominated by a prominent dust jet that resolved into at least three smaller jets emanating from a broad basin in the middle of the nucleus. Because the major dust jet remained fixed in orientation, it is evidently aligned near the rotation axis of the nucleus.

Handling ethical conflicts in the clinical setting

Ethical conflict in the clinical setting generally arises in situation of uncertainty, ambiguity, and complexity. This report discusses 4 cases of conflict between clinicians, between clinicians and patient, and between clinicians and family. Presented in enough detail for the reader to appreciate the extent and nature of the conflict, these cases are difficult and in many ways unresolved. Some conflicts may be inevitable and would not be prevented by even the most conscientious clinician. The authors discuss various approaches and resources that may prevent or ameliorate conflict. However, no easy answers are offered, but the importance of open communication of differing viewpoints in an atmosphere of trust and respect are emphasized.

The interaction of AR-A008055 and its enantiomers with the GABA(A) receptor complex and their sedative, muscle relaxant and anticonvulsant activity

AR-A008055 [(+/-)-1-(4-methyl-5-thiazolyl)-1-phenylmethylamine] is structurally related to clomethiazole and has been used to probe the mechanism of the neuroprotective effect of clomethiazole. Clomethiazole, (+/-)-AR-A008055 and (S)-(-)-AR-A008055 all displaced [35S]-t-butyl-bicyclophosphorothionate ([35S]TBPS) from rat cerebral cortex tissue (IC50 values: GABA, 8.1+/-0.04 microM; clomethiazole, 130+/-30 microM; (+/-)-AR-A008055, 494+/-7 microM; (S)-(-)-AR-A008055, 221+/-14 microM. (R)-(+)-AR-A008055 was without significant effect (IC50>1000 microM). None of the compounds interacted with NMDA or AMPA receptors or with sodium or calcium (N, P/Q) channels. Brain penetration of both enantiomers following their i.p. administration was excellent, with brain and plasma concentrations being similar. Clomethiazole dose-dependently inhibited spontaneous locomotor activity in rats and was approximately 10 times more sedative than either enantiomer of AR-A008055. Clomethiazole was more potent than (S)-(-)-AR-A008055 in the "pull-up" test (muscle relaxation) and in producing loss of righting reflex, while (R)-(+)-AR-A008055 had little effect. The time animals remained on a Rota-rod was of the order: clomethiazole<(S)-(-)-AR-A008055<(R)-(+)-AR-A008055. (S)-(-)-AR-A008055 (210 micromol/kg) raised seizure threshold to pentylenetetrazole (i.v.) by 119+/-21%. The (R)-(+)- enantiomer was not anticonvulsant. Overall, (S)-(-)-AR-A008055 exhibited a similar pharmacology to clomethiazole. However, its sedative and muscle relaxant effects were substantially less than clomethiazole, emphasising that these properties are not directly related to neuroprotective efficacy. The current data suggest that the proposed GABA uptake inhibitory property of (R)-(+)-AR-A008055 fails to produce significant sedative, myorelaxant or anticonvulsant activity.

Neuroprotective efficacy of AR-A008055, a clomethiazole analogue, in a global model of acute ischaemic stroke and its effect on ischaemia-induced glutamate and GABA efflux in vitro

We have investigated the neuroprotective properties of AR-A008055 [(+/-)-1-(4-methyl-5-thiazolyl-1-phenyl-methylamine], a novel compound structurally related to clomethiazole. Administration (i.p.) of (+/-)-AR-A008055 60 min after 5 min of global cerebral ischaemia in gerbils produced a dose-dependent protection of the hippocampus from damage. Both enantiomers [(R)-(+)-AR-A008055 and (S)-(-)- AR-A008055] at 600 micromol/kg produced similar protection to that following clomethiazole (600& micromol/kg) and both produced similar and sustained neuroprotection, at 4, 7 and 21 days post-insult. When infused intravenously over a 2-h period, both enantiomers produced concentration-dependent neuroprotection, with the enantiomers providing similar protection at every plasma concentration (50-200 nmol/ml). The efficacy of (S)-(-)-AR-A008055 was similar to clomethiazole, but it was slightly less potent. Ischaemia-induced glutamate efflux from rat brain cortical prisms in vitro was inhibited by both isomers (100 microM). The inhibitory effect of (R)-(+)-AR-A008055 was blocked by bicuculline (10 microM) and picrotoxin (100 microM), while the effect of (S)-(-)-AR-A008055 was only antagonised by picrotoxin. This indicated that (S)-(-)-AR-A008055, like clomethiazole, is able to open the GABA(A)-chloride channel in the absence of endogenous GABA. (R)-(+)-AR-A008055 was more potent than (S)-(-)-AR-A008055 in enhancing the concentration of GABA in the medium following 30 min exposure of tissue to the ischaemic conditions, suggesting that it is an effective GABA uptake inhibitor. This action may explain both its effect on glutamate efflux in vitro and its neuroprotective effect in vivo.

Effects of asphyxia on telencephalic microvessels of premature beagle pups

The authors identified alterations in the brain microvasculature of the premature Beagle pup that could be attributed to asphyxia and potentially associated with the etiology of intraventricular hemorrhage (IVH). Beagle pups were delivered by cesarean section six days before their predicted whelping date and exposed to an alternating protocol of asphyxial episodes known to produce IVH. Data from the telencephalic microvasculature at both the germinal matrix (an area susceptible to IVH) and the borderzone cerebral cortex (an area rarely involved in hemorrhage) were analyzed. The germinal matrix microvessels responded differently to asphyxia than the cortical vessels. The germinal matrix microvessels maintained junctional complexes and intraluminal microvilli, and increased in cross-sectional luminal area following asphyxia; however, total vessel cross-sectional area did not change. After the asphyxial insult, cortical microvessels no longer exhibited intraluminal microvilli and increased in both total cross-sectional area and luminal area. The number of junctional complexes in cross-sections of cortical vessels was significantly reduced due at least in part to the narrowing of the endothelial cell lateral borders. The data provide indirect evidence to substantiate vasodilation speculated to be due to an increased cerebral blood flow to telencephalic vessels (both the germinal matrix and cerebral cortex) following asphyxia. The data also suggest differential rates of maturation between germinal matrix and cortical microvessels.

Buffer zones promoting oligotrophication in golf course runoffs: fiddler crabs as estuarine health indicators

Nitrogen pollution above a threshold level induces a eutrophication process in coastal creek ecosystems and consequently impacts on the water quality. The remedy for this scenario is the introduction of methods to enhance oligotrophication by means of constructed wetlands and buffer zones. This paper discusses new data on nitrogen flux and population changes in the primary consumers in the Bradley Creek ecosystem, adjacent to the Duck Haven Golf Course in southeastern North Carolina. In 1998-99, over different seasons, density distribution of the field populations of the fiddler crab Uca minax, was monitored as an indicator of environmental health. A control site at Whiskey Creek, adjacent to the University Center for Marine Sciences, was monitored in the same period since this site is not influenced by any golf course nutrient flux. The results pointed out that threshold level for optimum population density in Spartina grandiflora salt marsh is 0.1 mg/L of nitrates. A dense crab population, adjacent to the golf course with a buffer zone, was indicative of restoration of the estuarine ecosystem. A model, involving the use of constructed wetlands for oligotrophication, is being prepared on the basis of studies conducted by the University of South Alabama for a stormwater wetland constructed adjacent to the university's golf course.

Treatment of a molasses based distillery effluent in a constructed wetland in central India

A field-scale 4-celled, horizontal subsurface constructed wetland (CW) was installed to evaluate removal efficiencies of wastewater constituents in an industrial distillery effluent. Total and dissolved solids, NH4-N, TKN, P and COD were measured. This CW design provides four serial cells with synthetic liners and a river gravel base. The first two unplanted cells provide preliminary treatment. Specific gravel depths and ensuing biofilm growth provides anaerobic treatment in Cell 1 and anaerobic treatment in Cell 2. Cell 3 was planted with Typha latifolia with an inserted layer of brick rubble (for phosphorus removal). Locally grown reed, Phragmites karka was planted in Cell 4. COD was reduced from 8420 mg/l 3000 from Cell 1 to the outlet of Cell 4. Likewise other parameters: total and dissolved solids, ammonium and total nitrogen, and total P, indicated declining trends at the 4-celled CW effluent. This study reveals how high strength distillery wastewater strongly impacts morphology, aeration anatomy in the chiseled plant tissues, reed growth; and composition of the biofilm in the specialized substratum. The reliability of a CW for organic and nutrients reduction, in association with a poorly performing conventional system is discussed. There is an immense potential for appropriately designed constructed wetlands to improve high strength wastewaters in India.

Nociceptin/orphanin FQ inhibits ischaemia-induced glutamate efflux from rat cerebrocortical slices

Nociceptin/orphanin FQ (NC), the endogenous ligand for the G-protein coupled nociceptin receptor (NCR), has a modulatory role in various physiological processes including neurotransmitter release. We have examined the effects of NC, the analogues NC(1-13)NH2 and [F/G]NC(1-13)NH2 and the competitive antagonist [Nphe1]NC(1-13)NH2 (Nphe1) on glutamate efflux during an acute simulated ischaemic challenge in rat cerebrocortical slices. The increase in glutamate efflux seen with ischaemia was inhibited by NC (EC50 250 nM). At micromolar concentrations, the analogues were found to have a similar effect on glutamate efflux compared to NC. In all cases, inhibition of glutamate efflux was abolished by Nphe1 (30 microM). These results suggest a neuroprotective action for NC.

Meal fatty acid uptake in adipose tissue: gender effects in nonobese humans

We tested for gender differences in dietary fatty acid metabolism in 12 nonobese men and 12 nonobese women using the meal fatty acid tracer/adipose tissue biopsy study design. In addition to determining body composition, measurements of regional adipose tissue lipoprotein lipase activity, blood flow, and fat cell size were performed to place the meal fatty acid kinetic studies in perspective. Twenty-four hours after ingesting the test meal, the concentration of meal fatty acids was greater (P < 0.05) in abdominal subcutaneous than in thigh adipose tissue in both men (0. 61 +/- 0.12 vs. 0.45 +/- 0.09 mg/g) and women (0.59 +/- 0.10 vs. 0. 43 +/- 0.05) but was not different between men and women. A greater percentage of dietary fat was stored in subcutaneous adipose tissue in women than in men (38 +/- 3 vs. 24 +/- 3%, respectively, P < 0. 05), and a greater portion of meal fatty acid disposal was unaccounted for in men. Significant gender differences in regional adipose tissue blood flow after meal ingestion were noted; the differences were in the direction that could support greater nutrient storage in lower body fat in women.

Meal fatty acid uptake in human adipose tissue: technical and experimental design issues

The adipose tissue uptake of dietary fat has been studied using fatty acid radiotracers incorporated into a meal, followed by adipose tissue biopsies. A number of experimental design issues, including the use of isotopic tracers to measure meal fatty acid oxidation and plasma appearance of tracer, as well as the heterogeneity of adipose tissue fatty acid uptake, have been addressed. We examined these questions in a study of 24 volunteers (12 men and 12 women) who consumed a meal containing [(3)H]triolein and [(14)C]triolein. Slight differences in the purity of [(3)H]triolein vs. [(14)C]triolein were found, which could affect the apparent adipose tissue uptake of meal fatty acids. The adipose tissue triglyceride specific activity from bilateral biopsy sites agreed well, implying that a unilateral biopsy is satisfactory for measuring tracer uptake. Meal fatty acid oxidation measured using [(3)H]triolein and [(14)C]triolein was well correlated (r = 0.79, P < 0.0001). The peak tracer appearance in plasma chylomicrons occurred 1 h after the ingestion of a second, unlabeled meal. Our findings have implications for the experimental design of future meal fatty acid tracer/adipose tissue biopsy studies.

On the regulation of ischaemia-induced glutamate efflux from rat cortex by GABA; in vitro studies with GABA, clomethiazole and pentobarbitone

Prisms of adult rat cortex were maintained in vitro in either aerobic conditions (control) or conditions simulating an acute ischaemic challenge (hypoxia with no added glucose). Endogenous glutamate efflux increased with time in ischaemic conditions, being 2.7 fold higher than control efflux at 45 min. Returning prisms to control solution after 20 min of simulated ischaemia resulted in glutamate efflux returning to near-control values. Endogenous GABA efflux in ischaemic conditions also increased, being 4.5 fold higher than control efflux at 45 min. Ischaemia-induced glutamate efflux was not accompanied by increased lactate dehydrogenase efflux and was unaltered by omitting calcium from the extra-cellular solution and adding EGTA (0.1 mM). Both GABA and the GABA-mimetic clomethiazole inhibited ischaemia-induced glutamate efflux, with IC(50) values of 26 and 24 microM respectively. The maximum inhibition by either drug was 60 - 70%. Bicuculline (10 microM) abolished the inhibitory effect of GABA (100 microM) but not clomethiazole (100 microM). Picrotoxin (100 microM) abolished the action of both GABA and clomethiazole. Pentobarbitone inhibited glutamate efflux at 100 - 300 microM (maximal inhibition: 39%). Bicuculline (10 microM) abolished this effect. These data suggest that ischaemia-induced glutamate efflux from rat cerebral cortex is calcium-independent and not due to cell damage up to 45 min. The inhibitory effect of GABA, clomethiazole and pentobarbitone on ischaemia-induced glutamate efflux appears to be mediated by GABA(A) receptors. The results suggest that clomethiazole, unlike pentobarbitone, is able to activate the GABAA receptor-linked chloride channel directly and not merely potentiate the effect of endogenous GABA.

The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain

STUDY DESIGN

A correlative design using stepwise regression analysis.

OBJECTIVE

To explore the variation in spinal isometric strength that can be accounted for by anticipation of pain, sensory perception of pain, functional disability belief, and the fear-avoidance belief in chronic low back pain patients.

SUMMARY OF THE BACKGROUND DATA

Several biobehavioral factors contribute to the persistence of pain behavior in chronic patients. Recent studies suggest a need to explore the relation between reduced physical performance and the sensory and cognitive perception of pain.

METHODS

Sixty-three patients with chronic low back pain 20 to 56 years of age participated in this study. Visual Analogs Scales, the Fear-Avoidance Belief questionnaire, and the Disability Belief questionnaire were used to measure the sensory and cognitive dimensions of pain. Spinal isometric strength was measured by the Medx lumbar extension machine.

RESULTS

Analysis of variance and the stepwise regression analysis demonstrated that anticipation of pain and the fear-avoidance belief about physical activity significantly predicted variation in the spinal isometric strength deficit P < 0. 001. True pain experienced during the testing and answers to the Disability Belief questionnaire were not related.

CONCLUSION

The results of this study strongly support the hypothesis that spinal physical capacity in chronicity is not explained solely by the sensory perception of pain. The anticipation of pain and the fear-avoidance belief about physical activities were the strongest predictors of the variation in physical performance.

Variability in physician opinion on limiting pediatric life support

OBJECTIVE

We conducted this study to investigate how physicians in a pediatric intensive care unit (ICU) currently make decisions to withdraw and withhold life support. Consultation with the patient's primary caregiver often precedes decisions about withdrawal and limitation of life support in chronically ill patients. In these scenarios, the patient's primary caregiver was the pediatric oncologist. To evaluate the influence of subspecialty training, we compared the attitudes of the pediatric intensivists and the oncologists using scenarios describing critically ill oncology patients.

DESIGN

Cross-sectional survey. Each physician was randomly assigned 4 of 8 potential case scenarios.

SETTING

A total of 29 American pediatric ICUs.

PARTICIPANTS

Pediatric intensive care and oncology attendings and fellows.

INTERVENTION

Systematic manipulation of patient characteristics in two hypothetical case scenarios describing 6-year-old female oncology patients presenting to the ICU after the institution of mechanical ventilator support for acute respiratory failure. Cases 1 through 4 described a patient who, before admission, had a 99% projected 1-year probability of survival from her underlying cancer and suffered from severe neurologic disabilities. Cases 5 through 8 described a patient who was neurologically normal before admission and had a <1% chance of surviving longer than 1 year because of her underlying cancer. Each physician was randomly assigned 2 cases from cases 1 through 4 and 2 cases from cases 5 through 8. Within each of these case scenarios, parental preferences (withdraw or advance support or look for guidance from the caregivers) and probability of survival (5% vs 40%) were manipulated. Before distribution, the survey instrument was pilot-tested and underwent a rigorous assessment for clinical sensibility.

PRIMARY OUTCOME MEASURES

Physicians ratings of the importance of 10 factors considered in the decision to withdraw life support, and their decisions about the appropriate level of care to provide. Respondents were offered five management options representing five levels of care: 1) discontinue inotropes and mechanical ventilation but continue comfort measures; 2) discontinue inotropes and other maintenance therapy but continue mechanical ventilation and comfort measures; 3) continue with current management but add no new therapeutic intervention; 4) continue with current management, add additional inotropes, change antibiotics and the like as needed, but do not start dialysis; and 5) continue with full aggressive management and plan for dialysis if necessary. Respondents also were asked whether they would obtain an ethics consultation.

RESULTS

A total of 270 physicians responded to our survey (165 of 198 potentially eligible pediatric intensivists and 105 of 178 pediatric oncologists for response rates of 83% and 59%, respectively). The respondents considered the probability of ICU survival and the wishes of the parents regarding the aggressiveness of care most important in the decision to limit life-support interventions. No clinically important differences were found when the responses of oncologists were compared with those of intensivists. In six of eight possible scenarios, the same level of intensity of care was chosen by less than half of all respondents. In three scenarios, >/=10% of respondents chose full aggressive management as the most appropriate level of care, whereas another >/=10% chose comfort measures only when viewing the same scenario. The most significant respondent factors affecting choices were professional status (attending vs fellow) and the self-rated importance of functional neurologic status. The majority of respondents (83%) believed that the intensive care and the oncology staff were usually in agreement at their institution about the level of intervention to recommend to the parents. (ABSTRACT TRUNCATED)

Variations on an Expectancy-Value Model of Motivation in Science

Relationships among motivational variables from goal theory and expectancy-value theory were investigated in this correlational study of high school students. Self-report surveys of motivation in science were collected during biology classes from 69 males and 80 females. Outcome measures were effort, persistence, and achievement. Gender differences were noted in the pattern of zero-order correlations. Internal motivation variables were related to achievement in males but not females. Regression analyses indicated that the motivation variables explained large proportions of variance in the outcomes. However, the contribution of individual variables differed by gender. Most notable was perceived ability, which contributed significantly to predicting outcome measures for females but not males. Findings suggest that interventions may need to focus on different motivational aspects depending on gender. Copyright 1999 Academic Press.

Detection system for reaction-rate analysis in a low-volume proteinase-inhibition assay

High-throughput screening of large combinatorial chemical libraries in biochemical assays will benefit from reduced reagent volume and increased speed of measurement. Standard assays typically are performed in 96-well microtiter plates having 200-microL well volumes and up to an hour of incubation time. In this paper, we demonstrate a technique for precise and rapid measurement of the progress of an enzymatic reaction and its inhibition with reduced volume and time (for this work, the assay was mixed at the 200-microL level and detected in 2-microL volumes with minutes of total assay time). Directly measuring the enzyme activity in the small volume format yields a precise value for the median inhibitory concentration (IC50) of an inhibitor compound. The model assay is the endoproteolytic cleavage of a small fluorogenic peptide by human neutrophil collagenase (MMP-8). The fluorogenic peptide was labeled at one end with a UV/blue fluorophore (N-methylanthranilyl) and at the other end with a quencher (dinitrophenol). To generate inhibition data, a hydroxamate peptide analog inhibitor of collagenase, actinonin, was included in the reaction. The experiments were performed using ultraviolet laser illumination (325 nm wavelength) and parallel fluorescence detection by a cooled, charge-coupled-device camera system to increase sensitivity and speed. The assay volume was reduced to 2 microL for data collection, and the total time for mixing, incubation, and measurement was less than 6 min. For comparison to a standard format, the same assay was performed in a 96-well microtiter plate in 200 microL using 30 min of incubation and measurement in a microtiter plate fluorimeter. Median inhibitory concentrations (IC50) for actinonin of 73 +/- 16 and 100 +/- 14 nM were obtained in the 2- and 200-microL assays, respectively. One concern with assay miniaturization and increases in throughput is a potential loss of precision and accuracy. Laser excitation and parallel detection of fluorescence is a promising approach for increased speed and reduced cost without loss of precision for proteinase inhibition assays.

Functional aspects of skeletal muscle contractile apparatus and sarcoplasmic reticulum after fatigue

This study examined the effects of fatigue on the functional aspects of the contractile apparatus and sarcoplasmic reticulum (SR). Frog semitendinosus muscles were stimulated to fatigue, and skinned fibers or a homogenate fraction was prepared from both fatigued and rested contralateral muscles. In fatigued fibers, maximal Ca2+-activated force of the contractile apparatus was unaltered, whereas maximal actomyosin-ATPase activity was depressed by 20%. The Ca2+ sensitivity of force was increased, whereas that of actomyosin-ATPase was not altered. Also, the rate constant for tension redevelopment was decreased at submaximal Ca2+ concentration. These latter findings suggest that fatigue slows the dissociation of force-generating myosin cross bridges. Ca2+ uptake and Ca2+-ATPase activity of the SR were depressed by 46 and 21%, respectively, in the fatigued muscles. Fatigue also reduced the rates of SR Ca2+ release evoked by AgNO3 and 4-chloro-m-cresol by 38 and 45%, respectively. During fatigue, the contractile apparatus and SR undergo intrinsic functional alterations. These changes likely result in altered force production and energy consumption by the intact muscle.

Interaction of secretory leukocyte protease inhibitor with heparin inhibits proteases involved in asthma

Protease inhibition by secretory leukocyte protease inhibitor (SLPI) is accelerated by the sulfated polysaccharides. The nature of the SLPI-polysaccharide interaction, explored with affinity chromatography, indicated that this interaction was sensitive to the charge and type of polysaccharide. Dextran and chondroitin had the lowest affinity for SLPI, followed by dermatan, heparan, and dextran sulfates. While heparin bound SLPI tightly, the highest affinity heparin chains unexpectedly contained a lower level of sulfation than more weakly interacting chains. Heparin oligosaccharides, prepared using heparin lyase I were SLPI-affinity fractionated. Surprisingly, undersulfated heparin oligosaccharides bound SLPI with the highest affinity, suggesting the importance of free hydroxyl groups for high affinity interaction. Isothermal titration calorimetry was used to determine the thermodynamics of SLPI interaction with a low molecular weight heparin, an undersulfated decasaccharide and a tetrasaccharide. The studies showed 12-14 saccharide units, corresponding to molecular weight of approximately 4,800, were required for a 1:1 (SLPI:heparin) binding stoichiometry. Furthermore, an undersulfated decasaccharide was able to bind SLPI tightly (Kd approximately 13 nM), resulting in its activation and the inhibition of neutrophil elastase and pancreatic chymotrypsin. The in vitro assessment of heparin and the decasaccharide and tetrasaccharide using stopped-flow kinetics suggested that heparin was the optimal choice to study SLPI-based in vivo protease inhibition. SLPI and heparin were co-administered by inhalation in therapy against antigen-induced airway hyperresponsiveness in a sheep bronchoprovocation model. Heparin, in combination with SLPI demonstrated in vivo efficacy reducing early and late phase bronchoconstriction. Heparin also increased the therapeutic activity of SLPI against antigen-induced airway hyperresponsiveness.