Utility of in vivo metabolomics to support read-across for UVCB substances under REACH

Structure-based grouping of chemicals for targeted testing and read-across is an efficient way to reduce resources and animal usage. For substances of unknown or variable composition, complex reaction products, or biological materials (UVCBs), structure-based grouping is virtually impossible. Biology-based approaches such as metabolomics could provide a solution. Here, 15 steam-cracked distillates, registered in the EU through the Lower Olefins Aromatics Reach Consortium (LOA), as well as six of the major substance constituents, were tested in a 14-day rat oral gavage study, in line with the fundamental elements of the OECD 407 guideline, in combination with plasma metabolomics. Beyond signs of clinical toxicity, reduced body weight (gain), and food consumption, pathological investigations demonstrated the liver, thyroid, kidneys (males only), and hematological system to be the target organs. These targets were confirmed by metabolome pattern recognition, with no additional targets being identified. While classical toxicological parameters did not allow for a clear distinction between the substances, univariate and multivariate statistical analysis of the respective metabolomes allowed for the identification of several subclusters of biologically most similar substances. These groups were partly associated with the dominant (> 50%) constituents of these UVCBs, i.e., indene and dicyclopentadiene. Despite minor differences in clustering results based on the two statistical analyses, a proposal can be made for the grouping of these UVCBs. Both analyses correctly clustered the chemically most similar compounds, increasing the confidence that this biological approach may provide a solution for the grouping of UVCBs.

Fluorescence based cell counting in collagen monolayer cultures of primary hepatocytes

Accurate determination of cell number is essential for the quantitative description of biological processes. The changes should be related to a measurable reference e.g. in the case of cell culture, the viable cell number is a very valuable reference parameter. Indirect methods of cell number/viability measurements may have up to 10 % standard deviation. This can lead to undesirable large deviations in the analysis of "-omics" data as well as time course studies. Such data should be preferably normalized to the exact viable cell number at a given time to allow meaningful interpretation and understanding of the biological processes. Manual counting of cell number is very laborious and not possible in certain experimental setups. We therefore, developed a simple and reliable fluorescence based method with an accuracy of 95-98 % for the determination of the viable cell number in situ. We optimized the seeding cell densities for primary rat hepatocytes for optimal cell adhesion. This will help in efficient use of primary cells which are usually limited in availability. The method will be very useful in the application of "-omics" techniques, especially metabolome analysis where the specific rates of uptake/production of metabolites can be reliably calculated.

C rossmodal agnosia for familiar people as a consequence of right infero polar temporal atrophy

A 60-year-old, right-handed woman, with no focal brain lesions, suffered from a progressive impairment in recognising people of personal relevance and public figures familiar to her in the premorbid period. The patient did not suffer from general cognitive deterioration. There was no ecological or clear psychometric evidence of visuoperceptual or visuospatial deficits. Her defective person recognition was not overcome by extra-facial (e.g., observing animated people in their usual surroundings) or extra-visual information (e.g., listening to the voice). Moreover, presenting the correct name in the presence of an unrecognised familiar person failed to prompt her familiarity judgement, or retrieval of the relevant biographical knowledge. The patient also had some recognition difficulties with famous buildings and songs as well as with some common objects. It is argued that the patient's difficulty in identifying familiar people was the consequence of progressive loss of stored exemplars of familiar persons and perhaps also of some other "unique items" (famous songs and monuments) in an independent subsystem of semantics that we term "exemplar semantics." We discuss the associative (semantic) nature and specificity of the deficit in person knowledge, the possible top-down negative influences of the loss of exemplars in the person recognition system, and the link between the disorders and the right/left temporal lobe.

Occupational physicians' perceptions and impact of 2009 GMC consent guidelines

BACKGROUND

In 2009, the General Medical Council (GMC) updated its guidance on consent, introducing a new statement that employees should be offered the opportunity to view reports, before the reports are sent to the employer.

AIMS

To investigate the effects of this change on the perceptions and practice of occupational physicians.

METHODS

A cross-sectional survey of UK occupational physicians via the Society of Occupational Medicine e-newsletter, seeking their opinions of the anticipated and actual effects of the guidance on employers, employees, occupational physicians and occupational health services.

RESULTS

Two hundred and ninety-five completed questionnaires were returned (estimated response rate 30%). Respondents included 25% of accredited UK specialists. Some reported improved standards and greater transparency, however the change was generally perceived as unfavourable, with employee and employer losses: 50% reported delay providing timely advice to employers and 35% reported delays in employees returning to work. Significant variation in practice and increased costs were reported, with variable effects on different services. Difficulties in areas such as pensions and health surveillance were reported. Some occupational physicians had moved to instant reporting; others had moved away from this to allow more care with wording of reports.

CONCLUSIONS

We found significant variations in practice between occupational physicians and concerns of employee and employer losses as a result of changes to the GMC consent guidance. Clearer guidance on practical implementation was desired. The background ethical reasoning should be stated so that the parameters of the guidance are delineated and its reach should be clarified.

Role of DHEA and growth factors in chromaffin cell proliferation

Dehydroepiandrostreone (DHEA) is a neuroactive steroid produced by the inner layer of the adrenal cortex close to the adrenomedullary cells. Chromaffin cell growth and proliferation are under the control of insulin-like growth factor II (IGF-II) and basic fibroblast growth factor (bFGF). The aim of the present study was to examine the role of DHEA on chromaffin cell proliferation induced by IGF-II and bFGF. In our model, DHEA significantly decreased IGF-II-induced proliferation by 48.7%, whereas it did not affect the proliferation induced by bFGF. These data suggest that DHEA exerts a paracrine function in the control of chromaffin cell growth.

[Disease Management Program for diabetes mellitus type 2: cooperation or resistance of the general practitioner]

AIM

of the study was to seize the attitudes of General Practitioners (GPs) towards the disease management program (DMP) for type 2 diabetes implemented in summer 2003 in Germany. Moreover we were interested in the way GPs realise the program in daily practice, e. g. how many patients and which patients they include.

METHOD

A postal questionnaire was sent twice to all GPs in the region of Hamburg (n = 1.230), in November 2003 and in December 2004. Response rate without reminder was 20 respective 16 percent.

RESULTS

In 2004 81 percent of the GPs taking part in the survey participate in the DMP. These doctors include a third of their patients with type 2 diabetes into the program. 65 percent of the GPs nevertheless do not believe, that the patients will benefit from the program. 47 percent of the participating GPs object to DMP in general. Only 66 percent say they follow the DMP guidelines for pharmacotherapy. Half of the doctors state they actively canvass patients for the program, while one fifth says they advice patients against participation. The GPs participate in first line to supply the demand of the patients and because of the public pressure less because they think the DMP is good in respect of content. In 2003 critics and pessimism regarding benefit for patients were even stronger than in 2004.

CONCLUSIONS

GPs participate in the DMP diabetes half-heartedly and with doubts. The results suggest selections in the inclusion of patients. Further research should find out whether patients being likely to profit from the DMP are systematically not included.

[Effectiveness of an outpatient disease management programme for chronic heart insufficiency patients]

The effectivity of a disease management programme (DMP) for outpatients suffering from chronic heart insufficiency (CHI) in primary care is presented. The programme is predominantly based on a weekly telephone monitoring by a case manager using a standardised questionnaire that scores CHI-relevant information of the patient. If the score exceeds a predefined limit the patient's general practitioner is alarmed. An observational study including a total of 115 patients indicates a significant decline of the hospital admission rate (p < 0.0001), as the primary outcome measure, whereas the total length of hospitalization remained constant. The findings are compared with other studies' results and the aims of a randomised controlled trial on the efficacy of DMP on patients with chronic heart failure are discussed.

Evaluation of a monoclonal antibody-based enzyme immunoassay for early detection of herpes simplex virus genital infection

A monoclonal antibody-based enzyme immunoassay test for detection of herpes simplex virus (HSV) type-common antigen was evaluated in 40 women with vulvar lesion suspicious for genital HSV infection. The assay gave interpretable readings in 90% of the cases, with sensitivity and specificity of 100% and 92% respectively, a negative predictive value of 100%, and a positive predictive value of 75%. With a few limitations, the assay may be used for early diagnosis of genital HSV infection.

Bee sting anaphylaxis in an urban population of South Australia

The clinical manifestations and circumstances of bee sting anaphylaxis have been studied retrospectively in 98 subjects. Most reactions occurred in children but the most severe reactions were seen in adult males, of whom 7 lost consciousness and 2 required cardiopulmonary resuscitation. Most stings causing anaphylaxis occurred on the unprotected feet whilst the subject was on lawn in the afternoons in December, January and February when the maximum daily temperature was between 20 and 30 degrees C. This is the temperature range when bees are particularly active in gathering pollen. However, a significantly greater frequency of anaphylactic reactions occurred at higher temperatures when bees are less active, suggesting that high environmental temperature may predispose the individual to greater exposure to bees or possibly to anaphylactic reactions per se. The presence of atopy did not appear to predispose subjects to bee venom hypersensitivity. Considerable anxiety and lifestyle alteration were identified in some subjects. The alleviation of this anxiety is considered an appropriate indication for bee venom immunotherapy.

Serum IgG antibodies to gliadin in children with celiac disease as measured by an immunofluorescence method

Antigliadin antibodies (AGAs) were studied in sera from 190 patients divided into five clinical groups. Group I included 28 sera from children with newly diagnosed celiac disease on a normal diet. Group II consisted of 43 sera from children with celiac disease who were fed a gluten-free diet (GFD). Group III included 25 sera from children with celiac disease who had been in remission but exposed to a gluten-containing diet (GCD). Group IV consisted of 46 sera from children with chronic diarrheal disorders other than celiac disease. Group V included 43 sera from healthy children. The observed p values proved that (a) mean titer levels of AGAs in Groups I and III were significantly higher than the mean values for all other groups (p less than 0.001), and (b) the mean titer level of AGAs in Group II was significantly higher than the mean values for Groups IV and V. A good correlation between the AGA titers and the morphology of the duodenal mucosa was found in children with celiac disease. The examination of IgG AGAs by the immunofluorescence technique used in our study appears to be a useful tool in the follow-up of individual patients to determine adherence to a GFD.

Bee-sting mortality in Australia

Death as a result of a bee sting is uncommon in Australia. During the 22 years from 1960 to 1981, 25 individuals have been recorded by the Australian Bureau of Statistics as having died shortly after a bee sting. This gives a mortality incidence of 0.086/1 000 000 population per year, but may be an underestimate, as we report two additional fatalities that did not appear in the records of the Bureau of Statistics. South Australia has the highest mortality rate from bee stings of all the Australian States, with a recorded fatality rate of 0.26/1 000 000 population per year. As in other surveys, fatalities occur predominantly in men over 40 years of age, which suggests that there may be other contributory risk factors, for example, coronary atherosclerosis. No deaths were reported in individuals aged from six to 19 years, the age group in which bee-sting anaphylaxis is particularly common. It thus appears that the prevention of death per se is not a strong rationale for routine bee-venom immunotherapy in schoolchildren and young adults.