Subclinical Doses of Combined Fumonisins and Deoxynivalenol Predispose Clostridium perfringens–Inoculated Broilers to Necrotic Enteritis

Fumonisins (FB) and deoxynivalenol (DON) are mycotoxins which may predispose broiler chickens to necrotic enteritis (NE). The objective of this study was to identify the effects of subclinical doses of combined FB and DON on NE. A total of 480 day-old male broiler chicks were divided into four treatment groups; 1) control group (basal diet + Clostridium perfringens); 2) necrotic enteritis group (basal diet + Eimeria maxima + C. perfringens); 3) FB + DON group (basal diet + 3 mg/kg FB + 4 mg/kg DON + C. perfringens); and 4) FB + DON + NE group (basal diet + 3 mg/kg FB + 4 mg/kg DON + E. maxima + C. perfringens). Birds in NE and FB + DON + NE groups received 2.5 × 10³E. maxima on day 14. All birds were inoculated with C. perfringens on days 19, 20, and 21. On day 35, birds in the NE, FB + DON, and FB + DON + NE groups had 242, 84, and 339 g lower BWG and a 19-, 2-, and 22-point increase in FCR respectively, than in the control group. Subclinical doses of FB + DON increased (p < 0.05) the NE lesion scores compared to the control group on day 21. On day 21, birds in the NE, FB + DON, and FB + DON + NE groups had increased (p < 0.05) serum FITC-D, lower (p < 0.05) jejunal tight junction protein mRNA, and increased (p < 0.05) cecal tonsil IL-1 mRNA compared to control group. On day 21, birds in the NE group had decreased (p < 0.05) villi height to crypt depth ratio compared to the control group and the presence of FB + DON in NE-induced birds further decreased the villi height to crypt depth ratio. Birds in the NE, FB + DON, and FB + DON + NE groups had increased (p < 0.05) C. perfringens, lower (p < 0.05) Lactobacillus loads in the cecal content, and a lower (p < 0.05) CD8⁺: CD4⁺ cell ratio in the cecal tonsils compared to the control group. It can be concluded that subclinical doses of combined FB and DON predispose C. perfringens-inoculated birds to NE, and the presence of FB + DON in NE-induced birds exacerbated the severity of NE.

Mental health and associated factors among undergraduate students during Covid-19 pandemic in Chile

Introduction

Very few studies have explored mental health among undergraduate students in Chile, especially during the Covid-19 pandemic. International studies have estimated the prevalence of depression at around 28%.

Objectives

i) To determine the prevalence of mental health problems among undergraduate students at a private university in Chile; ii) to explore the associated factors in the context of the Covid-19 pandemic.

Methods

This was a cross-sectional study, approved by the Ethical Committee of the Universidad de los Andes, Santiago Chile (CEC201984). Undergraduate students completed an online survey between August and September 2020. Mental health was assessed using The Depression, Anxiety and Stress Scale-21; suicidality, using the Columbia Suicide Severity Rating Scale; insomnia using the Insomnia Severity Index; and several individual, family, and university factors. Variables regarding the Covid-19 were also assessed, such as personal and family history of covid-19 contagion and death of family members due to Covid-19. A multivariate logistic analysis was performed.

Results

5,037 students responded to the survey. 70.4% were female, mean age, 21 years. 37.1% had depression; 38%, anxiety; 54.6%, stress; 32.6%, insomnia; and 20.5%, suicidal ideation (last month). The most important risk factors were non-medical use of benzodiazepine and fear of contracting Covid-19; the most relevant protective factors were high family functionality and a high sense of university belonging.

Conclusions

This is one of the first studies that has evaluated mental health among undergraduate students in the context of the Covid-19 pandemic in Chile. The findings showed concerning levels of mental health problems.

Disclosure

No significant relationships.

Acceptability y feasibility of “Yo Sé Lo Que Quiero (YSLQQ)” (Unplugged) program: a drug prevention intervention for adolescents in Chile

Introduction

Substance misuse among adolescents is a public health problem because of its prevalence and consequences.

Objectives

i) To develop a culturally adapted version of the Unplugged program in Chile, renamed as “Yo Sé Lo Que Quiero (YSLQQ)”, for substance use prevention; ii) To evaluate the acceptability and feasibility of its implementation.

Methods

Pilot study, with randomized controlled trial design, with two arms (Intervention Group, IG; and Control Group, CG). The sample consisted of 1,556 students from 6th to 8th grade from six schools (1:1 ratio) in Santiago, Chile. The IG received the 12 sessions of the YSLQQ program and the CG the usual substance use prevention activities. Acceptability was assessed through a student questionnaire, and feasibility through teacher self-report.

Results

More than half of the students reported that they liked the sessions. 61.3% were satisfied with the duration of the program and 61.7% with the activities. 68% of students agreed that the program helped them to have more refusal skills towards tobacco, alcohol, and drug use in the future. On the other hand, concerning feasibility and fidelity, 88.9% of the teachers remained faithful to the manual, and 91.6% of the activities were fulfilled according to the manual.

Conclusions

The present study demonstrated that “Yo Sé Lo Que Quiero” program is acceptable and feasible for future implementation in adolescents.

Disclosure

No significant relationships.

Validation of the european drug addiction prevention trial questionnaire (EU-DAP) for substance use screening and to assess risk and protective factors among adolescents in chile

Introduction

Substance use is highly prevalent among Chilean adolescents, and the damage it causes at the neurobiological, psychological, and social levels is well known. However, there are no validated screening instruments that also assess risk and protective factors for this Chilean population.

Objectives

To evaluate the psychometric properties of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap).

Methods

A cross-sectional study was carried out in 13 schools in Santiago of Chile. The sample included 2,261 adolescents of 10 to 14 years old. The linguistic and cultural adaptation was conducted using focus groups, the construct validity was evaluated using confirmatory factor analysis, and measures of its reliability were also determined. Furthermore, the associations regarding risk and protective factors with substance use were explored.

Results

Substance use questions were well understood by adolescents. Regarding the subscales of risk and protective factors, they needed some changes, and once completed, all new subscales had good or adequate goodness of fit adjustment. Regarding reliability, all of the new subscales had good or acceptable internal consistency according to the omega coefficient (range from 0.69 to 0.89). Finally, most of the risk and protective factors measured by the questionnaire were strongly associated with different substance use outcomes, especially those related to positive and negative beliefs or attitudes towards drugs, normative beliefs, and refusal skills.

Conclusions

The current findings suggest that the EU-Dap questionnaire is a valid and reliable instrument, and it may help to evaluate the effectiveness of preventive interventions in the future.

Disclosure

No significant relationships.

Effect of dietary synbiotic supplementation on performance parameters in turkey poults administered a mixed Eimeria species inoculation I

This study examined the effects a synbiotic feed additive (PoultryStar meUS) on performance and intestinal health parameters in turkey poults administered a mixed Eimeria inoculation. The synbiotic feed additive consisted of Lactobacillus reuteri, Enterococcus faecium, Bifidobacterium animalis, Pediococcus acidilactici and a fructo-oligosaccharide prebiotic. Dietary treatments began on day of hatch, and poults were placed on a normal starter, starter containing Clinacox, or starter containing PoultryStar until the conclusion of the experiment on day 42. In addition, on day of hatch, all poults, with exception of the negative control, were orally inoculated with Salmonella enterica Enteritidis. On day 16, poults in inoculated treatment groups received an oral dose of Eimeria adenoides and Eimeria meleagrimitis oocysts resulting in a 2 × 3 factorial arrangement of treatments. BW were measured at weekly intervals after challenge, and fecal samples were collected from all pens during day 21 to day 33 to monitor fecal shedding and calculate oocyst per gram of feces. Five day after Eimeria inoculation, inoculated PoultryStar-fed (I-PS) and inoculated Clinacox-fed (I-CL) poults, on average, weighed and gained significantly more weight (P < 0.05) than inoculated controls (I-CON) and were similar to uninoculated treatments. Between day 21 and day 28, I-PS and I-CL poults showed a 23% improvement (P < 0.001) in percent change in BW gained relative to I-CON, and overall weight gain as a percentage was similar to the uninoculated control. Overall incidence of macroscopic intestinal lesions on day 21 and day 28 was low, but I-PS and I-CL poults were generally less positive than I-CON, and no oocysts were detected in the feces of any group except I-CON which cycled as expected. From this study, it can be concluded that incorporating PoultryStar into the diet of poults reared to 6 wk ameliorates and prevents aspects of performance loss and negative impacts on gut health seen with mixed Eimeria inoculation.

28Impact of non-invasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in developing countries

Background

Cardiovascular mortality is higher in developing countries. Part of that is suboptimal testing. Cardiac magnetic resonance (CMR) is the gold standard for measuring structure, function of the heart and adds incremental value by imaging scarring and to assess iron level. Despite the existence of MRI units, CMR is identified as a complex test, with poor training and availability in developing countries.

Purpose

To assess the potential impact of a faster CMR protocol at a multicentre level in developing countries; implementing it with an education program, for the assessment cardiomyopathies.

Methods

An international partnership. A rapid CMR protocol for the evaluation of cardiac volumes, function and tissue characterization (Cardiac Iron T2* and LGE for scar) Figure 1a. We deployed the protocol as a multicentre study: Argentina, Peru, India and South Africa accompanied by a program of education. Pre-scan clinical information, scanning data: complications, image quality and post-scan follow-up of participants for the assessment on impact, between 3 to 24 months.

Results

510 scans (4 countries, 6 cities, 12 centres) were performed with the rapid CMR protocol. Contrast studies in 378 (74%). There were no scan-related complications. Quality of the studies was maintained in a high level as an average of 89%. 97% of studies responded referral's question. All patients with contrast CMR scan have had at least one 2D echocardiogram before CMR. Average scan duration was 21±6 mins for contrast studies and 12±3 for non-contrast T2* protocol. The most common underlying diagnoses were non-ischaemic cardiomyopathy in 73% of participants (including cardiac iron level assessment in 26%, HCM in 17%, DCM in 15%), 27% for ischaemic cardiomyopathy and 15% for other pathologies. 4 of the 12 participant centres started to incorporate CMR for the first time. Findings impacted management in 60% of patients, including new diagnosis in 21% of participants. See table 1, figure 1b. For just cardiac iron assessment: 1/3 of participants had iron deposited in the heart with 14% of patients in severe levels.

Conclusions

CMR can be delivered faster and easier. When this abbreviated protocol is enabled with education, it can be implemented in developing countries with existing technology. This protocol shows high quality exam, with an important impact on patient's management.

Characteristics and impact on management Contrast studies Non-contrast studies All patients (%) 378 (74) 132 (36) Age, mean (range) years 54 (16–93) 24 (13–41) Male (%) 151 (39) 64 (48) Pre-echocardiography exam (%) 370 (98) 42 (32) Scanning duration mean (SD) 21 (6) 12 (3) Good quality exam (%) 329 (87) 120 (91) Impact on management Total All patients (%) 510 (100) Completely new diagnosis (%) 105 (21) Change/Addition of Medication (%) 128 (25) Intervention/ Surgery (%) 31 (6) Invasive angiography/biopsy (%) 25 (5) Hospital discharge/admission (%) 15 (3) TOTAL 306 (60%) SD: Standard Deviation.

Acknowledgement/Funding

Global Engagement UCL, UK Foreign & Commonwealth Office and The Peruvian Scientific, Technological Development and Technological Innovation (FONDECYT)

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Fractures on bisphosphonates in osteoporosis pseudoglioma syndrome (OPPG): pQCT shows poor bone density and structure

Osteoporosis pseudoglioma syndrome (OPPG) is a rare autosomal recessive disorder of childhood osteoporosis and blindness due to inactivating mutations in LDL receptor-like protein 5 (LRP5). We and others have reported improvement in areal bone mineral density (aBMD) by DXA in OPPG on short term bisphosphonates. Long-term data on bisphosphonate use in OPPG and measures of volumetric BMD (vBMD) and cortical structure are not available. In addition, no long-term DXA data on untreated OPPG is available. The aims of this study were to: (1) record low trauma fractures and longitudinal aBMD by DXA in 5 OPPG patients on chronic bisphosphonate treatment, and in 4 OPPG patients never treated (2) to perform tibia peripheral quantitative CT (pQCT) to evaluate volumetric bone mineral density (vBMD), cortical structure and calf muscle area in 6 OPPG patients and 14 unaffected first degree family members. pQCT results were converted to sex-specific Z-scores for age and adjusted for tibia length based on data in >700 reference participants. We observed 4 fractures (3 femoral shafts) in 3 OPPG patients while on bisphosphonates, after each achieved significant improvement in aBMD. OPPG participants had significantly lower mean trabecular vBMD (-1.51 vs. 0.17, p = 0.002), cortical area (-2.36 vs. 0.37; p < 0.001) and periosteal circumference (-1.86 vs. -0.31, p = 0.001) Z-scores, compared with unaffected participants and had a trend toward lower muscle area Z-score (-0.69 vs. 0.47, p = 0.12). These data demonstrate substantial bone fragility despite improvements in aBMD. The pQCT data provide insight into the fragility with substantial deficits in trabecular vBMD and cortical dimensions, consistent with OPPG effects of bone formation. Treatment that improves bone quality is needed to reduce fractures in OPPG.

Yield and impact of emergency capsule enteroscopy in severe obscure-overt gastrointestinal bleeding

BACKGROUND AND STUDY AIMS

Patients with obscure-overt gastrointestinal bleeding (OOGIB) are defined by overt hemorrhage and negative upper and lower endoscopy findings. At present, the place of emergency capsule enteroscopy in patients with severe OOGIB is unknown. The aim of this study was to assess the diagnostic yield and the impact of emergency capsule enteroscopy on further management in patients with severe OOGIB.

PATIENTS AND METHODS

Between 2003 and 2010, we retrospectively included all patients with severe OOGIB who underwent emergency capsule enteroscopy in the 24-48 h following negative urgent upper and lower endoscopy. Severe OOGIB was defined by ongoing bleeding with hemodynamic instability and/or the need for significant red blood cell transfusion.

RESULTS

Out of 5744 patients hospitalized in our Gastrointestinal Bleeding Unit, 55 (1%) presented with severe OOGIB and underwent emergency capsule enteroscopy. Capsule enteroscopy showed blood in 41 patients (75%) and lesions in 37 patients (67%). Findings included small bowel angiodysplasia in 19 patients (35%), ulcers in 7 (13%), tumors in 5 (9%), small-bowel varices in 2 (3%), cecum angiodysplasia in 4 (7%), fresh blood in small bowel without identified lesion in 12 (22%). Specific diagnostic and therapeutic procedures were undertaken in 78 % of patients. Further management included endoscopy (54%), surgery (22%), and radiology (2%).

CONCLUSIONS

Emergency capsule enteroscopy identified bleeding lesions in 67 % of patients with severe OOGIB. Emergency capsule enteroscopy seems to be a promising diagnostic tool with a subsequent impact on clinical management in patients with severe OOGIB.

Outcome of patients with obscure gastrointestinal bleeding after negative capsule endoscopy: results of a one-year follow-up study

BACKGROUND

Capsule endoscopy (CE) is an effective method for investigating the small bowel, especially in cases of obscure gastrointestinal bleeding (OGIB), although the long-term outcome of patients with a negative CE is generally not known.

PATIENTS AND METHODS

For 49 patients with OGIB and a negative CE, their referring physicians filled out a follow-up questionnaire to assess bleeding recurrence and any repeat investigations after negative video capsule endoscopy (VCE).

RESULTS

A minimum follow-up duration of one year (median: 15.9 months) was available for 35 patients with an overall rebleeding rate of 23% (n=8). Of these eight patients, four women presented with recurrence prior to new investigations. In the four remaining patients, repeat endoscopy work-ups after negative CE were performed and revealed previously missed lesions with bleeding potential, mainly in the stomach. Overall, 13 patients, with or without rebleeding, had repeat endoscopy work-ups after a negative CE, leading to a definitive diagnosis in nine patients, with lesions located in the stomach and colon in eight of them.

CONCLUSION

Patients with OGIB and a negative CE had a low rate of rebleeding. This study highlights the importance of the initial endoscopy work-up, and suggests that CE be proposed after a minimum of two gastroscopies and one complete colonoscopy.

Endoscopic band ligation could decrease recurrent bleeding in Mallory-Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine

BACKGROUND

Mallory-Weiss syndrome (MWS) with active bleeding at endoscopy may require endoscopic haemostasis the modalities of which are not well-defined.

AIM

To compare the efficacy of endoscopic band ligation vs. hemoclip plus epinephrine (adrenaline) in bleeding MWS.

METHODS

From 2001 to 2008, 218 consecutive patients with a MWS at endoscopy were hospitalized in our Gastrointestinal Bleeding Unit. In 56 patients (26%), an endoscopic haemostasis was required because of active bleeding. Band ligation was performed in 29 patients (Banding group), while hemoclip application plus epinephrine injection was performed in 27 patients (H&E group). Treatment efficacy and early recurrent bleeding were retrospectively compared between the two groups.

RESULTS

Primary endoscopic haemostasis was achieved in all patients. Recurrent bleeding occurred in 0% in Banding group vs. 18% in H&E group (P = 0.02). The use of hemoclips plus epinephrine (OR = 3; 95% CI = 1.15-15.8) and active bleeding at endoscopy (OR = 1.9; 95% CI = 1.04-5.2) were independent predictive factors of early recurrent bleeding.

CONCLUSIONS

Haemostasis by hemoclips plus epinephrine was an independent predictive factor of rebleeding. This result suggests that band ligation could be the first choice endoscopic treatment for bleeding MWS, but requires further prospective assessment.

Hepatitis C virus compartmentalization and infection recurrence after liver transplantation

Hepatitis C virus (HCV) compartmentalization may have important implications in the pathogenesis of HCV infection. The aim of this study was to investigate the presence and relevance of HCV compartmentalization in the setting of liver transplantation (LT). We collected samples of serum, peripheral blood mononuclear cells (PBMC), perihepatic lymph nodes (PLN) and liver explant at the time of LT, and serum and PBMC after transplantation from 57 HCV-infected cirrhotic patients undergoing LT: 38 individuals received antiviral treatment before LT and 19 were untreated controls. HCV-RNA levels were determined by real-time PCR and the hypervariable region 1 (HVR-1) was sequenced. HCV-RNA was detected in all samples from control patients. In virological responders, recurrence after LT was associated with residual HCV-RNA in the liver explant. Within the entire cohort, 47% of patients harbored differences in direct sequences from distinct compartments. Quasispecies analysis revealed that in most cases, HVR-1 sequences recovered after infection recurrence were identical or closely related to those isolated from the liver explant and serum at the time of LT. Our study shows that a significant proportion of HCV-infected cirrhotic patients exhibit compartmentalization. Viral variants originating within the liver appear to be the main cause of HCV recurrence after LT.

Review Paper: Gene Expression Profiling in Veterinary and Human Medicine: Overview of Applications and Proposed Quality Control Practices

High throughput molecular analysis of veterinary tissue samples is being applied to a wide range of research questions aimed at improving survival, development of diagnostic assays, and improving the economics of commercial production of animal products. Many of these efforts also, implicitly or explicitly, have ramifications for the clinical care of humans and, potentially, animals. Here we provide an overview of applications of gene expression profiling in veterinary research and practice. We then focus on the current state of quality control and quality assurance efforts in gene expression profiling studies, underscoring lessons learned from such analysis of human samples. Finally, we propose practices aimed at ensuring the reliability and reproducibility of such assays. The implementation of quality assurance practices by a trained pathologist is an essential link in the chain of events leading ultimately to reliable and reproducible research findings and appropriate clinical care.

Physician initiated cancer screening discussions and patient intention to engage in screening behavior

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Background: Cancer screening for colon, breast, and prostate cancer remains underutilized. Physician (MD)-patient discussions of screening are common but the impact of these discussions is unknown. Methods: 2489 40–70 year old subjects completed a national survey of cancer prevention information acquisition and decision making (median age 53, 49% male, 77% white, 59% married, 61% some college). Subjects reported whether their MD initiated discussions (MDID) about colonoscopy, mammography, & PSA within the past year. Age eligible subjects were “non-routine screeners” (NRS: never screened or colonoscopy >10 yrs, mammography >2 yrs or PSA>2 yrs prior) or “routine screeners” (RS).The endpoint was intention to screen when next eligible. Results: 46%, 75% and 60% of subjects reported intentions to obtain colonoscopy, mammography and/or PSA. Logistic regression was used to determine the association between MDID and intentions to screen controlling for sociodemographics and recency of screening. For colonoscopy and mammography, MDID was significantly associated with intention to screen for NRS but not RS groups; the opposite was true for PSA. For the NRS group: comparing those saying no versus yes to MDID, intentions were 15% vs. 43% for colonoscopy, 29% to 61% for mammography (RS: 85% vs. 91% and 82% vs. 85%). For PSA, NRS: 46% vs.52% but RS group 65% vs. 85%. All interactions (screening by MDID) were significant, p<.001. Conclusions: Given high intentions to undergo colon and breast cancer screening among patients who have been screened routinely, physician discussion preferentially increases intentions for colon and breast cancer screening among patients who are not routinely undergoing the screening test. Conversely, physician discussion preferentially influences prostate cancer screening intentions among patients who have been screened in the past two years- perhaps because men who have not undergone screening are more resolved in their decision not to screen. These results define subgroups of patients where physician attention may have the greatest impact on screening adherence.

No significant financial relationships to disclose.

Diversity of human rotaviruses detected in Sicily, Italy, over a 5-year period (2001-2005)

Rotavirus infection was detected in 39.9% of 1030 children hospitalized with gastroenteritis in Palermo, Italy, in the period 2001-2005. Rotavirus strains belonging to G1, G4 and G9 types were continually detected, with G1 being the most common type in 2001, 2002 and 2004. A G4 epidemic occurred in 2003, while G9 was predominant in 2005. G2 strains displayed a low prevalence, except in 2003. G3 rotaviruses accounted for 2.7-17% of the gastroenteritis episodes in 2002-2005. The P-type of a subset of 166 strains confirmed the circulation of the usual G/P combinations, but single G1P[6], G9P[9] and G6P[9] strains were also found.

Cancer information acquisition differs by patient characteristics

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Background: While cancer patients have access to multiple sources of information, including mass media, the internet and personal and professional contacts, little is known about use of these sources in decision making. Methods: 43 patients with one of three cancer types (37% breast, 28% colon and 35% prostate, 58% stage 1) randomly recruited through the Pennsylvania Cancer Registry completed semi-structured in-person interviews about cancer related information acquisition and decision making. (Median age 59 (range 40–71), 47% male, 79% white, 74% married, mean education 14.6 years (SD = 2.48). Separate analyses were performed for actively looking for information (seeking) vs. passively coming across information (scanning). The primary endpoint was patient use of information sources in cancer related decision making. Results: All cancer patients reported use of both interpersonal and mass media information sources in making cancer related decisions. Patients with more advanced cancer (stage 3 vs. stage 1 or 2), higher education, and younger age were more likely to actively seek cancer information (χ2 = 4.7, p = .095, χ2 = 10, p = .04 and χ2 = 8.6, p = .07). Breast cancer patients and women were more likely to report passively coming across information (χ2 = 9.1, p = .058 and χ2 = 5.1, p = .078). Conclusions: Cancer information acquisition varied according to patient characteristics. Seeking was reported more in younger patients and those with higher formal education, and more advanced cancer. Highly educated and younger patients may be better at navigating the information environment; patients with more advanced cancer may have increased anxiety causing them to actively seek information. Scanning was more common among breast cancer patients and women. Women may attend to general health related information more than men or information about breast cancer may be more accessible and pervasive than information on colon or prostate cancer.

No significant financial relationships to disclose.

Motor neuron pathology in experimental autoimmune encephalomyelitis: studies in THY1-YFP transgenic mice

Using adult male C57BL/6 mice that express a yellow fluorescent protein transgene in their motor neurons, we induced experimental autoimmune encephalomyelitis (EAE) by immunization with myelin oligodendrocyte glycoprotein peptide 35-55 (MOG peptide) in complete Freund's adjuvant (CFA). Control mice of the same transgenic strain received CFA without MOG peptide. Early in the course of their illness, the EAE mice showed lumbosacral spinal cord inflammation, demyelination and axonal fragmentation. By 14 weeks post-MOG peptide, these abnormalities were much less prominent, but the mice remained weak and, as in patients with progressive multiple sclerosis, spinal cord atrophy had developed. There was no significant loss of lumbar spinal cord motor neurons in the MOG peptide-EAE mice. However, early in the course of the illness, motor neuron dendrites were disrupted and motor neuron expression of hypophosphorylated neurofilament-H (hypoP-NF-H) immunoreactivity was diminished. By 14 weeks post-MOG peptide, hypoP-NF-H expression had returned to normal, but motor neuron dendritic abnormalities persisted and motor neuron perikaryal atrophy had appeared. We hypothesize that these motor neuron abnormalities contribute to weakness in this form of EAE and speculate that similar motor neuron abnormalities are present in patients with progressive multiple sclerosis.

Androgen receptor gene CAG trinucleotide repeats in anovulatory infertility and polycystic ovaries

Hyperandrogenism is currently thought to be central to the pathogenesis of polycystic ovarian syndrome (PCOS), a common endocrine disorder in premenopausal women characterized by irregular menstruation and anovulatory infertility. Although hyperandrogenism is characteristic, some women with PCOS have normal serum androgen levels. All androgens act through the X-linked androgen receptor (AR), the N-terminal domain of which contains a polyglutamine tract encoded by a highly polymorphic CAG trinucleotide repeat tract. Recently, variations in this CAG microsatellite tract, while remaining within the normal polymorphic range (11-38 CAGs), have been inversely correlated with receptor activity. Thus, short tracts are associated with high intrinsic AR activity and increased severity and earlier age of onset of the androgen-regulated tumor prostate cancer, whereas longer CAG tracts are associated with low AR activity and oligospermic infertility. To investigate the role of the CAG repeat tract in PCOS, we measured its length in 91 patients with ultrasound diagnosis of polycystic ovaries, irregular menstrual cycles, and anovulatory infertility and compared them to 112 control subjects of proven fertility with regular menses. Fluorescent-labeled DNA fragments containing the CAG repeat tract were amplified from leucocytic DNA, and their lengths were compared with internal size markers on an automated DNA Sequencer. There were no differences in the mean CAG length between patients and controls when both alleles were considered together or separately. Because there is a subset of PCOS patients whose serum androgens are normal, we compared differences in CAG length between patients whose serum testosterone (T) levels were below the normal laboratory mean, to those that were higher. There was a trend for a lower mean CAG biallelic length among anovulatory patients with T less than 1.73 nmol/L compared with those whose T was more than 1.73 nmol/L (22.47 +/- 0.36 vs. 23.25 +/- 0.29). This difference in CAG length between patients with low and high T levels (20.38 +/- 0.51 vs. 21.98 +/- 0.29) was highly significant (P = 0.004) when only the shorter allele of each individual was considered. Ethnic differences were also evident in our data; Indian subjects had a significantly shorter AR-CAG length compared with Chinese, being 22.08 +/- 0.50 and 23.16 +/- 0.17, respectively. Our data indicate an association between short CAG repeat length and the subset of anovulatory patients with low serum androgens, suggesting that the pathogenic mechanism of polycystic ovaries in these patients could be due to the increased intrinsic androgenic activity associated with short AR alleles.

Can dialysis adequacy be achieved by tailoring the dialysis prescription in an Asian pediatric population on nightly intermittent peritoneal dialysis?

This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline in residual renal function and was attributable to significant improvements in the peritoneal clearances of urea and creatinine (p < 0.05). The mid arm muscle circumference (MAMC) increased significantly (p = 0.006), while FFM increased from 25.68 +/- 7.92 kg to 26.95 +/- 9.83 kg, and %FAT decreased from 21.56% +/- 8.41% to 18.66% +/- 8.16%. The increase in FFM correlated significantly with a decrease in serum creatinine (r = -0.94, p = 0.005). In conclusion, tailoring the dialysis prescription in NIPD, without adding high-dose therapy, resulted in a trend of improvement in dialysis adequacy and some nutritional parameters.

Functional interplay between nuclear factor-kappaB and c-Jun integrated by coactivator p300 determines the survival of nerve growth factor-dependent PC12 cells

Nerve growth factor (NGF) activates the transcription factors nuclear factor kappaB (NF-kappaB) and activator protein-1 (AP-1) in sympathetic neurons. Whereas NGF-inducible NF-kappaB is required for the survival of neurons, c-Jun has the ability to promote neuronal death. In this report, we have examined the effect of NGF withdrawal on c-Jun and NF-kappaB transcription factors in PC12 cells differentiated to a neuronal phenotype. We show that the withdrawal of NGF from these cultures results in de novo synthesis of c-Jun, increase in AP-1 activity, and down-regulation of NF-kappaB activity. To investigate how the signal transduction pathways activating c-Jun and NF-kappaB are differentially regulated by NGF, we performed transcriptional analyses. Expression of ReIA (NF-kappaB) suppressed the c-Jun-dependent transcription of c-jun, and this effect was reversed by overexpression of the coactivator p300. RelA's effects on c-Jun transcription were mediated by competitive binding of the carboxy-terminal region of RelA to the CH1 domain of p300, which also binds to c-Jun; deletion of this region abrogated the ability of RelA to inhibit c-Jun activity. Furthermore, the inhibition of endogenous NF-kappaB in NGF-maintained neuronal PC12 cells led to the induction of c-Jun synthesis and a marked increase in cell death. Together, these studies demonstrate a functional interaction between NF-kappaB and c-Jun and suggest a novel mechanism of NF-kappaB-mediated neuroprotection.

Oligomeric hydrolysable tannins from Tibouchina multiflora

Two hydrolysable tannins, nobotanin O and nobotanin P, were isolated from the leaf extract of Tibouchina multiflora (Melastomataceae) and their dimeric and tetrameric structures elucidated on the basis of spectral data and chemical correlations with nobotanin B and K, respectively. Thirteen known hydrolysable tannins including nobotanins A, B, C and J, which are oligomers characteristic of the Melastomataceae, were also isolated.

Detection and effects on platelet function of anti-platelet antibody in mule foals with experimentally induced neonatal alloimmune thrombocytopenia

Horse mares carrying mule foals were immunized during the last trimester of pregnancy with whole acid-citrate-dextrose-anticoagulated donkey blood to experimentally induce neonatal alloimmune thrombocytopenia. Thrombocytopenia occurred in the neonatal mule foals born to immunized horse mares within 24 hours after ingestion of their dams' colostrum. Mule foals born to mares not immunized with donkey blood did not develop thrombocytopenia. These findings suggest that antibodies may have been directed against a donkey platelet antigen present in the mule foals but not present in their dams. The objectives of this study were to determine whether anti-platelet antibody could be detected in mule foals with experimentally induced neonatal alloimmune thrombocytopenia, to identify any platelet proteins recognized by serum antibody in these foals, and to determine if platelet function was altered by sera from these mule foals. An indirect enzyme-linked immunosorbent assay demonstrated significantly higher absorption at 1:200 of platelet-bindable immunoglobulin G in serum from thrombocytopenic mule foals, compared with nonthrombocytopenic mule foals. Sera from thrombocytopenic and nonthrombocytopenic mule foals produced similar binding patterns in western immunoblots with donkey platelet proteins separated on sodium dodecyl sulfate polyacrylamide gels. Maximal platelet aggregation and relative slope of aggregation in response to collagen were significantly inhibited after incubation with sera from thrombocytopenic mule foals. These results suggest that mule foals with induced alloimmune thrombocytopenia have serum antibodies that bind to platelets and may compete with collagen binding sites to impair platelet aggregation.

Phosphorylation by p44 MAP Kinase/ERK1 stimulates CBP histone acetyl transferase activity in vitro

The transcriptional coactivator CBP displays an intrinsic histone acetyl transferase (HAT) activity which seems to participate in transcriptional activation through the destabilization of nucleosome structure. CBP is involved in the activity of several transcription factors that are nuclear endpoints of intracellular signal transduction pathways. In some instances, the transcription factors are phosphorylated upon cell activation, which induces their interaction with CBP. CBP itself is a phosphoprotein and can be phosphorylated by cycle-dependent kinases or by MAP kinases. Here we show that CBP phosphorylation by p44 MAP kinase/ERK1 results in the stimulation of its HAT enzymatic activity. The p44 MAP kinase/ERK1 phosphorylation sites are located in the C-terminal part of the protein, outside of the HAT domain. These sites are required for enzymatic stimulation, suggesting that phosphorylation by p44 MAP kinase/ERK1 induces a conformational change of the CBP molecule. Our data suggest that, in some instances, CBP itself might be a target for signal transduction pathways.

HIV-1 Tat-mediated activation of glycogen synthase kinase-3beta contributes to Tat-mediated neurotoxicity

Human immunodeficiency virus type 1 (HIV-1) Tat induces neuronal apoptosis. To examine the mechanism(s) that contribute to this process, we studied Tat's effects on glycogen synthase kinase-3beta (GSK-3beta), an enzyme that has been implicated in the regulation of apoptosis. Addition of Tat to rat cerebellar granule neurons resulted in an increase in GSK-3beta activity, which was not associated with a change in protein expression and could be abolished by the addition of an inhibitor of GSK-3beta (lithium). Lithium also enhanced neuronal survival following exposure to Tat. Coprecipitation experiments revealed that Tat can associate with GSK-3beta, but direct addition of Tat to purified GSK-3beta had no effect on enzyme activity, suggesting that Tat's effects might be mediated indirectly. As the activation of platelet activating factor (PAF) receptors is critical for the induction of neuronal death by several candidate HIV-1 neurotoxins, we determined whether PAF can also activate GSK-3beta. Application of PAF to neuronal cultures activated GSK-3beta, and coincubation with lithium ameliorated PAF-induced neuronal apoptosis. These findings are consistent with the existence of one or more pathways that can lead to GSK-3beta activation in neurons, and they suggest that the dysregulation of this enzyme could contribute to HIV-induced neuronal apoptosis.

Inflammatory bowel disease in horses: 11 cases (1988-1998)

OBJECTIVE

To determine clinical and surgical abnormalities in, and long-term outcome of, horses that undergo surgery because of colic secondary to inflammatory bowel disease (IBD).

DESIGN

Retrospective study.

ANIMALS

11 horses.

PROCEDURE

Medical records of horses that had undergone abdominal surgery and in which IBD had been diagnosed on the basis of histologic examination of intestinal biopsy specimens were reviewed.

RESULTS

5 horses were examined because of acute colic and 6 were examined because of chronic colic. At surgery, all 11 horses had edematous or hemorrhagic bowel segments suggestive of IBD. In addition, 6 horses had circumferential mural bands (CMB) causing constriction of the small (4 horses) or large (2) intestine. Intestinal resections were performed in 7 horses. All 11 horses survived surgery and were discharged from the hospital; 10 horses were still alive at the time of follow-up (1.5 to 7 years after surgery).

CLINICAL IMPLICATIONS

Results suggest that IBD is an uncommon cause of colic in horses. Surgical resection of segments of intestine with constrictive CMB may relieve clinical signs of colic. Horses with IBD that had surgery had a good prognosis for long-term survival.

Ablation of the nephrosplenic space for treatment of recurring left dorsal displacement of the large colon in a racehorse

Left dorsal displacement of the large colon was diagnosed in a 3-year-old Thoroughbred gelding. Conservative treatment that included lunging after administration of phenylephrine and rolling while under general anesthesia was not successful. The displaced segment of colon was reduced surgically through a ventral midline incision, but displacement recurred 4 days after surgery. Ablation of the nephrosplenic space by suturing the nephrosplenic ligament to the splenic capsule was performed through the left flank. At followup 1 year after surgery, the horse had not had further signs of colic and had returned to racing. Other methods to prevent large colon displacement, including colon resection and colopexy, are not recommended for athletic horses. Ablation of the nephrosplenic space, however, may be efficacious.

Neuromuscular electrical stimulation and dynamic bracing as a treatment for upper-extremity spasticity in children with cerebral palsy

We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES of the antagonist extensors combined with dynamic orthotic traction during the day. A static brace was used at night. Spasticity of the wrist and fingers was assessed periodically using the Zancolli classification. Treatment ranged from 3 to 43 months. After treatment with electrical stimulation and dynamic bracing, all the patients moved up 1 to 3 levels in the Zancolli classification and showed a marked improvement in upper-extremity function. These results show that combining NMES and dynamic orthotic traction dramatically decreases spasticity of the upper extremity in young patients with cerebral palsy.