Exploratory analysis of machine learning approaches for surveillance of Zika-associated birth defects

In 2016, Centers for Disease Control and Prevention (CDC) established surveillance of pregnant women with Zika virus infection and their infants in the U.S. states, territories, and freely associated states. To identify cases of Zika-associated birth defects, subject matter experts review data reported from medical records of completed pregnancies to identify findings that meet surveillance case criteria (manual review). The volume of reported data increased over the course of the Zika virus outbreak in the Americas, challenging the resources of the surveillance system to conduct manual review. Machine learning was explored as a possible method for predicting case status. Ensemble models (using machine learning algorithms including support vector machines, logistic regression, random forests, k-nearest neighbors, gradient boosted trees, and decision trees) were developed and trained using data collected from January 2016-October 2017. Models were developed separately, on data from the U.S. states, non-Puerto Rico territories, and freely associated states (referred to as the U.S. Zika Pregnancy and Infant Registry [USZPIR]) and data from Puerto Rico (referred to as the Zika Active Pregnancy Surveillance System [ZAPSS]) due to differences in data collection and storage methods. The machine learning models demonstrated high sensitivity for identifying cases while potentially reducing volume of data for manual review (USZPIR: 96% sensitivity, 25% reduction in review volume; ZAPSS: 97% sensitivity, 50% reduction in review volume). Machine learning models show potential for identifying cases of Zika-associated birth defects and for reducing volume of data for manual review, a potential benefit in other public health emergency response settings.

Subcutaneous Ancrod after Operation for Fractured Hip - a Dose-Ranging and Feasibility Study

We have conducted a dose-ranging and feasibility study of daily subcutaneous injections of ancrod (Arvin) as a potential antithrombotic method in 28 patients following operation for fractured neck of femur. Sustained, predictable fibrinogen depletion during the first post-operative week was induced by four different regimes. A total dose of 10 units/kg weight, given in divided doses starting on the day of operation, is suggested as a possible antithrombotic regime. Ancrod treatment produced a rise in fibrinogen/fibrin degradation products, prolongation of the thrombin clotting time, and a fall in plasminogen, plasma viscosity, blood viscosity and haematocrit-corrected blood viscosity. A rise in plasma fibrinogen and corrected blood viscosity were observed in 14 control patients. Plasma fibrinogen was correlated with plasma viscosity and corrected blood viscosity. No adverse effects of treatment occurred. Subcutaneous ancrod appears to be a simple, safe, and feasible potential antithrombotic method, and merits trials of efficacy in the prevention of post-operative thromboembolism.

Use of the Litomosoides sigmodontis Infection Model of Filariasis to Study Type 2 Immunity

Helminth parasites infect over 2 billion people worldwide resulting in huge global health and economic burden. Helminths typically stimulate Type 2 immune responses and excel at manipulating or suppressing host-immune responses resulting in chronic infections that can last for years to decades. Alongside the importance for the development of helminth treatments and vaccines, studying helminth immunity has unraveled many fundamental aspects of Type 2 immunity and immune regulation with implications for the treatment of autoimmunity and Type 2-mediated diseases, such as allergies. Here we describe the maintenance and use of Litomosoides sigmodontis, a murine model for studying host-parasite interactions, Type 2 immunity, and vaccines to tissue-dwelling filarial nematodes, which in humans cause lymphatic filariasis (e.g., Brugia malayi) and onchocerciasis (Onchocerca volvulus).

Prevalence of Gastroesophageal Reflux in Cats During Anesthesia and Effect of Omeprazole on Gastric pH

Background

Gastroesophageal reflux (GER) is poorly characterized in anesthetized cats, but can cause aspiration pneumonia, esophagitis, and esophageal stricture formation.

Objective

To determine whether pre‐anesthetic orally administered omeprazole increases gastric and esophageal pH and increases serum gastrin concentrations in anesthetized cats, and to determine the prevalence of GER using combined multichannel impedance and pH monitoring.

Animals

Twenty‐seven healthy cats undergoing elective dental procedures.

Methods

Prospective, double‐masked, placebo‐controlled, randomized clinical trial. Cats were randomized to receive 2 PO doses of omeprazole (1.45–2.20 mg/kg) or an empty gelatin capsule placebo 18–24 hours and 4 hours before anesthetic induction. Blood for measurement of serum gastrin concentration was collected during anesthetic induction. An esophageal pH/impedance catheter was utilized to continuously measure esophageal pH and detect GER throughout anesthesia.

Results

Mean gastric pH in the cats that received omeprazole was 7.2 ± 0.4 (range, 6.6–7.8) and was significantly higher than the pH in cats that received the placebo 2.8 ± 1.0 (range, 1.3–4.1; P < .001). Omeprazole administration was not associated with a significant increase in serum gastrin concentration (P = .616). Nine of 27 cats (33.3%) had ≥1 episode of GER during anesthesia.

Conclusions and Clinical Relevance

Pre‐anesthetic administration of 2 PO doses of omeprazole at a dosage of 1.45–2.20 mg/kg in cats was associated with a significant increase in gastric and esophageal pH within 24 hours, but was not associated with a significant increase in serum gastrin concentration. Prevalence of reflux events in cats during anesthesia was similar to that of dogs during anesthesia.

Use of Oral Cholera Vaccine and Knowledge, Attitudes, and Practices Regarding Safe Water, Sanitation and Hygiene in a Long-Standing Refugee Camp, Thailand, 2012-2014

Oral cholera vaccines (OCVs) are relatively new public health interventions, and limited data exist on the potential impact of OCV use on traditional cholera prevention and control measures—safe water, sanitation and hygiene (WaSH). To assess OCV acceptability and knowledge, attitudes, and practices (KAPs) regarding cholera and WaSH, we conducted cross-sectional surveys, 1 month before (baseline) and 3 and 12 months after (first and second follow-up) a preemptive OCV campaign in Maela, a long-standing refugee camp on the Thailand-Burma border. We randomly selected households for the surveys, and administered questionnaires to female heads of households. In total, 271 (77%), 187 (81%), and 199 (85%) households were included in the baseline, first and second follow-up surveys, respectively. Anticipated OCV acceptability was 97% at baseline, and 91% and 85% of household members were reported to have received 1 and 2 OCV doses at first follow-up. Compared with baseline, statistically significant differences (95% Wald confidence interval not overlapping zero) were noted at first and second follow-up among the proportions of respondents who correctly identified two or more means of cholera prevention (62% versus 78% and 80%), reported boiling or treating drinking water (19% versus 44% and 69%), and washing hands with soap (66% versus 77% and 85%); a significant difference was also observed in the proportion of households with soap available at handwashing areas (84% versus 90% and 95%), consistent with reported behaviors. No significant difference was noted in the proportion of households testing positive for Escherichia coli in stored household drinking water at second follow-up (39% versus 49% and 34%). Overall, we observed some positive, and no negative changes in cholera- and WaSH-related KAPs after an OCV campaign in Maela refugee camp. OCV campaigns may provide opportunities to reinforce beneficial WaSH-related KAPs for comprehensive cholera prevention and control.

Safe water, sanitation, and hygiene (WaSH) are the primary measures for cholera prevention and control. Since 2010, oral cholera vaccines (OCVs) have been recommended as an additional tool for endemic and epidemic cholera prevention and control. Given the relatively new use of OCVs in public health programs, there is limited information on the impact of OCV use on traditional WaSH activities, i.e., can they serve as complementary tools, or will OCV use have a negative impact on WaSH-related behaviors? This study reports the findings of knowledge, attitudes and practices (KAP) surveys conducted before and after a preventive OCV campaign (2013) in a long-standing refugee camp in Thailand, where frequent cholera outbreaks had occurred in recent years. The surveys demonstrated high acceptability of the OCV campaign and several modest improvements in cholera and WaSH KAPs among the camp population. OCV campaigns may be used as opportunities to reinforce cholera and WaSH-related messaging towards strengthening comprehensive cholera prevention and control.

Alternative Approaches To Target the COX-2 Pathway To Reduce Breast Cancer Metastasis

Background: The cyclooxygenase-2 (COX-2) enzyme is highly expressed in breast cancer and is associated with a poorer prognosis. Past efforts have focused on targeting the COX-2 enzyme with pharmacologic COX-2 inhibitors including celecoxib and rofecoxib. Recent safety concerns have led us to test the hypothesis that targeting downstream members of the COX-2 pathway will be more efficacious and safer. The principle COX-2 product in tumors is prostaglandin E2 (PGE2) which mediates cellular effects by binding to four distinct G-protein-coupled receptors designated EP1, EP2, EP3 and EP4.Materials and Methods: Using pharmacologic and genetic approaches and a preclinical model of metastatic, triple-negative (ER, PR, Her-2 negative) breast cancer, we have examined the role of EP4 and EP1 in malignant behavior. We determined the effect of antagonizing either EP1 or EP4 with the pharmacologic antagonists AH23848, ONO-AE3-208 or SC19220 on metastatic ability of line 66.1 or line 410.4 mammary tumor cells injected into syngeneic Balb/cByJ female mice and compared efficacy of receptor antagonists to either a COX-2 inhibitor (celecoxib) or a dual COX-1/COX-2 inhibitor (indomethacin). We also reduced the expression of either receptor by tranducing tumor cells with specific shRNAs and determined the effect of EP gene silencing on metastatic potential. Using mice with specific deletions of immune effector cells, we also examined the role of host immunity in controlling tumor metastasis.Results: Inhibition of EP4 receptor signaling with the selective EP4 antagonists AH23848 or ONO-AE3-208 limits breast cancer metastasis to the same degree as achieved with a COX inhibitor. Likewise, gene silencing of EP4 with a vector expressing EP4 siRNA also limits metastatic capacity. The therapeutic effect of EP4 blockade is compromised in mice lacking functional Natural Killer cells and NK-mediated lysis of mammary tumor cells is enhanced in the presence of EP4 antagonists. Conversely, blocking EP1 with either the pharmacologic antagonist SC19220 or by gene-silencing promotes tumor metastasis. The expansion of tumors implanted into the mammary fat pad was not affected by modulating EP expression levels, indicating that EP1 functions as a suppressor of metastasis. Interestingly, breast tumors from African-American women express significantly less EP1 than tumors from Caucasian women, suggesting that EP1 could contribute to breast cancer disparities. Ongoing studies are evaluating the relationship of EP expression to long term survival.Discussion: These data support the hypothesis that therapeutic targeting of EP4 may be an alternative approach to the use of COX inhibitors to limit metastatic disease. The mechanism of metastasis control is likely to involve activation of Natural Killer cells. Shifting the balance towards activation of the metastasis suppressor EP1 could be an additional means to reduce breast cancer metastasis.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6140.

Effects of kaolin particle film on Myzus persicae (Hemiptera: Aphididae) behaviour and performance

The emergence of resistance mechanisms to, and revocation of, many insecticides used in the control of the polyphagus aphid pest, Myzus persicae (Sulzer), has increased the pressure to develop novel approaches for the control of the pest in many crops. Kaolin-based particle films provide a physical barrier against insect pests and show considerable potential for controlling M. persicae. We conducted a series of laboratory experiments to investigate the mode of action of kaolin against aphids. The material appeared to have no direct effect on M. persicae; spraying adult aphids with aqueous kaolin suspension had no significant impact on their subsequent survival or reproduction on untreated plants. Similarly, when aphids were placed on kaolin-treated host-plants (Brassica oleracea), their performance (survival, growth rate and reproduction) was not significantly different from aphids on untreated plants. However, when M. persicae were given a choice between kaolin-treated and untreated (or water solvent-treated) leaf areas, both adults and nymphs exhibited a significant preference for non-kaolin-treated host-plant material. Rejection of kaolin-treated plant material occurred very rapidly (within 20 min) and this behavioural effect may be related to the efficacy of kaolin in controlling aphids under field conditions.

Knowledge gained by mothers enrolled in a home visitation program

This study examined whether new mothers would gain knowledge of child development after participating in a home visitation program for six months, and whether there would be differences between adolescent mothers and older mothers. Forty-seven mothers were administered the Knowledge Inventory of Development and Behavior: Infancy to School-age (KIDS) after the birth of their babies and six months later. Results indicated an overall increase in total knowledge of child development for mothers (of all ages) participating in a home visitation program. KIDS subscale scores indicated a significant increase in new mothers' knowledge about both infant and school-age development. There was no significant difference between the adolescent and older mothers in knowledge of infant development.

Aromatase and COX-2 expression in human breast cancers

We have investigated aromatase and the inducible cyclooxygenase COX-2 expression using immunocytochemistry in tumors of a series of patients with advanced breast cancer treated with aromatase inhibitors. Aromatase was expressed in 58/102 breast cancers. This is similar to the percentage previously reported for aromatase activity. Interestingly, aromatase was expressed in a variety of cell types, including tumor, stromal, adipose, and endothelial cells. Since prostaglandin E2 is known to regulate aromatase gene expression and is the product of COX-2, an enzyme frequently overexpressed in tumors, immunocytochemistry was performed on the tissue sections using a polyclonal antibody to COX-2. Aromatase was strongly correlated (P<0.001) with COX-2 expression. These results suggest that PGE2 produced by COX-2 in the tumor may be important in stimulating estrogen synthesis in the tumor and surrounding tissue. No correlation was observed between aromatase or COX-2 expression and the response of the patients to aromatase inhibitor treatment. However, only 13 patients responded. Nine of these patients were aromatase positive. Although similar to responses in other studies, this low response rate to second line treatment suggests that tumors of most patients were no longer sensitive to the effects of estrogen. Recent clinical studies suggest that greater responses occur when aromatase inhibitors are used as first line treatment. In the intratumoral aromatase mouse model, expression of aromatase in tumors is highly correlated with increased tumor growth. First line treatment with letrozole was effective in all animals treated and was more effective than tamoxifen in suppressing tumor growth. Letrozole was also effective in tumors failing to respond to tamoxifen, consistent with clinical findings. In addition, the duration of response was significantly longer with the aromatase inhibitor than with tamoxifen, suggesting that aromatase inhibitors may offer better control of tumor growth than this antiestrogen.

Prospective evaluation of prenatal maternal serum screening for trisomy 18

OBJECTIVE

Our goal was to evaluate the performance of prenatal serum screening for trisomy 18.

STUDY DESIGN

All 40,762 samples for maternal serum testing (August 1991 to June 1994) with a trisomy 18-positive screen (n = 175, alpha-fetoprotein < or =0.75 multiples of the median, unconjugated estriol < or =0.60 multiples of the median, human chorionic gonadotropin < or =0.55 multiples of the median) were analyzed. Results of all amniocenteses, ultrasonographic studies, and birth or death certificate information were obtained from the Iowa Expanded Serum Screening Program, the Iowa Department of Public Health, and the Iowa Birth Defects Registry.

RESULTS

We obtained the expected screen-positive rate for trisomy 18 (0.43%, 175/40,762). Fourteen samples from outside the state were excluded, which left 161 cases with outcome data obtained through amniocentesis (n = 121), birth certificates (n = 34), telephone contact (n = 2), or a sonogram indicating a nonviable gestation (n = 4). Of 121 screen-positive women undergoing amniocentesis, 119 had a normal karyotype and 2 had an abnormal karyotype: 69,XXY and 47,XY,+18. Of 36 who declined amniocentesis, none had findings consistent with aneuploidy on clinical neonatal examination. Of the 103 patients who had a detailed ultrasonographic study at the University of Iowa, 27 had a subtle fetal abnormality or growth alteration. Both cases with aneuploidy were in this group. An additional 7 cases of trisomy 18 without the typical trisomy 18 maternal serum screening pattern were diagnosed during this period either at amniocentesis performed because of increased Down syndrome risk indicated by serum screening (n = 1), by elevated alpha-fetoprotein level (n = 1), or by advanced maternal age (n = 2) with serum for screening drawn coincidentally, or they were diagnosed postnatally (n = 3). Three of the 7 cases had early second-trimester ultrasonographic examinations, and all showed abnormalities.

CONCLUSIONS

The detection rate of trisomy 18 among patients offered amniocentesis was significantly lower (p < 0.05) than the expected rate (10/161 on the basis of published data). Combining serum screening with detailed ultrasonographic evaluations may improve predictive value by more precisely targeting amniocentesis toward those at highest risk.

Serum cortisol concentration and testosterone to cortisol ratio in elite prepubescent male gymnasts during training

Serum cortisol concentrations and testosterone:cortisol concentration ratios of eight prepubescent elite male gymnasts (mean age 10 years 11 months) and 11 controls (mean age 11 years 1 month) were examined during 5 consecutive training days. During this period, the gymnasts trained 3 h each day with moderate intensity mobility, strength and skill exercises while the controls were relatively sedentary. Blood samples were taken from all the boys in both groups before (1630 hours) and 30 min after (2000 hours) training on 4 days. Serum cortisol concentrations of the gymnasts were not significantly different from those of the controls throughout the experiment. Serum cortisol concentrations of both groups were significantly larger (P < 0.05) at 1630 hours than at 2000 hours, indicating that cortisol secretion followed the typical adult circadian change, seemingly unaltered by training. However, there was a significant decrease (P < 0.05) in the testosterone:cortisol ratio of the gymnasts when compared with controls from day 1 to day 3. After a rest on day 4 the testosterone: cortisol ratio of the gymnasts significantly increased (P < 0.05) but the ratio of the control group also increased indicating that there may have been some day-to-day change by factor(s) other than training. The most obvious factor which may have accounted for the unresponsiveness of serum cortisol concentration to the gymnastics training was that the exercise intensity was too low. However, several days of the training seemed to reduce the anabolic to catabolic balance but further experiments are needed to confirm this finding.

Familiarity and recognition of faces in old age

Elderly persons exceed young adults in false recognitions of new faces. One account claims there are age-related deficits in memory for context of encounter with faces. Because of these deficits, elderly persons frequently recognize faces on the basis of perceived familiarity (i.e., resemblance to face representations in memory), which is high for some new faces. To test this context-recollection hypothesis, we had young adult and elderly subjects judge whether faces: (1) had been seen previously in a test (though no face was repeated), and (2) were subjectively familiar (though no face was famous). The elderly exceeded the young subjects in seen-before judgements (false recognitions), and only the elderly showed a positive correlation between false recognitions and subjective familiarity. In Experiment 2, this finding was extended from false recognitions to correct recognitions, supporting the view that elderly persons, compared to young adults, rely more on resemblance in recognizing faces.

False recency and false fame of faces in young adulthood and old age

Studies of age differences in face recognition have shown age-related increases in false-alarm errors: elderly persons exceed young adults in judging new faces to be old. To distinguish among theoretical accounts of this finding, we compared young and elderly subjects in two recognition tasks: (1) that of judging whether faces were recent or nonrecent, and (2) that of judging whether faces were famous or nonfamous. The major independent variable was prior presentation of faces-including nonrecent and nonfamous foils-1 week before the test. False recent judgments in response to nonrecent faces and false famous judgments in response to nonfamous faces were higher among the elderly. Moreover, these age-related differences in false-alarm rates were larger for faces viewed 1 week previously than for entirely new faces. The findings suggest that, compared to young adults, older individuals rely relatively more on perceived familiarity, and relatively less on recollection of context, in making recognition decisions.

Young and old faces in young and old heads: The factor of age in face recognition

Research on aging and face recognition has shown age-related differences that are reflected most clearly in false-alarm errors. Elderly subjects exceed young adults in false recognitions that new faces are "old." To determine if this difference between young and elderly subjects might differ for young versus elderly faces, an experiment was conducted in which half of the young and elderly subjects studied and recognized young and middle-aged faces, and the remainder studied and recognized middle-aged and elderly faces. Replicating prior research, age-related deficits in recognition accuracy (d') were reduced with older faces, and this effect generalized from measures of face recognition to measures of face-picture recognition. However, the age-related increase in false recognitions of faces was not affected by face age.

Aging and memory for pictures of faces

The hypothesis that pictorial aspects of face-recognition memory are lower in old age was tested in 2 studies. Young and elderly Ss viewed 48 face pictures, and then took a test containing identical copies of input faces, pictorially changed versions of input faces, and entirely new faces. Replicating prior findings, Experiment 1 showed that false recognitions of entirely new faces were higher among elderly Ss. However, there were no age differences in distinguishing identical from pictorially changed faces. Using a modified test, Experiment 2 showed that although the elderly Ss had good knowledge that changed faces were changed, they had relatively poor knowledge of how they were changed. There appears to be age differences in analytical matching of pictorial information against information in memory.

Correlation of natural killer activity with tumorigenesis of a preneoplastic mouse mammary lesion

Tissue infiltrating lymphocytes isolated from the preneoplastic mouse mammary hyperneoplastic alveolar nodule (HAN) tissue line C4 express high levels of natural killer (NK) activity, which gradually wanes as spontaneous tumors develop (W. Z. Wei and G. Heppner. Br. J. Cancer, 55: 589-594, 1987). Experiments were performed to test whether modulation of NK cell activity would be associated with altered progression of HAN to tumor. Administration of polyinosinic-polycytidylic acid, which activates NK activity but does not directly affect mammary epithelial cell growth, to HAN-bearing mice enhanced tumor progression, as measured by a decrease in the latency period and increase in the incidence of mammary adenocarcinomas developing in the HAN implants. Antiasialo GM1, which reduces NK activity, reduced tumor progression. The net effect of indomethacin, which may inhibit mammary epithelial cell growth but enhances NK cell function, was to prolong the latency period of tumor development. However, this effect was reversed by interleukin 2, which activates NK cells. These findings suggest that NK activity may provide positive signals for progression of preneoplastic mammary lesions to frank neoplasia.

Effect of salivary proteins on binding curves of three radioimmunoassay kits: Amerlex-M progesterone, Amerlex cortisol, and Biodata testosterone

Radioimmunoassay (RIA) is generally used to measure certain salivary hormones because of its high sensitivity. For speed and simplicity, it has been used in the form of "direct" assays, i.e., without first extracting the analyte from its matrix. Investigating the effect of the principal salivary proteins on the binding behavior of three commercial RIA kits, we found that the Amerlex-M [125I]progesterone binding was greatly reduced when alpha-amylase and mucins were added to the binding medium, whereas IgA and IgG were less effective. The Serono Biodata [125I]testosterone binding was unaffected by proteins, while the Amerlex [125I]cortisol binding was decreased by alpha-amylase and mucins. The protein influence was largely eliminated when an extraction step was incorporated. Thus, direct RIA of saliva may be subject to matrix effects, to extents that vary with the kit and that may adversely affect the quality of the assay results.

Effect of salivary proteins on binding curves of three radioimmunoassay kits: Amerlex-M progesterone, Amerlex cortisol, and Biodata testosterone

Radioimmunoassay (RIA) is generally used to measure certain salivary hormones because of its high sensitivity. For speed and simplicity, it has been used in the form of "direct" assays, i.e., without first extracting the analyte from its matrix. Investigating the effect of the principal salivary proteins on the binding behavior of three commercial RIA kits, we found that the Amerlex-M [125I]progesterone binding was greatly reduced when alpha-amylase and mucins were added to the binding medium, whereas IgA and IgG were less effective. The Serono Biodata [125I]testosterone binding was unaffected by proteins, while the Amerlex [125I]cortisol binding was decreased by alpha-amylase and mucins. The protein influence was largely eliminated when an extraction step was incorporated. Thus, direct RIA of saliva may be subject to matrix effects, to extents that vary with the kit and that may adversely affect the quality of the assay results.

Aging and memory for pictures of faces

The hypothesis that pictorial aspects of face-recognition memory are lower in old age was tested in 2 studies. Young and elderly Ss viewed 48 face pictures, and then took a test containing identical copies of input faces, pictorially changed versions of input faces, and entirely new faces. Replicating prior findings, Experiment 1 showed that false recognitions of entirely new faces were higher among elderly Ss. However, there were no age differences in distinguishing identical from pictorially changed faces. Using a modified test, Experiment 2 showed that although the elderly Ss had good knowledge that changed faces were changed, they had relatively poor knowledge of how they were changed. There appears to be age differences in analytical matching of pictorial information against information in memory.

Effectiveness of a controlled drinking self-help manual: one-year follow-up results

Following the description of six-month follow-up results by Heather et al. (1986), this article reports one-year follow-up for a cohort of media-recruited problem drinkers sent either a controlled drinking self-help manual or a general advice and information booklet. Among those remaining in the sample, mean reduction in drinking at six months had been retained at the one-year point. This stability of reduced consumption included respondents showing evidence of late dependence or high consumption at initial assessment. When respondents who had received other forms of treatment had been excluded, the results confirmed the superior effectiveness of the self-help manual in enabling problem drinkers to reduce consumption. Evidence for a superior outcome among respondents interviewed by telephone, rather than contacted solely by post, was again observed. Some limited evidence is presented as to the reliability and validity of self-reports of consumption in the main sample.

Intramuscular vitamin E repletion in children with chronic cholestasis

Progressive spinocerebellar degeneration was identified in six children with chronic cholestatic liver disease and attributed to severe vitamin E deficiency. In addition to areflexia, ataxia, dysmetria, and diminished vibratory and position sense, three patients had pigmentary retinopathy. Abnormalities were present on electromyography, nerve conduction studies, and electroretinography. Because the vitamin E deficiency was not corrected by oral administration of massive doses of vitamin E, vitamin E was administered by the intramuscular route. With doses of 50 to 100 mg of vitamin E every three to seven days, over a 32-month interval (range, 15 to 44 months), vitamin E deficiency and abnormal red blood cell peroxide hemolysis were corrected. Other than discomfort and occasional edema at the site of injection, there were no side effects of parenteral vitamin E therapy. In several other studies intramuscular vitamin E therapy has produced significant neurologic improvement in patients with similar characteristics. In this study clinical progression of spinocerebellar degeneration was arrested but improvement could not be demonstrated despite adequate vitamin E replacement.

The role of filtration in the provision of leukocyte poor red cells to multitransfused patients

Five techniques for the preparation of leukocyte poor red cells were investigated to compare their efficiency in preventing febrile transfusion reactions with their cost of production, in order to establish a cost-effective transfusion programme for chronically anemic patients. Leukocyte depletion and preparation costs per unit for the products were:--microaggregate filtered red cells (MF): 25% leucocyte removal at a cost of $A2; buffy coat poor red cells (BCP): 70% at $A2; washed buffy coat poor red cells (WBCP): 88% at $A28; cotton wool filtered red cells (CWF): 93% at $A23; reconstituted frozen red cells (FC): 97% at $A80. The 5 products were transfused into 103 thalassemia patients with a documented history of febrile transfusion reactions. Reaction rates, expressed as a percentage of units transfused over a 12 mth period (MF 7%, BCP 0.3%, WBCP 0.1%, CWF 0.1%, FC 0.2%) correlated well with the degree of leukocyte depletion. The cost of CWF was reduced by a further 10% using the filter in line during the transfusion. Serum from these patients was screened for leukocyte and platelet antibodies using microlymphocytotoxic, granulocyte immunofluorescence and platelet immunofluorescence assays. There was no correlation between the antibodies present and the type of leukocyte poor product required by a patient to prevent a febrile reaction. A progressive regimen of transfusion (BCP to CWF to FC as the patient reacts) has now been adopted, with considerable cost saving.

Differential sensitivity of metastatic versus nonmetastatic mammary tumor cells to macrophage-mediated cytostasis

Sensitivity to macrophage-mediated cytostasis was determined with 4 tumor cell lines derived from a single, spontaneously arising mouse mammary tumor. Cytostasis was measured in a 48-hour [3H]thymidine-incorporation assay with the use of maleic vinyl ether (pyran) fraction 2 (MVE-2)-elicited peritoneal macrophages as effector cells. Metastatic tumor lines 66 and 410.4 were less sensitive than nonmetastatic lines 67 and 168. Pretreatment of tumor cells with indomethacin for 24 hours before assay increased the cytostatic sensitivity of the metastatic tumor lines but did not affect that of the nonmetastatic tumor lines. Addition of 100 ng lipopolysaccharide (LPS)/ml to the assay mixture of MVE-2-primed macrophages and tumor cells or pretreatment of macrophages with LPS markedly lessened the differences in cytostatic sensitivity among the metastatic and nonmetastatic lines. Pretreatment of tumor cells with indomethacin plus addition of LPS during the effector phase of the assay completely abrogated differences in sensitivity. These results suggest that differences in sensitivity of metastatic versus nonmetastatic tumor cells to macrophage cytostasis are due to both tumor cell (prostaglandin) and effector cell (activation state) factors.

Relationship of natural killer cytotoxicity to clinical and biochemical parameters of primary human breast cancer

We have determined the natural killer (NK) activity of peripheral blood lymphocytes obtained from 121 women undergoing surgery for primary breast cancer. NK activity was measured using 51Cr-labeled K562 target cells and effector: target ratios of 100:1, 50:1 and 10:1. The patients' lymphocytes gave a wide range of values with a mean (+/- S.E.) cytotoxicity of 22.6% +/- 1.3, and a median of 20.9% at the 50:1 effector:target ratio. These results did not differ significantly from the mean and median NK levels obtained with the peripheral blood lymphocytes of normal blood donors (mean = 23.1% +/- 1.9, median = 18.8%). Mean NK activity determined at the first postsurgical examination (less than or equal to 6 months postoperative) was significantly lower than the mean NK activity at surgery. The most significant decreases were seen in patients undergoing chemotherapy prior to the first follow-up examination. Subsequent tests (greater than 6 mo, less than or equal to 12 mo) show a recovery of NK activity to preoperative levels. A negative correlation was seen between NK level and maximum tumor diameter. NK levels also varied with tumor histiotype. No association was seen between NK levels and either the number of involved lymph nodes, pathologic tumor grade, the presence of estrogen or progesterone receptor, or the age, menopausal status or smoking history of the patients. A positive correlation was seen, however, between NK levels and number of pregnancies and live births.

Benzodiazepine anxiolytic action and affinities for serotonergic and adrenergic receptors

Tissue homogenates were prepared from brains of four week old Lewis rats. 5HT receptors were prepared from three brain regions and labelled with 3H-5HT and 3H-spiperone. Alpha-receptors were prepared from rat forebrains and labelled with 3H-WB4101 and 3H-clonidine. Incubations were carried out at seven concentrations for each of twelve benzodiazepines. IC50 values were derived from specific binding versus log (drug concentration) plots. The benzodiazepines appeared to have little affinity for 5HT or NA post-synaptic receptors in rat brain.

The effects of benzodiazepines on hormones in women with idiopathic hirsutism

A single blind study was planned to investigate whether benzodiapines would reduce androgens in women with idiopathic hirsutism. Placebo was given for the first month followed by four months of a benzodiazepine (chlorazepate 15 mg nocte or diazepam 10 mg nocte ). Plasma samples were collected during the follicular and luteal phases of each therapy month. Hair growth was assessed monthly. Eighteen women concluded the five months of the trial of whom ten received chlorazepate and eight diazepam. Comparison of follicular plasma samples during the placebo phase and fourth month of benzodiazepine found a significant increase in sex hormone binding globulin and a significant decrease in dehydroepiandrosterone sulphate with benzodiazepine therapy. No significant effects on hair growth were observed. A longer therapy time may be needed to demonstrate effects of benzodiapines on hirsutism. Further studies are needed to determine whether benzodiazepines affect hormonal parameters in normal men and women.

Assessment of the antidepressant activity of dothiepin and its metabolites by preclinical tests

The affinities of dothiepin and its principal metabolites northiaden, dothiepin sulphoxide and northiaden sulphoxide for [3H]imipramine binding sites in the rat cortical homogenates, and for [3H]spiperone and [3H]serotonin receptor sites in preparations from the rat frontal cortex and hippocampus were studied. As inhibitors of [3H]imipramine binding, the strengths of the drugs are, in terms of their IC50 (concentration corresponding to 50% inhibition): dothiepin 2.8 X 10(-6) M, northiaden 5.0 X 10(-6) M, northiaden sulphoxide 4.0 X 10(-5) M and dothiepin sulphoxide 3.2 X 10(-5) M. The potencies of the drugs in inhibiting serotonergic binding followed a similar trend. Using frontal cortical tissue suspensions and [3H]spiperone, the IC50 values were determined to be: dothiepin 4.2 X 10(-6) M, northiaden 5.0 X 10(-6) M, northiaden sulphoxide 1.6 X 10(-4) M and dothiepin sulphoxide 1.6 X 10(-4) M; whereas in hippocampal suspensions and using [3H]serotonin, the IC50 values were 2.5 X 10(-6) M, northiaden 4.0 X 10(-5) M, dothiepin sulphoxide 2.5 X 10(-4) M and northiaden sulphoxide greater than 10(-3) M. The influence of the drugs on the uptake of [14C]serotonin into human platelets was also investigated. All had an inhibitory effect upon the uptake, the order of potency being dothiepin greater than northiaden greater than northiaden sulphoxide greater than dothiepin sulphoxide. Plots of 1/v versus 1/s showed that the inhibition was competitive for all four compounds.

Ligand binding and platelet uptake studies of loxapine, amoxapine and their 8-hydroxylated derivatives

Loxapine, amoxapine and their 8-hydroxylated derivatives were studied by means of [3H]imipramine binding to rat cortical membranes, [3H]spiperone binding to rat striatal membranes, and the inhibition of serotonin uptake by human platelets. As inhibitors of [3H]imipramine binding: amoxapine greater than hydroxyamoxapine greater than loxapine = hydroxyloxapine; as inhibitors of platelet serotonin uptake: hydroxyamoxapine greater than amoxapine greater than hydroxyloxapine greater than loxapine; and as inhibitors of [3H]spiperone binding: loxapine greater than amoxapine greater than hydroxyamoxapine greater than hydroxyloxapine. The antipsychotic properties of loxapine and amoxapine were supported by the binding results, which also indicated the probable antipsychotic activities of the metabolites. All 4 compounds may possess dual action of antidepressant effect as well as antipsychotic effect.

The value or arthrography in the management of internal derangements of the knee: the first 1000 are the worst

The acceptance of arthrography of the knee as an accurate diagnostic procedure by both radiologists and orthopaedic surgeons in the United Kingdom has been slow compared to many other parts of the world. The value of arthrography in the diagnosis of meniscal lesions is discussed with reference to the first 1000 documented cases in the authors' series. It is considered that the results obtained from such early experience is more relevant to those about to start as an arthrographic service. Problems in clinical, arthrographic and arthroscopic diagnosis are discussed. Arthrography constitutes an accurate method of diagnosing such lesions and should be employed whenever clinical doubt about the diagnosis of an internal derangement of the knee is encountered. In a selected group of 137 patients, in whom both arthrography and arthroscopy was performed, the two investigations showed a comparable accuracy of 89.8 and 88.3% respectively.

Pharmacokinetics of N-desmethyldiazepam after a single oral dose of clorazepate: the effect of smoking

The pharmacokinetics of N-desmethyldiazepam was evaluated after oral administration of clorazepate 20 mg to 12 healthy male volunteers (6 smokers; 6 non-smokers), aged 23-29 years. Plasma levels of desmethyldiazepam were measured by gas liquid chromatography. The half life of elimination (t1/2 beta) was significantly longer in the non-smoking volunteers than in the smokers: 54.7 +17.7 versus 29.8 +9.9 h (p less than 0.05). Peak plasma concentrations (Cmax) were higher in non-smokers than in smokers, 413 +106 micrograms/l and 245 +50 micrograms/l, respectively (p less than 0.05). The sedative effect of clorazepate was less severe in smokers than in non-smokers.

Antitumor activity of Listeria monocytogenes on a guinea pig fibrosarcoma

Listeria monocytogenes-mediated tumor inhibition was studied in strain 13 guinea pigs by using a methylcholanthrene-induced fibrosarcoma (MCA-1). Mixtures of Listeria and tumor cells in ratios of 1:100, 1:200, or 1:400 (Listeria:MCA-1 cells) led to significant suppression of tumor growth. Intralesional injection of tumors on day 6 posttransplantation led to the regression of a highly significant number of tumors. Animals receiving injections of Listeria, either in a mixture with tumor cells or intralesionally, displayed enhanced skin test reactivity to a tumor extract. Tumor regressors were resistant for at least 2 to 3 months after the initial transplant to rechallenge with MCA-1 cells. Thus, with this particular tumor-host system, Listeria was successfully employed as an antitumor agent with no visibly detrimental side effects to the host.

Enflurane nephrotoxicity and pre-existing renal dysfunction

This study provides the first morphological evidence of significant structural damage following high doses of enflurane alone and confirms previous findings of transient renal functional abnormalities following high dosage enflurane. The study also indicates that enflurane may have a greater potential for renal toxicity in the presence of renal impairment. Treatment of Fischer 344 rats with a nephrotoxic dose of gentamicin prior to six hours of enflurane (GE) anaesthesia at 1 MAC resulted in increased serum concentration of the enflurance metabolite inorganic fluoride (GE, 43.9 +/- 1.5; E, 34.5 +/- 1.8 mu mol/L), increased urine flow rate and a greater degree of structural damage in renal proximal convoluted tubule cells than was observed with either gentamicin (G) or enflurane (E) alone. Treatment with gentamicin prior to enflurane also resulted in reduced urinary osmolality compared to enflurane or gentamicin alone (GE, 742 +/- 57; E, 1709 +/- 66; G, 985 +/- 32 m0sm/kg).

Subcutaneous ancrod after operation for fractured hip--a dose-ranging and feasibility study

We have conducted a dose-ranging and feasibility study of daily subcutaneous injections of ancrod (Arvin) as a potential antithrombotic method in 28 patients following operation for fractured neck of femur. Sustained, predictable fibrinogen depletion during the first post-operative week was induced by four different regimes. A total dose of 10 units/kg weight, given in divided doses starting on the day of operation, is suggested as a possible antithrombotic regime. Ancrod treatment produced a rise in fibrinogen/fibrin degradation products, prolongation of the thrombin clotting time, and a fall in plasminogen, plasma fibrinogen and corrected blood viscosity were observed in 14 control patients. Plasma fibrinogen was correlated with plasma viscosity and corrected blood viscosity. No adverse effects of treatment occurred. Subcutaneous ancrod appears to be a simple, safe, and feasible potential antithrombotic method, and merits trials of efficacy in the prevention of post-operative thromboembolism.

Bacteriological and histopathological evaluation of guinea pigs after infection with Listeria monocytogenes

Randomly bred guinea pigs were infected with Listeria monocytogenes using the intracardial, intravenous and intraperitoneal routes of infection. Doses of Listeria ranged from 5 to 1,000 x the 50% lethal dose based on the 50% lethal dose for intracardially injected Listeria. A complete necropsy was performed on all animals that died after infection. Gross and microscopic examination of tissues revealed major pathological features which include myocarditis, edema and congestion with interstitial pneumonitis present in the lungs, and fatty hepatic changes with focal necrosis. For all or a majority of the animals, large numbers of Listeria were likewise recovered from these organs and from lymph nodes, spleen, kidneys, and adrenal gland tissue. Of the three routes of infection used, guinea pigs were most susceptible to Listeria injected via the intracardial route. The relatively high lethal dose of listeric for the quinea pig, however, suggests that the organism is a low-grade pathogen for this species.

Gastrointestinal sarcoidosis diagnosed by conjunctival biopsy

Ophthalmologic examination of a 31-year-old black man presenting with an intractable gastric ulcer revealed small conjunctival nodules in the lower cul-desac that were sarcoid granulomas by microscopy. Previous endoscopic examination had revealed polyps in the gastric antrum, and a biopsy and microscopic examination had revealed granulomatous lesions, but a definite diagnosis could not be made until the ophthalmoscopic examination.

Initial experience with a small dedicated computer system in a diagnostic x-ray department

The operation of a small computer system involved in day to day management in an X-ray department is described. The system consists of the following equipment: PDP 8/F central processor with 8K core storage, 32K magnetic disc storage, High-speed paper tape reader (300 characters/s) and punch (50 characters/s), 3 Olivetti TE318 terminals with sprocket feed, paper tape reader and punch (10 characters/s). The system stores patient data relating to name, address, age, ward, referring physician, examination(s) requested, date of request, date of examination, date of report. From this data a large volume of relevant statistics is made available to the department and to the health authority. Labels for identifying record card, film envelope and X-ray films are automatically typed. During reporting coded phrases can be used by the radiologist. Interesting films can be recorded and recalled for library or consultation purposes as can research items. At report typing stage, the report heading is automatically recalled from the computer store. Coded phrases are typed automatically as is the radiologist's name and the date of the report. A 'DAYBOOK' IS TYPED AUTOMatically at the end of each working day. Problems encountered in running the system and future developments are described.