Molecular Phylogenetics of Physa acuta (Pulmonata: Basommatophora): an Invasive species in Central Punjab Pakistan

Physids belong to Class Gastropoda; belong to Phylum Mollusca and being bioindicators, intermediate hosts of parasites and pests hold a key position in the ecosystem. There are three species of Genus Physa i.e. P. fontinalis, Physa acuta and P. gyrina water bodies of Central Punjab and were characterized on the basis of molecular markers High level of genetic diversity was revealed by polymorphic RAPD, however SSR markers were not amplified. The multivariate analysis revealed polymorphism ranging from 9.09 percent to 50 percent among the three Physid species. Total number of 79 loci were observed for the three species under study and 24 loci were observed to be polymorphic. These RAPD fragment(s) can be developed into co dominant markers (SCAR) by cloning and can be further sequenced for the development of the Physa species specific markers to identify the introduced and native species in Pakistan.

Characterization of the species of genus Physa on the basis of typological species concept from Central Punjab

Physids belong to Class Gastropoda; Phylum Mollusca have important position in food web and act as bio indicators, pests and intermediate host. Being resistant these are called cockroaches of malacology. Physid snails were collected from different water bodies of Faisalabad (Punjab) and were identified up to species using morphological markers. The morphometry of the specimens was carried out with the help of a digital Vernier caliper in millimeters (mm) using linear measurement of shell characters. Linear regression analysis of the AL/SW ratio vs AL and SL/SW ratio vs AL indicated that allometric growth exists only in Physa acuta when compared with P.gyrina and P. fontinalis. This study will lead to assess the status of the Physid species in Central Punjab. The Principal component analysis shows that the Component 1 (Shell Length) and component 2 (Shell Width) are the most prolific components and nearly 80 percent of the identification. The distance between P. acuta and P. fontinalis is 5.4699, P. acuta and P. gyrina is 7.6411, P. fontinalis and P. gyrina is 16.6080 showing that P. acuta resembles with P. fontinalis, and both these specimens donot resemble with P. gyrina. P.acuta is an invasive species and shows bioactivity making it a potent candidate for bioactive substances.

Neuromuscular manifestations of lead poisoning in opium and herbal users in Iran

Opium sale is prohibited in Iran, and sellers mix it with lead to increase the weight. Herein, we describe neuromuscular findings in nine patients who developed lead poisoning due to opium/drug consumption. The mean age of patients was 53±3.5 years and their mean blood lead level was 122.6±20.8μg/dL. Most of the patients had an acute/subacute course presenting as axonal or demyelinating sensorimotor polyneuropathy, motor neuron disease, and multiple mononeuropathies with favorable response to the chelation therapy. Lead poisoning should be considered in patients with a history of opium use and neuromuscular symptoms.

Pulmonary overexpression of inhibitor κBα decreases the severity of ventilator-induced lung injury in a rat model

BACKGROUND

Activation of the nuclear factor-κB (NF-κB) pathway is central to the pathogenesis of lung injury and inflammation. We determined whether targeted overexpression of inhibitor-κBα (IκBα) in the lung could decrease the severity of ventilator-induced lung injury (VILI).

METHODS

Anaesthetized adult male Sprague-Dawley rats were randomly allocated to undergo intratracheal instillation of: (i) vehicle alone (surfactant, n=10); (ii) 1×10(10) adeno-associated virus encoding IκBα (AAV-IκBα, n=10); (iii) 5×10(10) AAV-IκBα (n=10); and (iv) 1×10(10) AAV-Null (n=5). This was followed by 4 h of injurious mechanical ventilation. Subsequent experiments examined the effect of IκBα overexpression in animals undergoing 'protective' mechanical ventilation.

RESULTS

IκBα overexpression increased survival duration at both the lower [3.8 h (0.4)] and higher [3.6 h (0.7)] doses compared with vehicle [2.7 h (1.0)] or the null transgene [2.2 h (0.8)]. IκBα overexpression reduced the alveolar-arterial oxygen gradient (kPa) at both the lower [53 (21)] and higher [52 (19)] doses compared with vehicle [75 (8.5)] or the null transgene [70 (15)], decreased alveolar neutrophil infiltration, and reduced alveolar concentrations of interleukin (IL)-1β and IL-10. The lower IκBα dose was as effective as the higher dose. IκBα overexpression had no effect in the setting of protective lung ventilation.

CONCLUSIONS

Inhibition of pulmonary NF-κB activity by IκBα overexpression reduced the severity of VILI in a rat model.

Analysis of cytokines in ECOG E4Z02: A phase III randomized study of l-carnitine supplementation for fatigue in patients with cancer

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Background: The purpose of the study was to investigate associations between fatigue, depression and pain and serum levels of proinflammatory cytokines among pts randomized to l-carnitine supplementation or placebo. Methods: 376 cancer pts with normal hemoglobin and fatigue assessed as moderate or severe were randomized to 4 wks of supplementation with oral carnitine (n=189) or placebo (n=187) 1000 mg bid. Serum levels of 10 inflammatory cytokines and growth factors were measured with Luminex bead ELISA at baseline and 4 wks for 98 pts. Wilcoxon rank sum tests were used to compare cytokine levels between arms and between pts with/without symptoms. Multivariable models of fatigue, depression and pain at 4 wks were examined, adjusting for treatment arm, baseline symptoms and baseline cytokine levels. Results: There were no statistically significant differences in cytokine levels between pts with or without severe fatigue, pain, or depression at baseline. Levels of IL-1rα were higher at baseline among pts randomized to placebo (p=0.01) and increased after 4 wks, while levels among pts randomized to l-carnitine declined (p <0.001). Levels of IFN-γ, TGF-α, IL-6, and TNF-α decreased more among pts randomized to placebo (p=0.008, p=0.006, p=0.01, and p=0.05, respectively). Pts with severe pain at 4 wks had greater declines in levels of EGF, IFN-γ, IL-1α, and IL-1rα than pts without (p=0.05, 0.05, 0.02 and 0.03, respectively). Reductions in IL-1α and TGF-α predicted lower pain severity at 4 wks (p=0.02 and p=0.04, respectively). Conclusions: Levels of proinflammatory cytokines or EGFR ligands failed to distinguish between patients with moderate vs. severe fatigue or levels of depression and pain (severe vs. not) prior to treatment intervention. Lower levels of IL-1α and TGF-α appear to be associated with improvement of pain severity but are not associated with treatment. Mechanisms for these findings require exploration.

No significant financial relationships to disclose.

Phase III randomized, placebo-controlled trial of L-carnitine supplementation for fatigue in patients with cancer

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Background: Carnitine deficiency has been reported in pts with cancer. This study was done to determine the prevalence of carnitine deficiency and the impact of supplementation on fatigue. Methods: Between November 2005 and January 2007, 376 pts with an invasive malignancy and normal hemoglobin levels with fatigue assessed as moderate or severe (score of 2 or higher on “I feel fatigued” question on FACIT-F) within 4 wks were randomized to 4 wks of supplementation with oral carnitine (n=189) or placebo (n=187) 1000 mg twice daily with meals. All pts then received 4 wks of open-label carnitine. Pts were stratified on gender, performance status (PS), and current receipt of chemotherapy. Quality of life was assessed at baseline, wk 4, and wk 8. The study was designed to detect a difference of 0.5 standard deviations in the change of average daily fatigue between the arms at 4 wks using the Brief Fatigue Index (BFI). Results: More than half of pts were male, had metastatic disease and were currently receiving chemotherapy. At study entry, 15% had ECOG PS 2–3, 39% were taking analgesics and 28% were taking antidepressants. There was no difference in the change in scores from baseline to wk 4 on the BFI, FACIT-F, Brief Pain Index (BPI) severity, BPI interference, or CES-D between arms (Wilcoxon p=0.56, 0.62, 0.61, .64, 0.93, respectively). The proportion of pts with severe fatigue or significant depression declined over time on both arms. Carnitine deficiency was defined using the acyl:free carnitine ratio and free carnitine levels. Deficiency levels were 34%, 11%, and 14% among pts randomized to carnitine and 32%, 33%, and 11% among pts randomized to placebo at baseline, wk 4, and wk 8, respectively (p<0.001 at 4 wks). An exploratory analysis suggests an improvement among pts who were carnitine deficient at the beginning of supplementation. Conclusions: Carnitine supplementation reduced deficiency levels but did not have a significant effect on fatigue, pain or depression. Analyses of carnitine metabolites are ongoing.

No significant financial relationships to disclose.

Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast

BACKGROUND

The need for sentinel lymph node (SLN) biopsy in patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) is debated. Advocates recommend such biopsy based on a high incidence of SLN involvement in some series. Opponents discourage SLN biopsy based on a perceived low incidence of nodal involvement in this setting. These contradictory arguments are generally based on small studies. The present study is a meta-analysis of the reported data on the incidence of SLN metastasis in patients with DCIS.

METHODS

A search of electronic databases identified studies reporting the frequency of SLN metastases in DCIS. The random-effects method was used to combine data.

RESULTS

Twenty-two published series were included in the meta-analysis. The estimate for the incidence of SLN metastases in patients with a preoperative diagnosis of DCIS was 7.4 (95 per cent confidence interval (c.i.) 6.2 to 8.9) per cent compared with 3.7 (95 per cent c.i. 2.8 to 4.8) per cent in patients with a definitive (postoperative) diagnosis of DCIS alone. This was a significant difference with an odds ratio of 2.11 (95 per cent c.i. 1.15 to 2.93).

CONCLUSION

Patients with a preoperative diagnosis of DCIS should be considered for SLN biopsy.

The association of HLA-DRB, DQA1, DQB1 alleles and haplotype frequency in Iranian patients with pulmonary tuberculosis

OBJECTIVES

To investigate HLA-DRB1, DQA1 and DQB1 allelic polymorphism in Iranian patients with pulmonary tuberculosis (PTB).

METHODS

Forty patients with smear-positive PTB and 100 healthy individuals as a control group were studied for MHC class II allelic polymorphism by polymerase chain reaction with sequence-specific primers (PCR-SSP). The primer was supplied by biotest in the standard kit. DRB low resolution SSP and DQA, DQB intermediate resolution SSP was applied.

RESULTS

The comparison of the patients and the control group showed a significant increase in the frequency of the HLA-DRB1*07 and DQA1*0101 alleles (OR 2.7, 95%CI 1.19-6.13, P = 0.025 and OR 2.66, 95%CI 1.15-6.44, P = 0.04, respectively) in the patient group. The frequency of DQA1*0301 and DQA1*0501 was also significantly decreased (OR 0.254, 95%CI 0.075-0.865, P = 0.033 and OR 0.53, 95%CI 0.3-0.95, P = 0.045, respectively) in the PTB patients. Concerning haplotype frequency, DRB1*11501, QDQA1*0103 and DQB1*0601 were increased, but this difference was not statistically significant. In the DQB1 locus, DQB1*0501 was non-significantly over-represented.

CONCLUSIONS

HLA-DRB1*07 and HLA-DQA1*0101 appeared to be the predisposing alleles and HLA-DQA1*0301 and 0501 the protective alleles in our patients with TB.

[Computer-assisted navigated cup placement of different cup types in hip arthroplasty--a randomised controlled trial]

AIM

The position of the acetabular implant has a great influence on the outcome of total hip arthroplasty. The acetabular implants differ in their characteristics during insertion. In order to control the influence of the implant in different axes, 80 implantations of acetabular component were performed under computer-assisted control by a surogate navigation system.

METHOD

Within a prospective randomised study, 70 total hip replacements were performed by one surgeon using two different uncemented implants (PPF screw cup/Hedrocel pressfit cup). The position of the cup was measured at different times during surgery and was compared to 10 cemented PE cup placements.

RESULTS

During the milling procedure the anteversion of the two uncemented cups differed significantly (p = 0.026). The standard deviation of anteversion during implantation different significantly relating to the cup type: press-fit cup 3.86 degrees, screw cup 2.1 degrees and cemented PE cups 0,84 degrees. The inclination was less susceptible.

CONCLUSION

The cup design of uncemented acetabular implants influences the outcome of surgery. In our trial a spherical press-fit cup showed a greater variability than the screw-cup. The CAS system can be used as a tool to minimise these effects.

[Using the CAS (computer-assisted surgery) system in arthroscopic cruciate ligament surgery--adaptation and application in clinical practice]

AIM AND METHOD

The anterior cruciate ligament (ACL) is of great importance for the knee joint function. In the case of a complete ligament injury there is hardly any chance for complete recovery. The clear advantages of an operative reconstruction by replacing the ACL has been shown in many trails. The accurate placement of the graft's insertions has a significant effect on the mid- and probably long-term outcome of this procedure. Reviewing the literature, there are poor long-term results of ACL replacement in 5 to 52% of all cases, depending on the score system. One of the main reasons for unacceptable results is graft misplacement. This led to the construction of a CAS system for ACL replacement. The system assists this surgical procedure by navigating the exact position of the drilling holes. The Potential deformation quantity of the transplant can be controlled by this system in real time.

RESULTS

40 computer-assisted ACL replacements have been performed under active use of the CAS system. The short-term results are encouraging, no special complications have been seen so far. Prospective long-term follow-up studies are ongoing.

CONCLUSION

ACL reconstruction by manual devices has many sources of error. The CAS system is able to give the surgeon reasonable views that are unachieveable by conventional surgery. He is therefore able to control a source of error and to optimise the results. The feasibility of this device in clinical routine use has been proven.

[Computer-assisted navigated acetabulum placement in hip prosthesis implantation--application study in routine clinical care]

AIM

This study serves to examine the feasibility of a CAS system in clinical routine use in the field of total hip replacement.

METHOD

Within a prospective study 70 total hip replacements were performed by one surgeon (KB) between March and November, 1999 using a CAS system for preoperative planning and intraoperative cup placement.

RESULTS

The average operating time was 70 min. This means an average increase in total time of operation about 15-20 min. The average blood loss was 630 ml. No additional specific complications due to the use of the system were seen. There was no additional trauma created by percutaneous pointing at the spina or flxing a dynamic reference base (DRB) at the pelvis.

CONCLUSION

The active application of this CAS system in clinical routine use showed very good results in feasibility and can be considered as reliable. The navigated cup placement shows the potential of improving the results in cup placement, thus improving the outcome of hip arthroplasty.

Decreased bone mineral density in prepubertal children with sickle cell disease: correlation with growth parameters, degree of siderosis and secretion of growth factors

Patients with sickle cell disease (SCD) frequently have bone disorders of multifactorial aetiology. We attempted to analyse the relationships between bone mineral density (BMD) on the one hand and auxologic parameters, degree of siderosis, function of the growth hormone (GH)/insulin-like growth factor-I (IGF-I)/IGF-binding protein 3 (IGFBP3) axis, and calcium-phosphate balance in 28 prepubertal children with SCD and 15 age-matched children with constitutional short stature (CSS). Children with SCD had significantly decreased BMD (77.9 +/- 11.9 per cent of normal BMD for age and sex) and circulating concentrations of IGF-I (91 +/- 31 ng/ml) and IGFBP3 (1.7 +/- 0.44 mg/l) compared with the control group (BMD = 93.5 +/- 8.2 per cent of normal BMD for age and sex, IGF-I = 221 +/- 48 ng/ml, and IGFBP3 = 2.3 +/- 0.34 mg/ml). GH response to provocation was defective (peak below 10 micrograms/l) in 40 per cent of children with SCD. Those with SCD with defective GH secretion had significantly lower circulating IGF-I concentration and BMD than those with normal GH secretion. Serum calcium, phosphate and alkaline phosphatase concentrations were normal in all children with SCD. BMD was correlated significantly with height, weight, and body mass index as well as with the circulating concentrations of IGF-I and IGFBP3. It is suggested that increasing the circulating IGF-I concentration, either through increasing the caloric intake of subjects and/or via GH/IGF-I therapy, may improve growth and bone mineralization in these patients.

Rapid commitment to negative selection of a thymocyte line independent of CD4 co-engagement

Biochemical and genetic investigations of thymocyte negative selection will be facilitated by the availability of cultured cell lines representing immature thymocytes, but to date thymocyte lines have demonstrated resistance to Ag receptor-mediated death. It is shown here that a CD4+CD8+ TCR alpha beta+ cell line with a TCR of known Ag and class II MHC specificity (cytochrome c with I-Ek) undergoes Ag dose-dependent apoptotic death in a manner consistent with negative selection of normal thymocytes. In contrast to superantigen-induced selection, apoptosis in this model is unaffected by blocking co-engagement of CD4 and the TCR. At high Ag doses, a significant fraction of thymocytes becomes committed to apoptosis within 2 h of contact with antigen-pulsed APCs, while increased interaction times increase the probability of death. Longer contact periods are required at lower Ag doses. These kinetics of commitment to apoptosis suggest that, in normal negative selection, a thymocyte clone may be deleted after any of several encounters with MHC-bearing cells during progress through the thymus. They also suggest why negative selection predominates when a specific peptide is competent both to delete and to select positively.

Rapid commitment to negative selection of a thymocyte line independent of CD4 co-engagement

Biochemical and genetic investigations of thymocyte negative selection will be facilitated by the availability of cultured cell lines representing immature thymocytes, but to date thymocyte lines have demonstrated resistance to Ag receptor-mediated death. It is shown here that a CD4+CD8+ TCR alpha beta+ cell line with a TCR of known Ag and class II MHC specificity (cytochrome c with I-Ek) undergoes Ag dose-dependent apoptotic death in a manner consistent with negative selection of normal thymocytes. In contrast to superantigen-induced selection, apoptosis in this model is unaffected by blocking co-engagement of CD4 and the TCR. At high Ag doses, a significant fraction of thymocytes becomes committed to apoptosis within 2 h of contact with antigen-pulsed APCs, while increased interaction times increase the probability of death. Longer contact periods are required at lower Ag doses. These kinetics of commitment to apoptosis suggest that, in normal negative selection, a thymocyte clone may be deleted after any of several encounters with MHC-bearing cells during progress through the thymus. They also suggest why negative selection predominates when a specific peptide is competent both to delete and to select positively.

Demonstration of DNA damage/repair in individual cells using in situ end labelling: association of p53 with sites of DNA damage

We describe the development and application of in situ end labelling (ISEL) to identity sites of damaged DNA in the nuclei of individual cells. In cell culture, exposure to a variety of genotoxic agents induced a dose and time-dependent increase in nuclear labelling. In addition, examination of histological sections of human skin exposed to solar-stimulated UV light showed ISEL in both keratinocytes and superficial dermal cells, with the same spatial and temporal distribution as that of a marker of DNA repair, PCNA (proliferating cell nuclear antigen). Using co-localization techniques and confocal microscopy, we found increased levels of p53 in many ISEL-positive cells in vitro, with a similar distribution of labelling in the nucleus. This observation provides further evidence for a direct role of p53 in the recognition of damaged DNA. Thus, ISEL should prove a convenient method for demonstrating genotoxic insult in individual cells and in histological material, and may have value in toxicological screening. This high-resolution microscopy technique can also be used to compare the spatial distribution of various proteins implicated in the response to DNA damage with the sites of the lesion.

Regulation of cell number in the mammalian gastrointestinal tract: the importance of apoptosis

The regulation of cell number in adult tissues is determined by the balance of cell production and cell loss. In the gastrointestinal tract, where there are well defined zones of proliferation and migration of both epithelial cells and associated fibroblasts, it is widely held that cell loss occurs by shedding into the gut lumen. Since the evidence for this is not compelling, we investigated the distribution and amount of apoptosis in the normal mammalian gut. In the stomach, small intestine and colon of rodents and man, there is a small number of apoptotic bodies in the epithelium and in the immediate sub-epithelial connective tissue. Engulfment by adjacent epithelial cells and sub-epithelial macrophages accounts for the removal of apoptotic bodies. Apoptotic bodies are not randomly distributed but are found towards the distal end of the known cellular migration routes of both epithelial and mesenchymal cells. Furthermore, consideration of the absolute numbers of apoptotic bodies, their rapid clearance and the dimensions of the small intestinal villi and colonic crypts indicates that the cell loss in the normal murine intestine can largely be explained on the basis of the observed apoptosis. Despite being inconspicuous in histological material, apoptosis probably accounts for the bulk of cell loss in the gut and is a central feature of the regulation of cell number in adult tissues.

In situ end-labelling detects DNA strand breaks in apoptosis and other physiological and pathological states

We have investigated the use of a novel technique, in situ end-labelling, as a means of the specific identification of apoptotic cells in formalin-fixed, paraffin-processed tissue sections. The technique relies on the presence of DNA strand breaks in apoptotic cells, caused by activation of endogenous nuclease activity during the process of cell death. These strands are labelled with a non-isotopic reporter molecule in the presence of a DNA polymerase, and labelled DNA is identified immunohistochemically. We show that in situ end-labelling stains cells with the morphological characteristics of apoptosis, and greatly simplifies their identification. Furthermore, in two model systems, the number of labelled cells parallels the number of cells undergoing apoptosis as measured by alternative techniques. The ability of the Klenow fragment of DNA polymerase to label apoptotic nuclei suggests that the characteristic DNA fragmentation seen during this process involves the formation of DNA breaks with a 5' overhang. In situ end-labelling will be valuable for the identification and quantitation of apoptosis in a range of normal tissues and in a variety of pathological states. However, the technique is not specific for programmed cell death, and results must be interpreted with caution and correlated with morphological criteria of apoptosis.

Expression of the nuclear membrane protein statin in cycling cells

Statin is a 57 kD protein previously reported to be expressed by cells in G0. We have studied the detailed distribution of statin immunoreactivity in normal human and rat tissues, and correlated this with investigation of in vitro model systems. By laser confocal microscopy, statin immunoreactivity is localized to the nuclear membrane. In contrast to previous reports, using in vitro model systems we found that statin was also expressed by replicating cells as judged by both co-localization with [3H]thymidine-labelled and Ki67-labelled cells. Furthermore, in a nude mouse xenograft model the number of statin-labelled cells exceeded the number of quiescent cells as assessed by both fraction of labelled mitosis methods and labelling with [3H]thymidine and Ki67. We conclude that although there is an association between expression of the 57 kD nuclear membrane protein statin and growth arrest, this is not absolute and it is expressed in a sub-population of cycling cells. The properties of statin closely resemble those of nuclear lamins, members of the intermediate filament family.

Epithelial proliferation in Barrett's esophagus by proliferating cell nuclear antigen immunolocalization

Proliferating cell nuclear antigen (PCNA) is an auxiliary protein to DNA polymerase delta and is an absolute requirement for cellular proliferation. Specialized-type Barrett's columnar-lined esophagus (CLE) is associated with adenocarcinomatous change. In the present study, the cellular proliferation of three histological types of CLE was assessed by semiquantitative evaluation of PCNA immunolocalization in 93 biopsy specimens from 45 patients using the murine monoclonal PC10. Statistical comparison was performed by the Mann-Whitney U test. Luminal surface cell labeling was uncommon in all histological types other than specialized CLE where 25 of the 43 biopsy specimens had at least occasional luminal surface cell labeling. Mean crypt labeling score of 4.06 for specialized type exceeded that for junctional (mean, 3.12; P < 0.001) and fundic types (mean, 1.6; P < 0.001). Gland cell PCNA staining scores for specialized-type CLE (mean, 3.18) exceeded that of junctional (mean, 1.97; P < 0.001) and fundic (mean, 1.04; P < 0.001). Summated PCNA scores for specialized-type, mean of 8.29, exceeded junctional mean score of 5.45 (P < 0.001) and fundic mean score of 2.76 (P < 0.001). PCNA immunolocalization reveals a high proportion of cells in cycle in the specialized-type CLE and expansion of the proliferative compartment, which may explain the association of specialized-type CLE with malignancy.