Prognostic Factors for Pediatric, Adolescent, and Young Adult Patients with Non-DIPG Grade 4 Gliomas: A Contemporary Pooled Institutional Experience

PURPOSE/OBJECTIVE(S)

WHO grade 4 gliomas are rare tumors in the pediatric and AYA (adolescent and young adult) population. In this study, we evaluate prognostic factors, toxicities, and outcomes in the pediatric versus AYA population.

MATERIALS/METHODS

This retrospective pooled institutional study included patients < 30 years old with grade 4 gliomas. Overall survival (OS) and progression free survival (PFS) were characterized using Kaplan-Meier and Cox regression analysis.

RESULTS

Ninety-seven patients (n = 20 < 15y, n = 77 ≥ 15y) were identified with a median age 23.9y at diagnosis. Most had biopsy-proven glioblastoma (91%) and the remainder had diffuse midline glioma, H3K27M-altered (9%). All patients received surgery and adjuvant radiotherapy. Median PFS and OS were 20.9 months and 79.4 months, respectively. Gross total resection was associated with better PFS in multivariate analysis [HR 2.00 (1.01-3.62), p = 0.023]. Age ≥15y was also associated with improved OS [HR 0.36 (0.16-0.81), p = 0.014] while female gender [HR 2.12 (1.08-4.16), p = 0.03] and K27M altered histology [HR 2.79 (1.11-7.02), p = 0.029] were associated with worse OS. Only 7% of patients experienced grade 2 toxicity during radiation. Sixty-two percent of patients experienced tumor progression, 28% local and 34% distant. Analysis of salvage treatment found reirradiation was not associated with improved OS, but second surgery and systemic therapy significantly improved survival from the time of tumor progression.

CONCLUSION

Age is a significant prognostic factor in WHO grade 4 glioma, which may reflect age-related molecular alterations in the tumor. Diffuse midline glioma was associated with worse OS compared to hemispheric glioblastoma; this may be related to lack of effective targeted therapies. Surgery and systemic therapy were effective salvage options that significantly improved outcome. Better understanding of prognostic factors may guide future treatment within this understudied patient population, and prospective studies are warranted.

The Implementation of Preeclampsia Screening and Prevention (IMPRESS) Study

BACKGROUND

Preeclampsia affects between 2% and 5% of pregnancies and is one of the leading causes of perinatal morbidity and mortality worldwide. Despite strong evidence that the combination of systematic preeclampsia screening based on the Fetal Medicine Foundation preeclampsia risk calculation algorithm with treatment of high-risk patients with low-dose aspirin reduces the incidence of preterm preeclampsia more than currently used risk-factor-based screening, real-world implementation studies have not yet been done in Canada.

OBJECTIVE

This study aimed to assess the operational feasibility of implementing first-trimester screening and prevention of preterm preeclampsia (<37 weeks) alongside a publicly funded first-trimester combined screening program for aneuploidies.

STUDY DESIGN

This was a prospective implementation study. Consecutive pregnant patients referred for first-trimester combined screening (11-13+6 weeks) were offered screening for preeclampsia based on the Fetal Medicine Foundation algorithm concomitantly with their aneuploidy screen. Consenting participants were screened using maternal risk factors, mean arterial pressure, uterine artery Doppler pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor. Risk for preterm preeclampsia (<37 weeks) was calculated using the Fetal Medicine Foundation algorithm, and individuals with a risk score ≥1 per 100 were recommended to use aspirin (162 mg once daily at bedtime, <16-36 weeks). Implementation metrics assessed included: acceptability, operational impact, proportion of aspirin initiation, quality and safety measures, and screen performance.

RESULTS

Between December 1, 2020 and April 23, 2021, 1124 patients consented to preeclampsia screening (98.3% uptake), and 92 (8.2%) screened positive. Appointments for patients receiving first-trimester combined screening aneuploidy and preeclampsia screening averaged 6 minutes longer than first-trimester combined screening alone, and adding uterine artery Doppler pulsatility index averaged 2 minutes. Of the 92 patients who screened as high-risk for preeclampsia, 72 (78.3%) were successfully contacted before 16 weeks' gestation. Of these, 62 (86.1%) initiated aspirin, and 10 (13.9%) did not. Performance audit identified a consistent negative bias with mean arterial pressure measurements (median multiple of the median <1 in 10%); other variables were satisfactory. There were 7 cases of preterm preeclampsia (0.69%): 5 and 2 in the high- and low-risk groups, respectively. Screening detected 5 of 7 (71.4 %) preterm preeclampsia cases, with improved performance after adjustment for aspirin treatment effect.

CONCLUSION

This study confirms the operational feasibility of implementing an evidence-based preeclampsia screening and prevention program in a publicly funded Canadian setting. This will facilitate implementation into clinical service and the scaling up of this program at a regional and provincial level.

Factors influencing interprofessional team collaboration when delivering care to community-dwelling seniors: A metasynthesis of Canadian interventions

The rapid growth in the proportion of adults over the age of 65 translates into greater need of complex, highly specialized care. Hence, coupled with other factors, healthcare expenditures in Canada have grown exponentially, creating tension for a high-quality care while managing costs. Interventions with community-based interprofessional teams have been piloted across Canada as a means to provide efficient specialized care. These teams must, however, work collaboratively for a more comprehensive and patient-centered care. This metasynthesis aimed to identify common factors or characteristics found to be essential for a collaborative practice among members of an interdisciplinary team delivering coordinated care to community-dwelling seniors in both rural and urban centers in Canada. Six databases (Medline, CINAHL, Sage, JSTOR, ProQuest, Web of Science) were searched for qualitative peer-reviewed articles on community-based interventions with interprofessional teams in Canada and published between 2005-2018. Six articles were included and appraised using the COREQ guidelines for quality, followed by a thematic analysis for common themes related to team collaboration. Overarching themes related to practices of interprofessional collaboration were trust and respect, communication, and shared vision. Sub-themes included trust in the relationship between health care professional, professional identity and role clarity, interprofessional communication, communication with the client or family, and common goals. Interprofessional teams work collaboratively when trust and respect, communication, and shared vision are valued and present. Agencies coordinating interprofessional teams for community-based care could be pivotal in ensuring an environment conducive to collaboration, such as learning and team building opportunities.

Adolescent forced swim stress increases social anxiety-like behaviors and alters kappa opioid receptor function in the basolateral amygdala of male rats

Adolescence is a developmental period marked by robust neural alterations and heightened vulnerability to stress, a factor that is highly associated with increased risk for emotional processing deficits, such as anxiety. Stress-induced upregulation of the dynorphin/kappa opioid receptor (DYN/KOP) system is thought to, in part, underlie the negative affect associated with stress. The basolateral amygdala (BLA) is a key structure involved in anxiety, and neuromodulatory systems, such as the DYN/KOP system, can 1) regulate BLA neural activity in an age-dependent manner in stress-naïve animals and 2) underlie stress-induced anxiety in adults. However, the role of the DYN/KOP system in modulating stress-induced anxiety in adolescents is unknown. To test this, we examined the impact of an acute, 2-day forced swim stress (FSS - 10 min each day) on adolescent (~postnatal day (P) 35) and adult Sprague-Dawley rats (~P70), followed by behavioral, molecular and electrophysiological assessment 24 h following FSS. Adolescent males, but not adult males or females of either age, demonstrated social anxiety-like behavioral alterations indexed via significantly reduced social investigation and preference when tested 24 h following FSS. Conversely, adult males exhibited increased social preference. While there were no FSS-induced changes in expression of genes related to the DYN/KOP system in the BLA, these behavioral alterations were associated with alterations in BLA KOP function. Specifically, while GABA transmission in BLA pyramidal neurons from non-stressed adolescent males responded variably (potentiated, suppressed, or was unchanged) to the KOP agonist, U69593, U69593 significantly inhibited BLA GABA transmission in the majority of neurons from stressed adolescent males, consistent with the observed anxiogenic phenotype in stressed adolescent males. This is the first study to demonstrate stress-induced alterations in BLA KOP function that may contribute to stress-induced social anxiety in adolescent males. Importantly, these findings provide evidence for potential KOP-dependent mechanisms that may contribute to pathophysiological interactions with subsequent stress challenges.

Comprehensive genomic profiles of metastatic and relapsed salivary gland carcinomas are associated with tumor type and reveal new routes to targeted therapies

Background

Relapsed/metastatic salivary gland carcinomas (SGCs) have a wide diversity of histologic subtypes associated with variable clinical aggressiveness and response to local and systemic therapies. We queried whether comprehensive genomic profiling could define the tumor subtypes and uncover clinically relevant genomic alterations, revealing new routes to targeted therapies for patients with relapsed and metastatic disease.

Patients and methods

From a series of 85 686 clinical cases, DNA was extracted from 40 µm of formalin-fixed paraffin embedded (FFPE) sections for 623 consecutive SGC. CGP was carried out on hybridization-captured, adaptor ligation-based libraries (mean coverage depth, >500×) for up to 315 cancer-related genes. Tumor mutational burden was determined on 1.1 Mb of sequenced DNA. All classes of alterations, base substitutions, short insertions/deletions, copy number changes, and rearrangements/fusions were determined simultaneously.

Results

The clinically more indolent SGC including adenoid cystic carcinoma, acinic cell carcinoma, polymorphous low-grade adenocarcinoma, mammary analog secretory carcinoma, and epithelial-myoepithelial carcinomas have significantly fewer genomic alterations, TP53 mutations, and lower tumor mutational burden than the typically more aggressive SGCs including mucoepidermoid carcinoma, salivary duct carcinoma, adenocarcinoma, not otherwise specified, carcinoma NOS, and carcinoma ex pleomorphic adenoma. The more aggressive SGCs are commonly driven by ERBB2 PI3K pathway genomic alterations. Additional targetable GAs are frequently seen.

Conclusions

Genomic profiling of SGCs demonstrates important differences between traditionally indolent and aggressive cancers. These differences may provide therapeutic options in the future.

Interprofessional collaboration and the care and management of type 2 diabetic patients in the Middle East: A systematic review

The World Health Organization has ranked the Middle East (ME) as the second most prevalent region globally for type 2 diabetes. Currently, treatment options initiated by physicians focus mainly on pharmaceuticals; however, lifestyle factors also have a tremendous impact on a patient's wellness or illness. A potential solution to this issue is to use an interprofessional team approach when caring for this patient population. The purpose of this systematic review is to look at the present literature involving the use of an interprofessional team approach to the care and maintenance of people with type 2 diabetes in the ME. A PRISMA flow diagram demonstrates the authors' literature search and screening process. The systematic review includes nine studies with mixed-methodologies performed in the Middle Eastern region in an outpatient or primary care setting, and demonstrates the use of interprofessional collaboration when providing care for type 2 diabetic patients. A meta-analysis was not included due to the heterogeneity of the studies; however, data analysis is discussed and results are demonstrated through an extraction tool developed by the authors based on The Cochrane Collaboration's data collection form. The aim of this review is to construct meaning surrounding the use and effectiveness of this collaborative approach with the adult and geriatric Middle Eastern diabetic patient population. Recommendations include continued support from multiple healthcare professions, involving nurses, pharmacists, dietitians, and physicians to promote holistic and patient-centred-care leading to fewer type 2 diabetes complications and hospital admissions.

Characteristics of a four element gyromagnetic nonlinear transmission line array high power microwave source

In this paper, a solid-state four element array gyromagnetic nonlinear transmission line high power microwave system is presented as well as a detailed description of its subsystems and general output capabilities. This frequency agile S-band source is easily adjusted from 2-4 GHz by way of a DC driven biasing magnetic field and is capable of generating electric fields of 7.8 kV/m at 10 m correlating to 4.2 MW of RF power with pulse repetition frequencies up to 1 kHz. Beam steering of the array at angles of ±16.7° is also demonstrated, and the associated general radiation pattern is detailed.

Abstract P1-10-20: Importance of the patient voice in drug development: Early-stage breast cancer and measurement gaps concerning the treatment experience

Background: Most early-stage breast cancer (EBC) patients (pts) do not experience signs or symptoms of disease; approximately 90% of women diagnosed in breast screening are asymptomatic in the US (Ryerson et al. 2015). Rather, side effects of cancer therapy have the greatest impact and can be burdensome to pts on and after treatment. Bother and impact have not been thoroughly assessed from the patient perspective in trials. Qualitative research with 56 pts undergoing or completing (after 3 and within 24 mos of) systemic treatment were conducted to assess the need for EBC-focused patient-reported outcome (PRO) measures.

Methods: Semi-structured interviews were conducted to better understand the treatment experience; the interview guide was developed in consultation with breast cancer advocates who were former pts. The interview sample was determined to capture findings across EBC therapies (HER2-targeted [HER2], hormone/endocrine [H/E], and/or chemotherapy [CT]). Treatment experience, including treatment-related symptoms and treatment impact (e.g. on activities of daily living, emotional aspects) were discussed in each 90-minute session. Pts rated level of bother of symptoms and impacts on an 11-point scale. Disease stage, treatment received, surgery, and other health information was collected from medical charts. Qualitative analysis was conducted with ATLAS.ti software. Symptom data was reviewed to appropriately analyze therapy subgroups.

Results: Stage Ia (17.9%), Ib (14.3%), IIa (32.1%), IIb (25.0%), or IIIa (7.1%) pts that received adjuvant (75%) or neoadjuvant (25%) therapy participated; 106 unique treatment-related symptoms were reported. Symptoms most frequently reported included hair loss (86.7%), change in taste (73.3%), and tiredness/fatigue (71.1%) on CT (n=45); tiredness/fatigue (34.8%), runny nose (26.1%), and watery eyes (21.7%) on HER2 (n=23); and hot flashes (50.0%), joint pain (37.5%), and weight gain (20.1%) on H/E (n=24). The most common symptoms reported after therapy completion included memory loss (63.6%), symptoms of neuropathy (numbness, tingling, and pain in fingers, 63.6%), and tiredness/fatigue (45.5%) (n=11). CT symptoms rated by ≥ 25% of pts that were most bothersome included tiredness/fatigue (x -=8.2, n=18**), hair loss (x -=8.2, n=32**), and memory loss (x -=7.7, n=15**). HER2 and H/E ratings of bother were less frequent. EBC treatment was associated with significant impact on pts' lives; categories described are below:

Impact category Average bother rating* (n**)Concerns with treatment9.5 (2)Physical/functional7.7 (36)Work or school7.5 (37)Sleep7.5 (21)Daily tasks and activities7.4 (95)Emotional7.4 (62)Sexual behavior7.1 (22)Cognitive function6.8 (6)Social6.7 (54)Appearance6.5 (32)* Rating on 11-pt scale; 0=none to 10=extremely bothersome ** n=number of patients rating the level of bother

Conclusion: Treatment-related symptoms and associated degree of bother differed by treatment group. Pts' descriptions of treatment impact provided additional insight into the burden of EBC. EBC-specific PROs included in trials that gain pts' perspective on experience with treatment would further inform pts and may also inform therapy choice.

Citation Format: Petersen JA, Gauthier MA, Piault E, DeBusk KPA, Buzaglo JS, Eng-Wong J, Glazer JR, Green MC, Johnson JM, Spears PA, Evans CJ. Importance of the patient voice in drug development: Early-stage breast cancer and measurement gaps concerning the treatment experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-20.

Material selection of a ferrimagnetic loaded coaxial delay line for phasing gyromagnetic nonlinear transmission lines

Implementing nonlinear transmission line (NLTL) technology in the design of a high power microwave source has the benefits of producing a comparatively small and lightweight solid-state system where the emission frequency is easily tuned. Usually, smaller in physical size, single NLTLs may produce significantly less power than its vacuum based counterparts. However, combining individual NLTL outputs electrically or in free-space is an attractive solution to achieve greater output power. This paper discusses a method for aligning a four element NLTL antenna array with coaxial geometry using easily adjustable temporal delay lines. These delay lines, sometimes referred to as pulse shock lines or pulse sharpening lines, are placed serially in front of the main NLTL line. The propagation velocity in each delay line is set by the voltage amplitude of an incident pulse as well as the magnetic field bias. Each is adjustable although for the system described in this paper, the voltage is held constant while the bias is changed through applying an external DC magnetic field of varying magnitude. Three different ferrimagnetic materials are placed in the temporal delay line to evaluate which yields the greatest range of electrical delay with the least amount of variability from consecutive shots.

Effects of twenty percent alkaline-treated corn stover without or with yucca extract on performance and nutrient mass balance of finishing steers fed modified distillers grains-based diets

Two experiments were conducted with 192 steers each (during the winter [November to May] or summer [June to October]) to evaluate 3 diets with or without Yucca schidigera extract in a 3 × 2 factorial on steer growth performance and N mass balance. One factor was diet (DM basis): 1) 5% untreated corn stover, 51% corn, and 40% modified distillers grains plus solubles (MDGS; CON); 2) 20% calcium oxide-treated corn stover (CaO added at 5% of stover DM), 40% MDGS, and 36% corn (TRT); or 3) 20% untreated corn stover, 40% MDGS, and 36% corn (NONTRT). The other factor was dietary extract at 0 (NOYE) or 1.0 g/d per steer (YE). No interaction between diet and YE was detected (P > 0.51) for growth performance and carcass traits in winter and only for DMI in summer. Final BW, ADG, DMI, or G:F were not different (P ≥ 0.28) between cattle fed CON and TRT, whereas cattle fed NONTRT had lesser ADG, HCW, and G:F compared to CON and TRT in the winter experiment. During the summer, final BW and ADG tended to be greater (P ≥ 0.07) for CON compared to TRT. Cattle fed TRT had reduced (P < 0.01) G:F compared to CON. No difference was observed (P ≥ 0.36) between YE and NOYE in the winter experiment for performance or carcass traits. In the summer, cattle fed YE had greater (P < 0.02) HCW, ADG, and DMI compared to NOYE. In the summer experiment, cattle fed YE had greater (P < 0.01) N intake, N excretion, and amount of N lost (kg/steer) compared to NOYE, but no difference (P = 0.33) was observed for percentage of N volatilized (% of excretion). Diet had no effect (P > 0.18) on amount (kg/steer) or percentage of N volatized in the winter or summer. All diets had similar amounts (P > 0.13) of DM and OM removed from the pen surface in both summer and winter. Feeding CaO-treated corn stover as a partial grain replacement had no impact on performance in winter but decreased G:F in summer. Although high-fiber diets increased the amount of OM on pen surfaces, they did not impact N volatilized. Feeding a Y. schidigera extract did not affect N balance or manure characteristics.

Costs and benefits of non-invasive fetal RhD determination

OBJECTIVE

Non-invasive fetal Rhesus (Rh) D genotyping, using cell-free fetal DNA (cffDNA) in the maternal blood, allows targeted antenatal anti-RhD prophylaxis in unsensitized RhD-negative pregnant women. The purpose of this study was to determine the cost and benefit of this approach as compared to routine antenatal anti-RhD prophylaxis for all unsensitized RhD-negative pregnant women, as is the current policy in the province of Alberta, Canada.

METHODS

This study was a decision analysis based on a theoretical population representing the total number of pregnancies in Alberta over a 1-year period (n = 69 286). A decision tree was created that outlined targeted prophylaxis for unsensitized RhD-negative pregnant women screened for cffDNA (targeted group) vs routine prophylaxis for all unsensitized RhD-negative pregnant women (routine group). Probabilities at each decision point and costs associated with each resource were calculated from local clinical and administrative data. Outcomes measured were cost, number of women sensitized and doses of Rh immunoglobulin (RhIG) administered.

RESULTS

The estimated cost per pregnancy for the routine group was 71.43 compared with 67.20 Canadian dollars in the targeted group. The sensitization rates per RhD-negative pregnancy were equal, at 0.0012, for the current and targeted programs. Implementing targeted antenatal anti-RhD prophylaxis would save 4072 doses (20.1%) of RhIG over a 1-year period in Alberta when compared to the current program.

CONCLUSIONS

These data support the feasibility of a targeted antenatal anti-RhD prophylaxis program, at a lower cost than that of the existing routine prophylaxis program, with no increased risk of sensitization.

Bias-field controlled phasing and power combination of gyromagnetic nonlinear transmission lines

Gyromagnetic Nonlinear Transmission Lines (NLTLs) generate microwaves through the damped gyromagnetic precession of the magnetic moments in ferrimagnetic material, and are thus utilized as compact, solid-state, frequency agile, high power microwave (HPM) sources. The output frequency of a NLTL can be adjusted by control of the externally applied bias field and incident voltage pulse without physical alteration to the structure of the device. This property provides a frequency tuning capability not seen in many conventional e-beam based HPM sources. The NLTLs developed and tested are mesoband sources capable of generating MW power levels in the L, S, and C bands of the microwave spectrum. For an individual NLTL the output power at a given frequency is determined by several factors including the intrinsic properties of the ferrimagnetic material and the transmission line structure. Hence, if higher power levels are to be achieved, it is necessary to combine the outputs of multiple NLTLs. This can be accomplished in free space using antennas or in a transmission line via a power combiner. Using a bias-field controlled delay, a transient, high voltage, coaxial, three port, power combiner was designed and tested. Experimental results are compared with the results of a transient COMSOL simulation to evaluate combiner performance.

Abstract P4-11-04: Targeted vaccination against human a-lactalbumin may provide immunotherapy and immunoprevention of triple negative breast cancer

We have previously shown that a-lactalbumin vaccination mediates protection against the development of murine breast cancer in the absence of any detectable inflammatory changes in all normal non-lactating tissues examined. Based on these results, we have proposed that α-lactalbumin vaccination of healthy, cancer-free, adult women may provide safe and effective immunoprevention of breast cancer. Several issues have been raised over the past several years questioning the feasibility of applying this autoimmune strategy for breast cancer immunoprevention in the normal, healthy, cancer-free adult female population. These concerns have focused on whether adult women would be immunologically responsive to human α-lactalbumin, whether a history of lactation would create an insurmountable tolerance that would preclude generating effective immunity against α-lactalbumin, whether α-lactalbumin is immunologically available in human breast tumors, and whether expression of α-lactalbumin in normal non-breast tissues would predispose to systemic autoimmune complications. Here we provide an accumulation of several new findings that directly address these issues: 1) In vitro priming of peripheral blood mononuclear cells (PBMC) from normal healthy adult women results in frequencies of α-lactalbumin-specific interferon-gamma (IFNγ) producing T cells that are consistent with those mediating protection against breast tumor formation in mice; 2) Frequencies of IFNγ-producing T cells and the level of protection from the development of breast tumors are virtually identical whether vaccination occurs in parous mice with a history of lactation and breastfeeding or whether vaccination occurs in non-parous mice with no history of lactation; 3) ONCOMINE data base searches repeatedly show highly significant overexpression of α-lactalbumin in triple negative breast cancer (TNBC). This expression was confirmed experimentally using several methods including RT-PCR, Western blot analysis, and longitudinal visualization of α-lactalbumin gene expression during in vivo growth of human TNBC in immunodeficient mice. This in vivo visualization of α-lactalbumin gene expression was facilitated by measuring bioluminescence from growing human HCC1937 TNBC cells stably transfected with a lentivirus designed to regulate firefly luciferase expression under control of the human α-lactalbumin promoter; and 4) Evidence from the Human Protein Atlas indicates negative immunohistochemical staining for α-lactalbumin in 78 normal human tissues examined, thereby confirming the widely held view that α-lactalbumin expression in normal human tissues is confined exclusively to the lactating breast. Collectively, these findings indicate that normal, healthy, adult women are capable of mounting an immune response to human α-lactalbumin, that a history of lactation and breastfeeding has no impact on the induced immunity and the protection it provides against the development of breast cancer, and that α-lactalbumin vaccination may be most effective in providing therapy and immmunoprevention of TNBC, the most aggressive form of breast cancer and the most common variant occurring in women with BRCA1 mutations (supported by NIH R01 CA140350).

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-11-04.

Postgraze assessment of toxicosis symptoms for steers grazed on toxic endophyte-infected tall fescue pasture

A 2-yr pen experiment was conducted using 12 different crossbred Angus steers each year to determine if short-term changes in prolactin concentrations, body temperature, and vasoconstriction reflect recovery from fescue toxicosis after steers that previously grazed toxic endophyte (Neotyphodium coenophialum)-infected Kentucky 31 tall fescue [Lolium arundinaceum (Schreb.) Darbysh] are placed on nontoxic feed. Groups of 6 steers from toxic endophyte-infected and endophyte-free tall fescue grazing treatments were blocked by BW for assignment to pens as a randomized complete block design with 2 replications. Two environments were implemented by initiating the experiment on 18 August in yr 1 and on 8 September in yr 2 for durations of 30 and 21 d, respectively. Rectal temperatures were recorded, jugular blood was collected for assaying serum prolactin, and cross sections of the caudal artery were ultrasonically imaged at selected time points to evaluate temporal changes in the response variables. Rectal temperatures in steers on the toxic endophyte pasture treatment declined (P < 0.05) linearly over time in yr 1 and 2 and were similar (P > 0.10) to those on endophyte-free treatment on d 30 in yr 1 and by d 15 in yr 2. Prolactin concentrations in steers on the toxic endophyte pasture treatment showed curvilinear increases (P < 0.05) over time and were similar (P > 0.10) to steers on the endophyte-free treatment by d 15 in yr 1 and by d 10 in yr 2. Luminal areas of the caudal artery in toxic endophyte steers were less (P < 0.05) than those in endophyte-free steers across all dates in both years. Results indicated that rectal temperatures in steers after they are removed from toxic fescue may decrease over time, but temporal changes in rectal temperatures could be affected more by prevailing ambient temperatures than by actual mitigation of fescue toxicosis. Prolactin concentrations in steers after they are removed from toxic endophyte tall fescue can increase and stabilize in less than 2 wk, but alkaloid-induced vasoconstriction that causes a vulnerability to severe heat stress is not alleviated within 30 d.

Quality of extracranial carotid evaluation with 256-section CT

BACKGROUND AND PURPOSE

To date, no systematic evaluation of image quality has been performed on the 256-section multidetector CT scanner for extracranial carotid evaluations. We evaluated image quality, patient dose, and examination time and compared these parameters with a 64-section multidetector CT.

MATERIALS AND METHODS

We reviewed extracranial CTA scans obtained on a 256-detector CT scanner in 50 consecutive patients. Image quality was analyzed for artifacts and vessel contrast opacification from the aortic arch to the skull base, dose to patient, and scan time. Results were compared with a control group of 50 patients imaged on a 64-section CT scanner. A Fisher exact test was used to analyze both groups with respect to vessel contrast opacification and presence of artifacts, and a Student t test was used to assess differences in patient dose between the 2 groups.

RESULTS

Quantitative and qualitative evaluations revealed >95% acceptable vessel opacification at all levels measured on the 256-section scanner. Scan time was improved (4 seconds on 256-channel). There were fewer artifacts related to metallic streak on the 256-channel CTA study, and DLP was lower on the 256-channel CTA (113.9 versus 159.8 mGy).

CONCLUSIONS

The 256-channel CTA imaging protocol for carotid arteries yielded similar vessel contrast opacification compared with the 64-channel CTA but with fewer metallic artifacts, a modest decrease in scan time, similar image quality, and a statistically significant reduction in radiation dose of 10%.

Antagonism of lateral saphenous vein serotonin receptors from steers grazing endophyte-free, wild-type, or novel endophyte-infected tall fescue

Pharmacologic profiling of serotonin (5HT) receptors of bovine lateral saphenous vein has shown that cattle grazing endophyte-infected (Neotyphodium coenophialum) tall fescue (Lolium arundinaceum) have altered responses to ergovaline, 5HT, 5HT2A, and 5HT7 agonists. To determine if 5HT receptor activity of tall fescue alkaloids is affected by grazing endophyte-free (EF), wild-type [Kentucky-31 (KY31)], novel endophyte AR542-infected (MAXQ), or novel endophyte AR584-infected (AR584) tall fescue, contractile responses of lateral saphenous veins biopsied from cattle grazing these different fescue-endophyte combinations were evaluated in presence or absence of antagonists for 5HT2A (ketanserin) or 5HT7 (SB-269970) receptors. Biopsies were conducted over 2 yr on 35 mixed-breed steers (361.5 ± 6.3 kg) grazing EF (n = 12), KY31 (n = 12), MAXQ (n = 6), or AR584 (n = 5) pasture treatments (3 ha) between 84 and 98 d (Yr 1) or 108 to 124 d (Yr 2). Segments (2 to 3 cm) of vein were surgically biopsied, sliced into 2- to 3-mm cross-sections, and suspended in a myograph chamber containing 5 mL of oxygenated Krebs-Henseleit buffer (95% O2/5% CO2; pH = 7.4; 37°C). Veins were exposed to increasing concentrations of 5HT, ergovaline, and ergovaline + 1 × 10(-5) M ketanserin or + 1 × 10(-6) M SB-269970 in Yr 1. In Yr 2, ergotamine and ergocornine were evaluated in presence or absence of 1 × 10(-5) M ketanserin. Contractile response data were normalized to a reference addition of 1 × 10(-4) M norepinephrine. In Yr 1, contractile response to 5HT and ergovaline were least (P < 0.05) in KY31 pastures and the presence of ketanserin greatly reduced (P < 0.05) the response to ergovaline in all pastures. However, presence of SB-269970 did not (P = 0.91) alter contractile response to ergovaline. In Yr 2, there was no difference in contractile response to ergotamine (P = 0.13) or ergocornine (P = 0.99) across pasture treatments, but ketanserin reduced (P < 0.05) the contractile response to both alkaloids. The 5HT2A receptor is involved in alkaloid-induced vascular contraction and alkaloid binding may be affected by exposure to different endophyte-fescue combinations.

Isolation and characterization of the ecdysone receptor and its heterodimeric partner ultraspiracle through development in Sciara coprophila

Regulation of DNA replication is critical, and loss of control can lead to DNA amplification. Naturally occurring, developmentally regulated DNA amplification occurs in the DNA puffs of the late larval salivary gland giant polytene chromosomes in the fungus fly, Sciara coprophila. The steroid hormone ecdysone induces DNA amplification in Sciara, and the amplification origin of DNA puff II/9A contains a putative binding site for the ecdysone receptor (EcR). We report here the isolation, cloning, and characterizing of two ecdysone receptor isoforms in Sciara (ScEcR-A and ScEcR-B) and the heterodimeric partner, ultraspiracle (ScUSP). ScEcR-A is the predominant isoform in larval tissues and ScEcR-B in adult tissues, contrary to the pattern in Drosophila. Moreover, ScEcR-A is produced at amplification but is absent just prior. We discuss these results in relation to the model of ecdysone regulation of DNA amplification.

The California Pertussis Epidemic 2010: A Review of 986 Pediatric Case Reports From San Diego County

BACKGROUND

The California Department of Public Health (CDPH) declared a pertussis epidemic on 23 June 2010. More cases were reported in 2010 (9146) than in any year since 1947. We describe the characteristics of pertussis epidemiology and disease from 986 reported cases in children in San Diego County (population 3.2 million).

METHODS

Descriptive statistics were abstracted from CDPH pertussis case report forms that were completed by public health nurses investigating reports of positive laboratory results for pertussis and reports of illnesses compatible with pertussis.

RESULTS

Of 1144 reported adult and pediatric cases, 753 (66%) were confirmed and 391 were probable/suspect. Children aged <19 years comprised 86% of all reported cases in San Diego County; of these, 22% were aged 11-18 years, 29% were aged 6-10 years, 27% were aged 1-5 years, and 22% were aged <1 year (with 70% aged <6 months). Case rates were highest in infants aged <6 months (651 per 100 000 population). Of those aged >1 year, the highest attack rates were in preschool children aged 1-5 years (114 per 100 000) and elementary school children aged 6-10 years (141 per 100 000). Of 51 children hospitalized, 82% were aged <6 months; 2 deaths occurred in these young infants. Paroxysmal cough was noted in over 70% of children in all age groups; post-tussive vomiting occurred in 36% (aged 11-18 years) to 57% (aged <6 months) of children.

CONCLUSIONS

Pertussis vaccine efficacy may decrease more rapidly than previously believed, facilitating spread of pertussis in elementary school-aged children. The highest case rates and the only mortality occurred in infants aged <6 months.

Steer and pasture responses for a novel endophyte tall fescue developed for the upper transition zone

A 2-yr grazing experiment was conducted with crossbred steers (8 to 10 mo and with initial BW of 304 kg ± 34 kg in 2008 and 277 kg ± 24 in 2009) to evaluate animal performance and pasture responses of a late maturing tall fescue [Lolium arundinaceum (Schreb.) Darbysh; KYFA9301] population infected with the AR584 novel, non-toxic endophyte (Neotyphodium coenophialum; NE9301) as compared with Kentucky 31 fescue infected with the common toxic endophyte strain (KY31), 'Jesup' MaxQ fescue infected with the AR542 endophyte (MaxQ), and endophyte-free KYFA9301 (EF9301). Treatments were assigned for seeding in 1.0-ha pastures in a randomized complete block design with 3 replications. Pastures were grazed from 6 May to 23 July in 2008 (76 d) and 2 April to 25 June in 2009 (84 d). Each pasture was grazed with 4 tester steers and put-and-take steers were used to maintain forage mass at 2,500 ± 250 kg DM/ha. Shrunk BW was taken at initiation and termination of grazing each year. Rectal and skin temperatures were recorded, and jugular blood was collected each year at approximately d 28, 56, and study completion. Forage samples were collected at 2-wk intervals for analyzing CP, IVDMD, ADF, and NDF. Responses were analyzed with mixed models, and preplanned orthogonal contrasts were used to compare KY31 with non-toxic fescues, EF9301 vs. novel endophyte fescues, and NE9301 vs. MaxQ. All steer responses were similar (P > 0.10) among the non-toxic fescues. Average daily gains and total BW gain/ha for the 3 non-toxic fescues were greater (P < 0.001) than for KY31. Rectal/skin temperatures for the 3 non-toxic fescues were less (P < 0.001) and serum prolactin concentrations were greater (P < 0.01) than for KY-31. Pasture carrying capacity was greater (P = 0.003) for KY31 than the 3 non-toxic fescues and was greater for EF9301 (P = 0.017) than the 2 novel endophyte fescues. However, stocking rates (kg BW/ha) at the initial and midpoint days of grazing were similar (P > 0.40) among endophyte-fescue combinations, but by the end of the grazing season, stocking rate was greater (P < 0.001) for KY31 than for the non-toxic fescues and was greater (P = 0.053) for NE9301 than for MaxQ. Results indicated that NE9301 is as effective as EF9301 and MaxQ in improving BW gain and alleviating fescue toxicosis and that NE9301 can provide greater carrying capacities than MaxQ in late June and July.

eNOS-uncoupling in age-related erectile dysfunction

Aging is associated with ED. Although age-related ED is attributed largely to increased oxidative stress and endothelial dysfunction in the penis, the molecular mechanisms underlying this effect are not fully defined. We evaluated whether endothelial nitric oxide synthase (eNOS) uncoupling in the aged rat penis is a contributing mechanism. Correlatively, we evaluated the effect of replacement with eNOS cofactor tetrahydrobiopterin (BH(4)) on erectile function in the aged rats. Male Fischer 344 'young' (4-month-old) and 'aged' (19-month-old) rats were treated with a BH(4) precursor sepiapterin (10 mg/kg intraperitoneally) or vehicle for 4 days. After 1-day washout, erectile function was assessed in response to electrical stimulation of the cavernous nerve. Endothelial dysfunction (eNOS uncoupling) and oxidative stress (thiobarbituric acid reactive substances, TBARS) were measured by conducting western blot in penes samples. Erectile response was significantly reduced in aged rats, whereas eNOS uncoupling and TBARS production were significantly increased in the aged rat penis compared with young rats. Sepiapterin significantly improved erectile response in aged rats and prevented increase in TBARS production, but did not affect eNOS uncoupling in the penis of aged rats. These findings suggest that aging induces eNOS uncoupling in the penis, resulting in increased oxidative stress and ED.

Bochdalek hernia in the adult: demographics, presentation, and surgical management

BACKGROUND

Bochdalek hernias are a very rare form of diaphragmatic hernias. There are no robust studies that reveal the true natural history of this disease process. The aim of this study was to summarize clinically relevant data for the purpose of assisting surgeons with the work-up, diagnosis, and treatment of adult patients with Bochdalek hernia.

METHODS

A literature search was performed using PubMed, Google scholar, EMBASE and the following keywords: Bochdalek hernia, congenital diaphragmatic hernia, and posterolateral hernia. All case reports and series after 1955 that pertained to adults were included in the review. The following data points were queried: age, sex, presentation, studies utilized during work-up, laterality, surgical approach, hernia sac management, specific minimally invasive surgical techniques, and follow-up.

RESULTS

A total of 124 articles comprising 173 patients met the inclusion criteria. Based on the data provided, several conclusions regarding this disease process can be made. Most patients present with symptoms related to their hernia (86%). Pain is the most common complaint (69%). While laparotomy is the most widely used surgical approach (38%), minimally invasive surgical techniques have gained popularity since their first report in 1995. Laparoscopic repair can be performed with a low complication rate (7%) and short hospital stay (4 days).

CONCLUSIONS

Using modern surgical techniques to include laparoscopy, repair can be performed safely, with a short hospital stay, and with minimal morbidity or mortality.

Syndromes of the first and second branchial arches, part 2: syndromes

A variety of congenital syndromes affecting the face occur due to defects involving the first and second BAs. Radiographic evaluation of craniofacial deformities is necessary to define aberrant anatomy, plan surgical procedures, and evaluate the effects of craniofacial growth and surgical reconstructions. High-resolution CT has proved vital in determining the nature and extent of these syndromes. The radiologic evaluation of syndromes of the first and second BA should begin first by studying a series of isolated defects (cleft lip with or without CP, micrognathia, and EAC atresia) that compose the major features of these syndromes and allow a more specific diagnosis. After discussion of these defects and the associated embryology, we discuss PRS, HFM, ACS, TCS, Stickler syndrome, and VCFS.

Syndromes of the first and second branchial arches, part 1: embryology and characteristic defects

A variety of congenital syndromes affecting the face occur due to defects involving the first and second BAs. Radiographic evaluation of craniofacial deformities is necessary to define aberrant anatomy, plan surgical procedures, and evaluate the effects of craniofacial growth and surgical reconstructions. High-resolution CT has proved vital in determining the nature and extent of these syndromes. The radiologic evaluation of syndromes of the first and second BAs should begin first by studying a series of isolated defects: CL with or without CP, micrognathia, and EAC atresia, which compose the major features of these syndromes and allow more specific diagnosis. After discussion of these defects and the associated embryology, we proceed to discuss the VCFS, PRS, ACS, TCS, Stickler syndrome, and HFM.

Correlates of language impairment in children with galactosaemia

PURPOSE

This study describes risk factors associated with language impairment in children with classic galactosaemia.

METHOD

Thirty-three 4-16-year-old participants with classic galactosaemia and a history of speech sound disorders completed a battery of cognitive and language measures and their parents completed a family history questionnaire.

RESULTS

Nine of the sixteen (56%) participants with typical cognitive development and 15 of the 17 (88%) with borderline-low cognitive development had language impairments. Participants with typical cognitive development more often had an expressive language disorder, whereas those with borderline-low cognitive development more often had a mixed receptive-expressive language disorder. Participants with Q188R/Q188R genotypes had increased risk for both cognitive and language impairments. The IQs of younger siblings who did not consume milk postnatally were 10-56 points higher than the IQs of their older siblings with galactosaemia who had consumed milk postnatally. However, 4 of 5 younger siblings who were lactose-restricted from birth had language impairments. Typically-reported risk factors for language disorder, including parental history of speech/learning problems and low parental education level, were not significantly associated with cognitive or language impairments in the present sample of children with galactosaemia.

CONCLUSIONS

Children with galactosaemia and speech disorders have a 4-6 times greater risk for language impairment than children with early speech disorders of unknown origin. Early dietary lactose may increase the risk for cognitive and language impairments; however, the lack of significant associations of language impairment with days of milk consumption, and other familial and educational risk factors, is consistent with prenatal causation.

Cholinergic mechanisms of cutaneous active vasodilation during heat stress in cystic fibrosis

To test the hypothesis that cutaneous active vasodilation in heat stress is mediated by a redundant cholinergic cotransmitter system, we examined the effects of atropine on skin blood flow (SkBF) increases during heat stress in persons with (CF) and without cystic fibrosis (non-CF). Vasoactive intestinal peptide (VIP) has been implicated as a mediator of cutaneous vasodilation in heat stress. VIP-containing cutaneous neurons are sparse in CF, yet SkBF increases during heat stress are normal. In CF, augmented ACh release or muscarinic receptor sensitivity could compensate for decreased VIP; if so, active vasodilation would be attenuated by atropine in CF relative to non-CF. Atropine was administered into skin by iontophoresis in seven CF and seven matched non-CF subjects. SkBF was monitored by laser-Doppler flowmetry (LDF) at atropine treated and untreated sites. Blood pressure [mean arterial pressure (MAP)] was monitored (Finapres), and cutaneous vascular conductance was calculated (CVC = LDF/MAP). The protocol began with a normothermic period followed by a 3-min cold stress and 30-45 min of heat stress. Finally, LDF sites were warmed to 42 degrees C to effect maximal vasodilation. CVC was normalized to its site-specific maximum. During heat stress, CVC increased in both CF and non-CF (P < 0.01). CVC increases were attenuated by atropine in both groups (P < 0.01); however, the responses did not differ between groups (P = 0.99). We conclude that in CF there is not greater dependence on redundant cholinergic mechanisms for cutaneous active vasodilation than in non-CF.

Expression profiles of 50 xenobiotic transporter genes in humans and pre-clinical species: a resource for investigations into drug disposition

Carrier-mediated transporters play a critical role in xenobiotic disposition and transporter research is complicated by species differences and their selective tissue expression. The purpose of this study was to generate a comprehensive data set of xenobiotic transporter gene expression profiles in humans and the pre-clinical species mouse, rat, beagle dog and cynomolgus monkey. mRNA expression profiles of 50 genes from the ABC, SLC and SLCO transporter superfamilies were examined in 40 human tissues by microarray analyses. Transporter genes that were identified as enriched in the liver or kidney, or that were selected for their known roles in xenobiotic disposition, were then compared in 22 tissues across the five species. Finally, as clinical variability in drug response and adverse reactions may be the result of variability in transporter gene expression, variability in the expression of selected transporter genes in 75 human liver donors were examined and compared with the highly variable drug metabolizing enzyme CYP3A4.

Absence of alpha-synuclein mRNA expression in normal and multiple system atrophy oligodendroglia

alpha-Synuclein is a major constituent of glial cytoplasmic inclusions (GCIs), which are pathognomic for multiple system atrophy (MSA). We have previously demonstrated that in normal human brain, alpha-synuclein mRNA has a restricted pattern of neuronal expression and no apparent glial expression. The current study used double-label in situ hybridization to determine if alpha-synuclein mRNA is expressed by oligodendroglia of MSA cases. Analysis of MSA brain tissue revealed depletion of regional signal for this transcript in many brain areas due to extensive neurodegeneration. Cellular analysis of oligodendroglia in crus cerebri, a GCI-rich region ventral to substantia nigra, revealed an absence of alpha-synuclein mRNA signal in control and MSA cases. However, an abundance of this transcript was detected in melanin-containing neurons of substantia nigra. Therefore, oligodendroglia do not express alpha-synuclein mRNA in control and MSA cases suggesting that involvement of alpha-synuclein in GCI pathology of MSA is due to its ectopic presence in oligodendroglia.

An index of biotic integrity based on the summer polyhaline zooplankton community of the Chesapeake Bay

A zooplankton index of biotic integrity was developed for the polyhaline waters of the Chesapeake Bay using data from a long-term environmental assessment program in which both zooplankton and water quality were regularly monitored. Summer (July to September) sampling events were classified as either coming from impaired or reference (least-impaired) conditions based on water quality conditions. Seventeen zooplankton community metrics were evaluated under these criteria and nine were chosen for a composite index. These were the Simpson diversity index, and abundance of barnacle larvae, rotifers, cladocerans, copepods, total mesozooplankton, and predators. The composite index of biotic integrity correctly classified about 94% of the impaired samples and about 82% of the reference samples. Average classification efficiency was 88%. This index appears to be an effective measure of eutrophication for the summer polyhaline waters of the Chesapeake Bay ecosystem.

Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature

BACKGROUND

Little grade A medical evidence exists to support the use of prosthetic material for hiatal closure. Therefore, the authors compiled and analyzed all the available literature to determine whether the use of prosthetic mesh in hiatoplasty for routine laparoscopic fundoplications (LF) or for the repair of large (>5 cm) paraesophageal hernias (PEH) would decrease recurrence.

METHODS

A literature search was performed using an inclusive list of relevant search terms via Medline/PubMed to identify papers (n = 19) describing the use of prosthetic material to repair the crura of patients undergoing laparoscopic PEH reduction, LF, or both.

RESULTS

Case series (n = 5), retrospective reviews (n = 6), and prospective randomized (n = 4) and nonrandomized (n = 4) trials were identified. Laparoscopic procedures (n = 1,368) were performed for PEH, gastroesophageal reflux disease (GERD), hiatal hernia, or a combination of the three. Group A (n = 729) had primary suture repair of the crura, and group B (n = 639) had repair with either interposition of mesh to close the hiatus or onlay of prosthetic material after hiatal or crural closure. The use of mesh was associated with fewer recurrences than primary suture repair in both the LF and PEH groups. The mean follow-up period did not differ between the groups (20.7 months for group A vs. 19.2 months for group B). None of the papers cited any instance of prosthetic erosion into the gastrointestinal tract.

CONCLUSIONS

The current data tend to support the use of prosthetic materials for hiatal repair in both routine LF and the repair of large PEHs. Longer and more stringent follow-up evaluation is necessary to delineate better the safety profile of mesh hiatoplasty. Future randomized trials are needed to confirm that mesh repair is superior to simple crural closure.

Sodium butyrate induces apoptosis in MSN neuroblastoma cells in a calcium independent pathway

Sodium butyrate (NaBt), a histone deacetylase inhibitor, can cause apoptosis in a number of cancer cells. However, the mechanism of this action is poorly understood. Increased intracellular [Ca(2+)] level has been suggested as a likely mechanism, but there is little corroborating data. In this report we provide evidence that NaBt-treated MSN neuroblastoma cells undergo massive apoptosis in the presence of serum and regardless of external or internal [Ca(2+)] levels. Presented data suggest that apoptotic effect of NaBt is both time- and dose-dependent (LD50 1 mM); and that, presence of serum or cAMP, a second messenger molecule that modulates the apoptotic program in a wide variety of cells could not circumvent the apoptotic effect of NaBt. Our findings suggest that NaBt-induced apoptosis in MSN neuroblastoma cells occurs via a pathway that is independent of Ca(2+) flux, intracellular [Ca(2+)] or cAMP levels. Further, we also present data that exclude a role for PKC or histones acetylation.

Early prenatal diagnosis of oculoauriculofrontonasal syndrome by three-dimensional ultrasound

Oculoauriculofrontonasal syndrome is a rare developmental field defect that represents an abnormal morphogenesis of the frontonasal eminence. It consists of features of both oculoauriculovertebral spectrum and frontonasal malformation. A few cases in the literature have described this syndrome, but to the best of our knowledge the present case is the first early prenatal diagnosis of this severe condition using three-dimensional ultrasonography.

Detection of novel splice forms in human and mouse using cross-species approach

Millions of transcript sequences have become available for characterizing the transcriptome of human and mouse. Transcript databases have been extensively mined for extracting alternative splicing information within the same species; but they also represent a potentially valuable resource for the discovery of alternative splice variants in another species. In this study, we have performed analysis of alternative splicing patterns for 7,475 pairs of human and mouse genes. We found that cross-species transcript analysis could accomplish the same level of sensitivity in detecting constitutive splice patterns as EST resource from the same species. In contrast, identifying alternative splice patterns in human genes, mouse transcripts achieved only 50% of the sensitivity of human EST and 70% of the sensitivity of human mRNA. While identifying alternative splice patterns in mouse genes, human transcripts are 38% more sensitive than mouse mRNA, and reach 60% of the sensitivity of mouse EST. Furthermore, using the cross-species approach, we predicted novel alternative splice patterns for 42% of human genes and 51% of mouse genes. Splice site motif analysis suggests that the majority of predicted novel splice patterns are expressed in human. EST-based frequency analysis shows that novel splice patterns are expressed at lower frequency than alternative splice patterns present in the transcript data from both species, possibly explaining why they remain undetected in the transcript data of the same species.

Identification of genes expressed in a human scleral cDNA library

PURPOSE

Clones established from a human scleral cDNA library were systematically sequenced. Public database sequence comparisons were performed to generate a profile of genes expressed in the human sclera and identify candidate genes for inherited diseases with scleral involvement.

METHODS

A directionally cloned pCMV-PCR cDNA library was constructed from RNA isolated from scleras of human donor eyes with known plano refractive history. Plasmid DNA was extracted from randomly selected cDNA clones, and the insert sequences were determined by 5' end single-pass sequencing. Expressed sequence tags (ESTs) were generated and analyzed with the GenBank BLASTN program to identify sequence homologies to known genes.

RESULTS

A total of 609 ESTs underwent BLAST analysis. Of these, 341 (56%) matched 228 known human genes and 4 non-human genes, 252 matched uncharacterized ESTs, and 16 showed no significant homology to human or non-human known sequences. The most redundant connective tissue-related genes were alphaA-crystalline, Xalpha-1 collagen, and beta-5 integrin. Other extracellular matrix gene matches were biglycan, syndecan, decorin, fibromodulin, proline arginine-rich end leucine-rich repeat protein, transgelin, TIMP-1, and fibulin 1. Human scleral expression of all but decorin and biglycan has not previously been reported.

CONCLUSIONS

This effort provides the first partial list of genes expressed in human sclera. Identification of genes expressed in the sclera contributes to our understanding of scleral biology, and potentially provides positional candidate genes for scleral disorders such as high myopia.

Design and in vivo immunogenicity of a polyvalent vaccine based on SIVmac regulatory genes

Most vaccine modalities for human immunodeficiency virus type 1 (HIV-1) tested for immunogenicity and efficacy in the SIVmac (simian immunodeficiency virus) macaque model do not include the viral regulatory proteins. Because viral regulatory proteins are expressed early during the virus life cycle and represent an additional source of antigens, their inclusion as a vaccine component may increase the overall virus-specific immune response in vaccinees. However, at least two of the early proteins, Tat and Nef, may be immunosuppressive, limiting their usefulness as components of an SIV vaccine. We have constructed a polyvalent chimeric protein in which the open reading frames for Tat and Nef have been reassorted and the nuclear localization sequence for Tat and Rev and the myristoylation site for Nef have been removed. The resulting DNA plasmid (pDNA-SIV-Retanef) (pDNA-SIV-RTN) encodes a protein of 55 kDa (Retanef) that localizes at the steady state in the cytoplasma of transfected cells. Both the DNA-SIV-RTN and the highly attenuated recombinant poxvirus vector NYVAC-SIV-RTN were demonstrated to be immunogenic in SIVmac251-infected macaques treated with ART as well as in naive macaques. An equivalent strategy may be used for the generation of polyvalent antigens encoding the regulatory proteins in a HIV-1 vaccine candidate.

Inhibition of scleral proteoglycan synthesis blocks deprivation-induced axial elongation in chicks

A specific inhibitor of proteoglycan synthesis was administered to chicks undergoing the development of form deprivation myopia in order to test the hypothesis that increases in proteoglycan synthesis are responsible for normal and/or deprivation-induced ocular elongation in chicks. Chicks undergoing monocular form deprivation were treated with p-nitrophenyl-beta-D-xylopyranoside (beta-xyloside) via i.p. injection every 8 hr for 5-11 days. Ocular measurements were made at the end of the experiment using high frequency A-scan ultrasound in conjunction with a LabView (v. 5.0) analysis program. Following ultrasound measurements, sclera were isolated and proteoglycans characterized by Sepharose CL-2B and Western blot analyses. Preliminary studies indicated that i.p. administration of beta-xyloside maximally inhibited sulfate incorporation into proteoglycans 8 hr after administration. Beta-xyloside treatment resulted in a significant reduction in the axial length, vitreous chamber depth, and rate of axial elongation of form deprived eyes as compared with form deprived eyes from vehicle treated chicks (P < 0.01, P < 0.05, P < 0.05, respectively). No significant differences were detected in anterior chamber depth, lens thickness, choroid thickness or retina thickness in form deprived eyes of beta-xyloside treated chicks as compared with that of vehicle controls. No significant differences were detected in contralateral non-deprived fellow eyes between beta-xyloside treated and vehicle treated chicks for any ocular measurement. Analysis of proteoglycans indicated that the xyloside treatment resulted in the accumulation of smaller proteoglycans due, in part, to the presence of underglycosylated aggrecan within the scleral matrix. These results indicate that interruption of normal scleral proteoglycan synthesis inhibits form deprivation-induced ocular elongation, supporting the hypothesis that scleral proteoglycan synthesis and accumulation are largely responsible for increases in axial length in form deprived chick eyes.

Influence of isometric exercise on blood flow and sweating in glabrous and nonglabrous human skin

The distribution of the reflex effects of isometric exercise on cutaneous vasomotor and sudomotor function is not clear. We examined the effects of isometric exercise by different muscle masses on skin blood flow (SkBF) and sweat rate (SR) in nonglabrous skin and in glabrous skin. The latter contains arteriovenous anastomoses (AVAs), which cause large fluctuations in SkBF. SkBF was measured by laser-Doppler flowmetry (LDF) and reported as cutaneous vascular conductance (CVC; LDF/mean arterial pressure). SR was measured by capacitance hygrometry. LDF and SR were measured at the sole, palm, forearm, and ventral leg during separate bouts of isometric handgrip (IHG) and isometric leg extension (ILE). CVC and its standard deviation decreased significantly during IHG and ILE in the palm and sole (P < 0.05) but not in the forearm or leg (P > 0.05). Only palmar SR increased significantly during IHG and ILE (P < 0.05). We conclude that the major reflex influences of isometric exercise on the skin include AVAs and palmar sweat glands and that this is true for both arm and leg exercise.

Pre-emptive targeting of the epitope spreading cascade with genetically modified regulatory T cells during autoimmune demyelinating disease

Epitope spreading or endogenous self-priming has been implicated in mediating the progression of autoimmune disease. In the present study we created an immune-deviated, epitope spreading response in SWXJ mice after the onset of experimental autoimmune encephalomyelitis, a prototypic autoimmune animal model widely used in multiple sclerosis research. We established an immunoregulatory spreading repertoire by transferring T cells genetically modified to produce high levels of IL-10 in response to a dominant epitope spreading determinant. Installation of a Th2/Tr1-like spreading repertoire resulted in a marked and prolonged inhibition of disease progression and demyelination characterized by 1) bystander inhibition of the recall response to the priming immunogen, and 2) a Th1-->Tr1 immune-deviated spreading response involving a shift in the source of IL-10 production from the transferred regulatory population to the host-derived, endogenously primed repertoire. Thus, our data provide a rationale for cell-based therapeutic intervention in multiple sclerosis by showing that pre-emptive targeting of the epitope spreading cascade with regulatory T cells effectively induces an immune-deviated spreading response capable of inhibiting ongoing inflammatory autoreactivity and disease progression.

Institutional learning curve for sentinel node biopsy at a community teaching hospital

Sentinel lymph node biopsy (SLB) is gaining popularity as an alternative to axillary lymph node dissection for breast cancer staging. Although publications have described the inherent learning curve few have analyzed actual performance in community hospitals. This study analyzes the institutional learning curve for SLB in a community teaching hospital without a formal sentinel node credentialing policy. We conducted an analysis of the initial 96 SLBs performed by 15 general surgeons over a 34-month period. The main outcomes were rate of identification of sentinel node and accuracy of SLB. Overall SLB was successful in identifying one or more sentinel nodes (mean = 2.2) in 73 per cent of attempted cases. There were marked differences in performance of individual surgeons; identification rates varied from 25 to 100 per cent. Only one surgeon performed more than 15 procedures during the study period. Nineteen of 21 cases with positive nodes were correctly characterized (sensitivity = 90.5%; 95% confidence interval = 76-100%; false negative rate = 9.5%). Our institutional learning curve was longer than high-volume individual experiences published in the literature, with a lower rate of sentinel node identification. SLB appears to be sensitive for detecting malignancy, but the small number of patients with positive nodes in our series limits our conclusions. The marked variability in individual surgeon performances and the slow rate of overall improvement in our institution suggest a need for a formalized policy for SLB training.

The influence of topical capsaicin on the local thermal control of skin blood flow in humans

To test whether heat-sensitive receptors participate in the cutaneous vascular responses to direct heating, we monitored skin blood flow (SkBF; laser Doppler flowmetry) where the sensation of heat was induced either by local warming (T(Loc); Peltier cooling/heating unit) or by both direct warming and chemical stimulation of heat-sensitive nociceptors (capsaicin). In part I, topical capsaicin (0.075 or 0.025%) was applied to 12 cm(2) of skin 1 h before stepwise local warming of untreated and capsaicin-treated forearm skin. Pretreatment with 0.075% capsaicin cream shifted the SkBF/T(Loc) relationship to lower temperatures by an average of 6 +/- 0.8 degrees C (P < 0.05). In part II, we used a combination of topical capsaicin (0.025%) and local warming to evoke thermal sensation at one site and only local warming to evoke thermal sensation at a separate site. Cutaneous vasomotor responses were compared when the temperatures at these two sites were perceived to be the same. SkBF differed significantly between capsaicin and control sites when compared on the basis of actual temperatures, but that difference became insignificant when compared on the basis of the perceived temperatures. These data suggest heat-sensitive nociceptors are important in the cutaneous vasodilator response to local skin warming.

Identification of a mutation causing increased expression of the tas gene in Escherichia coli FX-11

Studies of N-ethyl-N-nitrosourea (ENU)-induced mutagenesis with a tyrosine auxotroph of Escherichia coli revealed a new type of revertant. This mutant strain was interesting because: (i) it was not a true revertant of the nonsense (ochre) defect nor a tRNA suppressor mutation; and (ii) it was induced by ENU to greater extent in a UmuC-defective host. Genetic mapping located the probable mutation to a region of the E. coli chromosome containing a newly described gene called tas. To investigate this mutation, the upstream region of the tas gene from both wild-type and mutant cells was cloned into a promoterless lacZ expression vector and recombined onto a lambda bacteriophage. Recombinant bacteriophage were inserted into the bacterial chromosome and beta-galactosidase (betaGal) assays were performed. These assays revealed an almost three-fold greater expression of betaGal from the mutant DNA than from the wild-type DNA. Sequence analysis of the region directly upstream of the tas gene revealed a G:C to A:T transition at base number 2263 (numbering based on GenBank Accession #AE000367), located within a potential promoter site. Further sequencing indicated no other mutations within the 1454bp region analyzed; however, there were several nucleotide differences seen in our B/r strain of E. coli, when compared with the published E. coli K-12 sequence. A total of 10 base differences were discovered; one in mutH, six within a potential open reading frame (ORF-o237) and three in non-coding regions. Yet, none of the changes altered the predicted amino acid sequences. These results provide evidence of a mechanism for increased expression of the novel gene tas and support the neutral drift hypothesis for the evolution of DNA sequences.

HTLV-1 p12(I) protein enhances STAT5 activation and decreases the interleukin-2 requirement for proliferation of primary human peripheral blood mononuclear cells

The p12(I) protein, encoded by the pX open reading frame I of the human T-lymphotropic virus type 1 (HTLV-1), is a hydrophobic protein that localizes to the endoplasmic reticulum and the Golgi. Although p12(I) contains 4 minimal proline-rich, src homology 3-binding motifs (PXXP), a characteristic commonly found in proteins involved in signaling pathways, it has not been known whether p12(I) has a role in modulating intracellular signaling pathways. This study demonstrated that p12(I) binds to the cytoplasmic domain of the interleukin-2 receptor (IL-2R) beta chain that is involved in the recruitment of the Jak1 and Jak3 kinases. As a result of this interaction, p12(I) increases signal transducers and activators of transcription 5 (STAT5) DNA binding and transcriptional activity and this effect depends on the presence of both IL-2R beta and gamma(c) chains and Jak3. Transduction of primary human peripheral blood mononuclear cells (PBMCs) with a human immunodeficiency virus type 1-based retroviral vector expressing p12(I) also resulted in increased STAT5 phosphorylation and DNA binding. However, p12(I) could increase proliferation of human PBMCs only after stimulation of T-cell receptors by treatment of cells with low concentrations of alphaCD3 and alphaCD28 antibodies. In addition, the proliferative advantage of p12(I)-transduced PBMCs was evident mainly at low concentrations of IL-2. Together, these data indicate that p12(I) may confer a proliferative advantage on HTLV-1-infected cells in the presence of suboptimal antigen stimulation and that this event may account for the clonal proliferation of infected T cells in vivo. (Blood. 2001;98:823-829)

Diurnal variation in cutaneous vasodilator and vasoconstrictor systems during heat stress

It is not clear whether the diurnal variation in the cutaneous circulatory response to heat stress is via the noradrenergic vasoconstrictor system or the nonadrenergic active vasodilator system. We conducted whole body heating experiments in eight male subjects at 0630 (AM) and 1630 (PM). Skin blood flow was monitored by laser-Doppler flowmetry at control sites and at sites pretreated with bretylium (BT) to block noradrenergic vasoconstriction. Noninvasive blood pressure was used to calculate cutaneous vascular conductance. The sublingual temperature (T(or)) threshold for cutaneous vasodilation was significantly higher in PM at control and at BT-treated sites (both P < 0.01), suggesting the diurnal shift in threshold depends on the active vasodilator system. The slope of cutaneous vascular conductance as a percentage of its maximum with respect to T(or) was significantly lower in AM at control sites only. Also, in the AM, the slope at control sites was significantly lower than that at BT-treated sites (P < 0.05), suggesting that the diurnal change in the sensitivity of cutaneous vasodilation depends on vasoconstrictor system function. Overall, the diurnal variation in the reflex control of skin blood flow during heat stress involves both vasoconstrictor and active vasodilator systems.

Free major histocompatibility complex class I heavy chain is preferentially targeted for degradation by human T-cell leukemia/lymphotropic virus type 1 p12(I) protein

Human T-cell leukemia virus type 1 (HTLV-1) establishes a persistent infection in the host despite a vigorous virus-specific immune response. Here we demonstrate that an HTLV-1-encoded protein, p12(I), resides in the endoplasmic reticulum (ER) and Golgi and physically binds to the free human major histocompatibility complex class I heavy chains (MHC-I-Hc) encoded by the HLA-A2, -B7, and -Cw4 alleles. As a result of this interaction, the newly synthesized MHC-I-Hc fails to associate with beta(2)-microglobulin and is retrotranslocated to the cytosol, where it is degraded by the proteasome complex. Targeting of the free MHC-I-Hc, and not the MHC-I-Hc-beta(2)-microglobulin complex, by p12(I) represents a novel mechanism of viral interference and disrupts the intracellular trafficking of MHC-I, which results in a significant decrease in surface levels of MHC-I on human T-cells. These findings suggest that the interaction of p12(I) with MHC-1-Hc may interfere with antigen presentation in vivo and facilitate escape of HTLV-1-infected cells from immune recognition.

Telepathology in India

Telepathology is the most recent addition to the pathologist's diagnostic tools. It is the acquisition of macroscopic and microscopic images for electronic transmission for diagnosis, consultation and/or education. With the addition of the personal computer at the pathologist's desktop, the stage has been set for one of the greatest advantages the Internet has to offer. Telepathology in India is in infancy, and we at PathoIndia (www.Pathoindia.com) have started a series of publication images from interesting cases in the form of weekly quiz. After cases are published, hundreds of pathologists from around the world are invited by e-mail to send in their diagnosis and comments. The responses to this quiz suggest that telepathology is catching on in the pathology community. Another intention of this series is to identify and select qualified international and Indian pathologists who would be willing to help colleagues from India requesting second opinions online.