Surveillance for Soil-Transmitted Helminths in High-Risk County, Mississippi, USA

Recent reports of hookworm infection in Alabama, USA, has prompted surveillance in Mississippi, given the states' similar environmental conditions. We collected stool specimens from 277 children in Rankin County, Mississippi. Kato-Katz microscopic smear, agar plate culture, and quantitative PCR indicated no soil-transmitted helminths. Nevertheless, further surveillance in other high-risk Mississippi counties is warranted.

Clinical characteristics of pregnancy and lactation associated osteoporosis: An online survey study

Pregnancy and lactation associated osteoporosis is a rare and often severe osteoporosis presentation. Little information is available about etiology, clinical characteristics, risk factors and predictors of severity. Using an anonymized questionnaire, we defined clinical characteristics and potential risk factors for disease severity in PLO including primiparity, heparin exposure and celiac disease.

PURPOSE

Pregnancy and lactation associated osteoporosis (PLO) is a rare form of early-onset osteoporosis in which young women present with fractures, usually multiple vertebral fractures, during late pregnancy or lactation. Little information is available about etiology, clinical characteristics, risk factors and predictors of disease severity.

METHODS

PLO patients were recruited to complete an anonymized online questionnaire. Disease severity was defined as total number of fractures during or after the first pregnancy associated with a fracture(s). Analyses related disease severity to potential predictors including diseases/conditions or medication exposures.

RESULTS

177 completed surveys were received between 5/29/2018 and 1/12/2022. Average age at initial PLO fracture event was 32 ± 5 years. The majority were primiparous with singleton pregnancy and 79% fractured during lactation. Subjects reported 4.7 ± 2.7 total PLO fractures, with 48% reporting ≥ 5 fractures. Vertebral fractures, reported by 164/177 responders (93%), were the most common fracture type. Conditions and medications most commonly reported included vitamin D deficiency, amenorrhea unrelated to pregnancy, nephrolithiasis, celiac disease (CD), oral steroid use, heparin products during pregnancy and progestin only contraceptive after pregnancy. CD and heparins exposure during pregnancy were significantly related to disease severity.

CONCLUSION

This is the largest study characterizing clinical features of PLO to date. The large number of participants and broad range of clinical and fracture characteristics queried has yielded novel information on the characteristics of PLO and potential risk factors for its severity, including primiparity, exposure to heparin and CD. These findings provide important preliminary data that can help target future mechanistic investigations.

Chronic axillary wounds in cats: what do we know and how should we manage them?

PRACTICAL RELEVANCE

Axillary wounds most often occur in outdoor cats that wear a collar, typically after having been missing. These wounds are commonly chronic and indolent in nature, and although there is so far no consensus on an explanation for this, it is likely that there are several factors involved.

CLINICAL CHALLENGES

Axillary wounds are often difficult to manage due to the frequent presence of infection, their histopathological characteristics and their location, where there is excessive tension and movement of the axillary tissues. Initial surgical treatment has a high reported incidence of failure and complications in the literature, with wound breakdown reported most commonly. Giving due consideration to the difficulties of managing these wounds, however, will help practitioners to decrease the occurrence of complications and the need for multiple procedures, and therefore improve the outcome.

EQUIPMENT

Initial approach and surgical management can be achieved using standard medical equipment and surgical kit available to general practitioners.

EVIDENCE BASE

This review discusses the surgical techniques reported in the literature to have successfully treated chronic axillary wounds and recommendations are also provided based on the authors' clinical experience.

Recombinant pregnancy-specific glycoprotein-1-Fc reduces functional deficit in a mouse model of permanent brain ischaemia

Background

The well-characterised role of the immune system in acute ischaemic stroke has prompted the search for immunomodulatory therapies. Pregnancy-specific glycoproteins (PSGs) are a group of proteins synthesised by placental trophoblasts which show immunomodulatory properties. The aim of this study was to determine whether a proposed PSG1-based therapeutic enhanced recovery in a mouse model of brain ischaemia and to explore possible immunomodulatory effects.

Methods

Mice underwent permanent electrocoagulation of the left middle cerebral artery (pMCAO). They received saline (n = 20) or recombinant pregnancy-specific glycoprotein-1-alpha “fused” to the Fc domain of IgG1 (rPSG1-Fc) (100 μg) (n = 22) at 1 h post-ischaemia. At 3 and 5 days post-ischaemia, neurobehavioural recovery was assessed by the grid-walking test. At 5 days post-ischaemia, lesion size was determined by NeuN staining. Peripheral T cell populations were quantified via flow cytometry. Immunohistochemistry was used to quantify ICAM-1 expression and FoxP3+ cell infiltration in the ischaemic brain. Immunofluorescence was employed to determine microglial activation status via Iba-1 staining.

Results: rPSG1-Fc significantly enhanced performance in the grid-walking test at 3 and 5 days post-ischaemia. No effect on infarct size was observed. A significant increase in circulating CD4⁺ FoxP3+ cells and brain-infiltrating FoxP3+ cells was noted in rPSG1-Fc-treated mice. Among CD4⁺ cells, rPSG1-Fc enhanced the expression of IL-10 in spleen, blood, draining lymph nodes, and non-draining lymph nodes, while downregulating IFN-γ and IL-17 in spleen and blood. A similar cytokine expression pattern was observed in CD8⁺ cells. rPSG1-Fc reduced activated microglia in the infarct core.

Conclusion

The administration of rPSG1-Fc improved functional recovery in post-ischaemic mice without impacting infarct size. Improved outcome was associated with a modulation of the cytokine-secreting phenotype of CD4⁺ and CD8⁺ T cells towards a more regulatory phenotype, as well as reduced activation of microglia. This establishes proof-of-concept of rPSG1-Fc as a potential stroke immunotherapy.

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rPSG1-Fc enhances functional recovery in a mouse model of permanent brain ischaemia.

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rPSG1-Fc increases circulating CD4⁺ FoxP3+ cells and brain-infiltrating FoxP3+ cells.

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rPSG1-Fc increases the expression of IL-10 among CD4⁺ cells in spleen, blood, and lymph nodes.

Active Surveillance With Seroprevalence-based Infection Rates Indicates Racial Disparities With Pediatric SARS-CoV-2 Requiring Hospitalization in Mississippi, March 2020-February 2021

BACKGROUND

Racial disparities in SARS-CoV-2 infection, hospitalization, and multisystem inflammatory syndrome in children (MIS-C) have been reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and COVID-19 hospitalizations among non-Hispanic Black and White children using active surveillance based on seroprevalence-based cumulative incidence of pediatric SARS-CoV-2 infection in a defined catchment 16-county area of Mississippi.

METHODS

Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the major pediatric referral hospital for Mississippi, University of Mississippi Medical Center, from March 2020, to February 2021. Race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples from persons <18 years to calculate cumulative SARS-CoV-2 infections in the population.

RESULTS

Thirty-eight MIS-C cases and 74 pediatric acute COVID-19 hospitalizations were identified. Cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections.

CONCLUSIONS

From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show strikingly higher incidence of SARS-CoV-2-hospitalization and MIS-C in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These disparities in SARS-CoV-2 manifestations cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions will lessen disparities observed with SARS-CoV-2 manifestations in children.

Pregnancy-specific glycoproteins: evolution, expression, functions, and disease associations

Pregnancy-specific glycoproteins (PSGs) are members of the immunoglobulin superfamily and are closely related to the predominantly membrane-bound CEACAM proteins. PSGs are produced by placental trophoblasts and secreted into the maternal bloodstream at high levels where they may regulate maternal immune and vascular functions through receptor binding and modulation of cytokine and chemokine expression and activity. PSGs may have autocrine and paracrine functions in the placental bed, and PSGs can activate soluble and extracellular matrix bound TGF-β, with potentially diverse effects on multiple cell types. PSGs are also found at high levels in the maternal circulation, at least in human, where they may have endocrine functions. In a non-reproductive context, PSGs are expressed in the gastrointestinal tract and their deregulation may be associated with colorectal cancer and other diseases. Like many placental hormones, PSGs are encoded by multigene families and they have an unusual phylogenetic distribution, being found predominantly in species with hemochorial placentation, with the notable exception of the horse in which PSG-like proteins are expressed in the endometrial cups of the epitheliochorial placenta. The evolution and expansion of PSG gene families appears to be a highly active process, with significant changes in gene numbers and protein domain structures in different mammalian lineages, and reports of extensive copy number variation at the human locus. Against this apparent diversification, the available evidence indicates extensive conservation of PSG functions in multiple species. These observations are consistent with maternal-fetal conflict underpinning the evolution of PSGs.

Equine pregnancy-specific glycoprotein CEACAM49 secreted by endometrial cup cells activates TGFB

In early equine pregnancy, a highly invasive trophoblast cell subpopulation, the chorionic girdle cells, invade the endometrium and form endometrial cups (EC). These cells express classical MHC molecules, thereby stimulating a humoral and cellular immune response, resulting in a massive accumulation of maternal CD4+ and CD8+ T cells around the EC. Nevertheless, no immediate destruction of endometrial cups by maternal lymphoid cells occurs, presumably due to immune tolerance. Although the environment of EC is rich in TGFB and in FOXP3+, CD4+ T cells, the mechanisms leading to tolerance have not been elucidated. Recently, we discovered that equine trophoblast cells secrete pregnancy-specific glycoproteins (PSGs). Since human and murine PSGs activate latent TGFB, we hypothesized that equine PSGs may have a similar activity. We performed plasmon surface resonance experiments to show that equine PSG CEACAM49 can directly bind to the latency-associated peptide (LAP) of both TGFB1 and TGFB2. We then found that the binding of CEACAM49 leads to the activation of TGFB1 as determined by both ELISA and cell-based assays. Furthermore, the activation of TGFB is a unique function of PSGs within the human CEA family, because CEACAM1, 3, 5, 6, 8 do not activate this cytokine. This finding further strengthens the classification of CEACAM49 as an equine PSG. Based on our results, we hypothesize that activation of latent TGFB in the EC environment by equine PSGs secreted by invasive trophoblast cells, could contribute to the generation of regulatory T cells (Tregs) to maintain immune tolerance.

Parasitic Disease Surveillance, Mississippi, USA

Surveillance for soil-transmitted helminths, strongyloidiasis, cryptosporidiosis, and giardiasis was conducted in Mississippi, USA. PCR performed on 224 fecal samples for all soil-transmitted helminths and on 370 samples for only Necator americanus and Strongyloides stercoralis identified 1 S. stercoralis infection. Seroprevalences were 8.8% for Toxocara, 27.4% for Cryptosporidium, 5.7% for Giardia, and 0.2% for Strongyloides parasites.

Establishing consensus on the best ways to educate children about animal welfare and prevent harm: An online Delphi study

Many animal welfare organisations deliver education programmes for children and young people, or design materials for schoolteachers to use. However, few of these are scientifically evaluated, making it difficult for those working in this field to establish with any certainty the degree of success of their own programmes, or learn from others. There has been no guidance specifically tailored to the development and evaluation of animal welfare education interventions. Accordingly, a three-stage online Delphi study was designed to unearth the expertise of professionals working in this field and identify degree of consensus on various aspects of the intervention process: design, implementation and evaluation. Thirty-one experts participated in Round 1, representing eleven of 13 organisations in the Scottish Animal Welfare Education Forum (SAWEF), and eleven of 23 members of the wider UK-based Animal Welfare Education Alliance (AWEA). Seven further professionals participated, including four based in Canada or the US. Eighty-four percent of the original sample participated in Round 2, where a high level of consensus was apparent. However, the study also revealed areas of ambiguity (determining priorities, the need for intervention structure and degree of success). Tensions were also evident with respect to terminology (especially around cruelty and cruelty prevention), and the common goal for animal welfare to be part of school curricula. Findings were used to develop a web-based framework and toolkit to enable practitioners to follow evidence-based guidance. This should enable organisations to maximise the quality and effectiveness of their interventions for children and young people.

The challenges and future development of animal welfare education in the UK

At present, UK schools are not required to teach children about animal welfare. This undoubtedly contributes to widespread deficien- cies in knowledge, and misconceptions about animals needs, likes, and dislikes. Aware of the issues at hand, animal welfare organi- sations create their own materials for teachers to use, and/or deliver educational programmes directly to children and young people. As the design, content, processes and outcomes associated with these interventions are rarely documented publicly or systematically evaluated, there is little evidence to guide the development of animal welfare education. A three-stage online Delphi study was used to identify who current interventions target, what delivery methods are being used, and how expert practitioners describe priorities and challenges in the field. Thirty-one experts participated in Round 1, with 84% of the sample (n = 26) also taking part in Round2. Qualitative analysis revealed passionate accounts about the far-reaching potential of educating children about animals. However, we also identified ambiguities and tensions that could thwart the future development of effective animal welfare education. Alongside the production of a web-based framework and evidence-based toolkit to support practitioners, findings will be used to encourage animal welfare professionals to work towards producing shared terminology, definitions, and outcomes frameworks; focusing on positive education and the idea of harm as opposed to cruelty. This should facilitate collaboration with schoolteachers and education policy-makers to assess the ways in which animal welfare might be successfully incorporated within formal education in the future. These data suggest many potential avenues for inclusion, although a holistic approach emphasising the links between humans, animals and the environment, within the context of young peoples recent activism and contemporary health, societal and environmental issues, may be most successful.

Effect of Teriparatide on Bone Remodeling and Density in Premenopausal Idiopathic Osteoporosis: A Phase II Trial

CONTEXT

Premenopausal women with idiopathic osteoporosis (IOP) have abnormal skeletal microarchitecture and variable tissue-level bone formation rate (BFR).

OBJECTIVES

Compare 6 months (M) of teriparatide versus placebo on areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA), bone turnover markers (BTMs) and BFR at 3M by quadruple-labeled transiliac biopsy. Characterize 12M and 24M effects of teriparatide on aBMD and whether BTMs and BFR predict response.

DESIGN

6M phase 2 randomized controlled trial (RCT) followed by open extension.

SETTING

Tertiary referral centers.

PATIENTS

Premenopausal women with IOP.

INTERVENTIONS

A total of 41 women were randomized to either teriparatide 20 mcg (n = 28) or placebo (n = 13). After 6M, those on placebo switched to teriparatide for 24M; those on teriparatide continued for 18M.

MAIN OUTCOME MEASURES

6M RCT: Between-group differences in lumbar spine (LS) aBMD (percent change from baseline), 3M BFR, and hypercalcemia. Open-label extension: Within-group change in LS aBMD over 12M and 24M. Secondary outcomes included aBMD change at other sites and relationship between BTMs, BFR, and changes in aBMD.

FINDINGS

Over 6M, LS aBMD increased by 5.5% (95% CI: 3.83, 7.19) in teriparatide and 1.5% (95% CI: -0.73, 3.83) in placebo (P = 0.007). There were increases in 3M BTMs, and BFR (cancellous and endocortical BFR: between-groups P = 0.004). Over 24M, teriparatide increased LS aBMD by 13.2% (95% CI: 10.3, 16.2), total hip by 5.2% (95% CI: 3.7, 6.7) and femoral neck by 5.0% (95% CI: 3.2, 6.7; all P ≤ 0.001). Serum N-terminal propeptides of procollagen type 1 (P1NP) and 3M endocortical BFR were moderately associated with LS aBMD response. Teriparatide was well-tolerated.

CONCLUSIONS

Teriparatide increased BFR and formation markers and was associated with marked aBMD improvements in most premenopausal women (82%) with IOP.

Changes in Skeletal Microstructure Through Four Continuous Years of rhPTH(1-84) Therapy in Hypoparathyroidism

Bone remodeling is reduced in hypoparathyroidism, resulting in increased areal bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) and abnormal skeletal indices by transiliac bone biopsy. We have now studied skeletal microstructure by high-resolution peripheral quantitative computed tomography (HR-pQCT) through 4 years of treatment with recombinant human PTH(1-84) (rhPTH[1-84]) in 33 patients with hypoparathyroidism (19 with postsurgical disease, 14 idiopathic). We calculated Z-scores for our cohort compared with previously published normative values. We report results at baseline and 1, 2, and 4 years of continuous therapy with rhPTH(1-84). The majority of patients (62%) took rhPTH(1-84) 100 μg every other day for the majority of the 4 years. At 48 months, areal bone density increased at the lumbar spine (+4.9% ± 0.9%) and femoral neck (+2.4% ± 0.9%), with declines at the total hip (-2.3% ± 0.8%) and ultradistal radius (-2.1% ± 0.7%) (p < .05 for all). By HR-pQCT, at the radius site, very similar to the ultradistal DXA site, total volumetric BMD declined from baseline but remained above normative values at 48 months (Z-score + 0.56). Cortical volumetric BMD was lower than normative controls at baseline at the radius and tibia (Z-scores -1.28 and - 1.69, respectively) and further declined at 48 months (-2.13 and - 2.56, respectively). Cortical porosity was higher than normative controls at baseline at the tibia (Z-score + 0.72) and increased through 48 months of therapy at both sites (Z-scores +1.80 and + 1.40, respectively). Failure load declined from baseline at both the radius and tibia, although remained higher than normative controls at 48 months (Z-scores +1.71 and + 1.17, respectively). This is the first report of noninvasive high-resolution imaging in a cohort of hypoparathyroid patients treated with any PTH therapy for this length of time. The results give insights into the effects of long-term rhPTH(1-84) in hypoparathyroidism. © 2020 American Society for Bone and Mineral Research.

Penile Fracture Caused by Straddle Injury to a Nonerect Penis

We present the case of a 36-year-old male who sustained a straddle injury with classic signs of a urethral injury. He had blood at the meatus, a high-riding prostate, a butterfly hematoma, and he was unable to void. A retrograde urethrogram confirmed a bulbar urethral injury. After attempts at primary realignment with a Foley failed, he underwent suprapubic tube placement. However, when his physical examination worsened, an MRI revealed a concomitant injury to his left corpus cavernosum. This is the first reported case in the literature in which blunt trauma to a nonerect penis caused a penile fracture.

Socioeconomic inequalities and the equity impact of population-level interventions for adolescent health: an overview of systematic reviews

OBJECTIVES

Despite robust evidence on health inequalities in adulthood, less attention has been paid to inequalities in adolescence. The aim of this overview was to examine systematic review (SR) evidence on the equity impact of population-level interventions intended to improve health, happiness and wellbeing for adolescents.

STUDY DESIGN

An overview (review of systematic reviews).

METHODS

Eleven electronic databases were systematically searched to identify SRs of population-level interventions for adolescent health. A secondary data analysis of socioeconomic inequality was conducted to identify whether SRs reported on primary studies in terms of disadvantage, by measures of socioeconomic status (SES) and by differential effects.

RESULTS

35,310 review titles were screened; 566 full texts were retrieved and 140 SRs met the predefined selection criteria. Differential intervention effects were considered in 42/140 (30%) SRs, 18/140 (13%) reported primary studies using an SES measure and 16/140 (11%) explicitly reported differential effects. 15/140 SRs (11%) explicitly focused on socioeconomic inequalities; of these 4/15 reported differential intervention effects in more detail, 7/15 concluded there was insufficient primary evidence to identify the impact of interventions on socioeconomic inequalities and 4/15 planned to examine differential effects by SES, but this was not reported further.

CONCLUSIONS

Our overview identifies that there is limited SR evidence on the equity impact of population-level interventions for adolescent health. Strengthening the evidence on whether interventions narrow or widen inequalities for adolescents must be a priority for public health research.

Opposite Expression Patterns of Spry3 and p75NTR in Cerebellar Vermis Suggest a Male-Specific Mechanism of Autism Pathogenesis

Autism is a genetically complex neurobehavioral disorder with a population prevalence of more than 1%. Cerebellar abnormalities, including Purkinje cell deficits in the vermis, are consistently reported, and rodent models of cerebellar dysfunction exhibit features analogous to human autism. We previously analyzed the regulation and expression of the pseudoautosomal region 2 gene SPRY3, which is adjacent to X chromosome-linked TMLHE, a known autism susceptibility gene. SPRY3 is a regulator of branching morphogenesis and is strongly expressed in Purkinje cells. We previously showed that mouse Spry3 is not expressed in cerebellar vermis lobules VI-VII and X, regions which exhibit significant Purkinje cell loss or abnormalities in autism. However, these lobules have relatively high expression of p75NTR, which encodes a neurotrophin receptor implicated in autism. We propose a mechanism whereby inappropriate SPRY3 expression in these lobules could interact with TrkB and p75NTR signaling pathways resulting in Purkinje cell pathology. We report preliminary characterization of X and Y chromosome-linked regulatory sequences upstream of SPRY3, which are polymorphic in the general population. We suggest that an OREG-annotated region on chromosome Yq12 ∼60 kb from SPRY3 acts as a silencer of Y-linked SPRY3 expression. Deletion of a β-satellite repeat, or alterations in chromatin structure in this region due to trans-acting factors, could affect the proposed silencing function, leading to reactivation and inappropriate expression of Y-linked SPRY3. This proposed male-specific mechanism could contribute to the male bias in autism prevalence.

Magnetic Resonance Imaging Parameters at 1 Year Correlate With Clinical Outcomes Up to 17 Years After Autologous Chondrocyte Implantation

Background:

The ability to predict the long-term success of surgical treatment in orthopaedics is invaluable, particularly in clinical trials. The quality of repair tissue formed 1 year after autologous chondrocyte implantation (ACI) in the knee was analyzed and compared with clinical outcomes over time.

Hypothesis:

Better quality repair tissue and a better appearance on magnetic resonance imaging (MRI) 1 year after ACI lead to improved longer-term clinical outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Repair tissue quality was assessed using either MRI (11.5 ± 1.4 [n = 91] or 39.2 ± 18.5 [n = 76] months after ACI) or histology (16.3 ± 11.0 months [n = 102] after ACI). MRI scans were scored using the whole-organ magnetic resonance imaging score (WORMS) and the magnetic resonance observation of cartilage repair tissue (MOCART) score, with additional assessments of subchondral bone marrow and cysts. Histology of repair tissue was performed using the Oswestry cartilage score (OsScore) and the International Cartilage Repair Society (ICRS) II score. Clinical outcomes were assessed using the modified Lysholm score preoperatively, at the time of MRI or biopsy, and at a mean 8.4 ± 3.7 years (maximum, 17.8 years) after ACI.

Results:

At 12 months, the total MOCART score and some of its individual parameters correlated significantly with clinical outcomes. The degree of defect fill, overall signal intensity, and surface of repair tissue at 12 months also significantly correlated with longer-term outcomes. The presence of cysts or effusion (WORMS) significantly correlated with clinical outcomes at 12 months, while the presence of synovial cysts/bursae preoperatively or the absence of loose bodies at 12 months correlated significantly with long-term clinical outcomes. Thirty percent of repair tissue biopsies contained hyaline cartilage, 65% contained fibrocartilage, and 5% contained fibrous tissue. Despite no correlation between the histological scores and clinical outcomes at the time of biopsy, a lack of hyaline cartilage or poor basal integration was associated with increased pain; adhesions visible on MRI also correlated with significantly better histological scores.

Conclusion:

These results demonstrate that MRI at 12 months can predict longer-term clinical outcomes after ACI. Further investigation regarding the presence of cysts, effusion, and adhesions and their relationship with histological and clinical outcomes may yield new insights into the mechanisms of cartilage repair and potential sources of pain.

Skeletal Microstructure and Estimated Bone Strength Improve Following Parathyroidectomy in Primary Hyperparathyroidism

CONTEXT

High-resolution peripheral quantitative computed tomography (HRpQCT) is a noninvasive imaging technology that can provide insight into skeletal microstructure and strength. In asymptomatic primary hyperparathyroidism (PHPT), HRpQCT imaging has demonstrated both decreased cortical and trabecular indices, consistent with evidence for increased fracture risk. There are limited data regarding changes in HRpQCT parameters postparathyroidectomy.

OBJECTIVE

To evaluate changes in skeletal microstructure by HRpQCT in subjects with PHPT after parathyroidectomy.

DESIGN

We studied 29 subjects with PHPT (21 women, 8 men) with HRpQCT at baseline and 6, 12, 18, and 24 months postparathyroidectomy.

MAIN OUTCOME MEASURES

Volumetric bone mineral density, microarchitectural indices, and finite element analysis at the distal radius and tibia.

RESULTS

At both the radius and tibia, there were significant improvements in total, cortical, and trabecular volumetric bone density as early as 6 months postparathyroidectomy (24-month values for total volumetric bone density, radius: +2.8 ± 4%, tibia: +4.4 ± 4%; P < 0.0001 for both), cortical thickness (radius: +1.1 ± 2%, tibia: +2.0 ± 3%; P < 0.01 for both), and trabecular bone volume (radius: +3.8 ± 5%, tibia: +3.2 ± 4%; P < 0.0001 for both). At both sites, by finite element analysis, stiffness and failure load were improved starting at 6 months postparathyroidectomy (24-month values for failure load, radius: +6.2 ± 6%, tibia: +4.8 ± 7%; P < 0.0001 for both).

CONCLUSIONS

These results provide information about skeletal microarchitecture in subjects with PHPT followed through 2 years after parathyroidectomy. Estimated bone strength is improved, consistent with data showing decreased fracture risk postparathyroidectomy.

Children and young people's conceptualizations of depression: a systematic review and narrative meta-synthesis

BACKGROUND

There is an increasing research interest in conceptualizations of mental illness, examined in association with help-seeking, stigma and treatment preferences. A recent focus on young people's concepts has been identified, with depression being one of the most examined conditions.

METHODS

The purpose of this systematic review is to synthesize evidence on children and adolescents' conceptualizations of depression, adopting the model of illness representations. The review further aims to examine developmental trends, gender differences and the role of experience. A systematic review and narrative meta-synthesis were conducted, reviewing 36 studies identified through a systematic search of six databases in March 2016.

RESULTS

Thirty-six quantitative and qualitative studies were included. Half of the young people are able to recognize depression, and recognition increases when symptoms are more severe (e.g. suicidality). Young people are able to name a variety of causes for depression. Mental health professionals are considered the appropriate source of help by half of the young people, followed by family and peers. However, stigma constitutes a major barrier to help-seeking. There are developmental trends and gender differences in young people's conceptualization of depression, while experience with depression is associated with a broader conceptualization.

CONCLUSIONS

Young people's concepts of depression resemble aspects of adult conceptualizations, however are sometimes incomplete. Further research on younger children and clinical populations is needed. Research on young people's conceptualizations informs both clinical practice and mental health literacy interventions.

Assertiveness as a Mediating Variable in Conformity to Confederates of High and Low Status

40 men and 40 women, college students high and low in assertiveness, were exposed to an Asch-like conformity paradigm involving confederates of high and low status. The 40 highly assertive students conformed significantly less often than the 40 low in assertiveness to confederates of high and low status.

Factors Considered by Vocational Rehabilitation Professionals in Employability and Earning Capacity Assessment

The purpose of this study was to identify the factors that contributed to vocational rehabilitation assessment of earning capacity. Rehabilitation professionals who attended a national forensic rehabilitation conference were asked to rate the importance of 26 variables in development of opinions of earning capacity. Exploratory factor analysis revealed four themes in the responses: intrinsic characteristics of the worker, transferable skills components, worker traits, and labor market conditions. Multivariate analysis of variance found no significant differences in mean importance of the factors among forensic rehabilitation professionals practicing in different legal forums or in retention by plaintiff, defense, or neutral status, as well as no significant interactions. The results of this study will assist in the establishment of a standardized methodology for developing opinions of earning capacity consistent between forums of practice and competing parties in adjudication of vocational disability claims.

Pregnancy-specific glycoprotein expression in normal gastrointestinal tract and in tumors detected with novel monoclonal antibodies

Pregnancy-specific glycoproteins (PSGs) are immunoglobulin superfamily members related to the carcinoembryonic antigen-related cell adhesion molecule (CEACAM) family and are encoded by 10 genes in the human. They are secreted at high levels by placental syncytiotrophoblast into maternal blood during pregnancy, and are implicated in immunoregulation, thromboregulation, and angiogenesis. To determine whether PSGs are expressed in tumors, we characterized 16 novel monoclonal antibodies to human PSG1 and used 2 that do not cross-react with CEACAMs to study PSG expression in tumors and in the gastrointestinal (GI) tract using tissue arrays and immunohistochemistry. Staining was frequently observed in primary squamous cell carcinomas and colonic adenocarcinomas and was correlated with the degree of tumor differentiation, being largely absent from metastatic samples. Staining was also observed in normal oesophageal and colonic epithelium. PSG expression in the human and mouse GI tract was confirmed using quantitative RT-PCR. However, mRNA expression was several orders of magnitude lower in the GI tract compared to placenta. Our results identify a non-placental site of PSG expression in the gut and associated tumors, with implications for determining whether PSGs have a role in tumor progression, and utility as tumor biomarkers.

Epithelial cell shedding and barrier function: a matter of life and death at the small intestinal villus tip

The intestinal epithelium is a critical component of the gut barrier. Composed of a single layer of intestinal epithelial cells (IECs) held together by tight junctions, this delicate structure prevents the transfer of harmful microorganisms, antigens, and toxins from the gut lumen into the circulation. The equilibrium between the rate of apoptosis and shedding of senescent epithelial cells at the villus tip, and the generation of new cells in the crypt, is key to maintaining tissue homeostasis. However, in both localized and systemic inflammation, this balance may be disturbed as a result of pathological IEC shedding. Shedding of IECs from the epithelial monolayer may cause transient gaps or microerosions in the epithelial barrier, resulting in increased intestinal permeability. Although pathological IEC shedding has been observed in mouse models of inflammation and human intestinal conditions such as inflammatory bowel disease, understanding of the underlying mechanisms remains limited. This process may also be an important contributor to systemic and intestinal inflammatory diseases and gut barrier dysfunction in domestic animal species. This review aims to summarize current knowledge about intestinal epithelial cell shedding, its significance in gut barrier dysfunction and host-microbial interactions, and where research in this field is directed.

Psg22 expression in mouse trophoblast giant cells is associated with gene inversion and co-expression of antisense long non-coding RNAs

Pregnancy-specific glycoproteins (PSGs) are secreted carcinoembryonic antigen (CEA)-related cell adhesion molecules-related members of the immunoglobulin superfamily and are encoded by multigene families in species with haemochorial placentation. PSGs may be the most abundant trophoblast-derived proteins in human maternal blood in late pregnancy and there is evidence that dysregulation of PSG expression is associated with gestational pathology. PSGs are produced by syncytiotrophoblast in the human placenta and by trophoblast giant cells (TGCs) and spongiotrophoblast in rodents, and are implicated in immune regulation, angiogenesis and regulation of platelet function. PSGs are encoded by 17 genes in the mouse and ten genes in the human. While functions appear to be conserved, the typical protein domain organisation differs between species. We analysed the evolution of the mouse Psg genomic locus structure and report inversion of the Psg22 gene within the locus. Psg22 is the most abundant Psg transcript detected in the first half of mouse pregnancy and we identified antisense long non-coding RNA (lncRNA) transcripts adjacent to Psg22 associated with an active local chromatin conformation. This suggests that an epigenetic regulatory mechanism may underpin high Psg22 expression relative to the other Psg gene family members in TGCs.

Infant cervical range of motion in the sagittal plane

Background:

Data pertaining to infant sagittal cervical range of motion (CROM) is lacking. Previous studies have either quantified motions other than sagittal or quantified sagittal range of motion in children >3 years old. Data capture in infants is complex and novel methods are required to overcome previous limitations. Such data is invaluable to inform paediatric injury models, such as those for shaken baby syndrome and automotive safety.

Methods:

Nine infants were recruited from a local group of parents (mean age=406 days, SD=19). Sagittal range-of-motion was measured using two miniature accelerometers (THETAmetrix), which provide orientation angle with respect to gravity. One sensor was placed on the forehead and one over the T2–3 spinous process. Sagittal range of motion was determined by subtracting the tilt angle of thorax sensor from that of the forehead and then summing the total sagittal movement cycle to yield resultant cervical range of motion. Infants were placed in their usual highchair and encouraged to move their head into flexion and extension by a parent focussing their attention on a favourite toy. At the point of maximal motion, the lead researcher applied gentle overpressure to ensure full range was achieved with parental consent. Once one full cycle of sagittal motion was achieved, data collection was terminated.

Results:

Overpressure was not possible in two infants, therefore, their data was omitted. The mean peak sagittal range of motion was 115° (SD=12) with a 95% CI=106–124°.

Conclusions:

The described methods were successful in measuring sagittal CROM in infants and could be used to determine range of motion in even younger infants. The data produced is in agreement with previous reports on older children; however, this method overcomes limitations of other data capture methods.

Implications:

The results provide the first estimate of infant CROM. These data can serve as reference for models of musculoskeletal and neurological injury, including those for shaken baby syndrome and automotive safety.

The reliability of novel multiregional spinal motion measurement device

Background:

Current spinal range of motion (ROM) measurement methods have limitations ranging from the amount of detail obtained to environmental costs and complexity. In particular, limited regional spinal motion is obtained using the current methods. However, a new portable ‘string’ of accelerometers is proposed to overcome these limitations.

Objectives:

This study seeks to determine the reliability of this sensor string in measuring three-dimensional spinal ROM and to investigate the relative motions across six different regions.

Methods:

Two procedures were undertaken on 18 healthy participants. Protocol one: two sensors were placed on the forehead and T1 to measure cervical ROM; and protocol two: six sensors were placed on the spinous processes of T1, T4, T8, T12, L3 and S1 to measure thoraco-lumbar regional ROM.

Results:

The ICC values for all regions were found to be high, ranging from ICC=0.88–0.99 for all movements and regions of the spine, demonstrating that the proposed methods were highly reliable for repeated measures. The standard error of the means (SEMs) were small, ranging from 0.7–5.2°. The flexion/extension motion demonstrated a mean SEM of 1.9° and 1.1° for lateral bending motions. Slightly larger SEMs were observed for rotation, especially for the upper thoracic (UT) and mid thoracic (MT) region with an overall mean SEM of 3.1°. Minimum detectable change (MDC) values ranged from 1.9–14.4°. The flexion/extension motion demonstrated a mean MDC of 5.2° with 3.1° for lateral bending motions. Slightly larger MDCs were observed for rotation (mean MDC=8.4°), especially for the UT and MT region.

Implications:

This method was able to quantify the relative contribution of differing regions to the overall motion. The method described represents a reliable method of assessing spinal ROM across multiple spinal regions.

Signaling mediated by the NF-κB sub-units NF-κB1, NF-κB2 and c-Rel differentially regulate Helicobacter felis-induced gastric carcinogenesis in C57BL/6 mice

The classical nuclear factor-kappaB (NF-κB) signaling pathway has been shown to be important in a number of models of inflammation-associated cancer. In a mouse model of Helicobacter-induced gastric cancer, impairment of classical NF-κB signaling in the gastric epithelium led to the development of increased preneoplastic pathology, however the role of specific NF-κB proteins in Helicobacter-associated gastric cancer development remains poorly understood. To investigate this C57BL/6, Nfkb1^−/−, Nfkb2^−/− and c-Rel^−/− mice were infected with Helicobacter felis for 6 weeks or 12 months. Bacterial colonization, gastric atrophy and preneoplastic changes were assessed histologically and cytokine expression was assessed by qPCR. Nfkb1^−/− mice developed spontaneous gastric atrophy when maintained for 12 months in conventional animal house conditions. They also developed more pronounced gastric atrophy after short-term H. felis colonization with a similar extent of preneoplasia to wild-type (WT) mice after 12 months. c-Rel^−/− mice developed a similar degree of gastric atrophy to WT mice; 3 of 6 of these animals also developed lymphoproliferative lesions after 12 months of infection. Nfkb2^−/− mice developed minimal gastric epithelial pathology even 12 months after H. felis infection. These findings demonstrate that NF-κB1- and NF-κB2-mediated signaling pathways differentially regulate the epithelial consequences of H. felis infection in the stomach, while c-Rel-mediated signaling also appears to modulate the risk of lymphomagenesis in gastric mucosa-associated lymphoid tissue.

Rapid visual stimulation increases extrasynaptic glutamate receptor expression but not visual-evoked potentials in the adult rat primary visual cortex

The model most used to study synaptic plasticity, long-term potentiation (LTP), typically employs electrical stimulation of afferent fibers to induce changes in synaptic strength. It would be beneficial for understanding the behavioral relevance of LTP if a model could be developed that used more naturalistic stimuli. Recent evidence suggests that the adult visual cortex, previously thought to have lost most of its plasticity once past the critical period, is in fact capable of LTP-like changes in synaptic strength in response to sensory manipulations alone. In a preliminary study, we used a photic tetanus (PT; flashing checkerboard stimulus) to induce an enhancement of the visual-evoked potential (VEP) in the primary visual cortex of anesthetised adult rats. In the present study, we sought to compare the mechanisms of this novel sensory LTP with those of traditional electrical LTP. Unexpectedly, we found that sensory LTP was not induced as reliably as we had observed previously, as manipulations of several parameters failed to lead to significant potentiation of the VEP. However, we did observe a significant increase in visual cortex glutamate receptor expression on the surface of isolated synapses following the PT. Both AMPA receptor expression and N-methyl-d-aspartate (NMDA) receptor subunit expression were increased, specifically in extrasynaptic regions of the membrane, in PT animals. These results provide biochemical confirmation of the lack of change in the VEP in response to PT, but suggest that PT may prime synapses for strengthening upon appropriate subsequent activation, through the trafficking of glutamate receptors to the cell surface.

Ultrasonographic findings of the pancreas in cats with elevated serum pancreatic lipase immunoreactivity

BACKGROUND

Pancreatitis is a common disease in cats that is difficult to diagnose.

HYPOTHESIS/OBJECTIVES

To determine the sensitivity and specificity of ultrasonographic changes of the pancreas with serum feline pancreatic lipase immunoreactivity (fPLI) as the standard for diagnosis of pancreatitis.

ANIMALS

35 cats with clinical signs consistent with pancreatitis with an abdominal ultrasound examination and serum fPLI concentration measured within 3 days of the ultrasound.

METHODS

Retrospective study: Pancreatic thickness, pancreatic margination, pancreatic echogenicity, and peripancreatic fat echogenicity were evaluated. Sensitivity and specificity were calculated with an elevated serum fPLI concentration indicative of pancreatitis as the standard for diagnosis.

RESULTS

Serum fPLI was elevated and diagnostic for pancreatitis in 19 of 35 cats. The single ultrasound characteristic with the highest sensitivity was hyperechoic peripancreatic fat at 68% (95% confidence interval = 44-87%), indicating a moderate probability that cats with pancreatitis will have this abnormality on ultrasonographic examination. Specificity was >90% for each of increased pancreatic thickness, abnormal pancreatic margin, and hyperechoic peripancreatic fat. The sensitivity and specificity of ultrasound were 84% (95% confidence interval = 60-97%) and 75% (95% confidence interval = 48-93%), respectively, in cats with elevated serum fPLI indicative of pancreatitis.

CONCLUSIONS AND CLINICAL IMPORTANCE

The presence of a thick left limb of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat in cats with appropriate clinical signs and elevated serum fPLI are highly supportive of pancreatitis.

A low noise preamplifier with optoelectronic overload protection for radioactivity measurement

Pulses from detectors used for radioactivity measurement can vary in size by several orders of magnitude. Large pulses will lead to saturation at the preamplifier output and extension of the pulse length. As a consequence, the dead time of the system increases and pulses may be lost. Electronic design techniques employed to protect against overloading tend to increase the amplifier noise level. However, an optoelectronic method of overload protection has been devised which has only a negligible effect on noise. An infrared light emitting diode interfaced to the output of the preamplifier is linked by fibre optic cable to an ultra-low leakage photodiode at the input. The conduction of the photodiode increases with the amplitude of the preamplifier output signal. Excess current is thereby prevented from entering the preamplifier and causing saturation. The preamplifier has been tested on 4π beta-gamma and gas counting systems and found to give good protection against overloading.

Life-extending dietary restriction and ovariectomy result in similar feeding rates but different physiologic responses in grasshoppers

Dietary restriction (DR) and reduced reproduction each extend life span in many species. Females undergoing DR typically experience a reduction in their fecundity, which raises the question of whether the two treatments are actually extending life span in overlapping ways. Life span in lubber grasshoppers has been shown to be increased by DR, and separately by ovariectomy (OVX). Here, we test the combination of these on life span. If life extension by the two treatments are additive, it would suggest that they likely act through separate pathways. The experimental groups were: fully reproductive and fully fed (ShamFD); ovariectomized and fully fed (OVXFD); fully reproductive and restricted diet (ShamDR); and ovariectomized and restricted diet (OVXDR). The median life spans of these groups were: ShamFD=245 d, OVXFD=285 d, ShamDR=286 d, and OVXDR=322 d. Feeding rate for the OVXFD group was 64% of ad libitum, similar to the 70% of ad libitum that was used for ShamDR. We also measured hemolymph parameters of physiology in these same individuals. Hemolymph levels of vitellogenin (the egg yolk-precursor protein) were increased 5-fold by OVX, but were not affected by DR. In addition, hemolymph total anti-oxidant activity (per μg protein) was significantly reduced by OVX, but was not affected by DR. We show that OVX and DR produce different physiological responses in grasshoppers, despite life extensions and feeding levels that were not significantly different. These data suggest that OVX and DR might extend life span via distinct pathways.

The OARSI histopathology initiative - recommendations for histological assessments of osteoarthritis in the rabbit

AIM

The primary goal of this body of work is to suggest a standardized system for histopathological assessment of experimental surgical instability models of osteoarthritis (OA) in rabbits, building on past experience, to achieve comparability of studies from different centres. An additional objective is to review methodologies that have been employed in the past for assessing OA in rabbits with particular reference to the surgical anterior cruciate ligament transection (ACLT) model.

METHODS

A panel of scientists and clinician-scientists with recognized expertise in assessing rabbit models of OA reviewed the literature to provide a critical appraisal of the methods that have been employed to assess both macroscopic and microscopic changes occurring in rabbit joint tissues in experimental OA. In addition, a validation of the proposed histologic histochemical grading system was performed.

RESULTS

The ACLT variant of the surgical instability model in skeletally mature rabbits is the variation most capable of reproducing the entire range of cartilage, synovial and bone lesions recognized to be associated with OA. These lesions can be semiquantitatively graded using macroscopic and microscopic techniques. Further, as well as cartilage lesions, this ACLT model can produce synovial and bone lesions similar to that of human OA.

CONCLUSIONS

The ACLT variant of the surgical instability model in rabbits is a reproducible and effective model of OA. The cartilage lesions in this model and their response to therapy can be graded according to an adapted histological and histochemical grading system, though also this system is to some extent subjective and, thus, neither objective nor entirely reproducible.

Metal cluster chemistry: Structure and stereochemistry in the polynuclear rhodium hydrides H(n)Rh(n)[P(OR)(3)](2n)

Crystallographic analyses of x-ray and neutron diffraction data have provided a definitive structural representation of {HRh[P(O-i-C(3)H(7))(3)](2)}(2) and {HRh[P(OCH(3))(3)](2)}(3). These polynuclear hydrides are generated from square planar H(2)Rh[P(OR)(3)](2) units by edge (hydrogen atom) sharing and by vertex (hydrogen atom) sharing to form the dimeric and trimeric structures, respectively. The square-planar units are held together through four-center and three-center two-electron Rh-H-Rh bonds in the dimer and trimer, respectively. The dimer and trimer molecules each add one molecule of hydrogen to form H[(i-C(3)H(7)O)(3)P](2)RhH(3)Rh [P(O-i-C(3)H(7))(3)](2) and H(5)Rh(3)[P(OCH(3))(3)](6), respectively. NMR spectral information has served to define the stereochemical features of these polyhydrides. The significance of this chemistry in the metal cluster-metal surface analogy is described.

Selective potentiation of the metabotropic glutamate receptor subtype 2 blocks phencyclidine-induced hyperlocomotion and brain activation

Previous preclinical and clinical studies have demonstrated the efficacy of group II metabotropic glutamate receptor (mGluR) agonists as potential antipsychotics. Recent studies utilizing mGluR2-, mGluR3-, and double knockout mice support that the antipsychotic effects of those compounds are mediated by mGluR2. Indeed, biphenyl indanone-A (BINA), an allosteric potentiator of mGluR2, is effective in experimental models of psychosis, blocking phencyclidine (PCP)-induced hyperlocomotion and prepulse inhibition deficits in mice. In this study, we administered the NMDA receptor antagonist PCP (5.6 mg/kg i.p.) to rats, an established animal model predictive of schizophrenia. Here, we show that BINA (32 mg/kg i.p.) attenuated PCP-induced locomotor activity in rats. Using behaviorally relevant doses of BINA and PCP, we performed pharmacological magnetic resonance imaging (phMRI) to assess the specific brain regions that underlie the psychotomimetic effects of PCP, and examined how BINA modulated the PCP-induced functional changes in vivo. In anesthetized rats, acute administration of PCP produced robust, sustained blood oxygenation level-dependent (BOLD) activation in specific cortical, limbic, thalamic, and striatal regions. Pretreatment with BINA suppressed the amplitude of the BOLD response to PCP in the prefrontal cortex, caudaute-putamen, nucleus accumbens, and mediodorsal thalamus. Our results show key brain structures underlying PCP-induced behaviors in a preclinical model of schizophrenia, and, importantly, its reversal by potentiation of mGluR2 by BINA, revealing specific brain regions functionally involved in its pharmacological action. Finally, our findings bolster the growing body of evidence that mGluR2 is a viable target for the treatment of schizophrenia.

Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic

BACKGROUND

Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes.

AIM

This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service.

RESULTS

46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non-menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non-menthol smokers. At 4-week follow up, AA, Latino and White non-menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non-menthol counterparts. At 6-month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non-menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9).

CONCLUSIONS

Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non-menthol smokers within the same ethnic/racial groups.

Causes of death in the Kasekela chimpanzees of Gombe National Park, Tanzania

Understanding the rates and causes of mortality in wild chimpanzee populations has important implications for a variety of fields, including wildlife conservation and human evolution. Because chimpanzees are long-lived, accurate mortality data requires very long-term studies. Here, we analyze 47 years of data on the Kasekela community in Gombe National Park. Community size fluctuated between 38 and 60, containing 60 individuals in 2006. From records on 220 chimpanzees and 130 deaths, we found that the most important cause of mortality in the Kasekela community was illness (58% of deaths with known cause), followed by intraspecific aggression (20% of deaths with known cause). Previous studies at other sites also found that illness was the primary cause of mortality and that some epidemic disease could be traced to humans. As at other study sites, most deaths due to illness occurred during epidemics, and the most common category of disease was respiratory. Intraspecific lethal aggression occurred within the community, including the killing of infants by both males and females, and among adult males during the course of dominance-related aggression. Aggression between communities resulted in the deaths of at least five adult males and two adult females in the Kasekela and Kahama communities. The frequency of intercommunity violence appears to vary considerably among sites and over time. Intercommunity lethal aggression involving the Kasekela community was observed most frequently during two periods. Other less common causes of death included injury, loss of mother, maternal disability, and poaching.

The acute management of head injury

The management of traumatic brain injury has undergone extensive revision as the results of large collaborative outcome studies have cast doubt on many traditional 'common sense' practices. The primary goal of identifying and treating intracranial hypertension has given way to a focus on secondary brain ischemia, in which cerebral perfusion pressure and oxygen delivery have gained new importance. With the exception of impending herniation, the routine use of hyperventilation and high-dose barbiturates is no longer recommended. Hypertonic saline, given as intermittent boluses, has joined mannitol as an effective means of reducing cerebral edema. Preliminary results from a large multi-center study have cast doubt on the benefit of the broad application of hypothermia in improving outcome in traumatic brain injury.

Mannose-binding lectin gene polymorphisms in a cohort study of ANCA-associated small vessel vasculitis

OBJECTIVE

To investigate whether single nucleotide polymorphisms (SNPs) within the mannose-binding lectin (MBL) gene are associated with small vessel vasculitis (SVV) and are a risk factor for intercurrent infection, as described previously in other autoimmune diseases.

METHODS

Six SNPs in the MBL promoter and coding region were genotyped by sequence-specific polymerase chain reaction or restriction fragment length polymorphism assay in 170 white Caucasians with SVV and 372 ethnically matched controls in a case-control association study. Serum MBL levels were measured by ELISA. The genotype and protein concentrations were correlated to clinical details retrieved from hospital records.

RESULTS

No differences in allelic and genotypic frequencies were detected between patients with SVV and control subjects. MBL deficiency did not increase the susceptibility to infection (P = 0.6, Fisher's exact test) or the duration of hospital stay.

CONCLUSION

Our data suggest that MBL polymorphisms are not associated with SVV and do not influence the incidence of concomitant infections. These results raise doubts about the usefulness of MBL polymorphisms as a predictive marker for infection in SVV.