Sensitization to food and inhalant allergens in relation to age and wheeze among children with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is common in children; however, persistence of AD with or without asthma is less common. Longitudinal studies remain limited in their ability to characterize how IgE antibody responses evolve in AD, and their relationship with asthma.

OBJECTIVE

To use a cross-sectional study design of children with active AD to analyse age-related differences in IgE antibodies and relation to wheeze.

METHODS

IgE antibodies to food and inhalant allergens were measured in children with active AD (5 months to 15 years of age, n = 66), with and without history of wheeze.

RESULTS

Whereas IgE antibodies to foods persisted at a similar prevalence and titre throughout childhood, IgE antibodies to all aeroallergens rose sharply into adolescence. From birth, the chance of sensitization for any aeroallergen increased for each 12-month increment in age (OR ≥ 1.21, P < 0.01), with the largest effect observed for dust mite (OR = 1.56, P < 0.001). A steeper age-related rise in IgE antibody titre to dust mite, but no other allergen was associated with more severe disease. Despite this, sensitization to cat was more strongly associated with wheeze (OR = 4.5, P < 0.01), and linked to Fel d 1 and Fel d 4, but not Fel d 2. Comparison of cat allergic children with AD to those without, revealed higher IgE levels to Fel d 2 and Fel d 4 (P < 0.05), but not Fel d 1.

CONCLUSIONS AND CLINICAL RELEVANCE

Differences in sensitization to cat and dust mite among young children with AD may aid in identifying those at increased risk for disease progression and development of asthma. Early sensitization to cat and risk for wheeze among children with AD may be linked to an increased risk for sensitization to a broader spectrum of allergen components from early life. Collectively, our findings argue for early intervention strategies designed to mitigate skin inflammation in children with AD.

Determination of 20 coccidiostats in milk, duck muscle and non-avian muscle tissue using UHPLC-MS/MS

In this paper, methods were developed to measure coccidiostats in bovine milk, duck muscle and non-avian species. The methods were validated to the maximum levels and MRLs laid down in European Union legislation. A simple sample preparation procedure was developed for the isolation of coccidiostat residues from bovine, ovine, equine, porcine and duck muscle tissue, based on solvent extraction with acetonitrile and concentration. An alternative method had to be developed for milk samples based on the QuEChERS sample preparation approach because of the high water content in this matrix. Milk samples were adjusted to basic pH with sodium hydroxide and extracted by using a slurry of acetonitrile, MgSO4 and NaCl. Purified sample extracts were subsequently analysed by using UHPLC-MS/MS in a 13.2-min chromatographic run. It was found that the use of rapid polarity switching enabled both negatively and positively charged ions to be analysed from a single injection. By using this approach, solvent usage was reduced significantly and sample throughput improved. The method was validated for the analysis of 20 coccidiostats (arprinocid, clopidol, decoquinate, diclazuril, diaveridine, ethopabate, halofuginone, laidlomycin, lasalocid, maduramicin, monensin, narasin, nequinate, nicarbazin, robenidine, salinomycin, semduramicin, toltrazuril, toltrazuril sulphoxide and toltrazuril sulphone) in muscle and milk. The method is quantitative for toltrazurils, but it cannot be used for confirmation because only the precursor ion is monitored. Accuracy values for muscle ranged from 80% to 125%, while CCα ranged from 2.2 µg kg(-1) for clopidol to 122 µg kg(-1) for toltrazuril sulphoxide. Bovine milk accuracy ranged from 84% to 120% for all analytes except maduramicin, semduramicin and salinomycin, for which the values were higher. CCα values achieved ranged from 1.1 µg kg(-1) for arprinocid, nequinate and lasalocid to 27 µg kg(-1) for toltrazuril.

GENDER, SEXUALITY, AND ETHNICITY AS FACTORS OF CLUB DRUG USE AMONG ASIAN AMERICANS

This article examines the relationship between substance use and gender, sexuality, ethnicity, and nativity among 250 Asian American youths involved in the dance club/rave scene. We find distinct patterns of drug use differing by country of origin and ethnicity. However, contrary to some literature we do not find significant differences corresponding to immigration status, or number of years in the U.S. The most significant differences between subgroups are related to gender and sexuality: male respondents consume more drugs, more frequently than female respondents, and non-heterosexual respondents consume more than heterosexual respondents, with differing patterns for men's and women's sexual subgroups. There were also significant gender and sexuality differences with respect to the contexts in which respondents consume drugs, with the most significant differences being between heterosexual and non-heterosexual men. As we discuss, these findings illustrate the need for further investigation of drug use patterns of gender and sexuality within Asian American communities.

Tailored chemotherapy (CT) information (info) faxed to general practitioners (GP) improves knowledge and confidence in managing side effects (SFX): Results from a randomized controlled trial (RCT)

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Background: The literature indicates discontinuity in patient (pt) care and poor communication between hospitals and community practice. GPs would like more info about CT, SFX and how to manage these. We aimed to develop standardized info for GPs about CT and to assess the impact of this in an RCT. Primary endpoints were: confidence managing pts having CT, knowledge of CT SFX, and satisfaction with both info and shared care of pts. Secondary endpoints included how useful and instructive GPs found the info. Methods: Peter Mac IRB approved the study. Initial focus group work with GPs informed the development of info about 23 CT regimens. GPs of pts due to commence a CT regimen for the first time were randomized to receive usual correspondence (UC) or UC plus info. Prior to randomization GPs were telephoned and verbal consent obtained. Telephone questionnaire (qstnre) assessed GPs confidence in managing pts and knowledge of CT SFX, as well as satisfaction with info and shared care of pts. GPs in the intervention group were then faxed the relevant info. One week later all GPs were phoned and completed a similar standardized qstnre. Measures used a 5 point scale/range. Results: 97 GPs managed 97 pts receiving 21 types of CT. GPs on average had 27.1 yrs clinical experience (SD=9.8) and were managing 5.5 pts receiving CT (SD=6.8). Of 97 GPs randomized, 81 (83.5%) completed the follow up qstnre. GPs confidence in managing CT SFX was fair at baseline (M=3.34, SD=0.69). GPs in the intervention group demonstrated a significantly greater increase in confidence (difference 0.36; p<0.01) and knowledge of CT SFX - eg febrile neutropenia (diff 0.55; p<0.01) - and close to significant effect for satisfaction with info / shared care (diff 0.35; p=0.051) compared with UC. GPs receiving info + UC also considered it significantly more useful (diff 1.48; p<0.001) and instructive (diff 1.88; p<0.001) than GPs who only received UC. Conclusions: Info about CT faxed to GPs is a simple, inexpensive intervention that increases GPs knowledge of CT SFX and confidence in managing pts. Further, GPs find this info more useful and instructive than UC alone. This intervention could have widespread application.

No significant financial relationships to disclose.

Atomic force microscopy of BHK-21 cells: an investigation of cell fixation techniques

The atomic force microscope (AFM) has been used to image a wide variety of biological samples, including cultured cells, in air. Whilst cultured cells have been prepared for AFM analysis using a variety of matrices and fixatives, a definitive study of sample preparation and its effects on cell morphology has not, as far as the authors are aware, previously been reported. Although a considerable number of cell fixatives exist, no single fixative is ideal for all investigations. Prior to the performance of specialised techniques, such as atomic force microscopy of cultured cells in air, the cell fixation method must be investigated and optimised. The fixative abilities of 2% paraformaldehyde-lysine-periodate, 0.25% glutaraldehyde, paraformaldehyde-glutaraldehyde, 4% phosphate-buffered formal saline, 1% formaldehyde, methanol:acetone, formal saline, 4% paraformaldehyde and ethanol:acetic acid were assessed in this study. A qualitative assessment system was used to evaluate the efficacy of the above fixatives using conventional fixation criteria (i.e. the presence of fibroblastic morphology consistent with optical microscopy and the absence of fixation artifacts). The optimal fixative was identified as 4% paraformaldehyde, which was capable of providing optically consistent images of BHK-21 (fibroblastic) cells, whose heights remained within the measurement capability of the AFM instrument used in this study.

Atomic force microscopy analysis of enveloped and non-enveloped viral entry into, and egress from, cultured cells

Since its invention, the atomic force microscope has been used to image a wide variety of biological samples, including viruses. Viral entry into, and egress from, cultured cells has been extensively studied using numerous scientific techniques and to a limited extent using atomic force microscopy. One of the main structural differences that can exist between viruses is the absence, or presence, of an envelope and this factor has consequences for the mode of viral entry and egress. In this study, the entry into, and egress from, cultured cells of enveloped and non-enveloped viruses were investigated using atomic force microscopy. No significant cell surface changes were observed following infection with enveloped or non-enveloped viruses. Although roughness analysis of viral entry revealed cell smoothing post-infection, no differences between the roughness values of enveloped and non-enveloped viral entry were observed. Line analysis of viral entry revealed minor differences between cells infected with an enveloped rather than a non-enveloped virus. These differences may represent a distinction between the uptake processes of enveloped and non-enveloped viruses. Studies of viral egress revealed that infected cells were undergoing cytopathic changes. Whilst topographic, height and roughness differences clearly occurred between virally- and mock-infected cells, no significant differences were elucidated between enveloped and non-enveloped viral egress.

Effect of high levels of intense sweetener intake in insulin dependent diabetics on the ratio of dietary sugar to fat: a case–control study

OBJECTIVE

To examine the influence of intense sweetener consumption on nutrient intakes in insulin dependent diabetics compared to controls.

DESIGN

Case-control food consumption survey.

SETTING

Dietary data were collected from individuals in Ireland between 1998 and 1999.

SUBJECTS

Diabetics were recruited through diabetic outpatient departments of St. James's Hospital Dublin. Controls were friends of the patients or staff/students of Trinity College and University College Dublin. Of the 171 diabetics contacted, 122 agreed to participate (70% response rate) and 119 completed the study.

INTERVENTIONS

In all, 3-day food diaries were used to collect the food consumption data.

MAIN OUTCOME MEASURES

Fat--sugar seesaw, intense sweetness.

RESULTS

Patients had significantly higher % energy from starch, lower % energy from sugars and a high intake of fibre compared to controls. In both groups, there was an inverse relationship between % energy from fat and % en from sugar, with the diabetics at the lower level of sugar intake. A score of intense sweetness intakes was computed and across tertiles of this score, there were no significant effects on macronutrient intakes.

CONCLUSION

The fat-sugar seesaw present in the diabetic group was at a lower level compared to the control group. A high intake of intense sweeteners does not have a detrimental effect on macronutrient and micronutrient intakes.

Evidence of patient-to-patient transmission of hepatitis C virus through contaminated intravenous anaesthetic ampoules

Two separate cases of acute hepatitis C virus (HCV) infection following medical procedures, arthroscopy and colonoscopy, are reported. In both episodes, patient risk factors were reviewed, and staff and other patients' sera were tested for HCV antibodies and RNA. HCV RNA positive samples were genotyped, sequenced, and subjected to phylogenetic analysis. No risk factors for HCV infection were identified for either case except for medical procedures. HCV RNA positive patients were identified preceding both cases on the respective theatre lists. HCV infection in a second low risk patient was also identified. Nucleic acid sequencing and phylogenetic analysis of HCV from the two putative source patients and the three recipient patients demonstrated a high degree of relatedness respectively. The results suggest that patient-to-patient transmission occurred in both episodes via contamination of intravenous anaesthetic ampoules with HCV used on multiple patients. Injectable medication ampoules should not be used for more than one patient.

Chronic neck pain following road traffic accidents in an Irish setting and it's relationship to seat belt use and low back pain

Chronic neck pain following road traffic accidents is a highly prevalent condition in developed societies. It constitutes the main element of chronic whiplash syndrome, and is often used synonymously with that term. It is also a highly controversial condition, with debate in the extensive literature as to the nature of the complaint. We performed an analysis of 100 consecutive patients presenting for treatment of chronic neck pain following road traffic accidents. The mean duration of neck pain was 15.5 months and 90% of patients reported wearing a seatbelt at the time, a significantly greater proportion than the general population (p<0.001). All patients in the study were involved in litigation related to the accident. The mean time off work due to the injury was 4.9 months (range 1 week-3 years). 60 patients also complained of accident related low back pain, a statistically significant association with whiplash syndrome (p<0.001). Our study demonstrates a significantly high incidence of reported seatbelt use in patients presenting with chronic neck pain and whiplash syndrome. We also found a significant association between whiplash and chronic lumbar pain, an association having important medico-legal implications and requiring further analysis.

Immobilisation of Semliki forest virus for atomic force microscopy

Semliki Forest virus (SFV), an alphavirus, is a single-stranded positive-sense RNA virus. The RNA genome is surrounded by a protein shell known as the capsid which itself is surrounded by a lipid envelope of host cell origin. In this study, SFV strain L10 enveloped virus and its capsid were immobilised onto silicon wafer supports which had been pre-coated with a monolayer of the relevant anti-viral antibody. After drying, the samples were imaged in air, using non-contact mode atomic force microscopy (AFM). Quantification of the AFM images has revealed that both the strain L10 enveloped virus and capsid collapse when immobilised in this manner. The capsid undergoes more significant collapse compared to the enveloped virus. The dimensions of the immobilised enveloped virus and capsid have been compared to a model where the free spherical particles collapse into ellipsoids during immobilisation. For the immobilised capsid the dimensions are consistent with this model whereas for the enveloped virus the model is less effective. The dimensions of the enveloped virus appear to be affected by the antibody used for immobilisation.

Diastasis of the pubic symphysis peculiar to horse riders: modern aspects of pelvic pommel injuries

Diastasis of the pubic symphysis is a well documented injury typically associated with high energy trauma. Three cases in horse riders are here described, emphasising the appropriate modern investigation, including computed tomography, and orthopaedic and urological management.

Dietary treatments of obesity

Numerous dietary treatments that purport to promote something unique for stimulating weight loss have been published. These treatments include fad diets, diets formulated by various commercial slimming clubs, very-low-energy diets (VLCD) and conventional diets. Fad diets may possibly reduce some weight short-term; however, there is no scientific basis to their long-term use. Commercial slimming clubs may be suitable for some individuals but they need to be properly assessed professionally. There are specific guidelines for the use of VLCD, which are only appropriate for short-term use. There is scientific evidence to suggest that conventional diets can produce both short- and long-term weight loss. A successful weight-loss programme depends on a multidisciplinary team approach. Management strategies should be devised for addressing issues such as goals, monitoring, follow-up, relapse and evaluation. Initial assessments should include medical, laboratory and anthropometric data, fitness level and dietary and behavioural attitudes. These results will form the basis of the treatment plan. Frequent visits to the clinic are fundamental in promoting continuing weight loss during the long-term maintenance stage of treatment. The visits should be made worthwhile for the patient. Realistic and attainable goals for diet, exercise and behaviour modification should be made. The diet should have a novel approach and be tailored to the needs of the patient. It should be adequate nutritionally, low in energy and fat. The overall aim should be to promote lifelong changes in lifestyle, improvement in quality of life and health risks.

Association of tumor necrosis factor polymorphism with primary sclerosing cholangitis

BACKGROUND/AIMS

Primary sclerosing cholangitis is associated with the HLA haplotypes A1-B8-DRB3*0101-DRB1*0301-DQA1*0501-DQB1*0201 and DRB3*0101-DRB1*1301-DQA1*0103-DQB1* 0603. However, the interpretation of these genetic associations is controversial. One explanation may be that HLA-encoded susceptibility is due to other genes carried on these haplotypes such as the HLA class III tumor necrosis factor genes. The aim of the study was to investigate tumor necrosis factor genetics in a large series of well-defined patients.

METHODS

One hundred and ten HLA genotyped patients and 126 control subjects were studied by polymerase chain reaction genotyping for 3 different tumor necrosis factor gene polymorphisms: -308, -238 and an Ncol restriction fragment length polymorphism in the lymphotoxin alpha gene.

RESULTS

Overall, 58% of patients had the TNF2 allele, compared with 29% of controls, p(c) = 0.0001. No association was found with either of the other tumor necrosis factor polymorphisms examined. TNF2 was significantly increased in the presence of B8 and DRB3*0101 only, and was independent of DRB1*0301 (p(c)<0.04). The associations with B8 and TNF2 were stronger than the associations with any of the HLA class II alleles examined.

CONCLUSION

HLA-encoded genetic susceptibility to primary sclerosing cholangitis may be determined by polymorphism within the HLA class III region, in particular with the TNF2 allele.

Cloning of a full-length insulin-like growth factor-I complementary DNA in the goldfish liver and ovary and development of a quantitative PCR method for its measurement

Five forms of insulin-like growth factor-I (IGF-I) complementary DNA (cDNA) were isolated by PCR from goldfish liver and ovary, using primers based on common carp IGF-I sequence. In the goldfish liver, we cloned and sequenced three IGF-I forms (1,2, and 3), and elucidated the full-length cDNA sequence using the 5'-and 3'-RACE. Two IGF-I forms (1 and 2) were cloned from the goldfish ovary and were found to have differences with respect to both size and nucleotide sequence compared to liver IGF-I. The entire liver IGF-I form 1 sequence was found to be 833 nucleotides long, containing a 483-nucleotide open reading from encoding 161 amino acids. The deduced amino acid sequence of the mature peptide was compared to IGF-I sequences of other vertebrates, and found to have 97 and 93% similarity to carp and salmon IGF-I, respectively, In this study we also developed a competitive quantitative PCR method and demonstrated an increase in IGF-I expression following treatments with growth hormone or gonadotropin-releasing hormone in the goldfish liver.

Autoimmune hepatitis overlapping with primary sclerosing cholangitis in five cases

OBJECTIVE

We report five cases (four male; median age 20 yr, range 14-38 yr) of an autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome. The patients presented with jaundice, elevated serum aminotransferase and alkaline phosphatase activities, hyperglobulinemia with high immunoglobulin G (IgG) levels, circulating antinuclear and/or smooth muscle autoantibodies (> or = 1:40), and moderate to severe interface hepatitis on liver biopsy (with biliary features in four).

METHODS

All five fulfilled criteria for diagnosis of "definite" autoimmune hepatitis and showed marked responses to prednisolone and azathioprine therapy, with relapses occurring during reduction or withdrawal of treatment. Cholangiographic features of primary sclerosing cholangitis were found in three patients at presentation and after intervals of 7 and 14 yr in the other two. Only two had evidence of inflammatory bowel disease. Diagnostic criteria for identifying those patients who may benefit from immunosuppressive therapy were reviewed.

RESULTS

Review of the literature revealed only 11 similar cases that were sufficiently well described for comparison. However, in contrast to these and the present cases, preliminary data from other studies have suggested a marked association with ulcerative colitis and a poor response to immunosuppressive therapy.

CONCLUSIONS

It is recommended that the possibility of an autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome responsive to immunosuppressive therapy should be considered in any patient presenting with a hepatitic illness with hyperglobulinemia, antinuclear or smooth muscle autoantibodies, and biliary changes on liver biopsy. Cholangiography should be considered in such patients.

Transient expression and oil body targeting of an Arabidopsis oleosin-GUS reporter fusion protein in a range of oilseed embryos

An Arabidopsis oleosin gene including 860 bp of promoter as well as coding sequence was fused to the reporter, β-glucuronidase (GUS). In transient expression assays following particle bombardment, the Arabidopsis gene in both transcriptional and translational fusions with GUS was functional in a range of oilseed embryos as determined histochemically and fluorimetrically. Significantly, upon homogenization and separation into cytoplasmic and oil body fractions, the complete oleosin-GUS fusion was found to be targeted to the oil bodies in all of the heterologous species tested including canola, flax, soybean, sunflower, safflower, cotton, castor bean, coriander as well as the monocot, corn. The utilization of oleosin protein fusions for recombinant protein expression should be applicable to this wide range of oilseed crops. Additionally, the method of transient expression subcellular targeting should be useful in determining structural motifs controlling intracellular trafficking of these proteins.

Characterization of the inducible nitric oxide synthase oxygenase domain identifies a 49 amino acid segment required for subunit dimerization and tetrahydrobiopterin interaction

The oxygenase domain of inducible NO synthase (residues 1-498, iNOSox) is the enzyme's catalytic center. Its active form is a homodimer that contains heme and tetrahydrobiopterin (H4biopterin) and binds l-arginine [Ghosh, D. K., & Stuehr, D. J. (1995) Biochemistry 34, 801]. To help identify protein residues involved in prosthetic group and dimeric interaction, we expressed H4biopterin-free iNOSox in Escherichia coli. The iNOSox was 80% dimeric but contained a low-spin heme iron that bound DTT as a sixth ligand. The iNOSox bound H4biopterin or L-arginine with high affinity, which displaced DTT from the heme and caused spectral changes consistent with a closing up of the heme pocket. The H4biopterin-replete iNOSox could catalyze conversion of Nomega-hydroxyarginine to citrulline and NO in a H2O2-supported reaction. Limited trypsinolysis of the H4biopterin-free iNOSox dimer cut the protein at a single site in its N-terminal region (K117). H4biopterin protected against the cleavage whereas l-arginine did not. The resulting 40 kDa protein contained thiol-ligated low-spin heme, was monomeric, catalytically inactive, showed no capacity to bind H4biopterin or l-arginine, and did not dimerize when provided with these molecules, indicating that residues 1-117 were important for iNOSox dimerization and H4biopterin/l-arginine interaction. A deletion mutant missing residues 1-114 was partially dimeric but otherwise identical to the 40 kDa protein regarding its spectral and catalytic properties and inability to respond to l-arginine and H4biopterin, whereas a deletion mutant missing residues 1-65 was equivalent to wild-type iNOSox, narrowing the region of importance to amino acids 66-114. Mutation of a conserved cysteine in this region (C109A) decreased H4biopterin affinity without compromising iNOSox dimeric structure, L-arginine binding, or catalytic function. These results suggest that residues 66-114 of iNOSox are involved in productive H4biopterin interaction and subunit dimerization. H4biopterin binding appears to stabilize the protein structure in this region, and through doing so activates iNOS for NO synthesis.

Association of celiac disease with microsatellite polymorphisms close to the tumor necrosis factor genes

Celiac disease is tightly linked to the MHC class II region on chromosome 6. We have studied two highly polymorphic microsatellite loci, TNFa and b, near the TNF genes in the class III region of the MHC, for evidence of their association to CD, as compared to a control population. Our findings show that the microsatellite allele most significantly associated with the disease is TNFb3, which is found in 86.3% of CD patients versus 24.5% of controls, with allele frequencies of 0.5392 and 0.1290, respectively (p < 0.001). The TNFa2 allele had a frequency of 0.6122 in CD patients and 0.2627 in controls (p < 0.001), with phenotype frequencies of 87.8% and 50.0%, respectively. TNFa6 and -a11 and TNFb5 have significantly reduced frequencies in CD patients. TNFb3 shows a maximal level of linkage disequilibrium with HLA-DQB1*0201 in celiac patients. However, while the DQB1*0201/TNFa2 haplotype was strongly associated with CD, DQB1*0201 was not significantly in linkage disequilibrium with TNFa2, suggesting that TNFa2 is independently associated with CD. This association could have functional significance as TNFa2 has been correlated with high TNF production.

Classification and expression of a family of cyclin gene homologues in Brassica napus

In order to investigate the role of cell division in plant development, we isolated several plant genes which encode homologues of animal and yeast cell cycle regulators known as cyclins. Through the use of degenerate primers and the polymerase chain reaction (PCR) we isolated a Brassica sequence which showed homology to the 'cyclin box' functional domain found within cyclin proteins. Southern blot analysis indicated that Brassica napus has a large number of genes containing cyclin box-related sequences. This was further supported by the isolation of cyclin box sequences from six different genomic clones. In addition, we have isolated two different cyclin cDNA clones, BnCYC1 and BnCYC2, from a Brassica napus shoot apical cDNA library. Both of the cDNA clones contain a 'destruction box' regulatory domain similar to animal mitotic cyclins. Northern blot analysis using BnCYC2 shows mRNA levels which correlate well with the level of cell division in various tissues. Messenger RNA abundance was highest in 1-3 mm leaves, root tips and shoot apices. The mRNA detected using BnCYC1 was restricted to young leaves and the shoot apex, suggesting divergent, organ-specific roles for cyclin family members. The results demonstrate that the plant cyclin gene family is more extensive than previously demonstrated and consists of genes expressed in all dividing tissues as well as a subset of developmentally specific members.

Transverse fracture of the patella in children

We report two cases of transverse fracture of the patella in children. Contrary to the general belief that this fracture is common in children, we could not find any reported cases since 1973. Both of our cases were sports-related and each illustrates a different mechanism of injury.

The enhancement of polyclonal T cell proliferation by beta-endorphin

Beta-endorphin (beta-end) is a naturally occurring opioid peptide that has been implicated as a modulator of immune function. In this communication, data are presented to illustrate that beta-end enhances proliferation of murine splenocytes stimulated by the T cell mitogen, Con A. The T cell sensitivity of this effect was demonstrated in cell preparations enriched for T cells by nylon wool separation. The opioid specificity of the enhancement indicates that the C-terminus of the 31 amino acid peptide contributed significantly to the effect. In addition, the magnitude and the incidence of the enhancement was highly dependent on the concentration of Con A, the density of the tested cells and the timing of the addition of beta-end relative to that of Con A. These observations suggest that the state of activation of the T cell is a principal determinant of its sensitivity to beta-end. Overall, the data provide compelling evidence for the existence of an immunomodulatory role for beta-end.

Endoscopic treatment of urinary tract calculi

Removal of urinary tract calculi by endourological techniques is now widely practised and has reduced the indications for open surgical removal to a minority of cases. A review of 270 consecutive patients who presented to the Meath Hospital Urology department with urinary tract calculi and were treated by percutaneous or transurethral endoscopy is herein reported. The rates of successful clearance of renal (95%) and ureteric (78%) calculi compare well with previous reports. The majority of complications were minor and a low overall complication rate was experienced at ureterorenoscopy. In our experience, endourological treatment of urinary tract calculi is successful, efficient and safe and is the recommended approach to urinary tract calculi that require surgical intervention.

The Kilkenny Health Project: food and nutrient intakes in randomly selected healthy adults

1. Sixty healthy subjects aged 35-44 years (thirty men and thirty women) were randomly selected from electoral registers to participate in a dietary survey using the 7 d weighed-intake method during June-August 1985. 2. Energy intake (MJ/d) was 12.5 for men and 8.4 for women. Fat contributed 36.0 and 39.1% of the total energy intake of men and women respectively. When this was adjusted to exclude energy derived from alcoholic beverages, the corresponding values were 38.8 and 39.7% respectively. The major sources of dietary fat (%) were spreadable fats (28), meat (23), milk (12) and biscuits and cakes (11). 3. The subjects were divided into low- and high-fat groups both on the relative intake of fat (less than 35% or greater than 40% dietary energy from fat) and on the absolute intake of fat (greater than or less than 120 g fat/d). By either criterion, high-fat consumers had lower than average intakes of low-fat, high-carbohydrate foods such as potatoes, bread, fruit and table sugar, and higher intakes of milk, butter and confectionery products. Meat intake was higher among high-fat eaters only when a high-fat diet was defined as a percentage of energy.

Controlled studies of nutritional intake in patients with malignant disease undergoing treatment

Ninety-seven patients with cancer, undergoing radiation treatment, were studied. Forty-two were given special dietary counseling and supplements of Sustagen or Isocal; 42 controls received no special advice or supplements. Thirteen patients were excluded because of poor prognoses and the ethical need for food supplements. Nutrient intake of all groups was assessed by 3-d diet records in household measures in the first and the last week of treatment. Intake was significantly higher in the adjunctive than the control group. The excluded group, despite supplementation, had intakes similar to the control group. No difference was observed between the control and adjunctive groups in clinical status at the end of treatment or in long-term outcome.

Serum ionized calcium and parathyroid hormone in renal stone disease

Serum ionized calcium was shown to be significantly elevated in a group of twenty-eight subjects with idiopathic hypercalciuria in whom the mean total serum calcium concentration was within normal limits. Measurement of parathyroid hormone levels confirmed that elevated values are suppressible by infusion of calcium. Ten subjects with simultaneous elevation of serum ionized calcium and parathormone levels above 3 S.D. of normal were referred for neck exploration, and a parathyroid adenoma was found and removed in nine. Significant decreases to normal values of serum ionized calcium and parathormone levels of urine and calcium excretion were documented some weeks following operation. The results conflict with both the alimentary calcium hyperabsorption theory and the renal calcium leak theory of the aetiology of idiopathic hypercalciuria, and support the possibility that idiopathic hypercalciuria in many cases represents an early or mild form of 'normocalcaemic' primary hyperparathyroidism.

Differences between metabolic responses to fasting in obese diabetic and obese nondiabetic subjects

The metabolic response to two weeks' fasting and the influence of starvation on glucose tolerance have been studied in obese diabetic and obese nondiabetic subjects.

After an overnight fast, mean concentrations of both blood glucose and plasma triglyceride were significantly greater in the diabetics than in the nondiabetics. In neither group, however, were correlations found in any combination between circulating levels of triglyceride, glucose, insulin, free fatty acids, or the degree of obesity. During the fast, concentrations of plasma triglyceride and blood glucose fell slightly in the nondiabetics, but strikingly in the diabetics, and in the latter these reductions were highly correlated.

Glucose tolerance was impaired by starvation in the nondiabetics but considerably improved in the diabetics. In the former, the rise in both serum insulin and plasma lactate concentrations was delayed following starvation. In the latter, the most striking change was a reduction in the basal glucose concentration after fasting; a rise in lactate levels was observed prior to starvation but no elevation was detected during the post-fast glucose tolerance test, while serum insulin responses remained unchanged.

It is suggested that in some obese diabetics the development of endogenous hypertriglyceridemia is dependent on increased hepatic gluconeogenesis, and that a reduction in gluconeogenesis is the principal mechanism by which both plasma triglyceride levels are decreased, and glucose tolerance improved, in such patients following starvation. It is further suggested that both diminished β-cell responsiveness and decreased muscle glycolysis contribute to the genesis of starvation diabetes.