PSUN336 Dietary sugar and protein differentially regulate the insulin and IGF1 homologs Dilp2 and Dilp6 in Drosophila

Growth deficits are frequently seen among children in resource-poor settings where malnutrition and chronic enteric infections are common. The insulin/IGF1 signaling pathway promotes cell and organismal growth across the animal kingdom. To better understand how malnutrition and infection impair growth, we investigated insulin/IGF1 signaling under such conditions using Drosophila as a model organism. In Drosophila, seven insulin-like peptides (Dilps) activate the insulin/IGF signaling pathway through a single known insulin receptor. Major circulating Dilps include Dilp2, produced from neurosecretory insulin-producing cells in the brain, and Dilp6, produced by the fat body, a functional analog of liver. Like insulin, mature Dilp2 lacks a C-peptide, whereas this sequence is retained in the IGF1 homolog Dilp6. We previously reported that bacterial infection and innate immune signaling negatively regulate whole-animal growth in Drosophila larvae by reducing circulating Dilp6 but not Dilp2. Here we asked whether Dilp2 and Dilp6 also respond differently to dietary sugar and protein, as secretion of insulin-like hormones is rigidly regulated by dietary nutrients. We used dual-epitope tagged Dilp2 and Dilp6 alleles to measure endogenous, circulating Dilp2 or Dilp6 in larvae. We find that circulating Dilp2 decreased by 60% after six hours of starvation on non-nutritive agar, and we observed a 90% decrease in Dilp2 from fed levels after 24 hours of starvation. In contrast, circulating Dilp6 was only reduced by 33% after 24 hours of starvation. Next, we asked whether Dilp2 and Dilp6 respond to specific dietary nutrients by adding yeast extract (to mimic the wild protein source) and/or sucrose to agar. Hemolymph Dilp2 was recovered to 73% of fed levels by the addition of yeast extract; addition of sucrose did not increase Dilp2 levels above the starved condition. Although the circulating level of Dilp6 was not strongly reduced by starvation, hemolymph Dilp6 was increased 40% by a sucrose-only diet compared with the normal, fed condition. Surprisingly, a yeast extract-only diet led to a 70% inhibition of circulating Dilp6 compared with the normal fed state. Addition of sucrose to the yeast diet led to a dose-dependent increase in Dilp6, suggesting that this hormone responds to the ratio of sugar to protein in the diet. Together, these data suggest that Dilp2 and Dilp6 secretion is controlled by distinct environmental conditions ranging from infection to dietary composition. An open question is how these two hormones carry distinct information to target organs despite binding to the single known insulin receptor encoded in the Drosophila genome.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Landslides on Ceres: Diversity and Geologic Context

Landslides are among the most widespread geologic features on Ceres. Using data from Dawn's Framing Camera, landslides were previously classified based upon geomorphologic characteristics into one of three archetypal categories, Type 1(T1), Type 2 (T2), and Type 3 (T3). Due to their geologic context, variation in age, and physical characteristics, most landslides on Ceres are, however, intermediate in their morphology and physical properties between the archetypes of each landslide class. Here we describe the varied morphology of individual intermediate landslides, identify geologic controls that contribute to this variation, and provide first-order quantification of the physical properties of the continuum of Ceres's surface flows. These intermediate flows appear in varied settings and show a range of characteristics, including those found at contacts between craters, those having multiple trunks or lobes; showing characteristics of both T2 and T3 landslides; material slumping on crater rims; very small, ejecta-like flows; and those appearing inside of catenae. We suggest that while their morphologies can vary, the distribution and mechanical properties of intermediate landslides do not differ significantly from that of archetypal landslides, confirming a link between landslides and subsurface ice. We also find that most intermediate landslides are similar to Type 2 landslides and formed by shallow failure. Clusters of these features suggest ice enhancement near Juling, Kupalo and Urvara craters. Since the majority of Ceres's landslides fall in the intermediate landslide category, placing their attributes in context contributes to a better understanding of Ceres's shallow subsurface and the nature of ground ice.

A Novel Mycoplasma sp. Associated with Phallus Disease in Goose Breeders: Pathological and Bacteriological Findings

In April 2014, poor fertility in a major commercial goose breeder operation in California triggered the submission of six live affected Toulouse ganders ( Anser anser ) to the California Animal Health and Food Safety Laboratory, Turlock branch (University of California-Davis). Toulouse were principally affected among all breeds, and their egg fertility dropped from 65.7% to less than 33.9% in the first 40 days of the 2014 breeding season. The flock consisted of 410 adult birds, 90 males and 320 females, between 2 and 5 yr of age. Inspection of the flock revealed that 44.4% of the Toulouse ganders had severe phallic deformities that prevented them from mating. At postmortem examination, severe yellowish fibrocaseous exudate disrupted the architecture of the phallus and occasionally produced fistulating tracts through the wall of the organ. Microscopically, multifocal lymphoid nodules were noted in the mucosa and submucosa of the phallus and were associated with extensive granulomatous reaction, intralesional bacteria, and spermatozoa. Mycoplasma spp. were isolated from the phallus of affected and nonaffected birds, and PCR protocols targeting the 16S-23S ribosomal RNA intergenic spacer regions and the RNA polymerase beta subunit gene were performed to identify the isolates. Three distinct species were identified on sequencing and analysis using the National Center for Biotechnology Information basic local alignment search tool: Mycoplasma cloacale , Mycoplasma anseris , and an unknown novel Mycoplasma sp. Additionally, Pasteurella multocida , in combination with other bacteria, was also isolated from the phallic lesions and identified as serotype 3 with a DNA profile of 1511 (National Veterinary Service Laboratory). This is the first report of these Mycoplasma spp. and other bacteria associated with reproductive disease in ganders in the United States.

Characterization of Seven Outbreaks of Hemorrhagic Hepatopathy Syndrome in Commercial Pullets Following the Administration of a Salmonella Enteritidis Bacterin in California

Between April 2013 and April 2015, seven flocks belonging to three different major commercial egg producers inCalifornia experienced a mild increase in mortality 2 to 3 wk after administration of Salmonella Enteritidis bacterins. Strains of chickens involved were H&N (flock A1, A2, B2, C1, C2, and C3) and Lohmann white (flock B1). Vaccination was administered individually through injection either in the breast muscles or subcutis in the legs between 11 and 18 wk of age in all flocks. Clinical signs ranged from inapparent to lameness, reluctance to walk, greenish diarrhea, and retching-like symptoms. The mortality ranged from 0.16% to 1.38% per week, with the highest peaks occurring usually 2 to 3 wk postvaccination, and then declined rapidly. Postmortem examinations revealed enlarged livers with disseminated hemorrhages and pale foci of necrosis. Also, severe extensive hemorrhages in the intestine, heart, and proventriculus were observed in a few birds. Various degrees of productive, exudative giant cell granulomatous myositis were observed invading deeply the muscles and subcutis at the site of vaccination. The myositis was always associated with optically empty vacuoles positive for neutral lipids by Oil Red O stain. Droplets of Oil Red O material were also noticed in the affected livers and intestines. Congo red stain highlighted the presence of amyloid in moderate to severe amounts in the breast muscles and moderate amounts in livers, spleens, and intestines. Salmonella antigens were detected in the injection sites and livers by immunohistochemical staining. No viruses or toxic substances were recovered from the liver, spleen, intestine, and pectoral muscles, and the few bacteria isolated were interpreted as secondary postmortem invaders. In addition, livers and bile tested for hepatitis E virus were negative by reverse-transcriptase polymerase chain reaction.

The geomorphology of Ceres

Analysis of Dawn spacecraft Framing Camera image data allows evaluation of the topography and geomorphology of features on the surface of Ceres. The dwarf planet is dominated by numerous craters, but other features are also common. Linear structures include both those associated with impact craters and those that do not appear to have any correlation to an impact event. Abundant lobate flows are identified, and numerous domical features are found at a range of scales. Features suggestive of near-surface ice, cryomagmatism, and cryovolcanism have been identified. Although spectroscopic analysis has currently detected surface water ice at only one location on Ceres, the identification of these potentially ice-related features suggests that there may be at least some ice in localized regions in the crust.

Reliability of measurement of tempo-spatial parameters of gait after stroke using GaitMat II

Objective: (1) To find the inter-rater and intra-rater reliability of raters using GaitMat II to measure tempo-spatial gait parameters of stroke patients. (2) To find if reliability is related to abnormality of footprint patterns.

Design: A prospective agreement study.

Setting: A movement analysis laboratory.

Subjects: Nineteen adults who were at least six months after stroke and able to walk 4 metres with or without assistance participated as subjects in this study. There were five raters.

Methods: Subjects completed at least two walks along GaitMat II. The raw footprint data were analysed independently by each of the five raters.

Results: Mean intraclass correlation coefficients (ICCs) for each rater within subject ranged from 0.8398 to 0.9318. However eight of the 17 parameters tested showed significant differences between raters ( p = 0.0029 to p<0.0001). When the most inexperienced rater was excluded, differences between experienced raters ( n = 4) was found to be statistically insignificant for all parameters. The association of the mean score and standard deviation of experienced raters was significant for nine parameters ( r values 0.5087 to0.9459), i.e., as walking pattern became more abnormal, variation in scoring between raters increased.

Conclusions: GaitMat II may have acceptable inter-rater reliability if raters have experience of gait analysis but disagreement may increase when stroke patients exhibit more abnormal gait patterns.

Vitamin a Deficiency in Turkey Poults

Vitamin A deficiency was diagnosed in a commercial flock of 13,000 4–6-week-old turkey poults in the summer of 2004. The birds were initially submitted for examination because of a 3% increase in the reported daily mortality of the flock. Clinically, affected birds had stunted growth and ruffled feathers, showed signs of incoordination, and were depressed. At necropsy, pale white pseudomembranous to mucoid material was observed on the mucosal surface of the tongue, oral cavity, portions of the esophagus, and the crop of some birds. Histologically, there was squamous metaplasia of the mucosal epithelium of the oral mucosa, esophagus, sinuses, nasal glands, bronchi, proventriculus, and the bursa of Fabricius. Vitamin A was not detected in the feed sample at a detection limit of 0.5 mg/kg. Serum vitamin A concentrations in 7 birds were very low and ranged from 0.05 to 0.1 mg/L. Vitamin A concentrations in livers were extremely low (0.1 mg/kg wet weight, 1/7 poults) or undetectable (<0.1 mg/kg wet weight, 6/7 poults). A diagnosis of vitamin A deficiency was made based on gross and microscopic lesions and vitamin A concentrations in serum, liver, and feed. To the authors' knowledge, this is the first documented case of vitamin A deficiency in poults submitted from a commercial meat turkey producer comparatively depicting the gross and microscopic lesions with those found in other species of birds and mammals.

Nurses' Perspectives on the Process of Attaining Baby-Friendly Designation

The Baby-Friendly Hospital Initiative is a global initiative that aims to protect, promote, and support breastfeeding. This study explores and describes the process of attaining Baby-Friendly designation from nurses' perspectives. A purposive sampling design was used to recruit registered nurse participants in a large, safety-net, tertiary care facility. Data were collected via semistructured interviews and were analyzed using descriptive interpretative analysis. The following themes were revealed: Resistance, Culture, Investment in the Journey, Teamwork, and Source of Pride. Results indicate that comfortable yet antiquated practices led to fear of change and resistance. Initial culture shock was mediated by a successful education model, powerful experiences, and positive outcomes.

Trichodinosis associated with pathology of the reproductive tract in waterfowl

Trichodinid ciliophorans are opportunistic parasites of many species of fish, amphibians, and molluscs, but yet never reported in association with lesions in birds. Postmortem and histopathological evaluation of a commercial adult Toulouse gander and female goose, and a wild Mallard drake revealed the presence of severe pathological parasitic colonization of their reproductive tracts. Histopathological findings included moderate to severe granulocytic inflammation, acanthosis, accentuation of the rete pegs, and proliferative hyperplastic squamous metaplasia of the mucosa of the ejaculatory ducts and groove, sulcus spermaticus, glandular part of the phallus (cavum penis), and oviduct in association with large numbers of ciliated protozoa anchored to the tissues or free in the lumen. These protozoa had characteristic morphological features analogous to the family of Trichodinidae. The source of this parasitism could not be determined. To our knowledge, this is the first report of trichodinosis associated with pathology in birds.

An Unusual Outbreak of Chlamydiosis in Commercial Turkeys Involving the Nasal Glands

An unusual outbreak of chlamydiosis was diagnosed in 15,000, 13-wk-old organically grown turkeys housed in a semiconfinement housing system. The disease was characterized by unilateral or bilateral swelling above the eye due to mild-to-severe inflammation of the nasal glands in 3%-5% of the birds. Except for a slight drop in feed and water consumption, the birds did not exhibit any respiratory signs, morbidity, and mortality. Chlamydiosis in the turkeys was confirmed by immunofluorescence, immunohistochemistry, and PCR assay of the nasal glands. Other samples such as conjunctiva, lungs, air sacs, heart, liver, spleen, and feces were negative for chlamydia by florescence antibody test in birds submitted over several weeks. Chlamydia psittaci strain B was isolated in chicken egg embryos and typed by multilocus sequence variable number of tandem repeats analysis, multilocus sequence typing, and ompA gene sequencing as a CP3-like strain. This is the first report of a naturally occurring chlamydiosis affecting the nasal glands in turkeys.

Effectiveness and cost-effectiveness of height-screening programmes during the primary school years: a systematic review

OBJECTIVE

To determine the effectiveness and cost-effectiveness of height screening (of children aged 4 to 11) to identify height-related conditions.

DESIGN

Systematic review and economic modelling.

SETTING AND INTERVENTION

We included published and unpublished screening studies of any design, except case reports, conducted in any setting that measured children's height as part of a population-level assessment. Studies were identified by electronic database searches, contact with experts and from bibliographies of retrieved studies.

PARTICIPANTS

Children aged between 4 and 11 years.

OUTCOME MEASURES

Diagnostic yield of height-related conditions and change in quality of life, as measured by quality-adjusted life years (QALYs), for early versus late treatment of underlying conditions.

RESULTS

Twelve studies described a height-screening programme and provided data on the diagnostic yield of newly diagnosed height-related conditions. Where reported, yield for growth-hormone deficiency (per 1000 children screened) ranged from 0.05 (1 in 20,000) to 0.62 (approximately 1 in 1500) and for Turner syndrome (per 1000 children screened) was between 0.02 (1 in 50,000) and 0.07 (approximately 1 in 14,000). As a secondary gain, children with other potentially treatable conditions were identified; diagnostic yields ranged from 0.22 to 1.84 per 1000 children screened. Three studies did not detect any new cases, but all of these studies had methodological limitations. Economic modelling suggested that height screening is associated with health improvements and is cost effective for a willingness to pay threshold of pound 30,000 per QALY.

CONCLUSIONS

This review indicates the utility and acceptable cost-effectiveness of height screening arising from increased detection of height-related disorders and secondary pick-up of other undiagnosed conditions. Further research is needed to obtain more reliable data on quality of life gains and costs associated with early interventions for height-related conditions. The exact role of height-screening programmes in improving child health remains to be determined.

Collaborative care for depression in UK primary care: a randomized controlled trial

BACKGROUND

Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial.

METHOD

We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9).

RESULTS

We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32).

CONCLUSIONS

Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.

A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions

OBJECTIVES

To clarify the role of growth monitoring in primary school children, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes.

DATA SOURCES

Electronic databases were searched up to July 2005. Experts in the field were also consulted.

REVIEW METHODS

Data extraction and quality assessment were performed on studies meeting the review's inclusion criteria. The performance of growth monitoring to detect disorders of stature and obesity was evaluated against National Screening Committee (NSC) criteria.

RESULTS

In the 31 studies that were included in the review, there were no controlled trials of the impact of growth monitoring and no studies of the diagnostic accuracy of different methods for growth monitoring. Analysis of the studies that presented a 'diagnostic yield' of growth monitoring suggested that one-off screening might identify between 1:545 and 1:1793 new cases of potentially treatable conditions. Economic modelling suggested that growth monitoring is associated with health improvements [incremental cost per quality-adjusted life-year (QALY) of 9500 pounds] and indicated that monitoring was cost-effective 100% of the time over the given probability distributions for a willingness to pay threshold of 30,000 pounds per QALY. Studies of obesity focused on the performance of body mass index against measures of body fat. A number of issues relating to human resources required for growth monitoring were identified, but data on attitudes to growth monitoring were extremely sparse. Preliminary findings from economic modelling suggested that primary prevention may be the most cost-effective approach to obesity management, but the model incorporated a great deal of uncertainty.

CONCLUSIONS

This review has indicated the potential utility and cost-effectiveness of growth monitoring in terms of increased detection of stature-related disorders. It has also pointed strongly to the need for further research. Growth monitoring does not currently meet all NSC criteria. However, it is questionable whether some of these criteria can be meaningfully applied to growth monitoring given that short stature is not a disease in itself, but is used as a marker for a range of pathologies and as an indicator of general health status. Identification of effective interventions for the treatment of obesity is likely to be considered a prerequisite to any move from monitoring to a screening programme designed to identify individual overweight and obese children. Similarly, further long-term studies of the predictors of obesity-related co-morbidities in adulthood are warranted. A cluster randomised trial comparing growth monitoring strategies with no growth monitoring in the general population would most reliably determine the clinical effectiveness of growth monitoring. Studies of diagnostic accuracy, alongside evidence of effective treatment strategies, could provide an alternative approach. In this context, careful consideration would need to be given to target conditions and intervention thresholds. Diagnostic accuracy studies would require long-term follow-up of both short and normal children to determine sensitivity and specificity of growth monitoring.

Intraobserver reproducibility of Doppler measurements of uterine artery blood flow velocity in premenopausal women

OBJECTIVE

To determine the intraobserver repeatability of Doppler measurements of uterine artery blood flow velocity and the contribution of various factors to within-subject variance.

DESIGN

Seventeen healthy premenopausal women underwent vaginal Doppler ultrasound examination of the uterine artery by the same observer. Three measurements were taken at each of three sites: 1) the currently recommended sampling site; 2) the ascending branch of the uterine artery at a level between the lower and middle third of the corpus uteri; 3) 1.5 cm lateral to the recommended sampling site. Three measurements were taken at each site. For each measurement, three uniform consecutive cardiac cycles were analyzed. Peak systolic velocity, time-averaged maximum velocity, and pulsatility index were calculated. Each Doppler shift spectrum was analyzed twice. Thus, for each women, 18 measurement results per sampling site were obtained. Analysis of variance was used.

RESULTS

The effect of sampling site on measurements of peak systolic velocity and time-averaged maximum velocity was non-significant, but pulsatility index values obtained at the distal sampling site were slightly higher than those obtained at the other sites (P = 0.01). Repetition accounted for most of the within-subject variance. Averaging the results of the three repeat measurements yielded increased intraclass correlation coefficients: 0.79-0.89 for peak systolic velocity, 0.80-0.92 for time-averaged maximum velocity and 0.86-0.93 for pulsatility index.

CONCLUSION

As the effect of repetition on the results of Doppler measurements of uterine artery blood flow velocity is large, the average of several repeat measurements should be used to enhance measurement reproducibility. However, it is not worth doing more than one analysis of a Doppler shift spectrum, and it is not worth analyzing more than one cardiac cycle per spectrum.

Lack of association of ACE/angiotensinogen genotype with renal function in autosomal dominant polycystic kidney disease

ACE polymorphisms have recently been shown to associate with worse renal and or cardiovascular outcome, with the D allele widely reported as a risk factor for cardiovascular disease. In autosomal dominant polycystic kidney disease (ADPKD), there are conflicting reports of an association between ACE polymorphisms and disease phenotype. There are no previous reports of any association between angiotensinogen polymorphisms and clinical phenotype in ADPKD. We examined the ACE I/D and angiotensinogen M235T polymorphisms in 176 patients with ADPKD. Patients are categorized into three groups according to the reason for initial investigation. Clinical history and examination findings were recorded at the time of first referral. A cohort of 17 patients had progressive renal impairment observed after 3 or more years of follow-up. Reciprocal creatinine against time was plotted in this group. From the patient population of 176, a total of 33 patients reached end-stage renal failure (ESRF) or a serum creatinine greater than 500 microm/liter. ACE genotype and M235T polymorphism frequencies were compared across groups. Serum creatinine and presence of hypertension and onset of ESRF were taken as outcome variables; age and source of referral were taken as confounding variables. There was no association of any genotype or allele with either creatinine, inverse creatinine, hypertension, or age at end-stage renal failure. These findings do not support the proposition that ACE genotype or angiotensinogen polymorphisms are associated with a worse prognosis in patients with ADPKD.

Producing benchmarks for clinical practice

Clinical benchmarking has huge potential for improving health care. Students exploring benchmarks for fundamental and essential aspects of care produced a number of interesting key factors and continuums of care. A significant feature of the development of the Department of Health benchmarks has been the inclusion of service users.

Sugar printing rheumatic diseases: a potential method for disease differentiation using immunoglobulin G oligosaccharides

OBJECTIVE

To look for oligosaccharide structural variants of IgG that may be unique to specific rheumatic diseases.

METHODS

Using normal-phase high-performance liquid chromatography technology, a comparison was made of the oligosaccharide pools released from serum IgG from patients with systemic lupus erythematosus (SLE) (n = 10), ankylosing spondylitis (AS) (n = 10), primary Sjögren's syndrome (n = 6), juvenile chronic arthritis (JCA) (n = 13), psoriatic arthritis (n = 9), rheumatoid arthritis (RA) (n = 5), and healthy control individuals (n = 19).

RESULTS

The oligosaccharide pools were resolved into 13 peaks and the relative proportions of the peaks in each disease group was significantly different from that in healthy controls (P < 0.0001-0.05). A characteristic serum IgG oligosaccharide profile, or sugar print, for each of the rheumatic diseases was found. The sugar prints exhibited a range of glycosylation patterns whereby all RA (P < 0.0001) and JCA (P < 0.006) patients had predominantly agalactosyl structures, while SLE (P < 0.03-0.0001) and AS (P < 0.025-0.0001) patients had predominantly digalactosyl structures.

CONCLUSION

The data suggest that each disease is associated with a specific mechanism that gives rise to alterations in the normal glycosylation pattern of IgG. Sugar printing of IgG is therefore a potential means for the differentiation of rheumatic diseases and may provide insight into disease pathogenesis.

Co-authorship--a means to an end

Nursing Praxis in New Zealand (Praxis) seeks to foster publication as a medium for the development of nursing research and scholarship within the New Zealand nursing community. To achieve that vision, this journal has a strong commitment to supporting nurses to write and prepare manuscripts for publication. This article is a continuation of the Praxis Writing for Publication series and it seeks to explore the way in which co-authorship can be an effective tool for assisting authors to publish. As there is so much clinical innovation and critique happening in New Zealand at present, along with the completion of a considerable amount of nursing research, we are surprised that Praxis is not being overwhelmed with manuscripts. Reflecting on our own experiences of completing research, and then having to find the extra energy from somewhere to disseminate the research findings, we appreciate just how daunting the process of writing an article can be. However, writing does not have to be overwhelmingly difficult, or a solitary activity. We believe that co-authorship is one means of overcoming perceived barriers to submitting manuscripts for publication.

The preparation and introduction of nursing auxiliaries: the MidCentral Health experience

This paper outlines how nursing auxiliaries (known as care assistants) were successfully introduced into MidCentral Health. The professional issues this introduction created are discussed, and the measures taken to maintain standards of care described.

Applications in in ovo technology

By mid-August 1995, 55% of broiler embryos in North America were vaccinated for Marek's disease using the INOVOJECT system, with 201 INOVOJECT machines placed with 16 of the top 25 poultry producers, providing the industry with the capacity to inject in excess of 400 million eggs per month or about 5 billion eggs per annum. In ovo administration of a bursal disease antibody-infectious bursal disease virus (BDA-IBDV) complexed vaccine to specific-pathogen-free (SPF) embryos was safer and more potent than conventional IBDV vaccine alone because it delayed the appearance of bursal lesions, produced no early mortality, produced higher geometric mean antibody titers against IBDV, and generated protective immunity against challenge. In ovo administration of a BDA-IBDV complexed vaccine to broiler embryos generated antibody titers against IBDV sooner than conventional virus vaccinates, and generated protective immunity against challenge Direct DNA injection of plasmid DNA encoding beta-galactosidase into breast muscle in ovo and posthatch was an effective means to achieve both gene transfer and expression, with potential for the development of gene vaccines using plasmids encoding protective antigens from poultry pathogens. In ovo administration of 800 U chicken myelomonocytic growth factor (cMGF), a chicken hematopoietic cytokine for cells of the monocytic-granulocytic lineages, significantly reduced mortality associated with Escherichia coli exposure within the hatcher when compared to PBS controls (6.1 vs 12.4, P < or = 0.05), but not when compared to a yeast expression control. A procedure was developed enabling injection prior to the onset of incubation without compromising embryo viability. This in ovo injection process has opened up the window of embryo development during incubation for intervention, as illustrated by the 100% male phenotype produced in chicks hatching from eggs injected with aromatase inhibitor prior to incubation. These data illustrate some of the in ovo applications presently in use by the poultry industry, and under development or in research at EMBREX.

The effects of early and late administration of M-20 derived interleukin-1 inhibitor on experimental systemic lupus erythematosus

M-20 interleukin-1 inhibitor is produced by a myelomonocytic cell line. The effects of this molecule, mediated via IL-1 inhibition, include decreased proliferative responses of mouse thymocytes, human T-cells and fibroblasts and reduction in parameters of acute inflammation. Previously, we have demonstrated the emergence of a disease resembling systemic lupus erythematosus (SLE) in naive mice immunized with anti-DNA antibodies carrying different pathogenic idiotypes. The disease was manifested by increased titers of various mouse antibodies, concomitant with the appearance of elevated erythrocyte sedimentation rate (ESR), proteinuria and leukopenia. We have applied this model of experimental SLE (immunized with MIV-7, a human monoclonal antibody) to evaluate the influence of M-20 IL-1 inhibitor, administered at different stages (2 weeks before, 1 month and 3 months following immunization) for a period of 2 weeks, on the findings of the disease in mice. It was shown that M-20 IL-1 inhibitor given 2 weeks prior to the immunization resulted in suppression of the disease induction as documented by lower antibody titer level (30%-50% in the immunized mice as compared with controls). Furthermore, reduced autoantibody levels were accompanied by other beneficial findings consisting of lower ESR, less severe proteinuria and elevated leukocyte counts. No beneficial effects of M-20 IL-1 inhibitor were observed when the agent was administered 1 or 3 months following immunization. We conclude that M-20 IL-1 inhibitor has a favorable effect on experimental SLE in mice, provided it is administered before induction of the disease.

Impaired absorption of zidovudine in patients with AIDS-related small intestinal disease

OBJECTIVES

To investigate the effect of small intestinal disease (SID) on the absorption of zidovudine (ZDV) in patients with AIDS.

METHODS

Fourteen fasted homosexual men with AIDS received a single oral dose of ZDV (5 mg/kg). Nine subjects had clinical evidence of intestinal disease (chronic diarrhoea with wasting) confirmed by reduced fat absorption measured indirectly using the 14C-triolein test. Five subjects had AIDS-related symptoms other than those affecting the gastrointestinal tract with normal fat absorption. Sequential measurements of plasma ZDV including its glucuronide metabolite (GZDV) were obtained using radio-immunoassay and ZDV/GZDV concentrations-time profiles of both groups of subjects were compared. Comparisons were also made for each of the following computed variables: the maximum plasma concentration (Cmax), time to reach Cmax (Tmax), area under the plasma concentration-time curve (AUC0-6 h), the elimination half-life (t 1/2), and apparent oral clearance (CL0).

RESULTS

In patients with SID, Cmax ZDV was reduced (6.39 +/- 3.39 versus 11.51 +/- 5.01 mumol/l; P < 0.05) and Tmax ZDV prolonged (0.81 +/- 0.51 versus 0.40 +/- 0.14 h; P < 0.05) but AUC0-6 h ZDV was no different from the non-SID group (8.03 +/- 2.73 versus 14.56 +/- 9.0 mumol/l-1xh; P = 0.06). There were no differences in t 1/2 ZDV (1.22 +/- 0.20 versus 1.13 +/- 0.30 h) or CL0 ZDV (3017 +/- 1158 versus 1700 +/- 889 ml/min; P > 0.05) between SID and non-SID groups, respectively, and GZDV values were comparable between the two groups.

CONCLUSIONS

These data suggest delayed absorption rather than altered metabolism of ZDV in AIDS-related SID and raise the possibility of drug malabsorption. The clinical efficacy of orally administered low-dose ZDV regimens may require further evaluation in patients with chronic diarrhoea and AIDS.

Observer variability in volumetric blood flow measurements in leg arteries using duplex ultrasound

Duplex ultrasound volumetric flow measurements have not found a major clinical use because of variability caused by errors in estimating cross-sectional area (CSA) and in measuring time averaged mean velocity (TAMeV). We determined inter- and intraobserver variation in volumetric blood flow measured at rest in the common femoral artery (CFA) and its main branches, the superficial femoral (SFA) and profunda femoris (PFA) arteries, in 20 normal subjects. The product of TAMeV and CSA was taken as volumetric flow. The coefficient of variation of TAMeV was consistently greater than that of CSA. Interobserver variation for blood flow (16.2%, 20.2% and 40.3% for CFA, SFA and PFA, respectively) was larger than intraobserver variation (13.0%, 15.1%, 21.2%). In conclusion, these data define the minimum changes in VQ that can be realistically detected and indicate that, with modern duplex Doppler equipment, volumetric flow can be used as a reliable haemodynamic measure for monitoring patients before and after surgical or radiological intervention.

Challenging the myths: the lived experience of chronic leg ulcers

Leg ulcers are a chronic condition that affects a significant number of New Zealanders. While the management of the ulcers themselves has received much attention in the nursing and medical literature, little is known about what it is like to live with chronic leg ulcers, and how they impact on quality of life.

Multimodality management of recurrent adult malignant gliomas: results of a phase II multiagent chemotherapy study and analysis of cytoreductive surgery

Fifty-one adult patients with recurrent malignant gliomas were treated in a Phase II trial of multidrug chemotherapy (6-thioguanine, dibromodulcitol, procarbazine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea, 5-fluorouracil, and hydroxyurea). Thirty-one patients underwent radical tumor debulking, before the administration of chemotherapy. Fifty-seven percent of all patients had either an objective radiographic response or stabilization of disease after the institution of therapy. The overall median survival time (MST) was 40 weeks; it was 79 and 33 weeks for anaplastic astrocytoma and glioblastoma patients, respectively. The overall median time to tumor progression (MTP) was 19 weeks--32 weeks for anaplastic astrocytoma patients and 13 weeks for glioblastoma patients. Serious chemotoxicity occurred in 35% of patients without permanent morbidity or mortality. The factors that affected response (including disease stabilization), MTP, and MST were identified through a multivariate statistical analysis. A longer MTP was associated with higher Karnofsky scores, lower grade initial histology, lack of prior chemotherapy, greater degree of myelotoxicity, smaller postoperative tumor volumes, greater extent of surgical resection, and a local versus diffuse recurrence pattern. A longer MST was associated with higher Karnofsky scores, lower grade histology at the time of recurrence, greater degree of myelotoxicity, and lobar versus deep tumor location. Response (including disease stabilization) correlated with higher Karnofsky scores, lower grade histology (initial and current), prior lower grade histology, smaller preoperative tumor volume, longer intervals from the time of initial diagnosis, and absence of prior chemotherapy. These results suggest that, in addition to established prognostic factors such as Karnofsky scores, other factors including prior chemotherapy administration, patterns of tumor recurrence, and tumor location may be important variables to consider in future Phase II-III clinical trials. Of the treatment variables analyzed, greater surgical debulking and smaller postoperative tumor volumes were associated with prolonged MTP but not MST, and greater myelotoxicity had a positive association with all outcomes. The significance of this latter relationship and its relevance to chemotherapy dosing will require further study. Standardization in the design and reporting of clinical trials and the use of computer-assisted tumor volume calculations to assess the extent of surgical resection and the response to therapy are advocated.