Roadmap For The Expression Of Canonical and Extended Endocannabinoid System Receptors and Proteins in Peripheral Organs of Preclinical Animal Models

The endocannabinoid system is widely expressed throughout the body and is comprised of receptors, ligands, and enzymes that maintain metabolic, immune, and reproductive homeostasis. Increasing interest in the endocannabinoid system has arisen due to these physiologic roles, policy changes leading to more widespread recreational use, and the therapeutic potential of Cannabis and phytocannabinoids. Rodents have been the primary preclinical model of focus due to their relative low cost, short gestational period, genetic manipulation strategies, and gold-standard behavioral tests. However, the potential for lack of clinical translation to non-human primates and humans is high as cross-species comparisons of the endocannabinoid system has not been evaluated. To bridge this gap in knowledge, we evaluate the relative gene expression of 14 canonical and extended endocannabinoid receptors in seven peripheral organs of C57/BL6 mice, Sprague-Dawley rats, and non-human primate rhesus macaques. Notably, we identify species- and organ-specific heterogeneity in endocannabinoid receptor distribution where there is surprisingly limited overlap among the preclinical models. Importantly, we determined there were only five receptors (CB2, GPR18, GPR55, TRPV2, and FAAH) that had identical expression patterns in mice, rats, and rhesus macaques. Our findings demonstrate a critical, yet previously unappreciated, contributor to challenges of rigor and reproducibility in the cannabinoid field, which has profound implications in hampering progress in understanding the complexity of the endocannabinoid system and development of cannabinoid-based therapies.

Twelve Steps to Financial Freedom for Plastic Surgeons

Financial stress and lack of financial well-being are significant contributors to physician burnout. Many trainees believe little can contribute to developing financial freedom during their training years. However, residency is a pivotal moment in a young attending's life; strategic financial steps taken during this time can lead to a path of financial freedom and well-being for years to come.

Methods

We introduce 12 effective financial steps physicians can take at the start of their careers. These essential steps were compiled both anecdotally and from published financial resources such as White Coat Investigator and the Millionaire Next Door. Steps include building your "why," becoming financially educated, eliminating debt, attaining insurance, optimizing contracts, awareness of self-net worth, budgeting, maximizing investment strategies, smart investing, wise spending, K.I.S.S, and creating a personal financial plan.

Results

As an example, an IRA is a retirement account set up by you, and to take advantage of the tax benefits, you must have a modified adjusted gross income of less than $124,000 as a single tax filer for 2022. Most physicians are compensated at a rate higher than this; however, there is a legal loophole to take advantage of to allow earners to still contribute to a Roth IRA that is discussed.

Conclusions

Financial education is the first step toward a path to financial success in a young physician's life. Implementation of these 12 financial steps early in a physician's career will enrich one's financial freedom and well-being.

Parent Motivational Climate, Sport Enrollment Motives, and Young Athlete Commitment and Enjoyment in Year-Round Swimming

Parents are known to influence the athlete sport experience through motivational climates. Athletes' perception of motivational climates and their own motives for sport participation influence enjoyment and long-term sport commitment. It is unknown, however, the extent parent motives for initially enrolling their child in a year-round sports program associate with children's sport participation enjoyment and commitment. The purposes of this study were to (a) determine parent motives for enrolling their child (5-8 years) in year-round swimming and (b) explore the relationships of parent motives and motivational climates with child enjoyment and commitment. Parents (n = 40) completed questionnaires on enrollment motives and motivational climate, while children (n = 40) answered questions on enjoyment and commitment. Of the seven motives measured, parents enrolled children in swimming primarily for fitness benefits (M = 4.5, SD = .45) followed by skill mastery (M = 4.31, SD = .48) and fun (M = 4.10, SD = .51) reasons. Findings revealed the fitness motive was moderately, negatively correlated with the success-without-effort facet of a performance climate (r = -.50, p < .01). The fun motive was moderately, positively associated with commitment (r = .43, p < .01). Parent motives for enrolling their child in sport may impact the young child sport experience and long-term sport continuation via motivational climates, enjoyment, and commitment.

The Effect of Antiretroviral Therapy for the Treatment of HIV-1 in Pregnancy on Gestational Weight Gain

BACKGROUND

Gestational weight gain above the Institute of Medicine recommendations is associated with increased risk of pregnancy complications. The goal was to analyze the association between newer HIV antiretroviral regimens (ART) on gestational weight gain.

METHODS

This is a retrospective cohort study of pregnant women with HIV-1 on ART. The primary outcome was incidence of excess gestational weight gain. Treatment effects were estimated by ART regimen type using log-linear models for relative risk, adjusting for pre-pregnancy BMI and presence of detectable viral load at baseline.

RESULTS

303 pregnant women were included in the analysis. Baseline characteristics including pre-pregnancy BMI, viral load at prenatal care entry, and gestational age at delivery were similar by ART, including 53% of the entire cohort initiated ART before pregnancy ( p = NS). Excess gestational weight gain occurred in 29% of the cohort. Compared to non-INSTI or TAF exposed persons, receipt of INSTI+TAF had a 1.7-fold increased relative risk of excess gestational weight gain, (95%CI 1.18, 2.68, p< 0.01), while women who received TDF had a 0.64-fold decreased relative risk (95% CI 0.41, 0.99, p=0.047) of excess gestational weight gain. INSTI alone was not significantly associated with excess weight gain in this population. The effect of TAF without INSTI could not be inferred from our data. There was no difference in neonatal, obstetric, or maternal outcomes between the groups.

CONCLUSIONS

Pregnant women receiving ART with a combined regimen of INSTI and TAF have increased risk of excess gestational weight gain.

Fitness-related benefits: land-based versus aqua-base

BACKGROUND

It is well documented that individuals participating in land-based aerobic activities receive several fitness-related benefits. Given its virtual weightlessness, thermoregulatory comfort, and ease of movements, aqua-based aerobic activities are commonly perceived as a simpler form of exercise, therefore, lacking the fitness-related benefits equivalent to that of land-based aerobic activities. The purpose of this study was to compare fitness-related benefits between land-based (LAND) versus aqua-based (AQUA) aerobic activity classes within a 15-week period.

METHODS

One hundred and fifty-four volunteers participating in LAND (N.=76) and AQUA (N.=78) exercise groups were required to exercise 2 days per week, 50 minutes per day, for 15 weeks. Pre- and post-fitness assessments obtained were body composition, muscular endurance, muscular strength, cardiorespiratory endurance, and flexibility.

RESULTS

Mixed ANOVA showed a main effect and interaction for body composition in which, overall, participants decreased more body fat percentage in the land group. A main effect for both muscular strength and muscular endurance was revealed, but no interactions. There were no significant main effects or interactions for neither cardiorespiratory endurance nor flexibility.

CONCLUSIONS

Individuals participating in land-based aerobic activities displayed greater decreases in percent body fat when compared to aqua-based aerobic activities, whereas both land- and aqua-based displayed improvements in muscular strength and muscular endurance. There were no changes in cardiorespiratory endurance and flexibility within both groups.

Using a ResearchKit Smartphone App to Collect Rheumatoid Arthritis Symptoms From Real-World Participants: Feasibility Study

Background

Using smartphones to enroll, obtain consent, and gather self-reported data from patients has the potential to enhance our understanding of disease burden and quantify physiological impact in the real world. It may also be possible to harness integral smartphone sensors to facilitate remote collection of clinically relevant data.

Objective

We conducted the Patient Rheumatoid Arthritis Data From the Real World (PARADE) observational study using a customized ResearchKit app with a bring-your-own-device approach. Our objective was to assess the feasibility of using an entirely digital approach (social media and smartphone app) to conduct a real-world observational study of patients with rheumatoid arthritis.

Methods

We conducted this observational study using a customized ResearchKit app with a bring-your-own-device approach. To recruit patients, the PARADE app, designed to guide patients through a series of tasks, was publicized via social media platforms and made available for patients in the United States to download from the Apple App Store. We collected patient-reported data, such as medical history, rheumatoid arthritis-related medications (past and present), and a range of patient-reported outcome measures. We included in the assessment a joint-pain map and a novel objective assessment of wrist range of movement, measured by the smartphone-embedded gyroscope and accelerometer.

Results

Within 1 month of recruitment via social media campaigns, 399 participants self-enrolled, self-consented, and provided complete demographic data. Joint pain was the most frequently reported rheumatoid arthritis symptom to bother study participants (344/393, 87.5%). Severe patient-reported wrist pain appeared to be inversely linked with the range of wrist movement measured objectively by the app. At study entry, 292 of 399 participants (73.2%) indicated a preference for participating in a mobile app–based study. The number of participants in the study declined to 45 of 399 (11.3%) at week 12.

Conclusions

Despite the declining number of participants over time, the combination of social media and smartphone app with sensor integration was a feasible and cost-effective approach for the collection of patient-reported data in rheumatoid arthritis. Integral sensors within smartphones can be harnessed to provide novel end points, and the novel wrist range of movement test warrants further clinical validation.

Lp-PLA2 activity is associated with increased risk of diabetic retinopathy: a longitudinal disease progression study

AIMS/HYPOTHESIS

The aim of the study was to examine the association between lipoprotein-associated phospholipase A₂ (Lp-PLA₂) activity levels and incident diabetic retinopathy and change in retinopathy grade.

METHODS

This was a cohort study of diabetic participants with serum collected at baseline and routinely collected diabetic retinal screening data. Participants with type 2 diabetes from the GoDARTS (Genetics of Diabetes Audit and Research in Tayside Scotland) cohort were used. This cohort is composed of individuals of white Scottish ancestry from the Tayside region of Scotland. Survival analysis accounting for informative censoring by modelling death as a competing risk was performed for the development of incident diabetic retinopathy from a disease-free state in a 3 year follow-up period (n = 1364) by stratified Lp-PLA₂ activity levels (in quartiles). The same analysis was performed for transitions to more severe grades.

RESULTS

The hazard of developing incident diabetic retinopathy was 2.08 times higher (95% CI 1.64, 2.63) for the highest quartile of Lp-PLA₂ activity compared with the lowest. Higher Lp-PLA₂ activity levels were associated with a significantly increased risk for transitions to all grades. The hazards of developing observable (or more severe) and referable (or more severe) retinopathy were 2.82 (95% CI 1.71, 4.65) and 1.87 (95% CI 1.26, 2.77) times higher for the highest quartile of Lp-PLA₂ activity compared with the lowest, respectively.

CONCLUSIONS/INTERPRETATION

Higher Lp-PLA₂ levels are associated with increased risk of death and the development of incident diabetic retinopathy, as well as transitions to more severe grades of diabetic retinopathy. These associations are independent of calculated LDL-cholesterol and other traditional risk factors. Further, this biomarker study shows that the association is temporally sensitive to the proximity of the event to measurement of Lp-PLA_2.

Monitoring design for assessing compliance with numeric nutrient standards for rivers and streams using geospatial variables

Implementation of numeric nutrient standards in Colorado has prompted a need for greater understanding of human impacts on ambient nutrient levels. This study explored the variability of annual nutrient concentrations due to upstream anthropogenic influences and developed a mathematical expression for the number of samples required to estimate median concentrations for standard compliance. A procedure grounded in statistical hypothesis testing was developed to estimate the number of annual samples required at monitoring locations while taking into account the difference between the median concentrations and the water quality standard for a lognormal population. For the Cache La Poudre River in northern Colorado, the relationship between the median and standard deviation of total N (TN) and total P (TP) concentrations and the upstream point and nonpoint concentrations and general hydrologic descriptors was explored using multiple linear regression models. Very strong relationships were evident between the upstream anthropogenic influences and annual medians for TN and TP ( > 0.85, < 0.001) and corresponding standard deviations ( > 0.7, < 0.001). Sample sizes required to demonstrate (non)compliance with the standard depend on the measured water quality conditions. When the median concentration differs from the standard by >20%, few samples are needed to reach a 95% confidence level. When the median is within 20% of the corresponding water quality standard, however, the required sample size increases rapidly, and hundreds of samples may be required.

Physical function and health-related quality-of-life in a population-based sample

BACKGROUND. It is of interest to understand whether impaired physical function is associated with health-related quality-of-life (HRQOL). We examined upper and lower body physical function and its relationship with two domains of HRQOL among men. METHODS. We conducted a population-based observational study of musculoskeletal health among Boston, MA residents, the Boston Area Community Health/Bone Survey. Participants were 1219 randomly-selected Black, Hispanic, and White males (30-79 years). Upper body function was measured using hand grip strength, while lower body function was measured by combining a timed walk and a chair stand test. HRQOL was measured using the physical (PCS-12) and mental health (MCS-12) component scores of the SF-12. Multivariate linear regression models were used to estimate the association between poor function and HRQOL. RESULTS. There was a significant association of poor upper body physical function with the MCS-12 (β coefficient: -4.12, p = 0.003) but not the PCS-12 (β coefficient: 0.79, p = 0.30) compared to those without poor function. Those with poor lower body physical function had significantly lower PCS-12 scores (β: -2.95, p = 0.007), compared to those without poor function, but an association was not observed for MCS-12 scores. CONCLUSIONS. Domains of physical function were not consistently related to domains of HRQOL.

Lean mass, muscle strength, and physical function in a diverse population of men: a population-based cross-sectional study

Background

Age-related declines in lean body mass appear to be more rapid in men than in women but our understanding of muscle mass and function among different subgroups of men and their changes with age is quite limited. The objective of this analysis is to examine racial/ethnic differences and racial/ethnic group-specific cross-sectional age differences in measures of muscle mass, muscle strength, and physical function among men.

Methods

Data were obtained from the Boston Area Community Health/Bone (BACH/Bone) Survey, a population-based, cross-sectional, observational survey. Subjects included 1,157 black, Hispanic, and white randomly-selected Boston men ages 30-79 y. Lean mass was assessed by dual-energy x-ray absorptiometry. Upper extremity (grip) strength was assessed with a hand dynamometer and lower extremity physical function was derived from walk and chair stand tests. Upper extremity strength and lower extremity physical function were also indexed by lean mass and lean mass was indexed by the square of height.

Results

Mean age of the sample was 47.5 y. Substantial cross-sectional age differences in grip strength and physical function were consistent across race/ethnicity. Racial/ethnic differences, with and without adjustment for covariates, were evident in all outcomes except grip strength. Racial differences in lean mass did not translate into parallel differences in physical function. For instance, multivariate modeling (with adjustments for age, height, fat mass, self-rated health and physical activity) indicated that whereas total body lean mass was 2.43 kg (approximately 5%) higher in black compared with white men, black men had a physical function score that was approximately 20% lower than white men.

Conclusions

In spite of lower levels of lean mass, the higher levels of physical function observed among white compared with non-white men in this study appear to be broadly consistent with known racial/ethnic differences in outcomes.

The ketogenic diet in childhood epilepsy: where are we now?

The ketogenic diet is a therapeutic dietary treatment for epilepsy in children which is resistant to medication. Until recently, evidence for use and resources available has been sparse. This review aims to provide a summary of the evidence supporting its use in children, some guidance towards its implementation and the services currently available in the UK.

Modification of Lignins by Growing Cells of the Sulfate-Reducing Anaerobe Desulfovibrio desulfuricans

The anaerobic sulfate-reducing bacterium Desulfovibrio desulfuricans was grown on medium supplemented with either Kraft lignin or lignosulfonate. Only lignosulfonate contributed to the growth of D. desulfuricans cells, by replacing sulfate, a natural electron acceptor for this microorganism. Kraft lignin added to the culture medium could not substitute for lactate or sulfate, both necessary culture medium components. However, it was found to enhance the viability of D. desulfuricans cells. When changes occurring in lignin during growth of Desulfovibrio cultures were monitored, it was found that both lignin preparations could be partially depolymerized. Spectrophotometric and elemental analysis of biologically treated lignins suggested that both the polyphenolic backbone and lignin functional groups were affected by D. desulfuricans. After treatment, a twofold increase in the sulfur content of Kraft lignin and a minor decrease (14%) in the sulfur content of lignosulfonate were observed. After biological treatment, Kraft lignin and lignosulfonate both bound larger quantities of heavy metals.

THE VISIBILITY OF MONOCHROMATIC RADIATION AND THE ABSORPTION SPECTRUM OF VISUAL PURPLE

1. After a consideration of the existing data and of the sources of error involved, an arrangement of apparatus, free from these errors, is described for measuring the relative energy necessary in different portions of the spectrum in order to produce a colorless sensation in the eye. 2. Following certain reasoning, it is shown that the reciprocal of this relative energy at any wave-length is proportional to the absorption coefficient of a sensitive substance in the eye. The absorption spectrum of this substance is then mapped out. 3. The curve representing the visibility of the spectrum at very low intensities has exactly the same shape as that for the visibility at high intensities involving color vision. The only difference between them is their position in the spectrum, that at high intensities being 48 µµ farther toward the red. 4. The possibility is considered that the sensitive substances responsible for the two visibility curves are identical, and reasons are developed for the failure to demonstrate optically the presence of a colored substance in the cones. The shift of the high intensity visibility curve toward the red is explained in terms of Kundt's rule for the progressive shift of the absorption maximum of a substance in solvents of increasing refractive index and density. 5. Assuming Kundt's rule, it is deduced that the absorption spectrum of visual purple as measured directly in water solution should not coincide with its position in the rods, because of the greater density and refractive index of the rods. It is then shown that, measured by the position of the visibility curve at low intensities, this shift toward the red actually occurs, and is about 7 or 8 µµ in extent. Examination of the older data consistently confirms this difference of position between the curves representing visibility at low intensities and those representing the absorption spectrum of visual purple in water solution. 6. It is therefore held as a possible hypothesis, capable of direct, experimental verification, that the same substance—visual purple—whose absorption maximum in water solution is at 503 µµ, is dissolved in the rods where its absorption maximum is at 511 µµ, and in the cones where its maximum is at 554 µµ (or at 540 µµ, if macular absorption is taken into account, as indeed it must be).

Frailty, serum androgens, and the CAG repeat polymorphism: results from the Massachusetts Male Aging Study

CONTEXT

The CAG repeat polymorphism in the androgen receptor, denoted (CAG)n, is thought to (inversely) index androgen sensitivity. We hypothesized that (CAG)n would exhibit a modifying influence on the association between circulating total and calculated free testosterone (TT and FT) and physical frailty in aging men.

OBJECTIVE

The objective of the study was to establish the influence of (CAG)n on the relation between circulating TT, FT, LH, SHBG, and frailty.

DESIGN

This was a prospective cohort study of health and endocrine functioning in randomly selected men, with a baseline (T1: 1987-89) and two follow-up (T2: 1995-1997; T3: 2002-2004) visits.

SETTING

This was an observational study of men residing in greater Boston, MA.

PARTICIPANTS

A total of 624 subjects aged 50-86 yr were retained.

MAIN OUTCOME MEASURES

The frailty phenotype was measured at T3. Components included weight loss, exhaustion, low physical activity, weakness, and slowness. Subjects exhibiting two of these five components were considered to be in an intermediate state, and those exhibiting three or more were considered frail.

RESULTS

(CAG)n was positively associated with TT and FT. Multivariable regression analyses revealed no influence of CAG on longitudinal within-subject changes in hormone levels or cross-sectional (T3) associations between hormone concentrations and the prevalence of intermediate frailty or frailty. Models incorporating subjects' history of hormone decline produced similar negative results.

CONCLUSIONS

This population-based study does not support the hypothesis that interindividual differences in (CAG)n can account for a lack of association between circulating androgens and the frailty phenotype. Longitudinal analyses are needed to confirm these conclusions.

Association of sex hormones and C-reactive protein levels in men

OBJECTIVES

The age-associated decline in sex hormone levels in men is paralleled by an increase in cardiovascular disease and associated risk factors including low grade chronic inflammation. The objective of this analysis was to investigate the association between sex hormone levels and C-reactive protein (CRP) in a population-based sample of men.

DESIGN

Population-based, cross-sectional observational survey.

PARTICIPANTS

A multistage stratified design was used to recruit a random sample of 2301 racially and ethnically diverse men age 30-79 years. Blood samples were obtained on 1899 men. Analyses were conducted on 1559 men with complete data on CRP and sex hormone levels.

MEASUREMENTS

High-sensitivity CRP levels. The association between CRP and sex hormone levels was assessed using multiple linear regression models.

RESULTS

An inverse association was observed, in both bivariate and multivariate analyses, between CRP and total testosterone, free testosterone and SHBG levels. These associations remained statistically significant after adjusting for age, body mass index, comorbid conditions and lifestyle factors. A positive trend between oestradiol (total and free) and CRP levels was not statistically significant.

CONCLUSIONS

A robust, inverse dose-response correlation between testosterone and SHBG levels with CRP levels provides further evidence of a potential role of androgens in inflammatory processes.

Relation between serum testosterone, serum estradiol, sex hormone-binding globulin, and geometrical measures of adult male proximal femur strength

CONTEXT

Although previous studies have indicated associations between circulating testosterone (T) or estradiol (E2) concentrations and bone mineral density, the relationship between gonadal steroids and skeletal geometry is not well defined.

OBJECTIVE

Our objective was to uncover the relation between circulating T or E2 and proximal femur geometry in a diverse sample of men.

DESIGN

We used data on 808 men enrolled in the Boston Area Community Health/Bone Study. Serum concentrations of total and calculated free T and E2 were obtained via early-morning blood sampling. The geometry of the proximal femur at three sites (the narrow neck, intertrochanter, and shaft) was obtained using the Hip Structural Analysis technology. Analyses adjusted for subjects' age, height, total body lean mass and fat mass, and level of physical activity were performed.

SETTING

In-home interviews accompanied by subject visits to the General Clinical Research Center at Boston University School of Medicine were performed.

STUDY PARTICIPANTS

A randomly selected cohort of men living in Boston, MA (ages 30-79 yr) was included in the study.

INTERVENTIONS

These were not applicable.

MAIN OUTCOME MEASURES

Bone mineral density and bone outer diameter, cross-sectional area (measuring bone material), and section modulus (an index of bending strength) were calculated.

RESULTS

In age-adjusted models, E2 was positively associated with hip strength parameters, whereas T was not. Adjustment for age and other parameters resulted in substantial reductions in, but not complete elimination of, associations between E2 and hip strength parameters.

CONCLUSION

Circulating E2 is strongly associated with proximal femur strength, an association that is partially mediated by body composition.

Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome

BACKGROUND & AIMS

Bloating symptoms are common in patients with irritable bowel syndrome (IBS) seen in primary care and gastrointestinal clinics. However, the underlying mechanisms of IBS are poorly understood, and there are few data available about the epidemiology of this syndrome or the impact of its symptoms. We investigated the prevalence, characteristics, and impact of bloating symptoms in patients with IBS.

METHODS

IBS patients were identified by Rome II criteria in a U.S. population representative web-based survey. Patients were asked about the quality, frequency, and severity of their gastrointestinal symptoms. The impact of these symptoms was investigated by assessing patients' health-related quality of life, utilization of health care, and use of medications.

RESULTS

Of the 337 IBS patients in this study, 82.5% (n = 278) reported bloating symptoms, the second most bothersome symptom after abdominal cramping. The symptoms were more prevalent in female patients, 87.4% (n = 209), than in male patients, 70.4% (n = 69) (P < .0001), and in patients with constipation, 88.7% (n = 47), and mixed symptoms, 88.8% (n = 135), than in patients with diarrhea, 72.3% (n = 96), (P = .02 and P < .01, respectively). Bloating symptoms were the third (of 14) most important reason to seek medical care, and more than half of the patients reported regular use of anti-gas medications. Bloating symptoms were associated with decreased energy levels (P = .04), food intake (P < .01), and physical functioning (P = .06).

CONCLUSIONS

Bloating symptoms are common in patients with IBS, and their prevalence and relative severity differ on the basis of sex and IBS subtype. Bloating symptoms are associated with a decrease in the quality of life and increases in health care utilization and use of medications.

Association between testosterone and estradiol and age-related decline in physical function in a diverse sample of men

OBJECTIVES

To examine the association between aging and physical function in men by testing a theoretically based model of aging, hormones, body composition, strength, and physical function with data obtained from men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey.

DESIGN

Cross-sectional, observational survey.

SETTING

Population-based.

PARTICIPANTS

Eight hundred ten black, Hispanic, and white randomly selected men from the Boston area aged 30 to 79.

MEASUREMENTS

Testosterone, estradiol, sex hormone-binding globulin, lean and fat mass, grip strength, and summated index of physical function (derived from walk and chair stand tests).

RESULTS

Measures of grip strength and physical function declined strongly with age. For instance, 10 years of aging was associated with a 0.49-point difference (scale 0-7) in physical function. Age differences in total testosterone and estradiol concentrations were smaller than age differences in their free fractions. Weak or nonsignificant age-adjusted correlations were observed between hormones and measures of physical function, although path analysis revealed a positive association between testosterone and appendicular lean mass and a strong negative association between testosterone and total fat mass. Lean and fat mass, in turn, were strongly associated with grip strength and physical function, indicating the possibility that testosterone influences physical function via indirect associations with body composition.

CONCLUSION

The age-related decline in serum testosterone concentration in men has a weak association with physical strength and functional outcomes through its associations with lean and fat mass.

Epidemiology of opioid pharmacy claims in the United States

OBJECTIVE

To describe opioid pharmacy claims patterns in the United States among an insured population.

DESIGN

Information was obtained from the US insurance claims database, IMS Lifelink, between 1997 and 2002. Descriptive statistics of opioid claims patterns were described with stratification by gender, age, and year of use.

RESULTS

The prevalence of insured people with opioid claims increased from 17.1 percent in 1997 to 18.4 percent in 2002. Among people with an opioid claim, 24 percent had > or =30 days and 10 percent had > or =90 days of days supplied based on the insurance claims. Prevalence varied by type of opioid; 56 percent of people with a claim received propoxyphene, 43 percent received codeine, 23 percent received oxycodone, and 17 percent received hydrocodone. Sustained-release opioids were found among 6 percent of those with a claim. With respect to the dose of opioids in the pharmacy claims (expressed as morphine equivalent total daily dose), 71 percent had claims for <50 mg, 55 percent had claims for 50-99 mg, and 24 percent had claims for > or =100 mg. Women, individuals with cancer, and older patients had significantly more pharmacy claims as well as claims for higher doses of opioids (p < 0.05). Internal medicine and family practice specialists were responsible for 22.4 percent and 20.9 percent of all opioid claims.

CONCLUSIONS

Opioid pharmacy claims increased slightly over time. Older patients, women and patients with a cancer diagnosis had significantly more opioid claims and claims for higher doses than the younger patients, men, and those without cancer.

Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample

CONTEXT

Risk factors for low testosterone and symptomatic androgen deficiency (AD) may be modifiable.

OBJECTIVE

Our objective was to examine demographic, anthropometric, and medical correlates of low testosterone and symptomatic AD.

DESIGN

Data were used from the Boston Area Community Health Survey, an epidemiological study conducted from 2002-2005.

SETTING

Data were obtained from a community-based random sample of racially and ethnically diverse men.

PATIENTS OR OTHER PARTICIPANTS

Data were available for 1822 men.

MAIN OUTCOME MEASURES

Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations of covariates with 1) low testosterone and 2) symptomatic AD. The operational definition of low testosterone was serum total testosterone less than 300 ng/dl and free testosterone less than 5 ng/dl; symptomatic AD was defined as the additional presence of symptoms: any of low libido, erectile dysfunction, or osteoporosis or two or more of sleep disturbance, depressed mood, lethargy, or diminished physical performance.

RESULTS

Factors associated with low testosterone included age (OR = 1.36; 95% CI= 1.11-1.66, per decade), low per-capita income ($6000 or less per household member vs. more than $30,000; OR = 2.86; 95% CI = 1.39-5.87), and waist circumference (per 10-cm increase; OR = 1.75; 95% CI = 1.45-2.12). Only age (OR = 1.36; 95% CI = 1.04-1.77), waist circumference (OR = 1.88; 95% CI = 1.44-2.47), and health status (OR = 0.21; 95% CI = 0.05-0.92, excellent vs. fair/poor) were associated with our construct of symptomatic AD. Of all variables, waist circumference was the most important contributor in both models.

CONCLUSIONS

Waist circumference is a potentially modifiable risk factor for low testosterone and symptomatic AD. Manifestation of symptoms may be a consequence of generally poor health status.

The natural history of symptomatic androgen deficiency in men: onset, progression, and spontaneous remission

OBJECTIVES

To describe the onset, progression, and remission of symptomatic androgen deficiency (SAD) using longitudinal data from the Massachusetts Male Aging Study (MMAS).

DESIGN

A prospective, population-based study of men living in Boston, Massachusetts. Data were collected in three waves: T1 (1987/89), T2 (1995/97), T3 (2002/04). Onset, progression, and remission were defined in terms of transitions in SAD status from one wave to the next.

SETTING

In-person, in-home interviews.

PARTICIPANTS

Seven hundred sixty-six community-dwelling men aged 40 to 70 at baseline (T1) contributed data from T1 to T2 and 391 from T2 to T3.

MEASUREMENTS

SAD was defined in terms of serum total and free testosterone (T) levels and symptoms associated with low circulating androgens. Total T and sex hormone-binding globulin (SHBG) were measured using radioimmunoassay. Free T was calculated from total T and SHBG measurements.

RESULTS

At T2 or T3, the likelihood of SAD was markedly greater for subjects who had exhibited SAD at the previous wave (odds ratio=3.8, 95% confidence interval=1.9-7.4), overall 55% of subjects who exhibited SAD experienced remission by the next study wave. The probability of SAD was greater with older age and greater body mass index. Multivariate models demonstrated that the likelihood of remission was at least 50% for most subpopulations.

CONCLUSION

Over approximately 15 years of follow-up, SAD did not represent a stable health state. The likelihood of SAD would remit exceeded the likelihood that it would not, particularly among younger and leaner men.

Warburg revisited: imaging tumour blood flow and metabolism

In the 1930s, Otto Warburg reported that anaerobic metabolism of glucose is a fundamental property of all tumours, even in the presence of an adequate oxygen supply. He also demonstrated a relationship between the degree of anaerobic metabolism and tumour growth rate. Today, this phenomenon forms the basis of tumour imaging with fluorodeoxyglucose positron emission tomography (FDG-PET). More recently, Folkman has demonstrated that malignant growth and survival are also dependent on tumour vascularity which is increasingly evaluated in vivo using techniques such as contrast enhanced computed tomography or magnetic resonance imaging (MRI). Although it is reasonable to hypothesise that the metabolic requirements of tumours are mirrored by alterations in tumour haemodynamics, the relationship between tumour blood flow and metabolism is in fact complex. A well-developed tumour vascular supply is required to ensure a sufficient delivery of glucose and oxygen to support the metabolism essential for tumour growth. However, an inadequate vascularisation of tumour will result in hypoxia, a factor that is known to stimulate anaerobic metabolism of glucose. Thus, the balance between tumour blood flow and metabolism will be an important indicator of the biological status of a tumour and hence the tumour's likely progression and response to treatment. This article reviews the molecular biology of tumour vascularisation and metabolism, relating these processes to currently available imaging techniques while summarising the imaging studies that have compared tumour blood flow and metabolism. The potential for vascular metabolic imaging to assess tumour aggression and sub-classify treatment response is highlighted.

Prevalence of symptomatic androgen deficiency in men

CONTEXT

Despite recognition that androgen deficiency in men should be defined according to biochemical and clinical criteria, most prevalence estimates are based on low testosterone levels alone.

OBJECTIVE

The objective of this study was to examine the association between symptoms of androgen deficiency and low total and calculated free testosterone levels and estimate the prevalence of symptomatic androgen deficiency in men.

DESIGN

This study was a population-based, observational survey.

PARTICIPANTS

A total of 1,475 Black, Hispanic, and white men, between the ages of 30-79 yr, with complete data on testosterone, SHBG, and symptoms of androgen deficiency, and who are not taking medications that impact sex steroid levels were randomly selected from the Boston Area Community Health Survey.

OUTCOME

Outcomes were measured as symptomatic androgen deficiency, defined as low total (<300 ng/dl) and free (<5 ng/dl) testosterone plus presence of low libido, erectile dysfunction, osteoporosis or fracture, or two or more of following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance.

RESULTS

Mean age of the sample was 47.3 +/- 12.5 yr. Approximately 24% of subjects had total testosterone less than 300 ng/dl, and 11% of subjects had free testosterone less than 5 ng/dl. Prevalence of symptoms were as follows: low libido (12%), erectile dysfunction (16%), osteoporosis/fracture (1%), and two or more of the nonspecific symptoms (20%). Low testosterone levels were associated with symptoms, but many men with low testosterone levels were asymptomatic (e.g. in men 50+ yr, 47.6%). Crude prevalence of symptomatic androgen deficiency was 5.6% (95% confidence interval: 3.6%, 8.6%), and was not significantly related to race and ethnic group. Prevalence was low in men less than 70 yr (3.1-7.0%) and increased markedly with age to 18.4% among 70 yr olds. Projection of these estimates to the year 2025 suggests that there will be as many as 6.5 million American men ages 30-79 yr with symptomatic androgen deficiency, an increase of 38% from 2000 population estimates.

CONCLUSIONS

Prevalence of symptomatic androgen deficiency in men 30 and 79 yr of age is 5.6% and increases substantially with age. The aging of the U.S. male population will cause a large increase in the burden of symptomatic androgen deficiency. Future work should address the clinical significance of low testosterone levels in asymptomatic men.

The application of microbore UPLC/oa-TOF-MS and 1H NMR spectroscopy to the metabonomic analysis of rat urine following the intravenous administration of pravastatin

The metabonomic effects of hepatotoxic doses of pravastatin on the urinary metabolic profiles of female rats have been investigated using ultra performance liquid chromatography (UPLC)-oa-TOF-MS and, independently, by (1)H NMR spectroscopy. UPLC was performed using a 1 mm microbore column packed with 1.7 microm particles. Examination of the data obtained from the individual animals, aided by statistical interpretation of the data, made it possible to identify potential markers for toxicological effects, with both NMR and UPLC-MS analysis highlighting distinct changes in the urinary metabolite profiles. These markers, which included elevated taurine and creatine, as well as bile acids, were consistent with hepatotoxicity in some animals, and this hypothesis was supported by histopathological and clinical chemistry findings. The analytical data from both techniques could be used to define a metabolic "trajectory" as toxicity developed and to provide an explanation for the lack of hepatotoxicity for one of the animals. The two analytical approaches (UPLC-MS and NMR) were found to be complementary whilst the use of a 1mm i.d. x 100 mm column reduced the amount of sample required for analysis to 2 microL, compared with 10 microL for a 2.1mm i.d. x 100 mm column. The 1mm i.d. column also provided increased signal-to-noise without loss of chromatographic efficiency.

Primary cutaneous aggressive epidermotropic CD8 positive cytotoxic T-cell lymphoma of the ear

We report a case of an epidermotropic CD8+ cutaneous T-cell lymphoma which initially presented as an ulcerated lesion of the pinna. Although T-cell lymphomas may present as cutaneous lesions, the ear is rarely involved. This uncommon presentation and the need for multiple biopsies means that the diagnosis of these lesions may be delayed or missed. A high index of suspicion is required when evaluating cutaneous lesions in the head and neck area.

Determinants of healthcare-seeking behaviour among subjects with irritable bowel syndrome

BACKGROUND

Doctor visits for irritable bowel syndrome are associated with high medical costs. Predictors of medical consultation for irritable bowel syndrome remain poorly understood.

AIM

To determine factors associated with healthcare seeking for irritable bowel syndrome.

METHODS

Subjects from previous US population-based survey were contacted 2 years later. Those who continued to have irritable bowel syndrome were included.

RESULTS

49% of subjects sought medical care for abdominal symptoms in the past year. Healthcare seeking did not differ significantly between males and females, but more females received an irritable bowel syndrome diagnosis. Predictors of irritable bowel syndrome healthcare seeking differed by gender. In multivariate analysis, age > or = 55 years (OR = 2.8, 95% CI: 1.5-5.4), fear abdominal symptoms relates to serious illness (OR = 1.7, 95% CI: 0.95-3.1), decreased bowel movements (OR = 1.8, 95% CI: 0.98-3.2), dyspepsia (OR = 1.7, 95% CI: 0.94-3.2) and pelvic pain (OR = 2.3, 95% CI: 1.2-4.4) were associated with seeking care in females. Among males, being disabled (OR = 11.6, 95% CI: 2.4-56.1) and abdominal cramping (OR =4.3, 95% CI: 1.2-15.4) were associated with seeking care. Healthcare seekers had lower irritable bowel syndrome-related quality of life. Neither pain severity nor mental health status was associated with seeking care.

CONCLUSION

Healthcare-seeking behaviour among irritable bowel syndrome patients was determined by presence of comorbidities and extent that irritable bowel syndrome affected quality of life, not physical symptoms or mental health status.

Stability of irritable bowel syndrome using a Rome II-based classification

BACKGROUND

As there is no biological marker for irritable bowel syndrome, a diagnosis is made using symptom-based criteria.

AIM

To evaluate the stability of self-reported symptoms consistent with Rome II-based irritable bowel syndrome classification.

METHODS

Irritable bowel syndrome subjects identified in a 2001 population-based study by modified Rome II criteria were re-contacted 2 years later. Data were collected via a web-based questionnaire.

RESULTS

Of the 697 subjects, 30% remained in the same irritable bowel syndrome subtype in both surveys, 18.4% changed irritable bowel syndrome subtype and 52% no longer met the irritable bowel syndrome criteria at follow-up. Subjects continuing to meet the irritable bowel syndrome criteria were more likely to have been initially classified in the alternating irritable bowel syndrome subtype and had more psychological impairment and lower irritable bowel syndrome-related quality of life than subjects not fulfilling the irritable bowel syndrome criteria at follow-up. Lack of pain caused more subjects to fall out of the irritable bowel syndrome criteria than the absence of non-painful bowel symptoms. However, the majority of subjects that did not fulfill the pain component of the irritable bowel syndrome criteria continued to report abdominal pain of at least moderate severity.

CONCLUSION

In a US population-based follow-up study using modified Rome II criteria, we found irritable bowel syndrome is episodic in nature and current classification is limited in capturing fluctuation of disease over time.

The comparative metabonomics of age-related changes in the urinary composition of male Wistar-derived and Zucker (fa/fa) obese rats

The global metabolite profiles of endogenous compounds excreted in urine by male Wistar-derived and Zucker (fa/fa) obese rats were investigated from 4 to 20 weeks of age using both 1H NMR spectroscopy and HPLC-TOF/MS with electrospray ionisation (ESI). Multivariate data analysis was then performed on the resulting data which showed that the composition of the samples changed with age, enabling age-related metabolic trajectories to be constructed. At 4 weeks it was possible to observe differences between the urinary metabolite profiles from the two strains, with the difference becoming more pronounced over time resulting in a marked divergence in their metabolic trajectories at 8-10 weeks. The changes in metabolite profiles detected using 1H NMR spectroscopy included increased protein and glucose combined with reduced taurine concentrations in the urine of the Zucker animals compared to the Wistar-derived strain. In the case of HPLC-MS a number of ions were found to be present at increased levels in the urine of 20 week old Zucker rats compared to Wistar-derived rats including m/z 71.0204, 111.0054, 115.0019, 133.0167 and 149.0454 (negative ion ESI) and m/z 97.0764 and 162.1147 (positive ion ESI). Conversely, ions m/z 101.026 and 173.085 (negative ion ESI) and m/z 187.144 and 215.103 (positive ion ESI) were present in decreased amounts in urine from Zucker compared to Wistar-derived rats. Metabolite identities proposed for these ions include fumarate, maleate, furoic acid, ribose, suberic acid, carnitine and pyrimidine nucleoside. The utility of applying metabonomics to understanding disease processes and the biological relevance of some of the findings are discussed.

D-Serine-induced nephrotoxicity: a HPLC-TOF/MS-based metabonomics approach

HPLC-MS-based metabonomic analysis was used to investigate urinary metabolic perturbations associated with D-serine-induced nephrotoxicity. D-Serine causes selective necrosis of the proximal straight tubules in the rat kidney accompanied by aminoaciduria, proteinuria and glucosuria. Alderely Park (Wistar-derived) rats were dosed with either D-serine (250 mg/kg ip) or vehicle (deionised water) and urine was collected at 0-12, 12-24, 24-36 and 36-48 h post-dosing. Samples were analysed using a Waters Alliance HT 2795 HPLC system coupled to a Waters Micromass Q-ToF-micro equipped with an electrospray source operating in either positive or negative ion mode. Changes to the urinary profile were detected at all time points compared to control. In negative ion mode, increases were observed in serine (m/z=103.0077), m/z=104.0376 (proposed to be hydroxypyruvate) and glycerate (m/z=105.0215), the latter being metabolites of D-serine. Furthermore, an increase in tryptophan, phenylalanine and lactate and decreases in methylsuccinic acid and sebacic acid were observed. Positive ion analysis revealed a decrease in xanthurenic acid, which has previously been assigned and reported using HPLC-MS following exposure to mercuric chloride and cyclosporine A. A general aminoaciduria, including proline, methionine, leucine, tyrosine and valine was also observed as well as an increase in acetyl carnitine. Investigation of additional metabolites altered as a result of exposure to D-serine is on-going. Thus, HPLC-MS-based metabonomic analysis has provided information concerning the mechanism of D-serine-induced renal injury.

Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain

OBJECTIVE

We sought to describe irritable bowel syndrome (IBS) treatment among women with chronic pelvic pain.

STUDY DESIGN

We performed a cross-sectional study of new chronic pelvic pain patients between 1993 and 2000 (n = 987). IBS was defined by Rome I criteria. IBS treatment was defined as lower gastrointestinal drugs or referral. Analyses were descriptive and multivariable.

RESULTS

IBS occurred in 35% of patients. In the highest quartile of pain, women with IBS were not more likely to have IBS treatment initiated. In the lowest three quarters of pain, women with IBS were 5.08 times more likely to have IBS treatment initiated. IBS was not diagnosed 40% of the time. IBS treatments were not recommended to 67% of patients with IBS. More than 35% of patients were prescribed narcotics.

CONCLUSION

IBS is not consistently diagnosed and treated even in a pelvic pain clinic. Yet, treatment of IBS may reduce the overall abdominal pain of these patients.

Sodium benzoate attenuates D-serine induced nephrotoxicity in the rat

D-Serine causes selective necrosis to the straight portion of the rat renal proximal tubules. The onset is rapid, occurring within 3-4 h and accompanied by proteinuria, glucosuria and aminoaciduria. The metabolism of D-serine by D-amino acid oxidase (D-AAO) may be involved in the mechanism of toxicity. D-AAO is localized within the peroxisomes of renal tubular epithelial cells, which is also the location of D-serine reabsorption. To address the role of D-AAO in D-serine-induced nephrotoxicity, we have examined the effect of sodium benzoate (SB) on the renal injury. SB has been shown to be a potent, competitive inhibitor of kidney D-AAO in vitro. Male Alderley Park rats were exposed to D-serine (500 mg/kg i.p.) 1 h after exposure to SB (125, 250, 500 or 750 mg/kg i.p.). Urine was collected for 0-6 h, then terminal plasma samples and kidneys were taken at 6.5 h. A second group of animals was given SB (500 mg/kg) followed by D-serine (500 mg/kg i.p.; 1 h later) and urine was collected after 0-6, 6-24 and 24-48 h. Terminal plasma samples and kidneys were taken at 48 h. 1H NMR spectroscopic analysis of urine, combined with principal component analysis, demonstrated that SB was able to prevent D-serine-induced perturbations to the urinary profile in a dose dependent manner. This was confirmed by measurement of plasma creatinine and urinary glucose and protein and histopathological examination of the kidneys. Assessment 48 h after D-serine administration revealed that nephrotoxicity was observed in animals pre-treated with SB (500 mg/kg) although the extent of injury was less pronounced than following D-serine alone. These results demonstrate that whilst prior exposure to SB prevents the initial onset of D-serine-induced nephrotoxicity, renal injury is still apparent at later time points. D-AAO activity in the kidney was decreased by 50% 1 h after dosing with SB suggesting that inhibition of this enzyme may be responsible for the observed protection.

The metabonomics of aging and development in the rat: an investigation into the effect of age on the profile of endogenous metabolites in the urine of male rats using 1H NMR and HPLC-TOF MS

The effect of aging and development in male Wistar-derived rats on the profile of endogenous metabolites excreted in the urine was investigated using both (1)H NMR spectroscopy and HPLC-TOF MS using electrospray ionisation (ESI). The endogenous metabolites were profiled in samples collected from male rats every two weeks from just after weaning at 4 weeks up to 20 weeks of age. Multivariate data analysis enabled clusters to be visualised within the data according to age, with urine collected at 4 and 6 weeks showing the greatest differences by both analytical techniques. Markers detected by (1)H NMR spectroscopy included creatinine, taurine, hippurate and resonances associated with amino acids/fatty acids, which increased with age, whilst citrate and resonances resulting from glucose/myoinositol declined. A number of ions were detected by HPLC-MS that were only present in urine samples at 4 weeks of age in both positive and negative ESI, with a range of ions, including e.g. carnitine, increasing with age. Age predictions by PLS-regression modelling demonstrated an age-related trend within these data, between 4 and 12 weeks for HPLC-MS and 4-16 weeks for NMR. The possible utility of these techniques for metabonomic investigations of age-related changes in the rat is discussed and the importance of employing suitable control animals in pharmacological and toxicological studies is highlighted.

D-serine-induced nephrotoxicity: possible interaction with tyrosine metabolism

D-serine selectively damages renal proximal tubule cells in rats by a mechanism that is not fully understood. Recent proteomic analysis identified that D-serine elevated plasma fumarylacetoacetate hydrolase (FAH). FAH is involved in tyrosine catabolism; hence, this pathway may be involved in mediating the toxicity. This work examines whether 2-(2-nitro-4-trifluoromethylbenzoyl)-cyclohexane-1,3-dione (NTBC), a potent inhibitor of the enzyme 4-hydroxyphenylpyruvate dioxygenase (HPPD) located upstream of FAH, modulates D-serine-induced nephrotoxicity. Rats were pretreated with NTBC (0.5 mg/kg p.o.) or corn oil and then 30 min later given either D-serine (250 mg/kg i.p.) or water. Urine was collected every 12 h until termination (48 h) and analysed by 1H NMR spectroscopy and principal component analysis (PCA). Markers of proximal tubule injury were evident in urine following treatment with D-serine and NTBC + D-serine. PCA could not distinguish between these urine samples suggesting that NTBC does not effect the development of nephrotoxicity. Clinical chemistry analysis of urine and terminal plasma samples and histopathological examination of the kidneys confirmed this. NTBC alone caused a marked increase in the excretion of 4-hydroxyphenylpyruvate (HPPA) and 4-hydroxyphenyllactate (HPLA); however, HPPA and HPLA excretion was minimal following NTBC + D-serine. Instead marked tyrosinuria was observed suggesting that D-serine-induced renal damage markedly affects the handling of increased levels of HPPA and HPLA resulting from the inhibition of HPPD.

Prevalence and Characteristics of Irritable Bowel Syndrome Among Women With Chronic Pelvic Pain

OBJECTIVE

We sought to evaluate whether there are unique characteristics associated with irritable bowel syndrome (IBS) within a population that has chronic pelvic pain.

METHODS

This cross-sectional study of new referral patients attending a pelvic pain clinic between 1993 and 2000 (N = 987) evaluated characteristics associated with IBS at entry to the clinic. The characteristics that we evaluated included demographic characteristics, clinical diagnoses, history of abuse, depression, pain, and prior abdominal surgeries.

RESULTS

Thirty-five percent of chronic pelvic pain patients had IBS defined by Rome I criteria. Age 40 years or older (odds ratio [OR] = 1.98, 95% confidence interval [CI]: 1.27, 3.11), muscular back pain (OR = 5.37, 95% CI: 0.98, 29.29), Symptom Checklist-90 global index score in top quartile (OR = 1.77, 95% CI: 1.09, 2.86), depression (OR = 1.93, 95% CI: 1.24, 3.01), 6 or more pain sites (OR = 1.67, 95% CI: 1.01, 2.78), and history of adult physical abuse (OR = 1.51, 95% CI: 1.01, 2.26) were associated with IBS in the final reduced multivariable model.

CONCLUSION

Specific characteristics distinguish women with IBS suggesting that IBS and chronic pelvic pain are not simply manifestations of the same disorder. Our findings could help physicians attempt to effectively treat women with IBS and chronic pelvic pain. Physicians could diagnose and treat IBS in conjunction with treatment for chronic pelvic pain.

A Novel Class of HIV-1 Inhibitors that Targets the Viral Envelope and Inhibits CD4 Receptor Binding

BMS-378806 is a prototype of a new class of small molecule HIV-1 inhibitors that blocks viral attachment to cells. This compound exhibits potent inhibitory activity against a panel of HIV-1 laboratory and clinical isolates (M- and T-tropic), selective for HIV-1 and inactive against HIV-2, SIV and a panel of other viruses. BMS-378806 exhibits no significant cytotoxicity and displays many attractive pharmacological properties such as low protein binding, minimal serum effect on anti-HIV-1 potency, good oral bioavailability in animal species and a clean safety profile in initial animal toxicology studies. The compound binds to gp120 and blocks the attachment of the HIV-1 envelope protein to cellular CD4 receptors via a specific and competitive mechanism. BMS-378806 binds directly to gp120 at an approximately 1:1 stoichiometry, with a binding affinity similar to that of soluble CD4. Further confirmation that this class of compounds targets the envelope in infected cells was obtained through the isolation of resistant variants and the mapping of resistance substitutions to the HIV-1 envelope. In particular, two substitutions, M426L and M475I, are situated at or near the CD4 binding pocket of gp120. Recombinant HIV-1 carrying these two substitutions demonstrated significantly reduced susceptibility to inhibition. Using these HIV-1 gp120 resistant variants and gp120/CD4 contact site mutants, the potential BMS-378806 target site was localized to a specific region within the CD4 binding pocket of gp120. Together, the data show that BMS-378806 is the first of a new class of HIV inhibitors with the potential to become a valued addition to our current repertoire of antiretroviral drugs.

Documenting the Current Definitions of Chronic Pelvic Pain: Implications for Research

OBJECTIVE

We examined chronic pelvic pain definitions used in published research, because the definition has direct implications for investigating causation and evaluating treatment.

DATA SOURCES

MEDLINE was searched for published articles in an Abridged Index Medicus journal from 1966 to 2001, restricted to humans, females, and English language. "Chronic pelvic pain" was used as a keyword.

METHODS OF STUDY SELECTION

We reviewed 101 abstracts of publications of chronic pelvic pain. Forty-three articles met the criteria of human, female, English language, chronic pelvic pain, and use of an experimental, cohort, case-control, or cross-sectional study design.

TABULATION, INTEGRATION, AND RESULTS

The following were not explicitly specified in the chronic pelvic pain definitions in these articles: duration of pain in 44%, restriction by pathology in 74%, location of pain in 93%, restriction by comorbidity in 95%, and additional inclusion/exclusion criteria in 65%.

CONCLUSION

We conclude that an explicit chronic pelvic pain definition is not used for research of this population. The use of a poor operational chronic pelvic pain research definition reduces the ability to investigate causation and improve treatment of this condition.

Geometric phase associated with mode transformations of optical beams bearing orbital angular momentum

We present direct measurements of a new geometric phase acquired by optical beams carrying orbital angular momentum. This phase arises when the transverse mode of a beam is transformed following a closed path in the space of modes. The measurements were done via the interference of two copropagating optical beams that pass through the same interferometer parts but acquire different geometric phases. The method is insensitive to dynamical phases. The magnitude and sign of the measured phases are in excellent agreement with theoretical predictions.

Effect of intestinal microflora on the urinary metabolic profile of rats: a (1)H-nuclear magnetic resonance spectroscopy study

1. Analysis of urine by (1)H-nuclear magnetic resonance (NMR) spectroscopy is used to detect biochemical disturbances predictive of toxicological changes. Recent studies, using (1)H-NMR spectroscopy have suggested that Alderley Park rats can be classified as hippuric acid (HA) or m-(hydroxyphenyl)propionic acid (m-HPPA) excretors. Evidence exists for the role of intestinal microflora in the excretion of aromatic phenolic compounds including HA and m-HPPA. 2. We sought to investigate whether intestinal microflora contribute to the difference in excretion. Urinary HA and m-HPPA levels were monitored to characterize excretion over time. The effect of intestinal microflora on the (1)H-NMR spectrum was also investigated using antibiotics to sterilize the intestine. Finally, the levels of m-HPPA and phenylpropionic acid (a precursor for HA) were analysed in the caecum and colon (entire tissue, including contents). 3. Characterization confirmed the presence of HA and m-HPPA excretors; enquiries revealed that the rats were obtained from two floors within a barriered breeding unit. Housing the rats from the two floors together for 21 days resulted in comparable levels of HA and m-HPPA excretion demonstrating that the profiles are not stable. 4. Following antibiotic treatment, HA and m-HPPA excretion decreased, indicating that intestinal microflora contribute to the excretion of these compounds. Finally, m-HPPA levels were higher in the colon of rats that excreted m-HPPA whilst PPA was increased in the caecum and colon of rats that excreted HA. 5. These results demonstrate that the observed difference in HA/m-HPPA excretion is due to differences in the intestinal microflora.

A quantitative analysis of perineurial cell basement membrane collagen IV, laminin and fibronectin in diabetic and non-diabetic human sural nerve

The thickness of the perineurial cell basement membrane was examined in diabetic and non-diabetic human sural nerve. A significant increase in thickness was found in the diabetic group. The nature of this thickening was investigated using immunohistochemistry and image analysis in order to semi-quantify three of the major intrinsic components of the perineurial cell basement membrane: collagen IV, laminin and fibronectin. Amounts of all three components were shown to be increased in the diabetic group, but not significantly so. However, significant linear correlations between fascicle size and perineurial collagen IV, laminin and fibronectin were identified in both diabetic and non-diabetic nerve.

Degradation of explosives by nitrate ester reductases

Explosive-contaminated land poses a hazard both to the environment and to human health. Microbial enzymes, either in their native or heterologous hosts, are a powerful and low-cost tool for eliminating this environmental hazard. As many explosives have only been present in the environment for 10 years, and with similar molecules not known in Nature, the origin of enzymes specialized for the breakdown of explosives is of particular interest. Screening of environmental isolates resulted in the discovery of flavoproteins capable of denitrating the explosives pentaerythritol tetranitrate (PETN) and glycerol trinitrate. These nitrate ester reductases are related in sequence and structure to Old Yellow Enzyme from Saccharomyces carlsbergenisis. All the members of this family have alpha/beta barrel structures and FMN as a prosthetic group, and reduce various electrophilic substrates. The nitrate ester reductases are, however, unusual in that they display activity towards the highly recalcitrant, aromatic explosive 2,4,6-trinitrotoluene, via a reductive pathway resulting in nitrogen liberation. We have embarked on a detailed study of the structure and mechanism of PETN reductase from a strain of Enterobacter cloacae. Work is focused currently on relating structure and function within this growing family of enzymes, with a view to engineering novel enzymes exhibiting useful characteristics.

Glutamine synthetase activity and expression are not affected by the development of motor neuronopathy in the G93A SOD-1/ALS mouse

The expression and activity of the enzyme glutamine synthetase (GS) were examined in the G93A/SOD-1 transgenic mouse model of progressive motor neuronopathy to investigate the mechanisms underlying degeneration of the motor neurones. Clinical signs appeared in G93A/SOD-1 mice at around 90 days, with severe spasticity and loss of self-righting reflex from 120 to 150 days of age. GS expression was examined using western blotting in primary astrocyte cultures derived from newborn (P1-2) G93A/SOD-1 mice and their non-transgenic littermates and in lower spinal cord from animals at 30, 60 and 90 days of age and disease end-stage (120-150 days). There were no differences in the levels of GS expression in the transgenic mice compared to the unaffected littermates at any of the disease stages examined. GS activity was measured spectrophotometrically in spinal cord extracts at these disease stages. There was a decrease in V(max) at 60 days compared to 30 days in both groups of mice (3.48+/-0.58 cf. 6.43+/-1.83 mmol/h/mg protein; non-transgenic littermates), with GS activity highest at end-stage (9.38+/-0.71 mmol/h/mg protein cf. 7.64+/-0.42 mmol/h/mg protein in littermates). Conversely, K(m) was transiently increased at 60 days (2.53+/-0.26 mM cf. 1.32+/-0.20 in littermates), remaining within the range of 30 day measurements from 90 days onwards. There were no differences in V(max) or K(m) values between the G93A/SOD-1 mice and their unaffected non-transgenic littermates at any of the disease stages examined. We conclude that there is no evidence that a change in glutamine synthetase activity or expression contributes to the progressive neurodegeneration observed in the G93A/SOD-1 mice.