Health-related quality of life across disease stages in patients with amyotrophic lateral sclerosis: results from a real-world survey

BACKGROUND

Amyotrophic lateral sclerosis (ALS) is characterized by a rapid disease course, with disease severity being associated with declining health-related quality of life (HRQoL) in persons living with ALS (pALS). The main objective of this study was to assess the impact of disease progression on HRQoL across King's, Milano-Torino Staging (MiToS), and physician-judgement clinical staging. Additionally, we evaluated the impact of the disease on the HRQoL of care partners (cALS).

METHODS

Data were sourced from the Adelphi ALS Disease Specific Programme (DSP)™, a cross-sectional survey of neurologists, pALS and cALS presenting in a real-world clinical setting between July 2020 and March 2021 in Europe and the United States.

RESULTS

Neurologists (n = 142) provided data for 880 pALS. There were significant negative correlations between all three clinical staging systems and EuroQol (European Quality of Life) Five Dimension Five Level Scale (EQ-5D-5L) utility scores and visual analogue scale (VAS) ratings. Although not all differences were significant, 5-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5) scores showed a stepwise increase in HRQoL impairment at each stage of the disease regardless of the staging system. At later stages, high levels of fatigue and substantial activity impairment were reported. As pALS disease states progressed, cALS also experienced a decline in HRQoL and increased burden.

CONCLUSIONS

Across outcomes, pALS and cALS generally reported worse outcomes at later stages of the disease, highlighting an unmet need in this population for strategies to maximise QoL despite disease progression. Recognition and treatment of symptoms such as pain and fatigue may lead to improved outcomes for pALS and cALS.

POS0743 CLINICAL CHARACTERISTICS AND BURDEN AMONG PATIENTS WITH SLE AND MUSCULOSKELETAL ORGAN INVOLVEMENT: RESULTS FROM A REAL-WORLD STUDY IN THE US

Background

Limited information exists concerning the clinical burden and unmet need of musculoskeletal (MSK) organ involvement among patients with SLE in clinical practice.

Objectives

To examine demographics, clinical status, treatment patterns, and patient-reported outcomes (PROs) among patients with SLE in clinical practices and assess the impact of MSK organ involvement.

Methods

Data were drawn from the Adelphi Real World Lupus IV (2021) Disease Specific Programme™, a point-in-time survey of 79 US physicians and their patients with SLE. Physicians completed questionnaires regarding patient demographics, clinical status, and treatment. The same patients were invited to complete questionnaires containing the EuroQoL 5-Dimensions (EQ-5D), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue) and Work Productivity & Activity Impairment questionnaire (WPAI) PRO tools.

Physicians stated their patients’ organ involvement at the time of data collection (current), in the categories of musculoskeletal, mucocutaneous, renal, cardiorespiratory, constitutional, haematologic, ophthalmologic, gastrointestinal, respiratory, or other.

Two mutually exclusive patient groups were analysed:

A.MSK – Current physician assessed musculoskeletal organ involvement (+/- other organ/tissue involvement).

B.Non-MSK – No current musculoskeletal organ involvement as assessed by the physician

Bivariate analysis was conducted for numeric variables using t-tests; binary categorical variables using a Fisher’s exact test; ordinal categorical variables using a Mann-Whitney test; and other categorical variables were compared using a chi-squared test.

Results

A total of 595 patients were included in this analysis: 64.7% MSK and 35.3% non-MSK. Mean[SD] patient age was 45.2[14.3] years, 83.2% were female, 53.3% were White/Caucasian, 27.9% were African American, and mean[SD] time diagnosed with any SLE was 5.3[6.2] years.

Point-in-time assessment of clinical status, treatment patterns and patient-reported outcomes, revealed that those with MSK organ involvement assessed by their rheumatologist had higher overall SLE disease severity, more flares in the last 12 months, and slightly worse quality of life scores and work impairment.

Table 1.

Point-in-time clinical status, treatment patterns and PROs among patients with SLE MSK organ involvement

TotalMSKNon-MSKp value(n=595)(n=385)(n=210)Physician-Reported Patient Clinical Status & Treatment HistoryCurrent SLE severity, n(%)Mild405 (68.1)243 (63.1)162 (77.1)<0.001Moderate169 (28.4)128 (33.3)41 (19.2)Severe21 (3.5)14 (3.6)7 (3.3)Current joint symptoms, n(%)Joint tenderness251 (42.2)210 (54.6)41 (19.5)<0.001Joint stiffness255 (42.9)212 (55.1)43 (20.5)<0.001Joint swelling135 (22.7)111 (28.8)24 (11.4)<0.001Mean [SD] Flares in the last 12 months1.6 [1.7]1.7 [1.8]1.2 [1.3]0.015Currently prescribed, n(%)Belimumab113 (19.0)79 (20.5)34 (16.2)0.198Immunosuppressant164 (27.6)105 (27.3)59 (28.1)0.830Corticosteroids333 (56.0)228 (59.2)105 (50.0)0.030Antimalarials429 (72.1)268 (69.6)161 (76.7))0.067Mean [SD] years on current treatment2.9 [3.6]2.5 [3.0]3.6 [4.4]<0.001Patient-Reported OutcomesMean [SD] EQ5D-5L Utility score (0= death to 1= full health)0.79 [0.20]0.76 [0.22]0.85 [0.16]0.002Mean [SD] FACIT-Fatigue score (0 worst fatigue to-52= no fatigue)32.4 [12.0]31.0 [11.5]35.4 [12.6]0.005Mean [SD] WPAI, overall work impairment score(0= no impact to 100= completely impacted)29.0 [21.0]30.5 [18.6]25.9 [25.2]0.223

Conclusion

In this large sample of patients with SLE followed in clinical practices in the U.S., compared to those with little or no rheumatologist assessed MSK involvement, those with MSK involvement, had lower quality of life, with higher impact on their work productivity. These results highlight the heterogeneity of SLE and the impact of major MSK manifestations on quality of life in SLE.

References

N/A

Disclosure of Interests

Aisha Vadhariya Employee of: Eli Lilly and Company, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jianmin Wu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kirstin Griffing Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Fiona Bailey: None declared, James Hetherington: None declared, Elke Rottier: None declared, Sophie Barlow: None declared, Karen Costenbader Consultant of: Lilly, Astra Zeneca, Janssen, Amgen, Glaxo Smith Kline, Grant/research support from: Exagen, Gilead, Merck

AB0554 CLINICAL CHARACTERISTICS AND BURDEN AMONG PATIENTS WITH SLE STRATIFIED BY SLEDAI DERIVED SEVERITY: RESULTS FROM A REAL-WORLD STUDY IN THE US

Background

Data are limited concerning the distribution of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores among patients with SLE in clinical practice and the characteristics of patients with specific SLEDAI scores.

Objectives

To investigate SLE patient demographics, clinical status, treatment patterns, and patient reported outcomes (PROs), overall and stratified by SLEDAI score.

Methods

Data were drawn from the Adelphi Real World Lupus IV (2021) Disease Specific Programme™, a point-in-time survey of 79 US rheumatologists and patients with SLE. Rheumatologists completed questionnaires regarding patient demographics, clinical status, and treatment. The same patients were invited to complete questionnaires containing the EuroQoL 5-Dimensions (EQ-5D), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue) and Work Productivity & Activity Impairment questionnaire (WPAI) Patient-Reported Outcomes (PRO) tools.

Physicians completed 24 questions based on the SLEDAI-2K questionnaire regarding their patients’ current clinical manifestations, from which a SLEDAI score was derived1. Patients were grouped based on their score: SLEDAI=0 (none), SLEDAI=1-6 (mild), SLEDAI=7-12 (moderate), and SLEDAI>12 (severe)2.

Data from patients without rheumatologist-perceived renal organ involvement and ≥ 1 year of SLE duration were included for analysis using bivariate tests.

Results

A total of 273 patients were included in this analysis. Mean [SD] patient age was 47.0[14.2] years, 83.9% were female, 57.1% were White/Caucasian, and 24.9% were African American.

Table 1.

Point-in-time clinical status, treatment patterns and PROs among patients with SLE stratified by SLEDAI score

Table 1.Total Sample (n=273)SLEDAI=0 (n=60, 22%)SLEDAI=1-6 (n=79, 28.9%)SLEDAI=7-12 (n=70, 25.6%)SLEDAI>12 (n=64, 23.4%)p valuePhysician-Reported Clinical Status and Treatment HistoryCurrent SLE severity, n(%)Mild221 (81.0)51 (85.0)70 (88.6)53 (75.7)47 (73.4)0.057Moderate49 (18.0)9 (15.0)9 (11.4)16 (22.9)15 (23.4)Severe3 (1.1)0 (0.0)0 (0.0)1 (1.4)2 (3.1)Current joint symptoms, n(%)Joint tenderness109 (39.9)24 (40.0)27 (34.2)28 (40.0)30 (46.9)0.498Joint stiffness121 (44.3)22 (36.7)33 (41.8)37 (52.9)29 (45.3)0.293Joint swelling60 (22.0)17 (28.3)13 (16.5)19 (27.1)11 (17.2)0.190Mean [SD] Flares in the last 12 months1.6 [1.5]1.3 [1.2]1.7 [1.7]1.5 [1.3]1.8 [1.5]0.550Currently prescribed, n(%)Belimumab58 (21.3)14 (23.3)18 (12.9)8 (10.1)15 (21.4)0.011Immunosuppressants48 (17.6)7 (11.7)26 (18.6)10 (12.7)13 (18.6)0.052Corticosteroids138 (50.6)35 (58.3)62 (44.3)29 (36.7)32 (45.7)0.003Antimalarials206 (75.5)28 (46.7)108 (77.1)64 (81.0)59 (84.3)<0.001Patient-Reported OutcomesMean [SD] EQ5D-5L Utility score (0=death to 1= full health)0.79 [0.19]0.83 [0.12]0.82 [0.21]0.79 [0.14]0.69 [0.25]0.024Mean [SD] FACIT-Fatigue score (0=worst fatigue to 52= no fatigue)32.7 [12.2]36.8 [8.7]36.1 [12.5]29.1 [9.8]26.4 [14.3]<0.001Mean [SD] WPAI overall (0= no impact to 100= completely impacted)26.8 [21.2]25.2 [15.8]19.5 [23.6]35.7 [20.2]31.9 [26.7]0.131

49% of SLE patients were categorized as SLEDAI 7-12 or >12 (moderate or severe).

Among the SLEDAI 7-12 (moderate) patients, 75.7% were subjectively categorized by their physician as having mild SLE. Of the SLEDAI >12 patients (severe), 73.4% were categorized as having mild SLE.

Joints symptoms and flaring in the last 12 months were not significantly different across SLEDAI groups.

Patients with greater SLEDAI reported lower EQ5D and greater FACIT-Fatigue scores. There was no statistical difference in WPAI between the SLEDAI groups.

Conclusion

A disconnect between point-in-time SLEDAI and physician-perceived severity exists. Patients with SLE, irrespective of SLEDAI, had high prevalence of joint symptoms, but higher SLEDAI impacted quality of life.

References

[1]Gladman D et al., Journal of Rheumatology, 2002.

[2]Fanouriakis A et al., Annals of the rheumatic diseases, 2019.

Disclosure of Interests

Aisha Vadhariya Employee of: Eli Lilly and Company, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jianmin Wu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kirstin Griffing Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Fiona Bailey: None declared, James Hetherington: None declared, Elke Rottier: None declared, Sophie Barlow: None declared, Karen Costenbader Consultant of: Lilly, Astra Zeneca, Janssen, Amgen, Glaxo Smith Kline, Grant/research support from: Exagen, Gilead, Merck

Volumetric MRI study of the intrauterine growth restriction fetal brain

OBJECTIVES

Intrauterine growth restriction (IUGR) is a pathologic fetal condition known to affect the fetal brain regionally and associated with future neurodevelopmental abnormalities. This study employed MRI to assess in utero regional brain volume changes in IUGR fetuses compared to controls.

METHODS

Retrospectively, using MRI images of fetuses at 30-34 weeks gestational age, a total of 8 brain regions-supratentorial brain and cavity, cerebral hemispheres, temporal lobes and cerebellum-were measured for volume in 13 fetuses with IUGR due to placental insufficiency and in 21 controls. Volumes and their ratios were assessed for difference using regression models. Reliability was assessed by intraclass correlation coefficients (ICC) between two observers.

RESULTS

In both groups, all structures increase in absolute volume during that gestation period, and the rate of cerebellar growth is higher compared to that of supratentorial structures. All structures' absolute volumes were significantly smaller for the IUGR group. Cerebellar to supratentorial ratios were found to be significantly smaller (P < 0.05) for IUGR compared to controls. No other significant ratio differences were found. ICC showed excellent agreement.

CONCLUSIONS

The cerebellar to supratentorial volume ratio is affected in IUGR fetuses. Additional research is needed to assess this as a radiologic marker in relation to long-term outcome.

KEY POINTS

• IUGR is a pathologic fetal condition affecting the brain • IUGR is associated with long-term neurodevelopmental abnormalities; fetal characterization is needed • This study aimed to evaluate regional brain volume differences in IUGR • Cerebellar to supratentorial volume ratios were smaller in IUGR fetuses • This finding may play a role in long-term development of IUGR fetuses.

Efficient light emission from inorganic and organic semiconductor hybrid structures by energy-level tuning

The fundamental limits of inorganic semiconductors for light emitting applications, such as holographic displays, biomedical imaging and ultrafast data processing and communication, might be overcome by hybridization with their organic counterparts, which feature enhanced frequency response and colour range. Innovative hybrid inorganic/organic structures exploit efficient electrical injection and high excitation density of inorganic semiconductors and subsequent energy transfer to the organic semiconductor, provided that the radiative emission yield is high. An inherent obstacle to that end is the unfavourable energy level offset at hybrid inorganic/organic structures, which rather facilitates charge transfer that quenches light emission. Here, we introduce a technologically relevant method to optimize the hybrid structure's energy levels, here comprising ZnO and a tailored ladder-type oligophenylene. The ZnO work function is substantially lowered with an organometallic donor monolayer, aligning the frontier levels of the inorganic and organic semiconductors. This increases the hybrid structure's radiative emission yield sevenfold, validating the relevance of our approach.

Guidelines for the public health management of typhoid and paratyphoid in England: practice guidelines from the National Typhoid and Paratyphoid Reference Group

OBJECTIVES

The Typhoid and Paratyphoid Reference Group (TPRG) was convened by the Health Protection Agency (HPA) and the Chartered Institute of Environmental Health (CIEH) to revise guidelines for public health management of enteric fever. This paper presents the new guidelines for England and their rationale.

METHODS

Methods include literature reviews including grey literature such as audit data and case studies; analysis of enhanced surveillance data from England, Wales and Northern Ireland; review of clearance and screening schedules in use in other non-endemic areas; and expert consensus.

RESULTS

The evidence and principles underpinning the new guidance are summarised. Significant changes from previous guidance include: • Algorithms to guide risk assessment and management, based on risk group and travel history; • Outline of investigation of non-travel cases; • Simplified microbiological clearance schedules for cases and contacts; • Targeted co-traveller screening and a "warn and inform" approach for contacts; • Management of convalescent and chronic carriers.

CONCLUSIONS

The guidelines were launched in February 2012. Feedback has been positive: the guidelines are reported to be clear, systematic, practical and risk-based. An evaluation of the guidelines is outlined and will add to the evidence base. There is potential for simplification and consistency between international guidelines.

Risedronate in adults with osteogenesis imperfecta type I: increased bone mineral density and decreased bone turnover, but high fracture rate persists

Bisphosphonates can increase bone mineral density (BMD) in children with osteogenesis imperfecta (OI). In this study of adults with OI type I, risedronate increased BMD at lumbar spine (but not total hip) and decreased bone turnover. However, the fracture rate in these patients remained high.

INTRODUCTION

Intravenous bisphosphonates given to children with OI can increase BMD and reduce fracture incidence. Oral and/or intravenous bisphosphonates may have similar effects in adults with OI. We completed an observational study of the effect of risedronate in adults with OI type I.

METHODS

Thirty-two adults (mean age, 39 years) with OI type I were treated with risedronate (total dose, 35 mg weekly) for 24 months. Primary outcome measures were BMD changes at lumbar spine (LS) and total hip (TH). Secondary outcome measures were fracture incidence, bone pain, and change in bone turnover markers (serum procollagen type I aminopropeptide (P1NP) and bone ALP). A meta-analysis of published studies of oral bisphosphonates in adults and children with OI was performed.

RESULTS

Twenty-seven participants (ten males and seventeen females) completed the study. BMD increased at LS by 3.9% (0.815 vs. 0.846 g/cm(2), p = 0.007; mean Z-score, -1.93 vs. -1.58, p = 0.002), with no significant change at TH. P1NP fell by 37% (p = 0.00041), with no significant change in bone ALP (p = 0.15). Bone pain did not change significantly (p = 0.6). Fracture incidence remained high, with 25 clinical fractures and 10 major fractures in fourteen participants (0.18 major fractures per person per year), with historical data of 0.12 fractures per person per year. The meta-analysis did not demonstrate a significant difference in fracture incidence in patients with OI treated with oral bisphosphonates.

CONCLUSIONS

Risedronate in adults with OI type I results in modest but significant increases in BMD at LS, and decreased bone turnover. However, this may be insufficient to make a clinically significant difference to fracture incidence.

Evaluation of certain food additives and contaminants

This report represents the conclusions of a Joint FAO/WHO Expert Committee convened to evaluate the safety of various food additives, including flavouring agents, with a view to recommending acceptable daily intakes (ADIs) and to preparing specifications for identity and purity. The Committee also evaluated the risk posed by two food contaminants, with the aim of advising on risk management options for the purpose of public health protection. The first part of the report contains a general discussion of the principles governing the toxicological evaluation and assessment of intake of food additives (in particular flavouring agents) and contaminants. A summary follows of the Committee's evaluations of technical, toxicological and intake data for certain food additives (acidified sodium chlorite, asparaginase from Aspergillus oryzae expressed in Aspergillus oryzae, carrageenan and processed Eucheuma seaweed, cyclotetraglucose and cyclotetraglucose syrup, isoamylase from Pseudomonas amyloderamosa, magnesium sulfate, phospholipase A1 from Fusarium venenatum expressed in Aspergillus oryzae, sodium iron(III) ethylenediaminetetraacetic acid (EDTA) and steviol glycosides); eight groups of related flavouring agents (linear and branched-chain aliphatic, unsaturated, unconjugated alcohols, aldehydes, acids and related esters; aliphatic acyclic and alicyclic terpenoid tertiary alcohols and structurally related substances; simple aliphatic and aromatic sulfides and thiols; aliphatic acyclic dials, trials and related substances; aliphatic acetals; sulfur-containing heterocyclic compounds; aliphatic and aromatic amines and amides; and aliphatic alicyclic linear alpha, beta -unsaturated di- and trienals and related alcohols, acids and esters); and two food contaminants (aflatoxin and ochratoxin A). Specifications for the following food additives were revised: maltol and ethyl maltol, nisin preparation, pectins, polyvinyl alcohol, and sucrose esters of fatty acids. Specifications for the following flavouring agents were revised: maltol and ethyl maltol, maltyl isobutyrate, 3-acetyl-2,5-dimethylfuran and 2,4,5-trimethyl-delta-oxazoline (Nos 1482, 1506 and 1559), and monomenthyl glutarate (No. 1414), as well as the method of assay for the sodium salts of certain flavouring agents. Annexed to the report are tables summarizing the Committee's recommendations for intakes and toxicological evaluations of the food additives and contaminants considered.

Risk assessment of substances that are both genotoxic and carcinogenic

The European Food Safety Authority (EFSA) and the World Health Organization (WHO), with the support of the International Life Sciences Institute, European Branch (ILSI Europe), organized an international conference on 16-18 November 2005 to discuss how regulatory and advisory bodies evaluate the potential risks of the presence in food of substances that are both genotoxic and carcinogenic. The objectives of the conference were to discuss the possible approaches for risk assessment of such substances, how the approaches may be interpreted and whether they meet the needs of risk managers. ALARA (as low as reasonably achievable) provides advice based solely on hazard identification and does not take into account either potency or human exposure. The use of quantitative low-dose extrapolation of dose-response data from an animal bioassay raises numerous scientific uncertainties related to the selection of mathematical models and extrapolation down to levels of human exposure. There was consensus that the margin of exposure (MOE) was the preferred approach because it is based on the available animal dose-response data, without extrapolation, and on human exposures. The MOE can be used for prioritisation of risk management actions but the conference recognised that it is difficult to interpret it in terms of health risk.

Quantum-chemical investigation of second-order nonlinear optical chromophores: Comparison of strong nitrile-based acceptor end groups and role of auxiliary donors and acceptors

We report a detailed quantum-chemical investigation of donor-acceptor substituted dipolar nonlinear optical chromophores incorporating the 4-(dimethylamino)phenyl donor end group and a variety of strong heterocyclic acceptor end groups, including tricyanofurans and tricyanopyrroles. In particular, we study the variation of the molecular second-order polarizability (beta) with the acceptor end group and when inserting auxiliary donors (thiophene) and acceptors (thiazole) into the pi bridge. Both finite-field calculations (in the context of local contributions) and sum-over-states calculations were carried out in order to probe the relationship between beta and the chemical structure of the various chromophores. The trends obtained with these two methods are fully consistent. The large beta values (up to 700 x 10(-30) esu) as well as the observed tunability of the optical absorption maximum (lambda(max)) make the chromophores investigated here interesting candidates for use in electro-optic applications at telecommunications wavelengths.

Fe(II)-to-Co(III) charge-transfer transitions in methylene-bridged metallocene salts

Four compounds have been studied which contain ferrocene or octamethylferrocene donors linked by CH(2) bridges to cobaltocenium or pentamethylcobaltocenium acceptors. The electronic spectra of these compounds cannot be accounted for by superposition of those of the constituent metallocenes; in each case, a low-energy solvatochromic absorption is observed, the energy of which parallels the difference in electrode potentials between the iron and cobalt centers. This absorption is assigned to Fe(II)-to-Co(III) charge transfer; analysis using Hush theory gives delocalization parameters V and alpha in the ranges 46-130 meV and 0.019-0.069, respectively, indicating much stronger coupling between the metal centers than in structurally similar ferrocene/ferrocenium systems.

Fe(II)-to-Co(III) charge-transfer transitions in methylene-bridged metallocene salts

Four compounds have been studied which contain ferrocene or octamethylferrocene donors linked by CH(2) bridges to cobaltocenium or pentamethylcobaltocenium acceptors. The electronic spectra of these compounds cannot be accounted for by superposition of those of the constituent metallocenes; in each case, a low-energy solvatochromic absorption is observed, the energy of which parallels the difference in electrode potentials between the iron and cobalt centers. This absorption is assigned to Fe(II)-to-Co(III) charge transfer; analysis using Hush theory gives delocalization parameters V and alpha in the ranges 46-130 meV and 0.019-0.069, respectively, indicating much stronger coupling between the metal centers than in structurally similar ferrocene/ferrocenium systems.

(eta 5-Cyclopentadienyl)(kappa 3-hydrotris(pyrazolyl)borate)cobalt(II)--the first high-spin cobalt organometallic complex

(eta 5-Cyclopentadienyl)(kappa 3-hydrotris(pyrazolyl)borate)-cobalt(II) has been synthesised; magnetic and crystallographic data indicate this to be the first example of a high-spin cobalt organometallic complex whilst its pentamethylcyclopentadienyl analogue is found to have a low-spin electronic configuration.

Hydrothermal synthesis of (C6N2H14)2(UVI2UIVO4F12), a mixed-valent one-dimensional uranium oxyfluoride

A new hybrid organic-inorganic mixed-valent uranium oxyfluoride, (C6N2H14)2(U3O4F12), UFO-17, has been synthesized under hydrothermal conditions using uranium dioxide as the uranium source, hydrofluoric acid as mineralizer, and 1,4-diazabicyclo[2.2.2]octane as template. The single-crystal X-ray structure was determined. Crystals of UFO-17 belonged to the orthorhombic space group Cmcm (no. 63), with a = 14.2660(15) A, b = 24.5130(10) A, c = 7.201(2) A, and Z = 4. The structure reveals parallel uranium-containing chains of two types: one type is composed of edge-sharing UO2F5 units; the other has a backbone of edge-sharing UF8 units, each sharing an edge with a pendant UO2F5 unit. Bond-valence calculations suggest the UF8 groups contain UIV, while the UO2F5 groups contain UVI. EXAFS data give results consistent with the single-crystal X-ray structure determination, while comparison of the uranium LIII-edge XANES of UFO-17 with that of related UIV and UVI compounds supports the oxidation-state assignment. Variable-temperature magnetic susceptibility measurements on UFO-17 and a range of related hybrid organic-inorganic uranium(IV) and uranium(VI) fluorides and oxyfluorides further support the formulation of UFO-17 as a mixed-valent UIV/UVI compound.

PNA-dependent gene chemistry: stable coupling of peptides and oligonucleotides to plasmid DNA

Two approaches are described for stably conjugating peptides, proteins and oligonucleotides onto plasmid DNA. Both methods use a peptide nucleic acid (PNA) clamp, which binds irreversibly and specifically to a binding site cloned into the plasmid. The first approach uses a biotin-conjugated PNA clamp that can be used to introduce functional biotin groups onto the plasmid to which streptavidin can bind. Atomic force microscopy images of linearized plasmid show streptavidin localized at the predicted PNA binding site on the DNA strand. Peptides and oligonucleotides containing free thiol groups were conjugated to maleimide streptavidin, and these streptavidin conjugates were bound to the biotin-PNA-labeled plasmid. In this way, peptides and oligonucleotides could be brought into stable association with the plasmid. A second approach used a maleimide-conjugated PNA clamp. Methods are described for conjugating thiolated peptides and oligonucleotides directly to the maleimide-PNA-DNA hybrid. This straightforward technology offers an easy approach to introduce functional groups onto plasmid DNA without disturbing its transcriptional activity.

Multiple attempts at embryo transfer: does this affect in-vitro fertilization treatment outcome?

In this study, we retrospectively analysed data from 877 patients who had 1204 embryo transfer procedures following in-vitro fertilization (IVF) at Midland Fertility Services, UK, between January 1991 and December 1995 to investigate the factors contributing to failure of embryo transfer at first attempt and the impact of immediate retransfer of retained embryos on the treatment outcome. Embryos were significantly more likely to be retained when the embryo transfer catheter was contaminated with mucus (3.3 versus 17.8%, P = 0.000001) or blood (3.3 versus 12%, P = 0.00001) and when the transfer procedure was difficult compared with when it was easy (20.3 versus 0.8%, P = 0.00001). There was no significant difference in the clinical pregnancy rate between those who had all their embryos transferred at the first attempt (24.7%) and those who required more than one attempt (23.2%). The types of embryo transfer catheter used in the unit did not show any difference in terms of embryo retention. Although we recommend aspiration of cervical mucus in order to reduce the rate of retained embryos, there is no evidence from our study to suggest that pregnancy rate is compromised when embryos are retained, provided they are discovered and immediately retransferred into the uterine cavity. Immediate retransfer is more convenient to the patients and reduces the laboratory workload without compromising the treatment outcome.

Stable expression of heterologous microtubule-associated proteins (MAPs) in Chinese hamster ovary cells: evidence for differing roles of MAPs in microtubule organization

To study the effects of microtubule-associated proteins (MAPs) on in vivo microtubule assembly, cDNAs containing the complete coding sequences of a Drosophila 205-kD heat stable MAP, human MAP 4, and human tau were stably transfected into CHO cells. Constitutive expression of the transfected genes was low in most cases and had no obvious effects on the viability of the transfected cell lines. High levels of expression, as judged by Western blots, immunofluorescence, and Northern blots, could be induced by treating cells with sodium butyrate. High levels of MAPs were maintained for at least 24-48 h after removal of the sodium butyrate. Immunofluorescence analysis indicated that all three MAPs bound to cellular microtubules, but only the transfected tau caused a rearrangement of microtubules into bundles. Despite high levels of expression of these exogenous MAPs and the bundling of microtubules in cells expressing tau, transfected cells had normal levels of assembled and unassembled tubulin. With the exception of the tau-induced bundles, microtubules in transfected cells showed the same sensitivity as control cells to microtubule depolymerization by Colcemid. Further, all three MAPs were ineffective in reversing the taxol-dependent phenotype of a CHO mutant cell line. The absence of a quantitative effect of any of these heterologous proteins on the assembly of tubulin suggests that these MAPs may have different roles in vivo from those inferred previously from in vitro experiments.

How should we define the caring role? Broadening the parameters of the concept of care

There are many different interpretations of the dynamics of the nurse/patient relationship and the contrasting needs and priorities nurses and patients attach to it. This article outlines varying interpretations of the concept of care, and suggests the concept can be broadened to reflect the physical, emotional, cognitive and intuitive aspects of the caring role.

Synthesis of carbonic anhydrase in rabbit and chicken reticulocyte lysates

The synthesis of carbonic anhydrase, the second most abundant soluble protein of red blood cells, is shown to occur in rabbit and chicken reticulocyte lysates. This translation product was identified by chloroform/ethanol extraction, polyacrylamide gel electrophoresis in sodium dodecylsulphate and peptide mapping. In rabbit retic-locyte lysates, predominantly one of the two red cell isozymes, carbonic anhydrase I, is synthesised. The proportion of carbonic anhydrase synthesis (0.2-0.8% of total protein synthesis) in vitro is comparable to that (0.2-1.0%) in vivo for both rabbit and chicken reticulocytes.

Investigations into the mechanism of reduction of ethanol sleep by thyrotropin-releasing hormone (TRH)

Thyrotropin-releasing hormone (TRH), administered intraperitoneally, was found to antagonize ethanol-induced sleep and hypothermia in mice without affecting brain ethanol content. This reduction of the actions of ethanol was also apparent after oral or intracisternal administration of TRH. In addition, TRH reduced ethanol-induced sleep in rats, hamsters, gerbils and guinea pigs. Evidence that the pituitary-thyroid axis is not necessary for the effects of TRH was provided by observations that hypophysectomy did not reduce TRH antagonism of ethanol narcosis and findings that neither triiodothyronine nor thyrotropin mimicked its action. Certain analogs of TRH, which have little effect on the pituitary, were also found to antagonize ethanol-induced sleep and hypothermia. Pretreatment with the antiadrenergic drugs, alpha-methyltyrosine, phentolamine and propranolol did not antagonize the ability of TRH to reduce sleep induced by ethanol. However, after intracisternal administration of atropine methyl nitrate, TRH no longer caused a significant reduction of sleep, even though TRH antagonism of the ethanol-induced hypothermia was still apparent. In contrast, central administration of other anticholinergic drugs, such as delta-tobocurarine and hexamethonium, reduced ethanol-induced sleep and this effect was additive with TRH. Carbachol also reduced ethanol sleeping time and this effect was also blocked by atropine methyl nitrate. The antagonism of ethanol-induced sleep by dibutyryl cyclic adenosine 3', 5'-monophosphate was significantly reduced but not blocked by atropine methyl nitrate. Results provide evidence that TRH has a direct extrapituitary action on brain and that both TRH and ethanol may interact with central cholinergic systems.