O5: THE CLIFF AND CONOR STUDIES NOVEL ASSESSMENT TOOLS IN COLORECTAL LIVER METASTASES (CLIFF STUDY - CHANGE IN LIVER FUNCTION AND FAT IN PRE-OPERATIVE CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES, CONOR STUDY

Introduction

Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastases (CLM). Patient selection is key, but there is wide variation in practice. Pre-operative chemotherapy can improve oncological outcomes, however chemotherapy-associated liver injury (CALI) may hinder liver regenerative capacity. Standard pre-operative assessments fail to accurately capture factors such as CALI and future liver remnant (FLR) function. The CLiFF and CoNoR studies utilise two novel assessment techniques, aiming to improve patient outcomes.

Method

The CLiFF study prospectively assesses two primary outcomes in 35 patients undergoing pre-operative chemotherapy for CLM: 1) change in liver function (via LiMAx test: direct assessment of hepatic functional capacity), and 2) change in liver fat (via advanced MR imaging (in-house spectroscopy and modified Dixon technique, scaled up via Perspectum LiverMultiScan)). The CoNoR study assesses potential added benefit of these novel tools in CLM resectability decision-making via sequential workstreams: a systematic review and international hepatobiliary expert interviews inform the online survey, assessing added benefit via online MDT scenarios.

Result

Preliminary CLiFF analysis suggests that CALI changes in liver fat and function are unrelated. Liver fat analysis techniques are compared and correlated with digital histological analysis. The CoNoR systematic review identifies key factors influencing CLM resectability decision-making and informs the international expert interviews, scheduled to occur during a February 2020 international hepatobiliary conference.

Conclusion

These studies are the first to assess where these novel tools might be utilised to maximal patient benefit within the Hepatobiliary MDT, and the first systematic review in CLM resectability decision-making.

Take-home message

These two linked studies evaluate the use of two novel assessment tools in the treatment of colorectal liver metastases, with the potential to improve patient selection for curative resection and patient outcomes.

PATEY PRIZE SESSION

Directed Accumulation of Anticancer Depsipeptides by Characterization of Neoantimycins Biosynthetic Pathway and an NADPH-Dependent Reductase

Neoantimycins (NATs) are members of antimycin-types of depsipeptides with outstanding anticancer activities. We isolated NAT-A (1) and -F (2) from the fermentation extract of Streptomyces conglobatus. The NAT biosynthetic gene cluster ( nat BGC) was identified by genome sequencing and bioinformatics analysis. nat BGC includes two nonribosomal peptide synthetase (NRPS) and one polyketide synthase (PKS) gene, and a gene cassette (10 genes), of which the encoded enzymes share high homology to the ones responsible for 3-formamidosalicylate (3-FAS) biosynthesis in the antimycin biosynthetic pathway. Heterologous expression of the partial nat BGC without the 3-FAS gene cassette in the antimycin producer, Streptomyces albus J1074, results in the production of 1 and 2, suggesting that the nat BGC indeed directs NATs biosynthesis. Targeted in-frame deletion of the reductase gene ( natE) abolished the production of 1 and 2 but accumulated two NAT derivatives, the known NAT-H (3) and a new NAT-I (4). Biochemical verification demonstrated that the recombinant NatE indeed catalyzes an NADPH-dependent reaction of 3 or 4 to 1 or 2, respectively. Compound 3 presented significantly stronger activities against eight cancer cell lines than the ones using cisplatin, the clinical chemotherapy medicine. In particular, 3 displayed 559- and 57-fold higher activity toward human melanoma and cervix epidermoid carcinoma cells, respectively, compared with cisplatin. The new derivative, 4, was 1.5- to 10.9-fold more active than cisplatin toward five cancer cell lines. The evaluation of NATs biosynthesis depicted here will pave the way to generate new NAT derivatives through rational pathway engineering.

Enzymology of Pyran Ring A Formation in Salinomycin Biosynthesis

Tetrahydropyran rings are a common feature of complex polyketide natural products, but much remains to be learned about the enzymology of their formation. The enzyme SalBIII from the salinomycin biosynthetic pathway resembles other polyether epoxide hydrolases/cyclases of the MonB family, but SalBIII plays no role in the conventional cascade of ring opening/closing. Mutation in the salBIII gene gave a metabolite in which ring A is not formed. Using this metabolite in vitro as a substrate analogue, SalBIII has been shown to form pyran ring A. We have determined the X-ray crystal structure of SalBIII, and structure-guided mutagenesis of putative active-site residues has identified Asp38 and Asp104 as an essential catalytic dyad. The demonstrated pyran synthase activity of SalBIII further extends the impressive catalytic versatility of α+β barrel fold proteins.

Enzymology of Pyran Ring A Formation in Salinomycin Biosynthesis

Tetrahydropyran rings are a common feature of complex polyketide natural products, but much remains to be learned about the enzymology of their formation. The enzyme SalBIII from the salinomycin biosynthetic pathway resembles other polyether epoxide hydrolases/cyclases of the MonB family, but SalBIII plays no role in the conventional cascade of ring opening/closing. Mutation in the salBIII gene gave a metabolite in which ring A is not formed. Using this metabolite in vitro as a substrate analogue, SalBIII has been shown to form pyran ring A. We have determined the X-ray crystal structure of SalBIII, and structure-guided mutagenesis of putative active-site residues has identified Asp38 and Asp104 as an essential catalytic dyad. The demonstrated pyran synthase activity of SalBIII further extends the impressive catalytic versatility of α+β barrel fold proteins.

Site-specific modification of the anticancer and antituberculosis polyether salinomycin by biosynthetic engineering

The complex bis-spiroacetal polyether ionophore salinomycin has been identified as a uniquely selective agent against cancer stem cells and is also strikingly effective in an animal model of latent tuberculosis. The basis for these important activities is unknown. We show here that deletion of the salE gene abolishes salinomycin production and yields two new analogues, in both of which the C18C19 cis double bond is replaced by a hydroxy group stereospecifically located at C19, but which differ from each other in the configuration of the bis-spiroacetal. These results identify SalE as a novel dehydratase and demonstrate that biosynthetic engineering can be used to redirect the reaction cascade of oxidative cyclization to yield new salinomycin analogues for use in mechanism-of-action studies.

High-precision calibration of MRS thermometry using validated temperature standards: effects of ionic strength and protein content on the calibration

Currently, there is very limited ability to measure the temperature of the brain, but a direct technique for its estimation in vivo could improve the detection of patients at risk of temperature-related brain damage, help in the diagnosis of stroke and tumour, and provide useful information on the mechanisms of thermoregulation of the brain. In this article, new calibrations in vitro of MRS thermometry using temperature-stabilised reference phantoms are reported. The phantoms comprise two concentric glass spheres: the inner sphere contains the phantom material to be measured by MRS, and the outer sphere contains a substance with a known temperature stable to within 0.2 °C. The substances were freezing organic fixed-point compounds (diphenyl ether and ethylene carbonate, freezing at 26.3 and 35.8 °C, respectively) or temperature-controlled circulating water. The phantom temperature was continuously monitored with a fluoroptic probe calibrated at the National Physical Laboratory with traceability to the International Temperature Scale 1990 (ITS-90). The MRS temperature calibration was obtained by measuring the chemical shift of water relative to N-acetylaspartate (NAA) in a single voxel as a function of temperature using a 1.5-T Philips Intera scanner. Measurements were made for several phantom materials to assess the effect of tissue composition on the water-NAA chemical shift against temperature calibration. The phantom mixtures contained 25 mm of NAA buffered to pH 6.5 or 7.5 and several ionic salts or bovine serum albumin (BSA). Spectra were acquired from 25 to 45 °C. The correlation between frequency differences and phantom temperature was very linear with small residuals. However, the linear fitting parameters varied with ionic composition and BSA concentration. The 'apparent' temperature (calibrated using the water-NAA frequency differences) decreased by approximately 1 °C for every 100 mm increase in ionic concentration and increased proportionally to the concentration of BSA.

Effects of Alzheimer's disease transgenes on neurochemical expression in the mouse brain determined by ¹H MRS in vitro

Transgenic models of human disease can be used to understand pathology and to discover biomarkers of disease presence, progression and response to therapy. Here we report a study of longitudinal metabolic differences between TASTPM transgenic Alzheimer's disease (AD) mice and their wild type counterparts using (1)H magnetic resonance spectroscopy (MRS) to look for potential biomarkers for use in AD research and drug discovery. Chloroform methanol extractions were performed on the brains of mice aged between 3 and 18 months. (1)H MR spectra were recorded from the aqueous fractions. Absolute metabolite concentrations, determined from resonance integrals relative to an internal standard, were analysed by 2-way ANOVA (genotype x age). Significant effects of age alone were identified for creatine, glutamine and total choline-containing compounds. There was a marked increase in creatine in the oldest (15-18 mo) TASTPM mice. The increase in creatine was unexpected and may be caused by osmotic stress in older animals as plaque load increases. Care should be taken when using creatine as a reference metabolite during scans of these animals in vivo. A significant effect of genotype alone was identified for myo-inositol (MI), which was higher in TASTPM mice at all ages. Succinate, glycerophosphocholine and choline all showed significant effects of age and genotype. No significant effects were detected in N-acetylaspartate (NAA) levels. Increased MI could be a marker of gliosis or microglial activation in TASTPM mice, but the absence of an age dependence for MI levels means it may be a biomarker of disease, but not of disease progression. Decreased succinate is indicative of disrupted neuronal energy metabolism, an effect that has been seen in human AD.

Wear and surface analysis of 38 mm ceramic-on-metal total hip replacements under standard and severe wear testing conditions

The purpose of this study was to compare the wear of zirconia-toughened alumina (ZTA) and alumina femoral heads tested against as-cast CoCrMo alloy acetabular cups under both standard and severe wear conditions. A new severe test, which included medio-lateral displacement of the head and rim impact upon relocation, was developed. This resulted in an area of metal transfer and an area of increased wear on the superior-anterior segment of the head that were thought to be due to dislocation and rim impact respectively. While the wear of all ceramic heads was immeasurable using the gravimetric method, the wear rates for the metallic cups from each test were readily calculated. An average steady state wear rate of 0.023 ± 0.005 mm3/106 cycles was found for the cups articulating against ZTA under standard wear conditions. A similar result had previously been obtained for the wear of cups articulated against alumina heads of the same size (within the same laboratory). Under severe wear conditions an increase in the metallic cup steady state wear rate was found with the ZTA and alumina tests giving 0.623 ± 0.252 and 1.35 ± 0.154 mm3/106 cycles respectively. Wear of the ceramic heads was detected using atomic force microscopy which showed, under severe wear conditions, a decrease in polishing marks and occasional grain removal. The surfaces of the ZTA heads tested under standard conditions were virtually unchanged from the unworn samples. Friction tests showed low friction factors for all components, pre and post wear.

Tribological and surface analysis of 38mm alumina–as-cast Co–Cr–Mo total hip arthroplasties

There is currently much discussion over the use of ceramic femoral components against metal acetabular cups, for use in total hip arthroplasty. The current study investigates six hot isostatically pressed alumina femoral heads of 38 mm diameter articulating against six as-cast Co—Cr—Mo metallic acetabular cups. Standard walking-cycle simulator wear testing was carried out to 5×106 cycles using the Durham Mark II hip wear simulator, and wear was determined gravimetrically. In addition, surface topography, using a non-contacting profilometer, an atomic force microscope, and an optical microscope, was monitored throughout the wear test. The wear of the ceramic heads was found to be undetectable using the current gravimetric method; however, a change in the surface topography was seen, as grain removal on the pole was observed through atomic force microscopy analysis. A biphasic wear pattern was found for the metallic cups, with low wear rates of 1.04 ± 0.293 mm3/106 cycles (mean, ±95 per cent confidence interval) and 0.0209 ± 0.004 mm3/106 cycles (mean, ±95 per cent confidence interval) for running-in and steady state wear phases respectively. Frictional measurement revealed that the joints were tending towards full fluid-film lubrication in parts of the walking cycle. The results show that the combination of hot isostatically pressed alumina and as-cast Co—Cr—Mo is a promising alternative for total hip arthroplasties.

Assessing human 5-HT function in vivo with pharmacoMRI

A number of novel ways of using magnetic resonance imaging (MRI) to visualise the action of drugs on animal and human brain (pharmacoMRI or phMRI) are becoming established tools in translational psychopharmacology. Using drugs with known pharmacology it is possible to investigate how neurotransmitter systems are involved in neural systems engaged by other processes, such as cognitive challenge (modulation phMRI) or to examine the acute effects of the drug itself in the brain (challenge phMRI). In this article we discuss the principles behind phMRI and review studies investigating the effect of serotonin (5-HT) manipulations. 5-HT modulation phMRI studies show the involvement of 5-HT in a broad range of neural processes ranging from motor function through 'cold' cognition, such as memory and response inhibition, to emotional processing. We highlight findings in brain areas that show some consistency or complementarity across studies, such as the ventrolateral orbitofrontal cortex where modulation by 5-HT is task-specific, and the amygdala in emotional processing where 5-HT is predominantly inhibitory. 5-HT challenge phMRI is promising but as yet few studies have been carried out. New ways of analysing phMRI data include connectivity analysis which holds the promise of going beyond identifying isolated areas of activation/modulation to understanding functional circuits and their neurochemistry. 5-HT phMRI now needs to be taken into patient populations and methods of investigating treatment effects need to be developed. If this is successful then phMRI will provide a genuinely exciting opportunity for the rapid development of better treatments for psychiatric conditions.

Plasma volume response to 30-s cycle ergometry: influence on lipid and lipoprotein

PURPOSE

It has been suggested that exercise-induced changes in plasma volume (PV) confound the interpretation of biochemical data obtained during the recovery period from exercise. No studies have sought to assess the effect of short-duration, high-intensity exercise on PV change and plasma lipid and lipoprotein concentrations. The purpose of this study was to compare power profiles, changes in PV, and plasma lipid and lipoprotein concentrations immediately after and 24 h after exercise.

METHODS

Subjects undertook two 30-s, high-intensity cycle ergometer protocols after optimization of resistive loads calculated from total body mass (TBM) and fat-free mass (FFM). Power output indices were recorded and blood samples were analyzed before, immediately after, and 24 h after exercise.

RESULTS

Peak power outputs were significantly greater in FFM (1020+/-134 vs 953+/-114 W for FFM and TBM, respectively, P<0.05). No differences were found between TBM and FFM for mean power output, fatigue index, or work done. Significant decreases (P<0.05) in PV of 12.0+/-5.7 and 12.3+/-6.7% were recorded immediately after exercise for both TBM and FFM, respectively. At 24 h after exercise, a significant (P<0.05) increase in PV of 4.2+/-10.3% was recorded for TBM only. Significant increases (P<0.01) were recorded for serum triglyceride, cholesterol, HDL cholesterol, and LDL cholesterol immediately after exercise for both TBM and FFM. These increases disappeared when corrected for PV changes, with the exception of LDL cholesterol in TBM, which still displayed a significant increase compared with the preexercise values (2.50+/-0.74 mM (before) vs 2.72+/-0.84 mM (immediately after)).

CONCLUSIONS

Our data show that short-duration, high-intensity cycle ergometer exercise tests can induce significant plasma volume decreases in untrained subjects, which may affect the interpretation of bloodborne biochemical parameters.

Fasting nonesterified fatty acid profiles in childhood and their relationship with adiposity, insulin sensitivity, and lipid levels

OBJECTIVE

The objective of this study was to examine the major constituent of nonesterified fatty acids in children with respect to auxologic parameters, insulin sensitivity, and lipid levels, because nonesterified fatty acid levels are elevated in obesity and are important in the development of comorbidities.

METHODS

Fasting blood samples were obtained from 73 children (43 girls; 49 obese; median [range] age: 11.4 [0.9-17.6] years). Concentrations of the major circulating nonesterified fatty acids (myristate, palmitate, oleate, stearate, and arachidate) were determined by gas chromatography mass spectrometry, alongside measurement of insulin, adiponectin, and lipid profiles.

RESULTS

The sum of all nonesterified fatty acids was significantly higher in obese versus normal-weight children, although gender (but not age or puberty) was an important determinant, with the difference remaining significant only in boys. Overall, obese children had higher concentrations of myristate, palmitate, and oleate but not stearate or arachidate. Age was an important determinant of myristate and arachidate, whereas gender proved more important for palmitate and stearate. Fasting insulin concentrations were not associated with either total nonesterified fatty acid concentrations or any of the individual nonesterified fatty acids, although a positive correlation was found between adiponectin and total nonesterified fatty acid concentrations that was independent of obesity status and that seemed mediated by changes in palmitate and stearate. Serum total cholesterol and low-density lipoprotein (but not high-density lipoprotein) levels seemed to correlate positively with circulating concentrations of palmitate, oleate, and stearate, whereas serum triacylglycerols correlated with myristate, palmitate, and oleate concentrations.

CONCLUSIONS

Nonesterified fatty acid concentrations are elevated in obese children, primarily as a result of increases in myristate, palmitate, and oleate. Independent effects of nonesterified fatty acids on circulating adiponectin levels and lipid parameters were observed, although we found no relationship between nonesterified fatty acid concentrations and the insulin resistance identified with obesity.

Delineation of large deletions of the MECP2 gene in Rett syndrome patients, including a familial case with a male proband

Comprehensive genetic screening programs have led to the identification of pathogenic methyl-CpG-binding protein 2 (MECP2) mutations in up to 95% of classical Rett syndrome (RTT) patients. This high rate of mutation detection can partly be attributed to specialised techniques that have enabled the detection of large deletions in a substantial fraction of otherwise mutation-negative patients. These cases would normally be missed by the routine PCR-based screening strategies. Here, we have identified large multi-exonic deletions in 12/149 apparently mutation-negative RTT patients using multiplex ligation-dependent probe amplification (MLPA). These deletions were subsequently characterised using real-time quantitative PCR (qPCR) and long-range PCR with the ultimate aim of defining the exact nucleotide positions of the breakpoints and rearrangements. We detected an apparent deletion in one further patient using MLPA; however, this finding was contradicted by subsequent qPCR and long-range PCR results. The patient group includes an affected brother and sister with a large MECP2 deletion also present in their carrier mother. The X chromosome inactivation pattern of all female patients in this study was determined, which, coupled with detailed clinical information, allowed meaningful genotype-phenotype correlations to be drawn. This study reaffirms the view that large MECP2 deletions are an important cause of both classical and atypical RTT syndrome, and cautions that apparent deletions detected using high-throughput diagnostic techniques require further characterisation.

The assessment of antiangiogenic and antivascular therapies in early-stage clinical trials using magnetic resonance imaging: issues and recommendations

Vascular and angiogenic processes provide an important target for novel cancer therapeutics. Dynamic contrast-enhanced magnetic resonance imaging is being used increasingly to noninvasively monitor the action of these therapeutics in early-stage clinical trials. This publication reports the outcome of a workshop that considered the methodology and design of magnetic resonance studies, recommending how this new tool might best be used.

The development of functional imaging in the diagnosis, management and understanding of childhood brain tumours

Imaging plays a fundamental role in the management of children with brain tumours. A series of new techniques, commonly grouped under the heading functional imaging, promise to give information on the properties and biological characteristics of tissues thereby adding to the structural information available from current imaging. The EPSRC funded a workshop to bring together clinicians from the UK Children's Cancer Study Group and scientific experts in the field to identify clinical problems in childhood brain tumours that may be addressed by functional imaging and to develop a clinical test bed for applying, evaluating and developing this new technology. The presentations and discussion sessions from the workshop are summarised and a review of the current 'state of the art' for this rapidly developing area provided. A key output of the workshop was agreement on a series of hypotheses which can be tested in carefully designed clinical studies.

The 100-day PSA: usefulness as surrogate end point for biochemical disease-free survival after definitive radiotherapy of prostate cancer

Overall and biochemical disease-free (bNED) survival data after definitive radiotherapy (RT) for prostate cancer (CaP) requires decades of patient follow-up. Surrogates involving dynamics of prostate-specific antigen (PSA) decline, PSA nadir and time thereto have been unrewarding. This study investigated the metric of the PSA value 100 days after RT (PSA(100)), analyzed with respect to 8-y bNED survival. A total of 214 patients with T1-3 CaP were treated with definitive RT (defined as dose >66 Gy) in our institution between 1/1/1988 and 12/31/2000. All were subject to continuous follow-up with routine PSA levels. Biochemical failure (77 patients) was defined by the ASTRO criteria (n=67) or by the date of first hormonal therapy for a rising PSA, which did not meet the ASTRO criteria (n=10). No patients were included if they received postoperative radiation, or if hormones were administered prior to bNED recurrence, if any. Patients were stratified by PSA(100) values </= or >4.0 ng/ml, and </= or <2.5 ng/ml. Median follow-up was 64.3 months: follow-up data were calculated as of time to last PSA, with data collection as of 12/31/02. Patients with PSA(100)</=4.0 ng/ml had 62% 8-y bNED survival, and those with PSA(100)>4.0 ng/ml had 20% 8-y bNED survival (P<0.001). Use of a PSA(100) cutoff of 2.5 ng/ml yielded no significant difference in 8-y bNED survival (P=0.229). Cox proportional analysis revealed that initial PSA (P=0.006), stage (P=0.001) and PSA(100)</=4.0 ng/ml (P=0.002) were significantly related to bNED survival, but that age (P=0.887), race (P=0.500), RT dose (P=0.669), Gleason sum (P=0.091), and PSA(100)</=2.5 ng/ml (P=0.128) were not. In conclusion, PSA(100) using a cutoff of 4 ng/ml is a valuable and reliable surrogate for bNED survival after definitive RT, requiring less follow-up than other metrics. Patients with less values will have only about a 1 in 3 chance of bNED failure at 8 y.

Development of vigabatrin-induced lesions in the rat brain studied by magnetic resonance imaging, histology, and immunocytochemistry

Vigabatrin, the gamma-aminobutyric acid transaminase (GABA-T)-inhibiting anticonvulsant drug, was given orally at a dose of 275 mg/kg/day to rats (n = 6) in their feed for a period of 12 weeks, during which T2-weighted magnetic resonance images (MRIs) and diffusion-weighted MRIs (DWIs) were collected at weeks 1, 3, 6, 9, and 12. Half the rats (n = 3; and half their age-matched littermate controls; n = 3) were then killed for histopathological confirmation of the observed VGB-induced cerebellar and cortical white-matter lesions. VGB was removed from the diet and additional MRIs of the remaining rats taken at weeks 14, 17, 20, and 24, at which time they (n = 3), along with remaining controls (n = 3), were also killed for histopathology. The T2-weighted MRIs acquired were used to compute T2 relaxation time maps. Statistically significant VGB-induced T2 increases were observed in the frontal and occipital cortices and in the cerebellar white matter (CWM). The cerebellar lesions were more clearly discerned by eye in the DWIs than by T2-contrast alone. During the recovery period the VGB-treatment group CWM-T2 and CWM-DWI hyperintensity greatly decreased as the reversible lesion disappeared. As expected, histological and immunocytochemical examinations demonstrated the presence of intra-myelinic edema, microvacuolation, and reactive astrocytosis in the CWM and cortex after 12 weeks VGB-treatment. In the remaining animals microvacuolation of the white matter had not completely resolved during the 12-week recovery phase. The data show that quantitative MRI T2-relaxometry can be used to detect VGB-induced CNS pathology, and also suggest that DWI is particularly sensitive to the cerebellar lesion. The reversible neurotoxicity of global GABA-elevation in experimental animals is discussed.

The Kawasaki identity and the Fluctuation Theorem

In this paper we show that the Fluctuation Theorem of Evans and Searles [D. J. Evans, D. J. Searles, Phys. Rev. E 50, 1645 (1994)] implies that the Kawasaki function exp(-Omega(t)) is unity for all time t. We confirm this relationship using experimental data obtained using optical tweezers, and show that the Kawasaki function is a valuable diagnostic tool.

Random packings of spheres and spherocylinders simulated by mechanical contraction

We introduce a simulation technique for creating dense random packings of hard particles. The technique is particularly suited to handle particles of different shapes. Dense amorphous packings of spheres have been formed, which are consistent with the existing work on random sphere packings. Packings of spherocylinders have also been simulated out to the large aspect ratio of alpha=160.0. Our method packs randomly oriented spherocylinders to densities that reproduce experimental results on anisotropic powders and colloids very well. Interestingly, the highest packing density of phi=0.70 is achieved for very short spherocylinders rather than spheres. This suggests that slightly changing the shapes of the particles forming a hard sphere glass could cause it to melt. Comparisons between the equilibrium phase diagram for hard spherocylinders and the densest possible amorphous packings have interesting implications on the crystallization of spherocylinders as a function of aspect ratio.

How hard is a colloidal "hard-sphere" interaction?

Poly-12-hydroxystearic acid (PHSA) is widely used as a coating on colloidal spheres to provide a "hard-sphere-type" interaction. These hard spheres have been widely used in fundamental studies of nucleation, crystallization, and glass formation. Most authors describe the interaction as "nearly" hard sphere. In this paper we directly measure this interaction, using layers of PHSA adsorbed onto mica sheets in a surfaces force apparatus. We find that the layers, in appropriate solvents, have no long-range interaction. When the solvent is decahydronaphthalene (decalin), the repulsion rises from zero to the maximum measurable over a distance range of 15-20 nm. The data is converted to equivalent forces between spheres of different diameters, and modeled using a hard core potential. Using zeroth-order perturbation theory and computer simulation, we demonstrate that the equation of state does not deviate from that of a perfect hard-sphere system under any relevant experimental conditions.

5-HT(2C) receptor activation by m-chlorophenylpiperazine detected in humans with fMRI

Functional brain imaging using selective drug probes offers the opportunity to investigate regional neuronal activation linked to receptor stimulation or inhibition. In a placebo-controlled, balanced order design in eight male volunteers, the 5-HT(2c) agonist, m-chlorophenylpiperazine (mCPP) increased blood oxygen level dependent (BOLD) signal in the hypothalamus, caudate, pallidum, amygdala and pyriform cortex, anterior cingulate gyrus and choroid plexus (p < 0.001 uncorrected), areas with high density of 5-HT(2c) receptors. Activation in the hypothalamus correlated significantly with the prolactin response (p < 0.05 small volume corrected). In a subsequent Go/NoGo task, mCPP enhanced activation in right lateral orbitofrontal cortex (p < 0.05 small volume corrected). These findings suggest that pharmacoMRI is a potentially powerful tool for investigating neurotransmitter function in humans.

In vivo GABA+ measurement at 1.5T using a PRESS-localized double quantum filter

A point-resolved spectroscopy (PRESS)-localized double quantum filter was implemented on a 1.5T clinical scanner for the estimation of gamma-amino butyric acid (GABA) concentrations in vivo. Several calibrations were found to be necessary for consistent results to be obtained. The apparent filter yield was approximately 38%; filter strength was sufficient to reduce the singlet metabolite peaks in vivo to below the level of the noise. Metabolite-nulled experiments were performed, which confirmed that significant overlap occurred between macromolecule signals and the GABA resonance at 3.1 ppm. Although the multiplet arm at 2.9 ppm was confirmed to be relatively free of contamination with macromolecules, some contribution from these and from peptides is likely to remain; therefore, the term GABA+ is used. GABA+ concentrations were estimated relative to creatine (Cr) at the same echo time (TE) in a group of controls, studied on two occasions. The GABA+ concentration in 35-ml regions of interest (ROIs) in the occipital lobe was found to be 1.4 +/- 0.2 mM, with scan-rescan repeatability of 38%.

A comparison of cell and tissue extraction techniques using high-resolution 1H-NMR spectroscopy

Analysis of brain metabolites by a wide range of analytical techniques is typically achieved using biochemical extraction methodologies that require either two separate samples or two separate extraction steps to prepare both aqueous and organic metabolite fractions. However there are a number of brain pathologies in which both aqueous metabolite and lipid changes occur so that a simultaneous extraction of both fractions would be valuable. The methanol-chloroform (M/C) technique enables extraction of both aqueous metabolites and lipids simultaneously. It is already well established for lipid extraction of cells and tissue but its efficiency and reproducibility for extraction of aqueous metabolites is unknown. Therefore, we compared the aqueous metabolite yield and the reproducibility of the M/C method to the commonly used perchloric acid (PCA) method, using 1H-NMR spectroscopy of adult rat brain and purified rat astrocyte culture extracts. The results indicate that M/C is a superior technique for aqueous metabolite extraction from both brain tissue and cells when compared to the PCA method. The M/C extraction technique enables the simultaneous extraction of both lipids and aqueous metabolites from a single sample using small solvent-volumes, making it well suited for NMR investigations of both tissues and cells.

Motions in binary mixtures of hard colloidal spheres: melting of the glass

Dynamic light-scattering experiments are performed on binary mixtures of hard-sphere-like colloidal suspensions with a size ratio of 0.6. The optical properties of the particles are such that the relative contrast of the two species is very sensitive to temperature, a feature that is exploited to obtain the three partial coherent intermediate scattering functions. The glass transition is identified by the onset of structural arrest, or arrest of the alpha process, on the time scale of the experiment. This is observed in a one-component suspension at a packing fraction of 0.575. The intermediate scattering functions measured on the mixtures quantify how, on introduction of the smaller spheres, the alpha process is released, i.e., how the glass melts. Increasing the fraction of smaller particles causes the alpha process to speed up but, at a given wave vector, also incurs a change to its amplitude in proportion to the change in the (partial) structure factor.

Molecular dynamics study of the stability of the hard sphere glass

Glassy states have been observed in hard-spherelike colloidal suspensions; however, some recent work suggests that a stable, one-component hard-sphere glass doesn't exist. A possible resolution of this dilemma is that colloidal glass formation results from a small degree of particle polydispersity. In order to investigate this further, we used the molecular-dynamics method to explore the phase behavior of both one- and two-component hard-sphere systems. It was found that the metastable fluid branch of the one-component system ceased to exist at a volume fraction marginally above melting, instead this system always crystallized within a relatively short period of time. Binary systems with a size ratio gamma=0.9 were then used as the simplest approximation to model a polydisperse hard-sphere colloidal system. Here the crystallization process was slowed down dramatically for all volume fractions and the fluid state was maintained for many relaxation times. Indeed, at the lowest volume fraction straight phi=0.55 no sign of crystallization was seen on the simulation time scale. The systems at intermediate volume fractions did eventually crystallize but at the highest volume fraction of straight phi=0.58, a dramatic slowing down in the crystallization process was observed. This is qualitatively in agreement with the experimental results on colloidal suspensions. Using the insight gained from this paper, the reasons behind a polydisperse system forming a stable glass, in contrast to the one-component system, are elucidated.

Elevated plasma cholecystokinin at high altitude: metabolic implications for the anorexia of acute mountain sickness

The aims of the present study were to measure the satiety neuropeptide cholecystokinin (CCK) in humans at terrestrial high altitude to investigate its possible role in the pathophysiology of anorexia, cachexia, and acute mountain sickness (AMS). Nineteen male mountaineers aged 38 +/- 12 years participated in a 20 +/- 5 day trek to Mt. Kanchenjunga basecamp (BC) located at 5,100 m, where they remained for 7 +/- 5 days. Subjects were examined at rest and during a maximal exercise test at sea-level before/after the expedition (SL1/SL2) and during the BC sojourn. There was a mild increase in Lake Louise AMS score from 1.1 +/- 1.2 points at SL1 to 2.3 +/- 2.3 points by the end of the first day at BC (P < 0.05). A marked increase in resting plasma CCK was observed on the morning of the second day at BC relative to sea-level control values (62.9 +/- 42.2 pmol/L(-1) vs. SL1: 4.3 +/- 8.3 pmol/L(-1), P < 0.05 vs. SL2: 26.5 +/- 25.2 pmol/L(-1), P < 0.05). Maximal exercise increased CCK by 78.5 +/- 24.8 pmol/L(-1), (P < 0.05 vs. resting value) during the SL1 test and increased the plasma concentration of non-esterified fatty acids and glycerol at BC (P < 0.05 vs. SL1/SL2). The CCK response was not different in five subjects who presented with anorexia on Day 2 compared with those with a normal appetite. While there was no relationship between the increase in CCK and AMS score at BC, a more pronounced increase in resting CCK was observed in subjects with AMS (> or =3 points at the end of Day 1 at BC) compared with those without (+98.9 +/- 1.4 pmol/L(-1) vs. +67.6 +/- 37.2 pmol/L(-1), P < 0.05). Caloric intake remained remarkably low during the stay at BC (8.9 +/- 1.4 MJ.d(-1)) despite a progressive decrease in total body mass (-4.5 +/- 2.1 kg after 31 +/- 13 h at BC, P < 0.05 vs. SL1/SL2), which appeared to be due to a selective loss of torso adipose tissue. These findings suggest that the satiogenic effects of CCK may have contributed to the observed caloric deficit and subsequent cachexia at high altitude despite adequate availability of palatable foods. The metabolic implications of elevated CCK in AMS remain to be elucidated.

Moderate hypothermia ameliorates liver energy failure after intestinal ischaemia-reperfusion in anaesthetised rats

BACKGROUND/PURPOSE

Intestinal ischaemia-reperfusion (IR) can cause liver failure. The aims of this work were to study the effects of intestinal IR on liver energy metabolism and to evaluate the effects of moderate hypothermia.

METHODS

Intestinal IR (90-minute intestinal ischaemia plus 60-minute or 240-minute reperfusion) was achieved by clamping and unclamping the superior mesenteric artery in rats. Normothermia or moderate hypothermia (30 degrees to 33 degrees C) was maintained by adjusting the environmental temperature. The ratio of hepatic inorganic phosphate to adenosine triphosphate (ATP) was monitored continuously during intestinal IR using in vivo phosphorus ((31)P) magnetic resonance spectroscopy. Phosphorus metabolites also were measured in extracts prepared from freeze-clamped liver and intestine.

RESULTS

Mortality occurred exclusively during normothermic intestinal IR. A progressive increase in the hepatic inorganic phosphate to ATP ratio after normothermic intestinal IR was observed. Moderate hypothermia delayed this effect. Analysis of liver extracts confirmed above findings. However, there was no difference in intestinal phosphocreatine or ATP between normothermic and hypothermic rats undergoing intestinal IR.

CONCLUSIONS

Intestinal IR at normothermia was associated with liver energy failure and high mortality rate. Moderate hypothermia ameliorated liver energy failure but did not attenuate intestinal energy failure after intestinal IR. Hypothermia may prove to be useful in the management of patients with intestinal IR injuries in the future.

Cerebrovascular reactivity following focal brain ischemia in the rat: a functional magnetic resonance imaging study

An essential goal of stroke research is to identify potentially salvageable regions of brain that may respond to therapy. However, current imaging methods are inadequate for this purpose. We therefore used dynamic magnetic resonance imaging of vascular reactivity following focal occlusion in the rat to determine whether measurement of perfusion reserve would help resolve this problem. We used the increase in blood-oxygen-level-dependent (BOLD) signal that occurs in normal brain following a CO2 challenge, to map vascular reactivity over the brain at 30-min intervals for 3.5 h after complete (CO) or partial (PO) focal ischemia. We assessed the regional correspondence between reactivity changes and areas of lowered apparent diffusion coefficient (ADC) and initial perfusion deficit. The area of lowered ADC was significantly smaller in the PO group compared to the CO group despite similar areas of perfusion deficit (P < 0.05). We identified four distinct areas within hypoperfused brain: a core area with low/absent reactivity and low ADC; borderzone areas with normal reactivity and either reduced ADC (CO group) or normal ADC (PO group); and an area with normal ADC and reduced/absent reactivity. In all ischemic regions, the BOLD peak arrival time in the brain was delayed or absent. There was a negative correlation between BOLD peak latency time and ADC (r = -0.42, P < 0.001), although latency alone did not differentiate individual ischemic regions. In conclusion, combining perfusion, ADC, and vascular reactivity mapping of the ischemic brain enables improved discrimination of core and borderzone regions.

Backpropagation of physiological spike trains in neocortical pyramidal neurons: implications for temporal coding in dendrites

In vivo neocortical neurons fire apparently random trains of action potentials in response to sensory stimuli. Does this randomness represent a signal or noise around a mean firing rate? Here we use the timing of action potential trains recorded in vivo to explore the dendritic consequences of physiological patterns of action potential firing in neocortical pyramidal neurons in vitro. We find that action potentials evoked by physiological patterns of firing backpropagate threefold to fourfold more effectively into the distal apical dendrites (>600 microm from the soma) than action potential trains reflecting their mean firing rate. This amplification of backpropagation was maximal during high-frequency components of physiological spike trains (80-300 Hz). The disparity between backpropagation during physiological and mean firing patterns was dramatically reduced by dendritic hyperpolarization. Consistent with this voltage dependence, dendritic depolarization amplified single action potentials by fourfold to sevenfold, with a spatial profile strikingly similar to the amplification of physiological spike trains. Local blockade of distal dendritic sodium channels substantially reduced amplification of physiological spike trains, but did not significantly alter action potential trains reflecting their mean firing rate. Dendritic electrogenesis during physiological spike trains was also reduced by the blockade of calcium channels. We conclude that amplification of backpropagating action potentials during physiological spike trains is mediated by frequency-dependent supralinear temporal summation, generated by the recruitment of distal dendritic sodium and calcium channels. Together these data indicate that the temporal nature of physiological patterns of action potential firing contains a signal that is transmitted effectively throughout the dendritic tree.

Burst excitation for quantitative diffusion imaging with multiple b-values

A quantitative imaging sequence has been developed to exploit the intrinsic sensitivity of Burst NMR data to molecular diffusion. In the scan time of a single spin echo experiment, it is possible to acquire many images of the same slice, with a different T(2) and diffusion weighting. Under favorable conditions, it is possible to obtain both the diffusion coefficient and T(2) from the same experiment; or, by correcting for T(2) relaxation using a control image, more precise diffusion coefficients may be measured. The quantitative values in rat brain are in agreement with those from conventional experiments. The major gains of this method are the potentially reduced scan time, the higher number of acquired images corresponding to different diffusion weightings, the reduced sensitivity to inter-scan motion artifact and to local variations in magnetic susceptibility, and an automatic co-registration between T(2) and diffusion images. Problems with the sequence include a lower signal-to-noise ratio than is achievable with diffusion-weighted spin-echo imaging, the limitation of measuring only in-plane components of diffusion and, at present, single-slice acquisition.

Acute changes in MRI diffusion, perfusion, T(1), and T(2) in a rat model of oligemia produced by partial occlusion of the middle cerebral artery

Oligemic regions, in which the cerebral blood flow is reduced without impaired energy metabolism, have the potential to evolve toward infarction and remain a target for therapy. The aim of this study was to investigate this oligemic region using various MRI parameters in a rat model of focal oligemia. This model has been designed specifically for remote-controlled occlusion from outside an MRI scanner. Wistar rats underwent remote partial MCAO using an undersize 0.2 mm nylon monofilament with a bullet-shaped tip. Cerebral blood flow (CBF(ASL)), using an arterial spin labeling technique, the apparent diffusion coefficient of water (ADC), and the relaxation times T(1) and T(2) were acquired using an 8.5 T vertical magnet. Following occlusion there was a decrease in CBF(ASL) to 35 +/- 5% of baseline throughout the middle cerebral artery territory. During the entire period of the study there were no observed changes in the ADC. On occlusion, T(2) rapidly decreased in both cortex and basal ganglia and then normalized to the preocclusion values. T(1) values rapidly increased (within approximately 7 min) on occlusion. In conclusion, this study demonstrates the feasibility of partially occluding the middle cerebral artery to produce a large area of oligemia within the MRI scanner. In this region of oligemic flow we detect a rapid increase in T(1) and decrease in T(2). These changes occur before the onset of vasogenic edema. We attribute the acute change in T(2) to increased amounts of deoxyhemoglobin; the mechanisms underlying the change in T(1) require further investigation.

Apparent diffusion coefficient and MR relaxation during osmotic manipulation in isolated turtle cerebellum

The apparent diffusion coefficient (ADC) and relaxation times of water were measured by magnetic resonance imaging (MRI) in the isolated turtle cerebellum during osmotic cell volume manipulation. The aim was to study effects of cell volume changes, a factor in ischemia and spreading depression, in isolation from considerations of blood flow and metabolism. Cerebella were superfused at 12-14 degrees C with solutions ranging from 50-200% normal osmolarity. Hypotonic solutions, which are known to cause cell swelling, led to reductions of ADC and increases of T(2), while hypertonic solutions had the opposite effect. This supports the concept that ADC varies with the extracellular space fraction and, combined with published data on extracellular ion diffusion, is consistent with fast or slow exchange models with effective diffusion coefficients that are approximately 1.7 times lower in intracellular than in extracellular space. Spin-spin relaxation can be affected by osmotic disturbance, though such changes are not seen in all pathologies that cause cell swelling.

Time course and magnitude of movement-related gating of tactile detection in humans. II. Effects of stimulus intensity

This study examined the effect of systematically varying stimulus intensity on the time course and magnitude of movement-related gating of tactile detection and scaling in 17 human subjects trained to perform a rapid abduction of the right index finger (D2) in response to a visual cue. Electrical stimulation was delivered to D2 at five different intensities. At the lowest intensity, approximately 90% of stimuli were detected at rest (1 x P(90)); four multiples of this intensity were also tested (1.25, 1.5, 1.75, and 2. 0 x P(90)). At all intensities of stimulation, detection of stimuli applied to the moving digit was diminished significantly and in a time-dependent manner, with peak decreases occurring within +/-12 ms of the onset of electromyographic activity in the first dorsal interosseous (25-45 ms before movement onset). Reductions in the proportion of stimuli detected were greatest at the lowest stimulus intensity and progressively smaller at higher intensities. No shift in the timing of the decreases in performance was seen with increasing intensity. Once the weakest intensity at which most stimuli were perceived during movement had been established (2 x P(90)), magnitude estimation experiments were performed using two stimulus intensities, 2 x P(90) (5 subjects) and 3 x P(90) (3 subjects). Significant movement-related decreases in estimated stimulus magnitude were observed at both intensities, the time course of which was similar to the time course of reductions in detection performance. As stimulus intensity increased, the magnitude of the movement-related decrease in scaling diminished. A model of detection performance that accurately described the effect of stimulus intensity and timing on movement-related reductions in detection was created. This model was then combined with a previous model that described the effects of stimulus localization and timing to predict detection performance at a given stimulation site, intensity, and time during movement. Movement-related gating of tactile perception represents the end result of movement-related effects on the transmission and subsequent processing of the stimulus. The combined model clearly defines many of the requirements that proposed physiological mechanisms of movement-related gating will have to fulfill.

Falsely elevated digoxin level of 45.9 ng/mL due to interference from human antimouse antibody

CASE REPORT

We report the case of a 77-year-old man who was admitted to the intensive care unit with a serum digoxin level of 45.9 ng/mL. The patient was hemodynamically stable throughout his hospital course and did not require antidigoxin antibody fragments. The elevated digoxin level was determined by subsequent testing to be falsely elevated by interference from human antimouse antibodies in his serum. A repeat digoxin measurement using an assay not affected by human antimouse antibodies indicated a level of 1.3 ng/mL. Newer digoxin assays are not affected by human antimouse antibody interference, but clinicians should be aware of possible human antimouse antibody interference with older digoxin assays and in other tests utilizing mouse monoclonal antibody reagents.

Gene expression analysis by massively parallel signature sequencing (MPSS) on microbead arrays

We describe a novel sequencing approach that combines non-gel-based signature sequencing with in vitro cloning of millions of templates on separate 5 microm diameter microbeads. After constructing a microbead library of DNA templates by in vitro cloning, we assembled a planar array of a million template-containing microbeads in a flow cell at a density greater than 3x10(6) microbeads/cm2. Sequences of the free ends of the cloned templates on each microbead were then simultaneously analyzed using a fluorescence-based signature sequencing method that does not require DNA fragment separation. Signature sequences of 16-20 bases were obtained by repeated cycles of enzymatic cleavage with a type IIs restriction endonuclease, adaptor ligation, and sequence interrogation by encoded hybridization probes. The approach was validated by sequencing over 269,000 signatures from two cDNA libraries constructed from a fully sequenced strain of Saccharomyces cerevisiae, and by measuring gene expression levels in the human cell line THP-1. The approach provides an unprecedented depth of analysis permitting application of powerful statistical techniques for discovery of functional relationships among genes, whether known or unknown beforehand, or whether expressed at high or very low levels.

Intestinal metabolism after ischemia-reperfusion

PURPOSE

This study explores the effects of ischemia-reperfusion on various metabolic aspects of the small intestine.

METHODS

Intestinal ischemia-reperfusion was obtained by clamping and unclamping the superior mesenteric artery in adult rats. Four groups of animals were studied: (A) sham operation for 150 minutes, (B) 90-minute intestinal ischemia, (C) 150-minute intestinal ischemia, and (D) 90-minute intestinal ischemia followed by 60-minute reperfusion. Body temperature was maintained at normothermia (36.5 to 37.5 degrees C). Concentrations of intestinal glucose, succinate, lactate, amino acids, phosphocholine (PC), glycerophosphocholine (GPC), choline, and phosphoenergetics were measured using magnetic resonance spectroscopy of freeze-clamped small intestine extracts.

RESULTS

Intestinal ischemia (groups B and C) alone caused a significant drop in glucose and phosphoenergetics but caused an increase in amino acids, succinate, and lactate. Ischemia and ischemia-reperfusion decreased PC and GPC but increased choline. After intestinal reperfusion (group D), no recovery of phosphoenergetics was observed, but there was partial recovery of glucose, succinate, lactate, and amino acids.

CONCLUSIONS

There is no recovery of phosphoenergetics after 90 minutes of intestinal ischemia followed by 60 minutes of reperfusion. Partial recovery of glucose, succinate, lactate, and amino acids may reflect equilibration of these metabolites between damaged cells and extracellular fluid.

Site independence of EPSP time course is mediated by dendritic I(h) in neocortical pyramidal neurons

Neocortical layer 5 pyramidal neurons possess long apical dendrites that receive a significant portion of the neurons excitatory synaptic input. Passive neuronal models indicate that the time course of excitatory postsynaptic potentials (EPSPs) generated in the apical dendrite will be prolonged as they propagate toward the soma. EPSP propagation may, however, be influenced by the recruitment of dendritic voltage-activated channels. Here we investigate the properties and distribution of I(h) channels in the axon, soma, and apical dendrites of neocortical layer 5 pyramidal neurons, and their effect on EPSP time course. We find a linear increase (9 pA/100 microm) in the density of dendritic I(h) channels with distance from soma. This nonuniform distribution of I(h) channels generates site independence of EPSP time course, such that the half-width at the soma of distally generated EPSPs (up to 435 microm from soma) was similar to somatically generated EPSPs. As a corollary, a normalization of temporal summation of EPSPs was observed. The site independence of somatic EPSP time course was found to collapse after pharmacological blockade of I(h) channels, revealing pronounced temporal summation of distally generated EPSPs, which could be further enhanced by TTX-sensitive sodium channels. These data indicate that an increasing density of apical dendritic I(h) channels mitigates the influence of cable filtering on somatic EPSP time course and temporal summation in neocortical layer 5 pyramidal neurons.

Anterior electroencephalographic asymmetry changes in elderly women in response to a pleasant and an unpleasant odor

Greater left than right frontal EEG activation has been associated with increased positive and/or decreased negative affect, whereas greater right than left frontal activation has been associated with the opposite pattern. Substantial research has documented the trait properties of asymmetry, as well as responses to pleasant and unpleasant stimuli. The present study examined changes in anterior alpha asymmetries in response to pleasant (vanilla), unpleasant (valerian), and neutral (water) odors. As predicted, vanilla produced relative left frontal activation compared to valerian and water. Frontal asymmetry did not differ in response to valerian compared to water. The results are consistent with the hypothesis that the left frontal region of the brain is involved in positive/approach-related emotion, and extend previous results into the olfactory realm.

Hypercarbia and mild hypothermia, only when not combined, improve postischemic bioenergetic recovery in neonatal rat brain slices

In the immature brain, postischemic metabolism may be influenced beneficially by the effect of inducing hypercarbia or hypothermia. With use of 31P nuclear magnetic resonance spectroscopy, intracellular pH (pHi) and cellular energy metabolites in ex vivo neonatal rat cerebral cortex were measured before, during, and after substrate and oxygen deprivation in in vitro ischemia. Early postischemic hypothermia (fall in temperature -3.2 +/- 1.0 degrees C) delayed the normalization of pHi after ischemia by inducing an acid shift in pHi (P < 0.01). Postischemic hypercarbia (Krebs-Henseleit bicarbonate buffer equilibrated with 10% carbon dioxide in oxygen) and hypothermia induced separate, but potentially additive, reversible decreases in pHi, each of approximately -0.16 pH unit (P < 0.05). When these postischemic perturbations were applied in isolation, there was significant improvement of approximately 20% in the recovery of beta-ATP (P < 0.05). In combination, however, hypercarbia and hypothermia worsened recovery in ATP by approximately 20% (P < 0.05). In control tissue, which had not been exposed to ischemia, ATP content was also significantly reduced by co-administration of the two treatments (P < 0.05), an effect that persisted even after discontinuing the perturbing conditions. Therefore, in this vascular-independent neonatal preparation, early postischemic modulation of metabolism by hypercarbia or hypothermia appears to confer improved bioenergetic recovery, but only if they are not administered together.

Prospective evaluation of mild to moderate pediatric acetaminophen exposures

STUDY OBJECTIVE

To determine whether pediatric patients with acute, mild to moderate acetaminophen exposures, treated with home monitoring alone, develop systemic signs of hepatic injury.

METHODS

A prospective, observational study of calls to a regional poison center over a 25-month period was performed. Patients were eligible for the study if they were younger than 7 years and had an acute maximum possible acetaminophen exposure of up to 200 mg/kg. Exclusion criteria included previous decontamination measures, possibility of ingestion of an extended-release preparation, health or medication issues that could increase susceptibility to hepatotoxicity, current symptoms of hepatotoxicity, and indeterminable ingestions. Study protocol included reviewing the signs and symptoms of early and late acetaminophen toxicity, a 4- to 6-hour follow-up call, and a 72-hour follow-up call. Outcome measures were defined as a verbal report by the patient's parent or guardian of the presence or absence of signs or symptoms of hepatotoxicity.

RESULTS

A total of 1,039 patients were enrolled in the study, including 519 girls and 520 boys, with exposures ranging from 20 to 200 mg/kg. Eighteen patients were lost to follow-up; data were incomplete for 2 patients. At 72-hour follow-up, the remaining 1,019 patients were all doing well, without signs or symptoms of hepatotoxicity.

CONCLUSION

On the basis of these data, pediatric patients with acute acetaminophen exposures of up to 200 mg/kg, treated with home monitoring alone, do not develop signs or symptoms of hepatic injury.

Action potential backpropagation and somato-dendritic distribution of ion channels in thalamocortical neurons

Thalamocortical (TC) neurons of the dorsal thalamus integrate sensory inputs in an attentionally relevant manner during wakefulness and exhibit complex network-driven and intrinsic oscillatory activity during sleep. Despite these complex intrinsic and network functions, little is known about the dendritic distribution of ion channels in TC neurons or the role such channel distributions may play in synaptic integration. Here we demonstrate with simultaneous somatic and dendritic recordings from TC neurons in brain slices that action potentials evoked by sensory or cortical excitatory postsynaptic potentials are initiated near the soma and backpropagate into the dendrites of TC neurons. Cell-attached recordings demonstrated that TC neuron dendrites contain a nonuniform distribution of sodium but a roughly uniform density of potassium channels across the somatodendritic area examined that corresponds to approximately half the average path length of TC neuron dendrites. Dendritic action potential backpropagation was found to be active, but compromised by dendritic branching, such that action potentials may fail to invade relatively distal dendrites. We have also observed that calcium channels are nonuniformly distributed in the dendrites of TC neurons. Low-threshold calcium channels were found to be concentrated at proximal dendritic locations, sites known to receive excitatory synaptic connections from primary afferents, suggesting that they play a key role in the amplification of sensory inputs to TC neurons.

In vitro cloning of complex mixtures of DNA on microbeads: physical separation of differentially expressed cDNAs

We describe a method for cloning nucleic acid molecules onto the surfaces of 5-micrometer microbeads rather than in biological hosts. A unique tag sequence is attached to each molecule, and the tagged library is amplified. Unique tagging of the molecules is achieved by sampling a small fraction (1%) of a very large repertoire of tag sequences. The resulting library is hybridized to microbeads that each carry approximately 10(6) strands complementary to one of the tags. About 10(5) copies of each molecule are collected on each microbead. Because such clones are segregated on microbeads, they can be operated on simultaneously and then assayed separately. To demonstrate the utility of this approach, we show how to label and extract microbeads bearing clones differentially expressed between two libraries by using a fluorescence-activated cell sorter (FACS). Because no prior information about the cloned molecules is required, this process is obviously useful where sequence databases are incomplete or nonexistent. More importantly, the process also permits the isolation of clones that are expressed only in given tissues or that are differentially expressed between normal and diseased states. Such clones then may be spotted on much more cost-effective, tissue- or disease-directed, low-density planar microarrays.

The relationship between the apparent diffusion coefficient measured by magnetic resonance imaging, anoxic depolarization, and glutamate efflux during experimental cerebral ischemia

A reduction in the apparent diffusion coefficient (ADC) of water measured by magnetic resonance imaging (MRI) has been shown to occur early after cerebrovascular occlusion. This change may be a useful indicator of brain tissue adversely affected by inadequate blood supply. The objective of this study was to test the hypothesis that loss of membrane ion homeostasis and depolarization can occur simultaneously with the drop in ADC. Also investigated was whether elevation of extracellular glutamate ([GLU]e) would occur before ADC changes. High-speed MRI of the trace of the diffusion tensor (15-second time resolution) was combined with simultaneous recording of the extracellular direct current (DC) potential and on-line [GLU]e from the striatum of the anesthetized rat. After a control period, data were acquired during remote middle cerebral artery occlusion for 60 minutes, followed by 30 minutes of reperfusion, and cardiac arrest-induced global ischemia. After either focal or global ischemia, the ADC was reduced by 10 to 25% before anoxic depolarization occurred. After either insult, the time for half the maximum change in ADC was significantly shorter than the corresponding DC potential parameter (P < 0.05). The [GLU]e remained at low levels during the entire period of varying ADC and DC potential and did not peak until much later after either ischemic insult. This study demonstrates that ADC changes can occur before membrane depolarization and that high [GLU]e has no involvement in the early rapid ADC decrease.

Mechanisms and consequences of action potential burst firing in rat neocortical pyramidal neurons

1. Electrophysiological recordings and pharmacological manipulations were used to investigate the mechanisms underlying the generation of action potential burst firing and its postsynaptic consequences in visually identified rat layer 5 pyramidal neurons in vitro. 2. Based upon repetitive firing properties and subthreshold membrane characteristics, layer 5 pyramidal neurons were separated into three classes: regular firing and weak and strong intrinsically burst firing. 3. High frequency (330 +/- 10 Hz) action potential burst firing was abolished or greatly weakened by the removal of Ca2+ (n = 5) from, or by the addition of the Ca2+ channel antagonist Ni2+ (250-500 microm; n = 8) to, the perfusion medium. 4. The blockade of apical dendritic sodium channels by the local dendritic application of TTX (100 nM; n = 5) abolished or greatly weakened action potential burst firing, as did the local apical dendritic application of Ni2+ (1 mM; n = 5). 5. Apical dendritic depolarisation resulted in low frequency (157 +/- 26 Hz; n = 6) action potential burst firing in regular firing neurons, as classified by somatic current injection. The intensity of action potential burst discharges in intrinsically burst firing neurons was facilitated by dendritic depolarisation (n = 11). 6. Action potential amplitude decreased throughout a burst when recorded somatically, suggesting that later action potentials may fail to propagate axonally. Axonal recordings demonstrated that each action potential in a burst is axonally initiated and that no decrement in action potential amplitude is apparent in the axon > 30 microm from the soma. 7. Paired recordings (n = 16) from synaptically coupled neurons indicated that each action potential in a burst could cause transmitter release. EPSPs or EPSCs evoked by a presynaptic burst of action potentials showed use-dependent synaptic depression. 8. A postsynaptic, TTX-sensitive voltage-dependent amplification process ensured that later EPSPs in a burst were amplified when generated from membrane potentials positive to -60 mV, providing a postsynaptic mechanism that counteracts use-dependent depression at synapses between layer 5 pyramidal neurons.

Comparison of the toxicities of two iron formulations in a swine model

OBJECTIVE

To describe the histopathologic and pharmacokinetic differences of acute iron poisoning between chewable multivitamins with iron and solid iron tablets in a swine model.

METHODS

This was a prospective, randomized, unblinded toxicity study of iron poisoning of two iron formulations in male Yorkshire pigs. Eight swine were randomized to receive 60 mg/kg of iron in either solid iron tablets or chewable multivitamins with iron. Serum iron, arterial blood gases, and episodes of vomiting were recorded over a ten-hour period. Routine histologic evaluations of the esophagus, stomach, small intestine, large intestine, and liver were performed immediately after the study period. Pharmacokinetic analyses of area under the concentration-time curve (AUC), time to peak concentration, and peak serum iron concentration were performed.

RESULTS

There was no significant difference between the serum iron levels except at three and four hours. There was a significant higher AUC in the chewable group compared with the solid group. Pathologic evaluation identified severe esophageal inflammation and focal erosion in the solid iron tablet group in two of the four animals, compared with no focal erosions and minimal esophageal inflammation in the chewable group. No significant change was identified in the liver, small intestine, or large intestine in either group.

CONCLUSIONS

These results demonstrate increased local gastrointestinal toxicity following a large ingestion of solid iron tablets in a swine model, compared with chewable multivitamins with iron. Higher serum iron levels were identified in the animals that received chewable multivitamins with iron.

The availability of activated charcoal and ipecac for home use

Traditionally, ipecac has been used in the home; however, recently attention has focused on pre-hospital activated charcoal (AC) administration. In an effort to assess the availability of AC and ipecac, we conducted a telephone survey. One-hundred and 18 pharmacies were randomly selected from the 59 counties in California to assess availability of AC (liquid or powder) and/or ipecac. Ninety-four (80%) pharmacies participated. Seventy-nine of the pharmacies had ipecac compared to 8 which had AC. Three pharmacies had pre-mixed aqueous AC while 5 had AC in powder formulation. There was no difference between chains and community in AC or ipecac availability. The major limitations of effective GI decontamination are AC availability and rapidity in its administration. Our results identify a significant delay in the administration of AC if a parent was referred to a local pharmacy for home or pre-hospital decontamination. As more toxicologists and poison centers move towards pre-hospital and home AC much education of pharmacists as well as pediatricians and parents is required.

Molecular aspects of blood pressure regulation

After 100 years of measurement, reasons for interindividual and populational variation in blood pressure have proven difficult to identify. Use of 24-hr blood pressure monitoring has revealed additional intra-individual variation. Variability in kidney function, extracellular sodium and potassium (Na:K) balance, and factors affecting water, sodium, and potassium resorption obviously affect blood pressure. Alterations in these and additional factors predict development of hypertension. In recent decades the molecular revolution has increased scrutiny of genetic factors contributing to interindividual and populational differences in blood pressure and hypertension. Most investigations across populations and environments have focused on components of the renin-angiotensin-aldosterone system. DNA polymorphisms within this system clearly are associated with blood pressure and hypertension; however, these associations tend to vary across race and ethnicity, ecological settings, and sex. There is clear evidence that polymorphisms at the renin, angiotensinogen, and angiotensin-converting enzyme loci influence both blood pressure and hypertension. In addition, evidence suggests gene-gene and gene-environment interactions along with sex-specific actions of these loci on blood pressure.