Processing/activation of caspases, -3 and -7 and -8 but not caspase-2, in the induction of apoptosis in B-chronic lymphocytic leukemia cells

Chlorambucil and prednisolone, two commonly used drugs in the treatment of chronic lymphocytic leukemia (CLL), induce apoptosis in CLL cells. We have investigated the involvement in this apoptotic cell death of caspases, which cleave critical cellular substrates thereby acting as the executioners of the apoptotic process. Induction of spontaneous or chlorambucil/prednisolone-induced apoptosis of freshly isolated B-CLL cells in culture resulted in the activation of the 'effector' caspases, -3 and -7, but generally not of caspase-2. Activation of caspases-3 and -7 was accompanied by the proteolysis of the DNA repair enzyme, poly (ADP-ribose) polymerase. Induction of apoptosis was also accompanied by the processing of caspase-8, the extent of which varied between patients. Induction of apoptosis and processing of all the caspases was inhibited by the cell permeable caspase inhibitor, benzyloxycarbonyl-Val-Ala-Asp (OMe) fluoromethyl ketone (Z-VAD.fmk). Our results demonstrate a key role for the activation and processing of caspases in the execution phase of apoptosis in CLL cells. Apoptosis of CLL cells resulted in the selective activation of some but not all caspases. Our results suggest that the dysregulation of apoptosis observed in CLL may be due to the signalling leading to the activation of caspases rather than a deletion of pro-caspases. High levels of caspase-8 in CLL cells in conjunction with low levels of CD95 receptor may offer new therapeutic opportunities for the treatment of CLL.

Shingles: a review of diagnosis and management

Herpes zoster or shingles results from reactivation of varicella zoster virus previously dormant in cells of the dorsal root ganglion. The incidence of shingles increases with age and immunosuppression. Guidelines for managing shingles are now available and implementation, with the emphasis on early treatment, may reduce the severity of a shingles attack and reduce the incidence of complications.

The natural history of untreated lower urinary tract symptoms in middle-aged and elderly men over a period of five years

OBJECTIVES

To describe changes in untreated lower urinary tract symptoms (LUTS), levels of bothersomeness and interference in selected living activities arising from LUTS in a cohort of men followed up for a period of 5 years.

METHODS

1,994 men aged 40-79 years registered in four health centres in Scotland completed a urinary symptom questionnaire in the community. 1,177 (71% of original eligible participants) were followed up at 5 years.

RESULTS

The mean level of LUTS and the level of bothersomeness they caused increased universally between baseline and 5 years. The largest increases in mean symptom levels occurred for straining, hesitancy, incomplete emptying, weak stream and nocturia, and for mean levels of bothersomeness, i.e. dribbling, incomplete emptying, weak stream, frequency, nocturia and intermittency. The increase in mean interference level in selected living activities arising from LUTS was less marked. The progression of LUTS over time in individual men was very variable; however, the overall trend was one of continuing deterioration.

CONCLUSION

If left untreated, overall levels of middle-aged and elderly mens' LUTS, bothersomeness and interference in selected activities caused by these symptoms will increase over time.

Depletion of dopamine in the prefrontal cortex decreases the basal electrophysiological activity of mesolimbic dopamine neurons

One hypothesis regarding the etiology of schizophrenia proposes that disruption of the dopaminergic innervation of the prefrontal cortex leads to an increase in dopamine (DA) transmission in subcortical regions. In the present study, we examined the effect of 6-hydroxydopamine lesions of the medial prefrontal cortex (mPFC) dopamine innervation on the spontaneous electrophysiological activity of ventral tegmental DA neurons recorded in vivo. DA cell activity was assessed along three dimensions: (1) the relative proportion of DA neurons exhibiting spontaneous activity, (2) their basal firing rate, and (3) the mean percentage of spikes fired in bursts. In lesioned rats, DA neurons in the ventral tegmental area (VTA) exhibited a significantly slower mean firing rate, as well as a significant reduction in the percentage of spikes fired in bursts relative to controls. In contrast, depletion of DA in the mPFC did not have a significant effect on the relative proportion of VTA DA neurons exhibiting spontaneous activity. We suggest that by reducing the basal electrophysiological activity of VTA DA neurons, mPFC DA depletion may lead to an increase in the level of responsivity of the system to excitatory stimuli. Thus, the magnitude of increase in action potential-dependent DA release that occurs in response to a challenge may be augmented in lesioned rats.

Cardiopulmonary resuscitation training: where are we now?

The aim of this study was to assess the current situation with regard to cardiopulmonary resuscitation training and organisation 10 years after guidelines were published by the Royal College of Physicians. Questionnaires were sent to 100 UK hospital trusts (88 responses) and 200 general practitioners on Wirral, Merseyside (92 responses). Most trusts gave their staff annual training in CPR, but only 80% trained all staff who came into contact with patients. Not all trusts employed resuscitation training officers, carried out routine audit or had formal CPR policies. The majority of GPs had had no training in CPR for more than five years. Only one practice had a defibrillator, yet 14% had needed to carry out CPR in the past 12 months. Less than half the GPs ever discussed CPR with appropriate patients. The resuscitation service in this country is fragmented, and certain areas--particularly in the training of GPs--need attention.

Using the SARs to add policy value to household projections

"Household projections are at the centre of the debate about future housing requirements in England. The Census of Population Sample of Anonymised Records offers actual and potential opportunities to ¿add value' to traditional projections. This article gives examples of such added value, including testing definitional sensitivity of projection outcomes, assisting further detailed disaggregation of projected components, assisting the matching of household projections to dwelling supply, and offering scope to explore via data linkage the relationships between household projections and ¿backlog' housing needs, affordability, dwelling size, and tenure."

Functional MRI lateralization of memory in temporal lobe epilepsy

OBJECTIVE

To determine the feasibility of using functional magnetic resonance imaging (fMRI) to detect asymmetries in the lateralization of memory activation in patients with temporal lobe epilepsy (TLE).

BACKGROUND

Assessment of mesial temporal lobe function is a critical aspect of the preoperative evaluation for epilepsy surgery, both for predicting postoperative memory deficits and for seizure lateralization. fMRI offers several potential advantages over the current gold standard, intracarotid amobarbital testing (IAT). fMRI has already been successfully applied to language lateralization in TLE.

METHODS

fMRI was carried out in eight normal subjects and 10 consecutively recruited patients with TLE undergoing preoperative evaluation for epilepsy surgery. A complex visual scene encoding task known to activate mesial temporal structures was used during fMRI. Asymmetry ratios for mesial temporal activation were calculated, using regions of interest defined in normals. Patient findings were compared with the results of IAT performed as part of routine clinical evaluation.

RESULTS

Task activation was nearly symmetric in normal subjects, whereas in patients with TLE, significant asymmetries were observed. In all nine patients in whom the IAT result was interpretable, memory asymmetry by fMRI concurred with the findings of IAT including two patients with paradoxical IAT memory lateralization ipsilateral to seizure focus.

CONCLUSIONS

fMRI can be used to detect asymmetries in memory activation in patients with TLE. Because fMRI studies are noninvasive and provide excellent spatial resolution for functional activation, these preliminary results suggest a promising role for fMRI in improving the preoperative evaluation for epilepsy surgery.

Biogeographic origins of goannas (Varanidae): a molecular perspective

This project aims to clarify the phylogenetic relationships among the extant species of Varanus in order to elucidate the origins of Varanidae, using DNA sequences. Results obtained for a minimum of 662 nucleotides of 12S rRNA sequence data from each of 21 extant species of Varanus indicate that the Australian varanids form a single monophyletic clade and also suggest that within the Australian varanids, members of the subgenus Odatria (pygmy monitors) may from a clade separate from those in the subgenus Varanus (large monitors). The Asian species appear to be sister taxa to the Australian species, while the two African species investigated were most divergent, suggesting that the Varanidae are not Gondwanic in origin. Hypothesis testing analyses were performed and involved constraining the 12S sequence data according to previously described topologies and testing the difference using parametric and nonparametric statistics. The phylogeny generated using 12S sequence data was statistically different from previously described morphological trees, while there was some support for topologies based on chomosomal and immunological datasets. Overall, our results suggest that the Australian species may be derived from an Asian source and are, therefore, in agreement with the hypothesis based on the fossil record suggesting that Varanidae may be Asian in origin.

Asthma diagnosis by spirometry. Sensitive or specific?

Spirometry is the recommended first-line investigation for diagnosing asthma, with greater than 15% improvement in FEV1 considered diagnostic. However, evidence suggests a majority of asthmatics may go undetected at 15%, thus a lower diagnostic value may be preferred.

Vascular compromise and amputation after intramedullary nailing of a tibia fracture

A case is presented of a fifty-three-year-old man with a displaced tibia-fibula fracture that was treated with an intramedullary nail. The morning after surgery pulses were absent and did not improve after fasciotomies. The patient was transferred to our institution, where an arteriogram showed tapering of the anterior tibial and peroneal vessels in the mid-calf and occlusion of the posterior tibial artery at the level of the ankle. Vascular status did not improve after heparinization and arteriogram thrombolysis. The patient ultimately underwent below-the-knee amputation and subsequent revision to above-the-knee amputation.

Characteristics of patients with shingles admitted to a district general hospital

Little is known about why some patients with shingles are admitted to hospital. We reviewed 72 case notes from a list of 80 patients admitted to hospital with shingles over a six-year period. Pain was the main complaint of the patients admitted, most of whom were elderly and lived alone. The commonest site of involvement in hospital admissions was the eye (herpes zoster ophthalmicus). Diagnosis of shingles was made after admission in 12 patients, eight of whom had originally been diagnosed as having an acute medical or surgical condition. We conclude that the prodromal phase of shingles may lead to misdiagnosis.

Quetiapine: results of four phase II and III clinical trials

The data on efficacy and tolerance from four (phase II and III) trials of quetiapine (Seroquel(R) or ICI 204,636) in a total of 1,461 patients with acute exacerbations of chronic or sub-chronic schizophrenia are briefly reviewed. Together, the results of these trials have demonstrated antipsychotic efficacy in comparison with placebo and equivalent efficacy to haloperidol. In spite of its short plasma elimination half-life, quetiapine is equally effective when given in twice-daily and three-time daily doses. The optimum dose is between 300 mg and 400 mg per day, and the main and most consistent adverse effect is sedation. It has a low extrapyramidal side effect liability and does not produce sustained elevations in plasma prolactin levels.

Gender affects renal vasoconstrictor response to Ang I and Ang II

This study tested the hypothesis that gender affects the pressor and renal vasoconstrictor responses to angiotensin (Ang) I and Ang II in salt-replete normotensive subjects. Ang I and Ang II were infused in graded doses into 9 men and 8 women in a randomized, single-blind, crossover study. There were no differences between genders in baseline blood pressure, heart rate, sodium excretion, renal plasma flow, angiotensin-converting enzyme (ACE) genotype, ACE activity, plasma renin activity, aldosterone, or Ang II levels. Although pressor responses to Ang I and Ang II were similar in men and women, there was a negative relationship between the change in mean arterial pressure and the change in heart rate during Ang I and II infusion in women only. The half-time of the pressor response after discontinuation of Ang I but not Ang II infusion was greater in men than in women (9.5+/-2.2 versus 4.3+/-2.1 minutes, P<.05). This difference in duration did not result from gender differences in the metabolism of Ang I because Ang II levels measured during Ang I infusion were identical in men and women. In contrast, the renal vasoconstrictor response to Ang I and Ang II was significantly increased in women compared with that in men (Ang I, -243+/-31 versus -138+/-13 U/1.73 m2; Ang II, -233+/-25 versus -175+/-18 U/1.73 m2; P<.03). These data suggest an effect of gender on baroreflex reactivity during angiotensin infusion. Moreover, in the setting of similar Ang II concentrations, the dramatic difference in the renal vasoconstrictor responses to Ang I and Ang II between salt-replete men and salt-replete women suggests gender differences at a pharmacodynamic level.

Topographic distribution of seizure onset and hippocampal atrophy: relationship between MRI and depth EEG

Medial temporal lobe epilepsy (MTLE) is associated with hippocampal cell loss and organization of the dentate gyrus. Some studies suggest a correlation between the topographic distribution of cell loss and site of epileptogenesis. We studied the relationship between the site of ictal onset with the presence of segmental atrophy in patients with non-lesional MTLE using magnetic resonance imaging (MRI) and depth EEG. Ictal recordings were obtained from 27 patients with longitudinal hippocampal depth electrodes and variable combinations of subdural strips sampling medial temporal structures. The location of the depth electrode contacts was correlated with anatomical landmarks. Seizures were analyzed for the distribution of onset along the long axis of the hippocampus. MRI analysis were performed to detect segmental atrophy. Outcome was assessed 1 year or more following anterior temporal lobectomy. Twenty-five patients had unilateral, and two had bilateral, hippocampal atrophy. One hundred and forty-seven seizures were reviewed: 21 showed focal onset and 126 showed regional onset. Ictal onset involved the amygdala and anterior half of the hippocampus in 80% of the seizures while only 40% of patients had atrophy of these segments. Most patients had excellent outcome. In patients with MTLE the primary area of epileptogenesis does not parallel the hippocampal segments with the greatest degree of volume loss.

Apparent and true metabolizable energy values of feedstuffs for ducks

Two experiments were conducted, each with 24 White Pekin ducks, to determine the AME and TME content of five feedstuffs for ducks. In each experiment, fasting losses were obtained from six ducks and six ducks were used for each feedstuff. Each experiment lasted 102 h with an initial 48-h period and a 54-h excreta collection period. During the first 48-h period, all birds were tube-fed dextrose (30 g/100 mL of water) at 8 and 32 h after feed was withdrawn. Thirty grams of each feedstuff were tube-fed (30 g/100 mL of water) at 48 and 54 h after feed was withdrawn. The birds from which fasting losses were obtained were intubated with 30 g dextrose (30 g/100 mL of water) at 48 and 54 h after feed was withdrawn. Excreta were collected during the last 54 h into bags screwed onto lids sutured around the vent of each bird. In the first experiment, the feedstuffs evaluated were corn, dehulled oats, and wheat. The fasting energy and nitrogen losses per bird in the 54-h collection period were 12.1 kcal and 0.29 g, respectively. The AMEn values for the birds fed corn, dehulled oats, and wheat were 3.10, 3.48, and 3.14 kcal/g, respectively. The TMEn values for the respective feedstuffs were 3.27, 3.64, and 3.30 kcal/g. In the second experiment, the feedstuffs evaluated were corn, parboiled rice, and rye. The fasting energy and nitrogen losses per bird in the 54-h collection period were 18.9 kcal and 1.09 g, respectively. The AMEn values for the birds fed corn, parboiled rice, and rye were 3.24, 3.45, and 2.69 kcal/g, respectively. The TMEn values for the respective feedstuffs were 3.40, 3.61, and 2.85 kcal/g. The data provide new information on AMEn and TMEn values of corn, wheat, parboiled rice, dehulled oats, and rye for ducks.

Loss of dopamine terminals in the medial prefrontal cortex increased the ratio of DOPAC to DA in tissue of the nucleus accumbens shell: role of stress

We examined whether dopamine depletion in the medial prefrontal cortex of the rat differentially affects basal and evoked dopamine and 3,4-dihydroxyphenylacetic acid (DOPAC) content in the subareas of the neostriatum and nucleus accumbens. Loss of approximately 80% of tissue dopamine content in the medial prefrontal cortex did not significantly alter basal tissue concentrations of dopamine or DOPAC or the DOPAC:dopamine ratio in either the nucleus accumbens core or shell or the medial or lateral neostriatum. However, tail pressure stress significantly increased the DOPAC:dopamine ratio in the nucleus accumbens shell of lesioned rats. Because dorsal and ventral areas of the medial prefrontal cortex preferentially innervate the core and shell, respectively, we sought to determine whether the selective effect of lesions on dopamine terminals in the shell of the nucleus accumbens are paralleled by greater dopamine loss in the ventral medial prefrontal cortex. 6-Hydroxydopamine decreased tissue concentrations of dopamine in both the dorsal (-74%) and ventral medial prefrontal cortex (-68%). In lesioned rats, few tyrosine hydroxylase-immunoreactive fibers remained in the dorsal medial prefrontal cortex whereas a dense innervation remained in the ventralmost area. The present data suggest that the influence of mesocortical dopamine neurons on the dopamine projection to the nucleus accumbens shell is expressed only under conditions of stress. Furthermore, lesion-induced alterations in dopamine neurons projecting to the nucleus accumbens shell are not due to a more extensive loss of dopamine terminals in the ventral than in the dorsal medial prefrontal cortex.

Doctors' knowledge of post-splenectomy prophylaxis

A questionnaire was sent to 160 hospital doctors and 200 general practitioners about post-splenectomy prophylaxis during the month of September 1995. A total of 118 questionnaires were returned (43% hospital doctors and 25% GPs). Most doctors (99%) knew that splenectomised patients were at risk of pneumococcal infection; 72% of hospital doctors and 50% of GPs knew of the risk of Haemophilus influenza infection but only 50% of hospital doctors and 33% of GPs knew of the same risks involving meningococcal infection and malaria. Half of the GPs were not aware of H. influenzae type B (Hib) vaccine for prophylaxis and 85% of these and 50% of hospital doctors did not know prophylaxis should be lifelong. There was no significant difference in the knowledge between hospital doctors and GPs.