Development and application of a GFP-FRET intracellular caspase assay for drug screening

Apoptosis is a crucial biological process, and activation of caspase endoproteases is essential for proper regulation and execution of apoptosis. Because caspases also appear to be central players in several pathological states, there is a practical need within the biopharmaceutical research community for facile, noninvasive cellular assays for the discovery of compounds that modulate caspase activity. Tandem molecules of green fluorescent protein (GFP) stably expressed within cells can serve as a genetically encoded sensor of protease activity. Using this technology, we have developed a stable cellular system for the screening of agents that modulate activation of the caspase cascade. This assay technology allows for the real-time monitoring of apoptosis in situ, using conventional fluorescent plate reader detection. By applying this assay system to an actual compound screen, small-molecule inducers of cell apoptosis were reliably identified. Follow-up pharmacology confirmed that the rank-order potency of primary hits using the intracellular GFP assay corresponded to that found using a conventional, cell lysis-based assay method.

Low-cost video-films in the teaching of undergraduate and postgraduate medical students

The high cost of producing good-quality video-films for teaching has hindered the use of this method, which has been shown to improve significantly the efficiency of teaching and the retention of knowledge. During the last five years, a series of short video-films has been produced using inexpensive video-cameras and home video-recording and editing equipment. A variety of techniques were developed to allow recording of lecture presentations, while using the equipment as a teaching aid, without the need for technical staff. The positioning of the camera, the monitor, the slide projector and lighting were critical to the productions. Similar productions at low cost were obtained from recordings of operating theatre sessions, tutorials and clinical ward rounds. A survey of students exposed to teaching with video-film as part of a lecture presentation confirmed that the subject matter being taught was more easily understood and enjoyable and generated more discussions on than other forms of teaching.

An epidemiological study to establish the prevalence of urinary symptoms and felt need in the community: the Leicestershire MRC Incontinence Study. Leicestershire MRC Incontinence Study Team

BACKGROUND

The aim of the study was to establish the prevalence of urinary symptoms and felt need in adults. This paper discusses problems with setting thresholds to distinguish cases from non-cases in this field of research. Few studies have provided detailed age- and sex-specific prevalence estimates for felt need in relation to urinary symptoms.

METHODS

A cross-sectional postal survey was carried out of 15,904 community-dwelling adults aged 40 years or more registered with general practitioners in Leicestershire. Subjects were selected randomly by household from the Leicestershire Health Authority Register. The postal questionnaire consisted of questions on general health, urinary and bowel symptoms, quality of life, service use and demographic characteristics.

RESULTS

Thirty-four per cent of the sample reported clinically significant symptoms. The prevalence and severity of symptoms increased with age. However, only 2 per cent of the sample reported symptoms that were clinically significant, bothersome and socially disabling.

CONCLUSION

Urinary symptoms are very common in adults over 40 years of age living in the community. However, symptom-based estimates probably overestimate the level of need for health care in the community. It may be more effective and efficient to target services, in the first instance, on those people who report clinically significant symptoms that are bothersome or socially disabling. A consensus on thresholds and definitions of urinary symptoms is required to standardize clinical and research work and to target services more appropriately.

Why the high rate of dropout from individualized cognitive-behavior therapy for bulimia nervosa?

OBJECT

To investigate predictors of dropout from cognitive-behavior therapy for bulimia nervosa.

METHOD

Pretreatment assessment measures were examined including the Eating Disorder Inventory-2, Body Satisfaction Questionnaire, Beck Depression Inventory, Beck Hopelessness Scale, the Locus of Control of Behavior Scale, and demographic and behavioral measures.

RESULTS

Forty-three percent (n = 14) of clients with a DSM-IV diagnosis of bulimia nervosa dropped out of treatment prematurely. No differences were found between treatment completers and dropouts with respect to the initial severity of bulimia-related symptoms. Noncompleters were, however, found to have significantly higher depression and hopelessness scores as well as elevated levels of external locus of control. Discriminate analysis showed that these variables resulted in a 90% prediction accuracy of individuals who prematurely dropped out of treatment.

DISCUSSION

Results suggest a need to focus treatment directly on factors such as hopelessness and depression in addition to standard bulimia procedures to ensure clients are able to engage in therapy.

Mental health care reforms in Britain and Italy since 1950: a cross-national comparative study

This paper discusses a cross-national comparative study, which compares the implementation and geographical outcomes of mental health reforms in Britain and Italy since 1950. Working within a cross-national framework, the research adopts a sensitivity to the role of place by exploring the social and spatial restructuring of mental health care service provision in two localities - Sheffield and Verona. By focusing upon the local experiences of mental health care reform, the research strives to gain a clearer understanding of why local geographies of mental health care provision appear to vary across space, both within national boundaries and across them.

A five-base pair deletion in the sedlin gene causes spondyloepiphyseal dysplasia tarda in a six-generation Arkansas kindred

A six-generation kindred from Arkansas with X-linked recessive spondyloepiphyseal dysplasia tarda (SEDT) was investigated by genetic linkage and mutation analysis. SEDT had been mapped on the X-chromosome (Xp22.2), and the clinical and radiographic evolution of this kindred had been published. Linkage analysis proved informative for all five polymorphic markers tested, and DXS987 and DXS16 co-segregated with the Arkansas kindred (peak logarithm of the odds scores, 3.54 and 3.36, respectively). Subsequently, dinucleotide deletion in a new gene designated "sedlin" was reported to cause SEDT in three families. In an affected man and obligate carrier woman in the Arkansas kindred, we found a 5-bp deletion in exon 5 of sedlin. The defect causes a frameshift, resulting in eight missense amino acids and premature termination. The 5-bp deletion was then demonstrated to segregate with SEDT in the four living generations, including eight affected males and nine obligate carrier females. Furthermore, the deletion was identified in four females who potentially were heterozygous carriers for SEDT. The mutation was not detected in the two young sons of the consultand (believed to be a carrier because of her subtle radiographic skeletal changes and then shown to have the deletion), but they were too young for x-ray diagnosis Identification of a defect in sedlin in this SEDT kindred enables carrier detection and presymptomatic diagnosis and reveals an important role for this gene in postnatal endochondral bone formation.

Why are patients prescribed psychotropic drugs by general practitioners? Results of an international study

BACKGROUND

There has been growing interest in factors that might influence the prescription of psychotropic drugs in general practice.

METHOD

This was a multi-centre study using a two-phase stratified sampling strategy in primary care facilities from 14 different countries to determine factors associated with the prescription of psychotropic drugs.

RESULTS

A total of 1763 consecutive GP attenders aged between 16 and 65 years of age were recruited. Although antidepressants were used more for depressive disorders and anxiolytics for patients with anxiety, the differential diagnosis was otherwise not an important factor in prescribing behaviour. Antidepressants and anxiolytics were prescribed twice as frequently in client centred clinics following a 'personal physician model' as opposed to non-client centred settings, where care was less personalized. The reverse was true of hypnotics (adjusted odds ratio of 0.5). General practitioners with a positive view of their undergraduate psychiatric training and who had had further postgraduate experience in the speciality were significantly less likely to prescribe medication, and if they did they were more likely to use antidepressants. Older patients were significantly more likely to be prescribed psychotropic medication. Several other patient factors emerged when individual classes of medication were considered; these included the loss of a spouse and the absence of physical ill health in the case of antidepressants, and female sex, fewer years of schooling and unemployment in the case of anxiolytics.

CONCLUSIONS

Social, health care and GP factors are at least as important as clinical features in the prescription and choice of psychotropic medication.

Post-operative computed tomography in two dogs with cerebral meningioma

Post-operative computed tomography (CT) has been described as a technique for diagnosing incomplete resection or recurrence of cerebral neoplasms in humans. The characteristics of immediate postoperative CT images in dogs with intracranial pathology are unknown. This report describes findings from preoperative, immediate post-operative, and 4 week to 9 month follow-up CT examinations in two dogs with histologically-confirmed cerebral meningiomas. In images of one dog after surgery there was mild contrast enhancement of the tissue surrounding the surgical site. This enhancement had resolved in later images and was probably the result of surgically induced trauma. In post operative images of the other dog there was significant hyperattenuation of the tissues around the surgical site. In post contrast images there was increased enhancement that was evident in later images. These findings, although not supported by necropsy, probably indicate incomplete excision of the tumor.

Annotated checklist of the mosquito species encountered during arboviral studies in Iquitos, Peru (Diptera: Culicidae)

A checklist of the mosquito fauna encountered during arboviral studies in Iquitos, Peru, is presented. A total of 16 genera, 30 subgenera, and 96 species were identified, including 24 species reported from Peru for the 1st time. Notations on the taxonomy and biology for 28 species are also provided.

Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures

PURPOSE

To determine the long-term efficacy of vagus nerve stimulation (VNS) for refractory seizures. VNS is a new treatment for refractory epilepsy. Two short-term double-blind trials have demonstrated its safety and efficacy, and one long-term study in 114 patients has demonstrated a cumulative improvement in efficacy at 1 year. We report the largest prospective long-term study of VNS to date.

METHODS

Patients with six or more complex partial or generalized tonic-clonic seizures enrolled in the pivotal EO5 study were prospectively evaluated for 12 months. The primary outcome variable was the percentage reduction in total seizure frequency at 3 and 12 months after completion of the acute EO5 trial, compared with the preimplantation baseline. Subjects originally randomized to low stimulation (active-control group) were crossed over to therapeutic stimulation settings for the first time. Subjects initially randomized to high settings were maintained on high settings throughout the 12-month study.

RESULTS

The median reduction at 12 months after completion of the initial double-blind study was 45%. At 12 months, 35% of 195 subjects had a >50% reduction in seizures, and 20% of 195 had a >75% reduction in seizures.

CONCLUSIONS

The efficacy of VNS improves during 12 months, and many subjects sustain >75% reductions in seizures.

1-[2-[(Heteroaryloxy)heteroaryl]carbamoyl]indolines: novel and selective 5-HT2C receptor inverse agonists with potential as antidepressant/anxiolytic agents

Bisaryl ethers have been identified with excellent 5-HT2C affinity and selectivity over both 5-HT2A and 5-HT2B receptors. Compounds such as 11, 27 and 38 have potent oral activity in a centrally mediated pharmacodynamic model of 5-HT2C function and their potential as novel non-sedating anxiolytic and antidepressants is under investigation.

1-[2-[(Heteroarylmethoxy)aryl]carbamoyl]indolines are selective and orally active 5-HT2C receptor inverse agonists

Bisarylmethoxyethers have been identified with nanomolar 5-HT2C affinity and selectivity over both 5-HT2A and 5-HT2B receptors. Compounds such as 1, 2, 8, 12, 14 and 18 have potent oral activity in a centrally mediated pharmacodynamic model of 5-HT2C function and their therapeutic potential is currently under further investigation.

Big issues, small systems: managing with information in medical research

This subject of this article is the design of a database system for handling files related to the work of the Molecular Genetics Department of the International Blood Group Reference Laboratory. It examines specialist information needs identified within this organization and it indicates how the design of the Rhesus Information Tracking System was able to meet current needs. Rapid Applications Development prototyping forms the basis of the investigation, linked to interview, questionnaire, and observation techniques in order to establish requirements for interoperability. In particular, the place of this specialist database within the much broader information strategy of the National Blood Service will be examined. This unique situation is analogous to management activities in broader environments and a number of generic issues are highlighted by the research.

Nondeletional T-cell receptor transgenic mice: model for the CD4(+) T-cell repertoire in chronic hepatitis B virus infection

Chronicity after infection with the hepatitis B virus (HBV) can occur for a variety of reasons. However, once established, chronicity may be maintained by high levels of viral proteins circulating in the serum. To examine the characteristics of T cells capable of coexisting with the secreted hepatitis B e antigen (HBeAg), T-cell receptor (TCR) transgenic (Tg) mice were produced. To ensure that HBeAg-specific T cells would not be deleted in the presence of serum HBeAg, the TCR alpha- and beta-chain genes used to produce the TCR-Tg mice were derived from T-cell hybridomas produced from immunizing HBeAg-Tg mice. A TCR-Tg lineage (11/4-12) was produced that possessed a high frequency ( approximately 67%) of CD4(+) T cells that expressed a Tg TCR specific for the HBeAg. As predicted, when 11/4-12 TCR-Tg mice were bred with HBeAg-Tg mice no deletion of the HBeAg-specific CD4(+) T cells occurred in the thymus or the spleen. Functional analysis of the TCR-Tg T cells revealed that the HBeAg-specific CD4(+) T cells escaped deletion in the thymus and periphery by virtue of low avidity. Regardless of their low avidity, HBeAg-specific TCR-Tg T cells could be activated by exogenous HBeAg, as measured by cytokine production in vitro and T-helper-cell function for anti-HBe antibody production in vitro and in vivo. Furthermore, activated TCR-Tg HBeAg-specific T cells polarized to the Th1 subset were able to elicit liver injury when transferred into HBeAg or HBcAg-Tg recipients. Therefore, HBeAg-specific CD4(+) T cells that can survive deletion or anergy in the presence of circulating HBeAg nonetheless are capable of being activated and of mediating liver injury in vivo. The 11/4-12 TCR-Tg lineage may serve as a monoclonal model for the HBe/HBcAg-specific CD4(+) T-cell repertoire present in chronically infected HBV patients.

The feto-placental unit stimulates the pregnancy-associated increase in maternal bone metabolism

The aim of the study was to investigate role of the feto-placental unit in the pregnancy-induced increase in maternal bone metabolism. To achieve this, circulating concentrations of carboxy terminal pro-peptide of type I pro-collagen (PICP, a marker of bone formation) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP, a marker of bone resorption) were measured in three groups of pregnant women. Group 1 comprised 12 women with singleton pregnancies; group 2, nine women with twin pregnancies; and group 3, 19 women with multifetal pregnancies (> or =3 fetuses) before and after selective fetal reduction to twin pregnancies. Blood samples were obtained at 10-12 weeks gestation (groups 1-3, pre-fetal reduction in group 3) and 4 weeks and 8 weeks later (groups 2 and 3). Before fetal reduction there was a significant correlation between the number of fetuses and the concentrations of both PICP and ICTP (r = 0.503 and P = 0.001 and r = 0.573 and P < 0.001 respectively). The circulating concentrations of PICP and ICTP were significantly higher in the pre-reduction multifetal pregnancies than in the twin pregnancies (P < 0.001 and P = 0.0013 respectively). The circulating concentrations of ICTP in multifetal pregnancies fell by 4 weeks after fetal reduction to those observed in control twins. Concentrations of PICP were unaltered after fetal reduction. Higher order multiple pregnancies had the greatest decline in ICTP concentrations. These data suggest that the increased bone turnover observed in the multifetal pregnancies is due to a factor derived from the feto-placental unit and that this factor acts primarily to stimulate bone resorption.

Analysis of the results of the C-Fit uncemented total hip arthroplasty in young patients with hydroxyapatite or porous coating of components

Young patients at 2 separate centers received a C-Fit uncemented arthroplasty, with randomization to porous or hydroxyapatite coating. No difference in survival could be found between components that were porous or hydroxyapatite coated, with 27.5% being revised within 8 years, mainly for aseptic loosening. Acetabular augmentation screws or offset acetabular liners similarly did not affect outcome. Two of the offset liners had spun within the metal acetabular liners, with early failure. Some of the survivors showed poor clinical scores, but there was no correlation between clinical score and radiographic evidence of loosening. These results are comparable to the poorest reported survival figures in the literature for uncemented prostheses. Prosthesis coating could not be shown to affect component survival for this prosthesis.

The effects of a low-dose regimen of fosinopril on elevated urinary albumin excretion in normotensive type 1 diabetic patients

Normotensive type 1 diabetics with persistent albuminuria were randomized between 12 months' treatment with low-dose fosinopril (10 mg/d) and placebo in a 24-month, double-blind, crossover trial. Metabolic and cardiovascular variables were measured every three months and two-dimensional and M-mode echocardiography was performed before and after each treatment phase. Low-dose fosinopril led to 70% reduction in urinary albumin excretion (UAE) (220 +/- 199 vs 82 +/- 67 mg/24-h, p < 0.05), but UAE did not change during placebo treatment; the maximal change became apparent after 3 months and was reversible once treatment was stopped. Even though blood pressure (BP) did not change during fosinopril treatment, there was a significant correlation between baseline UAE and diastolic BP (r = 0.77, p = 0.027) and between change in UAE and change in systolic BP (r = 0.84, p = 0.01). The change in UAE approached borderline significance in correlation with the change in triglyceride concentration (r = 0.66, p = 0.07). Low-dose fosinopril favorably affects the "cardiorenal syndrome" seen in type 1 diabetics with persistent microalbuminuria.