B lymphocyte stimulator expression in patients with rheumatoid arthritis treated with tumour necrosis factor alpha antagonists: differential effects between good and poor clinical responders

OBJECTIVE

To assess the effects of tumour necrosis factor (TNF) antagonist therapy on B lymphocyte stimulator (BLyS) expression in patients with rheumatoid arthritis (RA).

METHODS

Blood from 38 patients with RA from a single centre was collected prior to and following initiation of TNF antagonist therapy. Plasma BLyS protein levels, blood leukocyte BLyS mRNA levels and disease activity were longitudinally monitored. Twelve patients with RA who either refused or were felt not to be candidates for TNF antagonist therapy and five normal healthy volunteers served as TNF antagonist-naïve controls.

RESULTS

Baseline plasma BLyS protein levels, but not blood leukocyte BLyS mRNA levels, were elevated in patients with RA. Plasma BLyS protein levels declined following initiation of TNF antagonist therapy in good responders (GR) to TNF antagonist therapy but not in poor responders (PR). By contrast, the erythrocyte sedimentation rate (ESR) declined in response to TNF antagonist therapy in GR and PR. TNF antagonist therapy did not promote change in blood leukocyte BLyS mRNA levels in either GR or PR, suggesting that the TNF antagonist-associated changes in circulating BLyS protein levels reflected changes in local BLyS production in the affected joints rather than changes in systemic BLyS production. BLyS expression did not change over time in either the normal or RA control groups.

CONCLUSIONS

A good clinical response to TNF antagonist therapy in patients with RA is associated with a decline in plasma BLyS protein levels. Increased BLyS expression in affected joints may contribute to ongoing disease activity, and reduction of such expression may help promote a favourable clinical response to TNF antagonist therapy.

Cellular scaling rules for primate brains

Primates are usually found to have richer behavioral repertoires and better cognitive abilities than rodents of similar brain size. This finding raises the possibility that primate brains differ from rodent brains in their cellular composition. Here we examine the cellular scaling rules for primate brains and show that brain size increases approximately isometrically as a function of cell numbers, such that an 11x larger brain is built with 10x more neurons and approximately 12x more nonneuronal cells of relatively constant average size. This isometric function is in contrast to rodent brains, which increase faster in size than in numbers of neurons. As a consequence of the linear cellular scaling rules, primate brains have a larger number of neurons than rodent brains of similar size, presumably endowing them with greater computational power and cognitive abilities.

Unequal representation of cardinal vs. oblique orientations in the middle temporal visual area

A possible neurobiological basis for the "oblique effect" is linked to the finding that more neural machinery is devoted to processing cardinal vs. oblique orientations in primary visual cortex (V1). We used optical imaging to determine whether more territory is devoted to processing horizontal and vertical orientations than oblique orientations in owl monkey middle temporal visual area (MT), a visual area highly sensitive to moving stimuli. We found that more of MT was devoted to representing cardinal than oblique orientations, and that the anisotropy was more prominent in parts of MT representing central vision (< or =10 degrees). Neural responses to orientations of 0 degrees and 90 degrees were also greater than those to 45 degrees and 135 degrees . In comparison, an overrepresentation of cardinal orientations in the representation of central vision in owl monkey V1 was relatively small and inconsistent. Our data could explain the greater sensitivity to motion discrimination when stimuli are moved along cardinal meridians and suggest that the neural machinery necessary to explain the motion oblique effect either originates in MT or is enhanced at this level.

Geometric morphometrics defines shape differences in the cortical area map of C57BL/6J and DBA/2J inbred mice

Background

We previously described planar areal differences in adult mouse visual, somatosensory, and neocortex that collectively discriminated C57BL/6J and DBA/2J inbred strain identity. Here we use a novel application of established methods of two-dimensional geometric morphometrics to examine shape differences in the cortical area maps of these inbred strains.

Results

We used Procrustes superimposition to align a reliable set of landmarks in the plane of the cortical sheet from tangential sections stained for the cytochrome oxidase enzyme. Procrustes superimposition translates landmark configurations to a common origin, scales them to a common size, and rotates them to minimize an estimate of error. Remaining variation represents shape differences. We compared the variation in shape between C57BL/6J and DBA/2J relative to that within each strain using a permutation test of Goodall's F statistic. Significant differences in shape in the posterior medial barrel subfield (PMBSF), as well as differences in shape across primary sensory areas, characterize the cortical area maps of these common inbred, isogenic strains.

Conclusion

C57BL/6J and DBA/2J have markedly different cortical area maps, in both size and shape. These differences suggest polymorphism in genetic factors underlying cortical specification, even between common isogenic strains. Comparing cortical phenotypes between normally varying inbred mice or between genetically modified mice can identify genetic contributions to cortical specification. Geometric morphometric analysis of shape represents an additional quantitative tool for the study of cortical development, regardless of whether it is studied from phenotype to gene or gene to phenotype.

Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer

AIMS

Patients with oesophageal cancer undergoing chemoradiation with curative intent are at high risk of malnutrition and its complications, including increased side effects of treatment. We have developed a nutrition pathway (NP), involving the early then periodic nutrition assessment of all patients presenting to the multidisciplinary oesophageal clinic who were planned to receive definitive chemoradiation.

MATERIALS AND METHODS

Patients were assessed as at 'low', 'moderate' or 'severe' nutrition risk, and were provided with appropriate nutrition intervention ranging from preventative advice (low risk), oral nutrition support (moderate risk) to enteral feeding (severe risk). Outcomes for 24 patients treated before implementation of the NP were compared with those of 24 patients treated using the NP.

RESULTS

Patients managed using the NP experienced less weight loss (mean weight change -4.2 kg +/-6.4 cf. -8.9 kg +/- 5.9, P = 0.03), greater radiotherapy completion rates (92% cf. 50%, P = 0.001), fewer patients had an unplanned hospital admission (46% cf. 75%, P = 0.04), and those that did had a shorter length of stay (3.2 days +/- 5.4 cf. 13.5 days +/- 14.1, P = 0.002).

CONCLUSION

Early and regular nutrition assessment/intervention and a multidisciplinary approach to nutrition care results in improved treatment tolerance for patients with oesophageal cancer receiving chemoradiation.

Distribution across cortical areas of neurons projecting to the superior colliculus in new world monkeys

Surprisingly little is known about the proportions of projections of different areas and regions of neocortex to the superior colliculus in primates. To obtain an overview of such projection patterns, we placed a total of 10 injections of retrograde tracers in the superior colliculus of three New World monkeys (Callithrix, Callicebus, and Aotus). Because cortex was flattened and cut parallel to the surface, labeled corticotectal neurons could be accurately located relative to architectonic boundaries and surface features. While there was variability across cases and injection sites, the summed results clearly support several conclusions. One, three well-defined visual areas, V1 (18%), V2 (14%), and MT (11%), contributed nearly half of the total of labeled cells. Two, several other visual areas (V3, DL, DM, and FST) that are early in the processing hierarchy provided another fifth of the total. Three, inferior temporal visual areas of the ventral stream provided only minor projections. Four, visuomotor fields (FEF, FV, cortex in the region of SEF, and posterior parietal cortex) contained less than 10% of the labeled neurons. Five, few labeled neurons were in auditory or somatosensory areas. The results indicate that cortical inputs to the superior colliculus originate predominantly from early visual areas rather than from multimodal or visuomotor areas.

Optical imaging of visually evoked responses in the middle temporal area after deactivation of primary visual cortex in adult primates

The middle temporal area (MT) is a visual area in primates with direct and indirect inputs from the primary visual cortex (V1), a role in visual motion perception, and a suggested role in "blindsight." When V1 is deactivated, some studies report continued activation of MT neurons, which has been attributed to an indirect pathway to MT from the superior colliculus. Here we used muscimol to deactivate V1 while optically imaging visually evoked activity in MT in two primates, owl monkeys and galagos, where MT is exposed on the brain surface. The partial loss of V1 inputs abolished all or nearly all evoked activity in the retinotopically matched part of MT. Low levels of activation that persisted in portions of MT that were unstimulated or retinotopically congruent with the blocked portion of V1 appeared to reflect the spread of activity from stimulated to unstimulated parts of MT. Thus, a significant pathway based on the superior colliculus was not demonstrated.

Variation in the cortical area map of C57BL/6J and DBA/2J inbred mice predicts strain identity

BACKGROUND

Recent discoveries suggest that arealization of the mammalian cortical sheet develops in a manner consonant with principles established for embryonic patterning of the body. Signaling centers release morphogens that determine regional growth and tissue identity by regulating regional expression of transcription factors. Research on mouse cortex has identified several candidate morphogens that affect anteroposterior or mediolateral cortical regionalization as well as mitogenesis. Inbred strains of laboratory mice can be exploited to study cortical area map formation if there are significant phenotypic differences with which to correlate gene polymorphism or expression data. Here we describe differences in the cortical area map of two commonly used inbred strains of laboratory mice, C57BL/6J and DBA/2J. Complete cortical hemispheres from adult mice were dissected and stained for the cytochrome oxidase enzyme in order to measure histochemically defined cortical areas.

RESULTS

C57BL/6J has the larger neocortex, relatively larger primary visual cortex (V1), but relatively smaller posterior medial barrel subfield of the primary somatosensory cortex (PMBSF). The sample of C57BL/6J and DBA/2J mice can be discriminated with 90% accuracy on the basis of these three size dimensions.

CONCLUSION

C57BL/6J and DBA/2J have markedly different cortical area maps, suggesting that inbred strains harbor enough phenotypic variation to encourage a forward genetic approach to understanding cortical development, complementing other approaches.

Conversion analysis for mutation detection in MLH1 and MSH2 in patients with colorectal cancer

CONTEXT

The accurate identification and interpretation of germline mutations in mismatch repair genes in colorectal cancer cases is critical for clinical management. Current data suggest that mismatch repair mutations are highly heterogeneous and that many mutations are not detected when conventional DNA sequencing alone is used.

OBJECTIVE

To evaluate the potential of conversion analysis compared with DNA sequencing alone to detect heterogeneous germline mutations in MLH1, MSH2, and MSH6 in colorectal cancer patients.

DESIGN, SETTING, AND PARTICIPANTS

Multicenter study with patients who participate in the Colon Cancer Family Registry. Mutation analyses were performed in participant samples determined to have a high probability of carrying mismatch repair germline mutations. Samples from a total of 64 hereditary nonpolyposis colorectal cancer cases, 8 hereditary nonpolyposis colorectal cancer-like cases, and 17 cases diagnosed prior to age 50 years were analyzed from June 2002 to June 2003.

MAIN OUTCOME MEASURES

Classification of family members as carriers or noncarriers of germline mutations in MLH1, MSH2, or MSH6; mutation data from conversion analysis compared with genomic DNA sequencing.

RESULTS

Genomic DNA sequencing identified 28 likely deleterious exon mutations, 4 in-frame deletion mutations, 16 missense changes, and 22 putative splice site mutations. Conversion analysis identified all mutations detected by genomic DNA sequencing--plus an additional exon mutation, 12 large genomic deletions, and 1 exon duplication mutation--yielding an increase of 33% (14/42) in diagnostic yield of deleterious mutations. Conversion analysis also showed that 4 of 16 missense changes resulted in exon skipping in transcripts and that 17 of 22 putative splice site mutations affected splicing or mRNA transcript stability. Conversion analysis provided an increase of 56% (35/63) in the diagnostic yield of genetic testing compared with genomic DNA sequencing alone.

CONCLUSIONS

The data confirm the heterogeneity of mismatch repair mutations and reveal that many mutations in colorectal cancer cases would be missed using conventional genomic DNA sequencing alone. Conversion analysis substantially increases the diagnostic yield of genetic testing for mismatch repair mutations in patients diagnosed as having colorectal cancer.

Overview of the visual system oftarsius

Tarsiers, which are currently considered to constitute the sister group of anthropoid primates, exhibit a number of morphological specializations such as remarkably large eyes, big ears, long hind legs, and a nearly naked tail. Here we provide an overview of the current state of knowledge on the tarsier visual system and describe recent anatomical observations from our laboratory. Its large eyes notwithstanding, the most remarkable feature of the tarsier brain is the large size and distinct lamination of area V1. Based on the need of tarsier for optimal scotopic vision and acuity to detect small prey in low lighting conditions, tarsiers may have preserved a high level of visual acuity by enlarging V1 at the expense of other areas. The other classically described visual regions are present in tarsier, albeit many borders are not clearly distinct on histochemical or immunohistochemical preparations. Tarsiers also have a large number and unusual distributions of cones in the retina, with high numbers of M/L-cones in the central retina and S-cones surprisingly at the periphery, which may be sensitive to UV light and may be useful for prey detection. These adaptive specializations may together account for the unique nocturnal predatory requirements of tarsiers.

Reappraisal of DL/V4 boundaries based on connectivity patterns of dorsolateral visual cortex in macaques

We placed injections of 3-5 distinguishable tracers in different dorsolateral locations in the visual cortex of four macaque monkeys to help define the extent of the dorsolateral visual complex (DL) commonly known as area V4. Injections well within DL/V4 region labeled neurons in V2, V3, MT, IT, and sometimes V1. In contrast, injections in caudal area 7a dorsal to current descriptions of DL/V4 produced a different pattern of labeled neurons largely involving posterior parietal and adjoining occipital cortex, as well as cortex of the medial wall. Injections placed in the dorsal prelunate cortex (DP), near the expected location of the dorsal border of DL/V4, labeled neurons in a third pattern, including regions of the posterior parietal and occipital cortex, inferior temporal (IT) cortex, and sometimes parts of dorsal area V2, DL/V4 complex and MT. Injections placed near or ventral to previous estimates of the ventral border of the rostral divisions of DL (DLr) and near the expected rostroventral border of V4 with TEO labeled cells in a pattern distinctively different from either central DL/V4 injections or those dorsal to DL/V4. Injections placed rostroventral to DL/V4 labeled neurons over a large extent of the IT cortex, while failing to label neurons in V1, V2 and MT. Injections that partially involved the rostroventral border of DL/V4 produced a similar pattern of labeled neurons, but also labeled a few cells in ventral V1 and V2, as well as many in DL/V4. Dorsal and rostroventral injections also labeled different regions of the prefrontal cortex, but only DL/V4 injections that included area DP labeled neurons in the prefrontal cortex. The results revealed contrasting and transitional connection patterns for four regions of the dorsolateral visual cortex, and they provided evidence for the locations of dorsal and rostroventral borders of the DL/V4 complex.

Optical imaging of visually evoked responses in prosimian primates reveals conserved features of the middle temporal visual area

Optical imaging of intrinsic cortical responses to visual stimuli was used to characterize the organization of the middle temporal visual area (MT) of a prosimian primate, the bush baby (Otolemur garnetti). Stimulation with moving gratings revealed a patchwork of oval-like domains in MT. These orientation domains could, in turn, be subdivided into zones selective to directional movements that were mainly orthogonal to the preferred orientation. Similar, but not identical, zones were activated by movements of random dots in the preferred direction. Orientation domains shifted in preference systematically either around a center to form pinwheels or as gradual linear shifts. Stimuli presented in different portions of the visual field demonstrated a global representation of visual space in MT. As optical imaging has revealed similar features in MT of New World monkeys, MT appears to have retained these basic features of organization for at least the 60 million years since the divergence of prosimian and simian primates.

Anatomical and functional organization of somatosensory areas of the lateral fissure of the New World titi monkey (Callicebus moloch)

The organization of anterior and lateral somatosensory cortex was investigated in titi monkeys (Callicebus moloch). Multiunit microelectrode recordings were used to identify multiple representations of the body, and anatomical tracer injections were used to reveal connections. (1) Representations of the face were identified in areas 3a, 3b, 1, S2, and the parietal ventral area (PV). In area 3b, the face was represented from chin/lower lip to upper lip and neck/upper face in a rostrocaudal sequence. The representation of the face in area 1 mirrored that of area 3b. Another face representation was located in area 3a. Adjoining face representations in S2 and PV exhibited mirror-image patterns to those of areas 3b and 1. (2) Two representations of the body, the rostral and caudal ventral somatosensory areas (VSr and VSc), were found in the dorsal part of the insula. VSc was roughly a reversal image of the S2 body representation, and VSr was roughly a reversal of PV. (3) Neurons in the insula next to VSr and VSc responded to auditory stimuli or to both auditory and somatosensory stimuli. (4) Injections of tracers within the hand representations in areas 3b, 1, and S2 revealed reciprocal connections between these three areas. Injections in areas 3b and 1 labeled the ventroposterior nucleus, whereas injections in S2 labeled the inferior ventroposterior nucleus. The present study demonstrates features of somatosensory cortex of other monkeys in titi monkeys, while revealing additional features that likely apply to other primates.

The genitals and gluteal skin are represented lateral to the foot in anterior parietal somatosensory cortex of macaques

Detailed electrophysiological maps of the representations of trunk and adjacent body parts in area 3b and area 1 of somatosensory cortex were obtained in three macaque monkeys (Macaca mulatta and Macaca radiata) of either sex. A total of 211 microelectrode penetrations 250-300 microm apart resulted in 1,190 recording sites. During penetrations deep into the posterior bank of the central sulcus, recordings were made every 300 microm to depths of 6-7 mm until sites unresponsive to somatic stimuli were reached. Cortex was later cut parasagittally and sections were stained for cytochrome oxidase (CO) or Nissl substance. Contrary to expectations from earlier reports, the genitalia were represented lateral to the representations of the foot in cortex along the area 3b/1 border. The gluteal skin including the gluteal pads and the base of the tail were also represented in this section of cortex. Only a small region of cortex was devoted to the genitalia, and neurons in this cortex had receptive fields that were large and typically included skin of the inner thigh and belly. The lower, middle and upper trunk were represented more laterally, followed by the neck, upper head and arm. The receptive fields on the trunk were roughly the same size as those for the middle and lower trunk and slightly smaller on the upper trunk.

Responses of neurons in the middle temporal visual area after long-standing lesions of the primary visual cortex in adult new world monkeys

The retinotopic organization of the middle temporal visual area (MT) was determined in six adult owl monkeys and one adult marmoset 69 d to 10 months after lesions of the dorsolateral primary visual cortex (V1). The lesions removed were limited to extensive parts of the representation of the lower visual quadrant in V1. Microelectrodes were used to record from neurons at numerous sites in MT to determine whether parts of MT normally devoted to the lower visual quadrant (1) were unresponsive to visual stimuli, (2) acquired responsiveness to inputs from intact portions of V1, or (3) became responsive to some other visually driven input such as a relay from the superior colliculus via the pulvinar to MT. All monkeys (n = 6) with moderate to moderately large lesions had unresponsive portions of MT even after 10 months of recovery. These unresponsive regions were retinotopically equivalent to the removed parts of V1 in normal animals. Thus, there was no evidence for an alternative source of activation. In addition, these results indicate that any retinotopic reorganization of MT based on inputs from intact portions of V1 was not extensive, yet neurons near the margins of responsive cortex may have acquired new receptive fields, and the smallest 5 degrees lesion of V1 failed to produce an unresponsive zone. Deprived portions of MT were not remarkably changed in histological appearance in cytochrome oxidase, Nissl, and Wisteria floribunda agglutinin preparations. Nevertheless, some reduction in myelin staining and other histological changes were suggested. We conclude that MT is highly dependent on V1 for activation in these monkeys, and alternative sources do not become effective over months when normal activation is absent. Additionally, remaining V1 inputs have only a limited capacity to expand their activation territory into deprived portions of MT.

The organization of sensory cortex

Recent studies of primary visual cortex (V1) redefine layers 3 and 4 of V1 in monkeys and show that monkeys, apes and humans have different laminar specializations. Projections from V1 define a smaller, but complete, third visual area, and a dorsomedial area. The middle temporal visual area has two types of motion-sensitive modules with inputs from cytochrome oxidase columns in V1. Second-level somatosensory areas have been described in humans, and a second-level auditory area is shown to respond to somatosensory stimuli.

Oxidative Stress in Cystic Fibrosis: Dietary and Metabolic Factors

OBJECTIVE

To examine oxidative stress in CF by measuring 8-iso-PGF2alpha and antioxidant defenses, in relation to dietary intake, immune function and clinical status.

METHODS

We measured total plasma concentrations of 8-iso-PGF2alpha and dietary antioxidants (vitamin E, vitamin C, beta-carotene), erythrocyte antioxidant enzyme activities (glutathione peroxidase and superoxide dismutase), lung function and dietary intake in 21 CF subjects and 21 healthy age- and gender-matched controls.

RESULTS

Total plasma 8-iso-PGF2alpha concentration (median [quartile 1-quartile 3]) was significantly higher in CF subjects compared to controls (214 pg/mL (155-331) vs. 135 pg/mL (101-168), p = 0.001). Neutrophil, monocyte and total white cell counts were elevated in the CF group and these correlated with 8-iso-PGF2alpha concentration. Despite similar dietary intake, lower plasma antioxidant concentrations were observed in the CF group (vitamin E, p < 0.001, vitamin C, p = 0.004, beta-carotene, p = 0.001). 8-iso-PGF2alpha correlated negatively with plasma vitamin E, C and beta-carotene concentrations.

CONCLUSION

Oxidative stress is increased in CF patients, despite normal dietary antioxidant intake. The immune response appears to be a key factor causing oxidative stress. Antioxidant intervention aimed at reducing oxidative stress in CF needs to be assessed.

Topographic patterns of v2 cortical connections in a prosimian primate (Galago garnetti)

Topographic patterns of cortical connections of the second visual area (V2) were examined in a lorisiform prosimian primate (Galago garnetti). Up to five different tracers were injected into dorsal and ventral V2. Tracers included wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) and up to four fluorochromes. Tracer injections consistently labeled neurons and terminals in primary visual cortex (V1), V2, the middle temporal area (MT), and the dorsolateral visual area (DL). Labeled neurons were also found in other proposed extrastriate areas such as the dorsomedial visual area (DM), dorsointermediate area (DI), middle temporal crescent (MTc), medial superior temporal area (MST), ventral posterior parietal area (VPP), and caudal inferotemporal cortex (ITc), but these connections were more variable and less dependent on the retinotopic position of injection sites in V2. Areal boundaries were identified by differences in cytochrome oxidase (CO) and myelin staining. We conclude that V2 cortical connections in prosimian galagos are similar to those in simian primates, suggesting that prosimians and other lines of primate evolution have retained several visual areas from a common ancestor that relate to V2 in similar ways. Architectural features of striate and extrastriate areas in prosimian galagos are similar to simian primates, with notable exceptions such as stripes in V2, which appear to be less differentiated in galagos.

Organization of sensory cortex in the East African hedgehog (Atelerix albiventris)

We investigated the organization of neocortex in the East African hedgehog (Atelerix albiventris) with microelectrode recordings from sensory areas that were later correlated with cytochrome oxidase patterns in sections of flattened cortex. The location of corticospinal projecting neurons was also examined and related to sensory areas by making small injections of wheat germ agglutinin-horseradish peroxidase into the spinal cord. Our goals were to determine how hedgehog cortex is organized, how much sensory areas overlap, and to compare results with recent findings in other insectivores. Evidence was found for three separate topographically organized somatosensory areas, two visual areas, and a caudolateral auditory area. A medial somatosensory area corresponded to S1, the primary somatosensory area, whereas two lateral areas partially encircled auditory cortex and corresponded to the parietal ventral area (PV) and the secondary somatosensory area (S2). Primary visual cortex (V1) was delineated by a caudomedial cytochrome oxidase dark oval, and a more lateral visual area between V1 and somatosensory cortex corresponded to V2, or area 18. Two patches of corticospinal projecting cells were found primarily overlapping S1 and S2. Some bimodal auditory and somatosensory responses were found in parts of PV and S2, but for the most part, areas had relatively sharp histochemically apparent and physiologically defined borders. The present results indicate that the caudal neocortex of hedgehogs has only a few sensory areas, corresponding to those commonly found in several other small-brained mammals. Hedgehog cortical organization differs significantly in somatotopy, number, and position of fields from that of closely related shrews and moles. Thus, clear specializations occur, even within the order Insectivora.

Normal growth in cystic fibrosis associated with a specialised centre

OBJECTIVE

To assess the impact of lifetime continuous care within the John Hunter Hospital cystic fibrosis (CF) clinics on growth and lung function.

DESIGN

A cross sectional survey of variables affecting nutritional status in CF was undertaken for 1993 and 1997. Data were retrieved from medical records and grouped into 5 year age bands.

MAIN OUTCOME MEASURES

Change in height z-score, weight centile, and forced expiratory volume in one second (FEV(1)) between patient cohorts receiving specialised care for different lengths of time.

RESULTS

Improved mean height z-score (-0.880 v -0.047) and weight centile (28.3% v 48.1%) for the 10-15 year age group in 1997, who had received continuous lifetime care within the clinic, compared with the same age group in 1993, for whom continuous medical care started at an older age. There was no corresponding improvement in FEV(1), as an indicator of lung function, in this group (81.6% predicted v 89.5% predicted).

CONCLUSIONS

This study suggests that lifetime continuous care within a specialised CF centre is associated with improved growth but not improved lung function.