Basal and inducible anti-inflammatory epoxygenase activity in endothelial cells

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We examined epoxygenase product formation and regulation in endothelial cells.

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The epoxygenase CYP2J2 is an LPS (TLR-4) inducible enzyme in endothelial cells.

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The endothelial cell line EA.Hy926 synthesises epoxygenase products.

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Inhibition of endothelial epoxygenases increases TNFα secretion.

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Soluble epoxide hydrolase inhibitors reduce inflammation-induced TNFα and NFκB.

The roles of CYP lipid-metabolizing pathways in endothelial cells are poorly understood. Human endothelial cells expressed CYP2J2 and soluble epoxide hydrolase (sEH) mRNA and protein. The TLR-4 agonist LPS (1 μg/ml; 24 h) induced CYP2J2 but not sEH mRNA and protein. LC–MS/MS analysis of the stable commonly used human endothelial cell line EA.Hy926 showed active epoxygenase and epoxide hydrolase activity: with arachidonic acid (stable epoxide products 5,6-DHET, and 14,15-DHET), linoleic acid (9,10-EPOME and 12,13-EPOME and their stable epoxide hydrolase products 9,10-DHOME and 12,13-DHOME), docosahexaenoic acid (stable epoxide hydrolase product 19,20-DiHDPA) and eicosapentaenoic acid (stable epoxide hydrolase product 17,18-DHET) being formed. Inhibition of epoxygenases using either SKF525A or MS-PPOH induced TNFα release, but did not affect LPS, IL-1β, or phorbol-12-myristate-13-acetate (PMA)-induced TNFα release. In contrast, inhibition of soluble epoxide hydrolase by AUDA or TPPU inhibited basal, LPS, IL-1β and PMA induced TNFα release, and LPS-induced NFκB p65 nuclear translocation. In conclusion, human endothelial cells contain a TLR-4 regulated epoxygenase CYP2J2 and metabolize linoleic acid > eicosapentaenoic acid > arachidonic acid > docosahexaenoic acid to products with anti-inflammatory activity.

Farmer decision-making and risk perceptions towards outwintering cattle

Increasing financial pressures has led farmers to manage cattle outside for the winter months. In temperate areas the environmental risks of outwintering cattle are exacerbated by cooler and wetter weather and identifying how farmers perceive these risks is essential to understanding how potential hazards could be mitigated. A series of workshops were conducted with cattle producers in England and Wales to understand their perceptions of the risks, their decision-making with respect to outwintering and their options for mitigating these risks. A range of risks were identified, but emphasis was placed on environmentally-related risks, such as soil damage, and on social risks, such as public perception of their treatment of the animals. The uncertainties due to the weather were highlighted as the most unmanageable risk. Another significant barrier to mitigating environmental impacts emerged from the lack of options towards choosing appropriate fields in which to conduct outwintering. We argue that the farmer-led nature of outwintering and the development of a wide range of systems is evidence of outwintering being a systems-innovation. We conclude that there is a role for Government intervention through the provision of information which clarifies cross-compliance breaches, but also encourages farmer-led innovation to develop more responsive outwintering systems.

A field evaluation of a footbathing solution for the control of digital dermatitis in cattle

Footbathing is one of the most commonly used methods for controlling digital dermatitis (DD). A farm-based trial was undertaken using six dairy herds involving over 600 cubicle-housed Holstein-Friesian cattle. Split footbaths (length 2.2m) were used to compare the efficacy of two dips, namely, a positive control (5% copper sulphate) and a non-heavy metal-based proprietary dip. The dips were used from early January 2009 for a minimum of 103 days, bathing twice a day for 3 consecutive days every week, using one footbath (three herds) or two in line (three herds). The lesions of DD on the hind feet of cattle were scored by borescope while the animals were being milked, on three occasions (at approximately days 0, 55 and 110) and then compared both directly and by calculating the change in severity from the previous examination (when possible). Data from the 408 cows that had their feet examined for lesions on all three occasions were analysed separately. A reduction in lesion score was seen for both footbath products, but feet bathed in 5% copper sulphate improved more (OR=1.6, CI: 1.14-2.32; P<0.01), and, irrespective of solution, there was a significantly greater improvement in those herds where two footbaths were used (OR=3.39, CI: 2.07-5.19; P<0.001). Lesion improvement over time also increased with lactation number (OR=1.13, CI: 1.02-1.25; P<0.05).

Implementation of neuro-oncology service reconfiguration in accordance with NICE guidance provides enhanced clinical care for patients with glioblastoma multiforme

Background:

Brain tumours account for <2% of all primary neoplasms but are responsible for 7% of the years of life lost from cancer before age 70 years. The latest survival trends for patients with CNS malignancies have remained largely static. The objective of this study was to evaluate the change in practice as a result of implementing the Improving Outcomes Guidance from the UK National Institute for Health and Clinical Excellence (NICE).

Methods:

Patients were identified from the local cancer registry and hospital databases. We compared time from diagnosis to treatment, proportion of patients discussed at multidisciplinary team (MDT) meetings, treatment received, length of inpatient stay and survival. Inpatient and imaging costs were also estimated.

Results:

Service reconfiguration and implementation of NICE guidance resulted in significantly more patients being discussed by the MDT—increased from 66 to 87%, reduced emergency admission in favour of elective surgery, reduced median hospital stay from 8 to 4.5 days, increased use of post-operative MRI from 17 to 91% facilitating early discharge and treatment planning, and reduced cost of inpatient stay from £2096 in 2006 to £1316 in 2009. Patients treated with optimal surgery followed by radiotherapy with concomitant and adjuvant temozolomide achieved outcomes comparable to those reported in clinical trials: median overall survival 18 months (2-year survival 35%).

Conclusions:

Advancing the management of neuro-oncology patients by moving from an emergency-based system of patient referral and management to a more planned elective outpatient-based pattern of care improves patient experience and has the potential to deliver better outcomes and research opportunities.