Influence of birth weight on gene regulators of lipid metabolism and utilization in subcutaneous adipose tissue and skeletal muscle of neonatal pigs

Epidemiological studies suggest that low-birth weight infants show poor neonatal growth and increased susceptibility to metabolic syndrome, in particular, obesity and diabetes. Adipose tissue development is regulated by many genes, including members of the peroxisome proliferator-activated receptor (PPAR) and the fatty acid-binding protein (FABP) families. The aim of this study was to determine the influence of birth weight on key adipose and skeletal muscle tissue regulating genes. Piglets from 11 litters were ranked according to birth weight and 3 from each litter assigned to small, normal, or large-birth weight groups. Tissue samples were collected on day 7 or 14. Plasma metabolite concentrations and the expression ofPPARG2,PPARA,FABP3, andFABP4genes were determined in subcutaneous adipose tissue and skeletal muscle. Adipocyte number and area were determined histologically. Expression ofFABP3and4was significantly reduced in small and large, compared with normal, piglets in adipose tissue on day 7 and in skeletal muscle on day 14. On day 7,PPARAandPPARG2were significantly reduced in adipose tissue from small and large piglets. Adipose tissue from small piglets contained more adipocytes than normal or large piglets. Birth weight had no effect on adipose tissue and skeletal muscle lipid content. Low-birth weight is associated with tissue-specific and time-dependent effects on lipid-regulating genes as well as morphological changes in adipose tissue. It remains to be seen whether these developmental changes alter an individual's susceptibility to metabolic syndrome.

Pseudomonas aeruginosa bacteremia over a 10-year period: multidrug resistance and outcomes in transplant recipients

AIM

Transplant recipients are at risk for hospital-acquired infections (HAIs), including those caused by Pseudomonas aeruginosa. Of all HAIs, bloodstream infection (BSI) remains one of the most life-threatening.

METHODS

Over a 10-year period, we studied 503 patients, including 149 transplant recipients, with pseudomonal BSI from the University of Pittsburgh Medical Center. Trends in antimicrobial susceptibility, risk factors for multidrug resistance (MDR), and outcomes were compared between transplant and non-transplant patients.

RESULTS

Resistance to all antibiotic classes was significantly greater in pseudomonal blood culture isolates from transplant compared with non-transplant patients (P<0.001). Of isolates from transplant recipients (n=207), 43% were MDR, compared with 18% of isolates from non-transplant patients (n=391) (odds ratio [OR] 3.47; 95% confidence interval [CI] 2.34-5.14, P<0.001). Among all patients, independent risk factors for MDR P. aeruginosa BSI included previous transplantation (OR 2.38; 95% CI 1.51-3.76, P<0.001), hospital-acquired BSI (OR 2.41; 95% CI 1.39-4.18, P=0.002), and prior intensive care unit (ICU) admission (OR 2.04; 95% CI 1.15-3.63, P=0.015). Mortality among transplant recipients was 42%, compared with 32% in non-transplant patients (OR 1.55; 95% CI 0.87-2.76, P=0.108). For transplant recipients, onset of BSI in the ICU was the only independent predictor of mortality (OR 8.00; 95% CI 1.71-37.42, P=0.008).

CONCLUSIONS

Transplant recipients are at greater risk of MDR P. aeruginosa BSI, with an appreciable mortality. Future management must concentrate on the implementation of effective preventative strategies.

Periocular basal cell carcinoma: 5-year outcome following Slow Mohs surgery with formalin-fixed paraffin-embedded sections and delayed closure

AIM

The aim of the study was to determine the 5-year outcome of periocular basal cell carcinoma (BCC) managed by Mohs surgery using formalin-fixed, paraffin-embedded sections (Slow Mohs).

METHODS

This was a prospective, non-comparative, interventional case series of all patients with periocular BCC treated by Slow Mohs in Newcastle upon Tyne, UK, between 1985 and 1999. Data collected included demographic information, indication for Slow Mohs, tumour site, histology, recurrence rate after 5 years and cosmetic outcome.

RESULTS

Of 287 BCCs in 278 patients, 5-year follow-up data were available for 173 (60.2%). Recurrence following Slow Mohs occurred in one patient: 0.34% of total and 0.58% of those with 5-year follow-up. The main indication for Slow Mohs was most frequently due to the tumour site. Cosmetic outcome was deemed excellent in 56%, good in 18%, adequate in 8%, unknown in 14% and revision advised in only 4%.

CONCLUSION

The low 5-year recurrence rate (0.58%) reported in this prospective series confirms the importance of margin-controlled removal of recurrent, poorly defined or critically sited BCCs, and illustrates that Slow Mohs is equivalent to standard Mohs. While delayed closure does not appear to compromise cosmetic outcome, this technique offers a histologically superior and cheaper alternative to frozen-section Mohs surgery.

Ensembl 2009

The Ensembl project (http://www.ensembl.org) is a comprehensive genome information system featuring an integrated set of genome annotation, databases, and other information for chordate, selected model organism and disease vector genomes. As of release 51 (November 2008), Ensembl fully supports 45 species, and three additional species have preliminary support. New species in the past year include orangutan and six additional low coverage mammalian genomes. Major additions and improvements to Ensembl since our previous report include a major redesign of our website; generation of multiple genome alignments and ancestral sequences using the new Enredo-Pecan-Ortheus pipeline and development of our software infrastructure, particularly to support the Ensembl Genomes project (http://www.ensemblgenomes.org/).

Molecular epidemiology of Pseudomonas aeruginosa in adult patients with cystic fibrosis in Northern Ireland

Isolates (n = 51) of Pseudomonas aeruginosa obtained from the sputa of 29 adult patients attending the Regional Cystic Fibrosis Centre in Northern Ireland were compared using an enterobacterial repetitive intergenic consensus sequence (ERIC2) primer in a random amplification of polymorphic DNA (RAPD) polymerase chain reaction (PCR) method. Resulting banding patterns showed a high degree of genetic heterogeneity among all isolates from the patients examined, suggesting a non-clonal relationship between isolates from these patients, when employing this genotyping technique.

Effect of Acute Administration of Recombinant Human Leptin during the Neonatal Period on Body Temperature and Endocrine Profile of the Piglet

BACKGROUND

Leptin is produced predominantly by white adipocytes; in adults it regulates appetite and energy expenditure but its role in the neonate remains to be fully established.

OBJECTIVES

To examine the effects of acute administration of recombinant human leptin on the endocrine profile and thermoregulation of neonatal pigs.

METHODS

24 pairs of siblings (n = 48) were administered with either a single dose (4 microg ml(-1) kg(-1) body weight) of leptin (L: n = 24) or a placebo (P: n = 24) on day 6 of neonatal life. Rectal temperature was recorded, and tissue samples were taken at 1 (n = 12), 2 (n = 12), 4 (n = 12) or 6 (n = 12) hours post-administration. Plasma concentrations of hormones and metabolites were determined in conjunction with messenger RNA (mRNA) for leptin and uncoupling protein-2.

RESULTS

Plasma leptin increased following leptin administration, and differences in concentrations of insulin, thyroxine and non-esterified fatty acids were observed between the two groups. Initially, rectal temperature decreased in L pigs but returned to start values by 1.5 h. This decline in rectal temperature was delayed in placebo animals, resulting in differences between treatments at 1.5 and 2 h.

CONCLUSIONS

Acute leptin administration alters the endocrine profile of pigs and influences the thermoregulatory ability of the neonate.

Living in the borderlands; writing in the margins: an autoethnographic tale

A prerequisite to helping others is, arguably, some semblance of understanding of one's own self. But, how does one do self in a way that satisfies the integrity of psychotherapeutic theory, or the tenets of qualitative research? Moreover, what are the implications for the morally marginalized and uncertain in an era of epistemological and ontological certainty? These questions preface the raw data that constitutes the bulk of this paper: messy-text emails, reflections and comments from others, in relation to the breakdown experiences of two mental health academics/practitioners/teachers/supervisors. The methodology is autoethnography, thus the aim evocative. The textual presentation is in triple-column form: in the first is the accounts of the protagonists, Short and Grant; the second contains reflections from friends and family, and the final is Clarke's pan-theoretical reflections on both.

Ensembl 2008

The Ensembl project (http://www.ensembl.org) is a comprehensive genome information system featuring an integrated set of genome annotation, databases and other information for chordate and selected model organism and disease vector genomes. As of release 47 (October 2007), Ensembl fully supports 35 species, with preliminary support for six additional species. New species in the past year include platypus and horse. Major additions and improvements to Ensembl since our previous report include extensive support for functional genomics data in the form of a specialized functional genomics database, genome-wide maps of protein–DNA interactions and the Ensembl regulatory build; support for customization of the Ensembl web interface through the addition of user accounts and user groups; and increased support for genome resequencing. We have also introduced new comparative genomics-based data mining options and report on the continued development of our software infrastructure.

Sacred radical of psychiatry

At least a dozen articles in this journal have referred directly to the psychiatry of Thomas Szasz, even favourably on occasions. Szasz makes no distinction between the occupational statuses of mental health workers and so his work is relevant to nurses. Szasz's central claims take on renewed vitality given recent developments in forensic care, especially in Britain. In this article, I criticize Szasz's rationale of what constitutes illness as opposed to disease. In addition, I question - in a nuanced way - his views on custodial psychiatry and his use of history to bolster his clams. I also comment on recent developments in biological research and their implications for diagnosing schizophrenia: further, I link the question of such diagnoses to Szasz's assertion that private contracts are the definitive test of what counts as mental illness. Lastly, I ask if improvements in mental health care contradict Szaszian criticisms and/or his seeming inability/unwillingness to acknowledge such changes.

Colony stimulating factor use and outcomes for breast, lung, and colorectal cancer patients in Washington State

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Background: Guidelines recommend colony stimulating factor (CSF) primary prophylaxis (PP) with chemotherapy if febrile neutropenia risk (FN) is =20%. Use of and outcomes for persons receiving CSF in clinical practice are relatively unknown. Methods: Using claims for Medicare and Medicaid enrollees linked to the Puget Sound SEER registry, breast (BCa), lung (LCa) and colorectal cancer (CRCa) patients diagnosed 2002–04 who received chemotherapy were categorized as: CSF at the start of chemotherapy (PP); other CSF; no CSF. Logistic regression was used to determine predictors of CSF PP and hospitalization for FN, controlling for cancer stage, age, sex, race, chemotherapy FN risk (from the National Comprehensive Cancer Network), radiation therapy, CSF use, health insurance, surgery =30 days of chemotherapy. Results: 364 BCa, 908 LCa, and 452 CRCa patients received chemotherapy. 43% of BCa, 30% of LCa, and 15% of CRCa patients received CSF. Only 9%, 6%, and 0.6% of patients initiated CSF as PP in the first cycle of chemotherapy. CSF use increased for all cancers, but most for BCa, (36% in 2002 to 70% in 2004); PP increased from 5% to 26%. Significant predictors (p<0.05) of PP were: BCa–local vs distant stage (OR 0.2), regional vs distant (OR 0.6), chemotherapy FN risk high vs low (OR 6.7); LCa–chemotherapy FN risk high vs low (OR 8.9), intermediate vs low (OR 6.3). FN incidence was 11%, 18% and 32% for BCa, CRCa, LCa, respectively. Significant predictors of FN were: BCa–nonwhite race (OR 2.7); LCa–surgery within 30 days (OR 1.7); CRCa–regional vs. distant (OR 0.4) and chemotherapy FN risk intermediate vs. low (OR 4.2). Conclusions: CSF use has increased significantly, but often in settings where efficacy is uncertain. Cancer type, stage and chemotherapy risk of FN influenced use of primary prophylaxis. Non-chemotherapy factors also appear to influence risk for FN.

No significant financial relationships to disclose.

Unilateral external ophthalmoplegia in Miller Fisher syndrome: case report

Background

A description of the diagnostic features of Miller Fisher syndrome.

Case presentation

The clinical presentation, investigation, and subsequent progress of our patient with clinical unilateral external ophthalmoplegia.

Conclusion

Our case demonstrates the presentation of clinical unilateral external ophthalmoplegia as part of the full triad of Miller Fisher syndrome.

Ensembl 2007

The Ensembl (http://www.ensembl.org/) project provides a comprehensive and integrated source of annotation of chordate genome sequences. Over the past year the number of genomes available from Ensembl has increased from 15 to 33, with the addition of sites for the mammalian genomes of elephant, rabbit, armadillo, tenrec, platypus, pig, cat, bush baby, common shrew, microbat and european hedgehog; the fish genomes of stickleback and medaka and the second example of the genomes of the sea squirt (Ciona savignyi) and the mosquito (Aedes aegypti). Some of the major features added during the year include the first complete gene sets for genomes with low-sequence coverage, the introduction of new strain variation data and the introduction of new orthology/paralog annotations based on gene trees.

Submicroscopic deletions and duplications in individuals with intellectual disability detected by array-CGH

Intellectual disability (ID) affects about 3% of the population (IQ < 70), and in about 40% of moderate (IQ 35-49) to severe ID (IQ < 34), and 70% of cases of mild ID (IQ 50-70), the etiology of the disease remains unknown. It has long been suspected that chromosomal gains and losses undetectable by routine cytogenetic analysis (i.e., less than 5-10 Mb in size) are implicated in ID of unknown etiology. Array CGH has recently been used to perform a genome-wide screen for submicroscopic gains and losses in individuals with a normal karyotype but with features suggestive of a chromosome abnormality. In two recent studies, the technique has demonstrated a approximately 15% detection rate for de novo copy number changes of individual clones or groups of clones. Here, we describe a study of 22 individuals with mild to moderate ID and nonsyndromic pattern of dysmorphic features suspicious of an underlying chromosome abnormality, using the 3 Mb and 1 Mb commercial arrays (Spectral Genomics). Deletions and duplications of 16 clones, previously described to show copy number variability in normal individuals [Iafrate et al., 2004; Lapierre et al., 2004; Schoumans et al., 2004; Vermeesch et al., 2005] were seen in 21/22 subjects and were considered polymorphisms. In addition, three subjects showed submicroscopic deletions and duplications not previously reported as normal variants. Two of these submicroscopic changes were of de novo origin (microdeletions at 7q36.3 and a microduplication at 11q12.3-13.1) and one was of unknown origin as parental testing of origin could not be performed (microduplication of Xp22.3). The clinical description of the three subjects with submicroscopic chromosomal changes at 7q36.3, 11q12.3-13.1, Xp22.3 is provided.

So what exactly is a nurse?

The problematic nature of defining nursing is examined. Contrasts are set out in respect of the work of different grades of practitioner and how these do or do not constitute nursing care. A concept of caring and caring profession is utilized as a backdrop by which it is argued that caring can be defended as an ethical position independently of its objects of care. The paper asserts the existence of different perspectives within mental health nursing and demonstrates how these are influenced by extraneous forces. It concludes by (1) defending universal moral rules that operate independently of situations or the objects to which they apply and (2) that the usefulness of invoking a nursing identity may be less rather than more illuminative in exposing what mental health (psychiatric) 'nursing' is.

The approval process for hyperthermic intraoperative intraperitoneal chemotherapy

AIMS

To clarify the requirements for Food and Drug Administration approval in the United States for hyperthermic intraoperative intraperitoneal chemotherapy administration. Also, to review the status of the approval process in Europe.

METHODS

The obstacles to be overcome for approval by the Food and Drug Administration for a new drug approval and for a new device approval were reviewed. Drugs approved in the past were examined for their potential for current application in this technology.

RESULTS

The likelihood that the approval of a heater circulator along with the approval for specific chemotherapy agents for heated intraoperative intraperitoneal chemotherapy was judged to be remote. Rather, the continued use of "homemade heater circulators" and the off-label use of appropriate chemotherapy agents augmented by heat will continue to be the standard of care. The European community currently has several heater circulators approved for hyperthermic intraoperative intraperitoneal chemotherapy administration. These devices have been specifically approved for oncologic indications.

CONCLUSIONS

Continued research and development of heated intraoperative intraperitoneal chemotherapy is necessary. As the requirement for prevention and treatment of the peritoneal surface component of gastrointestinal and gynecologic oncology expands, new investigations into the approval process in the United States will be necessary. Publication of results from institutions pioneering these new treatment strategies will, of necessity, continue.

Ensembl 2006

The Ensembl () project provides a comprehensive and integrated source of annotation of large genome sequences. Over the last year the number of genomes available from the Ensembl site has increased from 4 to 19, with the addition of the mammalian genomes of Rhesus macaque and Opossum, the chordate genome of Ciona intestinalis and the import and integration of the yeast genome. The year has also seen extensive improvements to both data analysis and presentation, with the introduction of a redesigned website, the addition of RNA gene and regulatory annotation and substantial improvements to the integration of human genome variation data.