Retrospective comparative examination of the long term effects of venous access devices on upper extremity limb measurement in children with haemophilia: pilot observations from a single haemophilia treatment centre

BACKGROUND

Venous access devices (VADs) have been used in some individuals with haemophilia to facilitate infusions of factor concentrates. Studies have reported complications of infection and thrombosis with VADs but there have been no studies looking at the potential effect that VADs may have on growth of the upper extremities in children with haemophilia. We hypothesize that there could be potential growth discrepancies in upper extremities in children with VADs related to changes in blood flow to the extremity caused by the VADs.

METHODS

This study was a cohort descriptive comparative study to determine if VAD use correlated to discrepancies in upper extremity limb measurement data. A multivariate analysis compared limb measurements with VAD use, bleeding, clotting, infections, surgeries, chest wall collateral patterns and magnetic resonance venogram results.

RESULTS

A total of 59 children with haemophilia participated (36 subjects with VADs, 23 subjects without). Overall, in subjects with VADs the non-VAD side was found to be shorter and measured less in girth than the VAD side. These differences did not reach statistical significance except bicep/tricep girth in the 11-15 age group. There was no correlation found between duration of VAD placement and subject age vs. length and girth measurements. When comparing subjects with VADs to those without VADs, no differences in measurements were seen. Differences in girth were measured between dominant hand and non-dominant hand in all subjects indicating that the dominant hand arm was larger. Reproducibility of this data may be hampered by limitations of sample size, subject homogeneity and variability in bleeding history between subject groups.

Characterization of bacterial growth and the influence of antibiotics by means of UV resonance Raman spectroscopy

In this work we monitor the bacterial growth of a Bacillus pumilus batch culture by means of UV resonance Raman spectroscopy. Excitation with a wavelength of 244 nm especially enhances the Raman scattering of the aromatic amino acids and the nucleic acid bases and therefore is a good method to track the metabolic changes that occur during bacterial growth. Furthermore, a drug from the fluoroquinolone group is added to the bacterial suspension at the beginning of the exponential growth phase. With the help of chemometrical methods such as hierarchical cluster analysis (HCA) and principal component analysis (PCA) it is possible to visualize the small changes that occur in the UV resonance Raman spectra due to the interaction of the drug with its biological targets DNA and the enzyme gyrase within the bacterial cell.

Classification of lactic acid bacteria with UV-resonance Raman spectroscopy

UV-resonance Raman spectroscopy is applied as a method for the identification of lactic acid bacteria from yogurt. Eight different strains of bacteria from Lactobacillus acidophilus, L. delbrueckii ssp. bulgaricus, and Streptococcus thermophilus were investigated. At an excitation wavelength of 244 nm signals from nucleic acids and proteins are selectively enhanced. Classification was accomplished using different chemometric methods. In a first attempt, the unsupervised methods hierarchical cluster analysis and principal component analysis were applied to investigate natural grouping in the data. In a second step the spectra were analyzed using several supervised methods: K-nearest neighbor classifier, nearest mean classifier, linear discriminant analysis, and support vector machines.

Bisquaternary caracurine V and iso-caracurine V salts as ligands for the muscle type of nicotinic acetylcholine receptors: SAR and QSAR studies

The binding constants (K(i) values) of 24 caracurine V and 6 iso-caracurine V analogues for the muscle type of nicotinic ACh receptors (nAChR) from Torpedo californica were determined in a binding assay using (+/-)-[(3)H]epibatidine as a radioligand. The allyl alcohol group present in the iso-caracurine V ring system was found to be essential for high binding affinity. The most potent compounds are the dimethyl and di-(4-nitrobenzyl)-iso-caracurinium V salts 29 (18 nM), and 31 (79 nM), respectively. Compound 29 and the corresponding diallyl analogue 30 (350 nM) exhibited similar binding affinities as the equally substituted neuromuscular-blocking agents toxiferine I (14 nM) and alcuronium (234 nM), respectively. The SAR results were confirmed by QSAR studies, which additionally revealed that the presence of hydrogen-bond acceptor groups close to the quaternary nitrogen, is detrimental for the nicotinic binding affinity. The diallyl- and dimethylcaracurinium V salts 13 and 27, respectively, which are known to be among the most potent allosteric modulators of M(2) receptors (EC(50)=10 and 8nM, respectively), exhibited rather low nicotinic binding affinities for muscle type nAChR (K(i)=1.5 and 5.2 microM, respectively). Such a large difference in affinity suggests that it is possible to develop compounds with high muscarinic allosteric potency and low or negligible affinities for (alpha1)(2)beta1gammadelta nAChR. Additionally, the iso-caracurine V analogues with binding affinities comparable to those of (+)-tubocurarine and alcuronium could become a new class of neuromuscular-blocking agents.

Die posttraumatische Verbitterungsst�rung (PTED)

Adaptation disorders are a heterogeneous group of mental disorders. Although they play a major role in clinical practice, are difficult to treat, and often lead to chronicity and disability, diagnostic algorithms are vague and scientific research is rare. Clinical practice has shown a subtype of adaptation disorder that is characterized primarily by lasting embitterment after exceptional though normal life events which violate basic beliefs. This disorder can be called post-traumatic embitterment disorder (PTED). A case vignette and results of a pilot study are reported. Critical life events were found to be job loss in 38%, conflicts at work in 24%, death of a loved one in 14%, familial strain in 14%, and other events in 10%. When reminded of the critical event, patients report feelings of embitterment (85.7%), sadness (81.0%), anger (76.2%), or helplessness (75.0%). When standardized assessments are made, they fulfill criteria of various comorbid disorders such as GAD (38.1%), depression (33.3%) and dysthymia (33.3%), agoraphobia (28.6%), or panic (19.0%). Of the patients, 81% said they avoid places which remind them of the critical events. Impairments were suffered in work (70%), leisure (65%), and familial relations (57.1%).

The effect of n-3 fatty acids on coronary atherosclerosis: results from SCIMO, an angiographic study, background and implications

According to the model of "response to injury," the arterial endothelium is occasionally injured in hyperlipidemia, hypertension, diabetes mellitus and in other states known as risk factors. The ensuing inflammatory response is modulated by cytokines and growth factors, among them platelet-derived growth factor (PDGF), and monocyte chemoattractant protein-1 (MCP-1). In two independent studies, we demonstrated that mRNA levels for PDGF-A and -B and for MCP-1 are reduced after ingestion of n-3 fatty acids by human volunteers. This reduction persists after monocyte stimulation/differentiation by adherence. Moreover, the reduction is brought about only by dietary n-3 fatty acids and not by other classes of unsaturated fatty acids (n-6 or n-9). This appears to be one major mechanism of action of reduced progression/increased regression of established coronary artery disease by ingestion of 1.5 g/d n-3 fatty acids, as assessed by coronary angiography in a randomized placebo-controlled double-blind intervention study in 223 patients. The study was conducted according to "Good Clinical Practice," comprehensive rules regulating investigations with pharmaceutical compounds. Together, our investigations lend support to the importance of PDGF-A, PDGF-B, and MCP-1 in the pathogenesis of atherosclerosis, and the beneficial role of n-3 fatty acids therein.

Shaping in plant cells

Plant cells adopt a diversity of different shapes that are adapted to their specific functions. Central to the development of specialised form is the modification of cell-wall composition and organisation. A number of recent papers emphasise the importance of the cell wall to cell shaping, in the definition of both localised regions that are expandable and regions that are more resistant to mechanical forces. The organisation and activity of the cytoskeleton, and the activity of signalling pathways, are also essential in defining regions of the cell wall that will grow and those that will not. Although turgor has long been assumed to be a rather passive contributor to cell shaping, recent reports show that, in some cells, differential changes in turgor may have a role in establishing specialised cell form.

Synthesis and acetylcholinesterase inhibition of 5-desamino huperzine A derivatives

(E)- and (Z)-5-Desamino huperzine A derivatives have been synthesized using a new synthetic strategy towards the huperzine A skeleton. These derivatives showed AChE inhibition constants in the low micromolar range and thus display better activity than all previously synthesized C5 derivatives.

Enteral human IgG for prevention of necrotising enterocolitis: a placebo-controlled, randomised trial

BACKGROUND

Neonatal necrotising enterocolitis is a serious, commonly fatal disease in premature neonates. Although feeding with expressed breast milk and other good nursery practices are partly protective, preventive measures are needed. Treating neonates enterally with a mixture of human IgA and IgG, prepared from donated blood, has been claimed to protect against necrotising enterocolitis. However, no IgA preparation is available in Australia. Our aim, therefore, was to identify whether or not enteral IgG could prevent the disorder.

METHODS

We did a multicentre, double-blind, placebo- controlled trial. We randomly assigned 768 infants to receive human IgG 1200 mg/kg daily, and 761 to receive placebo, for up to 28 days. Treatment began at the same time as enteral feeding. The primary outcome measure was the proportion of infants who developed definite necrotising enterocolitis during the trial, and any deaths that resulted from the disorder in the treatment and placebo groups. Analysis was on an intention-to-treat basis.

FINDINGS

43 infants developed definite necrotising enterocolitis in the IgG group, ten of whom died. In the placebo group, 41 infants contracted the disorder and six died (p=0.47). 25 infants on IgG and 36 on placebo had suspect necrotising enterocolitis (p=0.14).

INTERPRETATION

Supplementation of enteral feeds with human IgG does not reduce necrotising enterocolitis.

[Wxanthema and acute polyarthritis in a young patient]

A young woman developed acute polysynovitis and vasculitis-like changes to the skin. Her blood cultures were positive for Neisseria meningitidis, enabling us to diagnose chronic meningococcemia. This finding was a surprise; in retrospect this diagnosis would not have been expected in light of the fact that there was no meningism, the patient's general condition was only slightly diminished and the temperatures were subfebrile. Besides an episode of vasculitis, the primary differential diagnosis of acute polysynovitis in young women should include a bacterial infection, for example with Neisseria. Usually, Neisseria gonorrhoeae (gonococci) are involved and, as in the case described, only very rarely Neisseria meningitidis (meningococci). The present case report is given to illustrate new clinical aspects of known, but rare disease, to remind clinicians to consider the differential diagnosis of acute polyarthritis and to generate discussion about the clinical signs and pathogenesis of reactive arthritides, in particular, Neisseria.

Structure-activity relationships in a series of bisquaternary bisphthalimidine derivatives modulating the muscarinic M(2)-receptor allosterically

Hexane-bisammonium-type compounds containing lateral phthalimide moieties are well-established ligands of the common allosteric binding site of muscarinic M(2) receptors. Previous structure-activity relationships (SAR) revealed two positively charged centers and two lateral phthalimide moieties in a defined arrangement to be essential of a high allosteric potency. The purpose of this study was to replace one carbonyl group of the phthalimides with hydrogens, hydroxy, alkoxy, phenyl, benzyl, and benzylidene groups in order to check the influence of these substituents on the allosteric activity in antagonist-linked receptors. The analysis of the quantitative SAR indicated that a high allosteric potency is related to a certain amount of rigidity as well as polarizibility and the ability to form hydrophobic interactions.

Nephrotoxic and peroxidative potential of meropenem and imipenem/cilastatin in rat and human renal cortical slices and microsomes

BACKGROUND

Carbapenems are a relatively new class of beta-lactam antibiotics characterized by a broad spectrum of antibacterial activity. Meropenem (MER), a new carbapenem has shown a lower nephrotoxic potential compared to imipenem (IMI). IMI is used in a fixed one-to-one combination with the nephroprotective agent cilastatin (CIL). The present studies examined whether MER and IMI/CIL produce peroxidative and nephrotoxic alterations including oxidative changes in rat and human renal cortical slices and microsomes.

MATERIALS AND METHODS

Untreated slices and microsomes were incubated in vitro for various periods of time in phosphate-buffered media containing various concentrations of MER, IMI/CIL or for comparison cephaloridine (CPH). Lipid peroxidation was monitored by the determination of malondialdehyde (MDA) in incubation media and slices in the presence or absence of antioxidants. Total glutathione, oxidized glutathione (GSSG), pyruvate-stimulated gluconeogenesis and paraaminohippurate (PAH) accumulation were measured in slices.

RESULTS

In rat renal cortical slices, MER, IMI/CIL and CPH induced a time- and concentration-dependent MDA production (content in incubation media plus slices). 5 mM MER, 5 mM IMI/CIL and 3 mM CPH were the lowest concentrations which caused a significant MDA production after 3 hs compared to control (control 61.5+/-15.3 nmol MDA/g tissue, MER 75.4+/-10.9, p<0.001; control 48.0+/-8.7, IMI/CIL 65.1+/-11.7, p<0.001; control 61.5+/-15.3, CPH 113.0+/-28.2, p<0.001). 20 mM MER, 20 mM IMI/CIL and 12 mM CPH revealed marked MDA production after 3 hs in human renal cortical slices (control 29.8+/-4.2 nmol MDA/g tissue, MER 49.4+/-8.7, p<0.01; control 27.6+/-7.0, IMI/CIL 68.3+/-9.9, p<0.001; control 32.5+/-7.7, CPH 93.8+/-31.6, p<0.001) and in human renal microsomes (control 1.0+/-0.9 nmol MDA/mg protein, MER 2.9+/-1.0, p<0.05; IMI/CIL 6.8+/-2.2, p<0.001; CPH 8.4+/-2.2, p<0.001), respectively. The corresponding MDA production was about 2-fold higher in rat renal cortical slices and almost the same in rat renal microsomes. Antioxidants reduced the MER-induced increase in MDA content in rat renal cortical slices by 48% (alpha-tocopherol, 10(-4) M), 72% ((+)-cyanidanol-3, 10(-5) M) and 100% (DPPD, N, N'-diphenyl-p-phenylendiamine, 10(-6) M). In rat renal cortical slices, MER and IMI/CIL induced an increase up to 50% in the content of GSSG and a corresponding %-decrease in reduced glutathione (GSH). In rat renal cortical slices, MER and IMI/CIL induced a time- and concentration-dependent decrease in PAH accumulation and gluconeogenesis. PAH accumulation was already reduced by 5 mM MER after 1 h (control slice to medium ratio 18.3+/-6.8, MER 10.7+/-1.9, p<0.05) and by 10 mM IMI/CIL after 3 h (control 16.9+/-5.6, IMI/CIL 5.5+/-1.3, p<0.001). Pyruvate-stimulated gluconeogenesis after 3 hs was already reduced by 2.5 mM MER (control 5.7+/-2.1 micromol glucose/g tissue/h, MER 3.9+/-1.1, p<0.05) and by 10 mM IMI/CIL (control 5.7+/-2.1, IMI/CIL 2.8+/-1.0, p<0.001).

CONCLUSION

Thus, MER and IMI/CIL (at concentrations more than 10-fold higher as peak plasma concentrations achieved in humans) revealed an oxidative change (depletion of GSH, production of GSSG), a peroxidative potential (production of MDA) and a nephrotoxic potential (reduction in pyruvate-stimulated gluconeogenesis and PAH accumulation). Human kidney seems to be less susceptible to beta-lactam antibiotic-induced lipid peroxidation than rat kidney.

LCC15-MB: a vimentin-positive human breast cancer cell line from a femoral bone metastasis

The LCC15-MB cell line was established from a femoral bone metastasis that arose in a 29-year-old woman initially diagnosed with an infiltrating ductal mammary adenocarcinoma. The tumor had a relatively high (8%) S-phase fraction and 1/23 positive lymph nodes (LN). Both the primary tumor and LN metastasis were positive for estrogen receptor (ER) and progesterone receptor (PgR), but lacked erbB2 expression. Approximately one year later, the patient presented with a 0.8 cm comedo-type intraductal mammary adenocarcinoma in the left breast that was negative for ER and PgR, but positive for erbB2. Thirty-five months after the initial diagnosis she was treated for acute skeletal metastasis, and stabilized with a hip replacement. At this time, tumor cells were removed from surplus involved bone, inoculated into cell culture, and developed into the LCC 15-MB cell line. The bone metastasis was a poorly differentiated adenocarcinoma lacking ER, PgR, and erbB2, characteristics shared by the LCC15-MB cells, although ER can be re-expressed by treatment of the LCC15-MB cells for 5 days with 75 microM 5-aza-2'-deoxycytidine. The LCC15-MB cell line is tumorigenic when implanted subcutaneously in NCr nu/nu mice and produces long-bone metastases after intracardiac injection. Although the bone metastasis from which the LCC15-MB cell line was derived lacked vimentin (VIM) expression, the original primary tumor and lymph node metastasis were strongly VIM positive, as are LCC15-MB cells in vitro and in nude mice. The karyotype and isozyme profiles of LCC15-MB cells are consistent with its origin from a human female, with most chromosome counts in the hypertriploid range. Thirty-two marker chromosomes are present. These cells provide an in vitro/in vivo model in which to study the inter-relationships between ER, VIM, and bone metastasis in human breast cancer.