Toward the elimination of hepatitis B: networking to promote the prevention of vertical transmission of hepatitis B virus through population-based interventions and multidisciplinary groups in Africa

The WHO African Region had 81 million people with chronic hepatitis B in 2019, which remains a silent killer. Hepatitis B virus (HBV), hepatitis delta virus (HDV), and HIV can be transmitted from the mother to child. If the HBV infection is acquired at infancy, it may lead to chronic hepatitis B in 90% of the cases. WHO reports that 6.4 million children under 5 years live with chronic hepatitis B infection worldwide. The prevention of mother-to-child transmission (PMTCT) of HBV is therefore critical in the global elimination strategy of viral hepatitis as we take lessons from PMTCT of HIV programs in Africa. We sought to create a network of multidisciplinary professional and civil society volunteers with the vision to promote cost-effective, country-driven initiatives to prevent the MTCT of HBV in Africa. In 2018, the Mother-Infant Cohort Hepatitis B Network (MICHep B Network) with members from Cameroon, Zimbabwe, and the United Kingdom and later from Chad, Gabon, and Central African Republic was created. The long-term objectives of the network are to organize capacity-building and networking workshops, create awareness among pregnant women, their partners, and the community, promote the operational research on MTCT of HBV, and extend the network activities to other African countries. The Network organized in Cameroon, two "Knowledge, Attitude and Practice" (KAP) surveys, one in-depth interview of 45 health care workers which revealed a high acceptability of the hepatitis B vaccine by families, two in-person workshops in 2018 and 2019, and one virtual in 2021 with over 190 participants, as well as two workshops on grant writing, bioethics, and biostatistics of 30 postgraduate students. Two HBV seroprevalence studies in pregnant women were conducted in Cameroon and Zimbabwe, in which a prevalence of 5.8% and 2.7%, respectively, was reported. The results and recommendations from the MICHep B Network activities could be implemented in countries of the MICHep B Network and beyond, with the goal of providing free birth dose vaccine against hepatitis B in Africa.

Fuzzy AHP point factored inference system for detection of cardiovascular disease

The World health organization (WHO) reported that cardiovascular disease is the leading cause of death worldwide, particularly in developing countries. But while diagnosing cardiovascular disease, medical practitioners might have differences of opinions and faced challenging when there is inadequate information and uncertainty of the problem. Therefore, to resolve ambiguity and vagueness in diagnosing disease, a perfect decision-making model is required to assist medical practitioners in detecting the disease at an early stage. Thus, this study designs a fuzzy analytic hierarchy process (FAHP) point-factored inference system to detect cardiovascular disease. The attributes are selected and classified into sub-attributes and point factor scale using the clinical data, medical practitioners, and literature review. Fuzzy AHP is used in calculating the attribute weights, the strings are generated using the Mamdani fuzzy inference system, and the strength of each set of fuzzy rules is calculated by multiplying the attribute weights with the point factor scale. The string weights determine the output ranges of cardiovascular disease. Moreover, the results are validated using sensitivity analysis, and comparative analysis is performed with AHP techniques. The results show that the proposed method outperforms other methods, which are elucidated by the case study.

An intuitionistic dense fuzzy AHP- TOPSIS method for military robot selection

Land, marine and airborne are the three types of military robots used in the War-field. Land robots are the most crucially considered robots. Selecting a military land robot for a specific purpose is one of the challenging problems for a decision-maker to find the most preferred alternative when it includes fuzziness. Intangible factors are used while selecting the appropriate robotic system as it effectively deals with fuzziness. Intuitionistic dense fuzzy set, which is the combination of intuitionistic fuzzy set and dense fuzzy set, is capable of dealing with intangible factors. This study aims to design the integrated model on intuitionistic dense fuzzy AHP-TOPSIS to choose the most preferable military land robots under various circumstances. Robots for different types of situations, namely bomb disposal, search and rescue, surveillance and reconnaissance and war-fighter are considered. Moreover, the intuitionistic dense fuzzy AHP is utilized to calculate the subjective weights of the criteria and intuitionistic dense fuzzy TOPSIS is used to rank the alternatives. Further, a sensitivity analysis is examined to demonstrate the quality of the outcome and the results are compared with the fuzzy set, intuitionistic fuzzy set, and dense fuzzy set to show the efficiency of the proposed methodology.

Systemic juvenile idiopathic arthritis in French Afro-Caribbean children, a retrospective cohort study

INTRODUCTION

The epidemiology and clinical presentation of systemic juvenile idiopathic arthritis (sJIA) in the Afro-Caribbean population is not well described.

METHODS

Retrospective study conducted between January 2000 and January 2022 in the French Overseas Departments of America. Clinical data were obtained from multiple sources: computerized hospital archives, registries of referring pediatricians, and the French National Registry for rare diseases. The disease studied was sJIA defined according to international criteria.

RESULTS

Twenty-five patients were identified. Mean age at diagnosis was 7.5 years (range: 1.2-14.9 years) and mean duration of follow-up was 5.2 years (range: 0.5-16 years). All patients had joint involvement at diagnosis with 68% presenting inflammatory arthritis and 32% inflammatory joint pain. Sixteen percent had coronary involvement at onset. More than half (52%) suffered from macrophage activation syndrome (MAS) during childhood (32% at onset). The mean number of flares in childhood was 2 (Range: 1-5). Sixty-eight percent of patients had disease control during childhood without biotherapy. The most frequent second line treatment was anakinra (7/8). There was no difference in clinical or biological severity according to gender. The median duration of treatment during childhood was 5 months (range: 2-144) and 72% had a cumulative treatment duration of less than one year.

CONCLUSION

These patients of Afro-Caribbean origin suffering from sJIA showed some specificities, such as a higher rate of MAS and coronary involvement at onset. The incidence per year was stable over a 20-year period. Overall outcomes during childhood were similar to western countries.

Histology-verified myocardial fibrosis and quantification in severe AS patients: correlation with non-invasive LV myocardial tissue assessment

Background

Myocardial fibrosis (MF) is a common finding and a potential adverse prognostic marker in several cardiac diseases, including in severe aortic stenosis (AS). While histological analysis obtained through endomyocardial biopsy remains the gold-standard for MF assessment, non-invasive cardiac imaging may offer surrogate biomarkers for fibrosis. We tried to assess the correlation between MF quantification at histopathology and cardiac magnetic resonance (CMR)-derived tissue characterization data in patients with severe AS.

Methodology

Single-center prospective cohort enrolling 71 patients with severe symptomatic high-gradient AS undergoing surgical aortic valve replacement (SAVR) (mean age 71±9 years; 49% male, mean valvular transaortic gradient 60±20 mmHg; mean left ventricle [LV] ejection fraction 58±9%). Those with past history of myocardial infarction or cardiomyopathy were excluded. All patients underwent pre-operative CMR study with LV tissue characterization and quantification. Normal T1 mapping value was defined as >1021ms as per center protocol. Myocardial tissue was obtained during SAVR either through myocardial biopsy at basal LV septum or harvested from surgical myectomy specimens. Masson's trichrome stain was used for collagen/fibrosis assessment. Automatic quantification was obtained at QuPathTM digital pathology software after applying a dedicated artificial intelligence algorithm on ultra-high-resolution digital slide scanning images.

Results

Histology-confirmed MF was observed in all patients (median percentage of fibrotic myocardial tissue 15% [IQR 9–22%]). Median global T1 mapping and extracellular volume (ECV) percentage was 1048ms (IQR 1027–1078) and 24% (IQR 20–30%), respectively. Late gadolinium enhancement (LGE) with a non-ischemic pattern was present in 42 patients (59%) with a median LGE mass of 5.8g [IQR 1.0–10.2]; median percentage of 3.7% [IQR 0.6–10.4]. While neither T1 mapping (global or basal LV septum), ECV nor LGE had any significant correlation with histology-confirmed MF (Figure 1) the vast majority had significantly elevated global and basal LV septum T1 mapping – 81% and 92%, respectively.

Conclusion

In this single-center prospective study, microscopic MF was present in all patients with severe symptomatic high-gradient AS, was accompanied by elevated T1 mapping values but no correlation was found between myocardial fibrosis at histopathology analysis and CMR-derived LV tissue characterization parameters. This may not only stem from sampling (single point biopsy vs. whole myocardial tissue assessment) but also from distinct evaluation of different types of fibrosis by different methods.

Funding Acknowledgement

Type of funding sources: None.

An intuitionistic fuzzy decision support system for COVID-19 lockdown relaxation protocols in India

In January 2020, the World Health Organization (WHO) identified a world-threatening virus, SARS-CoV-2. To diminish the virus spread rate, India implemented a six-month-long lockdown. During this period, the Indian government lifted certain restrictions. Therefore, this study investigates the efficacy of India's lockdown relaxation protocols using fuzzy decision-making. The decision-making trial and evaluation laboratory (DEMATEL) is one of the fuzzy MCDM methods. When it is associated with intuitionistic fuzzy circumstances, it is known as the intuitionistic fuzzy DEMATEL (IF-DEMATEL) method. Moreover, converting intuitionistic fuzzy into a crisp score (CIFCS) algorithm is an aggregation technique utilized for the intuitionistic fuzzy set. By using IF-DEMATEL and CIFCS, the most efficient lockdown relaxation protocols for COVID-19 are determined. It also provides the cause and effect relationship of the lockdown relaxation protocols. Additionally, the comparative study is carried out through various DEMATEL methods to see the effectiveness of the result. The findings would be helpful to the government's decision-making process in the fight against the pandemic.

POS1295 SYSTEMIC AND AUTO-INFLAMMATORY DISEASES OF PEDIATRIC ONSET: THE EXPERIENCE OF THE FRENCH OVERSEAS DEPARTMENTS OF AMERICA

Background

Systemic diseases of pediatric onset are more frequent in Afro-Caribbean population, especially Pediatric systemic lupus (pSLE).

Objectives

Our work is a retrospective study of patients followed in French overseas departments of America for systemic disease or auto-inflammatory syndrome of pediatric onset. It describes their clinical and biological specificities at diagnosis, during childhood and early adulthood.

Methods

Our retrospective study was conducted between 01/01/2000 and 01/09/2021. Listings of adult patients with pediatric onset and pediatric patients were obtained in each center through computerized hospital archives, list of patients followed by referent pediatricians and adult specialists in internal medicine and the French National Registry for rare disease. Data were then gathered by going through their medical files. The spectrum of diseases studied included pSLE, Sjogren syndrome, antiphospholipid syndrome (APS), connectivitis, systemic scleroderma, dermatomyositis, Systemic juvenile idiopathic arthritis (sJIA), unclassified auto-inflammatory syndrome.

Results

2148 patients were identified on a 21 year-period, and 135 patients were included. Most patients diagnosed with a systemic pathology (102) suffered from pSLE (53%), followed by dermatomyositis (17%). Average follow up was 8.3 years (0.3 - 25 years), median age at last follow up was 21.2 (14 - 36.7). We found an increase in the number of new diagnoses throughout the years. For pSLE, sex repartition was 4/1 girl/boy and did not vary according to age (p= 0,31). At onset, patients had 10 Sclicc criteria (4-12) and median EULAR/ACR 2019 score was 38 (12 - 54). The combination of typical skin involvement, arthritis and fever was found for 87%. At onset, a third of patients had renal involvement, 15% had Neurolupus and 41% cardiac involvement. All patients had a positive ANA and Anti-DNA antibodies, followed by anti-Ssa/Ssb antibodies (78%), Anti-Sm (78%) and anti RNP (52%). During childhood, 54% had renal involvement and 26% suffered from Neurolupus. Patients suffered in median from 3 flares and 26% suffered from more than 5 flares during childhood. Pre-pubertal patients (26%) had worst outcomes, 93% had renal and / or neurological involvement, they had more flares (median at 5 p = 0,02) and needed an average of 4 background therapies (p = 0,04). Boys seemed to have better disease control at transition to adult care but gender was not an independent predictor of severity during childhood (p = 0,21). 17 patients had dermatomyositis, 29% of them had respiratory involvement during childhood. 33 patients had auto-inflammatory syndromes mostly sJIA (67%), 50% of them had hemophagocytic syndrome during childhood and their disease was controlled by steroids for 64%, 36% needed biotherapy. The overall mortality was 3%.

Conclusion

This is a large cohort of patients of Afro-Caribbean origin with a higher frequency of pSLE. Although the outcomes for these patients were similar to western countries, they had loud symptoms at onset, not corelated to delay at diagnosis. Compared to ethnic studies of North America or Africa, the French health care system being universal and free, the bias related to socio-economic status was lower. This work will continue with the exploration by transcriptomic and genetic tests for early and severe forms to identify the extra-environmental causes. The environmental factors specific to these regions should be explored in additional prospective studies.

Figure 1.

Clinical and biological characteristics of patients with pediatric onset systemic lupus. Orange: clinical signs at onset, Green: immunological profile, Blue: evolutive profile and proportion of organ involvement during childhood. ANA: anti-nuclear antibody.

Disclosure of Interests

None declared

Designing DEMATEL method under bipolar fuzzy environment

Bipolar fuzzy graph is more precise than a fuzzy graph when dealing with imprecision as it is focusing on the positive and negative information of each vertex and edge. Nowadays, researchers have utilized bipolar fuzzy graphs in decision-making problems. Bipolar fuzzy competition graphs aid to compute the competition between the vertices in bipolar fuzzy graphs. To depict the best competitions among the competitions of bipolar fuzzy graphs, the best bipolar fuzzy competition graph can be defined using bipolar fuzzy α-cut and the strength of the competition between the vertices can also be determined. Fuzzy graphs are used well to frame modelling in real-time problems. In particular, when the real-time scenario is modelled using the bipolar fuzzy graph, it gives more precision and flexibility. At present, researchers have focused on decision-making techniques with bipolar fuzzy graphs. The DEMATEL method is one of the powerful decision-making tools. It effectively analyses the complicated digraphs and matrices. The fuzzy DEMATEL technique can convert the interrelations between factors into an intelligible structural model of the system and divide them into cause and effect groups. Therefore, this study attempts to design the DEMATEL method under the bipolar fuzzy environment. To illustrate this proposed technique, the problem of identifying the best mobile network is taken. With this method, the benefits and drawbacks of networks are measured and a complicated bipolar fuzzy directed graph can be transformed into a viewed structure.

Evaluation and Cardiac Rehabilitation on a patient with a congenital heart disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

Severe congenital heart disease (CHD) requiring surgical intervention occurs in 6 of 1000 live-born infants. Substantial improvements in surgical treatment and perioperative care have led to excellent long-term cardiac outcomes for most of these patients and, consequentially, to a significant increase in survival rates.

Formal evaluations of preschool, school-aged children and adolescents born with complex CHD demonstrate a pattern of neurodevelopmental sequelae, which may appear alone, or in combination.

Purpose

F. is a 21 years-old patient with repaired complex transposition of the great arteries with ventricular septal defect, who have already undergone three surgeries: a) an initial palliative surgery (pulmonary artery banding and ductus arteriosus ligation) at the neonatal period; b) a corrective surgery (arterial switch and VSD closure) at the end of the first year of life and c) Pulmonary artery plasty for residual pulmonary stenosis at the age of 16 years-old. Now, he was admitted to our department for urgent wide-complex tachycardia treatment.  His initial assessment documented a subjectively impaired motor development, and subsequently, a formal assessment was performed.

Methods

The Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2) is an individually administrated test that resorts to a series of engaging, goal-directed activities to measure a wide array of motor skills in individuals ages 4 through 21. The BOT-2 uses a subtest and composite structure that highlights motor performance in the broad functional areas of stability, mobility, strength, coordination, and object manipulation.

Results

Patient"s performance in the four main motor skill areas will be report, namely: Fine Manual Control, Manual Coordination, Body Coordination, and Strength and Agility. Because Fabio completed all four parts of the BOT-2, a comprehensive score from all four areas, the Total Motor Composite, will also be reported. Fabio"s scores were compared to the ones of a control group of age and gender-matched individuals.

This Patient started sessions of Cardiac Rehabilitation. The rehabilitation sessions are conducting for 1 hour three times a week for 1 year. This program still in progress, but we speculate that the will improve his motor abilities and developmental skills.

Conclusion

The risk of a poor developmental outcome varies according to the specific cardiac effect. In addition, there is significant interindividual variation in developmental outcome even among children with the same cardiac defect. Other factors may contribute to neurologic dysfunctions. These factors can be divided into three main categories and time-frames: prenatal, perioperative and post-discharge.

Cognitive appraisal in fish: stressor predictability modulates the physiological and neurobehavioural stress response in sea bass

The role of cognitive factors in triggering the stress response is well established in humans and mammals (aka cognitive appraisal theory) but very seldom studied in other vertebrate taxa. Predictability is a key factor of the cognitive evaluation of stimuli. In this study, we tested the effects of stressor predictability on behavioral, physiological and neuromolecular responses in the European sea bass (Dicentrarchus labrax). Groups of four fish were exposed to a predictable (signalled) or unpredictable (unsignalled) stressor. Stressor predictability elicited a lower behavioural response and reduced cortisol levels. Using the expression of immediate early genes (c-fos, egr-1, bdnf and npas4) as markers of neuronal activity, we monitored the activity of three sea bass brain regions known to be implicated in stressor appraisal: the dorsomedian telencephalon, Dm (putative homologue of the pallial amygdala); and the dorsal (Dld) and ventral (Dlv) subareas of the dorsolateral telencephalon (putative homologue of the hippocampus). The activity of both the Dm and Dlv significantly responded to stressor predictability, suggesting an evolutionarily conserved role of these two brain regions in information processing related to stressor appraisal. These results indicate that stressor predictability plays a key role in the activation of the stress response in a teleost fish, hence highlighting the role of cognitive processes in fish stress.

Microbial Oxidation of Hydrocarbons: Properties of a Soluble Methane Monooxygenase from a Facultative Methane-Utilizing Organism, Methylobacterium sp. Strain CRL-26

Methylobacterium sp. strain CRL-26 grown in a fermentor contained methane monooxygenase activity in soluble fractions. Soluble methane monooxygenase catalyzed the epoxidation/hydroxylation of a variety of hydrocarbons, including terminal alkenes, internal alkenes, substituted alkenes, branched-chain alkenes, alkanes (C(1) to C(8)), substituted alkanes, branched-chain alkanes, carbon monoxide, ethers, and cyclic and aromatic compounds. The optimum pH and temperature for the epoxidation of propylene by soluble methane monooxygenase were found to be 7.0 and 40 degrees C, respectively. Among various compounds tested, only NADH(2) or NADPH(2) could act as an electron donor. Formate and NAD (in the presence of formate dehydrogenase contained in the soluble fraction) or 2-butanol in the presence of NAD and secondary alcohol dehydrogenase generated the NADH(2) required for the methane monooxygenase. Epoxidation of propylene catalyzed by methane monooxygenase was not inhibited by a range of potential inhibitors, including metal-chelating compounds and potassium cyanide. Sulfhydryl agents and acriflavin inhibited monooxygenase activity. Soluble methane monooxygenase was resolved into three components by ion-exchange chromatography. All three compounds are required for the epoxidation and hydroxylation reactions.

Intracapsular carcinoma ex pleomorphic adenoma. Report of a case with unusual metastatic behaviour

Intracapsular carcinomas ex pleomorphic adenoma are exceedingly rare salivary glands tumours, known to have a benign clinical behaviour with metastatic unrecognised potential. We report a case of a 57-year-old female patient presenting with a typical example of intracapsular carcinoma ex pleomorphic adenoma of the parotid gland and evidence of ipsilateral cervical lymph node metastases two years before. The behaviour of this unique case illustrates the disputed malignancy of carcinomas arising within encapsulated pleomorphic adenomas.

A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms

We describe the impact of a psychosocial intervention, critical time intervention (CTI), on the cardinal symptom dimensions of schizophrenia, namely negative, positive, and general psychopathology. Ninety-six men with schizophrenia and other psychotic disorders who were discharged from a homeless shelter were randomly assigned to receive either CTI or usual services only. CTI is a time-limited intervention designed to enhance continuity of care during the transition from institution to community. Symptom severity at baseline and at 6 months was assessed using the Positive and Negative Syndrome Scale. Using data on 76 subjects for whom we have complete symptom data, we assessed the impact of CTI on change in symptoms. The results suggest that CTI was associated with a statistically significant decrease in negative symptoms at the 6-month follow-up, reflecting modest clinical improvement. There was no significant effect on positive or general psychopathology symptoms.

Risk factors for homelessness among indigent urban adults with no history of psychotic illness: a case-control study

OBJECTIVES

This study identified risk factors for homelessness among indigent urban adults without dependent children and with no history of psychotic illness.

METHODS

We conducted a matched case-control study, stratified by sex, of 200 newly homeless men and women and 200 indigent men and women with no history of homelessness. Newly homeless case subjects were recruited from shelter assessment centers in New York City. Never-homeless control subjects, selected from public assistance centers, were single adults applying for home relief. Control subjects were matched with case subjects according to ethnicity, age, and sex. Trained interviewers employed standardized research instruments to probe 3 domains of risk factors: symptom severity and substance use disorder, family support and functioning, and prior use of services.

RESULTS

Significant interaction effects by sex were present for symptom severity, heroin use disorder, and prior service use. Greater numbers of the homeless of both sexes lacked a high school diploma and had less income from all sources, including from their families, than of the never homeless.

CONCLUSIONS

Newly homeless men and women with no history of psychotic illness differed from their never-homeless counterparts in the 3 domains investigated, but socioeconomic factors were also important.

Human immunodeficiency virus sexual risk reduction in homeless men with mental illness

BACKGROUND

The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness.

METHODS

Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active before the trial were the main target of the intervention. Sexual risk behavior was the primary outcome.

RESULTS

Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up.

CONCLUSIONS

This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.

Childhood experiences and current adjustment of offspring of indigent patients with schizophrenia

OBJECTIVE

This study reports the childhood experiences, current life situation and level of adjustment, and prior mental health service use of offspring of indigent people with schizophrenia.

METHODS

Sixty-eight patient-parents were asked for consent for researchers to contact their adolescent and adult offspring. Thirty-nine consenting offspring were interviewed with an assessment battery that included measures of current occupational and social functioning, psychiatric status, and mental health service use.

RESULTS

Interviewed offspring were raised in an average of three different settings from birth to 18 years of age. Relatives, particularly grandparents and aunts, were more likely to provide surrogate parenting than were nonkin foster parents and were more significant nurturing figures than biological parents. The typical offspring had a high school diploma, was gainfully employed, and was involved with a spouse or household partner or had a close friend. Twenty-three of the 39 offspring had children, and most were raising their children alone. Ten offspring had a diagnosis of major depression, schizoaffective disorder, or drug or alcohol abuse, but none had a diagnosis of schizophrenia. Four of the ten offspring with a psychiatric diagnosis had never been treated.

CONCLUSIONS

Findings underscore the need for long-term studies of families with a parent who is a psychiatric patient. Rehabilitation efforts should include extended family who play a critical role in raising offspring during periods when patient-parents are unable to do so. Offspring should be included in efforts to educate families about schizophrenia.

Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter

OBJECTIVES

This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care.

METHODS

Ninety-six men with severe mental illness who were entering community housing from a shelter institution were randomized to receive 9 months of a "critical time" intervention plus usual services or usual services only. The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period. To elucidate time trends, survival curves were used.

RESULTS

Over the 18-month follow-up period, the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group. Survival curves showed that after the 9-month period of active intervention, the difference between the two groups did not diminish.

CONCLUSIONS

Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness, even after the period of active intervention.

Restoration of the transcription activation function to mutant p53 in human cancer cells

The p53 tumor suppressor gene product is a sequence-specific transcription activator frequently mutated in a variety of human malignancies. Typically, tumor-derived p53 missense mutants are defective in DNA binding and this is likely to result in a failure to active p53-regulated genes. Hence, restoring function to mutant p53 represents an attractive target to develop a novel cancer chemotherapeutic agent. We now show that a small chemically modified peptide derived from p53 restores sequence-specific DNA binding to a subset of p53 mutants. Moreover, when microinjected into human colon carcinoma cells this peptide restores the transcription activation function to endogenous mutant p53 protein. This is the first example showing that a small peptide molecule can reverse the effect of several inactivating missense mutations and restore protein function.

Immunization against growth hormone releasing factor or chronic feed restriction initiated at 3.5 months of age reduces ovarian response to pulsatile administration of gonadotropin-releasing hormone at 6 months of age and delays onset of puberty in heifers

A severe or moderate suppression of serum insulin-like growth factor I (IGF-I) was induced in heifers, beginning at 104 days of age, by active immunization against growth hormone-releasing factor (GRFi) or by chronic feed restriction (RES), respectively. We hypothesized that reduced serum IGF-I results in decreased serum estradiol-17 beta (E2), which in turn delays onset of puberty. The objectives of this experiment were to determine 1) whether GRFi and RES would alter follicular development and delay onset of puberty through similar mechanisms, and 2) whether GnRH would enhance follicular growth in control, GRFi, and RES heifers at 6 mo of age. Changes in IGF-I, somatotropin, LH, FSH, and E2 were evaluated. Serum IGF-I was greater in control than in RES heifers, and was greater in both these groups than in GRFi heifers by 169 days of age. Basal LH decreased in control and RES but not in GRFi heifers from 136 to 157 days of age. During the same period, a decrease in mean FSH was detected in control but not in GRFi and RES heifers. RES decreased mean serum E2 from 148 to 183 days of age. At 6 mo of age, pulsatile administration of GnRH (5 micrograms every 2 h for 42-46 h) increased serum LH and FSH similarly across treatments but had no effect on the number of follicles > or = 8 mm in GRFi and RES heifers relative to saline treatment. Serum E2 and IGF-I in follicular fluid from follicles > or = 8 mm were increased in all GnRH-treated heifers; however, concentrations of both hormones were lower in GRFi than in control or RES heifers. The main effect of treatments on serum IGF-I was reflected in follicles < or = 7 mm; follicular fluid IGF-I was greater in control than in RES heifers and was greater in both these groups than in GRFi heifers. Serum E2 was lower in RES than in control and GRFi heifers from 253 to 281 days of age. Because of an interaction, E2 was lower in GRFi-GnRH than in control-GnRH heifers but similar in GRFi-saline and control-saline heifers. By 393 days of age, 0% of RES and 32% of GRFi heifers had reached puberty compared to 71% of control heifers. These data support our hypothesis that decreased serum IGF-I results in decreased serum E2. GRFi appears to delay puberty in heifers because decreased serum IGF-I impairs the ovary's ability to synthesize preovulatory concentrations of E2, thereby delaying stimulation of an LH surge. In contrast, RES may delay puberty by delaying follicular development at two stages: a) decreased IGF-I in follicles < or = 7 mm may delay predominant follicular growth, and b) decreased LH may delay maturation of the preovulatory follicle.

Prognostic significance of biomarkers (c-erbB-2, p53, proliferating cell nuclear antigen, and DNA content) in salivary duct carcinoma

Salivary duct carcinoma (SDC), a rare neoplasm of the major salivary glands, is a high-grade carcinoma with a predilection for elderly men. The authors investigated the prognostic role of p53, c-erbB2, proliferating cell nuclear antigen (PCNA), and DNA flow cytometry in a pathobiological evaluation of a cohort of 30 patients with these neoplasms. The patient group comprised 24 men and 6 women, with ages ranging from 22 to 87 years (mean = 61 years). Twenty-eight tumors were located in the parotid gland and two in the submandibular gland. Tumor size ranged from 1.0 to 8.0 cm (mean = 3.48 cm). Regional metastases were found in 73.3% (22 patients), systemic metastases in 43.3% (13 patients), and recurrences in 8 (26.6%) patients. DNA aneuploidy was found in 18 tumors (58.0%) and DNA diploidy in 12 (42%), with proliferative fractions ranging from 8.60% to 15.5 (mean = 10.6%). p53 protein nuclear immunostaining was positive in 56.6% and c-erbB2 overexpression was observed in 63% of the tumors. PCNA positivity ranged from 16.5% to 91.0%, with a mean of 49.5%. p53 immunopositivity, DNA aneuploidy, high growth, and proliferative fractions by PCNA and flow cytometry did not correlate with patient outcome. These results indicate that tumor size (P = .05), distant metastasis (P = .006), and C-erbB2 amplification (P = .04) are independent prognostic parameters in patients with salivary duct carcinoma.

Endocrine and ovarian responses to exogenous estradiol-17 beta in 6-month-old heifers previously immunized against growth hormone-releasing factor

We hypothesized that estradiol-17 beta (E2) was capable of stimulating an LH surge in 6-mo-old heifers immunized against growth hormone-releasing factor (GRFi). To test this hypothesis Angus x Simmental heifers were immunized against GRF (n = 11) or human serum albumin (HSAi) (n = 6) at 113 d of age. Heifers were injected i.m. with 500 micrograms of E2 at 172 d of age. To characterize the LH response, samples were collected at frequent intervals for 1 h before and 32 h after E2. To assess ovarian responses, real-time ultrasonography was performed from d 9 to 20, and serum progesterone was evaluated from d 6 to 25 after E2, then weekly for 13 wk. Exogenous E2 stimulated (P < .001) LH surges, preceded by negative E2 feedback that decreased serum LH, in all GRFi and HSAi heifers. During the negative feedback period, serum LH was greater (P < .001), and the change in LH from before to after E2 was lower (P < .05), in GRFi than in HSAi heifers. Puberty occurred in 7/17 heifers within 66 d after receiving E2. We conclude that GRFi does not impair the release of an E2-induced LH surge, but it does decrease hypothalamo-hypophyseal sensitivity to the inhibitory effect of E2.

Membrane topology of the rat kidney neutral and basic amino acid transporter

A recently cloned rat kidney protein (NBAT) mediates the sodium-independent transport of neutral as well as basic amino acids and cystine when expressed in Xenopus laevis oocytes. The human equivalent of this transporter may be the one that is defective in cystinuria. Immunocytochemical studies have indicated that NBAT is primarily localized in the brush border membranes of rat kidney and intestinal epithelial cells, a localization consistent with its proposed role in amino acid transport. Two contrasting topological models have been proposed for NBAT: a four membrane-spanning domain (MSD) Nin-Cin model and a single MSD Nin-Cout model. We have investigated the topology of this membrane protein using two different approaches. One method was an immunofluorescent labeling technique in which intact or membrane-permeabilized cells expressing NBAT were probed with antibodies directed against putative extracellular and intracellular domains of the protein. In the second method, fragments generated by limited surface proteolysis of intact brush border membrane vesicles were subjected to immunoblot analysis using several site-specific antibodies. Both approaches yielded results consistent with a four MSD Nin-Cin topological model for NBAT.

Correlates of codisorders in homeless and never homeless indigent schizophrenic men

We recently completed a case-control study of 100 literally homeless and 100 never homeless indigent schizophrenic men in New York City, in which concurrent substance abuse and antisocial personality disorder were widespread. In this paper we probe the correlates of 'pure' schizophrenia (single disorder, N = 60), schizophrenia and substance abuse (double disorder, N = 89), and schizophrenia, substance abuse, and antisocial personality disorder (triple disorder, N = 50), across the homeless/never homeless distinction. Subjects were recruited from a homeless shelter and mental health service programmes in Upper Manhattan. Psychologist and social worker interviewers administered the Structured Clinical Interview for DSM-III-R, I, and II and other structured instruments to explore social, family and illness history, the current illness, and aspects of treatment and family support. Codisorder subjects emerged from more disadvantaged family backgrounds, experienced greater school difficulties, began drug use in early adolescence, were more prone to hyperactivity in childhood, and were more likely to have spent time in jail. While codisorder groups did not differ on key aspects of schizophrenia, the triple disorder group was found to suffer from a more severe form of substance abuse than double disorder subjects, associated with an earlier age of onset and abuse of a wider array of substances. The widespread prevalence of codisorders among indigent schizophrenic men has major significance for clinical psychiatry. Study of the correlates of codisorders has revealed important differences in social, family, and illness history which may guide the development of more effective treatments and improved service delivery.

Radioimmunoassays for the C-terminus of prothymosin alpha and the N-terminus of parathymosin alpha for the measurement of the levels of alpha-thymosins in human cancer

A radioimmunoassay specific for the C-terminus of human prothymosin alpha was developed using the synthetic peptide [Cys-Aca degrees]-human prothymosin alpha (90-109)-OH coupled to KLH as antigen and the analogue [Tyr-Aca degrees]-human prothymosin alpha (90-109)-OH labelled with 125I as tracer. The radioimmunoassay measured intact prothymosin alpha, in the range of 2-100 pmol and does not cross-react with the partly homologous polypeptide parathymosin alpha. A major epitope was located in the segment 95-107. A radioimmunoassay specific for the N-terminus of human parathymosin alpha, also measuring intact parathymosin alpha in the range of 1-20 pmol and not cross-reacting with prothymosin alpha, was developed using the synthetic peptide [Cys-Aca degrees]-human parathymosin alpha (1-30)-OH as antigen coupled to KLH and the analogue [Tyr-Aca degrees]-human parathymosin alpha (1-10)-OH labelled with 125I as tracer. A major epitope was located in the segment 1-10. These radioimmunoassays, together with a previously established radioimmunoassay for the N-terminus of prothymosin alpha, permitted the identification of the molecular forms of the cross-reactive materials in both normal and neoplastic breast tissue extracts as intact prothymosin alpha and parathymosin alpha. It was also possible to reveal significantly higher levels of both alpha-thymosins in breast cancer tissue compared to the nearby healthy tissue--the mean of 14 samples was over 14-fold higher--suggesting a role of both prothymosin alpha and parathymosin alpha in cell proliferation. The reported radioimmunoassays are expected to facilitate the search for prognostic and/or diagnostic applications of these polypeptides in human cancer.

Risk factors for homelessness among schizophrenic men: a case-control study

OBJECTIVES

To identify risk factors for homelessness among the severely mentally ill, we conducted a case-control study of 100 indigent schizophrenic men meeting criteria for literal homelessness and 100 such men with no homeless history.

METHODS

Subjects were recruited from shelter, clinic, and inpatient psychiatric programs in Upper Manhattan. Clinical interviewers employed standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use.

RESULTS

Homeless subjects showed significantly higher levels of positive symptoms, higher rates of a concurrent diagnosis of drug abuse, and higher rates of antisocial personality disorder. Homeless subjects experienced greater disorganization in family settings from birth to 18 years and less adequate current family support. Fewer homeless subjects than subjects in the never-homeless comparison group had a long-term therapist. These differences remained when demographic variables were adjusted statistically.

CONCLUSIONS

Homeless schizophrenic men differed from their domiciled counterparts in all three domains we investigated; family background, nature of illness, and service use history. Findings are discussed in relation to policy and programs for the severely mentally ill.

Follow-up of chronically homeless mentally ill men

OBJECTIVE

To supply information on the efficacy of on-site day treatment for homeless mentally ill men in shelters, the authors followed up homeless mentally ill men 18 months after placement in community housing.

METHOD

The 42 subjects had been evaluated before and 6 months after entering an on-site day treatment program. The authors reinterviewed 34 of these patients again 1 year after the first follow-up to determine housing status, hospitalization, aftercare, criminal justice contacts, income, and employment.

RESULTS

By the 18-month follow-up the positive effects of the program at 6 months had deteriorated; 44% of the men had returned to shelters at some point during the follow-up period, and the number of men with criminal justice contacts had increased to a proportion exceeding that before the program. A concurrent diagnosis of substance abuse increased the risk of homelessness during follow-up.

CONCLUSIONS

These findings underscore the need for innovative treatment and support services for the homeless mentally ill who have concurrent substance abuse.

Characterization of the rat neutral and basic amino acid transporter utilizing anti-peptide antibodies

High-titer, site-specific antibodies have been produced against the rat kidney broad-spectrum, sodium-independent neutral and basic amino acid transporter (NBAA-Tr) whose cDNA we cloned earlier. These antibodies have allowed us to characterize the transporter protein in normal rat tissues and in various cellular and in vitro expression systems. Western analysis detected 84- to 87-kDa glycosylated species enriched in rat renal and jejunal epithelial cell brush border membranes. In vitro translation of NBAA-Tr complementary RNA in the rabbit reticulocyte lysate system yielded a 78-kDa protein, a molecular mass that was predicted by the amino acid sequence deduced from the cloned cDNA. Translation in the presence of rough microsomal membranes yielded a glycosylated 89-kDa species. Glycosylated 87- to 89-kDa species were also expressed in Xenopus oocytes microinjected with NBAA-Tr complementary RNA and in COS-7 cells transfected with NBAA-Tr cDNA. Localization of NBAA-Tr in renal and intestinal brush border membranes is consistent with its proposed role in transepithelial transport of amino acids.

Type-specific and cross-reactive epitopes in human papillomavirus type 16 capsid proteins

Genital human papillomavirus (HPV) 16 infection is frequently associated with cancer of the uterine cervix, as well as with precancerous lesions. In order to generate serologic reagents which might be useful in the diagnosis of HPV 16 infection, rabbit polyclonal and mouse monoclonal antisera were raised to carboxy terminal peptides from the HPV 16 L1 and L2 open reading frames (ORFs). Anti-L1 and -L2 peptide sera recognized HPV 16 L1 and L2 fusion proteins in Western blots and by immunoprecipitation. In Western blot analysis of L1 proteins from different HPV types, antisera to the L1 peptide reacted only with HPV 16, thus identifying an HPV 16 type-specific linear epitope. Anti-L2 peptide sera reacted with L2 fusion proteins from HPVs 6 and 16, but not from BPV, thus identifying a partially cross-reactive epitope in the HPV 16 L2. Computer analysis of carboxy terminal amino acid sequences of the L1 and L2 ORFs of multiple HPV types supported the Western blot findings. Despite the HPV 16 type specificity found in Western blots, anti-L1 peptide sera identified nuclear antigen by immunocytochemistry in cervical biopsies infected with HPV 16, as well as other genital HPV types. Anti-L2 peptide sera failed to recognize antigen in infected tissue.