P-414 Ultrastructural and functional defects in cilia of endometrial glands from women with reproductive failure

Study question

Do endometrial gland factors influence pregnancy success?

Summary answer

Increased proportion of cilia defects during the window of implantation in endometrial glands from women with reproductive failure compared to controls

What is known already

Endometrial glands are important for embryo implantation and successful pregnancy. There is an unmet clinical need to relate endometrial gland structure to function, identify markers for reproductive failure and targets for therapeutic interventions. Ciliated epithelial cells in the endometrium are a distinct cell type with a particular cell transcriptomic signature. Cilia defects have been reported in endometrial glands from women with reproductive failure however, a quantitative study of cilia defects in endometrial glands is yet to be established.

Study design, size, duration

An observational study comparing women with subfertility, recurrent pregnancy loss and controls

Participants/materials, setting, methods

Endometrial samples were collected during the implantation period from fertile controls (n = 10), women with subfertility (n = 11) and women with recurrent pregnancy loss (n = 15). Ciliated cells in endometrial glands were imaged by transmission electron microscopy and the proportion of cilia defects were quantified and compared between study groups. Endometrial glands were isolated from endometrial biopsies and the cilia beat frequency of ciliated cells was quantified by high-speed video analysis.

Main results and the role of chance

Our study reports a significant increase in the proportion of cilia ultrastructural defects in endometrial glands from women with subfertility versus fertile controls (P < 0.05). Cilia defects included microtubule disarrangement, transposition and loss of cilia inner dynein arm motor proteins. Ciliated cells in endometrial glands from women with recurrent pregnancy loss demonstrated a higher proportion of defects compared to fertile controls but this did not reach statistical significance (P = 0.07). A significant decrease in cilia beat frequency was reported in ciliated cells of endometrial glands from women with subfertility compared to fertile controls (P < 0.05).

Limitations, reasons for caution

This is an observational study with a relatively small sample size however, the participants in the study and control groups were matched for age, BMI and menstrual cycle characteristics.

Wider implications of the findings

This study quantified ultrastructural and functional differences of ciliated cells in endometrial glands from women with reproductive failure. Endometrial glands with perturbed cilia structure and function may be non-conductive to successful pregnancy. Differences in endometrial gland cilia could be used to identify a perturbed endometrium and develop targeted therapies.

Trial registration number

not applicable

Improving the WHO Surgical Safety Checklist sign-out

BACKGROUND

The WHO Surgical Safety Checklist has been shown to reduce perioperative morbidity and mortality worldwide. There is evidence to suggest that sign-out is the most poorly performed phase of the checklist as it coincides with a period of high workload for team members. This study aimed to see whether modification of this process might result in greater compliance.

METHODS

A controlled longitudinal (before and after) study was performed to evaluate the effect of a modified checklist sign-out on compliance in a single surgical department. Checklist quality was evaluated by measurement of checklist completion, active participation, and team member presence. Workload assessment was performed to identify the optimal moment for the sign-out process. The sign-out process was modified through an iterative multidisciplinary approach, informed by results from the workload assessment. Feedback was obtained through staff surveys.

RESULTS

A total of 185 operations were used, with an intervention group in vascular surgery and a control group in orthopaedics. The optimal timing for sign-out was identified as after final wound closure. The modified sign-out process improved active participation of team members (21 of 34 versus 31 of 34; P = 0.010). In the control group, complete compliance improved (48 of 76 versus 30 of 41; P = 0.041). However, active participation decreased (53 of 76 versus 19 of 41; P = 0.022). No differences were noted between groups in team member presence. Eighteen of 21 staff questioned viewed the modifications positively.

CONCLUSION

The optimal sign-out timing was identified as immediately after final wound closure prior to undraping the patient.

Electrospun nanofibers with surface oriented lamellar patterns and their potential applications

This work shows conclusively that lamellar surface patterns can be obtained with diverse ceramic compositions during electrospinning. The lamellar structure formation is governed by the creation of an outer shell during the thermal treatment of initially uniform cylindrical fibers, consisting of polymer and pre-ceramic compounds. By changing the polymer to pre-ceramic ratio in the electrospinning solution, we demonstrate for the first time a facile way to control the obtained surface structure and the orientation of the lamellas. Furthermore, the lamellar morphology was illustrated in seven different compositions. This report provides a new pathway to obtain unique surface patterns in metal-oxide nanofibers and demonstrates their utilization in different applications. Specifically, we demonstrate the prospect of utilizing Ni-Al-O fibers with lamellar structures as alternative Li-ion battery anodes. In addition, we show the potential of Fe-Al-O fibers as an effective catalyst material.

FRI0354 FACTORS AFFECTING SELF-REPORTED PHYSICAL CTIVITY IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Despite the known benefits of exercise1, patients with osteoarthritis (OA) and rheumatoid arthritis (RA) are reported to have low levels of physical activity2. Exercise participation is not well studied in psoriatic arthritis (PsA) cohorts. This study aims to explore which factors predict exercise participation across cohorts and specifically in the PsA cohort.

Objectives:

The primary aim of this study was to determine which clinical factors were predictive of self- reported physical activity levels in patients with PsA. A secondary aim was to explore differences in self-reported physical activity levels amongst patients with PsA, OA and RA.

Methods:

Patients with the diagnosis of PsA, RA or OA are recruited prospectively at two tertiary hospital rheumatology clinics over 12 months. Demographic data is captured by the multi-dimensional health assessment questionnaire, the international physical activity questionnaire short form captures self-reported physical activity and self-efficacy for exercise (SEE) is assessed using the SEE scale. Clinical data including joint count, body mass index and co-morbidities including fibromyalgia are collected for all patients, in addition to PsA specific data including skin and enthesitis indices.

Results:

205 patients (PsA n=62, RA n=83, OA n=60) were recruited across two sites. There was no significant difference in self-reported physical activity between OA, RA and PsA cohorts. Fibromyalgia was present in 30% of each cohort. In patients with PsA, univariate analysis showed that co-existent fibromyalgia, age and self-efficacy for exercise were predictors of physical activity levels. Skin disease and enthesitis were not predictors of physical activity in the PsA cohort.

Table 1.

Univariate Analyses of effect of Clinical Features on Physical Activity levels in PsA

Non-exercisers versus ExercisersOR (95% CI)P-valueLEI1.35 (0.92-1.97)0.127PASI0.8 (0.6-1.07)0.133DLQI1.03 (0.92-1.16)0.589BMI0.97 (0.91-1.04)0.415DAS280.79 (0.55-1.14)0.205Concurrent Fibromyalgia4.46 (1.37-14.49)0.012Age1.05 (1.00-1.10)0.013Self-efficacy for exercise0.97 (0.95-0.99)0.019Pain1.17 (0.99-1.37)0.061Function1.3 (1.02-1.65)0.031Patient global1.14 (0.96-1.34)0.128Depression0.97 (0.51-1.84)0.930Table 2.

Multivariable Analysis on Physical Activity in PsA

Non-exercisers vs ExercisersOR (95% CI)P-valueConcurrent fibromyalgia5.1 (1.44-18.08)0.0117Age1.05 (1.00-1.11)0.0342

Conclusion:

In the PsA cohort, fibromyalgia and age were associated with lower levels of physical activity. DLQI, PASI, LEI did not predict physical activity in PsA. Multivariate analysis showed higher pain levels and lower self-efficacy scores were associated with lower physical activity across arthritis groups.

References:

[1]Der Ananian C, Wilcox S, Watkins K, Saunders RP, Evans AE. (2008). Factors Associated with Exercise Participation in Adults with Arthritis.Journal of Aging and Physical Activity, 16: 125-143

[2]Wilcox S, Der Ananian C, Abbott J, Vrazel J, Ramsey C, Sharpe PA, Brady T. (2006). Perceived Exercise Barriers, Enablers, and Benefits Among Exercising and Nonexercising Adults With Arthritis: Results from a Qualitative Study.Arthritis & Rheumatism, 55(4): 616-627

Acknowledgments:

Joseph Descallar

Dana Georgevsky

Dr Michael Oliffe

Dr Diana Chessman

Department of Rheumatology, Liverpool Hospital NSW Australia

Department of Rheumatology, Westmead Hospital NSW Australia

Disclosure of Interests:

None declared

An xQTL map integrates the genetic architecture of the human brain's transcriptome and epigenome

We report a multi-omic resource generated by applying quantitative trait locus (xQTL) analyses to RNA sequence, DNA methylation and histone acetylation data from the dorsolateral prefrontal cortex of 411 older adults who have all three data types. We identify SNPs significantly associated with gene expression, DNA methylation and histone modification levels. Many of these SNPs influence multiple molecular features, and we demonstrate that SNP effects on RNA expression are fully mediated by epigenetic features in 9% of these loci. Further, we illustrate the utility of our new resource, xQTL Serve, by using it to prioritize the cell type(s) most affected by an xQTL. We also reanalyze published genome wide association studies using an xQTL-weighted analysis approach and identify 18 new schizophrenia and 2 new bipolar susceptibility variants, which is more than double the number of loci that can be discovered with a larger blood-based expression eQTL resource.

Randomised clinical trial: the clinical efficacy and safety of an alginate-antacid (Gaviscon Double Action) versus placebo, for decreasing upper gastrointestinal symptoms in symptomatic gastroesophageal reflux disease (GERD) in China

BACKGROUND

There is a paucity of large-scale studies evaluating the clinical benefit of the Gaviscon Double Action (DA) alginate-antacid formulation for treating gastroesophageal reflux disease (GERD) symptoms.

AIM

Randomised double-blind placebo-controlled parallel-group study to evaluate efficacy and safety of Gaviscon DA in reducing heartburn, regurgitation and dyspepsia symptoms in individuals with mild-to-moderate GERD in China.

METHODS

Participants with symptomatic GERD (n = 1107) were randomised to receive Gaviscon DA or placebo (two tablets four times daily) for seven consecutive days. The primary endpoint compared the change in Reflux Disease Questionnaire (RDQ) score for the GERD (heartburn + regurgitation) dimension between Gaviscon DA and placebo. Secondary endpoints compared the change in RDQ scores for individual heartburn, regurgitation and dyspepsia dimensions, overall treatment evaluation (OTE) scores and incidence of adverse events (AEs).

RESULTS

Mean RDQ GERD scores: 2.51 for Gaviscon DA and 2.50 for placebo at baseline; 1.25 for Gaviscon DA and 1.46 for placebo post treatment. Gaviscon DA was statistically superior to placebo in reducing GERD and dyspepsia RDQ scores [least-squares mean (LSM) difference: GERD -0.21, P < 0.0001; dyspepsia -0.18, P = 0.0004], despite a substantial placebo response. The Gaviscon DA group reported more favourable overall treatment responses than the placebo group across all OTE categories (P < 0.0001). Superior relief of GERD symptoms was observed both in those with non-erosive and those with erosive reflux disease (LSM difference -0.14 [P = 0.038] and -0.29 [P < 0.0001] respectively). Incidence of AEs was similar in both groups.

CONCLUSION

Gaviscon DA tablets provide effective and safe reduction in acid reflux and dyspepsia symptoms in Chinese individuals with mild-to-moderate GERD. ClinicalTrials.gov: NCT01869491.

Hybrid phase-change plasmonic crystals for active tuning of lattice resonances

Tunable lattice resonances are demonstrated in a hybrid plasmonic crystal incorporating the phase-change material Ge2Sb2Te5 (GST) as a 20-nm-thick layer sandwiched between a gold nanodisk array and a quartz substrate. Non-volatile tuning of lattice resonances over a range Δλ of about 500 nm (1.89 µm to 2.27 µm) is achieved experimentally via intermediate phase states of the GST layer. This work demonstrates the efficacy and ease of resonance tuning via GST in the near infrared, suggesting the possibility to design broadband non-volatile tunable devices for optical modulation, switching, sensing and nonlinear optical devices.

Enhancement of waste activated sludge anaerobic digestion by a novel chemical free acid/alkaline pretreatment using electrolysis

Anaerobic digestion of waste activated sludge (WAS) is relatively poor due to hydrolysis limitations. Acid and alkaline pretreatments are effective in enhancing hydrolysis leading to higher methane yields. However, chemical costs often prohibit full-scale application. In this study, 12 V two-chamber electrolysis using an anion exchange membrane alters sludge pH without chemical dosing. pH dropped from 6.9 to 2.5 in the anode chamber and increased to 10.1 in the cathode chamber within 15 h. The volatile suspended solids solubilisation of WAS was 31.1% in the anode chamber and 34.0% in the cathode chamber. As a result, dissolved chemical oxygen demand increased from 164 to 1,787 mg/L and 1,256 mg/L in the anode and cathode chambers, respectively. Remixing of sludge from the two chambers brought the pH back to 6.5, hence no chemical neutralisation was required prior to anaerobic digestion. Methane yield during anaerobic digestion at 20 d retention time was 31% higher than that of untreated sludge. An energy balance assessment indicated that the non-optimised process could approximately recover the energy (electricity) expended in the electrolysis process. With suitable optimisation of treatment time and voltages, significant energy savings would be expected in addition to the benefit of decreased sludge volume.

The effect of pressure pad location of spinal orthosis on the treatment of adolescent idiopathic scoliosis (AIS)

Patient with moderate AIS is usually prescribed with spinal orthosis aiming to mechanically support and prevent the spine from further deterioration. In the conventional fitting method, pre-brace X-ray is the main reference, thus, the pressure pad of spinal orthosis may not be accurately located to the strategic areas because the spinal deformities could change 3-dimensionally once pressure pad is applied. A high correlation (r > 0.98) between Cobb's angle and spinous process angle (SPA) was found in the recent studies. With the advancements of 3D clinical ultrasound (3D CUS), tracing SPA along a scoliotic spine becomes possible and this can be used to estimate Cobb's angle. This study aimed to evaluate the effect of pressure pad location of spinal orthosis in the treatment of AIS and 3D CUS was used to trace SPA for estimation of Cobb's angle. The in-brace X-rays were assessed for confirmation of treatment effectiveness. The subjects were divided into ultrasound-guided fitting group A (n=21) and conventional fitting group B (n=22). In the group A, pressure pads were tested at 5 locations - the prescribed location as in the conventional fitting (referred to the pre-brace X-ray), and 1 cm and 2 cm above and below the prescribed location, and 3D CUS was applied to trace the SPA in these 5 pad locations, and the pad location with the lowest estimated Cobb's angle was selected in the final fitting. The assessments of in-brace X-rays showed that the mean Cobb's angle of group A decreased from 28.9° (pre-brace) to 18.6° (immediate in-brace) while the mean Cobb's angle of group B decreased from 27.1° (pre-brace) to 22.5° (immediate in-brace). There was a significant difference (p < 0.05) in the correction of Cobb's angle between the two groups. The results showed that accurate pressure pad location does play an important role in the reduction of Cobb's angle and 3D CUS can be considered as a non-invasive and effective assessment tool to improve orthotic treatment of AIS.

Lattice resonances in antenna arrays for liquid sensing in the terahertz regime

Terahertz antenna arrays supporting narrow lattice resonances are proposed as an alternative sensor-on-chip approach to liquid sensing. An array of metallic rectangular antennas fabricated on a polyethylene naphthalate (PEN) substrate is used to demonstrate the sensing of a number of fluids. Good agreement is shown between experiment and simulation with Q-factors of around 20 and a figure-of-merit (FOM) of 3.80 being achieved. Liquid sensing with antenna arrays is simple both in terms of fabrication and setup. The working frequency can be tuned with a suitable choice of substrates and array parameters. The nature of the lattice resonance means that the whole sample is used to provide the conditions required for resonance occurrence, eliminating the need to preferentially locate the sample in small areas of high field concentration. The antenna arrays could also potentially be coupled with a microfluidic system for in situ sensing or used in a reflection setup.

Broadband multi-layer terahertz metamaterials fabrication and characterization on flexible substrates

Microscopic split-ring-resonator (SRR) arrays are fabricated on 100 μm thick polyethylene naphthalate (PEN) films by femtosecond laser micro-lens array (MLA) lithography. The transmission properties of these metamaterials are characterized by THz Time Domain Spectroscopy (THz-TDS). Tunable resonance responses can be achieved by changing SRR structural design parameters. By stacking 2D PEN metamaterial films with different frequency responses together, a broadband THz filter with full width at half maximum (FWHM) of 0.38 THz is constructed. The bandwidth of the resonance response increases up to 4.2 times as compared to the bandwidths of single layer metamaterials. Numerical simulation reveals that SRR layers inside the multi-layer metamaterials are selectively excited towards specific frequencies within the broadband response. Meanwhile, more than one SRR layers respond to the chosen frequencies, resulting in the enhancement of the resonance properties. The multi-layer metamaterials provide a promising way to extend SRR based metamaterial operating region from narrowband to broadband with a tunable feature.

Generation of pronounced Fano resonances and tuning of subwavelength spatial light distribution in plasmonic pentamers

Arrays of plasmonic pentamers consisting of five metallic nano-disks were designed and fabricated to achieve a pronounced Fano Resonance with polarization-independent far-field spectral response at normal incidence due to the structure symmetry of pentamers. A mass-spring coupled oscillator model was applied to study plasmon interactions among the nano-disks. It was found that the direction of the excitation light polarization can flexibly tune the spatial localization of near-field energy at sub-wavelength scales while the collective optical properties are kept constant. It can lead to a selective storage of excited energy down to sub-20 nm gap at a normal incident with a single light source.

Innovative practice. applying academic psychosmatic medicine in rural California

Background

Imperial County is designated as medically underserved and one of the poorest counties in CA. Our practice started in 1994 and serves the gap between the County Mental Health Services (CMHS) that treats the severely and chronically ill and the general medical community that faces the unmet need of specialty care for “less” severe patients.

Methods

A plan was started to provide both psychiatric care and liaison activities. The community has 2 community general hospitals. Contracts were established with CMHS and private insurers to assure coverage of services. The plan was extended to dialysis units and long term facilities. Systematic collection of consult data was started in 1998.

An electronic medical record was established with specific fields designated for research purposes. Working in association with UCSD, we established a number of IRB approved protocols. In addition, we contracted with a number of pharmaceutical companies to become a research site for mult-center trials.

Results

Over 300 consultations were performed yearly. The most common consultations involved assessments of: elderly agitated patients, conservatorship evaluations and suicide attempts.

Conclusion

PM strategies added value in the provision of psychiatric services and contract negotiation in this rural community. Applying an academic model decreased the gap between CMHS and the medical community. Patients appeared satisfied to see the same psychiatrists at different treatment settings (i.e. general hospital, dialysis unit, NSF). All interventions were covered by the diverse payment sources.

Application of 3-D ultrasound in assisting the fitting procedure of spinal orthosis to patients with adolescent idiopathic scoliosis

Spinal orthosis is generally applied to the patients with adolescent idiopathic scoliosis (AIS) during puberty to mechanically support the spine and prevent further deterioration. However, the optimum location of pressure is not easy to be determined and the X-ray taken is not a real time presentation of the spinal curvature. With the advancement of clinical ultrasound, tracing spinal processes along a scoliotic spine becomes possible, which means spinous process angle (SPA) can be obtained from ultrasound images. Moreover, SPA is found to be highly correlated with Cobb's angle. Since the outcome of orthotic intervention for AIS is considered to be associated with accurate orthosis fitting, this study seeks to apply three-dimensional (3-D) ultrasound in the fitting procedure of spinal orthosis for patients with AIS. The accuracy of pressure pad location in brace can help to improve the effectiveness of spinal orthosis treatment. By means of the ultrasound assessments, spinous process angle is examined and used as the parameter to evaluate the optimal location for pressure pad. The intra-rater reliability [ICC (1, 3)] for using ultrasound to measure SPA is >0.9 (p<0.05). Furthermore, the correlation between Cobb's angle estimated from the measurement of SPA in 3-D ultrasound images and Cobb's angle measured from X-ray is highly significant (R=0.98, p<0.01). According to these findings, ultrasound can be further developed as a non-invasive real-time assessment tool for spinal curvature especially in fitting stage to improve the treatment effect of the spinal orthosis.

Chromosome translocations and fusion genes in breast cancer

Abstract #2021

Background: Little is known about chromosome translocations in the common epithelial cancers such as breast cancer, in spite of the central role played by translocations and consequent gene fusions in haematopoietic cancers.&#x2028; Methods: We present a comprehensive analysis by array painting of the chromosome translocations of four breast cancer cell lines, DU4475, HCC1806, HCC1187 and ZR-75-30. In array painting chromosomes are isolated by flow cytometry, amplified and hybridized to DNA microarrays. All breakpoints, totalling nearly 250, were mapped to at least 1Mb resolution and most balanced breakpoints were mapped to about 2kb resolution using custom oligonucleotide arrays. The remaining unbalanced breakpoints were mapped to around 20kb by identifying copy number steps in Affymetrix SNP6 array hybrizations obtained by the Sanger Institute's Cancer Genome Project. Breast tumours in parraffin section in tissue microarrays were screened by FISH to see whether selected breakpoints found in the cell lines are present in breast tumours.&#x2028; Results: We found at least 12 reciprocal translocations in the four cell lines, substantially more than expected, and many more rearrangements were balanced for at least one participating chromosome. Many of the breakpoints were within or adjacent to cancer-relevant genes, and three of the translocations have already been shown to form fusion transcripts, RIF1-PKD1L1, PUM1-TRERF1 and TAX1BP1-AHCY. For selected genes targetted by the translocations, about 100 breast tumours were screened for breaks. Breaks were found in two to six cases for several of the genes, confirming that some of them were broken in breast tumours. For example two cases of unbalanced breakage were identified in PKD1L1, and these were confirmed by array-CGH.&#x2028; Discussion: Our results suggest that breast cancers have fusion genes, and support the emerging view that chromosome rearrangements are likely to play a significant role in common epithelial cancers.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2021.

Herniation of caecum through the foramen of Winslow

The radiological features on plain abdominal imaging and CT in a case of caecal herniation through the foramen of Winslow is presented. This rare condition is associated with a high morbidity and mortality, which emphasizes the importance of accurate preoperative diagnosis.

Shedding of distinct cryptic epitope (HU177) in sera of melanoma patients

8550

Background: Our preclinical data suggest that a newly identified cryptic epitope HU177 within collagen regulates endothelial and tumor cell adhesion in-vitro and angiogenesis and tumor growth in-vivo. We investigated whether 1) HU177 shedding can be measured in melanoma patients’ sera, and 2) if HU177 concentration correlates with clinicopathological features, recurrence and survival. Methods: Sera from 291 melanoma patients (primary Stage I, n=140; II n=41; III n=29; recurrent/metastatic n=81) and 30 normal volunteers prospectively enrolled at the NYU School of Medicine were analyzed for HU177 epitope concentration (ng/ml) by ELISA. Microtiter plates were incubated overnight with monoclonal antibody (anti-HU177 epitope). Patients’ sera and standards (denatured type-IV collagen) were added in duplicate followed by dilutions of biotinylated anti-collagen type IV polyclonal and HRP-labeled anti-biotin antibodies with multiple washes after each incubation. Absorbance was monitored at 400 nm. Results: The mean concentration of anti-HU177 epitope was 5.8 ng/ml (range 0.1 to 139.8). Normal volunteers were 1.6±0.3 (mean ± SEM). A significant correlation was observed between HU177 concentration and tumor thickness in patients who presented with primary melanoma (=1.00 mm, n=113, 3.8±0.4; 1.01–3.99 mm, n=72, 8.9 ±2.1; =4.00 mm, n=22, 10.3±2.2; P=0.003 by ANOVA test) and nodular melanoma histological subtype (nodular, n=47, 10.5±3.1; superficial spreading, n=95, 4.4±0.5; others, n=68, 6.0±2.1; P=0.02, ANOVA). Multivariate analysis confirmed the independent correlation between higher HU177 concentration and nodular subtype after controlling for tumor thickness (P=0.04). Primary patients with ulcerated melanomas and those who developed recurrences both showed higher HU177 epitope levels, however, the difference was not significant (P>0.05). Conclusions: This is the first study on HU177 epitope shedding in melanoma patients. Data demonstrate the clinical feasibility of HU177 testing in melanoma patients’ sera and suggest that HU177 epitope shedding correlates with thicker primary melanomas. Longer follow-up is required to better define the prognostic value of HU177 epitope shedding in melanoma patients.

[Table: see text]

Modulation of prostacyclin and thromboxane secretion by cytotrophoblasts from normal and pre-eclamptic human pregnancies

We and others have previously observed an imbalance in cytotrophoblast secretion of the vasoactive prostanoids prostacyclin and thromboxane A(2) in pre-eclampsia. To examine the effects of potential modulators of this imbalance, cytotrophoblasts isolated from normal and pre-eclamptic pregnancies were incubated in the presence of lipopolysaccharide, the calcium ionophore A23187, tumour necrosis factor alpha, or interleukin 1beta, with or without the cyclo-oxygenase inhibitor, indomethacin. Further incubations included the drugs tranylcypromine, a prostacyclin synthetase inhibitor (0.1, 10 microM ), or the thromboxane synthetase inhibitor, pirmagrel (0.001, 1 microM ). Results showed that cytotrophoblasts from pre-eclamptic pregnancies had increased thromboxane production and significant stimulation of prostacyclin production by lipopolysaccharide and calcium ionophore. Lipopolysaccharide stimulated thromboxane production in normal cytotrophoblasts, while indomethacin almost completely inhibited production of both prostanoids. Tranylcypromine mildly inhibited prostacyclin production in normal cytotrophoblasts only, whereas pirmagrel strongly inhibited thromboxane production in a dose-related manner, with reciprocal increase in prostacyclin production occurring in cytotrophoblasts from pre-eclamptic pregnancies. This study confirmed that cytotrophoblasts from pre-eclamptic women had increased thromboxane production and showed that pirmagrel, at the relatively low dose of 0.001 microM, was able to normalize the imbalance of thromboxane and prostacylin production and may therefore warrant further investigation as a treatment for pre-eclampsia.

Poliovirus 3C protease-mediated degradation of transcriptional activator p53 requires a cellular activity

Infection of HeLa cells with poliovirus leads to rapid shut-off of host cell transcription by RNA polymerase II. Previous results have suggested that both the basal transcription factor TBP (TATA-binding protein) and transcription activator proteins such as CREB (cyclic AMP-responsive element-binding protein) and Oct-1 (the octamer-binding factor) are cleaved by the viral-encoded protease, 3C(Pro). Here we demonstrate that the transcriptional activator (and tumor suppressor) p53 is degraded by the viral protease 3C both in vivo and in vitro. Unlike other transcription factors that are directly cleaved by 3C(pro), degradation of p53 requires a HeLa cell activity in addition to 3C(Pro). The degradation of p53 by 3C(Pro) does not appear to involve the ubiquitin pathway of protein degradation. Vaccinia virus infection of HeLa cells leads to inactivation of the cellular activity required for 3C(Pro)-mediated degradation of p53. The vaccinia-encoded protein (CrmA) is known to inhibit caspase I (ICE protease) that converts inactive IL-1beta to an active secreted form. Incubation of HeLa cells with caspase I inhibitor Z-VAD-fmk does not interfere with 3C(Pro)-mediated degradation of p53. The cellular activity present in extracts of HeLa cells can be fractionated through phosphocellulose. A partially purified fraction that elutes at 0.6 M KCl from phosphocellulose contains the activity that degrades p53 in a 3C(Pro)-dependent manner. These results suggest that both poliovirus-encoded protease 3C(Pro) and a cellular activity are required for the degradation of p53 observed in cells infected with poliovirus.

A proapoptotic peptide for the treatment of solid tumors

We have designed a novel peptide, DP1, which is able to mediate significant induction of apoptosis in solid tumors by local injection. This peptide, comprised of a protein transduction domain (PTD), PTD-5, fused to an antimicrobial peptide, (KLAKLAK)2, was able to trigger rapid apoptosis in a variety of cell lines in vitro, including MCA205 murine fibrosarcomas and human head and neck tumors. Furthermore, direct injection of DP1 into day 7 established MCA205 tumors in C57BL/6 mice resulted in the induction of tumor apoptosis and subsequent reduction in tumor volume. These results suggest that DP1 may be used clinically to treat accessible solid tumors or as an adjuvant therapy in conjunction with radiotherapy, standard chemotherapy, immunotherapy, or surgical debulking.

Crowding and violence on psychiatric wards: explanatory models

OBJECTIVE

Violence is widely prevalent on acute-care psychiatric wards, and crowding has been identified as a major risk factor. This paper explores why patients may respond to crowding with violence.

METHOD

We carried out a literature review on Medline, using the key words "violence" and "crowding." We conducted an additional hand search of the references collected from the reviewed papers.

RESULTS

Factors specific to the relation between crowding on acute-care inpatient psychiatric wards and violence can be divided under the following headings: 1) patient density, privacy, and control; 2) ward architecture; 3) the social organization of psychiatric wards; 4) interpersonal space; 5) phylogenic theories; and 6) anthropological theories of human behaviour.

CONCLUSIONS

We offer explanatory models for this relation and suggest strategies to counter the effects of crowding. Recommendations are made for future studies.

Selective neurodegeneration, without neurofibrillary tangles, in a mouse model of Niemann-Pick C disease

The BALB/c mouse model of Niemann-Pick type C (NPC) disease exhibits neuropathological similarities to the human condition. There is an age-related cerebral atrophy, demyelination of the corpus callosum, and degeneration of cerebellar Purkinje cells in the NPC mouse. In human NPC, many cortical and subcortical neurons contain neurofibrillary tangles, which are thought by some investigators to play an important role in the neurodegenerative process. The purpose of the present study was to determine whether neurodegeneration occurs in the NPC mouse, in brain regions other than the cerebellum and whether the degeneration is related to the presence of neurofibrillary tangles. Using light microscopic methods with immunohistochemistry, electron microscopy, and cell counting methods, 11-week-old NPC(+/+) and NPC(-/-) animals were examined. In the NPC(-/-) mice, there were 96% fewer Purkinje cells, 28% fewer neurons in the prefrontal cortex, 20% fewer neurons in the thalamus, and 63% fewer glial cells in the corpus callosum. On the other hand, previous studies indicate normal numbers of neurons and glial cells in these same neuroanatomical regions in young NPC(-/-) mice. There were normal numbers of cholinergic neurons in sections assessed in the striatum and basal forebrain in the 11-week-old animals and no evidence of neurofibrillary tangles within cells. The present data indicate that both neurons and glial cells die in the NPC mouse but that all cells are not equally vulnerable. There was no evidence for neurofibrillary tangles in the NPC mouse, and therefore the degenerative process in the mouse is unrelated to the neurofibrillary tangle.

Ward crowding and incidents of violence on an acute psychiatric inpatient unit

OBJECTIVE

Violence in psychiatric wards is common, and it is on the rise. This study examined the relationship between ward occupancy level and staff-to-patient ratio and incidents of aggressive behavior, both physical and verbal, on an acute inpatient unit in rural New Zealand.

METHODS

Logistic regression was used to analyze data collected from the ward's log of adverse incidents and the ward census over a 12-month period. A physical incident was defined as an unwelcome physical contact or willful damage to property. Incidents of self-harm were excluded. Verbal aggression was any threat of physical or sexual harm.

RESULTS

Among 381 admissions during the study period, 58 incidents were recorded--25 incidents of verbal aggression and 33 incidents of physical violence. Logistic regression demonstrated that the occupancy level was positively associated with the occurrence of any type of violent incident. The average occupancy level when an incident occurred was 77 percent, compared with 69 percent when no incidents occurred. The average occupancy level was significantly higher when verbal incidents occurred (80 percent) than when physical incidents occurred (70 percent). No association was found between violence and staff-to-patient ratio. Incidents were significantly more likely to occur during the afternoon shifts (3 p.m. to 11 p.m.).

CONCLUSIONS

Crowding was found to be significantly associated with aggressive incidents, and in particular with verbal aggression.

Radiosensitization of tumor-targeted radioimmunotherapy with prolonged topotecan infusion in human breast cancer xenografts

Clinical radioimmunotherapy (RIT) of solid tumors holds great promise, but as yet has been unable to deliver tumoricidal radiation doses without unacceptable toxicity. Our experimental approach aims to potentiate the therapeutic action of radioimmunoconjugates at the tumor site and thus improve the efficacy of RIT by combination with other treatment modalities. The topoisomerase I inhibitors are a unique class of chemotherapeutic agents that interfere with DNA breakage-reunion by inhibiting the action of topoisomerase I. Preclinical studies suggest that prolonged infusion of topoisomerase I inhibitors enhances cell toxicity due to ionizing radiation. We evaluated the efficacy of combined treatment with continuous administration of topotecan and 90Y-MX-DPTA BrE3 monoclonal antibody (which recognizes an epitope of breast epithelial mucin expressed in most breast cancers) on human mammary carcinoma xenografts in nude mice. Topotecan or 90Y-BrE3 treatment alone delayed overall tumor growth rate transiently but did not affect survival. The combination of RIT with topotecan substantially reduced growth of relatively large established tumors and caused complete tumor regressions and prolonged tumor-free survival in a substantial proportion of treated animals. In vitro studies demonstrated an increase in apoptotic rate and a decrease in cell proliferation of tumor cell lines treated with this combination. We combined the radiosensitization property of topotecan and the specificity of systemic RIT to establish a novel therapy for solid tumors in an experimental tumor xenograft model.

Specific organ gene transfer in vivo by regional organ perfusion with herpes viral amplicon vectors: implications for local gene therapy

BACKGROUND

Many gene therapy strategies would benefit from efficient, regional organ delivery of therapeutic genes.

METHODS

Regional perfusions of lung, liver, or bladder were performed to determine if rapid and efficient gene transfer can be accomplished in vivo, and to determine if in vivo gene transfer can be limited to the organ of interest. In addition, herpes simplex virus tumor necrosis factor (HSVtnf), carrying the human tumor necrosis factoralpha gene was used as a treatment for methylcholanthrene sarcoma in a syngeneic lung metastases model in Fisher rats.

RESULTS

A 20-minute perfusion using HSV carrying beta-galactosidase (HSVlac) produced significant expression of this marker gene isolated to the target organs, without organ-specific tissue injury or inflammation. Regional perfusion of organs with HSV carrying the cytokine gene tumor necrosis factor alpha also resulted in high-level local organ production of this cytokine (2851 +/- 53 pg/g tissue in perfused lung versus 0 for the contralateral lung). For the current vector construct, expression of the gene of interest peaked between 2 and 4 days and was undetectable by 2 weeks after perfusion. In animals undergoing perfusion as treatment for pulmonary sarcoma, there was no difference between tumor counts in lungs perfused with HSVlac (17 +/- 6) or HSVtnf (22 +/- 8), but either treatment resulted in lower tumor counts than controls (111 +/- 24 nodules per lung, P <.02).

CONCLUSIONS

Regional organ perfusion using herpes viral vectors is an effective and well-tolerated in vivo method of transiently delivering potentially toxic gene products to target organs in directing gene therapy. Regional lung perfusion with HSV amplicons reduces tumor burden in a rat model of pulmonary metastases, though HSVtnf cannot be demonstrated to augment the cytopathic effect of the HSV amplicon alone in the current model.

Regulation of DNA-dependent protein kinase activity by ionizing radiation-activated abl kinase is an ATM-dependent process

Ionizing radiation (IR) treatment results in activation of the nonreceptor tyrosine kinase c-Abl because of phosphorylation by ATM. In vitro evidence indicates that DNA-dependent protein kinase (DNA-PK) can also phosphorylate and thus potentially activate Abl kinase activity in response to IR exposure. To unravel the role of ATM and DNA-PK in the activation of Abl, we assayed Abl, ATM, and DNA-PK activity in ATM- and DNA-PKcs-deficient cells after irradiation. Our results show that despite the presence of higher than normal levels of DNA-PK kinase activity, c-Abl fails to become activated after IR exposure in ATM-deficient cells. Conversely, normal activation of both ATM and c-Abl occurs in DNA-PKcs-deficient cells, indicating that ATM but not DNA-PK is required for activation of Abl in response to IR treatment. Moreover, activation of Abl kinase activity by IR correlates well with activation of ATM activity in all phases of the cell cycle. These results indicate that ATM is primarily responsible for activation of Abl in response to IR exposure in a cell cycle-independent fashion. Examination of DNA-PK activity in response to IR treatment in Abl-deficient cells expressing mutant forms of Abl or in normal cells exposed to an inhibitor of Abl suggests an in vivo role for Abl in the down-regulation of DNA-PK activity. Collectively, these results suggest a convergence of the ATM and DNA-PK pathways in the cellular response to IR through c-Abl kinase.

Acoustic rhinometry and computed tomography scans for the diagnosis of nasal septal deviation, with clinical correlation

OBJECTIVE

The aim in this study was to analyze the efficiency and reliability of acoustic rhinometry (AR) readings in recognition of nasal septal deviation.

METHOD

We compared 24 patients' AR readings with their sinus CT scans. The patient data were analyzed by comparison with normative data, area, and percentage differences between the two sides. Additionally, the data further analyzed by receiver operating characteristic curve and Spearman correlation of CT and AR in determining nasal septal deviation.

RESULTS

The sensitivity of AR in detecting anterior septal deviations was found to be 54%, with a specificity of 70%. A very highly significant correlation (P < or = 0.001) was found between minimal cross-sectional area (CSA) 1 values and CT results.

DISCUSSION

In the interpretation of AR readings, comparison of each CSA value should be included, in addition to use of the total absolute CSA values.

CONCLUSION

According to our findings the diagnosis of nasal septal deviation can be supported by AR readings.