High Resolution Imaging with Focused kV X-Rays for Small Animal Radio-Neuromodulation

PURPOSE/OBJECTIVE(S)

High precision radiotherapy for small animal radio-neuromodulation requires conformal treatment to very small targets down to 2.5 mm. A focused kV technique based on novel usage of polycapillary x-ray lenses can focus x-ray beams to <0.2 mm in diameter, which is ideal for such uses. Such application also requires high resolution CT images for treatment planning and setup, which was hard to achieve using conventional x-ray tube. In this work, we demonstrate the feasibility of using a virtual focal spot generated with an x-ray lens to perform high-resolution CBCT acquisition.

MATERIALS/METHODS

The experiment with x-ray lens was set up on an x-ray tabletop system to generate a virtual focal spot. A pinhole image was acquired for the virtual focal spot and compared with the one acquired with the conventional focal spot without the lens. The planar imaging resolution with and without the lens were evaluated using a line pair resolution phantom. The spatial resolution of the two settings were estimated by reconstructing a 0.15-mm wire phantom and comparing its full width half maximum (FWHM). A CBCT scan of a rodent head was also acquired to further demonstrate the improved resolution using the x-ray lens.

RESULTS

Compared to conventional imaging acquisition with a measured x-ray focal spot of 0.395 mm FWHM, the virtual focal spot size was measured at 0.175 mm. The reduction in focal spot size with lens leads to an almost doubled planar imaging resolution and a 26% enhancement in 3D spatial resolution. A realistic CBCT acquisition of a rodent head mimicked the imaging acquisition step for radio-neuromodulation and further showed the improved visualization for fine structures.

CONCLUSION

This work demonstrated that the focused kV x-ray technique was capable of generating small focal spot size of <0.2 mm. The proposed method provides an adaptive imaging platform to acquire x-ray and CBCT images for treatment planning and setup with improved spatial resolution compared to conventional CBCT image acquisition.

Effect of grazing different forage systems prior to and during mating on the liveweight, condition score, conception and reproductive rate of maternal-composite ewe lambs

Context Economic modelling identified that mating of ewe lambs for lambing at 1 year of age has the potential to increase the profitability of sheep-production systems in south-western Victoria. In order to optimise reproductive rates, ewe lambs should weigh at least 35–40 kg, have a condition score (CS) of 3.0 at mating, and be gaining weight (100–150 g/day) during mating. However, typical perennial ryegrass (Lolium perenne L.) pastures in south-west Victoria do not support the attainment of these targets without additional supplementation. Aim Our research aimed to determine how grazing summer-active pastures or brassica (Brassica napus L.) forages affects the liveweight, CS, conception and reproductive rate of ewe lambs when offered before and during mating compared with a system using perennial ryegrass plus supplement. Methods A field experiment was conducted at Hamilton, Victoria, Australia, in 2014 and 2016 testing seven forage treatments replicated four times in a complete block design. The treatments were: canola (B. napus, two treatments of different cultivars), forage brassica, lucerne (Medicago sativa L.), chicory (Cichorium intybus L.), plantain (Plantago lanceolata L.) and perennial ryegrass. Key results Ewe lambs grazing canola or forage brassica had higher (P &lt; 0.05) liveweight gains during the pre-mating and mating periods than those grazing the perennial ryegrass treatment (148 vs 75 g/day in 2014, s.e.m. 17; 139 vs 54 g/day in 2016, s.e.m. 17). In 2014, spring-sown dual-purpose canola, lucerne and chicory resulted in higher (P &lt; 0.05) reproductive rates (144–151%) than the perennial ryegrass treatment (103%); forage brassica and plantain gave intermediate results (128% and 129%). Conclusion Brassica forages (including spring-sown canola), lucerne and chicory can support the attainment of key liveweight and CS targets for successful mating of ewe lambs in autumn. Implications Spring-sown canola is therefore a viable alternative forage for use by livestock producers in southern Australia and presents an opportunity to incorporate an alternative income stream in mixed-farming systems.

Effect of defoliation on spring-sown winter-type canola (Brassica napus) grain yield, quality and morphology

Context In Australia’s high-rainfall zone (&gt;550 mm/year), winter-type canola (Brassica napus L.) can be sown in spring and grazed as a forage crop during its vegetative phase, producing a canola grain crop in late spring of the second year. The timing, length and intensity of grazing or defoliation that can be imposed on canola before a grain yield penalty occurs remains largely unknown. Aim Our research aimed to determine the impact of grazing spring sown canola during summer and autumn on the subsequent canola grain yield. Methods A paddock-scale field experiment was conducted over 2 years, 2013–14 and 2015–2016, at Hamilton, Victoria, Australia, with two winter-type canola treatments and three grazing–defoliation sub-treatments replicated four times in a replicated block design. The canola cultivars used were Hyola971CL and Taurus in 2013–14 and Hyola971CL and Brazzil in 2015–16. The three grazing–defoliation sub-treatments were: NG, no grazing; VG, grazing with sheep for a 10-week period during the vegetative phase over summer–autumn; RG, grazing with sheep as per the VG sub-treatment and then in the reproductive phase, either cutting the canola for silage in August (2013–14) or grazing with sheep between 28 July and 17 August 2016 (2015–16). Key results The VG sub-treatment resulted in no grain-yield penalty (P &gt; 0.05) relative to NG in either year. In 2014, canola grain yields from VG for Hyola971CL and Taurus were 2.32 and 2.13 t/ha, compared with NG grain yields of 2.66 and 2.19 t/ha. In 2016, grain yields from VG for Hyola971CL and Brazzil were 2.14 and 1.74 t/ha, compared with NG grain yields of 1.87 and 1.90 t/ha. The RG sub-treatment reduced (P &lt; 0.05) canola grain yield by ~65% in 2014 and 80% in 2016 compared with NG and VG. Conclusions Spring-sown winter-type canola can be grazed during summer and autumn in southern Australia with no grain-yield penalty relative to ungrazed canola. However, further grazing or defoliation in winter once bud elongation commences can result in large grain-yield penalties. Implications Spring-sown winter-type canola is a viable forage option for filling the summer–autumn feed gap in southern Australia while also providing a dual-purpose income in mixed-farming systems.

Spring-sown winter-type canola (Brassica napus) as summer–autumn forage for sheep production in southern Australia

Context Filling the summer–autumn feed gap is a key priority for sheep producers in southern Australia’s high-rainfall zone. Aim Our research aimed to determine whether spring-sown winter-type canola (Brassica napus L.) could increase herbage mass and nutritive characteristics during summer and autumn relative to other forage options in southern Australia’s HRZ. Methods A field experiment was conducted at Hamilton, Victoria, Australia, in 2014 and 2016 testing seven forage treatments replicated four times in the complete block design. The treatments were: canola (two treatments of different cultivars), forage brassica (B. napus), lucerne (Medicago sativa L.), chicory (Cichorium intybus L.), plantain (Plantago lanceolata L.) and perennial ryegrass (Lolium perenne L.). Key results Herbage mass and nutritive characteristics of the canola varieties did not differ (P &gt; 0.05) from forage brassica. Herbage mass in March 2014 was 3.35–3.64 t dry matter (DM)/ha for brassicas; 1.05–1.37 t DM/ha for perennial ryegrass, plantain and chicory; and 2.94 t DM/ha for lucerne (P &lt; 0.001, l.s.d. = 1.20). In March 2016, herbage mass was 1.86–2.05 t DM/ha for brassicas and 2.14–2.49 for the other forage treatments (P &lt; 0.05; l.s.d. = 0.47). Brassicas had higher (P &lt; 0.05) metabolisable energy (ME) concentrations and lower (P &lt; 0.05) neutral detergent fibre (NDF) concentrations on most sampling dates than chicory, plantain, lucerne and perennial ryegrass. The crude protein (CP) concentration of the brassica treatments was not different (P &gt; 0.05) from that of the other forage treatments. Concentrations of ME, CP and NDF were very similar between years for the brassicas, with March ME, CP and NDF concentrations of 12.0–13.2 MJ/kg DM, 14.0–20.1% DM and 16.7–23.6% DM. Conclusion Canola provided increased or equivalent levels of herbage mass and nutritive characteristics compared with other forage options in south-western Victoria on most, but not all, sampling dates. However, the annual spring-sowing requirement is a challenge under variable spring-rainfall conditions and may limit productivity if there is poor establishment. Implications Spring-sown canola is a viable alternative forage for livestock producers and offers a potential second income stream in high-rainfall-zone livestock farming systems.

New decade, new response: Altering the public health response to toxigenic cutaneous diphtheria

Background

Classical diphtheria is a potentially fatal respiratory disease mediated by the diphtheria toxin of Corynebacterium diphtheriae. Due to high vaccination rates against this toxin in Canada, the national incidence of respiratory diphtheria is near zero, and the toxin plays no recognized role in cutaneous diphtheria. Therefore, in this study, we assessed the diagnostic and public health benefits of diphtheria toxin testing and cutaneous diphtheria investigations in a highly vaccinated population.

Methods

Over the last 10 years, we retrospectively determined: the number of C. diphtheriae isolates identified in the province of Alberta, Canada; the disease state of each individual tested (disease vs asymptomatic carrier); the source (cutaneous vs respiratory); and the number of toxin tests performed.

Results

In 10 years, zero cases of respiratory diphtheria and three cases of toxigenic cutaneous diphtheria were identified. Despite zero cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases.

Conclusions

This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease.

Key messages

Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.

P12.02 Glioblastoma Multiforme immunological blockades and the implications of glioma cancer stem cells

BACKGROUND

Glioblastoma Multiforme (GBM) is classified as a WHO grade IV astrocytoma that continues to circumvent classical and novel chemo-, radio- and immuno-therapies. The recent FDA approvals for the use of targeted immunotherapies against inhibitory checkpoint ligands (for melanoma; ipilimumab and nivolumab) have brought the use of monoclonal antibody therapies to the forefront of GBM research. However, poor immunological responses, exemplified by down-regulation of anti-tumour T-cell activity, and up-regulation of immunosuppressive cells and secreted factors within the tumour micro-environment, have limited the effectiveness of immunotherapy in GBM to date. Therefore, understanding how GBM modulates an extensive repertoire of immune checkpoint ligands and the functional consequence on immune evasion is necessary to develop more targeted immuno-therapeutics.

MATERIAL AND METHODS

Patient derived glioblastoma cell lines were cultured using established serum-based or glioma cancer stem cell (gCSC) conditions. The phenotypes of resultant GBM cells and gCSC’s were characterised using flow cytometry and immunocytochemistry, to assess expression of neural lineage and stem cell-associated markers. Thereafter, cells were screened for the expression of an extensive range of inhibitory checkpoint ligands by flow cytometry. Finally, the secretion of immune modulating factors by GBM cells and gCSC’s were evaluated by using XL cytokine proteome arrays. Cytokines that appeared to be differentially expressed were subsequently measured using Cytometric Bead Arrays.

RESULTS

Adherent gCSC’s and gCSC derived glioma-spheres express nestin, CD44, A2B5 and vimentin, consistent with a stem cell phenotype. Furthermore, the gCSC’s exhibited reduced expression of the neural lineage markers NeuN and OSP. Flow cytometry analyses revealed that glioblastoma cells expressed all 11 checkpoint ligands investigated. Interestingly, gCSC’s showed higher levels of PD-L1, B7-H3, CD155 and HVEM expression than GBM cells.

CONCLUSION

Glioblastoma Multiforme is highly immuno-suppressive, which is reinforced by this study. Glioblastoma cells express all the inhibitory checkpoint ligands investigated and glioma cancer stem cell cultures up-regulate expression levels further. This implies that GBM cells are heavily equipped to inhibit infiltrating T-cells, exemplifying the need to find suitable therapeutics that target multiple immuno-suppressive mechanisms simultaneously.

Management of ureteropelvic junction obstruction in children-a roundtable discussion

The investigation, management and follow-up of paediatric ureteropelvic junction obstruction is not standardized. The Young Pediatric Urology Committee of the European Society of Pediatric Urology interviewed five experts in the field on various aspects of management and compared this with published literature.

A systematic review and meta-analysis revealing realistic outcomes following paediatric torsion of testes

INTRODUCTION

Reported testicular loss rates following paediatric testicular torsion often reflect the surgical decision-making process, rather than long-term survival of the testes.

OBJECTIVES

We aim to perform systematic analysis and meta-analysis to investigate testicular salvage rates and to assess predictors of long-term viability.

STUDY DESIGN

Systematic review according to PRISMA guidelines was performed to investigate immediate and long-term (>12 months) testicular loss rates following torsion in the paediatric population. Literature search and study inclusion were performed by two investigators. A study quality score was derived and attributed to each study. Predictors of testicular loss were described. Proportions meta-analysis was performed with random effects modelling, and testing for heterogeneity.

RESULTS

Twelve studies were includedm, 6 reporting early orchidectomy rates, and 6 reporting long-term outcomes. Study quality was generally low.

DISCUSSION

The mean early testicular loss rate was 39%, whereas meta-analysis revealed late loss to approach 50%. Predictors of outcomes include prehospital symptom duration, location of presentation, transfer to a tertiary centre, social affluence and use of ultrasound prior to diagnosis or transfer.

CONCLUSIONS

This study has shown a considerable late testicular loss rate, which must be relayed to families even after testicular salvage. Delay in time to presentation is consistently found to predict poor outcomes.

Autologous tolerogenic dendritic cells for rheumatoid and inflammatory arthritis

Objectives

To assess the safety of intra-articular (IA) autologous tolerogenic dendritic cells (tolDC) in patients with inflammatory arthritis and an inflamed knee; to assess the feasibility and acceptability of the approach and to assess potential effects on local and systemic disease activities.

Methods

An unblinded, randomised, controlled, dose escalation Phase I trial. TolDC were differentiated from CD14+ monocytes and loaded with autologous synovial fluid as a source of autoantigens. Cohorts of three participants received 1×10⁶, 3×10⁶ or 10×10⁶ tolDC arthroscopically following saline irrigation of an inflamed (target) knee. Control participants received saline irrigation only. Primary outcome was flare of disease in the target knee within 5 days of treatment. Feasibility was assessed by successful tolDC manufacture and acceptability via patient questionnaire. Potential effects on disease activity were assessed by arthroscopic synovitis score, disease activity score (DAS)28 and Health Assessment Questionnaire (HAQ). Immunomodulatory effects were sought in peripheral blood.

Results

There were no target knee flares within 5 days of treatment. At day 14, arthroscopic synovitis was present in all participants except for one who received 10×10⁶ tolDC; a further participant in this cohort declined day 14 arthroscopy because symptoms had remitted; both remained stable throughout 91 days of observation. There were no trends in DAS28 or HAQ score or consistent immunomodulatory effects in peripheral blood. 9 of 10 manufactured products met quality control release criteria; acceptability of the protocol by participants was high.

Conclusion

IA tolDC therapy appears safe, feasible and acceptable. Knee symptoms stabilised in two patients who received 10×10⁶ tolDC but no systemic clinical or immunomodulatory effects were detectable.

Trial registration number

NCT01352858.

Detection of (135) Cs by accelerator mass spectrometry

RATIONALE

The ability to measure both (135) Cs and (137) Cs can provide an estimate of the age and source of Cs isotopes in an environmental sample. Accelerator mass spectrometry (AMS) consistently reports lower abundance sensitivities than other techniques and, with the addition of an on-line reaction cell, simpler isobaric suppression. Therefore, an AMS methodology was developed to measure Cs isotopes using CsF2- as the initial anion.

METHODS

The ion beam is passed through the Isobar Separator for Anions (ISA) where it is captured by radiofrequency quadrupoles in a gas cell before injection into the tandem accelerator. In the ISA, the beam reacts with O2 gas, selectively removing the BaF2- and leaving the Cs analyte to be reaccelerated and sent through the remainder of the AMS system.

RESULTS

The BaF2- signal was attenuated by a factor of 10(5) in the ISA while 25% of the original CsF2- current was transmitted into the accelerator. (135) Cs was measured without any interference from (133) Cs to an abundance sensitivity of 1.3 × 10(-10) . The abundances of four stable Ba isotopes (masses 133, 134, 135 and 137) were measured and no isotope-dependent bias was detected using the ISA in vacuum.

CONCLUSIONS

The results demonstrate the feasibility of measuring long-lived Cs isotopes without Ba interference by AMS with on-line isobar separation and the ability to use shorter lived Cs isotopes for yield tracing.

Endoscopic retrograde cholangio-pancreatography practice in district general hospitals in North East England: a Northern Regional Endoscopy Group (NREG) study

AIM

Endoscopic retrograde cholangio-pancreatography (ERCP) is an important tool for the management of pancreato-biliary disease. The aim of this study was to compare the current practice of ERCP in North East England against the key 2004 National Confidential Enquiry Report into Patient Outcome and Death (NCEPOD) recommendations and the standards set by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG).

METHODS

This was a prospective multicentre study involving all hospitals in North East England, coordinated through the Northern Regional Endoscopy Group (NREG).

RESULTS

Fourteen endoscopy units submitted data for 481 ERCPs. Mean dose of midazolam was 3.24 mg (standard deviation 1.35; range 1-8 mg). Coagulation profile results were available on 469 patients (97%). Radiological investigations were documented in 96% of the procedures (463 of 481) prior to ERCP. The most common indication for ERCP was related to choledocholithiasis and its complications.  All procedures were performed with a therapeutic intent. A total of 84% of all patients were either American Society of Anesthesiologists grade I or II. The selective biliary cannulation rate was 87.3%. The total completion rate of all procedures was 80.2% (381 of 475) and completion of therapy was 89.5% (425 of 475). The 30-day mortality rate was 2% (ten patients) and procedure-related complications occurred in 5% of patients. There were no deaths directly as a result of ERCP; all deaths were related to underlying medical conditions.

CONCLUSIONS

The practice of ERCP in North East England adheres to the key recommendations of the NCEPOD and the standards set by JAG. The rates of complications compare favourably with those reported internationally.

Understanding gastro-oesophageal reflux disease: a patient-cluster analysis

OBJECTIVE

To determine whether patients with gastro-oesophageal reflux disease (GERD) can be grouped according to the physical and psychological impact of their disease.

METHODS

In this multinational study, 7713 primary care physicians (PCPs) and gastrointestinal (GI) specialists took part in a structured online survey to determine how they perceive the clinical and psychological needs of their GERD patients, based on their three most recent consultations. Patients were grouped according to one of the five clusters that were subjectively developed based on preceding qualitative research.

RESULTS

Findings are reported for 1157 respondents (875 PCPs, 282 GI specialists), who reviewed 3471 patient records. Two of the five original clusters were collapsed because of overlapping characteristics, giving rise to three patient clusters. Patients with 'long-term, disrupting GERD' (39%) had symptoms considered to have not only high physical but also psychological impact. Patients with 'recurrent, distressing GERD' (14%) experienced both physical and psychological impact and were worried about the recurrent, restrictive nature of their disease or the possibility of having a more serious underlying condition. Patients with 'inconveniencing GERD' (48%) had less frequent symptoms with overall lower impact. Overall, there was a trend for GI specialists to more likely see patients at higher clinical need than PCPs.

CONCLUSIONS

Patients with GERD can generally be classified according to the physical and psychological impact of their disease. Recognition that such patients have different needs may facilitate improved management of GERD by allowing treatment to be tailored according to the patient's need.

Factors associated with poor asthma control in children aged five to 13 years

BACKGROUND

Most children with asthma should be able to achieve acceptable control. However, are there differences between those with acceptable and poor control, and if so, how can health care approaches be modified accordingly?

OBJECTIVE

To examine the characteristics of elementary school children aged five to 13 years with acceptable and poor levels of asthma control.

METHODS

The present cross-sectional study of children with asthma used five indicators of control, as outlined by the Canadian Asthma Consensus Report, to categorize acceptable and poor asthma control.

RESULTS

Of 153 children, 115 (75%) were rated as having poorly controlled asthma. Of those with poor control, 65 (64%) children were currently using inhaled corticosteroids, and 65% of those reported using inhaled corticosteroids daily versus as needed. Fifty-one per cent of the children with poorly controlled asthma had exposure to tobacco smoke, whereas 79% of the children with asthma under acceptable control were from households with no smokers (P=0.002). The poor control group also had significantly worse parental perceptions of the psychosocial impact of asthma on their child. No significant difference was found in the percentage of those who had written action plans in the poor control group (28%) compared with the acceptable control group (26%), and similar percentages in each group stated that they used the plans.

CONCLUSIONS

Despite the high use of inhaled corticosteroids, the majority of children had poorly controlled asthma. The poor control group had more exposure to tobacco smoke and a worse psychosocial impact due to asthma. Few children had past asthma education and action plans, suggesting that there is a need to improve access to and tools for education.

Proteomic analysis for the early detection and rational treatment of cancer--realistic hope?

Proteomics is an emerging field in medical science focused on the library of proteins specific to a given biosystem, the proteome, and understanding relationships therein. This field incorporates technologies that can be applied to serum and tissue in order to extract important biological information to aid clinicians and scientists in understanding the dynamic biology of their system of interest, such as a patient with cancer. These tools include laser capture microdissection, tissue lysate arrays and mass spectrometry approaches. These new technologies are more potent coupled with advanced bioinformatics analysis. They are used to characterize the content of, and changes in, the proteome induced by physiological changes, benign and pathologic. The application of these tools has assisted in the discovery of new biomarkers and may lead to new diagnostic tests and improvements in therapeutics. These tools additionally can provide a molecular characterization of cancers, which may allow for individualized molecular therapy. Understanding the basic concepts and tools used will illustrate how best to apply these technologies for patient benefit for the early detection of cancer and improved patient care.

Determinants of quality of life in first-episode psychosis

OBJECTIVE

To assess patient and/or illness characteristics associated with aspects of quality of life (QOL) in first-episode psychosis (FEP).

METHOD

Patient characteristics, symptom ratings and Wisconsin QOL scale (client version) were assessed. Data were analysed with correlation coefficients and a hierarchical regression analysis.

RESULTS

Patients presented with varying levels of QOL on different domains. The level of 'general satisfaction' was related to age of onset and social premorbid adjustment; 'weighted index of QOL' to social premorbid adjustment and inversely to educational premorbid adjustment; 'social relations' inversely to duration of untreated psychosis (DUP), length of prodrome and negative symptoms; 'psychological well-being' inversely to depression and educational premorbid adjustment; 'activities of daily living' to social premorbid adjustment and inversely to negative symptoms; and 'outlook on symptoms' to level of depression.

CONCLUSION

Domains of self-rated QOL in FEP patients are differentially associated with malleable and non-malleable aspects of patient and illness characteristics.

Insulin signalling: effects of prior exercise

After the discovery and clinical use of insulin for treatment of diabetes it became clear that some of the biological effect of insulin was dependent on the circumstances under which it was given. Relevant for this review is the notion that physical activity, in addition to its own direct metabolic effects also markedly affects the ability of insulin to stimulate a range of metabolic processes. More specifically, during and for a prolonged period after, exercise elicits effects on processes such as insulin-induced muscle glucose uptake and glucose metabolism which influence systemic glucose homeostasis. These phenomena are probably responsible for the improvement in glucose homeostasis and metabolic control that typically occurs with exercise in people with insulin resistance and probably contributes to the reduced risk for development of type 2 diabetes in individuals who engage in regular exercise. Here we focus on the influence of a single bout of exercise on the action of insulin on processes such as glucose uptake and glucose storage in skeletal muscle.

Client and staff views on facilities and services, before and after the convergence of sexual, reproductive and women's services

OBJECTIVE

To evaluate client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services.

METHODS

Evaluation involved questionnaire survey of clients and staff, one-to-one interviews with staff and review of routinely collected clinical activity data.

RESULTS

The integration of the three services led to a reduction in stigma associated with attending sexual health services. Despite some staff concerns, the number of men attending the services did not decrease. There was increased satisfaction with the new service, especially the quality of facilities. There were increased numbers of referrals between clinical services in the Sandyford Initiative.

CONCLUSIONS

Sexual, reproductive and women's services can be integrated to provide improved facilities for clients.

Intraspecific molecular variation in the seaweed fly Coelopa frigida consistent with behavioural distinctness of British and Swedish populations

The major aim of this study was to compare the intraspecific variation and genetic structure of the behaviourally distinct British and Swedish populations of the seaweed fly Coelopa frigida. C. frigida has been the subject of intense study into the basis of female choice. The behaviour of British females is consistent with a 'good genes' model, whereas that of the Swedish flies suggests a Fisher process, in which the difference between the former and the latter is defined by female choice increasing offspring viability in 'good genes' models. Through a study of variability in the mitochondrial cytochrome oxidase II gene from more than 600 flies, we show that there is clear differentiation at the molecular level between the two countries' populations, with an FST of > 75% and no shared haplotypes. Tajima's test reveals an excess of rare variants relative to expectation, which, if not the result of selective sweep, indicates either a population expansion or purifying selection against weakly deleterious variants. Within the two populations, substantial subpopulation differentiation is observed in the UK, where there is also evidence of isolation by distance. Swedish populations exhibit lower variability, and no evidence of isolation by distance, with the latter result possibly being related to the continuous distribution of suitable habitat. The pattern of intraspecific variation is explainable by a combination of contemporary and also historical factors. British and Swedish populations may have been descended from at least two separate founding populations during the recolonization of these areas following Pleistocene glaciations.

Immortalisation of primary cells

Knowledge of the target cells is fundamental to maximise efficiency in attempts at immortalisation of specific cell types. It is also important to optimise the primary cell culture system to promote the survival of the target cell population. Other important factors that may influence the success in obtaining immortalised cells include the toxicity and efficiency of the immortalisation procedure. These can be assessed experimentally and if necessary appropriate techniques can be employed to purify the target cells. When cell lines have been established it is vital to assess them at an early stage for desired scientific and practical features as well as determining their stability and life-span. Furthermore, early characterisation of cell line authenticity (e.g. genetic characters, species of origin) and quality control testing will avoid wasted time and resources should contamination with micro-organisms or another cell line occur. Establishing a programme of immortalisation is a serious undertaking that should only be considered when there are no candidate continuous cell lines available. However, new approaches to modify the biology of cells to give extended life-span, whilst retaining the characteristics of differentiated cells in vivo, will hopefully provide valuable new substrates for in vitro toxicology.

Inhibition by dietary dibenzoylmethane of mammary gland proliferation, formation of DMBA-DNA adducts in mammary glands, and mammary tumorigenesis in Sencar mice

Dibenzoylmethane (DBM) is a minor constituent of licorice and a beta-diketone analogue of curcumin. Feeding 1% DBM in the diet to Sencar mice during both the initiation and the post-initiation periods strongly inhibited 7,12-dimethylbenz[a]anthracene (DMBA)-induced mammary tumor multiplicity and mammary tumor incidence by 97%. In further in vivo studies to elucidate the possible mechanisms of the inhibitory action of DBM, feeding the 1% DBM in the AIN-76A diet to immature Sencar mice for 4-5 weeks decreased the uterine wet weight by 43%, inhibited the proliferation rate of mammary gland epithelial cells by 53%, uterine epithelium by 23%, and uterine stroma by 77%, when mice were killed during the first estrus phase of estrous cycle. In addition, feeding 1% DBM in the diet to Sencar mice at 2 weeks before, during and 1 week after DMBA treatment (intubation of 1 mg DMBA per mouse once a week for 5 weeks) inhibited formation of total DMBA-DNA adducts in mammary glands by 72% using a post-32P-labeling assay. Thus, feeding 1% DBM diet to Sencar mice inhibited formation of DMBA-DNA adducts in mammary glands and lowered the proliferation rate of the mammary gland in vivo. These results may explain the strong inhibitory actions of dietary DBM on mammary carcinogenesis in mice.

Validity of double- and single-leg vertical jumps as tests of leg extensor muscle function

The purpose of this research was to determine if 5 weeks of resistance training for the shoulder and hip flexor muscles produces improvements in vertical jumping (VJ) performance. Twenty-eight men were assessed on tests of shoulder power, leg extensor muscle function, and VJ performance using jumps performed from a standing position, a 3-stride run-up, and double- and single-leg takeoffs. A shoulder and hip flexor training group (n = 14) improved significantly more than a nontraining control group (n = 12) in shoulder power and 2 VJ performance tests, but not in the tests of leg extensor muscle function. It was concluded that the arm swing and free-leg drive significantly influence VJ performance and, therefore, VJ tests are not valid for assessment of leg extensor muscle function.

Angiographic findings of persistent primitive hepatic venous plexus with underdevelopment of the infrahepatic inferior vena cava in pediatric patients

OBJECTIVE

We describe the angiographic diagnosis and significance of persistence of the primitive hepatic venous plexus with underdevelopment of the infrahepatic inferior vena cava.

CONCLUSION

We recommend that inferior venacavography be performed in routine assessment before surgery of patients with azygos or hemiazygos continuation of the inferior vena cava, in whom redirection of systemic venous blood to the pulmonary artery is contemplated.

Inhibition of benzo[a]pyrene- and 1,6-dinitropyrene-DNA adduct formation in human mammary epithelial cells bydibenzoylmethane and sulforaphane

Numerous phytochemicals have been examined for their capacity to act as cancer chemopreventive agents. Dibenzoylmethane, a minor constituent of licorice and a compound structurally-related to curcumin, recently was identified as an effective inhibitor of chemically-induced rat mammary DNA-adduct formation and tumorigenesis (Carcinogenesis 19(1998)1039-1043). The present studies were conducted to examine the capacity of dibenzoylmethane to inhibit the formation of DNA adducts following exposure to benzo[a]pyrene (BP) and 1,6-dinitropyrene (1,6-DNP), and to stimulate the expression of glutathione-S-transferase (GST) and NAD(P)H-quinone reductase (QR) proteins in the human mammary epithelial cell line MCF-10F. In addition, the efficacy of dibenzoylmethane as an enzyme inducer and adduct inhibitor was compared with that of sulforaphane, a potent inducer of phase II detoxification enzymes and inhibitor of chemically-induced rat mammary tumorigenesis. Dibenzoylmethane at concentrations from 0.1 M to 2.0 microM inhibited BP-DNA adduct formation by 63 to 81%. Likewise, sulforaphane inhibited BP-DNA adduct formation by 68 to 80% over the same concentration range. DNA adduct formation following exposure to 1,6-DNP was significantly inhibited by 46 to 61% due to dibenzoylmethane treatment (0.1 to 2.0 microM) and 30 to 56% due to sulforaphane treatment at the same concentrations. The expression of QR and GSTP1-1 proteins were increased by 3 to 4-fold and 3 to 5-fold, respectively, for MCF-10F cells treated with sulforaphane (0.5-2.0 microM). Dibenzoylmethane treatment at the same concentrations did not induce GSTP1-1 expression and significantly stimulated QR expression only at the 2.0 microM concentration. These data indicate that human mammary epithelial MCF-10F cells can convert BP and 1,6-DNP to DNA-binding forms, and that DNA adduct formation can be inhibited by the phytochemicals dibenzoylmethane and sulforaphane. The inhibition of BP-DNA and 1, 6-DNP adduct formation by sulforaphane was associated with increases in QR and GST protein expression. The mechanisms underlying the capacity of dibenzoylmethane to inhibit BP-DNA and 1,6-DNP-DNA adduct formation could not be explained by changes in QR or GST expression and remain to be determined. Together these data suggest that dibenzoylmethane and sulforaphane warrant continued evaluation as breast cancer chemopreventive agents.

Selected aspects of cardiac tumors in infancy and childhood

Considerable literature concerning cardiac tumors in infancy and childhood has accumulated summarizing the prevalence, histologic types, clinical presentation and outcome, and changing imaging algorithms [1, 7, 10, 14, 20, 24, 33, 37, 43, 48, 57, 58, 60-62, 67, 69, 70, 90, 105, 106, 110, 124, 139, 140, 142, 143, 149]. In this review, we focus on selected aspects of cardiac tumors in the neonate, infant, and child, with an emphasis on imaging modalities [6, 13, 15, 18, 21-23, 60, 71, 77, 80, 92, 98, 99, 103, 107, 112, 114, 119, 146]. Various types of primary cardiac tumors in childhood are discussed in this article.

Manipulation of the phenotype of immortalised rat hepatocytes by different culture configurations and by dimethyl sulphoxide

The liver-specific phenotype of immortalised rat hepatocytes is not irretrievably lost as they age in culture but can be manipulated by modifying the culture environment. Testosterone metabolism was used to investigate the profile of cytochrome P450 isoenzymes present in two immortalised cell lines, P9 and LQC, and in primary cultures of rat hepatocytes, cultured on collagen films, gels and double gel cultures (sandwich configuration). The extent of testosterone metabolism, and the range of metabolites produced, was increased in immortalised cells by the presence of collagen as a substratum film or gel but survival was poorer and the range of metabolites was reduced in sandwich culture. In contrast, testosterone metabolism was retained in primary hepatocytes in sandwich cultures at a higher level than in collagen film or gel cultures. Expression of alpha class glutathione-S-transferases (GSTs) increased and that of GSTP1 decreased (changes which indicate a recovery of normal liver GST phenotype) when the medium of immortalised cell cultures was supplemented with dimethyl sulphoxide (DMSO). DMSO also improved ethoxyresorufin O-deethylation (EROD) and testosterone metabolism in immortalised cells. It also markedly inhibited proliferation, DNA, RNA and protein synthesis. Maximal testosterone metabolism was observed in immortalised cells cultured on collagen gels in the presence of 1% (v/v) DMSO. Development of a protocol for treating immortalised liver cells cultured on collagen gels with DMSO to switch between proliferation and differentiation may provide a convenient system expressing the xenobiotic metabolising enzymes required for in vitro toxicity testing.

Umbilical cord endothelial cells expressing large T antigen: comparison with primary cultures and effect of cell age

A number of human endothelial cell lines from umbilical cord cells (HUVECs) have been generated by transfection with SV40 large T and small t antigen sequences. Comparison of these lines with primary cultures of HUVECs has been carried out by monitoring the expression of a number of endothelial cell markers with specific regard to cell age. The secreted levels of the protein plasminogen activator inhibitor (PAI) was found to be significantly reduced in SV40-transfected cells when compared to untransfected controls. Tissue plasminogen activator (tPA) and urokinase (uPA) levels were unchanged. As cells entered crisis, there was a rapid and significant increase in the levels of tPA, uPA, and PAl and this was observed for all clones screened. The endothelial cell marker von Willebrand Factor (vWF) was found intracellularly and was also secreted into the medium. The levels were not altered between transfected and untransfected cells. Angiotensin converting enzyme (ACE) activity was maintained in cell lines at levels found in nonimmortalized HUVECs. Both isoforms (alpha and beta) of IL-1 (interleukin-1) increased as cells approached crisis, and the presence of these cytokines may be responsible for the increased levels of tPA, PAI, and uPA. With one exception, the ability of the transfected cells to produce prostacyclin (PGI2) was lost by all clones.

Balloon angioplasty of native coarctation: clinical outcomes and predictors of success

OBJECTIVES

We sought to investigate the clinical impact of balloon angioplasty for native coarctation of the aorta (CoA) and determine predictors of outcome.

BACKGROUND

Balloon dilation of native CoA remains controversial and more information on its long-term impact is required.

METHODS

Hemodynamic, angiographic and follow-up data on 69 children who underwent balloon angioplasty of native CoA between 1988 and 1996 were reviewed. Stretch, recoil and gain of CoA circumference and area were calculated and related to outcomes.

RESULTS

Initial systolic gradients (mean +/- SD, 31+/-12 mm Hg) fell by -74+/-27% (p < 0.001), with an increase in mean CoA diameters of 128+/-128% in the left anterior oblique and 124+/-87% in the lateral views (p < 0.001). Two deaths occurred, one at the time of the procedure and one 23 months later, both as a result of an associated cardiomyopathy. Seven patients had residual gradients of >20 mm Hg. One patient developed an aneurysm, stable in follow-up, and four patients had mild dilation at the site of the angioplasty. Freedom from reintervention was 90% at one year and 87% at five years with follow-up ranging to 8.5 years. Factors significantly associated with decreased time to reintervention included: a higher gradient before dilation, a smaller percentage change in gradient after dilation, a small transverse arch and a greater stretch and gain, but not recoil.

CONCLUSION

Balloon dilation is a safe and efficient treatment of native CoA in children. Greater stretch and gain are factors significantly associated with reintervention, possibly related to altered elastic properties and vessel scarring.

De novo 46,XX,t(6;7)(q27;q11;23) associated with severe cardiovascular manifestations characteristic of supravalvular aortic stenosis and Williams syndrome

Supravalvular aortic stenosis may present as an isolated finding or as part of Williams syndrome. Williams syndrome is a contiguous gene syndrome associated with neurodevelopmental and multisystemic manifestations caused by hemizygous deletion at 7q11.23. We report on the prenatal and histopathological findings in a patient with a chromosome translocation involving the Williams syndrome critical region. The initial abnormality on fetal ultrasound was hydrops fetalis detected at 30 weeks and echocardiography showed narrowing of the aorta and the pulmonary arteries. The baby died shortly after delivery and an autopsy revealed diffuse tubular thickening with luminal narrowing of the aorta, aortic branches, and the pulmonary arteries. Histopathology showed dysplasia of the media with reduced elastic content and "cartwheel" arrangement of collagen, elastic, and muscle fascicles. The karyotype was 46,XX,t(6;7)(q27;q11.23). Three signals were detected using the Oncor fluorescent in situ hybridization probe for elastin-Williams syndrome (WSCR) suggesting that the break in chromosome 7 is within the elastin-Williams gene. This patient is of special interest because of the prenatal presentation and the chromosomal translocation involving the elastin-Williams syndrome locus.

Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty

We prospectively studied the continuous "modified" femoral three-in-one block for postoperative pain after total knee arthroplasty. Sixty-two patients undergoing elective knee arthroplasty under spinal anesthesia with bupivacaine (B) and fentanyl were randomized to receive 0.2% B, 0.1% B, or placebo at 10 mL/h for 48 h after an initial bolus of 30 mL of the same solution via the femoral block catheter. The catheters were inserted under the fascia iliaca using a "double pop" technique and a peripheral nerve stimulator and were advanced 15-20 cm cranially. Venous plasma levels of B, desbutylbupivacaine, and 4-hydroxy B were measured daily for 3 days. All patients received patient-controlled analgesia with morphine and indomethacin suppositories for 48 h. Using computed tomography, we evaluated the catheter location for 20 patients. The catheter tips, located superior to the upper third of the sacroiliac joint in the psoas sheath, were labeled as ideally located. The group receiving 0.2% B had a larger block success rate, smaller morphine consumption in the immediate postoperative period (15 vs 22 mg) and during the first postoperative day (9 vs 18 mg), and achieved a greater range of motion in the immediate postoperative period (91 degrees +/- 10 degrees vs 80 degrees + 13 degrees ). Visual analog scores for pain during both rest and activity were low but similar between the groups. Forty percent of the catheters evaluated were ideally located. Ideal location and use of 0.2% B resulted in 100% success of blockade of all three nerves. The S1 root was blocked in up to 76% of patients. The plasma levels of B, 4-hydroxy B, and desbutylbupivacaine were below the toxic range during the infusion. We conclude that continuous fascia iliaca block with 0.2% B results in opioid-sparing and improved range of motion during the immediate postoperative period. Larger doses of bupivacaine may safely be used in the immediate postoperative period if needed.

IMPLICATIONS

Continuous fascia iliaca block with 0.2% bupivacaine reduces opioid requirements and improves range of motion in the immediate postoperative period compared with a placebo and 0.1% bupivacaine. Plasma levels are below the toxic range with this dose. Only 40% of the catheters are positioned in the ideal location. With the smaller dose of bupivacaine, the success rate with this block is small.

Posttraumatic stress disorder and interpersonal functioning in Vietnam War veterans: a mediational model

This study examines the association between posttraumatic stress disorder (PTSD) and interpersonal functioning in a New Zealand community sample of 756 Vietnam War veterans. The results support previous research findings showing that PTSD adversely affects veterans' interpersonal relationships, family functioning, and marital/dyadic adjustment and show that the effects of PTSD on family functioning and dyadic adjustment are mediated by severity of interpersonal problems. It is suggested that higher levels of PTSD affect the ability of veterans to initiate and maintain interpersonal relationships and that these interpersonal problems are evident in poorer levels of family functioning and poorer dyadic adjustment.

Determination of domperidone in human serum and human breast milk by high-performance liquid chromatography-electrospray mass spectrometry

A sensitive and selective method for the determination of domperidone in human breast milk and serum has been developed. The same method may be successfully applied to both matrices to a lower limit of quantitation of 0.5 ng/ml. Samples are processed by a liquid-liquid extraction, and analyzed by LC-ESI-MS in positive ion mode. There was no interference, on the domperidone quantitation, from over 30 drugs. Samples from patients, at various times post-dose, were analyzed and a large number showed significant levels of domperidone in the breast milk as well as in the serum.

Myocardial bridging in children with hypertrophic cardiomyopathy--a risk factor for sudden death

BACKGROUND

Myocardial bridging may cause compression of a coronary artery, and it has been suggested that myocardial ischemia may result. The clinical significance and prognostic value of myocardial bridging of the left anterior descending coronary artery in children with hypertrophic cardiomyopathy are unknown. We sought to determine the prevalence and clinical effects of myocardial bridging in children with hypertrophic cardiomyopathy who underwent cardiac catheterization.

METHODS

Angiograms from 36 children with hypertrophic cardiomyopathy were reviewed to determine whether myocardial bridging was present and, if so, to assess the characteristics of systolic narrowing of the left anterior descending coronary artery caused by myocardial bridging and the duration of residual diastolic compression. We also reviewed clinical data on these patients.

RESULTS

Myocardial bridging was present in 10 (28 percent) of the patients. Compression of the left anterior descending coronary artery persisted for a mean (+/-SD) of 50+/-17 percent of diastole. As compared with patients without bridging, patients with bridging had a greater incidence of chest pain (60 percent vs. 19 percent, P=0.04), cardiac arrest with subsequent resuscitation (50 percent vs. 4 percent, P=0.004), and ventricular tachycardia (80 percent vs. 8 percent, P<0.001). On average, the patients with bridging had a reduction in systolic blood pressure with exercise of 17+/-27 mm Hg, as compared with an elevation of 43+/-31 mm Hg in those without bridging (P<0.001). The patients with bridging also had greater ST-segment depression with exercise (median, 5 vs. 0 mm, P=0.004) and a shorter duration of exercise (mean, 6.6+/-2.4 vs. 9.1+/-1.4 minutes, P=0.008). The degree of dispersion of the QT interval corrected for heart rate on the electrocardiogram was greater in patients with bridging than in those without bridging (104+/-46 vs. 48+/-31 msec, P=0.002). Kaplan-Meier estimates of the proportions of patients who had not died or had cardiac arrest with subsequent resuscitation five years after the diagnosis of hypertrophic cardiomyopathy were 67 percent among patients with bridging and 94 percent among those without bridging (P=0.004).

CONCLUSIONS

Myocardial bridging is associated with a poor outcome in children with hypertrophic cardiomyopathy. Our observations suggest that bridging is associated with myocardial ischemia

High-dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels

High-dose etoposide (2.0-2.4 g m(-2)) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize peripheral blood progenitor cells (PBPCs), although in some patients this is associated with significant toxicity. Sixty-three patients with malignancy were enrolled into this non-randomized sequential study. The majority (55/63, 87%) had received at least two prior regimens of chemotherapy, and seven patients had previously failed to mobilize following high-dose cyclophosphamide with G-CSF. Consecutive patient groups received etoposide at three dose levels [2.0 g m(-2) (n = 22), 1.8 g m(-2) (n = 20) and 1.6 g m(-2) (n = 21)] followed by daily G-CSF. Subsequent leukaphereses were assayed for CD34+ cell content, with a target total collection of 2.0 x 10(6) CD34+ cells kg(-1). Toxicity was assessed by the development of significant mucositis, the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (16%) had less than the minimum target yield collected. Median collections in the three groups were 4.7 (2 g m(-2)), 5.7 (1.8 g m(-2)) and 6.5 (1.6 g m(-2)) x 10(6) CD34+ cells kg(-1). Five of the seven patients who had previously failed cyclophosphamide mobilization achieved more than the target yield. Rehospitalization incidence was significantly lower in patients receiving 1.6 g m(-2) etoposide than in those receiving 2.0 g m(-2) (P = 0.03). These data suggest that high-dose etoposide with G-CSF is an efficient mobilization regimen in the majority of heavily pretreated patients, including those who have previously failed on high-dose cyclophosphamide with G-CSF. An etoposide dose of 1.6 g m(-2) appears to be as effective as higher doses but less toxic.