Herpes zoster mRNA vaccine induces superior vaccine immunity over licensed vaccine in mice and rhesus macaques

Herpes zoster remains an important global health issue and mainly occurs in aged and immunocompromised individuals with an early exposure history to Varicella Zoster Virus (VZV). Although the licensed vaccine Shingrix has remarkably high efficacy, undesired reactogenicity and increasing global demand causing vaccine shortage urged the development of improved or novel VZV vaccines. In this study, we developed a novel VZV mRNA vaccine candidate (named as ZOSAL) containing sequence-optimized mRNAs encoding full-length glycoprotein E encapsulated in an ionizable lipid nanoparticle. In mice and rhesus macaques, ZOSAL demonstrated superior immunogenicity and safety in multiple aspects over Shingrix, especially in the induction of strong T-cell immunity. Transcriptomic analysis revealed that both ZOSAL and Shingrix could robustly activate innate immune compartments, especially Type-I IFN signalling and antigen processing/presentation. Multivariate correlation analysis further identified several early factors of innate compartments that can predict the magnitude of T-cell responses, which further increased our understanding of the mode of action of two different VZV vaccine modalities. Collectively, our data demonstrated the superiority of VZV mRNA vaccine over licensed subunit vaccine. The mRNA platform therefore holds prospects for further investigations in next-generation VZV vaccine development.

A therapeutic hepatitis B mRNA vaccine with strong immunogenicity and persistent virological suppression

Here we report on the development and comprehensive evaluations of an mRNA vaccine for chronic hepatitis B (CHB) treatment. In two different HBV carrier mouse models generated by viral vector-mediated HBV transfection (pAAV-HBV1.2 and rAAV8-HBV1.3), this vaccine demonstrates sufficient and persistent virological suppression, and robust immunogenicity in terms of induction of strong innate immune activation, high-level virus-specific antibodies, memory B cells and T cells. mRNA platform therefore holds prospects for therapeutic vaccine development to combat CHB.

Efficacy and safety of duloxetine in osteoarthritis or chronic low back pain: a Systematic review and meta-analysis

OBJECTIVE

To evaluate the efficacy and safety of duloxetine in the treatment of patients with osteoarthritis (OA) or chronic low back pain (CLBP).

METHODS

Relevant randomized controlled trials (RCTs) were searched in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Included RCTs compared the efficacy and safety of duloxetine vs placebo in the treatment of OA or CLBP. Weighted mean difference (WMD) were calculated for continuous outcomes while risk ratio (RR) were calculated for dichotomous outcomes.

RESULTS

Nine RCTs were included in our meta-analysis. Duloxetine had significant improvement over placebo in Brief Pain Inventory 24-h average pain [WMD: -0.67; 95% confidence interval (CI):-0.80, -0.53], weekly mean of the 24-h average pain (WMD: -0.65; 95% CI: -0.79, -0.52), Patient's Global Impression of Improvement (WMD: -0.41; 95% CI: -0.49, -0.32), Clinical Global Impression of Severity (WMD: -0.32; 95% CI: -0.38, -0.25), European Quality of Life Questionnaire-5 Dimension (WMD: 0.04; 95% CI: 0.02, 0.07). In addition, duloxetine is associated with more treatment-emergent adverse events (TEAEs) (RR: 1.25; 95% CI: 1.17, 1.33) and discontinuations for adverse events (AEs) (RR: 2.31; 95% CI: 1.81, 2.94). However, there was no statistically significant difference in serious AEs between duloxetine and placebo.

CONCLUSION

Duloxetine had modest to moderate effects on pain relief, function improvement, mood regulation and improvement in quality of life with mild AEs in the treatment of OA or CLBP. Future RCTs should focus on comparing duloxetine with other oral drugs and assessing the long-term safety of duloxetine.

Zinc Deficiency and Long-Term Outcome in Cases After Isolated Intestinal Transplantation in Taiwan

OBJECTIVES

The small intestine is the primary site for absorption of dietary zinc. Intestinal transplant recipients are at high risk for zinc deficiency because of the long process of posttransplant adaptation. We initiated an intestinal transplant program in Taiwan in 2007. In this study, we aimed to retrospectively investigate the incidence of zinc deficiency in recipients after intestinal transplantation.

METHODS

Twenty-one isolated intestinal transplants were performed in 20 patients with 1 retransplantation. The level of serum zinc was monitored periodically, and zinc supplements were administered when zinc level was below 700 ng/mL. Twelve patients with graft above 1-year survival and with available related data were enrolled for the analysis of zinc deficiency. The levels of serum zinc were tracked, and the protocol of zinc supplementation is discussed herein.

RESULTS

The survival rates of 20 transplant recipients for 1 year, 3 years, and 5 years were 85%, 75%, and 65%, respectively. In the 12 grafts that survived longer than 1 year, we found that zinc deficiency was highest during the third (41.7%) to sixth (50%) month after transplantation. Sustained supplementation of zinc was required for over 70% of patients throughout the 3-year period to maintain their zinc level around the lower normal limit.

CONCLUSION

The outcome of isolated small bowel transplantation is promising. Periodical monitoring and sufficient dosing of zinc supplements should be considered into the posttransplant protocol to prevent zinc deficiency after intestinal transplantation.

Study on Permeability of Porous Ultra-High Molecular Weight Polyethylene (UHMWPE)

In recent years, porous materials are gaining in popularity for engineering applications, due to their special characteristics, such as low density, large specific surface area, and excellent permeability. In this study, powder processing technique was used to prepare ultra-high molecular weight polyethylene UHMWPE porous materials. Sintering temperature was obtained by combining differential scanning calorimetry (DSC) analysis and tensile tests. The surface morphology of sintering necks and tensile fracture were observed by scanning electron microscopy (SEM). Finally, single factor tests and orthogonal experiments were conducted to optimize three main processing parameters for a better permeability. It is found that the proper sintering temperature range would be from 143 to 153.1°C. According to the significance of influence, processing factors come in the sequence of the particle size, the compaction strength and the sintering temperature. Porous materials were successfully prepared, under the optimized parameters as the particle size >250 μm, the compaction strength of 2.5 MPa and the sintering temperature of 152°C.

Clinical Research Informatics for Big Data and Precision Medicine

OBJECTIVES

To reflect on the notable events and significant developments in Clinical Research Informatics (CRI) in the year of 2015 and discuss near-term trends impacting CRI.

METHODS

We selected key publications that highlight not only important recent advances in CRI but also notable events likely to have significant impact on CRI activities over the next few years or longer, and consulted the discussions in relevant scientific communities and an online living textbook for modern clinical trials. We also related the new concepts with old problems to improve the continuity of CRI research.

RESULTS

The highlights in CRI in 2015 include the growing adoption of electronic health records (EHR), the rapid development of regional, national, and global clinical data research networks for using EHR data to integrate scalable clinical research with clinical care and generate robust medical evidence. Data quality, integration, and fusion, data access by researchers, study transparency, results reproducibility, and infrastructure sustainability are persistent challenges.

CONCLUSION

The advances in Big Data Analytics and Internet technologies together with the engagement of citizens in sciences are shaping the global clinical research enterprise, which is getting more open and increasingly stakeholder-centered, where stakeholders include patients, clinicians, researchers, and sponsors.

UBE2S, a novel substrate of Akt1, associates with Ku70 and regulates DNA repair and glioblastoma multiforme resistance to chemotherapy

Glioblastoma multiforme (GBM) is the most common primary malignant brain cancer in adults. However, the molecular events underlying carcinogenesis and their interplay remain elusive. Here, we report that the stability of Ubiquitin-conjugating enzyme E2S (UBE2S) is regulated by the PTEN/Akt pathway and that its degradation depends on the ubiquitin-proteasome system. Mechanistically, Akt1 physically interacted with and phosphorylated UBE2S at Thr 152, enhancing its stability by inhibiting proteasomal degradation. Additionally, accumulated UBE2S was found to be associated with the components of the non-homologous end-joining (NHEJ) complex and participated in the NHEJ-mediated DNA repair process. The association of Ku70 with UBE2S was enhanced, and the complex was recruited to double-stranded break (DSB) sites in response to etoposide treatment. Furthermore, knockdown of UBE2S expression inhibited NHEJ-mediated DSB repair and rendered glioblastoma cells more sensitive to chemotherapy. Overall, our findings provide a novel drug target that may serve as the rationale for the development of a new therapeutic approach.

Mechanisms mediating renal sympathetic nerve activation in obesity-related hypertension

Excessive renal sympathetic nerve activation may be one of the mechanisms underlying obesity-related hypertension. Impaired baroreflex sensitivity, adipokine disorders-such as leptin, adiponectin, and resistin-activation of the renin-angiotensin system, hyperinsulinemia, insulin resistance, and renal sodium retention present in obesity increase renal sympathetic nerve activity, thus contributing to the development of hypertension. Renal sympathetic denervation reduces both renal sympathetic activity and blood pressure in patients with obesity-related hypertension.

Adaptive semantic tag mining from heterogeneous clinical research texts

OBJECTIVES

To develop an adaptive approach to mine frequent semantic tags (FSTs) from heterogeneous clinical research texts.

METHODS

We develop a "plug-n-play" framework that integrates replaceable unsupervised kernel algorithms with formatting, functional, and utility wrappers for FST mining. Temporal information identification and semantic equivalence detection were two example functional wrappers. We first compared this approach's recall and efficiency for mining FSTs from ClinicalTrials.gov to that of a recently published tag-mining algorithm. Then we assessed this approach's adaptability to two other types of clinical research texts: clinical data requests and clinical trial protocols, by comparing the prevalence trends of FSTs across three texts.

RESULTS

Our approach increased the average recall and speed by 12.8% and 47.02% respectively upon the baseline when mining FSTs from ClinicalTrials.gov, and maintained an overlap in relevant FSTs with the base- line ranging between 76.9% and 100% for varying FST frequency thresholds. The FSTs saturated when the data size reached 200 documents. Consistent trends in the prevalence of FST were observed across the three texts as the data size or frequency threshold changed.

CONCLUSIONS

This paper contributes an adaptive tag-mining framework that is scalable and adaptable without sacrificing its recall. This component-based architectural design can be potentially generalizable to improve the adaptability of other clinical text mining methods.

A distribution-based method for assessing the differences between clinical trial target populations and patient populations in electronic health records

OBJECTIVE

To improve the transparency of clinical trial generalizability and to illustrate the method using Type 2 diabetes as an example.

METHODS

Our data included 1,761 diabetes clinical trials and the electronic health records (EHR) of 26,120 patients with Type 2 diabetes who visited Columbia University Medical Center of New-York Presbyterian Hospital. The two populations were compared using the Generalizability Index for Study Traits (GIST) on the earliest diagnosis age and the mean hemoglobin A1c (HbA1c) values.

RESULTS

Greater than 70% of Type 2 diabetes studies allow patients with HbA1c measures between 7 and 10.5, but less than 40% of studies allow HbA1c<7 and fewer than 45% of studies allow HbA1c>10.5. In the real-world population, only 38% of patients had HbA1c between 7 and 10.5, with 12% having values above the range and 52% having HbA1c<7. The GIST for HbA1c was 0.51. Most studies adopted broad age value ranges, with the most common restrictions excluding patients >80 or <18 years. Most of the real-world population fell within this range, but 2% of patients were <18 at time of first diagnosis and 8% were >80. The GIST for age was 0.75.

CONCLUSIONS

We contribute a scalable method to profile and compare aggregated clinical trial target populations with EHR patient populations. We demonstrate that Type 2 diabetes studies are more generalizable with regard to age than they are with regard to HbA1c. We found that the generalizability of age increased from Phase 1 to Phase 3 while the generalizability of HbA1c decreased during those same phases. This method can generalize to other medical conditions and other continuous or binary variables. We envision the potential use of EHR data for examining the generalizability of clinical trials and for defining population-representative clinical trial eligibility criteria.

Microchannel Deformation of Polymer Chip in In-Mold Bonding

Microchannel deformation is a problem which often occurs in the thermal bonding of polymer microfluidic chip, and which is significantly determined by bonding parameters. In this paper, numerical analysis of the microchannel deformation in the process of in-mold bonding polymer chip was conducted, using Young's modulus and shear relaxation modulus of polymethylmethacrylate (PMMA) obtained in creep tests. Adhesion between the top and two lateral walls of microchannel was observed in the results, which can be attributed mainly to the viscoelastic deformation of PMMA. It was also revealed that the maximum percent deformation of microchannel is in height, and that bonding temperature had greater effect on the deformation of microchannel than bonding pressure and bonding time. The deformation of microchannel in simulation were consistent with those of experiment under the optimized parameters of 105 °C, 2 MPa and 240 s.

Feasibility of feature-based indexing, clustering, and search of clinical trials. A case study of breast cancer trials from ClinicalTrials.gov

BACKGROUND

When standard therapies fail, clinical trials provide experimental treatment opportunities for patients with drug-resistant illnesses or terminal diseases. Clinical Trials can also provide free treatment and education for individuals who otherwise may not have access to such care. To find relevant clinical trials, patients often search online; however, they often encounter a significant barrier due to the large number of trials and in-effective indexing methods for reducing the trial search space.

OBJECTIVES

This study explores the feasibility of feature-based indexing, clustering, and search of clinical trials and informs designs to automate these processes.

METHODS

We decomposed 80 randomly selected stage III breast cancer clinical trials into a vector of eligibility features, which were organized into a hierarchy. We clustered trials based on their eligibility feature similarities. In a simulated search process, manually selected features were used to generate specific eligibility questions to filter trials iteratively.

RESULTS

We extracted 1,437 distinct eligibility features and achieved an inter-rater agreement of 0.73 for feature extraction for 37 frequent features occurring in more than 20 trials. Using all the 1,437 features we stratified the 80 trials into six clusters containing trials recruiting similar patients by patient-characteristic features, five clusters by disease-characteristic features, and two clusters by mixed features. Most of the features were mapped to one or more Unified Medical Language System (UMLS) concepts, demonstrating the utility of named entity recognition prior to mapping with the UMLS for automatic feature extraction.

CONCLUSIONS

It is feasible to develop feature-based indexing and clustering methods for clinical trials to identify trials with similar target populations and to improve trial search efficiency.

Interactions between stem cells and their niche in the Drosophila ovary

The Drosophila ovary contains at least three types of active stem cells, namely, germ-line stem cells (GSCs), escort stem cells (ESCs), and follicular stem cells (FSCs), which work together to efficiently assemble egg chambers. Among the three stem cell types, the GSC is among the first shown to be controlled by the niche due to its easy identification and welldefined surrounding cells. We have shown that the niche controls GSC self-renewal, anchorage, aging, and competition, and the GSC also signals back to the niche for its maintenance. The FSC is an attractive model for studying epithelial stem cell regulation and signal integration because we have shown that it resembles mammalian epithelial stem cells and requires multiple signaling pathways for its self-renewal. In this chapter, we have highlighted the findings of our studies on interactions between Drosophila ovarian stem cells and their niches during normal development and aging and on stem cell competition for niche occupancy. We further discuss their implications in general stem cell biology and future directions in this exciting area.

Topography-guided treatment of decentered laser ablation using LaserSight's excimer laser

PURPOSE

To assess the efficacy of topography-guided laser ablation for correction of previously decentered laser ablation using LaserSight's excimer laser.

METHODS

Re-treatment was performed to correct decentered ablation using LaserSight's excimer laser for 18 patients who previously underwent LASIK surgery for myopia correction in both eyes. For each patient, only the decentered eye was re-treated while the other asymptomatic eye forms a control group for this study. Measurements were conducted on ablation center, best spectacle-corrected visual acuity (BSCVA), contrast sensitivity and corneal aberrations pre- and post-operatively.

RESULTS

For the retreated 18 eyes, the mean decentration was significantly reduced from 1.32+/-0.28mm to 0.61+/-0.23mm post-operatively (t=16.24, p<0.001), and with a significant improvement in mean BSCVA from 0.08+/-0.09 logMAR to 0.01+/-0.11 logMAR (t=4.58, p<0.001). The post-operative contrast sensitivity at the spatial frequencies (SF) of 1.00 and 0.70 was significantly improved (p<0.05 for both SFs). Corneal higher-order aberrations (HOAs), including the coma-like aberrations and spherical aberration, were decreased. In comparing the measurements for the retreated group to those for the control group, no significant differencewas found either in decentration or in BSCVA, but the contrast sensitivity at 0.70 was lower and the level of corneal aberrations was higher.

CONCLUSIONS

Topography-guided ablation with LaserSight excimer laser is effective to correct decentered ablation. However, the re-treated eye is still inferior to the eye with originally centered ablation in corneal optical quality or visual performance.

CNS atypical teratoid/rhabdoid tumor registry: An update

12507

Background: Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant tumor of the central nervous system (CNS) in childhood, comprising up to 20% of malignant CNS tumors in patients < 3 years old. Although aggressive approaches including surgery, chemotherapy, intrathecal chemotherapy, high dose chemotherapy with hematopoietic stem cell transplant (HD-HSCT) and/or radiation have resulted in prolonged survival, overall survival remains poor. Methods: We reviewed pediatric patients with AT/RT on an IRB- approved registry formed in 1995 with new insight based on updated outcomes and additional patient enrollment. Upon patient entry, the managing physician submitted pertinent medical records for data abstraction. Physicians were contacted in accordance with privacy regulations for updated records. The Kaplan-Meier method was used to estimate survival time (from diagnosis to death or most recent status update) and groups were compared using the log-rank test at a significance level of p<0.05 with SAS® software version 9.1. Results: Analysis was conducted on 73 patients with a 4:3 male to female ratio. Age at diagnosis ranged from 5 days to 234 months, median = 19 months. Twenty-five patients have no evidence of disease, median 59 months from diagnosis (range 10–140). Forty-three patients (59%) developed recurrent or progressive disease; 6 of these patients are alive at a median of 28 months from recurrence (range 4–38). Forty-four patients (60%) are dead of disease; median time to death was 7 months from diagnosis (range 0–62). Factors correlating with survival are: primary tumor site not in spinal cord (p=0.029), lack of metastatic disease (p=0.024), gross total resection (p<0.001), and upfront radiation particularly in children < 3 years old (p<0.001). HD-HSCT appears to result in improved survival in children < 3 years of age who do not receive radiation, though the small sample size does not yield a statistically significant survival advantage. Conclusions: In treatment of AT/RT, extent of surgical resection and upfront radiation are beneficial for overall survival, particularly in young children. Early information regarding upfront HD-HSCT in lieu of radiation for children < 3 years of age with AT/RT suggests it may be effective. Prospective studies are warranted to further investigate this treatment.

No significant financial relationships to disclose.

Retinogeniculate connections: A balancing act between connection specificity and receptive field diversity

Retinogeniculate connections are one of the most striking examples of connection specificity within the visual pathway. In almost every connection there is one dominant afferent cell per geniculate cell, and both afferent and geniculate cells have very similar receptive fields. The remarkable specificity and strength of retinogeniculate connections have inspired comparisons of the lateral geniculate nucleus (LGN) with a simple relay that connects the retina with the visual cortex. However, because each retinal ganglion cell diverges to innervate multiple cells in the LGN, most geniculate cells must receive additional inputs from other retinal afferents that are not the dominant ones. These additional afferents make weaker connections and their receptive fields are not as perfectly matched with the geniculate target as the dominant afferent. We argue that these 'match imperfections' are important to create receptive field diversity among the cells that represent each point of visual space in the LGN. We propose that the convergence of dominant and weak retinal afferents in the LGN multiplexes the array of retinal ganglion cells by creating receptive fields that have a richer range of positions, sizes and response time courses than those available at the ganglion cell layer of the retina.

On the Number of Genes Controlling the Grass Stage in Longleaf Pine

The grass stage is an inherent and distinctive developmental trait of longleaf pine (Pinus palustris), in which height growth in the first few years after germination is suppressed. In operational forestry practice the grass stage extends for two to several years and often plays a role in planting failures and decisions to plant alternative species. Interspecies hybrids involving loblolly (P. taeda) and slash (P. elliottii var. elliottii) pines have been investigated as a means to produce planting stock with improved early height growth and to develop backcross populations for advanced generation breeding. We have reevaluated data from several interspecies populations, with the objective of estimating the number of genes contributing to the difference in first-year height growth between longleaf and loblolly pines. Estimates based on means and variances of parental and interspecies hybrid and backcross families suggest a minimum of 4 to 10 genes with standard errors less than half the estimates. These results suggest that the grass stage has evolved through the accumulation of alleles at several loci, each with small effects on various components of first-year height growth. Given the complexity of the grass-stage trait, tree breeders may need to combine genetic marker analysis with recurrent backcross breeding to efficiently develop longleaf pine planting stock for improved reforestation.

Mapping quantitative trait loci controlling early growth in a (longleaf pine x slash pine) x slash pine BC(1) family

Random amplified polymorphic DNA (RAPD) markers were employed to map the genome and quantitative trait loci controlling the early growth of a pine hybrid F(1) tree ( Pinus palustris Mill. x P. elliottii Engl.) and a recurrent slash pine tree ( P. elliottii Engl.) in a (longleaf pine x slash pine) x slash pine BC(1) family consisting of 258 progeny. Of the 150 hybrid F(1) parent-specific RAPD markers, 133 were mapped into 17 linkage groups covering a genetic distance of 1,338.2 cM. Of the 116 slash pine parent-specific RAPD markers, 83 were mapped into 19 linkage groups covering a genetic distance of 994.6 cM. A total of 11 different marker intervals were found to be significantly associated with 13 of the 20 traits on height and diameter growth using MAPMAKER/QTL. Nine of the eleven marker intervals were unique to the hybrid parent 488 genome, and two were unique to the recurrent parent 18-27 genome. The amount of phenotypic variance explained by the putative QTLs ranged from 3.6% to 11.0%. Different QTLs were detected at different ages. Two marker intervals from the hybrid parent 488 were found to have QTL by environment interactions.

The natural history of diabetic peripheral neuropathy determined by a 12 year prospective study using vibration perception thresholds

The development and long term progression of diabetic peripheral neuropathy was studied using vibration perception threshold (VPT) as a validated measure. Three hundred and ninety-two patients had a normal age corrected VPT (12.1 +/- 3.7 volts) at baseline, with an age corrected logarithmic VPTscore < 12. 19.9% developed an abnormal VPT over a 12 year period, increasing from 14.2 +/- 3.7 volts (VPTscore 10.4 +/- 0.6) at baseline to 35.9 +/- 9.5 volts (VPTscore 12.6 +/- 0.45) at follow up (P = 0.0001), and from 10.1 +/- 3.7volts (VPTscore 9.4 +/- 0.8) to 14.2 +/- 4.7 (VPTscore 9.8 +/- 0.8) in the rest. Over 80% thus retained a "normal" VPT after a mean diabetes duration of 16 years despite only average glycaemic control, suggesting that non-ideal long term glycaemic control leads to neuropathy in a subset of predisposed patients. VPT was correlated in 123 diabetic patients with definitive criteria for neuropathy and a range of quantitative sensory and autonomic tests. 62/63 patients with abnormal VPT fulfilled neuropathy criteria; of patients with normal VPT who fulfilled neuropathy criteria, all had at least one abnormal thermal threshold test result. We conclude that a combination of log-transformed VPT values (VPTscore > 10.1) and thermal thresholds can identify diabetic patients at risk of developing peripheral neuropathy and select patients likely to benefit from prophylaxis in clinical trials.

Mapping genes conferring resistance to Phytophthora root rot of soybean, Rps1a and Rps7

A linkage map was constructed for two Phytophthora sojae Kauf. +Gerd. root rot resistance genes, Rps1a and Rps7, in soybean (Glycine max (L.) Merr.) using microsatellite or simple sequence repeat (SSR) markers. An F2 population consisting of 81 individuals derived from a cross between OX281, which carries Rps7, and Mukden, which carries Rps1a, was used as the mapping population. A linkage map consisting of 10 SSR markers was first constructed using the computer software MapMaker/EXP 3.0. Rps1a and Rps7 were then placed at two different loci in the same linkage group with LOD scores of 2.88 and 9.16, respectively. Rps1a and Rps7 were linked at a distance of 13.8 cM. Rps1a was flanked by Satt159 (0.7 cM) and Satt009 (3.2 cM). Rps7 was flanked by Satt009 (10.6 cM) and Satt125 (29.1 cM).

Data mining for indicators of early mortality in a database of clinical records

This paper describes the analysis of a database of diabetic patients' clinical records and death certificates. The objective of the study was to find rules that describe associations between observations made of patients at their first visit to the hospital and early mortality.Pre-processing was carried out and a knowledge discovery in databases (KDD) package, developed by the Lanner Group and the University of East Anglia, was used for rule induction using simulated annealing.The most significant discovered rules describe an association that was not generally known or accepted by the medical community, however, recent independent studies confirm their validity.

The characterization of prepro-Insulin-like growth factor-1 Ea-2 expression and Insulin-like growth factor-1 genes (devoid 81 bp) in the zebrafish ( Danio rerio )

In this study, we cloned zebrafish (Danio rerio) IGF-1 cDNA and gene from zebrafish brain cDNA library and adult zebrafish genomic library, respectively. Based on two cDNAs sequence with different length of 5'- and 3'-untranslated region (5UTR and 3UTR) and one nucleotide difference at glutamine (A9, CAG) of A domain represented at IGF-1 sequence. One of zebrafish IGF-1 genes named as IGF-1a gene. The zebrafish IGF-1a gene spanned approximately 15 kb and is divided into five exons. The results of IGF-1 cDNA and genomic Southern blotting, all indicated that the zebrafish have more than one IGF-1 gene. The genomic organization of zebrafish IGF-1a gene in an exon is devoid of 81 bp segment which is located at 3' end of exon 3 encoded 27 amino acid of E domain. The segment of 27 amino acid exists in known teleost IGF-1 genes but is absent in zebrafish IGF-1 gene. The E domain of zebrafish IGF-1 Ea-2 is encoded by 3' end of exon 3 (16 amino acid), full of exon 4 (12 amino acid) and exon 5 (19 amino acid). The sequence data revealed the zebrafish IGF-1a gene encoded IGF-1a Ea-2 mRNA. In combination RT-PCR with Southern blotting, zebrafish IGF-1 genes abundantly expressed IGF-1 Ea-2 mRNA in all tested adult tissues and developmental stages of embryo. The IGF-1 Ea-2 mRNA was first detected during embryo development from blastula stage to hatching, during yolk absorption and at feeding. All these findings suggest that the expression of pro-IGF-1 Ea-2 is not controlled by alternative splicing but alternative gene usage in the zebrafish.

A simple technique for the simultaneous determination of molecular weight and activity of superoxide dismutase using SDS-PAGE

A direct and rapid SDS-PAGE staining method for in situ identification of activity and molecular weight of superoxide dismutase following denaturing treatment has been developed. This technique was based on the removal of SDS after SDS-PAGE and two-step staining procedures of the SDS-polyacrylamide gel to present the achromatic activity-zones of the enzymes. We demonstrated that the detection sensitivity of SDS-PAGE staining method was the same as the traditional xanthine oxidase-NBT solution assay. Through the SDS-PAGE staining method, three classes of superoxide dismutases with distinct molecular sizes were identified in situ. Moreover, activity of copper and zinc containing superoxide dismutase in crude extracts of Escherichia coli and Actinobacillus pleuropneumoniae was significantly enhanced using the two-step staining procedure.

Geographic and social factors are related to increased morbidity and mortality rates in diabetic patients

AIMS

To investigate differences in metabolic control, access to healthcare, clinical outcomes and mortality rates in people from different cultural and ethnic backgrounds living in different geographical areas within central London.

METHODS

Out of a cohort of 610 patients living within the Greater London boundary and having a first visit to St Thomas' hospital in 1982-1985, 332 patients (54%) were reviewed in 1995, 186 patients (30%) died between 1982 and 1995 and 92 patients (16%) were lost to follow-up. The patients' corresponding 'electoral wards' were ascertained in relation to postcodes of residence (Mapinfo). Each electoral ward has a Jarman 'Underprivileged Area Score' (UPA) so that patients can be clustered into prosperous, intermediate or deprived areas.

RESULTS

Patients living in deprived areas (n = 181) were older (61.3 years (95% confidence interval (CI) 59.5-63.1) vs. 58.6 years (95% CI 55.1-62.1), P = 0.01) and had a higher body mass index (29.2 kg/m2 (95% CI 28.4-30.0) vs. 25.7 kg/m2 (95% CI 24.1-27.2), P = 0.003) and worse glycaemic control (HbA1 (%), 10.5 (95% CI 10.1-10.9) vs. 9.1 (95% CI 8.2-10.0), P = 0.003) than patients in prosperous areas (n = 59). Patients in deprived areas were more likely to be Caucasian (P < 0.005), and were less likely to be insulin-treated (P = 0.004). Smoking was more prevalent in deprived areas (P = 0.02). The prevalence of microvascular complications was related to geographical location and the age-sex adjusted mortality rate was significantly higher in deprived than prosperous areas (2.6 vs. 1.91 per 100 person-years).

CONCLUSIONS

Environmental factors affect diabetes outcomes; increased morbidity and mortality rates in diabetic patients are related to socio-economic and ethnic status.

Showing neuropathy is related to increased mortality in diabetic patients - a survival analysis using an accelerated failure time model

Diabetic subjects still have a reduced life expectancy despite many potential advances in patient care. Furthermore, population-based studies in well-defined cohorts of patients, to investigate the reduced life expectancies, are generally lacking. Computerized baseline data on a cohort of diabetic patients first attending our clinic during 1982-1985 were used to identify risk factors for increased mortality. This was carried out using an accelerated failure time (ACF) model. Out of 794 patients entered into the model, 201 (25.3%) patients died between 1982 and 1995. Baseline microvascular diabetic complications (peripheral sensory neuropathy and nephropathy) were found to be associated with increased mortality in patients, indicating that these are important, often overlooked, markers for those at greatest risk. Patients with type I (insulin dependent) diabetes mellitus were also identified as being at greater risk.

Late quaternary extinction of a tree species in eastern North America

Widespread species- and genus-level extinctions of mammals in North America and Europe occurred during the last deglaciation [16,000-9,000 yr B.P. (by (14)C)], a period of rapid and often abrupt climatic and vegetational change. These extinctions are variously ascribed to environmental change and overkill by human hunters. By contrast, plant extinctions since the Middle Pleistocene are undocumented, suggesting that plant species have been able to respond to environmental changes of the past several glacial/interglacial cycles by migration. We provide evidence from morphological studies of fossil cones and anatomical studies of fossil needles that a now-extinct species of spruce (Picea critchfieldii sp. nov.) was widespread in eastern North America during the Last Glacial Maximum. P. critchfieldii was dominant in vegetation of the Lower Mississippi Valley, and extended at least as far east as western Georgia. P. critchfieldii disappeared during the last deglaciation, and its extinction is not directly attributable to human activities. Similarly widespread plant species may be at risk of extinction in the face of future climate change.

Outcome on diabetic foot complications in relation to clinical examination and quantitative sensory testing: a case-control study

A total of 405 diabetic patients who first attended St Thomas' Diabetes Clinic between 1982 and 1985 had a detailed standardized computerized first visit record, including a structured foot examination and toe vibration perception thresholds (VPT, Biothesiometer), were reviewed in 1995. None of the patients had a history of foot ulceration at first visit. Twenty-five patients (6.2%) developed foot ulcers (n = 11, 2.7%) or had an amputation (n = 14, 3.5%) over a mean 12-year period. Twenty of these patients were then individually matched with 3 non-ulcer patients. Statistically significant odds ratios (OR) were found for a baseline abnormal age-adjusted toe VPT (OR 4.38, CI 1.11-17.26; p = 0.01); abnormal clinical examination (at least 1 abnormality out of: ankle jerks, tuning fork or cotton wool sensation; OR 2.3, CI 1.00-5.20; p < 0.01); and HbA1 (OR 1.30, CI 1.01-1.66; P < 0.02) in patients who subsequently developed lower extremity complications. The sensitivity of VPT (70%) was better than that for clinical testing (55 %) in predicting long-term complications, although all tests showed similar specificity (70-72%). The risk of events also doubled for every 10 years of diabetes (OR 2.10, CI 1.11-4.30; p = 0.02). We conclude that age-corrected VPT measurements, which are objective and simple to perform, are better predictors of future foot complications than semi-quantitative tests in diabetes clinics. We encourage their use in the campaign to reduce the morbidity of diabetic peripheral neuropathy.

Linking a hospital diabetes database and the National Health Service Central Register: a way to establish accurate mortality and movement data

We have established a records linkage between 'Diabeta' (the computerized clinical records system in the Diabetes Unit of St Thomas' Hospital) and the National Health Services Central Register (NHSCR) of the United Kingdom. Over 7000 diabetic patient records have been collected since 1973. Demographic data on all diabetic patients were retrieved and submitted to the NHSCR via a floppy disk. A matching system (automatic or manual) was used by the NHSCR to identify deceased patients and the most recent demographic data was provided on patients alive. This linkage resulted in an update of 91% of records in Diabeta. The findings of the update included: (1) 86% of diabetic patient's death had not been notified to the hospital and were not recorded on Diabeta. Mortality can now be assessed accurately as an outcome measure in our diabetic population. (2) Provision of the NHS number to Diabeta, as before it was not available on many patients seen in the hospital. The NHS number is a key patient identifier which can be used to exchange information within the NHS-wide network. (3) Diabetes was recorded as a cause of death in only 36% of death certificates. Analyses of death certificates alone must thus give poor information about mortality in diabetes. (4) Geographical location of patients on the database was updated, enabling tracing of patients for long-term studies and analyses of movement.

Transvaginal sonographic assessment of cervical dynamics during the third trimester of normal pregnancy

BACKGROUND

To obtain a normogram of measurements of the uterine cervix by transvaginal sonography during the third trimester of normal primiparous pregnancies and to relate these measurements to the events surrounding labor.

METHODS

A prospective observational study, set in Guangzhou, Peoples Republic of China, was undertaken. Fifty-five normal nulliparous Chinese women with singleton pregnancies were studied from 30 weeks gestation until delivery. Serial transvaginal ultrasound examinations were performed at 30, 32, 34 and 36 weeks gestation and weekly thereafter.

RESULTS

There was a significant correlation between gestational age and cervical length and width. Funnelling of the internal os was present in 25% of cases, and its earliest appearance was at 36 weeks. There was no consistent relationship between funnel length and width and gestational age. The duration of the first stage of labor was inversely correlated with the last ultrasound measurement of cervical length, but there was no relationship with either cervical width nor the presence of funnelling. The cervical changes in this population differed from those found in Caucasians.

CONCLUSIONS

There is a direct relationship between both cervical width and length and gestational age and an inverse relationship with cervical length and the duration of labor. Funnelling of the internal os was not a predictor of the early onset of labor. The dimensions and features of the Asian cervix differ from those of the Europeans, and this should be considered when conducting further studies of a similar nature.

G protein-mediated inhibition of phospholipase C activity in a solubilized membrane preparation

In solubilized bovine brain membrane preparations AlF4- (20 microM AlCl3 plus 10 mM NaF) and 50 nM guanosine 5-O-(2-thiotriphosphate) (GTP gamma S) promoted a rapid but transient inhibition of phospholipase C (PLC) activity. Maximal inhibition was evident within 7 min of incubation, followed by reversal of inhibition. In contrast, 10 microM GTP gamma S did not induce inhibition of PLC activity but rather produced a time-dependent stimulation of PLC activity. GTP gamma S-dependent inhibition of PLC activity was concentration-dependent with half-maximal inhibition at 1 nM. Inhibition was antagonized by guanosine 5-O-(2-thiodiphosphate (GDP beta S). Pertussis toxin delayed the onset of inhibition by GTP gamma S but did not prevent the inhibitory effect. alpha o-GTP gamma S or alpha o-GDP had little effect on PLC activity. alpha i-GTP gamma S and alpha i-GDP produced a 15% inhibition of PLC activity. Beta gamma subunits did not inhibit basal PLC activity but did attenuate the net degree of inhibition due to GTP gamma S. Inhibition was associated with a decrease in the Ca2+ sensitivity of PLC. Preincubation of membranes with anti-PLC-beta 1 antibody, but not anti-PLC-gamma 1 or anti-PLC-delta 1, prevented the GTP gamma S-mediated inhibition of PLC. These studies implicate PLC-beta 1 as an effector system that is under negative modulation by a G protein-dependent mechanism.