First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment

The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9  GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36  GeV/c^{2}, rejecting cross sections above 9.2×10^{-48}  cm at the 90% confidence level.

1189 ASSESSMENT OF DISCHARGE DESTINATION FOLLOWING SHORT-TERM DELIRIUM PLACEMENT

Introduction

“Pathway three delirium” is a short-term placement in a care home specific to North Yorkshire, for patients diagnosed with delirium during hospital admission, who are medically fit but have not recovered cognitively enough for discharge home. The goal is to allow extra time to recover from delirium, to allow return to patients’ own homes. At this placement, patients are followed up by the acute hospital liaison team.

Aims

To assess final discharge destinations after pathway three delirium placement. To analyse characteristics between discharge groups.

Methods

We analysed electronic records of patients on this pathway between August 2020 and November 2021. Data was gathered on age, gender, prior cognitive impairment, visual impairment, hearing impairment, living alone, requiring package of care, and alcohol misuse.

Results

64 patients were included, 39 females (61%), 25 males (39%), average age of 83.7 years. 20 (31%) were discharged home, 26 (41%) remained in residential or nursing homes, 10 (16%) were readmitted to hospital, 8 (12%) discharge location was unknown or “other”. Average age of those discharged home was 82.65yo, those discharged to residential/nursing homes: 83.88yo, and those readmitted: 85.8yo. 80% of those discharged home were women, compared to 61% of the total group and 50% of those who remained in nursing/residential care. The discharged home group contained 80% patients who lived alone, versus 58% in the residential/nursing home group, and 30% in readmitted. 25% of the home group had a care package pre-admission: versus 46% in the residential/nursing home group, and 38% across all groups. Cognitive impairment, sensory impairment and alcohol intake showed no apparent difference across destination.

Conclusions

These findings show that this short-term delirium placement enables some patients to return to their own home. Analysis suggests that younger patients, women and those with apparently less social support were more likely to go home.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Yeast fermentate prebiotic improves intestinal barrier integrity during heat stress by modulation of the gut microbiota in rats

Aims

To evaluate efficacy of Saccharomyces cerevisiae fermentate prebiotic (EH) in protection of intestinal barrier integrity in rats during heat stress, to analyze the impact of heat stress and preventive treatment with EH on the structure of the gut microbiota.

Methods and Results

Two groups of rats were treated orally with EH or phosphate‐buffered saline for 14 days. On day 15, half of the rats in each group were exposed to heat stress conditions, while control animals were kept at room temperature. Histological and Western blot analyses of the intestine, culture‐based microbiological analysis and high‐throughput 16S rRNA sequencing for the gut microbiota were performed for each rat. Exposure of animals to heat stress conditions resulted in inhibition of tight junction (TJ) proteins expression, decrease of Paneth and goblet cells, decrease of beneficial and increase of pathogenic bacteria. Oral treatment of rats with EH before stress significantly prevents these adverse effects by elevation of the gut beneficial bacteria, particularly butyrate‐producing bacteria.

Conclusions

Essential effect of EH in protection of intestinal barrier integrity during heat stress is connected with beneficial modulation of the gut microbiota.

Significance and Impact of the Study

Our results will contribute to the development of new approaches to prevention of heat stress‐related complications.

Neuropsychiatric systemic lupus erythematosus: association with global disease activity

Objective

To determine whether patients with neuropsychiatric (NP) events attributed to systemic lupus erythematosus (SLE) have more global disease activity than patients with NP events not attributed to SLE.

Methods

Patients were recruited from an academic lupus clinic. Global disease activity was measured with the SLE Disease Activity Index 2000 (SLEDAI-2K) and organ damage with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI). NP disease was defined using the ACR case definitions and decision rules for attribution of NP events to SLE and non-SLE causes.

Results

There were 68 patients (age (mean ± SD) 40.8 ± 15.2 years, 85% female, 94% Caucasians) with 126 NP events. SLEDAI-2K scores in patients with NP events attributed to SLE were higher than in patients with NP events attributed to non-SLE causes even when NP variables were removed from the SLEDAI-2K (mean ± SD: SLE NP = 7.36 ± 5.42 vs non-SLE NP = 5.53 ± 4.57, P = 0.042). Patients with CNS and diffuse NP events, rather that PNS and focal events, accounted for the group differences in SLEDAI-2K scores. There were no significant differences in total SDI scores comparing NP events due to SLE vs. non-SLE causes (mean ± SD: 2.1 ± 1.8 vs. 1.7 ± 1.7; p = 0.28) even when NP variables were omitted.

Conclusions

Increased global SLE disease activity is associated with concurrent NP events attributed to SLE, particularly for diffuse NP and CNS NP events. The findings have diagnostic and therapeutic implications for SLE patients with NP events and inform pathogenetic mechanisms underlying NPSLE.

The impact of sex ratio and economic status on local birth rates

Human mating and reproductive behaviour can vary depending on various mechanisms, including the local sex ratio. Previous research shows that as sex ratios become female-biased, women from economically deprived areas are less likely to delay reproductive opportunities to wait for a high-investing mate but instead begin their reproductive careers sooner. Here, we show that the local sex ratio also has an impact on female fertility schedules. At young ages, a female-biased ratio is associated with higher birth rates in the poorest areas, whereas the opposite is true for the richest areas. At older ages, a female-biased ratio is associated with higher birth rates in the richest, but not the poorest areas. These patterns suggest that female-female competition encourages poorer women to adopt a fast life-history strategy and give birth early, and richer women to adopt a slow life-history strategy and delay reproduction.

The effects of explicit timing and feedback on compositional response rate in elementary school children

The effects of several variables on compositional response rate were investigated in three classrooms. After establishing baseline composition rates in each of the three classrooms, an experimental phase was introduced that consisted of: explicit timing of the children's composition period with a stopwatch, immediate feedback on the number of words each child produced, public posting of the greatest number of words written by each child to date, and instructions to try to exceed their highest score. In the second-grade classroom, these conditions were introduced, removed, and re-introduced. In two fifth-grade classrooms, these conditions were introduced according to a multiple baseline, across classes. In all cases, introduction of the experimental conditions led to a doubling of rate of words written by students and an increase in subjective quality ratings of compositions made by independent judges.

Development of a European system for identification of emerging mycotoxins in wheat supply chains

This paper describes the results of a research project aimed at the conceptual development of an identification system for emerging mycotoxins in European feed and food supply chains of wheat. Basic requirements for such a system were addressed, including the selection of indicators, locating information sources, development of underlying model, and investigation of stakeholders' needs. The selection and ranking of key indicators for identifying emerging mycotoxins was based on a literature review, followed by a structured expert judgment study. The expert study was based on the Delphi technique and used a panel of 43 European experts. The Delphi procedure resulted in a selected set of 12 key indicators for each of three relevant stages of the wheat chain (cultivation; transport and storage; processing). For wheat cultivation, these were: relative humidity/rainfall, crop rotation, temperature, tillage practice, water activity in the kernels, crop variety, harvest conditions, changes in fungal populations, fungicide use, plant health, regional infection pressure and food safety awareness. For the majority of the selected indicators, information sources were identified in specific European countries. However, most sources are not readily accessible and particular data is lacking. A theoretical concept for a model underlying the envisioned emerging mycotoxin identification system has been developed. The model links the key indicators and their information sources to aid and promote identification of emerging mycotoxins. It manages different types of information sources and levels of available information. The needs of various stakeholder groups regarding the system were investigated by means of two empirical elicitation sessions. The results showed that all stakeholders considered that such a system would be beneficial. One major challenge expected in establishing the system is stakeholder commitment to sharing data and information. This requires great efforts in improving communication and interaction between the key stakeholders.

A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow

BACKGROUND

A Mediterranean-type diet rich in fish, fruit and vegetables and low in saturated fats has been associated with health benefits, including improved cardiovascular profile and benefit in RA.

OBJECTIVE

To overcome obstacles to healthy eating by a community-based intervention promoting a Mediterranean-type diet in patients with RA living in socially deprived areas of Glasgow.

METHODS

130 female patients with RA aged 30-70 years (median 55), disease duration 8 years were recruited from three hospital sites. The intervention group (n = 75) attended weekly 2-hour sessions for 6 weeks in the local community, including hands-on cooking classes backed up with written information. The control group (n = 55) were given dietary written information only. Both groups completed food frequency questionnaires (FFQs), and clinical and laboratory measures were assessed at baseline, 3 and 6 months.

RESULTS

Significant benefit was shown in the intervention group compared with controls for patient global assessment at 6 months (p = 0.002), pain score at 3 and 6 months (p = 0.011 and 0.049), early morning stiffness at 6 months (p = 0.041) and Health Assessment Questionnaire score at 3 months (p = 0.03). Analysis of the FFQs showed significant increases in weekly total fruit, vegetable and legume consumption and improvement in the ratio of monounsaturated:saturated fat intake and systolic BP in the intervention group only. The cooking classes were positively received by patients and tutors; cost/patient for the 6 week course was 84 pounds (124 euro).

CONCLUSIONS

Results demonstrate that a 6 week intervention can improve consumption of healthier foods. If implemented more widely it may prove a popular, inexpensive and useful adjunct to other RA treatment.

Immunosuppressive effects of radiation on human dendritic cells: reduced IL-12 production on activation and impairment of naive T-cell priming

Dendritic cells (DC) are professional antigen-presenting cells (APC) of the immune system, uniquely able to prime naive T-cell responses. They are the focus of a range of novel strategies for the immunotherapy of cancer, a proportion of which include treating DC with ionising radiation to high dose. The effects of radiation on DC have not, however, been fully characterised. We therefore cultured human myeloid DC from CD14+ precursors, and studied the effects of ionising radiation on their phenotype and function. Dendritic cells were remarkably resistant against radiation-induced apoptosis, showed limited changes in surface phenotype, and mostly maintained their endocytic, phagocytic and migratory capacity. However, irradiated DC were less effective in a mixed lymphocyte reaction, and on maturation produced significantly less IL-12 than unirradiated controls, while IL-10 secretion was maintained. Furthermore, peptide-pulsed irradiated mature DC were less effective at naive T-cell priming, stimulating fewer effector cells with lower cytotoxicity against antigen-specific targets. Hence irradiation of DC in vitro, and potentially in vivo, has a significant impact on their function, and may shift the balance between T-cell activation and tolerization in DC-mediated immune responses.

Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial

BACKGROUND

Evidence for disease modifying activity of low dose corticosteroid treatment in rheumatoid arthritis is contradictory. Studies showing radiological benefit suggest that continued treatment is required to sustain the effect.

OBJECTIVE

To evaluate the effect of low dose oral prednisolone in early rheumatoid arthritis on disease activity over two years.

DESIGN

Double blind placebo controlled trial.

METHODS

Patients with rheumatoid arthritis, duration <3 years (n = 167), were started on a disease modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by stratified randomisation to prednisolone 7 mg/day or placebo. Primary outcome measure was radiological damage, assessed by the modified Sharp method. Clinical benefit was a secondary outcome. A proactive approach to identifying and treating corticosteroid adverse events was adopted. Patients who discontinued sulphasalazine were offered an alternative DMARD.

RESULTS

90 of 257 patients eligible for the study refused to participate (more women than men). Of those enrolled, 84% were seropositive for rheumatoid factor, median age 56 years, median disease duration 12 months, female to male ratio 1.8:1. Prednisolone was given to 84 patients; of these 73% continued prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were no significant differences in radiological score or clinical and laboratory measures at 0 and 2 years.

CONCLUSIONS

Low dose prednisolone conferred no radiological or clinical benefit on patients maintained on a DMARD over two years. Low dose corticosteroids have no role in the routine management of rheumatoid arthritis treated with conventional disease modifying drugs.

Attitude of rheumatoid arthritis patients to treatment with oral corticosteroids

OBJECTIVE

To assess the attitudes of rheumatoid arthritis (RA) patients to oral corticosteroid treatment, factors influencing these views and their likely clinical impact.

METHODS

A cross-sectional survey of 158 consecutive RA out-patients was carried out at two centres over 2 weeks. Demography, disease duration, function [Health Assessment Questionnaire (HAQ)], erythrocyte sedimentation rate (ESR), years of formal education and social deprivation index were noted. Prospective recruitment into the multicentre West of Scotland Early Rheumatoid Arthritis Corticosteroid Trial (WOSERACT) was monitored and reasons for refusal to participate (when available) were noted at three of the centres.

RESULTS

Forty-eight (32%) patients were willing to be treated with oral corticosteroid and 100 (68%) were not. The former were older (P = 0.002), had a higher ESR (P = 0.007), poorer function (P = 0.001) and greater previous exposure to disease-modifying anti-rheumatic drugs (P = 0.013). Ninety patients refused to participate in WOSERACT, in 46 cases (40 female, 6 male) the reason being concerns about corticosteroids.

CONCLUSIONS

This study shows a high level of concern about and refusal of corticosteroid treatment in RA, due mainly to patient concerns about adverse effects. Rheumatologists need to be aware of these attitudes as they are likely to affect prescribing.

Mechanisms involved in the induction of apoptosis by T-2 and HT-2 toxins in HL-60 human promyelocytic leukemia cells

T-2 and HT-2 toxins belong to a group of mycotoxins that are widely encountered as natural contaminants known to elicit toxic responses in hematopoietic cells. In the present study, HL-60 cells were used to characterize the apoptotic effects of T-2 and a major metabolite, HT-2, and to examine the mechanisms involved. Apoptotic cells were identified microscopically by chromatin condensation and nuclear fragmentation, by flow cytometric analysis, and by DNA gel electrophoresis. T-2 and HT-2 induced concentration-dependent apoptosis after 24 h in HL-60 cells, starting at concentrations of 3.1 and 6.25 ng/ml respectively. An increased number of apoptotic cells could be observed 4-6 h after exposure to 12.5 ng/ml of toxin. Little cytotoxicity (plasma membrane damage) was observed even after exposure to concentrations of toxins (25-50 ng/ml) inducing apoptosis in 60-100% of the cells. The apoptotic process was almost completely blocked in the presence of the general caspase inhibitor zVAD.fmk. In contrast, no or only minor effects were observed with the more specific caspase inhibitors DEVD.CHO, IETD.fmk, and DEVD.fmk. As judged by Western blotting, the levels of several procaspases (-3, -7, -8, -9, but not -12) were reduced 3-6 h after exposure to toxin. Substantial increases in the presumed active form(s) of caspase-8 and -9 were observed. Furthermore, poly(ADP-ribose) polymerase (PARP) was already markedly cleaved 3 h after toxin treatment, indicative of active caspase-3 and -7. No or only minor changes in Bcl-2, Bcl-XL and Bax levels were observed. BAPTA-AM and ZnCl2 blocked the degradation of procaspases, the fragmentation of PARP, and the induction of apoptosis. In summary, both T-2 and HT-2 induced apoptosis, with T-2 being somewhat more potent than HT-2. The divalent calcium concentration, [Ca2+], appears to be involved in the activation of several caspases, resulting in DNA fragmentation, chromosomal condensation, and nuclear fragmentation.

HLA-DQ and DRB1 polymorphism and susceptibility to type 1 diabetes in Jamaica

Genetic susceptibility to type 1 diabetes is determined by a combination of HLA-DQ and DRB1 alleles. In the present study, HLA associations with type 1 diabetes were investigated in the Jamaican population. DRB1 and DQ genotyping was performed on 45 type 1 diabetic patients and 132 control subjects born and resident in Jamaica. The small number of patients available for study reflected the low prevalence of type 1 diabetes in Jamaica. The results were compared with those from other African heritage populations and white Caucasians. The highest relative risk was associated with the DRB1*03-DQ2/DRB1*04-DQ8 genotype. Both DRB1*0401-DQ8 and DRB1*0408-DQ8 were positively associated with disease. DRB1*0408-DQ8 is uncommon amongst white Caucasians, where DRB1*0401-DQ8 is the major predisposing haplotype. The DRB1*1503-DQ6 haplotype was associated with protection from diabetes in the Jamaican population. This haplotype is rare amongst white Caucasians, where DRB1*1501-DQ6 is the protective haplotype. Data from African heritage populations suggest that DRB1*1503-DQ6 might be less protective than DRB1*1501-DQ6. DRB1*03-DQA1*0401-DQB1*0402 was associated with protection from diabetes in the Jamaican population, whereas in white Caucasians DRB1*08-DQA1*0401-DQB1*0402 is predisposing. These data demonstrate that comparison of genetic associations with type 1 diabetes in races with population-specific DRB1-DQ haplotypes provides new information as to the exact determinants of disease susceptibility. Further support is provided for roles of the DQ genes and the DRB1 gene (or a gene in linkage disequilibrium with it) in determining susceptibility to type 1 diabetes.

A longitudinal study comparing scaling, osseous surgery, and modified Widman procedures: results after 5 years

BACKGROUND

Scaling and root planing, osseous surgery, and modified Widman procedures are effective methods for treating periodontal diseases. Studies have been carried out to determine if these procedures are more effective than others in reducing clinical probing depths, while maintaining clinical attachment levels. The purpose of this report is to present 5-year results from a longitudinal study comparing scaling and root planing (SRP), osseous surgery (OS), and modified Widman (MW) therapies. The study has been completed for 12 years.

METHODS

Sixteen adult patients with moderate to advanced periodontal disease were treated with initial scaling and oral hygiene procedures in a private practice. Posthygiene data were used to compare changes in plaque and gingival indices, probing depth (PD), clinical attachment levels (CAL), and recession. Frequency distributions were used to compare changes at individual sites. The first published report was from baseline to one year. This follow-up report is from baseline through 5 years.

RESULTS

At 5 years, there were significant decreases in gingival and plaque scores. For the 3 procedures, there were significant decreases in baseline 4 to 6 mm PD (P<0.0001); however, there were no differences between the methods. Similar findings were noted for PD initially greater than 7 mm. At 5 years, OS had the greatest number of 1 to 3 mm sites (332 sites, 73.2%), while MW had the fewest number of 4 to 6 mm PD (98 sites, 21.8%). SRP had the fewest 7 mm and greater sites (15 sites, 3.4%). At 5 years, CAL loss for 1 to 3 mm PD was statistically significant for the 3 procedures. There were slight gains in CAL for 4 to 6 mm probing depths. These gains were not significant. Similar findings were seen for CAL for probing depths greater than 7 mm. OS had the greatest number of sites losing more than 2 mm of CAL (64 sites), followed by SRP (21 sites) and MW (34 sites), respectively.

CONCLUSIONS

This 5-year clinical trial demonstrates that with good patient maintenance excellent clinical results can be achieved with various methods of treatment. Within the limits of this study, SRP, OS, and MW were effective at reducing probing depths with slight changes in clinical attachment levels.

An interim report of an intervention strategy for diabetes care in Jamaica

The high prevalence (17.9%) of diabetes mellitus and its attendant costs have been recognized for some time. The diabetic public has hitherto been too oriented to seeking health care at the secondary and tertiary health care centres; a much too costly approach. As a part of a wellness promotion thrust as well as an awareness and intervention strategy, a number of health care agencies have collaborated in a training programme of lay diabetes facilitators. This was intended to allow a domino effect of "each one teach one" within the community. This intervention programme was undertaken over an 18-month period. No significant changes were achieved in glycaemia levels. The impact on hospital admissions and community awareness is yet to be assessed. Laboratory results indicated good correlation between glycosuria and hyperglycaemia. This could influence the thrust in maintaining glycosuria assessment alongside blood glucose monitoring. This approach would have a cost benefit for government clinics islandwide. Whilst it may be difficult to identify any one parameter that may be responsible for change, it will be possible to assume that this intervention strategy, the only innovation in the health care delivery modalities, may have contributed.

Patients' perceptions of medical students in a longitudinal family medicine clerkship

BACKGROUND

Although educational characteristics of ambulatory clinical environments are becoming clearer, less is known concerning patient opinions about participating in medical student instruction in ambulatory settings. Such perceptions may have an important influence on recruitment and retention of community faculty.

METHODS

Surveys were administered to 121 patients seen by medical students during a longitudinal family medicine clerkship. The survey explored patients' opinions regarding the extent of direct student involvement in their care, students'competence, and patient feelings about participating in medical student instruction.

RESULTS

Patients felt that students were highly involved in providing care and that they performed competently and professionally. Patients found participation in medical education enjoyable, not excessively time-consuming or disruptive, and believed that students' participation improved the quality of care they received.

CONCLUSIONS

Patients in our family medicine clerkship do not have negative perceptions about their participation in medical student education. In fact, this study suggests that such participation may actually enhance patient satisfaction.

Restraint reduction in acute care: an interdisciplinary approach

The authors discuss an interdisciplinary project to reduce the use of restraints in an acute care setting. They describe the process, beginning with initial planning and then working and evaluation phases. Common patient problems often requiring restraint are identified, with suggested solutions. Outcomes of the project were that fall rates did not increase and the use of restraints decreased by 83%.

Mass rearing the weevil Hylobius transversovittatus (Coleoptera: Curculionidae), biological control agent of Lythrum salicaria, on semiartificial diet

Lythrum salicaria L., purple loosestrife, an invasive Eurasian perennial, is degrading wetlands across temperate North America. Chemical, physical, and mechanical methods failed to provide long-term control. Therefore, four host-specific insect species (two leaf feeders, a root feeder, and a flower feeder) were introduced as biological control agents. To increase the availability of adults of the root feeding weevil Hylobius transversovittatus Goeze for field releases, we developed a semiartificial diet. Suitability of different diet formulations (varying vitamin mixes, salt mixes, antimicrobials, water content, root content) and temperatures for larval development were evaluated. We also monitored how rearing on artificial diet and the number of larvae per container affected larval development time, larval survival, adult weight, and incidences of deformities. Rearing larvae on artificial diet reduced development time from 1-2 yr to 2-3 mo. Larval development was fastest and survival rates highest under constant temperatures of 25 degrees C. Hatch rate and larval survival decreased if eggs were surface sterilized. Using FABCO antimicrobials could not prevent fungal contamination; use of methyl paraben and sorbic acid was successful in suppressing fungal and bacterial growth throughout larval development time to <10%. The moisture content of the diet did not significantly affect larval survival, development, or adult weight. Decreasing the proportion of purple loosestrife roots in the diet reduced adult weight and the proportion of larvae completing development, and increased development time; no larvae were able to complete development in root-free diet. With an increase in the number of larvae per cup, survival rates were reduced. The experiments revealed a female biased sex ratio: females consistently developed faster and were heavier than males. Incidence of adult deformities was consistently below 5%. Increased availability of adults for field release as a result of mass production using the semiartificial diet will accelerate the biocontrol program targeting purple loosestrife. We are able to produce several hundred weevils per week and have adapted the diet to rear other root-feeding weevils.

Activated mesothelial cells produce heparin-binding growth factors: implications for tumour metastases

Curative surgery for gastrointestinal malignancy is commonly thwarted by local tumour recurrence. The heparin-binding growth factors, basic fibroblast growth factor (bFGF), heparin-binding epidermal growth factor-like growth factor (HB-EGF) and vascular epidermal growth factor (VEGF) are all implicated in the metastatic process, but whether or not these essential growth factors are produced by the activated peritoneum is unknown. This study reveals that peritoneal mesothelial cells constitutively express mRNA for bFGF, HB-EGF and two VEGF spliced variants, VEGF121 and VEGF165. Mesothelial activation with interleukin (IL)-1b or tumour necrosis factor (TNF)-a produced an up-regulation of mRNA for HB-EGF and VEGF, but not bFGF expression. IL-6 failed to stimulate growth factor expression, whereas IL-2 produced a marked suppression in HB-EGF and bFGF, but not VEGF expression. Mesothelial cells were shown to predominantly express mRNA for the intermediate affinity (bg(c)) IL-2 receptor. Cytokine-induced growth factor up-regulation was confirmed at the protein level using Western blotting of mesothelial cell lysates for HB-EGF and culture supernatant enzyme-linked immunosorbent assay for VEGF. The production of these growth factors by human mesothelial cells may play a significant role in post-operative peritoneal tumour recurrence. Their common heparin-binding property offers a potential therapeutic target for manipulating the growth factor environment of the human peritoneum.

Processing of procorticotropin-releasing hormone (pro-CRH): molecular forms of CRH in normal and preeclamptic pregnancy

This study examined the different molecular forms of CRH in normal and preeclampsia maternal plasma and protease-blocked placental extracts using antibodies to different regions of the CRH precursor, pro-CRH. In the absence of protease inhibitors, chromatographed normal placental extracts contained four peaks of immunoreactivity corresponding to unprocessed approximately 19-kDa pro-CRH, its approximately 8-kDa intermediate metabolite, pro-CRH125-194, its approximately 2.8-kDa midportion fragment, pro-CRH125-151, and 4.75-kDa CRH1-41. However, if protease inhibitors were included in the extraction medium, only pro-CRH and pro-CRH125-194 were found. Pro-CRH processing was more extensive in protease-blocked preeclampsia placentas than in those from normal pregnancy, with three peaks corresponding to pro-CRH, proCRH125-194, and mature CRH1-41 peptide found. Using quantitative competitive PCR, the messenger ribonucleic acid levels of CRH precursor in preeclampsia placentas were 1.7-fold higher than those in normal placentas (37.83 +/- 3.48 vs. 21.83 +/- 2.59 attomoles/microg total ribonucleic acid, respectively; P < 0.005). Preeclampsia placentas contained significantly more CRH1-41 cross-reactivity (4.72 +/- 1.22 pmol/g) than normal term placentas (1.52 +/- 0.39 pmol/g; P < 0.048) extracted in medium containing protease inhibitors. The content of pro-CRH(125+/-151)-reactive species in these extracts followed the same pattern, with more immunoreactivity detected in preeclampsia placentas (4.23 +/- 1.39 pmol/g) than in those from normal term pregnancies (1.44 +/- 0.32 pmol/g; P < 0.01). Sequential plasma samples from 10 women with normal pregnancy and 5 women with preeclampsia were assayed for pro-CRH(125-151)- and CRH(1-41)-immunoreactive species In normal pregnancy, maternal plasma CRH(1-41) immunoreactivity rose with increasing gestational age, reaching 460 +/- 48 pmol/L at term. In women with preeclampsia, CRH(1-41) levels at each gestational age point were higher than those at the equivalent stage of normal pregnancy. In contrast, the levels of pro-CRH(125-151)-immunoreactive species remained barely detectable throughout normal and preeclamptic pregnancy. Both pro-CRH and CRH(1-41), but not pro-CRH(125-151), were shown to bind to the plasma CRH-binding protein. Our findings highlight the importance of protection of placental tissue from degrading enzymes during extraction and show that most of the CRH in the human placenta exists as unprocessed pro-CRH, with very little in the form of CRH(1-41) except in preeclampsia. Our studies using maternal plasma indicate that CRH(1-41) is the only one of the pro-CRH fragments studied to be maintained in significant amounts in the maternal circulation and also the only fragment studied for which a specific plasma binding protein exists.

Research and continuous improvement: the merging of two entities?

Hospital administrators are under pressure to provide a quality product at reasonable prices. As a result, all aspects of hospital structure and culture are under review, which places continuous improvement (CI) programs addressing quality and satisfaction in a more prominent role. Although the theory, data collection methods, and analysis techniques of continuous improvement have grown considerably since the days of quality assurance, clinical problems in healthcare organizations are also increasingly complex and difficult to solve. From this perspective, research has a great deal to offer our current continuous improvement efforts. This paper proposes that CI and research are similar problem-solving approaches, based on philosophies that provide direction for theorizing, collecting and analyzing data, and identifying solutions. A clinical problem elaborates on the similarities of each approach. Finally, common misconceptions are discussed.

Intracellular retention of the corticotrophin-releasing hormone (CRH) precursor within COS-7 cells

We investigated the intracellular localization of CRH in transiently transfected COS-7 cells expressing the full-length rat corticotropin-releasing hormone (CRH) precursor cDNA. CRH synthesized by transfected COS-7 cells is mainly stored intracellularly. In contrast, CHO-K1 cells expressing the same CRH precursor stored and released equal amounts of immunoreactive (IR)-CRH. Ultrastructural analysis revealed that CRH is stored in electron-dense aggregates in the RER of transiently transfected COS-7 cells and does not migrate into the Golgi apparatus. On the basis of the different intracellular localization, storage, and release of CRH in COS-7 and CHO-K1 cells, we hypothesize that the intracellular trafficking of CRH within the constitutive secretory pathway for protein secretion not only depends on its primary amino acid sequence but might also be influenced by intracellular conditions or factors.

The effects of guided bone regeneration and grafting on implants placed into immediate extraction sockets. An experimental study in dogs

Guided bone regeneration (gbr) for the treatment of insufficient bone volume around implants can be performed using membranes with or without grafting materials (i.e., autogenous, allogenous, xenogenous, or alloplastic grafts). A possible way to evaluate the quality of implant osseointegration is the torque necessary to remove implants from their bony housing. The aim of this study was to compare the torques necessary to remove dental implants from implant beds reconstructed with different bone substitutes and GBR or GBR alone in 6 adult mongrel dogs. All mandibular premolars were extracted and 3 extraction sockets on each side were enlarged using a trephine bur. A 13 mm titanium screw-type dental implant (3.75 mm diameter) was placed in each enlarged extraction socket so that only the apical 3 to 4 mm were engaged in bone. The 3 defects were then randomly treated with either 1) canine demineralized freeze-dried bone allograft (DFDBA) plus GBR using an expanded polytetrafluoroethylene membrane (DFDBA+GTAM); 2) bioabsorbable hydroxyapatite and GBR (HA+GTAM); or 3) GBR (GTAM alone). After 6 months, the torque to remove the implants was measured in 4 animals and analyzed using ANOVA. There were no statistically significant differences between the 3 groups (GTAM alone: 46.37+/-16.41 Ncm; HA+GTAM: 46.00+/-16.59 Ncm; DFDBA+ GTAM: 52.15+/-29.24 Ncm). In addition, the influence of early removal of barriers on the torque values was evaluated with the t-test. Comparing exposed versus retained membranes by treatment modality, the only statistically significant difference was found in the DFDBA+GTAM group. When the torque values of all implants with exposed and retrieved membranes were compared to all those with retained membranes a significant difference could be detected. Histologic sections were prepared from the 2 dogs not included in the removal torque testing. In the histometric analysis the GTAM alone group showed a mean mineralized bone-to-implant-contact of 27.1%, the DFDBA+GTAM group of 34.6%, and the HA+GTAM of 39.3%. The mineralized bone-to-implant-contact of the HA+GTAM group was significantly higher than that of the GTAM alone group. In addition, the mineralized bone-to-implant-contact was divided into an apical and coronal part using the apical seventh thread as the dividing landmark. In the apical region, there was no significant difference between the groups regarding mineralized bone-to-implant-contact. In the coronal part the mineralized bone-to-implant-contact of the GTAM alone group was significantly lower compared to the other 2 groups. Within the limits of this investigation, it can be concluded that the type of grafting material will not influence torque removal values, but that early membrane exposure and removal will negatively influence the torque measurements. The combination of GBR with a bone substitute increased the mineralized bone-to-implant contact.

Analyzing amenorrhea

When menarche has failed to occur or menstrual cycles have stopped, the problem can be traced back to a functional or structural defect in the hypothalamus, pituitary, ovaries, or uterus. In most cases, the history is the principal source of diagnostic information. Necessary laboratory studies include one for the most common cause of amenorrhea: pregnancy.

The insulin gene region and susceptibility to insulin-dependent diabetes mellitus in four races; new insights from Afro-Caribbean race-specific haplotypes

The IDDM2 component of the genetic susceptibility to insulin-dependent diabetes mellitus (IDDM) has been mapped to chromosome 11p15.5. The exact identity of IDDM2 remains uncertain. It has been suggested that IDDM2 maps within the 5' VNTR (variable number tandem repeat) polymorphism upstream of the insulin gene (INS). This has not been confirmed and a contribution from other INS gene region polymorphisms cannot be excluded. We present INS region genotype data from four racial groups: the Japanese, Hong Kong Chinese, North Indian Asians and Afro-Caribbeans (two groups; one born and resident in the UK, one in Jamaica). These races have not been previously studied with the range of INS region polymorphisms included here. No INS polymorphism was associated with IDDM across all races. These data from this study thus do not identify any INS polymorphism as IDDM2. The Afro-Caribbean race showed a very different distribution of INS genotypes from the other races and novel race-specific INS haplotypes were identified. Analysis of these excluded a contribution to susceptibility to IDDM from the- 23HphI INS polymorphism. An Afro-Caribbean INS haplotype which differed only at the VNTR from the very protective INS haplotype (VPH) identified in white Caucasians was detected. Population analysis of this haplotype will allow direct assessment of the role of the VNTR in susceptibility to IDDM. In conclusion, the diverse Afro-Caribbean TH/INS/IGF2 haplotypes identified in this study will be valuable in mapping IDDM2 more precisely.

Effect of social deprivation on disease severity and outcome in patients with rheumatoid arthritis

OBJECTIVE

Social deprivation is now recognised to have an important impact on morbidity and mortality. This study sought to ascertain the effect of deprivation, if any, on disease severity, functional disability, and outcome in rheumatoid patients in Glasgow.

METHODS

814 patients with rheumatoid arthritis (RA) were assessed for clinical, functional, and laboratory indices of disease activity. Deprivation categories for individual patients were determined using the Carstairs index. Five year follow up is available for 440 patients.

RESULTS

The study population of RA patients live largely in the most deprived areas. Patients from deprived areas have significantly poorer function at outset and at five years as defined by the Health Assessment Questionnaire (HAQ) score. This is not attributable to differences in disease duration in patients from the most deprived regions or compliance with treatment. Furthermore, these patients do not achieve over five years the initial functional level of those living in the most advantaged localities.

CONCLUSION

RA patients from deprived areas have poorer function, which is associated with greater need--medical, social, and paramedical. Strategies and resources for healthcare need to be adjusted according to this variation.

Assessment of guided tissue regeneration procedures in intrabony defects with bioabsorbable and non-resorbable barriers

THE PURPOSE OF THIS STUDY was to assess periodontal regenerative techniques in intrabony defects utilizing a bioabsorbable, polylactic acid (PLA) barrier or the non-resorbable, expanded polytetrafluoroethylene (ePTFE) barrier. Thirty patients (26 to 64 years old) each with one radiographically evident intrabony periodontal lesion of probing depth > or = 6 mm participated in a 12-month controlled clinical trial. The subjects were randomly divided into two independent groups. The test group (n = 16) received a PLA barrier. The control group (n = 14) received an ePTFE barrier. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and bone fill were recorded by a single calibrated examiner not involved with the surgical treatment prior to surgery, and at 6, 9, and 12 months postsurgery. The treatment results were statistically analyzed utilizing two sets of data. The "averaged-site" data set consisted of values computed from the averaging of measurements from all sites encompassing the defect. The second data set was comprised of only the deepest measurement of the defect. Statistical tests used to analyze these data sets included the t-test and paired t-test for parametric data and the Wilcoxon rank sum test and the Wilcoxon signed rank test for non-parametric data. Analyses with both the averaged-site data and deepest-site data resulted in significant improvements in PD reductions, CAL, and bone fill, after 12 months of healing with both the PLA and ePTFE barrier devices. Comparisons of healing response between treatments found no significant differences when the averaged-site data were analyzed. When only the deepest site of the defect was considered, the control group resulted in significantly more attachment gain (ePTFE, 3.36 mm; PLA, 1.75 mm; P < 0.02) and shallower probing depths (ePTFE, 3.29 mm; PLA, 4.69 mm; P < 0.01) than the test group. In intrabony defects, the use of PLA or ePTFE barriers in GTR procedures yielded comparable clinical results; however, in this study, data analysis using the deepest site of the defect found, after 12 months of healing, significantly more attachment gain and shallower probing depths with ePTFE.

Effect of disease modifying agents on the lipid profiles of patients with rheumatoid arthritis

OBJECTIVE

To determine the effect of intramuscular gold and oral hydroxychloroquine (HCQ) on the lipid profile of patients with rheumatoid arthritis (RA).

METHOD

A prospective randomised clinical trial of 12 months' duration was performed in 100 RA patients. Data on clinical and laboratory parameters of disease activity, and fasting serum lipid samples was collected at baseline and at three monthly intervals over one year.

RESULTS

The expected second line response was seen with no significant difference in efficacy between the groups at 12 months. The HCQ group had a significant overall improvement in their lipid profile while there was a trend for lipid profiles in the gold group to worsen.

CONCLUSIONS

HCQ is an effective second line agent that has beneficial effects on serum lipids. This should be taken into account when choosing a disease modifying anti-rheumatic drug in patients who suffer from RA and who have significant cardiovascular risk factors.

Post-translational processing of proopiomelanocortin in the pituitary and in the brain

Proopiomelanocortin (POMC) is a neuropeptide precursor molecule which is translocated to the secretory pathway within neuroendocrine cells. It is cleaved by the action of endopeptidases to yield mature peptides like adrenocorticotrophic hormone (ACTH), beta-lipotrophin (beta-LPH), beta-endorphin. In this review we present evidence on the cleavage specificities and structure of endoproteases which cleave neuropeptide precursors at pairs of basic amino acids and on the identity and mode of action of exopeptidases. This information is derived from cloning of their corresponding cDNAs and subsequent expression within neuroendocrine cells; and also from biochemical studies. We discuss the intracellular targeting and sorting mechanisms of POMC within neuroendocrine cells. We also examine the tissue-specific post-translational processing of POMC within the anterior and intermediate lobes of the pituitary gland and within the central nervous system.