Prenatal iodine supplementation and early childhood neurodevelopment: the PoppiE trial - study protocol for a multicentre randomised controlled trial

INTRODUCTION

Observational studies suggest both low and high iodine intakes in pregnancy are associated with poorer neurodevelopmental outcomes in children. This raises concern that current universal iodine supplement recommendations for pregnant women in populations considered to be iodine sufficient may negatively impact child neurodevelopment. We aim to determine the effect of reducing iodine intake from supplements for women who have adequate iodine intake from food on the cognitive development of children at 24 months of age.

METHODS AND ANALYSIS

A multicentre, randomised, controlled, clinician, researcher and participant blinded trial with two parallel groups. Using a hybrid decentralised clinical trial model, 754 women (377 per group) less than 13 weeks' gestation with an iodine intake of ≥165 µg/day from food will be randomised to receive either a low iodine (20 µg/day) multivitamin and mineral supplement or an identical supplement containing 200) µg/day (amount commonly used in prenatal supplements in Australia), from enrolment until delivery. The primary outcome is the developmental quotient of infants at 24 months of age assessed with the Cognitive Scale of the Bayley Scales of Infant Development, fourth edition. Secondary outcomes include infant language and motor development; behavioural and emotional development; maternal and infant clinical outcomes and health service utilisation of children. Cognitive scores will be compared between groups using linear regression, with adjustment for location of enrolment and the treatment effect described as a mean difference with 95% CI.

ETHICS AND DISSEMINATION

Ethical approval has been granted from the Women's and Children's Health Network Research Ethics Committee (HREC/17/WCHN/187). The results of this trial will be presented at scientific conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04586348.

Does having children affect women's oral health? A longitudinal study

BACKGROUND

Many believe women's oral health deteriorates as a result of having children. If so, such associations should exist among women but not among men. The aims of this study were to investigate whether number of children is associated with experience of dental disease and tooth loss among both men and women and to examine whether this association is affected by other variables of interest.

METHODS

This study used data from the Dunedin Multidisciplinary Health and Development study, a longitudinal study of 1037 individuals (48.4% female) born from April 1972 to March 1973 in Dunedin, New Zealand, who have been examined repeatedly from birth to age 45 years.

RESULTS

Data were available for 437 women and 431 men. Those with low educational attainment were more likely to have more children and began having children earlier in life. Having more children was associated with experiencing more dental caries and tooth loss by age 45, but this association was dependent on the age at which the children were had. Those entering parenthood earlier in life (by age 26) had poorer dental health than those entering parenthood later in life, or those without children. There was no association between number of children and periodontal attachment loss (PAL). Low educational attainment, poor plaque control, never routine dental attendance, and smoking (for PAL) were associated with PAL, caries experience, and tooth loss.

CONCLUSIONS

Social factors associated with both the timing of reproductive patterns and health behaviors influence the risk of dental disease and its management.

Using Advanced Cell Culture Techniques to Differentiate Pluripotent Stem Cells and Recreate Tissue Structures Representative of Teratoma Xenografts

Various methods are currently used to investigate human tissue differentiation, including human embryo culture and studies utilising pluripotent stem cells (PSCs) such as in vitro embryoid body formation and in vivo teratoma assays. Each method has its own distinct advantages, yet many are limited due to being unable to achieve the complexity and maturity of tissue structures observed in the developed human. The teratoma xenograft assay allows maturation of more complex tissue derivatives, but this method has ethical issues surrounding animal usage and significant protocol variation. In this study, we have combined three-dimensional (3D) in vitro cell technologies including the common technique of embryoid body (EB) formation with a novel porous scaffold membrane, in order to prolong cell viability and extend the differentiation of PSC derived EBs. This approach enables the formation of more complex morphologically identifiable 3D tissue structures representative of all three primary germ layers. Preliminary in vitro work with the human embryonal carcinoma line TERA2.SP12 demonstrated improved EB viability and enhanced tissue structure formation, comparable to teratocarcinoma xenografts derived in vivo from the same cell line. This is thought to be due to reduced diffusion distances as the shape of the spherical EB transforms and flattens, allowing for improved nutritional/oxygen support to the developing structures over extended periods. Further work with EBs derived from murine embryonic stem cells demonstrated that the formation of a wide range of complex, recognisable tissue structures could be achieved within 2–3 weeks of culture. Rudimentary tissue structures from all three germ layers were present, including epidermal, cartilage and epithelial tissues, again, strongly resembling tissue structure of teratoma xenografts of the same cell line. Proof of concept work with EBs derived from the human embryonic stem cell line H9 also showed the ability to form complex tissue structures within this system. This novel yet simple model offers a controllable, reproducible method to achieve complex tissue formation in vitro. It has the potential to be used to study human developmental processes, as well as offering an animal free alternative method to the teratoma assay to assess the developmental potential of novel stem cell lines.

CHD1 loss sensitizes prostate cancer to DNA damaging therapy by promoting error-prone double-strand break repair

Background

Deletion of the chromatin remodeler chromodomain helicase DNA-binding protein 1 (CHD1) is a common genomic alteration found in human prostate cancers (PCas). CHD1 loss represents a distinct PCa subtype characterized by SPOP mutation and higher genomic instability. However, the role of CHD1 in PCa development in vivo and its clinical utility remain unclear.

Patients and methods

To study the role of CHD1 in PCa development and its loss in clinical management, we generated a genetically engineered mouse model with prostate-specific deletion of murine Chd1 as well as isogenic CHD1 wild-type and homozygous deleted human benign and PCa lines. We also developed patient-derived organoid cultures and screened patients with metastatic PCa for CHD1 loss.

Results

We demonstrate that CHD1 loss sensitizes cells to DNA damage and causes a synthetic lethal response to DNA damaging therapy in vitro, in vivo, ex vivo, in patient-derived organoid cultures and in a patient with metastatic PCa. Mechanistically, CHD1 regulates 53BP1 stability and CHD1 loss leads to decreased error-free homologous recombination (HR) repair, which is compensated by increased error-prone non-homologous end joining (NHEJ) repair for DNA double-strand break (DSB) repair.

Conclusions

Our study provides the first in vivo and in patient evidence supporting the role of CHD1 in DSB repair and in response to DNA damaging therapy. We uncover mechanistic insights that CHD1 modulates the choice between HR and NHEJ DSB repair and suggest that CHD1 loss may contribute to the genomic instability seen in this subset of PCas.

Fitbit Activity Trackers Interrupt Workplace Sedentary Behavior: A New Application

This study investigated whether Fitbit devices can reduce sedentary behavior among employees in the workplace. Participants were asked to wear Fitbits during 8-hour work shifts, 5 days per week, for 8 weeks. They were instructed to stand at least once every 30 minutes throughout the workday. The goal of the study was to determine whether standing once every 30 minutes was a feasible strategy for reducing sedentary workplace behavior. On average, participants completed 36 of 40 workdays using Fitbits. The number of times participants stood during an 8-hour workday averaged 12 stands per day (maximum 16 stands per day). These results indicate that Fitbit technology is effective for recording and tracking interruptions in sitting time; however, to reduce sitting behavior, alternate approaches are required to motivate larger numbers of workers to participate.

Prospective controlled cohort study of Troponin I levels in patients undergoing elective spine surgery for degenerative conditions: Prone versus supine position

Prior studies have suggested that elevated serum Troponin-I (TnI) levels immediately after non-cardiac surgical procedures (8-40%) represent subclinical cardiac stress which independently predicts increased 30-day mortality. Routine post-operative TnI monitoring has therefore been suggested as a standard of care. However, no prior studies have focussed on elective degenerative spine surgery, whilst few have measured pre-op TnI. Further, prolonged prone positioning could represent an additional, independent, cardiac stress. We planned a prospective controlled cohort study of consecutive TnI levels in routine elective spine surgery for degenerative spine conditions, incorporating 3 groups: 'prone<2h', 'prone>2h' and 'supine' positioning. TnI levels (>0.04μg/L) were recorded immediately pre-/post-surgery, and by 24h of surgery. N=120 patients were recruited. Complete results were obtained in 92 (39 supine, 53 prone). No significant between-groups differences were observed in demographic or cardiovascular risk factors. Validated TnI-elevation by 24h was not observed in any group. Spurious elevations were recorded in one 'prone<2h' and one 'prone>2h'. One non-ST segment myocardial infarction (STEMI) occurred on day 7 without TnI elevation by 24h (prone>2h). There was no 30-day mortality.

CONCLUSIONS

Despite a lower cut-off, no validated TnI elevation was observed in any group by 24h after surgery. One non-STEMI had not been associated with TnI-elevation by 24h. Immediately peri-operative cardiac stress therefore appeared comparatively rare in patients undergoing routine elective spine surgery. Further, prone positioning did not represent an additional, independent, risk. Routine immediately post-operative TnI monitoring in elective spine surgery therefore appears unjustified. Our study highlighted several caveats regarding consecutive TnI testing.

Impact of gavage dosing procedure and gastric content on adverse respiratory effects and mortality in rat toxicity studies

Unscheduled mortality preceded by adverse respiratory clinical signs in rats dosed by oral gavage may not only be caused by technical gavage error or systemic toxicity but may also be caused by gastro-esophageal reflux and subsequent aspiration of high concentrations of drug formulation. In a 3 week oral gavage rat toxicity study for an early drug development compound, preterminal deaths (approximately 20% of animals) at high doses (≥1000 mg kg(-1) ) and concentrations (≥60 mg ml(-1) ) were preceded by recurrent dyspnea, rales or excessive salivation, without evidence of accidental intrapulmonary gavage error. Histological evaluation revealed extensive necrosis and inflammatory changes in the upper respiratory tract, especially in the nasal turbinates and/or nasopharynx. The presence of food particles in inflammatory exudates suggested a retrograde aspiration of stomach content with test formulation via the nasopharyngeal duct into the posterior region of the nose. In contrast, no mortality or adverse respiratory effects were observed in rats following 2 week intravenous administration at comparable exposures or oral gavage administration at lower concentrations (≤20 mg ml(-1) ). In a pharmacology study, the compound caused a dose-dependent increase in gastric content (partly due to inhibition of gastric emptying), providing a pharmacological basis for the suspected gavage-mediated gastroesophageal reflux. Reducing the dose volume and dosing fasted animals substantially reduced or eliminated the respiratory effects and mortality at the high test article concentrations, demonstrating that the adverse effects are related to the gavage method.

Oral anticoagulation in atrial fibrillation: A pan-European patient survey

BACKGROUND

Anticoagulation with vitamin K antagonists (VKAs) provides effective stroke prophylaxis in patients with atrial fibrillation (AF). Optimisation of such therapy requires frequent monitoring, dose adjustments and stringent lifestyle restrictions. We conducted a large multinational survey in patients with chronic AF to gain insights into their perceptions and understanding of VKA use.

METHODS

Eligible patients were adults with AF who had been prescribed VKAs for at least 1 year. A total of 711 patient interviews were conducted in seven European countries during June and July 2004.

RESULTS

The majority of patients (58% male; mean age 68 years) claimed to understand their treatment programme; despite this, only 7% knew that VKA use is aimed at preventing strokes and 24% stated that they would have liked more information. Patients attended an average of 14 monitoring sessions in the previous year; however, 21% missed appointments, especially younger patients (<65 years). The International Normalized Ratio (INR) was within the target range in most or all of the last five to ten visits in 64% of patients; nonetheless, 38% were not aware that an INR outside the target range is associated with health risks. On average, patients required dose adjustments every four sessions. VKA treatment impacted 67% of patients in terms of diet, socialising, career and independence, especially younger patients (74%).

CONCLUSIONS

Monitoring, dose adjustments and lifestyle restrictions to optimise the intensity of anticoagulation with VKAs are problematic for patients with AF, and their knowledge of the consequences of such therapy is often poor.

Orthopaedic intervention in early rheumatoid arthritis. Occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years

OBJECTIVES

To assess the occurrence of and predictive factors for orthopaedic surgery in an inception cohort of rheumatoid arthritis (RA) patients recruited and followed prospectively for 5 yr in nine regions in England.

METHODS

Standard clinical, laboratory and radiological assessments and all interventions were recorded at baseline and yearly in RA patients (less than 2 yrs symptoms) prior to the use of disease-modifying drugs.

RESULTS

One thousand and sixty-four patients completed 5 yr of follow-up. Two hundred and sixty-four orthopaedic procedures for RA were performed in 181 (17%) patients at a median of 36.5 months from baseline. Seventy-five (7%) had replacements of major joints. Risk factors at baseline for large joint replacement surgery were a low haemoglobin concentration [odds ratio scores (OR) 3.4, 95% confidence interval (CI) 2.1-5.8] and high scores for erythrocyte sedimentation rate (ESR) (OR 3.2, CI 1.8-5.3), disease activity (DAS) (OR 2.1, CI 1.2-3.5) and Larsen X-rays (OR 2.6, CI 1.4-4.8). For hand or foot joint surgery (4%), risk factors included female gender (OR 3.2, CI 1.3-7.6), joint score (OR 2.3, CI 1.2-4.3), erosions (OR 2.3, CI 1.1-4.8), DAS (OR 2.4, 1.3-4.5) and Health Assessment Questionnaire score (OR 1.9, CI 1.0-3.6). No significant associations were seen for tendon, soft tissue or other minor procedures (6%). The HLA-DRB1 RA shared epitope was associated with any type of orthopaedic surgery (OR 1.7, CI 1.1-2.7).

CONCLUSIONS

Eleven per cent of RA patients treated with conventional drug therapy for 5 yr underwent large- or small-joint surgery, an outcome which could be compared against that for new disease-modifying drugs. Risk factors varied according to type of surgery, but included standard clinical and laboratory measures. In order to reduce the eventual need for surgery, a therapeutic target in the first year of RA is the suppression of disease activity, as measured by haemoglobin and ESR. These are useful details for clinicians, health professionals and patients.

A Welch-type test for homogeneity of contrasts under heteroscedasticity with application to meta-analysis

A common problem that arises in the meta-analysis of several studies, each with independent treatment and control groups, is to test for the homogeneity of effect sizes without the assumptions of equal variances of the treatment and the control groups and of equal variances among the separate studies. A commonly used test statistic, frequently denoted as Q, is the weighted sum of squares of the differences of the individual effect sizes from the mean effect size, with weights inversely proportional to the variances of the effect sizes. The primary contributions of this article are the presentation of improved and very accurate approximations to the distributions of the Q statistic when the effect size is a linear contrast such as the difference between the treatment and control means. Our improved approximation to the distribution of Q under the null hypothesis is based on a multiple of an F-distribution; its use yields a substantial reduction in the type I error rate of the homogeneity test. Our improved approximation to the distribution of Q under an alternative hypothesis is based on a shift of a chi-square distribution; its use allows for much greater accuracy in the computation of the power of the homogeneity test. These two improved approximate distributions are developed using the Welch methodology of approximating the moments of Q by the use of multivariate Taylor expansions. The quality of these approximations is studied by simulation. A secondary contribution of this article is a study of how best to combine the variances of the treatment and control groups (needed for the calculation of weights in the Q statistic). Our conclusion, based on simulations, is that use of pooled variances can result in substantially erroneous conclusions.

Support, mutual aid and recovery from dual diagnosis

Recovery from substance abuse and mental health disorders (dual-diagnosis) requires time, hard work and a broad array of coping skills. Empirical evidence has demonstrated the buffering role of social support in stressful situations. This paper investigates the associations among social support (including dual-recovery mutual aid), recovery status and personal well-being in dually-diagnosed individuals (N = 310) using cross-sectional self-report data. Persons with higher levels of support and greater participation in dual-recovery mutual aid reported less substance use and mental health distress and higher levels of well-being. Participation in mutual aid was indirectly associated with recovery through perceived levels of support. The association between mutual aid and recovery held for dual-recovery groups but not for traditional, single-focus self-help groups. The important role of specialized mutual aid groups in the dual recovery process is discussed.

Recovery challenges among dually diagnosed individuals

Although there is a high prevalence of co-occurring mental and substance abuse disorders, and empirical evidence shows the need to integrate multiple treatment services for dually diagnosed persons, service integration is relatively recent and often poorly implemented. Moreover, service providers and clients often hold divergent views of what constitute appropriate and feasible treatment goals. This paper presents interview data from an urban sample of dually diagnosed members of self-help groups (N = 310) concerning the challenges confronting them in their recovery, and discusses the interrelations of these issues. The findings indicate that most clients struggle with emotional and socioeconomic issues, which bear significantly on their ability to handle adequately other aspects of recovery.

Neutrophilia and congestive heart failure after acute myocardial infarction

BACKGROUND

Inflammation associated with acute myocardial infarction (AMI) is frequently marked by a peripheral leukocytosis and relative neutrophilia. Whether this process may contribute to the development of postinfarction congestive heart failure (CHF) is not established. The objective of this study was to examine the association between hospital admission peripheral total leukocyte count and the neutrophil percentage and the subsequent development of CHF in patients with AMI. The study was designed as a retrospective cohort study in the setting of a tertiary referral hospital. Participants included 185 patients discharged with a diagnosis of AMI between May 1 and Sept 30, 1996.

METHODS AND RESULTS

Outcome measures included clinical episodes of CHF with confirmatory chest roentgenogram findings and/or echocardiographic evidence of contractile dysfunction. Multivariable logistic regression analyses were performed to examine the relation between the total leukocyte count, neutrophil percentage, and the development of CHF in the first 4 days after AMI while controlling for baseline characteristics and early therapeutic interventions. Thirty-one percent of the cohort had a leukocyte count >11.0 x10(9)/L on admission to the hospital; 65% had a neutrophil percentage >65%, and 61% had a lymphocyte percentage </=25%. CHF developed in 43% of the cohort. Of these, 92. 5% had relative neutrophilia (neutrophil percentage >65%) compared with 45% of those in whom CHF did not develop. Multivariable analysis revealed a highly significant association between relative neutrophilia and the subsequent development of CHF (odds ratio 14.3; 95% confidence interval 5.2 to 39.3).

CONCLUSIONS

Relative neutrophilia on admission to the hospital in patients with AMI is significantly associated with the early development of CHF. This association may help in the identification of individuals at high risk who might benefit from more aggressive interventions to prevent or reduce the risk of CHF.

Motoneuron apoptosis is blocked by CEP-1347 (KT 7515), a novel inhibitor of the JNK signaling pathway

Neurons undergoing apoptosis can be rescued by trophic factors that simultaneously increase the activity of extracellular signal-regulated kinase (ERK) and decrease c-Jun N-terminal kinase (JNK) and p38. We identified a molecule, CEP-1347 (KT7515), that rescues motoneurons undergoing apoptosis and investigated its effect on ERK1 and JNK1 activity. Cultured rat embryonic motoneurons, in the absence of trophic factor, began to die 24-48 hr after plating. During the first 24 hr ERK1 activity was unchanged, whereas JNK1 activity increased fourfold. CEP-1347 completely rescued motoneurons for at least 72 hr with an EC50 of 20 +/- 2 nM. CEP-1347 did not alter ERK1 activity but rapidly inhibited JNK1 activation. The IC50 of CEP-1347 for JNK1 activation was the same as the EC50 for motoneuron survival. Inhibition of JNK1 activation by CEP-1347 was not selective to motoneurons. CEP-1347 also inhibited JNK1 activity in Cos7 cells under conditions of ultraviolet irradiation, osmotic shock, and inhibition of glycosylation. Inhibition by CEP-1347 of the JNK1 signaling pathway appeared to be selective, because CEP-1347 did not inhibit p38-regulated mitogen-activated protein kinase-activated protein kinase-2 (MAPKAP2) activity in Cos7 cells subjected to osmotic shock. The direct molecular target of CEP-1347 was not JNK1, because CEP-1347 did not inhibit JNK1 activity in Cos7 cells cotransfected with MEKK1 and JNK1 cDNA constructs. This is the first demonstration of a small organic molecule that promotes motoneuron survival and that simultaneously inhibits the JNK1 signaling cascade.

A bioluminescent assay for agonist activity at potentially any G-protein-coupled receptor

Transient expression of apoaequorin in Chinese hamster ovary (CHO) cells and reconstitution with the co-factor coelenterazine resulted in a large, concentration-dependent agonist-mediated luminescent response following cotransfection with the endothelin ETA, angiotensin ATII, thyrotropin-releasing hormone (TRH), and neurokinin NK1 receptors, all of which interact pre-dominantly with the G alpha q-like phosphoinositidase-linked G-proteins. A substantially greater luminescence was obtained with mitochondrially targeted apoaequorin compared to cytoplasmically expressed apoaequorin. To generate a system amenable for the study of agonist activity at virtually any G-protein-coupled receptor the alpha subunit of the receptor promiscuous G-protein G alpha 16 was either transiently or stably expressed in CHO cells together with apoaequorin. In cells expressing G alpha 16, but not in its absence, agonists at a series of receptors which normally interact with either G alpha s or G alpha i were now able to cause a luminescent response from mitochondrially targeted apoaequorin. In the case of the A1 adenosine receptor, this response was clearly a result of activation of G alpha 16 and not a consequence of the release of the G alpha i-associated beta/gamma complex, as the luminescent response was unaffected by pertussis toxin treatment of the cells, whereas agonist-mediated inhibition of adenylyl cyclase activity was attenuated. These studies describe the use of coexpressed apoaequorin as a reporter for G-protein-coupled receptor-mediated calcium signaling. Furthermore, coexpression of G alpha 16 and apoaequorin provides a basis for a generic mammalian cell microplate assay for the assessment of agonist action at virtually any G-protein-coupled receptor, including orphan receptors for which the physiological signal transduction mechanism may be unknown.

Transurethral resection of the prostate: still the gold standard

BACKGROUND

In recent times there has been a number of newer methods advocated as treatment for bladder outlet obstruction. Prior to embracing these newer technologies, the authors' experiences with conventional transurethral resection of the prostate should be evaluated and compared with those experienced in the newer modalities. The objective was to determine whether a standard transurethral resection of the prostate (TURP) still compared favourably with the newer modalities in terms of duration of stay, duration of catheterization, re-admission rate, re-catheterization rate, cost and long-term results. The results are compared with those of workers whose level of expertise was the best that could be achieved with transurethral needle ablation (TUNA) and laser prostatectomy.

METHODS

During the 3-year period from September 1992 to September 1995, 575 TURP were carried out in a regional hospital. The total duration of stay, the postoperative duration of stay, the re-catheterization and re-admission rates were assessed and the costs estimated.

RESULTS

Transurethral resection of the prostate was shown to compare favourably in terms of the duration of hospital admission and the duration of catheterization, and to have a significantly lower re-catheterization rate and a significantly lower re-admission rate than the newer modalities.

CONCLUSION

Transurethral resection of the prostate is still the method of choice for surgical management of bladder outlet obstruction, and it remains as the gold standard. Having reviewed the results of the newer modalities as carried out by the experts in those fields, it was found that TURP compares favourably with those procedures. From the point of view of duration of stay, duration of catheterization, re-admission rate and re-catheterization rate, as well as cost and long-term results, TURP remains as the gold standard and the newer modalities are not believed to be advantageous at this stage.

A radioactive binding assay for inhibitors of trkA kinase

The high-affinity receptor for nerve growth factor (NGF), trkA, is a receptor-linked tyrosine kinase. The binding of NGF to trkA, depending on the context of its environment, can cause beneficial or deleterious responses in the target cells. For example, the activation of trkA in sympathetic and sensory neurons causes the subsequent survival and differentiation of these cells. On the other hand, the activation of trkA by NGF in other cells has been implicated in several pathologies including inflammation-induced hyperalgesia and several cancers. A radioactive binding assay to evaluate inhibitors of the kinase domain of trkA has been developed and validated. The assay monitors the specific binding of an inhibitor of trkA kinase activity, the indolocarbazole K-252a, to the trkA receptor. [3H]K-252a binds with high affinity to one site on the cytoplasmic kinase domain of the trkA receptor. Binding is saturable and reversible with a dissociation constant (Kd) of 1.5 nM. The binding assay has been used in competition binding experiments to determine the inhibition constants for other indolocarbazole compounds. The IC50 values for compounds obtained in the binding assay correlate very well with the IC50 values obtained in an enzyme-linked immunosorbent assay for trkA tyrosine kinase activity.

In vitro and in vivo secretion of human ISG15, an IFN-induced immunomodulatory cytokine

ISG15, a 15-kDa protein of unique primary amino acid sequence, functions intracellularly as a ubiquitin homologue and a cytokine that induces production of IFN-gamma and augments NK/lymphokine-activated killer cell proliferation and function. ISG15 is secreted from monocytes and lymphocytes, and in this study we have characterized in vitro and in vivo production of ISG15 in response to IFN-alphabeta. Low levels of ISG15 were present constitutively in PBMCs; dose-dependent ISG15 synthesis was observed in response to IFN-alpha or IFN-beta, but not IFN-gamma. High m.w. conjugates, present in PBMC extracts constitutively, were enhanced after IFN-alpha or IFN-beta treatment. Metabolic labeling experiments demonstrated that IFN-beta-induced ISG15 was released from primary cultures of peripheral blood CD3+ (including both CD4+ and CD8+ subpopulations). Furthermore, ISG15 was released from viable cell lines of monocyte, T lymphocyte, B lymphocyte, and epithelial origins. Since ISG15 was secreted in response to IFN treatment in vitro, its levels in the serum of healthy human volunteers treated with IFN-beta(ser) were quantitated by asymmetric sandwich ELISA. Both single and multiple doses of IFN-beta(ser) increased serum ISG15 levels significantly (p < 0.01) over baseline. A maximum 7.3-fold enhancement of serum ISG15 was obtained after multiple injections of 8 million units of IFN-beta(ser). Significant change was observed at 24 and 48 h of multiple 0.02-million-unit injections, yielding 1.2- and 1.7-fold increases over basal levels, respectively. These studies suggest that ISG15 is a novel member of the cytokine cascade that is synthesized and released in response to IFN-beta both in vitro and in vivo.

In vitro and in vivo secretion of human ISG15, an IFN-induced immunomodulatory cytokine

ISG15, a 15-kDa protein of unique primary amino acid sequence, functions intracellularly as a ubiquitin homologue and a cytokine that induces production of IFN-gamma and augments NK/lymphokine-activated killer cell proliferation and function. ISG15 is secreted from monocytes and lymphocytes, and in this study we have characterized in vitro and in vivo production of ISG15 in response to IFN-alphabeta. Low levels of ISG15 were present constitutively in PBMCs; dose-dependent ISG15 synthesis was observed in response to IFN-alpha or IFN-beta, but not IFN-gamma. High m.w. conjugates, present in PBMC extracts constitutively, were enhanced after IFN-alpha or IFN-beta treatment. Metabolic labeling experiments demonstrated that IFN-beta-induced ISG15 was released from primary cultures of peripheral blood CD3+ (including both CD4+ and CD8+ subpopulations). Furthermore, ISG15 was released from viable cell lines of monocyte, T lymphocyte, B lymphocyte, and epithelial origins. Since ISG15 was secreted in response to IFN treatment in vitro, its levels in the serum of healthy human volunteers treated with IFN-beta(ser) were quantitated by asymmetric sandwich ELISA. Both single and multiple doses of IFN-beta(ser) increased serum ISG15 levels significantly (p &lt; 0.01) over baseline. A maximum 7.3-fold enhancement of serum ISG15 was obtained after multiple injections of 8 million units of IFN-beta(ser). Significant change was observed at 24 and 48 h of multiple 0.02-million-unit injections, yielding 1.2- and 1.7-fold increases over basal levels, respectively. These studies suggest that ISG15 is a novel member of the cytokine cascade that is synthesized and released in response to IFN-beta both in vitro and in vivo.

Immunoregulatory properties of ISG15, an interferon-induced cytokine

ISG15 is a 15-kDa protein of unique primary amino acid sequence, which is transcriptionally regulated by interferon (IFN) alpha and IFN-beta. Because it is synthesized in many cell types and secreted from human monocytes and lymphocytes, we postulated that ISG15 might act to modulate immune cell function. ISG15 stimulated B-depleted lymphocyte proliferation in a dose-dependent manner with significant proliferation induced by amounts of ISG15 as low as 1 ng/ml (58 pM). Maximal stimulation of [3H]thymidine incorporation by B-depleted lymphocytes occurred at 6-7 days. Immunophenotyping of ISG15-treated B-depleted lymphocyte cultures indicated a 26-fold expansion of natural killer (NK) cells (CD56+). In cytotoxicity assays, ISG15 was a potent inducer of cytolytic activity directed against both K562 (100 lytic units per 10(6) cells) and Daudi (80 lytic units per 10(6) cells) tumor cell targets, indicating that ISG15 enhanced lymphokine-activated killer-like activity. ISG15-induced NK cell proliferation required coculturing of T and NK cells, suggesting that soluble factor(s) were required. Measurement of ISG15-treated cell culture supernatants for cytokines indicated production of IFN-gamma (> 700 units/ml). No interleukin 2 or interleukin 12 was detected. IFN-gamma itself failed to stimulate lymphocyte proliferation and lymphokine-activated killer cell activation. Further, induced expression of IFN-gamma mRNA was detected by reverse transcription-PCR in T lymphocytes after ISG15 treatment but not in NK cells. Enhancement of NK cell proliferation, augmentation of non-major histocompatibility complex-restricted cytotoxicity, and induction of IFN-gamma from T cells identify ISG15 as a member of the cytokine cascade and suggest that it may be responsible for amplifying and directing some of the immunomodulatory effects of IFN-alpha or IFN-beta.

Consumers as peer specialists on intensive case management teams: impact on client outcomes

OBJECTIVE

The study examined whether employing mental health consumers as peer specialists in an intensive case management program can enhance outcomes for clients with serious mental illness.

METHODS

A quasiexperimental, longitudinal, nonequivalent control group design was used to compare outcomes of clients assigned to three case management conditions: teams of case managers plus peer specialists, teams of case managers plus nonconsumer assistants, and case managers only. Outcomes were measured at baseline and at three six-month intervals. Repeated-measures analysis of variance was used to assess between-group differences.

RESULTS

Complete data were available for 104 clients. Compared with clients in the other two groups, clients served by teams with peer specialists demonstrated greater gains in several areas of quality of life and overall reduction in the number of major life problems experienced. They also reported more frequent contact with their case managers and the largest gains of all three groups in the areas of self-image and outlook and social support. No differences in outcomes were found between clients served by teams with nonconsumer assistants and those served by case managers only.

CONCLUSIONS

Integration of peer specialists into intensive case management programs appears to lead to enhanced quality of life for clients and more effective case management.

Membranes of human neuroblastoma SH-SY5Y cells contain specific binding sites for [3H]K-252A

K-252a and the structurally similar compound staurosporine promote neurotrophic responses in several cell lines (PC12, SH-SY5Y human neuroblastoma) and in cultures of primary neurons. The molecular mechanisms involved in the induction of these neurotrophic activities are unknown. It is demonstrated in this report that [3H]K-252a binds to SH-SY5Y membranes and that the binding is specific and saturable with a Kd of 2.7 nM and a Bmax of 100,000 sites per cell. The association of [3H]K-252a with its binding site is rapid and reversible, and the binding was inhibited by unlabeled K-252a and by staurosporine. Binding of [3H]K-252a was not inhibited by the potent protein kinase C (PKC) inhibitor GF109203X. Down regulation of PKC by treating SH-SY5Y cells with a phorbol ester did not cause a reduction in the specific binding of [3H]K-252a to membranes, suggesting that the binding is not to PKC. Treatment of the SH-SY5Y membranes with trypsin and by boiling destroyed all specific binding of [3H]K-252a. These results suggest that the [3H]K-252a binds to a specific protein site that is associated with membranes of SH-SY5Y cells.

Production and characterization of recombinant mouse brain-derived neurotrophic factor and rat neurotrophin-3 expressed in insect cells

Bioactive brain-derived neurotrophic factor (BDNF) and neurotrophin-3 were produced using the baculovirus expression system and purified to homogeneity using ion-exchange and reversed-phase chromatography. Yields of purified neurotrophin-3 (300-500 micrograms/L) were similar to levels reported for baculovirus-expressed nerve growth factor (NGF), whereas initial yields of BDNF were significantly lower (20-50 micrograms/L). Improved production of BDNF (150-200 micrograms/L) was achieved by expressing BDNF from a chimeric prepro-NGF/mature BDNF construct using the Trichoplusia ni insect cell line. Tn-5B1-4. Examination of the distribution of BDNF protein from both the non-chimeric prepro-BDNF and the chimeric prepro-NGF/mature BDNF viruses in Sf-21- and Tn-5B1-4-infected cells suggests a specific deficiency in the Tn-5B1-4 cells in processing the nonchimeric precursor. In addition, the vast majority of the BDNF protein at 2 days after infection was intracellular and insoluble. N-terminal amino acid sequencing of purified recombinant BDNF and neurotrophin-3 demonstrated that the insect cells processed their precursors to the correct N-terminus expected for the mature protein. Bioactivity was characterized in vitro on primary neuronal cultures from the CNS and PNS.

Postcardiac catheterization time-in-bed study: enhancing patient comfort through nursing research

Cardiac catheterization has become a routine diagnostic procedure. Little has been written about standards for nursing care related to bed rest postcatheterization. The purpose of this experimental study was to determine whether there was a significant difference in incidence of bleeding from catheter insertion site between those patients who remained in bed for 12 hours and those who remained in bed for 6 hours post-procedure. There was no significant difference between the two groups. Postprocedure bed rest was reduced from 12 to 6 hours in this tertiary care medical center. Decreasing time in bed reduced cost and patient discomfort.

A human 15-kDa IFN-induced protein induces the secretion of IFN-gamma

A 15,000 molecular weight protein (15-kDa), induced and secreted by human PBMC after treatment with IFN-alpha or -beta, was assessed for its ability to modulate cellular function. Although it had no effect on growth or 2'5'-A synthetase activity in Daudi, U-937, or HL-60 cells, when incubated with fresh human PBMC, LPS-induced monocyte cytotoxicity against WEHI-164 target cells was augmented. This stimulation was inhibited by both an antibody against TNF-alpha and a rabbit polyclonal antiserum to the 15-kDa protein. Furthermore, when the 15-kDa protein was added to PBMC an increase in GTP cyclohydrolase I activity, as assessed by neopterin secretion, resulted. Neopterin secretion by PBMC in response to the 15-kDa was increased in a dose-responsive manner up to more than sixfold over baseline, with a 15-kDa concentration of less than 10 ng/ml effective. The 15-kDa protein also stimulated indoleamine 2,3-dioxygenase (IDO) activity in fresh, human PBMC. Induction of neopterin secretion and IDO activity was inhibited by a polyclonal antiserum to 15-kDa. LPS-induced cytotoxic activity was not augmented by 15-kDa pretreatment of purified monocytes, indicating the need for the presence of a second cell population and the indirect action of the 15-kDa on the induction of monocyte activities. When PBMC or purified CD3+ cells, but not purified CD14+ cells, were incubated with the 15-kDa protein, secretion of a factor was induced that resulted in the induction of IDO activity in PMA-differentiated THP-1 cells. An antibody to IFN-gamma, but not IFN-alpha, inhibited the induction of IDO activity by this secreted factor. In addition, antiserum to the 15-kDa blocked the secretion of IFN-gamma from the CD3+ cells. Thus, a 15-kDa product of IFN-alpha- and IFN-beta-treated monocytes and lymphocytes can stimulate secretion of IFN-gamma from CD3+ cells.

A human 15-kDa IFN-induced protein induces the secretion of IFN-gamma

A 15,000 molecular weight protein (15-kDa), induced and secreted by human PBMC after treatment with IFN-alpha or -beta, was assessed for its ability to modulate cellular function. Although it had no effect on growth or 2'5'-A synthetase activity in Daudi, U-937, or HL-60 cells, when incubated with fresh human PBMC, LPS-induced monocyte cytotoxicity against WEHI-164 target cells was augmented. This stimulation was inhibited by both an antibody against TNF-alpha and a rabbit polyclonal antiserum to the 15-kDa protein. Furthermore, when the 15-kDa protein was added to PBMC an increase in GTP cyclohydrolase I activity, as assessed by neopterin secretion, resulted. Neopterin secretion by PBMC in response to the 15-kDa was increased in a dose-responsive manner up to more than sixfold over baseline, with a 15-kDa concentration of less than 10 ng/ml effective. The 15-kDa protein also stimulated indoleamine 2,3-dioxygenase (IDO) activity in fresh, human PBMC. Induction of neopterin secretion and IDO activity was inhibited by a polyclonal antiserum to 15-kDa. LPS-induced cytotoxic activity was not augmented by 15-kDa pretreatment of purified monocytes, indicating the need for the presence of a second cell population and the indirect action of the 15-kDa on the induction of monocyte activities. When PBMC or purified CD3+ cells, but not purified CD14+ cells, were incubated with the 15-kDa protein, secretion of a factor was induced that resulted in the induction of IDO activity in PMA-differentiated THP-1 cells. An antibody to IFN-gamma, but not IFN-alpha, inhibited the induction of IDO activity by this secreted factor. In addition, antiserum to the 15-kDa blocked the secretion of IFN-gamma from the CD3+ cells. Thus, a 15-kDa product of IFN-alpha- and IFN-beta-treated monocytes and lymphocytes can stimulate secretion of IFN-gamma from CD3+ cells.

An interferon-induced 16-kD protein is present in the membranes of interferon-sensitive but not in interferon-resistant mouse cells

Human interferon-alpha (IFN-alpha) or IFN-beta has been shown to induce a 17-kD membrane protein in human cells which when eluted from SDS gels inhibited the multiplication of cells of different human cell lines. We show herein that mouse IFN-alpha/beta induces a 16-kD membrane protein in L1210 and Friend erythroleukemia cells sensitive to IFN-alpha/beta, (but not in the derived IFN-alpha/beta-resistant cell lines) as well in primary and monolayer cultures of mouse embryonic fibroblasts and adult mouse hepatocytes, and in suspensions of spleen cells. In addition, IFN-alpha/beta enhanced the expression of an 11-kD membrane protein which could be shown by immunoprecipitation to be beta 2-microglobulin. Anticell proliferation activity was not recovered from the 16-kD fraction of the SDS gels.

IFN-induced 15-kDa protein is released from human lymphocytes and monocytes

The enhancement or inhibition of synthesis of specific proteins by IFN is believed to cause subsequent IFN-induced biological responses. The roles of most of these proteins in the biological responses induced by the IFNs, for example, inhibition of virus replication and inhibition of cell growth, remain largely unknown. Our recent research has focused on the induction and synthesis of an IFN-induced 15-kDa protein. In this report we show that human lymphocytes and monocytes, after treatment with IFN-beta, release into the medium an IFN-induced 15-kDa protein. At 24 h after induction of the 15-kDa protein in lymphocytes or monocytes, more than 50% of the total 15-kDa protein is in the medium. The human monocytic cell line THP-1 also releases 15-kDa protein into the medium after its induction by IFN-beta. An intracellular half-life of 12 h has been calculated for the 15-kDa protein in monocytes and THP-1 cells. The exocellular release of the 15-kDa protein by lymphocytes and monocytes suggests that 1) it may have an intercellular signaling role and 2) it may be an in vivo mediator of some of the biological responses induced by IFN.

IFN-induced 15-kDa protein is released from human lymphocytes and monocytes

The enhancement or inhibition of synthesis of specific proteins by IFN is believed to cause subsequent IFN-induced biological responses. The roles of most of these proteins in the biological responses induced by the IFNs, for example, inhibition of virus replication and inhibition of cell growth, remain largely unknown. Our recent research has focused on the induction and synthesis of an IFN-induced 15-kDa protein. In this report we show that human lymphocytes and monocytes, after treatment with IFN-beta, release into the medium an IFN-induced 15-kDa protein. At 24 h after induction of the 15-kDa protein in lymphocytes or monocytes, more than 50% of the total 15-kDa protein is in the medium. The human monocytic cell line THP-1 also releases 15-kDa protein into the medium after its induction by IFN-beta. An intracellular half-life of 12 h has been calculated for the 15-kDa protein in monocytes and THP-1 cells. The exocellular release of the 15-kDa protein by lymphocytes and monocytes suggests that 1) it may have an intercellular signaling role and 2) it may be an in vivo mediator of some of the biological responses induced by IFN.

Clumsiness in children--do they grow out of it? A 10-year follow-up study

The question of whether problems of motor co-ordination in early childhood recede with age has rarely been addressed. This paper reports the findings from a follow-up study of 17 children, identified by their teachers as having poor motor co-ordination at age six. Now age 16, these children and their matched controls completed a battery of assessments. The results suggest that the majority of children still have difficulties with motor co-ordination, have poor self-concept and are experiencing problems of various kinds in school. However, there are individual differences in the extent to which the children have learned to cope with their continuing difficulties over the years.

A 15-kD interferon-induced protein and its 17-kD precursor: expression in Escherichia coli, purification, and characterization

Using recombinant DNA technology, a 15-kD interferon (IFN)-induced protein and its 17-kD precursor have been expressed in Escherichia coli to obtain sufficient quantities of each protein for the investigation of their biological roles. Both the 15-kD and 17-kD proteins have been purified to homogeneity and crystallized. The recombinant 15-kD protein has an identical reversed-phase HPLC elution profile to that of the native 15-kD protein purified from human cells. Furthermore, the recombinant 15-kD and 17-kD proteins have identical amino- and carboxy-terminal amino acid sequences to those predicted from the DNA sequence. The native and recombinant 15-kD proteins give identical tryptic peptide maps, and the recombinant 17-kD protein gives only one additional tryptic peptide. We conclude that the recombinant 17-kD and 15-kD proteins are identical to the 17-kD precursor and the 15-kD stable product synthesized in human cells in response to IFN stimulation. In addition, we have demonstrated that the recombinant 17-kD precursor protein can be converted to the 15-kD protein by cytoplasmic extracts of human cells.