A-04 Acute Sports-Related Concussion Associations Between Cognitive Symptoms, Memory Performance, and Default Mode Network Hub Connectivity

Purpose: Disruptions in cognitive performance are commonly reported after a sports-related concussion (SRC) and may be related to brain network changes, particularly within the default mode network (DMN). Since well-connected brain regions across networks (hubs) play an important role in network organization, we hypothesize that DMN hubs will be disrupted after a SRC and associated with cognitive symptoms and cognitive performance. Methods: We collected resting-state fMRI, symptoms, and cognitive performance data from 44 student-athletes at baseline, after a SRC, and at recovery. Participation coefficient defined hubs for each athlete. We compared changes in functional connectivity between hubs and non-hubs within the DMN and between DMN hubs and non-hubs in the remaining networks. We used linear regression to examine the relationship between functional connectivity, cognitive symptoms, and cognitive performance while controlling for concussion history. Results: Functional connectivity between hubs and non-hubs within the DMN increased from baseline to post-injury and decreased from post-injury to recovery, but not to baseline connectivity levels. Post-injury functional connectivity was related to increased cognitive symptoms and decreased visual memory performance. Functional connectivity decreased between hubs in the DMN and non-hubs in the cingulo-opercular, salience, somatomotor, and visual networks from baseline to post-injury. Cognitive symptoms and visual memory performance were related to functional connectivity between DMN hubs and visual network non-hubs. Conclusions: Self-reported cognitive symptoms and cognitive performance were associated with changes in DMN hub connectivity. This relationship may suggest a decrease in efficiency between brain networks after a SRC and may provide insight into post-injury compensation during task performance.

Evaluation of the need to prescribe opioid medication to control post-surgical pain of different periodontal/oral surgeries

BACKGROUND

To determine the level of perceived pain after different types of periodontal/oral surgical procedures, and the differences in patients' selection of pain management, over the counter (OTC) versus opioid, based on procedure type.

METHODS

Patients undergoing surgical procedures were asked to complete a pain questionnaire at four time points: 1) before surgery 2) first dose of analgesic at home, 3) 24 hours postoperatively, and 4) 72 hours postoperatively. The questionnaire consisted of numerical and descriptive scales to describe the perceived pain.

RESULTS

A total of 198 patients completed the questionnaire. All surgical procedures were grouped into five major categories: bone augmentation procedures (11% BAP), teeth extractions (26% EXT), surgical implant placement (25% IP), mucogingival surgeries (21% MGS), and pocket elimination procedures (17%). IP surgery was associated with significantly less pain compared with MGS and EXT (P <0.05). There was a statistically significant difference for taking any medication based on type of surgical procedure at 24 hours (P <0.05).

CONCLUSIONS

IP is associated with significantly lower perceived pain compared with EXT and MGS surgery. Analgesic consumption was generally parallel to pain perception. A considerable number of patients elected to control the post-surgical pain using OTC medication up to 72 hours. Periodontal/oral surgery procedures vary in the amount of perceived postoperative pain. Tailoring postoperative medications to the type of periodontal/oral surgery performed will help prevent overprescribing of opioids.

B-33 Cognitive Mechanisms Associated with Emotion-Focused Pulling in Trichotillomania

Objective

A revised version of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult (MIST-A) provides scores for two distinct behavioral patterns of hair pulling in trichotillomania: emotion and intention pulling. The current study explored the relationship between these scales and several cognitive domains.

Method

This study used baseline data from a randomized controlled trial of a cognitive-behavior therapy intervention for trichotillomania. Participants from the general community were eligible if they met diagnostic criteria for trichotillomania. Thirty-two individuals were enrolled and completed baseline measures. The sample was 78% female, and the mean age was 34. At baseline, participants completed diagnostic interviews, self-report symptom questionnaires, and tasks from the Cambridge Neuropsychological Test Automated Battery (the stop-signal test, the intra/extra dimensional shift task, and the Cambridge gambling task ). These provided scores of intra and extra dimensional set-shifting, response inhibition, decision making quality, and sensitivity to risk. Correlational analyses were conducted comparing each cognitive score to each MIST-A score.

Results

Analyses revealed significant negative correlations between emotion pulling score and decision making quality r (30) = -.383, = .031 and emotion pulling score and sensitivity to risk r (30) = -.396, p = .025.

Conclusion

These findings provide initial insight into some of the cognitive mechanisms associated with emotion focused pulling. Individuals who pull their hair with the aim of reducing negative emotions (e.g. boredom, anxiety) showed themselves on the gambling task to be more willing to bet on an unlikely outcome, and less willing to adjust their betting amount according to the likelihood of an outcome.

Abstract P3-08-01: Characteristics, outcomes and prognostic factors of luminal androgen receptor (LAR) triple-negative breast cancer (TNBC)

Background: The LAR subtype is a genomically distinct subset of TNBC. Using a large cohort of non-metastatic TNBC patients (pts) with long term follow-up, we sought to further characterize the clinicopathologic features and outcomes of LAR vs non-LAR TNBC.

Methods: From a cohort of 9982 women with surgically-treated non-metastatic breast cancer, 605 met criteria for TNBC (ER/PR&lt;1% and HER2-negative) by central pathology. RNA extracted from 304 FFPE tumor specimens using the HighPure RNA extraction kit was subjected to TruSeq RNA Access library preparation and sequencing on a HiSeq2500. Adequate RNA was available for 283 pts. Tumors were classified as LAR or non-LAR using a shrunken centroid model, CABAL (Clustering Among BAsal and Luminal androgen receptor). In addition to previously described analyses [Leon-Ferre et al, Breast Cancer Res Treat 2017], immunohistochemical (IHC) androgen receptor (AR) staining was performed and the impact of various parameters on invasive disease-free survival (IDFS) and overall survival (OS) was assessed using Cox proportional hazards models.

Results: 58 (20%) tumors were classified as LAR and 225 (80%) as non-LAR. Compared to non-LAR, LAR pts were older (mean age 65 vs 54) and more often postmenopausal (79%vs53%), both p=0.01. Apocrine histology was more common among LAR tumors (21%vs0%), which were also lower grade (grade3: 69%vs95%) and had lower Ki-67 (Ki-67&gt;15%: 64%vs82%), all p&lt;0.01. Additionally, LAR tumors had lower median stromal tumor infiltrating lymphocytes (TILs, 20%vs25%) and were less frequently lymphocyte-predominant [≥50% stromal or intratumoral TILs (19%vs32%)], although neither reached statistical significance. AR IHC was available for 223 of 283 tumors. Median AR IHC score in LAR was 65% (range 0-100%) vs 0% (range 0-90%) in non-LAR. T/N stage, surgery type, and receipt of adjuvant chemotherapy (AdjCT) or radiotherapy were similar between LAR and non-LAR. LAR pts had shorter IDFS and OS compared to non-LAR (5.6 vs 11.8 yrs and 10.8 vs 20.8 yrs, respectively), although this did not reach statistical significance. Test of proportional hazard assumption was not significant for IDFS or OS (p = 0.30 and 0.09). IDFS estimates were numerically higher in LAR vs non-LAR (80.2%vs70.5%,p = 0.92) at 3yrs post-diagnosis; whereas the opposite was true (40.9%vs55.6%,p = 0.07) after 10yrs. OS estimates at 3 and 5yrs were similar between LAR and non-LAR, but at 10yrs OS was inferior in LAR (40.9%vs66.4%,p = 0.24). In a univariate analysis including both LAR and non-LAR, older age, higher N stage, lower TILs and absence of AdjCT were associated with poorer IDFS and OS. In a multivariate analysis, higher N stage and absence of AdjCT remained associated with both poorer IDFS and OS; while lower stromal TILs were associated with poorer IDFS (p=0.01), and with a trend towards poorer OS (p=0.07).

Conclusions: LAR TNBCs occurred in older women, were lower grade, and had lower TIL density than nonLAR tumors. While significant differences in IDFS or OS were not demonstrated, LAR pts exhibited a numerically lower risk of a disease event at 3yrs, but higher risk by 10yrs compared to nonLAR pts. In the entire cohort, higher N stage, absence of AdjCT and lower TILs were independently associated with poorer outcomes.

Citation Format: Leon-Ferre RA, Polley M-Y, Liu H, Kalari KR, Boughey JC, Liu MC, Cafourek V, Negron V, Ingle JN, Thompson KJ, Tang X, Barman P, Carlson E, Visscher DW, Carter JC, Couch FJ, Goetz MP. Characteristics, outcomes and prognostic factors of luminal androgen receptor (LAR) triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-01.

Trajectories of traumatic stress symptoms during conflict: A latent class growth analysis

BACKGROUND

The ways in which traumatic stress symptoms unfold under situations of ongoing threat and trauma exposure are poorly understood. The current study aims to identify traumatic stress symptom trajectories during conflict, as well as potential risk factors.

METHODS

Experience sampling methods were used to study traumatic stress symptoms during the 2014 Israel-Gaza conflict in 100 Israeli civilians exposed to rocket fire. Summary reports of traumatic symptoms were made twice-daily for 30 days via mobile phone.

RESULTS

Latent class growth analysis revealed four distinct classes (low, reducing, moderate, and high) characterised by their trajectory of traumatic stress symptoms during the conflict. Female gender, not being in a relationship, and higher prior trauma exposure were identified as potential risk factors.

LIMITATIONS

Data were not collected in the early phase of the conflict, the sample was relatively small, and only traumatic stress symptoms were investigated as outcomes.

CONCLUSIONS

This study identified heterogeneous traumatic stress symptom trajectories among civilians during a conflict, with different subgroups showing distinct response patterns over time, associated with various risk factors. Investigating responses to ongoing trauma, and identifying predictors of different stress symptom trajectories has clinical implications for the targeted delivery of interventions. Further exploration of heterogeneous trajectories could potentially elucidate mechanisms that drive resilience and recovery, including in situations of ongoing exposure such as during conflict.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Does a specialist voice clinic change ENT clinic diagnosis?

General ENT clinics lack the high quality diagnostic equipment and multidisciplinary advice that is available in the voice clinic. We wished to find out if referral to a specialist voice clinic from general ENT consultant clinics resulted in a change in diagnosis. Lists of voice clinic attendees were reviewed between January 2003 and May 2004. Notes were obtained for 20 patients who attended voice clinic after referral from a general ENT clinic: 3 had no diagnosis on referral to voice clinic, a diagnosis was given after attendance; 8 had their referring diagnosis changed by attendance; and 9 had no change. The voice clinic adds diagnostic value to the service available in general ENT clinics.

Impact of polychlorinated biphenyls (PCBs) on the immune function of fish: age as a variable in determining adverse outcome

Polychlorinated biphenyls (PCBs) are a major contaminant of global extent in water resources and aquatic biota. Due to its high lipid solubility, PCBs fail to be degraded and, therefore, continue to bioaccumulate throughout the environment and food chain. To determine the impact of PCBs on the immune system of aged and juvenile Japanese medaka (Oryzias latipes), fish were injected with the coplanar PCB congener 126 and examined after 3 and 14 days. PCB 126 produced oxidative stress in both age groups of fish 14 days post-injection; however, juvenile medaka appeared more susceptible than aged fish. Humoral immunity, as determined by antibody forming cell (AFC) numbers, was significantly depressed for up to 14 days post-injection in both age groups. These results demonstrate the sensitivity of the fish immune response for predicting PCB-induced immunotoxicity and identify age as a variable in determining adverse outcome.

Electroglottographic measurements of glottal function in vocal fold paralysis in women

The purpose of the study was to determine how electroglottographic measures change with voice recovery in women with vocal fold palsy compared with healthy speakers, and which coefficient best represents dysphonia. An electroglottograph with speech studio 1.04 software was used to record and analyse the data. Electroglottographic data were collected from 22 female patients and 16 healthy female speakers. Our findings show that the mean values of open quotient (OpQ), closing quotient (ClQ), % Irregularity and contact quotient (Qx) differ between the groups of patients and controls. % Irregularity, Qx and OpQ significantly correlated with the perceptual degree of dysphonia. Electroglottographic recordings can objectify dysphonia in patients with vocal fold palsy. Electroglottography is a suitable non-invasive tool for tracking the patients' long-term progress. % Irregularity best represents the vocal fold dysfunction in patients with a vocal fold palsy.

Diaminoindanes as microsomal triglyceride transfer protein inhibitors

The synthesis and biological activities of biarylamide-substituted diaminoindanes as microsomal triglyceride transfer protein (MTP) inhibitors are described. One of the more potent compounds, 8aR, inhibited both the secretion of apoB from Hep G2 cells and the MTP-mediated transfer of triglycerides between synthetic acceptor and donor liposomes with IC(50) values of 0.7 and 70 nM, respectively. In normolipidemic rats and dogs, oral administration of 8aR dose-dependently reduced both plasma triglycerides and total cholesterol. Moreover, in rats and dogs, 8aR also prevented the postprandial rise in plasma triglycerides following a bolus administration of a fat load. Because MTP inhibitors decrease very low density lipoprotein assembly in the liver, the potential for hepatic lipid accumulation was evaluated. In normolipidemic rats, hepatic cholesterol and triglyceride contents were dose-dependently increased by 8aR. However, hepatic lipid accumulation resulted in negligible change in total liver weight and was reversible after withdrawal of the compound.

Obesity in adults and children: a call for action

Obesity/overweight in adults and children is a worldwide health problem associated with substantial economic burden as measured by paid sick leave, life and disability insurance rates, and obesity-related physician visits and hospital stays. Overweight/obese people experience hypertension, elevated cholesterol, and type 2 diabetes and suffer more joint and mobility problems than people within the normal weight for height range. While there is need to understand individual behaviors that can be modified to promote weight loss and weight maintenance, there is as great a need to consider contextual factors at the societal level that can impede or even sabotage weight control efforts. In every country with improved living standards people will continue to eat too much and engage in too little physical activity. The call for action is for all modernized societies to alter environments and attitudes to support, rather than hinder, healthy dietary intake and being physically active.

Formal perceptual evaluation of voice quality in the United Kingdom

This document is a position statement on the formal perceptual evaluation of voice quality in the United Kingdom (UK). It addresses a number of clinical issues pertaining to the complexity of voice quality analysis. There is also a brief description of the three formal perceptual protocols most commonly used in the UK: The Vocal Profile Analysis (VPA), GRBAS and The Buffalo III Voice Profile. Potential clinical problems with perceptual voice quality evaluation are highlighted. Problems associated with the lack of defined terminology, limitless variety of voice quality, general lack of reliability data and difficulties in determining specificity and sensitivity are discussed. A practical guide for selecting an evaluation scheme is described. The conclusion is that the GRBAS scheme should be recommended as the absolute minimum standard for practising UK voice clinicians. However, there is a clear need to develop a more satisfactory perceptual rating scheme that is clinically realistic, theoretically sound, internationally acceptable and has proven reliability.

Intra-amygdala injection of the substance P [NK(1) receptor] antagonist L-760735 inhibits neonatal vocalisations in guinea-pigs

The involvement of the basolateral amygdala in mediating the inhibition of neonatal vocalisation by substance P (NK(1) receptor) antagonists was examined. These studies determined whether the time course for separation-induced vocalisations in guinea-pig pups coincided with NK(1) receptor internalisation (a marker of substance P release) in the amygdala, and whether vocalisations could be blocked by focal injection of the NK(1) receptor antagonist L-760735 into this brain region. The peak period for neonatal vocalisations occurred 5-10 min following maternal separation. This coincided with the peak increase in the number of cells in the basolateral amygdala exhibiting NK(1) receptor endocytosis, consistent with the proposal that substance P is released in the amygdala as a result of isolation stress. Focal injection of L-760735 (15 nmol per side) but not L-770765 (an analogue of L-760735 which has low NK(1) receptor affinity) into the basolateral amygdala attenuated separation-induced vocalisations. In contrast, injection of L-760735 (15 nmol per side) into the dorsal ventricular nucleus of the thalamus, a region with relatively low density of NK(1) receptors, had no effect on neonatal vocalisations. These findings are consistent with other evidence that the amygdala is one possible site of action for the inhibition of neonatal vocalisations by substance P antagonists.

Engineering American society: the lesson of eugenics

We stand at the threshold of a new century, with the whole human genome stretched out before us. Messages from science, the popular media, and the stock market suggest a world of seemingly limitless opportunities to improve human health and productivity. But at the turn of the last century, science and society faced a similar rush to exploit human genetics. The story of eugenics--humankind's first venture into a 'gene age'--holds a cautionary lesson for our current preoccupation with genes.

Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: from birth to 16 years

Moffitt's theory regarding two types of adolescent antisocial behavior was investigated using a prospective, longitudinal study of normal and abnormal development in a primarily low socioeconomic status, ethnically diverse sample. Results supported the presence of an early-onset/persistent (EOP) group and an adolescence-onset (AO) group. Groups were most reliably and significantly distinguished by indices of socioemotional history within the first 3 years, but no significant differences were found on early measures of temperament or neuropsychological functioning. EOPs scored significantly lower than other groups on measures of neuropsychological functioning only during late childhood and adolescence, suggesting that the declines in verbal functioning that have been so reliably found in this and other samples of early-starting antisocial adolescents are progressive and consequent to adverse experience. In adolescence, AOs were significantly more likely to report high levels of internalizing symptoms and life stress, suggesting that AO antisocial behavior is not a benign phenomenon. Implications of these findings for etiologic theories of adolescent antisocial behavior are discussed.

Validation of a single-item measure of usual physical activity

The purpose of this study was to assess the reliability and validity of a single-item measure of Usual Physical Activity and to assess its usefulness as a physical activity tool for perimenopausal women. 188 perimenopausal women participated (age: M = 47 yr., SD = 3; range = 40-55). Data were collected using the Women's Health Assessment Scale, the Physical Activity Questionnaire, the Perimenopause-related Quality of Life Scale, a health history and demographic questionnaire, and the rater. Scores were stable over a 2-wk. interval. Convergent validity was supported by a correlation of .66 between ratings on Usual Physical Activity and the Physical Activity Questionnaire. Concurrent validity was supported by the association of the rating of Usual Physical Activity with three parameters of Body Mass Index, psychosomatic symptoms, and perimenopause related quality of life, known to be associated with physical activity. Highly active women had a lower Body Mass Index than less active and inactive women. Active women tended to report fewer and less distressing psychosomatic symptoms and better quality of life. These findings support the use of rating of Usual Physical Activity to classify perimenopausal women into categories of physical activity.

Psychotic symptoms in posttraumatic stress disorder

Recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions. The presence of psychotic symptoms in PTSD is associated with a more severe level of psychopathology, similar to that of chronic schizophrenia. In this review, the differential diagnosis of psychotic symptoms in PTSD is discussed, including possible comorbid schizophrenia, psychotic depression, substance-induced psychosis, and personality disorder. A recent biologic study supporting the existence of a unique subtype of PTSD with psychotic features is also addressed, as are the similarities between PTSD with psychotic features and psychotic depression disorder. Finally, data on the treatment implications of psychotic symptoms in PTSD are presented. The intriguing recent findings on psychotic symptoms in PTSD need further investigation in noncombat-related PTSD populations before findings can be generalized to all individuals with PTSD.

Birthweight and infant mortality in Bulgaria's transition crisis

Between 1988 and 1991, years of political and economic crisis, Bulgaria reported a 25% increase in infant mortality. From 1991 to 1995, the rate then dropped slightly. Analysis of detailed unpublished vital statistics shows that the reported increase could not have been a result of more complete reporting of early neonatal mortality for very low-weight births. Old reporting practices continue unchanged. Rather, these statistics reveal an increase in the proportion of low-weight births, combined with rising death rates, particularly for low-weight births in the postneonatal period, but also for normal-weight babies.

Biomarkers of immunotoxicity in fish: from the lab to the ocean

Historically, host immunocompetence has been monitored using a battery of immune parameters. Recently, many of these same assays have been employed as biomarkers for predicting chemical-induced immunotoxicity in wildlife species. In this laboratory, assays measuring immunopathology, immune cell function, and host resistance against bacteria have been used successfully to assess immunotoxicity in laboratory-reared Japanese medaka (Oryzias latipes) and in feral fish populations. As an example of the latter, smallmouth bass collected from a PCB-contaminated site demonstrated significantly reduced phagocyte function and antioxidant activity compared to reference site fish. Taken together, these studies along with those from other investigators demonstrate the usefulness of immune assays as indicators to predict the toxicological risk associated with 'real-world' polluted aquatic environments.

Trajectories of fetal loss in the Czech Republic

Using data for 555,038 pregnancies conceived in the Czech Republic in 1987-1990, we show that pronounced differences in fetal survival in the middle trimester of pregnancy by marital status, educational level, and labor force attachment become much smaller at full term; survival differences by age at conception and number of previous deliveries show relatively constant proportional hazards throughout gestation. Social inequalities in postpartum life chances have been documented previously, but we show that similar inequalities exist before birth.

Targeted expression of human CuZn superoxide dismutase gene in mouse central nervous system

Copper zinc superoxide dismutase (CuZnSOD) is an important enzyme for the detoxification of reactive oxygen species. Particularly in the central nervous system (CNS), reactive oxygen species are often associated with acute brain injuries and chronic neurodegeneration. It has been demonstrated in vivo that there is an inverse correlation between CuZnSOD activity and neuronal death after acute brain injury. To further understand the protective role of CuZnSOD upon neurons, we have generated transgenic mouse lines with targeted expression of the human CuZnSOD gene (SOD1) that is driven by a rat neuron-specific enolase gene promoter in neurons of the CNS. The transgenic SOD1 expression was restricted to the CNS identified by reverse transcriptase polymerase chain reaction and SOD gel electrophoresis assays. The CuZnSOD activity was significantly increased in the brain stem of the transgenic mice. Immunostaining of human CuZnSOD activity showed that Purkinje cells in the cerebellar cortex were the most intensely stained neurons in the CNS of the transgenic mice.

Pharmacokinetic interactions between microemulsion formulated cyclosporine A and diltiazem in renal transplant recipients

OBJECTIVE

Bilateral cyclosporin A (CsA) and diltiazem pharmacokinetic interactions have previously been investigated, however, not with the new microemulsion preconcentrate formulation of CsA (Sandimmun Neoral). In addition, the pharmacokinetic effects on the pharmacological active metabolites of diltiazem have not previously been investigated. We performed a pharmacokinetic interaction study in renal transplant recipients, measuring both unmetabolised CsA and diltiazem in addition to three of the main metabolites of diltiazem (MA, M1, M2).

METHODS

Nine CsA-treated renal transplant patients were treated with diltiazem, 90-120 mg b.i.d., for 4 weeks. Pharmacokinetic investigations were performed both before and at the end of the diltiazem treatment period. Six non-CsA-treated renal transplant patients served as controls of CsA interactions with diltiazem and its metabolites.

RESULTS

Diltiazem treatment resulted in a significant mean increase in the area under the concentration time curve (AUC) for CsA of 51(8)% (P < 0.008) and a peak concentration (Cmax) of 34(8)% (P < 0.05), without altering time to peak concentration (tmax). CsA, however, did not significantly influence diltiazem pharmacokinetics, though two of the metabolites (M1 and M2) tended to be increased.

CONCLUSIONS

Diltiazem interacts significantly with the pharmacokinetics of CsA in the new microemulsion formulation. Microemulsion-formulated CsA, however, did not show significant interaction with diltiazem pharmacokinetics.

A simple and sensitive high-performance liquid chromatography assay of diltiazem and main metabolites in renal transplanted patients

A sensitive and specific reversed-phase high-performance liquid chromatographic method was developed for determination of the benzothiazepine calcium channel blocker diltiazem and three of its main metabolites in human plasma. A solid-phase extraction method (C18) is described for isolating diltiazem and the metabolites N-demethyl-diltiazem (M(A)), deacetyldiltiazem (M1) and N-demethyl-deacetyl-diltiazem (M2) from human plasma spiked with trans-diltiazem as internal standard. Chromatographic analysis of the eluate was accomplished using a reversed-phase column (C8) and a mobile phase consisting of acetonitrile, potassium dihydrogen phosphate-buffer (pH 2.9), triethylamine and methanol (280:598:2:90 v/v/v/v). The limit of detection was 5 ng/ml for diltiazem and 2.5 ng/ml for the metabolites (UV detection). Recoveries were > 75% for all substances. Precision analysis indicated a coefficient of variation below 5% for both diltiazem and metabolites at plasma concentrations ranging from 30 to 120 ng/ml for diltiazem and from 15 to 60 ng/ml for the metabolites. The accuracy was < 3% for diltiazem at all concentrations investigated. Metabolites showed an accuracy of < 7% at higher concentrations, however at low concentration the accuracy was < 16%. A pilot study has been performed in order to study whether the method was applicable to patients and volunteers. Plasma samples from renal transplanted patients treated with cyclosporin A and healthy volunteers did not show any interference by cyclosporin A with the determination of diltiazem and metabolites.

Low-weight neonatal survival paradox in the Czech Republic

Analysis of vital statistics for the Czech Republic between 1986 and 1993, including 3,254 infant deaths from 350,978 first births to married and single women who conceived at ages 18-29 years, revealed a neonatal survival advantage for low-weight infants born to disadvantaged (single, less educated) women, particularly for deaths from congenital anomalies. This advantage largely disappeared after the neonatal period. The same patterns have been observed for low-weight infants born to black women in the United States. Since the Czech Republic had an ethnically homogenous population, virtually universal prenatal care, and uniform institutional conditions for delivery, Czech results must be attributed to social rather than to biologic or medical circumstances. This strengthens the contention that in the United States, the black neonatal survival paradox may be due as much to race-related social stigmatization and consequent disadvantage as to any hypothesized hereditary influences on birth-weight-specific survival.

Onset and progression of motor deficits in motor neuron degeneration (mnd) mice are unaltered by the glycine/NMDA receptor antagonist L-701,324 or the MAO-B inhibitor R(-)-deprenyl

NMDA-mediated neurotoxicity and oxidative stress have been implicated in the etiology of a number of degenerative diseases including motor neuron disease. The present study examined the effect of chronic administration of the glycine/NMDA receptor antagonist L-701,324 and the monoamine oxidase B inhibitor (r)-deprenyl on the onset and rate of progression of neurological impairment in the motor neuron degeneration (mnd) mouse, a murine model of neurodegeneration. Neurological assessment of mnd mice revealed an onset of motor deficits at 6 months of age as observed by the loss of hindlimb reflex extension. By 7 months, balance was also markedly impaired as measured by deficits in rotarod performance and ability to remain on balancing beams. At 8 months of age mnd mice exhibited gross abnormalities in walking pattern; animals were unable to flex their hindlimbs and tended to walk in small labored movements. Daily administration of L-701,324 (10 mg/kg p.o.) or r(-)-deprenyl (1 mg/kg p.o.) to mnd mice from 4 to 8 months of age failed to delay the onset of symptoms or slow the rate of deterioration of motor performance. These findings suggest that excessive activation of NMDA receptors may not be involved in the pathological process leading to motor neuron dysfunction in mnd mice and do not suggest a protective effect of deprenyl on motor neurons in these mice.

Transgenic knockout mice exclusively expressing human hemoglobin S after transfer of a 240-kb betas-globin yeast artificial chromosome: A mouse model of sickle cell anemia

Sickle cell anemia (SCA) and thalassemia are among the most common genetic diseases worldwide. Current approaches to the development of murine models of SCA involve the elimination of functional murine alpha- and beta-globin genes and substitution with human alpha and betas transgenes. Recently, two groups have produced mice that exclusively express human HbS. The transgenic lines used in these studies were produced by coinjection of human alpha-, gamma-, and beta-globin constructs. Thus, all of the transgenes are integrated at a single chromosomal site. Studies in transgenic mice have demonstrated that the normal gene order and spatial organization of the members of the human beta-globin gene family are required for appropriate developmental and stage-restricted expression of the genes. As the cis-acting sequences that participate in activation and silencing of the gamma- and beta-globin genes are not fully defined, murine models that preserve the normal structure of the locus are likely to have significant advantages for validating future therapies for SCA. To produce a model of SCA that recapitulates not only the phenotype, but also the genotype of patients with SCA, we have generated mice that exclusively express HbS after transfer of a 240-kb betas yeast artificial chromosome. These mice have hemolytic anemia, 10% irreversibly sickled cells in their peripheral blood, reticulocytosis, and other phenotypic features of SCA.

Reversal of behavioural and electrophysiological correlates of experimental peripheral neuropathy by the NK1 receptor antagonist GR205171 in rats

In adult rats response latencies to innocuous mechanical stimuli were found to be reduced and, in electrophysiological studies, the receptive fields of dorsal horn neurones were enlarged 7-14 days after chronic constriction injury of the sciatic nerve. The NK1 receptor antagonist GR205171 at 3 mg kg(-1) blocked responses to NK1 agonist evoked activity and reversed the mechanical hypersensitivity following nerve ligation in behavioural assays. GR205171 also reversed the receptive field expansion of spinal dorsal horn neurones caused by loose ligation of the sciatic nerve in an electrophysiological assay in anaesthetised rats. The less active enantiomer L-796,325 did not block NK1 agonist evoked activity at up to 10 mg kg(-1) and had no effect on behavioural or electrophysiological changes following nerve injury, indicating that the effects of GR205171 were attributable to selective NK1 receptor blockade. These data suggest that NK1 receptor antagonists may be useful for the treatment of certain types of neuropathic pain.

Overexpression of SOD1 in transgenic rats protects vulnerable neurons against ischemic damage after global cerebral ischemia and reperfusion

Transient global cerebral ischemia resulting from cardiac arrest is known to cause selective death in vulnerable neurons, including hippocampal CA1 pyramidal neurons. It is postulated that oxygen radicals, superoxide in particular, are involved in cell death processes. To test this hypothesis, we first used in situ imaging of superoxide radical distribution by hydroethidine oxidation in vulnerable neurons. We then generated SOD1 transgenic (Tg) rats with a five-fold increase in copper zinc superoxide dismutase activity. The Tg rats and their non-Tg wild-type littermates were subjected to 10 min of global ischemia followed by 1 and 3 d of reperfusion. Neuronal damage, as assessed by cresyl violet staining and DNA fragmentation analysis, was significantly reduced in the hippocampal CA1 region, cortex, striatum, and thalamus in SOD1 Tg rats at 3 d, as compared with the non-Tg littermates. There were no changes in the hippocampal CA3 subregion and dentate gyrus, resistant areas in both SOD1 Tg and non-Tg rats. Quantitative analysis of the damaged CA1 subregion showed marked neuroprotection against transient global cerebral ischemia in SOD1 Tg rats. These results suggest that superoxide radicals play a role in the delayed ischemic death of hippocampal CA1 neurons. Our data also indicate that SOD1 Tg rats are useful tools for studying the role of oxygen radicals in the pathogenesis of neuronal death after transient global cerebral ischemia.

Altered surfactant homeostasis and alveolar type II cell morphology in mice lacking surfactant protein D

Surfactant protein D (SP-D) is one of two collectins found in the pulmonary alveolus. On the basis of homology with other collectins, potential functions for SP-D include roles in innate immunity and surfactant metabolism. The SP-D gene was disrupted in embryonic stem cells by homologous recombination to generate mice deficient in SP-D. Mice heterozygous for the mutant SP-D allele had SP-D concentrations that were approximately 50% wild type but no other obvious phenotypic abnormality. Mice totally deficient in SP-D were healthy to 7 months but had a progressive accumulation of surfactant lipids, SP-A, and SP-B in the alveolar space. By 8 weeks the alveolar phospholipid pool was 8-fold higher than wild-type littermates. There was also a 10-fold accumulation of alveolar macrophages in the null mice, and many macrophages were both multinucleated and foamy in appearance. Type II cells in the null mice were hyperplastic and contained giant lamellar bodies. These alterations in surfactant homeostasis were not associated with detectable changes in surfactant surface activity, postnatal respiratory function, or survival. The findings in the SP-D-deficient mice suggest a role for SP-D in surfactant homeostasis.

A cost measurement study for a tele-oncology practice

The costs of providing oncology services in three different ways were measured. Services were provided to a peripheral hospital by: conventional clinics, in which the oncologist worked at the hospital concerned; outreach clinics, in which an oncologist was flown in periodically from a central hospital; telemedicine clinics, in which the oncologist at the central hospital practised via a video-link. During a one-year study period, 2400 patients were seen in conventional clinics, 81 in outreach clinics and 103 in telemedicine clinics. At these workloads the average costs per patient were $149, $897 and $812, respectively. However, the average costs cannot be compared directly without further information about the shape of the unit cost curves.

In-frame elimination of exon 10 in Cftrtm1Unc CF mice

Cystic fibrosis (CF) is a severe autosomal-linked inherited disease in humans. Transgenic CF animals play a crucial role in the study of molecular mechanisms underlying disease pathology. In the present study, CFTR mRNA expression was examined in different tissues from one CF mouse model that contains a disruption in exon 10 sequence of the CF transmembrane conductance regulator (CFTR) gene. Multiple tissue samples were collected from new-born normal (+/+), homozygous (-/-), and heterozygous (+/-) mice and compared for their CFTR mRNA expression. Total RNA samples were prepared from eight different tissues (nasal mucosa, trachea, lung, colon, intestine, pancreas, liver, gonads, and brain) and then analyzed by reverse transcription polymerase chain reaction (RT-PCR) amplification. A 329-bp fragment comprising exon 9 through exon 11 of the CFTR gene was amplified from all tissues of the normal mouse. In contrast, a 137-bp fragment was observed in tissue samples from homozygous CF mice. Both the 329-bp and 137-bp fragments were detected in samples from heterozygous mice. Direct sequencing analysis of the amplified fragments showed an exon 9-exon 11 splice junction, indicating that the entire exon 10 sequence was eliminated from homozygous CF mice. RT-PCR analysis of the 3' end of CFTR mRNA showed the presence of a 682-bp, exon 20-24 fragment in -/- and +/- mice. These results demonstrate that an alternately spliced CFTR mRNA is produced in this CF 'knock-out' mouse. A semi-quantitative comparison of the wild-type and exon 10 minus CFTR (CFTR-E10) mRNA in heterozygote animals indicated that less (but a detectable amount) mutant CFTR mRNA was present in all organs tested. There was, however, a significant reduction of CFTR-E10 mRNA in the liver and the pancreas. Since the deletion of exon 10 is in-frame, the significance of the CFTR-E10 mRNA in terms of CFTR protein and function requires further analysis.

Edema formation exacerbates neurological and histological outcomes after focal cerebral ischemia in CuZn-superoxide dismutase gene knockout mutant mice

In a variety of studies. CuZn-superoxide dismutase (CuZn-SOD) has been shown to protect against ischemic brain injury. A possible role for CuZn-SOD-related modulation of neuronal viability has been suggested by the finding that CuZn-SOD inhibits brain edema formation following various kinds of neurological insults. We have evaluated the role of CuZn-SOD on brain edema formation following focal cerebral ischemia in mice bearing a disruption of the CuZn-SOD gene (Sod1). Homozygous mutants (Sod1-/-) had no detectable CuZn-SOD activity and heterozygous mutants (Sod1+/-) showed a 50% decrease compared to wild-type mice. Sod1-/- mice showed a high level of blood-brain barrier (BBB) disruption shortly after 1 hr of middle cerebral artery occlusion and 100% mortality at 24 hr following ischemia. Sod1+/- mice showed a moderate level of BBB disruption and 30% mortality. The Sod1+/- animals had increased infarct volume and brain swelling, accompanying exacerbated neurological deficits at 24 hr following ischemia. These results indicate the important role of superoxide anions in the development of brain edema after focal cerebral ischemia and suggest the possibility that brain edema formation may contribute to the exacerbation of ischemic brain injury and neurological deficits in knockout mutant mice.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a cluster of abdominal complaints frequently encountered in the primary setting. It is the most common gastrointestinal complaint seen in primary practice and accounts for 50% of referrals to gastroenterologists. Although the pathology of the disease currently is unclear, the diagnosis is not one of exclusion. When confronting this clinical syndrome of abdominal pain, bloating, flatulence, and changes in bowel habits, the clinician is called upon to balance the need to rule out organic causes with the expense and risk of testing. Optimally, the clinician can use established guidelines that clarify the most efficient approach to diagnosing and treating IBS, while providing the patient with the reassurance and education needed to deal with this chronic disease. This article deals with the pathophysiology, diagnosis, and management of IBS.

Aspects of voice quality: display, measurement and therapy

One approach to outcome measures for speech and language therapy is to display measures of the physical, acoustic, correlates of the perceptually salient features of the structure of speech. A difficulty with this approach is that there is no simple mapping of physical correlates onto speech percepts. In this workshop the physical measures of voice fundamental frequency and larynx contact quotient are explored in relation to the perception, analysis and treatment of aspects of voice quality in a speech and language therapy clinic. A fundamental principle is to analyse samples of continuous speech. The workshop will focus on clients with unilateral vocal fold paralysis.

Reduction of CuZn-superoxide dismutase activity exacerbates neuronal cell injury and edema formation after transient focal cerebral ischemia

Apoptotic neuronal cell death has recently been associated with the development of infarction after cerebral ischemia. In a variety of studies, CuZn-superoxide dismutase (CuZn-SOD) has been shown to protect the brain from ischemic injury. A possible role for CuZn-SOD-related modulation of neuronal viability is suggested by the finding that CuZn-SOD inhibits apoptotic neuronal cell death in response to some forms of cellular damage. We evaluated this possibility in the model of transient focal cerebral ischemia in mice bearing a disruption of the CuZn-SOD gene (Sod1). Homozygous mutant (Sod1 -/-) mice had no detectable CuZn-SOD activity, and heterozygous mutants (Sod1 +/-) showed a 50% decrease compared with wild-type mice. Sod1 -/- mice showed a high level of blood-brain barrier disruption soon after 1 hr of middle cerebral artery occlusion and 100% mortality at 24 hr after ischemia. Sod1 +/- mice showed 30% mortality at 24 hr after ischemia, and neurological deficits were exacerbated compared with wild-type controls. The Sod1 +/- animals also had increased infarct volume and brain swelling, accompanied by increased apoptotic neuronal cell death as indicated by the in situ nick-end labeling technique to detect DNA fragmentation and morphological criteria. These results suggest that oxygen-free radicals, especially superoxide anions, are an important factor for the development of infarction by brain edema formation and apoptotic neuronal cell death after focal cerebral ischemia and reperfusion.

A cost analysis of a tele-oncology practice

Costs were monitored for three different types of oncology practice: a telemedicine clinic and a fly-in outreach clinic, both held in rural areas, and a traditional clinic held in a city hospital. Total expenses were calculated over the year May 1995 to April 1996. The average cost per telemedicine visit was $812. The average cost per outreach clinic visit was $897. Flying in oncology support for this practice was therefore about 10% more costly than telemedicine. While the outreach cost may have been inappropriately high due to a slow start-up phase, it was still less expensive during this period to be seen via telemedicine. For comparison, the average cost per traditional oncology clinic visit was $149. However, this figure does not take into account the costs of access to a city-based service by rural patients.

Developmental abnormalities and age-related neurodegeneration in a mouse model of Down syndrome

To study the pathogenesis of central nervous system abnormalities in Down syndrome (DS), we have analyzed a new genetic model of DS, the partial trisomy 16 (Ts65Dn) mouse. Ts65Dn mice have an extra copy of the distal aspect of mouse chromosome 16, a segment homologous to human chromosome 21 that contains much of the genetic material responsible for the DS phenotype. Ts65Dn mice show developmental delay during the postnatal period as well as abnormal behaviors in both young and adult animals that may be analogous to mental retardation. Though the Ts65Dn brain is normal on gross examination, there is age-related degeneration of septohippocampal cholinergic neurons and astrocytic hypertrophy, markers of the Alzheimer disease pathology that is present in elderly DS individuals. These findings suggest that Ts65Dn mice may be used to study certain developmental and degenerative abnormalities in the DS brain.