Elastographic parameters of liver steatosis and fibrosis predict independently the risk of incident chronic kidney disease and acute myocardial infarction in patients with type 2 diabetes mellitus

AIMS

The aim of this prospective study was to examine the relationship between controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) with the risk of developing a composite endpoint inclusive of incident acute myocardial infarction (AMI), cerebrovascular insult (CVI) or chronic kidney disease (CKD) in people with type 2 diabetes mellitus (T2DM).

METHODS

This study included 238 T2DM outpatients without chronic liver diseases.

RESULTS

The patient population was followed for a median period of 7.6 years. Kaplan-Meier survival analyses showed that there was a higher proportion of patients who developed the aforementioned composite outcome (P < 0.001 by the log-rank test), as well as CKD (P < 0.001) or AMI alone (P = 0.014) among those with elevated CAP values (≥238 dB/m) at baseline. Similarly, Kaplan-Meier survival analyses showed that there was a higher proportion of patients who developed the composite outcome (P < 0.001), as well as CKD (P < 0.001), or AMI alone (P < 0.001) among those with elevated LSM values (≥7.0/6.2 kPa). In multivariable regression analyses, the presence of elevated CAP (adjusted-hazard ratio 2.34, 95% CI 1.32-4.15) and elevated LSM (adjusted-hazard ratio 2.84, 95% CI 1.92-4.21), independently of each other, were associated with a higher risk of developing the composite outcome, as well as incident AMI or CKD alone after adjusting for traditional cardiovascular risk factors and diabetes-related variables.

CONCLUSIONS

Our study shows that the elastographic parameters of liver steatosis and fibrosis independently predict the long-term risk of developing chronic vascular complications in T2DM patients.

Significant liver fibrosis, as assessed by fibroscan, is independently associated with chronic vascular complications of type 2 diabetes: A multicenter study

AIMS

The aim of this study was to investigate whether controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as assessed by vibration-controlled transient elastography (VCTE), are associated with chronic vascular complications of diabetes mellitus type 2 (T2DM).

METHODS

We studied 442 outpatients with established T2DM, and who underwent VCTE and extensive assessment of chronic vascular complications of diabetes.

RESULTS

A quarter of analyzed patients had a previous history of myocardial infarction and/or ischemic stroke, and about half of them had at least one microvascular complication (chronic kidney disease (CKD), retinopathy or polyneuropathy). The prevalence of liver steatosis (i.e., CAP ≥ 238 dB/m) and significant liver fibrosis (i.e., LSM ≥ 7.0/6.2 kPa) was 84.2% and 46.6%, respectively. Significant liver fibrosis was associated with an increased likelihood of having myocardial infarction (adjusted-odds ratio 6.61, 95%CI 1.66-37.4), peripheral polyneuropathy (adjusted-OR 4.55, 95%CI 1.25-16.6), CKD (adjusted-OR 4.54, 95%CI 1.24-16.6) or retinopathy (adjusted-OR 1.81, 95%CI 1.62-1.97), independently of cardiometabolic risk factors, diabetes-related variables, and other potential confounders. Liver steatosis was not independently associated with any macro-/microvascular diabetic complications.

CONCLUSIONS

Significant liver fibrosis is strongly associated with the presence of macro-/microvascular complications in patients with T2DM. These results offer a new perspective on the follow-up of people with T2DM.

CAMP@FLASH: an end-station for imaging, electron- and ion-spectroscopy, and pump-probe experiments at the FLASH free-electron laser

The non-monochromatic beamline BL1 at the FLASH free-electron laser facility at DESY was upgraded with new transport and focusing optics, and a new permanent end-station, CAMP, was installed. This multi-purpose instrument is optimized for electron- and ion-spectroscopy, imaging and pump-probe experiments at free-electron lasers. It can be equipped with various electron- and ion-spectrometers, along with large-area single-photon-counting pnCCD X-ray detectors, thus enabling a wide range of experiments from atomic, molecular, and cluster physics to material and energy science, chemistry and biology. Here, an overview of the layout, the beam transport and focusing capabilities, and the experimental possibilities of this new end-station are presented, as well as results from its commissioning.

Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial

BACKGROUND/OBJECTIVES

There is substantial evidence of superiority of enteral nutrition (EN) to parenteral nutrition in acute pancreatitis (AP) treatment, but few studies evaluated its effectiveness compared to no intervention. The objective of our trial was to compare the effects of EN to a nil-by-mouth (NBM) regimen in patients with AP.

METHODS

Patients with AP were randomized to receive either EN via a nasojejunal tube initiated within 24 h of admission or no nutritional support. Systemic inflammatory response syndrome (SIRS) was assessed as the primary outcome. Secondary outcomes included mortality, organ failure, local complications, infected pancreatic necrosis, surgical interventions, length of hospital stay, adverse events and inflammatory response intensity. Outcomes were compared using Student's t-test and Mann-Whitney U test as appropriate.

RESULTS

214 patients were randomized in total, 107 to each group. SIRS occurrence was similar between groups, with 48 (45%) versus 51 (48%), respectively (RR 0.94; 95% CI 0.71-1.26). No significant reduction of persistent organ failure (RR 0.81; 95% CI 0.52-1.27) and mortality (RR 0.59; 95% CI 0.28-1.23) was present in the EN group. There were no significant differences in other outcomes between the groups. When analyzing the occurrence of SIRS and mortality in subgroup of patients with severe disease no significant differences were noted.

CONCLUSION

Our results showed no significant reduction of persistent organ failure and mortality in patients with AP receiving early EN compared to patients treated with no nutritional support (NCT01965873).

Nanoscale spin reversal by non-local angular momentum transfer following ultrafast laser excitation in ferrimagnetic GdFeCo

Ultrafast laser techniques have revealed extraordinary spin dynamics in magnetic materials that equilibrium descriptions of magnetism cannot explain. Particularly important for future applications is understanding non-equilibrium spin dynamics following laser excitation on the nanoscale, yet the limited spatial resolution of optical laser techniques has impeded such nanoscale studies. Here we present ultrafast diffraction experiments with an X-ray laser that probes the nanoscale spin dynamics following optical laser excitation in the ferrimagnetic alloy GdFeCo, which exhibits macroscopic all-optical switching. Our study reveals that GdFeCo displays nanoscale chemical and magnetic inhomogeneities that affect the spin dynamics. In particular, we observe Gd spin reversal in Gd-rich nanoregions within the first picosecond driven by the non-local transfer of angular momentum from larger adjacent Fe-rich nanoregions. These results suggest that a magnetic material's microstructure can be engineered to control transient laser-excited spins, potentially allowing faster (~ 1 ps) spin reversal than in present technologies.

Fractal morphology, imaging and mass spectrometry of single aerosol particles in flight

The morphology of micrometre-size particulate matter is of critical importance in fields ranging from toxicology to climate science, yet these properties are surprisingly difficult to measure in the particles' native environment. Electron microscopy requires collection of particles on a substrate; visible light scattering provides insufficient resolution; and X-ray synchrotron studies have been limited to ensembles of particles. Here we demonstrate an in situ method for imaging individual sub-micrometre particles to nanometre resolution in their native environment, using intense, coherent X-ray pulses from the Linac Coherent Light Source free-electron laser. We introduced individual aerosol particles into the pulsed X-ray beam, which is sufficiently intense that diffraction from individual particles can be measured for morphological analysis. At the same time, ion fragments ejected from the beam were analysed using mass spectrometry, to determine the composition of single aerosol particles. Our results show the extent of internal dilation symmetry of individual soot particles subject to non-equilibrium aggregation, and the surprisingly large variability in their fractal dimensions. More broadly, our methods can be extended to resolve both static and dynamic morphology of general ensembles of disordered particles. Such general morphology has implications in topics such as solvent accessibilities in proteins, vibrational energy transfer by the hydrodynamic interaction of amino acids, and large-scale production of nanoscale structures by flame synthesis.

Nanoplasma dynamics of single large xenon clusters irradiated with superintense x-ray pulses from the linac coherent light source free-electron laser

The plasma dynamics of single mesoscopic Xe particles irradiated with intense femtosecond x-ray pulses exceeding 10(16)  W/cm2 from the Linac Coherent Light Source free-electron laser are investigated. Simultaneous recording of diffraction patterns and ion spectra allows eliminating the influence of the laser focal volume intensity and particle size distribution. The data show that for clusters illuminated with intense x-ray pulses, highly charged ionization fragments in a narrow distribution are created and that the nanoplasma recombination is efficiently suppressed.

Femtosecond dark-field imaging with an X-ray free electron laser

The emergence of femtosecond diffractive imaging with X-ray lasers has enabled pioneering structural studies of isolated particles, such as viruses, at nanometer length scales. However, the issue of missing low frequency data significantly limits the potential of X-ray lasers to reveal sub-nanometer details of micrometer-sized samples. We have developed a new technique of dark-field coherent diffractive imaging to simultaneously overcome the missing data issue and enable us to harness the unique contrast mechanisms available in dark-field microscopy. Images of airborne particulate matter (soot) up to two microns in length were obtained using single-shot diffraction patterns obtained at the Linac Coherent Light Source, four times the size of objects previously imaged in similar experiments. This technique opens the door to femtosecond diffractive imaging of a wide range of micrometer-sized materials that exhibit irreproducible complexity down to the nanoscale, including airborne particulate matter, small cells, bacteria and gold-labeled biological samples.

Femtosecond free-electron laser x-ray diffraction data sets for algorithm development

We describe femtosecond X-ray diffraction data sets of viruses and nanoparticles collected at the Linac Coherent Light Source. The data establish the first large benchmark data sets for coherent diffraction methods freely available to the public, to bolster the development of algorithms that are essential for developing this novel approach as a useful imaging technique. Applications are 2D reconstructions, orientation classification and finally 3D imaging by assembling 2D patterns into a 3D diffraction volume.

Time-resolved protein nanocrystallography using an X-ray free-electron laser

We demonstrate the use of an X-ray free electron laser synchronized with an optical pump laser to obtain X-ray diffraction snapshots from the photoactivated states of large membrane protein complexes in the form of nanocrystals flowing in a liquid jet. Light-induced changes of Photosystem I-Ferredoxin co-crystals were observed at time delays of 5 to 10 µs after excitation. The result correlates with the microsecond kinetics of electron transfer from Photosystem I to ferredoxin. The undocking process that follows the electron transfer leads to large rearrangements in the crystals that will terminally lead to the disintegration of the crystals. We describe the experimental setup and obtain the first time-resolved femtosecond serial X-ray crystallography results from an irreversible photo-chemical reaction at the Linac Coherent Light Source. This technique opens the door to time-resolved structural studies of reaction dynamics in biological systems.

In vivo protein crystallization opens new routes in structural biology

Protein crystallization in cells has been observed several times in nature. However, owing to their small size these crystals have not yet been used for X-ray crystallographic analysis. We prepared nano-sized in vivo-grown crystals of Trypanosoma brucei enzymes and applied the emerging method of free-electron laser-based serial femtosecond crystallography to record interpretable diffraction data. This combined approach will open new opportunities in structural systems biology.

Self-terminating diffraction gates femtosecond X-ray nanocrystallography measurements

X-ray free-electron lasers have enabled new approaches to the structural determination of protein crystals that are too small or radiation-sensitive for conventional analysis¹. For sufficiently short pulses, diffraction is collected before significant changes occur to the sample, and it has been predicted that pulses as short as 10 fs may be required to acquire atomic-resolution structural information^1-4. Here, we describe a mechanism unique to ultrafast, ultra-intense X-ray experiments that allows structural information to be collected from crystalline samples using high radiation doses without the requirement for the pulse to terminate before the onset of sample damage. Instead, the diffracted X-rays are gated by a rapid loss of crystalline periodicity, producing apparent pulse lengths significantly shorter than the duration of the incident pulse. The shortest apparent pulse lengths occur at the highest resolution, and our measurements indicate that current X-ray free-electron laser technology⁵ should enable structural determination from submicrometre protein crystals with atomic resolution.

Radiation damage in protein serial femtosecond crystallography using an x-ray free-electron laser

X-ray free-electron lasers deliver intense femtosecond pulses that promise to yield high resolution diffraction data of nanocrystals before the destruction of the sample by radiation damage. Diffraction intensities of lysozyme nanocrystals collected at the Linac Coherent Light Source using 2 keV photons were used for structure determination by molecular replacement and analyzed for radiation damage as a function of pulse length and fluence. Signatures of radiation damage are observed for pulses as short as 70 fs. Parametric scaling used in conventional crystallography does not account for the observed effects.

Biosocial and nutritional effects on body composition in young adults from Wrocław, Poland

This work concerns the questions if and to what extent social variables past and present, and actual sports activity and nutritional and smoking habits, have an influence on body compartment indices, and how this differs between female and male medical students from Wrocław, Poland. Backward stepwise regression was applied to four dependent variables, i.e. Body Mass Index (BMI), %Fat Mass (%FM), Extracellular Water/Intracellular Water Index (100 x ECW/ICW) and Body Cell Mass Index (BCMI=BCM/height2), and for eighteen independent variables including nutrition, parents' social status, smoking and sports activity. Females ate meat less frequently and fruit and vegetables more often, and drank beer less frequently but milk more often than did male students. It seems that there exists some effect on fat accumulation resulting from difference in nutrition between females and males. The results may be interpreted in terms of a parental gender effect on body composition of children associated with different conditions of life and nutrition in childhood and youth for female and male students in Wrocław.

Aging with quality of life--a challenge for society

This article focus on biological, nutritional, psychological, medical and social variables which have proven useful indicators for assessing wellbeing of individuals. Such objective data (measured by the two investigators) and subjective information (self-reported by the participants) were collected between 2002-2003 from samples of healthy, free living females and males aged between 59 and 92 years from Vienna and surroundings. In both these groups some habitual practices (habit variables) were observed of elderly and old which have a negative influence on health i.e low daily liquid uptake and smoking. There is also a fair amount of overweight and obesity (BMI>or=30) and also of hypertension, particularly in males, There is also malnourishment, predominantly in females, as reflected by the Body Cell Mass Index. Several participants either were not aware of being hypertensive or admitted that they deliberately ignored medical advice. With respect to social variables there are greater percentages of married males and widowed females. Possibly partially resulting from this loss of the partner a greater number of females report feelings of loneliness than do males. Positive results relate to the overall high percentages of family contacts, positive feelings towards life and physical activity as reported by the large majority of the participants. These findings stress the need for further information of living habits of the elderly and old as a possible guide of helping improve their quality of life.

Body composition characteristics are associated with the bone density of the proximal femur end in middle- and old-aged women and men

OBJECTIVES

In the present study the associations between bone density of the proximal femur end and weight status, fat distribution patterns (FDI) and body composition parameters i.e. amount of body fat and lean body mass were tested in a sample of old aged women and men.

METHODS

In 77 healthy women ranging in age from 60 to 92 years (x=71.8 years) and 62 healthy men ranging in age from 60 to 86 years (x=71.5 years) the bone mineral density (BMD of the proximal femur end and the body composition parameters absolute fat mass, relative fat mass, lean body mass and bone mineral content were estimated by dual energy X-ray absorptiometry. Additionally, the weight status (body mass index, BMI) and the FDI were calculated. The bone density of the proximal femur end was correlated with the absolute fat mass and the lean body mass as well as with the BMI and the FDI.

RESULTS

BMD correlated in females significantly positively with parameters of body composition, in males no significant correlations between fat mass (absolute and relative) and BMD as well as BMD/stature was found. Furthermore, it was shown that the weight status (BMI; r(2)=0.13, P<0.0003 in males and r(2)=0.27, P<0.000 in females), and the lean body mass (r(2)=0.21, P<0.001 in males, r(2)=0.36, P<0.004 in females) were associated significantly positively with the BMD of the proximal femur end in both sexes. The absolute fat mass had a significant impact on BMD in the female subsample only (r(2)=0.24, P<0.000).

CONCLUSIONS

A lower weight status and a low amount of lean body mass, indicating not only lack of biomechanical forces of the proximal femur end, but also a lack of physical activity can be assumed to be associated increased bone loss and the development of osteoporosis in both sexes. An association between low amount of fat tissue and decreased BMD was especially found in women and may be due to the reduced conversion rates from androgens to estrogens in a low amount of fat tissue.

[Significance of body weight status for bone density in the elderly and very old]

Reduced bone density and osteoporosis are significant health problems and contributors to disability and mortality among older women and men. Therefore the decline of bone mineral content (BMC) and bone mineral density (BMD) are aspects of ageing with great medical and social significance. In recent years a low body weight was declared to be an important risk factor for the development of osteoporosis. In the present study the impact of weight status, defined by the categories of the WHO, on BMC of the whole body and BMD of the proximal femur end, determined by dual energy x-ray absorptiometry (DEXA), were studied in 77 female and 62 male probands aged between 60 and 92 years (x = 71.7 yrs). With increasing weight status (BMI categories), BMC and BMD increased significantly (p < 0.001). This was true of both sexes. Even moderate overweight women and men (BMI 25.0-29.99) showed a significantly higher bone density than their normal weight counterparts (BMI < 25.0). In the present study a marked positive impact of body weight on bone density of old-aged women and men could be shown.

Clinical outcome of microsurgical subinguinal varicocelectomy in infertile men

The present study assesses the clinical outcome of microsurgical subinguinal varicocelectomy in infertile men, especially with regard to sperm count, motility and fertility. Between June 1990 and October 1998, 272 patients had subinguinal microsurgical varicocelectomy operations for clinical varicoceles, and their long-term results were assessed. In nearly all the patients there was a significant improvement in sperm count and sperm motility after 3 and 6 months. Very few complications arose from this procedure. We concluded that microsurgical subinguinal varicocelectomy is an effective treatment for clinical varicoceles in infertile men. The significant improvement in the quality of spermatozoa, the low complication rates and the remarkably high pregnancy rates make this a valuable alternative to in vitro reproduction techniques.

Milk consumption, smoking and lead concentration in human hair

Trace elements in hair samples were examined in 79 medical and sports students in Vienna and 77 biology students in Rome (ages 19-31 years). Lead concentration was determined by inductively coupled plasma mass spectrometry. The effect of smoking on lead levels is confirmed. Those who consume milk and dairy products daily show a lower lead concentration than those who consume them occasionally, both overall and in smokers and non-smokers. The effects of milk consumption and smoking appear to be independent. It seems that smokers may not enjoy the protective effect of milk consumption to the same extent as non smokers.

A qualitative approach to assessing body compartments using bioelectrical variables

A total of twelve subsamples of healthy European adults (207 males, 208 females) and Ecuadorian school children (300 males, 300 females) were studied with regard to their normal balance of body composition by calculating their bioelectrical values measured by a Phase-Sensitive Impedance Analyzer (BIA 101, Akern s.r.l., Florence, Italy). The method involved bivariate analysis of reactance and phase angle and the associated Bioelectrical nomogram (i.e. 'Biagram') which gives valuable information on the ratio of extra-cellular to body cell masses and confirmed that the vast majority of the subjects were in good physical condition. The few cases of outliers were attributable to slight dehydration after excessive physical activity in the adult sample or to slight overhydration or malnutrition in the child sample. The results of the qualitative approach in various areas of assessment of body composition in healthy and diseased subjects implies its usefulness as a tool in epidemiological studies.

Bioelectrical impedance analysis and anthropometry in Ecuadorian children of African ancestry

In the city of Esmeraldas, north-western coast of Ecuador, height, weight, and body composition of 600 male and female schoolchildren of African ancestry in the age groups four, five and six years were investigated. All the children were apparently healthy without any obvious or reported pathologies and in accordance with data from personal information were assigned to one of two socio-economic classes. The greater values for weight and height shown by children in the higher socio-economic group than in the less well off are compatible with those for more fat and water as obtained by the BIA investigation. Additional information on nutritional, muscular and general health status was obtained from positioning and degree of dispersion of the 'Biagram' ellipses. It seems that both the anthropometric and the bioelectrical impedance methods provide useful information on the differences due to belonging to one or other of the socio-economic groups.

Body composition characteristics after menopause

The effect of menstrual and reproductive history on body fat development after postmenopause was investigated in 278 healthy females aged between 44 and 67 years (x = 55.8 yrs). The absolute and relative amount of body fat was determined by means of dual energy x-ray absorptiometry. Significant associations between body fat after menopause and age at menarche, age at menopause, and average cycle length were observed. Furthermore the age at first as well as at last birth and the weight gain during pregnancies were related significantly with body fat after menopause. Overweight (BMI > 25.0) during postmenopause was significantly associated with an early menarche, a late menopause, an early first birth and a higher weight gain during pregnancies.

Early evolutionary origin of the neurotrophin receptor family

Neurotrophins and their Trk receptors play a crucial role in the development and maintenance of the vertebrate nervous system, but to date no component of this signalling system has been found in invertebrates. We describe a molluscan Trk receptor, designated Ltrk, from the snail Lymnaea stagnalis. The full-length sequence of Ltrk reveals most of the characteristics typical of Trk receptors, including highly conserved transmembrane and intracellular tyrosine kinase domains, and a typical extracellular domain of leucine-rich motifs flanked by cysteine clusters. In addition, Ltrk has a unique N-terminal extension and lacks immunoglobulin-like domains. Ltrk is expressed during development in a stage-specific manner, and also in the adult, where its expression is confined to the central nervous system and its associated endocrine tissues. Ltrk has the highest sequence identity with the TrkC mammalian receptor and, when exogenously expressed in fibroblasts or COS cells, binds human NT-3, but not NGF or BDNF, with an affinity of 2.5 nM. These findings support an early evolutionary origin of the Trk family as neuronal receptor tyrosine kinases and suggest that Trk signalling mechanisms may be highly conserved between vertebrates and invertebrates.

A substance P (neurokinin-1) receptor mutant carboxyl-terminally truncated to resemble a naturally occurring receptor isoform displays enhanced responsiveness and resistance to desensitization

Two isoforms of the substance P (SP) receptor, differing in the length of the cytoplasmic carboxyl-terminus by approximately 8 kDa, have been detected previously in rat salivary glands and other tissues. The binding and functional properties of these two isoforms have been investigated using full-length (407 amino acids) and carboxyl-terminally truncated (324 amino acids) rat SP receptors transfected stably into Chinese hamster ovary cells. Both the full-length and the truncated receptor bound radiolabeled SP with a similar Kd ( approximately 0.1 nM). The average number of high affinity SP binding sites per cell was 1.0 x 10(5) and 0.3 x 10(5) for the full-length and the truncated SP receptor, respectively. In both cell lines, SP induced a rapid but transient increase in cytosolic calcium concentration ([Ca2+]i), which consisted of the release of Ca2+ from intracellular stores and the influx of extracellular Ca2+. Both components are dependent on phospholipase C activation. Although the full-length and the truncated receptor utilize the same calcium pathways, they differ in their EC50 values (0.28 nM for the full-length; 0.07 nM for the truncated). These differences in responsiveness may be related to the observed differences in receptor desensitization. The truncated receptor, in contrast to the full-length receptor, does not undergo rapid and long-lasting desensitization. Cells possessing the short isoform of the SP receptor would thus be expected to exhibit a prolonged responsiveness.

[Decision to use complementary medicine: fact oriented or irrational?]

PROBLEM AND OBJECTIVE

Complementary medicine is being used to varying extent in all industrial countries. There are incomplete data concerning efficacy, safety and costs of such treatment, while little is known about special features and motivation of those persons who choose complementary medicine. The aim of the study was to ascertain, among patients who use complementary medicine and those who prefer traditional medicine, any differences with regard to sociodemographic, disease-related and psychological characteristics and their life-style.

PATIENTS AND METHODS

A total of 419 patients were studied by a standardised interview and questionnaire (168 items) and divided into two groups (group 1: those using conventional treatment [n - 197; 91 women, 106 men; average age 43.2 +/- 16.9 years]; group 2: those preferring complementary medicine [n = 222; 159 women, 63 men; average age 43.2 +/- 15.0 years]). They were recruited from specialist internal medical or generalist medical practice with or without offer of complementary medicine (additional term: natural healing methods). Statistical analysis was with Student's-t-test and the chi(2)-test [correction of gamma-test].

RESULTS

Those patients who chose to be treated by complementary medicine clearly differed from the others with respect to sociodemographic, disease-related and psychological characteristics, as well as life-style. The patient-doctor relationship also differed between the two groups. On average those of group 2 had a higher educational level (higher education: 10.3% in group 1; 15.9 in group 2) and lower risk factors (68.9% nonsmokers in group 1, 77.8% in group 2; alcohol abstinence: 33.2 vs 46.4%). Patients in both groups preferred conventional medicine for serious diseases (cardiac infarct; tumour; AIDS).

CONCLUSIONS

In general, those patients who choose complementary medicine have a healthier life-style. As the number of these patients is on the increase. Since as yet the efficacy, risks and costs of complementary medicine have been inadequately investigated, research in this area should be intensified.

Phospholipids inhibit proteolysis of protein kinase C alpha by mM calcium-requiring calpain

The alpha isoform of protein kinase C (PKC alpha) is rapidly hydrolyzed by mM Ca(2+)-requiring calpain (calcium-activated neutral proteinase) under cell-free conditions (Shea et al, 1994, FEBS Lett. 350:223). In the present study, we demonstrate that this hydrolysis is inhibited by phosphatidyl serine, diacylglycerol, phosphatidyl choline, phosphatidyl inositol, and phosphatidic acid. With the exception of phosphatidic acid, these phospholipids did not directly inhibit calpain activity as evidenced by degradation of [14C]azocasein, suggesting that the nature of inhibition of calpain-mediated PKC alpha degradation is due to an effect of phospholipids on PKC alpha conformation. These findings suggest that m calpain-mediated PKC alpha hydrolysis may be specifically minimized at the plasma membrane, and leave open the possibility that such a mechanism exists in situ. In addition, the unique inhibition of calpain activity by phosphatidic acid suggests the existence of a specific mechanism by which this phospholipid regulates PKC alpha activity.

Secular change in height in Austria: an effect of population stratification?

The records of height on some 700,000 18-year-old Austrian males, called for examination as to their fitness for conscription, were analysed. The data covered 14 conscription years (1980-93), representing males born in the years 1962-75. The sample covered over 90% of the total male population of those cohorts in Austria. The data were analysed by birth year to show the secular trend in 18-year-old stature and its rate, which overall amounted to 0.53 cm/decade. Analysis by urban-rural residence showed that both participated in the trend, but that the urban-rural differences were appreciably less than the differences between the types of school the young men had attended. The rate of increase over the 14 years was less within each of the eight subgroups (urban-rural, four school categories). It is argued that the secular trend in height that has occurred is largely attributable to the change in social stratification, as evidenced by the changed proportion of subjects who attended schools of different types.

Heavy metal concentration in hair of students in Rome

The levels of five heavy metals (As, Cr, Co, Ni, Pb) in scalp hair were measured in 20 male and 20 female biology students of Rome. Female levels were generally higher except for arsenic and chromium. Sex and smoking resulted most important for heavy metal concentration in hair. Thus smokers show significantly higher levels of lead and slightly increased levels of cadmium, cobalt and nickel.

Psychosocial needs of family caregivers of terminally ill patients

The primary caregivers (mean age = 63 yr.) of 28 terminally ill veterans (mean age = 67 yr.) who were living at home were surveyed for their concrete and psychosocial needs. The caregivers also completed the Beck Depression Inventory, the Life Satisfaction Index, the Provision of Social Relations scale, and the Burden Inventory. The rank order of concrete and psychosocial needs is reported for these caregivers. Increased scores on depression were associated with decreased life satisfaction as was low social support. Not surprisingly, higher numbers of concrete and psychosocial needs were associated with increases in depression.

Heavy metals in human hair samples from Austria and Italy: influence of sex and smoking habits

Hair samples from 79 young healthy adults from Vienna (Austria) and Rome (Italy) were analyzed for As, Cd, Co, Cr, Ni and Pb by ICP-MS. No differences were found between the two locations except for chromium, which was significantly higher in the Viennese population (P < 0.001). In both cities male hair contained higher arsenic (P < 0.001) and lower cadmium (P < 0.05) levels than female hair, and in Vienna lead concentrations were lower in males (P < 0.05). Striking differences appeared when smokers were compared with non-smokers. Geometric means (micrograms/g) of smokers versus non-smokers were: arsenic 0.081 vs. 0.065, cadmium 0.075 vs. 0.038 (P < 0.05), cobalt 0.025 vs. 0.010 (P < 0.05), chromium 0.84 vs. 0.72 (P < 0.05), lead 3.42 vs. 1.47 (P < 0.001) and nickel 0.64 vs. 0.32 (P < 0.005). Consideration of a large number of biological and behavioural factors minimizes bias inherent in unmatched sample composition.

Complementary chromatographic analysis of free diacylglycerols and potential glycerophospholipid precursors in human SH-SY5Y neuroblastoma cells following incubation with lithium chloride

We performed detailed chromatographic analyses on the molecular species of the major glycerophospholipids (GPLs) and free sn-1,2-diacylglycerols (DAGs) from SH-SY5Y human neuroblastoma cells following incubation with or without LiCl. For this comparison the inositol, choline, ethanolamine and serine GPLs were dephosphorylated with phospholipase C and the released sn-1,2-diacylglycerols along with the DAGs were subjected to high-temperature GLC on polar and non-polar capillary columns as their trimethylsilyl and tert.-butyl-dimethylsilyl ethers. A 30-min incubation with 10 mM LiCl increased the total amount of human neuroblastoma DAGs by 32-58% (P < 0.05) to 2.6 pmol/micrograms cell protein. This was accompanied by a limited qualitative shift in the molecular species pattern, the most obvious of which was the increase (13%) in the major saturated-polyunsaturated molecular species and the ca. 46% increase in the minor 18:1-18:1 species over control levels. The DAGs originated mainly from the inositol GPLs (IGPLs), as indicated by the high levels of the characteristic 18:0-20:4n6 (18:0-20:3n9) species in both IGPLs and DAGs, and to a lesser extent from the choline GPLs (CGPLs), as indicated by the high proportion in CGPLs of the oligoenoic species, which were largely absent from IGPLs. Alkenylacylglycerols were not detected in DAGs, although they made up some 60% of the total ethanolamine GPLs (EGPLs). No significant changes in the molecular species composition of the cellular GPLs, including IGPLs, were detected after exposure to LiCl.

Brief communication: the skull attributed to Mozart--craniosynostosis or not?

The results of a detailed morphological analysis of the skull attributed to Mozart are presented which refute a recent claim that the skull as well as several of Mozart's portraits show indications of uncomplicated trigonocephaly. These indications according to the present analysis are within the limits of normal variation and derive from retention of part of the long arm of the anterior fontanelle.

Alterations in the metabolism of choline-containing phospholipids by lithium and carbachol in SH-SY5Y neuroblastoma cells

To investigate choline phospholipid metabolism in the human neuroblastoma cell line SH-SY5Y, cultures labeled with [14C-methyl]choline were incubated for up to 30 min in Krebs-Ringer-glucose-N-2-hydroxyethyl-piperazine-N1-2-ethane sulfonic acid (HEPES) buffer with or without 10 mmol/L LiCl. When desired, 1 mmol/L of the muscarinic agonist carbamoylcholine was present during the last minute of incubation. When cells were exposed for 10 min to lithium, radioactivity in phosphatidylcholine, lysophosphatidylcholine, and sphingomyelin was 40%-140% higher than in controls incubated in buffer only. This contrasted with the results from carbamoylcholine-containing incubations, which gave radioactivities lower than or equal to controls. Carbamoylcholine added to the LiCl-containing incubations yielded results only minimally different from LiCl alone. Phosphorylcholine radioactivity was also elevated by about 50% after 10 min incubation with LiCl with or without added carbamoylcholine, but was not increased in incubations with the agonist by itself. Similar changes were observed for intracellular choline but after only 5 min. These data suggest that carbamoylcholine does not stimulate phosphatidylcholine degradation, whereas LiCl can significantly affect its metabolism and may affect signal transduction via second messengers in human neuroblastoma cells.

Molecular species of glycerophospholipids and diacylglycerols of cultured SH-SY5Y human neuroblastoma cells

Total lipid extracts were obtained from SH-SY5Y human neuroblastoma cells grown to confluency in mycoplasma-free 10% fetal calf serum. The major glycerophospholipid classes and free diacylglycerols (DAG) were isolated and quantitated by silicic acid and DEAE-cellulose column and thin-layer chromatography. The choline (CGPL), ethanolamine (EGPL), serine (SGPL), and inositol (IGPL) glycerophospholipids were converted to the corresponding diradylglycerols by phospholipase C. The molecular species of the diradylglycerols were determined by capillary gas-liquid chromatography of the trimethylsilyl or t-butyldimethylsilyl ethers. The CGPL was rich in the oligoenoic species and IGPL was rich in the polyenoic species, especially the 18:0-20:4(n-6). The EGPL contained 30-40% diacyl, 60-64% alkenylacyl, and 1-3% alkylacyl species, which were also rich in polyenoic derivatives. Small amounts of alkenylacyl species were detected also in CGPL. The cellular DAG possessed a molecular species composition halfway between those of the DAG moieties of CGPL and IGPL. The cells grown in the presence of 10% calf serum exhibited great variability in the content of 20:3(n-9) fatty acid, which was found to substitute for the 20:4(n-6) acid in the molecular species with 18:0 in both IGPL and DAG. The 20:3(n-9) was largely absent from the CGPL, but occurred also in EGPL, where it was preferentially associated with 18:0 in the diacyl but with 18:1 in the alkylacyl and alkenylacyl species. The detailed documentation of molecular species of glycerophospholipids of the neuroblastoma cells offers new opportunities for identification of the source of free DAG released in transmembrane signalling.

Elevated phosphatidyl-CMP is not the source of diacylglycerol accumulation induced by lithium in NG108-15 cells

Previous studies have shown that in the neuroblastoma x glioma hybrid cell line NG108-15 lithium is able to induce an increase in diacylglycerol levels. This effect was shown to be enhanced by the presence of bradykinin. Another striking effect of lithium was a marked gain in the level of the liponucleotide phosphatidyl-CMP. Increased phosphatidyl-CMP levels were detected in the presence of lithium alone but were considerably more pronounced in the presence of both lithium and bradykinin. These results are consistent with the inhibitory action of lithium on key enzymes of the degradation pathway of inositol phosphates, resulting in a decrease in cellular inositol content and in an elevation in levels of phosphorylated inositols. Comparison of the mass of the inositol phosphates and diacylglycerol showed that the lithium-induced diacylglycerol levels were substantially greater than would be expected from phosphoinositide hydrolysis alone. One possible reason for the increase in the level of diacylglycerol through the action of lithium is the reversal of the reaction for the formation of phosphatidyl-CMP. The resulting phosphatidic acid would then need to be further dephosphorylated to diacylglycerol. The lithium-induced elevation of phosphatidyl-CMP was prevented by addition of myo-inositol (10-30 mM), suggesting that the increase in liponucleotide level was due to depletion of cellular inositol. Under the same conditions the elevated diacylglycerol concentration remained unchanged. Consequently, phosphatidyl-CMP is not its source, and diacylglycerol may arise through an effect of lithium on the degradation of phospholipids other than phosphoinositides. The action of phospholipase C or D on phosphatidylcholine is the most likely mechanism.

Differential expression and subcellular localization of protein kinase C alpha, beta, gamma, delta, and epsilon isoforms in SH-SY5Y neuroblastoma cells: modifications during differentiation

A decrease in protein kinase C activity caused either by treatment with inhibitors, such as staurosporine or H-7, or by prolonged exposure to phorbol diesters has been proposed to be involved in the early events of SH-SY5Y neuroblastoma cell differentiation. Because eight distinct isoforms of protein kinase C with discrete subcellular and tissue distributions have been described, we determined which isoforms are present in SH-SY5Y cells and studied their modifications during differentiation. The alpha, beta 1, delta, and epsilon isoforms were present in SH-SY5Y cells, as well as in rat brain. Protein kinase C-alpha and -beta 1 were the most abundant isoforms in SH-SY5Y cells, and immunoreactive protein kinase C-delta and -epsilon were present in much smaller amounts than in rat brain. Subcellular fractionation and immunocytochemistry demonstrated that all four isoforms are distributed bimodally in the cytoplasm and the membranes. Immunocytochemical analysis showed that the alpha isoform is associated predominantly with the plasma membrane and the processes extended during treatment with 12-tetradecanoyl-13-acetyl-beta-phorbol or staurosporine, and that protein kinase C-epsilon is predominantly membrane-bound. Its localization did not change during differentiation. Western blots of total SH-SY5Y cell extracts and of subcellular fractions probed with isoform-specific polyclonal antibodies showed that when SH-SY5Y cells acquired a morphologically differentiated phenotype, protein kinase C-alpha and -epsilon decreased, and protein kinase C-beta 1 did not change. These data suggest distinct roles for the different protein kinase C isoforms during neuronal differentiation, as well as possible involvement of protein kinase alpha and epsilon in neuritogenesis.

Distinct mechanisms of differentiation of SH-SY5Y neuroblastoma cells by protein kinase C activators and inhibitors

Certain biological actions of phorbol esters cannot be duplicated by diacylglycerol (DAG). Thus, the human neuroblastoma cell line SH-SY5Y differentiates when exposed to 12-tetradecanoyl-13-acetyl-beta-phorbol (TPA) and protein kinase C (PKC) inhibitors, but not when exposed to DAG. To investigate the specific features of the phorbol diester molecule that might be responsible for these effects, we examined the extension of neurites, expression of neuron-specific enolase, and appearance and localization of phosphorylated high molecular weight neurofilament subunits (NF-H). TPA, 12-deoxy-13-tetradecanoyl-beta-phorbol, and staurosporine, but not DAG or 4-O-methyl-TPA, caused neurite outgrowth. Neuron-specific enolase was expressed in cells treated with TPA and 12-deoxy-13-tetradecanoyl-beta-phorbol but not with DAG, staurosporine, or 4-O-methyl-TPA. NF-H increased in the perikarya of cells treated with DAG and 4-O-methyl-TPA, in processes and to varying degrees in perikarya of TPA- and 12-deoxy-13-tetradecanoyl-beta-phorbol-treated cells, but much more in the processes than in the perikarya of staurosporine-differentiated cells. These findings and additional differences between the differentiation induced by TPA (a PKC activator) and staurosporine (a PKC inhibitor), including distinct morphology of the cell body and processes and time of appearance of the morphological phenotype, suggest that activators and inhibitors of PKC induce differentiation of SH-SY5Y cells by different mechanisms, and that the five-membered/seven-membered terpene ring region present in TPA must be intact for the induction of morphological differentiation.

Size and shape of human cranial sutures--a new scoring method

A method for the differentiation of sutural patterns of the human cranial vault is introduced. Three criteria of differentiation are considered, one for size and two for shape: 1) maximal shape extension; 2) basic configuration; 3) secondary protrusion. The method is illustrated here for the coronal and lambdoid sutures of 70 recent Italian skulls (35 adult males and 35 adult females). Differences between coronal and lambdoid sutural size and shape can be detected analytically; for example, the coronal suture commonly shows lesser degrees of shape extension, a simpler basic configuration, and an absence of secondary protrusion. Heterogeneity within each suture, as well as a relationship among corresponding sections and between the three criteria adopted, have been also observed; symmetry predominates for both the sutures, and sexual differences are slight.

Influence of lithium on second messenger accumulation in NG108-15 cells

Treatment of NG108-15 cells with bradykinin for 10 min resulted in a reduction of phosphatidylinositol levels with no change in the other inositol lipids. Accompanying this was a small increase in diacylglycerol but no modification in the level of inositol phosphates. Addition of bradykinin to cells incubated for 30 min in buffer containing lithium did not cause a further decrease in the labeling of phosphatidylinositol, but was accompanied by an increase in mass of the three inositol phosphates. The increase was about 150% for inositol monophosphate, 40% for inositol bisphosphate and 80% for inositol trisphosphate. Under these conditions there was a marked increase in the ability of bradykinin to elevate the content of diacylglycerol. Moreover lithium by itself induced an increase in diacylglycerol six times as great as the increase in total inositol phosphates. The excess diacylglycerol may have its origin in phospholipids other than phosphoinositides.

Ultrastructure of an identified molluscan neuron in organ culture and cell culture following axotomy

We examined the ultrastructure of neuron 5 from the buccal ganglion of the mollusc Helisoma trivolvis after axotomy and organ culture, and after isolation of the same neuron in culture. Buccal ganglia containing axotomized neurons 5 were cultured either in host snails or in Leibovitz medium conditioned with ganglia. In addition, some neurons 5 were isolated from buccal ganglia by micro-dissection and plated into culture. Neuron 5 and its processes were identified in both whole mounts and plastic sections of buccal ganglia after intracellular injection with Lucifer Yellow or horseradish peroxidase. Five days after axotomy of neuron 5, thick sections of buccal ganglia stained with toluidine blue revealed that densely staining basophilic bodies (Nissl bodies) within the cytoplasm had dispersed, i.e., they had undergone chromatolysis. Coincident with chromatolysis was an overall increase in diffuse basophilic staining within the cytoplasm of neuron 5 when maintained in organ culture. The dispersion of Nissl bodies viewed by light microscopy correlated with a more freely arranged rough endoplasmic reticulum and associated polysomes within neuron 5 as seen by electron microscopy. Isolated neurons 5 did not possess densely staining Nissl bodies when examined after 2 days in vitro, thus indicating that chromatolysis occurred earlier in isolated neurons. Furthermore, no increase in diffuse cytoplasmic basophilia was observed within isolated neurons 5 cultured in vitro. However, isolated neurons 5 exhibited a marked increase in the number of lipid-like bodies (0.5-1.5 micron in diameter) that were particularly evident in scanning electron micrographs. Scanning and transmission electron micrographs revealed that the isolated neurons were free of associated glia, but non-neuronal cells (hemocytes) would attach themselves to the somata and neurites. Glia surrounding neuron 5 within buccal ganglia exhibited a marked hypertrophy following axotomy and organ culture. Hypertrophy of glia was absent, however, if ganglia were axotomized and left within the animal or axotomized ganglia were implanted into host animals and examined 5 days later by electron microscopy. These observations indicate that, following axotomy, a molluscan neuron may exhibit different morphological features depending on its microenvironment. In addition, the hypertrophy of glia surrounding neurons in Helisoma was not associated with axotomy per se, but with organ culture.

Requirements for the activation of protein kinase C: comparison of the molecular geometries of phorbol and diacylglycerol

MM2 calculations have been performed on a number of derivatives of phorbol and diacylglycerol (DAG) to establish the molecular features required for the activation of protein kinase C by a detailed comparison of the molecular geometries in these two classes of compounds. For DAG, a dihedral angle of about -60 degrees appears to be required for the oxygens at C2 and C3 because that angle is fixed at this value in phorbols. There is good agreement between the computed Boltzmann distribution for the O1-C1-C2-O2 dihedral angle and NMR results for the same angle in phospholipids, as obtained by others. A conformer of DAG is identified with dihedral angles corresponding to those of beta-phorbols. This conformer, however, is 3.2 kcal/mol above the global minimum found for DAG. The molecular geometry of this conformer is consistent with that of a number of active and inactive rigid analogues of DAG. The preferred conformation in beta-phorbol diesters is found to be stabilized by an antiparallel stacking of the ester carbonyl groups. The lack of activity of alpha-phorbol esters appears to be due to differences in a portion of the molecule containing the five-membered/seven-membered rings, which are far from the DAG-like end of the phorbol molecule. It is proposed that some of the biological activities of phorbol diesters may be due to this portion of the beta-phorbol molecule, which might represent a second active region, distinct from that resembling DAG.