Biomarkers of Motor Outcomes After Stroke

Predicting motor outcomes after stroke based on clinical judgment alone is often inaccurate and can lead to inefficient and inequitable allocation of rehabilitation resources. Prediction tools are being developed so that clinicians can make evidence-based, accurate, and reproducible prognoses for individual patients. Biomarkers of corticospinal tract structure and function can improve prediction tool performance, particularly for patients with initially moderate to severe motor impairment. Being able to make accurate predictions for individual patients supports rehabilitation planning and communication with patients and families.

Modulation of ipsilateral motor evoked potentials during bimanual coordination tasks

Introduction

Ipsilateral motor evoked potentials (iMEPs) are difficult to obtain in distal upper limb muscles of healthy participants but give a direct insight into the role of ipsilateral motor control.

Methods

We tested a new high-intensity double pulse transcranial magnetic stimulation (TMS) protocol to elicit iMEPs in wrist extensor and flexor muscles during four different bimanual movements (cooperative-asymmetric, cooperative-symmetric, non-cooperative-asymmetric and non-cooperative-symmetric) in 16 participants.

Results

Nine participants showed an iMEP in the wrist extensor in at least 20% of the trials in each of the conditions and were classified as iMEP+ participants. iMEP persistence was greater for cooperative (50.5 ± 28.8%) compared to non-cooperative (31.6 ± 22.1%) tasks but did not differ between asymmetric and symmetric tasks. Area and amplitude of iMEPs were also increased during cooperative (area = 5.41 ± 3.4 mV × ms; amplitude = 1.60 ± 1.09 mV) compared to non-cooperative (area = 3.89 ± 2.0 mV × ms; amplitude = 1.12 ± 0.56 mV) tasks and unaffected by task-symmetry.

Discussion

The upregulation of iMEPs during common-goal cooperative tasks shows a functional relevance of ipsilateral motor control in bimanual movements. The paired-pulse TMS protocol is a reliable method to elicit iMEPs in healthy participants and can give new information about neural control of upper limb movements. With this work we contribute to the research field in two main aspects. First, we describe a reliable method to elicit ipsilateral motor evoked potentials in healthy participants which will be useful in further advancing research in the area of upper limb movements. Second, we add new insight into the motor control of bimanual movements. We were able to show an upregulation of bilateral control represented by increased ipsilateral motor evoked potentials in cooperative, object-oriented movements compared to separate bimanual tasks. This result might also have an impact on neurorehabilitation after stroke.

Fast-food outlet availability and obesity: Considering variation by age and methodological diversity in 22,889 Yorkshire Health Study participants

This study investigated if the relationship between residential fast-food outlet availability and obesity varied due to methodological diversity or by age. Cross-sectional data (n = 22,889) from the Yorkshire Health Study, England were used. Obesity was defined using self-reported height and weight (BMI ≥ 30). Food outlets ("fast-food", "large supermarkets", and "convenience or other food retail outlets") were mapped using Ordnance Survey Points of Interest (PoI) database. Logistic regression was used for all analyses. Methodological diversity included adjustment for other food outlets as covariates and continuous count vs. quartile. The association between residential fast-food outlets and obesity was inconsistent and effects remained substantively the same when considering methodological diversity. This study contributes to evidence by proposing the use of a more comprehensive conceptual model adjusting for wider markers of the food environment. This study offers tentative evidence that the association between fast-food outlets and obesity varies by age.

Neighbourhood typologies and associations with body mass index and obesity: A cross-sectional study

Little research has investigated associations between a combined measure of the food and physical activity (PA) environment, BMI (body-mass-index) and obesity. Cross-sectional data (n=22,889, age 18-86years) from the Yorkshire Health Study were used [2010-2013]. BMI was calculated using self-reported height and weight; obesity=BMI≥30. Neighbourhood was defined as a 2km radial buffer. Food outlets and PA facilities were sourced from Ordnance Survey Points of Interest (PoI) and categorised into 'fast-food', 'large supermarkets', 'convenience and other food retail outlets' and 'physical activity facilities'. Parks were sourced from Open Street Map. Latent class analysis was conducted on these five environmental variables and availability was defined by quartiles of exposure. Linear and logistic regressions were then conducted for BMI and obesity respectively for different neighbourhood types. Models adjusted for age, gender, ethnicity, area-level deprivation, and rural/urban classification. A five-class solution demonstrated best fit and was interpretable. Neighbourhood typologies were defined as; 'low availability', 'moderate availability', 'moderate PA, limited food', 'saturated' and 'moderate PA, ample food'. Compared to low availability, one typology demonstrated lower BMI (saturated, b=-0.50, [95% CI=-0.76, -0.23]), while three showed higher BMI (moderate availability, b=0.49 [0.27, 0.72]; moderate PA, limited food, b=0.30 [0.01, 0.59]; moderate PA, ample food, b=0.32 [0.08, 0.57]). Furthermore, compared to the low availability, saturated neighbourhoods showed lower odds of obesity (OR=0.86 [0.75, 0.99]) while moderate availability showed greater odds of obesity (OR=1.18 [1.05, 1.32]). This study supports population-level approaches to tackling obesity however neighbourhoods contained features that were health-promoting and -constraining.

Associations between the combined physical activity environment, socioeconomic status, and obesity: a cross-sectional study

AIMS

This study investigates associations between the combined physical activity environment and obesity and explores any sub-group effects by individual-level socioeconomic status.

METHODS

In a large cross-sectional cohort ( n = 22,889) from the Yorkshire Health Study, body mass index was calculated using self-reported height and weight and obesity was defined as a body mass index ≥ 30. The physical activity environment was split into 'unfavourable physical activity', 'moderately favourable physical activity' and 'favourable physical activity' environments. This was based on the count of parks and physical activity facilities within a 2 km radial buffer centred on home addresses. A favourable physical activity environment was defined as having ≥1 physical activity facility and ≥1 park, unfavourable as having no physical activity facility and park and any other combinations defined as moderately favourable. Logistic regression (odds ratios) identified associations with obesity.

RESULTS

Relative to 'unfavourable physical activity environments', individuals within favourable physical activity environments were less likely to be obese (odds ratio = 0.90; 95% confidence interval = 0.82-0.97), and there was no effect for moderately favourable environment. Furthermore, once stratified by education level, this relationship was only present for those of higher education.

CONCLUSION

Our findings provide novel UK evidence and is one of the first papers internationally that highlights the importance of considering the interplay of individual-level socioeconomic factors when investigating associations between the physical activity environment and obesity.

Access and quality of parks and associations with obesity: A cross-sectional study

Public health is increasingly engaging with multi-faceted obesity prevention efforts. Although parks represent key community assets for broader public health, they may not be distributed equitably and associations with obesity are equivocal. We investigated park access and quality relative to deprivation and obesity with individual-level data from the Yorkshire Health Study. Compared to the least deprived areas, the moderately and most deprived areas had a greater park access and park quality in terms of features and amenities. However, parks in the moderately and most deprived areas also had the most safety concerns and incivilities. Although deprivation was associated with obesity, contrary to current policy guidance, both park access and quality appear less important for understanding variations in obesity within this study. Although sub-group analyses by deprivation tertile revealed that low quality park amenities in highly and moderately deprived areas may be important for understanding obesity prevalence, all other associations were non-significant.

Multiple rodent models and behavioral measures reveal unexpected responses to FTY720 and DMF in experimental autoimmune encephalomyelitis

Experimental autoimmune encephalomyelitis (EAE) is a widely-used rodent model for multiple sclerosis (MS), but a single model can hardly capture all features of MS. We investigated whether behavioral parameters in addition to clinical motor function scores could be used to assess treatment efficacy during score-free intervals in the relapsing-remitting EAE model in SJL/J mice. We studied the effects of the clinical reference compounds FTY720 (fingolimod, 0.5mg/kg/day) and dimethyl fumarate (DMF, 20-30 mg/kg/day) on clinical scores in several rodent EAE models in order to generate efficacy profiles. SJL/J mice with relapsing-remitting EAE were studied using behavioral tests, including rotarod, gait analysis, locomotor activity and grip strength. SJL/J mice were also examined according to Crawley's sociability and preference for social novelty test. Prophylactic treatment with FTY720 prevented clinical scores in three of the four EAE rodent models: Dark Agouti (DA) and Lewis rats and C57BL/6J mice. Neither prophylactic nor late-therapeutic treatment with FTY720 reduced clinical scores or reversed deficits in the rotarod test in SJL/J mice, but we observed effects on motor functions and sociability in the absence of clinical scores. Prophylactic treatment with FTY720 improved the gait of SJL/J mice whereas late-therapeutic treatment improved manifestations of reduced social (re)cognition or preference for social novelty. DMF was tested in three EAE models and did not improve clinical scores at the dose used. These data indicate that improvements in behavioral deficits can occur in absence of clinical scores, which indicate subtle drug effects and may have translational value for human MS.

Empowerment and satisfaction in a multinational study of routine clinical practice

OBJECTIVE

Decision-making between mental health clinicians and patients is under-researched. We tested whether mental health patients are more satisfied with a decision made (i) using their preferred decision-making style and (ii) with a clinician with the same decision-making style preference.

METHOD

As part of the CEDAR Study (ISRCTN75841675), a convenience sample of 445 patients with severe mental illness from six European countries were assessed for desired clinical decision-making style (rated by patients and paired clinicians), decision-specific experienced style and satisfaction.

RESULTS

Patients who experienced more involvement in decision-making than they desired rated higher satisfaction (OR=2.47, P=0.005, 95% CI 1.32-4.63). Decisions made with clinicians whose decision-making style preference was for more active involvement than the patient preference were rated with higher satisfaction (OR=3.17, P=0.003, 95% CI 1.48-6.82).

CONCLUSION

More active involvement in decision-making than the patient stated as desired was associated with higher satisfaction. A clinical orientation towards empowering, rather than shared, decision-making may maximise satisfaction.

Nano-LC-MS/MS for the quantitation of prostanoids in immune cells

Prostanoids, derivatives of arachidonic acid, are involved in inflammation and immune reactions. To understand the role of prostanoids produced by diverse immune cells, a highly sensitive quantitation method for prostaglandin E2 (PGE2), prostaglandin D2 (PGD2), 6-keto prostaglandin F1α (6-keto PGF1α), prostaglandin F2α (PGF2α), and thromboxane B2 (TXB2) by means of nano-liquid chromatography-tandem mass spectrometry has been developed. It was validated according to the guidelines of the Food and Drug Administration (FDA) in terms of linearity, precision, accuracy, recovery, stability, and lower limit of quantitation (LLOQ). The LLOQ were 25 pg/mL in the injected solution (75 fg on column (o.c.)) for PGE2 and PGD2 and 37.5 pg/mL (112.5 fg on column) for 6-keto PGF1α, PGF2α, and TXB2, respectively. It was successfully applied to murine mast cells isolated from paws after zymosan injection and to CD4(+) and CD8(+) T lymphocytes from blood of sensitized versus non-sensitized mice in context of a delayed type hypersensitivity model. About 5,000 (T cells) to 40,000 (mast cells) cells were sufficient for quantitation. In the mast cells, the production of PGE2 increased at a significantly higher extent than the synthesis of the other prostanoids. The T lymphocytes did not show any difference in prostanoid production, no matter whether they were obtained from sensitized mice or non-sensitized mice.

Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists

To investigate the relationship between survival in colorectal cancer patients and the number of lymph nodes examined by a pathologist, previously attributed to stage migration, we used data from a cohort of 5174 colorectal cancer patients recruited between September 1991 and August 1994, and followed-up for 5 years. We selected cases with data present on all prognostic variables, and stratified them into three groups by number of nodes examined. We made a multivariate survival comparison using a Cox regression model. In all, there were 3592 cases with data present on all prognostic variables. Patients who had >10 nodes identified had a significant survival advantage over those who had 5–10 identified, who had in turn a similar advantage over those with 0–4 identified (P<0.001). This effect was present in the whole group and at all Dukes' stages, although statistically significant only in stages B (P=0.004) and C (P=0.019). The effect remained after adjustment in a Cox regression model in which the mean number of nodes taken out by each surgical firm did not predict survival. In a sub-group with data on lymphocytic infiltration into the primary tumour a survival advantage was noted in those with prominent rather than mild infiltration (P<0.001): the former also tended to have more nodes found (P=0.015). Stage migration alone cannot explain these results, as survival advantages are noted across the whole population independent of stage. Lymphocytic infiltration into the primary tumour is prognostically important, and is associated with the number of nodes found. Reactive enlargement of lymph nodes in the mesentery may make them easier to find, reflect immune response to the tumour, and thus indirectly impact upon survival.

Trends and geographic inequalities in the prevalence of Down syndrome in Europe, 1980-1999

BACKGROUND

EUROCAT is a network of population-based registries for the epidemiologic surveillance of congenital anomalies covering approximately one quarter of births in the European Union. Down syndrome constitutes approximately 8% of cases of registered congenital anomaly in Europe, with over 7000 affected pregnancies in the 15 current member states of the European Union each year. In this paper, we aim to examine trends in the live birth prevalence of Down syndrome in Europe in the light of trends in maternal age and in prenatal diagnosis.

METHODS

Descriptive analysis of data from 24 EUROCAT registries, covering 8.3 million births 1980-99. Cases include live births, stillbirths and terminations of pregnancy following prenatal diagnosis.

RESULTS

Since 1980, the proportion of births to mothers of 35 years of age and over has risen quite dramatically from 8 to 14% for the European Union as a whole, with steeper rises in some regions. By 1995-1999, the proportion of "older" mothers varied between regions from 10% to 25%, and the total prevalence (including terminations of pregnancy) of Down syndrome varied from 1 to 3 per 1000 births. Some European regions have shown a more than twofold increase in total prevalence of Down syndrome since 1980. The proportion of cases of Down syndrome which were prenatally diagnosed followed by termination of pregnancy in 1995-1999 varied from 0% in the three regions of Ireland and Malta where termination of pregnancy is illegal, to less than 50% in 14 further regions, to 77% in Paris. The extent to which terminations of pregnancy were concen trated among older mothers varied between regions. The live birth prevalence has since 1980 increasingly diverged from the rising total prevalence, in some areas remaining approximately stable, in others decreasing over time.

CONCLUSION

The rise in average maternal age in Europe has brought with it an increase in the number of pregnancies affected by Down syndrome. The widespread practice of prenatal screening and termination of pregnancy has in most of the regions covered by EUROCAT counteracted the effect of maternal age in its effect on live birth prevalence. Under the joint influences of maternal age and prenatal screening the pattern of geographic inequalities in Down syndrome live birth prevalence in Europe has also been changed.

Selection and interpretation of clinical pathology indicators of hepatic injury in preclinical studies

This position paper delineates the expert recommendations of the Regulatory Affairs Committee of the American Society for Veterinary Clinical Pathology for the use of preclinical, clinical pathology endpoints in assessment of the potential for drug-induced hepatic injury in animals and humans. Development of these guidelines has been based on current recommendations in the relevant preclinical and human clinical trial literature; they are intended to provide a method for consistent and rigorous interpretation of liver-specific data for the identification of hepatic injury in preclinical studies and potential liability for hepatic injury in human patients.

Prevalence of congenital anomalies in five British regions, 1991-99

AIMS

To describe trends in total and live birth prevalence, regional differences in prevalence, and outcome of pregnancy of selected congenital anomalies.

METHODS

Population based registry study of 839,521 births to mothers resident in five geographical areas of Britain during 1991-99. Main outcome measures were: total and live birth prevalence; pregnancy outcome; proportion of stillbirths due to congenital anomalies; and secular trends.

RESULTS

The sample consisted of 10,844 congenital anomalies, giving a total prevalence of 129 per 10,000 registered births (95% CI 127 to 132). Live birth prevalence was 82.2 per 10,000 births (95% CI 80.3 to 84.2) and declined significantly with time. The proportion of all stillbirths with a congenital anomaly was 10.5% (453 stillbirths). The proportion of pregnancies resulting in a termination increased from 27% (289 cases) in 1991 to 34.7% (384 cases) in 1999, whereas the proportion of live births declined from 68.2% (730 cases) to 58.5% (648 cases). Although similar rates of congenital anomaly groups were notified to the registers, variation in rates by register was present. There was a secular decline in the total prevalence of non-chromosomal and an increase in chromosomal anomalies.

CONCLUSIONS

Regional variation exists in the prevalence of specific congenital anomalies. For some anomalies this can be partially explained by ascertainment variation. For others (neural tube defects, diaphragmatic hernia, gastroschisis), higher prevalence rates in the northern regions (Glasgow and Northern) were true differences. Live birth prevalence declined over the study due to an increase in terminations of pregnancy.

The Index of Multiple Deprivation 2000 and accessibility effects on health

STUDY OBJECTIVE

To investigate whether the Index of Multiple Deprivation 2000 (IMD) is more strongly related to inequalities in health in rural areas than traditional deprivation indices. To explore the contribution of the IMD domain "geographical access to services" to understanding rural health variations.

DESIGN

A geographically based cross sectional study.

SETTING

Nine counties in the south west region of England.

PARTICIPANTS

All those aged below 65 who reported a limiting long term illness in the 1991 census, and all those who died during 1991-96, aged less than 65 years.

MAIN RESULTS

The IMD is comparable with the Townsend score in its overall correlation with premature mortality (r(2) = 0.44 v 0.53) and morbidity (r(2) = 0.79 v 0.76). Correlation between the Townsend score and population health is weak in rural areas but the IMD maintains a strong correlation with rates of morbidity (r(2) = 0.70). The "geographical access to services" domain of the IMD is not strongly correlated with rates of morbidity in rural areas (r(2) = 0.04), and in urban areas displays a negative correlation (r(2) = -0.47).

CONCLUSIONS

The IMD has a strong relation with health in both rural and urban areas. This is likely to be the result of the inclusion of data in the IMD on the numbers of people claiming benefits related to ill health and disability. The domain "geographical access to services" is not associated with health in rural areas, although it displays some association in urban areas. This domain is potentially important but, as yet, inadequately specified in the IMD for the purposes of health research.

Redistribution of glycolipid raft domain components induces insulin-mimetic signaling in rat adipocytes

Caveolae and caveolin-containing detergent-insoluble glycolipid-enriched rafts (DIG) have been implicated to function as plasma membrane microcompartments or domains for the preassembly of signaling complexes, keeping them in the basal inactive state. So far, only limited in vivo evidence is available for the regulation of the interaction between caveolae-DIG and signaling components in response to extracellular stimuli. Here, we demonstrate that in isolated rat adipocytes, synthetic intracellular caveolin binding domain (CBD) peptide derived from caveolin-associated pp59(Lyn) (10 to 100 microM) or exogenous phosphoinositolglycan derived from glycosyl-phosphatidylinositol (GPI) membrane protein anchor (PIG; 1 to 10 microM) triggers the concentration-dependent release of caveolar components and the GPI-anchored protein Gce1, as well as the nonreceptor tyrosine kinases pp59(Lyn) and pp125(Fak), from interaction with caveolin (up to 45 to 85%). This dissociation, which parallels redistribution of the components from DIG to non-DIG areas of the adipocyte plasma membrane (up to 30 to 75%), is accompanied by tyrosine phosphorylation and activation of pp59(Lyn) and pp125(Fak) (up to 8- and 11-fold) but not of the insulin receptor. This correlates well to increased tyrosine phosphorylation of caveolin and the insulin receptor substrate protein 1 (up to 6- and 15-fold), as well as elevated phosphatidylinositol-3' kinase activity and glucose transport (to up to 7- and 13-fold). Insulin-mimetic signaling by both CBD peptide and PIG as well as redistribution induced by CBD peptide, but not by PIG, was blocked by synthetic intracellular caveolin scaffolding domain (CSD) peptide. These data suggest that in adipocytes a subset of signaling components is concentrated at caveolae-DIG via the interaction between their CBD and the CSD of caveolin. These inhibitory interactions are relieved by PIG. Thus, caveolae-DIG may operate as signalosomes for insulin-independent positive cross talk to metabolic insulin signaling downstream of the insulin receptor based on redistribution and accompanying activation of nonreceptor tyrosine kinases.

No such thing as a bad day

This is an excerpt from Hamilton Jordan's book No Such Thing as a Bad Day reprinted with permission.

Constructing meiotic maps with known error probability

We propose methods to construct meiotic gene maps while controlling the probability of a decision-error. First, a single step gene ordering procedure is presented whose decision-error probability is bounded above by a prespecified threshold. The bound for the error probability is valid under quite general circumstances. The ordering procedure is optimal in the sense of having maximal predictive probability of correct ordering among all procedures subject to the same bound on the error probability. Second, to reduce the number of hypotheses to be tested, a stepwise ordering procedure is presented. A Monte Carlo simulation study demonstrated the integrity of the proposed error bound for the stepwise procedure under a wide variety of situations, including data coming from different laboratories and marker typing errors. The stepwise procedure was applied to version 2 of the public database maintained by the Cooperative Human Linkage Center and maps of the 23 chromosomes were generated such that the probability that the order of the markers in a given chromosome is incorrect is less than 1%.

Hantavirus pulmonary syndrome

We present the first case of Hantavirus pulmonary syndrome in the Dallas/Fort Worth area. The patient was a 50-year-old previously healthy white man, who had adult respiratory distress syndrome (ARDS) and hypotensive shock after 1 week of nonspecific "viral" symptoms. Despite supportive care, the patient died within several hours of presentation. This case illustrates several of the classic hallmarks of hantavirus infection such as hemoconcentration, thrombocytopenia, ARDS, and shock.

Scene-based and object-centered inhibition of return: evidence for dual orienting mechanisms

We investigated whether inhibition of return (IOR) could be observed in location-based, scene-based, and object-centered frames of reference. IOR was found to move both with a separate cued object (scene-based) and with a location within a single rotating object (object-centered). Importantly, however, IOR was also associated with the environmental location cued when cuing was of a separate object (scene-based), whereas facilitation of the cued location was found when cuing was of a component within an object. These results suggest that location is of central importance to scene-based representations of separate objects, which appear to be encoded in viewer-centered coordinates, whereas environmental locus is of little relevance when attention orients within a single object. The results also provide further evidence for the coexistence of both excitation and inhibition associated with uninformative exogenous cues.

A family study of autism: cognitive patterns and levels in parents and siblings

First-degree relatives of 99 autism probands and of 36 Down's syndrome controls were assessed with standardised tests of intellectual functioning, reading, and spelling. Higher mean verbal IQ scores, and discrepancies in favour of verbal scores, were characteristic of autism relatives. No consistent differences were found on performance scales, reading, and spelling tests. Among autism relatives, siblings affected with the broad phenotype of autism had significantly lower IQ scores and poorer reading and spelling performances than unaffected siblings. However, the small size of the cognitive difference and the lack of a distinctive cognitive profile indicates that standardised cognitive measures used in this study are unlikely to improve the operationalised definition of the broad phenotype of autism. The slightly superior verbal performance of relatives in the autism group might represent some form of heterozygote advantage.

Analysis of lipid metabolism in adipocytes using a fluorescent fatty acid derivative. I. Insulin stimulation of lipogenesis

Stimulation of lipid synthesis (lipogenesis) is one of the most pronounced metabolic actions of insulin. Here we demonstrate insulin-stimulated lipogenesis in isolated rat adipocytes using a fatty acid derivative which carries a fluorophore. Three major fluorescent lipid products (lipids 1, 2, 3) are generated as revealed by TLC analysis and subsequent fluorescent scanning or imaging. Lipolytic digestion and labeling studies suggest monoacylglycerol-3-phosphate and diacylglycerol (-3-phosphate) structures harboring a single fluorescent fatty acyl residue each for lipids 1 and 3 (2), respectively. Fluorescent triglycerides are not generated. Assaying acylation with isolated microsomes using the purified lipids 1 and 3 indicates that incorporation of one fluorescent fatty acyl residue into glycerol(-3-phosphate) interferes with subsequent esterification. Pretreatment of the adipocytes with insulin significantly stimulates synthesis of lipids 1 and 2, only. The insulin concentration-response relationship (EC50 = 0.5 nM) and the maximal insulin response for synthesis of lipid 1 (stimulation factor = 14- to 20-fold at low glucose and 3- to 7-fold at high glucose) are comparable with those for incorporation of [3-3H]glucose into total adipocyte lipids. Thus this fluorescence-based assay may be useful for studying insulin action and lipogenesis.

Transplantation of transduced chondrocytes protects articular cartilage from interleukin 1-induced extracellular matrix degradation

Gene therapy used in the context of delivering a therapeutic gene(s) to chondrocytes offers a new approach for treating chondrocyte-mediated cartilage degradation associated with various human arthropathies including osteoarthritis. In this study, gene delivery to human osteoarthritis chondrocytes in monolayer culture was demonstrated using two adenoviral vectors (Ad.CMVlacZ and Ad.RSVntlacZ) carrying the Escherichia coli beta-galactosidase marker gene, and a third vector (Ad.RSV hIL-1ra) containing the cDNA for human interleukin-1 receptor antagonist. At an moi of 10(3) plaque-forming units/chondrocyte, > 90% of the infected cells stained positive for E. coli beta-galactosidase activity, indicating a high efficiency of transduction. Genetically modified chondrocytes were then transplanted onto the articular surface of osteoarthritic cartilage organ cultures with and without the underlying subchondral bone. Both in situ staining of the cartilage organ cultures for E. coli beta-galactosidase activity and examination by scanning electron microscopy indicated that the transplanted chondrocytes adhered and integrated into the articular surface and continued to express transgenic protein. Chondrocytes transduced with Ad.RSV hIL-1ra and seeded onto the surface of osteoarthritic cartilage secreted high levels of biologically active IL-1 receptor antagonist. The Ad.RSV hIL-1ra-treated cartilage samples were resistant to IL1-induced proteoglycan degradation over 10 d of sustained organ culture. These data demonstrate that transplantation of transduced chondrocytes onto the articular surface protects cartilage from IL-1-induced extracellular matrix degradation.

A protocol for rapid screening of proteoglycan-degrading metalloproteinase inhibitors

A procedure is described for rapid, high-volume screening of proteoglycan-degrading metalloproteinase inhibitors. The procedure was developed by modifying the proteoglycan-polyacrylamide particle assay for proteases, polysaccharidases (Nagase and Woessner, 1980), and the 1,9-dimethylmethylene blue (DMB) assay for sulfated glycosaminoglycans (Farndale et al., 1982). The following modifications have made the new protocol suitable for evaluating a large number of compounds simultaneously: 1) Pipetting steps were automated using a pipetting robot. 2) Speed and sensitivity of the 1,9-dimethylmethylene assay were increased by scaling down the assay and measuring absorbance using an automatic multiwell plate reader. 3) Data capture and analysis were simplified using computer programs. The modified procedure is rapid, sensitive, reliable, and requires a small sample size. Above all, the procedure is suitable for high-volume screening: approximately 100 compounds can be evaluated in 1 day.

The psychometric properties of a tinnitus handicap questionnaire

The psychometric properties of a tinnitus handicap questionnaire are reported. There were two phases in this study. In Phase I, 87 questions were administered to 100 tinnitus patients. From their responses, 59 items that were either redundant, insensitive, or had low item-total correlations were eliminated. In Phase II, the resulting 27-item questionnaire was administered to 319 patients. Fifty-three of these patients also completed psychological and psychophysical measures that were used to validate the questionnaire. A factor analysis of patients' responses revealed a three-factor structure. These three factors appeared to reflect the physical, emotional, and social consequences of tinnitus (Factor 1), hearing ability of the patient (Factor 2), and the patients' view of tinnitus (Factor 3). Although the 27-item questionnaire had high internal consistency reliability and validity as reflected by correlations with life satisfaction and depression scales, it is recommended that only the items on the Factor 1 and the Factor 2 subscales be scored because of the low internal consistency reliability of the Factor 3 subscale. This questionnaire can be used to compare a patient's tinnitus handicap with the norm, identify specific areas of handicaps, and to monitor a patient's progress with particular treatment programs.

Autism diagnostic observation schedule: a standardized observation of communicative and social behavior

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ = 59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ = 95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.