The Association of Psychotherapy With Burnout, Depression, and Measures of Well-Being in Residents and Fellows: A Pilot Study

PURPOSE

Resident physicians experience high rates of burnout and depression but rarely prioritize their well-being or seek mental health care. The Accreditation Council for Graduate Medical Education mandated that training programs prioritize resident wellness and emotional and mental health to ensure readily available and accessible mental health care. To help meet that requirement and circumvent barriers to accessing care, the University of California San Diego Healer Education Assessment & Referral (HEAR) Program offers residents and fellows short-term therapy for coping with challenges that threaten their well-being. This report describes the results of a pilot study designed to evaluate the feasibility and effectiveness of the HEAR Program's resident therapy program.

METHOD

The cohort included residents and fellows who completed at least 1 postbaseline assessment from January to May 2022. Measures of fulfillment, burnout, self-compassion, quality of life, depression, and suicidal ideation were assessed and compared before and up to 12 weeks after enrollment.

RESULTS

Of the 39 residents who consented to participation, 30 completed at least 1 postbaseline assessment. Most outcomes improved after therapy, with significant increases in fulfillment (mean [SE] coefficient, 0.24 [0.08]; z score, 2.86; P = .004), self-compassion (mean [SE] coefficient, 0.37 [0.07]; z score, 5.72; P < .001), and quality of life ( P < .001) and significant reductions in burnout (Stanford burnout scale: mean [SE] coefficient, -0.27 [0.07]; z score, -4.01; P < .001; single-item burnout scale: mean [SE] coefficient, -0.34 [0.08]; z score, -4.37; P < .001) and depression severity (mean [SE] coefficient, -1.08 [0.25]; z score, -4.36; P < .001).

CONCLUSIONS

This pilot study noted improvements in fulfillment, compassion, quality of life, and function, as well as reductions in burnout and depression severity, among resident physicians. Future studies in larger cohorts are needed to validate these findings and inform further optimization of this program.

Stimulating Antitumoral Immunity by Percutaneous Cryoablation and Combination Immunoadjuvant Therapy in a Murine Model of Hepatocellular Carcinoma

PURPOSE

To test the hypothesis that antitumoral immunity can be induced after cryoablation (cryo) of hepatocellular carcinoma (HCC) through coadministration of the immunostimulant CpG and an immune checkpoint (programmed cell death 1 [PD-1]) inhibitor.

MATERIALS AND METHODS

Sixty-three immunocompetent C57BL/6J mice were generated with 2 orthotopic HCC tumor foci: 1 for treatment and 1 to observe for antitumoral immunity. Tumors were treated with incomplete cryo alone or intratumoral CpG and/or a PD-1 inhibitor. The primary endpoint was death or when the following criteria for sacrifice were met: tumor > 1 cm (determined using ultrasound) or moribund state. Antitumoral immunity was assessed using flow cytometry and histology (tumor and liver) as well as enzyme-linked immunosorbent assay (serum). Analysis of variance was used for statistical comparisons.

RESULTS

At 1 week, the nonablated satellite tumor growth was reduced by 1.9-fold (P = .047) in the cryo + CpG group and by 2.8-fold (P = .007) in the cryo + CpG + PD-1 group compared with that in the cryo group. Compared with cryo alone, the time to tumor progression to endpoints was also prolonged for cryo + CpG + PD-1 and cryo + CpG mice, with log-rank hazard ratios of 0.42 (P = .031) and 0.27 (P < .001), respectively. Flow cytometry and histology showed increased cytotoxic T-cell infiltration (P = .002) and serum levels of the proinflammatory cytokine interferon-γ (P = .015) in tumors and serum of cryo + CpG mice compared with those in tumors and serum of mice treated with cryo alone. High serum levels of the anti-inflammatory cytokine tumor growth factor-β and the proangiogenesis chemokine C-X-C motif chemokine ligand 1 were correlated with a shorter time to endpoints and faster tumor growth.

CONCLUSIONS

Cryo combined with the immunostimulant CpG promoted cytotoxic T-cell infiltration into tumors, slowed tumor growth, and prolonged the time to progression to endpoints in an aggressive murine HCC model.

Manipulation of the nucleoscaffold potentiates cellular reprogramming kinetics

Somatic cell fate is an outcome set by the activities of specific transcription factors and the chromatin landscape and is maintained by gene silencing of alternate cell fates through physical interactions with the nuclear scaffold. Here, we evaluate the role of the nuclear scaffold as a guardian of cell fate in human fibroblasts by comparing the effects of transient loss (knockdown) and mutation (progeria) of functional Lamin A/C, a core component of the nuclear scaffold. We observed that Lamin A/C deficiency or mutation disrupts nuclear morphology, heterochromatin levels, and increases access to DNA in lamina-associated domains. Changes in Lamin A/C were also found to impact the mechanical properties of the nucleus when measured by a microfluidic cellular squeezing device. We also show that transient loss of Lamin A/C accelerates the kinetics of cellular reprogramming to pluripotency through opening of previously silenced heterochromatin domains while genetic mutation of Lamin A/C into progerin induces a senescent phenotype that inhibits the induction of reprogramming genes. Our results highlight the physical role of the nuclear scaffold in safeguarding cellular fate.

Consensus Guidelines for the Definition of Time-to-Event End Points in Image-guided Tumor Ablation: Results of the SIO and DATECAN Initiative

There is currently no consensus regarding preferred clinical outcome measures following image-guided tumor ablation or clear definitions of oncologic end points. This consensus document proposes standardized definitions for a broad range of oncologic outcome measures with recommendations on how to uniformly document, analyze, and report outcomes. The initiative was coordinated by the Society of Interventional Oncology in collaboration with the Definition for the Assessment of Time-to-Event End Points in Cancer Trials, or DATECAN, group. According to predefined criteria, based on experience with clinical trials, an international panel of 62 experts convened. Recommendations were developed using the validated three-step modified Delphi consensus method. Consensus was reached on when to assess outcomes per patient, per session, or per tumor; on starting and ending time and survival time definitions; and on time-to-event end points. Although no consensus was reached on the preferred classification system to report complications, quality of life, and health economics issues, the panel did agree on using the most recent version of a validated patient-reported outcome questionnaire. This article provides a framework of key opinion leader recommendations with the intent to facilitate a clear interpretation of results and standardize worldwide communication. Widespread adoption will improve reproducibility, allow for accurate comparisons, and avoid misinterpretations in the field of interventional oncology research. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.

Diagnosis, Staging, and Patient Selection for Locoregional Therapy to Treat Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related mortality and the only cancer for which the incidence and mortality are on the rise. Sensitive and specific screening and diagnostic approaches, robust staging regimens, multidisciplinary tumor boards, and patient/family education and engagement in the shared decision-making process help to identify a patient's optimal treatment options. Locoregional therapies have been the mainstay for treating intermediate-stage disease, but they are finding special applications for early and advanced disease. This review discusses the diagnosis of HCC, current accepted staging models, and treatment of HCC, with a focus on locoregional therapies.

SAT-336 Time Restricted Feeding Delays Breast Cancer Initiation and Growth in a Mouse Model of Postmenopausal Obesity

Background: The prevalence of obesity and the metabolic syndrome (MetS) has increased dramatically in developed countries over the last three decades (Flegal et al., 2012). Numerous studies indicate that adiposity and the MetS are independent risk factors for multiple diseases including cancer, particularly postmenopausal breast cancer (Kim et al., 2018). Therefore improving the metabolic health of obese postmenopausal women may mitigate their risk for breast cancer. Accumulating evidence suggests that time-restricted feeding (TRF), a form of intermittent fasting in which food intake is limited to a defined period during the normal active phase, can have a positive influence on metabolic health. Importantly, interventional studies in obese mice and small clinical studies in humans have demonstrated that TRF can improve metabolic health even though obesity is maintained (Sutton et al., 2018). Time restriction rather than calorie restriction is thus a promising method to control the negative sequelae of obesity, due to the hunger and irritability that reduces compliance with long-term calorie restriction. The objective of this study was to investigate whether TRF attenuates breast cancer in a mouse model of postmenopausal obesity and whether this effect is mediated by reducing the hyperinsulinemia associated with obesity. Methods: Ovariectomized mice were used as postmenopausal mice model. The ovariectomized mice were initially made obese by feeding 60% high fat diet (HFD) for 10 weeks and then grouped into a continued ad libitum group (24 h access to food) or a TRF group (8 h access to food during active phase). For an orthotopic tumor model, mice were injected with E0771 breast cancer cells into four mammary fat pads per mouse three weeks following the start of TRF. As a tumor initiation model, transgenic PyMT mice were used to assess tumor onset and growth following the same TRF or AL access to the HFD. The insulin dependency of tumor growth was studied by increasing insulinemia using an implanted insulin pump, or by reducing insulin secretion using diazoxide. Insulin effects on tumor cell proliferation and migration was further validated in vitro. Results and Conclusion: TRF had a dramatic effect, reducing tumor growth in obese mice fed a high fat diet (HFD) to levels seen in lean mice. Tumor growth and initiation was also delayed in the transgenic PyMT model of mammary tumorigenesis. Our results further suggest that the antitumor effect of TRF is at least partially mediated by reducing hyperinsulinemia, suggesting that this intervention may be effective in breast cancer prevention and therapy. References: • Flegal, K. M. et al., (2012), JAMA 307, 491-497. • Kim, N. H. et al. (2018). Dig Dis Sci 63, 3126-3133. • Sutton, E. F. et al. (2018). Cell Metab 27, 1212-1221 e1213.

An Evaluation of Trends in Patient and Public Awareness of IR

PURPOSE

To evaluate patient and public awareness of interventional radiology (IR).

MATERIALS AND METHODS

This single-center study prospectively administered voluntary paper surveys to 80 patients in an academic hospital radiology waiting room. Separate, Internet-based surveys were administered to the general public. Additionally, Internet metadata were used to evaluate relative search engine activity and IR-related news coverage compared with similar procedural specialties.

RESULTS

65% of radiology department outpatients had no prior knowledge of IR. Of the general population surveyed, 72% could not identify an interventional radiologist as a physician. Relative annual IR-related Google search volumes peaked in 2004 and were at their nadir in 2011. After normalizing for number of practicing physicians, IR was the subject of substantially fewer Google searches than similar specialties (15.9% of urology volumes, 27.9% of cardiology volumes, and 39.0% of vascular surgery volumes). Between 2006 and 2016, IR had a similar rate of annual increase in the volume of Internet news results as similar medical specialties, although the volumes reached by IR in 2016 were obtained by more established fields, such as cardiology, in 2011.

CONCLUSIONS

These data provide metrics of current and historical awareness trends in IR, which demonstrate low patient and public awareness. The findings of this study may help guide future efforts to promote patient and public awareness of IR.

Web-Based Tools and Mobile Applications To Mitigate Burnout, Depression, and Suicidality Among Healthcare Students and Professionals: a Systematic Review

OBJECTIVE

Being a healthcare professional can be a uniquely rewarding calling. However, the demands of training and practice can lead to chronic distress and serious psychological, interpersonal, and personal health burdens. Although higher burnout, depression, and suicide rates have been reported in healthcare professionals, only a minority receive treatment. Concerns regarding confidentiality, stigma, potential career implications, and cost and time constraints are cited as key barriers. Web-based and mobile applications have been shown to mitigate stress, burnout, depression, and suicidal ideation among several populations and may circumvent these barriers. Here, we reviewed published data on such resources and selected a small sample that readily can be used by healthcare providers.

METHODS

We searched PubMed for articles evaluating stress, burnout, depression, and suicide prevention or intervention for healthcare students or providers and identified five categories of programs with significant effectiveness: Cognitive Behavioral Therapy (online), meditation, mindfulness, breathing, and relaxation techniques. Using these categories, we searched for Web-based (through Google and beacon.anu.edu.au -a wellness resource website) and mobile applications (Apple and mobile. va.gov/appstore ) for stress, burnout, depression, and suicide prevention and identified 36 resources to further evaluate based on relevance, applicability to healthcare providers (confidentiality, convenience, and cost), and the strength of findings supporting their effectiveness.

RESULTS

We selected seven resources under five general categories designed to foster wellness and reduce burnout, depression, and suicide risk among healthcare workers: breathing (Breath2Relax), meditation (Headspace, guided meditation audios), Web-based Cognitive Behavioral Therapy (MoodGYM, Stress Gym), and suicide prevention apps (Stay Alive, Virtual Hope Box).

CONCLUSIONS

This list serves as a starting point to enhance coping with stressors as a healthcare student or professional in order to help mitigate burnout, depression, and suicidality. The next steps include adapting digital health strategies to specifically fit the needs of healthcare providers, with the ultimate goal of facilitating in-person care when warranted.

Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm

Radiologists play a central role in the assessment of patient response to locoregional therapies for hepatocellular carcinoma (HCC). The identification of viable tumor following treatment guides further management and potentially affects transplantation eligibility. Liver Imaging Reporting and Data Systems (LI-RADS) first introduced the concept of LR-treated in 2014, and a new treatment response algorithm is included in the 2017 update to assist radiologists in image interpretation of HCC after locoregional therapy. In addition to offering imaging criteria for viable and nonviable HCC, new concepts of nonevaluable tumors as well as tumors with equivocal viability are introduced. Existing guidelines provided by response evaluation criteria in solid tumors (RECIST) and modified RECIST address patient-level assessments and are routinely used in clinical trials but do not address the variable appearances following different locoregional therapies. The new LI-RADS treatment response algorithm addresses this gap and offers a comprehensive approach to assess treatment response for individual lesions after a variety of locoregional therapies, using either contrast-enhanced CT or MRI.

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience

PURPOSE

To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS).

MATERIALS AND METHODS

Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded.

RESULTS

The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 μGy * m(2) vs 21,414 μGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01).

CONCLUSIONS

Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation.

Elimination of the truncated message from the herpes simplex virus thymidine kinase suicide gene

Introduction of the Herpes simplex virus thymidine kinase (HSV-tk) gene into target cells renders them susceptible to killing by ganciclovir (GCV). We are studying the use of HSV-tk-transduced T lymphocytes in the context of hematopoietic stem cell transplantation. We have previously shown, in vitro and in vivo, the occurrence of transduced cells resistant to GCV due to a deletion within HSV-tk. This deletion, a consequence of the presence of cryptic splice donor and acceptor sites, originates in the retroviral producer cell. Here we adopt two different methods that introduce third-base degenerate changes at the cryptic splice sites and so prevent splicing. Consequently, the HSV-tk protein is unaltered and the sensitivity of the target cells to GCV is preserved. The use of this mutated HSV-tk should reduce the likelihood of the development of resistant genetically modified cells during clinical trials.

Habitat loss and raptor predation: disentangling long- and short-term causes of red grouse declines

The number of red grouse (Lagopus lagopus scoticus) shot in the UK has declined by 50% during the 20th century This decline has coincided with reductions in the area of suitable habitat and recoveries in the populations of some avian predators. Here we use long-term records of shooting bags and a large-scale manipulation of raptor density to disentangle the effects of habitat loss and raptor predation on grouse populations. The numbers of grouse harvested on the Eskdale half of Langholm Moor in southern Scotland declined significantly during 1913-1990 and grouse bags from the whole moor from 1950 to 1990 exhibited an almost identical but non-significant trend. Hen harriers (Circus cyaneus) and peregrine falcons (Falco peregrinus) were absent or bred at low densities on this moor throughout this period but heather-dominant vegetation declined by 48% between 1948 and 1988. Harrier and peregrine breeding numbers on Langholm Moor increased to high levels following protection in 1990 whilst grouse density and grouse bags declined year after year until shooting was abandoned in 1998. The prediction of a peak in grouse bags on Langholm Moor in 1996 based on the patterns of bags during 1950-1990 was supported by the observed peaks in 1997 on two nearby moors with few raptors which formerly cycled in synchrony with Langholm Moor. This study demonstrates that, whilst long-term declines in grouse bags were most probably due to habitat loss, high levels of raptor predation subsequently limited the grouse population and suppressed a cycle. This study thus offers support to theoretical models which predict that generalist predators may suppress cycles in prey populations.

[Preparation of cell therapy products: contribution of closed systems]

A phase I clinical trial is being currently performed in our institution, aiming at evaluating the feasibility and toxicity related to the administration of Herpes Simplex-thymidine kinase gene-expressing human primary T lymphocytes following allogeneic hematopoietic stem cell transplantation. The need for safe and standardized preparation conditions for gene-modified cells is crucial. We describe the closed culture system used in the current trial for ex vivo retroviral-mediated gene transfer and transduced cell selection. Cell handling is performed in closed systems using sampling and transfer pack bags, culture bags and a sterile connection device which avoids opening the culture system. This closed system allows safe and reproducible ex vivo preparation of gene-modified primary T-lymphocytes for clinical use.

Arsenic residues in predatory birds from an area of Britain with naturally and anthropogenically elevated arsenic levels

Birds of prey forage over large areas and so might be expected to accumulate contaminants which are elevated but heterogeneously distributed in the general environment. The aim of this study was to test the hypothesis that arsenic levels in raptors from a region with elevated environmental arsenic concentrations were higher than those in birds from an uncontaminated part of Britain. Arsenic concentrations in the liver, kidney and muscle of kestrels, Falco tinnunculus, sparrowhawks, Accipiter nisus, and barn owls, Tyto alba, from south-west (SW) England, an area with naturally and anthropogenically (through mining) elevated environmental arsenic concentrations, were compared with those in birds from SW Scotland, where no such geochemical anomaly exists. Arsenic residues in kestrels from SW England were approximately three times greater than those in birds from SW Scotland for the three tissue types analysed. This was not the case for the other species in which arsenic residues were similar in birds from both regions. It is suggested that differences between species in both diet and arsenic metabolism could explain why kestrels have elevated arsenic tissue burdens in response to general environmental contamination but sparrowhawks and barn owls do not.

The purification of CD34 cells from human cord blood: comparison of separation techniques and cytokine requirements for optimal growth of clonogenic progenitors

This study was performed to assess the methods which gave maximal recovery of purified CD34/45+ cells from a cord blood specimen and optimal growth of progenitors cultured from the purified cells. Cord blood samples were separated using Percoll gradients (either one (1.080) or two successive (1.080 and 1.068) gradient(s)) and commercially available devices for CD34+ cell isolation (affinity columns as manufactured by CellPro Inc. or immunomagnetic separation procedure as devised by Baxter Inc.). "CellPro' or "Baxter' techniques gave similar results in terms of nucleated, CD34/45+ and progenitor cell concentration; however, the yield of CD34/45+ cells in the CD34+ enriched fraction was significantly higher when using the "CellPro' technique. We also found significantly higher numbers of CD34/45+ cells in the CD34+ enriched final fraction when using only one, 1.080, Percoll density gradient in the first separation step. Using one density separation step followed by the "CellPro' technique, we obtained an average of 3 x 10(6) purified CD34/45+ cells from samples containing 8.5 x 10(8) nucleated cells. Granulomonocytic progenitors (CFU-GM) and mixed progenitors (CFU-GEMM) cells from light-density and purified CD34/45+ cell fractions were evaluated. We found that 20-30% of the light-density cells and the purified CD34/45+ cells, yielded a granulomonocytic colony in serum free medium in the presence of interleukins 3 and 6, erythropoietin, granulomonocytic and granulocytic colony-stimulating factors and stem cell factor. The addition of tumour-necrosis factor alpha to the cocktail significantly improved the growth of CFU-GEMM allowing 10% of the purified CD34/45+ cells to yield a mixed colony, which confirms the role of this cytokine on CD34+ cells from cord blood. This study provides an improved method for recovery of CD34/45+ purified cells and their colony formation. These methods may serve as a basis for studies on CD34/45+ cell amplification and gene transfer.

Lead concentrations in birds of prey in Britain

This paper reports on lead (Pb) concentrations in the livers of 424 individuals of 16 raptor species found dead and sent for analysis to the Institute of Terrestrial Ecology, Monkswood, from the early 1980s to the early 1990s. Elevated Pb concentrations in liver (>20 ppm dry wt), within the range associated with Pb poisoning mortality in raptors, were recorded in one peregrine (4% of species sample) and one buzzard (2% of species sample). These birds are likely to have ingested lead gunshot in the flesh of their prey. Another one each of these species had liver Pb concentrations of 15-20 ppm dry wt, reflecting unusually high absorption of Pb. No individuals of any other species had >15 ppm dry wt liver Pb, although some had 6-15 ppm. The source of Pb in these birds was unknown, but it could have resulted from high Pb concentrations in prey items, including some containing lead shot. Median liver Pb concentrations were generally very low (ranging from <0.07 to 1.61 ppm dry wt for species with sample sizes exceeding 10). In sparrowhawks, for which a large sample was available, liver Pb concentrations in all but one individual were low (<2.6 ppm dry wt). Pb concentrations in juveniles were significantly lower than in adults, and were lowest in recently fledged birds.

The effect of temperature on spontaneous action potential discharge of the isolated sinus venosus from winter and summer plaice (Pleuronectes platessa)

The spontaneous cardiac pacemaker activity and conformation were recorded in vitro, using intracellular recording methods, from heart tissue of summer- and winter-caught plaice. The effects of changing temperature on the pacemaker rate, duration of action potential and diastolic depolarization were investigated by altering the temperature of the superfusing medium. The resting intrinsic rate of discharge was significantly greater in pacemaker cells from winter plaice (P=0.05), but there was no significant difference between winter and summer fish in the apparent Arrhenius activation energies for this process. However, there was a significant difference in the estimated intercept, indicating a thermal shift in the processes underlying the spontaneous pacemaker rhythm. There was no significant difference in the diastolic depolarization duration recorded from winter and summer fish over the temperature range 4&shy;22 &deg;C. The major effect of previous environmental temperature was on the duration of the action potential (P&lt;0.02), indicating that the observed changes in pacemaker discharge rate were not influenced by the processes that determine the duration of the pacemaker diastolic depolarisation but were modulated by the channel events that give rise to the action potential.

Toward cord blood banking: density-separation and cryopreservation of cord blood progenitors

It has been shown that cord blood collected at birth can be used to successfully engraft a human lymphocyte antigen (HLA)-matched sibling suffering from a malignant disease. It has been further suggested that this source of cells may be used in unrelated but HLA-compatible patients. These wide indications would imply the establishment of cord blood banks comprising 10(5) or more samples. In this report we show that it is possible to fractionate and freeze cord blood samples without major loss in granulomonocytic or erythroblastic progenitors (CFU-GM and BFU-E). Density separation should be carried out using Percoll of density 1.080. Separated samples should be frozen and thawed in the presence of DNase I. This procedure should allow the storage of approximately 10 mL samples in cryotubes containing a number of CFU-GM and BFU-E sufficient to engraft a patient weighing less than 30 kg. These data provide a rationale for establishing cord blood banks.

Long-term trends in organochlorine and mercury residues in some predatory birds in Britain

Residue levels of organochlorine pesticides (HEOD, DDE), polychlorinated biphenyls (PCBs) and mercury (Hg) in the livers of five predatory bird species were monitored in Britain over a 28-year (1963-1990) period. Of two raptor species, sparrowhawks contained higher levels of most chemicals than did kestrels. Among three fish-eaters, herons and kingfishers contained the highest levels of DDE and HEOD, while herons and great-crested grebes contained the highest levels of PCBs and mercury. Species differences were related partly to diet and habitat. In sparrowhawks and kestrels, residues of HEOD and DDE were higher in eastern, arable districts than elsewhere, especially in the 1960s and 1970s. In the fish-eaters, similar regional differences in residue levels were apparent in herons, especially in the 1970s, but not in the other species, for which samples were smaller. Over the 28 years, most species showed significant downward trends in HEOD, DDE and Hg levels, but only two fish-eaters showed significant declines in PCB levels. The downward trends in DDE and HEOD followed successive restrictions in the use of organochlorine pesticides, and were accompanied by recoveries in the populations and breeding success of affected species. Downward trends in mercury were associated with reductions in both agricultural use and industrial emissions.

Mortality from the pesticides aldrin and dieldrin in British Sparrowhawks and Kestrels

Among 1029 dead Sparrowhawks and 1055 dead Kestrels from various parts of Britain that were examined over the period 1963-90, the main causes of death were (a) collisions of various kinds (b) starvation or disease and (c) organochlorine poisoning. The main chemical which caused poisoning was HEOD, derived from the insecticides aldrin and dieldrin. Other deaths were attributed to poisoning by DDE (the main metabolite of the insecticide DDT) and by HE (heptachlor epoxide, derived from the insecticide heptachlor). Sparrowhawks whose deaths were attributed to HEOD poisoning contained 5-85 µg g(-1) HEOD in their livers (wet weight), while Kestrels contained 6-99 µg g(-1) HEOD. Such birds were typically lighter in weight than collision victims, but heavier than starved or diseased birds. In the period 1963-75, HEOD probably accounted for about 50% of all recorded Sparrowhawk deaths and 39% of all recorded Kestrel deaths in eastern arable districts, but a smaller proportion elsewhere. Geographical variation in the proportion of deaths attributed to HEOD paralleled variation in the proportion of land devoted to arable crops on which aldrin and dieldrin were mainly used. It also paralleled variation in the extent of population decline in these species. Moreover, the proportion of deaths attributed to HEOD declined between 1963-75 and 1976-86, following a marked reduction in aldrin-dieldrin use, and fell to nil in 1987-90, when aldrin and dieldrin were withdrawn altogether. Over this period, the populations of both species recovered from a decline which occurred in the late 1950s, when aldrin-dieldrin were first introduced.

The cytoskeleton of stromal cells from human bone marrow cultures resembles that of cultured smooth muscle cells

The cytoskeleton of stromal cells from the adherent layer of human Dexter-type cultures has been studied. It was found that the stress fibers contained actin specific for smooth muscle, mainly the alpha SM actin isoform. The intermediate filaments consisted of vimentin, and there were no desmin filaments. This pattern was similar to that of cultured vascular smooth muscle cells. The detectability of the alpha SM actin isoform is coincident with the appearance of stromal cells in long-term marrow cultures and may provide a useful marker for stromal cells. The potential in vivo cellular counterpart for stromal cells generated in the Dexter-type culture system is discussed.

Rodenticides in British barn owls

Out of 145 Barn Owls found dead through accidents (66%), starvation (32%), shooting (2%) and poisoning (<1%), 10% contained residues of rodenticides, difenacoum or brodifacoum, in their livers. Difenacoum was in the range 0.005-0.106 microg g(-1) fresh weight, and brodifacoum was in the range 0.019-0.515 microg g(-1). Minimum levels of detection were about 0.005 microg g(-1) for both chemicals. Mice fed for 1 day on food containing difenacoum and brodifacoum died after 2-11 days. Within these mice residues were present at greater concentration in the liver than in the rest of the carcass. The mean mass of residue in a whole 35g mouse was estimated at 10.17 microg (range 4.73-20.65 microg) for difenacoum and 15.36 microg (range 8.07-26.55) for brodifacoum. Such poisoned mice were fed to Barn Owls for successive periods of 1, 3 and 6 days. All six owls fed on difenacoum-dosed mice survived all three treatments, in which up to an estimated 101.7 microg of difenacoum was consumed, and the coagulation times of their blood returned to near normal in less than 5-23 days. Four of the six owls fed on brodifacoum-dosed mice died 6-17 days after the 1-day treatment, but the survivors also survived the 3-day and 6-day treatments. Those that died had each eaten 3 mice, with a combined weight of about 105g and a total brodifacoum content of about 46.07 microg, which was equivalent to a dose of 0.150-0.182 mg kg(-1) of owl body weight. After death these owls had 0.63-1.25 micro g(-1) of brodifacoum in their livers. Blood from the survivors would not coagulate at 9 days post-treatment, but did so at 16 days in one bird and between 38 and 78 days in the other. It is concluded that: (1) Barn Owls in Britain are now widely exposed to second-generation rodenticides; (2) not all owls exposed to these chemicals are likely to receive a lethal dose; (3) brodifacoum is more toxic to owls than difenacoum; and (4) while there is yet no evidence that rodenticides have had any appreciable effect on Barn Owl populations in Britain, further monitoring of residue levels and population trends in desirable.

Trends in organochlorine and mercury levels in Gannet eggs

Levels of DDE, HEOD, PCBs and mercury were measured in Gannet eggs from several colonies around Britain during 1971-1987. At two colonies (Ailsa Craig and Bass Rock) sampled throughout this period, organochlorine levels declined between the early 1970s and 1983, and then increased again. The trends at other colonies, sampled over shorter periods, were generally consistent with those at Ailsa Craig and Bass Rock. Trends in mercury levels were more variable, and increases were observed at four colonies and declines at two. Some shell-thinning occurred in association with DDE contamination. However, levels of this chemical were too low to affect breeding success in the years concerned. The same was probably true of the other chemicals.

Determination of critical pollutant levels in wild populations, examples from organochlorine insecticides in birds of prey

In assessing effects of pollutants on wild organisms, ecological concern is not so much with the protection of individuals, but with the maintenance of self-sustaining populations. Measures of the toxicity of chemicals made under laboratory conditions are thus of limited use when applied to populations in the field. For wild populations the critical level of any pollutant is that level which will lead to population decline (LPD). Among a range of species, this level may bear no consistent relationship to the LD(50) (or LC(50)). In some British birds of prey, whose numbers had been reduced mainly by HEOD poisoning, it was possible to determine the level of HEOD in the birds below which population recovery occurred. For Sparrowhawk and Kestrel, this was equivalent to a geometric mean HEOD level in livers of birds found dead of about 1.0 microg g(-1) (in wet weight). For Peregrines, it was equivalent to a geometric mean HEOD level in addled eggs of 0.7 microg g(-1) (wet weight).

Megakaryocytic development in liquid cultures of cryopreserved leukocyte stem cell concentrates from chronic myelogenous leukemia patients

The proliferation and differentiation of human megakaryocytes in liquid culture has been obtained using cryopreserved light-density blood cell concentrates from chronic myelogenous leukemia (CML) patients. A large number of megakaryocytes, representing 20%-60% of total cells cultured, developed after 12-14 days in liquid cultures supplemented with human plasma, while fetal calf serum supported the development of cells of the megakaryocytic lineage poorly. Ploidy studies showed the presence of 8N and 16N cells in human plasma-supplemented cultures while very few cells with DNA content greater than 4N were found in those supplemented with fetal calf serum. Using the FACS IV cytofluorometer, 1-2 X 10(6) megakaryocytes/h were sorted after immunolabeling of the human plasma-cultured cells with a monoclonal antibody reacting against the platelet glycoprotein complex IIb-IIIa. Thus, cryopreserved CML blood stem cell concentrates seem to offer a reproducible source of human megakaryocytes that retain their capacity to proliferate and differentiate in liquid cultures. These megakaryocytes can be used for the study of platelet glycoprotein biosynthesis as well as the regulation of megakaryocytopoiesis.

Stereophotogrammetric analysis of changes in body volume associated with the induction of anaesthesia

Changes in the volume of the trunk were measured in seven supine patients, when anaesthesia was induced with thiopentone i.v. Stereo-photograms were taken before and after induction and measurements of volume calculated from contour plots of a reconstructed stereo image. The changes in volume of the visible part of the trunk were between -846 and +505 ml. No systematic change in total or lower trunk ("abdominal") volume was evident, but there was a significant negative linear relationship (r = -0.87) between upper trunk ("ribcage") volume change and obesity (expressed as actual weight/expected weight). Changes in volume were more evident in the upper parts of the supine subject, in both ribcage and abdomen (P less than 0.05).