Constructing a Plasma Nutriproteome for Population Assessment: Analytical Considerations

Objectives

Micronutrient status is rarely assessed in low-income settings. Proteomics may offer a proxy by measuring plasma proteins correlated with nutrients on a single platform. However, the proteome is huge, diverse and measured in different ways. We describe an analytic framework and decision process to explore nutrient: protein (N:P) associations for micronutrient status assessment.

Methods

In plasma of 435 1st trimester women in rural Bangladesh, we compared relative protein abundance, revealed by a multiplexed slow off-rate modified aptamer assay (SomaLogic, Inc), to biochemical concentrations of vitamins A, D, E, B9, B12, Zn, Se, Cu, I, & Fe, 5 carotenoids, cholesterol and AGP. After log2-transforming protein abundance per convention, N:P relationships were summarized by simple linear regression. We assessed reliability by Pearson correlation (rp) and coefficients of variation (CV) in 20 blind duplicates. To define each plasma nutriproteome [proteins correlating at a false discovery rate < 0.05], in all samples we explored a) normalizing protein abundance to the median of our sample vs not, b) assessing correlations by rp vs Spearman rank (rs) estimators, and c) log2-transforming (log2) nutrients vs not. We compared differences in the number of proteins and N:P correlative strength (either more negative/positive by rp or rs) in each proteome when nutrient concentrations were left untransformed vs log2-transformed.

Results

In duplicates, log2-transformed proteins that were normalized, vs not, to the sample-specific median generated higher median rp (0.92 vs. 0.87) and rs (0.87 vs. 0.85) and lower CV (4.8% vs. 11.7%). The median (IQR) size of the nutriproteomes was 147 (41–340) proteins by rp and 87 (29–639) by rs. For >50% of proteins in 13 nutriproteomes, rp was stronger than rs (in either +/− direction), favoring use of rp. Log2-transforming folate (B9), Zn & cholesterol increased proteome size by 39, 223 & 875 proteins and strengthened rp for >50% of proteins than untransformed nutrients. Other proteomes remained larger when nutrient concentrations remained untransformed.

Conclusions

Comparing plasma protein: nutrient associations via methods of normalization, transformation, and correlation offers a framework to guide plasma nutriproteome definition.

Funding Sources

Johns Hopkins University.

A Plasma Cuprome Exists With Predictors of Copper Status in Nepalese Children

Objectives

Copper (Cu) is an essential micronutrient but, due to difficulties of measuring Cu by atomic absorption spectroscopy (AAS), plasma Cu status is rarely assessed in low income countries. A less costly assay is needed. We have explored whether plasma Cu concentration can be predicted by modelling strongly associated plasma proteins, assessed by mass spectrometry (MS), that could be assayed with other nutriproteomic biomarkers on one platform in the future.

Methods

In plasma samples from 500 Nepalese children 6–8 y of age, the mean (SD) plasma Cu concentration measured by AAS was 23.3 ± 5.7 mmol/L, with 13.6% classified as deficient (< 10 mmol/L). We quantified relative abundance of 982 plasma proteins by iTRAQ tandem MS following affinity depletion of six high abundance proteins (Cole J Nutr 2013) and correlated their relative abundance with plasma Cu by linear mixed effects regression. We defined a stringent plasma cuprome comprising proteins associated with Cu at a false discovery rate (q) < 0.01. Missing values were imputed and proteins were fit by forward, stepwise regression analysis, meeting an AIC reduction of ≥ 30, to model plasma Cu status.

Results

There were 134 (q < 0.01) proteins in the plasma cuprome. Among 62 positive correlates were ceruloplasm (r = 0.65), 9 complement proteins (r = 0.29 to 0.45), 4 serpin protease inhibitors (r = 0.31 to 0.43) with others involved in coagulation, 5 LRR structural motifs as found in toll-like receptors (r = 0.35 to 0.58), signaling enzymes such as CDC42BPA (r = 0.70) and proinflammatory reactants and regulators such as CRP, AGP, amyloids and TNIP1 (r = 0.40 to 0.56). Among 72 negative correlates (r = −0.29 to −0.42) are lipid and sterol binding and transport proteins including apolipoproteins/lipocalins, enzyme regulating proteins, extracellular adhesion, signaling and matrix proteins. Different members of serine peptidase inhibitor members were among + and – correlates. Forward stepwise regression fit 6 proteins (CP, CDC42BPA, LRRC47, TDRD9, LLRIQ1, LRRCC1) that explain 76.5% of the variance (R2) in plasma Cu, sufficient for predicting plasma Cu status of a population.

Conclusions

A large, diverse plasma cuprome exists, as revealed in young Nepalese children, from which six proteins may adequately predict plasma Cu status.

Funding Sources

Bill & Melinda Gates Foundation (OPPGH5241) & Johns Hopkins University.

Plasma proteins associated with circulating carotenoids in Nepalese school-aged children

Carotenoids are naturally occurring pigments that function as vitamin A precursors, antioxidants, anti-inflammatory agents or biomarkers of recent vegetable and fruit intake, and are thus important for population health and nutritional assessment. An assay approach that measures proteins could be more technologically feasible than chromatography, thus enabling more frequent carotenoid status assessment. We explored associations between proteomic biomarkers and concentrations of 6 common dietary carotenoids (α-carotene, β-carotene, lutein/zeaxanthin, β-cryptoxanthin, and lycopene) in plasma from 500 6-8 year old Nepalese children. Samples were depleted of 6 high-abundance proteins. Plasma proteins were quantified using tandem mass spectrometry and expressed as relative abundance. Linear mixed effects models were used to determine the carotenoid:protein associations, accepting a false discovery rate of q < 0.10. We quantified 982 plasma proteins in >10% of all child samples. Among these, relative abundance of 4 were associated with β-carotene, 11 with lutein/zeaxanthin and 51 with β-cryptoxanthin. Carotenoid-associated proteins are notably involved in lipid and vitamin A transport, antioxidant function and anti-inflammatory processes. No protein biomarkers met criteria for association with α-carotene or lycopene. Plasma proteomics may offer an approach to assess functional biomarkers of carotenoid status, intake and biological function for public health application. Original maternal micronutrient trial from which data were derived as a follow-up activity was registered at ClinicalTrials.gov: NCT00115271.

A roadmap for the development of alternative (non-animal) methods for systemic toxicity testing

Systemic toxicity testing forms the cornerstone for the safety evaluation of substances. Pressures to move from traditional animal models to novel technologies arise from various concerns, including: the need to evaluate large numbers of previously untested chemicals and new products (such as nanoparticles or cell therapies), the limited predictivity of traditional tests for human health effects, duration and costs of current approaches, and animal welfare considerations. The latter holds especially true in the context of the scheduled 2013 marketing ban on cosmetic ingredients tested for systemic toxicity. Based on a major analysis of the status of alternative methods (Adler et al., 2011) and its independent review (Hartung et al., 2011), the present report proposes a roadmap for how to overcome the acknowledged scientific gaps for the full replacement of systemic toxicity testing using animals. Five whitepapers were commissioned addressing toxicokinetics, skin sensitization, repeated-dose toxicity, carcinogenicity, and reproductive toxicity testing. An expert workshop of 35 participants from Europe and the US discussed and refined these whitepapers, which were subsequently compiled to form the present report. By prioritizing the many options to move the field forward, the expert group hopes to advance regulatory science.

Socio-demographic and clinical characteristics of individuals with diagnoses of eating disorder in a university hospital in Istanbul

OBJECTIVE

This paper reports the first-ever description of a clinical eating disorder population from Turkey. The aim of this study was to examine the socio-demographic and clinical characteristics of individuals with diagnosis of eating disorders (IDED) referred to a university psychiatry clinic in Istanbul between 2003 and 2009.

METHOD

The diagnoses and subtype of 111 IDEDs, the referral type to the hospital, setting of treatment, and state of involuntary hospitalization were evaluated by interview and semi-structured questionnaire.

RESULTS

The clinical sample included 64 individuals with anorexia nervosa (AN), 38 with bulimia nervosa (BN), and 9 with eating disorder not otherwise specified (EDNOS), including only one male. Younger individuals and those with a lower BMI were significantly more likely to be family referred and hospitalized involuntarily.

DISCUSSION

The overall socio-demographic features of the sample are generally consistent with data collected in other communities. However, aspects of the clinical features, referral types of eating disorders and subtypes exhibit some characteristics peculiar to our sample.

Proposal of a 2-tier histologic grading system for canine cutaneous mast cell tumors to more accurately predict biological behavior

Currently, prognostic and therapeutic determinations for canine cutaneous mast cell tumors (MCTs) are primarily based on histologic grade. However, the use of different grading systems by veterinary pathologists and institutional modifications make the prognostic value of histologic grading highly questionable. To evaluate the consistency of microscopic grading among veterinary pathologists and the prognostic significance of the Patnaik grading system, 95 cutaneous MCTs from 95 dogs were graded in a blinded study by 28 veterinary pathologists from 16 institutions. Concordance among veterinary pathologists was 75% for the diagnosis of grade 3 MCTs and less than 64% for the diagnosis of grade 1 and 2 MCTs. To improve concordance among pathologists and to provide better prognostic significance, a 2-tier histologic grading system was devised. The diagnosis of high-grade MCTs is based on the presence of any one of the following criteria: at least 7 mitotic figures in 10 high-power fields (hpf); at least 3 multinucleated (3 or more nuclei) cells in 10 hpf; at least 3 bizarre nuclei in 10 hpf; karyomegaly (ie, nuclear diameters of at least 10% of neoplastic cells vary by at least two-fold). Fields with the highest mitotic activity or with the highest degree of anisokaryosis were selected to assess the different parameters. According to the novel grading system, high-grade MCTs were significantly associated with shorter time to metastasis or new tumor development, and with shorter survival time. The median survival time was less than 4 months for high-grade MCTs but more than 2 years for low-grade MCTs.

Toxicity testing in the 21st century: a vision and a strategy

With the release of the landmark report Toxicity Testing in the 21st Century: A Vision and a Strategy, the U.S. National Academy of Sciences, in 2007, precipitated a major change in the way toxicity testing is conducted. It envisions increased efficiency in toxicity testing and decreased animal usage by transitioning from current expensive and lengthy in vivo testing with qualitative endpoints to in vitro toxicity pathway assays on human cells or cell lines using robotic high-throughput screening with mechanistic quantitative parameters. Risk assessment in the exposed human population would focus on avoiding significant perturbations in these toxicity pathways. Computational systems biology models would be implemented to determine the dose-response models of perturbations of pathway function. Extrapolation of in vitro results to in vivo human blood and tissue concentrations would be based on pharmacokinetic models for the given exposure condition. This practice would enhance human relevance of test results, and would cover several test agents, compared to traditional toxicological testing strategies. As all the tools that are necessary to implement the vision are currently available or in an advanced stage of development, the key prerequisites to achieving this paradigm shift are a commitment to change in the scientific community, which could be facilitated by a broad discussion of the vision, and obtaining necessary resources to enhance current knowledge of pathway perturbations and pathway assays in humans and to implement computational systems biology models. Implementation of these strategies would result in a new toxicity testing paradigm firmly based on human biology.

Toxicity testing in the 21st century: a vision and a strategy

With the release of the landmark report Toxicity Testing in the 21st Century: A Vision and a Strategy, the U.S. National Academy of Sciences, in 2007, precipitated a major change in the way toxicity testing is conducted. It envisions increased efficiency in toxicity testing and decreased animal usage by transitioning from current expensive and lengthy in vivo testing with qualitative endpoints to in vitro toxicity pathway assays on human cells or cell lines using robotic high-throughput screening with mechanistic quantitative parameters. Risk assessment in the exposed human population would focus on avoiding significant perturbations in these toxicity pathways. Computational systems biology models would be implemented to determine the dose-response models of perturbations of pathway function. Extrapolation of in vitro results to in vivo human blood and tissue concentrations would be based on pharmacokinetic models for the given exposure condition. This practice would enhance human relevance of test results, and would cover several test agents, compared to traditional toxicological testing strategies. As all the tools that are necessary to implement the vision are currently available or in an advanced stage of development, the key prerequisites to achieving this paradigm shift are a commitment to change in the scientific community, which could be facilitated by a broad discussion of the vision, and obtaining necessary resources to enhance current knowledge of pathway perturbations and pathway assays in humans and to implement computational systems biology models. Implementation of these strategies would result in a new toxicity testing paradigm firmly based on human biology.

Control of Drosophila perineurial glial growth by interacting neurotransmitter-mediated signaling pathways

Drosophila peripheral nerves, similar structurally to the peripheral nerves of mammals, comprise a layer of axons and inner glia, surrounded by an outer perineurial glial layer. Although it is well established that intercellular communication occurs among cells within peripheral nerves, the signaling pathways used and the effects of this signaling on nerve structure and function remain incompletely understood. Here we demonstrate with genetic methods that the Drosophila peripheral nerve is a favorable system for the study of intercellular signaling. We show that growth of the perineurial glia is controlled by interactions among five genes: ine, which encodes a putative neurotransmitter transporter; eag, which encodes a potassium channel; push, which encodes a large, Zn(2+)-finger-containing protein; amn, which encodes a putative neuropeptide related to the pituitary adenylate cyclase activator peptide; and NF1, the Drosophila ortholog of the human gene responsible for type 1 neurofibromatosis. In other Drosophila systems, push and NF1 are required for signaling pathways mediated by Amn or the pituitary adenylate cyclase activator peptide. Our results support a model in which the Amn neuropeptide, acting through Push and NF1, inhibits perineurial glial growth, whereas the substrate neurotransmitter of Ine promotes perineurial glial growth. Defective intercellular signaling within peripheral nerves might underlie the formation of neurofibromas, the hallmark of neurofibromatosis.

Cerebral sinovenous thrombosis in children

BACKGROUND

Cerebral sinovenous thrombosis in children is a serious disorder, and information is needed about its prevention and treatment.

METHODS

The Canadian Pediatric Ischemic Stroke Registry was initiated in 1992 at the 16 pediatric tertiary care centers in Canada. Children (newborn to 18 years of age) with symptoms and radiographic confirmation of sinovenous thrombosis were included.

RESULTS

During the first six years of the registry, 160 consecutive children with sinovenous thrombosis were enrolled, and the incidence of the disorder was 0.67 cases per 100,000 children per year. Neonates were most commonly affected. Fifty-eight percent of the children had seizures, 76 percent had diffuse neurologic signs, and 42 percent had focal neurologic signs. Risk factors included head and neck disorders (in 29 percent), acute systemic illnesses (in 54 percent), chronic systemic diseases (in 36 percent), and prothrombotic states (in 41 percent). Venous infarcts occurred in 41 percent of the children. Fifty-three percent of the children received antithrombotic agents. Neurologic deficits were present in 38 percent of the children, and 8 percent died; half the deaths were due to sinovenous thrombosis. Predictors of adverse neurologic outcomes were seizures at presentation and venous infarcts.

CONCLUSIONS

Sinovenous thrombosis in children affects primarily neonates and results in neurologic impairment or death in approximately half the cases. The occurrence of venous infarcts or seizures portends a poor outcome.

Implementing the revised American Psychiatric Association practice guideline for the treatment of patients with eating disorder

Practice guidelines aspire to be authoritative statements regarding the state of the art in quality care for various clinical problems. The American Medical Association Partnership has set forth stringent parameters for guideline development by professional organizations, and these have been followed by the American Psychiatric Association in creating its practice guidelines for the treatment of patients with eating disorders. The revised edition, published in January 2000, benefitted from extensive input from a wide array of psychiatrists, psychologists, pediatricians, and other recognized experts who blended together available evidence-based practice with a considerable amount of clinical experience and consensus. These guidelines are useful for practitioners, students, and health-resource managers. Future research will continue to lead to constant upgrades.

E-mail as a therapeutic adjunct in the outpatient treatment of anorexia nervosa: Illustrative case material and discussion of the issues

OBJECTIVE

To explore using adjunctive e-mail in treating anorexia nervosa.

METHOD

Four treatment plans were supplemented by obligatory e-mail emphasizing patients' reports of specific eating-related behaviors. Office visits occurred weekly to once every few months. E-mail contact occurred once to several times per week. Patients also saw other providers.

RESULTS

All patients have shown good clinical improvement. Patients provided their assessments of contributions made by the use of e-mail and generally found it to be helpful.

DISCUSSION

E-mail has had excellent patient acceptability and adherence. Benefits have been attributed to increased therapeutic contact, "talking" on demand, and having to frequently confront one's integrity, honesty, and eating behaviors. Little clinician time is needed for reading and responding to e-mails. Informed consent and confidentiality issues must be carefully addressed. Controlled trials are warranted to further evaluate the roles that adjunctive e-mail may play in clinical research and practice.

Development and validation of the Parental Intrusiveness Rating Scale among bulimic and comparison women

OBJECTIVE

Based on hypotheses generated during clinical interviews with 80 women with a lifetime history of bulimia nervosa (BN), we designed an instrument for assessing the extent to which women with BN report parental intrusiveness and breakdown of appropriate role boundaries during their adolescent development.

METHOD

Through an iterative process of item generation and scale administration, the Parental Intrusiveness Rating Scale (PIRS), consisting of 20 maternal items and 20 paternal items, was developed. Maternal subscales include Invasion of Privacy, Jealousy and Competition, and Overconcern with the Daughter's Eating, Weight, and Shape. Paternal subscales include Invasion of Privacy, Seductiveness, and Overconcern with the Daughter's Eating, Weight, and Shape. We validated the instrument using a subset of the above BN and comparison women (ns = 55 and 33, respectively), as well as an independent sample of women with BN and college comparison subjects (ns = 31 and 540, respectively).

RESULTS

Parental intrusiveness scores were significantly positively correlated with disturbed relationships in the family of origin of our initial cohort. Reliability analyses, both test-retest and item-scale correlations, revealed adequate to strong statistical associations in the combined sample.

CONCLUSION

The PIRS promises to enrich our understanding of problematic parental behaviors among women who develop BN and allows us to broaden the conceptualization of familial risk factors for this disorder.

Parental intrusiveness in adolescence recalled by women with a history of bulimia nervosa and comparison women

OBJECTIVE

To learn if women with a lifetime history of bulimia nervosa (BN) report more intrusive parental behavior during adolescence than their nonclinical peers, and to provide further validation of the Parental Intrusiveness Rating Scale (PIRS).

METHOD

We administered the PIRS to 86 women with a lifetime history of BN and 573 comparison subjects and examined between-group differences.

RESULTS

Relative to the comparison group, lifetime BN subjects reported higher levels of parental intrusiveness, specifically maternal invasion of privacy, maternal jealousy and competition, paternal seductiveness, and maternal and paternal overconcern with the daughter's eating, weight, and shape. There were no between-group differences in paternal invasion of privacy. In exploratory analyses with the comparison sample, Caucasian women reported greater maternal jealousy and competition than Asian American/Pacific Islander women, but there were no other differences.

CONCLUSION

These results support clinical observations of high levels of parental intrusiveness in the adolescent experiences of women who develop BN. Nonclinical women of diverse ethnic backgrounds report largely equivalent experiences.

Social support, social adjustment, and recovery status in bulimia nervosa

OBJECTIVE

To examine recovery status in bulimia nervosa (BN) and its relation to social support and social adjustment.

METHOD

Using a cross-sectional design, we administered the modified Social Support Questionnaire and the Social Adjustment Scale-Self-Report (SAS-SR) to 40 women, each of whom was actively bulimic (ABN), was in remission from BN (RBN), or had no history of eating disturbance (comparison).

RESULTS

In terms of social support, relative to RBN and comparison subjects, the ABN group had significantly fewer persons in their friendship and kinship networks available to provide emotional support, although the groups were equivalent in number of persons available to provide things and advice. Relative to the comparison group, both bulimic groups were significantly dissatisfied with the quality of emotional support provided by relatives. On the SAS-SR, women in the ABN group displayed the poorest overall social functioning. The RBN group was functioning significantly better than the ABN group, but significantly more poorly than the comparison group.

DISCUSSION

Our results suggest that the social functioning of RBN women lies between ABN women and non-eating-disordered women, indicating both gains relative to the active phase and residual deficits.

The quality of psychiatric residency : the assessment of programs and options for distributing psychiatric residents in the service of health care reform

Recent health care reform initiatives proposed training fewer medical specialists, including psychiatrists, and determining the size and location of training programs via centralized regulatory mechanisms. Facing such potential future developments, the American Association of Directors of Psychiatric Residency Training appointed a Task Force on the Quality of Residency Programs to develop informed recommendations for the field. This paper describes the Task Force's considerations and recommendations concerning how the least damaging and most effective decisions could be made regarding the distribution of residency positions, program size, and the future funding of training stipends. The recommendations emphasize voluntary decisions, feedback from local and regional stakeholders regarding perceived needs and demands for psychiatrists, and Federal or regional funding of postgraduate training stipends that are not primarily tied to providing clinical services.

Downsizing psychiatric residency programs : a pilot study

Under the varied pressures of decreasing recruitment of American medical school graduates into psychiatry, the thrust of health care policymakers to decrease the production of specialist physicians, and financial cutbacks for training by hospitals, universities, and governments at all levels, many psychiatric training programs are considering downsizing or have already implemented plans to do so. The authors describe the motivations, early experiences, anticipated concerns, and thoughts regarding downsizing obtained from interviews or questionnaires provided by 17 programs in 1993. On the basis of the authors' experiences, some recommendations are offered for the many programs likely to deal with this issue in the future.

Practice guidelines and psychiatric education : potential implications

The American Psychiatric Association's practice guidelines provide authoritative guidance for assessing and treating major clinical problems that psychiatrists face. This article reviews the social context in which practice guidelines have emerged, opportunities they afford educators, and limitations in their educational and practice applications. Practice guidelines should be used in residents' and medical students' seminars and in continuing medical education activities. The incentive to study guidelines may increase as their likely use as information sources for questions on in-service and specialty board certification examinations as well as in clinical quality-assurance activities becomes more widely recognized.

Intercomparison of analytical methods for arsenic speciation in human urine

An intercomparison exercise was conducted for the quantification of arsenic species in spiked human urine. The primary objective of the exercise was to determine the variance among laboratories in the analysis of arsenic species such as inorganic As (As+3 and As+5), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA). Laboratories that participated had previous experience with arsenic speciation analysis. The results of this interlaboratory comparison are encouraging. There is relatively good agreement on the concentrations of these arsenic species in urine at concentrations that are relevant to research on the metabolism of arsenic in humans and other mammals. Both the accuracy and precision are relatively poor for arsenic concentrations of less than about 5 micrograms/l.

Preparing psychiatric residents for managed care. Values, proficiencies, curriculum, and implications for psychotherapy training

As managed care psychiatric service systems become increasingly prominent in academic centers and the larger world of psychiatric practice, residency programs find themselves having to adapt to the value systems and training paradigms necessary for preparing house staff to deal with these systems. Many of the values and some of the necessary proficiencies differ considerably from those of traditional fee-for-service psychiatric practice. This article delineates the value systems under which managed care systems operate, the clinical proficiencies that will be needed by psychiatrists practicing in such settings, the experiential and didactic curriculum necessary to prepare today's psychiatric residents for adapting to managed care-oriented practices, and the implications of these changes for psychotherapy education and training.

Histories of childhood trauma and complex post-traumatic sequelae in women with eating disorders

The profound self-destructiveness and tenacity of eating disorders found among women abused and neglected in childhood become comprehensible when understood within a complex posttraumatic conceptualization as desperate attempts to regulate overwhelming affective states and construct a coherent sense of self and system of meaning. Trauma leads to the predictable consequences of dysregulation of the arousal system, avoidance, and constriction of affect; coherence of self and world are shattered. Abused patients' childhood experiences teach them that to need is to expose oneself to the pain of abandonment and betrayal at the hands of individuals responsible for their care. Consequently, needs-psychological, physical, and spiritual-come to be perceived as dangerous, and human relationships are simultaneously yearned for and feared. Robbed of the opportunity to develop a cohesive self and a coherent system of meaning and faith to sustain from within, the traumatized eating-disorder patient turns to the culture to tell her who to be and how to live; she learns that to conquer rather than satisfy needs and to be "in control" (an internal state of equanimity manifested externally in a thin body) will bring meaning and purpose. Binge eating, purging, and starving become apt metaphors for the boundless hunger, the wish to fulfill needs together with the wish to rid oneself forever of need, the desire to "purify" the damaged psychic and physical self, and the hope of restoring meaning. The treatment of the traumatized eating disorder patient is complex. Individual therapy provides the opportunity for intensive relational work that begins to restore faith in human connection and that provides a "safe base" from which to examine the trauma and separate past from present. Therapy groups for eating-disordered women and trauma survivors provide relief from isolation, valuable perspectives from others who have "been there," and the opportunity to contribute to others' healing as one heals. Ultimately, these patients must be willing to leave the world of obsession with food and weight, which guarantees safety from interpersonal hurt while it simultaneously guarantees that hope will not be restored. Though reconnecting with humanity carries the risk of further pain, it opens up the opportunity for connection, healing, and growth.

Engineering of a sugar-derivatized porous network for hepatocyte culture

Many tissue engineering applications require a scaffold or template conducive to cell attachment and maintenance of functions. It may also be advantageous in some cases for these scaffolds to have a controlled porous architecture to facilitate cellular or tissue ingrowth. In this study, we have engineered a porous carbohydrate-derivatized substrate for hepatocyte culture. Polystyrene foams, with pore sizes up to 100 microns, fabricated by phase separation from a homogeneous naphthalene solution, were derivatized with lactose and heparin, both of which are known to promote rat hepatocyte attachment and maintenance of its differentiated functions. Rat hepatocytes cultured on these derivatized foams exhibited a rounded cellular morphology with many microvilli evident on the surface of the cells. The hepatocytes showed an increase in albumin secretion for the first 3 days of culture in a defined, serum-free medium, and dropped back to initial levels by the end of 7 days. The production of cytochrome P450-dependent hydroxytestosterone metabolites were also measured. Two testosterone metabolites were maintained and five others were present but decreased over a culture period of 1 week. These carbohydrate-derivatized porous substrates may be useful for large-scale culture of hepatocytes, toxicology screening and for use in a liver assist device.

Lasionectes exleyi, sp, nov., the first remipede crustacean recorded from Australia and the Indian Ocean, with a key to the world species

The first remipede crustacean from the Southern Hemisphere and the Indian Ocean is reported. Lasionectes exleyi, sp. nov., is described from an anchialine cave on the Cape Range peninsula of Western Australia. This is the eleventh species of modern remipede to be described and the second species to be described in the genus Lasionectes. A key to all known species is presented. The discovery of remipedes in Australia represents the first occurrence of a genus other than Speleonectes off the Bahamas Banks and only the second continental occurrence of extant remipedes. The species is known from below a density interface in a single nutrient-enriched cave.

Temporal evolution of neuropathologic changes in an immature rat model of cerebral hypoxia: a light microscopic study

The sequential evolution of neuropathologic changes was studied in an immature model of cerebral hypoxia-ischemia. According, 7-day postnatal rats were subjected to unilateral common carotid artery ligation combined with 2 h of hypoxia (breathing in 8% oxygen) and their brains were examined by light microscopy at recovery intervals ranging from 0 to 3 weeks. Immediately following hypoxia, a large area with a pale staining border was noted occupying most of the cerebral hemisphere ipsilateral (IL) to the occluded common carotid artery; in approximately half of the brains the dorsomedial cortex of the contralateral (CL) hemisphere was also involved. Most neurons in the pale area had nuclei containing a coarse granular condensation of chromatin. Within a few hours, the majority of neurons in the IL hemisphere had developed pyknotic nuclei and clear or eosinophilic perikarya. After 24 h these changes had evolved in the majority of brains into coagulation necrosis (infarction) in the IL hemisphere and foci of selective neuronal necrosis in the CL cortex. Within a few days infarcts became partially cavitated, and by 3 weeks a smooth-walled cystic infarct had developed. Activated microglia/macrophages and reactive astrocytes were first seen at 4 and 24 h, respectively. No parenchymal neutrophilic infiltrate was seen at any time point.

Aspects of childhood physical punishment and family environment correlates in bulimia nervosa

Although histories of child sexual abuse among eating disorder patients have attracted considerable attention in the past decade, relatively little is known about parental physical abuse among these patients. We examined aspects of childhood parental physical punishment and its family environmental correlates among women with a lifetime history of bulimia nervosa (BN group; n = 80) and women with no history of eating disorder (Control group; n = 40), recruited primarily by newspaper advertisement. Women in the BN group reported significantly more physical punishment and perceived their discipline to have been more harsh and capricious than women in the Control group. Nonetheless, the groups did not differ significantly in the extent to which they believed they deserved their punishment or in their belief that they were "physically abused." Further, subjects often failed to assert that they had been physically abused despite meeting conservative criteria, while the reverse tendency was uncommon. Finally, increased levels of physical punishment were associated with greater global family pathology in the BN group, but not in the Control group. Our findings underscore the necessity of explicitly inquiring about physically punitive events in the histories of bulimic women, as well as beliefs regarding these events.

Providing residents with a comprehensive educational program in outpatient psychiatry : integrating an outpatient curriculum into outpatient management teams

As part of their efforts to prepare psychiatry residents for comprehensive, practical outpatient psychiatric practice, the authors have established an organized training program in ambulatory psychiatry. The program consists of outpatient management teams that run from mid-PGY-2 to PGY-4, a specified minimum number of mandatory outpatient hours for continuity patient care, and suggested guidelines for residents' outpatient experiences. An outpatient management team curriculum has been designed for team leaders and trainees that consists of specific topics in outpatient care, associated learning objectives, and readings for each topic. This curriculum, which supplements our previous program of conferences, individual supervision, and a yearlong psychotherapy seminar series, has been refined over the past 5 years. The authors describe the program and the topics included in the curriculum.