Targeting temporal metabolic needs of T follicular helper cells to treat cGVHD utilizing a mitochondrial pyruvate carrier inhibitor

The curative potential of allogeneic hematopoietic stem cell transplantation is limited by development of chronic graft versus host disease (cGVHD) and metabolic regulation of immune cells is a promising therapeutic target. During cGVHD, interactions between T follicular helper (TFH) and germinal center B (GCB) cells result in production of alloreactive class-switched antibodies that attack host tissues, causing multi-organ damage and tissue fibrosis. We show the metabolic dependencies of TFH change throughout cGVHD progression and targeting mitochondrial pyruvate transport is an effective strategy to mitigate disease. Pyruvate, the end product of glycolysis, is transported by the mitochondrial pyruvate carrier (MPC) for use in the tricarboxylic acid cycle and oxidative phosphorylation (OXPHOS). TFH require glycolysis in order to induce a GC reaction, both in an immunization model and in an in vivo systemic cGVHD model with bronchiolitis obliterans (BO). Furthermore, Seahorse data from TFH extracted early in disease development in the BO model demonstrate increased dependency on glycolysis. But Seahorse data also indicates TFH undergo a shift away from glycolysis and toward OXPHOS as cGVHD continues. Based on the central role of MPC in tying pyruvate to multiple metabolic pathways, we examined an inhibitor of MPC (7ACC1) in reducing TFH activity. Administration of 7ACC1 resulted in inhibition of GCB production of class switched antibody in an in vitro assay. These findings were additionally supported in vivo, whereby daily treatment after establishment of cGVHD resulted in a decrease in disease severity. These data provide evidence that inhibiting mitochondrial pyruvate transport is a viable therapeutic strategy for cGVHD.

This work was supported by grants from National Institutes of Health, National Institute of Allergy, and Infectious Diseases R37 AI34495, T32 AI007313; National Heart, Lung, and Blood Institute R01 HL56067, R01 HL11879, R01 HL115114 ; National Cancer Institute P01 CA065493

Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication

INTRODUCTION Life expectancy in patients with schizophrenia is 15-20 years less than the general population. A dominant cause of morbidity and mortality in these patients is cardiovascular disease. Adverse consequences of modifiable cardiovascular risk factors can be reduced by regular monitoring of metabolic outcomes and intervention if required. AIM To evaluate the metabolic screening in primary care for patients with schizoaffective disorders managed in primary care. To show the usefulness of combining simple practice audits in evaluating such areas of clinical practice. METHODS An audit was undertaken in eight general practices in the Waikato and Bay of Plenty regions of New Zealand. Specifically, the monitoring of patients with schizophrenia or schizoaffective disorder whose antipsychotic medication was prescribed by primary care doctors was audited. Patient monitoring was compared to the guideline recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Best Practice Advisory Centre (BPAC). RESULTS In total, 117 patients were included in the audit and none were fully monitored, as recommended by the RANZCP guidelines. Although two-thirds of patients had been evaluated for glycosylated haemoglobin (HbA1c), lipids, blood pressure, complete blood count and weight, <10% of patients had had prolactin, waist circumference or electrocardiogram measurements recorded. The proportion of patients having a HbA1c measured was also significantly higher in younger patients and patients who were non-Māori or enrolled with an urban practice (all P<0.05). When using the simplified BPAC guidelines, half of all patients were correctly monitored. DISCUSSION These findings show there is room for improvement in the monitoring of patients receiving antipsychotic medication in primary care. This may indicate the need for clear guidance and general practitioner education around the monitoring requirements of these patients. Alternatively, a more simplified monitoring protocol may need to be developed. This audit has also shown that there is value in several practices completing the same audit and providing a larger cohort of patients for pooled data analysis.

Note on in vitro digestion of avocado products for pigs

In vitro (pepsin/pancreatin) digestibility coefficients of pulp, seed, and peel of avocados of the Creole and Hass varieties were studied according to a 2 x 3 factorial arrangement in which the factors were the variety and parts of the fruit. Creole avocado were heavier in natura than Hass exemplars (310.7 g and 156.8 g), whereas Hass had a greater proportion of pulp than the Creole fruits (76.0% and 64.6%). No significant interactions were observed. In vitro digestibility of dry matter (DM), organic matter (OM), and nitrogen (N) were higher for the Creole variety compared with the Hass. In vitro digestibility of N was similar in the pulp and seeds, and higher than in the peels (731, 773, and 550 g/kg-1, respectively). Use of the entire avocado as pig feedstuff would have a lower nutritional value compared with feeding just avocado pulp. Supplementation of a diet based on avocado with additional protein may be needed for optimal production.

SAT0581 SERIOUS INFECTION RATES WITH BIOLOGICAL DISEASE MODIFYING ANTI-RHEUMATIC AGENTS (bDMARDs) AND PREDISPOSING FACTORS: A 5-YEAR RETROSPECTIVE REVIEW

Background:

Biological and targeted synthetic disease modifying anti-rheumatic agents (bDMARDs) increase the risk of serious infections (SIs), however there is limited ‘real-world’ evidence comparing the relative risk of SI for individual bDMARDs. (1,2)

Objectives:

This study examines the rates of SIs in a non-select Australian Northern Queensland (NQ) cohort of patients with various rheumatic diseases receiving treatment with a bDMARD, to define predisposing factors and directly compare the bDMARDs.

Methods:

A retrospective review was performed for all patients who received a bDMARD through the Townsville Hospital Rheumatology Department over the 5-year period between June 2013 and May 2018. Episodes of a SI were defined as infection requiring admission or use of intravenous antibiotics. For each bDMARD the rate of SI per 100 patient years (PYs) was calculated and patient demographics and comorbidities were analysed. Between group differences were assessed using independent samples t-tests or ANOVA. Where assumptions were violated, Mann-Whitney U tests or Kruskal-Wallis tests were used. For categorical variables, chi-square tests were used, except when assumptions were violated when Fisher’s Exact tests were used.

Results:

296 patients received bDMARDs with an overall SI rate of 11.7/100PYs. There was no significant difference in presence of SI by disease type with 24% of patients with rheumatoid arthritis versus 19% with psoriatic arthritis, 14% with ankylosing spondylitis and 29% with “other” (X2=3.11; df=3; p=0.37). Respiratory tract infections were the most common infection (46%) followed by skin and soft tissue infections (23%). The highest incidence rate of SI occurred with rituximab (29.72 SI/100PYs) followed by certolizumab (22.50 SI/100PYs) and tocilizumab (15.00 SI/100PYs). Duration of time on a bDMARD, disease duration and use of methotrexate or leflunomide were not shown to significantly increase the risk of SI for the entire cohort. The characteristics which were shown to significantly increase SI rates were; prednisone use, increasing age, chronic pulmonary comorbidity and specifically in those with rheumatoid arthritis male gender and total duration of bDMARD use.

Conclusion:

In this real-world NQ cohort of patients treated with a bDMARD for a rheumatic disease, we have identified a number of factors potentially contributing to the risk of the development of SIs. This study provides valuable data on SI rates in an Australian ‘real-world’ cohort that may assist clinicians’ choice of bDMARD in patients with a high baseline risk of infection and highlights the importance of minimising prednisone use in patients on bDMARDs.

References:

[1]Ramiro S, Sepriano A, Chatzidionysiou K, et al. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017;76:1093–1101.

[2]Singh J, Wells G, Christensen R, et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;16:CD008794.

Disclosure of Interests: :

Kate Celkys: None declared, Jason Ly: None declared, Muriel Soden Speakers bureau: Speaker Fees from Pfizer in 2016

Inhibiting fatty acid synthesis (FAS) can prevent and treat chronic graft versus host disease (cGVHD)

GVHD remains the primary complication of allogeneic hematopoietic stem cell transplantation. Considerable interest exists in understanding how metabolism affects immune cell function. We show targeting FAS represents an attractive strategy to ameliorate cGVHD. Acetyl-CoA carboxylase 1 (ACC1) catalyzes the first step of FAS, and can be pharmacologically inhibited with either Soraphen A or 5-(Tetradecyloxy)-2-furoic acid (TOFA). FAS is critical for T cell effector responses, a finding we confirmed using an in vivo multiorgan system cGVHD model with bronchiolitis obliterans, a model dependent on germinal centers (GC), IgG2c secretion, lung deposition and fibrosis. Compared to wild type T cells, cGVHD mice receiving CD4CreACC1fl/fl allogeneic T cells had reduced cGVHD severity assessed by pulmonary function test and immune phenotyping. As thymic regulatory T cell (tTreg) infusion can prevent and treat cGVHD, we examined tTreg FAS needs. Inhibiting FAS in sorted tTreg via drug (Soraphen A; TOFA) or genetic (FoxP3CreACC1fl/fl) strategies increased oxidative and glycolytic metabolism measured by Seahorse assay, that correlated with superior in vitro suppressor function. These findings were extended in vivo where transfer of FoxP3CreACC1fl/fl tTreg, at day 28 following disease establishment, decreased cGVHD severity. Daily treatment of cGVHD mice from day 28 to day 56 with TOFA reversed cGVHD. An in vitro assay in which T follicular regulatory cells suppress T follicular helper and GC B cell class switching showed that inhibiting tTreg FAS can increase their suppression of GC responses. These data provide evidence that inhibiting FAS can prevent or treat cGVHD and enhance Treg function, providing a new approach to ameliorate cGVHD.

[Clinical management of acute stroke]

Stroke management dramatically changed during the last decades. Evidence shows that an early admission in a stroke unit offers the best chance of recovery to the stroke patient. The most spectacular aspect of the stroke unit activity consists of the hyperacute diagnostic and therapeutic stroke procedures, including prompt neuroimaging, intravenous thrombolysis and mechanical thrombectomy.

A comparison of the cost of primary closure or rectus abdominis myocutaneous flap closure of the perineum after abdominoperineal excision

AIM

Perineal wound complications following abdominoperineal resection continue to be a major challenge. The aim of this study was to compare the clinical outcomes and cost of primary closure (PC) and rectus abdominis myocutaneous (RAM) flap reconstruction.

METHOD

This was a retrospective case review of consecutive patients by one surgeon over 11 years. Patient demographics, risk factors, operative details and complications were identified. Inpatient and outpatient costs were calculated.

RESULTS

A total of 31 patients underwent a RAM reconstruction and 37 a PC. There were no significant differences in the incidence of wound complications or in the overall costs for either method of perineal closure. When there were no complications the mean costs were significantly higher in the RAM group ($20 948 vs $17 189, P = 0.005), mainly because of the longer operating time. However, the costs of perineal wound complications were greater in the PC group (8394 vs 25 911, P = 0.012). These wounds took longer to heal (median 2 months vs 5.5 months, P = 0.005) and more often required a further reconstructive surgical procedure (RAM 0 vs PC 8, P = 0.006).

CONCLUSION

This is the first study reporting on the cost implications of PC and RAM flap reconstruction. The overall costs were similar. This implies appropriate clinical selection when choosing between procedures. While the RAM flap is more expensive to perform, the finding that it decreases the clinical severity and cost of perineal wound complications supports its use when there is a high risk of perineal wound complications.

Ethnic, clinical and immunological factors in systemic lupus erythematosus and the development of lupus nephritis: results from a multi-ethnic New Zealand cohort

The aim of this study was to identify risk factors for lupus nephritis including clinical, laboratory, and ethnic factors in a cohort of lupus patients in New Zealand. A retrospective study of patients from two teaching hospitals in Auckland, New Zealand. Patients were selected if they had attended as either an inpatient, or a rheumatology outpatient between 2000 and 2005. 170 patients had SLE according to ACR classification. Lupus nephritis (LN) was diagnosed according to ACR criteria. Clinical, laboratory, and ethnic data were gathered from the patient notes. Twenty-four patients had LN at diagnosis and 32 patients developed LN after diagnosis. LN was associated with serositis ( P = 0.008), cutaneous vasculitis ( P = 0.026), anaemia ( P = 0.005), CRP elevation >6 months ( P < 0.001), hypocomplementaemia >6 months ( P < 0.0001). Patients with elevated doublestranded DNA (dsDNA) (>5 × normal) were more likely to develop type IV LN ( P = 0.0096). Forty-one percent of patients were Caucasian, 12% Maori, 23% Pacific People, 16% Asian, 6% Indian. Maori patients with SLE (odds ratio (OR) = 8.47, 95% confidence interval (CI) = 2.11—33.96, P = 0.002), and Pacific People (OR = 3.11, 95% CI = 1.29—11.48, P = 0.014) had increased risk for developing LN. Anaemia at presentation (hazard ratio (HR) 3.2, 95% CI = 1.4—7.1, P = 0.004), and low complement >6 months (HR = 3.4, 95% CI = 1.4—8.7, P = 0.008) were independent risk factors for developing LN after SLE diagnosis. In New Zealand, Pacific People and Maori patients with SLE have a higher incidence of LN, and patients with anaemia and hypocomplementaemia are more likely to develop LN after diagnosis. Patients with high dsDNA levels are more likely to develop Type IV lupus nephritis. Lupus (2007) 16, 830—837.

[Stroke and aging]

Stroke risk increases with aging and one third of ischemic strokes occurs in very elderly (> or = 80 years). These are responsible of two thirds of the overall stroke-related morbi-mortality. Stroke in very elderly differs from younger individuals by sex ratio (more women), risk factors (more atrial fibrillation and hypertension) and usually a worse functional outcome. Very elderly are likely to benefit from stroke unit care and early revascularisation treatments although they have historically been excluded from this urgent management. These issues are likely to worsen in the future with the increasing impact of stroke on our aging societies.

Salvage of the PWI/DWI mismatch up to 48 h from stroke onset leads to favorable clinical outcome

BACKGROUND AND PURPOSE

In acute ischemic stroke perfusion/diffusion-weighted image, mismatch using magnetic resonance imaging approximates the ischemic penumbra. For early time windows, mismatch salvage improves clinical outcomes, but uncertainty exists at later time epochs. We hypothesized that (a) mismatch may exist up to 48 h; (b) the proportion of mismatch salvage is time independent; and (c) when salvaged, it improves clinical outcomes.

METHODS

Magnetic resonance imaging was performed within 48 h of ischemic stroke. Perfusion-weighted image was defined by relative Tmax two-second delay. Perfusion/diffusion-weighted image mismatch was the perfusion-weighted image not overlapped by the diffusion-weighted image when coregistered. Infarct volume and disability (modified Rankin Score) were assessed at three-months. Mismatch salvage was the region not overlapped by final infarction. Favorable outcome was defined as modified Rankin Score 0-1.

RESULTS

Sixty-six patients were studied [mean age 69.9 years (standard deviation 13.1), initial median National Institute of Health Stroke Scale 9.0 (interquartile range 6.0, 18.3)]. There was no relationship between time of stroke onset and the proportion of mismatch salvaged (P = 0.73). Age (adjusted odds ratio = 0.92, 95% confidence interval 0.86-0.98, P = 0.01), initial National Institute of Health Stroke Scale (adjusted odds ratio = 0.80, 95% confidence interval 0.70-0.92, P < 0.01), mismatch volume (adjusted odds ratio = 0.98, 95% confidence interval 0.968-0.1, P = 0.05), and percentage of mismatch salvage (adjusted odds ratio = 1.04, 95% confidence interval 0.99-1.07, P = 0.05) were independently associated with favorable outcome.

CONCLUSION

Using coregistered perfusion/diffusion-weighted image criteria, mismatch persists up to 48 h post stroke. For the whole group, the proportion of mismatch salvage remains independent of time and, although the effect is small, its salvage is independently associated with improved clinical outcomes at three-months. Larger sample sizes are needed to determine the time limit for mismatch salvage.

Investigation of mechanism of drug-induced cardiac injury and torsades de pointes in cynomolgus monkeys

BACKGROUND AND PURPOSE

Drug candidates must be thoroughly investigated for their potential cardiac side effects. During the course of routine toxicological assessment, the compound RO5657, a CCR5 antagonist, was discovered to have the rare liability of inducing torsades de pointes (polymorphic ventricular arrhythmia) in normal, healthy animals. Studies were conducted to determine the molecular mechanism of this arrhythmia.

EXPERIMENTAL APPROACH

Toxicological effects of repeat dosing were assessed in naïve monkeys. Cardiovascular effects were determined in conscious telemetry-implanted monkeys (repeat dosing) and anaesthetized instrumented dogs (single doses). Mechanistic studies were performed in guinea-pig isolated hearts and in cells recombinantly expressing human cardiac channels.

KEY RESULTS

In cynomolgus monkeys, RO5657 caused a low incidence of myocardial degeneration and a greater incidence of ECG abnormalities including prolonged QT/QTc intervals, QRS complex widening and supraventricular tachycardia. In telemetry-implanted monkeys, RO5657 induced arrhythmias, including torsades de pointes and in one instance, degeneration to fatal ventricular fibrillation. RO5657 also depressed both heart rate (HR) and blood pressure (BP), with no histological evidence of myocardial degeneration. In the anaesthetized dog and guinea-pig isolated heart studies, RO5657 induced similar cardiovascular effects. RO5657 also inhibited Kv11.1 and sodium channel currents.

CONCLUSIONS AND IMPLICATIONS

The molecular mechanism of RO5657 is hypothesized to be due to inhibition of cardiac sodium and Kv11.1 potassium channels. These results indicate that RO5657 is arrhythymogenic due to decreased haemodynamic function (HR/BP), decreased conduction and inhibition of multiple cardiac channels, which precede and are probably the causative factors in the observed myocardial degeneration.

Systematic review and meta-analysis of cutting diathermy versus scalpel for skin incision

Background

Skin incisions have traditionally been made using a scalpel. Cutting diathermy, a more recent alternative, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest otherwise, claiming that diathermy may offer potential advantages with respect to blood loss, incision time and postoperative pain. The aim of this meta-analysis was to compare skin incisions made by either scalpel or cutting diathermy.

Methods

A systematic literature search and review was performed for studies published from January 1980 until June 2011. Randomized clinical trials comparing scalpel and cutting diathermy for skin incisions of any operation were included. Primary outcomes included wound complication rate, blood loss, incision times and pain scores.

Results

Fourteen randomized trials met the criteria for inclusion in the meta-analysis, providing outcome data for a total of 2541 patients (1267 undergoing skin incision by cutting diathermy and 1274 by scalpel). The median length of follow-up across all studies was 6 weeks (range 4 days to 19 months). Compared with a scalpel incision, cutting diathermy resulted in significantly less blood loss (mean difference 0·72 ml/cm2; P &lt; 0·001) and shorter incision times (mean difference 36 s; P &lt; 0·001), with no differences in the wound complication rate (odds ratio 0·87; P = 0·29) or pain score at 24 h (mean difference 0·89; P = 0·05).

Conclusion

Skin incisions made by cutting diathermy are quicker and associated with less blood loss than those made by scalpel, and there are no differences in the rate of wound complications or postoperative pain.

SOD1 overexpression improves features of the oligodendrocyte precursor response in vitro

Spinal cord injury (SCI) produces a significant loss of oligodendrocytes (OL) and demyelination. The oligodendrocyte precursor cells (OPCs) response includes a group of cellular changes in OPCs that are directed to replenish OL loss from the injury. However, this adaptive response is hampered and OPCs eventually die or fail to differentiate to mature and functional OL. In this study, we wanted to evaluate if overexpression of human superoxide dismutase 1 (hSOD1) in OPCs from the SOD1 transgenic rat could improve some of the features of the OPC response in vitro. We found that hSOD1 overexpression increases the proliferation of OPCs and accelerates their differentiation to mature OL in vitro. Furthermore, hSOD1 overexpression reduces oxidative stress-mediated death in OPCs. These results suggest hSOD1 as a therapeutic target to increase OPC response success and potentially, OL replacement and remyelination after SCI.

Retention of Sn(IV) and Pu(IV) onto four argillites from the Callovo–Oxfordian level at Bure (France) from eight equilibrated sedimentary waters

Within the framework of studies concerning the migration of radionuclides in a potential nuclear waste disposal host rock, the retention properties of clayey materials towards Sn(IV) and Pu(IV) are approached. Chemical sorption is quantified with the partitioning coefficientKd, whose value is dependent on the physico-chemical conditions. Four argillites are selected from three different deep boreholes at Bure to characterise the retention of Pu(IV) and Sn(IV) in eight waters close to the interstitial solution. No differences in major mineralogical composition distinguished these argillite samples. However, significant differences in retention properties of these argillites in the same water towards Sn, could be attributed to minor phases not identified by DRX. Retention of Sn or Pu is not sensitive to weak physico-chemical conditions variations.Ehconditions were imposed in the stability domain of Pu(IV). An auxiliary redox couple was tested and its impact on the results is briefly discussed. Sorption reversibility is verified for Sn(IV) and Pu(IV).

Penumbral mismatch is underestimated using standard volumetric methods and this is exacerbated with time

BACKGROUND AND AIMS

The mismatch between perfusion weighted images (PWI) and diffusion weighted images (DWI) using MR is increasingly being applied in patient selection for therapeutic trials. Two approaches to the calculation of the mismatch volume exist--the commonly used volumetric and the more precise co-registration method, the latter of which considers lesion topography. That there are differences in the mismatch volume analysed by each method and that these are time dependent was hypothesised.

METHODS

Patients within 48 h of ischaemic stroke onset had baseline MR PWI/DWI mismatch and T2 outcome volumes at 3 months. Volumetric mismatch volume was defined as PWI minus DWI lesion. Co-registration mismatch volume was defined as the PWI defect lesion not overlapped by the co-registered DWI lesion.

RESULTS

72 patients of median age 74.0 years were studied. Median baseline MR was at 5.9 h (IQR 3.0, 20.4 h) after stroke onset. Consistent underestimation of the mismatch volume occurred using the volumetric method (volumetric median 9.3 ml, IQR 0, 63 ml; co-registration median 20.1 ml, IQR 3.2, 69.8 ml; p<0.0001). This difference increased with time from stroke onset (p = 0.006).

CONCLUSIONS

Volumetric analysis consistently underestimates the PWI/DWI mismatch volume compared with the more precise co-registration method. This effect increases with time.

A test of radon service providers available on the Internet

With the announcement of the Government of Canada's Radon Guideline and increased public awareness of radon risk, more and more Canadians wish to test their homes for radon. Radon service providers available on the Internet have attracted many homeowners' attention. These services provide an easy and less expensive way for homeowners to test radon levels in their homes. However, a question has frequently been asked, 'How reliable are the radon testing services available on the Internet?' To answer this question, we ordered 36 radon testing kits from 10 service providers on the Internet. The test results showed that online radon testing services could collectively meet the performance requirement. However, the quality of a few service providers needs to be improved.

PRACTICAL IMPLICATIONS

Indoor radon tests were performed with detectors ordered from 10 service providers available on the Internet. The results showed that online radon testing services could collectively meet the performance requirement. However, the quality of a few service providers needs to be improved.

Variation of soil radon concentrations in southern Ontario

Radon has been identified as the second leading cause of lung cancer after tobacco smoking. Information on indoor radon concentrations is required to assess the lung cancer burden due to radon exposure. However, radon data in highly populated southern Ontario are very limited. Since radon in soil is believed to be the main source of radon in homes, measurements of soil gas radon concentrations can be used to estimate variations in radon potential of indoor environments. This study reports a transect survey of natural background variation in soil radon levels across southern Ontario. The results indicate that radon risk could be high in some areas of southern Ontario.

Drivers of Germ Cell Maturation

Spermatogenesis requires progression of germ line stem cells through a precisely ordered differentiation pathway to form spermatozoa. Diverse and dynamic signals from the transforming growth factor-beta (TGF-beta) superfamily influence many stages of germ cell development. For example, interactions between several TGF-beta superfamily ligands (bone morphogenetic proteins, activin, and glial-derived neurotrophic growth factor [GDNF]) appear to govern the onset of spermatogenesis, and we are exploring how germ cells interpret these competing signals. We examined the in vivo impact of activin on testis development using two mouse models, the inhba-/- mouse (which lacks the gene encoding the activin A subunit and dies at birth) and BK mice, with inhbb (encoding the activin betaB subunit) replacing inhba (which survive to adulthood and show delayed fertility onset in males). Distinct effects on Sertoli cell and germ cell populations during fetal and early postnatal development were measured. We recognize that specific proteins, including downstream targets of TGF-beta signals, such as Smads, must move into the nucleus to implement the gene transcription changes required for development. We hypothesized that changes at the level of cellular nuclear transport machinery may be required to mediate this. Examination of proteins involved in classical nuclear import, the importins, revealed that each importin has a developmentally regulated expression pattern in male germ cells. Because each importin binds a selected range of cargo proteins and mediates their nucleocytoplasmic passage, our findings suggest that each importin ferries cargo required for discrete stages of spermatogenesis.

Reading impairment in the neuronal migration disorder of periventricular nodular heterotopia

OBJECTIVE

To define the behavioral profile of periventricular nodular heterotopia (PNH), a malformation of cortical development that is associated with seizures but reportedly normal intelligence, and to correlate the results with anatomic and clinical features of this disorder.

METHODS

Ten consecutive subjects with PNH, all with epilepsy and at least two periventricular nodules, were studied with structural MRI and neuropsychological testing. Behavioral results were statistically analyzed for correlation with other features of PNH.

RESULTS

Eight of 10 subjects had deficits in reading skills despite normal intelligence. Processing speed and executive function were also impaired in some subjects. More marked reading difficulties were seen in subjects with more widely distributed heterotopia. There was no correlation between reading skills and epilepsy severity or antiepileptic medication use.

CONCLUSION

The neuronal migration disorder of periventricular nodular heterotopia is associated with an impairment in reading skills despite the presence of normal intelligence.

Bimodal release of theophylline from "seed-matrix" beads made of acrylic polymers

The purpose of this research was to design a "seed-matrix" structure for an in vitro bimodal theophylline release profile and to investigate the mechanism and kinetics of drug release as well as the influence of various factors on the properties of the theophylline-containing microspheres. "Seed" microspheres with high theophylline content were prepared from Eudragit L100 and Eudragit S100, copolymers of methyl methacrylate and methacrylic acid, by the solvent removal process. The seed-matrix beads were subsequently prepared by incorporation of the seed microspheres into Eudragit RL100, a copolymer of acrylic and methacrylic acid esters with a low content of quaternary ammonium group. Increasing the size of encapsulated drug particles and the rate of agitation during the preparation, or decreasing the amount of surfactants led to an increase in the size of the microspheres produced. Scanning electron microscopy revealed porous morphology of the microspheres. The release rate of theophylline was enhanced as the content of methacrylic acid in the copolymer increased and the size of the microspheres decreased. The kinetics of drug release from the microspheres was controlled by swelling at the early stage and by diffusion in the later stage. The drug was released from the matrix of the seed-matrix beads at pH 1.2 and from both the matrix and the seeds at pH 6.8. A bimodal release profile of theophylline was obtained from the seed-matrix beads made of acrylic polymers.

An evaluation of the quality of life among long-term survivors of breast cancer

Attention to the quality of life (QOL) among long-term of breast cancer is long overdue. Modest improvements in overall survival have led to a greater emphasis on how women are living with the disease. The purpose of this paper is to report the results of a descriptive study that evaluated the quality of life of 294 breast cancer survivors, and to review the continuum of positive and negative QOL outcomes in this population. Members of the National Coalition for Cancer Survivorship (NCCS) were surveyed and received two QOL instruments: the Quality of Life-Cancer Survivors Tool (QOL-CS) and the Functional Assessment of Cancer Therapy (FACT-G), and a demographic data tool. The main research variables were the subscales (Physical, Psychological, Social, and Spiritual Well-being) and individual items of the QOL-CS and the FACT-G. Results indicated that: a) fatigue, aches and pains, and sleep problems were persistent after treatment ended; b) psychological distress from cancer diagnosis and treatment, and fear of recurrent, metastatic, and recurrent disease were problematic over time; c) family distress, sexuality, and family burden issues were of greatest social concern; and d) uncertainty over the future plagued breast cancer survivors long-term. Breast cancer survivors also reported good outcomes in hopefulness, having a life purpose, and having a positive change after the treatment.

CONCLUSIONS

breast cancer survivors experienced long-term changes after completion of treatment which affected overall quality of life. However, many positive benefits were also gained which helped to balance the worse outcomes.

Quality of life in long-term cancer survivors

PURPOSE/OBJECTIVES

To describe the quality of life (QOL) of long-term cancer survivors.

DESIGN

Descriptive, mailed survey.

SETTING

Membership of the National Coalition for Cancer Survivorship (NCCS), which is a nonprofit, peer-support network for people living with cancer.

SAMPLE

687 (57%) of the 1,200 members of NCCS completed the survey. The mean age of the sample was 49.6 years; 81% were female. The predominant cancer diagnoses were breast (43%), lymphoma (9%), ovarian (8%), and Hodgkin's disease (8%).

METHODS

Mailed survey using three instruments: a demographic tool, the Quality of Life-Cancer Survivors (QOL-CS) tool, and the Functional Assessment of Cancer Therapy-General (FACT-G) tool.

MAIN RESEARCH VARIABLES

Subscale and individual items of QOL including physical, psychological, social, and spiritual well-being.

FINDINGS

Results include areas of positive effects for cancer survivors and continued demands of survivorship. Based on scoring of 0 (worst outcome) to 10 (best outcome), cancer survivors' mean QOL-CS subscores were 5.88 for psychological well-being, 6.59 for spiritual well-being, 6.62 for social well-being, and 7.78 for physical well-being. Several demographic factors (e.g., evidence of active disease; female gender; presence of spouse/partner or children; length of time since diagnosis; income) had significant influence on QOL.

CONCLUSIONS

Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness.

IMPLICATIONS FOR NURSING PRACTICE

The growing population of cancer survivors has long-term needs for nursing care that address multidimensional aspects of QOL.

Studies of the digestibility of pigs fed dietary sucrose, fructose or glucose

Digestion of sucrose, fructose and glucose was studied in pigs with reentrant cannulas in the distal ileum or intact pigs fed diets formulated with sucrose, fructose and glucose as the major energy source and torula yeast. Sucrose and glucose were completely digested in the small intestine (apparent digestibility, 98.3 and 98.3%, respectively but a fraction of the dietary fructose escaped to the large intestine (adjusted value, 11.7%). There was no carbohydrate in rectal contents of the pigs. There was no carbohydrate influence on the pre-caecal or total digestibility of nitrogen.

A three-year study of impetigo in Sydney

Two hundred and forty-three cases of impetigo, which were seen in children in Sydney in the three-year period from July, 1983 to June, 1986, were studied. The great majority of cases was seen in summer and autumn, and over half the cases occurred in the preschool age group. Staphylococcus aureus was grown from 86% of the cases; in 69% of cases it was the only organism to be found, indicating the predominant importance of this organism in impetigo in Sydney in the 1980s. Antibiotic-sensitivity testing of the staphylococci that were cultured demonstrated that fewer than 2% of strains were sensitive to penicillin and fewer than 50% of strains were sensitive to erythromycin. Our experience suggests that flucloxacillin is the antibiotic agent of choice in the treatment of impetigo in children in Sydney.