The role of altered glycosylation in human nucleus pulposus cells in inflammation and degeneration

Intervertebral disc (IVD) degeneration causes low-back pain through disc compression, prolapse and herniation. Inflammation of the IVD and subsequent degeneration produce altered glycosylation profiles in several animal models of IVD injury and ageing, although the function of this altered glycosylation pattern in a human is unknown. Altered N-glycome, specifically sialylated and fucosylated N-glycosylation motif expression, might play a role in inflammation and disease progression. Healthy (foetal and adolescent idiopathic scoliosis) and degenerated (lumbar degeneration) human IVD glycosylation patterns were studied using lectin histochemistry. Small-molecule fluorinated sugar analogues (3Fax-Peracetyl Neu5Ac; 2F-Peracetyl-Fucose) were used to inhibit sialylation and fucosylation in an in vitro model of inflammation, to investigate their effects on the glycosignature, cell metabolism, extracellular matrix synthesis and cell migration. The effects of interleukin (IL)-1β, tumour necrosis factor (TNF)-α and IL-6 on glycosylation in human nucleus pulposus cells were investigated by lectin histochemistry, PCR and enzyme-linked immunosorbent assay (ELISA). In the in vitro model of IVD degeneration, cytokine-induced inflammation-induced hypersialylation was observed, as indicated by Sambucus nigra I binding. However, this modification was inhibited by the sialyltransferase inhibitor. Inhibition of sialylation and fucosylation modulates cell migration and protein translation of catabolic enzymes in response to inflammation. The altered patterns of glycosylation in human tissue in degeneration was consistent with previous IVD studies in murine, bovine and ovine models. The present study was the first functional investigation of glycosylation in human degenerated IVD, elucidating the role of the glycome in disease progression and identified potential therapeutic targets for future regenerative therapies.

The nature effect in motion: visual exposure to environmental scenes impacts cognitive load and human gait kinematics

Prolonged exposure to urban environments requires higher cognitive processing resources than exposure to nature environments, even if only visual cues are available. Here, we explored the moment-to-moment impact of environment type on visual cognitive processing load, measuring gait kinematics and reaction times. In Experiment 1, participants (n = 20) walked toward nature and urban images projected in front of them, one image per walk, and rated each image for visual discomfort. Gait speed and step length decreased for exposure to urban as compared with nature scenes in line with gait changes observed during verbal cognitive load tasks. We teased apart factors that might contribute to cognitive load: image statistics and visual discomfort. Gait changes correlated with subjective ratings of visual discomfort and their interaction with the environment but not with low-level image statistics. In Experiment 2, participants (n = 45) performed a classic shape discrimination task with the same environmental scenes serving as task-irrelevant distractors. Shape discrimination was slower when urban scenes were presented, suggesting that it is harder to disengage attention from urban than from nature scenes. This provides converging evidence that increased cognitive demands posed by exposure to urban scenes can be measured with gait kinematics and reaction times even for short exposure times.

Quasi-isothermal modulated DSC as a valuable characterisation method for soft tissue biomaterial crosslinking reactions

Glutaraldehyde (Glut) is an extensively used sterilant and fixative for the crosslinking of natural soft tissue biomaterials like bovine pericardium (BP) to provide stability and is required for its application in vivo. There is plenty of debate around the reaction mechanism of Glut with natural biomaterials. Differential scanning calorimetry (DSC) is a commonly used technique that is typically used to measure the thermal profile of polymers. However, a variation known as quasi-isothermal modulated differential scanning calorimetry (QiMDSC) has been utilised for the analysis of polymorphic transformations in both the pharmaceutical and food industries. This communication will address QiMDSC as a method for analysing soft tissue biomaterials and their crosslinking mechanisms and how it can be applied to other biomaterial applications.

Utilisation of Clinical Networks to Facilitate Elective Surgical Workload; A Preliminary Analysis

Clinical networks have potential to increase elective surgical workload for benign conditions in non-cancer centres. The aims of this study were to determine outcomes for elective laparoscopic cholecystectomy in our unit and to evaluate early experience in managing benign surgical workload referred from the tertiary centre within our clinical network. An analysis of cholecystectomies performed at Mayo General Hospital was conducted (2003-2013). A review of elective procedures more recently referred from Galway University Hospital (GUH) waiting lists was also conducted. 1937 consecutive cholecystectomies were performed with an overall laparoscopic conversion rate of 1.7% (33/1875). The total major complication rate was 0.93% (18/1937). 151 selected procedures originating from GUH have been performed since December 2013 without adverse events. Laparoscopic cholecystectomy can be performed in significant volume in the general hospital environment. This and other appropriate benign surgical procedures may be performed outside of tertiary units according to network agreements.

Welfare state regimes and income-related health inequalities: a comparison of 23 European countries

OBJECTIVE

The objective of this study was to determine whether the magnitude of income-related health inequalities varies between welfare regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern and Eastern). Specifically, it examined whether the Scandinavian welfare state regime has smaller income-based health inequalities than the other welfare state regimes.

METHODS

The first (2002) and second (2004) waves of the representative cross-sectional European Social Survey (ESS), which comprised more than 80 000 respondents, were used to analyse income inequalities (relative health difference between the first and third income tertile) in self-reported health (general health, limiting longstanding illness) amongst those aged 25 or more. Data related to 23 European countries classified into five welfare state regimes. The study controlled for age and adjusted for educational attainment.

RESULTS

When comparing the health of the first income tertile with the third, the Scandinavian countries only seemed to hold an intermediate position: they did not have the smallest, or the largest, health inequalities. However, the Anglo-Saxon welfare states had the largest income-related health inequalities for both men and women, while countries with Bismarckian welfare states tended to demonstrate the smallest. This pattern was unchanged after controlling for educational attainment. However, education seemed to explain the largest part of income-related health inequalities in the Southern regime.

CONCLUSION

This study shows that the magnitudes of income-related health inequalities indeed vary by welfare state regime. However, this variation was not always in the direction expected as the Scandinavian countries did not exhibit the smallest health inequalities.

Etanercept therapy in patients with a positive tuberculin skin test

INTRODUCTION

Etanercept (Enbrel), a tumor necrosis factor-alpha (TNF-alpha) antagonist, is commonly used for the treatment of a variety of rheumatic diseases. Tuberculosis (TB) infections have been associated with chronic TNF-alpha blocking therapy, and there is concern that such therapy may predispose patients to TB reactivation. In this study, we attempted to evaluate the frequency of latent TB reactivation among patients treated with etanercept.

METHODS

All patients with either a positive purified protein derivative (PPD) for TB or a previous history of therapy for latent TB infection (LTBI) who were prescribed etanercept in the division of rheumatology at John H. Stroger Jr Hospital of Cook County prior to November 2005 were enrolled in this study. A retrospective chart review was performed looking for evidence of active TB infection during etanercept treatment.

RESULTS

Forty-eight patients with a positive PPD were treated with etanercept, and followed for an aggregate of 818 patient-months of etanercept exposure, with a mean follow-up period of 17 months (range 5 to 48 months); all patients had at least one follow-up visit. Forty-four patients (92%) were fully or partially treated with LTBI therapy prior to initiation of etanercept. Chest roentgenograms were available for review in 43 patients, ten of which had evidence of old granulomatous disease. No cases of active TB were described during the study period.

CONCLUSIONS

In this small retrospective analysis, none of the 48 patients with positive PPDs who were treated with etanercept for average of 17 months developed active TB.

MRS of oligodendroglial tumors: Correlation with histopathology and genetic subtypes

BACKGROUND

Oligodendroglial neoplasms with combined loss of chromosomes 1p and 19q may have a good prognosis and respond to procarbazine-lomustine (CCNU)-vincristine (PCV) chemotherapy.

OBJECTIVE

To determine whether single voxel magnetic resonance spectroscopy (SV-MRS) obtained through routine clinical practice distinguishes between histopathologic and genetic subtypes of oligodendroglial tumors.

METHODS

Forty-eight patients with oligodendroglial tumors (19 oligodendrogliomas and 29 oligoastrocytomas) underwent molecular genetic analysis to determine allelic imbalance in chromosomes 1p36 and 19q13. SV-MRS was obtained pretherapy to determine tumor metabolite ratios.

RESULTS

Grade III oligodendroglial tumors had higher choline (Mann-Whitney; p = 0.002), methyl lipid (Mann-Whitney; p = 0.002), and combined methylene lipid and lactate ratios (Mann-Whitney; p < 0.001) than grade II tumors. Lactate did not distinguish between tumor types (Fisher exact test; p = 0.342) or grade (Fisher exact test; p = 0.452). There were no significant associations when tumors were analyzed according to histopathology or genetic subtypes.

CONCLUSION

As a noninvasive diagnostic tool used in routine clinical practice, SV-MRS has the potential benefit of determining oligodendroglial tumor grade but not subtypes classified by histopathology or molecular genetics. MRS may be useful for determining the timing of therapy but is unlikely to predict chemosensitivity.

Epidemiological features of a newly described serotype of Shigella boydii

We report the clinical, microbiological, and epidemiological features of an emerging serotype, Shigella boydii 20. We interviewed patients about symptoms, and history of travel and visitors during the week before illness onset. Seventy-five per cent of the 56 patients were Hispanic. During the week before illness onset, 18 (32%) travelled abroad; 17 (94%) had visited Mexico. Eight (21%) out of 38 who had not travelled had foreign visitors. There were eight closely related patterns by PFGE with XbaI. S. boydii 20 may be related to travel to Mexico and Hispanic ethnicity. Prompt epidemiological investigation of clusters of S. boydii 20 infection may help identify specific vehicles and risk factors for infection.

Durometer Hardness and the Stress-Strain Behavior of Elastomeric Materials

The Durometer hardness test is one of the most commonly used measurements to qualitatively assess and compare the mechanical behavior of elastomeric and elastomeric-like materials. This paper presents nonlinear finite element simulations of hardness tests which act to provide a mapping of measured Durometer Shore A and D values to the stress-strain behavior of elastomers. In the simulations, the nonlinear stress-strain behavior of the elastomers is first represented using the Gaussian (neo-Hookean) constitutive model. The predictive capability of the simulations is verified by comparison of calculated conversions of Shore A to Shore D values with the guideline conversion chart in ASTM D2240. The simulation results are then used to determine the relationship between the neo-Hookean elastic modulus and Shore A and Shore D values.

The simulation results show the elastomer to undergo locally large deformations during hardness testing. In order to assess the potential role of the limiting extensibility of the elastomer on the hardness measurement, simulations are conducted where the elastomer is represented by the non-Gaussian Arruda-Boyce constitutive model. The limiting extensibility is found to predict a higher hardness value for a material with a given initial modulus. This effect is pronounced as the limiting extensibility decreases to less than 5 and eliminates the one-to-one mapping of hardness to modulus. However, the durometer hardness test still can be used as a reasonable approximation of the initial neo-Hookean modulus unless the limiting extensibility is known to be small as is the case in many materials, such as some elastomers and most soft biological tissues.

Molecular characterization of gentamicin-resistant Enterococci in the United States: evidence of spread from animals to humans through food

We evaluated the molecular mechanism for resistance of 360 enterococci for which the gentamicin MICs were >/=128 micro g/ml. The aac(6')-Ie-aph(2")-Ia, aph(2")-Ic, and aph(2")-Id genes were identified by PCR in isolates from animals, food, and humans. The aph(2")-Ib gene was not identified in any of the isolates. Two Enterococcus faecalis isolates (MICs > 1,024 micro g/ml) from animals failed to generate a PCR product for any of the genes tested and likely contain a new unidentified aminoglycoside resistance gene. Pulsed-field gel electrophoresis (PFGE) analysis showed a diversity of strains. However, 1 human and 18 pork E. faecalis isolates from Michigan with the aac(6')-Ie-aph(2")-Ia gene had related PFGE patterns and 2 E. faecalis isolates from Oregon (1 human and 1 grocery store chicken isolate) had indistinguishable PFGE patterns. We found that when a gentamicin-resistant gene was present in resistant enterococci from animals, that gene was also present in enterococci isolated from food products of the same animal species. Although these data indicate much diversity among gentamicin-resistant enterococci, the data also suggest similarities in gentamicin resistance among enterococci isolated from humans, retail food, and farm animals from geographically diverse areas and provide evidence of the spread of gentamicin-resistant enterococci from animals to humans through the food supply.

How do General Practitioners learn of their patient's deaths?

OBJECTIVES

To investigate the methods by which General Practitioners learn, or do not learn, of their patients deaths, when the deaths occur in an institution in which the General Practitioner has no direct role in their care.

DESIGN

Using a semi-structured telephone questionnaire the relevant General Practitioners were asked of the method, if any, by which they had learned of their patients deaths, and their views on this.

SETTING

Sligo, Ireland.

RESULTS

In 6 (16%) of the 37 cases, the GP was informed of the death within one working day by hospital staff. In 22 (59%) of the cases, the GP had learned of the death through other means. In 9 (26%) of the cases the GP had not learned of the death. In 28 (75%) of the cases, the GPs were dissatisfied with either the fact that they did not know of the death, or even if they did know, the method by which they learned of the patients death.

CONCLUSION

General Practitioners, for a variety of reasons, wish to learn of their patient's deaths within a short length of time of such deaths occurring. When deaths occur in an institution in which the GP has no direct role in the care of their patients, the information is not forwarded to the GP within a reasonable length of time in the vast majority of cases. Such institutions need to realise the importance of this simple act, and to make it routine to forward the information.

Molecular genetic analysis of archival gliomas using diagnostic smears

Investigation of the clinical significance of genetic alterations in gliomas requires molecular genetic analysis using samples from retrospective or prospective clinical studies. However, diagnostic tissue is often severely limited and because of fixation, paraffin-embedded tissues (PET) contain degraded DNA. Intra-operative cytological preparations (smears) archived after diagnosis may represent an additional source of clinical material for genetic analysis. In this study, tissue samples were obtained by precision microdissection of archived diagnostic smears from 20 cases (1961-1999). All samples produced polymerase chain reaction (PCR) products for the beta globin gene, but the most recent samples amplified best and gave longer amplimers. For six cases, direct comparison was made between samples microdissected from smears and the corresponding PET. Samples from smears showed improved PCR performance and similar alleles on microsatellite marker analysis. One case, with smears of uninvolved cortex and tumour tissue available for microdissection, showed allelic imbalance at 10q23 on the basis of the smear results alone. PCR products from smears were shown to be suitable for direct sequence analysis (p53 gene). A PTEN mutation, found previously in an anaplastic astrocytoma by analysis of PET, was detected in the corresponding diagnostic smear. The results of this study indicate that tissue samples microdissected from diagnostic intra-operative cytological preparations may be suitable for molecular genetic analysis of gliomas.

Is salmeterol ergogenic?

OBJECTIVE

To assess the effects of 50 micrograms of inhaled salmeterol on pulmonary function, selected physical capacities, and fine motor control in 16 nonasthmatic male cyclists and triathletes, mean age of 23.2 (SD = 3.5) years.

DESIGN

Randomized double-blind placebo-controlled crossover trial.

SETTING

Human Physical Performance Laboratory, the University of Western Australia.

SUBJECTS

Sixteen healthy male high-performance nonasthmatic athletes with a mean age of 23.2 years participated in the study.

INTERVENTION

Subjects attended three experimental testing sessions at which salmeterol (50 micrograms), a placebo, or "no treatment" was administered in random order in a double-blind fashion, on separate occasions, prior to exercise.

MAIN OUTCOME MEASURES

During each testing, session lung function was measured before and 10 min after the treatment. Tests of reaction time and hand steadiness and then two anaerobic cycle tests followed. The first, a 10-s all-out sprint was followed, after a 3-min rest, by a 30-s all-out sprint performed on a front access bicycle ergometer. After 10 min recovery, leg flexion-extension peak torque was measured on a Biodex isokinetic dynamometer at speeds of 120 and 180 degrees s-1.

MAIN RESULTS

Lung function variables, reaction time, movement time, alactic anaerobic power, lactacid anaerobic power, and leg-flexion and leg-extension muscular strength were similar among the three treatment groups.

CONCLUSIONS

The preexercise administration of 50 micrograms of inhaled salmeterol has no performance-enhancing effects in nonasthmatic athletes. We believe that athletes with asthma should be permitted to use salmeterol before competition.

Case study of a patient with severe nephrotic syndrome

M.T. battled SLE for 9 years before renal failure occurred. She is now free of extrarenal symptoms of lupus, as has been described elsewhere (Ziff & Hilderman, 1983). The patient has regained here appetite, lost 13 pounds, recovered some strength and reestablished her social network. Without the severe proteinuria, M.T. has a chance to improve her nutritional status and increase her albumin. Her pulmonary status may also improve if she can refrain from smoking. Although fatigue is a debilitating feature of lupus, M.T. has increased stamina and is learning energy conservation techniques. Immediately after surgery, she did experience problems with bleeding, pneumonia, and pleural effusions, but the medical and nursing management prevented serious adverse outcomes. Fluid balance is no longer problematic, and M.T. is approaching her ideal body weight as her nutritional status improves. Her serum albumin has increased to about 2.6 gm/dl with some decrease in her proteinuria.

The effects of shear stress on endothelial cell retention and function on expanded polytetrafluoroethylene

We evaluated the adherence of indium 111-radiolabeled endothelial cells to fibronectin-treated expanded polytetrafluoroethylene surfaces exposed to high (437 s-1) vs low (218 s-1) shear and the influence of shear on prostacyclin production. Canine jugular vein factor VIII-positive endothelial cells in passages 3 through 6 were incubated with 111Indium-oxine, and labeled cells were seeded onto fibronectin-treated expanded polytetrafluoroethylene patches. Patches with confluent cells were exposed to shear in a Weissenberg rheogoniometer for intervals ranging up to 60 minutes. Percent endothelial cell retention was determined by gamma counting of patches and media and by histologic evaluation. Prostacyclin production (tritiated radioimmunoassay of 6-keto-prostaglandin F1 alpha) was assayed on perfusing media. Results showed no differences in 6-keto-prostaglandin F1 alpha production between shear rates or time periods. Endothelial cell retention did not differ between the shear rates. Rotational shear caused persistent cell loss over time in either high- or low-shear conditions. This persistent cell loss in response to steady rotational shear differs from that in response to identical rates of pulsatile linear shear in our laboratory where cell loss approached zero after 15 minutes.

Health status and disease activity in systemic lupus erythematosus

The physical manifestations of disease activity and health status of patients with systematic lupus erythematosus (SLE) were measured in this study. Forty-nine patients completed the Arthritis Impact Measurement Scale (AIMS) and consented to examination for physical features of SLE documented by a Clinical Activity Index (CAI). Results showed a mean score of 22 on the AIMS and 6.6 on the CAI. The total scores for each measure were significantly correlated (r = 0.55, p less than 0.001), indicating a relationship between health status and clinical disease activity. The total score for CAI was significantly correlated with the physical activity, pain, and depression subscales of health status. The total score for health status was significantly correlated with mucocutaneous, musculoskeletal, and general features of CAI. Within scale correlations were also found. Mucocutaneous aspects of disease activity were significantly correlated with pain and depression. Musculoskeletal features were significantly correlated with physical activity and pain. General aspects of SLE, including fatigue, were significantly correlated with physical activity. The study concludes that there is a relationship between certain physical features of SLE and key components of health status.

Myocardial tissue iron delocalization and evidence for lipid peroxidation after two hours of ischemia

Ischemic tissue injury has been proposed to be in part due to oxygen-radical-mediated lipid peroxidation. In vitro studies of such reactions show that they are thermodynamically unfavorable unless catalyzed by transitional metals such as iron in low molecular weight species (LMWS iron), ie, the iron-ADP complex. This study tests for iron delocalization into a LMWS pool during myocardial ischemia and for increased tissue malondialdehyde (MDA), a product of lipid peroxidation. Anesthesia was induced in eight dogs (weighing 20 to 30 kg) with ketamine and maintained by ventilation with 1% halothane. The left anterior descending coronary artery was ligated in four animals, and the circumflex coronary artery was ligated in the other four. Two hours after ligation, the animals were sacrificed by a central venous injection of KCl. Tissue samples were immediately taken from the ischemic zone and from the corresponding nonischemic zone. MDA was determined by the thiobarbituric acid assay. LMWS iron was determined on a tissue ultrafiltrate by the o-phenanthroline assay. Statistical data analysis used the matched-pair two-tailed t test. LMWS iron was 18.3 nM/100 mg in ischemic tissue versus 13.1 nM/100 mg in nonischemic tissue (t = 4.14; P less than .01). MDA was 0.91 nM/100 mg in ischemic tissue versus 0.83 nM/100 mg in nonischemic tissue (t = 7.27; P less than .005). We conclude that there is a significant increase in tissue LMWS iron and in MDA after two hours of regional myocardial ischemia. This iron might be the catalyst for maturation of tissue injury during reperfusion as observed by other investigators.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood flow in the cerebral cortex during cardiac resuscitation in dogs

Regional cerebral cortical blood flow (rCCBF) in 15 large dogs was determined using the double thermistor dilution method during standard closed-chest massage (CCM), CCM with an epinephrine infusion at 30 micrograms/kg/min (CCM + Epi), and open-chest cardiac massage (OCCM). As a percentage of prearrest flow values, the rCCBF was 9.8% with CCM, 35% with CCM + Epi, and 156% with OCCM. The rCCBF was reduced significantly with CCM (P less than .005) and CCM + Epi (P less than .01). OCCM generated flows indistinguishable from prearrest values. The use of high-dose epinephrine significantly increased the rCCBF during CCM. The implications for intact neurologic resuscitation of these reductions in rCCBF with CCM are important.

Removal of histological sections from glass for electron microscopy: use of Quetol 651 resin and heat

A method is described for using the epoxy resin Quetol 651 and heat for convenient and rapid separation of conventional histological sections from glass slides for subsequent ultrathin sectioning for retrospective electron microscopy. The same method is useful when Epon-Araldite is substituted for the Quetol 651 resin.

Synaptic plasticity in the cerebral cortex of mice: effects of radiation and anesthesia

In the neuropil of layers II and III of the frontal cortex of adult mice, as seen in the electron microscope, sodium pentobarbital anesthesia alone results in a significant decrease in synaptic profile length at 1 day after anesthetization, followed by a return to normal or above normal levels after 2-28 days, while the number of synaptic profiles per unit cross section (profile incidence) is not altered; irradiation with 5-500 rad plateau argon particles significantly inhibits the profile shortening effect of anesthesia at 1 day after exposure, but this inhibition is not dose related; an inverse dose relationship in profile incidence appears at 2 days following irradiation with argon particles; at 1 to 2 hours after 150 or 220 rad x-irradiation, profile incidence is significantly reduced while the length is increased, effects that appear to be dose related and unaffected by adrenalectomy.

Internal and external barriers to obtaining prenatal care

Few studies have examined the reasons women do not obtain medical care during their pregnancies. A retrospective case review of 70 patients in a large metropolitan hospital who received minimal prenatal care examined demographic variables and reasons women gave for not seeking care. Data suggested there are both internal and external barriers to care. More women cited reasons including depression, denial, and fear than cited financial or transportation problems. Implications for social work intervention in the hospital and in the community are drawn from the data and discussed.

Finished surface texture, abrasion resistance, and porosity of Aspa glass-ionomer cement

1. With the finishing agents tested Concise had a smoother surface texture than Aspa. 2. The smoothest surface was on Concise polymerized against a Mylar matrix strip. The smoothest surface for Aspa was obtained with a silicon carbide disk. 3. Aspa abraded about three times as rapidly by volume as Concise when tested by a two-body abrasion method. 4. Significantly more air bubbles were entrapped by hand mixing within Aspa than within Concise. 5. Controlled clinical studies of the glass-ionomer cements are needed before they can be fully evaluated as restorative materials.