Observation of the effect of gravity on the motion of antimatter

Einstein's general theory of relativity from 19151 remains the most successful description of gravitation. From the 1919 solar eclipse2 to the observation of gravitational waves3, the theory has passed many crucial experimental tests. However, the evolving concepts of dark matter and dark energy illustrate that there is much to be learned about the gravitating content of the universe. Singularities in the general theory of relativity and the lack of a quantum theory of gravity suggest that our picture is incomplete. It is thus prudent to explore gravity in exotic physical systems. Antimatter was unknown to Einstein in 1915. Dirac's theory4 appeared in 1928; the positron was observed5 in 1932. There has since been much speculation about gravity and antimatter. The theoretical consensus is that any laboratory mass must be attracted6 by the Earth, although some authors have considered the cosmological consequences if antimatter should be repelled by matter7-10. In the general theory of relativity, the weak equivalence principle (WEP) requires that all masses react identically to gravity, independent of their internal structure. Here we show that antihydrogen atoms, released from magnetic confinement in the ALPHA-g apparatus, behave in a way consistent with gravitational attraction to the Earth. Repulsive 'antigravity' is ruled out in this case. This experiment paves the way for precision studies of the magnitude of the gravitational acceleration between anti-atoms and the Earth to test the WEP.

N-Aryl-linked spirocyclic polymers for membrane separations of complex hydrocarbon mixtures

The fractionation of crude-oil mixtures through distillation is a large-scale, energy-intensive process. Membrane materials can avoid phase changes in such mixtures and thereby reduce the energy intensity of these thermal separations. With this application in mind, we created spirocyclic polymers with N-aryl bonds that demonstrated noninterconnected microporosity in the absence of ladder linkages. The resulting glassy polymer membranes demonstrated nonthermal membrane fractionation of light crude oil through a combination of class- and size-based "sorting" of molecules. We observed an enrichment of molecules lighter than 170 daltons corresponding to a carbon number of 12 or a boiling point less than 200°C in the permeate. Such scalable, selective membranes offer potential for the hybridization of energy-efficient technology with conventional processes such as distillation.

Access Matting Reduces Mixedgrass Prairie Soil and Vegetation Responses to Industrial Disturbance

Substantial interest exists in understanding the role of low-disturbance construction methods in mitigating industrial impacts to native grassland soils and vegetation. We assessed soil and vegetation responses to conventional high-disturbance sod-stripping and revegetation on sandy soils, and the alternative practice of low-disturbance access matting to provide a temporary work surface on sandy and loamy soils. Treatments were associated with high-voltage transmission tower construction during 2014 within the Mixedgrass Prairie. High-disturbance sites were hydroseeded in May of 2015, while low-disturbance sites recovered naturally. We assessed soil physical (bulk density, water infiltration) and chemical properties (organic matter, pH, and electrical conductivity) after construction and herbage biomass for three growing seasons. Sod-stripping led to 53% greater soil bulk density and 51% less organic matter than nondisturbed controls, while water infiltration increased by 32% in these high-sand (>80%) soils. In contrast, access matting led to minimal soil property changes regardless of the texture. While total herbage biomass was unaffected by all construction treatments, sod-stripping reduced grass biomass by 80% during the first growing season, which coincided with a 119% increase in forb mass. Root biomass (0-15 cm) also declined 77% with sod-stripping. Vegetation biomass on sites with access matting remained largely unaffected by the disturbance. Overall, low-disturbance construction methods using access matting were more effective than sod-stripping in mitigating the negative impacts of industrial development on Mixedgrass soil properties, as well as vegetation biomass, and are recommended as a best management practice during industrial disturbance.

Impact of empiric weight-based vancomycin dosing on nephrotoxicity and mortality in geriatric patients with methicillin-resistant Staphylococcus aureus bacteraemia

WHAT IS KNOWN AND OBJECTIVE

Few studies have evaluated the effect of vancomycin dosing on the health outcomes in geriatric patients. Data are needed to determine whether higher vancomycin dosing strategies are more effective in geriatric patients and/or lead to excessive rates of adverse events.

METHODS

This study used a subset of patients aged ≥65 years from a multicentre, retrospective, cohort study of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Patients received ≥ 48 h of empiric vancomycin between 1 July 2002 and 30 June 2008. We compared the incidence of nephrotoxicity and in-hospital mortality in patients who received guideline-recommended dosing (at least 15 mg/kg/dose) to patients who received lower dosing. Multivariable generalized mixed-effect models were constructed to determine independent risk factors for nephrotoxicity and in-hospital mortality.

RESULTS AND DISCUSSION

Half of the cohort (46% of 92 patients) received guideline-recommended dosing. Empiric use of weight-based dosing did increase the percentage of patients achieving a vancomycin trough ≥ 15 mg/L (57% vs. 42%). Nephrotoxicity occurred in 32% of patients and 26% died during their hospitalization. Guideline-recommended dosing was not associated with significant changes in nephrotoxicity (OR 1·13; 95% CI 0·40-3·19) or in-hospital mortality (OR 1·14; 95% CI 0·41-3·18) in the multivariable analysis.

WHAT IS NEW AND CONCLUSION

In this study of geriatric patients, guideline-recommended dosing was not associated with significant changes in nephrotoxicity or mortality. As 40% of the patients who received guideline-recommended dosing failed to achieve a target vancomycin trough of ≥ 15 mg/L, future studies should focus on dosing strategies to increase target attainment rate.

Isoforms of Wilms' tumor suppressor gene (WT1) have distinct effects on mammary epithelial cells

The role of WT1 (Wilm's tumor suppressor gene) in breast cancer is controversial, with evidence for both tumor-promoting and tumor-suppressing activities. In order to address this question, we expressed different WT1 isoforms in the mammary epithelial cell line H16N-2, which does not express endogenous WT1. Cells were stably transfected with either WT1 (-Ex5/-KTS) or WT1 (+Ex5/+KTS) under the control of the inducible metallothionein promoter. Induction of WT1 (-Ex5/-KTS) upregulated p21, causing a slowing of proliferation and a G2-phase cell cycle arrest. In artificial basement membrane, the WT1 (-Ex5/-KTS) isoform promoted the appearance of highly organized acinar cellular aggregates. In contrast, WT1 (+Ex5/+KTS) had no effect on p21 or proliferation, but rather caused an epithelial-mesenchymal transition and a redistribution of E-cadherin from the cell membrane to the cytoplasm. This isoform also causes the cellular aggregates growing in artificial basement membrane to appear significantly less organized than control cells. Thus, different WT1 isoforms have distinct effects in this cell line, suggesting that depending on the ratio of WT1 isoform expression in mammary epithelial cells, WT1 could function to either promote or suppress a transformed phenotype.

Women's perceptions of support from partners, family members and close friends for smoking cessation during pregnancy--combining quantitative and qualitative findings

This article reports on data collected as part of a four-phase study initiated to strengthen practice in the field of smoking cessation during pregnancy. It focuses on the perceived support pregnant smokers would receive for quitting smoking and how this support could be effectively used by incorporating the education of partners/family in smoking cessation intervention strategies. Both quantitative and qualitative methods were employed, and data were collected from pregnant smokers through semistructured interviews and self-completed questionnaires. From the questionnaire data, the women reported that they would receive considerable support from their partners if they decided to stop smoking. The interviews, however, revealed that this support was 'potential' rather than 'real' and that the partners mostly made 'token gestures' such as smoking outside. None of the interviewed respondents reported receiving help in educating their partner/family about the risks of active and passive smoking, thus reducing the potential positive role they could play in smoking cessation. Whilst health professionals are aware of the important role the partner/family may play in successful smoking cessation interventions, these significant others are generally not involved. This study highlights the need for consideration to be given to providing opportunities for couples to be fully involved in smoking cessation interventions outside the antenatal environment.

Trace element homeostasis during continuous sedation with propofol containing EDTA versus other sedatives in critically ill patients

OBJECTIVE

To evaluate changes in serum and urinary zinc, cobalt, copper, iron, and calcium concentrations in critically ill patients receiving propofol containing disodium edetate (disodium ethylenediaminetetraacetic acid [EDTA]) versus sedative agents without EDTA.

DESIGN

This was a randomised, open-label, parallel-group study with randomisation stratified by baseline Acute Physiology and Chronic Health Evaluation (APACHE II) scores.

SETTING

Intensive care units (ICU) in 23 medical centres.

PATIENTS

Medical, surgical, or trauma ICU patients 17 years of age or older who required mechanical ventilator support and sedation.

INTERVENTIONS

A total of 106 patients received propofol containing 0.005 % EDTA (propofol EDTA), and 104 received other sedative agents without EDTA (non-EDTA). Only the first 108 patients were assessed for urinary trace metal excretion. Twenty-four-hour urine samples were collected on days 2, 3, and 7 and every 7 days thereafter for determination of zinc, cobalt, copper, iron, and calcium excretion; EDTA levels; urine osmolality; albumin levels; and glucose levels. The first 143 patients were assessed for serum concentration of zinc, cobalt, copper, iron, and calcium; creatinine; blood urea nitrogen; and albumin at baseline and once during each 24-hour urine collection.

MEASUREMENTS AND RESULTS

For the assessment of trace metals, patients receiving propofol EDTA demonstrated increased mean urinary excretion of zinc, copper, and iron compared with the normal range. All patients receiving sedatives demonstrated increased urinary excretion of zinc and copper above normal reference values. Compared with the non-EDTA sedative group, the propofol EDTA group demonstrated increased urinary excretion of zinc and iron. Mean serum concentrations of zinc and total calcium were decreased in both patient groups. Serum zinc concentrations increased from baseline to day 3 in the non-EDTA sedative group but not in the propofol EDTA group. Renal function, measured by blood urea nitrogen, serum creatinine, and creatinine clearance, did not deteriorate during ICU sedation with either regimen.

CONCLUSION

This study showed that critical illness is associated with increased urinary losses of zinc, copper, and iron. Propofol EDTA-treated patients had greater urinary losses of zinc and iron and lower serum zinc concentrations compared with the non-EDTA sedative group. No adverse events indicative of trace metal deficiency were observed in either group. The clinical significance of trace metal losses during critical illness is unclear and requires further study.

Immunopathogenesis of HIV-associated dementia

This review provides a subjective analysis of the advances in our understanding of the immunopathogenesis of HIV-associated dementia that have occurred over the past 12 months. The review will focus on the following areas: (i) the role of chemokines and cytokines; (ii) the role of astrocytes, astrocyte cell death and non-productive infection of astrocytes; (iii) a model of the neuropathogenesis of HIV-associated dementia and its impact on treatment paradigms and future research. The requirements for the development of HIV-associated dementia are immunosuppression, the loss of macrophage regulation, central nervous system HIV infection of microglia and macrophages with a neurovirulent HIV strain, restricted HIV infection of astrocytes, and astrocyte cell death, all of which lead to an intracellular milieu that is neurotoxic. This cascade can be prevented and probably reversed by the use of highly active antiretroviral therapy, which controls viral replication both systemically and centrally. However, for those patients who have resistant virus and persistently high levels of replication, or who develop resistance or toxicity, other treatment strategies need to be developed. The control of excessive microglial and macrophage activation or a diminution of astrocyte and neuronal apoptosis could have benefits in terms of cognitive function. We therefore need to develop further our understanding of the immunopathogenesis of HIV-associated dementia so that we can control a number of other steps in the cascade rather than simply controlling the viral replication.

Correlation between neurological progression and astrocyte apoptosis in HIV-associated dementia

The pathogenesis of HIV-associated dementia (HIVD) has been postulated to be due to the indirect effects of HIV infection, including the aberrant central nervous system production of cytokines and other neurotoxins. A correlation between the severity of dementia and production of neurotoxins in HIVD has been demonstrated. We have previously identified nonproductive HIV infection of astrocytes. Because astrocytes participate in the inactivation of neurotoxins, we hypothesize that HIV nonproductive infection of astrocytes may lead to an environment in which there is a significant level of astrocyte apoptosis and a consequent increase in the levels of neurotoxins and that this results in more rapidly progressing dementia. Postmortem brain tissue was examined from clinically well-characterized HIV-positive demented patients, HIV-positive nondemented patients, and HIV-seronegative nondemented control subjects. The HIVD group was further categorized into subjects with rapid and those with slow progression of dementia. Tissue was paraformaldehyde fixed and paraffin embedded, and 6-microm sections from the basal ganglia and mid-frontal gyrus were processed to detect apoptosis by in situ transferase dUTP nick end labeling. Astrocytes were co-localized using immunohistochemical techniques. In situ polymerase chain reaction (PCR) techniques were utilized to detect HIV DNA in astrocytes. The density of apoptotic astrocytes was significantly greater in the HIV-positive groups than in the HIV-negative group (p < 0.01). The HIVD rapid progressors had a significantly greater number of apoptotic astrocytes in the basal ganglia than did the HIVD slow progressors (p < 0.05). In addition, there were a greater number of HIV DNA-positive astrocytes, as demonstrated by in situ PCR, in the HIVD rapid progressors than in the slow progressor and HIV-nondemented groups. These data suggest that there is an increased rate of astrocyte loss in the subjects with rapidly progressive dementia, in association with an increased number of HIV DNA-positive astrocytes. The results emphasize the importance of understanding more completely the role of HIV infection of astrocytes in the neuropathogenesis of HIVD.

Dialysis addition of trehalose/glycerol cryoprotectant allows recovery of cryopreserved mouse spermatozoa with satisfactory fertilizing ability as assessed by yield of live young

Mouse sperm cryopreservation provides a means for storing the genetic information in genetically modified mice (mutants, transgenics, and "knockouts") in a cost- and space-effective manner. Sperm from this species are highly sensitive to cryodamage, which has impeded their cryopreservation in the past. The cryoprotectant used in this study was 6% glycerol (0.65 M) plus 7.5% trehalose (0.22 M), which was added to a concentrated suspension of sperm from B6SJLF1/J mice in bicarbonate-free buffer by dialysis to minimize osmotic stress on the cells. Sperm suspensions were frozen in 0.25 mL straws and stored in liquid N2. Eggs were obtained from B6SJLF1/J superovulated females. For in vitro fertilization (IVF), 15-25 microL of sperm suspension post-thaw from one straw was added directly to each of three 1.5 mL drops of fertilization medium containing 30 eggs each, for 3 replicates per experiment. The fertilized eggs were scored for blastocyst formation, after which 12 blastocysts from each drop were implanted into pseudopregnant CD-1 females. The number of live pups were then scored at birth. Ten experiments yielded 21.7 +/- 1.4 (SD) blastocysts per 30 eggs inseminated (72%) and 7.3 +/- 0.4 (SD) live pups per 12 blastocysts implanted (61%). The overall yield of live pups was 44 per 100 eggs inseminated (44%). This yield should be satisfactory for maintaining a mouse strain through sperm cryostorage, with restart of the strain through IVF and embryo transfer. The method should also provide improvement in human sperm cryopreservation, as human sperm are less sensitive to cryodamage than are mouse sperm.

The photoequilibration of the ortho-, meta-, and para-isomers of substituted benzenes in ace- tonitrile and the photoaddition of 2,2,2-tri- fluoroethanol (TFE) to the same isomers: a survey

The phototransposition (ortho, meta, para) in acetonitrile of a number (25) of disubstituted benzenes have been examined. For some cases (methylbenzonitriles, trifluoromethyltoluenes, and trifluoromethylbenzonitriles) photostationary states could be reached but others (methylanisoles, methoxybenzonitriles, dicyanobenzenes, and methy 4-toluyl sulfone) were unreactive. The photoaddition of 2,2,2-trifluoroethanol (TFE) to the same compounds as well as 5 monosubstituted cases was also examined. The products obtained for reactive compounds were all TFE ethers of bicyclo[3.1.0]hex-3-en-2-ol derivatives. For benzene and alkylbenzenes (toluene, ortho-xylene) these photoadducts are formed by ground state addition of TFE to benzvalene derivatives. For others (methylbenzonitriles), bicyclic diradicals or carbenes are likely intermediates. Many substituted compounds (anisole, fluorobenzene, methyl benzoate, methyl anisoles, methoxybenzonitriles, dicyanobenzenes, trifluoromethylbenzonitriles, and fluorotoluenes) did not react with TFE. The trifluoromethylbenzonitriles did however undergo phototransposition in TFE, the only compounds to do so.Key words: substituted benzenes, phototransposition, photoaddition.

A comparison of efficacy of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in the therapeutic setting of chemotherapy-induced myelosuppression

A randomized, double-blind, multicenter study in 181 afebrile cancer patients with ANC levels < 500/microL receiving myelosuppressive chemotherapy was undertaken to compare sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the treatment of chemotherapy-induced myelosuppression. Patients received daily subcutaneous (SC) injections of either agent until ANC levels reached at least 1500/microL. There was no statistical difference between treatment groups in the mean number of days to reach an ANC of 500/microL, but the mean number of days to reach ANC levels of 1000/microL and 1500/microL was approximately one day less in patients receiving filgrastim. Fewer patients in the sargramostim arm were hospitalized, and they had a shorter mean length of hospitalization, mean duration of fever, and mean duration of i.v. antibiotic therapy compared with patients who received filgrastim. Both growth factors were well tolerated. No patient was readmitted to the hospital after growth factor was discontinued. Sargramostim and filgrastim have comparable efficacy and tolerability in the treatment of standard-dose chemotherapy-induced myelosuppression in community practice.

Herpes simplex replication and dissemination is not increased by corticosteroid treatment in a rat model of focal Herpes encephalitis

Neurological damage in Herpes simplex type 1 encephalitis results from neuronal cell death secondary to viral invasion, and from inflammatory changes and cerebral oedema secondary to the immune response to the virus. Corticosteroids could have an important role in the management of Herpes simplex encephalitis because their anti-inflammatory action reduces cerebral oedema. However their use has been limited by concerns that their immunosuppressive actions could increase viral replication and spread. The present study examined this issue in a rat model in which injection of HSV-1 into the cervical vagus nerve produced a well-defined focal encephalitis, characterised by an orderly progression of the virus through central neural pathways connected with vagal afferent termination sites in the medulla oblongata. After injection of HSV-1, rats were treated twice a day, either with vehicle (saline, 400 microl i.p.), with acyclovir (30 mg/kg i.p.), with dexamethasone (5 mg/kg i.p.), or with both acyclovir and dexamethasone. Animals were sacrificed after 72 h, and viral load in different brain regions was quantified by computer-assisted measurement of the area occupied by immunohistochemical reaction product. Treatment with acyclovir reduced viral load to 17 +/- 5% of the saline value (P < 0.01). After dexamethasone treatment, the viral load (63 +/- 13% of the saline value) was also reduced (P < 0.05). Treatment with both acyclovir and dexamethasone reduced viral load to 26 +/- 8% of the saline value (P < 0.01 compared with saline, and P > 0.05 compared to acyclovir alone). Our results confirm the effectiveness of acyclovir in a new model of HSV-1 infection, and provide evidence that corticosteroids do not inhibit the antiviral action of acyclovir. In addition corticosteroids may decrease the extent of infection in their own right. The acute time course studied in our model parallels the time course of acute Herpes simplex encephalitis in humans. Our data suggests that corticosteroids are not detrimental when combined with acyclovir in the management of this condition.

Rosiglitazone has no clinically significant effect on nifedipine pharmacokinetics

To examine the effects of repeat oral dosing of rosiglitazone on the pharmacokinetics of nifedipine, a prototype CYP3A4 substrate, a randomized, open-label, crossover study was performed with two treatment phases separated by a washout period of at least 14 days. Twenty-eight healthy male volunteers received either a single 20 mg oral nifedipine dose or rosiglitazone 8 mg orally once daily for 14 days with a single 20 mg oral nifedipine dose administered on day 14. Plasma nifedipine concentrations were determined over the 24-hour period following administration of the nifedipine doses. Lack of effect was defined as the demonstration that the 90% CI was contained entirely within a symmetrical 30% range either side of unity on the loge-scale. Following rosiglitazone + nifedipine administration, the area under the nifedipine concentration-time curve from time zero to infinity (AUC(0-infinity)) was 13% lower than that after administration of nifedipine alone. This difference in nifedipine AUC(0-infinity) was not deemed to be clinically significant since the 90% CI was contained within the protocol-defined 30% range (point estimate for ratio of geometric means 0.87; 90% CI: 0.79, 0.96). Rosiglitazone had no marked effect on nifedipine peak plasma concentration (point estimate: 0.99; 90% CI: 0.73, 1.34) or time to peak concentration compared with nifedipine alone. Rosiglitazone coadministration produced a small decrease in the mean nifedipine half-life (point estimate: -0.77; 90% CI: mean difference -1.29 h, -0.25 h). Both treatment regimens were well tolerated and associated with a favorable safety profile. Rosiglitazone, at the highest dose used in clinical studies, produced a small, clinically insignificant decrease in nifedipine exposure. The very small effect on nifedipine pharmacokinetics suggests that rosiglitazone is an extremely weak inducer of CYP3A4, a characteristic that distinguishes rosiglitazone from troglitazone.

Management of nonspecific low back pain by physiotherapists in Britain and Ireland. A descriptive questionnaire of current clinical practice

STUDY DESIGN

A descriptive questionnaire of chartered physiotherapists.

OBJECTIVE

To investigate current physiotherapeutic management of low back pain throughout Britain and Ireland.

SUMMARY OF BACKGROUND DATA

Physiotherapists play a key role in low back pain management. Although clinical guidelines for best practice have been developed recently, there has been no large-scale attempt to describe current physiotherapeutic treatment approaches within Britain or Ireland.

METHODS

After semi-structured interviews (n = 6) and two pilot studies (n = 77) were done, postal questionnaires were distributed to four regional cluster samples of the membership of two physiotherapy professional organizations (n = 2654). After two mailings, a random sample of 90 nonresponders were followed up. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Ltd., Woking, Surrey, UK), and precision of the survey estimates was assessed by calculation of sampling errors and intraclass correlation coefficients for cluster sampling.

RESULTS

Results were received from 1548 therapists (total response rate, 58.3%); of these, 813 reported that they were practicing in settings in which they treated patients with low back pain. Analysis of the results indicated the overall popularity of the Maitland mobilization and McKenzie approaches among physiotherapists. Although exercise per se was mentioned frequently by respondents, a marked difference in opinion among therapists regarding the optimal type of exercise for low back pain was obvious. Little evidence was demonstrated of the use of manipulation, fitness programs, or multidisciplinary efforts involving behavioral and physical aspects of treatment. Commonly used methods of electrotherapy were interferential therapy, ultrasound, pulsed short-wave diathermy, and transcutaneous electrical nerve stimulation.

CONCLUSIONS

The results of this study emphasize the need to evaluate further and improve the dissemination of findings regarding the effectiveness of specific physiotherapy approaches for low back pain management.

Pharmacokinetics and pharmacodynamics of SB 209670, an endothelin receptor antagonist: effects on the regulation of renal vascular tone

OBJECTIVE

To evaluate the pharmacokinetics and pharmacodynamics of an infusion of SB 209670, a non-peptide endothelin-A/endothelin-B receptor antagonist.

METHODS

The study was conducted in 2 parts. Part 1 was a placebo-controlled, single-blind, rising-dose crossover evaluation of the pharmacokinetics and safety of SB 209670 infused at doses that ranged from 0.2 to 1.5 mirog kg(-1) for approximately 8 hours in 17 healthy male volunteers. In part 2, renal hemodynamic effects of a 4-hour infusion of SB 209670 were assessed in 10 healthy male volunteers in a 2-period, period-balanced, single-blind, randomized, placebo-controlled crossover study.

RESULTS

SB 209670 appeared to display linear kinetics over the dose range from 0.2 to 1.5 microg kg(-1) min(-1). The half-life was approximately 4 to 5 hours. Plasma immunoreactive endothelin-1 increased in an apparent dose-dependent manner. Mean renal hemodynamic responses (para-aminohippurate clearance) increased by approximately 15% relative to placebo (P = .007). Renal sodium excretion was similar during SB 209670 and placebo infusion.

CONCLUSION

The pharmacokinetics of intravenous SB 209670 appeared to be linear, and infusion resulted in dose-related increases in immunoreactive endothelin-1. The lack of anti-natriuretic effect and the renal vasodilator response observed in this study indicate that SB 209670 does not possess any partial agonist activity. Further, the renal hemodynamic response supported a potential physiologic role for endogenous endothelin in the maintenance of renal vascular tone in humans.

Safety and pharmacokinetics of an intramuscular monoclonal antibody (SB 209763) against respiratory syncytial virus (RSV) in infants and young children at risk for severe RSV disease

We conducted a multicenter, double-blind, placebo-controlled, randomized trial of a humanized monoclonal antibody against a respiratory syncytial virus (RSV) fusion protein (SB 209763) to evaluate its safety, pharmacokinetics, and fusion inhibition and neutralization titers. Forty-three infants who were either delivered prematurely ( Collapse

Key Words Collapse

MESH Headings

• Antibodies, Monoclonal/administration & dosage
• Antibodies, Monoclonal/adverse effects
• Antibodies, Monoclonal/pharmacokinetics
• Antibodies, Monoclonal, Humanized
• Antibodies, Viral/administration & dosage
• Antibodies, Viral/immunology
• Child, Preschool
• Double-Blind Method
• Female
• Half-Life
• Humans
• Infant
• Injections, Intramuscular
• Male
• Respiratory Syncytial Virus Infections/immunology
• Respiratory Syncytial Virus Infections/prevention & control
• Respiratory Syncytial Viruses/immunology

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Grants Collapse

Affiliation(s)

H C Meissner Department of Pediatrics, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
J R Groothuis
W J Rodriguez
R C Welliver
G Hogg
P H Gray
R Loh
E A Simoes
P Sly
A K Miller
A I Nichols
D K Jorkasky
D E Everitt
K A Thompson

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Quantitative analysis of cancellation tasks in neglect

Patients with spatial neglect do not explore contralateral space effectively. Although cancellation tasks are used widely to assess this visual search deficit, their methods of analysis are not well established. We introduce logistic regression analyses for cancellation tasks in 7 patients with left neglect. We investigated the influences of spatial location, stimuli number, and target discriminability on the probability of canceling a target. As a group, neglect patients showed left and near neglect. They also explored and canceled targets further into contralateral space on arrays with fewer visual stimuli. Individual analyses revealed exceptions to these group patterns, such as two patients with far rather than near neglect. Only patients with relatively mild neglect canceled more targets when they were more easily discriminated from distracters. Logistic regression models accounted for 0.68 the variance in cancellation performances of the entire group. Shifting the unit of analysis from the proportion of targets canceled to the probability of detecting individual targets offers a powerful parametric method to analyze group and individual performances on cancellation tasks and can reveal functional dissociations in neglect.

Comparison of glycerol, other polyols, trehalose, and raffinose to provide a defined cryoprotectant medium for mouse sperm cryopreservation

Most procedures for mouse sperm cryopreservation have utilized raffinose to provide hypertonicity for cell desiccation prior to freezing and glycerol to block intracellular ice formation. Trehalose has been shown in other cell systems to provide positive protection to the plasma membrane and so was examined as a replacement for raffinose. Comparison of 3 and 6% glycerol and 7.5 and 20% sugar showed that 6% glycerol and 7.5% sugar gave maximal protection consistently and so were adopted as standard. Comparison of raffinose and trehalose at this concentration showed trehalose to give significantly better recovery of intact cells: 48 +/- 6% for trehalose, 36 +/- 9% for raffinose (+/- SE, n = 5; arc sine transformed data; P < 0.01). Less hydrophilic polyols should prove more permeant to the membrane than glycerol, enter the cell rapidly, and so possibly inhibit lethal intracellular ice formation effectively. We hypothesized that one of these polyols plus glycerol would be a more effective cryoprotectant than glycerol alone. The polyols tested as supplements to 6% glycerol were propane-1,2-diol, propane-1,3-diol, 1,1,1-tris-(hydroxymethyl)ethane (THME), and 2-ethyl-2-(hydroxymethyl)-propane-1,3-diol (EHMP). With 6% glycerol and 7.5% raffinose or trehalose, the two diols and THME gave less cryoprotection than with glycerol alone, and EHMP reduced postthaw membrane integrity to nil, thus invalidating the hypothesis. Comparison of bicarbonate-containing medium MJB to bicarbonate-free medium NTP, both with 6% glycerol/7.5% trehalose, showed no difference in recovery of membrane-intact cells. For ease of pH maintenance, NTP was chosen for studies of addition prefreeze and removal postthaw of 6% glycerol/7.5% trehalose cryoprotectant with in vitro fertilization as endpoint. Three protocols for cryoprotectant handling were tested: serial addition/dilution; dialysis addition and removal; and dialysis addition and direct insemination without cryoprotectant removal. The last proved significantly superior (P < 0.01), giving 62% fertilized eggs, normalized to controls, compared to 21% for dialysis addition and removal and 32% for serial addition and dilution. The glycerol/trehalose combination thus provides a defined cryoprotectant which, when used with addition by dialysis prefreeze and direct insemination postthaw, yields a satisfactory yield of fertilized eggs in an in vitro fertilization system.

Weigh(t)ing for awareness

We wished to learn if weight perception can be extinguished by studying two patients with right hemisphere brain damage. When lifting weights simultaneously, a patient with right frontal damage was not biased in her judgments of which weight was heavier. By contrast, a patient with right parietal damage reported left-sided weights as being lighter than those on the right. Psychophysical power functions revealed that her awareness of increasing weights on the left was dampened compared to the right when lifting weights individually on each side. Strikingly, her awareness of weight changes on the left was completely abolished when she lifted weights in both hands simultaneously. She demonstrated an unusual split in awareness, being motorically aware of and actively engaged with left-sided weights while being unaware of their incremental changes.

One-hour paclitaxel plus carboplatin in the treatment of advanced non-small cell lung cancer: results of a multicentre, phase II trial

The aim of this phase II study was to determine the activity and toxicity of paclitaxel (administered by 1-h infusion) and carboplatin in advanced non-small cell lung cancer when used in a multicentre, community-based treatment setting. 100 chemotherapy-naive patients with stage IIIB or IV non-small cell lung cancer were treated between March 1995 and February 1996. All patients had Karnofsky performance status 70-100, measurable disease and adequate bone marrow, kidney and liver function. All patients received intravenous (i.v.) paclitaxel 225 mg/m2 by 1-h infusion followed immediately by carboplatin at a targeted area under the concentration time curve (AUC) of 6.0 using the Calvert formula. Courses were repeated every 21 days. Colony stimulating factors were not used routinely. 38 of 94 evaluable patients (40%) had objective responses to treatment (3 complete responses, 35 partial responses). An additional 32 patients had stable disease at initial re-evaluation. Weight gain during treatment was experienced by 47% of patients with objective response or stable disease. The median survival in this group of 100 patients was 8 months, with an actuarial 1-year survival of 42%. Leucopenia was common, but hospitalisation for treatment of neutropenia and fever occurred in only 3% of courses. Cumulative peripheral neuropathy was common, but usually appeared after the third or fourth course and was severe (grade 3) in only 15% of patients. Other grade 3 and 4 toxicity was uncommon. There was one treatment-related death due to sepsis. This large multicentre community-based phase II trial demonstrated the efficacy of paclitaxel and carboplatin combination chemotherapy in advanced non-small cell lung cancer. When paclitaxel is given by 1-h infusion, this regimen is easily administered in the outpatient setting.

Incidence of urinary incontinence and constipation during pregnancy and postpartum: survey of current findings at the Rotunda Lying-In Hospital

OBJECTIVE

To assess the impact of pregnancy upon continence and constipation.

DESIGN

A questionnaire survey.

SETTING

Maternity wards in the Rotunda Lying In Hospital, Dublin, Republic of Ireland.

POPULATION

7771 women who were delivered of liveborn infants.

METHODS

Questionnaires were delivered and collected by physiotherapy staff as part of routine postnatal care.

RESULTS

Analysis of data using chi2 tests showed significant differences between three parity groups [primigravidae, multigravidae (2-4) and multigravidae (5+)] for symptoms of both urinary incontinence (chi2 = 119.54, df = 2, P = 0.000) and constipation (chi2 = 12.53, df = 3, P = 0.002); the incidence of both constipation and urinary incontinence increased with parity.

CONCLUSION

The results of this survey have emphasised the relation between parity and postpartum incontinence which stresses the importance of early diagnosis and intervention.

Human sperm glutathione reductase activity in situ reveals limitation in the glutathione antioxidant defense system due to supply of NADPH

In order to characterize further the antilipoperoxidative enzyme system of human sperm, that part of the system designed to provide reducing equivalents for the reduction of highly reactive and potentially damaging lipid hydroperoxides to relatively inert hydroxylipids was examined. The substrate that provides the reducing equivalents directly to glutathione peroxidase (GPX) is reduced glutathione (GSH), which is in turn oxidized to glutathione disulfide (GSSG). The reducing equivalents needed for regeneration of GSH through the action of glutathione reductase (GRD) are provided by NADPH, produced by the action of glucose-6-phosphate dehydrogenase (G6P-DH) on substrates glucose-6-phosphate and NADP+. The kinetic properties of the enzymes GRD and G6P-DH were determined by standard enzyme activity assay at 24 and 37 degrees C. At 37 degrees C, the Vmax for GRD was found to be 36 nmol/min x 10(8) cells, with Km values for GSSG and NAPH of 150 microM and 16 microM, respectively; the Vmax for G6P-DH was 3.3 nmol/min x 10(8) cells with Km for NADP+ of 8 microM. This suggested that G6P-DH activity was limiting in this reductive pathway. The activity of GRD in situ in intact cells was estimated using the thiol-reactive fluorogenic probe ThioGlo-1, which is cell permeant and reacts rapidly with GSH to give a highly fluorescent adduct. Mixing a suspension of human sperm with the fluorogenic reagent at 37 degrees C gave an initial rapid increase in fluorescence, followed by a slower one. The rapid phase is due to reaction with intracellular GSH already present; the slow phase is due to reaction with GSH generated by the GRD-catalyzed reduction of GSSG. Both rates showed first-order kinetics. Calculation of the maximal rate as NADPH oxidation, attributable to in situ GRD activity, gave the value of 1.0 nmol/min x 10(8) cells, less than the maximum for NADPH production by the dehydrogenase. These results support the suggestion that NADPH production limits the capacity of the pathway leading to hydroperoxide reduction in human sperm. We propose that the antilipoperoxidative defense system of human sperm has just sufficient capacity to allow these cells to fulfill their function but is limited to allow their timely disposal from the female reproductive tract.

Water permeability, Lp, of the mouse sperm plasma membrane and its activation energy are strongly dependent on interaction of the plasma membrane with the sperm cytoskeleton

Two parameters fundamental to cell cryobiology are the water permeability (hydraulic conductivity), Lp, and its activation energy, EA. The Lp can be calculated from two experimental determinations: the critical osmolality, Osmcrit, at which 50% of the cells lyse, and the time, tcrit, to 50% lysis in a highly hyposmotic medium, based on the assumption that the cells swell to lysis with minimal resistance to swelling. We have reported [Cryobiology 32, 220-238 (1995)] that mouse sperm in hyposmotic medium show minimal swelling and so fail to meet this assumption. The concept that resistance to swelling was due to anchoring of the plasma membrane through cytoskeletal interaction was examined by treating mouse sperm with 5 microM cytochalasin D to depolymerize the cytoskeletal filamentous actin (f-actin), whose presence was established by staining with fluorescently labeled phalloidin. Diminution of fluorescence due to loss of f-actin induced by cytochalasin D was shown by flow cytometry. Mouse sperm treated with cytochalasin D showed tail curling in hyposmotic medium, similar to that observed with bovine and human sperm, indicating that the standard swelling model was applicable to these cells. Two sets of Lp values were calculated from tcrit: one using individual means of Osmcrit and one using the mean of means of Osmcrit between 37 and 4 degrees C, as these individual means were not significantly different. Values (micron.min-1.atm-1), respectively, were 9.95, 7.15 (37 degrees C); 1.51, 0.91 (22 degrees C); 0.54, 0.78 (12 degrees C); 0.47, 0.50 (4 degrees C); 0.33 (0 degree C); and 0.36 (-3 degrees C). Arrhenius plots gave EA = 13.7 and 11.7 kcal/mol, respectively. Values of t1/2 were calculated from the first-order rate constants characterizing the kinetics of cell lysis at the higher four temperatures; Lp values calculated from these, and the two sets of Osmcrit values described were 5.70, 4.09 (37 degrees C); 1.18, 0.71 (22 degrees C); 0.62, 0.90 (12 degrees C); and 0.34, 0.37 (4 degrees C). Arrhenius plots gave EA = 14.2 and 11.0 kcal/mol, respectively. We propose that these EA values are characteristic of the plasma membrane relatively unperturbed by cytoskeletal interactions. In untreated sperm, decrease of Lp with decreasing temperature and presence of cryoprotectant and the cytoskeletal interactions all act to hamper the sperm cells' ability to respond to osmotic stress encountered during freezing and thawing, such that these cells are especially sensitive to cryodamage.

Randomized trial comparing the tolerability of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in cancer patients receiving myelosuppressive chemotherapy

A prospective, randomized, double-blind, multicenter study in cancer patients receiving myelosuppressive chemotherapy was undertaken to evaluate and compare the tolerability of sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the prophylaxis or treatment of chemotherapy-induced neutropenia. In all, 137 evaluable patients received sargramostim (300 micrograms; 193 mg/m2) or filgrastim (481 mg; 7 mg/kg) once daily by self-administered s.c. injection, usually beginning within 48 h after completion of chemotherapy. With the exception of a slightly higher incidence of grade 1 fever (< 38.1 degrees C) with sargramostim, there were no statistically significant differences in the incidence or severity of local or systemic adverse events possibly related to the growth factors. Although the study was not designed to evaluate efficacy directly, there also were no statistically significant differences between treatment groups in total days of growth factor therapy, days of hospitalization, or days of i.v. antibiotic therapy during the treatment period. Both sargramostim and filgrastim were comparably well tolerated when given by s.c. injection in this group of patients, and no clinically significant differences between the growth factors were demonstrated.

Awareness of deficit in Alzheimer's disease: relation to caregiver burden

Patients with Alzheimer's disease (AD) show varying degrees of awareness of their deficits. To examine the impact of this phenomenon upon the distress experienced by family caregivers of AD patients, we analyzed caregiver burden in relation to patient awareness of deficit in three different functional domains. The relationship of burden to selected sociodemographic variables was also explored. Results of multiple regression analyses suggested that caregiver burden was associated with impaired patient awareness of memory deficit independent of disease stage and dementia severity. The findings suggest that impaired awareness may be an important mediator of caregiver burden, a concern in the management of AD.

Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success

A retrospective analysis of 260 completed intrauterine insemination (IUI) cycles was used in an attempt to identify significant variables predictive of treatment success. Couples received a maximum of three IUI cycles for the treatment of anovulation, cervical factors or unexplained infertility. Male factor problems were largely excluded by pretreatment screening. The overall pregnancy rate was 19.6% per completed cycle, the miscarriage rate 15.6%, the multiple pregnancy rate 23.5% and the cancellation rate 19%. Logistic regression identified four significant IUI variables [follicle number (P < 0.005), endometrial thickness (P < 0.005), duration of infertility (P < 0.01) and progressive motility (P < 0.05)] which were the most predictive of IUI success. The chance of conceiving when only one follicle was produced was only 7.6%, whereas with two follicles this chance increased to 26%. These variables were incorporated into a statistical model to allow the prediction of the chance of success in subsequent cycles. We conclude that careful patient selection criteria coupled with successful ovarian stimulation is the model for IUI success.

Pneumonitis-associated hyperprocalcitoninemia

Elevated serum levels of the prohormone of calcitonin (CT), procalcitonin (ProCT), have been documented in illnesses such as inhalational burn injury, in several sepsis syndromes, and in endotoxemia. In this study, we measured and characterized the circulating precursor forms of CT during the course of infectious pneumonitis. The initial (mean +/- SEM) serum total multiform CT level in 12 patients with acute infectious pneumonia was 1,019 +/- 430 pg/mL. In comparison, the mean level of total CT for 19 age-matched control patients without lung disease was 32 +/- 6 pg/mL (P < 0.001). The mean serum total CT level on initial examination was greater in the 6 patients with bacterial isolates, at 1,793 +/- 752 pg/mL, than in those with nonbacterial infectious pneumonia, at 242 +/- 109 pg/mL (P = 0.018). After admission to the hospital, patients' serum total CT progressively declined concomitantly with the clinical resolution of the pneumonia; at discharge, mean serum level was 121 +/- 34 pg/mL. On discharge, the patients who had persistent radiographic abnormalities had significantly higher levels than did those who had complete resolution. Both the mean serum calcium and phosphate were significantly lower at the initial time of study than at discharge (P < 0.002 and P < 0.0004, respectively). Gel filtration chromatography of sera obtained during the acute pneumonitis phase revealed increased levels of precursor forms of CT, including ProCT; these levels diminished with clinical resolution. In an additional three patients, the serum total CT increased very rapidly after aspiration (within 6 to 12 hours); the peak levels were several times greater than the upper limits of normal. In these patients, the principal serum CT components were ProCT and other precursor forms. These results show that both infectious and aspiration pneumonitis are associated with a rapid increase in circulating ProCT and other precursor forms of CT.

Results of a double-blind placebo-controlled study of the double-stranded RNA drug polyI:polyC12U in the treatment of HIV infection

In this multicenter, randomized, double-blind study the activity of polyI:polyC12U administered with zidovudine was evaluated in the treatment of HIV infection. Thirty-six HIV-positive, pre-AIDS individuals (100-500 CD4+ cells/mm3) who had had at least six months of zidovudine therapy received polyI:polyC12U (400 or 700 mg) or placebo twice weekly with zidovudine. PolyI:polyC12U subjects with baseline CD4+ counts > or = 300/mm3 showed a trend towards reduced CD4+ loss versus placebo recipients. PolyI:polyC12U subjects were more likely to exhibit positive delayed-type hypersensitivity responses than placebo recipients. Placebo subjects crossing over to polyI:polyC12U therapy demonstrated improved CD4+ and delayed-type hypersensitivity responses. PolyI:polyC12U subjects with baseline CD4+ counts > or = 300/mm3 were less likely to develop AIDS than similar placebo subjects. PolyI:polyC12U therapy of HIV-positive subjects restored or stabilized immune function as indexed by delayed-type hypersensitivity reactivity and, in individuals with CD4+ counts > 300/mm3, abrogated CD4+ loss and reduced disease progression. PolyI:polyC12U was generally well-tolerated in this zidovudine-treated population. No subject discontinued therapy due to an adverse reaction or aberrant laboratory parameter.

Do type as eat differently? A comparison of men and women

Type A behaviour has been associated with coronary heart disease, but little is known about how Type A behaviour relates to diet. As part of a cross-sectional epidemiological study in Northern Ireland, Type A behaviour was assessed using a validated questionnaire and diet assessed using weighed records. Diet was described in terms of nutrient intake, food intake and dietary pattern. The study population comprised 245 men and 306 women aged 16 to 64 years. The relation between Type A behaviour and diet was examined by calculating partial correlation coefficients between A-type score and dietary variables, controlling for age and household socio-economic group. In men Type A score showed a weak but significant association with fat and protein intake, and intake of beef, cheese, yoghurt and chips. In women, Type A score showed a weak positive association with sugar and alcohol intake. In both men and women, Type A score was positively associated with the "convenience" dietary pattern. These relationships are discussed in the context of the dominant food ideology and coronary risk.

Assessment of the anti-microbial agent C31G as a spermicide: comparison with nonoxynol-9

The broad-spectrum anti-microbial agent, C31G, containing an equimolar mixture of n-dodecyl-dimethylamine-N-oxide (C12-N-O) and N-(n-dodecyl), N-dimethyl-glycine (C12-betaine), was tested for spermicidal activity in comparison with the currently used spermicide, nonoxynol-9 (N-9). The rate of sperm cell permeabilization by the spermicides, as assayed with the fluorescent probe, TO-PRO-1, increased as the cube of the C31G concentration, while the rate increase was linear with N-9 concentration. At 0.04%, the rate of sperm cell permeabilization with both spermicides is at the limit of rapid measurement. C31G diffuses through cervical mucus at a more rapid rate than does N-9. C31G has long been known to aid wound healing and reduce inflammation, whereas N-9 has been reported to induce vaginal irritation. C31G would, thus, seem to have the spermicidal efficacy, the broad range of anti-microbial activity, and the lack of inflammatory activity that is sought in the ideal vaginal spermicide.

Attitudinal dimensions of food choice and nutrient intake

A diet low in fat and rich in fibre has been recommended to optimize general health and in particular cardiovascular health. Health attitudes to fat and fibre were studied in relation to food and nutrient intake and sociocultural and lifestyle factors amongst the general population of Northern Ireland. The study population comprised 592 adults aged 16-64 years; health attitudes to fat and fibre were assessed by questionnaire (based on a social psychological model, which adjusted for taste and convenience factors). Dietary intake was estimated using the weighed inventory technique. Fat-phobic and fibre-philic attitudes were more prevalent in women than men. Fat-phobic attitudes in women were inversely related to intake of fat through a reduced intake of chips, butter and sausages. In contrast, men's fat-phobic attitudes were not strongly correlated with fat intake; consumption of chips and sausages was negatively associated with fat-phobic attitudes, but cake/biscuit, buns/pastries and milk consumption was positively associated with fat-phobic attitudes. Fibre-philic attitudes were positively associated with dietary fibre intake; intakes of potatoes, vegetables, wholemeal bread and breakfast cereal were positively associated with fibre-philic attitudes. There were clear sociocultural and lifestyle differences in relation to dietary attitude. These findings have implications for campaigns designed to effect population dietary change.

Efficacy and safety of a seven-day, transdermal estradiol drug-delivery system: comparison with conjugated estrogens and placebo. The Transdermal Estradiol Patch Study Group

OBJECTIVE

To evaluate the efficacy and safety of a new, seven-day, transdermal estradiol system in healthy postmenopausal women with hot flushes.

METHODS

Two studies are described. In the first study, subjects were randomized to treatment with a 0.05 mg/day estradiol patch, a 0.1 mg/day estradiol patch, or a placebo patch; and in the second study, to treatment with either of the two estradiol patches or oral conjugated estrogens (as Premarin) 0.625 mg/day. Efficacy was evaluated on the basis of diary entries recording hot-flush frequency and severity. Subjects' and investigators' global assessments of treatment efficacy were recorded at follow-up visits.

RESULTS

In Study 1, both the 0.05-mg and 0.1-mg estradiol patches were significantly more effective than placebo in reducing hot flushes and were associated with higher global assessments. In Study 2, all three active treatments produced a significant reduction in the number of hot flushes compared with base-line. There were no statistically significant between-group differences, although the response to the 0.1-mg estradiol patch was greater, and to the 0.05-mg estradiol patch less, than the response to conjugated estrogens. The patches were generally well tolerated. Skin irritation from the patch was the most common adverse experience in both studies.

CONCLUSIONS

The new, seven-day, transdermal system effectively and safely treats post-menopausal vasomotor symptoms.

The role of drug metabolism in drug discovery: a case study in the selection of an oxytocin receptor antagonist for development

Drug discovery is a process involving multiple disciplines and interests. During the research phase of drug discovery, usually a large number of compounds are evaluated for biological activity and toxicological potential in animal species. Various types of problems with respect to pharmacodynamics, pharmacokinetics, and toxicity are commonly encountered at this stage. Drug metabolism, as a discipline participating in a drug discovery team, can play an important role in identifying factors underlying the problems, facilitate the optimal selection of compounds for further development, provide information on metabolites for possible improvement in drug design, and contribute to the identification of the appropriate animal species for subsequent toxicity testing. During the process of evaluating oxytocin receptor antagonists for further development for treatment of preterm labor, in vivo and in vitro drug metabolism studies conducted in rats, dogs, and monkeys contributed to the selection of L-368,899 as the development candidate on the basis of pharmacokinetic and metabolism observations. The presence of active N-demethylated metabolites of two other equipotent compounds in rats and dogs was found to be the major factor responsible for the discrepancy between oral bioavailability and efficacies observed for these 2 compounds. For L-368,899, a compound that demonstrated 20-40% oral bioavailability in rats, dogs, and chimpanzees, extensive first-pass metabolism rather than absorption was determined as the major factor responsible for the poor bioavailability (< 1%) in rhesus monkeys. In vitro metabolism studies with hepatic microsomes from rats, dogs, monkeys, and humans substantiated the conclusion that the rate of hepatic metabolism of L-368,899 in monkeys is faster than in the other species.

Gonadotropin requirements of the developing follicle

OBJECTIVE

To evaluate follicular FSH and LH requirements during suppression of endogenous gonadotropins with the GnRH antagonist Nal-Glu and whether LH-like activity could be supplied by administering subcutaneous hCG.

DESIGN

Randomized clinical trial.

PARTICIPANTS

Thirty-two normally cycling females in the late follicular phase (dominant follicle mean diameter > or = 14 mm).

INTERVENTION

Twelve normal women were randomized to receive 150 IU IM FSH with or without 75 IU SC hCG; 11 subjects were randomized to receive 225 IU FSH with or without 50 IU SC hCG; 9 women received 150 or 225 IU IM hMG. Subjects returned the next day for repeat blood sample and ultrasound.

RESULTS

Continued follicular maturation, as evidenced by rising E2 levels, correlated with serum immunoactive and bioactive FSH levels and was unrelated to bioactive LH-hCG. Two hundred twenty-five international units of exogenous FSH consistently supported follicular maturation. There was a similar increase in mean follicular diameter in women with an E2 rise versus those with a plateau or fall. In subjects receiving SC mini-dose hCG, serum bioactive LH-hCG levels were increased significantly and were similar to levels before Nal-Glu.

CONCLUSIONS

During administration of a GnRH-a, the maturing follicle appears to require only FSH support. In markedly hypogonadotropic women, mini-dose hCG may be a more practical alternative to recombinant LH to promote normal follicle maturation.

Late pulmonary sequela following burns: persistence of hyperprocalcitonemia using a 1-57 amino acid N-terminal flanking peptide assay

Seven patients were evaluated at a mean duration of 8.4 yr after sustaining inhalational injury associated with burns. At the time of re-examination, the patients were asymptomatic and had normal chest X-rays, and arterial blood gases. Three of the seven patients had abnormally elevated serum calcitonin levels. The spirometry (FEV1) measurements showed an inverse trend to that of the serum calcitonin levels. The elevated calcitonin levels had an abnormal predominance of the procalcitonin component as assessed by several region specific antisera. The serum calcitonin also showed a significant correlation with the hormone level which had been obtained at the time of prior discharge from the hospital (r = 0.91). Although there appears to be no or minimal chronic pulmonary sequela to inhalational injury in burns by pulmonary testing, we speculate that the hyperprocalcitonemia in some of the patients may reflect a long-term hyperplastic response of the bronchio-epithelial pulmonary neuroendocrine cells. The potential significance of this and other lung-associated endocrine markers is discussed.

Heparin-coated cardiopulmonary bypass circuits: hemostatic alterations and postoperative blood loss

This prospective, randomized study involving patients undergoing isolated coronary artery bypass grafting investigated whether the use of heparin-coated bypass circuits with an uncoated cardiotomy reservoir (n = 10) compared with standard uncoated bypass circuits (n = 10) resulted in differences in patient outcome and hemostatic alterations. There were no differences in postoperative blood loss, transfusion requirements, and routine coagulation test results between groups. Immunoassays for platelet alpha-granule constituents platelet factor 4 and beta-thromboglobulin, thrombin generation by-product F1.2, fibrinopeptide A, thrombin-antithrombin complex, and fibrinolysis by-product D-dimer also demonstrated no significant differences between groups, although trends for lower platelet secretion with heparin coating were noted. Increases were found in beta-thromboglobulin and platelet factor 4 concentrations at 10 (p < 0.03) and 30 minutes (p < 0.001) of CPB, respectively, and continuing throughout CPB (p < 0.001) for both groups versus values measured before incision. No significant differences were seen between levels 5 minutes prior to aortic cross-clamp release and those obtained 8 and 45 minutes after cross-clamp release. Conversely, no significant increases in F1.2, thrombin-antithrombin complex, and D-dimer were seen prior to release of the aortic cross-clamp, but afterward increases occurred that were highly significant (p < 0.001). The temporal data suggest that platelet activation occurs primarily as a result of contact with the cardiopulmonary bypass circuitry, whereas thrombin generation and fibrinolytic activity are not significant until reperfusion of the heart and lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

BR140, a novel zinc-finger protein with homology to the TAF250 subunit of TFIID

The Br140 protein was initially identified due to its co-purification with an integrin. We have cloned and sequenced the cDNA corresponding to the Br140 protein. Analysis of the amino acid sequence indicates that Br140 has features characteristic of gene regulatory proteins, including zinc fingers. Furthermore, Br140 has a homology to a family of transcriptional co-activators, one of which is a characterized component of the general transcriptional machinery. Immunologic studies indicate that Br140 has a broad tissue distribution and is abundant in testes and spermatogonia. Br140 is primarily a nuclear protein. These results suggest that Br140 may be a part of the general transcriptional machinery.

Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction

OBJECTIVE

To evaluate further the safety and efficacy of selective ostial salpingography combined with transcervical wire recanalization for the diagnosis and treatment of proximal tubal obstruction.

DESIGN

Prospective study.

SETTING

Division of Reproductive Endocrinology and Department of Radiology at Harbor-University of California Los Angeles (UCLA) Medical Center, a tertiary care academic institution.

PATIENTS

Twenty-eight infertile patients diagnosed with proximal tubal obstruction by hysterosalpingogram (HSG) or by chromopertubation at laparoscopy (total of 46 obstructed tubes).

INTERVENTIONS

After antibiotic prophylaxis and IV analgesia a conventional HSG was performed. If proximal tubal obstruction was confirmed, selective salpingography was done under fluoroscopic guidance. If proximal tubal obstruction was still present, wire recanalization using a new prototype cannula was then performed. If recanalization was successful, contrast media was injected to confirm tubal patency.

MAIN OUTCOME MEASURES

Proximal tubal patency, complete tubal patency, pregnancies.

RESULTS

Eleven of 46 tubes (23.9%) were patent by HSG. Ostial salpingography of the remaining 35 tubes revealed 6 patent tubes (13%). Nine of the 29 obstructed tubes (31%) had successful wire recanalization, and 8 of these were patent distally. There were 4 intrauterine pregnancies (IUPs) and 1 ectopic pregnancy after recanalization and 2 IUPs after ostial salpingography.

CONCLUSION

Selective salpingography should be considered at the time of an HSG showing proximal tubal obstruction. If indicated, wire recanalization can also be attempted. Selective ostial salpingography combined with wire recanalization is a safe and effective procedure for the diagnosis and treatment of PTO.

Thrombin activity resides on LVAD Dacron inflow and outflow grafts

Patients on left ventricular assist devices (LVADs) are at increased risk for thromboembolism, and they experience elevations in platelet release and thrombin activity indices during device implantation. The Dacron grafts that lead from the ventricle to the LVAD and back to the aorta may harbor thrombin activity and protect this thrombin from anticoagulant action. To investigate this possibility, specimens isolated from LVAD grafts at the time of device explantation or implantation were incubated with citrated platelet poor plasma (cPPP), cPPP and 2 U/ml of heparin, cPPP and 2 U/ml of recombinant hirudin (r-hirudin), or cPPP and 50 U/ml of heparin. Thrombin activity was measured by the increase in incubated cPPP fibrinopeptide A (FPA) concentrations over cPPP FPA levels, without material contact. A chromogenic substrate for thrombin verified the effects seen. Thrombin activity was found at comparable levels on both the inflow and outflow LVAD grafts at explantation. This activity was not inhibited by low concentrations of heparin, but 50 U/ml of heparin and 2 U/ml of r-hirudin reduced the activity. At graft implantation (after preclotting), thrombin activity was higher than at explantation, but susceptibility to inhibition by heparin was also significantly greater. These results confirm that the LVAD Dacron grafts harbor surface thrombin activity resistant to anticoagulation that may be a primary source for LVAD thrombogenicity.

Experimental tests of three-dimensional model of urinary concentrating mechanism

Recently, a new model of the urinary concentrating process has been proposed that takes into account the three-dimensional architecture of the renal medulla. Under the assumptions of the model, computer simulations predicted significant axial osmolality gradients in the inner medulla without active transport by the inner medullary loop of Henle. Two of the model assumptions (which constitute hypotheses for this study) were: (1) the osmotic water permeability of the initial part of the inner medullary collecting duct (initial IMCD) is very low even in the presence of vasopressin; and (2) there is significant lateral separation of structures such that thin descending limbs are far from the collecting ducts at the same inner medullary level. The first hypothesis was addressed by perfusing rat initial IMCD segments in vitro and measuring osmotic water permeability. With the osmotic gradient oriented as predicted by the model (lumen greater than bath), vasopressin increased the osmotic water permeability from 286 to 852 microns/s. Three additional series of experiments confirmed the high water permeability in the presence of vasopressin. The second hypothesis was addressed by morphometric analysis of histologic cross-sections of the rat renal medulla. Mean distances of descending limbs to the nearest adjacent collecting duct were very small throughout the inner medulla (less than 6 microns) and substantially less than in the outer medulla (28 microns). It was concluded that the data are inconsistent with both hypotheses and therefore do not support the feasibility of the "three-dimensional" model of the renal inner medulla. The axial distributions of loops of Henle and collecting ducts in the rat renal medulla are also reported.

Dietary behaviour and health in Northern Ireland: an exploration of biochemical and haematological associations

STUDY OBJECTIVE

The aim was to determine the relationships between dietary behaviour and biochemical and haematological measures.

DESIGN

This was a cross sectional population study.

SETTING

The study took place in the general community within Northern Ireland.

SUBJECTS

522 randomly selected adults aged 18-64 years took part (65% of the eligible sample).

MEASUREMENTS AND MAIN RESULTS

Four dietary behaviours were identified using principal components analysis from 7 d weighed dietary records described in terms of mean intake of 41 food groups. Haematological and biochemical analyses were carried out on non-fasting blood samples. Social, personal, and lifestyle information was ascertained through interviewer administered questionnaires. Partial correlations controlled for age and smoking behaviour were calculated. There were significant negative associations between iron status measures and the "traditional" behaviour, while the "meat and two veg" behaviour showed positive associations. There were positive associations between the "cosmopolitan" and "convenience" behaviours and folate status in women. White cell count and platelet levels in women were negatively associated with the "traditional" and "cosmopolitan" behaviours. Total cholesterol levels showed significant negative associations with the "cosmopolitan" behaviour in women and HDL cholesterol levels were positively associated with the "cosmopolitan", "convenience" and "meat and two veg" behaviours.

CONCLUSIONS

Through a multivariate approach to dietary assessment it is possible to identify food combinations that cluster and interact to influence biochemical and haematological indices of health status.

The diets of men in four areas of the UK: the Caerphilly, Northern Ireland, Edinburgh and Speedwell studies

Nutrient intakes in four areas of the UK were compared, 7-d weighed intake data were obtained for representative community samples of middle-aged men in Caerphilly (South Wales), Northern Ireland, Edinburgh and Bristol (Speedwell). Intakes of energy were higher in Edinburgh than in the other three areas, but following allowance for this, differences in nutrient intakes were very small. The exceptions were P/S ratio and alcohol consumption. The P/S ratio for Northern Ireland (0.38) was considerably higher than that for the other areas (0.30 to 0.32). The proportion of heavy drinkers was higher in Edinburgh (15 per cent) than in other areas (5-9 per cent) and the proportion of abstainers was highest in Northern Ireland (38 per cent). Differences in nutrient intakes did not parallel the differences in ischaemic heart disease (IHD) mortality rates between the areas.

Dietary behaviours and sociocultural demographics in Northern Ireland

Subjects aged 16-64 years (592; 258 men and 334 women), randomly selected from the population of Northern Ireland, kept a 7 d weighed record of all food and drink consumed. Social, personal and anthropometric data were also collected. From the weighed records food consumption was described in terms of forty-one food groups. Using principal components analysis, four distinct dietary patterns were generated which were identified as a traditional diet, a cosmopolitan diet, a convenience diet and a 'meat and two veg' diet. These dietary patterns were then correlated with sociocultural, lifestyle and anthropometric variables. It is clear that dietary behaviour is influenced by a number of inter-related sociocultural demographics and that identifiable population groups in Northern Ireland have different dietary behaviours.

Iron sufficiency in the population of Northern Ireland: estimates from blood measurements

Estimates of iron status in a random sample (218 men, 283 women) of the Northern Ireland population (aged 18-64 years) were obtained from blood measurements. Multiple criteria were used to determine Fe deficiency and body Fe stores were calculated as an index of Fe sufficiency. Three distinct groups with respect to Fe stores were identified on the basis of sex and menstrual status. Estimates of body Fe stores, mean (and SD), were 13.4 (SD 5.97), 5.3 (SD 6.09) and 8.5 (SD 6.72) mM for men, woman aged 18-44 years and women aged 45-64 years respectively. The prevalence of Fe-deficiency anaemia was low, ranging from 0.5% in men to 6.6% and 4.6% in the younger and older women respectively. The prevalence of Fe deficiency was low in men (1.4%) and older women (5.7%) rising to 11.0% in the younger group of women. The disproportionately elevated serum ferritin relative to transferrin saturation supported the suggestion that chronic inflammation might have influenced Fe status measurements in men and older women.