Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV)

BACKGROUND

To evaluate drug use (alcohol, tobacco, cannabis and other drugs) and its association with mean CD4/CD8 T cell count ratio, a marker of chronic inflammation, in virally suppressed people living with HIV-1 (PLWH) in Nouvelle Aquitaine, France.

METHODS

A multi-centric, cross-sectional analysis was conducted in 2018-19 in the QuAliV study-ANRS CO3 AQUIVIH-NA cohort. Tobacco, alcohol, cannabis, and other drug use (poppers, cocaine, amphetamines, synthetic cathinones, GHB/GBL) were self-reported. CD4 and CD8 T cell counts and viral load measures, ± 2 years of self-report, and other characteristics were abstracted from medical records. Univariable and multivariable linear regression models, adjusted for age, sex, HIV risk group, time since HIV diagnosis, and other drug use were fit for each drug and most recent CD4/CD8 ratio.

RESULTS

660 PLWH, aged 54.7 ± 11.2, were included. 47.7% [315/660] had a CD4/CD8 ratio of < 1. Their mean CD4/CD8 ratio was 1.1 ± 0.6. 35% smoked; ~ 40% were considered to be hazardous drinkers or have alcohol use disorder; 19.9% used cannabis and 11.9% other drugs. Chemsex-associated drug users' CD4/CD8 ratio was on average 0.226 (95% confidence interval [95% CI] - 0.383, - 0.070) lower than that of non-users in univariable analysis (p = 0.005) and 0.165 lower [95% CI - 0.343, 0.012] in multivariable analysis (p = 0.068).

CONCLUSIONS

Mean differences in CD4/CD8 ratio were not significantly different in tobacco, alcohol and cannabis users compared to non-users. However, Chemsex-associated drug users may represent a population at risk of chronic inflammation, the specific determinants of which merit further investigation.

TRIAL REGISTRATION NUMBER

NCT03296202.

Severe bacterial non-AIDS infections in persons with HIV: the epidemiology and evolution of antibiotic resistance over an 18-year period (2000-2017) in the ANRS CO3 AquiVih-Nouvelle-Aquitaine cohort

BACKGROUND

Severe non-AIDS bacterial infections (SBIs) are one of the leading causes of hospital admissions among persons with HIV (PWH) in regions with high ART coverage.

METHODS

This large prospective cohort study of PWH examined the types of infections, bacterial documentation, and evolution of antibiotic resistance among PWH hospitalized with SBIs over an 18-year period.

RESULTS

Between 2000 and 2017, 459 PWH had at least one SBI with bacterial documentation. Among the 847 SBIs, there were 280 cases of bacteremia, 269 cases of pneumonia, and 240 urinary tract infections. The 1025 isolated bacteria included Enterobacteriaceae (n = 394; mainly Escherichia coli), Staphylococcus aureus (n = 153) and Streptococcus pneumoniae (n = 82). The proportion of S. pneumoniae as the causative agent in pneumonia and bacteremia decreased sharply over time, from 34% to 8% and from 21 to 3%, respectively.The overall antibiotic resistance of S. aureus and S. pneumoniae decreased progressively but it increased for Enterobacteriaceae (from 24% to 48% for amoxicillin-clavulanate, from 4 to 18% for cefotaxime, and from 5% to 27% for ciprofloxacin). Cotrimoxazole prophylaxis was associated with higher nonsusceptibility of S. pneumoniae to amoxicillin and erythromycin, higher nonsusceptibility of Enterobacteriaceae to beta-lactams and fluoroquinolones, and a higher risk of extended-spectrum β-lactamase producing Enterobacteriaceae.

CONCLUSIONS

The bacterial resistance pattern among PWH between 2014 and 2017 was broadly similar to that in the general population, with the exception of a higher resistance profile of Enterobacteriaceae to fluoroquinolones. The use of cotrimoxazole as prophylaxis was associated with an increased risk of antibiotic resistance.

Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy

We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm³. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.

The Effect of Older Siblings on Language Development as a Function of Age Difference and Sex

The number of older siblings a child has is negatively correlated with the child’s verbal skills, perhaps because of competition for parents’ attention. In the current study, we examined the role of siblings’ sex and age gap as moderating factors, reasoning that they affect older siblings’ tendency to compensate for reduced parental attention. We hypothesized that children with an older sister have better language abilities than children with an older brother, especially when there is a large age gap between the two siblings. We reanalyzed data from the EDEN cohort ( N = 1,154) and found that children with an older sister had better language skills than those with an older brother. Contrary to predictions, results showed that the age gap between siblings was not associated with language skills and did not interact with sex. Results suggest that the negative effect of older siblings on language development may be entirely due to the role of older brothers. Our findings invite further research on the mechanisms involved in this effect.

From the morphological to the transcriptomic characterization of a compromised three-dimensional in vitro model mimicking atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease in which skin barrier function is disrupted. In this AD environment, proinflammatory cytokines are upregulated, promoting a vicious circle of inflammation. Although several three-dimensional in vitro models mimicking AD have been published, no study has presented a fully characterized and controlled model of AD-related inflammation.

OBJECTIVES

To develop and characterize, from the morphological to the molecular level, a compromised reconstructed epidermis (RE) mimicking AD-related inflammation in vitro.

METHODS

Normal human keratinocytes were used to generate RE, treated or not with an inflammatory cocktail (polyinosinic-polycytidylic acid, tumour necrosis factor-α, interleukin-4 and interleukin-13).

RESULTS

The inflammatory cocktail induces some modifications observed in patients with AD: (i) it leads to spongiosis; (ii) it alters early and terminal differentiation proteins; (iii) it increases thymic stromal lymphopoietin and interleukin-8 secretion by keratinocytes and (iv) it results in a specific gene expression pattern.

CONCLUSIONS

The inflammatory context contributes to the morphological, functional and transcriptomic changes observed in AD skin. As a result, this compromised RE model shares some characteristics with those found in AD skin and thus can be used as a relevant tool for screening formulations and drugs for the treatment of AD.

Root biomass production in populations of six rooted macrophytes in response to Cu exposure: intra-specific variability versus constitutive-like tolerance

Intra-specific variability of root biomass production (RP) of six rooted macrophytes, i.e. Juncus effusus, Phragmites australis, Schoenoplectus lacustris, Typha latifolia, Phalaris arundinacea, and Iris pseudacorus grown from clones, in response to Cu exposure was investigated. Root biomass production varied widely for all these macrophytes in control conditions (0.08 μM) according to the sampling site. Root biomass production of T. latifolia and I. pseudacorus in the 2.5-25 μM Cu range depended on the sampling location but not on the Cu dose in the growth medium. For P. australis, J. effusus, S. lacustris, and P. arundinacea, an intra-specific variability of RP depending on both the sampling location and the Cu-dose was evidenced. This intra-specific variability of RP depending on the sampling location and of Cu-tolerance for these last four species suggests that Cu constitutive tolerance for all rooted macrophytes is not a species-wide trait but it exhibits variability for some species.

Arundo donax L., a candidate for phytomanaging water and soils contaminated by trace elements and producing plant-based feedstock. A review

Plants and associated microorganisms are used to remediate anthropogenic metal(loid) contamination of water, soils and sediments. This review focuses on the potential of Arundo donax L. (Giant reed) for alleviating risks due to soils, water, and sediments contaminated by trace elements (TE), with emphasis on its advantages and limits over macrophytes and perennial grasses used for bioenergy and plant-based feedstock. Arundo donax is relevant to phytomanage TE-contaminated matrices, notably in its native area, as it possesses characteristics of large biomass production even under nutrient and abiotic stresses, fast growth rate, TE tolerance and accumulation mainly in below ground plant parts. Cultivating A. donax on contaminated lands and in constructed wetlands can contribute to increase land availability and limit the food vs. plant-based feedstock controversy. To gain more tools for decision-taking and sustainable management,further researches on A. donax should focus on: interactions between roots, TE exposure, and rhizosphere and endophytic microorganisms; biomass response to (a)biotic factors; sustainable agricultural practices on marginal and contaminated land; integration into local, efficient, energy and biomass conversion chains with concern to biomass quality and production; Life-Cycle Assessment including contaminant behavior, as well as environmental, agricultural and socio-economic benefits and drawbacks.

[Special outpatient services at 5 and 8 years in very-preterm children in the EPIPAGE study]

The immature brain is highly susceptible to the consequences of very preterm birth with a high rate of long-term neurodisabilities in survivors and high use of specific outpatient services to limit the functional effects of the disabilities. To assess the economic burden for the social and health care system, it is necessary to inventory the community supports and need for special education or rehabilitation used by preterm children. Such studies are few and were done only in extremely low-birthweight or extremely preterm newborns in the United States.

OBJECTIVE

To study the rates of specific outpatient services and special education at 5 years of age and between 5 and 8 years of age in a geographically-defined population of children born very preterm.

DESIGN, SETTING AND PATIENTS

2901 liveborn children before 33 weeks'gestation (WG) and one control group of 666 liveborn children at 39-40WG were included in nine regions of France in 1997 corresponding to more than one third of all births. At five years, these children had a medical examination and were evaluated by a psychologist at local centres organised for the study in every region. Cognitive function was assessed by the mental processing composite scale (PMC) of the Kauffmann Assessement Battery for Children test, which is considered to be equivalent to intelligence quotient and behavioral difficulties using the Strength and Difficulties questionnaire completed by the parents. Data for dependence or compensatory aids, i.e. occupational therapy or physical therapy, speech therapy, psychologist or psychiatrist visits, orthoptic therapy, wearing glasses, wearing hearing aid, specific equipment to walk (walker, wheelchair...), orthopaedic treatment or anti-epileptic treatment were collected from parents. At eight years, a postal questionnaire was sent to the parents to collect data on specific outpatient services and special treatments at home and school. Stata software was used (version 9.0). Main outcome measures. Parent Questionnaire for identifying children with chronic conditions and specific health care needs at 5 and 8 years and categorization of developmental neurodisabilities based on examination of children and psychometric evaluation at 5 years.

RESULTS

At 5 years data were obtained for respectively 1817 and 396 children born before 33WG or at 39-40WG, which represent 80% of the very preterm children and 71% of the at term children. At 8 years we obtained data for 63% of the very preterm children and 59% of the at term children. At 5 years, care in a rehabilitation center and/or specific outpatient services were required for 41% of children born between 24 and 28WG, 32% of children born between 24 and 32WG and 15% of those born at 39-40WG. Between 5 and 8 years, these figures were respectively 61%, 50% and 36%. In the very preterm group, rates of specific outpatient services were higher than 80% if the child had a motor and/or a neurosensory deficit. In case of cognitive deficiencies (PMC < 85), rates of specific outpatient services were low at 37% at 5 years and increases at 63% between 5 and 8 years.

CONCLUSION

Compared to the children born at term, the very preterm children have considerable educational needs, which are inversely related to gestational age at birth and to age of the children at the time of reporting. Despite economic burden, efforts to improve access to services are necessary, in particular in case of cognitive impairment.

The association between type 1 diabetes and the ITPR3 gene polymorphism due to linkage disequilibrium with HLA class II

A fine mapping study of the MHC region in a Swedish case-control population sample reported a novel type 1 diabetes (T1D) association from the inositol 1-, 4-, 5-trisphosphate receptor type 3 gene (ITPR3) in a case-control study, reportedly independent of the HLA class II effect. We attempted to replicate this novel association in a family-based study of 1120 T1D families with at least one affected child, an approach immune to population stratification. We found association of the ITPR3 single nucleotide polymorphisms (SNPs) rs2296336 with T1D but in a direction opposite to that reported. Moreover, rs2296336 was in linkage disequilibrium (LD) with specific alleles of the HLA DQB1 gene. Conditional regression showed that all of the ITPR3 SNP T1D association could be accounted for by the DQB1 effect. Therefore, our findings do not support an obvious role of genetic variation of the ITPR3 gene in T1D risk.

The association between the IFIH1 locus and type 1 diabetes

AIMS/HYPOTHESIS

We set out to validate a recently reported type 1 diabetes association from the IFIH1 gene variation in an independent cohort from a population of mixed European descent.

METHODS

We genotyped five single-nucleotide polymorphisms in the IFIH1 locus, i.e. rs2111485, rs1990760, rs3747517, rs17783344 and rs984971589, in 589 type 1 diabetes nuclear family trios (1,767 individuals).

RESULTS

This study independently replicated the reported genetic association using a family-based approach.

CONCLUSIONS/INTERPRETATION

The reported type 1 diabetes association is from a linkage disequilibrium region including three candidate genes, i.e. FAP, IFIH1 and GCA. Further variant discovery and fine mapping could help clarify a novel type 1 diabetes mechanism.

Impact of the use of antenatal corticosteroids on mortality, cerebral lesions and 5-year neurodevelopmental outcomes of very preterm infants: the EPIPAGE cohort study

OBJECTIVE

To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24-27 and 28-32 weeks of gestational age (GA).

DESIGN

Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years.

SAMPLE AND METHODS

The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24-27 and 28-32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes.

MAIN OUTCOME MEASURES

Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years.

RESULTS

In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41-0.91]) and white matter injury (OR = 0.60 [0.46-0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27-0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results.

CONCLUSION

The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors.

X-ray and ellipsometric study of strong critical adsorption

Carpenter [Phys. Rev. E 61, 532 (2000)] succeeded in determining a single universal model, called the P1 model, that could describe the ellipsometric critical adsorption data from the liquid-vapor interface of four different critical binary liquid mixtures near their critical demixing temperatures. The P1 model also recently has been used to describe neutron reflectometry data from a critical liquid mixture/crystalline quartz interface. However, in another recent study, the P1 model failed to simultaneously describe x-ray reflectometry and ellipsometry data from the liquid-vapor surface of the critical mixture n -dodecane + tetrabromoethane (DT). In this paper, we resolve this discrepancy between x-ray and ellipsometric data for the DT system. At large length scales (far from the interface) the local concentration is described by the P1 model in order to correctly reproduce the temperature dependence of the ellipsometric data. Close to the interface, however, the molecular structure must be correctly accounted for in order to quantitatively explain the x-ray data. An important conclusion that arises from this study is that neutron or x-ray reflectometry is most sensitive to short-range interfacial structure, but may provide misleading information about long-range interfacial structure. Ellipsometry provides a more accurate measure of this long-range interfacial structure. Complex interfacial structures, possessing both short- and long-range structure, are therefore best studied using multiple techniques.

Allelic effects on gene regulation at the autoimmunity-predisposing CTLA4 locus: a re-evaluation of the 3' +6230G>A polymorphism

Genetic variation at a linkage disequilibrium block encompassing the cytotoxic T-lymphocyte antigen-4 (CTLA4) gene influences susceptibility to autoimmunity, but identifying the polymorphism(s) responsible for this effect has been challenging. Recently, a single-nucleotide polymorphism (SNP) located 3' to the known polyadenylation site of CTLA4 (+6230G>A) and strongly associated with autoimmune disease was reported to regulate levels of soluble CTLA4 isoform (sCTLA4) but not the full-length isoform. The purpose of the present study is to define the mechanistic effect of the 3'SNP on the isoforms of CTLA4 (alternative splicing vs polyadenylation vs effects on RNA stability). However, using allele-specific single-nucleotide primer extension, we found no difference between mRNA transcripts derived from either +6230G>A allele in 11 heterozygous individuals, in either of the two known CTLA4 isoforms. We also found no effect of this polymorphism on ICOS (inducible costimulator), a putative downstream target. In addition, repeated attempts at 3' RACE (3'rapid amplification of cDNA ends) were unsuccessful in amplifying any contiguous sequence past the known CTLA4 polyadenylation site and no such sequence was found in the EST databases. We conclude that the mechanism of the observed association of the +6230 SNP with autoimmune disease remains to be determined, but does not involve modulation of steady-state mRNA of any known CTLA4 isoform.

First Report of Melampsora larici-populina on Populus spp. in Eastern North America

In September 2002, yellow spots were observed on the leaf surface of a hybrid poplar (Populus maximowiczii Henry × P. balsamifera L.) grown at the Berthier forest nursery (46°2'N, 73°11'W) in the St. Lawrence Valley (Lanaudière Region, Québec, Canada). Disease severity was low, but the pathogen was present on a hybrid that was previously thought to be resistant to Melampsora medusae Thuem, the only reported poplar rust in eastern North America. Uredinia typical of a Melampsora sp. were observed on the abaxial leaf surface. The observed urediniospores were longer (32 to 48 μm) than the expected range for M. medusae (23 to 35 μm) and possessed an apical bald spot; thick paraphyses were also observed. These characteristics are diagnostic of M. larici-populina Kleb (2). Samples were deposited in the National Mycological Herbarium of Canada (DAOM 232107 and 232108) and in the Quebec Forest Biology Herbarium (QFB14703 and 14704). DNA was extracted from uredinia, and the internal transcribed spacer (ITS) of the ribosomal RNA gene was amplified and sequenced (GenBank Accession Nos. AY429656 and AY429657). There was a 100% match between the two sequences obtained and that of M. larici-populina (GenBank Accession No. AY375267), but there was approximately 12% divergence with the ITS sequence of M. medusae (GenBank Accession No. AY375273-5). This is the first report of M. larici-populina in eastern North America. This fungus was reported on P. trichocarpa × P. deltoides hybrids in the western United States in the early 1990s (1). It appears that M. larici-populina can overwinter in Québec because it was observed again at the nursery in September 2003. The occurrence of M. larici-populina in eastern North America has direct implications for the poplar industry since the host specificities of M. medusae and M. larici-populina differ; P. balsamifera and P. maximowiczii are sensitive to M. larici-populina (3). Hybrids with P. balsamifera or P. trichocarpa components may be particularly at risk. References: (1) G. Newcombe and G. A. Chastagner. Plant Dis. 77:532, 1993. (2) J. Pinon. Eur. J. For. Pathol. 3:221, 1973. (3) J. Pinon. Silvae Genet. 41:25, 1992.

Factors influencing rural Wisconsin elders in completing advance directives

PURPOSE

Advance directives can assist in end-of-life decision-making. This study explores the factors that influence completion of advance directives.

METHODS

Qualitative study using in-depth interviews of 10 patients over age 60 in a rural office practice.

RESULTS

Major themes: (1) patient autonomy: the patient and family role as decision maker, the physician as educator; (2) barriers that deter patients from completing advance directives include fear and confusion about these documents; and (3) quality of life is an important value in end-of-life decision-making.

CONCLUSIONS

Decision making about advance directives is a personal and family issue, but physician efforts to initiate the process and educate patients are important, especially if done routinely in the office or preferably in community settings. The main difference between those who do and don't complete advance directives is an understanding of the documents and their purpose.

Behavioral and biochemical effects of L-tryptophan and buspirone in a model of cerebellar atrophy

The Lurcher mutant mouse can be considered an adequate model of autosomal dominant spinocerebellar atrophy because of the severe degeneration of its cerebellar cortex and inferior olive. The purpose of this study was to determine whether the motor coordination deficits of Lurcher mutants could be improved after chronic administration of the serotonin (5-hydroxytryptamine; 5-HT) precursor, L-tryptophan, or of the 5-HT(1A) agonist, buspirone. During these treatments, the mice were submitted to behavioral evaluations using the coat hanger and the rotorod tests, as well as an inclined screen and a vertical grid test. At the end of treatments, 5-HT and 5-hydroxindole-3-acetic acid (5-HIAA) were measured in six brain regions. On the coat hanger test, administration of L-tryptophan accelerated movements along the horizontal bar by 44%, while buspirone increased the time spent on the apparatus by 11%. Neither drug had an effect on climbing ability or on the time spent on a rotating beam. Administration of L-tryptophan increased 5-HIAA levels in frontal cortex, neostriatum, thalamus, brainstem, cerebellum and spinal cord, but elevated 5-HT only in neostriatum, brainstem and cerebellum. In contrast, buspirone led to 5-HT increases in cerebellum and augmented 5-HIAA in the spinal cord. The modest test-specific improvements are consistent with some of the clinical data concerning 5-HT pharmacotherapy in patients suffering from cerebellar atrophy.

Bridging the gap between conventional and alternative medicine

BACKGROUND

The use of various forms of complementary and alternative medicine (CAM) has become widespread. We investigated this use in Madison, Wisconsin.

METHODS

We conducted semistructured indepth interviews focused on the knowledge, attitudes, and behaviors of a random sample of 17 patients who had used both CAM and conventional therapies during the past year. Participants were recruited using telephone listings. Twenty alternative practitioners were selected to represent the major modalities. The topics discussed included healing philosophy, choices of therapeutic methods, and ideas concerning concurrent use of differing therapeutic modalities. An 8-member multidisciplinary team analyzed the transcripts individually and in group meetings.

RESULTS

Four major themes emerged from the interview data: (1) holism, (2) empowerment, (3) access, and (4) legitimization. Both patients and providers distinguished between the socially legitimized and widely accessible but disempowering and mechanistic attributes of conventional medicine and the holistic and empowering but relatively less accessible and less legitimate nature of alternative healing. There was a strong call for integrating the best aspects of both.

CONCLUSIONS

Practitioners and users of alternative therapies in the Madison area confirmed both the alternative and complementary natures of unconventional health care, called for more integrated and accessible health care, and provided insights that could be useful in bridging the gap between conventional and alternative medicine.

What physicians can learn from consumers of dietary supplements

BACKGROUND

Many Americans consume dietary supplements, including vitamins, minerals, herbs, and amino acids. Government regulation of dietary supplements is limited, and patients typically do not consult with their physicians regarding the use of supplements.

METHODS

We conducted a qualitative study to describe patients' decisions about the use of dietary supplements and the communication they have with their physicians about such use. Four focus groups of customers from 3 local suburban health food stores were interviewed.

RESULTS

The customers in the health food stores we investigated were motivated to pursue wellness and wanted to take responsibility for their health. They would welcome a partnership with their physicians, but generally believed that physicians are closed-minded and have little knowledge about dietary supplements. These consumers determined the effectiveness of dietary supplements through personal study and subjective experimentation.

CONCLUSIONS

The health food store customers in our study were self-informed consumers who did not consult their physicians about their use of dietary supplements, because they did not believe that physicians were knowledgeable about or interested in supplements. An open-minded patient-centered approach would help physicians provide better care for patients who use dietary supplements.

Serotonin innervation of Lurcher mutant mice: basic data and manipulation with a combination of amantadine, thiamine and L-tryptophan

The Lurcher (Lc/+) mutant mouse is characterized by a considerable atrophy of the cerebellum due to a massive loss of cerebellar Purkinje and granule cells, as well as of neurons from the inferior olivary nucleus. In this study the effects of a therapeutic combination of amantadine, thiamine and L-tryptophan on the serotonin (5-HT) innervation was assessed in Lurcher mice by autoradiography, using [3H]citalopram to label 5-HT transporters. In wild type mice as well as in both saline-treated and drug-treated Lurcher mutants, [3H]citalopram binding remained unchanged in forebrain and brainstem regions. In the cerebellum, labelling of deep cerebellar nuclei (CBnuc) was about twofold higher than in the cortex (CBctx). In saline-treated Lurcher mutants compared to wild type mice, the densities of [3H]citalopram were 98% higher in CBctx, and 180% higher in CBnuc. In CBctx of drug-treated Lurcher mutants, transporter densities were 89% higher than in the wild type, but did not differ from the saline-treated Lurcher. In the CBnuc of the drug-treated Lurcher mutants, [3H]citalopram binding was 50% higher than in the saline-treated Lurcher group, and 320% higher than in wild type mice. The results show that 5-HT transporters, already upregulated in the CBnuc of Lurcher mutant mice, can be further increased by a pharmacological treatment, possibly altering the availability of 5-HT in some of its target areas.

The treatment of spinocerebellar ataxias: facts and hypotheses

Actual therapeutic assays in spinocerebellar ataxias, i.e. in Friedreich's ataxia (FA) and olivopontocerebellar atrophy (OPCA) are discussed in relation to (i) the serotoninergic theory; (ii) the excitotoxic action of glutamate; and (iii) cerebrospinal fluid thiamine deficiency in ataxic patients. Data from the literature show that neurochemical deficiencies arising from cerebellar damage in both FA and OPCA patients are multiple. Assays of replacement and neuroprotective therapeutics with a single drug have produced controversial data or mildly effective results. Consequently, it is hypothesized that a drug cocktail, i.e. L-5-hydroxytryptophan, thiamine and amantadine hydrochloride, would be more beneficial. This cocktail proved to be useful in open studies, improving respiratory disorders in FA patients. More powerful inhibitors of N-methyl-D aspartate receptor channels should be tried initially in animal experiments.

Infant feeding practices: understanding the decision-making process

BACKGROUND

Using qualitative methods, this case study of an inner-city family practice explores how a group of eight minority women and their families decided whether to breast-feed or bottle-feed their infants and how the office and hospital settings affected this decision-making process.

METHODS

The methods included depth interviews, a focus group interview, and participant observation.

RESULTS

Five key themes emerged from the data: 1) knowledge alone does not ensure any particular decision, 2) support is primarily from family networks in this group, with health care providers in a secondary role, 3) mothers and their families want to provide their infants with quantifiably sufficient nourishment, 4) physical and psychosocial satisfaction with the feeding method chosen is important, and 5) breast-feeding in public is not acceptable.

CONCLUSION

If the nutritional and bonding advantages do not outweigh the social embarrassment, inconvenience, and insecurity of breast-feeding, then bottle-feeding is chosen as the preferred method of infant feeding in this case study. Timely interventions in the postpartum period by providers often play a critical role in the initial success of breast-feeding.

The role of single photon emission computed tomography brain imaging with 99mTc-bicisate in the localization and definition of mechanism of ischemic stroke

99mTc-bicisate (99mTc-ECD) is a new brain perfusion imaging agent formulated from a radiochemically stable kit (Neurolite). A multicenter trial was conducted to determine the sensitivity and specificity of single photon emission computed tomography (SPECT) imaging with 99mTc-bicisate in the localization of ischemic stroke; 170 subjects were enrolled, 128 patients with stroke and 42 controls. Imaging results from 148 subjects (107 stroke patients and 41 controls) were considered evaluable. In the evaluable subjects, SPECT brain imaging with 99mTc-bicisate (21.0 +/- 2.5 mCi) was interpreted without clinical information and was compared with a final assessment using all clinical, diagnostic, and laboratory procedures except the 99mTc-bicisate SPECT results. 99mTc-bicisate was safe and well-tolerated. SPECT imaging with 99mTc-bicisate demonstrated a specificity of 98% and a sensitivity of 86% for localization of strokes (kappa, 0.75; 95% confidence interval, 0.64-0.86). Results were unchanged over time and were similar for all stroke mechanisms except for lacunar disease (sensitivity, 58%). In a secondary analysis, a normal image or small, deep (e.g., subcortical) perfusion defect was highly predictive of a lacunar mechanism. Defects involving the cortical surface were strongly associated with nonlacunar mechanisms. SPECT imaging with 99mTc-bicisate is a sensitive marker in the localization of perfusion defects associated with ischemic stroke and may assist in the determination of the underlying mechanism of a stroke.

Retrograde transneuronal transport of the fluorescent dye rhodamine beta-isothiocyanate from the primary and centrifugal visual systems in the pigeon

The transneuronal labeling properties of the fluorescent dye Rhodamine beta-isothiocyanate (RITC) were investigated in the pigeon following the intraocular injection of the tracer either alone or in combination with kainic acid (RITC/KA). The RITC was transported bidirectionally from the eye producing both orthograde axonal and terminal labeling of the primary visual system (PVS) and retrograde labeling of the centrifugal visual system (CVS) comprising the n. isthmo-opticus (NIO) and associated ectopic neurons (EN) as well as the tractus isthmo-opticus (TIO). In addition, RITC-positive cell bodies were identified in layers 9/10 of the optic tectum, n. isthmi parvocellularis (Ipc) and the hyperstriatum accessorium (HA) subdivision of the telencephalic visual Wulst. In the RITC/KA experiments, the orthograde transport of the dye within the PVS was selectively suppressed and this coincided with the absence of somatic labeling in n. Ipc and HA. The results are explained in terms of transneuronal transport of RITC, involving the terminal uptake and subsequent retrograde axonal transport of the tracer within second-order neurons in n. Ipc and HA which project to the PVS and in tectal layers 9/10 projecting to the CVS. Moreover, the transneuronal transport of RITC, as demonstrated using the present experimental conditions, appears to be very specific and only labeled distant cell populations known to project to either the PVS or CVS.

Mental dysfunction: a clinical pilot project in the elderly

In recognizing that there will be an increase in the number of individuals with dementing illnesses well into the next century, the authors show how one institution is coping with this problem today. The authors outline an innovative approach to admission and discharge planning and monitoring of patients with irreversible dementias and behavioral problems. Nurses and other team members need a mechanism (ie, a flow chart) to monitor behavior and plot progress within an individualized program designed to meet the needs of dementia patients.