A protocol for the prospective study of urinary cadmium with risk of fracture, bone loss, and muscle loss

Cadmium (Cd) is a heavy metal and natural element found in soil and crops with increasing concentrations linked to phosphate fertilizers and sewage sludge applied to crop lands. A large fraction of older US men and woman have documented Cd exposure. Cd exposure has proven health concerns such as risk of lung cancer from inhalation and impaired renal function; however, growing evidence suggests it also influences bone and muscle health. Given that low levels of Cd could affect bone and muscle, we have designed prospective studies using the two largest and most detailed US studies of bone health in older men and women: the Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures. We are investigating the association of urinary cadmium (U-Cd), as a surrogate for long-term Cd exposure, with bone and muscle health. Building off suggestive evidence from mechanistic and cross-sectional studies, this will be the first well-powered prospective study of incident fracture outcomes, bone loss, and muscle loss in relation to U-Cd, an established biomarker of long-term Cd exposure. The following is a proposed protocol for the intended study; if successful, the proposed studies could be influential in directing future US policy to decrease Cd exposure in the US population similar to recent policies adopted by the European Union to limit Cd in fertilizers.

Local People Standings on Existing Farm Animal Welfare Legislation in the BRIC Countries and the USA. Comparison with Western European Legislation

This study explored the demand for improved farm animal welfare (FAW) legislation in the BRIC countries and the USA. Results are discussed in comparison to Europe. Interviewees ranked their willingness to support or oppose introduction of more FAW-friendly laws in their country. A multinomial logistic regression was fit to the data (p < 0.001), with the parameters "country × gender" (p < 0.001) and "country × age" (p < 0.001) found significant. Americans, Russian women, and older Brazilian men are very supportive. The age effect is also felt in India, where older people are more supportive. Chinese, American men, and younger Indians are less supportive. Russian males are the group that oppose the most, followed by younger Brazilians and Indians. The law and its application vary a lot between countries. Nevertheless, the societal willingness to improve FAW legislation is high in all countries. The willingness is higher in Europe. The different cultural backgrounds, the socio-economic factors, and the social, economic, and environmental sustainability are enough reasons to create barriers to policy harmonization in the global trade of farm animal products.

Prévalence de la dénutrition et évaluation de l’efficacité d’une prise en charge nutritionnelle précoce chez les patients hospitalisés atteints du COVID-19

Introduction et but de l’étude

L’infection par le SARS-Cov2 (COVID-19) s’associe à un risque majeur de dénutrition. Cependant, les données nutritionnelles chez les patients atteints de COVID-19 sont limitées. Nos objectifs étaient :

– d’évaluer la prévalence de la dénutrition chez les patients hospitalisés pour COVID-19 à j0 puis à j30 post-hospitalisation ;

– d’étudier les liens entre dénutrition et gravité de la maladie à l’admission ;

– d’étudier l’impact de la dénutrition sur une évolution défavorable de la maladie (transfert vers une unité de soins intensifs (USI) ou décès) ;

– d’évaluer l’impact d’une prise en charge nutritionnelle précoce.

Matériel et méthodes

Tous les patients hospitalisés pour COVID-19 dans le service de médecine interne du CHU Pitié-Salpêtrière ont été inclus du 21 mars au 24 avril 2020 (n = 114, 60,5 % d’hommes, âge : 59,9 ± 15,9 ans). L’état nutritionnel de ces patients a été défini en utilisant les critères de la Haute Autorité de santé (HAS) 2019. Les caractéristiques cliniques, radiologiques et biologiques des patients atteints de COVID-19 ont été comparées en fonction de leur statut nutritionnel. Une régression logistique a été utilisée pour évaluer les associations entre les paramètres nutritionnels et l’évolution défavorable de la maladie. Une prise en charge nutritionnelle précoce selon la perte de poids et d’appétit des patients (consistant à une alimentation enrichie, une prévention du syndrome de renutrition inappropriée, des compléments nutritionnels oraux CNO et/ou une nutrition entérale NE), a été mise en place dès l’admission. À j30 post-hospitalisation, les données nutritionnelles cliniques, biologiques, anthropométriques, ont été collectées afin d’étudier l’évolution de l’état nutritionnel.

Résultats et analyse statistique

La prévalence globale de la dénutrition à j0 était de 44,6 % (14,2 % de dénutrition modérée, 30,4 % de dénutrition sévère). Celle-ci atteignait 66,7 % chez les patients provenant d’un service de réanimation. Une hypoalbuminémie initiale était associée à un risque plus élevé de transfert en unité de soins intensifs (pour 10 g/L d’albumine, OR [IC95 %] : 0,31 [0,1 ; 0,7] ; p < 0,01) et ce, indépendamment de l’âge et de la CRP. Après prise en charge nutritionnelle (69 % de CNO et 2,6 % de NE), la prévalence de la dénutrition à j30 post-hospitalisation était de 20,6 % (15,2 % de dénutrition modérée et 5,4 % de dénutrition sévère). À j30, on observait une masse musculaire basse selon impédancemétrie et une fonction musculaire altérée selon Handgrip chez 29,3 % des patients par rapport aux normes HAS.

Conclusion

La COVID-19 en service de médecine est associée à une forte prévalence de la dénutrition, encore plus marquée chez les patients provenant d’une USI. L’hypoalbuminémie à l’admission est associée à une évolution défavorable de la maladie, et ce indépendamment de la CRP et de l’âge. Un dépistage et une prise en charge nutritionnelle globale est possible (malgré les difficultés de recueil de données anthropométriques et de mise en place de la stratégie nutritionnelle liées aux mesures barrière), nécessaire et efficace chez ces patients, de manière précoce, ainsi que dans le suivi.

Growth performance and carcass yield of broiler chickens in response to carbohydrases and its association with phytase

ABSTRACT An experiment was conducted to evaluate broiler chicken performance and carcass yield in response to carbohydrase supplementation (Xylanase and Betaglucanase; XB) and association of carbohydrase and phytase (PHY). A total of 1,920 day-old male broiler chicks (Cobb 500) were distributed in a completely randomized design with 8 treatments and 8 replicates each, allocated in 64 pens with 30 chicks each. The treatments were: Positive Control (PC); Negative Control (NC): reduced ME [-120kcal/kg (Starter) and -170kcal/kg (Finisher)]; NC + XB [50g/ton]; NC + XB [100g/ton]; NC + XB [150g/ton]; NC + XB [50g/ton] + PHY [100g/ton]; NC + XB [100g/ton] + PHY [100g/ton]; NC + XB [150g/ton] + PHY [100g/ton]. The inclusion of XB (150) and XB (50, 100, and 150) associated with phytase increased feed intake than positive control when considering the total rearing phase. The feed conversion ratio of all broilers fed diets with energy reduction were worse than positive control, even with the addition of enzymes, and did not differ between them. There was no significant effect of treatments on carcass parameters.

The Deepwater Horizon Oil Spill Through the Lens of Human Health and the Ecosystem

This review examines current research ascertaining the impact of the Deepwater Horizon oil spill on human health and ecosystems. Driven by the need to strategically focus research funding, the authors also assess the implications of those findings and promote a transdisciplinary research agenda addressing critical gaps.Epidemiologic studies conducted in workers and vulnerable communities in the spill's aftermath showed that non-chemical stressors affect resilience. Ecosystem-wise salt marsh species showed variability in structural and functional changes, attributed to species-specific tolerance, oil exposure, and belowground plant organs damage.Lacking baseline exposure assessment data hampers assessing the impact of chemical stressors. Research priorities include leveraging existing women/child dyads and worker cohorts to advance exposure characterization and counter early adverse effects in most vulnerable populations. Key policy gaps include mandated just-in-time emergency resources to ascertain immediate post-event exposures and contemporary legislation addressing human and ecosystem health in an integrated rather than silo fashion.

Association of groundwater constituents with topography and distance to unconventional gas wells in NE Pennsylvania

Recently we reported an association of certain diseases with unconventional gas development (UGD). The purpose of this study is to examine UGD's possible impacts on groundwater quality in northeastern Pennsylvania. In this study, we compared our groundwater data (Columbia 58 samples) with those published data from Cabot (1701 samples) and Duke University (150 samples). For each dataset, proportions of samples with elevated levels of dissolved constituents were compared among four groups, identified as upland far (i.e. ≥1km to the nearest UGD gas well), upland near (<1km), valley far (≥1km), and valley near (<1km) groups. The Columbia data do not show statistically significant differences among the 4 groups, probably due to the limited number of samples. In Duke samples, Ca and CI levels are significantly higher in the valley near group than in the valley far group. In the Cabot dataset, methane, Na, and Mn levels are significantly higher in valley far samples than in upland far samples. In valley samples, Ca, Cl, SO4, and Fe are significantly higher in the near group (i.e. <1km) than in the far group. The association of these constituents in valley groundwater with distance is observed for the first time using a large industry dataset. The increase may be caused by enhanced mixing of shallow and deep groundwater in valley, possibly triggered by UGD process. If persistent, these changes indicate potential for further impact on groundwater quality. Therefore, there is an urgent need to conduct more studies to investigate effects of UGD on water quality and possible health outcomes.

Prevalence of bovine milk pathogens in Azorean pastures: mobile versus fixed milking machines

The aims of the present study were (1) to evaluate the influence of using mobile (n=47) or fixed (n=45) milking machines in Azorean herds on the apparent prevalence of several milk pathogens in bulk tank milk (BTM) and (2) to determine whether separated subclinical mastitic cows can serve, in real time, as predictors of milk pathogen prevalence for the remaining animals at the herd level. The use of a mobile or fixed milking machine influenced (P≤0.05) the prevalence of Staphylococcus aureus (72.3 per cent; n=34 v 51.1 per cent; n=23, respectively) and Klebsiella species (46.8 per cent; n=22 v 26.7 per cent; n=12, respectively). S aureus (95 per cent CI OR 1.1 to 6.0) and Klebsiella species (95 per cent CI OR 1.0 to 5.8) were 2.5 times more likely to increase in the BTM of herds using mobile milking machines. The prevalence of coagulase-negative staphylococci (100 per cent; n=92), Escherichia coli (75.0 per cent), Corynebacterium bovis (57.6 per cent), Enterococcus species (55.4 per cent), Streptococcus dysgalactiae (51.1 per cent), Streptococcus uberis (41.3 per cent), Actinomyces pyogenes or Peptostreptococcus indolicus (41.3 per cent) and Streptococcus agalactiae (32.6 per cent) in BTM remained similar among the herds. κ coefficients were always <0.70, indicating intra-herd disagreement of the prevalence of milk pathogens between BTM and separated milking cows. Milking hygiene should be improved in pastures, focusing specifically on herds that use a mobile milking machine. The segregated cows at milking time are not good predictors of milk pathogens in BTM.

Description of a model to optimise the feeding of amino acids to growing pullets

1. A nutrition model is described that may be used to optimise the amino acid nutrition of laying-type pullets prior to the onset of lay. It is not a method of optimising lifetime laying performance. 2. The potential growth and composition of the body, feathers, ovary and oviduct are described from hatching to the age at which sexual maturity is attained, from which the daily amino acid and energy requirements for the average individual in the population can be calculated. 3. There are two parts to the approach used, the first being a description of the model itself and the second being a description of how the required information was gathered. A number of assumptions made in developing the model are discussed. 4. The rates of maturing of the body, feather-free body and body protein of the DeKalb pullets used were shown to be constant at 0.017/d and those of feathers at 0.02/d. These are considerably slower than those of the oviduct and ovary (0.139 and 0.084/d respectively). The ovary attained a higher mature weight (78.4 vs. 58.7 g) than the oviduct. 5. The age at which the growth of the reproductive organs is initiated in the model is defined by the user. The daily amount of threonine required to meet the requirements for maintenance and potential growth of the developing tissues and organs is calculated for each day of the growing period from hatching to the age at which the first egg is laid. A method of calculating the required daily concentration of threonine in the feed is described, from which a feeding programme may be derived. 6. For the model to produce an optimum economic feeding programme for a population of laying-type pullets, more information than is available from this study is required. These issues are discussed in the paper.

Conservation implications of complex population structure: lessons from the loggerhead turtle (Caretta caretta)

Complex population structure can result from either sex-biased gene flow or population overlap during migrations. Loggerhead turtles (Caretta caretta) have both traits, providing an instructive case history for wildlife management. Based on surveys of maternally inherited mtDNA, pelagic post-hatchlings show no population structure across the northern Atlantic (phi(ST) < 0.001, P = 0.919), subadults in coastal habitat show low structure among locations (phi(ST) = 0.01, P < 0.005), and nesting colonies along the southeastern coast of the United States have strong structure (phi(ST) = 0.42, P < 0.001). Thus the level of population structure increases through progressive life history stages. In contrast, a survey of biparentally inherited microsatellite DNA shows no significant population structure: R(ST) < 0.001; F(ST) = 0.002 (P > 0.05) across the same nesting colonies. These results indicate that loggerhead females home faithfully to their natal nesting colony, but males provide an avenue of gene flow between regional nesting colonies, probably via opportunistic mating in migratory corridors. As a result, all breeding populations in the southeastern United States have similar levels of microsatellite diversity (H(E) = 0.70-0.89), whereas mtDNA haplotype diversity varies dramatically (h = 0.00-0.66). Under a conventional interpretation of the nuclear DNA data, the entire southeastern United States would be regarded as a single management unit, yet the mtDNA data indicate multiple isolated populations. This complex population structure mandates a different management strategy at each life stage. Perturbations to pelagic juveniles will have a diffuse impact on Atlantic nesting colonies, mortality of subadults will have a more focused impact on nearby breeding populations, and disturbances to adults will have pinpoint impact on corresponding breeding populations. These findings demonstrate that surveys of multiple life stages are desirable to resolve management units in migratory marine species.

Atrial flutter ablation with a new radiofrequency catheter

OBJECTIVE

To assess the performance of a new radiofrequency catheter, specially designed for inferior vena cava-tricuspid annulus (IVC-TA) isthmus ablation, in the treatment of atrial flutter.

PATIENTS

IVC-TA isthmus ablation was performed in thirteen patients, eleven men and two women, aged 60 +/- 12, with a diagnosis of typical atrial flutter, symptomatic despite anti-arrhythmic therapy. The flutter was present for more than one year in seven patients and was paroxysmal in the remainder. The echocardiogram showed atrial enlargement in six patients. Atrial flutter was an isolated phenomenon in seven patients and in the remainder was associated with arterial hypertension (two patients), ischemic heart disease (two patients) and dilated cardiomyopathy (two patients).

METHODS

In the electrophysiologic study four diagnostic catheters were used, including one duodecapolar for mapping the tricuspid annulus. In the patients who presented with sinus rhythm, atrial flutter was induced with programmed atrial stimulation, and then the atrial activation circuit was mapped. To demonstrate the entrainment phenomenon the IVC-TA isthmus was over-stimulated, to prove that this was the slow zone of the circuit. The radiofrequency energy was applied in the IVC-TA isthmus with the Medtronic Cosio-Fluttr ablation catheter, for 60 sec per application, with temperature control and with a maximum energy output of 50 W. Criteria for success were not only the disappearance of the atrial flutter during the application of radiofrequency energy, but also the demonstration of bi-directional IVC-TA isthmus block.

RESULTS

The primary success rate was 100%. The mean procedure time was 110 +/- 22 min, mean fluoroscopy time was 23 +/- 4 min and the number of radiofrequency energy pulses was 9 +/- 3. There were no complications. The patients were followed for a mean time of 8 +/- 4 months and atrial flutter recurred in only one patient (8%).

CONCLUSIONS

Atrial flutter ablation with the new Medtronic Cosio-Fluttr catheter, specially designed for the application of radiofrequency at the IVC-TA isthmus, is a safe procedure and has a high success rate. It simplifies ablation, decreasing the number of radiofrequency energy pulses, without using long sheaths and keeping short procedure and fluoroscopy times.

[Deciding about pacing mode in sinus node dysfunction: should carotid sinus massage be performed and in which circumstances?]

OBJECTIVE

To state the incidence of carotid sinus syndrome (CSS) with atrioventricular node manifestation in patients with sinus node dysfunction (SND) and indication for a definitive pacemaker (PM), we propose a new protocol between atrial pacing AAI and double chamber DDD.

POPULATION AND METHODS

69 patients (PTS) (male 71%), median age 65 +/- 10 years, with SND (normal PQ and no intraventricular conduction defect), that had a PM implant following the protocol that included carotid sinus massage for the pacing decision, were followed prospectively between December 1995 and November 1999. During the protocol we implanted DDD PM in PTS with Wenckebach less than 130 or Wenckebach equal/over 130 and CSS. At least, in PTS with Wenckebach equal/over 130 and no CSS we implanted AAI PM. The follow-up was between 4 months and 4 years, with clinical evaluation in the first and fourth months and then half yearly, with carotid sinus massage in the first evaluation.

RESULTS

About 1/4 of the 69 patients followed had SND without carotid sinus syndrome, or atrioventricular node repercussion; the SND involved the atrioventricular node in 56% of the patients, and there was a relation between the SND and carotid sinus syndrome in 18.8%. The follow-up revealed, in all patients, a complete remission of the symptoms, and when we repeated the carotid sinus massage in the first evaluation, there was a response like in the surgery room, in all patients.

CONCLUSIONS

There is a significant number of patients with SND and carotid sinus syndrome. The carotid sinus massage performed in the surgery room does not influence the test sensitivity and specificity in the diagnosis of carotid sinus syndrome. The authors think that carotid sinus massage should be considered in the protocol that defines the pacing mode, in patients with SND, and that influence the choice of pacemaker in 18.8% of patients.

Relationship between semantic paraphasias and related nonverbal factors

Word-finding deficits are a common problem in aphasic patients. One hypothesis suggests that the difficulty that patients experience in naming objects or pictures is related to a disruption in the ability to access the lexicon. Another hypothesis suggests that these problems are caused by a disruption of the mental dictionary and the semantic representations contained in it. The main purpose of this study is to assess whether nonverbal factors such as the ability to distinguish between similar attributes of objects is related to word-use problems in aphasia. 14 adults with left hemisphere cerebrovascular accidents and some word use deficit were administered the first 30 items of the Boston Naming Test and the Conceptual Matching subtest of the Detroit Test of Learning Aptitude. Errors on the Conceptual Matching subtest correlated significantly with the number of semantic paraphasias.

Myocardial architecture, texture and left ventricular heterogeneity in the pulsed Doppler tissue imaging pattern

The regional contribution for the global ventricular functional performance is complex and heterogeneous, the myocardial texture could reflect this particular aspect, during the phases of myocardial contraction and relaxation. The objective of our clinical study was to evaluate the relationship between the segmental myocardial velocity pattern by Doppler tissue imaging and the ultrasound characteristics of the left ventricular myocardium analysed by computerized ultrasound densitometry with the calculation of its intensity (dB), in a population of 22 subjects without clinical history of cardiovascular pathology, 50% female gender, mean age 43 +/- 11 years (19-66 years). In the methodology of study, the left ventricular myocardium was divided in 16 segments, according with the transthoracic echocardiographic recommendations of the American Society of Echocardiography (A.S.E.). During one cardiac cycle interval, the ultrasound characteristics of the left ventricular myocardium were evaluated continuously and in a quantitative manner, applying the computerized ultrasound densitometry method on the gray scale images of the ventricular myocardium, with the sample size identical to the myocardial wall thickness. The peak (Vmax-cm/sec) and mean (Vm-cm/sec) pulsed Doppler tissue imaging velocities, individuals, segmental and a total velocities, contraction and relaxation velocities of the left ventricular myocardium were obtained immediately after the computerized ultrasound densitometry analysis. Ultrasound densitometry and Doppler tissue imaging data were obtained in a total number of 352 left ventricular myocardial segments. Using the multiple linear correlation matrix analysis, the ultrasound intensity registered inverse significant correlation's with the Doppler tissue imaging Vmax and Vm for the systolic "s" wave in the total segments and each one of them (r = -0.66; p = 0.001; interval 2-18 cm/sec; r = -0.52 to -0.70) and with the early diastolic "e" wave (r = -0.42; p = 0.01; interval 2-19 cm/sec; r = -0.35 to -0.55). Direct correlation's were obtained for the computerized ultrasound densitometry intensity and Doppler tissue imaging Vmax and Vm of the late diastolic "a" wave in the total number of the left ventricular myocardial wall segments and in each one of them (r = 0.51; p = 0.01; interval 1-17 cm/sec; r = 0.42 a 0.66). We conclude that in our study and under physiological conditions of myocardial performance, a direct correlation was obtained between the ultrasound characteristics of the ventricular myocardial imaging and its velocities of contraction and relaxation. These facts reflect the close relationship between left ventricular myocardial structure and function, analyzed by the new ultrasound Doppler technologies.

Spontaneous ovarian hyperstimulation and primary hypothyroidism with a naturally conceived pregnancy

BACKGROUND

Ovarian hyperstimulation syndrome, not related to ovulation induction, is rare. A MEDLINE search from 1987 to 1997 using the key words "spontaneous ovarian stimulation," "pregnancy," and "hypothyroidism" revealed only five cases: three associated with pregnancies and two with primary hypothyroidism.

CASE

A 25-year-old white gravida 2, para 1, at 11-12 weeks' gestation presented with mild distension of a nontender abdomen, myxedematous facies, and large bilateral, multilobulated ovarian cysts. Conception had occurred spontaneously. Thyroid stimulating hormone was elevated, and free triiodothyronine and free thyroxine were low. Hypothyroidism, associated with spontaneous ovarian hyperstimulation syndrome, was diagnosed, and oral levothyroxine (0.10 mg/day) was started. With TSH still elevated at 21 weeks, levothyroxine was increased to 0.20 mg/day, and by 24 weeks, TSH and ovarian size were normal. Vaginal delivery of a 1120 g male infant occurred at 28 weeks.

CONCLUSION

A case of naturally conceived pregnancy associated with spontaneous ovarian hyperstimulation and primary hypothyroidism is reported.

Bartter's syndrome and pregnancy

Bartter's syndrome is a rare renal tubular disorder and few cases are reported associated with pregnancy. We describe a case of long standing disease with a good obstetric outcome in which the main concern was to maintain normal potassium serum levels.

Alpha3beta1-integrin as a critical mediator of the hepatic differentiation response to the extracellular matrix

The extracellular matrix (ECM) promotes the differentiation of many cell types, and ECM remodeling in the liver has been implicated in embryonic development, tissue injury, and oncogenesis. Integrins are heterodimeric ECM receptors that play critical roles in transducing the composition of the ECM in the cell environment. We previously showed that mouse H2.35 cells, a conditionally transformed, liver-derived cell line, assume a more differentiated hepatocyte morphology and enhanced liver-specific gene expression when the cells are cultured on gelatinous ECM substrata. Here we show that H2. 35 cells express relatively high levels of alpha3beta1-integrins, similar to that previously shown for immature hepatocytes, transformed hepatocytes, and biliary cells. However, the cell morphological responses that depend on alpha3beta1-integrin have not been defined. We found that transfecting H2.35 cells with antisense RNA construct directed to alpha3-subunit messenger RNA perturbs the initial cell attachment to laminin and collagen, and strongly inhibits cell morphological, proliferative, and gene expression responses to a collagen gel substratum. In situ hybridization to mouse embryo tissues demonstrates the presence of alpha3-subunit messenger RNAs in newly formed hepatocytes. We suggest that alpha3beta1-integrins are important for immature and transformed hepatocytes to respond morphologically to the extracellular matrix.

Cardiac consequences of renal transplantation changes in left ventricular morphology

OBJECTIVE

The aim of this study was to characterize changes in left ventricular morphology and function by conventional echocardiography in a pediatric population after renal transplantation (RT).

MATERIAL AND METHODS

This study includes 21 children, 11 female and 10 male, aged 11.8 +/-2.6 years at the time of renal transplantation. Eleven were on regular hemodialysis treatment and two on continuous peritoneal dialysis for 31.8 +/- 31.6 months; eight were transplanted without prior dialysis. Eight children were hypertensive before RT and nine (seven de novo) after RT. The patients were analysed in a prospective follow-up study with echocardiography immediately before and 30.2 +/- 15 months after successful renal transplantation. We measured the following echocardiographic parameters: Left ventricular end diastolic (LVED) and end systolic diameter (LVES), left atrial dimension (LAD), septal thickness (IVST), posterior wall thickness (PWT), shortening fraction (SF) and left ventricular index mass (LVIM). The paired Student's test, Fisher exact test and Pearson's correlation were used for statistical analysis. We analyzed the echocardiographic changes in the total group and separately in the subgroups with and without prior hemodialysis, as well as the influence of the duration of dialysis, anemia and hypertension.

RESULTS

1. After renal transplantation we found a decrease in the LVED LVES, LAD, IVST and PWT measurements (p < 0.05). There was a negligible increase in SF. The LVIM decreased from 139 g/m2 to 104 g/m2, representing a 21% reduction of the initial value, but this reduction was not of statistically significant. 2. The findings were similar in the hemodialysis group-LVIM decreased from 167.6 g/m2 to 94.9 g/m2, representing a 35% reduction in the initial value. 3. In the non dialysis group LVED, LVES, LAD and SVT decreased and LVIM showed a minor increase. There was a negligible increase in SF. 4. We found an increased LVIM in children with prior hemodialysis before RT, especially if dialysis lasted for more than two years. 5. Amelioration of hematocrit correlated with reduction of LVIM. 6. Regression of LV hypertrophy after RT was not dependent on blood pressure levels.

CONCLUSIONS

Renal transplantation resulted in a tendency towards normalization of the echocardiographic parameters analysed: Contractility, as assessed by shortening fraction, was normal in this population. Although cardiac hypertrophy and dilation is reversible after RT, it would seem that children may benefit from an earlier transplantation.

[Gaucher's disease in pregnancy]

A case of Gaucher's disease associated with pregnancy is reported. Although clinical symptoms were not present, portal hypertension was detected by ultrasound in the 13th week of pregnancy. Maternal anemia implied the use of erythropoietin from the 33rd week onwards. Good perinatal and maternal outcomes were achieved and there were no hemorrhagic complications.

Major histocompatibility complex binding affinity of an antigenic determinant is crucial for the differential secretion of interleukin 4/5 or interferon gamma by T cells

Differential activation of CD4+ T-cell precursors in vivo leads to the development of effectors with unique patterns of lymphokine secretion. To investigate whether the differential pattern of lymphokine secretion is influenced by factors associated with either the display and/or recognition of the ligand, we have used a set of ligands with various class II binding affinities but unchanged T-cell specificity. The ligand that exhibited approximately 10,000-fold higher binding to I-Au considerably increased the frequency of interferon gamma-producing but not interleukin (IL) 4- or IL-5-secreting cells in vivo. Using an established ligand-specific, CD4+ T-cell clone secreting only IL-4, we also demonstrated that stimulation with the highest affinity ligand resulted in interferon gamma production in vitro. In contrast, ligands that demonstrated relatively lower class II binding induced only IL-4 secretion. These data suggest that the major histocompatibility complex binding affinity of antigenic determinants, leading to differential interactions at the T cell-antigen-presenting cell interface, can be crucial for the differential development of cytokine patterns in T cells.

Development of 124 sequence-tagged sites and cytogenetic localization of 217 cosmids for human chromosome 10

A total of 124 new chromosome 10-specific sequence-tagged sites (STSs) were derived from two sources: (1) DNA sequences obtained from anonymous clones in new libraries enriched for human chromosome 10 inserts, and (2) published sequences of genes and other loci already known to map to chromosome 10. Libraries were constructed from a somatic cell hybrid carrying human chromosomes 10 and Y. A cosmid library was made from total DNA of the hybrid and probed with labeled total human DNA to identify clones with human DNA inserts. Two hundred seventeen cosmids were mapped to regions of human chromosome 10 by fluorescence in situ hybridization. Twenty-five cosmids represent probes that have been placed on the genetic map previously. One hundred ninety-two cosmids represent new probes that have not been mapped previously. Cosmids carrying inserts with CA repeats were identified by hybridization with a labeled poly(dC-dA)-poly(dG-dT) probe and subcloned to yield microsatellite STS markers. Two small insert plasmid libraries were made, the first by subcloning inserts from a chromosome 10-enriched lambda phage library (LL10NS01) and the second by cloning Alu element-mediated PCR products amplified from hybrid DNA. STSs were generated from the DNA sequences of clone inserts. Chromosome 10-specific STSs were distinguished from Y chromosome STSs by one or both of the following criteria: (1) successful PCR amplification from a template consisting of DNA from another chromosome 10-containing cell line, NA10926B, or (2) FISH localization to chromosome 10 of the source cosmid or of YACs isolated by PCR screening with the STS. These libraries were the source of 90 new chromosome 10-specific STSs, 42 of which contain CA repeats.

Phorbol regulation of topoisomerases I and II in human leukemia cells. Studies in an additional cell pair sensitive or resistant to phorbol-induced differentiation

We previously reported (Zwelling et al., Cancer Res 50: 7116-7122, 1990) that etoposide-induced DNA cleavage and mRNA coding for topoisomerase II are reduced in HL-60 cells induced to differentiate by phorbol ester. Reduction of etoposide-induced cleavage and topoisomerase II message did not occur in the derived cell line 1E3 (which is resistant to phorbol-induced differentiation), implying that topoisomerase II activity may be related to the state of cell differentiation. We have extended these studies using a new phorbol sensitive/resistant cell pair, S (sensitive) and PET (phorbol ester tolerant). Phorbol ester exposure not only reduced etoposide-induced DNA cleavage and topoisomerase II mRNA in S cells but also decreased the amount of immunoreactive topoisomerase II enzyme in whole S cells. However, immunoreactive topoisomerase II extracted from the nuclei of phorbol-treated S cells was not reduced compared with that from the nuclei of untreated S cells. This suggests that topoisomerase II contained in nuclear extracts is not always representative of the total cellular enzyme. Dramatic decreases in the amount, activity, or gene expression of topoisomerase II were not observed after phorbol treatment of the resistant PET cells; this is consistent with the potential involvement of topoisomerase II in monocytoid differentiation. Levels of topoisomerase I enzyme and mRNA fell in both S and PET cells after phorbol treatment; therefore, the genes for topoisomerases I and II did not appear to be regulated coordinately.

Further characterization of an amsacrine-resistant line of HL-60 human leukemia cells and its topoisomerase II. Effects of ATP concentration, anion concentration, and the three-dimensional structure of the DNA target

The characterization of type II topoisomerases from amsacrine-sensitive (HL-60) and amsacrine-resistant (HL-60/AMSA) human leukemia cells was extended. The intercalator resistance and etoposide sensitivity of the HL-60/AMSA cells themselves were confirmed, and the stability of this pharmacologic phenotype over many hundreds of cell generations was demonstrated. Prolonging exposure of HL-60/AMSA cells to amsacrine did not alter their sensitivity relative to that of HL-60 cells. Improved methods of immunoblotting allowed clear demonstration that the topoisomerase II within these cells exhibited sensitivity and resistance characteristics that mirrored those of the cells and the isolated enzymes themselves. Additional biochemical characterization of the type II topoisomerases indicated that both enzymes relaxed supercoiled DNA in a distributive fashion and that the ATP concentrations at which optimal catalytic activity of the two enzymes was exhibited were identical. The enzymes differed, however, in their activity optima in buffers of various type and ionic strength. Furthermore, the inability of the HL-60/AMSA enzyme to exhibit enhanced DNA cleavage in the presence of amsacrine could be overcome if the DNA target molecule contained a bend cloned into its polylinker region. By contrast, a bend in a DNA plasmid containing no polylinker was resistant to amsacrine-enhanced cleavage in the presence of HL-60/AMSA topoisomerase II, as was a plasmid containing a polylinker with no bend. This suggests that an unusual DNA conformation (a bend) in a specific DNA context (a polylinker) may be a favored site for topoisomerase II action. It also suggests a mechanism by which the sites and extent of topoisomerase II activity can be controlled in cells.

[Tuberculosis infection level and tuberculin conversion after intradermal BCG in school children of Botucatu, São Paulo, Brazil in 1969]

Procurou-se determinar, no 2.° semestre de 1969, o nível de infecção tuberculosa nos escolares da sede municipal de Botucatu, nas idades de 7 a 15 anos (exclusive) e o efeito do BCG intradérmico e da própria prova em si na viragem tuberculínica. Utilizamos PPD RT23 com 2UT (0,04 mcg) de acordo com a recomendação do Serviço Nacional de Tuberculose. A prevalência desta infecção se situou em torno de 6%, a qual, embora aparentemente baixa, ainda sugere ser a tuberculose problema de Saúde Pública local, com necessidade de melhor controle. Não houve diferença estatística significante entre os níveis encontrados nos grupos bases (A + B) e o controle, C, mas em relação aos atributos considerados, ela predominou na faixa etária de 11 a 15 anos, nos não brancos e no sexo masculino, com aumento significante de nível entre as provas realizadas num período de 90 dias. Não houve diferença significativa para os resultados encontrados entre a primeira e segunda provas realizadas no grupo B o que, entretanto se apresentou evidente no grupo A, após a utilização do BCG intradérmico, sugerindo forte estímulo alérgico para o mesmo. Os resultados foram encaminhados ao Dispensário Regional de Tuberculose para as necessárias medidas de controle.

[Tuberculosis infection and the use of oral and intradermal BCG in school children of Laranjal Paulista, São Paulo, Brazil]

Foi pesquisado no 2.° semestre de 1969, o índice de infecção tuberculosa nos escolares de nível primário da sede municipal de Laranjal Paulista, SP, com faixa etária de 7 a 15 anos. Utilizou-se PPD RT23 com 2UT (0,04 mcg) de acordo com a 2.ª recomendação do Serviço Nacional de Tuberculose, sendo encontrado nível de 8% de reatores fortes o que sugere necessidade de intensificação local do controle da tuberculose. Houve diferenças significativas a 5% quanto à cor e grupo etário, predominando nos "não brancos" e nos de 11 a 15 anos, o mesmo não ocorrendo, entretanto, quanto ao sexo. Os reatores e seus conviventes foram encaminhados ao Dispensário de Tuberculose. Foi também pesquisada a viragem tuberculínica pelo BCG oral e intradérmico, comparados com grupo controle, encontrando-se resultados significantes. O resultado verificado no grupo que tomou BCG por via intradérmica foi quase duas vezes maior que os observados no grupo de BCG oral. Não houve diferenças quanto ao sexo e grupo etário, mas o grupo "não branco" mostrou-se mais reativo. Não foram definidas estatisticamente as reações pós-vacinais e a expectativa populacional foi considerada dentro da esperada para atividades desse tipo.