Cellular and humoral immunogenicity of the COVID-19 vaccine and COVID-19 disease severity in individuals with immunodeficiency

Background

A well-coordinated adaptive immune response is crucial for limiting COVID-19 disease. Some individuals with immunodeficiency are at a high risk of developing severe COVID-19. Therefore, the development of standardized methods for measuring different arms of the vaccine response in the setting of immunodeficiency is of particular interest. In this study, we compared the vaccine response of individuals living with immunodeficiency with healthy controls in terms of interferon gamma (IFN-γ) production and spike protein-specific antibody level post primary COVID-19 vaccination and booster vaccines. Additionally, the disease severity of those individuals who contracted COVID-19 was assessed.

Methods

Whole blood was stimulated overnight from 71 participants and 99 healthy controls. Commercially available PepTivator^® peptide pool and trimeric spike protein stimulation were used. ELISA was used to analyze IFN-γ levels. The total SARS-CoV-2 spike protein antibody titre was measured using a Roche Elecsys^® S total antibody assay. Patient characteristics, COVID-19 infection status and IDDA 2.1 'Kaleidoscope' scores were recorded. Vaccine responses were scored from zero to three.

Results

99% of healthy controls, 89% of individuals with IEI and 76% with secondary immunodeficiency (SID) had an IFN-γ level above the validated reference range after peptide mix stimulation following primary vaccination. There was an increase in IFN-γ levels in patients with inborn errors of immunity (IEI) following the booster vaccine (p = 0.0156). 100% of healthy controls, 70% of individuals living with IEI and 64% of individuals living with SID had detectable spike protein-specific antibody levels following the primary vaccination. 55% of immunodeficiency patients who had mild COVID-19 and 10% with moderate/severe COVID-19 had detectable antibody and IFN-γ levels post vaccine. The mean pre-infection IDDA 2.1 scores were higher in individuals who developed moderate/severe COVID-19 (25.2 compared to 9.41).

Conclusions

Covid whole-blood IGRA is a highly accurate, straightforward and robust assay and can be easily adapted to measure cellular response to COVID-19. A complete evaluation of the vaccine response may be particularly important for individuals living with immunodeficiency. A clinical immunodeficiency score and a validated vaccine response score may be valuable tools in estimating COVID-19 disease risk and identifying individuals living with immunodeficiency who may benefit from enhanced vaccination schedules.

42 EXPLORING THE IMPACT OF AGE AND FRAILTY STATUS ON THE IMMUNE RESPONSE TO COVID-19 ILLNESS USING DETAILED IMMUNO-PHENOTYPING

Background

Methods

Results

Conclusion

1237 Optimising Outpatient Care After Paediatric Burns: The Development of a Chatbot To Identify Complications And Provide Clinical Advice

Aim

More than 6000 children require specialist care from one of fourteen regional burns services in England and Wales each year. Families often have to travel long distances and may not have access to specialist care with restricted services due to Covid-19. This quality improvement project aimed to:

Method

We conducted a national service evaluation of children’s burns services in England and Wales. We then conducted a PRISMA compliant systematic review up to September 2020 to identify studies reporting chatbot use to deliver outpatient care. A chatbot was then developed using Dialogflow to identify complications and provide advice to families.

Results

Across England and Wales, 11 children’s burns services reported outpatient practice: six services follow up all children at three months, three have variable follow-up and two discharge all patients. Our systematic review identified 10 studies reporting chatbot use although none were used following burns. A frame-based system-focused chatbot was developed in conjunction with expert burns surgeons and patient representatives.

Conclusions

Chatbots are effective and acceptable alternatives for in-person follow up. We demonstrate national variation in the provision of outpatient paediatric burn care and have developed a chatbot that can address clinical concerns and provide reassurance to patients and family members. Future studies will determine the acceptability and safety of this chatbot.

Automated conversational agents for post-intervention follow-up: a systematic review

BACKGROUND

Advances in natural language processing and other machine learning techniques have led to the development of automated agents (chatbots) that mimic human conversation. These systems have mainly been used in commercial settings, and within medicine, for symptom checking and psychotherapy. The aim of this systematic review was to determine the acceptability and implementation success of chatbots in the follow-up of patients who have undergone a physical healthcare intervention.

METHODS

A systematic review of MEDLINE, MEDLINE In-process, EMBASE, PsychINFO, CINAHL, CENTRAL and the grey literature using a PRISMA-compliant methodology up to September 2020 was conducted. Abstract screening and data extraction were performed in duplicate. Risk of bias and quality assessments were performed for each study.

RESULTS

The search identified 904 studies of which 10 met full inclusion criteria: three randomised control trials, one non-randomised clinical trial and six cohort studies. Chatbots were used for monitoring after the management of cancer, hypertension and asthma, orthopaedic intervention, ureteroscopy and intervention for varicose veins. All chatbots were deployed on mobile devices. A number of metrics were identified and ranged from a 31 per cent chatbot engagement rate to a 97 per cent response rate for system-generated questions. No study examined patient safety.

CONCLUSION

A range of chatbot builds and uses was identified. Further investigation of acceptability, efficacy and mechanistic evaluation in outpatient care pathways may lend support to implementation in routine clinical care.

Using Clinical Prompts in General Practice to Increase Participation in the National Bowel Cancer Screening Program: A Case Study Protocol

Background: One in 12 Australians is expected to develop bowel cancer by age 85. Over 90% of bowel cancers can be successfully treated if detected early yet participation rates in the National Bowel Cancer Screening Program (NBCSP) are currently only 39%. Research shows that general practitioner (GP) recommendation is a key predictor for bowel cancer screening uptake. However the current NBCSP invitation system does not involve GPs, making it difficult for them to know when a patient has received a test kit in the mail, and in turn play a role in screening behavior. Research suggests that GP point-of-care clinical prompts, encouraging GPs to discuss screening with their patients, can increase fecal occult blood testing. Such a ´reminder´ system is integral to other screening programs in Australia, however no such system exists for the NBCSP. The George Town Medical Centre located in rural Tasmania, has recently implemented a reminder prompt for bowel cancer screening as part of its standard clinical practice. This paper describes the protocol used to implement and evaluate this service. Aim: Our research aims to determine whether a clinical prompt delivered to GPs at point-of-care, can increase bowel cancer screening participation in patients attending a rural Tasmanian general practice. Secondary aims include assessing GP and patient attitudes toward the prompt and determining socio-demographic differences in the effect of the prompt on screening participation. Methods: The clinical prompt was implemented in January 2018. Active patients turning 50 (n=106), 60 (n=141) or 70 (n=103) in 2018 were eligible to receive the prompt. The prompt was created within the practice management software and associated with each eligible patient's file. GPs were provided with information on the NBCSP as well as resources to support their conversation with patients including a sample kit. The number of patients with whom the GP discussed screening and the number of patients who completed a kit will be collected after 12 months. Screening rates of patients eligible for the prompt will be compared with patients turning 54, 64 and 74 in 2018, controlling for potential covariates including age, gender and socioeconomic status. Interviews with all GPs (n=10) and a minimum of 10 patients will be conducted to gain an understanding of attitudes toward the prompt. Results: To date the prompt has been successfully integrated into the practice and GPs have begun encouraging patients to use their NBCSP kits. Attitudes of GPs and patients toward the prompt and preliminary data on kit usage will also be presented. Conclusion: A clinical prompt in general practice may be a simple and cost effective way to increase participation in the National Bowel Cancer Screening Program. The findings from this study will have implications for the program in terms of engaging GPs in the screening invitation process. The results will further be used to inform a pilot study in Tasmania.

Comparative effects of desloratadine, fexofenadine, and levocetirizine on nasal adenosine monophosphate challenge in patients with perennial allergic rhinitis

Summary Background There are no data directly comparing the relative efficacy of modern H(1)-antihistamines in allergic rhinitis using nasal provocation challenge. Objective We elected to study the comparative effectiveness of usual clinically recommended doses of desloratadine (DES), fexofenadine (FEX), and levocetirizine (LEV), on nasal adenosine monophosphate (AMP) challenge in patients with perennial allergic rhinitis (PAR). Methods 16 patients with PAR were randomized in double-blind cross-over fashion to receive single doses of DES 5 mg, FEX 180 mg, LEV 5 mg, or placebo (PL), with nasal AMP challenge performed 12 h after dosing. Measurements of peak nasal inspiratory flow (PNIF) were made over 60 min after nasal AMP challenge. Results Pre-challenge values (mean+/-SEM) for PNIF (L/min) were not significantly different comparing all groups; DES (129+/-9), FEX (128+/-11), LEV (128+/-13), and PL (128+/-12). The maximum % PNIF fall from baseline over 60 min after nasal AMP challenge was significantly attenuated (P<0.05) compared to PL (50+/-4), with DES (32+/-5), FEX (36+/-4), and LEV (36+/-4). The area under the 60-min time-response curve (%.min) was also significantly attenuated (P<0.05) compared to PL (2110+/-268), with DES (1126+/-285), FEX (1225+/-255), and LEV (1261+/-194). There were no significant differences between the three H(1)-antihistamines for any outcomes. Conclusion DES, FEX, and LEV were equally effective in attenuating the response to nasal AMP challenge. However, further long-term studies will be required to study their comparative effects on nasal symptoms, quality of life, as well as on nasal inflammatory cells.

Molecular genetic analysis of neuronal ceroid lipofuscinosis

The neuronal ceroid lipofuscinoses comprise a group of inherited neurodegenerative disorders characterized by the accumulation of autoflourescent lipopigment in neurones and other cell types. Three main childhood sub-types occur: infantile (Haltia-Santavouri disease, locus CLN1), late-infantile (Jansky-Bielschowsky disease, locus CLN2) and juvenile (Spielmeyer-Sjogren-Vogt, Batten disease, locus CLN3). Inheritance is autosomal recessive. The basic biochemical defect remains unknown. The infantile disease Iocus (CLN1) has been mapped to human chromosome 1p32 and the juvenile disease Iocus (CLN3) to human chromosome 16p12 by linkage analysis. Marker loci in strong allelic association with the disease loci have been identified in each case and haplotype analysis suggests a founder mutation for CLN1 and CLN3. Classical late-infantile disease (CLN2) has been shown not to be an allelic variant of either CLN1 or CLN3. Identification of linked markers has provided a new method for pre-natal diagnosis. Work is in progress to clone CLN1 and CLN3 and to map CLN2. This will allow elucidation of the molecular genetic basis of the neuronal ceroid lipofuscinoses.

Incorporating language phenotypes strengthens evidence of linkage to autism

We investigated the effect of incorporating information about proband and parental structural language phenotypes into linkage analyses in the two regions for which we found the highest signals in our first-stage affected sibling pair genome screen: chromosomes 13q and 7q. We were particularly interested in following up on our chromosome 7q finding in light of two prior reports of linkage of this region to developmental language disorder, since one of the diagnostic criteria for autism is absent or abnormal language development. We hypothesized that if the language phenotype were genetically relevant to linkage at the chromosome 7q locus, then incorporating parents phenotypes would increase the signal at that locus, and most of the signal would originate from the subset of families in which both probands had severe language delay. The results support these hypotheses. The linkage signals we obtained on chromosome 7q as well as at least one signal on chromosome 13q are mainly attributable to the subgroup of families in which both probands had language delay. This became apparent only when the parents' history of language-related difficulties was also incorporated into the analyses. Although based on our data, we were not able to distinguish between epistasis or heterogeneity models, we tentatively concluded that there may be more than one autism susceptibility locus related to language development.

"I would rather be size 10 than have straight A's": a focus group study of adolescent girls' wish to be thinner

The study aimed to investigate the body concerns of adolescent girls, together with the underlying motivations for the wish to be thinner. Focus group methodology was employed in order to access participants' experience in their own language. Altogether 67 girls of Year 11 (aged approximately 16 years) took part in five groups. Audiotaped and transcribed discussions were systematically coded for themes and rated on frequency, extensiveness, intensity, specificity and level of agreement. As expected, sociocultural influences, in particular the media, were reported as exerting the strongest pressures to be thin. More importantly, however, the girls displayed an unexpected sophistication in their conceptualization of the role of both media effects and body image in the construction of their self-image. Contrary to assumptions made in quantitative research, despite clearly articulating a desire to be thinner, the girls also described how this did not necessarily mean they were dissatisfied with their bodies. The findings suggest that the girls' meta-awareness and sophisticated understanding of the media and other pressures, may serve to moderate against these forces which would otherwise seem overwhelming.

Genetics of the epilepsies

Molecular genetic analysis of mendelian epilepsies in humans and mice has revealed a diversity of underlying genes in symptomatic epilepsies associated with disordered brain development and neuronal survival. In contrast, the idiopathic mendelian epilepsies have emerged as a new category of channelopathies. New epilepsy loci have been mapped and one new epilepsy gene isolated. Functional analysis of epilepsy genes is providing new insights into the pathways that lead from mutant gene to hyperexcitable neurones. The major challenge for the future is the analysis of genetic epilepsies with complex inheritance.

Molecular genetics of human epilepsies

The term epilepsy encompasses a heterogeneous group of disorders, with a lifetime cumulative incidence of 3%. Genetic factors are thought to contribute to the aetiology in up to 60% of cases. Various molecular and cellular mechanisms give rise to epilepsy, and epilepsy genes fall into several distinct categories. They include genes in which mutations cause abnormal ion-channel function, disordered brain development, progressive neurodegeneration and disturbances of cerebral energy metabolism. In this review, we have focused on current understanding of the molecular genetic bases of human inherited epilepsies. Particular reference has been given to specific idiopathic epilepsies, neuronal migration disorders (cortical dysgeneses) and the progressive myoclonic epilepsies, and how information about this group of disorders might be used to develop new treatment strategies.

Molecular genetics of the neuronal ceroid lipofuscinoses

The neuronal ceroid lipofuscinoses (NCLs) are a group of inherited neurodegenerative disorders characterised by the accumulation of autofluorescent storage material in neurons and other cell types. The clinical features include visual impairment, progressive myoclonic epilepsy, and cognitive decline reflecting progressive neurodegeneration. The NCLs are subdivided into several subtypes according to age of onset, clinical course, and ultrastructure of the storage material. The molecular genetic basis of this group of disorders has recently been clarified. Mutations in the gene encoding a lysosomal enzyme, palmitoyl protein thioesterase (PPT), cause infantile NCL (locus CLN1 on chromosome 1p32) or Haltia-Santavuori disease. This Finnish disease is characterised ultrastructurally by granular osmiophilic deposits (GRODs). Juvenile-onset NCL with GRODs also is caused by mutations in PPT. Classic late-infantile NCL (Jansky-Bielschowsky disease) is caused by mutations in a gene encoding a pepstatin-insensitive lysosomal peptidase (CLN2 on chromosome 11p15), and juvenile-onset NCL (Batten disease) is caused by mutations in a gene encoding a 438-amino-acid membrane protein (CLN3 on chromosome 16p12) of unknown function. A locus for Finnish variant late-infantile NCL, CLN5, has been mapped to chromosome 13q22 and a locus for variant late-infantile NCL, CLN6, to chromosome 15q21-23. These and further advances will allow the molecular basis of the NCLs to be elucidated and may lead to new strategies for diagnosis and treatment.

Genetic evidence for the neuronal nitric oxide synthase gene (NOS1) as a susceptibility locus for infantile pyloric stenosis

The etiological role of the gene for neuronal nitric oxide synthase (NOS1) in infantile pyloric stenosis (PS) was investigated by analysis of two intragenic polymorphisms (NOS1a and NOS1b) in 27 families. There was significant overall transmission disequilibrium between PS and NOS1a (P = .006). Consideration of each allele independently revealed a highly significant tendency for allele 7 (210 bp) to be preferentially transmitted to the affected offspring (P = .0006). These observations suggest that NOS1 is a susceptibility locus for PS.

Clinical assessment of the 1987 American College of Rheumatology criteria for rheumatoid arthritis

The 1987 American College of Rheumatology (ACR) criteria for the classification of rheumatoid arthritis (RA) were clinically assessed. These criteria do not include findings of synovial fluid (SF) analysis and require no exclusion criteria. We have studied sequential patients with arthritis seen in four rheumatology centers in the Philadelphia area. Classifications by the ACR criteria were compared with our clinical diagnoses. Two hundred ninety eight patients were evaluated, 113 with RA and 185 with other diagnoses. Classifications as RA by the ACR criteria corresponded to our clinical diagnosis in 95% of the cases, corroborating the high sensitivity previously reported. However, we found a lower specificity (73%) than that reported (89%). False positive classifications as RA were found in 71% of patients with psoriatic arthritis, 48% of patients with SLE, and 31% of patients with gout. The specificity could be improved to 89% by excluding disorders with obvious distinguishing extraarticular features such as psoriasis or by SF findings of monosodium urate crystals. Awareness of these possible sources of confusion will further increase the teaching and epidemiologic value of these useful simplified criteria.

Linkage analysis of late-infantile neuronal ceroid-lipofuscinosis

The neuronal ceroid-lipofuscinoses (NCL) are a group of neurodegenerative disorders with an autosomal-recessive pattern of inheritance. There are 3 main categories of childhood NCL, namely, infantile, late-infantile, and juvenile NCL. These can be distinguished on the basis of age of onset, clinical course, and histopathology. A number of variant forms of NCL have also been described, and these show symptoms intermediary between the main classical forms. The genes for both the infantile and juvenile forms of NCL have previously been mapped to chromosome areas 1p32 and 16p12, respectively. The gene for late-infantile NCL (LINCL), CLN2, has been excluded from both these loci, but its location is as yet unknown. Recently, CLN5, the gene for the Finnish variant form of LINCL, was mapped to 13q21.1-32. Using the 3 microsatellite markers which were most tightly linked to CLN5, we have excluded CLN2 from this region using a subset of 17 families. Thus, CLN2 represents a fourth distinct genetic locus involved in the pathogenesis of NCL.

Genetics of the epilepsies

The epilepsy gene map has been refined and extended with new information concerning benign familial neonatal convulsions, benign familial infantile convulsions, Unverricht-Lundborg disease, epilepsy with progressive mental retardation and juvenile myoclonic epilepsy. Understanding of the molecular basis of paroxysmal disorders affecting the central nervous system has been revolutionalized with the identification of mutations in genes for the neurotransmitter receptors, GLRA1 and CHRNA4, and a voltage-gated potassium channel, KCNA1, as causes of inherited neurological disease.

Defined chromosomal assignment of CLN5 demonstrates that at least four genetic loci are involved in the pathogenesis of human ceroid lipofuscinoses

We demonstrate here that at least four genetically separate loci are involved in the pathogenesis of human neuronal ceroid lipofuscinoses (NCLs), fatal brain disorders of children. Earlier the assignments of the infantile and juvenile subtypes of NCL to 1p32 and 16p12 had revealed two loci; and here a variant subtype of the late-infantile form of NCL is mapped to a well-defined region on 13q21.1-q32, whereas the clinically similar, classical form of late-infantile NCL was found to represent the fourth, yet-unidentified NCL locus. The linkage disequilibrium was crucial for locus assignment in our highly limited family material, and the data exemplify the significance of this phenomenon in the random mapping of rare human diseases.

Batten disease (Spielmeyer-Vogt disease, juvenile onset neuronal ceroid-lipofuscinosis) gene (CLN3) maps to human chromosome 16

The ceroid-lipofuscinoses are a group of inherited neurodegenerative disorders characterized by the accumulation of autofluorescent lipopigment in neurons and other cell types. The underlying biochemical defect is unknown. Batten disease (Spielmeyer-Vogt disease, juvenile onset neuronal ceroid-lipofuscinosis) displays autosomal recessive inheritance. Genetic linkage studies were undertaken to determine the chromosomal location of the Batten disease mutation (CLN3). Following identification of linkage to the haptoglobin locus, linkage analysis has been carried out in 42 families by using DNA markers for loci on the long arm of human chromosome 16. The maximal lod score between Batten disease and the locus D16S148 calculated for combined sexes is 6.05 at a recombination fraction theta = 0.00. Multilocus analysis using five loci indicated the most likely order to be HP-D16S151-D16S150-CLN3-D16S148-D16S147. The maximal location score for CLN3 was 48 (equivalent to a lod score of 10.4) in that interval within this fixed marker map.

Sublethal hemorrhage impairs the acute peritoneal inflammatory response in the rat

Hemorrhagic shock increases the risk of septic complications in injured patients. In this study, we investigated the effect of sublethal hemorrhage on the acute peritoneal inflammatory response and the clearance of bacteria from the peritoneal cavity of the rat. Sprague-Dawley rats were subjected to sublethal hemorrhage, resuscitated, and then inoculated intraperitoneally with a suspension of viable Escherichia coli in saline. Sham-hemorrhaged rats served as controls. Sublethal hemorrhage decreased survival and impaired the influx into the peritoneum of polymorphonuclear leukocytes and macrophage colony-forming cells. There was no difference between groups in the clearance of viable bacteria from the peritoneum; clearance of blood-borne bacteria was decreased in the hemorrhaged animals. We conclude that sublethal hemorrhage in the rat inhibits the acute peritoneal inflammatory response, but has little or no effect on the early removal of bacteria from the peritoneal cavity.

Reality orientation with elderly patients in the community: an empirical evaluation

There is now good evidence that elderly mentally impaired patients can be re-orientated for time, place and person using the technique of reality orientation (RO). To date, all empirical trials demonstrating this have been carried out on elderly institutionalized patients. This technique however might be of greater value to those elderly dementing patients still living with relatives in the community but attending geriatric psychiatry day hospitals, where they could receive RO in a consistent and systematic way. The results of an empirical study of RO with a group of such patients is reported. These showed that day hospital patients could be effectively re-orientated and that concomitant with changes in level of orientation of the patients, there were parallel changes in the patients' behaviour at home, reported stress on relatives and in relatives' mood.

Influence of blood glucose concentration on brain lactate accumulation during severe hypoxia and subsequent recovery of brain energy metabolism

The effects of hypoxaemia on regional cerebral blood flow (CBF) and brain cortical metabolite concentrations were investigated at different blood glucose concentrations in rats under nitrous oxide anaesthesia. Tissue hypoxia of 15-min duration was induced by a combination of arterial hypoxaemia, hypotension, and clamping of the right carotid artery. Blood glucose concentrations were manipulated by varying the food intake in the 24 h before the experiment, and by glucose administration. Cortical CBF doubled during hypoxia on the intact side, but did not differ significantly from control values on the clamped side. In the clamped hemisphere there was a substantial decrease in adenylate energy charge. At brain tissue glucose concentration of 1 mumol g-1 and above, there was an inverse correlation between adenylate energy charge and brain lactate concentration. In starved animals with mean brain glucose of 0.32 +/- 0.00 mumol g-1, lactate concentration was significantly lower, in spite of equally severe disruption of energy state. Recovery of brain adenylate energy charge was worse in fed and glucose-infused groups than in the fasted group. These results demonstrate that limitation of substrate supply during severe hypoxia in the rat allows enhanced recovery of brain energy metabolism following the hypoxic episode.

Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study

In recent years increasing interest has centered on the elderly psychogeriatric patient living in the community and the part played by relatives in supporting these patients. There is a need, however, for ways of assessing the behavioural disturbance shown by such patients at home and the effect this behaviour has on relatives. Ratings by relatives of the behaviour at home of elderly dementing patients attending a geriatric psychiatry day hospital, together with the relatives' own ratings of the degree of stress and upset being experienced were obtained. Using the technique of factor analysis was shown that the patient's behaviour and the relative's reaction could be analysed into a number of separate categories and that these were differentially related to each other. Thus, for example, personal distress in the relative was related mainly to the amount of apathetic and withdrawn behaviour shown by the patient, whereas negative feelings held by the relative towards the patient were related only to the degree of disturbance of the patient's mood. The construction of scales measuring these different aspects of patient's behaviour and relative's reaction is described.

Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study

In recent years increasing interest has centered on the elderly psychogeriatric patient living in the community and the part played by relatives in supporting these patients. There is a need, however, for ways of assessing the behavioural disturbance shown by such patients at home and the effect this behaviour has on relatives. Ratings by relatives of the behaviour at home of elderly dementing patients attending a geriatric psychiatry day hospital, together with the relatives' own ratings of the degree of stress and upset being experienced were obtained. Using the technique of factor analysis was shown that the patient's behaviour and the relative's reaction could be analysed into a number of separate categories and that these were differentially related to each other. Thus, for example, personal distress in the relative was related mainly to the amount of apathetic and withdrawn behaviour shown by the patient, whereas negative feelings held by the relative towards the patient were related only to the degree of disturbance of the patient's mood. The construction of scales measuring these different aspects of patient's behaviour and relative's reaction is described.

Free fatty acids in the rat brain in moderate and severe hypoxia

The effects of mild, moderate, and severe hypoxia on cerebral cortical concentrations of free fatty acids (FFAs) were investigated in artificially ventilated rats under nitrous oxide anaesthesia. No change occurred during either mild (arterial PO2 35-40 mm Hg) or moderate (PO2 25-30 mm Hg) hypoxia. The effects of severe hypoxia (PO2 about 20 mm Hg) combined with hypotension (mean arterial blood pressure 80-85 mm Hg) varied with the EEG pattern and the tissue energy state. Thus, a major increase in total as well as in individual FFAs occurred first when EEG was severely depressed (almost isoelectric) and energy homeostasis disrupted. On a relative basis the greatest change occurred in free arachidonic acid. It is concluded tha hypoxia is associated with an increase in the concentrations of FFAs in brain tissue, provided that tissue oxygen deficiency is severe enough to cause tissue energy failure. However, an increase in FFAs does not invariably accompany minor reductions in the adenylate energy charge (EC) of the tissue.

Indomethacin improves survival in gram-negative sepsis

A clinically relevant rat model of peritoneal sepsis was developed through the use of (a) intraperitoneal insertion of rat fecal pellets or (b) live E. coli intraperitoneal injections. Therapy with indomethacin and lidocaine were evaluated in this model. Indomethacin alone, or in combination with appropriate antibiotics, significantly improved survival. Lidocaine did not show an increase in survival. These findings suggest that indomethacin may be beneficial in treatment of human sepsis.

The prevalence of calcified upper urinary tract stone disease in a random population--Cumbernauld Health Survey

It is difficult to obtain the true prevalence of stone disease in community. A proper random sample of a population has been studied and a figure of 3.83% of calcified stones have been found in 2,000 subjects. The significance of biochemical, bacteriological, skeletal and other surgical abnormalities is discussed. It is now possible to study individual groups within the population with respect to stone disease.

Hemispheric specialization of language: an EEG study of bilingual Hopi indian children

Electroencephalographic (EEG) recordings were obtained from electrode placements over the left and right frontal and parietal lobes of the brain in sixteen Hopi Indian children listening to tape recorded children's stories in the Hopi and English languages. Spectral analysis of the EEG data revealed that, for the parietal leads, alpha desynchronization was relatively greater over the right hemisphere for listening to Hopi than for listening to English, which indicates a greater right hemisphere participation in the processing of the Hopi speech. The results of the experiment are directionally consistent with our hypothesis, and imply that linguistic relativity may exist on a neurolinguistic level, such that languages can differ in the relative degree to which they serve as instruments of thought in a propositional, left hemisphere mode, or in an appositional, right hemisphere mode.

Involvement of the Golgi Apparatus in the Synthesis and Secretion of Hydroxyproline-rich Cell Wall Glycoproteins

Pulse labeling of carrot root phloem parenchyma (Daucus carota L. cv. Nantes) tissue with (14)C-proline followed by fractionation of the cytoplasmic organelles on sucrose gradients was used to determine the identity of the membranous organelles involved in the secretion of the hydroxyproline-rich glycoproteins of the cell wall. Identification of the organelles was done through electron-microscopical observations and through the localization of marker enzymes on the sucrose gradients. Enrichment of the organelles involved in secretion was determined by measuring the percentage of the incorporated radioactivity present as (14)C-hydroxyproline. The Golgi apparatus (dictyosome) was found to be a major site of glycoprotein transport. This identification was based on the observed enrichment of dictyosomes paralleling the purification of newly synthesized cell-wall glycoproteins. A marker enzyme for the Golgi apparatus, inosinediphosphatase, banded with the newly synthesized cell wall glycoproteins on sequential isopycnic and rate zonal sucrose gradients. Marker enzymes for the endoplasmic reticulum and the plasma membrane were clearly separated from the dictyosome-rich fraction. UDP-arabinose arabinosyl transferase, an enzyme involved in the glycosylation of the peptide moiety of this glycoprotein, also banded with the dictyosomes on both kinds of gradients. The results suggest an important role of the Golgi apparatus in the biosynthesis and the secretion of the cell wall glycoproteins of higher plants.