The Human Phenotype Ontology in 2024: phenotypes around the world

The Human Phenotype Ontology (HPO) is a widely used resource that comprehensively organizes and defines the phenotypic features of human disease, enabling computational inference and supporting genomic and phenotypic analyses through semantic similarity and machine learning algorithms. The HPO has widespread applications in clinical diagnostics and translational research, including genomic diagnostics, gene-disease discovery, and cohort analytics. In recent years, groups around the world have developed translations of the HPO from English to other languages, and the HPO browser has been internationalized, allowing users to view HPO term labels and in many cases synonyms and definitions in ten languages in addition to English. Since our last report, a total of 2239 new HPO terms and 49235 new HPO annotations were developed, many in collaboration with external groups in the fields of psychiatry, arthrogryposis, immunology and cardiology. The Medical Action Ontology (MAxO) is a new effort to model treatments and other measures taken for clinical management. Finally, the HPO consortium is contributing to efforts to integrate the HPO and the GA4GH Phenopacket Schema into electronic health records (EHRs) with the goal of more standardized and computable integration of rare disease data in EHRs.

The DataHarmonizer: a tool for faster data harmonization, validation, aggregation and analysis of pathogen genomics contextual information

Pathogen genomics is a critical tool for public health surveillance, infection control, outbreak investigations as well as research. In order to make use of pathogen genomics data, they must be interpreted using contextual data (metadata). Contextual data include sample metadata, laboratory methods, patient demographics, clinical outcomes and epidemiological information. However, the variability in how contextual information is captured by different authorities and how it is encoded in different databases poses challenges for data interpretation, integration and their use/re-use. The DataHarmonizer is a template-driven spreadsheet application for harmonizing, validating and transforming genomics contextual data into submission-ready formats for public or private repositories. The tool's web browser-based JavaScript environment enables validation and its offline functionality and local installation increases data security. The DataHarmonizer was developed to address the data sharing needs that arose during the COVID-19 pandemic, and was used by members of the Canadian COVID Genomics Network (CanCOGeN) to harmonize SARS-CoV-2 contextual data for national surveillance and for public repository submission. In order to support coordination of international surveillance efforts, we have partnered with the Public Health Alliance for Genomic Epidemiology to also provide a template conforming to its SARS-CoV-2 contextual data specification for use worldwide. Templates are also being developed for One Health and foodborne pathogens. Overall, the DataHarmonizer tool improves the effectiveness and fidelity of contextual data capture as well as its subsequent usability. Harmonization of contextual information across authorities, platforms and systems globally improves interoperability and reusability of data for concerted public health and research initiatives to fight the current pandemic and future public health emergencies. While initially developed for the COVID-19 pandemic, its expansion to other data management applications and pathogens is already underway.

Future-proofing and maximizing the utility of metadata: The PHA4GE SARS-CoV-2 contextual data specification package

Background

The Public Health Alliance for Genomic Epidemiology (PHA4GE) (https://pha4ge.org) is a global coalition that is actively working to establish consensus standards, document and share best practices, improve the availability of critical bioinformatics tools and resources, and advocate for greater openness, interoperability, accessibility, and reproducibility in public health microbial bioinformatics. In the face of the current pandemic, PHA4GE has identified a need for a fit-for-purpose, open-source SARS-CoV-2 contextual data standard.

Results

As such, we have developed a SARS-CoV-2 contextual data specification package based on harmonizable, publicly available community standards. The specification can be implemented via a collection template, as well as an array of protocols and tools to support both the harmonization and submission of sequence data and contextual information to public biorepositories.

Conclusions

Well-structured, rich contextual data add value, promote reuse, and enable aggregation and integration of disparate datasets. Adoption of the proposed standard and practices will better enable interoperability between datasets and systems, improve the consistency and utility of generated data, and ultimately facilitate novel insights and discoveries in SARS-CoV-2 and COVID-19. The package is now supported by the NCBI’s BioSample database.

Financial implications of CT-guided lung biopsy in a tertiary centre: a radiologists' perspective

AIM

To evaluate the financial costs of performing computed tomography (CT)-guided lung biopsies in a large tertiary centre to help guide service development.

MATERIALS AND METHODS

Local financial data were collected to create a balance sheet, considering all expenses as well as revenue sources associated with the procedure. Data were based on accurate pricing and income data and evaluated on a per-procedure basis, with consideration of additional costs arising from post-procedural complications. Revenue data were estimated based on reimbursement information. A small coding quality audit was also performed to check if reimbursement claims were filed correctly.

RESULTS

This study demonstrated a healthy income generated from CT-guided lung biopsy procedures with a profit margin of 50%. Notably different financial impact was observed when comparing the same procedure undertaken on an outpatient as opposed to inpatient basis with inpatient procedures generating a net loss of - £2,146.79 a year. Overall, the activity generated a profit of £157,015.25, after accounting for loss generated by inpatient activity.

CONCLUSION

This analysis furthered understanding of the financial impact from performing CT-guided lung biopsy and will enable better planning and expansion of the service in the future, with emphasis around day-case and ambulatory service development, the positive intended consequence being an improved patient pathway.

Protein Production and Secretion in Exocrine Cells

Acinar cells of exocrine glands are highly specialized for producing, storing, and discharging secretory proteins for use on surfaces that represent interfaces between the organism and the surrounding environment. These functions are achieved through the secretory pathway that includes a series of functionally distinct intracellular compartments — the endoplasmic reticulum, subcompartments of the Golgi complex, and the secretion granule in which exportable macromolecules are stored at high concentrations. Most secretion occurs by granule exocytosis in response to external hormonal or neural stimuli. Although these processes have been traced in a variety of morphological and biochemical studies, very Utile is known about the mechanisms involved in facilitating and maintaining secretory storage, orchestrating discharge at the apical cell surface, and in ensuring conservation and re-internalization of the granule membrane. Recent studies initiated on cell fractions obtained from the rat parotid gland have provided significant insight into the protein storage conditions that prevail in the granule interior and the components of the granule membrane that are likely to be involved in general secretory function such as exocytosis.

Discrimination of Left-Right Orientation with Directional Markers

Pre-reading kindergartners ( n = 64) were divided equally into experimental and control groups of similar age and IQ. The experimentals discriminated the reversible letters, b, d, p, q, using special left and right markers plus brief instruction in both up-down and left-right discrimination. The controls had no markers and no instruction. The experimentals improved significantly on the over-all discrimination of letters, but the significant reduction of left-right reversal errors was partly offset by a significant increase of up-down inversion errors. These results held for both a detection task and a recognition task, and there were no interactions with age or sex. The results were interpreted as evidence that the difficulty that young children have in discriminating left-right orientation is due simply to the lack of obvious directional reference points.

Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema

BACKGROUND

Pleural effusions and empyema may complicate lower respiratory tract infections. Treatment of these collections of pus includes surgical drainage and the use of intra-pleural fibrinolysis to break down fibrin bands that may cause loculation.

OBJECTIVES

To conduct a systematic review of the benefit of adding intrapleural fibrinolytic therapy to intercostal tube drainage in the treatment of complicated para pneumonic effusions and empyema to reduce mortality or the need for subsequent surgical debridement of the pleural space.

SEARCH STRATEGY

We searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Trial authors were contacted for further information and details regarding the possibility of unpublished trials was requested. The most recent search was conducted in November 2006.

SELECTION CRITERIA

All studies in the review were Randomised Controlled Trials in adult patients with post-pneumonic empyema or complicated parapneumonic effusions who had not had prior surgical intervention or trauma. The intervention was an intrapleural fibrinolytic agent (streptokinase or urokinase) via an intercostal chest drain (ICD) versus control, or a comparison of the two agents.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data . Study authors were contacted for further information.

MAIN RESULTS

Seven studies met the eligibility criteria of the review, recruiting 761 participants. The only consistent end points in all trials were treatment failure, as gauged by the requirement for additional intervention including surgery or death. In studies where patients had either loculation and empyema, there was no significant difference in the risk of death with fibrinolytics (RR 1.08; 95% CI 0.69 to 1.68). When treatment failure was considered as surgical intervention, fibrinolytics reduced the risk of this outcome (RR 0.63; 95% CI 0.46 to 0.85), but there is discordance between earlier positive studies and the more recent negative study by Maskell.

AUTHORS' CONCLUSIONS

Intrapleural fibrinolytic therapy confers significant benefit in reducing the requirement for surgical intervention for patients in the early studies included in this review but not in the more recently published Maskell study. The reasons for this difference are uncertain. Separate subgroup analysis of proven loculated/septated effusions from the available data in our meta-analysis suggests a potential overall treatment benefit with fibrinolytics, but these results should be treated with caution as the data are incomplete and the benefit is not significant in the subgroup of high quality trials (Cochrane Grade A). Intrapleural fibrinolytics have not been shown to significantly increase adverse events, but the confidence interval is too wide to firmly exclude this possibility.

Indacaterol provides sustained 24 h bronchodilation on once-daily dosing in asthma: a 7-day dose-ranging study

BACKGROUND

Indacaterol is a novel, once-daily beta(2)-agonist in development for the treatment of asthma and chronic obstructive pulmonary disease. Studies were required to determine optimal dose(s) for continuing investigation.

OBJECTIVE

A dose-ranging study was undertaken to evaluate efficacy and safety of indacaterol.

METHODS

A total of 436 patients with persistent asthma receiving inhaled corticosteroids were randomized to 7 days treatment with once-daily indacaterol 50, 100, 200, or 400 microg via multi-dose dry-powder inhaler (MDDPI; Certihaler), indacaterol 400 microg via single-dose dry-powder inhaler (SDDPI), or placebo. Serial 24-h spirometry was performed on days 1 and 7. Vital signs, laboratory evaluations, and adverse events were monitored.

RESULTS

All doses of indacaterol increased the mean time-standardized area under the curve of forced expiratory volume in 1 s (FEV(1)) from 22 to 24 h postdose (P <or= 0.001 vs placebo) on days 1 and 7, with clinically relevant treatment-placebo differences of 240, 260, 350, 300, and 380 ml on day 1 and 230, 220, 320, 250, and 270 ml on day 7 for indacaterol 50, 100, 200, and 400 microg via MDDPI and 400 microg via SDDPI, respectively. All doses increased mean FEV(1) (P < 0.05 vs placebo) from 5 min to 24 h postdose on days 1 and 7. All doses were well tolerated. Most adverse events were mild-to-moderate in severity: most frequently reported were respiratory, thoracic, and mediastinal disorders.

CONCLUSION

Once-daily dosing with indacaterol provided sustained 24-h bronchodilation in patients with moderate-to-severe asthma, with a satisfactory overall safety profile. Indacaterol 200 microg appears the optimum dose, offering the best efficacy/safety balance.

Characterization of intensity-dependent optical rotation phenomena in chiral molecules in solution

The rotation of the plane of polarization of linearly polarized light by chiral molecules in solution is due to a forward scattering event. Ordinary optical rotation, a single-photon effect, is independent of intensity. As the light intensity is increased, other effects can appear, such as two-photon scattering or alignment of the molecule by one photon and scattering with a change of polarization by another. Both of these effects result in intensity-dependent (or nonlinear) optical rotation. A polarimeter was used to measure the nonlinear optical rotation of solutions in a heterodyne experiment. No nonlinear optical rotation was found in molecules lacking an absorption band near the laser frequency. In the three pyrimidine nucleosides studied, which do have such an absorption band, a nonlinear optical rotation was identified that was cumulative with each laser pulse. The effect persisted with a time constant that was on the order of seconds and characteristic of the molecule.

Indacaterol, a novel inhaled beta2-agonist, provides sustained 24-h bronchodilation in asthma

The present study examined the bronchodilator and safety profiles of single-dose indacaterol in intermittent or persistent asthma. In the present double-blind crossover study, 42 patients were randomised to receive single doses of indacaterol (50, 100, 200 and 400 microg) or placebo via a hydrofluoroalkane pressurised metered-dose inhaler. The primary efficacy comparisons were the per cent changes in forced expiratory volume in one second (FEV(1 )) between indacaterol and placebo 30 min and 21 h post-dose. All doses resulted in prolonged bronchodilation, with indacaterol 200 and 400 microg meeting pre-specified efficacy criteria. The mean percentage increases in FEV(1) from placebo with indacaterol 200 and 400 microg were 7.6 and 14.9%, respectively, at 30 min, and 7.5 and 10.4%, respectively, at 21 h post-dose. At these doses, changes in mean FEV(1) relative to placebo were statistically significant from 5 min to 25 h, inclusive. At 5 min, the geometric least squares mean values for FEV(1) were 3.08 and 3.22 L for the 200 and 400 microg doses, respectively, compared with 2.99 L for placebo. At 24 h after dosing, the baseline-adjusted geometric least square mean FEV(1) was 3.13, 3.11, 3.24 and 3.30 L for indacaterol 50, 100, 200 and 400 microg, respectively, and 2.98 L for placebo. All treatments were well tolerated. Once-daily indacaterol at doses of 200 and 400 microg provided sustained 24-h bronchodilation, with a rapid onset and a good tolerability and safety profile.

Fourth Paper: Shear Behaviour of Elastohydrodynamic Oil Films at High Rolling Contact Pressures

The variation with sliding speed of the traction transmitted by E.H.L. oil films has been measured in a rolling contact disc machine, at contact pressures up to 260,000 lbf/in2and at various rolling speeds and disc temperatures. From the traction measurements at very low sliding speeds, under isothermal conditions, the variation in apparent viscosity of the oil with pressure and temperature has been found. The variation with temperature at high pressure was exponential with an index similar to that at low pressure. The variation with pressure showed a striking reduction in the rate of increase with pressure in the high pressure region (> 105lbf/in2).

At high sliding speeds the traction coefficient was found to approach a common ‘ceiling’, which was largely independent of contact pressure, rolling speed and disc temperature. The ceiling appears to be a function of sliding speed only; it falls from 0.07 at 5 in/s to 0.04 at 60 in/s.

Using the measurements of apparent viscosity obtained at low rolling speed, it has been shown conclusively that the limitation (or ceiling) in traction at intermediate sliding speeds cannot be explained by Crook's theory of a reduction in Newtonian viscosity by frictional heating. Alternative explanations based upon plastic shear of the lubricant when a critical shear stress is reached are much more consistent with the observations. But further work is necessary to elucidate fully the behaviour of E.H.L. films in sliding.

The importance of irradiance and area in neonatal phototherapy

BACKGROUND

Despite a long period of development, there are still considerable variations in the spectral output, the levels of irradiance, and irradiated area provided by commercial phototherapy systems. These variations depend on the types and output of the lamps used to produce the phototherapy, along with the design of the systems, and principally on whether the phototherapy is provided from overhead or underneath.

OBJECTIVE

To see whether commercially available phototherapy systems produce sufficient irradiance over the surface area of the neonate.

METHODS

Surface plots of the output irradiance were made on a number of systems and used to calculate the effective irradiance on the surface of a premature or term baby, using mapped outlines.

RESULTS

A 10-fold difference in peak central irradiances was found between the systems tested, with a fourfold to fivefold difference in effective irradiance to the baby surfaces. Although work published over 20 years ago showed that levels of irradiance should reach 2 mW/cm2 to achieve optimal effectiveness, some of the commercial systems tested do not appear to achieve this level.

CONCLUSION

Purchasers of neonatal phototherapy systems need to take into account whether the systems will produce sufficient irradiance over the area to ensure maximal effect, to keep the treatment time to a minimum.

A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection

OBJECTIVE

Practice varies as to whether or not suction is applied to under-water seal drains following lung surgery. We tested the null hypothesis that there is no difference with respect to air leak duration.

METHODS

Patients undergoing thoracotomy or video assisted thoracoscopic surgery for lobectomy or wedge resection had either low-pressure suction or no suction applied to their underwater seal bottles postoperatively. Patients were allocated using minimization, a method of unbiased allocation ensuring balance between the arms of a trial with respect to known or suspected confounding factors. The trial was powered for duration of air leak. If an air leak persisted on the 7th post-operative day, the surgeon determined further management. Kaplan-Meier survival analysis of air leak duration and a log rank test were performed on an intention-to-treat basis, with observations censored at 144h (6 complete days).

RESULTS

Of the 254 patients that entered the trial, data were available for analysis for 239 (123 no-suction and 116 suction). There was no significant difference in the cumulative persistence of air leaks between the two groups (P=0.62) and inspection of the Kaplan-Meier curves suggests that any difference is negligible.

CONCLUSIONS

Applying suction to the underwater seal drains following lung surgery makes no difference in terms of air leak duration. In the light of this finding we have adopted a uniform policy of no suction being applied to the underwater seal, from the time of surgery, unless a specific clinical judgment is made to use it. The anticipated gains are that this will reduce work and cost and aid mobilization.

306. Testicular growth factor expression after hemicastration in the neonatal boar

The molecular mechanisms associated with testicular hypertrophy after hemicastration are poorly understood. Sertoli cells in culture underwent increased proliferation when exposed to fibroblast growth factor-2 (FGF2)1 and transforming growth factor-α (TGFα).2 To determine whether FGF2 and TGFα expression is upregulated during accelerated testicular growth after hemicastration in the boar animals were assigned to (a) control (n = 12), no treatment; (b) hemicastrated (n=14), left testis removed on Day 10 after birth. The right testis was removed from half the control and hemicastrated boars, respectively, on Days 15 and 20 after birth. RNA was extracted from sections of frozen testis, cDNA synthesised using TaqMan® Reverse Transcription, and real-time PCR performed. FGF2 expression was determined using forward (5′GTG TTA CAG ACG AGT GTT TCT TTT TTG3′), internal (5′acg act gga atc taa t3′) and reverse (5′TTC CTC GAC CGG TAA GTA TTG TAG T3′) primers. TGFα expression was similarly determined using forward (5′GGC TGT CCT CAT CAT CAC ATG T3′), internal (5′tgc tga tac act gct gc3′) and reverse (5′CGG CAC CAC TCA CAG TGT TT3′) primers. Data were analysed by ANOVA and LSD test (testis weight) and unpaired two-tailed t-tests assuming equal variance (FGF2, TGFα). There was no difference (P > 0.05) in testis weight between hemicastrated (3.9 ± 0.3 g; mean ± SEM) and control (3.6 ± 0.5 g) boars on Day 5 but on Day 10 hemicastrated boars had a greater (P = 0.01) testis weight (6.2 ± 0.8 g) than controls (4.3 ± 0.4 g). There were no differences (P > 0.05) between control and hemicastrated boars in TGFα or FGF2 expression on Days 5 and 10. It is concluded from the findings that upregulation of TGFα or FGF2 gene expression is not required for testicular hypertrophy subsequent to hemicastration in the neonatal boar. (1)Biol Reprod (1987); 37: 665–674.(2)Mol Cell Endocrinol (2001); 181: 221–227.

Intra-pleural fibrinolytic therapy versus conservative management in the treatment of parapneumonic effusions and empyema

BACKGROUND

Effusions and empyema may complicate lower respiratory tract infections. Loculation of fluid is a major problem with this condition and treatments have included surgical drainage and the use of intra-pleural fibrinolysis to break down fibrin bands that may cause loculation.

OBJECTIVES

To conduct a systematic review of the benefit of adding intrapleural fibrinolytic therapy to intercostal tube drainage in the treatment of complicated para pneumonic effusions and empyema.

SEARCH STRATEGY

The Cochrane Controlled Trials Register was initially searched for relevant RCT's. Trial authors were contacted for further information and details regarding the possibility of unpublished trials was requested. The most recent search was conducted in July 2003.

SELECTION CRITERIA

All studies in the review were Randomised Controlled Trials in adult patients with empyema or complicated para pneumonic effusions who had not had prior surgical intervention or trauma. The intervention was an intrapleural fibrinolytic agent (streptokinase or urokinase) versus control or a comparison of the two.

DATA COLLECTION AND ANALYSIS

All identified studies were reviewed independently by two reviewer and all data collected. Reviews were scored according to the Cochrane assessment of allocation concealment and the Jadad scale of methodological quality. Disagreements between reviewers were referred to a third reviewer. Where further information was required, authors of trial papers were contacted for further details.

MAIN RESULTS

Four studies were included, one which directly compared the fibrinolytics streptokinase and urokinase. Three small RCTs (total 104 patients) compared streptokinase or urokinase versus normal saline control. The pooled data showed significant benefits in terms of hospital stay, time to defervescence, improvement in chest radiograph, requirement for surgery, but the results were not always consistent across studies. Complications attributable to therapy were not observed.

REVIEWERS' CONCLUSIONS

The numbers of patients in the controlled trials are small. In meta-analysis of these trials, intrapleural fibrinolytic therapy confers significant benefit when compared with normal saline control. Although lesser levels of evidence suggest that intrapleural fibrinolysis can be considered as an important adjunctive therapy to intercostal tube drainage in these conditions, on the basis of RCT evidence alone, we cannot recommend the routine use of fibrinolysis in their management as the trial numbers are too small. Both streptokinase and urokinase are equally efficacious but streptokinase has a slightly higher non-fatal complication rate. Life-threatening complications are rare and were not seen in the RCTs.

A phase I study of 99mTc-hR3 (DiaCIM), a humanized immunoconjugate directed towards the epidermal growth factor receptor

A phase I trial was conducted to evaluate the safety, tumour and normal tissue localization, pharmacokinetics and radiation dosimetry of Tc-hR3, a humanized monoclonal antibody directed towards the epidermal growth factor receptor, in 12 patients with recurrent or metastatic epithelial malignancies. Patients were injected intravenously with 3.0 mg or 6.0 mg (1010 MBq) of Tc-hR3. Blood and plasma concentrations of radioactivity were measured and a complete 24 h urine collection was obtained. Whole-body images were acquired up to 24 h post-injection and normal organ uptake quantified. Radiation dosimetry was estimated using MIRDose. Safety was evaluated by clinical observation, biochemical/haematological testing and by measuring immune response to Tc-hR3. There were no adverse effects, no changes in biochemical/haematological indices and no immune response to Tc-hR3. Tc-hR3 was rapidly cleared from the blood with a distribution half-life of 10.8+/-3.8 min. The volume of distribution, and clearance, were 180+/-37 ml.kg and 14+/-3 ml.kg.min, respectively. The elimination phase could not be discerned due to increasing blood radioactivity at later times. About 19-24% was excreted in the urine. Normal tissue uptake was mainly in the liver (44-50%), spleen (3-4%) and kidneys (3%). Imaging was positive in one patient with squamous cell carcinoma of the mouth and an involved cervical lymph node. The whole-body radiation dose from Tc-hR3 was 1.34+/-0.02x10 mSv.Bq. We conclude that Tc-hR3 exhibited an excellent safety profile. Future studies to determine the sensitivity and specificity of imaging with Tc-hR3 in a larger group of patients with pre-selection for epidermal growth factor receptor positivity are planned.

Enhancing the effectiveness of tobacco package warning labels: a social psychological perspective

OBJECTIVE

To outline social psychological principles that could influence the psychosocial and behavioural effects of tobacco warning labels, and to inform the development of more effective tobacco warning labels.

DATA SOURCES

PsycInfo and Medline literature searches and expert guided selection of principles and theories in social psychology and of tobacco warning labels, including articles, books, and reports.

CONCLUSIONS

Tobacco warning labels represent a potentially effective method of influencing attitudes and behaviours. This review describes social psychological principles that could be used to guide the creation of more effective warning labels. The potential value of incorporating warning labels into a broader public health education campaign is discussed, and directions for future research are suggested.

Agreement between general practice prescription data and self-reported use of hormone replacement therapy and treatment for various illnesses

BACKGROUND

Epidemiological studies of the effects of hormone replacement therapy (HRT) often rely on exposure data and information on past health from self-administered questionnaires. The accuracy with which women report current use of HRT and the specific preparation in use is not known. This study aims to compare aspects of self-reported use of HRT and treatment for various conditions with data from general practice prescription records.

METHODS

Reported questionnaire data on use of HRT were compared with those on the general practice prescription record for 570 women participating in the Million Women Study from two general practices in the UK.

RESULTS

There was excellent agreement between data from the self-administered questionnaire and the prescription record: 96% agreement (kappa = 0.91) for current use of HRT, 95% agreement (kappa = 0.90) for any use of HRT during the period covered by the prescription record, and 97% agreement (kappa = 0.95) among current users for whether the HRT preparation contained oestrogen alone, combined oestrogen/progestogen, or some other constituents. Among former HRT users who provided questionnaire information on the preparation they used most recently, there was 69% agreement on the proprietary preparation used and 97% agreement (kappa = 0.93) on the hormonal constituents used. Agreement between reported treatment for various conditions and the presence of a prescription appropriate for that condition ranged from 89-99% (kappa 0.53-0.92), and was highest for thyroid disease and asthma.

CONCLUSION

Important aspects of use of HRT, such as type of preparation currently being used, are reported very reliably by women completing a self-administered questionnaire.

Dissemination of heart health promotion: lessons from the Canadian Heart Health Initiative Ontario Project

Situated in central-eastern Canada, Ontario is the largest province with a population of 11 million. Ontario is considered a fairly rich province at the centre of Canada's manufacturing and financial sectors. Public health services in Ontario are primarily delivered through public health departments, each administered by a local board of health and regulated by provincial legislation and program guidelines. The Canadian Heart Health Initiative Ontario Project (CHHIOP) was a four year project (1994 to 1998) undertaken as part of the dissemination phase of the Canadian Heart Health Initiative (CHHI) (see O'Loughlin et al., p.4). CHHIOP is one component of a long-term process to develop and implement effective heart health programs in Ontario.

From diversity comes understanding: health promotion capacity-building and dissemination research in Canada

Non-communicable diseases are the major cause of preventable death in industrialized countries and a growing concern elsewhere (Singapore Declaration, 1998). Modifiable risk factors for these diseases are prevalent [e.g., in Canada, 75% of adults have at least one modifiable risk factor for cardiovascular disease (CVD)] (Heart and Stroke Foundation of Canada, 1997).

Amplified delivery of indium-111 to EGFR-positive human breast cancer cells

A method is described to amplify the delivery of 111In to human breast cancer cells utilizing a novel human serum albumin-human EGF (HSA-hEGF) bioconjugate substituted preferentially in the HSA domain with multiple DTPA metal chelators for 111In. 111In-DTPA-HSA-hEGF exhibited a lower receptor-binding affinity than 111In-DTPA-hEGF but was rapidly and specifically bound, internalized and translocated to the nucleus in EGFR-positive MDA-MB-468 breast cancer cells. 111In-DTPA-HSA-hEGF was cytotoxic in vitro mainly through the emission of short-range Auger electrons and partially through the effects of the hEGF moiety to MDA-MB-468 cells overexpressing EGFR (1-2 x 10(6) receptors/cell) but not towards MCF-7 breast cancer cells with a 100-fold lower level of EGFR on their surface. The cytotoxicity in vitro against MDA-MB-468 cells of 111In-DTPA-HSA-hEGF substituted with nine DTPA chelators was enhanced 4-fold compared to 111In-DTPA-hEGF monosubstituted with DTPA. Studies are planned to further evaluate 111In-DTPA-HSA-hEGF in vivo as a new imaging and targeted radiotherapeutic agent for breast cancer.

The effect of drugs and toxins on the process of apoptosis

In this review we examine the modifying effect of specific drugs on apoptosis. Apoptosis is a type of cell death prevalent during many physiological and pathological conditions, consisting of several steps, namely, initiating stimuli, transduction pathways, effector mechanisms, nuclear fragmentation, and phagocytosis. Pharmacological substances such as glucocorticoids can either induce or inhibit the process of apoptosis in various cells depending on the type of drug and its concentration. Understanding the mechanisms of interaction of drugs with cells undergoing apoptosis could encourage novel therapeutic approaches to human diseases in which apoptosis has a critical role.

Glucose-dependent insulinotropic peptide is an integrative hormone with osteotropic effects

Glucose-dependent insulinotropic peptide (GIP) is a gut-derived hormone known to be important in modulating glucose-induced insulin secretion. In addition, GIP receptors are widely distributed and may have effects on multiple other tissues: fat cells, adrenal glands, endothelium and brain. We have demonstrated recently that GIP also has anabolic effects on bone-derived cells. We now demonstrate that GIP administration prevents the bone loss associated with ovariectomy. We propose that GIP plays a unique role in signaling the bone about nutrient availability, indicating the importance of the gut hormones in directing absorbed nutrients to the bone, and suggesting the concept of an 'entero-osseous axis'. Thus, GIP plays an integrative role helping coordinate efficient and targeted nutrient absorption and distribution.

Pharyngogastric colonic interposition for total oesophageal occlusion in epidermolysis bullosa

Epidermolysis bullosa comprises a group of rare heritable disorders, characterized by blistering of skin and other epithelial lined structures following minor trauma. In the oesophagus, trauma from food boluses leads to bullae, ulceration and scarring, with formation of strictures. Oesophageal strictures are usually managed with balloon dilatation. We describe a case of a 19-year-old woman whose oesophageal stricture did not respond to balloon dilatation. She underwent a substernal colon interposition between the pharynx and stomach. The surgery included cervical, thoracic and abdominal approaches, with involvement of three specialist surgeons. Three months after surgery, the patient reported to be swallowing with little difficulty. Because of the high risk of morbidity and mortality associated with this surgery, we recommended that the patient should be managed in a specialist centre, with availability of intensive care facilities and the possibility of providing a multidisciplinary approach during surgery.

Osteoblast-derived cells express functional glucose-dependent insulinotropic peptide receptors

Glucose-dependent insulinotropic peptide (GIP) is a 42-amino acid peptide synthesized and secreted from endocrine cells in the small intestine. The role of GIP in coupling nutrient intake and insulin secretion, the incretin effect, is well known. We report that GIP receptor messenger RNA and protein are present in normal bone and osteoblast-like cell lines, and that high affinity receptors for GIP can be demonstrated by [125I]GIP binding studies. When applied to osteoblast-like cells (SaOS2), GIP stimulated increases in cellular cAMP content and intracellular calcium, with both responses being dose dependent. Moreover, administration of GIP results in elevated expression of collagen type I messenger RNA as well as an increase in alkaline phosphatase activity. Both of these effects reflect anabolic actions of presumptive osteoblasts. These results provide the first evidence that GIP receptors are present in bone and osteoblast-like cells and that GIP modulates the function of these cells.

Recycling and refilling of transmitter quanta at the frog neuromuscular junction

1. Fluorescent dyes have been used at the frog neuromuscular junction to label synaptic vesicular membrane. Retrieved membrane is reformed into vesicles, which are released along with pre-existing vesicles. Consequently, if vesicular refilling with acetylcholine (ACh) is depressed by inhibitors, two sizes of quanta should be released: normal and smaller. As recycling continues the fraction of smaller size quanta should increase exponentially. 2. We enhanced the rate of quantal release by elevating the K+ concentration. The principal inhibitors were (-)-vesamicol (VES), hemicholinium-3 (HC3), and NH4+. Quantal size measurements were fitted to one and to two cumulative lognormal probability distribution functions. When two fitted better, the statistical significance assessment took into account the three additional parameters used in calculating the fit. 3. After recycling in the presence of inhibitor, many sets were fitted better by two lognormal functions. As recycling continued, the fraction of the miniature endplate potential voltage-time integrals ( MEPPs) in the larger sub-population decreased exponentially. 4. The size of the releasable pool was estimated by counting the quanta released by carbonyl cyanide m-chlorophenylhydrazone (CCCP). This was compared to pool sizes calculated from the inhibitor experiments. The two estimates of pool size were indistinguishable, with mean values ranging from about 170,000 to 270,000. 5. With all of the treatments tested, the means of the sizes in the smaller sub-population of MEPPs were about 1/3 those of the larger sub-populations. 6. Recycling synaptic vesicles appear to be incorporated into the releasable pool from which they have roughly the same probability of release as the pre-existing vesicles.