Biomonitoring for workplace exposure to copper and its compounds is currently not interpretable

This paper sets out to explore the requirements needed to recommend a useable and reliable biomonitoring system for occupational exposure to copper and its inorganic compounds. Whilst workplace environmental monitoring of copper is used to measure ambient air concentrations for comparison against occupational exposure limits, biological monitoring could provide complementary information about the internal dose of workers, taking into account intra-individual variability and exposure from all routes. For biomonitoring to be of reliable use for copper, a biomarker and the analytical ability to measure it with sufficient sensitivity must be identified and this is discussed in a range of matrices. In addition, there needs to be a clear understanding of the dose-response relationship of the biomarker with any health-effect (clinical or sub-clinical) or, between the level of external exposure (by any route) and the level of the copper biomarker in the biological matrix being sampled, together with a knowledge of the half-life in the body to determine accurate sampling times. For many biologically non-essential metals the requirements for reliable biomarkers can be met, however, for 'essential' metals such as copper that are under homeostatic control, the relationship between exposure (short- or long-term) and the level of any copper biomarker in the blood or urine is complex, which may limit the use and interpretation of measured levels. There are a number of types of biomarker guidance values currently in use which are discussed in this paper, but no values have yet been determined for copper (or its inorganic compounds) due to the complexity of its essential nature; the US The American Conference of Governmental Industrial Hygienists (ACGIH) has however indicated that it is considering the development of a biological exposure index for copper and its compounds. In light of this, we present a review of the reliability of current copper biomarkers and their potential use in the occupational context to evaluate whether there is value in carrying out human biomonitoring for copper exposure. Based on the available evidence we have concluded that the reliable use of biomonitoring of occupational exposure to copper and its application in risk assessment is not possible at the present time.

Evaluating the risk to humans from mineral oils in foods: Current state of the evidence

Key issues around the evaluation of risks to humans from mineral oils in food and feedstuffs are discussed. MOHs (MOAH and MOSH) occur in food due to intentional use, contamination from environmental sources and during transport/processing, or through migration from food contact materials. Problems in setting and enforcing human health guidelines for MOH include uncertainty around MOH toxicity and the specialist expertise needed for analysis of complex food matrices. Currently, the method of choice for measuring mineral oils is LC-GC-FID, however some complex food matrices also require additional analytical techniques to differentiate between some naturally occurring hydrocarbons and those from other sources, including of petrogenic origin. This requires the skills of an experienced analyst. Significant toxicological gaps for MOHs prevent robust human health risk assessment and the derivation of guidance values. As food-grade mineral oils are virtually MOAH-free, the key issue explored here is the relevance to humans of liver (micro)granulomas observed in F344 rats following oral intake. Available data suggest that despite the ubiquitous nature of MOH in the human diet, the prevalence of liver lipogranulomas in the population is low. These are not associated with inflammation and based on current evidence are not considered of human health significance.

Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview

OBJECTIVE

The role of serrated polyps (SPs) as colorectal cancer precursor is increasingly recognised. However, the true prevalence SPs is largely unknown. We aimed to evaluate the detection rate of SPs subtypes as well as serrated polyposis syndrome (SPS) among European screening cohorts.

METHODS

Prospectively collected screening cohorts of ≥1000 individuals were eligible for inclusion. Colonoscopies performed before 2009 and/or in individuals aged below 50 were excluded. Rate of SPs was assessed, categorised for histology, location and size. Age-sex-standardised number needed to screen (NNS) to detect SPs were calculated. Rate of SPS was assessed in cohorts with known colonoscopy follow-up data. Clinically relevant SPs (regarded as a separate entity) were defined as SPs ≥10 mm and/or SPs >5 mm in the proximal colon.

RESULTS

Three faecal occult blood test (FOBT) screening cohorts and two primary colonoscopy screening cohorts (range 1.426-205.949 individuals) were included. Rate of SPs ranged between 15.1% and 27.2% (median 19.5%), of sessile serrated polyps between 2.2% and 4.8% (median 3.3%) and of clinically relevant SPs between 2.1% and 7.8% (median 4.6%). Rate of SPs was similar in FOBT-based cohorts as in colonoscopy screening cohorts. No apparent association between the rate of SP and gender or age was shown. Rate of SPS ranged from 0% to 0.5%, which increased to 0.4% to 0.8% after follow-up colonoscopy.

CONCLUSIONS

The detection rate of SPs is variable among screening cohorts, and standards for reporting, detection and histopathological assessment should be established. The median rate, as found in this study, may contribute to define uniform minimum standards for males and females between 50 and 75 years of age.

Setting evidence-based occupational exposure limits for manganese

In 2004, a review by the Institute of Environment and Health (IEH) made recommendations on occupational exposure limits (OELs) for manganese and its inorganic compounds for inhalable and respirable fractions respectively. These OELs were based on a detailed comprehensive evaluation of all the scientific data available at that time. Since then, more published studies have become available and a number of occupational standard-setting committees (EU SCOEL, US ACGIH-TLV, and German MAK) have proposed OEL's for manganese and its inorganic compounds that are somewhat lower that those proposed in the 2004 review. Based on current understanding, the key toxicological and human health issues that are likely to influence a health-based recommendation relate to: neurotoxicology; reproductive and developmental toxicology; and mutagenicity/carcinogenicity. Of these, it is generally considered that neurotoxicity presents the most sensitive endpoint. As such, many of the studies that have been reported since the IEH review have sought to use those neurofunctional tests that appear to be particularly sensitive at identifying the subtle neurological changes thought to associate with manganese toxicity. These recent studies have, however, continued to be limited to a significant extent by reliance on cross-sectional designs and also by use of unreliable exposure estimation methods. Consequently the strength of the potential association between manganese exposure and these subtle subclinical cognitive or neuromotor changes is still poorly characterised and the relevance of these minor differences in terms of either their clinical or quality of life consequences remains unknown. Based upon the overall evidence, it is concluded that the 8-h time weighted averages (TWA) for respirable (0.05mg/m³ as Mn) and inhalable (0.2mg/m³ as Mn) fractions as recommended by the SCOEL in 2011 are the most methodologically-sound, as they are based on the best available studies, most suited to the development of health-based OELs for both respirable and inhalable fractions. The dose-response characterisation informed by the examined studies used can be considered to establish a true human NOAEL for all the neurofunctional endpoints examined within the selected studies.

What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care

Understanding and addressing patient attitudes to their care facilitates their engagement and attendance, improves the quality of their experience and the appropriate utilisation of resources. Gastrointestinal endoscopy is a commonly performed medical procedure that can be associated with patient anxiety and apprehension. Measuring patient attitudes to endoscopy can be undertaken through a number of approaches with contrasting benefits and limitations. Methodological validation is necessary for accurate interpretation of results and avoiding bias. Retrospective post-procedure questionnaires measuring satisfaction are easily undertaken but have limited value, particularly in directing service improvements. Patient experience questionnaires indicate areas of poor care but may reflect the clinician's not the patient's perspective. Directly assessing patient priorities and expectations identifies what is important to patients in their healthcare experience (patient-reported value) that can also provide a basis for other forms of evaluation. Published studies of patient attitudes to their endoscopy procedure indicate the importance of ensuring that endoscopists and their staff control patient discomfort, have adequate technical skill and effectively communicate with their patient relating to the procedure and results. Environmental factors, including noise, privacy and the single-sex environment, are considered to have less value. There are contrasting views on patient attitudes to waiting times for the procedure. Implementing patient-centred care in endoscopy requires an understanding of what patients want from their healthcare experience. The results from available studies suggest implications for current practice that relate to the training and practice of the endoscopist and their staff.

Sources of variability in biomarker concentrations

Human biomonitoring has become a primary tool for chemical exposure characterization in a wide variety of contexts: population monitoring and characterization at a national level, assessment and description of cohort exposures, and individual exposure assessments in the context of epidemiological research into potential adverse health effects of chemical exposures. The accurate use of biomonitoring as an exposure characterization tool requires understanding of factors, apart from external exposure level, that influence variation in biomarker concentrations. This review provides an overview of factors that might influence inter- and intraindividual variation in biomarker concentrations apart from external exposure magnitude. These factors include characteristics of the specific chemical of interest, characteristics of the likely route(s) and frequency of exposure, and physiological characteristics of the biomonitoring matrix (typically, blood or urine). Intraindividual variation in biomarker concentrations may be markedly affected by the relationship between the elimination half-life and the intervals between exposure events, as well as by variation in characteristics of the biomonitored media such as blood lipid content or urinary flow rate. Variation across individuals may occur due to differences in time of sampling relative to exposure events, physiological differences influencing urinary flow or creatinine excretion rates or blood characteristics, and interindividual differences in metabolic rate or other factors influencing the absorption or excretion rate of a compound. Awareness of these factors can assist researchers in improving the design and interpretation of biomonitoring studies.

α-Tocopherol supplementation does not affect monocyte endothelial adhesion or C-reactive protein levels but reduces soluble vascular adhesion molecule-1 in the plasma of healthy subjects

Vascular monocyte retention in the subintima is pivotal to the development of cardiovascular disease and is facilitated by up-regulation of adhesion molecules on monocytes/endothelial cells during oxidative stress. Epidemiological studies have shown that cardiovascular disease risk is inversely proportional to plasma levels of the dietary micronutrients, vitamin C and vitamin E (alpha-tocopherol). We have tested the hypothesis that alpha-tocopherol supplementation may alter endothelial/monocyte function and interaction in subjects with normal ascorbate levels (> 50 microM), as ascorbate has been shown to regenerate tocopherol from its oxidised tocopheroxyl radical form in vitro. Healthy male subjects received alpha-tocopherol supplements (400 IU RRR-alpha-tocopherol/day for 6 weeks) in a placebo-controlled, double-blind intervention study. There were no significant differences in monocyte CD11b expression, monocyte adhesion to endothelial cells, plasma C-reactive protein or sICAM-1 concentrations post-supplementation. There was no evidence for nuclear translocation of NF-kappaB in isolated resting monocytes, nor any effect of alpha-tocopherol supplementation. However, post-supplementation, sVCAM-1 levels were decreased in all subjects and sE-selectin levels were increased in the vitamin C-replete group only; a weak positive correlation was observed between sE-selectin and alpha-tocopherol concentration. In conclusion, alpha-tocopherol supplementation had little effect on cardiovascular disease risk factors in healthy subjects and the effects of tocopherol were not consistently affected by plasma vitamin C concentration.

Reference ranges for key biomarkers of chemical exposure within the UK population

Human biomonitoring (HBM) is a widely accepted tool to aid assessment of chemical uptake in risk assessment. However, our understanding of the biological relevance of the results of HBM can be restricted, due in some part to the limited information on background environmental exposures and biomarker concentrations in the general population. The study described here specifically addresses the question of what constitutes normal background levels in the UK population of a number of biomarkers (the chemical itself or one of its stable metabolites) for a variety of environmental chemicals that are frequently encountered because of their widespread use. The environmental chemicals selected for this study were benzene, chlorinated hydrocarbons, dithiocarbamates, cadmium, mercury, naphthalene, diethylhexyl phthalate, synthetic pyrethroids and xylene. Volunteers (n=436) were randomly sought by a postal survey based on the UK Electoral Register. Participants were asked to complete a questionnaire and provide a urine sample. The overall response rate was 7.5%, with volunteers being recruited from all areas of the UK including, England, Scotland, Wales and Northern Ireland. Study participants were adults and comprised 45% male and 55% females. We have conducted a simple, postal-based, cost-effective study and generated similar reference values to very large surveys such as NHANES. This demonstrates that large investigations may not be necessary to get a reasonable idea of environmental exposures, especially in initial 'screening-type' investigations to identify particular exposures of concern or to demonstrate that exposures are reassuring low and that no further survey data needs to be gathered.

Large scale calcium channel gene rearrangements in episodic ataxia and hemiplegic migraine: implications for diagnostic testing

BACKGROUND

Episodic ataxia type 2 (EA2) and familial hemiplegic migraine type 1 (FHM1) are autosomal dominant disorders characterised by paroxysmal ataxia and migraine, respectively. Point mutations in CACNA1A, which encodes the neuronal P/Q-type calcium channel, have been detected in many cases of EA2 and FHM1. The genetic basis of typical cases without CACNA1A point mutations is not fully known. Standard DNA sequencing methods may miss large scale genetic rearrangements such as deletions and duplications. The authors investigated whether large scale genetic rearrangements in CACNA1A can cause EA2 and FHM1.

METHODS

The authors used multiplex ligation dependent probe amplification (MLPA) to screen for intragenic CACNA1A rearrangements.

RESULTS

The authors identified five previously unreported large scale deletions in CACNA1A in seven families with episodic ataxia and in one case with hemiplegic migraine. One of the deletions (exon 6 of CACNA1A) segregated with episodic ataxia in a four generation family with eight affected individuals previously mapped to 19p13. In addition, the authors identified the first pathogenic duplication in CACNA1A in an index case with isolated episodic diplopia without ataxia and in a first degree relative with episodic ataxia.

CONCLUSIONS

Large scale deletions and duplications can cause CACNA1A associated channelopathies. Direct DNA sequencing alone is not sufficient as a diagnostic screening test.

Comparative analyses of multi-species sequences from targeted genomic regions

The systematic comparison of genomic sequences from different organisms represents a central focus of contemporary genome analysis. Comparative analyses of vertebrate sequences can identify coding and conserved non-coding regions, including regulatory elements, and provide insight into the forces that have rendered modern-day genomes. As a complement to whole-genome sequencing efforts, we are sequencing and comparing targeted genomic regions in multiple, evolutionarily diverse vertebrates. Here we report the generation and analysis of over 12 megabases (Mb) of sequence from 12 species, all derived from the genomic region orthologous to a segment of about 1.8 Mb on human chromosome 7 containing ten genes, including the gene mutated in cystic fibrosis. These sequences show conservation reflecting both functional constraints and the neutral mutational events that shaped this genomic region. In particular, we identify substantial numbers of conserved non-coding segments beyond those previously identified experimentally, most of which are not detectable by pair-wise sequence comparisons alone. Analysis of transposable element insertions highlights the variation in genome dynamics among these species and confirms the placement of rodents as a sister group to the primates.

Effects of oral vitamin C on monocyte: endothelial cell adhesion in healthy subjects

Monocyte recruitment and retention in the vasculature is influenced by oxidative stress and is involved in cardiovascular disease (CVD). Individuals with low plasma ascorbate are at elevated risk of CVD. It is unknown whether vitamin C supplementation affects monocyte adhesion to endothelial cells (ECs) in healthy non-smokers. In a randomised double-blind crossover study the effect of vitamin C supplementation (six weeks, 250 mg/day) was determined in subjects with normal (HIC) and below average (LOC) plasma vitamin C concentration at baseline (mean=67 microM, n=20, mean=32 microM, n=20, respectively). LOC subjects showed 30% greater monocyte adhesion to ECs. This was significantly reduced by 37% (P<0.02) following vitamin C supplementation to levels of HIC monocyte adhesion. No differences in plasma malondialdehyde concentrations were observed between groups or after supplementation. In conclusion, vitamin C supplementation normalises monocyte adhesion in subjects with low plasma vitamin C (LOC). This process may be related to a direct effect on monocytes, independent of lipid peroxidation.

The effects of vitamin C supplementation on protein oxidation in healthy volunteers

We have investigated vitamin C supplementation effects on immunoglobulin oxidation (carbonyls) and total plasma protein sulfhydryls in healthy human volunteers. After receiving placebo, plasma ascorbate and oxidation markers were unchanged. Following 5 weeks supplementation with vitamin C (400 mg/day), plasma ascorbate increased but no significant effect on protein oxidation was observed. At 10 and 15 weeks supplementation, carbonyl levels were significantly reduced (P < 0.01) in subjects with low baseline ascorbate (29.51 +/- 5.3 microM) but not in those with normal baseline ascorbate (51.81 +/- 2.3 microM). To eliminate any effect from seasonal variation in dietary antioxidant intake, a second phase was undertaken. Subjects on vitamin C for 15 weeks were randomly assigned to receive either placebo or vitamin C. No difference in plasma sulfhydryl content was observed. Subjects withdrawn from supplementation showed an increase in immunoglobulin carbonyl content (P < 0.01). This demonstrates that dietary vitamin C supplementation can reduce certain types of oxidative protein damage in subjects with low basal antioxidant.

An audit of European training in obstetrics and gynaecology

During 1997, The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) circulated a questionnaire to audit training in Europe. Results describe number and gender in each country, access to training, duration of training, tutor/tutee scheme, logbooks, minimum curriculum, assessment, criteria for accreditation, training abroad, final examination, hospital inspection, subspecialty, academic training, and career progression. Quality of life is tried to address with questions relating to salary, working hours, maternity leave, annual leave and study leave. EBCOG has drawn up recommendations to try and achieve a standardisation of quality of training whilst fully understanding that complete standardisation of training is not a realistic possibility due to social, cultural and ethical differences. A repeat audit is planned after 3 years to close the feedback loop.

Responsiveness of human infant cerebral arteries to sympathetic nerve stimulation and vasoactive agents

Responses of segments of basilar and middle cerebral arteries of eight human infants to activation of perivascular nerves and to vasoactive drugs were studied using a resistance artery myograph. The infants ages ranged from 23 wk of gestation to 34 postnatal days. Neurogenic vasoconstriction occurred in all segments and at 8 Hz was 12.7 +/- 3.5% (11%) of tissue maximum and was blocked by phentolamine (10(-6) M). There was no evidence of a neurogenic dilator response. Catecholamine histofluorescence was seen in nerves in the adventitia at all ages studied. Norepinephrine ED50 was 7.6 +/- 1.8 x 10(-7) M, and its maximum effect was 43.1 +/- 5.7% of tissue maximum. Both neural and norepinephrine responses were greater than those of the proximal parts of adult human middle cerebral arteries obtained postmortem and surgically removed adult human pial arteries. Electron microscopy demonstrated that neural density at the adventitiomedial junction in the infant vessels was greater than in the pial arteries. Constrictor responses to serotonin and prostaglandin F2 alpha were minimal in the two infants of 23 and 24 wk of gestation but were clearly present in the older infants. Histamine and acetylcholine were potent vasodilators. Indomethacin potentiated agonist-induced contraction. In a limited number of trials angiotensin II, neuropeptide Y, caused contraction and bradykinin, relaxation. It is concluded that there is a quantitative similarity between the studied responses of infant cerebral artery segments and human pial arteries of similar diameter. However, sympathetic nerves may potentially play a more important role in the regulation of cerebrovascular tone in the infant compared with the adult, and during the gestational period examined these vessels possess an indomethacin-sensitive system that buffers agonist tone.

Chemiluminescence determination of hydroperoxides following radiolysis and photolysis of free amino acids

Hydroperoxides were determined in selected amino acids using three free radical generating systems by a sensitive (50 pmol limit of detection) and specific high performance liquid chromatography (HPLC)/chemiluminescence method. UVB and gamma radiation produced significant hydroperoxide formation, particularly in the aromatic amino acids tyrosine and tryptophan. Hydroperoxide yield was found to be dependent on both amino acid and irradiation source. Generation of hydrogen peroxide as a by-product of irradiation caused interference with chemiluminescence detection demonstrating the need for catalase addition. Hydroperoxides were not detectable following metal-catalysed H2O2 breakdown. We suggest that metal ions could interfere with the detection of hydroperoxides by causing preferential decomposition.

Heart rates and abdominal temperatures of free-ranging South Georgian shags, Phalacrocorax georgianus

The South Georgian shag (Phalacrocorax georgianus) shows a remarkable diving ability comparable to that of penguins, yet nothing is known of the physiology of these birds. In this study, heart rates and abdominal temperatures were recorded continuously in four free-ranging South Georgian shags using an implanted data-logger. A time&shy;depth recorder was also attached to the back of the implanted birds to record their diving behaviour. The diving behaviour of the birds was essentially similar to that reported in other studies, with maximum dive durations for individual birds ranging between 140 and 287 s, and maximum depths between 35 and 101 m. The birds, while at the nest, had a heart rate of 104.0&plusmn;13.1 beats min-1 (mean &plusmn; s.e.m.) and an abdominal temperature of 39.1&plusmn;0.2 &deg;C. During flights of 221&plusmn;29 s, heart rate and abdominal temperature rose to 309.5&plusmn;18.0 beats min-1 and 40.1&plusmn;0.3 &deg;C, respectively. The mean heart rate during diving, at 103.7&plusmn;13.7 beats min-1, was not significantly different from the resting values, but the minimum heart rate during a dive was significantly lower at 64.8&plusmn;5.8 beats min-1. The minimum heart rate during a dive was negatively correlated with both dive duration and dive depth. Abdominal temperature fell progressively during a diving bout, with a mean temperature at the end of a bout of 35.1&plusmn;1.7 &deg;C. The minimum heart rate during diving is at a sub-resting level, which suggests that the South Georgian shag responds to submersion with the 'classic' dive response of bradycardia and the associated peripheral vasoconstriction and utilisation of anaerobic metabolism. However, the reduction in abdominal temperature may reflect a reduction in the overall metabolic rate of the animal such that the bird can remain aerobic while submerged.

THE USE OF HEART RATE TO ESTIMATE OXYGEN CONSUMPTION OF FREE-RANGING BLACK-BROWED ALBATROSSES DIOMEDEA MELANOPHRYS

Heart rates (fh) and rates of oxygen consumption (V(dot)O2) were measured in eight black-browed albatrosses (Diomedea melanophrys) when walking on a treadmill, with the aim of using fh to predict V(dot)O2 in free-ranging albatrosses. The resulting relationship between the variables was: V(dot)O2 (ml min-1) = [0.0157fh (beats min-1)]1.60, r2=0.80, P&lt;0.001. In addition to the calibration procedure, six of the albatrosses were injected with doubly labelled water (DLW), and fh and V(dot)O2 were monitored continuously over a 3 day period while the birds were held in a respirometer. During the 3 day period, the birds were walked for up to 3&shy;4 h day-1 in bouts lasting approximately 0.5 h. The heart rate data were used to estimate the metabolic rates of these birds using the above regression. Estimates of metabolic rate derived from fh, DLW and respirometry did not differ (ANOVA; P=0.94), primarily because of the variance between individual birds. There was also no significant difference between the different estimates obtained from the different equations used to calculate energy expenditure from the DLW technique (ANOVA; P=0.95). Mean estimates of V(dot)O2 from fh under active and inactive conditions differed from measured values of V(dot)O2 by -5.9 % and -1.7 % respectively. In addition, the estimates of V(dot)O2 from fh at different walking speeds did not differ significantly from the measured values. It appears that, in the black-browed albatross, fh is as good a predictor of the mean metabolic rate of free-ranging birds as DLW or time&shy;energy budgets combined with either respirometry or DLW. However, the method should be applied to as many individuals and as many instances of a particular behaviour as possible. The heart rate technique offers potential for much more detailed analyses of the daily energy budgets of these birds, and over much longer periods, than has previously been possible.

Viewer-centred and object-centred coding of heads in the macaque temporal cortex

An investigation was made into the sensitivity of cells in the macaque superior temporal sulcus (STS) to the sight of different perspective views of the head. This allowed assessment of (a) whether coding was 'viewer-centred' (view specific) or 'object-centred' (view invariant) and (b) whether viewer-centred cells were preferentially tuned to 'characteristic' views of the head. The majority of cells (110) were found to be viewer-centred and exhibited unimodal tuning to one view. 5 cells displayed object-centred coding responding equally to all views of the head. A further 5 cells showed 'mixed' properties, responding to all views of the head but also discriminating between views. 6 out of 56 viewer and object-centred cells exhibited selectivity for face identity or species. Tuning to view varied in sharpness. For most (54/73) cells the angle of perspective rotation reducing response to half maximal was 45-70 degrees but for 19/73 it was greater than 90 degrees. More cells were optimally tuned to characteristic views of the head (the full face or profile) than to other views. Some cells were, however, found tuned to intermediate views throughout the full 360 degree range. This coding of many distinct head views may have a role in the analysis of social signals based on the interpretation of the direction of other individuals' attention.

Glucuronidation of 3'-azido-3'-deoxythymidine by rat and human liver microsomes

The glucuronidation of 3'-azido-3'-deoxythymidine (AZT) by rat and human liver microsomes has been studied in vitro. The AZT-glucuronide was preliminarily identified through specific hydrolysis by beta-glucuronidase and rigorous product identification was performed by high-field proton nuclear magnetic resonance and fast-atom-bombardment mass spectrometry. A beta-linked 5'-O-glucuronide was the exclusive product formed in liver microsomes. Rat and human liver microsomal uridine 5'-diphosphoglucuronyltransferase activities toward AZT were investigated. These studies revealed that AZT had a lower Km and a 5-6-fold higher relative catalytic efficiency for uridine 5'-diphosphoglucuronyltransferase in human as compared to rat liver microsomes which may play a role in the quantitative differences observed in the degree of AZT glucuronidation between rat and human.

Frameworks of analysis for the neural representation of animate objects and actions

A variety of cell types exist in the temporal cortex providing high-level visual descriptions of bodies and their movements. We have investigated the sensitivity of such cells to different viewing conditions to determine the frame(s) of reference utilized in processing. The responses of the majority of cells in the upper bank of the superior temporal sulcus (areas TPO and PGa) found to be sensitive to static and dynamic information about the body were selective for one perspective view (e.g. right profile, reaching right or walking left). These cells can be considered to provide viewer-centred descriptions because they depend on the observer's vantage point. Viewer-centred descriptions could be used in guiding behaviour. They could also be used as an intermediate step for establishing view-independent responses of other cell types which responded to many or all perspective views selectively of the same object (e.g. head) or movement. These cells have the properties of object-centred descriptions, where the object viewed provides the frame of reference for describing the disposition of object parts and movements (e.g. head on top of shoulders, reaching across the body, walking forward ‘following the nose’). For some cells in the lower bank of the superior temporal sulcus (area TEa) the responses to body movements were related to the object or goal of the movements (e.g. reaching for or walking towards a specific place). This goal-centred sensitivity to interaction allowed the cells to be selectively activated in situations where human subjects would attribute causal and intentional relationships.

Relation between precorneal tear film stability and tear production rate in normal eyes

The clinically diagnosed dry eye generally has an unstable tear film and changes in the corneal epithelium but, not necessarily, hyposecretion of tears. In normal asymptomatic eyes we found, using a noninvasive technique, a significant relation between precorneal tear film stability and tear production rates (TPR's).

Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function

The pharmacokinetics of ganciclovir was evaluated in 21 patients with life- or sight-threatening cytomegalovirus infections. Thirteen patients had normal renal function and eight patients had various degrees of renal insufficiency. Most patients received 5 mg of ganciclovir/kg as a 1-hour intravenous infusion twice daily for periods of up to 2 weeks. Quantification of ganciclovir was assessed by high-performance liquid chromatography and radioimmunoassay. In patients with normal renal function, a biexponential decay of ganciclovir from plasma was observed, with an initial distribution half-life (t1/2) of 0.76 +/- 0.67 hour and a terminal elimination t1/2 of 3.60 +/- 1.40 hours. A large fraction of the administered dose was excreted in urine, and total clearance of ganciclovir correlated well with creatinine clearance. In patients with renal insufficiency who were receiving 5 mg of ganciclovir/kg, the terminal elimination t1/2 of ganciclovir was markedly increased (11.50 +/- 3.90 hours), as compared with values obtained in patients with normal renal function. Hemodialysis efficiently reduced levels of ganciclovir in plasma by approximately 53.0% +/- 11.5%, a finding that indicates this drug should be administered after dialysis.

Diurnal variation in precorneal tear film stability

The stability of the precorneal tear film as inferred from the tear thinning time (TTT) appears to vary over a single 12-h period. The form of this variation is subject dependent. For the average patient the stability is low early in the morning, and tends to rise to equilibrium level between 10:00 a.m. and 12 noon.

Pancreatic society of great britain and ireland: annual meeting, 1980: second scientific session

With the increase in the number of diabetic patients in renal failure new attempts are being made to improve both the results of cadaveric transplantation and the quality of rehabilitation. A combined approach of renal and segmental pancreatic transplantation has been made in patients with major diabetic complications. We here report the early Cambridge experience using this management.

The psychiatric resident as an ex-officio community board member

The authors describe a program in which third-year psychiatric residents participate as ex-officio members on the boards of community service agencies. Experience as board members gives residents a broad understanding of issues related to the delivery of community mental health services and encourages them to continue community involvment after their training is completed.

Severe Rickets with Multiple Spontaneous Fractures

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