Fast absolute 3D CGO-based electrical impedance tomography on experimental tank data

Objective.To present the first 3D CGO-based absolute EIT reconstructions from experimental tank data.Approach.CGO-based methods for absolute EIT imaging are compared to traditional TV regularized non-linear least squares reconstruction methods. Additional robustness testing is performed by considering incorrect modeling of domain shape.Main Results.The CGO-based methods are fast, and show strong robustness to incorrect domain modeling comparable to classic difference EIT imaging and fewer boundary artefacts than the TV regularized non-linear least squares reference reconstructions.Significance.This work is the first to demonstrate fully 3D CGO-based absolute EIT reconstruction on experimental data and also compares to TV-regularized absolute reconstruction. The speed (1-5 s) and quality of the reconstructions is encouraging for future work in absolute EIT.

3D ELECTRICAL IMPEDANCE TOMOGRAPHY RECONSTRUCTIONS FROM SIMULATED ELECTRODE DATA USING DIRECT INVERSION texp AND CALDERÓN METHODS

The first numerical implementation of a t ^exp method in 3D using simulated electrode data is presented. Results are compared to Calderón's method as well as more common TV and smoothness regularization-based methods. The t ^exp method for EIT is based on tailor-made non-linear Fourier transforms involving the measured current and voltage data. Low-pass filtering in the non-linear Fourier domain is used to stabilize the reconstruction process. In 2D, t ^exp methods have shown great promise for providing robust real-time absolute and time-difference conductivity reconstructions but have yet to be used on practical electrode data in 3D, until now. Results are presented for simulated data for conductivity and permittivity with disjoint non-radially symmetric targets on spherical domains and noisy voltage data. The 3D t ^exp and Calderón methods are demonstrated to provide comparable quality to their 2D counterparts, and hold promise for real-time reconstructions due to their fast, non-optimized, computational cost.

Fetal exome sequencing for isolated increased nuchal translucency: should we be doing it?

Objective

To evaluate the utility of prenatal exome sequencing (ES) for isolated increased nuchal translucency (NT) and to investigate factors that increase diagnostic yield.

Design

Retrospective analysis of data from two prospective cohort studies.

Setting

Fetal medicine centres in the UK and USA.

Population

Fetuses with increased NT ≥3.5 mm at 11–14 weeks of gestation recruited to the Prenatal Assessment of Genomes and Exomes (PAGE) and Columbia fetal whole exome sequencing studies (n = 213).

Methods

We grouped cases based on (1) the presence of additional structural abnormalities at presentation in the first trimester or later in pregnancy, and (2) NT measurement at presentation. We compared diagnostic rates between groups using Fisher exact test.

Main outcome measures

Detection of diagnostic genetic variants considered to have caused the observed fetal structural anomaly.

Results

Diagnostic variants were detected in 12 (22.2%) of 54 fetuses presenting with non‐isolated increased NT, 12 (32.4%) of 37 fetuses with isolated increased NT in the first trimester and additional abnormalities later in pregnancy, and 2 (1.8%) of 111 fetuses with isolated increased NT in the first trimester and no other abnormalities on subsequent scans. Diagnostic rate also increased with increasing size of NT.

Conclusions

The diagnostic yield of prenatal ES is low for fetuses with isolated increased NT but significantly higher where there are additional structural anomalies. Prenatal ES may not be appropriate for truly isolated increased NT but timely, careful ultrasound scanning to identify other anomalies emerging later can direct testing to focus where there is a higher likelihood of diagnosis.

Prenatal ES has a low diagnostic rate (<2%) for isolated increased NT but is significantly more likely to yield a diagnosis where there are additional fetal structural anomalies.

Linked article This article is commented on by AN Talati and NL Vora, p. 61–62 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16942.

Beltrami-net: domain-independent deep D-bar learning for absolute imaging with electrical impedance tomography (a-EIT)

OBJECTIVE

To develop, and demonstrate the feasibility of, a novel image reconstruction method for absolute electrical impedance tomography (a-EIT) that pairs deep learning techniques with real-time robust D-bar methods and examine the influence of prior information on the reconstruction.

APPROACH

A D-bar method is paired with a trained convolutional neural network (CNN) as a post-processing step. Training data is simulated for the network using no knowledge of the boundary shape by using an associated nonphysical Beltrami equation rather than simulating the traditional current and voltage data specific to a given domain. This allows the training data to be boundary shape independent. The method is tested on experimental data from two EIT systems (ACT4 and KIT4) with separate training sets of varying prior information.

MAIN RESULTS

Post-processing the D-bar images with a CNN produces significant improvements in image quality measured by structural SIMilarity indices (SSIMs) as well as relative [Formula: see text] and [Formula: see text] image errors.

SIGNIFICANCE

This work demonstrates that more general networks can be trained without being specific about boundary shape, a key challenge in EIT image reconstruction. The work is promising for future studies involving databases of anatomical atlases.

Comparing D-bar and common regularization-based methods for electrical impedance tomography

Objective:

To compare D-bar difference reconstruction with regularized linear reconstruction in electrical impedance tomography.

Approach:

A standard regularized linear approach using a Laplacian penalty and the GREIT method for comparison to the D-bar difference images. Simulated data was generated using a circular phantom with small objects, as well as a ‘Pac-Man’ shaped conductivity target. An L-curve method was used for parameter selection in both D-bar and the regularized methods.

Main results:

We found that the D-bar method had a more position independent point spread function, was less sensitive to errors in electrode position and behaved differently with respect to additive noise than the regularized methods.

Significance:

The results allow a novel pathway between traditional and D-bar algorithm comparison.

Robust computation in 2D absolute EIT (a-EIT) using D-bar methods with the 'exp' approximation

OBJECTIVE

Absolute images have important applications in medical electrical impedance tomography (EIT) imaging, but the traditional minimization and statistical based computations are very sensitive to modeling errors and noise. In this paper, it is demonstrated that D-bar reconstruction methods for absolute EIT are robust to such errors.

APPROACH

The effects of errors in domain shape and electrode placement on absolute images computed with 2D D-bar reconstruction algorithms are studied on experimental data.

MAIN RESULTS

It is demonstrated with tank data from several EIT systems that these methods are quite robust to such modeling errors, and furthermore the artefacts arising from such modeling errors are similar to those occurring in classic time-difference EIT imaging.

SIGNIFICANCE

This study is promising for clinical applications where absolute EIT images are desirable but previously thought impossible.

EIT Imaging of admittivities with a D-bar method and spatial prior: experimental results for absolute and difference imaging

Electrical impedance tomography (EIT) is an emerging imaging modality that uses harmless electrical measurements taken on electrodes at a body's surface to recover information about the internal electrical conductivity and or permittivity. The image reconstruction task of EIT is a highly nonlinear inverse problem that is sensitive to noise and modeling errors making the image reconstruction task challenging. D-bar methods solve the nonlinear problem directly, bypassing the need for detailed and time-intensive forward models, to provide absolute (static) as well as time-difference EIT images. Coupling the D-bar methodology with the inclusion of high confidence a priori data results in a noise-robust regularized image reconstruction method. In this work, the a priori D-bar method for complex admittivities is demonstrated effective on experimental tank data for absolute imaging for the first time. Additionally, the method is adjusted for, and tested on, time-difference imaging scenarios. The ability of the method to be used for conductivity, permittivity, absolute as well as time-difference imaging provides the user with great flexibility without a high computational cost.

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

BACKGROUND

The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health.

METHODS

The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people.

RESULTS

Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes.

CONCLUSION

Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.

Evidence-based interventions in primary care following acute coronary syndrome in Australia and New Zealand: a systematic scoping review

BACKGROUND

Coronary artery disease has a significant disease burden, but there are many known barriers to management of acute coronary syndrome (ACS). General practitioners (GPs) bear considerable responsibility for post-discharge management of ACS in Australia and New Zealand (NZ), but knowledge about the extent and efficacy of such management is limited. This systematic review summarises published evidence from Australia and New Zealand regarding management in primary care after discharge following ACS.

METHODS

A search of PubMed, Scopus, CINAHL-Plus and PSYCINFO databases in August 2015 was supplemented by citation screening and hand-searching. Literature was selected based on specified criteria, and assessed for quality using the Mixed Methods Appraisal Tool (MMAT). Extracted data was related to evidence-based interventions specified by published guidelines.

RESULTS

The search yielded 19 publications, most of which reported on quantitative and observational studies from Australia. The majority of studies scored at least 75 % on the MMAT. Diverse aspects of management by GPs are presented according to categories of evidence-based guidelines. Data suggests that GPs are more likely to prescribe ACS medications than to assist in lifestyle or psychological management. GP referral to cardiac rehabilitation varied, and one study showed an improvement in the number of ACS patients with documented ACS management plans. Few studies described successful interventions to improve GP management, though some quality improvement efforts through education and integration of care with hospitals were beneficial. Limited data was published about interventions effective in rural, minority, and Indigenous populations.

CONCLUSIONS

Research reflects room for improvement in GP post-discharge ACS management, but little is known about effective methods for improvement. Additional research, both observational and interventional, would assist GPs in improving the quality of post-discharge ACS care.

Minority recruitment to the Selenium and Vitamin E Cancer Prevention Trial (SELECT)

Background Previous large chemoprevention studies have not recruited significant numbers of minorities. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is a large phase III study evaluating the impact of selenium and vitamin E on the clinical incidence of prostate cancer. Over 400 SELECT study sites in the USA, Canada, and Puerto Rico recruited men to this trial. The SELECT recruitment goal was 24% minorities, with 20% black, 3% Hispanic, and 1% Asian participants. The goal for black participants was set at 20% because of their proportion in the United States population and their prevalence of prostate cancer.

Methods The minority recruitment strategies in SELECT were to: 1) consider minority recruitment during site selection; 2) expand the eligibility criteria by lowering the age criterion for black men and including men with controlled co-morbid illnesses; 3) develop a national infrastructure; 4) give additional funds to sites with the potential to increase black enrollment; and 5) provide resources to maximize free media opportunities to promote SELECT.

Results SELECT recruitment began in August 2001 and was intended to last five years, but concluded two years ahead of schedule in June 2004. Of the 35 534 participants enrolled, 21% were minorities, with 15% black, 5% Hispanic, and 1% Asian.

Conclusions Careful planning, recruitment of large numbers of clinical centers and adequate resources accomplished by the combined efforts of the National Cancer Institute (NCI), Southwest Oncology Group (SWOG), SELECT Recruitment and Adherence Committee (RAC), SELECT Minority and Medically Underserved Subcommittee (MMUS), and the local SELECT sites resulted in attainment of the estimated sample size ahead of schedule and recruitment of the largest percentage of black participants ever randomized to a cancer prevention trial.

Effect of niacin on triglyceride-rich lipoprotein apolipoprotein B-48 kinetics in statin-treated patients with type 2 diabetes

AIM

To investigate the effects of extended-release (ER) niacin on apolipoprotein B-48 (apoB-48) kinetics in statin-treated patients with type 2 diabetes (T2DM).

METHODS

A total of 12 men with T2DM were randomized to rosuvastatin or rosuvastatin plus ER niacin for 12 weeks and then crossed to the alternate therapy. Postprandial metabolic studies were performed at the end of each treatment period. D3-leucine tracer was administered as subjects consumed a high-fat liquid meal. ApoB-48 kinetics were determined using stable isotope tracer kinetics with fractional catabolic rates (FCRs) and secretion rates derived using a non-steady-state compartmental model. Area-under-the-curve (AUC) and incremental AUC (iAUC) for plasma triglyceride and apoB-48 were also calculated over the 10-h period after ingestion of the fat meal.

RESULTS

In statin-treated patients with T2DM, apoB-48 concentration was lower with ER niacin (8.24 ± 1.98 vs 5.48 ± 1.14 mg/l, p = 0.03) compared with statin alone. Postprandial triglyceride and apoB-48 AUC were also significantly lower on ER niacin treatment (-15 and -26%, respectively; p < 0.05), without any change to triglyceride and apoB-48 iAUC. ApoB-48 secretion rate in the basal state (3.21 ± 0.34 vs 2.50 ± 0.31 mg/kg/day; p = 0.04) and number of apoB-48-containing particles secreted in response to the fat load (1.35 ± 0.19 vs 0.84 ± 0.12 mg/kg; p = 0.02) were lower on ER niacin. ApoB-48 FCR was not altered with ER niacin (8.78 ± 1.04 vs 9.17 ± 1.26 pools/day; p = 0.79).

CONCLUSIONS

ER niacin reduces apoB-48 concentration by lowering fasting and postprandial apoB-48 secretion rate. This effect may be beneficial for lowering atherogenic postprandial lipoproteins and may provide cardiovascular disease risk benefit in patients with T2DM.

Effects of extended-release niacin on the postprandial metabolism of Lp(a) and ApoB-100-containing lipoproteins in statin-treated men with type 2 diabetes mellitus

OBJECTIVE

The effects of extended-release niacin (ERN; 1-2 g/d) on the metabolism of lipoprotein(a) (Lp(a)) and apolipoprotein (apo) B-100-containing lipoproteins were investigated in 11 statin-treated white men with type 2 diabetes mellitus in a randomized, crossover trial of 12-weeks duration.

APPROACH AND RESULTS

The kinetics of Lp(a) and very low-density lipoprotein (VLDL), intermediate-density lipoprotein, and low-density lipoprotein (LDL) apoB-100 were determined following a standardized oral fat load (87% fat) using intravenous administration of D3-leucine, gas chromatography-mass spectrometry, and compartmental modeling. ERN significantly decreased fasting plasma total cholesterol, LDL cholesterol, and triglyceride concentrations. These effects were achieved without significant changes in body weight or insulin resistance. ERN significantly decreased plasma Lp(a) concentration (-26.5%) and the production rates of apo(a) (-41.5%) and Lp(a)-apoB-100 (-32.1%); the effect was greater in individuals with elevated Lp(a) concentration. ERN significantly decreased VLDL (-58.7%), intermediate-density lipoprotein (-33.6%), and LDL (-18.3%) apoB-100 concentrations and the corresponding production rates (VLDL, -49.8%; intermediate-density lipoprotein, -44.7%; LDL, -46.1%). The number of VLDL apoB-100 particles secreted increased in response to the oral fat load. Despite this, total VLDL apoB-100 production over the 10-hour postprandial period was significantly decreased with ERN (-21.9%).

CONCLUSIONS

In statin-treated men with type 2 diabetes mellitus, ERN decreased plasma Lp(a) concentrations by decreasing the production of apo(a) and Lp(a)-apoB-100. ERN also decreased the concentrations of apoB-100-containing lipoproteins by decreasing VLDL production and the transport of these particles down the VLDL to LDL cascade. Our study provides further mechanistic insights into the lipid-regulating effects of ERN.

Effect of Niacin on High-Density Lipoprotein Apolipoprotein A-I Kinetics in Statin-Treated Patients With Type 2 Diabetes Mellitus

Objective—

To investigate the effect of extended-release (ER) niacin on the metabolism of high-density lipoprotein (HDL) apolipoprotein A-I (apoA-I) in men with type 2 diabetes mellitus on a background of optimal statin therapy.

Approach and Results—

Twelve men with type 2 diabetes mellitus were recruited for a randomized, crossover design trial. Patients were randomized to rosuvastatin or rosuvastatin plus ER niacin for 12 weeks and then crossed over to the alternate therapy after a 3-week washout period. Metabolic studies were performed at the end of each treatment period. HDL apoA-I kinetics were measured after a standardized liquid mixed meal and a bolus injection of d3-leucine for 96 hours. Compartmental analysis was used to model the data. ER niacin significantly decreased plasma triglyceride, plasma cholesterol, non-HDL cholesterol, low-density lipoprotein cholesterol, and apoB (all P <0.05) and significantly increased HDL cholesterol and apoA-I concentrations ( P <0.005 and P <0.05, respectively). ER niacin also significantly increased HDL apoA-I pool size (6088±292 versus 5675±305 mg; P <0.001), and this was attributed to a lower HDL apoA-I fractional catabolic rate (0.33±0.01 versus 0.37±0.02 pools/d; P <0.005), with no significant changes in HDL apoA-I production (20.93±0.63 versus 21.72±0.85 mg/kg per day; P =0.28).

Conclusions—

ER niacin increases HDL apoA-I concentration in statin-treated subjects with type 2 diabetes mellitus by lowering apoA-I fractional catabolic rate. The effect on HDL metabolism was independent of the reduction in plasma triglyceride with ER niacin treatment. Whether this finding applies to other dyslipidemic populations remains to be investigated.

Abstract C11: Factors impacting implementation of a community coalition-driven evidence-based intervention: Results from a cluster randomized controlled trial

Background: For the past two decades there has been increased emphasis on implementing community coalition-driven, evidence-based interventions. However, little information is available to determine which elements of coalition infrastructure and partnerships are most supportive of successful intervention implementation. The Educational Program to Increase Colorectal Cancer Screening (EPICS) is a cluster randomized controlled trial (cRCT) currently underway in 20 communities located in 12 US states. The objective of this paper is to describe the role of three elements important in EPICS implementation by community coalitions: organizational infrastructure, facilitator selection and partnership formation. We hypothesized that more experienced community coalitions with larger, formal structures will train more facilitators and establish more partnerships when compared to smaller, less formal coalitions.

Methods: National Black Leadership Initiative on Cancer (NBLIC) community coalitions were charged with recruiting facilitators and community partners for EPICS delivery. The role of the facilitators was to deliver the educational intervention to small groups of participants. Facilitators selected were either community health educators (CHEs) – persons with a health professions degree - or community health workers (CHWs). Partnerships were formed with churches, clinics and other community sites to serve as settings and to assist in participant recruitment. Data were collected using a mixed method approach: two self-administered surveys (Organizational Assessment and Facilitator Baseline, Knowledge, Attitudes and Confidence Survey) and telephone key informant interviews. Descriptive analyses of the three groups of study participants (e.g., community coalitions, facilitators and partners) and correlational analysis was also performed within each community coalition to test for differences in facilitator and partnership type.

Results: A total of 20 community coalitions, 204 facilitators and 61 community institutions formed partnerships for EPICS implementation. Organizational Structure: All but one community coalition targets primarily African American populations (95.24%). Facilitator Selection: CHEs and CHWs were demographically similar (e.g., gender, race, age, language of preference, marital status, religious preference, and insurance coverage). While the association between community coalition size and the number of CHEs was not significant, there was a significant difference between community coalition size and the number of CHWs. Smaller and medium-sized coalitions engaged more CHWs as facilitators (p=0.0071). Partnership Formation: Community coalition size did not correlate with partnership type or number. Community coalitions indicating partnerships with clinics were more likely to select CHEs than CHWs (p=0.0338).

Conclusions: We examined multiple organizational characteristics to determine their relationship to facilitators and partners implementing EPICS. Although demographically similar, CHWs were selected more often by smaller and medium-sized community coalitions to train as EPICS facilitators. This finding suggests that smaller community coalitions, with a less formal structure were more likely to engage individuals with limited health backgrounds to facilitate the intervention. As a community-driven intervention, EPICS facilitation does not require a health professional for delivery. Interestingly, for community coalitions planning to implement EPICS in clinical settings, CHEs were selected over CHWs as facilitators.

Citation Format: Selina A. Smith, Sandra J. Hamilton, Rene D. Jackson, Mechelle D. Claridy, Ernest Alemah-Mensah, Joyce Q. Sheats, Joyce Q. Sheats. Factors impacting implementation of a community coalition-driven evidence-based intervention: Results from a cluster randomized controlled trial. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C11.

Endothelial dysfunction in diabetes: pathogenesis, significance, and treatment

Type 2 diabetes (T2D) markedly increases the risk of cardiovascular disease. Endothelial dysfunction (ED), an early indicator of diabetic vascular disease, is common in T2D and independently predicts cardiovascular risk. Although the precise pathogenic mechanisms for ED in T2D remain unclear, at inception they probably involve uncoupling of both endothelial nitric oxide synthase activity and mitochondrial oxidative phosphorylation, as well as the activation of vascular nicotinamide adenine dinucleotide phosphate oxidase. The major contributing factors include dyslipoproteinemia, oxidative stress, and inflammation. Therapeutic interventions are designed to target these pathophysiological factors that underlie ED. Therapeutic interventions, including lifestyle changes, antiglycemic agents and lipid-regulating therapies, aim to correct hyperglycemia and atherogenic dyslipidemia and to improve ED. However, high residual cardiovascular risk is seen in both research and clinical practice settings. Well-designed studies of endothelial function in appropriately selected volunteers afford a good opportunity to test new therapeutic interventions, paving the way for clinical trials and utilization in the care of the diabetic patient. However, based on the results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled low-density lipoprotein cholesterol.

Atherogenic dyslipidemia and combination pharmacotherapy in diabetes: recent clinical trials

Patients with type 2 diabetes (T2D) are at a markedly increased risk of cardiovascular disease (CVD). Dyslipidemia is a common risk factor and a strong predictor of CVD in T2D patients. Although statins decrease the incidence of CVD in T2D, residual cardiovascular risk remains high despite the achievement of optimal or near-optimal plasma low-density lipoprotein (LDL) cholesterol concentrations. This may, in part, be due to uncorrected atherogenic dyslipidemia. Hypertriglyceridemia, the driving force behind diabetic dyslipidemia, results from hepatic overproduction and/or delayed clearance of triglyceride-rich lipoproteins. In patients treated with a statin to LDL-cholesterol goals, the addition of ezetimibe, fenofibrate, niacin, or n-3 fatty acid ethyl esters may be required to correct the persistent atherogenic dyslipidemia. Clinical trial evidence describing best practice is limited, but recent data supports the strategy of adding fenofibrate to a statin, and suggests specific benefits in dyslipidemic patients and in the improvement of diabetic retinopathy. However, based on results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled LDL-cholesterol. Further evidence is required to support the role of ezetimibe and n-3 fatty acids in treating residual CVD risk in statin-treated T2D patients.

Atherogenic dyslipidemia and combination pharmacotherapy in diabetes: recent clinical trials

Patients with type 2 diabetes (T2D) are at a markedly increased risk of cardiovascular disease (CVD). Dyslipidemia is a common risk factor and a strong predictor of CVD in T2D patients. Although statins decrease the incidence of CVD in T2D, residual cardiovascular risk remains high despite the achievement of optimal or near-optimal plasma low-density lipoprotein (LDL) cholesterol concentrations. This may, in part, be due to uncorrected atherogenic dyslipidemia. Hypertriglyceridemia, the driving force behind diabetic dyslipidemia, results from hepatic overproduction and/or delayed clearance of triglyceride-rich lipoproteins. In patients treated with a statin to LDL-cholesterol goals, the addition of ezetimibe, fenofibrate, niacin, or n-3 fatty acid ethyl esters may be required to correct the persistent atherogenic dyslipidemia. Clinical trial evidence describing best practice is limited, but recent data supports the strategy of adding fenofibrate to a statin, and suggests specific benefits in dyslipidemic patients and in the improvement of diabetic retinopathy. However, based on results from a recent clinical trial, niacin should not be added to a statin in individuals with low high-density lipoprotein cholesterol and very well controlled LDL-cholesterol. Further evidence is required to support the role of ezetimibe and n-3 fatty acids in treating residual CVD risk in statin-treated T2D patients.

A direct D-bar reconstruction algorithm for recovering a complex conductivity in 2-D

A direct reconstruction algorithm for complex conductivities in W^2,∞ (Ω), where Ω is a bounded, simply connected Lipschitz domain in ℝ², is presented. The framework is based on the uniqueness proof by Francini [Inverse Problems 20 2000], but equations relating the Dirichlet-to-Neumann to the scattering transform and the exponentially growing solutions are not present in that work, and are derived here. The algorithm constitutes the first D-bar method for the reconstruction of conductivities and permittivities in two dimensions. Reconstructions of numerically simulated chest phantoms with discontinuities at the organ boundaries are included.

Prevalence and predictors of abnormal arterial function in statin-treated type 2 diabetes mellitus patients

Arterial dysfunction (AD) in type 2 diabetes mellitus (T2DM) predicts cardiovascular events. The objective was to investigate the prevalence and predictors of AD in statin-treated T2DM patients. We measured flow-mediated (FMD) and nitrate-mediated (NMD) brachial artery dilatation in 86 statin-treated T2DM patients. Patients were classified into 2 groups: normal arterial function (FMD ≥3.7% with NMD ≥11.9%) or AD (FMD <3.7% with or without NMD <11.9%). Endothelial dysfunction without smooth muscle cell dysfunction (ED) was defined as FMD less than 3.7% with NMD of at least 11.9%, and endothelial dysfunction with smooth muscle cell dysfunction (ED/SMD) was defined as FMD less than 3.7% with NMD less than 11.9%. Predictors of arterial function were investigated using linear and logistic regression methods. The prevalence of AD was 33.7% (23.2% with ED and 10.5% with ED/SMD). In multivariate linear regression, history of hypertension (P < .01), statin dose (P < .05), and estimated glomerular filtration rate (eGFR) (P = .02) were significant predictors of FMD. Sex (P < .01) and creatinine (P = .03) or eGFR (P = .02) predicted NMD. In multivariate logistic regression, the independent predictors of AD were history of hypertension (odds ratio [OR], 8.79; 95% confidence interval, 2.14-36.12; P < .01), age (OR, 1.08; 1.01-1.17; P = .03), and statin dose (OR, 0.33; 0.12-0.87; P = .02). A history of hypertension (OR, 8.99; 1.87-43.26; P < .01) was the sole independent predictor of ED; eGFR (OR, 0.01; 0.00-0.26; P < .01) independently predicted ED/SMD. Our data suggest that one third of statin-treated diabetic patients have residual AD, mainly due to ED alone. Earlier identification and treatment of hypertension and renal impairment may improve AD and further decrease cardiovascular risk in such patients.

Niacin improves small artery vasodilatory function and compliance in statin-treated type 2 diabetic patients

We investigated the effect of niacin (nicotinic acid prolonged release) on forearm vasodilatory function and arterial compliance in statin-treated type 2 diabetic patients with endothelial dysfunction. In a parallel group study, we randomised 15 subjects, with LDL-cholesterol ≤2.5 mmol/L, to niacin (dose titrated to 1500 mg/day over 8 weeks, then maintained for a further 12 weeks) or no additional treatment. Niacin increased maximal post-ischaemic forearm blood flow (mean ± SEM 6.4±2.4 vs. -2.3±1.2 ml/100 ml/min, p = 0.001) and small artery compliance (1.3±0.8 vs. -2.3±1.1 ml/mmHg, p = 0.01) compared with no additional treatment, but did not alter large artery compliance, blood pressure nor heart rate. Niacin decreased serum triglycerides by 47% (p = 0.04), with no change in LDL-cholesterol, HDL-cholesterol, apolipoprotein (Apo) B-100 nor ApoA-I (p > 0.05). Adding niacin to statin therapy improves small artery vasodilatory function and compliance in type 2 diabetes. This may relate to a decrease in serum triglycerides and/or a direct benefit of niacin on vascular biology.

Fenofibrate concomitantly decreases serum proprotein convertase subtilisin/kexin type 9 and very-low-density lipoprotein particle concentrations in statin-treated type 2 diabetic patients

AIM

Diabetic dyslipidaemia, characterized by hypertriglyceridaemia as a result of elevated serum very-low-density lipoprotein (VLDL) concentrations, contributes to the increased risk of cardiovascular disease (CVD) in type 2 diabetes (T2DM). Proprotein convertase subtilisin/kexin type 9 (PCSK9) may play a role in regulating VLDL metabolism. We investigated the effect of fenofibrate on serum PCSK9 and VLDL particle concentrations in T2DM patients already receiving statin therapy.

METHODS

In a double-blind randomized crossover study, 15 statin-treated T2DM patients (63 +/- 8 years, body mass index (BMI) 29 +/- 3 kg/m(2)) were treated with fenofibrate (145 mg/day) or matching placebo for 12 weeks. Serum PCSK9 concentrations were measured by immunoassay. VLDL particle concentration and size were determined by nuclear magnetic resonance spectroscopy.

RESULTS

Fenofibrate decreased serum triglycerides (-23%), VLDL-triglycerides (-51%), total cholesterol (-11%), LDL-cholesterol (-16%), apolipoprotein B-100 (-16%), apolipoprotein C-III (-20%) and PCSK9 (-13%) concentrations compared with placebo (p < 0.05). Fenofibrate also decreased serum concentrations of large (-45%), medium (-66%) and small VLDL (-67%) particles (p < 0.05), without altering VLDL particle size. Serum PCSK9 reduction correlated with decreases in total (r = 0.526, p = 0.044) and small (r = 0.629, p = 0.021) VLDL particle concentrations.

CONCLUSIONS

Fenofibrate concomitantly decreased serum PCSK9 and VLDL particle concentrations in statin-treated T2DM patients. These findings support a mechanistic link between PCSK9 and VLDL metabolism, possibly through an effect of PSK9 on VLDL receptor degradation.

Impact of supplemental site grants to increase African American accrual for the Selenium and Vitamin E Cancer Prevention Trial

BACKGROUND

African American accrual to prevention trials at rates representative of the disease burden experienced by this population requires additional resources and focused efforts.

PURPOSE

To describe the rationale, context, and criteria for selection of sites that received Minority Recruitment Enhancement Grants (MREGs) to increase African American recruitment to the Selenium and Vitamin E Cancer Prevention Trial (SELECT). To determine if African American accrual was higher among the 15 MREG sites when compared with similar nonawarded sites.

METHODS

Changes in African American accrual at sites that received MREGs are compared with changes in a group of 15, frequency-matched, nonawarded sites using a quasi-experimental, post hoc analysis. Successful and unsuccessful recruitment strategies reported by the MREG sites are described.

RESULTS

The increased number of African American participants accrued per month at MREG sites post-funding was higher than the change at comparison sites by a factor of 3.38 (p = 0.004, 95% CI: 1.51-7.57). An estimated 602 additional African American participants were recruited at MREG sites due to MREG funding, contributing to the overall 14.9% African American recruitment. Successful recruitment strategies most reported by MREG sites included increasing staff, transportation resources, recruiting through the media, mailings, and prostate cancer screening clinics during off-hours.

LIMITATIONS

Comparison sites were chosen retrospectively, not by randomization. Although comparison sites were selected to be similar to MREG sites with regard to potential confounding factors, it is possible that unknown factors could have biased results. Cost-effective analyses were not conducted.

CONCLUSIONS

MREG sites increased African American accrual in the post-funding period more than comparison sites, indicating MREG funding enhanced the sites' abilities to accrue African American participants. Targeted grants early in the accrual period may be a useful multi-site intervention to increase African American accrual for a prevention study where adequate African American representation is essential.

Coenzyme Q10 improves endothelial dysfunction in statin-treated type 2 diabetic patients

OBJECTIVE

The vascular benefits of statins might be attenuated by inhibition of coenzyme Q(10) (CoQ(10)) synthesis. We investigated whether oral CoQ(10) supplementation improves endothelial dysfunction in statin-treated type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

In a double-blind crossover study, 23 statin-treated type 2 diabetic patients with LDL cholesterol <2.5 mmol/l and endothelial dysfunction (brachial artery flow-mediated dilatation [FMD] <5.5%) were randomized to oral CoQ(10) (200 mg/day) or placebo for 12 weeks. We measured brachial artery FMD and nitrate-mediated dilatation (NMD) by ultrasonography. Plasma F(2)-isoprostane and 24-h urinary 20-hydroxyeicosatetraenoic acid (HETE) levels were measured as systemic oxidative stress markers.

RESULTS

Compared with placebo, CoQ(10) supplementation increased brachial artery FMD by 1.0 +/- 0.5% (P = 0.04), but did not alter NMD (P = 0.66). CoQ(10) supplementation also did not alter plasma F(2)-isoprostane (P = 0.58) or urinary 20-HETE levels (P = 0.28).

CONCLUSIONS

CoQ(10) supplementation improved endothelial dysfunction in statin-treated type 2 diabetic patients, possibly by altering local vascular oxidative stress.

Therapeutic regulation of endothelial dysfunction in type 2 diabetes mellitus

Endothelial dysfunction is universal in diabetes, being intimately involved with the development of cardiovascular disease. The pathogenesis of endothelial dysfunction in diabetes is complex. It is initially related to the effects of fatty acids and insulin resistance on 'uncoupling' of both endothelial nitric oxide synthase activity and mitochondrial function. Oxidative stress activates protein kinase C (PKC), polyol, hexosamine and nuclear factor kappa B pathways, thereby aggravating endothelial dysfunction. Improvements in endothelial function in the peripheral circulation in diabetes have been demonstrated with monotherapies, including statins, fibrates, angiotensin-converting enzyme (ACE) inhibitors, metformin and fish oils. These observations are supported by large clinical end point trials. Other studies show benefits with certain antioxidants, L-arginine, folate, PKC-inhibitors, peroxisome proliferator activated receptor (PPAR)-alpha and -gamma agonists and phosphodiesterase (PDE-5) inhibitors. However, the benefits of these agents remain to be shown in clinical end point trials. Combination treatments, for example, statins plus ACE inhibitors and statins plus fibrates, have also been demonstrated to have additive benefits on endothelial function in diabetes, but there are no clinical outcome data to date. Measurement of endothelial dysfunction in cardiovascular research can provide fresh opportunities for exploring the mechanism of benefit of new therapeutic regimens and for planning and designing large clinical trials.

Selenium in the Blackfoot, Salt, and Bear river watersheds

Nine stream sites in the Blackfoot River, Salt River, and Bear River watersheds in southeast Idaho, USA were sampled in May 2001 for water, surficial sediment, aquatic plants, aquatic invertebrates, and fish. Selenium was measured in these aquatic ecosystem components, and a hazard assessment was performed on the data. Water quality characteristics such as pH, hardness, and specific conductance were relatively uniform among the nine sites. Of the aquatic components assessed, water was the least contaminated with selenium because measured concentrations were below the national water quality criterion of 5 microg/L at eight of the nine sites. In contrast, selenium was elevated in sediment, aquatic plants, aquatic invertebrates, and fish from several sites, suggesting deposition in sediments and food web cycling through plants and invertebrates. Selenium was elevated to concentrations of concern in fish at eight sites (> 4 microg/g in whole body). A hazard assessment of selenium in the aquatic environment suggested a moderate hazard at upper Angus Creek (UAC) and Smoky Creek (SC), and high hazard at Little Blackfoot River (LiB), Blackfoot River gaging station (BGS), State Land Creek (SLC), upper (UGC) and lower Georgetown Creek (LGC), Deer Creek (DC), and Crow Creek (CC). The results of this study indicate that selenium concentrations from the phosphate mining area of southeast Idaho were sufficiently eleated in several ecosystem components to cause adverse effects to aquatic resources in southeastern Idaho.

Commotio cordis?A report of three cases

Commotio cordis is a recognised cause of sudden death in which an apparently minor blow to the chest causes ventricular fibrillation and cardiac arrest. It is best known for causing death during games of youth baseball in the United States, but individual cases have been recorded as a result of a wide range of activities, principally sporting. The underlying biochemical and mechano-electric causes have been well documented. However, there are few reported cases where commotio cordis is implicated as the cause of death in homicide cases. We present three cases from the north-east of England where an assault caused death by this mechanism.

Fear information and social phobic beliefs in children: a prospective paradigm and preliminary results

This paper presents a first attempt to develop a prospective paradigm to test Rachman's (Behav. Res. Ther. 15 (1977) 375) theory of fear acquisition for social fears. Following the prospective paradigm for animal fears developed by Field et al. (Behav. Res. Ther. 39 (2001) 1259) an attempt is made to adapt this paradigm to look at the effect of fear information in the development of social fears. A large group of normal children (N=135) who were at an age (10-13 years) at which social concerns are most pertinent were tested using this paradigm. They were given positive, negative or neutral information about three social situations: public speaking, eating in public, and meeting a new group of children. Children's fear beliefs were measured before and after the information was given and the information was given by a teacher, a same age peer or no information was given (a control). The results indicate that although information can change social fear beliefs it is dependent upon the type of social activity and who provides the information. The implications of these initial results for our understanding of both the role of fear information in the development of social fear beliefs, and the limitations of this current paradigm are discussed.

Sudden death and suicide: a comparison of brain weight

BACKGROUND

Recent evidence suggests that the brain weight of individuals over the age of 60 who commit suicide is significantly higher than in those who die of natural causes.

AIMS

To ascertain whether brain weight is different in people of a younger age who commit suicide than in those who die accidentally.

METHOD

A retrospective review of post-mortem reports collecting height, weight and brain weight in 100 suicide victims (87 males, mean age 38.5 years) and 100 age/gender-matched controls who died accidentally or of natural causes (87 males, mean age 38.7 years). Comparison by t-test was made of brain weight in isolation as well as brain weight corrected for height, weight and body mass index.

RESULTS

These results reveal no significant difference in brain weight in suicide cases compared to the general population (P > 0.05). The brain weight of those who died by hanging was significantly higher than of those who died by overdose.

CONCLUSIONS

Whatever the significant neuropsychiatric elements are that influence suicidal behaviour, they do not consistently affect brain weight in the population studied.

Assessment of selenium effects in lotic ecosystems

The selenium literature has grown substantially in recent years to encompass new information in a variety of areas. Correspondingly, several different approaches to establishing a new water quality criterion for selenium have been proposed since establishment of the national water quality criterion in 1987. Diverging viewpoints and interpretations of the selenium literature have lead to opposing perspectives on issues such as establishing a national criterion based on a sediment-based model, using hydrologic units to set criteria for stream reaches, and applying lentic-derived effects to lotic environments. This Commentary presents information on the lotic verse lentic controversy. Recently, an article was published that concluded that no adverse effects were occurring in a cutthroat trout population in a coldwater river with elevated selenium concentrations (C. J. Kennedy, L. E. McDonald, R. Loveridge, and M. M. Strosher, 2000, Arch. Environ. Contam. Toxicol. 39, 46-52). This article has added to the controversy rather than provided further insight into selenium toxicology. Information, or rather missing information, in the article has been critically reviewed and problems in the interpretations are discussed.

Changes in skeletal muscle in males and females following endurance training

Gender differences in substrate selection have been reported during endurance exercise. To date, no studies have looked at muscle enzyme adaptations following endurance exercise training in both genders. We investigated the effect of a 7-week endurance exercise training program on the activity of β-oxidation, tricarboxylic acid cycle and electron transport chain enzymes, and fiber type distribution in males and females. Training resulted in an increase in [Formula: see text]O2peak for both males and females of 17% and 22%, respectively (P < 0.001). The following muscle enzyme activities increased similarly in both genders: 3-β-hydroxyacyl CoA dehydrogenase (38%), citrate synthase (41%), succinate-cytochrome c oxidoreductase (41%), and cytochrome c oxidase (COX; 26%). The increase in COX activity was correlated (R2 = 0.52, P < 0.05) with the increase in [Formula: see text]O2peak/ fat free mass. Fiber area, size, and % area were not affected by training for either gender, however, males had larger Type II fibers (P < 0.05) and females had a greater Type I fiber % area (P < 0.05). Endurance training resulted in similar increases in skeletal muscle oxidative potential for both males and females. Training did not affect fiber type distribution or size in either gender.Key words: endurance training, oxidative potential, gender.

Changes in skeletal muscle in males and females following endurance training

Gender differences in substrate selection have been reported during endurance exercise. To date, no studies have looked at muscle enzyme adaptations following endurance exercise training in both genders. We investigated the effect of a 7-week endurance exercise training program on the activity of beta-oxidation, tricarboxylic acid cycle and electron transport chain enzymes, and fiber type distribution in males and females. Training resulted in an increase in VO2peak, for both males and females of 17% and 22%, respectively (P < 0.001). The following muscle enzyme activities increased similarly in both genders: 3-beta-hydroxyacyl CoA dehydrogenase (38%), citrate synthase (41%), succinate-cytochrome c oxidoreductase (41%), and cytochrome c oxidase (COX; 26%). The increase in COX activity was correlated (R2 = 0.52, P < 0.05) with the increase in VO2peak/fat free mass. Fiber area, size, and % area were not affected by training for either gender, however, males had larger Type II fibers (P < 0.05) and females had a greater Type I fiber % area (P < 0.05). Endurance training resulted in similar increases in skeletal muscle oxidative potential for both males and females. Training did not affect fiber type distribution or size in either gender.

Cardiac findings in an individual with neurofibromatosis 1 and sudden death

Vascular lesions in neurofibromatosis 1 (NF1) are infrequently recognised as manifestations of the disease, yet they can produce serious complications. Most individuals with NF1 vasculopathy are asymptomatic, which may contribute to underestimation of its frequency. A recent study indicates that vascular changes in individuals with NF1 contribute to mortality at younger ages. We report the sudden death of a young man with NF1. On autopsy examination there was evidence of an intramyocardial vasculopathy characteristic of the vascular pathology previously described in NF1. Other cardiac findings included non-specific cardiomyopathic changes, myocardial fibrosis, and a "floppy" mitral valve.

Insights into the pathogenesis of neurofibromatosis 1 vasculopathy

Intrinsic lesions of arterial walls are an important manifestation of neurofibromatosis 1 (NF1). Neurofibromin is expressed in blood vessel endothelial and smooth muscle cells, and NF1 vasculopathy may result from an alteration of neurofibromin function in these cells. Elucidation of the role of neurofibromin in the maintenance and repair of blood vessels may lead to novel approaches to the treatment of NF1 vasculopathy and vascular disease in general.

Hazard assessment of selenium and other trace elements in wild larval razorback sucker from the Green River, Utah

Contaminant investigations of the Green River in northeastern Utah have documented selenium contamination at sites receiving irrigation drainage. The Green River provides critical habitat for four endangered fishes including the largest extant riverine population of endangered razorback sucker. Although 2175 larval razorback suckers were collected from the river between 1992 and 1996, very few juveniles have been captured within recent decades. Selenium concentrations were measured in larval razorback suckers collected from five sites in the Green River (Cliff Creek, Stewart Lake Drain, Sportsman's Drain, Greasewood Corral, and Old Charlie Wash) to assess the potential for adverse effects on recruitment of larvae to the juvenile stage and the adult population. Larvae from all sites contained mean selenium concentrations ranging from 4.3 to 5.8 microg/g. These values were at or above the proposed toxic threshold of 4 microg/g for adverse biological effects in fish, which was derived from several laboratory and field studies with a wide range of fish species. At two sites, Cliff Creek and Stewart Lake Drain, selenium concentrations in larvae increased over time as fish grew, whereas selenium concentrations decreased as fish grew at Sportsman's Drain. Evaluation of a 279-larvae composite analyzed for 61 elements demonstrated that selenium and, to a lesser extent, vanadium were elevated to concentrations reported to be toxic to a wide range of fish species. Elevated selenium concentrations in larval razorback suckers from the five sites suggest that selenium contamination may be widespread in the Green River, and that survival and recruitment of larvae to the juvenile stage may be limited due to adverse biological effects. Selenium contamination may be adversely affecting the reproductive success and recruitment of endangered razorback sucker.

Water-sediment controversy in setting environmental standards for selenium

A substantial amount of laboratory and field research on selenium effects to biota has been accomplished since the national water quality criterion was published for selenium in 1987. Many articles have documented adverse effects on biota at concentrations below the current chronic criterion of 5 microg/L. This commentary will present information to support a national water quality criterion for selenium of 2 microg/L, based on a wide array of support from federal, state, university, and international sources. Recently, two articles have argued for a sediment-based criterion and presented a model for deriving site-specific criteria. In one example, they calculate a criterion of 31 microg/L for a stream with a low sediment selenium toxicity threshold and low site-specific sediment total organic carbon content, which is substantially higher than the national criterion of 5 microg/L. Their basic premise for proposing a sediment-based method has been critically reviewed and problems in their approach are discussed.

Effects of the herbicide atrazine on Ambystoma tigrinum metamorphosis: duration, larval growth, and hormonal response

We exposed larval tiger salamanders (Ambystoma tigrinum) reared in the laboratory from eggs collected from a prairie wetland in North Dakota to three concentrations of atrazine (0, 75, and 250 micrograms/L) in a static renewal test to determine the pesticide's effect on (1) plasma corticosterone and thyroxine concentrations, (2) larval size, and (3) days-to-stage at stages 2 and 4 of metamorphic climax. We found significant effects of atrazine on each of these response variables. Plasma thyroxine was elevated in both atrazine-exposed groups compared with the control group; plasma corticosterone was depressed in the 75 micrograms/L treatment compared with both the control and 250 micrograms/L treatment. Larvae exposed to 75 micrograms/L atrazine reached stage 4 later but at a size and weight comparable to the control group. By contrast, larvae in the 250 micrograms/L treatment progressed to stage 4 at the same time but at a smaller size and lower weight than larvae in the control group. These results indicate that the herbicide has the potential to influence tiger salamander life history. We present a model consistent with our results, whereby corticosterone and thyroxine interact to regulate metamorphosis of tiger salamanders based on nutrient assimilation and adult fitness.

Expression of the 'dead box' RNA helicase p68 is developmentally and growth regulated and correlates with organ differentiation/maturation in the fetus

The human DEAD box protein p68 is an established RNA-dependent ATPase and RNA helicase, p68 has been highly conserved in evolution and appears to be essential for normal growth, suggesting that this protein plays an important role in the cell. Although the biochemical activities of p68 are fairly well characterized, little is known about its biological function. This report shows that p68 is detectable in quiescent cell lines, but its expression is induced by serum, suggesting that this protein may play a role in cell growth. It is also shown that both p68 mRNA and protein are differentially expressed in adult tissues; in this case, however, the levels do not always correlate with proliferation status, suggesting that the regulation of expression in the animal may be different from that in cell lines. Finally, it is shown that p68 expression is developmentally regulated and appears to correlate with organ differentiation/maturation. These findings suggest that p68 expression may not simply reflect proliferation/differentiation status and that it appears to be regulated in a more complex way.

Safety and tolerability of 619C89 after acute stroke

BACKGROUND

619C89 is a use-dependent sodium channel blocker which reduces hemispheric infarction volume by up to 60% after permanent middle cerebral artery occlusion in rats. Intravenous doses of up to 1 mg/kg have been well tolerated by healthy young and elderly volunteers. This study sought to assess safety and tolerability of 619C89 in the treatment of acute stroke.

METHODS

Patients were randomised within 12 h of onset of stroke to receive 619C89 or placebo as an intravenous loading dose, followed by maintenance doses given 8 hourly for 64 h in a double-blind, ascending-dose tolerance study. Dosing commenced at 0.5 mg/kg loading plus 0.25 mg/kg/8 h maintenance for the first group and increased in increments of 0.5 mg/kg loading +0.25 mg/kg/8 h maintenance thereafter. Safety evaluation was continued for 3 months.

RESULTS

48 patients were recruited. 12 received placebo and 36 received 619C89 in doses up to 2.5 mg/kg loading plus 1.25 mg/kg/8 h. Dose escalation was stopped after the occurrence of hallucinations in 5 of 18 patients who received 2 mg/kg/8 h or more. Gastro-intestinal upset and confusion were also possibly drug related. No drug-related effects on cardiovascular function were found.

CONCLUSIONS

619C89 was associated with significant central nervous system side-effects at doses of 2 mg/kg + 1 mg/kg/8 h or greater as discrete intravenous infusions within 12 h of stroke onset. It may also cause gastro-intestinal side-effects. Doses below this are well tolerated in patients. No adverse cardiovascular effects were seen.

Hazard evaluation of inorganics, singly and in mixtures, to flannelmouth sucker Catostomus latipinnis in the San Juan River, New Mexico

Larval flannelmouth sucker (Catostomus latipinnis) were exposed to arsenate, boron, copper, molybdenum, selenate, selenite, uranium, vanadium, and zinc singly, and to five mixtures of five to nine inorganics. The exposures were conducted in reconstituted water representative of the San Juan River near Shiprock, New Mexico. The mixtures simulated environmental ratios reported for sites along the San Juan River (San Juan River backwater, Fruitland marsh, Hogback East Drain, Mancos River, and McElmo Creek). The rank order of the individual inorganics, from most to least toxic, was: copper > zinc > vanadium > selenite > selenate > arsenate > uranium > boron > molybdenum. All five mixtures exhibited additive toxicity to flannelmouth sucker. In a limited number of tests, 44-day-old and 13-day-old larvae exhibited no difference in sensitivity to three mixtures. Copper was the major toxic component in four mixtures (San Juan backwater, Hogback East Drain, Mancos River, and McElmo Creek), whereas zinc was the major toxic component in the Fruitland marsh mixture, which did not contain copper. The Hogback East Drain was the most toxic mixture tested. Comparison of 96-h LC50 values with reported environmental water concentrations from the San Juan River revealed low hazard ratios for arsenic, boron, molybdenum, selenate, selenite, uranium, and vanadium, moderate hazard ratios for zinc and the Fruitland marsh mixture, and high hazard ratios for copper at three sites and four environmental mixtures representing a San Juan backwater, Hogback East Drain, Mancos River, and McElmo Creek. The high hazard ratios suggest that inorganic contaminants could adversely affect larval flannelmouth sucker in the San Juan River at four sites receiving elevated inorganics.

Sensitivity of the cough reflex in young and elderly subjects

OBJECTIVE

To compare the sensitivity of the cough reflex--which is said to be normal in elderly people--in elderly and young subjects.

SUBJECTS

20 elderly (14 female) subjects, mean (SEM) age 83 (1) years and 20 young (nine female) subjects, mean (SEM) age 27 (1) years, who were all non-smokers. None of the subjects was taking antitussive drugs and none suffered from clinically evident lung, cardiac or neurological disease. Five elderly subjects were unable to perform adequate spirometry and were excluded from analysis.

DESIGN AND OUTCOME MEASURES

Each subject inhaled 10 ml of nebulized distilled water and isotonic saline (as placebo) for 30 s, 10 min apart in a randomized double-blind crossover fashion. The cough frequency induced with each treatment was recorded on a click counter.

RESULTS

Cough frequency on inhaling distilled water was significantly lower in the elderly group than in the younger group, with a difference of 9.53 (95% confidence intervals: 3.63, 15.4; P < 0.001). None of the subjects coughed when inhaling placebo solution, resulting in significant differences in cough frequencies between distilled water and placebo of 5.87 (2.82, 8.92; P < 0.05) for the elderly group and 15.4 (11.0, 19.8; P < 0.0005) for the younger group.

CONCLUSIONS

The sensitivity of the cough reflex appears to be significantly reduced in elderly subjects. This may increase the risk of aspiration and bronchopulmonary infection in old age, even in the absence of respiratory disease.

Acute toxicity of firefighting chemical formulations to four life stages of fathead minnow

Laboratory studies were conducted with four early life stages of fathead minnow, Pimephales promelas, to determine the acute toxicity of five firefighting chemical formulations in standardized soft and hard water. Egg, fry, 30-day posthatch, and 60-day posthatch life stages were tested with three fire retardants (Fire-Trol GTS-R, Fire-Trol LCG-R, and Phos-Chek D75-F) and two fire-suppressant foams (Phos-Chek WD-881 and Ansul Silv-Ex). Fry were generally the most sensitive life stage tested, whereas the eggs were the least sensitive life stage. Formulation toxicity was greater in hard water than in soft water for all life stages tested. Fire-suppressant foams were more toxic than the fire retardants. The 96-hr LC50s derived for fathead minnows were rank ordered from the most toxic to the least toxic formulation as follows: Phos-Chek WD-881 (13-32 mg/liter) > Silv-Ex (19-32 mg/liter) > Fire-Trol GTS-R (135-787 mg/liter) > Phos-Chek D75-F (168-2250 mg/liter) > Fire-Trol LCG-R (519-6705 mg/liter) (ranges are the lowest and highest 96-hr LC50 for each formulation).

Acute toxicity of fire control chemicals to Daphnia magna (Straus) and Selenastrum capricornutum (Printz)

Acute toxicity tests were conducted exposing Daphnia magna Straus (daphnid) in soft and hard reconstituted waters (hardness 42 and 162 mg/liter as CaCO3, respectively), and Selenastrum capricornutum Printz (algae) in ASTM algal assay medium (hardness 15 mg/liter as CaCO3) to fire retardants Fire-Trol GTS-R, Fire-Trol LCG-R, and Phos-Chek D75-F, and foam suppressants Phos-Check WD-881 and Silv-Ex. The chemicals were slightly toxic to practically harmless to daphnids and moderately toxic to algae. Water quality did not consistently alter the toxicity of the test chemicals to daphnids. The most toxic chemical to daphnids was Silv-Ex (48-hr EC50 7 mg/liter in soft and hard waters), whereas the least toxic chemical to daphnids was Fire-Trol LCG-R (48-hr EC50 848 mg/liter in soft water, 813 mg/liter in hard water). The most toxic chemical to algae was Fire-Trol LCG-R (96-hr IC50 10 mg/liter), and the least toxic chemical was Phos-Chek D75-F (96-hr IC50 79 mg/liter). Un-ionized ammonia concentrations near the EC50 or IC50 value in tests with the Fire-Trol compounds were frequently equal to or above reported LC50 un-ionized ammonia concentrations. Un-ionized ammonia concentrations in tests with Phos-Chek D75-F were low, thus other toxic components present in the compounds probably contributed to the toxicity. When compared to the daphnids tested in ASTM soft water, the Fire-Trol compounds were most toxic to algae, whereas Phos-Chek D75-F and the foam suppressants were most toxic to daphnids. The results of these tests are comparable to those obtained from research conducted in other laboratories with the same species and similar chemicals. Accidental entry of fire-fighting chemicals into aquatic environments could adversely affect algae and aquatic invertebrates, thus disrupting ecosystem function.

Hazard assessment of inorganics to three endangered fish in the Green River, Utah

Acute toxicity tests were conducted with three life stages of Colorado squawfish (Ptychocheilus lucius), razorback sucker (Xyrauchen texanus), and bonytail (Gila elegans) in a reconstituted water quality simulating the middle part of the Green River of Utah. Tests were conducted with boron, lithium, selenate, selenite, uranium, vanadium, and zinc. The overall rank order of toxicity to all species and life stages combined from most to least toxic was vanadium = zinc > selenite > lithium = uranium > selenate > boron. There was no difference between the three species in their sensitivity to the seven inorganics based on a rank-order evaluation at the species level. Colorado squawfish were 2-5 times more sensitive to selenate and selenite at the swimup life stage than older stages, whereas razorback suckers displayed equal sensitivity among life stages. Bonytail exhibited equal sensitivity to selenite, but were five times more sensitive to selenate at the swimup life stage than the older stages. Comparison of 96-hr LC50 values with a limited number of environmental water concentrations in Ashley Creek, Utah, which receives irrigation drainwater, revealed moderate hazard ratios for boron, selenate, selenite, and zinc, low hazard ratios for uranium and vanadium, but unknown ratios for lithium. These inorganic contaminants in drainwaters may adversely affect endangered fish in the Green River.

Selenium in eggs and milt of razorback Sucker (Xyrauchen texanus) in the middle Green River, Utah

Eggs from three female and milt from five male endangered razorback suckers (Xyrauchen texanus) were collected from the Razorback Bar (about 20 km upstream of Ashley Creek) in the Green River of northeastern Utah. Eggs, but not milt, had concentrations of selenium that were above the range of selenium concentrations in control fish from laboratory studies or reference fish from field studies. The concentrations, however, were below those reported in selenium-exposed fish that had reproductive problems in laboratory studies or field investigations. Tests with three streamside spawned pairs of razorback suckers, which were sampled for eggs and milt in this study, resulted in no hatching of fertilized eggs. Concentrations of selenium in eggs and milt were significantly correlated with selenium concentrations in muscle plugs taken from the same fish, but egg and milt concentrations were not significantly different from muscle plugs. Selenium concentrations in eggs of razorback suckers in the Green River may be sufficiently elevated to cause reproductive problems that are contributing to the decline of this species in the upper Colorado River Basin.

Cerebral blood flow increases during insulin-induced hypoglycaemia in type 1 (insulin-dependent) diabetic patients and control subjects

The effect of insulin-induced hypoglycaemia on cerebral blood flow was examined using the intravenous xenon-clearance technique in 9 patients with Type 1 (insulin-dependent) diabetes (aged 20 to 43 years) and 9 age-matched control subjects before, during and after hypoglycaemia. Cerebral blood flow rose in both groups. The mean basal cerebral flood flow values were not significantly different and during hypoglycaemia mean cerebral blood flow increased by 17% (p = 0.008) in the diabetic patients and by 21% (p = 0.0003) in the control subjects. The results suggest that in young diabetic patients without autonomic neuropathy or microangiopathy cerebral vessels dilate normally in response to hypoglycaemia. The physiological importance of an increase in cerebral blood flow during hypoglycaemia is uncertain; but glucose availability is increased.