Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females

OBJECTIVE

Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions.

DESIGN

Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach.

DATA SOURCES

MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022.

ELIGIBILITY

Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females.

RESULTS

Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited.

CONCLUSION

Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes.

PROSPERO REGISTRATION NUMBER

This review was registered on PROSPERO CRD42021224582 on 8 January 2021.

Dose assessment for polonium-210 (Po-210) in New Zealand shellfish

Worldwide, Po-210 is an important contributor to human ionising radiation exposure through food. To characterise the ionising radiation dose for New Zealanders from Po-210 in shellfish, a dose assessment was undertaken. Deterministic and probabilistic dietary models were constructed by assigning shellfish consumption rates to Po-210 activity concentrations measured in shellfish. Modelling was undertaken for different shellfish consumer populations and geographical areas. Dietary modelling estimated an annual dose range from 4 μSv to 6070 μSv. The lowest dose was calculated for the overall shellfish consumer population residing in areas where baseline Po-210 activity concentrations were measured in shellfish. The highest dose was calculated for the high shellfish consumer population residing in areas where elevated activity concentrations were measured in shellfish. For the majority of the New Zealand population, the total estimated dose did not exceed the selected reference level of 1000 μSv, and Po-210 is therefore not a cause of concern. About 50% of high shellfish consumers residing in areas where shellfish had elevated Po-210 activity concentrations were exposed to ionising radiation resulting in an annual dose higher than 1000 μSv. Exposure assessment for different demographic groups identified that higher shellfish consumption rates in the population identifying as Māori lead to higher doses of ionising radiation for this group.

Spatial variability in Polonium-210 and Lead-210 activity concentration in New Zealand shellfish and dose assessment

The activity concentrations of Polonium-210 (²¹⁰Po) and Lead-210 (²¹⁰Pb) were determined in shellfish (Perna canaliculus and Paphies subtriangulata) sampled bimonthly from March 2018 to February 2019 from 14 sites around New Zealand. Activity concentrations of ²¹⁰Po ranged from 4.7 ± 1.1 to 324 ± 17 Bq. kg^-1 with a mean value of 57 ± 72 Bq. kg^-1 (wet weight). The activity concentrations of ²¹⁰Pb were lower than those for ²¹⁰Po (0.1 ± 0.4 and 1.9 ± 0.4 Bq. kg^-1, with a mean value of 0.7 ± 0.4 Bq. kg^-1, wet weight). The calculated ²¹⁰Po/²¹⁰Pb activity concentration ratios were higher than unity in all samples indicating that radionuclides are not in equilibrium in shellfish and most of the ²¹⁰Po was unsupported by its grandparent ²¹⁰Pb. No significant difference was noted in ²¹⁰Po activity concentration between different seasons, species or shellfish condition index. Significant spatial variability in ²¹⁰Po activity concentration was observed with elevated ²¹⁰Po activity concentration in two sampling sites: Ninety Mile Beach (mean 257 ± 47 Bq. kg^-1) and Maunganui Bluff (mean 127 ± 22 Bq. kg^-1). Elevated ²¹⁰Po is hypothesised to be related to an increase of ²¹⁰Po accumulation through diet. Individuals who consume large quantities of shellfish (10 g per day or more) from areas affected by elevated ²¹⁰Po activity concentration may be exposed to an annual committed effective dose from ²¹⁰Po in shellfish in excess of 1 mSv.

Argatroban is stable in citrated whole blood for 24 hours

INTRODUCTION

Argatroban is a direct thrombin inhibitor used as an anticoagulant for patients who have Heparin induced thrombocytopenia. Quantification can be performed using a dilute thrombin time or anti-iia assay. Our preferred method is Hemoclot Thrombin Inhibitor Assay (HTI).To the best of our knowledge, no one has published on the stability of plasma argatroban in whole citrated blood at room temperature.

METHODS

Forty matched samples obtained from 4 patients receiving argatroban. 1 mL of the whole blood was removed from the sample into a labelled plastic tube and left on the laboratory bench at room temperature for 24 hours prior to centrifugation. The remaining sample was spun at 2000 g for 10 minutes and the plasma aliquoted off and labelled 0 hour and stored at -80°C prior to testing. At 24 hours the plastic tube containing whole blood was centrifuged at 2000 g for 10 minutes and the plasma aliquoted off and labelled 24 hours and stored at -80°C prior to testing. HTI assay was used for plasma argatroban determination.

RESULTS

The lowest argatroban level obtained was 0.16 μg/mL at 0 hour; 0.18 μg/mL at 24 hours from the same pair, the highest argatroban level obtained was 1.72 μg/mL at 0 hour;1.76 μg/mL for the same pair at 24 hours. The mean result for 0 hour was 0.57 μg/mL and 0.60 μg/mL at 24 hours.

CONCLUSION

This study proposes that patients receiving treatment in hospitals who cannot provide a dedicated argatroban plasma concentration method could have their samples sent on whole blood within 24 hours of venepuncture to a laboratory who could provide the test.

Donor-Derived Metastatic Melanoma and Checkpoint Inhibition

Donor-derived malignancy, particularly melanoma, is a rare but known complication of organ transplantation. Here we describe a case of metastatic melanoma in a deceased-donor kidney transplant recipient. After diagnosis, the patient was successfully treated with cessation of immunosuppression, explantation of the renal allograft, and novel melanoma therapies, including the mutation-targeted agents dabrafenib and trametinib and the immune checkpoint inhibitor nivolumab. These 2 new classes of melanoma therapy have revolutionized the course of metastatic melanoma, altering it from one of nearly certain mortality to one of potential cure. This case reviews the mechanisms of action of these therapies and reports our experience with them in the rare setting of donor-derived melanoma in a dialysis-dependent patient.

e-Health and new moms: Contextual factors associated with sources of health information

OBJECTIVE

Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors.

DESIGN AND SAMPLE

Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample.

MEASURES

Use of online media about mother-baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education.

RESULTS

Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother-baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messaging (χ² statistics, p < .001). Stress and race/ethnicity were among factors associated with preferences.

CONCLUSIONS

Mothers widely used e-Health related media, but use was associated with contextual factors. In public health efforts to reach new mothers, partnering with mother-favored Web sites, focusing on audience-relevant media, and adopting attributes of successful sites are recommended strategies.

Validity of a sensor-based table-top platform to measure upper limb function

Objective measurement is an essential part of the assessment process in neurological dysfunction such as stroke. However, current clinical scores are insensitive and based on subjective observation from experts. Technology provides an opportunity for enhanced accuracy and specificity of objective measurement. This study describes the use of an interactive force-sensitive table-top platform for the assessment of reach in post-stroke patients, admitted as part of a three week intensive upper limb training programme. Objective measures from the reachable workspace were extracted and included normalised reach distance, normalised reached speed and reach dragging. The data was compared to standardised Fugl-Meyer (FM) clinical scores, recorded at admission (FMPRE) and discharge (FMPOST). Results indicate strong relationships between the three objective measures and subjective FM scores, with significant Spearman correlations found in all cases (|ρ| > 0.5, p < 0.05). The results highlight the validity for a sensor-based table-top system to provide a simple, flexible, and objective platform for assessment of impaired upper limb motor function.

SITAR: a system for independent task-oriented assessment and rehabilitation

INTRODUCTION

Over recent years, task-oriented training has emerged as a dominant approach in neurorehabilitation. This article presents a novel, sensor-based system for independent task-oriented assessment and rehabilitation (SITAR) of the upper limb.

METHODS

The SITAR is an ecosystem of interactive devices including a touch and force-sensitive tabletop and a set of intelligent objects enabling functional interaction. In contrast to most existing sensor-based systems, SITAR provides natural training of visuomotor coordination through collocated visual and haptic workspaces alongside multimodal feedback, facilitating learning and its transfer to real tasks. We illustrate the possibilities offered by the SITAR for sensorimotor assessment and therapy through pilot assessment and usability studies.

RESULTS

The pilot data from the assessment study demonstrates how the system can be used to assess different aspects of upper limb reaching, pick-and-place and sensory tactile resolution tasks. The pilot usability study indicates that patients are able to train arm-reaching movements independently using the SITAR with minimal involvement of the therapist and that they were motivated to pursue the SITAR-based therapy.

CONCLUSION

SITAR is a versatile, non-robotic tool that can be used to implement a range of therapeutic exercises and assessments for different types of patients, which is particularly well-suited for task-oriented training.

Tracking official development assistance for reproductive health in conflict-affected countries: 2002-2011

OBJECTIVE

To provide information on trends on official development assistance (ODA) disbursement patterns for reproductive health activities in 18 conflict-affected countries.

DESIGN

Secondary data analysis.

SAMPLE

18 conflict-affected countries and 36 non-conflict-affected countries.

METHODS

The Creditor Reporting System (CRS) database was analyzed for ODA disbursement for direct and indirect reproductive health activities to 18 conflict-affected countries (2002-2011). A comparative analysis was also made with 36 non-conflict-affected counties in the same 'least-developed' income category. Multivariate regression analyses examined associations between conflict status and reproductive health ODA and between reproductive needs and ODA disbursements.

MAIN OUTCOME MEASURES

Patterns of ODA disbursements (constant U.S. dollars) for reproductive health activities.

RESULTS

The average annual ODA disbursed for reproductive health to 18 conflict-affected countries from 2002 to 2011 was US$ 1.93 per person per year. There was an increase of 298% in ODA for reproductive health activities to the conflict-affected countries between 2002 and 2011; 56% of this increase was due to increases in HIV/AIDS funding. The average annual per capita reproductive health ODA disbursed to least-developed non-conflict-affected countries was 57% higher than to least-developed conflict-affected countries. Regression analyses confirmed disparities in ODA to and between conflict-affected countries.

CONCLUSIONS

Despite increases in ODA for reproductive health for conflict-affected countries (albeit largely for HIV/AIDS activities), considerable disparities remains.

TWEETABLE ABSTRACT

Study tracking 10 years of aid for reproductive aid shows major disparities for conflict-affected countries.

Investigation of isometric strength and control of the upper extremities in multiple sclerosis

Isometric force assessment can provide insights into strength and motor control in patients with neurological disabilities. This study investigated the connection between isometric strength and control in nine multiple sclerosis (MS) patients and four healthy subjects using a compact isometric setup. The participants carried out isometric assessment tasks in both upper extremities in six directions. Strength was measured through maximum voluntary force/torque (MVF/T), while control ability was measured by applying a constant force/torque of 25% of MVF/T. Isometric control was quantified using coefficient of variation, force directing ability, sample-entropy and spectral bandwidth. The MS patients were also assessed using two impairment measures (Motricity Index and hand-grip strength), and two activity measures (Action Research Arm Test and Nine Hole Peg Test). The results indicate that isometric strength and control (measured by spectral bandwidth) were correlated in most directions. Among the four control measures, spectral bandwidth – a measure introduced in this study – was found to be strongly related to the force/torque regularity as measured by sample-entropy. Isometric strength and spectral bandwidth for all directions were well correlated with the impairment measures, but their correlation with the activity scales was moderate and direction-dependent. Overall the results show potential for using the isometric setup and protocol for assessment in MS population.

Successful treatment of acute severe graft-versus-host-disease in a pancreas-after-kidney transplant recipient: case report

The development of acute graft-versus-host-disease (GVHD) in recipients of pancreas transplants is a rare and quite often a fatal post-transplantation complication. We present a 38-year-old male with a longstanding history of type 1 diabetes mellitus and end-stage kidney disease, with a living unrelated kidney transplant from his wife for 3 years, who received an enteric-drained 5-antigen HLA-mismatched deceased-donor pancreas. Five weeks after transplantation, he presented with spiking fevers, severe skin rash, diarrhea, pancytopenia, and increasingly abnormal liver function tests. Skin biopsies were consistent with grade 3 acute GVHD. The patient was treated for GVHD with escalated doses of tacrolimus, pulse doses of steroids, and basiliximab. He was discharged after a 4-week hospital stay with complete resolution of his rash, fever, abnormal liver enzymes, and leukopenia. He remained in good health with excellent kidney and pancreas allograft function 3 years later.

Mental health literacy and postpartum depression: a qualitative description of views of lower income women

The purpose of this study is to understand mental health literacy (MHL) (Jorm, 2000) in lower income women postpartum and share participant experiences of recognizing and seeking help for depressive symptoms. Focus group textual data were received from 25 participants who completed a weight and psychosocial health longitudinal study. Iterative content data analysis using Jorm's framework provided thematic understandings descriptive of MHL. Women recognized behavioral changes indicating mental distress, but fears prevented them from seeking help, and some resorted to risky behaviors. This framework could guide providers to identify women who may benefit from early intervention for postpartum depressive symptoms.

Anticonvulsant medication use for the management of pain following spinal cord injury: systematic review and effectiveness analysis

STUDY DESIGN

Systematic review and effectiveness analysis.

OBJECTIVES

Assess the effectiveness of anticonvulsants for the management of post spinal cord injury (SCI) neuropathic pain.

SETTING

Studies from multiple countries were included.

METHODS

CINAHL, Cochrane, EMBASE and MEDLINE were searched up to April 2013. Quality assessment was conducted using the Jadad and the Downs and Black tools. Effect sizes and odds ratios were calculated for primary and secondary outcome in the included studies.

RESULTS

Gabapentinoids, valproate, lamotrigine, levetiracetam and carbamazepine were examined in the 13 included studies, ten of which are randomized controlled trials. Large effect size (0.873-3.362) for improvement of pain relief was found in 4 of the 6 studies examining the effectiveness of gabapentin. Pregabalin was shown to have a moderate to large effect (0.695-3.805) on improving neuropathic pain post SCI in 3 studies. Valproate and levetiracetam were not effective in improving neuropathic pain post SCI, while lamotrigine was effective in reducing neuropathic pain amongst persons with incomplete lesions and carbamazepine was found effective for relief of moderate to intense pain.

CONCLUSION

Gabapentin and pregabalin are the two anticonvulsants which have been shown to have some benefit in reducing neuropathic pain.

A Study of the Health Literacy Needs of People With Visual Impairments

The purpose of this mixed methods study was to understand preferences surrounding health literacy for 18 men and women with permanent and severe visual impairment (VI). Participants completed demographic questions—the National Eye Institute Visual Function Questionnaire (NEI-VFQ)—and 1 semi-structured interview to ascertain views on obtaining, processing, and understanding health information. Overall, the sample had low total eye health scores on the NEI-VFQ—indicating that the sample represented a group with severe visual impairments. The sample mentioned multiple health promotion topics of interest and types of devices used to gain information. They also described multiple barriers to health information, which could be eliminated. Implications for intervention development and technology use are provided.

MRI of the rotator interval of the shoulder

The rotator interval of the shoulder joint is located between the distal edges of the supraspinatus and subscapularis tendons and contains the insertions of the coracohumeral and superior glenohumeral ligaments. These structures form a complex pulley system that stabilizes the long head of the biceps tendon as it enters the bicipital groove of the humeral head. The rotator interval is the site of a variety of pathological processes including biceps tendon lesions, adhesive capsulitis and anterosuperior internal impingement. This article describes the anatomy, function and pathology of the rotator interval using magnetic resonance imaging (MRI).

The locus and modulation of the location negative priming effect

Responding to the location of a target is slower when it appears at a recent distractor location [ignored-repetition (IR) trial] than when it arises at a new position [control (CO) trial], defining the location negative priming (NP) effect. On IR trials, both the distractor location and response are from the prior trial, and the locus question asks whether the delayed responding that arises is caused by the reused distractor position (i.e., a location locus) or the need to execute a distractor output (i.e., a response locus). A location NP procedure was used, incorporating a many:1 location-to-response mapping design, along with a response cue on some trials. A response locus for the location NP effect was indicated. Distractor-turned-target responses took longer to initiate than new outputs (many:1 paradigm), and valid response cues reduced distractor response interference and the location NP effect. Importantly, a possible S-R compatibility problem within the many:1 S-R paradigm was not supported.

The locus of location repetition latency effects

We examined the processing locus (location vs. response) of location repetition effects in terms of the event [target (t) or distractor (d)] that initially occupied and then re-occupied the repeated location (i.e., t-to-t, t-to-d, d-to-t, d-to-d). Trials were presented in pairs (prime, then probe) and 2:1 location-to-response mappings were used. Generally, for all repetition conditions, perceptual processing at the repeated location itself was facilitated (location locus), while re-activated responses delayed output production (response locus). More specifically, perceptual facilitation observed for a repeated location was independent of the kind of processing (i.e., t or d) that occurred earlier, suggesting that it is not the labeling of locations as relevant or irrelevant that determines location repetition effects. Response production was significantly slowed only when a just-inhibited response had then to be executed, which supported the view that the spatial negative priming effect has a response locus.

Can the location negative priming process operate in a proactive manner?

The location negative priming (NP) effect refers to the fact that the processing of a current target stimulus (probe trial) is delayed when it appears at a location that has recently contained a distractor event (prime trial), relative to when it occurs at a previously unoccupied position. One view is that the process causing the NP effect involves the inhibition of the internal representation of the prime-distractor event, and that the future processing of target stimuli that involve this event are prolonged because this distractor inhibition is persistent. In this study, we examined the possibility that the NP process (inhibition) could act proactively; specifically asking whether inhibition could be allocated to a location merely predicted to hold a future distractor event. To do this, we cued the probe distractor's location using an otherwise traditional location NP paradigm. No evidence of a proactive NP process was obtained. Probe-trial target latency was the same whether it appeared at the cued distractor location or at a new location, but was delayed when it occupied the prime-distractor location (NP effect). The location NP process is seemingly a reactive one, applying inhibition only when an actual distractor is present, much as past theories have implied.

The Influence of Distractor-Only Prime Trials on the Location Negative Priming Mechanism

Abstract. Two experiments were conducted that examined the influence of distractor-only prime trials on the “location” negative priming (NP) effect. In all experiments, the probe trial always lacked a distractor. We showed that the predictable absence of a probe distractor caused the elimination of the location NP effect when the prime trial contained both a target and a distractor event (T + D→T), but not when the prime contained only a to-be-ignored distractor event (D→T) ( Milliken, Tipper, Houghton, & Lupianez, 2000 ). The preservation of the NP effect seen with the distractor-only prime trials (D→T) was not the result of its lacking a prime-trial selection, nor was it the consequence of its representing a higher level of episodic similarity than the T + D→T condition. Finally, the location NP effect observed for the D→T condition is seemingly consistent with the view that location NP and the inhibition-of-return effects share a common underlying process ( Milliken et al., 2000 ).

Composting under controlled conditions

Three cylindrical reactors, each with a working capacity of approximately 200 litres, were used to investigate composting. The process was optimised and conditions were controlled so that composting on a laboratory-scale thermally resembled that occurring in the core of large open heaps. A baseline flow of humidified air aerated the reactors in five-minute bursts. The reactors operated as closed systems with facilities to analyse the composition of the off-gas for ammonia, oxygen and carbon dioxide. Temperature was used to monitor the progress of the process. Heat loss from the reactor surface was compensated for with an external heat source. A basic model of radial conductive heat losses showed that 53 watts per square-metre would be the maximum heat flux needed to keep the temperature difference across the reactor to within a degree when running at 60 degrees C. A heating cable was used, which could supply 150 watts per square-metre, and the radial temperature difference was reduced to within a degree in more than 60% of the recorded temperatures in the case studies presented. The temperature of the composting material was held at 60 degrees C using a high flow rate 'cooling' aeration with temperature feedback. This, however, led to a mean vertical temperature difference of at least 10 degrees C. The aeration strategy resulted in a well-aerated material, which favoured aerobic microbial activity and the temperature increased as a result of the internally generated heat associated with composting. Three-quarters of the ammonia was emitted in the first week.

Who writes guidelines, and who should?

AIM

To confirm or refute the impression that diagnostic radiology was often not represented on guideline writing committees, despite the fact that guidelines often made statements with implications for radiological practice.

MATERIALS AND METHODS

We took two approaches. Firstly we examined all published Scottish Intercollegiate Guidelines Network (SIGN) guidelines and extracted the disease topic, the number of authors and peer reviewers, the number that were radiologists, and independently decided whether, given the content, radiologist input at the writing or review stage was necessary. We also searched for all guidelines on management of stroke worldwide (a single disease topic with major radiological implications) and extracted the proportion of authors that were radiologists.

RESULTS

Of 47 SIGN guidelines on different diseases, 11 (23%) had a radiologist in the authorship (13/594, 2.2% total authors), and 5/47 (11%) had a radiologist specialist reviewer (10/529, 1.8% total reviewers). Independent review of the guidelines' content suggested that 76% of guidelines should have had a radiologist author and 91% a radiologist reviewer (discrepancy 53% and 80% respectively). Amongst 22 guidelines on acute stroke management in the world literature with 202 authors (where stated), there were only two radiologists (1%), both on one guideline which was specifically to do with imaging of stroke (5% of all stroke guidelines identified).

CONCLUSION

Diagnostic radiology is poorly represented on guideline writing committees, although frequently guidelines have implications for radiological practice. Radiologists should try to be more involved in guideline production.

Safety and security policies on psychiatric acute admission wards: results from a London-wide survey

Very little research evidence is available regarding current safety and security procedures on acute psychiatric wards. This includes controversial areas such as the temporary removal of personal property, the searching of patients and visitors, the use of alarms and modern technology, and locking of entrances to regulate those entering and leaving. This is also despite widening dismay over increasing violence within a variety of hospital settings, the comparatively high risk of physical assault faced by mental health professionals and an abundance of literature and training in regards to violence management and prevention. To gain an understanding of current safety and security measures, a London-wide survey of acute admission wards was undertaken revealing a wide variety of measures and policies in operation. Over 100 NHS and private wards were sent questionnaires; there was a response rate of 70%. Results show that a significant proportion of acute admission wards are now locked at all times and a small proportion of units have 24-hour security/reception staff on-site and a low level of modern technology usage such as CCTV and electronic access systems. There is wide variation in items banned, restrictions placed on inpatients, and the searching of patients and visitors. Two independently varying emphases of ward security policies were identifiable, the first aimed at preventing harm to patients using door security, banning of item and restrictions on inpatients. The other is aimed at reducing risks to staff via searching of patients, use of security guards and sophisticated alarm systems. There is some preliminary evidence that these security policies are differentially associated with levels of absconding and violent incidents. Further research to guide practice is urgently required.

Fluorescence imaging of submicrometric lattices of colour centres in LiF by an apertureless scanning near-field optical microscope

We report fluorescence imaging of colour centres in Lithium Fluoride (LiF) using an apertureless Scanning Near Field Optical Microscope (SNOM). The sample consists of periodically spaced submicrometric coloured areas F2 laser-active colour centres produced by low-energy electron beam lithography on the surface of a LiF thin film. A silicon Atomic Force Microscope (AFM) tip is used as an apertureless optical probe. AFM images show a uniform surface roughness with a RMS of 7.2 nm. The SNOM images of the red fluorescence of colour centres excited at lambda = 458 nm with an argon ion laser show that the local photon emission is unambiguously related to the coloured areas and that topographic artefacts can be excluded.

Frequent attenders in general practice: a retrospective 20-year follow-up study

We describe a 20-year retrospective study of 58 patients with a cross-matched control group in one practice, who initially attended more than 12 times in 1975. The study establishes that frequent attendance is not consistent; the majority of high-attending patients in general practice revert over a short period of time to a normal consulting pattern. Diseases, rather than patients, appear to dictate high consulting rates. Consistent high attendance is largely owing to multiple pathology.

Simultaneous heart and kidney transplantation in patients with end-stage heart and renal failure

Combined simultaneous organ transplantation has become more common as selection criteria for transplantation have broadened. Broadening selection criteria is secondary to improved immunosuppression and surgical techniques. The kidney is the most common extrathoracic organ to be simultaneously transplanted with the heart. A series of 13 patients suffering from both end-stage heart and renal failure underwent 14 simultaneous heart and kidney transplantations at Temple University Hospital between 1990 and 1999. This is the largest series reported from a single center. Three patients died during the initial hospitalization for an in-hospital mortality of 21%. Of 10 patients who left the hospital, 1-year survival was 100% and 2-year survival 75%. One patient required retransplant for rejection within the first year. Overall mortality at 1 and 2 years was 25 and 41%, respectively. Four out of nine (44%) patients greater than 5 years post-transplant were alive. Of the 10 patients who left the hospital, 66% were alive at 5 years. One patient succumbed to primary nonfunction of the cardiac allograft, while the four other deaths were secondary to bacterial or fungal sepsis. The patient's racial backgrounds were equally divided between African-American and white. These results are similar to those reported in a United Network of Organ Sharing Database (UNOS) registry analysis of 84 simultaneous heart and kidney transplants that found 1- and 2-year survival to be 76 and 67%, respectively. Simultaneous heart and kidney transplantation continues to be a viable option for patients suffering from failure of these two organ systems, although the results do not match those of heart transplant alone.

Comparison of short and long-term renal function in liver transplant patients receiving cyclosporin or FK 506

Long-term renal function was compared in 49 liver recipients [25 patients received cyclosporin (CyA) and 24 patients received FK 506] followed for a period of 1 year. Creatinine (CR) and glomerular filtration rate (GFR) pretransplantation (pre-Tx) and at 1, 3, 5, and 12 months post-Tx were recorded, as well as incidences of hyperkalemia, post-Tx hypertension, and insulin-dependent diabetes mellitus (IDDM) in the two groups. At 1 year post-Tx, the mean Cr had risen from baseline by 56% and 60% in the FK and CyA groups, respectively; the mean GFR had dropped by 32% in FK patients and by 27% in CyA patients. Acute nephrotoxicity occurred in 7/25 CyA patients (2/7 required dialysis) and 9/26 FK patients (7/9 required dialysis; 2/7 were switched to CyA). None remained on dialysis at 3 months. Renal insufficiency persisted at 1 year in 7/16 patients with early toxicity (CyA, 4; FK, 3) and in 3 of the remaining 36 pts (P < 0.001). Hyperkalemia occurred in 4/25 CyA, and in 12/24 FK patients (P < 0.025), post-Tx hypertension occurred in 15 CyA, and 7 FK patients (P < 0.05), and IDDM occurred in 4 CyA and 7 FK patients (P = ns). FK 506 and CyA, thus, exerted similar chronic renal effects. Although acute renal insufficiency improved upon dose reduction, renal impairment was permanent in some cases.

Toxoplasma gondii secretes a calcium-independent phospholipase A(2)

Phospholipases A(2) (PLA(2)) play an important role in Toxoplasma gondii host cell penetration. They are also key enzymes in the host cell response to the parasite invasion. PLA(2) hydrolyse cellular phospholipids, releasing multiple inflammatory lipidic mediators. We have investigated the biochemical characterisation of T. gondii PLA(2) activity in a mouse-cultured tachyzoite homogenate and in the peritoneal exudate from infected mice, using the hydrolysis of a fluorescent phosphatidylglycerol labelled at the sn-2 position. Spectrofluorimetry and thin-layer chromatography showed a PLA(2) activity (about 0.5-2 nmol/min per mg), calcium-independent, secreted into infected mice peritoneal exudate, with a broad pH activity ranging between 6.5 and 9.5 and resistant to a great number of potential PLA(2) inhibitors except dithio-nitrobenzoic acid (1 mM). An associated phospholipase A(1) activity was also displayed. These results suggest that Toxoplasma gondii displays specific phospholipases different from host enzymes and probably involved at critical steps of infectious cycle.

Characterization of two members of the maize gene family, Incw3 and Incw4, encoding cell-wall invertases

Two maize putative cell-wall invertase genes (Incw3 and Incw4) have been isolated by screening a genomic DNA library (Zea mays L. W22) using the cDNA probes encoding the two maize cell-wall invertases Incw1 and Incw2. The Incw3 and Incw4 genes contain six exons/five introns and five exons/four introns, respectively. The protein sequences deduced from both genes revealed a beta-fructosidase motif and a cysteine catalytic site known to be conserved in invertase genes. A detailed analysis of the protein and nucleotide sequences provides evidence that the Incw3 and the Incw4 genes encode putative cell-wall invertases. Furthermore, the isoelectric point deduced from the INCW4 protein sequence suggested that the Incw4 gene may encode a unique type of cell-wall invertase unbound in the apoplast. Gene expression studies using RT-PCR and in-situ RT-PCR hybridization showed that the Incw3 expression is organ/tissue-specific and developmentally regulated. In contrast, the Incw4 gene is constitutively expressed in all vegetative and reproductive tissues tested.

Inhibitory activity of anti-interleukin-4 and anti-interleukin-10 antibodies on Toxoplasma gondii proliferation in mouse peritoneal macrophages cocultured with splenocytes from infected mice

Cocultures of splenocytes from Toxoplasma gondii-immunized mice or from naive mice, separated by a transwell membrane from naive macrophage layers, induced a decrease in T. gondii proliferation in macrophages in comparison with cultures without splenocytes or cocultures with splenocytes from infected mice. Interleukin 4 (IL-4) and IL-10 levels increased in cocultures of splenocytes from infected mice with naive macrophages. In contrast, the levels of these cytokines decreased in cocultures with splenocytes from immunized mice. No correlation was found between the release of interferon-gamma (IFN-gamma) and the inhibition of parasite multiplication. Cocultures with splenocytes from immunized mice induced an increase in tumor necrosis factor-alpha (TNF-alpha) levels. In contrast, in cocultures with splenocytes from infected mice, TNF-alpha production decreased. In cocultures with splenocytes from infected mice, T. gondii proliferation in macrophages was neutralized by anti-IL4 or anti-IL10 antibodies and was associated with increased TNF-alpha production. Moreover, this study demonstrates the significant combined effect of IL-4 and IL-10 on the down-regulation of macrophage-effector functions. A soluble positive signal was given by splenocytes to induce the production of TNF-alpha by macrophages. This signal was inhibited by IL4 and IL10. This process is biologically relevant in the regulation of T. gondii proliferation.

Th1/Th2 cytokines and ICAM-1 levels post-liver transplant do not predict early rejection

Th1 derived cytokines IFN-gamma and IL-2, Th2 cytokine IL-4, and ICAM-1 have been implicated in liver allograft rejection. In order to determine whether monitoring of cytokine profiles during the first days post-liver transplant can predict early rejection we measured IFN-gg, IL-2, sIL-2 receptor, IL-4 and ICAM-1 in 22 patients, in plasma samples obtained within 4 h after liver perfusion (baseline) and between postoperative days (POD) 3-6. ICAM-1 and sIL-2R levels at POD 3-6 were significantly higher than at baseline but did not differ in presence or absence of rejection. Mean percentage increase of ICAM-1 levels was significantly lower in patients with Muromonab-C3 Orthoclone OKT3 (J.C. Health Care) (OKT3) whereas percentage increase of sIL-2R levels was higher in OKT3-treated patients. IFN-gamma levels at POD 3-6 increased from baseline while IL-4 levels were unchanged. Levels of IFN-gamma, IL-4 and their ratios did not correlate with rejection or immunosuppressive therapy. Thus, Th1/Th2 cytokine monitoring during the first week post-transplant does not predict early rejection and immunosuppressive therapy is the predominant factor affecting ICAM and sIL-2R levels after liver transplantation.

Cytokine profiles in early rejection following OKT3 treatment in liver transplant patients

OKT3 , a murine monoclonal antibody specific to the human CD3 complex, induces immunosuppression by depletion of T cells. Administration of OKT3 results in significant release of proinflammatory cytokines, such as TNFalpha and IL1beta. Liver recipients who experience rejection within 3 weeks after transplantation with OKT3 prophylaxis recover their T cells by postoperative day 10 despite complete initial clearance. We sought to analyze the role of proinflammatory and Th-1 cytokines in T cell recovery and rejection after liver transplantation with OKT3 prophylaxis. In plasma samples from 32 patients, we measured TNFalpha, IL1beta and IL6 (before transplant and on postoperative days 1, 2 and 3) and IL2, IFNgamma, sIL2R and slCAM (postoperative days 5, 7 and 10) and examined possible correlations with T-cell recovery and occurrence of rejection within 3 weeks. TNFalpha, IL1beta, and IL6 did not correlate with T-cell recovery. In patients who rejected, IL2 and IFNgamma on postoperative days 5 and 7 correlated with degree of T-cell recovery by day 10; a significant rise in sIL2R over time also correlated with T-cell recovery in this group. Our results emphasize the role of Th-1 cytokines in rejection following OKT3 induction and suggest that markers of T cell activation may predict risk.

Correlation between von Willebrand factor levels and early graft function in clinical liver transplantation

Cold preservation/reperfusion leads to sinusoidal endothelial cell (SEC) activation and damage in nearly every liver transplantation; the extent of these changes influences early graft function. Upon reperfusion, activated SEC show increased expression of adhesion molecules, including von Willebrand factor (vWF) which is released into the circulation. This study was designed to evaluate the levels of vWF measured in the caval effluent and correlate these findings with known markers of SEC damage and early graft function. Data were obtained from 35 patients undergoing orthotopic liver transplantation (LTx). Two samples were taken from each patient for measurement of vWF: a) from the portal vein immediately prior to reperfusion; and b) from the first 50 ml of the caval effluent. Commercial assays were used to measure vWF, as well as hyaluronic acid (HA), thrombomodulin (TM), IL-1 beta, IL-6, IL-8 and TNF-alpha. Patients were divided into two groups based on early graft function. Poor early graft function (PEGF) was defined as a peak aspartate transaminase (AST) or alanine transaminase (ALT) level > 2500 U/L during the first three postoperative days (POD) and a prothrombin time (PT) > 16 s on POD 2 (n = 8). The remaining 27 patients had good early graft function (GEGF). In patients with GEGF, vWF levels dropped significantly between the two time points. This change was not observed in those with PEGF. A positive linear correlation was observed in the PEGF group between vWF and HA and IL-6. The different pattern of change in vWF between the two groups, as well as the positive correlation between HA, IL-6 and vWF in PEGF, suggest that vWF may be a useful marker of early graft function.

Ivr2, a candidate gene for a QTL of vacuolar invertase activity in maize leaves. Gene-specific expression under water stress

Water shortage produced an early and large stimulation of acid-soluble invertase activity in adult maize leaves whereas cell wall invertase activity remained constant. This response was closely related to the mRNA level for only one of the invertase gene (Ivr2), encoding a vacuolar isoform. In parallel, four quantitative trait loci (QTLs) were detected for invertase activity under control and nine under stressful conditions. One QTL in control and one in stressed plants was located near to the Ivr2 gene on chromosome 5. Other QTLs for invertase activity were found close to carbohydrate QTLs; some of them formed 'stress clusters'.