Managing climate refugia for freshwater fishes under an expanding human footprint

Within the context of climate adaptation, the concept of climate refugia has emerged as a framework for addressing future threats to freshwater fish populations. We evaluated recent climate-refugia management associated with water use and landscape modification by comparing efforts in the US states of Oregon and Massachusetts, for which there are contrasting resource use patterns. Using these examples, we discuss tools and principles that can be applied more broadly. Although many early efforts to identify climate refugia have focused on water temperature, substantial gains in evaluating other factors and processes regulating climate refugia (eg stream flow, groundwater availability) are facilitating refined mapping of refugia and assessment of their ecological value. Major challenges remain for incorporating climate refugia into water-quality standards, evaluating trade-offs among policy options, addressing multiple species' needs, and planning for uncertainty. However, with a procedurally transparent and conceptually sound framework to build upon, recent efforts have revealed a promising path forward.

Enumeration of Total Aerobic Microorganisms in Foods by SimPlate® Total Plate Count–Color Indicator Methods and Conventional Culture Methods: Collaborative Study

The relative efficacy of the SimPlate® Total Plate Count–Color Indicator (TPC–CI) method (SimPlate 35°C) was compared with the AOAC Official Method 966.23 (AOAC 35°C) for enumeration of total aerobic microorganisms in foods. The SimPlate TPC–CI method, incubated at 30°C (SimPlate 30°C), was also compared with the International Organization for Standardization (ISO) 4833 method (ISO 30°C). Six food types were analyzed: ground black pepper, flour, nut meats, frozen hamburger patties, frozen fruits, and fresh vegetables. All foods tested were naturally contaminated. Nineteen laboratories throughout North America and Europe participated in the study. Three method comparisons were conducted. In general, there was <0.3 mean log count difference in recovery among the SimPlate methods and their corresponding reference methods. Mean log counts between the 2 reference methods were also very similar. Repeatability (sr) and reproducibility (sR) standard deviations were similar among the 3 method comparisons. The SimPlate method (35°C) and the AOAC method were comparable for enumerating total aerobic microorganisms in foods. Similarly, the SimPlate method (30°C) was comparable to the ISO method when samples were prepared and incubated according to the ISO method.

Visual Immunoprecipitate Assay Eight Hour Method for Detection of Enterohemorrhagic Escherichia coli O157:H7 in Raw and Cooked Beef (Modification of AOAC Official Method 996.09): Collaborative Study

AOAC Official Method 996.09, Visual Immunoprecipitate Assay (VIP®) for Escherichia coli O157:H7, was modified to incorporate a new enrichment protocol using BioControl EHEC8™ medium for testing raw and cooked beef. Foods were tested by VIP assay and the U.S. Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) enrichment procedure and the FDA Bacteriological Analytical Manual (BAM) isolation and confirmation techniques. A total of 15 collaborators participated. Raw and cooked ground beef were inoculated with E. coli O157:H7 at 2 different levels: a high level, where predominantly positive results were expect d, and a low level where fractional recovery was anticipated. Collaborators tested 396 test portions and controls by both methods, for a total of 792 test portions. Of the 396 paired test portions, 75 were positive and 230 were negative by both the VIP and culture methods. Eleven test portions were presumptively positive by VIP and could not be confirmed culturally; 32 were negative by VIP, but confirmed positive by culture; and 65 were negative by the culture method, but confirmed positive by the VIP method. There was no statistical difference between results obtained with the VIP for EHEC 8 h method and the culture method except for cooked beef, where the VIP had significantly higher recovery for one inoculation level.

Making time for what's important: what elements should we value when planning practice-based professional training?

Newly qualified professional healthcare graduates, whether training to become doctors, dentists, veterinary surgeons or nurses, tend to need some support as they take their first steps along that bumpy road from university to confident, competent practice. We identify some key features of the UK programme of dental practice-based training to acknowledge its strengths - 12 months of clinical practice within a well-established dental team, one-to-one weekly meetings with the same dedicated mentor, regular peer learning with the same group of peers over 12 months and the opportunity to observe role models from the profession including training programme directors and other general dental practitioners (GDPs). This educational programme is unique to dentistry and this article outlines why we believe it is important to value these features when designing postgraduate professional training in healthcare sciences.

Designing a Monitoring Program to Estimate Estuarine Survival of Anadromous Salmon Smolts: Simulating the Effect of Sample Design on Inference

A number of researchers have attempted to estimate salmonid smolt survival during outmigration through an estuary. However, it is currently unclear how the design of such studies influences the accuracy and precision of survival estimates. In this simulation study we consider four patterns of smolt survival probability in the estuary, and test the performance of several different sampling strategies for estimating estuarine survival assuming perfect detection. The four survival probability patterns each incorporate a systematic component (constant, linearly increasing, increasing and then decreasing, and two pulses) and a random component to reflect daily fluctuations in survival probability. Generally, spreading sampling effort (tagging) across the season resulted in more accurate estimates of survival. All sampling designs in this simulation tended to under-estimate the variation in the survival estimates because seasonal and daily variation in survival probability are not incorporated in the estimation procedure. This under-estimation results in poorer performance of estimates from larger samples. Thus, tagging more fish may not result in better estimates of survival if important components of variation are not accounted for. The results of our simulation incorporate survival probabilities and run distribution data from previous studies to help illustrate the tradeoffs among sampling strategies in terms of the number of tags needed and distribution of tagging effort. This information will assist researchers in developing improved monitoring programs and encourage discussion regarding issues that should be addressed prior to implementation of any telemetry-based monitoring plan. We believe implementation of an effective estuary survival monitoring program will strengthen the robustness of life cycle models used in recovery plans by providing missing data on where and how much mortality occurs in the riverine and estuarine portions of smolt migration. These data could result in better informed management decisions and assist in guidance for more effective estuarine restoration projects.

A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations

Peanut (PN) and tree nut (TN) allergies are among the leading causes of fatal food-induced anaphylaxis and are increasing in prevalence, especially in children. Their cosensitization and concurrent clinical allergy have been understudied. This retrospective study investigated the correlation between PN and TN allergy, both in terms of in vitro sensitization (IVS) and clinical allergic manifestations. We conducted a retrospective medical record review at the Allergy Clinic at University Hospital of Brooklyn. Fourteen hundred six charts were reviewed, of which 76 (5.4%) had documented relevant clinical allergy: PN allergy but not TN allergy (n = 29) or TN allergy but not PN allergy (n = 11) or both (n = 30). Six patients with PN allergy but no TN exposure history were not included in the analysis. The majority of patients (67/76, 88.1%) had a concurrent history of asthma, rhinoconjunctivitis, or AD. Sensitivity of TN IVS predicting PN IVS was 38/39 (97%). Similarly, sensitivity of PN IVS predicting TN IVS was 38/42 (91%). Sensitivity of TN clinical allergy predicting PN allergy was 30/59 (51%). Sensitivity of PN clinical allergy predicting TN allergy was 30/41 (73%). The total number of organ systems involved in reported clinical reactions correlated with IVS to TN (p = 0.004) but not IVS to PN (p = 0.983). In summary, we found PN sensitization predicts TN sensitization in vitro, with lower predictability for clinical reactions.

Effect of commercially available egg cures on the survival of juvenile salmonids

There is some concern that incidental consumption of eggs cured with commercially available cures for the purpose of sport fishing causes mortality in juvenile salmon. We evaluated this by feeding juvenile spring Chinook (Oncorhynchus tshawytscha) and steelhead (O. mykiss) with eggs cured with one of five commercially available cures. We observed significant levels of mortality in both pre-smolts and smolts. Depending on the experiment, 2, 3, or 4 of the cures were associated with mortality. Mortality tended to be higher in the smolts than in the parr, but there was no clear species effect. The majority of mortality occurred within the first 10 d of feeding. Removal of sodium sulfite from the cure significantly reduced the level of mortality. Soaking the eggs prior to feeding did not reduce mortality. We observed a clear relationship between the amount of cured egg consumed each day and the survival time. We conclude that consumption of eggs cured with sodium sulfite has the potential to cause mortality in juvenile steelhead and Chinook salmon in the wild.

Paracardiac masses caused by a right coronary artery aneurysm and a saphenous vein graft aneurysm

Two unusual cases of large aneurysms, one located in the native right coronary artery and the other in a saphenous vein graft, are reported. Their size and mode of presentation as asymptomatic paracardiac masses on chest x-ray films make them unique. It is proposed that these entities be considered as part of the differential diagnosis of paracardiac masses.

Survival of migrating salmon smolts in large rivers with and without dams

The mortality of salmon smolts during their migration out of freshwater and into the ocean has been difficult to measure. In the Columbia River, which has an extensive network of hydroelectric dams, the decline in abundance of adult salmon returning from the ocean since the late 1970s has been ascribed in large measure to the presence of the dams, although the completion of the hydropower system occurred at the same time as large-scale shifts in ocean climate, as measured by climate indices such as the Pacific Decadal Oscillation. We measured the survival of salmon smolts during their migration to sea using elements of the large-scale acoustic telemetry system, the Pacific Ocean Shelf Tracking (POST) array. Survival measurements using acoustic tags were comparable to those obtained independently using the Passive Integrated Transponder (PIT) tag system, which is operational at Columbia and Snake River dams. Because the technology underlying the POST array works in both freshwater and the ocean, it is therefore possible to extend the measurement of survival to large rivers lacking dams, such as the Fraser, and to also extend the measurement of survival to the lower Columbia River and estuary, where there are no dams. Of particular note, survival during the downstream migration of at least some endangered Columbia and Snake River Chinook and steelhead stocks appears to be as high or higher than that of the same species migrating out of the Fraser River in Canada, which lacks dams. Equally surprising, smolt survival during migration through the hydrosystem, when scaled by either the time or distance migrated, is higher than in the lower Columbia River and estuary where dams are absent. Our results raise important questions regarding the factors that are preventing the recovery of salmon stocks in the Columbia and the future health of stocks in the Fraser River.

Miniature electronic technologies now allow researchers to track a salmon's migration from its birthplace in a river's headwaters in the Rocky Mountains to the North Pacific, opening a window on the mysteries of migration and survival. Surprisingly, outward migrating salmon (smolts) have similar survival during migration down dammed and undammed rivers, challenging widely held notions about factors affecting salmon abundance. Elements of the large-scale POST (Pacific Ocean Shelf Tracking) acoustic telemetry array revealed the migrations. Although salmon smolt survival to the Pacific Ocean was comparable in both the dammed Columbia and undammed Fraser rivers, it was higher in the Columbia once distance or travel time was taken into account—and higher within the hydropower system than below the dammed section. There is not yet enough evidence to determine whether (1) the Fraser has a problem that reduces salmon survival to that of a heavily dammed river or (2) factors other than dams play a larger, unsuspected role in salmon survival. Wherever future research leads on those questions, the new fish tagging technology has demonstrated itself as a useful tool for obtaining objective scientific data with important value in a number of public policy arenas.

Electronic tagging of two species of salmon smolts reveals similar survival rates during migration down the dammed Columbia and undammed Fraser Rivers, challenging popular notions about factors affecting salmon abundance.

Chronic administration of fluoxetine alters locomotor behavior, but does not potentiate the locomotor stimulating effects of CRH in juvenile Chinook salmon (Oncorhynchus tshawytscha)

The present study investigated: 1) the behavioral effects of chronic administration of a serotonin uptake inhibitor (fluoxetine) in juvenile Chinook salmon, Oncorhynchus tshawytscha and, 2) whether chronic administration of fluoxetine alters the behavioral effects of corticotropin-releasing hormone (CRH). Chronic (20 day) treatment with fluoxetine decreased locomotor activity when compared to fish given long-term injections of saline. An intracerebroventricular (i.c.v.) injection of CRH had no effect on locomotor activity following a 20 day intraperitoneal treatment with either saline or fluoxetine. Chronic treatment with fluoxetine also increased the amount of time fish spent near the center of the tank. A similar increase was seen in fish given a chronic intraperitoneal (i.p.) series of saline followed by an acute i.c.v. injection of CRH. However, the effect was not additive when fish were given chronic i.p. injections of fluoxetine followed by an acute i.c.v. injection of CRH. These results provide evidence to support the hypothesis that the serotonergic system is involved in mediating locomotor activity and habitat choice in teleosts.

Central administration of corticotropin-releasing hormone alters downstream movement in an artificial stream in juvenile chinook salmon (Oncorhynchus tshawytscha)

We evaluated the effect of corticotropin-releasing hormone (CRH) on spatial distribution and downstream movement in an artificial stream in juvenile Chinook salmon (Oncorhynchus tshawytscha) during the period when the fish were able to tolerate seawater. An intracerebroventricular (ICV) injection of CRH (500 ng) to hatchery fish significantly increased the proportion of fish that were distributed downstream of a mid-stream release site. A second group of hatchery fish were given ICV injections of saline (control) or CRH (500 ng) and released near the top of the stream. The time taken to enter a trap at the lower end of the stream was recorded. In all cases the groups given CRH had a higher proportion of fish that did not enter the trap within 60 min of release. However, in those fish that did enter the trap, treatment with CRH increased the speed of downstream movement to this point relative to control fish. Wild sub-yearling Chinook salmon were captured during their downstream migration to the estuary and given ICV injections of saline or CRH (500 ng) either 2, 3, or 7 days after transport from the river. As with hatchery fish, a significantly higher proportion of wild fish that were administered CRH did not enter the trap at the lower end of the stream. The mean time of passage for control fish decreased on each successive day (day 2 > day 3 > day 7). In contrast, the mean passage time of the wild fish that were given CRH was relatively constant through time, and was only significantly faster than control fish on day 2. The current study provides evidence that CRH alters the downstream movement of juvenile Chinook in a simulated stream environment, and produces behavioral effects similar to those of juvenile salmonids that are stressed during their downstream migration.

Evidence That GABA Mediates Dopaminergic and Serotonergic Pathways Associated With Locomotor Activity in Juvenile Chinook Salmon (Oncorhynchus tshawytscha)

The authors examined the control of locomotor activity in juvenile salmon (Oncorhynchus tshawytscha) by manipulating 3 neurotransmitter systems--gamma-amino-n-butyric acid (GABA), dopamine, and serotonin--as well as the neuropeptide corticotropin releasing hormone (CRH). Intracerebroventricular (ICV) injections of CRH and the GABAA agonist muscimol stimulated locomotor activity. The effect of muscimol was attenuated by administration of a dopamine receptor antagonist, haloperidol. Conversely, the administration of a dopamine uptake inhibitor (4',4"-difluoro-3-alpha-[diphenylmethoxy] tropane hydrochloride [DUI]) potentiated the effect of muscimol. They found no evidence that CRH-induced hyperactivity is mediated by dopaminergic systems following concurrent injections of haloperidol or DUI with CRH. Administration of muscimol either had no effect or attenuated the locomotor response to concurrent injections of CRH and fluoxetine, whereas the GABAA antagonist bicuculline methiodide potentiated the effect of CRH and fluoxetine.

Short-term exposure of Chinook salmon (Oncoryhnchus tshawytscha) to o,p-DDE or DMSO during early life-history stages causes long-term humoral immunosuppression

We evaluated the effect of short-term exposures to a xenobiotic chemical during early life-history stages on the long-term immune competence of chinook salmon (Oncoryhnchus tshawytscha). Immersion of chinook salmon eggs in a nominal concentration of o,p-dichlorodiphenyldichloroethylene (o,p-DDE; 10 ppm) for 1 hr at fertilization followed by immersion in the same dose for 2 hr at hatch resulted in a significant reduction in the ability of splenic leukocytes from fish 1 year after treatment to undergo blastogenesis upon in vitro stimulation with lipopolysaccharide. We also observed that the vehicle, dimethyl sulfoxide (DMSO), caused a significant reduction in the ability of the splenic leukocytes to express surface immunoglobin M (SIgM) at this time. The concentration of o,p-DDE in a pooled sample of whole fry from this treatment was 0.53 microg/g lipid 1 month after first feeding but was undetectable in all other treatments. Mortality rate, time to hatch, fish length, and weight were unaffected by treatment with o,p-DDE. Similarly, sex ratios, gonadal development, and concentrations of plasma estradiol and 11-ketotestosterone were not affected by the treatment. In addition, we found no evidence that plasma lysozyme concentrations or the mitogenic responses of splenic leukocytes to concanavalin A or polyinosinic-polycytidylic acid were influenced by the treatment. In this experiment, a brief period of exposure to o,p-DDE or DMSO during early development was able to induce long-term effects on humoral immune competence of chinook salmon. Such immunosuppression may increase susceptibility to disease, which may in turn be critical to regulating the population.

Evidence that acute serotonergic activation potentiates the locomotor-stimulating effects of corticotropin-releasing hormone in juvenile chinook salmon (Oncorhynchus tshawytscha)

The present study investigated whether the serotonergic system is involved in mediating the behavioral effects of corticotropin-releasing hormone (CRH) in juvenile spring chinook salmon, Oncorhynchus tshawytscha. An intracerebroventricular (ICV) injection of CRH induced hyperactivity. The effect of CRH was potentiated in a dose-dependent manner by the concurrent administration of the serotonin (5-HT) selective reuptake inhibitor fluoxetine. However, administration of fluoxetine alone had no effect on locomotor activity, suggesting that the locomotor-stimulating effect of CRH is mediated by the activation of the serotonergic system. Conversely, ICV injections of the 5-HT(1A) receptor antagonist NAN-190 attenuated the effect of CRH on locomotor activity when given in combination with CRH but had no effect when administered alone. These results provide the first evidence to support the hypothesis that the effect of CRH on locomotor activity in teleosts is mediated by activating the serotonergic system.

Central administration of corticotropin-releasing hormone stimulates locomotor activity in juvenile chinook salmon (Oncorhynchus tshawytscha)

This study evaluated the effect of corticotropin-releasing hormone (CRH) on locomotor activity, habitat choice, and social behavior in juvenile spring chinook salmon (Oncorhynchus tshawytscha). An intracerebroventricular (ICV) injection of CRH caused a dose-dependent increase in locomotor activity. The stimulatory effect of exogenous CRH on locomotor activity lasted for at least 24 h. Injection (ICV) of a peptide antagonist of CRH, alpha-helical CRH(9-41) (ahCRH), prevented the increase in locomotor activity when administered concurrently with CRH. Furthermore, fish administered the antagonist alone had significantly lower locomotor activity levels compared to saline-injected control fish. The effects of CRH are often dependent on the social context. However, no evidence was found that the presence of conspecifics during the testing procedure affected locomotor activity following ICV injections of CRH. Similarly, ICV injections of CRH or ahCRH did not have a significant effect on the mean time spent in contact with a conspecific. However, the position of fish in the tank was affected by the treatments. ICV injections of CRH significantly increased the amount of time that fish spent near the center of the tank. Furthermore, ICV injections of ahCRH significantly increased the mean time taken for fish to find cover in the tank. The effect of CRH and ahCRH on locomotor activity was not related to changes in plasma cortisol or thyroxine. These results support the hypothesis that endogenous CRH within the central nervous system is involved in the stimulation of locomotor activity in fish. Furthermore, CRH may also alter habitat choice in a novel environment.

Inhibition of tendon cell proliferation and matrix glycosaminoglycan synthesis by non-steroidal anti-inflammatory drugs in vitro

The purpose of this study was to investigate the effects of some commonly used non-steroidal anti-inflammatory drugs (NSAIDs) on human tendon. Explants of human digital flexor and patella tendons were cultured in medium containing pharmacological concentrations of NSAIDs. Cell proliferation was measured by incorporation of 3H-thymidine and glycosaminoglycan synthesis was measured by incorporation of 35S-Sulphate. Diclofenac and aceclofenac had no significant effect either on tendon cell proliferation or glycosaminoglycan synthesis. Indomethacin and naproxen inhibited cell proliferation in patella tendons and inhibited glycosaminoglycan synthesis in both digital flexor and patella tendons. If applicable to the in vivo situation, these NSAIDs should be used with caution in the treatment of pain after tendon injury and surgery.

96-Well Plate-Based Method for Total Collagen Analysis of Cell Cultures

Total collagen assays are often laborious and use large quantities of consumables. We have developed a new method of assaying total 3H-proline-labeled collagen from cultured cells. Cells and media are harvested from 96-well plates directly onto fiberglass filtermats and counted in the Wallac 1205 flat-bed scintillation counter (BetaPlate™). The assay was validated by comparison with a traditional total collagen assay. The resulting assay provides a rapid one-step method for quantifying collagen synthesis, which, unlike many collagen assays, does not require extensive dialysis or precipitation of proteins.

Internal mammary artery perfusing Leriche's syndrome in association with significant coronary arteriosclerosis: four case reports and review of literature

Four cases of collateral perfusion of a lower extremity by way of an internal mammary artery in the presence of Leriche's syndrome are described. Angiographic documentation preceding coronary artery bypass grafting prevented an acutely ischemic leg in two of the cases.

Internal mammary artery perfusing the Leriche's syndrome

Two cases of collateral perfusion of a lower extremity, by way of an internal mammary artery, in the presence of Leriche's syndrome are described. The importance of recognizing this condition prior to coronary artery bypass grafting is emphasized.

What determines geographical variation in rates of acceptance onto renal replacement therapy in England?

OBJECTIVE

To determine the independent effects of need and supply factors on the known geographical variation in acceptance rates onto renal replacement therapy (RRT) in England.

METHODS

Data were obtained from all renal units in England on the characteristics of all cases aged 16 years and over, resident in England, who were accepted onto RRT in 1991 and 1992. Of these, 5715 (94.5%) had a valid postcode that could be matched to a census ward. Multilevel modelling using Poisson regression was used. The number of acceptances in each census ward within age bands 16-34, 35-64 and 65+ was the dependent variable. Independent effects modelled were: (1) individual factors (age, sex); (2) census ward need factors--ethnicity (expressed as the percentage of the ward population that was Asian or African-Caribbean), socio-economic deprivation--and supply factors--'access' to the nearest renal unit using crowfly and road travel time and distance, and services available to each ward expressed as number of haemodialysis stations per 100,000 catchment population of the nearest renal unit; (3) district health authority level effects.

RESULTS

Age was a major determinant of acceptance, with a 7-fold higher rate in males aged over 64 years compared with younger men. Acceptance rates were lower in females, with a negative age-sex interaction in females aged over 64 years. The percentage of both Asian and African-Caribbean populations per ward was a highly significant positive determinant. Deprivation was also a significant determinant, best represented by a customised index. There was an inverse relation of acceptance with distance, especially road travel time. Other supply side variables had a significant effect though there was no independent district effect. There was some variation in the strength of these relationships by type of area (Greater London, urban and non-urban).

CONCLUSIONS

Need and supply factors influence service use as expressed as acceptance onto RRT. Pressure to expand RRT services needs to be aimed at areas with large minority ethnic populations and those living far from existing units.

Doppler velocimetry in the fetus with a single umbilical artery

OBJECTIVE

To study Doppler velocimetry in fetuses with a single umbilical artery (SUA) as compared to normal.

STUDY DESIGN

Private and clinic patients were referred to a perinatal center: 45 with SUA and 124 randomly selected fetuses with a three-vessel cord were studied from 18 to 41 weeks' gestation. Color Doppler flow and energy were utilized to evaluate the umbilical arteries at the fetal abdominal wall as well as the course around the bladder. In addition to Doppler velocimetry, an anatomic survey, estimated fetal weight (EFW) and amniotic fluid index (AFI) were assessed at each examination.

RESULTS

Doppler velocimetry in SUA demonstrated indices in the normal range but lower than in normal cords from 26 weeks until near term. Anatomic anomalies were found in 8.9% of SUA as compared to 4.8% for three-vessel cords. Intrauterine growth restriction (IUGR) was seen in four cases of SUA and none in the control group. EFW and AFI for both groups were virtually identical.

CONCLUSION

SUA cords theoretically carry a normal blood volume, and the decreased resistance to flow and larger arterial diameter allow this to occur. Anomalies and IUGR are elevated in infants with SUA. Overall, EFW and AFI were the same in both groups of patients.

Modelling the spatial distribution of teenage conception rates within Wessex

This study attempts to determine which factors account for the spatial variation in teenage conception rates within the former Wessex Regional Health Authority and what factors account for the eventual outcomes of these conceptions. Postcoded data on all teenage conceptions from 1991 to 1994 were collected and related to census ward level information and indicators of accessibility to family planning services. The results show that the variation in teenage conception rates and conception outcomes is principally determined by the age of the teenager, deprivation levels, the presence of certain homogeneously distinct groups and the distance to the nearest youth-oriented family planning clinic.

Semen characteristics and fertility tests required for storage of spermatozoa

This review addresses critical issues in the selection of semen donors who are very fertile. Traditional semen parameters have been employed and are still used to assess pre- and post-freeze samples in order to discriminate between donors of high and low fecundity. The most predictive factor is the number of motile spermatozoa per straw and the number of motile spermatozoa inseminated. Nevertheless, no absolute standards for fertile samples can be derived from the basic semen examination. The employment of sperm function testing such as the hamster penetration test or computerized motility analysis has been shown to enhance moderately the prediction of fertility of semen samples however, further studies are necessary to determine if these improvements are clinically useful. The need to determine with a high degree of confidence the fecundity of donor semen is enhanced by limitations in the number of pregnancies allowed per donor. The recent publication of league tables in the UK has put extra pressure in clinics to use highly fertile donors. Spermatozoa are also cryostored for patients prior to cancer treatment. With the development of intracytoplasmic sperm injection every sample produced by cancer patients can be stored irrespective of the quality. However, several factors need to be elucidated to maximize the fertility of those patients. The establishment of regional centres in Europe will be a good starting point to deal with many of the issues raised in this review.

Brain natriuretic peptide is stable in whole blood and can be measured using a simple rapid assay: implications for clinical practice

OBJECTIVES

To compare the stability of brain natriuretic peptide (BNP) to that of N-terminal atrial natriuretic peptide (NT-ANP) in whole blood and plasma stored under different conditions. To compare a rapid, simple, direct (unextracted) BNP assay to a conventional assay using plasma extraction.

DESIGN

Blinded, prospective, comparative study.

SETTING

Tertiary referral cardiology department.

SUBJECTS

Forty two subjects (24 men, 18 women) comprising 28 patients with left ventricular systolic dysfunction (LVSD) ranging from mild to severe and 14 healthy volunteers.

MAIN OUTCOME MEASURES

Stability of NT-ANP and BNP when stored as whole blood or plasma at room temperature over three days. Reproducibility of measurements.

RESULTS

BNP was stable in whole blood stored at room temperature for three days; mean change in concentration -7.4% (95% CI 0.6 to -14.8), (direct), -6.3% (5.0 to -16.4), (extracted); whereas a significant decline in BNP concentration was noted in plasma stored at room temperature; -23.2% (-13.7 to -31.6), (direct); -14.4% (-3.2 to -24.3), (extracted). By contrast a small nonsignificant rise in NT-ANP concentration was noted both in whole blood and plasma stored at room temperature for three days; whole blood +8.6% (+22.3 to -3.5), plasma +6.3%, (23.2 to -8.4). The reproducibility of the BNP measurements, and particularly the rapid, direct, measurement, was superior to that for NT-ANP.

CONCLUSIONS

BNP is shown to be stable in whole blood for three days and can be measured using a rapid, simple assay. Routine assay of BNP is feasible in ordinary clinical practice and may be of value to general practitioners and hospital based physicians in the diagnosis and management of patients with LVSD. Samples can be sent to a central laboratory without special handling requirements.

Implementing comprehensive quality control in the andrology laboratory

Comprehensive quality control procedures were integrated into the routine semen analysis workload of a large university-based andrology laboratory. Methods were chosen to match as far as possible those which have been used successfully for many years in disciplines such as clinical chemistry. Levey-Jennings and cusum charts were plotted in order to monitor the immunobead-binding test for antisperm antibodies and a video-taped control sample for computerized semen analysis. A cryopreserved semen control was also charted. Daily manual sperm counts were plotted against the corresponding computer-assisted semen analysis (CASA) value. Multiple readings of 30 slides were used to monitor morphology assessments. Monthly means for morphology were also calculated regularly. Coefficients of variation were calculated for all variables and were found to be more appropriate for some aspects, such as CASA, than for others, such as morphology, when difference from the previous reading of the same slide was found to be more useful. These integrated quality control procedures had a direct influence on the production of results from the laboratory. Together with a high standard of technician training, comprehensive routine quality control based on repeated analyses of control samples is an effective way of assuring the validity of semen analysis results.

Clinical value of sperm morphology for in-vivo fertility: comparison between World Health Organization criteria of 1987 and 1992

The World Health Organization (WHO, 1992) has suggested new criteria for scoring sperm morphology. This study compares the clinical value of the new criteria, i.e. classification of a man as fertile or infertile, to those previously established by the WHO (1987). Papanicolaou-stained semen smears from 166 men attending our infertility clinic, whose fertility status was known, were scored using both methods. Using logistic discriminant analysis for compositional data, no difference between these two sets of criteria with respect to predicting pregnancy outcome was observed. The categorization of the abnormalities (head, midpiece, tail) provides no extra clarification. The WHO (1992) cut-off point of 30% for normal forms is not appropriate, as approximately half of the men in the fertile group had a normal sperm morphology below this limit. In conclusion, the present WHO (1992) classification of sperm morphology is of no additional clinical value. Studies on sperm morphology should concentrate on obtaining biological data on, and measurements of, spermatozoa which are functionally active. Only then can the definition of normal be achieved and clinically useful criteria be adopted.

Patient compliance with colorectal cancer screening in general practice

A randomized controlled trial to test patient compliance with screening for colorectal cancer in association with general practice health checks was carried out in six practices (three urban and three rural). A total of 1588 patients aged 45-64 years were randomized to one of four intervention groups. In the first group patients were posted a Haemoccult test (Kline Beckman) kit. This group was not invited for a health check. In the second group patients were posted the Haemoccult test kit, together with an invitation to attend for a health check. In the third group patients were posted an invitation for a health check, which explained that the patient would be offered the Haemoccult test kit by the nurse at the health check. In the fourth group patients were just invited for a health check. It was found that combining faecal occult blood testing with the health check did not reduce attendance at the health check--43.5% of patients attended when the Haemoccult test kit was offered by the nurse at the health check, 43.6% attended when a test kit was included with the invitation to attend the health check and 42.9% attended when the health check invitation was posted on its own. Overall, compliance with Haemoccult testing was not significantly increased by associating it with a health check (26.2% versus 25.5%) but compliance was higher when the faecal occult blood testing kit was enclosed with the health check invitation than when it was offered at the health check (31.7% versus 20.6%, P less than 0.001). It is easier and cheaper to combine various screening procedures. Although the overall use of the Haemoccult test in the study population was low, there is no reason why the relatively higher compliance rate obtained on posting the test kit with a health check invitation cannot be achieved in previously unscreened populations with higher expected compliance rates. However, faecal occult blood screening for colorectal cancer should not be undertaken on a population basis until its effectiveness in reducing mortality has been proven by randomized trial.

Induction of tissue-specific proline-rich protein multigene families in rat and mouse parotid glands by isoproterenol. Unusual strain differences of proline-rich protein mRNAs

A dramatic induction of proline-rich protein mRNAs by the beta-agonist isoproterenol in the parotid and submandibular glands of both rats and mice has been demonstrated using Northern and dot-blot hybridizations and cell-free translation. Proline-rich protein mRNAs were either very low or not detectable in glands of control rats and mice. After 4 days of isoproterenol treatment, mRNAs encoding these unusual proteins comprised over 50% of the total glandular mRNAs. A 2-4-fold increase in proline-rich protein mRNAs was observed in rat parotid glands as soon as 4 h after treatment. The rat proline-rich protein multigene family encodes two groups of mRNAs with sizes ranging from 600 to 1100 bases. Cell-free translations gave about 10-12 proline-rich proteins. In glands of isoproterenol-treated mice, major species of proline-rich protein mRNAs were observed at 1050 and 1300 bases for BALB/cJ and DBA/2J mice and at 1100 and 1200 bases for CD-1 and C57BL/6J mice. Cell-free translations showed unusual differences in proteins synthesized from the four strains after isoproterenol treatment. AtT20 cells were transfected with a mouse proline-rich protein gene inserted into the plasmid pUC8 (pUMP2-BE). Transcription of proline-rich protein mRNA was induced by exposing these transfected cells to either isoproterenol or cAMP, plus theophylline.

Novel multigene families encoding highly repetitive peptide sequences. Sequence analyses of rat and mouse proline-rich protein cDNAs

Multigene families encode the proline-rich proteins that are so prominent in human saliva and are dramatically induced in mouse and rat salivary glands by isoproterenol treatment and by feeding tannins. A cDNA encoding an acidic proline-rich protein of rat has been sequenced (Ziemer, M. A., Swain, W. F., Rutter, W. J., Clements, S., Ann, D. K., and Carlson D. M. (1984) J. Biol. Chem. 259, 10475-10480). This study presents the nucleotide sequences of five additional proline-rich protein cDNAs complementary to both mouse and rat parotid and submandibular gland mRNAs. Amino acid compositions deduced from the nucleotide sequences are typical for proline-rich proteins: 25-45% proline, 18-22% glycine, and 18-22% glutamine and generally an absence of sulfur-containing amino acids except for the initiator methionine. These proline-rich proteins display unusual repeating peptide sequences of 14-19 amino acids. The derived amino acid sequence of the cDNA insert of plasmid pMP1 from mouse has a 19-amino acid sequence which is repeated four times. The inserts of plasmids pUMP40 and pUMP4 also from mouse encode for 12 and 11 repeats of a 14-amino acid peptide, respectively. These repetitive sequences, and others from rat and mouse cDNAs and from human genomic clones, all show very high homologies and likely evolved from duplication of internal portions of an ancestral gene. Gene conversion could account for the high degree of conservation of nucleotide sequences of the repeat regions. Protein derived from the nucleotide sequences are all characterized by four general regions: a putative signal peptide, a transition region, the repetitive region, and a carboxyl-terminal region. The 5'-flanking sequences and sequences encoding the putative signal peptides are highly conserved (greater than 94%) in all six cDNAs. This sequence conservation may be important in the regulation of the biosynthesis of these unusual proteins.

Induction of proline-rich glycoprotein synthesis in mouse salivary glands by isoproterenol and by tannins

Glycoproteins which contain about 45 mol% proline were dramatically induced in mouse parotid and submandibular glands by isoproterenol treatment, but these unusual proteins were not detected in control animals. These acid-soluble substances were obtained by extracting tissues with 10% trichloroacetic acid, as reported previously for isolating proline-rich proteins from rat submandibular glands (Mehansho, H., and Carlson, D.M. (1983) J. Biol. Chem. 258, 6616-6620). Three major proline-rich glycoproteins were induced in parotid glands with apparent molecular weights of 66,000 (GP-66p), 45,000 (GP-45p), and 27,000 (GP-27p), whereas only one such protein was expressed by the submandibular glands (66,000 (GP-66sm]. Both GP-66p and GP-66sm contained about 19% carbohydrate with the following molar ratios, respectively; GalNAc, 1.0, 1.0; Gal, 1.6, 2.3; GlcNAc, 0.8, 1.1; sialic acid, 0.9, 1.9. The peptide chains of GP-66p and GP-66sm appear to be identical by amino acid compositions, glycopeptide analysis, and preliminary amino acid sequencing data. Northern blot analysis of RNAs from parotid glands of normal and isoproterenol-treated rats, probed with a 32P-labeled proline-rich protein cDNA, confirmed that control animals were devoid of mRNAs encoding these proteins and that isoproterenol treatment dramatically induced expression of these genes. Feeding sorghum high in tannins caused changes in the parotid glands similar to those observed upon isoproterenol treatment, as noted earlier with rats (Mehansho, H., Hagerman, A., Clements, S., Butler, L., Rogler, J., and Carlson, D.M. (1983) Proc. Natl. Acad. Sci. U.S.A. 80, 3948-3952). These glycoproteins have high affinities for tannins as demonstrated by competitive binding curves.

Salivary proline-rich protein genes on chromosome 8 of mouse

Endonuclease restriction (Hind III) fragments of DNA from Chinese hamster X mouse somatic cell hybrids hybridized with proline-rich protein complementary DNA clones only when the DNA was isolated from cells containing mouse chromosome 8, or a fragment of chromosome 8. The evidence suggests that proline-rich protein genes are located at the proximal portion of chromosome 8 toward the centromere.

Nucleotide sequence analysis of a proline-rich protein cDNA and peptide homologies of rat and human proline-rich proteins

Plasmids containing cDNAs for proline-rich proteins have been isolated from a cDNA library prepared from parotid glands of isoproterenol-treated rats. The nucleotide sequence of one of these cDNAs (pRP33) has been determined, and it encodes an acidic proline-rich protein. The N-terminal 13 amino acids are highly hydrophobic and may be part of a signal peptide. The next 66 amino acids constitute an acidic domain which is interrupted by a short (8 residue) basic region. The sequence beginning at proline 80 contains six tandemly repeated regions of 18 to 19 amino acids in length with the prototype sequence PPPQGGPQXPPQPGXPQG. Two pairs of these repeats (amino acid residues 116 to 152 and 153 to 189) are 93% homologous in nucleotide sequence. The high homology in both nucleotide and amino acid sequences in the repeat region suggests that this protein may have evolved by duplication of internal portions of a progenitor gene.

Modulation of proline-rich protein biosynthesis in rat parotid glands by sorghums with high tannin levels

Feeding of sorghum with a high level of tannin (high-tannin sorghum) to rats caused changes in gene expression in parotid glands similar to isoproterenol treatment. Within 3 days the parotid glands were enlarged about 3-fold and a series of proline-rich proteins were increased about 12-fold. Unlike isoproterenol treatment, no changes were observed in the submandibular glands, and a Mr 220,000 glycoprotein in parotid glands was not induced. Amino acid analyses, electrophoretic patterns, and cell-free translations of mRNAs all confirmed that the proline-rich proteins induced by feeding high-tannin sorghum were identical to those induced by isoproterenol treatment. Binding curves for proline-rich proteins to tannins showed affinities 10-fold greater than bovine serum albumin and tannins.

Aortic stenosis: echocardiographic cusp separation and surgical description of aortic valve in 22 patients

Diminished echocardiographic aortic cusp separation is used as one indicator of the severity of aortic stenosis. To test the validity of this index, 22 patients--12 (55 percent) with isolated aortic valve disease and 10 (45 percent) with aortic stenosis associated with mitral or coronary artery disease--underwent M mode echocardiographic examination before aortic valve replacement. Tracings of diagnostic quality were obtained without difficulty from all 22 patients. Cardiac catheterization was performed in 21 patients. Echocardiographic cusp separation was measured from the apparent mid-systolic orifice and from the outer periphery of the anterior cusp to the outer periphery of the posterior cusp (maximal peripheral cusp separation). Mid-systolic cusp separation varied in nearly every patient, depending on the angle of leaflet presentation to the ultrasonic beam. Maximal peripheral cusp separation measured 16 mm in 18 of 22 patients (82 percent); it indicated neither the severity of the aortic stenosis as documented with cardiac catheterization nor the mobility of the cusps seen at operation. The surgical and echocardiographic descriptions of leaflet and aortic root calcification were similar. In situ examination of aortic cusp separation indicated that diseased aortic valves are not comparable with normal valves or valves with uncomplicated congenital obstruction. The aortic leaflets were curled, fused, calcified and deformed from their natural state of coaptation. Abnormal thickening and limited or eccentric mobility of the aortic leaflets were useful indicators of the cause of valve disease, but cusp deformity secondary to aortic stenosis invalidated mid-systolic cusp separation and maximal peripheral cusp separation as indicators of the severity of aortic stenosis.