Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

The NHGRI-EBI GWAS Catalog: knowledgebase and deposition resource

The NHGRI-EBI GWAS Catalog (www.ebi.ac.uk/gwas) is a FAIR knowledgebase providing detailed, structured, standardised and interoperable genome-wide association study (GWAS) data to >200 000 users per year from academic research, healthcare and industry. The Catalog contains variant-trait associations and supporting metadata for >45 000 published GWAS across >5000 human traits, and >40 000 full P-value summary statistics datasets. Content is curated from publications or acquired via author submission of prepublication summary statistics through a new submission portal and validation tool. GWAS data volume has vastly increased in recent years. We have updated our software to meet this scaling challenge and to enable rapid release of submitted summary statistics. The scope of the repository has expanded to include additional data types of high interest to the community, including sequencing-based GWAS, gene-based analyses and copy number variation analyses. Community outreach has increased the number of shared datasets from under-represented traits, e.g. cancer, and we continue to contribute to awareness of the lack of population diversity in GWAS. Interoperability of the Catalog has been enhanced through links to other resources including the Polygenic Score Catalog and the International Mouse Phenotyping Consortium, refinements to GWAS trait annotation, and the development of a standard format for GWAS data.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

A joint NCBI and EMBL-EBI transcript set for clinical genomics and research

Comprehensive genome annotation is essential to understand the impact of clinically relevant variants. However, the absence of a standard for clinical reporting and browser display complicates the process of consistent interpretation and reporting. To address these challenges, Ensembl/GENCODE1 and RefSeq2 launched a joint initiative, the Matched Annotation from NCBI and EMBL-EBI (MANE) collaboration, to converge on human gene and transcript annotation and to jointly define a high-value set of transcripts and corresponding proteins. Here, we describe the MANE transcript sets for use as universal standards for variant reporting and browser display. The MANE Select set identifies a representative transcript for each human protein-coding gene, whereas the MANE Plus Clinical set provides additional transcripts at loci where the Select transcripts alone are not sufficient to report all currently known clinical variants. Each MANE transcript represents an exact match between the exonic sequences of an Ensembl/GENCODE transcript and its counterpart in RefSeq such that the identifiers can be used synonymously. We have now released MANE Select transcripts for 97% of human protein-coding genes, including all American College of Medical Genetics and Genomics Secondary Findings list v3.0 (ref. 3) genes. MANE transcripts are accessible from major genome browsers and key resources. Widespread adoption of these transcript sets will increase the consistency of reporting, facilitate the exchange of data regardless of the annotation source and help to streamline clinical interpretation.

Workshop proceedings: GWAS summary statistics standards and sharing

Genome-wide association studies (GWASs) have enabled robust mapping of complex traits in humans. The open sharing of GWAS summary statistics (SumStats) is essential in facilitating the larger meta-analyses needed for increased power in resolving the genetic basis of disease. However, most GWAS SumStats are not readily accessible because of limited sharing and a lack of defined standards. With the aim of increasing the availability, quality, and utility of GWAS SumStats, the National Human Genome Research Institute-European Bioinformatics Institute (NHGRI-EBI) GWAS Catalog organized a community workshop to address the standards, infrastructure, and incentives required to promote and enable sharing. We evaluated the barriers to SumStats sharing, both technological and sociological, and developed an action plan to address those challenges and ensure that SumStats and study metadata are findable, accessible, interoperable, and reusable (FAIR). We encourage early deposition of datasets in the GWAS Catalog as the recognized central repository. We recommend standard requirements for reporting elements and formats for SumStats and accompanying metadata as guidelines for community standards and a basis for submission to the GWAS Catalog. Finally, we provide recommendations to enable, promote, and incentivize broader data sharing, standards and FAIRness in order to advance genomic medicine.

Sequencing-based genome-wide association studies reporting standards

Genome sequencing has recently become a viable genotyping technology for use in genome-wide association studies (GWASs), offering the potential to analyze a broader range of genome-wide variation, including rare variants. To survey current standards, we assessed the content and quality of reporting of statistical methods, analyses, results, and datasets in 167 exome- or genome-wide-sequencing-based GWAS publications published from 2014 to 2020; 81% of publications included tests of aggregate association across multiple variants, with multiple test models frequently used. We observed a lack of standardized terms and incomplete reporting of datasets, particularly for variants analyzed in aggregate tests. We also find a lower frequency of sharing of summary statistics compared with array-based GWASs. Reporting standards and increased data sharing are required to ensure sequencing-based association study data are findable, interoperable, accessible, and reusable (FAIR). To support that, we recommend adopting the standard terminology of sequencing-based GWAS (seqGWAS). Further, we recommend that single-variant analyses be reported following the same standards and conventions as standard array-based GWASs and be shared in the GWAS Catalog. We also provide initial recommended standards for aggregate analyses metadata and summary statistics.

The NHGRI-EBI GWAS Catalog of published genome-wide association studies, targeted arrays and summary statistics 2019

The GWAS Catalog delivers a high-quality curated collection of all published genome-wide association studies enabling investigations to identify causal variants, understand disease mechanisms, and establish targets for novel therapies. The scope of the Catalog has also expanded to targeted and exome arrays with 1000 new associations added for these technologies. As of September 2018, the Catalog contains 5687 GWAS comprising 71673 variant-trait associations from 3567 publications. New content includes 284 full P-value summary statistics datasets for genome-wide and new targeted array studies, representing 6 × 10⁹ individual variant-trait statistics. In the last 12 months, the Catalog's user interface was accessed by ∼90000 unique users who viewed >1 million pages. We have improved data access with the release of a new RESTful API to support high-throughput programmatic access, an improved web interface and a new summary statistics database. Summary statistics provision is supported by a new format proposed as a community standard for summary statistics data representation. This format was derived from our experience in standardizing heterogeneous submissions, mapping formats and in harmonizing content. Availability: https://www.ebi.ac.uk/gwas/.

Ensembl 2020

The Ensembl (https://www.ensembl.org) is a system for generating and distributing genome annotation such as genes, variation, regulation and comparative genomics across the vertebrate subphylum and key model organisms. The Ensembl annotation pipeline is capable of integrating experimental and reference data from multiple providers into a single integrated resource. Here, we present 94 newly annotated and re-annotated genomes, bringing the total number of genomes offered by Ensembl to 227. This represents the single largest expansion of the resource since its inception. We also detail our continued efforts to improve human annotation, developments in our epigenome analysis and display, a new tool for imputing causal genes from genome-wide association studies and visualisation of variation within a 3D protein model. Finally, we present information on our new website. Both software and data are made available without restriction via our website, online tools platform and programmatic interfaces (available under an Apache 2.0 license) and data updates made available four times a year.

Determination of Minerals and Trace Elements in Milk, Milk Products, Infant Formula, and Adult Nutrition: Collaborative Study 2011.14 Method Modification

Official Method SM 2011.14/ISO 15151:2018/IDF 229:2018 uses microwave digestion of samples and inductively coupled plasma–atomic emission spectrometry for determination of nine elements, including Ca, Cu, Fe, K, Mg, Mn, Na, P, and Zn. The method was evaluated in a collaborative study of 25 products, including 13 fortified nutritional products (powders, ready-to-feed liquids, and liquid concentrates), five product placebos, six dairy products (liquids, powders, butter, and processed cheese), and the National Institute for Standards and Technology (NIST) Standard Reference Material (SRM) 1849a, in compliance with AOAC INTERNATIONAL Standard Method Performance Requirement (SMPR®) 2014.004. This study significantly expanded the applicability of Official Method 2011.14 beyond the original scope of chocolate milk powder, dietetic milk powder, infant cereal, peanut butter, and wheat gluten. The study included 14 collaborators from 11 countries, and results were compared to SMPR 2014.004. Accuracy of the method was demonstrated using NIST SRM 1849a, yielding recoveries across all laboratories of 98–101% for the nine elements. Precision for the 13 fortified nutritional product samples was 2.2–3.9% for repeatability (relative SD of repeatability) and 6.0–12.2% for reproducibility (RSDR). Excluding Mn, which was present at a wide range of concentrations, the reproducibility was 6.0–9.5%, meeting the performance requirements of SMPR 2014.004. Placebo samples (not fortified with Cu, Fe, Mn, or Zn) yielded acceptable repeatability of 1.8–2.9% for Ca, K, Mg, Na, and P (minerals) but 5.4–29.4% for the low levels of Cu, Fe, Mn, and Zn (trace elements). Reproducibility for the placebos showed the same pattern, with acceptable reproducibility (5.4–10.3%) for minerals but not for the low levels of the trace elements (13.2–82.8%). In the six dairy product samples, repeatability ranged from 1.6 to 3.6% for the minerals, Zn, and the low range of Mn but from 9.4 to 24.6% for Cu, Fe, and the high range of Mn, where concentrations were low as for the nutritional placebos. Reproducibility in the dairy samples was 5.3–8.8% for the minerals but 11.4–55.0% for the trace elements. The mean concentrations of Cu, Fe, and Zn in the dairy products were similar with those in the placebo products, while Zn was present at levels more similar with the fortified nutritional products. Thus, the method met the SMPR criteria except where the trace minerals were present at very low levels. Based on these results, the AOAC Stakeholder Panel for Infant Formula and Adult Nutritionals recommended Final Action status of the expanded applicability of the method. The method was adopted as Final Action by the AOAC Official Methods Board.

Determination of Vitamin B12 in Fortified Bovine Milk- Based Infant Formula Powder, Fortified Soya-Based Infant Formula Powder, Vitamin Premix, and Dietary Supplements by Surface Plasmon Resonance: Collaborative Study

A collaborative study was conducted on an inhibition-based protein-binding assay using the Biacore Q™ biosensor instrument and the Biacore Qflex™ Kit Vitamin B12 PI. The samples studied included infant formula, cereals, premixes, vitamin tablets, dietary supplements, and baby food. The collaborative study, which involved 11 laboratories, demonstrated that the assay showed an RSDr of 1.59–27.8 and HorRat values for reproducibility of 0.34–1.89 in samples with levels ranging from ppm to ppb. The assay studied is a label-free protein binding-based assay that uses the principle of surface plasmon resonance (SPR) to measure the interaction between vitamin B12 and a specifc binding protein. A Biacore Q biosensor uses this principle to detect binding directly at the surface of a sensor chip with a hydrophilic gold-dextran surface. The instrument passes a mixture of prepared sample extract and binding protein solution across a covalently immobilized vitamin B12 chip surface, and the response is given as free-binding protein as the mixture binds to the immobilized surface. This technique uses the specifcity and robustness of the protein-ligand interaction to allow minimal sample preparation and a wide range of matrixes to be analyzed rapidly. The reagents and accessories needed to perform this assay are provided as the ready-to-use format “Qflex Kit Vitamin B12 PI.” The method is intended for routine use in the quantitative determination of vitamin B12 (as cyanocobalamin) in a wide range of food products, dietary vitamin supplements, and multivitamin premixes.

Scaling up data curation using deep learning: An application to literature triage in genomic variation resources

Manually curating biomedical knowledge from publications is necessary to build a knowledge based service that provides highly precise and organized information to users. The process of retrieving relevant publications for curation, which is also known as document triage, is usually carried out by querying and reading articles in PubMed. However, this query-based method often obtains unsatisfactory precision and recall on the retrieved results, and it is difficult to manually generate optimal queries. To address this, we propose a machine-learning assisted triage method. We collect previously curated publications from two databases UniProtKB/Swiss-Prot and the NHGRI-EBI GWAS Catalog, and used them as a gold-standard dataset for training deep learning models based on convolutional neural networks. We then use the trained models to classify and rank new publications for curation. For evaluation, we apply our method to the real-world manual curation process of UniProtKB/Swiss-Prot and the GWAS Catalog. We demonstrate that our machine-assisted triage method outperforms the current query-based triage methods, improves efficiency, and enriches curated content. Our method achieves a precision 1.81 and 2.99 times higher than that obtained by the current query-based triage methods of UniProtKB/Swiss-Prot and the GWAS Catalog, respectively, without compromising recall. In fact, our method retrieves many additional relevant publications that the query-based method of UniProtKB/Swiss-Prot could not find. As these results show, our machine learning-based method can make the triage process more efficient and is being implemented in production so that human curators can focus on more challenging tasks to improve the quality of knowledge bases.

As the volume of literature on genomic variants continues to grow at an increasing rate, it is becoming more difficult for a curator of a variant knowledge base to keep up with and curate all the published papers. Here, we suggest a deep learning-based literature triage method for genomic variation resources. Our method achieves state-of-the-art performance on the triage task. Moreover, our model does not require any laborious preprocessing or feature engineering steps, which are required for traditional machine learning triage methods. We applied our method to the literature triage process of UniProtKB/Swiss-Prot and the NHGRI-EBI GWAS Catalog for genomic variation by collaborating with the database curators. Both the manual curation teams confirmed that our method achieved higher precision than their previous query-based triage methods without compromising recall. Both results show that our method is more efficient and can replace the traditional query-based triage methods of manually curated databases. Our method can give human curators more time to focus on more challenging tasks such as actual curation as well as the discovery of novel papers/experimental techniques to consider for inclusion.

Patient-centred dietetic care from the perspectives of older malnourished patients

BACKGROUND

Governing organisations for health services currently recommend a patient-centred (PC) approach to practice for all health professions, including dietetics. For the vulnerable older malnourished patient, this approach needs to be prioritised to improve outcomes. The paucity of patient experience data likely limits evidence-based, patient-centred care (PCC) from being implemented effectively. The present study aimed to identify quality indicators of dietetic services from the perspectives of older malnourished patients to inform evidence-based PC dietetic care.

METHODS

Surveys were completed by a sample of 28 females and 28 males (mean age 81 years) who had been seen by a dietitian for malnutrition assessment. In-depth, face-to-face, semi-structured interviews were undertaken with a sub-sample of four females and six males (mean age 81 years). Interviews were transcribed verbatim. Thematic analysis of transcripts and open-ended survey responses was conducted to determine patient-identified quality indicators.

RESULTS

Three structure indicators (continuity of care through regular contact and post-discharge dietetic follow-up; interdisciplinary coordination and collaboration; and high-quality hospital food services), five process indicators (addressing a patient's primary medical concern; involving the patient's family; providing clear and simple dietetic information; providing expert dietary knowledge; utilising interpersonal communication skills) and three outcome indicators (improvement in health status; improvement or maintenance of independence; weight gain) were identified. The experiences of older malnourished patients with dietetic services, as described in the present study, reinforce the importance of ensuring high-quality and tailored dietetic care as a key element of PC dietetic services.

CONCLUSIONS

The quality indicators of dietetic services identified in the present study may facilitate dietitians to provide evidence-based PCC for older malnourished patients.

The new NHGRI-EBI Catalog of published genome-wide association studies (GWAS Catalog)

The NHGRI-EBI GWAS Catalog has provided data from published genome-wide association studies since 2008. In 2015, the database was redesigned and relocated to EMBL-EBI. The new infrastructure includes a new graphical user interface (www.ebi.ac.uk/gwas/), ontology supported search functionality and an improved curation interface. These developments have improved the data release frequency by increasing automation of curation and providing scaling improvements. The range of available Catalog data has also been extended with structured ancestry and recruitment information added for all studies. The infrastructure improvements also support scaling for larger arrays, exome and sequencing studies, allowing the Catalog to adapt to the needs of evolving study design, genotyping technologies and user needs in the future.

Are Atrial Fibrillation Guidelines Altering Management? A Community Based Study

Background and Aims: We wanted to determine the prevalence of atrial fibrillation (AF) in a community based cross sectional study in greater Glasgow and how current anti thrombotic management compares to published guidelines. Methods: 1466 patients with AF were identified in General Practices in our community and 1008 consented to take part. Their demographic details and medical history were recorded. Results: 1466 patients (mean age 73.4; 55% female) with AF were identified, in our community, giving a prevalence of 1%. 53% of patients were on warfarin therapy. Of those not receiving warfarin, only one third had a putative contra-indication. The proportion of AF patients on warfarin increased with increasing stroke risk, and over the period of the study. Conclusions: Prevalence of AF was in keeping with previous estimates. The proportion of patients with AF receiving warfarin therapy appears to be increasing. In the moderate risk group, there was a tendency to use more warfarin in the younger age groups compared to the elderly. It was in the moderate and low risk groups that there was still evidence of deviation from published guidelines.

A new technique for the radiolabelling of mixed leukocytes with zirconium-89 for inflammation imaging with positron emission tomography

Mixed leukocyte (white blood cells [WBCs]) trafficking using positron emission tomography (PET) is receiving growing interest to diagnose and monitor inflammatory conditions. PET, a high sensitivity molecular imaging technique, allows precise quantification of the signal produced from radiolabelled moieties. We have evaluated a new method for radiolabelling WBCs with either zirconium-89 ((89) Zr) or copper-64 ((64) Cu) for PET imaging. Chitosan nanoparticles (CNs) were produced by a process of ionotropic gelation and used to deliver radiometals into WBCs. Experiments were carried out using mixed WBCs freshly isolated from whole human blood. WBCs radiolabelling efficiency was higher with [(89) Zr]-loaded CN (76.8 ± 9.6% (n = 12)) than with [(64) Cu]-loaded CN (26.3 ± 7.0 % (n = 7)). [(89) Zr]-WBCs showed an initial loss of 28.4 ± 5.8% (n = 2) of the radioactivity after 2 h. This loss was then followed by a plateau as (89) Zr remains stable in the cells. [(64) Cu]-WBCs showed a loss of 85 ± 6% (n = 3) of the radioactivity after 1 h, which increased to 96 ± 6% (n = 3) loss after 3 h. WBC labelling with [(89) Zr]-loaded CN showed a fast kinetic of leukocyte association, high labelling efficiency and a relatively good retention of the radioactivity. This method using (89) Zr has a potential application for PET imaging of inflammation.

Erring on the side of caution: pregnant women's perceptions of consuming fish in a risk averse society

BACKGROUND

Fish and seafood are good sources of several nutrients that are important for foetal growth and development. Despite guidelines encouraging the eating of fish during pregnancy, research indicates that pregnant women may be limiting or avoiding these foods. Possible factors contributing to this include concerns regarding levels of mercury and other contaminants and pregnant women's purported heightened risk consciousness. The present study aimed to explore pregnant women's perceptions of consuming fish and seafood during pregnancy.

METHODS

Semi-structured telephone interviews were conducted with 15 pregnant women across all three trimesters in New South Wales, Australia. Questions focussed on exploring nutrition information received during pregnancy, dietary changes made during pregnancy and, more specifically, perceptions of fish and seafood, as well as views on information of fish and seafood commonly provided to pregnant women. Data were collected, then transcribed and analysed using an inductive coding process, guided by the qualitative theory grounded approach.

RESULTS

Multiple inter-related themes were found to shape pregnant women's perceptions related to fish and seafood consumption during pregnancy; namely, the understanding of fish and seafood as part of a healthy diet, external factors such as cost, individual preferences such as taste, and confidence in choosing and preparing fish. The context of a risk adverse society permeated these themes.

CONCLUSIONS

The present study provides insight into the inter-related factors that influence pregnant women's consumption or avoidance of fish and seafood.

The subtype of GluN2 C-terminal domain determines the response to excitotoxic insults

It is currently unclear whether the GluN2 subtype influences NMDA receptor (NMDAR) excitotoxicity. We report that the toxicity of NMDAR-mediated Ca²⁺ influx is differentially controlled by the cytoplasmic C-terminal domains of GluN2B (CTD^2B) and GluN2A (CTD^2A). Studying the effects of acute expression of GluN2A/2B-based chimeric subunits with reciprocal exchanges of their CTDs revealed that CTD^2B enhances NMDAR toxicity, compared to CTD^2A. Furthermore, the vulnerability of forebrain neurons in vitro and in vivo to NMDAR-dependent Ca²⁺ influx is lowered by replacing the CTD of GluN2B with that of GluN2A by targeted exon exchange in a mouse knockin model. Mechanistically, CTD^2B exhibits stronger physical/functional coupling to the PSD-95-nNOS pathway, which suppresses protective CREB activation. Dependence of NMDAR excitotoxicity on the GluN2 CTD subtype can be overcome by inducing high levels of NMDAR activity. Thus, the identity (2A versus 2B) of the GluN2 CTD controls the toxicity dose-response to episodes of NMDAR activity.

Pituitary adenylate cyclase-activating peptide induces long-lasting neuroprotection through the induction of activity-dependent signaling via the cyclic AMP response element-binding protein-regulated transcription co-activator 1

Pituitary adenylate cyclase-activating peptide (PACAP) is a neuroprotective peptide which exerts its effects mainly through the cAMP-protein kinase A (PKA) pathway. Here, we show that in cortical neurons, PACAP-induced PKA signaling exerts a major part of its neuroprotective effects indirectly, by triggering action potential (AP) firing. Treatment of cortical neurons with PACAP induces a rapid and sustained PKA-dependent increase in AP firing and associated intracellular Ca²⁺ transients, which are essential for the anti-apoptotic actions of PACAP. Transient exposure to PACAP induces long-lasting neuroprotection in the face of apoptotic insults which is reliant on AP firing and the activation of cAMP response element (CRE) binding protein (CREB)-mediated gene expression. Although direct, activity-independent PKA signaling is sufficient to trigger phosphorylation on CREB’s activating serine-133 site, this is insufficient for activation of CREB-mediated gene expression. Full activation is dependent on CREB-regulated transcription co-activator 1 (CRTC1), whose PACAP-induced nuclear import is dependent on firing activity-dependent calcineurin signaling. Over-expression of CRTC1 is sufficient to rescue PACAP-induced CRE-mediated gene expression in the face of activity-blockade, while dominant negative CRTC1 interferes with PACAP-induced, CREB-mediated neuroprotection. Thus, the enhancement of AP firing may play a significant role in the neuroprotective actions of PACAP and other adenylate cyclase-coupled ligands.

The treatment of run-off from a fertiliser plant for nitrification, denitrification and phosphorus removal by use of constructed wetlands: a demonstration study

The paper describes an evaluation carried out on demonstration scale to show that it was possible to use a Hybrid Reed Bed System comprising a Horizontal flow and a Vertical Flow Bed for treating the high strength run-off from a fertiliser packaging plant. The site is located close to an estuary which is sensitive to nutrients. The environmental regulators were therefore concerned that excessive mass flows of nitrate, ammoniacal nitrogen and phosphate, potentially arising from the site run-off, were not discharged into the estuary. The fertiliser manufacturing company required a simple, low maintenance system for removing nitrogen and phosphorus. A series of experimental runs were carried out to characterise the performance of the Hybrid System, establishing the effluent quality that could be achieved and the mass removal rate which was appropriate for acceptable treatment. These tests showed that it was possible to achieve a reduction of 79% in Total N whilst using molasses as a carbon source for denitrification. When using a 4:1 recycle ratio this produced an effluent with concentrations of 14 mg NH(4)-N/litre and 18 mg NO(3)-N/litre from treating site run-off containing concentrations in the order of 75 mg/litre of both NH(3)N and NO(3)-N. Chemical dosing with an iron salt brought the P concentration down to around 0.5 mg PO(4)-P/litre.

Microdosing imaging pharmacokinetic (PK) study of the antisense oligonucleotide (ASO) to survivin (LY2181308) using positron emission tomography (PET): A novel paradigm in clinical drug development

3578

Background: Survivin, an inhibitor of an apoptosis protein, widely overexpressed in cancer is associated with poor clinical outcome. We performed the first worldwide human microdosing imaging PK study of an ASO with LY2181308, a specific, second generation antisense inhibitor of Survivin using carbon-11 radiolabelled LY2181308 ([11C]LY2181308). Methods: LY2181308 was administered at the recommended phase II dose (750 mg over 3 hours IV daily x 3, then once weekly). [11C]LY2181308 was manufactured to GMP standard by random [11C]methylation with [11C]methyl iodide of LY2181308 using a GE Tracerlab FXc molecule. [11C]LY2181308-PET scans were performed at baseline and during treatment infusion. [11C]LY2181308 uptake in normal tissue and tumour was quantified. Results: Three pts (2 female Caucasian/1 male Asian) were scanned after administering [11C]LY2181308 which delivered (135–376 μg) of LY2181308. Despite its large size (6778 amu), [11C]LY2181308 rapidly distributed to tissues, with maximal uptake in kidney followed by liver, spleen, vertebral body, tumour, spinal cord, lung, and muscle at baseline. Although renal uptake was high, urinary elimination (bladder activity) was low suggesting renal trapping of [11C]LY2181308 at baseline. For a normalised injected dose of 1 mg, mean (range) tumour concentrations of 31 (4–41) ng/ml were observed at baseline, consistent with that predicted from the preclinical PK/PD model. In a pt with mesothelioma who also had a second [11C]LY2181308-PET scan during LY2181308 treatment infusion, there was about 2-fold increase in [11C]LY2181308 tumour uptake, in contrast to markedly reduced uptake in kidneys, liver, and spleen and similar aortic (circulatory) [11C]LY2181308 levels. In this patient, tumour [18F]FDG- PET uptake at 28 days was reduced by up to 40% after treatment, suggesting drug activity. Conclusions: [11C]LY2181308 pharmacokinetics suggest biologically active human tumour drug concentrations can be attained. LY2181308 therapy saturated normal tissue kinetics and increased tumour uptake of [11C]LY2181308. Data uniquely obtained from fully regulated microdosing studies may rationalise and hasten drug development.

[Table: see text]

Prevalence of gastrointestinal bacterial pathogens in a population of zoo animals

Faecal prevalence of gastrointestinal bacterial pathogens, including Campylobacter, Escherichia coli O157:H7, Salmonella, Shigella, Yersinia, as well as Arcobacter, were examined in 317 faecal specimens from 44 animal species in Belfast Zoological Gardens, during July-September 2006. Thermophilic campylobacters including Campylobacter jejuni, Campylobacter coli and Campylobacter lari, were the most frequently isolated pathogens, where members of this genus were isolated from 11 animal species (11 of 44; 25%). Yersinia spp. were isolated from seven animal species (seven of 44; 15.9%) and included, Yersinia enterocolitica (five of seven isolates; 71.4%) and one isolate each of Yersinia frederiksenii and Yersinia kristensenii. Only one isolate of Salmonella was obtained throughout the entire study, which was an isolate of Salmonella dublin (O 1,9,12: H g, p), originating from tiger faeces after enrichment. None of the animal species found in public contact areas of the zoo were positive for any gastrointestinal bacterial pathogens. Also, water from the lake in the centre of the grounds, was examined for the same bacterial pathogens and was found to contain C. jejuni. This study is the first report on the isolation of a number of important bacterial pathogens from a variety of novel host species, C. jejuni from the red kangaroo (Macropus rufus), C. lari from a maned wolf (Chrysocyon brachyurus), Y. kristensenii from a vicugna (Vicugna vicugna) and Y. enterocolitica from a maned wolf and red panda (Ailurus fulgens). In conclusion, this study demonstrated that the faeces of animals in public contact areas of the zoo were not positive for the bacterial gastrointestinal pathogens examined. This is reassuring for the public health of visitors, particularly children, who enjoy this educational and recreational resource.

Dental health of 5-year-olds following community-based oral health promotion in Glasgow, UK

AIM

A community development oral health promotion programme based on the principles of the Ottawa Charter was conducted in an attempt to improve the dental health of children under 5 years of age in two severely socioeconomically challenged pilot districts in Glasgow, UK. Later phased extension involved all of the area's most deprived communities. The aim of the present study was to assess dental health outcomes by secondary analysis of routine caries datasets for Glasgow 5-year-olds over the interval from 1997-1998 to 2003-2004.

DESIGN

Wilcoxon tests assessed change in d3mft scores and logistic regression was used to analyse binomial scores (e.g. % d3mft = 0).

RESULTS

After adjusting for age and deprivation (DepCat) in pilot districts 1 and 2, significant redistributions of the relative frequency of d3mft scores were observed (P = 0.012 and P < 0.001, respectively), mean d3mft decreased from 5.5 to 3.6 and from 6.0 to 3.6, respectively, and the proportions with d3mft = 0 increased from 11% to 29% and from 10% to 32%, respectively [P = 0.010, odds ratio (OR) = 0.25, and P = 0.006, OR = 0.30, respectively, for d3mft > 0]. Following extension of the programme into all of Glasgow's socioeconomically challenged areas, the mean d3mft values of 5-year-olds reduced in all DepCat 7 communities, and across Glasgow as a whole from 4.9 to 4.1 and from 3.5 to 3.1, respectively, while the proportion with d3mft = 0 increased from 20% to 32% (P < 0.001) and from 34% to 42% (P < 0.001), respectively.

CONCLUSION

Dental health improvements were observed in pilot districts and across all DepCat 7 communities following the roll-out of the programme. This change was of sufficient magnitude to impact upon area-wide statistics for Glasgow.

Regulation of Expression of Dopamine β-Hydroxylase in PC12 Cells by Glucocorticoids and Cyclic AMP Analogues

Regulation of catecholamine biosynthesis is crucial in the adaptation to various physiological conditions, such as stress, and in several disorders, including hypertension and depression. In this study we have found that in PC12 cells, the mRNA levels of dopamine beta-hydroxylase (DBH), the enzyme that catalyzes the formation of norepinephrine from dopamine, can be regulated by glucocorticoids and cyclic AMP (cAMP) analogues. Treatment with dexamethasone increased DBH mRNA levels by 6 h. with maximal elevation (four- to fivefold) obtained after 1 day of exposure, and these levels were maintained for up to 4 days. DBH mRNA levels were also elevated on treatment of PC12 cells with 8-bromo cAMP for 8 h to 1 day. The response to 8-bromo cAMP, however, was bimodal, because DBH mRNA levels declined below control values on treatment for > 1 day. In combined treatments with 8-bromo cAMP and dexamethasone, the cAMP effect was dominant. To begin to characterize the regulation of DBH mRNA, genomic clones for rat DBH were isolated, and 1 kb of the 5' flanking region was sequenced. Several putative regulatory elements, which may be involved in cAMP and glucocorticoid regulation, were identified, including two adjacent cAMP response elements, another element that can also bind members of the ATF/CREB family of transcription factors, a NF-kappa B-like sequence, several AP-2 sites, and three core glucocorticoid receptor binding sequences.

Investigation of factors affecting the adsorption of functional molecules onto gel silicas

Flow microcalorimetry and infrared spectroscopy were used to study the surface structure and adsorptive properties of a series of calcined and uncalcined porous silicas. The adsorbates DL-menthol, (R)-(+)-limonene, (+/-)-citronellal and carvone were selected for their functionality, that included carbonyl, vinylic and hydroxyl groups. The amounts of probe retained by the silicas together with the energy exchange involved in the adsorption/desorption process were determined by flow microcalorimetry. The functional groups involved in these interactions were studied by means of infrared spectroscopy. It was observed that the strongest interactions with the silica surface took place through hydrogen bonding onto the surface silanol. The most retentive probes were found to be those with a carbonyl group in their structure. Adsorption onto calcined silicas was found to be less energetic than onto the equivalent calcined samples. The adsorption densities were compared with theoretical predictions based on molecular models. In all cases apart from citronellal monolayer coverage were not observed due to steric effects.

Further evidence for biological effects resulting from ionizing radiation doses in the diagnostic X-ray range

In this study we assessed cell response to ionizing radiation doses in the diagnostic X-ray range, using metabolic performance as the biological end point. HeLa cells were irradiated between 3.5 mGy (standard deviation (SD=2.5%) and 55.1 mGy (SD=0.9%) with 110 kV X-rays, and after 7 days metabolic capacity of cultures was measured spectrophotometrically with resazurin. Cells receiving 7.5 mGy or greater showed impaired proliferation. At 7.5 mGy this effect was prevented by nitric oxide synthase inhibitor N G-monomethyl-L-arginine but not by ascorbic acid or p38 MAPK inhibitor SB203580. We conclude that HeLa cell proliferation is adversely affected by doses within the range of some radiological examinations, through a mechanism involving nitric oxide.

Feasibility of a men's health promotion programme in Irish primary care

BACKGROUND

To assess the feasibility of offering health promotion and preventive medicine initiatives in primary care.

AIMS

A pilot study aimed at men in general practice to establish the uptake, acceptability and effectiveness of interventions in health initiatives.

METHODS

One thousand men aged 18-65 were selected at random from five general practices in the Western Health Board area. Practices were randomly allocated to one of four brief interventions: cardiovascular screening, cancer screening, stress management or general lifestyle advice.

RESULTS

Fifty-five per cent of men responded, with 35.7% actually attending. There were minor but significant short-term changes in health status and behaviours. Participants expressed high levels of satisfaction, but tended to prefer interventions with an explicit clinical component.

CONCLUSION

It is at least as feasible to offer health promotion for men in primary care as it is for other demographic groups, but adequate training and resources are required.

Impact evaluation of a folate education campaign with and without the use of a health claim

OBJECTIVE

To measure the impact of a Kellogg/Northcott Society multimedia folate education campaign, run nationally from July 1998 to June 1999, with and without the use of health claims.

METHOD

Three national telephone surveys of more than 500 Australian women aged 18-44 in July and November 1998 and May 1999.

RESULTS

Awareness of the role of folate in the prevention of birth defects rose from 21% at baseline to 29% in November 1998 and 44% in May 1999. Awareness of the recommendation to take folate before pregnancy rose by 8% in the first six months of the campaign (without health claims) and by 22% in the second half (when health claims were incorporated). At the end of the campaign, the foods most commonly cited as sources of folate were leafy green vegetables (72%), breakfast cereals (70%), fruit (41%) and bread (40%).

CONCLUSION

Inclusion of a specific health claim explaining the role of folate in preventing birth defects appeared to increase the impact of the folate education campaign.

IMPLICATIONS

Changing food regulations to permit health claims may increase the impact of health promotion campaigns involving industry partnerships. Future folate programs should target young women (aged 18-24), those in rural areas and those on lower incomes.