Striatal brain volume linked to severity of substance use in high-risk incarcerated youth

Substance use disorders among juveniles are a major public health concern and are often intertwined with other psychosocial risk factors including antisocial behavior. Identifying etiological risks and mechanisms promoting substance use disorders remains a high priority for informing more focused interventions in high-risk populations. The present study examined brain gray matter structure in relation to substance use severity among n = 152 high-risk, incarcerated boys (aged 14-20). Substance use severity was positively associated with gray matter volume across several frontal/striatal brain regions including amygdala, pallidum, putamen, insula, and orbitofrontal cortex. Effects were apparent when using voxel-based-morphometric analysis, as well as in whole-brain, data-driven, network-based approaches (source-based morphometry). These findings support the hypothesis that elevated gray matter volume in striatal reward circuits may be an endogenous marker for vulnerability to severe substance use behaviors among youth.

Complete absence of GLUT1 does not impair human terminal erythroid differentiation

The Glucose transporter 1 (GLUT1) is one of the most abundant proteins within the erythrocyte membrane and is required for glucose and dehydroascorbic acid (Vitamin C precursor) transport. It is widely recognized as a key protein for red cell structure, function, and metabolism. Previous reports highlighted the importance of GLUT1 activity within these uniquely glycolysis-dependent cells, in particular for increasing antioxidant capacity needed to avoid irreversible damage from oxidative stress in humans. However, studies of glucose transporter roles in erythroid cells are complicated by species-specific differences between humans and mice. Here, using CRISPR-mediated gene editing of immortalized erythroblasts and adult CD34+ hematopoietic progenitor cells, we generate committed human erythroid cells completely deficient in expression of GLUT1. We show that absence of GLUT1 does not impede human erythroblast proliferation, differentiation, or enucleation. This work demonstrates for the first-time generation of enucleated human reticulocytes lacking GLUT1. The GLUT1-deficient reticulocytes possess no tangible alterations to membrane composition or deformability in reticulocytes. Metabolomic analyses of GLUT1-deficient reticulocytes reveal hallmarks of reduced glucose import, downregulated metabolic processes and upregulated AMPK-signalling, alongside alterations in antioxidant metabolism, resulting in increased osmotic fragility and metabolic shifts indicative of higher oxidant stress. Despite detectable metabolic changes in GLUT1 deficient reticulocytes, the absence of developmental phenotype, detectable proteomic compensation or impaired deformability comprehensively alters our understanding of the role of GLUT1 in red blood cell structure, function and metabolism. It also provides cell biological evidence supporting clinical consensus that reduced GLUT1 expression does not cause anaemia in GLUT1 deficiency syndrome.

Europe PMC in 2023

Europe PMC (https://europepmc.org/) is an open access database of life science journal articles and preprints, which contains over 42 million abstracts and over 9 million full text articles accessible via the website, APIs and bulk download. This publication outlines new developments to the Europe PMC platform since the last database update in 2020 (1) and focuses on five main areas. (i) Improving discoverability, reproducibility and trust in preprints by indexing new preprint content, enriching preprint metadata and identifying withdrawn and removed preprints. (ii) Enhancing support for text and data mining by expanding the types of annotations provided and developing the Europe PMC Annotations Corpus, which can be used to train machine learning models to increase their accuracy and precision. (iii) Developing the Article Status Monitor tool and email alerts, to notify users about new articles and updates to existing records. (iv) Positioning Europe PMC as an open scholarly infrastructure through increasing the portion of open source core software, improving sustainability and accessibility of the service.

Association of Positive MRI Findings and Clinical Outcomes in Sub-acute and Chronic Phases of Pediatric Mild Traumatic Brain Injury

OBJECTIVE

This study aims to examine the rates of incidental findings (IF) and radiologic common data elements (rCDE), and to explore how these magnetic resonance imaging (MRI) findings contribute to a broad assessment of clinical outcomes (symptoms, cognitive and behavioral functioning, and quality of life) in the sub-acute (SA: ∼1 week), early chronic (EC: ∼4 months), and late chronic (LC: ∼1 year) phases of pediatric mild traumatic brain injuries (pmTBI).

BACKGROUND

It is unclear whether MRI findings have clinical implications following injury.

DESIGN/METHODS

Two hundred thirty-three pmTBI patients and 168 HC aged 8-18 completed an MRI scan and a comprehensive clinical assessment at SA visit, with a subset completing the clinical assessment at EC (182 pmTBI; 158 HC) and LC (143 pmTBI; 141 pmTBI) visits. All MRI findings were noted by board-certified neuroradiologists and coded based on published criteria for rCDE by 2 independent researchers, who were blinded to diagnosis group. A series of 2 × 3 (group [pmTBI vs HC] × MRI findings [IF vs rCDE vs normal]) generalized linear model was conducted for outcomes at each visit. Possible and probable rCDE were pooled for the latter analyses.

RESULTS

One hundred sixty-four participants (40.9%) showed positive MRI findings (113 IF, 43 possible rCDE, 8 probable rCDE). As expected, probable rCDE was exclusively observed in pmTBI patients (Fisher's exact one-sided = 0.012), however the incidence of IF and possible rCDE was similar between groups (χ2 = 2.969; p's = 0.085). While group effects were observed on several outcome measures, no interaction of Group × MRI findings survived the correction for multiple comparisons (p's > 0.01). An MRI findings effect (p < 0.001) was observed on child-rated Children's Behavior Questionnaire at SA visit (normal > IF and rCDE; p's = 0.009). However, this effect was no longer significant at EC and LC (p's = 0.439).

CONCLUSIONS

Overall, the current results do not suggest that MRI findings have clinical implications or interacts with pmTBI to worsen outcomes.

Europe PMC in 2020

Europe PMC (https://europepmc.org) is a database of research articles, including peer reviewed full text articles and abstracts, and preprints - all freely available for use via website, APIs and bulk download. This article outlines new developments since 2017 where work has focussed on three key areas: (i) Europe PMC has added to its core content to include life science preprint abstracts and a special collection of full text of COVID-19-related preprints. Europe PMC is unique as an aggregator of biomedical preprints alongside peer-reviewed articles, with over 180 000 preprints available to search. (ii) Europe PMC has significantly expanded its links to content related to the publications, such as links to Unpaywall, providing wider access to full text, preprint peer-review platforms, all major curated data resources in the life sciences, and experimental protocols. The redesigned Europe PMC website features the PubMed abstract and corresponding PMC full text merged into one article page; there is more evident and user-friendly navigation within articles and to related content, plus a figure browse feature. (iii) The expanded annotations platform offers ∼1.3 billion text mined biological terms and concepts sourced from 10 providers and over 40 global data resources.

P702Anti-thrombin nanoparticles for reduce vascular damage and promote functional recovery in acute ischemic kidney injury well after reperfusion

Introduction

We have shown previously that pretreatment of acute ischemic kidney injury (AKI) in mice prior to reperfusion with anti-thrombin perfluorocarbon nanoparticles (PFC NP) limits damage to endothelium and hastens functional recovery. However, whether such treatments are effective after AKI is established is not known. We hypothesized that thrombin would continue to exert deleterious clotting and molecular signaling effects in AKI well after reperfusion that would respond to sustained local inhibition with long acting anti-thrombin nanoparticles.

Methods

23 C57Bl6 mice underwent bilateral kidney ischemia for 17 min, followed by 2 hours reperfusion and i.v. injection of anti-thrombin PPACK (D-phenylalanyl-L-prolyl-L-arginine chloromethyl ketone)-conjugated PFC NP (∼ 13,000 PPACK per PFC NP), or plain PFC NP (control: no drug). At 24 hours BUN was measured, and mice were euthanized for kidney histological assessment (H&E), protein expression (western blot) and eicosanoid mediators of inflammation (LC-MS/MS: AB SCIEX 5500 QTRAP).

Results

BUN at 24 hours after AKI was 63.29±9.09 vs 110.96±6.21 (P<0.002), for treated versus untreated mice, respectively, a 43% improvement. Western blots (Figure) indicated 40% reduction of canonical NF-kB signaling pathway protein p65 (p<0.01) and 2.2 fold increases in Bcl-xL: Bax ratio (P<0.01). Vascular damage, as indicated by glomerular and mesangial hemorrhage (Figure), was reduced, as was tubular cell swelling and edema. Levels of inflammatory procoagulant eicosanoids (e.g., PGE1, TBX2, PGA2, 15-HETE, 5-HETE, etc.) generally were higher in renal medulla than in cortex, and were suppressed by PPACK PFC NP.

Discussion

Continued inhibition of thrombin in AKI with locally-acting PPACK PFC NP preserved vascular integrity, limited renal hemorrhage, mitigated inflammation and tubular cell death, and accelerated functional recovery even when administered 2 hours after reperfusion. Because these PPACK PFC NP do not prolong bleeding times or coagulation parameters beyond ∼30–60 min after injection, yet maintain prolonged local surveillance against activated thrombin, they represent a potentially useful therapeutic strategy for established AKI after an ischemic insult.

Acknowledgement/Funding

DK102691

An evaluation of methods for the isolation of nontuberculous mycobacteria from patients with cystic fibrosis, bronchiectasis and patients assessed for lung transplantation

BACKGROUND

RGM medium is an agar-based, selective culture medium designed for the isolation of nontuberculous mycobacteria (NTM) from the sputum of patients with cystic fibrosis (CF). We evaluated RGM medium for the detection of NTM in patients with CF (405 samples), bronchiectasis (323 samples) and other lung diseases necessitating lung transplantation (274 samples).

METHODS

In total, 1002 respiratory samples from 676 patients were included in the study. Direct culture on RGM medium, with incubation at two temperatures (30 °C and 37 °C), was compared with conventional culture of decontaminated samples for acid-fast bacilli (AFB) using both a solid medium (Löwenstein-Jensen medium) and a liquid medium (the Mycobacterial Growth Indicator Tube; MGIT).

RESULTS

For all three patient groups, significantly more isolates of NTM were recovered using RGM medium incubated at 30 °C than by any other method (sensitivity: 94.6% vs. 22.4% for conventional AFB culture; P < 0.0001). Significantly more isolates of Mycobacterium abscessus complex were isolated on RGM at 30 °C than by AFB culture (sensitivity: 96.1% vs. 58.8%; P < 0.0001). The recovery of Mycobacterium avium complex was also greater using RGM medium at 30 °C compared to AFB culture (sensitivity: 83% vs. 70.2%), although this difference was not statistically significant and a combination of methods was necessary for optimal recovery (P = 0.21).

CONCLUSIONS

In the largest study of RGM medium to date, we reaffirm its utility for isolation of NTM from patients with CF. Furthermore; we show that it also provides an effective tool for culture of respiratory samples from patients with bronchiectasis and other lung diseases.

Accelerating multiscale modelling of fluids with on-the-fly Gaussian process regression

We present a scheme for accelerating hybrid continuum-atomistic models in multiscale fluidic systems by using Gaussian process regression as a surrogate model for computationally expensive molecular dynamics simulations. Using Gaussian process regression, we are able to accurately predict atomic-scale information purely by consideration of the macroscopic continuum-model inputs and outputs and judge on the fly whether the uncertainty of our prediction is at an acceptable level, else a new molecular simulation is performed to continually augment the database, which is never required to be complete. This provides a substantial improvement over the current generation of hybrid methods, which often require many similar atomistic simulations to be performed, discarding information after it is used once. We apply our hybrid scheme to nano-confined unsteady flow through a high-aspect-ratio converging-diverging channel, and make comparisons between the new scheme and full molecular dynamics simulations for a range of uncertainty thresholds and initial databases. For low thresholds, our hybrid solution is highly accurate-around that of thermal noise. As the uncertainty threshold is raised, the accuracy of our scheme decreases and the computational speed-up increases (relative to a full molecular simulation), enabling the compromise between accuracy and efficiency to be tuned. The speed-up of our hybrid solution ranges from an order of magnitude, with no initial database, to cases where an extensive initial database ensures no new MD simulations are required.

Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils

There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.

A generalized optimization principle for asymmetric branching in fluidic networks

When applied to a branching network, Murray’s law states that the optimal branching of vascular networks is achieved when the cube of the parent channel radius is equal to the sum of the cubes of the daughter channel radii. It is considered integral to understanding biological networks and for the biomimetic design of artificial fluidic systems. However, despite its ubiquity, we demonstrate that Murray’s law is only optimal (i.e. maximizes flow conductance per unit volume) for symmetric branching, where the local optimization of each individual channel corresponds to the global optimum of the network as a whole. In this paper, we present a generalized law that is valid for asymmetric branching, for any cross-sectional shape, and for a range of fluidic models. We verify our analytical solutions with the numerical optimization of a bifurcating fluidic network for the examples of laminar, turbulent and non-Newtonian fluid flows.

A Portable Diode Array Spectrophotometer

A cheap portable visible light spectrometer is presented. The spectrometer uses readily sourced items and could be constructed by anyone with a knowledge of electronics. The spectrometer covers the wavelength range 450-725 nm with a resolution better than 5 nm. The spectrometer uses a diffraction grating to separate wavelengths, which are detected using a 128-element diode array, the output of which is analyzed using a microprocessor. The spectrum is displayed on a small liquid crystal display screen and can be saved to a micro SD card for later analysis. Battery life (2 × AAA) is estimated to be 200 hours. The overall dimensions of the unit are 120 × 65 × 60 mm, and it weighs about 200 g.

Pseudouridines in U2 snRNA stimulate the ATPase activity of Prp5 during spliceosome assembly

Pseudouridine (Ψ) is the most abundant internal modification identified in RNA, and yet little is understood of its effects on downstream reactions. Yeast U2 snRNA contains three conserved Ψs (Ψ35, Ψ42, and Ψ44) in the branch site recognition region (BSRR), which base pairs with the pre-mRNA branch site during splicing. Here, we show that blocks to pseudouridylation at these positions reduce the efficiency of pre-mRNA splicing, leading to growth-deficient phenotypes. Restoration of pseudouridylation at these positions using designer snoRNAs results in near complete rescue of splicing and cell growth. These Ψs interact genetically with Prp5, an RNA-dependent ATPase involved in monitoring the U2 BSRR-branch site base-pairing interaction. Biochemical analysis indicates that Prp5 has reduced affinity for U2 snRNA that lacks Ψ42 and Ψ44 and that Prp5 ATPase activity is reduced when stimulated by U2 lacking Ψ42 or Ψ44 relative to wild type, resulting in inefficient spliceosome assembly. Furthermore, in vivo DMS probing analysis reveals that pseudouridylated U2, compared to U2 lacking Ψ42 and Ψ44, adopts a slightly different structure in the branch site recognition region. Taken together, our results indicate that the Ψs in U2 snRNA contribute to pre-mRNA splicing by directly altering the binding/ATPase activity of Prp5.

Loneliness and social isolation as risk factors for mortality: a meta-analytic review

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.

Sunlight-powered kHz rotation of a hemithioindigo-based molecular motor

Photodriven molecular motors are able to convert light energy into directional motion and hold great promise as miniaturized powering units for future nanomachines. In the current state of the art, considerable efforts have still to be made to increase the efficiency of energy transduction and devise systems that allow operation in ambient and non-damaging conditions with high rates of directional motions. The need for ultraviolet light to induce the motion of virtually all available light-driven motors especially hampers the broad applicability of these systems. We describe here a hemithioindigo-based molecular motor, which is powered exclusively by nondestructive visible light (up to 500 nm) and rotates completely directionally with kHz frequency at 20 °C. This is the fastest directional motion of a synthetic system driven by visible light to date permitting materials and biocompatible irradiation conditions to establish similarly high speeds as natural molecular motors.

Although photodriven molecular motors—capable of converting light into unidirectional motion—hold promise for many applications, these typically require ultraviolet light. Here, the authors design and analyse a motor that can operate at high speeds (kHz) under visible light at ambient temperature.

A randomized, double-blind, placebo-controlled, phase 3 trial to evaluate the efficacy, safety, and tolerability of prucalopride in men with chronic constipation

OBJECTIVES

Prucalopride is effective at alleviating symptoms of chronic constipation in women. The aim of this study was to assess the efficacy of 12 weeks of prucalopride treatment compared with placebo in men with chronic constipation.

METHODS

This was a multicenter, stratified, randomized, parallel-group, double-blind, placebo-controlled, phase 3 study (ClinicalTrials.gov identifier: NCT01147926). The primary end point was the proportion of patients with a mean of three or more spontaneous complete bowel movements (SCBMs) per week across the treatment period. Efficacy end points were assessed using daily electronic diaries, global assessment of the severity of constipation and efficacy of treatment, and Patient Assessment of Constipation-Symptoms (PAC-SYM) and Patient Assessment of Constipation-Quality of Life (PAC-QOL) questionnaires.

RESULTS

In total, 374 patients were enrolled in the study. Significantly more patients achieved a mean of three or more SCBMs per week in the prucalopride group (37.9%) than in the placebo group (17.7%, P<0.0001). The proportion of patients rating their constipation treatment as "quite a bit" to "extremely" effective at the final on-treatment visit was 46.7 and 30.4% in the prucalopride and placebo groups, respectively. The difference between treatment groups was statistically significant (P<0.0001). The proportion of patients with an improvement of at least 1 point in PAC-QOL satisfaction subscale score was 52.7 and 38.8% in the prucalopride and placebo groups, respectively (P=0.0035). Prucalopride had a good safety profile and was well tolerated.

CONCLUSIONS

Prucalopride is effective, has a good safety profile, and is well tolerated for the treatment of men with chronic constipation.

The future is now: model-based clinical trial design for Alzheimer's disease

Failures in trials for Alzheimer's disease (AD) may be attributable to inadequate dosing, population selection, drug inefficacy, or insufficient design optimization. The Coalition Against Major Diseases (CAMD) was formed in 2008 to develop drug development tools (DDT) to expedite drug development for AD and Parkinson's disease. CAMD led a process that successfully advanced a clinical trial simulation (CTS) tool for AD through the formal regulatory review process at the US Food and Drug Administration (FDA) and European Medicines Agency (EMA).

The Zeeman Effect in Quadrupole Double Resonance Spectra: Dependence of the Line Shapes on the Orientation of the Electric Field Gradient Tensor

The solid effect spectrum of 1,4-dichlorobenzene was recorded at magnetic field strengths in excess of 50 G; at these field strengths Zeeman structure is seen on the 35Cl resonance. Unlike in single resonance experiments, peaks are asymmetric, and the high frequency and low frequency solid effect peaks have not the same shape. Computer calculation o f the solid effect spectrum gives peaks which show the same asymmetry as the experimental spectrum. The simulated line shapes are found to depend on the direction the principal components of the electric field gradient in the crystal framework and indicate that qyy lies in the plane o f the benzene ring.

17O Quadrupole Dips in Ammonium Persulphate

The magnetic field dependence of the 1H spin-lattice relaxation time in ammonium persulphate shows pronounced minima near the 1H magnetic resonance frequencies of 1,200 and 2,200 kHz. These are interpreted in terms of a model involving cross-relaxation between 1H in the NH4 ion and 17O in natural abundance in the S2O2- 8 ions, the latter having a much shorter spin-lattice relaxation time. A theoretical analysis of the shape of the minima is used to derive values for the 17O quadrupole parameters. This analysis results in best estimate values for the quadrupole coupling constant of 6.75 (± 0.05) MHz and an asymmetry of 0.30 (± 0.02). Such values are indicative o f O-H hydrogen bonding and suggest the S2O2- 8 ion is not undergoing rapid reorientation at temperatures below 320 K.

Nuclear Quadrupole Double Resonance of Compounds with Transannular Boron—Nitrogen Bonds

The boron and nitrogen nuclear quadrupole double resonance spectra of several ring compounds with transannular boron-nitrogen bonds are reported. The electron donation from nitrogen to boron as seen by their quadrupole coupling parallels the boron-nitrogen bond lengths. One of the compounds exhibits a transannular valence topomerisation between two identical boron-nitrogen pairs in solution which is frozen in the solid state but may possibly exist in a preformed state of this equilibrium from its quadrupole coupling. The oxygen-boron π-bond in boroxines, whose extent is deduced from the quadrupole coupling in one of the compounds with a boroxine-like structure at boron and in (PhBO)3, is approximately half as strong as the nitrogen-boron π-bond in borazine.

Clinical networks influencing policy and practice: the establishment of advanced practice pharmacist roles for specialist palliative care services in South Australia

Objectives To operationalise the concept of ‘advanced practice roles’ in pharmacy within the new integrated regionalised palliative care service model outlined in the Palliative Care Services Plan 2009–2016, SA Health. Methods A working group was established under the auspices of the Palliative Care Clinical Network to progress the development of advanced practice pharmacist roles for regionalised palliative care services. A pharmacy stakeholder forum was conducted in December 2010 to provide further guidance on the advanced practice pharmacist roles in the following domains: education; network links and partnerships; quality and safety; and research. Results Advanced practice pharmacist positions were created for each of the three regionalised palliative care services in South Australia (SA). Funding was obtained for a Statewide Palliative Care Pharmacy Network project, to build a sustainable community-based palliative care pharmacy network. Advanced practice pharmacists commenced in the regionalised palliative care services of SA on 4 October 2011. Conclusions The Statewide Palliative Care Clinical Network and the SA Palliative Care Plan provided a policy framework that supported involvement and advocacy in the planning of the advanced practice pharmacist roles. Collaboration between leaders in workforce reform, service planners, specialist palliative care providers and the pharmacy sector was a key enabler for developing the advanced practice pharmacist positions for regionalised palliative care services. What is known about the topic? The advanced practice palliative care pharmacist role reflects a new direction for the discipline of pharmacy and has been embraced at a time when a nationally endorsed Advanced Pharmacy Practice Framework has been published, while recognising that registration for pharmacists in Australia currently does not have specific endorsement for advanced practice. What does this paper add? This paper outlines the value of collaboration across settings and sectors. There is an opportunity for these roles to align with the new nationally endorsed framework for advanced practice in pharmacy. What are the implications for practitioners? These new positions strengthen the links between the hospital and community pharmacy sectors to enhance a quality use of medicines approach with improved access to end-of-life medicines for home-based palliative care clients, which actively facilitates a home death for those who choose it.

Perception of emergency medicine by consultants and specialist registrars from other hospital specialties

BACKGROUND

This is the first study to consider feedback on the specialty of emergency medicine (EM) given by other hospital specialties.

METHOD

A questionnaire was sent to 100 randomly selected consultants and specialist registrars from other specialties in a district general hospital in Northern England. The response rate was 67%.

RESULTS

80% of respondents felt that the official term for the specialty should be "accident and emergency medicine". Resuscitation and major trauma were given the highest importance scores (>9/10) when evaluating the purpose of EM and minor injuries were given an intermediate importance score (6.5/10). Respondents advocated "rapid rule out" of acute medical problems by the emergency department (75%) and "any trained individual" carrying out ultrasound (72%) or stroke thrombolysis (59%) in the emergency department. Rapid sequence induction of anaesthesia exclusively by emergency physicians was unpopular (3%). Respondents were least satisfied with the study department's documentation, availability of senior staff 24 h/day and the availability of equipment and drugs. Polyclinics and closure of smaller emergency department were unpopular future proposals, while 70% advocated a revival of traditional out-of-hours general practice services.

CONCLUSION

The perceived purpose, strengths and weaknesses of EM provide a focus for training and development, while opinion on new practices indicates areas where resistance to change may be met. The results can contribute to decision-making for emergency departments and for EM as it strives to adapt to its role in the modern NHS. Further similar studies are planned on a wider scale.

Temporal discrimination learning of operant feeding in goldfish (Carassius auratus)

Operant temporal discrimination learning was investigated in goldfish. In the first experiment, there was a fixed daily change in illumination. Eight subjects were trained to operate a lever that reinforced each press with food. The period during which responses were reinforced was then progressively reduced until it was 1 hr in every 24. The final 1-hr feeding schedule was maintained over 4 weeks. The feeding period commenced at the same time each day throughout. The food dispensers were then made inactive, and a period of extinction ensued for 6 days. The pattern of responding suggested that the fish were able to exhibit temporal discrimination in anticipation of feeding time. This pattern of responding persisted for a limited number of days during the extinction procedure. The second experiment produced evidence that operant temporal discrimination could develop under continuous illumination.

Identification of recognition residues for ligation-based detection and quantitation of pseudouridine and N6-methyladenosine

Over 100 chemical types of RNA modifications have been identified in thousands of sites in all three domains of life. Recent data suggest that modifications function synergistically to mediate biological function, and that cells may coordinately modulate modification levels for regulatory purposes. However, this area of RNA biology remains largely unexplored due to the lack of robust, high-throughput methods to quantify the extent of modification at specific sites. Recently, we developed a facile enzymatic ligation-based method for detection and quantitation of methylated 2′-hydroxyl groups within RNA. Here we exploit the principles of molecular recognition and nucleic acid chemistry to establish the experimental parameters for ligation-based detection and quantitation of pseudouridine (Ψ) and N⁶-methyladenosine (m⁶A), two abundant modifications in eukaryotic rRNA/tRNA and mRNA, respectively. Detection of pseudouridylation at several sites in the large subunit rRNA derived from yeast demonstrates the feasibility of the approach for analysis of pseudouridylation in biological RNA samples.

Biochemical Purification of Box H/ACA RNPs Involved in Pseudouridylation

Box H/ACA RNPs, each consisting of four common core proteins and a single unique RNA, are the most complex pseudouridylases yet discovered. The RNA component serves as a guide that directs a target uridine for modification. To study the functions and mechanisms of RNA pseudouridylation, it is desirable to isolate the intact box H/ACA RNP complexes. Purified RNPs will allow further identification and characterization of the RNA component in each RNP complex and permit a systematic analysis of the mechanism by which the enzymes convert uridines to pseudouridines in a site-specific manner. Over the years, a number of purification techniques have been developed, providing important tools for RNA pseudouridylation research. Here, we describe three of these techniques, including biotin-streptavidin affinity purification by use of biotinylated 5-fluorouridine (5FU)-containing RNA, tandem affinity purification (TAP) by TAP-tagging one of the four core proteins in the complex, and immunoprecipitation by use of antibodies against one of the four core proteins.

Once-daily, high-concentration MMX mesalamine in active ulcerative colitis

BACKGROUND & AIMS

SPD476 (LIALDA in the US; MEZAVANT in the EU; otherwise known as MMX mesalamine; Shire Pharmaceuticals Inc., Wayne, PA, under license from Giuliani SpA, Milan, Italy) is a novel, once-daily, high-strength (1.2 g/tablet) formulation of mesalamine, utilizing MMX Multi Matrix System (MMX) technology designed to deliver the active drug throughout the colon. We performed a double-blind, multicenter study, comparing MMX mesalamine vs placebo for the treatment of active ulcerative colitis. A delayed-release oral mesalamine (ASACOL; Procter & Gamble, Cincinnati, OH) reference arm was included.

METHODS

Three hundred forty-three patients with active, mild-to-moderate ulcerative colitis received MMX mesalamine 2.4 g/day or 4.8 g/day given once daily, ASACOL 2.4 g/day given in 3 divided doses, or placebo for 8 weeks. The primary end point was the proportion of patients in clinical and endoscopic remission (modified ulcerative colitis disease activity index of < or =1 with rectal bleeding and stool frequency scores of 0, no mucosal friability, and a > or =1-point reduction in sigmoidoscopy score from baseline).

RESULTS

A significantly greater proportion of patients receiving MMX mesalamine 2.4 g/day given once daily (40.5%; P = .01) and 4.8 g/day given once daily (41.2%; P = .007) achieved clinical and endoscopic remission at week 8, vs placebo (22.1%). The clinical and endoscopic remission rate for ASACOL (32.6%; P = .124) was not significantly superior to placebo. All active treatments were well-tolerated.

CONCLUSIONS

Once-daily MMX mesalamine was efficacious and well-tolerated for the induction of clinical and endoscopic remission. MMX mesalamine offers effective and convenient mesalamine therapy, potentially improving treatment compliance.

Once daily MMX mesalazine for the treatment of mild-to-moderate ulcerative colitis: a phase II, dose-ranging study

BACKGROUND

SPD476 (MMX mesalazine), is a novel, once daily, high-strength mesalazine formulation (1.2 g/tablet) that utilizes Multi Matrix System (MMX) technology to delay and extend delivery of the active drug throughout the colon.

AIM

To assess the safety and efficacy of MMX mesalazine in patients with mild-to-moderately active ulcerative colitis, in a pilot, phase II, randomized, multicentre, double-blind, parallel-group, dose-ranging study (SPD476-202).

METHODS

Thirty-eight patients with mild-to-moderately active ulcerative colitis were randomized to MMX mesalazine 1.2, 2.4 or 4.8 g/day given once daily for 8 weeks. Remission ulcerative colitis-disease activity index (UC-DAI) < or =1, a score of 0 for rectal bleeding and stool frequency, and > or =1 -point reduction in sigmoidoscopy score from baseline was the primary end point.

RESULTS

Week 8 remission rates were 0%, 31% and 18% of patients receiving MMX mesalazine 1.2, 2.4 and 4.8 g/day respectively. No statistically significant difference in remission was observed between treatment groups. MMX mesalazine 2.4 and 4.8 g/day groups demonstrated greater improvement in overall UC-DAI and component scores from baseline, compared with the 1.2 g/day group.

CONCLUSION

MMX mesalazine given as 2.4 or 4.8 g/day once daily is well tolerated and effective for the treatment of mild-to-moderately active ulcerative colitis.

The impact of intellectual functioning on symptoms and service use in schizophrenia

BACKGROUND

This study aims to evaluate differences in the clinical profiles and use of psychiatric services by people with schizophrenia with and without borderline intellectual functioning. Both groups in this study were receiving standard community psychiatric care.

METHODS

A naturalistic sample of 372 people with schizophrenia completed the National Adult Reading Test. Data were collected prospectively over 18 months on psychiatric symptoms and service use. Three hundred and thirteen had normal intellectual functioning (mean age 43, range 20-76 years) and 59 had borderline or lower intellectual functioning (mean age 45, range 21-81 years). This was defined by a National Adult Reading Test error score of more than 40.

RESULTS

People with borderline or lower intellectual functioning had a lower quality of life, more severe psychotic symptoms, reduced functioning and fewer antidepressant prescriptions. There were no significant differences in service use including hospital admission.

CONCLUSIONS

People with schizophrenia and borderline or lower intellectual functioning are a more disabled group within general adult psychiatric services who should be the focus of initiatives for improved service delivery.

The cardiovascular and respiratory health of people with schizophrenia

OBJECTIVE

To examine the cardiovascular and respiratory health of people with severe mental illness (SMI) and compare findings with the Health Surveys for England.

METHOD

A prospective, multi-centre observational prevalence study of 602 patients with schizophrenia-related psychoses carried out in six locations across the UK over 24 months.

RESULTS

Compared with general population subjects, people with SMI reported higher rates of angina and respiratory symptoms and had poor lung function. Much of this increased risk could be explained by lifestyle risk factors; there were increased levels of obesity among younger people with SMI.

CONCLUSION

Key indicators of the cardiovascular and respiratory health of people with SMI are poor compared with those of the general population. Care plans should prioritize interventions to attenuate lifestyle risk factors. Evidence of increasing obesity in younger patients is of particular concern, predicting even greater health needs in the future.

Maintenance antipsychotic medication patterns in outpatient schizophrenia patients: a naturalistic cohort study

OBJECTIVE

Newer antipsychotics are increasingly used in schizophrenia maintenance. The UK change has been slow with little known on switching patterns. We aimed to investigate antipsychotic prescribing patterns in schizophrenia patients.

METHOD

A naturalistic six-site cohort sample of 600 patients were interviewed by researchers at 6-monthly intervals for 2 years to record their clinical and social functioning; use of services and medication for the preceding 6 months was obtained by structured extraction from clinical case notes.

RESULTS

Alterations in antipsychotic medication were frequent in this group, mainly during periods of inpatient care. Atypical prescribing increased steadily, though slowly, across the period. Polypharmacy was less than anticipated.

CONCLUSION

Inpatient care remains the main forum for switching of antipsychotics. The UK maintains a slow shift to atypical antipsychotics.

The dental health of people with schizophrenia

OBJECTIVE

To examine the dental health of community dwelling people with schizophrenia and to compare results with those in the general population.

METHOD

Dental health of 428 people with schizophrenia in six different areas of the UK was assessed by a self-report questionnaire.

RESULTS

Compared with the general population, significantly more of the younger patients were edentate (3-39% vs. 1-20%) and fewer had more than 20 teeth (70% vs. 83%). None of four dental health targets had been achieved in the patient population. More patients had last visited the dentist because of trouble with their teeth; fewer had visited for a check-up. Fewer patients cleaned their teeth daily; this group had more negative symptoms.

CONCLUSION

The dental health of people with schizophrenia is poor. Community mental health teams should encourage them to attend their community dentist regularly.

Pilot study of an Internet-based electronic patient treatment record and communication system for haemophilia, Advoy.com

Communication between patients and haemophilia centres is important in the management of the disease. Traditionally this has been done by paper records which give retrospective and often incomplete data. This paper describes the development and pilot study of a novel Internet-based electronic patient treatment log. The advantages of the system include up to date information available to the haemophilia centre, less data entry, better quality records and an individualized alert system for significant events. The system was tested with ten patients at three UK haemophilia centres and found to be feasible and easy to use. In the opinion of the patients and health care professionals involved in the pilot study, the system improves quality, accuracy, accessibility and usefulness of patient generated data. Development of the system is ongoing and its use extended to other haemophilia centres.

Economic evaluation of gemcitabine alone and in combination with cisplatin in the treatment of nonsmall cell lung cancer

OBJECTIVE

To evaluate the cost effectiveness of gemcitabine in the treatment of nonsmall cell lung cancer (NSCLC).

METHODS

Gemcitabine was compared with best supportive care and gemcitabine/cisplatin was compared with three standard chemotherapies and four other novel chemotherapy combinations. Costs and effectiveness measures were based on resource and outcome data from previously reported clinical trials. All direct costs associated with NSCLC treatment were included and adjusted to year 2000 values.

PERSPECTIVE

UK National Health Service.

RESULTS

Gemcitabine plus best supportive care was associated with an incremental cost per progression-free life year gained of pound sterling5228 compared with best supportive care alone. In comparison with standard chemotherapies, gemcitabine/cisplatin was associated with an incremental cost per progression-free life year gained of pound sterling1751 versus etoposide/cisplatin and cost per 1-year survival gain of pound sterling5681 versus mitomycin/vinblastine/platinum. Incremental cost per tumour response was pound sterling2032 relative to etoposide/cisplatin, pound sterling5169 relative to mitomycin/ifosfamide/cisplatin and pound sterling6240 relative to mitomycin/vinblastine/platinum. Compared with four novel (newer) combination chemotherapies gemcitabine/ cisplatin showed cost savings in each case, with the same or better outcome. Thus, gemcitabine/cisplatin showed improved cost effectiveness and dominance. Sensitivity analyses showed the results were robust to variations to the values of key parameters.

CONCLUSION

Gemcitabine alone or in combination with cisplatin was assessed to be a cost-effective or cost-saving therapy when compared with best supportive care, standard chemotherapy regimens and novel chemotherapy combinations. Chemotherapy regimens containing gemcitabine therefore represent good value for money and efficient use of healthcare resources in the treatment of advanced NSCLC.

Uncertainty of Outcomes as a Component of Active Coping

Abstract Control or control-belief is often viewed as being directly instrumental in facilitating active coping in aversive situations, and yet the empirical evidence for the effects of control is inconclusive. In this study we investigated the role of feedback and predictability in determining the effects of control-belief during an aversive reaction time task. Ninety-six subjects were allocated to one of eight conditions in a 2 × 2 × 2 control-belief by feedback by predictability factorial design. All subjects were matched in terms of the nature of the task and in the number and time of receipt of both the warning signal and noise. Heart rate reactivity and task performance (reaction time) were measured. Subjects who received feedback displayed greater phasic heart rate responses following the noise stimulus and smaller decreases in heart rate during the postimpact period than those without feedback, particularly in predictable conditions. Control-belief had no effect on heart rate responses. None of the factors led to better task performance. These findings are discussed in relation to processes of active coping and attentional processes of stimulus input, and the need for further studies examining the relative contributions of control-belief, feedback, and predictability in determining cardiovascular function is highlighted.

Prediction and control as determinants of behavioural uncertainty: effects on task performance and heart rate reactivity

Control or control-belief is often viewed as being directly instrumental in facilitating coping mechanisms in aversive situations, and yet the empirical evidence for the beneficial effects of control is inconclusive. In this study we investigated the role of predictability in determining the effects of perceived control during an aversive reaction time task. Fifty-six subjects were allocated to one of four groups; predictable-control, predictable-no control, unpredictable-control, unpredictable-no control. In the predictable conditions, subjects could temporally predict the occurrence of an aversive noise. In the perceived control conditions, duration of the aversive tone was contingent on subject's performance. All subjects were matched in terms of the nature of the task and in the number and time of receipt of both the warning signal and noise. Heart rate reactivity and two performance parameters were measured, reaction time and performance increase. Both predictability and control-belief led to a reduction in heart rate reactivity, although they appeared to function independently and at different points in the sequence of events. That is, predictability or perceived control was sufficient to mitigate the effects of an aversive situation. Neither perception of control or predictability led to better task performance. These results are discussed in terms of behavioural uncertainty explanations.

Detecting hereditary hemochromatosis

Hereditary hemochromatosis is the most commonly inherited autosomal recessive disorder. Hemochromatosis is a current or potential progression of abnormally high accumulations of iron in the liver. If left untreated, the condition can lead to chronic or irreversible hepatic fibrosis, cirrhosis, hepatocellular carcinoma, arthritis, and organ failure. Common signs and symptoms seen in the primary care setting include fatigue, weakness, abdominal pain, palpitations, skin pigmentation changes, and arthropathy, but any symptom associated with organ damage may be reported. Because prompt intervention can cease or reverse the debilitating effects of iron overload, prompt disease diagnosis and treatments are imperative.

Transcription factor nuclear factor-kappa B is activated in neurons after focal cerebral ischemia

Nuclear factor-kappa B (NF-kappaB) is a multisubunit transcription factor that when activated induces the expression of genes encoding acute-phase proteins, cell adhesion molecules, cell surface receptors, and cytokines. NF-kappaB is composed of a variety of protein subunits of which p50-and p65-kDa (RelA) are the most widely studied. Under resting conditions, these subunits reside in the cytoplasm as an inactive complex bound by inhibitor proteins, IkappaB alpha and IkappaB beta. On activation, IkappaB is phosphorylated by IkappaB kinase and ubiquitinated and degraded by the proteasome; simultaneously, the active heterodimer translocates to the nucleus where it can initiate gene transcription. In the periphery, NF-kappaB is involved in inflammation through stimulation of the production of inflammatory mediators. The role of NF-kappaB in the brain is unclear. In vitro, NF-kappaB activation can be either protective or deleterious. The role of NF-kappaB in ischemic neuronal cell death in vivo was investigated. Adult male rats were subjected to 2 hours of focal ischemia induced by middle cerebral artery occlusion (MCAO). At 2, 6, and 12 hours after reperfusion, the expression and transactivation of NF-kappaB in ischemic versus nonischemic cortex and striatum were determined by immunocytochemistry and by electrophoretic mobility gel-shift analysis. At all time points studied, p50 and p65 immunoreactivity was found exclusively in the nuclei of cortical and striatal neurons in the ischemic hemisphere. The contralateral nonischemic hemisphere showed no evidence of nuclear NF-kappaB immunoreactivity. Double immunofluorescence confirmed expression of p50 in nuclei of neurons. Increased NF-kappaB DNA-binding activity in nuclear extracts prepared from the ischemic hemisphere was further substantiated by electrophoretic mobility gel-shift analysis. Because the activation of NF-kappaB by many stimuli can be blocked by antioxidants in vitro, the effect of the antioxidant, LY341122, previously shown to be neuroprotective, on NF-kappaB activation in the MCAO model was evaluated. No significant activation of NF-kappaB was found by electrophoretic mobility gel-shift analysis in animals treated with LY341122. These results demonstrate that transient focal cerebral ischemia results in activation of NF-kappaB in neurons and supports previous observations that neuroprotective antioxidants may inhibit neuronal death by preventing the activation of NF-kappaB.