Perceptions of palliative care in Huntington's disease: A qualitative study

INTRODUCTION

Palliative care focuses on improving patient and family quality of life by managing symptoms, psychosocial issues and spiritual concerns. Huntington's disease is a progressive neurodegenerative disorder with no current disease modifying therapy. Although the palliative care model has been postulated to be an integral part of HD care, there are gaps in knowledge about how this care should be implemented. This study aims to identify perceptions of palliative care in Huntington's Disease (HD), palliative care needs of people living with HD, and at what point they feel they would benefit from these resources.

METHODS

Participants volunteered from a large academic institution patient base to be involved in semi structured interviews that explored patient and caregiver experience surrounding their diagnosis, disease management, quality of life, and areas for improvement. Inclusion criteria for participants was a diagnosis of Huntington's disease and/or a self-identified caregiver of a person living with the disease.

RESULTS

A total of 12 independent patients, three independent caregivers, and five dyads completed the interviews. Themes identified included needs that would provide patient and caregiver centered treatment, current gaps in care, an openness and desire for palliative care, and knowledge about the desired timing of palliative care in treatment plans.

CONCLUSION

People living with HD and caregivers of people with HD most desire access to treatment that would focus on symptom management, availability of social resources, advanced care planning and spiritual wellbeing. The preferred timing of this intervention for most individuals would be at the onset of symptoms.

Atmospheric pollution, soil nutrients and climate effects on Mucoromycota arbuscular mycorrhizal fungi

Fine root endophyte mycorrhizal fungi in the Endogonales (Mucoromycota arbuscular mycorrhizal fungi, M‐AMF) are now recognized as at least as important globally as Glomeromycota AMF (G‐AMF), yet little is known about the environmental factors which influence M‐AMF diversity and colonization, partly because they typically only co‐colonize plants with G‐AMF. Wild populations of Lycopodiella inundata predominantly form mycorrhizas with M‐AMF and therefore allow focussed study of M‐AMF environmental drivers. Using microscopic examination and DNA sequencing we measured M‐AMF colonization and diversity over three consecutive seasons and modelled interactions between these response variables and environmental data. Significant relationships were found between M‐AMF colonization and soil S, P, C:N ratio, electrical conductivity, and the previously overlooked micronutrient Mn. Estimated N deposition was negatively related to M‐AMF colonization. Thirty‐nine Endogonales Operational Taxonomic Units (OTUs) were identified in L. inundata roots, a greater diversity than previously recognized in this plant. Endogonales OTU richness correlated negatively with soil C:N while community composition was mostly influenced by soil P. This study provides first evidence that M‐AMF have distinct ecological preferences in response to edaphic variables also related to air pollution. Future studies require site‐level atmospheric pollution monitoring to guide critical load policy for mycorrhizal fungi in heathlands and grasslands.

Analogies for a No-Analog World: Tackling Uncertainties in Reintroduction Planning

Species reintroductions involve considerable uncertainty, especially in highly altered landscapes. Historical, geographic, and taxonomic analogies can help reduce this uncertainty by enabling conservationists to better assess habitat suitability in proposed reintroduction sites. We illustrate this approach using the example of the California grizzly, an iconic species proposed for reintroduction.

Resveratrol protects neurons from cannulae implantation injury: implications for deep brain stimulation

Brain-implantable electrodes such as those used in deep brain stimulation (DBS) have a promising future in end-stage Parkinson's disease therapy. However, there is considerable injury when electrodes penetrate brain tissue. For instance, broken blood vessels and glial scar formation may impede continual DBS or electrical recording from specific neurons. To begin addressing this key safety issue, we tested the therapeutic potential of resveratrol in reducing brain trauma caused by DBS-like surgery. Microinfusion of resveratrol (10 μM) directly applied to the sub-thalamic nucleus (STN) of the rat brain significantly minimized the formation of astrocytic gliosis in response to a 27-G precision-glide cannula implant. The therapeutic effects of resveratrol extended to the "kill zone", a boundary zone of about 100 μm comprising the cannula implant and surrounding neurons. We also found that resveratrol not only provided almost complete protection from mechanical injury to the brain, but that it also prevented undesirable motor deficits often seen in animals with lesions to the STN. Lastly, continuous infusion of resveratrol over a 4-week period led to the inhibition of pro-apoptotic, neurodegenerative and cell division cycle genes that may be associated with a reduction in astrocytic gliosis and glial scar formation within the STN. Taken together, these data suggest that application of resveratrol to the brain is an effective adjunct surgical procedure for minimizing acute neuronal injury when electrodes are implanted directly into the STN.

Unilateral vocal cord paralysis associated with subdural haemorrhage in a newborn infant

A term infant developed stridor, hoarse cry and respiratory distress after forceps-assisted delivery. Oral feeding resulted in aspiration. Flexible laryngoscopy showed a right-sided vocal cord paralysis (VCP). A magnetic resonance image (MRI) of the brain revealed an ovoid lesion in the posterior fossa impinging on the brainstem, which was considered to represent a subdural haematoma. Clinical signs of vocal cord palsy and the associated MRI changes resolved spontaneously by 6 weeks of age. Vocal cord palsy is a common cause of stridor in newborn infants, although in many cases it is considered idiopathic. This is the first report of vocal cord palsy associated with subdural haemorrhage after instrumental delivery, and may represent an important and previously unappreciated cause of VCP. This case highlights the importance of magnetic resonance brain imaging in those infants with VCP in whom the aetiology is uncertain.

Mechanism of interleukin-25 (IL-17E)-induced pulmonary inflammation and airways hyper-reactivity

BACKGROUND

IL-25, a novel member of the IL-17 cytokine family, promotes CD4+ T-helper 2 lymphocyte-like (Th type-2) inflammatory responses in the lung. Although IL-25 up-regulates IL-13 in the lung, the contribution of this and other type 2 cytokine signalling pathways to the induction and persistence of airways hyper-reactivity (AHR) and allergic inflammation are unclear.

OBJECTIVE

To determine the downstream factors employed by IL-25 to induce Th type-2 pulmonary inflammation and AHR.

METHODS

IL-25 was delivered to the airways of BALB/c mice by intra-tracheal (i.t.) instillation and AHR and Th type-2 inflammatory responses were characterized in wild type (WT) and Th type-2-cytokine and -signalling pathway-deficient (-/-) mice.

RESULTS

IL-25 treatment resulted in AHR, eosinophilic inflammation, mucus hypersecretion and a progressive increase in the production of Th type-2 cytokines in the lungs. Levels of arginase-I (arg-I) and eotaxin were also elevated by IL-25 treatment. A significant reduction in AHR, and attenuation of mucus production was observed in IL-25-treated IL-13-/-, IL-4 receptor alpha (IL-4Ralpha-/-)- and signal-transducer-and-activator-of-transcription-factor-6 (STAT6-/-)-deficient mice. AHR was also inhibited in IL-4(-/-)- and IL-5/eotaxin(1)(-/-)- deficient mice treated with IL-25, however, mucus hypersecretion was not completely ablated. IL-25 promoted Th type-2 responses by directly acting on naïve T cells.

CONCLUSION

IL-25 potently (single dose) induces sustained AHR and acute pulmonary inflammation with eosinophilia. IL-25-induced AHR is dependent on the production of Th type-2 cytokines, and removal of IL-13 and its signal transduction pathway prevents IL-25-induced airways inflammation and AHR. IL-25 potently induces inflammatory cascades that may exacerbate allergic airways inflammation by promoting Th type-2 cytokine responses in conjunction with the up-regulation of factors (eotaxin and arg-I) that can amplify inflammation associated with allergic disorders. Dysregulation in IL-25 production may predispose to features of allergic airways disease.

Safety and immunogenicity of an oral, inactivated, whole-cell vaccine for Shigella sonnei: preclinical studies and a Phase I trial

Orally delivered, inactivated whole-cell vaccines are safe methods of inducing local and systemic immunity. To increase surface proteins associated with adherence and invasion, Shigella sonnei were grown in BHI broth containing deoxycholate. A whole-cell vaccine (SsWC) was then produced by formalin inactivation. In pre-clinical studies, the SsWC vaccine was immunogenic and protected against S. sonnei-induced keratoconjunctivitis in the guinea pig model. In a randomized, double-blind, placebo-controlled, Phase I study, 10 evaluable subjects received either three doses of SsWC on Days 0, 14, and 28 (N = 3); five doses of SsWC on Days 0, 2, 4, 6, and 28 (N = 4); or placebo (N = 3). Each dose contained 2.0 x 10(10) inactivated cells. Serum and fecal antibodies against SsWC, LPS, and IpaC were measured by ELISA. A > or = 4-fold increase in titer was considered significant. Both SsWC dosing regimens were well tolerated. No fever or severe gastrointestinal symptoms were noted by any of the vaccinated subjects. Antibody responses were similar in the two dosing groups. Serum IgG or IgA responses to SsWC were seen in six of seven vaccinees (86%), to LPS in four of seven (57%), and to IpaC in five of seven (61%). Fecal IgA responses to these three antigens developed in five of five, three of five, and three of five subjects, respectively. Among the seven vaccinees, geometric mean rises in serum IgA levels to all three immunogens were significant; IgG increases trended toward significance (paired one-tailed t-test). We conclude that SsWC was immunogenic and protective in animal studies and well tolerated and immunogenic in a Phase I trial.

The acetylcholinesterase gene and organophosphorus resistance in the Australian sheep blowfly, Lucilia cuprina

Acetylcholinesterase (AChE), encoded by the Ace gene, is the primary target of organophosphorous (OP) and carbamate insecticides. Ace mutations have been identified in OP resistants strains of Drosophila melanogaster. However, in the Australian sheep blowfly, Lucilia cuprina, resistance in field and laboratory generated strains is determined by point mutations in the Rop-1 gene, which encodes a carboxylesterase, E3. To investigate the apparent bias for the Rop-1/E3 mechanism in the evolution of OP resistance in L. cuprina, we have cloned the Ace gene from this species and characterized its product. Southern hybridization indicates the existence of a single Ace gene in L. cuprina. The amino acid sequence of L. cuprina AChE shares 85.3% identity with D. melanogaster and 92.4% with Musca domestica AChE. Five point mutations in Ace associated with reduced sensitivity to OP insecticides have been previously detected in resistant strains of D. melanogaster. These residues are identical in susceptible strains of D. melanogaster and L. cuprina, although different codons are used. Each of the amino acid substitutions that confer OP resistance in D. melanogaster could also occur in L. cuprina by a single non-synonymous substitution. These data suggest that the resistance mechanism used in L. cuprina is determined by factors other than codon bias. The same point mutations, singly and in combination, were introduced into the Ace gene of L. cuprina by site-directed mutagenesis and the resulting AChE enzymes expressed using a baculovirus system to characterise their kinetic properties and interactions with OP insecticides. The K(m) of wild type AChE for acetylthiocholine (ASCh) is 23.13 microM and the point mutations change the affinity to the substrate. The turnover number of Lucilia AChE for ASCh was estimated to be 1.27x10(3) min(-1), similar to Drosophila or housefly AChE. The single amino acid replacements reduce the affinities of the AChE for OPs and give up to 8.7-fold OP insensitivity, while combined mutations give up to 35-fold insensitivity. However, other published studies indicate these same mutations yield higher levels of OP insensitivity in D. melanogaster and A. aegypti. The inhibition data indicate that the wild type form of AChE of L. cuprina is 12.4-fold less sensitive to OP inhibition than the susceptible form of E3, suggesting that the carboxylesterases may have a role in the protection of AChE via a sequestration mechanism. This provides a possible explanation for the bias towards the evolution of resistance via the Rop-1/E3 mechanism in L. cuprina.

Singlet oxygen and superoxide characteristics of a series of novel asymmetric photosensitizers

The singlet oxygen quantum yields and superoxide quantum yields for a series of novel compounds based on an asymmetrical protoporphyrin molecule have been examined. Electron spin resonance was used to measure superoxide yield and time resolved luminescence for singlet oxygen. A comparison between these results and previously published cell survival data was carried out. A broad association was found between singlet oxygen quantum yield and clonogenic cell kill.

Novel asymmetric photosensitizers: an in vitro study

A series of compounds based on an asymmetrical protoporphyrin molecule have been examined. The paired groups of sensitizers differed in terms of the presence or absence of a permanent positive charge, in the alkyl side chain length and in having either a primary or secondary amine substituent. The effects of these variables on drug uptake, partition coefficient and photodynamic cell kill were tested. Drug uptake and partition coefficient were shown to be correlated. Differences in gross uptake were found within paired groups of sensitizers although cell-associated uptake alone did not correlate with clonogenic cell survival. Of the compounds tested it was the sensitizers with alkyl side chains, rather than the permanently positively charged compounds, which resulted in the greatest degree of clonogenic cell kill.

Pilot project on functional outcome in stroke

The purpose of this pilot project was to compare the outcome of stroke survivors cared for on an Acute Stroke Unit (ASU) to those who received care on a routine medical-surgical unit. The sample included a total of 88 patients, 68 admitted to an acute stroke unit and 20 admitted to a medical-surgical unit. The Functional Index Measure was used to assess in-hospital functional gains in the two groups. There appeared to be a trend toward increased functional gains in the group of stroke patients cared for on the Acute Strike Unit as compared to the group of patients cared for on medical-surgical units. These findings provide a foundation for neuroscience nurses and other health care professionals to study functional gains after stroke.

Improving information for nuclear medicine department outpatients

In two large inner city hospitals we have conducted a survey of the letters sent to patients before their attendance at a nuclear medicine department. The majority of questions asked for a graded answer (poor, fair, ok, good, excellent). Patients were handed the survey form when they had completed their test and the survey was continued until 100 valid replies had been received at each hospital. Information leaflets, as recommended by the British Nuclear Medicine Society (BNMS), were subsequently issued to all patients and at one hospital the patient information letters were rewritten. The surveys were then repeated. There was a significant (P < 0.001) improvement in patient satisfaction with the information provided. In some areas, for example, instructions about getting to the hospital, no different information was provided and there was no change between the surveys, as would be expected. Curiously, questions allowing free text answers were more often completed by patients from Dudley Road Hospital, Birmingham, than from Guy's Hospital, London. Some possible explanations for this difference are discussed. Particularly reassuring was that more women understood about precautions regarding pregnancy or breastfeeding as a result of the leaflets. We would recommend the advice of the BNMS to other nuclear medicine departments.

The uptake of porphyrin and zinc-metalloporphyrin by the primate prostate

The relative distribution of sensitizer drugs in the prostate and its contiguous organs is of importance in the treatment of localized prostatic cancer with photodynamic therapy. Using the primate model, whose prostate is both morphologically and physiologically homologous with its human counterpart, the distribution of hematoporphyrin derivative (HpD) amongst organs of urological interest was determined. Hematoporphyrin derivative levels were comparatively low in both caudal and cranial prostatic lobes (0.93-1.77 micrograms/g) and were similar to those in rectum, urethra and the skin. The reticuloendothelial organs, liver, spleen and also the kidney accumulated the highest quantities of porphyrin (4.76-9.8 micrograms/g, liver > spleen > kidney). Despite a high avidity of prostatic tissue for zinc, a zinc-metalloporphyrin (Zn-HpD) did not concentrate selectively in the prostate. The results are of clinical value in view of the homology between the primate and the human.

Nitrogen analogues of haematoporphyrin and haematoporphyrin derivative

The preparation of a number of amines related to haematoporphyrin (HP) and haematoporphyrin derivative (HPD) have been studied and their composition and structure discussed through examination of their 1H, 13C NMR and mass spectral data and other physical properties. In vitro biological studies have been carried out and have shown these amines to have a similar photodynamic efficiency to that of HPD. One of these showed cytotoxic properties at exceptionally low light energy levels.

Mechanism of action of beta-glycerophosphate on bone cell mineralization

Experiments were performed to determine whether beta-glycerophosphate (beta-GP) promoted mineralization in vitro by modulating bone cell metabolic activity and/or serving as a local source of inorganic phosphate ions (Pi). Using MC3T3-E1, ROS 17/2.8, and chick osteoblast-like cells in the presence of beta-GP or Pi, we examined mineral formation, lactate generation, alkaline phosphatase (AP) activity, and protein and phospholipid synthesis. Neither beta-GP nor Pi modulated any of the major biosynthetic activities of the bone cells. Thus, we found no change in the levels of phospholipids, and the total protein concentration remained constant. Measurement of lactate synthesis showed that beta-GP did not effect the rate of anaerobic glycolysis. Evaluation of medium Pi levels clearly indicated that beta-GP was hydrolyzed by bone cells; within 24 hours, almost 80% of 10 mM beta-GP was hydrolyzed. It is likely that this local increase in medium Pi concentration promoted rapid mineral deposition. Chemical, energy dispersive X-ray, and Fourier transform infrared analysis of the mineral formed in the presence of beta-GP showed that it was nonapatitic; moreover, mineral particles were also seen in the culture medium itself. Experiments performed with a cell-free system indicated that mineral particles formed spontaneously in the presence of AP and beta-GP and were deposited into a collagen matrix. We conclude that medium supplementation with beta-GP or Pi should not exceed 2 mM. If this value is exceeded, then there will be nonphysiological mineral deposition in the bone cell culture.

Ascorbic acid regulates multiple metabolic activities of cartilage cells

Bones grow in length because of the activities of cartilage cells in the epiphyseal growth plate. We have examined selected events that occur in the growth cartilage by the use of cultured epiphyseal cells; we have also evaluated the influence of ascorbate on these activities. Our studies indicate that 1) ascorbate induces the expression of a unique collagen isoform, type X collagen; 2) ascorbate stimulates alkaline phosphatase activity of maturing chondrocytes; and 3) ascorbate regulates the energy status of the maturing chondrocyte. We have found that in the presence of ascorbate there is a change in oxidative activity. Thus, lactate formation is inhibited, there is an increase in the adenylate energy charge ratio, and there is an elevation in the activity of isocitrate dehydrogenase. The results of these studies point to multiple effects of vitamin C on chondrocyte maturation involving changes in protein synthesis and energy metabolism.

The Tc3 family of transposable genetic elements in Caenorhabditis elegans

We describe genetic and molecular properties of Tc3, a family of transposable elements in Caenorhabditis elegans. About 15 Tc3 elements are present in the genomes of several different wild-type varieties of C. elegans, but Tc3 transposition and excision are not detected in these strains. Tc3 transposition and excision occur at high frequencies, however, in strain TR679, a mutant identified because of its highly active Tc1 elements. In TR679, Tc3 is responsible for several spontaneous mutations affecting the unc-22 gene. Tc3-induced mutations are unstable, and revertants result from precise or nearly precise excision of Tc3. Although Tc3 is very active in TR679, it is not detectably active in several other mutator mutants, all of which exhibit high levels of Tc1 activity. Tc3 is 2.5 kilobases long, and except for sequences near its inverted repeat termini, it is unrelated to Tc1. The termini of Tc3 are inverted repeats of at least 70 base pairs; the terminal 8 nucleotides of Tc3 are identical to 8 of the terminal 9 nucleotides of Tc1.

Systems therapy in a day-treatment setting

This is a paper about doing systems therapy in a day-treatment facility for children identified as severely emotionally disturbed. Children's emotional problems are seen and treated as aspects of family and larger-system problems. An intervention process has been articulated. Information management is a central team task. All staff are team members. While many theories and therapies inform the intervention process, there is no attempt to integrate approaches. Rather, a consultation process serves as a clearinghouse for information management. The managers of the information process think in systems terms and that thinking is "meta" to other positions. In this paper the thinking, the organization of the workplace, and some of the processes which people experience are explored.

3-amino-triazole effects on the eye of young and adult rabbits in the presence and absence of hydrogen peroxide

3-aminotriazole (3AT) is known to reduce catalase levels in ocular tissues when given intravenously or orally. Rabbits were given either 4 ml/kg of a 3M solution of 3AT intravenously or a 2% solution as drinking fluid. Intravenous 3AT administration was followed at 4 hrs by an intracameral injection of hydrogen peroxide (H2O2) to give an aqueous humor concentration of 3.2 mM in young (4-6 weeks of age) and a 3.3 mM in adult (6 months of age) rabbits. Tissues were taken for microscopy at either 6 or 24 hours after intracameral H2O2. Neither oral nor intravenous 3AT alone in adult rabbits, or intravenous 3AT in young rabbits, had any effect on either iris, ciliary process, or corneal endothelial morphology. After oral 3AT in adult rabbits, H2O2 caused highly edematous ciliary processes with dilated vessels; corneal endothelial cells were swollen. Previous studies in adult and young rabbits have shown that intracameral H2O2 alone caused few morphological changes in young, but marked changes in the adult that correlated with the 35 to 50% lower catalase levels found in iris and corneal endothelium, respectively, in adult ocular tissues. Young rabbits pre-treated with intravenous 3AT, when examined at 6 and 24 hours after intracameral H2O2, showed swollen ciliary processes, vessel dilation, alteration of the pigment epithelium and corneal endothelial damage. In non 3AT-treated young rabbits, H2O2 caused only minor morphological changes. In adult animals at 6 and 24 hours after intracameral H2O2 the ciliary processes were edematous in the absence of 3AT; after intravenous 3AT and intracameral H2O2 the changes were even more marked, with very severe swelling of ciliary processes and corneal endothelial damage. It is apparent that the decrease in catalase caused by 3AT allows H2O2 to induce damage even in young animals where it usually does not induce morphological changes. In adult animals, the effects of H2O2 are enhanced in the presence of 3AT.

Ammonium regulation in Aspergillus nidulans

l-Glutamate uptake, thiourea uptake, and methylammonium uptake and the intracellular ammonium concentration were measured in wild-type and mutant cells of Aspergillus nidulans held in various concentrations of ammonium and urea. The levels of l-glutamate uptake, thiourea uptake, nitrate reductase, and hypoxanthine dehydrogenase activity are determined by the extracellular ammonium concentration. The level of methylammonium uptake is determined by the intracellular ammonium concentration. The uptake and enzyme characteristics of the ammonium-derepressed mutants, meaA8, meaB6, DER3, amrA1, xprD1, and gdhA1, are described. The gdhA mutants lack normal nicotinamide adenine dinucleotide phosphate-glutamate dehydrogenase (NADP-GDH) activity and are derepressed with respect to both external and internal ammonium. The other mutant classes are derepressed only with respect to external ammonium. The mutants meaA8, DER3, amrA1, and xprD1 have low levels of one or more of the l-glutamate, thiourea, and methylammonium uptake systems. A model for ammonium regulation in A. nidulans is put forward which suggests: (i) NADP-GDH located in the cell membrane complexes with extracellular ammonium. This first regulatory complex determines the level of l-glutamate uptake, thiourea uptake, nitrate reductase, and xanthine dehydrogenase by repression or inhibition, or both. (ii) NADP-GDH also complexes with intracellular ammonium. This second and different form of regulatory complex determines the level of methylammonium uptake by repression or inhibition, or both.

Relation of brain sensitivity and hepatic metabolism of hexobarbitone to dose-response relations in infant and young rats

The dose-response relation to hexobarbitone of infant (5 day) and young (44 day) male rats was examined, and the relative contribution of hepatic metabolism (measured in vitro) and changes in brain sensitivity to the overall response were evaluated. The infant rat shows a parallel shift to the left in its dose-response curve with the relative potency of hexobarbitone almost 5 times greater than for the 44 day old animal. The slope of the curves show marked changes at the first lethal dose level of drug. This and other evidence suggest that death may not be merely an extension of the mechanism causing hypnosis. Infant rats exhibited a shorter increment in sleep time for increasing doses of hexobarbitone than is predictable from their low rate of in vitro metabolism. Although this is also true for the young rats, the two values are in much closer agreement than for the infant animals. Brain concentrations of hexobarbitone, measured upon regaining of the righting reflex, were lower in the infant than in the young rat. This suggests the central nervous system of the infant rat has an increased sensitivity to the drug.

The use of p-fluorophenylalanine with 'master strains' of Aspergillus nidulans for assigning genes to linkage groups

Four ‘master’ strains ofAspergillus nidulans, three of which are marked on each of the eight chromosomes, are used for assigning genes of unknown location to linkage groups. In this technique a heterozygous diploid is synthesized between one ‘master’ strain and a strain carrying an unlocated marker. This diploid is haploidized by growth onp-fluorophenylalanine, and the haploids thus obtained are classified for recombination between the unlocated marker and each of the markers of the ‘master’ strains. The marker or markers of the ‘master’ strain which show no recombination with the unlocated marker identify the chromosome pair on which the latter is located. One example is presented for each of the four ‘master’ strains.