Transversus abdominis muscle as a gastric or intestinal on-lay flap in two dogs and one cat

Historically, omentalisation and serosal patching have been used to augment gastrointestinal wall defects or incisions where gastrointestinal viability is of concern. This report describes the novel use of a transversus abdominis muscle on-lay flap to augment and provide support to compromised intestine in three cases. The muscle flap was used to support: the ileum following reduction of an intussusception in a dog (case 1), the gastric wall following gastric strangulation, dilation and volvulus in a diaphragmatic rupture in a cat (case 2) and the jejunum following enterotomy and full-thickness ulcer resection with primary repair in a dog (case 3). All animals were discharged within 4 days postoperatively with no short- or long-term complications reported by either the referring veterinary surgeons on routine postoperative examination or on telephone follow-up with the owners (case 1: 10 months, case 2: 30 months, case 3: 6 weeks). The creation of a flap of the transversus abdominis muscle may provide a useful alternative or adjunct to previously described techniques for supporting the gastrointestinal tract when gastrointestinal tissue viability is questionable or resection is not feasible. Further prospective clinical evaluation studies would be indicated to determine whether the muscle flap remains viable or compare whether this technique should be recommended over conventional methods.

A novel internal abdominal oblique muscle flap to close a major abdominal wall defect

This report describes a novel technique for abdominal wall reconstruction using an internal abdominal oblique muscle flap in an Australian kelpie. En bloc resection of a chondrosarcoma and biopsy scar centred on the 13th rib was performed to include full thickness thoracic wall (12th rib, extending caudally) and lateral abdominal wall (including the vascular pedicle of the external abdominal oblique muscle). The diaphragm was advanced to close the thorax. A flap using the caudal internal abdominal oblique muscle with the base dorsally was elevated and rotated 90° to fill the dorsal defect. The ventral defect was closed using the composite ventral abdominal muscles. The skin was closed primarily. The dog developed a self-resolving seroma. Twelve months postoperatively, the dog was able to engage in agility competitions. A viable muscle flap using the internal abdominal oblique muscle provides a useful alternative to previously described techniques for autogenous closure of a large abdominal wall wound.

Urinary incontinence in male dogs under primary veterinary care in England: prevalence and risk factors

OBJECTIVE

To estimate prevalence and identify demographic risk factors for urinary incontinence in male dogs.

METHODS AND METHODS

The study population included all dogs within the VetCompass database from September 1, 2009 to July 7, 2013. Electronic patient records were searched for urinary incontinence cases; demographic and clinical information were extracted and analysed.

RESULTS

Of 109,428 male dogs attending 119 clinics in England, there were an estimated 1027 dogs diagnosed with urinary incontinence, giving a prevalence of 0.94% (95% confidence interval: 0.88 to 1.00). Breeds with highest odds of incontinence in male dogs (compared with mixed breed dogs) included the bull mastiff (odds ratio: 17.21, 95% confidence interval: 6.65 to 44.56, case=5, non-case=314, P<0.001), Irish red setter (odds ratio: 12.79, 95% confidence interval: 4.83 to 33.84, case=5, non-case=142, P<0.001), fox terrier (odds ratio: 9.60, 95% confidence interval: 3.68 to 25.05, case=5, non-case=176, P < 0.001), bulldog (odds ratio: 5.72, 95% confidence interval: 2.24 to 14.59, case=5, non-case=929, P<0.001) and boxer (odds ratio: 3.65, 95% confidence interval: 1.84 to 7.25, case=10, non-case=1470, P<0.001). Increased odds of urinary incontinence were associated with greater age (age 9 to 12 years, odds ratio: 10.46, 95% confidence interval: 6.59 to 16.62, n=12,348, P<0.001) and being insured (odds ratio: 1.96, 95% confidence interval: 1.53 to 2.51, n=26,202, P<0.001). There was no association with castration or bodyweight using multi-variable analysis.

CLINICAL SIGNIFICANCE

The overall prevalence of urinary incontinence in male dogs is approximately 1%, which may be higher than expected given the sparsity of reports describing this problem. In contrast to bitches, neutering and bodyweight were not associated with greater odds of urinary incontinence, which is important when giving neutering advice.

Ultrastable Silicon Cavity in a Continuously Operating Closed-Cycle Cryostat at 4 K

We report on a laser locked to a silicon cavity operating continuously at 4 K with 1×10^{-16} instability and a median linewidth of 17 mHz at 1542 nm. This is a tenfold improvement in short-term instability, and a 10^{4} improvement in linewidth, over previous sub-10-K systems. Operating at low temperatures reduces the thermal noise floor and, thus, is advantageous toward reaching an instability of 10^{-18}, a long-sought goal of the optical clock community. The performance of this system demonstrates the technical readiness for the development of the next generation of ultrastable lasers that operate with an ultranarrow linewidth and long-term stability without user intervention.

Reduction of residual amplitude modulation to 1 × 10⁻⁶ for frequency modulation and laser stabilization

Active control and cancellation of residual amplitude modulation (RAM) in phase modulation of an optical carrier is one of the key technologies for achieving the ultimate stability of a laser locked to an ultrastable optical cavity. Furthermore, such techniques are versatile tools in various frequency modulation-based spectroscopy applications. In this Letter we report a simple and robust approach to actively stabilize RAM in an optical phase modulation process. We employ a waveguide-based electro-optic modulator (EOM) to provide phase modulation and implement an active servo with both DC electric field and temperature feedback onto the EOM to cancel both the in-phase and quadrature components of the RAM. This technique allows RAM control on the parts-per-million level where RAM-induced frequency instability is comparable to or lower than the fundamental thermal noise limit of the best available optical cavities.

Prevalence and antimicrobial resistance of canine urinary tract pathogens

This study aims to describe the incidence and risk factors for positive urinary tract culture, the prevalence of urinary tract pathogens in single organism and mixed cultures and changes in their antimicrobial resistance over 10 years. A retrospective review of computer records detailing canine urine samples submitted between August 1999 and September 2009 for culture and sensitivity in a UK tertiary referral hospital is described. 17.5 per cent of 5923 samples (670 of 4530 dogs) were positive cultures. 85.3 per cent of cultures yielded a single isolate. The prevalence of bacterial species differed between mixed and single isolate cultures. Entire and neutered female dogs were more likely to return positive cultures than male dogs (OR=2.5 and 1.5, respectively). Escherichia coli was most commonly isolated (53.9 per cent) and affected female dogs, older dogs and neutered dogs more. There was an increase in the antimicrobial resistance of Enterococcus faecalis and Pseudomonas Aeruginosa, and a decrease in the effectiveness of enrofloxacin, cephalexin and oxytetracycline. The prevalence of urinary bacterial isolates is described for a large group of dogs. Monitoring changes in antimicrobial efficacy and microbial resistance guides the empirical use of antimicrobials for the treatment of urinary tract infection and helps formulate strategic plans to limit drug resistance.

Expression analysis of loci associated with type 2 diabetes in human tissues

AIMS/HYPOTHESIS

Genetic mapping has identified over 20 loci contributing to genetic risk of type 2 diabetes. The next step is to identify the genes and mechanisms regulating the contributions of genetic risk to disease. The goal of this study was to evaluate the effect of age, height, weight and risk alleles on expression of candidate genes in diabetes-associated regions in three relevant human tissues.

METHODS

We measured transcript abundance for WFS1, KCNJ11, TCF2 (also known as HNF1B), PPARG, HHEX, IDE, CDKAL1, CDKN2A, CDKN2B, IGF2BP2, SLC30A8 and TCF7L2 by quantitative RT-PCR in human pancreas (n = 50), colon (n = 195) and liver (n = 50). Tissue samples were genotyped for single nucleotide polymorphisms (SNPs) associated with type 2 diabetes. The effects of age, height, weight, tissue and SNP on RNA expression were tested by linear modelling.

RESULTS

Expression of all genes exhibited tissue bias. Immunohistochemistry confirmed the findings for HHEX, IDE and SLC30A8, which showed strongest tissue-specific mRNA expression bias. Neither age, height nor weight were associated with gene expression. We found no evidence that type 2 diabetes-associated SNPs affect neighbouring gene expression (cis-expression quantitative trait loci) in colon, pancreas and liver.

CONCLUSIONS/INTERPRETATION

This study provides new evidence that tissue-type, but not age, height, weight or SNPs in or near candidate genes associated with increased risk of type 2 diabetes are strong contributors to differential gene expression in the genes and tissues examined.

Evidence for neuroendocrine function of a unique splicing form of TCF7L2 in human brain, islets and gut

AIMS/HYPOTHESIS

Variants in the TCF7L2 gene remain the strongest genetic associations with increased risk of type 2 diabetes. Recently, we identified a unique splicing form of TCF7L2 expressed in pancreatic islets, pancreas and colon and detected by assay 'ex13-13b'. The expression of ex13-13b strongly correlated with proinsulin in glucose-stimulated pancreatic islets, suggesting a potential role for this form in the development of type 2 diabetes. The goal of this study was to further characterise this unique TCF7L2 splicing form in human tissues.

METHODS

We used a panel of 34 human tissues and 80 human cell lines to measure the expression of assay ex13-13b with use of quantitative RT-PCR.

RESULTS

The highest expression of assay ex13-13b was detected in several areas of the brain (hypothalamus/thalamus, occipital lobe) and in neuronal cell line SHS5Y5. Low expression was confirmed in pancreatic islets, small intestine, pancreas and colon, while no expression was detected in other human tissues and cell lines. The expression of assay ex13-13b correlated with the gene for cocaine- and amphetamine-regulated transcript (CART, also known as CARTPT) in a panel of human tissues (n = 12, r = 0.85, p = 0.00046), pancreatic islets (n = 23, r = 0.62, p = 0.0016) and colon (n = 98, r = 0.54, p < 0.0001).

CONCLUSIONS/INTERPRETATION

The significant correlation between expression of a unique splicing form of TCF7L2, named here TCF7L2-NE, and CART, the gene for an anorexigenic neurohormone expressed in the central and peripheral nervous system, suggests that these transcripts may share neuroendocrine functions important for brain, gut and pancreatic islets.

Randomized clinical trial of single-dose antibiotic prophylaxis for non-reconstructive breast surgery

Background

The aim of this randomized clinical trial was to determine whether a single intravenous dose of 2 g flucloxacillin could prevent wound infection after primary non-reconstructive breast surgery.

Methods

The study included 618 patients undergoing local excision (n = 490), mastectomy (n = 107) or microdochectomy (n = 21). Patients were randomized to receive either a single dose of flucloxacillin immediately after the induction of anaesthesia or no intervention. Wound morbidity was monitored by an independent research nurse for 42 days after surgery.

Results

The incidence of wound infection was similar in the two groups: 10 of 311 (3·2 per cent) in the flucloxacillin group and 14 of 307 (4·6 per cent) in the control group (χ2 = 0·75, P = 0·387; relative risk 0·71, 95 per cent confidence interval 0·32 to 1·53). The groups also had similar wound scores and rates of moderate or severe cellulitis. Wound infection presented a median of 16 days after surgery.

Conclusion

The administration of a single dose of flucloxacillin failed to reduce the rate of wound infection after non-reconstructive breast surgery.

Isolation, cloning and expression analysis of EcPMA1, a putative plasma membrane H+ -ATPase transporter gene from the biotrophic pathogenic fungus Erysiphe cichoracearum

Little is known at the molecular level about the transporters involved in nutrient transfer in the plant/powdery mildew interaction. A PCR-based approach was used to identify and isolate a partial-length cDNA coding for an isoform of the plasma membrane H+ -ATPase (EcPMA1) in the biotrophic pathogenic fungus Erysiphe cichoracearum. Southern analysis suggests that EcPMA1 exists as a single-copy gene. Sequence analysis indicated a high similarity of EcPMA1 to other fungal H+ -ATPases. Expression of EcPMA1 increases in infected Arabidopsis leaves as the disease progresses, correlating with the growth of the pathogen.

Experimental implementation of optical clockwork without carrier-envelope phase control

We demonstrate optical clockwork without the need for carrier-envelope phase control by use of sum-frequency generation between a continuous-wave optical parametric oscillator at 3.39 microm and a femtosecond mode-locked Ti:sapphire laser with two strong spectral peaks at 834 and 670 nm, a spectral difference matched by the 3.39-microm radiation.

Transition metal transporters in plants

Transition metals such as Fe, Cu, Mn, and Zn are essential minerals for normal plant growth and development, although they can be toxic when present in excess. Thus, for healthy plant growth, a range of transition metals must be acquired from the soil, distributed around the plant, and their concentrations carefully regulated within different cells and organelles. Membrane transport systems are likely to play a central role in these processes. The application of powerful genetic and molecular techniques has now identified a range of gene families that are likely to be involved in transition metal transport. These include the heavy metal ATPases (HMAs), the Nramps, the cation diffusion facilitator (CDF) family, the ZIP family, and the cation antiporters. This review provides a broad overview of the range of potential transport systems now thought to be involved in the uptake, distribution and homeostasis of transition metals in plants.

Functional expression of AtHMA4, a P1B-type ATPase of the Zn/Co/Cd/Pb subclass

Mechanisms are required by all organisms to maintain the concentration of essential heavy metals (e.g. Zn and Cu) within physiological limits and to minimise the detrimental effects of non-essential heavy metals (e.g. Cd). Heavy-metal P-type ATPases (HMAs) are a subgroup of the P-type ATPase superfamily that may contribute to metal homeostasis in plants. We cloned and characterised a member of this family, AtHMA4, from Arabidopsis thaliana that clusters with the Zn/Co/Cd/Pb subclass of HMAs on phylogenetic analysis. Sequencing of the AtHMA4 cDNA showed that it contained the conserved motifs found in all P-type ATPases and also motifs that are characteristic of heavy-metal ATPases. Escherichia coli mutants defective in the HMAs, CopA and ZntA, were used in functional complementation studies. AtHMA4 was able to restore growth at high [Zn] in the zntA mutant but not at high [Cu] in the copA mutant, suggesting a role in zinc transport. Heterologous expression of AtHMA4 in Saccharomyces cerevisiae made the yeast more resistant to Cd but did not affect sensitivity to other metals compared with vector-transformed controls. The organ specificity of AtHMA4 was analysed in Arabidopsis and showed that AtHMA4 was expressed in a range of tissues with highest expression in roots. AtHMA4 was upregulated in roots exposed to elevated levels of Zn and Mn but downregulated by Cd. Possible physiological roles of this transporter in Arabidopsis are discussed.

Functional expression of AtHMA4, a P1B-type ATPase of the Zn/Co/Cd/Pb subclass

Mechanisms are required by all organisms to maintain the concentration of essential heavy metals (e.g. Zn and Cu) within physiological limits and to minimise the detrimental effects of non-essential heavy metals (e.g. Cd). Heavy-metal P-type ATPases (HMAs) are a subgroup of the P-type ATPase superfamily that may contribute to metal homeostasis in plants. We cloned and characterised a member of this family, AtHMA4, from Arabidopsis thaliana that clusters with the Zn/Co/Cd/Pb subclass of HMAs on phylogenetic analysis. Sequencing of the AtHMA4 cDNA showed that it contained the conserved motifs found in all P-type ATPases and also motifs that are characteristic of heavy-metal ATPases. Escherichia coli mutants defective in the HMAs, CopA and ZntA, were used in functional complementation studies. AtHMA4 was able to restore growth at high [Zn] in the zntA mutant but not at high [Cu] in the copA mutant, suggesting a role in zinc transport. Heterologous expression of AtHMA4 in Saccharomyces cerevisiae made the yeast more resistant to Cd but did not affect sensitivity to other metals compared with vector-transformed controls. The organ specificity of AtHMA4 was analysed in Arabidopsis and showed that AtHMA4 was expressed in a range of tissues with highest expression in roots. AtHMA4 was upregulated in roots exposed to elevated levels of Zn and Mn but downregulated by Cd. Possible physiological roles of this transporter in Arabidopsis are discussed.

The monosaccharide transporter gene, AtSTP4, and the cell-wall invertase, Atbetafruct1, are induced in Arabidopsis during infection with the fungal biotroph Erysiphe cichoracearum

Powdery mildew fungi are biotrophic pathogens that form a complex interface, the haustorium, between the host plant and the parasite. The pathogen acts as an additional sink, competing with host sinks, resulting in considerable modification of photoassimilate production and partitioning within the host tissue. Here, we examine the factors that may contribute to these changes. We show for the first time in one biotrophic interaction (Arabidopsis/Erysiphe cichoracearum) all of the following responses: Glc uptake in host tissues is enhanced after fungal infection; this coincides with the induction of expression of the monosaccharide transporter gene, Arabidopsis sugar transport protein 4 (AtSTP4), in infected leaves; invertase activity and transcript levels for a cell wall invertase, Atbetafruct1, increase substantially in Arabidopsis during attack by this pathogen. Before infection, Arabidopsis plants transformed with an AtSTP4 promoter-beta-glucuronidase construct show expression mainly in sink tissues such as roots; after infection, AtSTP4 expression is induced in the mature leaves and increases over the 6-d time period. Sections of infected leaves stained for beta-glucuronidase show that AtSTP4 expression is not confined to infected epidermal cells but is also evident in a wider range of cells, including those of the vascular tissue. The results are discussed in relation to the possible coordinated expression of hexose transporters and cell wall invertase in the host response to powdery mildew infection.

Cellular mechanisms for heavy metal detoxification and tolerance

Heavy metals such as Cu and Zn are essential for normal plant growth, although elevated concentrations of both essential and non-essential metals can result in growth inhibition and toxicity symptoms. Plants possess a range of potential cellular mechanisms that may be involved in the detoxification of heavy metals and thus tolerance to metal stress. These include roles for the following: for mycorrhiza and for binding to cell wall and extracellular exudates; for reduced uptake or efflux pumping of metals at the plasma membrane; for chelation of metals in the cytosol by peptides such as phytochelatins; for the repair of stress-damaged proteins; and for the compartmentation of metals in the vacuole by tonoplast-located transporters. This review provides a broad overview of the evidence for an involvement of each mechanism in heavy metal detoxification and tolerance.

Cellular mechanisms for heavy metal detoxification and tolerance

Heavy metals such as Cu and Zn are essential for normal plant growth, although elevated concentrations of both essential and non-essential metals can result in growth inhibition and toxicity symptoms. Plants possess a range of potential cellular mechanisms that may be involved in the detoxification of heavy metals and thus tolerance to metal stress. These include roles for the following: for mycorrhiza and for binding to cell wall and extracellular exudates; for reduced uptake or efflux pumping of metals at the plasma membrane; for chelation of metals in the cytosol by peptides such as phytochelatins; for the repair of stress-damaged proteins; and for the compartmentation of metals in the vacuole by tonoplast-located transporters. This review provides a broad overview of the evidence for an involvement of each mechanism in heavy metal detoxification and tolerance.

Molecular iodine clock

We demonstrate a simple optical clock based on an optical transition of iodine molecules, providing a frequency stability superior to most rf sources. Combined with a femtosecond-laser-based optical comb to provide the phase coherent clock mechanism linking the optical and microwave spectra, we derive an rf clock signal of comparable stability over an extended period. Measurements suggest the stability ( 5x10(-14) at 1 s) of the cw laser locked on the iodine transition is transferred to every comb component throughout the optical octave bandwidth (from 532 to 1064 nm) with a precision of 3.5x10(-15). Characterization of the performance of the optical clock shows (in-)stability below 3x10(-13) at 1 s (currently limited by the microwave sources), and 4.6x10(-13) over one year.

Application of multidimensional scaling to subjective evaluation of coded speech

We present results from a pilot study directed at developing an anchorable subjective speech quality test. The test uses multidimensional scaling techniques to obtain quantitative information about the perceptual attributes of speech. In the first phase of the study, subjects ranked perceptual distances between samples of speech produced by two different talkers, one male and one female, processed by a variety of codecs. The resulting distance matrices were processed to obtain, for each talker, a stimulus space for the various speech samples. This stimulus space has the properties that distances between stimuli in this space correspond to perceptual distances between stimuli and that the dimensions of this space correspond to attributes used by the subjects in determining perceptual distances. Mean opinion scores (MOS) scores obtained in an earlier study were found to be highly correlated with position in the stimulus space, and the three dimensions of the stimulus space were found to have identifiable physical and perceptual correlates. In the second phase of the study, we developed techniques for fitting speech generated by a new codec under investigation into a previously established stimulus space. The user is provided with a collection of speech samples and with the stimulus space for these speech samples as determined by a large-scale listening test. The user then carries out a much smaller listening test to determine the position of the new stimulus in the previously established stimulus space. This system is anchorable, so that different versions of a codec under development can be compared directly, and it provides more detailed information than the single number provided by MOS testing. We suggest that this information could be used to advantage in algorithm development and in development of objective measures of speech quality.

An evaluation of outcome after severe trauma

There is a perception that patients with severe trauma either die soon after the trauma or survive. This study evaluated 123 patients with severe trauma until 6 months after discharge from the Intensive Care Unit (ICU). At baseline, the median Injury Severity Score was 29 (interquartile range 20-38) and the median Acute Physiology and Chronic Health Evaluation II score was 13 (interquartile range 9-15). Injuries related to road transport accounted for 79% (97/123) of the injuries and the patients were predominantly male (66%) and young (75% < 38 years of age). The median stay in ICU was 11 days. Ten per cent of the patients (12/123) died during the study period, but one-quarter of the deaths were in hospital after discharge from ICU and one-quarter of the deaths occurred after discharge from hospital. It is impossible to carefully document the mortality due to severe trauma unless the survivors of ICU are reviewed after discharge from hospital.

Phase-coherent optical pulse synthesis from separate femtosecond lasers

We generated a coherently synthesized optical pulse from two independent mode-locked femtosecond lasers, providing a route to extend the coherent bandwidth available for ultrafast science. The two separate lasers (one centered at 760 nanometers wavelength, the other at 810 nanometers) are tightly synchronized and phase-locked. Coherence between the two lasers is demonstrated via spectral interferometry and second-order field cross-correlation. Measurements reveal a coherently synthesized pulse that has a temporally narrower second-order autocorrelation width and that exhibits a larger amplitude than the individual laser outputs. This work represents a new and flexible approach to the synthesis of coherent light.

Overexpression of Ref-1 inhibits hypoxia and tumor necrosis factor-induced endothelial cell apoptosis through nuclear factor-kappab-independent and -dependent pathways

We hypothesized that a redox-sensitive transcription factor, redox factor-1 (Ref-1) (HAP1, APE, and APEX), was critical in the regulation of endothelial cell survival in response to hypoxia and cytokines, including tumor necrosis factor (TNF)-alpha. Hypoxia resulted in a significant decrease in Ref-1 protein expression in both human umbilical vein endothelial cells and calf pulmonary artery endothelial cells. The hypoxia-induced decrease in Ref-1 expression was followed by a significant induction of apoptosis as measured by caspase 3 activity and nuclear morphology. Transient upregulation of Ref-1 significantly inhibited hypoxia-induced apoptosis. However, deletion of the redox-sensitive domain of Ref-1 abolished the antiapoptotic effect. We postulated that the antiapoptotic effects of Ref-1 were mediated through nuclear factor-kappaB (NF-kappaB). However, blockade of NF-kappaB with a dominant-negative IkappaB (S32A/S36A) expression vector had no effect on Ref-1-mediated survival under hypoxic conditions. The second aim of this study was to test the cytoprotective ability of Ref-1 upregulation in response to TNF-induced apoptosis. Ref-1 inhibition of TNF-induced death was associated with a significant potentiation of NF-kappaB activity. Deletion of the redox-sensitive domain of Ref-1 significantly inhibited TNF-induced NF-kappaB activation. Moreover, loss of the redox-sensitive domain also abolished the antiapoptotic effect of Ref-1 in response to TNF. To test whether Ref-1 induced activation of NF-kappaB was necessary to promote survival, we blocked NF-kappaB activity with a dominant-negative IkappaB (S32A/S36A). Indeed, blockade of NF-kappaB activity abolished the ability of Ref-1 to rescue TNF-induced apoptosis. In conclusion, upregulation of Ref-1 promotes endothelial cell survival in response to hypoxia and TNF through NF-kappaB-independent and NF-kappaB-dependent signaling cascades, respectively. Moreover, it seems that Ref-1 may act as a critical cofactor, mediating the TNF-induced NF-kappaB response in the vascular endothelium.

Upregulation of glucose metabolism during intimal lesion formation is coupled to the inhibition of vascular smooth muscle cell apoptosis. Role of GSK3beta

The purpose of this study was to define the role of metabolic regulatory genes in the pathogenesis of vascular lesions. The glucose transporter isoform, GLUT1, was significantly increased in the neointima after balloon injury. To define the role of GLUT1 in vascular biology, we established cultured vascular smooth muscle cells (VSMCs) with constitutive upregulation of GLUT1, which led to a threefold increase in glucose uptake as well as significant increases in both nonoxidative and oxidative glucose metabolism as assessed by 13C-nuclear magnetic resonance spectroscopy. We hypothesized that the differential enhancement of glucose metabolism in the neointima contributed to formation of lesions by increasing the resistance of VSMCs to apoptosis. Indeed, upregulation of GLUT1 significantly inhibited apoptosis induced by serum withdrawal (control 20 +/- 1% vs. GLUT1 11 +/- 1%, P < 0.0005) as well as Fas-ligand (control 12 +/- 1% vs. GLUT1 6 +/- 1.0%, P < 0.0005). Provocatively, the enhanced glucose metabolism in GLUT1 overexpressing VSMC as well as neointimal tissue correlated with the inactivation of the proapoptotic kinase, glycogen synthase kinase 3beta (GSK3beta). Transient overexpression of GSK3beta was sufficient to induce apoptosis (control 7 +/- 1% vs. GSK3beta 28 +/- 2%, P < 0.0001). GSK3beta-induced apoptosis was significantly attenuated by GLUT1 overexpression (GSK3beta 29 +/- 3% vs. GLUT1 + GSK3beta 6 +/- 1%, n = 12, P < 0.001), suggesting that the antiapoptotic effect of enhanced glucose metabolism is linked to the inactivation of GSK3beta. Taken together, upregulation of glucose metabolism during intimal lesion formation promotes an antiapoptotic signaling pathway that is linked to the inactivation of GSK3beta.

Diabetes reduces right atrial beta-adrenergic signaling but not agonist stimulation of heart rate in swine

This study assessed the effects of streptozotocin diabetes in swine on the heart rate response to beta-adrenergic stimulation the adenylyl cyclase signal transduction pathway. Diabetic animals (n = 9) were hyperglycemic compared to the control group (n = 10) (12.6 +/- 1.0 vs. 3.53 +/- 0.29 mM). There were no significant differences between the diabetic and nondiabetic groups in the heart rate response to isoproterenol, however, there was a significant reduction (14%) in beta-adrenergic receptor density in the right atrium in the diabetic (61 +/- 3 fmol/mg protein) versus the nondiabetic group (71 +/- 3) (P < 0.05). The content of guanosine triphosphate binding regulatory proteins (Gs and Gi) in the right atrium was not affected by diabetes, nor was adenylyl cyclase activity under unstimulated conditions or with receptor-dependent stimulation with isoproterenol. On the other hand, adenylyl cyclase activity was 34% lower when directly stimulated with forskolin, and it was reduced by 23% when stimulated through Gs with Gpp(NH)p. In conclusion, beta-adrenergic stimulation of heart rate with isoproteronol and the receptor-dependent signal transduction pathway remained intact in the right atrium of diabetic swine despite reduced beta-adrenergic receptor density, G-protein content, and direct stimulation of adenylyl cyclase activity.

Alternative dispute resolution and the physician--the use of mediation to resolve hospital-medical staff conflicts

The use of adversarial methods to resolve disputes arising out of medical staff matters can be time-consuming, costly, and disruptive to the hospital-medical staff relationship. As this article suggests, mediation is the preferred method of alternative dispute resolution for reaching mutually acceptable solutions with minimal harm to relationships.

The COBRA patient anti-dumping law: Part II--Impact on physician liability

This is the second part of a two-part article examining the federal patient anti-dumping statute, under which physicians are required to treat a hospital's emergency patients, including women in labor, and to comply with certain requirements that dictate when it is appropriate to transfer a patient. Part I discussed in detail the provisions of the statute. Part II analyzes various court interpretations of the law and its potential impact on physician liability.

The COBRA Patient Anti-Dumping Law: Part I--Requirements under the statute

Under the federal patient anti-dumping statute, physicians are required to treat a hospital's emergency patients, including women in labor, and must comply with detailed statutory provisions that govern when it is appropriate to transfer a patient to another facility. A thorough understanding of this law is necessary to minimize the risk of liability to the physician and the hospital. This article, the first of two parts, discusses the requirements under the statute. Part II, which will appear in a future issue, will discuss court interpretations of the statute and its impact on medical malpractice claims.

Identification of novel genes in late-onset Alzheimer's disease

Four genes affecting Alzheimer's Disease (AD)(AP, PS1, PS2, and APOE) have been identified and a fifth potential gene localized to chromosome 12. Collectively, these genes explain at most half of the genetic effect in AD. Understanding the genetics of AD is critical to developing new treatments. The quest to find the remaining AD genes led us to undertake a large genomic screen using over 466 families (730 affected sibpairs) in late-onset AD. In conjunction with this increase in power, we initiated several novel approaches to identify potential AD-related genes. This included stratification of the data into an autopsy-confirmed subset of 199 AD families. Each of these targeted analyses resulted in the identification of novel regions containing potential AD genetic risk factors. Our most significant finding was on chromosome 9 in the autopsy-confirmed subset where we obtained an MLS of 4.31. These approaches, together with new methodologies such as conditional linkage analysis, generalized family-based association tests (PDT), and a new generation of genetic markers (SNPs), opens the door for additional AD gene discovery. Such strategies are necessary if we are to understand the subtle and complex threads that, woven together, create the intricate tapestry of AD.

Precision phase control of an ultrawide-bandwidth femtosecond laser: a network of ultrastable frequency marks across the visible spectrum

We demonstrate that the stability of the current optical frequency comb generated by a Kerr-lens mode-locked femtosecond laser is limited by the microwave reference used for phase locking the comb spacing. Hence we implement precision frequency/phase control of the entire comb to the fundamental and second-harmonic frequencies of a stable cw laser without any external microwave reference. The stability of a cw iodine-stabilized laser is transferred to millions of comb lines (with an instability of 3 x 10(-13)) covering more than one octave of the optical frequency spectrum. In addition, the mode spacing of the comb can be used as a stable microwave frequency derived directly from a stable optical oscillator.

Antibiotic prophylaxis for patients undergoing breast surgery

Some groups of patients undergoing clean surgery benefit from the provision of antibiotic prophylaxis against wound infection. Breast surgery may belong to this category because several substantial studies have reported that it is accompanied by an unacceptably high rate of wound infection. However, only two clinical trials have addressed this issue and both produced equivocal results. Resolution of this problem is important because, aside from the usual advantages obtained by preventing such complications, wound infection diminishes the proportion of patients with breast cancer who start adjuvant regimens within an optimum time after surgery.

Accuracy comparison of absolute optical frequency measurement between harmonic-generation synthesis and a frequency-division femtosecond comb

Using an iodine-stabilized He-Ne laser as a transfer oscillator, we compare absolute measurements of the optical frequency from a traditional frequency synthesis chain based on harmonic generation and from the frequency division technique of an ultrawide bandwidth femtosecond frequency comb. The agreement between these two measurements, both linked to the Cs standard, is 220+/-770 Hz, yielding a measurement accuracy of 1.6x10(-12). We report 473 612 353 604.8+/-1.2 kHz as a preliminary updated value of the absolute frequency of the " f" component for the He-Ne laser international standard at 633 nm.

Detection of daily clouds on Titan

We have discovered frequent variations in the near-infrared spectrum of Titan, Saturn's largest moon, which are indicative of the daily presence of sparse clouds covering less than 1% of the area of the satellite. The thermodynamics of Titan's atmosphere and the clouds' altitudes suggest that convection governs their evolutions. Their short lives point to the presence of rain. We propose that Titan's atmosphere resembles Earth's, with clouds, rain, and an active weather cycle, driven by latent heat release from the primary condensible species.