Lewy body dementia: Overcoming barriers and identifying solutions

Despite its high prevalence among dementias, Lewy body dementia (LBD) remains poorly understood with a limited, albeit growing, evidence base. The public-health burden that LBD imposes is worsened by overlapping pathologies, which contribute to misdiagnosis, and lack of treatments. For this report, we gathered and analyzed public-domain information on advocacy, funding, research outputs, and the therapeutic pipeline to identify gaps in each of these key elements. To further understand the current gaps, we also conducted interviews with leading experts in regulatory/governmental agencies, LBD advocacy, academic research, and biopharmaceutical research, as well as with funding sources. We identified wide gaps across the entire landscape, the most critical being in research. Many of the experts participated in a workshop to discuss the prioritization of research areas with a view to accelerating therapeutic development and improving patient care. This white paper outlines the opportunities for bridging the major LBD gaps and creates the framework for collaboration in that endeavor. HIGHLIGHTS: A group representing academia, government, industry, and consulting expertise was convened to discuss current progress in Dementia with Lewy Body care and research. Consideration of expert opinion,natural language processing of the literature as well as publicly available data bases, and Delphi inspired discussion led to a proposed consensus document of priorities for the field.

FALCON systematically interrogates free fatty acid biology and identifies a novel mediator of lipotoxicity

Cellular exposure to free fatty acids (FFAs) is implicated in the pathogenesis of obesity-associated diseases. However, there are no scalable approaches to comprehensively assess the diverse FFAs circulating in human plasma. Furthermore, assessing how FFA-mediated processes interact with genetic risk for disease remains elusive. Here, we report the design and implementation of fatty acid library for comprehensive ontologies (FALCON), an unbiased, scalable, and multimodal interrogation of 61 structurally diverse FFAs. We identified a subset of lipotoxic monounsaturated fatty acids associated with decreased membrane fluidity. Furthermore, we prioritized genes that reflect the combined effects of harmful FFA exposure and genetic risk for type 2 diabetes (T2D). We found that c-MAF-inducing protein (CMIP) protects cells from FFA exposure by modulating Akt signaling. In sum, FALCON empowers the study of fundamental FFA biology and offers an integrative approach to identify much needed targets for diverse diseases associated with disordered FFA metabolism.

FALCON systematically interrogates free fatty acid biology and identifies a novel mediator of lipotoxicity

Cellular exposure to free fatty acids (FFA) is implicated in the pathogenesis of obesity-associated diseases. However, studies to date have assumed that a few select FFAs are representative of broad structural categories, and there are no scalable approaches to comprehensively assess the biological processes induced by exposure to diverse FFAs circulating in human plasma. Furthermore, assessing how these FFA- mediated processes interact with genetic risk for disease remains elusive. Here we report the design and implementation of FALCON (Fatty Acid Library for Comprehensive ONtologies) as an unbiased, scalable and multimodal interrogation of 61 structurally diverse FFAs. We identified a subset of lipotoxic monounsaturated fatty acids (MUFAs) with a distinct lipidomic profile associated with decreased membrane fluidity. Furthermore, we developed a new approach to prioritize genes that reflect the combined effects of exposure to harmful FFAs and genetic risk for type 2 diabetes (T2D). Importantly, we found that c-MAF inducing protein (CMIP) protects cells from exposure to FFAs by modulating Akt signaling and we validated the role of CMIP in human pancreatic beta cells. In sum, FALCON empowers the study of fundamental FFA biology and offers an integrative approach to identify much needed targets for diverse diseases associated with disordered FFA metabolism.

Highlights

FALCON (Fatty Acid Library for Comprehensive ONtologies) enables multimodal profiling of 61 free fatty acids (FFAs) to reveal 5 FFA clusters with distinct biological effectsFALCON is applicable to many and diverse cell typesA subset of monounsaturated FAs (MUFAs) equally or more toxic than canonical lipotoxic saturated FAs (SFAs) leads to decreased membrane fluidityNew approach prioritizes genes that represent the combined effects of environmental (FFA) exposure and genetic risk for diseaseC-Maf inducing protein (CMIP) is identified as a suppressor of FFA-induced lipotoxicity via Akt-mediated signaling.

Harnessing reaction-based probes to preferentially target pancreatic β-cells and β-like cells

Highly sensitive approaches to target insulin-expressing cells would allow more effective imaging, sorting, and analysis of pancreatic β-cells. Here, we introduce the use of a reaction-based probe, diacetylated Zinpyr1 (DA-ZP1), to image pancreatic β-cells and β-like cells derived from human pluripotent stem cells. We harness the high intracellular zinc concentration of β-cells to induce a fluorescence signal in cells after administration of DA-ZP1. Given its specificity and rapid uptake by cells, we used DA-ZP1 to purify live stem cell-derived β-like cells as confirmed by immunostaining analysis. We tested the ability of DA-ZP1 to image transplanted human islet grafts and endogenous mouse pancreatic islets in vivo after its systemic administration into mice. Thus, DA-ZP1 enables purification of insulin-secreting β-like cells for downstream applications, such as functional studies, gene-expression, and cell-cell interaction analyses and can be used to label engrafted human islets and endogenous mouse islets in vivo.

Heterogeneous mass distribution of the rubble-pile asteroid (101955) Bennu

The gravity field of a small body provides insight into its internal mass distribution. We used two approaches to measure the gravity field of the rubble-pile asteroid (101955) Bennu: (i) tracking and modeling the spacecraft in orbit about the asteroid and (ii) tracking and modeling pebble-sized particles naturally ejected from Bennu's surface into sustained orbits. These approaches yield statistically consistent results up to degree and order 3, with the particle-based field being statistically significant up to degree and order 9. Comparisons with a constant-density shape model show that Bennu has a heterogeneous mass distribution. These deviations can be modeled with lower densities at Bennu's equatorial bulge and center. The lower-density equator is consistent with recent migration and redistribution of material. The lower-density center is consistent with a past period of rapid rotation, either from a previous Yarkovsky-O'Keefe-Radzievskii-Paddack cycle or arising during Bennu's accretion following the disruption of its parent body.

Native Zinc Catalyzes Selective and Traceless Release of Small Molecules in β-Cells

The loss of insulin-producing β-cells is the central pathological event in type 1 and 2 diabetes, which has led to efforts to identify molecules to promote β-cell proliferation, protection, and imaging. However, the lack of β-cell specificity of these molecules jeopardizes their therapeutic potential. A general platform for selective release of small-molecule cargoes in β-cells over other islet cells ex vivo or other cell-types in an organismal context will be immensely valuable in advancing diabetes research and therapeutic development. Here, we leverage the unusually high Zn(II) concentration in β-cells to develop a Zn(II)-based prodrug system to selectively and tracelessly deliver bioactive small molecules and fluorophores to β-cells. The Zn(II)-targeting mechanism enriches the inactive cargo in β-cells as compared to other pancreatic cells; importantly, Zn(II)-mediated hydrolysis triggers cargo activation. This prodrug system, with modular components that allow for fine-tuning selectivity, should enable the safer and more effective targeting of β-cells.

The dynamic geophysical environment of (101955) Bennu based on OSIRIS-REx measurements

The top-shape morphology of asteroid (101955) Bennu is commonly found among fast-spinning asteroids and binary asteroid primaries, and might have contributed significantly to binary asteroid formation. Yet a detailed geophysical analysis of this morphology for a fast-spinning asteroid has not been possible prior to the Origins, Spectral Interpretation, Resource Identification, and Security-Regolith Explorer (OSIRIS-REx) mission. Combining the measured Bennu mass and shape obtained during the Preliminary Survey phase of OSIRIS-REx, we find a significant transition in Bennu's surface slopes within its rotational Roche lobe, defined as the region where material is energetically trapped to the surface. As the intersection of the rotational Roche lobe with Bennu's surface has been most recently migrating towards its equator (given Bennu's increasing spin rate), we infer that Bennu's surface slopes have been changing across its surface within the last million years. We also find evidence for substantial density heterogeneity within this body, suggesting that its interior has a distribution of voids and boulders. The presence of such heterogeneity and Bennu's top-shape is consistent with spin-induced failure at some point in its past, although the manner of its failure cannot be determined yet. Future measurements by the OSIRIS-REx spacecraft will give additional insights and may resolve questions regarding the formation and evolution of Bennu's top-shape morphology and its link to the formation of binary asteroids.

Keratinocyte Carcinoma as a Marker of a High Cancer-Risk Phenotype

Keratinocyte carcinoma (KC) (also referred to as nonmelanoma skin cancer) is by far the most common form of human cancer. A personal history of KC is well established to be associated with increased risk of recurrent KC and malignant melanoma, a less common yet more fatal form of skin cancer. More surprising is that a substantial body of epidemiologic evidence now indicates that a personal history of KC is significantly associated with an overall elevated risk of noncutaneous malignancies. This association is not limited to one or a few types of cancer but applies across many different types of malignancy. This association has been consistently observed in prospective studies across genders for both major histologic types of KC, basal cell carcinoma and squamous cell carcinoma. The risk of other cancers has been even stronger in those with younger compared with older age of onset of KC. A robust body of evidence lends support to the notion that KC may be a marker of a high cancer-risk phenotype. The underlying mechanisms for this association remain to be elucidated, but the cross-cutting nature of this association across numerous malignancies suggests that research to uncover these mechanisms is a promising line of inquiry that could potentially yield valuable insight into human carcinogenesis.

Effects of incubator temperature and oxygen concentration during the plateau stage of oxygen consumption on Turkey embryo long bone development

Temperature (TEM) and O(2) concentrations during the plateau stage of oxygen consumption are known to affect yolk utilization, tissue development, and thyroid metabolism in turkey embryos. Three experiments were conducted to evaluate these incubation effects on long bone development. Fertile eggs of Nicholas turkeys were used. In each trial, standard incubation conditions were used to 24 d, when the eggs containing viable embryos were randomly divided into 4 groups. Four experimental cabinets provided 4 TEM (36, 37, 38, or 39 degrees C) or 4 O(2) concentrations (17, 19, 21, or 23% O(2)). In the third experiment, 2 temperatures (36 and 39 degrees C) and 2 O(2) concentrations (17 and 23%) were evaluated in a 2 x 2 factorial design. Body and residual yolk weights were obtained. Both legs were dissected, and shanks, femur, and tibia weights, length, and thickness were recorded. Relative asymmetry of each leg section was calculated. Chondrocyte density was evaluated in slides stained with hematoxylin and eosin. Immunofluorescence was used to evaluate the presence of collagen type X and transforming growth factor beta. Hot TEM caused reduction of tibia weights and increase of shank weight when compared with cool TEM. The lengths of femur, tibia, and shanks were reduced by 39 degrees C. The relative asymmetry of leg weights were increased at 38 and 39 degrees C. Poult body and part weights were not affected by O(2) concentrations, but poults on 23% O(2) had bigger shanks and heavier tibias than the ones on 17% O(2). High TEM depressed the fluorescence of collagen type X and transforming growth factor beta. The O(2) concentrations did not consistently affect the immunofluorescence of these proteins. The chondrocyte density was affected by TEM and O(2) in resting and hypertrophic zones. In the third experiment, high TEM depressed BW, leg muscle weights, and shank length. Low O(2) reduced tibia and shanks as a proportion of the whole body. We concluded that incubation conditions affect long bone development in turkeys.

19 THE EFFECT OF PROGESTERONE ON FOLLICULAR DEVELOPMENT AND PREGNANCY RATE IN BEEF CATTLE

The objective was to determine the effect of the level of progesterone (P4) during the ovulatory wave on fertility. Low v. high progesterone concentrations which were expected to result in high v. low LH pulse-frequency were compared. Lactating, postpartum beef cows (n = 69) at random stages of the estrous cycle were given cloprostenol (PGF; Schering-Plough Animal Health, Pointe-Claire, QC, Canada) twice at an 11-day interval to synchronize ovulation (Day 0 = day of 2nd PGF). Cows were given 1.5 mg estradiol benzoate on Day 10 (7 days after expected ovulation). On Day 10, the Low-P4 group was given PGF and an intravaginal CueMate (Bioniche Animal Health, Belleville, ON, Canada) containing one P4 pod (expected to achieve a P4 plasma level of 1 ng mL–1). The High-P4 group also received a CueMate with one pod on Day 10, but no PGF was administered (i.e., cows were allowed to retain their CL for 4 days after expected emergence of the estradiol-induced wave). On Day 18, CueMates were removed and PGF was administered to both groups. Fifty-four to 56 h later, all animals received 12.5 mg of Lutropin-V (Bioniche) IM and were timed AI (TAI). Dominant follicle diameter was measured on Day 18 and at the time of AI. Pregnancy diagnosis was done by ultrasonography 27 days after AI to compare fertility between groups. Follicle diameter data were analyzed by Student's t-test and pregnancy rate data were compared by the chi-square test. The dominant follicle in the Low-P4 group was larger (P < 0.05) than in the high-P4 group on the day of the CueMate removal (Day 18) and on the day of the TAI (11.8 � 0.4 and 13.7 � 0.5 v. 13.3 � 0.6 and 15.3 � 0.6 in the High-P4 and Low-P4 groups, respectively). Pregnancy rate was similar (P = 0.16) between the groups (High-P4: 55.6% (20/36) and Low-P4: 44.4% (16/33)); however, a larger study is in progress to confirm these results. To conclude, Low-P4 resulted in a larger dominant follicle without any apparent effect on pregnancy rate. The project was funded by Saskatchewan ADF and NSERC. L. Pfeifer is funded through a CAPES scholarship. We acknowledge Schering-Plough and Bioniche for donation of pharmaceuticals.

20 ADMINISTRATION OF FOLLICLE-STIMULATING HORMONE AT CIDR REMOVAL DOES NOT AFFECT THE PREGNANCY RATE IN A CIDR-BASED, COSYNCH PROTOCOL IN LACTATING BEEF COWS

In previous studies, giving eCG at CIDR removal significantly increased the pregnancy rate after timed-AI in beef cows. However, eCG is not universally available. Therefore, we tested the hypothesis that giving pFSH at CIDR removal might improve the pregnancy rate in a CIDR-based, Cosynch protocol in postpartum, suckled Bos taurus beef cows; a secondary objective was to compare pregnancy rates when GnRH v. pLH was used to synchronize wave emergence and ovulation. This work was conducted as two experiments (separate locations). All cows were given a CIDR (containing 1.9 g progesterone; Pfizer Animal Health, Montreal, QC, Canada) on Day 0 (without regard to stage of estrous cycle or cyclicity). On Day 7, CIDRs were removed, all cows were concurrently given 25 mg PGF (Lutalyse; Pfizer Animal Health, Groton, CT, USA), half were given 20 mg pFSH (Folltropin-V; Bioniche Animal Health, Belleville, ON, Canada), and all cows were timed-AI 54 h later (Day 9). In Experiment 1, 240 cows [94 � 10.8 days postpartum; body condition score (BCS: 1 = emaciated, 9 = obese; mean � SD): 5.8 � 0.4] were used; at CIDR insertion and AI, cows were allocated to receive either 100 µg GnRH (n = 160; Cystorelin, Merial Canada Inc., Victoriaville, QC, Canada) or 12.5 mg pLH (n = 80; Lutropin-V, Bioniche Animal Health). In Experiment 2, 109 cows (59.2 � 19.5 days postpartum; BCS: 5.6 � 1.1) were used; all received 100 µg GnRH (Cystorelin) at CIDR insertion and AI. In Experiment 1, three cows that lost their CIDR were excluded; pregnancy rates after timed-AI (logistic regression, backward selection: parity, pFSH, synchronizing treatment, and their interactions) were not different between cows given pFSH v. control cows (64.7 v. 65.2%; P > 0.80), nor between cows given GnRH v. pLH (62.7 v. 69.6%; P = 0.91). However, there was an interaction (P < 0.04) between parity and the synchronizing treatment; in primiparous cows, pregnancy rates were significantly lower in those given GnRH v. pLH (59.3 v. 83.3%). In Experiment 2, pregnancy rates after timed-AI (logistic regression, backward selection: parity, pFSH, and their interaction) were not different between cows given pFSH v. control cows (38.2 v. 42.6%; P > 0.6). In conclusion, our hypothesis was not supported; giving pFSH at CIDR removal did not significantly improve the pregnancy rate in a CIDR-based, Cosynch protocol in postpartum, suckled Bos taurus beef cows.

13 EFFECTS OF PLASMA PROGESTERONE CONCENTRATIONS ON LH RELEASE AND OVULATION IN BEEF CATTLE GIVEN GnRH

Two experiments were conducted to determine the effects of plasma progesterone (P4) concentrations on LH release and ovulation in beef heifers and lactating beef cows given gonadotropin-releasing hormone (GnRH). Previously autoclaved, once-used CIDR inserts (Colazo et al. 2004 Anim. Reprod. Sci. 81, 25-34) were used for experimental purposes to induce differential plasma progesterone concentrations. In Experiment 1, postpubertal heifers received 25 mg of dinoprost i.m. (prostaglandin F (PGF); Lutalyse; Pfizer Animal Health, Montreal, Quebec, Canada). On Day 4 (estrus = Day 0), heifers were randomly assigned (10/group) to receive no treatment (control) or 1 or 2 autoclaved once-used CIDR (Pfizer Animal Health) inserts (1CIDR and 2CIDR, respectively). On Day 5, heifers in the 1CIDR group were given PGF twice 12 h apart. On Day 6, all heifers received 100 �g of GnRH i.m. (Cystorelin; Merial Canada, Inc., Victoriaville, Quebec, Canada). Once daily on Days 4 to 9, a blood sample was collected and ultrasonography was performed. On Day 6, heifers in the control (3.0 � 0.4 ng/mL; mean � SD) and 1CIDR groups (3.0 � 0.3 ng/mL) had lower (P < 0.01) plasma progesterone concentrations than those in the 2CIDR group (5.7 � 0.4 ng/mL). However, the diameter of the dominant follicle was larger (P < 0.001) in heifers in the control and 1CIDR groups than in the 2CIDR group (12.1 � 1.0, 11.5 � 0.7, and 10.1 � 0.7 mm, respectively). More (P < 0.01) heifers ovulated in response to GnRH in the control and 1CIDR groups than in the 2CIDR group (10/10, 9/10, and 3/10, respectively). In Experiment 2, ultrasound-guided follicular ablation (FA) was performed (to synchronize ovarian follicular wave emergence) 4 to 6 days after estrus in 20 postpubertal heifers and 20 mature lactating cows. Cattle were randomly and equally assigned to receive an autoclaved, once-used CIDR, either with no further treatment (High-P4) or with two PGF treatments 12 h apart (Low-P4) given after FA. All cattle received 100 �g of GnRH either 6 days after FA or the day after the dominant follicle reached 9 mm in diameter. Ultrasonography was performed daily (from 4 days after FA to ovulation or to 3 days after GnRH treatment). In three cows and three heifers per group, blood samples were collected every 30 min for 12 h after GnRH. The dominant follicle at GnRH treatment was larger in cows than heifers (11.0 � 1.1 vs. 10.3 � 0.9 mm, respectively; P = 0.05) and tended to be smaller in the High-P4 group vs. the Low-P4 group (10.3 � 1.0 vs. 11.0 � 1.0 mm; P = 0.06). Ovulatory response was not different (P = 0.9) between heifers (77.7%) and cows (78.9%), but combined for heifers and cows, was lower in High-P4 vs. Low-P4 cattle (61.1 vs. 94.7; P < 0.01). The GnRH-induced LH surge did not differ (P = 0.23) between cows and heifers, but it was lower and of shorter duration (P < 0.001) in the High-P4 group than in the Low-P4 group. In summary, higher plasma P4 concentrations resulted in decreased LH release and the proportion of cattle ovulating in response to GnRH treatment. There was no significant difference between heifers and cows in LH release or ovulatory response.

11 EFFECTS OF CIDR-BASED PRESYNCHRONIZATION AND eCG ON FERTILITY FOR A GnRH-BASED TIMED-AI PROTOCOL IN BEEF CATTLE

The objectives were to determine the effects of presynchronization and eCG on fertility for a GnRH-based timed-AI (TAI) protocol in beef cattle. Previously autoclaved once-used CIDR inserts (Colazo et al. 2004 Anim. Reprod. Sci. 81, 25-34) were used for experimental purposes so that all cattle had equivalent exogenous progesterone after Day 7 in Experiment 1, and to induce GnRH-responsive follicles in Experiment 2. In Experiment 1, 12-15 month old beef heifers (n = 447) were used (three locations, A, B, and C). On Day 0, half received a new CIDR insert (Pfizer Animal Health, Montreal, Quebec, Canada) and 500 �g of cloprostenol i.m. (PGF: Estrumate; Schering-Plough Animal Health, Pointe-Claire, Quebec, Canada). On Day 7, the remainder received an autoclaved once-used CIDR and all received 100 �g of GnRH i.m. (Cystorelin; Merial Canada, Inc., Victoriaville, Quebec, Canada). On Day 14, CIDR inserts were removed, PGF was given to all heifers, and heifers were given either 300 IU eCG i.m. (Pregnacol; Bioniche Animal Health, Belleville, Ontario, Canada) or no treatment (2 � 2 factorial design). On Day 16 (54-56 h after CIDR removal and PGF administration), heifers were given 100 �g of GnRH i.m., concurrent with TAI. Transrectal ultrasonography was done on Day 0 to assess ovarian structures, and on approximately Day 50 (range, 44-69) to confirm pregnancy. Overall, 72.7% of heifers were puberal on Day 0 (150/150, 5/37, and 170/260 for locations A, B, and C, respectively; P < 0.001). Pregnancy rate was affected (P < 0.001) by location (27.3, 62.2, and 51.1% for the three locations, respectively) but was not affected (P = 0.3) by puberal status at locations B and C. Pregnancy rate was not affected (P = 0.5) by presynchronization, but tended (P = 0.1) to be reduced by eCG treatment (40.4 vs. 47.7%, respectively). In Experiment 2, lactating crossbred beef cows (n = 411), 2-12 years of age were randomly allocated to receive either a previously used, autoclaved CIDR for 7 days and 25 mg of dinoprost i.m. (PGF: Lutalyse; Pfizer Animal Health) or no treatment (control; Day 0). At CIDR removal (Day 7), all cows received 100 �g of GnRH. On Day 14, all cows received PGF and were allocated to receive either 400 IU of eCG i.m. or no treatment (2 � 2 factorial design). On Day 16 (54-56 h after PGF), cows were given 100 �g of GnRH concurrent with TAI. Transrectal ultrasonographic examinations were done on approximately 65 cows in each group on Days 0, 7, and 14 to assess ovarian structures and on all cows on Day 42 to confirm pregnancy. Overall, 88.8% of cows had a corpus luteum (CL) on Day 0. Presynchronization increased both the proportion of cows that ovulated to GnRH treatment on Day 7 (76.7 vs. 55.0%; P < 0.001) and pregnancy rate (58.2 vs. 45.4%; P = 0.03) for cows that had received a CIDR vs. control cows. However, eCG treatment did not affect pregnancy rate (P = 0.3) in either group. In summary, presynchronization with a used CIDR and PGF prior to a Cosynch protocol increased ovulation rate to the first GnRH treatment and pregnancy rate in cows but not in heifers. In a GnRH-based TAI protocol, treatment with eCG had no significant effect on fertility in cows, but tended to decrease fertility in heifers.

Effects of formulation concentration on intravenous pharmacokinetics, chirality and in vitro solubility of oxfendazole and its metabolites in sheep

This study compared pharmacokinetic (PK) profiles in sheep dosed intravenously with three different concentrations of oxfendazole (OFZ). An in vitro plasma OFZ solubility study provided additional information on plasma saturation. For the PK study, 18 adult, parasite-free, female Suffolk cross sheep, allocated into three groups (n = 6), were treated intravenously, at a dose rate of 5 mg/kg bodyweight, with aqueous formulations containing at 4, 8 or 16% OFZ. Plasma drug concentrations were measured, for up to 72 h post-treatment, by a validated high performance liquid chromatography method with UV detection. OFZ and fenbendazole sulphone (FBZSO2) were the main metabolites detected in all three experimental groups. In animals given the 4% formulation, OFZ depleted according to a biexponential concentration vs. time curve. In contrast, those given 8 or 16% preparations produced atypical curves fitted by monoexponential equations. No statistically significant differences in area under concentration-time curves (AUC) were observed, but concentration-dependent differences in distribution and mean residence time (MRT) were evident. Compared with 4% OFZ, animals treated with 8 and 16% formulations had slower half-lives of metabolite formation, and lower AUC's, suggesting that OFZ sulphonation may have been modified. In vitro there was evidence of plasma saturation associated with 8 and 16% OFZ preparations. It is concluded that differences in PK profiles were related to OFZ solubility and/or tissue drug precipitation.

18 STRATEGIES TO IMPROVE FERTILITY WITH COSYNCH-CIDR PROTOCOLS IN BEEF CATTLE

Two experiments were designed to evaluate strategies to improve fertility with Cosynch-CIDR protocols in cattle. The first experiment investigated the effect of low levels of progesterone prior to a Cosynch-CIDR protocol. On Day 0, lactating beef cows (n = 34) and heifers (n = 37) were placed in two groups to receive 500 μg cloprostenol (PGF; Estrumate, Schering-Plough Animal Health, Pointe-Claire, Quebec, Canada) or a twice-used CIDR (Bioniche Animal Health, Belleville, Ontario, Canada) for 5 days (Pretreatment) or no treatment (Control). On Day 5, used CIDRs were removed and all cattle received a new CIDR (Pfizer Animal Health, Montreal, Quebec, Canada) and 100 μg GnRH (Cystorelin, Merial Canada Inc, Victoriaville, Quebec, Canada). On Day 12, CIDR were removed and PGF was given. A second GnRH was given concurrent with timed AI (TAI) on Day 14 (54–56 h after PGF). Cattle were examined by transrectal ultrasonography for CL and follicle development, and for confirmation of pregnancy (Days 42 to 49). Diameter of the dominant follicle on Day 5 was larger and more variable in cows than in heifers (15.5 ± 5.6 vs. 11.4 ± 3.5 mm, respectively; means, P < 0.001; variance, P < 0.003), and tended to be larger in the Pretreatment group (14.3 ± 4.9 vs. 12.6 ± 5.2 mm; P = 0.13). More Pretreated (60.0%) than Control (36.1%) cattle (P < 0.005), and more cows (64.7%) than heifers (32.4%; P < 0.03) ovulated following the first GnRH. At the time of TAI, 5 (13.5%) heifers had already ovulated (P < 0.03). Diameter of the preovulatory follicle was affected by parity (P < 0.001), but not Pretreatment (P = 0.4), and tended to be larger in heifers that became pregnant (P = 0.13). Pregnancy rate was not affected by parity (P = 0.71), or pretreatment (P = 0.34); pretreatment tended to increase pregnancy rate in heifers (63.2 vs. 38.9%; P = 0.19). The second experiment evaluated the use of eCG in a Cosynch-CIDR protocol in beef heifers. Beef heifers (n = 127) were fed 0.5 mg/head/day of MGA (Pfizer Animal Health) for 15 d; 12 d after the last feeding (designated as Day 0) heifers received a CIDR and 100 μg GnRH. On Day 7, CIDR were removed, and heifers received PGF, and were randomly placed in 2 groups to receive 300 IU of eCG (Pregnacol; Bioniche Animal Health) or no treatment (Control). On Day 9 (54–56 h after PGF), all heifers received 100 μg GnRH, concurrent with TAI. Ultrasonographic examinations were done as in the first experiment. Overall, 79.5% of the heifers had a CL, and 9.4% had a luteinized follicle on Day 0. Seventy-eight heifers (61.4%) ovulated following the first GnRH, and those that ovulated had a less variable preovulatory follicle size than those that did not (13.7 ± 1.7 vs. 13.8 ± 2.3 mm; means, P = 0.76; variance, P < 0.01). However, there was no difference in preovulatory follicle size (P = 0.63), or pregnancy rate (49.2 vs. 53.1%; P = 0.7) for eCG-treated vs. Control heifers. In summary, pretreatment with a twice-used CIDR plus PGF increased the proportion of cattle that ovulated to the first GnRH, but not preovulatory follicle size or fertility in cows; fertility tended to be improved in heifers. Treatment with eCG did not increase preovulatory follicle size or fertility in heifers subjected to an Cosynch-CIDR protocol.

13 EFFECTS OF PRESYNCHRONIZATION WITH A USED CIDR, AND TREATMENT WITH eCG ON FERTILITY IN LACTATING COWS SUBJECTED TO A COSYNCH PROTOCOL

The objectives were to investigate the effects of pretreatment with a used CIDR on follicle size and ovulation rate in cows after an injection of GnRH, and treatment with eCG at the time of PGF on preovulatory follicle size and fertility in cows subjected to a Cosynch protocol. Lactating crossbred beef cows (n = 292), 2 to 12 years of age were allocated to two groups to receive either a used CIDR (Bioniche Animal Health; Belleville, Ontario, Canada) for 15 days or no treatment (Control). At CIDR removal (Day 0), all cows received 100 μg of GnRH i.m. (Cystorelin, Merial Canada Inc., Victoriaville, Quebec, Canada). On Day 7, all cows received 500 μg of cloprostenol i.m. (PGF; Estrumate, Schering-Plough Animal Health, Pointe-Claire, Quebec, Canada) and were further allocated to receive either 400 IU of eCG i.m. (Pregnacol; Bioniche Animal Health) or no treatment (2 × 2 factorial design; n = 73 per group). On Day 9 (54 h after PGF), cows were given 100 μg of GnRH i.m., concurrent with timed AI (TAI). Transrectal ultrasonographic examinations were done on a subset of approximately 40 cows in each group on Days −15, 0, 7, and 9 to assess ovarian structures, and on all cows on Day 37 to confirm pregnancy. Data were analyzed by SAS CATMOD and ANOVA. Overall, 53% of cows had a CL present on Day −15 (P = 0.23). At first GnRH (Day 0), fewer CIDR-treated cows than Control cows had a CL (15.2 vs. 85.0%, respectively; P < 0.001), while mean (± SEM) diameters of the dominant follicle were larger in CIDR-treated cows (18.2 ± 0.4 vs. 13.8 ± 0.4 mm, respectively; P < 0.001). Moreover, the proportion of cows that ovulated following the first GnRH was higher (P < 0.001) in CIDR-treated (75.0%) than Control (48.7%) cows. Eight (10.0%) cows presynchronized with a CIDR did not ovulate and had a luteinized follicle (31.7 ± 1.9 mm) at the time of PGF. Although CIDR-treated cows had larger (P < 0.002) dominant follicles than Control cows on Day 9 (16.6 ± 0.3 vs. 15.2 ± 0.3 mm), presynchronization did not affect fertility (53.4 vs. 54.1%, respectively). However, diameter of the dominant follicle at TAI in cows that became pregnant was smaller in CIDR-treated vs. Control cows (15.3 ± 0.3 vs. 16.6 ± 0.3; P < 0.005). Treatment with eCG on Day 7 did not affect (P = 0.17) the diameter of the dominant follicle at TAI, but tended (P = 0.06) to increase pregnancy rate (58.9 vs. 48.6%). Furthermore, pregnancy rate tended to be higher (P = 0.08) in Control cows given eCG (47/73, 64.4%) than in the Control- (32/73, 43.8%), CIDR- (39/73, 53.4%) or CIDR/eCG- (39/73, 53.4%) treated cows. In addition, pregnancy rate was affected by parity; 2-yr-old cows had a lower (P < 0.04) pregnancy rate than older cows (42.9, 58.7, and 58.2% for 2, 3–4, and >5 years, respectively). Treatment with eCG increased pregnancy rate by 33% (P < 0.03) in 2-yr-old Control cows. In summary, presynchronization with a used CIDR prior to a Cosynch protocol increased the proportion of cows responding to the first GnRH. Although CIDR-treated cows had a smaller dominant follicle at TAI, pregnancy rate was not affected. Treatment with eCG increased fertility in Control cows; eCG may be useful in GnRH-based protocols in lactating beef cows.

183PREGNANCY RATE FOLLOWING TRANSFER OF IN VITRO- AND IN VIVO-PRODUCED BOVINE EMBRYOS TO LH-TREATED RECIPIENTS

The objective was to evaluate the effect of pLH treatment on pregnancy rates in recipients receiving in vivo- or in vitro-produced bovine embryos. Heifers (n=37) and lactating (n=28) and non-lactating (n=150) beef cows were treated at random stages of the cycle with 100μg GnRH i.m. (Cystorelin, Merial Canada Inc., Victoriaville, Quebec, Canada) on Day −9, 500μg cloprostenol i.m. (PGF; Estrumate, Schering Plough Animal Health, Pointe-Claire, Quebec, Canada) on Day —2 and GnRH on Day 0 (66h post-PGF; without estrus detection). Cattle were placed at random, by class, into three groups: no further treatment (Control; n=71), or 12.5mg pLH (Lutropin-V, Bioniche Animal Health, Belleville, Ontario, Canada) on Day 5 (n=72) or on Day 7 (n=72) after the second GnRH. On Day 7, cattle with a CL &gt;10mm in diameter (determined ultrasonically) received in vivo-produced, fresh (Simmental) or frozen (Holstein), or in vitro-produced frozen (Holstein) embryos (embryo type balanced among groups). Embryos were cryopreserved in 10% ethylene glycol; in vivo-produced frozen embryos were thawed 5 to 10s in air, 15s in a water-bath at 30°C and then “direct-transferred” nonsurgically. In vitro-produced frozen embryos (donated by IND Lifetech Inc., Delta, British Columbia, Canada) were thawed in a water-bath at 27°C for 10s and placed in ViGro Holding Plus medium (AB Technology, Pullman, WA, USA) at room temperature, evaluated and then transferred nonsurgically. Pregnancy was determined by ultrasonography on Day 35. Data were analyzed with CATMOD, chi-square and GLM procedures (SAS Institute, Cary, NC, USA.). Twenty cattle (9.3%) did not receive embryos; five heifers had cervical problems, and five heifers and 10 cows did not have a CL &gt;10mm. Overall, 7.1% of the recipients had two CL on the day of embryo transfer. There was no effect (P&gt;0.05) of treatment, embryo type (or interaction) or class of recipient on pregnancy rate (overall, 44.1%, 86/195; Table 1). Similarly, mean (±SD) CL diameter and luteal area did not differ (P&gt;0.05) among groups or between pregnant and open recipients (overall, 22.0±3.4mm and 352.0±108.7mm, respectively). However, recipients with a CL diameter ≥18mm tended (P&lt;0.1) to have a higher pregnancy rate (45.8 vs 25.0%). In a subset of 40 recipients examined ultrasonically on Day 12, 50% of those treated on Day 5 and 70% of those treated with pLH on Day 7 had two CL. In summary, overall pregnancy rate in GnRH-synchronized recipients receiving in vitro- or in vivo-produced embryos by nonsurgical transfer was 44.1%. Embryo survival to Day 35 was not affected by type of embryo or treatment with pLH 5 or 7 days after ovulation. Table 1 Pregnancy rate in recipients on Day 35 based on pLH treatment and embryo-type

Dexamethasone decreases plasma levels of the prochiral fenbendazole and its chiral and achiral metabolites in sheep

1. The effect of co-administration of either short- or long-acting formulations of DXM on hepatic function and the plasma pharmacokinetic behaviour of prochiral fenbendazole (FBZ) and its metabolites was evaluated in sheep. 2. Neither DXM treatment markedly affected any of the biochemical markers of hepatic function tested. In contrast, both formulations significantly modified the plasma pharmacokinetic behaviour of FBZ and its metabolites. 3. Plasma FBZ concentrations and the associated area under the time-concentration curves were significantly lower, although the plasma detection period was longer (72 versus 48 h) in the DXM pretreated animals compared with those given FBZ alone. 4. DXM also appeared to alter the pattern of FBZ absorption, possibly through effects on abomasal pH. The shape of the plasma concentration-time curves for oxfendazole (OFZ) and fenbendazole sulphone (FBZSO(2)) were similar to FBZ, raising the possibility that DXM treatment may have altered the liver biotransformation of the parent drug. 5. The concentrations of the (+) chiral metabolite of OFZ were significantly lower in DXM pretreated animals compared with those given FBZ alone. The trend was similar for the (-) antipode, although the differences between DXM pretreated and non-pretreated animals were not statistically significant.

Serotonin receptor mRNA expression in rat dorsal root ganglion neurons

In the present study, we have used in situ hybridization to examine the distribution of serotonin (5-HT) receptors in rat dorsal root ganglion (DRG) neurons. Within DRG neurons, mRNAs for 5-HT1B, 5-HT1D, 5-HT2A, 5-HT2B, 5-HT3B and 5-HT4 receptors were readily detected in small (<25 microm), medium (25-45 microm) and large (>45 microm) diameter neurons. In contrast mRNAs for 5-HT1A, 5-HT1E, 5-HT2C, 5-HT5A, 5-HT5B, 5-HT6 and 5-HT7 receptors were undetectable in these neurons. The present study provides an insight into the molecular profile of 5-HT receptor subtypes in neurons responsible for modulating sensory information.

Plexiform neurofibromas in NF1: toward biologic-based therapy

Neurofibromatosis type 1 (NF1) is one of the most common neurogenetic diseases affecting adults and children. Neurofibromas are one of the most common of the protean manifestations of NF1. Plexiform neurofibromas, which will frequently cause cosmetic abnormalities, pain, and neurologic deficits, are composed of "neoplastic" Schwann cells accompanied by other participating cellular and noncellular components. There is increasing evidence that loss of NF1 expression in neoplastic Schwann cells is associated with elevated levels of activated RAS, supporting the notion that the NF1 gene product, neurofibromin, acts as a growth regulator by inhibiting ras growth-promoting activity. In addition, there is increasing evidence that other cooperating events, which may be under cytokine modulation, are important for neurofibroma development and growth. Treatment of plexiform neurofibromas has been empiric, with surgery being the primary option for those with progressive lesions causing a major degree of morbidity. The efficacy of alternative treatment approaches, including the use of antihistamines, maturation agents, and antiangiogenic drugs, has been questionable. More recently, biologic-based therapeutic approaches, using drugs that target the molecular genetic underpinnings of plexiform neurofibromas or cytokines believed important in tumor growth, have been initiated. Evaluation of such trials is hindered by the unpredictable natural history of plexiform neurofibromas and difficulties in determining objective response in tumors that are notoriously large and irregular in shape. Innovative neuroimaging techniques and the incorporation of quality-of-life scales may be helpful in evaluation of therapeutic interventions. The ability to design more rational therapies for NF1-associated neurofibromas is heavily predicated on an improved understanding of the molecular and cellular biology of the cells involved in neurofibroma formation and growth.

Plasma achiral and chiral pharmacokinetic behaviour of intravenous oxfendazole co-administered with piperonyl butoxide in sheep

Co-administration of piperonyl butoxide (PB) potentiates fenbendazole (FBZ) in small ruminants. The resultant increase in bioavailability of FBZ and its metabolite oxfendazole (OFZ) has important implications for the efficacy of these drugs against benzimidazole (BZD)-resistant strains of Teladorsagia circumcincta. This study evaluated the racemic (achiral) and enantiomeric (chiral) plasma disposition kinetics of OFZ and its metabolites after the co-administration of PB and OFZ in sheep. Six 6-8-month-old, parasite-free, female Dorset sheep (30-40 kg) were used in a two-phase crossover experiment. In phase I, three sheep received 30 mg/kg PB orally, followed by a single intravenous (i.v.) injection of OFZ at 5 mg/kg. The other three animals were treated similarly except that 5 mL of water replaced PB. In phase 2, treatments for the two groups were reversed and were given 14 days after the initiation of phase I. Three analytes OFZ, FBZ and fenbendazole sulphone (FBZSO(2)) were recovered in plasma up to 48 h post-treatment in both experimental groups. Achiral and chiral pharmacokinetic (PK) profiles for OFZ, after the co-administration of PB, were characterized by a significantly greater area under the concentration--time curve (AUC) and a longer mean residence time (MRT). Chiral OFZ distribution ratios were comparable in both treatment groups. Piperonyl butoxide treatment markedly influenced the plasma PK profiles for FBZ and FBZSO(2) following OFZ administration. Production of FBZ was enhanced as reflected by increased (> 60%) AUC, delayed T(max) and a significantly delayed (> 45%) elimination (t(1/2)(el)). Although AUC values for FBZSO(2) were not significantly different between groups, this metabolite was depleted more slowly from plasma (t(1/2)(el) > 60% and MRT > 42%) following PB treatment. This study demonstrated that PB co-administration is associated with an inhibition of OFZ biotransformation, as evidenced by the significantly higher plasma concentrations of OFZ and FBZ, and this could have important implications in terms of anti-parasite therapy against BZD-resistant parasite strains.

Direct detection of 16S rRNA in soil extracts by using oligonucleotide microarrays

We report on the development and validation of a simple microarray method for the direct detection of intact 16S rRNA from unpurified soil extracts. Total RNAs from Geobacter chapellei and Desulfovibrio desulfuricans were hybridized to an oligonucleotide array consisting of universal and species-specific 16S rRNA probes. PCR-amplified products from Geobacter and Desulfovibrio were easily and specifically detected under a range of hybridization times, temperatures, and buffers. However, reproducible, specific hybridization and detection of intact rRNA could be accomplished only by using a chaperone-detector probe strategy. With this knowledge, assay conditions were developed for rRNA detection using a 2-h hybridization time at room temperature. Hybridization specificity and signal intensity were enhanced using fragmented RNA. Formamide was required in the hybridization buffer in order to achieve species-specific detection of intact rRNA. With the chaperone detection strategy, we were able to specifically hybridize and detect G. chapellei 16S rRNA directly from a total-RNA soil extract, without further purification or removal of soluble soil constituents. The detection sensitivity for G. chapellei 16S rRNA in soil extracts was at least 0.5 microg of total RNA, representing approximately 7.5 x 10(6) Geobacter cell equivalents of RNA. These results suggest that it is now possible to apply microarray technology to the direct detection of microorganisms in environmental samples, without using PCR.

A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of olanzapine, lorazepam, or placebo in treating acutely agitated patients diagnosed with bipolar mania

There are no rapid-acting intramuscular formulations of atypical antipsychotics available for quickly calming an agitated patient with bipolar disorder. In this study, 201 agitated patients with bipolar mania were randomly assigned to receive one to three injections of the atypical antipsychotic olanzapine (10 mg, first two injections; 5 mg, third injection), the benzodiazepine lorazepam (2 mg, first two injections; 1 mg, third injection), or placebo (placebo, first two injections; olanzapine, 10 mg, third injection) within a 24-hour period. Agitation was measured at baseline, every 30 minutes for the first 2 hours, and at 24 hours after the first injection using the Positive and Negative Syndrome Scale-Excited Component subscale and two additional agitation scales. At 2 hours after the first injection, patients treated with olanzapine showed a significantly greater reduction in scores on all agitation scales compared with patients treated with either placebo or lorazepam. At 24 hours after the first injection, olanzapine remained statistically superior to placebo in reducing agitation in patients with acute mania, whereas patients treated with lorazepam were not significantly different from those treated with placebo or olanzapine. Furthermore, no significant differences among the three treatment groups were observed in safety measures, including treatment-emergent extrapyramidal symptoms, the incidence of acute dystonia, or QTc interval changes. These findings suggest that intramuscular olanzapine is a safe and effective treatment for reducing acute agitation in patients with bipolar mania.

Liver and biliary system pathology in equine dysautonomia (grass sickness)

Hepatocellular and hepatobiliary damage was assessed in equine acute, subacute and chronic grass sickness cases (AGS, SAGS, CGS). Histopathological analysis showed that even in some early AGS cases enlarged hepatocytes, hepatocyte vacuolation indicative of lipid accumulation (steatosis), intrahepatocyte, canalicular and periportal deposition of pigments, frequent leucocyte infiltration and cholangitis occurred. Analysis of serum indicated significantly increased levels of unconjugated bilirubin in all groups and conjugated bilirubin in AGS and SAGS groups, increased levels of bile acids in some individuals from each group and significantly increased levels of glutamate dehydrogenase (GLDH) in AGS and SAGS cases. Conjugated bilirubin was significantly elevated in urine of AGS and SAGS cases. The evidence suggests that abnormal liver function involving moderate hepatocellular pathology in conjunction with steatosis and cholestasis may contribute to the pathogenesis of GS.

Advances in satellite remote sensing of environmental variables for epidemiological applications

Earth-observing satellites have provided an unprecedented view of the land surface but have been exploited relatively little for the measurement of environmental variables of particular relevance to epidemiology. Recent advances in techniques to recover continuous fields of air temperature, humidity, and vapour pressure deficit from remotely sensed observations have significant potential for disease vector monitoring and related epidemiological applications. We report on the development of techniques to map environmental variables with relevance to the prediction of the relative abundance of disease vectors and intermediate hosts. Improvements to current methods of obtaining information on vegetation properties, canopy and surface temperature and soil moisture over large areas are also discussed. Algorithms used to measure these variables incorporate visible, near-infrared and thermal infrared radiation observations derived from time series of satellite-based sensors, focused here primarily but not exclusively on the Advanced Very High Resolution Radiometer (AVHRR) instruments. The variables compare favourably with surface measurements over a broad array of conditions at several study sites, and maps of retrieved variables captured patterns of spatial variability comparable to, and locally more accurate than, spatially interpolated meteorological observations. Application of multi-temporal maps of these variables are discussed in relation to current epidemiological research on the distribution and abundance of some common disease vectors.

Social support and self-esteem predict changes in bipolar depression but not mania

INTRODUCTION

Our own and other research has suggested that social support predicts course of bipolar disorder, with particularly strong effects on depressive symptoms. Within this paper, we examine which components of social support appear most powerful.

METHODS

Thirty-one individuals with Bipolar I disorder were followed longitudinally for 9 months. Participants completed a standardized symptom severity interview monthly, and at a 2-month follow-up, they completed the Interpersonal Support Evaluation List. At a 6-month follow-up, they completed the Rosenberg Self-Esteem Inventory.

RESULTS

Self-esteem support appeared to the most important predictor of change in depression across a 6-month follow-up, and multiple regression analyses suggested that social support effects were mediated through self-esteem. LIMITATIONS AND IMPLICATIONS: Although the small sample size suggests a need for replication, current results highlight the importance of psychosocial variables in the course of bipolar depression. Self-esteem may be a particularly important target for clinical interventions.

Visualising the actin cytoskeleton

The actin cytoskeleton is a dynamic filamentous network whose formation and remodeling underlies the fundamental processes of cell motility and shape determination. To serve these roles, different compartments of the actin cytoskeleton engage in forming specific coupling sites between neighbouring cells and with the underlying matrix, which themselves serve signal transducing functions. In this review, we focus on methods used to visualise the actin cytoskeleton and its dynamics, embracing the use of proteins tagged with conventional fluorophores and green fluorescent protein. Included also is a comparison of cooled CCD technology, confocal and 2-photon fluorescence microscopy of living and fixed cells, as well as a critique of current procedures for electron microscopy.

Factors affecting graft excursion patterns in endoscopic anterior cruciate ligament reconstruction

The effect of femoral guide rotation in endoscopic anterior cruciate ligament (ACL) reconstruction is reviewed based on a previous report. The effect of varied offsets of the femoral guide (5.5 and 7.0 mm) are described. This is one of the few isometry studies to evaluate the knee through a practically full range of motion (0 degree-120 degrees). A 7-mm offset guide rotated to the 12:00 position yields the best single fiber and graft excursion patterns (P < 0.05). A 5.5-mm offset guide yields inferior single fiber and graft excursion patterns. Single fiber and graft isometry are similar but not identical in endoscopic ACL reconstruction. Centering the single fiber in the tibial tunnel has little effect on isometry patterns, demonstrating that the more posterior tibial positions needed for endoscopic reconstruction are acceptable from an isometry standpoint.

Factors affecting isometry of endoscopic anterior cruciate ligament reconstruction: the effect of guide offset and rotation

Eight normal cadaveric knee specimens were used to evaluate the effects of femoral and tibial tunnel positions on length excursions of a single wire and bone-patellar tendon-bone graft as measured by an isometer. Femoral attachment sites were varied by using a commercially available femoral pin guide with either a 5.5- or 7.0-mm offset and by aiming with the guide oriented vertically (12:00 notch position) or rotating 45 degrees toward the lateral condyle (1:30 or 10:30 notch position depending on right or left knee). Tibial isometry was altered by testing the wire against the posterior tunnel wall or 5-mm anterior using a custom centering device. Isometry was measured from 0 degrees to 120 degrees for each position tested. A 7-mm offset guide rotated to the 12:00 position yielded the best single fiber and graft excursion patterns (P < .05). A 5.5-mm offset guide yielded inferior single fiber and graft excursion patterns. Single fiber and graft isometry were found to be similar, but not identical in endoscopic anterior cruciate ligament reconstruction. Centering the single fiber in the tibial tunnel had little effect on excursion patterns, showing that the more posterior tibial positions needed for endoscopic reconstruction are acceptable from an isometry standpoint.

Cochlear implant extrusion in a child with keratitis, ichthyosis and deafness syndrome

We present a child with keratitis, ichthyosis and deafness (KID) syndrome implanted with a Nucleus device. We discuss the would complications of this child and the steps taken to deal with the problems encountered when the wound failed to heal, followed by the partial extrusion of her implant. Early surgical management involved resuturing the wound but when this failed a rotational flap was required to cover the implant package and allow eventual healing. Despite the wound problems and revision surgery she has a good audiological result.

Depression during mania. Treatment response to lithium or divalproex

BACKGROUND

Little information exists from controlled studies about clinical characteristics that predict treatment response in mania. The presence of depressive symptoms during manic episodes may be associated with poor response to psychopharmacological treatments. This is an investigation of the relation between depressive symptoms and treatment response in acute manic episodes.

METHODS AND DESIGN

In a parallel-group, double-blind study, 179 patients hospitalized for acute manic episodes were randomized to receive divalproex sodium, lithium carbonate, or placebo (ratio, 2:1:2). The study was carried out at 9 academic medical centers. Patients had comprehensive evaluations of behavior and symptoms before and during 3 weeks of treatment. The primary outcome measure, change in mania factor scores derived from the Schedule for Affective Disorders and Schizophrenia: Change Version, was compared in patients with and without depressive symptoms at baseline according to nurse- or physician-rated scales.

RESULTS

Depressive symptoms were associated with poor antimanic response to lithium and with better response to divalproex. This was not due to differences in overall severity of illness, substance abuse, gender, age, or history.

CONCLUSIONS

These data suggest that even a modest level of pretreatment depression-related symptoms is a robust predictor of lithium nonresponse, and is associated with better response to divalproex. Although their overall efficacy in acute mania is similar, lithium and divalproex may be most effective in clinically and biologically distinct groups of patients.

The cyclic dilemma: organic, functional, and environmental interaction in a young teenager

This Grand Rounds considers an early-adolescent female who demonstrated a mixed clinical picture including rapid cycling of psychotic behavior. The case presents issues commonly faced in hospital practice and provides an example of the use of standardized instruments in assessment and monitoring treatment, as well as a discussion of issues germane to inpatient child and adolescent psychiatrists and related treatment team members.

Limb salvage after bony and vascular gunshot injuries in a five-week-old infant

Combined bony and vascular injuries present challenging problems to orthopaedic and vascular surgeons. The use of temporary intraluminal vascular shunts produces significant reductions in ischaemia time and allows fracture stabilisation to be performed before definitive, delicate vascular repair. We report our management of a five-week-old infant who sustained a comminuted fracture of the femur with arterial and venous injuries in a shooting incident. Paediatric nasogastric feeding tubes were used as temporary vascular shunts to re-establish the distal circulation. Stabilisation of the fracture was then followed by vascular reconstruction and soft-tissue surgery, with a good result. We emphasise the need for skills from several surgical disciplines in the management of complex combined injuries.

Limb salvage after bony and vascular gunshot injuries in a five-week-old infant

Combined bony and vascular injuries present challenging problems to orthopaedic and vascular surgeons. The use of temporary intraluminal vascular shunts produces significant reductions in ischaemia time and allows fracture stabilisation to be performed before definitive, delicate vascular repair. We report our management of a five-week-old infant who sustained a comminuted fracture of the femur with arterial and venous injuries in a shooting incident. Paediatric nasogastric feeding tubes were used as temporary vascular shunts to re-establish the distal circulation. Stabilisation of the fracture was then followed by vascular reconstruction and soft-tissue surgery, with a good result. We emphasise the need for skills from several surgical disciplines in the management of complex combined injuries.