Regulation of Angiogenesis Discriminates Tissue Resident MSCs from Effective and Defective Osteogenic Environments

Background: The biological mechanisms that contribute to atrophic long bone non-union are poorly understood. Multipotential mesenchymal stromal cells (MSCs) are key contributors to bone formation and are recognised as important mediators of blood vessel formation. This study examines the role of MSCs in tissue formation at the site of atrophic non-union. Materials and Methods: Tissue and MSCs from non-union sites (n = 20) and induced periosteal (IP) membrane formed following the Masquelet bone reconstruction technique (n = 15) or bone marrow (n = 8) were compared. MSC content, differentiation, and influence on angiogenesis were measured in vitro. Cell content and vasculature measurements were performed by flow cytometry and histology, and gene expression was measured by quantitative polymerase chain reaction (qPCR). Results: MSCs from non-union sites had comparable differentiation potential to bone marrow MSCs. Compared with induced periosteum, non-union tissue contained similar proportion of colony-forming cells, but a greater proportion of pericytes (p = 0.036), and endothelial cells (p = 0.016) and blood vessels were more numerous (p = 0.001) with smaller luminal diameter (p = 0.046). MSCs showed marked differences in angiogenic transcripts depending on the source, and those from induced periosteum, but not non-union tissue, inhibited early stages of in vitro angiogenesis. Conclusions: In vitro, non-union site derived MSCs have no impairment of differentiation capacity, but they differ from IP-derived MSCs in mediating angiogenesis. Local MSCs may thus be strongly implicated in the formation of the immature vascular network at the non-union site. Attention should be given to their angiogenic support profile when selecting MSCs for regenerative therapy.

Cross-Generational Transmission of Early Life Stress Effects on HPA Regulators and Bdnf Are Mediated by Sex, Lineage, and Upbringing

Early life stress (ELS) is a potent developmental disruptor and increases the risk for psychopathology. Various forms of ELS have been studied in both humans and rodents, and have been implicated in altered DNA methylation, gene transcription, stress hormone levels, and behavior. Although recent studies have focused on stress-induced epigenetic changes, the extent to which ELS alters HPA axis function and stress responsivity across generations, whether these effects are sex-specific, and how lineage interacts with upbringing to impact these effects, remain unclear. To address these points, two generations of rodents were utilized, with the first generation subjected to ELS via maternal separation, and the second to a balanced cross-fostering paradigm. We hypothesized that ELS would disrupt normative development in both generations, manifesting as altered methylation and expression of genes associated with stress signaling pathways (Nr3c1, Nr3c2, and Bdnf), blunted corticosterone (CORT), and anxiety-like behaviors. Additionally, we expected deficits in the second generation to be modulated by caretaking environment and for the pattern of results to differ between the sexes. Results suggest that direct exposure to ELS leads to sex-specific effects on gene regulation and HPA functioning in adulthood, with maternal separation leading to increases in Bdnf methylation in both sexes, decreases in Bdnf expression in females, and decreases in Nr3c1 methylation in males, as well as blunted CORT and less anxiety-like behavior in females. These alterations converged with caretaking to impart perturbations upon the subsequent generation. Across sex, ELS lineage led to decreased methylation of Nr3c1, and increased methylation of Bdnf. In fostered animals, upbringing by a previously stressed mother interacted with offspring lineage to impact methylation of Nr3c1 and Bdnf. Upbringing was also implicated in altered anxiety-like behavior in males, and baseline CORT levels in females. Such effects may correspond with observed alterations in maternal behavior across groups. In conclusion, ELS conferred enduring sex-specific alterations, both first-hand and trans-generationally via lineage and upbringing. Importantly, lineage of cross-fostered pups was sufficient to normalize or disturb maternal behavior of foster-dams, an observation requiring further elucidation. These results have implications for multi-generational effects of ELS in humans and may motivate early interventions.

Effects of early life stress on cocaine conditioning and AMPA receptor composition are sex-specific and driven by TNF

Exposure to early life adversity can predispose adolescents to the formation of substance abuse disorders. In rodents, early stressors such as repeated maternal separation (MS) impact AMPAR activity in the prefrontal cortex (PFC) and nucleus accumbens (NAc), regions involved in drug-cue association after cocaine-induced conditioned place preference (CPP). Notably, previous reports suggest that the pro-inflammatory cytokine tumor necrosis factor (TNF) regulates AMPAR subunit composition; increased TNF levels are reported to reduce GluA2-positive AMPARs. Since MS can elevate adolescent TNF levels, the stressor may therefore alter AMPAR subunit composition via neuroimmune signaling, thereby affecting cocaine-induced CPP. We tested the specific role of soluble TNF in MS-induced GluA2 loss and cocaine-induced CPP with biologic disruption of TNF signaling. TNF gene and protein expression were elevated in both PFC and NAc of MS males, but not females. GluA2 expression was reduced in both regions in only male MS rats, and systemic treatment with either ibudilast - a phosphodiesterase inhibitor, or XPro1595 - a blood-brain barrier-permeable blocker of soluble TNF - reversed such loss. MS males also formed greater preference for a cocaine-paired environment, the expression of which returned to control levels after XPro1595 administration. These data suggest a sex-specific mechanistic link between TNF signaling and changes in GluA2 expression and drug-cue conditioning, thereby providing further evidence for a role of MS and neuro-immune activity in cortical and striatal AMPAR changes. Moreover, manipulation of the TNF signaling pathway represents a novel approach for influencing response to reinforcing effects of drug use.

Adolescent food restriction in rats alters prefrontal cortex microglia in an experience-dependent manner

Microglia are resident immune cells of the brain that can regulate neural communication and excitability. Any environmental influence on microglial activity has the potential to alter subsequent neural physiology and behavior. Within the prefrontal cortex, several types of stressors have been shown to increase microglial expression of activation markers such as ionized calcium-binding adapter molecule-1 (Iba-1), which suggests altered microglial activity. Recent reports in rodents suggest that exposure to forms of early-life stress such as maternal separation can alter microglial responsivity to subsequent challenges. Several learning paradigms used in rodents require food restriction to provoke motivational states that facilitate approach behaviors. Here, we tested whether food restriction (increasing from 13 g/day-23 g/day in males and 10 g/day-20 g/day in females, which reduced body weight to 72-84% free-fed weight) in adolescent rats is a sufficient challenge to affect microglial Iba-1 expression, and whether previous exposure to postnatal maternal separation influenced microglial outcomes. We measured prefrontal cortex Iba-1 expression and microglial morphology after 20 days of ad libitum or restricted food availability in males and females with or without exposure to maternal separation. Food-restricted animals displayed higher levels of Iba-1 in the prefrontal cortex, with hyper-ramified microglial morphology in maternally separated males and control females, compared to those that were free-fed. Together, our data provide evidence that food restriction paradigms may have unintended effects in some behavioral protocols.

An evaluation of immunization services, using the reaching every district criteria, in two districts of Gujarat, India

Background

Immunizations are considered the most successful and cost-effective public health interventions employed today. While immunization coverage in India has improved dramatically in the last decade, areas of very low coverage persist. The University of Michigan School of Public Health and the Indian Institute of Public Health Gandhinagar collaborated to document strengths and weaknesses of immunization service delivery in two districts in India.

Methods

This report describes a qualitative assessment of clinic level immunization service delivery in ten primary health centers (PHCs) located in two districts of Gujarat, India. Assessment criteria were derived from the Reaching Every District (RED) strategy that is intended to provide a framework for delivering childhood immunizations. Staff from the PHCs were interviewed in April 2013.

Results

Interviews revealed several barriers to immunization service delivery including: 1) Vaccine and supply stockouts; 2) Hard to reach communities; 3) Unreliable Internet access; 4) Cold chain equipment malfunctions; 5) Inconsistently maintained and utilized immunization records and registries.

Conclusions

Immunization service delivery is a complex process that can encounter barriers at many stages. A RED-based evaluation of the vaccine delivery system in Gujarat, India identified several points where the system was performing sub-optimally and possible solutions to successfully address these challenges.

Cognitive impairment effects of early life stress in adolescents can be predicted with early biomarkers: Impacts of sex, experience, and cytokines

Childhood adversity increases vulnerability to psychiatric disorders that emerge in adolescence, in a sex-dependent manner. Early adversity modeled in rodents with maternal separation (MS) affects cognition and medial prefrontal cortex (mPFC) circuitry. Humans and animals exposed to early life adversity also display heightened circulating inflammatory cytokines, however the predictive relationship of these early measures with later behavioral deficits is unknown. Here, male and female rats were exposed to MS or control rearing during the postnatal period (P2-21). Blood samples were taken at distinct developmental time points for analysis of the pro-inflammatory cytokine IL-1β and the anti-inflammatory cytokines IL-4, and IL-10, followed by win-shift cognitive testing and analysis of mPFC parvalbumin (PVB) immunofluorescent interneurons in adolescence. Regression analyses were conducted to explore the relationship between early cytokines and adolescent behavioral measures. We observed sex- and age-dependent effects of MS on circulating cytokines. MS also yielded adolescent decreases in mPFC PVB and cognitive deficits, which were predicted by early cytokine expression in a sex- and experience-dependent manner. Taken together, the present data reveals that circulating cytokines and PVB levels are predictive of adolescent cognitive deficits, and therefore provide compelling evidence for a putative role of early biomarkers in mediating MS-induced behavioral dysfunction. Importantly, predictive relationships often depended on sex and on MS history, suggesting that early life experiences may yield individualistic mechanisms of vulnerability compared to the general population.

Functional Uncoupling NMDAR NR2A Subunit from PSD-95 in the Prefrontal Cortex: Effects on Behavioral Dysfunction and Parvalbumin Loss after Early-Life Stress

Exposure to early-life stress increases vulnerability to psychiatric disorders, including depression, schizophrenia, and anxiety. Growing evidence implicates aberrant development of the prefrontal cortex (PFC) in the effects of early-life stress, which often emerge in adolescence or young adulthood. Specifically, early-life stress in the form of maternal separation (MS) in rodents has been shown to decrease parvalbumin (PVB)-positive interneurons in the adolescent PFC; however, the mechanism underpinning behavioral dysfunction and PVB loss is not yet known. We recently reported that MS causes overexpression of the NMDA subunit NR2A in the PFC of adolescent rats. Elevated PFC NR2A is also found in developmental models of schizophrenia and is correlated with behavioral deficits, acting largely through its association with the postsynaptic protein PSD-95. In addition, adolescent maturation of PVB-positive interneurons relies on NR2A-driven NMDA activity. Therefore, it is possible that the NR2A/PSD-95 signaling complex has a role in adolescent MS effects. Here, we aimed to determine whether a discrete manipulation of PFC NR2A could prevent MS effects on PFC-controlled behaviors, including cognition, anxiety, and novelty-induced hyperlocomotion, as well as PVB loss in adolescence. We intracranially infused the NR2A-specific blocking peptide TAT2A in order to uncouple NR2A from PSD-95 in the early-adolescent PFC, without antagonizing the NMDA receptor. We demonstrated that MS rats treated with TAT2A during early adolescence were protected from MS-induced PVB loss and exhibited less anxious behavior than those infused with control peptide. These data implicate NR2A-related N-methyl-D-aspartate receptor development in adolescent behavioral and neural consequences of early-life stress.

Broken or maladaptive? Altered trajectories in neuroinflammation and behavior after early life adversity

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This paper reviews how early life adversity alters neuroimmune mechanisms.

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Neuroimmune sensitization from early life adversity impacts circuitry at discrete life stages.

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Neuroimmune and neurodevelopmental influences can impact behavior and vulnerability.

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Sexual dimorphism in immune and brain development yield distinct effects of early life adversity.

Exposure to adversity and stress early in development yields vulnerability to mental illnesses throughout the lifespan. Growing evidence suggests that this vulnerability has mechanistic origins involving aberrant development of both neurocircuitry and neuro-immune activity. Here we review the current understanding of when and how stress exposure initiates neuroinflammatory events that interact with brain development. We first review how early life adversity has been associated with various psychopathologies, and how neuroinflammation plays a role in these pathologies. We then summarize data and resultant hypotheses describing how early life adversity may particularly alter neuro-immune development with psychiatric consequences. Finally, we review how sex differences contribute to individualistic vulnerabilities across the lifespan. We submit the importance of understanding how stress during early development might cause outright neural or glial damage, as well as experience-dependent plasticity that may insufficiently prepare an individual for sex-specific or life-stage specific challenges.

Early life stress disrupts social behavior and prefrontal cortex parvalbumin interneurons at an earlier time-point in females than in males

Early life stress exposure (ELS) yields risk for psychiatric disorders that might occur though a population-specific mechanism that impacts prefrontal cortical development. Sex differences in ELS effects are largely unknown and are also essential to understand social and cognitive development. ELS can cause dysfunction within parvalbumin (PVB)-containing inhibitory interneurons in the prefrontal cortex and in several prefrontal cortex-mediated behaviors including social interaction. Social behavior deficits are often the earliest observed changes in psychiatric disorders, therefore the time-course and causation of social interaction deficits after ELS are important to determine. PVB interneuron dysfunction can disrupt social behavior, and has been correlated in males with elevated markers of oxidative stress and inflammation, such as cyclooxygenase-2 after ELS. Here, we measured the effects of maternal separation ELS on social interaction behaviors in males and females. Prefrontal cortex PVB and cyclooxygenase-2 were also measured in juveniles and adolescents using Western blots. ELS led to social interaction alterations earlier in females than males. Sexually dimorphic behavioral changes were consistent with prefrontal cortex PVB loss after ELS. PVB levels were decreased in ELS-exposed juvenile females, while males exposed to ELS do not display parvalbumin decreases until adolescence. Early behavioral and PVB changes in females did not appear to be mediated through cyclooxygenase-2, since levels were not affected in ELS females. Therefore, these data suggest that ELS affects males and females differently and with distinct developmental profiles.

Unsuspected pheochromocytoma multisystem crisis: a fatal outcome in a young male patient

Pheochromocytoma is a great mimicker and has varied presentation. It can present as medical emergency with hypertensive emergencies, acute cardiac event, neurological manifestations, systemic inflammatory response syndrome, acute respiratory distress syndrome, and metabolic emergencies. Here we report a young individual who after a bout of exercise developed breathlessness and rapidly developed multiorgan failure which was fatal and post mortem examination revealed pheochromocytoma in right adrenal gland. Pheochromocytoma multisystem crisis is discussed.

Persistence and safety risk assessment of propineb in Indian tea

A supervised field trial was conducted on tea with propineb at 1,750 and 3,500 g a.i./ha at two locations (Assam and Darjeeling), applied thrice at an interval of 10 days during the year 2006-2007. Propineb residue was measured spectrophotometrically at 435 nm in terms of CS2. The initial deposit of propineb in green tea leaves were found to be in the range of 16.26-35.96 mg/kg and the residue persisted up to 10 days irrespective of doses and locations with half-life value ranging from 2.24 to 2.43 days and preharvest interval of 17.17-21.37 days. Made tea residues ranged from 9.27 to 20.86 mg kg(-1) on 7 days and no residues could be detected on 14 days. Infusion study indicated that propineb did not infuse into tea liquor from made tea. The limit of determination was found to be 0.1 mg kg(-1) in terms of propineb for green tea leaves, made tea, and tea liquor. The tea applied with the recommended dose of propineb is safe for consumption as liquor.

Spectral and electro-optic response of UV-written waveguides in LiNbO3 single crystals

An experimental study of the spectral and electro-optic response of direct UV-written waveguides in LiNbO3 is reported. The waveguides were written using c.w. laser radiation at 275, 300.3, 302, and 305 nm wavelengths with various writing powers (35-60 mW) and scan speeds (0.1-1.0 mm/sec). Spectral analysis was used to determine the multimode and single mode wavelength regions and, the cut-off point of the fabricated waveguides. Electro-optic characterization of these waveguides reveals that the electro-optic coefficient (r33) decreases for longer writing wavelengths, with a maximum of 31 pm/V for 275 nm and, is reduced to 14 pm/V for waveguides written with 305 nm.

A Phenomenological Model for Predicting Fatigue Life in Bovine Trabecular Bone

Cyclic loading of bone during daily activities can lead to fatigue degradation and increased risk of fracture in both the young and elderly population. Damage processes under cyclic loading in trabecular bone result in the reduction of the elastic modulus and accumulation of residual strain. These effects increase with increasing stress levels, leading to a progressive reduction in fatigue life. The present work analyzes the effect of stress and strain variation on the above damage processes in bovine trabecular bone, and develops a phenomenological model relating fatigue life to the imposed stress level. The elastic modulus reduction of the bone specimens was observed to depend on the maximum compressive strain, while the rate of residual strain accumulation was a function of the stress level. A model was developed for the upper and lower bounds of bone elastic modulus reduction with increasing number of cycles, at each stress range. The experimental observations were described well by the model. The model predicted the bounds of the fatigue life with change in fatigue stress. The decrease in the fatigue life with increasing stress was related to corresponding increases in the residual strain accumulation rates at the elevated stress levels. The model shows the validity of fatigue predictions from relatively few cyclic experiments, by combining trends observed in the monotonic and the cyclic tests. The model also presents a relatively simple procedure for predicting the endurance limit for bovine trabecular bone specimens.

Healthcare applications based on software agents

Healthcare has been recognised as one of the most important areas for enterprise applications and services. Presently, information technologists and systems engineers all over the world are working towards achieving better efficiency and quality of service in various sectors of healthcare, such as telemedicine, hospital management, patient-care, and treatment. This paper addresses the issue of more effective and efficient handling of doctor-patient relationship. The idea is to use Software Agent technology to extend the patient-doctor relationship beyond the physical and logistical limitation of face-to-face consultations in patient management. Software agents can provide an extension of the doctor by interacting with the patient via a computer and the Internet. The agent is visualised as an anthropomorphic figure to further enhance the patient interaction.

A methodology for the development of software agent based interoperable telemedicine systems: a tele-electrocardiography perspective

Telemedicine involves the integration of information, human-machine, and healthcare technologies. Because different modalities of patient care require applications running on heterogeneous computing environment, software interoperability is a major issue in telemedicine. Software agent technology provides a range of promising techniques to solve this problem. This article discusses the development of a methodology for the design of interoperable telemedicine systems (illustrated with a tele-electrocardiography application). Software interoperability between different applications can be modeled at different levels of abstraction such as physical interoperability, data-type interoperability, specification-level interoperability, and semantic interoperability. Software agents address the issue of software interoperability at semantic level. A popular object-oriented software development methodology - unified modeling language (UML) - has been used for this development. This research has demonstrated the feasibility of the development of agent-based interoperable telemedicine systems. More research is needed before widespread deployment of such systems can take place.

An epidemiological review of red cell transfusions in cancer chemotherapy

OBJECTIVE

The objective of this chart review was to determine the frequency of transfusion and prevalence of anemia (hemoglobin result < 100 g/L) in patients receiving chemotherapy.

DESIGN

This study was a retrospective review of medical charts.

SETTING

Patients receiving chemotherapy were included from 12 tertiary care comprehensive cancer centres across Canada.

MAIN OUTCOME MEASURE

The primary study outcome measure was red blood cell transfusion rate, controlling for patient variables.

RESULTS

The 616 patients included had started chemotherapy in January-June 1992. For each subject, data collection finished 4 weeks after the end of the first regimen or after a maximum follow-up period of 26 weeks. Seventy-two patients (12%; 95% confidence interval 9.5% to 14.5%) were transfused for anemia (reasons other than blood loss), and 28% (95% confidence interval 24.5% to 31.5%) of the subjects were anemic during treatment. The univariate analyses of transfusion for anemia yielded significant associations with prognostic factors. In the multivariate analyses, platinum (odds ratio [OR] = 6.69) and anthracycline (OR = 3.56) chemotherapy, baseline hemoglobin (OR = 0.96) and disease stage (OR = 1.72) were statistically significant contributors.

CONCLUSION

In this patient cohort, red blood cell transfusion was infrequent (12%). However, patient groups at high risk of transfusion could be identified, with platinum-based chemotherapy being the most significant contributing factor. The information obtained from this multicentre study may prove helpful in developing supportive care guidelines for the management of chemotherapy-related anemia requiring transfusion.

Staging investigations in patients with breast cancer: the role of bone scans and liver imaging

HYPOTHESIS

Metastatic workup for patients newly diagnosed as having breast cancer is variable, especially for early disease (T1-2 N0-1). Routine bone scans and liver imaging are often performed without any evidence to support their usefulness.

DESIGN

A retrospective review of patients with breast cancer referred to our center during a 2-year period was performed to determine the value of staging investigations in detecting metastases.

RESULTS

Of the total 250 patients referred to our center after initial diagnosis, 25 (10.0%) were diagnosed as having metastases, 23 of whom had either clinical symptoms or signs suggestive of metastatic disease or abnormalities on routine blood work or chest x-ray examinations. Only 2 patients with metastatic disease were diagnosed solely on bone scan results; none were diagnosed solely on liver imaging (either with an ultrasound or radionuclide isotope liver scan). Overall, 3% (5/161) of patients with pathologic T1-2 N0-1 disease had metastases diagnosed compared with 30% (18/61) of patients with pathologic stage T3-4 or N2 disease.

CONCLUSIONS

Our results confirm the low yield of routine bone scans and liver imaging among patients with asymptomatic, pathologically confirmed, early stage (T1-2 N0-1) breast cancer. Therefore, we do not recommend these tests for such patients, although intensive investigations are appropriate for more advanced (stage T3-4 or N2) tumors.

Technique for measuring grating frequency

Experimentally the real and imaginary parts of the Fourier spectrum are separated and used to detect the nature of the object, i.e., whether the object is an odd or even function or a combination of both. A modified Twyman-Green setup is used for this purpose. This type of splitting of the object function into even and odd parts may become useful in different fields of image processing. As an application the same technique is used for accurate measurement of the grating frequency.

A study of nosocomial infection in relation to different host factors in an Indian teaching hospital

Out of a total of 422 patients studied, 164 (38.8%) developed nosocomial infection. The rate was higher (41.6%) in males than in females (34.7%). A rising trend of infection was observed with age, maximum (69.6%) being in the above 60 age group. Nosocomial infection rate was inversely proportional to the socio-economic status of the patient. At the same time some underlying diseases in the patients influenced the rate of infection to a great extent, eg infection rates in patients with anaemia (53.7%), diabetes mellitus (85.2%), hypertension (82.0%) and obesity (51.5%) were much more than in patients with no such underlying disease (17.5%).

Effect of statil on kidney structure, function and polyol accumulation in diabetes mellitus

We examined the effects of an aldose-reductase inhibitor, statil, which blocks the conversion of glucose to sorbitol, in rats rendered diabetic with streptozotocin in order to determine whether the anticipated changes in sorbitol content was associated with beneficial lack of changes in renal morphology and function. Groups of diabetic, insulin-treated and untreated rats were fed statil daily for a period of five months; each group was paired with a non-drug-treatment control group. At the conclusion of the study period, statil was not found to affect renal sorbitol concentrations nor did it effect functional or structural changes seen in the kidney. We conclude that further study, using other doses of statil and longer duration over which data is collected, must be undertaken in order to implicate the polyol pathway in the renal complications of diabetes mellitus.