RFX6 regulates human intestinal patterning and function upstream of PDX1

The gastrointestinal (GI) tract is complex and consists of multiple organs with unique functions. Rare gene variants can cause congenital malformations of the human GI tract, although the molecular basis of these has been poorly studied. We identified a patient with compound-heterozygous variants in RFX6 presenting with duodenal malrotation and atresia, implicating RFX6 in development of the proximal intestine. To identify how mutations in RFX6 impact intestinal patterning and function, we derived induced pluripotent stem cells from this patient to generate human intestinal organoids (HIOs). We identified that the duodenal HIOs and human tissues had mixed regional identity, with gastric and ileal features. CRISPR-mediated correction of RFX6 restored duodenal identity. We then used gain- and loss-of-function and transcriptomic approaches in HIOs and Xenopus embryos to identify that PDX1 is a downstream transcriptional target of RFX6 required for duodenal development. However, RFX6 had additional PDX1-independent transcriptional targets involving multiple components of signaling pathways that are required for establishing early regional identity in the GI tract. In summary, we have identified RFX6 as a key regulator in intestinal patterning that acts by regulating transcriptional and signaling pathways.

Additional bypass graft or concomitant surgical ablation? Insights from the HEIST registry

BACKGROUND

Surgical ablation for atrial fibrillation at the time of isolated coronary artery bypass grafting is reluctantly attempted. Meanwhile, complete revascularization is not always possible in these patients. We attempted to counterbalance the long-term benefits of surgical ablation against the risks of incomplete revascularization.

METHODS

Atrial fibrillation patients undergoing isolated coronary artery bypass grafting for multivessel disease between 2012 to 2022 and included in the HEart surgery In atrial fibrillation and Supraventricular Tachycardia registry were divided into complete revascularization, complete revascularization with additional grafts, and incomplete revascularization cohorts; these were further split into surgical ablation and non-surgical ablation subgroups.

RESULTS

A total of 8,405 patients (78% men; age 69.3 ± 7.9) were included; of those, 5,918 (70.4%) had complete revascularization, and 556 (6.6%) had surgical ablation performed. Number of anastomoses was 2.7 ± 1.2. The median follow-up was 5.1 [interquartile range 2.1-8.8] years. In patients in whom complete revascularization was achieved, surgical ablation was associated with long-term survival benefit: hazard ratio 0.69; 95% confidence intervals (0.50-0.94); P = .020 compared with grafting additional lesions. Similarly, in patients in whom complete revascularization was not achieved, surgical ablation was associated with a long-term survival benefit of 0.68 (0.49-0.94); P = .019. When comparing surgical ablation on top of incomplete revascularization against complete revascularization without additional grafts or surgical ablation, there was no difference between the 2: 0.84 (0.61-1.17); P = .307, which was also consistent in the propensity score-matched analysis: 0.75 (0.39-1.43); P = .379.

CONCLUSION

To achieve complete revascularization is of utmost importance. However, when facing incomplete revascularization at the time of coronary artery bypass grafting in a patient with underlying atrial fibrillation, concomitant surgical ablation on top of incomplete revascularization is associated with similar long-term survival as complete revascularization without surgical ablation.

Internal aortic annuloplasty remodeling ring in bicuspid aortic valve repair: different phenotypes

We describe our approach, which is based on using an internal bicuspid annuloplasty ring not only to provide annular reduction but also to routinely achieve 180° valve symmetry. The HAART 200 ring has a circular base geometry with 180° subcommissural posts. It is sized according to the intercommissural diameter and keeps that dimension unchanged. The non-fused leaflet serves as a reference, and its free-edge length is measured with a ball sizer that predicts the required ring diameter (D): D =free-edge diameter/1.5 with transannular suturing. The ring brings the sinus-to-sinus dimension centrally to improve leaflet coaptation. More importantly, the ring remodels the fused and nonfused sinuses into equal annular segments, thereby increasing the mobility of the fused segment, facilitating its later plication. In this way, the ring establishes 180° valve geometry.

Interdisciplinarity for social justice enterprise: intersecting education, industry and community arts perspectives

The role of interdisciplinarity in achieving authentic and transformative learning outcomes is both contested and complex. At the same time, traditional disciplinary ways of being, doing and knowing have been further tested by the impact of COVID-19 on students, schools and communities. In Tasmania, already experiencing amongst the lowest levels of educational attainment in Australia, the educational implications of COVID-19 have been polarising. Preliminary reports have employed interdisciplinary perspectives to understand how the situation is unfolding. Extremes of privilege and poverty have intensified, with accentuated disadvantage experienced by already vulnerable groups, whilst ingenuity, adaptability and innovation have flourished elsewhere. The spectrum and range of this polarisation yield compelling evidence for the inadequate address of complex societal problems through singular disciplines or institutions. This article explores storied data generated from the intersections of interdisciplinary strategy enacted across three settings: education, creative industries and community-based arts practice. The data derive from two Tasmanian case studies where interdisciplinary collaboration between the education sector, creative industries and community is well established. In subsequent discussion, the multidisciplinary authorship team make and offer meaning from participatory lived experiences of pursuing social justice outcomes prior to and during the COVID-19 pandemic. From this, we posit how lived experiences of interdisciplinarity impact social justice enterprise in times of increasingly complex socio-economic challenge. In addressing these concerns, we elucidate the role interdisciplinarity plays in both enabling and inhibiting social justice imperatives shared across education, creative industry and community-based arts practice immediately prior to and during a global pandemic. In so doing, we elicit the ways interdisciplinary practices, partnerships and priorities recalibrate in response to global challenges.

Rapid Hygiene Assay Sensitive to Cumulative Adenylate Homologues Exhibits Equal or Higher Frequencies of Soil Contamination Detection than Assay Limited to ATP Detection

ABSTRACT

Based upon regulatory and food industry-driven food safety standards, there is a need for rapid, accurate methods for assessing sanitary conditions. A commonly used assay is based on the assessment of the biochemical molecule adenosine triphosphate (ATP). A more recent assay, the total adenylate homologue-based (AXP) assay, targets the cumulative presence of ATP and its dephosphorylated homologues, adenosine diphosphate and adenosine monophosphate. Yet there is little information that compares the practical performance of these two assays. This work examined these two assay types with a comparative study in a grade A dairy foods processing plant and a licensed and inspected meat processing facility. A total of 1,920 concomitant analyses were conducted with main variables of assay type, processing facility type, and hygiene zone category. Statistical process control methodology was used to calculate 95% confidence control limits; data beyond those limits were considered contamination events. Results demonstrated that overall, the AXP assay detected contamination events approximately two times more often than the assay based on ATP only. This increase in the rate of contamination event detection was especially prevalent in the meat processing facility, where across all hygienic zones, there were 38 versus 85 contaminations events detected for the ATP and AXP assays, respectively. Across hygiene zones, the AXP data displayed either an equal or an increased incidence of soil detection compared with data from the ATP assay. This study provides applied evidence that assays solely dependent on ATP concentrations are less able to detect soil contaminants under conditions that favor ATP dephosphorylation reactions.

HIGHLIGHTS

Aortic valve annuloplasty with the HAART geometric ring and ascending aorta replacement

Approximately one-third of patients suffering from aortic insufficiency (AI) present also with an ascending aortic aneurysm. AI is most commonly due to a combination of sinotubular junction and annular dilatation. Valve reimplantation or prosthetic valve replacement may not be ideal for these patients, and ascending aortic aneurysm resection with aortic valve repair using geometric internal ring annuloplasty is a simple, successful, and reproducible alternative treatment approach. In this video tutorial we demonstrate aortic valve repair using the HAART 300 annuloplasty ring with concomitant ascending aorta replacement.

Evidence of Oxidative Stress and Secondary Mitochondrial Dysfunction in Metabolic and Non-Metabolic Disorders

Mitochondrial dysfunction and oxidative stress have been implicated in the pathogenesis of a number of diseases and conditions. Oxidative stress occurs once the antioxidant defenses of the body become overwhelmed and are no longer able to detoxify reactive oxygen species (ROS). The ROS can then go unchallenged and are able to cause oxidative damage to cellular lipids, DNA and proteins, which will eventually result in cellular and organ dysfunction. Although not always the primary cause of disease, mitochondrial dysfunction as a secondary consequence disease of pathophysiology can result in increased ROS generation together with an impairment in cellular energy status. Mitochondrial dysfunction may result from either free radical-induced oxidative damage or direct impairment by the toxic metabolites which accumulate in certain metabolic diseases. In view of the importance of cellular antioxidant status, a number of therapeutic strategies have been employed in disorders associated with oxidative stress with a view to neutralising the ROS and reactive nitrogen species implicated in disease pathophysiology. Although successful in some cases, these adjunct therapies have yet to be incorporated into the clinical management of patients. The purpose of this review is to highlight the emerging evidence of oxidative stress, secondary mitochondrial dysfunction and antioxidant treatment efficacy in metabolic and non-metabolic diseases in which there is a current interest in these parameters.

Arts practice and disconnected youth in Australia: Impact and domains of change

Background: This paper describes research conducted with Big hART, Australia's most awarded participatory arts company. It considers three projects, LUCKY, GOLD and NGAPARTJI NGAPARTJI across separate sites in Tasmania, Western NSW and Northern Territory, respectively, in order to understand project impact from the perspective of project participants, Arts workers, community members and funders. Methods: Semi-structured interviews were conducted with 29 respondents. The data were coded thematically and analysed using the constant comparative method of qualitative data analysis. Results: Seven broad domains of change were identified: psychosocial health; community; agency and behavioural change; the Art; economic effect; learning and identity. Conclusions: Experiences of participatory arts are interrelated in an ecology of practice that is iterative, relational, developmental, temporal and contextually bound. This means that questions of impact are contingent, and there is no one path that participants travel or single measure that can adequately capture the richness and diversity of experience. Consequently, it is the productive tensions between the domains of change that are important and the way they are animated through Arts practice that provides sign posts towards the impact of Big hART projects.

The value of [18F]fluorodeoxyglucose-PET/CT in oesophageal cancer

[¹⁸F]Fluorodeoxyglucose-positron emission tomography/computed tomography (CT) is recognized as a useful adjunct to conventional imaging with CT and endoscopic ultrasonography for the staging of oesophageal cancer, for response assessment and identification of recurrent disease and it may provide prognostic information.

[(18)F]2-fluoro-2-deoxy-D-glucose PET/CT in mediastinal masses

Computed tomography (CT) and magnetic resonance imaging (MRI) are excellent modalities for the localization of mediastinal masses and there are often features that may allow the correct diagnosis to be made. However, CT and MRI cannot usually assess the aggressiveness of masses or identify viable tumour in residual masses after chemotherapy. Metabolic imaging using [¹⁸F]fluorodeoxyglucose (FDG)-positron emission tomography/CT, although not required in many cases, may be helpful for further characterization of masses and to guide the most appropriate site for biopsy.

Sox17 and Sox4 differentially regulate beta-catenin/T-cell factor activity and proliferation of colon carcinoma cells

The canonical Wnt pathway is necessary for gut epithelial cell proliferation, and aberrant activation of this pathway causes intestinal neoplasia. We report a novel mechanism by which the Sox family of transcription factors regulate the canonical Wnt signaling pathway. We found that some Sox proteins antagonize while others enhance beta-catenin/T-cell factor (TCF) activity. Sox17, which is expressed in the normal gut epithelium but exhibits reduced expression in intestinal neoplasia, is antagonistic to Wnt signaling. When overexpressed in SW480 colon carcinoma cells, Sox17 represses beta-catenin/TCF activity in a dose-dependent manner and inhibits proliferation. Sox17 and Sox4 are expressed in mutually exclusive domains in normal and neoplastic gut tissues, and gain- and loss-of-function studies demonstrate that Sox4 enhances beta-catenin/TCF activity and the proliferation of SW480 cells. In addition to binding beta-catenin, both Sox17 and Sox4 physically interact with TCF/lymphoid enhancer factor (LEF) family members via their respective high-mobility-group box domains. Results from gain- and loss-of-function experiments suggest that the interaction of Sox proteins with beta-catenin and TCF/LEF proteins regulates the stability of beta-catenin and TCF/LEF. In particular, Sox17 promotes the degradation of both beta-catenin and TCF proteins via a noncanonical, glycogen synthase kinase 3beta-independent mechanism that can be blocked by proteasome inhibitors. In contrast, Sox4 may function to stabilize beta-catenin protein. These findings indicate that Sox proteins can act as both antagonists and agonists of beta-catenin/TCF activity, and this mechanism may regulate Wnt signaling responses in many developmental and disease contexts.

Safety study of induction chemotherapy and synchronous radiotherapy (RT) and cetuximab in stage III non-small cell lung cancer (NSCLC): SCRATCH (Cohort I)

18032

Background: The addition of cetuximab can increase the efficacy of chemotherapy for advanced NSCLC. Concomitant cetuximab and RT is superior to RT alone for locally advanced squamous cell head & neck carcinoma. The SCRATCH study (cohort I) is a phase I study to assess the safety of synchronous cetuximab and radical RT in patients with Stage III NSCLC. Methods: Cohort I will contain 12 patients with inoperable stage III NSCLC. Inclusion criteria are performance status 0–1, adequate organ function, and disease encompassable within a radical RT volume. Exclusion criteria are previous malignancy, thoracic RT or treatment with EGFR targeted therapy. Patients receive platinum-based induction chemotherapy, followed by weekly intravenous cetuximab (initial dose 400mg/m2; maintenance dose 250mg/m2) and concomitant RT (64Gy/32fractions/45days). The primary end-point is toxicity. NCI Common Toxicity Criteria (CTC) V3.0 assessments are performed weekly during radiotherapy, and at regular follow-up visits. Results: Data from the first 9 patients is available. 2 patients stopped receiving cetuximab early due to toxicity. 1 experienced grade 3 fatigue following the initial dose, and the other declined further treatment after developing grade 2 skin toxicity. 2 patients have died, 1 from disease progression and 1 from thromboembolic disease. Both deaths occurred between months 2 and 4 post RT and were not attributed to the cetuximab therapy. Of the 7 living patients, 2 have survived 1 year (measured from the first day of induction chemotherapy). The maximum NCI CTC V3.0 scores are summarised in the table below. Conclusions: The results suggest that the early and late toxicities of synchronous cetuximab and radical RT are acceptable. Data on all 12 patients will be available by June 2007. SCRATCH Study cohorts II-IV follow on and will recruit sequentially. They will assess the safety of adding concomitant cisplatin (±vinorelbine) to cetuximab and radical RT.

[Table: see text]

No significant financial relationships to disclose.

Global analysis of the transcriptional network controlling Xenopus endoderm formation

A conserved molecular pathway has emerged controlling endoderm formation in Xenopus zebrafish and mice. Key genes in this pathway include Nodal ligands and transcription factors of the Mix-like paired homeodomain class, Gata4-6 zinc-finger factors and Sox17 HMG domain proteins. Although a linear epistatic pathway has been proposed, the precise hierarchical relationships between these factors and their downstream targets are largely unresolved. Here, we have used a combination of microarray analysis and loss-of-function experiments to examine the global regulatory network controlling Xenopus endoderm formation. We identified over 300 transcripts enriched in the gastrula endoderm, including most of the known endoderm regulators and over a hundred uncharacterized genes. Surprisingly only 10% of the endoderm transcriptome is regulated as predicted by the current linear model. We find that Nodal genes, Mixer and Sox17 have both shared and distinct sets of downstream targets, and that a number of unexpected autoregulatory loops exist between Sox17 and Gata4-6, between Sox17 and Bix1/Bix2/Bix4, and between Sox17 and Xnr4. Furthermore, we find that Mixer does not function primarily via Sox17 as previously proposed. These data provides new insight into the complexity of endoderm formation and will serve as valuable resource for establishing a complete endoderm gene regulatory network.

Mutations in genes encoding inner arm dynein heavy chains inTetrahymena thermophila lead to axonemal hypersensitivity to Ca2+

Calcium-dependent ciliary reversals are seen in ciliated protozoans such as Tetrahymena in response to depolarizing stimuli, but the axonemal mechanisms responsible for this response are not well understood. The model is that the outer arm dyneins (OADs) control the beating frequency while the inner arm dyneins (IADs) regulate ciliary waveform. Since ciliary reversal is a type of waveform change, the model would predict that IAD mutations could affect ciliary reversal. We have used gene disruption techniques to generate several behavioral mutants of Tetrahymena with functional disruptions of various IADs. One such mutant, called KO-6, is missing I1 (the two-headed IAD) and is unable to show ciliary reversals in response to any stimuli due to a loss of axonemal Ca2+ sensitivity [Eur J Cell Biol 80 (2001) 486-497; Cell Motil Cytoskeleton 53 (2002) 281-288.]. In contrast, disruption of 3 one-headed IADs [Liu et al., Cell Motil Cytoskeleton 59 (2004), 201-214] produced mutants, which showed over-responsiveness in bioassays measuring either their depolarization-induced avoiding reactions (AR) in Na+ and Ba2+ solutions or their duration of backward swimming (continuous ciliary reversal or CCR) in K+ solutions. Detergent-extracted and reactivated mutants also showed increased probabilities of CCR at lower Ca2+ concentrations suggesting that the behavioral over-responsiveness of these three mutants in vivo is due to increased axonemal Ca2+ sensitivity. Our data suggest the possibility that the one-headed IADs and the two-headed IAD act antagonistically in vivo and that loss of any one of the one-headed IADs leads to behavioral over-responsiveness due to less resistance to I1-induced reversals.

Smad2 and Smad3 coordinately regulate craniofacial and endodermal development

Ligands of the transforming growth factor-beta (TGF-beta) superfamily are involved in numerous developmental and disease processes. TGF-beta, activins, and nodal ligands operate through the highly homologous Smad2 and Smad3 intracellular mediators. Smad2 mutants exhibit early embryonic lethality, while Smad3 mutants are viable, but show a plethora of postnatal phenotypes, including immune dysfunction and skeletal abnormalities. Previously, we have shown that the Smad2 and Smad3 genes function cooperatively during liver morphogenesis. Here we show that Smad2 and Smad3 are required at a full dosage for normal embryonic development. Animals lacking one allele of each gene exhibit a variably penetrant phenotype in which structures in the anterior and ventral midline are reduced or lost; additionally, we demonstrate that this craniofacial defect and the previously reported hepatic phenotypes are both due to defects in the definitive endoderm. A reduction of endodermal gene expression as well as a failure to displace the visceral endoderm occurs despite the formation of a normal foregut pocket. This precedes any defects in anterior patterning and likely causes the abnormalities observed in craniofacial and midline development, as well as hepatogenesis.

Sox17 and beta-catenin cooperate to regulate the transcription of endodermal genes

Recent studies have led to a model of the molecular pathway that specifies the endoderm during vertebrate gastrulation. The HMG box transcription factor Sox17 is a key component of this pathway and is essential for endoderm formation; however, the molecular events controlled by Sox17 are largely unknown. We have identified several direct transcriptional targets of Sox17, including Foxa1 and Foxa2. We show that beta-catenin, a component of Wnt signaling pathway, physically interacts with Sox17 and potentiates its transcriptional activation of target genes. We identify a motif in the C terminus of Sox17, which is conserved in all the SoxF subfamily of Sox proteins, and this motif is required for the ability of Sox17 to both transactivate target genes and bind beta-catenin. Nuclear beta-catenin is present in endoderm cells of the gastrula, and depletion of beta-catenin from embryos results in a repression of Sox17 target genes. These data suggest that in a mechanism analogous to Tcf/Lef interacting with beta-catenin, Sox17 and beta-catenin interact to transcribe endodermal target genes.

Disruption of genes encoding predicted inner arm dynein heavy chains causes motility phenotypes in Tetrahymena

The multi-dynein hypothesis [Asai, 1995: Cell Motil Cytoskeleton 32:129-132] states: (1) there are many different dynein HC isoforms; (2) each isoform is encoded by a different gene; (3) different isoforms have different functions. Many studies provide evidence in support of the first two statements [Piperno et al., 1990: J Cell Biol 110:379-389; Kagami and Kamiya, 1992: J Cell Sci 103:653-664; Gibbons, 1995: Cell Motil Cytoskeleton 32:136-144; Porter et al., 1996: Genetics 144:569-585; Xu et al., 1999: J Eukaryot Microbiol 46:606-611] and there is evidence that outer arms and inner arms play different roles in flagellar beating [Brokaw and Kamiya, 1987: Cell Motil. Cytoskeleton 8:68-75]. However, there are few studies rigorously testing in vivo whether inner arm dyneins, especially the 1-headed inner arm dyneins, play unique roles. This study tested the third tenet of the multi-dynein hypothesis by introducing mutations into three inner arm dynein HC genes (DYH8, 9 and 12) that are thought to encode HCs associated with 1-headed inner arm dyneins. Southern blots, Northern blots, and RT-PCR analyses indicate that all three mutants (KO-8, 9, and 12) are complete knockouts. Each mutant swims slower than the wild-type cells. The beat frequency of KO-8 cells is lower than that of the wild-type cells while the beat frequencies of KO-9 and KO-12 are not different from that of wild-type cells. Our results suggest that each inner arm dynein HC is essential for normal cell motility and cannot be replaced functionally by other dynein HCs and that not all of the 1-headed inner arm dyneins play the same role in ciliary motility. Thus, the results of our study support the multi-dynein hypothesis [Asai, 1995: Cell Motil Cytoskeleton 32:129-132].

Cardiac T-box factor Tbx20 directly interacts with Nkx2-5, GATA4, and GATA5 in regulation of gene expression in the developing heart

Tbx20 is a member of the T-box transcription factor family expressed in the forming hearts of vertebrate and invertebrate embryos. We report here analysis of Tbx20 expression during murine cardiac development and assessment of DNA-binding and transcriptional properties of Tbx20 isoforms. Tbx20 was expressed in myocardium and endocardium, including high levels in endocardial cushions. cDNAs generated by alternative splicing encode at least four Tbx20 isoforms, and Tbx20a uniquely carried strong transactivation and transrepression domains in its C terminus. Isoforms with an intact T-box bound specifically to DNA sites resembling the consensus brachyury half site, although with less avidity compared with the related factor, Tbx5. Tbx20 physically interacted with cardiac transcription factors Nkx2-5, GATA4, and GATA5, collaborating to synergistically activate cardiac gene expression. Among cardiac GATA factors, there was preferential synergy with GATA5, implicated in endocardial differentiation. In Xenopus embryos, enforced expression of Tbx20a, but not Tbx20b, led to induction of mesodermal and endodermal lineage markers as well as cell migration, indicating that the long Tbx20a isoform uniquely bears functional domains that can alter gene expression and developmental behaviour in an in vivo context. We propose that Tbx20 plays an integrated role in the ancient myogenic program of the heart, and has been additionally coopted during evolution of vertebrates for endocardial cushion development.

Solubilization of acyl heterogeneous triacylglycerol in phosphatidylcholine vesicles

The amount of acyl heterogeneous triacylglycerol (TG(HET)) solubilized by phosphatidylcholine (PC) vesicles, prepared by co-sonication of egg PC and small amounts (<6% w/w) of TG(HET), was determined using (13)C nuclear magnetic resonance (NMR). The acyl chains of TG(HET) were predominantly 16 or 18 carbons in length, 50% saturated, and approximately 21.7% (13)C isotopically enriched at the carbonyl carbon. The (13)C NMR spectra revealed two carbonyl resonances at chemical shift values between PC carbonyls and oil-phase TG carbonyls, confirming the presence of TG(HET) solubilized in PC vesicles. Oil-phase TG carbonyl peaks were present only in spectra of vesicles containing >3 wt % TG(HET). Integration of TG(HET) carbonyl resonances determined that PC vesicles solubilized 3.8 wt % of TG(HET), compared to 2.8 wt % of acyl homogeneous triolein. The difference between the maximum solubility of TG(HET) and that of homogeneous TG (TG(HOM)) with similar acyl chain lengths provides evidence that specific acyl composition, in addition to the acyl chain length of triacylglycerols, affects the solubility of TG in PC vesicles and TG-rich lipoprotein surfaces. Thus, TG(HET) may innately be a better model substrate than TG(HOM) for determination of substrate availability of TG at lipoprotein surfaces.

MR urography: evaluation of different techniques in non-dilated tracts

OBJECTIVE

To assess the effectiveness of different MRI sequences for the visualisation of the different components of the non-dilated urinary tract.

METHOD

20 asymptomatic individuals were prospectively evaluated using 2 different heavily T2 weighted sequences, and after the injection of 2 different doses of gadolinium (Gd-DTPA). Images were independently scored.

RESULTS

The low dose Gd-DTPA enhanced MR urography (MRU) sequence was the best overall sequence for the visualisation of both the pelvicalyceal systems and ureters. The combination of information from the other sequences was additive.

CONCLUSIONS

Combined use of heavily T2 weighted and Gd-DTPA enhanced MRU produces diagnostic images and does not require pre-imaging preparation other than oral hydration.

Bilateral third and unilateral sixth nerve palsies as early presenting signs of metastatic prostatic carcinoma

PURPOSE

To report four cases of cranial nerve palsy, which presented to the ophthalmologist as the only or one of the earliest manifestations of prostatic carcinoma. This is an infrequent complication of metastatic prostatic carcinoma usually only occurring late in the disease process in those with a history of prostatic carcinoma.

METHODS

The case records of four patients with a history of a cranial nerve palsy who attended the ophthalmology department and who had a recent or subsequent diagnosis of prostatic carcinoma were reviewed.

RESULTS

Diplopia caused by lesions affecting the third and sixth nerves sometimes in association with sensory symptoms may be a manifestation of metastatic prostatic carcinoma. These findings are consistent with base of the skull metastases from the condition. Two patients are still alive 54 months and 12 months after the diagnosis. One of the patients died 13 months after the diagnosis of prostatic carcinoma was made and the other died 21 months after the diagnosis from an unrelated hypertensive brain haemorrhage.

CONCLUSIONS

Any patient presenting with diplopia must have an adequate past medical history taken and in an elderly gentleman this should include symptoms of prostatic disease. If indicated urological referral and measurement of prostate specific antigen may be performed. In patients whose cranial nerve palsy is complicated by other sensory signs or those in whom no sign of recovery occurs in 2 months, a contrast CT scan asking for bone windows to be included may be helpful in delineating any pathology. Radiotherapy may be useful for the treatment of metastatic prostatic carcinoma causing cranial nerve palsies with some patients experiencing either complete or partial resolution of their symptoms. The effect of newer hormonal agents or chemotherapy on this aspect of the disease is not well documented in current literature.

The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS)

The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS) is in progress. The study design, accrual to date, and related research projects are described. Revised accrual rates and expected recruitment are given. 15 cancers have been detected to date, from a total of 1236 screening measurements. This event rate and the tumour grades reported are compared with recent reports from other studies in women at high risk of breast cancer.

Salmonella enterica serotype Enteritidis phage types 4, 7, 6, 8, 13a, 29 and 34: a comparative analysis of genomic fingerprints from geographically distant isolates

AIMS

To evaluate genetic heterogeneity in the most common phage types of Salmonella enterica serovar Enteritidis.

METHODS AND RESULTS

A total of 233 isolates of Salm. Enteritidis from England, Northern Ireland, Spain, Hong Kong and the USA belonging to phage types (PT) 4 (n=88), PT7 (n=12), PT6 (n=72), PT8 (n=14), PT13a (n=29), PT29 (n=14) and PT34 (n=4) were characterized by PstI-SphI (PS) ribotyping and pulsed-field gel electrophoresis after digestion of DNA with XbaI. PS ribotyping differentiated the isolates into 53 different PS types and PFGE showed 14 different macrorestriction profiles; with the combination of both methods, 73 combined types were identified. Some of these clones appeared to be present within several countries. Movement of foodstuffs, animals or people may have been involved in the spread of these strains. On the other hand, some clones were only found in specific locations.

CONCLUSIONS

Several well defined clonal lines seem to co-exist within the different phage types included in this study, and a combined typing approach may constitute a useful tool for epidemiological investigations. Clustering analysis of ribotypes and PFGE types agree with previous studies and suggest that phage types that share receptor binding properties can be distinguished as two families: the PT4 family including PT7 and PT6, and the PT8 family including PT13a. The other phage types are difficult to place in a family unless the geographical site of isolation is known.

SIGNIFICANCE AND IMPACT OF THE STUDY

This paper reports on an extensive assessment of the use of molecular tools for the study of the epidemiology of the enteric pathogen Salm. Enteritidis. It also gives new information regarding relationships among some common phage types.

New strategies for polymer development in pharmaceutical science--a short review

We are developing synthetic polymers for pharmaceutical and medical applications. These applications can be broadly grouped on how the polymer will be utilized e.g. material, excipient or molecule. Our focus is to develop polymers with more defined structures that are based on biological, physicochemical and/or materials criteria. Strategies are being developed to more efficiently optimize structure-property correlations during preclinical development. We describe two examples of our research on pharmaceutical polymer development: narrow molecular weight distribution (MWD) homopolymeric precursors which can be functionalized to give families of narrow MWD homo- and co-polymers, and hydrolytically degradable polymers.

A comparison of the shuttle and 6 minute walking tests with measured peak oxygen consumption in patients with heart failure

This study investigated the use of an incremental, externally-paced 10 m shuttle walk test (SWT) as an objective, reliable and predictive test of functional capacity in patients with heart failure (CHF). The SWT was compared to a 6 minute walk test (6WT) and a maximal symptom-limited treadmill peak oxygen consumption (VO2peak) test. Experiment 1 examined the reproducibility of the SWT. Two SWF trials were performed and distance ambulated (DA), heart rate (HR) and rate of perceived exertion (RPE) results compared. In experiment 2, SWT, 6WT, and VO2 peak tests were performed and HR. RPE and ambulatory VO2 compared. The SWT demonstrated strong test/retest reliability for DA (r = 0.98). HR (r = 0.96) and RPE (r = 0.89). Treadmill VO2 peak was significantly correlated with DA during the SWT (r = 0.83, P < 0.05), but not the 6WT. SWT peak VO2 (18.5 +/- 1.8 ml.kg(-1) x min(-1)) and treadmill VO2 peak (18.3 +/-2.0 ml.kg(-1) x min(-1)) were also highly correlated (r = 0.78, P < 0.05). Conversely, 6WT peak VO2 and treadmill VO2 peak were not significantly correlated. This study suggests the SWT is a reliable, objective test, highly predictive of VO2 peak which may be a more optimal field exercise test than the self paced 6WT.

Advancing the science of symptom management

Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars.

AIM

In this paper, we describe the evidence-based revised conceptual model, the three dimensions of the model, and the areas where further research is needed.

BACKGROUND/RATIONALE

The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.

Structural insights into the binding of cardiac glycosides to the digitalis receptor revealed by solid-state NMR

Several biologically active derivatives of the cardiotonic steroid ouabain have been made containing NMR isotopes ((13)C, (2)H, and (19)F) in the rhamnose sugar and steroid moieties, and examined at the digitalis receptor site of renal Na(+)/K(+)-ATPase by a combination of solid-state NMR methods. Deuterium NMR spectra of (2)H-labeled inhibitors revealed that the sugar group was only loosely associated with the binding site, whereas the steroid group was more constrained, probably because of hydrogen bonding to residues around the K(+)-channel region. Crosspolarization magic-angle spinning NMR showed that chemical shifts of inhibitors (13)C-labeled in the sugar group moved downfield by 0.5 ppm after binding to the digitalis site, suggesting that the sugar was close to aromatic side groups. A (19)F, (13)C- rotational-echo double-resonance NMR strategy was used to determine the structure of an inhibitor in the digitalis receptor site, and it showed that the ouabain derivatives adopt a conformation in which the sugar extends out of the plane of the steroid ring system. The combined structural and dynamic information favors a model for inhibition in which the ouabain analogues lie across the surface of the Na(+)/K(+)-ATPase alpha-subunit with the sugar group facing away from the surface of the membrane but free to move into contact with one or more aromatic residues.

2-Fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkin's disease: influence on patient management in a single institution

PURPOSE

Optimum therapy for patients with Hodgkin's disease (HD) is determined by a number of prognostic factors, one of which is an accurate definition of extent of disease (stage). Computerised tomography is widely used in staging but cannot reliably evaluate normal sized lymph nodes and some extranodal sites, e.g., liver, spleen and bone marrow. 2-Fluorine-18-fluoro-2-deoxy-D glucose (FDG) has been shown to concentrate preferentially in lymphoma sites (whether in nodal or extranodal tissue) and therefore may have a useful role in staging patients with HD. This study compares concurrent computerized tomography (CT) and FDG positron emission tomography (PET) in the staging of Hodgkin's disease and assesses the frequency of stage migration and possible changes in therapy related to the use of PET scanning.

PATIENTS AND METHODS

This was a single centre retrospective study of 44 patients with Hodgkin's disease who underwent both staging CT and PET prior to treatment between September 1993 and August 1998 at St. Thomas' Hospital. The number and sites of disease were assessed for each patient, documenting any stage and therapy modification prompted by PET findings.

RESULTS

One hundred fifty-nine sites of disease were demonstrated in forty-four patients by FDG-PET compared with eighty-four by CT. As a result, 18 (40.9%) patients were upstaged, nine of these by FDG-uptake in splenic or extranodal sites not visualised on CT. Only three patients were downstaged by PET results. Eleven patients (25%) had treatment modified by PET scan findings.

CONCLUSIONS

Significantly more sites of disease were identified by PET than CT resulting in stage changes and a modification of therapy in 25% of patients. This has important implications not only for current patient management but also for the design of future clinical trials.

Combined aerobic and resistance exercise training improves functional capacity and strength in CHF

This study examined the effect of a novel circuit weight training (CWT) program on cardiorespiratory fitness, muscular strength, and body composition in 13 patients with chronic heart failure (CHF), using a prospective randomized crossover protocol. Peak exercise oxygen uptake (VO(2 peak)) increased after the 8-wk CWT program (19. 5 +/- 1.2 vs. 22.0 +/- 1.5 ml. kg(-1). min(-1), P < 0.01), as did exercise test duration (15.2 +/- 0.9 vs. 18.0 +/- 1.1 min, P < 0. 001). Submaximal exercise heart rate was lower after training at 60 and 80 W (121 +/- 3 vs. 134 +/- 5 beats/min, P < 0.01) as was rate pressure product, whereas ventilatory threshold increased, from 52 +/- 3 to 58 +/- 3% of VO(2 peak) (P < 0.05). CWT also increased maximal isotonic voluntary contractile strength for seven different muscle groups, from 392 to 462 kg (P = 0.001). CWT, an exercise prescription specifically targeting peripheral abnormalities in CHF, improves functional capacity and muscular strength in these patients.

Eosinophil development and bone marrow and tissue eosinophils in atopic asthma

BACKGROUND

Eosinophils develop from bone marrow (BM) progenitors, and interleukin-5 (IL-5) and eotaxin may act in expansion and mobilisation of BM eosinophils in asthma.

METHODS

We have examined phenotypic changes as CD34+ cells develop to the eosinophil lineage in vitro, and have evaluated BM eosinophils from asthmatic and control subjects for expression of the eotaxin receptor, CCR3.

RESULTS

Acquisition of receptors for IL-5 and CCR3 was an early event in eosinophil development. There were increased CD34+ cells, and mature and immature CCR3+ eosinophils in BM from asthmatics.

CONCLUSION

These data suggest that IL-5 may act early in eosinophil development, and that eotaxin has the capacity to mobilise a BM eosinophil pool in asthma.

Computed tomography findings in an inflamed meckel diverticulum

Meckel diverticulum, the commonest congenital abnormality of the gastrointestinal tract, may be difficult to diagnose. Appearances on CT are often non-specific unless there is connection to the umbilicus or a complication has occurred. We report a case of an inflamed Meckel diverticulum seen on CT.

Macrophage scavenger receptor(s) and oxidatively modified proteins in endometriosis

OBJECTIVE

To determine whether cultured human peritoneal macrophages have functional scavenger receptor(s) and whether activation of macrophages in endometriosis may involve an increase in scavenger receptor activity.

DESIGN

A controlled clinical study comparing peritoneal fluid (PF) macrophages of women with endometriosis and controls without endometriosis.

SETTING

Women undergoing laparoscopic evaluation and treatment in a tertiary medical center.

PATIENT(S)

Twenty-one women undergoing evaluation for pelvic pain or infertility and 10 women undergoing elective laparoscopic tubal ligation.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Evidence for functional macrophage scavenger receptor and evidence of ligands for the scavenger receptor in PF.

RESULT(S)

Peritoneal macrophages of women with endometriosis degrade significantly more endothelial cell-low density lipoprotein (EC-LDL) and copper-oxidized LDL (Cu-LDL) than native LDL. Macrophages of women with endometriosis also incorporate more labeled oleic acid into cholesteryl ester in the presence of oxidized LDL (Ox-LDL) than in the presence of native LDL. Western blot analysis demonstrates the presence of adducts between lipid peroxidation products and proteins in PF of patients with and without endometriosis. The PF of women with endometriosis competes with labeled Ox-LDL for uptake by mouse peritoneal macrophages in a dose-dependent manner.

CONCLUSION(S)

We demonstrate for the first time that human macrophages have functional scavenger receptor(s) and that activation of macrophages in endometriosis involves an increase in scavenger receptor activity. Two lines of evidence indicate the presence of ligands for the scavenger receptor in PF.

Evidence for oxidatively modified lipid-protein complexes in endometrium and endometriosis

OBJECTIVE

To evaluate for the presence of oxidatively modified lipid-protein complexes in endometriosis and endometrium of women with endometriosis and controls.

DESIGN

Controlled clinical study.

SETTING

Academic tertiary care center.

PATIENT(S)

Women undergoing surgery for pelvic pain, infertility, endometriosis, or tubal ligation controls.

INTERVENTION(S)

Biopsy of endometrium and endometriosis.

MAIN OUTCOME MEASURE(S)

Staining with antibodies to oxidatively modified lipid proteins (HNE-7, MDA2), macrophages (HAM-56), and muscle cell actin (HHF-35).

RESULT(S)

Both endometrium and endometriosis tissues contain stromal cells that immunostain with HAM-56 and show immunostaining (both intracellular and extracellular) with HNE-7 and MDA2. Some endometriotic implants show patchy staining with HHF-35. Endometrium was devoid of staining with HHF-35. Control staining with nonimmune sera in both tissues was also devoid of staining.

CONCLUSION(S)

These data strongly implicate the occurrence of oxidative stress in endometriosis tissue. These data also suggest that oxidative modification is a normal physiological process in endometrium.