Experiences of receiving an mHealth application with proactive nursing support among community-dwelling older adults: a mixed-methods study

BACKGROUND

As the population ages, a plethora of digital and mobile health applications for assistance with independent living have emerged. Still unknown, however, is how older adults sustain the use of these applications.

AIM

This study sought to explore the experiences of older adults following their participation in a programme that combined the use of an mHealth application with proactive telecare nursing support.

METHODS

We employed a concurrent mixed-methods design for this study. The quantitative strand included a survey, whereas the qualitative strand included open-ended questions as part of the survey to understand the participants' experiences. Participants for this study were community-dwelling older adults who had taken part in an interventional study that sought to examine the effects of mHealth and nurse support. A convenience sampling approach was employed to recruit potential participants for this study.

FINDINGS

Fifty-five older adults participated. The majority expressed positive attitudes and satisfaction with the app and the nurses' support. The app and nurses' support helped participants to understand their health status and obtain health information. Reasons to halt app usage included technical issues and limited social support.

CONCLUSION

Mobile apps with professional follow-up support could potentially support older adults in the community, although emerging concerns need to be addressed to sustain long-term usage of these apps.

Effectiveness of support from community health workers on the sustained use of a wearable monitoring device among community-dwelling older adults: A randomized trial protocol

BACKGROUND

Wearable monitoring devices, such as smartwatches and fitness bands, are health technologies for enhancing self-care management among community-dwelling older adults. While the evidence suggests that these devices can promote health, older adults often struggle to use them over the long term. Community health workers can effectively motivate older adults to change their health behaviors. This study proposes an intervention involving community health workers as peer supporters to promote sustained daily use of wearable monitoring devices among community-dwelling older adults.

METHODS

The intervention group in this randomized controlled trial will receive the Live with Wearable Monitoring Device program from trained community health workers with the support of a nurse and social workers through a one-time home visit and regular phone calls. The control group will receive only the wearable monitoring device. Data will be collected at baseline, 1 month, 3 months, and 6 months.

DISCUSSION

Merely providing older adults with wearable monitoring devices may not lead to the realization of the potential health benefits of these devices, as long-term usage can be challenging. The results of this trial can provide evidence for a new approach to enhancing self-management and community healthcare among community-dwelling older adults, ultimately improving their health outcomes.

IMPACT

Wearable monitoring devices not only enable real-time monitoring of vital signs, but can also support tailored messaging and facilitate virtual communication between users and healthcare professionals. Despite considerable health benefits, there is evidence showing that older adults largely stop using them after a few months. This study is the first to use a peer support approach to help older adults incorporate a wearable monitoring device in their daily routines in conjunction with goal setting and regular reminders. This will boost the self-care ability of the older adults, allowing them to continue physically functioning in the community.

TRIAL REGISTRATION

This study was prospectively registered at clinicaltrials.gov (identifier: NCT05269303). Registration date: 24/2/2022.

The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial

BACKGROUND

Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time.

OBJECTIVE

We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app.

METHODS

This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect.

RESULTS

A total of 37.8% of mHealth+I and 18.3% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant (χ²₁=6.81, P=.009). Improvements in self-efficacy (β=4.30, 95% CI 0.25-8.35, P=.04) and depression levels (β=-1.98, 95% CI -3.78 to -0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 (β=-1.38, 95% CI -1.98 to -0.78, P<.001), with a marginal increase at T3.

CONCLUSIONS

The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1159/000509129.

Effect of a Mobile Health Application With Nurse Support on Quality of Life Among Community-Dwelling Older Adults in Hong Kong: A Randomized Clinical Trial

IMPORTANCE

Mobile health (mHealth) smartphone apps are becoming increasingly popular among older adults, although the reactive care approach of these apps has limited their usability.

OBJECTIVE

To evaluate the effects of an interactive mHealth program supported by a health-social partnership team on quality of life (QOL) among community-dwelling older adults in Hong Kong.

DESIGN, SETTING, AND PARTICIPANTS

This was a 3-group, randomized clinical trial conducted in 5 community centers in Hong Kong from December 1, 2020, to April 30, 2022, with a last follow-up date of January 31, 2022. Participants included older adults aged at least 60 years who were living within the service area, used a smartphone, and had at least 1 of the following problems: chronic pain, hypertension, or diabetes. Data were analyzed from May 1 to 10, 2022.

INTERVENTIONS

Participants were randomly assigned to the mHealth with interactivity (mHealth+I) group, mHealth group, or control group. Participants in the mHealth+I group received the mHealth app and nurse case management supported by a health-social partnership team. The mHealth group received the mHealth app only. The control group received no mHealth app or health-social care services.

MAIN OUTCOMES AND MEASURES

The primary outcome was the change in QOL from baseline to 3 months after completion of the intervention.

RESULTS

Among 221 participants (mean [SD] age 76.6 [8.0] years; 185 [83.7%] women), 76 were randomized to the control group, 71 were randomized to the mHealth group, and 74 were randomized to the mHealth+I group. The most common chronic diseases or problems were hypertension (147 participants [66.5%]), pain (144 participants [65.2%]), cataracts (72 participants [32.6%]), and diabetes (61 participants [27.6%]). At 3 months after the intervention and compared with the intervention group, there were no statistically significant differences in either the physical component summary (mHealth+I: β = -1.01 [95% CI, -4.13 to 2.11]; P = .53; mHealth: β = 0.22 [95% CI, -3.07 to 3.50]; P = .90) or the mental component summary (mHealth+I: β = -0.87 [95% CI, -4.42 to 2.69]; P = .63; mHealth: β = 1.73 [95% CI, -1.89 to 5.34]; P = .35) QOL scores. Only secondary outcomes, including self-efficacy (β = -2.31 [95% CI, -4.26 to -0.36]; P = .02), systolic blood pressure (β = -2.30 [95% CI, -5.00 to -0.13]; P = .04), pain levels (β = 1.18 [95% CI, 0.52 to 2.00]; P = .02), and health services utilization (β = 0.98 [95% CI, 0.32 to 2.09]; P = .048) improved in the mHealth+I group compared with the control group.

CONCLUSIONS AND RELEVANCE

This randomized clinical trial found no difference in the primary outcome between the mHealth+I group and the control group confirming that there were no incremental benefits to adding interactivity in mHealth programs for older adults with chronic diseases.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT03878212.

A randomized controlled trial of an mHealth application with nursing interaction to promote quality of life among community-dwelling older adults

SIGNIFICANCE

Using mHealth apps alone at home without the support of healthcare experts could mean that older adults might not fully utilize the functions of the apps, recognize their benefits, and sustain their use. Incorporating an integrated health-social partnership model to support the app usage when further help is needed by the older adults might maximize the apps' benefits in the long term.

OBJECTIVES

This study aimed to examine the benefits of adding nursing interaction supported by a health-social partnership model in the use of mHealth, and the sustained beneficial effects on psychological outcomes, including quality of life, self-efficacy, and depression, among older adults after the completion of the program.

METHODS

A three-arm, randomized controlled trial design was adopted. Community-dwelling older adults with chronic pain, hypertension, or diabetes, were randomly assigned to either the mHealth, mHealth with interactivity, or control group. Subjects in both the mHealth and the mHealth with interactivity groups received the mHealth application. In addition, the mHealth with interactivity group received support from a nurse case manager, who was supported by a health-social partnership team. mHealth apps and services from a nurse case manager were not provided to the control group. The primary outcome measure was quality of life, and secondary outcomes were self-efficacy and depression. Data were collected at pre-intervention (T1), post-intervention (T2), and at 3 months post-intervention to measure the sustained effect of the program.

RESULTS

There were 74 mHealth+I, 71 mHealth, and 76 control group subjects enrolled in the program. No statistically significant between-group, within-group, and interaction effects between group and time in both physical component summary (PCS) and mental component summary (MCS) scores were found among the three groups. The mHealth group showed an improvement in PCS and depression scores from T1 to T2, sustained at T3; while the mHealth+I group demonstrated improved self-efficacy from T1 to T2, with a decrease at T3.

CONCLUSION

Adding nurse-directed telephone calls may be of little to no benefit at all in the long term. Future studies may consider a longer intervention period to build and sustain quality of life and self-efficacy levels among community-dwelling older adults.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT03878212.

Effect of a Telecare Case Management Program for Older Adults Who Are Homebound During the COVID-19 Pandemic: A Pilot Randomized Clinical Trial

IMPORTANCE

Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage.

OBJECTIVE

To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months.

INTERVENTIONS

Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls.

MAIN OUTCOMES AND MEASURES

The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis.

RESULTS

A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95% CI, -0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = -8.30; 95% CI, -13.14 to -3.47; P = .001) and quality of life (physical component score: β = 4.99; 95% CI, 0.29-9.69; P = .04).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04304989.

Effects of a Video-Based mHealth Program for Homebound Older Adults: Study Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Although homebound older adults are among the highest users of hospital services, the existing health and social services that are provided to them in the community are limited and fragmented. This study attempts to bring this group of older adults to providers' attention by designing a health-social-oriented self-care mobile Health (mHealth) program and subjecting it to empirical testing. The aim of this study is to shift the current reactive, cure-oriented approach to a preventive and health-promoting model, empowering homebound older adults to take an active role in their health, be responsive to their care needs, and subsequently improve their holistic health.

METHODS

This is a pilot randomized controlled trial. The study is supported by 5 community centers with an estimated sample size of 68 subjects. The subjects will be randomly assigned to video-based mHealth or control groups when they (1) are aged 60 or over, (2) go outdoors less than once a week in the current 6 months, (3) live within the service areas, and (4) use a smartphone. Subjects in the video-based mHealth group will receive a 3-month program comprising 2 main interventions: nurse case management supported by a social service team and video messages covering self-care topics, delivered via smartphone. The control group will receive usual care. Data will be collected at 2 time points - pre-intervention (T1) and post-intervention (T2). The primary outcome will be self-efficacy, and secondary outcomes will include health outcomes (activities of daily living, instrumental activities of daily living, and medication adherence), perceived well-being outcomes (quality of life and depression), and health service utilization outcomes (outpatient clinic, emergency room, and hospital admission).

DISCUSSION

The current study will add to the knowledge gap in using mHealth supported by a health-social team to enhance quality of life and self-care and meet the needs of these particularly vulnerable older adults.

Abstract P6-08-08: Age-Related differences in clinicopathologic features and survival amongst women with triple negative breast cancer: A population-based study

INTRODUCTION: Women with triple-negative breast cancers (TNBC) have a tendency to present at younger ages and with more advanced disease. We sought to comprehensively evaluate the characteristic features, surgical management, and survival outcomes of a large, population-based cohort of patients with TNBC according to age at diagnosis.

METHODS: We queried the Surveillance, Epidemiology, and End Results (SEER) database to identify women aged 18 years or older with a diagnosis of TNBC between 2010-2014. Clinicopathologic and treatment level variables were compared amongst TNBC patients according to age at the time of TNBC diagnosis. The Kaplan-Meier method and Cox PH Regression was then used to examine short-term breast cancer-specific survival (BCSS) outcomes.

RESULTS: Between 2010-2014, 214,138 women were diagnosed with breast cancer, of which 23,614 (11.13%) had TNBC. The median age at TNBC diagnosis was 57.7 years. Younger TNBC patients were more likely to be of African American (&lt;40 years, 20.1% vs. ≥70 years, 15.5%; p&lt;0.001) or Hispanic race (&lt;40 years, 21.9% vs. ≥70 years, 7.0%; p&lt;0.001), diagnosed with larger tumors (T2-T3; &lt;40 years, 70.2%; 40-49 years, 61.7%; 50-59 years, 55%; 60-69 years, 48.1%; ≥70 years, 49.5%; p&lt;0.001) and present with lymph node positive disease (&lt;40 years, 36.7%; 40-49 years, 34.8%; 50-59 years, 32.5%; 60-69 years, 27.5%; ≥70 years, 27.9%; p&lt;0.001). With respect to local therapy, younger women also had a greater tendency to undergo bilateral mastectomy (&lt;40 years, 34.3%; 40-49 years, 23.1%; 50-59 years, 13.4%; 60-69 years, 8.4%; ≥70 years, 3.3%; p&lt;0.001). The estimated one and four-year BCSS for the entire cohort was 94.4% and 79.7%, respectively, with the youngest women &lt;40 years and older women ≥70 years demonstrating the poorest unadjusted BCSS at four years (&lt;40 years, 76.95%; 40-49 years, 82.1%; 50-59 years 80.9%; 60-69 years 81.7%; ≥70 years, 78.6%; log rank p&lt;0.001). In Cox PH analysis adjusting for race, stage, pathologic features, and local therapy, age greater than 70 years remained significantly associated with worse cancer-specific survival (HR1.60, 95% CI 1.39-1.84).

CONCLUSION: In the population studied, more than 40% of very young women with TNBC are of African American or Hispanic race. When compared to older ages, younger women with TNBC are more likely to receive bilateral mastectomy and have more advanced stage at presentation. Women at both age extremes (≥70 years and &lt;40 years at diagnosis) demonstrate worse cancer-specific survival outcomes. In older women, this may be due to undertreatment, and in younger women, to delays in diagnosis and/or worse tumor biology. Further studies are needed to evaluate age-related discrepancies in local and systemic therapy and cancer-specific survival in TNBC.

Citation Format: Wong SM, Boileau J-F, Martel K, Ferrario C, Basik M. Age-Related differences in clinicopathologic features and survival amongst women with triple negative breast cancer: A population-based study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-08.

[Impact of maternal risky behaviors on the behaviors of children born to adolescent and young mothers]

Objective: To examine the impact of maternal risky behaviors on the behaviors of children born to adolescent and young mothers. Methods: Adolescents and young Chinese mothers were recruited from an integrated young mother supportive program in Hong Kong between January and June 2015. Eligible mothers were asked to complete a questionnaire on their sociodemographic characteristics and history of risky behavior as well as their children's behaviors. Multiple regression analyses were conducted to explore the association between maternal risky behaviors and their children's behaviors. Results: Among 201 respondents, there were 187 (93.0%) ex-drinkers, 136 (67.7%) ex-smokers, and 83 (41.3%) ex-addicts. Compared to the reference group, children of mothers with drug use behaviors were more likely to have abnormal SDQ total difficulties scores (odds ratio 2.60, P=0.01), those of ex-drinking mothers had more behavioral difficulties and more conduct problems (B=3.82 and 1.37, P both=0.01) and those of ex-smoking mothers had more conduct problems (B=0.74, P=0.01) after adjustment for confounders. Children of active drug-taking mothers also had more emotional symptoms (B=1.77, P=0.04) and hyperactivity/inattention problems (B=2.14, P=0.03). Conclusion: The history of mother's risky behavior was significantly associated with the behavioral problems of the children.

On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease

BACKGROUND AND PURPOSE

Intravoxel incoherent motion imaging can measure both microvascular and parenchymal abnormalities simultaneously. The contamination of CSF signal can be suppressed using inversion recovery preparation. The clinical feasibility of inversion recovery-intravoxel incoherent motion imaging was investigated in patients with cerebrovascular disease by studying its reproducibility.

MATERIALS AND METHODS

Sixteen patients with cerebrovascular disease (66 ± 8 years of age) underwent inversion recovery-intravoxel incoherent motion imaging twice. The reproducibility of the perfusion volume fraction and parenchymal diffusivity was calculated with the coefficient of variation, intraclass correlation coefficient, and the repeatability coefficient. ROIs included the normal-appearing white matter, cortex, deep gray matter, white matter hyperintensities, and vascular lesions.

RESULTS

Values for the perfusion volume fraction ranged from 2.42 to 3.97 ×10^-2 and for parenchymal diffusivity from 7.20 to 9.11 × 10^-4 mm²/s, with higher values found in the white matter hyperintensities and vascular lesions. Coefficients of variation were <3.70% in normal-appearing tissue and <9.15% for lesions. Intraclass correlation coefficients were good to excellent, showing values ranging from 0.82 to 0.99 in all ROIs, except the deep gray matter and cortex, with intraclass correlation coefficients of 0.66 and 0.54, respectively. The repeatability coefficients ranged from 0.15 to 0.96 × 10^-2 and 0.10 to 0.37 × 10^-4 mm²/s for perfusion volume fraction and parenchymal diffusivity, respectively.

CONCLUSIONS

Good reproducibility of inversion recovery-intravoxel incoherent motion imaging was observed with low coefficients of variation and high intraclass correlation coefficients in normal-appearing tissue and lesion areas in cerebrovascular disease. Good reproducibility of inversion recovery-intravoxel incoherent motion imaging in cerebrovascular disease is feasible in monitoring disease progression or treatment responses in the clinic.

DSM-5 Update in Psychodermatology

Up to a third of dermatology outpatients have a significant psychiatric issue complicating their skin complaint. Although the ideal would frequently involve psychiatric assessment, those with comorbid mental illness often refuse psychiatric referral. As a result, it is imperative that dermatologists be mindful of psychiatric comorbidity in their patients and comfortable with the fundamentals of psychodermatologic diagnosis and therapy. This update summarizes current concepts, relevance, and therapeutics in psychodermatology, including aspects pertinent to depression, anxiety, obsessive-compulsive, impulse-control, and delusional disorders as described in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5, published in 2013 by the American Psychiatric Association).

Gabapentin for the treatment of carpal tunnel syndrome: a randomized controlled trial

OBJECTIVE

Based on its efficacy in treating neuropathic pain, gabapentin may be effective for the treatment of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the efficacy of gabapentin for symptom relief in CTS.

METHODS

We conducted a randomized, double-blinded, placebo-controlled trial recruiting patients with newly diagnosed idiopathic CTS of more than a period of three months. Diagnosis was based on characteristic symptoms with electrophysiological confirmation. Patients were randomly assigned to an active group receiving gabapentin (starting dose 300 mg once daily to a target of 900 mg daily) or a placebo group. Primary end-point was the global symptom score (GSS), which was measured at baseline, two, and eight weeks.

RESULTS

There was no significant difference in baseline variables between the two treatment groups. Hundred and forty patients were enrolled in the study, of whom 71 were randomly assigned to gabapentin group and 69 assigned to placebo group. Both gabapentin and placebo produced significant improvement in symptoms at two and eight weeks. The GSS at 2 and 8 weeks was 16.4 (SD 9.4) and 13.4 (SD 9.7), respectively, in the active group versus 14.9 (SD 9.0) and 12.5 (SD 8.9) in the control group (P < 0.01). But by eight weeks, the mean reduction in symptom severity of patients on gabapentin [-10.4 (SD 10.8)] was not significant when compared with placebo [-8.7 (SD 8.1), P < 0.39]. Adverse events were not severe and included dizziness, somnolence, and headache.

CONCLUSIONS

Gabapentin did not produce a significant reduction in symptom severity compared with placebo over an eight-week period.

Fast-dissolving microparticles fail to show improved oral bioavailability

Oral dosage forms are the preferred means of delivering drugs for systemic absorption. However, development problems occur for drugs with poor water solubility and/or gastrointestinal permeability. It is generally believed that the in-vivo bioavailability of poorly water-soluble drugs from Class II of the Biopharmaceutics Classification System can be improved by increasing the dissolution rate. We have attempted to increase the in-vivo oral bioavailability of a model Class II drug (griseofulvin) by preparing rapidly-dissolving particles. The solvent-diffusion method was used to prepare particles with hydrophilic surfactants (Brij 76/Tween 80 surfactant blend) and in-vivo studies were conducted in rats. The griseofulvin particles produced were bipyramidal in habit with a particle size of 2.18 ± 0.12 mm; they contained crystalline drug and a relatively large proportion (12% w/w) of hydrophilic surfactant. The latter and the small particle size ensured rapid particle dispersion and dissolution in-vitro. Thus, within 30 min of the in-vitro dissolution test, the bipyramidal particles had released ∼70% of drug compared with ∼10% from the starting material (particle size 12.61 ± 1.11 μm). However, the rapid and increased drug dissolution in-vitro was not translated to rapid and enhanced absorption in-vivo, and the oral bioavailability of the model drug was found to be the same from the control and from the bipyramidal particles. The poor in-vivo performance of the bipyramidal particles showed that although the dissolution rate of a Class II drug is thought to be a good indicator of its in-vivo bioavailability, this is not always the case.

Plastocyanin transit peptide interacts with Potato virus X coat protein, while silencing of plastocyanin reduces coat protein accumulation in chloroplasts and symptom severity in host plants

Potato virus X coat protein (PVXCP) is, through communication with host proteins, involved in processes such as virus movement and symptom development. Here, we report that PVXCP also interacts with the precursor of plastocyanin, a protein involved in photosynthesis, both in vitro and in vivo. Yeast two-hybrid analysis indicated that PVXCP interacted with only the plastocyanin transit peptide. In subsequent bimolecular fluorescence complementation assays, both proteins were collocated within chloroplasts. Western blot analyses of chloroplast fractions showed that PVXCP could be detected in the envelope, stroma, and lumen fractions. Transmission electron microscopy demonstrated that grana were dilated in PVX-infected Nicotiana benthamiana. Furthermore, virus-induced gene silencing of plastocyanin by prior infection of N. benthamiana using a Tobacco rattle virus vector reduced the severity of symptoms that developed following subsequent PVX infection as well as the accumulation of PVXCP in isolated chloroplasts. However, PVXCP could not be detected in pea chloroplasts in an in vitro re-uptake assay using the plastocyanin precursor protein. Taken together, these data suggest that PVXCP interacts with the plastocyanin precursor protein and that silencing the expression of this protein leads to reduced PVXCP accumulation in chloroplasts and ameliorates symptom severity in host plants.

Fetal biometry in ethnic Chinese: biparietal diameter, head circumference, abdominal circumference and femur length

OBJECTIVES

To construct new reference charts and equations for fetal biometry in the Hong Kong ethnic Chinese population, and to compare them with existing references from different populations.

METHODS

This was a prospective observational study involving 709 women with singleton pregnancies and confirmed gestational age. For the purposes of this study, each woman was scanned once only, between 12 and 40 completed weeks of gestation, and the following fetal biometric measurements were recorded: biparietal diameter, head circumference, abdominal circumference and femur length. For each measurement, regression models were fitted to estimate the mean and SD at each gestational age. For comparison, the fetal biometric measurements of other populations at each gestation were expressed as Z-scores calculated with our reference equations. Results were presented graphically across the different gestational ages to allow visual comparison.

RESULTS

New charts and reference equations are reported in this Hong Kong Chinese population for fetal outer-inner and outer-outer biparietal diameter, head circumference, abdominal circumference and femur length. Equations for dating of pregnancy are presented. Our charts were very similar to those of the Singaporean population for most parameters. The main difference in our fetal biometric measurements compared with those of the UK and French populations was in FL.

CONCLUSIONS

Our new set of reference centiles for fetal biometric measurements and equations for dating of pregnancy in a Hong Kong Chinese population are ready for clinical use and research in appropriate ethnic Chinese groups.

First Report of Phytoplasma Infection of Grasses in Singapore

In September of 2005, patches of Cynodon dactylon showing symptoms of bleached leaves were first observed in an open field in Singapore. Samples were collected from this site, from which total DNA was extracted with a Qiagen DNeasy kit (Catalog No 69104) and analyzed for phytoplasma DNA by a PCR assay with phytoplasma universal primer pairs P1/PTint (3). Resulting PCR products were each diluted 1:30 with sterilized distilled water and used in nested PCR with primer pair R16F2n and R16R2 (1). Twenty-five C. dactylon samples were assessed by this means, of which eight of eight with bleached leaves and four of seventeen symptomless samples tested positive. Widened disease surveillance identified the grasses, Axonopus compressus and Paspalum conjugatum, with similar bleached leaf symptoms in December 2006 and May 2007, respectively. Twenty-three of fifty-three A. compressus and six of twenty P. conjugatum samples were detected as positive for phytoplasma infection with the above PCR methods. A comparative analysis of sequences derived from the three grass hosts determined that the phytoplasma infecting C. dactylon (Genbank Accession No. EU234510) was most similar (>99%) to 'Candidatus Phytoplasma cynodontis' (GenBank Accession No. AB052871.1), whereas those detected in A. compressus (Genbank Accession No. EU234511) and P. conjugatum (Genbank Accession No. EU234512) were most similar (>99%) to the Brachiaria white leaf phytoplasma (GenBank Accession No. AB052872.1) (2). To our knowledge, this is the first report of phytoplasmas in C. dactylon, A. compressus, and P. conjugatum in Singapore. References: (1) I. M. Lee et al. Int. J. Syst. Evol. Microbiol. 48:1153, 1998. (2) C. Marcone et al. Int. J. Syst. Evol. Microbiol. 54:1077, 2004. (3) C. D. Smart et al. Appl. Environ. Microbiol. 62:2988, 1996.

Dexmedetomidine infusion as a supplement to isoflurane anaesthesia for vitreoretinal surgery

BACKGROUND

We explored the sympatholytic property of dexmedetomidine, especially its role in intraocular pressure (IOP) reduction, haemodynamic stability, and attenuation of extubation response.

METHOD

In this double-blind, randomized, controlled trial approved by the Hospital Ethics Committee, 60 patients undergoing elective vitreoretinal surgery were allocated to two groups, receiving either placebo or dexmedetomidine. A loading dose of dexmedetomidine 2.5 microg kg(-1) h(-1) (or placebo in same volume) was infused for 10 min immediately before induction of anaesthesia with propofol, followed by a maintenance dexmedetomidine or placebo infusion at 0.4 microg kg(-1) h(-1) till 30 min before the end of the operation. Anaesthesia was maintained with isoflurane, oxygen, and air mixture. IOP was measured before the loading dose and 1 min after tracheal intubation. The mean arterial pressure (MAP) and heart rate (HR) during loading, induction, maintenance, extubation, and recovery period were measured. The degree of strain on extubation was graded from 0 to 5.

RESULTS

The use of vasopressor/labetalol/atropine and the reduction in IOP were comparable between the two groups. There was a significant variation in MAP and HR over time within group, but not between groups. The median degree of strain was significantly lower (P = 0.049), and the time to reach Aldrete score of 10 shorter (P = 0.031) in the dexmedetomidine group.

CONCLUSION

Dexmedetomidine can be used without undue haemodynamic fluctuation and can decrease the excitatory response during extubation. The reduction in IOP with dexmedetomidine was comparable with placebo.

Hibiscus chlorotic ringspot virus p27 and its isoforms affect symptom expression and potentiate virus movement in kenaf (Hibiscus cannabinus L.)

Hibiscus chlorotic ringspot virus (HCRSV), a member of the genus Carmovirus, encodes p27 (27-kDa protein) and two other in-frame isoforms (p25 and p22.5) that are coterminal at the carboxyl end. Only p27, which initiates at the 2570CUG codon, was detected in transfected kenaf (Hibiscus cannabinus L.) protoplasts through fusion to a Flag tag at either its N or C terminus. Subcellular localization of a p27-green fluorescent fusion protein in kenaf epidermal cells showed that it was localized to membrane structures close to cell walls. To study the functions of these proteins, a number of start codon mutants and premature translation termination mutants were constructed. Phenotypic differences were observed between the wild-type virus and these mutants during infection. Infectivity assays on plants indicated that p27 is a determinant of symptom severity. Without p25, appearance of symptoms on systemically infected kenaf leaves was delayed by 4 to 8 days. In a timecourse analysis, Western blot assays revealed that the delay corresponded to retardation in virus systemic movement, which suggested that p25 is probably involved in virus systemic movement. Mutations disrupting expression of p22.5 did not affect symptoms or virus movement.

Enhancement of the dissolution rate and oral absorption of a poorly water soluble drug by formation of surfactant-containing microparticles

The slow dissolution rate exhibited by poorly water-soluble drugs is a major challenge in the drug development process. Following oral administration, drugs with slow dissolution rates generally show erratic and incomplete absorption which may lead to therapeutic failure. The aim of this study was to improve the dissolution rate and subsequently the oral absorption and bioavailability of a model poorly water-soluble drug. Microparticles containing the model drug (griseofulvin) were produced by spray drying the drug in the absence/presence of a hydrophilic surfactant. Poloxamer 407 was chosen as the hydrophilic surfactant to improve the particle wetting and hence the dissolution rate. The spray dried particles were characterized and in vitro dissolution studies and in vivo absorption studies were carried out. The results obtained showed that the dissolution rate and absolute oral bioavailability of the spray dried griseofulvin/Poloxamer 407 particles were significantly increased compared to the control. Although spray drying griseofulvin alone increased the drug's in vitro dissolution rate, no significant improvement was seen in the absolute oral bioavailability when compared to the control. Therefore, it is believed that the better wetting characteristics conferred by the hydrophilic surfactant was responsible for the enhanced dissolution rate and absolute oral bioavailability of the model drug.

Single vs. two steroid injections for carpal tunnel syndrome: a randomised clinical trial

We investigated the efficacy of a single vs. double steroid injections in the treatment of carpal tunnel syndrome (CTS) in a randomised double-blind controlled trial. Patients with idiopathic CTS were randomised into (i) one group receiving a baseline methylprednisolone acetate injection plus a saline injection 8 weeks later and (ii) a second group receiving methylprednisolone acetate injection at baseline and at 8 weeks. The primary outcome was the Global Symptom Score (GSS). Forty patients were recruited. By 40 weeks, the mean GSS improved from 25.6 to 14.1 in the single-injection group whereas from 26.7 to 12.6 in the reinjection group, but there was no significant difference in GSS between the two groups (p = 0.26). There were also no significant differences in terms of electrophysiological and functional outcomes. The results suggest that an additional steroid injection confers no added benefit to a single injection in terms of symptom relief.

Cervical length at 18-22 weeks of gestation for prediction of spontaneous preterm delivery in Hong Kong Chinese women

OBJECTIVE

To assess the value of a single cervical length measurement by transvaginal sonography (TVS) at the time of mid-trimester anomaly scan for predicting spontaneous preterm delivery (SPD) among Chinese women.

METHODS

A prospective observational study was carried out involving 2880 subjects with singleton pregnancies and confirmed gestational age. Cervical length was measured at 18-22 weeks of gestation.

RESULTS

The incidence of SPD < 34 weeks and < 37 weeks were 0.7% and 3.7%, respectively. Women with SPD < 34 weeks and SPD < 37 weeks had shorter median cervical lengths (32.6 mm and 36.2 mm, respectively) than those with term deliveries (37.6 mm) (P = 0.006 and 0.025, respectively). The predictive performance of cervical length was better for SPD < 34 weeks compared with < 37 weeks. A cervical length < or = 27 mm, which corresponded to the 4th centile, occurred in 36.8%, 62.5% and 100% of those with SPD < 34, < 30 and < 26 weeks, respectively. The positive likelihood ratio (LR) of a cervical length < or = 27 mm in predicting SPD < 34 weeks was 9.8. Using logistic regression, both short cervix and funneling were independent predictors for SPD < 34 weeks of gestation. The coexistence of funneling and a cervical length < or = 27 mm gave a positive predictive value (PPV) and LR of SPD < 34 weeks of 14.7% and 26.0, respectively.

CONCLUSIONS

Mid-trimester cervical length is predictive of SPD in Chinese women. However, given the low PPV of a short cervical length, its clinical utility is still limited in low-risk populations.

Can the urine dipstick test reduce the need for microscopy for assessment of systemic lupus erythematosus disease activity?

OBJECTIVE

Urine microscopic examination is an important component of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). We investigated whether the urine dipstick test can reduce the need for microscopy for the assessment of SLEDAI.

METHODS

We studied 269 urine samples from 259 SLE patients with Albustix and Hemastix reagent strips. The results were compared to concomitant microscopic examination of urinary sediment.

RESULTS

When trace red blood cell was defined as the cutoff, the sensitivity, specificity, and negative predictive value (NPV) of the Hemastix urine test were 0.98, 0.53, and 0.99, respectively, for hematuria; 0.82, 0.47, and 0.90, respectively, for the presence of pyuria; and 0.91, 0.44, and 0.98, respectively, for the presence of casts by microscopic examination. When proteinuria of 1+ was defined as the cutoff, the sensitivity, specificity, and NPV of the Albustix test were 1.00, 0.46, and 0.99, respectively, for urinary casts; and 0.82, 0.49, and 0.90, respectively, for the presence of pyuria. When both Albustix and Hemastix were applied as screening test, urine microscopy could be reduced by 27%; however, 8% of cases with normal Albustix and Hemastix tests had at least one abnormality on urine microscopy examination.

CONCLUSION

In patients with SLE, a combination of Albustix and Hemastix urine tests showed reasonable sensitivity to detect abnormalities in urine sediment. Based on these results, routine urine microscopy can be limited to SLE patients with abnormal Albustix or Hemastix tests. Rarer causes of abnormal renal function in lupus, such as tubulointerstitial nephritis or drug induced interstitial nephritis, would be manifested by pyuria and therefore would not necessarily be detected by changes in the blood and protein detectors on the urine dipstick.

Clinical Case Notes. Successful treatment of surgically induced necrotizing scleritis with tacrolimus

A 46-year-old man developed surgically induced necrotizing scleritis (SINS) 7 months following uneventful primary bare sclera pterygium excision. The patient underwent two scleral patch grafts for SINS but despite the use of cyclophosphamide and azathioprine, the scleral patch grafts failed within 1 month of surgery on both occasions. Tacrolimus was used for his third scleral patch graft. No recurrence of necrotizing scleritis was observed for 2 years. Tacrolimus may be considered as a valuable adjunctive immunosuppressant in the management of resistant necrotizing scleritis.

Determination of complete nucleotide sequence of Hibiscus latent Singapore virus: evidence for the presence of an internal poly(A) tract

We have sequenced the complete genome of a hibiscus-infecting tobamovirus, Hibiscus latent Singapore virus (HLSV). The experimental host range of HLSV is similar to that of another distinct species of hibiscus infecting tobamovirus, Hibiscus latent Fort Pierce virus (HLFPV). The genomic structure of HLSV is similar to other tobamoviruses in general. It consists of a 5' untranslated region (UTR), followed by ORFs encoding for a 128 kDa protein and a 186 kDa readthrough protein, a 30 kDa movement protein (MP), 18 kDa coat protein (CP) and a 3' UTR. The unique feature of HLSV is the presence of a poly(A) tract within its 3' UTR. In our previous work, we have reported MP and CP sequences of HLSV and its phylogenetic analysis. Here we report the complete nucleotide sequence of HLSV, phylogenetic analysis of the nucleotide and amino acid sequences of 128/186 kDa ORFs and the presence of a uniquely located poly(A) tract within the 3' UTR.

Long-term outcome of carpal tunnel syndrome after conservative treatment

The purpose of this study was to investigate the long-term prognosis of patients with carpal tunnel syndrome (CTS). We prospectively followed-up patients with CTS for 80 weeks. Thirty cases had been treated with a single injection of methylprednisolone acetate and another 30 with a 10-day course of prednisolone. At the end of the follow-up period, there were no significant differences in symptoms as measured by global symptom score and in the proportion of patients who progressed to decompressive surgery. Few patients who were not operated on (11.4%) remain asymptomatic.

Breakage of resistance to Cucumber mosaic virus by co-infection with Zucchini yellow mosaic virus : enhancement of CMV accumulation independent of symptom expression

Resistance to the cucumovirus Cucumber mosaic virus (CMV) in cucumber cv. Delila was manifested as a very low level of accumulation of viral RNA and capsid protein, and an absence of CMV-induced symptoms. In addition, resistance was observed at the single cell level, with a reduction in accumulation of CMV RNAs, compared to accumulation in cells of the susceptible cucumber cv. Bet Alpha. Resistance to CMV in cv. Delila was broken by co-infection with the potyvirus Zucchini yellow mosaic virus (ZYMV). Resistance breakage in cv. Delila plants was manifested by an increase in the accumulation of (+) and (-) CMV RNA as well as CMV capsid protein, with no increase in the level of accumulation of ZYMV. Resistance breakage in the resistant cultivar by ZYMV also occurred at the single cell level. Thus, synergistic interactions known to occur between a potyvirus and a cucumovirus led to resistance breakage during a double infection. However, resistance breakage was not accompanied by an increase in disease symptoms beyond those induced by ZYMV itself. On co-inoculation with an asymptomatic variant of ZYMV-AG an enhancement of CMV infection occurred without disease manifestation. Consequently, intensification of viral RNA and capsid protein accumulation can occur without a corresponding increase in disease development, suggesting that different host genes regulate viral accumulation and disease development in the CMV-resistant cucumber plants.

An unusual cause of carpal tunnel syndrome

Tuberculosis is an uncommon cause of carpal tunnel syndrome. We report a patient with systemic lupus erythematosus who developed hand numbness. Ultrasonic, operative and microbiological findings supported the diagnosis of median nerve compression secondary to a tuberculous abscess. The symptoms resolved with surgical excision and antituberculous chemotherapy.

Genetic variability in the coat protein genes of two orchid viruses: Cymbidium mosaic virus and Odontoglossum ringspot virus

The variability in coat protein gene sequences of Cymbidium mosaic virus (CymMV) and Odontoglossum ringspot virus (ORSV) that naturally infect orchids worldwide was investigated. Samples were collected from Korea, Singapore and Taiwan. The sequence data were compared with available published coat protein gene sequences of CymMV and ORSV, including those from Japan and Thailand. Among CymMV isolates, the homology was 89.1%-99.7% and 93.2%-100% at the nucleotide and amino acid levels, respectively. Among the ORSV isolates, the homology was 95.5%-100% and 93%-100% at the nucleotide and amino acid levels, respectively. No particular region of variability could be defined in either of the viruses. In deduced amino acid sequence, the N-terminal was more conserved than the C-terminal in both CymMV and ORSV. By comparing all sequences determined in this study and those that are published in the GenBank databases, we did not find clustering based on geographical distribution or sequence identity. Such high sequence conservation suggests that both CymMV and ORSV coat protein genes are suitable candidates to provide resistance to orchids cultivated in different geographical locations.

Hibiscus virus S is a new subgroup II tobamovirus: evidence from its unique coat protein and movement protein sequences

The coat protein (CP) and movement protein (MP) sequences of a new tobamovirus infecting Hibiscus rosa-sinensis L were determined. The CP gene encodes 163 amino acid (aa) residues and with a theoretical molecular weight of 18.19 kDa. The MP gene encodes 282 amino acids and its theoretical molecular weight is 30.36 kDa. The nucleotide (nt) and aa sequences of the CP were 46.88 % to 51.63 % and 45.34 % to 57.06 % identical to other tobamoviruses, respectively. The nt and aa sequence identities of MP ranged from 38.81 % to 43.90 % and 30.85 % to 37.88 %, respectively. The predicted virion origin of assembly (OAS) was located in the CP gene. Phylogenetic trees generated based on the nt and aa sequences of both CP and MP genes indicate that this new virus clusters with members of subgroup II of tobamoviruses. Although this hibiscus virus shared a high nt and aa sequence identity with Sunn-hemp mosaic virus (SHMV), Western analysis showed that it is serologically unrelated to SHMV. We propose the name Hibiscus virus S (HVS) for this Singapore isolate. This is the first report on partial nt sequence of a tobamovirus that infects hibiscus.

Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome

OBJECTIVE

Sonographic examination of the median nerve has been suggested as a useful alternative to electrophysiologic study in the diagnosis of carpal tunnel syndrome. To determine its usefulness and the best diagnostic criterion, sonograms of patients with the disease were compared with sonograms of healthy subjects in a case-control study.

METHODS

Patients with carpal tunnel syndrome and asymptomatic controls who were matched for age and sex were enrolled and underwent sonography of the wrists. Eight separate sonographic criteria were analyzed in each wrist. Data from the patient group and the control group were compared to establish optimal diagnostic criteria for carpal tunnel syndrome, using receiver operating characteristic analytic techniques.

RESULTS

Thirty-five patients with carpal tunnel syndrome and 35 asymptomatic controls were examined. Increased cross-sectional area of the median nerve was found to be the most predictive measure of carpal tunnel syndrome, proximal to the tunnel inlet, at the tunnel inlet, and at the tunnel outlet, with significant differences between patients and controls. Using a receiver operating characteristic curve, a cut-off value >0.098 cm(2) at the tunnel inlet provided a diagnostic sensitivity of 89% and a specificity of 83%.

CONCLUSION

Sonographic measurement of the median nerve cross-sectional area is both sensitive and specific for the diagnosis of carpal tunnel syndrome.

Redox signal transduction by the ArcB sensor kinase of Haemophilus influenzae lacking the PAS domain

The Arc (anoxic redox control) two-component signal transduction system of Escherichia coli, which comprises the tripartite ArcB sensor kinase and the ArcA response regulator, modulates the expression of numerous operons in response to redox conditions of growth. We demonstrate that the arcA and arcB genes of Haemophilus influenzae specify a two-component system. The Arc proteins of the two bacterial species sufficiently resemble each other that they can participate in heterologous transphosphorylation in vitro. Moreover, the Arc system of H. influenzae mediates transcriptional control according to the redox condition of growth both autologously in its own host and homologously in E. coli, indicating a high degree of functional conservation of the signal transduction system. The H. influenzae ArcB, however, lacks the PAS domain present in the region of E. coli ArcB linking the transmembrane to the cytosolic catalytic domains. Because the PAS domain participates in signal reception in a variety of sensory proteins, including sensors of molecular oxygen and redox state, a similar role was previously ascribed to it in ArcB. Our results demonstrate that the ArcB protein of H. influenzae mediates signal transduction in response to redox conditions of growth despite the absence of the PAS domain.

Enflurane actions on spinal cords from mice that lack the beta3 subunit of the GABA(A) receptor

BACKGROUND

Gamma-aminobutyric acid type A (GABA(A)) receptors are considered important in mediating anesthetic actions. Mice lacking the beta3 subunit of this receptor (beta3-/-) have a higher enflurane minimum alveolar concentration (MAC) than wild types (+/+). MAC is predominantly determined in spinal cord.

METHODS

The authors measured three population-evoked responses in whole spinal cords, namely, the excitatory postsynaptic potential (pEPSP), the slow ventral root potential (sVRP), and the dorsal root potential. Synaptic and glutamate-evoked currents from motor neurons in spinal cord slices were also measured.

RESULTS

Sensitivity of evoked responses to enflurane did not differ between +/+ and -/- cords. The GABA(A) receptor antagonist bicuculline significantly (P < 0.05) attenuated the depressant effects of enflurane on pEPSP, sVRP and glutamate-evoked currents in +/+ but not -/- cords. The glycine antagonist strychnine elevated the pEPSP to a significantly greater extent in -/- than in +/+ cords, but the interactions between strychnine and enflurane did not differ between -/- and +/+ cords.

CONCLUSIONS

Similar enflurane sensitivity in spinal cords from -/- and +/+ mice was coupled with a decreased role for GABA(A) receptors in mediating the actions of enflurane in the former. This finding implies that other anesthetic targets substitute for GABA(A) receptors. Increase in glycine receptor-mediated inhibition was found in -/- cords, but the glycine receptor does not appear to be a substitute anesthetic target. This mutation thus led to a quantitative change in the molecular basis for anesthetic depression of spinal neurotransmission in a fashion not predicted by the mutation itself. The results argue against an immutable dominant role for GABA(A) receptors in mediating spinal contributions to MAC.

Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome

The authors compared the effectiveness of low-dose, short-term oral prednisolone vs local methylprednisolone injection in a prospective, double-blinded, parallel treatment study of carpal tunnel syndrome (CTS). A single injection of 15 mg methylprednisolone resulted in significant improvement in global symptom scores over a 12-week period. This study demonstrated the superiority of local steroid injection to oral steroid in the treatment of CTS.

Is anomalous production of omega and omega; evidence for disoriented chiral condensates?

No conventional picture of nucleus-nucleus collisions has yet been able to explain the abundance of Omega and Omega; hadrons in central collisions between Pb nuclei at 158A GeV at the CERN SPS. We argue that this is evidence that they are produced as topological defects arising from the formation of disoriented chiral condensates with an average domain size of about 2 fm.

Complete sequences and phylogenetic analyses of a Singapore isolate of broad bean wilt fabavirus

The complete nucleotide (nt) sequence of a Singapore isolate of broad bean wilt fabavirus from Megakepasma erythrochlamys L., designated BBWV-ME, was determined. Its bipartite genome consisted of two positive-sense single-stranded ribonucleic acids (RNA). RNA1 (5951 nt in length) encoded a putative protease cofactor, nucleotide triphosphate (NTP)-binding domain (helicase), viral genome-linked protein (VPg), protease and RNA-dependent RNA polymerase (RdRp). RNA2 (3607 nt in length) encoded a putative movement protein (MP) and coat proteins (CP). Genome organization of BBWV-ME was similar to other viruses in the Comoviridae family. Phylogenetic analyses showed that fabaviruses were more closely related to the comoviruses than the nepoviruses.

15-deoxy-delta12,14-prostaglandin J2, a specific ligand for peroxisome proliferator-activated receptor-gamma, induces neuronal apoptosis

Although considerable research has shown a role for peroxisome proliferator-activated receptors (PPAR) in adipose differentiation and in the regulation of inflammation, little is known about its possible functions in neurons. We investigated the role of PPARgamma in primary cultures of cortical neurons and human neuroblastoma SH-SYSY cells. Incubation of cortical neurons with the specific PPARgamma ligand 15-Deoxy-delta12,14-prostaglandin J2 (15d-PGJ2) induced morphological changes including neurite degeneration and nuclear condensation that were consistent with neurons dying by apoptosis. The morphological changes associated with incubation of cortical neurons with 15d-PGJ2 were prevented following pretreatment of neurons with the general caspase inhibitor, Z-VAD. These results highlight a novel role for PPARgamma in neurons and suggest that unwarranted activation of PPARgamma may contribute to the neuronal apoptosis associated with certain neurodegenerative disorders including Alzheimer's disease (AD).