Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial.

PURPOSE: To examine whether in-bed cycling assists critically ill adults to reduce acute muscle wasting, improve function and improve quality of life following a period of critical illness. MATERIALS AND METHODS: A single-centre, two-group, randomised controlled trial with blinded assessment of the primary outcome was conducted in a tertiary ICU. Critically ill patients expected to be mechanically ventilated for at least 48 h were randomised to 30 min daily in-bed cycling in addition to usual-care physiotherapy (n = 37) or usual-care physiotherapy (n = 37). The primary outcome was muscle atrophy of rectus femoris cross-sectional area (RFCSA) measured by ultrasound at Day 10 following study enrolment. Secondary outcomes included manual muscle strength, handgrip strength, ICU mobility score, six-minute walk test distance and health-related quality of life up to six-months following hospital admission. RESULTS: Analysis included the 72 participants (mean age, 56-years; male, 68%) who completed the study. There were no significant between-group differences in muscle atrophy of RFCSA at Day 10 (mean difference 3.4, 95% CI -6.9% to 13.6%; p = .52), or for secondary outcomes (p-values ranged p = .11 to p = .95). CONCLUSIONS AND RELEVANCE: In-bed cycling did not reduce muscle wasting in critically ill adults, but this study provides useful effect estimates for large-scale clinical trials. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12616000948493.

A field test of the use of pop-off data storage tags in freshwater fishes.

In the present study, pop-off data storage tags (pDST) without any transmitting capabilities were attached to 118 adult salmonids in a 19 000 km2 freshwater system (Lake Ontario). The 9·3 cm long cylindrical tags were externally attached to fishes using a backpack-style harness, set to record pressure (dBar ≈ depth in m) and temperature every 70 s (and at some key times, every 5 s) and programmed to release from the harness and float to the surface after c. 1 year. Recapture of the bright-orange tags for data retrieval relied on members of the public finding tags on shore, or on anglers capturing fishes with tags attached and using the contact information displayed on each tag to mail tags to the research team in exchange for a monetary reward. Thirty-seven tags were found and returned from the 118 released (31%), while 26 of the 118 tags (22%) remained scheduled to pop-off in summer 2017. Of the 37 tags returned, 23 were from wild-caught fishes (out of 88 wild-caught and tagged fishes; 26%) and yielded useful data whereas 14 were from hatchery-reared fishes that were opportunistically tagged and appear to have been unable to acclimate to life in the wild and died days to weeks after release. The field study described here thus demonstrated that pDSTs can be a viable option for collecting large amounts of high-resolution depth and temperature data for salmonids in freshwater systems. Technical challenges, limitations and unknowns related to the use of pDSTs with freshwater fishes are discussed. In addition, pDSTs are compared with alternate electronic tagging technologies and assessed for their potential as a more widespread tool in research on freshwater fishes.

Bridging the translational divide: identical cognitive touchscreen testing in mice and humans carrying mutations in a disease-relevant homologous gene.

Development of effective therapies for brain disorders has been hampered by a lack of translational cognitive testing methods. We present the first example of using the identical touchscreen-based cognitive test to assess mice and humans carrying disease-related genetic mutations. This new paradigm has significant implications for improving how we measure and model cognitive dysfunction in human disorders in animals, thus bridging the gap towards effective translation to the clinic.

Tracking the Temporal Dynamics of Intracellular Lead Speciation in a Green Alga.

Organisms have developed metal regulatory mechanisms in response to changes in the bioavailability of trace metals. Just as metal bioavailability dictates cellular uptake, intracellular metal speciation determines the availability of metals to exert biological effects. However, the missing link in understanding the relationship between metal uptake and biological responses is the ability to accurately measure intracellular metal speciation. We conducted Pb exposure studies on the well-characterized model green alga Chlamydomonas reinhardtii and identified temporal changes in intracellular Pb speciation under conditions relevant for fresh water ecosystems using resonant X-ray emission spectroscopy (RXES), which possesses enhanced sensitivity to functional group chemistry relative to X-ray absorption spectroscopy (XAS). Analysis of RXES maps show that only a small fraction of total intracellular Pb was complexed by thiol groups. Initial sequestration of Pb in oxides and inorganic phosphate was followed by binding of Pb to organic phosphate, suggesting potential interference in vital cellular functions. These results contrast proposed detoxification responses involving complexation by thiol groups from peptides.

How tumours escape mass destruction.

It is now well established that the immune system can control neoplastic development and growth in a process termed immunosurveillance. A link between host immunosurveillance and neoplastic progression is revealed in cases where the immune response becomes compromised due to genetic or other pathological conditions, resulting in a substantially increased incidence and rate of spontaneous tumour formation in both preclinical animal models and patients. It has also been demonstrated in tumour-bearing hosts that the tumorigenic process itself can promote a state of immunosuppression that, in turn, facilitates neoplastic progression. The ability of neoplastic populations to induce a hostile microenvironment through both cell contact-dependent and -independent immunosuppressive networks is a significant barrier to effective cell-mediated immunity and immunotherapy. Thus, a competent immune system is integral for the control of neoplastic disease, and dissecting the plethora of tumour escape mechanisms that disrupt this essential host defense capability is integral for the development of effective immunotherapeutic paradigms.

Human IgE response to the Schistosoma haematobium 22.6 kDa antigen.

In Schistosoma mansoni and S. japonicum infection, the 22.6 kDa tegumental antigens Sm22.6 and Sj22.6 are principal targets for the human IgE response, and levels of IgE to Sm22.6 have been correlated with resistance to re-infection after chemotherapy. S. haematobium is arguably a more important species in terms of human infection, and in this report we describe for the first time the molecular characterization of a cDNA from S. haematobium (Sh22.6) that is closely homologous to Sm22.6 and Sj22.6. As a member of the tegument-associated antigen family, Sh22.6 possesses EF-hand domains and regions homologous to the dynein light chain domains. We have expressed recombinant Sh22.6 and studied the IgE responses to the antigen in a group of 99 infected individuals (68 children and 31 adults) from an endemic area of Gabon who donated blood before and 5 weeks after praziquantel treatment. IgE to Sh22.6 was detected by ELISA in 18 subjects (18%), and in the majority of responders levels rose between pre- and post-treatment. Interestingly, the proportion of adults expressing IgE to Sh22.6 was 35.5%, significantly higher than the 10.3% seen in children. IgE from at least 10 of the 18 ELISA responders recognized Sh22.6 on Western blots of adult worm extract and recombinant antigen. These results demonstrate that like related molecules in other species, Sh22.6 is a target for the human IgE response. The data also indicate that changes in the IgE response occur with age or with progressive exposure to key antigens.

Embryonic stem cells differentiate into oligodendrocytes and myelinate in culture and after spinal cord transplantation.

Demyelination contributes to the loss of function consequent to central nervous system (CNS) injury. Enhanced remyelination through transplantation of myelin-producing cells may offer a pragmatic approach to restoring meaningful neurological function. An unlimited source of cells suitable for such transplantation therapy can be derived from embryonic stem (ES) cells, which are both pluripotent and genetically flexible. In this paper we show that oligodendrocyte cultures can be reliably produced from retinoic acid-induced ES cells and that these oligodendrocytes can myelinate axons in vitro. Methods were further developed for generating highly enriched cultures of oligodendrocytes through an additional culturing step, producing an intermediate "oligosphere" stage. To test whether ES cells can survive, migrate, and differentiate into mature myelin-producing cells in areas of demyelination in the adult CNS, ES cells were transplanted into the dorsal columns of adult rat spinal cord 3 days after chemical demyelination. In the demyelination site, large numbers of ES cells survived and differentiated primarily into mature oligodendrocytes that were capable of myelinating axons. Furthermore, when oligosphere cells were transplanted into the spinal cords of myelin-deficient shiverer (shi/shi) mutant mice, the ES cell-derived oligodendrocytes migrated into the host tissue, produced myelin and myelinated host axons. These studies demonstrate the ability of ES cell-derived oligodendrocytes to myelinate axons in culture and to replace lost myelin in the injured adult CNS. Transplantation of ES cells may be a practical approach to treatment of primary and secondary demyelinating diseases in the adult CNS.

Th2-type CD4+ cells neither enhance nor suppress antitumor CTL activity in a mouse tumor model.

Many cervical cancers express the E7 protein of human papillomavirus 16 as a tumor-specific Ag (TSA). To establish the role of E7-specific T cell help in CD8+ CTL-mediated tumor regression, C57BL/6J mice were immunized with E7 protein or with a peptide (GF001) comprising a minimal CTL epitope of E7, together with different adjuvants. Immunized mice were challenged with an E7-expressing tumor cell line, EL4.E7. Growth of EL4.E7 was reduced following immunization with E7 and Quil-A (an adjuvant that induced a Th1-type response to E7) or with GF001 and Quil-A. Depletion of CD8+ cells, but not CD4+ cells, from an immunized animal abrogated protection, confirming that E7-specific CTL are necessary and sufficient for TSA-specific protection in this model. Immunization with E7 and Algammulin (an alum-based adjuvant) induced a Th2-like response and provided no tumor protection. To investigate whether a Th2 T helper response to E7 could prevent the development of an E7-specific CTL-mediated protection, mice were simultaneously immunized with E7/Algammulin and GF001/Quil-A or, alternatively, were immunized with GF001/Quil-A 8 wk after immunization with E7/Algammulin. Tumor protection was observed in each case. We conclude that an established Th2 response to a TSA does not prevent the development of TSA-specific tumor protective CTL.

Vaccine-induced Th1-type responses are dominant over Th2-type responses in the short term whereas pre-existing Th2 responses are dominant in the longer term.

The effect of adjuvant on induction of human papillomavirus type 16 E7 protein-specific cytotoxic T lymphocytes (CTL) and immunoglobulin G (IgG)2a antibody was studied in C57BL/6 J mice immunized with various adjuvants and E7 protein. Quil-A adjuvant, but not complete Freund's adjuvant (CFA) or Algammulin, induced a T-helper 1 (Th1)-type response to E7, which was characterized by CTL activity against a tumour cell line transfected with E7 protein and by E7-specific IgG2a. All tested adjuvants elicited comparable levels of E7-specific IgG1. The longest duration and greatest magnitude of CTL response was seen following two immunizations with the highest dose of E7 and Quil-A. Simultaneous immunization with a Th1 and a T helper 2 (Th2)-promoting adjuvant gave a Th1-type response. However, E7 and Quil-A were unable to induce a Th1-type response (as measured by the inability to generate anti-E7 IgG2a antibody) in animals with a pre-existing Th2-type response to E7. These results suggest that saponin adjuvants may be suitable for immunotherapy in humans where a Th1-type response is sought, provided that there is no pre-existing Th2-type response to the antigen.

Perceived Barriers to HIV Prevention Among University Students in Sierra Leone, West Africa.

This article presents the results of a small pilot study of students at Fourah Bay College in Freetown, the capital of Sierra Leone, West Africa, to provide baseline data to the National AIDS Programme in planning educational interventions aimed at preventing the spread of HIV. Results of the survey indicate that barriers to HIV prevention in Sierra Leone include persistence of belief in the idea that AIDS is not real but is a conspiracy to prevent Africans from having sex or having children, an ambivalence among women students regarding sexuality issues, a lack of familiarity with the parameters of the epidemic in Africa, and a belief that condom use behavior is not amenable to change. Implications of these findings are discussed. Further research is needed to include the portion of the population that is not literate.

An unusual presentation of oat cell carcinoma.

A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Distant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye.

Analysis of the complete sequence of a muscle calcium-binding protein of Schistosoma mansoni.

The complete sequence of the cDNA encoding a 20 kDa calcium-binding protein of Schistosoma mansoni (Sm20) has been determined. The predicted amino acid sequence contains 4 EF hand domains but examination of the predicted secondary structure of Sm20, together with the specific residues in each calcium-binding domain, suggests that only 1 EF hand (domain IV) is functional. Sm20 is most homologous to calmodulin, troponin C and the regulatory light-chain of myosin, particularly those of invertebrates. However, troponin C and the regulatory light-chain of myosin can be distinguished from Sm20 by size and by their differential levels of expression during the life-cycle. Sm20 also appears to be distinct from calmodulin but may be functionally equivalent to the soluble sarcoplasmic calcium-binding proteins of molluscs and crustacea which may act as a reservoir for calcium in muscle. Sm20 is encoded by a small multi-gene family whose members are clustered within a 15 kb region of the genome. A 20 kDa antigen, cross-reactive with Sm20, is expressed in Schistosoma haematobium, Fasciola hepatica and Paragonomus mexicanus.

Infection with Pneumocystis carinii is prevalent in healthy Gambian children.

Pneumocystis pneumonia is rarely identified in the many immunosuppressed individuals with acquired immune deficiency syndrome (AIDS) and malnutrition in Africa. To test whether infection with Pneumocystis carinii occurs in the continent we conducted a comparative serological study, measuring by enzyme-linked immunosorbent assay antibodies to the parasite in 150 healthy young individuals from both Britain and the Gambian savanna. The prevalence of significant titres of antibody to P. carinii steadily increased with age and included more than 70% of both populations by 8 years of age. Infection with P. carinii is, therefore, common in the Gambia. Thus opportunistic pneumocystis pneumonia may be an important but largely unrecognized disease in the continent, though its impact is probably diminished by the prevalence of fatal tuberculous infection, particularly in the AIDS population.

PIP: The prevalence of sero-positivity toward Pneumocystis carinii parasite antigens was determined in 150 British subjects aged 3 months-40years, and in 150 Gambians of the same age age range. The Gambians were from Katabas villages north of the Gambian river. The sera were tested with an ELISA assay developed from parasites and cysts isolated from rats, which were previously shown to share many antigens with organisms from humans. IgG titers reactive with P. carinii increased with age in the British and Gambian subjects, with essentially no positives at ages 3-6 months, to a peak of 70% positive in both groups by age 8 years. British children and parents were questioned about history of pneumonia illness, with negative findings. There are very few reports of P. carinii infections, judging from sputum and bronchoscopic lavage, in African AIDS patients. 2 cases of Cryptococcus have been reported, but tuberculosis is a common and rapidly lethal infection in African AIDS patients.

Surgical treatment of glossopharyngeal neuralgia via the pharyngeal approach.

Idiopathic glossopharyngeal neuralgia is an uncommon disorder which often fails to respond to medical treatment. Surgical treatment most commonly consists of intracranial section of the glossopharyngeal nerve and upper vagal rootlets. We present three cases treated by the much simpler pharyngeal approach and argue that in appropriately selected patients this approach should receive more serious consideration.

Fetal heart rate changes associated with general anesthesia.

Decreased fetal heart rate variability was noted 90 seconds after the induction of general anesthesia with sodium thiopentone and fentanyl in a patient undergoing basket extraction of a renal calculus at 30 weeks' gestation. The fetal sleep pattern lasted for 105 minutes after the anesthetic was discontinued, 45 minutes after the mother was fully awake.

Tonsil flora in the very young tonsillectomy patient.

The tonsil flora of 20 children below the age of 4 years undergoing tonsillectomy, and a control group of 18 children were studied using tonsil swabs and core specimens. The study group had a significantly higher culture rate of anaerobic organisms, whereas there was no significant difference between the groups in respect of aerobic pathogens. Since most anaerobic organisms are relatively resistant to the antibiotics usually prescribed for recurring tonsillitis, the use of more appropriate antimicrobial therapy may be helpful in the prevention of early tonsillectomy.