HBsAg and HBcrAg as predictors of HBeAg seroconversion in HBeAg-positive patients treated with nucleos(t)ide analogues.

HBeAg seroconversion marks an important spontaneous change and treatment end-point for HBeAg-positive patients and is a pre-requisite for HBsAg loss or functional cure. In this retrospective analysis, we aimed to identify predictors of seroconversion using serum quantitative HBsAg and HBcrAg, in HBeAg-positive patients treated with nucleos(t)ide analogues (NA). Data and samples from 118 HBeAg-positive adults (genotypes A-G) started on NA between Jan 2005 and Sept 2016 were retrospectively analysed at several time-points. The predictive power of on-treatment levels of HBsAg and HBcrAg was determined using receiver operating curve (ROC) analysis and cut-off values determined by maximized Youden's index. About 36.4% of patients achieved HBeAg seroconversion after a median of 39 months' treatment. On treatment kinetics of HBV DNA, HBsAg and HBcrAg differed between HBeAg seroconverters and nonseroconverters. A combination of HBsAg and HBcrAg had the greatest predictive value for HBeAg seroconversion: at 6 months, HBsAg of 3.9 log10  IU/mL and HBcrAg of 5.7 log10 U/mL had a sensitivity of 71.4%, specificity of 79.5%, positive predictive value (PPV) of 65.2% and negative predictive value (NPV) of 83.8%, with AUROC of 0.769 (0.668, 0.869; 95%CI), and at 12 months, HBsAg 3.8 log10  IU/mL and HBcrAg 5.5 log10 U/mL had a sensitivity of 73.7%, specificity of 79.5%, PPV of 63.6% and NPV of 86.1%, with AUROC 0.807 (0.713, 0.901; 95% CI). In conclusion, our results may be used to identify patients who are unlikely to achieve treatment end-points, which will be important as the future management of chronic hepatitis B looks to therapies that offer functional cure.

Genetic refinement and physical mapping of a chromosome 16q candidate region for inflammatory bowel disease.

Crohn's disease (CD) is a complex genetic disorder for which a susceptibility gene, IBD1, has been mapped within the pericentromeric region of chromosome 16. In order to refine the location of IBD1, 77 multiplex CD families were genotyped for 26 microsatellite markers evenly spaced by approximately 1 cM. Nonparametric linkage analyses exhibited a maximum NPL score of 3.49 (P=2.37x10(-4)) in a region centred by markers D16S3136, D16S3117 and D16S770. Simulation studies showed that the probability for IBD1 to be located in a 5 cM region around these markers was 70%. A 2.5 Mb YAC and BAC contig map spanning this genetic region on chromosome band 16q12 was built. TDT analyses demonstrated suggestive association between the 207 bp allele of D16S3136 (P<0.05) and a new biallellic marker hb27g11f-end (P=0.01). These markers were located in the hb27g11 and hb87b10 BAC clones from the contig. Taken together, the present results provide a crucial preliminary step before an exhaustive linkage disequilibrium mapping of putatively transcribed regions to identify IBD1.

The angioblastic meningioma: a reappraisal of the nosological problem. Light-, electron-microscopic, tissue, and organ culture observations.

The validity of the concept of the angioblastic meningioma, now in dispute, was reexamined by reviewing 79 meningeal and angioblastic tumors of the central nervous system and by comparing the fine structural characteristics and in vitro evolution of 2 typical meningiomas and 1 intracranial hemangiopericytoma. While most tumors show the consistent features of either hemangiopericytoma or hemangioblastoma, there exist transitional forms between these tumors and typical meningioma. There is also a greater degree of morphological overlap at the electron microscopic level than has been recognized up till now. In view of these findings the concept of the angioblastic meningioma deserves to be retained as a generic term to include craniospinal hemangiopericytomas and transitional forms between hemangiopericytoma, hemangioblastoma and classic meningioma. It is postulated that all these tumors share a common origin from polyblastic mesenchymal cells originating in or derived from the meninges.

Susceptibility of a fetal tongue cell line derived from bighorn sheep to five serotypes of bluetongue virus and its potential for the isolation of viruses.

A cell line (BHFTE) was derived from a tongue explant of a bighorn sheep fetus (Ovis canadensis nelsoni). The cells have been maintained through 23 serial passages, and the modal number of chromosomes was calculated to be 55. Monolayer cultures were shown to be susceptible to various viruses, including bluetongue virus (BTV). Of 5 BTV serotypes (2, 10, 11, 13, and 17) tested, each produced a cytopathic effect (CPE) on initial passage at 33 C. A field isolate (serotype 10) of BTV from a black-tailed deer (Odocoileus hemionus columbianus) in its second passage in Vero-M cells also produced CPE when inoculated into BHFTE cells. Antigens of BTV were demonstrated by direct immunofluorescence in the cytoplasm of BHFTE cells inoculated with homogenates of chicken embryos injected with clinical specimens from a domestic sheep and an Arabian oryx (Oryx gazella leucoryx). A suspension of BTV-infected gnats (Culicoides spp.) produced CPE and BTV-specific fluorescence on the first passage in cells inoculated with a suspension of blood from sheep experimentally infected with BTV. Additionally, selected bovine viruses induced CPE in the cells. The cell line, which is free of mycoplasma and bovine viral diarrhea virus contamination, may be useful in diagnostic medicine and research involving the ruminant species.

Challenges to therapy in the future.

Quadruple therapy (with a proton pump inhibitor (PPI), metronidazole, tetracycline and bismuth) is generally reserved for second-line treatment; however, studies using this regimen for 7 days have found it to be effective even in metronidazole-resistant strains. Resistance is an ongoing problem with antimicrobial therapy but considerable progress has now been made into understanding the underlying genetic mechanisms of this process. Metronidazole resistance in Europe is usually in the range of 20-30% of strains but may be as high as 70% in some countries. One genetic mechanism involved is thought to be a mutation of the rdxA gene. Macrolide resistance appears to be on the increase in Europe, varying from 1% in some countries to 13% in others. The genetic mechanism involved has been shown to be a point mutation of a ribosomal RNA. Amoxicillin resistance is an emerging problem that has an adverse effect on eradication rates in clinical practice. Resistance has been shown to be caused by the absence of one of the four binding proteins in the cell wall. Few novel antibiotics have been developed for use in eradication therapy, although rifabutin, secnidazole and furazolidone have shown some success as part of combination therapy. Alternative therapies that have been tested include mucosal protective agents which have been used in place of a PPI in some eradication regimens with some success, and the somatostatin analog, octreotide, that has been used as part of quadruple therapy in place of a PPI and produced eradication rates of approximately 88%. The ultimate challenge is still to develop a safe and effective vaccine against Helicobacter pylori. Current and future research will also focus on identifying genetic targets for therapy, adhesion molecule analogs to prevent binding of the bacterium, and urease inhibitors. The current triple therapy treatment options available for the eradication of Helicobacter pylori infection are over 90% effective in susceptible organisms and there are very few medical conditions to which we can offer such efficacious treatment. Unfortunately, the recommendations made at consensus conferences are not always put into practice and physicians in primary care may be unaware of the true efficacy of eradication therapy. Treatment is very simple: three drugs, twice a day for 1 week. The main focus for both primary care physicians and gastroenterologists should be to reinforce the need for patient compliance, otherwise we will see an increase in antibiotic resistance. Patients should be prewarned that they may experience some mild side effects and should be encouraged to complete the course of treatment. The real challenge for the future will be the management of patients who do not respond to first-line treatment. This paper will focus on potential problems with therapy, such as antibiotic resistance, and possible future solutions, such as novel antibiotics and vaccines.

Novel therapeutic approaches to the management of Helicobacter pylori infection.

The eradication of Helicobacter pylori is indicated in a variety of conditions and the Maastricht consensus has recommended that first line regimens have an eradication rate of more than 80%. Present optimal first line therapy is proton pump inhibitor based triple therapy, but other regimens based on Ranitidine Bismuth Citrate may prove to be as effective, simple and well tolerated providing an alternative form of therapy. A variety of agents have been employed in various second line eradication regimens but no large scale trials have been conducted to establish the optimal second line regimen, following failure of standard line therapy. Novel antibiotics with activity against Helicobacter pylori are urgently required as resistance has developed to standard agents such as Clarithromycin and Metronidazole. Other agents such as the histamine receptor antagonist, Ebrotidine, and the proton pump inhibitor, Rabeprazole may have clinically important anti Helicobacter properties not merely related to their acid lowering effects. The ideal therapy would be safe effective vaccination but in the near future therapy is likely to be based on pharmacological agents taken orally.

Human ecchordosis physaliphora and chick embryonic notochord. A comparative electron microscopic study.

The ecchordosis physaliphora, a small gelatinous mass attached to the midline of the clivus, is characterized ultrastructurally by glycogen-laden intracytoplasmic vacuoles, focally distended endoplasmic reticulum and perinuclear cisterns with cytoplasmic invaginations, large clusters of granular endoplasmic reticulum interdigitating with mitochondria, and an abundant extracellular space. These morphologic features are also present in the 9-day embryonal chick notochord and the human chordoma and serve to reaffirm the derivation of the ecchordosis and chordoma from notochordal rests.

Career paths of graduates of a degree-linked nursing course.

The aim of this study was to follow the career development of all 103 former students of the BSc (Hons) degree in human biology at the University of Surrey who also took the nursing option leading to qualification as SRN, at St George's School of Nursing, London. These individuals qualified between 1970 and 1980. A postal questionnaire was used and a 97% response was obtained. The employment of each respondent was recorded at various time intervals after qualification and categorized to facilitate analysis. Findings were generally in accordance with the preliminary findings of the Universities of Manchester and Edinburgh follow-up studies. The majority of respondents chose and followed careers in nursing. The most common categories of employment for the first 5 years after qualification were hospital and community nursing. Sixty-two percent had taken further training in various fields of nursing. A larger proportion of human biologist nurse graduates had selected careers in community nursing, nursing research and nursing education than had Edinburgh nurse graduates. There was support for the suggestion that nurse graduates choose to consolidate their experience before breaking their career on account of motherhood. Between 9 and 31% were in non-nursing employment during the first 5 years of employment. Most of these were studying or working in health related fields. This figure was higher than that found in Edinburgh and reflects the nature of the degree-linked human biology/nursing option course.

In vitro characteristics of a sacrococcygeal chordoma maintained in tissue and organ culture systems.

Explants of a human sacral chordoma were successfully maintained on collagen-coated coverslips, gelfoam sponge matrices, and Millipore filter platforms for up to 30 days. Tumor cells cultured on collagen-coated coverslips became increasingly vacuolated whereas those maintained in organ culture were entirely free of vacuoles after 22 days in vitro. A single basic tumor cell, small and polygonal with a large central spherical nucleus and abundant endoplasmic reticulum and Golgi apparatus, was recognized. Vacuoles were formed as the result of the progressive expansion of smooth endoplasmic reticulum. Coalescence of these vacuoles produced the physaliferous cell of light microscopy.

Heterogeneity of calcium stores and elementary release events in canine pulmonary arterial smooth muscle cells.

To examine the nature of inositol 1,4,5-trisphosphate (IP(3))-sensitive and ryanodine (Ryn)-sensitive Ca(2+) stores in isolated canine pulmonary arterial smooth cells (PASMC), agonist-induced changes in global intracellular Ca(2+) concentration ([Ca(2+)](i)) were measured using fura 2-AM fluorescence. Properties of elementary local Ca(2+) release events were characterized using fluo 3-AM or fluo 4-AM, in combination with confocal laser scanning microscopy. In PASMC, depletion of sarcoplasmic reticulum Ca(2+) stores with Ryn (300 microM) and caffeine (Caf; 10 mM) eliminated subsequent Caf-induced intracellular Ca(2+) transients but had little or no effect on the initial IP(3)-mediated intracellular Ca(2+) transient induced by ANG II (1 microM). Cyclopiazonic acid (CPA; 10 microM) abolished IP(3)-induced intracellular Ca(2+) transients but failed to attenuate the initial Caf-induced intracellular Ca(2+) transient. These results suggest that in canine PASMC, IP(3)-, and Ryn-sensitive Ca(2+) stores are organized into spatially distinct compartments while similar experiments in canine renal arterial smooth muscle cells (RASMC) reveal that these Ca(2+) stores are spatially conjoined. In PASMC, spontaneous local intracellular Ca(2+) transients sensitive to modulation by Caf and Ryn were detected, exhibiting spatial-temporal characteristics similar to those previously described for "Ca(2+) sparks" in cardiac and other types of smooth muscle cells. After depletion of Ryn-sensitive Ca(2+) stores, ANG II (8 nM) induced slow, sustained [Ca(2+)](i) increases originating at sites near the cell surface, which were abolished by depleting IP(3) stores. Discrete quantal-like events expected due to the coordinated opening of IP(3) receptor clusters ("Ca(2+) puffs") were not observed. These data provide new information regarding the functional properties and organization of intracellular Ca(2+) stores and elementary Ca(2+) release events in isolated PASMC.

Ethanol- and nicotine-induced membrane changes in embryonic and neonatal chick brains.

In order to study the effects of EtOH and/or nicotine on brain membrane fatty acid composition, various concentrations of EtOH and/or nicotine were injected into the air sac of chicken eggs at 0 days of incubation. Controls were injected with saline. Experimental groups were injected with either 200 micromol EtOH/kg egg, 100 micromol nicotine/kg egg, 200 micromol nicotine/kg egg, 200 micromol EtOH/kg and 100 micromol nicotine/kg egg, or 200 micromol EtOH/kg and 200 micromol nicotine/kg egg. In all experimental groups, EtOH- and nicotine-induced decreases in brain long-chain polyunsaturated membrane fatty acids were observed in stage 44 embryos, stage 45 embryos, and neonatal chicks. These EtOH- and nicotine-induced decreases in brain membrane polyunsaturated fatty acids correlated with elevated levels of brain lipid hydroperoxides and reduced brain acetylcholinesterase (AChE; EC. 3.1.1.7) activities.

Inhibition of tumor cell invasion by verapamil.

Verapamil, a calcium channel antagonist, inhibits murine B16 melanoma and colon adenocarcinoma C26 tumor metastasis by altering platelet aggregation [Tsuruo, T., et al. (1985) Cancer Chemother. Pharmacol., 14:30-33]. However, the role of calcium homeostasis in regulating several biochemical pathways implicated in other steps of the metastatic cascade suggests that calcium channel antagonists could also inhibit metastasis by other mechanisms. In this report, non-toxic doses of verapamil reversibly decreased human A375M and C8161 melanoma cell invasion and metastasis in a dose-dependent manner. Verapamil reduced cellular invasion and metastases by up to 96% (range 78-96%). Concomitantly, verapamil disrupts microtubule and microfilament organization and inhibits unidirectional cell migration but does not affect cellular adhesion to endothelial monolayers or reconstituted basement membranes. In addition, tumor cells treated with verapamil have a decrease in mRNA of type IV collagenase, a proteinase important in tumor cell degradation of basement membranes. Collectively, these data offer additional evidence regarding the mechanisms of action of verapamil as an anti-metastatic agent.

Quality of health care in inflammatory bowel disease: development of a reliable questionnaire (QUOTE-IBD) and first results.

OBJECTIVES: As inflammatory bowel disease is a chronic disorder, usually with an early onset in life, quality of care plays an important role for patients. The aim of this study was to develop a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease. METHODS: Ten generic questions were already available because the questionnaire is based on an existing instrument. Patients with inflammatory bowel disease in seven countries were involved in the development of additional disease-specific items. Validation and first field testing of the total questionnaire (QUOTE-IBD) was performed in The Netherlands. RESULTS: A total of 380 patients cooperated in the development of 13 disease-specific items, with high internal reliability (Cronbach's alpha = 0.83). Another 162 patients were involved in validating and testing of the QUOTE-IBD, which consists of 23 items in total. Pearson's correlation coefficient between QUOTE-IBD and visual analog scale scores of health care items was 0.55. Intraclass correlation coefficient of two assessments was 0.64. First testing showed that patients gave relatively poor marks to some part of health care services, such as providing information about extraintestinal complaints and the psychological as well as physical approach to complaints. CONCLUSIONS: A short, valid, reliable questionnaire was developed to measure the opinions of patients with inflammatory bowel disease on quality of health care. The QUOTE-IBD can be used for identification of areas for improvement, with the aim of optimizing health care in inflammatory bowel disease.