COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2).

BACKGROUND: Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE: To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS: In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS: CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION: Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.

Parkinson disease loci in the mid-western Amish.

Previous evidence has shown that Parkinson disease (PD) has a heritable component, but only a small proportion of the total genetic contribution to PD has been identified. Genetic heterogeneity complicates the verification of proposed PD genes and the identification of new PD susceptibility genes. Our approach to overcome the problem of heterogeneity is to study a population isolate, the mid-western Amish communities of Indiana and Ohio. We performed genome-wide association and linkage analyses on 798 individuals (31 with PD), who are part of a 4,998 member pedigree. Through these analyses, we identified a region on chromosome 5q31.3 that shows evidence of association (p value < 1 × 10(-4)) and linkage (multipoint HLOD = 3.77). We also found further evidence of linkage on chromosomes 6 and 10 (multipoint HLOD 4.02 and 4.35 respectively). These data suggest that locus heterogeneity, even within the Amish, may be more extensive than previously appreciated.

A unique emotional processing profile of euthymic bipolar disorder? A critical review.

OBJECTIVES: To undertake a critical review of the literature on emotional processing (EP) in bipolar patients in remission. This literature review focuses on a number of dimensions of EP including facial emotion recognition, emotional memory, affective theory of mind (ToM), affective attention and affective auditory information processing. METHODS: A systematic search was conducted through PsychINFO and Medline databases to obtain relevant literature. Studies that include behavioural measures of EP were included. RESULTS: The findings from this review demonstrate that bipolar disorder (BD) patients continue to exhibit some EP deficits during euthymic phases. A number of factors believed to contribute to such findings have been highlighted. CONCLUSIONS: This review has shed light on some of the conflicting findings reported in the literature and thus offers a more comprehensive profile of euthymic bipolar patients' EP abilities. This information could enrich clinicians' therapeutic efforts to minimise relapse by attending to euthymic bipolar patients' specific emotional processing difficulties.

Outcome of partner notification in patients diagnosed with genital warts attending a provincial clinic in East Anglia, England.

We retrospectively reviewed partner notification of patients diagnosed with first episode genital warts seen in the genitourinary (GU) medicine clinic, Great Yarmouth, UK, from January 2005 to December 2008. Of 947 patients diagnosed with genital warts, 486 (51.3%) were men, median age 25 years; 461 (48.7%) were women, median age 21 years and the partner notification index was 32.9%. In our cohort, 310 patients 33.2% reported having had a casual partner that could not be traced. The median relationship duration of partners whose contact attended was nine months and those whose contact did not attend was two months, (χ(2) = 49.72, P < 0.0001). The odds ratio (OR) of a contact attending after seeing a health adviser was 2.94 (95% confidence interval [CI] = 1.79-4.86). In our cohort 35.6% of contacts whose partners saw a health adviser attended compared with 15.7% of contacts whose partner did not see a health adviser (χ(2) = 19.7, P < 0.0001). Among the contacts 26% had genital warts, 28% had another sexually transmitted infection (STI) and 12% had both genital warts and another STI. The low partner notification index was associated with the reported casual partnerships seen in the cohort. Partner notification was enhanced when patients saw a health adviser.

Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti-TNF therapy: results from the British Society for Rheumatology Biologics Register.

OBJECTIVES: To evaluate the risk of septic arthritis (SA) in patients with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy. METHODS: Using data from the British Society for Rheumatology Biologics Register, a prospective observational study, the authors compared the risk of SA between 11 881 anti-TNF-treated and 3673 non-biological disease-modifying antirheumatic drug (nbDMARD)-treated patients. RESULTS: 199 patients had at least one episode of SA (anti-TNF: 179, nbDMARD: 20). Incidence rates were: anti-TNF 4.2/1000 patient years (pyrs) follow-up (95% CI 3.6 to 4.8), nbDMARD 1.8/1000 pyrs (95% CI 1.1 to 2.7). The adjusted HR for SA in the anti-TNF cohort was 2.3 (95% CI 1.2 to 4.4). The risk did not differ significantly between the three agents: adalimumab, etanercept and infliximab. The risk was highest in the early months of therapy. The patterns of reported organisms differed in the anti-TNF cohort. Prior joint replacement surgery was a risk factor for SA in all patients. The rate of postoperative joint infection (within 90 days of surgery) was 0.7%. This risk was not significantly influenced by anti-TNF therapy. CONCLUSIONS: Anti-TNF therapy use in RA is associated with a doubling in the risk of SA. Physicians and surgeons assessing the RA patient should be aware of this potentially life-threatening complication.

Influence of anti-tumor necrosis factor therapy on cancer incidence in patients with rheumatoid arthritis who have had a prior malignancy: results from the British Society for Rheumatology Biologics Register.

OBJECTIVE: To explore the influence of anti-tumor necrosis factor (anti-TNF) therapy upon the incidence of cancer in patients with rheumatoid arthritis (RA) and prior malignancy. METHODS: Using data from the British Society for Rheumatology Biologics Register, a national prospective observational study established in 2001, we identified 293 patients with a prior malignancy from over 14,000 patients with RA. We compared rates of incident malignancy in 177 anti-TNF-treated patients and 117 patients with active RA treated with traditional disease-modifying antirheumatic drugs (DMARDs), all with prior malignancy. One patient switched therapy and contributed to both cohorts. RESULTS: The rates of incident malignancy were 25.3 events/1,000 person-years in the anti-TNF cohort and 38.3/1,000 person-years in the DMARD cohort, generating an age- and sex-adjusted incidence rate ratio of 0.58 (95% confidence interval 0.23-1.43) for the anti-TNF-treated cohort compared with the DMARD cohort. Of the patients with prior melanomas, 3 (18%) of 17 in the anti-TNF cohort developed an incident malignancy, compared with 0 of 10 in the DMARD cohort. CONCLUSION: The way in which UK rheumatologists are selecting patients with RA and prior malignancy to receive anti-TNF therapy is not leading to an increased risk of incident malignancy. Although reassuring, these results should not be interpreted as indicating that it is safe to treat all RA patients with prior malignancy with anti-TNF therapy.

Parental perspectives on the causes of an autism spectrum disorder in their children.

Autism Spectrum Disorders (ASDs) are complex neurodevelopmental disorders with many biological causes, including genetic, syndromic and environmental. Such etiologic heterogeneity impacts considerably upon parents' needs for understanding their child's diagnosis. A descriptive survey was designed to investigate parental views on the cause(s) of ASD in their child. Among the 41 parents who replied to the questionnaire, genetic influences (90.2%), perinatal factors (68.3%), diet (51.2%), prenatal factors (43.9%) and vaccines (40.0%) were considered to be the most significant contributory factors. Parents reported inaccurately high recurrence risks, misperceptions of the contribution of various putative factors, feelings of guilt and blame regarding their child's diagnosis, as well as a lack of advocacy for genetic counseling by non-geneticist professionals. This study offers clinicians and researchers further insight into what parents believe contributed to their child's diagnosis of ASD and will help facilitate genetic counseling for these families.

The effect of sex on central histaminergic responses and corticosterone bioperiodicity in Sprague-Dawley rats.

Male and female rats demonstrate a difference in the relationship between food intake and H(1) receptor binding, which may be due to hormonal differences that exist. The relationship between the endocrine and histaminergic regulation and synchronization of food intake needs to be elucidated. Male and female rats fed 25% protein displayed bioperiodicity in mean corticosterone levels of 148.95+/-33.71 and 288.48+/-47.84 ng/ml, respectively. Accompanying bioperiodic times were of 22.43+/-1.35 h (males) and a period of 21.42+/-1.96 h (females). Central H(1) receptors in male rats had a mean bioperiodic value of 102.37+/-1.95 pmol/g protein with a period of 21.66+/-1.85 h, while that for females was 97.42+/-4.19 pmol/g protein with a period of 10.23+/-0.95 h. Central histaminergic activity affects feeding in rats with distinct gender variation that is bioperiodic in nature and functions as a major regulatory mechanism.

Human iodine requirements determined by the saturation kinetics model.

Iodine plays a decisive role in metabolism and the process of early growth and development of most organs, especially of the brain. Effects of iodine deficiency include goiter, stillbirth and miscarriage, neonatal and juvenile thyroid deficiency, dwarfism, mental defects, deaf mutism, spastic weakness and paralysis. In this study, the application of a mathematical model (derived from Machaelis-Menten enzyme kinetics) to iodine measured in urine samples from a randomly selected group derived from the Egyptian village of West El-Mawhoub in the Dakhlah Oasis resulted in the conclusion that iodine excretion parameters can be used to characterize iodine utilization and accurately predict the level of salt iodination required to maintain proper physiological functions. The four parameter saturation kinetics model analysis indicated that a salt iodination level of 63 mg/kg reduced the severity of IDD, with 83% of the studied subjects having urinary excretion levels of 1.18 micromol/L. This gives a convenient mechanism for providing adequate dietary iodine with a non-invasive index for the avoidance of IDD. Commercially available salt was analyzed using standard iodiometric titration methods to determine iodination levels. Analysis revealed that only 20% of the commercially available salt complied with the manufacturer's label and revealed the presence of large individual variability between batches amounting to -95 to +150% of the claimed iodine level. Therefore, salt iodination requires careful supervision to ensure that promised iodine levels are being delivered and consumed.

Direct visualization of cholecystokinin subtype2 receptors in rat central nervous system using anti-peptide antibodies.

The cholecystokinin receptor, subtype 2 (CCK(2)R), is considered, based on receptor autoradiography, to be the predominant receptor for this peptide transmitter in the mammalian central nervous system. To directly visualize the CCK(2)R we utilized a convenient and sensitive immunohistochemical procedure using antipeptide receptor antibodies raised in rabbits against unique portions of the carboxyl tail and third intracellular loop of the CCK(2)R. Antibodies were characterized by ELISA and Western blotting, and used for immunohistochemistry in rat brain sections. Studies with both antibodies revealed a widespread topographic distribution of CCK(2)R-like immunoreactivity (CCK(2)R-LI) in regions such as cortex, olfactory bulb, nucleus accumbens, septum, striatum, hippocampus, basolateral amygdala, habenula, hypothalamus, thalamus, ventral mesencephalon, inferior colliculus, parabrachial nucleus, pontine nucleus, supercolliculus, red nucleus, subcommisural and occulomotor nucleus, area postrema, solitary, olivary, cochlear, cuneate and trigeminal nuclei and spinal cord dorsal horn in agreement with the results of previous receptor autoradiography.

CCK/dopamine interactions in Fawn-Hooded and Wistar-Kyoto rat brain.

The aim of this study was to compare the actions of CCK neuropeptides within the nucleus accumbens (N.Acc) of alcohol preferring (Fawn-Hooded, FH) and alcohol nonpreferring (Wistar-Kyoto, WKY) rats. CCK-8S (30-300 nM) facilitated the K(+) stimulated release of [(3)H]dopamine (DA) from N.Acc prisms in both rat strains, whereas CCK-4 (30 nM-1 microM) caused a significant decrease of evoked [(3)H]DA in the FH rat only. A scattered distribution of CCK-A and -B receptor immunopositive varicose fibers were visualized throughout the N.Acc of both rat strains along with a topographic distribution of CCK receptor positive cells throughout the ventral mesencephalon.

Histochemistry in rat brain and spinal cord with an antibody directed at the cholecystokininA receptor.

Various neurobiological evidence indicates that A-subtype cholecystokinin (CCKA) receptors are widely distributed through the mammalian neuroaxis despite the sparse localization found by receptor autoradiography. To address this paradox, immunohistochemistry has been performed in rat brain and spinal cord using an antibody directed at a portion of the amino terminal sequence of the CCKA receptor. Immunoreactivity, visualised using diaminobenzidine, was widely and topographically distributed being most concentrated in medulla and spinal cord. Many forebrain areas contained specifically labelled neurones, notably the nucleus accumbens, septum, stria terminalis, habenula, substantia nigra, ventral tegmental area and lateral geniculate nucleus. In medulla, heavily labelled perikarya were found in parabrachial and trigeminal nuclei, while in spinal cord immunoreactivity was localized in dorsal horn. Localization of immunoreactivity was consistent with the reported distribution of CCKA receptor-mediated mechanisms. Our observations represent the first attempt to describe the localization of the CCKA receptor in brain using immunohistochemistry and support its wide functional involvement in the central nervous system.

Food intake is inversely correlated with central nervous system histamine receptor (H1) concentrations in male Sprague-Dawley rats fed normal, low protein, low energy or poor quality protein diets.

The reported studies were designed to examine relationships between whole-brain histamine receptors (H1) and food intake in male Sprague-Dawley rats. Three different experiments were conducted. In each experiment, control rats were fed normal protein (25 g casein/100 g food) and normal metabolizable energy (16.21 kJ/100 g food) diets. Feeding low protein diets (1 g casein/100 g food) elevated central H1 receptor concentrations (P < 0.0027) and reduced voluntary food intake (P < 0.007) compared with normal diets. Feeding low energy diets lowered H1 receptor concentrations (P < 0.0089) and increased voluntary food intake (P < 0.0012). Low quality protein diets also affected the central nervous histaminergic system. Whole-brain H1 receptor concentrations were significantly higher for rats fed low quality protein (25 g gelatin/100 g food) compared with rats fed casein (P < 0.0001). Rats fed medium quality protein (25 g wheat gluten/100 g food) or low quality protein ate significantly less food (P < 0.0001). In all experiments, dietary manipulation affected central histamine receptors. Elevated concentrations of H1 receptors were associated with a decrease in food intake whereas lowered concentrations of H1 receptors were associated with an increase in food intake (P < 0.001). The results of these experiments support the hypothesis that central histamine H1 receptor concentrations in male rats are inversely correlated with voluntary food intake and affected by dietary composition.

Gender affects rats' central nervous system histaminergic responses to dietary manipulation.

The histaminergic system (histamine and its H1-receptor) of the central nervous system has been implicated in control of food intake. The reported studies were designed to examine the effects of food restriction and very low (1%) protein diets on central nervous system H1-receptors in male and female rats. In a series of experiments, groups of rats were freely fed a 25% protein diet, a 1% protein diet, or fed the 25% protein diet at 4 g/100 g body weight for 14-20 d. When freely fed 25% protein diets, females had higher whole-brain H1-receptor binding than males on d 1 (female 122.36 +/- 4.53 and male 65.78 +/- 3.82 pmol/g protein; P < 0.001). Changing diets affected central H1-receptor binding in both males and females (P < 0.003). When rats were fed both restricted levels of food and 1% protein diets, the receptor binding of males increased by d 5 whereas that of females decreased by d 5 (P < 0.001). When fed 1% protein diets, females had decreased H1-receptor binding (98.4 +/- 2.38 pmol/g protein) and that in males increased to 119.81 +/- 5.09 pmol/g protein. After 15 d, females had eaten significantly more food than males: females 166 +/- 4.9 g, males 124 +/- 1.9 g (P< 0.0007). Males had a significantly greater weight loss than females: males -28.8 +/- 2.6 g, females -17.08 +/- 0.97 g (P < 0.0007). When fed restricted diets, females had decreased H1-receptor binding (93.81 +/- 5.58 pmol/g) whereas binding in males increased to 111.27 +/- 8.55 pmol/g. Preliminary saturation binding studies indicated that restricted food intake lowered receptor density (females consuming 25% protein: 715 +/- 30 pmol/g protein; female restricted: 467 +/- 28 pmol/g protein, P < 0.05), while 1% protein increased receptor sensitivity, i.e., lowered KD (males consuming 25% protein: 15.3 +/- 1.8 nmol; males fed low protein: 2.8 +/- 0.27 nmol). This study suggests that dietary manipulation affects central H1-receptor binding in a gender-specific manner, thereby modulating central histaminergic activity during food or protein deficit.

On the distribution of cholecystokinin B receptors in monkey brain.

In view of recent evidence for a role for the B subtype of cholecystokinin (CCKB) receptor in panic and anxiety, the distribution of CCKB receptors in the forebrain of a Rhesus macaca monkey was examined by receptor autoradiography employing [125I]D-Tyr25(Nleu28,31)-CCK25-33S. CCKB receptors were widely and topographically distributed in cortex. Other structures with notable labelling included the basal ganglia, presubiculum, amygdala, mamillary bodies, cerebellar cortex and pineal gland. The distribution of CCKB receptors further supports roles for this peptide in behavioural processes.

Dietary induced anorexia: a review of involvement of the histaminergic system.

This review examines possible relationships between anorexia, dietary intake and central nervous system histaminergic activity. The hypothesis being reviewed is that one component of normal or pathophysiological neuroregulation of food intake involves histaminergic activity in the central nervous system, as influenced by concentrations and bioperiodicities of histamine and/or histamine receptors. Changes in concentrations of receptors are gender specific. Low protein quality or quantity diets elevate both central histamine and histamine receptors (H1) in rats while significantly decreasing their food intake. When injected with histaminergic antagonists, rats fed low protein diets increase food intake and have improved efficiency of weight gain. This review supports a dual hypotheses: central histaminergic activity is involved in the regulation of food intake, but food intake patterns (including dietary composition or energy content) can modify central histaminergic activity. This review also suggests that modified histamine and/or H1 receptor concentrations are potential mechanisms for elevated central histaminergic activity in food intake-related pathophysiological states. Thus, dietary interventions (clinically- or self-imposed) which modify food intake or diet composition have the potential of affecting the histaminergic system. Also, drugs with antihistaminergic properties have the potential of affecting food intake/weight gain patterns by interfering with normal neurochemical signals.

Growth requirements of endothelial cells in culture: variations in serum and amino acid concentrations.

Endothelial cell growth in vitro is limited to the availability of nutrients from commercially available media and added serum. Nutrients, such as amino acids, are chiefly derived from the cell culture medium, rather than from added serum, and optimal endothelial cell growth may be dependent on amino acid levels in the culture media. To test this hypothesis, porcine pulmonary artery-derived endothelial cells were exposed to culture medium 199 (M199), amino acid-deficient M199 (dM199), as well as dM199 supplemented with amino acids. Cell protein was similar in cells cultured for 3 d in M199 supplemented with 1, 3, 5 or 10% bovine calf serum, respectively. Addition of amino acid solutions (L-amino acids [Laa], DL-amino acids [DLaa], 2Laa, or Laa+glutamine) to dM199 demonstrated a cell dependence for optimal growth on the type of amino acids as well as on the total available nitrogen in the media. Compared with M199, dM199 supplemented with Laa only partially supported long-term growth of endothelial cells in culture. On the other hand, dM199 supplemented with either 2Laa, DLaa, or Laa+ glutamine was superior over M199 with regard to endothelial cell growth. The addition of Laa+glutamine to dM199 was most growth-supporting, with an increase of over 2.6-fold in total cell protein compared with cells cultured with M199. These results suggest that, in addition to the presence of essential amino acids, total available nitrogen in culture media may be a critical factor for optimal endothelial cell growth.

Localisation and properties of AMPA-insensitive kainate sites: receptor autoradiography and gene expression in rat brain.

Kainic acid (KA)-sensitive glutamate sites have been investigated by receptor autoradiography and in situ hybridisation histochemistry (ISHH) to evaluate their relationship to specific high-affinity KA receptors identified in molecular biological studies. Autoradiography with [3H]KA in the presence of the AMPA-selective antagonist NBQX (1 microM) revealed a widespread distribution of receptors through brain, especially in neocortex, hippocampal CA3, corpus striatum and granule cell layer of cerebellum. Specific binding was insensitive to the AMPA-selective agonist, S-5-fluorowillardiine, but inhibited by kainoids in a manner suggestive of receptor heterogeneity. Expression of the KA-2 receptor subunit mRNA by ISHH was also localised in hippocampal CA3 and cerebellar granule cells, suggesting some high-affinity native KA receptors labelled by [3H]KA were likely to include the KA-2 subunit in their heteromeric assembly.