Development and validation of the first point-of-care assay to objectively monitor adherence to HIV treatment and prevention in real-time in routine settings.

OBJECTIVE: HIV prevention and treatment studies demonstrate that pharmacologic adherence metrics are more accurate than self-report. Currently available metrics use liquid-chromatography/tandem-mass-spectrometry (LC-MS/MS), which is expensive and laboratory-based. We developed a specific and sensitive antibody against tenofovir, the backbone of treatment and prevention, but conversion to a lateral flow assay (LFA) - analogous to a urine pregnancy test - is required for point-of-care testing. We describe the development of the first LFA to measure antiretroviral adherence in real-time. METHODS: Previous work in a directly observed therapy study of providing tenofovir disoproxil fumarate (TDF) to HIV-noninfected volunteers at various simulated adherence patterns defined the appropriate cut-off for the LFA (1500 ng tenofovir/ml urine). We developed the LFA using a sample pad for urine; a conjugate pad coated with TFV-specific antibodies conjugated to colloidal gold nanoparticles; a nitrocellulose membrane striped with tenofovir-antigen (test line) and a control line; with an absorbent pad to draw urine across the reaction membrane. RESULTS: We tested 300 urine samples collected from the directly observed therapy study by this LFA and the gold-standard method of LC-MS/MS. The LFA demonstrated 97% specificity (95% CI 93-99%) and 99% sensitivity (94-100%) compared with LC-MS/MS. The LFA accurately classified 98% of patients who took a dose within 24 h as adherent. CONCLUSION: We describe the development and validation of the first point-of-care assay to measure short-term adherence to HIV prevention and treatment in routine settings. The assay is low-cost, easy-to-perform and measures the breakdown product (tenofovir) of both TDF and tenofovir alafenamide (TAF). This assay has the potential to improve HIV and PrEP outcomes worldwide by triggering differentiated service delivery with further study merited.

Dietary resistant starch dose-dependently reduces adiposity in obesity-prone and obesity-resistant male rats.

BACKGROUND: Animal studies show that diets containing resistant starch (RS) at levels not achievable in the human diet result in lower body weight and/or adiposity in rodents. We aimed to determine whether RS dose-dependently reduces adiposity in obesity-prone (OP) and obesity-resistant (OR) rats. METHODS: Male Sprague-Dawley rats (n=120) were fed a moderate-fat, high-energy diet for 4 wk. Rats that gained the most weight (40%) were classified as obesity-prone (OP) and obesity-resistant (OR) rats were the 40% that gained the least weight. OP and OR rats were randomly allocated to one of six groups (n=8 for each phenotype). One group was killed for baseline measurements, the other five groups were allocated to AIN-93 based diets that contained 0, 4, 8, 12 and 16% RS (as high amylose maize starch) for 4 wk. These diets were matched for total carbohydrate content. At 0, 4 and 7 wk from the start of the study insulin sensitivity was calculated by homeostasis model assessment of insulin resistance (HOMA-IR) and adiposity was determined by dual-energy X-ray absorptiometry (DXA). At 8 wk, rats were euthanized and fat pad weights, intestinal digesta short chain fatty acid (SCFA) pools and plasma gut hormone levels were determined. RESULTS: Obesity prone rats gained less weight with 4, 12 and 16% RS compared to 0% RS, but the effect in OR animals was significant only at 16% RS. Irrespective of phenotype, diets containing ≥8% RS reduced adiposity compared to 0% RS. Energy intake decreased by 9.8 kJ/d for every 4% increase in RS. All diets containing RS increased total SCFA pools in the caecum and lowered plasma GIP concentrations compared to the 0% RS, whereas plasma GLP-1 and PYY were increased when the diet contained at least 8% RS. Insulin sensitivity was not affected by RS. CONCLUSION: RS in amounts that could be potentially consumed by humans were effective in reducing adiposity and weight gain in OP and OR rats, due in part to a reduction in energy intake, and changes in gut hormones and large bowel carbohydrate fermentation.

Classification of Rotylenchulus reniformis Numbers in Cotton Using Remotely Sensed Hyperspectral Data on Self-Organizing Maps.

Rotylenchulus reniformis is one of the major nematode pests capable of reducing cotton yields by more than 60%, causing estimated losses that may exceed millions of dollars U.S. Therefore, early detection of nematode numbers is necessary to reduce these losses. This study investigates the feasibility of using remotely sensed hyperspectral data (reflectances) of cotton plants affected with different nematode population numbers with self-organizing maps (SOM) in correlating and classifying nematode population numbers extant in a plant's rhizosphere. The hyperspectral reflectances were classified into three classes based on R. renifomis population numbers present in plant's rhizosphere. Hyperspectral data (350-2500 nm) were also sub-divided into Visible, Red Edge + Near Infrared (NIR) and Mid-IR region to determine the sub-region most effective in spectrally classifying the nematode population numbers. Various combinations of different feature extraction and dimensionality reduction methods were applied in different regions to extract reduced sets of features. These features were then classified using a supervised-SOM classification method. Our results suggest that the overall classification accuracies, in general, for most methods in most regions (except visible region) varied from 60% to 80%, thereby, indicating a positive correlation between the nematode numbers present in plant's rhizosphere and the corresponding plant's hyperspectral signatures. Results showed that classification accuracies in the Mid-IR region were comparable to the accuracies obtained in other sub-regions. Finally, based on our findings, the use of remotely-sensed hyperspectral data with SOM could prove to be extremely time efficient in detecting nematode numbers present in the soil.

Measurement of phenol and p-cresol in urine and feces using vacuum microdistillation and high-performance liquid chromatography.

In this article, we describe a simple, sensitive, accurate, and repeatable method for the measurement of phenol and p-cresol (4-methylphenol) in human urine and feces. We examined a number of parameters to identify an optimal extraction protocol. Purification of sample extracts was achieved by low-temperature vacuum microdistillation. Separation was achieved in approximately 15 min by high-performance liquid chromatography (HPLC) with quantification by fluorescence at 284/310 nm. Limits of detection for phenol were 2 ng/ml for urine and 20 ng/g for feces, and those for p-cresol were 10 ng/ml for urine and 100 ng/g for feces. For comparison, approximate mean values for urine are 3 microg/ml for phenol and 30 microg/ml for p-cresol, and those for feces are 1 microg/g for phenol and 50 microg/g for p-cresol. An experienced analyst can process 60 samples each day using this method.

End-member extraction for hyperspectral image analysis.

We investigate the relationship among several popular end-member extraction algorithms, including N-FINDR, the simplex growing algorithm (SGA), vertex component analysis (VCA), automatic target generation process (ATGP), and fully constrained least squares linear unmixing (FCLSLU). We analyze the fundamental equivalence in the searching criteria of the simplex volume maximization and pixel spectral signature similarity employed by these algorithms. We point out that their performance discrepancy comes mainly from the use of a dimensionality reduction process, a parallel or sequential implementation mode, or the imposition of certain constraints. Instructive recommendations in algorithm selection for practical applications are provided.

Wholegrain foods made from a novel high-amylose barley variety (Himalaya 292) improve indices of bowel health in human subjects.

Himalaya 292 (Hordeum vulgare var. Himalaya 292) is a novel hull-less barley variety lacking activity of a key enzyme of starch synthesis giving a grain containing less total starch, more amylose and higher total dietary fibre. Animal trials have shown that Himalaya 292 contains more resistant starch and has greater positive impact on biomarkers of large-bowel health than comparable wholegrain cereal products. The present study compared the effects of foods made from wholegrain Himalaya 292 with those made from wholegrain wheat on faecal biomarkers of bowel health in human subjects. Seventeen male and female volunteers aged 31-66 years consumed similar quantities of Himalaya 292, whole-wheat or refined cereal foods daily for 4 weeks in a randomised cross-over design. Total dietary fibre intakes from weighed food records were 45, 32 and 21 g/d for the Himalaya 292, whole-wheat and refined cereal periods, respectively. Compared with the refined cereal foods, consumption of Himalaya 292 foods resulted in 33 % higher faecal weight, a lowering of faecal pH from 7.24 to 6.98, a 42 % higher faecal concentration and a 91 % higher excretion of butyrate, a 57 % higher faecal total SCFA excretion and a 33 % lower faecal p-cresol concentration. pH and butyrate concentration and excretion were also significantly different compared with wholemeal wheat. It is concluded that consumption of a diet that included foods made from Himalaya 292 supplied more fibre and improved indices of bowel health compared with refined cereal foods and, for some indices, similar wholemeal wheat foods at equivalent levels of intake.

Evaluation of possible tourniquet systems for use in the Canadian Forces.

OBJECTIVE: Hemorrhage from extremity wounds is the leading cause of preventable death on the battlefield. Tourniquets have been identified as the most reasonable option for controlling life threatening extremity hemorrhage in the tactical phase of an operation. The purpose of this trial was to determine which tourniquet systems are effective under simulated combat conditions and make recommendations to the Canadian Forces (CF) on an approach to tourniquet use. METHODS: 5 tourniquet systems were tested: Self Applied Tourniquet System (SATS); One-Handed Tourniquet (OHT); tie & cravat Improvised Tourniquet (IT); pneumatic Emergency Medical Tourniquet (EMT); and latex surgical tubing (ST). On June 25, 2004, ten junior medics from 1 Field Ambulance volunteered for the study. They were divided into five groups of two and rotated through all tourniquets. Each group was timed on the speed of application, and effectiveness of the tourniquets on the lower limbs was determined by a Doppler probe and loss of palpable pulses. Subjective analysis by questionnaire was used to determine ease of use, durability, portability, patient comfort, and preference. RESULTS: Occlusion of the posterior tibial pulse, as measured by Doppler flow, occurred 0-10% of the time with the OHT, 40-50% with the SATS and IT, 70-80% with the EMT, and 90% with the ST. The presence of winter clothing did not change the effectiveness of the tourniquets. The OHT, SATS, IT, and EMT took an average of 30-40 seconds to apply while the ST took only 24 seconds. From most painful to least were: the IT (severe pain-could not tolerate); ST and SATS (moderate-severe pain); OHT (minor-moderate pain); and EMT (no pain-minor discomfort). CONCLUSIONS: The most effective tourniquets were the EMT and ST. The ST is also the lightest, fastest, easiest to learn, and the cheapest but it causes a lot of pain and presumably, local tissue damage. ST can be issued to every soldier with a minimum of training and used effectively in the "Care Under Fire" phase. The EMT, which causes the least pain and is equally effective, can be applied during the "Tactical Field Care" phase by the medic to replace the surgical tubing. Fine adjustments can be made to the EMT, which allows the medic to safely deflate the device, assess the wound, determine if a tourniquet is required, and re-inflate quickly if necessary.

Expression of adrenomedullin mRNA is altered with gestation and labour in human placenta and fetal membranes.

The aim of the present study was to investigate whether placental and fetal membrane AdM (adrenomedullin) mRNA expression changes with gestation and human labour, as we have previously found labour-associated changes in AdM content in fetal membranes [Al-Ghafra, Gude, Brennecke and King (2003) Clin. Sci. 105, 419-423]. Placentas and fetal membranes were collected either at term or pre-term from women either in-labour or not-in-labour, and AdM mRNA abundance was measured in tissue extracts by Northern blot analysis. Increases were found in the relative abundance of amniotic tissue AdM mRNA in both in-labour and not-in-labour groups at term compared with those at pre-term, and there were positive correlations with gestational age. Relative abundance of choriodecidual tissue AdM mRNA was also significantly elevated in the not-in-labour groups between pre-term and term tissues, although there was no significant correlation with gestational age. However, placental AdM mRNA expression was neither significantly increased at term (compared with pre-term) nor correlated with gestational age. In addition, there were significant increases in AdM mRNA in amnion and choriodecidua in the in-labour group compared with the not-in-labour group for both pre-term and term gestations. There was no difference in AdM mRNA in placental tissues between labour groups. In conclusion, the present study provides evidence that AdM production by fetal membranes is increased in amniotic and choriodecidual tissues at term, compared with pre-term, and in response to labour.

Honokiol protects against carbon tetrachloride induced liver damage in the rat.

This study aims to investigate the possible hepato-protective effects of honokiol against liver damage and cirrhosis induced by carbon tetrachloride (CCl(4)) in the rat. Rats were treated acutely, or chronically with CCl(4) at 5 day intervals (0.06 mL/100 g body weight, administered as 50% vol/vol solution in liquid paraffin) by gavage, in combination with phenobarbitone in drinking water (0.5 g/L for 7 days prior to, and during CCl(4) treatment) to induce liver damage. Some were also co-treated with 0.1 mg/kg or 0.03 mg/kg honokiol (i.p.) or with appropriate vehicle. In vivo measurement of the liver sinusoidal area was performed using confocal microscopy following i.v. fluorescein isothiocyanate (FITC) dextran. Liver histology and function tests were performed, and liver and body weights were measured. Confocal microscopy showed that acute and chronic CCl(4) treatment significantly reduced the sinusoidal area. Honokiol (0.1 mg/kg, but not 0.03 mg/kg) partially reversed the decrease in the sinusoidal area after acute or chronic treatments with CCl(4). Acute and chronic CCl(4) treatment produced significant histological liver damage. Honokiol (0.1 mg/kg) significantly reduced the histological damage caused by chronic treatment. Chronic treatment with CCl(4) caused a significant increase in the bilirubin level that was not observed following the high dose of honokiol (0.1 mg/kg). In conclusion, this study showed that honokiol exhibits potent hepato-protective effects in rats treated with CCl(4).

Artificial neural networks and three-dimensional digital morphology: a pilot study.

In this pilot study, we used an unsupervised learning algorithm for self-organization and pattern matching to create feature maps that can be applied to morphological problems. We designed a network to analyze 83 first and/or second upper and lower molar sets representing 13 anthropoid primate species, based on three-dimensional measures obtained from laser-digitized, virtual specimens. As shown in a comparison with a principal-component analysis of the virtual specimens, the artificial neural network approach provided more biologically meaningful information than the conventional multivariate analysis approach. The methodology discovered partitions and hierarchical clusters consistent with anthropoid systematics, from the species (or subspecies) level to the highest categories, by sorting and allocating upper and lower molar teeth. As one might expect, measures of upper molars were richer in phenetic information than those of lower molars, even among the anatomically diverse platyrrhines. We also show that reducing taxonomic noise (i.e. biological variation) by limiting the analysis to a monophyletic subset improves discrimination.

A novel high-amylose barley cultivar (Hordeum vulgare var. Himalaya 292) lowers plasma cholesterol and alters indices of large-bowel fermentation in pigs.

Hordeum vulgare var. Himalaya 292 is a new barley cultivar with altered starch synthesis and less total starch but more amylose, resistant starch (RS) and total and soluble NSP including beta-glucan. To determine its nutritional potential, young pigs were fed diets containing stabilised wholegrain flours from either Himalaya 292, Namoi (a commercial barley), wheat bran or oat bran at equivalent dietary NSP concentrations for 21 d. Serum total cholesterol was significantly lowered by the Himalaya 292 diet relative to wheat bran, indicating that Himalaya 292 retained its hypocholesterolaemic potential. In all groups SCFA concentrations were highest in the proximal colon and decreased towards the rectum. Digesta pH was lowest in the proximal colon and highest in the distal colon. Large-bowel and faecal pH were significantly lower in the pigs fed the barley and oat diets, indicating greater bacterial fermentation. Caecal and proximal colonic pH was lowest and SCFA pools highest in the pigs fed Himalaya 292. Total and individual SCFA were lowest in the mid- and distal colon of the pigs fed Himalaya 292 or oat bran. These data suggest the presence of more RS in Himalaya 292 and suggest that its fermentation was rapid relative to transit. Differences in faecal and large-bowel anaerobic, aerobic, coliform and lactic acid bacteria were relatively small, indicating a lack of a specific prebiotic action. These data support the potential of this novel barley cultivar to improve health through plasma cholesterol reduction and increased large-bowel SCFA production.

Growth and function of the normal human placenta.

The placenta is the highly specialised organ of pregnancy that supports the normal growth and development of the fetus. Growth and function of the placenta are precisely regulated and coordinated to ensure the exchange of nutrients and waste products between the maternal and fetal circulatory systems operates at maximal efficiency. The main functional units of the placenta are the chorionic villi within which fetal blood is separated by only three or four cell layers (placental membrane) from maternal blood in the surrounding intervillous space. After implantation, trophoblast cells proliferate and differentiate along two pathways described as villous and extravillous. Non-migratory, villous cytotrophoblast cells fuse to form the multinucleated syncytiotrophoblast, which forms the outer epithelial layer of the chorionic villi. It is at the terminal branches of the chorionic villi that the majority of fetal/maternal exchange occurs. Extravillous trophoblast cells migrate into the decidua and remodel uterine arteries. This facilitates blood flow to the placenta via dilated, compliant vessels, unresponsive to maternal vasomotor control. The placenta acts to provide oxygen and nutrients to the fetus, whilst removing carbon dioxide and other waste products. It metabolises a number of substances and can release metabolic products into maternal and/or fetal circulations. The placenta can help to protect the fetus against certain xenobiotic molecules, infections and maternal diseases. In addition, it releases hormones into both the maternal and fetal circulations to affect pregnancy, metabolism, fetal growth, parturition and other functions. Many placental functional changes occur that accommodate the increasing metabolic demands of the developing fetus throughout gestation.

Investigation of the effects of peppermint oil and valerian on rat liver and cultured human liver cells.

1. The aim of the present study was to investigate the effects of peppermint oil and valerian on rat liver and cultured human hepatoma cells. 2. Rats received a single oral dose of peppermint oil (8.3-830 microL/kg) or valerian (0.31-18.6 g/kg), or daily oral doses of 83 microL/kg peppermint oil or 3.1 g/kg valerian for 28 days. After 24 h, rats were anaesthetized and measurements made of bile flow, liver function and in vivo sinusoidal area. Livers were then removed for histology. 3. Bile flow was unaffected by any treatment, except acute high-dose peppermint oil (830 microL/kg; 70% increase in flow). No change in liver enzyme activity was found, except for a 45% increase in alkaline phosphatase after chronic peppermint oil. No change in sinusoidal area in vivo or in histology was found following any treatment, although pretreatment with carbon tetrachloride reduced sinusoidal bed area and produced histological damage. Incubation of human hepatoma cells with 0.5 microL/mL (but not 0.05 microL/mL) peppermint oil or 20 mg/mL (but not 2 mg/mL) valerian resulted in increased cell death. 4. In conclusion, the present study demonstrated in vitro toxicity of high doses of valerian and peppermint oil in cultured human hepatoma cells and, at doses 2-3 orders of magnitude greater than those recommended for human use, an increase in rat bile flow after acute peppermint oil and an increase in alkaline phosphatase after chronic peppermint oil.

Effect of fetal macrosomia on human placental glucose transport and utilization in insulin-treated gestational diabetes.

The aim of this study was to compare glucose transport and utilization in human placentae from pregnancies affected by insulin-treated GDM with and without macrosomia, and from non-diabetic control pregnancies. Placental lobules were perfused for 4 h. Maternal D-glucose concentration was 4, 8, 16, or 24 mM while the fetal D-glucose was maintained at 3mM. 14C-D-glucose and 3H-L-glucose were infused into the maternal circulation. Radioactivity, D-glucose and L-lactate levels were measured in the fetal and maternal effluent perfusates. Glucose uptake from the maternal perfusate, and transfer to the fetal effluent were not significantly different between groups. Insulin-treated GDM group without macrosomia had reduced glucose utilization compared to the control group while the insulin-treated GDM group with macrosomia did not. Lactate release into the fetal effluent was significantly reduced in both insulin-treated GDM groups compared to the control group. In conclusion, placental glucose utilization is different between insulin-treated GDM placentae with and without fetal macrosomia.

In vivo detection of morphological and microvascular changes of the colon in association with colitis using fiberoptic confocal imaging (FOCI).

Using a well-established rodent model of inflammatory bowel disease (IBD), the present study examined changes in the microvasculature of the colonic mucosa in association with ulcerative colitis (UC). The results were compared to microscopic alterations in tissue morphology to establish a temporal relationship between microcirculatory dysfunction and IBD pathology. Mild colitis was induced in rats by the oral consumption of 5% dextran sulfate sodium (DSS) in drinking water. Control animals were provided with water ad libitum. After 3, 5, and 7 days of oral ingestion of DSS, anesthetized rats were laparotomized. The mucosal surface of the distal colon was then examined using fiber optic confocal imaging (FOCI; excitation 488 nm argon ion laser, detection above 515 nm). Changes in the mucosal architecture were examined following the topical application of the fluorescent dye, tetracycline hydrochloride. Tetracycline hydrochloride, an antibiotic used widely in clinical medicine, enabled imaging of the crypts at the surface of the mucosa. Spatial changes in the microvascular structure were assessed following the intravenous administration of fluorescein isothiocyanate dextran (FITC-dextran). Confocal images were correlated with clinical parameters, including weight loss, occult blood, and stool consistency. Attenuation of the colonic epithelium was detected on day 3 colitis. Morphological changes including crypt loss, crypt distortion, and inflammatory cell infiltrate were detected on day 5 and day 7 colitis. Dual channel imaging showed the mucosal capillary network outlining the stromal confines of the mucus-secreting glands in control tissue. Experimental colitis resulted in diffuse hypervascularity and tortuosity of the capillary vessels. Evidence of increased vessel leakiness (leakage of FITC-dextran from the lumen) was first detected on day 5 colitis. Complete disruption of the normal honeycomb pattern of the vessels and capillary dilation was evident after 7 days of DSS ingestion. These findings suggest that the pathogenesis of ulcerative colitis is associated with changes in the vascular architecture as demonstrated in vivo using confocal microscopy.