Comparison of Disease Activity in SPMS and PPMS in the Context of Multicenter Clinical Trials

Background

Retrospective single center natural history studies have shown that times to reach disability milestones and ages at which they are reached are similar in primary (PPMS) and secondary (SPMS) progressive multiple sclerosis suggesting that they may be phenotypic variations of the same disease.

Objective

Here we compared longitudinal disease activity in SPMS and PPMS in the context of international multicenter clinical trials.

Methods

We analyzed all objective outcome measures that were systematically collected over 2 years for all subjects randomized to placebo arms in one SPMS and one PPMS clinical trial over the last decade. Conventional and exploratory definitions of clinical disease activity were used. Disease activity was analyzed in 3 different categories intermittent activity, progression, and improvement. Conventional MRI measures and one patient reported outcome measure of quality of life were included when available for comparison. Heat maps were drawn for all results followed by hierarchical clustering.

Results

There were 101 outcome variables from 206 SPMS subjects and 79 outcome variables from 135 PPMS subjects. The comparison revealed that SPMS and PPMS subjects exhibited similar disease activity over 2 years in all but two of the variables in common worsening in the EDSS sensory system was more common in PPMS while worsening on the 9 hole PEG was more common in SPMS. Intermittent activity was the most common pattern of disease activity in SPMS and PPMS. Clinical worsening and improvement occurred at similar frequency in both.

Conclusion

Longitudinal disease activity was nearly identical in SPMS and PPMS subjects in the context of the two multicenter international clinical trials we examined.     

4D Multi-Modality Tissue Segmentation of Serial Infant Images

Accurate and consistent segmentation of infant brain MR images plays an important role in quantifying patterns of early brain development, especially in longitudinal studies. However, due to rapid maturation and myelination of brain tissues in the first year of life, the intensity contrast of gray and white matter undergoes dramatic changes. In fact, the contrast inverse around 6–8 months of age, when the white and gray matter tissues are isointense and hence exhibit the lowest contrast, posing significant challenges for segmentation algorithms. In this paper, we propose a longitudinally guided level set method to segment serial infant brain MR images acquired from 2 weeks up to 1.5 years of age, including the isointense images. At each single-time-point, the proposed method makes optimal use of T1, T2 and the diffusion-weighted images for complimentary tissue distribution information to address the difficulty caused by the low contrast. Moreover, longitudinally consistent term, which constrains the distance across the serial images within a biologically reasonable range, is employed to obtain temporally consistent segmentation results. Application of our method on 28 longitudinal infant subjects, each with 5 longitudinal scans, shows that the automated segmentations from the proposed method match the manual ground-truth with much higher Dice Ratios than other single-modality, single-time-point based methods and the longitudinal but voxel-wise based methods. The software of the proposed method is publicly available in NITRC (http://www.nitrc.org/projects/ibeat).     

The effects on heart rate and temperature of mice and vas deferens responses to noradrenaline when their cage mates are subjected to daily restraint stress

Performing stressful procedures in view of cage mates may cause stress in observer animals. However, it is not known if stressful procedures performed in close proximity to, but not in view of cage mates are stressful for the (observer) cage mates. Radiotelemetry and postmortem in vitro studies of the vas deferens were used to determine the effects of stress on observers. Heart rate (HR) and core body temperature (cBT) were recorded for 1 h following weighing of a cage mate or 1 h during restraint of a cage mate and the hour following return of the restrained mouse to the cage. This procedure was repeated daily for 15 days. HR and cBT were increased in observers during both restraint and weighing of cage mates. Analysis of the area under the curve showed that HR and cBT in observers were significantly higher during restraint of a cage mate than after weighing of a cage mate. When mice were returned to the cage after weighing or restraint, HR and cBT were significantly higher in the cage mates of restrained animals. Comparison between days 1, 3, 7 and 14 found that, as the experiment progressed, HR and cBT were significantly reduced in the observer mice during the hour following return of the cage mates after restraint. Results from previous studies have shown that chronic stress causes the vas deferens to become hypersensitive to exogenous application of noradrenaline (NAd). In this study, vas deferens from observers of restraint had a significantly increased response to NAd. These results indicate that stressful procedures should be conducted in isolation from other mice.     

Comparison of the cidal activity of tea tree oil and terpinen-4-ol against clinical bacterial skin isolates and human fibroblast cells

Aims: The aim of this study was to compare both the antimicrobial activity of terpinen‐4‐ol and tea tree oil (TTO) against clinical skin isolates of meticillin‐resistant Staphylococcus aureus (MRSA) and coagulase‐negative staphylococci (CoNS) and their toxicity against human fibroblast cells. Methods and Results: Antimicrobial activity was compared by using broth microdilution and quantitative in vitro time‐kill test methods. Terpinen‐4‐ol exhibited significantly greater bacteriostatic and bactericidal activity, as measured by minimum inhibitory and bactericidal concentrations, respectively, than TTO against both MRSA and CoNS isolates. Although not statistically significant, time‐kill studies also clearly showed that terpinen‐4‐ol exhibited greater antimicrobial activity than TTO. Comparison of the toxicity of terpinen‐4‐ol and TTO against human fibroblasts revealed that neither agent, at the concentrations tested, were toxic over the 24‐h test period. Conclusions: Terpinen‐4‐ol is a more potent antibacterial agent against MRSA and CoNS isolates than TTO with neither agent exhibiting toxicity to fibroblast cells at the concentrations tested. Significance and Impact of the Study: Terpinen‐4‐ol should be considered for inclusion as a single agent in products formulated for topical treatment of MRSA infection. However, further work would initially be required to ensure that resistance would not develop with the use of terpinen‐4‐ol as a single agent.     

Engagement on the Backroads: Insights for Anthropology and Education

This article is a slightly revised version of the Presidential Address delivered at the annual business meeting of the Council on Anthropology and Education, Washington, D.C., December 1, 2007.  ["little communities," ethnography as picaresque, parrhesia]     

Extracellular superoxide production by Enterococcus faecalis requires demethylmenaquinone and is attenuated by functional terminal quinol oxidases

The intestinal commensal bacterium, Enterococcus faecalis, is unusual among prokaryotic organisms in its ability to produce substantial extracellular superoxide. Transposon mutagenesis, allelic replacement, and electron spin resonance (ESR)-spin trapping showed that superoxide production and generation of derivative hydroxyl radical were dependent on membrane-associated demethylmenaquinone. Extracellular superoxide was generated through univalent reduction of oxygen by reduced demethylmenaquinone. Moreover, extracellular superoxide production was inhibited by exogenous haematin, an essential cofactor for cytochrome bd, and by fumarate, a substrate for fumarate reductase. As integral membrane quinol oxidases, cytochrome bd and fumarate reductase redox cycle demethylmenaquinone, and are necessary for aerobic and anaerobic respiration respectively. A rat model of intestinal colonization demonstrated that conditions exist in the mammalian intestinal tract that permit a mode of respiration for E. faecalis that results in the formation of hydroxyl radical. These results identify and characterize the mechanism by which E. faecalis generates extracellular free radicals.     

Regulation of sulfate assimilation in Cytophaga johnsonae

We have studied the regulation of sulfate assimilation by the gliding bacterium Cytophaga johnsonae in which 20% of the total sulfur is in the sulfornate moiety of sulfonolipid. Added cystine inhibited sulfate uptake and growth with cystine as sulfur source resulted in a repression of sulfate uptake. However, low concentrations of cystine preferentially repressed the terminal reactions of sulfate assimilation responsible for cysteine synthesis while allowing the transport and activation of sulfate for sulfonolipid synthesis. The significance of this novel pattern of regulation in bacteria is discussed.     

An isolation method of DNA from Pneumocystis carinii: a quantitative comparison to known parasitic protozoan DNA

1. A method for isolating DNA from Pneumocystis carinii is described. 2. The DNA content per nucleus is 0.22-0.34 pg. 3. This finding is consistent with other parasitic protozoa DNA content per nuclei.