Long-term outcome in relation to renal sympathetic activity in patients with chronic heart failure.

AIMS: Although cardiac sympathetic activation is associated with adverse outcome in patients with chronic heart failure (CHF), the influence of renal sympathetic activity on outcome is unknown. We assessed the hypothesis that renal noradrenaline (NA) spillover is a predictor of the combined endpoint of all-cause mortality and heart transplantation in CHF. METHODS AND RESULTS: Sixty-one patients with CHF, New York Heart Association (NYHA) I-IV (66% NYHA III-IV), and left ventricular ejection fraction (LVEF) 26+/-9% (mean+/-SD) were studied with cardiac and renal catheterizations at baseline and followed for 5.5+/-3.7 years (median 5.5 years, range 12 days to 11.6 years). Nineteen deaths and 13 cases of heart transplantation were registered. Only renal NA spillover above median, 1.19 (interquartile range 0.77-1.43) nmol/min, was independently associated with an increased relative risk (RR) of the combined endpoint (RR 3.1, 95% CI 1.2-7.6, P=0.01) in a model also including total body NA spillover, LVEF, glomerular filtration rate (GFR), renal blood flow, cardiac index, aetiology, and age. CONCLUSION: Renal noradrenergic activation has a strong negative predictive value on outcome independent of overall sympathetic activity, GFR, and LVEF. These findings suggest that treatment regimens that further reduce renal noradrenergic stimulation could be advantageous by improving survival in patients with CHF.     

Maternal Physical Activity Is Associated With Improved Blood Pressure Regulation During Late Pregnancy

Background

Cardiovagal baroreflex gain (cBRG) reflects an individual's ability to buffer swings in blood pressure. It is not well understood how this mechanism is influenced by physical activity in pregnancy. Because pregnant women tend to engage in low levels of moderate-to-vigorous physical activity (MVPA) and high levels of sedentary behaviour, we sought to determine the influence of MVPA and sedentary behaviour on cBRG and mean arterial pressure (MAP) in pregnancy.

Enhancement of MHC-I Antigen Presentation via Architectural Control of pH-Responsive,Endosomolytic Polymer Nanoparticles

Protein-based vaccines offer a number of important advantages over organism-based vaccines but generally elicit poor CD8⁺ T cell responses. We have previously demonstrated that pH-responsive, endosomolytic polymers can enhance protein antigen delivery to major histocompatibility complex class I (MHC-I) antigen presentation pathways thereby augmenting CD8⁺ T cell responses following immunization. Here, we describe a new family of nanocarriers for protein antigen delivery assembled using architecturally distinct pH-responsive polymers. Reversible addition-fragmentation chain transfer (RAFT) polymerization was used to synthesize linear, hyperbranched, and core-crosslinked copolymers of 2-(N,N-diethylamino)ethyl methacrylate (DEAEMA) and butyl methacrylate (BMA) that were subsequently chain extended with a hydrophilic N,N-dimethylacrylamide (DMA) segment copolymerized with thiol-reactive pyridyl disulfide (PDS) groups. In aqueous solution, polymer chains assembled into 25 nm micellar nanoparticles and enabled efficient and reducible conjugation of a thiolated protein antigen, ovalbumin. Polymers demonstrated pH-dependent membrane-destabilizing activity in an erythrocyte lysis assay, with the hyperbranched and cross-linked polymer architectures exhibiting significantly higher hemolysis at pH ≤ 7.0 than the linear diblock. Antigen delivery with the hyperbranched and cross-linked polymer architecture enhanced in vitro MHC-I antigen presentation relative to free antigen, whereas the linear construct did not have a discernible effect. The hyperbranched system elicited a four- to fivefold increase in MHC-I presentation relative to the cross-linked architecture, demonstrating the superior capacity of the hyperbranched architecture in enhancing MHC-I presentation. This work demonstrates that the architecture of pH-responsive, endosomolytic polymers can have dramatic effects on intracellular antigen delivery, and offers a promising strategy for enhancing CD8⁺ T cell responses to protein-based vaccines.

Electronic supplementary material

The online version of this article (doi:10.1208/s12248-014-9697-1) contains supplementary material, which is available to authorized users.KEY WORDS: MHC-I antigen presentation, pH-responsive nanoparticle, polymer architecture, RAFT polymerization, vaccine     

CYP3A isoforms in Ewing's sarcoma tumours: an immunohistochemical study with clinical correlation

Ewing's sarcoma is an aggressive malignancy of bone and soft tissue with high incidence of metastasis and resistance to chemotherapy. Cytochrome P450 (CYP) monooxygenases are a family of enzymes that are involved in the metabolism of exogenous and endogenous compounds, including anti‐cancer drugs, and have been implicated in the aggressive behaviour of various malignancies. Tumour samples and clinical information including age, sex, tumour site, tumour size, clinical stage and survival were collected from 36 adult and paediatric patients with Ewing's sarcoma family tumours. Tissue microarrays slides were processed for immunohistochemical labelling for CYP3A4, CYP3A5 and CYP3A7 using liver sections as positive control. The intensity of staining was scored as negative, low or high expression and was analysed statistically for any association with patients' clinical information. Four cases were later excluded due to inadequate viable tissue. CYP3A4 staining was present in 26 (81%) cases with high expression noted in 13 (40%) of 32 cases. High expression was significantly associated with distant metastases (P < 0.05). CYP3A5 and CYP3A7 were expressed in 5 and 13 cases respectively (15.6%, 40.6%). There was no association between the expression of CYP3A isoforms and age, sex, tumour size, or location (pelvic or extra‐pelvic). None of the biomarkers showed any correlation with overall or disease‐free survival. In conclusion, expression of CYP3A isoforms is noted in Ewing's sarcoma tumours and high CYP3A4 expression may be associated with metastasis. Additional studies are needed to further investigate the role of CYP3A4 in the prognosis of these tumours.     

Epidemiology and natural history of hepatitis C virus infection among children and young people

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Comprehensive health status assessment of centenarians: results from the 1999 large health survey of veteran enrollees

BACKGROUND: Information on the health status of centenarians provides a means for understanding the health care needs of this growing population. Therefore, we examined the health status of a national cohort of centenarian veteran enrollees. METHODS: Ninety-three centenarian veteran enrollees returned a complete health history questionnaire, which included questions about sociodemographic information, age-associated conditions, health behaviors, health-related quality of life as measured by the Veterans SF-36, and change in health status. RESULTS: Centenarian veteran enrollees are a group with major impairment across multiple dimensions of health-related quality of life despite having a relatively low prevalence of diseases. They had considerable physical limitations as reflected by their physical health summary scores (26.2 +/- 8.3). However, their mental health was comparatively good (mental health summary score 44.1 +/- 12.5). Compared to younger elderly veterans (ages 85-99), centenarians had a lower prevalence of hypertension, angina or myocardial infarction, diabetes, and chronic low back pain (p <.05). Centenarians had significantly worse physical functioning, role physical, vitality, and social functioning scores than did younger elderly veterans. The two groups did not differ in their general health, bodily pain, role emotional, and mental health scores. Centenarians did not perceive much decline in their physical or mental health during the preceding year. CONCLUSIONS: Centenarian veteran enrollees are a group with a low number of age-associated diseases and good mental health despite substantial physical limitations. These results support future studies of services directed toward improvement of function as opposed to those focused solely on the treatment of diseases.     

Little evidence for enhanced phenotypic evolution in early teleosts relative to their living fossil sister group

Since Darwin, biologists have been struck by the extraordinary diversity of teleost fishes, particularly in contrast to their closest “living fossil” holostean relatives. Hypothesized drivers of teleost success include innovations in jaw mechanics, reproductive biology and, particularly at present, genomic architecture, yet all scenarios presuppose enhanced phenotypic diversification in teleosts. We test this key assumption by quantifying evolutionary rate and capacity for innovation in size and shape for the first 160 million y (Permian–Early Cretaceous) of evolution in neopterygian fishes (the more extensive clade containing teleosts and holosteans). We find that early teleosts do not show enhanced phenotypic evolution relative to holosteans. Instead, holostean rates and innovation often match or can even exceed those of stem-, crown-, and total-group teleosts, belying the living fossil reputation of their extant representatives. In addition, we find some evidence for heterogeneity within the teleost lineage. Although stem teleosts excel at discovering new body shapes, early crown-group taxa commonly display higher rates of shape evolution. However, the latter reflects low rates of shape evolution in stem teleosts relative to all other neopterygian taxa, rather than an exceptional feature of early crown teleosts. These results complement those emerging from studies of both extant teleosts as a whole and their sublineages, which generally fail to detect an association between genome duplication and significant shifts in rates of lineage diversification.Numbering ∼29,000 species, teleost fishes account for half of modern vertebrate richness. In contrast, their holostean sister group, consisting of gars and the bowfin, represents a mere eight species restricted to the freshwaters of eastern North America (1). This stark contrast between teleosts and Darwin''s original “living fossils” (2) provides the basis for assertions of teleost evolutionary superiority that are central to textbook scenarios (3, 4). Classic explanations for teleost success include key innovations in feeding (3, 5) (e.g., protrusible jaws and pharyngeal jaws) and reproduction (6, 7). More recent work implicates the duplicate genomes of teleosts (8–10) as the driver of their prolific phenotypic diversification (8, 11–13), concordant with the more general hypothesis that increased morphological complexity and innovation is an expected consequence of genome duplication (14, 15).Most arguments for enhanced phenotypic evolution in teleosts have been asserted rather than demonstrated (8, 11, 12, 15, 16; but see ref. 17), and draw heavily on the snapshot of taxonomic and phenotypic imbalance apparent between living holosteans and teleosts. The fossil record challenges this neontological narrative by revealing the remarkable taxonomic richness and morphological diversity of extinct holosteans (Fig. 1) (18, 19) and highlights geological intervals when holostean taxonomic richness exceeded that of teleosts (20). This paleontological view has an extensive pedigree. Darwin (2) invoked a long interval of cryptic teleost evolution preceding the late Mesozoic diversification of the modern radiation, a view subsequently supported by the implicit (18) or explicit (19) association of Triassic–Jurassic species previously recognized as “holostean ganoids” with the base of teleost phylogeny. This perspective became enshrined in mid-20th century treatments of actinopterygian evolution, which recognized an early-mid Mesozoic phase dominated by holosteans sensu lato and a later interval, extending to the modern day, dominated by teleosts (4, 20, 21). Contemporary paleontological accounts echo the classic interpretation of modest teleost origins (22–24), despite a systematic framework that substantially revises the classifications upon which older scenarios were based (22–25). Identification of explosive lineage diversification in nested teleost subclades like otophysans and percomorphs, rather than across the group as a whole, provides some circumstantial neontological support for this narrative (26).Open in a separate windowFig. 1.Phenotypic variation in early crown neopterygians. (A) Total-group holosteans. (B) Stem-group teleosts. (C) Crown-group teleosts. Taxa illustrated to scale.In contrast to quantified taxonomic patterns (20, 23, 24, 27), phenotypic evolution in early neopterygians has only been discussed in qualitative terms. The implicit paleontological model of morphological conservatism among early teleosts contrasts with the observation that clades aligned with the teleost stem lineage include some of the most divergent early neopterygians in terms of both size and shape (Fig. 1) (see, for example, refs. 28 and 29). These discrepancies point to considerable ambiguity in initial patterns of phenotypic diversification that lead to a striking contrast in the vertebrate tree of life, and underpins one of the most successful radiations of backboned animals.Here we tackle this uncertainty by quantifying rates of phenotypic evolution and capacity for evolutionary innovation for the first 160 million y of the crown neopterygian radiation. This late Permian (Wuchiapingian, ca. 260 Ma) to Cretaceous (Albian, ca. 100 Ma) sampling interval permits incorporation of diverse fossil holosteans and stem teleosts alongside early diverging crown teleost taxa (Figs. 1 and ​and2A2A and Figs. S1 and ​andS2),S2), resulting in a dataset of 483 nominal species-level lineages roughly divided between the holostean and teleost total groups (Fig. 2B and Fig. S2). Although genera are widely used as the currency in paleobiological studies of fossil fishes (30; but see ref. 31), we sampled at the species level to circumvent problems associated with representing geological age and morphology for multiple congeneric lineages. We gathered size [both log-transformed standard length (SL) and centroid size (CS); results from both are highly comparable (Figs. S3 and ​andS4);S4); SL results are reported in the main text] and shape data (the first three morphospace axes arising from a geometric morphometric analysis) (Fig. 2A and Figs. S1) from species where possible. To place these data within a phylogenetic context, we assembled a supertree based on published hypotheses of relationships. We assigned branch durations to a collection of trees under two scenarios for the timescale of neopterygian diversification based on molecular clock and paleontological estimates. Together, these scenarios bracket a range of plausible evolutionary timelines for this radiation (Fig. 2B). We used the samples of trees in conjunction with our morphological datasets to test for contrasts in rates of, and capacity for, phenotypic change between different partitions of the neopterygian Tree of Life (crown-, total-, and stem-group teleosts, total-group holosteans, and neopterygians minus crown-group teleosts), and the sensitivity of these conclusions to uncertainty in both relationships and evolutionary timescale. Critically, these include comparisons of phenotypic evolution in early crown-group teleosts—those species that are known with certainty to possess duplicate genomes—with rates in taxa characterized largely (neopterygians minus crown teleosts) or exclusively (holosteans) by unduplicated genomes. By restricting our scope to early diverging crown teleost lineages, we avoid potentially confounding signals from highly nested radiations that substantially postdate both genome duplication and the origin of crown teleosts (26, 32). This approach provides a test of widely held assumptions about the nature of morphological evolution in teleosts and their holostean sister lineage.Open in a separate windowFig. 2.(A) Morphospace of Permian–Early Cretaceous crown Neopterygii. (B) One supertree subjected to our paleontological (Upper) and molecular (Lower) timescaling procedures to illustrate contrasts in the range of evolutionary timescales considered. Colors of points (A) and branches (B) indicate membership in major partitions of neopterygian phylogeny. Topologies are given in Datasets S4 and S5. See Dataset S6 for source trees.Open in a separate windowFig. S1.Morphospace of 398 Permian–Early Cretaceous Neopterygii. Three major axes of shape variation are presented. Silhouettes and accompanying arrows illustrate the main anatomical correlates of these principal axes, as described in Open in a separate windowFig. S2.Morphospace of 398 Permian–Early Cretaceous Neopterygii, illustrating the major clades of (A) teleosts and (B) holosteans.Open in a separate windowFig. S3.Comparisons of size rates between (A) holosteans and teleosts, (B) crown teleosts and all other neopterygians, (C) crown teleosts and stem teleosts, (D) crown teleosts and holosteans, and (E) stem teleosts and holosteans. Comparisons were made using the full-size SL dataset, a CS dataset, and a smaller SL dataset pruned to exactly match the taxon sampling of the CS dataset. Identical taxon sampling leads the CS and pruned SL datasets to yield near identical results. Although the larger SL dataset results often differ slightly, the overall conclusion from each pairwise comparison (i.e., which outcome is the most likely in an overall majority of trees) is identical in all but one comparison (E, under molecular timescales).Open in a separate windowFig. S4.Comparisons of size innovation between (A) holosteans and teleosts, (B) crown teleosts and all other neopterygians, (C) crown teleosts and stem teleosts, (D) crown teleosts and holosteans, and (E) stem teleosts and holosteans. Comparisons were made using the full-size SL dataset, a CS dataset, and a smaller SL dataset pruned to exactly match the taxon sampling of the CS dataset. Comparisons of size innovation are presented for K value distributions of the three datasets resemble each other closely.     

Biochemical and clinical manifestations of dopamine-producing paragangliomas: utility of plasma methoxytyramine

Measurements of plasma-free normetanephrine and metanephrine provide a sensitive test for diagnosis of pheochromocytoma but may fail to detect tumors that produce predominantly dopamine. Such tumors are extremely rare, usually found as extraadrenal paragangliomas. This report describes measurements of plasma concentrations of free methoxytyramine, the O-methylated metabolite of dopamine, in 120 patients with catecholamine-producing tumors, including nine with extraadrenal paragangliomas secreting predominantly dopamine. In seven of these nine patients, tumors were found incidentally or secondary to the space-occupying complications of the lesions. Plasma concentrations of free methoxytyramine and dopamine were increased in all nine patients, including two with normal plasma and urinary normetanephrine and metanephrine and normal urinary outputs of dopamine. Relative increases above normal for plasma methoxytyramine (104-fold) and dopamine (56-fold) were much greater (P < 0.001) than those for urinary dopamine (3-fold). Insensitivity of the latter for identification of dopamine-secreting tumors was due to dependence of the urinary amine on renal extraction and decarboxylation of circulating 3,4-dihydroxyphenylalanine. Measurements of plasma-free methoxytyramine, in addition to normetanephrine and metanephrine, are unlikely to improve diagnosis of pheochromocytomas in hypertensive patients with symptoms of catecholamine excess but may be useful in selected patients for identification of tumors that produce predominantly dopamine.