Pepsin measured in induced sputum - a test for pulmonary aspiration in children?

Purpose The purpose of this study was to investigate if pepsin measured in sputum is a useful marker of pulmonary aspiration secondary to gastroesophageal reflux (GER) in children. It is possible that the induced sputum procedure could cause GER and invalidate the results. The hypothesis stated that healthy children (those without history of respiratory or gastroesophageal symptoms) would not have pepsin detected in induced sputum. Methods Children attending surgical outpatients in the Royal Belfast Hospital for Sick Children (Belfast, Northern Ireland) were recruited. After spirometry, sputum was obtained by induction with hypertonic 3% saline. Spirometry was repeated, and complications were noted. An “in-house” enzyme-linked immunosorbent assay was used to measure pepsin concentration in sputum. The lower limit of detection of pepsin was 1.19 ng/mL. Results Children (n = 21) aged 4 to 16 years were recruited. Twenty children completed the study. No adverse effects were reported. Pepsin was detected in 17 (85%) of 20 sputum samples. Conclusions The act of sputum induction appears to induce physiologic GER in a healthy childhood population. The analysis of pepsin in sputum obtained by sputum induction is therefore not useful in the investigation of reflux-related respiratory disease.

Climate drivers for peatland palaeoclimate records

Reconstruction of hydroclimate variability is an important part of understanding natural climate change on decadal to millennial timescales. Peatland records reconstruct 'bog surface wetness' (BSW) changes, but it is unclear whether it is a relative dominance of precipitation or temperature that has driven these variations over Holocene timescales. Previously, correlations with instrumental climate data implied that precipitation is the dominant control. However, a recent chironomid inferred July temperature record suggested temperature changes were synchronous with BSW over the mid-late Holocene. This paper provides new analyses of these data to test competing hypotheses of climate controls on bog surface wetness and discusses some of the distal drivers of large-scale spatial patterns of BSW change. Using statistically based estimates of uncertainty in chronologies and proxy records, we show a correlation between Holocene summer temperature and BSW is plausible, but that chronologies are insufficiently precise to demonstrate this conclusively. Simulated summer moisture deficit changes for the last 6000 years forced by temperature alone are relatively small compared with observations over the 20th century. Instrumental records show that summer moisture deficit provides the best explanatory variable for measured water table changes and is more strongly correlated with precipitation than with temperature in both Estonia and the UK. We conclude that BSW is driven primarily by precipitation, reinforced by temperature, which is negatively correlated with precipitation and therefore usually forces summer moisture deficit in the same direction. In western Europe, BSW records are likely to be forced by changes in the strength and location of westerlies, linked to large-scale North Atlantic ocean and atmospheric circulation. (C) 2009 Elsevier Ltd. All rights reserved.

Validity of a 1 minute walk test for children with cerebral palsy.

The concurrent validity of a 1 minute walk test at a child's maximum walking speed was assessed in children with bilateral spastic cerebral palsy (BSCP). The distance covered during the 1 minute walk test was compared with the children's gross motor function as assessed by the Gross Motor Function Measure (GMFM). Twenty-four male and 10 female children with CP (mean age 11y, range 4 to 16y) participated in the study. Gross Motor Function Classification System (GMFCS) levels were; level I (n=3), level II (n=17), level III (n=10), and level IV (n=4). Participants had clinical diagnoses of symmetrical diplegia (n=19), asymmetrical diplegia (n=14), and quadriplegia (n=1). Results showed a significant correlation between GMFM score and the distance covered during the 1 minute walk (r=0.92; p<0.001). There was also a significant decrease in the distance walked with increasing GMFCS level (p<0.001). We concluded that the 1 minute walk test is a valid measure for assessing functional ability in children with ambulatory BSCP. Its cost-effectiveness and user friendliness make it a potentially useful tool in the clinical setting. Further study needs to address its reliability and ability to detect change over time.

Dendrochronological evidence for a lower water-table on peatland around 3200-3000 BC from subfossil pine in northern Scotland

Tree-ring analysis of subfossil Pinus sylvestris L., from nine new peatland sites located beyond the species’ current northern limit in Scotland, established a regional chronology called WRATH-9. The chronology has been provisionally dated against Irish pine chronologies and provides the first annual resolution picture of Scots pine expansion from c. 3200 bc and subsequent demise from c. 3000 bc. Pine germination and growth is suggested to be associated with a widespread fall in bog water-tables that indicates a regional climatic control. Bog pines progressively declined in number, rather than died out in a single event, reflecting their growth in a marginal habitat, close to a critical ecological threshold. The use of tree-ring sequences from in situ bog pine macrofossils provides a higher resolution insight into past conditions than possible with existing radiocarbon and pollen-based chronologies.

Development of a Diagnostic Genetic Test for Simplex and Autosomal Recessive Retinitis Pigmentosa

PURPOSE: Retinitis pigmentosa (RP) causes hereditary blindness in adults (prevalence, approximately 1 in 4000). Each of the more than 30 causative genes identified to date are responsible for only a small percentage of cases. Genetic diagnosis via traditional methods is problematic, and a single test with a higher probability of detecting the causative mutation would be very beneficial for the clinician. The goal of this study therefore was to develop a high-throughput screen capable of detecting both known mutations and novel mutations within all genes implicated in autosomal recessive or simplex RP. DESIGN: Evaluation of diagnostic technology. PARTICIPANTS AND CONTROLS: Participants were 56 simplex and autosomal recessive RP patients, with 360 population controls unscreened for ophthalmic disease. METHODS: A custom genechip capable of resequencing all exons containing known mutations in 19 disease-associated genes was developed (RP genechip). A second, commercially available arrayed primer extension (APEX) system was used to screen 501 individual previously reported variants. The ability of these high-throughput approaches to identify pathogenic variants was assessed in a cohort of simplex and autosomal recessive RP patients. MAIN OUTCOME MEASURES: Number of mutations and potentially pathogenic variants identified. RESULTS: The RP genechip identified 44 sequence variants: 5 previously reported mutations; 22 known single nucleotide polymorphisms (SNPs); 11 novel, potentially pathogenic variants; and 6 novel SNPs. There was strong concordance with the APEX array, but only the RP genechip detected novel variants. For example, identification of a novel mutation in CRB1 revealed a patient, who also had a single previously known CRB1 mutation, to be a compound heterozygote. In some individuals, potentially pathogenic variants were discovered in more than one gene, consistent with the existence of disease modifier effects resulting from mutations at a second locus. CONCLUSIONS: The RP genechip provides the significant advantage of detecting novel variants and could be expected to detect at least one pathogenic variant in more than 50% of patients. The APEX array provides a reliable method to detect known pathogenic variants in autosomal recessive RP and simplex RP patients and is commercially available. High-throughput genotyping for RP is evolving into a clinically useful genetic diagnostic tool.