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1.  Responses of primate LGN cells to moving stimuli involve a constant background modulation by feedback from area MT☆ 
Neuroscience  2013;246(100):254-264.
Graphical abstract
•We investigated the influence of area MT feedback on LGN cell responses to visual stimuli.•We used focal GABA micro-iontophoresis to reversibly block area MT cell responses.•Inactivating area MT feedback produced clear and reversible changes in LGN cell responses.•Effects were observed across magno, parvo and koniocellular LGN cell types.
The feedback connections from the cortical middle temporal (MT) motion area, to layer 6 of the primary visual cortex (V1), have the capacity to drive a cascaded feedback influence from the layer 6 cortico-geniculate cells back to the lateral geniculate nucleus (LGN) relay cells. This introduces the possibility of a re-entrant motion signal affecting the relay of the retinal input through the LGN to the visual cortex. The question is whether the response of LGN cells to moving stimuli involves a component derived from this feedback. By producing a reversible focal pharmacological block of the activity of an MT direction column we show the presence of such an influence from MT on the responses of magno, parvo and koniocellular cells in the macaque LGN. The pattern of effect in the LGN reflects the direction bias of the MT location inactivated. This suggests a moving stimulus is captured by iterative interactions in the circuit formed by visual cortical areas and visual thalamus.
PMCID: PMC3696733  PMID: 23644057
LGN, lateral geniculate nucleus; MT, middle temporal; RF, receptive field; V1, primary visual cortex; lateral geniculate nucleus; feedback influence; area MT
2.  Aging blunts hyperventilation-induced hypocapnia and reduction in cerebral blood flow velocity during maximal exercise 
Age  2011;34(3):725-735.
Cerebral blood flow (CBF) increases from rest to ∼60% of peak oxygen uptake (VO2peak) and thereafter decreases towards baseline due to hyperventilation-induced hypocapnia and subsequent cerebral vasoconstriction. It is unknown what happens to CBF in older adults (OA), who experience a decline in CBF at rest coupled with a blunted ventilatory response during VO2peak. In 14 OA (71 ± 10 year) and 21 young controls (YA; 23 ± 4 years), we hypothesized that OA would experience less hyperventilation-induced cerebral vasoconstriction and therefore an attenuated reduction in CBF at VO2peak. Incremental exercise was performed on a cycle ergometer, whilst bilateral middle cerebral artery blood flow velocity (MCA Vmean; transcranial Doppler ultrasound), heart rate (HR; ECG) and end-tidal PCO2 (PETCO2) were monitored continuously. Blood pressure (BP) was monitored intermittently. From rest to 50% of VO2peak, despite greater elevations in BP in OA, the change in MCA Vmean was greater in YA compared to OA (28% vs. 15%, respectively; P < 0.0005). In the YA, at intensities >70% of VO2peak, the hyperventilation-induced declines in both PETCO2 (14 mmHg (YA) vs. 4 mmHg (OA); P < 0.05) and MCA Vmean (−21% (YA) vs. −7% (OA); P < 0.0005) were greater in YA compared to OA. Our findings show (1), from rest-to-mild intensity exercise (50% VO2peak), elevations in CBF are reduced in OA and (2) age-related declines in hyperventilation during maximal exercise result in less hypocapnic-induced cerebral vasoconstriction.
PMCID: PMC3337932  PMID: 21559869
Cerebral blood flow; Humans; Aging; Ventilation; Exercise intensity; Cycling; Life Sciences; Molecular Medicine; Geriatrics/Gerontology; Cell Biology
3.  Quality of life after treatment of laryngeal carcinoma: a single centre cross-sectional study 
Laryngeal cancer treatment inherently affects life's most basic functions and significantly affects quality of life (QOL). We aimed to identify which aspects of QOL and which patients are most affected by the various treatment options.
The University of Washington Quality of Life (UW-QOL) questionnaire was administered to all patients with laryngeal cancer treated at a single institution over a seven-year period (2003–2010).
In total, 41 patients responded. All had been treated for squamous cell carcinoma of the larynx. Questionnaires were completed at a median of 18.5 months after treatment. The overall quality of life was 81.1/100 as assessed by the UW-QOL scale, with only 4.9% reporting ‘poor’ or worse QOL. Neither patient age nor time after treatment significantly affected any aspect of QOL. Patients undergoing primary radiotherapy reported the best QOL. Those undergoing chemoradiotherapy or combined surgical treatment and chemoradiotherapy reported the worst QOL, particularly in terms of social eating, taste and saliva production. Patients with a T stage ≥2 and those with nodal metastases reported a significantly worse QOL.
Overall, QOL in our patients was good. This study highlights the aspects of QOL most affected by various treatments for laryngeal cancer and identifies areas in which therapeutic intervention may be focused. It also provides information to guide clinicians when assisting patients to make informed decisions regarding treatment of their head and neck cancer.
PMCID: PMC3566683  PMID: 22041234
University Washington Quality of Life; Head and neck neoplasm
4.  Malignant peripheral nerve sheath tumour presenting as a pneumothorax 
The British Journal of Radiology  2011;84(1006):e197-e199.
Malignant peripheral nerve sheath tumours are rare and aggressive soft-tissue sarcomas of ectomesenchymal origin. These tumours commonly occur in patients with neurofibromatosis Type 1 with a cumulative lifetime risk of 10%. The vast majority of cases present with clinical evidence of a soft-tissue mass with or without features of nerve irritation and loss of function arising from the lesion of origin. The primary presentation of a malignant peripheral nerve sheath tumour with a pneumothorax in the absence of widespread metastatic disease in a patient with no medical or family history of neurofibromatosis has never been reported in the literature.
We present a unique case of a systemically well 34-year-old male who presented with clinical evidence of a right-sided pneumothorax. The chest radiograph identified the right-sided pneumothorax and revealed an apical pleural mass that was confirmed by intravenous contrast-enhanced CT of the thorax. The patient was referred for video-assisted thorascopic surgical pleurodesis and biopsy of the lesion. Histopathology analyses confirmed the diagnosis of malignant peripheral nerve sheath tumour.
To the best of our knowledge, no such case reports have been published in the literature. A diagnosis of malignant peripheral nerve sheath tumour should be considered as one of the rarer possibilities in patients presenting with pneumothoraces in association with apical pleural lesions.
PMCID: PMC3473769  PMID: 21933975
5.  Pediatric sciatic neuropathies 
Neurology  2011;76(11):976-980.
The incidence, cause, and prognosis of sciatic neuropathy in children is not well understood. We report our 30-year experience of 53 patients with pediatric sciatic neuropathies (SN).
Prospective review of the history, physical examination, electrophysiologic findings, and clinical course of children with SN.
The etiology of SN injury was varied and included trauma (13), iatrogenic causes (13) (8 orthopedic surgeries and 5 miscellaneous surgeries), prolonged extrinsic compression and immobilization (6), tumors (7), vascular (5), idiopathic and progressive (4), infantile and nonprogressive (2), and unknown, presumed postviral (3). Electrophysiologic studies demonstrated abnormalities in motor conduction studies of the peroneal nerve in 44/53 (83%) or tibial nerve in 35/51 (67%). Sensory conduction studies were abnormal in sural nerve in 34 of 43 cases (79%), and superficial peroneal nerves in 15/25 (60%). Needle EMG was abnormal in peroneal innervated muscles in all subjects, in tibial nerve innervated muscles in 43/51 (84%), and in the hamstrings in 18/29 (62%). Prognosis for recovery was variable and depended on the etiology and the severity of the nerve injury.
SN is an uncommon mononeuropathy in children. The causes of SN are varied in children compared to adults. Electrophysiologic studies in children may be limited by poor tolerance but play an important role in establishing the diagnosis.
PMCID: PMC3271574  PMID: 21403109
6.  Hypertensive chorioretinopathy with Elschnig spots in a 3-year-old child 
Eye  2011;25(3):394-395.
PMCID: PMC3178321  PMID: 21212802
7.  Potentiation of sensory responses in ventrobasal thalamus in vivo via selective modulation of mGlu1 receptors with a positive allosteric modulator 
Neuropharmacology  2012;62(4):1695-1699.
Metabotropic glutamate subtype 1 (mGlu1) receptor is thought to play a role in synaptic responses in thalamic relay nuclei. The aim of this study was to evaluate the positive allosteric modulator (PAM) Ro67-4853 as a tool to modulate thalamic mGlu1 receptors on single thalamic neurones in vivo. Ro67-4853, applied by iontophoresis onto ventrobasal thalamus neurones of urethane-anaesthetised rats, selectively enhanced responses to the agonist (S)-3,5-dihydroxy-phenylglycine (DHPG), an effect consistent with mGlu1 potentiation. The PAM was also able to enhance maintained responses to 10 Hz trains of sensory stimulation of the vibrissae, but had little effect on responses to single sensory stimuli. Thus Ro67-4853 appears to be a highly selective tool that can be useful in investigating how mGlu1 receptor potentiation can alter neural processing in vivo. Our results show the importance of mGlu1 in sensory processing and attention mechanisms at the thalamic level and suggest that positive modulation of mGlu1 receptors might be a useful mechanism for enhancing cognitive and attentional processes.
► We the studied effects of Ro67-4853, an mGlu1 PAM, on single thalamic cells in vivo. ► Ro67-4853 selectively potentiated responses to the agonist DHPG. ► Ro67-4853 potentiated sensory synaptic responses to repetitive vibrissa stimulation. ► Ro67-4853 is a selective tool to potentiate mGlu1-mediated neural processing in vivo. ► Positive modulation of mGlu1 may be a useful means to enhance cognition and attention.
PMCID: PMC3657174  PMID: 22178704
mGlu1 receptors; Ro67-4853; Thalamus; Cortico-thalamic; Sensory processing; Attention
8.  Impulsivity and cognitive distortions in pathological gamblers attending the UK National Problem Gambling Clinic: a preliminary report 
Psychological Medicine  2011;41(12):2625-2635.
Pathological gambling (PG) is a form of behavioural addiction that has been associated with elevated impulsivity and also cognitive distortions in the processing of chance, probability and skill. We sought to assess the relationship between the level of cognitive distortions and state and trait measures of impulsivity in treatment-seeking pathological gamblers.
Thirty pathological gamblers attending the National Problem Gambling Clinic, the first National Health Service clinic for gambling problems in the UK, were compared with 30 healthy controls in a case-control design. Cognitive distortions were assessed using the Gambling-Related Cognitions Scale (GRCS). Trait impulsivity was assessed using the UPPS-P, which includes scales of urgency, the tendency to be impulsive in positive or negative mood states. Delay discounting rates were taken as a state measure of impulsive choice.
Pathological gamblers had elevated impulsivity on several UPPS-P subscales but effect sizes were largest (Cohen's d>1.4) for positive and negative urgency. The pathological gamblers also displayed higher levels of gambling distortions, and elevated preference for immediate rewards, compared to controls. Within the pathological gamblers, there was a strong relationship between the preference for immediate rewards and the level of cognitive distortions (R2=0.41).
Impulsive choice in the gamblers was correlated with the level of gambling distortions, and we hypothesize that an impulsive decision-making style may increase the acceptance of erroneous beliefs during gambling play.
PMCID: PMC3206226  PMID: 21733207
Behavioural addiction; decision making; delay discounting; problem gambling; risk taking
9.  Changes in very older person admissions to an ICU over a decade 
Critical Care  2011;15(Suppl 1):P468.
PMCID: PMC3068397
10.  Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment 
European Addiction Research  2010;16(2):99-107.
Little comparable information is available regarding clinical characteristics of opioid-dependent women from different countries. In the present study, women from the USA, Canada and a Central European country, Austria, screened for participation in the Maternal Opioid Treatment Human Experimental Research study, were compared with respect to their demographic and addiction histories.
Pregnant women (n = 1,074) were screened for study participation using uniformed clinical criteria and instruments. The screening results were compared with regard to exclusion, demographics, drug use, and psychosocial and treatment histories.
Compared to the screened US and Canadian women, Austrian women were more likely to be younger (p < 0.001), white (p < 0.001), had significantly lower levels of educational attainment (p < 0.001), were less likely to use opioids daily (p < 0.001) and more likely to have been prescribed buprenorphine (p < 0.001). Compared to both rural and urban US groups, the Austrian group was less likely to have legal issues (p < 0.001) and was younger when first prescribed agonist medication (p < 0.001).
The differences between North American and European groups may offer unique insights concerning treatment and pregnancy outcomes for opioid-dependent pregnant women.
PMCID: PMC2917735  PMID: 20160444
Pregnancy; Opioid dependence; Methadone; Buprenorphine
11.  Addiction Severity Index Composite Scores as Predictors for Sexual-Risk Behaviors and Drug-Use Behaviors in Drug-Dependent Pregnant Patients 
HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations.
Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women.
Pregnant women (N=76) completing pretreatment ASI and HIV-risk questionnaires.
The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p<.001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps<.05.
Conclusions and Scientific Significance
Pregnant drug-dependent women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.
PMCID: PMC2925399  PMID: 20141393
substance abuse; pregnancy; sexual behavior; HIV; drug addiction
12.  Home‐based versus clinic‐based self‐sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial 
Sexually Transmitted Infections  2007;83(7):552-557.
To test whether more women are screened for sexually transmitted infections when offered home‐based versus clinic‐based testing and to evaluate the feasibility and acceptability of self‐sampling and self‐testing in home and clinic settings in a resource‐poor community.
Women aged 14–25 were randomised to receive a home kit with a pre‐paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self‐collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self‐tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrolment on sociodemographic and sexual history, and at the 6‐week follow‐up on feasibility and acceptability.
626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6‐week follow‐up visit. Forty‐seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea.
Self‐sampling and self‐testing are feasible and acceptable options in low‐income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.
PMCID: PMC2598654  PMID: 17901084
13.  Hypnotherapy for non‐cardiac chest pain: long‐term follow‐up 
Gut  2007;56(11):1643.
PMCID: PMC2095665  PMID: 17938446
non‐cardiac chest pain; hypnotherapy
14.  The cosmopolitan maternal heritage of the Thoroughbred racehorse breed shows a significant contribution from British and Irish native mares 
Biology Letters  2010;7(2):316-320.
The paternal origins of Thoroughbred racehorses trace back to a handful of Middle Eastern stallions, imported to the British Isles during the seventeenth century. Yet, few details of the foundation mares were recorded, in many cases not even their names (several different maternal lineages trace back to ‘A Royal Mare’). This has fuelled intense speculation over their origins. We examined mitochondrial DNA from 1929 horses to determine the origin of Thoroughbred foundation mares. There is no evidence to support exclusive Arab maternal origins as some historical records have suggested, or a significant importation of Oriental mares (the term used in historic records to refer to Middle East and western Asian breeds including Arab, Akhal-Teke, Barb and Caspian). Instead, we show that Thoroughbred foundation mares had a cosmopolitan European heritage with a far greater contribution from British and Irish Native mares than previously recognized.
PMCID: PMC3061175  PMID: 20926431
Thoroughbred horse; foundation of breed; maternal origins; phylogenetics; mitochondrial DNA
15.  Smoking in Pregnant Women Screened for an Opioid Agonist Medication Study Compared to Related Pregnant and Non-Pregnant Patient Samples 
Little is known about the prevalence and severity of smoking in pregnant opioid dependent patients.
To first characterize the prevalence and severity of smoking in pregnant patients screened for a randomized controlled trial, MOTHER (Maternal Opioid Treatment: Human Experimental Research), comparing two agonist medications; and second, to compare the MOTHER screening sample to published samples of other pregnant and/or substance use disordered patients.
Pregnant women (N=108) screened for entry into an agonist medication comparison study were retrospectively compared on smoking variables to samples of pregnant methadone-maintained patients (N=50), pregnant opioid or cocaine dependent patients (N =240), non-pregnant methadone-maintained women (N =75), and pregnant non-drug-addicted patients (N=1,516).
Of screened patients, 88% (n = 95) smoked for a mean of 140 months (SD=79.0) starting at a mean age of 14 (SD=3.5). This rate was similar to substance use disordered patients and significantly higher compared to general pregnant patients (88% v. 22%, p < .001).
Conclusion and Scientific Significance
Aggressive efforts are needed to reduce/eliminate smoking in substance-abusing pregnant women.
PMCID: PMC2925409  PMID: 20180667
pregnancy; substance abuse; pharmacologic treatment; opioid dependence; methadone; buprenorphine
16.  Prevalence, distribution and correlates of endocervical human papillomavirus types in Brazilian women 
We determined the prevalence, distribution and correlates of human papillomavirus (HPV) types in 386 mixed-income, sexually active women in São Paulo, Brazil. Endocervical samples were tested for HPV DNA with L1 primers MY09 and MY11; negative and indeterminate samples were retested using GP 5+/6+ consensus primers. HPV was detected in 35% of all women; high-risk/probable high-risk types in 20%; low-risk types in 7%; and an indeterminate type in 10%. Twenty-five HPV types were found overall: 17 (probable) high-risk types and eight low-risk types. Approximately one-third (29%) of women with HPV infection were positive for type 16 or 18 and 36% were positive for types 6, 11, 16 or 18. The presence of (probable) high-risk HPV was associated with younger age, more lifetime sex partners and abnormal vaginal flora. Additional studies mapping the distribution of HPV types worldwide are necessary to prepare for vaccination programmes and direct future vaccine development.
PMCID: PMC2847515  PMID: 20089995
Brazil; human papillomavirus; HPV type; sexually transmitted infections
17.  Agrobacterium-mediated transformation of durum wheat (Triticum turgidum L. var. durum cv Stewart) with improved efficiency 
Journal of Experimental Botany  2010;61(6):1567-1581.
An efficient Agrobacterium-mediated durum wheat transformation system has been developed for the production of 121 independent transgenic lines. This improved system used Agrobacterium strain AGL1 containing the superbinary pGreen/pSoup vector system and durum wheat cv Stewart as the recipient plant. Acetosyringone at 400 μM was added to both the inoculation and cultivation medium, and picloram at 10 mg l−1 and 2 mg l−1 was used in the cultivation and induction medium, respectively. Compared with 200 μM in the inoculation and cultivation media, the increased acetosyringone concentration led to significantly higher GUS (β-glucuronidase) transient expression and T-DNA delivery efficiency. However, no evident effects of acetosyringone concentration on regeneration frequency were observed. The higher acetosyringone concentration led to an improvement in average final transformation efficiency from 4.7% to 6.3%. Furthermore, the concentration of picloram in the co-cultivation medium had significant effects on callus induction and regeneration. Compared with 2 mg l−1 picloram in the co-cultivation medium, increasing the concentration to 10 mg l−1 picloram resulted in improved final transformation frequency from 2.8% to 6.3%, with the highest frequency of 12.3% reached in one particular experiment, although statistical analysis showed that this difference in final transformation efficiency had a low level of significance. Stable integration of foreign genes, their expression, and inheritance were confirmed by Southern blot analyses, GUS assay, and genetic analysis. Analysis of T1 progeny showed that, of the 31 transgenic lines randomly selected, nearly one-third had a segregation ratio of 3:1, while the remainder had ratios typical of two or three independently segregating loci.
PMCID: PMC2852660  PMID: 20202997
Acetosyringone; Agrobacterium tumefaciens; durum wheat cv Stewart; picloram; transformation
18.  Analysis of critical care referrals 
Critical Care  2010;14(Suppl 1):P469.
PMCID: PMC2934354
19.  Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? 
British Journal of Sports Medicine  2006;40(11):935-939.
To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis.
Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre‐procedure and post‐procedure.
There was significant reduction in VAS pain score between pre‐procedure and 10 months post‐procedure when it had a median (IQR) of 1.00 (1–1.75), range 0–7. The median (IQR) Nirschl score, which at pre‐procedure was 6.00 (5–7), range 4–7, had decreased at 4 weeks to 4.00 (2.25–5), range 2–7, and at 10 months to 1.00 (1–1.75), range 0–7, revealing a significant decrease (z = 3.763, p<0.001). The hypo‐echoic change in the flexor tendon significantly decreased between pre‐procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre‐procedure, when there was a mean (SD) of 6.10 (1.62), range 4–9, and at 10 months, when it was 3.60 (2.56), range 0–9 (p<0.001).
The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.
PMCID: PMC2465032  PMID: 16990441
autologous blood; medial epicondylitis; treatment; ultrasound
20.  Treatment of non‐cardiac chest pain: a controlled trial of hypnotherapy 
Gut  2006;55(10):1403-1408.
Non‐cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting.
This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina‐like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory.
Patients and methods
Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication.
Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores.
Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.
PMCID: PMC1856426  PMID: 16627548
hypnosis; non‐cardiac chest pain
21.  Treatment of Opioid Dependent Pregnant Women: Clinical and Research Issues 
This paper addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance is provided to aid clinical decision-making, based on both research evidence and the collective clinical experience of the authors which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project. MOTHER is a double-blind, double-dummy, flexible–dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the opioid dependence treatment among pregnant women and their neonates. The paper begins with a discussion of appropriate assessment during pregnancy, and then addresses clinical management stages, including maintenance medication selection, induction and stabilization, opioid agonist medication management before, during and after delivery, pain management, breast-feeding, and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed.
PMCID: PMC2633026  PMID: 18248941
pregnancy; substance abuse; pharmacologic treatment; opioid dependence; methadone; buprenorphine
22.  Detailed Analysis of the Expression of an Alpha-gliadin Promoter and the Deposition of Alpha-gliadin Protein During Wheat Grain Development 
Annals of Botany  2008;102(3):331-342.
Background and Aims
Alpha-gliadin proteins are important for the industrial quality of bread wheat flour, but they also contain many epitopes that can trigger celiac (cœliac) disease (CD). The B-genome-encoded α-gliadin genes, however, contain very few epitopes. Controlling α-gliadin gene expression in wheat requires knowledge on the processes of expression and deposition of α-gliadin protein during wheat grain development.
A 592-bp fragment of the promotor of a B-genome-encoded α-gliadin gene driving the expression of a GUS reporter gene was transformed into wheat. A large number of transgenic lines were used for data collection. GUS staining was used to determine GUS expression during wheat kernel development, and immunogold labelling and tissue printing followed by staining with an α-gliadin-specific antibody was used to detect α-gliadin protein deposited in developing wheat kernels. The promoter sequence was screened for regulatory motifs and compared to other available α-gliadin promoter sequences.
Key Results
GUS expression was detected primarily in the cells of the starchy endosperm, notably in the subaleurone layer but also in the aleurone layer. The α-gliadin promoter was active from 11 days after anthesis (DAA) until maturity, with an expression similar to that of a 326-bp low molecular weight (LMW) subunit gene promoter reported previously. An α-gliadin-specific antibody detected α-gliadin protein in protein bodies in the starchy endosperm and in the subaleurone layer but, in contrast to the promoter activity, no α-gliadin was detected in the aleurone cell layer. Sequence comparison showed differences in regulatory elements between the promoters of α-gliadin genes originating from different genomes (A and B) of bread wheat both in the region used here and upstream.
The results suggest that additional regulator elements upstream of the promoter region used may specifically repress expression in the aleurone cell layer. Observed differences in expression regulator motifs between the α-gliadin genes on the different genomes (A and B) of bread wheat leads to a better understanding how α-gliadin expression can be controlled.
PMCID: PMC2701793  PMID: 18621967
Alpha-gliadin; promoter; expression; deposition; wheat; Triticum aestivum; grain development

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