“The dust hasn't settled yet”: the National Q fever Management Program, missed opportunities for vaccination and community exposures

AIMS

To determine the proportion of notifiable cases of Q fever attributable to occupational and community exposures and to identify missed opportunities for Q fever vaccination in notifications of occupational exposures.

METHODS

A review of Q fever notifications to the BSPHU from January 2000 to September 2006 was undertaken. Notifications were categorised according to probable exposure source. Occupational exposures were further categorised according to reported past exposure to Q fever and Q fever vaccination status.

RESULTS

One hundred and ninety-one Q fever notifications were identified, with occupational exposure reported in 106 cases and community exposure reported in 69 cases. In the occupational exposures, 76 cases (71%) were not vaccinated, 15 (14%) reported past exposure to Q fever and eight reported vaccination prior to illness onset, but vaccination status could not be independently verified. Community acquired Q fever was most commonly attributed to living or working near a high-risk industry (26, 38%), incidental exposures such as farm visits, or attending sale yards (27, 39%).

CONCLUSIONS

Occupationally acquired cases of Q fever continue to be reported in significant numbers and opportunities for vaccination are being missed. There is an ongoing need to ensure that all employees in high-risk industries are screened and vaccinated. The proportion of community acquired notifications of Q fever has increased since the National Q fever Management Program started, commensurate with the decline in occupationally acquired cases. These proportions may be expected to change with the cessation of the program in Queensland in December 2006.

Optimization of a 12-hour TaqMan PCR-based method for detection of Salmonella bacteria in meat

We developed a 12-h Salmonella detection method, based on 8 h of preenrichment, followed by automated DNA extraction and a sensitive real-time PCR. The method was optimized to obtain the highest possible yield of cells and DNA. The growth of different Salmonella strains in various preenrichment media and the effects of adding growth-promoting and selective reagents were explored, taking into account their PCR compatibility. The effects of (i) analyzing larger volumes (1 to 5 ml) from preenriched samples and introducing wash steps prior to DNA extraction, (ii) regulating the amount of paramagnetic particles (increasing it from 60 to 90 microl) in the DNA extraction, (iii) eluting the DNA in reduced volumes (25 or 50 microl rather than 100 microl), and (iv) increasing the PCR template volume (from 5 to 20 microl) were investigated. After 8 h of preenrichment, buffered peptone water yielded the highest number of salmonellae. When analyzing minced meat samples, positive effects of increasing the initial sampling volume from 1 to 5 ml and increasing the amount of paramagnetic particles to 90 microl were observed. However, washing the pellet and eluting the DNA in reduced volumes (25 and 50 microl) had no positive effects and resulted in decreased reproducibility. Increasing the amount of PCR template DNA from 5 to 20 mul improved the threshold cycle value by approximately 2. The improved 12-h PCR method was successfully compared to a reference culture method with 100 minced meat and poultry samples, with a relative accuracy of 99%, a relative sensitivity of 98%, and a relative specificity of 100%.

Superposition of quantum and classical rotational motions in Sc2C2@C84 fullerite

The superposition of the quantum rotational motion (tunneling) of the encapsulated Sc(2)C(2) complex with the classical rotational motion of the surrounding C(84) molecule in a powder crystal of Sc(2)C(2)@C(84) fullerite is investigated by theory. Since the quantum rotor is dragged along by the C(84) molecule, any detection method which couples to the quantum rotor (in casu the C(2) bond of the Sc(2)C(2) complex) also probes the thermally excited classical motion (uniaxial rotational diffusion and stochastic meroaxial jumps) of the surrounding fullerene. The dynamic rotation-rotation response functions in frequency space are obtained as convolutions of quantum and classical dynamic correlation functions. The corresponding Raman scattering laws are derived, and the overall shape of the spectra and the width of the resonance lines are studied as functions of temperature. The results of the theory are confronted with experimental low-frequency Raman spectra on powder crystals of Sc(2)C(2)@C(84) [M. Krause et al., Phys. Rev. Lett. 93, 137403 (2004)]. The agreement of theory with experiment is very satisfactory in a broad temperature range.

Eile mit Weile

Ein 36-jähriger Portugiese wurde wegen eines diffusen Krankheitsgefühls, eines Gewichtsverlusts von 25 kg im letzten halben Jahr sowie wegen Nachtschweißes auf Zuweisung eines Hausarztes bei uns im Spital abgeklärt. Im CT des Thorax und Abdomens fand sich nebst einer bis nach retrosternal reichenden Struma eine Raumforderung im vorderen oberen Mediastinum. Gleichzeitig wurde die Diagnose einer Hyperthyreose vom Typ eines Morbus Basedow gestellt. Diese wurde mittels Carbimazol thyreostatisch behandelt. Aufgrund der unklaren Dignität wurde die Raumforderung im vorderen oberen Mediastinum thorakoskopisch entfernt. Histologisch handelte es sich um eine Thymushyperplasie mit Begleitthymitis ohne Zeichen der Malignität. Die Assoziation von Morbus Basedow und Thymushyperplasie ist in der Literatur beschrieben, bei Internisten und auch Endokrinologen jedoch wenig bekannt. Die Thymushyperplasie ist unter thyreostatischer Therapie regredient. Rückblickend hätten wir bei unserem Patienten auf die Thymektomie verzichten sollen.

Defining the transcriptional redundancy of early bodywall muscle development in C. elegans: evidence for a unified theory of animal muscle development

Myogenic regulatory factors (MRFs) are required for mammalian skeletal myogenesis. In contrast, bodywall muscle is readily detectable in Caenorhabditis elegans embryos lacking activity of the lone MRF ortholog HLH-1, indicating that additional myogenic factors must function in the nematode. We find that two additional C. elegans proteins, UNC-120/SRF and HND-1/HAND, can convert naïve blastomeres to muscle when overproduced ectopically in the embryo. In addition, we have used genetic null mutants to demonstrate that both of these factors act in concert with HLH-1 to regulate myogenesis. Loss of all three factors results in embryos that lack detectable bodywall muscle differentiation, identifying this trio as a set that is both necessary and sufficient for bodywall myogenesis in C. elegans. In mammals, SRF and HAND play prominent roles in regulating smooth and cardiac muscle development. That C. elegans bodywall muscle development is dependent on transcription factors that are associated with all three types of mammalian muscle supports a theory that all animal muscle types are derived from a common ancestral contractile cell type.

[The term breech trial: the rise and fall of a randomized controlled trial--a critical survey]

Six years after publication of the results of the first international randomized controlled trial with the main question which mode of delivery is the best for term breech babies, there are increasing concerns about the validity of the study data concluding caesarean delivery was safer for breech babies. In January 2006 published article in the American Journal of Obstetrics and Gynecology the data of the study has been analysed again. The author comes to the conclusion that because of mistakes in the study design the results are unreliable and that the study group should withdraw the recommendations. Furthermore in his article he quotes from the study and emphasizes the mistakes.

Comparative, collaborative, and on-site validation of a TaqMan PCR method as a tool for certified production of fresh, campylobacter-free chickens

Certified Campylobacter-free poultry products have been produced in Denmark since 2002, the first example of fresh (unprocessed and nonfrozen) chickens labeled "Campylobacter free." This success occurred partly through use of a 4-hour gel-based PCR testing scheme on fecal swabs. In this study, a faster, real-time PCR approach was validated in comparative and collaborative trials, based on recommendations from the Nordic system for validation of alternative microbiological methods (NordVal). The comparative real-time PCR trial was performed in comparison to two reference culture protocols on naturally contaminated samples (99 shoe covers, 101 cloacal swabs, 102 neck skins from abattoirs, and 100 retail neck skins). Culturing included enrichment in both Bolton and Preston broths followed by isolation on Preston agar and mCCDA. In one or both culture protocols, 169 samples were identified as positive. The comparative trial resulted in relative accuracy, sensitivity, and specificity of 98%, 95%, and 97%, respectively. The collaborative trial included nine laboratories testing neck skin, cloacal swab, and shoe cover samples, spiked with low, medium, and high concentrations of Campylobacter jejuni. Valid results were obtained from six of the participating laboratories. Accuracy for high levels was 100% for neck skin and cloacal swab samples. For low levels, accuracy was 100% and 92% for neck skin and cloacal swab samples, respectively; however, detection in shoe cover samples failed. A second collaborative trial, with an optimized DNA extraction procedure, gave 100% accuracy results for all three spiking levels. Finally, on-site validation at the abattoir on a flock basis was performed on 400 samples. Real-time PCR correctly identified 10 of 20 flocks as positive; thus, the method fulfilled the NordVal validation criteria and has since been implemented at a major abattoir.

Controlled study of mold growth and cleaning procedure on treated and untreated wet gypsum wallboard in an indoor environment

The basis for some common gypsum wallboard mold remediation practices was examined. The bottom inch of several gypsum wallboard panels was immersed in bottled drinking water; some panels were coated and others were untreated. The panels were examined and tested for a period of 8 weeks. This study investigated: (a) whether mold growth, detectable visually or with tape lift samples, occurs within 1 week on wet gypsum wallboard; (b) the types, timing, and extent of mold growth on wet gypsum wallboard; (c) whether mold growth is present on gypsum wallboard surfaces 6 inches from visible mold growth; (d) whether some commonly used surface treatments affect the timing of occurrence and rate of mold growth; and (e) if moldy but dried gypsum wallboard can be cleaned with simple methods and then sealed with common surface treatments so that residual mold particles are undetectable with typical surface sampling techniques. Mold growth was not detected visually or with tape lift samples after 1 week on any of the wallboard panels, regardless of treatment, well beyond the 24-48 hours often mentioned as the incubation period. Growth was detected at 2 weeks on untreated gypsum. Penicillium, Cladosporium, and Acremonium were early colonizers of untreated panels. Aspergillus, Epicoccum, Alternaria, and Ulocladium appeared later. Stachybotrys was not found. Mold growth was not detected more than 6 inches beyond the margin of visible mold growth, suggesting that recommendations to remove gypsum wallboard more than 1 foot beyond visible mold are excessive. The surface treatments resulted in delayed mold growth and reduced the area of mold growth compared with untreated gypsum wallboard. Results showed that simple cleaning of moldy gypsum wallboard was possible to the extent that mold particles beyond "normal trapping" were not found on tape lift samples. Thus, cleaning is an option in some situations where removal is not feasible or desirable. In cases where conditions are not similar to those of this study, or where large areas may be affected, a sample area could be cleaned and tested to verify that the cleaning technique is sufficient to reduce levels to background or normal trapping. These results are generally in agreement with laboratory studies of mold growth on, and cleaning of, gypsum wallboard.

siRNA-mediated AML1/MTG8 depletion affects differentiation and proliferation-associated gene expression in t(8;21)-positive cell lines and primary AML blasts

The chromosomal translocation t(8;21) is associated with 10-15% of all cases of acute myeloid leukaemia (AML). The resultant fusion protein AML1/MTG8 interferes with haematopoietic gene expression and is an important regulator of leukaemogenesis. We studied the effects of small interfering RNA (siRNA)-mediated AML1/MTG8 depletion on global gene expression in t(8;21)-positive leukaemic cell lines and in primary AML blasts using cDNA arrays, oligonucleotide arrays and real-time reverse transcription-polymerase chain reaction (RT-PCR). Suppression of AML1/MTG8 results in the increased expression of genes associated with myeloid differentiation, such as AZU1, BPI, CTSG, LYZ and RNASE2 as well as of antiproliferative genes such as IGFBP7, MS4A3 and SLA both in blasts and in cell lines. Furthermore, expression levels of several genes affiliated with drug resistance or indicative of poor prognosis AML (BAALC, CD34, PRG2, TSPAN7) are affected by AML1/MTG8 depletion. In conclusion, siRNA-mediated suppression of AML1/MTG8 cause very similar changes in gene expression pattern in t(8;21)-positive cell lines and in primary AML blasts. Furthermore, the results suggest that the specific targeting of AML1/MTG8 function may be a promising approach for complementing existing treatment strategies.

Expression profiling of Wilms tumors reveals new candidate genes for different clinical parameters

Wilms tumor is the most frequent renal neoplasm in children, but our understanding of its genetic basis is still limited. We performed cDNA microarray experiments using 63 primary Wilms tumors with the aim of detecting new candidate genes associated with malignancy grade and tumor progression. All tumors had received preoperative chemotherapy as mandated by the SIOP protocol, which sets this study apart from related approaches in the Unites States that are based on untreated samples. The stratification of expression data according to clinical criteria allowed a rather clear distinction between different subsets of Wilms tumors. Clear-cut differences in expression patterns were discovered between relapse-free as opposed to relapsed tumors and tumors with intermediate risk as opposed to high risk histology. Several differentially expressed genes, e.g.TRIM22, CENPF, MYCN, CTGF, RARRES3 and EZH2, were associated with Wilms tumor progression. For a subset of differentially expressed genes, microarray data were confirmed by real-time RT-PCR on the original set of tumors. Interestingly, we found the retinoic acid pathway to be deregulated at different levels in advanced tumors suggesting that treatment of these tumors with retinoic acid may represent a promising novel therapeutic approach.

Self-motion and the hippocampal spatial metric

Self-motion signals are sufficient for animal navigation ("path integration") and for updating hippocampal location-specific firing. The contributions of ambulatory, vestibular, and optic self-motion signals to CA1 unit activity and EEG were studied while rats either walked or drove a car between locations on a circular track (referred to as WALK and CAR, respectively) or experienced pseudomotion, in which the animal was stationary and the environment was rotated (WORLD). Fewer pyramidal cells expressed place fields during CAR and those that did exhibited substantially larger place fields. The number of theta cycles required to traverse a place field increased, whereas the slope of the theta phase of firing versus position function was reduced. The presence and/or location of place fields were not well correlated between conditions. These effects were even more accentuated during WORLD. These results are not explainable by a simple "smearing out" of place fields but, in terms of size of place fields relative to the track size, are comparable with what would be observed if the track circumference was reduced and the animal moved around it at a correspondingly slower speed. Theta (and its 14-18 Hz harmonic) power were dependent on velocity, but the gain of this function was substantially reduced during CAR and WORLD, again as if the rat were moving more slowly. The spatial scale over which the hippocampal population vector is updated appears to be derived primarily from the gain of a self-motion velocity signal with approximately equal components derived from ambulation, vestibular, and optic-flow signals.