Organ-selective growth in the offspring of protein-restricted mothers

Recent epidemiological studies in people whose birth weights were recorded many years ago suggest links between impaired growth during early life and the development of diseases, including diabetes, much later in life. The long-term effects of retarded early growth are proposed to result from malnutrition at critical periods of fetal or infant development leading to reduction in the growth of organs and permanent changes in their metabolism or structure, or both. In order to investigate this, a rat model was established which involved feeding either a diet containing 200 g protein/kg or an isoenergetic diet containing 80 g protein/kg to pregnant and lactating rats. In addition, cross-fostering techniques were employed which allowed a separate evaluation of the prenatal or the postnatal periods. The offspring were studied at 21 d of age or were weaned onto a normal laboratory chow and studied at 11 months of age. The 80 g protein/kg diet during pregnancy did not affect the overall reproductive although more subtle differences were evident. Permanent growth retardation was evident in offspring subjected to maternal protein restriction during the postnatal period. At 21 d of age the offspring of protein-restricted mothers exhibited selective changes in organ growth: compared with the body weight, the lung and brain experienced a smaller decrease in weight: the heart, kidney and thymus decreased proportionately: whereas, the pancreas, spleen, muscle and liver showed a greater reduction in weight. In older animals the muscle weight was lower in the male rats and the relative weight of pancreas was increased in the female rats.

Adequacy of cervical cytology sampling with the Cervex brush and the Aylesbury spatula: a population based randomised controlled trial

OBJECTIVE

To compare the adequacy of cervical cytology sampling with two sampling instruments commonly used in primary care-namely, the Aylesbury spatula and the Cervex brush.

DESIGN

Pair matched, population based randomised controlled trial.

SETTING

86 general practices and family planning clinics in Greater Manchester.

SUBJECTS

15 882 cervical smears taken from women aged 20-64 years as part of the national cervical screening programme.

INTERVENTIONS

Participating centres were allocated to sample with either the Cervex brush or the Aylesbury spatula.

MAIN OUTCOME MEASURE

Inadequate smear rate.

RESULTS

5.4% and 5.5% (433/8086 and 426/7796) of smears taken with the Cervex brush and the Aylesbury spatula respectively were reported as inadequate (odds ratio 0.95; 95% confidence interval 0.74 to 1.22).

CONCLUSION

The Cervex brush offers no advantage over the Aylesbury spatula in reducing inadequate smear rates in the primary care setting.

High-resolution genotyping elucidates the epidemiology of group A streptococcus outbreaks

Streptococcus pyogenes strains were genotyped by a combination of molecular methods for high- resolution epidemiologic studies of disease outbreaks. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of the emm gene is reported. Alone or in conjunction with other molecular techniques (16S ribotyping, pulsed-field gel electrophoresis, and detection of exotoxin genes), PCR-RFLP could differentiate outbreak-related strains from contemporaneous background strains of the same M serotype. Three outbreaks were studied: pharyngitis in a boarding school (serotype M5), cross-infection in a hospital burn unit (serotype M76), and severe invasive disease in two elderly care homes (serotype R28). It was possible, for example, to identify within serotype R28 a clone with particular potential for invasive disease. In all cases, the four molecular methods yielded complementary results that were hierarchically related. Strains could be assigned to the outbreak or the background in a precise, reproducible, and rapid manner.

Cervical smears--an opportunity for disinvestment?

BACKGROUND

The National Cervical Screening Programme was introduced to increase population coverage while reducing the overscreening of women at low risk.

AIM

To describe the frequency with which cervical smears are unnecessarily repeated within the prescribed screening interval.

METHOD

All cervical smears taken in a primary care setting in Manchester from women aged 20-64, during 1988-92, were identified. A smear was considered unscheduled if it was taken within 30 months of a preceding smear and if there was no clinical indication or laboratory recommendation for an early repeat smear.

RESULTS

A total of 100 134 smears were identified from 85 594 women attending 130 general practices and 40 NHS community clinics; 12 633 women subsequently had 14 702 unscheduled smears; 50% of the unscheduled smears were taken by 18% of the general practices and 8% of the NHS community clinics.

CONCLUSION

If they are replicated elsewhere, these findings suggest a substantial disinvestment opportunity.

Capillaria hepatica parasitism

Capillaria hepatica is rarely encountered in humans, with fewer than 30 documented cases. The clinico-pathological features of capillaria hepatica infection, diagnosed on liver biopsy of a 6-year-old child are discussed. Pathologically, it is characterised by prominent granulomatous lesions in the liver surrounding the eggs, which on cursory examination may be confused with Schistosoma mansoni.

Fluorescent location of cells of cytological interest in cervical smears prestained with thionin

Cervical cells of cytological interest were located in conventional smears, treated with thionin for quantitative DNA staining by subsequent treatment with fluorescent probes for a cell surface protease. Normal mature cervical epithelial cells failed to bind these fluorescent probes whilst metaplastic cells, glandular cells, and dyskaryotic cells were readily located. By this means, the nuclear staining of these fluorescent cells of cyotological interest enabled them to be classified by a cytologist.

Molecular subtyping of prevalent M serotypes of Streptococcus pyogenes causing invasive disease

Reproducible methodologies and a scheme for high-resolution genotyping of Streptococcus pyogenes were defined with respect to a study of six predominant M serotypes causing invasive group A streptococcal disease in the United Kingdom. Serotype reference strains were compared with nine clinical isolates of each serotype from patients with diseases such as pneumonia, puerperal sepsis, toxic shock-like-syndrome, cellulitis, or necrotizing fasciitis. Four enzymes were evaluated for their discriminatory power in 16S rRNA gene-specific ribotyping. Discriminatory power was greatest with EcoRI, which generated serotype-specific ribotypes, and with SacI, which could subdivide strains of the same M serotype. Twenty-five combined ribotypes were found among the 60 strains, and the indices of discriminatory power (D values) of this method varied from 0.51 within serotype M1 to 0.98 within strains of serotype M5. Macrorestriction with the rarely cutting endonuclease SmaI and pulsed-field gel electrophoresis gave D values varying from 0.37 within serotype M1 to the maximal 1.0 within serotype M5. Comparison of macrorestriction profiles revealed various degrees of genetic heterogeneity within M serotypes. Strains of M1, M3, M6, and M11 exhibited clonally related macrorestriction profiles, while those of R28 and M5 strains were consistent with polyphyletic origin.

Clinical benefit from nebulized human recombinant DNase in Kartagener's syndrome

Nebulized recombinant human DNase (rhDNase) reduces sputum viscosity, improves pulmonary function, and results in a small reduction in acute respiratory exacerbations requiring intravenous antibiotics in many patients with cystic fibrosis (CF). rhDNase is now recommended for use in CF patients with moderately severe suppurative lung disease. A 14-year-old girl with suppurative lung disease [forced expiratory volume in 1 second (FEV1) 69% and forced vital capacity (FVC) 81% predicted] secondary to Kartagener's syndrome and severe gastroesophageal reflux had worsening spirometry together with intractable gastrointestinal symptoms over the previous 18 months despite conventional treatment. She was, therefore, started on 2.5 mg rhDNase once daily. Her cough lessened and the volume of sputum decreased within 72 hours of commencement of treatment; this improvement was strongly associated with a dramatic reduction in gastrointestinal symptoms. Spirometry after 4 weeks of treatment demonstrated a 20% improvement in FEV1 and a 13% improvement in FVC. These improvements have been maintained after 4 months of rhDNase therapy. The use of rhDNase should be considered in patients with Kartagener's syndrome and a multicenter trial may be justified.

Histomorphometric and biochemical characterization of bone following acute severe burns in children

Severe burns in adults is associated with an uncoupling of normal remodeling, low bone formation without reduced resorption. The risk of osteopenia that may occur under such circumstances is heightened by our detection in a cross-sectional study of low bone mass in severely burned children. We report here the acute histomorphometric and biochemical response of bone to severe burn injury, as well as bone mass in severely burned children. We enrolled 24 patients ages 5.8 to 17.5 years following burns of 63 +/- 16% (SD) body surface area. Serum and urine were collected weekly until iliac crest bone biopsy was obtained 26 +/- 10 days postburn. Seventeen of 18 patients, including 5 patients receiving growth hormone treatment to accelerate wound healing, failed to take up doxycycline in trabecular bone, and had no detectable osteoblasts at the osteoid seam, while eroded surface was normal and osteoblasts were documented by staining. Thus, bone formation was virtually absent. There was an eightfold elevation in urinary free cortisol excretion and high serum levels of acute phase reactants and interleukin-1 beta and -6. Biochemical markers of bone formation, osteocalcin, and type I procollagen propeptide were low, as were resorptive markers urinary pyridinoline and deoxypyridinoline. However, there was no correlation with resorptive surface. Mean age-related z-score for bone mass was -1.06 +/- 1.05, 40 days postburn. Immobilization and endogenous corticosteroid production may be the main factors responsible for acutely reduced bone formation while inflammatory cytokines may mediate resorption.

Correlation of cell surface fluorescence with conventional PAP analysis of cells of cytological interest obtained from cervical scrapes

Archival PAP stained cervical smears were destained and treated with a fluorescent probe for a cell surface enzyme (GB). Cells which exhibited cell surface fluorescence were demonstrated to be cells of cytological interest in the analysis of cervical smears. These cells could be directly related to PAP and reclassified by subsequent restaining with PAP. Fluorescent cell surface technology was shown to be compatible with conventional PAP staining.

Large myofascial fibromatosis involving the shoulder girdle

An 11 year old girl presented with gradually increasing swelling over left scapular region and limitation of movements. On examination, a mass with firm to hard consistency was found fixed to the scapula. Clinical diagnosis of fibromatosis was confirmed by needle biopsy. Radical excision of the tumor was carried out and the resultant large exposed area was covered by transpositional rotation of trapezius myocutaneous flap. Microscopic examination of excised tumor revealed spindle shaped elongated cells in the form of whorls and trabeculae. The post operative course of the patient was uneventful with no evidence of recurrence at the end of 22 months.

Flagellin gene profiling of Helicobacter pylori infecting symptomatic and asymptomatic individuals

Diversity within and around the flagellin (fla) A gene of Helicobacter pylori was studied by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) analysis and genomic Southern blot hybridization profiling. Four distinct pattern types were identified by DdeI restriction analysis of the 1.5-kb flaA amplicon of 55 strains. Most strains (73%) had the same flaA RFLP type, but subtypic variation was evident in some strains. No consistent associations were observed for selected strain subsets between the DdeI flaA profiles and phenotype (motility and cytotoxicity), urease gene profile or patient symptomatology. A subset of seven (F-1 profile) and four (F-2 profile) strains with identical HindIII digest patterns provided further evidence that the flaA gene was relatively highly conserved within H. pylori. By contrast, the flaA gene blot hybridization profiles were more diverse and consistent with greater variation at restriction sites in adjacent regions of the genome. We conclude that analyses of polymorphisms within the flaA gene provide limited discrimination between strains of H. pylori. The flaA genomic blot profiles offer greater potential for molecular typing purposes, although no associations with other pathogenicity factors or disease symptoms could be deduced.

Molecular typing of Helicobacter pylori isolates from asymptomatic, ulcer and gastritis patients by urease gene polymorphism

The gastric-adapted bacterium Helicobacter pylori plays an important role in gastritis and ulcer disease, but no phenotypic typing scheme presently exists for this organism. With a view to the development of genotypic typing, we have compared isolates of H. pylori from gastritis or ulcer patients with those from subjects exhibiting no disease. Variation was analysed at the urease genes, ureA and ureCD, by employing PCR-generated probes in genomic Southern blot hybridizations. Whilst ureA restriction fragments provided a fourfold subgrouping of strains, ureCD fragments were considerably more discriminatory. Twenty-four combined ureACD profiles were generated with Hind III, subdividing the 64 strains into 11 types and 13 single profiles. The most prevalent profile (UI) was found in 33% of strains, almost all from gastritis or ulcer patients. On the other hand strains isolated from asymptomatic individuals had the most diverse ureACD profiles. A key finding from this set of isolates was that strains of H. pylori associated with general gastroduodenal disease were genetically more homogeneous than strains carried by people without disease symptoms.

Anaerobic digestion of a mixture of cheese whey, poultry waste and cattle dung: a study of the use of adsorbents to improve digester performance

This paper-describes the results of a study aimed at improving the efficiency of anaerobic digestion of a mixture of cattle dung, poultry waste and cheese whey at a ratio of 2 : 1 : 3 (w/w on dry weight basis) in terms of total gas production, methane content and process stability by adding various adsorbents. The adsorbents appeared to improve the digester performance, for example about a two-fold enhancement in total gas production with 17% enriched methane content were achieved with the addition of 4 g litre(-1) of silica gel.

Effect of temperature and retention time on biomethanation of cheese whey-poultry waste-cattle dung

Various conditions, such as temperature, total solid content, cattle dung-poultry waste-cheese whey ratio, retention time and stirring, were optimized with an ultimate aim of improving anaerobic digestion. Maximum gas production (2.2 litres litre(-1) of digester day(-1)) with enriched methane content (62% CH(4)) was found with a retention time of 10 days, having a loading rate of 6.0 g total solid litre(-1) of digester day(-1) at 40 degrees C, and total solid of 6% (w/v) using a mixture of cattle dung, poultry waste and cheese whey in the ratio of 2:1:3 (w/w).

Genetic diversity of Helicobacter pylori indexed with respect to clinical symptomatology, using a 16S rRNA and a species-specific DNA probe

DNA probes are described which identify group and fingerprint strains of the human gastric pathogen Helicobacter pylori, on the basis of well-defined band homologies. A 544 bp internal fragment of the 16S ribosomal RNA gene was generated by polymerase chain reaction (PCR) with primers derived from the Escherichia coli rRNA gene sequence. In genomic Southern blots this probe detected restriction site variation around these loci, generating simple but strain-specific molecular fingerprints. A small conserved chromosomal fragment of 1.2 kbp, Hps, species-specific for H. pylori, was obtained by cloning random HindIII fragments into pUC19. It was useful for dot-blot identification, and also separated isolates into one major and two minor groups. When results for these two probes were combined, a baseline characterization of genotype was obtained. A band-matching database of molecular fingerprints for the type strain and 63 clinical isolates of H. pylori from asymptomatic, ulcer and gastritis contexts is presented. No significant association between the genotypes at this level of definition and the associated clinical symptomatology of the isolates was detected.

Molecular typing of thermotolerant species of Campylobacter with ribosomal RNA gene patterns

Ribosomal RNA gene restriction patterns (ribopatterns) of 72 strains representing Campylobacter jejuni (subspecies jejuni and doylei), C. coli, C. upsaliensis and C. lari including the urealytic (UPTC) biovar were determined using four common restriction endonucleases (HaeIII, HindIII, PstI and PvuII). The relative effectiveness of these enzymes for general molecular typing of the thermotolerant campylobacters was assessed. Ribotypes (HaeIII) were defined on the basis of computer-assisted numerical analysis. For C. jejuni, C. coli and C. lari, the HaeIII ribopatterns provided a high level of typability and discrimination, with patterns that were reproducible and easy to code for numerical analysis. There was evidence of diversity within three of the HaeIII types, and PstI ribopatterns proved the most reliable for detecting such differences. C. upsaliensis also could be ribotyped with HaeIII, but HindIII, PvuII and PstI were less satisfactory for this species. For such campylobacters, the HindIII ribopatterns generally were complex and difficult to compare, and the PvuII profiles provided the least discrimination. We conclude that the choice of restriction endonuclease is of critical importance when applying ribotyping to different species of Campylobacter. HaeIII ribopatterns were the most effective means of typing strains of different thermotolerant species of campylobacters and, when combined with PstI ribopatterns, offered a highly discriminatory basis for molecular typing.