Investigation of ticks and red blood cell parasites of a population of reintroduced mainland tammar wallabies (Notamacropus eugenii eugenii)

Ticks and blood smears were collected from a reintroduced population of threatened tammar wallabies (Notamacropus eugenii eugenii). Ixodes hirsti was common during autumn/winter, and Amblyomma spp. in spring/summer, reflecting the seasonal density of questing A. triguttatum triguttatum. Red blood cell parasites were not detected in the 90 smears analysed.

The influence of the introduction of national guidelines on preterm birth prevention practice: UK experience

Objective

To identify the current status of specialist preterm labour (PTL) clinics and identify changes in management trends over the last 5 years following release of the NICE preterm birth (PTB) guidance.

Design

Postal Survey of Clinical Practice.

Setting

UK.

Population

All consultant‐led obstetric units.

Methods

A questionnaire was sent by post to all 187 NHS consultant‐led obstetric units. Units with a specialist PTL clinic were asked to answer a further six questions defining their protocol for risk stratification and management.

Main outcome measures

Current practice in specialist PTL clinics. Changes in treatment trends over 5 years.

Results

Thirty‐three PTL prevention clinics were identified, with 73% running weekly. NHS staff (84%) have replaced university staff as the lead clinicians (from 69% in 2012 to 21% in 2017), suggesting this clinic has become increasingly integrated with standard care for women at the highest risk of PTB. There has been a large shift from nearly half of clinics offering cerclage as primary treatment for short cervix to offering more choice (30%) between at least two of cerclage, vaginal progesterone or pessary and combinations of primary treatments (18%), demonstrating more equipoise among clinicians regarding therapies for short cervix.

Conclusions

Over 5 years, there has been a 44% increase in the number of specialist PTL clinics in the UK. Although there is a better consensus over the target high‐risk population, there is increasing heterogeneity among first‐line treatments for short cervix.

Tweetable abstract

UK PTB prevention clinics have increased by 44% over 5 years, with increasing clinical equipoise to best Rx for short cervix.

UK PTB prevention clinics have increased by 44% over 5 years, with increasing clinical equipoise to best Rx for short cervix.

Screening and management of the small for gestational age fetus in the UK: A survey of practice

BACKGROUND

Antenatal detection of the small for gestational (SGA) fetus has become an important indicator of quality of antenatal care in the UK. This has been driven by a desire to reduce stillbirth in this at risk group.

METHODS

We conducted a postal survey of 187 NHS consultant units within the UK to determine what the current practice for the detection and subsequent management of the suspected SGA fetus was following the guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2013.

RESULTS

The survey was performed in 3 rounds between 2016 and 2017 with a response rate of 65%. 85% of units assessed risk factors for SGA at booking. 81% of units used a customized symphysis fundal height (SFH) chart to screen for SGA with 95% of them using a cut off of <10th centile to refer for ultrasound assessment. When ultrasound is used to detect SGA, 80% of units used estimated fetal weight (EFW), with 89% of these using a cut off of <10th centile to diagnose SGA. Umbilical artery (UA) Doppler monitoring was undertaken in 97% of management and 94% delivered after 37 weeks. Only 24% of units had a dedicated fetal growth clinic, whilst 48% of units were able to offer computerised CTG to monitor the SGA fetus.

CONCLUSIONS

Overall there is consistency in the screening methods for SGA (customised SFH charts) and identification of suspected SGA (SFH <10th centile, EFW <10th centile, UA monitoring and induction of labour at term). There was a low uptake of computerized CTG to monitor SGA babies and a low number of specialised fetal growth clinics.

Characterization of bauxite residue (red mud) for 235U, 238U, 232Th and 40K using neutron activation analysis and the radiation dose levels as modeled by MCNP

This study employs thermal and epithermal neutron activation analysis (NAA) to quantitatively and specifically determine absorption dose rates to various body parts from uranium, thorium and potassium. Specifically, a case study of bauxite residue (red mud) from an industrial facility was used to demonstrate the feasibility of the NAA approach for radiological safety assessment, using small sample sizes to ascertain the activities of ²³⁵U, ²³⁸U, ²³²Th and ⁴⁰K. This proof-of-concept was shown to produce reliable results and a similar approach could be used for quantitative assessment of other samples with possible radiological significance. ²³⁸U and ²³²Th were determined by epithermal and thermal neutron activation analysis, respectively. ²³⁵U was determined based on the known isotopic ratio of ²³⁸U/²³⁵U. ⁴⁰K was also determined using epithermal neutron activation analysis to measure total potassium content and then subtracting its isotopic contribution. Furthermore, the work demonstrates the application of Monte Carlo Neutral-Particle (MCNP) simulations to estimate the radiation dose from large quantities of red mud, to assure the safety of humans and the surrounding environment. Phantoms were employed to observe the dose distribution throughout the human body demonstrating radiation effects on each individual organ.

A Comparison of Outcomes in Patients with Infrapopliteal Disease Randomised to Vein Bypass or Plain Balloon Angioplasty in the Bypass vs. Angioplasty in Severe Ischaemia of the Leg (BASIL) Trial

OBJECTIVE

The aim was to compare outcomes in a subgroup of patients with infrapopliteal (IP) disease randomised to infrapopliteal vein bypass (VB) or plain balloon angioplasty (PBA) in the original BASIL trial.

METHODS

A comparison of outcomes from patients randomised to VB or PBA undergoing revascularisation for severe limb ischaemia (SLI) because of IP disease with or without femoropopliteal disease. Data were extracted from case report forms from the BASIL trial. The primary outcome was amputation free survival (AFS); secondary outcomes included overall survival (OS), 30 day mortality and morbidity, freedom from arterial re-intervention, immediate technical success, repeat and crossover interventions, length of hospital stay, and quality of revascularisation.

RESULTS

A total of 104 patients were identified in the BASIL study with IP disease, 56 randomised to IP VB, and 48 to IP PBA. Groups were similar at baseline except for more chronic kidney disease and non-steroidal anti-inflammatory drug use in the VB group, and more previous surgical arterial intervention and antihypertensive use in the PBA group. There were no statistically significant differences in AFS or OS; however, clinically important trends were apparent in favour of a VB first strategy. Patients allocated to VB demonstrated significantly quicker relief of rest pain when compared with PBA (p = .005), but no significant differences in improved tissue healing. Median length of index hospital admission was significantly greater in the VB than in the PBA group (18 vs. 10 days, p < .0001) but there was no difference between the two groups in median total hospital stay between randomisation and the primary endpoint (VB 43.5 vs. PBA 42 days).

CONCLUSIONS

Further randomised trials, like BASIL-2 and BEST-CLI, are required to determine whether patients with severe limb ischaemia who require IP revascularisation and who are suitable for VB should have bypass or endovascular intervention as their primary revascularisation procedure.

Diagnostic accuracy of individual antenatal tools for prediction of small-for-gestational age at birth

OBJECTIVE

To determine the accuracy of fetal and newborn growth charts for the prediction of small-for-gestational age (SGA) at birth (birth weight < 10^th centile).

METHODS

This was a prospective cohort study performed within a UK specialist fetal growth clinic. A total of 105 consecutive pregnant women referred for a suspected SGA fetus were included. All pregnancies were managed according to a standard protocol using estimated fetal weight (EFW) plotted on customized Gestation Related Optimal Weight (GROW) charts. The last antenatal estimates of EFW (according to charts of GROW, Hadlock et al. and Mikolajczyk et al.), abdominal circumference (AC) (according to charts of Hadlock et al., INTERGROWTH-21^st Project and Chitty et al.) or change in AC over time (calculated according to Pregnancy Outcome Prediction (POP) study) were compared against four birth-weight charts (GROW, INTERGROWTH-21^st , Mikolajczyk et al. and World Health Organization (WHO)). The ability of each antenatal test to predict adverse perinatal outcome (APO) was assessed.

RESULTS

Birth weight < 10^th centile was assigned in 62 (59%) neonates using the GROW chart, 57 (54%) using the Mikolajczyk et al. chart, 55 (52%) using the INTERGROWTH-21^st chart and 51 (49%) using the WHO chart. AC-Hadlock had the best negative likelihood ratio (range, 0.3-0.4) and sensitivity (range, 74%-82%) for predicting SGA as defined by all four postnatal birth-weight charts. AC-INTERGROWTH-21^st had the best positive likelihood ratio (range, 5.9-10.9) and specificity (94%-96%). For prediction of APO, AC-Hadlock and EFW-GROW had the best sensitivities (57% and 52%, respectively), whereas AC-POP had the best positive likelihood ratio (2.2) and specificity (88%). Antenatal prediction of APO increased to a sensitivity of 61% when AC-POP and EFW-GROW were combined; however, specificity was only 56%.

CONCLUSIONS

We have identified wide variation in the diagnostic accuracy of various antenatal tools for the prediction of both SGA and APO, dependent on the choice of chart. Suboptimal diagnostic accuracy of commonly used antenatal tests may lead to increasing medicalization without prevention of APO. Researchers should focus their attention on a combination of fetal biometry and biomarkers for better prediction of SGA and prevention of APO. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Retention and remobilization dynamics of fine particles and microorganisms in pastoral streams

Both microbial metabolism and pathogen retention and remobilization are dependent on downstream transport of fine particles, which migrate in a series of deposition and resuspension events. All fine particles, including clay minerals, particulate organic carbon, nutrients and microbes, are often considered to be transported similarly in the environment because of a lack of specific observations comparing their relative transport. We conducted a tracer injection study to compare the transport and retention of the fecal indicator bacterium Escherichia coli, synthetic inert fluorescent fine particles, and a dissolved conservative tracer. We found that the fluorescent fine particles and bacteria were transported similarly, with both having greater retention than the solute tracer. We used a stochastic model to evaluate in-stream retention and migration of the solute, fluorescent particles, and E. coli. The best-fit model parameters indicate that different stream reaches had varied retention characteristics, but always showed greater retention of fluorescent particles and E. coli compared to the solute tracer. Direct measurements within known retention areas after the injection showed that the majority of the fluorescent particles and E. coli were retained near the sediment-water interface in macrophyte stands or filtered within the top 3 cm of the streambed sediment. Both the tracer particles and E. coli were retained within these regions for multiple months following the injection experiment. The stochastic model properly captured the wide range of storage timescales and processes we observed in the stream. Our results demonstrate the importance of the streambed sediment and in-stream macrophytes as short- and long-term reservoirs for fine organic particles and microbes in streams.

Serum total hCGβ level is an independent prognostic factor in transitional cell carcinoma of the urothelial tract

Background:

Serum total human chorionic gonadotrophin β subunit (hCGβ) level might have prognostic value in urothelial transitional cell carcinoma (TCC) but has not been investigated for independence from other prognostic variables.

Methods:

We utilised a clinical database of patients receiving chemotherapy between 2005 and 2011 for urothelial TCC and an independent cohort of radical cystectomy patients for validation purposes. Prognostic variables were tested by univariate Kaplan–Meier analyses and log-rank tests. Statistically significant variables were then assessed by multivariate Cox regression. Total hCGβ level was dichotomised at < vs ⩾2 IU l⁻¹.

Results:

A total of 235 chemotherapy patients were eligible. For neoadjuvant chemotherapy, established prognostic factors including low ECOG performance status, normal haemoglobin, lower T stage and suitability for cisplatin-based chemotherapy were associated with favourable survival in univariate analyses. In addition, low hCGβ level was favourable when assessed either before (median survival not reached vs 1.86 years, P=0.001) or on completion of chemotherapy (4.27 vs 0.42 years, P=0.000002). This was confirmed in multivariate analyses and in patients receiving first- and second-line palliative chemotherapy, and in a radical cystectomy validation set.

Conclusions:

Serum total hCGβ level is an independent prognostic factor in patients receiving chemotherapy for urothelial TCC in both curative and palliative settings.

Efficacy of isavuconazole, voriconazole and fluconazole in temporarily neutropenic murine models of disseminated Candida tropicalis and Candida krusei

OBJECTIVES

The aim of this study was to assess the dose-response of isavuconazole, voriconazole and fluconazole in disseminated Candida tropicalis and Candida krusei infections.

METHODS

Mice were immunosuppressed using either one dose [temporarily neutropenic (TN)] or two doses [persistently neutropenic (PN)] of cyclophosphamide. Treatment was started 5 h after infection with oral isavuconazole (6, 15, 30, 60, 90, 120 or 150 mg/kg equivalent active compound), intravenous voriconazole (5, 20 or 40 mg/kg plus grapefruit gavage twice daily) or oral fluconazole (15, 50 or 150 mg/kg) all administered twice daily. Kidney burden was assessed for C. tropicalis, and kidney and brain burden for C. krusei.

RESULTS

Vehicle controls developed a non-lethal infection with high burdens in both models. In the TN models, isavuconazole, voriconazole and fluconazole (>50 mg/kg) reduced kidney burden compared with controls; >60 mg/kg isavuconazole and 50 mg/kg fluconazole were superior to alternative treatments (other than voriconazole 40 mg/kg). Isavuconazole (all doses) reduced brain burden (P<0.05) in the C. krusei model; fluconazole (all doses) and voriconazole (5 and 20 mg/kg) did not. In the C. krusei kidney burden model, isavuconazole 120 and 150 mg/kg and voriconazole 40 mg/kg were superior to controls and fluconazole. In the C. tropicalis model, PN isavuconazole (all doses), voriconazole (>5 mg/kg) and fluconazole (all doses) reduced kidney burden (P<0.05). Only isavuconazole (all doses) and 40 mg/kg voriconazole were effective against C. krusei in the brain, isavuconazole and voriconazole reduced tissue burden (P<0.05). Fluconazole had no significant effect on brain burden even at 150 mg/kg.

CONCLUSIONS

Isavuconazole significantly reduced kidney burden in mice infected with C. tropicalis and both kidney and brain burdens in mice infected with C. krusei. Isavuconazole was as effective as voriconazole and much more effective than fluconazole at reducing brain burden.

Participation in two phase II prophylactic HIV vaccine trials in the UK

There will be a continued imperative to recruit large numbers of healthy volunteers to early phase prophylactic HIV vaccine (PHV) trials. We studied mechanisms associated with participation in two related phase II PHV trials. The most cited reasons for volunteering were altruism and a personal connection to HIV. The most successful recruiting strategies targeted organisations dealing with HIV, health or social issues, or were directed to large audiences through the mass media. However, circulated emails and word of mouth were the most resource-effective approaches. Group discussions and the collection of a pool of potential volunteers were much less effective than one-to-one discussions and immediate screening after recruitment. We utilised our findings to devise key recommendations to assist PHV trial teams who are planning future studies.

Demography of a yellow-footed rock-wallaby Petrogale xanthopus colony in the threatened New South Wales sub-population

The remnant New South Wales (NSW) yellow-footed rock-wallaby (Petrogale xanthopus) population underwent a substantial decline between 1985 and 1992 and remained at dangerously low levels until 1995. To determine the processes underlying this decline, a population study was conducted at one colony, between winter 1995 and winter 1998. The colony was observed to remain relatively constant in size, consisting of between 12 or 13 individuals throughout the study. Reproductive rates were found to be relatively high. Both reproduction and pouch young survival were comparable with those reported for other P. xanthopus colonies, while adult survival rates were higher than those noted in other studies. Because population size remained constant during the study and adult survivorship was consistently high, this suggested that juvenile recruitment into the colony was low. Such low levels of recruitment may have had a substantive role in the slow decline of the entire NSW P. xanthopus population. The results of this study suggest that any management actions undertaken in the NSW P. xanthopus population should focus on increasing juvenile survival rates. Further research is required to determine whether juvenile survival is constrained by predation or competition with other herbivores.

Nuclear BAG-1 expression inhibits apoptosis in colorectal adenoma-derived epithelial cells

BAG-1 is an anti-apoptotic protein that is frequently deregulated in a variety of malignancies including colorectal cancer. There are three isoforms: BAG-1L is located in the nucleus, BAG-1M and BAG-1S are located both in the nucleus and the cytoplasm. In colon cancer, the expression of nuclear BAG-1 is associated with poorer prognosis and is potentially a useful predictive factor for distant metastasis. However, the function of BAG-1 in colonic epithelial cells has not been studied. Having previously shown a predominant nuclear localisation of BAG-1 in adenoma-derived cell lines, we wanted to determine the function of nuclear BAG-1 in these non-tumourigenic cells, to identify whether nuclear BAG-1 was implicated in tumour progression in the colon. In the current report we established that nuclear BAG-1 inhibits apoptosis in a colorectal adenoma-derived cell line. We demonstrate that apoptosis induced by gamma-radiation or the vitamin D analogue EB1089 in the non-tumourigenic human colorectal adenoma-derived S/RG/C2 cell line, was preceded by a decrease in nuclear and an increase in cytoplasmic BAG-1 expression. This change in subcellular localisation of BAG-1 was due to the redistribution of the BAG-1M isoform. In addition, we have shown that the maintenance of high nuclear BAG-1 through enforced expression of the nuclear localised BAG-1L isoform enhanced cellular survival after gamma-radiation or exposure to EB1089. Furthermore the expression of cytoplasmic BAG-1S isoform fused with a nuclear localisation signal protected against gamma-radiation induced apoptosis. This demonstrates that nuclear localisation of the BAG-1 protein confers a survival advantage in colorectal adenoma-derived cells and that nuclear BAG-1 could potentially be an important survival factor in colorectal carcinogenesis.