Multiplex Reverse Transcriptase PCR Assay for Simultaneous Detection of Three Fish Viruses

A multiplex reverse transcriptase (RT)-PCR assay was developed for the simultaneous detection of three different fish viruses: infectious pancreatic necrosis virus (IPNV), infectious hematopoietic necrosis virus (IHNV), and viral hemorrhagic septicemia virus (VHSV). The sensitivity levels of the multiplex RT-PCR assay were 100, 1, and 32 50% tissue culture infective doses/ml for IPNV, IHNV, and VHSV, respectively.

Isolation of infectious salmon anemia virus (ISAV) from Atlantic salmon in New Brunswick, Canada

Infectious salmon anemia virus (ISAV) was isolated at a marine grow-out site in New Brunswick, Canada, from Atlantic salmon Salmo salar which experienced mortalities due to hemorrhagic kidney syndrome (HKS). Of 20 fish sampled in this study, 14 showed histologically various degrees of interstitial hemorrhaging, tubular epithelial degeneration and necrosis, and tubular casts in the posterior kidney, typical of HKS. Posterior kidney and spleen homogenates produced a cytopathic effect on chinook salmon embryo (CHSE-214) cells 10 to 14 d after inoculation. Pleomorphic virus particles in the size range 80 to 120 nm were seen by electron microscopy. The virus was confirmed as ISAV using reverse transcriptase-polymerase chain reaction (RT-PCR). This is a systematic diagnostic study of the isolation of ISAV on the North American continent and the first description of the growth of ISAV on the CHSE-214 cell line.

Genomic relationships of the North American isolate of infectious salmon anemia virus (ISAV) to the Norwegian strain of ISAV

Nucleotide and deduced amino acid sequences were determined for a 436 bp reverse transcriptase-polymerase chain reaction (RT-PCR) cDNA fragment from genome segment 8 and a 1151 bp RT-PCR cDNA fragment from genome segment 2 of the North American isolate of infectious salmon anemia virus (ISAV) and compared to the published sequences of Norwegian isolates of ISAV. The North American ISAV isolate exhibited 82.9% identity with the Sotra 92/93 ISAV isolate from Norway in the partial cDNA sequence of genome segment 2, which encodes a polymerase component protein (PB1). The North American ISAV exhibited 88 and 89% identity with 2 partial cDNA sequences of genome segment 8 (nonstructural, NS, gene) reported for the Glesvaer/2/90 isolate from Norway. The North American ISAV exhibited 96.6% similarity with the Sotra 92/93 ISAV isolate from Norway in the deduced amino acid sequences of the PB1 protein. The deduced amino acid sequence of the protein encoded in the partial cDNA fragment of open reading frame (ORF) 1 of genome segment 8 of the North American ISAV exhibited only 71.2 and 66.7% similarity with the 2 sequences of the Norwegian Glesvaer/2/90 isolate. However, the North American ISAV isolate exhibited 96.2 and 87.2% similarity with the 2 sequences of the Norwegian Glesvaer/2/90 isolate in the deduced amino acid sequences of the protein encoded in the partial cDNA of ORF 2. Comparison of these partial cDNA nucleotide and deduced amino acid sequences confirmed that the North American isolate is ISAV. However, the differences observed in these genomic sequences suggest that the North American isolate may represent a distinct genomic variant from the previously described Norwegian strains.

Timer error and beam quality variation during "ramp-up" of a superficial X-ray therapy unit

Superficial and orthovoltage therapy machines generally exhibit a "ramp-up region" during which the dose rate increases from zero to the steady state output. This can produce a significant dose deficit, which can be made up by adding a correction to the treatment time. This correction, which can be determined from the intercept of the dose versus time plot, takes no account of either the true duration of the ramp-up region or the beam quality variation while it takes place. A new method for investigating the ramp-up region is proposed, and the results are presented for a 100 kVp beam. Measurements of beam quality in terms of half value layer (HVL) have been made as a function of time. A change in HVL from an average of 2.9 mm aluminium in the ramp-up region to 3.1 mm for the steady state region has been observed. A significant random variation in the time between initiation of the radiation and the beginning of the ramp-up region was also observed which was traced to a time varying signal in the control system.

Investigation and modelling of the surface dose from linear accelerator produced 6 and 10 MV photon beams

The radiation reaction from the surface dose to a patient's skin is clinically important as an indicator of tolerance to treatment and is frequently the most visible side-effect from external beam radiotherapy. To quantify surface dose, its build-up was investigated in a solid water phantom over a range of field sizes, source to skin distances, wedge angles and beam shaping conditions. These data were analysed and used to produce an empirical model of the effect of these factors which predicted surface dose to within 5% under test conditions. The effects of changing treatment techniques was investigated by comparing fixed to dynamic wedges, and multileaf collimator (MLC) with alloy blocks. It was found that the MLC reduced the surface dose relative to alloy blocks but that dynamic wedges made no change relative to open fields. Fixed wedges reduced the relative surface dose as a consequence of beam hardening. It is hoped that routine clinical use of the model to calculate skin dose will increase awareness of situations in which the skin sparing effect of modern linear accelerators may be compromised.

State funding of comprehensive primary medical care service programs for medically underserved populations

OBJECTIVES

This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities.

METHODS

A brief questionnaire was used to ask health agencies in all 50 states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs.

RESULTS

Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program.

CONCLUSIONS

The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative.

The in vivo and in vitro characterisation of an engineered human antibody to E-selectin

BACKGROUND

E-selectin is an endothelial cell specific adhesion molecule that is believed to play an important role in the early stages of leukocyte extravasation.

OBJECTIVES

Here we describe the construction and evaluation of an engineered human monoclonal antibody that blocks E-selectin function.

RESULTS

SPLAT-1 is an engineered human monoclonal antibody that has a very similar affinity for E-selectin as its murine parent antibody. In vitro SPLAT-1 blocks the binding of human leukocytes to E-selectin and does not mediate antibody-dependent cellular cytotoxicity (ADCC) or complement-mediated lysis of endothelial cells. In vivo, SPLAT-1 inhibits the recruitment of leukocytes to cytokine-inflamed human skin grafted on to SCID mice and has a long circulating half-life in primates. It does not appear to provoke an immune response in primates even on repeat administration.

CONCLUSIONS

SPLAT-1 has the characteristics of a antibody suitable for human therapy studies.

Serial changes in cardiac output during normal pregnancy: a Doppler ultrasound study

OBJECTIVES

To determine the direction and magnitude of change in cardiac output (CO) during pregnancy.

STUDY DESIGN

We performed serial measurements of CO on five occasions from 24 weeks gestation to term and once during the puerperium in 26 normal pregnancies (156 measurements) using Doppler ultrasound measurement of flow velocity profiles and aortic root cross sectional area.

RESULTS

CO increased to 7.0 l/min by 32 weeks gestation, 49% above baseline values. It fell to 5.7 l/min by term, 21% above baseline. The peak in CO corresponded with an increase in heart rate to 91 beats/min, 32% above baseline. Stroke volume peaked at 36 weeks gestation, by which time CO had already begun to decline.

CONCLUSIONS

CO increased in a linear fashion until 32 weeks gestation and then declined to term, but to a value still greater than the postpartum baseline. These findings have obvious management implications for patients with serious heart disease complicating pregnancy.

Comparison of different procedures for serotyping aquatic birnavirus

The current classification of aquatic birnaviruses is based on seroneutralization assays with polyclonal antibodies. In this study a comparison of several procedures used for serotyping aquatic birnaviruses was made with 10 virus strains (4 reference strains from salmonids and 6 birnaviruses isolated from turbot [Scophthalmus maximus]). The relationships among the birnavirus strains were studied by seroneutralization assay with polyclonal antibodies and by immunodot assay with both polyclonal and monoclonal antibodies. The results were compared with a presumptive classification obtained from analysis of restriction enzyme patterns of cDNA products obtained by PCR amplification. No correlation was found among the results obtained by the different procedures. The seroneutralization and the immunodot assays with polyclonal antibodies were not useful in classifying these birnaviruses strains; however, patterns of reaction with monoclonal antibodies emphasized the individuality of the strains, particularly in the case of two strains (231 and 460) whose patterns did not correspond to established serotypes. The application of PCR and restriction enzyme analysis is a promising system for approaching the classification of this viral group on the basis of genomic differences and similarities. The variable results obtained in this comparison lead us to think that the current classification of aquatic birnavirus may not be the most accurate and there is a need for modification incorporating recent isolates, not only from salmonid species but also from marine fish.

Antifibrotic action of interleukin-1 receptor antagonist in lapine monoarticular arthritis

OBJECTIVE

To determine if the administration of interleukin-1 receptor antagonist (IL-1ra) to animals with established antigen induced arthritis had any beneficial effects on the synovitis and cartilage destruction.

METHODS

Antigen induced arthritis was induced in New Zealand White rabbits, and after two weeks IL-1ra was administered every six hours over a 72 hour period. Animals were then killed and joint tissues examined for the degree of synovitis, synovial fibrosis, and cartilage damage.

RESULTS

The response of the arthritis to the treatment was minor in terms of joint swelling, leucocyte accumulation, or cartilage proteoglycan loss. However, the synovial fibrosis was not only halted by administration of IL-1ra, but reversed. The inflamed synovial linings of IL-1ra treated animals showed a significant loss of synovial collagen content and a reappearance of the synovial fat spaces which are prominent in the normal synovial lining.

CONCLUSION

This study shows that IL-1ra has potent antifibrotic activity and suggests the use of this agent for the reversal of the fibroproliferative process which is so important in the pathology of rheumatoid arthritis.

Role of TNF alpha in the induction of antigen induced arthritis in the rabbit and the anti-arthritic effect of species specific TNF alpha neutralising monoclonal antibodies

OBJECTIVE

To investigate the role of tumour necrosis factor alpha (TNF alpha) in the development of antigen induced arthritis (AIA) in rabbits.

METHODS

Monoclonal antibodies to rabbit TNF alpha were developed in rats and were used to detect TNF alpha in synovial fluid by enzyme linked immunosorbent assay and to localise it in tissue sections of synovium and cartilage from rabbits up to 21 days after induction of AIA. An antibody which neutralised TNF alpha activity in vitro was injected into rabbits to block TNF alpha action in vivo in AIA. Joint swelling, leucocyte infiltration into synovium and proteoglycan loss from cartilage were measured and compared with a control group, which were injected with sterile saline.

RESULTS

Monoclonal antibodies to purified rabbit TNF alpha were prepared in rats and two were selected which were able to neutralise rabbit TNF alpha in a cytotoxicity bioassay. TNF alpha was detected in significant concentrations (21.7 (SE 0.5) pg/ml) in the arthritic joint fluid of rabbits with AIA only at one day after induction and it was then also sparsely localised in cells of the synovium, but from day 3 onwards it was localised more strongly in the deep zone of articular cartilage. Injection of anti-TNF monoclonal antibody R6 over three days into rabbits with AIA reduced joint swelling and leucocyte infiltration into joint fluid and decreased the expression of CD11b and CD18 on cells in the joint fluid. However, there was no significant reduction in the loss of proteoglycan from articular cartilage, although the joint fluid at three days contained a lower glycosaminoglycan content. The antibody R6 gave most effect at a dose of 0.6 mg/kg and there was no increase in its effectiveness at a fivefold greater dose (3.0 mg/kg). Treatment over 10 days gave a more complete suppression of joint swelling, but did not result in any less proteoglycan loss from cartilage. Treatment for five days with a 16 day follow up gave a significant reduction in swelling for several days beyond the treatment, but the swelling then slowly returned, until by day 21 there was no significant difference in joint swelling and there was also no recovery of cartilage proteoglycan content. A rabbit anti-rat immunoglobulin response was detected at 21 days, which may have limited the long term effectiveness of the antibody.

CONCLUSIONS

In AIA in rabbits, TNF alpha was only detected in synovial fluid at one day after induction and there was only limited cellular localisation of TNF alpha in synovium and cartilage from three days. However, neutralising TNF alpha with a monoclonal antibody was effective in suppressing inflammatory changes in the joint during the acute onset of AIA, but it had little effect on the loss of proteoglycan from cartilage. The results suggest that blocking inflammation and synovitis with anti-TNF alpha may be more easily achieved than preventing damage to articular cartilage.

In situ hybridisation for decorin mRNA in rabbit synovium during antigen-induced arthritis

Decorin mRNA was localised primarily in the lining layer of normal rabbit synovium. The distribution changed during the development of antigen-induced arthritis. It became more abundant deeper in the synovium and may be correlated with the progressive increase in the deposition of collagen.

Therapeutic potential of cytokine manipulation

Interleukin 1 is just one of a large, growing, collection of potent cytokines that are produced by a variety of cells and have a myriad of overlapping activities. Many of these cytokines have important pathophysiological actions in diseases ranging from rheumatoid arthritis to AIDS. Selective inhibition of the synthesis or of the action of specific cytokines may have therapeutic benefit. In this review, Brian Henderson and Simon Blake discuss the ways in which cytokine function could be manipulated pharmacologically for therapeutic benefit.

The prevention of the maternal manifestations of pre-eclampsia by intensive antihypertensive treatment

The purpose of the study was to determine if reduction of pregnancy hypertension to normal prevented the clinical maternal manifestations of pre-eclampsia. Thirty-six women with hypertension, but without proteinuria, were allotted at random to a test group of 17 who received intensive treatment, and a control group of 19 who were managed according to routine methods by hospital staff unconnected with the study. The development of proteinuria was chosen as an indicator of pre-eclampsia. Proteinuria developed significantly more often in the control group (in six of the 19 women) than in the test group (in one of the 17 women).

Dietary protein intake modulates glomerular eicosanoid production in the rat

The quantity of protein in the diet modulates glomerular function. To study the effect of dietary protein intake on glomerular eicosanoid production, rats were randomized to either a high- (40%) or low- (8.5%) protein isocaloric diet. Ten to fourteen days later glomeruli were isolated and incubated in the absence (basal) and presence (stimulated conditions) of arachidonic acid, and production rates of prostaglandin (PG) E2, PGF2 alpha, and thromboxane B2 (TxB2) were determined by direct radioimmunoassay. Under basal conditions, glomerular production of all three eicosanoids was significantly greater in rats ingesting the high-protein diet. Glomerular production of PGE2 and TxB2 was also greater in animals fed the high-protein diet in the presence of arachidonic acid, suggesting that glomerular cyclooxygenase activity was augmented. In contrast, ingestion of a high-protein diet was not associated with a significant increase in eicosanoid production by renal papillae or in TxB2 release by clotting blood. To investigate the potential role of the renin-angiotensin system in the dietary protein-induced modulation of glomerular eicosanoid production, rats ingesting a high- or low-protein diet were randomized to treatment with an angiotensin-converting enzyme inhibitor or no therapy. Enalapril attenuated the dietary protein-induced augmentation in glomerular eicosanoid production. This effect occurred only when administered in vivo, since the active metabolite enalapril did not alter PGE2 production by isolated glomeruli when added in vitro. Dietary protein intake also modulated glomerular eicosanoid production in three models of experimental renal disease in the rat (streptozotocin-induced diabetes mellitus, Heymann nephritis, and partial renal ablation).(ABSTRACT TRUNCATED AT 250 WORDS)

Autoregulation of tissue blood flow in essential hypertension

Autoregulation of tissue blood flow is a mechanism by which tissues control their own blood supply. The mechanism is dependent on an intrinsic capacity of tissues to vary their arteriolar resistance in relation to their needs. One view of the nature of the increased peripheral resistance in essential hypertension is that it represents autoregulatory vasoconstriction functioning to hold in check a cardiac output that would otherwise be excessive; in this situation autoregulation would be functioning normally. An alternative view is that the increased peripheral resistance represents the effect of a direct-acting vasoconstrictor substance; in this situation autoregulation would be rendered defective in its vasodilator capacity. A study of autoregulatory vasodilatation in eight subjects with essential hypertension supported an autoregulatory mechanism as the cause of the increased peripheral resistance.

Increased prostaglandin production by glomeruli isolated from rats with streptozotocin-induced diabetes mellitus

Abnormalities in glomerular function have been observed frequently in the early stages of both clinical and experimental diabetes mellitus. Because prostaglandins (PGs) are present in the glomerulus and have profound effects on glomerular hemodynamics, and because abnormalities of PG metabolism have been noted in other tissues from diabetics, we studied PG biosynthesis in glomeruli obtained from rats in the early stages of experimental diabetes mellitus. Streptozotocin, 60 mg/kg, was administered intravenously to male Sprague-Dawley rats. Control rats received an equal volume of the vehicle. Glomeruli were isolated 9-23 d later. Production of eicosanoids was determined by two methods: by direct radioimmunoassay after incubation of glomeruli under basal conditions and in the presence of arachidonic acid (C20:4), 30 microM, and by radiometric high-performance liquid chromatography (HPLC) after incubation of glomeruli with [14C]C20:4. When assessed by radioimmunoassay, mean basal production of both prostaglandin E2 (PGE2) and prostaglandin F2 alpha (PGF2 alpha) was twofold greater in the diabetic animals whereas production of thromboxane B2 (TXB2) was not significantly greater than control. In response to C20:4, both PGE2 and PGF2 alpha were also greater in the diabetic animals, but these differences were not statistically significant. The increased rate of basal PG production did not appear to be related directly to the severity of the diabetic state as reflected by the degree of hyperglycemia at the time of sacrifice. In fact, the rates of glomerular PG production in the individual diabetic animals correlated inversely with the plasma glucose concentration. The increased rate of PG synthesis did not appear to be due to a nonspecific effect of streptozotocin inasmuch as glomerular PG production was not increased significantly in streptozotocin-treated rats which were made euglycemic by insulin therapy. Furthermore, addition of streptozotocin, 1-10 mM, to the incubation media had no effect on PGE2 production by normal glomeruli. PGE2 production by normal glomeruli was also not influenced by varying the glucose concentration in the incubation media over a range of 1-40 mM. When metabolism of [14C]C20:4 was evaluated by high-performance liquid chromatography conversion to labeled PGE2, PGF2 alpha, TXB2, and hydroxyheptadecatrienoic acid by diabetic glomeruli was two- to threefold greater compared with that in control glomeruli, whereas no significant difference in conversion to 12- and 15-hydroxyeicosatetraenoic acid occurred. These findings indicate that glomerular cyclooxygenase but not lipoxygenase activity was increased in the diabetic animals. A concomitant increase in glomerular phospholipase activity may also have been present to account for the more pronounced differences in PG production noted in the absence of exogenous unlabeled C20:4. These abnormalities in PG biosynthesis by diabetic glomeruli may contribute to the altered glomerular hemodynamics in this pathophysiologic setting.

Development of a method for rating cognitive responses to a diagnosis of cancer

The development of a method for rating cognitive responses to the diagnosis of early breast cancer, lymphoma and Hodgkin's disease is described in the context both of recent coping theory and a previous study by this Unit relating outcome to response to diagnosis. The ratings are defined in a manual using simple language and avoiding assumptions about the functions of responses; examples are given.

Amino (hydroxyethoxymethyl) purine: a new well-absorbed prodrug of acyclovir

Acyclovir is an effective treatment for herpes simplex and herpes zoster infections, but it is somewhat limited by low oral absorption. 2-amino-9-[(2hydroxyethoxy)methyl]-9H-purine (BW A515U), a new prodrug of acyclovir, when evaluated in 10 patients with haematological malignancies, was well tolerated, excellently absorbed, and produced high plasma concentrations of acyclovir which were comparable to those with intravenous acyclovir. The plasma concentrations after oral BW A515U were much higher than those after oral acyclovir.

Quantitation of the response of human tumor spheroids to daily radiation exposures

Two human tumor lines, NB-100 neuroblastoma and C-32 melanoma, were grown as multicellular tumor spheroids (MTS) and exposed to daily doses of gamma rays, 5 days per week. It required daily doses of 200 rad to arrest the growth of the NB-100 MTS, while 350 rad per day was required to arrest the growth of the C-32 MTS. Calculation of the delay in time to grow 200 um beyond the original size yielded similar differences in radiation resistance. When the volume of the treated MTS was expressed as a fraction of their potential volume and plotted as a function of cumulative dose, there appeared to be little fraction size dependence over the range studied. This prediction was tested experimentally and confirmed: daily administration of two 100 rad doses separated by 4 hours to NB-100 MTS was only marginally less effective than a daily single dose of 200 rad. These data suggest that MTS may prove to be valuable tools in studying the response of human tumors to clinical exposure protocols, including hyperfractionation.

Reaction to a diagnosis of breast cancer. Relationship between denial, delay and rates of psychological morbidity

Psychological responses were measured in a newly diagnosed group of breast cancer patients during their hospital stay for primary surgical treatment by mastectomy. The aim was to assess the extent to which patients responded to the stress of a cancer diagnosis by denying the seriousness of the illness, and how this related to both level of distress and prior delay in seeking treatment. The data indicated that patients who denied the seriousness of a cancer diagnosis experienced significantly less mood disturbance during this period than those who were more accepting of the implications of this diagnosis. These findings suggest that a denial rather than a confrontation-coping-response may effectively reduce the short-term distress experienced during this initial period of hospitalization. Contrary to predictions, we failed to show an association between the length of delay in seeking treatment and denial of the diagnosis.

Aetiology of chronic constrictive pericarditis

In a consecutive series of 32 cases of chronic constrictive pericarditis treated by pericardiectomy during the past 25 years, four were attributable to rheumatoid disease, two to trauma, one to sarcoidosis, and four, at a maximum, to tuberculosis. In the remaining 21 cases of undetermined aetiology there was no evidence of tuberculosis. It appears, therefore, that tuberculosis was not a common cause of chronic constrictive pericarditis during the period under review, which included the 1950s and early 1960s when tuberculosis was widespread.

Nifedipine in the treatment of hypertension

Nifedipine, a calcium antagonist with a predominant vasodilator action, was evaluated for the treatment of hypertension. A 20 mg-tablet, with a slower absorption and a more sustained blood-level than provided by the 10 mg-capsule was administered to 20 patients. The duration of the trial was 20 weeks. All patients achieved a significant reduction in both systolic (p less than 0.05) and diastolic (p less than 0.001) blood-pressure (B.P.), but 10 patients were withdrawn before completion of the trial period. Two patients, although achieving a fall in B.P. which was significant, did not reach to target level (less than 160/90) on maximal dosage, one patient suffered a stroke due to a cerebral infarct, and seven patients were withdrawn because of side-effects due mainly to vasodilatation. The remaining 10 patients obtained a satisfactory response. In nine patients, who had achieved a satisfactory result, there was no change in plasma renin activity (P.R.A.) during chronic nifedipine administration.