Improvements to the newborn bloodspot screening service are required to meet national standards

OBJECTIVES

The UK Newborn Screening Programme has standards to facilitate the early identification and treatment of five specific diseases to prevent lifelong impairment or death. This audit aimed to assess the newborn bloodspot screening programme in an inner London borough and to make recommendations for service improvement.

METHODS

Data on babies registered with a general practitioner in the borough between April 2008 and March 2009 were obtained from the borough's health database and the laboratory result systems and compared with national screening standards. Interviews were conducted with the leads of each service providing components of newborn screening.

RESULTS

A total of 292 (8%) out of 3636 babies registered within the audit period had no result on the database (average 1 in 13). Regional reports revealed that over the previous three years the borough, like many others, had consistently failed to achieve the core standards for newborn bloodspot screening. Major areas of concern identified by this audit pertained to the quality of the bloodspot sample, response to requests for repeat samples, timely identification of untested babies and communication of results to parents.

CONCLUSION

The audit revealed that for the majority of children registered in the borough, screening was successfully carried out. However, gaps in the service meant that with current practice one affected child could be missed every seven years. Recommendations include staff training, frequent data reviews, and providing a coordinating officer to oversee the programme and follow up missing results.

Effect of recovery duration from prior exhaustive exercise on the parameters of the power-duration relationship

The physiological equivalents of the curvature constant (W′) of the high-intensity power-duration (P-tLIM) relationship are poorly understood, although they are presumed to reach maxima/minima at exhaustion. In an attempt to improve our understanding of the determinants of W′, we therefore aimed to determine its recovery kinetics following exhaustive exercise (which depletes W′) concomitantly with those of O2 uptake (V̇o2, a proxy for the kinetics of phosphocreatine replenishment) and blood lactate concentration ([L−]). Six men performed cycle-ergometer exercise to tLIM: a ramp and four constant-load tests, at different work rates, for estimation of lactate threshold, W′, critical power (CP), and maximum V̇o2. Three further exhausting tests were performed at different work rates, each preceded by an exhausting “conditioning” bout, with intervening recoveries of 2, 6, and 15 min. Neither prior exhaustion nor recovery duration altered V̇o2 or [L−] at tLIM. Postconditioning, the P-tLIM relationship remained well characterized by a hyperbola, with CP unchanged. However, W′ recovered to 37 ± 5, 65 ± 6, and 86 ± 4% of control following 2, 6, and 15 min of intervening recovery, respectively. The W′ recovery was curvilinear [interpolated half time ( t1/2) = 234 ± 32 s] and appreciably slower than V̇o2 recovery ( t1/2 = 74 ± 2 s) but faster than [L−] recovery ( t1/2 = 1,366 ± 799 s). This suggests that W′ determines supra-CP exercise tolerance, its restitution kinetics are not a unique function of phosphocreatine concentration or arterial [L−], and it is unlikely to simply reflect a finite energy store that becomes depleted at tLIM.

Optimal neural differentiation and extension of hybrid neuroblastoma cells (NDC) for nerve-target evaluations using a multifactorial approach

In vitro models of tissues, such as the cornea, represent systems for modeling cell-to-cell interactions and tissue function. The objective of this study was to develop an optimized nerve differentiation medium to incorporate into a 3D in vitro model to study innervation and cell targeting. A hybrid neuroblastoma cell line (NDC) was examined for its ability to differentiate into neurons, produce neurites, and functionally contact target cells. Neuronal differentiation of NDCs was optimized through a combinatorial approach which involved culturing cells in the presence of various extracellular matrices and soluble factors. A serum-free medium containing nerve growth factor (NGF), dimethyl sulfoxide (DMSO), or dexamethasone resulted in the greatest proportion of NDCs demonstrating a neuronal morphology. Similarly, with supplementation of cyclic AMP (cAMP) or NGF, neurite extension was optimized. Combining these factors generated an optimized differentiation and extension medium, relative to the individual components alone. In co-culture with epithelial cells, NDC neurites generated in the optimized medium formed contacts with epithelial targets and produced substance P. Similarly, NDCs seeded into a collagen matrix produced neurites that projected through the matrix to target epithelial cells, promoted epithelial stratification, and increased the rate of epithelial wound healing. As well, differentiated NDCs could target and alter acetylcholine receptor clustering in mouse C2C12 myotubes, demonstrating synaptic plasticity. Our data supports the use of NDCs, in combination with optimized medium, for generating an innervated in vitro model.

Vibration therapy in multiple sclerosis: a pilot study exploring its effects on tone, muscle force, sensation and functional performance

Objective: To examine the effectiveness of whole body vibration (WBV) on tone, muscle force, sensation and functional performance in people with multiple sclerosis.

Design: A randomized cross-over pilot study.

Setting: Revive MS Support Therapy Centre. Glasgow, UK.

Subjects: Sixteen people with multiple sclerosis were randomly allocated to one of two groups.

Intervention: Group 1 received four weeks of whole body vibration plus exercise three times per week, two weeks of no intervention and then four weeks of exercise alone three times per week. Group 2 were given the two treatment interventions in the reverse order to group 1.

Main measures: Ten-metre walk, Timed Up and Go Test, Modified Ashworth Scale, Multiple Sclerosis Spasticity Scale (MSSS-88), lower limb muscle force, Nottingham Sensory Assessment and Multiple Sclerosis Impact Scale (MSIS-29) were used before and after intervention.

Results: The exercise programme had positive effects on muscle force and well-being, but there was insufficient evidence that the addition of whole body vibration provided any further benefit. The Modified Ashworth Scale was generally unaffected by either intervention, although, for each group, results from the MSSS-88 showed whole body vibration and exercises reduced muscle spasms (P = 0.02). Although results for the 10-m walk and Timed Up and Go Test improved, this did not reach statistical significance (P = 0.56; P = 0.70, respectively). For most subjects sensation was unaffected by whole body vibration.

Conclusion: Exercise may be beneficial to those with multiple sclerosis, but there is limited evidence that the addition of whole body vibration provides any additional improvements. Further larger scale studies into the effects of whole body vibration in people with multiple sclerosis are essential.

High frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway

SUMMARY

A 72 year-old man with an anticipated difficult airway secondary to a large, obstructing supraglottic tumour was scheduled for a panendoscopy. An elective pre-induction transtracheal catheter was placed to allow oxygenation if airway maintenance proved difficult. Following induction of anaesthesia, tracheal intubation was impossible and ventilation via both a facepiece and a laryngeal mask airway became progressively more difficult. An emergency tracheostomy was attempted whilst oxygenation was maintained with transtracheal jet ventilation, but the position of the transtracheal catheter made tracheostomy impossible. The catheter was removed and high frequency jet ventilation was then used via the laryngeal mask airway to maintain oxygenation. To our knowledge, the use of high frequency jet ventilation through the laryngeal mask airway in a critically obstructed airway has not been described before.

Lack of association between the interferon-alpha signature and longitudinal changes in disease activity in systemic lupus erythematosus

OBJECTIVE

To study the longitudinal expression of interferon (IFN)-inducible genes in systemic lupus erythematosus (SLE) and determine their suitability as disease biomarkers.

METHODS

RNA was isolated from the peripheral blood of 94 patients with SLE and 11 controls and reverse transcribed into cDNA. The expression levels of five IFN-responsive genes (LY6E, OAS1, IFIT1, ISG15 and MX1) were determined by quantitative PCR, normalised to GAPDH and summed to generate a global IFN score. Patients were followed longitudinally for a period of 3-12 months, and the association between disease activity, as measured by the SLE disease activity index (SLEDAI-2K), and other clinical and laboratory variables was examined.

RESULTS

The expression of all five IFN-responsive genes was significantly higher in patients with SLE than in controls. The expression of LY6E, OAS1, IFIT1 and the global IFN score was associated with high disease activity. The global IFN score was also associated with active renal disease, a decreased C3, and the presence of anti-dsDNA or anti-RNA binding protein antibodies at a single point in time. However, there was a poor correlation between changes in this score and changes in disease activity, C3 or anti-dsDNA antibody levels in patients followed longitudinally. In most patients the levels of IFN-induced gene expression remained relatively stable over 3-12 months despite marked changes in disease activity. Nevertheless, in patients with low/moderate disease activity, those with high IFN scores had a more recent history of sustained high disease activity.

CONCLUSION

The findings indicate that IFN-induced gene expression has limited clinical utility as a biomarker of acute changes in disease activity.

The effect of temperature on bougies: a photographic and manikin study

We investigated the effect of temperature on single use and reuseable bougies. In a photographic study, three bougies (Portex Venn reuseable (R), Portex single use (S) and Breathesafe single use (B)) were exposed to increasing temperatures and sequential photographs were taken of the bougies uncoiling from a preformed curve. Bougie type was associated with rate of uncoiling, type R maintaining its curve the longest but changing temperature did not affect this. In a randomised cross-over manikin study, 16 anaesthetists attempted to pass two bougies (Portex reuseable (R) and Portex single use (S)) at three temperatures (10, 20 and 30 degrees C) into the trachea of a manikin. Type R was significantly associated with higher success rate of tracheal placement compared to type S. Change of temperature was significant with success rate increasing with lower temperature. The odds of success at 10 degrees C was six times that at 30 degrees C (OR (95%) 6.7 (1.7, 25.7)). We concluded that both bougies performed best at 10 degrees C.