Transferring patients with Ebola by land and air: the British military experience

The Ebola epidemic of 2014/2015 led to a multinational response to control the disease outbreak. Assurance for British aid workers included provision of a robust treatment pathway including repatriation back to the UK. This pathway involved the use of both land and air assets to ensure that patients were transferred quickly, and safely, to a high-level isolation unit in the UK. Following a road move in Sierra Leone, an air transportable isolator (ATI) was used to transport patients for the flight and onward transfer to the Royal Free Hospital. There are several unique factors related to managing a patient with Ebola virus disease during prolonged evacuation, including the provision of care inside an ATI. These points are considered here along with an outline of the evacuation pathway.

Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer

Background

The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.

Methods

Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.

Results

Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).

Conclusion

NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

Effect of exposure to silica in inducing autoimmune hepatitis: an experimental animal-controlled study

OBJECTIVE

The aim of this experimental study is to investigate the effect of subcutaneous and oral sodium silicate in inducing the autoimmune hepatitis.

MATERIALS AND METHODS

Twelve Brown Norway rats were studied, six rats were challenged with Sodium Silicate and the rest were challenged with normal saline as a control group. At 14th week post-sodium silicate or normal saline exposure, the rats were sacrificed. Histopathological studies were conducted in six positive autoantibodies responding silicate group rats and then compared with an equal number of negative autoantibodies responding control rats.

RESULTS

The liver findings from sodium silicate group of animals showed a histopathological reaction in 3/6 (50%) compared with 0/6 of the corresponding control saline group (p = 0.09). However, the absolute differences in the percentage between the two groups was 50%, the subcutaneous sodium silicate sub-group showed hepatic tissue response close to being statistically significant level (p = 0.05).

CONCLUSIONS

After correlating the results with autoantibodies including serum antinuclear antibodies and anti ribo-nucleoprotein response of the same rats, it is concluded that sodium silicate play a role in inducing the autoimmune hepatitis in a genetically susceptible rat model.

Is there an association between pseudoexfoliation syndrome and knee osteoarthritis?

AIM

The purpose of this study was to investigate whether there is an association between pseudoexfoliation (PEX) syndrome and knee osteoarthritis (OA), and compare to compare patients with PEX and OA to a control group without PEX.

DESIGN AND METHODS

This observational case-control study examined 254 subjects: 127 cases with PEX in at least one eye and 127 controls without PEX. A full ophthalmic examination including slit lamp biomicroscopy, gonioscopy, applanation tonometry, pupil dilation, and fundus examination was performed for the diagnosis of PEX. Knee pain was evaluated using a visual analogue scale (VAS). Knee OA was diagnosed according to American College of Rheumatology (ACR) criteria and graded according to the Kellgren and Lawrence (KL) grading scale on radiographic examination.

RESULTS

Of the 254 subjects, 171 (67.3%) had severe OA and 83 (32.7%) mild OA. Of the 171 patients with severe knee OA, 93 (54.4%) had ocular PEX and the remaining 78 (45.6%) had normal ophthalmologic examination results. Both the PEX and the control groups contained 127 patients; the number of patients with moderate-severe OA was significantly (p = 0.032) higher in the PEX group as compared to controls: 93 patients (73.2%) in the PEX group and 78 (61.5%) in the control group. VAS score (p = 0.037) and KL grade (p = 0.024) were significantly higher in the PEX group than in controls. As evidenced by the odds ratios (ORs) pertaining to the severity of OA, age (OR = 1.112; 95% confidence interval, CI: 1.054-1.173) and PEX (OR = 2.044; 95% CI: 1.164-3.584) had a significant influence, but gender did not.

CONCLUSION

This study suggests a probable relationship between OA and ocular PEX. Further studies are needed to analyze the molecular basis of this association. Patients with severe knee OA should be informed about the possibility of having PEX and may be referred for ophthalmologic examination.

Microparticle association and heterogeneity of tumor-derived tissue factor in plasma: is it important for coagulation activation?

BACKGROUND

Tumor-derived tissue factor (TF) activates coagulation in vitro and in vivo in an orthotopic model of human pancreatic cancer. Here, we further characterized tumor-derived TF in this model.

METHODS

Conditioned medium (CM) of L3.6pl human pancreatic tumor cells and plasma from nude mice bearing L3.6pl tumors were ultracentrifuged, and the pellets were filtered through membranes with different pore sizes. The size distribution of particles was analyzed in CM or plasma fractions with nanoparticle tracking and dynamic light scattering. Human TF antigen and activity were measured in pellets and supernatants with ELISA and clotting or thrombin generation assays, respectively. Human alternatively spliced TF (asTF) was measured with ELISA. Human TF and thrombin-antithrombin complex (TAT) concentrations were assessed in plasma of mice injected with filtered fractions of CM.

RESULTS

Particles in both CM and plasma were < 0.4 μm. TF antigen and activity in the CM were mainly associated with microparticles (MP). Approximately 50% of antigen and 20% of activity were associated with particles of < 0.1 μm. Injection of < 0.1 μm particles into mice caused a 30% drop in platelet counts and an increase in TAT levels. In contrast, ~ 90% of TF antigen in tumor-bearing mice plasmas was non-sedimentable, whereas TF activity was exclusively associated with MP. Particles of < 0.1 μm and the supernatants of both CM and plasma gained TF activity after addition of exogenous phospholipids. Although asTF was found in MP-free CM supernatants, it was also present in CM and plasma pellets.

CONCLUSIONS

Tumor-derived particles of < 0.1 μm and non-sedimentable TF are or can become procoagulant in the presence of phospholipids, and may contribute to the procoagulant potential of circulating TF.

Spontaneous remission in acute myeloid leukemia: A Case Report

Spontaneous remission of Acute Myeloid leukaemia (AML) is an uncommon event, temporary and its mechanism is yet to be determined. We report here a case of spontaneous remission of AML in a 35 years old male who was diagnosed with AML (M4) in Jan 2011. He presented very ill with fever, bleeding tendency and oral candidacies. He received supportive care only and chemotherapy was withheld. His general condition improved and fever subsided. White blood cell (WBC) count started to drop spontaneously and gradually until he became leukopenic and developed febrile neutropenia. After the second recovery, his full blood count (FBC) and bone marrow examination showed haematological remission. He was followed up for six weeks after which relapse occurred. Chemotherapy was started immediately, but unfortunately was not continued because of sepsis. The patient died four weeks after relapse. Other reports on the spontaneous remission of AML showed a similar temporary period of remission with different duration, and then followed by relapse. Possible mechanisms of spontaneous remission in AML are discussed with a review of the literature.

KEYWORDS

Acute myeloid leukemia, spontaneous remission.

Myeloperoxidase induces the priming of platelets

The release of myeloperoxidase (MPO) from polymorphonuclear neutrophils is a hallmark of vascular inflammation and contributes to the pathogenesis of vascular inflammatory processes. However, the effects of MPO on platelets as a contributory mechanism in vascular inflammatory diseases remain unknown. Thus, MPO interaction with platelets and its effects on platelet function were examined. First, dose-dependent binding of MPO (between 1.7 and 13.8nM) to both human and mouse platelets was observed. This was in direct contrast to the absence of MPO in megakaryocytes. MPO was localized both on the surface of and inside platelets. Cytoskeleton inhibition did not prevent MPO localization inside the three-dimensional platelet structure. MPO peroxidase activity was preserved upon the MPO binding to platelets. MPO sequestered in platelets catabolized NO, documented by the decreased production of NO (on average, an approximately 2-fold decrease). MPO treatment did not affect the viability of platelets during short incubations; however, it decreased platelet viability after long-term storage for 7 days (an approximately 2-fold decrease). The activation of platelets by MPO was documented by an MPO-mediated increase in the expression of surface platelet receptors P-selectin and PECAM-1 (of about 5 to 20%) and the increased formation of reactive oxygen species (of about 15 to 200%). However, the activation was only partial, as MPO did not induce the aggregation of platelets nor potentiate platelet response to classical activators. Nor did MPO induce a significant release of the content of granules. The activation of platelets by MPO was connected with increased MPO-treated platelet interaction with polymorphonuclear leukocytes (an approximately 1.2-fold increase) in vitro. In conclusion, it can be suggested that MPO can interact with and activate platelets, which can induce priming of platelets, rather than the classical robust activation of platelets. This can contribute to the development of chronic inflammatory processes in vessels.

Decorin is a part of the ovarian extracellular matrix in primates and may act as a signaling molecule

STUDY QUESTION

Is decorin (DCN), a putative modulator of growth factor (GF) signaling, expressed in the primate ovary and does it play a role in ovarian biology?

SUMMARY ANSWER

DCN expression in the theca, the corpus luteum (CL), its presence in the follicular fluid (FF) and its actions revealed in human IVF-derived granulosa cells (GCs), suggest that it plays multiple roles in the ovary including folliculogenesis, ovulation and survival of the CL.

WHAT IS KNOWN ALREADY

DCN is a secreted proteoglycan, which has a structural role in the extracellular matrix (ECM) and also interferes with the signaling of multiple GF/GF receptors (GFRs). However, DCN expression and action in the primate ovary has yet to be determined.

STUDY DESIGN, SIZE, DURATION

Archival human and monkey ovarian samples were analyzed. Studies were conducted using FF and GC samples collected from IVF patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Immunohistochemistry, western blotting, RT-PCR, quantitative RT-PCR (qPCR) and enzyme-linked immunosorbent assay (ELISA) studies were complemented by cellular studies, including the measurements of intracellular Ca²⁺, reactive oxygen species (ROS), epidermal GF receptor (EGFR) phosphorylation by DCN and caspase activity.

MAIN RESULTS AND THE ROLE OF CHANCE

Immunohistochemistry revealed strong DCN staining in the connective tissue and follicular thecal compartments, but not in GCs of pre-antral and antral follicles. Pre-ovulatory follicles could not be studied, but DCN was associated with connective tissue of CL samples and the cytoplasm of luteal cells. DCN expression in monkey CL doubled (P < 0.05) towards the end of the luteal lifespan. DCN was found in human FF obtained from IVF patients (mean: 12.9 ng/ml; n = 20) as determined by ELISA. DCN mRNA and/or protein were detected in freshly isolated and cultured, luteinized human GCs. In the latter, exogenous human recombinant DCN increased intracellular Ca²⁺ levels and induced the production of ROS in a concentration-dependent manner. DCN, like epidermal GF, phosphorylated EGFR significantly (P < 0.05) and reduced the activity of caspase 3/7 in cultured GCs. The data indicate the expression of DCN in the theca of growing follicles, in FF of ovulatory follicles and in the CL. Therefore, DCN may exert paracrine actions via GF/GFR systems in multiple ovarian compartments.

LIMITATIONS, REASONS FOR CAUTION

Functional studies were performed in cultures of human luteinized GCs, which are an apt model but may not fully mirror the pre-ovulatory GC compartment or the CL. Other human ovarian cells, including the thecal cells, were not available.

WIDER IMPLICATIONS OF THE FINDINGS

In accordance with its evolving roles in other organs, ovarian DCN is an ECM-associated component, which acts as a multifunctional regulator of GF signaling in the primate ovary. DCN may thus be involved in folliculogenesis, ovulation and the regulation of the CL survival in primates.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by Deutsche Forschungsgemeinschaft (DFG) MA1080/17-3 and in part DFG MA1080/21-1 (to AM), NIH grants HD24870 (S.R.O. and R.L.S.), the Eunice Kennedy Shriver NICHD/NIH through cooperative agreement HD18185 as part of the Specialized Cooperative Centers Program in Reproduction and Infertility Research (S.R.O.) and 8P51OD011092-53 for the operation of the Oregon National Primate Research Center (G.A.D., J.D.H., S.R.O. and R.L.S).

High levels of the extracellular matrix proteoglycan decorin are associated with inhibition of testicular function

Decorin (DCN), a component of the extracellular matrix of the peritubular wall and the interstitial areas of the human testis, can interact with growth factor (GF) signalling, thereby blocking downstream actions of GFs. In the present study the expression and regulation of DCN using both human testes and two experimental animal models, namely the rhesus monkey and mouse, were examined. DCN protein was present in peritubular and interstitial areas of adult human and monkey testes, while it was almost undetectable in adult wild type mice. Interestingly, the levels and sites of testicular DCN expression in the monkeys were inversely correlated with testicular maturation markers. A strong DCN expression associated with the abundant connective tissue of the interstitial areas in the postnatal through pre-pubertal phases was observed. In adult and old monkeys the DCN pattern was similar to the one in normal human testes, presenting strong expression at the peritubular region. In the testes of both infertile men and in a mouse model of inflammation associated infertility (aromatase-overexpressing transgenic mice), the fibrotic changes and increased numbers of tumour necrosis factor (TNF)-α-producing immune cells were shown to be associated with increased production of DCN. Furthermore, studies with human testicular peritubular cells isolated from fibrotic testis indicated that TNF-α significantly increased DCN production. The data, thus, show that an increased DCN level is associated with impaired testicular function, supporting our hypothesis that DCN interferes with paracrine signalling of the testis in health and disease.