Detection of high serological prevalence and comparison of different tests for Salmonella in pigs in Northern Ireland

Thirty-one farrow-to-finish pig units with a Zoonoses National Control Programme (ZNCP) for Salmonella above the UK target of 10 per cent during the previous 12 months were selected for the study. Pooled faecal samples were collected from different groups of pigs. Furthermore, mice, rat and bird faeces and carcases were collected, if found on the unit. In total, 937 samples were collected on-farm and analysed for Salmonella. The four carcases selected monthly per producer by the slaughterhouse for the British Pig Executive ZNCP Salmonella Programme were tested for antibodies to groups B and C with a mix-ELISA test. The same four carcases were swabbed externally and internally, mesenteric lymph nodes (MLNs) were collected and colonic contents were swabbed. A wide variety of Salmonella serovars was isolated from the samples. Most of the isolates were detected in the rearing herd (on-farm) and in the MLNs (slaughterhouse). There was no correlation between ELISA results from the meat juice and bacteriological isolations using Spearman correlation analyses. Furthermore, no significant association was found between positive results of ELISA and positive results from the bacteriological samples taken.

Identification and evaluation of [11C]GSK931145 as a novel ligand for imaging the type 1 glycine transporter with positron emission tomography

The type-1 glycine transporter (GlyT1) is an important target for the development of new medications for schizophrenia. A specific and selective positron emission tomography (PET) GlyT1 ligand would facilitate drug development studies to determine whether a drug reaches this target and help establish suitable doses for clinical trials. This article describes the evaluation of three candidate GlyT1 PET radioligands (GSK931145, GSK565710, and GSK991022) selected from a library of compounds based on favorable physicochemical and pharmacological properties. Each candidate was successfully labeled using [(11)C]methyl iodide or [(11)C]methyl triflate and administered to a pig pre- and postadministration with a pharmacological dose of a GlyT1 inhibitor to determine their suitability as PET ligands in the porcine brain in vivo. All three candidate ligands were analyzed quantitatively with compartment analyses employing a plasma input function. [(11)C]GSK931145 showed good brain penetration and a heterogeneous distribution in agreement with reported GlyT1 localization. Following pretreatment with GSK565710, uptake of [(11)C]GSK931145 was reduced to homogeneous levels. Although [(11)C]GSK565710 also showed good brain penetration and a heterogeneous distribution, the apparent level of specific binding was reduced compared to [(11)C]GSK931145. In contrast, [(11)C]GSK991022 showed a much lower brain penetration and resultant signal following pretreatment with GSK565710. Based on these findings [(11)C]GSK931145 was identified as the most promising ligand for imaging GlyT1 in the porcine brain, possessing good brain penetration, specific signal, and reversible kinetics. [(11)C]GSK931145 is now being progressed into higher species.

Autologous bone grafting on steroids: preliminary clinical results. A novel treatment for nonunions and segmental bone defects

Clinical management of delayed healing or nonunion of long bone fractures and segmental bone defects poses a substantial orthopaedic challenge. Surgical advances and bone tissue engineering are providing new avenues to stimulate bone growth in cases of bone loss and nonunion. The reamer-irrigator-aspirator (RIA) device allows surgeons to aspirate the medullary contents of long bones and use the progenitor-rich "flow-through" fraction in autologous bone grafting. Dexamethasone (DEX) is a synthetic steroid that has been shown to induce osteoblastic differentiation. A series of 13 patients treated with RIA bone grafting enhanced with DEX for nonunion or segmental defect was examined retrospectively to assess the quality of bony union and clinical outcomes. Despite the initial poor prognoses, promising results were achieved using this technique; and given the complexity of these cases the observed success is of great value and warrants controlled study into both standardisation of the procedure and concentration of the grafting material.

Clinical practice recommendations for bipolar disorder

OBJECTIVE

To provide clinically relevant evidence-based recommendations for the management of bipolar disorder in adults that are informative, easy to assimilate and facilitate clinical decision-making.

METHOD

A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. These preliminary recommendations underwent extensive consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives.

RESULTS

The clinical practice recommendations for bipolar disorder (bipolar CPR) summarise evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative.

CONCLUSION

These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation.

Clinical practice recommendations for depression

OBJECTIVE

To provide clinically relevant evidence-based recommendations for the management of depression in adults that are informative, easy to assimilate and facilitate clinical decision making.

METHOD

A comprehensive literature review of over 500 articles was undertaken using electronic database search engines (e.g. MEDLINE, PsychINFO and Cochrane reviews). In addition articles, book chapters and other literature known to the authors were reviewed. The findings were then formulated into a set of recommendations that were developed by a multidisciplinary team of clinicians who routinely deal with mood disorders. The recommendations then underwent consultative review by a broader advisory panel that included experts in the field, clinical staff and patient representatives.

RESULTS

The clinical practice recommendations for depression (Depression CPR) summarize evidence-based treatments and provide a synopsis of recommendations relating to each phase of the illness. They are designed for clinical use and have therefore been presented succinctly in an innovative and engaging manner that is clear and informative.

CONCLUSION

These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of depression. Further, the novel style and practical approach should promote uptake and implementation.

Patient and nurse evaluation of recombinant human follicle-stimulating hormone administration methods: comparison of two follitropin injection pens

OBJECTIVE

Ovarian stimulation by injection of gonadotrophins is an essential part of assisted reproductive technology (ART) protocols. Two studies (a German pilot study and an Australian study) aimed to assess and compare the ease-of-use, safety and efficacy of two follitropin injection pens.

METHODS

Patient satisfaction (questionnaire) and safety were assessed in patients undergoing ART at a German centre for in vitro fertilisation (IVF), randomised either to the follitropin alfa pen or to the follitropin beta pen. Patient satisfaction (questionnaire) was assessed in patients undergoing ART at an Australian IVF centre, using the follitropin alfa pen, and previous experience with the follitropin beta pen was compared. The experience of IVF nurses with both pens was assessed using a similar questionnaire. Statistical significance was not determined in either study.

RESULTS

In the German study (n = 31), patients favored the follitropin alfa pen over the follitropin beta pen because they found preparation faster, were more confident of accurate dosing and had to make fewer dose adjustments. Treatments delivered by both pens were well tolerated; eight adverse events (AEs) occurred, two AEs (including one case of ovarian hyperstimulation syndrome, OHSS) in two patients using the follitropin alfa pen and six AEs (including three cases of OHSS, one of which was serious) in six patients using the follitropin beta pen. Patients (n = 140) and nurses (n = 11) in the Australian study scored the follitropin alfa pen highly and patients favored it over the follitropin beta pen; the risk of OHSS was also considered greater in the follitropin beta pen group, with nearly a twofold higher rate of cycle cancellation due to OHSS risk compared with the follitropin alfa pen group.

CONCLUSIONS

Taken together, results from these two small studies suggest that the follitropin alfa pen was effective, well tolerated, and patient and nurse acceptance appeared to be higher for the follitropin alfa pen versus the follitropin beta pen, which may benefit compliance, leading to improved outcomes.

Facilitated Endogenous Repair: Making Tissue Engineering Simple, Practical, and Economical

Facilitated endogenous repair is a novel approach to tissue engineering that avoids the ex vivo culture of autologous cells and the need for manufactured scaffolds, while minimizing the number and invasiveness of associated clinical procedures. The strategy relies on harnessing the intrinsic regenerative potential of endogenous tissues using molecular stimuli, such as gene transfer, to initiate reparative processes in situ. In the simplest example, direct percutaneous injection of an osteogenic vector is used to stimulate bone healing. If necessary, additional progenitor cells and space-filling scaffolds can be provided by autologous bone marrow, muscle, fat, and perhaps other tissues. These can be harvested, processed, and reimplanted by simple, expedited, intraoperative procedures. Examples of repair of experimental osseous and osteochondral lesions in laboratory animals are described. If successful, these strategies will provide methods for tissue regeneration that are not only effective but also inexpensive, safe, and clinically expeditious. Although orthopaedic examples are given here, the technology should be more generally applicable.

Salmonella in slaughter pigs in Northern Ireland: prevalence and use of statistical modelling to investigate sample and abattoir effects

A cross-sectional survey of pigs at slaughter in Northern Ireland was undertaken to determine the overall prevalence of Salmonella infection. In total 513 pigs were sampled across four abattoirs, with Salmonella spp. isolated from the caecal contents of 31.4% (95% confidence interval [CI] 27.4%-35.4%) and from 40.0% (95% CI 35.8%-44.3%) of swabs taken from the surface of carcasses post-evisceration. Two serovars, S. Typhimurium and S. Derby, were predominant and accounted for 52% and 35% respectively, of isolates from caecal contents. Antimicrobial resistance was most common amongst isolates of S. Typhimurium with 63.9% multiresistant compared to 10.8% of S. Derby isolates and 8.0% of other Salmonella spp. The proportion of pigs showing serological evidence of infection was significantly lower, with 11.5% (95% CI 8.9%-14.6%) and 10.1% (95% CI 7.7%-13.1%) of meat-juice samples giving positive and suspect reactions, respectively. The ratio of caecal positive to serologically positive animals is higher than in a number of other studies and may suggest recent infection, such as infection occurring during transport or lairage, in a proportion of animals. Statistical (logistic regression) modelling was used to investigate the association between the risk of Salmonella on carcasses and the isolation of Salmonella from caecal contents, and/or the serological status of the animal, while adjusting for other possible explanatory and confounding variables such as abattoir, season, day and time of sampling. The occurrence of Salmonella in caecal contents (odds ratio [OR] 2.39; 95% CI 1.52-3.77) or a suspect/positive serological reaction (OR 2.15; 95% CI 1.28-3.61) were both independently associated with the occurrence of Salmonella on carcasses in homebred, but interestingly not in imported animals. In most multivariable models there were also significant differences in carcass contamination between seasons with the highest odds of carcass contamination occurring in the April to June quarter and the lowest in the October to December quarter. Differences between sampling days were also evident with the highest odds of carcass contamination at the end of the week (Fridays) and the lowest at the start of the week (Mondays). These associations, after adjusting for the caecal or serological result, would suggest the occurrence of abattoir effects, such varying residual levels of abattoir contamination, which are independent of the individual pig status.