Cytokine profile of Armenian patients with Familial Mediterranean fever

OBJECTIVES

Despite the well-defined genetics of FMF, limited information is available regarding the regulation of inflammation by cytokines.

DESIGN AND METHODS

The levels of systemic cytokines and other markers of inflammation in FMF patients and control were measured by ELISA and Cytometric Bead Array (CBA).

RESULTS

In FMF attack the levels of IL-6, IL-10, IL-17, TGF-beta, CRP, and sIL-2R were significantly different from the norm and FMF remission.

CONCLUSIONS

Inflammation in FMF involves Treg and Th17 lineages.

European biliary atresia registries: summary of a symposium

Biliary atresia (BA) is a rare but potentially devastating disease. The European Biliary Atresia Registry (EBAR) was set up to improve data collection and to develop a pan-national and interdisciplinary strategy to improve clinical outcomes. From 2001 to 2005, 100 centers from 22 countries registered with EBAR via its website (www.biliary-atresia.com). In June 2006, the first meeting was held to evaluate results and launch further initiatives. During a 5-year period, 60 centers from 19 European countries and Israel sent completed registration forms for a total of 514 BA patients. Assuming the estimated incidence of BA in Europe is 1:18,000 live births, 35% of the expected 1488 patients from all EBAR participating countries were captured, suggesting that reporting arrangements need improvement. At the meeting, the cumulative evaluation of 928 BA patients including patients from other registries with variable follow-up revealed an overall survival of 78% (range from 41% to 92%), of whom 342 patients (37%) have had liver transplants. Survival with native liver ranged from 14% to 75%. There was a marked variance in reported management and outcome by country (e.g., referral patterns, timing of surgery, centralization of surgery). In conclusion, EBAR represents the first attempt at an overall evaluation of the outcome of BA from a pan-European perspective. The natural history and outcome of biliary atresia is of considerable relevance to a European population. It is essential that there is further support for a pan-European registry with coordination of clinical standards, further participation of parent support groups, and implementation of online data entry and multidisciplinary clinical and basic research projects.

Circulating stromelysin-1 (MMP-3): a novel predictor of LV dysfunction, remodelling and all-cause mortality after acute myocardial infarction

INTRODUCTION

Changes to cardiac matrix are central to ventricular remodelling after acute MI and matrix metalloproteinase expression is implicated in this process. We investigated the temporal profile of MMP-3 and its relationship to LV dysfunction and prognosis following AMI.

METHODS

We studied 382 patients with AMI. Plasma MMP-3 was measured at 0-12, 12-24 h and for subsequent 24 h periods during admission. LV function (LVEF) was assessed by echocardiography pre-discharge and at a median of 148 days and clinical endpoints at a median of 313 days.

RESULTS

MMP-3 peaked prior to discharge thus pre-discharge levels were used in analyses. MMP-3 was associated with patient age (p<0.001), creatinine (p<0.001) and was higher in males (p<0.001) and hypertensives (p<0.001). MMP-3 inversely correlated with LVEF at follow-up (p=0.043), was higher in subjects with LVEF <40% (p=0.017) and in subjects with increasing EDV (p=0.017) or ESV (p=0.007) compared to those in whom volumes fell between visits. In the 58 patients reaching the endpoint of death or heart failure, MMP-3 was higher (p<0.001). On Kaplan-Meier analysis, subjects with levels above optimum cut off identified via ROC curves were more likely to suffer a clinical event (p=0.037).

CONCLUSION

MMP-3 is associated with left ventricular dysfunction, adverse left ventricular remodelling and prognosis after AMI.

Radiological features of progressive tumoral calcinosis in chronic renal failure

We present the case of a young adult patient with chronic renal failure who developed painful subcutaneous nodules after failed renal transplant and recommencing dialysis. These nodules were juxta-articular in location and initially located over both shoulders. Radiological evaluation suggested tumoral calcinosis. The patient was placed on a strict dialysis and dietary regimen but was suboptimally compliant with same. The patient developed progressive disease with an increase in size and number of juxta-articular calcified soft-tissue masses. However, 6 months following a second renal transplant clinical and radiological follow up demonstrated marked resolution both in symptomatology and radiographic findings. We present the plain radiographic, CT and MRI findings which demonstrate the typical radiological features of tumoral calcinosis. We correlate these findings with clinical course and histological findings following surgical excision of one of these masses.

Effect of complementary alternative medical (CAM) therapy on tumor response, control and recurrence in prostate cancer patients (PCpts) treated with radiation therapy (RT)

15585

Background. CAM therapy in pts receiving RT has been questioned due to possible interference with oxidative mechanisms aimed at killing tumor cells. We addressed this controversy by analyzing tumor response, control and recurrence in PCpts treated with RT + CAM. Methods. The population consisted of 125 RT-treated PCpts with localized tumors: CAM cohort (n=69; median age=62.5 yrs; range=46–81); nonCAM cohort (n=56; median age=61.0 yrs; range=48–80). For the CAM cohort, 41%, 42%, 9% and 7% had T1c, T2a, T2b and T2c tumors respectively with 1 T3b tumor; for the nonCAM cohort, 39%, 38%, 14% and 7% had T1c, T2a, T2b and T2c tumors respectively with 1 T3a tumor. RT consisted of external beam therapy (4500–5000 cGy) in conjunction with high dose rate brachytherapy (600- 650 cGy/fraction x 2–3 fractions) administered over 6–8 weeks; this occurred for 65/69 CAM and 52/56 nonCAM pts. The remaining pts received either HDR monotherapy, tomotherapy, or IMRT + tomotherapy. In addition, 5/69 CAM and 2/56 nonCAM pts received hormonal therapy. CAM regimens included at least one antioxidant (range=1–7) including Green Tea Extract; Melatonin; and high-potency multivitamins. All pts were monitored ≥ 24 months post radiation therapy. Results. In the CAM cohort, median pretreatment PSA was 5.95ng; nadir PSA was 0.08ng; and last PSA was 0.18ng with median followup of 28.96 (range=24–46) months; 3 biochemical failures were seen at 6, 10 and 12 months. In the nonCAM cohort, median pretreatment PSA was 6.4ng; nadir PSA was 0.06ng; and last PSA was 0.166ng with median followup of 28.26 (range=24–43) months; 2 biochemical failures at 13 and 28 months with 1 death at 37 months were seen. Conclusion. Concomitant CAM treatment does not effect RT-mediated tumor response, control or recurrence rates in PCpts with localized disease. Neither the magnitude of the response or its durability for at least 2 years are negatively affected by CAM-based antioxidant supplements designed to improve patient tolerance and quality of life. Investigations in well-defined populations receiving consistent CAM regimens offer the opportunity to elucidate positive benefits for patient management.

No significant financial relationships to disclose.

A specific male olfactory sensillum detects behaviorally antagonistic hairpencil odorants

Within insect species, olfactory signals play a vital role in communication, particularly in the context of mating. During courtship, males of many moth species release pheromones that function as aphrodisiacs for conspecific females, or repellants to competing conspecific males. The physiology and antennal lobe projections are described of olfactory receptor neurons within an antennal sensillum present on male Heliothis virescens F. (Lepidoptera: Noctuidae) moths sensitive to conspecific male H. virescens-produced pheromone components. Olfactory receptor neurons responded to hexadecanyl acetate and octadecanyl acetate hairpencil components, and Z11-hexadecenyl acetate, an odorant used by closely related heliothine species in their female produced pheromone, which is antagonistic to male H. virescens responses. This acetate-sensitive sensillum appears homologous to a sensillum type previously described in females of this species, sharing similar physiology and glomerular projection targets within the antennal lobe. Wind tunnel observations indicate that H. virescens hairpencil odors (hexadecanyl acetate, octadecanyl acetate) function to antagonize responses of conspecific males following a female sex pheromone plume. Thus, male-male flight antagonism in H. virescens appears to be mediated by this particular sensillum type.

A Systematic Review of Worldwide Cancer Nursing Research

The aim of this study was to assess the cancer nursing research papers published in the past decade; identify their characteristics in terms of country of origin, participants, settings, diagnostic foci, and methodologic choices; and evaluate their quality. A systematic review was carried out of all published papers in the Cumulative Index of Nursing and Allied Health Literature between the years 1994 and 2003, using the keywords "cancer," "nursing," and "research." A total of 619 papers met inclusion criteria and were evaluated by 5 researchers. Almost half the papers were derived from the United States (49.1%), followed by the UK, Sweden, Canada, and Australia. In more than half of the published papers (52.2%), health professionals (mostly nurses) were the studies' participants. Also, much of the published research used patients with mixed diagnosis, or patients with breast or hematologic cancers. Two-thirds of the studies were quantitative, whereas most studies were descriptive in nature. The quality of both quantitative and qualitative studies was low, with only a small percentage meeting the highest quality criteria. Studies reporting funding and those published in journals with an impact factor showed a higher quality score than those not reporting funding or not published in journals with an impact factor. Cancer nursing research is still in a developmental stage, although it has made a considerable contribution to the evidence base of the discipline. A number of issues need to be tackled before we improve our output, such as organizational or workforce issues, infrastructure support, funding, and methodologic challenges.

GENE EXPRESSION OF STRETCH-ACTIVATED CHANNELS AND MECHANOELECTRIC FEEDBACK IN THE HEART

1. Mechanoelectric feedback (MEF) in the heart is the process by which mechanical forces on the myocardium can change its electrical properties. Mechanoelectric feedback has been demonstrated in many animal models, ranging from isolated cells, through isolated hearts to whole animals. In humans, MEF has been demonstrated directly in both the atria and the ventricles. It seems likely that MEF provides either the trigger or the substrate for some types of clinically important arrhythmias. 2. Mechanoelectric feedback may arise because of the presence of stretch-sensitive (or mechano-sensitive) ion channels in the cell membrane of the cardiac myocytes. Two types have been demonstrated: (i) a non-specific cation channel (stretch-activated channel (SAC); conductance of approximately 25 pS); and (ii) a potassium channel with a conductance of approximately 100 pS. The gene coding for the SAC has not yet been identified. The gene for the potassium channel is likely to be TREK, a member of the tandem pore potassium channel gene family. We have recorded stretch-sensitive potassium channels in rat isolated myocytes that have the properties of TREK channels expressed in heterologous systems. 3. It has been shown that TREK mRNA is expressed heterogeneously in the rat ventricular wall, with 17-fold more expression in endocardial compared with epicardial cells. This difference is reflected in the TREK currents recorded from endocardial and epicardial cells using whole-cell patch-clamp techniques, although the difference in current density was less pronounced (approximately threefold). Consistent with this, we show here that when the ventricle is stretched by inflation of an intraventricular balloon in a Langendorff perfused rat isolated heart, action potential shortening was more pronounced in the endocardium (30% shortening at 40 mmHg) compared with that in the epicardium (10% shortening at the same pressure). 4. Computer models of the mechanics of the (pig) heart show pronounced spatial variations in strain in the myocardium with large transmural differences (in the left ventricle in particular) and also large differences between the base and apex of the ventricle. 5. The importance of MEF and the non-homogeneous gene expression and strain distribution for arrhythmias is discussed.

Radiation-induced transgenerational alterations in genome stability and DNA damage

Mutation induction in directly exposed cells is currently regarded as the main component of the genetic risk of ionizing radiation for humans. However, recent data on the transgenerational increases in mutation rates in the offspring of irradiated parents indicate that the genetic risk could be greater than predicted previously. Here, we have analysed transgenerational changes in mutation rates and DNA damage in the germline and somatic tissues of non-exposed first-generation offspring of irradiated inbred male CBA/Ca and BALB/c mice. Mutation rates at an expanded simple tandem repeat DNA locus and a protein-coding gene (hprt) were significantly elevated in both the germline (sperm) and somatic tissues of all the offspring of irradiated males. The transgenerational changes in mutation rates were attributed to the presence of a persistent subset of endogenous DNA lesions (double- and single-strand breaks), measured by the phosphorylated form of histone H2AX (gamma-H2AX) and alkaline Comet assays. Such remarkable transgenerational destabilization of the F(1) genome may have important implications for cancer aetiology and genetic risk estimates. Our data also provide important clues on the still unknown mechanisms of radiation-induced genomic instability.

A prototype sourceless kinematic-feedback based video game for movement based exercise

This paper presents a prototype kinematic and audio feedback based video game, availing of a scalable motion capture acquisition system, based around a number of orientation sensors. The orientation sensors used are USB based tri-axis magnetic and gravitational field transducers. The novel video-game is capable of incorporating the real time data from these sensors to control an on screen avatar, which in turn can be programmed to give appropriate instructions to the user i.e. play a sound file, once the user obtains a certain posture. The video game is designed to promote physical exercise and movement based relaxation, in particular; yoga. In addition, design considerations; implementation and performance of the system are analyzed, discussed and the accuracy qualitatively analyzed by comparing movement data obtained from it to that of a validated motion analysis technique, the CODA motion analysis system.

Changing trends in the management of infantile hypertrophic pyloric stenosis--an audit over 11 years

BACKGROUND

This article is a follow-up to an audit performed by the Department of Surgery and published in the Irish Journal of Medical Science in 1996. This audit reviewed all cases of Infantile Hypertrophic Pyloric Stenosis (IHPS) operated on over 22 years up to 1991.

AIMS

We aim to demonstrate that radiologic investigations, namely barium meal and ultrasound, have been increasingly employed in the diagnosis of IHPS. In addition, ultrasound is now the investigation of choice.

METHODS

We have reviewed all cases of IHPS, at the same institution, over the subsequent 11 years, with reference to any radiological investigations performed. In the previous study, the diagnosis of IHPS was made clinically in 92.6% with the remainder diagnosed radiologically.

RESULTS

Over 11 years, 157 patients were diagnosed with IHPS. Male to female ratio was 4.06:1. Median age was four weeks (range 1-18 weeks).Twenty-four per cent had a barium meal, 36% had an ultrasound and 13% had both performed.

CONCLUSION

We conclude a change in practice in the management of IHPS with radiology, particularly ultrasound, playing an increasing role.

Serial pressure gradients across a thoracic coarctation of the aorta during pregnancy

Case of maternal aortic coarctation distal to the left subclavian artery followed throughout a successful pregnancy with serial echocardiography. We demonstrate changes in pressure gradients across the defect which may have management implications in similar pregnancies.

A qualitative evaluation of an adolescent cancer unit

MULHALL A., KELLY D. & PEARCE S. (2004) European Journal of Cancer Care13, 16-22 A qualitative evaluation of an adolescent cancer unit The Expert Advisory Group on Cancer (1995) recommended that cancer centres in the UK should make provision for adolescents with cancer. However, although their number is growing, only a small number of specialist adolescent cancer units currently exist, and teenagers may often be treated in more general settings. To date, no formal evaluation of adolescent cancer units has taken place. This study adopted a qualitative approach to evaluate the first specialist adolescent oncology unit, which was established in the UK 10 years ago. The aim was to provide insight into: the culture of the unit; the experiences of patients and parents on the unit and the staff who worked there; and how the unit was valued by these groups. Semi-structured interviews were conducted with 10 teenagers with cancer, 10 parents and 14 professionals. Systematic non-participant observation of routine activities in the unit was undertaken also. Interview transcripts and observational data were analysed to identify key themes and categories. Six categories emerged from the data: (1) cancer and the cancer unit: although the word cancer had negative connotations, it provided a common supportive bond for adolescents and families on the unit; (2) what it feels like over time: key points in the adolescent cancer experience were emphasized as significant. These included diagnosis, end of treatment and recurrence of cancer; (3) physical structures and facilities: these were focused around the needs of adolescents with cancer and helped to provide a suitable environment of care; (4) the social context: approaches to care were relaxed in nature and suited the needs of adolescents and their families; (5) the family: there was an emphasis on maintaining normal routines whilst managing the impact of cancer on family relationships; and (6) specialism and expertise: the availability of an expert team of professionals with specialized insight into adolescents' needs was pivotal to creating an appropriate environment of care. In conclusion, the complex care and treatment needs of adolescents with cancer may best be met by specialist units.

Delayed increase in extracellular glycerol with post-traumatic electrographic epileptic activity: support for the theory that seizures induce secondary injury

Early post-traumatic seizures occur commonly and may have adverse clinical consequences. In order to determine the significance of post-traumatic seizures, we performed a prospective assessment of the consequences of epileptic activity by assessing the change in extracellular glycerol levels. Glycerol is a marker of cellular membrane breakdown. Thirteen patients underwent combined electroencephalography (EEG) and cerebral microdialysis monitoring. Two patients had seizures on EEG with associated delayed elevations of glycerol associated with the seizure activity. Higher mean levels of glycerol were present in those patients with seizures compared to those without seizures (p < 0.001). Preliminary evidence suggests that post-traumatic seizures lead to additional membrane injury as reflected by elevated extracellular glycerol levels.

The effect of fermented liquid feeding on the faecal microbiology and colostrum quality of farrowing sows

This study investigated the effects of fermented liquid feed (FLF) on the lactic acid bacteria (LAB):Coliform (L:C) ratio in the faeces of farrowing sows and the quality of sow colostrum. Eighteen multiparous sows were randomly allocated to one of three dietary treatments for approximately 2 weeks prior to farrowing and for 3 weeks after parturition. The three dietary treatments were dry pelleted feed (DPF), nonfermented liquid feed (NFLF), and fermented liquid feed (FLF). A rifampicin-resistant mutant of Lactobacillus plantarum was used to ferment liquid feed. Coliforms and lactic acid bacteria (LAB) in the faeces of farrowing sows and piglets were estimated by standard microbiological techniques. Intestinal epithelial cells (IEC-6) and blood lymphocytes were used to evaluate the mitogenic activity of colostral samples taken at parturition. Results demonstrated that while the LAB population was not significantly affected by dietary treatment, significant differences in coliform population were observed in the sow faecal samples taken 7 days after parturition. Faeces excreted from sows fed FLF had significantly (P < 0.001) lower numbers of coliforms than sows fed NFLF or DF. Piglets from sows fed FLF excreted faeces that were higher in LAB (7.7 vs. 7.3 log10 CFU g (-1); P < 0.01) and lower in coliforms (7.5 vs. 8.1 log10 CFU g (-1); P < 0.001) than faeces from the piglets of DF-fed dams. Colostrum from sows fed FLF had a significantly greater (P < 0.001) mitogenic activity on both intestinal cells (IEC-6) (79326 +/- 3069 CPM) and blood lymphocytes (1903 +/- 204 CPM) compared with colostrum from dry feed fed sows (53433 +/- 1568 and 1231 +/- 61.4 CPM, respectively). The combined effects of enhanced maternal/passive immunity and the reduction in the level of environmental contamination with faecal pathogens, achieved by FLF, may be important in achieving improved health status for both sows and piglets.

Investigation of the effect of FK506 (tacrolimus) and cyclosporin on gingival overgrowth following paediatric liver transplantation

INTRODUCTION

Gingival overgrowth associated with immunosuppression following liver transplantation is a commonly recognized clinical problem. The aims of this study were to determine the incidence of gingival overgrowth in a group of children post liver transplantation and to compare gingival overgrowth in children receiving FK506 with those receiving cyclosporin.

METHODS

Seventy-nine children (aged 15-196 months) undergoing liver transplantation at Birmingham Children's Hospital between October 1998 and October 2000 were studied. Gingival overgrowth was assessed in a blinded fashion and scored in a previously validated manner. Gingival overgrowth scores of the patients on each immunosuppressant drug were then compared.

RESULTS

Fifty-two patients were treated with cyclosporin and 27 treated with tacrolimus. Eighteen children were also receiving nifedipine (also known to cause gingival overgrowth) and were considered separately. Of the 41 children receiving cyclosporin alone, 26 exhibited gingival overgrowth compared to zero of 20 patients receiving tacrolimus alone. Those children treated with immunosuppression plus nifedipine developed gingival overgrowth, however, this was much less marked in the tacrolimus group.

CONCLUSION

Tacrolimus, unlike cyclosporin, is not associated with gingival overgrowth when used for immunosuppression following liver transplantation in children, and may be the drug of choice for children.

Capturing the spatial percepts evoked by moving tactile stimuli: a novel approach

Forced-choice procedures are conventionally used to study the percepts evoked by stimuli that move across the skin and enable an unbiased estimation of subjects' sensory capacities. These procedures, however, require subjects to assign complicated percepts to one of a small number of experimenter-defined response categories, none of which may satisfactorily describe the perceptual experience. To address this limitation, we developed a psychophysical approach, which graphically captures spatial information about a moving stimulus in a holistic manner. Briefly summarized, the stimulus object controlled for location, velocity, direction and distance is moved across the skin of a blind-folded subject, after which the subject draws its path on a life-size, two-dimensional photograph of the body region stimulated. Using this approach, we demonstrated that the drawings contain perceptually relevant information, estimates of direction discrimination and subjective traverse length derived from the drawings closely parallel data obtained with forced-choice and magnitude estimation methods, respectively, and generate comparable psychophysical functions of stimulus velocity. In addition, information is represented in the complex shapes of the curves and in the locations at which they are drawn. Analyses of these latter features support the hypothesis that non-sensory factors (individual subject biases) also affect the drawings.

Hepatitis C-Z: recent advances

In this review, recently identified hepatitis viruses (hepatitis C, hepatitis D, hepatitis E, hepatitis F, hepatitis G, transfusion transmissible virus) are described, and the implications for paediatric liver disease discussed.

Estimation of the prevalence of diagnosed diabetes from primary care and secondary care source data: comparison of record linkage with capture-recapture analysis

STUDY OBJECTIVE

To compare multiple source linkage and capture-recapture analysis in determining the current age and gender specific prevalence of type 1 and type 2 diabetes in a UK white population. To assess whole population trends in diabetes prevalence and treatment by comparison with previous studies.

DESIGN

Data were obtained from hospital sources and all 74 general practices in the study population. Analyses were carried out both by record linkage and by use of a two source capture-recapture model to correct for incomplete ascertainment.

SETTING

County of Clwyd, North Wales: total population 418,200.

MAIN RESULTS

By record linkage the age adjusted prevalence of all diabetes was 2.04 (95% confidence intervals 2.00 to 2.09)%. Using the capture-recapture method it was 2.29 (2.24 to 2.33)%. From capture-recapture data the age adjusted prevalence of type 1 diabetes was 0.40 (0.37 to 0.43)% in men and 0.28 (0.25 to 0.30)% in women; the prevalence of type 2 was 2.03 (1.97 to 2.09)% in men and 1.67 (1.62 to 1.72)% in women. These figures represent an increase compared with previous surveys. The age specific prevalence of type 2 diabetes was greater in men in a ratio of approximately 1.5:1 and there were more patients treated by diet alone.

CONCLUSIONS

Record linkage using multiple sources underestimates the prevalence of diabetes compared with capture-recapture estimates. The results suggest the prevalence of known diabetes in the UK has approximately doubled in less than 20 years. There is an increasing preponderance of male patients and of patients treated currently with diet alone.

Feral goats in south-western Queensland: a permanent component of the grazing lands

Feral goats were harvested in south-western Queensland at four sites under two regimes (opportunistic harvesting and sustained control). We assessed how this impacted on their contribution to total grazing pressure, on soil and pasture conditions and on the economics of goat management. The population impact was not consistent across sites with the same treatment, with 62% and 84% reductions in numbers in the two northern sites (one opportunistic harvesting site and one sustained control site) while numbers in the southern sites essentially remained the same. The contribution of goats to grazing pressure ranged from 3 to 30%; kangaroos contributed 16–36%; and livestock contributed 37–72%. Harvest rates of feral goats calculated for each of the sites ranged from 17 to 41%. There was no consistent relationship between population changes and the harvest rates. Seasonal conditions had greater influence on pasture and soil conditions than did changes in feral goat populations. The average cost of mustering goats (based on 34 operations) was $1.93 per head. Mustering costs increased markedly when goat density was lower than 10/km2. Average trapping costs (based on 7 trapping programs) were $2.08 per head. This compared with on-farm prices of $16–$25 per head in 1997. Personal circumstances and preferences of individual landholders were the key determinant of the level of control undertaken. Variability in price contributed to landholders being apprehensive about the viability of the goat industry. There are few simple tools available for landholders to estimate feral goat numbers and this makes effective management of total grazing pressure difficult.

Preparing nurse managers to mentor students

AIM

To explore clinical nurse managers' perceptions of factors influencing their ability to perform their clinical leadership role.

METHOD

A random sample of 15 clinical nurse managers in four acute NHS trusts was interviewed in depth to identify and explore factors that they perceived to be helping or hindering their performance. The qualitative data were analysed to identify recurrent themes, which were used to develop a survey questionnaire that was distributed to the remaining clinical nurse managers in the four trusts (n = 152).

RESULTS

The response rate was 65 per cent (n = 99). Many of the clinical nurse managers reported poor preparation to undertake key aspects of their role and did not favour open learning as a method of continuing professional development.

CONCLUSION

The findings are of interest in the context of the new framework proposed by the English National Board (ENB) and the Department of Health for the preparation of nurse educators. Many of the findings are identical to the advisory standards set out for mentors in Preparation of Mentors and Teachers: A New Framework of Guidance (ENB and DoH 2001a). Attention to the development of clinical nurse managers, as well as new mentors, should continue to ensure that the proposed changes meet the needs of both groups.

Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data

Simulations are of particular advantage in research studies where large samples are necessary to achieve statistical power and the information must be collected under uniform conditions in order to aid interpretation. In the study reported below, simulation was achieved through the use of medical photography accompanied by case studies of the same patients. All information was collected on the same day. The purpose of the study was to determine the validity of the three pressure ulcer risk assessment scales most commonly used in clinical nursing practice in the UK. Each clinical nurse assessed the same four patients using three risk assessment scales and a visual analogue scale designed to capture their own clinical judgement. External validity was assessed by a panel of tissue viability experts who provided independent ratings. Data were obtained from 236 clinical nurses, yielding 941 risk assessments. Experience with this approach to data collection suggests that it requires careful planning. This should include measures to ensure that the simulated information is valid and that all data collectors have been adequately trained and are able to motivate the nurses participating in the study. Providing consideration is given to these issues, the use of simulation can help to collect data that would be difficult to obtain by more conventional means. It is also important to recognize that clinical decisions are de-contextualized in simulations because they are reduced to verbal and visual summaries. The decision to use simulations should thus be taken only if this is acknowledged.

Epstein-Barr virus infection in paediatric liver transplant recipients: detection of the virus in post-transplant tonsillectomy specimens

AIMS

Post-transplant lymphoproliferative disease (PTLD) is an important and serious complication in transplant patients. Recent studies have suggested that quantitative assessment of Epstein-Barr virus (EBV) infection in transplant patients might help to identify those at risk of developing PTLD. Therefore, tonsils from paediatric liver transplant recipients were studied for evidence of EBV infection.

METHODS

Tonsils were studied by in situ hybridisation for the detection of the small EBV encoded nuclear RNAs (EBERs). The phenotype of EBV infected cells was determined by double labelling in situ hybridisation and immunohistochemistry. The expression of viral latent and lytic antigens was determined by immunohistochemistry. Tonsils from patients without known immune defects were studied as controls.

RESULTS

Tonsils from transplant patients showed pronounced follicular hyperplasia and minor paracortical hyperplasia. In situ hybridisation revealed variable numbers of EBV infected B cells in the tonsils from transplant patients (range, 2-1000/0.5 cm(2); mean, 434/0.5 cm(2); median, 105/0.5 cm(2)). Lower numbers were detected in the control tonsils (range, 1-200/0.5 cm(2); mean, 47/0.5 cm(2); median, 9/0.5 cm(2)). The latent membrane protein 1 (LMP1) of EBV was not detected and there were only rare cells in two cases showing expression of the EBV encoded nuclear antigen 2 (EBNA2). There was no evidence of lytic infection. None of the patients developed PTLD within a follow up period of up to five years.

CONCLUSIONS

These data indicate that tonsillar enlargement in paediatric liver transplant patients does not necessarily imply a diagnosis of PTLD. Furthermore, the presence of increased numbers of EBV infected cells in tonsils from liver transplant recipients by itself does not indicate an increased risk of developing PTLD.

A clinical inflammatory syndrome attributable to aerosolized lipid-DNA administration in cystic fibrosis

Immunologic reactivity to lipid-DNA conjugates has traditionally been viewed as less of an issue than with viral vectors. We performed a dose escalation safety trial of aerosolized cystic fibrosis transmembrane conductance regulator (CFTR) cDNA to the lower airways of eight adult cystic fibrosis patients, and monitored expression by RT-PCR. The cDNA was complexed to a cationic lipid amphiphile (GL-67) consisting of a cholesterol anchor linked to a spermine head group. CFTR transgene was detected in three patients at 2-7 days after gene administration. Four of the eight patients developed a pronounced clinical syndrome of fever (maximum of 103.3EF), myalgias, and arthralgia beginning within 6 hr of gene administration. Serum IL-6 but not levels of IL-8, IL-1, TNF-alpha, or IFN-gamma became elevated within 1-3 hr of gene administration. No antibodies to the cationic liposome or plasmid DNA were detected. We found that plasmid DNA by itself elicited minimal proliferation of peripheral blood mononuclear cells taken from study patients, but led to brisk immune cell proliferation when complexed to a cationic lipid. Lipid and DNA were synergistic in causing this response. Cellular proliferation was also seen with eukaryotic DNA, suggesting that at least part of the immunologic response to lipid-DNA conjugates is independent of unmethylated (E. coli-derived) CpG sequences that have previously been associated with innate inflammatory changes in the lung.

Adjuvant-induced joint inflammation causes very rapid transcription of beta-preprotachykinin and alpha-CGRP genes in innervating sensory ganglia

Neuropeptides synthesized in dorsal root ganglia (DRG) have been implicated in neurogenic inflammation and nociception in experimental and clinical inflammatory arthritis. We examined the very early changes in response to adjuvant injection in a rat model of unilateral tibio-tarsal joint inflammation and subsequent monoarthritis. Within 30 min of adjuvant injection ipsilateral swelling and hyperalgesia were apparent, and marked increases in beta-preprotachykinin-A (beta-PPT-A) and alpha-calcitonin gene-related peptide (CGRP)-encoding mRNAs were observed in small-diameter L5 DRG neurones innervating the affected joint. This response was augmented by recruitment of additional small-diameter DRG neurones expressing beta-PPT-A and CGRP transcripts. The increased mRNA was paralleled by initial increases in L5 DRG content of the protein products, substance P and calcitonin gene-related peptide. Within 15 min of adjuvant injection there were increases in electrical activity in sensory nerves innervating a joint. Blockade of this activity prevented the rapid induction in beta-PPT-A and CGRP mRNA expression in DRG neurones. Increased expression of heteronuclear (intron E) beta-PPT-A RNA suggests that increases in beta-PPT-A mRNA levels were, at least in part, due to transcription. Pre-treatment with the protein synthesis inhibitor cycloheximide had no effect upon the early rise in neuropeptide mRNAS: This and the rapid time course of these changes suggest that increased sensory neural discharge and activation of a latent modulator of transcription are involved.