The outcome of computed tomography in patients with acute renal colic from a low-volume hospital

OBJECTIVE

To assess the interobserver variability of unenhanced helical computed tomography (UHCT) in patients with acute renal colic admitted into a low-volume hospital.

MATERIALS AND METHODS

All admissions with acute renal colic between August 2002 and February 2004 (18 months) were registered. A total of 133 CT scans were performed on patients suspected of having a stone in the urinary tract (< 24 h after admission). All records were subsequently evaluated, the acute CT scans were re-evaluated by a radiological specialist. Interobserver agreements were assessed by means of Kappa analysis.

RESULTS

A total of 133 consecutive patients met the criteria for inclusion, of whom 62 were women and 71 were men. A total of 67 stones in 53 patients were identified. The variability of the radiological diagnosis (doctors under training and one consultant) was calculated, and the Kappa values were +0.66 and +0.69 for stones on the right and left side, respectively. The Kappa values for stones in ureter and the kidney were +0.79 and +0.52, respectively. In addition to stone disease, there were additional diagnoses in 30 patients (23%), out of whom seven had a malignant tumor.

CONCLUSION

In a low-volume hospital with fewer than 100 procedures a year, we found the UHCT method to be safe and reliable with a good interobserver agreement and Kappa value.

Cyclooxygenase-2 inhibition: effects on tumour growth, cell cycling and lymphangiogenesis in a xenograft model of breast cancer

Cyclooxygenase-2 (COX-2) is associated with poor-prognosis breast cancer. We used a nude mouse xenograft model to determine the effects of COX-2 inhibition in breast cancer. Oestrogen receptor (ER)-positive MCF7/HER2-18 and ER-negative MDAMB231 breast cancer cell lines were injected into nude mice and allowed to form tumours. Mice then received either chow containing Celecoxib (a COX-2 inhibitor) or control and tumour growth measured. Tumour proliferation, apoptosis, COX-2, lymphangiogenesis and angiogenesis were assessed by immunohistochemistry (IHC), Western blotting or Q-PCR. Celecoxib inhibited median tumour growth in MCF7/HER2-18 (58.7%, P=0.029) and MDAMB231 (46.3%, P=0.0002) cell lines compared to control. Cyclooxygenase-2 expression decreased following Celecoxib treatment (MCF7/HER2-18 median control 65.3% vs treated 22.5%, P=0.0001). Celecoxib increased apoptosis in MCF7/HER2-18 tumours (TUNEL 0.52% control vs 0.73% treated, P=0.0004) via inactivation of AKT (median pAKT^ser473 57.3% control vs 35.5% treated, P=0.0001 – confirmed at Western blotting). Q-PCR demonstrated decreased podoplanin RNA (lymphangiogenesis marker) in the MCF7/HER2-18 – median 2.9 copies treated vs 66.6 control (P=0.05) and MDAMB231-treated groups – median 160.7 copies vs 0.05 control copies (P=0.015), confirmed at IHC. Cyclooxygenase-2 is associated with high levels of activated AKT^ser473 and lymphangiogenesis in breast cancer. Cyclooxygenase-2 inhibition decreases tumour growth, and may potentially decrease recurrence, by inactivating AKT and decreasing lymphangiogenesis.

Hepatitis C virus infection in Scotland: epidemiological review and public health challenges

INTRODUCTION

In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) "is one of the most serious and significant public health risks of our generation".

METHODS

To appreciate the prevention and care challenges posed by HCV in Scotland, we reviewed all country-specific data on i) the prevalence of infection among different populations, ii) the numbers infected with HCV, and iii) the current and future HCV disease burden.

RESULTS

An estimated 1% of Scotland's population has HCV; 85-90% of those infected were injecting drug users (IDUs). Reductions in HCV prevalence among young IDUs during the early 1990s suggest that the incidence of HCV had decreased; since then, the absence of further reductions highlight that existing prevention measures are insufficient. Two-thirds of the estimated 37,500 chronically HCV-infected individuals in Scotland remain undiagnosed and two-thirds of this group are former IDUs. An estimated 9,000 former IDUs were living with either moderate or severe HCV disease in 2004; if the current uptake of antiviral therapy continues, this number was estimated to double by 2016. Approximately 1,200 HCV-infected IDUs had developed liver failure by 2004; this figure was predicted to increase to 3,200 by 2020.

CONCLUSIONS

Scotland faces three principal public health challenges: i) the prevention of HCV among current IDUs, ii) the diagnosis of HCV-infected persons, particularly those most in need of therapy to prevent severe HCV disease, and iii) the current and future provision of adequate resources to ensure that the movement of patients through the diagnostic and clinical care pathway is optimal.

Evaluation of a model for maximizing interprofessional education in an acute hospital

A one-year planning phase established a rolling programme of bi-monthly interprofessional clinical teaching workshops derived directly from patient experiences in an acute hospital. Pre-registration healthcare students from 8 professions spent an afternoon in the hospital training centre, randomly allocated to one of 6-8 small working groups. Using a problem-based methodology they analysed a ward case with patient consent, chosen to reflect the input of a wide range of health professionals. Students worked through a prepared workbook facilitated by a range of tutors from all disciplines. Each small group reported back on one aspect of team working to the entire cohort entering into debate and discussion with the support of clinical and academic tutors. Post course patient details were found on a website enabling students to progress their uni-professional knowledge, e.g., on anatomy, physiology, pharmacology etc. The questionnaire evaluation on over 126 students and 11 tutors identified that interprofessional competencies were understood and valued. Students related principles of team working and collaborative practice to their placement experiences of team work. Interactive learning enables further appreciation of professions roles and responsibilities and the importance of teamwork to optimize patient care (82.0 - 90.5%). The half-day learning model can be easily supported by busy clinical staff, led by hospital educators and accessed by students on hospital placements, at a mid-point in training, with learning supported by consenting in-patients or recent admissions prepared to share their experiences.

Effects of oestrogens and anti-oestrogens on normal breast tissue from women bearing BRCA1 and BRCA2 mutations

There is considerable interest in whether anti-oestrogens can be used to prevent breast cancer in women bearing mutations in the BRCA1 and BRCA2 genes. The effects of oestradiol (E₂), tamoxifen (TAM) and fulvestrant (FUL) on proliferation and steroid receptor expression were assessed in normal breast epithelium taken from women at varying risks of breast cancer and implanted into athymic nude mice, which were treated with E₂ in the presence and absence of TAM or FUL. Tissue samples were taken at various time points thereafter for assessment of proliferative activity and expression of oestrogen and progesterone receptors (ERα and PgR) by immunohistochemistry. Oestradiol increased proliferation in the breast epithelium from women carrying mutations in the BRCA1/2 genes, those otherwise at increased risk and those at population risk of breast cancer. This increase was reduced by both TAM and FUL in all risk groups. In the absence of E₂, PgR expression was reduced in all risk groups but significantly more so in the BRCA-mutated groups. Subsequent E₂ treatment caused a rapid, complete induction of PgR expression in the population-risk group but not in the high-risk or BRCA-mutated groups in which PgR induction was significantly delayed. These data suggest that the mechanisms by which E₂ induces breast epithelial PgR expression are impaired in BRCA1/2 mutation carriers, whereas those regulating proliferation remain intact. We conclude that early anti-oestrogen treatment should prevent breast cancer in very high-risk women.

An innovative method for counting females of soybean cyst nematode with fluorescence imaging technology

Use of resistant cultivars is one of the major tactics for combating soybean cyst nematode, Heterodera glycines Ichinohe, which is the most destructive pathogen affecting soybean seed production. However, developing new H. glycines-resistant soybean cultivars is a very labor-intensive process, partially due to the lack of a quick method for counting the H. glycines females that develop on soybean roots. We have developed a fluorescence image-based system for counting females on excised seedling roots cultured on nutrient media in petri dishes. In this system, the females fluoresced when exposed to a wavelength of 570 nm. The fluorescent images were captured with a digital camera, transferred to a computer, and displayed on a monitor. The image of an entire sample was viewed at once, and the fluorescing females were counted manually. This system significantly improved the efficiency and accuracy of counting females developed on cultured seedling roots compared to a microscope counting method. The potential for applications in the screening of nematode-resistant crops is discussed.

Coregistration of quantitative proton magnetic resonance spectroscopic imaging with neuropathological and neurophysiological analyses defines the extent of neuronal impairments in murine human immunodeficiency virus type-1 encephalitis

Relatively few immune-activated and virus-infected mononuclear phagocytes (MP; perivascular macrophages and microglia) may affect widespread neuronal dysfunction during human immunodeficiency virus type 1 (HIV-1)-associated dementia (HAD). Indeed, histopathological evidence of neuronal dropout often belies the extent of cognitive impairment. To define relationships between neuronal function and histopathology, proton magnetic resonance spectroscopic imaging (1H MRSI) and hippocampal long-term potentiation (LTP) were compared with neuronal and glial immunohistology in a murine model of HIV-1 encephalitis (HIVE). HIV-1(ADA)-infected human monocyte-derived macrophages (MDM) were stereotactically injected into the subcortex of severe combined immunodeficient (SCID) mice. Sham-operated and unmanipulated mice served as controls. Seven days after cell injection, brain histological analyses revealed a focal giant cell encephalitis, with reactive astrocytes, microgliosis, and neuronal dropout. Strikingly, significant reductions in N-acetyl aspartate concentration ([NAA]) and LTP levels in HIVE mice were in both injected and contralateral hemispheres and in brain subregions, including the hippocampus, where neuropathology was limited or absent. The data support the importance of 1H MRSI as a tool for assessing neuronal function for HAD. The data also demonstrate that a highly focal encephalitis can produce global deficits for neuronal function and metabolism.

Temporally distinct Escherichia coli 0157 outbreaks associated with alfalfa sprouts linked to a common seed source--Colorado and Minnesota, 2003

Escherichia coli O157 outbreaks were identified in Minnesota in February 2003 involving seven persons and in Colorado in July 2003 involving 13 persons. Case isolates from the two states had matching pulsed-field gel electrophoresis (PFGE) patterns. Independent case-control studies linked infections in each outbreak with eating alfalfa sprouts that were traced to the same seed distributor. The Colorado sprouter reportedly complied with the Food and Drug Administration (FDA) sprout guidance, whereas the Minnesota sprouter did not. These investigations revealed that increased compliance with existing FDA guidance is needed and that additional research is needed to improve the alfalfa seed decontamination process. This reaffirms the FDA recommendation that raw alfalfa sprouts should be considered potentially contaminated and avoided by persons at high-risk such as the elderly, young children, and immunocompromised persons. PFGE played an essential role in linking these two temporally and geographically distinct E. coli O157 outbreaks.

Reflection mode imaging with nanoscale resolution using a compact extreme ultraviolet laser

We report the demonstration of reflection mode imaging of 100 nm-scale features using 46.9 nm light from a compact capillary-discharge laser. Our imaging system employs a Sc/Si multilayer coated Schwarzschild condenser and a freestanding zone plate objective. The reported results advance the development of practical and readily available surface and nanostructure imaging tools based on the use of compact sources of extreme ultraviolet light.