Supercritical carbon dioxide generated vascular endothelial growth factor encapsulated poly(DL-lactic acid) scaffolds induce angiogenesis in vitro

The ability to deliver, over time, biologically active vascular endothelial growth factor-165 (VEGF) through tailored designed scaffolds offers tremendous therapeutic opportunities to tissue-engineered therapies. Porous biodegradable poly(DL-lactic) acid (PLA) scaffolds encapsulating VEGF have been generated using supercritical CO2 (scCO2) and the kinetic release and angiogenic activity of these scaffolds examined in vitro and in an ex vivo chick chorioallantoic membrane (CAM) angiogenesis model. After processing through scCO2, VEGF maintained its angiogenic activity as assessed by increased tubule formation of human umbilical vein endothelial cells (HUVEC) cultured on Matrigel (VEGF = 1937 +/- 205 microm; scCO2-VEGF = 2085 +/- 234 microm; control = 1237 +/- 179 microm). VEGF release kinetics from scCO2-VEGF incorporated PLA monolith scaffolds showed a cumulative release of VEGF (2837 +/- 761 rhog/ml) over a 21 day period in culture. In addition, VEGF encapsulated PLA scaffolds increased the blood vessel network in the CAM compared to controls; control, 24.8 +/- 9.6; VEGF/PLA, 44.1 +/- 12.1 (vessels/field). These studies demonstrate that the controlled release of growth factors encapsulated into three-dimensional PLA scaffolds can actively stimulate the rapid development of therapeutic neovascularisation to regenerate or engineer tissues.

Differential sensitivity of flounder (Platichthys flesus) in response to oestrogenic chemical exposure: an issue for design and interpretation of monitoring and research programmes

This study was conducted as an initial investigation of 'differential response' in one of the main sentinel organisms used for monitoring programmes in United Kingdom estuaries, the flounder Platichthys flesus. It has been hypothesised that monitoring using species with a wide geographical spread and limited migration, such as flounder, might result in the comparison of different genetic stocks and certainly of populations with differing early life stage contaminant exposure histories. Furthermore, it is probable that these pre-exposure and genetic differences could manifest themselves in an ability to respond differently to contaminant exposure, so-called 'differential response'. It is important that the extent and nature of this response is understood, if we want to be able to fully interpret the monitoring data from such programmes. During this study, flounder were collected from four separate sources; wild caught fish from the estuaries of the Rivers Alde, Mersey and Tyne, and farmed flounder from Port Erin Farm, Isle of Man. Under controlled laboratory conditions, groups of fish from each source were exposed to water-borne concentrations of the synthetic oestrogen ethynylestradiol (EE2) at a nominal concentration of 50 ng/l. Plasma was taken from each male fish after 6 and 10 days exposure and analysed for the presence of vitellogenin (VTG) using an ELISA technique. Significant levels of VTG induction were evident in fish from all sources after both 6 and 10 days exposure. Flounder from the Mersey were the only fish with significantly elevated initial background levels of VTG (day 0) and this appeared to be reflected in that these specimens showed the highest induction response after day 6. However, after day 10, fish from all other sites had a slightly higher mean VTG than those from the Mersey which showed significantly (p < 0.05) lower mean plasma VTG. It is suggested that other differential responses may have been masked by the use of a high dose of EE2 which produced maximum induction in nearly all fish. The findings of the study are discussed in terms of implications for further research into the differential response issue and how the initial plasma VTG figures contribute to a time-series from the Mersey, Tyne and Alde estuaries.

HIV infection among heroin users and area of residence

The aim of this study was to develop a hypothesis to explain the link between HIV prevalence and area of residence. The study was conducted in two parts using two existing data sources. In Part 1, the bloodborne viral test status and test results of a sample of clients attending treatment in December 2001 in two areas of Dublin, an inner city area (Dublin 8) and a suburban area (Dublin 24), were extracted from the Bloodborne Viral Status Dataset created by Grogan. In Part 2 the characteristics of heroin users seeking treatment for the first time at treatment services in their respective areas of residence, Dublin 8 or Dublin 24, between 1997 and 2000 were examined, using data from the National Drug Treatment Reporting System. A higher proportion of heroin users in Dublin 8 had HIV and hepatitis C than did their counterparts in Dublin 24. The analysis suggests that heroin users in Dublin 8 were more likely both to have ever used cocaine and to have used heroin daily, than were those who lived in Dublin 24. Also, a higher proportion of injectors living in Dublin 8 used heroin and cocaine concurrently than did their counterparts in Dublin 24. In both samples, heroin users who lived in Dublin 8 were older than those who lived in Dublin 24. The findings led to a hypothesis:'The risk of acquiring HIV is associated with area of residence and may be linked to cocaine use.

Exploring the use of caged Nucella lapillus to monitor changes to TBT hotspot areas: a trial in the River Tyne estuary (UK)

Caged dogwhelks (Nucella lapillus) and mussels (Mytilus edulis) were placed in situ at sites along the River Tyne (UK) in order to investigate the potential for monitoring any change in tributyltin (TBT) mediated effects. After 6 months the development of imposex was investigated in the dogwhelks and concentrations of TBT were determined in the whole tissues of both species. Sites within the estuary showed a high degree of imposex, whilst those at sites North and South of the estuary mouth exhibited significantly lower induction. Concentrations of TBT measured in the dogwhelk and mussel tissues showed the same pattern. The success of the caging technique, occurrence of imposex at other UK sites and the need for further monitoring at TBT impacted locations in the light of current international controls on the use of TBT-based antifouling paints on sea-going vessels are discussed.

Completeness and accuracy of the drug treatment reporting system in Dublin, Ireland

BACKGROUND

The National Drug Treatment Reporting System (NDTRS) is the Irish treated-drug misuse surveillance system.

AIM

To measure completeness and accuracy of the NDTRS.

METHODS

Cross-sectional survey of clinical records and matching NDTRS reporting forms of a random sample of 520 clients attending 4 Dublin treatment centres. Using clients' clinical records as the gold standard, system completeness (proportion of sample reported to the NDTRS) and accuracy of selected variables (proportion of reported clients' information on the NDTRS that matched clinical record information) were measured.

RESULTS

452/520 (87%) selected records were retrieved. The NDTRS was only 61.1% (95% CI 56.5-65-5) complete; completeness differed across treatment centres (21.8%-85.6%, p < 0.0001) and was greater for new and returning clients than for continuing clients (81.7% versus 53.9% respectively, p < 0.0001). Problems were identified with the accuracy of some key variables.

CONCLUSIONS

Urgent actions have been taken to improve the completeness and accuracy of the reporting system.

The management of basal cell carcinomas

The mortality and morbidity associated with basal cell carcinoma (BCC) is low. However, BCCs represent a significant burden to the health service due to their high and increasing incidence. This audit was designed to examine the management of BCCs by a dermatology department and to highlight deficiencies in the service offered to patients. The mean intervals between the first dermatology clinic visit and definitive treatment by the dermatology and the plastic surgery departments were 62 and 129 days respectively. Factors contributing to the delay included the frequent use of diagnostic incisional biopsies and the high referral rate from dermatology to the department of plastic and reconstructive surgery. In 90% of cases the dermatologist made an accurate clinical diagnosis. Despite this, diagnostic biopsies were performed in 72% of cases, often necessitating additional hospital visits. Forty three percent of cases were treated definitively by dermatology, whereas over 50% were referred to the department of plastic surgery. A number of changes are planned or are in process as a consequence of the audit.

Levels of the flame retardants hexabromocyclododecane and tetrabromobisphenol A in the blubber of harbor porpoises (Phocoena phocoena) stranded or bycaught in the U.K., with evidence for an increase in HBCD concentrations in recent years

Within the U.K. Marine Mammals Stranding Program, analysis of brominated flame retardants began in 1999. Initially, the focus of attention was the brominated diphenyl ethers. Since the withdrawal of the pentamix and octamix polybrominated diphenyl ether (PBDE) formulations from the EU market prior to August 2004, two other high-volume products, hexabromocyclododecane (HBCO) and tetrabromobisphenol A (TBBP-A), have been included. We report the concentrations of these compounds in the blubber of harbor porpoises (Phocoena phocoena) stranded or dying due to physical trauma in the U.K. during the period 1994-2003. Analysis was undertaken using LC/MS method on a diastereoisomer basis. Eighty-five samples were analyzed for HBCD, and 68 of these for TBBP-A. alpha-HBCD dominated over the other isomers and was detected in all samples analyzed at concentrations ranging from 10 to 19 200 microg kg(-1) wet weight. The maximum concentration was about double that reported in earlier U.K. studies. TBBP-A was detected in only 18 samples and at much lower concentrations, from 6 to 35 microg kg(-1) wet weight. Investigation of possible time trends indicated a sharp increase in HBCD concentrations from about 2001 onward, which was not confounded by age (length), sex, nutritional status, or location. This may be a result of changing patterns of use of HBCD following limitations on the production and use of two PBDE formulations within the EU and will feed ongoing risk assessment activities.

Case report:DNA testing resolves unusual results in the Dombrock system

Typing for antigens in the Dombrock blood group system and identifying the corresponding antibodies are notoriously difficult tasks. The reagents are scarce and the antibodies are weakly reactive. When RBCs from family members of a patient with an antibody to a high-prevalence Dombrock antigen were tested for compatibility,an unusual pattern of inheritance was observed:RBCs from the patient's children and one niece, in addition to those from some of the patient's siblings,were compatible. This prompted the performance of DNA-based assays for DO alleles and the results obtained were consistent with and explained the compatibility test results. It was possible to study this large kindred because of the cooperation of family members, hospital personnel, and reference laboratory staff.

Epidemiological findings and medical, legal, and public health challenges of an investigation of severe soft tissue infections and deaths among injecting drug users -- Ireland, 2000

In May 2000, public health authorities in Dublin, Ireland, identified a cluster of unexplained severe illness among injecting drug users (IDUs). Similar clusters were also reported in Scotland and England. Concurrent investigations were undertaken to identify the aetiology and source of the illnesses. In Dublin, 22 IDUs were identified with injection-site inflammation resulting in hospitalization or death; eight (36%) died. Common clinical findings among patients with severe systemic symptoms included leukaemoid reaction and cardiogenic shock. Seventeen (77%) patients reported injecting heroin intramuscularly in the 2 weeks before illness. Of 11 patients with adequate specimens available for testing, two (18%) were positive by 16S rDNA PCR for Clostridium novyi. Clinical and laboratory findings suggested that histotoxic Clostridia caused a subset of infections in these related clusters. Empiric treatment for infections among IDUs was optimized for anaerobic organisms, and outreach led to increased enrolment in methadone treatment in Dublin. Many unique legal, medical, and public health challenges were encountered during the investigation of this outbreak.

Using HIPE data as a research and planning tool: limitations and opportunities

BACKGROUND

The Hospital Inpatient Enquiry (HIPE) system is an important information source for research and health service planning activities. However, as it was not designed explicitly for these purposes, some limitations exist.

AIMS

To make recommendations that would increase the value of HIPE as a research and planning tool.

METHODS

Experiences of using HIPE for research and planning exercises were analysed so as to identify its limitations and their impact on research and planning.

RESULTS

Limitations were identified regarding data quality, policy issues and the general system.

CONCLUSIONS

To increase the utility of HIPE as a research and planning tool, a number of changes are recommended, including: expanding the system to cover private hospitals and outpatient and emergency services; adopting routine small area and socio-economic coding; adopting unique personal identifiers; publishing regular detailed reports with in-depth analyses; and considering making hospital identifiers available in certain circumstances.

Could your case of necrotising fascitis be Pyoderma gangrenosum?

Necrotising fascitis is a fulminant infective process which can result in significant morbidity and can indeed be life threatening. It needs to be recognised early and managed aggressively with extensive surgical debridement followed by appropriate antibiotics. On the other hand, Pyoderma gangrenosum is a disease process that needs to be managed non-surgically. We present one such case, the diagnosis of which had treaded along the thin line between the two.

Hepatitis C among drug users: consensus guidelines on management in general practice

BACKGROUND

Hepatitis C (HCV) is a common cause of morbidity among patients who attend general practitioners (GPs) in Ireland for methadone maintenance treatment.

AIMS

To describe the development and content of guidelines for the management of HCV among current or former opiate users in the Eastern Regional Health Authority area attending GPs for methadone treatment.

METHODS

The guidelines were produced in five stages: identification of key stakeholders; development of evidence-based draft guidelines; discussion of content; determination of 'Delphi'-facilitated consensus and review by a sample of GPs for whom the guidelines would be intended.

RESULTS

The guidelines contain advice for GPs on all aspects of care of patients at risk of HCV, including general and preventative care, care of other bloodborne and hepatotoxic viruses, and the factors to be considered and appropriate evaluation prior to referring a patient for assessment at a hepatology unit.

CONCLUSIONS

GPs have an important role to play in the care of patients at risk of, or infected with, HCV.

The potential impact on travel times of closure and redistribution of A&E units in Ireland

Modelling has been used to estimate variations in travel time to Accident & Emergency (A&E) Departments for Acute Myocardial Infarction (AMI) and Road Traffic Accidents (RTA), taking into account three different distributions of A&E departments in the country. We have modelled three scenarios: current, the current distribution of A&E Departments; intermediate, two A&E Units for some Health Boards and one for others; and extreme, one A&E Department for each of the 10 Health Boards. The percentage of travel times that fall within an hour for AMI and RTA for the three scenarios (current, intermediate and extreme) are 85.6, 82.8, 70.0 and 81.8, 85.2, 71.8 percent respectively. While a redistribution of A&E Departments seems inevitable, a sensible modelling approach can be used to plan the new distribution of services to maintain equitable geographic access.

A 5-microm filter does not reduce propofol-induced pain

We assessed the effectiveness of a 5-microm filter in reducing propofol-induced pain and determined whether any reduction is due to removal of contaminants or an alteration in flow characteristics. A total of 120 unpremedicated women (ASA 1-3, aged 18-70 yr) were randomly allocated to one of three equal-sized groups. In group A, propofol was drawn up and injected through an unfiltered plastic cannula. In group B, propofol was drawn up through a 5-microm filter needle and injected through an unfiltered plastic cannula. In group C, propofol was drawn up and injected through a 5-microm filter needle. Unmodified propofol from a 20-ml rubber topped vial at room temperature was used. A 22-g cannula was inserted into the largest visible vein on the dorsum of the non-dominant hand. Propofol was administered at 0.5 ml.s-1 and patients were asked about pain every 10 s until unresponsive, by a blinded observer. The pain score for the patient was the taken as the most severe pain documented. The frequency and severity of pain were similar among groups. We conclude that a 5-microm filter does not reduce pain associated with injection of propofol drawn from a vial with a rubber bung.

Molecular characterization of the presence of Eubacterium spp and Streptococcus spp in endodontic infections

Eubacterium spp. and Streptococcus spp. are virulent, commonly identified microorganisms in endodontic infections. The purpose of this study was to use molecular methods to identify these organisms in 22 infected root canals that include eight cases with preoperative clinical symptoms and five cases with a history of diabetes mellitus. The presence of Streptococcus spp. and Eubacterium spp. was examined using two sets of PCR primers specific with multiple species within the respective genera. Positive specimens had their PCR products sequenced and phylogenetically analyzed to identify the specific species. Sixteen specimens (73%) contained Eubacterium spp. and nine (41%) were positive for Streptococcus spp. Eubacterium infirmum was the most prevalent Eubacterium sp. This organism was significantly associated with a history of diabetes (OR = 9.6; P = 0.04). Streptococcus anginosus was the most common Streptococcus sp., but neither it nor any of the other streptococci were significantly associated with the clinical parameters evaluated.

Hepatitis C infection among drug users attending general practice

BACKGROUND

The prevalence of hepatitis C (HCV) infection among injection drug users is high and addiction-related care is increasingly being provided by GPs in Ireland.

AIMS

To determine the prevalence and associated factors of HCV infection among injecting drug users attending general practice.

METHODS

The records of 571 patients attending 42 general practices in the Eastern Regional Health Authority (ERHA) area for methadone maintenance treatment were reviewed.

RESULTS

The HCV status was recorded in 380 cases (67%). Of these, 193 had a test performed by their GP, 74 had been tested by another service and 113 had no evidence of being tested, but HCV status was recorded based on information provided by the patient himself. A total of 276 cases were identified as being HCV positive (prevalence 73%), with no difference in prevalence between the three sources of information (p = 0.12). A history of injecting drug use was the major determinant of testing for HCV.

CONCLUSIONS

While a large proportion of drug users attending GPs for methadone maintenance treatment are known to be HCV positive, a considerable number have not been tested. Barriers to testing need to be explored to facilitate comprehensive screening.

Comparative evaluation of the VITEK 2 Advanced Expert System (AES) in five UK hospitals

OBJECTIVES

We carried out an evaluation of VITEK 2 in five UK laboratories, comparing results with 'gold standard' agar-dilution MIC data, assessing its ability to recognize resistant phenotypes and comparing results with those generated by routine antimicrobial susceptibility testing methods.

METHODS

Laboratories tested a collection of 82 strains selected on the basis of their challenging and characterized resistance mechanisms.

RESULTS

In comparison with the reference MIC method, VITEK 2 gave an essential agreement of 304/315 (enterococci), 1619/1674 (staphylococci) and 2937/3074 (Gram-negative bacilli): overall 96.0% agreement. Corresponding category (SIR) agreements with VITEK 2 were 247/252, 1496/1561 and 2478/2626 (overall 95.1%). Using five routine methodologies, category agreements ranged from 58/63 to 45/45; 222/232 to 174/174, and 333/372 to 250/259 for the three organism groups with an overall agreement of 95.0%. In contrast to VITEK 2 Advanced Expert System (AES), routine microbiology laboratories did not attempt to detect resistance mechanisms for every antibiotic studied. VITEK 2 AES detected all 19 resistance mechanisms in enterococci: where applicable, routine methods detected 14, 10 and 10. Of 30 resistance mechanisms in staphylococci, VITEK 2 AES detected 25 compared with 23, 20, 17 and 18 detected by routine methods. Finally, of 44 resistance mechanisms in Gram-negative bacilli, VITEK 2 AES detected 30 compared with 30, 23, 15 and 10 detected by routine methods.

CONCLUSIONS

VITEK 2 performed susceptibility tests accurately and the AES detected and interpreted resistance mechanisms appropriately. Heavy inocula in a liquid medium possibly favour better expression of certain resistance determinants. Although certain routine microbiology methods performed adequately, VITEK 2 AES offers a rapid, standardized method suited to laboratories lacking experience of resistance mechanisms and/or those not testing an appropriate number, or range, of antibiotics to detect resistance phenotypes.