Use of magnetic resonance imaging in the diagnosis of upper respiratory obstruction in a calf

In a calf with dyspnea, a mass located dorsal to the pharynx was visualized by ultrasonography. Magnetic resonance imaging (MRI) revealed a severe enlargement of the left medial retropharyngeal lymph node, compatible with an abscess. This is the first reported case of MRI use in bovine upper respiratory disease.

Ultrasonographic measurement of kidney-to-aorta ratio as a method of estimating renal size in dogs

Renal size is an important parameter in the assessment of renal disease in dogs. However, because of the great variability in body conformation, absolute renal measurements cannot solely be used when evaluating kidneys with ultrasonography. The use of a ratio comparing renal length and aortic luminal diameter (K/Ao) was investigated. After confirming the reproducibility of these measurements, K/Ao ratios were obtained in 92 dogs without clinical evidence of renal disease. Left and right K/Ao ratios were statistically similar. Based on 95% confidence intervals, renal size should be considered reduced if the K/Ao ratio is < 5.5 and increased when > 9.1.

Single-slice dynamic computed tomographic determination of glomerular filtration rate by use of Patlak plot analysis in anesthetized pigs

OBJECTIVE

To compare glomerular filtration rate (GFR) as estimated from Patlak plot analysis by use of single-slice computed tomography (CT) with that obtained from clearance of plasma inulin in pigs.

ANIMALS

8 healthy anesthetized juvenile pigs.

PROCEDURES

All pigs underwent precontrast, whole-kidney, helical CT; postcontrast single-slice dynamic CT; and postcontrast, whole-kidney CT for volume determination. On dynamic images, corrected Hounsfield unit values were determined for each kidney and the aorta. A Patlak plot for each kidney was generated, and plasma clearance per unit volume was multiplied by renal volume to obtain whole-animal contrast clearance. Mean GFR determined via inulin clearance (Inu-GFR) was measured from each kidney and correlated to mean GFR determined via CT (CT-GFR) for the left kidney, right kidney, and both kidneys by use of linear regression and Bland-Altman analyses.

RESULTS

CT-GFR results from 7 pigs were valid. Total and right kidney Inu-GFR were correlated with total and right kidney CT-GFR (total, R(2) = 0.85; right kidney, R(2) = 0.86). However, left kidney CT-GFR was poorly correlated with left kidney Inu-GFR (R(2) = 0.47). Bland-Altman analysis revealed no significant bias between Inu-GFR and CT-GFR for the left kidney, right kidney, or both kidneys.

CONCLUSIONS AND CLINICAL RELEVANCE

CT-GFR as determined by use of a single-slice acquisition technique, low-dose of iohexol, and Patlak plot analysis correlated without bias with Inu-GFR for the right kidney and both kidneys (combined). This technique has promise as an accurate CT-GFR method that can be combined with renal morphologic evaluation.

Ultrasound-guided coxofemoral arthrocentesis in horses

REASON FOR PERFORMING STUDY

Coxofemoral joint pain is probably underestimated due to difficulties in identifying hip pain. The deep location of the joint and proximity of the sciatic nerve make arthrocentesis based on external landmarks a difficult and potentially risky procedure in mature horses.

OBJECTIVES

To describe an ultrasound-guided injection technique of the coxofemoral joint in standing horses and to evaluate its accuracy and potential difficulties/complications.

METHODS

Nine mature horses had both pelvic areas prepared for sterile ultrasound examination (3.5 MHz curvilinear probe). Coxofemoral joints were located and penetrated at their craniodorsolateral aspect under ultrasonographic guidance and injected with sterile contrast medium. A standing ventrodorsal radiographic view of each hemipelvis centred on the hip was obtained for each horse to assess the injection site. Horses were evaluated for 10 days following injection for possible complications.

RESULTS

Intra-articular injection was successful in all 18 joints. The procedure was well tolerated by horses under minimal restraint. Mean +/- s.d. needle repositionings required before accurate placement was 1.5 +/- 1.3 per joint. Once the needle was in the joint, synovial fluid was obtained in 7/18 joints. Minimal periarticular contrast medium was detected in 2/18 joints. Mean +/- s.d. ultrasonographic examination time required for coxofemoral localisation, accurate needle positioning and injection was 4.3 +/- 2.1 min. No complications were observed in the 10 days following injection.

CONCLUSION

The ultrasound-guided coxofemoral arthrocentesis is an accurate, reliable and safe technique that offers a real time evaluation of needle introduction into the deep and narrow coxofemoral joint space.

POTENTIAL RELEVANCE

Although this technique remains to be tested on clinical cases, it is a promising tool to facilitate diagnosis of coxofemoral pain, septic arthritis or administration of intra-articular medication.

Developing audit standards required for outbreaks of communicable diseases—lessons from a mumps outbreak

BACKGROUND

A mumps outbreak occurred in 2004-05 in England and Wales. The outbreak in the Avon area of England led to mass vaccination of 16- to 24-year-olds with the measles, mumps and rubella vaccine (MMR). The response to the outbreak was audited. Literature and web searches for audit standards were undertaken, and experts in the field were contacted. No comprehensive audit standards for outbreaks of communicable diseases were found. This article describes an approach to developing audit standards for outbreaks of communicable diseases.

METHODS

Audit standards were developed based on the memorandum of understanding between the National Health Service (NHS) and Health Protection Agency. The audit was undertaken involving 25 staff.

RESULTS

The audit standards developed identified many areas for improvement including training, strategic co-ordination, inter-organizational communication, consistency and timeliness of communication. Conducting the audit was problematic because there were not pre-defined audit standards.

CONCLUSIONS

Audit standards should be developed, which include issues relating to the structure, process and outcome of responses to outbreaks. The development of audit standards for the management of outbreaks is crucial to evaluate outbreak control and make necessary improvements.

Characterization of polymeric dispersions of dimenhydrinate in ethyl cellulose for controlled release

Granulations of dimenhydrinate (DMH) were prepared using various concentrations of ethyl cellulose (EC) by the solid dispersion technique. Characterization was done using thermal analysis, powder X-ray diffraction, infrared spectroscopy, optical microscopy and dissolution studies. Humidity studies were performed to investigate the effect of moisture on the drug and solid dispersions. It was seen that the crystalline drug was converted into its amorphous form in all the granulations. There was no chemical interaction between the DMH and EC. The thermal decomposition of drug in the granules was not affected. Dissolution studies revealed that the drug release from the granulations was significantly reduced as compared to the pure drug. As the amount of ethyl cellulose increased, the drug release rate decreased and the drug release kinetics showed a better fit to zero-order kinetics. Humidity studies showed that the drug and granulations remained stable in conditions not exceeding 70%RH. At high humidity of 100%RH, there was formation of the hydrate crystal forms of the drug in the pure drug samples and granules with 1:1 DMH-EC content whereas the granules with higher polymer content did not show any significant changes indicating better drug stability in the granules.

(99M)Tc-ciprofloxacin in imaging of clinical infections in camelids and a goat

(99M)Tc-ciprofloxacin was used to image five adult camelids and a juvenile goat with clinical and/or radiographic signs of infection. (99m)Tc-ciprofloxacin (range 10-33 MBq/kg) was injected intravenously and a series of 2-min static images were acquired at 1- and 4-h postinjection. At 24-h postinjection, 5-min static images were acquired. Only the skull or abdomen was imaged in the adults; the whole body was imaged in the goat. The quality of the 1-, 4-, and 24-h studies was evaluated subjectively. Normal and abnormal areas of (99m)Tc-ciprofloxacin uptake were recorded and subjectively graded as mild, moderate or intense. Image quality was best 4-h postinjection. Twenty-four-hour images were poor because of insufficient radioactivity. (99m)Tc-ciprofloxacin imaging resulted in true positive or true negative scans in four of six animals. Two false-negative studies occurred. Intense (99m)Tc-cirofloxacin activity was seen in the lungs and urinary bladder, moderate/intense activity in the kidneys, and mild activity in the physes/epiphyses, liver and intermittently in the gastrointestinal tract. The normal distribution of (99m)Tc-ciprofloxacin in camelids/small ruminants differed from people. Further studies to determine the sensitivity and specificity of infection detection using (99m)Tc-ciprofloxacin in animals are warranted.

Binding of ciprofloxacin labelled with technetium Tc 99m versus 99mTc-pertechnetate to a live and killed equine isolate of Escherichia coil

This paper describes a simple methodology for evaluating the bacterial binding of ciprofloxacin labelled with technetium Tc 99m. Using this methodology, the binding of 99mTc-ciprofloxacin by live Escherichia coli was compared with the binding of 99mTc-ciprofloxacin by killed E. coli and the binding of 99mTc-pertechnetate (99mTcO4-) by live E. coli. The antimicrobial effect of 99mTc-ciprofloxacin on E. coli was evaluated. Four groups were defined: live E. coli with 99mTc-ciprofloxacin, live E. coli with 99mTcO4 , killed E. coli with 99mTc-ciprofloxacin, and killed E. coli with 99mTcO4-. After 0, 2, and 4 h of incubation of 1 x 10(8) colony-forming units of E. coli suspended in 5 mL of sterile distilled water with 1.85 MBq of 99mTc-ciprofloxacin or 99mTcO4, 1 mL from each sample was centrifuged. The radioactivity of the bacterial pellet and that of the supernatant were measured separately, and the percentage of sample radioactivity attributable to bacterial binding was calculated. Of the 99mTc-ciprofloxacin, 3.6% to 5.9% was bound to live or killed E. coli; only 0.1% to 0.2% of the 99mTcO4- was bound to live E. coli (P < 0.0001). No significant difference in 99mTc-ciprofloxacin binding was found between live and killed E. coli (P = 0.887). An antimicrobial effect on E. coli was seen with 99mTc-ciprofloxacin: colony counts were reduced after 4 h. The small amount of 99mTc-ciprofloxacin binding and the lack of difference in binding between live and killed E. coli may limit the utility of this methodology in evaluating the presence of E. coli infection.

Ultrasonography of peripheral nerves in the normal adult horse

A study of the ultrasonographic appearance and size of the sciatic, tibial, peroneal, suprascapular, radial, median, and ulnar nerves and a comparison with the anatomic size and location of these nerves in the normal adult horse is reported. Cadavers and live horses were studied. Landmarks for localization and techniques for nerve identification are described. The depth and diameter of each nerve at various locations and the success rate in imaging each nerve are reported. Statistically significant correlations were found between anatomically and ultrasonographically measured nerve depths and diameters. The success rate in identifying nerves was 70% in the live horses and 49% in cadavers, with the deep peroneal nerve being the easiest to identify. Some applications of this technique in horses are discussed.

Synthesis and biological evaluation of clitocine analogues as adenosine kinase inhibitors

Adenosine kinase (AK) is the primary enzyme responsible for adenosine metabolism. Inhibition of AK effectively increases extracellular adenosine concentrations and represents an alternative approach to enhance the beneficial actions of adenosine as compared to direct-acting receptor agonists. Clitocine (3), isolated from the mushroom Clitocybe inversa, has been found to be a weak inhibitor of AK. We have prepared a number of analogues of clitocine in order to improve its potency and demonstrated that 5'-deoxy-5'-amino-clitocine (7) improved AK inhibitory potency by 50-fold.

Mechanism of termination of DNA replication of Escherichia coli involves helicase-contrahelicase interaction

Using yeast forward and reverse two-hybrid analyses, we have discovered that the replication terminator protein Tus of Escherichia coli physically interacts with DnaB helicase in vivo. We have confirmed this protein-protein interaction in vitro. We show further that replication termination involves protein-protein interaction between Tus and DnaB at a critical region of Tus protein, called the L1 loop. Several mutations located in the L1 loop region not only reduced the protein-protein interaction but also eliminated or reduced the ability of the mutant forms of Tus to arrest DnaB at a Ter site. At least one mutation, E49K, significantly reduced Tus-DnaB interaction and almost completely eliminated the contrahelicase activity of Tus protein in vitro without significantly reducing the affinity of the mutant form of Tus for Ter DNA, in comparison with the wild-type protein. The results, considered along with the crystal structure of Tus-Ter complex, not only elucidate further the mechanism of helicase arrest but also explain the molecular basis of polarity of replication fork arrest at Ter sites.

A single domain of the replication termination protein of Bacillus subtilis is involved in arresting both DnaB helicase and RNA polymerase

The current models that have been proposed to explain the mechanism of replication termination are (i) passive arrest of a replication fork by the terminus (Ter) DNA-terminator protein complex that impedes the replication fork and the replicative helicase in a polar fashion and (ii) an active barrier model in which the Ter-terminator protein complex arrests a fork not only by DNA-protein interaction but also by mechanistically significant terminator protein-helicase interaction. Despite the existence of some evidence supporting in vitro interaction between the replication terminator protein (RTP) and DnaB helicase, there has been continuing debate in the literature questioning the validity of the protein-protein interaction model. The objective of the present work was two-fold: (i) to reexamine the question of RTP-DnaB interaction by additional techniques and different mutant forms of RTP, and (ii) to investigate if a common domain of RTP is involved in the arrest of both helicase and RNA polymerase. The results validate and confirm the RTP-DnaB interaction in vitro and suggest a critical role for this interaction in replication fork arrest. The results also show that the Tyr(33) residue of RTP plays a critical role both in the arrest of helicase and RNA polymerase.

Requirement for p27(KIP1) in retinoblastoma protein-mediated senescence

In vivo and in vitro evidence indicate that cells do not divide indefinitely but instead stop growing and undergo a process termed cellular proliferative senescence. Very little is known about how senescence occurs, but there are several indications that the retinoblastoma protein (pRb) is involved, the most striking being that reintroduction of RB into RB(-/-) tumor cell lines induces senescence. In investigating the mechanism by which pRb induces senescence, we have found that pRb causes a posttranscriptional accumulation of the cyclin-dependent kinase inhibitor p27(KIP1) that is accompanied by an increase in p27(KIP1) specifically bound to cyclin E and a concomitant decrease in cyclin E-associated kinase activity. In contrast, pRb-related proteins p107 and p130, which also decrease cyclin E-kinase activity, do not cause an accumulation of p27(KIP1) and induce senescence poorly. In addition, the use of pRb proteins mutated in the pocket domain demonstrates that pRb upregulation of p27(KIP1) and senescence induction do not require the interaction of pRb with E2F. Furthermore, ectopic expression of p21(CIP1) or p27(KIP1) induces senescence but not the morphology change associated with pRb-mediated senescence, uncoupling senescence from the morphological transformation. Finally, the ability of pRb to maintain cell cycle arrest and induce senescence is reversibly abrogated by ablation of p27(KIP1) expression. These findings suggest that prolonged cell cycle arrest through the persistent and specific inhibition of cdk2 activity by p27(KIP1) is critical for pRb-induced senescence.

A new application for the Antoine equation in formulation development

Characterization of formulation components in pre-formulation and formulation studies will be made easier if a rapid method to evaluate the evaporation characteristics of an ingredient in the formulation is developed. This study aims at providing a simple and rapid thermogravimetric method for estimating the vapor pressure characteristics using the Antoine equation as the analytical tool. The heat treatment for the majority of benzoic acid derivatives follows zero-order rate processes that are in good correlation with their evaporation process. The optimum conditions for the rising temperature experiments were found when the heating rate was 10 degrees C/min in an atmosphere of dry nitrogen (100 ml/min). Methyl paraben was taken as the calibration compound since its Antoine constants are reported in the literature, and its selected thermodynamic parameters were evaluated using the Langmuir equation. The coefficient of vaporization (k macro) was determined to be 124,525+/-0.8, with units being reported in the S.I. system. The corresponding vapor-pressure plots were obtained for the remaining compounds and their Antoine constants calculated.

ABT-702 (4-amino-5-(3-bromophenyl)-7-(6-morpholinopyridin-3-yl)pyrido[2, 3-d]pyrimidine), a novel orally effective adenosine kinase inhibitor with analgesic and anti-inflammatory properties: I. In vitro characterization and acute antinociceptive effects in the mouse

Adenosine (ADO) is an inhibitory neuromodulator that can increase nociceptive thresholds in response to noxious stimulation. Inhibition of the ADO-metabolizing enzyme adenosine kinase (AK) increases extracellular ADO concentrations at sites of tissue trauma and AK inhibitors may have therapeutic potential as analgesic and anti-inflammatory agents. ABT-702 is a novel and potent (IC(50) = 1. 7 nM) non-nucleoside AK inhibitor that has several orders of magnitude selectivity over other sites of ADO interaction (A(1), A(2A), A(3) receptors, ADO transporter, and ADO deaminase). ABT-702 was 1300- to 7700-fold selective for AK compared with a number of other neurotransmitter and peptide receptors, ion channel proteins, neurotransmitter/nucleoside reuptake sites, and enzymes, including cycloxygenases-1 and -2. ABT-702 was equipotent (IC(50) = 1.5 +/- 0. 3 nM) in inhibiting native human AK (placenta), two human recombinant isoforms (AK(long) and AK(short)), and AK from monkey, dog, rat, and mouse brain. Kinetic studies revealed that AK inhibition by ABT-702 was competitive with respect to ADO and noncompetitive with respect to MgATP(2-). AK inhibition by ABT-702 was demonstrated to be reversible after 4 h of dialysis. ABT-702 is orally active and fully efficacious in reducing acute somatic nociception (ED(50) = 8 micromol/kg i.p.; 65 micromol/kg p.o.) in the mouse hot-plate assay. ABT-702 also dose dependently reduced nociception in the phenyl-p-quinone-induced abdominal constriction assay. The antinociceptive effects of ABT-702 in the hot-plate assay were blocked by the nonselective ADO receptor antagonist theophylline, and by the A(1)-selective antagonist cyclopentyltheophylline (10 mg/kg i.p.), but not by a peripherally selective ADO receptor antagonist 8-(p-sulfophenyl)-theophylline (50 mg/kg i.p.), by the A(2A)-selective antagonist 3, 7-dimethyl-1-propargylxanthine (1 mg/kg i.p.) or the opioid antagonist naloxone (5 mg/kg i.p.). Thus, ABT-702 is a novel and potent non-nucleoside AK inhibitor that effectively reduces acute thermal nociception in the mouse by a nonopioid, non-nonsteroidal anti-inflammatory drug, ADO A(1) receptor-mediated mechanism.

Rehabilitation of a person with severe traumatic brain injury

A case study report of a long and intensive rehabilitation programme for a young woman after she sustained a severe diffuse axonal injury in a motor vehicle accident is described in detail. The purpose of this paper is to encourage specialist brain injury rehabilitation services to offer extended rehabilitation programmes to patients, even with very severe injuries. Significant functional improvements and enhanced quality of life frequently reward the high cost and hard work involved.

Good design practice for medical devices and equipment, Part II: Design for validation

Medical devices and their associated process equipment must be reliable and fit for purpose. In light of the recent changes to the medical device regulations, manufacturers must now take an integrated approach to design, development and validation. Good design practice encourages this integrated approach while ensuring fitness for purpose within commercial reality. A review of current literature related to good design practice carried out in Part I of this paper showed that there is inadequate guidance regarding the integration of validation with design. This paper proposes a practical approach to design for validation aimed at making devices easier and more economic to validate. The approach comes in the form of a model of design for validation that illustrates the basic relationship between design, development and validation and a series of design tactics that were formulated in order to help designers take a more proactive approach to validation during design.

The use of conjoint analysis to elicit community preferences in public health research: a case study of hospital services in South Australia

AIMS

To demonstrate the use of conjoint analysis (CA) in public health research through a survey of the South Australian community about aspects of their public hospital services.

METHODS

A series of focus groups determined the most important attributes in choice of hospital services. These were built into a CA survey, using the discrete choice approach. The survey was posted to a representative sample of 700 South Australians. Theoretical validity, internal consistency and non-response bias were all investigated.

RESULTS

Some 231 individuals returned the questionnaire. The attribute, 'improvement in complication rates' was positively associated with choice of hospital. Three attributes were found to be negatively associated with such choice: 'waiting times for casualty', 'waiting times for elective surgery' and, anomalously, 'parking and transport facilities'. 'Travel time' and the cost attribute, 'Medicare levy' were not statistically significant. Trade-offs between the significant attributes were estimated, as were satisfaction or utility scores for different ways of providing hospital services. Results concerning internal consistency and internal validity were encouraging, but some potential for non-response bias was detected.

CONCLUSION

A high premium is placed on the quality of hospital care and members of the community are prepared to choose between hospitals largely on the basis of outcomes and length of waiting times for elective surgery and in casualty.

IMPLICATIONS

CA can yield potentially policy-relevant information about community preferences for health services.

Good design practice for medical devices and equipment, Part I: A review of current literature

Changes to the medical device regulations within the past few years have forced medical device manufacturers to take an integrated approach to design and validation in order to ensure that their products are reliable and fit for purpose. Good design practice encourages fitness for purpose within commercial reality. This paper contains a review of the current literature that is relevant to good design practice. The results show that there is inadequate guidance regarding the integration of validation with design. Thus, there is a need for good design practice to include 'design for validation' which is aimed at designing medical devices to make them easier and more economic to validate. Research has been carried out at the Cambridge Engineering Design Centre in order to develop an approach that provides guidance in order to help designers achieve integrated design, development and validation. This will be reported in part II of this paper.