Outbreak of adenovirus genome type 7d2 infection in a pediatric chronic-care facility and tertiary-care hospital

An outbreak of adenovirus infection that involved residents of a pediatric chronic-care facility, staff of a tertiary-care hospital, and a nosocomial hospital case was studied. In the pediatric facility, 31 (33%) of 93 residents had adenovirus infection, and 8 died. Risk factors for illness were an age of < 7 years (P = .004), presence of a tracheostomy (P = .015), and residence on a particular floor (P < .001). In the tertiary-care hospital, 36 health care workers had adenovirus infection; 26 (72%) had failed to follow strict contact and droplet precautions, and 30 (83%) continued to care for patients while they had symptoms. A 5-month-old patient with underlying lung disease acquired severe adenovirus infection in this hospital. All isolates were adenovirus type 7 (Ad7). DNA restriction analysis revealed the band patterns of all isolates to be identical and characteristic of the genome type d2. Thus, Ad7d2 caused significant morbidity and mortality in persons in the pediatric chronic-care facility and tertiary-care hospital. This is the first published description of Ad7d2 strains in the United States.

An imidazoline pseudodipeptide suitable for solid phase peptide synthesis

This paper describes the synthesis of two diastereoisomers of an imidazoline dipeptide mimetic (a 4,5 dihydroimidazole-4-carboxylic acid), suitably protected for incorporation into solid phase peptide synthesis (SPPS) using the Fmoc protocol, from a phenylalanine-derived thioimidate and an alpha,beta-diaminopropanoic acid ester, followed by protecting group manipulation.

Peptide specificity of RT1-A1(c), an inhibitory rat major histocompatibility complex class I natural killer cell ligand

The rat major histocompatibility complex class Ia allelomorph RT1-A1(c) is a potent ligand for the recently identified inhibitory rLy-49 receptor, STOK-2. With the ultimate objective of studying the interactions of these molecules using structural and functional methods, we undertook a detailed study of its peptide specificity. The study revealed that designing an "ideal peptide" by choosing the most abundant residues in the "binding motif" obtained by pool sequencing does not necessarily yield an optimal binding peptide. For RT1-A1(c), as many as four positions, P2, P4, P5, and P9, were detected as putative anchors. Since this molecule displays a preference for highly hydrophobic peptides, we tested binding of peptides derived from the known leader peptide sequences of other rat histocompatibility complex class I molecules. One such peptide, found to bind well, requiring 1.6 microm peptide to achieve 50% stabilization, was searched for in vivo. Natural RT1-A1(c) binding peptides were purified from rat splenocytes and characterized by mass spectrometry using a combined matrix-assisted laser desorption ionization/time-of-flight and quadrupole time-of-flight approach. Results showed that the signal sequence-derived peptide was not detectable in the purified peptide pool, which was composed of a complex spectrum of peptides. Seven of these self-peptides were successfully sequenced.

The ultrastructure and metabolism of ejaculated tammar wallaby sperm are impaired by swim-up procedures when compared with sperm from the cauda epididymidis

The metabolism, rate of intracellular accumulation of sugars, motility and ultrastructure of ejaculated tammar sperm were impaired by swim-up into artificial media, particularly when the cells were subsequently exposed to N-acetyl-D-glucosamine (NAG). The inclusion of hyaluronate, serum albumin, catalase or Desferal in swim-up media helped prevent deterioration of sperm motility, but failed to prevent detrimental NAG-induced metabolic and ultrastructural changes. However, the sperm were unavoidably diluted during swim-up into artificial media and their behavioural properties were modified by dilution. Thus, sperm collected from the cauda epididymidis were immotile and their rate of oxygen uptake was low in undiluted caudal epididymal semen (CES). Nevertheless, these sperm were viable, and vigorous motility was induced by 5- to 50-fold dilution in Krebs-Ringer phosphate (KRP). Sperm respiration also dramatically increased with moderate dilution (5- or 15-fold) in KRP, but decreased again at higher rates (50-fold). This suggested that motility and the metabolic properties of tammar sperm are modified both by dilution and on leaving the suppressing conditions of the epididymis. Diluted tammar epididymal sperm also displayed a Pasteur effect, but rapidly lost capacity for motility in an oxygen-depleted atmosphere. It was concluded that swim-up procedures compromise ejaculated tammar sperm by promoting dilution-induced changes. This may alter the permeability of the membrane with loss of the enzymes that process the ammonia generated during the metabolism of NAG in seminal plasma. Subsequent exposure to NAG further promotes ultrastructural damage culminating in loss of viability.

Avian reovirus infections

Avian reoviruses are ubiquitous among poultry flocks. Although infection is usually present without disease, reoviruses may occasionally be involved in several disease syndromes of which viral arthritis/tenosynovitis in chickens is the most important, particularly in broiler breeds. While reoviruses have been isolated from turkeys and several other species of birds with various conditions, the presence of the virus has been conclusively linked with disease in relatively few instances. In chickens in particular, avian reoviruses with a wide spectrum of pathogenic capability have been isolated and several antigenic types exist. Diagnosis is dependent on the detection of the virus in clinical samples, although the presence of the virus does not necessarily confirm that this is the cause of the disease, except where reoviruses are detected in affected joints. Serological tests are usually difficult to interpret in view of widespread and frequently harmless reovirus infection. The principal approach to control of viral arthritis/tenosynovitis is by vaccination using attenuated vaccines in young birds, followed by inactivated preparations for breeders intended to protect chicks by maternal antibodies. Many vaccines are based on the S1133 strain isolated in the United States of America, but these may not be effective against antigenic variants.

Avian infectious laryngotracheitis

Avian infectious laryngotracheitis (ILT) herpesvirus continues to cause sporadic cases of respiratory disease in chickens world-wide. Sources of transmission of ILT infection are three-fold, namely: chickens with acute upper respiratory tract disease, latently infected 'carrier' fowls which excrete infectious laryngotracheitis virus (ILTV) when stressed, and all fomites (inanimate articles as well as the personnel in contact with infected chickens). Infectious laryngotracheitis virus infectivity can persist for weeks to months in tracheal mucus or carcasses. Rigorous site biosecurity is therefore critical in ILT disease control. Furthermore, while current (modified live) ILT vaccines can offer good protection, the strains of ILTV used in vaccines can also produce latent infections, as well as ILT disease following bird-to-bird spread. The regional nature of reservoirs of ILTV-infected flocks will tend to interact unfavourably with widely varying ILT control practices in the poultry industry, so as to periodically result in sporadic and unexpected outbreaks of ILT in intensive poultry industry populations. Precautions for trade-related movements of chickens of all ages must therefore include an accurate knowledge of the ILT infection status, both of the donor and recipient flocks.

Relationship between motility and oxygen consumption of sperm from the cauda epididymides of the rat

The oxygen consumption of rat sperm was low (2.7 microL O2 10(8) sperm(-1) h(-1)) in caudal epididymal semen (CES) when stimulation of motility was avoided. The addition of 1 microL of Krebs Ringer phosphate buffer (KRP) to 40 microL of CES (CES:KRP = 40:1) did not activate motility, but stimulated oxygen consumption 2-fold. Inclusion of 1-5 mM glucose, acetate, pyruvate or lactate in the KRP further stimulated respiration rate (up to 4.3-fold) without activating motility, but respiration was reduced when 2-deoxyglucose replaced energy substrates. Inclusion of dibutyryl cAMP (1 mM) activated sperm motility in all samples and stimulated oxygen consumption 2.9-fold. Dilution of CES at the ratio of CES:KRP = 40:1000 also activated sperm motility and stimulated respiration rate 2.9-fold. The combined effect of dibutyryl cAMP and glucose in stimulating respiration was greater than their individual effects. However, the response to cAMP or substrates was not altered by incubation in KRP containing either 0 or 0.5 mM Ca2+. It was concluded that the motility and metabolism of rat epididymal sperm are suppressed in vivo. Respiration can be stimulated by a small (1.025-fold) dilution and further stimulated by the inclusion of energy substrate, without activating motility. However, a larger dilution or inclusion of cAMP activated motility and simultaneously stimulated metabolism, with exogenous substrate being required to stimulate respiration to the maximum rate. This suggests that prior to activation, the rate of oxygen consumption and sperm motility are not coupled.

Angiogenesis in the hypertensive lung: response to ambient oxygen tension

The present study further analyzes the growth and reorganization of the vessels adjacent to capillaries in the hyperoxia-adapted lung in response to a lower ambient oxygen tension. The aim of the study was to determine the source of the new smooth muscle cells known to develop in these segments on return to breathing air. To accomplish this we determined the reorganization of vessel walls by quantitative light-microscopy techniques, and vascular cell phenotype(s) by high-resolution microscopy, in the lungs of rats that breathed a high oxygen tension (87% O2 for 4 weeks), followed by weaning to a lower oxygen tension (87-20% O2 over 1 week) and return to breathing air (for 1, 2 or 4 weeks). Return to breathing air initially triggered wall growth in a subset of vessels and wall thinning in others before wall thinning predominated throughout the vessel population. Interstitial fibroblasts were identified as the source of new perivascular cells. The recruitment of these cells was accompanied by loss of elastic laminae from vessel walls. Subsequently, most perivascular cells expressed a smooth muscle phenotype and elastic laminae were restored. Arteriography demonstrated an increase in the number of patent vessels on return to air, and light- and high-resolution microscopy restitution of the capillary network. We propose that in the hyperoxia-adapted lung return to breathing air represents a relative hypoxia that triggers differential patterns of vessel and capillary growth to meet new functional demands set by the lower ambient oxygen tension.

pH and bicarbonate in the ductuli efferentes testis of the rat

The pH and bicarbonate concentrations of luminal fluids in the efferent ducts of the rat were estimated from pH measurements of samples in vitro under conditions of controlled temperature and carbon dioxide tension. The pH of scrotal blood was estimated to be more acidic than systemic blood (mean pH=7.44) at either of the putative scrotal carbon dioxide tensions (5% and 7%, pH, respectively,=7.42 and 7.28). For PCO2 tensions of 5% and 7%, respectively, the data indicated that the pH in the efferent ducts was significantly higher (distal initial zone pH=7.55 or 7.41; coni vasculosi pH=7.66 or 7.51; p < 0.01) than in fluid entering (rete testis fluid, pH=7.34 or 7.20) or leaving the ducts (zone 1a of the epididymal duct 7.26 or 7.11). Bicarbonate concentrations were also significantly higher (p < 0.01) in the efferent ducts (35.4 +/- 4.7 mM, distal initial zone; 45.2 +/- 7.6 mM, coni vasculosi) than in fluids entering (22.9 +/- 3.6 mM) or leaving (20.4 +/- 4.9 mM) the ducts. Estimates of the reabsorption of bicarbonate and fluid indicated that 96% of the testicular output of bicarbonate was reabsorbed in the efferent ducts, but there was also some secretion of bicarbonate into the ducts. It is concluded that luminal pH and bicarbonate levels in the efferent ducts of the rat are high relative to those found in the epididymis where low pH and bicarbonate contributes to sperm quiescence during storage. Nevertheless, the high rate of bicarbonate reabsorption in the efferent ducts is a major contributor to the establishment of the low pH and bicarbonate milieu of the epididymis.

Spermiogenesis and spermiation in a monotreme mammal, the platypus, Ornithorhynchus anatinus

Spermatogenesis in the platypus (Ornithorhynchus anatinus) is of considerable biological interest as the structure of its gametes more closely resemble that of reptiles and birds than marsupial or eutherian mammals. The ultrastructure of 16 steps of spermatid development is described and provides a basis for determining the kinetics of spermatogenesis. Steps 1-3 correspond to the Golgi phase of spermatid development, steps 4-8 correspond to the cap phase, steps 9-12 are the acrosomal phase, and steps 13-16 are the maturation phase. Acrosomal development follows the reptilian model and no acrosomal granule is formed. Most other features of spermiogenesis are similar to processes in reptiles and birds. However, some are unique to mammals. For example, a thin, lateral margin of the acrosome of platypus sperm expands over the nucleus as in other mammals, and more than in reptiles and birds. Also, a tubulobulbar complex develops around the spermatid head, a feature which appears to be unique to mammals. Further, during spermiation the residual body is released from the caudal end of the nucleus of platypus sperm leaving a cytoplasmic droplet located at the proximal end of the middle piece as in marsupial and eutherian mammals. Other features of spermiogenesis in platypus appear to be unique to monotremes. For example, nuclear condensation involves the formation of a layer of chromatin granules under the nucleolemma, and development of the fibrous sheath of the principal piece starts much later in the platypus than in birds or eutherian mammals.

Fluid and electrolyte reabsorption in the ductuli efferentes testis

The efferent ducts of mammals are a series of ducts that are arranged in parallel and reabsorb most of the fluid released with spermatozoa from the testis. This function is essential for spermatogenesis, and for sperm maturation and storage in the epididymis. There is evidence for the involvement of three major transport processes in the bulk reabsorption of water and low molecular weight solutes from the ducts: active solute transport, passive (presumably paracellular) diffusion and fluid phase endocytosis. A small back-flux into the ducts via anion secretion also appears to occur. Control of fluid reabsorption by the efferent ducts is emerging as a complex process with multiple components. Reabsorption is flow dependent which provides local control of reabsorption with a rapid response to changes in luminal conditions. Sex steroids (oestrogen as well as androgen), but not mineralocorticosteroids, are involved in the chronic control of reabsorption in the ducts. Control of epithelial transport in the efferent ducts appears to be mediated by cAMP and probably other signal transduction systems.

Immune responses in the epididymis: implications for immunocontraception

In recent years the need to develop vaccines against a variety of sexually transmitted diseases, the desire to treat male infertility and interest in developing alternative contraceptive methods have focused research interest on the immunology of the male reproductive tract. This paper reviews the current state of knowledge of immunity in the male tract. Both physical and immune mechanisms that operate to maintain the blood-testis barrier are discussed with regard to (i) their importance in preventing autoimmune responses against spermatozoa and (ii) how these can be overcome to induce specific immunity in the testis and efferent ducts. The role of both the systemic and mucosal arms of the humoral immune response are discussed both in terms of immune-mediated infertility and the induction of specific immunity. Finally some novel approaches to elicit immunity in the male reproductive tract are discussed.

Evolution of the vertebrate epididymis

This review examines the structure and function of the extratesticular sperm ducts of vertebrates in terms of their evolutionary development and adaptive significance. The primitive extratesticular duct system of Chondrichthyes is described as an example of the vertebrate archetype. Adaptations of the duct system in higher vertebrates have involved a loss of some structures and specialization of others. The duct system probably evolved as a homeostatic mechanism to facilitate fertilization and some embryological development under conditions protected from the external environment. However, it is argued that the ducts also play an important role in the competition between males to achieve paternity. In vertebrates that practise internal fertilization the ducts are involved in post-testicular maturation and storage of spermatozoa. The biological significance of post-testicular sperm maturation has not been resolved. By contrast, sperm storage is essential in most male vertebrates because of the slow rate of spermatogenesis, particularly in ectotherms. Sperm storage is also important in the competition between males for paternity as it enables a male to mate a 'partner' a number of times during an oestrus in order to reduce the prospect of being cuckolded by another male. The extent of sperm maturation and storage in the epididymis of particular vertebrates depends on the relative roles of the testis and its extragonadal ducts in the competition between males for paternity. These roles depend on a number of factors, including allometric limitations to testis size, metabolic rate and the development of endothermy, and the reproductive strategy of females of the species.

The role of computed tomography in the diagnosis of acute appendicitis

BACKGROUND

Routine contrast-enhanced computed tomography (CECT) has been described as an accurate diagnostic imaging modality in patients with acute appendicitis. However, most patients with acute appendicitis can be diagnosed by clinical findings and physical exam alone. The role of CECT in patients suspected of having appendicitis but with equivocal clinical exams remains ill defined.

METHODS

One hundred and seven consecutive patients who were thought to have appendicitis but with equivocal clinical findings and/or physical exams were imaged by CECT over a 12-month period. Oral and intravenous contrast-enhanced, spiral abdominal and pelvic images were obtained using 7-mm cuts. CECT images were interpreted by a board-certified radiologist. Main outcome measures included CECT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in the diagnosis of acute appendicitis, comparing CECT with ultrasound, and determining the impact of CECT on the clinical management of this patient population.

RESULTS

A group of 107 patients consisting of 44 males (41%) and 63 females (59%) with a median age of 33 years (range 13 to 89 years) were imaged with CECT to evaluate suspected appendicitis. Of the 107 CECTs performed, 11 false-positive and 3 false-negative readings were identified, resulting in a sensitivity of 92%, specificity of 85%, PPV of 75%, NPV of 95%, and an overall accuracy of 90%. Forty-three patients were imaged with ultrasound and CECT, and CECT had significantly better sensitivity and accuracy (30% versus 92% and 69% versus 88%, P<0.01). With regard to clinical management, 100% (36/36) of patients with appendicitis, and 4.2% (3/71) of patients without appendicitis underwent appendectomy. Therefore, the overall negative appendectomy rate was 7.6% (3/39).

CONCLUSIONS

CECT is a useful diagnostic imaging modality for patients suspected of having acute appendicitis but with equivocal clinical findings and/or physical exams. CECT is more sensitive and accurate than ultrasound and is particularly useful in excluding the diagnosis of appendicitis in those without disease.

Early house moves, indoor air, heating methods and asthma

OBJECTIVES

To assess whether house moves or certain housing conditions are a risk factor for the development of childhood asthma.

DESIGN

A case-control study of asthmatic and non-atopic children aged 4-16 years.

SUBJECTS

One hundred children with confirmed asthma in a group general practice of 11000 patients in Plymouth, U.K. Each was matched by age and gender with a child with no history of wheeze, eczema or hay fever.

MAIN OUTCOME MEASURES

House moves and main heating methods, prior to the age of onset of asthma in cases and controls.

RESULTS

There was a non-significant association between early house moves and the subsequent development of asthma. No association was found with heating methods, except for ducted-air heating which, because of the small numbers involved could have occurred by chance. None of the other factors studied affecting indoor air showed an association.

CONCLUSION

Moving house at an early age may increase the risk of developing asthma, or may be associated with other more important risk factors, such as increased general mobility and hence, exposure to viral infections. Heating methods or other factors likely to affect the indoor air quality in early life were not useful predictors of subsequent asthma in children.

The Middle Years Group: a holistic approach to the management of the menopause in primary care

OBJECTIVES

The menopause is attaining greater significance as symptoms and long-term sequelae are amenable to hormone replacement treatment. However, hormone replacement treatment is no panacea and all women undergoing the menopause need to make informed decisions about its use. The aim of this study was to assess the effects of a series of group sessions for women aged 45-55 years, dealing with physical, social, emotional and medical aspects of the climacteric.

METHODS

All women registered at the Roborough surgery were invited to join a group for four sessions, led by the health visitor and counsellor, with a doctor leading one session on hormone replacement treatment. Women's views on the group were obtained by questionnaire. Prescribing data on hormone replacement treatment and antidepressants were analysed for attenders and a matched group of those invited who did not attend.

RESULTS

Twelve percent of invited women attended. All stated that sessions helped an understanding of the physical and emotional changes at this time. No significant differences were found in the use of hormone replacement treatment, antidepressants or in subsequent use of the counsellor's services between the attenders and a matched group of non-attenders.

CONCLUSIONS

This group offered all women at risk the opportunity to discuss, share and learn about all aspects of the menopause. It was well received and made no major differences to the uptake of hormone replacement treatment.

A retrospective study of the relationship between childhood asthma and respiratory infection during gestation

BACKGROUND

Wheeze in children has been found to be associated with prior antepartum haemorrhage and raised levels of IgE in cord blood, and acute wheezing episodes are intimately linked with respiratory viral infections.

OBJECTIVE

To assess the relationship between maternal presentation with respiratory tract infections in pregnancy and childhood asthma, taking into account factors which could affect presentation.

METHODS

This was a case-control study of 200 asthmatic children, 5-16-year-old, age-matched with one control, having no recorded history of wheeze. Data on respiratory tract infections, maternal wheeze, atopy and smoking was collected from primary care records. Deprivation score was assessed according to small residential areas and subjects were equally distributed between four general practices in Plymouth, UK.

RESULTS

Presentation with respiratory tract infections during pregnancy was significantly associated with childhood asthma (OR 1.69, 95% confidence interval 1.05-2.77, P = 0.03). The association was marginally stronger for infections in the first trimester (OR 2.30, 95% CI 1.05-5.41, P = 0.04) and for those with cough during pregnancy (OR 2.24, 95% CI 1.23-4.22, P = 0.007). The associations remained significant after allowing for the effect of the independent variables (gender, maternal smoking, maternal wheeze, allergic rhinitis, eczema, asthma treatment in pregnancy and deprivation [Townsend] score), using multiple logistic regression analysis (ORs and 95% CIs 1.91, 1.14-3.22; 2.32, 1.01-5.34 and 2.29, 1.17-4.48, respectively). There was also an association between numbers of presentations with respiratory infections and childhood asthma (test for trend, P = 0.02).

CONCLUSIONS

This study has shown an association between presentation with respiratory infection during gestation and childhood asthma. The results were not affected by the other independent variable factors studied and therefore provide some evidence to support the theory that respiratory viruses may be implicated in the aetiology of asthma.

The role of Na+-H+ exchange in fluid and solute transport in the rat efferent ducts

In vivo microperfusion techniques were used to investigate the role of Na+-H+ exchange in the efferent ducts of the rat. Individual efferent ducts were perfused with a Krebs-Ringer bicarbonate solution (KRB) containing 0, 1, 3, 5 or 7.5 mM amiloride. Concentrations of 1-5 mM amiloride inhibited fluid reabsorption from the efferent ducts in a linear dose-dependent manner with an apparent Km of 3 mM. Inhibition was maximal at 5 mM with reabsorption reduced by about 70 %. The effects of amiloride were completely reversible and there was little effect of amiloride on luminal osmolality and concentrations of Na+, Cl- or K+. It is concluded that Na+-H+ exchange is one of the principal mechanisms responsible for fluid and electrolyte reabsorption in the efferent ducts and offers a means by which the efferent ducts are able to achieve flow-dependent, autoregulated fluid reabsorption.

Investigation into avian pneumovirus persistence in poults and chicks using cyclosporin A immunosuppression

One-day-old poults or two-week old chicks were infected oculonasally with avian pneumovirus. Cloacal swabs were collected for virus isolation as were selected tissues (Harderian gland, turbinates, trachea, lungs and kidneys) from birds killed at regular intervals up to 33 days post infection (p.i.) for poults, and up to 40 days p. i. for chicks. In an attempt to induce virus re-excretion, the T-cell-suppressor cyclosporin A (CSA) was given for 12 days starting from three weeks p.i. in poults and from four weeks p.i. in chicks. Birds were sampled for virus isolations up to day 12 post CSA treatment. Virus was recovered only up to day nine p.i. in poults, and day five p.i. in chicks during the acute phase of the infection. Despite T-cell suppression, there was no evidence of re-excretion of the virus, and hence no evidence for the persistence of virus in the tissues examined.

To store or mature spermatozoa? The primary role of the epididymis

The function of the epididymis is considered in the context that it is necessary to transport spermatozoa for internal fertilization, but is also an adaptation involved in the competition between males to achieve paternity. Post-testicular sperm maturation and storage occur in lower vertebrates, such as the chondrichthyes, in which sperm storage is essential due to the slow rate of spermatogenesis. These roles persist in higher vertebrates, including mammals. However, they are less important in certain birds, in which the rate of sperm production by the testes is sufficient to supply enough spermatozoa to cope with the demands of a competitive mating system. There is no evidence for mammals, other than humans, that spermatozoa can achieve the capacity to fertilize an ovum without passing through some of the proximal epididymis. Storage of spermatozoa in the epididymis is probably not essential for a male to achieve conception in a protected mating system, but is very important in a competitive mating system. There is some variation between species in the magnitude of the epididymal storage region. This is related to the descent of the epididymides (and testes) into a scrotal sac in some species and/or the demands of the mating system in other species. The claims that humans are not dependent on post-testicular sperm maturation and storage need to be qualified, as they are based on studies of abnormal tracts and tests of fertility which are not rigorous. Nevertheless, the claims are of considerable clinical significance and may indicate that humans are less dependent on post-testicular sperm maturation and storage than other mammals. This may be an adaptation of the testes and epididymides to the scrotal conditions of modern man or a response to changing environmental factors.