Review of Crimean Congo hemorrhagic fever infection in Kosova in 2008 and 2009: prolonged viremias and virus detected in urine by PCR

Crimean-Congo hemorrhagic fever (CCHF) is a virus transmitted predominantly by ticks. However, contact with infected body fluids or tissues can result in animal-to-human or human-to-human transmission. Numbers of CCHF cases appear to be increasing, especially in Europe. We reviewed cases admitted to a tertiary referral unit in Kosova with suspected CCHF in 2008 and 2009, and looked at a smaller number of specimens which were sent to the Health Protection Agency, Porton Down, U.K., in further detail. The clinical features of cases admitted with suspected CCHF infection were assessed in more detail, and these are the focus of this article. Between 2008 and 2009, the numbers of patients admitted for suspected CCHF infection increased. Of the samples received in Porton Down, CCHF virus was detected in urine samples, and these patients were found to have prolonged viremia. The detection of CCHF in urine, as well as the prolonged viremias seen, are important for clinicians to know, as they may have public health implications with regard to the risk of infection, as well as provide insights into the biology and pathophysiology of infection. Further studies are required regarding the pathogenesis of this virus.

Molecular epidemiologic investigation of an anthrax outbreak among heroin users, Europe

In December 2009, two unusual cases of anthrax were diagnosed in heroin users in Scotland. A subsequent anthrax outbreak in heroin users emerged throughout Scotland and expanded into England and Germany, sparking concern of nefarious introduction of anthrax spores into the heroin supply. To better understand the outbreak origin, we used established genetic signatures that provided insights about strain origin. Next, we sequenced the whole genome of a representative Bacillus anthracis strain from a heroin user (Ba4599), developed Ba4599-specific single-nucleotide polymorphism assays, and genotyped all available material from other heroin users with anthrax. Of 34 case-patients with B. anthracis-positive PCR results, all shared the Ba4599 single-nucleotide polymorphism genotype. Phylogeographic analysis demonstrated that Ba4599 was closely related to strains from Turkey and not to previously identified isolates from Scotland or Afghanistan, the presumed origin of the heroin. Our results suggest accidental contamination along the drug trafficking route through a cutting agent or animal hides used to smuggle heroin into Europe.

Denis RD, Stahlman J, Stamen R, Stanecka E, Stanek RW, Stanescu C, Stanescu-Bellu M, Stapnes S, Starchenko EA, Stark J, Staroba P, Starovoitov P, Staszewski R, Staude A, Stavina P, Steele G, Steinbach P, Steinberg P, Stekl I, Stelzer B, Stelzer HJ, Stelzer-Chilton O, Stenzel H, Stern S, Stewart GA, Stillings JA, Stockton MC, Stoerig K, Stoicea G, Stonjek S, Strachota P, Stradling AR, Straessner A, Strandberg J, Strandberg S, Strandlie A, Strang M, Strauss E, Strauss M, Strizenec P, Ströhmer R, Strom DM, Strong JA, Stroynowski R, Strube J, Stugu B, Stumer I, Stupak J, Sturm P, Styles NA, Soh DA, Su D, Subramania HS, Succurro A, Sugaya Y, Suhr C, Suk M, Sulin VV, Sultansoy S, Sumida T, Sun X, Sundermann JE, Suruliz K, Susinno G, Sutton MR, Suzuki Y, Suzuki Y, Svatos M, Swedish S, Sykora I, Sykora T, Sánchez J, Ta D, Tackmann K, Taffard A, Tafirout R, Taiblum N, Takahashi Y, Takai H, Takashima R, Takeda H, Takeshita T, Takubo Y, Talby M, Talyshev A, Tamsett MC, Tanaka J, Tanaka R, Tanaka S, Tanaka S, Tanasijczuk AJ, Tani K, Tannoury N, Tapprogge S, Tardif D, Tarem S, Tarrade F, Tartarelli GF, Tas P, Tasevsky M, Tassi E, Tatarkhanov M, Tayalati Y, Taylor C, Taylor FE, Taylor GN, Taylor W, Teinturier M, Teixeira Dias Castanheira M, Teixeira-Dias P, Temming KK, Ten Kate H, Teng PK, Terada S, Terashi K, Terron J, Testa M, Teuscher RJ, Therhaag J, Theveneaux-Pelzer T, Thoma S, Thomas JP, Thompson EN, Thompson PD, Thompson PD, Thompson AS, Thomsen LA, Thomson E, Thomson M, Thun RP, Tian F, Tibbetts MJ, Tic T, Tikhomirov VO, Tikhonov YA, Timoshenko S, Tipton P, Tique Aires Viegas FJ, Tisserant S, Todorov T, Todorova-Nova S, Toggerson B, Tojo J, Tokár S, Tokushuku K, Tollefson K, Tomoto M, Tompkins L, Toms K, Tonoyan A, Topfel C, Topilin ND, Torchiani I, Torrence E, Torres H, Torró Pastor E, Toth J, Touchard F, Tovey DR, Trefzger T, Tremblet L, Tricoli A, Trigger IM, Trincaz-Duvoid S, Tripiana MF, Trischuk W, Trocmé B, Troncon C, Trottier-McDonald M, Trzebinski M, Trzupek A, Tsarouchas C, Tseng JCL, Tsiakiris M, Tsiareshka PV, Tsionou D, Tsipolitis G, Tsiskaridze V, Tskhadadze EG, Tsukerman II, Tsulaia V, Tsung JW, Tsuno S, Tsybychev D, Tua A, Tudorache A, Tudorache V, Tuggle JM, Turala M, Turecek D, Turk Cakir I, Turlay E, Turra R, Tuts PM, Tykhonov A, Tylmad M, Tyndel M, Tzanakos G, Uchida K, Ueda I, Ueno R, Ugland M, Uhlenbrock M, Uhrmacher M, Ukegawa F, Unal G, Undrus A, Unel G, Unno Y, Urbaniec D, Usai G, Uslenghi M, Vacavant L, Vacek V, Vachon B, Vahsen S, Valenta J, Valente P, Valentinetti S, Valero A, Valkar S, Valladolid Gallego E, Vallecorsa S, Valls Ferrer JA, van der Graaf H, van der Kraaij E, Van Der Leeuw R, van der Poel E, van der Ster D, van Eldik N, van Gemmeren P, van Vulpen I, Vanadia M, Vandelli W, Vaniachine A, Vankov P, Vannucci F, Vari R, Varol T, Varouchas D, Vartapetian A, Varvell KE, Vassilakopoulos VI, Vazeille F, Vazquez Schroeder T, Vegni G, Veillet JJ, Veloso F, Veness R, Veneziano S, Ventura A, Ventura D, Venturi M, Venturi N, Vercesi V, Verducci M, Verkerke W, Vermeulen JC, Vest A, Vetterli MC, Vichou I, Vickey T, Vickey Boeriu OE, Viehhauser GHA, Viel S, Villa M, Villaplana Perez M, Vilucchi E, Vincter MG, Vinek E, Vinogradov VB, Virchaux M, Virzi J, Vitells O, Viti M, Vivarelli I, Vives Vaque F, Vlachos S, Vladoiu D, Vlasak M, Vogel A, Vokac P, Volpi G, Volpi M, Volpini G, von der Schmitt H, von Loeben J, von Radziewski H, von Toerne E, Vorobel V, Vorwerk V, Vos M, Voss R, Voss TT, Vossebeld JH, Vranjes N, Vranjes Milosavljevic M, Vrba V, Vreeswijk M, Vu Anh T, Vuillermet R, Vukotic I, Wagner W, Wagner P, Wahlen H, Wahrmund S, Wakabayashi J, Walch S, Walder J, Walker R, Walkowiak W, Wall R, Waller P, Wang C, Wang H, Wang H, Wang J, Wang J, Wang R, Wang SM, Wang T, Warburton A, Ward CP, Warsinsky M, Washbrook A, Wasicki C, Watkins PM, Watson AT, Watson IJ, Watson MF, Watts G, Watts S, Waugh AT, Waugh BM, Weber M, Weber MS, Weber P, Weidberg AR, Weigell P, Weingarten J, Weiser C, Wellenstein H, Wells PS, Wenaus T, Wendland D, Weng Z, Wengler T, Wenig S, Wermes N, Werner M, Werner P, Werth M, Wessels M, Wetter J, Weydert C, Whalen K, Wheeler-Ellis SJ, White A, White MJ, White S, Whitehead SR, Whiteson D, Whittington D, Wicek F, Wicke D, Wickens FJ, Wiedenmann W, Wielers M, Wienemann P, Wiglesworth C, Wiik-Fuchs LAM, Wijeratne PA, Wildauer A, Wildt MA, Wilhelm I, Wilkens HG, Will JZ, Williams E, Williams HH, Willis W, Willocq S, Wilson JA, Wilson MG, Wilson A, Wingerter-Seez I, Winkelmann S, Winklmeier F, Wittgen M, Wollstadt SJ, Wolter MW, Wolters H, Wong WC, Wooden G, Wosiek BK, Wotschack J, Woudstra MJ, Wozniak KW, Wraight K, Wright C, Wright M, Wrona B, Wu SL, Wu X, Wu Y, Wulf E, Wynne BM, Xella S, Xiao M, Xie S, Xu C, Xu D, Yabsley B, Yacoob S, Yamada M, Yamaguchi H, Yamamoto A, Yamamoto K, Yamamoto S, Yamamura T, Yamanaka T, Yamaoka J, Yamazaki T, Yamazaki Y, Yan Z, Yang H, Yang UK, Yang Y, Yang Z, Yanush S, Yao L, Yao Y, Yasu Y, Ybeles Smit GV, Ye J, Ye S, Yilmaz M, Yoosoofmiya R, Yorita K, Yoshida R, Young C, Young CJ, Youssef S, Yu D, Yu J, Yu J, Yuan L, Yurkewicz A, Zabinski B, Zaidan R, Zaitsev AM, Zajacova Z, Zanello L, Zaytsev A, Zeitnitz C, Zeman M, Zemla A, Zendler C, Zenin O, Ženiš T, Zinonos Z, Zenz S, Zerwas D, Zevi della Porta G, Zhan Z, Zhang D, Zhang H, Zhang J, Zhang X, Zhang Z, Zhao L, Zhao T, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. A search for [Formula: see text] resonances with the ATLAS detector in 2.05 fb-1 of proton-proton collisions at [Formula: see text]

A search for top quark pair resonances in final states containing at least one electron or muon has been performed with the ATLAS experiment at the CERN Large Hadron Collider. The search uses a data sample corresponding to an integrated luminosity of 2.05 fb-1, which was recorded in 2011 at a proton-proton centre-of-mass energy of 7 TeV. No evidence for a resonance is found and limits are set on the production cross-section times branching ratio to [Formula: see text] for narrow and wide resonances. For narrow Z' bosons, the observed 95 % Bayesian credibility level limits range from 9.3 pb to 0.95 pb for masses in the range of mZ'=500 GeV to mZ'=1300 GeV. The corresponding excluded mass region for a leptophobic topcolour Z' boson (Kaluza-Klein gluon excitation in the Randall-Sundrum model) is mZ'<880 GeV ([Formula: see text]).

A multiplex real-time PCR for identifying and differentiating B. anthracis virulent types

Bacillus anthracis is closely related to the endospore forming bacteria Bacillus cereus and Bacillus thuringiensis. For accurate detection of the life threatening pathogen B. anthracis, it is essential to distinguish between these three species. Here we present a novel multiplex real-time PCR for simultaneous specific identification of B. anthracis and discrimination of different B. anthracis virulence types. Specific B. anthracis markers were selected by whole genome comparison and different sets of primers and probes with optimal characteristic for multiplex detection of the B. anthracis chromosome, the B. anthracis pXO1 and pXO2 plasmids and an internal control (IC) were designed. The primer sets were evaluated using a panel of B. anthracis strains and exclusivity was tested using genetically closely related B. cereus strains. The robustness of final primer design was evaluated by laboratories in three different countries using five different real-time PCR thermocyclers. Testing of a panel of more than 20 anthrax strains originating from different locations around the globe, including the recent Swedish anthrax outbreak strain, showed that all strains were detected correctly.

An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland

An investigation is currently underway to explore and control an outbreak of Bacillus anthracis among drug users (mainly injecting) in Scotland. Contaminated heroin or a contaminated cutting agent mixed with the heroin is considered to be the most likely source and vehicle of infection. Heroin users have been advised of the risk. The risk to the general public is regarded as very low.

Periostin promotes a fibroblastic lineage pathway in atrioventricular valve progenitor cells

Differentiation of prevalvular mesenchyme into valve fibroblasts is an integral step towards the development of functionally mature cardiac valves. Although clinically relevant, little is known regarding the molecular and cellular mechanisms by which this process proceeds. Genes that are regulated in a spatio-temporal pattern during valve remodeling are candidates for affecting this differentiation process. Based on its expression pattern, we have focused our studies on the role of the matricellular gene, periostin, in regulating the differentiation of cushion mesenchymal cells into valve fibroblasts. Herein, we demonstrate that periostin expression is coincident with and regulates type I collagen protein production, a major component of mature valve tissue. Adenoviral-mediated knock-down of periostin in atrioventricular mesenchyme resulted in a decrease in collagen I protein expression and aberrant induction of myocyte markers indicating an alteration in AV mesenchyme differentiation. In vitro analyses using a novel "cardiotube" assay further demonstrated that expression of periostin regulates lineage commitment of valve precursor cells. In these cells, expression of periostin and collagen I are regulated, in part, by TGFbeta-3. We further demonstrate that TGFbeta-3, through a periostin/collagen pathway, enhances the viscoelastic properties of AV cushion tissue surface tension and plays a crucial role in regulating valve remodeling. Thus, data presented here demonstrate that periostin, a TGFbeta-3 responsive gene, functions as a crucial mediator of chick AV valve maturation via promoting mesenchymal-to-fibroblast differentiation while blocking differentiation of alternative cell types (myocytes).

A fatal case of Lassa fever in London, January 2009

In January 2009, the eleventh case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified.

A fatal case of Lassa fever in London, January 2009

In January 2009, the eleventh [corrected] case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified.

Investigations and control measures following a case of inhalation anthrax in East London in a drum maker and drummer, October 2008

The patient is believed to have acquired the infection from making animal hide drums. Environmental investigations identified one drum and two pieces of animal skins contaminated with anthrax spores.

Investigations and control measures following a case of inhalation anthrax in East London in a drum maker and drummer, October 2008

We discuss the investigations and control measures undertaken following the notification of a fatal case of inhalation anthrax in East London. The patient is believed to have acquired the infection from making animal hide drums. Environmental investigations identified one drum and two pieces of animal skins contaminated with anthrax spores.

Attachment of Yersinia pestis to human respiratory cell lines is inhibited by certain oligosaccharides

Pneumonic plague is an aggressive disease that is clinically difficult to treat. Inhibition of attachment using oligosaccharide receptor mimics may provide an alternative to antibiotics. The virulent Yersinia pestis strain GB was demonstrated to attach to the murine monocyte cell line (J774A.1) and a range of human respiratory epithelial cell lines: nasal (RPMI-2650), bronchial (BEAS2-B) and alveolar (A549). Attachment was greatest to the A549 and BEAS2-B cell lines. Pre-treatment of the cell lines with tunicamycin reduced attachment by 55-65 %, indicating the importance of cell-surface carbohydrates in adhesion. The cell lines displayed differences in the oligosaccharides that inhibited attachment. p-Nitrophenol was the best inhibitor for each cell line. Disaccharides such as GalNAcbeta1-3Gal and GalNAcbeta1-4Gal were also good inhibitors, particularly for the RPMI-2650 cell line. This demonstrates the potential of oligosaccharides as potential anti-adhesion therapeutics.

Common oligosaccharide moieties inhibit the adherence of typical and atypical respiratory pathogens

Intervention in bacterial adhesion to host cells is a novel method of overcoming current problems associated with antibiotic resistance. Antibiotic-resistant strains of bacteria that cause respiratory tract infections are a problem in hospitals and could be used in bioterrorist attacks. A range of bacterial species was demonstrated to attach to an alveolar epithelial (A549) cell line. In all cases, cell surface oligosaccharides were important in attachment, demonstrated by reduced adhesion when A549 cells were pre-treated with tunicamycin. Bacillus anthracis and Yersinia pestis displayed a restricted tropism for oligosaccharides compared to the environmental, opportunistic pathogens, Pseudomonas aeruginosa, Burkholderia cenocepacia, Burkholderia pseudomallei and Legionella pneumophila. The compound with the greatest anti-adhesion activity was p-nitrophenol. Other generic attachment inhibitors included the polymeric saccharides (dextran and heparin), GalNAcbeta1-4Gal, GalNAcbeta1-3Gal, Galbeta1-4GlcNAc and Galbeta1-3GlcNAc. Burkholderia pseudomallei attachment was particularly susceptible to oligosaccharide inhibition. Combinations of such compounds may serve as a novel generic therapeutics for respiratory tract infections.

Investigation of opportunistic pathogens in municipal drinking water under different supply and treatment regimes

Changing regulations to lower disinfectant byproducts in drinking water is forcing utilities to switch disinfection from chlorine to monochloramine. It is generally unknown whether this will impact positively or negatively on the microbiological quality of drinking water. A utility in Florida, using water with relatively high organic carbon levels from deep wells in several wellfields, made the decision to change its disinfection regime from chlorine to chloramine in order to meet the new regulations. To assess the impacts of such a change on the microbiology of its water supplies, it undertook a number of studies before and after the change. In particular, the presence of the opportunistic pathogens Legionella and Mycobacterium, and also the composition of drinking-water biofilms, were examined. A preliminary synthesis and summary of these results are presented here. Legionella species were widely distributed in source waters and in the distribution system when chlorine was the disinfectant. In some samples they seemed to be among the dominant biofilm bacteria. Following the change to monochloramine, legionellae were not detected in the distribution system during several months of survey; however, they remained detectable at point of use, although with less species diversity. A variety of mycobacteria (21 types) were widely distributed in the distribution system when chlorine was the disinfectant, but these seemed to increase in dominance after chloramination was instituted. At point of use, only four species of mycobacteria were detected. Other changes occurring with chloramination included (a) an altered biofilm composition, (b) increased numbers of total coliforms and heterotrophs and (c) nitrification of water storage tanks. The results suggested that consideration should be given to the microbiological effects of changing disinfection regimes in drinking-water and distribution system biofilms.

Synthesis and in vitro evaluation of a series of diketopiperazine inhibitors of plasminogen activator inhibitor-1

We have synthesized and evaluated a series of diketopiperazine-based inhibitors of PAI-1. These studies resulted in the identification of 34 which inhibited PAI-1 in vitro with an IC(50)=0.2 microM. The synthesis and SAR of these compounds are described.

Conservation conflicts across Africa

There is increasing evidence that areas of outstanding conservation importance may coincide with dense human settlement or impact. We tested the generality of these findings using 1 degree-resolution data for sub-Saharan Africa. We find that human population density is positively correlated with species richness of birds, mammals, snakes, and amphibians. This association holds for widespread, narrowly endemic, and threatened species and looks set to persist in the face of foreseeable population growth. Our results contradict earlier expectations of low conflict based on the idea that species richness decreases and human impact increases with primary productivity. We find that across Africa, both variables instead exhibit unimodal relationships with productivity. Modifying priority-setting to take account of human density shows that, at this scale, conflicts between conservation and development are not easily avoided, because many densely inhabited grid cells contain species found nowhere else.

Occurrence of Legionella in groundwater: an ecological study

The natural habitat of Legionella is the water environment. Little is known about their presence in groundwater in spite of the fact that many millions around the globe regularly rely on groundwaters. This pilot study was aimed at evaluating the occurrence of Legionella in groundwater samples (water and biofilms) collected from various sites. Water and biofilm samples from selected groundwater sources were examined for Legionella using culture media (selective and non-selective) and a semi-nested PCR assay. Innovative approaches such as immunomagnetic separation (IMS) in combination with cultivation and flow cytometry were also evaluated. The findings available thus far show that (a) Legionella could be readily recovered from groundwater samples by cultivation even though their numbers showed considerable variations, (b) surprisingly, the PCR methodology was not yet as sensitive as cultivation and (c) flow cytometry was not directly applicable on natural samples because of debris and the high number of heterotrophic associated microflora from which some members were likely to cross-react with the monoclonal antibody used for separation procedures (IMS).

Frailty, family, and church support among urban African American elderly

A community-based survey of 507 African Americans aged 60 and older from South Central Los Angeles was conducted to estimate the prevalence of frailty and describe the correlation between frailty, social support from family and church, and use of community services. Persons were considered frail if they met criteria for any of four conditions: functional impairment, depression, urinary incontinence, falls. Sixty-seven percent met criteria for frailty. Analyses revealed that frail elderly were significantly less likely to report feeling very close to family. Family contact, feeling that church was important, and receiving church support were similar for the frail and nonfrail. Frail elderly were more likely to use community services. These findings suggest that frail elderly in this population may not receive more support from family and church than nonfrail elderly. There is a need for caution when assuming families and churches in urban African American communities are able to support the most vulnerable elderly.

NHS boards. The odd couple

The appointment of chairs is seen as political and lacking in transparency. Their training is patchy. Nearly a third of chairs and chief executives in this study had experienced major difficulties in their relationship. Relationship breakdown was generally due to chairs' behaviour.

The role of atropine premedication in fiberoptic bronchoscopy using intravenous midazolam sedation

OBJECTIVE

Atropine premedication is widely used for fiberoptic bronchoscopy and may help by drying secretions, producing bronchodilatation, or preventing vasovagal reactions. The objective of this study was to see whether atropine premedication is really of practical benefit when patients are sedated with i.v. midazolam.

DESIGN

In a double-blind study, patients were randomly allocated to receive i.m. atropine (0.6 mg) or saline placebo (1 mL) as premedication 30 to 60 minutes before they were sedated with progressive doses of i.v. midazolam until judged to be lightly asleep.

SETTING

A District General Hospital in England.

PARTICIPANTS

One hundred consecutive patients referred for bronchoscopy.

MEASUREMENTS AND RESULTS

Samples taken during the procedure were washings for microbiology and cytology and brushings for cytology and biopsy, but no transbronchial biopsies. Peak flow readings were recorded before premedication and before the start of the procedure. During the procedure an estimate was made of pharyngeal and tracheobronchial secretions, bleeding, use of saline to wash out secretions, and local anesthetic needed to control coughing. Patients were monitored for saturation and cardiac rhythm. There was no significant bronchodilatation after premedication in either group, nor were there differences in secretions, use of saline, tracheobronchial bleeding, desaturation, and arrhythmias. More local anesthetic was needed to control coughing in the placebo group (mean 357 mg vs 331 mg in the atropine group, p=0.02), but this was not of practical significance.

CONCLUSION

When intravenous midazolam sedation is used for bronchoscopy, atropine premedication is not of benefit.

A comparative analysis of surveyors from six hospital accreditation programmes and a consideration of the related management issues

PURPOSE

To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes.

DATA SOURCE

The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study.

RESULTS

An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors.

CONCLUSION

Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'.

Industrial Genotoxicology Group collaborative trial to investigate cell cycle parameters in human lymphocyte cytogenetics studies

Human lymphocyte cultures have been used for many years for assessing the in vitro clastogenic potential of test substances. In these assays the harvest time should be based on the cell cycle time in order to ensure that cells are sampled at an appropriate time for the detection of clastogenic effects. The sources of variation in the cell cycle time in routine cytogenetic assays have not been well studied. Consequently 13 laboratories, all members of the Industrial Genotoxicology Group, participated in a collaborative study to measure the variation in cell cycle time in cultured human peripheral blood lymphocytes under various conditions. The study was performed in two phases, spaced 6 months apart. The average generation time (AGT) was measured by the incorporation of bromodeoxyuridine. Very similar AGTs were found in the presence and absence of S9 mix. The mean AGT (mean of four donors) in each laboratory varied from 11.2 to 17.1 h, indicating there is significant variability in cell cycle times of human peripheral blood lymphocytes between laboratories. There was greater variation between laboratories than within laboratories. A comparison of AGT values at 72 h performed in experiments at least 6 months apart indicated good reproducibility in most laboratories. The study indicates that a 24 h post-treatment harvest may result in the analysis of very few first division cells unless very significant cell cycle delay is induced by the test substance. It was also found that a post-harvest time equivalent to 1.5 cell cycles will result in an approximately equal mixture of first and second division cells and therefore should by suitable for assessing both the induction of chromosome aberrations and polyploidy.

Compositional differences between bilateral middle ear effusions in otitis media with effusion: evidence for a different etiology?

The aim of this study was to clarify the site of primary pathology in otitis media with effusion. Effusions were collected from 64 children with bilateral effusions at the time of myringotomy. The rheological properties and biochemical compositions of effusions were measured for 23 pairs of effusions, and the levels of the inflammatory mediators TNF alpha, IL-1beta, and IL-8 were measured in 41 pairs using specific enzyme-linked immunosorbent assays (ELISAs). Measurements from paired ears were compared using analysis of variance (ANOVA) tests and significant differences were found for reduced specific viscosity, mucin content, protein content, and levels of IL-8. The results demonstrate that the two ears have different immunological processes or rates of processes which might explain the significantly different rheological properties of effusions. This suggests that each ear undergoes pathological changes independently and has implications for using the opposite ear as a control in clinical trials.

A simple artificial urine for the growth of urinary pathogens

A simple artificial urine medium (AUM) has been developed which provides conditions similar to that found in human urine. AUM solidified with agar enabled the recovery of a wide range of urease-positive and -negative urinary pathogens. Liquid AUM supported growth at concentrations of up to 10(8) cfu ml-1, as found in normal urine. Reproducible, steady-state growth also occurred over many generations in continuous culture. AUM was capable of forming crystals and encrustations resembling those found in natural urinary tract infections. The medium is a suitable replacement for normal urine for use in a wide range of experiments modelling the growth and attachment of urinary pathogens in the clinical environment.

Sources of variability in data from a positive selection lacZ transgenic mouse mutation assay: an interlaboratory study

Experimental features of a positive selection transgenic mouse mutation assay based on a lambda lacZ transgene are considered in detail, with emphasis on results using germ cells as the target tissue. Sources of variability in the experimental protocol that can affect the statistical nature of the observations are examined, with the goal of identifying sources of excess variation in the observed mutant frequencies. The sources include plate-to-plate (within packages), package-to-package (within animals), and animal-to-animal variability. Data from five laboratories are evaluated in detail. Results suggest only scattered patterns of excess variability below the animal-to-animal level, but, generally, significant excess variability at the animal-to-animal level. Using source of variability analyses to guide the choice of statistical methods, control-vs-treatment comparisons are performed for assessing the male germ cell mutagenicity of ethylnitrosourea (ENU), isopropyl methanesulfonate (iPMS), and methyl methanesulfonate (MMS). Results on male germ cell mutagenesis of ethyl methanesulfonate (EMS) and methylnitrosourea (MNU) are also reported.

Accreditation programs for hospitals: funding and operation

Accreditation is a formal process by which an authorized body assesses and recognizes an individual, an organization (like a hospital), a program, or a group as complying with requirements such as standards or criteria. This article analyses and compares the activity and funding of six health care accrediting bodies which operate in five different countries, and which in 1994, accredited over 5000 health centres. The data included in this article could be useful for other institutions who wish to commence accreditation programmes for health care organizations.

Endocrine characterization of primary mediastinal lymphoma

Because of the characteristic presentation of primary mediastinal large cell lymphoma (PMLCL) in young females its known origin from thymic B-cells, there might be a role in lymphomagenesis for estrogen receptors as well as for known neuroendocrine thymic mediators. A retrospective review of all patients with diffuse large cell lymphoma seen at our institution from January 1985 to January 1994 revealed 75 consecutive cases with a diagnosis of PMLCL. Through retrieval from our pathologic archives and requests to outside pathologists, we recovered and analyzed 17 biopsy specimens for the presence of the following hormone receptors: estrogen, beta endorphin, prolactin, T3, growth hormone, and leutinizing hormone. None of the specimens stained for any of the reagents. The most plausible explanation is that PMLCL tissues are devoid of these hormonal receptors and thus these receptors do not seem to play a role in the pathogenesis of PMLCL.

Immunisation with DNA polynucleotides protects mice against lethal challenge with St. Louis encephalitis virus

In vivo transfection by intramuscular injection with plasmids expressing the immunogenic proteins of microbial pathogens has considerable potential as a vaccination strategy against many pathogens of both man and animals. Here we report that weanling mice given a single intramuscular injection of 50 micrograms of a plasmid, pSLE1 expressing the St. Louis encephalitis virus (SLE) prM/E protein under the control of the cytomegalovirus immediate early protein promoter produced SLE-specific antibody and were protected against lethal challenge with the virulent virus. Polynucleotide vaccine technology provides a unique opportunity to produce vaccines against flavivirus diseases of low incidence cheaply and rapidly, and to produce multivalent vaccines such as would be required for immunisation against dengue virus disease.

Examination of biofilm formation and risk of infection associated with the use of urinary catheters with leg bags

Urinary catheters and legs bags were simultaneously colonized by Escherichia coli and Proteus vulgaris using a model urinary drainage system. the system was continuously supplied with filter-sterilized artificial urine using a diurnal flow pattern. The extent of colonization was determined by assessment of both planktonic and biofilm formation over time. Contamination of the catheters resulted in rapid colonization of the whole system within a 24 h period. Contamination of the leg bags resulted in an ascending biofilm formation over a four-day period. Results indicated that infection risk could be minimized by changing the catheter and leg bags at least once a week. The design of the leg bags was not found to influence the rate or extent of biofilm formation.

Consistent expression of an epithelial cell adhesion molecule (C-CAM) during human prostate development and loss of expression in prostate cancer: implication as a tumor suppressor

Cell adhesion molecules have been suggested to function as tumor suppressor molecules. We have been studying one of the epithelial cell adhesion molecules (C-CAM), which belongs to the immunoglobulin gene superfamily. Transfection of a C-CAM cDNA expression vector into a highly tumorigenic human prostate cancer cell line (PC-3) suppresses tumor formation in nude mice. Alternatively, reducing C-CAM expression levels in the nontumorigenic rat prostate epithelial cell line NbE by the antisense expression vector markedly increases tumorigenicity of NbE cells in nude mice. These results suggest that C-CAM may be a tumor suppressor in prostate cancer. In this study, we examined the relationship between C-CAM expression during human prostate development and neoplastic progression by immunohistochemical staining of frozen sections. C-CAM predominantly localized on the plasma membrane of the basal cell layer in both the fetal and normal adult prostate gland. However, an overall decreased staining was seen in benign prostatic hyperplasia and high grade prostatic intraepithelial neoplasia. Furthermore, C-CAM was not detected in prostate carcinomas. Thus, a decrease in C-CAM expression may be an early event in hyperplastic/neoplastic transformation. These observations support the suggestion that C-CAM is a tumor suppressor in prostate cancer progression.

Brain metastases in osteosarcoma. Report of a long-term survivor and review of the St. Jude Children's Research Hospital experience

BACKGROUND

Brain metastasis has been considered a rare event in osteosarcoma, although with prolonged survival an increasing incidence has been suggested. There have been no prior reports of long-term survivors among patients with this complication.

METHODS

The authors describe a child treated for osteosarcoma who is alive and free of disease 8 years after the detection of brain metastases. Of 254 patients with primary osteosarcoma referred to St. Jude Children's Hospital between 1962 and 1989, 13 developed brain metastases, all after relapse or recurrence in another site. Concomitant active lung metastases were present in all of the patients except the one long-term survivor, whose pulmonary disease had responded to treatment with cisplatin and doxorubicin. Log-rank analyses were used to compare survival duration and the frequency of brain metastases among patients treated before and after 1982, when effective multiagent therapy was initiated.

RESULTS

Log-rank analyses comparing patients treated before and after 1982 showed that the introduction of effective modern therapy improved survival among patients at risk for brain metastases (i.e., those with recurrent and progressive disease, P = 0.007) but was not associated with a statistically significant increase in the frequency of brain metastases (15.5% versus 4.5%, P = 0.125).

CONCLUSIONS

Although the outlook for patients with this complication remains bleak, the resolution of brain metastases after eight courses of ifosfamide in the patient described in this article suggests that enrollment of selected patients in Phase II trials is merited.

Success through organisational audit

In the April issue of Health Services Management, Tessa Brooks discussed the appropriateness of total quality management to the NHS. Here she describes a means of assessing and monitoring an organisation's ability to deliver quality services: organisational audit.

Total quality management in the NHS

In 1989, the Department of Health embarked upon a programme to encourage the introduction of a managed approach to quality in the NHS. In 1990 it extended this programme to include 23 sites ranging from departments within units to total districts. The criteria for inclusion in the programme were loose, but all successful pilots marched under the banner of total quality management (TQM), a clearly defined concept with a well-documented history. Tessa Brooks summarises TQM and considers its place in the NHS.

Objectives to direct the training of emergency medicine residents on off-service rotation: otolaryngology

This is the sixth article in a continuing series on objectives for emergency medicine training; otolaryngological objectives will be presented. Otolaryngological skills and knowledge areas are frequently encountered in clinical practice. The Core Content in emergency medicine devotes an entire section to their listing. Off-service rotations provide some one-half of all rotational-based experience in emergency medicine training. Specific behaviorally based objectives for mastery of knowledge and skill areas provide guidance in a training rotation not directly under emergency medicine faculty supervision. References are suggested for additional and supportive information and reinforcement in skill and knowledge area mastery. These objectives are presented to aid in directing training of emergency medicine residents on an otolaryngological service.