Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations

Whole-body electromyostimulation has proven to be a highly effective alternative to conventional resistance-type exercise training. However, due to adverse effects in the past, very extensive contraindications have been put in place for the commercial, non-medical WB-EMS market. Considering recent positive innovations e.g., federal regulation, mandatory trainer education, revised guidelines, and new scientific studies on WB-EMS application, we believe that a careful revision of the very restrictive contraindications on WB-EMS is needed. This applies all the more because many cohorts with limited options for conventional exercise have so far been excluded. During a first meeting of an evidence-based consensus process, stakeholders from various backgrounds (e.g., research, education, application) set the priorities for revising the contraindications. We decided to focus on four categories of absolute contraindications: "Arteriosclerosis, arterial circulation disorders", "Diabetes mellitus" (DM), "Tumor and cancer" (TC), "Neurologic diseases, neuronal disorders, epilepsy". Based on scientific studies, quality criteria, safety aspects and benefit/risk assessment of the category, DM and TC were moved to the relative contraindication catalogue, while arteriosclerosis/arterial circulation disorders and neurologic diseases/neuronal disorders/epilepsy were still considered as absolute contraindications. While missing evidence suggests maintaining the status of neurologic diseases/neuronal disorders as an absolute contraindication, the risk/benefit-ratio does not support the application of WB-EMS in people with arteriosclerosis/arterial circulation diseases. Despite these very cautious modifications, countries with less restrictive structures for non-medical WB-EMS should consider our approach critically before implementing the present revisions. Considering further the largely increased amount of WB-EMS trials we advice regular updates of the present contraindication list.

Operationalising targeted next-generation sequencing for routine diagnosis of drug-resistant TB

BACKGROUND

Phenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India.

METHODS

Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below.

RESULTS

Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (n = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119.

CONCLUSIONS

Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.

Clinical utility of target-based next-generation sequencing for drug-resistant TB

BACKGROUND: In high TB burden countries, access to drug susceptibility testing is a major bottleneck. Targeted next-generation sequencing (tNGS) is a promising technology for rapid resistance detection. This study assessed the role of tNGS for the diagnosis of drug-resistant TB (DR-TB).METHODS: A total of 161 samples from bacteriologically confirmed TB cases were subjected to tNGS using the Deeplex^® Myc-TB kit and sequenced using the MiSeq platform. These samples were also processed for conventional phenotypic DST (pDST) using 13 drugs on Mycobacteria Growth Indicator Tube and line-probe assays (MTBDRplus and MTBDRsl).RESULTS: There were 146 DR-TB and 15 drug-susceptible TB (DS-TB) samples. About 70% of patients with DR-TB had no previous TB treatment history. Overall, 88.2% had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), 58.5% pre-extensively drug-resistant TB (pre-XDR-TB) and 9.2% had XDR-TB as defined by the WHO (2020). Around 8% (n = 13) of samples were non-culturable; however, identified 8 were resistant to first and second-line drugs using tNGS. Resistance frequency was similar across methods, with discordance in drugs less reliable using pDST or with limited mutational representation within databases. Sensitivities were aligned with literature reports for most drugs. We observed 10% heteroresistance, while 75% of strains were of Lineages 2 and 3.CONCLUSIONS: Programme data supported tNGS in the diagnosis of DR-TB for early treatment using individualised regimens.

Detecting tuberculosis: rapid tools but slow progress

The World Health Organization (WHO) currently recommends Xpert^® MTB/RIF as the initial test for all people with presumptive tuberculosis (TB). A number of challenges have been reported, however, in using this technology, particularly in low-resource settings. Here we examine these challenges, and provide our perspective of the barriers to Xpert scale-up as assessed through a survey in 16 TB burden countries in which the Médecins Sans Frontières is present. We observed that the key barriers to scale-up include a lack of policy adoption and implementation of WHO recommendations for the use of Xpert, resulting from high costs, poor sensitisation of clinical staff and a high turnover of trained laboratory staff; insufficient service and maintenance provision provided by the manufacturer; and inadequate resources for sustainability and expansion. Funding is a critical issue as countries begin to transition out of support from the Global Fund. While it is clear that there is still an urgent need for research into and development of a rapid, affordable point-of-care test for TB that is truly adapted for use in low-resource settings, countries in the meantime need to develop functional and sustainable Xpert networks in order to close the existing diagnostic gap.

Interferon-gamma response to the treatment of active pulmonary and extra-pulmonary tuberculosis

BACKGROUND

Interferon-gamma (IFN-γ) release assays (IGRAs) are used to diagnose tuberculosis (TB) but not to measure treatment response.

OBJECTIVE

To measure IFN-γ response to active anti-tuberculosis treatment.

DESIGN

Patients from the Henan Provincial Chest Hospital, Henan, China, with TB symptoms and/or signs were enrolled into this prospective, observational cohort study and followed for 6 months of treatment, with blood and sputum samples collected at 0, 2, 4, 6, 8, 16 and 24 weeks. The QuantiFERON® TB-Gold assay was run on collected blood samples. Participants received a follow-up telephone call at 24 months to determine relapse status.

RESULTS

Of the 152 TB patients enrolled, 135 were eligible for this analysis: 118 pulmonary (PTB) and 17 extra-pulmonary TB (EPTB) patients. IFN-γ levels declined significantly over time among all patients (P = 0.002), with this decline driven by PTB patients (P = 0.001), largely during the initial 8 weeks of treatment (P = 0.019). IFN-γ levels did not change among EPTB patients over time or against baseline culture or drug resistance status.

CONCLUSION

After 6 months of effective anti-tuberculosis treatment, IFN-γ levels decreased significantly in PTB patients, largely over the initial 8 weeks of treatment. IFN-γ concentrations may offer some value for monitoring anti-tuberculosis treatment response among PTB patients.

Surpassing the Exciton Diffusion Limit in Single-Walled Carbon Nanotube Sensitized Solar Cells

Semiconducting single-walled carbon nanotube (s-SWNT) light sensitized devices, such as infrared photodetectors and solar cells, have recently been widely reported. Despite their excellent individual electrical properties, efficient carrier transport from one carbon nanotube to another remains a fundamental challenge. Specifically, photovoltaic devices with active layers made from s-SWNTs have suffered from low efficiencies caused by three main challenges: the overwhelming presence of high-bandgap polymers in the films, the weak bandgap offset between the LUMO of the s-SWNTs and the acceptor C₆₀, and the limited exciton diffusion length from one SWNT to another of around 5 nm that limits the carrier extraction efficiency. Herein, we employ a combination of processing and device architecture design strategies to address each of these transport challenges and fabricate photovoltaic devices with s-SWNT films well beyond the exciton diffusion limit of 5 nm. While our solution processing method minimizes the presence of undesired polymers in our active films, our interfacial designs led to a significant increase in current generation with the addition of a highly doped C₆₀ layer (n-doped C₆₀), resulting in increased carrier separation efficiency from the s-SWNTs films. We create a dense interconnected nanoporous mesh of s-SWNTs using solution shearing and infiltrate it with the acceptor C₆₀. Thus, our final engineered bulk heterojunction allows carriers from deep within to be extracted by the C₆₀ registering a 10-fold improvement in performance from our preliminary structures.

Tuning the Morphology of Solution-Sheared P3HT:PCBM Films

Organic bulk heterojunction (BHJ) solar cells are a promising alternative for future clean-energy applications. However, to become attractive for consumer applications, such as wearable, flexible, or semitransparent power-generating electronics, they need to be manufactured by high-throughput, low-cost, large-area-capable printing techniques. However, most research reported on BHJ solar cells is conducted using spin coating, a single batch fabrication method, thus limiting the reported results to the research lab. In this work, we investigate the morphology of solution-sheared films for BHJ solar cell applications, using the widely studied model blend P3HT:PCBM. Solution shearing is a coating technique that is upscalable to industrial manufacturing processes and has demonstrated to yield record performance organic field-effect transistors. Using grazing incident small-angle X-ray scattering, grazing incident wide-angle X-ray scattering, and UV-vis spectroscopy, we investigate the influence of solvent, film drying time, and substrate temperature on P3HT aggregation, conjugation length, crystallite orientation, and PCBM domain size. One important finding of this study is that, in contrast to spin-coated films, the P3HT molecular orientation can be controlled by the substrate chemistry, with

PEDOT

PSS substrates yielding face-on orientation at the substrate-film interface, an orientation highly favorable for organic solar cells.

Direct oxidative modifications of signalling proteins in mammalian cells and their effects on apoptosis

The production of ROS is an inevitable consequence of metabolism. However, high levels of ROS within a cell can be lethal and so the cell has a number of defences against oxidative cell stress. Occasionally the cell's antioxidant mechanisms fail and oxidative stress occurs. High levels of ROS within a cell have a number of direct and indirect consequences on cell signalling pathways and may result in apoptosis or necrosis. Although some of the indirect effects of ROS are well known, limitations in technology mean that the direct effects of the cell's redox environment upon proteins are less understood. Recent work by a number of groups has demonstrated that ROS can directly modify signalling proteins through different modifications, for example by nitrosylation, carbonylation, di-sulphide bond formation and glutathionylation. These modifications modulate a protein's activity and several recent papers have demonstrated their importance in cell signalling events, especially those involved in cell death/survival. Redox modification of proteins allows for further regulation of cell signalling pathways in response to the cellular environment. Understanding them may be critical for us to modulate cell pathways for our own means, such as in cytotoxic drug treatments of cancer cells. Protein modifications mediated by oxidative stress can modulate apoptosis, either through specific protein modifications resulting in regulation of signalling pathways, or through a general increase in oxidised proteins resulting in reduced cellular function. This review discusses direct oxidative protein modifications and their effects on apoptosis.

The impact of mode of acquisition on biological markers of paediatric hepatitis C virus infection

Despite the introduction of blood donor screening, worldwide, children continue to become infected with hepatitis C virus (HCV) via un-sterile medical injections, receipt of unscreened blood and isolated hospital contamination outbreaks. It is plausible that the natural history and disease progression in these children might differ from that of their vertically infected counterparts. Vertically and parenterally HCV-infected children were prospectively followed within the European Paediatric HCV Network and the UK National HCV Register, respectively. Biological profiles were compared. Vertically and parenterally HCV-infected children differed in terms of some key characteristics including the male to female ratio and the proportion of children receiving therapy. Parenterally infected children were more likely to have at least one hepatomegaly event during follow-up, 20%vs 10%. Parenteral infection did not significantly affect the odds of being consistently viraemic (AOR 1.14, P = 0.703) and there was no significant difference in the odds of having consistently elevated ALT levels and mode of acquisition (AOR 0.83, P = 0.748). The proportion of children with 2 or more markers of HCV infection did not differ significantly by mode of acquisition (χ(2) 1.13, P = 0.288). This analysis does not support substantial differences between vertically and parenterally infected groups, but there are specific mechanisms identified requiring further investigation. Given the continued parenteral infection of children worldwide, it is vital that knowledge of disease progression in this group is accurate and that the differences in comparison with vertically infected children are clarified to inform more accurate and individualized clinical management.

Critical care at Role 4

This descriptive paper focuses on the sequence of events that occur during the admission and ongoing management of the Military Polytrauma patient to Critical Care, Area B, Queen Elizabeth Hospital Birmingham (QEHB). It is intended to inform new clinical staff, the wider DMS, and potentially other NHS intensive care units which may be called upon to manage such patients during a military surge or following a U.K. domestic major incident.

Filaggrin loss-of-function mutations are associated with early-onset eczema, eczema severity and transepidermal water loss at 3 months of age

BACKGROUND

Filaggrin loss-of-function (FLG) mutations are associated with eczema and skin barrier impairment, but it is unclear whether skin barrier impairment precedes phenotypic eczema in FLG mutation carriers.

OBJECTIVES

To study the association between FLG mutations, skin barrier impairment and clinical eczema at 3 months of age.

METHODS

A total of 88 infants were examined for eczema. Disease severity was determined by the SCORAD eczema severity score. Transepidermal water loss (TEWL) was measured on unaffected forearm skin. Venous blood samples were screened for the four most common FLG mutations found in the U.K. white population (R501X, 2282del4, R2447X and S3247X). Median SCORAD and TEWL measurements in children with and without eczema and FLG mutations were compared.

RESULTS

Thirty-three per cent (29/88) of children had clinical eczema. Median SCORAD was 10·6 (range 3·5-31·0). TEWL (g m⁻² h⁻¹) was higher in children with eczema compared with unaffected infants (median TEWL 14·24 vs. 11·24, P < 0·001). Higher TEWL was associated with more severe disease (r = 0·59, P < 0·001, median TEWL, SCORAD < 15, 13·1 vs. 29·6, SCORAD ≥ 15, P = 0·029). Clinically dry skin was associated with higher TEWL, even in the absence of eczema (median TEWL 17·55 vs. 11·08, P = 0·008). Seventeen per cent (15/88) of children carried at least one FLG mutation. FLG mutation carriers were significantly more likely to have clinically dry skin, even in the absence of eczema [odds ratio (OR) 8·50, 95% confidence interval (CI) 1·09-66·58, P = 0·042]. FLG mutation carriers were also more likely to have eczema by 3 months of age (OR 4·26, 95% CI 1·34-13·57, P = 0·014). FLG mutations were significantly associated with higher median TEWL (all children, FLG 'yes' 21·59 vs. FLG 'no' 11·24, P < 0·001), even without clinical eczema (FLG 'yes' 15·99 vs. FLG 'no' 10·82, P = 0·01).

CONCLUSIONS

By the age of 3 months, FLG mutations are associated with an eczema phenotype, dry skin and TEWL. The observation that TEWL is elevated in unaffected FLG mutation carriers suggests that skin barrier impairment precedes clinical eczema.

Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe

OBJECTIVES

The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations between mode of delivery and mother-to-child transmission (MTCT).

METHODS

The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their infants prospectively followed. Data on 5238 mother-child pairs (MCPs) enrolled in Western European ECS sites between 1985 and 2007 were analysed.

RESULTS

The elective CS rate increased from 16% in 1985-1993 to 67% in 1999-2001, declining to 51% by 2005-2007. In 2002-2004, 10% of infants were delivered vaginally, increasing to 34% by 2005-2007. During the HAART era, women in Belgium, the United Kingdom and the Netherlands were less likely to deliver by elective CS than those in Italy and Spain [adjusted odds ratio (AOR) 0.07; 95% confidence interval (CI) 0.04-0.12]. The MTCT rate in 2005-2007 was 1%. Among MCPs with maternal HIV RNA<400 HIV-1 RNA copies/mL (n=960), elective CS was associated with 80% decreased MTCT risk (AOR 0.20; 95% CI 0.05-0.65) adjusting for HAART and prematurity. Two infants born to 559 women with viral loads <50 copies/mL were infected, one of whom was delivered by elective CS (MTCT rate 0.4%; 95% CI 0.04-1.29).

CONCLUSIONS

Our findings suggest that elective CS prevents MTCT even at low maternal viral loads, but the study was insufficiently powered to enable a conclusion to be drawn as to whether this applies for viral loads <50 copies/mL. Diverging mode of delivery patterns in Europe reflect uncertainties regarding the risk-benefit balance of elective CS for women on successful HAART.

Salmonella typhimurium stimulation combined with tumour-derived heat shock proteins induces potent dendritic cell anti-tumour responses in a murine model

Appropriate activation of the immune system and effective targeting of tumour cells are the primary hurdles to be overcome for cancer immunotherapy to be successful and applicable to a wide range of tumour types. Our studies have examined the ability of bacterial-stimulated dendritic cells (DCs), loaded with tumour-associated antigens, to inhibit tumour growth in a murine model. Immature murine bone marrow-derived DCs were stimulated in vitro with the cytoplasmic fraction (CM) of Salmonella typhimurium in combination with heat shock proteins (hsps) from 4T1 tumours, isolated using heparin affinity chromatography. Activated DCs were administered subcutaneously. Tumours were generated by orthotopic inoculation of 4T1 cells in Balb/c mice. Primary tumour growth was measured using Vernier calipers, while lung metastases were measured using the clonogenic assay. S. typhimurium CM induced potent tumour necrosis factor (TNF)-alpha responses from DCs accompanied by significant up-regulation of CD80 and CD86 expression. When injected into mice, bacterial-stimulated DCs loaded with 4T1 hsps inhibited the formation of new 4T1 tumours and reduced the growth rate of established tumours. In addition, the number of lung metastatic nodules was reduced significantly in the DC-treated mice (1.6 +/- 0.6 versus 245.9 +/- 55.6, P = 0.0015). DCs stimulated with CM alone, exposed to tumour hsps alone or exposed to tumour hsps from an unrelated tumour cell line did not induce a protective immune response. Dendritic cells primed with a proinflammatory bacterial stimulus and tumour-associated antigens induce a protective anti-tumour immune response in this murine model.

Identification of carbonylated proteins by MALDI-TOF mass spectroscopy reveals susceptibility of ER

Reactive oxygen species are produced by metabolism over time, but can also be produced in more acute conditions of cell stress such as treatment with cytotoxic drugs. Treatment of HL-60 cells with peroxide results in cell death and protein carbonylation, a non-enzymatic protein modification that typically results from oxidative stress within cells. It has recently become clear that protein carbonylation during ageing is confined to specific proteins. It is therefore of interest to be able to identify which proteins are susceptible to protein carbonylation. Here we demonstrate immunoprecipitation of carbonylated proteins coupled with 2D-gel electrophoresis to identify carbonylated proteins by MALDI-TOF m/s fingerprinting. The results show that some ER proteins are readily carbonylated in response to peroxide treatment of HL-60 cells. This is likely to have implications for the induction of cell death in such cells.

The anticancer drug mithramycin A sensitises tumour cells to apoptosis induced by tumour necrosis factor (TNF)

In this report we show that mithramycin considerably increases the direct cytotoxic effect of tumour necrosis factor (TNF) on tumour cells in vitro. Sensitisation to TNF-induced apoptosis was prevented by the broad caspase inhibitor zVAD-fmk, whereas overexpression of Bcl-2 had no effect. Mithramycin also potentiated cell death induced by Fas agonistic antibodies. In contrast, mithramycin reduced the percentage of cells undergoing apoptosis due to factor withdrawal. TNF-induced activation of NF-kappaB (NF-κB)-dependent gene expression was not modulated by mithramycin treatment. Concomitantly with the increased sensitivity, the protein level of the short-spliced cFLIP variant was downregulated. These results indicate that mithramycin enhances TNF-induced cell death in an NF-κB-independent manner, and suggest that the Fas-associated death domain protein plays a crucial role in the TNF-sensitising effect of mithramycin.

Carbonylation of glycolytic proteins is a key response to drug-induced oxidative stress and apoptosis

Recent work has highlighted the importance of protein post-translational modifications such as phosphorylation (enzymatic) and nitrosylation (nonenzymatic) in the early stages of apoptosis. In this study, we have investigated the levels of protein carbonylation, a nonenzymatic protein modification that occurs in conditions of cellular oxidative stress, during etopside-induced apoptosis of HL60 cells. Within 1 h of VP16 treatment, a number of proteins underwent carbonylation due to oxidative stress. This was inhibited by the antioxidant N-acetyl-L-cysteine. Among the proteins found to be carbonylated were glycolytic enzymes. Subsequently, we found that the rate of glycolysis was significantly reduced, probably due to a carbonylation mediated reduction in enzymatic activity of glycolytic enzymes. Our work demonstrates that protein carbonylation can be rapidly induced through cytotoxic drug treatment and may specifically inhibit the glycolytic pathway. Given the importance of glycolysis as a source of cellular ATP, this has severe implications for cell function.

Signalling pathways regulating the dephosphorylation of Ser729 in the hydrophobic domain of protein kinase Cepsilon upon cell passage

We have recently demonstrated that in quiescent fibroblasts protein kinase C (PKC) epsilon(95) is phosphorylated at Ser(729), Ser(703), and Thr(566) and that upon passage of quiescent cells phosphorylation at Ser(729) is lost, giving rise to PKCepsilon(87). Ser(729) may be rephosphorylated later, suggesting cycling between PKCepsilon(87) and PKCepsilon(95). Here we show that the dephosphorylation at Ser(729) is insensitive to okadaic acid, calyculin, ascomycin C, and cyclosporin A, suggesting that dephosphorylation at this site is not mediated through protein phosphatases 1, 2A or 2B. We demonstrate that this dephosphorylation at Ser(729) requires serum and cell readhesion and is sensitive to rapamycin, PD98059, chelerythrine, and Ro-31-8220. These results suggest that the phosphorylation status of Ser(729) in the hydrophobic domain at Ser(729) is regulated independently of the phosphorylation status of other sites in PKCepsilon, by a mTOR-sensitive phosphatase. The mitogen-activated protein kinase pathway and PKC are also implicated in regulating the dephosphorylation at Ser(729).

Changes in protein kinase C epsilon phosphorylation status and intracellular localization as 3T3 and 3T6 fibroblasts grow to confluency and quiescence: a role for phosphorylation at ser-729?

Protein kinase C (PKC) epsilon in 3T3 and 3T6 fibroblasts and in C6 glioma cells migrated on SDS/PAGE predominantly as a doublet with molecular masses of 87 and 95 kDa (PKC epsilon(87) and PKC epsilon(95) respectively). PKC epsilon(95) predominates when cells reach confluency but PKC epsilon(87) was the main form detected within 15 min when confluent cells were passaged at low cell density into fresh medium containing serum and allowed to adhere. Matrix-assisted laser-desorption ionization-time-of-flight MS analysis and experiments with phosphospecific antibodies revealed that PKC epsilon(87) is phosphorylated at Thr-566 and Ser-703, and PKC epsilon(95) is additionally phosphorylated at Ser-729. Cell fractionation studies revealed that PKC epsilon(95) is associated with the nuclear fraction, whereas PKC epsilon(87) was found in the 100,000 g cytosol fraction. Immunofluorescence studies confirmed these findings and showed that PKC epsilon(95) had a perinuclear, probably Golgi, localization and PKC epsilon(87) was distributed in the cytosol. It is proposed that phosphorylation at Ser-729 may be important for determining the intracellular localization of PKC epsilon, and that a specific Ser-729 phosphatase may be activated on cell passage to convert PKC epsilon(95) to PKC epsilon(87).

Patient satisfaction with nursing care in a colorectal surgical population

This paper describes one arm of a much larger, multi-site study whose hypothesis was that evidence-based nursing practice is more effective than routine nursing care in improving patient outcomes and health gain. This arm of the study investigated patient satisfaction as an outcome measure for those patients undergoing colorectal surgery. The study's relevance for nurses is in the potential feedback for reviewing nursing practice and health care delivery. Patient satisfaction with nursing care was measured through a validated questionnaire, the SERVQUAL, followed by interviews with a percentage of the study population. The results of this arm of the study confirm the importance of measuring patient satisfaction through a triangulated method which investigates thoroughly, providing feedback for continuous quality improvement. The in-depth interviews provided greater insight into the results of the questionnaire, enabling clear feedback to nursing staff at the different sites of the study. Results of the questionnaire revealed age, sex and education levels of patients as major influences on individual perceptions of nursing care. Patients whose surgery resulted in stomas were also less satisfied with health-care delivery.

Subtle overlapping deletions in the terminal region of chromosome 6q24.2-q26: three cases studied using FISH

Interstitial deletions in the terminal region of chromosome 6 are rare. We describe three new cases with subtle interstitial deletions in the q24-q26 region of the long arm of chromosome 6. The karyotypes were analyzed at a 550 band level. Patient1 is a 9-month-old boy with an interstitial deletion, del(6)(q24.2q25.1), developmental delay, low birth weight, hypotonia, heart murmur, respiratory distress, craniofacial and genital anomalies. This is the first report of a case with deletion del(6)(q24.2q25.1). Patient 2 is a 17-year-old young man with an interstitial deletion del(6)(q25.1q25.3), developmental delay, short stature, mental retardation, autism, head, face, chest, hand and feet anomalies and a history of seizures. For the first time autism was described as a manifestation in 6q deletions. Patient 3 is baby boy with a de novo interstitial deletion, del(6)(q25.1q26), anomalies of the brain, genital organs, limbs and feet. This is the first report of a case with deletion, del(6)(q25.1q26). In all three patients, fluorescence in situ hybridization (FISH) using chromosome 6 painting probe ruled out an insertion. The ESR (6q25.1) and TBP (6q27) probes were used to confirm the breakpoints. Since TBP signal is present in all cases, it confirmed an interstitial deletion proximal to this probe. Patient 1 has a deletion of the ESR locus; Patient 2 and 3 have signals for the ESR locus on both chromosomes 6. Therefore the deletion in Patients 2 and 3 are between ESR and TBP loci distal to that of Patient 1. FISH validated the deletion breakpoints assessed by conventional cytogenetics.

A review of intensive care nurse staffing practices overseas: what lessons for Australia?

In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe. It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings. Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a 'progressive patient care' model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes.

"They think you're as stupid as your English is": constructing foreign domestic workers in Toronto

"In Canada, paid domestic work is often associated with (im)migrant women from a variety of countries of origin. We critically analyse Canada's foreign domestic worker programmes, noting the shifting definitions of which nationalities should participate. We note how gendered, racialised, and classed constructions of national identities infuse these programmes. We then turn to an empirical analysis of how foreign domestic workers are constructed in Toronto, where demand is the highest in Canada."

Ploidy independence of Ag-NOR number in neuroblastoma

BACKGROUND

Ag-NOR number and ploidy have potential use in predicting prognosis in malignancy. The issue of independence has not been conclusively studied. In contrast to other malignancies in neuroblastoma poor outcome is linked to diploidy, allowing independent analysis of the reaction of Ag-NOR status to outcome.

EXPERIMENTAL DESIGN

A consecutive unselected series of 20 pediatric neuroblastoma patients was used to study the relation between ploidy and mean Ag-NOR number per nucleus. Ploidy was established by flow cytometric analysis of nuclear suspensions prepared from Formalin fixed and paraffin embedded tissue. The mean number of Ag-NORs per nucleus was determined using 3-microns paraffin sections, silver staining methods and quantification procedures detailed in the literature.

RESULTS

The seven diploid lesions were found to have a mean Ag-NOR number per nucleus of 4.38 (range 0.86-7.5). The 13 aneuploid lesions were found to have a mean Ag-NOR number per nucleus of 2.31 (range 1.17-4.44). Probability of difference (Wilcoxon's two-tailed rank sum test) was greater than 99%. Nonsurvivors (6 of 10 diploid) had mean Ag-NOR number per nucleus of 4.34 (range 2.24-7.5). Survivors (9 of 10 aneuploid) had mean Ag-NOR number per nucleus of 1.73 (range 0.86-2.56). Probability of difference (Wilcoxon's two-tailed rank sum test) was greater than 99%. In aneuploid lesions (n = 13) a negative correlation exists between DNA index and mean number of Ag-NORs per nucleus (correlation coefficient 0.84, slope -0.74, probability of noncorrelation less than 0.010).

CONCLUSIONS

The present observations offer the first independent support to the theory that Ag-NOR number is an independent variable to DNA ploidy based on the unique feature of neuroblastoma that diploid lesions have an established poorer prognosis than aneuploid lesion. The observations, although the number of cases is too limited for independent analysis, confirm previously published, strong negative relations between mean Ag-NOR number per cell and survival in childhood neuroblastoma. This relation is similar to findings in other solid tumor lesions.