Clinical characteristics of two-hundred thirty-two dogs (2006-2018) treated for suspected anaphylaxis in Perth, Western Australia

OBJECTIVE

To describe the clinical features of dogs treated for suspected anaphylaxis in Perth, Western Australia.

DESIGN

Single-centre observational case series with retrospective and prospective phases.

METHODS

This was a two-phase study of dogs with clinical suspicion of anaphylaxis presenting to the emergency service of a university teaching hospital. Dogs required evidence of, and appropriate treatment of, a type 1 hypersensitivity reaction as well as two or more organs affected (or cardiovascular signs alone) to be included. Phase 1 includes retrospective case series of 186 dogs (March 2006-December 2018). Phase 2 includes prospective descriptive case series of 46 dogs (October 2017-July 2018) focused on clinical signs.

RESULTS

In phase 1, 88 (47%) dogs had evidence of insect exposure prior to the acute event. One hundred forty (75%) dogs had dermatological signs, 141 (76%) had gastrointestinal signs and 129 (69%) had cardiovascular signs. Ninety-two (49%) dogs had vasoconstrictive shock (5 with bradycardia), 24 (13%) had vasodilatory shock, 8 (4%) had mixed vasodilatory and vasoconstrictive shock and 5 (3%) had unclassifiable shock. On focused abdominal ultrasound, 42 of 71 (59%) dogs had gallbladder wall oedema and 3 of 71 (4%) dogs had peritoneal free fluid. In phase 2, the distributions of insect exposure, organ dysfunction and sonographic abnormalities were similar to phase 1.

CONCLUSION

Dogs presenting with suspected anaphylaxis showed a broad range of presentations. Dermatological signs were absent in a proportion of dogs, vasoconstrictive shock was more frequent than vasodilatory and unique features of shock were identified. This study highlights the challenges of diagnosis based on presenting features alone.

Transfusion practice in Australia: an internet-based survey

OBJECTIVE

To describe small animal transfusion practices in Australia, including access to blood products and frequency of pre-transfusion compatibility testing and medication administration.

METHODS

An online survey was disseminated to target Australian veterinarians treating dogs and cats. Information collected included demographics, sources of blood products, blood storage, recipient compatibility testing and administration of medications pre-transfusion. Associations between the use of compatibility tests and premedications were assessed using the χ² test. Significance was set at P < 0.05.

RESULTS

A total of 199 Australian veterinarians were included; however, there was some attrition of respondents over the course of the survey. The majority of respondents were in general practice (n = 133/199). Access to fresh whole blood was commonly reported for dogs (n = 179/199) and cats (n = 131/198), whereas blood components were less commonly available (canine red blood cells [RBC], n = 52/199 and plasma, n = 157/199; feline RBC, n = 9/198 and plasma, n = 21/198). Most blood was sourced from the pets of owners affiliated with the veterinary clinic (n = 179/196). The respondents who did not blood type or crossmatch dogs were significantly more likely to use premedication than those who did these tests (both comparisons: P < 0.001). Likewise, the respondents who did not blood-type cats were significantly more likely to use premedication (P = 0.003); however, there was no association between crossmatching and using premedication in cats (P = 0.183).

CONCLUSION

This is the first survey to describe transfusion practices across a variety of practice types throughout Australia. Future work is needed to determine how representative these results are of current transfusion practices across Australia, and if so, what can be done to optimise them.

Obstructive shock caused by right atrial thrombosis secondary to malignant pheochromocytoma in a dog

BACKGROUND

Obstructive shock can be caused by any lesion leading to extraluminal compression or intraluminal occlusion of the cardiac chambers or major vessels.

CASE REPORT

A 12-year-old, male castrated, Border Collie cross dog presented to a veterinary teaching hospital for collapse. A physical examination revealed severe vasoconstrictive shock and abdominal distension. Abnormalities on blood tests were consistent with systemic hypoperfusion. Cardiac underfilling, hepatomegaly with distended vasculature and ascites were identified by focused ultrasonography, raising suspicion of obstructive shock. This was supported by the radiographic findings of microcardia and a distended caudal vena cava (CVC). There was transient response to fluid therapy for blood volume expansion. Repeat focused ultrasonography during rapid intravenous fluid administration identified a right intra-atrial mass, assessed as likely to be causing obstruction of venous return. The dog was humanely euthanased given the guarded prognosis. At postmortem evaluation, a malignant pheochromocytoma in the left adrenal gland with tumour thrombus extending to the tricuspid valve through the CVC was found. The extensive thrombus caused the obstructive shock in this case. Metastasis in a peripheral lymph node and neoplastic emboli in the heart and lungs were also visible at the histopathological evaluation.

CONCLUSION

To the best of authors' knowledge, this is the first report of severe obstructive shock secondary to extension of caval tumour thrombus into the right atrium in a dog with malignant pheochromocytoma. Tumour thrombus from a malignant pheochromocytoma should be included as a differential diagnosis of obstructive shock, with or without a visible right intra-atrial mass, in dogs. Serial focused ultrasonography during intravenous fluid administration can aid diagnosis.

SnakeMap: four years of experience with a national small animal snake envenomation registry

SnakeMap is a national cloud-based, veterinary snakebite registry. It was designed to prospectively collect data of the clinical circumstances and temporospatial information on cases of snake envenomation in dogs and cats. We herein introduce the project and summarise the data from the first 4 years of SnakeMap. The registry is a veterinary community-based online database allowing case entry from veterinary hospitals across Australia. Registry data comprise hospital characteristics, patient characteristics, envenoming snake type, treatment and outcome variables, including time and geolocation of the snake bite. We present summative information on select key variables from the SnakeMap registry (1 July 2015 to 30 June 2019). Twenty-eight hospitals from 6 states/territories entered 624 cases into the registry, including 419 dogs (67%) and 205 cats (33%). Bite time was available in 216 animals of which 90 (42%) were reported to be bitten in the 3 hours between 03:00 pm and 05:59 pm; median bite to presentation interval was 60 (interquartile range [IQR] 30, 211) minutes in dogs and 95 (IQR 41, 238) minutes in cats. Bites occurred in the owner's yard in 356 dogs (85%) and 53 cats (26%). A snake venom detection kit was used in 172 cases (28%) and antivenom was administered in 523 cases (85%). Most animals (n = 534, 88%) survived to discharge (median hospitalisation of 25 [IQR 16, 62] hours). SnakeMap effectively collects relevant clinical data from dogs and cats with presumed snake bite and provides locally specific information on the epidemiology of snake envenomation in small animals.

High-Brightness Continuous-Wave Electron Beams from Superconducting Radio-Frequency Photoemission Gun

Continuous-wave photoinjectors operating at high accelerating gradients promise to revolutionize many areas of science and applications. They can establish the basis for a new generation of monochromatic x-ray free electron lasers, high-brightness hadron beams, or a new generation of microchip production. In this Letter we report on the record-performing superconducting rf electron gun with CsK_{2}Sb photocathode. The gun is generating high charge electron bunches (up to 10  nC/bunch) and low transverse emittances, while operating for months with a single photocathode. This achievement opens a new era in generating high-power beams with a very high average brightness.

Experimental Demonstration of Hadron Beam Cooling Using Radio-Frequency Accelerated Electron Bunches

Cooling of beams of gold ions using electron bunches accelerated with radio-frequency systems was recently experimentally demonstrated in the Relativistic Heavy Ion Collider at Brookhaven National Laboratory. Such an approach is new and opens the possibility of using this technique at higher energies than possible with electrostatic acceleration of electron beams. The challenges of this approach include generation of electron beams suitable for cooling, delivery of electron bunches of the required quality to the cooling sections without degradation of beam angular divergence and energy spread, achieving the required small angles between electron and ion trajectories in the cooling sections, precise velocity matching between the two beams, high-current operation of the electron accelerator, as well as several physics effects related to bunched-beam cooling. Here we report on the first demonstration of cooling hadron beams using this new approach.

Interleukin-8, interleukin-1β and tumour necrosis factor-α in sequential units of packed red blood cells collected from retired racing Greyhounds

BACKGROUND

We hypothesised that concentrations of interleukin-8 (IL-8), interleukin-1β (IL-1β) and tumour necrosis factor-α (TNF-α) would increase during storage in the third sequential unit (U3) of canine packed red blood cells (PRBC) collected from terminal donors in haemorrhagic shock. We further hypothesised that leucoreduction would prevent cytokine accumulation in U3 and that cytokine concentrations in U3 would be higher than in the first units (U1) collected from the same dogs.

METHODS

U1 and U3 were each collected from 12 anaesthetised healthy Greyhounds. Removal of leucocytes from half of each PRBC unit produced one leucoreduced (LR) and one non-leucoreduced (NLR) unit. Canine IL-8, IL-1β and TNF-α concentrations were measured in samples collected from the units during storage on days 0, 10, 20, 30 and 37.

RESULTS

The IL-8 concentration in U3 NLR units was significantly higher on days 10, 20, 30 and 37 than on day 0 and was significantly higher than in the LR units at all time points. The IL-1β concentration in U3 did not change over time, or between LR and NLR units. TNF-α was not detected in any unit. There were no significant differences in IL-8 or IL-1β concentrations between U3 and U1 at any time point; however, some NLR U3 units had markedly elevated IL-8 concentrations at day 37 (2060-20,682 pg/mL) compared with NLR U1 units (3369-5280 pg/mL).

CONCLUSION

NLR U3 units collected from dogs in haemorrhagic shock showed a significant increase in IL-8 concentrations during storage. Leucoreduction was effective at preventing the accumulation of IL-8. There was no difference detected between U3 and U1.

The acute-phase mediator serum amyloid A is associated with symptoms of depression and fatigue

OBJECTIVE

Establish whether inflammatory biomarkers-serum amyloid A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)-are related to key symptoms of depression, including anxiety and fatigue, in a cross-sectional, out-patient setting to identify biomarkers that reflect psychiatric symptomatology in a naturalistic, real-life population.

METHODS

We measured SAA, CRP, IL-6, and TNF-α in plasma samples from 89 adult psychiatric out-patients by multiplex, high-sensitivity electrochemiluminescent assays. Psychiatric symptoms were evaluated using the Hamilton Depression Rating Scale (HAMD-17), the Patient Health Questionnaire (PHQ-9), and the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS

Plasma SAA was most robustly associated with depressive symptoms across diagnostic boundaries in this cohort of out-patients. Elevated SAA was significantly associated with higher total scores on the HAMD-17 scale and correlated with multiple scale items that rated symptoms of fatigue and depressed mood, but not with anxiety-related items.

CONCLUSIONS

SAA might constitute a cross-diagnostic marker indicative of depressed mood and fatigue in a naturalistic patient setting. Because SAA activates Toll-like receptors 2 and 4, present on macrophages and glial cells, its association with depression severity could also implicate this inflammatory mediator in the pathogenesis of mood disorders.

The impact of human papillomavirus type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two-centre observational study

OBJECTIVE

To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy.

DESIGN

A two-centre observational study including vaccinated and unvaccinated women.

SETTING

Colposcopy clinics serving two health regions in Scotland, UK.

POPULATION

A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening.

METHODS

Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features.

MAIN OUTCOME MEASURES

Colposcopic features, HPV genotypes, mRNA expression, and cervical histology.

RESULTS

The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated).

CONCLUSIONS

In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines.

TWEETABLE ABSTRACT

Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+.

Upgrade of ductal carcinoma in situ on core biopsies to invasive disease at final surgery: a retrospective review across the Scottish Breast Screening Programme

AIM

To identify factors affecting upgrade rates from B5a (non-invasive) preoperative core biopsies to invasive disease at surgery and ways to improve screening performance.

MATERIAL AND METHODS

This was a retrospective analysis of 1252 cases of B5a biopsies across all six Scottish Breast Screening Programmes (BSPs), ranging between 2004 and 2012. Final surgical histopathology was correlated with radiological and biopsy factors. Data were analysed using basic Microsoft Excel and standard Chi-squared test used for evaluating statistical significance.

RESULTS

B5a upgrade rates for the units ranged from 19.2% to 29.2%, with an average of 23.6%. Mean sizes of invasive tumours were small (3-11 mm). The upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion, or asymmetry, compared with micro-calcification alone (33.2% versus 21.7%, p = 0.0004). The upgrade rate was significantly lower with the use of large-volume vacuum-assisted biopsy (VAB) devices than 14 G core needles (19.9% versus 26%, p = 0.013); in stereotactic than ultrasound-guided biopsies (21.2% versus 36.1%, p < 0.001). Heterogeneity of data from different centres limited evaluation of other potential factors.

CONCLUSION

Upgrade rates are lower for cases with micro-calcification as the sole mammographic feature with the use of VAB devices. Nevertheless, there is variation in practice across Scottish BSPs, including first-line biopsy technique and/or device; and it is of interest that a few centres maintain low upgrade rates despite not using VAB routinely for biopsy of micro-calcification.

Management of women with low grade cytology: how reassuring is a normal colposcopy examination?

OBJECTIVES

To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.

DESIGN

Cohort study within a randomised controlled trial.

SETTING

NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.

POPULATION

Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.

METHODS

Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.

MAIN OUTCOME MEASURES

Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.

RESULTS

The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.

CONCLUSION

For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.

Sentinel node biopsy in papillary thyroid cancer--what is the potential?

PURPOSE

Sentinel node biopsy (SNB) may identify lymph node metastases in patients with papillary thyroid cancer (PTC), enabling selective application of central node dissection (CND). The aim of this study was to assess the feasibility of implementing SNB in patients undergoing thyroidectomy for a cytologically indeterminate/suspicious/malignant thyroid nodule and to determine the potential improvement in clinical outcomes and the costs associated with the SNB technique.

METHODS

The treatment strategies and clinical and pathological outcomes of two retrospective cohorts of patients who underwent preoperative thyroid FNA over a 5-year period in two different centres were studied. The potential for implementing the SNB technique and the benefits and costs associated with implementation were estimated.

RESULTS

In centre 1, in 819 adult patients who had thyroid fine-needle aspiration cytology, the final cytology was indeterminate, suspicious and diagnostic of malignancy in 113, 29 and 28 patients, respectively. One hundred eight patients were 'suitable' for SNB. Twenty-three of these patients had PTC, six of whom underwent CND. Of these six patients, node metastasis was absent in five--the cohort in whom prophylactic CND may have been avoided consequent to a negative 'sentinel node' biopsy. Morbidity attributable to CND may have been avoided in up to four patients over a 5-year period. Costs associated with implementation of SNB outweighed any potential savings. Analysis of 491 patients in centre 2 confirmed that the benefit of SNB in PTC was similarly limited; morbidity attributable to CND may have been avoided in up to seven patients over a 5-year period.

CONCLUSIONS

Even under ideal conditions (assuming 100 % node identification rate and 0 % false negative rate), the potential short- to medium-term benefit of sentinel node biopsy in patients with thyroid cancer in centres implementing a policy of selective or routine prophylactic CND is low.

Which women default from follow-up cervical cytology tests? A cohort study within the TOMBOLA trial

OBJECTIVE

To identify factors associated with default from follow-up cervical cytology tests.

METHODS

A cohort study was conducted involving 2166 women, aged 20-59, with recent low-grade cervical cytology taken within the NHS Cervical Screening Programmes in Scotland and England, and managed by 6-monthly cytology in primary care. For the first (6-month) and second (12-month) surveillance cytology tests separately, women were categorized as 'on-time attendees' (attended ≤6 months of test being due), 'late attendees' (attended greater than 6 months after test was due) or 'non-attendees' (failed to attend). Multivariate odds ratios (ORs) were computed for factors associated with late and non-attendance.

RESULTS

For the first surveillance test, risk of non-attendance was significantly higher in younger women, those without post-secondary education, and non-users of prescribed contraception. Factors significantly associated with late attendance for the first test were the same as for non-attendance, plus current smoking and having children. The most important predictor of non-attendance for the second surveillance test was late attendance for the first test (OR = 9.65; 95% CI, 6.60-16.62). Non-attendance for the second test was also significantly higher among women who were younger, smokers and had negative cytology on the first surveillance test. Late attendance for the second surveillance test was higher in women who were younger, smokers, had children and attended late for the first test.

CONCLUSIONS

Women at highest risk of default from follow-up cytology tend to be young, smoke, lack post-secondary education, and have defaulted from a previous surveillance appointment. Tackling default will require development of targeted strategies to encourage attendance and research to better understand the reasons underpinning default.

The role of human papillomavirus testing in the management of women with low-grade abnormalities: multicentre randomised controlled trial

OBJECTIVE

To assess the value of a single human papillomavirus (HPV) test in making decisions on management of women with cervical cytology showing borderline nuclear abnormality (BNA) or mild dyskaryosis. In particular, to determine whether information on high-risk (hr) HPV status would be valuable in the choice between (1) cytological surveillance versus immediate referral to colposcopy, and (2) at colposcopy, between biopsy and recall versus immediate large loop excision of the transformation zone (LLETZ).

DESIGN

Multicentre individually randomised controlled trial, nested within the NHS Cervical Screening Programmes, investigating the value of HPV testing by testing for interactions between HPV status and (1) cytological surveillance versus colposcopy, and (2) biopsy and recall versus immediate LLETZ. Setting Grampian, Tayside and Nottingham. Population Women (n = 4439), aged 20-59 years, with a cytology test showing borderline nuclear abnormalities or mild dyskaryosis during October 1999 to October 2002.

METHODS

High-risk HPV status was determined at recruitment using the polymerase chain reaction assay with the GP5+/6+ general primer system. The results of this HPV testing were not disclosed to either the participating women or to those involved in their management. Women were randomised to either (1) 6-monthly cytological screening in primary care or (2) referral for colposcopy. Human papillomavirus status was used to stratify both randomisations. All women were followed for 3 years, concluding with an invitation to an exit appointment at which colposcopic examination was undertaken. In addition, in women who were randomised to initial colposcopy and underwent colposcopy, the association between hrHPV status and presence of cervical intraepithelial neoplasia (CIN) grade 2 or more severe disease (henceforth CIN2 or worse) was examined.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive and negative predictive values of the HPV test for predicting CIN2 or worse and the implications for the choice of management between cytological surveillance and immediate referral for colposcopy.

RESULTS

There were no significant interactions between management and HPV status. Hence, in women with mild dyskaryosis or BNA who are HPV positive, there is no advantage of (1) immediate colposcopy over cytological surveillance (P = 0.76) or (2) immediate LLETZ over biopsy and recall (P = 0.27). The sensitivity of HPV testing for detection of CIN2 or worse was 75.2% (95% CI 68.8-81.0%) among women with mild dyskaryosis and 69.9% (95% CI 61.7-77.3%) among those with BNA. Specificity was higher in those with BNA (71.3%; 95% CI 68.5-74.1%) than in those with mild dyskaryosis (46.9%; 95% CI 42.2-51.6%). Sensitivity decreased with increasing age whereas specificity increased. The negative predictive value was high, particularly among women with BNA (94.5%; 95% CI 92.9-96.0%). Across all ages, 22% of women who had CIN2 or worse were HPV negative. Conversely, 40% of those who were HPV positive did not have CIN. HPV was a much more reliable predictor in women aged over 40 years.

CONCLUSIONS

We conclude that in younger women with low-grade cytological abnormalities, a single HPV test would not be useful in determining who should be referred for colposcopy or the most effective management at colposcopy. In women over 40, a negative HPV test could be used to rule out further investigation.

198 EXOGENOUS CONTROL OF FOLLICULAR WAVE EMERGENCE IN WOOD BISON (BISON BISON ATHABASCAE)

Two methods for synchronizing ovarian follicular development in both wood bison (Bison bison athabascae) and plains bison (Bison bison bison) were tested as part of a project to conserve wood bison through the application of advanced reproductive technologies. A secondary objective was to test the effect of a long-acting neurolept tranquilizer, pipothiazine palmitate, on ovarian function in bison. Female wood bison (4 years old; n = 14) and plains bison (2-8 years old, n = 10), previously conditioned to daily examination in a chute, were divided randomly into 3 groups in which 1) ovarian follicles ≥5 mm were ablated by ultrasound-guided transvaginal follicle aspiration, 2) 5 mg of estradiol-17β in canola oil was given i.m. or 3) no treatment was given (control). The experiment was conducted in 3 replicates so that each animal rotated through each of the groups. Half of the bison, blocked by subspecies and treatment group, were given a single dose (150 mg) of pipothiazine palmitate i.m. The ovaries were examined daily by transrectal ultrasonography beginning 4 days before treatment and continuing until the dominant follicle of a new wave reached a diameter of 10 mm. No effect of treatment with pipothiazine palmitate was detected for any end point. In addition, no differences were detected between wood and plains bison for any end point. Consequently the pipothiazine palmitate and subspecies treatment groups were collapsed for further analyses. The interval and variation in the interval to new follicular wave emergence were compared by ANOVA. Wave emergence was detected on Day 1.0 ± 0.2 (mean ± SEM; Day 0 = day of treatment) in the follicle ablation group, and was earlier (P < 0.05) than in both the estradiol (Day 3.3 ± 0.3) and control (Day 4.0 ± 0.4) groups. The interval to follicle wave emergence was least variable in the follicle ablation group (P < 0.05) and tended to be less variable in the estradiol group (P = 0.09) than in the control group (residuals, 0.1 ± 0.04, 1.0 ± 0.2, and 1.6 ± 0.3 days, respectively). Ovulations occurred subsequent to estradiol administration in 10 of 23 (43%) bison. In conclusion, ovarian follicular wave emergence can be synchronized in bison during the anovulatory season. Follicular ablation consistently shortened and decreased the variability in the interval to new wave emergence. The synchronizing effect of estradiol was confounded by the induction of ovulation. Progesterone will be added in future studies to control the ovulatory effect of estradiol. Pipothiazine palmitate had no discernable effect on ovarian function and maybe useful in reducing the effects of handling stress on untrained animals. Supported by a grants from the Advancing Canadian Agriculture and Agri-Food Fund, the Agri-Food Innovation Fund, Parks Canada, the World Wildlife Fund, and the Northwest Territories.

Ligand-mediated selective targeting of adenovirus in metastatic breast cancer

Abstract #2126

The success of gene therapy relies on efficient and targeted delivery systems. Adenovirus vectors have a number of advantages for gene therapy. However, because of their lack of tumor tropism and their tendency to induce liver infection following systemic administration, they cannot be used for systemic attack on metastatic disease. Many solid tumors (e.g., colon, lung, and breast) and hematopoietic tumors over express the chemokine receptor CXCR4. CXCR4 belongs to the large superfamily of G protein-coupled receptors, and is known to participate in a number of biological processes including organogenesis, hematopoiesis, and immune response. Recent evidence has highlighted the role of CXCR4 in cancer, particularly in cancer metastasis due to dysregulation of the receptor leading to enhanced signaling. The present study addresses this issue by retargeting adenovirus to the breast cancer cells overexpressing CXCR4 receptor. We used sCAR-T4-CXCL12, a bispecific adaptor molecule with the ectodomain of CAR linked by the T4 fibritin trimerization motif to the human CXCR4 ligand CXCL12 (also known as SDF-1). The sCAR-T4-CXCL12 should therefore be useful in retargeting adenovirus vectors to CXCR4-positive metastases. Infectivity assays in the absence as well as presence of ligand were performed in human breast cancer MDA-MB-435 cells. Cells were infected with different titres of Ad-CMV-GFP-Luc with and without ligand. Forty-eight hours post-infection, cells were harvested and analysed for the GFP expression by fluorescent microscopy and flow cytometry. It was further interesting to observe the time-dependence of infectivity curve. For this purpose, MDA-MB-435 cells were incubated with optimum titre of Ad-CMV-GFP-Luc vector in the presence of CXCR4 targeting ligand at different time intervals. This was followed by expression analysis of GFP protein by fluorescent microscopy and flow cytometry. Quantification by flow cytometry demonstrated a dramatic 20- to 40-fold increase in the infectivity of MDA-MB-435 cells both in a dose-dependent and time-dependent manner using the sCAR-T4-CXCL12 targeted adenovirus compared to the untargeted vector. In this report, we show that sCAR-T4-CXCL12 can significantly redirect an adenoviral gene therapy vector to CXCR4-positive breast cancer cells in culture. This bispecific ligand should, therefore, be a powerful agent to retarget adenovirus vectors to tumor metastases. The future goal is to investigate the capacity of this agent to re-direct adenoviral vectors in vivo using breast cancer metastasis models.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2126.

Effects of the paralysis tick, Ixodes holocyclus, on the electrocardiogram of the Spectacled Flying Fox, Pteropus conspicillatus

OBJECTIVE

To evaluate cardiac electrical function in the Spectacled Flying Fox (bat) infested with Ixodes holocyclus.

DESIGN

Prospective clinical investigation of bats treated for naturally occurring tick toxicity.

PROCEDURE

ECGs were performed on bats with tick toxicity (n = 33), bats that recovered slowly (n = 5) and normally (n = 5) following treatment for tick toxicity, and on normal bats with no history of tick toxicity (n = 9).

RESULTS

Bats with tick toxicity had significantly prolonged corrected QT intervals, bradycardia and rhythm disturbances which included sinus bradydysrhythmia, atrial standstill, ventricular premature complexes, and idioventricular bradydysrhythmia.

CONCLUSIONS

The QT prolongation observed on ECG traces of bats with tick toxicity reflected delayed ventricular repolarisation and predisposed to polymorphic ventricular tachycardia and sudden cardiac death in response to sympathetic stimulation. The inability to document ventricular tachycardia in bats shortly before death from tick toxicity may be explained by a lack of sympathetic responsiveness attributable to the unique parasympathetic innervation of the bat heart, or hypothermia-induced catecholamine receptor down-regulation. Bradycardia and rhythm disturbances may be attributable to hypothermia.

An audit of oral care practice and staff knowledge in hospital palliative care

Mouth care is considered one of the most basic of nursing activities, and palliative care patients are especially vulnerable to oral problems (Macmillan Practice Development Unit, 1995). This article describes a project on developing oral care practice and staff knowledge, by nursing staff and Macmillan nurses at a hospital in central England. A baseline audit (audit I) was carried out to examine all aspects of current oral care practice and nursing knowledge, including assessment, implementation, prescribing and evaluation of care. Oral care guidelines and a programme of ward-based teaching were then introduced. Several months later a follow-up audit (audit II) was conducted. Results showed an improvement in all aspects of oral care and staff knowledge. Additional benefits of this process included improved professional relationships and the promotion of further audits in hospital palliative care. Recommendations include the need for further nursing research into oral care to build the evidence base further. Additionally, it is suggested that nurses must recognize their important and central role in improving this aspect of palliative care. Education and training is pivotal to this process.

Ground reaction force and spatiotemporal measurements of the gait of the mouse

Measurement of ground reaction forces with force plates permits quantification of the subtle changes in movement associated with a variety of pathophysiological states. The apparatus used here permits simultaneous recording of other spatial and temporal characteristics of gait. Since the mouse is becoming increasingly important for modeling human disorders, we have recorded ground reaction forces (P) in this species. To date, we have measured the vertical component (Pz) and found it to be similar to that of other species, in that a greater Pz is exerted via the forelimb, although the areas under the force/time curves, are not different. Different points of discontinuity are seen in the forelimb and hindlimb curves, indicating differential deployment. Pz varies consistently with stance time and is consistent across the adult life of the mouse. It is suggested that the technique has potential for the study of a variety of mouse models of disease and of their therapies.

Covering up what can't be seen: concealable stigma and mental control

In these studies the authors examined the effects of concealing a stigma in a social interaction relevant to the stigma. An interview paradigm called for undergraduate female participants who either did or did not have eating disordered characteristics to play the role of someone who did or did not have an eating disorder (ED) while answering stigma-relevant questions. The data suggest that the participants who concealed their stigmas become preoccupied with the control of stigma-relevant thoughts. In Study 1, participants with an ED who role-played not having an ED exhibited more secrecy, suppression, and intrusive thoughts of their ED and more projection of ED-related thoughts onto the interviewer than did those with an ED who role-played someone with an ED or those without an ED who role-played someone without an ED. This finding was replicated in Study 2, and the authors found both increasing accessibility of ED-related words among those participants with concealed stigmas during the interview and high levels of accessibility following the interview.

Covering up what can't be seen: concealable stigma and mental control

In these studies the authors examined the effects of concealing a stigma in a social interaction relevant to the stigma. An interview paradigm called for undergraduate female participants who either did or did not have eating disordered characteristics to play the role of someone who did or did not have an eating disorder (ED) while answering stigma-relevant questions. The data suggest that the participants who concealed their stigmas become preoccupied with the control of stigma-relevant thoughts. In Study 1, participants with an ED who role-played not having an ED exhibited more secrecy, suppression, and intrusive thoughts of their ED and more projection of ED-related thoughts onto the interviewer than did those with an ED who role-played someone with an ED or those without an ED who role-played someone without an ED. This finding was replicated in Study 2, and the authors found both increasing accessibility of ED-related words among those participants with concealed stigmas during the interview and high levels of accessibility following the interview.

The temporal relationship among anti-parasite immune elements expressed during the early phase of infection of the rat with Trichinella spiralis

Immunological parameters were measured during the first 20 days of infection with Trichinella spiralis in the rat. Expulsion of adult worms was complete by day 15 postinfection. Eosinophil and neutrophil numbers rose in the blood of infected rats above preinfection levels on days 3 and 6, respectively, and remained high to day 20 postinfection. Release of cytokines by Trichinella-antigen-stimulated mesenteric lymph node cells was measured, and a significant elevation in interferon (IFN)-gamma release was detected during the early stage of infection. Although initiated later, interleukin (IL)-10 release showed a pattern similar to IFN-gamma. Biphasic release of IL-5 was seen with significant elevation above the preinfection level on day 3 and after day 6 postinfection to the end of the study. IL-4 and IL-2 showed biphasic secretion as well, with the level of IL-4 high in the early and middle part of infection, while the level of IL-2 was detectable only at days 2, 3 and 6 postinfection. Serum anti-parasite IgE rose above preinfection levels after day 6 postinfection. Anti-parasite Ig-positive mesenteric lymph node (MLN) cells were evident by day 3 postinfection for IgM, and day 9 postinfection for IgA and total IgG. The number of Ig-positive MLN cells for all antibody classes returned to preinfection levels by day 20 postinfection. Evaluation of the temporal interactions of the key anti-parasite immune components with which the host engages Trichinella shows a complex interplay between Th1 and Th2 helper subsets.

Deep cognitive activation: a new approach to the unconscious

Deep cognitive activation occurs when a thought is so accessible as to have measurable effects on behavior or judgement, but is yet not consciously reportable. This state of mind has unique properties mimicking some characteristics of the psychoanalytic unconscious, but following theoretically from a consideration of processes of cognitive activation. The sources and consequences of deep cognitive activation are examined, with a view toward understanding how this state is implicated in the assessment, etiology, and treatment of psychopathology.

Deep cognitive activation: a new approach to the unconscious

Deep cognitive activation occurs when a thought is so accessible as to have measurable effects on behavior or judgement, but is yet not consciously reportable. This state of mind has unique properties mimicking some characteristics of the psychoanalytic unconscious, but following theoretically from a consideration of processes of cognitive activation. The sources and consequences of deep cognitive activation are examined, with a view toward understanding how this state is implicated in the assessment, etiology, and treatment of psychopathology.

Non-culture diagnosis and serogroup determination of meningococcal B and C infection by a sialyltransferase (siaD) PCR ELISA

Rapid, non-culture, serogroup determination of meningococcal infection is important in contact management where vaccination may be possible. The impending availability of polysaccharide-protein conjugate vaccines for serogroup C disease requires maximal case ascertainment, with serogroup determination, at a time when the number of culture confirmed meningococcal infections is decreasing. A polymerase chain reaction assay (PCR), based on a restriction fragment length polymorphism (RFLP) in the meningococcal serogroup B and C sialytransferase (siaD) gene, was developed to combine the non-culture diagnosis of meningococcal infection from CSF, whole blood and serum with serogroup (B and C) identification. The PCR assay was adapted to an ELISA format incorporating hybridization with serogroup-specific B and C oligonucleotide probes. Specificity for CSFs was 100% and sensitivities were respectively 81, 63 and 30% for CSFs, whole blood and sera. The serogroup-specific PCR ELISA is a significant addition to currently available tests for non-culture diagnosis of meningococcal infection and outbreak investigation.

Relation of threatened egotism to violence and aggression: the dark side of high self-esteem

Conventional wisdom has regarded low self-esteem as an important cause of violence, but the opposite view is theoretically viable. An interdisciplinary review of evidence about aggression, crime, and violence contradicted the view that low self-esteem is an important cause. Instead, violence appears to be most commonly a result of threatened egotism--that is, highly favorable views of self that are disputed by some person or circumstance. Inflated, unstable, or tentative beliefs in the self's superiority may be most prone to encountering threats and hence to causing violence. The mediating process may involve directing anger outward as a way of avoiding a downward revision of the self-concept.

HIV awareness at work

Shared personal and professional awareness of and commitment to HIV issues in employment prompted Sue Ellis and Liz Smart to set up a project which, through collaborative working between health promotion, personnel functions and trade unionists, would devise training materials to address employment issues and reduce concern about HIV infection in the workplace.

Familial cold urticaria. Investigation of a family and response to stanozolol

BACKGROUND

Familial cold urticaria is a rare cutaneous and systemic reaction to cold with autosomal dominant inheritance, distinctive clinical features, and unknown pathogenesis. Release of a chymotrypsinlike substance has been postulated. To date, no effective treatment has been reported.

OBSERVATIONS

Eight cases from a large family pedigree are described. Three members showed a very favorable response in their cold urticaria, when treated with stanozolol; the response was reproducible. Histologic examination of an early lesion in one case revealed evidence of mast cell degranulation.

CONCLUSIONS

The biochemical observations are probably secondary epiphenomena. Correction of a deficiency of an inhibitory protein is a possible mechanism of action of stanozolol as in hereditary angioedema.

Pneumococcal septic arthritis after splenectomy in Felty's syndrome

A patient with Felty's syndrome who developed bilateral knee septic arthritis and septicaemia due to Streptococcus pneumoniae is described. She had had a previous splenectomy for symptomatic thrombocytopenia, having received pneumococcal vaccine before the operation. Measurement of antibody to the 23 vaccine serotypes showed protective concentrations before infection to just two. The infecting serotype was not represented in the vaccine, but a vigorous antibody response to this serotype occurred. The patient also developed glomerulonephritis due to immune complex deposition.

Erythema elevatum diutinum--an unusual association with ulcerative colitis

We report the association of erythema elevatum diutinum (EED) with ulcerative colitis (UC). The patient, whose history included rheumatoid disease, diabetes mellitus (type I) and hypothyroidism developed EED during a severe acute exacerbation of UC which resolved following colectomy. To our knowledge this is the first report of such an association. Also of interest was the observation of Köebner phenomenon occurring at the sites where blood vessels were damaged.

Factors affecting the duration of breast feeding: 2. Early feeding practices and social class

Breast milk intake by babies on the third and the sixth postpartum day was measured by a test-weigh procedure in a group of 47 mothers and babies. Women who gave the largest amount of breast milk to their babies on the third postpartum day continued to breast feed for longer than women who gave smaller amounts. These mothers also suckled most frequently, gave least additional fluid to their babies, and their infants regained their birth weight most rapidly. However, an increased early milk intake and duration of breast feeding were both associated with higher social class. These results suggest that, although practices in the initiation of breast feeding are relevant, factors in the background and environment of the mother are also of fundamental importance. Thus recent emphasis on the importance of breast-feeding practices in the immediate puerperium should not divert attention from the equally important task of establishing the optimum conditions for breast feeding in the home environment of mothers.

Sodium-dependent choline binding in rat hippocampal synaptosomes

The binding of radiolabelled choline to lysed rat hippocampal synaptosomes was investigated. A portion of the binding sites was (a) detectable only when sodium ions were present, (b) sensitive to low concentrations of hemicholinium-3 (KD less than or equal to 70 nM), and (c) significantly reduced following electrolytic lesion of the septum. The similarity between this component of choline binding and the requirements of the sodium-dependent high affinity choline uptake process suggests that these binding sites are related to the choline transport system.

Competitive inhibition of sodium-dependent high affinity choline uptake by harmala alkaloids

The actions of five harmala alkaloids on the sodium dependent high affinity choline uptake activity in rat striatal synaptosomes was investigated. All five compounds were found to be competitive inhibitors of the uptake system. Harmalol (Ki approximately 3.4 microM) and 2-methylharmine (Ki approximately 5.7 microM) were found to be relatively potent inhibitors in a series with an ascending order of inhibitory potency of harmaline less than 2-methylharmaline less than harmine less than 2-methylharmine less than harmalol.

The effect of harmaline and related harmala alkaloids on ouabain-stimulated contractions of the guinea-pig ileum

Harmaline, harmine, 2-methylharmine and harmolol, members of the harmala family of alkaloids were tested for their action on ouabain-elicited contractions of the guinea-pig ileum. All four alkaloids were found to relax tissue previously contracted by ouabain, but they differed in their potency and reversibility. Harmaline was equipotent with harmine but more easily reversible. 2-Methylharmine and harmolol were found to be less potent and readily reversible. It is evident that the inhibition mediated by harmaline occurs at a site other than that which ouabain binds. Ca-free Tyrode caused relaxation of tissue contracted by ouabain. This effect was partially reversed in the presence of normal Tyrode solution. In presence of high K the response to ouabain was almost abolished. Harmaline inhibited Ca-induced contractions in a non-competitive manner while neither 2-methylharmine nor harmalol had any effect. In the discussion the action of harmala alkaloids is shown to be directly related with CA ion movements.

The effect of harmaline and related beta-carbolines on the acetylcholine-stimulated contractions of guinea-pig ileum

Five members of the Harmala family of alkaloids, four commercially available and one synthetic homologue, were tested for their actions on the acetylcholine-elicited contractions of the guinea-pig ileum. Under normal Tyrode conditions over comparable concentration ranges harmalol was without effect, harmaline and harmine exhibited competitive-noncompetitive inhibition whilst the related 2-methylated derivatives effected purely competitive antagonism. Binding studies using [3H]QNB have further confirmed the competitive aspect of this antagonism. The competitive-noncompetitive inhibitory property of harmaline on smooth muscle muscarinic receptors has not been previously reported. Harmaline is known to compete with Na+ binding sites and significantly complete substitution of Na+ by K+ in the Tyrode medium was found to abolish the noncompetitive component of harmaline inhibition. Explanations are offered for both the competitive and noncompetitive components of the inhibition produced by the Harmala alkaloids.

How long should a breast feed last?

Patterns of milk flow were studied in 50 mothers who were breast-feeding normal birth-weight babies on days 5-7 of the puerperium by progressive test weighing at 5-min intervals during two consecutive feeds. Compared with a regime in which mothers attempted to feed for 10 X 10 min on alternate breasts, a regime of 5 X 5 X 5 X 5 min increased the amount of milk taken in the first 10 min did not influence the final milk intake of the suckling-induced prolactin release. The wide variation of breast-feeding patterns between mothers was demonstrated in respect of the duration of the feed (mean 17.3 min; S.D. +/- 3.1; range 7-30 min), the initial rate of milk flow (mean 6 g/min; S.D. +/- 4.2, range 1-14 g/min) and the final milk intake (mean 70.9 g; S.D. +/- 20.5, range 42-125 g). The advice to breast-feed for 20 min was in appropriate for the majority of mothers because the nutritive feeding time was 15 min or less in 75% of the feeding episodes. The milk intake correlated with the initial rate of milk flow but not with the duration of the feed, the infant's birth weight, or the time since the last feed. It is suggested that the duration of a breast feed should be determined by the infant's response and not by an arbitrary time schedule.