Anadromous fish as biomarkers for the combined impact of marine and freshwater heavy metal pollution

Rivers along the eastern seaboard of the United States and Canada are becoming increasingly contaminated with heavy metals. This includes the Tusket River (Nova Scotia, Canada) which empties into the Gulf of Maine, near the Bay of Fundy. Whether anadromous fish such as alewife (Alosa pseudoharengus), exposed both to marine and freshwater contaminants, are accumulating these heavy metals and experiencing any changes in their morphology was explored in this study. Adult (4-6 years of age) Tusket River alewife (n = 38) were harvested and had external examinations including morphometrics (fork length, weight). Biopsies were taken and structural abnormalities noted. Morphometric data was compared to historical alewife reference data from 1985. Biopsies of muscle, liver and kidney had heavy metal profiles assessed. Major findings of this study include detectable levels (µg/g wet weight) of a number of heavy metals and concerning maximum concentrations achieved of arsenic (liver: 14 µg/g), cadmium (kidney: 2.6 µg/g), mercury (liver: 0.26 µg/g), magnesium (muscle: 460 µg/g), selenium (kidney: 4.0 µg/g) and zinc (liver: 38.0 µg/g). As well, reduced body weight for length and in 87% of fish, presence of spine curvatures (3-24°) not visible externally were noted. This study is the first detailed report in alewife of key tissue heavy metals, some at levels of concern, reductions in weight for length and spine abnormalities. These findings validate concerns regarding potential impacts of deteriorating conditions of rivers and their surrounding waters such as the Gulf of Maine on anadromous fish species.

Essential and non-essential heavy metal levels in key organs of winter flounder (Pseudopleuronectes americanus) and their potential impact on body condition

This study explored whether winter flounder, a benthic species, are potentially exposed to contaminants such as heavy metals released from the sediment of the Bay of Fundy/Gulf of Maine, both critical habitats identified to have increases in heavy metal levels. Experimentally in fish, exposure to certain heavy metals resulted in reduced weight for length and structural abnormalities, but it is unknown if this occurs in wild fish. Winter flounder (n = 72), harvested between 2015 and 2018 from the aforementioned western Atlantic region of Canada/USA, had detectable levels of most heavy metals, with some exhibiting levels of concern (arsenic, cadmium, lead, selenium, zinc) in muscle, liver, and kidney. A 1.4% incidence of structural abnormalities was noted. When compared to 1980 regionally matched flounder data, the 2018 flounder had significantly reduced weight for length, exacerbated with age. Clearly winter flounder are affected by worsening heavy metal contaminant levels in this geographic area.

Evolving epidemiology of carbapenemase-producing Enterobacterales: one hospital's infection prevention and control response over nine years

BACKGROUND

Preventing carbapenemase-producing Enterobacterales (CPE) transmission is a significant challenge for hospital infection prevention and control teams (IPCTs). Control measures include screening at-risk patients, contact tracing, and the isolation of carriers with contact precautions.

AIM

The evolution of infection prevention and control measures was assessed in a tertiary acute care hospital with predominately multi-bedded patient accommodation, from 2011 to 2019 as cases of CPE increased. The implications for, and the response and actions of, the IPCT were also reviewed.

METHODS

CPE data collected prospectively from our laboratory, IPCT, and outbreak meeting records were reviewed to assess how the IPCT adapted to the changing epidemiology, from sporadic cases, to outbreaks and to localized endemic CPE.

FINDINGS

Of 178 cases, 152 (85%) were healthcare-associated and there was a marked increase in cases from 2017. The number of screening samples tested annually increased from 1190 in 2011 to 16,837 in 2019, and six outbreaks were documented, with larger outbreaks identified in later years. OXA-48 carbapenemase was detected in 88% of isolates and attendance at outbreak meetings alone accounted for 463.5 h of IPCT members, and related staff time.

CONCLUSION

Despite considerable efforts and time invested by the IPCT, the number of CPE cases is increasing year-on-year, with more outbreaks being reported in later years, albeit partly in response to increased screening requirements. Infrastructural deficits, the changing epidemiology of CPE, and national policy are major factors in the increasing number of cases.

Food for thought. Malnutrition risk associated with increased risk of healthcare-associated infection

BACKGROUND

Infection and malnutrition are interconnected. UK and Irish guidelines recommend the Malnutrition Universal Screening Tool (MUST) for nutritional risk screening. Patients with a MUST score of ≥2 are considered at high risk of malnutrition and referral for nutritional assessment is recommended.

AIM

To explore the association between healthcare-associated infection (HCAI) and the MUST score categories of patients.

METHODS

This was a cross-sectional study in May 2017 on ten representative wards in our institution. Patient demographics, MUST score, presence of medical devices, HCAI and antimicrobial use were collected.

FINDINGS

Of 240 patients, the HCAI prevalence was 10.4% (N = 25) and 26% (N = 63) were at high risk of malnutrition (MUST score ≥2). Patients with HCAI were more likely to have had surgery (odds ratio (OR): 5.5; confidence interval (CI): 2.1-14.3; P < 0.001), a central vascular catheter (OR: 10.0; CI: 3.6-27.2; P < 0.001), or a urinary catheter in situ (OR: 7.5; CI: 2.8-20.0; P < 0.001), and to have a high risk of malnutrition (OR: 4.3; CI: 1.7-11.2; P < 0.001). A higher MUST score remained a significant predictor of a patient having HCAI on multivariate regression analysis (CI: 0.2-0.6; P < 0.001).

CONCLUSION

Patients at risk of malnutrition when assessed with the MUST were more likely to have HCAI. However, prospective studies are required to investigate the temporal association between MUST and HCAI and which interventions best address malnutrition risk and HCAI reduction in different settings.

Does poverty cause dental caries?

Dental caries generates significant health, financial and social costs to individuals and communities, but risk factors are not spread randomly and evenly throughout populations. People from lower socio-economic status (SES) and disadvantaged groups suffer a disproportionately greater disease burden. Clinicians and public health experts view this problem through a different lens. Dentists at the clinical coalface consider individual risk factors and behaviours, for example sugar consumption, cariogenic bacteria and poor oral hygiene, as major causes of dental caries. However, considerable evidence suggests that low SES, via traditional individual risk factors as mediators and through additional independent pathways, is another significant cause. Progressive clinical practice uses education, prevention and treatment to reduce the impact of individual risk factors. Policy-makers and health administrators use population-based approaches to improve the health of societies. The authors use literature review to argue for both a greater awareness of the upstream socio-economic causes of dental caries, and action from key community sectors to redress the societal inequalities contributing to dental health inequalities.

How would Mary Poppins fare in labour? Practically perfect? Unlikely

Introduction Unrealistic expectations of labour in first time mothers can present challenges to physicians and midwives. This study calculated the percentage of “practically perfect” births in nulliparous women, defined as a labour without intervention, an intact perineum and a positive neonatal outcome. Methods: This was a retrospective study of the nulliparous deliveries that occurred in the National Maternity Hospital over two years (2014/2015). To extract the perfect births, we excluded deliveries <37 weeks, induction/pre labour Caesarean Section (CS), Artificial Rupture of Membranes (ARM), oxytocin, fetal blood sample, emergency CS/instrumental deliveries, perineal damage and suboptimal Apgar scores. Results: 0.8% of nulliparous mothers had a practically perfect birth. Discussion Our results provide a useful statistic for clinicians and nulliparous mothers, which could be further validated by similar studies in similar units. The study had a large cohort which objectively quantified perfect births. Research on the subjective perception of perfect births could add value to these findings.

Understanding Optimum Fluoride Intake from Population-Level Evidence

Policy on fluoride intake involves balancing caries against dental fluorosis in populations. The origin of this balance lies with Dean’s research on fluoride concentration in water supplies, caries, and fluorosis. Dean identified cut points in the Index of Dental Fluorosis of 0.4 and 0.6 as critical. These equate to 1.3 and 1.6 mg fluoride (F)/L. However, 1.0 mg F/L, initially called a permissible level, was adopted for fluoridation programs. McClure, in 1943, derived an “optimum” fluoride intake based on this permissible concentration. It was not until 1944 that Dean referred to this concentration as the “optimal” concentration. These were critical steps that have informed health authorities through to today. Several countries have derived toxicological estimates of an adequate and an upper level of intake of fluoride as an important nutrient. The US Institute of Medicine (IOM) in 1997 estimated an Adequate Intake (AI) of 0.05 mg F/kg bodyweight (bw)/d and a Tolerable Upper Intake Level (UL) of 0.10 mg F/kg bw/d. These have been widely promulgated. However, a conundrum has existed with estimates of actual fluoride intake that exceed the UL without the expected adverse fluorosis effects being observed. Both the AI and UL need review. Fluoride intake at an individual level should be interpreted to inform more nuanced guidelines for individual behavior. An “optimum” intake should be based on community perceptions of caries and fluorosis, while the ultimate test for fluoride intake is monitoring caries and fluorosis in populations.

Anti-fibrotic Effects of CXCR4-Targeting i-body AD-114 in Preclinical Models of Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic fibrotic lung disease that is prevalent in individuals >50 years of age, with a median survival of 3–5 years and limited therapeutic options. The disease is characterized by collagen deposition and remodeling of the lung parenchyma in a process that is thought to be driven by collagen-expressing immune and structural cells. The G-protein coupled C-X-C chemokine receptor 4, CXCR4, is a candidate therapeutic target for IPF owing to its role in the recruitment of CXCR4⁺ fibrocytes from the bone marrow to fibrotic lung tissue and its increased expression levels by structural cells in fibrotic lung tissue. We have engineered a novel fully human single domain antibody “i-body” called AD-114 that binds with high affinity to human CXCR4. We demonstrate here that AD-114 inhibits invasive wound healing and collagen 1 secretion by human IPF fibroblasts but not non-diseased control lung fibroblasts. Furthermore, in a murine bleomycin model of pulmonary fibrosis, AD-114 reduced the accumulation of fibrocytes (CXCR4⁺/Col1⁺/CD45⁺) in fibrotic murine lungs and ameliorated the degree of lung injury. Collectively, these studies demonstrate that AD-114 holds promise as a new biological therapeutic for the treatment of IPF.

Codeine use, dependence and help-seeking behaviour in the UK and Ireland: an online cross-sectional survey

BACKGROUND

Codeine misuse and dependence poses a clinical and public health challenge. However, little is known about dependence and treatment needs in the UK and Ireland.

AIM

To characterize codeine use, dependence and help-seeking behaviour.

DESIGN

An online cross-sectional survey advertised on Facebook, Twitter, health and drug websites and e-mail circulars.

METHODS

The survey collected data on demographics and codeine use amongst adults from the UK and Ireland. The Severity of Dependence Scale measured the level of codeine dependence.

RESULTS

The sample of 316 respondents had a mean age of 35.3 years (SD = 12.3) and 67% were women. Of the 316 respondents, 54 scored ≥5 on the Severity of Dependence Scale indicating codeine dependence (17.1%). Our study found that codeine dependence is a problem with both prescribed and 'over-the-counter' codeine. Codeine dependence was associated with daily use of codeine, faking or exaggerating symptoms to get a prescription for codeine and 'pharmacy shopping' ( P < 0.01). A higher number of respondents had sought advice on the Internet (12%) rather than from their general medical practitioner (GP) (5.4%). Less than 1% of respondents had sought advice from a pharmacist.

CONCLUSIONS

Codeine dependent users were more likely to seek help on the Internet to control their use of codeine than from a GP, which may indicate a potential for greater specialized addiction treatment demand through increased identification and referrals in primary care.

Investigation of an association between onset of narcolepsy and vaccination with pandemic influenza vaccine, Ireland April 2009-December 2010

In 2011, the Irish Medicines Board received reports of onset of narcolepsy following vaccination against influenza A(H1N1)pdm09 with Pandemrix. A national steering committee was convened to examine the association between narcolepsy and pandemic vaccination. We conducted a retrospective population-based cohort study. Narcolepsy cases with onset from 1 April 2009 to 31 December 2010 were identified through active case finding. Narcolepsy history was gathered from medical records. Pandemic vaccination status was obtained from vaccination databases. Two independent experts classified cases using the Brighton case definition. Date of onset was defined as date of first healthcare contact for narcolepsy symptoms. Incidence of narcolepsy in vaccinated and non-vaccinated individuals was compared. Of 32 narcolepsy cases identified, 28 occurred in children/adolescents and for 24 first healthcare contact was between April 2009 and December 2010. Narcolepsy incidence was 5.7 (95% confidence interval (CI): 3.4–8.9) per 100,000 children/adolescents vaccinated with Pandemrix and 0.4 (95% CI: 0.1–1.0) per 100,000 unvaccinated children/adolescents (relative risk: 13.9; absolute attributable risk: 5.3 cases per 100,000 vaccinated children/adolescents). This study confirms the crude association between Pandemrix vaccination and narcolepsy as observed in Finland and Sweden. The vaccine is no longer in use in Ireland. Further studies are needed to explore the immunogenetic mechanism of narcolepsy.

Investigation of an association between onset of narcolepsy and vaccination with pandemic influenza vaccine, Ireland April 2009-December 2010

Binary file ES_Abstracts_Final_ECDC.txt matches

Sickness certification difficulties in Ireland--a GP focus group study

BACKGROUND

Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties.

AIMS

To explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland.

METHODS

A qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used.

RESULTS

Three major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification.

CONCLUSIONS

GPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.

Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study

BACKGROUND

Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).

AIM

To examine the feasibility of multi-centre CRI surveillance in nine Irish ICUs, using Hospitals in Europe Link for Infection Control through Surveillance (HELICS) definitions (CRI 1, CRI 2 and CRI 3).

METHODS

All non-tunnelled central venous catheters (CVCs) inserted in patients aged >18 years with an ICU stay ≥48 h were included over a three-month study period.

FINDINGS

Feasibility was demonstrated by the 99.5% return rate for study forms. Data on 1209 CVCs in 614 patients over 7587 CVC-days showed 17 episodes of CRI, representing a national rate of 2.2 per 1000 CVC-days [95% confidence interval (CI) 1.2-3.3]. Rates of CRI 1, CRI 2 and CRI 3 were 0.13 (95% CI 0.00-0.39), 0.79 (95% CI 0.16-1.42) and 1.39 (95% CI 0.60-2.17) per 1000 CVC-days, respectively. CRI was associated with length of ICU stay (P < 0.001), number of CVCs inserted (P < 0.001) and total number of CVC-days per patient (P < 0.001). CRI was higher in CVCs inserted in operating theatres (incident rate ratio 3.9, 95% CI 1.3-11.5; P = 0.02) compared with CVCs inserted in ICUs. Participant feedback reported minimal difficulty with surveillance implementation, and data collection required approximately 1 h per patient per week.

CONCLUSION

The study demonstrated that multi-centre ICU surveillance using HELICS CRI definitions was practical, feasible and provided clinically relevant information. CRI surveillance in ICUs, although labour intensive, is recommended to reduce CRI and allow ongoing evaluation of processes aimed at CRI reduction.

Survival in women with ovarian cancer before and after the introduction of adjuvant paclitaxel; a 25-year, single institution review

Adjuvant chemotherapy regime for ovarian cancer patients remains to be a contentious issue. The aim of this study was to compare the overall and progression-free survival of women with ovarian cancer before and after introduction of paclitaxel in our unit in 1992. A sample of 112 women who received adjuvant therapy following surgery for ovarian cancer was collected, 68 (61%) received platinum+alkylating agent before 1992 and later 44 (39%) received platinum+paclitaxel. Five-year survival was same in both treatment groups when there was no macroscopic disease after surgery (78% versus 70%) and when residual disease was <2 cm (50% versus 40%). Survival was greater in women with residual disease >2 cm in the platinum+paclitaxel group (50% versus 24%), (p = 0.04). However, progression-free survival was similar in both groups irrespective of stage or residual volume of disease. Therefore consideration to selective use of paclitaxel could reduce patient morbidity and costs significantly.

Peptides specific for Mycobacterium avium subspecies paratuberculosis infection: diagnostic potential

Mycobacterium avium subspecies paratuberculosis (Map) is the causative agent of Johne's disease (JD). Current serological diagnostic tests for JD are limited by their sensitivity when used in sub-clinical stages of the disease. Our objective was to identify peptides that mimic diagnostically important Map epitopes that might be incorporated into a new-generation JD diagnostic. Four peptides were isolated from a phage-displayed random peptide library by screening on antibodies derived from Map-infected goats. The peptides were recognised by antibodies from Map-infected goats but not by antibodies from uninfected goats. The peptides elicited immune responses in rabbits, which reacted strongly with bona fide Map antigens proving the peptides were true epitope mimics. To assess the diagnostic value a panel of goat sera was screened for reactivity's with peptides. The peptides were recognised by antibodies from a proportion of goats infected with Map compared with control animals with a diagnostic specificity of 100% and the sensitivity ranged from 50 to 75%. Combinations of any two peptides improved sensitivity 62.5-87.5% and 100% sensitivity was achieved with three of the four peptides in combination. These data suggest peptides representing diagnostically important Map epitopes could be incorporated into a sensitive diagnostic test.

Ethnic variation between white European women in labour outcomes in a setting in which the management of labour is standardised-a healthy migrant effect?

OBJECTIVE

To test the hypothesis that women from Eastern European countries have lower caesarean delivery rates and higher spontaneous labour rates relative to Irish women in a setting in which the management of labour is standardised.

DESIGN

A retrospective review of prospectively collected data.

SETTING

Tertiary referral centre, Dublin, Ireland.

POPULATION

All Irish and Eastern European term nulliparous women who laboured and delivered in 2008.

METHODS

A comparison of labour outcomes between women from Ireland and women from Eastern European countries.

MAIN OUTCOME MEASURES

The principal outcomes measured were the gestational age at onset of labour, whether labour was spontaneous or induced, the need for oxytocin augmentation, duration of labour, mode of delivery, epidural use and birthweight.

RESULTS

Of 2556 Irish (n = 2041) and Eastern European (n = 511) term cephalic singleton labours in the calendar year 2008, women from Eastern Europe were significantly more likely to labour spontaneously (74.6% versus 65.9%, P < 0.001), required less epidural analgesia (68.4% versus 59.7%) and were significantly less likely to require delivery by caesarean section (8.6% versus 15.7%, P < 0.001) than Irish women. This is despite no significant difference between the two groups with regard to mean birthweight (3581 g versus 3569 g, P = 0.6) or macrosomia (birthweight over 4000 g) (18% versus 16%, P = 0.4). There were significant differences in maternal age at delivery (27.2 years versus 29.2 years, P < 0.001) and body mass index (BMI) (24.1 kg/m² versus 25.4 kg/m², P < 0.001) between the two groups.

CONCLUSION

These findings confirm our hypothesis that economic migrants from Eastern European countries exhibit a so-called 'healthy migrant effect' in terms of obstetric outcomes.

Abstract P3-14-20: Phase 1 Dose-Escalation Study of the Investigational HER2/EGFR Inhibitor TAK-285 in Patients with Advanced Cancer

Background and Objectives: TAK-285 is a novel, orally active, dual HER2/EGFR inhibitor. Nonclinical data show that TAK-285 has high selectivity and specificity for binding to HER family kinases, and has demonstrated anti-tumor activity in a BT-474 mouse xenograft model of breast cancer. Nonclinical data also indicate that TAK-285 is not a substrate for the efflux transporters P-gp and BCRP and penetrates an intact blood-brain barrier in rats. This phase 1 dose-escalation study in patients with advanced cancer aimed to determine the safety and pharmacokinetic (PK) profile.

Methods: Adults had advanced histologically confirmed non-hematologic malignancies, life expectancy &gt;12 weeks, adequate bone marrow, liver and renal function, ECOG PS 0-2, and were refractory to other treatments. Oral TAK-285 was escalated from 50 to 500 mg QD or BID for 21 or 28 consecutive days of a 28-day cycle until disease progression or unacceptable toxicity was observed.

Results: At the data cut-off of 04/23/10, the dose-escalation portion was complete, and the RP2D expansion cohort is ongoing. Preliminary data from the dose-escalation cohorts are reported. 43 patients (median age 60 years [43-76]) were enrolled: 30% ≥65 years, 51% female, and 86% white. Dose levels were 50 mg QD (N=4), 50 mg BID (N=7), and 75 mg BID (N=6) on d 1-21; and 150 mg (N=6), 225 mg (N=4), 325 mg (N=3), 400 mg (N=6), and 500 mg (N=7) BID on d 1-28. Median duration of exposure across all cohorts was 52 days (3-267). Four patients experienced a DLT in Cycle 1: 1 patient (50 mg BID) had Grade 3 pancreatitis; 1 patient (150 mg BID) had Grade 3 chest pain and Grade 3 hypoxia; 1 patient (500 mg BID) had Grade 3 increased ALT; and 1 patient (500 mg BID) had Grade 3 diarrhoea and Grade 3 hypokalaemia. The MTD was 400 mg BID d 1-28. 30 patients (70%) discontinued TAK-285, primarily due to disease progression (n=19, 44%) or an AE (n=9, 21%). Most frequent AEs were fatigue (37%), diarrhoea (35%), nausea (26%), anorexia (21%), vomiting (16%), and elevated AST (16%). 58% of patients had a drug-related AE; the most frequent were diarrhoea (21%), fatigue (19%), and rash (includes rash, rash maculo-papular and rash macular; 12%). 35% of patients had a grade 3/4 AE; the most common were hypokalaemia (7%), ileus, abdominal pain, and hypoxia (5% each). Grade 3/4 AEs related to TAK-285 were the DLTs in Cycle 1 and Grade 4 rhabdomyolysis in 1 patient (400 mg BID, d 1-28) in Cycle 3. 42% of patients experienced a serious AE (SAE); the only SAE seen in &gt;1 patient was ileus (n=2). 4 (9%) patients had fatal AEs; none were considered related to TAK-285. Absorption was fast: plasma concentrations peaked 2-3 hours post-dose. Steady-state plasma exposures increased with dose in a greater than dose-proportional manner, with PK steady-state achieved by Day 8. Accumulation was noted with BID dosing (mean accumulation ratio, 2.4 at MTD); there was moderate fluctuation in plasma concentrations over the steady-state dosing interval (mean Cmax:Cmin ratio, 2.4 at MTD).

Conclusions: The MTD for TAK-285 was 400 mg BID d 1-28. The RP2D cohort is ongoing and includes CSF collection to assess the CNS distribution of TAK-285. Updated safety as well as efficacy data for the dose escalation cohorts will be presented.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-14-20.

Histological grading of epithelial ovarian carcinomas

The grade of an ovarian epithelial neoplasm provides useful information. However, different approaches to grading exist and many ovarian cancers are not graded. We examined primary ovarian cancers from patients treated at our hospital and applied the 'universal' grading system. We found a significant association between grade and clinical stage, with a survival difference between grades for low-stage tumours. The application of grade is discussed in the light of developments in the grading of other gynaecological cancers.

Urinary tract fistulas following gynaecological surgery

Urinary tract fistulas are a relatively uncommon but important complication of gynaecological surgery. Between 1980 and 1995 we identified 17 patients who developed a urinary tract fistula after gynaecological surgery. Seven of the patients had surgery performed for neoplastic disease but none of these patients received adjuvant radiotherapy before the formation of the fistula. There were 12 vesicovaginal fistulas and five ureteric fistulas. Four of the vesicovaginal fistulas were repaired by the vaginal approach and five vesicovaginal fistulas were repaired by the abdominal route. Three vesicovaginal fistulas were treated by catheterisation alone. Two of the 17 patients took medicolegal action. Early recognition and repair of urinary tract fistulas is recommended. Repair of vesicovaginal fistulas by the vaginal approach is advised. The litigious nature of this distressing condition is lessened when early primary closure is successful.

Peptide mimics selected from immune sera using phage display technology can replace native antigens in the diagnosis of Epstein-Barr virus infection

There is an expanding area of small molecule discovery, especially in the area of peptide mimetics. Peptide sequences can be used to substitute for the entire native antigen for use in diagnostic assays. Our approach is to select peptides that mimic epitopes of the natural immune response to Epstein–Barr virus (EBV) that may be recognised by antibodies typically produced after infection with EBV. We screened a random peptide library on sera from rabbits immunised with a crude preparation of EBV and serum antibodies from a patient with a high titer of EBV antibodies. We selected four peptides (Eb1–4) with the highest relative binding affinity with immune rabbit sera and a single peptide with high affinity to human serum antibodies. The peptides were coupled to the carrier molecule BSA and the recognition of the peptides by IgM antibodies in clinical samples after infection with EBV was measured. The sensitivities were Eb1 94%, Eb2, 3, 4 88%, H1 81% and all had 100% specificity. This study illustrates that the phage display approach to select epitope mimics can be applied to polyclonal antibodies and peptides that represent several diagnostically important epitopes can be selected simultaneously. This panel of EBV peptides representing a wide coverage of immunodominant epitopes could replace crude antigen preparations currently used for capture in commercial diagnostic tests for EBV.

Screening platelet concentrates for bacterial contamination: low numbers of bacteria and slow growth in contaminated units mandate an alternative approach to product safety

BACKGROUND AND OBJECTIVES

We introduced 100% screening of platelets for bacterial contamination in 2005 to reduce the risk of clinical sepsis from platelet transfusion. We test all outdating units again at expiry to assess the sensitivity of the initial test.

MATERIALS AND METHODS

We test all platelet concentrates prior to release for clinical use using a large volume automated culture technique on the day after manufacture. All units that expire unused are retested. Platelets still in stock on day 4 of storage may have a repeat culture performed, and are returned to stock with two extra days of shelf life.

RESULTS

Of 43,230 platelet units screened, 35 (0.08%) were positive; of 8282 expired unused, 18 (0.22%) were positive; and of 3310 day-4 retests, four (0.12%) were positive. Overall sensitivity of the initial screening test was 29.2% (95% confidence interval 19.4 to 39.1%). Thirteen of the 35 positive screening tests would have been expected to grow in both aerobic and anaerobic bottles; eight grew in aerobic culture only and five grew in anaerobic culture only, indicating that the likely number of bacteria in the contaminated platelet units at the time of sampling was less than 60 colony-forming unit per platelet unit.

CONCLUSIONS

Screening platelet concentrates for bacterial contamination using the most sensitive method available has a sensitivity of less than 40% because of the low numbers of bacteria in the initial contamination. Effective resolution of this problem will require a pathogen-inactivation technique.

Early stage endometrial carcinoma--a study of management and outcome

The surgical management of early stage endometrial carcinoma is controversial. The benefits of pelvic lymphadenectomy and administration of radiotherapy in this group have been disputed. We aimed to document the experience of stage 1 endometrial carcinoma at the National Maternity Hospital during the 10 year period 1989-1998 and to evaluate and compare clinical outcomes between retrospectively-assigned low and high-risk tumour groups. Seventy seven women were diagnosed with Stage 1 endometrial carcinoma in this period. Thirty-nine women had low-risk and 38 had high-risk tumours. Women with high-risk tumours were older and had a higher rate of lymph-vascular space invasion by tumour on histological examination. Three women (3.9%) developed disease recurrence and died of their disease; one low-risk and two high-risk tumour patients. Survival without recurrence did not differ between the two risk groups. No consistent pattern existed in surgical staging between the two risk groups. A prospectively-assigned definition of risk would minimise variations in clinical practice by providing a basis for a more tailored approach to adjuvant treatments.

Endocervical sampling: a comparison of endocervical brush, endocervical curette, and combined brush with curette techniques

OBJECTIVE

This study was conducted to compare the collection of endocervical specimens by endocervical brush, curette, and a combined curette and brush technique.

METHODS

Women underwent colposcopy with endocervical curettage using one of 3 collection methods.

RESULTS

The endocervical brush produced equivalent amounts of tissue and endocervical cells compared to the curette alone or combined techniques. More squamous and glandular atypia and SIL/AIS were found when a brush was used, but a statistically significant difference was not noted. The brush alone produced a significantly greater percentage of samples that were insufficient for diagnosis and more specimens without stromal components. The brush with the curette as a combined technique provided no improvement in amounts of tissue, endocervical cells/clusters, or amount of stroma retrieved.

CONCLUSION

Each technique has advantages and disadvantages in terms of what types of components are collected and what diagnosis may be determined from the sample taken.