Shorter TB treatment regimens should be safer as well

Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.

Unleashing the full power of LHCb to probe stealth new physics

In this paper, we describe the potential of the LHCb experiment to detect stealth physics. This refers to dynamics beyond the standard model that would elude searches that focus on energetic objects or precision measurements of known processes. Stealth signatures include long-lived particles and light resonances that are produced very rarely or together with overwhelming backgrounds. We will discuss why LHCb is equipped to discover this kind of physics at the Large Hadron Collider and provide examples of well-motivated theoretical models that can be probed with great detail at the experiment.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.

Factor Analysis of the Relationships between Personality and Motor Characteristics of Men and Women

To identify possible relationships among 16 motor and 11 personality variables, 152 women and 77 men, ages 22 to 30 yr., were tested, using factor analysis with varimax rotation. The hypotheses were that (1) specific personality characteristics are related to specific motor characteristics, (2) motor and personality characteristics are clustered in a common structure, (3) sex differences exist in the relations between personality and motor performance. Analyses confirmed Hypotheses 1 and 3. Only two of the 11 tested personality variables (Extraversion and ability to delay gratification) were related to some of the motor variables, Reaction time, Balance, and Kinesthesis. These relations as well as the factorial structure differed for men and women. As the personality and motor variables were not clustered in common factorial pattern for both sexes, Hypothesis 2 was rejected.

Sulphated Polymers are Potent and Selective Inhibitors of Various Enveloped Viruses, Including Herpes Simplex Virus, Cytomegalovirus, Vesicular Stomatitis Virus, Respiratory Syncytial Virus, and Toga-, Arena- and Retroviruses

The sulphated polymers, such as polyvinylalcohol sulphate (PVAS) and its co-polymer with acrylic acid (PAVAS), have proved to be potent inhibitors for herpes simplex virus, human cytomegalovirus, vesicular stomatitis virus, respiratory syncytial virus, Sindbis virus, Semliki Forest virus, Junin virus, Tacaribe virus, murine sarcoma virus and human immunodeficiency virus. They are not inhibitory to non-enveloped viruses, such as poliovirus and reovirus. The broad-spectrum antiviral effects of these compounds depend on their molecular weight and degree of sulphation. Pharmacokinetic studies in rabbits have indicated that after intravenous bolus injection the serum concentrations of these compounds decay biphasically, with an initial half-life of approximately 90–120 min.

One size doesn’t fit all: Tailoring adult antiretroviral treatment

Advances in antiretroviral treatment mean that patients in the public health system can be given more options in the management of their treatment. Although public health programmes tend to offer one-size-fits-all approaches, patients might benefit from a more flexible approach. In particular, we propose that people with HIV should be given more choice with regard to when to start treatment, and patients who experience efavirenz side-effects should be encouraged to switch to other medications, which will be facilitated by faster registration and lower prices of newer antiretrovirals. 

Trends in outpatient antibiotic use in Israel during the years 2000-2010: setting targets for an intervention

PURPOSE

The abundant use of antibiotics (Abs) in the community plays a major role in inducing Ab resistance, but the literature concerning patterns in outpatient Ab use is limited. This study aims to lay the foundations for future policy and interventional programs to address the rise in Ab resistance by looking at long-term trends in Ab usage in Israel.

METHODS

Defined daily doses per 1,000 inhabitants per day (DID) of total Ab use, consumption in different age groups, and of different Ab preparations were calculated for the years 2000, 2005, and 2010 in the eight districts of Israel. Data were collected from the pharmacy registries of "Clalit Health Services", the largest Health Maintenance Organization (HMO) in Israel, covering 4 million patients, representing 53 % of the population. Trends in use over time were analyzed.

RESULTS

The overall Ab usage in Israel has remained constant in the last decade. Three significant trends were identified in this study: an increase in the consumption of expensive, broad-spectrum Abs, paralleled by a reduction in narrow-spectrum Abs; an increase in Ab consumption among the elderly, counteracted by reduced usage among children; large regional variations in the overall and specific use of Ab agents.

CONCLUSIONS

Our main findings of increased broad-spectrum Ab consumption, primarily among the adult population in Israel, and a wide variability in Ab use between the regions in Israel, can focus our future studies on searching for the factors behind these trends to aid in constructing interventional methods for decreasing outpatient Ab overuse.

Tissue disposition, excretion and metabolism of 2,2′,4,4′,6-pentabromodiphenyl ether (BDE-100) in male Sprague–Dawley rats

The absorption, disposition, metabolism and excretion study of orally administered 2,2',4,4',6-pentabromodiphenyl ether (BDE-100) was studied in conventional and bile-duct cannulated male rats. In conventional rats, >70% of the radiolabelled oral dose was retained at 72 h, and lipophilic tissues were the preferred sites for disposition, i.e. adipose tissue, gastrointestinal tract, skin, liver and lungs. Urinary excretion of BDE-100 was very low (0.1% of the dose). Biliary excretion of BDE-100 was slightly greater than that observed in urine, i.e. 1.7% at 72 h, and glucuronidation of phenolic metabolites was suggested. Thiol metabolites were not observed in the bile as had been reported in other PBDE metabolism studies. Almost 20% of the dose in conventional male rats and over 26% in bile-duct cannulated rats was excreted in the faeces, mainly as the unmetabolized parent, although large amounts of non-extractable radiolabel were also observed. Extractable metabolites in faeces were characterized by mass spectrometry. Monohydroxylated pentabromodiphenyl ether metabolites were detected; mono- and di-hydroxylated metabolites with accompanying oxidative debromination were also observed as faecal metabolites. Tissue residues of [(14)C]BDE-100 in liver, gastrointestinal tract and adipose tissue contained only parent material. The majority of the 0-72-h biliary radioactivity was associated with an unidentified 79-kDa protein or to albumin.

Neurology of Fabry disease

BACKGROUND

Fabry disease has diverse neurological manifestations, many of which influence morbidity and quality of life.

AIMS

The aim of the study was to document the clinical and subclinical neurological manifestations in a cohort of Australian patients with Fabry disease, using multiple clinical tools and a multidisciplinary approach.

METHODS

Participants completed focused questionnaires and underwent clinical neurological examination, Neurocognitive testing using Mini Mental State Examination and Neuropsychiatry Unit Cognitive Screen, Quantitative Sensory Testing (QST), autonomic assessment using RR interval variation, intracranial magnetic resonance imaging (MRI) and audiology. In subsets of patients who had previously undergone QST and/or prospective serial quality-of-life assessments over the previous 5 years, results before and after enzyme replacement therapy were compared.

RESULTS

Twenty hemizygotes and two heterozygotes were recruited. The age (mean +/- standard deviation (SD)) of male participants was 40.4 +/- 11.9 years (range 20-62 years); the women were aged between 20 and 56 years. Increasing age was strongly associated with increasing neurological disability. Clinical peripheral neuropathy predominantly affected thermal sensation in all patients, with variable involvement of pinprick and light touch. QST confirmed these findings. Clinical cerebellar tests were commonly abnormal: this has not been previously reported in the absence of symptomatic cerebrovascular disease. There was hearing loss was in 90% of patients and no patient older than 44 years had normal hearing. MRI lesion prevalence increased with age. Despite neurological complications being common, formal cognitive testing was basically normal. QST thresholds for pain showed a significant change after enzyme replacement therapy.

CONCLUSIONS

Neurological complications in Fabry disease are common, complex and may be devastating. All patients studied had neurological involvement, with protean and diverse manifestations.

Aspergillosis in a North Island robin (Petroica longipes)

CASE HISTORY

A 3-year-old female North Island robin (Petroica longipes) was found dead on Tiritiri Matangi Island during the breeding season.

CLINICAL FINDINGS

The bird was in poor condition, and there was a 13 x 8 mm granulomatous mass in the thoracic cavity causing displacement of the heart and left lung. Histologically, the mass was a large granuloma infiltrated with fungal hyphae, and the liver contained multifocal aggregates of inflammatory cells.

DIAGNOSIS

Thoracic aspergillosis and multifocal hepatitis.

CLINICAL RELEVANCE

Determining the causes of death in populations of wild birds is often hampered by a lack of recovery of carcasses, autolysis and poor clinical history. In this case, the life history of the bird was known and recovery of the body was relatively swift. This is the first published description of aspergillosis in a free-living North Island robin.

Stereotypies and behavioural medicine: confusions in current thinking

Stereotypies are defined as being repetitive, unvarying behaviours that appear to have no goal or function. This group of behaviours presents itself commonly in clinical behavioural practice. In recent companion animal behaviour literature the nomenclature has been changed to obsessive-compulsive disorder without considering the confusion this may create. Theories about the role endorphins play as a cause of stereotypies and an assumption about stereotypies playing a 'coping' role have been presented as scientific fact with little evidence supporting them. A failure to consider changes associated with stereotypy maturation and a reliance on anecdotal treatment success has lead to confusion regarding certain aspects of the development, diagnosis and treatment of these conditions. In this paper I present the idea that much of our confusion surrounding stereotypies is created by attempts to oversimplify a complex phenomenon.

Time course of stress relaxation and recovery in human ankles

OBJECTIVE

To characterise the time course of stress relaxation and recovery from stress relaxation in human ankles.

DESIGN

Two experiments were conducted. The first used a randomised within-subjects design, and the second used a randomised between-subjects regression design.

BACKGROUND

Several studies have described the time course of stress relaxation in human joints, but most have looked only at the effects of short durations of stretch. The time course of recovery from stretch in human ankles has not been documented.

METHODS

In the first experiment, one ankle of each of eight subjects was stretched to a fixed dorsiflexion angle for 20 min. The ankle was then released for 2 min (during which time subjects either remained relaxed or performed isometric contractions), then stretched again. In a second experiment, on 24 subjects, the ankle was stretched for 20 min, then released between 0 and 20 min, then stretched again. In both experiments, subjects remain relaxed and ankle torque was measured continuously.

RESULTS

When a constant-angle stretch was applied to the ankle, torque declined bi-exponentially towards an asymptote that was 58% of the initial torque. Nearly 5 min of stretch were required to obtain half of the maximal possible stress relaxation. Torque had recovered by 43% within 2 min of the release of stretch, but the degree of recovery did not appear to depend on whether subjects remained relaxed or performed isometric contractions. The time course of recovery was similar to the time course of stress relaxation.

CONCLUSIONS

Long duration stretches are required to produce a large proportion of the maximal possible stress relaxation. Recovery is initially rapid when the stretch is released.

RELEVANCE

These data provide a description of the time course of the effects of stretch, and of the subsequent relief of stretch, on mechanical properties of human ankles.

Calcific myonecrosis: case report and review

Although a rare diagnosis, with few reports in the literature, calcific myonecrosis is a diagnosis that must be entertained in individuals presenting with expanding masses in the muscle compartments occurring years after an initial injury. The authors report a previously healthy 66-year-old man with an expanding right lower extremity mass felt initially to be an abscess. Despite presumably appropriate antimicrobial therapy, the lesion continued to expand, causing pain and loss of function. The patient subsequently underwent extensive debridement and free muscle flap transfer with an excellent outcome. This patient serves to remind us that, although calcific myonecrosis is an uncommonly encountered condition, it must be maintained in the differential diagnosis of an expanding muscle compartment mass.

Prevalence of anti-hepatitis A antibodies, hepatitis B viral markers, and anti-hepatitis C antibodies among immigrants from the former USSR who arrived in Israel during 1990-1991

The goal of this study was to assess the susceptibility of the sub-population of over 500,000 immigrants from the former USSR who came to Israel during 1989-94 to HAV infection, and to provide military physicians with estimates of the prevalence of HBV and HCV carriage in this sub-population. 987 males aged 17-49 and 195 females aged 17-19, reporting to military recruitment offices between December 1991 and March 1992 were tested. Anti-HAV, anti-HBV antibodies and hepatitis B surface antigen (HBsAg) were detected by using standard enzyme immunoassay (EIA) tests, and anti-HCV antibodies by a second-generation EIA and confirmed by a third-generation INNO-LIA test. It was found that in the 17-19-year age-group the prevalence of anti-HAV antibodies was 37%, anti-HBV was 12.8%, HBsAg was 3.0% and anti-HCV 1.3%. All markers were higher among males. The prevalence of anti-HAV and anti-HBs antibodies increased with age among males. That of HBsAg and anti-HCV antibodies increased with age overall. In the multiple logistic regression analysis, HAV and HBV seropositivity were significantly associated with the mother's education and republic of origin. It was concluded that the prevalence of anti-HAV antibodies is similar to that among the local population, which should not be considered at a higher risk of infection during military service. On the other hand, the higher prevalence of HBsAg and anti-HCV antibodies in this sub-population should heighten the awareness of the possibility of chronic liver pathology.

Immune status against diphtheria among immigrants from the former USSR who arrived in Israel during 1990-1991

Large outbreaks of diphtheria occurred recently in the former USSR. Between 1989 and 1994, a total of about 600,000 Soviet immigrants arrived in Israel. The immune status against diphtheria in a sample of 992 men aged 17-49 and 195 women aged 17-19, who arrived in Israel during 1990-91, was studied in order to evaluate the need for vaccination. Participants completed a self-administered questionnaire and diphtheria antitoxin antibody levels were measured by means of ELISA. At age 17-19, the prevalence of antitoxin antibody levels below the protective level of 0.01 IU/ml was 4.8% in the men and 2.1% in the women. Among the men, the percentage lacking protection declined from 4.8% at age 17-19 years to 1.6% at age 20-24, and increased to 18.2% at age 35-49. In the oldest group, the prevalence of those lacking protection was considerably higher than for the general Israeli population. In the multivariate analysis, age, mother's education and republic of origin were significantly associated with the absence of protection. Immigrants from the former USSR appear to be more susceptible to diphtheria, thus increasing the possibility of clinical disease, and it is recommended that they receive booster doses of diphtheria toxoid.

Molecular cloning and tissue distribution of a putative member of the rat opioid receptor gene family that is not a mu, delta or kappa opioid receptor type

A novel G protein-coupled receptor was cloned by PCR and homology screening. Its deduced amino acid sequence is 47% identical overall to the mu, delta and kappa opioid receptors and 64% identical in the putative transmembrane domains. When transiently expressed in COS-7 cells this receptor did not bind any of the typical mu, delta or kappa opioid receptor ligands with high affinity. In situ hybridization analysis revealed that LC132 mRNA is highly expressed in several rat brain areas, including the cerebral cortex, thalamus, subfornical organ, habenula, hypothalamus, central gray, dorsal raphe, locus coeruleus and the dorsal horn of the spinal cord. Based on this distribution and its high homology with the mu, delta and kappa opioid receptors, it is proposed that LC132 is a new member of the opioid receptor family that is involved in analgesia and the perception of pain.

1-O-hexadecyl-2-O-methyl-sn-glycero-3-phosphocholine inhibits diacylglycerol kinase in WEHI-3B cells

The effects of 1-O-hexadecyl-2-O-methyl-sn-glycero-3-phosphocholine (ET-16-OCH3-GPC) and its metabolite 1-O-hexadecyl-2-O-methyl-sn-glycerol (AMG) on the activity of diacylglycerol kinase (DGK) in WEHI-3B cells were investigated. Treatment of WEHI-3B cells with 200 nM 12-O-tetradecanoylphorbol-13-acetate (TPA) for 5 min leads to the activation of cytosolic DGK without significant effect on microsomal DGK. When these cells were first exposed to 50 microM ET-16-OCH3-GPC for 30 min prior to activation with TPA, the activity of DGK was inhibited by about 70%, as measured by the ability of enzyme to form [32P]phosphatidic acid ([32P]PA). Addition of either ET-16-OCH3-GPC or AMG to the preparation of enzyme in vitro also inhibited 1,2-dioleoyl-sn-glycerol (DG) phosphorylation in the presence of [gamma-32P]ATP. The IC50 value for inhibition of cytosolic DGK by ET-16-OCH3-GPC and AMG were about 8.5 and 15 microM, respectively. ET-16-OCH3-GPC also inhibited the ability of guanosine 5'-O-(3-thiophosphate) (GTP-gamma S) to activate DGK in vitro. The potency of ET-16-OCH3-GPC at 10 microM in inhibiting DGK was greater than that of sphingosine at 50 microM, but less than that of R59022 (a specific DGK inhibitor) at 10 microM.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of physical activity on concentration among junior high-school students

The level and quality of concentration were tested before and after each lesson in one class session. Two of the four classes participated in physical education activities, and the other two studied science. Each subject matter was studied the beginning and at the end of the school day. The research design was 2 x 2 x 2 factorial (two subject matters, two times of the school day, and as a repeated measure two times of test for each group at the beginning and end of each lesson). The level and the quality of concentration found at the end of each lesson were significantly higher than at the beginning. The subject matters did not influence concentration. It may be concluded that the time of day was the main influence on concentration, so teachers' claims against physical education activity lessons can be rejected. The increase in concentration toward the end of the lesson implies the need for careful lesson planning or even the consideration of increasing duration of lessons.

A comparative study of Japanese and British BCG vaccine strains in newborn infants

A prospective study on the British and Japanese BCG vaccines in newborn infants was carried out in which 317 and 285 infants were randomly allocated and vaccinated with the British and Japanese BCG vaccines, respectively. Four follow-up examinations were carried out with an average of 98% of the study cohort attending all sessions. About half the infants did not produce any visible response at the end of the first week. All, by the end of the third month, had characteristic BCG scars with an average diameter of 4.6 mm. A Mantoux test was carried out at six months. A mean skin induration of 7.2 mm (SD 5.3 mm) was recorded. Significantly higher proportions of infants given Japanese BCG were found to be tuberculin convertors (74.7%) when compared to those given British BCG (51.4%). Breast-feeding practices and the mothers' tuberculin status did not influence markedly their infants response to tuberculin.

Questions regarding the sequential neural generator theory of the somatosensory evoked potential raised by digital filtering

Digital bandpass filtering (300-2500 Hz) designed for zero phase shift was applied to somato-sensory evoked potentials recorded with cephalic bipolar montages. Four consistent negative and corresponding positive peaks with latencies of about 16, 18, 19, and 20 msec were elicited with median nerve stimulation. Peroneal nerve stimulation also elicited 4 reproducible negative-positive peaks having latencies of about 24, 26, 28, and 30 msec. Interpeak latencies measured 1.3 +/- 0.2 msec and 1.8 +/- 0.25 msec for median and peroneal elicited SEPs respectively. Because cephalic bipolar recordings cancel most far-field potentials, multiple generators cannot account for all the additional components seen. It is hypothesized that some of the high frequency components recorded are due to activity in recurrent intrathalamic neuronal networks.

Immunization of female rabbits against testosterone stimulates testosterone accumulation by isolated ovarian follicles

Ovarian follicles isolated from female rabbits after active immunization against testosterone-3-oxime bovine serum albumin produced more testosterone than similar follicles from controls.

Screening of human brain tumors for SV40-related T antigen

A series of 39 human brain tumors has been screened for the presence or absence of SV40-related T antigen by the direct and indirect immunoperoxidase methods. Two tumors of ependymal origin (malignant ependymoma, choroid plexus papilloma) revealed markedly positive nuclear staining for T antigen both in vivo and in vitro. The relationship of these tumors to their experimental counterparts inducible by recent human papovavirus isolates is discussed.

Psychiatric status of the marihuana user

This paper is concerned with the psychiatric evaluation of 81 volunteers in a marihuana project.

The psychiatric status has been evaluated in a standard manner and the drug history, both prescribed and non-prescribed, has been determined.

A method of classification of the non-adverse and adverse drug effects is suggested. Observations are made with respect to the subjective responses of the volunteers in regard to their drug intake, and these are compared to the hard data obtained in the neurophysiological and neuropsychological parts of the study and from fifteen key papers reviewed. The serious lack of precise methodological design and the need for more accurate information with respect to placebo effects, suggestibility and the social set in the area of marihuana use are noted.