Weight loss with GLP-1 analogues in preparation for transplantation

This case describes a woman in her 20s with a 6-month history of progressive exertional dyspnoea and cough. Examination revealed hypoxia on room air, sinus tachycardia, finger clubbing and bibasal inspiratory crackles. Inflammatory markers were mildly elevated and empirical antimicrobial therapy was commenced. A multidisciplinary discussion consensus diagnosis of acute interstitial pneumonitis was made based on the findings of high-resolution CT of the chest, macrophage predominant bronchoalveolar lavage cell differential and surgical lung biopsy. There was clinical and radiological deterioration despite glucocorticoids and antifibrotic therapy. A body mass index of 37.5 kg/m2 precluded her from lung transplant assessment and consideration. Following consultation with the weight management service, she was commenced on glucagon-like peptide 1 (GLP-1) analogue therapy. She had a remarkable response within 6 months, was listed for lung transplantation, and within 18 months of her initial presentation, a double lung transplantation was performed.

The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO

Extracorporeal Cardiopulmonary Resuscitation (ECPR) has potential benefits compared to conventional Cardiopulmonary Resuscitation (CCPR) in children. Although no randomised trials for paediatric ECPR have been conducted, there is extensive literature on survival, neurological outcome and risk factors for survival. Based on current literature and guidelines, we suggest recommendations for deployment of paediatric ECPR emphasising the requirement for protocols, training, and timely intervention to enhance patient outcomes. Factors related to outcomes of paediatric ECPR include initial underlying rhythm, CCPR duration, quality of CCPR, medications during CCPR, cannulation site, acidosis and renal dysfunction. Based on current evidence and experience, we provide an approach to patient selection, ECMO initiation and management in ECPR regarding blood and sweep flow settings, unloading of the left ventricle, diagnostics whilst on ECMO, temperature targets, neuromonitoring as well as suggested weaning and decannulation strategies.

Analysis of tissue lipidomics and computed tomography pulmonary fat attenuation volume (CTPFAV ) in idiopathic pulmonary fibrosis

BACKGROUND AND OBJECTIVE

There is increasing interest in the role of lipids in processes that modulate lung fibrosis with evidence of lipid deposition in idiopathic pulmonary fibrosis (IPF) histological specimens. The aim of this study was to identify measurable markers of pulmonary lipid that may have utility as IPF biomarkers.

STUDY DESIGN AND METHODS

IPF and control lung biopsy specimens were analysed using a unbiased lipidomic approach. Pulmonary fat attenuation volume (PFAV) was assessed on chest CT images (CTPFAV ) with 3D semi-automated lung density software. Aerated lung was semi-automatically segmented and CTPFAV calculated using a Hounsfield-unit (-40 to -200HU) threshold range expressed as a percentage of total lung volume. CTPFAV was compared to pulmonary function, serum lipids and qualitative CT fibrosis scores.

RESULTS

There was a significant increase in total lipid content on histological analysis of IPF lung tissue (23.16 nmol/mg) compared to controls (18.66 mol/mg, p = 0.0317). The median CTPFAV in IPF was higher than controls (1.34% vs. 0.72%, p < 0.001) and CTPFAV correlated significantly with DLCO% predicted (R2  = 0.356, p < 0.0001) and FVC% predicted (R2  = 0.407, p < 0.0001) in patients with IPF. CTPFAV correlated with CT features of fibrosis; higher CTPFAV was associated with >10% reticulation (1.6% vs. 0.94%, p = 0.0017) and >10% honeycombing (1.87% vs. 1.12%, p = 0.0003). CTPFAV showed no correlation with serum lipids.

CONCLUSION

CTPFAV is an easily quantifiable non-invasive measure of pulmonary lipids. In this pilot study, CTPFAV correlates with pulmonary function and radiological features of IPF and could function as a potential biomarker for IPF disease severity assessment.

Diffuse pulmonary meningotheliomatosis: a rare cause of multiple pulmonary nodules

This case describes a woman in her 50s who presented with recurrent lower respiratory tract infections. She was an ex-smoker and had worked on a livestock farm for many years. Chest radiograph and CT of the chest revealed multiple bilateral pulmonary nodules. Bronchoalveolar lavage and transbronchial biopsy did not confirm a unifying diagnosis and thus, surgical biopsy was pursued. Video-assisted thoracoscopic surgical guided biopsy of the right upper, middle and lower lobes demonstrated intraparenchymal minute nodules, consisting of bland epithelioid cells without any evidence of malignancy. The nodules stained positive for neural cell adhesion molecule (CD56) and progesterone receptor with weakly positive epithelial membrane antigen and smooth muscle actin. The combination of this characteristic staining pattern, the diffuse subcentimetre nature of the nodules and this clinical presentation fit with a diagnosis of the ultra-rare pulmonary disease, diffuse pulmonary meningotheliomatosis (DPM). This case highlights a rare cause of bilateral diffuse pulmonary nodules and thus, the breadth of differential diagnoses that need to be considered when approaching such a finding. Careful history-taking and thorough workup is often needed, typically requiring input from multiple specialties. DPM, while rare, should not be overlooked when considering the underlying cause of this presentation, especially in female patients. This case reiterates how common clinical presentations can unveil rare conditions and the contributions of physicians, pathologists and radiologists in the diagnosis and management of these complex diseases.

Pulmonary renal syndrome: a clinical review

The term "pulmonary renal syndrome" describes a clinical syndrome which is characterised by the presence of both diffuse alveolar haemorrhage and glomerulonephritis. It encompasses a group of diseases with distinctive clinical and radiological manifestations, as well as different pathophysiological processes. The most common diseases implicated are anti-neutrophil cytoplasm antibodies (ANCA)-positive small vessel vasculitis and anti-glomerular basement membrane (anti-GBM) disease. Prompt recognition is required as respiratory failure and end-stage renal failure can rapidly occur. Treatment includes a combination of glucocorticoids, immunosuppression, plasmapheresis and supportive measures. The use of targeted treatments has significantly reduced mortality. Thus, an understanding of pulmonary renal syndrome is essential for the respiratory physician.

Exercise Compared to Mindfulness for Physical and Mental Wellbeing in Medical Students

Aim Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The 'MED-WELL' programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the 'MED-WELL' programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the 'MED-WELL' programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration.

A 34-Year-Old Man With a Chylothorax and Bony Pain

CASE PRESENTATION

A 34-year-old man presented to a community hospital with sudden-onset pleuritic chest pain on a background of a 12-month indolent history of progressive exertional dyspnea. He denied cough, fevers, night sweats, or weight loss. He reported some low back pain and ache. He had a history of gastroesophageal reflux and was a current smoker with a 20-pack year history. There were no known occupational or environmental exposures and there was no family history of any lung disease.

Genetic Landscape of Rett Syndrome Spectrum: Improvements and Challenges

Rett syndrome (RTT) is an early-onset neurodevelopmental disorder that primarily affects females, resulting in severe cognitive and physical disabilities, and is one of the most prevalent causes of intellectual disability in females. More than fifty years after the first publication on Rett syndrome, and almost two decades since the first report linking RTT to the MECP2 gene, the research community's effort is focused on obtaining a better understanding of the genetics and the complex biology of RTT and Rett-like phenotypes without MECP2 mutations. Herein, we review the current molecular genetic studies, which investigate the genetic causes of RTT or Rett-like phenotypes which overlap with other genetic disorders and document the swift evolution of the techniques and methodologies employed. This review also underlines the clinical and genetic heterogeneity of the Rett syndrome spectrum and provides an overview of the RTT-related genes described to date, many of which are involved in epigenetic gene regulation, neurotransmitter action or RNA transcription/translation. Finally, it discusses the importance of including both phenotypic and genetic diagnosis to provide proper genetic counselling from a patient's perspective and the appropriate treatment.

'When you hear hooves, think zebras, not horses'; two challenging cases of interstitial lung disease (ILD)

Our case series describes two siblings with complex fibrosing lung diseases. The first patient was initially given a diagnosis of sarcoidosis based on imaging and exclusion of alternative diagnoses. A number of years after diagnosis, he had rapid deterioration of his disease and following surgical lung biopsy, his lung fibrosis was re-classified as chronic hypersensitivity pneumonitis (cHP) with a usual interstitial pneumonia pattern. He subsequently underwent successful lung transplantation. The second patient presented with rapidly progressing exertional dyspnoea. His bloods, imaging, bronchoalveolar lavage and histology were discussed at our multidisciplinary team meeting. His histology was most in keeping with subacute on cHP with overlapping imaging features between the two siblings. He was treated accordingly but unfortunately succumbed to his illness shortly after diagnosis. These cases highlight the difficulties differentiating between the various interstitial lung disease (ILD) subtypes and the challenges in management while also increasing awareness of familial ILD.

Bioprosthetic Valve Thrombosis while on a Novel Oral Anticoagulant for Atrial Fibrillation

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BPVT occurred while on a DOAC for treatment of AF.

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Echocardiographic and pathologic images of BPVT are shown.

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The definition of NVAF is not uniform in clinical trials or guidelines.

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The optimal anticoagulation strategy for BPV and AF is unclear.

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Caution is advised in using DOACs for AF in patients with BPVs.

Uses of cancer registries for public health and clinical research in Europe: Results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010-2012

AIM

To provide insight into cancer registration coverage, data access and use in Europe. This contributes to data and infrastructure harmonisation and will foster a more prominent role of cancer registries (CRs) within public health, clinical policy and cancer research, whether within or outside the European Research Area.

METHODS

During 2010-12 an extensive survey of cancer registration practices and data use was conducted among 161 population-based CRs across Europe. Responding registries (66%) operated in 33 countries, including 23 with national coverage.

RESULTS

Population-based oncological surveillance started during the 1940-50s in the northwest of Europe and from the 1970s to 1990s in other regions. The European Union (EU) protection regulations affected data access, especially in Germany and France, but less in the Netherlands or Belgium. Regular reports were produced by CRs on incidence rates (95%), survival (60%) and stage for selected tumours (80%). Evaluation of cancer control and quality of care remained modest except in a few dedicated CRs. Variables evaluated were support of clinical audits, monitoring adherence to clinical guidelines, improvement of cancer care and evaluation of mass cancer screening. Evaluation of diagnostic imaging tools was only occasional.

CONCLUSION

Most population-based CRs are well equipped for strengthening cancer surveillance across Europe. Data quality and intensity of use depend on the role the cancer registry plays in the politico, oncomedical and public health setting within the country. Standard registration methodology could therefore not be translated to equivalent advances in cancer prevention and mass screening, quality of care, translational research of prognosis and survivorship across Europe. Further European collaboration remains essential to ensure access to data and comparability of the results.

Clinical and biochemical outcome after hydroxocobalamin dose escalation in a series of patients with cobalamin C deficiency

BACKGROUND

CblC deficiency produces a combination of methylmalonic aciduria (MMA) and homocystinuria (HCU), and is the most common error of cobalamin metabolism. Patients present a wide spectrum of symptoms, ranging from early severe multisystemic forms, to milder late-onset phenotypes. Cognitive and visual impairment are nearly constant. Hydroxocobalamin (OHCbl), betaine, folinic acid, levocarnitine and eventually dietary protein restriction are the main therapeutic approaches. Although early introduction of OHCbl is crucial, no standardized protocols regarding dose adaptation exist. No reports on long-term outcomes after high doses of this vitamin have been published.

METHODS

In this study five patients with CblC deficiency (early severe forms) were treated with high doses of OHCbl for 18 to 30months. Clinical examinations, neurological assessment, and biochemical studies (plasma total homocysteine (tHcy), amino acids, hydroxocobalamin, and methylmalonic acid in urine) were periodically performed.

RESULTS

Variable clinical and biochemical outcomes were observed in patients treated with high doses of OHCbl. The best biochemical response was observed in those children with the worse metabolic control. By contrast, those patients with a concentration of tHcy around 50μmol/l or less showed only minor changes. Clinically, a considerable improvement was observed in those patients with severe problems in communication, expressive language and behavior.

CONCLUSIONS

According to our study, high OHCbl doses in CblC deficiency could have a greater benefit in those children with a prior history of suboptimal metabolic control, and also in those with severe neurological phenotypes. More specifically, we observed improvements in communication skills and behavior. These results should encourage further prospective trials to determine the optimal OHCbl regimen and to generate protocols and guidelines in this rare disorder.

A profile of hospital consultants: the health practices of a cohort of medical professionals

Personal health practices are important determinants of health. Smoking habits are well documented among doctors. However, alcohol consumption, exercise rates and obesity rates are not. No indigenous studies have been done in this area. This descriptive population study aims to determine these factors. A questionnaire was sent to 381 consultants in hospitals affiliated with UCC Medical School. The response rate was 52.5% (200/381). The smoking rate was 7.5% (15/200) and the alcohol consumption rate was 94% (188/200). Both were more prevalent in females. Over a fifth took no exercise and activity levels were similar between groups. Female consultants were better at weight management than males with a lower proportion over the healthy body mass index (BMI) level. The smoking rate and alcohol consumption rate is higher than other studies. When compared to the general population, doctors are a healthier weight and smoke less but more consultants drink and less exercise regularly.

Serratia entomophila bet gene induction and the impact of glycine betaine accumulation on desiccation tolerance

AIMS

The genes involved in choline transport and oxidation to glycine betaine in the biopesticidal bacterium Serratia entomophila were characterized, and the potential of osmoprotectants, coupled with increased NaCl concentrations, to improve the desiccation tolerance of this species was investigated.

METHODS AND RESULTS

Serratia entomophila carries sequences similar to the Escherichia coli betTIBA genes encoding a choline transporter and dehydrogenase, a betaine aldehyde dehydrogenase and a regulatory protein. Disruption of betA abolished the ability of Ser. entomophila to utilize choline as a carbon source. Quantitative reverse-transcriptase PCR analysis revealed that betA transcription was reduced compared to that of the upstream genes in the operon, and that NaCl and choline induced bet gene expression. Glycine betaine and choline increased the NaCl tolerance of Ser. entomophila, and osmotically preconditioned cultures survived better than control cultures following desiccation and immediately after application to agricultural soil.

CONCLUSIONS

Addition of glycine betaine and NaCl to growth medium can greatly enhance the desiccation survival of Ser. entomophila, and its initial survival in soil.

SIGNIFICANCE AND IMPACT OF THE STUDY

Serratia entomophila is sensitive to desiccation and does not persist under low soil moisture conditions. Techniques described here for enhancing the desiccation survival of Ser. entomophila can be used to improve formulations of this bacterium, and allow its application under a wider range of environmental conditions.

Electrical stunning of pigs: the effect of applied voltage on impedance to current flow and the operation of a fail-safe device

The concept of a 'fail-safe' device to ensure that sufficient current is delivered to render a pig immediately unconscious when electrically stunned was investigated. For live pigs, no significant correlation could be determined between the pre-stun low voltage sensed impedance and the actual, higher voltage stun impedance. In contrast, a good correlation was found using heads from pigs killed more than 24 h previously. The impedance of a live pig's head was predominantly a function of the stunning voltage and decreased non-linearly with increasing voltage. The 'difference' between live and dead pigs was attributed to an 'ageing effect' which is not significant in the first few hours post mortem. No change in phase angle between corresponding stunning current and voltage waveforms, indicated that tissue reactance was not a contributing factor. It is concluded that 'fail-safe' devices based on low voltage pre-stun sensing are unlikely to meet the current legislative requirements (Council Directive 93/119/EC).

Head-only electrical stunning of poultry using a waterbath: a feasibility study

1. The objective of this work was to investigate the feasibility of head only waterbath stunning as a means of generating immediate and long lasting unconsciousness while preventing wing flapping and avoiding carcass damage. 2. EEG measurements showed that immersion of the heads of the broilers for one second in a waterbath containing water of conductivity 2 x 5 mS/cm and a 50 Hz electric field of 10 V/cm resulted in immediate unconsciousness, and that increasing the electric field strength extended the duration of unconsciousness. 3. The passage of a 25-30 mA alternating current of frequency 2000 Hz through the broilers' bodies suppressed the wing flapping that followed a stun. 4. When the body current and electric field were applied simultaneously, wing flapping was prevented and EEG signals were suppressed for over 30 seconds indicating that the immediate unconsciousness lasted long enough to facilitate humane slaughter.

Serratia entomophilacoated seed to improve ryegrass establishment in the presence of grass grubs

The entomopathogenic bacterium Serratia entomophila is an alternative to chemical control of grass grub (Costelytra zealandica) and is applied in a granule formulation to established pastures Treatment of seed with microbial inoculants is an ideal mechanism for delivery and establishment of microbial control agents into the plant root zone where soil dwelling pests such as grass grub are located Seed treatment with S entomophila was tested in three glasshouse pot trials for its ability to protect germinating ryegrass seedlings from grass grub damage A range of larval densities was used and microbial seed treatment was compared with the insecticide imidacloprid At medium larval densities (equivalent to 70 larvae/m2) use of S entomophilacoated seed resulted in 85 seedling establishment in comparison with 82 emergence from imidaclopridtreated seed At a high larval density of 300/m2 where there was no establishment of untreated seed 3551 of seedlings established from S entomophilatreated seed Results suggest there is potential for seed coating to aid ryegrass establishment in autumnsown pastures

The antecedents of non-affective psychosis in a birth-cohort, with a focus on measures related to cognitive ability, attentional dysfunction and speech problems

OBJECTIVE

Adults with non-affective psychosis show subtle deviations in a range of developmental trajectories as children and adolescents.

METHOD

Based on a birth-cohort (n = 3801), we examined the Peabody Picture Vocabulary Test (PPTV) at age 5, and Raven's Standard Progressive Matrices (RSPM) and Wide Range Achievement Test reading scale (WRAT-R) at age 14. Items related to speech problems and attentional dysfunction were available from maternal- or self-report. At age 21, we identified 60 cohort members who were screen-positive for non-affective psychosis (SP-NAP).

RESULTS

Impaired performance on the PPVT and RSPM (but not WRAT-R) predicted SP-NAP for males only. Male cohort members in the highest quartile for attentional dysfunction at ages 5 and 14 were about 5-8 times more likely to develop SP-NAP. SP-NAP in males was significantly associated with speech problems at age 14.

CONCLUSION

Males who develop non-affective psychoses have subtle impairments in cognitive capacity prior to the development of their psychotic disorder.

Clinical experience with miglustat therapy in pediatric patients with Niemann-Pick disease type C: a case series

Niemann-Pick disease type C (NP-C) is an inherited neurovisceral lysosomal lipid storage disease characterized by progressive neurological deterioration. Different clinical forms have been defined based on patient age at onset: perinatal, early-infantile (EI), late-infantile (Li), juvenile and adult. We evaluated the efficacy and tolerability of miglustat in 16 symptomatic NP-C patients, with comparative reference to one neurologically asymptomatic, untreated patient. All patients were categorized according to age at neurological disease onset, and were assessed using a standardized clinical assessment protocol: disability and cognitive function scales, positron emission tomography (PET), and biochemical markers. PET and disability scale evaluations indicated that cerebral hypometabolism and neurological symptoms were stabilized during treatment in juvenile-onset NP-C patients. EI and Li NP-C patients, who had higher disease severity at baseline (treatment start), showed increased disability scores and progressive cerebral hypometabolism during follow up. Similarly, while cognitive scale scores remained relatively stable in patients with juvenile NP-C, cognition deteriorated in EI and Li patients. Plasma chitotriosidase (ChT) activity was lower in the juvenile NP-C subgroup than in EI and Li patients, and generally increased in patients who discontinued treatment. Plasma CCL18/PARC and ChT activities indicated greater macrophagic activity in EI and Li patients versus juveniles. Miglustat was generally well tolerated; frequent adverse events included diarrhea and flatulence, which were managed effectively by dietary modification and loperamide. Overall, miglustat appeared to stabilize neurological status in juvenile-onset NP-C patients, but therapeutic benefits appeared smaller among younger patients who were at a more advanced stage of disease at baseline.

Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study

BACKGROUND

Birth cohort studies have shown that individuals who develop non-affective psychoses display subtle deviations in behaviour during childhood and adolescence. We had the opportunity to examine the widely used Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) to explore the antecedents of non-affective psychosis.

METHOD

Based on a birth cohort of 3801 young adults, psychopathology was assessed at years 5 and 14 using the CBCL and/or the YSR. Screen-positive non-affective psychosis (SP-NAP) was assessed at year 21 by using the Composite International Diagnostic Interview (CIDI) or a self-report checklist. The association between childhood symptoms and SP-NAP was examined using logistic regression.

RESULTS

Of the cohort, 60 subjects were classified as SP-NAP. In males, SP-NAP was associated with higher scores: (a) on year 5 CBCL 'Total', 'Aggression' and 'Social, Attention and Thought' scores; (b) on year 14 CBCL 'Social', 'Attention' and 'Delinquency' scores, and (c) YSR 'Total' and many YSR subscores. These associations were less clear for females. Hallucinations at year 14 were associated with SP-NAP for both sexes. Boys with high 'Total' scores at both years 5 and 14 were at greatest risk of SP-NAP (a 5-fold risk), followed by boys and girls whose 'Social, Attention and Thought' scores either increased or remained high from years 5 to 14 (3- to 13-fold risk).

CONCLUSIONS

Individuals who screen positive for non-affective psychosis show increased psychopathology during childhood and adolescence. The psychopathological trajectory of children who go on to develop schizophrenia anticipates the heterogeneity associated with the full clinical syndrome.

Demographic correlates of psychotic-like experiences in young Australian adults

OBJECTIVE

Psychotic-like experiences (PLE) in the general community are common. The aims of this study were to examine the prevalence and demographic correlates of PLE in young adults.

METHOD

The sample consisted of 2441 subjects aged 18-23 years. Subjects completed the Composite International Diagnostic Interview (CIDI) and the 21-item Peters Delusional Inventory (PDI). Associations between age, gender, hallucinations and delusions were examined using logistic regression.

RESULTS

Both CIDI hallucinations and delusions predicted high scores on the PDI. Younger age was significantly associated with endorsement of CIDI delusions [odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.48-0.92) and with PDI total scores (OR = 0.68, 95% CI 0.55-0.83). Women were significantly more likely to endorse items related to hallucinations (OR = 1.49, 95% CI 1.14-1.95) but not delusions.

CONCLUSION

PLE are common in young adults. The mechanisms underpinning the age and gender gradients in PLE may provide clues to the pathogenesis of psychotic disorders.

Biochemical and pharmacological characterization of different recombinant acid alpha-glucosidase preparations evaluated for the treatment of Pompe disease

Pompe disease results in the accumulation of lysosomal glycogen in multiple tissues due to a deficiency of acid alpha-glucosidase (GAA). Enzyme replacement therapy for Pompe disease was recently approved in Europe, the U.S., Canada, and Japan using a recombinant human GAA (Myozyme, alglucosidase alfa) produced in CHO cells (CHO-GAA). During the development of alglucosidase alfa, we examined the in vitro and in vivo properties of CHO cell-derived rhGAA, an rhGAA purified from the milk of transgenic rabbits, as well as an experimental version of rhGAA containing additional mannose-6-phosphate intended to facilitate muscle targeting. Biochemical analyses identified differences in rhGAA N-termini, glycosylation types and binding properties to several carbohydrate receptors. In a mouse model of Pompe disease, glycogen was more efficiently removed from the heart than from skeletal muscle for all enzymes, and overall, the CHO cell-derived rhGAA reduced glycogen to a greater extent than that observed with the other enzymes. The results of these preclinical studies, combined with biochemical characterization data for the three molecules described within, led to the selection of the CHO-GAA for clinical development and registration as the first approved therapy for Pompe disease.

Vanishing white matter disease associated with progressive macrocephaly

Vanishing white matter disease (VWM) is one of the most frequent inherited childhood leukoencephalopathies. Five genes have been implicated in this disease ( EIF2B1-5), which encode the five subunits of translation initiation factor eIF2B. The disease has an autosomal recessive mode of inheritance. The age of onset and clinical severity vary widely. The diagnosis is based on magnetic resonance imaging (MRI) findings and is confirmed by molecular studies. We describe an affected female patient with a common and a novel mutation of the EIF2B5 gene, who demonstrated a progressive neurological and radiological deterioration. An unusual feature was her striking macrocephaly. She had an early clinical onset at two years of age and is currently still alive at 26 years of age.

Establishment of Serratia entomophila after application of a new formulation for grass grub control

The bacterium Serratia entomophila is a naturally occurring pathogen causing amber disease of the New Zealand grass grub (Costelytra zealandica) A novel granular formulation of S entomophila Bioshieldtrade; was applied to 18 pasture sites in a largescale programme to demonstrate efficacy against grass grub No significant difficulties were encountered in application of the granules through conventional machinery There were high populations of the applied bacteria in soil within the first week of application and within 6 weeks of application there was an average of 3 x 104 viable S entomophila of the applied strain per gram of soil This resulted in a significant (Plt;005) 20 increase in the incidence of amber disease in the treated grass grub populations compared to untreated populations Successful establishment of the bacteria in the soil and target population following Bioshieldtrade; granule application was demonstrated on a wide range of sites under various farming conditions

Effects of electrical water bath stunning current frequencies on the spontaneous electroencephalogram and somatosensory evoked potentials in hens

1. The effectiveness of water bath electrical stunning of chickens with a constant root mean square (rms) current of 100 mA per bird delivered for 3 s using 100, 200, 400, 800 and 1500 Hz sine wave alternating current (AC) was investigated in layer hens. The quantitative changes occurring in the electroencephalogram (EEG) and somatosensory evoked potentials (SEPs) were used to determine the effectiveness of stunning. The changes occurring in the EEG were evaluated using Fast Fourier Transformations (FFT) and the SEPs were averaged to determine whether they were present or abolished. 2. The results of FFT indicated that stunning of chickens with a constant rms current of 100 mA per bird using 100 or 200 Hz induced epileptiform activity in all the hens, immediately followed by a reduction in the total (2 to 30 Hz) and relative (13 to 30 Hz) power contents in the EEG frequency bands indicative of unconsciousness and insensibility. The SEPs were abolished in the majority of hens stunned with 100 Hz and all the hens stunned with 200 Hz. 3. By contrast, stunning using 400, 800 or 1500 Hz failed to induce epileptiform activity in all the birds, the total and relative power contents in the EEG frequency bands showed a substantial increase, rather than reduction, and the SEPs were also retained in the majority of chickens. It is therefore suggested that stunning using these frequencies failed to stun them satisfactorily. In these birds, occurrence of a painful arousal, rather than unconsciousness, could not be ruled out. 4. It is therefore suggested that water bath electrical stunning of chickens with a minimum rms current of 100 mA per bird delivered using 100 or 200 Hz would be adequate to ensure bird welfare under commercial conditions, provided both the carotid arteries in the neck are severed at slaughter. On humanitarian and bird welfare grounds, a rms current of greater than 100 mA per bird should be applied whilst using frequencies of 400 Hz or more of sine wave AC for water bath electrical stunning of chickens.

A tractable deterministic model with realistic latent period for an epidemic in a linear habitat

This paper describes a model for the spatial spread of an epidemic in which the latent period has a Gamma distribution with arbitrary mean and variance while the infected and uninfected may have different diffusion coefficients. Using a variant of the "linear chain trick" we derive a simple algorithm for the propagation speed of the infection front. By way of verification, we show that, with suitably matched parameters, the algorithm agrees closely with speeds obtained numerically from the corresponding model in which the latent period is a constant.

The effect of breastfeeding on child development at 5 years: a cohort study

OBJECTIVE

It is uncertain to what degree the relationship between breastfeeding and later cognitive development is a true biological effect, or is confounded by psychosocial factors. The study aim was to further investigate this relationship and the effect of duration of breast feeding on cognitive development.

METHODS

A total of 3880 children were followed from birth. Breastfeeding duration was measured by questionnaire at 6 months of age and a Peabody Picture Vocabulary Test Revised (PPVT-R) was administered at 5 years. PPVT-R scores were adjusted for the effects of a large array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVT-R scores were examined using analysis of variance and multiple linear regression.

RESULTS

A strong positive relationship was demonstrated between breastfeeding and the PPVT-R scores with increasing scores with increased duration of breastfeeding. After adjusting for a wide range of biological and social factors, the adjusted mean for those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when compared to those never breastfed.

CONCLUSION

These findings suggest a significant benefit to child development is conferred by breastfeeding and is related independently to longer periods of breastfeeding.

The effect of breastfeeding on child development at 5 years: a cohort study

OBJECTIVE

It is uncertain to what degree the relationship between breastfeeding and later cognitive development is a true biological effect, or is confounded by psychosocial factors. The study aim was to further investigate this relationship and the effect of duration of breast feeding on cognitive development.

METHODS

A total of 3880 children were followed from birth. Breastfeeding duration was measured by questionnaire at 6 months of age and a Peabody Picture Vocabulary Test Revised (PPVT-R) was administered at 5 years. PPVT-R scores were adjusted for the effects of a large array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVT-R scores were examined using analysis of variance and multiple linear regression.

RESULTS

A strong positive relationship was demonstrated between breastfeeding and the PPVT-R scores with increasing scores with increased duration of breastfeeding. After adjusting for a wide range of biological and social factors, the adjusted mean for those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when compared to those never breastfed.

CONCLUSION

These findings suggest a significant benefit to child development is conferred by breastfeeding and is related independently to longer periods of breastfeeding.

Simple models of massive epidemics of herpesvirus in Australian (and New Zealand) pilchards

In March 1995, a mass mortality of pilchard started to occur in South Australia. This spread very rapidly throughout the Australian pilchard's range, later reaching New Zealand. In November 1998, a similar mass mortality broke out in South Australia and also spread, at a slower rate, throughout the Australian range. The mortality appeared to be caused by a herpesvirus. The mortality spread as a classical epidemic front, but its speed of progress and the brief duration of mortalities at a given location are extreme. We apply simple epidemic modelling techniques, SIR and SEIR modelling, to examine the factors behind the spread of this mortality and the differences between the 1995 and 1998/9 epidemics. We discuss biological factors influencing the critical processes of long-distance (D) and local (beta) transmission of infection.

Impacts of transgenic plants and microorganisms on soil biota

Little is known about the impacts of transgenic plants and microorganisms on soil biota and processes despite the large number of field releases of transgenic crops Recent work has shown that transgenic plants can cause changes in the soil biota (both invertebrates and microorganisms) associated with these plants Often the changes are transient but their impact on the soil ecosystem remains unknown Horizontal gene transfer from genetically modified (GM) bacteria to indigenous soil bacteria has been demonstrated but movement of genes from transgenic plants if it occurs at all has not yet been detected in natural systems Soil invertebrates appear to play an important role in horizontal gene transfer between bacteria in soil

Evaluation of a pneumatically operated captive bolt for stunning/killing broiler chickens

1. Two separate experiments were carried out in this study. In experiment 1, the effectiveness of stunning broilers, as determined from physical responses, with a 6 mm diameter bolt and an air line pressure of 827 kPa, when fired at 90 degrees (perpendicular to the skull) 110 degrees, 120 degrees and 130 degrees (leaning towards beak) was evaluated. 2. In experiment 2, the effects of perpendicular shooting with two bolt diameters (3 and 6 mm) and two air line pressures (620 and 827 kPa) on spontaneous behaviour, electroencephalogram (EEG) and visually evoked potentials (VEPs) were evaluated in broilers. 3. Only the perpendicular shooting was effective in stunning/killing broilers (n= 10) as indicated by the immediate cessation of breathing and loss of neck muscle tension and eye reflexes. Deviations from the perpendicular shooting failed to stun 5 out of 9 broilers. The perpendicular vs non-perpendicular effect was significant. 4. Shooting broilers with a 3 mm bolt at air line pressures of 620 kPa (n=2) or 827 kPa (n=2) failed stun as indicated by the unaltered physical reflexes, EEG and VEPs. Shooting of two broilers with a 6 mm bolt at 620 kPa resulted in effective stunning and a very rapid recovery of consciousness in one bird and death in the other. 5. Captive bolt stunning of broilers with a 6 mm bolt and air line pressure of 827 kPa resulted in an immediate stun leading to death in all 6 broilers tested. In these broilers, a profound EEG suppression and abolition of VEPs occurred immediately after shooting. 6. It is suggested that the appropriate variables for captive bolt stunning of broilers are a minimum of 6 mm bolt diameter driven at an air line pressure of 827 kPa and a penetration depth of 10 mm.

Bias influencing maternal reports of child behaviour and emotional state

BACKGROUND

Previous research has indicated that there may be only a modest degree of agreement between different reporters of a child's behaviour (mental health). This raises the possibility that some descriptions of the child's behaviour may reflect the personal characteristics of the respondent. We examine two potential sources of bias that may influence reports of a child's behaviour/mental health. The first is the mental or emotional impairment of the respondent; the second concerns gender-related expectations of children.

METHODS

Mothers (and their children after the birth) were assessed at first clinic visit, 3-5 days after the birth, then 6 months, 5 years and 14 years after the birth. Some 70% of respondents giving birth remained in the study at the 14-year follow-up, leaving some 5277 cases for this analysis. At the 14-year follow-up, child behaviour (mental health) was assessed using the Child Behaviour Check List and the Youth Self Report. Maternal mental health was determined using the anxiety and depression subscales of the Delusions-Symptoms-States Inventory.

RESULTS

Mothers who were not emotionally impaired reported fewer child behaviour problems than did the children themselves. As the mother's current emotional impairment increased, so her reports of the child's behaviour problems increased, when compared with the child's own reports. Further, mothers attributed more internalising symptoms to female respondents, and more externalising symptoms to male respondents, than did the child respondents themselves.

CONCLUSIONS

Mothers differ systematically from their children when they are reporting their child's behaviour (mental health). The more emotionally impaired the mother, the greater the degree to which she imputes the child to have behaviour problems. Further, female children are attributed to have more internalising behaviours and male children externalising behaviours.

A phase 1/2 clinical trial of enzyme replacement in fabry disease: pharmacokinetic, substrate clearance, and safety studies

Fabry disease results from deficient alpha-galactosidase A (alpha-Gal A) activity and the pathologic accumulation of the globotriaosylceramide (GL-3) and related glycosphingolipids, primarily in vascular endothelial lysosomes. Treatment is currently palliative, and affected patients generally die in their 40s or 50s. Preclinical studies of recombinant human alpha-Gal A (r-halphaGalA) infusions in knockout mice demonstrated reduction of GL-3 in tissues and plasma, providing rationale for a phase 1/2 clinical trial. Here, we report a single-center, open-label, dose-ranging study of r-halphaGalA treatment in 15 patients, each of whom received five infusions at one of five dose regimens. Intravenously administered r-halphaGalA was cleared from the circulation in a dose-dependent manner, via both saturable and non-saturable pathways. Rapid and marked reductions in plasma and tissue GL-3 were observed biochemically, histologically, and/or ultrastructurally. Clearance of plasma GL-3 was dose-dependent. In patients with pre- and posttreatment biopsies, mean GL-3 content decreased 84% in liver (n=13), was markedly reduced in kidney in four of five patients, and after five doses was modestly lowered in the endomyocardium of four of seven patients. GL-3 deposits were cleared to near normal or were markedly reduced in the vascular endothelium of liver, skin, heart, and kidney, on the basis of light- and electron-microscopic evaluation. In addition, patients reported less pain, increased ability to sweat, and improved quality-of-life measures. Infusions were well tolerated; four patients experienced mild-to-moderate reactions, suggestive of hypersensitivity, that were managed conservatively. Of 15 patients, 8 (53%) developed IgG antibodies to r-halphaGalA; however, the antibodies were not neutralizing, as indicated by unchanged pharmacokinetic values for infusions 1 and 5. This study provides the basis for a phase 3 trial of enzyme-replacement therapy for Fabry disease.

Effect of electrical stun/kill method, interval between killing and neck cutting and blood vessels cut on blood loss and meat quality in broilers

1. Broiler chickens were killed using either an electrical waterbath (WB system) delivering 120 mA per bird (50 Hz, alternating current, AC) for 4 s or an alternative stun/kill method (ASK system); where head-only stunning for 1 s was immediately followed by head-to-body (vent) application for 1 s (150 mA, 50 Hz sine wave AC). Within each stun/kill system, the neck was cut ventrally or unilaterally 20, 60, or 180 s after killing. In addition, a control group of broilers was stunned with 100 mA per bird in a waterbath using 1500 Hz AC for 4 s and were bled by a ventral neck cut within 20 s. 2. Blood leaving the neck cut was collected for 90 s in a bin placed on an electronic balance and blood loss (g/kg body weight) calculated. 3. Individually identified, unplucked and uneviscerated carcases were held at ambient temperature until the end of the experimental day and then stored overnight in an air chiller (5 degrees C). The carcases were dissected and the incidence of broken furculum and coracoid bones, haemorrhaging in P. minor and P. major muscles, and discolouration of P. major muscles were determined. 4. When neck cutting was performed in broilers 20 s after the stun or kill, the ASK and WB systems, in comparison with high frequency stunning, produced on average about 10 g per kg less bleed out. Within the stun/kill systems, broilers killed by ASK had a greater bleed out than in the WB system. Neck cutting at 20 s or 60 s post-kill resulted in a greater bleed out than when performed after a delay of 180 s. Ventral or unilateral neck cutting resulted in a similar bleed out. 5. Stunning broilers with 1500 Hz AC resulted in lower incidences of broken bones, haemorrhaging in breast muscles and muscle discolouration post mortem than the stun/kill systems. These defects were significantly lower in the ASK than in the WB system. Delayed neck cutting increased the severity of discolouration occurring Post mortem in the breast muscles. 6. It is suggested that broilers killed by ASK can be neck cut with a delay of up to 180 s without compromising bleed out. The incidence of broken bones and haemorrhaging in breast muscles are significantly less with ASK than WB. 7. Owing to the commercial benefits and potential for improved welfare at slaughter, ASK would appear to be a better method than WB.

Mothers' mental illness and child behavior problems: cause-effect association or observation bias?

OBJECTIVE

A number of studies have consistently found that a mother's mental health (particularly her level of depression) is a strong predictor of mental health problems experienced by her child(ren). However, the validity of this finding is in doubt because the majority of these studies have relied on maternal reports as indicators of children's behavior.

METHOD

This prospective, longitudinal study examines data on the mental health of the mother from prior to the birth of her child to when the child reaches 14 years of age. Child behavior is measured at 14 years of age using reports from mother and child. Mother and child responses are compared to provide an indication of the possible magnitude of maternal observation bias in the reporting of child behavior problems.

RESULTS

Anxious and/or depressed mothers tend to report more cases of child behavior problems than do their mentally healthy counterparts or children themselves. Differences between mothers and youths in reporting behavior problems appear to be related to the mothers' mental health.

CONCLUSIONS

Current maternal mental health impairment appears to have a substantial effect on the reporting of child behavior problems by the mother, thereby raising questions about the validity of reports of child behavior by persons who are currently emotionally distressed.

Head circumference in ELBW babies is associated with learning difficulties and cognition but not ADHD in the school-aged child

This study examines whether a small head circumference (HC) and low head-circumference growth velocity (HGV) during the first year of life predict consequences at school age in learning, cognition, and concentration. A total of 124 extremely-low-birthweight (ELBW) infants (birthweight 500 to 999 g) born between 1977 and 1986 were eligible for follow-up at the corrected ages of 4, 8, and 12 months and 2, 4, and 6 years. Infants were categorized as having a small HC (< 3% or 3 to 10%) on the basis of the 1990 British growth data which allowed standardized z-scores to be calculated for HC, independent of gestation and corrected age. HGV measurements were calculated using differences in the HC z-scores. In 1995, parents of 87 children agreed to participate in a study of learning and attention at school age. Attention-deficit-hyperactivity disorder (ADHD) was assessed using the Du Paul Rating Scale. Academic performances were based on a teacher questionnaire dealing with aspects of reading, writing, mathematics, and spelling. A child was considered to have a learning difficulty if academic problems were present in at least one of these four areas. Intellectual ability was assessed using the McCarthy Scale at 6 years. HC < 3% and 3 to 10% at 8 months' corrected age was strongly associated with school-aged learning problems (P=0.004), with a moderate specificity (70%), positive predictive value (PPV) (67%), and sensitivity (67%). HGV < or = 10% from birth to 4 months was also associated with learning problems at school age (P=0.01) with a higher specificity (98%) and PPV (88%) but lower sensitivity (20%). A logistic regression analysis was performed with the risk for learning difficulties at 8 months as the dependent variable. Sex, gestation, birthweight, multiple births, and a history of intraventricular hemorrhage did not substantially alter the unadjusted odds ratio (4.7; 95% CI 1.9 to 13.6). Maternal age and education did not confound the relation. No association was found between HC or HGV and ADHD. HC < 3% at 4 months (P<0.02), 8 months (P=0.02), and 12 months (P=0.04), and HGV between birth and 4 months (P<0.01) were significantly associated with low cognitive ability at 6 years.