Beyond HIV microbicides: multipurpose prevention technology products

Multipurpose prevention technologies (MPTs) that aim to simultaneously prevent unintended pregnancy, HIV-1 infection and other sexually transmitted infections are among the most innovative and complex products currently in development within women's sexual and reproductive health care. In this review article, MPTs are placed within the wider context of combination products, combination drug products and multi-indication products. The current MPT product landscape is mapped and assessed with reference to existing products for the corresponding single indications, before identifying the gaps in the current MPT product pipeline and highlighting priority products and challenges moving forward.

Preliminary Results from a New Spin Spectrometer

The first preliminary results from a novel spectrometer for elementally-specific measurements of magnetic surfaces and ultrathin films are presented here. The key measurements are based upon spin-resolving and photon-dichroic photoelectron spectroscopy. True spinresolution is achieved by the use of a Mini-Mott detection scheme. The photon-dichroic measurements include the variant magnetic x-ray linear dichroism (MXLD). Both a multi-channel, energy dispersive collection scheme as well as the spin-detecting Mini-Mott apparatus are used in data collection. The [Spin Spectrometer] is based at the Spectromicroscopy Facility (Beamline7)at the Advanced Light Source.

Duodenal atresia: associated anomalies, prenatal diagnosis and outcome

BACKGROUND

The diagnosis of duodenal atresia is commonly made prenatally, either as an isolated lesion or due to its association with other chromosomal abnormalities (Robertson et al. in Semin Perinatol 18:182-195, 1994; Hemming and Rankin in J Prenat Diagn 27:1205-1211, 2007). The aim of this study was to describe the prevalence of associated anomalies, prenatal diagnostic accuracy and survival of cases of congenital duodenal atresia in our institution.

METHODS

All cases of duodenal atresia registered with our local congenital anomaly register over a 10-year period, 1995-2004 inclusive, were studied, including those resulting in termination of pregnancies, stillbirths, intrauterine deaths and neonatal deaths. To ensure high-case ascertainment, data were cross checked with prenatal ultrasound, cytogenetic laboratory, pathology department and neonatal surgical data base. Data were analysed for associated anomalies, accuracy of prenatal diagnosis and neonatal outcomes.

RESULTS

A total of 65 patients were initially diagnosed as having duodenal atresia, of these 4 were subsequently excluded (1 postnatal normal bowel and 3 high jejunal atresias). In the remaining 61 cases, 35 (57%) had an association with other congenital abnormalities and 26 (43%) were isolated anomalies. Thirty-five were male and 26 female (M:F = 1.4:1). Twenty-one out of 29 (72%) patients prenatally diagnosed, compared with 14 out of 32 (44%) patients diagnosed postnatally had associated anomalies. Duodenal atresia was suspected on routine prenatal ultrasonography at 20-week gestation in 33 cases and confirmed in 29 (48%) cases with 4 false-positive diagnoses (1 normal bowel and 3 high jejunal atresias). No prenatal diagnosis was made in 32 (52%) babies. Of the 61 cases, 53 were live births with 2 early neonatal deaths (1 cardiac and 1 VACTERL), 5 terminations, 2 intrauterine deaths and 1 stillbirth (Fig. 3). Overall neonatal survival was 96% (51 cases). Mortality in the group diagnosed prenatally was 34 % (10 cases).

CONCLUSION

This study shows an overall increased association of duodenal atresia with Down's syndrome. In the group diagnosed prenatally, mortality as well as the association with other congenital anomalies was found to be higher. We have demonstrated a greater prenatal diagnostic accuracy, but confirm postnatal outcomes similar to previous studies.

Postnatal outcome of antenatally diagnosed intra-abdominal cysts

The aim of this study is to establish the postnatal diagnosis and outcome of all abdominal cystic lesions diagnosed antenatally over a 13-year period. All prenatally suspected and postnatally confirmed intra-abdominal cysts seen and delivered between 1991 and 2004 were identified. Antenatal diagnosis, gestational age at delivery, sex and postnatal diagnosis and outcome were recorded. Fifty-five patients were identified with an antenatal diagnosis of abdominal cystic lesion. There were 53 live births and 2 intrauterine deaths. In 13 cases (24%) the cyst had resolved on a postnatal scan. Sixteen (29%) required surgical intervention postnatally. Twenty-six (47%) were given a "non-specific" diagnosis of abdominal cyst antenatally. Three (11%) of these non-specific cysts had resolved on postnatal scan. A "specific" diagnosis of the abdominal cyst was made antenatally in 29 cases (53%) of which 12 (43%) had the diagnosis confirmed postnatally. In ten (35%) of these there was a normal postnatal scan. Antenatal ultrasound scans may not reliably predict the exact pathological diagnosis of abdominal cystic lesions. However this study provides valuable information on the proportion of correctly diagnosed lesions and those that will persist into the postnatal period allowing more informative counselling for prospective parents.

Differential immunity in pigs with high and low responses to porcine reproductive and respiratory syndrome virus infection1,2

One hundred Hampshire x Duroc cross-bred pigs (HD) and 100 NE Index line (I) pigs were infected with porcine reproductive and respiratory syndrome (PRRS) virus and evaluated for resistance/susceptibility. Controls (100/line) were uninfected littermates to the infected pigs. Viremia, change in weight (WTdelta), and rectal temperature at 0, 4, 7, and 14 d postinfection were recorded. Lung, bronchial lymph node (BLN), and blood tissue were collected at necropsy (14 d postinfection). The first principal component from principal component analyses of all variables was used to rank the pigs for phenotypic response to PRRS virus. Low responders (low PRRS burden) had high WTdelta, low viremia, and few lung lesions; high responders (high PRRS burden) had low WTdelta, high viremia, and many lesions. The RNA was extracted from lung and BLN tissue of the 7 highest and 7 lowest responders per line and from each of their littermates. Expression of 11 innate and T helper 1 immune markers was evaluated with cDNA in a 2 x 2 x 2 factorial design. Significant upregulation in lung, lymph, or both of infected pigs relative to controls occurred for all but one gene. Expression differences were greater in HD than I pigs. Significant downregulation for certain immune genes in low pigs, relative to littermate controls, was detected in lung and BLN, particularly in line I. Serum levels of the immune cytokines affirmed the gene expression differences. High preinfection serum levels of IL 8 were significantly associated with PRRS virus-resistant, low pigs. After infection, low expression of interferon gamma in cDNA and in serum was also correlated with PRRS virus resistance. Important genetic associations were revealed for fine mapping of candidate genes for PRRS virus resistance and determining the causative alleles.

An aetiological classification of birth defects for epidemiological research

BACKGROUND

Congenital anomaly registers collect data on antenatally and postnatally detected anomalies for surveillance, research, and public health purposes. Each anomaly is coded using the International Statistical Classification of Diseases and Related Health Problems (ICD-9/ICD-10) based on body systems, allowing accurate comparisons between registers for individual anomalies. When commencing an environmental, epidemiological study, it became clear to us that there is no standard classification that takes aetiology into account. This paper describes a new classification for use in studies addressing aetiology.

METHOD

A classification system was evolved and piloted using cases in a study of geographical variation in congenital anomaly prevalence.1 Cases that were difficult to categorise were noted, and after discussion with a team of experts, the classification was adjusted accordingly.

RESULTS AND CONCLUSION

A robust, hierarchical method of classifying birth defects into eight categories has been produced, for use at source of data registration in conjunction with, but independent of, ICD coding.

The stability of micro-organisms preserved in LENTICULE discs, demonstrated by repeat sample distributions of the EQUAL Scheme for Indicator Organisms (water microbiology)

AIMS

To demonstrate the stability of microorganisms preserved in LENTICULE discs, employed by the EQUAL Scheme for Indicator Organisms.

METHODS AND RESULTS

Five sample batches containing several indicator organism parameters were each despatched in two separate distributions at intervals of up to 24 months apart. A comparison of participants' median counts and bar charts of their cumulated results was then made.

CONCLUSIONS

The results demonstrated that LENTICULE discs provided a remarkably stable preparation format for the maintenance of viable organisms in reproducible numbers.

SIGNIFICANCE AND IMPACT OF THE STUDY

Complex mixtures of organisms can be maintained in stable numbers for extended periods of time at a freezer temperature of -20 degrees C and satisfactorily transported without the requirement for cold chain conditions.

Prevalence of congenital anomalies in five British regions, 1991-99

AIMS

To describe trends in total and live birth prevalence, regional differences in prevalence, and outcome of pregnancy of selected congenital anomalies.

METHODS

Population based registry study of 839,521 births to mothers resident in five geographical areas of Britain during 1991-99. Main outcome measures were: total and live birth prevalence; pregnancy outcome; proportion of stillbirths due to congenital anomalies; and secular trends.

RESULTS

The sample consisted of 10,844 congenital anomalies, giving a total prevalence of 129 per 10,000 registered births (95% CI 127 to 132). Live birth prevalence was 82.2 per 10,000 births (95% CI 80.3 to 84.2) and declined significantly with time. The proportion of all stillbirths with a congenital anomaly was 10.5% (453 stillbirths). The proportion of pregnancies resulting in a termination increased from 27% (289 cases) in 1991 to 34.7% (384 cases) in 1999, whereas the proportion of live births declined from 68.2% (730 cases) to 58.5% (648 cases). Although similar rates of congenital anomaly groups were notified to the registers, variation in rates by register was present. There was a secular decline in the total prevalence of non-chromosomal and an increase in chromosomal anomalies.

CONCLUSIONS

Regional variation exists in the prevalence of specific congenital anomalies. For some anomalies this can be partially explained by ascertainment variation. For others (neural tube defects, diaphragmatic hernia, gastroschisis), higher prevalence rates in the northern regions (Glasgow and Northern) were true differences. Live birth prevalence declined over the study due to an increase in terminations of pregnancy.

Association between a functional polymorphism in the serotonin transporter gene and diarrhoea predominant irritable bowel syndrome in women

BACKGROUND AND AIMS

Serotonin (5-hydroxtryptamine, 5-HT) is an important factor in gut function, playing key roles in intestinal peristalsis and secretion, and in sensory signalling in the brain-gut axis. Removal from its sites of action is mediated by a specific protein called the serotonin reuptake transporter (SERT or 5-HTT). Polymorphisms in the promoter region of the SERT gene have effects on transcriptional activity, resulting in altered 5-HT reuptake efficiency. It has been speculated that such functional polymorphisms may underlie disturbance in gut function in individuals suffering with disorders such as irritable bowel syndrome (IBS). The aim of this study was to assess the potential association between SERT polymorphisms and the diarrhoea predominant IBS (dIBS) phenotype.

SUBJECTS

A total of 194 North American Caucasian female dIBS patients and 448 female Caucasian controls were subjected to genotyping.

METHODS

Leucocyte DNA of all subjects was analysed by polymerase chain reaction based technologies for nine SERT polymorphisms, including the insertion/deletion polymorphism in the promoter (SERT-P) and the variable tandem repeat in intron 2. Statistical analysis was performed to assess association of any SERT polymorphism allele with the dIBS phenotype.

RESULTS

A strong genotypic association was observed between the SERT-P deletion/deletion genotype and the dIBS phenotype (p = 3.07x10(-5); n = 194). None of the other polymorphisms analysed was significantly associated with the presence of disease.

CONCLUSIONS

Significant association was observed between dIBS and the SERT-P deletion/deletion genotype, suggesting that the serotonin transporter is a potential candidate gene for dIBS in women.

The requirements of the Data Protection Act 1998 for the processing of medical data

The Data Protection Act 1998 presents a number of significant challenges to data controllers in the health sector. To assist data controllers in understanding their obligations under the act, the Information Commissioner has published guidance, The Use and Disclosure of Health Data, which is reproduced here. The guidance deals, among other things, with the steps that must be taken to obtain patient data fairly, the implied requirements of the act to use anonymised or psuedonymised data where possible, an exemption applicable principally to records based research, the right of patients to object to the processing of their data, and the interface of the act and the common law duty of confidence.

Metabolic control of recombinant monoclonal antibody N-glycosylation in GS-NS0 cells

Variable N-glycosylation at Asn(297) in the Fc region of recombinant therapeutic immunoglobulin G (IgG) molecules, specifically terminal galactosylation and sialylation, may affect both pharmacokinetic behavior and effector functions of recombinant therapeutic antibodies. We investigated the hypothesis that IgG Fc glycosylation can be controlled by manipulation of cellular nucleotide-sugar metabolism. In control cultures, N-glycans associated with the Fc domain of a recombinant humanized IgG1 produced by GS-NS0 cells in culture were predominantly biantennary, variably beta-galactosylated (average 0.3 mol galactose complex N-glycan(-1)) structures with no bisecting N-acetylglucosamine residues, sialylation, or alpha1,3-linked galactosylation evident. However, a variable proportion (5% to 15%) of high-mannose (Man5 to Man9) oligosaccharides were present. To manipulate the cellular content of the nucleotide sugar precursor required for galactosylation, UDP-Gal, we included either 10 mM glucosamine or 10 mM galactose in the culture medium. In the case of the former, a 17-fold increase in cellular UDP-N-acetylhexosamine content was observed, with a concomitant reduction (33%) in total UDP-hexose, although the ratio of UDP-Glc:UDP-Gal (4:1) was unchanged. Associated with these alterations in cellular UDP-sugar content was a significant reduction (57%) in the galactosylation of Fc-derived oligosaccharides. The proportion of high-mannose-type N-glycans (specifically Man5, the substrate for N-acetylglucosaminyltransferase I) at Asn(297) was unaffected. In contrast, inclusion of 10 mM galactose in culture specifically stimulated UDP-Gal content almost five-fold. However, this resulted in only a minimal, insignificant increase (6%) in beta1,4-galactosylation of Fc N-glycans. Sialylation was not improved upon the addition of the CMP-sialic acid (CMP-SA) precursor N-acetylmannosamine (20 mM), even with an associated 44-fold increase in cellular CMP-SA content. Analysis of recombinant IgG1 Fc glycosylation during batch culture showed that beta1,4-linked galactosylation declined slightly during culture, although, in the latter stages of culture, the release of proteases and glycosidases by lysed cells were likely to have contributed to the more dramatic drop in galactosylation. These data demonstrate: (i) the effect of steric hindrance on Fc N-glycan processing; (ii) the extent to which alterations in cellular nucleotide-sugar content may affect Fc N-glycan processing; and (iii) the potential for direct metabolic control of Fc N-glycosylation.

Prenatal diagnosis of an epignathus: a case report and review of the literature

An epignathus is an extremely rare form of teratoma that arises from the oral cavity, most commonly from the palate. We describe a case identified sonographically at 17 weeks' gestation after a raised maternal serum alpha-fetoprotein was recorded. This pregnancy was terminated but we review the literature over the last 10 years and describe the management options available in such cases.

Health beliefs and endoscopic screening for colorectal cancer: potential for cancer prevention

BACKGROUND

Colorectal cancer can be prevented through endoscopic removal of adenomatous polyps. Because screening endoscopy rates are low, it is critical to identify correlates of screening behavior that are amenable to interventions to improve screening rates. Our purpose was to identify the correlates of endoscopic screening among persons at risk for colorectal cancer.

METHODS

We surveyed 1,160 healthy, adult, first-degree relatives of colorectal cancer patients in 583 kindreds, for a 43% response rate. Using multiple logistic regression analysis, we tested the association between screening behavior and perceived risk for colorectal cancer, the belief that colorectal cancer can be prevented, demographic factors, strength of family history, and practical barriers to screening.

RESULTS

Persons screened at least once were older, were male, had stronger family histories, had a regular doctor, and had health insurance. After these fixed factors were accounted for, the belief that colorectal cancer can be prevented and higher perceived risk were associated with significantly greater odds of screening.

CONCLUSIONS

This study establishes the need for trials evaluating the cancer prevention potential of the link between screening behavior and health beliefs. Physicians must be aware of their patients' family colorectal cancer history and recommend appropriate endoscopic screening for those at increased risk, particularly women. Patients should be educated about their cancer risk and about preventing colorectal cancer.

Correlations between microbial parameters from water samples: expectations and reality

Data which are collected in order to estimate the correlation between parameters must be analysed with caution. Classical statistics of correlation are often inappropriate. The "r" statistic is very easily distorted by non-Normal data. Non-parametric statistics can be helpful. The interpretation and usefulness of the estimates of correlation will depend on the study plan. If water samples come from disparate sources (e.g. upstream or downstream from sewage outlets) then parameters A and B may occur in their highest and lowest numbers according to how close the samples were to contamination sources thus correlating closely. However, if all samples come from sources with similar pollution levels then plots of A and B will show considerable scatter and apparently little correlation. So what is the relationship between A and B? An example of "perfect" correlation, as demonstrated by replicate counts of a single parameter from split samples, gave an r value of only 0.63 (p = 0.62) due to random variation in numbers of organisms between the two halves of the sample. Thus large amounts of data are needed for studying true correlation because relationships between parameters are embedded in the natural variation. This also illustrated that Standards for a single parameter can be "passed" or "failed" by two halves of the same sample. Study design is clearly of fundamental importance. Consideration must be given to the appropriate way of asking questions about correlation between different parameters.

Use of coping strategies and breast cancer survival: results from the Black/White Cancer Survival Study

This analysis was designed to evaluate the association between coping strategies and breast cancer survival among Black and White women in a large population-based study. A total of 442 Black and 405 White US women diagnosed with invasive breast cancer during 1985-1986 and actively followed for survival through 1994 were administered a modified Folkman and Lazarus Ways of Coping questionnaire. Coping strategies were characterized via factor analyses of the responses. Hazard ratios associated with coping strategies were estimated using Cox proportional hazards models, with adjustment for age, race, tumor stage, study location, tumor hormone responsiveness, comorbidity, health insurance status, smoking, relative body weight, and alcohol consumption. Emotion-focused coping strategies were significantly associated with survival. Expression of emotion was associated with better survival (hazard ratio = 0.6; 95% confidence interval: 0.4, 0.9). When it was considered jointly with the presence or absence of perceived emotional support, women reporting low levels of both emotional expression and perceived emotional support experienced poorer survival than women reporting high levels of both (hazard ratio = 2.5; 95% confidence interval: 1.7, 3.7). Similar risk relations were evident for Blacks and Whites and for patients with early and late stage disease. These results suggest that the opportunity for emotional expression may help improve survival among patients with invasive breast cancer.

Determination of the isotopic composition of uranium in urine by inductively coupled plasma mass spectrometry

A simple method based on inductively coupled plasma mass spectrometry (ICP-MS) was developed to identify exposure to depleted uranium by measuring the isotopic composition of uranium in urine. Exposure to depleted uranium results in a decreased percentage of 235U in urine samples causing measurements to vary between natural uranium's 0.72% and depleted uranium's 0.2%. Urine samples from a non-depleted uranium exposed group and a suspected depleted uranium exposed group were processed and analyzed by ICP-MS to determine whether depleted uranium was present in the urine. Sample preparation involved dry-ashing the urine at 450 degrees C followed by wet-ashing with a series of additions of concentrated nitric acid and 30% hydrogen peroxide. The ash from the urine was dissolved in 1 M nitric acid, and the intensity of 235U and 238U ions were measured by ICP-MS. After the samples were ashed, the ICP-MS measurements required less than 5 min. The 235U percentage in individuals from the depleted uranium exposed group with urine uranium concentrations greater than 150 ng L(-1) was between 0.20%-0.33%, correctly identifying depleted uranium exposure. Samples from the non-depleted uranium exposed individuals had urine uranium concentration less than 50 ng L(-1) and 235U percentages consistent with natural uranium (0.7%-1.0%). A minimum concentration of 14 ng L(-1) uranium was required to obtain sufficient 235U to allow calculating a valid isotopic ratio. Therefore, the percent 235U in urine samples measured by this method can be used to identify low-level exposure to depleted uranium.

Identification and semi-quantitation of Ostertagia ostertagi eggs by enzymatic amplification of ITS-1 sequences

A region within the first internal transcribed spacer (ITS-1) of the ribosomal DNA repeat of Ostertagia ostertagi has been identified that is 408 base pairs (bp) in length and is comprised of a 2 x 204 bp repeat. Universal polymerase chain reaction (PCR) primers which span this region, as well as a portion of the 5.8S rDNA, generate a 1011 bp fragment using genomic DNA from O. ostertagi. However, these same primers generate only a 600 bp (approximate) fragment using DNA from Haemonchus contortus, Cooperia oncophora and Oesophagostomum radiatum, as well as other species within the genus Ostertagia. When DNA samples derived from adult parasites of the different genera were mixed and simultaneously amplified, the O. ostertagi component could be identified within the mixed DNA populations. Furthermore, a correlation was observed between relative fluorescence intensities of the 1011 bp and the 600 bp PCR fragments and the percentage of O. ostertagi DNA within a mixture of parasite DNAs. A similar high correlation was obtained between the percentage of O. ostertagi DNA and percent O. ostertagi eggs in feces containing eggs of other nematode genera. This resulted in the generation of a protocol that can determine the percentage of O. ostertagi eggs within a mixed population of gastrointestinal nematode eggs. Results indicate a detection equivalent to 0.05 eggs.

Summary of the first round analyses of the Second International Swine CD Workshop

The reactivity of 176 monoclonal antibodies (mAb) submitted to the Second International Swine CD Workshop, together with 19 internal standards, was analyzed by flow cytometry on 16 different cell types as a means of establishing the proper cell subset for later detailed clustering analyses. The exact CD subset reactivity of the 19 internal standard mAb had been characterized in the First International Swine CD Workshop. The flow cytometric analyses resulted in 40 data sets which were then subjected to statistical clustering using the Leukocyte Typing Database IV (LTDB4) software. As result of this work, 22 clusters were defined. After review of these results, panels of mAb from the defined first round clusters were assigned to cell subsets. The respective mAb in those first round clusters were then distributed to subset group researchers for further examination during the second round of the workshop.

Report on the analyses of mAb reactive with porcine CD8 for the second international swine CD workshop

Based on an analysis of their reactivity with porcine peripheral blood lymphocytes (PBL), only three of the 57 mAbs assigned to the T cell/activation marker group were grouped into cluster T9 along with the two wCD8 workshop standard mAbs 76-2-11 (CD8a) and 11/295/33 (CD8b). Their placement was verified through the use of two-color cytofluorometry which established that all three mAbs (STH101, #090; UCP1H12-2, #139; and PG164A, #051) bind exclusively to CD8+ cells. Moreover, like the CD8 standard mAbs, these three mAbs reacted with two proteins with a MW of 33 and 35 kDa from lymphocyte lysates and were, thus, given the wCD8 designation. Because the mAb STH101 inhibited the binding of mAb 76-2-11 but not of 11/295/33, it was given the wCD8a designation. The reactivity of the other two new mAbs in the T9 cluster with the various subsets of CD8+ lymphocytes were distinct from that of the other members in this cluster including the standards. Although the characteristic porcine CD8 staining pattern consisting of CD8low and CD8high cells was obtained with the mAb UCP1H12-2, a wider gap between the fluorescence intensity of the CD8low and CD8high lymphocytes was observed. In contrast, the mAb PG164A, not only exclusively reacted with CD4-/CD8high lymphocytes, but it also failed to recognize CD4/CD8 double positive lymphocytes. It was concluded that this mAb is specific for a previously unrecognized CD8 epitope, and was, thus, given the wCD8c designation. A very similar reactivity pattern to that of PG164A was observed for two other mAbs (STH106, #094; and SwNL554.1, #009). Although these two mAbs were not originally positioned in the T cell subgroup because of their reactivity and their ability to inhibit the binding of PG164A, they were given the wCD8c designation. Overall, five new wCD8 mAbs were identified. Although the molecular basis for the differences in PBL recognition by these mAbs is not yet understood, they will be important in defining the role of CD8+ lymphocyte subsets in health and disease.

Overview of the Second International Workshop to define swine cluster of differentiation (CD) antigens

The aim of the Second International Swine Cluster of Differentiation (CD) Workshop, supported by the Veterinary Immunology Committee (VIC) of the International Union of Immunological Societies (IUIS), was to standardize the assignment of monoclonal antibodies (mAb) reactive with porcine leukocyte differentiation antigens and to define new antibody clusters. At the summary meeting of the workshop in July, 1995, revisions in the existing nomenclature for Swine CD were approved, so that the rules are now in accord with those for human and ruminant CD. Swine CD numbers will now be given to clusters of mAb to swine orthologues of human CD molecules when homology is proven by (1) suitable tissue distribution and lymphoid cell subset expression, (2) appropriate molecular mass of the antigen recognized by the mAbs, and (3) reactivity of mAbs with the cloned swine gene products, or cross-reactivity of the mAb on the human gene products. In some cases, this reactivity would not be fully proven, mainly due to the lack of cloned gene products; for these CD antigens, the respective clusters will be assigned by the prefix 'w' which will lead to 'wCD' antigens. As a result of the Second International Swine CD Workshop the assignment of 16 mAb to existing CD groups (CD2a, CD4a, CD5a, wCD6, wCD8, CD14, CD18a, wCD21, wCD25) was confirmed, and 2 mAb to existing swine workshop clusters (SWC). More importantly, for the work on the porcine immune system, was the definition of 5 new swine CD antigens, namely CD3 (recognized by 6 new mAb and 3 epitopes), CD16 (1 new mAb), wCD29 (2 mAb), CD45RA (3 mAb) and CD45RC (1 new mAb). Finally, the demarcation of two new SWC molecules in swine, SWC8 (2 mAb) and SWC9 (2 mAb) was confirmed.

Maintenance of Dispersed Reproductive Cells from Male and Female Ascaris suum

In vitro cultivation of tissues and cells provides an experimental methodology to define and manipulate physiological mechanisms that are not possible with in vivo techniques. Tissues from the germinative-growth zones of adult Ascaris suum gonads were excised and minced, and then enzymatically dispersed and transferred to an artificial, perienteric fluid-fetal calf-serum-medium complex. Cells were maintained in a viable state for 8 days, with medium replacement every 48 hours. During this period, morphological changes in the gonadal cells included decreased size, dedifferentiation, and degeneration. Two indices of metabolism, evolution of (1)CO from radiolabelled glucose and reduction of the tetrazolium salt MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium), decreased by approximately 50% and 60%, respectively. The in vitro procedures developed provide the first opportunity to examine specific cellular functions of nematode reproductive tissues over an extended period of time.

Endoscopic laser therapy for watermelon stomach

Eleven patients (nine females, two males) with anaemia due to acute and chronic gastrointestinal blood loss were found to have gastric antral vascular ectasia (watermelon stomach). Nine patients were transfusion-dependent, receiving a mean of 13.1 units over a mean period of 12.3 months. All patients received neodymium:yttrium-aluminium-garnet laser coagulation with a median of 3.0 treatment sessions. Post-treatment transfusion needs were abolished in six patients and minimal in two patients during a mean follow up of 27.3 months (range 12-60 months). Overall there was a mean reduction in transfusion requirement with treatment from 2.5 units per month to 0.4 units per month (P < 0.02). Mean pretreatment haemoglobin improved from 7.7 to 11.9 g/dL after treatment (P < 0.001). No complications occurred. Laser coagulation is safe and effective treatment for anaemia due to watermelon stomach and should be considered as first line therapy.

Family history of cancer and risk of lung cancer among lifetime nonsmoking women in the United States

In a multicenter study of lung cancer in lifetime nonsmokers in the United States, 646 female lung cancer patients and 1,252 population controls were interviewed regarding history of cancer in their first-degree relatives. A 30% increased risk (95% confidence interval 0.9-1.8) was found for a history of respiratory tract cancer in parents or siblings after adjustment for exposure to environmental tobacco smoke (ETS) in adult life. Lung cancer, which represented approximately two thirds of the respiratory tract cancers, occurred more frequently in first-degree relatives of lung cancer patients than in comparable relatives of population controls (ETS-adjusted odds ratio = 1.29, 95% confidence interval 0.9-1.9). In particular, a significant threefold increased risk for lung cancer was associated with lung cancer diagnosed in mothers and sisters. The increased risk in relation to family history of lung cancer was observed among parents and siblings who were smokers as well as in those who were nonsmokers. The association with family history of lung cancer was strengthened when the analysis was restricted to adenocarcinoma of the lung (ETS-adjusted odds ratio = 1.50, 95% confidence interval 1.0-2.2). However, there was no association between family history of other cancers and risk of lung cancer in nonsmokers.

Chilling, oxidative stress and antioxidant responses in Arabidopsis thaliana callus

Chilling of Arabidopsis thaliana (L.) Heynh. callus tissue to 4 degrees C led to conditions of oxidative stress, as indicated by increased levels of the products of peroxidative damage to cell membranes. Cellular H2O2 was also observed to increase initially upon chilling but by day 8 cellular levels had declined to below control levels. Although levels of catalase activity remained similar to those in unchilled tissue, activity of ascorbate peroxidase increased between days 4 and 8 of chilling to 4 degrees C. In callus held at 23 degrees C, levels of reduced glutathione remained static whereas they rose in callus held at 4 degrees C. Levels of oxidised glutathione were initially low but increased significantly by day 4 in the chilled callus. At 23 degrees C, however, levels of oxidised glutathione remained low. Between days 1 and 3 at 4 degrees C, levels of glutathione reductase activity increased but by day 8 glutathione reductase activity was similar to that in cells held at 23 degrees C. Exposure of callus to abscisic acid at 23 degrees C also led to increased activities of ascorbate peroxidase and glutathione reductase.

High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest

This trial compared blinded 10 mg aliquots of adrenaline with placebo in 194 cardiac arrest patients treated in hospital using American Heart Association guidelines. In-hospital and out-of-hospital arrests were included. Of the 339 eligible patients a large proportion (145 (45%)) were not randomised and received open 1 mg aliquots of adrenaline. This group is also analysed. Supervising physicians gave significant preference for males, patients with no previous cardiac history and without multiple organ disease to be given open 1 mg adrenaline. Patients in asystole at the time of consideration for entry were preferentially placed in the trial group (114 (69%) vs. 170 (88%)) and patients in ventricular fibrillation were preferentially given open 1 mg adrenaline (31 (21%) vs. 24 (12%) P < 0.03). The most beneficial rhythm changes which led to survival were sinus rhythm and ventricular tachycardia. Analysis of rhythm changes resulting from the dosing showed a significant (P = 0.01) change to a beneficial rhythm with 10 mg adrenaline but not for 1 mg adrenaline or placebo. This was not reflected by an improvement in immediate survival. No significant differences in immediate survival (IS) or hospital discharge (HD) exists between open 1 mg adrenaline (IS 14 (9.7%), HD 3 (2%)) or the 10 mg adrenaline (IS 9 (9.6%), HD 0) vs. placebo (IS 7 (7%), HD 0) trial arms. Patients reaching the point of use of adrenaline have a uniformly poor immediate survival (8.8%) and hospital discharge rate (0.9%). Dosing with 10 mg or 1 mg adrenaline does not influence outcome compared with placebo.

Historical cohort investigation of spontaneous abortion in the Semiconductor Health Study: epidemiologic methods and analyses of risk in fabrication overall and in fabrication work groups

The risk of spontaneous abortion (SAB) in the semiconductor industry was examined in a historical cohort study of pregnancies at 14 companies. We identified female employees who had worked for at least 6 months and whose ages ranged from 18 to 44 years during the 1986-1989 study period. Using company records, we included all fabrication-room (fab) employees and an approximately equal number of nonfabrication (nonfab) employees, for a total sample of 7,269. Telephone interviews with 6,088 women (84%) identified 904 eligible pregnancies and 113 SABs. Exposure classification was based on questionnaire and industrial hygiene assessments of tasks the women performed during the first trimester of pregnancy. Using logistic regression to control for age, smoking, ethnicity, education, income, year of pregnancy, and stress, we found a higher risk of SAB in fab employees than in nonfab employees (15.0% of fab pregnancies ended in SAB vs. 10.4% of nonfab pregnancies, adjusted relative risk [RR] = 1.43, 95% CI = 0.95-2.09). Analysis of fab work groups showed that the highest relative risk was in masking employees (17.5% SAB rate, adjusted RR = 1.78, 95% CI = 1.17-2.62 in comparison with nonfab employees). Within masking, the highest risk was found in etching-related process employees (22.2% SAB rate, adjusted RR = 2.08, 95% CI = 1.27-3.19 in comparison to nonfab employees.

Cochlear reimplantation

Since its inception in 1988 the Cochlear Implant Programme in Manchester has successfully implanted 69 adults and 23 children. Of these 92 procedures, three patients have undergone revision surgery with the insertion of either a new implant or re-positioning of the existing device. We examine the circumstances that lead to the need for reimplantation in these patients, discuss the technical aspects of revision surgery together with the functional results of such procedures.

Cochlear reimplantation

Since its inception in 1988, the Cochlear Implant Programme in Manchester has successfully implanted 61 adults and 15 children. Of these 76 patients, 3 have undergone revision surgery, and these cases are presented. One patient was a 43-year-old blind man who underwent routine implantation with a Nucleus device. Six weeks after implantation the patient experienced sudden device failure following an electric shock from a domestic appliance. The patient was reimplanted with a similar device 3 weeks later and is making good progress. Assessment of the original implant showed a failure of one of the capacitors in the receiver-stimulator circuit. The second patient was a 51-year-old woman who underwent routine implantation with a Nucleus 22-channel device. The patient's audiologic performance fluctuated, and 14 months after the original procedure the patient was reimplanted. Analysis by the manufacturer suggested that the original implant was unstable at higher temperatures. The third patient, a 55-year-old woman, was implanted with an Ineraid multichannel device into the right cochlea. A postoperative radiograph showed the implant to be incorrectly positioned, and the procedure was revised 4 weeks later. Here it was found that the electrode system was running across the promontory, toward the eustachian tube orifice. This was reimplanted with satisfactory results.

Whirlpool baths in nursing homes: use, maintenance, and contamination with Pseudomonas aeruginosa

Transmission of Pseudomonas aeruginosa wound infection was associated with the use of a whirlpool bath in a nursing home. The nursing home inspection unit asked for guidance on whirlpool baths in nursing homes and advice for proprietors about their use, cleaning, disinfection, and maintenance. Seventeen whirlpool baths in 16 nursing homes in two health districts were examined for the presence of P. aeruginosa. A survey was made of the use made of whirlpool baths, methods used to clean and disinfect them, and the occurrence of P. aeruginosa wound infection in users. P. aeruginosa were found in large numbers in water samples from all whirlpool baths after agitation. Only one of the 253 residents who used whirlpool baths was known to have a P. aeruginosa wound infection. The local nursing home inspection unit was advised that whirlpool baths could continue to be used in nursing homes but only by continent residents with intact skin. The bath should be cleaned and disinfected, preferably with hypochlorite, after each use; the bath should be more thoroughly cleaned and disinfected daily and the bath should be fully serviced at least once a year. Suspected or confirmed cases of P. aeruginosa infection in residents of nursing homes should be reported to the consultant in communicable disease control. The prevalence of known infection with P. aeruginosa was low in the residents of the nursing homes, but the unguided and unregulated use of whirlpool baths in nursing homes may present an infection hazard to residents who use the bath and to hospitals that admit residents from such nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Previous lung disease and risk of lung cancer among lifetime nonsmoking women in the United States

The authors conducted a population-based case-control study of lung cancer in nonsmoking women in five metropolitan areas of the United States between December 1, 1985, and November 30, 1990. In-person interviews were conducted with 412 lung cancer cases and 1,253 population controls, yielding information on history of nonmalignant lung diseases that were diagnosed by a physician. When lung cancer cases were compared with controls, history of any previous lung disease was associated with a significant increased risk of lung cancer (adjusted odds ratio (AOR) = 1.56, 95% confidence interval (CI) 1.2-2.0). Several lung diseases, including asthma, chronic bronchitis, pneumonia, and tuberculosis, were reported more often by lung cancer cases than by controls, and the difference was statistically significant for asthma (AOR = 1.67, 95% CI 1.1-2.5) and chronic bronchitis (AOR = 1.60, 95% CI 1.1-2.4). Since significant increased risks were observed for asthma and tuberculosis diagnosed before age 21 years, it is unlikely that reported prior lung diseases were prediagnostic manifestations of lung cancers. The increased risks associated with previous lung disease were observed for adenocarcinomas and other carcinomas of the lung; the point estimates were generally higher for the latter category. The risks associated with previous lung diseases remained unchanged after adjustment for potential confounders, including environmental tobacco smoke exposure during childhood and adult life and dietary factors.

Direct milk excretion of Campylobacter jejuni in a dairy cow causing cases of human enteritis

Consumption of milk contaminated with Campylobacter jejuni has been described as a cause of human enteritis. Although faecal contamination of milk with the organism has frequently been described, direct milk excretion of Campylobacter jejuni into milk has rarely been linked with cases of human infection. We describe the investigations undertaken following the isolation of Campylobacter jejuni from samples of unpasteurized milk prior to retail. Results of epidemiological investigations including typing of Campylobacter jejuni isolates using pyrolysis mass spectrometry, Penner and Lior serotyping, biotyping, phage typing and restriction fragment length polymorphism analysis provided convincing evidence implicating direct milk excretion of Campylobacter jejuni by one asymptomatic dairy cow as the source of the milk contamination and the cause of local cases of human enteritis.

Normal superoxide dismutase (SOD) gene in pregnancy-induced hypertension: is the decreased SOD activity a secondary phenomenon?

Reactive oxygen species (ROS) have been implicated in the pathogenesis of pregnancy-induced hypertension (PIH). A genetic factor is also thought to be associated with the disease. The aim of the present study was to investigate whether decreased superoxide dismutase (SOD) activity in PIH resulted from gene abnormalities. Fourteen patients with PIH were enrolled in the study. Normal pregnant women and normal nonpregnant women served as controls. Genomic DNA and mRNA were isolated from white cells and subjected to Southern and Northern blot analysis with a 600 bp CuZn-SOD probe. SOD activity was also determined in the white blood cells and red blood cells. The results showed that SOD activity was significantly reduced in patients with PIH compared to both control groups. There were no significant differences in the size of the CuZn-SOD gene and its expression between the patients with PIH and the controls. This study confirmed that there was a decreased SOD activity in PIH but revealed neither major structural changes in the genomic DNA nor mRNA size of CuZn-SOD. Our results suggest that the decreased SOD levels in PIH are not due to abnormalities in the CuZn-SOD gene and are an acquired phenomenon which occurs during the development of the disease.

Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study

OBJECTIVE

To determine the relative risk (RR) of lung cancer in lifetime never smokers associated with environmental tobacco smoke (ETS) exposure.

DESIGN

Multicenter population-based case-control study.

SETTING

Five metropolitan areas in the United States: Atlanta, Ga, Houston, Tex, Los Angeles, Calif, New Orleans, La, and the San Francisco Bay Area, Calif.

PATIENTS OR OTHER PARTICIPANTS

Female lifetime never smokers: 653 cases with histologically confirmed lung cancer and 1253 controls selected by random digit dialing and random sampling from the Health Care Financing Administration files for women aged 65 years and older.

MAIN OUTCOME MEASURE

The RR of lung cancer, estimated by adjusted odds ratio (OR) with 95% confidence interval (CI), associated with ETS exposure.

RESULTS

Tobacco use by spouse(s) was associated with a 30% excess risk of lung cancer: all types of primary lung carcinoma (adjusted OR = 1.29; P < .05), pulmonary adenocarcinoma (adjusted OR = 1.28; P < .05), and other primary carcinomas of the lung (adjusted OR = 1.37; P = .18). An increasing RR of lung cancer was observed with increasing pack-years of spousal ETS exposure (trend P = .03), such that an 80% excess risk of lung cancer was observed for subjects with 80 or more pack-years of exposure from a spouse (adjusted OR = 1.79; 95% CI = 0.99 to 3.25). The excess risk of lung cancer among women ever exposed to ETS during adult life in the household was 24%; in the workplace, 39%; and in social settings, 50%. When these sources were considered jointly, an increasing risk of lung cancer with increasing duration of exposure was observed (trend P = .001). At the highest level of exposure, there was a 75% increased risk. No significant association was found between exposure during childhood to household ETS exposure from mother, father, or other household members; however, women who were exposed during childhood had higher RRs associated with adult-life ETS exposures than women with no childhood exposure. At the highest level of adult smoke-years of exposure, the ORs for women with and without childhood exposures were 3.25 (95% CI, 2.42 to 7.46) and 1.77 (95% CI, 0.98 to 3.19), respectively.

CONCLUSION

Exposure to ETS during adult life increases risk of lung cancer in lifetime nonsmokers.

Slow-release sodium fluoride in the management of postmenopausal osteoporosis. A randomized controlled trial

OBJECTIVE

To test whether intermittent treatment with slow-release sodium fluoride and continuous calcium citrate supplementation inhibits vertebral fractures without causing fluoride complications.

DESIGN

A placebo-controlled, randomized trial.

SETTING

Outpatient setting of specialty clinics in Dallas and Temple, Texas.

INTERVENTIONS

Slow-release sodium fluoride (25 mg twice daily) in repeated 14-month cycles (12 months on treatment followed by 2 months off treatment) compared with placebo. Both groups took calcium citrate (400 mg calcium twice daily) continuously.

PATIENTS

110 patients with postmenopausal osteoporosis were randomly assigned to two groups. In the slow-release sodium fluoride group, 48 of 54 patients completed more than 1 cycle of treatment (mean, 2.44 cycles/patient), whereas 51 of 56 patients in the placebo group completed at least 1 cycle (mean, 2.14 cycles/patient) in this interim analysis.

MEASUREMENTS

Vertebral fracture rate and lumbar bone mineral content. Vertebral fractures were quantified from yearly radiographs. Bone mass was determined annually by densitometry.

RESULTS

In the sodium fluoride group, the mean L2 to L4 bone mineral content increased by 4% to 6% in each cycle and the mean femoral neck bone density increased by 4.1% and 2.1% during the first two cycles, but the radial bone density did not change. The placebo group showed no statistical change in bone mass at any site. Compared with the placebo group, the sodium fluoride group had a lower individual new vertebral fracture rate (0.057/patient cycle compared with 0.204/patient cycle, P = 0.017), a higher fracture-free rate (83.3% compared with 64.7%, P = 0.042), and a lower group fracture rate (0.085/patient cycle compared with 0.239/patient cycle, P = 0.006). The side-effect profile was similar for the two groups; no patient developed microfractures, hip fractures, or blood loss anemia.

CONCLUSIONS

Intermittent slow-release sodium fluoride plus continuous calcium citrate, administered for about 2.5 years, inhibits new vertebral fractures, increases the mean spinal bone mass without decreasing the radial shaft bone density, and is safe to use.

Rhythm changes during resuscitation from ventricular fibrillation

Defibrillation of patients with primary ventricular fibrillation (VF) results in a variety of rhythm changes. We analysed these changes in rhythm in 200 patients, using the American Heart Association's recommendation of two defibrillations prior to drug therapy. Sixty-three (31.5%) patients were immediate survivors with 38 (19%) being discharged from hospital alive. There was no difference between the age of immediate survivors (66.5 years, S.D. = 11.2) and non-survivors (68.3 years, S.D. = 13.7, P = 0.37). Immediate survivors were significantly more likely to be discharged alive from hospital if they were younger (70.0 years, S.D. 8.5 vs. 62.1 years, S.D. 15.8, P = 0.014). Increasing delays to the initiation of basic life support (CPR) and to defibrillation were associated with significantly less likelihood of cardioversion to sinus rhythm (P < 0.005 and P < 0.002, respectively). Those patients who stayed in VF were not more likely to be defibrillated into asystole or electro-mechanical dissociation. Seventeen percent (34) of patients were defibrillated to sinus rhythm after the first defibrillation and 14% (19) after the second, with similar hospital discharge rates (62% and 58%, respectively). Sixty percent (32) of patients in sinus rhythm, after two defibrillations, were discharged alive, compared to only 4% (6) of those patients not in sinus rhythm after two defibrillations. Our data provide new information on rhythm changes during resuscitation and supports the need for the earliest possible initiation of basic life support and defibrillation to improve survival from cardiac arrest due to ventricular fibrillation.

A review of patients attending a preliminary cochlear implant assessment clinic

The Cochlear Implant Programme at Manchester Royal Infirmary was established in 1988 and so far (January, 1992) 38 patients have been implanted with the Nucleus 22 channel intracochlear device and one with the Ineraid device. All patients who are referred for consideration for an implant are initially seen at a preliminary cochlear implant assessment clinic conducted by an ENT surgeon. One hundred and seventy three patients attended the initial outpatient screening clinic between 1987 and January 1992. Of these 112 patients (67.6 per cent) went on for further investigation regarding suitability for implantation. This paper details the aetiology and severity of deafness in these patients and explains how suitability for admission to the next stage of assessment was decided.

A novel truncated apolipoprotein B (apo B55) in a patient with familial hypobetalipoproteinemia and atypical retinitis pigmentosa

We have identified an apolipoprotein (apo) B mutation in a patient with an atypical form of retinitis pigmentosa (RP). In the family the eye disease is characterised by late age of onset and autosomal dominant inheritance. In addition to RP, the proband has low total cholesterol (4.5 mmol/l) and LDL-cholesterol (2.0 mmol/l) levels characteristic of the autosomal codominant apolipoprotein (apo) B deficiency disease hypobetalipoproteinemia (HBL). Using a monoclonal antibody directly against apo B and immunoblots of SDS polyacrylamide gel separated plasma, a normal apo B100 and a truncated apo B species with an estimated size of apo B54 was identified in the proband and his RP-affected sister. The location of the mutation in the apo B gene was identified using chemical cleavage of mismatch and this was confirmed by direct sequencing of an amplified fragment of DNA spanning the estimated site of the mutation. The mutation is a C----T transition at nucleotide 7692 which changes the CGA arginine2495 codon to a STOP codon resulting in the premature termination of apo B100. The truncated apo B protein is 2494 amino acids long with a predicted size of apo B55. Using allele specific oligonucleotides and oligonucleotide melting techniques, the proband, his sister and two other relatives out of a total of 20 family members, screened for the presence of the apo B55 mutation, were heterozygous for the mutation. The segregation of the apo B55 allele was confirmed in the family using the 3' variable number of tandem repeats of the apo B gene.(ABSTRACT TRUNCATED AT 250 WORDS)

Lung cancer in nonsmoking women: a multicenter case-control study

The association between exposure to environmental tobacco smoke and lung cancer in female lifetime nonsmokers was evaluated using data collected during the first 3 years of an ongoing case-control study. This large, multicenter, population-based study was designed to minimize some of the methodological problems which have been of concern in previous studies of environmental tobacco smoke and lung cancer. Both a cancer control group and a population control group were selected in order to evaluate recall bias. A uniform histopathological review of diagnostic material was conducted for case confirmation and detailed classification. Biochemical determination of current exposure to tobacco and screening of multiple sources of information to determine lifetime nonuse were utilized to minimize misclassification of smokers as nonsmokers. A 30% increased risk of lung cancer was associated with exposure to environmental tobacco smoke from a spouse, and a 50% increase was observed for adenocarcinoma of the lung. A statistically significant positive trend in risk was observed as pack-years of exposure from a spouse increased, reaching a relative risk of 1.7 for pulmonary adenocarcinoma with exposures of 80 or more pack-years. The predominant cell type of the reviewed, eligible lung cancer cases was adenocarcinoma (78%). Results were very similar when cases were compared to each control group and when separate analyses were conducted for surrogate and personal respondents. Other adult-life exposures in household, occupational, and social settings were each associated with a 40-60% increased risk of adenocarcinoma of the lung. No association was found between risk of any type of lung cancer and childhood exposures from a father, mother, or other household members.