Spinal infections in the north-east of Scotland: a retrospective analysis

INTRODUCTION

Spinal infection (SI) is uncommon and patients present with varied clinical features. In this review, the presentation, investigation, treatment and outcome of patients with SI in the north-east of Scotland were assessed.

METHODS

Electronic medical records of adult patients with SI hospitalised at a health board in the north-east of Scotland between 2014 and 2018 were analysed retrospectively. Collected variables included demographics, presenting clinical features, risk factors, comorbidities, admission blood results, microbiological investigations, imaging, treatment and outcomes.

RESULTS

Seventy-two patients were included. Mean age (±sd) was 63.3 years (±14.5). The lumbar spine was the most commonly involved region (51.4%). Back pain (84.7%), altered mobility (33.3%) and fever (29.2%) were the most frequent presenting features. Thoracic spine involvement (p = 0.041), urinary symptoms (p = 0.033), cauda equina syndrome (CES) (p = 0.027) and limb weakness (p = 0.026) were associated with poorer outcome. A better outcome was associated with back pain at presentation (p = 0.03) and underlying malignancy (p = 0.045). Diabetes (15.3%), recent falls (15.3%) and immunosuppression (12.5%) were common. A likely causative organism was found in 54 patients (75.0%) and Staphylococcus aureus was isolated in 41.7% of patients. Penicillins were used in 56.3% of patients and 20.8% underwent surgery. Outcomes were full recovery (38.2%), residual symptoms or neurological deficits (50.0%), paraplegia (4.4%) and death (7.4%).

CONCLUSIONS

Poorer outcomes occurred in patients with thoracic disease, limb weakness, urinary symptoms or CES, whereas better outcomes were associated with the presence of back pain on presentation and malignancy. This analysis highlights the diagnostic and therapeutic challenges of SI, alerting clinicians to key factors associated with prognosis.

Clinical correlation and assessment of olfactory dysfunction with n-butanol in COVID-19 patients: our experience

Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.

National trends in the incidence and management of retinopathy of prematurity in the United States, 2009 -2018

BACKGROUND

Retinopathy of prematurity is a major cause of morbidity in preterm infants but population-based studies to evaluate recent trends in incidence in the United States (US) are lacking. Moreover, previous studies did not include the use of anti-Vascular Endothelial Growth Factor medications. The objective was to examine the recent secular trends in the incidence and treatment of severe retinopathy of prematurity (sROP) in the United States (US) from 2009 to 2018.

METHODS

This was a population-based, serial cross-sectional study that utilized data from the National Inpatient Sample. The inclusion criteria were preterm infants with gestational age (GA) ≤30 weeks and length of stay > 28 days. The primary outcomes were trends in ROP surgery (photocoagulation, cryotherapy, scleral buckling, vitrectomy) and intravitreal injection of therapeutic (anti-VEGF) medications. The Cochrane-Armitage test was used to evaluate trends and P-value < 0.05 was considered significant.

RESULTS

Out of 279,664 hospitalizations that met the inclusion criteria, 12,942 (4.6%) had sROP. Those with sROP were more likely to have severe intraventricular hemorrhage (12.5% vs 6.1%), bronchopulmonary dysplasia (48.2% vs 25.9%), and pulmonary hypertension (10.7% vs 4.7%). From 2009-2018, sROP significantly increased from 3.4% to 5.3% (P < 0.001), ROP surgery decreased from 36.8% to 11.9% (P < 0.001) while intra-vitreal administration of therapeutic drugs increased from 2% to 7.6% (P < 0.001).

CONCLUSION

Surgery for sROP decreased while intra-vitreal administration of therapeutic drugs increased in the setting of increasing incidence of sROP in the US. Taken together, these findings suggest a gradual practice change and the long-term outcomes of intra-vitreal agents warrants future study.

Woodfordia fruticosa extract supplementation stimulates the growth of Lacticaseibacillus casei and Lacticaseibacillus rhamnosus with adapted intracellular and extracellular metabolite pool

AIM

To investigate the effect of Woodfordia fruticosa extract (WfE) on two probiotic bacteria: Lacticaseibacillus casei and Lacticaseibacillus rhamnosus.

METHODS AND RESULTS

WfE supplementation at 0·5 and 1 mg ml^-1 stimulated probiotic growth (P < 0·05), enhanced adhesion to CaCO₂ cells (P < 0·05) while inhibiting foodborne pathogens Escherichia coli and Staphylococcus aureus (P < 0·05). ¹ H-NMR based metabolomic studies indicated higher glucose : lactate and glucose : acetate in the extracellular matrix with significant variation (P < 0·05) in intracellular concentrations of lactate, acetate, glutamate, dimethylamine, phenylalanine, branched-chain amino acids and total cellular lipid composition. Fatty acid methyl ester analysis showed a chemical shift from saturated to unsaturated lipids with WfE supplementation. PCA plots indicated clear discrimination between test groups, highlighting variation in metabolite pool in response to WfE supplementation.

CONCLUSION

Phytonutrient-rich WfE exhibited prebiotic-like attributes, and probiotic bacteria showed altered metabolite pools as an adaptive mechanism.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report providing insights into the prebiotic-like activity of WfE on gut representative probiotics. The extended metabolomic studies shed light on the positive interaction between phytonutrients and beneficial bacteria that possibly help them to adapt to a phytonutrient-rich WfE environment. WfE with potential prebiotic attributes can be used in the development of novel synbiotic functional products targeting gut microbial modulation to improve health.

Nonsurgical treatment and early return to activity leads to improved Achilles tendon fatigue mechanics and functional outcomes during early healing in an animal model

Achilles tendon ruptures are common and devastating injuries; however, an optimized treatment and rehabilitation protocol has yet to be defined. Therefore, the objective of this study was to investigate the effects of surgical repair and return to activity on joint function and Achilles tendon properties after 3 weeks of healing. Sprague-Dawley rats (N = 100) received unilateral blunt transection of their Achilles tendon. Animals were then randomized into repaired or non-repaired treatments, and further randomized into groups that returned to activity after 1 week (RTA1) or after 3 weeks (RTA3) of limb casting in plantarflexion. Limb function, passive joint mechanics, and tendon properties (mechanical, organizational using high frequency ultrasound, histological, and compositional) were evaluated. Results showed that both treatment and return to activity collectively affected limb function, passive joint mechanics, and tendon properties. Functionally, RTA1 animals had increased dorsiflexion ROM and weight bearing of the injured limb compared to RTA3 animals 3-weeks post-injury. Such functional improvements in RTA1 tendons were evidenced in their mechanical fatigue properties and increased cross sectional area compared to RTA3 tendons. When RTA1 was coupled with nonsurgical treatment, superior fatigue properties were achieved compared to repaired tendons. No differences in cell shape, cellularity, GAG, collagen type I, or TGF-β staining were identified between groups, but collagen type III was elevated in RTA3 repaired tendons. The larger tissue area and increased fatigue resistance created in RTA1 tendons may prove critical for optimized outcomes in early Achilles tendon healing following complete rupture. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2172-2180, 2016.

Expeditious Synthesis, Antimicrobial and Antimalarial Activities of Novel Heterocycles Bearing Imidazole-oxadiazole Based Hybrid Pharmacophores

A facile synthesis of 2-substituted-5-amino-oxadiazole derivatives has been achieved by refluxing/sonicating a mixture of semicarbazide with various aromatic acids in conc. sulphuric acid alone. The isolated products were further condensed with p-dimethylaminobenzaldehyde/p-hydroxybenzaldehyde to obtain respective imino derivatives. Finally, some potentially biologically active imidazole analogues were obtained by reacting ammonium acetate and 5-bromoisatin with the synthesized imino products. All the newly synthesized compounds were thoroughly characterized by standard analytical techniques. These imidazole-oxadiazole hybrid compounds were also evaluated for their antimicrobial and antimalarial activities. The compounds all exhibited moderate to significant antimicrobial activity (6-10 mm, zone of inhibition) and promising antimalarial activity (IC₅₀ 0.037-0.100 µM). This report entails a detailed synthetic procedure, spectroscopic elucidation and activities of the synthesized compounds.

In vitro vancomycin susceptibility amongst methicillin resistant Staphylococcus aureus

BACKGROUND

Vancomycin is drug of choice for treatment of Methicillin Resistant Staphylococcus aureus (MRSA) infections. S. aureus with reduced vancomycin susceptibility (SA-RVS) is on rise. Current guidelines of detection of SA-RVS are based on MIC (Minimum Inhibitory Concentration) by broth or agar dilution methods. Vancomycin MIC by E test (Epsilometer Test) is an alternative. A study was undertaken to know the prevalence of SA-RVS and compare vancomycin MIC by agar dilution and E test.

METHODS

A prospective study was undertaken at tertiary care hospital; 232 clinical MRSA isolates were included. Vancomycin MIC was undertaken by agar dilution method and E test.

RESULTS

All isolates were sensitive to Linezolid. Two MRSA isolates had vancomycin MIC ≥4 μg/ml; vancomycin MIC50 and MIC90 of MRSA isolates was 0.5 and 0.2 μg/ml respectively by agar dilution method. There was agreement over 93.5% isolates in vancomycin susceptibility by agar dilution and E test. E test had sensitivity and positive predictive value of 1.0 (CI - 0.34-1.0) and 0.5 (CI - 0.17-0.83) respectively compare to agar dilution method.

CONCLUSIONS

MRSA isolates continues to be susceptible to vancomycin and Linezolid. E test was found equally suitable in initial screening for vancomycin susceptibility. Due to geographic variation in prevalence, there is need of ongoing surveillance of SA-RVC.

Molecular detection and epidemiology of chicken infectious anaemia virus in India

Chicken infectious anemia (CIA) is an economically important disease affecting poultry, especially young chicks, characterized by poor weight gain, anemia, immunosuppression and production losses. Recent reports indicate that the virus is emerging and re-emerging worldwide.  Also, scarce reports regarding the molecular detection and epidemiology of virus from India are available. The aim of this study was to determine the prevalence of the virus in the commercial poultry farms of the country employing polymerase chain reaction (PCR). Out of the suspected 424 field samples tested from 12 different states of the country during the last five years (2007-2012), 311 (73.3%) samples were found positive for CIAV-DNA indicating the wide prevalence of the virus in India. The age wise prevalence of the virus indicated high prevalence in young chicks of up to three weeks (80.3%) of age compared to 3-7 (66.6%) and 7-12 (25%) week age groups. Being an immunosuppressive emerging pathogen circulating among the poultry flocks of the country, suitable prevention and control measures need to be adopted timely. This is a first elaborative report on the molecular epidemiology of CIAV in poultry flocks of the country. Extensive epidemiological studies are suggested to know the magnitude of the virus affecting poultry industry of the country, and design and formulate effective disease prevention and control strategies to reduce economic losses being caused by emerging virus.

Survival analysis of patients with high-grade gliomas based on data mining of imaging variables

BACKGROUND AND PURPOSE

The prediction of prognosis in HGGs is poor in the majority of patients. Our aim was to test whether multivariate prediction models constructed by machine-learning methods provide a more accurate predictor of prognosis in HGGs than histopathologic classification. The prediction of survival was based on DTI and rCBV measurements as an adjunct to conventional imaging.

MATERIALS AND METHODS

The relationship of survival to 55 variables, including clinical parameters (age, sex), categoric or continuous tumor descriptors (eg, tumor location, extent of resection, multifocality, edema), and imaging characteristics in ROIs, was analyzed in a multivariate fashion by using data-mining techniques. A variable selection method was applied to identify the overall most important variables. The analysis was performed on 74 HGGs (18 anaplastic gliomas WHO grades III/IV and 56 GBMs or gliosarcomas WHO grades IV/IV).

RESULTS

Five variables were identified as the most significant, including the extent of resection, mass effect, volume of enhancing tumor, maximum B0 intensity, and mean trace intensity in the nonenhancing/edematous region. These variables were used to construct a prediction model based on a J48 classification tree. The average classification accuracy, assessed by cross-validation, was 85.1%. Kaplan-Meier survival curves showed that the constructed prediction model classified malignant gliomas in a manner that better correlates with clinical outcome than standard histopathology.

CONCLUSIONS

Prediction models based on data-mining algorithms can provide a more accurate predictor of prognosis in malignant gliomas than histopathologic classification alone.

Mephedrone ("bath salt") pharmacology: insights from invertebrates

Psychoactive bath salts (also called meph, drone, meow meow, m-CAT, bounce, bubbles, mad cow, etc.) contain a substance called mephedrone (4-methylcathinone) that may share psychostimulant properties with amphetamine and cocaine. However, there are only limited studies of the neuropharmacological profile of mephedrone. The present study used an established invertebrate (planarian) assay to test the hypothesis that acute and repeated mephedrone exposure produces psychostimulant-like behavioral effects. Acute mephedrone administration (50-1000 μM) produced stereotyped movements that were attenuated by a dopamine receptor antagonist (SCH 23390) (0.3 μM). Spontaneous discontinuation of mephedrone exposure (1, 10 μM) (60 min) resulted in an abstinence-induced withdrawal response (i.e. reduced motility). In place conditioning experiments, planarians in which mephedrone (100, 500 μM) was paired with the non-preferred environment during conditioning displayed a shift in preference upon subsequent testing. These results suggest that mephedrone produces three behavioral effects associated with psychostimulant drugs, namely dopamine-sensitive stereotyped movements, abstinence-induced withdrawal, and environmental place conditioning.

Prevalence of chicken infectious anaemia virus (CIAV) in commercial poultry flocks of northern India: a serological survey

Globally, the chicken infectious anaemia virus (CIAV) has gained much importance as an immunosuppressive and economically important emerging pathogen of poultry. In recent years, the virus has been detected and isolated from poultry flocks of India. The present study reports the first sero-epidemiological investigation of the presence of CIAV infection in poultry flocks of the country. A total of 404 serum samples were collected from chicken flocks of eleven poultry farms, which contain a total of 0.34 million birds from four Northern states, suspected of having chicken infectious anaemia (CIA). Screening of the sera samples using a commercially available enzyme-linked immunosorbent assay (ELISA) kit revealed 351 serum samples (86.88%) to be positive for CIAV antibodies. A high CIAV prevalence rate recorded in the present investigation, along with earlier virus detection reports, indicates the widespread distribution of the virus and that CIAV should be considered an economically important poultry pathogen affecting poultry industry of India. Extensive nationwide epidemiological studies are suggested for revealing the economic impact of CIA and to initiate further research along with devising and adapting suitable prevention and control strategies especially the use of suitable vaccines for safeguarding poultry health and production in the country.

Pyridine biodegradation in a novel rotating rope bioreactor

A novel immobilised bioreactor has been developed especially for the treatment of pollutants characterized by high volatility along with high water solubility and low microbial yields. The new bioreactor referred to as the rotating rope bioreactor (RRB) provides higher interfacial area (per unit reactor liquid volume) along with high oxygen mass transfer rate, greater microbial culture stability; and consequently higher substrate loadings and removal rates in comparison to other conventional rectors for the treatment of volatile compounds. Pyridine was used as a model compound to demonstrate the enhanced performance with RRB, when compared to that reported with other conventional bioreactors. The experimental results indicate that the novel RRB system is able to degrade pyridine with removal efficiency of more than 85% at higher pyridine concentration (up to 1000 mg/l) and loading [up to 400 mg/m(2)/h (66.86 g/m(3)/h)], with a shorter hydraulic retention time (9-18 h). The reactor has been in operation for the past 15 months and no loss of activity has been observed.

Enhanced erythrocytic lipid peroxides level in rabbits after repeated parental administration of iron

An experiment was conducted in rabbits to evaluate the possible involvement of oxidative stress in iron-overload animals. Ten adult female New Zealand white rabbits were divided into 2 equal groups with 5 animals each. Group II animals received intramuscular iron dextran injections (120 mg/kg body wt/day) on alternate day for 14 days (8 injections), while Group I animals did not receive any iron supplementation to serve as negative controls. The blood samples were collected by cardiac puncture before the start of iron dosing and thereafter, at weekly intervals for 28 days. The samples were processed to measure blood iron concentration, packed cell volume, erythrocytic lipid peroxide (LPO) level, superoxide dismutase (SOD) and catalase (CAT) activities. The blood iron concentration showed a rising trend following repeated iron administration, and the mean level recorded on day 14 was significantly higher than respective day 0 value. LPO level remained significantly higher from day 14 onwards till the end of the observation period of 14 more days after cessation of iron adminstration. Erythrocytic superoxide dismutase activities showed a transient significant rise on day 7, and thereafter, showed a declining trend, but remained statistically comparable to respective day 0 or corresponding value of the control animals.

Extensive arterial and venous thrombosis in a patient with ulcerative colitis--a case report

BACKGROUND

Vascular thrombosis is a rare but well-recognized extraintestinal manifestation of ulcerative colitis. Thrombosis usually involves the peripheral veins and less commonly the cerebral veins and the arterial system.

CASE REPORT

A case of a 22-year-old woman is reported who presented with an exacerbation of ulcerative colitis and developed extensive arterial and venous thrombosis. Good clinical improvement was achieved after treatment with steroids, sulfasalazine, and anticoagulation with enoxaparin followed by long-term warfarin.

CONCLUSION

Early recognition of thrombotic complications is essential in initiating lifesaving therapy.

Downstream effects on human low density lipoprotein of homocysteine exported from endothelial cells in an in vitro system

A model system is presented using human umbilical vein endothelial cells (HUVECs) to investigate the role of homocysteine (Hcy) in atherosclerosis. HUVECs are shown to export Hcy at a rate determined by the flux through the methionine/Hcy pathway. Additional methionine increases intracellular methionine, decreases intracellular folate, and increases Hcy export, whereas additional folate inhibits export. An inverse relationship exists between intracellular folate and Hcy export. Hcy export may be regulated by intracellular S-adenosyl methionine rather than by Hcy. Human LDLs exposed to HUVECs exporting Hcy undergo time-related lipid oxidation, a process inhibited by the thiol trap dithionitrobenzoate. This is likely to be related to the generation of hydroxyl radicals, which we show are associated with Hcy export. Although Hcy is the major oxidant, cysteine also contributes, as shown by the effect of glutamate. Finally, the LDL oxidized in this system showed a time-dependent increase in uptake by human macrophages, implying an upregulation of the scavenger receptor. These results suggest that continuous export of Hcy from endothelial cells contributes to the generation of extracellular hydroxyl radicals, with associated oxidative modification of LDL and incorporation into macrophages, a key step in atherosclerosis. Factors that regulate intracellular Hcy metabolism modulate these effects.

Cryptococcal meningitis in acute lymphoblastic leukemia

The occurrence of cryptococcal meningitis in acute lymphoblastic leukemia (ALL), despite being immunosuppresed state is uncommon. We report a 28-year gentleman in the maintenance treatment phase of ALL developing cryptococcal meningitis. The diagnosis was made by positive India ink staining and detection of cryptola antigen by latex agglutination. The patient was successfully treated with amphotericin B. The rarity of this condition in ALL is briefly discussed.

Comparison of patient satisfaction after redo and primary fundoplications

BACKGROUND

Although much has been written about the results and patient satisfaction with fundoplication for the treatment of gastroesophageal reflux disease, the reports have focused primarily on surgical successes. With the growing number of fundoplications being performed, more patients are requiring reoperation because of recurrent symptoms or side effects. Reports of success rates for reoperation are available, but information regarding patient satisfaction is limited.

METHODS

All the patients undergoing fundoplication at our institution were sent short-form health surveys (SF-12), Gastroesophageal reflux disease-specific quality-of-life questionnaires (QOLRAD), and queries regarding long-term satisfaction.

RESULTS

Between November 1992 and July 2000, 221 patients (198 primary and 23 redo) underwent fundoplication. There were 19 open cases (3 primary and 16 redo). In the primary group, 173 patients underwent Nissen, 23 underwent Toupet, and 2 underwent Collis fundoplications. In the redo group, 12 patients underwent Nissen, 9 underwent Toupet, 1 underwent Collis, and l underwent Belsey fundoplications. Follow-up surveys were completed for 130 patients (112 primary and 18 redo) at a mean of 32.6 months (range, 0.8-98 months). In the primary group, 87% of the patients were satisfied with their operation, as compared with 75% in the redo group. There was a trend toward higher SF-12 mental scores (46 +/- 12 vs 40 +/- 14; p = 0.07) and QOLRAD scores (6.2 +/- 1.3 vs 5.2 +/- 2.0; p = 0.07) in the primary fundoplication group. There was a significant difference in the SF-12 physical scores between the groups (32 +/- 13 for the primary group vs 18.5 +/- 11 for the redo group; p = 0.0002). Additionally, 61% of the patients in the redo group were again using antireflux medications, whereas only 24% of the patients in the primary group were using medications again.

CONCLUSION

Gastroesophageal reflux disease symptom scores and quality-of-life scores for patients undergoing redo fundoplication are lower than the scores of patients having primary fundoplication. Quality of life is similar between primary and redo fundoplication patients in the mental component. However, redo patients do not do as well physically more than 2 years after surgery.

Bleeding ileal schwannoma

We report a case of ileal schwannoma who presented with bleeding per rectum. Three-vessel angiogram was the only diagnostic investigation, and revealed tumor blush in the mid-ileal region. On exploration, an intraluminal mass was found in the mid-ileal region along with a feeding vessel in the mesentery. Resection of the involved ileum with end-to-end anastomosis was done. Histopathology showed benign schwannoma of ileum involving the submucosa, muscularis propria and serosa.

Automated monitoring of outcomes: application to treatment of drug abuse

This paper suggests a new approach for lowering follow-up costs, improving the delivery of health care, and monitoring treatment outcomes. An automated telephone follow-up system that calls, identifies, and interviews clients is an alternative method for monitoring patients that may be both reliable and cost-effective. To test the viability of such a system, the authors monitored a patient population that has historically been shown to be difficult to follow: recovering drug users and alcoholics. Forty-two subjects were asked to call the computer and complete interviews on a weekly basis for five months. Clients answered 25 recorded questions by pressing the keys on their telephone pads. The computer automatically analyzed the clients' answers and estimated a probability of relapse for each client. In addition, the computer automatically called subjects who failed to complete interviews at the scheduled times. The study showed that self-reported data collected by a computer are as reliable as data obtained through a written questionnaire and that clients are more willing to respond to computer interviews than to mailed written questionnaires. This study also provides preliminary data on the predictive ability of a questionnaire for predicting relapse.

A unique community of family-oriented prostitutes in Nepal uninfected by HIV-1

In the Mid Western and Far Western regions of Nepal live a unique group of prostitutes which maintains strong bonds resulting from 'untouchable' caste status and family tradition. Known as the Badis (pronounced 'bod ee'), it is estimated that well over 5000 Badi prostitutes are now actively engaged in the sex trade in Nepal. In 1991, a study of some of the social and cultural practices of this unique group was completed. In addition to the provision of counselling and information about STDs and AIDS, over 300 prostitutes were interviewed about their sex practices within the Badi community. Two hundred and twenty-eight Badi prostitutes consented to voluntary confidential testing for VDRL, and 250 consented to anonymous, unlinked serosurveillance for HIV-1. As previous studies have shown moderate to high rates of HIV-1 infection among prostitutes in general, and even higher rates of infection in low class prostitutes, some prevalence of VDRL as well as HIV-1 was expected. However, of the 228 Badi prostitutes tested, 154 (70%) were found to be VDRL positive, while none were found positive for HIV-1. At the same time, many of these prostitutes reported a history of constant and often untreated STDs. The implications for the future prevention of HIV infection in this group are obvious and striking. With immediate and effective STD treatment as well as counselling, the Badis represent one high risk group in which the global AIDS epidemic could be drastically reduced, or even averted.

Duration and patterns of transmission of Theiler's mouse encephalomyelitis virus infection

The duration and patterns of Theiler's murine encephalomyelitis virus (TMEV) transmission were studied in eight index mice inoculated orally. Transmission was monitored by testing for seroconversion to TMEV in sentinel mice in direct contact with index mice and in other sentinel mice in contact with bedding soiled by index mice. For the first 14 weeks after inoculation, two contact sentinels were housed with each index mouse for 1 week, then replaced with two new sentinels. For the remaining 16 weeks, contact sentinels were changed monthly. All index mice transmitted TMEV continuously (weekly) for 4 to 9 weeks. Thereafter, six index mice transmitted virus intermittently. All index mice ceased transmitting TMEV 7 to 22 weeks post-inoculation. Results obtained from sentinel mice in contact with bedding soiled by index mice were 86% concordant with those using contact sentinel mice. Seven index mice were treated with cyclophosphamide or hydrocortisone 30 weeks post-inoculation. One cyclophosphamide treated mouse reinitiated virus shedding.

Sterol and sesquiterpenoid biosynthesis during a growth cycle of tobacco cell suspension cultures

The accumulation and biosynthesis of sterols and fungal elicitor-inducible sesquiterpenoids by tobacco (Nicotiana tabacum) cell suspension cultures were examined as a function of a 10 day culture cycle. Sterols accumulated concomitantly with fresh weight gain. The rate of sterol biosynthesis, measured as the incorporation rate of [(14)C]acetate and [(3)H]mevalonate, was maximal when the cultures entered into their rapid phase of growth. Changes in squalene synthetase enzyme activity correlated more closely with thein vivo synthesis rate and accumulation of sterols than 3-hydroxy-3-methylglutaryl CoA reductase (HMGR) enzyme activity. Cell cultures entering into the rapid phase of growth also responded maximally to fungal elicitor as measured by the production of capsidiol, an extracellular sesquiterpenoid. However, the rate of sesquiterpenoid biosynthesis, measured as the incorporation rate of [(14)C]acetate and [(3)H]mevalonate, could not be correlated with elicitor-inducible HMGR or sesquiterpene cyclase enzyme activities, nor elicitor-suppressible squalene synthetase enzyme activity.

Validation of two scoring systems which assess the degree of physiologic instability in critically ill newborn infants

Modifications of the Physiologic Stability Index (PSI) and Therapeutic Intervention Scoring System (TISS) were used to evaluate the physiologic stability and need for therapeutic intervention in 55 infants hospitalized in the newborn ICU. After modifying the PSI to reflect neonatal physiology, we found that PSI scores correlated significantly with TISS values (r = .75, p less than .001) and Nursing Utilization Management Intervention System (NUMIS) classifications (r = .62, p less than .001). TISS values also correlated with NUMIS scores (r = .72, p less than .001). PSI and TISS scores increased significantly with each increase in NUMIS classification (p less than .001 for all comparisons). PSI and TISS scores decreased significantly between admission and either discharge (n = 41) or day 14 of hospitalization (n = 14, p less than .001). PSI and TISS scores were greater on days 1 and 5 in infants with hyaline membrane disease when compared with infants with transient tachypnea (p less than .001). Infants with PSI scores greater than or equal to 4 and TISS scores greater than or equal to 7 on day 1 took significantly longer to achieve adequate protein-calorie intakes than infants with lower first-day scores (p less than .002). The modified PSI and the TISS scoring systems are both useful objective measurements of the degree of physiologic instability in newborn infants requiring intensive care, and both scores identify those at increased risk for nutritional morbidity.