Improving Access to Patient Education: an Audit of Extant Educational Materials

Health information exchange between provider and patient, along with patient participation in their care (self-management), can lead to improved health outcomes. A step towards achieving better outcomes is the systematic provision of education materials to patients and caregivers throughout the cancer trajectory. An audit of patient education (PE) materials was conducted at a cancer center to identify content gaps and determine areas for future development. The PE audit was conducted in all outpatient clinics (13) and clinic-specific PE materials were identified, reviewed, and categorized by cancer type and under the following topics: About Cancer/Disease, Medical Tests and Imaging, Treatment, Symptom Management, Rehabilitation/Survivorship, General Wellbeing, Medical Device Care, Practical and Other. Four hundred forty-seven PE materials were included in the audit. Totals for each topic were summed and analyzed for education development opportunities. Results varied based on clinic and cancer type. Majority of the materials were found in the following clinics: Hematology (75), Genitourinary (74), and Gastrointestinal (57). The most common information topics were treatment (277), about cancer/disease (134), and symptom management (120). When broken down by cancer type, it was clear that while the collection of PE materials is well established for some diagnoses (e.g., 28 prostate cancer materials), there is a significant dearth in materials for others (e.g., 0 penile cancer materials). Audit results will be used to identify opportunities for future education material development. Determining cancer-specific information gaps is important in achieving equal information access for patients and caregivers, regardless of cancer diagnosis.

Identifying gaps in consumer health library collections: a retrospective review

Background:

The objective of this study was to determine if search request forms, which are used when a patron's request for information cannot be fulfilled at the time of contact with the library team, can be used to identify gaps in consumer health library collections.

Case Presentation:

Search request forms were collected from 2013 to 2020 and analyzed independently by two reviewers. Search request forms were included if they were complete and contained a record of how the request was fulfilled. Descriptive statistics were used to summarize patron characteristics. Search request forms were iteratively coded to identify themes in the data and determine if resources provided to patrons could be found within the library collection. The study team subsequently reviewed search request forms to determine reasons for identified gaps. Two hundred and forty-nine search request forms were analyzed. Six main content themes were identified: 1) understanding the cancer diagnosis, 2) cancer treatments, 3) understanding disease prognosis, 4) support during and after treatment, 5) natural health products and therapeutic effects in oncology, and 6) research literature. The majority of patrons were patients (53%). Over half (60%) of the submitted search request forms reflected collection gaps, and many (16%) contained queries for information about rare cancer diagnoses. The main reason that queries could not be satisfied was that there was limited consumer health information on the requested topics (53%).

Conclusions:

Search request forms are a useful resource for assessing gaps in consumer health library collections.

Evaluation of the scope, quality, and health literacy demand of Internet-based anal cancer information

Objectives

As there is a dearth of information about anal cancer available at cancer centers, patients often use the Internet to search for information. This is problematic, however, because the quality of information on the Internet is variable, and the health literacy demanded is higher than the average patrons’ capacity. The purposes of this study were to (1) determine the most common websites with anal cancer consumer health information, (2) identify the supportive care needs that each website addresses, and (3) evaluate the websites’ quality and health literacy demand.

Methods

Medical Subject Headings (MeSH) entry terms for “Anus Neoplasms” were used in Google Canada to identify websites. Seven domains of supportive care needs were defined using Fitch’s Supportive Care Framework for Cancer Care. Website quality was evaluated using the DISCERN tool. Health literacy demand was assessed using readability calculators, where best practice dictates a grade 6 or lower, and the Patient Education Material Assessment Tool (PEMAT) that computes a percentage score in 2 domains, understandability and actionability, with 80% being an acceptable score.

Results

Eighteen unique websites were evaluated. One website met health literacy best practices and had a “good” quality rating. Most websites addressed only 1 supportive care domain (61%), were of “fair” quality (67%), had readability scores higher than grade 6 (89%), and had PEMAT scores ranging from 41%–92% for understandability and 0–70% for actionability.

Conclusion

The information gaps on anal cancer websites warrant a need for more health literate anal cancer health information on the Internet.

Unilateral Recurrent Acute Retinal Necrosis Syndrome Caused by Cytomegalovirus in an Immune-Competent Adult

PURPOSE

To report an immune-competent patient with unilateral recurrent acute retinal necrosis syndrome caused by cytomegalovirus, and to highlight the importance of diagnostic vitreous biopsy and specific antiviral therapy in this condition.

METHODS

Case report.

RESULTS

A 75-year-old man with good general health had two episodes of acute retinal necrosis syndrome affecting his left eye. Vitreous biopsy was performed in each episode, and polymerase chain reaction analysis on the vitreous specimen was positive for cytomegalovirus and negative for varicella zoster virus and herpes simplex virus 1 and 2. On each occasion, investigations indicated past cytomegalovirus infection but no evidence of a systemic re-activation. No indication of immunodeficiency was found over a 2-year follow-up period. His management, which included systemic and intravitreal antiviral therapy, is discussed.

CONCLUSIONS

To the authors' knowledge, only two other cases of acute retinal necrosis syndrome caused by cytomegalovirus have been reported previously in immune-competent patients. This case illustrates the importance of vitreous biopsy for viral polymerase chain re-action studies in cases of acute retinal necrosis syndrome, in order to direct appropriate antiviral treatment. It also illustrates the role of an intravitreal antiviral drug that is effective against all three herpetic viruses.

Deconstructing Cancer Patient Information Seeking in a Consumer Health Library Toward Developing a Virtual Information Consult for Cancer Patients and Their Caregivers: A Qualitative, Instrumental Case Study

Background

Cancer patients and their caregivers want information about their disease and are interested in finding health information online. Despite the abundance of cancer information online, it is often fragmented, its quality is highly variable, and it can be difficult to navigate without expert-level knowledge of the cancer system. The Patient & Family Library at the Princess Margaret Cancer Centre offers a broad collection of high-quality cancer health information and staff are available to help patrons refine their questions and explore information needs that they may not have considered.

Objective

The purpose of this research study was to deconstruct patrons’ information-seeking behaviors in the library to assess the feasibility of replicating the services provided in the library through a Web app, extending the service beyond the walls of the cancer centre. The specific aims of this research were to understand (1) how patrons approach information seeking in the library (interface design), (2) how patrons communicate their informational needs (information categorization and metadata requirements), and (3) what resources are provided to address the patrons’ information needs (collection development).

Methods

We employed a qualitative, instrumental case study to deconstruct patrons’ health information-seeking behavior. The study population included patients, the librarian, and library volunteers. Ethnographic observation was conducted at the library over 3 days and key informant interviews with library staff were conducted to address the first aim. A closed card-sorting activity was conducted to address the second aim and the library shift logs and Search Request Forms (SRFs) were reviewed to address the third aim.

Results

A total of 55 interactions were recorded during the ethnographic observation and nine semistructured interviews were conducted during the key informant interviews. Seven library patron personas were identified: (1) Newbie, (2) Seasoned, (3) Direct, (4) Window Shopper, (5) Collector, (6) Information Seeker, and (7) Distressed. A total of 83 participants completed the closed card-sorting exercise. The participants’ conceptual clusters within the similarity matrix overlapped with the groupings created by the librarian, with a few differences. A total of 161 entries in the library shift log and 65 SRFs were analyzed to determine what resources were given to patrons. Most resources that patrons received were available online (61%), although almost half of these required special access (47%).

Conclusions

The study findings suggest it is possible to replicate library functions in a Web app with a few exceptions that cannot be replicated online. These elements include access to journal articles or other content behind paywalls and the librarian’s ability to encourage further discussion through empathy and active listening. Discussion with the librarian could serve to refine and predict needs through observing information seekers and to provide immediate connection to spiritual care and psychosocial support for patrons in distress.

A Diarylsulphone Non-Nucleoside Reverse Transcriptase Inhibitor with a Unique Sensitivity Profile to Drug-Resistant Virus Isolates

Structure-activity relationship evaluations with a series of diarylsulphone non-nucleoside reverse transcriptase (RT) inhibitors indicated that the steric properties of the molecule and compound lipophilicity primarily contributed to the overall level of activity of the compounds against human immunodeficiency virus type 1 (HIV-1). The most active compounds in the diarylsulphone series had an orthonitro group and yielded anti-HIV activity at sub-micromolar concentrations. Compounds of the diarylsulphone class exhibited antiviral properties similar to other members of the pharmacologic class of HIV-1 specific non-nucleoside reverse transcriptase inhibitors, including activity in a wide variety of established and primary human cells, activity against a wide variety of laboratory and clinical virus isolates, and activity when challenged at high multiplicity of infection. Synergistic inhibition of HIV-1 was observed when the diarylsulphone NSC 667952 was used with the nucleoside analogues AZT, ddl, 3TC and d4T, the protease inhibitor KNI 272 and the sulphonated dye resobene; additive effects were observed when NSC 667952 was used with the nucleoside analogue ddC and other non-nucleoside RT inhibitors. The diarylsulphones exhibited a unique sensitivity profile when evaluated against both virus isolates and purified reverse transcriptase containing non-nucleoside reverse transcriptase inhibitor resistance-engendering mutations. Unlike other members of the class of non-nucleoside compounds, NSC 667952 remained active against virus isolates with the L100I amino acid change in the RT. The compound was, however, highly sensitive to Y181C., K103N and K101E amino acid changes in the RT. The diarylsulphone selected for resistant virus populations which possessed the Y181C amino acid change in the reverse transcriptase and which exhibited enhanced sensitivity to the non-nucleoside inhibitors calanolide A and costatolide.

Extraordinary capture of a Randall's snapper Randallichthys filamentosus in the temperate south-eastern Indian Ocean and its molecular phylogenetic relationship within the Etelinae

The capture of a rarely encountered Randall's snapper Randallichthys filamentosus (female, 587 mm fork length) from the upper continental slope (c. 350 m) off the south coast of Western Australia (c. 34·5° S; 122·5° E) in January 2014 represents its first record from the temperate Indian Ocean and a southern range extension. This record suggests that spawning of this predominantly tropical species may probably be occurring in the eastern Indian Ocean, considering the extensive, and unlikely, distance the progeny would have otherwise travelled from its typical distribution in the western and central Pacific Ocean.

Real-time PCR validation of visually identified snapper Chrysophrys auratus (Sparidae) eggs

In this study, a total of 212 eggs were visually identified as snapper Chrysophrys auratus. Real-time PCR confirmed visual identification in 69% of cases but corroboration varied widely among plankton samples. The use of molecular tools to support visual identification prior to adopting daily egg production stock assessment methods should be considered.

Expression of chemokines CXCL4 and CXCL7 by synovial macrophages defines an early stage of rheumatoid arthritis

Background and objectives

For our understanding of the pathogenesis of rheumatoid arthritis (RA), it is important to elucidate the mechanisms underlying early stages of synovitis. Here, synovial cytokine production was investigated in patients with very early arthritis.

Methods

Synovial biopsies were obtained from patients with at least one clinically swollen joint within 12 weeks of symptom onset. At an 18-month follow-up visit, patients who went on to develop RA, or whose arthritis spontaneously resolved, were identified. Biopsies were also obtained from patients with RA with longer symptom duration (>12 weeks) and individuals with no clinically apparent inflammation. Synovial mRNA expression of 117 cytokines was quantified using PCR techniques and analysed using standard and novel methods of data analysis. Synovial tissue sections were stained for CXCL4, CXCL7, CD41, CD68 and von Willebrand factor.

Results

A machine learning approach identified expression of mRNA for CXCL4 and CXCL7 as potentially important in the classification of early RA versus resolving arthritis. mRNA levels for these chemokines were significantly elevated in patients with early RA compared with uninflamed controls. Significantly increased CXCL4 and CXCL7 protein expression was observed in patients with early RA compared with those with resolving arthritis or longer established disease. CXCL4 and CXCL7 co-localised with blood vessels, platelets and CD68⁺ macrophages. Extravascular CXCL7 expression was significantly higher in patients with very early RA compared with longer duration RA or resolving arthritis

Conclusions

Taken together, these observations suggest a transient increase in synovial CXCL4 and CXCL7 levels in early RA.

Detection and characterization of viruses of the genus Megalocytivirus in ornamental fish imported into an Australian border quarantine premises: an emerging risk to national biosecurity

This report documents an emerging trend of identification of Megalocytivirus-like inclusions in a range of ornamental fish species intercepted during quarantine detention at the Australian border. From September 2012 to February 2013, 5 species of fish that had suffered mortality levels in excess of 25% whilst in the post-entry quarantine and had Megalocytivirus-like inclusion bodies in histological sections were examined by PCR. The fish had been imported from Singapore, Malaysia and Sri Lanka. Ninety-seven of 111 individual fish from affected tanks of fish tested were positive for the presence of Megalocytivirus by PCR. Sequence analysis of representative PCR products revealed an identical sequence of 621 bp in all cases which was identical to a previously characterized Megalocytivirus (Sabah/RAA1/2012 strain BMGIV48). Phylogenetic analysis of available Megalocytivirus major capsid protein (MCP) sequences confirmed the existence of 3 major clades of Megalocytivirus. The virus detected in this study was identified as a member of Genotype II. The broad host range and pathogenicity of megalocytiviruses, coupled to the documented spread of ornamental fish into the environment, render this a significant and emerging biosecurity threat to Australia.

What criteria do consumer health librarians use to develop library collections? a phenomenological study

OBJECTIVES

The criteria for determining whether resources are included in consumer health library collections are summarized in institutional collection development policies (CDPs). Evidence suggests that CDPs do not adequately capture all of these criteria. The aim of this study was to describe the resource review experience of librarians and compare it to what is described in CDPs.

METHODS

A phenomenological approach was used to explore and describe the process. Four consumer health librarians independently evaluated cancer-related consumer health resources and described their review process during a semi-structured telephone interview. Afterward, these librarians completed online questionnaires about their approaches to collection development. CDPs from participating libraries, interview transcripts, and questionnaire data were analyzed. Researchers summarized the findings, and participating librarians reviewed results for validation.

RESULTS

Librarians all utilized similar criteria, as documented in their CDPs; however, of thirteen criteria described in the study, only four were documented in CDPs.

CONCLUSIONS

CDPs for consumer health libraries may be missing important criteria that are considered integral parts of the collection development process.

IMPLICATIONS

A better understanding of the criteria and contextual factors involved in the collection development process can assist with establishing high-quality consumer health library collections.

Treadmill walking effects on grip strength in young men with Down syndrome

This study was aimed at investigating the relation between grip strength and anthropometric factors and the impact of an aerobic exercise on grip strength in young men with Down syndrome (DS). This study was a pre-post design. Twelve males with DS were assigned to an exercise group, who walked using an incremental protocol on a treadmill for 20 min at aerobic levels. Eight additional persons with DS were assigned to an attentional control group, who watched a video. Measure of grip strength was tested pre- and post-interventions. The results showed positively significant relationship among grip strength and age (r=.74, p<.01), weight (r=.52, p=.02), body mass index (r=.61, p=.01) and waist circumference (r=.54, p=.02). In addition, Grip strength was slightly improved after exercise (p=.03) but decreased after control condition. The results showed that anthropometric factors, such as age, weight, body mass index and waist circumference, were positively correlated with grip strength in young men with DS. Further, improvement in grip strength can be found even after a single exercise session. This finding emphasizes the importance of maintaining an active lifestyle in persons with DS for performing activities of daily living.

Expression of FcRL4 defines a pro-inflammatory, RANKL-producing B cell subset in rheumatoid arthritis

Objectives

The success of B cell targeting therapies has highlighted the importance of B cells in rheumatoid arthritis pathogenesis. We have previously shown that B cells in the RA synovium are capable of producing pro-inflammatory and bone-destructive cytokines including RANKL. Here we sought to characterise the nature and functional relevance of the RANKL-producing B cell subset in the RA synovium.

Methods

Synovial fluid and peripheral blood B cells from patients with RA were analysed by flow cytometry for markers of B cell differentiation and activation and for chemokine receptors. FcRL4⁺ and FcRL4⁻ B cells sorted from synovial fluid were analysed for cytokine expression using Taqman low-density arrays. Synovial tissue biopsies obtained from patients with RA were analysed by immunofluorescence for CD20, RANKL and FcRL4. FCRL4 mRNA expression was determined in synovial tissue of RA patients and non-inflammatory control subjects by real-time PCR.

Results

RANKL-producing B cells in RA synovial tissue and fluid were identified as belonging to a distinct subset of B cells defined by expression of the transmembrane protein FcRL4. FcRL4+ B cells express a distinct combination of cytokines and surface proteins indicating a function distinct from that of FcRL4− B cells. Notably, FcRL4+ B cells expressed high levels of TNF-α and RANKL mRNA.

Conclusions

We have identified a novel pro-inflammatory B cell population in the RA synovium which is defined by expression of FcRL4 and responsible for RANKL production. This B cell population expresses high levels of CD20, and its removal by rituximab may contribute to the anti-inflammatory effect of this drug.

Development and validation of a range of endogenous controls to support the implementation of practical Taqman real-time PCR-based surveillance for fish diseases within aquaculture

The use of Taqman real-time PCR-based technology has recently become more frequent in the detection of pathogens in the aquaculture industry. This interest has necessitated the development of robust and reliable pathogen-detection assays. The development of a range of endogenous control assays to be run alongside these diagnostic assays works to further increase confidence in the latter. This study describes the design of a range of endogenous control assays based on the elongation factor 1-α (EF1-α) gene specific to a range of fish species including Atlantic salmon, Salmo salar; rainbow trout, Oncorhynchus mykiss; brown trout, Salmo trutta; cod, Gadus morhua; haddock, Melanogrammus aeglefinus; saithe, Pollachius virens; whiting, Merlangius merlangus; Norway pout, Trisopterus esmarkii; carp (family Cyprinidae), roach, Rutilus rutilus; European eel, Anguilla anguilla; and herring, Clupea harengus, as well as a number of fish cell lines. Evidence is provided of the validation of these assays for specific species, a range of tissue types and cell lines as well as an example of the potential uses of these assays.

Tendon regeneration and repair with stem cells

The use of stems cells in tendon repair is of particular interest given the frequency of tendon injuries worldwide together with the technical difficulty often encountered when repairing or augmenting tendons. Stems cells have the capability to differentiate into a variety of different cell types including osteocytes and tenocytes, and if normal architecture of damaged tendon (either macroscopic or microscopic) could be restored, this would significantly improve the management of patients with these injuries. There is already encouraging research on the use of stems cells clinically although considerable further work is required to improve knowledge and clinical applications of stem cells in tissue engineering.

Interferon response following infection with genetically similar isolates of viral haemorrhagic septicaemia virus (VHSV) exhibiting contrasting virulence in rainbow trout

Isolates of viral haemorrhagic septicaemia virus (VHSV) were identified which are genetically similar yet, based on their isolation history were considered likely to differ in virulence in juvenile rainbow trout. An experimental infection study was performed in order to verify this hypothesis and provide an experimental infectivity model with which to investigate the basis for susceptibility of rainbow trout to this commercially important virus. Significant differences in mortality were obtained following both intraperitoneal (IP) injection and immersion challenges with an early marine (DK-M.Rhabdo) and early rainbow trout VHSV isolate (DK-F1) respectively. Expression of Type I IFN, Mx1 (an IFN-inducible protein), and viral genes (encoding nucleo-, phospho-, matrix, glyco- and non-viron proteins) was studied in sequential tissue samples using real-time quantitative PCR (QPCR). Resulting data revealed a significant increase in IFN and Mx1 expression detected in fish challenged by IP injection with both isolates. Expression levels of these genes were directly related to the degree of viral replication as measured by the expression of VHSV RNAs. In immersion-challenged fish a significant increase in Mx1 was observed only when using the virulent isolate DK-F1; however no elevated host response was detectable in fish challenged with the marine isolate DK-M.Rhabdo. Quintessentially the inability to detect any virus in trout challenged with the marine isolate via immersion suggests the virus was incapable of establishing infection. The mechanisms for this appear to be more related to initial cellular entry and replication rather than due to the overcoming of initial infection via an elevated host innate immune response.

Application of a sensitive, specific and controlled real-time PCR assay to surveillance indicates a low prevalence of viral haemorrhagic septicaemia virus (VHSV) in wild herring, Clupea harengus L., in Scottish waters

Surveillance data on the distribution of viral haemorrhagic septicaemia virus (VHSV) in the North Sea (UK), targeting Atlantic herring in areas with previous virus detection, were obtained from research cruises conducted during 2005. The sensitive molecular approach of real-time RT-PCR (qRT-PCR) was applied alongside a newly developed endogenous positive control assay specific for herring (elongation factor 1α) to ensure integrity of template. Three hundred and five pools from 1937 individual herring were tested, and no evidence of VHSV in association with wild Atlantic herring was detected. Samples were obtained from Scottish waters where marine aquaculture is conducted. The results confirm that previous tissue culture studies have most likely not significantly underestimated the prevalence of carrier herring in this area. The significance of migratory species such as herring as a reservoir species for VHSV, with the potential to translocate virus genotypes between geographical areas, is discussed.

Histology, immunocytochemistry and qRT-PCR analysis of Atlantic salmon, Salmo salar L., post-smolts following infection with infectious pancreatic necrosis virus (IPNV)

Infectious pancreatic necrosis (IPN) is a very serious viral disease in terms of its impact on production of Atlantic salmon, Salmo salar L., fry and post-smolts. Post-smolts of Atlantic salmon were injected with infectious pancreatic necrosis virus (IPNV) and cohabited with naive fish to produce natural infection. Cohabitant fish were sampled every 2 days, up to day 36 post-infection (p.i.). From 90 cohabitant fish, 11 (12.2%) were positive by immunohistochemistry (IHC). The first detection of IPNV by IHC occurred on day 16 p.i. which coincided with the onset of mortality in this group. Besides the pancreas, the liver was found to be a key target organ for IPNV. For the first time, the virus was observed in the islets of Langerhans and in the kidney corpuscles of Stannius which suggests that the virus could affect the fish's metabolism. The liver of two fish, which showed the most widespread presence of IPNV by IHC, had a pathology including focal necrosis and widespread presence of apoptotic hepatocytes, many of which did not stain for virus by IHC. Up-regulation of cytokine gene expression was found only in the IHC-positive (IHC+ve) fish and reflected the level of infection as determined by IHC positivity of the liver. In most fish, interferon (IFN), Mx, γIFN and γIP were up-regulated in liver and kidney, while only IFN and Mx were up-regulated in gill. IL1β and TNFα were not induced in any tissue. The gill showed variable levels of constitutive expression of IL1β and γIFN. The two fish with liver pathology had the highest level of IFN expression, especially relative to the level of Mx expression, in the liver compared with the other IHC+ve fish which did not have a liver pathology. The results suggest that following widespread infection of hepatocytes, the cells may over-produce IFN, resulting in apoptosis of neighbouring cells with subsequent death from liver failure.

Detection of salmonid alphavirus RNA in wild marine fish: implications for the origins of salmon pancreas disease in aquaculture

Salmonid alphaviruses (SAVs), which include the aetiological agents of salmon pancreas disease (SPD) in farmed Atlantic salmon Salmo salar L. and sleeping disease (SD) in rainbow trout Oncorhynchus mykiss (Walbaum), are significant viral pathogens of European salmonid aquaculture. SAV is horizontally transmitted and the virus can survive for extended periods in seawater. A lack of convincing evidence for vertical transmission coupled to the fact that the SPD virus (SPDV) occurs in historically infected sites irrespective of fallow period duration suggests that a substantial reservoir of infection exists in the marine environment. We used a highly sensitive real-time PCR (qPCR) assay targeting a region of the SAV nsP1 gene to screen wild marine fish species for the presence of SAV in an attempt to identify such a potential reservoir. Screened fish species were caught in the vicinity of aquaculture activity in an area with a previous history of SAV infection (Shetland Isles, Scotland). SAV RNA was detected in internal organs (kidney and heart) from the flatfish species common dab Limanda limanda, long rough dab Hippoglossoides platessoides, and plaice Pleuronectes platessa. Based on these findings, sampling was extended to an area remote from aquaculture activity (Stonehaven Bay, NE coast of Scotland) from where heart tissues obtained from common dab also tested positive. While no virus could be cultivated from these samples, qPCR detections were shown to be SAV-specific by sequencing of an alternative gene region (E2) to that targeted by the qPCR assay. Analysis of these nucleotide sequences revealed minor differences to those previously obtained from farmed salmon, and subsequent phylogenetic analysis of an E2 dataset demonstrated a subtype V-like sequence.

Identifying potential virulence determinants in viral haemorrhagic septicaemia virus (VHSV) for rainbow trout

We identified viral haemorrhagic septicaemia virus (VHSV) isolates classified within Genotype Ib which are genetically similar (>99.4% glycoprotein amino acid identity) yet, based on their isolation history, were suspected to differ in virulence in juvenile rainbow trout. The virulence of an isolate recovered in 2000 from a viral haemorrhagic septicaemia disease episode in a marine rainbow trout farm in Sweden (SE-SVA-1033) was evaluated in juvenile rainbow trout via intraperitoneal injection and immersion challenge alongside 3 isolates recovered from wild-caught marine fish (DK-4p37, DK-5e59 and UKMLA98/6HE1) suspected of being of low pathogenicity to trout. Mortality data revealed that isolate SE-SVA-1033 caused VHSV-specific mortality in both intraperitoneal and immersion challenges (75.0 and 15.4%, respectively). The remaining Genotype Ib isolates caused significantly lower mortalities using the same experimental infection routes (<35.0 and <2.0%, respectively). Having identified VHSV isolates with clear differences in their pathogenicity, coding and inter-genic non-coding regions of 2 isolates (SE-SVA-1033 and DK-4p37) were determined and compared in order to identify potential markers responsible for the observed differences in virulence. Only 4 predicted amino acid substitutions were identified across the genome sequenced; these occurred in the N (R46G), G (S113G), NV (L12F) and L (S56A) proteins. These findings form the basis for further studies aimed at determining the biological significance of these mutations and suggest that small changes at the molecular level can cause significant changes in the virulence properties of VHSV isolates.

FishPathogens.eu/vhsv: a user-friendly viral haemorrhagic septicaemia virus isolate and sequence database

A database has been created, http://www.FishPathogens.eu, with the aim of providing a single repository for collating important information on significant pathogens of aquaculture, relevant to their control and management. This database will be developed, maintained and managed as part of the European Community Reference Laboratory for Fish Diseases function. This concept has been initially developed for viral haemorrhagic septicaemia virus and will be extended in future to include information on other significant aquaculture pathogens. Information included for each isolate comprises sequence, geographical origin, host origin and useful key literature. Various search mechanisms make it easy to find specific groups of isolates. Search results can be presented in several different ways including table-based, map-based and graph-based outputs. When retrieving sequences, the user is given freedom to obtain data from any selected part of the genome of interest. The output of the sequence search can be readily retrieved as a FASTA file ready to be imported into a sequence alignment tool of choice, facilitating further molecular epidemiological study.

An experimental investigation on aspects of infectious salmon anaemia virus (ISAV) infection dynamics in seawater Atlantic salmon, Salmo salar L

This study investigated infection dynamics of infectious salmon anaemia virus (ISAV) by conducting two experiments to examine minimum infective dose and viral shedding of ISAV. In terms of minimum infective dose, the high variability between replicate tanks and the relatively slow spread of infection through the population at 1 x 10(1) TCID(50) mL(-1) indicated this dose is approaching the minimum infective dose for ISAV in seawater salmon populations. A novel qPCR assay incorporating an influenza virus control standard with each seawater sample was developed that enabled the quantity of ISAV shed from infected populations to be estimated in values equivalent to viral titres. Viral shedding was first detected at 7 days post-challenge (5.8 x 10(-2) TCID(50) mL(-1)kg(-1)) and rose to levels above the minimum infective dose (4.2 x 10(1) TCID(50) mL(-1)kg(-1)) on day 11 post-challenge, 2 days before mortalities in ISAV inoculated fish started. These results clearly demonstrate that a large viral shedding event occurs before death. Viral titres peaked at 7.0 x 10(1) TCID(50) mL(-1)kg(-1) 15 days post-infection. These data provide important information relevant to the management of ISA.

Development of a widely applicable positive control strategy to support detection of infectious salmon anaemia virus (ISAV) using Taqman real-time PCR

Real-time PCR assays are being increasingly applied to the detection of fish pathogens due to their sensitivity, specificity and potential for high throughput sample processing. Such assays allow for the ready and efficient inclusion of appropriate quality controls which are fundamental to scientific integrity and to satisfying the demands of diagnostic test accreditation. In this article, we report development of a universal positive control strategy for real-time PCR assays, which has been used to support and improve a previously published method for detection of infectious salmon anaemia virus (ISAV). The strategy employed uses an RNA mimic template, which is based on the ISAV segment 8 target sequence but includes an artificial universal positive control sequence. Inclusion of this sequence, which is targeted by a second specific probe carrying a different fluorophore to the primary assay, allows for convenient screening of all real-time PCR reactions for the presence of contaminating positive control material. The development of readily distinguishable artificial positive control material offers distinct advantages to real-time PCR assays over using control material derived from clinical material.

Antiperspirant compositions based on titanium salts

Antiperspirant compositions have traditionally relied upon aluminium-based active compounds to reduce sweating. Titanium is a physiologically inert metal, and titanium metal chelates appear to induce superficial physical pore blockage to provide effective antiperspirancy in a variety of product types. Titanium metal chelates can be formed from titanium alkoxides and organic acids. Conflicting opinions as to the salt structure exist and, in the case of part-neutralized ammonium titanium lactate (ATL) salt, evidence has been seen for a range of ligands bound to different strengths at different stages of hydrolysis. Aluminium is thought to work by ductal diffusion to give antiperspirancy via neutralization to a polymeric, relatively superficial gel obstruction. ATL mimics conventional alumiunium salts in that it is mainly a topical antiperspirant active, with ATL-treated skin restored to normal patterns of sweating activity after a few tape-strips. Under acidic and near-neutral pH conditions, the ATL active is relatively stable to hydrolysis and can be formulated into topical compositions as either an aqueous solution of the active or as a free-flowing powder in anhydrous systems. When judged by an in vitro efficacy technique which is thought to predict in vivo performance, ATL functions as an effective antiperspirant.

Expression of Mx protein in tissues of Atlantic salmon post-smolts--an immunohistochemical study

A rabbit antiserum was produced from a 12-amino acid long peptide common to the 3 known isoforms of Atlantic salmon Mx proteins. The antibody stained ASK-1 cells 48h after stimulation with poly I:C. In Western blots of these cells, the antibody stained a doublet with MW about 75kDa and another band at about 65kDa, typical of the MW of Atlantic salmon Mx. Western blots of kidney from IPNV-injected salmon showed a similar staining pattern. In immunohistochemistry, the antibody stained the gill, kidney and liver tissue of a fish infected with IPNV by cohabitation. These tissues also expressed high levels of interferon (IFN) and Mx transcripts as determined by real-time qRT-PCR. Normal healthy salmon post-smolts sampled at 4-8 weeks after transfer to sea water had very low-level expression of IFN and Mx transcripts. However, at 4 and 5 weeks after sea water transfer the gill, kidney and liver of these fish stained strongly for Mx protein. Thereafter, immunostaining of Mx markedly diminished in all tissues, persisting weakly in the gill. It has been reported that Atlantic salmon smolts constitutively express IFN and Mx transcripts around the time of smolting. Presumably the Mx protein detected in the tissues for about 6 weeks after transfer to sea water resulted from such a transcriptional event. As Mx is known to provide protection against IPNV infections it is tempting to associate the duration of persistence of Mx protein with the outbreaks of IPN-related mortalities in post-smolts, 6-8 weeks after transfer to sea water.

Expression kinetics of ISG15 and viral major capsid protein (VP2) in Atlantic cod (Gadus morhua L.) fry following infection with infectious pancreatic necrosis virus (IPNV)

Atlantic cod fry (1g) were infected by intraperitoneal injection with IPNV and samples of liver were taken every second day from four fish up to day 21. Samples were analysed for levels of viral transcripts by real time RT-PCR and the induction of expression of interferon stimulated gene 15 (ISG15) transcripts were estimated by conventional RT-PCR relative to beta-actin. Mortality of over 40% occurred in infected groups between day 6 and 12 after infection. Levels of viral transcripts were low on day 1, rose on day 3, peaked on day 5 remaining high till day 13, and thereafter declined to low levels by day 21. The highest levels of viral transcripts, therefore, coincided with the onset and duration of mortality, but low levels persisted in surviving fish. ISG15 transcripts in control fish were detectable at low levels. Following infection with IPNV there was a marked increase in transcripts on day 3 and this level persisted up to day 21. This is the first report that IPNV induces the expression of the ISG15 gene in Atlantic cod.

Expression of interferon type I and II, Mx and gammaIP genes in the kidney of Atlantic salmon, Salmo salar, is induced during smolting

The expression in kidney tissue of interferon type I (IFNalpha) and type II (IFNgamma) genes and two of their inducible genes, Mx and gammaIP were monitored, using qRT-PCR, in a population of Atlantic salmon prior to and over the period of smolting and sea water transfer. The smolting process was induced by photoperiod manipulation in October and smolts were transferred to sea water in December. Prior to extending the light period in October, the fish showed extremely low level expression of the genes assayed. However, immediately on extending the light and up until 1 week after transfer to sea water, 26 of the 90 fish sampled showed up-regulated expression for IFNalpha, Mx and gammaIP. The highest levels were shown by two fish on the 2 days prior to sea water transfer. Eleven fish displayed elevated expression of IFNgamma but there was no apparent association with smolting or sea water transfer or expression of the other genes. At the end of the sampling period, 30 fish were tested by standard virological methods and found to be virus free. The results indicate that during the smolting process, Atlantic salmon consititutively express IFNalpha and Mx mRNA. Those individuals which express Mx close to the time of transfer to sea water would be expected to have high levels of the anti-viral Mx protein in tissues for the longest time after sea water transfer. This could provide an innate defence against viral pathogens which post-smolts may encounter for the first time on entering the marine environment. Those individuals which express Mx early in the smolting process may be more at risk of developing IPN or other viral diseases as post-smolts.

Can carotid ultrasound predict plaque histopathology?

AIM

European and North American studies have confirmed the benefits of carotid endarterectomy for patients with symptomatic carotid artery stenoses >70%. However, the management of asymptomatic patients and those with lesser degrees of stenosis is less certain. Several studies have suggested that, for these subgroups, the targeting of potentially unstable plaques, may help to identify those most at risk of cerebrovascular accidents and thus most likely to benefit from surgery. The aim of this study was to correlate the ultrasound features of carotid artery stenosis with the histopathological findings of the carotid endarterectomy specimens in order to identify features which will allow preoperative identification of clinically unstable plaques.

METHODS

Sixty consecutive patients with symptomatic, critical carotid stenosis were prospectively studied. Plaques were classified preoperatively into one of five types based on their echogenicity and were also assessed for irregularity and ulceration. These findings were then compared with the histopathological findings of the endarterectomy specimen.

RESULTS

Of 33 plaques considered on ultrasound to be uniformly or predominantly echolucent (unstable), 27 were found to be largely fatty or haemorrhagic (PPV =82%). Of 17 plaques considered to be predominantly echogenic (stable) on ultrasound, 11 were found to be predominantly fibrotic (PPV = 65%). Correlation between ultrasound irregularity or ulceration and histopathology was poor.

CONCLUSION

In routine clinical practice, ultrasound can identify with reasonable accuracy, plaques that are predominantly haemorrhagic or fatty, and therefore potentially unstable. This may have future implications in selection of patients for surgery.

Expression kinetics of interferon and interferon-induced genes in Atlantic salmon (Salmo salar) following infection with infectious pancreatic necrosis virus and infectious salmon anaemia virus

Infectious pancreatic necrosis virus (IPNV) and infectious salmon anaemia virus (ISAV) are economically important pathogens of the salmonid aquaculture industry. Atlantic salmon were challenged by intraperitoneal injection (i.p.) with either virus followed by time-course sampling. Cohabiting fish in the IPNV challenge were also sampled. Kidney tissue was analysed using a TaqMan real-time PCR assay to measure the expression of a range of host immune genes in relation to the endogenous control, elongation factor 1 alpha (ELF). Host genes measured included Mx, type I and type II interferon (IFN), gammaIFN induced protein (gammaIP), interleukin-1 beta (IL-1beta) and tumour necrosis factor alpha (TNF-alpha). Viral levels were also measured. In i.p. injected fish, both viruses greatly induced expression of Mx, gammaIP, type I and type II IFN by day 6 post-infection, however only ISAV caused substantial mortality. Some differences between the expression kinetics produced by both viruses were noted. Infection with ISAV increased IL-1beta expression following day 6, but no effect was seen in fish infected with IPNV. Neither virus induced TNF-alpha expression. This study confirms the presence of both type I and type II IFN responses and their induced genes in Atlantic salmon upon infection with an orthomyxovirus and a birnavirus.

Expression of Mx mRNA following infection with IPNV is greater in IPN-susceptible Atlantic salmon post-smolts than in IPN-resistant Atlantic salmon parr

The Mx response was compared in parr and post-smolt Atlantic salmon following intra-peritoneal injection of the same dose of Infectious Pancreatic Necrosis Virus (IPNV) per g of fish. Mx gene expression, measured by quantitative RT-PCR in liver, showed a maximum level 3days after injection in parr with undetectable levels on day 7. In post-smolts, similar levels as in parr were attained on day 3, but levels then continued to rise on day 5 and 7 to about 10 times higher than the peak level in parr. Poly I:C injected parr showed Mx levels similar to IPNV injected post-smolts. Mortality from IPN in post-smolts occurred on days 6 and 7. Levels of IPN VP2 transcripts in parr were very low and did not increase with time, suggesting viral replication was low. Individual variation in levels of Mx and IPN VP2 gene transcripts was very high in post-smolts and although data is limited there was an inverse relationship between the levels of Mx and VP2, suggesting that individuals with high Mx levels on day 5 may be able to prevent viral replication. This contrasts with the response in parr, where IPN-resistance was not associated with a high Mx response.