Minor capsid protein of human genital papillomaviruses contains subdominant, cross-neutralizing epitopes

Vaccination with virus-like particles (VLP), comprising both L1 and L2 of human papillomavirus (HPV) genital types 6, 16, and 18, induces predominantly type-specific neutralizing antibodies. L2 polypeptide vaccines protect animals against experimental challenge with homologous papillomavirus and cross-reactive epitopes are present in HPV L2. To assess L2-specific cross-neutralization of HPV genotypes, sheep were immunized with purified, bacterially expressed HPV6, 16, or 18 L2. In addition to neutralizing the homologous HPV type in vitro, antisera to each HPV L2 also cross-neutralized both heterologous HPV types. This suggests that unlike VLP-based prophylactic HPV vaccines, an L2 polypeptide vaccine may provide broad-spectrum protection.

Vaccine potential of a herpes simplex virus type 1 mutant with an essential glycoprotein deleted

Several approaches to the production of vaccines to human herpesviruses have been proposed. Subunit vaccines, subunits delivered by live vectors, and rationally attenuated vaccines have all been shown to be efficacious in animal models but suffer from uncertainties as to the roles of individual genes involved in pathogenesis and the most relevant components of the immune response required for protection in humans and the target antigens involved. With these problems in mind, we examined the vaccine potential of a fully disabled herpes simplex virus type 1 mutant that is capable of only a single round of replication, since a virus of this type should induce the full spectrum of immune responses but has no pathogenic potential. A virus has been described which lacks essential glycoprotein H (gH) and can be propagated in a cell line which supplies gH in trans (A. Forrester, H. Farrell, G. Wilkinson, J. Kaye, N. Davis-Poynter, and T. Minson, J. Virol. 66:341-348, 1992). Infection of normal cells with this mutant is indistinguishable from a wild-type infection, except that the resulting progeny are gH negative and noninfectious: the virus is self-limiting. Infection of mice by the ear pinna route was similarly self-limiting in that input infectivity decreased rapidly at the inoculation site and no infectivity was detected in sensory ganglia. Animals given a wide range of doses of the gH-negative mutant produced both humoral and T-cell responses to herpes simplex virus type 1 and proved solidly resistant to challenge with a high dose of wild-type virus. The gH-negative mutant is presumably capable of establishing a latent infection, but since no infectious virus was detected in numerous attempts to reactivate the mutant, the risk of a pathogenic outcome is minimal.

The effects of providing preoperative statistical anaesthetic-risk information

Are patients who are provided with details about anaesthesia risks on the eve of surgery better informed, and does the information increase their anxiety? Forty (ASA Class I or II) patients scheduled for surgery requiring general anaesthesia were randomly allocated to either a routine or a detailed information group. Levels of anxiety were assessed by the Spielberger State-Trait Anxiety Inventory. Actual knowledge of risks was assessed by a special visual analogue scale. Patients had experienced an average of five previous anaesthetics and so most patients in both groups knew the risks of common complications such as nausea and sore throat and were able to represent them accurately on the visual analogue scale. The detailed group, however, had gained more accurate knowledge of the likelihood of two rare complications, death (P < 0.001) and serious tooth damage (P < 0.05). Notwithstanding, there was no difference between the groups in anxiety. Thus, provision of detailed information about the risks of the complications of general anaesthesia did increase patients' knowledge but did not increase patients' levels of anxiety.

Identification and analysis of the pseudoknot-containing gag-pro ribosomal frameshift signal of simian retrovirus-1

The pro and pol genes of simian retrovirus-1 (SRV-1) are expressed as parts of a fusion protein generated by -1 ribosomal frameshifting. To investigate the requirements for frameshifting at the gag-pro overlap, we have inserted a stretch of 58 nucleotides containing the proposed frameshift signal into a plasmid that allows monitoring of translation in all three reading frames. In vitro translation of mRNAs derived from this plasmid indicated that the 58 nucleotides from the SRV-1 gag-pro overlap were sufficient to induce an efficient -1 shift in a heterologous context. Mutational analysis demonstrated that the slip site is formed at the heptanucleotide G GGA AAC. The frameshift efficiency of the wild type sequence in rabbit reticulocyte lysate was 23%. A second component of the frameshift signal is formed by a pseudoknot seven bases downstream of the slip site. The presence of this pseudoknot was confirmed by mutational analysis, employing complementary and compensatory base changes, and by probing the structure of short RNA transcripts containing the frameshift signal. Adding increasing amounts of an SRV-1 pseudoknot containing RNA transcript to a translation reaction programmed with an SRV-1 frameshift reporter mRNA had no effect on the frameshift efficiency, arguing against the role of a specific pseudoknot-recognising factor in the frameshifting process.

Expression of human papillomavirus type 16 L1 protein in Escherichia coli: denaturation, renaturation, and self-assembly of virus-like particles in vitro

Major capsid protein L1 of HPV16 was produced in a fused form in Escherichia coli using an inducible expression system. The protein formed insoluble aggregations (inclusion bodies) and the yield was more than 10% of total cell proteins. The inclusion bodies were isolated and solubilised with 8 M urea and the L1 proteins were purified by chromatographic separation. Following removal of the urea by gradual dialysis, the denatured L1 proteins spontaneously renatured and subsequently assembled into polymorphologic aggregations in vitro. Electron microscopy showed that the assembled material included structures resembling native empty capsids as well as incompletely formed capsids. After separation from the pool of polymorphologic structures by sucrose gradient sedimentation, the correctly formed virus-like particles (VLE. coliPs) were recognised by a HPV16 type-specific, conformational-dependent monoclonal antibody in an ELISA. This system offers not only a model for investigation of the intrinsic interactions that occur during L1 assembly, but also a potential route for convenient manufacture of highly purified VLP vaccines.

Acute phase response in horses: changes in plasma cation concentrations after localised tissue injury

An acute phase reaction was elicited in four horses to which Freund's adjuvant was administered intramuscularly. The localised inflammation was accompanied by changes in the plasma concentrations of copper, iron and zinc. The plasma copper concentration, the plasma ceruloplasmin copper concentration and the ceruloplasmin oxidase activity in the plasma steadily increased to a maximum 24 days after the administration of the adjuvant. At this time, the plasma copper concentration was 2.2 micrograms/ml, a 90 per cent increase over the baseline concentration. The ratio of the concentration of plasma ceruloplasmin copper to plasma copper remained constant, indicating that the non-ceruloplasmin bound copper component of the plasma is also an acute phase reactant in the horse. The plasma zinc and iron concentrations decreased to 59 per cent and 30 per cent of their respective baseline concentrations and the severity of the inflammation appeared to influence the plasma concentrations of each metal. Weak correlations between the plasma fibrinogen concentration and the plasma copper and zinc concentrations of 25 horses with plasma fibrinogen concentrations of 5 g/litre or greater indicated that a single measurement of plasma copper concentration is not useful in the diagnosis of non-specific inflammatory disorders of the horse. However, the results suggest that the plasma copper concentrations in serial samples may be used to monitor the resolution of inflammatory disorders in the horse.

Patients' desire for information about anaesthesia: Australian attitudes

Patients in a medium-sized Australian suburban general hospital were asked to complete a pre-operative questionnaire concerning their desire for information about their impending anaesthesia. The results are compared with those of Canadian and Scottish studies published recently. The Australian patients had a higher preference for information about complications, although some patients, mainly elderly, did not want to know about unpleasant aspects of peri-operative procedures or potential complications. As in the other countries, patients under the age of 50 years had a greater desire for information than those who were older (p < 0.05). All national groups accorded highest priority to meeting the anaesthetist before surgery. The results are discussed in relationship to the requirements for informed consent.

Suppression of erythropoiesis by intrauterine transfusions in hemolytic disease of the newborn: use of erythropoietin to treat the late anemia

Hemolytic disease of the fetus and newborn has three phases of anemia: in utero, in the first week of life, and in the weeks and months after birth. Intrauterine transfusions can ameliorate the severity of both fetal and early anemia, but late anemia and the need for transfusion remain significant problems. Bone marrow hypoplasia--probably a result of suppression of erythropoiesis from the intrauterine transfusions--was documented in the three patients tested in our study. Because erythropoietin (EPO) levels have been found to be low (i.e., normal) in these previously transfused patients despite the degree of anemia, we treated four affected infants with EPO, 200 microliters/kg subcutaneously three times a week, and noted reticulocytosis and increased hemoglobin values 2 to 4 weeks later. One patient again had reticulocytopenic anemia when the EPO therapy was stopped but responded to retreatment. Our study indicates that EPO treatment may be effective in the management of late anemia and could help to decrease the need for postnatal transfusions.

Test-retest reliability of the survey form of the Leyton Obsessional Inventory-Child Version

The test-retest reliability of the survey form of the Leyton Obsessional Inventory-Child Version was examined over a 2-wk. interval. Three age groups of children participated in the study, 8- to 10-year-olds, 11- to 13-year-olds, and 14-to 16-year-olds (N = 106). For the total Obsessive scores, the test-retest Pearson correlation coefficients for the three age groups were .51, .75, and .83, respectively, which suggest that the temporal stability of the instrument is a function of age.

An efficient selection system for packaging herpes simplex virus amplicons

Due to their simplicity and flexibility of genomic construction, herpes simplex virus (HSV) amplicon-based vectors are attractive vehicles for gene delivery. However, a significant problem faced in the generation of amplicon stocks is the low amplicon to helper virus (A/H) ratio. In order to improve the proportion of amplicons generated, a selection system for amplicon production was developed in which the HSV thymidine kinase (TK) gene is inserted into an amplicon plasmid and an HSV mutant with both TK and glycoprotein H (gH) genes deleted is used as a helper virus. Using a protocol in which amplicon stocks are passaged 2-3 times in BHK cells of TK- and gH+ genotype in the presence of selection medium containing methotrexate, stock preparations with high A/H ratio (up to 5:1) and high amplicon titre (>1 x 10(9) infectious units/ml) were generated. In vitro characterization demonstrated that a high level of biologically functional products can be efficiently produced from these amplicon constructs.

Inhibition of tumor necrosis factor alpha alters resistance to Mycobacterium avium complex infection in mice

Increased production of tumor necrosis factor alpha (TNF-alpha) appears to play an important role in the progression of human immunodeficiency virus disease. One treatment strategy being explored is the use of TNF-alpha inhibitors. TNF-alpha also appears to be important in conferring resistance to infections, and the inhibition of this cytokine may exacerbate the emergence of opportunistic pathogens, such as Mycobacterium avium complex (MAC). The present study examines the possibility that inhibition of TNF-alpha will increase the progression of disease in mice infected with MAC. C57BL/6 beige (bg/bg) mice have been shown to be highly susceptible to infection with MAC and are routinely used for testing of antimycobacterial drugs. However, bg/bg mice are known to exhibit impaired phagocyte and natural killer cell function. Since these cell types are important sources of TNF-alpha, the susceptibility of the bg/bg strain to infection with MAC was compared with those of the heterozygous (bg/+) and wild-type (+/+) strains of C57BL/6 mice. The susceptibilities of the bg/bg and bg/+ strains of mice infected with MAC were found to be comparable. The +/+ strain was the least susceptible. Mycobacterial burden and serum TNF-alpha levels increased over time in all the strains of mice tested. The bg/+ strain of C57BL/6 mice was then chosen to measure the activity of TNF-alpha antagonists. Treatment with dexamethasone decreased serum TNF-alpha levels and increased mycobacterial burden. Treatment with anti-TNF-alpha antibody or pentoxifylline did not significantly alter serum TNF-alpha levels but increased mycobacterial burden. Treatment with thalidomide neither consistently altered mycobacterial burden in the spleens or livers of infected mice nor affected serum TNF-alpha levels.

Experimentally induced lactic acidosis in the goat

Lactic acidosis was produced experimentally twice in each of 4 adult, female goats, by giving sucrose orally at the rate of 18 g/kg bodyweight. Changes in pH, osmolality, lactic acid concentration, and other constituents in ruminal fluid, plasma and blood were monitored over a period of 48 h. Also changes in urinary pH and sediment were examined. To ameliorate the metabolic disturbance, calcium hydroxide and bicarbonate treatment was employed after the 24 h samples had been collected and their acid-base status determined. A feature of the disturbance in the goats was that a metabolic alkalosis preceded the onset of lactic acidosis.

Randomised clinical study: comparison of acceptability, patient tolerance, cardiac stress and endoscopic views in transnasal and transoral endoscopy under local anaesthetic

BACKGROUND

Transnasal endoscopy (TNE) with ultrathin endoscopes has been advocated as an attractive alternative, for diagnostic upper endoscopy.

AIM

To assess tolerability, acceptability and quality of TNE, in comparison with standard upper endoscopy (SOGD, standard oesophago-gastro-duodenoscopy) under local anaesthetic.

METHODS

We prospectively recruited 157 patients (83 females/74 males) mean age 57 years. The Fujinon EG530N (5.9 mm) and EG530WR (9.4 mm) endoscopes were used. The endoscopist and all patients completed detailed questionnaires regarding tolerability, acceptance and quality of endoscopy using standard visual analogue scales (VAS). Oxygen saturation (SaO2 ), heart rate (HR) and systolic blood pressure (SBP) were recorded. Quality of biopsies was evaluated.

RESULTS

Analysis included 161 procedures (TNE:79, SOGD:82) with duodenal intubation achieved in all patients. VAS scores for patient comfort were significantly better in the TNE group (7.3 vs. 5.3 respectively, P < 0.001). Twenty patients with previous experience of standard endoscopy were randomised to TNE and 19 of them (95.5%) preferred the TNE. Gagging was significantly less in the TNE group (0.12 vs. 3.41 respectively, P < 0.001). Cardiovascular stress was significantly less in the TNE group irrespective of the degree of gagging or comfort. TNE biopsies were smaller, but adequate for definitive diagnosis, similarly to standard endoscopy.

CONCLUSIONS

Transnasal endoscopy is superior to SOGD in terms of comfort and patient acceptance with significantly less cardiovascular stress. TNE can routinely be used as alternative to SOGD under local anaesthetic, for diagnosis and should be preferentially offered in cardiorespiratory compromised patients.

Fetal demise secondary to massive rhabdomyoma in the early second trimester of pregnancy

Rhabdomyoma is the most common cardiac tumor in fetuses, often associated with tuberous sclerosis complex and usually diagnosed in the third trimester of pregnancy, with a benign course in the majority of cases. The hemodynamic impact of cardiac tumor depends on the location and size of the mass and the presence of dysrhythmia (4). Fetal cardiac rhabdomyoma accounts for less than 10% of fetal demise cases (1). This report presents a case of massive cardiac rhabdomyoma filling the entire right heart with pericardial extension, leading to hydrops and subsequent fetal death in the early second trimester of pregnancy.

Obsessive-compulsive behaviour in children and adolescents: a cross-sectional Australian study

OBJECTIVE

To examine the reliability of the survey form of the Leyton Obsessional Inventory-Child Version (LOI-CV), ascertain the prevalence of self-reported obsessive-compulsive behaviour together with age and sex differences and identify the most common obsessive-compulsive behaviours and their associated level of interference.

METHODOLOGY

The survey form of the LOI-CV was administered to a large sample of children and adolescents attending regular schools. Participants were aged between 8 and 16 years (n = 1602).

RESULTS

We found the survey instrument to have adequate internal consistency and test-retest reliability. There was an age-related decline in self-reported obsessive-compulsive behaviour and girls reported a higher level of obsessive-compulsive behaviour than boys. The most common obsessive-compulsive behaviours included: repeated thoughts or words, having trouble making decisions, having to do certain things and doing things in the exact manner and having a bad conscience. For the most part, these behaviours were associated with low levels of interference. However, for a significant minority of youth (5 to 14%), these behaviours did cause problems and significantly interfered with their lives.

CONCLUSIONS

Although many obsessive-compulsive behaviours are part of normal development, they may still be problematic for some children and adolescents.

Morphine patient-controlled analgesia is superior to meperidine patient-controlled analgesia for postoperative pain

The choice between morphine and meperidine for postoperative pain is usually based on the preference of the prescriber, as few objective comparative data are available. This blind, randomized study compared the efficacy and side effects of morphine and meperidine administered by patient-controlled analgesia (PCA) for postoperative pain. One hundred two consenting patients scheduled for major abdominal surgery were randomly assigned to receive PCA with morphine (0.75, 1.0, or 1.5 mg bolus dose size) or meperidine (9, 12, or 18 mg) for pain control. Postoperative assessments included pain at rest and on sitting, nausea, unusual dreams, the Multiple Affect Adjective Check List (a measure of mood), and the trailmaking tests A and B (measures of ability to concentrate). Pain on sitting (P = 0.037) but not pain at rest (P = 0.8) was significantly less in patients receiving morphine. Meperidine use was associated with poorer performance in the trailmaking tests and a greater incidence of dryness of the mouth. Severity of nausea, mood, and incidence of unusual dreams did not differ significantly between drugs. We conclude that meperidine should be reserved for those patients in whom morphine is judged inappropriate.

Changes in respiratory function during a wilderness multisport endurance competition

OBJECTIVE

To document the changes in respiratory function seen in competitors during a typical wilderness multisport endurance event.

METHODS

A prospective observational cohort study measuring forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) at baseline, midrace, and end of race in competitors in a 105-km ski/run/cycle/paddle race held midwinter in the mountains of Victoria, Australia.

RESULTS

Twenty-five adult subjects (22 men) between 20 and 42 years of age were studied. The mean decline in FEV1 was 15.1% (95% CI 10.3-19.8) and for FVC was 13.0% (95% CI 8.1-17.9). Fourteen (56%) of the 25 subjects had a >10% decline in FEV1 and FVC, and 7 (28%) of the 25 subjects had a >20% decline. In 9 control subjects, aged between 21 and 55 years, there was no significant change in FEV1 or FVC from prerace to end of race.

CONCLUSIONS

Significant declines in FEV1 and FVC are common during wilderness multisport endurance events. The focus of future research should be the etiology, which as yet remains speculative.

Wide complex tachycardia discrimination tool improves physicians' diagnostic accuracy

BACKGROUND

Timely and accurate discrimination of wide complex tachycardias (WCTs) into ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critically important. Previously we developed and validated an automated VT Prediction Model that provides a VT probability estimate using the paired WCT and baseline 12-lead ECGs. Whether this model improves physicians' diagnostic accuracy has not been evaluated.

OBJECTIVE

We sought to determine whether the VT Prediction Model improves physicians' WCT differentiation accuracy.

METHODS

Over four consecutive days, nine physicians independently interpreted fifty WCT ECGs (25 VTs and 25 SWCTs confirmed by electrophysiological study) as either VT or SWCT. Day 1 used the WCT ECG only, Day 2 used the WCT and baseline ECG, Day 3 used the WCT ECG and the VT Prediction Model's estimation of VT probability, and Day 4 used the WCT ECG, baseline ECG, and the VT Prediction Model's estimation of VT probability.

RESULTS

Inclusion of the VT Prediction Model data increased diagnostic accuracy versus the WCT ECG alone (Day 3: 84.2% vs. Day 1: 68.7%, p 0.009) and WCT and baseline ECGs together (Day 3: 84.2% vs. Day 2: 76.4%, p 0.003). There was no further improvement of accuracy with addition of the baseline ECG comparison to the VT Prediction Model (Day 3: 84.2% vs. Day 4: 84.0%, p 0.928). Overall sensitivity (Day 3: 78.2% vs. Day 1: 67.6%, p 0.005) and specificity (Day 3: 90.2% vs. Day 1: 69.8%, p 0.016) for VT were superior after the addition of the VT Prediction Model.

CONCLUSION

The VT Prediction Model improves physician ECG diagnostic accuracy for discriminating WCTs.

Infections in Patients With Left Ventricular Assist Devices: Current State and Future Perspectives

Mechanical circulatory support is increasingly being used as bridge-to-transplant and destination therapy in patients with advanced heart failure. Technologic improvements have led to increased patient survival and quality of life, but infection remains one of the leading adverse events following ventricular assist device (VAD) implantation. Infections can be classified as VAD-specific, VAD-related, and non-VAD infections. Risk of VAD-specific infections, such as driveline, pump pocket, and pump infections, remains for the duration of implantation. While adverse events are typically most common early (within 90 days of implantation), device-specific infection (primarily driveline) is a notable exception. No diminishment over time is seen, with event rates of 0.16 events per patient-year in both the early and late periods postimplantation. Management of VAD-specific infections requires aggressive treatment and chronic suppressive antimicrobial therapy is indicated when there is concern for seeding of the device. While surgical intervention/hardware removal is often necessary in prosthesis-related infections, this is not so easily accomplished with VADs. This review outlines the current state of infections in patients supported with VAD therapy and discusses future directions, including possibilities with fully implantable devices and novel approaches to treatment.

103 The Characteristics of Frail Older Patients Admitted Through an Emergency Department, who Experience New Disability due to Acute Illness

Background

No current tool reliably predicts functional decline risk. The modified Barthel Index (mBI) is a validated measure of disability, ideal for use within an interdisciplinary assessment. The aim of this prospective cohort study was to determine the proportion and characteristics of newly admitted frail older patients who experience drops in their Barthel index, requiring intervention.

Methods

Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, were assessed using an interdisciplinary assessment tool (IAT), from February 1st 2019 to March 31st 2019. Data was entered into an excel database on demographics, baseline mBI and inpatient (within 72 hours) mBI, frailty-associated co-morbidities and multi-disciplinary interventions and analysed using Student’s T-test.

Results

150 consecutive patients were assessed with a mean age (mean (+/- SD)) of 83.1(+/- 7.4). mBI scores were recorded for 111(74%) of patients. Mean mBI prior to current illness was 15.4(+/- 4.9). Post-illness mBI was 12.5(+/- 5.3). 65(58.6%) patients experienced an mBI drop. Mean drop was 4.9 (+/- 2.8) points. There was no difference in age or baseline mobility between those who either did or did not experience an mBI drop. Patients with a drop had higher mean pre-illness mBI (16.2 vs. 14.2; p-value 0.017, 4AT score (1.98 vs. 1.11; p-value 0.035) and increased falls history (40 vs. 18 patients; p-value <0.01), compared to patients with no drop. They required more referrals to the multidisciplinary team (3.7 vs. 2.9, p-value 0.002).

Conclusion

Higher proportions of frail patients experienced a drop in function compared with studies where age is used as a cut-off. Within this small frail patient cohort, age was surprisingly not associated with mBI drops. Using frailty as the main determinant for assessment rather than age, results in a different cohort of patients, at risk of functional decline. Future predictive tools should focus on frailty rather than on age.

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

BACKGROUND

Gastrointestinal bleeding (GIB) in patients with continuous flow left ventricular assist devices (CF-LVADs) is often related to GI angiodysplasia (GIAD). We previously reported data on VEGF inhibition with IV bevacizumab in the treatment of LVAD-associated GIAD bleeding, and now present follow-up data on patients treated with IV bevacizumab and/or low-dose oral pazopanib.

METHODS

All consecutive adult patients with LVAD-associated GIB from GIAD treated with bevacizumab or pazopanib, from July 20, 2017 to June 22, 2022, were included in the analysis. Data on hospitalizations, GI endoscopic procedures, and blood transfusions were obtained from first admission for GIB up to a median of 35.7 months following treatment initiation (range 1.3-59.8 months).

RESULTS

Eleven patients (91% male, mean 69.5 ± 8.9 years) were included. Eight patients (73%) received IV bevacizumab, two patients (18%) received oral pazopanib, and one patient (9%) received bevacizumab followed by pazopanib therapy. We observed a significantly decreased number of annualized hospitalizations for GIB (median difference - 2.87, p = 0.002), blood transfusions (median difference - 20.9, p = 0.01), and endoscopies (median difference - 6.95, p = 0.007) in patients pre- and post-anti-angiogenic therapy (bevacizumab and/or pazopanib). Similarly, a significant improvement in these clinical outcomes was noted in the bevacizumab group with decreased annualized hospitalizations (median difference - 2.75, p = 0.014), blood transfusions (median difference - 24.5, p = 0.047), and number of endoscopies (median differences -6.88, p = 0.006).

CONCLUSION

Anti-angiogenic therapy with IV bevacizumab and/or low-dose oral pazopanib appears to provide benefits in patients with LVAD-associated GIB with reduced hospitalizations, blood transfusions, and need for GI endoscopic procedures.

Dynamics of urinary levels of hCG during early pregnancy and accuracy of the home pregnancy test

The paper ‘Dynamics of urinary levels of hCG during early pregnancy and accuracy of the home pregnancy test’ has been retracted at the request of the authors. Since initiating the work 3 years ago improvements have been made to home pregnancy tests, and the device used in the study is no longer commercially available. The authors are conducting a similar study with a new pregnancy test device which suggests that some of the conclusions drawn in the retracted paper could now be misleading to health professionals and consumers.