Intradermal immunization with a bovine herpesvirus-1 DNA vaccine induces protective immunity in cattle

Although intramuscular (i.m.) injection of DNA encoding glycoprotein D (gD) of bovine herpesvirus-1 (BHV-1) induces immune responses in cattle, this route of delivery is inefficient. Here we assessed three parameters that may enhance the efficacy of a gD DNA vaccine in cattle. First, the immune response generated by i.m. injected plasmid expressing a secreted form of gD (tgD) was determined and found to be very similar in magnitude to the response induced by gD-expressing plasmid. Secondly, gD- and tgD-expressing plasmids were administered by intradermal (i.d.) immunization, which resulted in a superior immune response to the secreted form, but no improvement in the response to the membrane-associated form. However, the form of gD used for immunization did not influence the immunoglobulin subtype, the ratio of antigen-specific IgG1 to IgG2 being approximately 4:1. Finally, the effect of promoter strength was assessed by replacing the Rous sarcoma virus (RSV) promoter, which was used in the original experiments, with the human cytomegalovirus immediate early promoter and first intron A (HCMV/IA). Although upon transfection in vitro the HCMV/IA promoter appeared to be stronger than the RSV promoter, there was only a 2-fold higher antibody response in vivo upon i.d. injection of cattle. Protection against virus challenge was obtained in the calves immunized i.d. with tgD-encoding plasmid, as shown by a significant reduction in weight loss, virus excretion, temperature response and clinical disease. No significant protection was observed in the animals vaccinated i.d. with the gD-expressing plasmid, which correlates with the lower level of immunity pre-challenge.

Constant force probing with and without a stent in untreated periodontal disease: the clinical reproducibility problem and possible sources of error

There is presently no satisfactory method of detecting periodontal disease activity at a specified site by means of clinical measurements. This study was designed to examine the possible sources of error with regard to probing measurement reliability. Intra-examiner reproducibility of probing measurements was studied at 766 sites in 10 patients with untreated periodontitis, using a 0.25 N hinged constant force probe (a) with a stent for guidance and landmark, and (b) without stent. The stent made little difference to overall reproducibility of probing depths, though it appeared to reduce variation in different areas. Repeated probing led to an increase in some measurements, perhaps by an effect on tissues. Reproducibility of probing depth was lower in deep pockets, and about 2% of all probing depth scores varied by 3 mm or more at the same site. 4 possible sources of measurement error were noted: visual and tactile observational error, positional error and tissue change. The results are discussed in relation to the clinical detection of periodontal disease activity.

Ileal and jejunal Peyer's patches play distinct roles in mucosal immunity of sheep

The majority of pathogens enter the body through mucosal surfaces and it is now evident that mucosal immunity can provide effective disease protection. However, the induction of mucosal immunity will require efficient targeting of mucosal vaccines to appropriate mucosa-associated lymphoid tissue. An animal model, based upon the surgical preparation of sterile intestinal 'loops' (blind-ended segments of intestine), was developed to evaluate mucosal and systemic immune responses to enteric vaccines in ruminants. The effectiveness of end-to-end intestinal anastomoses was evaluated and fetal surgery did not disrupt normal intestinal function in lambs up to 6-7 months after birth. The immunological competence of Peyer's patches (PP) within the intestinal 'loops' was evaluated with a human adenovirus 5 vector expressing the gD gene of bovine herpesvirus-1. This vaccine vector induced both mucosal and systemic immune responses when injected into intestinal 'loops' of 5-6-week-old lambs. Antibodies to the gD protein were detected in the lumen of intestinal 'loops' and serum and PP lymphocytes proliferated in response to gD protein. The immune competence of ileal and jejunal PP was compared and these analyses confirmed that jejunal PP are an efficient site for the induction of mucosal immune responses. This was confirmed by the presence of gD-specific antibody-secreting cells in jejunal but not ileal PP. Systemic but not mucosal immune responses were detected when the vaccine vector was delivered to the ileal PP. In conclusion, this model provided an effective means to evaluate the immunogenicity of potential oral vaccines and to assess the immunological competence of ileal and jejunal Peyer's patches.

Protective capacity of the Pasteurella haemolytica transferrin-binding proteins TbpA and TbpB in cattle

The transferrin-binding proteins TbpA and TbpB from Pasteurella haemolytica biotype A serotype 1 were tested for their ability to confer protection against experimental P. haemolytica infection when administered to calves in vaccine formulations containing one or both antigens. Vaccine groups included TbpB (single immunization), TbpB (two immunizations), TbpA, TbpA+TbpB and a placebo. All animals that received TbpB had measurable antibody titres against the antigen at the time of challenge, while those that received TbpA did not show an antibody response. The TbpA+TbpB group showed the best protection against experimental challenge. Protection correlated with anti-TbpB antibody levels. The enhanced protection in the TbpA+TbpB group suggests TbpA contributed to protection through the induction of a non-antibody-mediated immune response. Sera from the TbpB-immunized animals was cross-reactive with TbpBs from other P. haemolytica serotypes.

Severe thrombocytopenia and patterns of bleeding in neonates: results from a prospective observational study and implications for use of platelet transfusions

OBJECTIVE

To describe patterns of clinical bleeding in neonates with severe thrombocytopenia (ST and platelet count <60 × 10(9) L(-1)), and to investigate the factors related to bleeding.

STUDY DESIGN

Seven tertiary-level neonatal units enrolled neonates (n = 169) with ST. Data were collected prospectively on all clinically apparent haemorrhages. Relationships between bleeding, platelet count and baseline characteristics were explored through regression analysis.

RESULTS

Bleeding was recorded in most neonates with ST (138/169; 82%), including 123 neonates with minor bleeding and 15 neonates with major bleeding. The most common sites of minor bleeding were from the renal tract (haematuria 40%), endotracheal tube (21%), nasogastric tube (10%) and skin (15%). Gestational age <34 weeks, development of ST within 10 days of birth and necrotizing enterocolitis were the strongest predictors for an increased number of bleeding events. For neonates with ST, a lower platelet count was not a strong predictor of increased bleeding.

CONCLUSIONS

The majority of neonates with ST bleed, although most episodes are minor. These findings establish the importance of clinical factors for bleeding risk, rather than minimum platelet count. Further studies should assess the clinical significance of different types of minor bleed for neonatal outcomes, the predictive value of minor bleeding for major bleeding and the role of platelet transfusions in preventing bleeding.

Observation of the narrow state X(3872)-->J/psipi+pi- in pp collisions at sqaure root of s=1.96 TeV

We report the observation of a narrow state decaying into J/psipi+pi- and produced in 220 pb(-1) of p p-bar collisions at =1.96 Tesqaure root of sV in the CDF II experiment. We observe 730+/-90 decays. The mass is measured to be 3871.3+/-0.7(stat)+/-0.4(syst) MeV/c2, with an observed width consistent with the detector resolution. This is in agreement with the recent observation by the Belle Collaboration of the X(3872) meson.

Neonatal invasive fungal infection in England 2004-2010

Rates of invasive fungal infection are highest among neonates, especially those of low birthweight. This study aimed to describe the current epidemiology of invasive neonatal fungal infections in a UK neonatal infection surveillance network. From 2004 to 2010 prospective multicentre surveillance was conducted by 14 neonatal units using a web-based database. Clinicians then completed a standardized pro forma for each positive fungal blood and/or cerebrospinal fluid culture. The overall incidence was 2.4/1000 neonatal unit admissions and was highest among babies <1000 g (extreme low birthweight, 18.8/1000). Only five infants (6%) were >1500 g. The majority of infections were caused by Candida albicans (59; 69%) and Candida parapsilosis (17; 20%); 33% of infants had received antifungal prophylaxis. Known risk factors (use of central venous catheter, parenteral nutrition, previous antibiotic use) were common among cases. The attributable case fatality rate was 21% (18/84). Extreme low birthweight infants remain at highest risk of invasive fungal infection and prophylaxis should be particularly considered for this group. The number needing to receive prophylaxis to prevent one case varies significantly among units, hence unit-specific decisions are required. Further research is still needed into the optimal empiric and therapeutic strategies.

Gene expression patterns accompanying a dietary shift in Drosophila melanogaster

The ability of many organisms to switch to new hosts can be critical to their survival in the wild. However, the genetic mechanisms underlying such shifts are poorly understood. In this study, we used complementary DNA (cDNA) microarrays to ask if changes in gene expression are observed in response to a dietary shift in Drosophila melanogaster, a dietary generalist. We found significant and repeatable differential expression in a number of genes related to metabolic function and stress, suggesting that a functional genomics approach will be useful in seeking loci involved in the ability of flies to utilize different resources.

Metronidazole: a double-blind trial in untreated human periodontal disease

The effect of metronidazole was assessed in 20 subjects with untreated periodontitis, in a double-blind trial. Subjects received a 1-week course of drug or placebo immediately after baseline examination, and were reassessed 1 month and 3 months later. A 0.25 N constant force probe and darkfield microscopy were used. At 1 month, a difference was observed between the deepest individual pockets in experimental and control groups, with regard to change in probing depth and the proportions of non-motile organisms. At 3 months, differences were observed in 1-3 mm baseline pockets, where a greater proportion of control pockets increased in probing depth, and in 4-6 mm pockets, where a greater proportion of baseline bleeding pockets had ceased to bleed in the experimental group. The differences were of limited clinical significance when compared to studies where metronidazole was used as an adjunct to other therapy, and the results were equivocal with regard to the specific plaque hypothesis, since inhibition of connective tissue attachment loss was not unambiguously demonstrable.

Monitoring untreated periodontal disease

The purpose of this study was to monitor clinical attachment levels, using a constant force probe, in patients with untreated periodontal disease, and to use darkfield microscopy to monitor changes in subgingival plaque. 10 patients with untreated disease were studied over 12 weeks. The parameters measured at baseline and every 4 weeks were probing depth, attachment level and bleeding. The subgingival microflora of the deepest site in each quadrant was examined by darkfield microscopy, using a Hellber counting chamber, at baseline and 12 weeks. The subgingival plaque from any site which lost more than 2 mm clinical attachment was also sampled and the microflora examined. Analysis of the results shows that 91% of probing depths and attachment levels remained the same or within +/- 1 mm. 3.5% of probing depths and 3.7% of attachment levels became deeper by 2 mm. 6.9% of probing depths and 4.5% of attachment levels became shallower by 2 mm. Only 6 sites out of 1029 showed loss of clinical attachment greater than 2 mm. Darkfield microscopy showed no differences in the proportion of microorganisms at the 6 sites which lost more than 2 mm of clinical attachment, compared with the baseline value. A surprising result was the tendency for probing depths and attachment levels to decrease, especially in deeper pockets. This study showed that none of the parameters monitored, i.e., probing depth, attachment level, bleeding or subgingival microflora, indicated which sites would lose attachment over a 12-week period.

End-of-life care pathways as tools to promote and support a good death: a critical commentary

This paper calls into question whether and how end-of-life care pathways facilitate the accomplishment of a 'good death'. Achieving a 'good death' is a prominent social and political priority and an ideal which underpins the philosophy of hospice and palliative care. End-of-life care pathways have been devised to enhance the care of imminently dying patients and their families across care settings and thereby facilitate the accomplishment of a 'good death'. These pathways have been enthusiastically adopted and are now recommended by governments in the UK as 'best practice' templates for end-of-life care. However, the literature reveals that the 'good death' is a nebulous, fluid concept. Moreover, concerns have been articulated regarding the efficacy of care pathways in terms of their impact on patient care and close analysis of two prominent end-of-life pathways reveals how biomedical aspects of care are privileged. Nonetheless drawing on a diverse range of evidence the literature indicates that end-of-life care pathways may facilitate a certain type of 'good death' and one which is associated with the dying process and framed within biomedicine.

First measurements of inclusive W and Z cross sections from run II of the fermilab tevatron collider

We report the first measurements of inclusive W and Z cross sections times leptonic branching ratios for pp collisions at square root[s]=1.96 TeV, based on their decays to electrons and muons. The data correspond to an integrated luminosity of 72 pb(-1) recorded with the CDF detector at the Fermilab Tevatron. We test e-mu universality in W decays, and we measure the ratio of leptonic W and Z rates from which the leptonic branching fraction B(W-->lnu) can be extracted as well as an indirect value for the total width of the W and the Cabibbo-Kobayashi-Maskawa matrix element, |V(cs)|.

Measurement of prompt charm meson production cross sections in pp collisions at square root s = 1.96 TeV

We report on measurements of differential cross sections dsigma/dp(T) for prompt charm meson production in ppmacr; collisions at sqrt[s]=1.96 TeV using 5.8+/-0.3 pb(-1) of data from the CDF II detector at the Fermilab Tevatron. The data are collected with a new trigger that is sensitive to the long lifetime of hadrons containing heavy flavor. The charm meson cross sections are measured in the central rapidity region |y|</=1 in four fully reconstructed decay modes: D0-->K-pi(+), D(*+)-->D0pi(+), D+-->K-pi(+)pi(+), D(+)(s)-->phipi(+), and their charge conjugates. The measured cross sections are compared to theoretical calculations.

Validity of a hinged constant force probe and a similar, immobilised probe in untreated periodontal disease

The validity of a hinged constant force probe (0.25 N) was compared with that of a similar but immobilised instrument, using the same interchangeable tip for both (0.64 mm diameter; 2 mm divisions). 60 sites were measured on teeth which were extracted subsequently, in patients with untreated periodontal disease, and the connective tissue attachment level was used as validity criterion. The clinical measurements of both probes correlated well with each other, but they differed significantly from the post-extraction connective tissue attachment level measurements, indicating a point 1.2 mm coronally to this, on average. A companion investigation of intra-operator probing depth reproducibility with the 2 probes, was undertaken in 14 patients, at 2 visits separated by 1 week in each case. All patients had untreated periodontal disease. A difference between probes was found at the first visit, but not at the second; the immobilised probe showed a difference between visits, reducing mean probing depth slightly at the second; when the immobilised probe was used first, there was a difference between probes. Further analysis of the results indicated that there was greatest agreement between probes when the constant force probe had been used before the immobilised probe at the second visit. The results suggested that these probes indicated a point above the connective tissue attachment level, related to pocket morphology, and that there was a moderate learning effect due to operator use of the constant force probe, which modified use of the immobilised probe.

Methodologies analysing individual practice in health care: a systematic review

AIM OF THE REVIEW

The aim of the systematic review was to identify, explore and evaluate the current level of knowledge of methodologies used in comparative analyses of the individual practice of doctors, nurses and midwives.

RATIONALE

The question of how roles and responsibilities might be shared differently between professional groups in order to promote improved, cost-effective health care requires a systematic analysis of existing roles and practice. To do this effectively, knowledge of the methodologies available for such an analysis is essential.

METHODS

A systematic review of the literature published since 1989 comparing the practice of doctors, nurses and midwives was undertaken.

FINDINGS

The findings are presented in tabular format and include the following categories of published methodologies: experimental/quasi-experimental; descriptive/nonexperimental and qualitative studies. The discussion centres on a critique of quantitative methodologies used to analyse individual practice in relation to role substitution and diversification. The potential contribution of qualitative methodologies in the analysis of individual practice is discussed.

CONCLUSIONS

The authors conclude that the current level of knowledge is biased towards quantitative research. It is argued that the assessment of health care roles and responsibilities would be well served by a more balanced approach that recognizes the strengths of both quantitative and qualitative work.

A descriptive single-centre experience of the management and outcome of maternal alloantibodies in pregnancy

BACKGROUND

Haemolytic disease of the fetus and newborn (HDFN) occurs when maternal IgG alloantibodies to fetal red blood cell antigens cross the placenta, causing haemolysis in the fetus and/or neonate. After delivery, the main concern is hyperbilirubinaemia, which can cause neurological damage.

OBJECTIVES

To summarise our current management and outcome data to inform health-care professionals counselling women whose pregnancies are at risk of HDFN and to compare these data with relevant studies.

METHODS

This is a retrospective descriptive study of all high-risk pregnancies at risk of HDFN at Guy's and St. Thomas' NHS Foundation Trust (GSTFT) Maternity Unit over a 7-year period. We defined high-risk pregnancies as those in whom anti-D, anti-c, anti-K or high (>32 or doubling strength) titres of all other antibodies were identified.

RESULTS

A total of 130 pregnancies in 112 women were followed up. A single alloantibody was found in 93 pregnancies (71.5%) and multiple alloantibodies in 37 pregnancies (28.5%). Anti-D was most commonly encountered (n = 48, 36.9%), followed by anti-c (n = 31, 23.8%) and anti-E (n = 15, 11.5%). In 65 of 130 pregnancies (50%), antibody concentrations triggered scans to screen for fetal anaemia. Of 130 pregnancies, 6 (4.6%) required intrauterine transfusions, and 31 of 130 (26%) neonates required post-natal intervention. Overall, morbidity was 0.1% and mortality 0.002%.

CONCLUSIONS

This study demonstrates that morbidity and mortality caused by HDFN is minimal. These results are reassuring for women at risk of HDFN as even severely affected cases are successfully managed in most instances. Further studies are needed to identify predictors of disease severity.

Measurement of the lifetime difference between Bs mass eigenstates

We present measurements of the lifetimes and polarization amplitudes for B(0)(s)-->J/psiphi and B(0)(d)-->J/psiK(*0) decays. Lifetimes of the heavy and light mass eigenstates in the B(0)(s) system are separately measured for the first time by determining the relative contributions of amplitudes with definite CP as a function of the decay time. Using 203+/-15 B(0)(s) decays we obtain tau(L) = (1.05(+0.16)(-0.13) +/- 0.02) ps and tau(H) = (2.07(+0.58)(-0.46) +/- 0.03) ps. Expressed in terms of the difference DeltaGamma(s) and average Gamma(s), of the decay rates of the two eigenstates, the results are DeltaGamma(s)/Gamma(s) = (65(+25)(-33) +/- 1)% and DeltaGamma(s) = (0.47(+0.19)(-0.24) +/- 0.01) ps(-1).

A microfluorometric method for quantifying RNA and DNA in terrestrial insects

Evidence is accumulating for a mechanistic linkage between body phosphorus content and growth and reproduction of individual organisms, due in part to variation in allocation of resources to ribosomal RNA. Testing this connection requires reliable methods of quantifying the nucleic acid content of individual organisms. Although methods for quantifying nucleic acids are available for a wide array of organisms, adaptation of such methods for study of insects has been neglected. Sensitive stains and high throughput fluorometric measurements are now available that substantially improve past methodologies. Here we present methods for the extraction and quantification of insect RNA and DNA based on the use of N-lauroylsarcosine and sonication for extraction, the nucleases RNase and DNase, and the use of microplate fluorescent assays to quantify nucleic acids as percent of body weight in insects. We illustrate the method using Drosophila and curculionid weevils.