Overexpression of HvCslF6 in barley grain alters carbohydrate partitioning plus transfer tissue and endosperm development

In cereal grain, sucrose is converted into storage carbohydrates: mainly starch, fructan, and mixed-linkage (1,3;1,4)-β-glucan (MLG). Previously, endosperm-specific overexpression of the HvCslF6 gene in hull-less barley was shown to result in high MLG and low starch content in mature grains. Morphological changes included inwardly elongated aleurone cells, irregular cell shapes of peripheral endosperm, and smaller starch granules of starchy endosperm. Here we explored the physiological basis for these defects by investigating how changes in carbohydrate composition of developing grain impact mature grain morphology. Augmented MLG coincided with increased levels of soluble carbohydrates in the cavity and endosperm at the storage phase. Transcript levels of genes relating to cell wall, starch, sucrose, and fructan metabolism were perturbed in all tissues. The cell walls of endosperm transfer cells (ETCs) in transgenic grain were thinner and showed reduced mannan labelling relative to the wild type. At the early storage phase, ruptures of the non-uniformly developed ETCs and disorganization of adjacent endosperm cells were observed. Soluble sugars accumulated in the developing grain cavity, suggesting a disturbance of carbohydrate flow from the cavity towards the endosperm, resulting in a shrunken mature grain phenotype. Our findings demonstrate the importance of regulating carbohydrate partitioning in maintenance of grain cellularization and filling processes.

Design and development of the BD Odon DeviceTM : a human factors evaluation process

OBJECTIVE

To (1) determine how intended users interact with and use the BD Odon Device in simulation, (2) use these findings to alter progressively the design of the BD Odon Device and (3) validate that these changes have improved the ability of practitioners to use the BD Odon Device.

DESIGN

Human factors evaluation study.

SETTING

Simulation suite designed to mimic delivery room.

POPULATION OR SAMPLE

Three hundred and ninety simulated operative births, performed by 100 practising clinicians.

METHODS

Simulated operative vaginal births performed using the BD Odon Device and the device Instructions for use were subjected to three formative human factors evaluations and one human factors validation test. Following each evaluation, findings were reviewed and the design of the BD Odon Device and Instructions for use were modified.

MAIN OUTCOME MEASURES

Successful performance of an operative vaginal birth using the BD Odon Device in accordance with provided training and Instructions for use.

RESULTS

Using version two of the BD Odon Device, and following exposure to face-to-face training and written instructions, 25% of accouchers were able successfully to perform a simulated operative vaginal birth. In the final evaluation, following device design and training material alterations, all accouchers were able successfully to perform a simulated operative vaginal birth using version four of the BD Odon Device.

CONCLUSIONS

Human factors evaluations have enabled a multi-professional device and training materials design team to alter the design of the BD Odon Device and the Instructions for use in an evidence-based fashion. This process has resulted in a device which has a predictable and likely safe pattern of use.

TWEETABLE ABSTRACT

Human Factors evaluations help make the BD Odon Device safe and usable for clinical practice.

Method for hull-less barley transformation and manipulation of grain mixed-linkage beta-glucan

Hull-less barley is increasingly offering scope for breeding grains with improved characteristics for human nutrition; however, recalcitrance of hull-less cultivars to transformation has limited the use of these varieties. To overcome this limitation, we sought to develop an effective transformation system for hull-less barley using the cultivar Torrens. Torrens yielded a transformation efficiency of 1.8%, using a modified Agrobacterium transformation method. This method was used to over-express genes encoding synthases for the important dietary fiber component, (1,3;1,4)-β-glucan (mixed-linkage glucan), primarily present in starchy endosperm cell walls. Over-expression of the HvCslF6 gene, driven by an endosperm-specific promoter, produced lines where mixed-linkage glucan content increased on average by 45%, peaking at 70% in some lines, with smaller increases in transgenic HvCslH1 grain. Transgenic HvCslF6 lines displayed alterations where grain had a darker color, were more easily crushed than wild type and were smaller. This was associated with an enlarged cavity in the central endosperm and changes in cell morphology, including aleurone and sub-aleurone cells. This work provides proof-of-concept evidence that mixed-linkage glucan content in hull-less barley grain can be increased by over-expression of the HvCslF6 gene, but also indicates that hull-less cultivars may be more sensitive to attempts to modify cell wall composition.

Prospecting for Energy-Rich Renewable Raw Materials: Sorghum Stem Case Study

Sorghum vegetative tissues are becoming increasingly important for biofuel production. The composition of sorghum stem tissues is influenced by genotype, environment and photoperiod sensitivity, and varies widely between varieties and also between different stem tissues (outer rind vs inner pith). Here, the amount of cellulose, (1,3;1,4)-β-glucan, arabinose and xylose in the stems of twelve diverse sorghum varieties, including four photoperiod-sensitive varieties, was measured. At maturity, most photoperiod-insensitive lines had 1% w/w (1,3;1,4)-β-glucan in stem pith tissue whilst photoperiod-sensitive varieties remained in a vegetative stage and accumulated up to 6% w/w (1,3;1,4)-β-glucan in the same tissue. Three sorghum lines were chosen for further study: a cultivated grain variety (Sorghum bicolor BTx623), a sweet variety (S. bicolor Rio) and a photoperiod-sensitive wild line (S. bicolor ssp. verticilliflorum Arun). The Arun line accumulated 5.5% w/w (1,3;1,4)-β-glucan and had higher SbCslF6 and SbCslH3 transcript levels in pith tissues than did photoperiod-insensitive varieties Rio and BTx623 (<1% w/w pith (1,3;1,4)-β-glucan). To assess the digestibility of the three varieties, stem tissue was treated with either hydrolytic enzymes or dilute acid and the release of fermentable glucose was determined. Despite having the highest lignin content, Arun yielded significantly more glucose than the other varieties, and theoretical calculation of ethanol yields was 10 344 L ha-1 from this sorghum stem tissue. These data indicate that sorghum stem (1,3;1,4)-β-glucan content may have a significant effect on digestibility and bioethanol yields. This information opens new avenues of research to generate sorghum lines optimised for biofuel production.

Dynamical skyrmion state in a spin current nano-oscillator with perpendicular magnetic anisotropy

We study the spectral characteristics of spin current nano-oscillators based on the Pt/[Co/Ni] magnetic multilayer with perpendicular magnetic anisotropy. By varying the applied magnetic field and current, both localized and propagating spin wave modes of the oscillation are achieved. At small fields, we observe an abrupt onset of the modulation sidebands. We use micromagnetic simulations to identify this state as a dynamical magnetic skyrmion stabilized in the active device region by spin current injection, whose current-induced dynamics is accompanied by the gyrotropic motion of the core due to the skew deflection. Our results demonstrate a practical route for controllable skyrmion manipulation by spin current in magnetic thin films.

Oxygen-dependent hydroxylation by Factor Inhibiting HIF (FIH) regulates the TRPV3 ion channel

Factor Inhibiting HIF (FIH) is an oxygen-dependent asparaginyl hydroxylase that regulates the hypoxia-inducible factors (HIFs). Several proteins containing ankyrin repeat domains have been characterised as substrates of FIH, although there is little evidence for a functional consequence of hydroxylation on these substrates. This study demonstrates that the transient receptor potential vanilloid 3 (TRPV3) channel is hydroxylated by FIH on asparagine 242 within the cytoplasmic ankyrin repeat domain. Hypoxia, FIH inhibitors and mutation of asparagine 242 all potentiated TRPV3-mediated current, without altering TRPV3 protein levels, indicating that oxygen-dependent hydroxylation inhibits TRPV3 activity. This novel mechanism of channel regulation by oxygen-dependent asparaginyl hydroxylation is likely to extend to other ion channels.

Spectral characteristics of the microwave emission by the spin Hall nano-oscillator

We utilized microwave spectroscopy to study the magnetization oscillations locally induced in a Permalloy film by a pure spin current, which is generated due to the spin Hall effect in an adjacent Pt layer. The oscillation frequency is lower than the ferromagnetic resonance of Permalloy, indicating that the oscillation forms a self-localized nonpropagating spin-wave soliton. At cryogenic temperatures, the spectral characteristics are remarkably similar to the traditional spin-torque nano-oscillators driven by spin-polarized currents. However, the linewidth of the oscillation increases exponentially with temperature and an additional peak appears in the spectrum below the ferromagnetic resonance, suggesting that the spectral characteristics are determined by interplay between two localized dynamical states.

Audit of perioperative blood transfusion

The main goal of perioperative transfusion is to reduce the morbidity and mortality associated with inadequate delivery of oxygen to the tissues during surgery. In this audit, the primary trigger for transfusion was clinical anaemia assessed by examination of a patient's conjunctiva [40.7%] followed by estimation of blood loss of greater 20% of total blood volume [29.3%]. Haemoglobin estimation in the operation theater was not done in 45.9% of studied patients and only 7.8% patients had transfusion based on this criteria. A common practice is to transfuse blood for hypovolaemia. This was the indication for blood transfusion in 96 patients (7.8%). Inappropriate use of blood in this way has led to wastage of a valuable resource and exposed patients to potential risks of unwanted side effects. Analysis of haemoglobin estimation at recovery room showed 32% of patient with co-morbidities had Hb > 10 gm% while 65% and 29.5% of patients without co-morbidities had Hb > 8 gm% and 10 gm% respectively. This reflects the practice of anaesthetists in maintaining a target of Hb of 10 gm% for both groups of patients while a target of 8 gm% is still relatively safe for patients with good cardiovascular reserves. This has resulted in signifant use of homologous blood which will certainly burden the blood bank and increase the cost of healthcare.

Surveillance of acute flaccid paralysis in Hong Kong: 1997 to 2002

OBJECTIVES

To describe the characteristics of patients reported with acute flaccid paralysis between 1997 and 2002, and to evaluate the performance of the acute flaccid paralysis surveillance system using indicators recommended by the World Health Organization.

DESIGN

Retrospective study.

SETTING

Department of Health, Hong Kong.

PARTICIPANTS

Children aged younger than 15 years who were reported to the Department of Health between 1997 and 2002 with acute flaccid paralysis.

RESULTS

Of 120 children with acute flaccid paralysis reported between 1997 and 2002, 42% were younger than 5 years of age. None of the cases were acute poliomyelitis or polio-compatible. A neurological cause was identified in 67.5% of cases, of which the most common was Guillain-Barre syndrome (42%), followed by transverse myelitis (15%). All except one of the performance indicators consistently met World Health Organization requirements and thus demonstrated the effectiveness of the acute flaccid paralysis surveillance programme. The acute flaccid paralysis notification rate consistently exceeded 1.0 per 100 000 population below 15 years of age. The requirement for adequate stool investigation was the single indicator that did not satisfy World Health Organization requirements. This highlighted the importance of maintaining physicians' awareness of acute flaccid paralysis surveillance.

CONCLUSION

Hong Kong should remain vigilant for acute flaccid paralysis. The effective surveillance system and its evaluation may serve as a model for surveillance of other infectious diseases.

The lack of epidemiological link between the HIV type 1 infections in Hong Kong and Mainland China

Blood samples were collected from 139 newly reported HIV-1 infections in Hong Kong over a 3-year period between 1999 and 2001, representing 22.8% of all reported cases. A majority of the patients were male (85.6%), Chinese (74%), and adult (97.1%) and acquired HIV-1 through sexual transmission (88.2%). The B and CRF01_AE were the major subtypes detected--49.6% and 44.6%, respectively. Over time, the frequency of CRF01_AE subtype increased, the B subtype decreased, and new subtypes of C (4) 2.8%, B' (1) 0.7%, and CRF07_BC (3) 2.2% emerged. The CRF01_AE subtype was commoner in female, Chinese, heterosexuals, and injection drug users whereas B subtype was commoner in male, white, and people with homosexual/bisexual contacts. There was no common source of infection from the analysis except a discernible cluster of Vietnamese injection drug users with the CRF01_AE subtype. The molecular findings did not suggest an epidemiological link between HIV infection in Hong Kong and Mainland China. Hong Kong's longstanding and extensive methadone treatment network may have contributed to the phenomenon.

Re-emergence of fatal human influenza A subtype H5N1 disease

Human disease associated with influenza A subtype H5N1 re-emerged in January, 2003, for the first time since an outbreak in Hong Kong in 1997. Patients with H5N1 disease had unusually high serum concentrations of chemokines (eg, interferon induced protein-10 [IP-10] and monokine induced by interferon gamma [MIG]). Taken together with a previous report that H5N1 influenza viruses induce large amounts of proinflammatory cytokines from macrophage cultures in vitro, our findings suggest that cytokine dysfunction contributes to the pathogenesis of H5N1 disease. Development of vaccines against influenza A (H5N1) virus should be made a priority.

Cavitation phenomena in mechanical heart valves: the role of squeeze flow velocity and contact area on cavitation initiation between two impinging rods

In this study, the closing dynamics of two impinging rods were experimentally analyzed to simulate the cavitation phenomena associated with mechanical heart valve closure. The purpose of this study was to investigate the cavitation phenomena with respect to squeeze flow between two impinging surfaces and the parameter that influences cavitation inception. High-speed flow imaging was employed to visualize and identify regions of cavitation. The images obtained favored squeeze flow as an important mechanism in cavitation inception. A correlation study of the effects of impact velocities, contact areas and squeeze flow velocity on cavitation inception showed that increasing impact velocities results in an increase in the risk of cavitation. It was also shown that for similar impact velocities, regions near the point of impact were found to cavitate later for those with smaller contact areas. It was found that the decrease in contact areas and squeeze flow velocities would delay the onset and reduce the intensity of cavitation. It is also interesting to note that the squeeze flow velocity alone does not provide an indication if cavitation inception will occur. This is corroborated by the wide range of published critical squeeze flow velocity required for cavitation inception. It should be noted that the temporal acceleration of fluid, often neglected in the literature, can also play an important role on cavitation inception for unsteady flow phenomenon. This is especially true in mechanical heart valves, where for the same leaflet closing velocity, valves with a seat stop were observed to cavitate earlier. Based on these results, important inferences may be made to the design of mechanical heart valves with regards to cavitation inception.

Perioperative death in Malaysia: the transition phase from a developing nation to a developed one

This paper examines the surgical pathology associated with perioperative deaths in a country that is undergoing the transition from a developing to a developed nation status. The data from an ongoing nation-wide perioperative mortality study was prospectively collected for the period July 1996 to December 1997 and analyzed. The surgical pathology related to perioperative deaths in Malaysia is different from other developing and developed countries. While death from trauma and the late presentation of surgical conditions are similar to developing countries, infective gastrointestinal conditions were rarely encountered. Diseases associated with advanced age such as colorectal cancer, peptic ulcer, urological diseases and vascular conditions are beginning to emerge. As the country races towards a developed nation status, increasing life expectancy and changing life-styles are expected to influence the disease pattern. The planning of surgical facilities and manpower development must recognize the changes taking place.

The long-term efficacy of plasma-derived hepatitis B vaccine in babies born to carrier mothers

The long-term efficacy of a childhood hepatitis B vaccination programme was evaluated. A total of 112 newborn babies of hepatitis B carrier mothers were given hepatitis B immune globulin (HBIG) and a 10-microg three-dose regimen of plasma-derived vaccine administered at a conventional (0, 1, 6 months), delayed (2, 3, 8 months) or accelerated (0, 1, 2 months) schedule. The vaccinees were followed up to determine their anti-HBs status over a 16-year period. Upon completion of the vaccination schedules, 92.6% developed antibody against surface antigen (anti-HBs) seroconverion, the rate of which fell to 33.3% at year 16. The three schedules were equally effective in preventing chronic infection, with a protective efficacy of 88.9% from hepatitis B surface antigen (HBsAg) carriage, compared with historical control. Vaccinees on the delayed schedule had a slightly higher seroconversion rate over years, and were better able to maintain an anti-HBs level of > or = 100 iu/L. Overall, a quarter demonstrated evidence of exposure to the virus, being positive for antibody against core antigen or HBsAg, or mounting a rise in anti-HBs during the follow-up period. We conclude that a three-dose hepatitis B vaccination regimen is generally effective in protecting newborns of hepatitis B carrier mothers from infection and chronic carriage. Booster is not needed even after 16 years of monitoring.

The implication of a reduced-dose hepatitis B vaccination schedule in low risk newborns

Five hundred and seventy-four babies born to HBsAg negative mothers in Hong Kong received either a regular (5 micro g) or reduced (2.5 micro g) three-dose regimen of recombinant hepatitis B vaccine. A significantly higher anti-HBs positivity rate (>or=10 mIU/ml), geometric mean titer (GMT) and the maintenance of a high anti-HBs level (>or=100 mIU/ml) were observed with the regular-dose regimen. The differences persisted, however, only up to 1 year post-vaccination. Over an 8-year period, only 1% of the vaccinees demonstrated anti-HBc seroconversion and none had become HBsAg positive. The long-term efficacy of the reduced-dose regimen was confirmed, even in an HBV endemic population.

Epidemiology and detection of human immunodeficiency virus among pregnant women in Hong Kong

OBJECTIVES

To determine the epidemiology of human immunodeficiency virus infection among pregnant women and the neonatal outcomes in Hong Kong.

DESIGN

Retrospective observational study composed of two parts: record review of pregnant women and unlinked anonymous screening of cord blood from neonates.

SETTING

Two human immunodeficiency virus clinics and the Government Virus Unit.

PARTICIPANTS

Female patients attending the two clinics who became pregnant and neonates who underwent routine metabolic screening by the Government Virus Unit between 1992 and 1999.

MAIN OUTCOME MEASURES

The outcomes of neonates born to women who had human immunodeficiency virus infection during pregnancy.

RESULTS

Forty-one human immunodeficiency virus-related pregnancies were recorded among 32 infected women. Fifteen pregnancies were terminated, of which 14 were in women who knew their infection status before conception. Twenty-six pregnancies continued to term, resulting in 26 live births. Twelve babies were born to women who knew their infection status before delivery. One baby was confirmed to be infected. Six women were given zidovudine for prophylaxis against vertical transmission and none of the babies were infected at birth. Of the remaining 14 human immunodeficiency virus-related pregnancies, the mothers' status became known only at a later date and nine (64.3%) babies were confirmed to be infected at the age of 18 months or older. The rate ratio of giving birth to an infected baby was 8.18 from mothers who did not know their status antenatally. Unlinked anonymous screening showed that the seroprevalence rate for human immunodeficiency virus in pregnant women was 0.032% (1/3125) in Hong Kong in 1999.

CONCLUSIONS

Human immunodeficiency virus-related pregnancy is not rare in Hong Kong and the majority of infected mothers were not identified and treated. Detection of these pregnancies will be invaluable for the prevention of mother-to-child transmission. Universal antenatal screening of human immunodeficiency virus antibody is proposed as an effective strategy.

Pulsatile flow studies of a porcine bioprosthetic aortic valve in vitro: PIV measurements and shear-induced blood damage

A two-dimensional particle image tracking velocimetry (PIV) system has been used to map the velocity vector fields and Reynolds stresses in the immediate downstream vicinity of a porcine bioprosthetic heart valve at the aortic root region in vitro under pulsatile flow conditions. Measurements were performed at five different time steps of the systolic phase of the cardiac cycle. The velocity vector fields and Reynolds stress mappings at different time steps allowed us to chart a time history of the stress levels experienced by fluid particles as they move across the aortic root. This Lagrangian description of the stresses experienced by individual blood cells enabled us to estimate the propensity of shear-induced damage to platelets and red blood cells. Coupled with flow visualization techniques, the hydrodynamic consequences of introducing a porcine bioprosthetic heart valve into the aortic root was examined. Although the PIV measurements may lack the accuracy of single point measuring systems, the overall view of the flow in the aortic root region compensates for the shortcoming.

Hepatitis B surface antigen variants in vaccinees, blood donors and an interferon-treated patient

Variants of hepatitis B virus (HBV), with amino acid substitutions in the major antigenic "a" determinant of hepatitis B surface antigen (HBsAg), have been described mainly in vaccinated children. In the present study in addition to vaccinated children, we have investigated Chinese blood donors positive for anti-HBc alone, and a patient with continuing liver disease after interferon-induced seroconversion to anti-HBs. Variants were detected in two of four children with break-through infections. One child had a double mutation (P142S and G145R) and the other a G145A substitution. Three of seven anti-HBc positive Chinese blood donors had a T131I substitution, whilst the interferon-treated patient had a treble amino acid substitution (P142S, G145R and N146D). The present results indicate that HBsAg variants may exist in individuals other than vaccinated children.

A case-controlled study on the use of HBsAg-positive donors for allogeneic hematopoietic cell transplantation

To compare the clinical and serological outcomes of patients receiving donors' marrow positive or negative for hepatitis B surface antigen (HBsAg), we studied 18 patients of allogeneic hematopoietic cell transplantation receiving HBsAg-positive marrow (group 1) and 18 receiving HBsAg-negative marrow (group 2). The recipients of the 2 groups were matched for hepatitis B virus (HBV) serology, sex, age, underlying hematological diseases, conditioning regimen, and prophylaxis against graft-versus-host diseases. Eight (44.4%) recipients in group 1 and 2 (11.1%) in group 2 suffered from HBV-related hepatitis posttransplant (P =.03). Furthermore, HBV-related hepatic failure was seen in 6 group 1 patients, but in none of the group 2 patients (P =.007). Five of the 9 (55.5%) HBsAg-negative recipients in group 1 became positive after receiving HBsAg-positive marrow. Serum HBV DNA was positive in all 5 donors of these patients, but in none of the donors of recipients who remained HBsAg negative (P =.008). Group 1 patients developing HBV-related hepatitis posttransplant were more likely to have a donor carrying a precore A(1896 )and/or core promoter T(1762)/A(1764) HBV variant (62. 5% versus 0%, P =.007). This study has demonstrated that a high incidence of HBV-related hepatitis was associated with the use of HBsAg-positive marrow for transplant, and a high viral load in the donor appeared to predispose recipients to the development of HBV-related hepatitis posttransplant. Further clinical trials will be necessary to determine the optimal management approach to this problem, including the use of the antiviral agents in the donors and the recipients. (Blood. 2000;96:452-458)

Twelve-year follow-up of a prospective randomized trial of hepatitis B recombinant DNA yeast vaccine versus plasma-derived vaccine without booster doses in children

A total of 318 children were prospectively randomized in group 1 with two 5-microg doses of recombinant vaccine given at 0 and 1 month; in group 2 with three 5-microg doses of recombinant vaccine given at 0, 1, and 6 months; or in group 3 with three doses of plasma-derived vaccine given at 0, 1, and 6 months. Eleven subjects with a hepatitis B surface antigen antibody (anti-HBs) titer of less than 10 mIU/mL at 12 months were given an extra dose of vaccine and were excluded from analysis. No booster doses were given to any other subjects. All children were followed up yearly for the level of anti-HBs titers and for the detection of hepatitis B infection. At the 12th year of follow-up, there were significantly fewer subjects with anti-HBs of 10 mIU/mL or above in group 1 (60.4%) when compared with group 2 (81.4%; P =.0287) and group 3 (79.0%; P =. 0381). The geometric mean titers (GMTs) of subjects of group 1 were significantly lower than those of group 2 and group 3 throughout the 12 years of follow-up. A total of 65 subjects had one or more episodes of anamnestic response. No subject became positive for hepatitis B surface antigen (HBsAg); 2 became positive for hepatitis B core antigen antibody (anti-HBc). In conclusion, the long-term protective immunity was better with three doses of hepatitis B vaccine (either the recombinant or plasma-derived) than with two doses. However, protection from hepatitis B infection could be equally achieved by either two doses or three doses of the vaccine. Booster doses were not necessary, probably because of effective anamnestic response.

Clearance of persistent hepatitis B virus infection in Chinese bone marrow transplant recipients whose donors were anti-hepatitis B core- and anti-hepatitis B surface antibody-positive

Thirteen hepatitis B surface antigen-positive Chinese patients who received hepatitis B surface antibody-positive marrow (hepatitis B core antibody-positive or -negative: 6 and 7, respectively) via allogeneic bone marrow transplantation (BMT) were studied. After BMT, 4 recipients had serologic clearance of hepatitis B surface antigen from hepatitis B core antibody-positive marrow, but none of the recipients of hepatitis B core antibody-negative marrow had serologic clearance (P=.02). There was no significant difference in the donors' hepatitis B surface antibody titer before BMT for patients with or without serologic clearance of hepatitis B surface antigen (2255.2+/-4244.0 vs. 854.2+/-2306.7 mIU/mL; P=not significant). Adoptive immunity clearance of hepatitis B surface antigen was favored by hepatitis B core antibody positive-donor marrow and was not related to donor pre-BMT hepatitis B surface antibody titer.

The effectiveness of surfactant replacement therapy for preterm infants with respiratory distress syndrome

Thirty preterm infants weighing > or = 800 g with clinical and radiological evidence of respiratory distress syndrome (RDS) requiring mechanical ventilation with FiO2 of > or = 40% were given modified bovine surfactant (Survanta). They were compared with equal number of historical controls. Infants who received surfactant showed prompt and highly significant improvement in FiO2, mean airway pressure, arterial/alveolar oxygen tension ratio and ventilatory index. There was significant improvement in mortality rate (10% vs 33%; p = 0.03). Among the survivors, surfactant-treated infants required shorter duration of continuous positive airway pressure (CPAP) (3.4 vs 9.6 days; p = 0.04). For survivors with birthweight of > 1000 g, surfactant-treated infants required shorter duration of ventilatory support (intermittent positive pressure ventilation + CPAP) (7.5 vs 18.9 days, p = 0.02). Overall, surfactant-treated infants achieved full enteral feeds sooner (15.7 days vs 24.6 days; p = 0.03) and required shorter duration of total parenteral nutrition (13.9 days vs 25.6 days; p = 0.02). We concluded that surfactant replacement therapy was effective in the treatment of preterm infants with RDS.

Fatal enterovirus 71 encephalomyelitis

During an outbreak of hand-foot-mouth disease caused by enterovirus 71 (EV-71) in 1997, 4 children presented with sudden cardiopulmonary collapse and minimal neurologic features. All children received cardiopulmonary resuscitation but died within a few hours of admission. Postmortem studies showed infection by EV-71 with extensive damage to the medulla and pons. We postulate an etiologic link between EV-71 and brainstem encephalomyelitis as the cause of pulmonary edema and death.

Steady flow dynamics of prosthetic aortic heart valves: a comparative evaluation with PIV techniques

Particle Image Velocimetry (PIV), capable of providing full-field measurement of velocities and flow stresses, has become an invaluable tool in studying flow behaviour in prosthetic heart valves. This method was used to evaluate the performances of four prosthetic heart valves; a porcine bioprostheses, a caged ball valve, and two single leaflet tilting disc valves with different opening angles. Flow visualization techniques, combined with velocity vector fields and Reynolds stresses mappings in the aortic root obtained from PIV, and pressure measurements were used to give an overall picture of the flow field of the prosthetic heart valves under steady flow conditions. The porcine bioprostheses exhibited the highest pressure loss and Reynolds stresses of all the valves tested. This was mainly due to the reduction in orifice area caused by the valve mounting ring and the valve stents. For the tilting disc valves, a larger opening angle resulted in a smoother flow profile, and thus lower Reynolds stresses and pressure drops. The St. Vincent valve exhibited the lowest pressure drop and Reynolds stresses.

Use of famciclovir to prevent HBV reactivation in HBsAg-positive recipients after allogeneic bone marrow transplantation

BACKGROUND/AIMS

Reactivation of chronic hepatitis B viral infection causes significant morbidity and mortality after bone marrow transplantation. Recently, nucleoside analogues, such as famciclovir, were found to have a direct suppressive effect on hepatitis B virus replication in both in vitro and in vivo studies. We have studied the effect of famciclovir on the incidence of hepatitis B virus reactivation and hepatitis after allogeneic bone marrow transplantation.

METHODS

Eight hepatitis B surface antigen (HBsAg)-positive patients who received allogeneic bone marrow transplantation were given oral famciclovir 250 mg three times daily, starting at least 1 week prior to bone marrow transplantation and continuing for 24 weeks after transplantation. Clinical and serological outcomes in these patients were compared with 24 HBsAg-positive recipients of allogeneic bone marrow transplantation who did not receive famciclovir (historical controls).

RESULTS

After bone marrow transplantation, there were five patients with hepatitis B virus reactivation among those who received famciclovir 250 mg three times daily. Four of these patients responded to increased dosages of 500 mg three times daily and did not develop hepatitis. The remaining patient suffered from hepatitis related to hepatitis B virus reactivation. Compared to historical controls, there were fewer cases of hepatitis due to hepatitis B virus reactivation and veno-occlusive disease. The median follow-up was 701.6 days (range: 50-2346 days) with ten deaths (three due to hepatic failure related to HBV reactivation) in those who did not receive famciclovir and one death (due to hepatic failure related to graft-versus-host disease) in those who received famciclovir.

CONCLUSIONS

Use of famciclovir significantly reduced hepatitis due to hepatitis B virus reactivation in HBsAg-positive recipients after allogeneic bone marrow transplantation.

Parvovirus B19 infection in Hong Kong

Human parvovirus B19 is a small DNA virus that can cause a number of diseases, notably erythema infectiosum in children, and aplastic crisis in patients with chronic haemolytic disorders. With the availability of serological tests for parvovirus infection, much is known about the prevalence of this virus in the Western population. However, there have not been any data on the epidemiological pattern of parvovirus B19 infection in Hong Kong and its surrounding region. In this report we have studied the sero-prevalence of parvovirus B19 in Hong Kong in 1983 and 1993, and were able to show a low incidence of parvovirus infection in the intervening 10 years, leading to a shift in the prevalence rate of parvovirus infection in the general population. From 1991 to 1996, of 276 patients presenting with illness which might have been caused by B19, only 2.5% were positive for IgM and 19.6% for IgG anti-B19. The prevalence of IgG anti-B19 among patients with thalassaemia major requiring frequent blood transfusion in 1995 was similar to those in the same age group in the general population, substantiating the observation that B19 infection was not common in Hong Kong in recent years.

Breastfeeding at 6 weeks and predictive factors

Despite the numerous changes made in accordance with the Baby Friendly Hospital Initiative at the University Hospital, Kuala Lumpur, the low rates of breastfeeding have persisted. This study aims to examine the current trend in infant feeding, and the influences of some perinatal and sociodemographic factors on breastfeeding. Five-hundred mothers with singleton pregnancies and healthy infants were interviewed at 6 weeks post-partum. Only 124 (25 per cent) mothers were practising exclusive breastfeeding (EBF), and 132 (26 per cent) mothers were using exclusive infant formula feeding (EIF). On logistic regression analyses, mothers who followed EBF were more likely to have had antenatal plans to breastfeed (Odds ratio 2.44, 95 per cent confidence interval 1.75-3.45), not in paid employment post-natally (OR 1.76, 95 per cent CI 1.31-2.36), of older age group (> 27 years) (OR 1.48, 95 per cent CI 1.13-1.93), had female infants (OR 1.38, 95 per cent CI 1.05-1.80) and of Indian ethnicity (compared to Chinese) (OR 3.87, 95 per cent CI 2.16-6.89). Breastfeeding difficulties were associated with decreased odds of EBF (OR 0.21, 95 per cent CI 0.13-0.34). Parental education, fathers' ages and incomes, primigravida status, Caesarean section, present of episiotomy, late first breastfeed, phototherapy, and length of hospital stay were not significant predictors of failure of EBF. In comparison, predictive factors for increased use of EIF were mothers who have had breastfeeding difficulties, < or = 9 years of schooling, and of Chinese descent. In conclusions, the overall rate of EBF by 6 weeks of age in infants born in this urban hospital had remained poor. The adverse factors for EBF identified in this study warrant further in-depth studies to determine effective ways of improving EBF rates.

Persistence of hepatic hepatitis B virus after serological clearance of HBsAg with autologous peripheral stem cell transplantation

Delayed clearance of hepatitis B surface antigen was previously reported in a 38 year old woman after high dose chemotherapy with autologous peripheral blood stem cell rescue. Sixteen months later, this patient remained hepatitis B surface antigen negative, hepatitis B surface antibody positive, and serum hepatitis B DNA negative by polymerase chain reaction. Serial liver biopsies (one at hepatitis B e antigen positive stage, one at hepatitis B e antibody positive stage, and one at hepatitis B surface antigen negative and hepatitis B surface antibody positive stage) showed a gradual resolution of the inflammatory activity with loss of hepatitis B e antigen and then hepatitis B surface antigen in the serum. However, the degree of fibrosis, though mild, remained the same. With the serological clearance of hepatitis B surface antigen, a small amount of hepatitis B virus DNA was still detectable in the nuclei of liver cells.

Steady flow velocity field and turbulent stress mappings downstream of a porcine bioprosthetic aortic valve in vitro

Velocity profiles and Reynolds stresses downstream of heart valve prostheses are vital parameters in the study of hemolysis and thrombus formation associated with these valves. These parameters have previously been evaluated using single-point measurement techniques such as laser Doppler anemometry (LDA). The purpose of this study is to map the velocity vector fields and Reynolds stresses downstream of a porcine bioprosthetic heart valve in the aortic root region with particle image velocimetry (PIV) techniques in vitro under steady flow conditions. PIV is essentially a multipoint measurement technique that allows full-field measurement of instantaneous velocity vectors in a flow field, thus allowing us to map the entire velocity or stress field over the aortic root (where single-point measurements are difficult). Coupled with flow visualization techniques, the hydrodynamic consequences of introducing a porcine bioprosthetic heart valve into the aortic root was examined, and compared with data obtained from an empty aortic root and an aortic root with the valve mounting ring alone. From our velocity and stress mappings, we found that the valve mounting ring effectively diminishes the central orifice area, giving rise to a higher central axial flow with strong recirculating regions and a corresponding large pressure drop. This in turn produces an intermixing zone between the central jet and recirculating region further downstream from the valve, which contributes to the high-stress zone measured. The development of the flow is further restricted by the valve stents, giving rise to stagnation regions and wakes. High-velocity gradients were also measured at the interface of the jet and recirculating region in the sinus cavity. The overall view of the velocity and stress mappings helps to identify regions of flow disturbances that otherwise may be lost with single-point measuring systems. Although the PIV measurements may lack the accuracy of single-point measuring systems, the overall view of the flow in the aortic root region compensates for the shortcoming.

A pandemic warning?

Introduction of new influenza type-A viruses, carrying different combinations of the viral envelope glycoproteins haemagglutinin (H) and neuraminidase (N), have led to three major pandemics of influenza in humans this century. Phylogenetic evidence suggests that these viruses have originated from avian influenza A viruses, either unchanged or after reassortment with humaninfluenza A viruses. In aquatic birds, all of the known H and N antigenic varieties (15 varieties carry H, nine carry N envelope glycoproteins) apparently circulate in a genetically conserved fashion. Viruses carrying the H1N1, H2N2 and H3N2 combinations were responsible for the Spanish flu of 1918, the Asian flu in 1957 and Hong Kong flu in 1968, respectively¹. An influenza A virus of the H5N1 subtype has now been identified in a human patient, raising discussions about its potential to spark a new human influenza pandemic.

Comparison of propofol and methohexitone as an induction agent in anaesthesia for electroconvulsive therapy

30 patients who received electroconvulsive therapy were anaesthetized with either Propofol or Methohexitone in a randomized cross-over study. Recovery times were shorter in those who received Propofol. The decrease in diastolic pressure after induction was greater with Propofol than with Methohexitone. There was a greater increase in the blood pressure after the electroconvulsive therapy in those who received Methohexitone. The duration of convulsion was similar for both agents.

Inactivated hepatitis A vaccine in healthy Chinese adults

OBJECTIVES

To study the safety, tolerability of and immune response to an inactivated hepatitis A vaccine in healthy Chinese adults.

DESIGN

Seronegative subjects were randomized to receive formalin-inactivated, alum-adjuvanted hepatitis A vaccine (25 units, MSD) at 0, 24 weeks (group I) or 0, 2, 24 weeks (group II).

SUBJECTS

Healthy Chinese adults aged 18 years or above were recruited. All subjects were staff of a regional hospital and primary care clinic in Hong Kong.

MAIN OUTCOME MEASURES

Side-effects, tolerance, seroconversion rate and geometric mean titre (GMT) of the two groups were noted and compared.

RESULTS

Thirty-two and 28 people were recruited into group I and group II, respectively. Antibody against hepatitis A developed in 100% of the recipients 1 month after the last dose of either regimen, with a GMT of around 450 IU L-1. High antibody levels were maintained at the end of one year. There was no statistically significant difference in the seroconversion rates and GMTs between the two regimens of vaccination. All subjects in group I seroconverted at 24 weeks after one single dose of the vaccine. No adverse effects were reported except for complaints of some mild local and constitutional symptoms.

CONCLUSIONS

The inactivated hepatitis A vaccine is highly immunogenic, safe and well-tolerated.

A reduced dose approach to hepatitis B vaccination for low-risk newborns and preschool children

The effectiveness of a 2.5 micrograms dose of the hepatitis B vaccine (B-Hepavac II) was compared with that of 5 micrograms in 587 low-risk neonates and 777 preschool children of age 3-8 years. The vaccines were administered at months 0, 1 and 3, with postvaccination serology tested at months 4 and 12. The seroconversion rates of the 2.5 microgram recipients (newborn: 93.5%; preschool children: 97.4%) are comparable with the 5 micrograms group (newborn: 95.7%; preschool children: 98.7%). The seroconversion rates of the newborns are, however, significantly lower in the 2.5 micrograms group if positive response is taken as a titre > 10 IU l-1, instead of > 0 IU l-1. The older children, on the other hand, achieved a higher seroconversion rate and geometric mean titre (GMT) when compared with the newborns. irrespective of the dose received.

Particle image velocimetry in the investigation of flow past artificial heart valves

Full-field measurement of instantaneous velocities in the flow field of artificial heart valves is vital as the flow is unsteady and turbulent. Particle image velocimetry (PIV) provides us the ability to do this as compared to other point measurement devices where the velocity is measured at a single point in space over time. In the development of a PIV system to investigate the flow field of artificial heart valves, many problems associated with the project arose and were subsequently resolved. Experience gained in the setting up of an environment conducive for PIV studies of artificial heart valves; from seed particle selection to refractive index matching, and the evolution of computer algorithms to satisfy the varied flow conditions in artificial heart valves are presented here. Velocity profiles and distributions are computed and drawn for a porcine tissue heart valve based on measurements with the PIV system developed.

Five-year follow-up of a prospective randomized trial of hepatitis B recombinant DNA yeast vaccine vs. plasma-derived vaccine in children: immunogenicity and anamnestic responses

In a prospective randomized trial, 318 children aged between 3 mo and 11 yr who were negative for all hepatitis B markers were randomized to receive two 5-micrograms doses of hepatitis B recombinant DNA yeast vaccine at 0 and 1 mo (group 1), three 5-micrograms doses of hepatitis B recombinant DNA yeast vaccine at 0, 1 and 6 mo (group 2) or three 10-micrograms doses of plasma-derived hepatitis B vaccine (group 3). The HBs antibody response rate at 8 mo was between 93% and 99%; it was still 75% to 87% at 5 yr in all three groups. Geometric mean titers at 1 yr were 83, 1,085 and 858 mIU/ml in groups 1, 2 and 3, respectively. These values had decreased after 5 yr to 47, 131 and 250 mIU/ml. Subjects in group 1 showed a significantly less proportional drop in geometric mean titer at the fifth year than did subjects in group 2 (p = 0.05) or group 3 (p = 0.015). None of the children developed HBc antibody, even after 5 yr of follow-up. We noted 42 episodes of significantly increased HBs antibody titers, probably due to anamnestic response, even when the titers had dropped to low levels. The mean age at which anamnestic response occurred was 8.7 yr.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis C virus antibody in multiply transfused Chinese with thalassaemia major

Thirty-four of 99 multiply transfused Chinese (49 females, 50 males) with thalassaemia major were positive for antibody to hepatitis C virus. There was no sex predominance in seropositivity with 18 females and 16 males positive. The mean (+/- SD) age and units of blood transfused were significantly higher in the seropositive patients (167 +/- 48 months, 206 +/- 82 units respectively) than the seronegative patients (113 +/- 56 months, 124 +/- 80 units respectively). The seropositive patients had higher mean (+/- SD) serum alanine aminotransferase, aspartate aminotransferase and ferritin concentrations (91 +/- 82 IU/L, 67 +/- 38 IU/L, 4797 +/- 2522 ng/ml respectively) than the seronegative patients (38 +/- 29 IU/L, 48 +/- 28 IU/L, 3620 +/- 2140 ng/ml respectively). Serum ferritin had an independent and significant effect on serum alanine aminotransferase in addition to that of seropositivity to hepatitis C virus.

Interactions between callosal, thalamic and associational projections to the visual cortex of the developing rat

The patterns of callosal interconnections between the visual cortices of rats display considerable plasticity in response to various neonatal manipulations. In the present study, many neurones in the principal visual thalamic relay nuclei, the dorsal lateral geniculate nucleus (DLG) and to a lesser extent those in the lateral posterior nucleus (LP) were destroyed by injections of the neurotoxin - kainic acid - on the first day of postnatal life. Four weeks later, as demonstrated with the anterograde and retrograde transport of the enzyme horseradish peroxidase (HRP) injected into the occipital lobe of one hemisphere, callosally projecting neurones and terminals were distributed more widely in the retinotopically organized areas 17, 18a and 18b of the visual cortex ipsilateral to the lesioned visual thalamus than in unoperated control animals of the same age. By contrast, in the visual cortex contralateral to the lesioned visual thalamus the areal distribution of callosally projecting neurones and terminals was similar to that of the controls, that is, largely but not exclusively restricted to the common border of areas 17 and 18a. Both in unoperated and operated animals, cells in lamina V of several cytoarchitectonically defined areas that are not retinotopically organized (area 8 in the frontal lobe, area 29d in the retrosplenial limbic cortex and perirhinal areas 35/13 in the temporal lobe) also project to contralateral visual cortices. In areas 8 and 29d, the total numbers, laminar distributions and densities of labelled callosal cells both ipsilateral and contralateral to the kainate-injected visual thalamus were similar to those in the controls. However, in the temporal lobe, the areal distribution of the labelled callosal neurones was more extensive than that in the controls and labelled cells in areas 35/13 of the cortex contralateral to the kainate-lesioned visual thalamus merged with those in the neighbouring areas 20 and 36. By contrast, the areal distribution of associational neurones in area 18a and in nonretinotopically organized areas projecting to area 17 were very similar in controls and in operated animals (neonatal kainate lesion of the visual thalamus, neonatal section of the corpus callosum or both procedures combined). However, in operated animals, the labelled associational neurones projecting from the supragranular laminae (II/III) of area 18a to area 17 constituted a higher proportion of all cells than did those in the unoperated control animals. Thus, overall the number of associational neurones projecting from area 18a to area 17 was slightly increased by the experimental manipulations performed.(ABSTRACT TRUNCATED AT 400 WORDS)

Pyogenic meningitis in hospitalized children in Kelantan, Malaysia

A 2.5-year retrospective study of pyogenic meningitis in hospitalized children in Kelantan was carried out with regard to aetiology, clinical features, investigation, treatment and outcome. There were 58 children with 43 cases (74.1%) occurring below the age of 1 year. Frequent presenting symptoms included fever (98.3%), fits (77.6%), anorexia (39.7%), vomiting (34.5%) and drowsiness (12.1%). On admission, 37 (63.7%) had neck stiffness, 10 (17.2%) had Kernig's sign and 32 (55.2%) had coma. CSF cultures were positive for Haemophilus influenzae in 29 (50%), Streptococcus pneumonia in 13 (22.4%) and Neisseria meningitidis in 3 (5.2%). The antibiotic sensitivity profiles showed that the three main organisms were 100% sensitive to Chloramphenicol, Streptococcus pneumoniae was 100% sensitive to penicillin, Neisseria meningitidis was 100% sensitive to penicillin and ampicillin, and Haemophilus influenzae was 90% sensitive to penicillin and ampicillin. The total hospital mortality was 18.9%. All but two of the eleven deaths occurred in children younger than 1 year. Nineteen of the 35 (54.3%) survivors attended for at least one follow-up after discharge from hospital. Of these 19 children, 47.4% had neurological sequelae.

Role of target tissue in regulating the development of retinal ganglion cells in the albino rat: effects of kainate lesions in the superior colliculus

Kainic acid or ibotenic acid was injected unilaterally into the major target regions of the axons of retinal ganglion cells--the superior colliculus (SC) or dorsal lateral geniculate nucleus (DLG)--of rat pups ranging in age from postnatal day 0 to postnatal day 10 (P0 - P10). While the collicular or geniculate neurons within the injection site died within 48 hours of the injection, damage to axons and terminals of extrinsic origin within the injected region was not apparent. The neuronal degeneration induced by the neurotoxins, observed at both the light and electron microscopic levels, resembled the neuronal degeneration that occurs in the colliculus during normal development. Macrophages were identified in the regions containing degenerating cells. Two to three weeks after the injections of neurotoxin, massive injections of the enzyme, horseradish peroxidase (HRP), were made into the retinorecipient nuclei. After about 24-hour survival time the numbers of retinal ganglion cells were estimated by counting the number of neurons containing HRP reaction products in sample areas distributed in a regular rectangular array across the entire retinal surface. In the animals in which the neurotoxin was injected into the SC during the first 4 postnatal days, there was a substantial reduction (on average 41.5%; the range: 27.5-65.5%) in the normal number (mean value of 113,000--Potts et al.: Dev. Brain Res. 3:481-486, '82) of retinal ganglion cells surviving the period of "naturally occurring ganglion cell death" in the retinae contralateral to the injected SC. By contrast, injections of neurotoxins into the DLG and/or the optic tract of newborn rats did not result in a significant reduction in the numbers of retinal ganglion cells surviving the period of naturally occurring ganglion cell death. The period of sensitivity of retinal ganglion cells to the injection of neurotoxin into the colliculi extends from birth to about the end of the first postnatal week; the greatest sensitivity seems to be restricted to the first 3-4 postnatal days. In the retinae in which the total number (and density) of ganglion cells was substantially reduced by the selective destruction of their target cells, the centro-peripheral difference in the somal diameters of the ganglion cells (apparent in normal animals) was abolished, both amongst the whole population of ganglion cells and amongst the ganglion cells with the largest somata, relatively thick axons, and large-gauge primary dendrites (Class I cells). The number and distribution of the Class I cells in the depleted retinae were, however, unaltered.(ABSTRACT TRUNCATED AT 400 WORDS)