Report of the Australian National Polio Reference Laboratory, 1 July to 31 December 2000

The Australian National Polio Reference Laboratory at the Victorian Infectious Diseases Reference Laboratory (VIDRL) is responsible for processing and testing samples for poliovirus from all Australian patients with acute flaccid paralysis and for identifying and characterising polioviruses recovered from untyped enteroviruses submitted from Australian laboratories. From 1 July to 31 December 2000, a total of 12 specimens from 7 patients with AFP were referred to the NPRL. Poliovirus type 3 Sabin-like was isolated from samples from 2 patients with suspected vaccine- associated paralytic poliomyelitis. No viruses were isolated from samples from the remaining 5 patients. Since 1995 a total of 1,325 isolates have been referred for testing from laboratories throughout Australia. Seven hundred (53%) were confirmed as Sabin vaccine-like polioviruses, 542 (41%) were non-polio enteroviruses and 82 (6%) yielded no virus or viruses other than enteroviruses. At Kyoto, Japan in October 2000, the Western Pacific Region of the World Health Organization was declared wild polio-free. This represents a significant step towards the global eradication of poliovirus with one quarter of the world's population free of endemic infections from wild poliovirus. Surveillance of AFP and containment of wild polioviruses has been coordinated at the VIDRL. Since February 2000, Australia has been developing and implementing a plan for the containment of wild poliovirus stocks and potentially infectious materials.

Plant glycerol-3-phosphate-1-acyltransferase (GPAT): structure selectivity studies

Squash glycerol-3-phosphate-1-acyltransferase has been crystallized and the structure of the enzyme determined, at 1.9-A resolution, using multiple isomorphous replacement of the wild type and a series of individual cysteine mutants. Competitive in vitro substrate selectivity assays have been established that differentiate between selective and non-selective forms of the enzyme. Particular care was taken to use near-physiological concentrations of both substrates. Clear substrate selectivity can be demonstrated with the natural substrate acyl-acyl carrier protein but not with the substrate analogue acyl-CoA. The use of site-directed mutagenesis, coupled to three-dimensional structural determinations, should provide a rational basis for elucidating structural components important in determining the substrate selectivity of this enzyme.

Report of the Australian National Polio Reference Laboratory. 1 July to 31 December 1999

Since 1994, as part of the global eradication of poliomyelitis, the Australian National Polio Reference Laboratory (NPRL) at the Victorian Infectious Diseases Reference Laboratory (VIDRL) has been responsible for virological testing to confirm the absence of poliomyelitis in Australia. Samples from patients with acute flaccid paralysis are transported to VIDRL for viral culture. Polio and enteroviruses are referred for intratypic differentiation as wild or Sabin (vaccine) strains. A total of 23 faecal specimens from 17 patients were processed for enterovirus culture in the period 1 July to 31 December 1999. Since 1995, 1,078 enterovirus isolates from six states have been tested for the presence of wild poliovirus. To date, 562 strains were confirmed as Sabin vaccine-like, one non Sabin-like strain was identical with a laboratory control virus and the other strains were non-polio enteroviruses or other viruses. A World Health Organization (WHO) workshop in diagnostic polio polymerase chain reaction techniques was held at VIDRL in November 1999. The laboratory was reaccredited as a regional polio reference laboratory for the WHO Western Pacific region and a national laboratory for Australia, the Pacific Island countries and Brunei Darussalam. Planning is proceeding for the polio-free certification and containment of laboratory stocks of wild poliovirus infectious materials in Australia.

Report of the Australian National Polio Reference Laboratory. 1 January 1999 to 30 June 1999. Towards WHO certification as wild poliovirus-free: laboratory surveillance in Australia

Since 1994 the Australian National Polio Reference Laboratory at the Victorian Infectious Diseases Reference Laboratory has been responsible for virological confirmation of the eradication of poliomyelitis in Australia. The laboratory is also a World Health Organization Western Pacific regional polio reference laboratory and the national polio laboratory for the Pacific Island countries and for Brunei Darussalam. It is now over two years since the last case of poliomyelitis was detected in the Western Pacific region of the World Health Organization. The co-operation of staff in all laboratories where polioviruses are handled and where samples from acute flaccid paralysis (AFP) patients are submitted is required until Australia and the region can be declared wild poliovirus-free. The characterisation of all polioviruses isolated in Australia in this reporting period led to the apparent detection of a non Sabin vaccine-like poliovirus in an environmental sample. The virus was found to be identical to a laboratory control isolate by sequencing. The environmental virus is therefore characterised as a contaminant, not a wild isolate. The investigation is outlined in this article, as well as the results of investigation and characterisation of all referred polioviruses.

Sustained attention and related perceptuomotor functions

The present study examined the relationship between two measures of sustained attention on the Continuous Performance Test (reaction time and omission errors) and several performance measures on neuropsychological tests. Analysis suggests that sustained attention as measured by processing speed predicts performance on neuropsychological measures of relatively greater complexity and that the Stroop test, which requires maintaining steady focus on a changing stimulus field, may be more sensitive to lapses in attention than other neuropsychological tests.

Report of the Australian National Polio Reference Laboratory. 1 January to 31 December 1998

The Australian National Polio Reference Laboratory was established at the Victorian Infectious Diseases Reference Laboratory (VIDRL) in late 1994 to carry out virological confirmation of the eradication of poliomyelitis in Australia. The laboratory is responsible for transporting samples from all Australian patients with acute flaccid paralysis (AFP) to VIDRL for poliovirus culture, identification and intratypic differentiation. The laboratory also performs polio serology on selected serum samples from AFP patients when faecal samples are not available. In 1998, faecal specimens were received from 11 patients with AFP. Adenovirus type 2 was isolated from 1 patient and an untypable non-polio enterovirus from another. No viruses were isolated from the other 9 patients. Since 1995, over 820 isolates have been transported to VIDRL from laboratories in five Australian states for testing. Three hundred and seventy three (45%) were confirmed as Sabin vaccine-like polioviruses, 416 (51%) were non-polio enteroviruses and 24 (3%) yielded no virus or viruses other than enteroviruses. Eight polioviruses are still uncharacterised.

Ectopic expression of the CRF-binding protein: minor impact on HPA axis regulation but induction of sexually dimorphic weight gain

Corticotrophin-releasing factor (CRF) and urocortin possess a high-affinity binding protein. Although the CRF binding protein (BP) can sequester these ligands and inhibit their activity, the endogenous activity of this protein is not understood. Therefore, transgenic mouse lines that over-express the CRF-BP were created. The transgene was constructed by ligating rat CRF-BP cDNA (1.1 kb) between a mouse metallothionein-I promoter (1.8 kb) and a nonfunctional human growth hormone gene sequence (2.1 kb) in a modified pBR322 plasmid and microinjecting the transgene into C57BL/6 x SJL hybrid ova. The transgene was expressed in 50% in both male and female progeny. All transgenic lines were maintained by crossing transgenic animals with wild-type C57BL/6 mates. Reverse-transcriptase (RT) PCR of the CRF-BP transgene showed that it is widely expressed not only in the brain and pituitary, but also peripheral tissues including the liver, kidney and spleen. Transgenic animals of both sexes showed significant increases in weight gain as established by analysis of variance; however, the weight gain profiles for each sex were distinct. High levels of circulating CRF-BP were detected in the transgenic animals, but the basal ACTH and corticosterone levels were not significantly decreased compared to wild-type littermates. The hypothalamopituitary-adrenal (HPA) axis was stimulated by systemic inflammation induced with lipopolysaccharide (LPS). An expected increase in transgene expression was observed and was accompanied by a significant attenuation of ACTH secretion at 3 h after LPS injection in the transgenic males but not the females. These data suggest that HPA axis regulation is significantly affected only with very high circulating levels of CRF-BP. Moreover, this work supports previous studies that implicate CRF and urocortin in the regulation of appetite and the binding protein expression may play a sexually dimorphic role in regulating this and other responses.

Parent to parent support and health care

Parent to Parent programs offer a unique model for personalizing family support services according to family preferences. Over 500 of these programs across the United States provide emotional and informational support through careful matching of veteran parents with referred parents who have a child with a disability. A national survey of Parent to Parent program coordinators and participating parents examined referral sources, program supports, program demographics/descriptions, and examples of best practices. Parent to Parent programs can complement health care services by empowering parents through information and support and should be an essential component of a comprehensive family support system.

Cancer consequences of the Chernobyl accident in Europe outside the former USSR: a review

The accident which occurred during the night of April 25-26, 1986 in reactor 4 of the Chernobyl nuclear power plant in the Ukraine released considerable amounts of radioactive substances into the environment. Outside the former USSR, the highest levels of contamination were recorded in Bulgaria, Austria, Greece and Romania, followed by other countries of Central, Southeast and Northern Europe. Studies of the health consequences of the accident have been carried out in these countries, as well as in other countries in Europe. This report presents the results of a critical review of cancer studies of the exposed population in Europe, carried out on the occasion of the 10th anniversary of the Chernobyl accident. Overall, three is no evidence to date of a major public health impact of the Chernobyl accident in the field of cancer in countries of Europe outside the former USSR.

Brain-periphery connections: do they play a role in mediating the effect of centrally injected interleukin-1 beta on gonadal function?

The immune system and several endocrine axes communicate with each other through a network of molecules which collectively produce a coordinated response to immune challenges. This phenomenon, necessary for the survival of the organism, is thought to involve the release, by activated cells in the periphery, of proteins, called cytokines, which inform the brain about immune activation. The brain then organizes a series of neuroendocrine responses which participate in the regulation of the host response. With regard to the influence of cytokines on the hypothalamic-pituitary-gonadal axis, we know that the injection of these proteins lowers gonadotropin-releasing hormone release, which in turn inhibits luteinizing hormone (LH) secretion. These changes would be expected to decrease sex steroid production and, indeed, estrogens and testosterone are low in female and male rats, respectively, following acute intracerebroventricular (i.c.v.) injection of interleukin (IL)-1 beta. There is, however, another possibility that central cytokines could alter ovarian and testicular function independently of changes in gonadotropin levels. Prolonged i.c.v. infusion of the cytokine into the female rat brain produced a dramatic rise in progesterone levels. The absence of a comparable change in the progesterone release rate of males infused with IL-1 beta, and the presence of marked surges of prolactin (PRL) in the females, suggests that IL-1 beta altered ovarian function, and that the persistence of large corpora lutea induced PRL release. The possibility that the cytokine might stimulate the brain circuits that regulate PRL release, while possible, appears remote, because male rats injected with IL-1 beta showed significantly blunted PRL levels. In intact adult male rats, i.c.v. IL-1 beta administration caused the expected decrease in LH and testosterone levels, but was also accompanied by a loss of testicular responsiveness to gonadotropins. Though elevated levels of corticosteroids are known to interfere with normal gonadal steroidogenesis, blockade of IL-1-induced corticosterone release did not reverse the inhibitory influence of the cytokine. One mechanism that deserves attention is the possibility that i.c.v. injection of IL-1 beta might increase circulating cytokine levels, and indeed plasma IL-6 concentrations were significantly elevated in rats treated with IL-1 beta. This humoral mechanism may disrupt testicular function through the documented inhibitory effects of blood-borne cytokines on Leydig cell function. In addition, brain cytokines might influence a variety of peripheral events through direct (neural?) connections. This brief review discusses the hypothesis that there are brain-to-gonad connections that bypass the pituitary, and presents results that might support the possibility that central injection of IL-1 beta decreases testosterone secretion independently of blunted LH levels.

The abbreviated injury scale as a predictor of outcome of severe head injury

OBJECTIVE

This study examined the correlation between the worst abbreviated injury scale 1990 (AIS) intracranial severity score and outcome following severe head injury.

DESIGN

The initial CT scans of 109 severely head injury patients were examined by a neuroradiologist and classified according to the worst applicable intracranial severity code from the AIS. This score was then correlated with the glasgow outcome scale (GOS) at 6 months. For comparison, the GOS was also correlated with the diffuse injury scale (DIS) described by L.F. Marshall et al. [5], the worst post-resuscitation Glasgow coma score (GCS) in the first 24 h, and the head injury outcome prediction tree described by Choi et al. [1].

RESULTS

Our results show Spearman rank correlation coefficients of 0.58 (p < 0.001), 0.47 (p < 0.001), 0.45 (p < 0.001), and 0.31 (p < 0.01) for the correlation between the AIS, prediction tree, DIS, and GCS respectively and the GOS. Independent outcome (i.e. GOS good or moderate) was strongly predicted by an AIS of 3 or less (positive predictive value 95%, specificity 98%, sensitivity 40%, likelihood ratio 25:1). Death or vegetative survival was less strongly predicted in patients with an AIS of 5 (positive predictive value 71%, specificity 75%, sensitivity 67%, likelihood ratio 2.7:1).

CONCLUSION

The AIS, based on initial CT scan, provides useful prognostic information in patients with severe head injury.

Use of a Gammarus pulex bioassay to measure the effects of transient carbofuran runoff from farmland

There is now much information on the presence of pesticides in surface waters, but very little about their actual effects on aquatic life. This paper reports on the transient concentrations of a carbamate insecticide carbofuran, which were observed in a head-water stream draining treated farmland, and describes the resulting effects on a bioassay organism. One month after an application of 3 kg carbofuran/ha as broadcast granules to an oilseed rape crop, carbofuran concentrations of up to 26 micrograms/liter were measured in a nearby headwater stream after heavy rainfall. The majority of the carbofuran was translocated via field drains (where concentrations up to 264 micrograms/liter were detected), although the possibility of some surface runoff cannot be ruled out. Peak carbofuran concentrations only persisted for about 24 hr after the rainfall event, although measurable levels could be detected for at least 4 days. An in situ bioassay of streamwater which monitored the feeding rate of the gammarid amphipod crustacean Gammarus pulex showed that feeding stopped completely during the rainfall event, and was rapidly followed by death of all the caged organisms. Subsequent laboratory studies of toxicity showed that the peak concentrations of carbofuran had exceeded the G. pulex 24-hr LC50 of 21 micrograms/liter, and that concentrations as low as 4 micrograms/liter could reduce feeding rate. These findings are discussed with reference to regulatory risk evaluation procedures.

Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination

OBJECTIVE

To examine the results of treatment of laparoscopically discovered gallbladder cancer.

DESIGN

Retrospective review of clinical data for the 10 patients with laparoscopically discovered gallbladder cancer who were referred to our institution for definitive surgical therapy.

SETTING

An oncologic referral center.

PATIENTS

All patients in the 24-month period from November 1990 to November 1992 with this entity who were referred for surgical therapy.

INTERVENTION

Exploratory laparotomy was performed on all patients. Resection with curative intent was performed when possible.

MAIN OUTCOME MEASURES

Resectability and outcome of cancer treatment.

RESULTS

In three patients, a subsequent radical resection was performed and as a result, two patients are currently free of disease. Intraperitoneal spread, not present at the original laparoscopy and associated with violation of tumor at laparoscopy, precluded potentially curative resection for four patients. In two of these patients, there was obvious tumor growth within the laparoscopy tracts.

CONCLUSIONS

Tumor dissemination is a real hazard of laparoscopic violation of gallbladder integrity in the presence of gallbladder cancer. Modification of management based on awareness of such a hazard is needed to improve resectability and outcome of future cases of laparoscopically discovered gallbladder cancer.

A prospective, randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunneled chronic venous access catheter infections in cancer patients

OBJECTIVE

This study was performed to evaluate the effect of a silver-impregnated cuff on the incidence of catheter-related bacteremia/fungemia or tunnel tract infection in cancer patients with chronic dual-lumen tunneled venous access catheters.

SUMMARY BACKGROUND DATA

Infection is a frequent and potentially life-threatening complication of tunneled chronic cuffed silastic central venous access catheters in cancer patients. Recent experience with antimicrobial silver-impregnated cuffs placed on nontunneled percutaneously inserted central venous catheters suggests that such a cuff may render the catheter less prone to infection.

METHODS

The authors prospectively randomized 200 cancer patients to receive either a dual-lumen 10 French tunneled cuffed silastic central venous access catheter or the same catheter with a second more proximal subcutaneous silver-impregnated cuff. All patients then were followed prospectively for infectious morbidity until the device was removed or the patient died.

RESULTS

The hazard rate for infection/day (95% confidence limits) was 0.0022 (0.0015 to 0.0030) for standard catheters compared with 0.0027 (0.0019 to 0.0037) for catheters with silver-impregnated cuffs (p = not significant). Regression analysis of infection-free interval of both catheter types shows no difference over the lifetime of catheter as well as the over the first 48 days after insertion.

CONCLUSIONS

The study indicated no effect of a silver-impregnated cuff in decreasing the incidence of catheter-related bacteremias/fungemias, tunnel infections, or the spectrum of causative microorganisms involved in cancer patients with tunneled chronic venous access catheters.

Prospective comparison of videopelviscopy with laparotomy for ectopic pregnancy

OBJECTIVE

To compare operative laparoscopy with laparotomy for the management of ectopic pregnancy in haemodynamically stable women.

DESIGN

Non-randomized prospective cohort study, treatment allocation depending on the surgical preference and experience of the on-call medical team.

SETTING

Provincial undergraduate teaching hospital.

SUBJECTS

87 consecutive and unselected haemodynamically stable women treated for ectopic pregnancy between 1 March 1988 and 31 August 1989.

INTERVENTIONS

Salpingotomy, salpingectomy, salpingo-oophorectomy or simple extraction of the ectopic pregnancy depending on its site, size and nature performed under laparoscopic control or laparotomy.

MAIN OUTCOME MEASURES

Operative outcome, duration of surgery, intra- and post-operative complications, post-operative hospital stay, return to normal domestic activities, return to work, changes in plasma beta-hCG concentrations, health and social service costs.

RESULTS

60 women were treated by videopelviscopy on 65 occasions and the other 27 were treated by laparotomy. The two groups were similar for age, parity and gestation at presentation. Of the 65 operative laparoscopies 61 (94%) were successful and all 27 laparotomies were completed uneventfully. Whereas the operating time was similar in the two groups, 55.3 and 51.1 min for videopelviscopy and laparotomy respectively, operative laparoscopy was associated with significantly shorter post-operative hospital stay (1.7 vs 5.2 days), faster return to domestic activities (1.5 vs 3.3 weeks) and work (2.5 vs 5.7 weeks) (P less than 0.001 for all). In economic terms, successful videopelviscopy was associated with a reduction in hospital accommodation costs by 69% (248 pounds vs 808 pounds), drug costs by 52% (8.38 pounds vs 17.57 pounds) and statutory sickness payment by 51% (130.25 pounds vs 266.51 pounds), that is an overall saving to the health and social services of 701.47 pounds or 50% per ectopic pregnancy (P less than 0.001).

CONCLUSIONS

Operative laparoscopy can be used to successfully treat most cases of extrauterine pregnancy with advantages over laparoscopy in terms of reduced hospitalization, faster recovery and lower health service costs.