Pulmonary metastasectomy in colorectal cancer: time for a trial

Pulmonary metastasectomy is undertaken for a range of cancers. The questions we raise here are specifically related to colorectal cancer, the commonest tumour for which pulmonary metastasectomy is undertaken. The primary objective of metastasectomy is to increase survival. There are no randomised trials in support of this practice nor are there any other forms of controlled studies. We present a critical look at the assumption of efficacy for this surgery and propose that a trial is needed and suggest a trial design.

Helicobacter pylori lipopolysaccharide interacts with TFF1 in a pH-dependent manner

BACKGROUND & AIMS

Little is known about how bacteria establish chronic infections of mucosal surfaces. Helicobacter pylori (H. pylori), a chronic pathogen that lives in the gastric mucosa of humans, interacts with the trefoil factor family (TFF) protein TFF1, which is found in gastric mucus. We aimed to characterize the interaction of H. pylori with TFF1 and to assess the role of this interaction in mediating colonization.

METHODS

Subcellular fractions of H. pylori were immobilized and then probed with TFF1, TFF2, or TFF3. The effect of glycosidases and preincubation with monosaccharides on the interaction and binding of TFF1 to a H. pylori adhesin was assessed. The interaction between H. pylori adhesin and TFF1 was characterized using surface plasmon resonance, flow cytometry, nondenaturing polyacrylamide gel electrophoresis, coimmunofluoresence, and incubation with tissue sections.

RESULTS

The H. pylori core oligosaccharide portion (rough form) of lipopolysaccharide (RF-LPS) bound to TFF1 and to a lesser extent TFF3; this interaction was inhibited by incubation of RF-LPS with mannosidase, glucosidase, or mixed monosaccharides. TFF1 also bound to human serum albumin-conjugated mannose and glucose. The optimum pH for binding was 5.0-6.0 for TFF1 and 7.0 for TFF3. H. pylori bound TFF1 in gastric mucus ex vivo; binding of LPS-coated latex beads to human antral gastric tissue was inhibited by TFF1.

CONCLUSIONS

TFF1 interacts specifically with H. pylori RF-LPS. The pH dependence of this interaction indicates that binding of H. pylori to TFF1 in the stomach could promote colonization of the mucus layer adjacent to the gastric epithelial surface.

Chronic hepatitis C infection in a patient with bone marrow hypoplasia

Chronic hepatitis C virus (HCV) infection is associated with multifarious extra-hepatic manifestations; the most described and discussed being mixed cryoglobulinemia which is strongly related to B-cell lymphoproliferative disorders (LPDs). We present a case of chronic HCV infection and mixed cryoglobulinemia, with minimal liver involvement. The case is a 53-year-old patient who was diagnosed as having bone marrow hypoplasia at the age of three. She received several blood transfusions to normalize her haemoglobin. At the age of 31, she was diagnosed with rheumatoid arthritis on account of her diffuse joint pain and inflammation, elevated rheumatoid factor (RF) and Raynaud’s phenomenon. Twenty years later, monoclonal gammopathy of IgG Lambda (one year later, changed to IgM Kappa) was detected during a routine examination. A bone marrow biopsy showed hypoplasia, Kappa positive B-lymphocytes and low-grade malignant lymphoma cells. PCR of the bone marrow aspirate was not contributory. No treatment was initiated owing to her poor bone marrow function and she is under regular follow-up.

High throughput ranking of recombinant avian scFv antibody fragments from crude lysates using the Biacore A100

Advances in molecular evolution strategies have made it possible to identify antibodies with exquisite specificities and also to fine-tune their biophysical properties for practically any specified application. Depending on the desired function, antibody/antigen interactions can be long-lived or short-lived and, therefore, particular attention is needed when seeking to identify antibodies with specific reaction-rate and affinity properties. Surface plasmon resonance (SPR) biosensors routinely generate sensitive and reliable kinetic data from antibody/antigen interactions for both therapeutic and diagnostic applications. However, many kinetic-based screening assays require rigorous sample preparation and purification prior to analysis. To ameliorate this problem, we developed a rapid and reliable assay for characterising recombinant scFv antibody fragments, directly from crude bacterial lysates. Ninety-six scFv antibodies derived from chickens immunised with C-reactive protein (CRP) were selected by phage display and evaluated using the Biacore A100 protein interaction array system. Antibodies were captured from crude bacterial extracts on the sensor chip surface and ranked based on the percentage of the complex left (% left) after dissociation in buffer. Kinetic rate constants (k(a) and k(d)) and affinity (K(D)) data were obtained for six clones that bound monomeric CRP across a broad affinity range (2.54 x 10(-8) to 3.53 x 10(-10) M). Using this assay format the A100 biosensor yielded high quality kinetic data, permitting the screening of nearly 400 antibody clones per day.

Biosensor developments: application to prostate-specific antigen detection

Prostate-specific antigen (PSA) is the best serum marker currently available for the detection of prostate cancer and is the forensic marker of choice for determining the presence of azoospermic semen in some sexual assault cases. Most current assays for PSA detection are processed on large analyzers at dedicated testing sites, which require that samples be sent away for testing. This leads to delays in patient management and increased administration costs. The recent emphasis placed on the need for point-of-care patient management has led to the development of novel biosensor detection strategies that are suitable for the miniaturization of assays for various targets including PSA. This review highlights the current and novel analytical technologies used for PSA detection, which will benefit clinicians, patients and forensic workers in the future.

[New approaches to the treatment of the HIV-infected patient]

HIV infection remains a major problem of public health in Belgium as well as globally. The number of new diagnosies of HIV infection in Belgium remains between two and three daily. Given the dramatic effect of antiretroviral therapy on the mortality due to HIV infection, the number of patients is constantly increasing. The different problems related to HIV care are also changing. Aging of the patients and chronic exposure to antiretroviral medications have induced new complications. We will present in this brief article several new experimental and clinical approaches in which our centre has participated during the last two years.

Production, characterisation and potential application of a novel monoclonal antibody for rapid identification of virulent Listeria monocytogenes

A panel of hybridomas was produced using intact Listeria monocytogenes serotype 1/2a cells as the immunogen. An IgG2a monoclonal antibody (mAb) 'mAb2B3' was isolated that reacted with L. monocytogenes but not with a representative panel of related Listeria spp. and non-Listeria spp. Binding activity was greatest against L. monocytogenes serotype 1/2a and was significantly enhanced when cells were prepared in Listeria enrichment broth (LEB). The reactive epitope was deduced, by immunoblot analysis, to be a surface localised protein of approximately 80 kilodaltons (kDa), putatively assumed to be internalin A (InlA). Recombinant InlA protein was subsequently expressed in Escherischia coli. When crude E. coli cell lysates were subjected to immunoblot analysis, it was demonstrated that the mAb bound specifically to the heterologously expressed recombinant InlA protein, thus confirming the specificity of the mAb. The mAb was further evaluated in a series of enzyme-linked-immunosorbent assay (ELISA)-based formats and in a surface plasmon resonance (SPR)-based biosensor platform. Both configurations were capable of differential identification of virulent L. monocytogenes at concentrations greater than or equal to 1x10(7) cells/ml. Notwithstanding the apparent insensitivity, the results indicate that InlA could be exploited as a marker for highly specific confirmatory identification of pathogenic L. monocytogenes following primary enrichment of suspect food samples, using the anti-InlA antibody 'mAb2B3', described herein.

The development of rapid fluorescence-based immunoassays, using quantum dot-labelled antibodies for the detection of Listeria monocytogenes cell surface proteins

Listeria monocytogenes is an important food-borne pathogen with an extremely high mortality rate (approximately 30%). Therefore, a highly sensitive, reproducible and rapid assay for its detection is vital. L. monocytogenes cells employ two surface bound proteins, Internalin A (InlA) and Internalin B (InlB) to promote invasion into host cells. Recombinant forms of both proteins were previously cloned and expressed in Escherichia coli. In this paper we describe how the InlB protein was sub-divided into three shorter overlapping peptide fragments yielding truncated functional protein of M(R) 23, 35 and 45 kDa, respectively. Purification of the InlB fragments by immobilised metal affinity chromatography (IMAC) was optimised and confirmed by electrophoresis and Western blotting. Identification of the antibody binding regions was achieved by probing the expressed polypeptide domains with a panel of antibodies and antibody fragments. The cloned peptide fragments were also used to develop novel fluorescence-based immunoassays incorporating quantum dots. The application of quantum dot-labelled anti-InlA monoclonal antibodies for immunostaining L. monocytogenes was also demonstrated.

Rickets in an adolescent girl

The authors present a case of rickets in an adolescent girl who presented to the emergency department with bone pain. Emergency department staff should be aware that rickets is not just a disease of early childhood.

[A review about nephropathia epidemica]

We propose a review of history, aetiology, physiopathology, clinical features, treatment and prevention of nephropathia epidemica (NE) which represents the only form of Hantavirus infection in Belgium.

[HIV seroprevalence among tuberculosis patients in Nkembo Hospital, Libreville, Gabon. Short note]

There are nearly 31,000 HIV infected patients in Gabon. In Libreville, the capital, the prevalence is estimated at 7.7%. About 2627 tuberculosis patients, all types included, have been notified in 2001 to the World Health Organization of which 43% of smear positive new cases. The co-infection HIV-TB worsens the overall prognosis of our patients. The objective of our study is to determine the HIV seroprevalence among our tuberculosis patients. It is a cross-sectional study conducted between June 25th and August 31th 2001. All patients are new or relapse tuberculosis cases. There is no difference between the types of tuberculosis. The diagnosis was clinical, radiological and based on smear AFB sputum (according to the Ziehl Neelsen method). The patients agreed orally for HIV testing. We made two tests: a rapid one followed by Elisa if positive. 358 patients were examined among them 141 women and 217 men. The M/F sex ratio was 1.53 and the average age 32 years. Proportion of new patients reached 61%. Ninety seven per cent of patients suffered from a pulmonary tuberculosis, 58% smear positive and 26% were HIV-1 positive. According to this status, no statistical difference was notified towards sex, types of disease or patients and the smear sputum results.

Development of a surface plasmon resonance-based immunoassay for Listeria monocytogenes

A polyclonal antibody was produced against Internalin B (InlB)-enriched extract and used to develop an inhibition assay to detect Listeria monocytogenes cells in solution using surface plasmon resonance. The gene sequence encoding for the InlB protein was cloned into a Qiagen pQE-60 vector, expressed in Escherichia coli, and purified by immobilized metal affinity chromatography. Protein G-purified anti-InlB-enriched extract polyclonal antibody was incubated with various concentrations of L. monocytogenes cells and subsequently injected over a purified-recombinant InlB (rInlB)-immobilized CM5 sensor chip surface. A decrease in antibody binding response was observed with increasing L. monocytogenes cell concentrations. Intraday and interday assay variability studies were carried out to evaluate precision and reproducibility. The assay had a limit of detection of less than 2 x 10(5) cells per ml and could be successfully reproduced with coefficients of variation of between 2.5 and 7.7%.

Wavelet analysis of pulse oximeter waveform permits identification of unwell children

BACKGROUND

Children who are unwell often display signs of circulatory compromise. It has been observed that pronounced changes occur in the appearance of the photoplethysmogram (pulse oximeter tracing) in these children. The aim of the study was to discover if wavelet transforms can identify more subtle changes in the photoplethysmogram of children who are unwell.

METHODS

Photoplethysmograms were obtained from children attending a paediatric accident and emergency department with clinical features suggestive of significant bacterial illness or circulatory compromise. Photoplethysmograms were also obtained from a control group of well children. Wavelet transforms were applied to the traces in an attempt to separate the two groups.

RESULTS

20 traces were obtained from unwell children and 12 from controls. Analysis of the entropy of the wavelet transform of the photoplethysmogram allows the differentiation of unwell children from controls (p = 0.00002).

CONCLUSIONS

Wavelet transform of the photoplethysmogram offers the possibility of a rapid non-invasive method of screening children for significant illness.

Novel assay format permitting the prolonged use of regeneration-based sensor chip technology

A polyclonal antibody raised against morphine-3-glucuronide (M3G, the main metabolite of heroin and morphine) was used in the development of a novel assay format using a surface plasmon resonance (SPR)-based biosensor. Previously developed assays have generated calibration curves based on differences in the quantity of response units binding to the surface of a chip coated with the analyte. The novel assay described here was based on the development of a standard curve using the slope of a series of consecutive binding interactions. Using this format, regeneration between each assay cycle was no longer required. This increased the useable life span of the chip surface and, as a result, decreased the cost associated with the assay. Thus, at least 15 binding interactions could be carried out before the saturation of antibody on the surface of the chip caused the response to deviate significantly from linearity. After 15 nonregenerated binding interactions, the slope still remained within 1.5% of the slope after a single binding event. Analysis time, and the sample volumes required were also markedly decreased while sensitivity was enhanced. The inhibition assay developed had a detection range of 270 to 17,500 pg ml(-1).

Standard pulse oximeters can be used to monitor respiratory rate

BACKGROUND

One of the most important limitations of standard pulse oximeters is the inability to detect changes in respiratory rate until oxygenation is affected. This study sought to determine if analysis of the plethysmogram by wavelet transforms would enable the determination of changes in respiratory rate at an earlier stage.

METHODS

Ten healthy adult volunteers were monitored, breathing at baseline and predetermined respiratory rates, using a standard pulse oximeter. Photo-plethysmograms captured in an attached lap top computer were then analysed using wavelet transforms.

RESULTS

Determination of baseline respiratory rate and subsequent changes including apnoea were easily identified.

COMMENT

Wavelet transforms permit the accurate determination of respiratory rate by a standard pulse oximeter.

An Algorithm for the Detection of Individual Breaths from the Pulse Oximeter Waveform

OBJECTIVES

To determine if wavelet analysis techniques can be used to reliably identify individual breaths from the photoplethysmogram (PPG).

METHODS

Photoplethysmograms were obtained from 22 healthy adult volunteers timing their respiration rate in synchronisation with a metronome. A secondary timing signal was obtained by asking the volunteers to actuate a small push button switch, held in their right hand, in synchronisation with their respiration. Each PPG was analyzed using primary wavelet decomposition and two new, related, secondary decompositions to determine the accuracy of individual breath detection.

RESULTS

The optimal breath capture was obtained by manually polling the three techniques, allowing detection of 466 out of the 472 breaths studied; a detection rate of 98.7% with no false positive breaths detected.

CONCLUSION

Our technique allows the accurate capture of individual breaths from the photoplethysmogram, and leads the way for developing a simple non-invasive combined respiration and saturation monitor.

A generic approach for the detection of whole Listeria monocytogenes cells in contaminated samples using surface plasmon resonance

The opportunistic food pathogen Listeria monocytogenes is of great concern to the food industry and its rapid detection is of major importance. This paper describes the detection of L. monocytogenes with a polyclonal antibody by means of a new subtractive inhibition assay using a BIAcore 3000 biosensor. Incubating L. monocytogenes cells and antibody for a short period of time, followed by subsequent separation of free unbound antibody with a stepwise centrifugation process, allowed the detection of 1 x 10(5) L. monocytogenes cells/ml in less than 30 min. Free antibody was passed over an anti-Fab ligand-coated sensor chip surface with the generated response being inversely proportional to the inhibiting cell concentration. The method was simple, rapid and needed minimum sample preparation. This assay format has the potential for the quick and sensitive detection of pathogens with limited sample handling and preparation.

A questionnaire survey of stress and bullying in doctors undertaking research

BACKGROUND

Research is an increasingly important aspect of higher medical training for many doctors. Studies investigating sources of stress, isolation, and workplace bullying have not previously sought information in this setting.

METHODS

An internet based questionnaire survey of doctors undertaking research (n = 259) was conducted to examine stressors and levels of job satisfaction in this potentially vulnerable group. In order to assess overall levels of satisfaction, we asked whether doctors would recommend their research post to a colleague.

RESULTS

There was a statistically significant association between those who would not recommend their post to a colleague and those who had difficulties in arranging funding and in writing up (p<0.001). Further significant correlations were found between dissatisfaction with the post and lack of help, support, and advice from supervisors and colleagues, wanting to change supervisors, experience of the major categories of workplace bullying, and having an inadequate clinical commitment (p<0.001). When the significant variables were entered into a multivariate analysis, the results showed that dissatisfaction was associated with wanting to change supervisors and with a threat to professional status.

CONCLUSIONS

Stress and bullying are common in doctors undertaking research. These findings have important implications for medical training and for doctors choosing research projects. Setting up systems of support may have important benefits.