First report of extended-spectrum-beta-lactamase-producing Salmonella enterica serovar Kentucky isolated from poultry in Ireland

Therapy of invasive human salmonellosis is complicated by increasing antimicrobial resistance. Food animals are the principal source of infection with nontyphoid Salmonella. We report the emergence of broad-spectrum-cephalosporin resistance in Salmonella enterica serovar Kentucky in poultry in Ireland.

The use of thalidomide in the management of bleeding from a gastric cancer

Medical management of severe gastrointestinal bleeding can present a therapeutic challenge. We describe a case of bleeding secondary to gastric cancer that failed to settle, despite treatment with tranexamic acid, etamsylate and sucralfate. Thalidomide was prescribed for its antiangiogenic properties. Bleeding settled within 1 week of starting 300 mg of thalidomide nocte. The effect appeared to be dose dependent, with bleeding recurring only when the dose was reduced to 100 mg of thalidomide nocte.

Marie R, Subra W, Petronella S, Gorenstein J, Fuchs-Young R, Santa R, Chavarria A, Ward J, Diamond P. Public talks and science listens: a community-based participatory approach to characterizing environmental health risk perceptions and assessing recovery needs in the wake of hurricanes katrina and rita

In response to the human health threats stemming from Hurricanes Katrina and Rita, inter-disciplinary working groups representing P30-funded Centers of the National Institute Environmental Health Sciences were created to assess threats posed by mold, harmful alga blooms, chemical toxicants, and various infectious agents at selected sites throughout the hurricane impact zone. Because of proximity to impacted areas, UTMB NIEHS Center in Environmental Toxicology was charged with coordinating direct community outreach efforts, primarily in south Louisiana. In early October 2005, UTMB/NIEHS Center Community Outreach and Education Core, in collaboration with outreach counterparts at The University of Texas MD Anderson Cancer Center @ Smithville TX/Center for Research in Environmental Disease sent two groups into southern Louisiana. One group used Lafourche Parish as a base to deliver humanitarian aid and assess local needs for additional supplies during local recovery/reclamation. A second group, ranging through New Iberia, New Orleans, Chalmette, rural Terrebonne, Lafourche and Jefferson Parishes and Baton Rouge met with community environmental leaders, emergency personnel and local citizens to 1) sample public risk perceptions, 2) evaluate the scope and reach of ongoing risk communication efforts, and 3) determine how the NIEHS could best collaborate with local groups in environmental health research and local capacity building efforts. This scoping survey identified specific information gaps limiting efficacy of risk communication, produced a community "wish list" of potential collaborative research projects. The project provided useful heuristics for disaster response and management planning and a platform for future collaborative efforts in environmental health assessment and risk communication with local advocacy groups in south Terrebonne-Lafourche parishes.

The effectiveness of methadone maintenance treatment: an overview

This paper reviews the evidence for the effectiveness of methadone maintenance as used in the treatment of opioid dependence. Findings from randomized controlled trials and observational studies suggest that methadone maintenance reduces heroin use, crime, injection-related risk behaviours and premature mortality among people dependent on opioids. The research further suggests that two aspects of treatment are important in ensuring this effectiveness. Methadone treatment is more effective when higher doses (>50 mg) are employed and, overall, the evidence suggests that a treatment goal of successful maintenance on methadone rather than total abstinence is appropriate. The importance of ancillary services in treatment outcome is less clear and is the subject of current research and debate.

CYP2B6 G516T genotyping in a UK cohort of HIV-positive patients: polymorphism frequency and influence on efavirenz discontinuation

OBJECTIVES

The nonnucleoside reverse transcriptase inhibitor (NNRTI) efavirenz undergoes phase I metabolism by the cytochrome P450 enzyme, CYP2B6. Previous studies outside of the United Kingdom have shown associations between the CYP2B6 polymorphism G516T and increased toxicity. This study aimed to develop a CYP2B6 G516T genotyping assay to identify individuals at risk of efavirenz toxicity. The frequency of this polymorphism in a UK HIV-infected population and its prevalence in individuals who had discontinued efavirenz were also to be assessed.

METHODS

Genomic DNA from HIV-positive patients (n = 206) attending clinic at Southmead Hospital, North Bristol NHS Trust was extracted from spare blood taken for CD4 monitoring. An allele-specific polymerase chain reaction (PCR) method for the CYP2B6 G516T polymorphism was used to assign patients' genotypes. Patients' age, sex, ethnicity and drug history were also recorded.

RESULTS

The G516T polymorphism was more prevalent in Blacks (16%; n = 10/63) than Caucasians (6%; n = 9/143). No significant difference in the distribution of genotypes between individuals who had discontinued efavirenz (n = 31) and individuals who had continued efavirenz (n = 74) was observed (chi(2); P = 0.63).

CONCLUSIONS

A genotyping method for the CYP2B6 G516T method was used to assess the polymorphism frequency in a UK cohort of HIV-infected patients. The polymorphism was not more prevalent in individuals who had discontinued efavirenz. Reasons for drug discontinuation are likely to be multifactorial and as this study showed cannot be explained by this genetic difference alone. For this reason we do not advocate testing for this polymorphism in routine clinical practice at present.

Endogenous opioids modify dyspnoea during treadmill exercise in patients with COPD

Exogenous opioid drugs, such as morphine, relieve breathlessness. The present study hypothesis was that endogenous opioids, released during the stress of exercise, modify dyspnoea in patients with chronic obstructive pulmonary disease. After familiarisation, patients performed an incremental treadmill exercise test followed by constant work on the treadmill for 10 min. At subsequent visits (2 to 3 days apart), patients received two puffs of albuterol, had a catheter placed in an arm vein for removal of blood to measure beta-endorphin immunoreactivity, received normal saline or 10 mg of naloxone intravenously in randomised order, and then performed high-intensity constant work rate exercise on the treadmill. The mean+/-sd age of the 17 patients (eight females and nine males) was 63+/-7 yrs, and post-bronchodilator forced expiratory volume in one second was 50+/-17% predicted. In both conditions, beta-endorphin levels increased three-fold from rest to end-exercise. The regression slope of breathlessness as a function of oxygen consumption (primary outcome), mean ratings of breathlessness throughout exercise and peak ratings of breathlessness were significantly higher with naloxone than normal saline. There were no differences in physiological responses throughout exercise between conditions. In conclusion, endogenous opioids modify dyspnoea during treadmill exercise in patients with chronic obstructive pulmonary disease by apparent alteration of central perception.

Sinusoidal obstructive syndrome diagnosed with superparamagnetic iron oxide-enhanced magnetic resonance imaging in patients with chemotherapy-treated colorectal liver metastases

PURPOSE

To assess the predictive value of superparamagnetic iron oxide (SPIO) -enhanced T2-weighted gradient echo (GRE) imaging to determine the presence and severity of sinusoidal obstructive syndrome (SOS).

PATIENTS AND METHODS

Sixty hepatic resection patients with colorectal metastases treated with chemotherapy underwent unenhanced magnetic resonance imaging (MRI) followed by T2-weighted GRE sequences obtained after SPIO. The images were reviewed in consensus by two experienced observers who determined the presence and severity of linear and reticular hyperintensities, indicating SOS-type liver injury, using a 4-point ordinal scale. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% CIs for the detection of SOS were calculated.

RESULTS

Twenty-four of 60 patients had moderate to severe SOS on MRI. MRI achieved a sensitivity of 87% (95% CI, 66% to 97%), specificity of 89% (95% CI, 75% to 97%), PPV of 83% (95% CI, 63% to 95%), and NPV of 92% (95% CI, 77% to 98%). SOS was never found at surgery or histology in patients whose background liver parenchyma was normal on SPIO-enhanced MRI.

CONCLUSION

SOS is present in a significant proportion of patients with treated colorectal metastases and is effectively detected on SPIO-enhanced T2-weighted GRE images.

An alloantibody to a high-prevalence MNS antigen in a person with a GP.JL/Mk phenotype

The low-prevalence MNS blood group antigenTSEN is located at the junction of glycophorin A (GPA) to glycophorin B (GPB) in several hybrid glycophorin molecules. Extremely rare people have RBCs with a double dose of the TSEN antigen and have made an antibody to a high-prevalence MNS antigen. We report the first patient who is heterozygous for GYP.JL and Mk. During prenatal tests,an alloantibody to a high-prevalence antigen was detected in the serum of a 21-year-old Hispanic woman. The antibody detected an antigen resistant to treatment by papain, trypsin, alpha-chymotrypsin, or DTT. The antibody was strongly reactive by the IAT with all RBCs tested except those having the MkMk, GP.Hil/GP.Hil, or GP.JL/GP.JL phenotypes. The patient's RBCs typed M+N-S+/-s-U+, En(a+/-), Hut-, Mi(a-), Mur-, Vw-, Wr(a-b-), and were TSEN+, MINY+. Reactivity with Glycine soja suggested that her RBCs had a decreased level of sialic acid. Immunoblotting showed the presence of monomer and dimer forms of a GP(A-B) hybrid and an absence of GPA and GPB. Sequencing of DNA and PCR-RFLP using the restriction enzyme RsaI confirmed the presence of a hybrid GYP(AB). The patient's antibody was determined to be anti-EnaFR. She is the first person reported with the GP.JL phenotype associated with a deletion of GYPA and GYPB in trans to GYP.JL.

Late results of mesh wound closure after elective open aortic aneurysm repair

INTRODUCTION

Incisional hernia is a common late complication after abdominal aortic aneurysm (AAA) repair. We examined the outcome after prophylactic placement of a pre-peritoneal polypropylene mesh during abdominal closure in consecutive patients having elective AAA repair.

REPORT

At least 30 months after surgery, 28 patients underwent clinical and ultrasound examination of their surgical wound for incisional hernias. Only one patient had a hernia in the original surgical scar. No patients had late mesh-related wound problems.

DISCUSSION

Pre-peritoneal polypropylene mesh placement is a simple, safe and effective method to decrease the incidence of incisional hernia after AAA repair.

Planning for an adaptive design: a case study in COPD

We discuss the practical and clinical considerations encountered when planning a Phase IIa trial in chronic obstructive pulmonary disease (COPD). Various adaptive strategies for reducing the cost of the trial and the statistical implications of these are explored. Use of the EAST software to evaluate the properties of the study designs with one or more interim analyses for futility, efficacy or either is described. We emphasize the rationale for choosing between alternative designs and the relationship between the clinical and statistical considerations.

Salmonella surveillance in raw and cooked meat and meat products in the Republic of Ireland from 2002 to 2004

The food industry, under the regulation of the Department of Agriculture and Food (DAF) in the Republic of Ireland, is required to undertake all microbiological testing in relation to zoonoses control, in laboratories approved by DAF. These laboratories submit a monthly report of all tests undertaken, together with all presumptive Salmonella isolates for confirmation, typing and storage to the Central Veterinary Research Laboratory (CVRL). Details of Salmonella tests on 110,229 raw and 25,189 cooked meat samples from 25 laboratories were recorded over the 3-year period 2002-2004. Salmonella spp. were isolated from 1.0% of the 110,229 raw meat samples and 0.1% of the 25,189 cooked meat samples tested. The percentage of raw meat samples contaminated with Salmonella decreased over the three-year period from 1.2% to 0.9%. There was no seasonal trend in the isolation of Salmonella from any of the meats or meat products. Recoveries of the organism were highest for turkey and chicken meats at 3.1% and 2.8%, respectively, followed by porcine meats at 2.1%. The recoveries were much lower for ovine meats and meat products at 0.2% and bovine meat and meat products at 0.16%.

HLA Cw*06 is not essential for streptococcal-induced psoriasis

BACKGROUND

Streptococcal throat infections and HLA Cw6 (Cw*06) have been implicated in the pathogenesis of psoriasis, particularly in the guttate form.

OBJECTIVES

To study 105 Irish patients with psoriasis to investigate the relationship between streptococcal infections and Cw*06.

METHODS

The patients were divided into two groups: those with guttate psoriasis or guttate flare (guttate group, GG, n=64) and those with chronic plaque psoriasis (chronic plaque group, CPG, n=41).

RESULTS

The incidence of Cw*06 was 86% in the GG and 73% in the CPG, which was not significantly different (P=0.1725) but the incidence in both groups was significantly higher than in an Irish control group (18%) (P<0.0001 vs. GG and P<0.0001 vs. CPG). Evidence for streptococcal infection was higher in the GG (56%) than in the CPG (32%) (P=0.0231). Of those patients with evidence of streptococcal infection, 30 of 36 GG (83%) and nine of 13 CPG (69%) patients possessed the Cw*06 genotype.

CONCLUSIONS

Thus, not all patients with streptococcal-related psoriasis carry Cw*06. The role of Cw*06 in psoriasis, if any, has yet to be determined.

Patient safety, systems design and ergonomics

The complexity of the health care environments necessitates an holistic and systematic ergonomics approach to understand the potential for accidents and errors to occur. The health service is also a socio-technical system, and design needs must be met within this context. This paper aims to present the design challenges and emphasises the specialised needs of the health care sector, when dealing with patient safety. It also provides examples of approaches and methods that ergonomists can bring to help inform our knowledge of these systems and the potential towards improving their safety. Mapping workshops provide an example of such methods. Results from these are used to illustrate how the knowledge base required for better design requirements can be generated. The workshops were developed specifically to help improve the design of medication packaging and thereby reduce the probability of medication error. The issues raised are now the subject of further research, design requirements guidance and new design concepts. The paper illustrates the need to engage with the design community and, through the use of robust scientific methods, to generate appropriate design requirements.

Evidence-based clinical policy: case report of a reproducible process to encourage understanding and evaluation of evidence

We report within a case study a reproducible process to facilitate the explicit incorporation of evidence by a multidisciplinary group into clinical policy development. To support the decision-making of a multidisciplinary Intersectoral Advisory Group (IAG) convened by the Royal Australasian College of Physicians Health Policy Unit, a systematic review of randomized controlled trials about environmental tobacco smoke and smoking cessation interventions in paediatric settings was first undertaken. As reported in detail here, IAG members were then formally engaged in a transparent and replicable process to understand and interpret the synthesized evidence and to proffer their independent reactions regarding policy, practice and research. Our intention was to ensure that all IAG members were democratically engaged and made aware of the available evidence. As clinical policy must engage stakeholder representatives from diverse backgrounds, a process to equalize understanding of the evidence and 'democratize' judgment about its implications is needed. Future research must then examine the benefits of such explicit steps when guidelines, in turn, are implemented. We hypothesize that changes to future practice will be more likely if processes undertaken to develop guidelines are transparent to clinicians and other target groups.

New MR techniques for the detection of liver metastases

It is well established that hepatic resection improves the long-term prognosis of many patients with liver metastases. However, incomplete resection does not prolong survival, so knowledge of the exact extent of intra-hepatic disease is crucially important in determining patient management and outcome. MR imaging is well recognised as one of the most sensitive methods for detecting metastases. Recent developments in gradient coil design, the use of body phased array coils and the availability of novel MR contrast agents have resulted in MR being recognised as the pre-operative standard in this group of patients. However, diagnostic efficacy is extremely dependent on the choice and optimisation of pulse sequences and the appropriate use of MR contrast agents. This article reviews current MR imaging techniques for the detection and characterisation of metastases and discusses the relative capability of different techniques for detecting small lesions.

Identification of erythrobactin, a hydroxamate-type siderophore produced by Saccharopolyspora erythraea

AIMS

To investigate the production of siderophores by Saccharopolyspora erythraea SGT2 and how this production is affected by the inoculum.

METHODS AND RESULTS

When grown in a low-iron, chemically defined medium (CDM), the soil dwelling actinomycete S. erythraea secretes a substance that is reactive in the nonspecific chrome azurol S (CAS) assay. Importantly, the production of CAS-reactive substance is highly reduced upon the addition of 0.925 micromol l(-1) iron to the cultures and has a peak of production in the late-log to early stationary growth phase. In addition, the culture supernatants tested were negative in the Arnow and Rioux assays but positive in the Csáky procedure. Interestingly, we also found evidence that the production of this CAS-reactive substance in CDM was highly reduced, when inoculated with cells that had been previously grown to late-stationary phase. Conversely, inocula derived from late-log to early stationary cultures presented high levels of CAS activity.

CONCLUSIONS

These results indicate that S. erythraea produces a hydroxamate-type siderophore that we have generically designated as erythrobactin. Additionally, the inocula growth stage plays a key role in siderophore production in S. erythraea.

SIGNIFICANCE AND IMPACT OF THE STUDY

It is the first evidence for siderophore synthesis in S. erythraea and one of the first examples of non-polyketide secondary metabolite production by this organism.

Reproductive performance of pubertal red deer (Cervus elaphus) hinds: effects of genetic introgression of wapiti subspecies on pregnancy rates at 18 months of age

Low reproductive productivity of young red deer (Cervus elaphus) hinds on New Zealand deer farms appears to reflect high incidences of puberty failure at 16 months of age. This is despite the general attainment of average liveweights 15-25 kg in excess of the accepted minimum threshold for puberty in subspecies of western European origin (scoticus, elaphus and hippelaphus) that form the basis of the national herd. The present study tests the hypotheses that introgression of the larger North American wapiti subspecies (nelsoni, manitobensis and roosevelti) into breeding herds (1) can be assessed from morphological features of individuals, (2) that there is a relationship between the level of wapiti parentage and non-pregnancy rate at 18 months of age (a proxy for puberty failure) and (3) that minimum liveweight thresholds for puberty increase with increasing levels of wapiti parentage. A total of 4329 18-month-old hinds across four "red" deer farms in southern New Zealand were scanned for pregnancy status. Each hind was assigned a wapiti score (WS) as a subjective assessment of the obviousness of wapiti features. Various body measurements were additionally recorded for each hind. A hair sample was collected for DNA analysis (14 markers) to objectively assign subspecies pedigree (i.e. "Elkmeter") on a subset of 1258 individuals. A total of 506 (11.7%) hinds were not pregnant at 18 months of age with rates varying between 4.1 and 37.3% between farms and years. Mean WS differed significantly between farms and reflected the genetic management policy of each farm. WS was positively correlated to Elkmeter for each farm/year (<0.05) although regression slopes varied significantly. WS was able to be adjusted for these differences to assign a corrected WS (CWS) for all 4329 individuals that estimated the proportion wapiti parentage. Discriminant analysis of morphological variables relative to Elkmeter supported the first hypothesis and showed that shoulder height and body length were good indicators of the degree of wapiti parentage within individuals. This enabled the development of an objective estimate of wapiti parentage (EWP). The actual level of such parentage within herds ranged from <5 to >55%. There was a significant negative association between wapiti parentage and pregnancy, which was strongly influenced by liveweight, supporting the second and third hypotheses. This was manifest as marked displacement of pregnancy probability curves in relation to liveweight between genotype groups, particularly for those groups with >20% wapiti parentage. For example, predicted threshold liveweights required to achieve a 90% pregnancy rate for EWP values that represent 0, 10, 20, 30, 40 and 50% wapiti parentage were 81, 81, 85, 106, 127 and approximately 137 kg, respectively. Within the study herds, the majority of hinds of 0-20% wapiti parentage exceeded the predicted 90% threshold liveweights for their genotype cohort. However, hinds with higher levels of wapiti parentage generally fell below the predicted threshold for their genotype group. The data strongly suggest that under liveweight performance levels measured for red deer, hinds with >20% wapiti parentage are at high risk of puberty failure.

Smart tool for force measurements during knee arthroscopy: in vivo human study

This paper describes the magnitude and patterns of forces obtained by using a probe, equipped with a six-axis force torque sensor, in knee arthroscopy. The probe was used by orthopaedic surgeons and trainees, who performed 11 different tasks in 10 standard knee arthroscopies. The force magnitude and patterns generated are presented; which can support the development of virtual arthroscopy systems with realistic haptic feedback. The results were compared across both groups of surgeons. A difference in the force patterns generated by senior versus junior surgeons was noted which can aid in the development of an objective assessment system for arthroscopy skills. The results could potentially be useful to assess future performance in real arthroscopy.

An anomaly in the isotopomer shift of the hyperfine spectrum of LiI

A high-precision examination of the hyperfine spectrum of 6LiI in comparison with 7LiI shows a shift in the iodine nuclear electric quadrupole moment that cannot be accounted for by a model in which the electric field gradient at the iodine site is assumed to depend only upon the internuclear distance between Li and I. The other hyperfine interactions are consistent between the two isotopomers, including the previously reported electric hexadecapole interaction of the iodine nucleus.

A molecular identification system for grasses: a novel technology for forensic botany

Our present inability to rapidly, accurately and cost-effectively identify trace botanical evidence remains the major impediment to the routine application of forensic botany. Grasses are amongst the most likely plant species encountered as forensic trace evidence and have the potential to provide links between crime scenes and individuals or other vital crime scene information. We are designing a molecular DNA-based identification system for grasses consisting of several PCR assays that, like a traditional morphological taxonomic key, provide criteria that progressively identify an unknown grass sample to a given taxonomic rank. In a prior study of DNA sequences across 20 phylogenetically representative grass species, we identified a series of potentially informative indels in the grass mitochondrial genome. In this study we designed and tested five PCR assays spanning these indels and assessed the feasibility of these assays to aid identification of unknown grass samples. We confirmed that for our control set of 20 samples, on which the design of the PCR assays was based, the five primer combinations produced the expected results. Using these PCR assays in a 'blind test', we were able to identify 25 unknown grass samples with some restrictions. Species belonging to genera represented in our control set were all correctly identified to genus with one exception. Similarly, genera belonging to tribes in the control set were correctly identified to the tribal level. Finally, for those samples for which neither the tribal or genus specific PCR assays were designed, we could confidently exclude these samples from belonging to certain tribes and genera. The results confirmed the utility of the PCR assays and the feasibility of developing a robust full-scale usable grass identification system for forensic purposes.

Comparison of Olanzapine and Risperidone in 367 First-Episode Patients with Non-Affective or Affective Psychosis: Results of an Open Retrospective Medical Record Study

INTRODUCTION

Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis.

METHODS

The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level).

RESULTS

367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms ( p = .054) and a shorter treatment duration to reach this remission in affective FEP patients ( p = .077). More extrapyramidal side effects ( p <.001) were related to RIS and more weight gain to OLZ-treatment ( p <.001).

DISCUSSION

Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.

Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging

PURPOSE

To prospectively compare accuracy of dynamic contrast material-enhanced thin-section multi-detector row helical computed tomography (CT), high-spatial-resolution three-dimensional (3D) dynamic gadolinium-enhanced magnetic resonance (MR) imaging, and superparamagnetic iron oxide (SPIO)-enhanced MR imaging with optimized gradient-echo (GRE) sequence for depiction of hepatic lesions; surgery and histologic analysis were the reference standard.

MATERIALS AND METHODS

Local ethics committee approval was granted, and written informed consent was obtained. Fifty-eight patients (45 men, 13 women; age range, 47-82 years) with hepatic metastases were imaged with multi-detector row CT (3.2-mm section thickness), 3D dynamic gadolinium-enhanced MR imaging (2.5-mm effective section thickness), and SPIO-enhanced MR by using an optimized T2-weighted GRE sequence. Images were reviewed independently by two blinded observers who identified and localized lesions with a four-point confidence scale. Accuracy of each technique was measured with alternative free-response receiver operating characteristic analysis. Results were correlated with findings at surgery with intraoperative ultrasonography or histopathologic examination. Statistical differences among techniques for each observer were measured.

RESULTS

Accuracy values for each observer for all metastases (n = 215) and 1.0-cm or smaller metastases (n = 80), respectively, follow: For CT, those for reader 1 were 0.82 and 0.65; for reader 2, 0.81 and 0.68. For gadolinium-enhanced MR imaging, those for reader 1 were 0.92 and 0.79; for reader 2, 0.90 and 0.76. For SPIO-enhanced MR imaging, those for reader 1 were 0.92 and 0.83; for reader 2, 0.92 and 0.81. For all metastases for both observers, there was no significant difference between MR techniques, but both were significantly more accurate than CT (P < .01). For metastases 1.0 cm or smaller and one observer, there was no significant difference between MR techniques, but both were more accurate than CT (P < .01); for the other observer, SPIO-enhanced MR imaging was more accurate than gadolinium-enhanced MR imaging (P < .05) and CT (P < .02), but there was no significant difference between gadolinium-enhanced MR imaging and CT (P = .2).

CONCLUSION

Accuracy for gadolinium-enhanced MR imaging and SPIO-enhanced MR imaging was similar. Both techniques were significantly more accurate than CT.

A review of an anaesthetic led vascular access list

The demand for insertion of long-term central venous (Hickman type) catheters is thought to be increasing. Organisation is required to meet this demand in a safe and efficient manner. This report reviews the results from a dedicated, anaesthetic led vascular access list over the initial 61-month period. One thousand procedures were performed. Nine hundred and twenty catheters were inserted under local anaesthesia, with or without intravenous sedation and analgesia. Eighty catheters were removed. All procedures were performed during a dedicated once weekly, morning list. A total of 53% of all procedures were performed on a day-case basis, 43% on in-patients. Only 1.5% of patients required an unexpected overnight stay (usually medically unfit patients). There were 81 (9%) cancellations on the day of procedure due to neutropaenia, pneumonia or urinary tract infections. Ultrasound guidance was used initially selectively in 14%, latterly in 100% of procedures and fluoroscopy in all insertions to confirm or adjust catheter position. This service has been well received by patients and oncology services. In addition it provides an interesting area of practice for anaesthetists and an ideal environment for teaching more advanced aspects of central venous access. It may provide a template of service for other centres.

High IGFBP-3 levels in marrow plasma in early-stage MDS: effects on apoptosis and hemopoiesis

The pathophysiology of the myelodysplastic syndromes (MDS) is incompletely understood. Tumor necrosis factor (TNF)alpha levels are elevated, particularly in early-stage MDS, and apoptosis in marrow cells is upregulated. Observations in other models have shown a role for insulin-like growth factor binding protein 3 (IGFBP-3) in TNFalpha-mediated apoptosis. We observed increased levels of IGFBP-3 in the marrow plasma of patients with MDS (P = 0.005) and hypothesized that altered IGFBP-3 levels contribute to the dysregulation of hemopoiesis in MDS by affecting proliferation and apoptosis. Western analysis of marrow plasma from MDS patients revealed an increase in the ratio of intact vs fragmented IGFBP-3 in early-stage MDS (relative to controls) that decreased with MDS disease progression, suggesting increased proteolysis with more advanced disease. Thus, these results provide evidence for dysregulation of IGFBP-3 in patients with MDS. While the data are complex, they are consistent with a modulatory effect of IGFBP-3 on hemopoiesis in MDS. Conceivably, understanding these mechanisms may allow for the development of novel therapeutic strategies.

Somatosensory activations during the observation of touch and a case of vision–touch synaesthesia

In this study, we describe a new form of synaesthesia in which visual perception of touch elicits conscious tactile experiences in the perceiver. We describe a female subject (C) for whom the observation of another person being touched is experienced as tactile stimulation on the equivalent part of C's own body. Apart from this clearly abnormal synesthetic experience, C is healthy and normal in every other way. In this study, we investigate whether C's 'mirrored touch' synesthetic experience is caused by overactivity in the neural system that responds to the observation of touch. A functional MRI experiment was designed to investigate the neural system involved in the perception of touch in a group of 12 non-synesthetic control subjects and in C. We investigated neural activity to the observation of touch to a human face or neck compared with the observation of touch to equivalent regions on an object. Furthermore, to investigate the somatosensory topography of the activations during observation of touch, we compared activations when observing a human face or neck being touched with activations when the subjects themselves were touched on their own face or neck. The results demonstrated that the somatosensory cortex was activated in the non-synesthetic subjects by the mere observation of touch and that this activation was somatotopically organized such that observation of touch to the face activated the head area of primary somatosensory cortex, whereas observation of touch to the neck did not. Moreover, in non-synesthetic subjects, the brain's mirror system-comprising premotor cortex, superior temporal sulcus and parietal cortex-was activated by the observation of touch to another human more than to an object. C's activation patterns differed in three ways from those of the non-synesthetic controls. First, activations in the somatosensory cortex were significantly higher in C when she observed touch. Secondly, an area in left premotor cortex was activated in C to a greater extent than in the non-synesthetic group. Thirdly, the anterior insula cortex bilaterally was activated in C, but there was no evidence of such activation in the non-synesthetic group. The results suggest that, in C, the mirror system for touch is overactive, above the threshold for conscious tactile perception.

Expression of ErbB receptors and mucins in the airways of long term current smokers

BACKGROUND

Airway epithelial goblet cell hyperplasia is known to occur in chronic smokers. Although the epidermal growth factor receptor has been implicated in this process, neither ErbB receptor expression nor the mucosecretory phenotype of the epithelium have been characterised in current smokers.

METHODS

Bronchial biopsies obtained from non-smokers (n = 10) and current smokers, with or without chronic obstructive pulmonary disease (n = 51), were examined immunohistochemically to measure the expression of epidermal growth factor receptor, ErbB2, ErbB3, ErbB4 and mucin subtypes (MUC2, MUC5AC and MUC5B) in the bronchial epithelium. The results were correlated with neutrophil counts measured in the airway wall and induced sputum.

RESULTS

Epidermal growth factor receptor, ErbB3 and MUC5AC expression, in addition to PAS staining, were significantly increased in all smokers compared with non-smokers, irrespective of the presence of chronic obstructive pulmonary disease. MUC5AC expression was significantly associated with both PAS staining and ErbB3 expression; no correlation was observed between either mucin or ErbB receptor expression and neutrophil counts.

CONCLUSIONS

The results suggest that long term current smoking induces enhanced epidermal growth factor receptor, ErbB3, and MUC5AC expression in vivo; these increases are not associated with the presence of neutrophilic inflammation. ErbB receptors may contribute to epithelial responses to cigarette smoke.

Impact of national guidelines about the management of colorectal cancer on Australian surgeons' awareness of evidence: a pre/post survey

OBJECTIVE

To evaluate the immediate impact of national evidence-based guidelines about colorectal cancer on Australian surgeons' self-reported practice and their deficits in awareness of scientific evidence underpinning clinical management practices.

DESIGN

Pre/post evaluation, comprising preguidelines survey (November 1998) and postguidelines survey (February 2001).

METHODS

One hundred and fourteen Australian surgeons returned postguidelines surveys, of whom 103 (90%) agreed to matching of their pre- and postguidelines responses. National distribution of the CRC guidelines occurred in November 1999. Over the ensuing year, dissemination strategies included seminars, presentations at conferences and journal articles. The main outcome measures used were changes in awareness of evidence for each of 23 clinical recommendations, changes in overall awareness score (maximum possible 23), changes in subscore for nine items for which evidence was compelling and predictors of change.

RESULTS

Of those surgeons followed up, 95% were aware of the guidelines and 32% had read them in detail. Only 47% recalled the consumer version. The three most highly rated topics in the guidelines were: high-risk familial syndromes (45%); screening based on family history of colorectal cancer (40%); population screening for colorectal cancer (25%). Compared with baseline, there was a modest improvement in the mean overall awareness score (P = 0.02). Paired analyses of awareness of the evidence for each of 23 individual topics revealed significant improvement only in five. For two, awareness significantly decreased.

CONCLUSIONS

Our pre/post findings are not inconsistent with the expectation that dissemination of the CRC guidelines has had some short-term impact. However, definitive evidence acquired through more rigorously designed controlled trials will be needed to determine first, whether surgical practice has changed and, second, whether implementation of the CRC guidelines or some other secular event caused such change.

Evidence based practice in population health: a regional survey to inform workforce development and organisational change

STUDY OBJECTIVE

To assess current capacity to implement evidence based practice (EBP) in population health.

DESIGN

Postal survey of a regional population health workforce in Sydney, Australia.

SETTING

Division of Population Health, South Western Sydney Area Health Service.

PARTICIPANTS

104 population health staff (response rate: 73%).

MAIN RESULTS

In the sample of regional population health practitioners, views about the current promotion of EBP were positive. Non-medical respondents with less that Masters degree were more likely to report "high self assessed need" to increase their capacity in EBP (p = 0.022). Confidence in understanding of EBP terminology was not associated with seniority but with highest level of education reached (p<0.000) and having medical qualifications (p<0.000). Occupational category was not associated with respondents' self assessed "need for evidence", "need for EBP skills" or "need to increase their capacity in EBP" in their current position. The proportion of participants "strongly" supporting implementation of a colorectal cancer screening programme whose benefit was expressed as relative risk reduction was greater than that so supporting a programme whose benefit was expressed as number needed to screen (p = 0.008). Most respondents referred to their immediate managers when seeking support for EBP.

CONCLUSIONS

The findings provide a quantitative baseline for capacity building through workplace programmes. Managerial commitment has been increased and performance development is now underway.

Disruption of Caenorhabditis elegans muscle structure and function caused by mutation of troponin I

Caenorhabditis elegans strains mutant for the unc-27 gene show abnormal locomotion and muscle structure. Experiments revealed that unc-27 is one of four C. elegans troponin I genes and that three mutant alleles truncate the protein: recessive and presumed null allele e155 terminates after nine codons; semidominant su142sd eliminates the inhibitory and C-terminal regions; and semidominant su195sd abbreviates the extreme C-terminus. Assays of in vivo muscular performance at high and low loads indicated that su142sd is most deleterious, with e155 least and su195sd intermediate. Microscopy revealed in mutant muscle a prevalent disorder of dense body positioning and a less well defined sarcomeric structure, with small islands of thin filaments interspersed within the overlap region of A bands and even within the H zone. The mutants' rigid paralysis and sarcomeric disarray are consistent with unregulated contraction of the sarcomeres, in which small portions of each myofibril shorten irregularly and independently of one another, thereby distorting the disposition of filaments. The exacerbated deficits of su142sd worms are compatible with involvement in vivo of the N-terminal portion of troponin I in enhancing force production, and the severe impairment associated with su195sd highlights importance of the extreme C-terminus in the protein's inhibitory function.