A strategy for detection of viruses in groundwater by PCR

We evaluated the use of the PCR for detection of enteric viruses in groundwater. To do this, we used an improved sample-processing technique and a large-volume amplification protocol. The objective of this study was to use advanced molecular techniques to develop a rapid and simple method which can be used by the water industry for detection of viral contamination in a variety of water samples. The strategy described here fulfills the water industry's need for a rapid, reliable, easily performed method for analyzing groundwater for virus contamination. Viruses were detected after concentration from at least 400 gallons (1,512 liters) of water by a filter adsorption and elution method, which resulted in a concentrate containing viruses. A total of 150 samples were analyzed by performing cell culture assays for enteroviruses and by performing reverse transcription PCR (RT-PCR) analyses for enteroviruses, hepatitis A virus, and rotavirus. Thirteen samples (8.7%) produced cellular cytopathic effects when the Buffalo green monkey cell line was used. When primers specific for enteroviruses were used in RT-PCR, 40 of 133 samples (30.1%) tested positive for the presence of enterovirus RNA. When hepatitis A virus-specific primers were used, 12 of 139 samples (8.6%) were considered positive for the presence of hepatitis A viral RNA. The RT-PCR analysis performed with rotavirus-specific primers identified 18 of 130 samples (13.8%) that were positive for rotavirus RNA sequences. Our sample-processing technique and large-volume PCR protocol (reaction volume, 300 microliter) resulted in sufficient removal or dilution of inhibitors so that more than 95% of the samples could be assayed by PCR. Because of its sensitivity for detecting viral nucleic acid sequences, PCR analysis should produce more positive results than cell culture analysis. Since either cell culture analysis or PCR can reveal only a "snapshot" of the quality of the groundwater being sampled, PCR seems to be a desirable rapid initial screening tool.

A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care

OBJECTIVE

To investigate whether women having medical or surgical terminations of pregnancy differ in their emotional distress before or after the procedure. To evaluate whether choice of procedure occurs, the factors influencing type of procedure and the effect of choice on emotional responses and satisfaction with care.

DESIGN

A prospective comparative study.

SETTING

A termination of pregnancy unit in a University Teaching Hospital.

PARTICIPANTS

Two hundred and seventy-five women attending for medical or surgical first trimester termination of pregnancy.

METHODS

Interviews concerning choice and measures of emotional status were completed prior to terminations. Four weeks after termination emotional functioning was reassessed together with satisfaction with care.

RESULTS

Women having a surgical termination waited longer for the procedure and were at more advanced gestation than those having the medical termination. There were no differences in emotional responses related to type of procedure or gestation. One-quarter remained highly anxious at four weeks. Medical and surgical groups did not differ in emotional status prior to termination. Those having the medical procedure rated it as marginally more stressful and experienced more post-termination physical problems and disruption to life. Seeing the fetus was associated with more intrusive events (nightmares, flashbacks, unwanted thoughts related to the experience). One-quarter of the medical and 67% of the surgical group reported having no choice in type of procedure. Only 53% of the medical group would choose the same procedure again compared with 77% of the surgical group.

CONCLUSIONS

Termination method did not influence emotional adjustment. Many women were not offered genuine choice of procedure. Having choice was considered very important but was unrelated to emotional distress or satisfaction with care.

Occupational risk factors and prostate cancer in U.S. blacks and whites

Although prostate cancer is a major disease, causal factors are only partially understood. We examined occupational risk factors for this disease in a large case control study among U.S. blacks and whites. The study included 981 new pathologically confirmed prostate cancer cases (479 blacks and 502 whites) diagnosed between 1986 and 1989, and 1,315 population controls (594 blacks and 721 whites) who resided in Atlanta, Detroit, and 10 countries in New Jersey, covered by population-based cancer registries. Information on occupation, including a lifetime work history, was collected by in-person interview. No clear patterns of risk were found for U.S. whites versus blacks, nor for white-collar versus blue-collar jobs. Farming was related to prostate cancer (OR = 2.17; 95% CI = 1.18-3.98). Risk was restricted, however, to short-term workers and workers in crop production. Risk was not limited to those farming after 1950, when widespread use of pesticides started. Risks increased with increasing years of employment in firefighting (chi 2trend, p = 0.02) and power plant operations (chi 2trend, p = 0.03), and were elevated among long-term railroad line-haulers (OR = 5.85; 95% CI = 1.25-27.4); jobs with potential polycyclic aromatic hydrocarbon (PAH) exposures. Risk was elevated among athletes (OR = 5.38; 95% CI = 1.48-19.6). However, most of the cases were athletes before 1960, so the potential use of anabolic steroids was excluded. Although some clues about potential occupational associations were found, the overall results show that occupation is not a major determinant of prostate cancer risk.

Diet design for a multicenter controlled feeding trial: the DELTA program. Delta Research Group

OBJECTIVE

To describe the process and results of diet standardization, diet validation, and monitoring of diet composition, which were key components of protocol 1 of Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA-1), the initial protocol in a program of multicenter human feeding studies designed to evaluate the effects of amount and type of fat on lipoproteins and hemostasis parameters in various demographic groups.

DESIGN

DELTA-1 was based on a randomized, blinded, crossover experimental design. Three diets were fed for 8 weeks to 103 healthy men and women aged 22 to 67 years at 4 field centers. Diet A, an average American diet, was designed to provide 37% of energy from fat, 16% of energy from saturated fatty acids (SFAs); diet B (step 1 diet) was designed to provide 30% of energy from fat, 9% of energy from SFA; and diet C (low SFA diet) was designed to provide 26% of energy from fat, 5% of energy from SFA. Key features of diet standardization included central procurement of fat-containing foods, inclusion of standard ingredients, precision weighing of foods--especially sources of fat and cholesterol--and use of standardized written procedures.

SETTING

For menu validation, a set of 12 menus for each diet was prepared in duplicate and chemically assayed. For monitoring of diet composition during the study, an 8-day diet cycle (6 weekday and 2 weekend menus) was sampled by every field center twice during each of 3 feeding periods.

STATISTICAL ANALYSES

Means (+/- standard error) were calculated and compared with target nutrient specifications.

RESULTS

DELTA-1 was able to provide a standardized diet that met nutrient specifications across 4 field centers over 24 weeks of participant feeding spanning a total of 8 months.

APPLICATIONS

Prestudy chemical validation of menus and continuous sampling and assay of diets throughout the study are essential to standardize experimental diets and to ensure that nutrient target goals are met and maintained throughout a controlled multicenter feeding study.

Effects of insulin and acipimox on VLDL1 and VLDL2 apolipoprotein B production in normal subjects

The objective of the study was to examine the potential differential effect of insulin and acipimox (both of which reduce free fatty acid [FFA] availability) on VLDL apolipoprotein (apo) B metabolism. We studied eight healthy men (age 40 +/- 4 years, BMI 25.8 +/- 0.9 kg/m2, plasma triglycerides 1.30 +/- 0.12 mmol/l) after an overnight fast (control study, n = 8), during inhibition of lipolysis with an antilipolytic agent, acipimox (n = 8), and under 8.5-h euglycemic-hyperinsulinemic conditions (n = 5). Plasma FFAs were similarly suppressed in the acipimox and insulin studies (approximately 70% suppression). 2H3-leucine was used to trace apo B kinetics in VLDL1 and VLDL2 subclasses (Svedberg flotation rates: 60-400 and 20-60), and a non-steady-state multicompartmental model was used to derive the kinetic constants. The mean rate of VLDL1 apo B production was 708 +/- 106 mg/day at the beginning and 602 +/- 140 mg/day at the end of the control study. Production of the lipoprotein decreased to 248 +/- 93 mg/day during the insulin study (P < 0.05 vs. control study) and to 375 +/- 92 mg/day (NS) during the acipimox study. Mean VLDL2 apo B production was significantly increased during the acipimox study (399 +/- 42 vs. 236 +/- 27 mg/day, acipimox vs. control, P < 0.05) but not during the insulin study (332 +/- 51 mg/day, NS). The fractional catabolic rates of VLDL1 and VLDL2 apo B were similar in all three studies. We conclude that acute lowering of FFAs does not change the overall production rate of VLDL particles, but there is a shift toward production of smaller and denser VLDL2 particles, and, thus, the amount of total VLDL particles secreted remained constant. Insulin acutely suppresses the total production rate of VLDL apo B by decreasing the production of large triglyceride-rich VLDL1 particles. Based on these findings, we postulate that insulin has a direct suppressive effect on the production of VLDL apo B in the liver, independent of the availability of FFAs.

N-terminal sequence polymorphism in the coagulase gene of Staphylococcus aureus and its potential use as an epidemiological marker

N-terminal DNA sequences of the coagulase gene were amplified from Staphylococcus aureus strain ISP8 (NCTC 8325-4) DNA using the polymerase chain reaction. The amplified DNA product (984 bp) was used to probe SmaI and DraI digested total DNA of methicillin- and multi-resistant S. aureus (MRSA) type strains, methicillin-sensitive S. aureus (MSSA) clinical isolates, and community (commensal) isolates. A SmaI fragment of a similar size in all the isolates examined hybridized with the coagulase gene fragment probe. All MRSA isolates, representing closely related (clonal) types, revealed identical coagulase hybridization patterns with DraI digested DNA. MSSA and community isolates closely related to ISP8 by SmaI fragment analysis shared closely related DraI/coagulase hybridization patterns, differing from that identified for the MRSAs. In contrast, the community and MSSA isolates not related to ISP8 as judged by total SmaI fragment polymorphisms, were also diverse in their DraI/coagulase hybridization patterns. In addition, the intensity of the hybridization signal obtained with the MRSA isolates varied significantly (less than) from the other isolates, indicating the presence of multiple and probably different coagulase genes between the isolates. The findings reported here indicate that hybridization analysis using single genes as DNA probes is less discriminant than restriction fragment length polymorphism analysis of the total genome of different isolates.

Effects of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy subjects: the DELTA Study, protocol 1

Few well-controlled diet studies have investigated the effects of reducing dietary saturated fatty acid (SFA) intake in premenopausal and postmenopausal women or in blacks. We conducted a multicenter, randomized, crossover-design trial of the effects of reducing dietary SFA on plasma lipids and lipoproteins in 103 healthy adults 22 to 67 years old. There were 46 men and 57 women, of whom 26 were black, 18 were postmenopausal women, and 16 were men > or =40 years old. All meals and snacks, except Saturday dinner, were prepared and served by the research centers. The study was designed to compare three diets: an average American diet (AAD), a Step 1 diet, and a low-SFA (Low-Sat) diet. Dietary cholesterol was constant. Diet composition was validated and monitored by a central laboratory. Each diet was consumed for 8 weeks, and blood samples were obtained during weeks 5 through 8. The compositions of the three diets were as follows: AAD, 34.3% kcal fat and 15.0% kcal SFA; Step 1, 28.6% kcal fat and 9.0% kcal SFA; and Low-Sat, 25.3% kcal fat and 6.1% kcal SFA. Each diet provided approximately 275 mg cholesterol/d. Compared with AAD, plasma total cholesterol in the whole group fell 5% on Step 1 and 9% on Low-Sat. LDL cholesterol was 7% lower on Step 1 and 11% lower on Low-Sat than on the AAD (both P<.01). Similar responses were seen in each subgroup. HDL cholesterol fell 7% on Step 1 and 11% on Low-Sat (both P<.01). Reductions in HDL cholesterol were seen in all subgroups except blacks and older men. Plasma triglyceride levels increased approximately 9% between AAD and Step 1 but did not increase further from Step 1 to Low-Sat. Changes in triglyceride levels were not significant in most subgroups. Surprisingly, plasma Lp(a) concentrations increased in a stepwise fashion as SFA was reduced. In a well-controlled feeding study, stepwise reductions in SFA resulted in parallel reductions in plasma total and LDL cholesterol levels. Diet effects were remarkably similar in several subgroups of men and women and in blacks. The reductions in total and LDL cholesterol achieved in these different subgroups indicate that diet can have a significant impact on risk for atherosclerotic cardiovascular disease in the total population.

Injuries among children in home and out-of-home care

As the number of children receiving care in out-of-home settings increases in the United States, the risk of injury in such settings has become the subject of intense research.

OBJECTIVES

This study examined the relative safety of out-of-home care compared with care in a child's own home.

METHODS

This community based prospective cohort study of 656 families in three adjacent counties in the Piedmont region of North Carolina characterizes the patterns and rates of injuries among children less than 5 years of age in three child care settings, home care (HC), center based care (CBC), and other out-of-home care (OOHC). Information about minor and severe injuries was obtained from parents using monthly telephone interviews over a one year period. Statistical modeling designed to handle unbalanced data with correlated observations was used as the primary tool for analysis.

RESULTS

Rate of minor injuries was highest in CBC, followed by HC, and then OOHC. However, these differences for OOHC may have been due to reporting biases and errors in rate estimates. There were no significant differences in severe injury rates among the three settings.

CONCLUSIONS

The risk of serious injury among children under 5 in CBC is not different from that of children in HC or OOHC despite the fact that the risk of minor injury is higher.

School-based hepatitis B immunization program: follow-up of non-participants at first school clinic

This research project was conducted in the Ottawa-Carleton region of Ontario to provide information on reasons why students did not participate in a Grade 7 hepatitis B school immunization project, and to determine whether telephone contact increased attendance at the community catch-up clinics above that achieved by a notice sent home with the child from school. A matched comparison group design was used. The overall uptake of the first dose of the vaccine in the region was 94% of 8,560 eligible students; 90% were immunized at the school clinic and 4% at the community catch-up clinic. About 4% of the parents refused to have their child immunized at the school or catch-up clinics. Of parents in the intervention group 198 (95%) were contacted by phone. The major reasons for non-participation at the school clinics were: (1) the child was not at school on the clinic day, or the child was sick (51%), (2) there were problems with the consent form (21%), and (3) the parents did not know of the program (10%). More students from the intervention group (72%) came for vaccination than did those of the control group (50%) (p < 0.01).

Metabolic basis of hypotriglyceridemic effects of insulin in normal men

The mechanism by which acute insulin administration alters VLDL apolipoprotein (apo) B subclass metabolism and thus plasma triglyceride concentration was evaluated in 7 normolipidemic healthy men on two occasions, during a saline infusion and during an 8.5-hour euglycemic hyperinsulinemic clamp (serum insulin, 490 +/- 30 pmol/L). During the insulin infusion, plasma triglycerides decreased by 22% (P < .05), and serum free fatty acid decreased by 85% (P < .05). The plasma concentration of VLDL1 apo B fell 32% during the insulin infusion, while that of VLDL2 apo B remained constant. A bolus injection of [3-(2)H]leucine was given on both occasions to trace apo B kinetics in the VLDL1 and VLDL2 subclasses (Svedberg flotation rate, 60-400 and 20-60, respectively), and the kinetic basis for the change in VLDL levels caused by insulin was examined using a non-steady-state multicompartmental model. The mean rate of VLDL1 apo B synthesis decreased significantly by 35% (P < .05) after 0.5 hour of the insulin infusion (523 +/- 87 mg/d) compared with the saline infusion (808 +/- 91 mg/d). This parameter was allowed to vary with time to explain the fall in VLDL1 concentration. After 8.5 hours of hyperinsulinemia, the rate of VLDL1 apo B synthesis was 51% lower (321 +/- 105 mg/d) than during the saline infusion (651 +/- 81 mg/d, P < .05). VLDL2 apo B production was similar during the saline (269 +/- 35 mg/d) and insulin (265 +/- 37 mg/d) infusions. No significant changes were observed in the fractional catabolic rates of either VLDL1 or VLDL2 apo B. We conclude that acute hyperinsulinemia lowers plasma triglyceride and VLDL levels principally by suppressing VLDL1 apo B production but has no effect on VLDL2 apo B production. These findings indicate that the rates of VLDL1 and VLDL2 apo B production in the liver are independently regulated.

Drawover vaporizers for sedation in intensive care

OBJECTIVE

We have undertaken a laboratory study to determine whether a drawover vaporizer in the inspiratory limb of an intensive care ventilator circuit can produce safe and therapeutic concentrations of isoflurane.

DESIGN

An Oxford Miniature Vaporizer (OMV) and Ohmeda TEC vaporizer were assessed over the range of inspired isoflurane concentrations, airway pressures and tidal volumes experienced in the ICU.

CONCLUSIONS

The experimental findings suggest that the OMV inhaler in plenum mode can be relied upon to produce safe concentrations of isoflurane over a clinically useful range of inspired concentrations. Furthermore, it behaves predictably over the range of airway pressures likely to be encountered in the patient admitted with acute severe asthma. However, we found that the Ohmeda TEC vaporizer did not perform reliably in this setting.

School-based hepatitis B immunization program: follow-up of non-participants at first school clinic

This research project was conducted in the Ottawa-Carleton region of Ontario to provide information on reasons why students did not participate in a Grade 7 hepatitis B school immunization project, and to determine whether telephone contact increased attendance at the community catch-up clinics above that achieved by a notice sent home with the child from school. A matched comparison group design was used. The overall uptake of the first dose of the vaccine in the region was 94% of 8,560 eligible students; 90% were immunized at the school clinic and 4% at the community catch-up clinic. About 4% of the parents refused to have their child immunized at the school or catch-up clinics. Of parents in the intervention group 198 (95%) were contacted by phone. The major reasons for non-participation at the school clinics were: (1) the child was not at school on the clinic day, or the child was sick (51%), (2) there were problems with the consent form (21%), and (3) the parents did not know of the program (10%). More students from the intervention group (72%) came for vaccination than did those of the control group (50%) (p < 0.01).

Marrow transplantation for chronic myeloid leukemia: the influence of plasma busulfan levels on the outcome of transplantation

The influence of busulfan (BU) plasma concentration on outcome of transplantation from HLA identical family members for the treatment of chronic myelogenous leukemia (CML) was examined in 45 patients transplanted in chronic phase (CP) (n = 39) or accelerated phase (AP) (n = 6). All patients received the same regimen of BU, 16 mg/kg orally and cyclophosphamide (CY), 120 mg/kg intravenously. Plasma concentrations of BU at steady state (C(SS)BU) during the dosing interval were measured for each patient. The mean C(SS)BU was 917 ng/mL (range, 642 to 1,749; median, 917; standard deviation, 213). Of patients with C(SS)BU below the median, seven (five of 18 in CP and two of four in AP) developed persistent cytogenetic relapse and three of these patients died. There were no relapses in patients with C(SS)BU above the median. The difference in the cumulative incidence of relapse between the two groups was statistically significant (P = .0003). C(SS)BU was the only statistically significant determinant of relapse in univariable or multivariable analysis. The 3-year survival estimates were 0.82 and 0.64 for patients with C(SS)BU above and below the median (P = .33). There was no statistically significant association of C(SS)BU with survival or nonrelapse mortality, although the power to detect a difference in survival between 0.82 and 0.64 was only 0.24, similarly C(SS)BU above the median was not associated with an increased risk of severe regimen-related toxicity. We conclude that low BU plasma levels are associated with an increased risk of relapse.

Defective regulation of triglyceride metabolism by insulin in the liver in NIDDM

Insulin administration to healthy subjects inhibits the production of very low density lipoprotein (VLDL)1 (Svedbergs flotation (Sf) rate 60-400) without affecting that of VLDL2 (Sf 20-60) sub-class. This study was designed to test whether this hormonal action is impaired in non-insulin-dependent diabetes mellitus (NIDDM). We studied six men with NIDDM (age 53 +/- 3 years, body mass index 27.0 +/- 1.0 kg/m2, plasma triglycerides 1.89 +/- 0.22 mmol/l) during an 8.5 h infusion of saline (control) and then in hyperinsulinaemic (serum insulin approximately 540 pmol/l) conditions during 8.5 h infusions of glucose and insulin to give either hyper- and normoglycaemic conditions. [3-2H]-leucine was used as tracer and kinetic constants derived using a non-steady-state multicompartmental model. Compared to the control study, patients with NIDDM reduced VLDL1 apo B production by only 3 +/- 8% after 8.5 h of hyperinsulinaemia (701 +/- 102 vs 672 +/- 94 mg/day respectively, NS) in hyperglycaemic conditions and by 9 +/- 21% under normoglycaemic conditions (603 +/- 145 mg/day). In contrast, in normal subjects insulin induced a 50 +/- 15% decrement in VLDL1 apo B production (p < 0.05). Direct synthesis of VLDL2 apo B in patients with NIDDM was not markedly affected by insulin. We conclude that a contributory factor to hypertriglyceridaemia in NIDDM is the inability of insulin to inhibit acutely the release of VLDL1 from the liver, despite efficient suppression of serum nonesterfied fatty acids.

O6-alkylguanine DNA alkyltransferase activity in student embalmers

O6-Alkylguanine-DNA alkyltransferase (AGT) activity was assessed in peripheral blood lymphocytes among 23 mortuary science students before and after 9 weeks in a laboratory course in techniques of embalming. Formaldehyde exposure was established by environmental monitoring. The average air concentration of formaldehyde during embalming was about 1.5 ppm. At the pre-exposure sampling, baseline DNA repair capacity tended to be reduced in subjects who reported a prior history of embalming (p = 0.08). From pre- to post-exposure, 17 subjects decreased in DNA repair capacity, while only 6 increased (p < 0.05). Analysis of variance, including adjustment for age, sex, and smoking status, confirmed these findings. Among the eight subjects who had no embalming experience during the 90 days before study, seven had decreased and one had increased AGT activity during the period of study (p < 0.05). For those with prior embalming experience, 10 subjects decreased in AGT activity, while 5 increased (p < 0.05). Although the major chemical exposure in embalming practice was to formaldehyde, no clear link was established between amount of formaldehyde exposure and AGT activity.

A historically controlled trial of tyrosine for cocaine dependence

Cocaine dependence continues to be a major public health problem and efforts to develop pharmacotherapies have been disappointing. Chronic cocaine use is believed to cause catecholamine depletion and similarities exist between cocaine withdrawal and major depression. Tyrosine is the dietary precursor to catecholamines and has yielded positive results in small trials of its antidepressant efficacy. Tyrosine 2 g every 8 hours was administered on an open-label basis to 49 cocaine-dependent individuals, as an adjunct to intensive out-patient drug abuse counseling. Retention in treatment at 90 days was compared to data from a control group of 80 subjects who had received 10 mg of imipramine per day in an earlier trial. Median retention was 17 days in both groups. No side effects were reported by the subjects receiving tyrosine. These results do not support the utility of tyrosine in the treatment of cocaine dependence.

Sensitive methods to study human apolipoprotein B metabolism using stable isotope-labeled amino acids

The objective of the study was to develop a sensitive method using stable isotope-labeled tracers that would permit the determination of apolipoprotein B (apoB) metabolism in very low-density lipoprotein subfractions (VLDL1, Sf 60-400; VLDL2, Sf 20-60), intermediate-density lipoprotein (IDL, Sf 12-20), and low-density lipoprotein (LDL, Sf 0-12). Six normolipidemic subjects were given trideuterated leucine, and its clearance from plasma and appearance in the four apoB-containing lipoprotein fractions were followed by use of a highly sensitive gas chromatography-mass spectrometry technique in which the m + 3-to-m + 2 ion ratio was selectively monitored. This analytic approach permitted the precise measurement of low enrichments in IDL and LDL and extension of the turnover out to 250-300 h. A compartmental model was developed to derive rate constants from the plasma and apoB enrichment curves. The model was uniquely identifiable once parameter dependencies had been introduced to reduce the number of unknowns. Values were obtained for apoB input into all lipoprotein density intervals, together with rates of interconversion and catabolism; these agreed well with results from radioiodinated tracer experiments. An alternative model structure was also explored in which input occurred only into VLDL1. Altering the protocol of tracer administration (bolus vs. primed constant infusion) and dose (over a 10-fold range) had no influence on the results obtained. The analytic and modeling approach described will permit stable isotopes to be used to elucidate key features of apoB metabolism in normal and pathological states.

Efficient expression of a Phanerochaete chrysosporium manganese peroxidase gene in Aspergillus oryzae

A manganese peroxidase gene (mnp1) from Phanerochaete chrysosporium was efficiently expressed in Aspergillus oryzae. Expression was achieved by fusing the mature cDNA of mnp1 with the A. oryzae Taka amylase promoter and secretion signal. The 3' untranslated region of the glucoamylase gene of Aspergillus awamori provided the terminator. The recombinant protein (rMnP) was secreted in an active form, permitting rapid detection and purification. Physical and kinetic properties of rMnP were similar to those of the native protein. The A. oryzae expression system is well suited for both mechanistic and site-directed mutagenesis studies.