Modes of failure following locking plate fixation of the distal radius: a thematic analysis of 517 fractures

Anterior locking plate fixation of the distal radius is a common procedure with reliable results. Failure of fixation is sometimes seen. The aim of the present study was to identify the reasons for failure. In total, 517 cases met the study inclusion criteria. Of them, 23 cases had failure of fixation (4.4%). Failure analysis generated qualitative data. Subsequent thematic analysis identified the primary mode of failure and contributing factors. Primary modes were identified as failure to support all key fracture fragments (n = 20), wrong choice of implant (n = 1), failure of union (n = 1) and poor bone quality (n = 1). Contributing factors were errors in plate positioning, fracture reduction, implant selection and screw configuration, as well as fracture pattern complexity and poor bone quality. Most failed fixations had a primary mode and two or three contributing factors. Overall anterior plating is reliable with a low rate of surgical failure. Knowledge of failure modes will aid operative planning and prevent failure.Level of evidence: V.

Laboratory comparison of field portable X-ray fluorescence spectrometer (FP-XRF) and inductively coupled plasma mass spectrometry (ICP-MS) for determination of airborne metals in stainless steel welding fume

Welding fume is a common exposure in occupational settings. Gravimetric analysis for total particulate matter is common; however, the cost of laboratory analyses limits the availability of quantitative exposure assessment for welding fume metal constituents in occupational settings. We investigated whether a field portable X-ray fluorescence spectrometer (FP-XRF) could provide accurate estimates of personal exposures to metals common in welding fume (chromium, copper, manganese, nickel, vanadium, and zinc). The FP-XRF requires less training and is easier to deploy in many settings than traditional wet laboratory analyses. Filters were analyzed both by FP-XRF and inductively coupled plasma mass spectrometry (ICP-MS). We estimated the FP-XRF limit of detection for each metal and developed a correction factor accounting for the non-uniform deposition pattern on filter samples collected with an Institute of Medicine (IOM) inhalable particulate matter sampler. Strong linear correlation was observed for all metals (0.72 Collapse

Key Words

• Analysis methods
• metals
• particulate matter
• welding fume

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MESH Headings

• Occupational Exposure/analysis
• Air Pollutants, Occupational/analysis
• Stainless Steel/analysis
• Copper/analysis
• Manganese/analysis
• Welding
• Nickel/analysis
• X-Rays
• Vanadium/analysis
• Environmental Monitoring/methods
• Chromium/analysis
• Zinc/analysis
• Spectrometry, X-Ray Emission/methods
• Gases/analysis
• Mass Spectrometry/methods
• Particulate Matter/analysis

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Grants

• R21 OH010661 NIOSH CDC HHS
• T42 OH008428 NIOSH CDC HHS

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Affiliation(s)

Ashley Newton Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Ana M Rule Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Berrin Serdar Environmental Health Associates LLC, Englewood, Colorado
Kirsten Koehler Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

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Germination and Simulated Gastrointestinal Digestion of Chickpea (Cicer arietinum L.) in Exhibiting In Vitro Antioxidant Activity in Gastrointestinal Epithelial Cells

Plant-based proteins, in particular pulse proteins, have grown in popularity worldwide. Germination, or sprouting, is an effective method to release peptides and other dietary compounds. However, the combination of germination and gastrointestinal digestion in enhancing the release of dietary compounds with potential health-beneficial biological activity has yet to be entirely elucidated. The present study illustrates the impact of germination and gastrointestinal digestion on the release of dietary compounds with antioxidant activity from chickpeas (Cicer arietinum L.). Germination up to 3 days (D0 to D3) increased the peptide content by denaturing chickpea storage proteins and increased the degree of hydrolysis (DH) in the gastric phase. The antioxidant activity was measured at three different dosages (10, 50, and 100 μg/mL) and compared between D0 and D3 on human colorectal adenocarcinoma cells (HT-29). A significant increase in antioxidant activity was observed in the D3 germinated samples in all three tested dosages. Further analysis identified 10 peptides and 7 phytochemicals differentially expressed between the D0 and D3 germinated samples. Among the differentially expressed compounds, 3 phytochemicals (2',4'-dihydroxy-3,4-dimethoxychalcone, isoliquiritigenin 4-methyl ether, and 3-methoxy-4,2',5'-trihydroxychalcone) and 1 peptide (His-Ala-Lys) were identified only in the D3 samples, indicating their potential contribution towards the observed antioxidant activity.

Kynurenine Pathway Regulation at Its Critical Junctions with Fluctuation of Tryptophan

The kynurenine pathway (KP) is the primary route for the catabolism of the essential amino acid tryptophan. The central KP metabolites are neurologically active molecules or biosynthetic precursors to critical molecules, such as NAD⁺. Within this pathway are three enzymes of interest, HAO, ACMSD, and AMSDH, whose substrates and/or products can spontaneously cyclize to form side products such as quinolinic acid (QA or QUIN) and picolinic acid. Due to their unstable nature for spontaneous autocyclization, it might be expected that the levels of these side products would be dependent on tryptophan intake; however, this is not the case in healthy individuals. On top of that, the regulatory mechanisms of the KP remain unknown, even after a deeper understanding of the structure and mechanism of the enzymes that handle these unstable KP metabolic intermediates. Thus, the question arises, how do these enzymes compete with the autocyclization of their substrates, especially amidst increased tryptophan levels? Here, we propose the formation of a transient enzyme complex as a regulatory mechanism for metabolite distribution between enzymatic and non-enzymatic routes during periods of increased metabolic intake. Amid high levels of tryptophan, HAO, ACMSD, and AMSDH may bind together, forming a tunnel to shuttle the metabolites through each enzyme, consequently regulating the autocyclization of their products. Though further research is required to establish the formation of transient complexation as a solution to the regulatory mysteries of the KP, our docking model studies support this new hypothesis.

Long-term outcomes of the Universal 2 total wrist replacement: revision and loosening at 10 years and beyond

The aim of this study was to ascertain the long-term revision rates of the Universal 2 wrist prosthesis in a previously published cohort of patients with rheumatoid arthritis. The time to, and reasons for revision were determined. Radiographs were analysed to determine whether loosening had occurred in the long-term according to the Wrightington zonal classification of loosening. Seventy-eight wrists from the original cohort of 85 wrists could be identified for analysis. The longest follow-up was 16 years and 29 wrists had follow-up beyond 10 years. Seventeen wrists had been revised or were on the waiting list for revision, an overall revision rate of 22%. The 10-year survivorship was 78%. Long-term revision was commonly for periprosthetic loosening with pain and component subsidence. In those with more than 10-year follow-up, significant lucency was seen in 16 carpal components and 15 radial components. Explant analysis showed significant polyethylene wear and we postulate this is the principal reason for component loosening.Level of evidence: IV.

Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty

Trapeziectomy for base of thumb arthritis is well established, but base of thumb arthroplasty offers potential advantages. The review covers the development of arthroplasty for the thumb from interposition arthroplasty to total joint replacement. It discusses contemporary prosthesis designs and results, including trapezial component geometry, bearing surfaces, and dual mobility.

Particle release from refit operations in shipyards: Exposure, toxicity and environmental implications

European harbours are known to contribute to air quality degradation. While most of the literature focuses on emissions from stacks or logistics operations, ship refit and repair activities are also relevant aerosol sources in EU harbour areas. Main activities include abrasive removal of filler and spray painting with antifouling coatings/primers/topcoats. This work aimed to assess ultrafine particle (UFP) emissions from ship maintenance activities and their links with exposure, toxicity and health risks for humans and the aquatic environment. Aerosol emissions were monitored during mechanical abrasion of surface coatings under real-world operating conditions in two scenarios in the Mallorca harbour (Spain). Different types of UFPs were observed: (1) highly regular (triangular, hexagonal) engineered nanoparticles (Ti-, Zr-, Fe-based), embedded as nano-additives in the coatings, and (2) irregular, incidental particles emitted directly or formed during abrasion. Particle number concentrations monitored were in the range of industrial activities such as drilling or welding (up to 5 ∗ 10⁵/cm³, mean diameters <30 nm). The chemical composition of PM₄ aerosols was dominated by metallic tracers in the coatings (Ti, Al, Ba, Zn). In vitro toxicity of PM₂ aerosols evidenced reduced cell viability and a moderate potential for cytotoxic effects. While best practices (exhaust ventilation, personal protective equipment, dust removal) were in place, it is unlikely that exposures and environmental release can be fully avoided at all times. Thus, it is advisable that health and safety protocols should be comprehensive to minimise exposures in all types of locations (near- and far-field) and periods (activity and non-activity). Potential release to coastal surface waters of metallic engineered and incidental nanomaterials, as well as fine and coarse particles (in the case of settled dust), should be assessed and avoided.

UK food and nutrition security during and after the COVID-19 pandemic

The COVID‐19 pandemic is a major shock to society in terms of health and economy that is affecting both UK and global food and nutrition security. It is adding to the ‘perfect storm’ of threats to society from climate change, biodiversity loss and ecosystem degradation, at a time of considerable change, rising nationalism and breakdown in international collaboration. In the UK, the situation is further complicated due to Brexit. The UK COVID‐19Food andNutritionSecurity project, lasting one year, is funded by the Economic and Social Research Council and is assessing the ongoing impact of COVID‐19 on the four pillars of food and nutrition security: access, availability, utilisation and stability. It examines the food system, how it is responding, and potential knock on effects on the UK’s food and nutrition security, both in terms of the cascading risks from the pandemic and other threats. The study provides an opportunity to place the initial lessons being learnt from the on‐going responses to the pandemic in respect of food and nutrition security in the context of other long‐term challenges such as climate change and biodiversity loss.

Personal and area exposure assessment at a stainless steel fabrication facility: an evaluation of inhalable, time-resolved PM10, and bioavailable airborne metals

This study describes a comprehensive exposure assessment in a stainless steel welding facility, measuring personal inhalable PM and metals, time-resolved PM10 area metals, and the bioavailable fraction of area inhalable metals. Eighteen participants wore personal inhalable samplers for two, nonconsecutive shifts. Area inhalable samplers and a time-resolved PM10 X-ray fluorescence spectrometer were used in different work areas each sampling day. Inhalable and bioavailable metals were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Median exposures to chromium, nickel, and manganese across all measured shifts were 66 (range: 13-300) μg/m3, 29 (5.7-132) μg/m3, and 22 (1.5-119) μg/m3, respectively. Most exposure variation was seen between workers ( 0.79 < ICC < 0.55 ) , although cobalt and inhalable PM showed most variation within workers. Manganese was the most bioavailable metal from the inhalable size fraction (16 ± 3%), and chromium and nickel were 1.2 ± 0.08% and 2.6 ± 1.2% bioavailable, respectively. This comprehensive approach to welding-fume exposure assessment can allow for targeted approaches to controlling exposures based not only on individual measurements, but also on metal-specific measures and assessments of bioavailability.

Using a mesocosm approach to evaluate marine benthic assemblage alteration associated with CO2 enrichment in coastal environments

The effects of acidification related to the CO₂ enrichment in the coastal environments on marine macrobenthic abundance, diversity and richness were analyzed in a medium- term (21 days) using mesocosm experiments. Two sampling sites located in the Bay of Cadiz - SW, Spain were selected and tested at pH values ranged from 7.9 to 6.0 (± 0.1). Moreover, variations in the concentrations of metals in the sediment samples were analyzed at the end of each experiment. The results showed low variation in the concentrations of metals in the sediment among the pH treatments. A significant decrease (p < 0.05) in the abundance, diversity and richness of assemblages were measured between the control and the lowest pH level in both sampling sites tested in this study (Rio San Pedro and El Trocadero). The majority of species were found in all samples except in pH 6.0 which only two species were found (Hydrobia ulvae and Scrobicularia plana,) in Rio San Pedro sediment fauna. In general, the results of cluster analysis showed 60% and 40% similarity in all replicated tests in El Trocadero and Rio San Pedro of sediment fauna, respectively. The results of the Principal Component Analysis (PCA) showed that both sediment parameters and pH reduction can interfere in the benthic assemblage indices. Although the assemblages' indices have shown decreases only in the lower pHs, the organisms also could be impacted by chronic effects. Therefore, the extension of this study is important in order to improve the knowledge about the risks associated with CO₂ enrichment in on marine organisms.

Does real-time objective feedback and competition improve performance and quality in manikin CPR training--a prospective observational study from several European EMS

Background

Previous studies have reported that the quality of cardiopulmonary resuscitation (CPR) is important for patient survival. Real time objective feedback during manikin training has been shown to improve CPR performance. Objective measurement could facilitate competition and help motivate participants to improve their CPR performance. The aims of this study were to investigate whether real time objective feedback on manikins helps improve CPR performance and whether competition between separate European Emergency Medical Services (EMS) and between participants at each EMS helps motivation to train.

Methods

Ten European EMS took part in the study and was carried out in two stages. At Stage 1, each EMS provided 20 pre-hospital professionals. A questionnaire was completed and standardised assessment scenarios were performed for adult and infant out of hospital cardiac arrest (OHCA). CPR performance was objectively measured and recorded but no feedback given. Between Stage 1 and 2, each EMS was given access to manikins for 6 months and instructed on how to use with objective real-time CPR feedback available. Stage 2 was undertaken and was a repeat of Stage 1 with a questionnaire with additional questions relating to usefulness of feedback and the competition nature of the study (using a 10 point Likert score). The EMS that improved the most from Stage 1 to Stage 2 was declared the winner. An independent samples Student t-test was used to analyse the objective CPR metrics with the significance level taken as p < 0.05.

Results

Overall mean Improvement of CPR performance from Stage 1 to Stage 2 was significant. The improvement was greater for the infant assessment. The participants thought the real-time feedback very useful (mean score of 8.5) and very easy to use (mean score of 8.2). Competition between EMS organisations recorded a mean score of 5.8 and competition between participants recorded a mean score of 6.0.

Conclusions

The results suggest that the use of real time objective feedback can significantly help improve CPR performance. Competition, especially between participants, appeared to encourage staff to practice and this study suggests that competition might have a useful role to help motivate staff to perform CPR training.

Expression of human CD46 modulates inflammation associated with GalTKO lung xenograft injury

Evaluation of lungs from GalTKO.hCD46 pigs, genetically modified to lack the galactose-α(1,3)-galactose epitope (GalTKO) and to express human CD46, a complement regulatory protein, has not previously been described. Physiologic, hematologic and biochemical parameters during perfusion with heparinized fresh human blood were measured for 33 GalTKO.hCD46, GalTKO (n = 16), and WT pig lungs (n = 16), and 12 pig lungs perfused with autologous pig blood. Median GalTKO.hCD46 lung survival was 171 min compared to 120 for GalTKO (p = 0.27) and 10 for WT lungs (p < 0.001). Complement activation, platelet activation and histamine elaboration were significantly reduced during the first 2 h of perfusion in GalTKO.hCD46 lungs compared to GalTKO (ΔC3a at 120' 812 ± 230 vs. 1412 ± 1047, p = 0.02; ΔCD62P at 120' 9.8 ± 7.2 vs. 25.4 ± 18.2, p < 0.01; Δhistamine at 60' 97 ± 62 vs. 189 ± 194, p = 0.03). We conclude that, in addition to significant down-modulation of complement activation, hCD46 expression in GalTKO lungs diminished platelet and coagulation cascade activation, neutrophil sequestration and histamine release. Because GalTKO.hCD46 lung failure kinetics correlated directly with platelet and neutrophil sequestration, coagulation cascade activation and a rise in histamine levels within the first hour of perfusion, further progress will likely depend upon improved control of these pathways, by rationally targeted additional modifications to pigs and pharmacologic interventions.

EFNS guidelines on diagnosis and treatment of primary dystonias

OBJECTIVES

to provide a revised version of earlier guidelines published in 2006.

BACKGROUND

primary dystonias are chronic and often disabling conditions with a widespread spectrum mainly in young people.

DIAGNOSIS

primary dystonias are classified as pure dystonia, dystonia plus or paroxysmal dystonia syndromes. Assessment should be performed using a validated rating scale for dystonia. Genetic testing may be performed after establishing the clinical diagnosis. DYT1 testing is recommended for patients with primary dystonia with limb onset before age 30, and in those with an affected relative with early-onset dystonia. DYT6 testing is recommended in early-onset or familial cases with cranio-cervical dystonia or after exclusion of DYT1. Individuals with early-onset myoclonus should be tested for mutations in the DYT11 gene. If direct sequencing of the DYT11 gene is negative, additional gene dosage is required to improve the proportion of mutations detected. A levodopa trial is warranted in every patient with early-onset primary dystonia without an alternative diagnosis. In patients with idiopathic dystonia, neurophysiological tests can help with describing the pathophysiological mechanisms underlying the disorder.

TREATMENT

botulinum toxin (BoNT) type A is the first-line treatment for primary cranial (excluding oromandibular) or cervical dystonia; it is also effective on writing dystonia. BoNT/B is not inferior to BoNT/A in cervical dystonia. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for primary generalized or cervical dystonia, after medication or BoNT have failed. DBS is less effective in secondary dystonia. This treatment requires a specialized expertise and a multidisciplinary team.

Potential of atmospheric pressure chemical ionization source in GC-QTOF MS for pesticide residue analysis

The potential applications of a new atmospheric pressure source for GC-MS analysis have been investigated in this work. A list of around 100 GC-amenable pesticides, which includes organochlorine, organophosphorus and organonitrogenated compounds, has been used to evaluate their behavior in the new source. Favoring the major formation of the molecular ion in the source has been the main goal due to the wide-scope screening possibilities that this fact brings in comparison with the traditional, highly fragmented electron ionization spectra. Thus, the addition of water as modifier has been tested as a way to promote the generation of protonated molecules. Pesticides investigated have been classified into six groups according to their ionization/fragmentation behavior. Four of them are characterized by the abundant formation of the protonated molecule in the atmospheric pressure source, mostly being the base peak of the spectrum. These results show that wide-scope screening could be easily performed with this source by investigating the presence of the protonated molecule ion, MH+. The developed procedure has been applied to pesticide screening in different food samples (nectarine, orange and spinach) and it has allowed the presence of several pesticides to be confirmed such as chlorpyriphos ethyl, deltamethrin and endosulfan sulfate. The availability of a quadrupole time-of-flight instrument made it feasible to perform additional MS/MS experiments for both standards and samples to go further in the confirmation of the identity of the detected compounds. Results shown in this paper have been obtained using a prototype source which exhibits promising features that could be applied to other analytical problems apart from those illustrated in this work.

Development and preliminary evaluation of the KIDCLOT PAC QL: a new health-related quality of life measure for pediatric long-term anticoagulation therapy

Long term anticoagulation (LTA) is hypothesized to induce treatment dissatisfaction influence quality of life (QOL). QOL is measured by a tool developed specific to the patient condition. Pediatric QOL inventory for children on LTA should assess constructs salient for this population. Identification and evaluation of QOL constructs, critical to improve care, and is accepted as the "gold-standard" measurement for patient-centered outcomes in clinical research.

OBJECTIVES

To develop and preliminarily validate a pediatric QOL inventory for children/families receiving LTA. Secondary objective was to determine how anticoagulation disrupts children's life.

METHODS

Stage 1: Item/theme generation through focus groups and existing inventories, Stage 2: Item reduction, inventory generation and content validity. Stage 3: Inventory refinement, implementation and reliability testing. Responses were evaluated for variability, internal consistency, and scale structure. Item reduction was based on response rate, item variability, and clinical utility.

RESULTS

Two inventories, KIDCLOT-PAC-Child -Tween QL and KIDCLOT-PAC Parent-proxy-QL were developed. Content and face validity was assessed by experts, parents, and patients. Internal consistency determined by Cronbach's alpha was good for parent-proxy(0.82) and child(0.89). Pearson correlation was acceptable with >0.5 for test-retest reliability (parent inventory).

CONCLUSIONS

KIDCLOT-PAC-QL is the first preliminarily validated inventory to assess QOL in anticoagulated children. The inventory identifies barriers in care and areas for improvement in order to modify care to provide the "best" management (improved QOL associated with safety and efficacy) for children requiring LTA.

Boerhaave's syndrome: a pain in the neck

Boerhaave's syndrome, or post-emetic rupture of the oesophagus, classically presents with vomiting, chest pain and subcutaneous emphysema. Mortality in this condition is very high and increases dramatically with delayed diagnosis and intervention. The vast majority of patients have a tear in the left posterior-lateral wall of the lower third of the oesophagus and require urgent surgical intervention. Spontaneous rupture of the cervical oesophagus is very rare and may present differently to oesophageal perforations elsewhere. A case is presented following vomiting in a 70-year-old woman, which was diagnosed by computed tomography scan and treated conservatively. The attending physician must be alert to the diagnosis of post-emetic cervical oesophageal perforation as prompt diagnosis and treatment is essential to reduce morbidity and mortality.

Intravenous ketamine for adult procedural sedation in the emergency department: a prospective cohort study

OBJECTIVES

To evaluate the use of intravenous ketamine for procedural sedation in adults attending the emergency department.

METHODS

A prospective study was performed over a 2-year period in 92 patients who received intravenous ketamine for procedural sedation in the emergency department of St Thomas' Hospital. All patients received 0.5-1.0 mg/kg ketamine intravenously for the procedure. Pulse rate, blood pressure oxygen saturations and incidence of adverse events (clonic movements, hypersalivation, laryngospasm, recovery agitation and vomiting) were recorded for all patients.

RESULTS

Adequate sedation was obtained in 91 of the 92 patients (98.9%) and successful completion of the procedure was achieved in 91 patients (98.9%). Adverse events occurred in 20 patients (21.7%). Four patients (7%) developed clonic movements, none of which required treatment. Twelve patients (13.0%) developed recovery agitation. In five cases the agitation was transient and required no treatment; the other seven patients were treated with intravenous midazolam. One of the patients who experienced recovery agitation also developed vomiting. Two other patients vomited, and one patient had vomiting and hypersalivation. One further patient developed hypersalivation. There were no reported episodes of laryngospasm.

CONCLUSIONS

Ketamine is an effective agent for procedural sedation in the emergency department. There were no serious adverse events associated with its use, but there is a significant incidence of recovery agitation which may require treatment with a benzodiazepine.

A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force

To review the literature on primary dystonia and dystonia plus and to provide evidence-based recommendations. Primary dystonia and dystonia plus are chronic and often disabling conditions with a widespread spectrum mainly in young people. Computerized MEDLINE and EMBASE literature reviews (1966-1967 February 2005) were conducted. The Cochrane Library was searched for relevant citations. Diagnosis and classification of dystonia are highly relevant for providing appropriate management and prognostic information, and genetic counselling. Expert observation is suggested. DYT-1 gene testing in conjunction with genetic counselling is recommended for patients with primary dystonia with onset before age 30 years and in those with an affected relative with early onset. Positive genetic testing for dystonia (e.g. DYT-1) is not sufficient to make diagnosis of dystonia. Individuals with myoclonus should be tested for the epsilon-sarcoglycan gene (DYT-11). A levodopa trial is warranted in every patient with early onset dystonia without an alternative diagnosis. Brain imaging is not routinely required when there is a confident diagnosis of primary dystonia in adult patients, whereas it is necessary in the paediatric population. Botulinum toxin (BoNT) type A (or type B if there is resistance to type A) can be regarded as first line treatment for primary cranial (excluding oromandibular) or cervical dystonia and can be effective in writing dystonia. Actual evidence is lacking on direct comparison of the clinical efficacy and safety of BoNT-A vs. BoNT-B. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for generalized or cervical dystonia, after medication or BoNT have failed to provide adequate improvement. Selective peripheral denervation is a safe procedure that is indicated exclusively in cervical dystonia. Intrathecal baclofen can be indicated in patients where secondary dystonia is combined with spasticity. The absolute and comparative efficacy and tolerability of drugs in dystonia, including anticholinergic and antidopaminergic drugs, is poorly documented and no evidence-based recommendations can be made to guide prescribing.

Auger energy shifts in fcc AgPd random alloys from complete screening picture and experiment

We extend the complete screening picture to ab initio calculations of Auger kinetic energy and Auger parameter shifts in metallic alloys. Experimental measurements of the L(3)M(4,5)M(4,5) Auger transition in fcc AgPd random alloys are compared with first-principles calculations and the results are in excellent agreement for both the Ag and Pd Auger shifts over the whole concentration range. We discuss the Auger kinetic energy shifts in terms of single-hole states for the 2p(3/2) core level and double-hole states for the 3d(5/2) level.

Outbreak of Pseudomonas aeruginosa folliculitis associated with a swimming pool inflatable

On 18 February 2002, the Communicable Disease Unit was notified by the local Public Health Service Laboratory of a child with a positive skin swab for Pseudomonas aeruginosa. This child had attended the local swimming pool and played on an inflatable, subsequently presenting to a Primary Care Nurse Practitioner with folliculitis. A total of 35 cases was identified during the outbreak. This paper describes a case-control study and microbiological sampling of the cases, the suspected inflatable and a survey of 10 swimming pool inflatables in the local area. The odds ratio for developing folliculitis following use of the inflatable was 12 (95% CI 1.05-136.80). The strain of P. aeruginosa found on the inflatable was identical to that obtained from skin swabs of cases. Nine of 10 (90%) of the inflatables sampled were colonized by P. aeruginosa. Attention should be given to the problem of routine decontamination of swimming pool inflatables. P. aeruginosa folliculitis needs to be considered in the differential diagnosis of skin rashes in children, especially in Primary Care.

Electrochemiluminescent detection of bacteria in blood components

Transfusion-transmitted bacterial infections cause significant patient morbidity and mortality. This study aimed to improve the sensitivity of a nucleic acid-based electrochemiluminescence (ECL) assay for pretransfusion bacterial testing of cellular blood components. The approach is dependent on the detection of bacterial 16S ribosomal RNA (rRNA). The modifications studied included the use of a chaotrope-based lysis buffer with high-energy mechanical cell disruption by RiboLysis, increased ruthenium (Ru2+) labelling per 16S rRNA molecule and concomitant use of fluorescent nucleic acid dyes (CyQUANT, Syto 17 red and Syto 61 red). The methodological changes made did lead to more effective bacterial cell disruption and enhanced ECL signal generation. Nevertheless, assay sensitivity was only slightly improved at approximately 10(4)-10(5) colony forming units per mL (CFU mL(-1)) and the results were highly inconsistent. The method is still not sensitive to the required 10(2) CFU mL(-1) and remains impractical for routine use in blood centres.

Transmission of visceral leishmaniasis through blood transfusions from infected English foxhounds to anemic dogs

OBJECTIVE

To conduct serologic surveillance for Leishmania spp in English foxhounds from a kennel, as well as recipients of blood from these dogs, and determine whether L infantum organisms could be transmitted via blood transfusion.

DESIGN

Serologic prevalence survey.

ANIMALS

120 English foxhounds and 51 dogs of various breeds receiving blood from these donors.

PROCEDURE

Foxhound blood donors, foxhound nondonors, and nonfoxhound blood recipient dogs were evaluated serologically for Leishmania spp by indirect fluorescent antibody testing. Dogs that received packed RBC (PRBC) transfusions from foxhound donors from mid-1996 through mid-2000 were identified. Furthermore, dogs were serologically evaluated if they had received fresh frozen plasma (FFP) transfusions in 1999 and 2000 from seropositive foxhound blood donors.

RESULTS

Thirty percent of the English Foxhounds were seropositive for Leishmania spp (titer > or = 1:16), although the degree of seropositivity varied considerably during the period. Furthermore, 57 foxhounds had been used as donors from 1996 to 2000, and 342 units of PRBC had been transfused to at least 227 patients. All 25 dogs screened that received PRBC from seronegative foxhound donors tested negative, whereas 3 of 7 dogs that received PRBC from seropositive donors tested positive. All 9 dogs that received FFP from seropositive foxhound donors remained seronegative.

CONCLUSIONS AND CLINICAL RELEVANCE

To our knowledge, this report documents the first transmission of Leishmania spp by blood transfusion. The use of foxhounds as blood donors may not be advisable in North America.

The N-terminal zinc finger of the erythroid transcription factor GATA-1 binds GATC motifs in DNA

The mammalian transcription factor GATA-1 is required for normal erythroid and megakaryocytic development. GATA-1 contains two zinc fingers, the C-terminal finger, which is known to bind (A/T)GATA(A/G) motifs in DNA and the N-finger, which is important for interacting with co-regulatory proteins such as Friend of GATA (FOG). We now show that, like the C-finger, the N-finger of GATA-1 is also capable of binding DNA but recognizes distinct sequences with the core GATC. We demonstrate that the GATA-1 N-finger can bind these sequences in vitro and that in cellular assays, GATA-1 can activate promoters containing GATC motifs. Experiments with mutant GATA-1 proteins confirm the importance of the N-finger, as the C-finger is not required for transactivation from GATC sites. Recently four naturally occurring mutations in GATA-1 have been shown to be associated with familial blood disorders. These mutations all map to the N-finger domain. We have investigated the effect of these mutations on the recognition of GATC sites by the N-finger and show that one mutation R216Q abolishes DNA binding, whereas the others have only minor effects.

Organization, expression, and function of Caulobacter crescentus genes needed for assembly and function of the flagellar hook

This paper reports on the organization, expression, and function of the divergently transcribed flbG and flaN operons in the hook gene cluster of Caulobacter crescentus. The transcription initiation site of flbG was determined previously, and in this work the transcription map was completed by locating the 3' end of the mRNA using nuclease S1 protection assays. A previous genetic study had suggested that the flbG operon is comprised of four genes; however, the nucleotide sequence revealed three tandemly arranged ORFs that correspond to 5'-flbG, flbH, and flgE. FlbG is similar to FliK proteins which are required for termination of hook synthesis, FlbH is similar to FlgD proteins which are essential scaffolding proteins that cap the hook during its assembly, and FlgE corresponds to the hook structural protein. The divergently transcribed flaN gene codes for a hook associated protein I homolog based on its inferred amino acid sequence similarity to FlgK proteins. Based on the amino acid sequence similarities and phenotypes of mutants, flbG, flbH, and flaN have been renamed fliK, flgD, and flgK, FlgD, FlgE, and FlgK proteins, with apparent molecular masses of 23, 68, and 41 kDa, respectively, were expressed from plasmids in a cell-free coupled transcription-translation system, and a protein corresponding to FliK was identified as part of a 190-kDa FliK-LacZ fusion protein. We present evidence showing that, in addition to its role in termination of hook synthesis, FliK is also required for initiation of hook assembly.