Immunogenicity and Vaccine Shedding After 1 or 2 Doses of rVSVΔG-ZEBOV-GP Ebola Vaccine (ERVEBO®): Results From a Phase 2, Randomized, Placebo-controlled Trial in Children and Adults

BACKGROUND

The rVSVΔG-ZEBOV-GP vaccine (ERVEBO®) is a single-dose, live-attenuated, recombinant vesicular stomatitis virus vaccine indicated for the prevention of Ebola virus disease (EVD) caused by Zaire ebolavirus in individuals 12 months of age and older.

METHODS

The Partnership for Research on Ebola VACcination (PREVAC) is a multicenter, phase 2, randomized, double-blind, placebo-controlled trial of 3 vaccine strategies in healthy children (ages 1-17) and adults, with projected 5 years of follow-up (NCT02876328). Using validated assays (GP-ELISA and PRNT), we measured antibody responses after 1-dose rVSVΔG-ZEBOV-GP, 2-dose rVSVΔG-ZEBOV-GP (given on Day 0 and Day 56), or placebo. Furthermore, we quantified vaccine virus shedding in a subset of children's saliva using RT-PCR.

RESULTS

In total, 819 children and 783 adults were randomized to receive rVSVΔG-ZEBOV-GP (1 or 2 doses) or placebo. A single dose of rVSVΔG-ZEBOV-GP increased antibody responses by Day 28 that were sustained through Month 12. A second dose of rVSVΔG-ZEBOV-GP given on Day 56 transiently boosted antibody concentrations. In vaccinated children, GP-ELISA titers were superior to placebo and non-inferior to vaccinated adults. Vaccine virus shedding was observed in 31.7% of children, peaking by Day 7, with no shedding observed after Day 28 post-dose 1 or any time post-dose 2.

CONCLUSIONS

A single dose of rVSVΔG-ZEBOV-GP induced robust antibody responses in children that was non-inferior to the responses induced in vaccinated adults. Vaccine virus shedding in children was time-limited and only observed after the first dose. Overall, these data support the use of rVSVΔG-ZEBOV-GP for the prevention of EVD in at-risk children. Clinical Trials Registration. The study is registered at ClinicalTrials.gov (NCT02876328), the Pan African Clinical Trials Registry (PACTR201712002760250), and the European Clinical Trials Register (EudraCT number: 2017-001798-18).

Pearls for Starting a Headache Surgery Practice in Academic and Private Practice

There has been a growing body of evidence indicative of the effectiveness of headache surgery in treating patients with refractory headache disorders. The American Society of Plastic Surgeons issued a Policy Statement in 2018 stating that peripheral nerve decompression surgery for the treatment of refractory chronic headache disorders in select patients is considered a standard of care treatment. This endorsement sparked the interest of numerous plastic surgeons into initiating their own headache surgery practices. However, establishing a headache surgery clinic introduces challenges and considerations. This report outlines the key pillars for launching a successful headache surgery practice in academic and private practice environments.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

A repeating fast radio burst associated with a persistent radio source

The dispersive sweep of fast radio bursts (FRBs) has been used to probe the ionized baryon content of the intergalactic medium1, which is assumed to dominate the total extragalactic dispersion. Although the host-galaxy contributions to the dispersion measure appear to be small for most FRBs2, in at least one case there is evidence for an extreme magneto-ionic local environment3,4 and a compact persistent radio source5. Here we report the detection and localization of the repeating FRB 20190520B, which is co-located with a compact, persistent radio source and associated with a dwarf host galaxy of high specific-star-formation rate at a redshift of 0.241 ± 0.001. The estimated host-galaxy dispersion measure of approximately [Formula: see text] parsecs per cubic centimetre, which is nearly an order of magnitude higher than the average of FRB host galaxies2,6, far exceeds the dispersion-measure contribution of the intergalactic medium. Caution is thus warranted in inferring redshifts for FRBs without accurate host-galaxy identifications.

Pre-farrow enrichment with burlap sheet: potential benefit for sow performance

Burlap has been proposed as an enrichment option for the conventional farrowing crate environment. Our objectives were to determine if burlap sheets hung in farrowing crates were used by sows and piglets and had any effect on farrowing and litter performance. Before sow entry, a sterilized burlap sheet (165 cm × 60 cm) was attached to every second farrowing crate so that it hung to the floor with easy animal access. Its length was measured immediately after farrowing and weaning. Routine sow and litter information from farrowing to weaning (day 18) were recorded. Complete data were analyzed for mixed-parity sows and litters with burlap (BURL; n = 277) and without burlap (CTRL; n = 277). Sows and their litters manipulated the burlap sheet to varying degrees. The BURL sows had a lower percentage of stillbirths (6.5% vs. 8.3%, BURL vs. CTRL, SE 0.4; P = 0.004), although there was only a trend towards more born alive (13.00 vs. 12.54, SE 0.25; P = 0.113). More piglets were fostered off BURL sows (8.4 vs. 7.1, SE 0.5; P = 0.049). No significant differences were apparent for other sow and litter measurements. Burlap sheets as a farrowing crate enrichment have potential to improve sow and litter performance.

Safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, administered concomitantly with influenza vaccine in healthy adults aged ≥50 years: a randomized phase 3 trial (PNEU-FLU)

Streptococcus pneumoniae and influenza viruses are associated with significant morbidity and mortality in older adults. Concomitant vaccination against these agents reduces hospitalization and mortality rates. This phase 3 trial evaluated safety, tolerability, and immunogenicity of concomitant and non-concomitant administration of V114, a 15-valent pneumococcal conjugate vaccine containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, 19A, 22F, 23F, 33F, and quadrivalent inactivated influenza vaccine (QIV), in healthy adults aged ≥50 years. Participants (N = 1,200) were randomized 1:1 to receive either V114 administered concomitantly with QIV (concomitant group) or QIV plus placebo (non-concomitant group) on Day 1, followed by placebo (concomitant group) or V114 (non-concomitant group) 30 days later. Randomization was stratified by age and history of pneumococcal polysaccharide vaccine receipt. Overall, 426 (71.0%) and 438 (73.5%) participants in the concomitant and non-concomitant groups experienced solicited injection-site adverse events (AEs); 278 (46.3%) and 300 (50.3%) reported solicited systemic AEs. Most solicited AEs were mild or moderate in severity and of short duration. Non-inferiority for pneumococcal- and influenza-specific antibody responses (lower bound 95% confidence interval of opsonophagocytic activity [OPA] and hemagglutination inhibition geometric mean titers [GMTs] ratios ≥0.5) was demonstrated for concomitant versus non-concomitant administration for all 15 pneumococcal serotypes and all four influenza strains. Consistent with previous studies, a trend was observed toward lower pneumococcal OPA GMTs in the concomitant versus the non-concomitant group. V114 administered concomitantly with QIV is generally well tolerated and immunologically non-inferior to non-concomitant administration, supporting coadministration of both vaccines.

Design of a Phase III efficacy, immunogenicity, and safety study of 9-valent human papillomavirus vaccine in prevention of oral persistent infection in men

BACKGROUND

Seven high-risk human papillomavirus (HPV) types (16/18/31/33/45/52/58) covered by the 9-valent HPV (9vHPV) vaccine cause >90% of HPV-related head and neck cancers (HNCs). An ongoing clinical trial (NCT04199689) was designed to evaluate 9vHPV vaccine efficacy against HPV oral persistent infection, a surrogate endpoint for HPV-related HNCs.

METHODS

In this double-blind, placebo-controlled, international trial, men aged 20-45 years (N = 6000) are randomized 1:1 to receive 9vHPV vaccine or placebo on day 1, month 2, and month 6. The primary objective is to demonstrate whether 9vHPV vaccination reduces incidence of HPV16/18/31/33/45/52/58-related 6-month oral persistent infection. Incidence of HPV6/11-related 6-month oral persistent infection will be evaluated as a secondary endpoint. Oral rinse and gargle samples will be collected on day 1, month 7, month 12, and every 6 months thereafter for HPV detection by PCR. Primary analyses will be performed in per-protocol populations. Efficacy in this case-driven study will be analyzed upon accrual of ≥20 primary efficacy endpoint cases. Serum will be collected at day 1 and months 7, 12, 24, 36, and 42; anti-HPV antibody titers will be measured by competitive Luminex immunoassay. Data will be summarized as geometric mean titers and seropositivity rates. Injection-site and systemic adverse events (AEs) will be collected for 15 days post-any vaccination and serious AEs through 6 months after the last vaccination; deaths and vaccine-related serious AEs will be collected throughout the study.

DISCUSSION

This trial is expected to generate important data regarding the potential for 9vHPV vaccine to prevent HPV-related head and neck disease.

Zinc Gluconate Induces Potentially Cancer Chemopreventive Activity in Barrett's Esophagus: A Phase 1 Pilot Study

BACKGROUND

Chemopreventive effects of zinc for esophageal cancer have been well documented in animal models. This prospective study explores if a similar, potentially chemopreventive action can be seen in Barrett's esophagus (BE) in humans.

AIMS

To determine if molecular evidence can be obtained potentially indicating zinc's chemopreventive action in Barrett's metaplasia.

METHODS

Patients with a prior BE diagnosis were placed on oral zinc gluconate (14 days of 26.4 mg zinc BID) or a sodium gluconate placebo, prior to their surveillance endoscopy procedure. Biopsies of Barrett's mucosa were then obtained for miRNA and mRNA microarrays, or protein analyses.

RESULTS

Zinc-induced mRNA changes were observed for a large number of transcripts. These included downregulation of transcripts encoding proinflammatory proteins (IL32, IL1β, IL15, IL7R, IL2R, IL15R, IL3R), upregulation of anti-inflammatory mediators (IL1RA), downregulation of transcripts mediating epithelial-to-mesenchymal transition (EMT) (LIF, MYB, LYN, MTA1, SRC, SNAIL1, and TWIST1), and upregulation of transcripts that oppose EMT (BMP7, MTSS1, TRIB3, GRHL1). miRNA arrays showed significant upregulation of seven miRs with tumor suppressor activity (-125b-5P, -132-3P, -548z, -551a, -504, -518, and -34a-5P). Of proteins analyzed by Western blot, increased expression of the pro-apoptotic protein, BAX, and the tight junctional protein, CLAUDIN-7, along with decreased expression of BCL-2 and VEGF-R2 were noteworthy.

CONCLUSIONS

When these mRNA, miRNA, and protein molecular data are considered collectively, a cancer chemopreventive action by zinc in Barrett's metaplasia may be possible for this precancerous esophageal tissue. These results and the extensive prior animal model studies argue for a future prospective clinical trial for this safe, easily-administered, and inexpensive micronutrient, that could determine if a chemopreventive action truly exists.

Effect of Slat and Gap Width of Slatted Concrete Flooring on Sow Gait Using Kinematics Analysis

The housing of gestating sows in groups requires sound information about the adapted design of the pen floor. Slatted concrete floors are commonly used for effective drainage of manure but can cause feet injuries and lameness. In the present study, kinematics were used to characterize the gait of 12 gilts and 12 lame sows walking in a corridor on slatted concrete floors with different combinations of slat (85, 105 or 125 mm) and gap (19, 22 or 25 mm) widths. The nine experimental floors were tested with slats in the perpendicular and parallel orientation to the direction of animal walk, according to a duplicated lattice design. Gait parameters were quantified using spatial, temporal and angular kinematics for front and rear limbs. Some parameters were significantly affected by the treatments (p < 0.05), but the effects differed between gilts and lame sows and between slat orientations. Gap width had a significant effect on parameters such as back angle, stride length, foot height, and carpal and tarsal joint angle amplitudes. Slat width significantly affected parameters such as foot height, and carpal and tarsal joint angle amplitudes. Comparisons of the different combinations of slat and gap widths revealed that slats with a width of 105-125 mm and gap width of 19-22 mm had the least effect on the gait characteristics of the gilts and sows.

Change to ecosystem properties through changing the dominant species: Impact of Pteridium aquilinum-control and heathland restoration treatments on selected soil properties

It is well known that soils are influenced by the plant species that grow in them. Here we consider the effects of management-induced changes to plant communities and their soils during restoration within a 20-year manipulative experiment where the aim was to change a late-successional community dominated by the weed, Pteridium aquilinum, to an earlier-successional grass-heath one. The ecological restoration treatments altered the above- and below-ground components of the community substantially. Untreated plots maintained a dense Pteridium cover with little understory vegetation, cutting treatments produce significant reductions of Pteridium, whereas herbicide (asulam) produced significant immediate reductions in Pteridium but regressed towards the untreated plots within 10 years. Thereafter, all asulam-treated plots were re-treated in year 11, and then were spot-sprayed annually. Both cutting and asulam treatments reduced frond density to almost zero and resulted in a grass-heath vegetation. There was also a massive change in biomass distribution, untreated plots had a large above-ground biomass/necromass that was much reduced where Pteridium was controlled. Below-ground in treated plots, there was a replacement of the substantive Pteridium rhizome mass with a much greater root mass of other species. The combined effects of Pteridium-control and restoration treatment, reduced soil total C and N as and available P concentrations, but increased soil pH and available N. Soil biological activity was also affected with a reduction in soil N mineralization rate, but an increased soil-root respiration. Multivariate analysis showed a clear trend along a pH/organic matter gradient, with movement along it correlated to management intensity from the untreated plots with low pH/high organic matter and treated plots with to a higher pH/lower organic matter in the sequence asulam treatment, cut once per year to cut twice per year. The role that these changed soil conditions might have in restricting Pteridium recovery are discussed.

Season, Transport Duration and Trailer Compartment Effects on Blood Stress Indicators in Pigs: Relationship to Environmental, Behavioral and Other Physiological Factors, and Pork Quality Traits

Simple Summary

Factors, such as ambient conditions, travel duration and vehicle design/compartment location have an impact on the welfare of pigs during transport, carcass bruises and meat quality. Based on this, we aimed to assess the effects of these factors on blood creatine kinase, lactate and cortisol concentrations in 384 pigs and assess their relationships with trailer temperature, and pigs’ heart rate and gastrointestinal tract temperature, behavior, carcass damage scores and meat quality. Although increased blood cortisol and creatine-kinase levels appear to indicate a physical stress condition in transported pigs, the weak to moderate correlations with environmental and other animal welfare indicators suggest that blood stress parameters can only be used as a complementary measurement in the assessment of the pigs’ response to transport stress.

Abstract

The objective of this study was to assess the effects of the season, travel duration and trailer compartment location on blood creatine-kinase (CK), lactate and cortisol concentrations in 384 pigs and assess their relationships with trailer temperature, heart rate and gastrointestinal tract temperature (GTT), behavior, carcass damage scores and meat quality. Blood CK was greater in pigs transported in summer (p = 0.02), after 18 h transportation (p < 0.001) and in pigs located in C4, C5 and C10 (p = 0.002). In winter, the concentration of blood lactate was higher (p = 0.04) in pigs transported for 6 h in C5. Pigs located in C10 showed higher (p = 0.01) concentration of cortisol than those transported for 18h in C4 in summer. The highest correlations were between blood cortisol and GTT (r = 0.53; p < 0.001), and between blood CK and GTT (r = 0.41; p < 0.001), truck temperature (r = 0.42; p < 0.001), and pH_u in the longissimus muscle (r = 0.41; p < 0.001). In conclusion, although increased blood cortisol and CK levels appear to indicate a physical stress condition in transported pigs, the weak to moderate correlations with environmental and other animal welfare indicators suggest that blood stress parameters can only be used as a complementary measurement in the assessment of the pigs’ response to transport stress.

Measure and characterization of lameness in gestating sows using force plate, kinematic, and accelerometer methods

The objective was to assess sows' lameness by measuring weight distribution on limbs using a force plate made up of 4 individual platforms each resting on 4 single-ended beam load cells. The weight was recorded at an average rate of 14 readings per s over a 15 min period. Ten sows (5 lame sows and 5 sound sows) were weighed twice on 2 different days to assess the repeatability of the measure. Sixty-one sows were then selected in 2 different sites and visually scored for lameness, using a 3-point scoring system (0=normal gait; 1=abnormal gait, and/or stiffness; and 2=shortened stride, and/or the sow puts less weight or avoids putting weight on 1 leg). Various measures were recorded from each sow using the force plate (percentage of weight, the ratio between the weights applied by contralateral legs, weight shifting, and amplitude of weight bearing and weight removing), kinematics (speed, stride length, swing time, stance time, foot height, and carpal and tarsal joints angle average and amplitude), and accelerometers (time spent standing during 24 h, frequency of stepping behavior during feeding, and latency to lie down after feed delivery). The within-sow CV for each measure taken from the force plate were lower than 15%, which reflects a good repeatability. Among force plate measures, only the weight shifting frequency and the ratio between the weights applied by contralateral legs differed between lameness scores. Sows that scored 2 had a higher frequency of weight shifting for fore legs (P=0.0003) and hind legs (P=0.0007) than sows scored 0 and 1. The ratio between the weights applied by contralateral legs decreased with the increase of lameness score for the hind limbs (P=0.014). However, these measures also differed between sites (P<0.01). These differences may be due to various reasons, including but not limited to genetics and housing systems. Nevertheless, the results suggest that force plate measures such as the asymmetry in the weight applied between a pair of legs and weight shifting are good indicators of lameness. Multivariate analysis on fore and hind legs showed independency between variables related to animals in movement (measures from kinematics) and variables related to static animals (measures from the force plate and accelerometers). Therefore, both static and dynamic methods need to be used to detect various lame sows.

Recent trends in organochlorine residues in mussels (Mytilus edulis) from the Mersey Estuary

Blue mussels (Mytilus edulis) taken from several sites in the Mersey Estuary, an urban-industrial water body in NW England, have been analyzed for residues of the persistent organochlorines, DDT, PCB congeners nos. 28, 52, 101, 118, 138, 153 and 180 (ICES7), and alpha-MHCH (alpha-methyl hexachlorocyclohexane). The concentration range for sigmaPCB (ICES7) was 13.9-34.9 microg kg(-1) in 1994 compared with 9.6-31.9 microg kg(-1) in 1998, whilst the equivalent concentrations of sigmaDDT were 8.9-32.4 microg kg(-1) and 4.5-16.8 microg kg(-1), respectively. The concentration of alpha-MHCH, an organochlorine largely restricted to the Mersey Estuary, was 1.2-11 microg kg(-1) in 1994 and 0.3-1.3 microg kg(-1) in 1998. At both sampling dates the inner estuary sites of Rock Ferry and Egremont were more contaminated than the outer estuary sites of New Brighton. Dove Point and Caldy Blacks. The lower concentrations of organochlorines in mussels in 1998 compared with 1994 are thought to be early evidence of significant improvements in water quality derived from major capital investment in the treatment of industrial effluents and sewage wastewater, linked to a combination of stricter legislative controls and the environmental benefits from the adoption of new, clean technologies in manufacturing.

Sedatives used in pediatric imaging: comparison of IV pentobarbital with IV pentobarbital with midazolam added

OBJECTIVE

This study was designed to evaluate safety, efficacy, and success of adding IV midazolam to an established IV pentobarbital protocol for pediatric sedation for radiologic imaging. Outcomes included sedation and discharge times as well as adverse events

SUBJECTS AND METHODS

This prospective study compared two different sedation protocols developed by the radiology sedation committee and approved by the hospital sedation committee at our institution. Patients in the pentobarbital group received IV pentobarbital alone, and patients in the pentobarbital--midazolam group received a combination of IV pentobarbital and midazolam. A total of 1070 infants and children were enrolled, and sedation data were entered into a computer database and reviewed at bimonthly radiology sedation committee meetings for safety, efficacy, efficiency, failed sedations, and adverse outcomes.

RESULTS

Mean age distribution, sex, American Society of Anesthesiologists physical status classification, fasting status, weight, and types of examinations were similarly distributed between the two study groups. Analysis of variance indicated longer times were required to sedate and to discharge patients who had received pentobarbital--midazolam (p < 0.001 for both times), even after adjusting for differences in the patients' ages and weights. The pentobarbital--midazolam group required more time to be successfully sedated and more time to discharge from the recovery room. The rates of adverse events and failed sedations were similar for both groups.

CONCLUSION

Midazolam does not have a beneficial effect on pentobarbital sedation and has no effect on the rate of adverse events. The prolonged time needed both to sedate and to discharge (timed from the initial dose of sedation) pediatric patients who have received midazolam should discourage physicians from combining it with pentobarbital for pediatric sedation.

The organochlorine contamination history of the Mersey estuary, UK, revealed by analysis of sediment cores from salt marshes

Sediment profiles in the Banks, Ince and Widnes Warth salt marshes in Northwest England contain a mappable record of historic pollution. For persistent organochlorine compounds this stretches back over 90 years. The PCB and HCH profiles can be successfully rationalised by dating methods, and they can be related to the dates of initial production and subsequent withdrawal from use of these chemicals as a result of restrictive environmental legislation. HCB has a more complex pollution profile as it has been manufactured in Northwest England, both deliberately as a pesticide and accidentally as a by-product of several chlorination processes, dating back to the start of the 20th century. The concentrations of degradation products of DDT are relatively constant through the sediment profile and are dominated by op'- and pp'-DDD with only minor contributions from the most toxic species, pp'-DDT. The quantities of these compounds resident in the reservoir of pollutants under these marshes have been calculated, and have fallen progressively in the last 30-50 years.

Memory in Old Age: Patterns of Decline and Preservation

This article reviews patterns of decline and preservation of memory skills in healthy older adults. Age-related changes in primary, working, and long-term memory abilities as determined by clinical assessment tools and laboratory-derived measures are discussed with specific review of evidence for age-related decline in encoding, storage, and retrieval of information from memory. Lastly, memory training techniques appropriate for the older adult population are reviewed.

The use of oral pentobarbital sodium (Nembutal) versus oral chloral hydrate in infants undergoing CT and MR imaging--a pilot study

BACKGROUND

Chloral hydrate, a commonly used oral sedative for infants undergoing imaging examinations, has a bitter taste and requires relatively large volume, provoking unpleasant reactions from the infants. Experience with an alternative sedative, oral pentobarbital (Nembutal), has not been reported for infants.

OBJECTIVE

To compare patient acceptance of oral Nembutal and oral chloral hydrate for sedation of infants up to 12 months of age.

METHODS AND MATERIALS

Fifty-four infants (mean age: 7 months) were prospectively enrolled. Parents chose Nembutal, chloral hydrate, or no preference. Thirty-eight infants received Nembutal (4-6 mg/kg) mixed with cherry syrup and 16 received chloral hydrate (50-100 mg/ kg). We recorded infant's acceptance of sedative, parental impression of infant's acceptance, time to sedation, time to discharge, adverse effects, parental preference of future sedative.

RESULTS

Infant acceptance and parental impression were better for Nembutal (P < 0.0001). Fewer parents in the Nembutal group preferred another sedative (P = 0.05). There was a trend toward shorter time to discharge with Nembutal (P = 0.03). There were no adverse effects in either group. One infant failed to sedate with Nembutal.

CONCLUSIONS

Compared with chloral hydrate, oral Nembutal has significantly better acceptance by infants and parents, equal effectiveness, and may result in a shorter time to discharge.

Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

BACKGROUND

Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur.

OBJECTIVE

The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes.

MATERIALS AND METHODS

Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression.

RESULTS

Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV.

CONCLUSION

The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives.

Engendering stress in Australia: the embodiment of social relationships

This study draws on data from an ethnographic study of health and illness in a suburb of a regional city of southeastern Australia. "Stress" was a significant emergent theme in one-third of 111 semistructured interviews, as well as focus groups and informal conversation. The researchers were able to construct a "lay epidemiology" in which stress was important in residents' understandings of the causes and symptoms of a range of health problems. The paper explores the different ways in which discourses of stress articulated the experience of structured gender relations among residents of Oceanpoint within the wider framework of a cultural critique of modernity in relation to the embodied self.

Polychlorinated biphenyls in small mammals from contaminated landfill sites

PCBs in small mammals living in a contaminated landfill site varied in both concentration and congener composition, reflecting both the feeding strategy of each species and the chlorination of the congeners. Body concentrations of SigmaPCB on a 1:1:1 Arochlor (1242:1254:1260) basis gave a rank order of Sorex araneus >> Apodemus sylvaticus > Microtus agrestis. Comparisons with data for other PCB-contaminated sites suggest that the SigmaPCB values in S. araneus from the landfill site may be of sufficient magnitude to inhibit reproductive capability and to cause other major organ dysfunction. There were also inter-specific differences in the whole body concentrations of the individually quantified congeners. For S. araneus, the rank order of concentrations of the selected ICES 7 marker PCB congeners was: No. 153>138>>180>118>>28>101>52. In M. agrestis the rank order was: No. 28>118>153>138>180, 52>101. The congener order for A. sylvaticus differed from both S. araneus and M. agrestis, but was more similar to the latter, being: No. 153>138>118>180>28>52, 101. The contribution of the different congeners to SigmaPCB in the mammals reflects the degree of chlorination of different congeners but varies with feeding strategy of the species. In the insectivorous S. araneus, heavily chlorinated congeners (Nos 153, 138 and 180) are most abundant, whereas the herbivore, M. agrestis showed congeners Nos 28 and 118 to be present in the highest amounts, whilst the equivalent pattern for the more omnivorous A. sylvaticus was intermediate between S. araneus and M. agrestis. The high concentrations of PCBs in S. araneus relative to the other species, suggests that it may serve as a useful biomarker of terrestrial environmental pollution by organochlorines.

Interaction of human immunodeficiency virus type I Rev protein with nuclear scaffold nucleoside triphosphatase activity

Human immunodeficiency virus type I encodes a regulatory protein, termed Rev, which is associated with the appearance of unspliced and partially spliced viral RNAs in the cytoplasm. Rev is believed to function via interaction with a sequence element in the env region of the viral RNA, termed the Rev-responsive element (RRE). In this study, we use a stably transfected, Rev-producing mouse cell line to show that low, functional levels of Rev are associated with the nuclear scaffold (NS). Immunohistochemical studies localize Rev to the NS. Furthermore, immunoblot analyses demonstrate the presence of Rev in NS preparations isolated from Rev-producing cells and document binding of purified Rev protein to isolated NS or to cloned lamin C in vitro. Results with an in vitro RNA transport assay suggest that Rev is associated with a significant defect in transport of RNAs which lack RRE, whereas transport of RRE-containing transcripts proceeds efficiently. This Rev-induced transport defect appears to be mediated via direct inhibition of NS nucleoside triphosphatase, an enzyme thought to be involved in the nucleocytoplasmic transport process. NS preparations isolated from Rev-producing cells show a significantly lower nucleoside triphosphatase activity than those from control preparations. Addition of Rev protein to isolated NS produces a significant inhibition of NS nucleoside triphosphatase activity, which is specifically reversed by addition of RRE transcripts. These data suggest that a major aspect of Rev function may involve selective modulation of host cell nucleocytoplasmic transport mechanisms via interaction with the NS.

Segregation analysis reveals evidence of a major gene for Alzheimer disease

In an attempt to resolve the relative influences of major genes, multifactorial heritability, and cohort effects on the susceptibility to Alzheimer disease (AD), complex segregation analysis was performed on 232 nuclear families. All families were consecutively ascertained through a single proband who was referred for diagnostic evaluation of a memory disorder. The results suggest that susceptibility to AD is determined, in part, by a major autosomal dominant allele with an additional multifactorial component. Single-locus, polygenic, sporadic, and no-transmission models, as well as recessive inheritance of the major effect, were significantly rejected. Excess transmission from the heterozygote was marginally significant and probably reflects the presence of phenocopies or perhaps the existence of two or more major loci for AD. The frequency of the AD susceptibility allele was estimated to be .038, but the major locus accounts for only 24% of the transmission variance, indicating a substantial role for other genetic and nongenetic mechanisms in the causation of AD.

Association of decreased paternal age and late-onset Alzheimer's disease. An example of genetic imprinting?

Several studies have identified advanced maternal age as a risk factor for Alzheimer's disease. This study evaluated maternal and paternal age at birth of 237 patients with Alzheimer's disease, each of whom was matched to five control subjects based on sex, year of birth, survival age, and location of residence. It was found that decreased paternal age substantially increased the susceptibility to the common form of Alzheimer's disease that occurs after the age of 67 years, whereas advanced maternal age had a negligible effect on risk of Alzheimer's disease. The higher incidence of late-onset Alzheimer's disease among persons born to younger fathers is consistent with a genetic imprinting mechanism involving DNA methylation. The proposed model postulates a role for environmental agents in the pathogenesis of Alzheimer's disease and accounts for families that show an aggregation of cases but no apparent pattern of inheritance.

Professional ideology and the construction of western psychiatry in Southeast Asia

This article provides a critical examination of the professional ideology associated with the expansion of psychiatric treatment in the ASEAN countries of Southeast Asia. Four components of professional ideology are identified: appeal to "modernization"; medicalization of social problems; integration of psychiatry with primary health care; and panhuman uniformity of mental illness. However, the adoption of psychiatric technology has been a significant factor in the erosion of indigenous systems of social and psychological support since the colonial period. Contemporary psychiatric practices are also shown to exacerbate social inequalities, enhance state control of the populace, and continue to operate without adequate validation of diagnoses and treatments.

Enzymatic dissociation of ovarian and uterine tissues

A method is described for the preparation of high yields of viable, dissociated cells from porcine theca interna and corpus luteum and from human and bovine endometrium. The tissues were dissociated by incubation at 37 degrees C in a mixture of 0.5% collagenase, 0.1% hyaluronidase and 0.1% pronase in balanced salt solution containing 1% chicken serum. This procedure consistently provided high yields of structurally and metabolically intact dispersed cells after a digestion period of 60 min. The procedure is superior to methods previously reported in the literature.