Lipopolysaccharide structure modulates cationic biocide susceptibility and crystalline biofilm formation in Proteus mirabilis

Chlorhexidine (CHD) is a cationic biocide used ubiquitously in healthcare settings. Proteus mirabilis, an important pathogen of the catheterized urinary tract, and isolates of this species are often described as "resistant" to CHD-containing products used for catheter infection control. To identify the mechanisms underlying reduced CHD susceptibility in P. mirabilis, we subjected the CHD tolerant clinical isolate RS47 to random transposon mutagenesis and screened for mutants with reduced CHD minimum inhibitory concentrations (MICs). One mutant recovered from these screens (designated RS47-2) exhibited ~ 8-fold reduction in CHD MIC. Complete genome sequencing of RS47-2 showed a single mini-Tn5 insert in the waaC gene involved in lipopolysaccharide (LPS) inner core biosynthesis. Phenotypic screening of RS47-2 revealed a significant increase in cell surface hydrophobicity and serum susceptibility compared to the wildtype, and confirmed defects in LPS production congruent with waaC inactivation. Disruption of waaC was also associated with increased susceptibility to a range of other cationic biocides but did not affect susceptibility to antibiotics tested. Complementation studies showed that repression of smvA efflux activity in RS47-2 further increased susceptibility to CHD and other cationic biocides, reducing CHD MICs to values comparable with the most CHD susceptible isolates characterized. The formation of crystalline biofilms and blockage of urethral catheters was also significantly attenuated in RS47-2. Taken together, these data show that aspects of LPS structure and upregulation of the smvA efflux system function in synergy to modulate susceptibility to CHD and other cationic biocides, and that LPS structure is also an important factor in P. mirabilis crystalline biofilm formation.

Neural functional connectivity changes to psychosocial stress in young adults with bipolar disorder and preliminary associations with clinical trajectories

BACKGROUND

Stress-related mechanisms are implicated in the pathophysiology of bipolar disorder and may contribute to heterogeneity in illness course. Yet, there is a lack of study investigating the neural mechanisms underlying the stress response in this condition. This study investigated changes in amygdala activation and functional connectivity in response to acute psychosocial stress in young adults with bipolar disorder and explored relations with clinical phenotype and prospective mood symptoms.

METHODS

42 young adults [19 with bipolar disorder, age_mean  ± SD =21.4 ± 2.2 years] completed a modified version of the Montreal Imaging Stress Task. Amygdala activation and functional connectivity with prefrontal cortex (PFC) regions of interest was calculated for control and stress conditions. Main effects of group, condition, and group by condition interaction on amygdala activation and connectivity were modeled. A subset of bipolar participants completed 1-year follow-up assessments. Relations between neural responses to stress with concurrent substance use and prospective mood symptoms were explored.

RESULTS

There were no between-group differences in amygdala activation or functional connectivity during the control condition. Increased right amygdala-right rostral PFC (rPFC) functional connectivity to stress was observed in bipolar disorder, compared to typically developing controls. In bipolar disorder, greater increase in right amygdala-right rPFC functional connectivity to stress was associated with less frequent cannabis use, and prospectively with shorter duration and lower severity of depression symptoms over follow-up.

CONCLUSION

Results from this preliminary study suggest differences in frontolimbic functional connectivity responses to stress in young adults with bipolar disorder and associations with cannabis use and prospective mood symptoms.

The Effects of Different Spectrophotometric Modes on Colour Measurement of Resin Composite and Porcelain Materials

OBJECTIVES

To investigate the influence of a number of controlled modes on the spectrophotometric analysis of the colour of resin composite and porcelain materials.

METHODS

A total of 20 samples of commercially available resin composite, and 20 samples of commercially available porcelain materials in four different shades were produced (five samples for each shade). Colour was measured using a spectrophotometer (CM2600-d, Minolta Konica) set with different colour measuring modes namely, small aperture size (SAV) or large aperture size (MAV); specular component included (SCI), or excluded (SCE); 0% (UV-) or 100% UV illumination (UV+). Colour data were then compared using paired T-test.

RESULTS

Colour coordinates measured with spectrophotometric modes set as 2° observation angle, SAV, SCI, and UV- were significantly different from those measured with 10° observation angle, MAV, SCE, and UV+ respectively in most cases for both materials.

CONCLUSION

Different spectrophotometric modes (2 or 10 degrees observation angle, SAV or MAV aperture size, 0% or 100% UV, and SCI or SCE) significantly influenced the absolute colour measurements of resin composite and porcelain samples.

CLINICAL SIGNIFICANCE

Measuring modes should be taken into consideration when comparing the results of absolute colour measurements of resin composite and dental porcelain materials.

The Effect of Try-In Paste and Resin Cement Shade on Colour Properties of Dental Veneers

OBJECTIVES

The purpose of this study was to investigate how different shades of try-in pastes, uncured and cured resin cements affect the overall colour of porcelain veneer restorations.

METHODS

A total of 90 porcelain veneers of shade Vita 1M1 VM7 and 0.6 mm thick were applied to bovine teeth using 3 shades of resin cement and their try-in paste produced by 3 manufacturers.

RESULTS

Colour differences produced between the try-in pastes and the corresponding shades of cured resin cements ranged from (ΔE* 1.18-3.1). The colour differences between uncured and cured resins of the same shade ranged from (ΔE* 0.78 - 1.41).

CONCLUSIONS

Different shades of try-in pastes and resin cements produced colour changes which are clinically useful in changing the colour of veneer restorations and therefore assist in colour matching to adjacent teeth. Clinically significant differences were noticed between try-in pastes and the cured resin of the same shade, however, there were relatively small changes measured between un-cured and cured resins. The colour match obtained by the try-in paste has to be treated with caution and further evaluation of the restoration made with the resin in place before curing is recommended.

CT pulmonary angiography in elderly patients: outcomes in patients aged >85 years

AIM

To assess the quality, safety, and outcomes following computed tomography pulmonary angiography (CTPA) performed in elderly patients.

MATERIALS AND METHODS

CTPA examinations were performed in 140 patients aged >85 years in three UK acute National Health Service (NHS) hospitals. Images were assessed for quality, pulmonary emboli, and other disease entities. Patients were assessed for contrast medium-induced nephropathy (CIN), and short-term and long-term survival. Statistics included Fisher's exact, Mann-Whitney U, and logrank tests.

RESULTS

The mean age of patients was 92 years with baseline creatinine ranging 57-310 μmol/l. CTPA was of good quality in 79% (110/140) of cases and pulmonary emboli were demonstrated in 16% (23/140). Warfarin or inferior vena cava (IVC) filter insertion was instigated in 70% (16/23) of patients with pulmonary emboli. No patient had an immediate contrast medium reaction or required renal replacement therapy. CIN was seen following 6% (8/140) of examinations but was not predicted by baseline renal function (p = 0.62). There was a trend towards increased patient mortality in the presence of CIN, although this did not reach statistical significance (p > 0.10). Patients with pulmonary emboli had improved median survival, although this did not reach significance (28 months versus 12 months, p = 0.16). Patients with other significant diseases reported on CTPA had significantly worse median survival (4 months versus 17 months, p = 0.025).

CONCLUSIONS

Patients aged >85 years undergoing CTPA have a low (6%) rate of CIN: this was not predicted by baseline renal function and did not impact on survival. CTPA in elderly patients is safe, facilitates active management of pulmonary emboli, and the discovery of additional disease entities informs survival.

Carbon fiber reinforced polymer dimensional stability investigations for use on the laser interferometer space antenna mission telescope

The laser interferometer space antenna (LISA) is a mission designed to detect low frequency gravitational waves. In order for LISA to succeed in its goal of direct measurement of gravitational waves, many subsystems must work together to measure the distance between proof masses on adjacent spacecraft. One such subsystem, the telescope, plays a critical role as it is the laser transmission and reception link between spacecraft. Not only must the material that makes up the telescope support structure be strong, stiff, and light, but it must have a dimensional stability of better than 1 pm Hz(-1/2) at 3 mHz and the distance between the primary and the secondary mirrors must change by less than 2.5 μm over the mission lifetime. Carbon fiber reinforced polymer is the current baseline material; however, it has not been tested to the pico meter level as required by the LISA mission. In this paper, we present dimensional stability results, outgassing effects occurring in the cavity and discuss its feasibility for use as the telescope spacer for the LISA spacecraft.

Response Rates in Non-Anthracycline Versus Anthracycline Exposed Patients with Metastatic Breast Cancer Treated with Lapatinib

Introduction: Anthracycline free regimens are increasingly used as adjuvant therapy for HER2 positive breast cancer due to concerns related to cardiac toxicity. Lapatinib plus capecitabine is approved for the treatment of patients with prior exposure to anthracyclines, taxanes and trastuzumab. With this recent shift in treatment practice, an exploratory analysis was performed to evaluate whether prior anthracycline exposure had an effect on clinical benefit in patients treated with lapatinib.Methods: The activity of lapatinib was examined in 7 completed studies (2 Phase III, 5 Phase II) in which lapatinib was administered as monotherapy or in combination with paclitaxel, bevacizumab, or letrozole for the treatment of HER2 positive metastatic breast cancer. In each study, patients were grouped by prior anthracycline exposure to evaluate the clinical activity of lapatinib containing regimens, as measured by overall response rate (RR).Results: In 7 studies, 192 of 593 patients were exposed to prior anthracycline. 401 patients were not. Lapatinib was administered as monotherapy in 3 studies and in combination in 4 studies. Within in each study, RR were similar in both groups (no prior anthracycline and prior anthracycline). In the combination of lapatinib plus letrozole, overall RR was higher in patients not exposed to prior anthracyclines (36.1% versus 18%). Cardiac data to be presented. Recognizing the limitations of patient numbers and cross study comparisons, as a whole, the results of this analysis indicate that patients had similar overall response rates to lapatinib regardless of exposure to prior anthracycline.Summary of Response Rate  Response Rate by Prior Exposure to Prior AnthracyclineStudyTreatment ArmsNo Prior Anthracycline, % (n/N)Prior Anthracycline, % (n/N)Total, % (n/N)EGF30001 (HER2+)lapatinib+paclitaxel56.7 (17/30)63.6 (14/22)59.6 (31/52)EGF30008 (HER2+)lapatinib+letrozole36.1 (22/61)18.0 (9/50)27.9 (31/111)EGF20009lapatinib QD22.4 (11/49)30.0 (6/20)24.6 (17/69) lapatinib BID30.2 (13/43)34.6 (9/26)31.9 (22/69)EGF102580lapatinib42.9 (18/42)N/A42.9 (18/42)EGF103009lapatinib10.6 (15/141)N/A10.6 (15/141)EGF103890lapatinib+bevacizumab16.7 (3/18)8.8 (3/34)11.5 (6/52)EGF105764lapatinib+paclitaxel76.5 (13/17)77.5 (31/40)77.2 (44/57) Conclusions: With the increasing availability of agents to treat breast cancer, it is common that many patients do not receive prior anthracycline treatment for their disease. In this exploratory analysis, it appears the clinical activity of lapatinib is maintained in patients with no prior anthracycline exposure; and as observed in the lapatinib plus letrozole combination study, may even increase the overall response rate.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5105.

An open-label expanded access study of lapatinib and capecitabine in patients with HER2-overexpressing locally advanced or metastatic breast cancer

BACKGROUND

The Lapatinib Expanded Access Program (LEAP) was designed to provide access to lapatinib plus capecitabine for HER2-positive metastatic breast cancer patients who previously received an anthracycline, a taxane, and a trastuzumab and had no other treatment options.

PATIENTS AND METHODS

LEAP opened globally and enrollment continued until lapatinib received regulatory approval in each participating country. Patients were assessed for progression-free survival (PFS) and overall survival (OS) and monitored for serious adverse events (SAEs).

RESULTS

As of 30 September 2008, 4283 patients from 45 countries enrolled in LEAP. The median treatment duration was 24.7 weeks. The most common drug-related SAEs were diarrhea (9.7%), vomiting (4.3%), and nausea (2.4%) and were mainly grade 3 or higher. The incidences of special interest SAEs were decreased left ventricle ejection fraction (0.5%), interstitial lung disease/pneumonitis (0.2%), and serious hepatobiliary events (0.4%). This safety profile is consistent with the overall lapatinib program. The median PFS and OS were 21.1 [95% confidence interval (CI) = 20.1-22.3] and 39.6 (95% CI = 37.7-40.7) weeks, respectively (n = 4006). Subgroup analysis showed longer PFS and OS in patients who had not received prior capecitabine.

CONCLUSIONS

These results demonstrate the safety and efficacy of lapatinib in a broader patient population compared with a clinical trial.

Diarrhea events in cancer patients (pts) treated with lapatinib

9125

Introduction: Lapatinib (L) is an oral dual ErbB1/ErbB2 tyrosine kinase inhibitor administered to > 5,000 pts in clinical trials. Low grade gastrointestinal adverse events: diarrhea, nausea and vomiting were recorded. We characterize here the diarrhea events related to L. Methods: Diarrhea events were recorded in 1,514 pts from 8 completed MBC and non-breast cancer clinical trials. Non-L treated pts in these trials were the comparator for analysis of toxicity grades, relationship to dose, time to onset, duration, required interventions and outcomes. Results: The L dose ranged from 1,000–1,500mg daily as monotherapy (n=928) or in combination with chemotherapy (n=198). Capecitabine alone (n=191)and tamoxifen alone (n=197) pts served as controls. For L and non-L groups the per pt diarrhea rates were: any grade 50%v33%; of those G1 54%v53%; G2 30%v30%; G3 15%v17%; G4 <1%v0% and SAEs 3% v 3%; respectively. There were no fatal L-related SAEs. For L, early diarrhea presentation <6 days(d) was 2x more frequent (44%v21%). In the non-L grp, diarrhea presented at 6–14 d in 30% pts. Delayed onset (>28 d) was similar: 22% on L v 26%, non-L. Initial G3 diarrhea or progression from G1/G2 to G3 was similar (Lv non-L): 4%v 3% and 4% v3%, respectively. The median number of events/pt (2) was the same for both groups and median duration was 5d (L) v 6d (non-L). Events (L v non-L) resolved in 89%v93%; and resolved with sequelae <1% v 1%; resolution was not recorded in 7%v4%. Events were managed in approximately 30% of pts with standard anti-diarrhea medications (loperimide and lomitil) and when more sever with hydration, octreotide & antibiotics. Majority of G1/G2 events were not treated. Most pts (85%) did not have L interrupted or dose adjusted and both group only 2% (L)v 2% (non-L) discontinued therapy due to diarrhea. Conclusions: Diarrhea related to L therapy (mostly used as monotherapy in this analysis) is usually mild to moderate, frequently does not require intervention, but pts monitoring is crucial. Importantly, L-related diarrhea appears as early events (before day 6) and is generally responsive to standard interventions. Analyses are ongoing to further identify its natural history, characteristics and pts at risk for serious events.

No significant financial relationships to disclose.

Cardiac safety in patients (pts) with metastatic breast cancer (MBC) treated with lapatinib (L) and trastuzumab (TRA)

514

Background: Clearly defined standards for assessing cardiac toxicity do not exist for newer agents used as treatment for BC, e.g., tyrosine kinase inhibitors. To evaluate the usefulness of increased cardiac monitoring and cardiac function (LVEF) in pts treated with L+TRA, data from 4 trials were analyzed. Methods: From July 2003 to Dec 2006, 238 pts received L+TRA (n=203) or L+TRA with paclitaxel or docetaxel (n=35) for HER2-positive MBC. LVEF was evaluated at screening, every 8 weeks after starting L+TRA, and at withdrawal via multiple-gated acquisition scans or echocardiograms. Rate of symptomatic cardiac events (CE; NCI CTCAE Grade 3 or 4 LV systolic dysfunction) or asymptomatic LVEF decreases (=20% relative to baseline and below the institution’s lower limit of normal) were assessed. Results: None of the 238 pts had a symptomatic CE. Four pts had a single asymptomatic LVEF decrease and 1 pt had 2 asymptomatic LVEF decreases, totaling 6 decreases in 5 (2.1%) pts. These pts were women aged 36–64 years and had previously received anthracyclines (A; n=2), A+TRA (n=2), or unknown therapy (n=1). Median time to onset of LVEF decrease was 83 days; all but 1 decrease occurred within 75 days after initiating L+TRA (range: 18–221 days). Baseline LVEFs of 62%, 60%, 62%, 74% and 58% decreased to 47%, 46%, 45%, 45%, and 45%, respectively. L+TRA was temporarily interrupted in 3 pts and continued in 2 pts despite LVEF decrease. Per investigators, LVEF decrease resolved with no further sequelae in 4 pts (59%, 56%, 60%, and 50%) and was ongoing in 1 pt. Conclusion: Initial data indicate L+TRA or L+TRA with taxanes does not constitute a serious incremental cardiac risk and may not require more stringent cardiac monitoring than is used for A or TRA alone. The combined effect of HER2 inhibition with L+TRA appears not to increase the risk of CE in this population.

No significant financial relationships to disclose.

Skin events (SE) among 1,126 patients (Pts) treated with lapatinib (L), an oral dual ErbB1/2 tyrosine kinase inhibitor (TKI)

9102

Background: Lapatinib (L) is active as a single agent and in combination with capecitabine in pts with ErbB2+ve breast cancer. Safety profile from > 5,000 pts demonstrates infrequent Grade (G)3/4 (10%) adverse events, with drug discontinuation (disc) required in (<2%) events. SEs were commonly reported and were likely due to ErbB1 inhibition in the epidermis, as hypothesized with the other ErbB1 TKIs. However, the SE with L appear to differ clinically from other TKIs. Methods: SE in 1,126 pts reported in 8 L trials ( EGF20001 , EGF20002 , EGF20003 , EGF20004 , EGF20008 , EGF20009 , EGF20014 , + EGF100151) were pre-defined as dermatitis, drug eruption, dry skin, pruritus/urticaria, skin disorder, skin infection, nail, and hair disorder. SE were characterized based on CTC grading, and examined as to their relationship to L dose, length of L exposure, tumor type, concurrent treatment, time to onset from L initiation, and time to resolution with L dose- reduction or disc. Furthermore clinical management, skin biopsies, photos, and outcome were examined. Results: Pts were treated with L monotherapy 1,000–1,500mg daily (N=928), or in combination with capecitabine (C) (N=198). Non-L containing arms of studies EGF100151 (N=191; C alone) and EGF20001 (N=197; tamoxifen alone) served as controls. Among all L treated pts, 54% experienced SE mostly as G1/2, and 69% L+C pts experienced G1–3 SE with 50% G2. Majority of SE were deemed not specific to L and were rarely severe (no G4). Only 1% required drug disc. Most frequently reported SEs were dermatitis/drug eruption (38% all grade; 3% G3) (8% all grade, 1% G3). The frequency of SE with L at 1,500 mg QD was 57%, 1250 mg QD was 41%, and 500 BID was 63%. Most SE developed early (45% day 1–14) and persisted a median of 29 days. The majority of L pts (82%) did not require intervention (ie, dose reduction, hold, or withdraw). Conclusions: This large collection of L treated pts demonstrates that SE related to L therapy are low grade, infrequently require intervention or dose reduction, and rarely cause drug disc. Further attempts to identify pts at high risk for skin toxicity, its management, and the pathophysiology of L related SE are ongoing.

No significant financial relationships to disclose.

TNFα increases the inflammatory response to vascular balloon injury without accelerating neointimal formation

There is now clear evidence for a contributory role of inflammatory processes to restenosis following vascular balloon injury and stent implantation. The aim of the present study was to study the effects of TNFalpha, administered locally in vivo immediately following balloon angioplasty, on the leukocyte adhesive response and extent of neointimal formation in a rabbit model of subclavian artery injury. Initial in vitro studies were performed with normal isolated artery rings to assess the vascular adhesive response to TNFalpha or IL-1beta. Pre-incubation with either cytokine prior to addition of (51)Cr-labelled leukocytes enhanced the adhesion of leukocytes to the artery in both a time- and concentration-dependent manner. Although both cytokines induced an increase in the expression of the adhesion molecules ICAM-1 and VCAM-1, only antibodies to ICAM-1 blocked the enhanced adhesion induced by the cytokines. In artery segments retrieved from rabbits that had previously undergone subclavian artery angioplasty either 24 h or 8 days previously, there was an injury-induced increase in adhesion of leukocytes assessed ex vivo. In segments obtained from rabbits that received a 15 min local infusion of TNFalpha (2 ng/min) to the injured artery immediately after the angioplasty procedure, leukocyte adhesion assessed ex vivo was further significantly enhanced. The pro-adhesive effect of TNFalpha was associated with an increased expression of both ICAM-1 and VCAM-1. However, TNFalpha administration did not alter the extent of neointimal formation observed 8 days after injury. These findings suggest that while TNFalpha may play a role following vascular injury, it does not act alone to induce neointimal formation. Thus anti-inflammatory strategies targeted at multiple cytokines may be more appropriate than targeting a single cytokine to reduce the response to vascular injury.

A1 and A2A adenosine receptor modulation of alpha 1-adrenoceptor-mediated contractility in human cultured prostatic stromal cells

1. This study investigated the possibility that adenosine receptors modulate the alpha(1)-adrenoceptor-mediated contractility of human cultured prostatic stromal cells (HCPSC). 2. The nonselective adenosine receptor agonist, 5'-N-ethylcarboxamido-adenosine (NECA; 10 nm-10 microm), and the A(1) adenosine receptor selective agonist, cyclopentyladenosine (CPA; 10 nm-10 microm), elicited significant contractions in HCPSC, with maximum contractile responses of 18+/-3% and 17+/-2% reduction in initial cell length, respectively. 3. In the presence of a threshold concentration of phenylephrine (PE) (100 nm), CPA (1 nm-10 microm) caused contractions, with an EC(50) of 124+/-12 nm and maximum contractile response of 37+/-4%. The A(1) adenosine receptor-selective antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX 100 nm) blocked this effect. In the presence of DPCPX (100 nm), NECA (1 nm-10 microm) inhibited contractions elicited by a submaximal concentration of PE (10 microm), with an IC(50) of 48+/-2 nm. The A(2A) adenosine receptor-selective antagonist 4-(2-[7-amino-2-[furyl][1,2,4]triazolo[2,3-alpha][1,3,5,]triazin-5-yl amino]ethyl)phenol (Zm241385 100 nm) blocked this effect. 4. In BCECF-AM (10 microm)-loaded cells, both CPA (100 pM-1 microm) and NECA (100 pm-10 microm) elicited concentration-dependent decreases in intracellular pH (pH(i)), with EC(50) values of 3.1+/-0.3 and 6.0+/-0.3 nm, respectively. The response to NECA was blocked by Zm241385 (100 nm; apparent pK(B) of 9.4+/-0.4), but not by DPCPX (100 nm). The maximum response to CPA was blocked by DPCPX (100 nm), and unaffected by Zm241385 (100 nm). 5. NECA (10 nm-10 microm) alone did not increase [(3)H]-cAMP in HCPSC. In the presence of DPCPX (100 nm), NECA (10 nm-10 microm) caused a concentration dependent increase in [(3)H]-cAMP, with an EC(50) of 1.2+/-0.1 microm. This response was inhibited by Zm241385 (100 nm). CPA (10 nm-10 microm) had no effect on cAMP, in the presence or absence of forskolin (1 microm). 6. These findings are consistent with a role for adenosine receptors in the modulation of adrenoceptor-mediated contractility in human prostate-derived cells.

A meta-analysis review of the effects of recombinant bovine somatotropin. 1. Methodology and effects on production

This manuscript presents the results of a review of the effects of recombinant bovine somatotropin (rBST) on milk production, milk composition, dry matter intake, and body condition score that was carried out by an expert panel established by the Canadian Veterinary Medical Association (CVMA). The panel was established by the CVMA in response to a request from Health Canada in 1998 and their report was made public in 1999. A series of meta-analyses was used to combine data on production and nutrition related parameters that were extracted from all randomized clinical trials, which had been published in peer-reviewed journals or which were provided by Health Canada, from the submission by Monsanto for registration of rBST in Canada. A companion paper will present the results of the effects of the drug on measures of health, reproductive performance, and culling parameters. Recombinant bovine somatotropin was found to increase milk production by 11.3% in primiparous cows and 15.6% in multiparous cows; although there was considerable variation from study to study. While some statistically significant effects on milk composition (% butterfat, protein, and lactose) were found, they were all very small. Treatment increased dry matter intake by an average 1.5 kg/day during the treatment period and dry matter intake remained elevated on into the first 60 days of the subsequent lactation. Despite the increase in dry matter intake, treated animals had lower body condition scores at the end of the treatment period, and the reduced scores persisted through until the start of the subsequent lactation.

A meta-analysis review of the effects of recombinant bovine somatotropin. 2. Effects on animal health, reproductive performance, and culling

This manuscript presents the results of a review of the effects of recombinant bovine somatotropin (rBST) on dairy cattle health, reproductive performance, and culling, that was carried out by an expert panel established by the Canadian Veterinary Medical Association (CVMA). The panel was established by the CVMA in response to a request from Health Canada in 1998 and their report was made public in 1999. A series of meta-analyses was used to combine data on health-related parameters that were extracted from all randomized clinical trials that had been published in peer-reviewed journals or which were provided by Health Canada from the submission by Monsanto for registration of rBST in Canada. A companion paper (1) presents the estimates of the effect of the drug on production parameters. Recombinant bovine somatotropin was found to increase the risk of clinical mastitis by approximately 25% during the treatment period but there was insufficient data to draw firm conclusions about the effects of the drug on the prevalence of subclinical intra-mammary infections. Use of rBST increased the risk of a cow failing to conceive by approximately 40%. For cows which did conceive, there was no effect on services per conception and only a small increase in average days open (5 days). Use of the drug had no effect on gestation length, but the information about a possible effect on the risk of twinning was equivocal. Cows treated with rBST had an estimated 55% increase in the risk of developing clinical signs of lameness. Few studies reported data on culling, but based on those that did, there appeared to be an increase risk of culling evident in multiparous cows. Use of the drug in 1 lactation period appeared to reduce the risk of metabolic diseases (particularly ketosis) in the early period of the subsequent lactation.

Alpha 1-adrenoceptor effects mediated by protein kinase C alpha in human cultured prostatic stromal cells

1 We have investigated the effects of alpha(1)-adrenoceptor stimulation upon contractility, Ca(2+) influx, inositol phosphate production, and protein kinase C (PKC) translocation in human cultured prostatic stromal cells (HCPSC). 2 The alpha(1)-adrenoceptor selective agonist phenylephrine elicited contractile responses of HCPSC, i.e. a maximal cell shortening of 45+/-6% of initial cell length, with an EC(50) of 1.6+/-0.1 microM. The alpha(1)-adrenoceptor selective antagonists prazosin (1 microM) and terazosin (1 microM) both blocked contractions to phenylephrine (10 microM). The L-type calcium channel blocker nifedipine (10 microM), and the PKC inhibitors Gö 6976 (1 microM) and bisindolylmaleimide (1 microM) also inhibited phenylephrine-induced contractions. 3 Phenylephrine caused a concentration dependent increase in inositol phosphate production (EC(50) 119+/-67 nM). This response was blocked by terazosin (1 microM). 4 Phenylephrine caused the translocation of the PKC alpha isoform, but not the beta, delta, gamma, epsilon or lambda isoforms, from the cytosolic to the particulate fraction of HCPSC, with an EC(50) of 5.7+/-0.5 microM. 5 In FURA-2AM (5 microM) loaded cells, phenylephrine elicited concentration dependent increases in [Ca(2+)](i), with an EC(50) of 3.9+/-0.4 microM. The response to phenylephrine (10 microM) was blocked by prazosin (1 microM), bisindolymaleimide (1 microM), and nifedipine (10 microM). 6 In conclusion, this study has shown that HCPSC express functional alpha(1)-adrenoceptors, and that the intracellular pathways responsible for contractility may be largely dependent upon protein kinase C activation and subsequent opening of L-type calcium channels.

Over-the-counter advice for genital problems: the role of the community pharmacist

This year, in the UK, levonorgestrel was approved for sale in pharmacies for emergency contraception. This study assessed, using a postal questionnaire, the ability of community pharmacists to provide advice relating to sexual health, their comfort and training in this area, and their knowledge of local genitourinary medicine (GUM) services. Fifty-four per cent of pharmacists responded. Most (79%) did not know where their nearest GUM department was; only 21% had ever advised a patient to attend a GUM clinic. Twenty-nine per cent said they were not able to broach the possibility of a sexually transmitted infection (STI) with a patient of both sexes. Forty-four per cent had received training related to post-coital contraception. Greater liaison between GUM departments and community pharmacists is suggested as a way of increasing the proportion of patients presenting to a pharmacist who are referred appropriately to a GUM clinic.

New aspects of the role of MR/P fimbriae in Proteus mirabilis urinary tract infection

Proteus mirabilis, a common cause of urinary tract infection (UTI), produces a number of different fimbriae including mannose-resistant Proteus-like fimbriae (MR/P). The precise role of different P. mirabilis fimbriae in ascending UTI has not yet been elucidated. In this study, a clinical isolate of P. mirabilis and an isogenic mutant unable to express MR/P were tested using different experimental approaches. They were tested for their ability to cause infection in an ascending co-infection model of UTI and in a haematogenous model in the mouse. In both models, the mutant was less able than the wild-type strain to colonise the lower and upper urinary tracts although infectivity was not abolished. In vitro adherence to uroepithelial cells was also assessed. Significant differences in adherence between both strains were observed at 1 h but not at 15 min post infection. We have also shown that a wild-type strain carries two copies of the mrpA gene. These data reinforce the importance of MR/P fimbriae in P. mirabilis UTI although other virulence factors may be necessary for efficient colonisation and development of infection.

Influences on the implementation of TQM in health care organizations: professional bureaucracies, ownership and complexity

TQM is introduced into many organisations in an attempt to improve productivity and quality. There are a number of organisational variables that have been recognised as influencing the success of TQM implementation including leadership, teamwork, and suppliers. This paper presents findings of a study of the implementation of TQM in Australian health care organisations. Structural factors were observed to affect the progress of TQM. Professional bureaucracies were less successful than machine bureaucracies. Private organisations were more successful than their public counterparts.

Multiple roles for Bordetella lipopolysaccharide molecules during respiratory tract infection

Bordetella pertussis, Bordetella parapertussis, and Bordetella bronchiseptica are closely related subspecies that cause respiratory tract infections in humans and other mammals and express many similar virulence factors. Their lipopolysaccharide (LPS) molecules differ, containing either a complex trisaccharide (B. pertussis), a trisaccharide plus an O-antigen-like repeat (B. bronchiseptica), or an altered trisaccharide plus an O-antigen-like repeat (B. parapertussis). Deletion of the wlb locus results in the loss of membrane-distal polysaccharide domains in the three subspecies of bordetellae, leaving LPS molecules consisting of lipid A and core oligosaccharide. We have used wlb deletion (Deltawlb) mutants to investigate the roles of distal LPS structures in respiratory tract infection by bordetellae. Each mutant was defective compared to its parent strain in colonization of the respiratory tracts of BALB/c mice, but the location in the respiratory tract and the time point at which defects were observed differed significantly. Although the Deltawlb mutants were much more sensitive to complement-mediated killing in vitro, they displayed similar defects in respiratory tract colonization in C5(-/-) mice compared with wild-type (wt) mice, indicating that increased sensitivity to complement-mediated lysis is not sufficient to explain the in vivo defects. B. pertussis and B. parapertussis Deltawlb mutants were also defective compared to wt strains in colonization of SCID-beige mice, indicating that the defects were not limited to interactions with adaptive immunity. Interestingly, the B. bronchiseptica Deltawlb strain was defective, compared to the wt strain, in colonization of the respiratory tracts of BALB/c mice beginning 1 week postinoculation but did not differ from the wt strain in its ability to colonize the respiratory tracts of B-cell- and T-cell-deficient mice, suggesting that wlb-dependent LPS modifications in B. bronchiseptica modulate interactions with adaptive immunity. These data show that biosynthesis of a full-length LPS molecule by these three bordetellae is essential for the expression of full virulence for mice. In addition, the data indicate that the different distal structures modifying the LPS molecules on these three closely related subspecies serve different purposes in respiratory tract infection, highlighting the diversity of functions attributable to LPS of gram-negative bacteria.

Non-typeable Haemophilus influenzae adhere to and invade human bronchial epithelial cells via an interaction of lipooligosaccharide with the PAF receptor

Adherence and invasion are thought to be key events in the pathogenesis of non-typeable Haemophilus influenzae (NTHi). The role of NTHi lipooligosaccharide (LOS) in adherence was examined using an LOS-coated polystyrene bead adherence assay. Beads coated with NTHi 2019 LOS adhered significantly more to 16HBE14 human bronchial epithelial cells than beads coated with truncated LOS isolated from an NTHi 2019 pgmB:ermr mutant (P = 0.037). Adherence was inhibited by preincubation of cell monolayers with NTHi 2019 LOS (P = 0.0009), but not by preincubation with NTHi 2019 pgmB:ermr LOS. Competitive inhibition studies with a panel of compounds containing structures found within NTHi LOS suggested that a phosphorylcholine (ChoP) moiety was involved in adherence. Further experiments revealed that mutations affecting the oligosaccharide region of LOS or the incorporation of ChoP therein caused significant decreases in the adherence to and invasion of bronchial cells by NTHi 2019 (P < 0.01). Analysis of infected monolayers by confocal microscopy showed that ChoP+ NTHi bacilli co-localized with the PAF receptor. Pretreatment of bronchial cells with a PAF receptor antagonist inhibited invasion by NTHi 2109 and two other NTHi strains expressing ChoP+ LOS glycoforms exhibiting high reactivity with an anti-ChoP antibody on colony immunoblots. These data suggest that a particular subset of ChoP+ LOS glycoforms could mediate NTHi invasion of bronchial cells by means of interaction with the PAF receptor.

Screening for urinary tract infections in a gynaecological setting: validity and cost-effectiveness of reagent strips

This study aims to test the validity and cost-effectiveness of reagent-strip analysis compared with microbiological laboratory testing for mass screening of urine for urinary tract infections in a gynaecological setting. Over a six-month period, urine samples from a convenient group of 228 women presenting in a gynaecological ward of an NHS Trust hospital were tested using Ames 8SG reagent strips to detect leucocyte esterase and nitrite. Total bacterial counts were also carried out; urine culture was recorded as positive if there was > 10(5) organisms/mL. Validity of the dipstick tests was measured, using four criteria (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV]), against the results of laboratory analysis. The combined use of the leucocyte esterase and nitrite tests produced results as follows: sensitivity, 96.4%; specificity, 88.5%; PPV, 54%; and NPV, 99.4%. Cost-effectiveness for visible costs was calculated as 48.6% for the 12.3% rate of infection in this study. The use of reagent strips in a mass-screening programme in a gynaecological setting proved both valid and cost-effective.

Genetic basis for lipopolysaccharide O-antigen biosynthesis in bordetellae

Bordetella bronchiseptica and Bordetella parapertussis express a surface polysaccharide, attached to a lipopolysaccharide, which has been called O antigen. This structure is absent from Bordetella pertussis. We report the identification of a large genetic locus in B. bronchiseptica and B. parapertussis that is required for O-antigen biosynthesis. The locus is replaced by an insertion sequence in B. pertussis, explaining the lack of O-antigen biosynthesis in this species. The DNA sequence of the B. bronchiseptica locus has been determined and the presence of 21 open reading frames has been revealed. We have ascribed putative functions to many of these open reading frames based on database searches. Mutations in the locus in B. bronchiseptica and B. parapertussis prevent O-antigen biosynthesis and provide tools for the study of the role of O antigen in infections caused by these bacteria.

Predicting 'normal' grip strength for rheumatoid arthritis patients

OBJECTIVE

An ability to predict accurately 'normal' grip strength in rheumatoid arthritis (RA) patients would facilitate a more accurate assessment of the degree of their functional loss. This, in turn, would allow the setting of more meaningful treatment goals aimed at restoring hand function towards normal. This study carefully measures three modalities of hand grip strength and their correlation with multiple simple anthropometric parameters in normal subjects. We aim to determine which of these parameters are best correlated to grip strength, and whether this correlation is strong enough to allow the accurate prediction of what normal grip strength should be in RA patients.

METHODS

In 81 normal subjects (67 female), power, pinch and tripod grip strength measurements were made using an MIE digital pinch grip analyser. These strength data were correlated with specific local forearm anthropometric measurements: forearm circumference, forearm length, forearm volume, hand circumference, hand length, hand volume, hand and forearm volume, and various general anthropometric parameters (weight, height and age). These normal subjects had been chosen so as to be age and sex matched with 83 RA patients (67 female) in whom the same strength and anthropometric parameters were assessed and correlated. In patients, the grip strength results were additionally correlated with two markers of disease activity: a modified Ritchie Articular Index local to the hand and forearm (mRAI) and a visual analogue scale (VAS) assessing subjective pain severity.

RESULTS

In normal subjects, clear correlations were demonstrated between hand grip strengths and all specific anthropometric variables, the strongest correlation being with forearm and hand volume (r = 0.729 and 0.638 for dominant and non-dominant hands, respectively; P < 0.01 for both). The patients were considerably weaker than normal subjects. Markers of disease activity showed a negative correlation with grip strength. In normal subjects, the dominant hand was significantly stronger than the non-dominant hand, and on average by 8%, while the opposite was true in patients, who were 20% weaker on the dominant side.

CONCLUSION

Simple anthropometric measurements, and forearm and hand volume in particular, would be useful at baseline for predicting 'normal' hand grip strength in RA patients, both in the clinical setting and in research trials aimed at improving grip strength and hand function.

Ultrastructural analysis of primary human urethral epithelial cell cultures infected with Neisseria gonorrhoeae

In men with gonococcal urethritis, the urethral epithelial cell is a site of infection. To study the pathogenesis of gonorrhea in this cell type, we have developed a method to culture primary human urethral epithelial cells obtained at the time of urologic surgery. Fluorescent analysis demonstrated that 100% of the cells stained for keratin. Microscopic analyses indicated that these epithelial cells arrayed in a pattern similar to that seen in urethral epithelium. Using immunoelectron and confocal microscopy, we compared the infection process seen in primary cells with events occurring during natural infection of the same cell type in men with gonococcal urethritis. Immunoelectron microscopy studies of cells infected with Neisseria gonorrhoeae 1291 Opa+ P+ showed adherence of organisms to the epithelial cell membrane, pedestal formation with evidence of intimate association between the gonococcal and the epithelial cell membranes, and intracellular gonococci present in vacuoles. Confocal studies of primary urethral epithelial cells showed actin polymerization upon infection. Polyclonal antibodies to the asialoglycoprotein receptor (ASGP-R) demonstrated the presence of this receptor on infected cells in the primary urethral cell culture. In situ hybridization using a fluorescent-labeled probe specific to the ASGP-R mRNA demonstrated this message in uninfected and infected cells. These features were identical to those seen in urethral epithelial cells in exudates from males with gonorrhea. Infection of primary urethral cells in culture mimics events seen in natural infection and will allow detailed molecular analysis of gonococcal pathogenesis in a human epithelial cell which is commonly infected.

A comparison of three electrodes for the measurement of pH in small volumes

An ion-sensitive field effect transistor (ISFET, Sentron, Sentron, Inc.) electrode was compared with a glass combination micro-electrode (MI-410, Micro-electrodes, Inc.) and a solid-state metal wire oxide pH sensor (Beetrode, World Precision Instruments, Inc.) with a liquid junction reference electrode (MERE1, World Precision Instruments, Inc.). The electrodes were assessed for linearity, reproducibility, accuracy, drift from the initial calibration between pH 4 and pH 7 and the time taken to record a stable reading. The ISFET was used to determine the pH in dental plaque samples (1 mg suspended in 20 microliters). The pH values correlated with the hydrogen ion concentration for all the electrodes (r = 0.98). The MI-410 fractured before this evaluation was completed. Coefficients of variation were 0.65% (pH 4) and 0.08% (pH 7) for the ISFET and 4.69% (pH 4) and 3.46% (pH 7) for the Beetrode. Both electrodes gave readings that differed significantly from the initial calibration, but the drift was greater for the Beetrode (F = 7.93; p = 0.0005) than the ISFET (F = 1.89; p = 0.1519). However, this drift was smaller than the change in pH as measured in dental plaque samples. The Beetrode gave a stable reading after 3.39 +/- 0.83 s and the ISFET after 2.2 +/- 0.76 s, while the MI-410 required at least 20 s. The ISFET type electrode is suitable for use in small volumes such as plaque suspensions, is easier to operate and yields results closer to the initial calibration than the Beetrode and is more robust than the MI-410 and the Beetrode.

The lipooligosaccharides of pathogenic gram-negative bacteria

Lipooligosaccharides (LOSs) are the major glycolipids expressed on mucosal Gram-negative bacteria, including members of the genera Neisseria, Haemophilus, Bordetella, and Branhamella. They can also be expressed on some enteric bacteria such as Campylobacter jejuni and Campylobacter coli strains. LOS is analogous to the lipopolysaccharide (LPS) found in other Gram-negative families. LOSs share similar lipid A structures with an identical array of functional activities as LPSs. LOSs lack O-antigen units with the LOS oligosaccharide structures limited to 10 saccharide units. The LOS species of pathogenic Neisseria can play a major role in pathogenesis through enhancing the resistance of the organism to killing by normal human serum. Other distinguishing characteristics of LOS are the structural and antigenic similarity of some LOS species to human glycolipids and the potential for certain LOSs to be modified in vivo by host substances or secretions. These modifications of LOS in different environments of the host result in synthesis of new LOS structures that probably benefit the survival of the pathogen. The LOS of N. gonorrhoeae can act as a ligand of human receptors, promoting invasion of host cells. It is becoming clearer that LOSs are crucial factors in the pathogenesis of bacteria that express them.

Altered lipopolysaccharide characteristic of the I69 phenotype in Haemophilus influenzae results from mutations in a novel gene, isn

The 169 phenotype of Haemophilus influenzae results from a mutation leading to a lipopolysaccharide molecule consisting only of lipid A and a single phosphorylated 2-keto-3-deoxyoctulosonic acid residue. In this paper we describe the identification of a gene which, when mutated, results in the 169 phenotype. We have named the gene isn. The predicted amino acid sequence of Isn is homologous to the product of the lmbN gene involved in the biosynthesis of the sugar-containing antibiotic lincomycin by Streptomyces lincolnensis. lsn is situated between two loci that are homologous to the dpp and art periplasmic permease systems in Escherichia coli. Northern (RNA) blot and primer extension analyses reveal that isn is transcribed as a monocistronic mRNA. Potential functions of Isn protein are discussed.

Guidelines for euthanasia of domestic animals by firearms

All animals that are to be killed, whether for food, for humane reasons, or because they are homeless, must receive a quick and painless death. In some smaller communities, veterinary or humane society expertise may not be readily available to humanely kill stray and unwanted animals. An alternative that provides for a humane death for the animal is by shooting. The following guidelines are intended to assist persons who must perform this usually distasteful task; they contain recommended techniques that will help to ensure that any animals killed by shooting will die in a humane way.