Aiming for elimination: Outcomes of a consultation pathway supporting regional general practitioners to prescribe direct-acting antiviral therapy for hepatitis C

To increase access to treatment, the Australian government enabled general practitioners (GPs) to prescribe direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV)-in consultation with a specialist if inexperienced in HCV management. This study describes the establishment and outcomes of a remote consultation pathway supporting GPs to treat HCV. Key stakeholders from primary and tertiary healthcare services in the Barwon South Western region developed and implemented an HCV remote consultation pathway. Pharmaceutical Benefits Schedule prescription data were used to evaluate GP DAA prescription 12 months pre-and post- pathway implementation. A retrospective review of patients referred for remote consultation for 12 months post- pathway inception was undertaken to determine the care cascade. HCV treatment initiation by GPs increased after implementation of the remote consultation pathway. In the 12-month study period, 74 GPs referred 169 people for remote consultation; 114 (67%) were approved for GP DAA treatment; 48 (28%) were referred for specialist assessment. In total, 119 (71%) patients commenced DAA; 69 were eligible for SVR12 assessment. Post-treatment HCV RNA data were available for 52 (75%) people; 37 achieved SVR12; 15 achieved SVR ranging from week 5 to 11 post-treatment. No treatment failure was detected. Collaborative development and implementation of a remote consultation pathway has engaged regional GPs in managing HCV. Follow-up post-treatment could be improved; however, no treatment failure has been documented. To eliminate HCV as a public health threat, it is vital that specialists support GPs to prescribe DAA.

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.

Intraoperative MR Imaging in Neurosurgery

Intraoperative magnetic resonance imaging (iMRI) has dramatically expanded and nowadays presents state-of-the-art technique for image-guided neurosurgery, facilitating critical precision and effective surgical treatment of various brain pathologies. Imaging hardware providing basic imaging sequences as well as advanced MRI can be seamlessly integrated into routine surgical environments, which continuously leads to emerging indications for iMRI-assisted surgery. Besides the obvious intraoperative diagnostic yield, the initial clinical benefits have to be confirmed by future-controlled long-term studies.

First biological measurements of deep-sea corals from the Red Sea

It is usually assumed that metabolic constraints restrict deep-sea corals to cold-water habitats, with 'deep-sea' and 'cold-water' corals often used as synonymous. Here we report on the first measurements of biological characters of deep-sea corals from the central Red Sea, where they occur at temperatures exceeding 20°C in highly oligotrophic and oxygen-limited waters. Low respiration rates, low calcification rates, and minimized tissue cover indicate that a reduced metabolism is one of the key adaptations to prevailing environmental conditions. We investigated four sites and encountered six species of which at least two appear to be undescribed. One species is previously reported from the Red Sea but occurs in deep cold waters outside the Red Sea raising interesting questions about presumed environmental constraints for other deep-sea corals. Our findings suggest that the present understanding of deep-sea coral persistence and resilience needs to be revisited.

Continuous-flux MOVPE growth of position-controlled N-face GaN nanorods and embedded InGaN quantum wells

We demonstrate the fabrication of N-face GaN nanorods by metal organic vapour phase epitaxy (MOVPE), using continuous-flux conditions. This is in contrast to other approaches reported so far, which have been based on growth modes far off the conventional growth regimes. For position control of nanorods an SiO(2) masking layer with a dense hole pattern on a c-plane sapphire substrate was used. Nanorods with InGaN/GaN heterostructures have been grown catalyst-free. High growth rates up to 25 microm h(-1) were observed and a well-adjusted carrier gas mixture between hydrogen and nitrogen enabled homogeneous nanorod diameters down to 220 nm with aspect ratios of approximately 8:1. The structural quality and defect progression within nanorods were determined by transmission electron microscopy (TEM). Different emission energies for InGaN quantum wells (QWs) could be assigned to different side facets by room temperature cathodoluminescence (CL) measurements.

One Step Nucleic Acid Amplification (OSNA) for intra-operative detection of lymph node metastases in breast cancer patients

21053

Background: Sentinel lymph node metastasis in breast cancer patients has conventionally been determined by intra- operative histopathological examination of frozen sections followed by definitive post-operative examination of permanent sections. The purpose of this study is to evaluate a more efficient method for intra-operative detection of lymph node metastasis in a clinical setting. Therefore, a new rapid method of detection of CK19 mRNA by One Step Nucleic Acid Amplification (OSNA) and Reverse Transcription Loop Mediated Isothermal Amplification (RT-LAMP) was tested against standard histological techniques. Methods: The clinical study was conducted at two facilities using 188 lymph nodes (46 patients). Lymph nodes from axillary dissected patients with breast cancer were divided into four slices. Alternate slices were used for the new method of CK19 mRNA detection (OSNA) and histopathological examination by hematoxylin & eosin and cytokeratin staining. For the analysis of concordance between both methods, the slices for histopathology were cut in 4 μm sections. For the OSNA method the other 2 slices were homogenised in a short sample preparation step. Afterwards CK19 mRNA was directly amplified from the tissue lysate within 16 minutes. Results: In the clinical study, an overall concordance rate between the OSNA assay and histopathology was 92%. Several discordant results are explainable with the expected uneven distribution of metastases within the lymph nodes. Conclusions: The study indicates that OSNA is a reliable and fast diagnostic tool for the detection of lymph node metastases in breast cancer patients. This method could be beneficial to avoid diagnostic delay for the patient or second surgery based on a post-operatively diagnosed positive lymph node.

No significant financial relationships to disclose.

[Extramedullary hematopoiesis as differential mediastinal space-occupying lesion diagnosis]

Intrathoracic extramedullary hematopoiesis is a rare disease in the differential diagnosis of mediastinal masses. It is suggested that asymptomatic masses should not be treated. A correct diagnosis can thus help to avoid an operation. The aim of this case report is to draw attention to this phenomenon as a cause of mediastinal masses and to provide information about diagnostic facilities available. We report the case of a 53-year-old male patient with hereditary spherocytosis as well as the case of a 59-year-old male patient with pyruvate kinase deficiency who showed intrathoracic paravertebral masses, that were identified in the first case by video-assisted thoracoscopic intervention (VATS) and in the second case by thoracotomy as a region of extramedullary hematopoiesis.

Purification of respiratory syncytial virus F and G proteins

Respiratory syncytial virus (RSV) is the most important cause of severe lower respiratory tract infections of infants in industrial nations. In addition, the participation of RSV in the genesis of asthma is under discussion. The RSV glycoproteins F and G have key positions in the viral pathogenesis. At present no satisfactory protein purification protocols are available for these proteins. The methods published for the G protein using preparative SDS-PAGE or immunoaffinity chromatography yield only small amounts of purified G protein that has partially lost its antigenicity. We describe a three-step purification protocol for these glycoproteins. RSV-infected HEp-2 cells were lysed by a Triton X-100 containing buffer. The viral proteins were captured by QAE-Sephadex A-50 material in a batch procedure. A first elution with 100 mM NaCl led to a crude F protein fraction, and a second elution with 300 mM NaCl led to a crude G protein fraction. The F protein was further purified on a Lentil-lectin Sepharose 4B column and finally polished using a Resource Isopropyl column. Lentil-lectin Sepharose 4B was also used to purify the G protein from the crude fraction, but polishing of the G protein was carried out on a Resource Q column. Homogenous RSV-F and RSV-G proteins were obtained by this protein purification protocol. No loss of antigenicity could be observed during this procedure as the highly purified viral proteins remain detectable by a set of monoclonal antibodies and specific antisera. The G protein was isolated as a 90000 monomer, whereas the purified F protein was recovered as a functional homodimer of 140000.