Clinical standards for the assessment, management and rehabilitation of post-TB lung disease

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

Phosphodiesterase 4 mediates interleukin-8-induced heterologous desensitization of the β2 -adrenergic receptor

Acute respiratory distress syndrome (ARDS) is a life-threatening illness characterized by decreased alveolar-capillary barrier function, pulmonary edema consisting of proteinaceous fluid, and inhibition of net alveolar fluid transport responsible for resolution of pulmonary edema. There is currently no pharmacotherapy that has proven useful to prevent or treat ARDS, and two trials using beta-agonist therapy to treat ARDS demonstrated no effect. Prior studies indicated that IL-8-induced heterologous desensitization of the beta2-adrenergic receptor (β₂ -AR) led to decreased beta-agonist-induced mobilization of cyclic adenosine monophosphate (cAMP). Interestingly, phosphodiesterase (PDE) 4 inhibitors have been used in human airway diseases characterized by low intracellular cAMP levels and increases in specific cAMP hydrolyzing activity. Therefore, we hypothesized that PDE4 would mediate IL-8-induced heterologous internalization of the β₂ -AR and that PDE4 inhibition would restore beta-agonist-induced functions. We determined that CINC-1 (a functional IL-8 analog in rats) induces internalization of β₂ -AR from the cell surface, and arrestin-2, PDE4, and β₂ -AR form a complex during this process. Furthermore, we determined that cAMP associated with the plasma membrane was adversely affected by β₂ -AR heterologous desensitization. Additionally, we determined that rolipram, a PDE4 inhibitor, reversed CINC-1-induced derangements of cAMP and also caused β₂ -AR to successfully recycle back to the cell surface. Finally, we demonstrated that rolipram could reverse CINC-1-mediated inhibition of beta-agonist-induced alveolar fluid clearance in a murine model of trauma-shock. These results indicate that PDE4 plays a role in CINC-1-induced heterologous internalization of the β₂ -AR; PDE4 inhibition reverses these effects and may be a useful adjunct in particular ARDS patients.

Effects of Racism on Oral Health in the United States

This paper comments on the Effects of Racism on Oral Health in the United States (US). It provides the background and sets the stage to raise questions about race: how was race defined originally, what exactly is race, and how have racial categories been enumerated? Following this path, the paper broadens the scope of view regarding data attributable to racial categories pointing to social and cultural factors that influence overall health outcomes, particularly those related to oral health. Oral health researchers, advocates, providers, administrators, program planners, and funders, among others rely on data, often compiled by racial categories. We should be aware of potential vagaries that can accompany race-based data, and its interpretation and application, regarding oral health. The paper suggests we should be mindful of other influences that affect documented differences among populations regarding their oral health status.

Practices and opinions of New Zealand veterinarians regarding control of bovine viral diarrhoea

AIMS

To explore recommendations that New Zealand veterinarians make for diagnosing and managing bovine viral diarrhoea (BVD) in cattle herds under different clinical scenarios and their opinions towards potential barriers and opportunities for implementing BVD control programmes in New Zealand.

METHODS

A cross-sectional survey of registered veterinarians in New Zealand was conducted in 2019. Respondents were asked about the approaches they would use to manage BVD under different clinical scenarios as well as their opinions on national BVD control. A subset of veterinarians completed a more in-depth survey providing additional free-text responses on a range of different BVD topics. Descriptive statistics were provided for all quantitative study variables and the free-text responses were also analysed to generate further insights into veterinarians' perceptions towards BVD management.

RESULTS

The cross-sectional survey was completed by 101 of an estimated 870 (11.6%) cattle veterinarians. Thirty-five veterinarians completed the in-depth survey. There was wide variation in the BVD diagnostic testing and vaccination protocols that respondents recommended under different clinical scenarios. Annual bulk milk BVD testing was perceived as a valuable tool for initiating BVD discussions with dairy farmers. Respondents indicated that beef farmers were more difficult to engage in BVD control largely due to the logistical challenges of yarding cattle at the appropriate times to implement interventions, with many farmers only contacting veterinarians after experiencing a BVD outbreak Most respondents (91/101; 90%) believed it was possible to eradicate BVD from New Zealand, but cited lack of farmer awareness and poor compliance with management recommendations as significant barriers. The measure with the most support for inclusion in a compulsory national eradication programme was requiring farmers to declare the status of their animals prior to sale while the least supported measure was requiring farmers to double fence boundaries to prevent nose-to-nose contact with neighbouring stock. Although respondents highlighted the need for farmers and industry to support any national eradication programme in order for it to be successful, there was also recognition that veterinarians could be more pro-active in engaging with farmers particularly in discussions around the economics of BVD.

CONCLUSIONS AND CLINICAL RELEVANCE

While the survey respondents appeared to be highly supportive of BVD control, it was perceived that financial and logistical barriers existed that could impede farmer engagement. Further extension efforts may be needed to ensure that veterinarians are presenting clear and consistent recommendations about BVD management to farmers.Abbreviations: BVD: Bovine viral diarrhoea; NAIT: National Animal Identification and Tracing System; PI: Persistently infected.

Quantitative proteomic comparison of salt stress in Chlamydomonas reinhardtii and the snow alga Chlamydomonas nivalis reveals mechanisms for salt-triggered fatty acid accumulation via reallocation of carbon resources

BACKGROUND

Chlamydomonas reinhardtii is a model green alga strain for molecular studies; its fully sequenced genome has enabled omic-based analyses that have been applied to better understand its metabolic responses to stress. Here, we characterised physiological and proteomic changes between a low-starch C. reinhardtii strain and the snow alga Chlamydomonas nivalis, to reveal insights into their contrasting responses to salinity stress.

RESULTS

Each strain was grown in conditions tailored to their growth requirements to encourage maximal fatty acid (as a proxy measure of lipid) production, with internal controls to allow comparison points. In 0.2 M NaCl, C. nivalis accumulates carbohydrates up to 10.4% DCW at 80 h, and fatty acids up to 52.0% dry cell weight (DCW) over 12 days, however, C. reinhardtii does not show fatty acid accumulation over time, and shows limited carbohydrate accumulation up to 5.5% DCW. Analysis of the C. nivalis fatty acid profiles showed that salt stress improved the biofuel qualities over time. Photosynthesis and respiration rates are reduced in C. reinhardtii relative to C. nivalis in response to 0.2 M NaCl. De novo sequencing and homology matching was used in conjunction with iTRAQ-based quantitative analysis to identify and relatively quantify proteomic alterations in cells exposed to salt stress. There were abundance differences in proteins associated with stress, photosynthesis, carbohydrate and lipid metabolism proteins. In terms of lipid synthesis, salt stress induced an increase in dihydrolipoyl dehydrogenase in C. nivalis (1.1-fold change), whilst levels in C. reinhardtii remained unaffected; this enzyme is involved in acetyl CoA production and has been linked to TAG accumulation in microalgae. In salt-stressed C. nivalis there were decreases in the abundance of UDP-sulfoquinovose (- 1.77-fold change), which is involved in sulfoquinovosyl diacylglycerol metabolism, and in citrate synthase (- 2.7-fold change), also involved in the TCA cycle. Decreases in these enzymes have been shown to lead to increased TAG production as fatty acid biosynthesis is favoured. Data are available via ProteomeXchange with identifier PXD018148.

CONCLUSIONS

These differences in protein abundance have given greater understanding of the mechanism by which salt stress promotes fatty acid accumulation in the un-sequenced microalga C. nivalis as it switches to a non-growth state, whereas C. reinhardtii does not have this response.

Estrogen Alleviates Sex-Dependent Differences in Lung Bacterial Clearance and Mortality Secondary to Bacterial Pneumonia after Traumatic Brain Injury

Traumatic brain injury (TBI) is the leading cause of injury-related death and disability in patients under the age of 46 years. Survivors of the initial injury often endure systemic complications such as pulmonary infection, and Pseudomonas aeruginosa is one of the most common causes of nosocomial pneumonia in intensive care units. Female patients are less likely to develop secondary pneumonia after TBI, and pre-clinical studies have revealed a salutary role for estrogen after trauma. Therefore, we hypothesized that female mice would experience less mortality after post-TBI pneumonia with P. aeruginosa. We employed a mouse model of TBI followed by P. aeruginosa pneumonia. Male mice had greater mortality and impaired lung bacterial clearance after post-TBI pneumonia compared with female mice. This was confirmed as a difference in sex hormones, as oophorectomized wild-type mice had mortality and lung bacterial clearance similar to male mice. There were differences in tumor necrosis factor-α secretion in male and female alveolar macrophages after P. aeruginosa infection. Finally, injection of male or oophorectomized wild-type female mice with estrogen restored lung bacterial clearance and prevented mortality. Our model of TBI followed by P. aeruginosa pneumonia is among the first to reveal sex dimorphism in secondary, long-term TBI complications.

Temporal trends in bulk tank milk antibody ELISA and PCR test results for bovine viral diarrhoea in New Zealand pastoral dairy herds

Aims: To describe temporal trends in bulk milk antibody ELISA and PCR testing for bovine viral diarrhoea (BVD) in New Zealand pastoral dairy herds and to assess the use of historical accession data to predict herd-level BVD incursions. Methods: Data on all diagnostic testing of bulk milk for BVD performed by the Livestock Improvement Corporation (Hamilton, NZ) over eight lactation seasons from 1 June 2010 to 31 May 2018 were analysed. This included anonymised herd identification, geographic location, herd size, sample collection date, sample to positive (S/P) ratio for antibody ELISA results, and cycle threshold values for PCR detecting viral RNA. Multivariable logistic regression was used to explore the relationship between historical accession data and the risk of herds having at least one positive bulk milk PCR test result in the 2017 season. Results: There were 156,034 bulk milk BVD diagnostic testing accessions for 10,495 uniquely identified dairy herds over the 8-season period. The prevalence of tested herds with at least one positive bulk milk PCR test result decreased from 14.6% (407/2,786) in the 2010 season to 5.6% (355/6,309) in the 2017 season with similarly marked declines in S/P ratios. In the 2017 season, 2,961/6,309 (46.9%) herds had S/P ratios greater than the 0.75 cut-off value indicating recent or active BVD virus transmission within the herd while 1,422/6,309 (22.5%) herds were classified as having negative or low S/P ratios. Herds that cleared BVD from the milking herd experienced a mean decline in S/P ratio of 0.11 units per year (min 0.05; max 0.18). In the multivariable analysis, the overall incidence risk of herds experiencing a BVD incursion in the 2017 season was 3.8% (146/3,848) and there were three significant predictors in the final model: herd size, PCR status in the 2014 season, and change in S/P ratio between the 2014 and 2015 seasons. The area under the receiver operating curve for the final model was 0.695 indicating poor discrimination. Conclusions and clinical relevance: The prevalence of dairy herds in New Zealand with positive bulk milk PCR test results and high S/P ratios has decreased over time, suggesting fewer herds are actively infected with BVD and that herd immunity may also be declining. Although monitoring trends in bulk milk test results provides useful information on changes in individual herd status, it is difficult to accurately predict when new incursions will occur and farmers should continue to maintain good biosecurity.

Post-tuberculosis lung health: perspectives from the First International Symposium

ALTHOUGH CURABLE, TB frequently leaves the individual with chronic physical and psycho-social impairment, but these consequences have been largely neglected. The 1^st International Post-Tuberculosis Symposium (Stellenbosch, South Africa) was held to discuss priorities and gaps in addressing this issue. A barrier to progress has been the varied terminology and nomenclature, so the Delphi process was used to achieve consensus on definitions. Lack of sufficient evidence hampered definitive recommendations in most domains, including prevention and treatment of post-TB lung disease (PTLD), but the discussions clarified the research needed. A consensus was reached on a toolkit for future PTLD measurement and on PTLD patterns to be considered. The importance of extra-pulmonary consequences and progressive impairment throughout the life-course was identified, including TB recurrence and increased mortality. Patient advocates emphasised the need to address the psychological and social impacts post TB and called for clinical guidance. More generally, there is an urgent need for increased awareness and research into post-TB complications.

Serological evidence for exposure to bovine viral diarrhoea virus in sheep co-grazed with beef cattle in New Zealand

Aims: To determine whether sheep that co-grazed with cattle that were suspected to be positive for bovine viral diarrhoea (BVD) virus had serological evidence of exposure to the virus.Methods: Eighteen commercial farms that routinely co-grazed cattle and sheep in the same paddocks were recruited through purposive sampling. The recruiting veterinarians identified nine farms with cattle herds that were known or highly suspected to be positive for BVD and nine farms that were considered to be free of BVD. Blood samples were taken from 15 ewes aged 1 year on each farm and samples were submitted to a commercial diagnostic laboratory to test for antibodies against pestiviruses using an ELISA. All samples that were positive were then tested using a virus neutralisation test (VNT)for antibodies against BVD virus.Results: Of the 270 blood samples, 17 were positive for pestivirus antibodies by ELISA and these originated from two farms that were known or suspected to have BVD virus-positive cattle. None of the samples from the nine flocks co-grazed with cattle herds that were known or suspected to be BVD virus-negative were positive for pestivirus antibodies. Within the two positive farms, 2/15 samples from the first farm and 15/15 samples from the second farm were antibody-positive. When the 17 positive blood samples were submitted for VNT, all 15 samples from the second farm tested positive for BVD virus antibodies with the highest titre being 1:512.Conclusions and clinical relevance: In this small sample of New Zealand sheep and beef farms with suspected BVD infection in cattle, there was evidence of pestivirus exposure in co-grazed sheep. Although we were unable to confirm the origin of the exposure in these sheep, these findings highlight that farmers who are trying to eradicate BVD from their cattle should be mindful that the infection may also be circulating in sheep, and both populations should be considered a possible risk to each other for generating transient and persistent infections. Further work is needed to estimate the true prevalence of New Zealand sheep flocks that are affected by BVD and the associated economic impacts.

Neuronal Wiskott-Aldrich syndrome protein regulates Pseudomonas aeruginosa-induced lung vascular permeability through the modulation of actin cytoskeletal dynamics

Pulmonary edema associated with increased vascular permeability is a severe complication of Pseudomonas (P.) aeruginosa-induced acute lung injury. The mechanisms underlying P aeruginosa-induced vascular permeability are not well understood. In the present study, we investigated the role of neuronal Wiskott Aldrich syndrome protein (N-WASP) in modulating P aeruginosa-induced vascular permeability. Using lung microvascular endothelial and alveolar epithelial cells, we demonstrated that N-WASP downregulation attenuated P aeruginosa-induced actin stress fiber formation and prevented paracellular permeability. P aeruginosa-induced dissociation between VE-cadherin and β-catenin, but increased association between N-WASP and VE-cadherin, suggesting a role for N-WASP in promoting P aeruginosa-induced adherens junction rupture. P aeruginosa increased N-WASP-Y256 phosphorylation, which required the activation of Rho GTPase and focal adhesion kinase. Increased N-WASP-Y256 phosphorylation promotes N-WASP and integrin αVβ6 association as well as TGF-β-mediated permeability across alveolar epithelial cells. Inhibition of N-WASP-Y256 phosphorylation by N-WASP-Y256F overexpression blocked N-WASP effects in P aeruginosa-induced actin stress fiber formation and increased paracellular permeability. In vivo, N-WASP knockdown attenuated the development of pulmonary edema and improved survival in a mouse model of P aeruginosa pneumonia. Together, our data demonstrate that N-WASP plays an essential role in P aeruginosa-induced vascular permeability and pulmonary edema through the modulation of actin cytoskeleton dynamics.

Practices and opinions of New Zealand beef cattle farmers towards bovine viral diarrhoea control in relation to real and perceived herd serological status

Aims: To investigate the seroprevalence of infection with bovine viral diarrhoea (BVD) virus among 75 beef herds and seroconversion in cattle during early pregnancy, and to determine the practices and opinions of farmers towards BVD control and their association with real and perceived herd serological status.Methods: Blood samples were collected before mating in 75 beef herds across New Zealand from 15 unvaccinated heifers that had delivered their first calf that season. Serum samples were tested for BVD antibodies using ELISA individually, and after pooling samples for each farm. Animals that were antibody-negative were retested at either pregnancy diagnosis or weaning. Farmers were asked to complete a detailed survey about herd demographics, BVD testing and vaccination practices, and opinions towards national BVD control.Results: Based on the pooled serum antibody ELISA results, there were 28/75 (37%) negative herds, 15/75 (20%) suspect herds, and 32/75 (43%) positive herds. Of 1,117 animals sampled 729 (65.3%) tested negative for BVD virus antibodies; when retested, 47/589 (8.0%) animals from 13/55 (24%) herds had seroconverted. Among 71 famers providing survey responses 11 (15%) believed their herd was infected with BVD, 24 (34%) were unsure and 36 (51%) did not think their herd was infected. Only 19/71 (18%) farmers had performed any BVD testing within the past 5 years and 50/70 (71%) had not vaccinated any cattle for BVD. Support for national BVD eradication programme was strong in 51/71 (56%) respondents, but the biggest challenge to BVD control was considered to be famer compliance. Compared to farmers who did not think their herd was infected, more farmers who thought BVD was present in their herds had previously tested for BVD, would consider testing all replacement calves, and would support establishing a national BVD database; fewer would consider purchasing BVD tested or vaccinated cattle only.Conclusions and clinical relevance: Only 15% of the beef farmers in this study believed their herds were infected with BVD virus and few of them had undertaken BVD screening. Nevertheless many were supportive of implementing a national BVD control programme. It is likely that the lack of farmer awareness around BVD and the failure of farmers to recognise the potential impacts in their herds are hindering progress in controlling the disease in New Zealand. There are opportunities for New Zealand veterinarians to be more proactive in helping beef farmers explore BVD management options.

Recommendations for the testing and control of bovine viral diarrhoea in New Zealand pastoral cattle production systems

Eradicating bovine viral diarrhoea (BVD) from cattle populations requires a clear approach for determining the epidemiological status of individual herds and implementing the appropriate control measures to ensure the transmission cycle is cost-effectively broken. This is particularly important in countries such as New Zealand where there is currently no coordinated national programme and the herd-level decisions to control BVD are left to the discretion of individual farmers and veterinarians. To ensure greater consistency in the information being delivered by different stakeholders, we review the epidemiology of BVD in the context of New Zealand pastoral production systems and provides a series of simplified recommendations for the future control of BVD in beef and dairy herds. Based on analysis of BVD test accession data from commercial diagnostic laboratories, it has been estimated that 40.6% of dairy herds and 45.6% of beef herds tested had positive results for antibodies to BVD virus. While BVD continues to remain widespread and under voluntary control in New Zealand, it is recommended that herds test all individual mixed-age cows and replacement heifers for BVD virus or antigen and remove persistently infected animals from the breeding population. All new breeding animals that have entered the herd either through purchase or birth should also be tested for BVD virus. Biosecurity risks should be managed by reducing contacts with other herds and implementing targeted vaccination programmes. All individual purchased cattle should be tested and confirmed negative for BVD virus before being moved onto the buyer's property, even if the herd of origin had a negative antibody-based screening test. Herds should continue annual antigen or virus testing of all calves as soon as possible after birth to identify any persistently infected animals.

Assessing the use of diagnostic laboratory accession data to support national bovine viral diarrhoea control in New Zealand

Aims: To assess the suitability of using existing national diagnostic laboratory testing data to support national bovine viral diarrhoea (BVD) research, surveillance, and control in New Zealand. Methods: Data on laboratory accessions for BVD diagnostic testing in New Zealand from 1 January 2015 to 31 December 2017 were provided by four commercial veterinary diagnostic companies. The data were integrated into a single dataset containing the unique accession number, sample submission date, farm location (territorial authority level), test type (bulk milk antibody-ELISA, bulk milk PCR, serum antibody-ELISA, blood/serum/tissue antigen-ELISA, or blood/serum/tissue PCR), and test results. Estimates for the number of registered cattle farms in each territorial authority were generated from the National Animal Identification and Tracing database. Results were summarised for July 2015 to June 2016 and July 2016 to June 2017. Results: There was a total of 59,007 unique BVD diagnostic test accessions including 39,920 (67.6%) for bulk milk antibody-ELISA, 27,832 (47.2%) for bulk milk PCR, 3,229 (5.5%) for serum antibody-ELISA, 9,132 (15.5%) for blood/serum/tissue antigen-ELISA, and 7,122 (12.1%) for blood/serum/tissue PCR. Of the 17,946 accessions for blood/serum/tissue samples, 4,316 (24.0%) were missing the herd production type and 6,678 (37.2%) were missing the animals age. Approximately 7,000/10,958 (65%) dairy herds and 1,600/43,611 (4%) beef herds were conducting annual BVD screening tests. In 2016/2017, the prevalence of accessions with ≥1 BVD-positive result was 40.6% for bulk milk antibody, 6.4% for bulk milk PCR, 45.6% for serum antibody, and 9.8% for blood/serum/tissue antigen-ELISA or PCR tests. There was substantial regional variation in both the percentage of herds testing for BVD and the prevalence of positive accessions. Following pooled serum antibody-ELISA, only 175/604 (29.0%) beef herds and 177/566 (31.3%) dairy herds had recorded follow-up testing. Conclusions and Clinical Relevance: Laboratory diagnostic accession data has the potential to provide valuable insights about BVD epidemiology in New Zealand, but there are significant limitations in the data collected and discrepancies in the different systems that each laboratory uses to measure, interpret, and record diagnostic data. There is a strong need to develop a more consistent national system for recording and sharing BVD test results to support BVD management at farm and industry levels. Abbreviations: BVD: Bovine viral diarrhoea; Ct: Cycle threshold; NAIT: National Animal Identification and Tracing; NZVP: New Zealand Veterinary Pathology; PI: Persistently infected; S/P: Sample to positive control.

Probiotics in Goat Milk Products: Delivery Capacity and Ability to Improve Sensory Attributes

Dairy foods, particularly those of bovine origin, are the predominant vehicles for delivery of probiotic bacteria. Caprine (goat) milk also possesses potential for successful delivery of probiotics, and despite its less appealing flavor in some products, the use of goat milk as a probiotic carrier has rapidly increased over the last decade. This review reports on the diversity, applicability, and potential of using probiotics to enhance the sensory properties of goat milk and goat milk-based products. A brief conceptual introduction to probiotic microorganisms is followed by an account of the unique physicochemical, nutritive, and beneficial aspects of goat milk, emphasizing its advantages as a probiotic carrier. The sensory properties of probiotic-enriched goat milk products are also discussed. The maintenance of probiotic viability and desirable physicochemical characteristics in goat milk products over shelf life is possible. However, the unpleasant sensory features of some goat milk products remain a major disadvantage that hinder its wider utilization. Nevertheless, certain measures such as fortification with selected probiotic strains, inclusion of fruit pulps and popular flavor compounds, and production of commonly consumed tailor-made goat milk-based products have potential to overcome this limitation. In particular, certain probiotic bacteria release volatile compounds as a result of their metabolism, which are known to play a major role in the aroma profile and sensory aspects of the final products.

Role of heme in lung bacterial infection after trauma hemorrhage and stored red blood cell transfusion: A preclinical experimental study

BACKGROUND

Trauma is the leading cause of death and disability in patients aged 1-46 y. Severely injured patients experience considerable blood loss and hemorrhagic shock requiring treatment with massive transfusion of red blood cells (RBCs). Preclinical and retrospective human studies in trauma patients have suggested that poorer therapeutic efficacy, increased severity of organ injury, and increased bacterial infection are associated with transfusion of large volumes of stored RBCs, although the mechanisms are not fully understood.

METHODS AND FINDINGS

We developed a murine model of trauma hemorrhage (TH) followed by resuscitation with plasma and leukoreduced RBCs (in a 1:1 ratio) that were banked for 0 (fresh) or 14 (stored) days. Two days later, lungs were infected with Pseudomonas aeruginosa K-strain (PAK). Resuscitation with stored RBCs significantly increased the severity of lung injury caused by P. aeruginosa, as demonstrated by higher mortality (median survival 35 h for fresh RBC group and 8 h for stored RBC group; p < 0.001), increased pulmonary edema (mean [95% CI] 106.4 μl [88.5-124.3] for fresh RBCs and 192.5 μl [140.9-244.0] for stored RBCs; p = 0.003), and higher bacterial numbers in the lung (mean [95% CI] 1.2 × 10(7) [-1.0 × 10(7) to 2.5 × 10(7)] for fresh RBCs and 3.6 × 10(7) [2.5 × 10(7) to 4.7 × 10(7)] for stored RBCs; p = 0.014). The mechanism underlying this increased infection susceptibility and severity was free-heme-dependent, as recombinant hemopexin or pharmacological inhibition or genetic deletion of toll-like receptor 4 (TLR4) during TH and resuscitation completely prevented P. aeruginosa-induced mortality after stored RBC transfusion (p < 0.001 for all groups relative to stored RBC group). Evidence from studies transfusing fresh and stored RBCs mixed with stored and fresh RBC supernatants, respectively, indicated that heme arising both during storage and from RBC hemolysis post-resuscitation plays a role in increased mortality after PAK (p < 0.001). Heme also increased endothelial permeability and inhibited macrophage-dependent phagocytosis in cultured cells. Stored RBCs also increased circulating high mobility group box 1 (HMGB1; mean [95% CI] 15.4 ng/ml [6.7-24.0] for fresh RBCs and 50.3 ng/ml [12.3-88.2] for stored RBCs), and anti-HMGB1 blocking antibody protected against PAK-induced mortality in vivo (p = 0.001) and restored macrophage-dependent phagocytosis of P. aeruginosa in vitro. Finally, we showed that TH patients, admitted to the University of Alabama at Birmingham ER between 1 January 2015 and 30 April 2016 (n = 50), received high micromolar-millimolar levels of heme proportional to the number of units transfused, sufficient to overwhelm endogenous hemopexin levels early after TH and resuscitation. Limitations of the study include lack of assessment of temporal changes in different products of hemolysis after resuscitation and the small sample size precluding testing of associations between heme levels and adverse outcomes in resuscitated TH patients.

CONCLUSIONS

We provide evidence that large volume resuscitation with stored blood, compared to fresh blood, in mice increases mortality from subsequent pneumonia, which occurs via mechanisms sensitive to hemopexin and TLR4 and HMGB1 inhibition.

Potential influence of dairy propionibacteria on the growth and acid metabolism of Streptococcus bovis and Megasphaera elsdenii

Ruminal acidosis is a prevalent disorder among dairy cows and feedlot cattle, which can significantly impair their health and productivity. This study, involving seven different strains of dairy propionibacteria, represents an in vitro investigation of the feasibility of using these organisms as direct-fed microbials to control lactic acid acumulation in the rumen. Interactions between the propionibacteria, Streptococcus bovis and Megasphaera elsdenii were evaluated in terms of effects on lactic, acetic and propionic acid metabolism, following co-incubation. Spot resistance tests showed slight but varying degrees of growth inhibition by S. bovis among the propionibacteria, while no inhibition was observed between M. elsdenii and the different strains of dairy propionibacteria. In the co-culture experiments comprising S. bovis in nutrient broth, significant differences in pH and the levels of production of lactic, acetic and propionic acid, were observed between treatments following inoculation with various propionibacteria and/or M. elsdenii. In general, lactic acid concentrations at the end of the incubation were significantly lower in the cultures containing propionibacteria compared with cultures comprising either S. bovis only or S. bovis + M. elsdenii, although efficacy of lactate metabolism varied between species and strains. Moreover,the accumulation of acetic and propionic acid in the combined cultures, but not in the solo S. bovis culture, indicated that these compounds were produced as a result of the metabolism of lactic acid by the propionibacteria and M. elsdenii.

Oestrogen receptor positive breast cancer metastasis to bone: inhibition by targeting the bone microenvironment in vivo

Clinical trials have shown that adjuvant Zoledronic acid (ZOL) reduces the development of bone metastases irrespective of ER status. However, post-menopausal patients show anti-tumour benefit with ZOL whereas pre-menopausal patients do not. Here we have developed in vivo models of spontaneous ER+ve breast cancer metastasis to bone and investigated the effects of ZOL and oestrogen on tumour cell dissemination and growth. ER+ve (MCF7, T47D) or ER-ve (MDA-MB-231) cells were administered by inter-mammary or inter-cardiac injection into female nude mice ± estradiol. Mice were administered saline or 100 μg/kg ZOL weekly. Tumour growth, dissemination of tumour cells in blood, bone and bone turnover were monitored by luciferase imaging, histology, flow cytometry, two-photon microscopy, micro-CT and TRAP/P1NP ELISA. Estradiol induced metastasis of ER+ve cells to bone in 80-100 % of animals whereas bone metastases from ER-ve cells were unaffected. Administration of ZOL had no effect on tumour growth in the fat pad but significantly inhibited dissemination of ER+ve tumour cells to bone and frequency of bone metastasis. Estradiol and ZOL increased bone volume via different mechanisms: Estradiol increased activity of bone forming osteoblasts whereas administration of ZOL to estradiol supplemented mice decreased osteoclast activity and returned osteoblast activity to levels comparable to that of saline treated mice. ER-ve cells require increased osteoclast activity to grow in bone whereas ER+ve cells do not. Zol does not affect ER+ve tumour growth in soft tissue, however, inhibition of bone turnover by ZOL reduced dissemination and growth of ER+ve breast cancer cells in bone.

Human breast cancer bone metastasis in vitro and in vivo: a novel 3D model system for studies of tumour cell-bone cell interactions

Bone is established as the preferred site of breast cancer metastasis. However, the precise mechanisms responsible for this preference remain unidentified. In order to improve outcome for patients with advanced breast cancer and skeletal involvement, we need to better understand how this process is initiated and regulated. As bone metastasis cannot be easily studied in patients, researchers have to date mainly relied on in vivo xenograft models. A major limitation of these is that they do not contain a human bone microenvironment, increasingly considered to be an important component of metastases. In order to address this shortcoming, we have developed a novel humanised bone model, where 1 × 10(5) luciferase-expressing MDA-MB-231 or T47D human breast tumour cells are seeded on viable human subchaodral bone discs in vitro. These discs contain functional osteoclasts 2-weeks after in vitro culture and positive staining for calcine 1-week after culture demonstrating active bone resorption/formation. In vitro inoculation of MDA-MB-231 or T47D cells colonised human bone cores and remained viable for <4 weeks, however, use of matrigel to enhance adhesion or a moving platform to increase diffusion of nutrients provided no additional advantage. Following colonisation by the tumour cells, bone discs pre-seeded with MDA-MB-231 cells were implanted subcutaneously into NOD SCID mice, and tumour growth monitored using in vivo imaging for up to 6 weeks. Tumour growth progressed in human bone discs in 80 % of the animals mimicking the later stages of human bone metastasis. Immunohistochemical and PCR analysis revealed that growing MDA-MB-231 cells in human bone resulted in these cells acquiring a molecular phenotype previously associated with breast cancer bone metastases. MDA-MB-231 cells grown in human bone discs showed increased expression of IL-1B, HRAS and MMP9 and decreased expression of S100A4, whereas, DKK2 and FN1 were unaltered compared with the same cells grown in mammary fat pads of mice not implanted with human bone discs.

Expression and function of enamel-related gene products in calvarial development

Enamel-related gene products (ERPs) are detected in non-enamel tissues such as bone. We hypothesized that, if functional, ERP expression corresponds with distinct events during osteoblast differentiation and affects bone development and mineralization. In mouse calvariae and MC3T3 cells, expression profiles of enamel-related gene products (ERPs) correlated with key events in post-natal calvarial development and MC3T3 cell mineralization. Developing skulls from both Amel- and Ambn-deficient animals were approximately 15% shorter when compared with those of wild-type controls, and their sutures remained patent for a longer period of time. Analysis of Amel- and Ambn-deficient calvariae and calvarial osteoblast cultures revealed a dramatic reduction in mineralized nodules, a significant reduction in Runx2, Sp7, Ibsp, and Msx2 expression, and a reduction in Alx4 in Amel-deficient calvariae vs. an increase in Alx4 in Ambn-deficient calvariae. Analysis of these data indicates that ERP expression follows defined developmental profiles and affects osteoblast differentiation, mineralization, and calvarial bone development. We propose that, in parallel to their role in the developing enamel matrix, ERPs have retained an evolutionary conserved function related to the biomineralization of bones.

The Colour Test for drug susceptibility testing of Mycobacterium tuberculosis strains

SETTING

Tartu, Estonia.

OBJECTIVE

To assess the performance and feasibility of the introduction of the thin-layer agar MDR/XDR-TB Colour Test (Colour Test) as a non-commercial method of drug susceptibility testing (DST).

DESIGN

The Colour Test combines the thin-layer agar technique with a simple colour-coded quadrant format, selective medium to reduce contamination and colorimetric indication of bacterial growth to simplify interpretation. DST patterns for isoniazid (INH), rifampicin (RMP) and ciprofloxacin (CFX) were determined using the Colour Test for 201 archived Mycobacterium tuberculosis isolates. Susceptibilities were compared to blinded DST results obtained routinely using the BACTEC™ Mycobacteria Growth Indicator Tube™ (MGIT) 960 to assess performance characteristics.

RESULTS

In all, 98% of the isolates produced interpretable results. The average time to positivity was 13 days, and all results were interpretable. The Colour Test detected drug resistance with 98% sensitivity for INH, RMP and CFX and 99% for multidrug-resistant tuberculosis. Specificities were respectively 100% (95%CI 82-100), 88% (95%CI 69-97) and 91% (95%CI 83-96) and 90% (95%CI 74-98). Agreement between the Colour Test and BACTEC MGIT 960 were respectively 98%, 96%, 94% and 97%.

CONCLUSION

The Colour Test could be an economical, accurate and simple technique for testing tuberculosis strains for drug resistance. As it requires little specialist equipment, it may be particularly useful in resource-constrained settings with growing drug resistance rates.

A single administration of combination therapy inhibits breast tumour progression in bone and modifies both osteoblasts and osteoclasts

We have previously shown that repeated sequential administration of doxorubicin, followed 24 h later by zoledronic acid, inhibits tumour growth in models of established breast cancer bone metastasis. As breast cancer patients only receive zoledronic acid every 3–4 weeks, the aim of the current study was to establish the anti-tumour and bone effects of a single administration of doxorubicin/zoledronic acid combination therapy in a bone metastasis model.

MDA-MB-231-GFP cells were injected i.c. in 6-week-old nude mice. On day 2, animals received PBS, doxorubicin (2 mg/kg i.v.), zoledronic acid (100 μg/kg s.c.) or doxorubicin followed 24 h later by zoledronic acid. Anti-tumour effects were assessed on days 15/23 by quantification of apoptotic and proliferating cells and changes in expression of genes implicated in apoptosis, proliferation and bone turnover. Bone effects were assessed by μCT analysis, bone histomorphometry and measurement of serum markers. A tumour-free control group was included.

Combination treatment reduced bone tumour burden compared to single agent or PBS control and increased levels of tumour cell apoptosis on day 15, but this was no longer detectable on day 23. Animals receiving zoledronic acid had increased bone density, without evidence of tumour-induced lesions. Bone histomorphometry showed that zoledronic acid caused a decrease in osteoblast and osteoclast numbers and an increase in osteoclast size, in both tumour-free and tumour-bearing animals.

Our data show that although zoledronic acid modifies the bone microenvironment through effects on both osteoblasts and osteoclasts, this does not result in a significant anti-tumour effect in the absence of doxorubicin.

The Innovative Socio-economic Interventions Against Tuberculosis (ISIAT) project: an operational assessment

SETTING

Tuberculosis (TB) affected households in impoverished shantytowns, Lima, Peru.

OBJECTIVE

To evaluate socio-economic interventions for strengthening TB control by improving uptake of TB care and prevention services.

DESIGN

Barriers to TB control were characterised by interviews with TB-affected families. To reduce these barriers, a multidisciplinary team offered integrated community and household socio-economic interventions aiming to: 1) enhance uptake of TB care by education, community mobilisation and psychosocial support; and 2) reduce poverty through food and cash transfers, microcredit, microenterprise and vocational training. An interim analysis was performed after the socio-economic interventions had been provided for 2078 people in 311 households of newly diagnosed TB patients for up to 34 months.

RESULTS

Poverty (46% earned <US$1 per day), depression (40%), stigmatisation (77%), and perceived isolation (39%) were common among TB patients (all P < 0.05 vs. non-patients). The project had 100% recruitment, and involved 97% of TB-affected households in regular visits, 71% in community groups, 78% in psychosocial support and 77% in poverty-reduction interventions. The socio-economic interventions were associated with increases in household contact TB screening (from 82% to 96%); successful TB treatment completion (from 91% to 97%); patient human immunodeficiency virus testing (from 31% to 97%); and completion of preventive therapy (from 27% to 87%; all P < 0.0001).

CONCLUSIONS

Socio-economic interventions can strengthen TB control activities.

KEYWORDS

tuberculosis; control; microcredit; poverty;social determinants.

Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications

OBJECTIVE

To quantify the impact of cash transfer and microfinance interventions on a selected list of tuberculosis (TB) risk factors and assess their potential role in supporting TB control.

DATA SOURCE

Published and unpublished references identified from clinical and social electronic databases, grey literature and web sites.

METHODS

Eligible interventions had to be conducted in middle- or low-income countries and document an impact evaluation on any of the following outcomes: 1) TB or other respiratory infections; 2) household socio-economic position; and 3) factors mediating the association between low household socio-economic position and TB, including inadequate health-seeking behaviours, food insecurity and biological TB risk factors such as human immunodeficiency virus (HIV) and adult malnutrition. Interventions targeting special populations were excluded.

RESULTS

Fifteen cash transfer schemes (four unconditional and 11 conditional) and seven microfinance programmes met the eligibility criteria. No intervention addressed TB or any other respiratory infection. Of 11 cash transfer and four microfinance interventions, respectively seven and four reported a positive impact on indicators of economic well-being. A positive impact on household food security was documented in respectively eight of nine and three of five cash transfer and microfinance interventions. Improved health care access was documented respectively in 10 of 12 cash transfer and four of five microfinance interventions. The only intervention evaluating impact on HIV incidence was a microfinance project that found no effect. No cash transfer or microfinance interventions had an impact on adult malnutrition.

CONCLUSIONS

Cash transfer and microfinance interventions can positively impact TB risk factors. Evaluation studies are urgently needed to assess the impact of these social protection interventions on actual TB indicators.

A DEFICIENCY DISEASE OF FOXES

A common and highly destructive dietary disease of silver foxes in captivity is pathologically the counter-part of Wernicke's hemorrhagic polioencephalitis of man. The disease in foxes is caused by feeding fish as 10 per cent., or more, of the diet. It is probable that the fish induce a B(1) avitaminosis which causes the characteristic pathology and the resultant symptoms.

INDUCTION OF TUMORS IN DOMESTIC RABBITS WITH NUCLEIC ACID PREPARATIONS FROM PARTIALLY PURIFIED SHOPE PAPILLOMA VIRUS AND FROM EXTRACTS OF THE PAPILLOMAS OF DOMESTIC AND COTTONTAIL RABBITS

A deoxyribonucleic acid preparation which showed infectivity and tumorigenic activity in domestic rabbits was isolated from the papillomatous tissue of wild cottontail rabbits by phenolic deproteinization procedure. The activity of the preparation could be completely abolished by its exposure to a minute amount (0.02 microg/ml) of DNAase. Antisera against Shope papilloma virus did not block the tumorigenic activity of the preparation, and trypsin and chymotrypsin had no effect on it. The extraction with phenol of a partially purified virus preparation also yielded extracts with tumorigenic potency. Extracts obtained from the domestic rabbit papilloma and submitted to phenolic deproteinization also proved infective and tumorigenic in rabbits of this sort, although the level of "tumorigenicity" was much lower than that of the cottontail preparations. Tests for intact virus, carried out with half of the extracts yielded wholly negative findings.

STUDIES ON HERPETIC INFECTION IN MICE : IV. THE EFFECT OF SPECIFIC ANTIBODIES ON THE PROGRESSION OF THE VIRUS WITHIN THE NERVOUS SYSTEM OF YOUNG MICE

Two-week-old mice inoculated with herpes virus on the pad of a hind foot regularly developed paralysis of the infected limb followed by paraplegia and encephalitis terminating fatally 5 or 6 days after inoculation. Hyperimmune rabbit serum given intraperitoneally at the time virus was inoculated on the foot pad prevented the formation of an herpetic lesion of the foot pad. When the antiserum was given 12 hours after inoculation of the virus, a typical infection of the epithelium of the foot pad developed, but the virus was prevented from causing obvious signs of infection of the nervous system in many of the animals. Amputation of the foot 2 hours after the inoculation of the virus prevented the paralysis of the hind leg. Some of the mice died of a delayed encephalitis. Amputation of the foot at 24 hours neither prevented nor delayed the sequence of paralysis of the hind leg, encephalitis, and death. In order to study immune serum therapy of an infection of the nervous system uncomplicated by a peripheral focus of infection or by traumatic disturbance of the central nervous system, 2-week-old mice were inoculated on the foot pad, the infected feet were amputated 24 hours later, and the immune serum was administered at varying intervals thereafter. Using litter mate controls and statistically significant numbers of mice, it was shown that hyperimmune rabbit serum, administered during the first one-third of the incubation period, retards and, in some cases, arrests the progress of herpetic infection within the nervous system.

Detection of root resorption using dentin and bone markers

OBJECTIVES - To test the hypothesis that during root resorption, organic matrix proteins and cytokines from the surrounding bone and dentin are released into the gingival crevice. MATERIAL AND METHODS - Subjects with mild (<2 mm loss) and severe root resorption (>2 mm) were identified. Control group subjects with no loss of root structure or undergoing orthodontic treatment were also identified. Gingival crevicular fluid (GCF) was collected non-invasively from the mesial and distal sides of each of the four upper incisors by using filter paper strips. The eluted GCF was used for analysis using western blot and enzyme-linked immunosorbent assay (ELISA) techniques. Antibodies used were against osteopontin (OPN), (osteoprotegerin) OPG, and receptor activator of nuclear factor kappa B ligand (RANKL). RESULTS - Western blot analysis showed differential expression of OPN, OPG, and RANKL in the control and root resorbed subjects. However, processed forms of these proteins were only observed in the root resorbed subjects. Results from ELISA with OPG antibodies revealed a difference in OPG concentration between the control and root resorption groups. ELISA results with RANKL antibodies did show a statistically significant difference between the control group and the two study groups. The ratio RANKL/OPG was statistically higher in subjects with severe root resorption than in the control subjects. CONCLUSIONS - Preliminary results confirm the presence of matrix proteins and cytokines in the GCF of root resorbed subjects. Further, OPG was locally present in excess amounts over RANKL and an increased RANKL/OPG in the study groups could be correlated with an increased bone resorption activity during orthodontic tooth movement.

Terahertz ambipolar dual-wavelength quantum cascade laser

Terahertz frequency quantum cascade lasers (THz QCLs) are compact solid-state sources of terahertz radiation that were first demonstrated in 2002. They have a broad range of potential applications ranging from gas sensing and non-destructive testing, through to security and medical imaging, with many polycrystalline compounds having distinct fingerprint spectra in the terahertz frequency range. In this article, we demonstrate an electrically-switchable dual-wavelength THz QCL which will enable spectroscopic information to be obtained within a THz QCL-based imaging system. The device uses the same active region for both emission wavelengths: in forward bias, the laser emits at 2.3 THz; in reverse bias, it emits at 4 THz. The corresponding threshold current densities are 490 A/cm(2) and 330 A/cm(2), respectively, with maximum operating temperatures of 98K and 120 K.

Apparent absolute oral bioavailability in excess of 100% for a vitronectin receptor antagonist (SB-265123) in rat. I. Investigation of potential experimental and mechanistic explanations

1. SB-265123 is a novel alphavbeta3 (the vitronectin receptor) antagonist. Previous rat studies with it revealed an apparent absolute oral bioavailability (Fapp) of greater than 100%. The present studies were conducted to investigate the potential causes for this observation. 2. Of 49 SB-265123 analogues evaluated in rat using an identical experimental design, Fapp > 100% was observed for 22 of them, suggesting that the observed Fapp >100% with SB-265123 was not anomalous. All 22 compounds had clearances < 15 ml min(-1) kg(-1). However, Fapp>100% were not recorded for all low-clearance analogues. 3. Using SB-265123 as a model to investigate potential artefacts, it was demonstrated that using a chiral assay did not decrease Fapp. Additionally, qualitative sample analysis demonstrated that no metabolites were present in the plasma that could interfere with the liquid chromatography coupled with tandem mass spectrometry detection assay. The high Fapp was also dose-order-, delivery system- and vehicle-independent, and was not affected by the feeding status of the animals. Furthermore, a linearity experiment and an absorption study indicated that oral administration of SB-265123 does not result in hepatic portal vein concentrations that exceed the pharmacokinetic linearity of SB-265123. 4. These observations suggest that the observed Fapp > 100% for SB-265123 is not due to an experimental artefact or an obvious pharmacokinetic non-linearity. The mechanism(s) for this phenomenon is explored further in the second part of the present paper.

Identifying the major influences on the microbial composition of roof harvested rainwater and the implications for water quality

Perceptions of the quality of roof harvested rainwater remain an impediment to widespread implementation of rainwater tanks on urban allotments. Previous literature reports on roof water quality have given little consideration to the relative significance of airborne environmental micro-organisms to roof catchment contamination and the issue of tank water quality. This paper outlines the findings of a recent study into the influence of weather on roof water contamination conducted at an urban housing development in Newcastle, on the east coast of Australia. Samples of direct roof run-off were collected during a number of separate rainfall events, and microbial counts were matched to climatic data corresponding to each of the monitored events. Roof run-off contamination was found to be under the strong influence of both wind speed and direction. The preliminary findings of an investigation currently under way into the microbial diversity of rainwater harvesting systems have also been presented. The results indicate that the composition of organisms present varied considerably from source to source and throughout the collection system. In all cases, evidence of faecal contamination was found to be negligible. The implications of these findings to the issues of tank water quality, health risk analysis and monitoring protocols have been discussed.

Analysis of nucleotide diversity of NAT2 coding region reveals homogeneity across Native American populations and high intra-population diversity

N-acetyltransferase 2 (NAT2), an important enzyme in clinical pharmacology, metabolizes antibiotics such as isoniazid and sulfamethoxazole, and catalyzes the transformation of aromatic and heterocyclic amines from the environment and diet into carcinogenic intermediates. Polymorphisms in NAT2 account for variability in the acetylator phenotype and the pharmacokinetics of metabolized drugs. Native Americans, settled in rural areas and large cities of Latin America, are under-represented in pharmacogenetics studies; therefore, we sequenced the coding region of NAT2 in 456 chromosomes from 13 populations from the Americas, and two from Siberia, detecting nine substitutions and 11 haplotypes. Variants *4 (37%), *5B (23%) and *7B (24%) showed high frequencies. Average frequencies of fast, intermediate and slow acetylators across Native Americans were 18, 56 and 25%, respectively. NAT2 intra-population genetic diversity for Native Americans is higher than East Asians and similar to the rest of the world, and NAT2 variants are homogeneously distributed across native populations of the continent.

Expression of receptor activator of nuclear factor kappabeta ligand (RANKL) and tumour necrosis factor related, apoptosis inducing ligand (TRAIL) in breast cancer, and their relations with osteoprotegerin, oestrogen receptor, and clinicopathological variables

BACKGROUND

Receptor activator of nuclear factor kappabeta ligand (RANKL) has an important role in bone remodelling, and tumour necrosis factor related, apoptosis inducing ligand (TRAIL) can induce apoptosis in cancer cells. Their functions are linked by their interactions with osteoprotegerin (OPG).

OBJECTIVE

To investigate the expression of RANKL and TRAIL in a large series of unselected breast cancers and to analyse the relations between these expressions and the expression of OPG, oestrogen receptor, and clinicopathological variables.

METHODS

395 breast cancers were sampled into tissue microarrays and immunohistochemistry undertaken for RANKL and TRAIL.

RESULTS

There was strong expression of RANKL in 14% of the cancers and strong expression of TRAIL in 30%. Expression of RANKL had a negative association with expression of oestrogen receptor (p = 0.036). Expression of TRAIL had a negative association with the Nottingham Prognostic Index (p = 0.021). There was a significant negative relation between expression of RANKL and TRAIL (p<0.005). Unsupervised cluster analysis produced a dendrogram that showed a clear division into two groups, and the expression of oestrogen receptor was significantly higher in one of those groups (p = 0.012).

CONCLUSIONS

There is apparent loss of expression of RANKL in 86% of breast cancers; those tumours that retain expression tend to be oestrogen receptor negative and of a high histological grade. There is strong expression of TRAIL in 30% of breast cancers and these tend to be of better prognostic type. These results may be important in the processes of metastasis to bone and the apoptotic cell death pathway in cancer.

Wind, rain and bacteria: The effect of weather on the microbial composition of roof-harvested rainwater

The microbiological and chemical quality of tank-stored rainwater is impacted directly by roof catchment and subsequent run-off contamination, via direct depositions by birds and small mammals, decay of accumulated organic debris, and atmospheric deposition of airborne micro-organisms and chemical pollutants. Previous literature reports on roof water quality have given little consideration to the relative significance of airborne micro-organisms. This study involved analyses of direct roof run-off at an urban housing development in Newcastle, on the east coast of Australia. A total of 77 samples were collected during 11 separate rainfall events, and microbial counts and mean concentrations of several ionic contaminants were matched to climatic data corresponding to each of the monitored events. Conditions both antecedent to, and those prevailing during each event, were examined to investigate the influence of certain meteorological parameters on the bacterial composition of the roof water and indirectly assess the relative contribution of airborne micro-organisms to the total bacterial load. Results indicated that airborne micro-organisms represented a significant contribution to the bacterial load of roof water at this site, and that the overall contaminant load was influenced by wind velocities, while the profile (composition) of the load varied with wind direction. The implications of these findings to the issues of tank water quality and health risk analysis, appropriate usage and system design are discussed.

Mechanisms of the Synergistic Interaction between the Bisphosphonate Zoledronic Acid and the Chemotherapy Agent Paclitaxel in Breast Cancer Cells in vitro

Breast cancer patients often receive both paclitaxel and zoledronic acid as part of their treatment, and these drugs are reported to have synergistic effects on the induction of apoptosis of breast cancer cells in vitro. We have found that the synergistic interaction is drug sequence dependent, with maximal levels of apoptosis achieved when cells are treated with paclitaxel followed by zoledronic acid, as opposed to the reverse sequence or simultaneous treatment. The synergistic interaction persists at clinically relevant concentrations and incubation periods. We report that the sequential treatment is associated with cell cycle changes and depends on breast cancer cell characteristics, with hormone independence, mutated p53 status and presence of BRCA1 gene being associated with higher levels of apoptosis. Finally, we have found that the synergistic induction of apoptosis is via zoledronic acid-mediated inhibition of the mevalonate pathway.

Tuberculosis skin testing, anergy and protein malnutrition in Peru

SETTING

Malnutrition and intestinal parasites cause immunosuppression. This may cause false-negative tuberculin skin tests (TST) and failure to identify tuberculosis (TB) infection.

OBJECTIVE

To assess factors associated with TST positivity and anergy in disadvantaged communities in Peru.

DESIGN

A study of 212 randomly selected adults: 102 in a rural Amazonian village and 110 shanty town residents in urban Lima.

RESULTS

Respectively 52% and 53% of urban and rural jungle populations were TST-positive. Using simultaneous tetanus and candida skin tests, 99% had at least one positive skin test. Generalised anergy was therefore rare, despite frequent intestinal parasitic infection, including 34% helminth infection prevalence in the jungle. TST positivity was associated with age (P = 0.001), known TB contact (P = 0.02) and poor household ventilation (P = 0.007). TST positivity was not significantly associated with crowding, reported past TB, single/multiple BCG vaccination, income, intestinal parasites, dietary factors, body mass index or body fat. Individuals with lower anthropometric body protein, as measured by corrected arm muscle area, were less likely to be TST-positive (P = 0.02), implying that protein malnutrition caused tuberculin-specific anergy.

CONCLUSION

These results identify the importance of household ventilation for community TB transmission and add to the evidence that protein malnutrition suppresses TB immunity, causing false-negative TST results.

Tolerance of deviations in eye and mouth position

OBJECTIVE

To develop and refine a technique for measuring the tolerance for deviations in facial appearance.

DESIGN

A psychophysical method was administered using photocopies of altered facial photographs to measure tolerances for deviations in eye position and mouth angulation and judges' reaction time.

METHODS

Stimulus photos were displayed as Kodachrome slides to 76 individuals grouped by their familiarity with craniofacial anomalies, i.e. dental professionals, orthodontic and craniofacial patients, also a group of normal patients.

RESULTS

(1) Tolerance for deviation of facial appearance varies inversely with the magnitude of the physical deviations from normal; (2) tolerance varies directly as a function of assumed familiarity with deviation; (3) response and reaction time varied inversely with the tolerance for facial deviation.

CONCLUSION

Significant differences in tolerance and reaction time were found among the groups and depended on whether an isolated feature was judged or if the feature was judged in the context of the whole face.

Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon

SETTING

Households of TB patients in the Peruvian Amazon.

OBJECTIVE

To investigate how knowledge and beliefs of household contacts about TB affected health seeking behavior.

DESIGN

Interviews with 73 patients finishing treatment and 79 of their adult household contacts.

RESULTS

Contacts were knowledgeable about free screening and treatment, but contacts who noted weight loss, not cough, were more likely to be screened for TB (P = 0.03). Forty-two per cent reported that TB was prevented by nutrition, 28% by separating eating utensils, and only 19% by avoiding a coughing patient. Only one household contact reported being stigmatized. Stigma centered upon nutrition, and only 12% knew of the association between TB and HIV. Only 14% had a BMI < 20, yet 30% reported regularly going to sleep hungry. Free food packages were reported to be the most important reason for treatment adherence by 33% of patients.

CONCLUSION

Contacts misperceived TB as a nutritional disease and did not fear airborne transmission, which should be corrected by public health education. Weight loss, and not cough, led to screening. Stigma appeared to be minimized because risk was perceived as personal, through malnutrition, rather than exposure-based. Nutritional incentives that utilize these beliefs may reduce diagnostic delay and enhance treatment adherence.

Osteoprotegerin (OPG) Produced by Bone Marrow Stromal Cells Protects Breast Cancer Cells from TRAIL-Induced Apoptosis

Advanced breast cancer is often associated with metastatic bone disease, causing a number of serious complications for the patients such as hypercalceamia, pain, nerve compression and fractures. The formation of bone metastases depends on complex interactions between tumour cells and the cells of the bone microenvironment, but the precise molecular mechanisms involved in the development of tumour-induced bone disease have not been identified. We have investigated the ability of bone marrow stromal cells (BMSC) isolated from breast cancer patients to generate osteoprotegerin (OPG), a molecule involved both in bone turnover and cell survival. The potential survival effects of OPG are mediated through binding to a member of the TNF super family, TNF-related Apoptosis Inducing Ligand (TRAIL), preventing association between TRAIL and its death-inducing receptors present on a number of tumour cell types. In the present report we show that bone marrow stromal cells isolated from breast cancer patients produce OPG when grown in culture. The levels of OPG present in BMSC conditioned medium is sufficient to protect breast cancer cells from undergoing TRAIL induced apoptosis. Our data suggest that bone-derived OPG may increase survival of breast cancer cells that reach the bone microenvironment as part of the metastatic process.

The value of counting BCG scars for interpretation of tuberculin skin tests in a tuberculosis hyperendemic shantytown, Peru

SETTING

The tuberculin skin test (TST) is widely used as a diagnostic or screening test for Mycobacterium tuberculosis infection and disease. A peri-urban shantytown in the desert hills of south Lima, Peru, highly endemic for tuberculosis, and where bacille Calmette-Guérin (BCG) vaccine had been given in multiple doses until 1995.

OBJECTIVE

To analyze the effect of multiple BCG vaccines on TST in a community-based setting.

DESIGN

Point-prevalence survey of TST reactions of 572 people aged 6-26 years from 255 households. TST reactions were compared to the observed number of BCG scars and other potential risk factors (age, living with a TST-positive person, and contact with active tuberculosis).

RESULT

People with two or more scars had significantly larger reactions, even after adjusting for potential risk factors. The adjusted population attributable fraction of being TST-positive and having two or more BCG scars was 26%.

CONCLUSION

There is no demonstrated benefit of repeat BCG vaccination. We therefore recommend that physicians take into consideration the number of BCG scars when interpreting the TST and that programs give no more than one BCG vaccination.