A Study of the Background Levels of Male DNA on Underpants Worn by Females

This study is the first to examine the background level of male DNA on underpants worn by females in the absence of sexual contact. Here, we examined 103 samples from the inside front of underpants from 85 female volunteers. Samples were examined for the presence of male DNA using NGM SElect and PowerPlex Y23 kits. Only five samples gave a "complete" Y-STR profile, even though 83.5% of our volunteers cohabited with a male. In all cases where a partner reference sample was available, the Y-STR profile matched the cohabiting partner. We have demonstrated that a Y-STR profile is not expected on the inside front of underpants worn by females after social contact alone. The results of this study are informative for evaluating the significance of a Y-STR profile on underpants in cases of alleged sexual assault.

Decreasing the risk of sudden unexpected death in epilepsy: structured communication of risk factors for premature mortality in people with epilepsy

BACKGROUND AND PURPOSE

Good practice guidelines highlight the importance of making people with epilepsy aware of the risk of premature mortality in epilepsy particularly due to sudden unexpected death in epilepsy (SUDEP). The SUDEP and Seizure Safety Checklist ('Checklist') is a structured risk communication tool used in UK clinics. It is not known if sharing structured information on risk factors allows individuals to reduce SUDEP and premature mortality risks. The aim of this study was to ascertain if the introduction of the Checklist in epilepsy clinics led to individual risk reduction.

METHODS

The Checklist was administered to 130 consecutive people with epilepsy attending a specialized epilepsy neurology clinic and 129 attending an epilepsy intellectual disability (ID) clinic within a 4-month period. At baseline, no attendees at the neurology clinic had received formal risk advice, whereas all those attending the ID clinic had received formal risk advice on multiple occasions for 6 years. The Checklist was readministered 1 year later to each group and scores were compared with baseline and between groups.

RESULTS

Of 12 risk factors considered, there was an overall reduction in mean risk score for the general (P = 0.0049) but not for the ID (P = 0.322) population. Subanalysis of the 25% of people at most risk in both populations showed that both sets had a significant reduction in risk scores (P < 0.001).

CONCLUSION

Structured discussion results in behavioural change that reduces individual risk factors. This impact seems to be higher in those who are at current higher risk. It is important that clinicians share risk information with individuals as a matter of public health and health promotion.

Transmission of multiple resistant Salmonella Concord from internationally adopted children to their adoptive families and social environment: proposition of guidelines

Since 2004, an increasing number of multidrug-resistant Salmonella serovar Concord infections have been isolated in Belgium among children adopted from Ethiopia. The patients or their family were interviewed and the isolates were subtyped. Between 2004 and 2009, a total of 39 Salmonella Concord infections were isolated from patients. Thirty-four isolates presented a multidrug resistance including resistance to extended-spectrum cephalosporins. Thirty-six cases involved children and 30 of these were adopted from Ethiopia. One case was due to contact with an adopted child and for the other 5 cases no direct epidemiological link with Ethiopia could be found, although four isolates displayed the same patterns observed on the adoptees’ isolates, strongly suggesting a phylogenetic relationship with the Ethiopian isolates. Our study confirmed the emergence in Europe of S. Concord isolates resistant to third-generation cephalosporin among Ethiopian adoptees. We have demonstrated that transmission (intra- and extra familial) can happen even if the frequency seems to be low. The presence and the transmission of such a multidrug-resistant Salmonella infection constitute a major concern, since such strains could jeopardize classical antibiotic therapy in patients at risk. This study provides useful information for parents adopting children and for their family practitioner.

Helping nursing homes "at risk" for quality problems: a statewide evaluation

The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 "at-risk" facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating "at-risk" facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in "at-risk" facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education.

Comparison of DNA extraction from cervical cells collected in PreservCyt solution for the amplification of Chlamydia trachomatis

OBJECTIVE

The aim of this study was to compare and evaluate three methods of DNA extraction for the amplification of Chlamydia trachomatis in uterine cervical samples collected in PreservCyt solution. ThinPrep is the trade name for the slide preparation.

METHODS

Thirty-eight samples collected in LCx buffer medium, which were identified as C. trachomatis infected by ligase chain reaction (LCR), were selected for this study. DNA from the PreservCyt samples was extracted by three methods: (i) QIAamp kit, (ii) boiling in Tris-EDTA buffer with Chelex purification, and (iii) Proteinase K digestion with Chelex purification. Sample DNA was tested for the presence of C. trachomatis by PCR using cryptic plasmid research (CTP) primers and major outer membrane protein research momp gene (MOMP) primers. Real-time (LightCycler) PCR for relative C. trachomatis quantification following DNA extraction was performed using primers (Hsp 60) for the 60 kDa heat-shock protein hsp60 gene.

RESULTS

Amplification using CTP primers was the most successful with each of the extraction protocols. Boiling in buffer was the least successful extraction method. QIAamp was the best extraction method, yielding the most positives with both the CTP and MOMP primers. Proteinase K-Chelex extraction gave similar sensitivity to QIAamp extraction with CTP primers but lower for MOMP primers.

CONCLUSIONS

The DNA extraction method must be carefully selected to ensure that larger PCR amplicons can be successfully produced by PCR and to ensure high sensitivity of detection of C. trachomatis. In this study it was found that the QIAamp extraction method followed by PCR with the CTP primers was the most successful for amplification of C. trachomatis DNA.

207OVARIAN STIMULATION, TRANSVAGINAL, ULTRASOUND-GUIDED OOCYTE RETRIEVAL, ICSI AND BLASTOCYST PRODUCTION IN SEQUENTIAL MEDIA IN THE WESTERN LOWLAND GORILLA (GORILLA GORILLA GORILLA)

Two young (ages: 15 and 16 yr;; studbook # 947 and # 939, respectively) parous female gorillas were initially primed with daily oral monophasic estrogen/progesterone treatment (Ovcon 35: Bristol-Myers Squibb Co., Princeton, NJ, USA) for 3 mo to synchronize their menstrual cycles. After withdrawing treatment, urine was tested daily for occult blood (Hemastix;; Baxter Healthcare Corp., Deerfield, IL, USA). On days 3–10 following the onset of menses (Day 1), ovarian activity was stimulated with 225 IU human FSH im (Repronex;; Ferring Pharmaceuticals, New South Wales, Australia). Then on Days 6–8 this treatment was combined with 25mg GnRH antagonist im (Antagon;; Organon, West Orange, NJ, USA) to prevent premature endogenous LH release. Final oocyte maturation was stimulated 36h after the last FSH/GnRH treatment with 10,000IU hCG im (Profasi;; Serono Lab., Hingham/Rockland, MA, USA) and oocyte retrieval was performed 36h post-hCG administration in sternal recumbency (knee-chest) using a 3–6mHz probe, 17-ga needles and 87mmHg (VMAR-5000 Regulated Vacuum Pump;; Cook Veterinary Products). Both gorillas displayed a thickened endometrium, and approximately 6 (# 947) to 10 (# 939) maturing follicles (10–15mm) were detected in each animal. In female # 947, one oocyte was collected but peritoneal fluid and pathology (hydrosalpinx) were also diagnosed and the right ovary showed no follicular development. A total of 3 oocytes were recovered in highly viscous follicular fluid containing massive amounts of cumulus cells. They were transported in a HEPES-buffered transport medium in a portable incubator (CryoLogic, Mulgrave, Victoria, Australia) at 37°C by airline immediately from Brownsville to Dallas, TX, USA, and within 6-h post-retrieval were fertilized by ICSI using cryopreserved sperm collected by rectal probe electrostimulation (age: est. 40yr ; studbook # 268). The fertilized oocytes were cultured in Gardner’s Sequential Medium at 37°C in 6% CO2 all three cleaved and developed to blastocysts by 115h post-ICSI. One high-quality expanding blastocyst was transported back to Brownsville, TX, and transferred transcervically into the oocyte donor (studbook # 939), and two fair-quality blastocysts were transported overnight to Omaha, NE, and transferred into a synchronized gorilla recipient (age: 29yr; studbook # 543/91). Weekly urine samples from the two embryo transfer recipients are being tested for pregnancy diagnosis using OvuQuick test strips (Quidel, San Diego, CA, USA). Acknowledgments: This research was supported in part by the Morris Animal Foundation (Ruth Morris Keesling Animal Health Study).

Use of home and community-based services by elderly black and white females

The study purpose was to determine the impact of demographic, social, environmental, and health indicators on utilization of community-based services among black and white female elders. Existing data from a regional Area Agency on Aging was used and the sample (N = 1816) included low income and rural females. Races differed in use and services most frequently used were case management, outreach, congregate meal, and home delivered meals. Multiple linear and logistic regression indicated that age, payment source, income adequacy, residence, health conditions, sensory impairment, and function were associated with the number and types of services used, but these differed by race. Study findings have implications for health care providers, educators, policy makers, and planners.

Phase I study of the pharmacokinetics of a radioimmunoconjugate, 90Y-T101, in patients with CD5-expressing leukemia and lymphoma

Ten patients with advanced or refractory CD5-expressing hematologic neoplasms [two with chronic lymphocytic leukemia and eight with cutaneous T-cell lymphoma (CTCL)] were treated in a Phase I study with the radioimmunoconjugate 90Y-T101, which targets CD5+ lymphocytes. Prior imaging studies using 111In-T101 demonstrated uptake in involved lymph nodes and skin in patients with CTCL, and Phase I studies with unmodified T101 demonstrated transient responses. In this study, patients were treated with 5 or 10 mCi of 90Y chelated to T101 via isothiocyanatobenzyl diethylenetriamine pentaacetic acid, along with tracer doses of 111In-T101 for imaging. The biodistribution of the radioimmunoconjugate was determined by measuring 90Y and 111In blood clearance, urine excretion, and accumulation in bone marrow and in involved skin lesions. The intravascular pharmacokinetics of 90Y were predicted by 111In-labeled T101. The greatest differences in biodistribution between 111In and 90Y were in the higher bone accumulation of 90Y and its lower urinary excretion. Imaging studies demonstrated targeting of skin lesions and involved lymph nodes in CTCL patients. The predominant toxicity was bone marrow suppression. Rapid antigenic modulation of CD5 on circulating T and B cells was observed. Recovery of T-cell populations occurred within 2-3 weeks; however, suppression of B-cell populations persisted after 5+ weeks. All CTCL patients developed human antimouse antibody after one cycle and thus were not retreated; one patient with chronic lymphocytic leukemia received a second cycle of therapy. Partial responses occurred in five patients, two with chronic lymphocytic leukemia and three with CTCL. The median response duration was 23 weeks. One CTCL patient who subsequently received electron beam irradiation to a residual lesion is disease-free after 6 years.

A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction

BACKGROUND AND STUDY AIMS

Clogging of biliary stents continues to be a major clinical problem. Different polymer materials may have different effects on clogging. In vitro studies have shown a direct relation between the frictional coefficient of a polymer and the amount of encrusted material. Teflon appeared to be the best polymer for biliary stents. Two different types of stents made of Teflon have been tested in clinical practice and showed favourable patency rates. However, a randomized trial has never been performed. We compared the patency of an Amsterdam-type polyethylene stent with a Teflon stent in a prospective randomized trial.

PATIENTS AND METHODS

Between September 1995 and November 1996, 42 patients received a Teflon stent and 42 patients a polyethylene stent. All patients had a distal malignant biliary stricture without a previous drainage procedure. Diagnoses included carcinoma of the pancreas (n = 76), papilla (n = 1), bile duct (n = 5) and metastases (n = 2). The internal and external diameter (10 Fr), length (9 cm) and stent design (a straight stent with two side flaps and one side hole at each end) were similar for both stents.

RESULTS

A reduction in bilirubin of more than 20% within one week was seen in 91% of the patients. Early complication rates were similar in both groups (10%). The median follow-up was 142 days. Stent dysfunction occurred in 28 Teflon and 29 polyethylene stents. The thirty-day mortality was 14% in both groups. Patient survival did not differ significantly between the groups (median survival: Teflon 165 days, polyethylene 140 days). The median stent patency was 83 days for Teflon and 80 days for polyethylene stents, and was not significantly different either.

CONCLUSION

Teflon material did not improve patency in biliary stents with an Amsterdam-type design.

The formation of professional and consumer solutions: ethics in the general practice setting

A general practice research project on ethics is underway at the University of New South Wales, funded by GPEP (General Practice Evaluation Program, Commonwealth Department of Human Services and Health, GPEP 386). Ethical issues, as defined and explored by general practitioners and consumers, are being examined across four areas of Sydney. So far, telephone interviews have been conducted (64% response rate) with a random sample of general practitioners (GPs). Face-to-face interviews have been conducted with 107 consumers, randomly sampled using ABS collection district information. Focus groups have been formed to discuss acceptable solutions to GP and consumer identified ethical issues. This report will report on some preliminary findings to date and will explore professional and consumer roles in the formation of ethical solutions.

Scintigraphic imaging with 123I-metaiodobenzylguanidine as a marker of cardiac adrenergic neurotransmission in the rat

This study was performed to determine if 123I-metaiodobenzylguanidine (123I-MIBG) could be used to create scintigraphic images of the rat heart and to determine if this method could be used to estimate cardiac norepinephrine turnover in the intact animal. Male F344 rats were injected i.v. with 200-350 muCi of 123I-MIBG. Beginning at 5 min after the injection, scintigraphic images were made every 30 min for 5 h. The half-life of 123I-MIBG retention within the heart during the 5 h of the experiment was determined by plotting the log of the counts for each image vs. time. The half-life of cardiac 123I-MIBG was 3.44 +/- 0.17 h with a rate constant of 0.21 +/- 0.01 (hr-1). In a separate experiment, methacholine, a parasympathomimetic agonist, was given after the injection of 123I-MIBG and increased 123I-MIBG efflux. Cardiac 123I-MIBG uptake was reduced by 65% in rats sympathetically denervated with 6 hydroxy dopamine indicating that 123I-MIBG is accumulating for the most part in adrenergic nerve terminals. We conclude that scintigraphic imaging with 123I-MIBG may be a useful procedure for estimating cardiac adrenergic nervous system activity in the intact animal.

[Pneumatosis cystoides intestinalis associated with Steinert disease]

We report the case of a 63-year-old patient suffering from myotonic dystrophy, complicated with respiratory insufficiency, who presented a pneumoperitoneum without sign of peritonitis. Diagnosis of pneumatosis cystoides coli was based on CT scan evidence. Given oxygenotherapy and antibiotherapy, the patient rapidly improved. The association between the two affections has, to our knowledge, not been previously described.

Pulmonary surfactant-associated protein SP-B has little effect on acyl chains in dipalmitoylphosphatidylcholine dispersions

Synthetic human pulmonary surfactant-associated protein SP-B has been interacted with chain-perdeuterated dipalmitoylphosphatidylcholine (DPPC-d62) in aqueous dispersions, and the dispersions were investigated by magnetic resonance spectroscopy. The protein caused only small perturbations of the deuterium magnetic resonance spectra in the gel and liquid-crystal states. In an amount of 11% by weight in DPPC, it produced a small reduction in the magnitude of the first moments of the spectra in the gel and a small increase (approximately 5%) in their magnitude in the liquid crystal. In the liquid crystal the protein was observed to cause a similar effect on all portions of the acyl chain, as observed by its proportional shifting of splittings obtained from "dePaked" spectra. Using data from circular dichroism spectra, the protein was found to be about 45% alpha-helical in methanol and in DPPC dispersions. alpha-Helical content was not significantly changed by the presence of 2 mM calcium or by the packing state of the acyl chains. The presence of the protein enhanced the adsorption rate of lipid into the air-water interface when dispersions of lipids or lipid plus SP-B were injected below the interface. The results could be consistent with the protein interacting with the lipid near the head groups or arranging itself around the edges of bilayer discs, or a combination of the two orientations.

Epifluorescence microscopic observation of monolayers of dipalmitoylphosphatidylcholine: dependence of domain size on compression rates

A fluorescence microscopic technique was used to observe phase transitions in monolayers of DPPC. The sizes of the domain structures observed were found to be dependent on the rate of compression of the monolayer. The distribution of domain sizes for different rates of compression were unimodal, but the scatter in the sizes was greater during slow compressions.

Lung cancer: rational strategies for early detection and intervention

The current mortality rate for lung cancer, which approaches 90% at two years, is not decreasing despite intensive clinical trials attempting to improve systemic therapy. New drug discoveries and dose intensification approaches have not resulted in more effective anti-tumor control. An alternative approach using sputum immunocytology for early lung cancer detection was recently reported. The proposed basis for this early detection reflects the underlying biology of immunodominant carbohydrate tumor-associated antigens, which are recognized as a class of oncofetal antigens. The process of bronchial epithelial carcinogenesis is associated with an evolution of carbohydrate display which reverses the sequence originally associated with fetal organ development. By elucidating this pattern of fetal carbohydrate display, a precise map of stage of bronchial carcinogenesis may emerge.

Effects of newborn screening of cystic fibrosis on reported maternal behaviour

Screening for cystic fibrosis is highly controversial. Concerns have been expressed that newborn screening may cause mothers, who had considered their child to be healthy before diagnosis, to overprotect their child. Some critics of screening also suggest that a period of delay from onset of symptoms to diagnosis may help a mother adjust to the reality of the child's lethal condition. This study compared the strength of overprotective child rearing attitudes of 29 mothers whose children were screened (13 had symptomatic children and 16 asymptomatic children) with the attitudes of 29 mothers whose children were diagnosed after the onset of symptoms. Results indicate that newborn screening had not increased a mother's tendency to overprotect her child with cystic fibrosis and in some cases the tendency had decreased. Further, delay in diagnosis when screening was not conducted usually caused mothers considerable personal distress.