Molecular and epidemiological evidence of patient-to-patient hepatitis C virus transmission in a Scottish emergency department

BACKGROUND

Transmission of hepatitis C virus (HCV) in the healthcare setting is rare. Routine infection prevention and control measures mean that this should be a preventable 'never event'.

AIM

To investigate the diagnosis of acute healthcare-associated HCV infection.

METHODS

Epidemiological and molecular investigation of a case of acute HCV infection associated with nosocomial exposure.

FINDINGS

Detailed investigation of the treatment history of a patient with acute HCV infection identified transmission from a co-attending patient in an emergency department as the likely source; this possibility was confirmed by virus sequence analysis. The precise route of transmission was not identified, though both patient and source had minimally invasive healthcare interventions. Review of infection, prevention and control identified potentially contributory factors in the causal pathway including hand hygiene, inappropriate use of personal protective equipment, and blood contamination of the surface of the departmental blood gas analyser.

CONCLUSION

We provide molecular and epidemiological evidence of HCV transmission between patients in an emergency department that was made possible by environmental contamination. Patients with HCV infection are higher users of emergency care than the general population and a significant proportion of those affected remain unknown and/or infectious. Equipment, departmental design, staff behaviour, and patient risk require regular review to minimize the risk of nosocomial HCV transmission.

Electromyographic Responses from the Vastus Medialis during Isometric Muscle Actions

This study examined the electromyographic (EMG) responses from the vastus medialis (VM) for electrodes placed over and away from the innervation zone (IZ) during a maximal voluntary isometric contraction (MVIC) and sustained, submaximal isometric muscle action. A linear electrode array was placed on the VM to identify the IZ and muscle fiber pennation angle during an MVIC and sustained isometric muscle action at 50% MVIC. EMG amplitude and frequency parameters were determined from 7 bipolar channels of the electrode array, including over the IZ, as well as 10 mm, 20 mm and 30 mm proximal and distal to the IZ. There were no differences between the channels for the patterns of responses for EMG amplitude or mean power frequency during the sustained, submaximal isometric muscle action; however, there were differences between channels during the MVIC. The results of the present study supported the need to standardize the placement of electrodes on the VM for the assessment of EMG amplitude and mean power frequency. Based on the current findings, it is recommended that electrode placements be distal to the IZ and aligned with the muscle fiber pennation angle during MVICs, as well as sustained, submaximal isometric muscle actions.

Relative risk of acute pancreatitis in initiators of exenatide twice daily compared with other anti-diabetic medication: a follow-up study

AIMS

Previously, a retrospective cohort study found no increased risk of acute pancreatitis with current or recent use of exenatide twice daily compared with use of other anti-diabetic drugs. This follow-up study investigated incident acute pancreatitis, with the use of a different data source and analytic method, in patients exposed to exenatide twice daily compared with patients exposed to other anti-diabetic medications.

METHODS

A large US health insurance claims database was used. Eligible patients had ≥ 9 months continuous enrollment without a claim for pancreatitis and a claim for a new anti-diabetic medication on or after 1 June 2005 to 31 March 2009. Cases of acute pancreatitis were defined as hospitalized patients with an Internation Classification of Disease 9 code of 577.0 in the primary position. A discrete time survival model was used to evaluate the relationship between exenatide twice daily and acute pancreatitis.

RESULTS

Of 482,034 eligible patients, 24,237 initiated exenatide twice daily and 457,797 initiated another anti-diabetic medication. Initiators of exenatide twice daily had more severe diabetes compared with initiators of other anti-diabetic medications. After adjustments for propensity score, insulin and use of medication potentially associated with acute pancreatitis, the odds ratio with exenatide twice daily exposure was 0.95 (95% CI 0.65-1.38). A secondary analysis that examined current, recent and past medication exposure found no increased risk of acute pancreatitis with exenatide twice daily, regardless of exposure category.

CONCLUSION

This study indicates that exposure to exenatide twice daily was not associated with an increased risk of acute pancreatitis compared with exposure to other anti-diabetic medications. These results should be interpreted in light of potential residual confounding and unknown biases.

Infrared microcalorimetric spectroscopy using quantum cascade lasers

We have investigated an IR microcalorimetric spectroscopy technique that can be used to detect the presence of trace amounts of target molecules. The chemical detection is accomplished by obtaining the IR photothermal spectra of molecules adsorbed on the surface of uncooled thermal micromechanical detectors. Although we use a chemical layer to absorb target molecules, IR microcalorimetric spectroscopy requires no chemical specific coatings. The chemical specificity of the presented method is a consequence of the wavelength-specific absorption of IR photons from tunable quantum cascade lasers due to vibrational spectral bands of the analyte. We have obtained IR photothermal spectra for trace concentrations of 1,3,5-Trinitroperhydro-1,3,5-triazine and a monolayer of 2-Sulfanylethan-1-ol (2-mercaptoethanol) over the wavelength region from 6 to 10 μm. We found that both chemicals exhibit a number of photothermal absorption features that are in good agreement with their respective IR spectra.

Characterization of hydrogen responsive nanoporous palladium films synthesized via a spontaneous galvanic displacement reaction

A model is presented regarding the mechanistic properties associated with the interaction of hydrogen with nanoporous palladium (np-Pd) films prepared using a spontaneous galvanic displacement reaction (SGDR), which involves PdCl(2) reduction by atomic Ag. Characterization of these films shows both chemical and morphological factors, which influence the performance characteristics of np-Pd microcantilever (MC) nanomechanical sensing devices. Raman spectroscopy, uniquely complemented with MC response profiles, is used to explore the chemical influence of palladium oxide (PdO). These combined techniques support a reaction mechanism that provides for rapid response to H(2) and recovery in the presence of O(2). Post-SGDR processing via reduction of PdCl(2)(s) in a H(2) environment results in a segregated nanoparticle three-dimensional matrix dispersed in a silver layer. The porous nature of the reduced material is shown by high resolution scanning electron microscopy. Extended grain boundaries, typical of these materials, result in a greater surface area conducive to fast sorption/desorption of hydrogen, encouraged by the presence of PdO. X-ray diffraction and inductively coupled plasma-optical emission spectroscopy are employed to study changes in morphology and chemistry occurring in these nanoporous films under different processing conditions. The unique nature of chemical/morphological effects, as demonstrated by the above characterization methods, provides evidence in support of observed nanomechanical response/recovery profiles offering insight for catalysis, H(2) storage and improved sensing applications.

Relative risk of acute pancreatitis in initiators of exenatide twice daily compared with other anti-diabetic medication: a follow-up study

AIMS

Previously, a retrospective cohort study found no increased risk of acute pancreatitis with current or recent use of exenatide twice daily compared with use of other anti-diabetic drugs. This follow-up study investigated incident acute pancreatitis, with the use of a different data source and analytic method, in patients exposed to exenatide twice daily compared with patients exposed to other anti-diabetic medications.

METHODS

A large US health insurance claims database was used. Eligible patients had ≥ 9 months continuous enrollment without a claim for pancreatitis and a claim for a new anti-diabetic medication on or after 1 June 2005 to 31 March 2009. Cases of acute pancreatitis were defined as hospitalized patients with an Internation Classification of Disease 9 code of 577.0 in the primary position. A discrete time survival model was used to evaluate the relationship between exenatide twice daily and acute pancreatitis.

RESULTS

Of 482,034 eligible patients, 24,237 initiated exenatide twice daily and 457,797 initiated another anti-diabetic medication. Initiators of exenatide twice daily had more severe diabetes compared with initiators of other anti-diabetic medications. After adjustments for propensity score, insulin and use of medication potentially associated with acute pancreatitis, the odds ratio with exenatide twice daily exposure was 0.95 (95% CI 0.65-1.38). A secondary analysis that examined current, recent and past medication exposure found no increased risk of acute pancreatitis with exenatide twice daily, regardless of exposure category.

CONCLUSION

This study indicates that exposure to exenatide twice daily was not associated with an increased risk of acute pancreatitis compared with exposure to other anti-diabetic medications. These results should be interpreted in light of potential residual confounding and unknown biases.

Influence of acute eccentric exercise on the H:Q ratio

The purpose of the present study was to examine the effects of an acute bout of eccentric exercise on maximal isokinetic concentric peak torque (PT) of the leg flexors and extensors and the hamstrings-to-quadriceps (H:Q) strength ratio. Sixteen male (mean±SD: age=20.9±2 years; stature=177.0±4.4 cm; mass=76.8±10.0 kg) volunteers performed maximal, concentric isokinetic leg extension and flexion muscle actions at 60°·sec - 1 before and after (24-72 h) a bout of eccentric exercise. The eccentric exercise protocol consisted of 4 sets of 10 repetitions for the leg press, leg extension, and leg curl exercises at 120% of the concentric one repetition maximum (1-RM). The results indicated that the acute eccentric exercise protocol resulted in a significant (P<0.05) decrease in isokinetic leg flexion (13-19%) and leg extension (11-16%) PT 24-72 h post-exercise. However, the H:Q ratios were unaltered by the eccentric exercise protocol. These findings suggest that an acute bout of eccentric exercise utilizing both multi - and single - joint dynamic constant external resistance (DCER) exercises results in similar decreases in maximal isokinetic strength of the leg flexors and extensors, but does not alter the H:Q ratio.

Expression and purification of glutathione-S-transferase fusion proteins

This unit describes how pGEX vectors can be used in bacterial systems to express foreign polypeptides as fusions with glutathione-S-transferase (GST). In general, such fusion proteins are soluble and are easily purified from lysed cells under nondenaturing conditions by absorption with glutathione-agarose beads, followed by elution in the presence of free glutathione. Potential applications of the pGEX vectors include the expression and purification of individual polypeptides (including short peptides) for use as immunogens and as biochemical and biological reagents, and in the construction of cDNA expression libraries. This protocol describes production and screening of pGEX transformants and purification of milligram quantities of fusion proteins from 1-liter cultures. The commentary describes several modifications to the expression and purification protocol that may be useful in cases where fusion proteins are insoluble or unstable.

Enzymatic and chemical cleavage of fusion proteins

This unit provides protocols for some commonly used methods of site-specific cleavage of fusion proteins. The first three protocols describe enzymatic cleavage of proteins using proteases (factor Xa, thrombin, and enterokinase) that display highly restricted specificities, which greatly decrease the likelihood that unwanted secondary cuts will occur. Three additional protocols describe specific cleavage of fusion proteins with chemical reagents (cyanogen bromide, hydroxylamine, and low pH) as an alternative to enzymatic cleavage.

Multiple orifice distribution system for placing green lacewing eggs into verticel larval rearing units

Green lacewings are widely used biological control agents for various insect pests. To meet the needs of growers, green lacewings are being mass-reared commercially around the world. A common salt shaker has been used regularly to distribute eggs into Verticel lacewing larval rearing units. This technique is time consuming and inefficient because the number of eggs distributed in each cell is inconsistent. The multiple orifice distribution (MOD) system described here greatly improved egg distribution efficiency by increasing the percentage of Verticel cells containing the desired one to four eggs per cell (i.e., 40.8 and 52.1% by using salt shaker method versus 61.9% by using the MOD system). This mechanical system significantly reduced the labor and time involved in the process and would cost under $3500. In addition, this new system could be modified for distribution of other insect eggs.

Methotrexate dosage reduction in patients with rheumatoid arthritis beginning therapy with infliximab: the Infliximab Rheumatoid Arthritis Methotrexate Tapering (iRAMT) trial

OBJECTIVE

Infliximab plus methotrexate (MTX) is approved for the treatment of rheumatoid arthritis (RA). Based on the benefit/risk profile of this combination therapy, lower doses of MTX would be preferable when infliximab efficacy can be maintained. We evaluated the ability of patients receiving infliximab plus MTX to achieve and maintain a clinical response while the dose of MTX was tapered.

METHODS

Infliximab infusions were administered at a minimum dosage of 3 mg/kg at 8-week intervals (following three loading doses at weeks 0, 2, and 6) to patients who had an inadequate response to MTX. MTX tapering was initiated at week 22 or later when at least a 40% improvement in the combined tender and swollen joint count was achieved; dosages were reduced by 5 mg every 8 weeks to a protocol-specified minimum dosage of 5 mg per week. If the required dosage of MTX after a flare was greater than the baseline dosage, the patient was considered a treatment failure.

RESULTS

Of the 210 patients enrolled, 159 (76%) achieved a 40% or better improvement in the combined tender and swollen joint count and had their MTX doses tapered. In these 159 responders, the median (mean) dose of MTX was reduced from 15 (16.5) mg per week at baseline to 5 (7.1) mg per week at week 54. From the time of initial response, 79% of these patients had a zero- or a one-vial increase in infliximab, corresponding to an approximate dose increase of 1 mg/kg, through week 54.

CONCLUSION

Approximately 75% of the patients participating in this trial achieved at least a 40% reduction in the combined swollen and tender joint count (correlating with an American College of Rheumatology 20% [ACR20] response in 83% of patients) while reducing the mean MTX dose by 57%.

Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study

Neutropenic sepsis remains a potentially life-threatening complication of anticancer chemotherapy. However, it is possible to identify patients who are at low risk for serious complications and for whom less-intensive, more-convenient treatment may be appropriate. The aim of this study was to assess the efficacy and safety of oral antibiotics in conjunction with early hospital discharge in comparison with standard in-patient intravenous antibiotics in patients with low-risk neutropenic fever. In all, 126 episodes of low-risk neutropenic fever occurred in 102 patients. Patients were randomised to receive either: an oral regimen of ciprofloxacin (750 mg 12 hourly) plus amoxicillin-clavulanate (675 mg 8 hourly) for a total of 5 days, or a standard intravenous regimen of gentamicin and tazocin (piperacillin/tazobactam) until hospital discharge. Patients randomised to oral antibiotics were eligible for discharge following 24 h of hospitalisation, if clinically stable and symptomatically improved. The efficacy of the two arms was similar: initial treatment was successful without antibiotic modification in 90% of episodes in the intravenous arm and 84.8% of episodes in the oral arm, P=0.55, absolute difference between the groups 5.2%; 95% confidence interval (CI) for the difference -7 to 17.3%. Only one episode in the oral arm was associated with significant clinical deterioration: this occurred within the initial in-patient assessment period. The median in-patient stay was 4 days in the intravenous arm (range 2-8) and 2 days in the oral arm (range 1-16 days), P&<0.0005. The reduction in hospital stay led to significant cost-savings in the oral arm. In conclusion, this study suggests that oral antibiotics in conjunction with early hospital discharge for patients who remain stable after a 24 h period of in-patient monitoring offers a feasible and cost-effective alternative to conventional management of low-risk neutropenic fever.

Dynamic in vitro quantification of bioprosthetic heart valve leaflet motion using structured light projection

Quantification of heart valve leaflet deformation during the cardiac cycle is essential in understanding normal and pathological valvular function, as well as in the design of replacement heart valves. Due to the technical complexities involved, little work to date has been performed on dynamic valve leaflet motion. We have developed a novel experimental method utilizing a noncontacting structured laser-light projection technique to investigate dynamic leaflet motion. Using a simulated circulatory loop, a matrix of 150-200 laser light points were projected over the entire leaflet surface. To obtain unobstructed views of the leaflet surface, a stereo system of high-resolution boroscopes was used to track the light points at discrete temporal points during the cardiac cycle. The leaflet surface at each temporal point was reconstructed in three dimensions, and fit using our biquintic hermite finite element approach (Smith et al., Ann. Biomed. Eng. 26:598-611, 2001). To demonstrate our approach, we utilized a bovine pericardial bioprosthetic heart valve, which revealed regions of complex flexural deformation and substantially different shapes during the opening and closing phases. In conclusion, the current method has high spatial and temporal resolution and can reconstruct the entire surface of the cusp simultaneously. Because it is completely noncontacting, this approach is applicable to studies of fatigue and bioreactor technology for tissue engineered heart valves.

The effect of concentric isokinetic strength training of the quadriceps femoris on electromyography and muscle strength in the trained and untrained limb

The purpose of the present investigation was to examine the effects of unilateral concentric isokinetic leg extension training on peak torque (PT) and electromyographic (EMG) responses in the trained and untrained limbs. Twenty adult men were randomly assigned to a training (TRN, n = 11) or control (CTL, n = 9) group. The TRN group performed 6 sets of 10 leg extensions 3 days per week for 12 weeks at a velocity of 90 degrees.s(-1). All subjects were tested every 4 weeks for PT and EMG responses of both legs at a velocity of 90 degrees.s(-1). The 3-way mixed factorial analysis of variance (ANOVA) indicated a significant (p < 0.05) increase in PT over the 12 weeks in both the trained and untrained limb for the TRN group but no significant change in PT in either limb for the CTL group. The results of the 3-way ANOVA for the EMG data indicated no significant change in EMG amplitude in the trained or untrained limb for the TRN or CTL group. The increase in PT in the absence of a change in EMG may result from hypertrophic factors and/or changes in the other muscles or muscle groups involved in leg extension.

Mechanomyography, electromyography, heart rate, and ratings of perceived exertion during incremental cycle ergometry

BACKGROUND

The purpose of this investigation was to examine the relationships of mchanomyography (MMG), electromyography (EMG), heart rate (HR), and ratings of perceived exertion (RPE) versus power output during incremental cycle ergometry.

METHODS

Nine adult males [mean (+/-SD) age 23 (+/-3) years] volunteered to perform an incremental test to exhaustion on a cycle ergometer. The MMG, EMG, HR, and RPE values were recorded at the end of each power output.

RESULTS

The normalized (expressed as a percentage of maximal values) relationships for MMG, HR, and RPE versus power output were linear, while the EMG versus power output relationship was quadratic. Furthermore, there were no significant (p > 0.10) differences between slope coefficients for the relationships among MMG, HR, and RPE versus power output.

CONCLUSIONS

The results of this investigation indicated that there were close associations among the mechanical (MMG), cardiac (HR), and perception of effort (RPE) aspects of cycle ergometry. In addition, there was a dissociation between the linear MMG pattern and quadratic EMG pattern with increasing power outputs.

Droplet size and spray volume effects on insecticide deposit and mortality of heliothine (Lepidoptera: Noctuidae) larvae in cotton

Effects of droplet size and volumetric application rate of tractor-applied lambda cyhalothrin (Karate Z 2.08 SC) on larval tobacco budworm, Heliothis virescens (F.), mortality and insecticide deposition on and within the canopy of mature cotton were explored by use of a laboratory bioassay incorporating field-sprayed cotton and a field trial incorporating natural insect infestations. Insecticide was applied in all combinations of three distinct droplet sizes and three volumetric application rates. Mortality of third-instar tobacco budworm occurring in leaf-disk bioassays was highly correlated with insecticide deposits (microg/leaf disk) at upper- and midcanopy levels. At the upper canopy level, mortality was negatively correlated with volumetric application rate and was not significantly correlated with droplet size. Deposit was negatively correlated with volumetric application rate at the lower plant level and larval mortality decreased with increasing droplet size. Results from this study do not support the recommendations of high volumetric application rates; and although droplet size was less influential than volumetric application rate in deposit and insect mortality, the data indicate a significant trend toward increased midcanopy larval mortality with smaller droplets.

Synergism between the potato glycoalkaloids alpha-chaconine and alpha-solanine in inhibition of snail feeding

Snails (Helix aspersa L.) were fed filter paper treated with the potato glycoalkaloids, alpha-solanine and alpha-chaconine, singly or together. In pure form, both glycoalkaloids deterred feeding, with chaconine being the more active compound. In combination, authentic solanine and chaconine interacted synergistically in their inhibition of feeding. The antifeedant activities of methanolic extracts of tuber peel of the potato varieties Majestic and Sharpe's Express presented via filter paper discs did not differ significantly from those of authentic glycoalkaloid solutions of comparable concentration and ratio. In contrast, feeding inhibition by diluted tuber peel extracts of the variety Homeguard was greater than that elicited by comparable authentic glycoalkaloid solutions suggesting additional inhibitory compound(s) in the peel of this variety. Comparison of data from peel extracts of all three potato varieties and authentic glycoalkaloids indicated that the level of feeding inhibition by the extracts was, at least in part, a consequence of a synergism between solanine and chaconine.

Personnel selection and the five-factor model: reexamining the effects of appplicant's frame of reference

Recently, 2 separate yet related criticisms have been levied against the adequacy of the five-factor model (or Big Five) as a descriptive taxonomy of job applicant personality: frame of reference effects (M. J. Schmit & A. M. Ryan, 1993) and socially desirable responding (A. F. Snell & M. A. McDaniel, 1998). Of interest, although both criticisms suggest that the five-factor model is inadequate, the frame of reference effects criticism suggests that the factor structure should be more complex, whereas socially desirable responding suggests that it should be less complex in job applicant contexts. The current research reports the results of a new study demonstrating the adequacy of the five-factor model as a descriptor of job applicant, job incumbent, and student personality. Implications for personality assessment and concurrent validation designs using personality measures are also discussed.

Is everyone in agreement? An exploration of within-group agreement in employee perceptions of the work environment

Multilevel researchers often gather individual-level data to measure group-level constructs. Within-group agreement is a key consideration in the measurement of such constructs, yet antecedents of within-group agreement have been little studied. The authors found that group member social interaction and work interdependence were significantly positively related to within-group agreement regarding perceptions of the work environment. Demographic heterogeneity was not significantly related to within-group agreement. Survey wording showed a complex relationship to agreement. Both evaluative items and socially undesirable items generated high within-group agreement. The use of a group rather than individual referent increased within-group agreement in response to descriptive items but decreased within-group agreement in response to evaluative items. Items with a group referent showed greater between-group variability than items with an individual referent.

Investigating the influence of social desirability on personality factor structure

This study provides a comprehensive investigation into whether social desirability alters the factor structure of personality measures. The study brought together 4 large data sets wherein different organizational samples responded to different personality measures. This facilitated conducting 4 separate yet parallel investigations. Within each data set, individuals identified through a social desirability scale as responding in an honest manner were grouped together, and individuals identified as responding in a highly socially desirable manner were grouped together. Using various analyses, the fit of higher order factor structure models was compared across the 2 groups. Results were the same for each data set. Social desirability had little influence on the higher order factor structures that characterized the relationships among the scales of the personality measures.

Diversity of hepatitis G virus within a single infected individual

The extent of population diversity among GB virus C (GBV-C)/hepatitis G virus (HGV) within a persistently infected individual (Iw) was investigated by sequence analysis of multiple clones generated from polymerase chain reaction (PCR)-amplified products of cDNA analogous to fragments of 5' non-coding region (5'NC), envelope region 1/2 (E1/E2) and non-structural region 3 (NS3) of viral genome. Although nucleotide substitutions were more common in coding regions than in the 5'NC region, there was no region corresponding to the hypervariable region of hepatitis C virus in the E1/E2 region. Transition substitution exceeded transversion by 7 to 12-fold, and 79.4% of substitutions were synonymous. This bias against substitutions producing amino acid replacements and the use of Pfu DNA polymerase with an error rate 10 times lower than the observed frequency of substitution, suggests that most substitutions were not artefactual. This data suggests that individual genomes of HGV within an infected individual may differ from each other at 0.23-0.84% nucleotide position and at 0.42-0.61% amino acid position.

Esophageal dilation for endosonographic evaluation of malignant esophageal strictures is safe and effective

OBJECTIVE

Endoscopic ultrasound (EUS) is accepted as the most accurate modality for T- and N-staging of esophageal cancer, but some malignant strictures prevent passage of the echoendoscope beyond the level of the tumor. This incomplete evaluation may decrease staging accuracy. Previous studies have yielded conflicting results regarding the safety and efficacy of esophageal dilation for EUS.

METHODS

We prospectively evaluated 267 consecutive patients undergoing EUS for esophageal carcinoma staging at our institution over a 66-month period to determine the number of patients requiring dilation for EUS examination, the success of dilation, safety of dilation, and clinical importance.

RESULTS

Among 267 endosonographic examinations of the esophagus, 81 (30.3%) required dilation to advance the echoendoscope beyond the level of the stricture. After dilation was performed, the echoendoscope could be passed through the stricture in 69 patients (85.2%), and in 63 of 67 of the patients dilated to > or = 14 mm (94.0%). No complications have occurred secondary to the dilations performed to permit completion of the endosonographic examination. Tumor staging by EUS after dilation was T2 (14.8%), T3 (56.8%), and T4 (21.0%), nodal staging N0 (14.6%) and N1 (75.3%); and M1 (9.9%).

CONCLUSIONS

We conclude that incremental, stepwise dilation of malignant strictures to 14 mm is safe and effective in permitting echoendoscope passage beyond the stenosis. The presence of a malignant stricture does not seem to diminish the utility of EUS staging of esophageal cancer.

A second outbreak of hepatitis C virus infection from anti-D immunoglobulin in Ireland

OBJECTIVE

To investigate the infectivity for hepatitis C virus (HCV) of intravenous anti-D immunoglobulin batches manufactured in Ireland between 1991 and 1994.

METHODS

Women who had received anti-D manufactured between 1991 and 1994 were screened for serological markers of HCV infection and for the presence of HCV RNA by RT-PCR amplification and virus genotyping.

RESULTS

44 women exposed to anti-D manufactured between 1991 and 1994 were polymerase chain reaction positive for HCV RNA, 19 of whom were infected with genotype 3a virus shown by phylogenetic analysis of the NS5B gene to be closely related to that from the single implicated donor.

CONCLUSIONS

Anti-D manufactured in 1991-1994 transmitted infection of HCV genotype 3a. The prevalence of HCV-specific antibody in anti-D recipients was relatively low (0.59%), consistent with the low level of virus RNA in these anti-D batches.

A self-directed home biofeedback system for women with symptoms of stress, urge, and mixed incontinence

PURPOSE

To evaluate a self-directed home biofeedback treatment system in a group of community dwelling, otherwise healthy women with symptoms of stress, urge, and mixed urinary incontinence (UI).

SETTING AND SUBJECTS

Fifty-five women, aged 25 to 81 years, participated in the study.

METHODS

Initial evaluation included a self-reported continence assessment, a 24-hour bladder and fluid habits diary, severity indices for stress and urge UI, and assessment of pelvic floor strength using a pneumatic biofeedback device. Subjects completed a 16-week self-directed program. Assessment and severity index data were self-reported using a continence assessment form, a 24-hour bladder habit and fluid form, and stress and urge incontinence severity indices. Strength level of the trainer, number of digital bands lit on the screen during contraction, number of sessions, and program (starter, intermediate, advanced, or maintenance) were recorded on data sheets.

INSTRUMENTS

The treatment system includes an 8-minute educational and motivational video; a journal for education, instructions, and daily documentation forms; and a home biofeedback trainer with pneumatic vaginal sensors that displays the strength of pelvic muscle contraction.

RESULTS

Forty-four women completed the 16-week program. At the end of treatment, 19 (43%) were dry and 16 (36%) reported 50% or more improvement in number of leaks per day, number of voids per day, or both. Women with stress leakage experienced a significant reduction in the number of incontinent episodes per day and the mean severity index of incontinence (P < .001). Participants with urge UI experienced a significant reduction in the mean number of voids per day and mean severity index for UI (P < .001). Younger subjects were more likely to improve when compared with older participants, but no significant differences were found when comparing women who take estrogen with those who do not take estrogen or when comparing those with a history of bladder surgery with those who had no previous surgery.

CONCLUSIONS

These data suggest that self-selected healthy women with symptoms of urge, stress, and mixed incontinence can improve their symptoms and lower their severity index with a minimal intervention, comprehensive, self-directed home biofeedback continence system.

Surface geometric analysis of anatomic structures using biquintic finite element interpolation

The surface geometry of anatomic structures can have a direct impact upon their mechanical behavior in health and disease. Thus, mechanical analysis requires the accurate quantification of three-dimensional in vivo surface geometry. We present a fully generalized surface fitting method for surface geometric analysis that uses finite element based hermite biquintic polynomial interpolation functions. The method generates a contiguous surface of C2 continuity, allowing computation of the finite strain and curvature tensors over the entire surface with respect to a single in-surface coordinate system. The Sobolev norm, which restricts element length and curvature, was utilized to stabilize the interpolating polynomial at boundaries and in regions of sparse data. A major advantage of the current method is its ability to fully quantify surface deformation from an unstructured grid of data points using a single interpolation scheme. The method was validated by computing both the principal curvature distributions for phantoms of known curvatures and the principal stretch and principal change of curvature distributions for a synthetic spherical patch warping into an ellipsoidal shape. To demonstrate the applicability to biomedical problems, the method was applied to quantify surface curvatures of an abdominal aortic aneurysm and the principal strains and change of curvatures of a deforming bioprosthetic heart valve leaflet. The method proved accurate for the computation of surface curvatures, as well as for strains and curvature change for a surface undergoing large deformations.

The effect of leg extension training on the mean power frequency of the mechanomyographic signal

The purpose of the present investigation was to examine the effect of concentric isokinetic leg extension training on the mean power frequency (MPF) of the mechanomyographic (MMG) signal. Twenty-one men were assigned into a training (TRN; n = 12) or control (CTL; n = 9) group. The TRN group performed six sets of leg extensions 3 days per week for 12 weeks at a velocity of 90 degrees /s. All subjects were tested every 4 weeks for peak torque (PT), while MMG was recorded from the vastus lateralis. PT increased, but there was no significant (P > 0.05) change in the MMG MPF over the 12-week training period. These results indicate that MMG MPF, measured from the vastus lateralis, was not sensitive to training-induced increases in leg-extension strength, possibly due to competing influences of hypertrophy on the MMG signal and/or training-induced adaptations in muscles other than the vastus lateralis.

Functional motor unit failure precedes neuromuscular degeneration in canine motor neuron disease

Hereditary canine spinal muscular atrophy (HCSMA) features rapidly progressive muscle weakness that affects muscles in an apparent proximal-to-distal gradient. In the medial gastrocnemius (MG) muscle of homozygous HCSMA animals, motor unit tetanic failure is apparent before the appearance of muscle weakness and appears to be presynaptic in origin. We determined whether structural changes in neuromuscular junctions or muscle fibers were apparent at times when tetanic failure is prevalent. We were surprised to observe that, at ages when motor unit tetanic failure is common, the structure of neuromuscular junctions and the appearance of muscle fibers in the MG muscle were indistinguishable from those of symptom-free animals. In contrast, in more proximal muscles, many neuromuscular junctions were disassembled, with some postsynaptic specializations only partially occupied by motor nerve terminals, and muscle fiber atrophy and degeneration were also apparent. These observations suggest that the motor unit tetanic failure observed in the MG muscle in homozygous animals is not due to synaptic degeneration or to pathological processes that affect muscle fibers directly. Together with previous physiological analyses, our results suggest that motor unit failure is due to failure of neuromuscular synaptic transmission that precedes nerve or muscle degeneration.

Low-dose continuous-infusion ceftazidime monotherapy in low-risk febrile neutropenic patients

One hundred and thirty-five cancer patients admitted with low-risk neutropenic fever received a low-dose schedule of ceftazidime as infusional monotherapy over a total of 180 episodes. Ceftazidime was administered as a 1-g bolus followed by a continuous infusion of 2 g per day. In this patient population the ceftazidime was both practical and well tolerated. Sixty-eight percent of patients responded with clinical improvement and complete resolution of fever within 48 h. Overall, 95% of patients responded, although 18% subsequently required antibiotic modification for persistent fever. Only 5% of episodes were considered failures due to clinical deterioration, and over the study period there was only 1 fatality due to respiratory failure. The median duration of hospitalisation was only 4 days (2-20). In conclusion, monotherapy with low-dose infusional ceftazidime appears safe and highly effective in this low-risk population of neutropenic patients and may reduce antibiotic costs appreciably.

Phylogenetic analysis of GBV-C/hepatitis G virus

Comparison of 33 epidemiologically distinct GBV-C/hepatitis G virus complete genome sequences suggests the existence of four major phylogenetic groupings that are equally divergent from the chimpanzee isolate GBV-C(tro) and have distinct geographical distributions. These four groupings are not consistently reproduced by analysis of the virus 5'-noncoding region (5'-NCR), or of individual genes or subgenomic fragments with the exception of the E2 gene as a whole or of 200-600 nucleotide fragments from its 3' half. This region is upstream of a proposed anti-sense reading frame and contains conserved potential RNA secondary structures that may be capable of directing the internal initiation of translation. Phylogenetic analysis of this region from certain South African isolates is consistent with previous analysis of the 5'-NCR suggesting that these belong to a fifth group. The geographical distribution of virus variants is consistent with a long evolutionary history that may parallel that of pre-historic human migrations, implying that the long-term evolution of this RNA virus is extremely slow.

Hepatocyte growth factor is elevated in chronic lung injury and inhibits surfactant metabolism

Adult respiratory distress syndrome may incorporate in its pathogenesis the hyperplastic proliferation of alveolar epithelial type II cells and derangement in synthesis of pulmonary surfactant. Previous studies have demonstrated that hepatocyte growth factor (HGF) in the presence of serum is a potential mitogen for adult type II cells (R. J. Panos, J. S. Rubin, S. A. Aaronson, and R. J. Mason. J. Clin. Invest. 92: 969-977, 1993) and that it is produced by fetal mesenchymal lung cells (J. S. Rubin, A. M.-L. Chan, D. P. Botarro, W. H. Burgess, W. G. Taylor, A. C. Cech, D. W. Hirschfield, J. Wong, T. Miki, P. W. Finch, and S. A. Aaronson. Proc. Natl. Acad. Sci. USA 88: 415-419, 1991). In these studies, we expand on this possible involvement of HGF in chronic lung injury by showing the following. First, normal adult lung fibroblasts transcribe only small amounts of HGF mRNA, but the steady-state levels of this message rise substantially in lung fibroblasts obtained from animals exposed to oxidative stress. Second, inflammatory cytokines produced early in the injury stimulate the transcription of HGF in isolated fibroblasts, providing a plausible mechanism for the increased amounts of HGF seen in vivo. Third, HGF is capable of significantly inhibiting the synthesis and secretion of the phosphatidylcholines of pulmonary surfactant. Fourth, HGF inhibits the rate-limiting enzyme in de novo phosphatidylcholine synthesis, CTP:choline-phosphate cytidylyltransferase (EC 2.7.7.15). Our data indicate that fibroblast-derived HGF could be partially responsible for the changes in surfactant dysfunction seen in adult respiratory distress syndrome, including the decreases seen in surfactant phosphatidylcholines.

The effects of leg angular velocity on mean power frequency and amplitude of the mechanomyographic signal

The purpose of the present investigation was to examine the effects of leg angular velocity on the mean power frequency (MPF) and amplitude of the mechanomyographic (MMG) signal during maximal concentric (CON) isokinetic muscle actions. Sixteen adult subjects performed maximal CON leg extensions on a calibrated Cybex 6000 dynamometer at leg angular velocities of 60 and 300 degrees.s-1. MMG was detected by a piezoelectric crystal contact sensor placed over the mid-portion of the vastus lateralis muscle. The results indicated a significant (p < 0.05) velocity-related decrease in peak torque (PT) and increase in MMG amplitude from 60 to 300 degrees.s-1. There was, however, no velocity-related change (p > 0.05) in MMG MPF. These findings did not support our hypothesis that increases across velocity in MMG amplitude were due to decreases in muscle stiffness as a result of a shift in the contribution of slow and fast-twitch muscle fibers to PT production. Future research should examine the potential influence of actin-myosin cycling rate as well as limb movement on the MPF and amplitude of the MMG signal.