Central Sleep Apnea in Adults: Diagnosis and Treatment

Background

While the literature has demonstrated a higher prevalence of moderate-to-severe obstructive sleep apnea (OSA) in the general population compared with central sleep apnea (CSA), more evidence is needed on the long-term clinical impact of and optimal treatment strategies for CSA.

Observations

CSA is overrepresented among certain clinical populations, such as those with heart failure, stroke, neuromuscular disorders, and opioid use. The clinical concerns with CSA parallel those of OSA. The absence of respiration (apneas and hypopneas due to lack of effort) results in sympathetic surge, compromise of oxygenation and ventilation, sleep fragmentation, and elevation in blood pressure. Symptoms such as excessive daytime sleepiness, morning headaches, witnessed apneas, and nocturnal arrhythmias are shared between the 2 disorders. A systematic clinical approach should be used to identify and treat CSA.

Conclusions

The purpose of this review is to familiarize the primary care community with CSA to aid in the identification and management of this breathing disturbance.

Operation Blood Rain Phase 2: Evaluating the Effect of Airdrop on Fresh and Stored Whole Blood

BACKGROUND

Transfusion of whole blood (WB) is a lifesaving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting WB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient WB at the point of injury to treat critically wounded patients or multiple hemorrhaging casualties. This study is a follow-up to the proof-of-concept study on the effect of airdrop on WB. In addition, this study confirms the statistical significance for the plausibility of using airdrop to deliver WB to combat medics treating casualties in the pre-hospital setting when Food and Drug Administration (FDA)-approved cold-stored blood products are not available.

METHODS

Forty-eight units of WB were collected and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a Standard Airdrop Training Bundle (SATB) parachute or 68-in pilot chute. Twenty-four of these units were dropped from a C-145 aircraft, and 24 were dropped from a C-130 aircraft. A control group of 15 units of WB was storedin a blood cooler that was not dropped. Baseline and post-intervention laboratory tests were measured in both airdroppedand control units, including complete blood count; prothrombin time/partial thromboplastin time (PT/PTT); pH, lactate,potassium, bilirubin, glucose, fibrinogen, and lactate dehydrogenase (LDH) levels; and peripheral blood smears.

RESULTS

The blood cooler, cooling packs, and all 48 WB units did notsustain any major damage from the airdrop. There was noevidence of hemolysis. Except for the one slightly damagedbag that was not sampled, all airdropped blood met parameters for transfusion per the Joint Trauma System Whole BloodTransfusion Clinical Practice Guideline and the Associationfor the Advancement of Blood and Biotherapies (AABB) Circular of Information for the Use of Human Blood and BloodComponents.

CONCLUSIONS

Airdrop of fresh or stored WB in ablood cooler with a chute is a viable way of delivering bloodproducts to combat medics treating hemorrhaging patientsin the pre-hospital setting. This study also demonstrated theportability of this technique for multiple aircraft. The techniques evaluated in this study have the potential for utilizationin other austere settings such as wilderness medicine or humanitarian disasters where an acute need for WB delivery by airdrop is the only option.

A simplified Barbervax® vaccination regimen in lambs to evoke immunological protection to Haemonchus contortus

This study assessed the feasibility of altering the pre-weaning vaccination schedule of the commercially available Barbervax® vaccine directed against Haemonchus contortus, to avoid the 2nd priming vaccination which typically falls between lamb marking and weaning. Merino lambs (n = 175) born to maiden ewes, located in the Northern Tablelands, New South Wales, were randomly allocated to treatment groups (n = 35) and subjected to five different vaccination regimes. One group remained as unvaccinated controls and another had the full set of three priming doses. The other three groups were vaccinated only at marking and weaning receiving a double dose of vaccine at marking and/or weaning. The hypothesis tested was that reducing the interval between lamb marking and weaning to 6 weeks, and providing a double dose of vaccine at marking, weaning or both would remove the need for the second priming vaccination between lamb marking and weaning. This priming vaccination in the vaccination protocol necessitates an additional mustering of ewes with young lambs at foot and is a time consuming and costly exercise which increases the risk of mis-mothering. Blood and faecal samples were collected at frequent intervals for worm egg count (WEC), larval differentiation and H. contortus vaccine specific ELISA antibody analysis. Overall, the results supported the hypothesis, and it was found that antibody titres and WEC reductions equivalent to the registered vaccine regimen were achieved by the alternative regimens. This finding requires further investigation under a wider range of conditions. Deviation from the registered vaccination protocol would constitute off-label usage, and at this time and until further evaluations are done these deviations are not recommended.

Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature

STUDY DESIGN

Literature review.

OBJECTIVES

Posterior cervical interfacet cages are an alternative to lateral mass fixation in patients undergoing cervical spine surgery. Recently, a percutaneous, tissue-sparing system for interfacet cage placement has been developed, however, there is limited clinical evidence supporting its widespread use. The aim was to review studies published on this system for patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications.

METHODS

Four electronic databases (PubMed, EMBASE, Scopus, and MEDLINE) were queried for original published studies that evaluated the percutaneous, tissue-sparing technique for posterior cervical fusion with interfacet cage placement. All studies reporting on open techniques and purely biomechanical studies were excluded.

RESULTS

The extensive literature search returned 7852 studies. After systematic review, a total of 7 studies met inclusion criteria. Studies were independently classified as retrospective or prospective cohort studies and each assessed by the GRADE criteria. Patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications were extracted from each study and presented.

CONCLUSIONS

Tissue-sparing, posterior cervical fusion with interfacet cages may be considered a safe and effective surgical intervention in patients failing conservative management for cervical spondylotic disease. However, the quality of evidence in the literature is lacking, and controlled, comparative studies are needed for definitive assessment.

Eye-Related Emergency Department Visits and The Opioid Epidemic: a 10-Year Analysis

PURPOSE

To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US).

METHODS

This retrospective cross-sectional study used National ED Sample (NEDS) (2006-2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers.

RESULTS

An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50-32.87]).

CONCLUSIONS

In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden.

Minimally invasive lateral approaches for the treatment of spinal tumors: single-position surgery without the "flip"

Although primary tumors of the spine and neural elements are rare, metastatic disease to the spine is quite common. Traditionally, surgical treatment for spinal tumor patients involves open decompression with or without stabilization. The single-position minimally invasive (MIS) lateral approach, which has been recently described over the recent decade, allows simultaneous access to the anterior and posterior columns with the patient positioned in the lateral decubitus position. Herein, we review the application of single-position MIS lateral surgery for the treatment of spinal neoplasm. The aim was to review the evolution, operative technique, outcomes, and complications associated with MIS lateral approaches for spinal tumors. The history of spinal tumor diagnosis and management are reviewed and discussed as well as the author's experience and literature regarding spinal tumor treatment outcome and surgical complications, with particular attention to single-position, MIS lateral approaches. In addition, the author's surgical technique is outlined in detail for thoracic, thoracolumbar and lumbar tumors. Furthermore, there are specific indications and complications associated with the surgical treatment of spinal tumors, and the MIS, single-position lateral approach, when applied appropriately, allows for concurrent access to the anterior and posterior column while mitigating the complications associated with traditional, open posterior-based approaches. In the treatment of spinal neoplasms, the goals of surgery are dictated by a number of tumor-specific and patient-specific factors. Therefore, operative treatment of tumors in the future may be a consolidation of historical surgical techniques and MIS, single-position lateral approaches. Regardless, multidisciplinary management is imperative for the individualized treatment of the patient and optimization of outcome.

Minimally invasive surgery for thoracolumbar spinal trauma

The indications for operative intervention after thoracolumbar spine trauma have been well described. Advances in minimally invasive techniques, including percutaneous pedicle screw fixation and mini-open anterolateral retractor-based approaches can improve surgical outcomes when appropriately applied by reducing blood loss, operative duration and post-operative pain. Moreover, they allow for theoretical advantages by preservation of muscular and skeletal blood supply and innervation that is typically lost during the muscular dissection of open approaches. For thoracolumbar spine fractures, percutaneous fixation allows for internal bracing of unstable fractures during healing while maintaining sagittal alignment. In instances of neurological compromise from fracture retropulsion, corpectomies may be required, and mini-open lateral approaches adopted from degenerative disease applications allow for a minimally invasive manner to treat the defect. These further allow for placement of wide rectangular-footprint expandable vertebral body replacement devices to provide anterior column support. We believe this allows for lower rates of subsidence and helps to maintain the biomechanical integrity necessary to prevent post-traumatic malalignment and kyphosis. Together, these minimally invasive techniques combined supply the spine surgeon with a minimally invasive armamentarium to treat nearly all thoracolumbar spine trauma. Surgeons should be comfortable with the strengths and shortcomings of these approaches in order to successfully apply them for this pathology.

Perioperative complications in patients treated with posterior cervical fusion and bilateral cages

Context:

Posterior cervical cages have recently become available as an alternative to lateral mass fixation in patients undergoing cervical spine surgery.

Aims:

The purpose of this study was to quantify the perioperative complications associated with cervical decompression and fusion in patients treated with a posterior cervical fusion (PCF) and bilateral cages.

Settings and Design:

A retrospective, multicenter review of prospectively collected data was performed at 11 US centers.

Subjects and Methods:

The charts of 89 consecutive patients with cervical radiculopathy treated surgically at one level with PCF and cages were reviewed. Three cohorts of patients were included standalone primary PCF with cages, circumferential surgery, and patients with postanterior cervical discectomy and fusion pseudarthrosis. Follow-up evaluation included clinical status and pain scale (visual analog scale).

Statistical Analysis Used:

The Wilcoxon test was used to test the differences for the data. The P level of 0.05 was considered significant.

Results:

The mean follow-up interval was 7 months (range: 62 weeks - 2 years). The overall postsurgery complication rate was 4.3%. There were two patients with neurological complications (C5 palsy, spinal cord irritation). Two patients had postoperative complications after discharge including one with atrial fibrillation and one with a parietal stroke. After accounting for relatedness to the PCF, the overall complication rate was 3.4%. The average (median) hospital stay for all three groups was 29 h.

Conclusions:

The results of our study show that PCF with cages can be considered a safe alternative for patients undergoing cervical spine surgery. The procedure has a favorable overall complication profile, short length of stay, and negligible blood loss.

The Topology of Autonomy

Policy debates are still too polarized between those who expect too much of ‘indigenous autonomy’ and those who expect too little. This article examines the local meaning of, and proposals toward, self-determination in a Totonac coffee-growing population in the Sierra Norte de Puebla, Mexico. The article argues for the complexity and context-dependency of ‘autonomy’. Several factors shape visions of autonomy/self-determination in the Sierra. First, the Zapatistas in Chiapas have inspired Totonac organizations toward antiglobalization discourses and new approaches to relations among culture, cosmology and agriculture. But, second, the inertia built up over three decades of state-assisted coffee production keeps development thinking trained on a major, if crisis-ridden, global market. Third, resource deterioration renders doubtful any full conversion to the ‘traditional’ subsistence farming called for by some Totonac rights organizations. Autonomy initiatives emerging in the Sierra are uneasy combinations of ethnic-purist, market-led and state-sponsored development models. The article suggests that in regions marked by global markets, state intervention and serious environmental constraints, ‘selfdetermination’ is about local design and control of heterogeneous, worldworthy economies.

Outpatient Minimally Invasive Lumbar Interbody: Fusion Predictive Factors and Clinical Results

STUDY DESIGN

Retrospective review of data from a prospective patient outcomes registry.

OBJECTIVE

The object of this work was to examine patient and surgical predictors of early postoperative discharge and test the predictive model against two clinical series of outpatient minimally invasive lumbar fusion patients.

SUMMARY OF BACKGROUND DATA

Outpatient and ambulatory surgery centers are regularly utilized for procedures with low-risk profiles and minimal need for extended postoperative observation, but little has been reported in lumbar spinal fusion producers.

METHODS

Two analyses were undertaken, an examination of patient characteristics to determine predictors of early (<24 hours) postoperative discharge and then clinical examinations of patients treated with lumbar fusion at an ambulatory surgery center. For the predictive arm of the study, 1033 patients treated with minimally invasive (MIS) lateral interbody fusion (XLIF) were grouped according to length of postoperative hospitalization with 873 patients discharged <24 hours (outpatients), and 160 discharged >23 hours after surgery (inpatients). For the clinical studies, 54 consecutive XLIF and 18 consecutive MIS posterior fusion patients were treated at an ambulatory surgery center with demographic, treatment, and complication data collected.

RESULTS

From the predictive study, the strongest baseline predictors of early postoperative discharge were a less advanced diagnosis (non-deformity), younger age, elevated baseline hemoglobin levels, and lower body mass index. The most predictive treatment variables that predicted early postoperative discharge were fewer number of levels treated and elevated postoperative hemoglobin levels.In the clinical series, outpatient surgeries were performed in younger patients (50.6 and 53.2 yr), at relatively few levels (96% of cases were at one or two levels), for simple degenerative disease. No intraoperative and few postoperatives complications were seen in either XLIF or MIS posterior fusions performed in ambulatory settings with no emergent transfers to inpatient facilities.

CONCLUSION

Select patients, by health and indication, can safely be treated as outpatients with XLIF or other modern MIS approaches. Being younger, having elevated preoperative hemoglobin levels, fewer levels being treated, for less advanced disease may predict early postoperative discharge.

LEVEL OF EVIDENCE

3.

Lumbar total disc replacement by less invasive lateral approach: a report of results from two centers in the US IDE clinical trial of the XL TDR® device

PURPOSE

To evaluate the clinical and radiographic outcomes following total disc arthroplasty using the XL TDR(®) Lumbar Disc in the treatment of patients with symptomatic degenerative disc disease at one level between L1-2 and L4-5.

METHODS

Data were compiled from two centers participating in a prospective, multi-center Food and Drug Administration-approved investigational device exemption clinical trial enrolling patients with single-level lumbar degenerative disc disease unresponsive to non-operative treatment. Longitudinal outcomes were evaluated through 3-year follow-up and included patient-reported pain, function, and general health, as well as radiographic measures such as maintenance of disc height and range of motion.

RESULTS

The two-center cohort included 64 treated patients, 42 % female, averaging 45.3 years of age (range 26-67). The majority of procedures were performed at the L4-5 level (75 %), uncomplicated, with minimal blood loss (88 % 0-50 cc), and in an outpatient setting (93.8 %). Postoperative events included 10 patients (15.6 %) with new hip flexion weakness, 7 (10.9 %) with new lower extremity weakness, and 10 (15.6 %) with new lower extremity sensory deficits, all resolved by 3 months in all but two patients whose deficits were prolonged but eventually resolved. Average disc height increased postoperatively from 7.2 to 12.1 mm (69 %), and was 10.7 mm (49 % increase from preoperative) at 3 years. Flexion/extension range of motion averaged 5.9° (SD 4.8°) at 3 years, and was not statistically different from preoperative (p = 0.471). Heterotopic ossification interfering with segmental motion was noted in 3 patients (10.3 %) at 3 years, none ankylosed (Grade IV). Postoperative improvement in patient-reported outcomes was significant (p < 0.01 for all measures) and maintained through 3-year follow-up. Satisfaction with results was reported by 85 % (51/60) of patients at 2 years and 93 % (28/30) at 3 years. There were no revisions through 3 years postoperative.

CONCLUSIONS

The results following XL TDR show good clinical and radiographic outcomes out to 3 years postoperative, with clinically significant improvements in pain, function, and general health, few complications, and high patient satisfaction.

Complications of the mini-open anterolateral approach to the thoracolumbar spine

The mini-open anterolateral approach to the thoracolumbar spine is gaining popularity as a minimally-invasive alternative to traditional open thoracolumbar approaches. Published studies reporting and discussing the complications associated with this minimally invasive approach, however, are limited. We performed a retrospective review of patients undergoing the mini-open lateral approach to the thoracolumbar spine for corpectomy/fusion. Intraoperative and postoperative complications are reported and analyzed. Eighty consecutive patients underwent the mini-open lateral approach with corpectomy and fusion for trauma (71%), tumor (26%) and infection (3%). Total complication rate was 12.5% (dural tear 2.5%, intercostal neuralgia 2.5%, deep vein thrombosis 2.5%, pleural effusion 1.3%, wound infection 1.3%, hardware failure 1.3%, hemothorax 1.3%). Two patients needed a re-operation to address the complication (hardware failure, hemothorax). There were no postoperative neurological complications. The mini-open anterolateral approach to the thoracolumbar spine is an appealing alternative to the traditional open approaches. This technique, however, is technically demanding and requires proficiency in the use of minimally invasive spinal surgery instruments and retractors.

Dispersal of invasive forest insects via recreational firewood: a quantitative analysis

Recreational travel is a recognized vector for the spread of invasive species in North America. However, there has been little quantitative analysis of the risks posed by such travel and the associated transport of firewood. In this study, we analyzed the risk of forest insect spread with firewood and estimated related dispersal parameters for application in geographically explicit invasion models. Our primary data source was the U.S. National Recreation Reservation Service database, which records camper reservations at > 2,500 locations nationwide. For > 7 million individual reservations made between 2004 and 2009 (including visits from Canada), we calculated the distance between visitor home address and campground location. We constructed an empirical dispersal kernel (i.e., the probability distribution of the travel distances) from these "origin-destination" data, and then fitted the data with various theoretical distributions. We found the data to be strongly leptokurtic (fat-tailed) and fairly well fit by the unbounded Johnson and lognormal distributions. Most campers ( approximately 53%) traveled <100 km, but approximately 10% traveled > 500 km (and as far as 5,500 km). Additionally, we examined the impact of geographic region, specific destinations (major national parks), and specific origin locations (major cities) on the shape of the dispersal kernel, and found that mixture distributions (i.e., theoretical distribution functions composed of multiple univariate distributions) may fit better in some circumstances. Although only a limited amount of all transported firewood is likely to be infested by forest insects, this still represents a considerable increase in dispersal potential beyond the insects' natural spread capabilities.

Streptococcus pyogenes infection of tonsil explants is associated with a human β-defensin 1 response from control but not recurrent acute tonsillitis patients

Host defence peptides (HDP), including the defensins and hCAP-18, function as part of the innate immune defences, protecting the host epithelia from microbial attachment and invasion. Recurrent acute tonsillitis (RAT), in which patients suffer repeated symptomatic tonsil infections, is linked to Streptococcus pyogenes, a group A streptococcus, and may reflect the impaired expression of such peptides. To address this, the defensin and hCAP-18 messenger RNA expression profiles of 54 tonsils excised from control and RAT patients undergoing tonsillectomy were quantified and compared. Marked variation in expression was observed between individuals from the two groups, but statistically no significant differences were identified, suggesting that at the time of surgery the tonsil epithelial HDP barrier was not compromised in RAT subjects. Surgical removal of the tonsils occurs in a quiescent phase of disease, and so to assess the effects of an active bacterial infection, HaCaT cells an in vitro model of the tonsil epithelium, and explants of patient tonsils maintained in vitro were challenged with S. pyogenes. The HaCaT data supported the reduced expression of hCAP-18/LL-37, human β-defensin 1 (HBD1;P < 0.01) and HBD2 (P < 0.05), consistent with decreased protection of the epithelial barrier. The tonsil explant data, although not as definitive, showed similar trends apart from HBD1 expression, which in the control tonsils but not the RAT patient tonsils was characterized by increased expression (P < 0.01). These data suggest that in vivo HBD1 may play a critical role in protecting the tonsil epithelia from S. pyogenes.

Attempts to immunize sheep against Teladorsagia circumcincta using fourth-stage larval extracts

A ConcanavilinA (ConA)-binding fraction of a detergent-soluble membrane extract from Teladorsagia circumcincta (formerly Ostertagia circumcincta) fourth-stage larvae was isolated, and two vaccine trials were conducted with this preparation in groups of 7 worm-free sheep. All groups were challenged with a total of 5000 T. circumcincta larvae from 1 week after the final immunization and protection assessed by comparing the egg and worm counts, and length of developing worms, of the immunized groups with their respective controls. Immunization with the ConA-binding antigen induced high-titre serum antibody responses in both trials. However, no significant reduction in either egg count or worm burdens was observed in the vaccinated groups in either trial. It was concluded that detergent-soluble, ConA-binding extracts prepared from T. circumcincta fourth-stage larvae did not contain significantly protective antigens, despite the fact that an extract prepared in a similar manner from Ostertagia ostertagi had previously significantly protected calves against homologous challenge.

Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicenter clinical experience

OBJECT

Symptomatic herniated thoracic discs remain a surgical challenge and historically have been associated with significant complications. While neurological outcomes have improved with the abandonment of decompressive laminectomy, the attempt to minimize surgical complications and associated morbidities continues through less invasive approaches. Many of these techniques, such as thoracoscopy, have not been widely adopted due to technical difficulties. The current study was performed to examine the safety and early results of a minimally invasive lateral approach for symptomatic thoracic herniated intervertebral discs.

METHODS

Sixty patients from 5 institutions were treated using a mini-open lateral approach for 75 symptomatic thoracic herniated discs with or without calcification. The mean age was 57.9 years (range 23-80 years), and 53.3% of the patients were male. Treatment levels ranged from T4-5 to T11-12, with 1-3 levels being treated (mean 1.3 levels). The most common levels treated were T11-12 (14 cases [18.7%]), T7-8 (12 cases [16%]), and T8-9 (12 cases [16%]). Symptoms included myelopathy in 70% of cases, radiculopathy in 51.7%, axial back pain in 76.7%, and bladder and/or bowel dysfunction in 26.7%. Instrumentation included an interbody spacer in all but 6 cases (10%). Supplemental internal fixation included anterolateral plating in 33.3% of cases and pedicle screws in 10%; there was no supplemental internal fixation in 56.7% of cases. Follow-up ranged from 0.5 to 24 months (mean 11.0 months).

RESULTS

The median operating time, estimated blood loss, and length of stay were 182 minutes, 290 ml, and 5.0 days, respectively. Four major complications occurred (6.7%): pneumonia in 1 patient (1.7%); extrapleural free air in 1 patient (1.7%), treated with chest tube placement; new lower-extremity weakness in 1 patient (1.7%); and wound infection in posterior instrumentation in 1 patient (1.7%). Reoperations occurred in 3 cases (5%): one for posterior reexploration, one for infection in posterior instrumentation, and one for removal of symptomatic residual disc material. Back pain, measured using the visual analog scale, improved 60% from the preoperative score to the last follow-up, that is, from 7.8 to 3.1. Excellent or good overall outcomes were achieved in 80% of the patients, a fair or unchanged outcome resulted in 15%, and a poor outcome occurred in 5%. Moreover, myelopathy, radiculopathy, axial back pain, and bladder and/or bowel dysfunction improved in 83.3%, 87.0%, 91.1%, and 87.5% of cases, respectively.

CONCLUSIONS

The authors' early experience with a large multicenter series suggested that the minimally invasive lateral approach is a safe, reproducible, and efficacious procedure for achieving adequate decompression in thoracic disc herniations in a less invasive manner than conventional surgical techniques and without the use of endoscopes. Symptom resolution was achieved at similar rates using this approach as compared with the most efficacious techniques in the literature, and with fewer complications in most circumstances.

Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion

Object

The minimally invasive lateral transpsoas approach for interbody fusion has been increasingly employed to treat various spinal pathological entities. Gaining access to the retroperitoneal space and traversing the abdominal wall poses a risk of injury to the major nervous structures. Nerve injury of the abdominal wall can potentially lead to paresis of the abdominal musculature and bulging of the abdominal wall. Abdominal wall nerve injury resulting from the minimally invasive lateral retroperitoneal transpsoas approach has not been previously reported. The authors describe a case series of patients presenting with paresis and bulging of the abdominal wall after undergoing a minimally invasive lateral retroperitoneal approach.

Methods

The authors retrospectively reviewed all patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion and in whom development of abdominal paresis developed; the patients were treated at 4 institutions between 2006 and 2010. All data were recorded including demographics, diagnosis, operative procedure, positioning, hospital course, follow-up, and complications. The onset, as well as resolution of the abdominal paresis, was reviewed.

Results

The authors identified 10 consecutive patients in whom abdominal paresis developed after minimally invasive lateral transpsoas spine surgery out of a total of 568 patients. Twenty-nine interbody levels were fused (range 1–4 levels/patient). There were 4 men and 6 women whose mean age was 54.1 years (range 37–66 years). All patients presented with abdominal paresis 2–6 weeks postoperatively. In 8 of the 10 patients, abdominal wall paresis had resolved by the 6-month follow-up visit. Two patients only had 1 and 4 months of follow-up. No long-term sequelae were identified.

Conclusions

Abdominal wall paresis is a rare but known potential complication of abdominal surgery. The authors report the first case series associated with the minimally invasive lateral transpsoas approach.

Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach

STUDY DESIGN

Prospective registry.

OBJECTIVE

The objective of this study is to examine procedural and long-term outcomes of a mini-open, lateral approach for tumor removal in the thoracic spine.

SUMMARY OF BACKGROUND DATA

The majority of spinal tumors present as metastatic tumors in the thoracic spine. Conventional surgical treatments have been associated with high rates of approach-related morbidities as well as difficult working windows for complete tumor excision. Recent advances in minimally invasive techniques, particularly mini-open (minimally invasive, not endoscopic) approaches, help to reduce the morbidities of conventional procedures with comparable outcomes.

METHODS

Twenty-one consecutively treated patients at 2 institutions were treated between 2007 and 2009. Treatment variables, including operating time, estimated blood loss, length of hospital stay, and complications were collected, as were outcome measures, including the visual analog scale for pain and the Oswestry disability index.

RESULTS

Twenty-one patients with thoracic spinal tumors were successfully treated with a minimally invasive lateral approach. Operating time, estimated blood loss, and length of hospital stay were 117 minutes, 291 mL, and 2.9 days, respectively. One (4.8%) perioperative complication occurred (pneumonia). Mean follow-up was 21 months. Two patients had residual tumor at last follow-up. Two patients died during the study as the result of other metastases (spine tumor was secondary). Visual analog scale improved from 7.7 to 2.9 and Oswestry disability index improved from 52.7% to 24.9% from preoperative to the last follow-up.

CONCLUSION

The mini-open lateral approach described here can be performed safely and without many of the morbidities and difficulties associated with conventional and endoscopic procedures. Proper training in minimally invasive techniques and the use of direct-visualization minimally invasive retractors are required to safely and reproducibly treat these complex indications.

Protective immunization of calves against Ostertagia ostertagi using fourth stage larval extracts

ConA lectin was used to isolate glycoproteins from detergent extracts of fourth stage Ostertagia ostertagi larvae. This preparation contained proteins additional to those observed in a similar fraction prepared from adult O. ostertagi. Two vaccine trials were conducted with this preparation, and sub-fractions thereof, in groups of 6-8 worm-free calves. All groups were challenged with 50,000 O. ostertagi larvae 1 week after the final immunization, and protection was assessed by comparing the egg and worm counts of the immunized groups with their respective controls. Immunization with the ConA-binding antigen or its sub-fractions induced high titre serum antibody responses. In the first trial, the cumulative egg count of the group immunized with unfractionated antigen was 60% lower than the corresponding control value, and worm counts were 47% lower. In the second trial, the cumulative egg counts of the vaccinated groups ranged from 70% to 85% lower than the corresponding controls, with worm counts up to 64% lower. It was concluded that detergent-soluble, ConA-binding extracts prepared from O. ostertagi fourth stage larvae contained protective immunogens that were as effective as the best antigens published for O. ostertagi to date.

Detection capacity, information gaps and the design of surveillance programs for invasive forest pests

Integrated pest risk maps and their underlying assessments provide broad guidance for establishing surveillance programs for invasive species, but they rarely account for knowledge gaps regarding the pest of interest or how these can be reduced. In this study we demonstrate how the somewhat competing notions of robustness to uncertainty and potential knowledge gains could be used in prioritizing large-scale surveillance activities. We illustrate this approach with the example of an invasive pest recently detected in North America, Sirex noctilio Fabricius. First, we formulate existing knowledge about the pest into a stochastic model and use the model to estimate the expected utility of surveillance efforts across the landscape. The expected utility accounts for the distribution, abundance and susceptibility of the host resource as well as the value of timely S. noctilio detections. Next, we make use of the info-gap decision theory framework to explore two alternative pest surveillance strategies. The first strategy aims for timely, certain detections and attempts to maximize the robustness to uncertainty about S. noctilio behavior; the second strategy aims to maximize the potential knowledge gain about the pest via unanticipated (i.e., opportune) detections. The results include a set of spatial outputs for each strategy that can be used independently to prioritize surveillance efforts. However, we demonstrate an alternative approach in which these outputs are combined via the Pareto ranking technique into a single priority map that outlines the survey regions with the best trade-offs between both surveillance strategies.

Attempts to immunize sheep against Haemonchus contortus using a cocktail of recombinant proteases derived from the protective antigen, H-gal-GP

The objective of this study was to determine whether an antigen cocktail containing recombinantly expressed versions of most of the protective proteases of H-gal-GP, a known protective antigen from Haemonchus contortus, would confer any protection to lambs in a vaccine-challenge trial. Haemonchus contortus metalloendopeptidases, MEP1, MEP3 and MEP4, were expressed as soluble recombinant proteins in insect cells, but attempts to express the H. contortus aspartyl proteases, PEP1 and PEP2, by the same techniques were not successful. Recombinant H. contortus PEP1 was therefore expressed in Escherichia coli and refolded. Groups of sheep were immunized thrice with either native H-gal-GP, a cocktail of recombinantly expressed proteins (rMEP1, rMEP3, rMEP4 and rPep1), or adjuvant only (QuilA in PBS). All sheep were challenged with 5000 infective larvae 1 week after the final vaccination. High levels of serum antibodies that recognized H-gal-GP were detected in both the native antigen and recombinant cocktail-immunized groups by the time of challenge, but protective immunity was only observed in the group immunized with native H-gal-GP.

A new chroococcacean alga from the proterozoic of queensland

Nannofossils section sign here described are from the middle Proterozoic Paradise Creek Formation, along Paradise Creek in northwestern Queensland, Australia. These fossils, in chert blebs associated with branched stromatolites, comprise cubic colonies analogous to living Eucapsis, a member of the blue-green algal family Chroococcaceae. The age of the enclosing rocks, bracketed by the ages of older and younger granitic events, is about 1.6 x 10(9) years. We record, therefore, a new chronological and biological datum in the currently accumulating sequence of pre-Paleozoic microbiotas.

Kinetics of the local immune response in the gastric lymph of lambs after primary and challenge infection with Teladorsagia circumcincta

Groups of 5-month-old lambs which had been trickle infected with Teladorsagia circumcincta for 8 weeks then drenched, and worm-free control lambs were challenged with 50 000 T. circumcincta L3s. From 10 days later fewer parasites were recovered from the previously infected sheep, and secondary cellular and humoral responses were observed in the gastric lymph. Increases in CD4+ and CD25+ T lymphoblast traffic on day 3, followed by CD21+ and IgA+ lymphoblasts on day 5, and an increase in total and parasite specific IgA concentrations peaking on day 6 were observed in previously infected lambs. Similar peaks in lymphoblast output were not observed until days 10-12 in the control lambs. This data was highly comparable with that obtained recently from yearling sheep subjected to an identical infection-challenge regime, and contrasted with that obtained from similar experiments in the 1980s when 4(1/2)-month-old previously infected lambs were more susceptible to and had much weaker immune responses to challenge than 10-month-old sheep. The fact that 40% fewer larvae were given during the trickle infection regime in the four recent trials is offered as an explanation for this difference.

Robustness of risk maps and survey networks to knowledge gaps about a new invasive pest

In pest risk assessment it is frequently necessary to make management decisions regarding emerging threats under severe uncertainty. Although risk maps provide useful decision support for invasive alien species, they rarely address knowledge gaps associated with the underlying risk model or how they may change the risk estimates. Failure to recognize uncertainty leads to risk-ignorant decisions and miscalculation of expected impacts as well as the costs required to minimize these impacts. Here we use the information gap concept to evaluate the robustness of risk maps to uncertainties in key assumptions about an invading organism. We generate risk maps with a spatial model of invasion that simulates potential entries of an invasive pest via international marine shipments, their spread through a landscape, and establishment on a susceptible host. In particular, we focus on the question of how much uncertainty in risk model assumptions can be tolerated before the risk map loses its value. We outline this approach with an example of a forest pest recently detected in North America, Sirex noctilio Fabricius. The results provide a spatial representation of the robustness of predictions of S. noctilio invasion risk to uncertainty and show major geographic hotspots where the consideration of uncertainty in model parameters may change management decisions about a new invasive pest. We then illustrate how the dependency between the extent of uncertainties and the degree of robustness of a risk map can be used to select a surveillance network design that is most robust to knowledge gaps about the pest.

Evaluating critical uncertainty thresholds in a spatial model of forest pest invasion risk

Pest risk maps can provide useful decision support in invasive species management, but most do not adequately consider the uncertainty associated with predicted risk values. This study explores how increased uncertainty in a risk model's numeric assumptions might affect the resultant risk map. We used a spatial stochastic model, integrating components for entry, establishment, and spread, to estimate the risks of invasion and their variation across a two-dimensional landscape for Sirex noctilio, a nonnative woodwasp recently detected in the United States and Canada. Here, we present a sensitivity analysis of the mapped risk estimates to variation in key model parameters. The tested parameter values were sampled from symmetric uniform distributions defined by a series of nested bounds (+/-5%, ... , +/-40%) around the parameters' initial values. The results suggest that the maximum annual spread distance, which governs long-distance dispersal, was by far the most sensitive parameter. At +/-15% or larger variability bound increments for this parameter, there were noteworthy shifts in map risk values, but no other parameter had a major effect, even at wider bounds of variation. The methodology presented here is generic and can be used to assess the impact of uncertainties on the stability of pest risk maps as well as to identify geographic areas for which management decisions can be made confidently, regardless of uncertainty.

Morphometric convergence and molecular divergence: the taxonomic status and evolutionary history of Gymnura crebripunctata and Gymnura marmorata in the eastern Pacific Ocean

To clarify the taxonomic status of Gymnura crebripunctata and Gymnura marmorata, the extent of morphological and nucleotide variation between these nominal species was examined using multivariate morphological and mitochondrial DNA comparisons of the same characters with congeneric species. Discriminant analysis of 21 morphometric variables from four species (G. crebripunctata, G. marmorata, Gymnura micrura and Gymnura poecilura) successfully distinguished species groupings. Classification success of eastern Pacific species improved further when specimens were grouped by species and sex. Discriminant analysis of size-corrected data generated species assignments that were consistently accurate in separating the two species (100% jackknifed assignment success). Nasal curtain length was identified as the character which contributed the most to discrimination of the two species. Sexual dimorphism was evident in several characters that have previously been relied upon to distinguish G. crebripunctata from G. marmorata. A previously unreported feature, the absence of a tail spine in G. crebripunctata, provides an improved method of field identification between these species. Phylogenetic and genetic distance analyses based on 698 base pairs of the mitochondrial cytochrome b gene indicate that G. crebripunctata and G. marmorata form highly divergent lineages, supporting their validity as distinct species. The closely related batoid Aetoplatea zonura clustered within the Gymnura clade, indicating that it may not represent a valid genus. Strong population structuring (overall Phi(ST) = 0.81, P < 0.01) was evident between G. marmorata from the Pacific coast of the Baja California peninsula and the Gulf of California, supporting the designation of distinct management units in these regions.

Kinetics of the local cellular response in the gastric lymph of immune and susceptible sheep to infection with Teladorsagia circumcincta

Groups of yearling sheep were trickle infected with Teladorsagia circumcincta for 8 weeks, then the infection cleared with anthelmintic and both these animals and a group of parasite naïve sheep were challenged with 50 000 infective T. circumcincta larvae. The previously infected sheep demonstrated acquired immunity to the parasite, manifested by reduced worm burdens which were evident as early as 2 days after challenge. Cannulation of the common efferent gastric lymph duct allowed the kinetics of their local cell traffic to be monitored, and the phenotype of these lymphocytes was analysed. A blast cell response, consisting of both T and B lymphocytes, was observed in both groups of sheep, however this occurred more rapidly in the previously infected, immune animals. CD4+, CD8+ and CD25+ blast cell output peaked at day 3 in the previously infected animals, whereas CD21+ blast cell output peaked slightly later at day 5. In the control group the peak output of all phenotypes of blast cells occurred more slowly, peaking 10 days after infection.

Spatio-temporal analysis of Xyleborus glabratus (Coleoptera: Curculionidae [corrected] Scolytinae) invasion in eastern U.S. forests

The non-native redbay ambrosia beetle, Xyleborus glabratus Eichhoff (Coleoptera: Curculionidae: Scolytinae), has recently emerged as a significant pest of southeastern U.S. coastal forests. Specifically, a fungal symbiont (Raffaelea sp.) of X. glabratus has caused mortality of redbay (Persea borbonia) and sassafras (Sassafras albidum) trees in the region; several other Lauraceae species also seem susceptible. Although the range of X. glabratus continues to expand rapidly, little is known about the species' biology and behavior. In turn, there has been no broad-scale assessment of the threat it poses to eastern U.S. forests. To provide a basic information framework, we performed analyses exploiting relevant spatio-temporal data available for X. glabratus. First, we mapped the densities of redbay and sassafras from forest inventory data. Second, we used climate matching to delineate potential geographic limits for X. glabratus. Third, we used county infestation data to estimate the rate of spread and modeled spread through time, incorporating host density as a weighting factor. Our results suggest that (1) key areas with high concentrations of redbay have yet to be invaded, but some are immediately threatened; (2) climatic conditions may serve to constrain X. glabratus to the southeastern U.S. coastal region; and (3) if unchecked, X. glabratus may spread throughout the range of redbay in <40 yr. Disruption of anthropogenic, long-distance dispersal could reduce the likelihood of this outcome.

Recent vaccine related studies with economically important gastrointestinal nematode parasites of ruminants

Although several native antigens of sufficient efficacy to be commercially useful have now been discovered for Haemonchus and Ostertagia, all will have to be synthesised artificially to be economically viable. Despite numerous attempts, recombinant DNA technology has not yet yielded the solution, but the effort continues, spurred on by the successes with cestodes and certain ticks. Teladorsagia and Trichostrongylus lag behind in the vaccine research stakes: here, the first and probably most difficult step of identifying a reliably protective native antigen extract does not seem to have been achieved yet. It may be necessary to stimulate elements of the mucosal response to induce protection, a subject still in its infancy as far as ruminants are concerned. Several laboratories have started to work on antigen delivery methods with this in mind. It is easy to understand why intestinal antigens protect against blood feeding Haemonchus rather than mucosal browsers, but quite why conventional immunisation works for Ostertagia, but not apparently for Teladorsagia or Trichostrongylus remains a mystery.

Cytokine expression in naïve and previously infected lambs after challenge with Teladorsagia circumcincta

Infection of sheep with Teladorsagia circumcincta triggers an immune response with predominantly type-2 (Th2) characteristics, including local eosinophila, mastocytosis and increased mucus production. In order to better understand the protective immune responses elicited, we used RT-PCR assays to define the changes in expression levels of a range of cytokine transcripts in lymph nodes draining the ovine abomasum following a challenge infection with T. circumcincta. This study compared the changes in cytokine expression in the abomasal lymph node following challenge with T. circumcincta in naïve sheep (Group 2) and sheep immunised by a previous trickle infection (Group 3), in comparison to unchallenged naive sheep (Group 1). There was a significant up-regulation of interleukin-4 (IL-4), IL-5 and IL-13 in both the challenged groups compared to naïve individuals. There was also an up-regulation of IL-1beta, IL-6, IL-10, IL-18, transforming growth factor-beta1 (TGFbeta1) and tumour necrosis factor-alpha (TNFalpha) by day 5 after infection. IL-12p40 was found to be increased in the previously infected Group 3 animals by day 5 following challenge. By contrast, transcription of this cytokine was found to be reduced by day 10 following infection of Group 2 animals. Expression of IL-2 and Interferon-gamma (IFNgamma) did not significantly differ between the three groups.

Parasite loss and inhibited development of Teladorsagia circumcincta in relation to the kinetics of the local IgA response in sheep

Groups of yearling sheep, which had been trickle infected with Teladorsagia circumcincta for 8 weeks and then drenched, were challenged with 50 000 T. circumcincta larvae together with groups of worm-free controls. Fewer parasites and a greater proportion of early fourth stage larvae were recovered from previously infected sheep compared to controls. Worm loss and arrested development were evident by 5 days after challenge whereas growth retardation of developing worms was observed by day 10. In the previously infected sheep a secondary IgA response was observed in the efferent gastric lymph from 5 days post-infection. Western blot analysis showed the lymph IgA to be predominantly dimeric and nonsecretory in nature and that the somatic antigens recognized were predominantly in the 100-250 kDa range. The concentration of IgA in lymph was always higher than in blood and in the previously infected sheep increased fivefold 8 days post-challenge in contrast to blood where IgA levels were unchanged. The timing of the response suggested that it occurred too late to have been the cause of worm loss or arrested development, though it may have retarded the growth of developing parasites.

Attempts to detect synergy between vaccination and anthelmintic against a drug resistant isolate of Haemonchus contortus

An experiment was conducted to determine whether any synergistic activity could be detected between an experimental vaccine and anthelmintic treatment against a drug resistant strain of Haemonchus contortus, i.e. would the combined effect of both interventions be greater than the sum of either alone. Two groups of 14 worm-free sheep were immunised twice, either with Haemonchus galactose containing glycoprotein complex (H-gal-GP) in QuilA as adjuvant or with adjuvant alone. All were challenged with 5000 Haemonchus L3 from the White River isolate which were resistant to ivermectin and fenbendazole. By 26 days post-challenge the H-gal-GP vaccinated sheep had shed 89% fewer nematode eggs than the adjuvant only controls, indicating that this antigen did indeed protect against the anthelmintic resistant isolate. Twenty six days after challenge seven vaccinates and seven control sheep were drenched with ivermectin, but over the next 11 days the mean egg count of either group did not differ significantly from those of the corresponding untreated groups of sheep. On day 37 the drenched sheep were treated with fenbendazole. This time the egg counts of both treated groups fell significantly compared to those of the corresponding untreated groups, but again there was no suggestion that the drug was more effective in the vaccinated sheep. It was concluded that there was no evidence for synergy between a gut membrane protein vaccine and ivermectin or fenbendazole against an anthelmintic resistant isolate of H. contortus.

An ovine chitinase-like molecule, chitinase-3 like-1 (YKL-40), is upregulated in the abomasum in response to challenge with the gastrointestinal nematode, Teladorsagia circumcincta

Mammalian chitinases and chitinase-like proteins are a group of molecules known to be upregulated and secreted in Th2-induced inflammatory responses, such as asthma, allergy and nematode infection. As part of an investigation of potential components of the innate immune response to Teladorsagia circumcincta, a gastrointestinal nematode that colonises the abomasum in sheep, we carried out RT-PCR analysis of two members of the mammalian chitinase family of molecules, acidic chitinase (ChiA) and chitinase-3 like 1 (Chi3L1) using primers to homologous bovine/human sequences. Both sets of primers detected transcripts in the abomasum which were confirmed to be ovine ChiA and Chi3L1 by sequence analysis. Chi3L1 transcripts were found to be significantly upregulated in both the abomasum and gastric lymph nodes in response to T. circumcincta challenge of previously infected animals.

Some observations on immunologically mediated inhibited Teladorsagia circumcincta and their subsequent resumption of development in sheep

Two similar experiments were conducted with groups of yearling sheep which had been trickle infected with Teladorsagia circumcincta for 6 weeks, treated with anthelmintic then challenged with a single dose of 50,000 larvae. Ten days after challenge these sheep contained significantly fewer worms and a significantly higher proportion of arrested early fourth stage larvae than controls which had not received the trickle infection. However, by 19 or 23 days after challenge most of the arrested worms had resumed development, a process which was accelerated in a group treated with corticosteroids. It was concluded that under these conditions arrested development of Teladorsagia was a short-lived, immunologically mediated phenomenon which could be reversed by immuno-suppressing the sheep.

Developments and hurdles in generating vaccines for controlling helminth parasites of grazing ruminants

As a direct consequence of rising drug resistance among common nematodes of grazing animals, efforts toward state-of-the-art vaccine development have clearly intensified in recent years, fuelled primarily by the advent of newer technologies in gene discovery, by advancements in antigen identification, characterisation and production. In this regard, it is appropriate to review progress that has been made in generating helminth vaccines and in particular, vaccines against common nematodes of production animals for consumption. In like manner, it is prudent to evaluate barriers that have hindered progress in the past and continue to present obstacles that must be solved when utilizing and depending on host immunity to attenuate parasitic infections.

Molecular characterization of a family of metalloendopeptidases from the intestinal brush border of Haemonchus contortus

Substantial protection against the economically important parasitic nematode Haemonchus contortus has been achieved by immunizing sheep with a glycoprotein fraction isolated from the intestinal membranes of the worm (H-gal-GP). Previous studies showed that one of the major components of H-gal-GP is a family of at least 4 zinc metalloendopeptidases, designated MEPs 1–4. This paper describes aspects of the molecular architecture of this protease family, including the proteomic analysis of the MEP fraction of the H-gal-GP complex. These enzymes belong to the M13 zinc metalloendopeptidase family (EC 3.4.24.11), also known as neutral endopeptidases or neprilysins. The sequences of MEPs 1 and 3 suggested a typical Type II integral membrane protein structure, whilst MEPs 2 and 4 had putative cleavable signal peptides, typical of secreted proteins. Proteomic analysis of H-gal-GP indicated that the extracellular domain of all 4 MEPs had been cleaved close to the transmembrane region/signal peptide with additional cleavage sites mid-way along the polypeptide. MEP3 was present as a homo-dimer in H-gal-GP, whereas MEP1 or MEP2 formed hetero-dimers with MEP4. It was found that expression of MEP3 was confined to developing 4th-stage larvae and to adult worms, the stages of Haemonchus which feed on blood. MEP-like activity was detected in the H-gal-GP complex over a broad pH range (5–9). Since all 4 MEPs must share a similar microenvironment in the complex, this suggests that each might have a different substrate specificity.

An immunogenic cathepsin F secreted by the parasitic stages of Teladorsagia circumcincta

Teladorsagia circumcincta is a common, pathogenic abomasal nematode of sheep. In order to improve disease control in parasite isolates resistant to several anthelmintics, alternative methods must be sought. Sheep develop acquired immunity to T. circumcincta so vaccination is a valid option for control. For this reason, we are investigating parasite excretory/secretory products for molecules, which have potential to invoke protective immunity against T. circumcincta. Here, we describe experiments in which we identified a novel, immunogenic cathepsin F secreted by L4 T. circumcincta. This protease, initially identified by mass spectrometry analysis, is the most abundant molecule in excretory/secretory products released in vitro by T. circumcincta harvested at 5, 6 or 9 days p.i. and is a target of specific, local IgA responses in sheep which are immune to challenge infection. The full-length cDNA encoding this secreted protease was isolated. Sequence and phylogenetic analyses indicated that the protease (designated T. circumcincta cathepsin F-1, Tci-CF-1) belongs to the cathepsin F class and exhibits greatest identity (>60%) to expressed sequence tags present in the Ostertagia ostertagi and Haemonchus contortus expressed sequence tag databases. Tci-CF-1 also displays high identity to hypothetical proteins identified in the genomes of Caenorhabditis elegans and Caenorhabditis briggsae, both proteins having been described as cathepsin F enzymes. Specific inhibitor binding assay of larval excretory/secretory products confirmed the classification of this excretory/secretory component as a cathepsin F. Reverse transcription-PCR studies indicated that Tci-cf-1 is developmentally regulated and is particular to the host parasitic stages of T. circumcincta. The abundance, immunogenicity and temporal expression pattern of Tci-CF-1 make this a potential vaccine candidate for teladorsagiosis.

Presence of the LDNF glycan on the host-protective H-gal-GP fraction from Haemonchus contortus

Immunization of sheep with the gut membrane-associated protein complex H-gal-GP of adult Haemonchus contortus induces high levels of protection against a homologous challenge infection. Protection is correlated with a systemic IgG response against the antigen. Analysis of the antibody response showed that the majority of the antigen-specific IgG was of the IgG2 isotype. A substantial proportion (74%) of this response was directed against the glycan component of H-gal-GP. The high immunogenicity of the H-gal-GP glycans may be due to the presence of the fucosylated LacdiNAc (LDNF) antigen. 2D electrophoresis, Western blotting and mass spectrometry analysis of H-gal-GP showed that this glycan epitope was specifically located on a metalloendopeptidase, MEP3. MEP3 is the most abundant protein in H-gal-GP and has been identified as one of the most likely protective components of the complex. Here, we present evidence that the LDNF glycan does not contribute to the protective capacity of H-gal-GP. Animals vaccinated with reduced and denatured H-gal-GP are not protected against subsequent infection, although the antibody response against the LDNF glycan is very similar to that of animals vaccinated with the native H-gal-GP. In addition, an alternative version of H-gal-GP, H-sialgal-GP, which is equally protective, but isolated by affinity chromatography on jacalin lectin rather than peanut lectin, contains a MEP3 component which has no detectable LDNF glycan.

Protection induced by vaccinating sheep with a thiol-binding extract of Haemonchus contortus membranes is associated with its protease components

Previous work has shown that a protein extract enriched for cysteine protease activity (TSBP) prepared from adult Haemonchus contortus using thiol sepharose affinity chromatography confers substantial protection against a single challenge infection. TSBP comprised proteases and other proteins. Here, TSBP were further fractionated using anion-exchange chromatography and fractions pooled on the basis of containing (1) protease activity, (2) a prominent non-protease peptide and (3) material which did not bind to the column. A protection trial showed that only the protease-enriched material conferred protective immunity and this was comparable to that observed in a TSBP-immunized positive control group. Immunization stimulated a marked IgG response with the IgG2 isotype predominating.

Protection studies with a globin-enriched protein fraction of Ostertagia ostertagi

The protective capacity of an adult stage Ostertagia ostertagi globin antigen was tested in four vaccination experiments in cattle. In a preliminary experiment, calves were vaccinated three times intraperitoneally with 250 microg globin in Freund's adjuvant and challenged with a trickled infection of 25,000 infective larvae. In three subsequent field studies, calves were vaccinated twice or three times intramuscularly with 80-100 microg globin in Quil A and challenged with a natural gastrointestinal nematode infection on pasture. Higher globin-specific antibody levels were detected in the vaccinated calves than in the control animals in all vaccine trials. In the preliminary experiment, geometric mean cumulative egg counts in the globin group were reduced by 52% and total worm burdens were reduced by 28%, compared to the controls. In the first field trial cumulative faecal egg counts were reduced by 63% in the vaccinated calves. However, the reduction in faecal egg output in these two experiments was not statistically significant and no reduction in faecal egg counts was observed in the vaccinated animals in the two last field trials. In conclusion, vaccination of calves with O. ostertagi globin resulted in highly variable protection levels after challenge infection.

Immunization against sheep scab: preliminary identification of fractions of Psoroptes ovis which confer protective effects

In an attempt to enrich for potentially protective Psoroptes ovis antigens, three separate vaccine trials were conducted in which groups of sheep were immunized three times with various fractions of a soluble extract of P. ovis mites using QuilA as adjuvant. These groups, as well as controls that received adjuvant only, were challenged with P. ovis, and protective immunity was assessed by measuring lesion areas and conducting mite counts 4 and 6 weeks later. All fractions stimulated high titre serum antibodies. Most conferred some protection on sheep with active disease, although there was considerable variation between sheep in all groups, including the controls. Some fractions were more protective than the extract itself, suggesting that the protective components had been concentrated. Indeed the best fraction, obtained by ion exchange chromatography, followed by a gel filtration step, slowed lesion growth to less than a third by 6 weeks after challenge and reduced mite numbers by more than 13 times compared to control sheep vaccinated with QuilA only. However, as judged by polyacrylamide gels, the polypeptide profile of this fraction was still complex, indicating that further work is required to identify the protective components.

Metalloendopeptidases from the intestinal brush border of Haemonchus contortus as protective antigens for sheep

Substantial protection against the economically important nematode Haemonchus contortus has been achieved by immunizing sheep with a glycoprotein fraction isolated from the intestinal membranes of this parasite. This fraction has been termed Haemonchus galactose-containing glycoprotein complex (H-gal-GP) since it was originally isolated through its selective binding to lectins with a specificity for N-acetylgalactosamine. A major component of this highly protective antigen complex is a family of four zinc metalloendopeptidases, designated MEPs 1-4. Various combinations of these MEPs were evaluated in immunization-challenge trials in sheep. In two experiments a combination of all four MEPs, separated from the rest of the complex by gel filtration in 8 m urea, significantly reduced H. contortus egg counts by 45 and 50%, an effect not significantly different from that conferred by 8 m urea treatment of H-gal-GP itself. Similarly, MEP3 alone or MEPs 1, 2 and 4 in combination, electroeluted from the complex following SDS gel electrophoresis, each reduced egg counts by some 33%. The MEPs are therefore protective components of H-gal-GP and from previously published findings, it appears that MEP3 is the most effective member of this metalloendopeptidase family. However, there was no significant protection when sheep were immunized with fully reduced and denatured H-gal-GP or with bacterially expressed recombinant forms of MEP 1 or the principal domains of MEP3, suggesting that conformational epitopes on the MEPs are required for immunity.

Aspartyl proteases from the intestinal brush border of Haemonchus contortus as protective antigens for sheep

A novel pepsin-like aspartyl protease was identified as a component of Haemonchus galactose-containing glycoprotein (H-gal-GP), which is an integral membrane glycoprotein complex located on the intestinal cells of Haemonchus contortus, and a highly protective antigen for sheep. This molecule, designated HcPEP2, showed 50% sequence identity with a previously described aspartyl protease from H-gal-GP known as HcPEP1. Fractions of H-gal-GP, either containing both HcPEP1 and 2 or other lower molecular weight components of the complex, were evaluated as protective antigens in immunization - challenge trials in sheep. When separated from the rest of the complex by gel filtration in 8 m urea, the HcPEP1 and 2 fraction significantly reduced H. contortus egg counts by 48% and worm numbers by 36%, but the lower molecular weight components were not significantly protective. However, the HcPEP1 and 2 fraction did not protect if electro-eluted from SDS-dissociated H-gal-GP, nor did bacterially expressed recombinant HcPEP1, suggesting that conformational epitopes are important for inducing immunity.

Regional assessment of ozone sensitive tree species using bioindicator plants

Tropospheric ozone occurs at phytotoxic levels in the northeastern and mid-Atlantic regions of the United States. Quantifying possible regional-scale impacts of ambient ozone on forest tree species is difficult and is confounded by other factors, such as moisture and light, which influence the uptake of ozone by plants. Biomonitoring provides an approach to document direct foliar injury irrespective of direct measure of ozone uptake. We used bioindicator and field plot data from the USDA Forest Service to identify tree species likely to exhibit regional-scale ozone impacts. Approximately 24% of sampled sweetgum (Liquidambar styraciflua), 15% of sampled loblolly pine (Pinus taeda), and 12% of sampled black cherry (Prunus serotina) trees were in the highest risk category. Sweetgum and loblolly pine trees were at risk on the coastal plain of Maryland, Virginia and Delaware. Black cherry trees were at risk on the Allegheny Plateau (Pennsylvania), in the Allegheny Mountains (Pennsylvania, West Virginia, and Maryland) as well as coastal plain areas of Maryland and Virginia. Our findings indicate a need for more in-depth study of actual impacts on growth and reproduction of these three species.