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PubMed2006

Memory abilities in children with subtypes of dyscalculia.

This study examines (a) mathematical skills of 2 subgroups of children with developmental dyscalculia (DD)--1 group with DD only and a second group with DD plus reading disorders (RDD)-and (b) analyzes the memory skills of both groups of children. Fifty 11- and 12-year-old children were selected from public schools in Guadalajara, Mexico. Seventeen children had DD only, 13 had RDD, and 20 were normal controls. Testing included 10 calculation and 6 memory subtests taken from the Evaluación Neuropsicológica Infantil (Matute, Rosselli, Ardila, and Ostrosky, in press). Results indicated that children with DD and children with RDD show a similar pattern of mathematical impairment. Both subgroups had significantly lower scores than the control group in working memory tasks. In addition, the RDD group had significantly lower scores than the control group in visual learning and semantic memory. Although the RDD group scored lower than the DD group in most memory tests, this difference did not reach significance. Working memory tests (digits backwards and sentence repetition) appeared to be the best predictors of mathematical test scores and may represent a major cognitive defect in children with specific defects in mathematics.

Aptitude↗
PubMed2006

Dilemmas in the management of twins discordant for anencephaly diagnosed at 11 + 0 to 13 + 6 weeks of gestation.

OBJECTIVE: To help develop an evidence-based approach to the best management of twin pregnancies discordant for anencephaly. METHODS: We retrospectively examined the management and outcome of 18 pregnancies discordant for anencephaly diagnosed at 11 + 0 to 13 + 6 weeks of gestation in our center. We combined these data with those from other publications. In total, there were 44 dichorionic pregnancies that were managed expectantly (n = 35) or by selective feticide (n = 9) and 19 monochorionic pregnancies that were managed expectantly. We also reviewed the literature to ascertain the outcome of monochorionic twin pregnancies undergoing cord occlusion. RESULTS: In the 35 dichorionic pregnancies that were managed expectantly, 20 (57.1%) developed polyhydramnios at 25-31 weeks; 13 were managed expectantly, five had amniodrainage and two had selective feticide. In 34 of the 35 cases the non-anencephalic twin was liveborn at a median gestation of 36 (range, 28-39) weeks and in six (17.6%) of these it was born before 33 weeks. In the dichorionic pregnancies that had selective feticide, there was one miscarriage and eight (88.9%) live births at a median gestation of 37 (range, 30-40) weeks and in one (12.5%) of these it was born before 33 weeks. In the monochorionic pregnancies, four (21.1%) anencephalic fetuses died at 20-32 weeks and in three of these the normal co-twin also died. In the 16 (84.2%) cases resulting in the live birth of the normal twin, delivery occurred at a median gestation of 33 (range, 27-39) weeks and in six (37.5%) of these it was before 33 weeks. Ultrasound-guided bipolar cord coagulation in 92 pregnancies, mostly complicated by twin reversed arterial perfusion sequence or severe twin-to-twin transfusion syndrome, was associated with a survival rate of 77.2% and early preterm delivery rate of 31.0%. CONCLUSION: Dichorionic twins discordant for anencephaly are best managed with serial ultrasound examinations for early diagnosis of polyhydramnios, which can then be treated either by amniodrainage or selective feticide. In monochorionic twins it is uncertain whether the best management is expectant or by cord occlusion.

Anencephaly↗
PubMed2003

Postexposure prophylaxis in children and adolescents for nonoccupational exposure to human immunodeficiency virus.

Exposure to human immunodeficiency virus (HIV) can occur in a number of situations unique to, or more common among, children and adolescents. Guidelines for postexposure prophylaxis (PEP) for occupational and nonoccupational (eg, sexual, needle-sharing) exposures to HIV have been published by the US Public Health Service, but they do not directly address nonoccupational HIV exposures unique to children (such as accidental exposure to human milk from a woman infected with HIV or a puncture wound from a discarded needle on a playground), and they do not provide antiretroviral drug information relevant to PEP in children. This clinical report reviews issues of potential exposure of children and adolescents to HIV and gives recommendations for PEP in those situations. The risk of HIV transmission from nonoccupational, nonperinatal exposure is generally low. Transmission risk is modified by factors related to the source and extent of exposure. Determination of the HIV infection status of the exposure source may not be possible, and data on transmission risk by exposure type may not exist. Except in the setting of perinatal transmission, no studies have demonstrated the safety and efficacy of postexposure use of antiretroviral drugs for the prevention of HIV transmission in nonoccupational settings. Antiretroviral therapy used for PEP is associated with significant toxicity. The decision to initiate prophylaxis needs to be made in consultation with the patient, the family, and a clinician with experience in treatment of persons with HIV infection. If instituted, therapy should be started as soon as possible after an exposure-no later than 72 hours-and continued for 28 days. Many clinicians would use 3 drugs for PEP regimens, although 2 drugs may be considered in certain circumstances. Instruction for avoiding secondary transmission should be given. Careful follow-up is needed for psychologic support, encouragement of medication adherence, toxicity monitoring, and serial HIV antibody testing.

Adolescent↗
PubMed1999

Essential role of transcription factor nuclear factor-kappaB in regulation of interleukin-8 gene expression by nitrite reductase from Pseudomonas aeruginosa in respiratory epithelial cells.

Persistent infection with Pseudomonas aeruginosa increases interleukin-8 (IL-8) levels and causes dense neutrophil infiltrations in the airways of patients with chronic airway diseases. Recently, we have reported that nitrite reductase from P. aeruginosa induces the production of IL-8 in respiratory cells, including bronchial epithelial cells. To determine the molecular mechanism(s) of nitrite reductase-induced IL-8 expression in respiratory cells, A549 epithelial cells were transfected with plasmids containing serial deletions of the 5'-flanking region of the IL-8 gene and then exposed to nitrite reductase. Nitrite reductase significantly enhanced IL-8 gene promoter-driven reporter activity. This increased IL-8 gene expression was inhibited by mutating the nuclear factor-kappaB (NF-kappaB) binding element. Nitrite reductase enhanced nuclear localization of the NF-kappaB binding complex. Furthermore, nitrite reductase induced the degradation of IkappaBalpha, the major cytoplasmic inhibitor of NF-kappaB, and the expression of IkappaBalpha mRNA. These data support the critical role of the activation of NF-kappaB in nitrite reductase-induced IL-8 gene expression in airway epithelium.

DNA-Binding Proteins↗
PubMedDate not supplied

Autorhythmometry: leads from single-sample medical check-ups toward a health science of time series.

Starting from the definition of health as given by the WHO, the authors emphasize that rhythms of biological variables should be taken into account if one is to arrive at a positive and individual definition of the concept of health. The evaluation of a single datum spot check of physiological functions does not permit to quantify health in dynamic terms whereas this may become possible when the rhythmic quality of these variables, according to a spectrum of characteristic frequencies, has been assessed. Rhythmometry provides for appropriate reference standards as regards both the population in general and the physical conditions of the same subject during certain spans in the (prospective) life history (spans selected according to consideration of risk and hence cost and benefit at a given age). The authors therefore stress the importance of rhythmometry, thanks to which the time course and other peculiarities of any biological phenomenon can be evaluated by obtaining serial measurements, objectively quantifying their characteristic features, and working out special models with the aid of computers. Of special interest, particularly for the evaluation of reference standards, is autorhythmometry (AR), to be used at least for certain variables. This is the method by which each subject studies himself, performing a certain number of measurements in the course of the day (or month or year) of his body temperature, blood pressure, cardiac rhythm, grip strength, etc. In AR, the subject takes an active part in the study of his condition of health and it has been shown that in the majority of cases these measurements are done with the utmost accuracy and precision, providing that the purpose of the operations to be performed has been adequately explained. The wide spread use of AR, during more or less extended periods in a lifetime, would permit the assessment of the normal situation for each individual and thus offer the possibility of diagnosing any disorder at its very beginning; it would thus be of great prophylactic value. The authors refer to the example of arterial blood pressure; widely different values for the normal levels can be found in the texts of different authors. They also show that a certain presure may be normal for a given subject at a certain time of day and be a sign of illness for another subject, or even for the same subject at a different ime. The authors suggest the introduction of AR in the curriculum of secondary schools and into the routine for outpatients and inpatients. This practice would increase the availability of information on public health at a lower cost. AR may be very usefully applied to chronotherapy: it is a well-known fact that there are rhythms of sensitivity and therefore rhythms of toxic as well as therapeutic effects for various drugs. These can be dove-tailed in such a way as to work out, for individual cases, a time for administration at which the therapeutic effect is at its maximum and the toxic one at its minimum...

Animals↗
PubMed2006

Phosphorylation of Ser158 regulates inflammatory redox-dependent hepatocyte nuclear factor-4alpha transcriptional activity.

In IL-1beta (interleukin 1beta)-stimulated rat hepatocytes exposed to superoxide, we have previously identified an IRX (inflammatory redox)-sensitive DR1 [direct repeat of RG(G/T)TCA with one base spacing] cis-acting activator element (nt -1327 to -1315) in the iNOS (inducible nitric oxide synthase) promoter: AGGTCAGGGGACA. The corresponding transcription factor was identified to be HNF4alpha (hepatocyte nuclear factor-4alpha). HNF4alpha DNA binding activity and transactivation potential are tightly regulated by its state of phosphorylation. However, the functional consequences of IRX-mediated post-translational phosphorylation of HNF4alpha have not been well characterized. In the setting of IL-1beta+H2O2, HNF4alpha functional activity is associated with a unique serine/threonine phosphorylation pattern. This indicates that an IRX-sensitive serine/threonine kinase pathway targets HNF4alpha to augment hepatocyte iNOS transcription. In the present study, following identification of phosphorylated residues in HNF4alpha, serial mutations were performed to render the target residues phosphorylation-resistant. Electrophoretic mobility-shift assays and transient transfection studies utilizing the iNOS promoter showed that the S158A mutation ablates IRX-mediated HNF4alpha DNA binding and transactivation. Gain-of-function mutation with the S158D phosphomimetic HNF4alpha vector supports a critical role for Ser158 phosphorylation. In vitro phosphorylation and kinase inhibitor studies implicate p38 kinase activity. Our results indicate that p38 kinase-mediated Ser158 phosphorylation is essential for augmentation of the DNA binding and transactivation potential of HNF4alpha in the presence of IL-1beta+H2O2. This pathway results in enhanced iNOS expression in hepatocytes exposed to pro-inflammatory cytokines and oxidative stress.

Animals↗
PubMed2006

The sagging rope sign in achondroplasia--different from Perthes' disease.

OBJECTIVE: The sagging rope sign is a radio-opaque line, seen on radiographs of the hips, with Perthes' disease. The main purpose of this study was to determine the incidence, cause and importance of this sign in achondroplasia, and to reveal how it differs from in Perthes' disease. DESIGN: Serial radiograms, along with 2-dimensional and 3-dimensional CT images were studied in 42 achondroplastic patients. PATIENTS: Forty-two achondroplastic patients, reported at our institute (for routine outpatient consultation, spine surgeries, deformity corrections, limb-lengthening procedures) were included in this study. There were 26 males and 16 females. RESULTS: The sign was observed bilaterally, in all patients. Evaluation of CT images revealed spherical heads, with presence of circumferential overhang in all hips. This circumferential overhang, seen on 3-D CT scan, corresponded to the sagging rope sign on radiographs. CONCLUSIONS: Presence of the sagging rope sign in bilateral hips is a characteristic feature of achondroplasia. It usually appears before epiphyseal closure. Its cause, incidence, and nature differ from Perthes' disease, and its presence does not carry a bad prognosis in achondroplasia.

Achondroplasia↗
PubMed2003

Use of ambulance dispatch data as an early warning system for communitywide influenzalike illness, New York City.

In 1998, the New York City Department of Health and the Mayor's Office of Emergency Management began monitoring the volume of ambulance dispatch calls as a surveillance tool for biologic terrorism. We adapted statistical techniques designed to measure excess influenza mortality and applied them to outbreak detection using ambulance dispatch data. Since 1999, we have been performing serial daily regressions to determine the alarm threshold for the current day. In this article, we evaluate this approach by simulating a series of 2,200 daily regressions. In the influenza detection implementation of this model, there were 71 (3.2%) alarms at the 99% level. Of these alarms, 64 (90%) occurred shortly before or during a period of peak influenza in each of six influenza seasons. In the bioterrorism detection implementation of this methodology, after accounting for current influenza activity, there were 24 (1.1%) alarms at the 99% level. Two occurred during a large snowstorm, 1 is unexplained, and 21 occurred shortly before or during a period of peak influenza activity in each of six influenza seasons. Our findings suggest that this surveillance system is sensitive to communitywide respiratory outbreaks with relatively few false alarms. More work needs to be done to evaluate the sensitivity of this approach for detecting nonrespiratory illness and more localized outbreaks.

Ambulances↗
PubMed1987

Evaluation of the relation between Pavlovian occasion-setting and instrumental discriminative stimuli: a blocking analysis.

Experiments with rat subjects used a blocking design (A+, then AB+) to assess the relation between Pavlovian occasion-setting and instrumental discriminative stimuli. Prior conditioning of both associative and occasion-setting functions of A in a serial feature-positive procedure blocked acquisition of an instrumental discriminative function by a novel stimulus (B) trained in compound with A. However, neither prior conditioning of only an A-US (unconditioned stimulus) association nor prior conditioning of Stimulus A using a Pavlovian simultaneous feature-positive procedure, which does not endow A with an occasion-setting function, blocked acquisition of an instrumental discriminative function by B. Prior acquisition of an instrumental discriminative function by A blocked acquisition of a Pavlovian occasion-setting function by a novel stimulus (B) trained in compound with A, but did not block acquisition of an association between B and the US. These outcomes indicate that Pavlovian occasion-setting and instrumental discriminative properties of a stimulus are functionally equivalent and that both Pavlovian occasion-setting and instrumental discriminative properties of a stimulus are functionally independent of simple associative relations between that stimulus and other events.

Animals↗
PubMed1986

[Ultrastructural study of 36 lymph node sites of Hodgkin's disease].

The authors report their ultrastructural findings of 36 involved lymph-nodes in Hodgkin's disease (HD), before any treatment. More than 400 tumour cells were studied. An analytical study was carried out on the different aspects presented by the nuclei (uni or multi-lobated); the nucleoli (compact, reticulate or dispersed); and the cytoplasm (immunoblastic, complex, intermediate). No cellular structure evoking phagocytic activity with digestion, and consequently an eventual histiomonocytic origin, could be detected even on serial sections. The presence of lipid inclusions, sometimes of glycogen, as well as certain peculiar structures are described and discussed. The ultrastructural aspects could be easily correlated with the different types of tumour cell described in HD using light microscopy. The various kinds of cells which could could be detected in the same lymph node, may correspond to a real tumour cell lineage, consisting, firstly, of a cell of immunoblastic type with a mono- or bilobated nucleus, then an intermediate type with a bilobated or multisegmented nucleus, and finally a complex cell type with a multisegmented nucleus. The lacunar cells are characterised by a fragile hyaloplasm, without cellular organelles at their periphery, these being concentrated around the nucleus. This special organisation explains the aspects observed in light microscopy. However, no explanation could be offered to understand this particular aspect of the cytoplasm. The ultrastructural characteristics of the Reed-Sternberg cells and their variants did not allow a precise cellular origin to be proposed. The absence of phagolysosomes pleads against a histiocytic origin. However their similarity of the interdigitated reticular cells did not seem sufficient to propose this origin. The likeliness of the cytoplasm of cells with mono- or bilobated nuclei with that of immunoblasts, constitutes the most interesting morphological feature. This fact, associated with the appearance of immunoblasts similar to Reed-Sternberg cells of infectious mononucleosis, suggests a lymphoid origin. The study of the reactive cells around the tumor cells did not allow any consequences to be drawn. One could simply note that the Reed-Sternberg cells and their variants were surrounded by lymphocytes, forming a kind of crown. No etiological agent could be detected. These data are compared to those of other publications, and discussed. This ultrastructural study, therefore, does not offer the solution to most of the questions which still remain to be answered as to the origin of the Reed-Sternberg cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Biopsy↗
PubMed1994

Mandatory anonymous HIV surveillance in Denmark: the first results of a new system.

OBJECTIVES: This paper describes the principles and first results of the newly implemented anonymous mandatory human immunodeficiency virus (HIV) reporting system in Denmark. METHODS: The system is based on a serially numbered form that is circulated among the laboratories, the physicians, and the national surveillance unit. All laboratories doing confirmatory tests for HIV antibodies must send a report form along with any positive test results. Before forwarding the form, the laboratory is to fill in the top part with the name and address of the requesting physician and send the back copy to the surveillance unit. The physicians are mandated by law to fill in the form with data on the patient and to keep two copies for their own files before sending the original to the surveillance unit. RESULTS: After a revision of the system, a response rate of 95% was obtained. CONCLUSIONS: We have established an anonymous mandatory HIV surveillance system in Denmark that enables routine evaluation of the completeness of reporting and nonresponding physicians to be reminded of their duty to report. Also, the physicians can act as mediators between patients and researchers; therefore, nested studies can be done without breaking the anonymity of the patient.

AIDS Serodiagnosis↗
PubMed2000

Electroconvulsive therapy for schizophrenia.

BACKGROUND: Electroconvulsive therapy (ECT) involves the induction of a seizure (fit) for therapeutic purposes by the administration of a low frequency electrical stimulus shock via electrodes applied to the scalp. At present it is used for those with schizophrenia but its effects are unclear. OBJECTIVES: To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning in those with schizophrenia. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), Medline (1966-1996), PsycLIT (1974-1996) and SCISEARCH (1996) were undertaken. The references of all identified studies were investigated. SELECTION CRITERIA: All randomised controlled trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics for people with schizophrenia, schizoaffective disorder or chronic mental disorder. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and analysed the data on an intention to treat basis. MAIN RESULTS: Less people with schizophrenia treated with ECT showed no improvement in general functioning when compared to those given placebo in the short term (OR 0.48 CI 99% 0.26-0.90). This effect, however, does not last. However, ECT is less effective than antipsychotic drug treatment for those with schizophrenia. Limited evidence exists to suggest that combining antipsychotic drugs and ECT increases the rate and extent of clinical improvement, in the short term, in one out of every five to six people. The evidence for the efficacy of ECT in the medium to long term is equivocal. Electroconvulsive therapy is also more effective than the now obsolete insulin coma treatment. REVIEWER'S CONCLUSIONS: There is some evidence to support the use of ECT for those with schizophrenia for short term relief of symptoms. Electroconvulsive therapy may be advocated as an adjunct to antipsychotic medication for those with schizophrenia who show a limited response to medication alone but the evidence for this is not strong. In fact in spite of more than five decades of widespread clinical use, the administration of ECT to those with schizophrenia lacks a strong research base.

Electroconvulsive Therapy↗
PubMed2005

Electroconvulsive therapy for schizophrenia.

BACKGROUND: Electroconvulsive therapy (ECT) involves the induction of a seizure for therapeutic purposes by the administration of a variable frequency electrical stimulus shock via electrodes applied to the scalp. The effects of its use in people with schizophrenia are unclear. OBJECTIVES: To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning for people with schizophrenia, and to determine whether variations in the practical administration of ECT influences outcome. SEARCH STRATEGY: We undertook electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), MEDLINE (1966-2004), PsycLIT (1974-1996),SCISEARCH (1996) and the Cochrane Schizophrenia Group's Register (July 2004). We also inspected the references of all identified studies and contacted relevant authors. SELECTION CRITERIA: We included all randomised controlled clinical trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics and different schedules and methods of administration of ECT for people with schizophrenia, schizoaffective disorder or chronic mental disorder. DATA COLLECTION AND ANALYSIS: Working independently, we selected and critically appraised studies, extracted data and analysed on an intention-to-treat basis. Where possible and appropriate we calculated risk ratios (RR) and their 95% confidence intervals (CI) with the number needed to treat (NNT). For continuous data Weighted Mean Differences (WMD) were calculated. We presented scale data for only those tools that had attained pre-specified levels of quality. We also undertook tests for heterogeneity and publication bias. MAIN RESULTS: This review includes 26 trials with 50 reports. When ECT is compared with placebo or sham ECT, more people improved in the real ECT group (n=392, 10 RCTs, RR 0.76 random CI 0.59 to 0.98, NNT 6 CI 4 to 12) and though data were heterogeneous (chi-square 17.49 df=9 P=0.04), its impact on variability of data was not substantial (I-squared 48.5%). There was a suggestion that ECT resulted in less relapses in the short term than sham ECT (n=47, 2 RCTs, RR fixed 0.26 CI 0.03 to 2.2), and a greater likelihood of being discharged from hospital (n=98, 1 RCT, RR fixed 0.59, CI 0.34 to 1.01). There is no evidence that this early advantage for ECT is maintained over the medium to long term. People treated with ECT did not drop out of treatment earlier than those treated with sham ECT (n=495, 14 RCTs, RR fixed 0.71 CI 0.33 to 1.52, I-squared 0%). Very limited data indicated that visual memory might decline after ECT compared with sham ECT (n=24, 1 RCT, WMD -14.0 CI -23 to -5); the results of verbal memory tests were equivocal. When ECT is directly compared with antipsychotic drug treatments (total n=443, 10 RCTs) results favour the medication group (n=175, 3 RCTs, RR fixed 'not improved at the end of ECT course' 2.18 CI 1.31 to 3.63). Limited evidence suggests that ECT combined with antipsychotic drugs results in greater improvement in mental state (n= 40, 1 RCT, WMD, Brief Psychiatric Rating Scale -3.9 CI - 2.28 to -5.52) than with antipsychotic drugs alone. One small study suggested more memory impairment after a course of ECT combined with antipsychotics than with antipsychotics alone (n=20, MD serial numbers and picture recall -4.90 CI -0.78 to -9.02), though this proved transient. When continuation ECT was added to antipsychotic drugs, the combination was superior to the use of antipsychotics alone (n=30, WMD Global Assessment of Functioning 19.06 CI 9.65 to 28.47), or CECT alone (n=30, WMD -20.30 CI -11.48 to -29.12). Unilateral and bilateral ECT were equally effective in terms of global improvement (n=78, 2 RCTs, RR fixed 'not improved at end of course of ECT' 0.79 CI 0.45 to 1.39). One trial showed a significant advantage for 20 treatments over 12 treatments for numbers globally improved at the end of the ECT course (n=43, RR fixed 2.53 CI 1.13 to 5.66). AUTHORS' CONCLUSIONS: The evidence in this review suggests that ECT, combined with treatment with antipsychotic drugs, may be considered an option for people with schizophrenia, particularly when rapid global improvement and reduction of symptoms is desired. This is also the case for those with schizophrenia who show limited response to medication alone. Even though this initial beneficial effect may not last beyond the short term, there is no clear evidence to refute its use for people with schizophrenia. The research base for the use of ECT in people with schizophrenia continues to expand, but even after more than five decades of clinical use, there remain many unanswered questions regarding its role in the management of people with schizophrenia.

Electroconvulsive Therapy↗
PubMed1998

Long-term trends in self-reported HIV risk behavior: injection drug users in Los Angeles, 1987 through 1995.

This article reviews trends in self-reported HIV risk behaviors across serial samples of injection drug-using (IDU) arrestees interviewed in Los Angeles. Between 1987 and 1995, a gradual decrease occurred in the percentage who share needles. However, measured over a past-year recall period, the prevalence of needle sharing remained high until 1994 to 1995, when it abruptly declined. Needle sharing with strangers and needle sharing at shooting galleries declined gradually throughout the study period. Among IDUs who shared needles, bleach use increased rapidly until 1991 but leveled off thereafter. No change occurred in number of sex partners, but condom use gradually increased among IDUs with 2 or more partners. Concurrent change in local needle exchange policy and practice may explain the abrupt decline in past-year needle sharing. New strategies may be needed to promote further increases in bleach use and condom use.

Condoms↗
PubMed2000

Campylobacter recovery from external and internal organs of commercial broiler carcass prior to scalding.

Campylobacter is a human pathogen commonly found on live broilers and processed carcasses. To plan effective intervention strategies, it would be helpful to know which Campylobacter populations are associated with the external and internal organs of broilers. Six carcasses were collected after exiting the bleed tunnel at a commercial broiler plant on each of three visits (n = 18). Carcasses were placed individually into sterile plastic bags, sealed, and covered with ice for transport to the laboratory. Five locations were sampled aseptically from each carcass: breast feathers (hand picked from the sternal tracts); breast skin, including the sternal tracts; crop; ceca; and colon. Samples included adhering contamination or lumen contents and were covered with phosphate-buffered saline and blended. Serial dilutions were made for examination of Campylobacter, coliform, Escherichia coli, and total aerobic bacterial populations. Average sample weights (grams) were as follows: feathers, 1.5; skin, 6.5; crop, 5.1; ceca, 7.8; and colon, 3.1. Campylobacter populations (mean log10 colony-forming units per gram of sample) found were feathers, 5.4; skin, 3.8; crop, 4.7; ceca, 7.3; and colon, 7.2. Coliform/E. coli populations observed were feathers, 6.4/6.0; skin, 5.3/4.9; crop, 4.3/3.7; ceca, 6.6/6.2; and colon, 5.8/5.3. Total aerobic bacterial populations found were feathers, 7.9; skin, 7.1; crop, 5.8; ceca, 6.8; and colon, 6.4. On a per gram basis, ceca and colon are the internal organs that if ruptured could cause the highest number of Campylobacter to be leaked onto the carcass. The crop also contained more Campylobacter per gram than did the skin, and if compromised may increase the numbers on the surface of the carcass. However, even with no contamination from an internal organ, a substantial population of Campylobacter is already resident on broiler skin as the carcass enters the early stages of processing.

Abattoirs↗
PubMed1989

Organ donation from intensive care units in England.

OBJECTIVE: To audit all deaths in intensive care units (excepting coronary care only and neonatal intensive care units) in England to assess potential for organ procurement. DESIGN: An audit in which 14 regional health authorities and London special health authorities each designated a regional liaison officer to identify intensive care units and liaise with Department of Health and the Medical Research Council's biostatistics unit in distribution, return, and checking of audit forms. Audit took place from 1 January to 31 March 1989 and will continue to 31 December 1990. SETTING: 278 Intensive care units in England. PARTICIPANTS: Colleagues in intensive care units (doctors, nurses, coordinators, and others), who completed serially numbered audit forms for all patients who died in intensive care. RESULTS: The estimated number of deaths in intensive care units was 3085, and validated audit forms were received for 2853 deaths (92%). Brain stem death was a possible diagnosis in only 407 (14%) patients (about 1700 cases a year) and was confirmed in 282 (10%) patients (an estimated 1200 cases a year). Half the patients (95% confidence interval 45% to 57%) in whom brain stem death was confirmed became actual donors of solid organs. Tests for brain stem death were not performed in 106 (26%) of 407 patients with brain stem death as a possible diagnosis, and general medical contraindication to organ donation was recorded for 48 (17%) of 282 patients who fulfilled brain stem death criteria before cessation of heart beat. The criteria were fulfilled before cessation of heart beat and in the absence of any general medical contraindication to organ donation in 234 patients, 8% of those dying in intensive care (an estimated 1000 cases a year). Consent for organ donation was given in 152 (70%) of 218 cases (64% to 76%) when the possibility of organ donation was suggested to relatives. In only 14 out of 232 families (6%; 3% to 9%) was there no discussion of organ donation with relatives. Corneal suitability was recorded as "not known" in a high proportion (1271; 45%) of all deaths and intensive care units reported only 123 corneal donors (4% of all audited deaths). CONCLUSION: When brain stem death is a possible diagnosis tests should always be carried out for confirmation. Early referral to the transplant team or coordinator should occur in all cases of brain stem death to check contraindications to organ donation. There should be increased use of asystolic kidney donation, and patients should be routinely assessed for suitability for corneal donation. Finally, more publicity and education are necessary to promote consent.

Aged↗
PubMed1985

Chest radiographs in congestive heart failure: response to therapy in acute and chronic heart disease.

Thirty-four men with left ventricular mechanical dysfunction were admitted to an intensive care unit with either an acute myocardial infarction (Group 1, n = 18) or worsening of clinical respiratory signs and symptoms in the setting of a chronic congestive cardiomyopathy (Group 2, n = 16). On admission, all individuals had pulmonary venous hypertension classified as at least Grade 3 by standard radiographic criteria. In each subject, mean pulmonary capillary wedge pressure (mm Hg), extravascular lung water (EVLW) (ml/kg), and chest radiographs were serially evaluated. In the patients in whom pharmacologic therapy successfully returned left ventricular filling pressures to near normal levels (less than or equal to 15 mm Hg), the chest radiograph returned to its baseline level (defined by the discharge radiograph) later in the patients with chronic heart failure (5.1 +/- 1.0 days) than in the patients with acute myocardial infarctions (2.1 +/- 1.2 days, p less than 0.01). Radiographic changes in extravascular water (interstitial and alveolar edema) mirrored changes in EVLW, although EVLW was initially greater in Group 2 (16.3 +/- 1.8 ml/kg) than in Group 1 (10.7 +/- 1.3 ml/kg, p less than 0.01). In the patients in whom filling pressures either worsened or changed less than 3 mm Hg, EVLW and chest radiographs did not markedly change. It is concluded that changes in radiographic pulmonary edema mirror changes in indicator-dilution measurements of EVLW. Radiographic phase lag represents a slow decline in EVLW after therapy for heart failure, which is prolonged in patients with chronic failure and greater EVLW.

Acute Disease↗
PubMed2004

Tumorigenesis facilitated by Pten deficiency in the skin: evidence of p53-Pten complex formation on the initiation phase.

Pten, a tumor suppressor gene, is mutated in various human cancers and in hereditary cancer syndromes, such as Cowden disease. We have previously developed a knockout mouse in which Pten is specifically disrupted in the skin, resulting in hyperproliferation and spontaneous tumorigenesis of the skin keratinocytes. In this study, we further clarified the effects of Pten deficiency in tumorigenesis, by using a two-step model in intact skin of Pten knockout mouse. Although the conventional protocol requires serial exposures to DMBA and TPA, mice deficient for Pten developed skin papilloma within 6 weeks after a single exposure to DMBA, indicating that loss of Pten has a tumor-promoting effect. Serial exposure to DMBA-TPA ointments produced 10-fold more papillomas in the skin of knockout mice than in the wild-type counterpart, suggesting an increased rate of initiation. Therefore, we precisely examined the effect of DMBA. This treatment was highly apoptotic in wild-type mice, whereas the number of apoptotic cells was diminished in Pten-deficient skin. Moreover, primary keratinocytes isolated from Pten-deficient mice were also resistant to the apoptotic effect of DMBA. The status of p53, Pten proteins and downstream targets of p53, such as p21, 14-3-3, and Reprimo, were also examined, and we found that accumulation of p53 protein and up-regulation of p53 targets were delayed in Pten-knockout skin. These observations suggest that Pten is involved in rapid recruitment of p53 in the tumor initiation phase.

9,10-Dimethyl-1,2-benzanthracene↗