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Laboratory-acquired West Nile virus infections--United States, 2002.

West Nile virus (WNV), a mosquito-borne flavivirus introduced recently to North America, is a human, equine, and avian neuropathogen. The majority of human infections with WNV are mosquito-borne; however, laboratory-acquired infections with WNV and other arboviruses also occur. This report summarizes two recent cases of WNV infection in laboratory workers without other known risk factors who acquired infection through percutaneous inoculation. Laboratory workers handling fluids or tissues known or suspected to be WNV-infected should minimize their risk for exposure and should report injuries and illnesses of suspected occupational origin to their supervisor.

Accidents, Occupational↗

Manual pressure distension of the human saphenous vein changes its biomechanical properties-implication for coronary artery bypass grafting.

Patency rates of saphenous vein grafts following coronary artery bypass grafting (CABG) depend on multiple factors. Information regarding the impact of biomechanical properties of vein grafts on patency rates is not available. The objective of the present study was to evaluate whether uncontrolled manual pressure distension during routine preparation of the saphenous vein in CABG-induced changes in the biomechanical properties of the vein. The morphometric and stress-strain properties were studied in isolated segments of the saphenous vein from 12 patients undergoing elective CABG. Six segments were manually distended without pressure control and six were not distended. The mechanical test was performed as a ramp inflation using syringe pump. The vein dimensions were obtained from digitised images at different pressures as well as at the no-load and zero-stress states. The circumferences, the wall and lumen area, the wall thickness, and the outer diameter as function of the applied pressure were largest in the segments with uncontrolled manual distension compared to those without distension (P<0.05). The opening angle and the absolute value of the residual strains were lower (P<0.01) and the circumferential stress-strain curve shifted to the left, indicating the wall became stiffer with uncontrolled manual distension compared to those without distension (P<0.05). In conclusion, manual pressure distension changed the morphometric and biomechanical properties of the saphenous vein. The perspective is that studies on biomechanical properties on the saphenous vein may guide surgeons how to handle graft material without causing major changes of the biomechanical properties during harvesting and preparation.

Aged↗

Mastering the infant donor eye: a new device for obtaining corneoscleral buttons for storage and corneal discs for keratoplasty.

The design and use of a new device for obtaining corneoscleral buttons for storage and corneal discs for keratoplasty from neonatal and adult donor eyes is described. The device is simple to use and eliminates most of the difficulties in handling infant donor eyes. It thus minimises the risk of damage to the corneal endothelium and the formation of stretch striae, which reduce the quality of the donor material for transplantation.

Adult↗

Effect of storage time of pleural effusions on immunocytochemical cell surface analysis of tumor cells.

To determine how long tumor cells can be stored without losing their immunocytochemical reactivity, five malignant pleural effusions in EDTA-coated tubes were analyzed after different storage times at either 4 degrees C or room temperature. Only minor differences were observed between the cells from the two storage conditions. Though there was a considerable decrease in the number of tumor cells attached to the slides from day 0 to 1, the number of tumor cells was still sufficient to allow their clear detection with the monoclonal antibody HEA-125 even on day 4 of storage in all cases. Therefore, for routine purposes, pleural fluids in EDTA-coated tubes can be stored for at least one day prior to immunocytochemical staining if the cells are gently handled during preparation. Pleural fluid is a richly nutritious medium not only for keeping cells alive but also for preserving their immunoreactivity.

Antigens, Neoplasm↗

Effects of sample handling on total carbon dioxide concentrations in canine and feline serum and blood.

OBJECTIVE: To determine whether underfilling blood collection tubes leads to in vitro reduction in serum measured total CO2 concentration ([TCO2]m) in canine and feline blood samples sufficient to create the impression of metabolic acidosis (pseudometabolic acidosis) or high anion gap. SAMPLE POPULATION: Blood samples from healthy client-owned animals (16 dogs, 17 cats). PROCEDURE: Venous blood samples were collected in random order for determination of serum [TCO2] and blood gas tensions. Blood gas analysis was performed on iced, capped blood samples. In dogs, serum [TCO2] was measured in 1-, 3-, and 10-ml samples in 10-ml type-B tubes and in a 3-ml sample in 3-ml type-A tubes. In cats, serum [TCO2] was determined in 1-, 2-, and 3-ml samples in 3-ml type-A tubes and in a 3-ml sample in 10-ml type-B tubes. RESULTS: For dogs, serum [TCO2] in full-tube, 10-ml samples was a mean +/- SD, 2.0 +/- 1.1 mmol/L greater than that in 3-ml samples and 3.7 +/- 1.3 mmol/L greater than the value in 1-ml samples; both differences were significant at P < 0.0001. The serum [TCO2] in full 3-ml samples was lower by 0.4 +/- 0.6 mmol/L than the value in full-tube 10-ml samples (P = 0.019). For cats, serum [TCO2] in full-tube, 3-ml samples was 0.5 +/- 0.6 mmol/L greater than that in 2-ml samples (P = 0.004) and was 1.5 +/- 0.8 mmol/L greater than the value in 1-ml samples (P < 0.0001). Serum [TCO2] in 3-ml samples of feline blood in 10-ml tubes was 0.8 +/- 0.8 mmol/L lower than that in samples from full 3-ml tubes (P = 0.0007). In dogs and cats, [TCO2] in fully filled collection tubes was approximately 6 mmol/L higher when calculated from blood gas analysis data than when chemically determined in serum. CONCLUSIONS AND CLINICAL RELEVANCE: Underfilling blood collection tubes results in a false decrease in serum [TCO2], which can contribute in part to descrepancies between blood gas and chemical analyses as estimates of plasma bicarbonate concentration. This, and other in vitro effects of sample handling and collection, may result in a false assessment of metabolic acidosis in dogs and cats.

Acidosis↗

Llama medicine. Physical examination, restraint and handling.

Llamas are generally docile, easily handled domestic animals. Special chutes have been designed for safe, efficient restraint for examination and diagnostic procedures, most of which are commonly performed on other species. Anatomic differences make some of these procedures unique to the llama.

Animals↗

Trauma and forensic medicine.

Trauma physicians are frequently involved in the evaluation and treatment of patients who are victims of crimes or themselves criminals. These physicians usually have little or no training in the forensic aspects of emergency medical care and therefore necessary evidence may often be overlooked, lost, inadvertently discarded, or its admissibility denied because of improper handling or documentation. Criteria were developed to evaluate the forensic medical aspects of such trauma cases and to discern the magnitude of the problem. The majority of the cases reviewed demonstrated significant forensic medical deficiencies primarily in the areas of documentation and/or handling or securing of evidence. Trauma physicians have the responsibility and potential liability to insure that necessary evidence is properly secured and preserved while caring for their patients. Educational programs should be developed for this purpose.

Accidents↗

Automated biological agent testing systems.

The events of September 11, 2001 revealed a need for regular monitoring of infrastructure systems. Efficient aerosol collection systems are currently in place in a variety of settings in order to sample the immediate surroundings. However, the consequence of regular monitoring is an exponential increase in the number of samples requiring rapid analysis. Automated biological agent testing systems offer a solution by providing the ability to rapidly handle large numbers of samples with fewer personnel. In addition, automated testing also offers the advantage of increased consistency and accuracy compared with human systems.

Automation↗

Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine.

OBJECT: There have been significant improvements in neurovascular technology and implants over the past decade. One such material, N-butyl cyanoacrylate (NBCA), is now commercially available for cerebral arteriovenous malformation (AVM) embolization in the US. An ethylene vinyl alcohol copolymer preparation, Onyx, which is currently being evaluated, is approved for use outside North America. Although reports indicate that Onyx may be superior to NBCA from an endovascular perspective, little information exists about its surgical handling characteristics. The purpose of this study was to compare the surgical handling characteristics of Onyx-treated vessels with those of NBCA-embolized vessels in an AVM resection model. METHODS: Fourteen pigs (two groups of seven) were anesthetized. A femoral artery was cannulated, followed by selective catheterization of the ascending pharyngeal arteries. Nidal rete mirabile (RM) embolizations were performed using either 6% Onyx or 20% NBCA. After angiographically confirmed obliteration of flow in the right RM, microsurgical resection of this structure was performed. Surgical handling characteristics of the embolized RM were rated on a scale of 1 to 5 and blood loss was recorded. Different surgeons performed the embolizations and resections. The surgeon who performed resections was blinded to the embolization agent used, and the data analysis was also performed in a blinded fashion. The surgical handling scores were superior (p < 0.05) in the Onyx-treated group. Although there was also less blood loss in this group, the difference was not significant. Subjectively, the surgeon who performed the resections believed that Onyx was softer and handled better than NBCA. CONCLUSIONS: Onyx, which may offer endovascular advantages, also seems to provide benefits for the surgeon.

Animals↗

Sample handling and stability of hepatocyte growth factor in blood samples.

As regards clinical studies performed on hepatocyte growth factor (HGF) during recent years, we have aimed in the present study to investigate the eventual differences in sample handling of this cytokine that might influence the results of serum concentrations. Venous blood from patients with current infectious diseases and controls was used in different sub-studies. Compared with samples separated within one hour, no significant changes in serum HGF levels were observed when whole blood stayed 4, or 24h at 6 degrees C before or 6h in room temperature after separation but HGF levels were significantly higher (P<0.01) when whole blood was kept at room temperature 4 and 24h before separation. Serum HGF was stable up to 20 freeze-thaw cycles. The serum concentrations of HGF were significantly higher than levels in the plasma (19%; P<0.05). A significant increase in serum HGF levels (12%, P<0.05) was observed after shaking the whole blood sample to a visible haemolysis, although the HGF concentration in blood cells was around half of that in serum. HGF tolerated storage at -70 degrees C for at least 4 months. We conclude that standardized methods in sample handling are important in the study of HGF concentrations in blood samples.

Adolescent↗

Quantitative assessment of carbon tetrachloride levels in human blood by head-space gas chromatography: application in a case of suicidal carbon tetrachloride intoxication.

A head-space gas chromatographic method for the determination of carbon tetrachloride in human blood is described. Standard samples with 0.5 ml whole blood containing different concentrations of CCl4 were analyzed at column temperatures ranging from 50 degrees to 90 degrees C. Advantages of this method include high sensitivity, simplicity in handling, rapid achievement of reliable results, accuracy and low costs. The practicability of this analytical method was studied in a patient following suicidal oral ingestion of a lethal dose of carbon tetrachloride.

Adult↗

The laboratory as an aid to clinical diagnosis.

The clinician may use the clinical pathology laboratory as a valuable aid to diagnosis and management, for the assessment of response to treatment, and in preventive medicine programs. Each "link in the chain," that is, sample selection, collection, handling, analysis, result reporting, and interpretation must be carefully and efficiently managed, using an informed combination of art and science, to provide a useful endpoint. This general introduction precedes more specific and detailed articles.

Animals↗

Buccal DNA collection: comparison of buccal swabs with FTA cards.

Collection and analysis of DNA, most commonly from blood or buccal cells, is becoming more common in epidemiologic studies. Buccal samples, which are painless to take and relatively easily collected, are often the preferred source. There are several buccal cell collection methods: swabs, brushes, mouthwash, and treated cards, such as FTA or IsoCode cards. Few studies have systematically compared methods of buccal cell collection with respect to DNA yield and amplification success under similar conditions. We compared buccal DNA collection and amplification using buccal swabs and FTA cards in 122 control subjects from our Australian case-control study of childhood acute lymphoblastic leukaemia. Buccal DNA was quantified using a real-time PCR for beta-actin and genotyped at the loci of three polymorphisms (MTHFR 677C>T, ACE I/D, and XPD 1012G>A). PCR was successful with DNA from buccal swabs for 62% to 89% of subjects and from FTA cards for 83% to 100% of subjects, depending on the locus. The matched pair odds ratios (95% confidence interval) comparing success of FTA cards with buccal swabs are as follows: MTHFR 677C>T using PCR-RFLP, 12.5 (11.6-13.5) and using real-time PCR, 130.0 (113.1-152.8); ACE I/D using PCR-amplified fragment length polymorphism, 3.36 (3.2-3.5); XPD 1012G>A using real-time PCR, 150.0 (132.7-172.3). FTA cards are a robust DNA collection method and generally produce DNA suitable for PCR more reliably than buccal swabs. There are, however, technical challenges in handling discs punched from FTA cards that intending users should be aware of.

Cheek↗

Effects of season and sample handling on measurement of plasma alpha-melanocyte-stimulating hormone concentrations in horses and ponies.

OBJECTIVE: To investigate effects of sample handling, storage, and collection time and season on plasma alpha-melanocyte-stimulating hormone (alpha-MSH) concentration in healthy equids. ANIMALS: 11 healthy Standardbreds and 13 healthy semiferal ponies. PROCEDURE: Plasma alpha-MSH concentration was measured by use of radioimmunoassay. Effects of delayed processing were accessed by comparing alpha-MSH concentrations in plasma immediately separated with that of plasma obtained from blood samples that were stored at 4 degrees C for 8 or 48 hours before plasma was separated. Effects of suboptimal handling were accessed by comparing alpha-MSH concentrations in plasma immediately stored at -80 degrees C with plasma that was stored at 25 degrees C for 24 hours, 4 degrees C for 48 hours or 7 days, and -20 degrees C for 30 days prior to freezing at -80 degrees C. Plasma alpha-MSH concentrations were compared among blood samples collected at 8:00 AM, 12 noon, and 4:00 PM. Plasma alpha-MSH concentrations were compared among blood samples collected in January, March, April, June, September, and November from horses and in September and May from ponies. RESULTS: Storage of blood samples at 4 degrees C for 48 hours before plasma was separated and storage of plasma samples at 4 degrees C for 7 days prior to freezing at -80 degrees C resulted in significant decreases in plasma alpha-MSH concentrations. A significantly greater plasma alpha-MSH concentration was found in September in ponies (11-fold) and horses (2-fold), compared with plasma alpha-MSH concentrations in spring. CONCLUSIONS AND CLINICAL RELEVANCE: Handling and storage conditions minimally affected plasma alpha-MSH concentrations. Seasonal variation in plasma alpha-MSH concentrations must be considered when evaluating pituitary pars intermedia dysfunction in equids.

Analysis of Variance↗

[A model for estimation of productivity and costs at a deparment of histopathology].

Two cost calculation models were used. The "top down" model calculated an average cost of all investigations; this proved suitable for the calculation of the costs of autopsies and electron microscopical specimens. The "bottom up" model calculated the cost of an individual investigation, depending on the resources used in handling each particular specimen; it was necessary to adopt this model for specimens sent for microscopy. Information about the type of specimen and technical details were registered in a computer system. Production was registered in points and the costs were distributed between the clinical departments. The study showed that the cost of the histological specimens varied considerably depending on the material received from the clinical departments. A model using points for technical details in a department of cyto- and histopathology is suitable for calculating production and cost.

Autopsy↗

Comparison of sample storage protocols for the determination of nutrients in natural waters.

There have been several reports on storage protocols for the determination of nutrients in natural waters but each one has been limited to a particular sample matrix and they have reached different, matrix specific conclusions. The aim of this study was therefore to systematically apply the various recommended storage protocols to a range of natural water matrices. Samples from four contrasting sites in the UK, collected in late winter (February, 1999), were filtered and stored under different conditions (-80 degrees C, -20 degrees C, 4 degrees C and at 4 degrees C and -20 degrees C with 0.1% (v/v) chloroform) for up to 247 days prior to analysis. The sites were the River Frome in Dorset (a chalk stream catchment) and three sites from the Tamar Estuary (draining a non-chalk catchment) with salinities of 0.5 per thousand, 10 per thousand and 34 per thousand, Samples and controls were analysed for total oxidised nitrogen (TON) and filterable reactive phosphorus (FRP) using a segmented flow analyser with spectrophotometric detection. To investigate possible seasonal effects (particularly changes in biological and chemical matrix composition). a second sampling campaign was undertaken in early autumn (October, 1999). The results showed that the optimum storage conditions for the determination of TON and FRP were highly matrix dependent. with significant differences in FRP stability between the Frome and Tamar catchments (due to different calcium concentrations) and between samples of different salinities (due to different bacterial populations and/or dissolved organic matter). General guidelines for sample handling and storage are listed and matrix specific recommendations presented for samples rich in calcium and dissolved organic matter.

Calcium↗

An improved procedure for enzymatic harvesting of highly purified canine venous endothelial cells for experimental small diameter vascular prostheses.

We developed a new device, the vein holder, to improve yield and purity of enzymatic harvests of venous endothelial cells. External jugular veins of mongrel dogs were dissected by a no-touch technique. In vitro length and circumference of the vein segments were decreased to about half of the in situ dimensions. The vein holder enabled mounting of the veins at 80% of their in situ length during endothelial cell harvesting. Trypan blue staining and scanning electron microscopic observations revealed that vein eversion as well as the new vein holder technique successfully removed the endothelium. Endothelial cell harvests by the eversion technique were, however, low and varied in size, viability, and purity. In contrast, the defined handling by the new vein holder technique regularly provided markedly increased amounts of endothelial cells. Most of the cells attached and developed cultures consisting of endothelial cells only, as shown by the uptake of DilAcLDL. Prostacyclin production of confluent cultures was similar to that of native veins. It is concluded that minimal handling, defined mounting, and prevention of overfilling the vein markedly improves endothelial cell harvests, providing greater amounts of viable and purified endothelial cells.

Animals↗