A traditional Ugandan Ficus natalensis bark cloth exhibits antimicrobial activity against methicillin-resistant Staphylococcus aureus.

AIMS: Surgical site, soft tissue and wound infections are some of the most prominent causes of healthcare-associated infections (HCAIs). Developing novel antimicrobial textiles and wound dressings may help alleviate the risk of developing HCAIs. We aimed to determine the antimicrobial efficacy of natural Ugandan bark cloth derived exclusively from the Ficus natalensis tree. METHODS AND RESULTS: Antimicrobial contact and disc diffusion assays, coupled with time-kill kinetic assays, demonstrated that bark cloth inhibited the growth of a clinically relevant methicillin-resistant Staphylococcus aureus (MRSA) strain and acted as a bactericidal agent causing a seven-log reduction in bacterial viability. Scanning electron microscopy was used to reveal morphological changes in the bacterial cell ultrastructure when exposed to bark cloth, which supported a proposed mechanism of antimicrobial activity. CONCLUSIONS: The observed antimicrobial properties, combined with the physical characteristics elicited by bark cloth, suggest this product is ideally suited for wound and other skin care applications. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report where a whole bark cloth product made by traditional methods has been employed as an antimicrobial fabric against MRSA. Bark cloth is a highly sustainable and renewable product and this study presents a major advance in the search for natural fabrics which could be deployed for healthcare applications.

Fitting the message to the location: engaging adults with antimicrobial resistance in a World War 2 air raid shelter.

AIMS: There are many different initiatives, global and local, designed to raise awareness of antimicrobial resistance (AMR) and change audience behaviour. However, it is not possible to assess the impact of specific, small-scale events on national and international outcomes-although one might acknowledge some contribution to the individual and collective knowledge and experience-focused 'science capital' As with any research, in preparation for a public engagement event, it is important to identify aims, and appropriate methods whose results might help satisfy those aims. Therefore, the aim of this paper was to develop, deliver and evaluate an event designed to engage an adult audience with AMR. METHODS AND RESULTS: The venue was a World War 2 air raid shelter, enabling comparison of the pre- and postantibiotic eras via three different activity stations, focusing on nursing, the search for new antibiotics and investigations into novel antimicrobials. The use of observers released the presenters from evaluation duties, enabling them to focus on their specific activities. Qualitative measures of audience engagement were combined with quantitative data. CONCLUSIONS: The evaluation revealed that adult audiences can easily be absorbed into an activity-particularly if hands-on-after a brief introduction. SIGNIFICANCE AND IMPACT OF THE STUDY: This research demonstrates that hands-on practical engagement with AMR can enable high-level interaction and learning in an informal and enjoyable environment.

Presence of an SH2 domain in the actin-binding protein tensin.

The molecular cloning of the complementary DNA coding for a 90-kilodalton fragment of tensin, an actin-binding component of focal contacts and other submembraneous cytoskeletal structures, is reported. The derived amino acid sequence revealed the presence of a Src homology 2 (SH2) domain. This domain is shared by a number of signal transduction proteins including nonreceptor tyrosine kinases such as Abl, Fps, Src, and Src family members, the transforming protein Crk, phospholipase C-gamma 1, PI-3 (phosphatidylinositol) kinase, and guanosine triphosphatase-activating protein (GAP). Like the SH2 domain found in Src, Crk, and Abl, the SH2 domain of tensin bound specifically to a number of phosphotyrosine-containing proteins from v-src-transformed cells. Tensin was also found to be phosphorylated on tyrosine residues. These findings suggest that by possessing both actin-binding and phosphotyrosine-binding activities and being itself a target for tyrosine kinases, tensin may link signal transduction pathways with the cytoskeleton.

Adherence to treatment in patients with epilepsy: associations with seizure control and illness beliefs.

OBJECTIVE: This study investigated non-adherence to antiepileptic drug treatment amongst patients with epilepsy in secondary care. The associations between adherence and seizure control, perceptions of illness and medication, anxiety and depression were also examined. METHODS: A cross-sectional study of fifty-four patients with epilepsy were recruited from a hospital epilepsy clinic. RESULTS: Fifty-nine percent were estimated to be non-adherent to medication. There was a negative correlation between adherence and frequency of seizures. Patients with poorly controlled epilepsy were more anxious, and expected a longer duration of their epilepsy. CONCLUSION: Assessment of adherence should be a routine part of management of epilepsy. Further recognition and support should be given to patients who have poor seizure control since they are more likely to be more anxious and have unhelpful illness and treatment beliefs.

Deletion analysis of the rodent selenoprotein W promoter.

To identify regulatory elements in the rat selenoprotein W (SeW) promoter, 2090, 1265, 741, and 404 base pair truncations of genomic DNA lying immediately upstream of the SeW coding sequence were cloned into a luciferase reporter vector (pGL3-Basic from Promega, Madison, WI, USA). 3656 and 406 base pair mouse SeW promoter constructs were also compared. SeW promoter activity was assayed in two rat cell lines: L8 muscle cells and C6 brain cells. The SeW promoter was 2-7 times more active (p<0.01) than SV40 promoter. Promoter activity of constructs of the SeW promoter ranging from 200 base pairs to 51 base pairs gradually decreased to zero in brain cells, but fell precipitously to zero in muscle cells. Some truncations stimulated promoter activity, suggesting the full-length promoter may contain binding sites for factors that suppress SeW expression.

Physical measures for treating depression in dialysis patients.

BACKGROUND: Depression is the most common psychological problem in the chronic dialysis population. The diagnosis of depression in patients on chronic dialysis is confounded by the fact that several symptoms of uraemia mimic the somatic components of depression. It affects their physical, psychological and social well-being. Furthermore, the frequent occurrence of cardiovascular problems and the pharmacokinetic consequences of renal impairment may make drug treatment of depression difficult. OBJECTIVES: The aim of this systematic review was to assess the efficacy and safety of physical measures in the treatment of depression in patients who are dialysed for end-stage renal disease. SEARCH STRATEGY: A comprehensive search strategy was employed to identify all Randomised Controlled Trials (RCTs) relevant to the treatment of depression in patients on chronic dialysis. The following database were searched - MEDLINE (1966-March 2004), EMBASE (1980-March 2004), PSYCHINFO (1872-March 2004), The Cochrane Library (Issue 1, 2004). Authors of included studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened. SELECTION CRITERIA: RCTs comparing drugs with placebo or no treatment, or a comparison of drugs against a combination of electroconvulsive therapy and drugs. DATA COLLECTION AND ANALYSIS: Data were abstracted by two investigators independently onto a standard form and subsequently entered into Review Manager 4.2. Relative risk (RR) for dichotomous data and a (weighted) mean difference (WMD) for continuous data were calculated with 95% confidence intervals (95% CI). MAIN RESULTS: Only one trial, with a total of 12 patients and of eight weeks duration was identified. The trial compared fluoxetine against placebo in depressed patients on chronic dialysis. This study did not show any significant difference in depression scores between the treatment and control groups or safety. AUTHORS' CONCLUSIONS: Firm conclusions on the efficacy of physical methods of treatment cannot be made as we identified only one small RCT that was of short duration. More larger and longer term RCTs are needed in this area. Current screening tools for depression are recognised to have poor specificity in the medically ill due to overlap of somatic symptoms of the medical illness. The development of a valid diagnostic tool would be helpful.

Psychosocial interventions for depression in dialysis patients.

BACKGROUND: Depression is the most common psychological problem in the dialysis population. The diagnosis of depression in dialysis patients is confounded by the fact that several symptoms of uraemia mimic the somatic components of depression. It affects the physical, psychological and social well being of the dialysis population in several ways. OBJECTIVES: The aim of this systematic review was to assess the effectiveness of psychosocial interventions in the treatment of depression in patients who are dialysed for end-stage renal disease. SEARCH STRATEGY: A comprehensive search strategy was employed to identify all randomised controlled trials (RCTs) relevant to the treatment of depression in dialysis patients. The following databases were searched - MEDLINE (1966 - October 2003), EMBASE (1980 - October 2003), PsycINFO (1872 - October 2003) and The Cochrane Library (issue 3, 2003). Authors of potential studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened. SELECTION CRITERIA: RCTs comparing any psychosocial intervention with control intervention or no intervention in depressed dialysis patients. DATA COLLECTION AND ANALYSIS: Data were to be abstracted by two investigators independently onto a standard form and entered into Review Manager 4.2. Relative risk (RR) for dichotomous data and a (weighted) mean difference (MD) for continuous data were to be calculated with 95% confidence intervals (CI). MAIN RESULTS: Despite extensive searching, no RCTs were identified. AUTHORS' CONCLUSIONS: Data were not available to draw conclusions about the effectiveness of psychosocial interventions in the treatment of depression in the chronic dialysis population, as we did not find any RCTs of psychosocial interventions to treat depression in dialysis patients. This review highlights the need for commencing and completing adequately powered RCTs to address the issue of psychosocial interventions for depression in dialysis patients.

Blood selenium and glutathione peroxidase activity in pregnant women: comparative assays in primates and other animals.

The influence of pregnancy on blood selenium levels and glutathione peroxidase (GSH-Px) activity was studied in women. Whole blood and plasma selenium levels decreased whereas erythrocyte and plasma GSH-Px activities increased with the progress of pregnancy. The ratio of erythrocyte GSH-Px activity to whole blood selenium levels was 4- to 5-fold higher in rats and sheep than in primates (humans and monkeys), suggesting that more selenium is associated with GSH-Px in erythrocytes from rats and sheep than from primates. In assays of blood with low GSH-Px activity such as that from humans or selenium-deficient animals, a component of the erythrocyte other than GSH-Px was found to contribute more to the peroxidase activity. Evidence was obtained to indicate that t-butyl hydroperoxide is a better substrate than hydrogen peroxide for the assay of low GSH-Px erythrocyte activity. The length of time that the blood was stored before assay was found to have an effect on erythrocyte GSH-Px activity, and the storage patterns may be dependent on the species of animal from which the blood is drawn.

Selenium distribution in blood fractions of New Zealand women taking organic or inorganic selenium.

Three groups of 11 New Zealand women each received, for 32 wk, yeast tablets with no added selenium (placebo) or 200 micrograms Se/d in tablets either as selenate or as selenium-enriched yeast (SeMet) in a double-blind selenium trial. Plasma and erythrocyte (RBC) samples were collected bimonthly. Gel filtration of plasma from women taking SeMet revealed two major selenium-containing peaks with most of the selenium in the second peak. In contrast, the first peak contained most of the selenium in plasma from women taking selenate. Chromatography of RBC lysates indicated that the majority of the selenium was with hemoglobin (Hb) in women taking SeMet but was about equally distributed between glutathione peroxidase (GSH-Px) and Hb in women taking selenate. The percentage of selenium associated with GSH-Px was found to be greater in RBCs and plasma of women taking selenate than of those taking SeMet.

Age-related changes in protein phosphorylation by rat hepatocytes.

The qualitative and quantitative changes in the phosphorylation of specific proteins in hepatocyte suspension from 5-, 12- and 22-month-old male Fischer F344 rats were analyzed by two-dimensional polyacrylamide gel electrophoresis. No qualitative changes in phosphorylation of individual proteins were observed with age. In addition, very few quantitative changes (less than 2% of proteins studied) in protein phosphorylation were detected. The phosphorylation of two acidic proteins decreased (50%) with age while the phosphorylation of one basic protein increased (300%) with age. The two acidic proteins and one basic protein that showed quantitative changes with age were found predominately in the microsome and nuclear fractions of hepatocytes, respectively. The effect of dietary restriction on the phosphorylation of proteins in male Fischer F344 rats was also studied. Although, dietary restriction alters the age-related incident of disease and prolongs longevity, it did not have any significant effect on phosphorylation of individual proteins in the liver.

Medical care use and expenditure among children and youth in the United States: analysis of a national probability sample.

Good access to health care for all US children and youth remains an important social policy goal. Recent patterns of access as reflected in the presence of regular care sources, health care use, health insurance coverage, and expenditures for medical care are described and analyzed using the subsample of all children 0 to 18 years of age from the 1980 National Medical Care Utilization and Expenditure Survey. Data from the survey indicate that in 1980, 92% of US children and youth had a regular care source and the same percentage were covered for the full year or part of the year by some form of public or private health insurance. However, use rates and patterns of expenditure continued to differ dramatically according to family background factors, particularly race, ethnicity, poverty status, and location of residence. These differences are analyzed and comparative data are presented for groups of children from various sociodemographic groups. Minority-group and near-poor children were found to be at highest risk for limited utilization of services and inadequate insurance coverage.

Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas.

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05); Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

Evaluation of children with possible appendicitis using technetium 99m leukocyte scan.

We evaluated the use of technetium 99m albumin colloid white blood cell (TAC-WBC) scan in 33 children with possible appendicitis. Ten children had appendicitis, four of whom had perforated their appendix at the time of surgery. Children with appendicitis differed from children without appendicitis in the incidence of right lower quadrant rebound tenderness (60% vs 17.4%), and white blood cell count (X10(3)/mm3) (14.0 + 1.9 vs 10.7 +/- 1.0). TAC-WBC scans were interpreted as either positive, negative, or indeterminate for appendiceal pathology. Twenty-five children had positive or negative scans for appendiceal pathology. There were 7 true positives, 2 false positives, 16 true negatives, and 0 false negatives. This resulted in a sensitivity of 100%, a specificity of 89%, an accuracy of 92%, a positive predictive value of 78%, and a negative predictive value of 100%. The TAC-WBC scan was indeterminate (abnormal but nondiagnostic for appendicitis) in eight children (24%), three of whom had appendicitis. The main values of TAC-WBC scan in our study of children with possible appendicitis were that it could be used emergently, it was abnormal in 100% of children with appendicitis, and it had a high negative predictive value (100%). The main limitation of TAC-WBC scan in our study was that it was indeterminate for appendiceal pathology in 24% of children. We recommend that TAC-WBC scan be used in children with possible appendicitis because it may allow outpatient management of up to 48%.

Evidence for oestrogen receptor alpha-immunoreactivity in gonadotrophin-releasing hormone-expressing neurones.

Having used the cingulate cortex to demonstrate the validity of our methods for detecting hitherto unrecognized oestrogen receptor alpha (ERalpha)-immunoreactive neurones, we have now employed immunoprecipitation and double-label immunohistochemistry to investigate whether the ERalpha protein is present in gonadotrophin-releasing hormone (GnRH)-containing cells. The immortalized GnRH cell line GT1-7 and GnRH neurones within the rat preoptic area were found to possess ERalpha-immunoreactivity (ERalpha-IR). These observations indicate that oestrogen may regulate the synthesis and release of GnRH by direct actions on GnRH neurones.

Evidence for extensive distribution of oestrogen receptor alpha-immunoreactivity in the cerebral cortex of adult rats.

The presence of oestrogen receptor alpha (ERalpha)-immunoreactivity (IR) in the cerebral cortex of adult rats has been investigated. Previous studies have reported a negligible presence of ERalpha or ERalpha mRNA in this region of the adult rat brain. We have used immunoprecipitation and immunohistochemistry, with various antibodies and fixatives, to detect this protein in the cingulate cortex. When the tissue was fixed using paraformaldehyde alone only faint ERalpha-IR was observed at this site. In contrast, following fixation either with acrolein (with or without paraformaldehyde) or with a mixture of paraformaldehyde and glutaraldehyde there was extensive ERalpha-IR throughout layers II to VI; this was absent when the antibodies were preincubated with the peptide fragment used in their production. The presence of ERalpha-IR in the nonfixed cingulate cortex of adult rats was confirmed by immunoprecipitation.

Oestrogen receptor beta-immunoreactivity in gonadotropin releasing hormone-expressing neurones: regulation by oestrogen.

Double-label immunohistochemistry was employed to establish whether immunoreactivity for the beta subtype of the oestrogen receptor (ER beta-IR) is present in gonadotropin releasing hormone (GnRH)-containing cells. In the immortalized GnRH cell line, GT1-7, almost all nuclei were immunoreactive for ER beta. In the preoptic area of ovariectomized rats, more than one-half of the GnRH neurones (52.0-63.5%) contained ER beta-IR within the nucleus; a smaller proportion of these neurones (5-10%) displayed a particularly intense nuclear signal for ER beta. The presence of ER beta-IR in the nuclei of GT1-7 cells and GnRH neurones is consistent with recent reports of ER beta mRNA in these cells. Oestrogen treatment reduced the percentage of GnRH neurones with detectable ER beta-IR. The range of signal intensity for ER beta and the incidence of the ER beta signal in GnRH neurones were comparable following double-label immunohistochemistry involving either bright field or fluorescent techniques. These findings raise the possibility that ER beta receptors mediate direct effects of oestrogen on GnRH neurones.

Efficacy of directed percutaneous fine-needle aspiration cytology in the diagnosis of intra-abdominal masses.

Directed percutaneous fine-needle aspiration (FNA) cytology was performed on 113 patients with intra-abdominal masses. The 47 male and 56 female patients had a median age of 56 years (range, 17 to 83 years). Computed tomography (CT) was used to localize the needle in 90 cases, and ultrasonography was used in the remaining 24 cases. The predominant sites aspirated were the liver (n = 40), pancreas (n = 23), and pelvis (n = 14). Seventy-eight of the 113 patients had a malignant neoplasm. Fine-needle aspiration cytology correctly identified 63 (88%) of the 78 cases. There were no false-positive studies. Computed tomography and UTZ ultrasonography were equally sensitive in detecting malignant neoplasms. In 38 patients with a history of previously treated malignant neoplasm, percutaneous aspiration cytology confirmed the presence of recurrent disease in 24 (75%) of 32 patients. Results of aspiration cytology obviated the need for a diagnostic laparotomy in 51 (65%) of the 78 patients with a malignant neoplasm. There was no serious morbidity or mortality associated with the procedure. We conclude that CT/ultrasonography-directed percutaneous FNA cytology is the procedure of choice in the workup of patients with intra-abdominal masses. The specificity is 100% and sensitivity is 90%. It is particularly useful in patients with extensive disease that would not be palliated by operation.

Repeated laparotomy for postoperative intra-abdominal sepsis. An analysis of outcome predictors.

To identify factors modifying the outcome of reoperation for intra-abdominal infection, we analyzed the management of 47 patients who underwent repeated laparotomy from July 1980 through July 1985. Overall mortality was 30% (14/47). Factors predictive of death were as follows: age greater than 60 years (86% mortality vs 21% mortality), preoperative vs no organ failure (57% vs 6%), multiple vs single abscess (53% vs 16%), and exploratory vs directed operative approach (39% vs 17%). Although the interval between the primary surgery and reoperation was similar between survivors (13 days) and nonsurvivors (14 days), five (36%) of 14 nonsurvivors were in septic shock and eight (57%) of 15 survivors showed evidence of organ failure prior to reoperation. The median survival period following reoperation in this group was only four days. Computed tomography (CT) and/or ultrasonography were performed to localize a source of infection in 24 patients. In nine (82%) of 11 patients, CT identified the abscess, while ultrasonography was positive in 15 (72%) of 21 patients. Neither the interval to operation nor the mortality was significantly different in patients diagnosed with CT and ultrasonography when compared with those who underwent exploration on the basis of clinical findings. To lower the mortality and to shorten the interval to reoperation in these high-risk patients, noninvasive diagnostic testing and confirmation by percutaneous sampling must be sought before the onset of clinical sepsis and organ failure.

Accuracy of combined clinical-mammographic-cytologic diagnosis of dominant breast masses. A prospective study.

Excisional biopsy is considered a mandatory part of the workup for patients with dominant breast masses. To evaluate the efficacy of a combined physical, mammographic, and fine-needle aspiration cytologic examination, 113 women were prospectively evaluated. Breast masses were listed as either benign or suspicious/malignant. All patients underwent a subsequent biopsy. Fifty-two (46%) of 113 patients had a malignant mass. The sensitivity and specificity of the individual tests were as follows: 96% and 66% for the physical examination; 94% and 73% for the mammographic examination; 90% and 93% for the fine-needle aspiration cytologic examination. For the 86 patients who underwent all three studies, the 25 patients with benign test results on all three examinations had a benign pathologic result. One (6%) of 18 patients with a single suspicious/malignant test result had cancer, 9 (64%) of 14 patients with two suspicious/malignant test results and 28 (97%) of 29 patients with three suspicious/malignant results also had breast cancer. We conclude that the combined triad of physical, mammographic, and fine-needle aspiration cytologic examinations is highly accurate in the diagnosis of breast masses, and patients in whom all three examination results are benign can be safely observed, obviating the need for an open biopsy.

Value of measuring hormone receptor levels of regional metastatic carcinoma of the breast.

To assess the value of measuring the estrogen- and progesterone-receptor content of metastatic nodal disease, 38 women with node-positive breast cancer were prospectively evaluated. Receptor content of the primary tumor and a pathologically confirmed positive node were measured simultaneously using a dual-isotope, dextran-coated, charcoal-binding assay. A receptor content of greater than or equal to 10 fmol/mg of cytosol protein was considered positive for both the estrogen-receptor and progesterone-receptor assays. Overall concordance between the primary tumors and the nodal metastases was 82% (31/38 patients) for the estrogen-receptor measurements and 84% (31/37 patients) for the progesterone-receptor measurements. Paired receptor levels were significantly correlated: r = .745 for the estrogen-receptor measurements and r = .805 for the progesterone-receptor measurements. Despite this correlation, 6 (25%) of 24 patients with an estrogen receptor-positive primary tumor had an estrogen receptor-negative nodal metastasis. Four (20%) of 20 patients with a progesterone receptor-positive primary tumor had a progesterone receptor-negative nodal metastasis. Six (24%) of 25 patients with tumors labeled as hormonally sensitive on the basis of the receptor content of the primary tumor had receptor-negative nodal disease. In reflecting the hormonal status of the more aggressive elements of the primary tumor, receptor levels of metastatic nodes may provide more useful information than the levels of the primary tumor as a guideline for further therapy.