RESUMEN
Australia is unique as a populated continent in that canine rabies is exotic, with only one likely incursion in 1867. This is despite the presence of a widespread free-ranging dog population, which includes the naturalized dingo, feral domestic dogs and dingo-dog cross-breeds. To Australia's immediate north, rabies has recently spread within the Indonesian archipelago, with outbreaks occurring in historically free islands to the east including Bali, Flores, Ambon and the Tanimbar Islands. Australia depends on strict quarantine protocols to prevent importation of a rabid animal, but the risk of illegal animal movements by fishing and recreational vessels circumventing quarantine remains. Predicting where rabies will enter Australia is important, but understanding dog population dynamics and interactions, including contact rates in and around human populations, is essential for rabies preparedness. The interactions among and between Australia's large populations of wild, free-roaming and restrained domestic dogs require quantification for rabies incursions to be detected and controlled. The imminent risk of rabies breaching Australian borders makes the development of disease spread models that will assist in the deployment of cost-effective surveillance, improve preventive strategies and guide disease management protocols vitally important. Here, we critically review Australia's preparedness for rabies, discuss prevailing assumptions and models, identify knowledge deficits in free-roaming dog ecology relating to rabies maintenance and speculate on the likely consequences of endemic rabies for Australia.
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Enfermedades de los Perros/prevención & control , Enfermedades de los Perros/transmisión , Rabia , Animales , Animales Salvajes , Australia/epidemiología , Conducta Animal , Mordeduras y Picaduras/virología , Bases de Datos Factuales , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/virología , Perros , Europa (Continente)/epidemiología , Humanos , Rabia/epidemiología , Rabia/prevención & control , Rabia/transmisión , Vacunas Antirrábicas , Investigación , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Ganglia of the knee joint are rare and are mostly an incidental finding during arthroscopy or MRI examinations. Usually their origin is intraarticular, arising from the menisci or ACL or PCL. Ganglia arising from the infrapatellar fat pad are rare and only few are mentioned in the literature. We report a case of infrapattellar ganglion in a 41-year-old female, which developed from the infrapattellar fad pad and with minimal intraarticular extension.
Asunto(s)
Ganglión/cirugía , Articulación de la Rodilla/cirugía , Tejido Adiposo/patología , Adulto , Femenino , Ganglión/patología , Humanos , Articulación de la Rodilla/patología , Imagen por Resonancia MagnéticaRESUMEN
We present a case of progressive atlanto-occipital dislocation, recognized by a new onset of positive neurologic findings. We discuss the anatomic relationship of the lower four cranial nerves to the foramen magnum and the atlanto-occipital joint. The importance of careful assessment of the cranial nerves prior to choosing a treatment algorithm is emphasized.
Asunto(s)
Articulación Atlantooccipital/diagnóstico por imagen , Articulación Atlantooccipital/lesiones , Deformidades Adquiridas de la Articulación/diagnóstico , Deformidades Adquiridas de la Articulación/etiología , Luxaciones Articulares/complicaciones , Luxaciones Articulares/diagnóstico , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/etiología , Adulto , Articulación Atlantooccipital/cirugía , Humanos , Deformidades Adquiridas de la Articulación/cirugía , Luxaciones Articulares/cirugía , Imagen por Resonancia Magnética , Masculino , Enfermedades del Sistema Nervioso/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Traumatismos de la Rodilla/diagnóstico , Traumatismos de los Tendones/diagnóstico , Accidentes por Caídas , Diagnóstico Diferencial , Humanos , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Rotura Espontánea/diagnóstico , Traumatismos de los Tendones/etiología , Traumatismos de los Tendones/cirugíaRESUMEN
Administration of exogenous endothelin-1 (ET-1) has been shown to stimulate neointimal hyperplasia following arterial balloon angioplasty (BA). However, the specific effects of ET-1 on the cellular and extracellular matrix response of the vessel wall after balloon injury and the persistence of these ET-1 effects have not been studied. The objectives of this study were to determine the acute (1 week) and long term (10 weeks) effects of administering exogenous ET-1 after arterial BA on neointimal hyperplasia, collagen synthesis and content, cellular proliferation, and ET(A) and ET(B) receptor expression. Thirty-one rabbits were randomized to receive subcutaneous ET-1 (500 pmol/kg/day for 1 week) or placebo time-release pellets and sacrificed at either 1 or 10 weeks after BA. At 1 week, there was a significant two-fold increase in intimal cross-sectional area (CSA) in ET-1 treated animals compared with placebo. ET-1 treated animals showed significant increases in collagen synthesis (ten-fold) and collagen content (three-fold) compared to placebo treated animals. ET-1 treated animals also had a significant increase (two-fold) in proliferation rates. In addition, ET(A) and ET(B) receptor expression were significantly upregulated in ET-1 treated animals. By 10 weeks these stimulatory effects on intimal CSA and collagen content were no longer evident with a 'catch up' phenomenon observed in the placebo treated animals. Similarly, ET(A) and ET(B) mRNA levels had declined significantly in both groups. Therefore, exogenous ET-1 acutely stimulates extracellular and cellular processes including increased expression of ET(A) and ET(B) receptors contributing to intimal hyperplasia. However, these effects are transient and not maintained long term after withdrawal of exogenous ET-1 stimulation.
Asunto(s)
Angioplastia de Balón/efectos adversos , Endotelina-1/farmacología , Túnica Íntima/patología , Análisis de Varianza , Animales , División Celular/efectos de los fármacos , Colágeno/metabolismo , Implantes de Medicamentos , Matriz Extracelular/metabolismo , Expresión Génica/efectos de los fármacos , Hiperplasia , Masculino , Microscopía Confocal , Modelos Animales , ARN Mensajero/análisis , Conejos , Distribución Aleatoria , Receptores de Endotelina/genética , Receptores de Endotelina/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estadísticas no Paramétricas , Estimulación Química , Factores de Tiempo , Túnica Íntima/metabolismoRESUMEN
Increased proteolytic activity may be a factor in intimal hyperplasia after balloon angioplasty (BA). The objectives of this study were to assess elastase activity after BA in a rabbit arterial double-injury model and the effects of elastase inhibition. Elastase activity increased immediately after BA, reached an 8-fold peak at 1 week, and declined to baseline levels by 4 weeks. Elastin zymography showed that the elastase activity was associated predominantly with a molecular mass of 25 kDa. Elastase activity was significantly inhibited in vitro by elafin and phenylmethylsulfonyl fluoride, selective inhibitors of serine elastases. A second group of animals was transfected after BA with a plasmid containing the cDNA for either elafin or a control (chloramphenicol acetyltransferase, CAT) construct by using a hemagglutinating virus of Japan-liposome transfection technique. Arterial segments were obtained at 48 hours, 1 week, and 4 weeks to assess transgene expression, arterial wall elastase activity, and intimal cross-sectional area, respectively. Elafin transgene expression was evident at 48 hours and resulted in a significant (80%) inhibition of elastase activity compared with chloramphenicol acetyltransferase-transfected arteries. There was a 43% reduction in intimal cross-sectional area in elafin-transfected arteries (0.28+/-0.22 versus 0.16+/-0.07 mm(2) for CAT-transfected versus elafin-transfected arteries, respectively; P<0.05). These data suggest that an early increase in serine elastase activity after BA contributes to intimal hyperplasia. Serine elastase inhibition may be a potential therapeutic approach to inhibit intimal hyperplasia.
Asunto(s)
Angioplastia de Balón , Arterias/enzimología , Arteriosclerosis/patología , Arteriosclerosis/terapia , Elastasa Pancreática/antagonistas & inhibidores , Elastasa Pancreática/metabolismo , Proteínas/farmacología , Inhibidores de Serina Proteinasa/farmacología , Túnica Íntima/enzimología , Túnica Íntima/patología , Animales , Arterias/patología , Arteriosclerosis/enzimología , Arterias Carótidas , ADN Complementario , Electroforesis en Gel de Poliacrilamida , Hiperplasia , Arteria Ilíaca , Inmunohistoquímica , Liposomas , Modelos Animales , Músculo Liso Vascular/enzimología , Plásmidos , Proteínas Inhibidoras de Proteinasas Secretoras , Proteínas/genética , ARN Mensajero/análisis , Conejos , Respirovirus , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transfección , TransgenesAsunto(s)
Adenocarcinoma Mucinoso/secundario , Neoplasias Óseas/secundario , Neoplasias Ováricas/diagnóstico , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/terapia , Carboplatino/administración & dosificación , Terapia Combinada , Resultado Fatal , Femenino , Humanos , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Paclitaxel/administración & dosificación , Dolor de Hombro/etiologíaRESUMEN
BACKGROUND: Restenosis complicates 30% to 40% of angioplasty procedures and may be unrelated to traditional coronary risk factors. Homocysteine, lipoprotein(a), and methylenetetrahydrofolate reductase (MTHFR 677T) (a genetic determinant of plasma homocysteine concentrations) are novel risk factors for coronary artery disease. Their roles in restenosis are unclear, and the potential synergism between homocysteine and lipoprotein(a) has not previously been studied. The objective of this study was to determine the relations among homocysteine, lipoprotein (a), MTHFR 677T, and restenosis after percutaneous transluminal coronary angioplasty. METHODS: This prospective study enrolled patients with successful elective percutaneous transluminal coronary angioplasty or stenting of a single, de novo, native coronary lesion. Fasting blood was drawn the morning of the procedure for homocysteine, lipoprotein(a), and MTHFR 677T. Follow-up angiography was performed 6 months after the procedure or earlier if clinically indicated. All cineangiograms were analyzed quantitatively. RESULTS: A total of 144 (92%) of 156 eligible patients underwent follow-up coronary angiography. The overall angiographic restenosis rate (residual stenosis >50%) was 31%. Mean homocysteine concentration was 10.1 +/- 3.7 micromol/L. Plasma homocysteine concentrations were not significantly different in patients with or without angiographic restenosis (9.6 +/- 3.3 vs 10.3 +/- 3.8 micromol/L; P =.31). Mean lipoprotein(a) concentration was 21.2 +/- 20.1 mg/dL. Plasma lipoprotein(a) concentrations were not significantly different in patients with or without restenosis (21.9 +/- 21.8 vs 20.9 +/- 19.5 mg/dL). Homozygosity for MTHFR 677T was present in 6.5% and was not associated with increased restenosis. No interaction between homocysteine and lipoprotein(a) was detected. CONCLUSIONS: Homocysteine, lipoprotein(a), and MTHFR 677T are not associated with restenosis after percutaneous transluminal coronary angioplasty.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Homocisteína/sangre , Adulto , Angiografía Coronaria , Enfermedad Coronaria/sangre , Femenino , Humanos , Lipoproteína(a)/sangre , Masculino , Metilenotetrahidrofolato Reductasa (NADPH2) , Persona de Mediana Edad , Oxidorreductasas actuantes sobre Donantes de Grupo CH-NH/sangre , Estudios Prospectivos , Recurrencia , Factores de RiesgoRESUMEN
BACKGROUND: The "organized approach" to cervical screening in Australia includes standardized quality assurance measures for laboratories. This study examines changes in the frequency and the positive predictive value of reporting severe abnormalities in cervical smears over a 3-year period as a guide to the effects of implementing these measures. METHODS: The results of screening in 6-month periods from January 1995 to December 1997 were determined. Biopsy follow-up for results in the high grade epithelial abnormality ("HGEA") and "inconclusive: possible HGEA" categories was obtained from the Western Australian Cervical Cytology Registry (CCR). RESULTS: Approximately 40,000 smears were examined in each 6-month period. The frequencies of reporting HGEA were 0.47%, 0.59%, 0.79%, 0.85%, and 0.84%, and 0.91% for the study periods (P < 0.001). For the inconclusive category, they were 0.24%, 0.18%, 0.24%, 0.31%, 0.38%, and 0.35% (P < 0.001). Biopsy follow-up was available for 83. 9%, 80.5%, 89.9%, 92.4%, 93.1%, and 90.3% of the HGEA results and for 78.6%, 71.7%, 80.5%, 75.0%, 87.1%, and 85.9% of the inconclusive results over the study periods. The yield of high grade lesions for the biopsied cases was 82.6%, 82.3%, 83.1%, 79.5%, 80.9%, and 79% for HGEA cases and 58.2%, 41.9%, 60.6%, 52.8%, 47.5%, and 54.1% for inconclusive cases. CONCLUSIONS: There was a doubling in the reporting of HGEA results, whereas the positive predictive value for biopsied cases remained at about 80%. Reporting rates for inconclusive: possible HGEA cases also doubled, but the yield of biopsy-proven, high grade lesions remained at about 50%. These changes occurred in the absence of ancillary testing and with targeted rescreening methods. A high rate of reporting HGEA, in combination with a high positive predictive value, is among the most important indicators of cervical cytology laboratory performance. Large improvements in results may occur using conventional methods of quality assurance. Cancer (Cancer Cytopathol)
Asunto(s)
Cuello del Útero/patología , Frotis Vaginal/tendencias , Adenocarcinoma/patología , Biopsia , Carcinoma in Situ/patología , Carcinoma de Células Escamosas/patología , Neoplasias Endometriales/patología , Endometrio/patología , Femenino , Humanos , Tamizaje Masivo/métodos , Valor Predictivo de las Pruebas , Neoplasias del Cuello Uterino/patología , Displasia del Cuello del Útero/patologíaRESUMEN
BACKGROUND: The fibrinolytic system is intimately involved in several processes that contribute to restenosis, including clot dissolution, cell migration, and tissue remodeling. However, the role of the individual activators (urokinase [uPA] and tissue plasminogen [tPA] activators) and inhibitors (plasminogen activator inhibitor [PAI-1]) of the fibrinolytic system in maintaining patency after coronary artery angioplasty and stenting is unclear. METHODS AND RESULTS: We prospectively studied 159 patients with stable angina who underwent successful elective angioplasty (n=110) or stenting (n=49) of de novo native coronary artery lesions. Plasma samples were drawn at baseline (before angioplasty) and serially after angioplasty (immediately afterward and 6 hours, 24 hours, 3 days, 7 days, 1 month, 3 months, and 6 months afterward). Antigen and activity assays were performed for uPA, tPA, and PAI-1. Follow-up quantitative coronary angiography was performed in 92% of eligible patients. The overall angiographic restenosis rate (diameter stenosis >50%) was 31% (37% in PTCA patients, 17% in stented patients). At all time periods, including baseline, uPA antigen levels were significantly higher and PAI-1 antigen levels were significantly lower in patients with restenosis. Restenosis rates for patients in the upper tertile of baseline uPA antigen levels were 2-fold higher than for those in the lower 2 tertiles (46% versus 24% and 22%, respectively; P<0.004). In a stepwise regression multivariate analysis, obstruction diameter after the procedure and uPA antigen were significant predictors of follow-up diameter stenosis. CONCLUSIONS: Plasma uPA antigen levels and PAI-1 antigen levels identify patients at increased risk for restenosis after percutaneous coronary revascularization.
Asunto(s)
Angiografía Coronaria , Enfermedad Coronaria/sangre , Inhibidor 1 de Activador Plasminogénico/análisis , Activador de Plasminógeno de Tipo Uroquinasa/sangre , Anciano , Angioplastia Coronaria con Balón , Biomarcadores , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/cirugía , Enfermedad Coronaria/terapia , Femenino , Fibrinólisis , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/prevención & control , Inhibidor 1 de Activador Plasminogénico/inmunología , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Stents , Activador de Tejido Plasminógeno/análisis , Activador de Plasminógeno de Tipo Uroquinasa/inmunologíaRESUMEN
A rat immunogenicity assay for IPV potency was validated and applied to routine vaccine testing as a potential alternative to the CFR Monkey Potency Assay. Potencies of pure trivalent polio, various combinations and experimental vaccines were tested with a view of producing a single dilution assay.
Asunto(s)
Alternativas a las Pruebas en Animales/métodos , Vacuna Antipolio de Virus Inactivados/inmunología , Alternativas a las Pruebas en Animales/normas , Animales , Macaca fascicularis , Vacuna Antipolio de Virus Inactivados/análisis , Vacuna Antipolio de Virus Inactivados/normas , Ratas , Estándares de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estados Unidos , Vacunas de Productos Inactivados/análisis , Vacunas de Productos Inactivados/inmunología , Vacunas de Productos Inactivados/normasRESUMEN
The manufacture of Therapeutic BCG can and should be a controlled process, to ensure adequate treatment doses are received by CIS patients. Standardization of production methods and CFU potency testing methods are essential to ensure continued successful treatment of CIS. Stability data can be used to validate assumptions about Therapeutic BCG potency used in clinical trials. Accelerated heat degradation studies of Therapeutic BCG should not be used for predictions of shelf life, but can be used for comparative purposes.
Asunto(s)
Vacuna BCG/normas , Administración Intravesical , Vacuna BCG/uso terapéutico , Técnicas Bacteriológicas , Carcinoma in Situ/tratamiento farmacológico , Carcinoma in Situ/terapia , Doxorrubicina/uso terapéutico , Estabilidad de Medicamentos , Humanos , Mycobacterium bovis/crecimiento & desarrollo , Preservación Biológica , Inducción de Remisión , Temperatura , Factores de Tiempo , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
Treatment of superficial bladder carcinoma in situ with Connaught BCG (ImmuCyst) significantly increased complete response rate and extended the disease-free interval when compared with Doxorubicin (DOX) chemotherapy. In 54 patients treated with ImmuCyst, 74% showed complete response compared with 42% of 60 patients treated with DOX. The median disease-free time was 48.2 months for BCG and 5.9 months for DOX treatment. Types and severity of adverse reactions were similar for both treatments and within tolerable ranges.