A reference interval for sweat chloride in infants aged between five and six weeks of age.

BACKGROUND: This study was designed to establish a reference interval for sweat chloride for infants without evidence of cystic fibrosis (CF), aged between 5 wk and 6 wk, a time when sweat testing is an integral part of newborn screening for CF. In addition, we compared the gold standard method of sweat testing (quantitative pilocarpine iontophoresis [QPIT, coulometry]) with an emerging methodology (Macroduct [ISE]). METHODS: This was a prospective study on healthy infants at 5-6 wk of age. Sweat collection was undertaken at home on both outer thigh areas using two methods (QPIT and Macroduct ). The order of testing was randomly assigned. Filter paper samples (QPIT) were analysed using flame photometry and coulometry. Macroduct samples were analysed using ion-selective electrodes (ISE, Abbott Architect c8000, UK). RESULTS: Insufficient sweat was collected on 28 occasions with the QPIT (coulometry) method and on 31 with the Macroduct (ISE) capillary system. We achieved a 92% success rate in undertaking two sweat collections consecutively (n = 177). Sweat chloride concentrations were normally distributed with excellent limits of agreement between the two methods of sweat collection and analysis (n = 150). Median (IQR) sweat chloride was 11.2 mmol/L (8-13) with QPIT (coulometry) method with a 99.5th centile (n = 165) of 24 mmol/L. CONCLUSION: The Macroduct (ISE) capillary sweat collection system is valid in this age group. Sweat chloride concentrations above 30 mmol/L should prompt assessment in a specialist CF centre.

Tuberculous meningitis: protracted course and clinical response to interferon-gamma.

A 12-year-old girl with protracted tuberculous meningitis received standard chemotherapy and dexamethasone and had a progressive cerebrospinal fluid neutrophilia, raised protein and depressed glucose levels. Her temperature was raised for 5 months until a second course of dexamethasone was given. At week 15, multiple tuberculomas and hydrocephalus were detected followed by acute hydrocephalus (week 58), which required a ventricular-peritoneal shunt. Tuberculomas resolved after a second course of dexamethasone but recurred 15 months later. Immunological investigations were normal including integrity of the type 1 cytokine pathway. From month 24, interferon-gamma was given subcutaneously (initially 50 microg/m(2)) and continued for 19 months. Within 2 weeks she responded clinically followed by a reduction in inflammatory signs on magnetic resonance imaging scan (but not in the tuberculomas). At month 44, when chemotherapy was stopped, the cerebrospinal fluid/serum albumin quotient was 57x10(-3) (normal <6.0x10(-3)), which supports continuing major impairment of the blood-brain barrier. Gene expression in peripheral blood mononuclear cells before and during treatment with interferon-gamma, assessed by gene array analysis, showed reduction in a number of cytokine and chemokine genes. The response to interferon-gamma might have been secondary to downregulation of certain cytokine and chemokine genes.

Three year field test of a plant growth promoting rhizobacteria enhanced phytoremediation system at a land farm for treatment of hydrocarbon waste.

Phytoremediation of total petroleum hydrocarbons (TPH) has the potential to be a sustainable waste management technology if it can be proven to be effective in the field. Over the past decade, our laboratory has developed a system which utilizes plant growth promoting rhizobacteria (PGPR) enhanced phytoremediation (PEP) that, following extensive greenhouse testing, was shown to be effective at remediating TPH from soils. This system consists of physical soil manipulation and plant growth following seed inoculation with PGPR. PGPR elicit biomass increases, particularly in roots, by minimizing plant stress in highly contaminated soils. Extensive development of the root system enhances degradation of contaminants by the plants and supports an active rhizosphere that effectively promotes TPH degradation by a broad microbial consortium. Following promising greenhouse trials, field tests of PEP were performed over a period of three years at a Southern Ontario site (approximately 130 g kg(-1) TPH) used for land farming of refinery hydrocarbon waste for many years. The low molecular weight fractions (the Canadian Council of Ministers of the Environment (CCME) fractions 1 and 2) were removed through land farming and bioremediation; the high molecular weight, recalcitrant fractions (CCME fractions 3 and 4) remained at high levels in the soil. Using PEP, we substantially remediated fractions 3 and 4, and lowered TPH from 130 g kg(-1) to approximately 50 g kg(-1) over a three year period. The amount of plant growth and extent of oil remediation were consistently enhanced by PGPR.