Isolation and characterization of APSE-1, a bacteriophage infecting the secondary endosymbiont of Acyrthosiphon pisum.

A bacteriophage infecting the secondary endosymbiont of the pea aphid Acyrthosiphon pisum was isolated and characterized. The phage was tentatively named bacteriophage APSE-1, for bacteriophage 1 of the A. pisum secondary endosymbiont. The APSE-1 phage particles morphologically resembled those of species of the Podoviridae. The complete nucleotide sequence of the bacteriophage APSE-1 genome was elucidated, and its genomic organization was deduced. The genome consists of a circularly permuted and terminally redundant double-stranded DNA molecule of 36524 bp. Fifty-four open reading frames, putatively encoding proteins with molecular masses of more than 8 kDa, were distinguished. ORF24 was identified as the gene coding for the major head protein by N-terminal amino acid sequencing of the protein. Comparison of APSE-1 sequences with bacteriophage-derived sequences present in databases revealed the putative function of 24 products, including the lysis proteins, scaffolding protein, transfer proteins, and DNA polymerase. This is the first report of a phage infecting an endosymbiont of an arthropod.     

Abdominal pain due to nerve compression]

Persistent abdominal pain in a 15-year-old girl was diagnosed after examination by the GP, the pediatrician, the gynaecologist and finally, the surgeon as rib-tip syndrome. The patient could be treated sufficiently by the injection of local anaesthetics and corticosteroids. In the rib-tip syndrome hypermobility of the lower ribs irritates the intercostal nerves causing pain along the lower edge of the chest. The condition can be established objectively with the aid of fluoroscopy and electrostimulation, electromyography or magnetic stimulation.     

“SPLIT” Pancreaticojejunostomy in the Surgical Treatment of Chronic Pancreatitis

“Split” pancreaticojejunostomy is a procedure consisting of vertical transection of the pancreas and anastomosis of both sides of the cut pancreatic duct with an interposed, Roux-en-Y jejunal loop. In this paper we report the long term results of this procedure in the treatment of eight patients with chronic pancreatitis (CP).     

An audit of occupational health care for employees with low-back pain

Guidelines for occupational rehabilitation of workers with low-backpain were developed as part of a larger study. We have formulatedcriteria for good practice of occupational rehabilitation onthe basis of these guidelines. To assess the quality of occupationalrehabilitation in the Netherlands, these criteria were subsequentlyused in an audit of medical records. The number of patientswho received care consistent with the guidelines was comparedto the number of patients eligible to receive that kind of care(performance rate). Six performance rates were calculated fromthe medical files of 40 workers with 48 new episodes of low-backpain. Two performance rates proved to be below 25% and two almost50%. The highest performance rate, that for curative policy,was 90%. These results are discussed in the light of the reliabilityof the original data. We recommend construction of guidelinesas well as reliable registration of the occupational rehabilitationprocess to increase the possibilities of auditing and to raisethe quality of occupational health care.     

Random bladder biopsies and the risk of recurrent superficial bladder cancer: a prospective study in 1026 patients

Summary We prospectively studied random bladder biopsies of normal-looking mucosa in 1026 unselected patients with primary superficial papillary transitional-cell carcinoma of the bladder. In a univariate analysis, the risk for recurrent disease was only slightly higher in patients with an abnormal biopsy result, the 2-year actuarial risk for recurrent disease being 47.5% in these subjects vs 44.5% in patients with a normal biopsy result (P=0.09, log-rank test). However, after correction for other prognostic factors using the Cox proportional-hazards model, an abnormal biopsy result had no prognostic value additional to that of conventional histo-pathology of the tumour with regard to the risk for recurrent disease. Additional therapy after transurethral resection of the tumour (P<0.001), tumour stage (P<0.001), the number of bladder areas affected by tumour (P<0.01) and tumour multiplicity (P=0.09) had significant prognostic value. We conclude that random biopsies of normal-looking mucosa during transurethral resection of superficial papillary bladder tumours are of little additional prognostic value with respect to the risk for recurrent disease.This study was financially supported by three regional Dutch comprehensive cancer centres: IKO, IKZ, and IKA/stedendriehoek Twente     

Induction of EAE by T cells specific for alpha B-crystallin depends on prior viral infection in the CNS

While myelin-reactive T cells are widely believed to play a pathogenic role in multiple sclerosis (MS), no substantial differences appear to exist in T-cell responses to myelin antigens between MS patients and healthy subjects. As an example, indistinguishable peripheral T-cell responses and serum antibody levels have been found in MS patients and healthy controls to alpha B-crystallin, a dominant antigen in MS-affected brain myelin. This suggests that additional factors are relevant in allowing myelin-reactive T cells to become pathogenic. In this study, we examined whether the inflammatory state of the CNS is relevant to the pathogenicity of alpha B-crystallin-specific T cells in mice. In normal mice, T-cell responses against alpha B-crystallin are limited by robust immunological tolerance. Reactive T cells were therefore generated in alpha B-crystallin-deficient mice, and these T cells were transferred into C57BL/6 recipients. While such a transfer in itself never induced any clinical signs of experimental autoimmune encephalomyelitis (EAE) in healthy recipient mice, acute EAE could be induced in animals that had been infected 7 days before with the avirulent A7(74) strain of Semliki Forest virus (SFV). SFV infection alone did not induce clinical disease, nor did it alter the expression levels of the target antigen. Our findings indicate that at least in mice, alpha B-crystallin-specific T cells can trigger EAE but only when prior viral infection has induced an inflammatory state in the CNS that helps recruit and activate T cells.     

The occupational health field in the cochrane collaboration

It is the aim of the Cochrane Collaboration to gather, summarise and disseminate evidence of health care interventions. Recently, the Occupational Health Field has started to do so for occupational health interventions. In this article we would like to describe the organisation and the methods used by the Field. First, the use of research information to improve the quality of occupational health practice is explained. Next, the process and contents of Cochrane Reviews are described. The pros and cons of Cochrane Reviews are listed and what occupational health practitioners can learn from it. There is a great variety of occupational health interventions that requires flexibility in which research design to use. The Occupational Health Field will enhance our understanding of the effectiveness of occupational health interventions in the coming years.     

A colo-colic invagination on the basis of MutYH-associated polyposis in a boy aged 14

A 14-year-old boy presented with acute abdominal pain, vomiting and diarrhoea. Colo-colic intussusception was diagnosed by means of a colonic contrast X-ray. The intussusception was successfully reduced during this procedure. Hundreds of polyps were seen throughout the entire colon. Genetic research showed a mutation of the MutYH gene. Proctocolectomy with ileoanal pouch anastomosis was carried out. The pathology specimen showed an intramucosal carcinoma and multiple adenomas. MutYH-associated polyposis coli is an autosomal recessive disease that occurs as a result of a mutation in the MutYH gene. This will lead to polyposis coli. An intussusception is a rarely seen symptom. Patients need preventive surgical treatment because of the high risk developing a colorectal carcinoma.     

A Comparison of Two Automated External Defibrillator Algorithms

OBJECTIVE: To compare the interval to delivery of the first shock by first responders in mannequin-based cardiac arrest scenarios using two automated external defibrillator (AED) algorithms. METHODS: Thirty-six (18 pairs) of Toronto firefighters (FFs) trained in two AED algorithms, algorithm I (A-I) and algorithm II (A-II), were studied. A-II mandates the immediate application of the AED once pulselessness is established. In contrast to A-I, A-II dictates that no CPR be initiated until it is required by the AED voice prompts. Each FF pair alternated roles while performing "shock-indicated," mannequin-based scenarios according to A-I and A-II. The interval from mannequin contact to delivery of the first shock was recorded. Five pairs were videotaped. The intervals to complete predetermined steps were compared between algorithms to determine in which step(s) time saving occurred. RESULTS: The mean (+/-SD) interval to the first shock in A-I was 80.7 seconds (+/-10.5 sec) (95% CI = 77.2 to 84.2 sec) vs 61.1 seconds (+/-8.75 sec) (95% CI = 58.2 to 64.0 sec) in A-II (p < 0.001). A-II shortened the interval to the first shock by 19.6 sec (+/-11.5) (95% CI = 15.8 to 23.4 sec). The time saving was a direct result of delaying CPR in A-II. CONCLUSION: A-II reduced the interval from mannequin contact to the first shock in standard training scenarios.