Serum phosphate: Does it more closely reflect the true state of acromegaly?

An increased serum phosphate (P) level is common in acromegaly patients, however, the relationships among P, growth hormone (GH), insulin-like growth factor 1 (IGF-1) and disease status remain unknown. To reveal these relationships, we examined the association of P with comprehensive clinical data. We measured the serum P, calcium, GH, oral glucose tolerance test-GH (OGTT-GH), IGF-1, and insulin-like growth factor binding protein-3 (IGBP-3) levels in 103 acromegaly patients. SAGIT® was used to assess the disease status comprehensively. Spearman’s rank correlation coefficient was obtained to evaluate the associations among the above parameters. Stepwise multiple linear regression analysis was performed to investigate factors independently associated factors with the SAGIT scores. The area under the receiver operating characteristic curve (AUCROC) was used to evaluate the efficacy of the percentage change in the serum phosphate level in predicting remission in patients with postoperatively discordant GH and IGF-1 levels. Hyperphosphatemia was found in 68.9% of patients at baseline. The serum P level was higher in the non-remission group, but no correlation was found between hyperphosphatemia and remission. We revealed a significant correlation between the P level and SAGIT® score in patients both preoperatively (r = 0.659, p = 0.000) and 1-year postoperatively without remission patients (r = 0.534, p = 0.027). All biochemical levels decreased significantly postoperatively, and the GH and OGTT-GH levels achieved early stability (1 month); however, the P, IGF-1 and IGBP-3 levels showed a gradual decline. A percentage change in P of −8.12% is recommended as a cut-off value for predicting remission in patients with postoperatively discordant GH and IGF-1 levels. As a metabolic product which affected by the GH/IGF-1 axis, serum P appears to more closely reflect the comprehensive disease status in acromegaly. When the GH and IGF-1 levels are discordant during follow-up, perioperative change in the P level may be a potential predictor of remission.     

Detection of vancomycin variable enterococci (VVE) among clinical isolates of Enterococcus faecium collected across India-first report from the subcontinent

PurposeEmergence of vancomycin variable enterococci (VVE) poses a challenge to empiric vancomycin therapy. Vancomycin-variable enterococci (VVE) are vanA-positive, yet phenotypically vancomycin-susceptible enterococci that can switch to a vancomycin-resistant phenotype when exposed to vancomycin. The aim of the present study was to determine the prevalence of VVE in India.MethodsIsolates of phenotypically vancomycin susceptible Enterococcus faecium from 20 tertiary care hospitals across India were collected and tested for the presence of vanA, vanR, vanS, vanB and vanC genes by conventional PCR using previously published primers. Isolates positive for vanA gene were considered as VVE.ResultsThe prevalence of VVE was 1.5% (5/340). Only one VVE isolate was positive for vanR and vanS, and all the isolates were negative for vanB and vanC.ConclusionsAlthough the prevalence is low, our finding emphasizes the importance of routinely screening for van genes in enterococci that are phenotypically susceptible. Silenced vanA able to escape detection and revert to resistance during vancomycin therapy represents a new challenge in clinical settings.     

Tissue flossing on ankle range of motion,jump and sprint performance: A follow-up study

ObjectivesPrevious results from our laboratory suggest that band flossing results in increased ankle range of motion (ROM) and jump performance 5-min following application. However, the time-course of such benefits is yet to be examined.DesignParallel group design.SettingUniversity laboratory.Participants69 recreational athletes (32 male/37 female).Main outcome measuresParticipants performed a weight-bearing lunge test (WBLT), a counter-movement jump (CMJ) and a 15 m sprint test (SPRINT) pre and up to 45-min post application of a floss band to both ankles (FLOSS) or without flossing of the ankle joints (CON).ResultsThere was a significant intervention × time interaction in favour of FLOSS when compared to CON for the WBLT (p < 0.05). These results were associated with trivial to small effect sizes at all time points. Small, but non-significant (p > 0.05) benefits were seen for FLOSS when compared to CON for CMJ force (mean ± 90%CI: 89 ± 101 N) and 15 m SPRINT times (−0.06 ± 0.04 s) at 45-min post.ConclusionThere is a trend towards a benefit for the use of floss bands applied to the ankle joint to improve ROM, jump and sprint performance in recreational athletes for up to 45-min following their application.     

Multi-detector computed tomography findings in ectopic pregnancy

The detection of an ectopic pregnancy on CT is a rare event. However with the increasing utilisation of CT in the emergency setting for the evaluation of acute abdominal pain, the inadvertent detection of an ectopic pregnancy on CT may become a more common event. Radiologists therefore need to be aware of the CT appearances of this potentially life threatening condition.     

Efficacy of a high quality O1/Campos foot-and-mouth disease vaccine upon challenge with a heterologous Korean O Mya98 lineage virus in pigs

In 2010 serotype O foot-and-mouth disease virus of the Mya98 lineage/SEA topotype spread into most East Asian countries. During 2010–2011 it was responsible for major outbreaks in the Republic of Korea where a monovalent O/Manisa vaccine (belonging to the ME-SA topotype) was applied to help control the outbreaks. Subsequently, all susceptible animals were vaccinated every 6 months with a vaccine containing the O/Manisa antigen. Despite vaccination, the disease re-occurred in 2014 and afterwards almost annually. This study focuses on the in vivo efficacy in pigs of a high quality monovalent commercial O₁/Campos vaccine against heterologous challenge with a representative 2015 isolate from the Jincheon Province of the Republic of Korea. Initially, viral characterizations and r₁ determinations were performed on six viruses recovered in that region during 2014–2015, centering on their relationship with the well characterized and widely available O₁/Campos vaccine strain. Genetic and antigenic analysis indicated a close similarity among 2014–2015 Korean isolates and with the previous 2010 virus, with distinct differences with the O₁/Campos strain. Virus neutralisation tests using O₁/Campos cattle and pig post vaccination sera and recent Korean outbreak viruses predicted acceptable cross-protection after a single vaccination, as indicated by r₁ values, and in pigs, by expectancy of protection. In agreement with the in vitro estimates, in vivo challenge with a selected field isolate indicated that O₁/Campos primo vaccinated pigs were protected, resulting in a PD50 value of nearly 10. The results indicated that good quality oil vaccines containing the O₁/Campos strain can successfully be used against isolates belonging to the O Mya98/SEA topotype.