Evaluation of real-time PCR for diagnosis of Bordetella pertussis infection

Background  

Nucleic acid amplification of the IS481 region by PCR is more sensitive than culture for detection and diagnosis of Bordetella pertussis but the assay has known cross-reactivity for Bordetella holmesii and its use as a routine diagnostic assay has not been widely evaluated.     

National survey on endoscopy training in the UK

IntroductionGastrointestinal (GI) endoscopy is an important skill for both gastroenterologists and general surgeons but concerns have been raised about the provision and delivery of training. This survey aimed to evaluate and compare the delivery of endoscopy training to gastroenterology and surgical trainees in the UK.MethodsA nationwide electronic survey was carried out of UK gastroenterology and general surgery trainees.ResultsThere were 216 responses (33% gastroenterologists, 67% surgeons). Gastroenterology trainees attended more non-training endoscopy lists (mean: 3.0 vs 1.2) and training lists than surgical trainees (mean: 0.9 vs 0.5). A significantly higher proportion of gastroenterologists had already achieved accreditation in gastroscopy (60.8% vs 28.9%), colonoscopy (66.7% vs 1.4%) and flexible sigmoidoscopy (33.3% vs 3.0%). More gastroenterology trainees aspired to achieve accreditation in gastroscopy (97.2% vs 79.2%), flexible sigmoidoscopy (91.7% vs 70.1%) and colonoscopy (88.8% vs 55.5%) by completion of training. By completion of training, surgeons were less likely than gastroenterologists to have completed the required number of procedures to gain accreditation in gastroscopy (60.3% vs 91.3%), flexible sigmoidoscopy (64.6% vs 68.6%) and colonoscopy (60.3% vs 70.3%).ConclusionsThis survey highlights marked disparities between surgical and gastroenterology trainees in both aiming for and achieving accreditation in endoscopy. Without changes to the delivery and provision of training as well as clarification of the role of endoscopy training in a surgical training programme, future surgeons will not be able to perform essential endoscopic assessment of patients as part of their management algorithm.     

From dialysis to transplantation: a 5-year longitudinal study on self-reported quality of life

Background

Little is known how health related quality of life (HRQOL) change in the transition from dialysis to renal transplantation (RTX). Longitudinal data addressing the patient-related outcomes are scarce, and particularly data regarding kidney-specific HRQOL are lacking. Thus, the aim of the current study was to assess HRQOL in patients followed from dialysis to RTX. Furthermore, to compare HRQOL in RTX patients and the general population.

Methods

In a prospective study, HRQOL was measured in a cohort of 110 patients (median age 53.5 (IQR 39–62) years, GFR 54 (45–72) ml/min/1.73 m²) in dialysis and after RTX using the self-administered Kidney Disease and Quality of Life Short Form version 1.3 (KDQOL-SF). Generic HRQOL in the RTX patients was compared to that of the general population (n?=?5903) using the SF-36. Clinical important change after RTX was defined as difference in HRQOL of SD/2.

Results

Follow-up time was 55 (IQR 50–59) months, and time after RTX was 41 (34–51) months. Four of nine domains in kidney-specific HRQOL improved after RTX, i.e. burden of kidney disease, effect of kidney disease, symptoms and work status. In SF-36, general health, vitality, social function and role physical improved after RTX, but none of the domains improved sufficiently to be regarded as clinically relevant change. There were highly significant differences in HRQOL between RTX patients and the general population after adjustment for age and gender for all items of SF-36 except for bodily pain and mental health.

Conclusions

HRQOL improved in the transition from dialysis to transplantation, but clinical relevant change was only obtained in the kidney specific domains. HRQOL was perceived considerably poorer in RTX patients than in the general population. Our observations point to the need of improving HRQOL even after RTX, and should encourage further longitudinal research and clinical attention during treatment shift.

     

Interleukin-3 and interleukin-7 are alternative growth factors for the same B-cell precursors in the mouse

Clones and lines of precursor (pre) B cells can be established by limiting dilutions of unseparated cell suspensions of fetal liver or bone marrow on stromal cells in the presence of interleukin (IL)-7. When IL-3 is used instead of IL-7, cultures are regularly overgrown by different precursor cells of the myeloid lineage, as well as by adherent cells that inhibit pre-B-cell expansion. However, in the presence of either IL-7 or IL-3, clones of pre-B cells can be established on stroma cells at frequencies near one in one when the cultures are initiated with cell sorter purified CD45RO (B220)+/c-kit+ fetal liver or bone marrow derived pre-B cells. Clones grown on stromal cells in the presence of IL-7 can be regrown in IL-3, and vice versa. Pre-B cells that proliferate on stromal cells in the presence of IL-7 or IL-3 have the same phenotype, ie, are B220+ c-kit+, CD43+, and surrogate light chain+. Removal of the growth factors (IL-7, respectively IL-3) from the cultures results in differentiation to surface immunoglobulin (slg) positive, c-kit-, CD43-, surrogate light chain- B cells, a fraction of which is lipopolysaccharide (LPS) responsive as shown by IgM secretion. These results show that IL-7 and IL-3 stimulate largely overlapping populations of precursor B cells from bone marrow to proliferate for long periods of time in the presence of stromal cells. Thus, IL-7 and IL-3 are alternative growth factors for the same pre-BI cell.