Comparison of broad range 16S rDNA PCR and conventional blood culture for diagnosis of sepsis in the newborn: a case control study

Background  

Early onset bacterial sepsis is a feared complication of the newborn. A large proportion of infants admitted to the Neonatal Intensive Care Unit (NICU) for suspected sepsis receive treatment with potent systemic antibiotics while a diagnostic workup is in progress. The gold standard for detecting bacterial sepsis is blood culture. However, as pathogens in blood cultures are only detected in approximately 25% of patients, the sensitivity of blood culture is suspected to be low. Therefore, the diagnosis of sepsis is often based on the development of clinical signs, in combination with laboratory tests such as a rise in C – reactive protein (CRP). Molecular assays for the detection of bacterial DNA in the blood represent possible new diagnostic tools for early identification of a bacterial cause.     

High school students as ambassadors of CPR—A model for reaching the most appropriate target population?

Background

There is mismatch in age between those usually trained in CPR and those witnessing out-of-hospital cardiac arrest with mean age reported at 30 and 65 years old, respectively. Two tier mass CPR self-training with manikin-DVD sets using school children has been reported. We have studied high school students as first tier and encouraged them to train older people.

Methods

Four separate groups were tested: students before or after training and second tier adults before or after training with first tier students as facilitators. CPR performance was videotaped and electronically documented on a Skillmeter Anne manikin.

Results

Each student reported to train mean 2.8 extra persons, and 43% were aged 50 or older. Pre-training results were poor, while first and second tier persons performed equally well after training, and within ERC guideline recommendations.

Conclusions

People trained at home with a manikin-DVD set and high school students as facilitators were able to perform CPR as recommended by ERC guidelines with a reasonable percentage aged 50 or older.     

The influence of Lidocaine temperature on pain during subcutaneous injection

Background: Injection of local anaesthetics is an uncomfortable procedure. The purpose of this study was to determine the influence of lidocaine temperature on pain during subcutaneous injection.

Methods: A randomised, double blind trial with 36 healthy volunteers was performed. Each subject received three injections of 4.5?ml 1% lidocaine subcutaneously on the abdomen; refrigerated (8?°C), at room temperature (21?°C), and warmed to body temperature (37?°C). By giving every subject injections of all three temperatures they served as their own controls. The participants were asked to evaluate the pain felt during the injection by placing a pencil mark on a 100?mm Visual Analogue Scale without intermediate markings immediately after every injection. They were told that the scale ranged from no pain to worst imaginable pain (0?=?best; 100?=?worst). Retrospectively the participants did a verbal assessment of the most and least painful injection.

Results: The median VAS score for the heated lidocaine was 16 (range =11–28), lidocaine at room temperature 25 (13–40) and for the cold 24 (11–35). The VAS scores for the heated lidocaine was significantly lower than for lidocaine at room temperature (p?=?0.004). Also, the verbal assessment of heated lidocaine being less painful than the injection at room temperature was statistically significant (p?=?0.015).

Conclusions: Injection with lidocaine heated to around body temperature was less painful than injection with lidocaine at room temperature. There was no statistically significant difference in verbal assessment or VAS scores between the cold lidocaine and that at room temperature.     

The impact of hyaluronan on monocyte Toll-like receptor expression in term infant cord blood

Aim: To explore the possible effects of hyaluronan, an endogenous mediator of inflammation, on monocyte surface expression of Toll‐like receptors 2 and 4 in human umbilical cord blood ex vivo, and in a model mimicking Gram‐negative neonatal sepsis. Methods: Term infant cord blood was obtained after elective caesarean sections, n = 15. Both unstimulated and lipopolysaccharide‐stimulated (10 ng/mL) blood was incubated with 500 μg/mL high‐ or low‐molecular‐weight hyaluronan for 6 h. Expression of Toll‐like receptors 2 and 4 on monocytes was measured using flow cytometry, and plasma concentrations of proinflammatory cytokines and matrix metalloproteinase 9 were analysed. Results (mean ± SEM): We found a significant decrease in Toll‐like receptor 4 expression in the presence of high‐molecular‐weight hyaluronan (HMW HA) in unstimulated blood (median fluorescence intensity 141 ± 7.3 vs. 163 ± 9.8, p = 0.019). There were no significant changes in Toll‐like receptor 2 expression. Levels of cytokines and matrix metalloproteinase 9 increased in the presence of both forms of hyaluronan. Conclusions: Our results confirm that hyaluronan affects the neonatal immune response. The biological significance of these findings requires further clarification. More studies are needed to validate the possible down‐modulation of Toll‐like receptor 4 exerted by HMW HA.     

Adequate Urinary Iodine Concentration among Infants in the Inland Area of Norway

Considering the importance of iodine to support optimal growth and neurological development of the brain and central nervous system, this study aimed to assess and evaluate iodine status in Norwegian infants. We collected data on dietary intake of iodine, iodine knowledge in mothers, and assessed iodine concentration in mother’s breast milk and in infant’s urine in a cross-sectional study at two public healthcare clinics in the inland area of Norway. In the 130 mother–infant pairs, the estimated infant 24-h median iodine intake was 50 (IQR 31, 78) µg/day. The median infant urinary iodine concentration (UIC) was 146 (IQR 93, 250) µg/L and within the recommended median defined by the World Health Organization for this age group. Weaned infants had a higher UIC [210 (IQR 130, 330) µg/L] than exclusively breastfed infants [130 (IQR 78, 210) µg/L] and partially breastfed infants [135 (IQR 89, 250) µg/L], which suggest that the dietary data obtained in this study did not capture the accurate iodine intake of the included infants. The iodine status of infants in the inland area of Norway seemed adequate. Weaned infants had higher UIC compared to breastfed infants, suggesting early access and consumption of other sources of iodine in addition to breast milk.     

Concentration‐dependent cytokine responses of silica nanoparticles and role of ROS in human lung epithelial cells

Reactive oxygen species (ROS) is regarded as a critical denominator in nanoparticle toxicology and inflammation. Previously, we have shown that silica nanoparticles sized 50 nm (Si50) induce release of CXCL8 and IL‐6 from BEAS‐2B cells, via mechanisms involving NFκB, p38 MAP kinase and TGF‐α‐activated EGF receptor. In the present study, the role of ROS‐mediated mechanisms in the concentration‐dependent Si50 induction of CXCL8 and IL‐6 responses was examined. Si50 (200 µg/mL) induced a time‐dependent ROS formation and a postponed increase in expression of haem oxygenase (HO‐1) mRNA and protein. Pre‐treatment with the ROS inhibitors N‐acetyl cysteine (NAC) and diphenyleneiodonium (DPI) partially attenuated CXCL8 and IL‐6 responses to 200 µg/mL, but not to 100 µg/mL Si50. The release of TGF‐α induced by Si50 (200 µg/mL) was significantly reduced by NAC, but not by DPI nor siRNA against NADPH oxidase DUOX‐1 (siDUOX‐1). Furthermore, siDUOX‐1 reduced Si50‐induced CXCL8, but not IL‐6. Both p38 and p65 phosphorylations were inhibited by siDUOX‐1, but for NAC only p65 phosphorylation reached a significant reduction. Neither NAC nor DPI reduced Si50‐induced CXCL8 and IL‐6 gene expressions. In conclusion, Si50‐induced CXCL8 and IL‐6 involved both ROS‐dependent and ROS‐independent mechanisms. Notably, the role of ROS seemed restricted to effects of higher concentrations of Si50 and not mediated via the gene expression.     

Synthetic hydrosilicate nanotubes induce low pro‐inflammatory and cytotoxic responses compared to natural chrysotile in lung cell cultures

Asbestos (Mg‐hydrosilicate; chrysotile) is known to cause pleural diseases, pulmonary fibrosis and lung cancers, via mechanisms strongly depending on diameter‐length ratio and possibly metal content. A critical question is whether synthetic hydrosilicate nanotubes (NTs) of short length possess little toxic potential compared to chrysotile. Five Mg‐ and two NiNTs of different lengths were assessed for cytotoxicity and pro‐inflammatory responses in THP‐1 macrophages and human bronchial epithelial lung cells (HBEC3‐KT), in comparison with chrysotile. NT lengths/diameters were characterized by TEM, surface areas by BET‐ and BJH analysis, and chemical composition by XRD. The different Mg‐ and NiNTs induced little cytotoxicity in both cell models, in contrast to chrysotile that induced marked cytotoxicity. The two longest synthetic MgNTs, with median lengths of 3 and 5 µm, induced increased levels of pro‐inflammatory cytokines in THP‐1 macrophages, but much less than chrysotile (median length 15 µm) and silica nanoparticles (Si10). The shortest NTs did not induce any increase in cytokines. In HBEC3‐KT cells, all synthetic NTs induced no or only small changes in cytokine responses, in contrast to chrysotile and Si10. The synthetic NTs induced lower TGF‐β responses than chrysotile in both cell models. In conclusion, the pro‐inflammatory responses were associated with the length of synthetic hydrosilicate NTs in THP‐1 macrophages, but not in HBEC3‐KT cells. Notably, the shortest NTs showed no or little pro‐inflammatory activity or cytotoxicity in both cell models. Such a safety by design approach is important for development of new materials being candidates for various new products.     

The fraction of lung cancer attributable to smoking in the Norwegian Women and Cancer (NOWAC) Study

Background We examined the association between active and passive smoking and lung cancer risk and the population attributable fraction (PAF) of lung cancer due to active smoking, in the Norwegian Women and Cancer Study, a nationally representative prospective cohort study.Methods We followed 142,508 women, aged 31–70 years, who completed a baseline questionnaire between 1991 and 2007, through linkages to national registries through December 2015. We used Cox proportional hazards models, to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). We calculated PAF to indicate what proportion of lung cancer cases could have been prevented in the absence of smoking.Results During the more than 2.3 million person-years of observation, we ascertained 1507 lung cancer cases. Compared with never smokers, current (HR 13.88, 95% CI 10.18–18.91) smokers had significantly increased risk of lung cancer. Female never smokers exposed to passive smoking had a 1.3-fold (HR 1.34, 95% CI 0.89–2.01) non- significantly increased risk of lung cancer, compared with never smokers. The PAF of lung cancer was 85.3% (95% CI 80.0–89.2).Conclusion More than 8 in 10 lung cancer cases could have been avoided in Norway, if the women did not smoke.Subject terms: Epidemiology, Oncology     

Dietary change among breast and colorectal cancer survivors and cancer-free women in the Norwegian Women and Cancer cohort study

Objective  

To study diet before and after diagnosis of breast and colorectal cancers compared with diet in cancer-free women in the Norwegian Women and Cancer study.