Indicators of need for occupational therapy in patients with chronic pain: occupational therapists' focus groups

This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings. Copyright © 2009 John Wiley & Sons, Ltd.     

Toxic activity of the CdtB component of Haemophilus ducreyi cytolethal distending toxin expressed from an adenovirus 5 vector

Wising C, Magnusson M, Ahlman K, Lindholm L, Lagergård T. Toxic activity of the CdtB component of Haemophilus ducreyi cytolethal distending toxin expressed from an adenovirus 5 vector. APMIS 2010; 118: 143–9. The Haemophilus ducreyi cytolethal distending toxin (HdCDT) catalytic subunit CdtB has DNase‐like activity and mediates DNA damage after its delivery into target cells. We constructed a replication‐deficient adenovirus type 5 (Ad5) vector expressing CdtB and investigated the toxic properties of this vector on HeLa cells. Ad5CdtB caused loss of cell viability, morphologic changes, and cell cycle arrest, findings similar to HdCDT intoxication. This confirmed that CdtB is responsible for the toxicity of the holotoxin when expressed in cells following transduction by an adenoviral vector, and indicated a possible potential of this novel strategy in studies of activity of intracellular products and in gene therapy of cancer.     

Thromboelastography in a cat with steroid responsive thrombocytopenia

A Devon Rex cat was presented for bruises, petechie, and ecchymoses. Marked thrombocytopenia was the only primary abnormality noted on initial hematology and other testing. Thromboelastography and clinical signs supported the conclusion that this was a true thrombocytopenia. Use of optical platelet counting to detect large platelets and prostaglandin E1 to prevent platelet aggregation ruled out pseudothrombocytopenia. Exclusion of likely causes of thrombocytopenia and a rapid response to immunosuppressive doses of prednisolone suggested this was an immune-mediated thrombocytopenia. Signs of bleeding returned when the prednisolone dosage was decreased, and the platelet count again increased rapidly to an increased dosage. Thromboelastography showed marked hypocoagulability and may be useful to differentiate true thrombocytopenia from pseudothrombocytopenia, which occurs commonly in cats.     

Screening for vancomycin‐resistant enterococci: results of a survey in Stockholm

Fang H, Nord CE, Ullberg M. Screening for vancomycin‐resistant enterococci: results of a survey in Stockholm. APMIS 2010; 118: 413–7. Vancomycin‐resistant enterococci (VRE) are emerging in Stockholm hospitals. To rapidly screen for VRE from stool and rectal swab samples, a detection assay combining broth enrichment and real‐time PCR was set up. From September to December 2008, 6914 samples were screened for VRE using the broth‐PCR combined assay. Of them, 5463 samples were reported as negative the day after sampling. Among the 6914 samples, 47 was screened as vanA probable and 44 of them were confirmed as VRE; 1314 samples was screened as vanB probable and 93 of them were confirmed as VRE. The 44 vanA‐type VRE isolates, detected from 31 patients, were clustered into four genetic types by pulsed‐field gel electrophoresis (PFGE). The same PFGE type was observed in multiple isolates recovered from the same patient with vanA VRE. The 93 vanB‐type VRE isolates were detected from 60 patients, 59 of them harboring VRE with PFGE type 1. One patient with vanB VRE had two isolates of distinct PFGE types (types 1 and 5). PFGE type 1 and PFGE type 2 were predominant clones in vanB and vanA strains, respectively, represented by 98.3% (59/60) of patients with vanB VRE and 77.4% (24/31) of patients with vanA VRE.     

Measurement of vascular water transport in human subjects using time‐resolved pulsed arterial spin labelling

Most approaches to arterial spin labelling (ASL) data analysis aim to provide a quantitative measure of the cerebral blood flow (CBF). This study, however, focuses on the measurement of the transfer time of blood water through the capillaries to the parenchyma (referred to as the capillary transfer time, CTT) as an alternative parameter to characterise the haemodynamics of the system. The method employed is based on a non‐compartmental model, and no measurements need to be added to a common time‐resolved ASL experiment. Brownian motion of labelled spins in a potential was described by a one‐dimensional general Langevin equation as the starting point, and as a Fokker–Planck differential equation for the averaged distribution of labelled spins at the end point, which takes into account the effects of flow and dispersion of labelled water by the pseudorandom nature of the microvasculature and the transcapillary permeability. Multi‐inversion time (multi‐TI) ASL data were acquired in 14 healthy subjects on two occasions in a test–retest design, using a pulsed ASL sequence and three‐dimensional gradient and spin echo (3D‐GRASE) readout. Based on an error analysis to predict the size of a region of interest (ROI) required to obtain reasonably precise parameter estimates, data were analysed in two relatively large ROIs, i.e. the occipital lobe (OC) and the insular cortex (IC). The average values of CTT in OC were 260 ± 60 ms in the first experiment and 270 ± 60 ms in the second experiment. The corresponding IC values were 460 ± 130 ms and 420 ± 139 ms, respectively. Information related to the water transfer time may be important for diagnostics and follow‐up of cerebral conditions or diseases characterised by a disrupted blood–brain barrier or disturbed capillary blood flow. Copyright © 2015 John Wiley & Sons, Ltd.     

The shifting trajectory of growth in femur length during gestation

Bone size is a determinant of bone strength and tracks in its percentile of origin during childhood and adolescence. We hypothesized that the ranking of an individual's femur length (FL) is established in early gestation and tracks thereafter. Fetal FL was measured serially using 2D ultrasound in 625 Norwegian fetuses. Tracking was assessed using Pearson correlation, a generalized estimating equation model, and by calculating the proportion of fetuses whose FL remained within the same quartile. Baseline FL Z‐score (weeks 10 to 19) and later measurements correlated, but more weakly as gestation advanced: r = 0.59 (weeks 20 to 26); r = 0.45 (weeks 27 to 33); and r = 0.32 (weeks 34 to 39) (p < 0.001). Tracking within the same quartile throughout gestation occurred in 13% of fetuses. Of the 87% deviating, 21% returned to the quartile of origin, so 34% began and ended in the same quartile, 38% deviated by one quartile, and 28% deviated by two or more quartiles by the end of gestation. A standard deviation higher baseline FL Z‐score, placental weight (150 g), maternal height (5 cm), and weight (10 kg), was associated with a 0.25, 0.15, 0.10, and 0.05 SD higher FL Z‐score at the end of gestation, respectively (p ranging from <0.001 to 0.02). Tracking within the same percentile throughout the whole of gestation, as suggest by growth charts, is uncommon. Deviation from tracking is more common and is the result of changes in growth velocity within and between fetuses and is partly influenced by maternal, fetal, and placental factors. © 2010 American Society for Bone and Mineral Research     

Shift of CTX-M genotypes has determined the increased prevalence of extended-spectrum β-lactamase-producing Escherichia coli in south-western Sweden

The prevalence of Escherichia coli producing extended-spectrum β-lactamases (ESBLs) markedly increased during 2004–2008 in south-western Sweden, with a greater increase in urinary isolates in hospitals (0.2–2.5%) than in the community (0.2–1.6%). ESBLs of genotype CTX-M predominated, with a significant (p <0.02) shift from the CTX-M-9 to CTX-M-1 phylogroup occurring among urinary ESBL-producing E. coli isolated early (n = 41) as compared with late (n = 221) in the study period. The increase in ESBL-producing E. coli was polyclonal, and only partly attributable to an increase (0–24%) in the number of O25b-ST131 isolates carrying CTX-M-15. The increase was prominent in men and in elderly patients, and warrants continued surveillance.