Membrane fractions of trypanosomes mimic the immunosuppressive and mitogenic effects of living parasites on the host

African trypanosomiasis in mice leads to profound changes in lymphoid tissues. In an attempt to define the nature of the trypanosome stimulus, we have studied the effect of radio-attenuated trypanosomes and their subcellular fractions in vivo. We find that relatively low doses of irradiated Trypanosoma brucei S42 injected into (CBA/H x C57B1/6)F1 mice mimicked the previously reported effects of infective parasites. 2 x 10(7) irradiated trypanosomes caused a greater than two-fold increase in spleen weight accompanied by a roughly 10-fold increase in background plaque forming cells (PFC) to sheep red blood cells (SRBC). The primary response to SRBC was significantly enhanced when priming was carried out on the day of trypanosome injection, but significantly suppressed when carried out 3 days later. Disruption of trypanosomes by freeze-thawing did not destroy their mitogenic or immunosuppressive activities. A membrane fraction collected by high speed centrifugation (150 000 x g) after removal of larger organelles at 12 000 x g retained both mitogenic and suppressive activities. The high speed supernatant lost the ability to enhance background PFC, but still caused partial immunosuppression with a much lower potency than the membrane pellet. Whether immunosuppression and enhanced PFC levels relate to the same parasite product is not clear as yet, but both effects can be ascribed to a membrane fraction of the parasite.     

Are Implantable Loop Recorders Useful in Detecting Arrhythmias in Children with Unexplained Syncope?

Introduction: Syncope and presyncope are symptoms that occur infrequently in children, are unpredictable, and represent a diagnostic challenge to the physician. Conventional diagnostic investigations are often unable to establish a diagnosis, making it difficult to determine patient risk and direct appropriate therapy. The implantable loop recorder (ILR) is a medical device that was created for prolonged monitoring of heart rate and rhythm and has been used in a limited number of pediatric studies in which the cause of the syncope is unknown.
Methods: This is a retrospective review of the clinical, surgical, and follow-up data of patients who had ILR devices implanted after conventional testing failed to identify a cause for their symptoms.
Results: The diagnostic yield of the ILR device in unmasking the cause for symptoms in our patient cohort was 64%. In our study, manually activated events accounted for 71% of all documented episodes and 68% of the cases involving hemodynamically important arrhythmias or transient rhythm changes. The ILR device can be safely implanted and explanted in children without significant morbidity, in most cases. None of our patients experienced any long-term adverse events associated with placement of the device and all were alive at last follow-up.
Conclusions: The use of the ILR device is a useful tool to help unmask arrhythmias as a cause of unexplained syncope in children. Patient selection for who should and should not have an ILR device implanted will continue to influence its diagnostic utility and generate controversy among stakeholders.     

Soft tissue management: flap design,incision, tissue elevation,and tissue retraction

The ultimate goal in surgical endodontics is not only the eradication of periapical pathosis but also preservation of periodontal conditions using suitable surgical techniques. Acceptable treatment outcomes are no longer possible without consideration of esthetic consequences for all involved dentoalveolar structures. During surgical endodontics the cortical bone is exposed by incising, elevating, and reflecting a full‐thickness tissue flap. Certain basic principles must be considered before deciding on the type of incision and flap design. Thorough knowledge of regional anatomical structures in conjunction, as well as prevailing periodontal conditions affect and must be considered when making the proper decision on how and where to reflect the mucoperiosteal tissues. Various modes of incision can be selected, including horizontal, sulcular, submarginal, and vertical releasing incisions. The variety of flaps reflects the number of variables to be considered before choosing an appropriate flap design. While many flap designs have been suggested over the years, some have become obsolete and new techniques have emerged. It is critical that incisions and tissue elevations and reflections are performed in a way that facilitates healing by primary intention. This can be obtained by complete and sharp incision avoiding severing or traumatizing the tissues during elevation; it is equally important to prevent drying of tissue remnants on the root surface and drying of the flap during the procedure. The introduction of microsurgery to surgical endodontics attempts to minimize trauma and to enhance surgical results. Because of the combination of magnification and more delicate instruments, improved and careful tissue handling has become possible. Additional improvements in flap design and soft tissue manipulation are considered key elements in enhanced biological and esthetic outcomes of marginal soft tissues.     

INTRAVESICAL INSTILLATION OF EPIRUBICIN, BACILLUS CALMETTE-GUERIN AND BACILLUS CALMETTE-GUERIN PLUS ISONIAZID FOR INTERMEDIATE AND HIGH RISK TA, T1 PAPILLARY CARCINOMA OF THE BLADDER: A EUROPEAN ORGANIZATION FOR RESEARCH AND TREATMENT OF CANCER GENITO-URINARY GROUP RANDOMIZED PHASE III TRIAL

PURPOSE: After transurethral resection, we compared the efficacy and side effects of weekly intravesical instillations of epirubicin, bacillus Calmette-Guerin (BCG), and BCG plus isoniazid during a 6-week interval followed by 3 weekly maintenance instillations at months 3, 6, 12, 18, 24, 30 and 36 in patients with intermediate and high risk Ta, T1 bladder cancer. MATERIALS AND METHODS: A total of 957 patients were randomized at 44 institutions in a phase III multicenter trial. RESULTS: The time to first recurrence was significantly longer in patients treated with BCG and BCG plus isoniazid compared to epirubicin (p = 0.0001) but there was no difference between the 2 BCG regimens (p = 0.27). Progression to muscle invasive cancer was rare (5%) and did not differ significantly among the 3 arms (p = 0.12). Drug induced cystitis was observed in 31% of the patients treated with epirubicin, 42% BCG and 45% BCG plus isoniazid. Systemic side effects, such as fever and malaise, were not observed in patients treated with epirubicin, but were noted in 31% BCG and 36% BCG plus isoniazid. CONCLUSIONS: Intravesical BCG with or without isoniazid provokes more side effects than epirubicin. Prophylactic isoniazid does not reduce the side effects of BCG, while BCG with or without isoniazid prolongs the time to first recurrence compared to epirubicin. Further followup is required before long-term conclusions can be made for progression-to-muscle invasive disease and survival.     

Inhibition of equine neutrophil chemotaxis and chemokinesis by a Taenia taeniaeformis proteinase inhibitor, taeniaestatin

Taeniaestatin, a recently isolated Taenia taeniaeformis proteinase inhibitor, was used to inhibit equine neutrophil migration. Taeniaestatin itself was not chemotactic when used as a chemotactic factor but taeniaestatin did inhibit neutrophil chemokinesis when tested in a Zigmond-Hirsch checkerboard assay. A dose-dependent inhibition of both chemokinesis and chemotaxis was observed when zymosan activated bovine sera (ZABS) was used as the chemotactic factor. This inhibition was greater than 95% when 5 mu of taeniaestatin was present on both the cell and chemotactic factor side of the chambers. Equine neutrophils gave dose- and time-dependent migration responses to purified bovine C5a with an ED50 of 1.04 X 10(-7)M. Taeniaestatin inhibited the C5a-mediated chemotactic and chemokinetic neutrophil responses (51% using 1 mu and greater than 95% with 5 mu of taeniaestatin). The inhibition of leucocyte motility by taeniaestatin was reversible and without cytotoxicity at the highest doses of taeniaestatin tested.     

NON-MALICIOUS ABSCONDING IN A MENTALLY HANDICAPPED WOMAN: SHORT-TERM SUCCESS BUT LONG-TERM PROBLEMS

Sometimes, the environment in which mentally handicapped people live is primarily responsible for some particular problem behaviour. We would like to present a situation where this seemed to be the case and to describe a procedure which helped initially to alleviate the problem but which, in the long-term, proved to be of limited usefulness. This was due, we believe, to difficulties inherent in many of our hospitals for the mentally handicapped, which are discussed below.     

Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders

boomer c.a. & mccormack b. (2010) Journal of Nursing Management  18, 633–644
Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods Programme evaluation methodology to determine the ‘worth’ of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators.