A physical linkage between cystic fibrosis airway surface dehydration and Pseudomonas aeruginosa biofilms

A vexing problem in cystic fibrosis (CF) pathogenesis has been to explain the high prevalence of Pseudomonas aeruginosa biofilms in CF airways. We speculated that airway surface liquid (ASL) hyperabsorption generates a concentrated airway mucus that interacts with P. aeruginosa to promote biofilms. To model CF vs. normal airway infections, normal (2.5% solids) and CF-like concentrated (8% solids) mucus were prepared, placed in flat chambers, and infected with an approximately 5 x 10(3) strain PAO1 P. aeruginosa. Although bacteria grew to 10(10) cfu/ml in both mucus concentrations, macrocolony formation was detected only in the CF-like (8% solids) mucus. Biophysical and functional measurements revealed that concentrated mucus exhibited properties that restrict bacterial motility and small molecule diffusion, resulting in high local bacterial densities with high autoinducer concentrations. These properties also rendered secondary forms of antimicrobial defense, e.g., lactoferrin, ineffective in preventing biofilm formation in a CF-like mucus environment. These data link airway surface liquid hyperabsorption to the high incidence of P. aeruginosa biofilms in CF via changes in the hydration-dependent physical-chemical properties of mucus and suggest that the thickened mucus gel model will be useful to develop therapies of P. aeruginosa biofilms in CF airways.     

Folate and neural tube defects: The role of supplements and food fortification

Periconceptional folic acid significantly reduces the risk of neural tube defects. It is difficult to achieve optimal levels of folate by diet alone, even with fortification of flour, especially because flour consumption in Canada is slightly decreasing. Intermittent concerns have been raised concerning possible deleterious effects of folate supplementation, including the masking of symptoms of vitamin B₁₂ deficiency and an association with cancer, especially colorectal cancer. Both concerns have been disproved. The Canadian Paediatric Society endorses the following steps to enhance folate intake in women of child-bearing age: encouraging the consumption of folate-rich foods such as leafy vegetables, increasing the level of folate food fortification, taking a supplement containing folate and B₁₂, and providing free folate supplementation to disadvantaged women of child-bearing age. These recommendations are consistent with those of the Society of Obstetricians and Gynaecologists of Canada.     

The Impact of Urinary Incontinence on Sexual Function and Sexual Satisfaction in Women with Spinal Cord Injury

Sexual function is a major concern for many individuals following spinal cord injury (SCI). Sexuality after SCI is a complex issue that is influenced by a number of social, psychological and physiological factors, including urinary incontinence (UI). To examine the experience of sexuality for women with SCI, to determine the impact of UI on sexual function and sexual satisfaction in these women, and to identify their main concerns regarding UI and sexuality. Using a phenomenological approach, seven in-depth interviews combining the interview guide approach and standardized open-ended questions were conducted. Two main categories were identified: Sexuality and the impact of UI on sexuality. Related themes were uncovered within each category. Both categories revealed emerging themes including 13 for sexuality and 10 for the impact of UI on sexuality. Five additional themes relevant to the research question but that did not fit into the initial categories were also identified. Intimacy and the sexual experience were negatively affected by UI as a result of SCI, and by an excessive concern about autonomic dysreflexia. There is a significant shortage of information available for women with SCI regarding sexual function in general, but more specifically, a lack of information on sexual function as it relates to UI. Future research should focus on creating resources to assist in this area which may improve the quality of life for these individuals.     

Comparison of two combined vaccines against typhoid fever and hepatitis A in healthy adults

A prospective, randomised, observer-blind, comparative study was performed in healthy adults with a new hepatitis A/typhoid combined vaccine, Viatim, and the marketed Hepatyrix vaccine. Both vaccines induced high levels of protective antibodies, but typhoid responses were higher and hepatitis A responses more rapid with Viatim compared with Hepatyrix. Both vaccines were well tolerated, no serious adverse events (SAEs) occurred, but more Viatim vaccinees had more mild or moderate local reactions (82.7%) than Hepatyrix (53.1%, p < 0.001). In this direct comparison Viatim induced more local reactions, but elicited a more rapid and higher immune response to both antigens than Hepatyrix.     

Race/ethnic variation in serum levels of IGF-I and IGFBP-3 in US adults

ObjectivesThe IGF axis plays a significant role in normal growth and development and variation in IGFs is associated with health outcomes. Past studies report variation in IGF levels among race/ethnic groups known to differ in disease incidence. This paper reports on race/ethnic variation in serum levels of IGF-I and IGF-BP3 in a nationally representative and ethnically diverse sample of US adults.DesignSerum IGF-I and IGFBP-3 levels from the fasting subsample (n = 6061) of respondents to the US National Health and Nutrition Examination Survey III (NHANES III) were analyzed using an IGF-I ELISA (Diagnostic Systems Laboratory (DSL) 10–5600) and an IGFBP-3 IRMA (DSL 6600). The NHANES is a combined examination and interview survey of a nationally representative sample of US adults. Regression analyses were used to estimate cross-sectional associations between the IGF axis and demographic variables.ResultsIn unadjusted analyses, serum IGF-I levels were higher in males than in females, and IGFBP-3 levels were higher in females than in males. Both analytes were lower in older adults. Univariate analyses indicate that serum levels of IGF-I are lower in female Non-Hispanic Whites (NHW) (256 [4.9]) and Hispanics (249 [6.6]) than in Non-Hispanic Blacks (NHB) (281 [4.9]). However, in males, IGF levels in NHWs (287 [3.6]) and NHBs (284 [4.3]) are similar and levels in Mexican–Americans are only moderately reduced (265 [3.4]). Notably, NHB’s have the highest molar ratio of IGF-I:IGFBP-3 at all ages. After adjustment for age and BMI, gender and race/ethnicity differences persist.ConclusionsThese cross-sectional data support exploration of the IGF axis as an explanation for some race/ethnic differences in cancer incidence.     

Vocal fold augmentation with calcium hydroxylapatite (CaHA).

OBJECTIVES: Evaluate the effectiveness of CaHA injection for patients with glottal incompetence. METHODS: Multi-center, open-label, prospective clinical study with each patient serving as his/her own control. Voice-related outcome measures were collected for pre-injection and 1, 3, and 6 months. RESULTS: Sixty-eight patients were available for evaluation. Fifty percent of the injection procedures were done in office. Fifty-seven percent were diagnosed with unilateral paralysis and 42% with glottal incompetence with mobile vocal folds. Patient satisfaction 6 months post showed 56% had significantly improved voice and 38% reported moderately improved voice. Paired t tests from baseline to 6 months showed significant improvements on the VHI and VAS (vocal effort), CAPE-V judgments of voice severity and videoendostroboscopy ratings of glottal closure, and objective voice measures of glottal closure (MPT and S:Z ratio). CONCLUSIONS: Preliminary results in this large cohort of patients demonstrate excellent clinical results.     

Why do patients known to renal services still undergo urgent dialysis initiation? A cross-sectional survey.

BACKGROUND: Unplanned, urgent initiation of renal replacement therapy (RRT) is associated with poorer outcomes than planned initiation. However, in many services worldwide, substantial numbers of patients still do not begin treatment electively. The aim of this study was to identify numbers of and possible risk factors for, patients starting unplanned RRT despite being known to renal services for > or =4 months. METHODS: A retrospective survey of electronic and medical records was conducted of patients starting RRT in a large regional UK renal network in 2003. Data extracted included information on demographic, biochemical and treatment factors. Patients were classified as known acute (starting dialysis urgently yet known to renal services > or =4 months) or elective (starting RRT in a planned manner with a fistula or peritoneal dialysis catheter). Urgent dialysis was defined as starting either with a haemodialysis catheter or as an inpatient. Logistic regression was used to identify factors predicting an urgent dialysis start. RESULTS: Data from 109 of the 126 eligible patients were included; 60 elective, 49 known acute. Reasons for presenting as known acute were illness (21), service (24) and patient related (17). More than one reason was identified for 11 patients. The known acute group had more severe anaemia and lower glomerular filtration rates. Fewer known acute patients had attended dedicated predialysis clinics (90% increased odds of known acute start for non-attendance, P = 0.001) and patient dialysis information sessions (P = 0.020). Dialysis counselling had begun sooner in elective patients (P = 0.003). Odds of an urgent dialysis start increased by 4% with each year of age (P = 0.024). CONCLUSIONS: Early dialysis education and predialysis clinic attendance were associated with greater likelihood of elective dialysis initiation. Further studies are required to determine the cost effectiveness of these interventions, but services that initiate RRT urgently in a high proportion of patients should consider improving predialysis clinic attendance and early dialysis education.