Heterotopic ossification (myositis ossificans) in acquired immune deficiency syndrome. Detection by gallium scintigraphy

A case of heterotopic ossification (myositis ossificans) secondary to the central nervous system complications of acquired immune deficiency syndrome (AIDS) is reported. Because of the overwhelming suspicion of infection in this patient, this diagnosis was not considered until a gallium scan revealed the typical findings of heterotopic ossification. Because of the increasing utilization of gallium imaging in the AIDS population, every imaging specialist should be aware of this potential disorder.     

Implementing a patient-led service for chronic conditions

Many chronic conditions with fluctuating levels of disease activity are traditionally managed by lifelong regular medical reviews. However, this means appointments do not always coincide with patient need, while the volume of reviews makes it difficult to respond quickly to requests for help. Research in rheumatoid arthritis suggests that hospital-initiated reviews can be replaced by patient-initiated reviews, supported by nurse-led initiatives.     

An electron microscope survey of the surface structures and hydrophobicity of oral and non-oral species of the bacterial genus Bacteroides

Seventeen strains of Bacteroides representing 10 species were examined by negative staining; the majority were from the mouth but a few non-oral strains were included. Seven species had peritrichously-arranged, non-flagellar appendages which could be divided by morphology and ultrastructure into two subgroups, fibrils and fimbriae. Bacteroides asaccharolyticus strains B536 and B537 and Bacteroides gingivalis strains W50, W83, WPH15 and WPH35 had fimbriae with mean width of 4.4 nm and 0.5 to 6.0 microns long depending on the strain. The fimbrial length within each strain also varied. Fibrils were present on two fresh oral isolates of Bacteroides melaninogenicus, Bacteroides intermedius strains T588 and W09, Bacteroides corporis ATCC 33547, Bacteroides oralis ATCC 33269 and Bacteroides buccae ATCC 33574. Fibrils consistently clumped into bundles of variable thickness and formed a fringe around the cell periphery, ranging from 0.27 to 1.2 microns long depending on the strain. Fibril lengths of each strain were uniform. Fibrils had no measurable width and the clumps tapered towards the free ends. Bacteroides loeschii VPI 9085, Bacteroides pentosaceus strains NP333 and J1 and Bacteroides capillosus 29799 had no detectable surface appendages. Fimbriate strains had a layer outside the outer membrane, with a mean thickness of between 17.8 and 28.6 nm. Both fibrillar and fimbriate strains produced many small membranous vesicles budding from the outer membrane. There were two morphological forms of vesicles, ones with either fimbriae or fibrils (species-dependent) and ones with no attached appendages. Of eleven strains tested for cell-surface hydrophobicity by partitioning between hexadecane and buffer, all but one was non-hydrophobic.     

Nursing support at the onset of rheumatoid arthritis: Time and space for emotions, practicalities and self-management

Background: Following a diagnosis of rheumatoid arthritis (RA), patients have to adapt to lifelong, unpredictable but repeated episodes of pain and disability, potentially leading to permanent loss of function and its consequences on their lives. We established nurse clinics with the aim of supporting newly diagnosed RA patients in adapting to and managing their long‐term condition. The aim of this study was to explore the content of clinic discussions in this new clinical service, in order to ascertain patients' needs upon diagnosis. Methods: All clinic letters from the nurse to the family doctor were analysed. Every topic mentioned was systematically coded independently by a researcher and a patient research partner, who compared and agreed codes. Codes were organized into categories, and, finally, into overarching themes. Results: Twenty‐four patients had 74 appointment letters. A total of 79 codes were identified, from which ten categories emerged, and, finally, three overarching themes. The first theme related to ‘Emotional support’, which underpinned the other two themes and was discussed in almost all appointments. Issues included discussions about the emotional consequences of RA, needing time to adjust, frustration and fears for the future. The second theme ‘Practicalities of the treatment of RA’, included subordinate themes relating to the nature of RA, such as identity, cause, timeline, consequences and treatment. Medication issues were discussed and referrals to the multidisciplinary team were made. The final theme related to the ‘Self‐management of RA’, and included discussions on physical symptoms and their management. Conclusions: The offer to attend a nurse clinic soon after diagnosis allowed RA patients to discuss a wide range of practical and self‐management issues. However, most patients also took the opportunity and time to discuss emotional reactions and adaptations to diagnosis. The data suggest an unmet need for emotional support that a nurse clinic might be able to provide. Copyright © 2007 John Wiley & Sons, Ltd.     

Purification and characterization of 26S proteasomes from human and mouse spermatozoa

We purified by fractionation on 10-40% glycerol gradients, 26S proteasomes from normal human spermatozoa. These proteasomes, which participate in the ATP-dependent degradation of ubiquitinated proteins, share a similar sedimentation coefficient to those purified from other human tissues. Fluorogenic peptide assays reveal they have chymotrypsin, trypsin and peptidyl-glutamyl-like peptide hydrolysing activities; the chymotrypsin activity is ablated by the specific 26S proteasome inhibitor MG132. Confirmation that these large proteases are 26S proteasomes is provided by detection of the 20S proteasome subunits HC2, XAPC7, RN3 and Z and regulatory ATPases MSS1, TBP1, SUG1 and SUG2 by Western analyses with monoclonal antisera. These antigens are found only in the gradient fractions enriched in proteolytic activities. We have also shown that, although mature spermatozoa from mice have considerably reduced amounts of a ubiquitin-conjugating enzyme (E2) and ubiquitin-protein conjugates in comparison with less mature germ cells, they retain relatively high values of 26S proteasome activity. This suggests that proteasomes may have further roles to play in normal sperm physiology.      

A comparative study of some technical aspects of three intra aortic balloon pump systems

Experiments were undertaken to examine some of the technical aspects of three intra aortic balloon pumping systems in current use. A comparative study of the response time, balloon displacement at varying rates, augmentation and diffusion of gases across the balloon membrane was made using the Hoogstraat, Datascope System 80 and the Avco 7 machines. A study of the response time, i. e. time taken for changes in pressure of the three machines using their recommended driving gases showed that it was the shortest for the Hoogstraat pump. When three different driving gases, carbon dioxide, helium and air, were used in the Hoogstraat machine, the response time was shortest with helium. Measurement of balloon displacement was made to examine the ability of the three machines to follow a varying regular rate and an irregular rhythm. At low regular rates the Hoogstraat, and at high rates the Datascope, showed the greatest displacement. The Datascope and Avco were able to follow irregular rates better than the Hoogstraat.Augmentation was studied by examining the pressure wave forms generated in a simulated arterial system (aorta) proximal and distal to the balloon using the three machines with the Vigon, Datascope and Avco Balloons. The analysis of the pressure waves was expressed as proximal and distal balloon displacement. The displacement was the greatest when the Datascope machine was used with a unidirectional Datascope balloon. Gas diffusion experiments were carried out using the Hoogstraat pump connected to the Datascope and Avco balloons with carbon dioxide and helium. Results showed that gas diffusion across the balloon membrane was greatest when the Avco balloon was used with carbon dioxide as the driving gas. the study has shown that there are differences in the way these machines work which need to be considered and examined further. A detailed knowledge of these technical aspects may help in the design and operation of intra aortic balloon pumping systems and thus in their application to clinical use.     

Glycosaminoglycan-depolymerizing enzymes produced by anaerobic bacteria isolated from the human mouth

A number of obligately anaerobic bacteria, some implicated in periodontal disease, were screened for their ability to produce enzymes capable of degrading hyaluronic acid and chondroitin-4-sulphate. Two screening methods were used following anaerobic incubation at 37 degrees C for 7 days. One involved incorporating the respective substrates and bovine-serum albumin into agar plates and, after incubation, flooding the plates with 2 M acetic acid. Clear zones were produced around colonies which produced enzymes capable of depolymerizing the substrates. The second was a sensitive spectrophotometric procedure based on the ability of certain bacteria to produce eliminase enzymes, which degrade the substrates to unsaturated products having a characteristic u.v. absorption at 232 nm. Strains of Bacteroides gingivalis and Bacteroides melaninogenicus degraded both substrates whereas Bacteroides asaccharolyticus degraded neither substrate by either method. Some bacteria gave negative results with the plate method whereas the more sensitive spectrophotometric assay proved positive. The number of anaerobic bacteria capable of degrading hyaluronic acid and chondroitin-4-sulphate in vitro may therefore have been underestimated in previous studies.