Establishing priorities for European collaboration in communicable disease surveillance

Background: Several collaborations in communicable disease surveillancehave developed between European Union member states. Involvementin these activities takes time and money. It is vital that collaborationsare established in areas most likely to be beneficial. An exercisewas undertaken to inform national surveillance centres and theEuropean Commission as to priority areas for the developmentof collaborations. Methods: A modified Delphi exercise was undertakenamongst the heads of centres with responsibilities for surveillanceat national level in the member states of the EU. Participantsdeveloped, agreed and ranked criteria for developing collaborations.A list of communicable diseases and syndromes was then rankedusing a Likert-type scale. Three rounds were undertaken. Betweenrounds, scores and a ranking were fed back showing where participantshad ranked items, compared to the overall mean and rank distribution.For the third round participants were asked to use a categoricalscale, nominating six or ten high priority disease areas. Results:Response rates were 87.5% for round 1, 44% round 2 and 87% round3. The low round 2 response rate appeared to be because respondentsdid not wish to alter their rankings. The six high priorityareas were outbreaks of gastroenteritis/food poisoning, CID/otherslow virus infections, serious imported diseases, legionellosis,antimicrobial resistance and tuberculosis. When participantsgave ten high priority areas meningococcal disease, travel advice,vaccination/immunization and influenza were also included. Thefinal lists were accepted at the meeting of participants. Conclusions:The process was successful in developing both a priority listand consensus.     

Ocular Defocus and the Friedmann Central Visual Field Analyser

ABSTRACT Several normal subjects were assessed using the Friedmann central visual field analyser whilst wearing either their full spectacle correction or +2.00 DS or more of contact lens-induced defocus. The results suggest a need to provide a patient with an appropriate spectacle correction during assessment with this device.     

Suppression of Erythromycin-induced Early Afterdepolarizations and Torsade de Pointes Ventricular Tachycardia by Mexiletine

Erythromycin is a selective I_Kr-blocking, action potential duration (APD)-prolonging drug, which may induce early afterdepolarizations (EADs) and torsade de pointes ventricular tachycardia. The successful termination of an erythromycin-induced clinical torsades de pointes by the authors with mexiletine prompted them to investigate in vitro whether erythromycin is able to induce EADs in Purkinje fibers and, if so, whether EADs are suppressible or not by mexiletine. Electrically stimulated canine Purkinje fibers (n=9) were superfused with erythromycin (200 mg/l) and action potentials were recorded by an intracellular microelectrode technique. Erythromycin induced a pronounced prolongation of APD and the appearance of EADs in all Purkinje preparations (9/9). After the addition of mexiletine (10 mM), a marked shortening of APD and the disappearance of EADs (7/9) were observed. Mexiletine, an inhibitor of the tetrodotoxin-sensitive window Na+-current, may prevent IKr-blocking drug-induced torsade de pointes ventricular tachycardia by abolishing APD prolongation and EADs.     

Time Course of Inhibition Induced by a Putative Saccadic Suppression Circuit in the Dorsal Lateral Geniculate Nucleus of the Rabbit

Psychological studies have revealed that a visual suppression occurs during the saccadic eye movements to maintain the stable visual image. This visual suppression is named saccadic suppression. A typical saccadic suppression precedes the saccadic eye movements by 30–60 ms, lasts 120–180 ms, and is followed by a 100–150-ms facilitation. Recently, we have revealed an inhibitory circuit connecting the deep layers of the superior colliculus (SC) to the dorsal lateral geniculate nucleus (LGN), via the central lateral nucleus in the thalamus (CL) and thalamic reticular nucleus (TRN). We speculated that this inhibitory circuit might mediate saccadic suppression in the rabbit. In the present study, we used intracellular recording technique to further examine the synaptic and intrinsic responses of CL cells, TRN cells, and LGN cells to the activation of this inhibitory circuit. We found that the stimulation of the deeper layers of the SC induced a fast excitation postsynaptic potential (EPSP) in CL cells, followed by a robust EPSP in TRN cells and a prolonged inhibitory postsynaptic potential (IPSP) in LGN cells. The EPSP in TRN cells was always followed by a small inhibitory postsynaptic potential (IPSP). The IPSP in LGN cells lasted about 133 ± 27 ms. Sometimes, a rebound bursting occurred after the IPSP in LGN cells. We also examined whether activation of this inhibitory circuit could suppress the retino-geniculo-cortical pathway. We found that the SC stimulation always suppressed the evoked potential in the visual cortex induced by the stimulation of the optic chiasm. Our results of the inhibitory circuit can induce an inhibition in the LGN and a suppression on the retino-geniculo-cortical pathway. The time courses of the inhibition and suppression were compatible with that of saccadic suppression revealed by psychological and physiological studies. These results support the idea that the inhibitory circuit of SC (deeper layers)-CL-TRN-LGN may mediate the saccadic suppression in the rabbit LGN. Copyright © 1996 Elsevier Science Inc.     

Oral rehabilitation of adult class II, division 1 malocclusion complicated by collapse of posterior occlusion

The complications and limitations in rehabilitating an adult woman with class II, division 1 malocclusion and posterior occlusal collapse is described with special consideration given to the aspects of time, the patient's personality and socio-economic situation. Fixed restorations were chosen for optimum function, comfort and to enhance the patient's emotional security. The importance of an individual treatment approach is stressed.     

Early Changes in Quiescent B Cell Physiology Subsequent to Cognate and Bystander Interaction with Helper T Cells

We have assessed early changes in quiescent B cells following cognate and bystander interaction with cloned helper T cells. Variables monitored include Ia expression, blastogenesis, G0 to G1 transition, and progression through cycle. We have also assessed the antigen specificity, Ia restriction, and dependence on membrane immunoglobulin crosslinking of both generation and delivery of effectors that mediate B cell responses. The results demonstrate that antigen presentation by quiescent B cells to T cells resulting in the generation of effectors that activate B cells is Ia-restricted and dependent on antigen and an (mIgM and mIgD) crosslinking signal. However, once generated, T cell effector functions act independently of Ia haplotype to promote Ia expression, blastogenesis, and G0 to G1 transition by most small B cells. Although these responses can be mediated by T cell supernatants, further progression of B cells through S, G2 and M is only efficient when Th cells are present in cultures. Thus, results suggest that one or more Ia unrestricted, labile and/or cell-associated factors, not active in most conventional T cell supernatants, are necessary to stimulate proliferation of small B cells.     

Possible Response of Acute Psychosis in Hepatic Encephalopathy to Levodopa

A favorable response to levodopa in two episodes of hepatic encephalopathy, the latter presenting as acute psychosis, is described in a patient with Budd-Chiari syndrome.