Pollution-affected fish hepatic transcriptome and its expression patterns on exposure to cadmium.

Individuals of the fish Lithognathus mormyrus were exposed to a series of pollutants including: benzo[a]pyrene, pp-DDE, Aroclor 1254, perfluorooctanoic acid, tributyl-tin chloride, lindane, estradiol, 4-nonylphenol, methyl mercury chloride, and cadmium chloride. Five mixtures of the pollutants were injected. Each mixture included one to three compounds. A microarray was constructed using 4608 L. mormyrus hepatic cDNAs cloned from the pollutant-exposed fish. Most clones (4456) were sequenced and assembled into 1494 annotated unique clones. The constructed microarray was used to identify changes in hepatic gene expression profile on exposure to cadmium administered to the fish by feeding or injections. Thirty-one unique clones showed altered expression levels on exposure to cadmium. Prominently differentially expressed genes included elastase 4, carboxypeptidase B, trypsinogen, perforin, complement C31, cytochrome P450 2K5, ceruloplasmin, carboxyl ester lipase, and metallothionein. Twelve sequences have no available annotation. Most genes (23) were downregulated and hypothesized to be affected by general toxicity due to the intensive cadmium exposure regime. The concept of an operational multigene cDNA microarray, aimed at routine and fast biomonitoring of multiple environmental threats, is outlined and the cadmium exposure experiment has been used to demonstrate functional and methodological aspects of the biomonitoring tool. The components of the outlined system include: (1) spotted array, composed of both pollution-affected and constitutively expressed genes, the latter are used for normalization; (2) standard, repeatable labeling procedure of a reference transcript population; and (3) biomarker indices derived from the profile of expression ratio across the pollution-affected genes, between the field-sampled transcript populations and the reference.

Hepatopancreatic multi-transcript expression patterns in the crayfish Cherax quadricarinatus during the moult cycle.

Alterations of hepatopancreatic multi-transcript expression patterns, related to induced moult cycle, were identified in male Cherax quadricarinatus through cDNA microarray hybridizations of hepatopancreatic transcript populations. Moult was induced by X-organ sinus gland extirpation or by repeated injections of 20-hydroxyecdysone. Manipulated males were sacrificed at premoult or early postmoult, and a reference population was sacrificed at intermoult. Differentially expressed genes among the four combinations of two induction methods and two moult stages were identified. Biologically interesting clusters revealing concurrently changing transcript expressions across treatments were selected, characterized by a general shift of expression throughout premoult and early postmoult vs. intermoult, or by different premoult vs. postmoult expressions. A number of genes were differentially expressed in 20-hydroxyecdysone-injected crayfish vs. X-organ sinus gland extirpated males.

Results of a search for missed cases of reportable communicable diseases using hospital discharge data.

To assess how reliably hospitals report serious, uncommon communicable diseases to the Department for Public Health, we searched the 1995 hospital discharge data set (HDDS) collected by the Kentucky Health Policy Board for cases of 11 diseases. Of 17 case records found, 4 represented disease occurrences that had been reported to the Department; 6 represented coding errors in the HDDS; 4 were instances where a reportable disease had been suspected but not confirmed by subsequent workup; 1 case was a resident of another state; and 2 were cases of invasive Hemophilus influenzae infection in adults that should have been reported to the Department. The study found no evidence that hospitals failed to report vaccine-preventable diseases. There was evidence that the HDDS needs improved accuracy to maximize its usefulness for public health purposes.

Rabies postexposure prophylaxis survey--Kentucky, 1994.

A survey of rabies postexposure prophylaxis administered by local health departments for a 1-year period showed that very few patients received treatment as a result of exposure to a confirmed rabid animal. Most prophylaxis was administered for contact with domestic animals in situations where existing recommendations for quarantine or laboratory testing of the animal were not followed. Because rabies in domestic animals in Kentucky is uncommon, these findings suggest that had the existing recommendations been followed, the prophylaxis would have been unnecessary in most cases.

Green tobacco sickness: occupational nicotine poisoning in tobacco workers.

In this study the authors describe the investigation of a 1992 outbreak of green tobacco sickness, a form of nicotine poisoning from dermal exposure, among 47 tobacco workers in a five-county region of central and south-central Kentucky. Cases were identified through medical record searches at participating hospitals, as well as from reports submitted to the Occupational Health Nurses in Agricultural Communities program. A case-control study was undertaken to assess risk factors for green tobacco sickness. In a 20-min telephone interview, 40 cases and 83 controls responded to questions contained in a questionnaire. In 1992, 47 persons (3 were under age 16 y) in the study region sought medical treatment for green tobacco sickness. Twelve persons were hospitalized and 2 required intensive-care treatment. The crude incidence in 1992 was 10.0/1,000 tobacco workers. In 1993, 66 cases (7 were under age 16 y) of green tobacco sickness were identified in the study region (i.e., annual incidence of 14.0/1,000). A case-control study demonstrated that ill workers were younger, and were more likely to have worked in wet conditions, compared with workers who were not ill. Green tobacco sickness is a common problem among tobacco workers that may be prevented by avoiding work in wet tobacco or by use of protective clothing. Children younger than 16 y of age represented 9% of the green tobacco sickness cases in 1992 and 1993. Current occupational safety and health laws do not address protection of tobacco workers with respect to green tobacco sickness.

Localization ability in infants with simulated unilateral hearing loss.

This study investigated the feasibility of using a localization task to rule out unilateral hearing loss in infants. Fourcorner localization ability was assessed in 29 normal-hearing infants (9-20 mo) using four different test stimuli. In these same infants, a mild unilateral hearing loss was simulated by occlusion of the external auditory canal and the test sequence was repeated. Analysis of front-back, right-left, and combined errors for each of the test stimuli revealed that this type of task may allow detection of unilateral hearing loss as slight as 25 dB HL.

Aided auditory thresholds in children with postmeningitic deafness.

Postmeningitic hearing loss is often bilateral, profound, and rapid in onset. Children with postmeningitic hearing loss may be identified as potential candidates for cochlear implantation. The length of time required for a definitive trial with conventional amplification, which must precede a final decision regarding cochlear implant surgery, has been the subject of debate. Twenty-five children with bilateral severe-to-profound postmeningitic sensorineural hearing loss were fitted with appropriate amplification and results of serial-aided tests were analyzed to determine the degree of benefit and changes in aided thresholds over time. Twelve children gave aided responses that clearly indicated the presence of residual hearing and good aided benefit. Ten youngsters have responded consistently in the vibrotactile range when aided, thus receiving limited benefit from conventional amplification. Of particular interest are three children who initially exhibited limited or no auditory responses but who, after a period of 16 to 25 months, showed excellent benefit with binaural hearing aids. These children are all in total communication programs and have received good auditory training. Caution should be exercised when concluding that such a child does not benefit from amplification.

Probe-tube microphone measures in hearing-impaired children and adults.

This study was designed to investigate the reliability of real-ear measurements of sound pressure level (SPL) and to compare these values with two coupler measures of SPL. A commercially available probe tube microphone system was used to measure real ear SPL in both children and adults. Test-retest reliability decreased as a function of frequency for both groups and, in general, was slightly poorer for the children. For both groups, coupler to real ear differences were larger for the 2 cm3 coupler than for the reduced volume coupler; however, no significant differences were observed between groups. In addition, a measure of ear canal volume was not found to be a good predictor of coupler to real ear discrepancies.

The pattern and stability of postmeningitic hearing loss in children.

Following meningitis, 280 children (168 boys, 112 girls) had audiological assessment, and 87 (31%) were initially found to have a sensorineural hearing loss in one or both ears. Twenty-three children were followed elsewhere. Of 64 children followed for an average of 3.46 years, 55 (86%) exhibited stable auditory thresholds over time, most commonly (24) bilateral, profound/anacusic losses. One moderate and four severe losses were identified, but no bilateral, mild losses. Nineteen children had asymmetric losses with varied audiometric configurations. Seven children presented with a unilateral hearing loss, again with a range of configurations. Auditory thresholds changed over time in nine children, either improving, declining, or fluctuating, over a variable interval ranging from 1 month to 12 years.

The electronic video endoscope: clinical experience with 1200 diagnostic and therapeutic cases in the community hospital.

Gastrointestinal endoscopic examinations with the Welch-Allyn and Fujinon electronic video endoscopes were evaluated in four phases in our community hospital endoscopy unit. Resolution and clinical comparisons to fiberoptic instruments offered advantages for the electronic systems. A review of 1200 consecutive procedures for efficacy, safety, and maintenance considerations was conducted. The use of the video endoscopes as first choice for nearly all diagnostic and therapeutic procedures was more favorable than for the ongoing experience with fiberoptic instruments.

AAFP--ASGE conjoint course on flexible sigmoidoscopy.

The first multidisciplinary course developed jointly by the American Academy of Family Physicians and the American Society for Gastrointestinal Endoscopy is described. This prototype program was designed to teach the skills of 35 cm flexible sigmoidoscopy (FS) to twenty family physicians. Gastroenterologist preceptors determined that all 20 family physicians could perform this procedural skill within ten supervised cases. A control group of family physicians was studied to determine flexible sigmoidoscope acquisition frequencies in separate cohorts (Continuing Medical Education (CME) versus no CME on flexible sigmoidoscopy). The study group acquired instruments more frequently (18/19 = 95%) (p less than or equal to .05) than those with previous CME on FS (8/14 = 57%) or without previous CME on FS (2/19 = 11%). Two-thirds of these physicians purchased 60-65 cm flexible instruments rather than the 35 cm instrument. Longitudinal studies will be required to determine whether or not this intervention will have a meaningful impact upon colorectal cancer screening behaviors by primary care physicians.

Cricopharyngeal myotomy: management of cervical dysphagia.

Cricopharyngeal myotomy has gained widespread acceptance as surgical treatment for various forms of cervical dysphagia. The case records of 33 patients who underwent cricopharyngeal myotomy for dysphagia originating from varying underlying diseases are reviewed. The majority of these patients were able to resume oral feeding following myotomy. Analysis of preoperative pharyngoesophageal manometry and contrast radiography identified diagnostic criteria for appropriate case selection.

Hepatic pathologic condition in asymptomatic Australia antigen carriers. A light microscopical study of 26 cases and a review of the literature.

Liver biopsies were performed on 26 Australia antigen carriers who were asymptomatic with normal liver function tests. The carriers are part of a prospective and long-term study designed to analyze the clinical and pathological consequences of persistent, though asymptomatic antigenemia. The liver abnormalities that were indicated on biopsy included fifteen specimens with "inflammatory changes" that were characterized by intralobular foci of mononuclear cells and/or portal tract infiltrates. Fifteen biopsy specimens demonstrated "ground-glass" cells. Nine biopsy specimens showed fatty change, and three specimens were normal. The results of our study in conjunction with cases that were reviewed in the literature indicate a narrow and mild spectrum of liver biopsy specimen abnormalities in the asymptomatic carrier with normal liver function tests. Prognostic inference from this liver biopsy data is premature and clinical follow-up of carriers is advocated.