Bone infection: a clinical priority for clinicians, scientists and educators.

Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the main unknown factors that may be involved, and the main targets for future intervention, include more accurate and less invasive diagnostic options, more thorough and accurate debridement protocols, and more potent and targeted antimicrobials. The underlying biology dominates the clinical management of bone infections, with features such as biofilm formation, osteolysis and vascularisation being particularly influential. Based on the persistence of this problem, an improved understanding of the basic biology is deemed necessary to enable innovation in the field. Furthermore, from the clinical side, better evidence, documentation and outreach will be required to translate these innovations to the patient. This review presents the findings and progress of the AO Trauma Clinical Priority Program on the topic of bone infection.

Fractionated radiation exposure amplifies the radioresistant nature of prostate cancer cells.

The risk of recurrence following radiation therapy remains high for a significant number of prostate cancer patients. The development of in vitro isogenic models of radioresistance through exposure to fractionated radiation is an increasingly used approach to investigate the mechanisms of radioresistance in cancer cells and help guide improvements in radiotherapy standards. We treated 22Rv1 prostate cancer cells with fractionated 2 Gy radiation to a cumulative total dose of 60 Gy. This process selected for 22Rv1-cells with increased clonogenic survival following subsequent radiation exposure but increased sensitivity to Docetaxel. This RR-22Rv1 cell line was enriched in S-phase cells, less susceptible to DNA damage, radiation-induced apoptosis and acquired enhanced migration potential, when compared to wild type and aged matched control 22Rv1 cells. The selection of radioresistant cancer cells during fractionated radiation therapy may have implications in the development and administration of future targeted therapy in conjunction with radiation therapy.

The challenge of contemporary nurse education programmes. Perceived stressors of nursing students: mental health and related lifestyle issues.

This study aimed to identify the lifestyle behaviours of nursing students. The research tool was a 146-item questionnaire based upon the College Lifestyle and Attitudinal National survey. Most students considered their mental health as either good or very good. Those in the final year were more likely to rate their mental health poorly. Many experienced programme-related stressors including examinations and assignments and studies in general. More than one-third also reported stressors related to relationships with clinical staff and clinical assessment of competence. There is a concern that the added demands of modern nursing programmes place the student under considerably more pressure, because of competing demands. While many students talk to their peers or family, many do not and prefer rather to go it alone, with some choosing to escape through alcohol or drugs. The support and encouragement of healthy coping mechanisms among nursing students is paramount to ensure a healthy nursing workforce for the future. Nursing students support the mental and physical health of others, and therefore in many ways ought to a role model. Nurturing and supporting their mental health is crucial to the future of profession.

Accumulation of glial fibrillary acidic protein and histone H4 in brain storage bodies of Tibetan terriers with hereditary neuronal ceroid lipofuscinosis.

The neuronal ceroid lipofuscinoses (NCLs) are inherited neurodegenerative diseases characterized by massive accumulation of autofluorescent storage bodies in neurons and other cells. A late-onset form of NCL occurs in Tibetan terrier dogs. Gel electrophoretic analyses of isolated storage body proteins from brains of affected dogs indicated that a protein of approximately 50 kDa was consistently prominent and a 16 kDa component was present in some brain storage body preparations. Mass spectral analysis identified the 50 kDa protein as glial fibrillary acidic protein (GFAP), isoform 2. GFAP identification was supported by immunoblot and immunohistochemical analyses. Histone H4 was the major protein in the 16 kDa component. Specific accumulation of GFAP and histone H4 in storage bodies has not been previously reported for any of the NCLs. Tibetan terrier NCL may be the canine correlate of one of the human adult-onset NCLs for which the genetic bases and storage body compositions have not yet been determined.

Interannual variations in the lipids of the Antarctic pteropods Clione limacina and Clio pyramidata.

Antarctic pteropods, Clione limacina (Order Gymnosomata) and Clio pyramidata (order Thecosomata), were collected near Elephant Island, South Shetland Islands, during 1997 and 1998. Total lipid was high in C. limacina (29--36 mg g(-1) wet mass) and included 46% of diacy1glyceryl ether (DAGE, as % of total lipid) for both 1997 and 1998. DAGE was not detected in C. pyramidata, which had mainly polar lipid and triacy1glycerol. 1-O-Alkyl glyceryl ethers (GE) derived from the DAGE consisted primarily of 15:0 and 16:0, with lower 17:0 and a17:0. The principal sterols of both pteropods included trans-dehydrocholesterol, brassicasterol, 24-methylenecholesterol, cholesterol and desmosterol. Levels of 24-methylenecholesterol and desmosterol were lower in both pteropods in 1997 compared to 1998. C. limacina had high levels of the odd-chain fatty acids 17:1(n--8)c and 15:0 in contrast to C. pyramidata. The previously proposed source of elevated odd-chain fatty acids in C. limacina is via propionate derived from phytoplankton DMPT; another possible source may be from thraustochytrids, which are common marine microheterotrophs. C. pyramidata had twice as much PUFA as C. limacina, largely due to higher 20:5(n--3). The PUFA 18:5(n--3) and very long chain fatty acids (C(24), C(26) and C(28) VLC-PUFA) were only detected in 1998 pteropods. In comparison, 1996 samples of C. limacina contained lower DAGE levels, which also may reflect differences in diet and oceanographic conditions. Interannual variations in specific lipid biomarkers are discussed with respect to possible different phytoplankton food sources available in the AMLR survey area.

Unusually high levels of non-saponifiable lipids in the fishes escolar and rudderfish identification by gas and thin-layer chromatography.

Analysis of the non-saponifiable lipids of the fishes Lepidocybium flavobrunneum and Ruvettus pretiosus (escolar), and Centrolophus niger and Tubbia spp. (rudderfish) was performed. The analyses were used to clarify the cause of recent reports of illness (diarrhoea) in Australia from consumption of purported rudderfish. Both escolar and rudderfish contained very high levels of oil (generally between 14 to 25%, as % wet mass) in the fillet and the oil compositions were different to most seafood. Escolar oil contained mainly wax ester (>90% of oil). The oil from five specimens of rudderfish contained mainly diacylglyceryl ether (DAGE, >80% of oil) or hydrocarbon (>80% of oil, predominately squalene). One rudderfish specimen contained mainly polar lipid. Major differences in oil content and composition, including fatty alcohol and glyceryl ether diols (derived from DAGE), were observed between purported individuals of the same species or related species of rudderfish, raising the possibility of geographic or seasonal differences affecting the oil composition. The oil composition of fish fillet samples associated with the health issues were consistent with the profiles for escolar, rather than rudderfish species. These findings, in particular the lipid class and fatty alcohol profiles, were supported by general protein fingerprinting results and were consistent with the samples originating from individuals of the escolar species L. flavobrunneum. The high wax ester content of the escolar group clarifies the reported diarrhoeal effects to consumers. Purgative properties of high wax ester containing fish oils have been reported for escolar and other species. The results highlight the potential for non-saponifiable lipid profiles to be used for identification of fish fillets and oils to at least group level.

The dihydrolipoyl acyltransferase (BCE2) subunit of the plant branched-chain alpha-ketoacid dehydrogenase complex forms a 24-mer core with octagonal symmetry.

Little is known of the plant branched-chain alpha-ketoacid dehydrogenase complex. We have undertaken a detailed study of the structure of the dihydrolipoyl acyltransferase (BCE2) subunit that forms the core of the complex, to which two other enzymes attach. Mature Arabidopsis thaliana BCE2 was expressed in Escherichia coli. The soluble recombinant protein was purified using a Superose 6 size-exclusion column to >90% homogeneity and was catalytically active. The recombinant protein formed a stable complex with a native molecular mass of 0.95 MDa and an S coefficient of 19.4, consistent with formation of a 24-mer. Negative-staining transmission electron microscopy of the recombinant protein confirmed that BCE2 forms a core with octagonal symmetry. Despite divergence of mammalian and plant BCE2s, there is clearly conservation of structure that is independent of primary sequence.

Lipids of gelatinous Antarctic zooplankton: Cnidaria and Ctenophora.

Cnidaria (Calycopsis borchgrevinki, Diphyes antarctica, Stygiomedusa gigantea, Atolla wyvillei, Dimophyes arctica) and Ctenophora (Beroe cucumis, B. forskalii, Pleurobrachia pileus, Bolinopsis infundibulum) were collected near Elephant Island, South Shetland Islands, during January and February 1997 and 1998. Total lipid was low in all zooplankton (0.1-5 mg g wet mass) and included primarily polar lipids (59-96% of total lipid). Triacylglycerols were 0-26% of total lipids, and wax esters were 0-11% in all species. Cholesterol was the major sterol in all Cnidaria (50-63% of total sterols) whereas in most ctenophores it was lower at 26-45%. These cholesterol levels are consistent with a combined carnivorous and phytoplanktivorous diet in the ctenophores, with the carnivorous diet more dominant in the Cnidaria. Other sterols included primarily trans-dehydrocholesterol, desmosterol, 24-methylcholest-5,22E-dien-3beta-ol, 24-nordehydrocholesterol, and 24-methylenecholesterol. Total stanols were 0-6% in all zooplankton. Eicosapentaenoic acid and docosahexaenoic acid were the major polyunsaturated fatty acids (PUFA) in all samples (7-25% of total fatty acids) except for A. wyvillei in which docosapentaenoic acid was 10% of total fatty acids. The PUFA 18:5n-3 was not detected in 1997 samples, but constituted 0.2-0.8% in most 1998 samples. Monounsaturated fatty acids included primarily 18:1n-9c, 16:1n-7c, and 18:1n-7c. The principal saturated fatty acids in all samples were 16:0, 18:0, and 14:0. These data are the first for many of these zooplankton species and the first sterol data for most species. The use of the signature lipid approach has enabled examination of aspects of trophodynamics not obtainable by conventional techniques.

A retrospective look at long-term adolescent recovery: clinicians talk to researchers.

The purpose of the present article is to identify factors associated with long-term recovery for adolescents. A group of 14 young adults were given semistructured in-depth (one to two hour) interviews. The subjects had been in recovery for two to 16 years. Length of stay in treatment, involvement with self-help groups, psychotropic medication, family support, peer support, spirituality, and other factors were identified as helpful for long-term recovery. A major limitation of this inquiry is that it does not meet minimum standards for research. It is hoped, however, that this inquiry can inform directions for further research.

Histidine modifying agents abolish pyruvate dehydrogenase kinase activity.

Pyruvate dehydrogenase kinase (PDK) specifically phosphorylates the E1alpha subunit of the pyruvate dehydrogenase complex (PDC). Sequence analysis of cloned PDKs led to the proposal that they are mechanistically related to prokaryotic 2-component His-kinases. The reaction mechanism of protein His-kinases involves autophosphorylation of a specific His residue followed by phosphotransfer to an Asp residue. Treatment of recombinant Arabidopsis thaliana PDK with the His-directed reagents diethyl pyrocarbonate (DEPC) and dichloro-(2,2':6', 2"-terpyridine)-platinum(II) dihydrate led to a marked inhibition of autophosphorylation. In addition, DEPC treatment abolished the ability of PDK to trans-phosphorylate and inactivate PDC. These results validate the prediction that PDKs require His residues for activity.

Cloning and characterization of the dihydrolipoamide S-acetyltransferase subunit of the plastid pyruvate dehydrogenase complex (E2) from Arabidopsis.

An Arabidopsis cDNA encoding the dihydrolipoamide S-acetyltransferase subunit of the plastid pyruvate dehydrogenase complex (E2) was isolated from a lambdaPRL2 library. The cDNA is 1709 bp in length, with a continuous open reading frame of 1440 bp encoding a protein of 480 amino acids with a calculated molecular mass of 50,079 D. Southern analysis suggests that a single gene encodes plastid E2. The amino acid sequence has characteristic features of an acetyltransferase, namely, distinct lipoyl, subunit-binding, and catalytic domains, although it is unusual in having only a single lipoyl domain. The in vitro synthesized plastid E2 precursor protein has a relative molecular weight of 67,000 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Upon incubation of the precursor with pea (Pisum sativum) chloroplasts, it was imported and processed to a mature-sized relative molecular weight of 60,000. The imported protein was located in the chloroplast stroma, associated with the endogenous pyruvate dehydrogenase. Catalytically active recombinant plastid E2 was purified as a glutathione S-transferase fusion protein. Analysis of plastid E2 mRNA by reverse transcriptase-polymerase chain reaction showed highest expression in flowers, followed by leaves, siliques, and roots. The results of immunoblot analysis indicate that protein expression was similar in roots and flowers, less similar in leaves, and even less similar in siliques. This is the first report, to our knowledge, describing a plastid E2.

The occurrence of hsp70 in the outer membrane of plant mitochondria.

Hsp70 was localized to the mitochondrial outer membranes of bean and cauliflower mitochondria. Western blotting showed that the outer membrane hsp70 was antigenically distinct from the mitochondrial-matrix hsp70, but was similar to the cytosolic form. The protein was resistant to solubilization with 200 mM sodium carbonate which showed the hsp70 was tightly bound to the outer membrane. Proteinase K studies suggested that the hsp70 was partially exposed to the cytosol with approximately 17% of the protein protease-accessible. It is suggested that the position of the outer membrane hsp70 could relate to a precursor unfolding function during protein import into mitochondria.

Comparison of MIDI Sherlock system and pulsed-field gel electrophoresis in characterizing strains of methicillin-resistant Staphylococcus aureus from a recent hospital outbreak.

An outbreak of methicillin-resistant Staphylococcus aureus infections at the University of Utah Health Sciences Center occurred over a 7-month period. While the isolates phenotypically appeared to be similar in gross morphology and have similar Vitek antibiotic susceptibility patterns, two additional methods of strain characterization were evaluated to enhance the epidemiological investigation: pulsed-field gel electrophoresis and gas chromatography with the MIDI Sherlock system. Sherlock uses gas chromatography to qualitatively and quantitatively analyze the cellular fatty acid composition of organisms and creates two-dimensional plots based on principal-component analysis to define groups of closely related organisms. All isolates were also evaluated by digesting their chromosomal DNAs with the low-frequency-cutting enzyme SmaI and separating the restriction fragments by contour-clamped homogeneous electric field gel electrophoresis. Sample preparation for this pulsed-field gel electrophoresis included a novel cell lysis procedure involving achromopeptidase, greatly reducing the turnaround time. Isolates tested were recovered from the following: 45 suspected outbreak patients, 6 hospitalized patients believed to be unrelated to the outbreak, 6 patients from outside the hospital, and one health care practitioner implicated in the outbreak. Of 45 phenotypically similar suspect strains, 43 clustered tightly on the Sherlock two-dimensional plot. All outbreak patient isolates were also identical by pulsed-field gel electrophoresis with the exception of the same two outliers identified by Sherlock. In this epidemiologic investigation, we found an excellent correlation between the Sherlock and pulsed-field gel electrophoresis results for strain characterization of methicillin-resistant S. aureus.

Identification of a 42-kDa plant mitochondrial outer membrane protein, MOM42, involved in the import of precursor proteins into plant mitochondria.

A 42-kDa plant outer mitochondrial membrane protein, MOM42, has been identified as an essential component of the plant mitochondrial precursor protein translocation apparatus. Immunological cross-reactivity has been detected between antibodies raised against both Neurospora and yeast mitochondrial outer membrane proteins and plant mitochondrial outer membrane proteins. Immunocompetition studies showed that import of precursors to Rieske FeS protein, ATPase su9-DHFR, and the adenine nucleotide transporter was inhibited in the presence of antibody to MOM42. The inhibition of Rieske Fes and su9-DHFR import was greater than that of the adenine nucleotide transporter. The competition studies suggest that the MOM42 is involved in the translocation of bound precursor proteins. The import data and the Western blots suggest that components of the mitochondrial import system are highly conserved.

Infection control and bone marrow transplantation.

BACKGROUND: Bone marrow transplantation for the treatment of malignancies is on the increase. Unfortunately, there are no well-validated infection control guidelines for this highly susceptible population. METHODS: Literature was reviewed concerning infection risks and interventions to decrease risks for bone marrow transplant recipients. RESULTS: Definitive information was generally lacking. However, basic "common sense" infection control recommendations for bone marrow transplantation were made in the following areas: air ventilation systems, design issues, environmental services, patient care issues, barrier precautions, nosocomial surveillance, and discharge planning. Recommendations must be tailored to each facility or setting. CONCLUSION: We conclude that validation of many of these recommendations is necessary to provide optimum care for bone marrow transplant recipients.

Promoting stimulus control with textual prompts and performance feedback for persons with mild disabilities.

We assessed whether written task analyses would serve as textual prompts for performing functional tasks by persons with mild disabilities. Several variables that could influence the effectiveness of textual prompts to promote stimulus control were examined across four groups. A consistent finding was that written specific task analyses combined with end-of-trial performance feedback were effective for promoting the acquisition and generalization of several tasks. Performance transferred immediately to natural discriminative stimuli when the written task analyses and feedback were withdrawn for most tasks and participants. For 2 participants, transfer of stimulus control was accomplished by prompt fading, using individualized written task analyses either with or without performance feedback (Group 1). When feedback was not provided, the effectiveness of written specific task analyses was inconsistent across groups. In contrast to the controlling effects of written specific task analyses, written generic task analyses, which specified only major task outcomes, when combined with performance feedback (Group 1) did not control responding. Overall, this research demonstrated the effectiveness of written specific task analyses and performance feedback to promote stimulus control for persons with mild disabilities.

Timing of strangulation in adult hernias.

This retrospective study aimed to determine why the incidence of strangulated hernias in adults remains high. Seventy-nine patients presented with clinical evidence of hernia strangulation which required urgent surgery during the period 1979-87. Forty-six patients (58 per cent) had noted a hernia present for at least 1 month before strangulation: 18 (23 per cent) had not reported it to their family doctor, 19 (24 per cent) were known by family practitioners or non-surgical medical personnel to have a hernia but had not been referred for surgical opinion, and nine (11 per cent) had been previously assessed surgically with a view to elective repair. Of these nine, five were considered unfit, three were on waiting lists for operation and one had refused surgery. Thirty-two patients (40 per cent) presented primarily with strangulation within days of developing a hernia. The duration of hernia before strangulation in one patient was unknown. Although an unavoidable number of patients will continue to present with strangulation within days of developing a hernia, the overall incidence could be significantly reduced by greater public awareness of the risks of hernia strangulation and by a policy of immediate patient referral and prompt elective repair.