Malonate degradation in Acinetobacter baylyi ADP1: operon organization and regulation by MdcR.

Transcriptional regulators in the LysR or GntR families are typically encoded in the genomic neighbourhood of bacterial genes for malonate degradation. While these arrangements have been evaluated using bioinformatics methods, experimental studies demonstrating co-transcription of predicted operons were lacking. Here, transcriptional regulation was characterized for a cluster of mdc genes that enable a soil bacterium, Acinetobacter baylyi ADP1, to use malonate as a carbon source. Despite previous assumptions that the mdc-gene set forms one operon, our studies revealed distinct promoters in two different regions of a nine-gene cluster. Furthermore, a single promoter is insufficient to account for transcription of mdcR, a regulatory gene that is convergent to other mdc genes. MdcR, a LysR-type transcriptional regulator, was shown to bind specifically to a site where it can activate mdc-gene transcription. Although mdcR deletion prevented growth on malonate, a 1 nt substitution in the promoter of mdcA enabled MdcR-independent growth on this carbon source. Regulation was characterized by methods including transcriptional fusions, quantitative reverse transcription PCR, reverse transcription PCR, 5'-rapid amplification of cDNA ends and gel shift assays. Moreover, a new technique was developed for transcriptional characterization of low-copy mRNA by increasing the DNA copy number of specific chromosomal regions. MdcR was shown to respond to malonate, in the absence of its catabolism. These studies contribute to ongoing characterization of the structure and function of a set of 44 LysR-type transcriptional regulators in A. baylyi ADP1.

Incidence of different causes of benign obstruction of the salivary glands: retrospective analysis of 493 cases using fluoroscopy and digital subtraction sialography.

To identify the incidence of different causes of benign obstruction of the salivary glands, we retrospectively analysed 788 anonymised sialography reports of 719 patients referred to the department of dental and maxillofacial radiology between 2006 and 2012. Reports that showed evidence of benign obstruction were included (n=493). Salivary stones were identified in 151 (31%), ductal strictures in 115 (23%), and mucus plugs in 295 (60%). In 67 cases (14%) there was evidence of 2 or 3 causes of obstruction. As previously reported, mucous plugs were the most common finding, possibly because of the use of fluoroscopy or digital subtraction sialography, or both. These methods enable images to be captured during the initial filling of the main duct and are likely to prevent mucus plugs from being obscured by the contrast medium, which is the case in conventional sialography when a single image is produced after the contrast has been injected.

A radiologist's guide to small bowel and multivisceral transplantation.

This review will describe the indications for the various small bowel containing transplants. The importance of early referral will be highlighted. Radiologists play a central role in assessing these complex patients prior to transplantation. Furthermore, in the postoperative period, radiologists play an important part in diagnosing and treating complications.

Where do AMU nurses perceive their educational needs? Results of the 20:10 project.

UNLABELLED: Our aim was to identify the perceived educational needs of nurses working in acute medicine to enable development of a training curriculum specifically for this staff group. METHODS: Post-graduate nurses from North Wales were invited to list 20 conditions and 10 skills for which they felt under prepared for their work in acute medicine. A workshop was then organized, attended by acute medicine nurses, medical colleagues and educationalists from two local universities to discuss initial data. RESULTS: Nurses identified particular needs for education around presenting symptoms with perceived deficits in knowledge or training. We found a heavy emphasis on respiratory and cardiac conditions. There was considerable overlap with frequent diagnostic categories from non-surgical hospital discharges and with priorities for training of junior doctors. Skills were often those traditionally associated with medical staff or care of patients with critical illnesses. CONCLUSION: The 20:10 project represents the first attempt to map educational needs of nursing staff on the Acute Medical Units of a large University Health Board using self-reported needs. The identified needs will support professional development, create incentives for recruitment and guide University postgraduate developments and commissioning.

Colorectal cancer detection: time to abandon barium enema?

OBJECTIVES: To assess the sensitivity of double contrast barium enema (DCBE) for diagnosing colorectal cancer (CRC). DESIGN: Retrospective evaluation of DCBE performed in the 2 years prior to diagnosis of CRC. SETTING: Teaching hospital in Cambridge, UK. PATIENTS: 1310 consecutive cases of CRC identified from cancer registry data. INTERVENTIONS: DCBE and colonoscopy. MAIN OUTCOME MEASURES: Sensitivity of DCBE for diagnosing CRC. RESULTS: 215 patients had undergone a DCBE within the 2 years prior to diagnosis with CRC. After excluding those reported as inadequate, 37 of these were reported as normal, giving a sensitivity of 83% (81-85%). CONCLUSIONS: The performance of DCBE is inadequate for the exclusion of CRC. Expansion of colonoscopy and CT colonography capacity is urgently required nationally so that DCBE can finally be abandoned as a firstline test in patients at risk of CRC.

Blood-borne viruses: are we taking them seriously? A survey of UK oral and maxillofacial surgeons.

The nature of the work done by oral and maxillofacial surgeons (OMFSs) potentially places them at risk of transmission of blood-borne viruses from patients. We investigated the incidence of exposure to infected blood among OMF surgeons, and whether enough protection is being used. An anonymous postal questionnaire was sent to all OMFS consultants working in the UK in 2008 (n=344) to investigate three areas relating to blood-borne viruses: incidence of surgeons experiencing and reporting exposure to potentially infected blood, their opinions about which patients pose a particular risk, and treatment plans and equipment selected when given two set clinical situations. A total of 148 consultants (43%) responded. Of the 80 respondents (61%) who had been exposed to blood within the last five years, more than two-thirds (n=55) did not always report such incidents. Eighty-five (60%) stated that they considered that all patients posed a risk to the surgeon, and 104 (73%) altered their practice depending on the perceived risk from the individual patient.

The appendix on CT.

Appendicitis can be a difficult clinical diagnosis to make. A negative appendicectomy rate of 20% has traditionally been accepted as the consequences of appendiceal perforation can be grave. Cross-sectional imaging is increasingly being employed in the investigation of adults with suspected appendicitis. This review will demonstrate the appearance of the normal appendix on computed tomography (CT) and its appearance in a range of inflammatory and neoplastic processes including appendicitis, Crohn's disease, infections, and benign and malignant tumours.

The appearance of the adrenal glands on computed tomography in multiple endocrine neoplasia type 1.

AIMS: To review the morphology of the adrenal glands in multiple endocrine neoplasia type 1 (MEN1) on computed tomography (CT) to compare the results with established normal values for adrenal size and nodularity and to correlate adrenal size with serum cortisol secretory dynamics. MATERIALS AND METHODS: Two observers independently reviewed the adrenal CT in 28 patients with MEN1, measuring the maximum width of the body of the gland and the medial and lateral limbs. Incidence and location of nodules >5 mm within the gland were recorded. Following exclusion of known cases of Cushing's syndrome, adrenal gland size was compared with previously documented normative data. Adrenal gland size was compared between patients with normal and abnormal cortisol dynamics. RESULTS: Comparison of mean adrenal size in MEN1 patients with normative data showed that the adrenal limbs were significantly larger in MEN1 than normal (P<0.0001 in all four limbs). Adrenal body was also significantly larger (P<0.05). Nodules were demonstrated in 17 (60%) of patients (versus 0.4-2% in the normal population). No statistically significant correlation was demonstrated between adrenal limb hyperplasia and abnormal cortisol dynamics. CONCLUSIONS: In patients with MEN1, adrenal limb hyperplasia and adrenal nodules are significantly more common than in the normal population, a phenomenon not previously documented in a quantitative manner. There was no significant correlation between adrenal limb hyperplasia and abnormal cortisol dynamics.

A randomized controlled trial on cross-infection control in maxillofacial trauma surgery: a comparison of intermaxillary fixation techniques.

Glove perforations and percutaneous injuries occur commonly during the treatment of facial fractures and reveal the need for safer techniques, especially in intermaxillary fixation. The Rapid IMF device does not use any wires and may provide better cross-infection control than wiring methods. The aim of this study was to test the hypothesis that Rapid IMF is associated with fewer glove perforations/ percutaneous injuries than traditional wiring techniques. The authors carried out a randomized controlled trial which included 120 patients with fractures of the mandible requiring open reduction and fixation. The participants were allocated either to the study group and treated with intraoperative Rapid IMF or to the control group and managed with intraoperative eyelet wire ties. Analysis of the results showed that the Rapid IMF group had significantly fewer glove perforations than the traditional method (0.67 per operation compared with 1.5), (P<0.0001). The incidence of skin-penetrating injuries was the same in both groups (rate 0.02/ procedure). The application of Rapid IMF was significantly faster than wiring (P<0.0001). Minor intraoperative complications were noted in both groups, but more in the Rapid IMF group. Most concerned loosening or fracture of the anchorage ties but the surgical outcome was not affected. Rapid IMF is a safer alternative to wiring methods with significant reduction in glove perforation rates and is quicker to apply than conventional wiring techniques.

Preoperative vascular assessment of the lower limb for harvest of a fibular flap: the views of vascular surgeons in the United Kingdom.

Adequate preoperative vascular assessment of the lower limb is essential before harvesting fibular free flaps to prevent ischaemic complications or failure of the flap. The best method of assessment remains controversial. Clinical examination, conventional angiography, colour flow Doppler, and magnetic resonance angiography have all been advocated. We asked 206 UK vascular surgeons for their opinions on preoperative assessment and potential issues of negligence and 85 (42%) completed the questionnaire. All respondents thought that further imaging should be done in addition to clinical examination, most of whom (n = 70) favoured colour flow Doppler (82%). In addition 75 (88%) considered that the surgeon would be judged to be negligent if clinical examination was the only preoperative assessment. In the light of these findings, we suggest that an objective assessment of the vasculature of the leg should be obtained before a fibular flap is harvested.

Developmental intervention in the newborn intensive care unit.

Developmental intervention for infants with perinatal asphyxia requires an individualized therapeutic plan. A team approach incorporating developmental goals and intervention strategies into the nursing care of these infants is essential for optimal developmental outcome. Therapeutic management must always be appropriate for the infant's health status, gestational age, and organizational capabilities. An understanding of the neurophysiologic basis for intervention and the therapeutic management techniques for infants who are sick, recuperating, or convalescing will help the nurse to promote optimal development when caring for the asphyxiated infant.

Identification and management of psychosocial and environmental problems of children with cancer.

An occupational therapist working as a rehabilitation specialist on the hematology-oncology team for pediatric malignancy identified and sought solutions for problems encountered among 49 pediatric oncology patients and their families. The occupational therapist's role as "CARE (CAncer REhabilitation) counselor" involved working with the patient, family, and team members to meet needs and provide services other than direct medical treatment. A variety of environmental needs and psychosocial problems were identified and managed. Prospective interaction from the time of diagnosis, resulting in 63 percent solution of all problems, was more effective than intervention initiated at other stages of illness.