Cross-sectional study of Ebola virus disease preparedness among National Health Service hospital trusts in England.

BACKGROUND: The largest outbreak of Ebola virus disease (EVD) is ongoing in West Africa. Air-travel data indicate that outside Africa, the UK is among the countries at greatest risk of importing a case of EVD. Hospitals in England were therefore instructed to prepare for the assessment and early management of suspected cases. However, the response of hospitals across England is undetermined. AIM: To evaluate the readiness of acute hospitals in England, and to describe the challenges experienced in preparing for suspected cases of EVD. METHODS: A cross-sectional study using semi-structured telephone interviews and online surveys of all acute National Health Service (NHS) hospital trusts in England (hospital trusts are the vehicle by which one or more NHS hospitals in a geographical area are managed). FINDINGS: In total, 112 hospital trusts completed the survey. All interviewed hospital trusts reported undertaking preparedness activities for suspected cases of EVD, and 97% reported that they were ready to assess suspected cases. Most hospital trusts had considered scenarios in accident & emergency (97%). However, fewer hospital trusts had considered specific obstetric (61%) and paediatric scenarios (79%), the provision of ventilatory and renal support (75%), or resuscitation in the event of cardiorespiratory arrest (56%). Thirty-four hospital trusts reported issues with timely access to category A couriers for sample transportation. Challenges included the choice, use and procurement of personal protective equipment (71%), national guidance interpretation (62%) and resource allocation/management support (38%). CONCLUSION: English hospital trusts have engaged well with EVD preparedness. Although subsequent national guidance has addressed some issues identified in this study, there remains further scope for improvement, particularly in a practical direction, for acute care services encountering suspected cases of EVD.

Immunolocalization of cathepsin D in the human central nervous system and central nervous system neoplasms.

The cellular distribution of the lysosomal proteinase cathepsin D was studied in a series of 76 neoplasms and 18 non-neoplastic tissues from the human central nervous system, using a well-characterized polyclonal antibody in a peroxidase-antiperoxidase technique. In the normal and developing brain, cathepsin D is confined to neurons and choroid plexus epithelium. Strong granular cytoplasmic staining was present in neuronal and choroid plexus neoplasms, and in reactive macrophages. A large variety of other neoplasms also exhibited positive cytoplasmic staining, albeit usually of a weaker diffuse type. Cathepsin D cannot be considered a specific marker for neuronal or choroid plexus neoplasms, but the antiserum used in this study may be of value in antibody panels for the investigation of these tumours. Its localization may also be of value in embryological studies, particularly in the cerebellum, and in investigations of steroid hormone receptor-associated proteins in meningiomas and Schwannomas.

Histological appearances of the nerves of the bladder in patients with denervation of the bladder after excision of the rectum.

Two groups of patients who developed denervation of the bladder after excision of the rectum for carcinoma have been studied by histological examination of bladder biopsies. The groups were compared with a group of control patients of a similar age. One group with denervation of the bladder was studied soon after (7 weeks) and the other group in the long term (10 months) after operation. Bladder biopsies were stained for acetylcholinesterase, catecholamines and connective tissue. Tissue was also processed for electron microscopy. In control patients, the ratio of cholinesterase positive nerves to the number of smooth muscle nuclei (24:100) was significantly greater than in patients with denervation of the bladder studied soon after operation (2.5: 100; P less than 0.01). Appearances consistent with degenerate nerve terminals were observed on electron microscopy in these patients. No increase in the density of adrenergic nerves was observed in either group of patients with denervation of the bladder. In the long term, a greater density of cholinergic innervation was noted compared with patients studied soon after operation (P less than 0.05). In addition, nerve terminals, similar in appearance to those of control patients, were observed on electron microscopy. The findings in patients with denervation of the bladder studied in the long term after operation are consistent with partial regeneration of autonomic nerves. They suggest that, whilst histological examination of bladder biopsies may be useful soon after excision of the rectum, they may be less sensitive in the long term.