Local anaesthetic repair of paraumbilical hernia as a safe option across a range of body mass indices.

INTRODUCTION: Local anaesthetic repair of paraumbilical hernia (PUH) is a commonly performed operation. The aim of this study was to investigate whether local anaesthesia (LA) repair of PUH was feasible in patients with a high body mass index (BMI) and whether BMI had an impact on patient reported pain scores. METHODS: Patients undergoing PUH repair under the care of single consultant in a district general hospital between March 2010 and January 2018 were recruited. Patient demographics, BMI, duration of operation, volume of LA infiltrated and grade of operating surgeon were available from the consultant's database. The database also included prospectively recorded patient reported pain scores based on a numerical scale (0-100) and overall patient satisfaction measured as a percentage. Patients were divided into three BMI categories: <25kg/m2, 25-30kg/m2 and >30 kg/m2. RESULTS: A total of 123 patients underwent PUH repair under LA during the study period. Six patients had no recorded BMI and were excluded from the analysis. Of the remaining 117 patients, 36 (31%) were in the normal BMI range, 35 (30%) in the overweight range and 46 (39%) in the obese range. There was no statistically significant difference between the BMI groups in terms of volume of LA used, duration of operation, postoperative pain scores or patient satisfaction. CONCLUSIONS: LA repair of PUH is feasible for patients with a raised BMI and does not result in higher postoperative pain scores or the need for higher doses of LA.

Experimental transmission of segmented filamentous bacteria (SFB) in rainbow trout Oncorhynchus mykiss.

Rainbow trout gastroenteritis (RTGE) has been the cause of acute mortality in farmed rainbow trout in Europe since 1992. Epidemiological analysis has indicated a strong association with high production levels and suggested an infectious aetiology. The condition is characterised by the presence of large numbers of segmented filamentous bacteria (SFB) in the intestine, but the role of these in the disease has not been confirmed, in part because the organisms cannot be cultured. Therefore, other approaches need to be developed to investigate the role of SFB in RTGE. Faecal material from clinically affected RTGE trout, either untreated or heat-inactivated, was administered to fish from a susceptible stock, to determine whether the SFB could be transferred artificially and survive in or colonise the new host. Using histology and nested PCR, SFB were detected in the pyloric caeca of fish 23 to 30 d after challenge with untreated faeces. Histological changes in the intestine and the presence of an unidentified Gram-negative coccus were also significantly associated with exposure to untreated faeces. Upregulation of IFN-γ, IL-17A/F and IL-22 gene expression in proximal intestine suggested a low-level immune response to the challenge.

Susceptibility of goldsinny wrasse, Ctenolabrus rupestris L. (Labridae), to viral haemorrhagic septicaemia virus (VHSV) genotype III: Experimental challenge and pathology.

Cleaner fish, such as wrasse, are being increasingly used to combat the sea lice infestation of Atlantic salmon (Salmo salar L.) in many European countries. To determine susceptibility of the goldsinny wrasse (Ctenolabrus rupestris L.) and pathogenesis of the viral haemorrhagic septicaemia virus (VHSV) genotype III isolate 12-654, previously associated with VHSV infection in the Shetland Islands in 2012, fish were experimentally challenged by intraperitoneal injection (IP), bath immersion and cohabitation routes. Cumulative proportion of moribund wrasse reached 17% following the virus immersion challenge while by the IP-route moribunds exceeded 50% within 14days post-challenge. Typical signs of VHS as reported in rainbow trout (Oncorhynchus mykiss), were not observed in moribund goldsinny wrasse. The most pronounced histopathological changes, consistent regardless of the route of infection, were observed within the heart and included atrium myofibril degeneration, focal infiltration and multifocal necrosis, with prominent swelling of the endocardium and occasional detachment. Pathological changes in the atrium were associated with presence of the viral antigen as confirmed by a positive immunohistochemical staining. Virus clearance and heart tissue recovery were noted although further experiments are required to confirm these observations. The results of a cohabitation experiment confirmed that goldsinny wrasse shed viable virus and therefore represent a risk of virus transmission to other VHSV susceptible species. Similarities between the pathology in goldsinny wrasse induced through the controlled experimental challenges and that of wrasse spp. from an infection occurrence in Shetland are discussed.

Culture-negative hand abscesses in immunocompetent individuals.

Gonococcal infection is a common sexually-transmitted infection in the older male population in our local setting. It is caused by Neisseria gonorrhoeae, and results in fever, dysuria and a foul-smelling discharge from the external urethral meatus. Occasionally, it may also present with disseminated gonococcal infection - dermatitis, septic arthritis and even meningitis or endocarditis. We present two unusual cases, where the primary presentation was that of multiple subcutaneous hand and wrist abscesses. This illustrates the need for competent history-taking, especially in culture-negative patients. We also recommend the use of gonococcal polymerase chain reaction tests in patients who demonstrate negative routine cultures, or in lieu of gonococcal culture when the diagnosis is equivocal or urgently required.

A strong two-photon induced phosphorescent Golgi-specific in vitro marker based on a heteroleptic iridium complex.

A new heteroleptic iridium complex demonstrated low cytotoxicity and near-infrared excitation (via two-photon absorption) for target-specific in vitro Golgi imaging in various cell lines (HeLa and A549 cells) with two-photon absorption cross section (~350 GM) in DMSO.

LARG at chromosome 11q23 has functional characteristics of a tumor suppressor in human breast and colorectal cancer.

Deletion of 11q23-q24 is frequent in a diverse variety of malignancies, including breast and colorectal carcinoma, implicating the presence of a tumor suppressor gene at that chromosomal region. We examined a 6-Mb region on 11q23 by high-resolution deletion mapping, using both loss of heterozygosity analysis and customized microarray comparative genomic hybridization. LARG (leukemia-associated Rho guanine-nucleotide exchange factor) (also called ARHGEF12), identified from the analysed region, is frequently underexpressed in breast and colorectal carcinomas with a reduced expression observed in all breast cancer cell lines (n=11), in 12 of 38 (32%) primary breast cancers, 5 of 10 (50%) colorectal cell lines and in 20 of 37 (54%) primary colorectal cancers. Underexpression of the LARG transcript was significantly associated with genomic loss (P=0.00334). Hypermethylation of the LARG promoter was not detected in either breast or colorectal cancer, and treatment of four breast and four colorectal cancer cell lines with 5-aza-2'-deoxycytidine and/or trichostatin A did not result in a reactivation of LARG. Enforced expression of LARG in breast and colorectal cancer cells by stable transfection resulted in reduced cell proliferation and colony formation, as well as in a markedly slower cell migration rate in colorectal cancer cells, providing functional evidence for LARG as a candidate tumor suppressor gene.

Synthesis and field electron emission properties of hybrid carbon nanotubes and nanoparticles.

Hybrid ZnO-carbon nanotubes as well as nanodiamond-carbon nanotubes were synthesized via a straightforward process of plasma enhanced chemical vapor deposition. For the former, ZnO nanoparticles were instantly coated on the tube surface in the final growing process of carbon nanotubes, while for the latter diamond nanoparticles were grown using pretreatment of a silicon substrate with Ni(NO(3))(2)·6H(2)O/Mg(NO(3))(2)·6H(2)O alcohol solution prior to deposition and a high H(2)/CH(4) gas flow ratio in the deposition process. The morphology and microstructure of the obtained hybrid materials were characterized by transmission electron microscopy. Both hybrid ZnO-carbon nanotubes and nanodiamond-carbon nanotubes exhibited excellent field emission properties.

Perfluorinated compounds in the Pearl River and Yangtze River of China.

A total of 14 perfluorinated compounds (PFCs) were quantified in river water samples collected from tributaries of the Pearl River (Guangzhou Province, south China) and the Yangtze River (central China). Among the PFCs analyzed, perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) were the two compounds with the highest concentrations. PFOS concentrations ranged from 0.90 to 99 ng/l and <0.01-14 ng/l in samples from the Pearl River and Yangtze River, respectively; whereas those for PFOA ranged from 0.85 to 13 ng/l and 2.0-260 ng/l. Lower concentrations were measured for perfluorobutane sulfonate (PFBS), perfluorohexane sulfonate (PFHxS), perfluorooctanesulfoamide (PFOSA), perfluorohexanoic acid (PFHxA), perfluoroheptanoic acid (PFHpA), perfluorononaoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA). Concentrations of several perfluorocarboxylic acids, including perfluorododecanoic acid (PFDoDA), perfluorotetradecanoic acid (PFTeDA), perfluorohexadecanoic acid (PFHxDA) and perfluorooctadecanoic acid (PFOcDA) were lower than the limits of quantification in all the samples analyzed. The highest concentrations of most PFCs were observed in water samples from the Yangtze River near Shanghai, the major industrial and financial centre in China. In addition, sampling locations in the lower reaches of the Yangtze River with a reduced flow rate might serve as a final sink for contaminants from the upstream river runoffs. Generally, PFOS was the dominant PFC found in samples from the Pearl River, while PFOA was the predominant PFC in water from the Yangtze River. Specifically, a considerable amount of PFBS (22.9-26.1% of total PFC analyzed) was measured in water collected near Nanjing, which indicates the presence of potential sources of PFBS in this part of China. Completely different PFC composition profiles were observed for samples from the Pearl River and the Yangtze River. This indicates the presence of dissimilar sources in these two regions.

Molecular methods for the epidemiological typing of Salmonella enterica serotype Typhi from Hong Kong and Vietnam.

A total of 217 and 73 strains of Salmonella enterica serotype Typhi isolated from 1985 to 1997 in Hong Kong and in 2 months of 1989 and 1990 in Vietnam, respectively, were studied. These isolates were typed by plasmid profile analysis, plasmid fingerprinting, ribotyping with PstI, and total DNA fingerprinting with NarI. There appeared to be no major outbreak of typhoid fever in Hong Kong during the study period since there was considerable heterogeneity among the isolates. Isolates from Hong Kong were different from those from Vietnam. Thirty-seven percent of Vietnamese isolates belonged to two predominant clones, with the rest being heterogeneous in nature. Total DNA fingerprinting supplemented with ribotyping could be a reliable and rapid method for epidemiological typing of S. enterica serotype Typhi.

Emerging resistance in Salmonella enterica serotype Typhi in Hong Kong.

A total of 182 Salmonella enterica serotype Typhi isolated from three hospitals in Hong Kong from 1986 to 1992 were tested for their susceptibility to 21 antimicrobial agents. Four percent or less were resistant to chloramphenicol, ampicillin, some of the cephalosporins, nalidixic acid, tetracycline and trimethoprim and 6% to 1024 mg/l sulfamethoxazole. All were susceptible to the aminoglycosides and the 4-quinolones. Nineteen isolates were resistant to at least 1, and up to 9, antibiotics. Of 8 chloramphenicolor multiply-resistant isolates studied, only 3 could transfer their resistances while resistance of one could only be mobilized. Four of 5 ampicillin-resistant strains produced a beta-lactamase of pI 5.5. Antibiotic resistances were mediated by plasmids of 106, 116 or 221 kb of incompatibility groups H, I1 and K. Three resistant isolates did not harbour any plasmid. A total of 43 (24%) S. Typhi harboured plasmids ranging in size from 4.3 to 221 kb. Plasmids of 106 kb and 8.5 kb were found in 17 and 10 isolates, respectively. Restriction enzyme digestion of these two plasmids showed that each could be differentiated into 3 types. Of 89 isolates that were phage typed, 38% were untypable, while 17% and 12% were of phage types E1 and A, respectively, and the rest belonged to 17 other types.

Cloning and molecular characterization of the murine herpesvirus 68 genome.

Murine herpesvirus 68 (MHV-68) is a naturally occurring herpesvirus of small free-living rodents. In order to facilitate the molecular characterization of the virus genome, a library of cloned restriction fragments has been produced and restriction enzyme cleavage maps deduced for the enzymes BamHI, EcoRI and HindIII. The MHV-68 genome comprises a region of unique DNA of approximately 118 kbp which is flanked by variable numbers of a 1.23 kb repeat unit. The organization of the MHV-68 genome is, therefore, most similar to that of the lymphotropic gamma 2 group of herpesviruses which include herpesvirus saimiri and herpesvirus ateles.

Murine herpesvirus 68 is genetically related to the gammaherpesviruses Epstein-Barr virus and herpesvirus saimiri.

Short nucleotide sequence analysis of seven restriction fragments of murine herpesvirus 68 (MHV-68) DNA has been undertaken and used to determine the overall genome organization and relatedness of this virus to other well characterized representatives of the alpha-, beta- and gammaherpesvirus subgroups. Nine genes have been identified which encode amino acid sequences with greater similarity to proteins of the gammaherpesvirus Epstein-Barr virus (EBV) than to the homologous products of the alphaherpesviruses varicella-zoster virus and herpes simples virus type 1 or the betaherpesvirus human cytomegalovirus. In addition, the genome organization of MHV-68 is shown to have an overall collinearity with that of the gammaherpesviruses EBV and herpesvirus saimiri. In common with these viruses, dinucleotide frequency analysis of MHV-68 coding sequences reveals a marked reduction in CpG dinucleotide frequency thus implicating a dividing cell population as the site of latency in vivo.

Human fibroblast interferon in tears of patients with picornavirus epidemic conjunctivitis.

We report the levels of coxsackievirus type A24 (CA24) and the levels and type of interferon produced early during naturally acquired picornavirus epidemic conjunctivitis. Virus levels ranging from 10(1.8) to 10(5.8) 50% tissue culture infective doses per ml were detected in 29 of 37 acute (collected 1 to 4 days after onset of conjunctivitis) tear samples. Interferon (10(1.5) to 10(3.3) U/ml) was detected in 12 of 29 tear samples collected on day 1, in 2 of 6 tear samples collected on day 2, and in 1 tear sample collected on day 3 after onset of conjunctivitis. The interferon activity in pooled tear samples was completely neutralized by antiserum against human fibroblast interferon, stable at pH 2.0, and active against different viruses. In addition, the interferon activity in tears, like human fibroblast and leukocyte interferons produced in vitro, protected human and rabbit, but not mouse, cells. This is the first report of production and identification of the antigenic type of interferon induced by an enterovirus during natural infection. The early appearance of fibroblast interferon suggests that it may be an important host defense at the local site of implantation against this and possibly other enterovirus infections.

Antibodies to germinating and yeast cells of Candida albicans in human and rabbit sera.

Two major antigenic components, I and II, were detected by double immunodiffusion in sonic extracts of the germinating (G) or yeast (Y) cells of the dimorphis organism, Candida albicans group A. Component I may be a heterogeneous mixture of antigens which are stable to heating and phenol. Component II is more homogeneous but is labile to heat and phenol. Rabbit antisera, showing only precipitin to component II or certain human sera at high dilution, were found to react with G cells to give an immunofluorescence which was confined to the germ tubes. This suggested that component II is localised on the germ tubes, whereas no immunofluorescent reaction against the yeast cells could be detected under the same conditions although component II was as readily extracted from these cells as from G cells. This suggested that component II might exist in a cryptic state in the Y cells. In support of the latter contention it was shown that live Y cells did not absorb precipitin to component II nor were they capable of providing these antibodies in rabbits. Using both human and rabbit sera, it was shown that the antigenic specificity of the immunofluorescence assay where Y cells were used was related to component I and that where G cells were used it was related to both components I and II.

The occurrence of Candida in hospital patients and normal subjects.

The distribution of different Candida species and different serogroups of C. albicans have been analysed. C. albicans is by far the most predominant species isolated from all clinical specimens. Group A of C. albicans was isolated 10 times more frequently than group B strains from patients who had respiratory infection and 4.4 times more frequently from those who had other clinical conditions. However, both serogroups were isolated at comparable frequencies from the genitals. In the instances where repeated isolation were made, colonization by one serogroup often occurs to the exclusion of the other serogroup and species. Thus, it was frequently observed that individual patients often gave repeated isolation of one serogroup of C. albicans only. These findings are of obvious diagnostic relevance and may facilitate the evaluation of possible clinical significance of laboratory studies.