Toxicity of cadmium on dynamic human gut microbiome cultures and the protective effect of cadmium-tolerant bacteria autochthonous to the gut.

Cadmium (Cd) is a heavy metal toxic to the gut microbiome. In this study, we cultivated two human gut microbiomes (A and B) in bioreactors with Cd at 0 and 20 ppm for 7 days to investigate effects of Cd on the gut microbiome and to isolate Cd-tolerant bacteria autochthonous to the gut. Cd showed profound toxicity, abolishing butyrate production, depleting microbes in microbiome B, and simplifying microbiome A to a small Cd-tolerant community after 2 d of incubation. When spiked into the Cd-sensitive microbiome B, the Cd-tolerant community from microbiome A and isolates from that community worked synergistically with microbiome B to enhance butyrate production and maintained this synergism at Cd concentrations up to 5 ppm. Bacteria isolated from this Cd-tolerant community included Enterococcus faecium, Enterobacter cloacae, Lactococcus lactis, and Lactobacillus taiwanensis species. This work demonstrates a straightforward method for identifying Cd-tolerant bacteria autochthonous to the human gut that synergize with the microbiome to protect against Cd-related loss of butyrate production.

Hypertrophic cardiomyopathy: lessons from history.

The modern description of hypertrophic cardiomyopathy is credited to the London pathologist, Robert Donald Teare who likened the disease to "a tumour of the heart" and published his observations in the British Heart Journal 50 years ago. Teare recognised asymmetrical hypertrophy and myocyte disarray as a familial condition associated with premature and sudden death in young people. He rightly deserves the accolade for bringing a poorly understood, but well recognised phenomenon into the public domain. Thick and heavy hearts had been of interest and investigation to physicians and pathologists for many centuries. This article reviews the early history of hypertrophic cardiomyopathy and reflects on several centuries of progress in our understanding of the condition.

Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults.

AIM: To quantify the observer variation in the sonographic measurement of optic nerve sheath diameter (ONSD) in normal adults. MATERIALS AND METHODS: Sixty-seven normal adult volunteers underwent ultrasound examination of each eye by three independent observers using a 7 MHz sector probe. Three measurements were made of each eye by each observer and a mean value calculated for each eye. Median and 5th-95th centile values for both intra- and inter-observer variation were calculated for the three observers. RESULTS: The median intra-observer variation was +/-0.1 mm, with 5th-95th centile values of +/-0-0.4 mm. The median inter-observer variation was +/-0.2-0.3 mm, with 5th-95th centile values of +/-0-0.7 mm. Careful review of examination technique by the three observers after the first 17 examinations was shown to reduce both intra- and inter-observer variation. CONCLUSION: The sonographic measurement of ONSD is a readily learned, reproducible technique with low intra- and inter-observer variation. The average inter-observer variation (+/-0.2 mm) is comparable to the inherent variability of the ultrasound machine. The importance of standardisation of examination technique is stressed.

Ultrasound of the thyroid gland in the newborn: normative data.

OBJECTIVE: To establish reference ranges for thyroid length, breadth, depth, and volume in healthy term Scottish infants. DESIGN: Prospective observational study of 100 (49 male) neonates. Length, breadth, and depth were measured, and the volume of each lobe was calculated using the formula for a prolate ellipsoid (volume = length x breadth x depth x pi/6). RESULTS: All measurements showed gaussian distribution, with no significant differences between the right and the left lobes. Values (mean (SD) range) were: length (cm), 1.94 (0.24) 0.9-2.5; breadth (cm), 0.88 (0.16) 0.5-1.4; depth (cm), 0.96 (0.17) 0.6-2.0; volume (ml), 0.81 (0.24) 0.3-1.7; combined volume (ml), 1.62 (0.41) 0.7-3.3. Although there was no difference in mean volume between right and left lobes, there was considerable variation (-0.8 to + 0.7 ml) between the two lobes in individual babies. CONCLUSIONS: Both lobes should be measured to give a combined volume. Our findings provide a reference against which thyroid hypoplasia or goitre can be evaluated.

Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus.

AIM: To evaluate the utility of measuring the optic nerve sheath diameter in children with shunted hydrocephalus, suspected of having raised intracranial pressure. METHODS: 23 children with shunted hydrocephalus were examined, six had well controlled ICP, 17 however manifested symptoms suggestive of intracranial hypertension. A clinical history was taken from all patients and their parents or carers. The shunt valve was examined clinically, and signs of raised intracranial pressure were sought. Ultrasound examination was performed in both eyes to measure the optic nerve sheath diameters 3 mm behind the globe. These measurements were compared with control data obtained from 102 children who attended the radiology department for unrelated renal ultrasound examination. RESULTS: Control data suggested that the upper limit of normal for optic nerve sheath diameter is 4.5 mm (measured 3 mm behind the globe) in patients over 1 year of age, and 4.0 mm in children less than 1 year of age. Those patients with functioning ventriculoperitoneal shunts had a mean optic nerve sheath diameter of 2.9 (SD 0.5) mm; those with raised intracranial pressure had a mean optic nerve sheath diameter of 5.6 (0.6) mm (p<0.0001). These results confirm that optic nerve sheath diameters in excess of the control data are strongly suggestive of raised intracranial pressure. CONCLUSION: The evaluation of the optic nerve sheath diameter is a simple non-invasive procedure, which is a potentially useful tool in the assessment and monitoring of children with hydrocephalus suspected of having raised intracranial pressure.