Chernobyl post-accident management: the ETHOS project.

ETHOS is a pilot research project supported by the radiation protection research program of the European Commission (DG XII). The project provides an alternative approach to the rehabilitation of living conditions in the contaminated territories of the CIS in the post-accident context of Chernobyl. Initiated at the beginning of 1996, this 3-y project is currently being implemented in the Republic of Belarus. The ETHOS project involves an interdisciplinary team of European researchers from the following institutions: the Centre d'etude sur l'Evaluation de la Protection dans le domaine Nucleaire CEPN (radiological protection, economics), the Institute National d'Agronomie de Paris-Grignon INAPG (agronomy, nature & life management), the Compiegne University of Technology (technological and industrial safety, social trust), and the Mutadis Research Group (sociology, social risk management), which is in charge of the scientific co-ordination of the project. The Belarussian partners in the ETHOS project include the Ministry of Emergencies of Belarus as well as the various local authorities involved with the implementation site. The ETHOS project relies on a strong involvement of the local population in the rehabilitation process. Its main goal is to create conditions for the inhabitants of the contaminated territories to reconstruct their overall quality of life. This reconstruction deals with all the day-to-day aspects that have been affected or threatened by the contamination. The project aims at creating a dynamic process whereby acceptable living conditions can be rebuilt. Radiological security is developed in the ETHOS project as part of a general improvement in the quality of life. The approach does not dissociate the social and the technical dimensions of post-accident management. This is so as to avoid radiological risk assessment and management being reduced purely to a problem for scientific experts, from which local people are excluded, and to take into consideration the problems of acceptability of decisions and the distrust of the population towards experts. These cannot be solved merely by a better communication strategy. This paper presents the main features of the methodological approach of the ETHOS project. It also explains how it is being implemented in the village of Olmany in the district of Stolyn (Brest region) in Belarus since March 1996, as well as its initial achievements.

Identification of a gene essential for O-acetylation of the Staphylococcus aureus type 5 capsular polysaccharide.

The Staphylococcus aureus serotype 5 capsular polysaccharide (CP5) has a trisaccharide repeating unit of (-->4)-3-O-Ac-beta-D-ManNAcAp-(1-->4)-alpha-L-FucNAcp-(1-->3 )-beta-D-FucNAcp-(1-->). Tn918 mutagenesis of strain Reynolds yielded a mutant that produced wild-type levels of O-deacetylated CP5. The site and orientation of the single transposon insertion in mutant JL232 were determined by analysis of Southern blots and amplification of DNA flanking the transposon. DNA sequencing revealed that Tn918 was inserted within an open reading frame of 627 bp. The predicted amino acid sequence encodes a protein of approximately 26 kDa with homology to members of the NodL-LacA-CysE family of bacterial acetyltransferases. Southern blot analysis showed that genes similar to cap5H were present only in strains of S. aureus belonging to capsular serotypes 2, 4 and 5. In an in vitro assay, the parental strain was more resistant to opsonophagocytic killing than the mutant strain. In a mouse model of staphylococcal infection, the parental strain was able to seed the bloodstream from the peritoneal cavity and colonize the kidneys more efficiently than the O-deacetylated mutant. When cap5H was provided to the mutant in trans, it fully restored CP5 O-acetylation. The virulence of the complemented mutant strain closely approximated that of the parental strain.

[Epidemiological study on tuberculin skin positivity in the La Spezia province. II. Evaluation of the data in the January-December, 1993 period]. / Indagine epidemiologica sulla cuti-positività tubercolinica in provincia di La Spezia (II): valutazione dei dati nel periodo gennaio-dicembre 1993.

In the past year (January-December 1993), the Authors has tested for positivity of childhood type tuberculosis (with "Tine-Test") 3079 children, belonging to three age groups: 6, 9 and 13 years. The results of positivity to the cuti-reaction were augmented, in comparison to the first report; for this reason, and because these data are very recent, the Authors thinks them are of interest.

Genetic analysis of type 5 capsular polysaccharide expression by Staphylococcus aureus.

Capsules are produced by over 90% of Staphylococcus aureus strains, and approximately 25% of clinical isolates express type 5 capsular polysaccharide (CP5). We mutagenized the type 5 strain Reynolds with Tn918 to target genes involved in CP5 expression. From a capsule-deficient mutant, we cloned into a cosmid vector an approximately 26-kb EcoRI fragment containing the transposon insertion. In the absence of tetracycline selection, Tn918 was spontaneously excised, thereby resulting in a plasmid containing 9.4 kb of S. aureus DNA flanking the Tn918 insertion site. The 9.4-kb DNA fragment was used to screen a cosmid library prepared from the wild-type strain. Positive colonies were identified by colony hybridization, and a restriction map of one clone (pJCL19 with an approximately 34-kb insert) carrying the putative capsule gene region was constructed. Fragments of pJCL19 were used to probe genomic DNA digests from S. aureus strains of different capsular serotypes. Fragments on the ends of the cloned DNA hybridized to fragments of similar sizes in most of the strains examined. Blots hybridized to two fragments flanking the central region of the cloned DNA showed restriction fragment length polymorphism. A centrally located DNA fragment hybridized only to DNA from capsular types 2, 4, and 5. DNA from pJCL19 was subcloned to a shuttle vector for complementation studies. A 6.2-kb EcoRI-ClaI fragment complemented CP5 expression in a capsule-negative mutant derived by mutagenesis with ethyl methanesulfonate. These experiments provide the necessary groundwork for identifying genes involved in CP5 expression by S. aureus.

Effects of in vitro and in vivo growth conditions on expression of type 8 capsular polysaccharide by Staphylococcus aureus.

Type 8 capsular polysaccharide (CP8) is widely prevalent among clinical isolates of Staphylococcus aureus, but the role that the capsule plays in the pathogenesis of staphylococcal infections is unclear. This study was performed to identify growth conditions that would optimize the production of CP8 and to determine whether enhanced CP8 expression would influence staphylococcal virulence. S. aureus Becker grown in a chemically defined broth medium with < 1 microM ferric nitrate produced up to eightfold more CP8 per milligram of biomass than did bacteria cultivated in the same medium containing 20 microM ferric nitrate. The bacteria produced > 350-fold more cell-associated CP8 per milligram of biomass when grown on the surface of Columbia agar than when grown in Columbia broth. Most of the CP8 produced by broth-grown cells was secreted into the culture medium. S. aureus cultivated on the surface of nitrocellulose membranes floating on Columbia broth produced levels of CP8 similar to those produced by cells grown on Columbia agar. Similarly, bacteria harvested from endocardial vegetations of rabbits infected with S. aureus produced high levels of CP8. These results indicate that staphylococci grown on surfaces, both in vitro and in vivo, produce larger quantities of cell-associated CP8 than those grown in liquid cultures. However, no differences were observed in the 50% lethal dose for mice of strain Becker grown on solid medium (high levels of capsule expression) or in liquid medium (low levels of capsule expression).

[An epidemiological study of skin tuberculin positivity in the province of La Spezia in 1988-1991: an evaluation of the results in 3932 cases]. / Indagine epidemiologica sulla cuti-positività tubercolinica in provincia di La Spezia negli anni 1988-1991: valutazione dei risultati su 3.932 casi.

In recent years (1989-1991) the author has tested for positivity of tuberculosis (with Tine-Test) 3.932 children, belonging to two age groups: 1-3 and 10-11 years. The results of positivity to the cutireaction (0% and 0.32% respectively) were lower, in comparison to other published reports.

[Child maltreatment (II): "institutional discomfort"]. / Il maltrattamento del bambino (II): il "disagio istituzionale".

In the present study, the A. puts in evidence some aspects of the disfunction of the organization in the paediatric care, ad emphasizes that the lack of organization is cause of the "institutional discomfort". The importance of this analysis for the operators of the public health system is great; in effect, some "borderline" cases are not entirely recognized. The explanation of this problem may be useful for the modification of the planning in the paediatric public care.

[Child abuse: analysis of the problem and description of some "borderline" aspects]. / Il maltrattamento del bambino: analisi del problema e descrizione di alcuni aspetti "borderline".

In the present study, the A. put in evidence some "historical" aspects of the child abuse and neglect, and emphasize "borderline" cases of this problem. The importance of this analysis for the operators of the Public Health System is great. In effect, some "borderline" cases are results of ignorance of child psychology and lack of sanitary paediatric organization in the Paediatric Divisions.

[Quality control in health care delivery: an experimental study]. / Il controllo di qualità nelle prestazioni sanitarie: uno studio applicativo.

In the present experimental study, the A. put in evidence a very important aspect for the management and the organization of the Public Health Service: the definition and the control of the "quality care". After a short introduction, the A. explains the methods and the results of the study: in the discussion the A. emphasizes the lacks and the qualifying aspects of the present study.

[Domestic accidents in childhood. A report on risk factors]. / Gli incidenti domestici nell'infanzia. Rapporto sui fattori di rischio.

The accidents are playing the most important part of the morbidity and the mortality of the childhood. The present report regards the risk factors at home; the A. emphasize that with limited difficulty and public expenditure are possible to remove the mayor part of identified risk factors. Thus reducing pain of the children and our parents, and also expenditures of the public health system.

[Extrapulmonary respiratory sounds in newborns: classification and iconographic contribution]. / I rumori respiratori extrapolmonari del neonato: contributo classificativo ed iconografico.

The extra-pulmonary stridors of the newborn represent a frequent and difficult diagnosis pathology for the radiologists and the neonatologist. After an introduction about the most important anatomical dates, A. reviews the reasons of the neonatologic stridor, and emphasizes the vascular congenital anomalies, most important for a early differential diagnosis. Concluding, are reported radiologic findings of this shifty pathology.

[Non-rhizomelic chondrodysplasia punctata. Presentation of a clinical case]. / Condrodisplasia "punctata" non rizomelica. Presentazione di un caso clinico.

Is described one case of non-rhizomelic chondro-dysplasia punctata; after an introduction in which the disease is considered in its nosography and ways of genetic transmission and the symptoms are described, the case is examined stressing the gravity of epiphyseal calcifications and the unusual localization of some of them together with megabladder and megacolon. The AA. conclude pointing out the main role of the x-ray examination in the diagnosis of the syndrome.

[Hereditary intolerance to fructose in infants. Presentation of a clinical case]. / L'intolleranza ereditaria al fruttosio del lattante. Presentazione di un caso clinico.

One case of hereditary fructose intolerance is examined: the disease was known exceptionally early when the baby was about two months old. The case is classified and described with the metabolic alterations typical of the syndrome and then it is examined stressing the difficulty in diagnosing it at such an early stage of the baby's life and the possibility of worsening the symptoms with unsuitable treatments (i.e. use of solutions fructose-containing). The author concludes advising to use the utmost care in feeding the baby since its birth in order to avoid an early administration of potentially dangerous carbohydrates.

[Recent findings on the subject of bronchopulmonary dysplasia]. / Recenti acquisizioni in tema di displasia broncopolmonare.

The improved techniques of medical care and reanimation of newborns have caused a relevant increase in the survival of those with a very low weight at their birth. Pathologies related both to the tissue immaturity of the patients treated and to the exceptionally strong technic of reanimation have increased: the bronchopulmonary dysplasia described by Northway and Coll. in 1967 is one of them. This work aims at examining the latest acquisitions of the syndrome, which in its early stages is still indistinguished from serious cases of HMD. The most efficient treatments applied are explained and prevention is stressed as the best therapy. The A. concludes that the reanimation therapy and the respiratory assistance should be carefully monitorized and there should be a close relationship between the neonatologist and the anaesthesiologist.

[Retinopathy of prematurity. Notes on pathogenesis and therapy]. / La retinopatia del pretermine. Note di patogenesi e terapia.

The retinopathy of prematurity reveals a pathology that involves a very important organ for the relation-life of a newborn. It was first identified and described by Terry in 1942. The incidence of retinopathy decreased dramatically after the discovery of the damages of oxygen an a sensitive immature retina and the oxygen monitoring therapy. Since the mid 1960's, the incidence of ROP is risen again, probably, in relation either to the more precise and developed techniques of examining, or to the increased rate of survival of a newborns with a very low birth weight, who are the most high-risk infants. This work considers the participations of several authors about the pathogenesis and the therapy of the retinopathy of prematurity. After a review of some historically important works, the author describes the pathogenesis of the illness and inspects the therapeutic methods that are now possible in relation to the changes and the stages of ROP (Vit. E, photocoagulation, cryotherapy, scleral buckling and vitrectomy). The conclusions of this study emphasize the essential role of the prevention and the early diagnosis of retinopathy and wish the diffusion and the standardizing of this methodologic approach.