Making Co-Enrolment Feasible for Randomised Controlled Trials in Paediatric Intensive Care

AIMS: Enrolling children into several trials could increase recruitment and lead to quicker delivery of optimal care in paediatric intensive care units (PICU). We evaluated decisions taken by clinicians and parents in PICU on co-enrolment for two large pragmatic trials: the CATCH trial (CATheters in CHildren) comparing impregnated with standard central venous catheters (CVCs) for reducing bloodstream infection in PICU and the CHIP trial comparing tight versus standard control of hyperglycaemia. METHODS: We recorded the period of trial overlap for all PICUs taking part in both CATCH and CHiP and reasons why clinicians decided to co-enrol children or not into both studies. We examined parental decisions on co-enrolment by measuring recruitment rates and reasons for declining consent. RESULTS: Five PICUs recruited for CATCH and CHiP during the same period (an additional four opened CATCH after having closed CHiP). Of these five, three declined co-enrolment (one of which delayed recruiting elective patients for CATCH whilst CHiP was running), due to concerns about jeopardising CHiP recruitment, asking too much of parents, overwhelming amounts of information to explain to parents for two trials and a policy against co-enrolment. Two units co-enrolled in order to maximise recruitment to both trials. At the first unit, 35 parents were approached for both trials. 17/35 consented to both; 13/35 consented to one trial only; 5/35 declined both. Consent rates during co-enrolment were 29/35 (82%) and 18/35 (51%) for CATCH and CHiP respectively compared with 78% and 51% respectively for those approached for a single trial within this PICU. The second unit did not record data on approaches or refusals, but successfully co-enrolled one child. CONCLUSIONS: Co-enrolment did not appear to jeopardise recruitment or overwhelm parents. Strategies for seeking consent for multiple trials need to be developed and should include how to combine information for parents and patients.     

Sucrose Breakdown in Relation to Fruit Growth of Acid Lime (Citrus aurantifolia)

The physiological capacity for sucrose breakdown in developingjuice sac cells of acid limes was estimated by assaying theactivity of the three enzymes of sucrose catabolism in additionto vacuolar acid hydrolysis. The maximum potential rates ofsucrose breakdown were compared with the observed rates of carbonutilization. Highest potential rates of sucrose breakdown (28.621mmol cm^–3 per hydrated active space d^–1) occurredat the initial stages of fruit development where carbon utilizationwas highest. As the fruit developed, the potential rates ofsucrose breakdown and carbon utilization declined to very lowlevels. At 80% of development, vacuolar acid hydrolysis becamethe only physiological mechanism for sucrose breakdown. Therelatively low amounts of sucrose hydrolysed by acid hydrolysisat this time were just sufficient to account for the measuredcarbon demands. The results suggest that carbon supplied bythis distinct sucrose catabolizing system is able to provideadequate levels of carbon skeletons for the observed levelsof respiration and dry weight deposition early in development,but becomes a limiting factor for growth in the later stages. Key words: Vacuolar acid hydrolysis, Citrus aurantifolia     

LEUKOCYTES IN “VIRUS X” INFECTION

Study of blood taken from patients with the recent “Virus X” “flu” syndrome showed slight leukopenia and the presence of abnormal lymphocytes, the most characteristic of which were those showing basophilic cytoplasm. These cells, often called Turk cells, and which the authors have termed “toxic” lymphocytes, are similar to those found in other virus infections.     

Abnormal kinetics of induction of UV-stimulated recombination in human DNA repair disorders

Recombination can result in genetic instability, and thus constitutes an important factor in the carcinogenic conversion of mammalian cells. Here we describe the occurrence of UV-stimulated recombination called enhanced recombination (EREC), measured with the use of Herpes Simplex Viruses type 1 mutants. In normal diploid human cells, EREC is induced by UV-C, mitomycin C and ENU, but not by X-ray or MMS. The kinetics of induction of EREC is similar to that of other SOS-like responses such as enhanced reactivation (ER) and enhanced mutagenesis (EM). In contrast to the latter responses, EREC is induced to higher levels and persists for longer periods in DNA repair deficient fibroblasts derived from xeroderma pigmentosum (XP), Cockayne syndrome (CS) and Trichothiodystrophy (TTD) patients. This observation indicates that EREC is a distinct SOS-like response. Apparently, the presence of unrepaired DNA lesions in the host genome is a strongly inducing signal for EREC. On the other hand, in cells derived from patients suffering from Bloom, Werner or Rothmund-Thomson syndrome (RTS) the EREC response is absent. These data indicate that determining EREC is a useful assay to investigate diploid human fibroblasts for abnormalities in UV-stimulated recombination.     

PCR improves diagnostic yield from lung aspiration in Malawian children with radiologically confirmed pneumonia

Background

Accurate data on childhood pneumonia aetiology are essential especially from regions where mortality is high, in order to inform case-management guidelines and the potential of prevention strategies such as bacterial conjugate vaccines. Yield from blood culture is low, but lung aspirate culture provides a higher diagnostic yield. We aimed to determine if diagnostic yield could be increased further by polymerase chain reaction (PCR) detection of bacteria (Streptococcus pneumoniae and Haemophilus influenzae b) and viruses in lung aspirate fluid.

Methods

A total of 95 children with radiological focal, lobar or segmental consolidation had lung aspirate performed and sent for bacterial culture and for PCR for detection of bacteria, viruses and Pneumocystis jirovecii. In children with a pneumococcal aetiology, pneumococcal bacterial loads were calculated in blood and lung aspirate fluid.

Results

Blood culture identified a bacterial pathogen in only 8 patients (8%). With the addition of PCR on lung aspirate samples, causative pathogens (bacterial, viral, pneumocystis) were identified singly or as co-infections in 59 children (62%). The commonest bacterial organism was S.pneumoniae (41%), followed by H. influenzae b (6%), and the commonest virus identified was adenovirus (16%), followed by human bocavirus (HBoV) (4%), either as single or co-infection.

Conclusions

In a select group of African children, lung aspirate PCR significantly improves diagnostic yield. Our study confirms a major role of S.pneumoniae and viruses in the aetiology of childhood pneumonia in Africa.     

Studies on a 3beta-hydroxysteroid sulphotransferase from rat liver.

A steroid sulphotransferase (EC 2.8.2.2) was partially purified from female rat liver. The enzyme was active towards the substrates, dehydroepiandrosterone, epiandrosterone and pregnenolone but was inactive towards oestrogens, cholesterol and ergocalciferol. A pH optimum of 5.0 was recorded but the enzyme was unstable at low pH. The enzyme was stimulated slightly by the addition of reducing agents and inhibited by p-chloromercuribenzoate and HgCl2. Crude enzyme activity was markedly stimulated by divalent cations but this effect was not observed with purified enzyme. A Km of 13 muM was calculated for the donor substrate 3'-phosphoadenylyl sulphate and the acceptor substrate, dehydroepiandrosterone had a Km value of 6 muM. The enzyme appeared to be highly susceptible to product inhibition by adenosine 3', 5'-diphosphate.     

Positioning the nodule,the hormone dictum

The formation of a nitrogen-fixing nodule involves two diverse developmental processes in the legume root: infection thread initiation in epidermal cells and nodule primordia formation in the cortex. Several plant hormones have been reported to positively or negatively regulate nodulation. These hormones function at different stages in the nodulation process and may facilitate the coordinated development of the epidermal and cortical developmental programs that are necessary to allow bacterial infection into the developing nodule. In this paper, we review and discuss how the tissue specific nature of hormonal action dictates where, when and how a nodule is formed.Key words: nodulation, hormone regulation, epidermis, cortex