Creating the Chesapeake Bay Marine Protected Area

The Chesapeake Bay provides economic benefits to its surrounding states in the form of tourism, fishing, recreation, and ecosystem services. However it is not sufficiently protected by these states and is suffering the consequences. This precious habitat needs more protection to ensure the long-term survival of the wildlife and services it provides. Creating a Marine Protected Area (MPA) at the mouth of the Chesapeake Bay and extending out in to the Atlantic Ocean will protect multiple habitats and fish populations, which will in turn improve the health of the Bay (Narula 2014). This MPA will restrict harmful fishing, drilling, dumping, and extraction techniques, while still allowing for large-scale commercial fishing so as to not hurt the industry (Brown et al. 2010). No-take zones are a small but vitally important part of any MPA, and will protect commercially important species to ensure their long-term survival (Wenzel 2011). A no-take zone is a designated area where any and all extractive fishing practices are prohibited. These zones offer the best protection available for the animals and habitat they protect. The designation of an “MPA” is a federal status, meaning the state government is not going to be entirely responsible for funding and enforcing this MPA. Instead, the National Oceanic and Atmospheric Administration, the US Fish and Wildlife Service, and the US Coast Guard will take on the responsibilities of enforcing the area (USA 2005)

HIV positive patient with GBS-like syndrome

Introduction. Guillain–Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up. Conclusion. This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive

The introduction of plastic and reconstructive surgery to the University of Glasgow undergraduate medical core curriculum

Misperceptions of plastic surgery remain common among medical students and the medical community. This creates barriers in recruitment to specialty and patient referral. Before this study, there was no formal plastic surgery teaching in University of Glasgow undergraduate medical core curriculum. A plastic surgery teaching pilot was implemented for fourth year students. Oncoplastic breast surgery was used as an example of gold standard multidisciplinary reconstructive surgery. Surveys collected data before and after provision of teaching across four parameters; identification of plastic surgery subspecialties, understanding of plastic surgery, opinion of the pilot and curriculum, career preferences and gender. The response rate was 57% (n=160). The most and least recognised subspecialties were burns (48% (n=75)) and perineal and lower limb reconstruction (0% (n=0)), respectively, with more students identifying aesthetic surgery (16% (n=26)) than hand (9% (n=15)) or skin cancer surgery (6% (n=9)). The majority (129 (81%)) thought plastic surgery was poorly represented in their curriculum and wanted further information (98 (61%)). Reported understanding of plastic surgery significantly improved (p≤0.00005). Those interested in surgical careers increased from 39% (n=63) to 41% (n=66) with more males than females reporting interest (p≤0.05). This study introduced plastic and reconstructive surgery into the undergraduate curriculum and led to further increased plastic surgery teaching. It improved student understanding, desire to gain more experience in the specialty and interest in surgical careers. Teaching students about subspecialties is vital to dispel misconceptions, ensure appropriate referrals and ignite interest in those with aptitude for surgical careers

Acute HCV in HIV positive men; viral evolution and cellular immune responses

Background: The natural history of early HCV infection has been only partially characterised previously, as primary infection is usually asymptomatic. An emerging epidemic of acute HCV virus (HCV) infection in HIV-positive men in Europe, Australia and the USA has allowed the recruitment of new cohorts of patients with early HCV. We aimed to describe the natural history of virus evolution and cellular immune responses in a rare cohort of acute HCV infected HIV-positive patients in order to identify key determinants of spontaneous clearance. Methods: 110 patients were recruited and followed at 1-3 monthly intervals for a median period of 3 years. HCV E2 envelope, NS5B polymerase and NS5A genes were amplified at multiple time points using PCR and cloning techniques from plasma, liver and lymphocytes. A library of 2295 HCV E2 sequences were available for analysis .The functional immune response was assessed by ELISpot and flow cytometry. Results: 14% of patients cleared HCV spontaneously while 86% progressed towards chronicity. Three patterns of infection were observed based on viral load dynamics; spontaneous clearance (SC) and 2 patterns of progression; plateau (PV) and fluctuating viraemia (FV). SC was associated with a >1.7log10 viral load drop within 100 days of infection (OR=2.76; p=<0.001), slow viral diversification of the envelope E2 gene and the emergence of an early multi-specific T-cell response. PV was associated with positive selection within E2 and rapid viral diversification. Superinfection with new HCV strains (40% of the cohort), delayed T-cell responses and the presence of HCV within lymphocytes were all associated with FV. CD4+ responses were particularly important in defining the final outcome of infection. Conclusions: Spontaneous clearance of acute HCV in HIV-positive men can be predicted by rapid decline in viral load, low viral diversity and T-cell response. Key words: HIV, HCV, HVR-

Nop9 is an RNA binding protein present in pre-40S ribosomes and required for 18S rRNA synthesis in yeast

Proteomic analyses in yeast have identified a large number of proteins that are associated with preribosomal particles. However, the product of the yeast ORF YJL010C, herein designated as Nop9, failed to be identified in any previous physical or genetic analysis of preribosomes. Here we report that Nop9 is a nucleolar protein, which is associated with 90S and 40S preribosomes. In cells depleted of Nop9p, early cleavages of the 35S pre-rRNA are inhibited, resulting in the nucleolar retention of accumulated precursors and a failure to synthesize 18S rRNA. Nop9 contains multiple pumilio-like putative RNA binding repeats and displays robust in vitro RNA binding activity. The identification of Nop9p as a novel, essential factor in the nuclear maturation of 90S and pre-40S ribosomal subunits shows that the complement of ribosome synthesis factors remains incomplete

Immediate access arteriovenous grafts versus tunnelled central venous catheters: study protocol for a randomised controlled trial

Background Autologous arteriovenous fistulae (AVF) are the optimal form of vascular access for haemodialysis. AVFs typically require 6 to 8 weeks to “mature” from the time of surgery before they can be cannulated. Patients with end-stage renal disease needing urgent vascular access therefore traditionally require insertion of a tunnelled central venous catheter (TCVC). TCVCs are associated with high infection rates and central venous stenosis. Early cannulation synthetic arteriovenous grafts (ecAVG) provide a novel alternative to TCVCs, permitting rapid access to the bloodstream and immediate needling for haemodialysis. Published rates of infection in small series are low. The aim of this study is to compare whether TCVC ± AVF or ecAVG ± AVF provide a better strategy for managing patients requiring immediate vascular access for haemodialysis. Methods/design This is a prospective randomised controlled trial comparing the strategy of TCVC ± AVF to ecAVG ± AVF. Patients requiring urgent vascular access will receive a study information sheet and written consent will be obtained. Patients will be randomised to receive either: (i) TCVC (and native AVF if this is anatomically possible) or (ii) ecAVG (± AVF). 118 patients will be recruited. The primary outcome is systemic bacteraemia at 6 months. Secondary outcomes include culture-proven bacteraemia rates at 1 year and 2 years; primary and secondary patency rates at 3, 6, 12 and 24 months; stenoses; re-intervention rates; re-admission rate; mortality and quality of life. Additionally, treatment delays, impact on service provision and cost-effectiveness will be evaluated. Discussion This is the first randomised controlled trial comparing TCVC to ecAVG for patients requiring urgent vascular access for haemodialysis. The complications of TCVC are considered an unfortunate necessity in patients requiring urgent haemodialysis who do not have autologous vascular access. If this study demonstrates that ecAVGs provide a safe and practical alternative to TCVC, this could instigate a paradigm shift in nephrology thinking and access planning.</p

Prevalence of HCV NS3 pre-treatment resistance associated amino acid variants within a Scottish cohort

Background: Protease inhibitors (PI) including boceprevir, telaprevir and simeprevir have revolutionised HCV genotype 1 treatment since their introduction. A number of pre-treatment resistance associated amino acid variants (RAVs) and polymorphisms have been associated with reduced response to treatment. Objectives: We measured the prevalence of RAVs/polymorphisms in a PI treatment-naïve HCV genotype 1 Scottish cohort using Sanger sequencing. Study design: Chronically infected, treatment-naïve, HCV genotype 1 patients (n = 146) attending NHS Greater Glasgow and Clyde clinics were investigated for RAVs/polymorphisms to the PIs boceprevir, telaprevir and simeprevir. The NS3/4A region was amplified by nested polymerase chain reaction. The 1.4 kb amplified product was sequenced using an ABI 3710XL DNA sequencer. Sequence analysis was performed using web-based ReCall (beta 2.10). Amino acid positions 36, 41, 43, 54, 55, 80, 109, 122, 155, 156, 168 and 170 were analysed for RAVs/polymorphisms. Results: Overall, 23.29% (34/146) of patients had an RAV or polymorphism detected. Overall, 13.69% (20/146) of patients had HCV virus that contained the Q8 K polymorphism. Other RAVs detected were: V36 M 0.70% (1/146), V36L 0.70% (1/146), T54S 6.85% (10/146), V55A 3.42% (5/146) and V/I170A 0.68% (1/146). Four patients had dual combinations of mutations (T54S + V36L; T54S + V55A and 2 patients with T54S + Q80K). Conclusions: Q80K was the most prevalent baseline polymorphism detected in the Scottish cohort. Simeprevir treatment is not recommended in patients infected with the Q80K genotype 1a variant. This highlights the need for baseline sequencing prior to administration of this drug in this population

Efficacy and safety of COVID-19 vaccines in older people

Declaration of Conflicts of Interest R.L.S. is a principal investigator in the Novavax COVID-19 vaccine trial. C.S. is a sub-investigator in the Novavax COVID-19 vaccine trial. E.C.T. has no conflicts of interest to declare. Views expressed are the authors’ own.Peer reviewedPostprin