Calcitonin gene-related peptide, adrenomedullin and flushing

Administration of calcitonin gene-related peptide (CGRP) or adrenomedullin (AM) can cause facial flushing, suggesting that the peptides may be important in hot flushes experienced particularly by post-menopausal women. Five studies have measured plasma CGRP concentrations in post-menopausal women who suffer from flushes; all demonstrated elevations of between 170% and 320% over control. Three of the studies showed a temporal relationship between flushes and CGRP elevation. A further study has shown that CGRP is elevated in the urine of women who suffer from flushes. Only a single study has investigated flushes in pre-menopausal women; no elevation of CGRP was observed. Flushes are also experienced by men undergoing androgen deprivation therapy. Whilst one study failed to find any increase in CGRP in the urine of these individuals, a small study has identified an increase in plasma CGRP. No studies have investigated plasma AM or the related peptide, intermedin/AM2. Overall, there is good evidence to show that flushes in post-menopausal women are accompanied by an increase in CGRP. CGRP could act centrally on the thermoregulatory centre of the hypothalamus as well as peripherally to cause vasodilation and sweating. However, it remains to be demonstrated that the elevated CGRP causes flushes. Recently developed CGRP antagonists provide an opportunity to test this hypothesis. If they are successful, they may represent a useful alternative to oestrogen replacement therapy.

Infection risk associated with a closed luer access device

The potential for microbial contamination associated with a recently developed needleless closed luer access device (CLAD) (Q-Syte™ Becton Dickinson, Sandy, UT, USA) was evaluated in vitro. Compression seals of 50 multiply activated Q-Syte devices were inoculated with Staphylococcus epidermidis NCTC 9865 in 25% (v/v) human blood and then disinfected with 70% (v/v) isopropyl alcohol followed by flushing with 0.9% (w/v) sterile saline. Forty-eight of 50 (96%) saline flushes passed through devices that had been activated up to a maximum of 70 times remained sterile. A further 25 Q-Syte CLADs that had undergone multiple activations were challenged with prefilled 0.9% (w/v) sterile saline syringes, the external luer tips of which had been inoculated with S. epidermidis NCTC 9865 prior to accessing the devices. None of the devices that had been accessed up to 70 times allowed passage of micro-organisms, despite challenge micro-organisms being detected on both the syringe tip after activation and the compression seals before decontamination. These findings suggest that the Q-Syte CLAD may be activated up to 70 times with no increased risk of microbial contamination within the fluid pathway. The device may also offer protection from the external surface of syringe tips contaminated with micro-organisms. © 2005 Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Ecological studies on river pollution control

This collection of papers records a series of studies, carried out over a period of some 50 years, on two aspects of river pollution control - the prevention of pollution by sewage biological filtration and the monitoring of river pollution by biological surveillance. The earlier studies were carried out to develop methods of controlling flies which bred in the filters and caused serious nuisance and possible public health hazard, when they dispersed to surrounding villages. Although the application of insecticides proved effective as an alleviate measure, because it resulted in only a temporary disturbance of the ecological balance, it was considered ecologically unsound as a long-term solution. Subsequent investigations showed that the fly populations in filters were largely determined by the amount of food available to the grazing larval stage in the form of filter film. It was also established that the winter deterioration in filter performance was due to the excessive accumulation of film. Subsequent investigations were therefore carried out to determine the factors responsible for the accumulation of film in different types of filter. Methods of filtration which were considered to control film accumulation by increasing the flushing action of the sewage, were found to control fungal film by creating nutrient limiting conditions. In some filters increasing the hydraulic flushing reduced the grazing fauna population in the surface layers and resulted in an increase in film. The results of these investigations were successfully applied in modifying filters and in the design of a Double Filtration process. These studies on biological filters lead to the conclusion that they should be designed and operated as ecological systems and not merely as hydraulic ones. Studies on the effects of sewage effluents on Birmingham streams confirmed the findings of earlier workers justifying their claim for using biological methods for detecting and assessing river pollution. Further ecological studies showed the sensitivity of benthic riffle communities to organic pollution. Using experimental channels and laboratory studies the different environmental conditions associated with organic pollution were investigated. The degree and duration of the oxygen depletion during the dark hours were found to be a critical factor. The relative tolerance of different taxa to other pollutants, such as ammonia, differed. Although colonisation samplers proved of value in sampling difficult sites, the invertebrate data generated were not suitable for processing as any of the commonly used biotic indexes. Several of the papers, which were written by request for presentation at conferences etc., presented the biological viewpoint on river pollution and water quality issues at the time and advocated the use of biological methods. The information and experiences gained in these investigations was used as the "domain expert" in the development of artificial intelligence systems for use in the biological surveillance of river water quality.