BMJ  2006;333:208 (22 July), doi:10.1136/bmj.333.7560.208

Minerva

Minerva

As the use of anthrax vaccine in members of the armed forces has increased, so have anxieties over its safety. A large case-control study of US military staff gives some reassurance: the risk of optic neuritis did not increase in 18 weeks after vaccination. The study also exonerated smallpox, hepatitis B, and influenza vaccines (Archives of Neurology 2006;63: 871-5[Abstract/Free Full Text]).

A nationwide study of adverse outcomes in acute hospitals in Belgium confirms what we already know about hospitals being dangerous places for patients (International Journal for Quality in Health Care 2006;18: 211-9[Abstract/Free Full Text]). Adverse outcomes affected more than 6% of people discharged. More interestingly though, even after adjusting for case mix, were the striking variations between hospitals. This shows the potential for improvement, the authors argue.

Most of us carry herpes simplex virus 1. It lies latent in the trigeminal ganglia until, reactivated by some sort of stress, it ambushes us with a cold sore. Only one viral gene is expressed during the latency phase, and no viral particles are produced. The product of that gene has now been identified (Nature 2006;442: 82-5[Medline]). It's a microRNA that protects the infected neurones from cell death, allowing the infection to persist. Mammalian cells sometimes use this RNA interference mechanism to restrict viral propagation but here it's the virus that uses it to survive

Innate immune responses, which are mediated through the reticuloendothelial system, protect against infection and tissue injury. But overproduction of proinflammatory cytokines, such as tumour necrosis factor and interleukin 1, can do more harm than good. A study in mice shows that a cholinergic pathway to the spleen, running in the vagus nerve, activates counter-regulatory anti-inflammatory mediators (Journal of Experimental Medicine 2006;203: 1623-8[Abstract/Free Full Text]). As well as providing evidence of a physiological link between the nervous and immune systems, the study helps to explain why asplenic people are so vulnerable to infection.

The layered architecture of the retina is precise and regular. Photoreceptors occupy the outermost layer, and retinal ganglion cells the innermost. In between are various types of retinal neurones. Mathematical modelling shows that this highly organised arrangement can develop from an initially random distribution, given some fairly simple rules to govern interactions between cells (Mathematical Medicine and Biology 2006;23: 79-99).

If a patient with Parkinson's disease is experiencing variable responses to a dose of levodopa, it may be worth checking whether she is infected with Helicobacter pylori. A small randomised controlled trial found that people in whom H pylori was successfully eradicated showed an increase of levodopa absorption, less clinical disability, and longer time with reduced symptoms (Neurology 2006;66: 1824-9[Abstract/Free Full Text]).

Since she writes under a pseudonym, Minerva's antennae are sensitive to arguments about the pros and cons of unsigned articles in scientific journals, which Chest (2006;129: 1395-6[Free Full Text]) has been exploring. She is sympathetic to the view that anonymity protects authors from academic or financial reprisals and that this enables honest and open comment. On the other hand, she sees the force of argument that unsigned articles violate the spirit of transparency intended to minimise, or at least reveal, potential conflicts of interest.

Before the invention of cardboard, tinplate, and bubble wrap, oak casks were an essential part of everyday life and commerce. Cask making, or coopering, was a highly skilled trade, and it survives today in the Scotch whisky industry. Although some of the work is now done with the help of machines, much must still be done by hand. Perhaps it's not surprising that a survey of upper limb disorders in coopers found a high prevalence of reported elbow symptoms and epicondylitis (Occupational Medicine 2006;56: 232-6[Abstract/Free Full Text]).

Familial essential tremor is generally transmitted as an autosomal dominant trait. A genome-wide scan indicated a major locus on chromosome 3. Now a genetic study has found that a variant in the dopamine D3 receptor gene, which is present on that chromosome, cosegregated with the condition in 23 out of 30 French families (Proceedings of the National Academy of Sciences 2006;103: 10753-8[Abstract/Free Full Text]). People who were homozygous for the variant allele tended to have more severe and earlier onset forms of the disease than heterozygotes. Selective antagonists for the dopamine D3 receptor may be a therapeutic option.

In several European countries, balneotherapy and spa therapy are common treatments for low back pain. Although they are expensive, the costs are sometimes reimbursed by health insurance systems. A systematic review of these treatments found only five randomised controlled trials. Judged by self reported pain on a visual analogue scale, the treatments were modestly effective (Rheumatology 2006;45: 880-4[Abstract/Free Full Text]). But sceptics may agree that a more important finding is the mismatch between the popularity of these interventions and the paucity of evaluations of their efficacy.

An 85 year old woman with ischaemic heart disease started taking 30 mg of nicorandil twice daily to control her angina. Three months later she developed oral ulceration followed by extensive painful ulceration within her natal cleft. Oral ulceration is a well known side effect of nicorandil. Perianal ulceration is a well documented but less well known side effect, especially with higher doses of the drug. Her ulcers resolved completely after she stopped taking nicorandil. A J Waters (WatersAJ{at}yahoo.com), senior house officer, K M Godfrey, professor, department of dermatology, Royal South Hants Hospital, Southampton SO14 0YG

 

Molecular biologists have found that a little work with Adobe Photoshop can perk up the visual impact of a fuzzy western blot no end. In an article rather optimistically entitled Stop Misbehaving, the editor of the Journal of Clinical Investigation (2006;116: 1740-1[CrossRef][Medline]) finds it necessary to explain that authors should not process images by increasing the contrast; by erasing extraneous bands or background noise; or by pasting in the same bands to represent multiple proteins or messenger RNAs. Despite being aghast at how much time he spends policing misconduct, the editor remains convinced that on the whole authors are an honest bunch and that it's only a few rotten apples that are spoiling things.

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BMJ 2006 333: 268. [Full Text] [PDF]