Using a system-on-a-chip implantable device to filter circulating infected cells in blood or lymph

This paper describes a system on a chip (SoC) that makes use of nanoscale cellular adhesion mechanisms in an integrated electronic microsystem to filter infected cells from blood or lymph. An example of a human immunodeficiency virus-specific SoC is explored in depth. Such systems work in vivo, and blood and lymph are filtered on a continuous basis. With the intelligence on the chip, captured cells can be identified and lyzed, expelled, or otherwise acted upon. These types of systems transfer the burden of research from traditional chemotherapy to bioengineering and system design.

Emerging Pathologies in Aquaculture: Effects on Production and Food Safety

Infectious diseases represent a limiting factor for the further development of Italian aquaculture. The recent introduction and spreading of new pathogens, along with the global climatic change, has contributed to a considerable decrease in trout production. Emerging pathologies in rainbow trout culture include viral diseases, e.g. infectious haematopoietic necrosis (IHN), bacterial diseases, such as lactococcosis and visceral flavobacteriosis, and parasitical diseases, e.g. proliferative kidney disease (PKD). Higher mortality rates in trout fry and fingerlings are generally induced by visceral flavobacteriosis and IHN, while the main losses in large trout during the warm season are due to lactococcosis and PKD. Mariculture has at present a better sanitary status compared to trout culture, but a rapid dissemination of pathogens, including zoonosis agents, is envisaged also for seabass and seabream. Emerging pathologies in sea bass include VNN, pseudotuberculosis, streptococcosis and tuberculosis. Seabream is much more resistant and is mainly affected by novel Vibrio infections and enteromyxidiosis. A good sanitary management of fish farms is essential for avoiding or limiting losses caused by emerging pathologies. Transmission of zoonosis agents to man, through the consumption of cultured fish, is very remote in Italy. On the contrary, transmission of Streptococcus iniae, Vibrio vulnificus and Mycobacterium marinum by means of improper manipulation of infected fish, could represent a potential hazard for fish farmers and fish processors, as well as for people preparing fish meals.

[Cutaneous complications following liver transplantation: epidemiologic and clinical study in 86 patients]

INTRODUCTION

Organ transplanted patients exhibit cutaneous lesions caused by immunosuppressive treatment and/or immunosuppression itself. Several selected studies concerning kidney transplants have been reported, but few concerning liver transplants. We report a retrospective study of skin diseases after liver transplantation.

PATIENTS AND METHOD

This study was carried out on liver transplanted patients at the University hospital in Besançon since 1986. Eighty six patients were examined between January 1997 and May 1998. Standardized data obtained at the clinical examination and from past history were compiled concerning cutaneous side effects of immunosuppressive treatments as well as infectious and tumoral skin lesions.

RESULTS

Cutaneous side effects related to immunosuppressive treatments: 46.5p. 100 of patients exhibited hypertrichosis, 18.5p. 100 gingival hyperplasia, 8.2p. 100 acne, 23.2p. 100 skin atrophy, 13.9p. 100 senile purpura and 17.4p. 100 sebaceous hyperplasia. Infectious diseases were 2 erysipelas, 2 folliculitis, 29 p. 100 of common fungal infections, 13.9p. 100 of mucocutaneous herpes simplex infections, 3p. 100 of zoster, 38.3p. 100 of cutaneous warts (24.4p. 100 of common warts and 7p. 100 of condylomata). Tumoral skin lesions were 17.4p. 100 of actinic keratoses, 13.9p. 100 of skin cancer (7 squamous and 11 basal cell carcinoma). A correlation was shown between time past graft and the occurrence of skin cancer, between actinic keratoses and skin cancer and between common warts and squamous cell carcinoma.

DISCUSSION

We have demonstrated that drug induced skin disorders, infections and tumoral skin diseases were similar and as frequent in liver as in kidney transplanted patients. However, a lower frequency of warts was observed in liver transplanted patients as well as a higher frequency of basal cell carcinoma, compared with squamous cell carcinoma. This ratio is reversed in kidney grafted patients. These results suggest that immunosuppression is lower in liver transplanted patients with possible age involvement.

Age-related disease pattern in infertile men: increasing incidence of infections in older patients

In a cross-sectional retrospective study, the age-dependency of semen parameters of men with specific andrological diseases was investigated in 3,698 men (mean age 33 years; range 19-63 years) attending a tertiary referral clinic for couple infertility. In all, 1,853 patients suffered from idiopathic infertility (mean age 33.2 years; range 19-60 years), 388 from infections of the accessory glands (34.2; 20-61), 363 had a history of maldescended testes (32.0; 20-51) and 833 a varicocele (33.6; 20-63). In 172 patients, a varicocele and an infection (34.3; 24-54) and in 94 a varicocele and a history of maldecended testes (32.5; 21-53) were found. Semen analysis was performed according to WHO criteria. An age-related decrease in testicular volume was not observed in any group. Total sperm count decreased significantly with advancing age only in patients with an infection of the accessory glands. We found no evidence for age-dependent progressive deterioration of semen variables in the other groups. It may be concluded that the causes for the spermatogenetic defects in men with idiopathic infertility, a history of maldescended testes or varicocele are acquired before adolescence and do not progress during adulthood. In contrast, infections of the accessory glands may lead to decreased sperm counts by functional impairment or partial occlusion of the seminal ducts. Thus, if in the general population declining sperm counts are observed, genital tract infections may be suspected as a contributing factor.

[Cytopathologist's role in detecting and identifying pathogens]

This review highlights the contribution of the cytopathologist in the diagnosis of infectious diseases, with emphasis on the detection and identification of microorganisms in various cytologic specimens. Morphological analysis of the main bacteria, parasites and mycoses observed in cytologic specimens, as well as the cytopathogenic effects of the viruses are discussed. The differential diagnosis (contaminants and exogenous or endogenous foreign bodies) is discussed. Finally, the main pathogens noted in each specimen are briefly reviewed.

Balancing protective immunity and immunopathology

The immune system is fighting a constant war against pathogens in its own territory. This requires a potent arsenal for efficient control of pathogens but also requires tight regulatory mechanisms in order to avoid excessive collateral damage. Maintaining equilibrium is the daily challenge of the immune system. Interactions between pathogens, antigen-presenting cells (APCs) and lymphocytes are critical in this balancing act. Of particular importance for the generation of protective immune responses is the induction of activation programs in APCs directly by pathogens or by T cell derived factors, such as CD40L, RANKL or cytokines. In order to counterbalance overshooting immune responses, T cells and APCs secrete anti-inflammatory cytokines that are key for maintaining a healthy balance between protection and immunopathology.

FLAG-IDA regimen (fludarabine, cytarabine, idarubicin and G-CSF) in the treatment of patients with high-risk myeloid malignancies

Forty-five patients with high-risk myeloid malignancies (32 acute myeloid leukemia and 13 high-risk myelodysplastic syndromes) were treated with fludarabine, cytarabine, idarubicin, and G-CSF (FLAG-IDA). Twenty-four (53%) patients achieved complete remission (CR), and five (11%) partial remission. Infection predominantly with pulmonary involvement was the most common regimen-related toxicity. Mucositis (15 patients) and pulmonary toxicity (19 patients) were the most frequently observed non-hematologic side effects. There were four early deaths and 12 patients presented with resistant disease. Overall survival (OS) at 12 months was 40%. The FLAG-IDA regimen shows evident antileukemic activity in patients with high-risk myeloid malignancies with acceptable toxicity.

The placenta in hematogenous infections

Although congenital infections have been known since ancient times, at present they constitute an evolution due to the broadening of diagnostic methods. Also, the histopathological examination of selected placentas has increased in perinatal pathology. All placentas should be examined grossly by the obstetrician or the neonatologist who must select the specimens to be sent for pathologic examination. The indications for selection at delivery to detect hematogenous infection are listed in Table 1. The placentas that do not meet guidelines for pathologic examination must be kept stored at 40 degrees C for at least 72 h. This routine ensures that the placentas of asymptomatic newborns who might present early manifestations suggestive of infection would be submittedfor pathologic examination.

The usefulness of telemedicine for the detection of infection/inflammation at the point of care

The objective of this study is to examine the possibility of using Telemedicine to diagnose the presence of the inflammatory response and to assess its intensity at the point of care. One drop of citrated peripheral venous blood from 15 patients with infection/inflammation and 15 controls were used to prepare the slides. Unstained pictures were analyzed using a microscope, video camera and image analyzer (INFLAMETTM, Biovision, Tel Aviv, Israel). The jpg-compressed images were transferred via telephone to a physician in a remote location. A significant correlation was noted between the white blood cell count and the number of leukocytes per square mm by image analysis (r = 0.67 p < 0.0001 n = 30), between the degree of leukocyte adhesiveness/aggregation and the concentration of C-reactive protein (r = 0.42 p = 0.02 n = 29) and between the degree of erythrocyte aggregation and either fibrinogen concentrations (r = 0.73 p < 0.0001) or erythrocyte sedimentation (r = 0.83, p < 0.0001). No problems occurred during file transmission and there were no transfer errors. Physicians can successfully estimate the presence of an inflammatory response and its intensity using a simple slide test, image analysis, and Telemedicine technology.

Neutrophil-rich Ki-1-positive anaplastic large cell lymphoma: a study by fine-needle aspiration biopsy

Fine-needle aspiration biopsy (FNAB) is an accurate, cost-effective method of evaluating lymphomas. The neutrophil-rich variant of anaplastic large cell lymphoma (NR-ALCL) is a rare non-Hodgkin lymphoma. To our knowledge, we present thefirst study of NR-ALCL by FNAB cytology. Histologic confirmation was available for both patients. Both cases were positive for Ki-1 (CD-30) and were either T-cell or null-cell phenotype. FNAB specimens were highly cellular with a single-cell pattern composed of pleomorphic tumor cells, "hallmark" tumor cells, and a background rich in neutrophils that occasionally obscured tumor cells. Diagnosis on FNAB is difficult owing to the rarity of this tumor, its resemblance to Hodgkin lymphoma and other non-Hodgkin lymphomas that express CD30, its similarity to an infectious process, and its occasional confusion with metastatic carcinoma and melanoma. Reproducible cytologic features usually are present, and the diagnosis can be made conclusively by FNAB in conjunction with ancillary studies.

Hyporesponsiveness to gammac-chain cytokines in activated lymphocytes from patients with systemic lupus erythematosus leads to accelerated apoptosis

Pathogenesis of autoimmune diseases like systemic lupus erythematosus (SLE) is unresolved. Dysregulation of programmed cell death is discussed as a pathogenetic factor. We have previously shown that increased in vitro apoptosis of cultured peripheral blood mononuclear cells (PBMC) is nonspecific for SLE. Importantly, however, in recent experiments with SLE PBMC from patients with infections and fever in vitro apoptosis was strongly accelerated. We therefore hypothesized that regulation of apoptosis might be disturbed in activated SLE lymphocytes. Thus, we generated phytohemagglutinine (PHA)/IL-2 stimulated lymphoblasts in vitro. These lymphoblasts readily undergo apoptosis after culture in cytokine-free medium, and can be rescued by addition of gammac-chain cytokines IL-2, -4, -7, or -15. In lymphoblasts from 60 SLE patients tested in comparison to lymphoblasts from normal donors cultured in parallel, we found significant hyporesponsiveness to gammac-chain cytokines in SLE cells. Minor differences were also seen in lymphoblasts from patients with other systemic autoimmunopathies (mixed connective tissue disease, vasculitis, n=49)and in lymphoblasts from patients with other autoimmune diseases (mainly rheumatoid or reactive arthritis, myositis, n=44). In patients with high erythrocyte sedimentation rate (> 25 mm/h), TNF-alpha (> 6.5 pg/ml) or IL-12 (> 4.7 pg/ml) serum levels or detectable IFN-gamma concentrations hyporesponsiveness to gammac-chain cytokines was even more pronounced in SLE lymphoblasts, but not in lymphoblasts from the other groups. Moreover, increased apoptosis was seen in lymphoblasts from SLE patients with decreased complement (C)4 or elevated dsDNA antibody levels. In conclusion, these data suggest that in SLE patients with increased inflammatory activity and/or Th1 dominance signaling through gammac-chain cytokine receptors is deteriorated, leading to facilitated apoptosis of activated lymphocytes and enlarged onflow of apoptotic material.

Atherosclerotic plaque burden, plaque vulnerability and arterial remodeling: the role of inflammation

Atherosclerotic narrowing of the arterial lumen is caused by gradual plaque growth and arterial remodeling. Expansive remodeling retards and constrictive remodeling accelerates narrowing of the lumen by plaque accumulation. In the acute phase luminal narrowing may be accelerated by rupture of a vulnerable plaque and subsequent thrombus formation. Inflammatory cells are key players in all these determinants of atherosclerotic luminal narrowing. Inflammatory cells are present in both early and advanced stages of atherosclerosis. Chronic infections have been suggested as trigger of arterial inflammation, but no causal relationship has yet been proved. Systemic markers of inflammation, like C-reactive protein, are predictors for the occurrence of future adverse cardiovascular events, confirming the role of inflammatory responses in arterial occlusive disease. In this review the central role of inflammation in atherosclerotic luminal narrowing will be discussed.

Randomized clinical trial of thalidomide, cyclosporine, and prednisone versus cyclosporine and prednisone as initial therapy for chronic graft-versus-host disease

Chronic graft-versus-host disease (CGVHD) is a major cause of morbidity following allogeneic bone marrow transplantation. Thalidomide is active in salvage therapy for high-risk or resistant CGVHD. In a prospective randomized trial, we tested initial therapy with thalidomide. Patients with extensive CGVHD were randomized to receive either cyclosporine and alternate-day prednisone (n = 27, no-thalidomide [no-thal] group) or cyclosporine, prednisone, and thalidomide (200-800 mg/day; n = 27, thal group). Although most patients responded, initial therapy with thalidomide did not improve control of CGVHD. Response rates were 83% versus 89% at 2 months (P = .7), 88% versus 84% at 6 months (P > .8) and 85% versus 73% at 1 year (P = .5) in the thal and no-thal groups, respectively. Multivariate analysis revealed related donor transplant (odds ratio [OR] = 11.3; P =.03) and de novo or quiescent onset of CGVHD (OR = 7.7; P =.04) to be significant predictors of good early response, whereas a platelet count of > or =100,000/microL was a significant predictor of good response (OR = 10.4; P =.04) at 1 year. Survival for the thal and no-thal groups was similar at 1 year (66% versus 74%) and 2 years (66% versus 54%, P = .85). Multivariate analysis revealed progressive onset CGVHD (relative risk [RR] = 4.2; P =.01), unrelated donor (RR = 5.7; P < .01), sex mismatch (RR = 7.9; P < .01), and platelet counts of <100,000/microL (RR = 3.8; P = .01) as significant predictors of poorer survival. These data suggest that despite a high response rate (79% response and 53% complete response) and encouraging survival rates (70% at 1 year and 60% at 2 years), thalidomide offers no clinical benefit when incorporated into initial therapy for CGVHD. The value of thalidomide as salvage therapy requires further study.

Role of fine-needle aspirates of focal lung lesions in patients with hematologic malignancies

OBJECTIVES

To evaluate the yield and safety of transthoracic fine-needle aspiration (FNA) in the diagnosis of pulmonary disease in patients with hematologic malignancy.

DESIGN

Retrospective chart review.

SETTING

Tertiary-care medical center.

PATIENTS

Sixty-seven patients with a hematologic malignancy or after bone marrow transplantation (BMT) for a hematologic malignancy who underwent a total of 71 FNAs for diagnosis of an unexplained parenchymal lung lesion from January 1, 1991, to June 30, 1999.

RESULTS

The underlying malignancy was lymphoma in 42 patients (63%), leukemia in 8 patients (12%), after allogeneic BMT in 12 patients (18%), after autologous BMT in 3 patients (4%), and other diseases in 2 patients. Radiographs showed focal abnormalities in all cases, and were nodules in 37%, masses in 37%, focal infiltrates in 21%, and cavitary lesions in 5%. The yield of FNA for a finding specific infection or cancer was 56% (40 of 71 FNAs). The FNA with inflammatory changes was clinically sufficient in another 11 patients for a total yield of 72% (51 of 71 FNAs). The yield for lung cancer was 90% (9 of 10 FNAs), for pulmonary lymphoma was 68% (21 of 31 FNAs), and for infection was 67% (10 of 15 FNAs). Complications occurred in 18 of 71 FNAs (25%), with pneumothorax in 14 patients (20%) and chest tube placement required in 4 patients (6%). Bleeding occurred in six patients (8%), including one death in a patient with abnormal hematologic parameters.

CONCLUSION

Transthoracic FNA in patients with hematologic malignancy and focal lung lesions has an excellent yield for detecting cancer and a yield comparable to bronchoscopy for the diagnosis of infections. It should be considered a useful diagnostic tool in this setting.

[Mechanisms of fever]

Fever represents a normal and adaptative response developed in case of host aggression, notably by infectious agents, and is part of a large defense system, the acute phase response. Fever mediators are mainly derived from the host cells and are pyrogenous cytokines such as interleukin-1, tumour necrosis factor alpha, interleukin-6 or interferons which act at the hypothalamus level via prostaglandin E2. Although fever has been conserved through evolution, its beneficial effects in humans are not well-established.

Bovine mastitis due to Prototheca zopfii: clinical, epidemiological and pathological aspects in a Brazilian dairy herd

The clinical, epidemiological and pathological aspects of protothecal mastitis in a Brazilian dairy herd are described. Prototheca zopfii infection was diagnosed in 11 of 121 milking cows. Clinical mastitis refractory to usual therapy was observed in 7 cows. Several environmental conditions conducive to the growth of Prototheca spp., such as wetness, muddiness and the presence of organic material, were present in the dairy. Improper milking practices and insanitary infusion of the intramammary antibiotics were also observed. Six cows with protothecal mastitis were slaughtered and the affected quarters of each cow were examined by histology and immunohistochemical staining for bovine keratin and P. zopfii. The histological lesions were characterized by interstitial infiltrates of macrophages, plasma cells and lymphocytes; algae were seen in the alveolar lumen and interstitium. The lack of a positive reaction with an antiserum against bovine keratin in the mammary alveolar epithelial layer in some affected areas suggests destruction of milk-producing tissues, which may be related to the low milk production observed. The algal organisms stained positively with a polyclonal antibody against P. zopfii.