Staphylococcus aureus re-colonization in atopic dermatitis: beyond the skin

Patients with atopic dermatitis (AD) are often heavily colonized by Staphylococcus aureus, which adversely affects eczema severity. Strategies to control S. aureus in AD include antibiotic and or antiseptics. However long-term efficacy is unclear. In this study we consider extra-cutaneous factors that may cause S. aureus re-colonization in adult AD. Twenty-one patients with AD were recruited and were assessed for: duration of AD, use of topical or oral antibiotic within the preceding 3 months, the number of hospital admissions during the preceding year and current treatment. The types of topical treatments used, vehicle, container and the expiry dates were also recorded. The severity of AD was assessed by SCORAD index. Microbiological assessment for S. aureus carriage from affected skin, anterior nares, emollient and topical steroid was undertaken using culture, Staphaurex test and antibiotic resistance. Of the patients 86% had S. aureus colonization. The median SCORAD score were greater in those colonized with S. aureus (P = 0.02) and those with contaminated treatments (P = 0.05). Prior antibiotic treatment, prior hospital admission and nasal carriage did not influence the median SCORAD. Three extra-cutaneous mechanisms by which S. aureus can re-colonize the skin were identified: antibiotic resistance, nasal carriage and treatment contamination.

A functional CD40 receptor is expressed in pancreatic beta cells

AIMS/HYPOTHESIS

Despite differences in function and embryonic origin, pancreatic islet cells and neurons express proteins belonging to the tumour necrosis factor receptor superfamily. While neurons express the CD40 receptor, it is unknown whether islet cells also express it. We investigated CD40 expression in human and mouse pancreatic islets as well as in NIT-1 insulinoma cells.

METHODS

CD40 expression was studied by reverse transcriptase polymerase chain reaction, flow cytometry, immunohistochemistry and western blot. Responses mediated by CD40 were assessed by a luciferase gene reporter assay following stimulation with a CD40 agonist antibody.

RESULTS

We found that CD40 is expressed in mouse and human pancreatic islet cells. CD40 is expressed by beta cells, and its expression is upregulated by proinflammatory cytokines (IL-1beta, IFN-gamma and TNF-alpha). CD40 signalling in NIT-1 insulinoma cells activates nuclear factor kappa-B, demonstrating that CD40 is functional.

CONCLUSIONS/INTERPRETATION

We present evidence that, in addition to immune cell types, mouse and human pancreatic beta cells express CD40. Its expression is upregulated by proinflammatory stimuli, and signalling through this receptor activates NF-kappaB. We suggest that the effects of inflammatory stimuli that affect beta cell function and survival may be also mediated by signalling through the CD40 receptor. Thus, CD40 may have a role in processes associated with islet autoimmunity and transplantation.

[Idiopathic hypertrophic pachymeningitis: a diagnostic dilemma]

INTRODUCTION

Idiopathic hypertrophic pachymeningitis (IHP) is a rare fibrosing inflammatory process of unknown pathogenesis that causes diffuse thickening of the duramater. In spite of the fact that this pathological entity has been linked to specific etiological agents such as syphilis, tuberculosis, mycosis and sarcoidosis, In recent years there has been an increase in the number of patients with IHP of undetermined cause.

CASE REPORT

58 year-old female with a long date history of oppressive headaches, frontally located at first, and later generalized, accompanied by weakness and asthenia; urinary incontinence, dizziness, vomiting, and gait ataxia. Physical examination revealed bilateral cerebellar signs, and optic atrophy. Magnetic resonance displayed a diffuse thickening of the falx cerebrii, and cerebellar tentorium, hypointense in T1 and T2- weighted images, and markedly enhanced following administration of intravenous Gd-DTPA. A biopsy obtained from the falx revealed conspicuous fibrosis, and focal chronic inflammatory mononuclear infiltrate. Complementary exams carried out in order to reveal a specific etiologic agent were negative.

CONCLUSION

Due to the variable clinical presentation, and the difficulty to establish the etiology of the pathological process, to make the diagnosis of IHP usually represents a true dilemma. This diagnosis is often made by exclusion.

Glycosylation of immunodominant linear epitopes in the carboxy-terminal region of the caprine arthritis-encephalitis virus surface envelope enhances vaccine-induced type-specific and cross-reactive neutralizing antibody responses

This study evaluated type-specific and cross-reactive neutralizing antibodies induced by immunization with modified surface glycoproteins (SU) of the 63 isolate of caprine arthritis-encephalitis lentivirus (CAEV-63). Epitope mapping of sera from CAEV-infected goats localized immunodominant linear epitopes in the carboxy terminus of SU. Two modified SU (SU-M and SU-T) and wild-type CAEV-63 SU (SU-W) were produced in vaccinia virus and utilized to evaluate the effects of glycosylation or the deletion of immunodominant linear epitopes on neutralizing antibody responses induced by immunization. SU-M contained two N-linked glycosylation sites inserted into the target epitopes by R539S and E542N mutations. SU-T was truncated at 518A, upstream from the target epitopes, by introduction of termination codons at 519Y and 521Y. Six yearling Saanen goats were immunized subcutaneously with 30 microg of SU-W, SU-M, or SU-T in Quil A adjuvant and boosted at 3, 7, and 16 weeks. SU antibody titers determined by indirect enzyme-linked immunosorbent assay demonstrated anamnestic responses after each boost. Wild-type and modified SU-induced type-specific CAEV-63 neutralizing antibodies and cross-reactive neutralizing antibodies against CAEV-Co, a virus isolate closely related to CAEV-63, and CAEV-1g5, an isolate geographically distinct from CAEV-63, were determined. Immunization with SU-T resulted in altered recognition of SU linear epitopes and a 2.8- to 4.6-fold decrease in neutralizing antibody titers against CAEV-63, CAEV-Co, and CAEV-1g5 compared to titers of SU-W-immunized goats. In contrast, immunization with SU-M resulted in reduced recognition of glycosylated epitopes and a 2.4- to 2.7-fold increase in neutralizing antibody titers compared to titers of SU-W-immunized goats. Thus, the glycosylation of linear immunodominant nonneutralization epitopes, but not epitope deletion, is an effective strategy to enhance neutralizing antibody responses by immunization.

A simple and reliable pretreatment protocol facilitates fluorescent in situ hybridisation on tissue microarrays of paraffin wax embedded tumour samples

AIMS

To describe a robust pretreatment protocol for preparing paraffin wax embedded tissues on tissue microarrays for fluorescence in situ hybridisation (FISH). The newly developed pretreatment protocol described here was compared with the commonly used sodium thiocyanate based protocol and two different heating methods used in standard antigen unmasking protocols for immunohistochemistry (pressure cooking and microwaving in citrate acid buffer).

METHODS

Dewaxed tissue sections were incubated in 10mM citric acid buffer at 80 degrees C for 30 minutes to two hours, followed by a short pepsin digestion (1-5 mg/ml). Pretreated tissues were co-denatured with DNA probes at 80 degrees C for 10 minutes, followed by hybridisation at 37 degrees C for 48-72 hours.

RESULTS

The three protocols using citrate acid buffer produced FISH signals with superior signal to noise ratios compared with sodium thiocyanate pretreatment. Most importantly, the best tissue attachment was achieved using the newly developed pretreatment protocol: on tissue microarrays less than 1% of cores were lost. To date, a total of 30 probes have been successfully hybridised on to breast tissue and multi-tissue microarrays.

CONCLUSION

This pretreatment protocol is easy, reproducible, and facilitates FISH on tissue microarrays, with potential for widespread application in cancer research.

Technical skills for weight loss: 2-y follow-up results of a randomized trial

OBJECTIVE

To investigate the sustained effectiveness of a novel skill-based intervention for weight loss.

DESIGN

Randomized, controlled trial.

SUBJECTS

A total of 80 overweight/obese women living in Connecticut.

MEASUREMENTS

Absolute weight difference measured in pounds and absolute change in body mass index (BMI). Secondary outcomes included changes in food frequency questionnaire (FFQ) data and waist-to-hip ratio.

RESULTS

In all 61, 35, and 34% of study participants completed the 6-, 12-, and 24-month assessments, respectively. At 6 months postintervention, both counseling-based (CBI) and skill-based (SBI) intervention groups had statistically significant decreases in absolute weight (4.0+/-3.6 and 1.7+/-3.0 kg, respectively). Compared to their baseline values, both CBI and SBI groups still maintained weight losses at 24 months (1.1+/-5.8 and 0.59+/-3.3 kg, respectively); however, the differences were not statistically significant. FFQ results showed that, within the SBI group, there was a significant decrease (P<0.05) in percent fat from baseline to 12 months and a nearly significant decrease in saturated fat from baseline to 24 months (P=0.07).

CONCLUSIONS

Both the novel SBI and conventional dietary counseling demonstrated some residual weight loss benefit at 2 y. Effects of the SBI on dietary intake patterns are encouraging, and warrant further study.

De novo hemolytic-uremic syndrome/thrombotic microangiopathy in renal transplant patients receiving calcineurin inhibitors: role of sirolimus

The aim of this study was to evaluate the outcome of ten renal transplant recipients who developed de novo hemolytic uremic syndrome/thrombotic microangiopathy (DnHUS) after treatment with calcineurin inhibitors among 3,862 patients transplanted during the period 2000-2001 in Spain, and the results of switching to sirolimus for resolution of this pathologic condition. No patient had end-stage disease due to primary HUS. The criteria of diagnosis were decreased renal function, biopsy-proven thrombotic microangiopathy, and no signs of acute rejection. Calcineurin inhibitors were completely removed and immediate treatment with sirolimus started after diagnosis. The follow-up period was 19.0+/-4.3 months, at least 12 months after diagnosis. One patient died of sepsis shortly after starting sirolimus therapy. The serum creatinine level in the series decreased from 5.2+/-2.6 mg/dL at the time of biopsy to 2.15+/-1.9 mg/dL 1 month later (P=.011). All but one of the nine recipients, who lost his graft 3 months later (80% success) maintained function, with a serum creatinine of 2.1+/-1.4 mg/dL and Cockroft index of 61.3+/-34 mL/min at the end of follow up. During this time, none of the patients experienced an acute rejection episode and sirolimus was maintained without any remarkable secondary effect. Sirolimus seems to be a promising alternative for the treatment of renal transplant patients who develop calcineurin inhibitor-induced DnHUS.

Chimerism analysis following allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning

We have performed a prospective study to evaluate early chimerism and its kinetics after allogeneic peripheral blood stem cell transplantation among 68 patients who received a reduced-intensity conditioning (RIC) regimen with fludarabine plus melphalan (n=40) or busulphan (n=28). Chimerism was analyzed by polymerase chain reaction amplification of short tandem repeats in unfractionated (UF) and/or fractionated nucleated cells from bone marrow and peripheral blood (PB). All of the patients showed initial donor engraftment and no patient presented primary or secondary graft failure. In UF samples, the probability of achieving stable complete donor chimerism (CDC) in PB within the first 6 months was 70% on day +30, 85% on day +100 and 95% on day +180. CDC in granulocytes was observed in nearly all cases from day +30 onwards. CDC in T cells, however, differed among melphalan and busulphan recipients during the first 3 months (100 vs 0% on day +30 and 93 vs 20% on day +90, respectively). In multivariate analysis, the only significant variable associated with the achievement of early CDC was having received more than two lines of chemotherapy pretransplant (P<0.02). No correlation was found between the rate of achieving early CDC and the occurrence of acute graft-versus-host disease (GVHD) or disease progression post-transplant. In multivariate analysis, the only variable that influenced the incidence of disease progression post-transplant was the development of chronic extensive GVHD (P<0.05). In conclusion, a state of CDC is readily obtained within the first 6 months after our RIC protocols. Donor myeloid engraftment occurs rapidly in all cases, while early T-cell CDC is more common in more immunosuppressed hosts and, perhaps, in melphalan recipients.

The importance of educational and psychological factors in Parkinson's disease quality of life

OBJECTIVE

To define the factors correlated with quality of life (QoL) in patients with idiopathic Parkinson's disease (PD).

BACKGROUND

PD has a substantial impact on QoL. Although several clinical factors have been associated with QoL in PD, the influence of patient's education still remains controversial.

METHODOLOGY

A consecutive series of patients with PD were examined using the unified Parkinson's Disease Rating Scale (UPDRS part I, II, III), Schwab and England (SE), and Hoehn and Yahr stage (H&Y). QoL was rated with the PDQ-39, cognition with the Mini-Mental State examination (MMSE), and the presence of depressive symptoms with the geriatric depression scale (GDS). Patient's characteristics, estimated cumulative levodopa dose (CLD), UPDRS, H&Y, MMSE and GDS were correlated with the PDQ-39 using univariate and multiple regression analysis.

RESULTS

A total of one hundred 58 patients (68 men, 90 women) with a mean age of 65.6 +/- 9.3 years, PD duration of 8.1 +/- 10.6 years, and education of 6.6 +/- 3.9 years were included. The mean PDQ-39 was 48.8 +/- 27.8, mean MMSE was 25.7 +/- 4, and mean GDS was 11.7 +/- 6.8. Using stepwise multiple regression analysis, the most important predictive factors were depression, UPDRS part I, UPDRS part II, and educational background, which accounted for a 61% of the variability of the PDQ-39 scores.

CONCLUSIONS

In our PD sample, educational, behavioural, and psychological factors influenced life satisfaction more than physical ones.

Determinants of cervical cancer screening in a poor area: results of a population-based survey in Rivas, Nicaragua

OBJECTIVE

To obtain baseline information for designing a community-based intervention programme aimed at increasing the cervical cancer screening coverage of women most at risk.

METHODS

A population-based survey, using proportional stratified two-stage cluster sampling in Rivas, one of the 16 Departments of Nicaragua. The individuals selected were interviewed at home by one of 26 interviewers, using a structured questionnaire. The questionnaire was designed to elicit (1) knowledge, attitudes and practices concerning sexual and reproductive health and behaviour, (2) risk factors for cervical cancer and (3) the use of health and cervical cancer screening services.

RESULTS

A total of 612 men and 634 women participated in the survey. Of the women who had been sexually active at least 3 years, only 41.1% had undergone screening within that period and were considered adequately screened. Correlates of inadequate screening status included low educational level, exclusive use of public health facilities and lack of knowledge about prevention and symptoms of cervical cancer. Negligence, absence of medical problems, fear, lack of knowledge and economic reasons were the main reasons given for not being screened. Reluctance to be screened in the future was related to lack of knowledge of the disease, inadequate screening status, older age and low educational level.

CONCLUSIONS

The current screening programme is not effective in reaching the majority of the population. Complementary activities such as education and information, as well as a more pro-active approach to invite women for screening are necessary.