Comparative in vitro activities of carbapenem L-749,345 and other antimicrobials against multiresistant gram-negative clinical pathogens

Carbapenems L-749,345 and imipenem had the lowest MICs at which 90% of isolates were inhibited (0.5 microg/ml) of 14 antimicrobial agents tested against 76 multiresistant gram-negative clinical isolates with TEM- or SHV-type extended-spectrum beta-lactamases and chromosomal or plasmid-determined AmpC beta-lactamases, but the MIC of L-749,345 for one isolate of Klebsiella pneumoniae was 16 microg/ml.

Alternative splicing of the high affinity cAMP-specific phosphodiesterase (PDE7A) mRNA in human skeletal muscle and heart

To further our understanding of the structure and function of phosphodiesterases of the newly identified family of high affinity cAMP-specific phosphodiesterases (PDE7), we identified and characterized the isozyme expressed in human skeletal muscle and the protein product of the previously isolated isozyme HCP1 (designated HSPDE7A1). We report the isolation of a cDNA encoding the full-length skeletal muscle isoform of human PDE7A (HSPDE7A2). The DNA sequence of this skeletal muscle cDNA indicates that PDE7A2 is a novel 5' splice variant of PDE7A encoding an isoform with a novel, hydrophobic N terminus. The 456-amino acid PDE7A2 protein is detected on Western blots as a band with an apparent mobility of 50 kDa. PDE7A2 is a high affinity cAMP-specific PDE (Km = 0.1 microM), which is localized to particulate cellular fractions. The PDE7A1 (HCP1) isozyme is detected on Western blots as a band with an apparent mobility of 57 kDa, demonstrating that the previously isolated HCP1 cDNA encodes the full-length PDE7A1 protein. The even distribution of PDE7A mRNA among fetal tissues and the relative abundance of its two mRNAs strongly suggest that the expression of PDE7A is regulated throughout development.

Cellular expression of adhesion factors in childhood rhabdomyosarcoma

Tumor invasion and metastasis are believed to involve the adhesive interaction of tumor cells with extracellular matrix (ECM). This study reports the expression of laminin, fibronectin, thrombospondin, tenascin, and CD44 in rhabdomyosarcoma cells taken from tumors derived from 12 pediatric patients. Twelve paraffin-embedded rhabdomyosarcomas consisting of five alveolar, six embryonal, and one botryoid subtype were examined. All tumors demonstrated positive staining for tenascin and thrombospondin, 10 were positive for fibronectin, 5 positive for laminin, and 4 positive for CD44. Both specimens without cellular staining for fibronectin were of embryonal subtype and no alveolar rhabdomyosarcomas were positive for CD44. No association of the expression of the studied ECM proteins and receptor with the presence of metastatic disease at clinical presentation or with the level of tumor differentiation was found.

Clinical significance of the immunohistochemical detection of p53 protein in endoscopic biopsy specimens

OBJECTIVE

To evaluate the utility of immunohistochemical staining of p53 expression in endoscopic biopsy specimens in clinical practice.

METHODS

Using a streptavidin-peroxidase (S-P) conjugate method with monoclonal p53 antibody Do-7, the expression of p53 was investigated immunohistochemically in 150 endoscopic biopsies and paired brushings from patients with benign and malignant gastric diseases. Among them, 22 cases with gastric carcinoma underwent the gastrectomy and the immunohistochemistry was repeated in the resected cancerous tissues of the same patient.

RESULTS

p53 expression in endoscopic specimens was detectable in 35.7% cases of gastric carcinoma (n = 70), 5.9% of gastric polyps (n = 17), 16.7% of gastric mucosal dysplasia (n = 18) and 4.0% of chronic atrophic gastritis (n = 25), but no protein expression was observed in cases of chronic active gastritis (n = 20). In 22 patients with tumor resection, 8 (36.4%) were identified with p53 expression in endoscopic specimens before surgery, while 10 (45.5%) were identified with the same expression in surgical specimens, the real positive rate was 80.0%, no false positives were observed in endoscopic specimens. Furthermore, p53 expression in gastric carcinoma was closely correlated with clinical stage and lymph nodes involvement, but did not correlate with histologic type.

CONCLUSIONS

Assay of p53 by immunohistochemistry in endoscopic biopsy specimens and brushings is an easy and reliable technique to assess p53 status in gastric carcinoma, and thus could serve as a marker to foresee the prognosis in these patients and assist in the diagnosis of malignancy before surgery. It may also be a valuable marker in screening patients with high risk of gastric carcinoma.

Response of the erythron and erythropoietin to autologous blood donations in paediatric subjects. Is erythropoietin supplement necessary?

OBJECTIVES

This study was undertaken to evaluate the need for erythropoietin (Epo) therapy to augment autologous blood collection in adolescents undergoing spinal corrective surgery.

METHODS

We measured serum Epo and parameters of iron metabolism in 35 adolescents undergoing autologous blood collection for orthopaedic surgery. Ages of subjects ranged from 11 to 16 years (mean 15.5 years) with a female predominance. Generally, 10% of intravascular blood volume was collected once a week up to a total of three collections.

RESULTS

There was an average 2.5-fold rise in serum Epo over the period of blood collection. Epo increased immediately after blood collection. There was a 1.4-fold rise in reticulocyte count, consistent with the Epo response, and an average of 1.5 units of red blood cells (200 ml/unit) being produced over this period. Despite this there was an average fall of 2 g/dl (15%) in haemoglobin level. Serum ferritin and transferrin saturation also fell.

CONCLUSIONS

Paediatric subjects are able to donate the required units of blood as they have a good Epo response to mild anaemia. The amount of blood donated did not exceed their total mobilisable iron and the iron supplement was adequate for red cell synthesis.

Successful treatment of a primary cardiac leiomyosarcoma with ifosfamide and etoposide

PURPOSE

Primary cardiac leiomyosarcoma is a rare malignant tumor in childhood. Patients with unresectable or partially resected cardiac leiomyosarcoma typically have a poor prognosis. The role of chemotherapy in the treatment of these patients has not been well defined.

PATIENT AND METHODS

A 6-week-old infant with an incompletely resected cardiac leiomyosarcoma was treated postoperatively with ifosfamide and etoposide.

RESULTS

The patient is disease-free and without apparent late effects 5 years following the completion of therapy.

CONCLUSION

The combination of ifosfamide and etoposide warrants further evaluation in patients with leiomyosarcoma.

Detection of extended-spectrum beta-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli

Forty clinical isolates of Escherichia coli and 141 isolates of Klebsiella pneumoniae that either transferred ceftazidime resistance or showed sulbactam enhancement of oxyimino-beta-lactam susceptibility were tested by disk diffusion methodology for susceptibility to aztreonam, cefotaxime, ceftazidime, and cefoxitin. With standard 30 micrograms antibiotic disks, the fraction of these extended-spectrum beta-lactamase (ESBL)-producing isolates testing resistant by National Committee for Clinical Laboratory Standards criteria was lowest (24%) with cefotaxime disks. Forty percent of the E. coli and 29% of the K. pneumoniae isolates appeared susceptible with at least one oxyimino-beta-lactam disk. Ceftazidime and aztreonam disks were equivalent in differentiating ESBL production, and both were superior to cefotaxime disks. Over half the E. Coli and 29% of the K. pneumoniae isolates tested cefoxitin resistant. In 30 isolates, cefoxitin resistance was transmissible and due to a plasmid-mediated AmpC-type beta-lactamase. With a 5-micrograms ceftazidime disk, a breakpoint could be chosen with high sensitivity and specificity for ESBL-producing organisms. Present disk diffusion criteria underestimate the prevalence of ESBL-producing strains.

The role of haemopoietic growth factors in the pathogenesis of the early anaemia of premature infants

The anaemia of prematurity has been attributed to an insufficient erythropoietin (Epo) level. However, haemopoiesis is known to be regulated by a cohort of growth factors including interleukin-3 (IL-3), IL-6, stem cell factor (SCF), granulocyte monocyte-colony stimulating factor (GM-CSF) and insulin-like growth factors-I and -II (IGF-1, IGF-II). Circulating levels of these growth factors were measured in cord blood at the following gestational ages: 25-28 weeks, 29-32 weeks, 33-36 weeks and > 37 weeks. This study indicates that low concentrations of IGFs as well as a low Epo level in early gestational ages may play a role in anaemia of prematurity.

[A study on the relationship between human papillomavirus and the incidence of cervical carcinoma]

OBJECTIVE

To determine the relationship between the infection by human papillomavirus (HPV) and the incidence of cervical carcinoma.

METHODS

Biopsy and paraffin wax embedded specimens (n = 99) from various cervical lesions in the department of gynecologic oncology were analysed by polymerase chain reaction (PCR) technique with multiple primers of HPV types 6b/11, 16 and 18.

RESULTS

Of 99 cervical specimens investigated, 20 were histopathologically diagnosed as cervical condyloma, 18 as cervical intraepithelial neoplasia (CIN) grade 1 approximately 2 (CIN1 approximately 2), 20 as CIN grade 3 (CIN3), 23 as cervical cancer and 18 as normal controls. Detection for HPV revealed that the positive rates of the five different groups were 85.0%, 83.3%, 80.0%, 87.0% and 27.8%, respectively. Those of the cervical lesions were significantly higher than that of the normal controls (P < 0.01). The predominant HPV type in condyloma and CIN1 approximately 2 group were HPV 6b/11 (positive rates 85.0% and 72.3%), while HPV 16 and (or) 18 DNA were more frequently found in the the CIN3 group (50.0%) and in the cervical cancer group (73.9%), The difference of distribution of HPV types in cervical condyloma, CIN1 approximately 2 and in CIN3, and cervical carcinoma was statistically significant (P < 0.01).

CONCLUSION

HPV infections are intimately linked to condyloma, CIN and carcinoma of the uterine cervix; the low-risk types HPV 6 and 11 seem to be associated with cervical condyloma and the low grade CIN; the high-risk types 16 and 18 are closely related to high grade CIN and cervical carcinoma.

Role of talectomy in the treatment of rigid talipes equinovarus deformities

The authors provide a review of the principles of talectomy as a surgical treatment option for severe, rigid, and resistant clubfoot deformities. Such deformities are associated with a high recurrence rate and frequently involve a large number of surgical interventions to attain a satisfactory result. Talectomy has been successfully used as both a primary and salvage procedure to treat such deformities, often eliminating the need for subsequent surgeries. A discussion of the operative technique, indications, advantages, and common complications associated with the procedure is presented. In addition, a case report of talectomy used to treat a severe, bilateral clubfoot deformity in a 4-year-old boy is included.

Phenotypic analysis of functional T-lymphocyte subtypes and natural killer cells in human cord blood: relevance to umbilical cord blood transplantation

Cord blood has been used successfully for stem cell transplantation in several haematological conditions: Fanconi's anaemia, leukaemia and Wiskott-Aldrich syndrome. On account of the low incidence of GVHD observed following cord blood transplantation, it has been suggested that cord blood be used for HLA-matched, or perhaps one or two antigens mismatched, and unrelated stem cell transplantation. Based on an extensive immunophenotype-functional correlation, we determined that cord blood contains mainly immature unprimed T lymphocytes that are predominantly suppressor cells. Recent findings suggest that dysregulated production of cytokines (IL-1, IL-2, TNF alpha) plays a role in GVHD. We showed that T cells in cord blood express receptors for IL-2, TNF alpha, but no receptors for IL-1. Similarly, NK cells, one of the effector cells of GVHD, express receptors for TNF alpha and gamma IFN but do not express receptors for IL-1, nor IL-2R alpha-chain (CD25) although IL-2R beta-chain is expressed. The potential for activation of T lymphocytes and NK cells therefore exists in the context of bone marrow transplantation. However, the high number of suppressor cells in cord blood most likely modulate the activation of lymphocytes and NK cells thereby minimizing GVHD.

[Long-term follow-up of patients with benign epilepsy of childhood with centro-temporal electroencephalography foci]

In 65 cases of benign epilepsy of childhood with controtemporal EEG, 15 were followed-up for 5-7 years, 27 were 8-9 years and 23 were 10-14 years. Last seizure happened 4-14 years ago. Their present age ranged from 14 to 23 years. The disease was not related to sex but negatively correlated to age when first seizure occurred. When reexamined by EEG, abnormal discharges varied in some cases. The relation between the type of EEG and course of disease was not confirmed. The age of most patients at last seizure was under 14 years.

Modification of catalytic properties of chicken liver fructose 1,6-bisphosphatase by allicin

The activity of chicken liver fructose 1,6-bisphosphatase increases dramatically after incubation with allicin, a major biologically active compound produced by garlic. Activation is more pronounced when the enzyme is assayed with Mn2+ than Mg2+. Maximum activation is accompanied by the disappearance of 4 highly reactive sulfhydryl groups per molecule of enzyme. This modification also leads to loss of activation by K+, and reduced sensitivity to inhibition by AMP, fructose 2,6-bisphosphate, and high concentration of fructose 1,6-bisphosphate. All the altered properties induced by allicin can be reversed by dithiothreitol or tris(2-carboxyethyl)phosphine, the latter being much more effective.

Serum ferritin measurement and the degree of agreement using four techniques

Four commercial assay kits to measure serum ferritin were compared to establish the degree of agreement and interchangeability between the different techniques based on the intraclass correlation coefficient (ri). Radioimmunoassay, microparticle enzyme immunoassay, enzyme-linked immunosorbent assay, and chemiluminescent immunoassay systems were used. The Pearson product-moment correlation factor (r) between any two methods was at least 0.98, and the intercept of the regression equations ranged from -0.613 to 3.797, indicating that the methods were comparable. Furthermore, the intraclass correlation coefficient (ri) was at least 0.98, suggesting that the methods were interchangeable.

Mechanism of action of the papillomavirus E2 repressor: repression in the absence of DNA binding

Repression of papillomavirus E2-dependent gene expression was studied by using transient transfections into mouse embryo fibroblast cells. Cotransfection of a gene corresponding to the naturally occurring repressor E2-TR along with the full-length E2 gene resulted in up to 98% repression of E2-dependent reporter gene expression. A series of E2 DNA-binding domain mutants were transferred into the E2-TR form and characterized for their ability to repress E2-dependent transactivation. All mutants which were defective for DNA binding but were dimerization competent repressed E2 transactivation as well or nearly as well as the wild-type repressor. E2 mutants which lacked dimerization activity repressed transactivation poorly or not at all. These results indicate that the E2 repressor can inhibit transcription, in the absence of DNA binding, by forming heterodimers with full-length E2.

Thrombospondin and other possible related matrix proteins in malignant and benign breast disease. An immunohistochemical study

Thrombospondin (TSP), which plays an important hemostatic role, is a 450-kd cytoadhesive protein present in the alpha granules of platelets. In vitro experiments using cultured malignant cells suggest that it may help to mediate malignant cell attachment to extracellular matrix and may be important in cancer invasiveness. The authors studied a group of malignant and benign breast tissues for the expression of TSP and provide evidence that TSP may have a role in tumor invasiveness. Using immunohistochemical techniques, the authors found in 48 fresh specimens of breast carcinoma that TSP stained strongly in the desmoplastic stroma or at the basement membrane associated with the malignant ductal epithelium. Tumor cells abutting these tissues revealed cytoplasmic staining for TSP. Stronger TSP staining was seen in the poorly differentiated tumors. These findings were compared with those of normal and benign breast tissue, which showed no TSP staining apart from reactivity in the large distended cysts of fibrocystic disease and faint staining in the stroma of fibroadenomas. Staining for integrin was positive in lymphocytes of both malignant and benign breast disease and equivocally also in the stromal cells of the breast cancer tissue. Immunoreactivity to TSP in tissues was also compared with that of fibronectin, laminin, and collagen type I, III, and IV. The overall findings suggest that thrombospondin may have a role in the tumor biology of invasiveness.

Tissue expansion as an alternative to skin grafting for closure of skin deficits

Recent advances in the technical aspects of tissue expanders for closure of skin deficits have led to an overall reduction in the high rate of complications typically associated with their usage. The authors provide a review of the recent refinements in the technique of the tissue expansion process. A discussion of current and future applications using this technique in the treatment of various lower extremity pathologies, including clubfoot, is presented. A case report on the use of a subcutaneous tissue expander for the treatment of a failed skin graft of the medial ankle is included.