Phylogenetic analysis of bluetongue virus genome segment 6 (encoding VP5) from different serotypes

Full-length cDNAs were sequenced for genome segment 6 from representative isolates of all 24 bluetongue virus (BTV) serotypes. Segment 6 is 1635 to 1645 nucleotides in length with a single open reading frame in all isolates. The deduced VP5 protein sequence is 526 amino acids long for most BTVs, except BTV-15 (isolate number RSArrrr/15), which is 527 amino acids long, and BTV-12 (isolate number RSArrrr/12) and BTV-22 (isolate number Nig1982/11), which were 529 amino acids long. Sequence comparisons have revealed the level of genetic diversity in segment 6, between different BTV serotypes and between isolates within a single serotype. The resulting sequences can be used to design RT-PCR primers for amplification and identification of segment 6 from new BTV isolates, providing potentially valuable diagnostic and research tools. These data are available on the international databases and accession numbers are listed on the website of the Institute for Animal Health (iah.bbsrc.ac.uk/dsRNA_virus_proteins/ btv_sequences.htm).

Molecular epidemiology of bluetongue viruses from disease outbreaks in the Mediterranean Basin

Bluetongue virus (BTV) serotype is primarily controlled by the variable outer coat protein VP2, encoded by genome segment 2. Phylogenetic analyses of segment 2 show that recent Mediterranean isolates of BTV-2 have a similar genetic lineage to those from sub-Saharan Africa and North America but are distinct from Asian strains. In contrast, isolates of BTV-9, from the eastern Mediterranean, are related to a genetic lineage from Asia. BTV-1 from Greece 2001 is also more closely related to Indian isolates, suggesting (in both cases) virus movement from east to west. Recent BTV-4 field isolates from Greece and Turkey are similar to each other, but differ from the Turkish type 4 vaccine strain. These sequencing studies are being used to establish a database for molecular epidemiological studies which is available on the website of the Institute for Animal Health. This resource will support and improve BTV serotype identification methods, by using sequence comparisons (via the Web) rather than by conventional serological techniques that require standardised (and therefore expensive) serological reagents. Phylogenetic trees for BTV genome segment 2 are available on the website.

Pediatric tracheostomy: a 13-year experience

Pediatric tracheostomy has been reported to be a surgical procedure with significant morbidity and mortality. The use of tracheostomy in airway management has changed over time as regards indication and outcome. A review of the last 13 years' experience in our institution was carried out to focus on this group of patients and the recent trends in airway management. A retrospective analysis of hospital records was done and information collected with respect to age, gender, indication for tracheostomy, duration, complications, and follow-up. Thirty-nine tracheotomies were done in 36 patients, of whom males outnumbered females 2:1. The mean patient age was 41.6 months while nearly a third were newborns. The indications were congenital and acquired obstructive lesions. Apart from nine cases, all have been treated and decannulated. Follow-up ranged from 1 month to 8 years, and decannulation time from 48 h to 45 months. Home tracheostomy care was very well managed by the parents. One tracheostomy-related death was encountered. Complications were minor and transient and occurred post-decannulation in our series, in contrast to the major complications, both acute and chronic, reported in the literature. More neonates and infants are undergoing tracheostomy and surviving. Pediatric tracheostomy is a safe procedure with home care by parents feasible.

An improved urine collection pad method: a randomised clinical trial

AIM

To evaluate a modified urine collection pad (UCP) method for its ability to reduce heavy mixed growth bacterial contamination of UCP samples in young children with suspected urinary tract infection (UTI).

METHOD

Febrile children under 2 years of age were randomised to two UCP METHODS: the same UCP kept in the nappy until urine was passed (single UCP group), or the UCP replaced with a fresh one every 30 minutes until urine was passed (replaced UCP group). In both groups a moisture sensitive audio alarm was used to signal passage of urine.

RESULTS

Eighty children were enrolled and a satisfactory sample was obtained in 68 (37 in the single UCP group and 31 in the replaced UCP group). In 12 children (15%), collection failed, mainly because of faecal soiling of the pad. UTI occurred in three children (4%). In the remaining 65 samples, heavy mixed growth (> 10(5) organisms/ml) occurred in 1/31 (3%) in the replaced UCP group compared with 10/35 (29%) in the single UCP group (p = 0.008). There were no adverse effects from the use of the moisture sensitive audio alarm.

CONCLUSION

Changing the UCP every 30 minutes almost eliminates heavy mixed growth contamination of UCP samples and substantially increases the proportion of UCP results that confidently exclude UTI. This represents a simple and clinically important improvement to the UCP method which is reliable for diagnosing and excluding UTI in young children still in nappies. It has potential for use in outpatient clinics, in the primary healthcare setting, or at home.

Large scale association analysis for identification of genes underlying premature coronary heart disease: cumulative perspective from analysis of 111 candidate genes

BACKGROUND

to date, only three groups have reported data from large scale genetic association studies of coronary heart disease using a case control design.

METHODS AND RESULTS

to extend our initial report of 62 genes, we present data for 210 polymorphisms in 111 candidate genes genotyped in 352 white subjects with familial, premature coronary heart disease (onset age for men, 45; for women, 50) and a random sample of 418 population based whites. Multivariate logistic regression analysis was used to compare the distributions of genotypes between cases and the comparison group while controlling for age, sex, body mass, diabetes, and hypertension. Significant associations were found with polymorphisms in thrombospondin-4 (THBS4), thrombospondin-2 (THBS2) and plasminogen activator inhibitor-2 (PAI2), the strongest being with the A387P variant in THBS4 (p = 0.002). The THBS2 and THBS4 associations have since been replicated. We evaluated polymorphisms in 40 genes previously associated with coronary heart disease and found significant (p<0.05) associations with 10: ACE, APOE, F7, FGB, GP1BA, IL1RN, LRP1, MTHFR, SELP, and THPO. For five of these genes, the polymorphism associated in our study was different from that previously reported, suggesting linkage disequilibrium as an explanation for failure to replicate associations consistently across studies. We found strong linkage disequilibrium between polymorphisms within and between genes, especially on chromosome 1q22-q25, a region containing several candidate genes.

CONCLUSIONS

despite known caveats of genetic association studies, they can be an effective means of hypothesis generation and complement classic linkage studies for understanding the genetic basis of coronary heart disease.

Intra-Oral Acid Production Associated with Eating Whole or Pulped Raw Fruits

The hypotheses that raw fruits, whether whole or pulped, were cleared rapidly from the mouth and that the sugars in the whole and pulped fruits are fermented with equal efficiency to acids by the oral microflora were tested in this study. Groups of 7-9 adult subjects chewed 10 g of raw, whole or pulped fruit (apple, banana, orange, pear and pineapple) for 1 min and whole, unstimulated saliva samples were collected during the following 60-min interval. Each saliva sample was assayed for the concentrations of fruit-derived sugars (glucose, fructose and sucrose), fruit-derived acids (malic and citric) and acids which may be produced as a result of bacterial fermentation (acetic, lactic, formic and succinic). We found the fruit-derived sugars were rapidly cleared from the mouth (within 5 min). The major bacterially produced acids were lactic and succinic, which reached maximum concentrations in the 5-min sample. There was no significant difference, within a fruit, in the salivary levels of any of the sugars or acids between the raw whole or raw pulped forms. In light of these findings it seems unwise to assume that fruits may be consumed without consideration of their acidogenic potential.

Cardiac involvement in Wilson's disease--an electrocardiographic observation

BACKGROUND

Wilson's disease is known for its protean manifestations; however electrocardiographic abnormalities have not received much attention.

AIM

To evaluate the various electrocardiographic (ECG) changes in patients with Wilson's disease.

METHOD

The resting ECGs of 50 patients with Wilson's disease were systematically analyzed independently by three observers after excluding other causes that could induce ECG abnormalities.

RESULT

Fifteen patients had at least one abnormality in the ECG. Sinus tachycardia was seen in eight and sinus bradycardia in six. Other abnormalities included: bifid P wave (1), ST elevation (2), ST depression (2), T inversion (4), ventricular premature contraction - VPC (1) and prominent U waves (1). QRS axis, PR interval, QRS complex, R/S amplitude ratio and QT interval were normal in all. Ventricular premature beats were not recorded in any. None had features of ventricular hypertrophy. There was no statistically significant difference in ECG abnormalities with reference to age, gender, duration of illness or treatment, serum copper or ceruloplasmin, and severity of neurological impairment.

CONCLUSION

ECG abnormalities are not uncommon in Wilson's disease and are presumably related to an underlying cardiomyopathy due to deposition of copper in heart.

Liver metastasis in renal chondrosarcoma

A 39-year-old woman who had a left radical nephrectomy for a renal chondrosarcoma presented 18 years later with a large epigastric mass and deep jaundice. The patient was very dyspnoeic and had a feeling of continuous pressure on her chest. Computed tomography arterioportography of the abdomen showed that the mass involved both lobes of the liver. Multiple non-anatomical resections of tumour masses were performed, including a mass arising from the falciform ligament, left lateral segment, and segments VII and VIII. The largest resected mass weighed 2.5kg and had a diameter of 15cm. Histopathology of the hepatic metastasis was similar to the original renal chondrosarcoma. The patient was followed up for 24 months postoperatively and had symptomatic relief. Our case demonstrates the slow-growing nature of this tumour and the usefulness of palliative surgery despite large tumour load.

Myxopapillary ependymoma of the temporal lobe--report of a rare case of temporal lobe epilepsy

Myxopapillary ependymomas are a benign variant of ependymomas, occurring almost exclusively in the cauda equina region. We report an extremely rare case of myxopapillary ependymoma located in the left anterior temporal lobe. A 22-year-old man is presented with intractable seizures of 2 years duration with no focal neurologic deficits. Imaging of the brain revealed a well-circumscribed heterogeneous mass in the left anterior temporal pole with no connection to the ventricles. Imaging of the spine was normal. The patient underwent surgical removal of the tumor and at follow-up 4 months after surgery, there was improvement in his memory and speech along with complete cessation of seizures. Microscopic examination revealed the tumor to be a myxopapillary ependymoma, further confirmed by histochemical and immunohistochemical stains. To the best of our knowledge, this is the first documentation of myxopapillary ependymoma at this location and consequently, the first case to clinically present as intractable temporal lobe epilepsy.

Paradoxical cerebral embolisation

Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty.

Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n=20) or knee (n=21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis.

Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.

Paradoxical cerebral embolisation. An explanation for fat embolism syndrome

Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n = 20) or knee (n = 21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.

Cost of Illness Associated with Metastatic Breast Cancer

This study assesses cost of illness of metastatic breast cancer (MBC) patients over a specific period of time as observed in Medicare program expenditure data. Incident cases of MBC from 1997 to 1999 were included. Direct care cost data were obtained from Medicare claims from a 5% national sample of program beneficiaries. Costs to the health care system were determined from the date of first diagnosis of MBC to the end of follow-up. A matched case-control study provided comparison of Medicare payments in cancer and non-cancer patients. A total of 397 MBC patients were identified and followed for an average of 16.2 months. The mean total cost was US$ 35,164 per MBC patient and US$ 4176 per person for the control group. Over the follow-up period, the MBC patients averaged 1.7 inpatient admissions per patient and 14.4 inpatient days per admission. The control group averaged 0.3 inpatient admissions per patient and 1.6 inpatient days per admission. Home health aide for MBC averaged one visit every 2 weeks. The direct costs for the older MBC patients were less than the direct costs of the younger MBC group. Multivariate regression analysis showed that as the age increased, the Medicare costs decreased within the MBC cohorts. Less combination treatments were provided for older MBC patients. Cost of illness was inversely proportional to age.

Immunoreactivity to MIB-1 in breast cancer: methodological assessment and comparison with other proliferation indices

The recent availability of the monoclonal antibody MIB-1 (which is able to detect the human nuclear cell proliferation-associated antigen Ki-67 even on formalin-fixed, paraffin-embedded sections, microwave-treated and routinely processed for immunohistochemistry) could open new avenues for validation of the clinical role of tumour cell proliferation on large, consecutive and unselected series of human tumours. However, the routine use of such a marker requires a methodological standardization as well as the comparative assessment of some technical and biological aspects. The MIB-1 index was determined in parallel samples from 50 consecutive invasive breast carcinomas processed with different fixatives for different times. The median values of MIB-1 indices following 2, 6 and 24 h of formalin fixation were similar (29.4%, 30.6% and 29.7%, respectively) and consistent with those reported in the literature; squared linear regression coefficients were 0.99. The median values of MIB-1 indices were markedly lower in Bouin-fixed, paraffin embedded, and in frozen samples (20.0% and 19.8%, respectively), with a poor correlation coefficient with the values detected following formalin fixation (R2 = 0.456). Moderate and poor correlations were observed between Ki-67 index and MIB-1 detected on frozen (rs, 0.78) or formalin-fixed, paraffin-embedded samples (rs, 0.47) and a minimal concordance was observed between TLI and MIB-1 or Ki-67 (rs, 0.25 and 0.22, respectively). Our results indicate interference of the fixative type on immunoreactivity to MIB-1 and also suggest that Ki-67 and MIB-1 reacted with different epitopes of the same antigen.

First-trimester uterine artery blood flow and birth weight

OBJECTIVES

To determine reference values for first-trimester uterine artery resistance index (RI) in healthy pregnant women with uncomplicated pregnancies and to investigate the relationship between uterine artery Doppler indices and birth weight.

METHODS

This was a cross-sectional study of 265 consecutive pregnant women attending routine ultrasound examination at 11-14 weeks' gestation. Both uterine arteries were identified using color Doppler ultrasound and the RI was measured. The presence or absence of an early diastolic notch was also noted. Pregnancy outcomes were obtained from the delivery suite database and birth weight was expressed as Z-scores.

RESULTS

The 5(th), 50(th) and 95(th) centiles for uterine artery RI between 11 and 14 weeks' gestation were 0.53, 0.71 and 0.85, respectively. Complete pregnancy outcome data were available for 246 fetuses. There was a significant negative correlation between birth-weight Z-scores and first-trimester uterine artery mean RI (r = - 0.219, P = 0.001). The difference in birth weight between fetuses with absent and those with bilateral diastolic notches was also significant (P < 0.001). Multiple regression analysis demonstrated that both mean RI (standardized regression coefficient = - 0.14, P = 0.039) and uterine artery notching (standardized regression coefficient = - 0.17, P = 0.017) contributed independently towards the prediction of birth-weight Z-score.

CONCLUSIONS

A significant negative correlation exists between birth weight and first-trimester uterine artery Doppler parameters, a reliable and non-invasive method of examining uteroplacental perfusion. The value of first-trimester uterine artery Doppler as a prognostic screening tool, either in isolation or in conjunction with maternal biochemistry, remains to be determined.

Bloody diarrhea caused by a needle in the pancreatic head

Bloody diarrhea in adolescents is not uncommon polyposis, inflammatory bowel disease, and infections are the usual causes. A 13-year-old boy with a metallic foreign body in the head of the pancreas presented with bloody diarrhea. The clinical problems and surgical approach are discussed.

PathMiner: predicting metabolic pathways by heuristic search

MOTIVATION

Automated methods for biochemical pathway inference are becoming increasingly important for understanding biological processes in living and synthetic systems. With the availability of data on complete genomes and increasing information about enzyme-catalyzed biochemistry it is becoming feasible to approach this problem computationally. In this paper we present PathMiner, a system for automatic metabolic pathway inference. PathMiner predicts metabolic routes by reasoning over transformations using chemical and biological information.

RESULTS

We build a biochemical state-space using data from known enzyme-catalyzed transformations in Ligand, including, 2917 unique transformations between 3890 different compounds. To predict metabolic pathways we explore this state-space by developing an informed search algorithm. For this purpose we develop a chemically motivated heuristic to guide the search. Since the algorithm does not depend on predefined pathways, it can efficiently identify plausible routes using known biochemical transformations.