Nosocomial Infections Decade-Specific Risk

Although the elderly are thought to be at increased risk for acquiring nosocomial infections (NIs), the degree of risk has not been carefully quantified. We determined the decade-specific risks of NIs. The rate was constant at approximately 10 per 1,000 discharged patients from birth to 40 to 49 years. Thereafter the rate rose logarithmically and peaked at greater than 100 per 1,000 discharges after 70 years. Of all NIs, 64% occurred after 60 years of age. Yet, this elderly group made up only 23% of hospitalized patients. In conclusion, while the elderly comprise a small fraction of hospitalized patients, they account for the majority of nosocomial infections.

Abstract 5532: Discovery of A-366, a novel small molecule inhibitor that uncovers an unappreciated role for G9a/GLP in the epigenetics of leukemia

Understanding the roles of epigenetic alterations in cancer development and maintenance holds great promise for cancer prevention, detection, and therapy. Cancer can be considered as a pathogenic state where cellular differentiation is suppressed (i.e. stem cell-like) and aberrant epigenetic patterning is commonly observed in tumors. Histone methyltransferases play a key role in epigenetics by modifying key lysine and arginine residues on histones and thereby influencing biological processes. Previous studies have suggested that the histone lysine methyltransferase G9a (EHMT2) is required to perpetuate malignant phenotypes through over-expression in a variety of cancer types. These reports have shown that pharmacologic inhibition or genetic ablation of G9a leads to retardation of tumor cell growth and cellular invasion in vitro as well as inhibition of metastasis in vivo. To further elucidate the enzymatic role of G9a in cancer, we describe herein the discovery of a novel histone methyltransferase inhibitor, A-366, that selectively inhibits G9a and the closely related GLP (EHMT1). A-366 is a peptide competitive inhibitor of G9a/GLP with in vitro enzymatic IC50 of ∼ 3 nM and cellular activity of ∼ 100 nM and > 100-fold selectivity over other methyltransferases and other non-epigenetic targets. A-366 has significantly less cytotoxic effects on the growth of solid tumor cell lines compared to other known G9a/GLP small molecule inhibitors despite roughly equivalent cellular activity on methylation of H3K9me2. However, the excellent selectivity profile of A-366 has aided in the discovery of an important role for G9a/GLP in lineage maintenance of a subset of leukemias. Treatment of various leukemia cell lines in vitro resulted in marked differentiation and morphological changes of these tumors in the absence of cytotoxicity resulting in cytostasis. Furthermore, treament of MV4;11 flank xenografts with A-366 resulted in growth inhibition in vivo consistent with the profile of H3K9me2 reduction observed. In summary, A-366 is a novel and highly selective peptide-competitive inhibitor of G9a/GLP that has enabled the discovery of a role for G9a/GLP enzymatic activity in the epigenetic maintenance of a subset of leukemia cells.

Citation Format: Jun Guo, Marina Pliushchev, Yupeng He, Debra Ferguson, Sujatha Jagadeeswaran, Andrew Petros, Chaohong Sun, Niru B. Soni, Bailin Shaw, Alla Korepanova, David Maag, Ramzi Sweis, Fritz G. Buchanan, Michael Michaelides, Alex Shoemaker, Chris Tse, Gary G. Chiang, William N. Pappano. Discovery of A-366, a novel small molecule inhibitor that uncovers an unappreciated role for G9a/GLP in the epigenetics of leukemia. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5532. doi:10.1158/1538-7445.AM2014-5532

Extracorporeal photopheresis for treatment of adults and children with acute GVHD: UK consensus statement and review of published literature

Extracorporeal photopheresis (ECP) has been used for over 20 years to treat acute GVHD (aGVHD) and chronic GVHD. Evidence on the efficacy of response in aGVHD has continued to accrue and data suggest that there is a good response and prolonged survival in both children and adults with grade II-IV aGVHD. Unlike chronic GVHD where treatment schedules are typically one or two times monthly for 12-18 months, patients with aGVHD respond rapidly to an intense weekly treatment schedule for 8 weeks, typically allowing steroids to be discontinued without flare-ups of aGVHD. Maintenance ECP therapy is generally not required. Many centres across Europe and United States treat aGVHD with ECP as second-line therapy and responses are excellent in a subset of patients. Unlike other second-line therapies, ECP is not immunosuppressive and has no reported drug interactions. Importantly, ECP does not have a negative impact on the graft-versus-malignancy effect of the transplant. This statement aims to select those patients most likely to respond to treatment and summarises treatment and monitoring schedules for the management of aGVHD in adult and paediatric patients to ensure the correct patients are treated with the optimal protocol for efficacy.

Efficient inscription of Bragg gratings in As2S3 fibers using near bandgap light

Efficient inscription of Fiber Bragg gratings (FBGs) in single-mode, thin cladding As(2)S(3) fibers is demonstrated by using near bandgap light at 532 nm. The FBGs with the reflectivity of over 80% can be induced in only 80-90 s, substantially faster than in previous reports. The dynamics of the grating growth are investigated in the photosensitivity process, showing a fast blue shift of the Bragg wavelength and then a somewhat slower red shift. The aging of the grating after fabrication is also reported, indicating a 37% decay of the grating strength.

16th IHIW: international histocompatibility working group in hematopoietic cell transplantation

The International Histocompatibility Working Group is a collaborative international effort to understand the HLA and non-HLA genetics of the transplantation barrier. The Working Group is comprised of experts in the fields of histocompatibility and immunogenetics, hematopoietic cell transplantation and outcomes research. Data for 25 855 unrelated donor transplants were submitted in support of research studies for the 16th International Histocompatibility Workshop. Active investigation is in progress in seven key areas: the impact of HLA matching, role of race and ethnicity, identification of permissible HLA mismatches, haplotype-associated determinants, minor histocompatibility antigens, immune response genes and KIR genetics. New hypotheses for the 16th workshop were developed for immunogenetic studies in cord blood and haploidentical-related donor transplantation.

Unrelated hematopoietic stem cell donors as research subjects

Requests for participation of unrelated stem cell donors in research transplant protocols are becoming more frequent. World Marrow Donor Association calls on donor registries to participate in research activities. Here, we discuss various implications of research participation and make some recommendations as how to make this possible.

Improving services for cleft lip and palate. A work in progress

Cleft lip and palate remains an orphan condition, falling between a variety of clinical disciplines, and often forgotten by public health consultants and health commissioners. Much remains to be done, and in the absence of leadership from clinicians or commissioners, progress may have to await the emergence of a stronger voice from organizations representing affected families.

The action of sodium salicylate and aspirin on some kallikrein systems

The effects of sodium salicylate and of aspirin on the actions of pancreatic, salivary and serum kallikreins have been investigated. Kinin production by the three enzymes was assessed using a guinea-pig isolated ileum preparation. The esterolytic activity of pancreatic and salivary kallikreins was measured by determining acid release from the synthetic substrate toluene-p-sulphonyl-L-arginine methyl ester. Sodium salicylate (up to 20 mM) or aspirin (up to 5 mM) failed to inhibit kinin production by each of the three enzymes. With salivary kallikrein, a concentration of 50 mM of sodium salicylate was required to produce a 50% inhibition of kinin production. No significant inhibition of esterolytic activity was produced by concentrations up to 5 mM of either sodium salicylate or aspirin. Prior incubation of sodium salcylate or aspirin with the enzymes also resulted in no significant effect of either drug on kinin production or esterolytic activity. Prior incubation of pancreatic or salivary kallikrein with the inhibitor from ox parotid gland (Trasylol) reduced both kinin production and esterolytic activity. Toluene-p-sulphonyl-L-arginine methyl ester (0.5 mM) inhibited kinin production by each of the three enzymes. It is concluded that sodium salicylate and aspirin are poor inhibitors of kallikrein activity in vitro.

Characterization of the active site of S. aureus monofunctional glycosyltransferase (Mtg) by site-directed mutation and structural analysis of the protein complexed with moenomycin

Bacterial cell wall transglycosylases (TGs) and transpeptidases (TPs) are ideal drug targets due to their essentiality, accessibility and lack of mammalian homologs. Although antibacterial therapy using the beta-lactam family of TP inhibitors has been successful for decades, potent TG inhibitors which are suitable for development into antibiotics for human use have yet to be identified. We sought to further understand the molecular interactions required to inhibit bacterial transglycosylation by characterizing the active site of Staphylococcus aureus (Sa) monofunctional transglycosylase (Mtg). Ten mutants were tested for their ability to polymerize Lipid II and to crystallize in the presence of moenomycin. Five of six putative active site mutants (E100Q, D101N, Q136E, E156T, and Y176F) were found to be catalytically inactive whereas a F104Y mutation did not affect activity. Four mutants generated to enhance crystal formation (F143T, V154T, L157T, and F158T) also retained activity. Here we also report the crystal structure of Sa Mtg E100Q mutant in complex with the inhibitor moenomycin to 2.1A resolution. The co-crystal structure revealed detailed interactions between the protein and inhibitor including portions of the polycarbon tail of moenomycin. The structure also contained an ordered phosphate ion which helped to identify the Lipid II binding site.

Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

BACKGROUND

Strategies to implement change in health professional performance have variable impact. A potential explanation is that the barriers to implementation are different in different settings and at different times. Change may be more likely if the strategies were specifically chosen to address the identified barriers.

OBJECTIVES

To assess the effectiveness of strategies tailored to address specific, identified barriers to change in professional performance.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register and pending files until end of December 2002. English language articles only were included.

SELECTION CRITERIA

Randomised controlled trials (RCTs) that reported objectively measured professional practice or health care outcomes in which at least one group received an intervention designed (or tailored) to address prospectively identified barriers to change.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed quality. We also contacted study authors to obtain any missing information. Quantitative and qualitative analyses were undertaken.

MAIN RESULTS

We included 15 studies. For Comparison 1 (an intervention tailored to address identified barriers to change compared to no intervention or an intervention(s) not tailored to the barriers), there was no consistency in the results and the effect sizes varied both across and within studies.A meta-regression of a subset of the included studies, using a classical approach estimated a combined OR of 2.18 (95% CI: 1.09, 4.34), p = 0.026 in favour of tailored interventions. However, when a Bayesian approach was taken, meta-regression gave a combined OR of 2.27 (95% Credible Interval: 0.92, 4.75), which was not statistically significant.

AUTHORS' CONCLUSIONS

Interventions tailored to prospectively identify barriers may improve care and patient outcomes. However, from the studies included in this review, we were unable to determine whether the barriers were valid, which were the most important barriers, whether all barriers were identified and if they had been addressed by the intervention chosen. Based on the evidence presented in this review, the effectiveness of tailored interventions remains uncertain and more rigorous trials (including process evaluations) are needed. Further research needs to address explicitly the questions of identifying and addressing barriers.

Helicobacter pylori-induced homotypic phagosome fusion in human monocytes is independent of the bacterial vacA and cag status

Following reports that a VacA+cag+ toxigenic but not a VacA-cag- non-toxigenic Helicobacter pylori strain induced homotypic phagosome fusion in murine macrophages, we addressed that phenomenon in human cells. Mononuclear phagocytes and epitheloid cells were challenged with H. pylori strains of different vacA and cag genotypes and with VacA- and Cag- isogenic mutants, and chased in the absence or presence of signal transduction modulators. Electron microscopy revealed that, in monocytes: (i) homotypic phagosome fusion was frequently induced by all live H. pylori strains investigated but not by exogenous VacA; (ii) phagosomes containing bacteria fused, but not those containing latex beads; (iii) fusion resulted in communal compartments resembling giant multivesicular bodies; and (iv) formation of these compartments was blocked by inhibiting the host cell regulators PI 3-kinase, phospholipase C and p42 MAP kinase. Whereas some internalized bacteria remained viable 1 h after uptake, none survived a 24 h period. In contrast to monocytes, infected epitheloid cells rarely developed communal compartments. In combination, these results demonstrate that, in human monocytes, the H. pylori-induced homotypic phagosome fusion depends on neither the vacuolating cytotoxin VacA nor the cag pathogenicity island of H. pylori and does not result in prolonged intracellular survival.

Ethanol-induced mitogen activated protein kinase activity mediated through protein kinase C

The aim of this study was to determine the pathway(s) by which ethanol activates mitogen-activated protein kinase (MAPK) signaling and to determine the role of Ca2+ in the signaling process. MAPK signaling was determined by assessing MAPK activity, measuring phosphorylated extracellular signaling-regulated kinase (pp 44 ERK-1 and pp 42 ERK-2) expression and ERK activity by measuring ERK-2-dependent phosphorylation of a synthetic peptide as a MAPK substrate in rat vascular smooth muscle cells. Ethanol activated extracellular signal-regulated kinase expression (ERK 1 and 2) could be observed when vascular smooth muscle cells (VSMCs) were stimulated for 5 min or less, but was inhibited when cells are treated for 10 min or more with 1-16 mM of ethanol. Maximum ethanol-induced MAPK activity was observed within 5 min with 4 or 8 mM. Ethanol stimulated MAPK activity was blocked by the protein kinase C (PKC) inhibitor (GF109203X) and epidermal growth factor (EGF) receptor antagonist (PD153035) by 41 +/- 24 and 34 +/- 12.3%, respectively. The calcium channel blocker, diltiazem and the chelating agent, BAPTA, reduced the activation of MAPK activity by ethanol, significantly. The data demonstrate that ethanol-stimulated MAPK expression is mediated partially through both the EGF-receptor and PKC intermediates and that activation through the PKC intermediate is calcium-dependent.

Pancytopenia responding to treatment of hyperthyroidism: a clinical case and review of the literature

A 46-year-old-man received high dose chemotherapy and an autologous stem-cell transplant for multiple plasmacytoma. He had a prolonged period of pancytopenia post-transplantation, which was thought to be due to a suboptimal dose of transplanted stem cells in combination with the effects of interferon therapy and an altered bone marrow microenvironment. Twenty-eight months after the transplant he was found to be hyperthyroid. Anti-thyroid therapy has led to a sustained improvement in his pancytopenia.

Biocomposites of non-crosslinked natural and synthetic polymers

Biocomposite films comprising a non-crosslinked, natural polymer (collagen) and a synthetic polymer, poly(epsilon-caprolactone) (PCL), have been produced by impregnation of lyophilised collagen mats with a solution of PCL in dichloromethane followed by solvent evaporation. This approach avoids the toxicity problems associated with chemical crosslinking. Distinct changes in film morphology, from continuous surface coating to open porous format, were achieved by variation of processing parameters such as collagen:PCL ratio and the weight of the starting lyophilised collagen mat. Collagenase digestion indicated that the collagen content of 1:4 and 1:8 collagen:PCL biocomposites was almost totally accessible for enzymatic digestion indicating a high degree of collagen exposure for interaction with other ECM proteins or cells contacting the biomaterial surface. Much reduced collagen exposure (around 50%) was measured for the 1:20 collagen:PCL materials. These findings were consistent with the SEM examination of collagen:PCL biocomposites which revealed a highly porous morphology for the 1:4 and 1:8 blends but virtually complete coverage of the collagen component by PCL in the 1:20 samples. Investigations of the attachment and spreading characteristics of human osteoblast (HOB) cells on PCL films and collagen:PCL materials respectively, indicated that HOB cells poorly recognised PCL but attachment and spreading were much improved on the biocomposites. The non-chemically crosslinked, collagen:PCL biocomposites described are expected to provide a useful addition to the range of biomaterials and matrix systems for tissue engineering.

Nitrate relationships between stream baseflow, well water, and land use in the Tomorrow-Waupaca Watershed

We examined the use of stream baseflow water quality as a representative measure of mean ground water quality in the Tomorrow-Waupaca Watershed in central Wisconsin and the relationship between agricultural land use and watershed water quality. From 1997 to 1999, 38 stream sites were sampled for nitrate during winter and summer baseflow conditions. Some sites have been sampled during winter baseflow conditions since 1994. The land area contributing ground water to each stream sampling site was delineated, resulting in 38 sub-basins. In addition, over 3500 test results from private wells in the watershed were compiled and mapped using a Geographic Information System (GIS). Nitrate concentrations in stream baseflow and well waters were found to have strong positive correlation in the sub-basins of second order or higher. This indicates that stream baseflow may be valid for monitoring mean ground water quality in watersheds predominantly fed by ground water, where much of the stream nitrate is believed to originate from ground water. Analysis of seasonal variation in the stream data showed that winter nitrate concentrations were higher than summer concentrations, implying that winter stream monitoring may be more critical for the assessment of overall ground water quality in the watershed. We also found that, as the amount of agricultural land increased in each sub-basin, average nitrate concentrations in the well and stream waters also increased, suggesting a connection between agricultural land use and nitrate contamination of water resources in the watershed.

Clinical and pathological features of posttransplant lymphoproliferative disorders: influence on survival and response to treatment

PURPOSE

To review the clinical and pathological characteristics of patients with posttransplant lymphoproliferative disorders (PTLD) occurring after solid organ transplantation and determine the influence of these characteristics on response to treatment and survival.

PATIENTS AND METHODS

Retrospective review of 32 patients.

RESULTS

Overall five-year survival was 59%. Forty-five percent of patients diagnosed within the first year after transplant had advanced disease. Characteristics that were associated with poorer survival were diagnosis within the first year posttransplant, monoclonal tumors and presentation with an infectious mononucleosis-like syndrome. Six of eight patients treated with surgery are alive and disease-free.

CONCLUSION

Patients with PTLD can achieve long-term survival. Surgery can play an important role in selected patients. Characteristics that may be associated with poorer survival are diagnosis within the first year after transplant, presence of a monoclonal tumor or an infectious mononucleosis-like presentation.