RANTES and MIP-1beta mRNA expression in human peripheral blood mononuclear cells: transcript quantification using NASBA technology

The importance of chemokines in the immune response, as well as in a range of specific disease states, is becoming increasingly apparent. The role of CC- (or beta-) chemokines and their receptors in the pathology and mechanisms of HIV-1 infection has served to intensify interest in these factors. Although the functionality of these factors resides in their protein forms, assays for the detection and quantification of these protein factors in clinical samples are not readily available. Consequently, we designed NASBA-based assays for the quantification of the mRNA encoding two members of the CC-chemokine family: RANTES and MIP-1beta. The NASBA-based assays are extremely sensitive, accurate, and reproducible across a dynamic range of at least four orders of magnitude. Inter-assay performance is comparable to intra-assay performance. We applied these methods to the analysis of normal human PBMC and PBMC from HIV-1 infected individuals. Although MIP-1beta mRNA levels are higher than RANTES levels in both populations, RANTES levels in HIV-1+ patients are higher than in normal individuals. The utility of these assays in longitudinal studies of specific subpopulations of cells, as well as their potential use in clinical diagnostics, is discussed.

Detection of dengue viral RNA using a nucleic acid sequence-based amplification assay

Faster techniques are needed for the early diagnosis of dengue fever and dengue hemorrhagic fever during the acute viremic phase of infection. An isothermal nucleic acid sequence-based amplification (NASBA) assay was optimized to amplify viral RNA of all four dengue virus serotypes by a set of universal primers and to type the amplified products by serotype-specific capture probes. The NASBA assay involved the use of silica to extract viral nucleic acid, which was amplified without thermocycling. The amplified product was detected by a probe-hybridization method that utilized electrochemiluminescence. Using normal human plasma spiked with dengue viruses, the NASBA assay had a detection threshold of 1 to 10 PFU/ml. The sensitivity and specificity of the assay were determined by testing 67 dengue virus-positive and 21 dengue virus-negative human serum or plasma samples. The "gold standard" used for comparison and evaluation was the mosquito C6/36 cell culture assay followed by an immunofluorescent assay. Viral infectivity titers in test samples were also determined by a direct plaque assay in Vero cells. The NASBA assay was able to detect dengue viral RNA in the clinical samples at plaque titers below 25 PFU/ml (the detection limit of the plaque assay). Of the 67 samples found positive by the C6/36 assay, 66 were found positive by the NASBA assay, for a sensitivity of 98.5%. The NASBA assay had a specificity of 100% based on the negative test results for the 21 normal human serum or plasma samples. These results indicate that the NASBA assay is a promising assay for the early diagnosis of dengue infections.

Macrophage-derived chemokine gene expression in human and macaque cells: mRNA quantification using NASBA technology

Macrophage-derived chemokine (MDC) is a CC-chemokine that inhibits infection by both macrophage- and T cell-tropic strains of HIV-1. This suppressor activity has led to great interest in fully characterizing the role of MDC in the pathogenesis of HIV-1 infection. Methods for the quantitation of constitutive levels of MDC protein in vivo are lacking. In this report, we describe the development and performance of a NASBA-based assay for the quantification of MDC mRNA expression in human and macaque cells. Although the constitutive in vivo levels of MDC mRNA in macaque and human T lymphocytes were low, in vitro activation of these cells greatly increased MDC transcription. Levels in the human and macaque cells were comparable under all conditions tested. Positive correlations between MDC transcription and protein expression were observed. The results indicate that this assay is extremely sensitive and reproducible over a five log dynamic range, and effectively quantifies MDC mRNA in resting and activated T cells. This assay may therefore permit characterization of the role of MDC in HIV-1/SIV pathogenesis, and in vaccine-induced immune responses.

Improving the environment of mice by using synthetic gauze pads

We conducted a study to evaluate the use of synthetic gauze pads for improving the environment of mice. To evaluate differences in clinical and pathology parameters, we used two treatment groups of mice, which were housed with or without gauze pads. The mice were assigned to the study at 5 to 7 weeks of age, and the study lasted 1 year. The mice were housed individually in stainless-steel ventilated cages with wire-mesh floors. Clinical observations, body weights, and food consumption were recorded frequently during the study. A complete necropsy, with histopathologic evaluation of tissues and collection of blood for clinical pathology, was performed at completion of the study. The mice with gauze pads preferred to rest on them. In addition, these mice showed a statistically significant reduction in food consumption, but their body weights and weight gains did not differ from those of animals without gauze pads. Synthetic gauze pads provide an improved environment for mice housed in cages with wire floors and may produce reduced food consumption. Gauze pads in the cages of mice do not seem to influence body weight gain, clinical signs, clinical pathology, or morphologic pathology.

The distribution of P2X receptor clusters on individual neurons in sympathetic ganglia and their redistribution on agonist activation

The distribution of P2X receptors on neurons in rat superior cervical ganglia and lability of P2X receptors on exposure to agonists were determined. Antibody labeling of each P2X subtype P2X(1)-P2X(7) showed neurons isolated into culture possessed primarily P2X(2) subunits with others occurring in order P2X(7) > P2X(6) > P2X(3) > P2X(1) > P2X(5) > P2X(4). Application of ATP and alpha,beta-meATP to neurons showed they possessed a predominantly nondesensitizing P2X receptor type insensitive to alpha,beta-meATP, consistent with immunohistochemical observations. P2X(1)-green fluorescent protein (GFP) was used to study the time course of P2X(1) receptor clustering in plasma membranes of neurons and internalization of receptors following prolonged exposure to ATP. At 12-24 h after adenoviral infection, P2X(1)-GFP formed clusters about 1 microm diameter in the neuron membrane. Application of ATP and alpha,beta-meATP showed these neurons possessed a predominantly desensitizing P2X receptor type sensitive to alpha,beta-meATP. Infection converted the major functional P2X receptor type in the membrane to P2X(1). Exposure of infected neurons to alpha,beta-meATP for less than 60 s led to the disappearance of P2X(1)-GFP fluorescence from the cell surface that was blocked by monensin, indicating the chimera is normally endocytosed into these organelles on exposure to agonist.

Genotyping of the CCR5 chemokine receptor by isothermal NASBA amplification and differential probe hybridization

The human CCR5 chemokine receptor functions as a coreceptor with CD4 for infection by macrophage-tropic isolates of human immunodeficiency virus type 1 (HIV-1). A mutated CCR5 allele which encodes a protein that does not function as a coreceptor for HIV-1 has been identified. Thus, expression of the wild-type and/or mutation allele is relevant to determining the infectability of patient peripheral blood mononuclear cells (PBMC) and affects disease progression in vivo. We developed a qualitative CCR5 genotyping assay using NASBA, an isothermal nucleic acid amplification technology. The method involves three enzymes and two oligonucleotides and targets the CCR5 mRNA, which is expressed in PBMC at a copy number higher than 2, the number of copies of DNA present encoding the gene. The single oligonucleotide set amplifies both alleles, and genotyping is achieved by separate hybridizations of wild-type- and mutation-specific probes directly to the single-stranded RNA amplification product. Assay sensitivity and specificity were demonstrated with RNAs produced in vitro from plasmid clones bearing the DNA encoding each allele. No detectable cross-reactivity between wild-type and mutation probes was found, and 50 copies of each allele were readily detectable. Analysis of patient samples found that 20% were heterozygous and 1% were homozygous for the CCR5 mutation. Thus, NASBA is a sensitive and specific means of rapidly determining CCR5 genotype and provides several technical advantages over alternative assay systems.

Peptide vaccination using nonionic block copolymers induces protective anti-viral CTL responses

High molecular weight nonionic block copolymers have been developed as vaccine adjuvants. We employed these adjuvants in water-in-oil emulsion and multiple emulsion formulations with a synthetic peptide-based antigen vaccine to test their ability to prime anti-viral CD8(+) T cell responses. Vaccines were made using the H-2(d)-restricted immunodominant peptide from lymphocytic choriomeningitis virus (LCMV), NP118-126, and administered to BALB/c ByJ (H-2(d)) mice. Peptide-containing emulsions were able to induce NP118-126 specific CTL and IFN-gamma secreting CD8(+) T cells in the vaccinated mice and these responses were maintained for at least 90 days post immunization. At all times, the responses induced by the copolymer formulations were equal to, or better than, formulations based on incomplete Freund's adjuvant (IFA). In addition, the responses induced by prophylactic vaccination using the multiple emulsion formulation resulted in accelerated viral clearance following infection with a strain of LCMV (clone 13) that causes a persistent infection in naïve adult mice. These results indicate that peptide vaccination using a formulation based on high molecular weight nonionic block copolymer in a simple water-in-oil or a multiple emulsion format can induce virus-specific CD8(+) T cell responses and confer protection sufficient enough to prevent the establishment of a persistent infection.

Transcatheter closure of a residual postmyocardial infarction ventricular septal defect with the Amplatzer septal occluder

Acute ventricular septal rupture following myocardial infarction carries a high mortality. Early surgery improves survival but long term outcome depends on residual shunting and left ventricular function. Residual shunting is common despite apparently successful closure and may require reoperation. Transcatheter closure is an established method of treating selected congenital defects but clinical experience of transcatheter closure in postinfarction ventricular septal rupture is minimal. Transcatheter closure of a residual ventricular septal defect was successfully done using a new device, the Amplatzer septal occluder, in a 50 year old Indian man who had previously undergone emergency surgical repair for postinfarction acute ventricular septal rupture. The technique is described and its potential as a treatment in postinfarction ventricular septal rupture, its possible complications, and the important aspects of case selection and device design are discussed.

Microvascular integrity as a predictor of left ventricular remodeling after acute anterior wall myocardial infarction

The purpose of this study was to investigate the relation of microvascular integrity and ventricular remodeling after acute myocardial infarction. Twenty-six patients with first acute anterior myocardial infarction were studied before discharge with myocardial contrast echocardiography (MCE). Opacification index (OI) and wall motion index were calculated in the left anterior descending artery territory and left ventricular diastolic volume was measured at baseline and during a 9-month follow-up. In total 26 patients, the regional wall motion improved but the left ventricular volume and global function was not changed significantly at follow-up. When the patients were divided into 3 groups according to opacification index (> or = 0.75, 0.5 approximately 0.75, < or = 0.5) at baseline, functional recovery was not observed and significant left ventricular dilatation was developed in patients with < or = 0.5 OI. Among the baseline echo-parameters such as ejection fraction, wall motion score, left ventricular volume and opacification index, the best predictor for long term left ventricular dilatation was the opacification index by multivariate analysis. In patients with acute anterior wall infarction the assessment of microvascular integrity by MCE at acute stage provides useful information regarding recovery of dysfunctional regional wall motion and ventricular remodeling.

Conservative operation for infective endocarditis of the mitral valve

BACKGROUND

Subvalvular preservation is necessary to maintain left ventricular function, but accidental retention of infected tissue could cause postoperative endocarditis.

METHODS

We examined 71 consecutive patients who underwent operation for mitral endocarditis. Endocarditis was uncontrolled and active in 24 patients, partially treated (unfinished antibiotic course) in 17, and healed in 30.

RESULTS

Valves were repaired in 17% versus 59% versus 63% and replaced with subvalvular preservation in 25% versus 6% versus 3% of the uncontrolled active, partially treated, and healed groups, respectively. Thirty-day mortality was 29% versus 0% versus 3.3% (p=0.003), total mortality was 46% versus 18% versus 17% (p=0.035), and complications-related mortality was 38% versus 11% versus 13% (p=0.054), respectively. There was a trend toward lower complications-related mortality with subvalvular preservation than without. Postoperative endocarditis occurred in 3 of 30 patients without and 1 of 41 patients with subvalvular preservation.

CONCLUSIONS

Postoperative mortality in uncontrolled active mitral endocarditis remains high, but results are good with partially treated or healed endocarditis. Subvalvular preservation improves outcome, does not increase postoperative endocarditis rates, and should be performed whenever feasible.

Midterm results of mitral valve repair with the Sculptor annuloplasty ring

BACKGROUND

The partly flexible Sculptor ring is more physiologic than the rigid Carpentier-Edwards ring and may improve outcome.

METHODS

We studied 221 consecutive patients who underwent mitral valve repair for mitral regurgitation. The Sculptor ring was randomly implanted in 30 patients (Sculptor ring group) and the Carpentier-Edwards ring in 36 patients (Carpentier-Edwards ring control group) from 1993 to 1994. Before 1993, 155 patients received the Carpentier-Edwards ring (Carpentier-Edwards ring historical group). Baseline group characteristics were similar.

RESULTS

Thirty-day mortality in the Sculptor ring, Carpentier-Edwards ring control, and Carpentier-Edwards ring historical groups was 0.0% versus 2.8% versus 3.2% (p = 0.61), respectively. At 18 months, survival was 86% +/- 6% versus 88% +/- 7% versus 90% +/- 3% (p = 0.89), and freedom from complications was 100% +/- 0% versus 100% +/- 0% versus 98% +/- 1% (p = 0.51) for endocarditis, 90% +/- 6% versus 94% +/- 4% versus 96% +/- 2% (p = 0.47) for severe mitral regurgitation, 93% +/- 5% versus 91% +/- 5% versus 92% +/- 2% (p = 0.91) for thromboembolism, and 77% +/- 8% versus 80% +/- 7% versus 82% +/- 3% (p = 0.49) for myocardial failure, respectively.

CONCLUSIONS

The Sculptor ring is a safe alternative to the prosthetic annuloplasty rings in current use. The benefits of its physiologic design are either clinically insignificant or undetectable with a small sample size.

Echocardiography in mitral valve repair for mitral regurgitation: the surgeon's needs

Mitral valve repair has become the operation of choice for mitral regurgitation. It is often technically more demanding than valve replacement. The role of echocardiography has now extended beyond the identification of severe mitral regurgitation that would benefit from surgical correction. It helps the surgeon to assess valve reparability preoperatively, to assess the need for valve surgery in equivocal cases of ischemic mitral regurgitation, to plan the operation, and to assess valve function after repair. This article aims to discuss the role of echocardiography in providing the information needed by the surgeon for successful mitral valve repair. The echocardiographer must understand the surgeon's needs, while surgeons should understand both the benefits and limitations of echocardiography.

Superiority of mitral valve repair in surgery for degenerative mitral regurgitation

OBJECTIVES

We aimed to assess the influence of type of operation on outcome in degenerative mitral regurgitation.

METHODS

We compared outcomes in 278 consecutive patients who underwent mitral valve repair (167 patients), replacement with subvalvular preservation (22 patients) and without subvalvular preservation (89 patients) for degenerative mitral regurgitation.

RESULTS

There was a trend towards lower mortality with repair and replacement with subvalvular preservation compared to replacement without subvalvular preservation. Thirty-day mortality was 1.2% vs 0.0% vs 4.7% (ns) respectively. Six-year survival was, respectively, 67.8 +/- 7.4% (P = 0.088) vs 80.8 +/- 11.0% (P = 0.25) vs 63.3 +/- 5.9% for all-cause death, 78.5 +/- 6.8% (P = 0.063) vs 95.5 +/- 4.4% (P = 0.092) vs 67.6 +/- 5.9% for all complication-related death and 80.5 +/- 6.9% (P = 0.076) vs 100.0 +/- 0.0% (P = 0.045) vs 72.8 +/- 5.8% for complication-related death due to myocardial failure. Multivariate analysis confirmed independent beneficial effects from repair compared to replacement without subvalvular preservation on complication-related death (hazard ratio 0.42, P = 0.010) and death from myocardial failure (hazard ratio 0.40, P = 0.014), and from repair compared to mechanical replacement on thromboembolism (hazard ratio 0.45, P = 0.029) and anticoagulation-related haemorrhage (hazard ratio 0.19, P = 0.026).

CONCLUSIONS

Mitral valve repair is superior to replacement. The greatest survival advantage is in reduced mortality from myocardial failure. Repair should be the operation of choice for degenerative mitral regurgitation.

Neutron and X-Ray Reflectivity Studies of the Adsorption of Aerosol-OT at the Air-Water Interface: The Structure of the Calcium Salt

We have used neutron and X-ray reflection to determine the structure of a layer of calcium bis-(2-ethyl 1-hexyl) sulphosuccinate (Aerosol-OT or AOT) adsorbed at the air/solution interface. The widths of the distributions of the chains and head groups of the molecule, and their positions in relation to the underlying water, have been measured at four concentrations varying from the solubility limit (CMC) at 4 x 10(-4) M to 1 x 10(-6) M. Over this concentration range the coverage changes from 68 &plusmn; 3 to 142 &plusmn; 8 &Aring;2 per AOT unit. The structure of the layer both is quite different from that of NaAOT and varies quite differently with surface concentration. The Ca(AOT)2 layer is slightly (1 &Aring;) further out from the water, but the chain region is thinner for the calcium surfactant. This is reflected most in the greatly reduced chain to head separation, which drops from about 6 &Aring; in NaAOT to about 4 &Aring; in Ca(AOT)2.

Increasing the immunogenicity of a trivalent influenza virus vaccine with adjuvant-active nonionic block copolymers for potential use in the elderly

High molecular weight nonionic block copolymers consisting of a large hydrophobic core made from repeat oxypropylene units and smaller hydrophilic blocks of oxyethylene repeat units were evaluated as adjuvants in experimental influenza virus vaccine formulations. The goal was to identify a copolymer that would increase the immunogenicity of the commercial Fluogen trivalent influenza virus vaccine. Vaccine experiments done using BALB/c mice provided data that allowed us to identify a copolymer that increased both antibody titers specific for total virus proteins as well as antibodies with hemagglutination inhibition (HAI) activity. This copolymer, termed CRL1005, increased the production of IgG1, IgG2a and IgG2b which suggested it increased the activity of both Type-1 and Type-2 T-helper lymphocytes. The CRL1005 copolymer was tested further in rhesus monkeys with similar results. Levels of antibodies specific for total virus protein preparations were increased as were HAI antibody titers following vaccination with the copolymer-supplemented Fluogen vaccine. Thus, the CRL1005 copolymer adjuvant appears to be compatible for use with the current generation of inactivated viron-based influenza vaccines and useful for increasing the immunogenicity. A more potent influenza virus vaccine could well be more efficacious in the aged segment of our population than current vaccines.

Mitral valve surgery in the elderly

BACKGROUND AND AIMS OF THE STUDY

Previous studies have shown that outcome from mitral valve surgery is poorer in the elderly. However, such studies did not distinguish between age itself, age-associated factors and interactions between age and other factors. We aimed to examine the relative influences of age and these other factors on outcome.

METHODS

We compared outcomes from mitral valve repair or replacement in 190 elderly (> or = 70 years) and 424 younger (< 70 years) consecutive adult patients.

RESULTS

At baseline, the elderly had more (p > 0.05) degenerative mitral regurgitation, coronary artery disease, left ventricular impairment, New York Heart Association (NYHA) class III or IV symptoms, bioprosthetic replacement and mitral valve repair. Operative mortality rate was low both in elderly (7/190 patients, 3.7%) and younger patients (15/424 patients, 3.5%, NS). Seven-year survival was poorer in the elderly with respect to overall survival, (49 +/- 6% vs. 72 +/- 3%, p = 0.0001), freedom from complications-related death (57 +/- 7% vs. 79 +/- 3%, p = 0.001), from death due to myocardial failure (66 +/- 6% vs. 86 +/- 3%, p < 0.0001) and from overt myocardial failure (44 +/- 7% vs. 74 +/- 3%, p = 0.0001). Multivariate analysis showed better survival with younger age, mitral valve repair, better preoperative NYHA class and better left ventricular function. However, 7-year freedom from complications-related death was excellent and similar in both elderly (90 +/- 7%) and younger (93 +/- 3%, NS) patients who underwent surgery early while in NYHA class I or II with left ventricular ejection fraction > 40%.

CONCLUSIONS

Late surgery contributes far more than age itself to poor outcome from mitral valve surgery in the elderly. If surgery is performed early and repair preferred to replacement whenever feasible, medium-term results are excellent in both young and old.

Importance of subvalvular preservation and early operation in mitral valve surgery

BACKGROUND

Mitral valve replacement (MVR) has a high mortality and morbidity. It has been suggested that preservation of the subvalvular apparatus and more optimal timing of surgery might improve outcome.

METHODS AND RESULTS

We performed a retrospective study of 612 consecutive patients who underwent mitral valve repair or replacement: 226 patients had repair, 68 had replacement with subvalvular preservation (MVR/SVP), and 318 had replacement without subvalvular preservation (MVR/NoSVP). Baseline characteristics were most unfavorable in the repair group with respect to age (P = .002) and in the repair and MVR/SVP groups with respect to NYHA functional class and left ventricular function (P = .044). Thirty-day mortality was lower in the repair (1.8%, P = .046) and MVR/SVP (1.5%. P = NS) groups than the MVR/NoSVP group (5.0%). Overall survival at 7 years was better in the repair (71.2 +/- 5.6%. P = .022) and MVR/SVP (66.2 +/- 12.4%, P = .017) groups than the MVR/NoSVP group (63.5 +/- 3.4%). Myocardial failure caused 66 of 107 complication-related deaths. Multivariate analysis confirmed independent beneficial effects of repair on 30-day mortality (odds ratio, 0.27, P < .05) and of repair and MVR/SVP on overall mortality (hazard ratios, 0.43, P < .001 and 0.40, P < .05, respectively) and complication-related death hazard ratios, 0.38, P < .001 and 0.35, P < .05, respectively). Preoperative NYHA class III or IV symptoms and left ventricular impairment were independent risk factors for death and myocardial failure.

CONCLUSIONS

Mitral valve repair is superior to replacement. If repair is not feasible, the subvalvular apparatus should be preserved. Early surgery before the development of severe symptoms and demonstrable left ventricular impairment is also needed to optimize outcome.

Mortality and morbidity after mitral valve repair: the importance of left ventricular dysfunction

A retrospective study of 219 consecutive patients who underwent mitral valve repair for mitral regurgitation or mixed mitral valve disease with at least moderate regurgitation was undertaken. The etiology was degenerative in 151 (68.9%) patients, endocarditis in 24 (10.9%), rheumatic in 22 (10.0%), ischemic in 13 (5.9%), congenital in five (2.3%) and cardiomyopathy in two (0.9%). The average age was 64.8 +/- 10.9 years, the average follow up 30.2 +/- 24.1 months. Pre-operatively, 74% were in NYHA functional class III or IV. Left ventricular function was assessed by angiography and echocardiography, and moderate or severe impairment (ejection fraction < or = 40%) was assumed to represent significant left ventricular dysfunction. There were six (2.7%) hospital deaths, four of which were due to left ventricular dysfunction. The seven-year mortality and seven-year combined mortality and morbidity were 14.4% and 37.1% respectively for complications related to left ventricular dysfunction, and 2.5% and 24.2% respectively for unrelated complications. Subgroup analysis showed that five-year mortality and five-year combined mortality and morbidity due to left ventricular dysfunction were significantly worse in patients who had pre-operative left ventricular dysfunction than those who did not: 28.5% vs. 6.1% (p < 0.001) and 52.4% vs. 17.8% (p < 0.001). There was nevertheless a significant incidence of postoperative left ventricular dysfunction in patients with satisfactory preoperative left ventricular function. In this group, five-year mortality and five-year combined mortality and morbidity due to left ventricular dysfunction were higher in patients who were in NYHA class III or IV preoperatively than in those who were not: 11.2% vs. 0% (NS) and 25.9% vs. 0% (p < 0.01) respectively, particularly if they also had early (3-10 days) post-operative left ventricular dysfunction: 20.4% (p < 0.001) and 41.7% (p < 0.001) respectively. Despite preservation of the mitral apparatus, left ventricular dysfunction remains a major cause of mortality and morbidity following mitral valve repair for mitral regurgitation.

Intestinal parasite infections in the inhabitants along the Hantan River, Chorwon-gun

The prevalence of intestinal parasite infections in inhabitants at the reaches of the Hantan River, Chorwon-gun, Korea, was observed from August 12 to September 14, 1993. Of 465 people observed by cellophane thick smear and formalin-ether concentration method, 2 Ascaris lumbricoides (unfertilized), 1 Trichuris trichiura, 39 Clonorchis sinensis and 16 Metagonimus egg positive cases were found. After treatment, the Metagonimus egg positive cases passed out flukes of Metagonimus Miyata type. Of 68 fish caught in the Hantan River, 14 (20.6%) were infected with metacercariae of Metagonimus, while no metacercaria of C. sinensis was found. At this area, soil-transmitted nematodes are very low, but clonorchiasis and metagonimiasis are prevalent by modernate endemicity.

Effect of a single Lernaeocera branchialis (Copepoda) on growth of Atlantic cod

A study was conducted to determine the influence of controlled water temperature on growth rate of Atlantic cod (Gadus morhua) after infection with a single, blood-feeding copepod, Lernaeocera branchialis. Initially, uninfected and infected fish were held in ambient seawater (0-10 C) in a raceway and fed to satiation from October to March. In a second trial simulating the water temperature at which cod live in winter (2-3 C), 2 groups of fish were kept in tanks through which sea water flowed, and they were fed to satiation from February through July. Infected cod held at the ambient temperature consumed more feed, had comparable weight-gain, and showed lower feed conversion efficiency (%) and k-factor than did control fish during autumn to early winter, whereas no difference was apparent during the remaining winter period. Also, no striking difference in feed consumed, weight gained, feed conversion efficiency or k-factor were apparent when the 2 groups of cod were held in heated sea water during winter to early summer. These results suggest that adult cod infected with 1 L. branchialis compensate for the infection in autumn rather than during winter by consuming more fed.

[Leukemia cutis: clinical and histopathological analysis of 14 cases]

We report 14 cases of leukemia cutis registered at Department of Dermatology, Veterans General Hospital Over a period of 18 years. There were one patient with acute lymphocytic leukemia (ALL), one with chronic lymphocytic leukemia (CLL), seven with acute monocytic leukemia (AMOL), one with acute myelomonocytic leukemia (AMML), and four with chronic myelocytic leukemia (CML). Multiple papules and nodules were the most frequent clinical lesions. Metastatic skin lesions occurred most commonly on legs (71%), followed by arms (64%), back (50%), anterior chest (50%), scalp (14%), and face (14%). The feet (7%) were rarely involved while palms and soles were rarely involved. Cutaneous leukemic lesions may be concomitant with or after, but never before the diagnosis of systemic leukemia in our series has had such change. In general, the histopathology of leukemia cutis showed diffuse or nodular infiltration of leukemic cells in the dermis and subcutaneous tissue, often typing of leukemia relays on more confirmative studies of peripheral smear and bone marrow biopsy. Leukemia cutis seems to be dissemination of systemic leukemia to the skin, and the presence of cutaneous leukemic lesions are associated with a very poor prognosis. Most patients (85%) died within 4 months after appearance of skin metastasis.