[Muscular sarcocystosis after travel to Malaysia: a case series from Germany]

BACKGROUND

Since 2011, about 100 travellers to the island of Tioman, Malaysia, have been diagnosed worldwide with suspected muscular sarcocystosis, a previously only sporadically observed parasitic disease. Source of infection and therapy remain unclear. Final diagnosis requires microscopic identification of cysts in muscle biopsies. The study objective was a systematic description of characteristic symptoms, laboratory investigations and treatment response.

METHODS

Systematic case series.

RESULTS

The 26 cases of 5 centers for tropical medicine in Germany showed a characteristic biphasic development: symptoms began in general 2 weeks after mid-holidays (min. 7.5, max. 22 days) with unspecific fever and headaches lasting for almost 1 week. After an asymptomatic period of 2 weeks, severe myalgia (6.5, scale 0-10) and fever developed and lasted for about 6 weeks (min. 7, max. 207 days), accompanied by creatin-phosphokinase(CK)-elevation (up to 3.5 times), and eosinophilia (2.9 times). One out of two muscle biopsies revealed a cyst typical for sarcocystosis. In 6 out of 7 patients an increase in Sarcocystis-specific antibody concentration could be demonstrated by ELISA. Treatment with systemic steroids and albendazole, or ivermectin resulted in significant symptomatic improvement in most of the patients. One patient was treated early with cotrimoxazole and subsequently did not develop a second phase of the disease. All patients had stayed in the North-West of the island Tioman.

CONCLUSIONS

Muscular sarcocystosis develops in a biphasic pattern with initial fever and later prolonged myalgia, eosinophilia, and CK-elevation. Steroids achieve symptomatic relief in the late phase. Early cotrimoxazole-therapy could possibly prevent parasitic muscle invasion. In fever after travel to Malaysia differential diagnosis should include sarcocystosis. The source of infection appears to be located in North-West of Tioman. Further studies are needed, including addressing early diagnosis and treatment.

Evidence of sulfur-bound reduced copper in bamboo exposed to high silicon and copper concentrations

We examined copper (Cu) absorption, distribution and toxicity and the role of a silicon (Si) supplementation in the bamboo Phyllostachys fastuosa. Bamboos were maintained in hydroponics for 4 months and submitted to two different Cu (1.5 and 100 μm Cu(2+)) and Si (0 and 1.1 mM) concentrations. Cu and Si partitioning and Cu speciation were investigated by chemical analysis, microscopic and spectroscopic techniques. Copper was present as Cu(I) and Cu(II) depending on plant parts. Bamboo mainly coped with high Cu exposure by: (i) high Cu sequestration in the root (ii) Cu(II) binding to amino and carboxyl ligands in roots, and (iii) Cu(I) complexation with both organic and inorganic sulfur ligands in stems and leaves. Silicon supplementation decreased the visible damage induced by high Cu exposure and modified Cu speciation in the leaves where a higher proportion of Cu was present as inorganic Cu(I)S compounds, which may be less toxic.

Three cases of donor-derived pulmonary tuberculosis in lung transplant recipients and review of 12 previously reported cases: opportunities for early diagnosis and prevention

INTRODUCTION

Solid organ transplant recipients have a higher frequency of tuberculosis (TB) than the general population, with mortality rates of approximately 30%. Although donor-derived TB is reported to account for <5% of TB in solid organ transplants, the source of Mycobacterium tuberculosis infection is infrequently determined.

METHODS

We report 3 new cases of pulmonary TB in lung transplant recipients attributed to donor infection, and review the 12 previously reported cases to assess whether cases could have been prevented and whether any cases that might occur in the future could be detected and investigated more quickly. Specifically, we evaluate whether opportunities existed to determine TB risk on the basis of routine donor history, to expedite diagnosis through routine mycobacterial smears and cultures of respiratory specimens early post transplant, and to utilize molecular tools to investigate infection sources epidemiologically.

FINDINGS

On review, donor TB risk was present among 7 cases. Routine smears and cultures diagnosed 4 asymptomatic cases. Genotyping was used to support epidemiologic findings in 6 cases.

CONCLUSION

Validated screening protocols, including microbiological testing and newer technologies (e.g., interferon-gamma release assays) to identify unrecognized M. tuberculosis infection in deceased donors, are warranted.

Do rhizospheric processes linked to P nutrition participate in U absorption by Lupinus albus grown in hydroponics?

Phosphate (P) is an essential element for plant development but is generally present in limiting amount in the soil solution. Plant species have developed different mechanisms promoting the solubilization of this element in soils to ensure a sufficient supply for their growth. One of these mechanisms is based on the ability of certain species such as L. albus to exude large amounts of citrate through specific tertiary roots called cluster-roots. Uranium (U) is an ubiquitous contaminant known firstly for its chemical toxicity and secondly for its high affinity for P with which it forms low-soluble complexes in soils. We highlight the effects of P-U interaction on the physiology of L. albus and particularly on citrate exudation, and the impact of this root process on the phytoavailability of U and its accumulation in plants in a hydroponic study. Different levels of P (1 and 100 μM) and U (0 and 20 μM) have been tested. Our results show no toxicity of U on the development of L. albus with an adequate P supply, whereas the effects of P starvation are amplified by the presence of U in the growth medium, except for the production of cluster-roots. Citrate exudation is totally inhibited by U in a low-P environment whereas it increases in the presence of U when its toxicity is lowered by the addition of P. The differences observed in terms of toxicity and accumulation are partly explained by the microphotographs obtained by electron microscopy (TEM-EDX): in the absence of P, U penetrates deep into the roots and causes lethal damages, whereas in presence of P, we observe the formation of U-P complexes which limit the internalization of the pollutant and so its toxicity.

Effects of silicon and copper on bamboo grown hydroponically

Due to its high growth rate and biomass production, bamboo has recently been proven to be useful in wastewater treatment. Bamboo accumulates high silicon (Si) levels in its tissues, which may improve its development and tolerance to metal toxicity. This study investigates the effect of Si supplementation on bamboo growth and copper (Cu) sensitivity. An 8-month hydroponic culture of bamboo Gigantocloa sp. "Malay Dwarf " was performed. The bamboo plants were first submitted to a range of Si supplementation (0-1.5 mM). After 6 months, a potentially toxic Cu concentration of 1.5 μM Cu(2+) was added. Contrary to many studies on other plants, bamboo growth did not depend on Si levels even though it absorbed Si up to 218 mg g(-1) in leaves. The absorption of Cu by bamboo plants was not altered by the Si supplementation; Cu accumulated mainly in roots (131 mg kg(-1)), but was also found in leaves (16.6 mg kg(-1)) and stems (9.8 mg kg(-1)). Copper addition did not induce any toxicity symptoms. The different Cu and Si absorption mechanisms may partially explain why Si did not influence Cu repartition and concentration in bamboo. Given the high biomass and its absorption capacity, bamboo could potentially tolerate and accumulate high Cu concentrations making this plant useful for wastewater treatment.

Proof-of-concept rare cancers in drug development: the case for rhabdomyosarcoma

Rare diseases typically affect fewer than 200,000 patients annually, yet because thousands of rare diseases exist, the cumulative impact is millions of patients worldwide. Every form of childhood cancer qualifies as a rare disease-including the childhood muscle cancer, rhabdomyosarcoma (RMS). The next few years promise to be an exceptionally good era of opportunity for public-private collaboration for rare and childhood cancers. Not only do certain governmental regulation advantages exist, but these advantages are being made permanent with special incentives for pediatric orphan drug-product development. Coupled with a growing understanding of sarcoma tumor biology, synergy with pharmaceutical muscle disease drug-development programs, and emerging publically available preclinical and clinical tools, the outlook for academic-community-industry partnerships in RMS drug development looks promising.

A randomised, non-crossover study of the GuardianCPV Laryngeal Mask versus the LMA Supreme in paralysed, anaesthetised female patients

We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV™ and the LMA Supreme™ in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10-ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20-40 ml were 31 (7) cmH2O for the GuardianCPV and 27 (7) cmH2O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH2O and 88 (43) cmH2O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients.

Effect of silicon on reducing cadmium toxicity in durum wheat (Triticum turgidum L. cv. Claudio W.) grown in a soil with aged contamination

Agricultural soil contamination and subsequently crops still require alternative solutions to reduce associated environmental risks. The effects of silica application on alleviating cadmium (Cd) phytotoxicity in wheat plants were investigated in a 71-day pot experiment conducted with a historically contaminated agricultural soil. We used amorphous silica (ASi) that had been extracted from a diatomite mine for Si distribution at 0, 1, 10 and 15 ton ASi ha(-1). ASi applications increased plant biomass and plant Si concentrations, reduced the available Cd in the soil and the Cd translocation to shoots, while Cd was more efficiently sequestrated in roots. But ASi is limiting for Si uptake by plants. We conclude that significant plant-available Si in soil contributes to decreased Cd concentrations in wheat shoots and could be implemented in a general scheme aiming at controlling Cd concentrations in wheat.

Protein kinase C iota as a therapeutic target in alveolar rhabdomyosarcoma

Alveolar rhabdomyosarcoma is an aggressive pediatric cancer exhibiting skeletal muscle differentiation. New therapeutic targets are required to improve the dismal prognosis for invasive or metastatic alveolar rhabdomyosarcoma. Protein kinase C iota (PKCι) has been shown to play an important role in tumorigenesis of many cancers but little is known about its role in rhabdomyosarcoma. Our gene expression studies in human tumor samples revealed overexpression of PRKCI. We confirmed overexpression of PKCι at the mRNA and protein level using our conditional mouse model that authentically recapitulates the progression of rhabdomyosarcoma in humans. Inhibition of Prkci by RNA interference resulted in a dramatic decrease in anchorage-independent colony formation. Interestingly, treatment of primary cell cultures using aurothiomalate (ATM), which is a gold-containing classical anti-rheumatic agent and a PKCι-specific inhibitor, resulted in decreased interaction between PKCι and Par6, decreased Rac1 activity and reduced cell viability at clinically relevant concentrations. Moreover, co-treatment with ATM and vincristine, a microtubule inhibitor currently used in rhabdomyosarcoma treatment regimens, resulted in a combination index (C. I.) of 0.470–0.793 through cooperative accumulation of non-proliferative multinuclear cells in the G2/M phase, indicating that these two drugs synergize. For in vivo tumor growth inhibition studies, ATM demonstrated a trend towards enhanced vincristine sensitivity. Overall, these results suggest that PKCι is functionally important in alveolar rhabdomyosarcoma anchorage-independent growth and tumor cell proliferation and that combination therapy with ATM and microtubule inhibitors holds promise for the treatment of alveolar rhabdomyosarcoma.

Directly measured mucosal pressures produced by the i-gel™ and Laryngeal Mask Airway Supreme™ in paralysed anaesthetised patients

The i-gel™ and LMA Supreme™ are extraglottic airway devices with non-inflatable and inflatable cuffs, respectively. We hypothesised that directly measured mucosal pressures would differ between these devices in anesthetised paralysed patients. Thirty patients were randomly allocated to receive one of these two devices. Four pressure sensors were attached to all airway devices used to measure mucosal pressure at the base of the tongue, the distal oropharynx, the hypopharynx and the pyriform fossa. At these four places, median (IQR [range]) i-gel mucosal pressures were 8.0 (2.7-10.7 [0-26.7]), 5.0 (2.7-7 [1.0-37.3]), 9.3 (2.7-13.3 [0-22.7] and 8.0 (2.7-10.7 [0-25.3]) cmH(2)O, respectively, and for the LMA Supreme, these were 5.0 (0.5-8.0 [0-33]), 4.0 (1.3-9.3 [0-24]), 10.7 (4-17.3 [0-26.7]) and 8.0 (0-10.7 [0-36]) cmH(2)O, respectively. Mucosal pressures were low and similar for both devices. The LMA Supreme mucosal pressures were higher in the hypopharynx than in the distal oropharynx (p = 0.04) and base of the tongue (p = 0.011). There were no pressure differences between the locations for the i-gel.

Determination of the silicon concentration in plant material using Tiron extraction

• The quantification of silicon (Si) in plants generally requires a digestion procedure before the determination of the dissolved Si concentration by spectrometric analysis. Recent procedures produce rapid and accurate measurements, but are based on either hazardous chemicals or sophisticated instrumentation. • Here, we describe a simpler procedure using Tiron. Tiron [4,5-dihydroxy-1,3-benzene-disulfonic acid disodium salt, (HO)(2)C(6)H(2)(SO(3)Na)(2)] is currently used as a selective extractant for amorphous silica in soils. Because Si in the shoots is mostly composed of amorphous opaline silica particles (i.e. phytoliths), we tested the Tiron extraction procedure for plants. • Our results are critically discussed in relation to two other standard procedures: electrothermal vaporization determination and high-temperature lithium-metaborate digestion. • We demonstrate that Tiron extraction is an alternative method which allows the rapid, safe and accurate quantification of Si in shoots of various plants covering a wide range of Si concentrations.

Introgressive hybridization in southern African baboons shapes patterns of mtDNA variation

Species, as main evolutionary units have long been considered to be morphological entities with limited hybridization potential. The occurrence of taxa which maintain morphological distinctness despite extensive hybridization is an interesting phenomenon. To understand the evolution of these taxa, descriptions of contemporary morphological and genetic variation are essential, also to reconstruct sound phylogenies. Baboons, with their wide geographic range, variant morphotypes, and extensive hybridization offer an intriguing model for those studies. We focus on the complex situation in southern Africa that, in contrast to east Africa, has been neglected in terms of baboon hybridization history. We aim to clarify the distribution and identify possible overlapping zones between different, previously described mitochondrial (mt) DNA clades of baboons that do not match with the ranges of traditionally recognized species. On the basis of the widespread sampling and mitochondrial cytochrome b gene sequencing, we constructed a phylogenetic tree that separates representatives of the two southern African baboon species, yellow and chacma baboons, into six clades: southern, northern and eastern chacmas, Kinda baboons and southern and Luangwa yellow baboons. The ranges of the chacma clades come into close contact or overlap in two regions in the Republic of South Africa and Namibia. Our phylogenetic reconstruction reveals mitochondrial paraphyly for chacma and yellow baboons, which is probably caused by introgressive hybridization and subsequent nuclear swamping, whereby males of the chacma morphotype population from the south invaded the yellow morphotype population in the north bringing their morphotype into a population that maintained its yellow baboon mtDNA.