Kruppel-like factor 2 (KLF2) regulates monocyte differentiation and functions in mBSA and IL-1β-induced arthritis

Kruppel-like factor 2 (KLF2) plays an important role in the regulation of a variety of immune cells, including monocytes. We have previously shown that KLF2 inhibits proinflammatory activation of monocytes. However, the role of KLF2 in arthritis is yet to be investigated. In the current study, we show that recruitment of significantly greater numbers of inflammatory subset of CD11b(+)F4/80(+)Ly6C+ monocytes to the inflammatory sites in KLF2 hemizygous mice compared to the wild type littermate controls. In parallel, inflammatory mediators, MCP-1, Cox-2 and PAI-1 were significantly up-regulated in bone marrow-derived monocytes isolated from KLF2 hemizygous mice, in comparison to wild-type controls. Methylated-BSA and IL-1β-induced arthritis was more severe in KLF2 hemizygous mice as compared to the littermate wild type controls. Consistent with this observation, monocytes isolated from KLF2 hemizygous mice showed an increased number of cells matured and differentiated towards osteoclastic lineage, potentially contributing to the severity of cartilage and bone damage in induced arthritic mice. The severity of arthritis was associated with the higher expression of proteins such as HSP60, HSP90 and MMP13 and attenuated levels of pPTEN, p21, p38 and HSP25/27 molecules in bone marrow cells of arthritic KLF2 hemizygous mice compared to littermate wild type controls. The data provide new insights and evidences of KLF2-mediated transcriptional regulation of arthritis via modulation of monocyte differentiation and function.

Obtaining high cure rates for challenging facial malignancies: A new method for producing rapid, accurate, high-quality frozen sections

PURPOSE

The authors developed a new system to provide rapid, accurate, full-face frozen sections.

OBJECTIVE

To evaluate the efficacy of the system when applied to the treatment of nonmelanoma cutaneous malignancies using Mohs micrographic surgery (MMS).

METHODS

Patients undergoing MMS procedures between 2003 and 2007 for nonmelanoma head and neck cutaneous malignancies were prospectively collected. Specimens were prepared either in a traditional cryostat-based manner or using the new system.

RESULTS

A total of 196 patients with 234 head and neck nonmelanoma cutaneous malignancies were included. The majority of tumours were basal cell carcinomas (89.5%). Of these, 38% demonstrated aggressive histologies (sclerosing or micronodular), and 30% were recurrent. On average, two levels (range one to six) and four blocks (range two to 23) were required to obtain clear margins. The mean defect size was 3.68 cm(2) (range 0.13 cm(2) to 37.68 cm(2)). Over the five-year study period, there were two recurrences in 234 cases (less than 1%), which compares favourably with other MMS series. The new system was associated with a shorter operative time than traditional specimen preparation (102 min versus 131 min; P=0.004). The new and traditional specimen preparation groups were similar in terms of the number of previous recurrences (29% versus 30%; P=1.00), defect size (3.7 cm(2) versus 4.0 cm(2); P=0.81) and the number of levels required (1.9 versus 1.5; P=0.05).

CONCLUSIONS

The new system enables fast, accurate, full-face frozen section specimens that are ideal for MMS. The speed of specimen preparation is demonstrated by faster operative times, and a low recurrence rate attests the accuracy and quality of the sections.

Clinicopathologic findings in Jamaican men with prostate cancer

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Background: Jamaican men appear to have higher age adjusted incidence rates (302/100K) than African Americans (250/100K) and Caucasians (182/100K). The purpose of this study is to examine the clinicopathologic findings in Jamaican born men presenting to Memorial Sloan-Kettering Cancer Center over a five-year period.

Methods: We reviewed the records of 150 Jamaican-born men seen at MSKCC for prostate cancer between 2003 and 2008. Age at diagnosis, highest pretreatment PSA levels, Gleason scores, and clinical stage were tabulated. Pathologic T and N stage was included for patients undergoing prostatectomy.

Results: 23 patients were excluded because the diagnosis of prostate cancer was not confirmed. The mean age at diagnosis was 59 years (37-77). The median PSA was 8 ng/mL (1-7,400 ng/mL). The distribution of Gleason scores was Gleason 6: 51 patients (40%), Gleason 7: 57 patients (45%), and Gleason 8-10: 19 patients (15%). 92% (75/81) of the men had organ confined disease by (cT1-2) by DRE. Of 46 men who had prostatectomy, 31 (67%) had organ confined disease (p T2) and 84% (37/44) were node negative.

Conclusions: Without a comparison cohort, no firm conclusions can be drawn. But, Jamaican born men presenting to MSKCC for treatment of prostate cancer do not seem to have unusually adverse pretreatment characteristics or more advanced pathological findings at prostatectomy. Our results may be affected by referral bias in favor of patients with lower risk disease. Further research is needed to determine if Jamaican men with prostate cancer present with more advanced stage or higher grade disease than men in the general population.

No significant financial relationships to disclose.

Insights into 'fermentonomics': evaluation of volatile organic compounds (VOCs) in human disease using an electronic 'e-nose'

Detection of volatile organic compounds (VOCs) is a common requirement in industry for which numerous methods are available. The electronic nose (e-nose) is an example. Rather than individual chemicals, the e-nose recognizes the 'aroma fingerprint' created by the collection of VOCs in samples, comparable to the human nose. We report on a novel application for gastrointestinal and metabolic medicine, and compare its results to mass spectrometry. Fermentation of undigested foods in the large bowel by its resident bacteria results in the creation of several chemicals including volatile gases that influence colonic and metabolic health. Using urine samples, preliminary results indicate the ability of the e-nose to distinguish between controls and those with inflammatory bowel disease or diabetes (separation rate of ∼97%). This emphasizes the different patterns of fermentation. Our term 'fermentonomics' describes the investigation and analysis of the fermentome by such non-invasive means. Such an approach has potentially wide application in medicine.

Camelimonas lactis gen. nov., sp. nov., isolated from the milk of camels

Three strains of Gram-negative, rod-shaped, non-spore-forming bacteria (M 2040T, M 1973 and M 1878-SK2), isolated from milk of camels at a camel-milk production farm in the United Arab Emirates, were investigated for their taxonomic allocation. On the basis of 16S rRNA gene sequence similarities, all three strains were shown to belong to the Alphaproteobacteria and were most closely related to Chelatococcus asaccharovorans and Chelatococcus daeguensis (95.1 and 95.2 % sequence similarity to the respective type strains). meso-Diaminopimelic acid was detected as the characteristic peptidoglycan diamino acid. The predominant compound in the polyamine pattern was spermidine, and sym-homospermidine was not detectable. The quinone system was ubiquinone Q-10. The polar lipid profile included the major compounds phosphatidylcholine and diphosphatidylglycerol and moderate amounts of phosphatidylethanolamine, phosphatidylglycerol, an unidentified glycolipid and two unidentified aminolipids. Minor lipids were also detected. The major fatty acid profile, consisting of C19 : 0 cyclo ω8c and C18 : 1 ω7c, with C18 : 0 3-OH as the major hydroxylated fatty acid, was similar to those of the genus Chelatococcus. The results of DNA–DNA hybridization experiments and physiological and biochemical tests allowed both genotypic and phenotypic differentiation of the isolates from described Chelatococcus species. Isolates M 2040T, M 1973 and M 1878-SK2 were closely related on the basis of DNA–DNA reassociation and therefore represent a single novel species. In summary, low 16S rRNA gene sequence similarities of 95 % with Chelatococcus asaccharovorans and marked differences in polar lipid profiles as well as in polyamine patterns support the description of a novel genus and species to accommodate these strains, for which the name Camelimonas lactis gen. nov., sp. nov. is proposed. The type strain of Camelimonas lactis is M 2040T (=CCUG 58638T =CCM 7696T).

Lower-body muscle structure and its role in jump performance during squat, countermovement, and depth drop jumps

The purpose of this study was to examine the relationship between lower-body muscle structure and vertical jump performance. Twenty-five resistance-trained men (age, 23.3 +/- 3.2 years; height, 176.1 +/- 7.4 cm; and weight, 86.2 +/- 11.6 kg) took part in both anatomical and jump performance testing. Muscle fascicle thickness, fascicle length, and pennation angle were analyzed for the vastus lateralis (VL) and the lateral gastrocnemius (LG). Jump height and both relative and absolute power were measured for the squat jump (SJ), countermovement jump (CMJ), and depth drop jump (DDJ). Regressions were used to determine if jump performance could be predicted using the aforementioned structures. No VL measurements were significantly correlated with any of the jump measures. Lateral gastrocnemius pennation angle was a significant but weak predictor of jump height for all 3 jump types (SJ: r2 = 0.212, p = 0.021; CMJ: r2 = 0.186, p = 0.018; DDJ: r2 = 0.263, p = 0.005). When comparing jump height at increasing preloads, none of the variables of interest could significantly predict the jump height differences between CMJ and SJ. However, LG fascicle length had a weak but significant inverse relationship with DDJ-CMJ (r2 = 0.152; p = 0.031). Lateral gastrocnemius thickness was the strongest predictor of absolute power for all jump types and between jump types (SJ: r2 = 0.181, p = 0.034; CMJ: r2 = 0.201, p = 0.014; DDJ: r2 = 0.122, p = 0.049; CMJ-SJ: r2 = 0.201, p = 0.014; DDJ-CMJ: r2 = 0.146, p = 0.034). Lateral gastrocnemius pennation angle was also the best predictor of relative power for all 3 jump types and between jump types (SJ: r2 = 0.172, p = 0.038; CMJ: r2 = 0.416, p = 0.000; DDJ: r2 = 0.167, p = 0.024; CMJ-SJ: r2 = 0.391, p = 0.000; DDJ-CMJ: r2 = 0.136, p = 0.039). Results for jump performance differ from those previously found for sprinting in that greater pennation and shorter fascicles, positively predicting jumping ability at increased prestretch loads reinforcing the need for training specificity. Our findings in resistance-trained men indicate that where jumping is vital to athletic success one can benefit from developing LG muscle architecture along with addressing eccentric strength.

The role of hepatitis E virus testing in drug-induced liver injury

BACKGROUND

Locally acquired hepatitis E is an emerging infection in developed countries and can be misdiagnosed as drug-induced liver injury.

AIM

To study the role of hepatitis E virus (HEV) testing in drug-induced liver injury.

METHODS

Retrospective review of a cohort of patients with suspected drug-induced liver injury (n = 69) and hepatitis E (n = 45). The standard criteria for drug-induced liver injury were applied. Patients with suspected drug-induced liver injury who met these criteria were retrospectively tested for HEV on stored sera taken at the time of presentation. The two cohorts were compared to determine variables that predicted either of the diagnoses.

RESULTS

Forty-seven out of 69 patients had criterion-referenced drug-induced liver injury. 22/47 were HEV negative and thus had confirmed drug-induced liver injury. 19/47 were not tested for HEV, as there was no sera available from the time of presentation. 6/47 were HEV positive and thus did not have drug-induced liver injury, but had hepatitis E infection. Compared to patients with confirmed drug-induced liver injury, patients with hepatitis E were significantly more likely to be male (OR 3.09, CI 1.05-9.08); less likely to present in November and December (0.03, CI 0.01-0.52); have lower serum bilirubin (P = 0.015); and higher serum alanine aminotransferase (P < 0.001) and alanine aminotransferase/alkaline phosphatase ratio (P < 0.001).

CONCLUSION

The diagnosis of drug-induced liver injury is not secure without testing for HEV.

Development and clinical evaluation of a PCR assay targeting the metalloprotease gene (mprA) of B. pseudomallei

A PCR assay targeting the metalloprotease gene (mprA) of Burkholderia pseudomallei was developed for the specific detection of this organism in pure cultures and clinical samples. All other closely related organisms including B. mallei the causative agent of glanders, and B. thailandensis tested negative. Burkholderia pseudomallei DNA was successfully amplified from paraffin-embedded lung tissue of a camel with a generalized B. pseudomallei infection. The developed PCR assay can be used as a simple tool for the specific and sensitive detection of B. pseudomallei.

An integrated treatment approach: a case report for dentinogenesis imperfecta type II

Dentinogenesis imperfecta type II or hereditary opalscent dentin is one of the most common autosomal dominant anomaly of dentin that occurs in both sex affecting approximately 1:8000 persons. Clinically this disorder is characterized by variable blue gray to yellow brown teeth, with fracture of enamel and excessive wear. The treatment strategy is focused towards protecting teeth from further wear and tear and total oral rehabilitation of patient with paramount importance to aesthetics, obtaining an appropriate vertical dimension and providing soft tissue support which will help to return the facial profile to a more normal appearance. A multidisciplinary treatment planning is required for treatment of these individuals.

Oxylipin covered ascospores of Eremothecium coryli

Eremothecium coryli is known to produce intriguing spindle-shaped ascospores with long and thin whip-like appendages. Here, ultra structural studies using scanning electron microscopy, indicate that these appendages serve to coil around themselves and around ascospores causing spore aggregation. Furthermore, using immunofluorescence confocal laser scanning microscopy it was found that hydrophobic 3-hydroxy oxylipins cover the surfaces of these ascospores. Using gas chromatography-mass spectrometry, only the oxylipin 3-hydroxy 9:1 (a monounsaturated fatty acid containing a hydroxyl group on carbon 3) could be identified. Sequential digital imaging suggests that oxylipin-coated spindle-shaped ascospores are released from enclosed asci probably by protruding through an already disintegrating ascus wall.

Cerebral venous sinus thrombosis presenting as subdural haematoma

The authors report a 39-year-old woman who presented with intermittent, excruciating nuchal and occipital headache. Magnetic resonance imaging and magnetic resonance angiography scans showed bilateral subdural haematomas with veno-occlusive disease of the superficial and deep venous systems. There were bridging collaterals with scalp veins, bleeds from which could explain the subdural haematoma. There was acute on chronic veno-occlusive disease with an acute rise in intracranial pressure and a bleed from the vein of Galen.

[Prevalence of Brugada syndrome among 35,309 inhabitants of Lorraine screened at a preventive medicine centre]

Brugada syndrome is a recently identified cause of sudden death. Its primary prevention remains controversial, and epidemiology poorly defined.

PATIENT POPULATION AND METHODS

Electrocardiograms (ECG) of 35,309 individuals (mean age = 37.2 years, 47% men) recorded over a 1-year period were reviewed and classified as (1) typical, (2) suspicious, and (3) negative. Subjects whose ECG was suspicious were offered a provocative test with flecainide, 2 mg/kg, i.v., and individuals whose ECG was typical were advised to undergo programmed ventricular stimulation (PVS).

RESULTS

In 14 men and 6 women between the ages of 24 and 77 years (mean =47.5), ECGs were typical (n=6) or suspicious (n=14). Among 6 subjects with typical ECGs, 3 underwent PVS, which was positive in 1, who received an implantable cardioverter defibrillator (ICD). Among 14 subjects whose ECGs were suspicious, 5 declined further investigations and 5 developed typical ECG characteristics of Brugada syndrome after flecainide administration. PVS was negative in 4 subjects who consented to the procedure. Overall, among 35,309 individuals screened, 11 had ECG findings consistent with Brugada syndrome and, over a follow-up of 30 months, all had remained free of adverse cardiac event.

CONCLUSIONS

we estimated a prevalence of Brugada syndrome of 0.3% in Lorraine. A single patient received an ICD for inducible ventricular tachyarrhythmia during PVS, representing a potential 30 per million asymptomatic adult rate of ICD implantation for this indication.

Psychometric characteristics of simulation-based assessment in anaesthesia and accuracy of self-assessed scores

The purpose of this study was to define the psychometric properties of a simulation-based assessment of anaesthetists. Twenty-one anaesthetic trainees took part in three highly standardised simulations of anaesthetic emergencies. Scenarios were videotaped and rated independently by four judges. Trainees also assessed their own performance in the simulations. Results were analysed using generalisability theory to determine the influence of subject, case and judge on the variance in judges' scores and to determine the number of cases and judges required to produce a reliable result. Self-assessed scores were compared to the mean score of the judges. The results suggest that 12-15 cases are required to rank trainees reliably on their ability to manage simulated crises. Greater reliability is gained by increasing the number of cases than by increasing the number of judges. There was modest but significant correlation between self-assessed scores and external assessors' scores (rho = 0.321; p = 0.01). At the lower levels of performance, trainees consistently overrated their performance compared to those performing at higher levels (p = 0.0001).

The perimeter technique for lentigo maligna: an alternative to Mohs micrographic surgery

BACKGROUND

Lentigo maligna (LM) presents a challenge for complete surgical excision because of its extensive subclinical spread and predilection for the face.

OBJECTIVE

To report our experience using the staged perimeter technique as an alternative to Mohs micrographic surgery for treatment of LM.

METHODS

The perimeter procedure was performed on 11 patients with LM between March 2003 and June 2004. Data on patient and lesion characteristics, number of stages required to obtain clear margins, and follow-up was obtained by chart review.

RESULTS

A mean of 1.9 stages were required to achieve clear margins. A mean of 7 tissue specimens were sent to pathology per patient for evaluation. After a mean follow-up of 4.7 months, all patients were free of recurrence.

CONCLUSIONS

The perimeter technique is a simple method of margin-controlled excision of LM. The main advantage is that all margins are examined with permanent sections. The main drawback is that multiple operative sessions are required to complete the procedure. This technique does not require specific Mohs training and is therefore applicable to non-Mohs surgeons.

Tetanus in a camel (Camelus dromedarius)--a case report

Twenty days after an open castration, a 5-year-old dromedary was presented to the Dubai Camel Hospital with severe central nervous symptoms. The dromedary showed the following signs: off feed, stiff gait with extended neck, external swelling of the preputial sheath and groin region, and foamy saliva drooling from the mouth. The dromedary was unable to swallow. Three days after admission, the camel developed lockjaw, and on the fifth day it was unable to stand owing to paralysis of the hindquarters. Because of the severity of the disease and because it did not respond to treatment, the camel was euthanized 26 days after the operation and submitted to the Central Veterinary Research Laboratory for further investigation. Both castration wounds were closed and spermiducts were filled with necrotic masses from which Clostridium tetani was isolated. Two mice, which were injected with the filtrate of the thioglycolate broth, developed typical signs of tetanic spasm of the hind leg. Faecal samples from camel and horse paddocks that were only 50 metres apart were negative for C. tetani. However, C. tetani was isolated from two soil samples of the horse paddock. It is recommended that camels should be vaccinated against tetanus prior to castration.