Candida albicans-associated necrotizing vasculitis producing life-threatening gastrointestinal hemorrhage

Patients undergoing treatment of acute lymphoblastic leukemia are at risk for fungal infections including disseminated candidiasis. We describe a case of systemic Candida albicans infection associated with life-threatening gastrointestinal hemorrhage due to unusual necrotizing vasculitis involving the gastrointestinal tract. We explore the association between Candida and such vasculopathy.

Police lie detection accuracy: the effect of lie scenario

Although most people are not better than chance in detecting deception, some groups of police professionals have demonstrated significant lie detection accuracy. One reason for this difference may be that the types of lies police are asked to judge in scientific experiments often do not represent the types of lies they see in their profession. Across 23 studies, involving 31 different police groups in eight countries, police officers tested with lie detection scenarios using high stakes lies (i.e., the lie was personally involving and/or resulted in substantial rewards or punishments for the liar) were significantly more accurate than law enforcement officials tested with low stakes lies. Face validity and construct validity of various lie scenarios are differentiated.

Widespread dysregulation of MiRNAs by MYCN amplification and chromosomal imbalances in neuroblastoma: association of miRNA expression with survival

MiRNAs regulate gene expression at a post-transcriptional level and their dysregulation can play major roles in the pathogenesis of many different forms of cancer, including neuroblastoma, an often fatal paediatric cancer originating from precursor cells of the sympathetic nervous system. We have analyzed a set of neuroblastoma (n = 145) that is broadly representative of the genetic subtypes of this disease for miRNA expression (430 loci by stem-loop RT qPCR) and for DNA copy number alterations (array CGH) to assess miRNA involvement in disease pathogenesis. The tumors were stratified and then randomly split into a training set (n = 96) and a validation set (n = 49) for data analysis. Thirty-seven miRNAs were significantly over- or under-expressed in MYCN amplified tumors relative to MYCN single copy tumors, indicating a potential role for the MYCN transcription factor in either the direct or indirect dysregulation of these loci. In addition, we also determined that there was a highly significant correlation between miRNA expression levels and DNA copy number, indicating a role for large-scale genomic imbalances in the dysregulation of miRNA expression. In order to directly assess whether miRNA expression was predictive of clinical outcome, we used the Random Forest classifier to identify miRNAs that were most significantly associated with poor overall patient survival and developed a 15 miRNA signature that was predictive of overall survival with 72.7% sensitivity and 86.5% specificity in the validation set of tumors. We conclude that there is widespread dysregulation of miRNA expression in neuroblastoma tumors caused by both over-expression of the MYCN transcription factor and by large-scale chromosomal imbalances. MiRNA expression patterns are also predicative of clinical outcome, highlighting the potential for miRNA mediated diagnostics and therapeutics.

The optimum length of the Silfverskiöld circumferential cross stitch

Three groups of six porcine deep flexor tendons were repaired with a locking loop modified Kessler core suture using 4-0 braided polyester. Silfverskiöld repairs were performed using 6-0 monofilament nylon taking bites 2, 4 and 6 mm from the cut end of the tendon. The repairs were tested to failure and record made of bulking, mode of failure, force to produce a 3 mm gap and the ultimate strength. Data were analysed using one-way ANOVA, with analysis of mode of failure using the Chi-squared test. The 4 mm repairs were significantly stronger than the 2 mm for all parameters but there was no difference between the 4 mm and 6 mm repairs. We feel that optimal repair strength is provided using bites 4 mm from the cut tendon ends. Taking bites further from the cut end has no significant benefits and carries the theoretical risk of increasing the work of flexion.

Obstetric risk factors for urinary incontinence and preventative pelvic floor exercises: Cohort study and nested randomized controlled trial

We conducted a cohort study assessing risk factors for developing urinary incontinence following childbirth, and a pilot randomized controlled trial of a physiotherapist-led intervention to reduce incidence of incontinence. A total of 723 women were recruited to the cohort study, of which 234 entered the nested trial and were randomized to intensive training in pelvic floor exercises or standard information. At 6 months post-partum, 45% of women reported some incontinence problems. A pre-existing incontinence problem was the best predictor of future incontinence (odds ratio 4.49, 95% confidence interval (CI) 3.09-6.53). Chronic constipation (1.86, 1.03-3.34) and episiotomy in at least one delivery (1.96, 1.25-3.07) were also independent risk factors, while an epidural or spinal (0.62, 0.42-0.92) was protective. The intervention as designed did not help in preventing future incontinence (relative risk 1.28, 95% CI 0.98-1.67), but this may be due to the failure to persuade the women to return for the classes. Any intervention aimed at promoting postnatal pelvic floor exercises should be limited to women who have already been experiencing incontinence problems.

Lin28 promotes transformation and is associated with advanced human malignancies

Multiple members of the let-7 family of miRNAs are often repressed in human cancers1,2, thereby promoting oncogenesis by de-repressing the targets K-Ras, c-Myc, and HMGA2 3,4. However, the mechanism by which let-7 miRNAs are coordinately repressed is unclear. The RNA-binding proteins Lin28 and Lin28B block let-7 precursors from being processed to mature miRNAs5–8, suggesting that over-expression of Lin28/Lin28B might promote malignancy via repression of let-7. Here we show that LIN28 and LIN28B are over-expressed in primary human tumors and human cancer cell lines (overall frequency ∼15%), and that over-expression is linked to repression of let-7 family miRNAs and de-repression of let-7 targets. Lin28/Lin28B facilitate cellular transformation in vitro, and over-expression is associated with advanced disease across multiple tumor types. Our work provides a mechanism for the coordinate repression of let-7 miRNAs observed in a subset of human cancers, and associates activation of LIN28/LIN28B with poor clinical prognosis.

Application of phage display to high throughput antibody generation and characterization

A phage display library has been constructed containing over 1010 human antibodies, allowing the large-scale generation of antibodies. Over 38,000 recombinant antibodies against 292 antigens were selected, screened and sequenced, and 4,400 resultant unique clones characterized further.

We have created a high quality phage display library containing over 10¹⁰ human antibodies and describe its use in the generation of antibodies on an unprecedented scale. We have selected, screened and sequenced over 38,000 recombinant antibodies to 292 antigens, yielding over 7,200 unique clones. 4,400 antibodies were characterized by specificity testing and detailed sequence analysis and the data/clones are available online. Sensitive detection was demonstrated in a bead based flow cytometry assay. Furthermore, positive staining by immunohistochemistry on tissue microarrays was found for 37% (143/381) of antibodies. Thus, we have demonstrated the potential of and illuminated the issues associated with genome-wide monoclonal antibody generation.

Rapidly progressive neurological deterioration in a child with Alpers syndrome exhibiting a previously unremarkable brain MRI

Alpers syndrome is a fatal disorder due to mutations in the POLG gene encoding the catalytic subunit of mitochondrial DNA polymerase gamma (Pol gamma) involved in mitochondrial DNA (mtDNA) replication. We describe a case of Alpers syndrome due to POLG mutations, with rapidly progressive course, a fatal outcome, and an essentially normal brain MRI in the early oligo-symptomatic phase. Our observation suggests that Alpers syndrome should be considered even in patients with an initially unremarkable brain MRI. The patient was found to harbor the p.Q497H, p.W748S and p.E1143G mutations in cis on one allele, and a fourth mutation, the p.G848S on the other allele. Although the individual mutations detected in the presented case have been previously reported, the specific genotype formed by the particular combination of these is novel.

The E3 ligase HACE1 is a critical chromosome 6q21 tumor suppressor involved in multiple cancers

Transformation and cancer growth are regulated by the coordinate actions of oncogenes and tumor suppressors. Here, we show that the novel E3 ubiquitin ligase HACE1 is frequently downregulated in human tumors and maps to a region of chromosome 6q21 implicated in multiple human cancers. Genetic inactivation of HACE1 in mice results in the development of spontaneous, late-onset cancer. A second hit from either environmental triggers or genetic heterozygosity of another tumor suppressor, p53, markedly increased tumor incidence in a Hace1-deficient background. Re-expression of HACE1 in human tumor cells directly abrogates in vitro and in vivo tumor growth, whereas downregulation of HACE1 via siRNA allows non-tumorigenic human cells to form tumors in vivo. Mechanistically, the tumor-suppressor function of HACE1 is dependent on its E3 ligase activity and HACE1 controls adhesion-dependent growth and cell cycle progression during cell stress through degradation of cyclin D1. Thus, HACE1 is a candidate chromosome 6q21 tumor-suppressor gene involved in multiple cancers.

Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial

As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed.

Lacunar lesions are independently associated with disability and cognitive impairment in CADASIL

OBJECTIVE

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy caused by mutations of the Notch3 gene. The disease is characterized by T2-hyperintense lesions (subcortical white matter lesions), T1-hypointense lesions (lacunar lesions), and T2*-weighted gradient-echo (GE) lesions (cerebral microhemorrhages [CMs]) visualized on clinical MRI sequences and is considered as a model of "pure" subcortical ischemic vascular dementia. Although numerous studies have investigated the impact of white matter lesions in patients with CADASIL, the clinical importance of lacunar lesions remains unknown. Our purpose was to examine the influence of the visible MRI markers in the disease, including the load of lacunar lesions on cognitive impairment and disability in CADASIL.

METHODS

We collected clinical data from 147 consecutive patients enrolled in an ongoing two-center prospective cohort study. Degree of disability was assessed by modified Rankin scale and Barthel index. Degree of cognitive impairment was assessed by Mattis Dementia Rating Scale and Mini-Mental Status Examination. T1-weighted, fluid-attenuated inversion recovery, and GE images were obtained on a 1.5-T MRI. Volume and location of lacunar lesions, white matter hyperintensities (WMHs), and CMs were assessed.

RESULTS

There was a significant independent association between age, volume of lacunar lesions, and global cognitive function scales when analyzed in a multivariable model. In contrast, WMHs and CMs had no independent influence on cognitive function. Disability in this cohort was associated with volume of lacunar lesions, CMs, systolic blood pressure, and age but not with WMHs.

CONCLUSIONS

Among the lesions observed on conventional MRI in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the overall lacunar lesion burden seems to have the most important impact on cognitive function and disability. These findings suggest that preventive strategies to decrease the risk of lacunar lesions as observed on MRI may reduce disease-related impairment in CADASIL. These results suggest that lacunar lesions may also play a key role in disability and cognitive impairment in more common forms of small-vessel disease.

CT and MRI 'ring sign' may be due to demyelination: diagnostic pitfall

We report a case of acute demyelinating encephalomyelitis (ADEM) in which both CT and MRI showed multiple ring-enhancing lesions suggestive of abscesses or brain tumour. This is a relatively rare phenomenon.

Hydrogen peroxide derived from amine oxidation mediates the interaction between aminosugars and semicarbazide-sensitive amine oxidase

Semicarbazide-sensitive amine oxidase (SSAO) also functions as a vascular-adhesion protein (VAP-1). The nature of the target site on lymphocytes to which endothelial-cell SSAO/VAP-1 binds is unknown. We have shown that amino sugars (galactosamine, glucosamine and mannosamine), which are not SSAO substrates, can bind to the enzyme as reversible inhibitors. Thus, they serve as a model system in which to study the interaction process. Binding occurred during substrate (benzylamine) oxidation but not when the amino sugar was incubated, for extended periods, with SSAO alone. These results suggest that one, or more of the products of the SSAO-catalysed amine oxidation might be necessary for the inhibitory process to occur. Two of the reaction products of benzylamine oxidation, benzaldehyde and ammonia were found to have no effect on the inhibition of SSAO by galactosamine. Preincubation of the enzyme with galactosamine plus H(2)O(2) was, however, found to result in time-dependent inhibition. This is not a result of the non-enzymic reaction between H(2)O(2) and the amino sugar, since preincubation of galactosamine with H(2)O(2) alone, for extended periods, did not give rise to an inhibitory species. The amount of exogenously added H(2)O(2) necessary for inhibition was very much greater than that formed during substrate oxidation. These results suggest that the H(2)O(2) formed as a product of the SSAO-catalysed oxidation reaction is more efective in promoting the binding of amino sugars.

Design of surface electrode array for electromyography in the genioglossus muscle

The patency of the upper airway is dependent on the sustained activity of upper airway muscles, in particular the genioglossus (GG) muscles which act to protrude the tongue. Obstructive sleep apnea syndrome (OSAS) is a common and serious disorder in which this mechanism fails, resulting in frequent collapse of the airway during sleep. The properties of the upper airway muscles are therefore of interest in both normal and OSAS subjects, so that their role in the pathogenesis of OSAS can be better understood. Electromyography (EMG) is an important tool for assessing muscle activity and has been used in many GG studies. We have designed a new appliance incorporating a surface electrode array for GG EMG recording. The electrode configuration enables estimation of muscle fibre conduction velocity (CV), an important parameter for monitoring muscle fatigue, which has not been studied before in the GG. The appliance is also designed to provide accurate and repeatable placement of electrodes. Preliminary results presented demonstrate the performance of our appliance, which will now be used to measure GG CV in a range of fatiguing conditions.

Unicorns or Tiger Woods: are lie detection experts myths or rarities? A response to on lie detection "wizards" by Bond and Uysal

Bond and Uysal (this issue) complain that expert lie detectors identified by O'Sullivan and Ekman (2004) are statistical flukes. They ignore one class of experts we have identified and misrepresent the procedures we use to identify the others. They also question the psychometric validity of the measures and protocol used. Many of their points are addressed in the chapter they criticize. The fruitfulness of the O'Sullivan-Ekman protocol is illustrated with respect to improved identification of expert lie detectors, as well as a replicated pattern of errors made by experts from different professional groups. The statistical arguments offered confuse the theoretical use of the binomial with the empirical use of the normal distribution. Data are provided that may clarify this distinction.

55. HIGH EFFICACY OF A HPV-16/18 L1 VIRUS-LIKE PARTICLE (VLP) VACCINE ADJUVANTED WITH AS04 AGAINST CIN2+ CAUSED BY HPV-16/18 INFECTION IN A BROAD POPULATION OF YOUNG WOMEN

Objectives: Previous studies with the HPV-16/18 L1 VLP AS04 vaccine have shown 100% efficacy against HPV 16/18 associated persistent infection and CIN in women with no previous exposure to oncogenic HPV. This interim analysis of a phase III, randomized, controlled trial assessed vaccine efficacy against HPV 16/18 associated CIN2+ and persistent infection with oncogenic HPV types in a broad population of women. Methods: Healthy women, aged 15-25 years, with d6 sexual partners and no previous colposcopy were eligible and were randomly allocated to 3 doses of HPV or hepatitis A (control) vaccine at 0, 1, 6 months. Serum antibodies for HPV 16/18 were assessed by ELISA. HPV DNA was detected by PCR on cervical cytology and biopsy. Vaccine efficacy was assessed in women who received at least one vaccine dose, had normal or low-grade cytology and were HPV 16/18 sero- and DNA negative at entry. Additional analyses were undertaken to assign causality where multiple HPV types were present. Immunogenicity was evaluated in a subset of women and safety was assessed in the entire vaccinated cohort. Results: 18729 women from Asia Pacific (34%), Europe (34%), North (16.5%) and Latin America (14.9%) were enrolled. 18525 were included in the cohort for vaccine efficacy analyses. Mean age was 20 years and mean follow up 15 months from dose 1. Most HPV 16/18 infections were detected prior to dose 3 in this analysis. Of 23 CIN2+ lesions associated with HPV 16/18, 14 contained multiple oncogenic HPV types: three showed no preceding infection or E4 gene expression for the relevant HPV vaccine type. Vaccine efficacy according to HPV DNA detected in the lesion was 90.4% (95% CI, 53.4-99.3); after additional analyses for causality assignment, efficacy was 100% (95% CI: 74.2-100). Cross-protection against 6-months infection with HPV-45, -31, -52; and broad protection against 12-month persistent non-16/18 oncogenic HPV infection was also demonstrated. Seroconversion was 99.5% after dose 2 and 3. Safety profiles were comparable between groups. Conclusions: In a broad cohort of women, high vaccine efficacy was observed against CIN2+ caused by HPV-16/18.

Attitudes of general dental practitioners in Europe to the microbial risk associated with dental unit water systems

Dental Unit Water Systems (DUWS) are used in dental practices to provide water for cooling of dental equipment and irrigation of the oral cavity. However, they have been demonstrated to be contaminated with micro-organisms. There are currently no European Union (EU) Commission guidelines for the microbial quality of water discharged by DUWS. This study was part of an EU research programme to investigate the microbial contamination of DUWS in general dental practice (GDP) in the UK, Denmark, Germany, The Netherlands, Ireland, Greece and Spain.

OBJECTIVE

To undertake a questionnaire survey on the type of DUWS in use and determine the attitude of GDPs to the risk of microbial infection from DUWS.

MATERIALS AND METHODS

The questionnaire was written and translated into the language of each country before being posted to each participating dentist. Dentists were asked to complete the questionnaire survey and return it by post.

RESULTS AND CONCLUSIONS

The major findings were that the majority of dentists did not clean, disinfect or determine the microbial load of their DUWS, and that dentists would welcome regular monitoring and advice on maintaining their DUWS; the introduction of guidelines; and recommendations on controlling the microbial load of DUWS.

Damage within a network of white matter regions underlies executive dysfunction in CADASIL

OBJECTIVE

To identify the important sites of white matter disruption that underpin executive dysfunction in CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), a genetic model of pure subcortical vascular disease.

METHODS

The anatomic pattern of correlation between tissue integrity and executive function was explored with diffusion tensor imaging (DTI), which provides quantitative measures of tissue integrity. Eighteen nondemented patients with CADASIL underwent DTI and cognitive assessment. DTI was normalized to a standard template and correlations assessed at every voxel across the brain with Statistical Parametric Mapping with cluster-level correction for multiple comparisons.

RESULTS

For executive tasks, correlations were found in a number of discrete regions in the white matter of the frontal lobes. A distinct, nonoverlapping pattern of correlation was seen for verbal memory. Significant independent correlations remained in some regions after co-varying for age and IQ.

CONCLUSIONS

Different cognitive functions correlate with structural integrity at different sites in the white and subcortical gray matter. The distribution of regions correlating specifically with executive function provides clues to the organization of the relevant cognitive networks and their important white matter projections. The cingulum bundle is one candidate tract that may carry anteroposterior connections important for executive processes.

Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European Union

Water delivered by dental unit water systems (DUWS) in general dental practices can harbor high numbers of bacteria, including opportunistic pathogens. Biofilms on tubing within DUWS provide a reservoir for microorganisms and should be controlled. This study compared disinfection products for their ability to meet the American Dental Association's guideline of <200 CFU x ml(-1) for DUWS water. Alpron, BioBlue, Dentosept, Oxygenal, Sanosil, Sterilex Ultra, and Ster4Spray were tested in DUWS (n = 134) in Denmark, Germany, Greece, Ireland, The Netherlands, Spain, and the United Kingdom. Weekly water samples were tested for total viable counts (TVCs) on yeast extract agar, and, where possible, the effects of products on established biofilm (TVCs) were measured. A 4- to 5-week baseline measurement period was followed by 6 to 8 weeks of disinfection (intermittent or continuous product application). DUWS water TVCs before disinfection ranged from 0 to 5.41 log CFU x ml(-1). Disinfectants achieved reductions in the median water TVC ranging from 0.69 (Ster4Spray) to 3.11 (Dentosept) log CFU x ml(-1), although occasional high values (up to 4.88 log CFU x ml(-1)) occurred with all products. Before treatment, 64% of all baseline samples exceeded American Dental Association guidelines, compared to only 17% following commencement of treatment; where tested, biofilm TVCs were reduced to below detectable levels. The antimicrobial efficacies of products varied (e.g., 91% of water samples from DUWS treated with Dentosept or Oxygenal met American Dental Association guidelines, compared to 60% of those treated with Ster4Spray). Overall, the continuously applied products performed better than those applied intermittently. The most effective products were Dentosept and Oxygenal, although Dentosept gave the most consistent and sustained antimicrobial effect over time.

White matter damage on diffusion tensor imaging correlates with age-related cognitive decline

BACKGROUND

Damage to white matter tracts, resulting in "cerebral disconnection," may underlie age-related cognitive decline.

METHODS

Using diffusion tensor MRI (DTI) to investigate white matter damage, and magnetic resonance spectroscopy (MRS) to look at its underlying pathologic basis, the authors investigated the relationship between white matter structure and cognition in 106 healthy middle-aged and elderly adults. Fractional anisotropy (FA) and mean diffusivity (MD) values, whole brain white matter histograms, and regions of interest placed in the white matter of the centrum semiovale were analyzed. Correlations with executive function, working memory, and information-processing speed were performed.

RESULTS

There was a progressive reduction in FA and increase in diffusivity with age in both region of interest (r = 0.551, p < 0.001), and whole brain histograms (r = 0.625, p < 0.001). DTI values correlated with performance in all three cognitive domains. After controlling for age, DTI parameters correlated with working memory but not with the other two cognitive domains. MRS studies found a correlation of N-acetyl aspartate, a neuronal marker, with DTI parameters (r = 0.253, p < 0.05).

CONCLUSION

The results are consistent with white matter damage due to axonal loss, causing age- related cognitive decline. Working memory may be particularly dependent on complex networks dependent on white matter connections.

From flawed self-assessment to blatant whoppers: the utility of voluntary and involuntary behavior in detecting deception

Malingering occupies a range on a continuum from biased self-perception to conscious, deliberate, serious lies. One aspect of this continuum is the element of self-conscious or deliberate control. Suggestions from Darwin's writings concerning the role of voluntary and involuntary activation of the facial muscles are examined and illustrated with data from a 40 year program of research on deception. The impact of the voluntary-involuntary distinction on the appearance, timing, symmetry and cohesion of facial expressions of emotion is explained. Data relevant to changes in vocal and gestural aspects of demeanor in honest and deceptive behavior are also reviewed. The relevance of these laboratory-based findings on the voluntary control of nonverbal behavior in assessing some types of malingering is discussed.

A characterization of anaerobic colonization and associated mucosal adaptations in the undiseased ileal pouch

INTRODUCTION

The resolution of pouchitis with metronidazole points to an anaerobic aetiology. Pouchitis is mainly seen in patients with ulcerative colitis pouches (UCP). We have recently found that sulphate reducing bacteria (SRB), a species of strict anaerobe, colonize UCP exclusively. Herein, we aimed to correlate levels of different bacterial species (including SRB) with mucosal inflammation and morphology.

METHODS

Following ethical approval, fresh faecal samples and mucosal biopsies were taken from 9 patients with UCP and 5 patients with familial adenomatous polyposis pouches (FAPP). For the purposes of comparison, faecal samples and mucosal biopsies were also taken from the stomas of 7 of the 9 patients with UC (UCS). Colonization by four types of strict anaerobes (SRB, Clostridium perfringens, Bifidobacteria and Bacteroides) as well as by three types of facultative anaerobes (Enterococci, Coliforms and Lactobacilli) was evaluated. Inflammatory scores and mucosal morphology were assessed histologically in a blinded fashion by a pathologist.

RESULTS

In general, strict anaerobes predominated over facultative in the UCP (P = 0.041). SRB were present in UCP exclusively. Even after exclusion of SRB from total bacterial counts, strict anaerobes still predominated. In the UCS, facultative anaerobes predominated. Strict and facultative anaerobes were present at similar levels in the FAPP. Enterococci were present at significantly reduced levels in the UCP when compared with the UCS (P = 0.031). When levels of SRB and other anaerobic species were individually correlated with mucosal inflammation and morphology, no trends were observed.

CONCLUSION

We have previously identified that SRB exclusively colonize UCP. In addition we have now identified a novel increase in the strict/facultative anaerobic ratio within the UCP compared to UCS. These stark differences in bacterial colonization, however, appear to have limited impact on mucosal inflammation or morphology.

Tumor heterogeneity affects the precision of microarray analysis

Microarray-based analysis of global gene expression patterns defines groups of genes that correlate with specific tumor types and prognosis, but the identified genes may not all be of equal clinical utility due to technical factors that affect the precision of their measurement. To analyze how technical variability in measured expression levels may impact microarray-based analysis in a clinical setting, we used Ewing sarcoma/peripheral neuroectodermal tumor (EWS/PNET) in a model system that replicates the clinical scenario in which microarray-based analysis of gene expression will likely occur, namely analysis of a fresh tumor sample by a single chip. By comparing variability of measured expression due to purely technical factors with variability due to biologic factors, we confirm that variability is dependent on the level of gene expression. We also demonstrate that the variability in expression level from either cell line or tumor samples is significantly higher than can be attributed to specific probe sets that have an intrinsically poor performance. These results have significant impact on the application of cDNA microarray chip for molecular analysis performed in a clinical setting.

Brief cognitive assessment for patients with cerebral small vessel disease

BACKGROUND

Cerebral small vessel disease is a common cause of cognitive impairment and vascular dementia. The cognitive deficit differs from that in Alzheimer's disease, with greater executive/attentional dysfunction and relatively intact episodic memory.

OBJECTIVE

To develop brief assessment tools that are better adapted to the neuropsychological profile of cerebral small vessel disease.

METHODS

32 subjects with ischaemic leukoaraiosis (history of lacunar stroke and leukoaraiosis on MRI), aged 50 to 84 years, and 17 age and education matched controls had a brief executive assessment, which took 20 minutes to administer, and a wide range of additional tests. The ability of the brief executive assessment to discriminate between groups-both individually and in combination-was evaluated and compared with that of the whole battery.

RESULTS

The brief executive assessment provided good sensitivity and specificity for identifying subjects with ischaemic leukoaraiosis (sensitivity 88%, specificity 88%, using the optimal combination of scores). The best individual tests were trail making and digit symbol, which were both far more sensitive than the mini-mental state examination (MMSE). The ability to discriminate between groups was maintained in subjects with MMSE > 27 and across the whole age range. The brief executive assessment performed well compared with the whole battery, with additional tests accounting for only a further 12% of between-group variance.

CONCLUSIONS

The brief executive assessment was sensitive to deficits found in ischaemic leukoaraiosis and discriminated them from the cognitive effects of healthy aging. The assessment has potential for bedside use and as a cognitive end point for clinical trials.

Microbial contamination of dental unit water systems

INTRODUCTION

Dental unit water systems (DUWS) may serve as a reservoir for biofilms that contribute to high numbers of bacteria in the water used during dental treatment. These microbes are predominantly harmless but potentially pathogenic organisms can also be present in the biofilm. This may pose a potential health risk for patients and dental personnel.

AIM

to determine the microbial levels of DUWS in dental practices.

MATERIALS AND METHOD

A cross-sectional study of water and tubing samples from 30 general dental practices (15 health board and 15 private surgeries) was undertaken as part of a pan-European investigation of the microbial qualitative and quantitative aspects of DUWS.

RESULTS

Microbial loads ranged from 100 to 104 cfu ml-1 and exceeded the European guidelines for drinking water in many cases. The available evidence suggested the presence of isolates most likely belonging to families of aquatic and soil bacteria. It was not possible to draw distinct conclusions correlating microbial loads with dental unit parameters, including age of the unit, water source and chemistry and presence or absence of anti-retraction devices. Opportunistic or true pathogens were not detected. Yeasts were observed in samples from three units although further analysis confirmed that these were not Candida albicans. A decontamination strategy applied to one of the units eliminated the yeasts completely.

CONCLUSIONS

Dental practitioners must be knowledgeable regarding microbial contamination and biofilm formation in dental unit waterlines. There is a need for development of European evidence-based guidelines and reliable control regimes for microbial contamination of DUWS.

Primary desmoplastic small round cell tumor of bone: report of a case with cytogenetic confirmation

We report a case of desmoplastic small round cell tumor occurring in the right ilium of a 13-year-old boy. Morphologically, the neoplasm consisted of small round cells of primitive appearance with a diffuse growth pattern replacing marrow space and eroding bone. Immunohistochemical staining was positive for vimentin, synapsin, CD99 (MIC2 protein), and FLI-1, prompting an initial diagnosis of Ewing sarcoma/primitive neuroectodermal tumor. However, a diagnosis of desmoplastic small round cell tumor was rendered after the detection by cytogenetic analysis of the reciprocal chromosomal translocation, t(11;22)(p13;q12), which is uniquely associated with this tumor. This is the first documented instance of desmoplastic small round cell tumor arising in bone.

Attitudes of Irish and European dentists to water quality of dental unit water systems

BACKGROUND

Dental unit water systems (DUWS) are used in dental practices to provide water to irrigate the oral cavity. Dental surgeries across the European Union (EU) use DUWS that may be prone to microbial contamination.

OBJECTIVES

To determine Irish dental practitioners' attitudes to perceived risk from working with DUWS and their protocols for the management of biofilm in their DUWS and compare these with other European dentists.

DESIGN

A questionnaire was used to determine DUWS types in use, practitioners' attitudes to risks associated with using DUWS and their DUWS management protocols.

RESULTS

There were six different types of DUWS, 40 per cent of which were > 5 years old, 42 per cent of DUWS were fed by purified or distilled water. Only four per cent of practitioners carried out microbiological analysis on their water, but 38 per cent indicated that they cleaned or disinfected their DUWS. One-hundred per cent of practitioners were not aware of national/international guidelines for microbial contamination of DUWS but 77 per cent were concerned about DUWS water quality.

CONCLUSIONS

The majority of practitioners were working with equipment that is < 5 years old. The majority of DUWS were not treated but practitioners were concerned about dental unit water quality and would welcome regular microbiological water tests and clear advice on cleaning/disinfection of the water supply in their dental units. Practitioner attitudes and behaviours were broadly similar in the other European countries studied.

Microbiological evaluation of dental unit water systems in general dental practice in Europe

A range of opportunistic pathogens have been associated with dental unit water systems (DUWS), particularly in the biofilms that can line the tubing. This study therefore aimed to assess the microbiology of DUWS and biofilms in general dental practices across seven European countries, including the United Kingdom (UK), Ireland (IRL), Greece (GR), Spain (ES), Germany (D), Denmark (DK) and the Netherlands (NL). Water supplied by 51% of 237 dental unit water lines exceeded current American Dental Association recommendations of < or = 200 colony-forming units (CFU) ml(-1). Microbiological loading of the source waters was between 0 (Denmark, the Netherlands and Spain) and 4.67 (IRL) log CFU ml(-1); water line samples from the DUWS ranged from 1.52 (ES) to 2.79 (GR) log CFU ml(-1); and biofilm counts ranged from 1.49 (GR) to 3.22 (DK) log CFU.cm(-2). Opportunistic pathogens such as legionellae (DK and ES), including Legionella pneumophila SG1 (DK and GR), and Mycobacterium spp. (DK, NL, GR, D and ES) were recovered occasionally. Presumptive oral streptococci (ES and NL), oral anaerobes (GR), Candida spp. (UK, NL and ES) and blood (GR and IRL) were detected at relatively low frequencies, but their presence indicated a failure of the 3-in-1 antiretraction valve, leading to back siphonage of oral fluids into the water and biofilm phase. These findings confirm that a substantial proportion of DUWS have high levels of microbial contamination, irrespective of country, type of equipment and source water. The study emphasizes the need for effective mechanisms to reduce the microbial burden within DUWS, and highlights the risk of occupational exposure and cross-infection in general dental practice.

NOD2/CARD15, TLR4 and CD14 mutations in Scottish and Irish Crohn's disease patients: evidence for genetic heterogeneity within Europe?

NOD2/caspase recruitment domain (CARD)15 variants are identified in up to 50% of Crohn's disease (CD) patients. Functional variants of toll-like receptor-4 (TLR4) and CD14 genes may also be relevant to disease pathophysiology. We aimed to assess the contribution of NOD2/CARD15, TLR4 and CD14 variants in Scottish and Irish CD patients. In all, 612 patients with well-characterised inflammatory bowel disease (252 Scottish CD, 247 Scottish UC, 113 Irish CD) and 304 controls were genotyped for variants of NOD2/CARD15 (1007fsinsC, G908R, R702W, P268S), TLR4 (A299G) and CD14 (T-159C). Genotype-phenotype analyses were performed. Variant 1007fsinsC (P=0.003) and G908R (P=0.008) but not R702W (P=0.269) alleles were more prevalent in Scottish CD (4.7, 1.8 and 7.1%, respectively) than Scottish control (2.3, 0.3 and 5.4%). CD allelic frequencies were lower than the series from Europe (P<0.00001) and North America (P<0.00001) but not Scandinavia (P<0.7). Associations were identified with age at diagnosis (P=0.002), ileal disease (P<0.02), penetrating disease (P=0.04) and inflammatory joint disease (P<0.02). TLR4 and CD14 variants did not differ between CD and controls. In conclusion, we present compelling evidence for genetic heterogeneity within Europe. These NOD2/CARD15 variants have a minor contribution in Scottish and Irish CD patients, consistent with an emerging pattern from Northern Europe.

Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis

BACKGROUND

Cerebral small vessel disease is a common cause of vascular dementia. Both discrete lacunar infarcts and more diffuse ischaemic changes, seen as confluent high signal (leukoaraiosis) on T2 weighted magnetic resonance imaging (MRI), occur. However, there is a weak correlation between T2 lesion load and cognitive impairment. Diffusion tensor MRI (DTI) is a new technique that may provide a better index of white matter damage.

OBJECTIVES

To determine whether DTI measures are correlated more strongly with cognitive performance than lesion load on T2 weighted images, and whether these correlations are independent of conventional MRI parameters.

METHODS

36 patients with ischaemic leukoaraiosis (leukoaraiosis plus a previous lacunar stroke) and 19 healthy volunteers underwent DTI, conventional MRI, and neuropsychological assessment.

RESULTS

On DTI, diffusivity was increased both within lesions and in normal appearing white matter. Mean diffusivity of normal appearing white matter correlated with full scale IQ (r = -0.46, p = 0.009) and tests of executive function. These correlations remained significant after controlling for age, sex, brain volume, and T1/T2 lesion volumes. No significant correlation was identified between T2 lesion load and IQ or neuropsychological scores. Of conventional measures, brain volume correlated best with cognitive function.

CONCLUSIONS

Diffusion tensor measurements correlate better with cognition than conventional MRI measures. They may be useful in monitoring disease progression and as a surrogate marker for treatment trials. The findings support the role of white matter damage and disruption of white matter connections in the pathogenesis of cognitive impairment in cerebral small vessel disease.

Endothelial nitric oxide gene haplotypes and risk of cerebral small-vessel disease

BACKGROUND AND PURPOSE

Genetic influences are important in multifactorial cerebral small-vessel disease (SVD) and may act via endothelial dysfunction. Nitric oxide (NO) synthesized by endothelial nitric oxide synthase (eNOS) is a key mediator of endothelial function. We determined the role of 3 potentially functional eNOS polymorphisms (T-786C, intron 4ab, G894T) located toward the 5' flanking end of the gene as risk factors for SVD and different SVD subtypes: isolated lacunar infarction (n=137) and ischemic leukoaraiosis (n=160).

METHODS

Three hundred patients with SVD and 600 community controls were studied. Genotypes were determined through polymerase chain reaction with or without restriction fragment digestion. Nitrate (NO(x)) levels were determined in a subgroup by use of a Griess method. Polymorphisms were tested individually and in combination with haplotype analysis.

RESULTS

The intron 4a variant was protective against SVD. This effect was confined to isolated lacunar infarction (odds ratio, 0.55; 95% confidence interval, 0.35 to 0.86; P=0.01). Haplotypes encountered were significantly different in this subtype compared with controls (P=0.001), with the -786C promoter/intron 4a combination particularly underrepresented. NO(x) levels were associated with the T-786C locus (P=0.03) but only in the presence of the intron 4a allele (P=0.07 for interaction).

CONCLUSIONS

The intron 4ab insertion/deletion genotype was associated with isolated lacunar infarction. Haplotype and functional studies suggested that the protective effect of the 4a variant could be mediated through changes in eNOS promoter activity and increased NO levels. The specific association with isolated symptomatic lacunar infarction and not ischemic leukoaraiosis may reflect different etiopathogeneses of the 2 subtypes. Lack of NO could predispose to localized microatheroma in proximal arterioles rather than diffuse arteriosclerosis affecting distal perforating vessels.

Systemic lupus erythematosus in Portugal: diagnosis and disease awareness from 1970 to 2001

A survey of systemic lupus erythematosus patients was carried out in Portugal. The length of time from disease appearance to diagnosis remained unchanged over the 1970-2001 study period, while awareness of the disease increased considerably in the population in the mid-1990s, apparently as a result of an awareness campaign conducted by the national lupus support group. The data are compared to results from similar studies worldwide.

Microencapsulation and oxidative stability of spray-dried fish oil emulsions

Emulsions of menhaden oil and sodium caseinate (NaCas) incorporating carbohydrates of varying dextrose equivalence (DE) were spray-dried to yield encapsulated fish oil powders. The effects of carbohydrate DE (5.5-38), core/wall ratio and NaCas/carbohydrate ratio on microencapsulation efficiency (ME) and oxidative stability of spray-dried emulsions were examined. The effect of alpha-tocopherol or Trolox C addition on the oxidative stability of herring oil emulsions and powders was also determined. ME of fish oil powders was greater than 90% in most cases. Peroxide value (PV) of menhaden oil powders decreased on increasing the DE of carbohydrates. PV of menhaden oil powders increased as core/wall ratio increased from 0.33-1.0. NaCas/DE 28 ratio did not affect PV values of powders. The addition of alpha-tocopherol or Trolox C decreased PV throughout the storage period; this effect was most pronounced for alpha-tocopherol added to the oil at a concentration of 100 ppm. Addition of alpha-tocopherol delays the onset of oxidation in stored fish oil powders.

Parasuicide and suicide in the south-west of Ireland

BACKGROUND

Suicidal behaviour has become recognised as a major public health problem.

AIM

To examine hospital-treated parasuicide and suicide in the Southern and Mid-Western Health Boards.

METHODS

Parasuicide data were derived from independent data collection in general and psychiatric hospitals and prisons between 1995 and 1997. The corresponding suicide data were obtained electronically from the Central Statistics Office.

RESULTS

Respectively, the annual person-based male, female and total European age-standardised rates were 128.9, 154.3 and 141.3 per 100,000 for parasuicide compared to 22.7, 5.5 and 14.1 per 100,000 for suicide. The parasuicide/suicide ratio varied markedly by age, gender, area and marital status. The majority of suicides were by hanging or drowning whereas drug overdose made up the vast majority of parasuicide acts. Parasuicide was largely a city phenomenon confined to the young of both genders whereas suicide was a significant problem for city and county men, especially young adult men.

CONCLUSION

There are striking differences between the patterns of fatal and non-fatal suicidal behaviour in Ireland, which should be considered in prevention initiatives.

TGF beta-1 downregulates DMP-1 and DSPP in odontoblasts

Transforming growth factor beta-1 (TGF beta-1) is a multifunctional growth factor that is expressed in numerous cell types. It has been shown to induce secretion of dentin extracellular matrix components associated with primary dentinogenesis and to play a role in tertiary or reparative dentinogenesis. In this study, we investigated the potential transcriptional regulation by TGF beta-1 of two dentin matrix proteins: dentin matrix protein 1 (DMP-1), and dentin sialophosphoprotein (DSPP). In vitro promoter studies were performed using plasmid constructs containing mouse DMP-1 and DSPP promoter sequences fused to the luciferase reporter gene. Constructs were transiently transfected in the mouse odontoblast cell line M06-G3 and cultured in the presence or absence of TGF beta-1. The integrity of the TGF beta-1 signaling pathway was investigated in the M06-G3 cells by identifying known key effectors of TGF beta-1 signal transduction. Transient transfection studies demonstrate for the first time that TGF beta-1 downregulates both DMP-1 and DSPP genes. Our findings indicate that the TGF beta-1 type I receptor ALK5 is expressed by odontoblasts as well as the signal transduction proteins Smad2, Smad3, and Smad4. These results suggest that TGF beta-1 regulates two key dentin proteins involved in matrix mineralization most likely mediated through the type I ALK5 receptor and transduced by Smads 2, 3, and 4.