A WBAN System for Ambulatory Monitoring of Physical Activity and Health Status: Applications and Challenges

Recent technological advances in sensors, low-power integrated circuits, and wireless communications have enabled the design of low-cost, miniature, lightweight, intelligent physiological sensor platforms that can be seamlessly integrated into a body area network for health monitoring. Wireless body area networks (WBANs) promise unobtrusive ambulatory health monitoring for extended periods of time and near real-time updates of patients' medical records through the Internet. A number of innovative systems for health monitoring have recently been proposed. However, they typically rely on custom communication protocols and hardware designs, lacking generality and flexibility. The lack of standard platforms, system software support, and standards makes these systems expensive. Bulky sensors, high price, and frequent battery changes are all likely to limit user compliance. To address some of these challenges, we prototyped a WBAN utilizing a common off-the-shelf wireless sensor platform with a ZigBee-compliant radio interface and an ultra low-power microcontroller. The standard platform interfaces to custom sensor boards that are equipped with accelerometers for motion monitoring and a bioamplifier for electrocardiogram or electromyogram monitoring. Software modules for on-board processing, communication, and network synchronization have been developed using the TinyOS operating system. Although the initial WBAN prototype targets ambulatory monitoring of user activity, the developed sensors can easily be adapted to monitor other physiological parameters. In this paper, we discuss initial results, implementation challenges, and the need for standardization in this dynamic and promising research field.

Mice lacking epidermal PPARγ exhibit a marked augmentation in photocarcinogenesis associated with increased UVB-induced apoptosis, inflammation and barrier dysfunction

Recent studies suggest that peroxisome proliferator-activated receptor gamma (PPARγ) agonists may have cancer chemopreventive activity. Other studies have shown that loss of epidermal PPARγ results in enhanced chemical carcinogenesis in mice via unknown mechanisms. However, ultraviolet B (UVB) exposure represents the primary etiological agent for skin cancer formation and the role of PPARγ in photobiology and photocarcinogenesis is unknown. In previous studies, we demonstrated that UVB irradiation of cells results in the formation of oxidized glycerophosphocholines that exhibit PPARγ ligand activity. We therefore hypothesized that PPARγ would prove to be a chemopreventive target in photocarcinogenesis. We first showed that UVB irradiation of mouse skin causes generation of PPARγ agonist species in vivo. We then generated SKH-1 hairless, albino mice deficient in epidermal Pparg (Pparg-/-(epi)) using a cytokeratin 14 driven Cre-LoxP strategy. Using a chronic model of UVB photocarcinogenesis, we next showed that Pparg-/-(epi) mice exhibit an earlier onset of tumor formation, increased tumor burden and tumor progression. Increased tumor burden in Pparg-/-(epi) mice was accompanied by a significant increase in epidermal hyperplasia and p53 positive epidermal cells in surrounding skin lacking tumors. After acute UVB irradiation, Pparg-/-(epi) mice exhibited an augmentation of both UVB-induced Caspase 3/7 activity and inflammation. Increased apoptosis and inflammation was also observed after treatment with the PPARγ antagonist GW9662. With chronic UVB irradiation, Pparg-/-(epi) mice exhibited a sustained increase in erythema and transepidermal water loss relative to wildtype littermates. This suggests that PPARγ agonists could have possible chemopreventive activity in non-melanoma skin cancer.

Criticality of the geological copper family

Because modern technology depends on reliable supplies of a wide variety of materials, and because of increasing concern about those supplies, a comprehensive methodology has been created to quantify the degree of criticality of the metals of the periodic table. In this paper, we apply this methodology to the elements of the geological copper family: Cu, As, Se, Ag, Te, and Au. These elements are technologically important, but show a substantial variation in different factors relating to their supply risk, vulnerability to supply restriction, and environmental implications. Assessments are made on corporate, national, and global levels for year 2008. Evaluations of each of the multiple indicators are presented and the results plotted in "criticality space", together with Monte Carlo simulation-derived "uncertainty cloud" estimates for each of the aggregated evaluations. For supply risk over both the medium term and long term, As is the highest risk of the six metals, with Se and Ag nearly as high. Gold has the most severe environmental implications ranking. Vulnerability to supply restriction (VSR) at the corporate level for an invented solar cell manufacturing firm shows Se, Te, and Cu as approximately equal, Cu has the highest VSR at the national level, and Cu and Au have the highest VSRs at the global level. Criticality vector magnitudes are greatest at the global level for As (and then Au and Ag) and at the national level for As and Au; at the corporate level, Se is highest with Te and Cu lower. An extension of this work, now in progress, will provide criticality estimates for several different development scenarios for the period 2010-2050.

Methodology of metal criticality determination

A comprehensive methodology has been created to quantify the degree of criticality of the metals of the periodic table. In this paper, we present and discuss the methodology, which is comprised of three dimensions: supply risk, environmental implications, and vulnerability to supply restriction. Supply risk differs with the time scale (medium or long), and at its more complex involves several components, themselves composed of a number of distinct indicators drawn from readily available peer-reviewed indexes and public information. Vulnerability to supply restriction differs with the organizational level (i.e., global, national, and corporate). The criticality methodology, an enhancement of a United States National Research Council template, is designed to help corporate, national, and global stakeholders conduct risk evaluation and to inform resource utilization and strategic decision-making. Although we believe our methodological choices lead to the most robust results, the framework has been constructed to permit flexibility by the user. Specific indicators can be deleted or added as desired and weighted as the user deems appropriate. The value of each indicator will evolve over time, and our future research will focus on this evolution. The methodology has proven to be sufficiently robust as to make it applicable across the entire spectrum of metals and organizational levels and provides a structural approach that reflects the multifaceted factors influencing the availability of metals in the 21st century.

Magnetic linear dichroism in the angular dependence of core-level photoemission from (Ga,Mn)As using hard x rays

We report a study of the electronic properties of the ferromagnetic semiconductor (Ga,Mn)As using magnetic linear dichroism in the angular dependence of Mn 2p photoemission under hard x-ray excitation. Bulk plasmon loss satellites demonstrate that the probed Mn ions are incorporated deep within the GaAs lattice, while the observed large dichroism indicates that the spectra originate from ferromagnetic substitutional Mn. Simulations of the spectra using an Anderson impurity model show that the ferromagnetic Mn 3d electrons of substitutional Mn in (Ga,Mn)As are intermediate between localized and delocalized.

Mode of breathing-tidal or slow and deep-through the I-neb Adaptive Aerosol Delivery (AAD) system affects lung deposition of (99m)Tc-DTPA

BACKGROUND

The I-neb AAD System was designed to deliver aerosol with two different breathing pattern algorithms: the Tidal Breathing Mode (TBM) and the Target Inhalation Mode (TIM). For the purpose of the study, the TBM breathing pattern algorithm was set to guide the subjects to inhalation during tidal breathing with aerosol pulsed during 50-80% of the time spent on inhalation, whereas the TIM breathing pattern was set to guide the subject to a slow and deep inhalation of up to approximately 9 sec with aerosol pulsed for up to 7 sec, leaving 2 sec for particle deposition in the lungs. In TIM, the inspiratory flow was guided to approximately 20 L/min through a built-in resistance in the mouthpiece.

METHODS

We have, in a randomized, open-label, crossover study of 12 healthy subjects evaluated lung deposition following administration of a radiolabeled aerosol from the I-neb AAD System with the TBM and TIM breathing patterns.

RESULTS

The results showed that mean lung deposition was significantly higher when using the I-neb AAD System with the TIM breathing pattern (73.3%) than with the TBM breathing pattern (62.8%). The mean exhaled fractions were low (<1%) for both breathing patterns. The nebulization time was significantly shorter with the TIM breathing pattern (3.0 min) than with the TBM breathing pattern (4.7 min).

CONCLUSIONS

The results of the present study showed that lung deposition with the slow and deep inhalation achieved through the I-neb AAD System in TIM was superior to the lung deposition achieved during tidal breathing in TBM. With the combination of high lung deposition, almost no loss of aerosol during exhalation, and short nebulization time the I-neb AAD System with the TIM breathing pattern should be of special value to patients who require multiple daily dosing of aerosolized medication, are using drugs that should not be wasted into the room air, or would benefit from a more efficient delivery system.

A STUDY OF THE MECHANISM OF NUCLEINATE-INDUCED LEUCOPENIC AND LEUCOCYTIC STATES, WITH SPECIAL REFERENCE TO THE RELATIVE ROLES OF LIVER, SPLEEN, AND BONE MARROW

The leucopenia induced by sodium nucleinate has been followed by repeated counts made simultaneously from the blood of a peripheral vein and from the internal organs, combined with a study of histological sections of the same organs taken with the counts. Measurements with the oncometer of changes in volume of the spleen have been correlated with the leucopenia and the leucocytosis following sodium nucleinate. It has thus been determined that the leucopenia is not the result of a vasomotor phenomenon, or of a change in blood volume, nor is it secondary to a retention of the white cells in the capillaries of lung or liver; it is due to the accumulation of neutrophilic leucocytes in the parenchyma of the spleen. That the spleen is solely responsible for the temporary depression of white cells in the general circulation under these conditions has been shown by splenectomy. In splenectomized rabbits no leucopenia developed, but instead a leucocytosis due to a direct action on the bone marrow. A profound change occurs in the distribution of the cells in the circulation at the moment of death. The liver, within a minute of the cessation of the circulation, shows a three- to fourfold increase in the number of white cells per c.mm., the differential count remaining unchanged. Thus estimations of the physiological distribution and redistribution of cells in the living state may be made only with the circulation unimpaired. The injection into normal rabbits of adenine and guanine nucleotides, split products of nucleic acid, gave immediate leucocytosis of bone marrow origin similar to that observed with the more complex molecule when the spleen was eliminated. The response of the bone marrow to chemotactic stimuli, such as those have used, may be reflected in the general circulation, through an absolute increase of young neutrophilic leucocytes, within a period of less than 1 hour. Within this brief period there takes place maturation from Myelocyte C and metamyelocyte into the early motile leucocyte, and the delivery of these just matured cells into the circulation. The response to one injection of nucleinate or nucleotide may persist into the 3rd and 4th days with a gradual depletion of the normal reserve of Myelocytes C in the bone marrow.

The association between neck disability and jaw disability

The association between cervical spine disorders (CSD) and temporomandibular disorders (TMD) has been extensively investigated. However, no studies investigating the relationship between the level of jaw disability and neck disability have been published. Therefore, the objective of this study was to determine whether there was a relationship between neck disability measured using the neck disability index (NDI) and jaw disability measured through the jaw function scale (JFS). A sample of 154 subjects who attended the TMD/Orofacial Pain clinic and students and staff at the University of Alberta participated in this study. All subjects were asked to complete the NDI, the JFS, the jaw disability checklist (JDC), and the level of chronic disability of TMD (chronic pain grade disability questionnaire used in the RDC/TMD). Spearman rho test was used to analyse the relationship between neck disability and jaw disability. Multiple regression analysis was used to determine the association between the level of chronic disability of TMD and neck disability. A strong relationship between neck disability and jaw disability was found (r = 0.82). A subject with a high level of TMD disability (grade IV) increased by about 19 points on the NDI when compared with a person without TMD disability. These results have implications for clinical practice. If patients with TMD have neck disability in addition to jaw disability, treatment needs to focus on both areas because the improvement of one could have an influence on the other.

Maternal and neonatal sepsis caused by Haemophilus influenzae type d

A 29-year-old pregnant woman was admitted to hospital with signs of sepsis and threatened pre-term labour. The premature neonate also showed signs of sepsis. Haemophilus influenzae biotype III was cultured from a midstream urine sample taken from the mother, maternal placental swabs and neonatal blood cultures. The placental and neonatal isolates were both found to be serotype d by PCR, and were indistinguishable by PFGE.

A gamma scintigraphy study to investigate lung deposition and clearance of inhaled amikacin-loaded liposomes in healthy male volunteers

BACKGROUND

The purpose of this study was to investigate the inhalation of a liposomal formulation of amikacin in healthy male volunteers in terms of pulmonary deposition, clearance, and safety following nebulization with a commercial jet nebulizer.

METHODS

Amikacin was encapsulated in liposomes comprised of dipalmitoyl phosphatidylcholine (DPPC) and cholesterol via a proprietary manufacturing process (20 mg/mL final amikacin concentration). The liposomes were radiolabeled with (99m)Tc using the tin chloride labeling method. A nominal dose of 120 mg of drug product was loaded into a PARI LC STAR nebulizer, aerosolized using a PARI Boy compressor where subjects inhaled for 20 min. Lung deposition was determined by gamma scintigraphy in three healthy male volunteers at the following time points (0, 1, 3, 6, 12, 24, 48, and 72 h post-administration).

RESULTS

Total lung deposition, expressed as a percentage of the emitted dose, was 32.3 +/- 3.4%. The time-dependent retention of radiolabeled liposomes was biphasic with an initial rapid reduction in counts, followed by a slower phase to 48 h. The overall mean retention at 24 and 48 h was 60.4 and 38.3% of the initial dose deposited, respectively. The observed clearance of radiolabel is consistent with clearance of amikacin following aerosol delivery to rats. There were no clinically significant changes in laboratory parameters, vital signs, or ECG. No adverse events including cough or bronchospasm were reported.

CONCLUSIONS

Inhalation of a single nominal dose of 120 mg liposomal amikacin results in prolonged retention of drug-loaded liposomes in the lungs of healthy volunteers. The treatment was well tolerated.

Survey of excited state neutron spectroscopic factors for Z=8-28 nuclei

We have extracted 565 neutron spectroscopic factors of sd and fp shell nuclei by systematically analyzing more than 2000 measured (d, p) angular distributions. We are able to compare 125 of the extracted spectroscopic factors to values predicted by large-basis shell-model calculations and evaluate the accuracies of spectroscopic factors predicted by different shell-model interactions in these regions. We find that the spectroscopic factors predicted for most excited states of sd-shell nuclei using the latest USDA or USDB interactions agree with the experimental values. For fp shell nuclei, the inability of the current models to account for the core excitation and fragmentation of the states leads to considerable discrepancies. In particular, the agreement between data and shell-model predictions for Ni isotopes is not better than a factor of 2 using either the GXPF1A or the XT interaction.

Pruritus ani

INTRODUCTION

Pruritus ani is a common condition with many causes, predominately anorectal pathology. There are some new insights and therapies, but the most recommendations are based on low-level evidence.

PATIENTS AND METHODS

A literature search was carried out using Medline and the internet with the keywords 'pruritus ani' from 1950 to 2007.

RESULTS

A review of the evidence is presented and a management plan based on the elimination of irritants and scratching, general control measures and active treatment measures is offered.

CONCLUSIONS

Treatment of primary and secondary pruritus ani has a good prospect of regression of symptoms and skin changes.

Palliative care rehabilitation survey: a pilot study of patients' priorities for rehabilitation goals

Rehabilitation in palliative care is often overlooked. Settings that do consider occupational or physical therapy for palliative care patients often consult to therapists with competing caseloads. Few therapists specialise in palliative care, but nearly all ask, 'What needs doing'? and 'How well am I doing that'? No existing instruments address their questions. The objective is to develop and test a questionnaire for identifying patient goals and priorities for rehabilitation in palliative care. A questionnaire representing 11 domains of the Canadian Model of Occupational Performance was designed and pilot tested at four palliative care sites. Each question reflected a typical rehabilitation intervention in palliative care. Patients were asked to rate how important each of these interventions was on a numerical rating scale (0, not important-10, extremely important). Open-ended questions captured verbatim comments regarding thoughts of rehabilitation. The questionnaire was tested for test-retest reliability with two interviews approximately 1 week apart. Forty patients participated in the first interview and 32 in the second. Eight of eleven domain sub-scores achieved an intra-class correlation coefficient of 0.6 or higher. The highest means were for the physical (8.2), institutional (7.8) and self-care (7.8) domains on the first interview and for the spiritual domain (7.9) on the second interview. Suggestions are provided to shorten the questionnaire and strengthen validity. This work furthers the understanding of the role of rehabilitation in palliative care. It also illustrates the feasibility of involving palliative care patients in research that contributes to setting standards and measuring quality of service.

Verrucous lymphovascular malformation versus verrucous hemangioma: controversial nomenclature

The International Society for the Study of Vascular Anomalies (ISSVA) divides congenital vascular anomalies into malformations and tumors and subclassified hemangiomas under tumors. However, evidence shows this accepted classification has not been widely employed. Particularly troublesome is the use of the term hemangioma, commonly used to describe a variety of vascular lesions (both malformations and tumors). The term verrucous hemangioma has been used to describe a congenital vascular anomaly with a progressive verrucous epidermal surface persisting throughout life unless surgically excised. Recent evidence suggests that some of these lesions may share histologic features of both hemangiomas and malformations, thereby causing nosologic confusion. We report a 15-year-old adolescent girl with such a lesion and review the literature and controversy of verrucous hemangiomas. In our case, the most appropriate diagnosis is verrucous lymphovascular malformation. Further testing of similar lesions will be necessary to fully understand the nature and classification of these lesions.

Electronic properties of the interface between p-CuI and anatase-phase n-TiO2 single crystal and nanoparticulate surfaces: A photoemission study

We present a study of the growth of the p-type inorganic semiconductor CuI on n-type TiO2 anatase single crystal (101) surfaces and on nanoparticulate anatase surfaces using synchrotron radiation photoemission spectroscopy. Core level photoemission data obtained using synchrotron radiation reveal that both the substrate (TiO2) and the overlayer (CuI) core levels shift to a lower binding energy to different degrees following the growth of CuI on TiO2. Valence band photoemission data show that the valence band maximum of the clean substrate differs from that of the dosed surface which may be interpreted qualitatively as due to the introduction of a new density of states within the band gap of TiO2 as a result of the growth of CuI. The valence band offset for the heterojunction n-TiO2p-CuI has been measured using photoemission for both nanoparticulate and single crystal TiO2 surfaces, and the band energy alignment for these heterojunction interfaces is presented. With the information obtained here, it is suggested that the interface between p-CuI and single crystal anatase-phase n-TiO2 is a type-II heterojunction interface, with significant band bending. The measured total band bending matches the work function change at the interface, i.e., there is no interface dipole. In the case of the nanoparticulate interface, an interface dipole is found, but band bending within the anatase nanoparticles remains quite significant. We show that the corresponding depletion layer may be accommodated within the dimension of the nanoparticles. The results are discussed in the context of the functional properties of dye-sensitized solid state solar cells.

Validation des plans de radiothérapie conformationnelle avec modulation d'intensité avec les images portales

The goal of this study was to show the feasibility of step and shoot intensity-modulated radiation therapy pre-treatment quality control for patients using the electronic portal imaging device (iViewGT) fitted on a Sli+ linac (Elekta Oncology Systems, Crawley, UK) instead of radiographic films. Since the beginning of intensity-modulated radiation therapy treatments, the dosimetric quality control necessary before treating each new patient has been a time-consuming and therefore costly obligation. In order to fully develop this technique, it seems absolutely essential to reduce the cost of these controls, especially the linac time. Up to now, verification of the relative dosimetry field by field has been achieved by acquiring radiographic films in the isocenter plane and comparing them to the results of the XiO planning system (Computerized Medical Systems, Missouri, USA) using RIT113 v4.1 software (Radiological Imaging Technology, Colorado, USA). A qualitative and quantitative evaluation was realised for every field of every patient. A quick and simple procedure was put into place to be able to make the same verifications using portal images. This new technique is not a modification of the overall methodology of analysis. The results achieved by comparing the measurement with the electronic portal imaging device and the calculation with the treatment planning system were in line with those achieved with the films for all indicators we studied (isodoses, horizontal and vertical dose profiles and gamma index).

Experiences using WinCE PocketPCs as computation and data acquisition platforms for ambulatory telemonitoring

Using a WinCE PocketPC as a central controller and computational platform to acquire and process medical data in an ambulatory telemonitoring environment seems to be a reasonable design decision. This paper summarizes the advantages and disadvantages of such a platform based upon recent experiences with wireless telemonitoring in large animals.

HL7-compliant healthcare information system for home monitoring

A secure, home-to-remote database communication hierarchy using Health Level Seven (HL7) has been developed. Measurements acquired from the patient via a wireless, wearable monitoring system are inserted into a local database using LabVIEW. Periodically, the HL7 client securely updates the remote database with information from the local database. HL7 communications are performed by Interfaceware's Chameleon software. Using Chameleon's flexible interface, doctors and researchers may access these patient data securely, confidentially, and remotely.

Ambulatory instrumentation suitable for long-term monitoring of cattle health

The benefits of real-time health diagnoses of cattle are potentially tremendous. Early detection of transmissible disease, whether from natural or terrorist events, could help to avoid huge financial losses in the agriculture industry while also improving meat quality. This work discusses physiological and behavioral parameters relevant to cattle state-of-health assessment. These parameters, along with a potentially harsh monitoring environment, drive a set of design considerations that must be addressed when building systems to acquire long-term, real-time measurements in the field. A prototype system is presented that supports the measurement of suitable physiologic parameters and begins to address the design constraints for continuous state-of-health determination in free-roaming cattle.

No evidence of Epstein-Barr virus association with Merkel cell carcinoma

BACKGROUND

Merkel cell carcinoma (MCC) is an aggressive tumor of cutaneous neuroendocrine cells with a reported 13-fold increased incidence in immunocompromised patients, raising the possibility that it is driven by an oncogenic virus. Additionally, Merkel cell hyperplasia is seen in the Epstein-Barr virus (EBV)-driven process oral hairy leukoplakia, and EBV is known to be involved in the pathogenesis of several other malignancies.

OBJECTIVE

We tested the hypothesis that EBV is involved in MCC.

METHODS

We employed EBV-encoded RNA in situ hybridization (ISH), lytic EBV ISH, latent membrane protein 1 immunohistochemistry, and BamH1Z leftward reading frame 1 immunohistochemistry to detect and localize EBV in paraffin sections of MCC from five patients as well as seven other cutaneous tumors and positive controls for EBV infection.

RESULTS

Positive controls reacted appropriately. However, there was no evidence of latent or lytic EBV in any of the MCC biopsies or other cutaneous tumors.

CONCLUSION

Our findings suggest that EBV is not associated with MCC.

Anticipation skill and susceptibility to deceptive movement

The ability to detect deceptive movement was examined in skilled and novice rugby players. Participants (14 per group) attempted to predict direction change from video of expert and recreational rugby players changing direction with and without deceptive movement. Confidence associated with judgments was recorded on each trial to seek evidence regarding use of inferential (heuristic-based) and direct-perceptual (invariant-based) judgments. Novices were found to be susceptible to deceptive movement whereas skilled participants were not; however, both skilled and novice participants were more confident on trials containing deceptive movement. The data suggest that the skill-level difference in sensitivity to advance visual information extends to deceptive information. The implications of this finding, and the importance of considering the underlying process of anticipation skill, are discussed.

As a bacterial culture medium, citrated sheep blood agar is a practical alternative to citrated human blood agar in laboratories of developing countries

Human blood agar (HuBA) is widely used in developing countries for the isolation of bacteria from clinical specimens. This study compared citrated sheep blood agar (CSBA) and HuBA with defibrinated horse blood agar and defibrinated sheep blood agar (DSBA) for the isolation and antibiotic susceptibility testing of reference and clinical strains of Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. Reference and clinical strains of all organisms were diluted in brain heart infusion and a clinical specimen of cerebrospinal fluid and cultured on all agars. Viable counts, colony morphology, and colony size were recorded. Susceptibility testing for S. pneumoniae and S. pyogenes was performed on defibrinated sheep blood Mueller-Hinton agar, citrated sheep blood Mueller-Hinton agar (CSB MHA), and human blood Mueller-Hinton agar plates. For all organisms, the colony numbers were similar on all agars. Substantially smaller colony sizes and absent or minimal hemolysis were noted on HuBA for all organisms. Antibiotic susceptibility results for S. pneumoniae were similar for the two sheep blood agars; however, larger zone sizes were displayed on HuBA, and quality control for the reference strain failed on HuBA. For S. pyogenes, larger zone sizes were demonstrated on HuBA and CSBA than on DSBA. Poor hemolysis made interpretation of the zone sizes difficult on HuBA. CSBA is an acceptable alternative for the isolation of these organisms. The characteristic morphology is not evident, and hemolysis is poor on HuBA; and so HuBA is not recommended for use for the isolation or the susceptibility testing of any of these organisms. CSB MHA may be suitable for use for the susceptibility testing of S. pneumoniae.

Treatment of gefitinib-associated folliculitis

Gefitinib (Iressa), an epidermal growth factor inhibitor approved for treatment of advanced nonsmall cell lung carcinoma, is associated with an acneiform distributed folliculitis. Treatment attempts for this folliculitis have been noted in the literature, but photodocumentation of results has not been reported. We report 3 consecutive cases of gefitinib-associated folliculitis with photodocumentation of their treatment responses to combination therapy with topical metronidazole and oral tetracyclines.

p38MAPK inhibition prevents disease in pemphigus vulgaris mice

Pemphigus vulgaris (PV) is a life-threatening autoimmune blistering skin disease characterized by detachment of keratinocytes (acantholysis). It has been proposed that PV IgG might trigger signaling and that this process may lead to acantholysis. Indeed, we recently identified a rapid and dose-dependent phosphorylation of p38 mitogen-activated protein kinase (p38MAPK) and heat shock protein (HSP) 27 after binding of PV antibodies to cultured keratinocytes. In human keratinocyte cultures, inhibitors of p38MAPK prevented PV IgG-induced phosphorylation of HSP27 and, more importantly, prevented the early cytoskeletal changes associated with loss of cell-cell adhesion. This study was undertaken to (i) determine whether p38MAPK and HSP25, the murine HSP27 homolog, were similarly phosphorylated in an in vivo model of PV and (ii) investigate the potential therapeutic use of p38MAPK inhibition to block blister formation in an animal model of PV. We now report that p38MAPK inhibitors prevented PV blistering disease in vivo. Targeting the end-organ by inhibiting keratinocyte desmosome signaling may be effective for treating desmosome autoimmune blistering disorders.

A tryptophan amphiphilic tetramerization domain-containing acetylcholinesterase from the bovine lungworm, Dictyocaulus viviparus

Acetylcholine (ACh) is one of an array of neurotransmitters used by invertebrates and, analogous to vertebrate nervous systems, acetylcholinesterase (AChE) regulates synaptic levels of this transmitter. Similar to other invertebrates, nematodes possess several AChE genes. This is in contrast to vertebrates, which have a single AChE gene, transcripts of which are alternatively spliced to produce different types of the enzyme which vary at their C-termini. Parasitic nematodes have a repertoire of AChE genes which include those encoding neuromuscular AChEs and those genes which code for secreted AChEs. The latter proteins exist as soluble monomers released by the parasite during infection and these AChE are distinct from those enzymes which the nematodes use for synaptic transmission in their neuromuscular system. Thus far, Dictyocaulus viviparus is the only animal-parasitic nematode for which distinct genes that encode both neuromuscular and secreted AChEs have been defined. Here, we describe the isolation and characterization of a cDNA encoding a putative neuromuscular AChE from D. viviparus which contains a tryptophan amphiphilic tetramerization (WAT) domain at its C-terminus analogous to the common 'tailed' AChE form found in the neuromuscular systems of vertebrates and in the ACE-1 AChE from Caenorhabditis elegans. This enzyme differs from the previously isolated, D. viviparus neuromuscular AChE (Dv-ACE-2), which is a glycosylphosphatidylinositol-anchored variant analogous to vertebrate 'hydrophobic' AChE.

Bacillary Angiomatosis Associated With Pseudoepitheliomatous Hyperplasia

Bacillary angiomatosis is an opportunistic bacterial infection caused by either Bartonella henselae or B. quintana. The classic histologic presentation of bacillary angiomatosis involves three components: a lobular proliferation of capillaries with enlarged endothelial cells, neutrophilic debris, and clumps of finely granular material identified as bacteria with staining techniques. Pseudoepitheliomatous hyperplasia is a histologic reaction pattern characterized by epithelial proliferation in response to a variety of stimuli, including mycobacterial, fungal, and bacterial infections. We describe a case of bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia in an immunocompromised patient with Acquired Immunodeficiency Syndrome. Histologic examination of a finger lesion demonstrated a capillary proliferation with neutrophilic debris and characteristic amorphous granular deposits. Warthin-Starry and Giemsa staining revealed clumps of coccobacilli. Cervical lymph node tissue also revealed organisms identified as Bartonella with PCR techniques. Stains and cultures for acid fast bacilli, fungus, and bacteria were negative. To our knowledge, there has been only one other report of bacillary angiomatosis presenting with pseudoepitheliomatous hyperplasia. We conclude that the differential diagnosis of entities associated with pseudoepitheliomatous hyperplasia should be expanded to include bacillary angiomatosis.

Complete FcRn dependence for intravenous Ig therapy in autoimmune skin blistering diseases

Numerous mechanisms of action have been proposed for intravenous Ig (IVIG). In this study, we used IgG passive transfer murine models of bullous pemphigoid (BP), pemphigus foliaceus (PF), and pemphigus vulgaris (PV) to test the hypothesis that the effect of IVIG in autoantibody-mediated cutaneous bullous diseases is to accelerate the degradation of pathogenic IgG by saturation of the MHC-like Fc receptor neonatal Fc receptor (FcRn). BP, PF, and PV are organ-specific antibody-mediated diseases in which autoantibodies target the hemidesmosomal antigen BP180 and desmosomal antigens Dsg1 and Dsg3, respectively. Antibodies against BP180, Dsg1, and Dsg3, when injected into neonatal mice, induce the BP, PF, and PV disease phenotypes, respectively. We found that FcRn-deficient mice were resistant to experimental BP, PF, and PV. Circulating levels of pathogenic IgG in FcRn-deficient mice were significantly reduced compared with those in WT mice. Administration of high-dose human IgG (HDIG) to WT mice also drastically reduced circulating pathogenic IgG levels and prevented blistering. In FcRn-deficient mice, no additional protective effect with HDIG was realized. These data demonstrate that the therapeutic efficacy of HDIG treatment in the pemphigus and pemphigoid models is dependent on FcRn. Thus, FcRn is a promising therapeutic target for treating such IgG-mediated autoimmune diseases.

Distinct phenotype associated with a cryptic subtelomeric deletion of 19p13.3-pter

Telomeres are gene rich regions with a high recombination rate. Cryptic subtelomeric rearrangements are estimated to account for 5% of mental retardation/malformation syndromes. Here we present the first patient with a deletion of 19p13.3, identified by subtelomeric FISH analysis. His features included a distinctive facial appearance, cleft palate, hearing impairment, congenital heart malformation, keloid scarring, immune dysregulation, and mild learning difficulties. Subtelomeric FISH analysis identified a deletion of 19p13.3-pter. The deletion size was determined to be 1.2 Mb by FISH analysis. It extended from within the chromosomal region covered by BAC RP11-50C6 to 19pter. The deleted area encompassed approximately 60 genes. Fifteen possible candidate genes were considered with respect to the phenotype, including follistatin-related precursor 3 (FSTL3) and serine-threonine kinase 11 (STK-11).

Anti-Desmoglein-1 Antibodies in Onchocerciasis, Leishmaniasis and Chagas Disease Suggest a Possible Etiological Link to Fogo Selvagem

Pemphigus foliaceus (PF) and the endemic form Fogo Selvagem (FS) are mediated by pathogenic antibodies to the EC1-2 domains of desmoglein-1. There is a preclinical phase with antibodies to only EC5. Based on geographic clustering of cases, FS is thought to have an, as yet unidentified, environmental trigger. In this study we have searched for anti-desmoglein-1 antibodies in sera from parasitic (leishmaniasis, Chagas, and onchocerciasis), and infectious diseases (leprosy and South American (SA) blastomycosis), which are prevalent in the same geographic regions of Brazil as FS. A specific and sensitive desmoglein-1 ELISA detected antibodies in 34 of 41 onchocerciasis (83%), 38 of 88 leishmaniasis (43%), 18 of 31 Chagas disease (58%), 7 of 28 SA blastomycosis (25%), and 14 of 83 leprosy sera (17%). These sera recognized epitopes restricted to the EC5 domain. These findings identify several etiological factors for FS. It is hypothesized that a component of insect vector saliva, rather than the parasite itself may trigger an antibody response to EC-5. In persons with the known HLA susceptibility alleles and living in endemic areas, a response to the EC1-2 domains may subsequently develop by epitope spreading with associated clinical signs of FS.