Streptococcus mutans copper chaperone, CopZ, is critical for biofilm formation and competitiveness

The oral cavity is a dynamic environment characterized by hundreds of bacterial species, saliva, and an influx of nutrients and metal ions such as copper. Although there is a physiologic level of copper in the saliva, the oral cavity is often challenged with an influx of copper ions. At high concentrations copper is toxic and must therefore be strictly regulated by pathogens for them to persist and cause disease. The cariogenic pathogen Streptococcus mutans manages excess copper using the copYAZ operon that encodes a negative DNA-binding repressor (CopY), the P1-ATPase copper exporter (CopA), and the copper chaperone (CopZ). These hypothetical roles of the copYAZ operon in regulation and copper transport to receptors led us to investigate their contribution to S. mutans virulence. Mutants defective in the copper chaperone CopZ, but not CopY or CopA, were impaired in biofilm formation and competitiveness against commensal streptococci. Characterization of the CopZ mutant biofilm revealed a decreased secretion of glucosyltransferases and reduced expression of mutacin genes. These data suggest that the function of copZ on biofilm and competitiveness is independent of copper resistance and CopZ is a global regulator for biofilm and other virulence factors. Further characterization of CopZ may lead to the identification of new biofilm pathways.

Clinical significance of group B streptococcus testing in late pregnancy

PURPOSE

This study aimed to detect the maternal group B streptococcus (GBS) by real-time PCR method, aiming to understand its germ-carrying situations and clinical significance.

MATERIALS AND METHODS

The secretions of one-third inferior segment of maternal vagina of 1,540 pregnant and postnatal women were collected for GBS detection by real-time PCR method, and the impacts of positive results on the fetus were observed.

RESULTS

The detection rate of GBS was 5.6% (86/1540); the premature birth rate of GBS-positive pregnant women was 29.1% (25/86), the miscarriage rate was 19.8% (17/86), the premature rupture rate was 26.7% (23/86), and the fetal distress rate was 24.4% (21/86).

CONCLUSIONS

The GBS germ-carriers showed increased rates of premature birth, miscarriage, premature rupture, and fetal distress, thus forming adverse effects towards the maternal and infant outcomes.

miR-125a-5p expression is associated with the age of breast cancer patients

Dysregulated miR-125 observed in multiple cancer types has suggested that it is involved in malignant proliferation and invasion. However, the clinical significance of miR-125 in human breast cancer (BC) has not yet been fully elucidated. In the present study, the expression of miR-125a-5p/3p and miR-125b in 143 pairs of BC and normal adjacent tissues (NATs) was measured by real-time quantitative PCR, and the correlation between expression and clinicopathological features was explored. miR-125a-5p and miR-125b were significantly down-regulated in BC tissue samples compared with their matched NAT samples, while the difference in miR-125a-3p expression between BC tissues and NATs was not statistically significant. The expression level of miR-125a-5p was found to be significantly higher in younger patients (<35 years) than in older patients (≥35, P = 0.005). When the patients were divided into three groups according to age (<35, 36-48, and ≥48 years), a gradual reduction in miR-125a-5p expression was observed in BC tissue samples that correlated to increases in age (P = 0.009). There were no significant correlations between miR-125 expression and other clinicopathological features including tumor size, histological grade, hormone receptor status, Her-2 status, and lymph node metastasis. Taken together, these findings suggest that miR-125a-5p may play an important role in BC progression in an age-dependent manner, and that the down-regulation of miR-125a-5p and miR-125b may serve as independent predictors for breast cancer.

Bioactive compounds in green tea leaves attenuate the injury of retinal ganglion RGC-5 cells induced by H2O2 and ultraviolet radiation

The Chinese commonly believe that tea helps maintain clear vision. This viewpoint has been recorded in Chinese medical books also. The key bioactive compounds in green tea leaves, (-)-epigallocatechin gallate (EGCG), L-theanine (theanine) and caffeine, were investigated for their abilities to attenuate the injury of retinal ganglion cells (RGC-5) induced by H2O2 and ultraviolet radiation. Theanine and caffeine promoted cell growth while concentrations of EGCG greater than 10μg/ml inhibited cell growth. The nine and caffeine both protected RGC-5 cells from injury as well as enhanced their recovery, while EGCG only protected the cells from injury and did not help them to recover. Tea is a unique drink, which is simultaneously enriched with EGCG, theanine and caffeine. The role of these compounds in optic nerve protection may partially explain why some tea drinkers feel enhanced vision.

Integrated analysis of gene expression and genomic aberration data in osteosarcoma (OS)

Cytogenetic analyses have revealed that complex karyotypes with numerous and highly variable genomic aberrations including single-nucleotide polymorphisms (SNPs) and copy number variants (CNVs), are observed in most of the conventional osteosarcomas (OSs). Several genome-wide studies have reported that the dysregulated expression of many genes is correlated with genomic aberrations in OS. We first compared OS gene expression in Gene Expression Omnibus (GEO) data sets and genomic aberrations in International Cancer Genome Consortium (ICGC) database to identify differentially expressed genes (DEGs) associated with SNPs or CNVs in OS. Then the function annotation of SNP- or CNV-associated DEGs was performed in terms of gene ontology analysis, pathway analysis and protein-protein interactions (PPIs). Finally, the expression of genes correlated with both SNPs and CNVs were confirmed by quantitative reverse-transcription PCR. Eight publicly available GEO data sets were obtained, and a set of 979 DEGs were identified (472 upregulated and 507 downregulated DEGs). Moreover, we obtained 1039 SNPs mapped in 938 genes, and 583 CNV sites mapped in 2915 genes. Comparing genomic aberrations and DGEs, we found 41 SNP-associated DEGs and 124 CNV-associated DEGs, in which 7 DGEs were associated with both SNPs and CNVs, including WWP1, EXT1, LDHB, C8orf59, PLEKHA5, CCT3 and VWF. The result of function annotation showed that ossification, bone development and skeletal system development were the significantly enriched terms of biological processes for DEGs. PPI network analysis showed that CCT3, COPS3 and WWP1 were the significant hub proteins. We conclude that these genes, including CCT3, COPS3 and WWP1 are candidate driver genes of importance in OS tumorigenesis.

Isolation, partial characterization, and cloning of an extracellular chitinase from the entomopathogenic fungus Verticillium lecanii

The entomopathogenic fungus Verticillium lecanii is a well-known biocontrol agent of fungal phytopathogens, as well as insect pests. A 42-kDa chitinase belonging to family 18 of the glycosyl hydrolases was isolated and partially characterized. Chitinase was purified using successive column chromatography on phenyl-sepharose, DEAE-sepharose, and CM-sepharose. The enzyme showed the highest activity at 40°C and pH 4.6. Enzyme activity was strongly activated in the presence of Mg(2+). The purified enzyme showed inhibitory activity of spore germination against several plant pathogens, particularly Fusarium moniliforme. The genomic DNA and cDNA sequences were resolved by polymerase chain reaction amplification and sequencing. Protein modeling and comparative investigation of different chitinase amino acids showed that chitinases are conserved in parasitic fungi.

Improving the effectiveness of (-)-epigallocatechin gallate (EGCG) against rabbit atherosclerosis by EGCG-loaded nanoparticles prepared from chitosan and polyaspartic acid

(-)-Epigallocatechin gallate (EGCG) is the major bioactive compound in green tea. Its effect is limited by the harsh environment of the gastrointestinal tract. The present study investigates how the effectiveness of EGCG is influenced by its encapsulation into self-assembled nanoparticles of chitosan (CS) and aspartic acid (PAA). Blank nanoparticles with a mean diameter of ca. 93 nm were prepared from 30-50 kDa PAA and 3-5 kDa CS with a mass rate of 1:1. EGCG was loaded in the nanoparticles to yield EGCG-CS-PAA nanoparticles with an average diameter of 102 nm, which were pH-responsive and demonstrated different EGCG release profiles in simulated gastrointestinal tract media. The average ratio (%) of lipid deposition for EGCG-CS-PAA nanoparticles administered orally to rabbits was 16.9 ± 5.8%, which was close to that of oral simvastatin (15.6 ± 4.1%). Orally administered EGCG alone yielded an average ratio of lipid deposit area of 42.1 ± 4.0%, whereas this value was 65.3 ± 10.8% for the blank nanoparticles. The effectiveness of EGCG against rabbit atherosclerosis was significantly improved by incorporating EGCG into the nanoformulation.

Improving the effectiveness of (-)-epigallocatechin gallate (EGCG) against rabbit atherosclerosis by EGCG-loaded nanoparticles prepared from chitosan and polyaspartic acid

(-)-Epigallocatechin gallate (EGCG) is the major bioactive compound in green tea. Its effect is limited by the harsh environment of the gastrointestinal tract. The present study investigates how the effectiveness of EGCG is influenced by its encapsulation into self-assembled nanoparticles of chitosan (CS) and aspartic acid (PAA). Blank nanoparticles with a mean diameter of ca. 93 nm were prepared from 30-50 kDa PAA and 3-5 kDa CS with a mass rate of 1:1. EGCG was loaded in the nanoparticles to yield EGCG-CS-PAA nanoparticles with an average diameter of 102 nm, which were pH-responsive and demonstrated different EGCG release profiles in simulated gastrointestinal tract media. The average ratio (%) of lipid deposition for EGCG-CS-PAA nanoparticles administered orally to rabbits was 16.9 ± 5.8%, which was close to that of oral simvastatin (15.6 ± 4.1%). Orally administered EGCG alone yielded an average ratio of lipid deposit area of 42.1 ± 4.0%, whereas this value was 65.3 ± 10.8% for the blank nanoparticles. The effectiveness of EGCG against rabbit atherosclerosis was significantly improved by incorporating EGCG into the nanoformulation.

Modification of vectors for functional genomic analysis in plants

Simple, efficient, and economical recombinant plant binary expression vectors for deciphering large-scale functional genomic research in plants and promoting crop improvement by genetically engineering and biotechnology is in great demand. In this research, using the pCHF3, pCAMBIA1301, pCAMBIA3300, pCAMBIA3301 vectors, we successfully constructed general plant binary expression vectors carrying CaMV35S and Arabidopsis rd29A promoters mediating multiple cloning sites (

MCS

SacI, KpnI, SmaI, BamHI, XbaI, SalI, and PstI). Meanwhile, a series of applicative binary expression vectors that can be utilized for subcellular localization were constructed by fusion of the MCS and eGFP. Subsequently, the recombinant vectors were successfully transferred into Arabidopsis thaliana and Nicotiana benthamiana for further investigation of functional elements in these plant binary expression vectors. Our results demonstrated that this system was a convenient and versatile vector system for phenotypic, functional, subcellular localization, and promoter activity analysis, and it provided a relatively high-efficiency and reliable platform for researchers in vector construction and may facilitate large-scale functional genomics analysis in plants.

Shape memory embracing fixator for Vancouver type B and type C periprosthetic femoral fractures

The purpose of this study was to analyze clinical and radiographical results of a group of patients with periprosthetic femoral fractures treated with the shape memory embracing fixator. We retrospectively reviewed twelve patients in whom a total of twelve periprosthetic femoral fractures were treated with the shape memory embracing fixator between August 2004 and February 2013. The patients were 3 men and 9 women (mean age, 69.9 years; range 42-92 years). The average duration of follow-up was 39.3 months (range 4-103 months). In one case, bone grafting was used. Postoperative evaluation was based on radiographs and Harris hip scores. All fractures healed at on average 4.4 months (range: 3 to 6 months) after surgery. None of the patients developed nonunion or malunion during the follow up. And there was no implant failure and no infection during follow up. The average Harris hip score at the final follow-up examination was 84.8 points. Results show that the shape memory embracing fixator is a safe and effective means for Vancouver type B and type C periprosthetic femoral fractures following hip arthroplasty.

Ethyl acetate-n-butanol gradient solvent system for high-speed countercurrent chromatography to screen bioactive substances in okra

High-speed countercurrent chromatographic separation (HSCCC) possesses the property of zero-loss of sample, which is very useful for the screening of bioactive components. In the present study, the ethyl acetate-n-butanol gradient HSCCC solvent system composed of n-hexane-ethyl acetate-n-butanol-water was investigated for the screening of bioactive substances. To screen the antiproliferative compounds in okra extract, we used the stationary phase ethyl acetate-n-butanol-water (1:1:10) as the stationary phase, and eluted the antiproliferative components by 6-steps of gradient using mobile phases n-hexane-ethyl acetate (1:2), n-hexane-ethyl acetate (1:4), n-hexane-ethyl acetate (0:4), n-butanol-ethyl acetate (1:4) n-butanol-ethyl acetate (1:2), n-butanol-ethyl acetate (2:2), and n-butanol-ethyl acetate (2:1). The fractions collected from HSCCC separation with the gradient solvent system were assayed for antiproliferative activity against cancer cells. Bioactive components were identified: a major anti-cancer compound, 4'-hydroxy phenethyl trans-ferulate, with middle activity, and a minor anti-cancer compound, carolignan, with strong activity. The result shows that the gradient solvent system is potential for the screening of bioactive compounds from natural products.

First Report of Bacterial Blight of Guar Caused by Xanthomonas axonopodis pv. cyamopsidis in China

Bacterial blight was observed on field-grown guar (Cyamopsis tetragonoloba L.) for the first time in China. The disease outbreak occurred in the Xinjiang Uyghur Autonomous Region after several weeks of unusually heavy rains during late summer 2013. The disease incidence was generally 40 to 50%, although values as high as 80% were observed in several fields. Initial field symptoms included water-soaked spots on leaves, pods, petioles, and stems. During later stages of infection, the color of the spots became dark. We also observed large, angular, necrotic lesions at leaf tips, black streaks on petioles and stems, split stems, defoliation, wilting or top withering, vascular necrosis, and dieback. Samples of diseased leaves, stems, petioles, pods, and seeds were surface sterilized, ground, and then plated onto King's B medium. Plates were incubated at 28°C for 72 h. Fifteen bacterial strains with yellow-pigmented, opaque, and round colonies were isolated. These strains were aerobic, gram-negative rods with a single, polar flagellum. They were positive for H₂S, esculin, oxidase, tobacco hypersensitivity, indole production from tryptophan, nitrate reduction to nitrite, and the utilization of glucose, mannose, trehalose, galactose, and starch. The maximum salt tolerance of the strains was 2 to 3%. Pathogenicity tests using eight strains were conducted in July 2013. A bacterial culture was suspended in sterile water with a final concentration of 10⁸ CFU/ml. Eight 4-week-old guar plants were inoculated by (i) spraying the bacterial suspension on the leaves until runoff, or (ii) puncturing the stems with a needle that had been dipped into the bacterial suspension. Sterile water was used as a negative control. Plants were kept in a mist room with 100% relative humidity for 24 h. Stem and leaf symptoms similar to those of the original plants were observed on the inoculated guar plants within 10 days of inoculation. No symptoms developed on the negative control plants. Yellow bacterial colonies re-isolated from inoculated plant tissues were morphologically identical to the original. 16S rDNA was amplified using universal primers (Pa 5'-AGTTTGATCCTGGCTCAG-3' and Ph 5'-TACCTTGTTACGACTTCGTCCCA-3') and sequenced. A BLAST search of the NCBI GenBank database indicated that the 16S rDNA sequences of three strains (accession nos. KF563926, KF563927, and KF563928) had 99.9% identity to Xanthomonas axonopodis strain XV938 (AF123091). Under greenhouse conditions, bacterial strains wilted asparagus bean and pea but rarely infected bean, kidney bean, faba bean, mung bean, soybean, red bean, pea, garbanzo bean, and peanut. Based on morphology, pathogenicity tests, 16S rDNA sequencing, and host plant specificity, the pathogen was confirmed as X. axonopodis pv. cyamopsidis (synonym: X. campestris pv. cyamopsidis [Patel et al., 1953]). To our knowledge, this is the first report of bacterial blight of guar caused by X. axonopodis pv. cyamopsidis in China. Guar has recently been introduced in Xinjiang Province. Our findings indicate that bacterial blight may pose a threat to the economic sustainability of guar production in the region. References: (1) I. A. Milyutina et a1. FEMS Microbiol. Lett. 239:17, 2004. (2) I. M. G. Almeida et al. Summa Phytopathol. 18:255, 1992. (3) J. D. Mihail et al. Plant Dis. 69:811, 1985.

Effect of CYP1A2 polymorphism on the pharmacokinetics of agomelatine in Chinese healthy male volunteers

WHAT IS KNOWN AND OBJECTIVE

Agomelatine is a melatonin (MT) analogue with agonistic properties and has been proven to be effective for various types of depressive symptoms. Following oral administration, agomelatine is primarily metabolized by the hepatic cytochrome P450 isoenzyme CYP1A2. The purpose of this study was to assess the influence of CYP1A2 single nucleotide polymorphisms (SNPs, rs762551, rs2069514, rs2472304, rs2470890) on agomelatine pharmacokinetics in the Chinese population.

METHODS

Seventy-two healthy Chinese male volunteers enrolled in the study received an oral dose of 25 mg of agomelatine after providing written informed consent. CYP1A2 SNPs were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Agomelatine plasma concentrations were determined by high performance liquid chromatography-tandem mass spectrometry, and the pharmacokinetics analyses were evaluated by nonparametric methods.

RESULTS AND DISCUSSION

After a single oral dose of 25 mg agomelatine, no significant differences existed in agomelatine pharmacokinetics between the rs2069514 GG homozygotes (n = 35) and the rs2069514 AG allele (n = 35) in all subjects. The mean agomelatine AUC0-7 , AUC0-∞ and Cmax for the rs762551 CC homozygotes (n = 9), rs2470890 CC homozygotes (n = 54) and rs2472304 GG homozygotes (n = 51) were much higher than the rs762551 AA allele (n = 31), rs2470890 CT allele (n = 17) and rs2472304 AG allele (n = 20) respectively (P < 0.05).

WHAT IS NEW AND CONCLUSION

The rs762551 A, rs2470890 T and rs2472304 A genotype presented a significantly lower level of agomelatine exposure (AUC, Cmax ) compared with the rs762551 C, rs2470890 C and rs2472304 G genotype in Chinese healthy subjects. It suggested that the rs762551, rs2470890 and rs2472304 genetic polymorphism might be associated with the marked interindividual variability of agomelatine, and the pharmacokinetic profile of agomelatine may be different in different races.

Root Rot of Chinese Jujube (Ziziphus jujuba) Caused by Cytospora sacculus in China

Ziziphus jujuba Mill. (Rhamanaceae), commonly known as Chinese jujube, is a plant that is native to China and widely distributed in China and South Korea. Chinese jujube is a traditional Chinese medicine and food that has been used for thousands of years. From spring 2011 to spring 2012, Chinese jujube trees (<4 years old) from commercial orchards in Kashi and Akzo developed symptoms of severe wilting, chlorosis, and stunting. The taproot and lateral roots exhibited black, sunken, necrotic lesions, and progression of these symptoms eventually caused mortality of infected trees. In April 2011 and 2012, 15 trees with root rot symptoms were collected from different orchards, and a fungus was recovered consistently from symptomatic rhizome samples that had been surface-sterilized with 0.1% mercuric chloride and plated onto potato dextrose agar (PDA). Thirteen isolates were obtained. Colony growth on PDA was initially white but gradually turned grayish yellow-brown, with the lower side of the plate turning a deep yellow-brown. Colony texture was felty and slightly raised with no concentric growth zones. Pycnidia formed abundantly after 30 days, and each exuded a dull orange cirrhus containing conidia. The conidiomatal stromata were immersed in the bark, erumpent, discoid, convex to conical, and 1.53 ± 0.13 mm in diameter. Discs were dark brown or grey, nearly flat, circular, and up to 0.6 mm in diameter, with one to eight lateral ostioles. Ostioles were brown, 40 to 80 mm in diameter, and located above the disc surface. Locules were globose, with four to eight in a stroma, undivided, and did not share common walls. Conidia were hyaline, eguttulate, and allantoid, with sizes of 12 to 20 × 1.0 to 1.5 μm. The agar culture and conidiomatal stromata morphology were in accordance with descriptions of Cytospora sacculus (1,4). PCR amplification of the internal transcribed (ITS) spacer region of rDNA (using primers ITS1/4), combined with amplification of the β-tubulin gene (using primers BT1a/BT1b) (2,3), followed by sequencing of the amplified DNA, led to identification of isolate 6T-17 as Valsa ceratosperma (anamorph C. sacculus). The sequence of the ITS1-5.8s-ITS2 region of rDNA (GenBank Accession No. JX560175) matched the ITS sequence of V. ceratosperma Accession AB369475 with 99% similarity, and the β-tubulin gene sequence (KC840674) resulted in a 99% match with that of V. ceratosperma Accession EU219136. Mycelial plugs of a culture of each fungal isolate on PDA were inoculated onto 10 rhizomes of 2-month-old seedlings of Z. jujube, and maintained in a greenhouse at 25 to 30°C. Ten rhizomes of 2-month-old seedlings of Z. jujuba were inoculated with non-colonized PDA plugs as the control treatment. After 2 months, all inoculated seedlings showed chlorotic leaves and root rot symptoms similar to those observed in the original commercial orchards. No symptoms were observed on the control plants. The pathogen was reisolated successfully from symptomatic plants but not from the control plants, fulfilling Koch's postulates. To our knowledge, this is the first report of C. sacculus causing a root rot of Z. jujuba trees in China. References: (1) G. C. Adams et al. Stud. Mycol. 52:83, 2005. (2) G. M. Arruda et al. Plant Pathol. 54:53, 2005. (3) J. Baskarathevan et al. Eur. J. Plant Pathol. 132:549, 2012. (4) J. B. Kepley et al. J. Arbor. 26:326, 2000.

The isolation and characterization of a telomerase immortalized goat trophoblast cell line

Trophoblast cells play vital roles in the processes of embryonic implantation and placentation. Many toxicological compounds can induce the malfunction of trophoblast cells, resulting in implantation failure or early embryonic loss. The finite lifespan of primary trophoblast cells limits investigation of the long-term effects of some toxicological compounds on trophoblast cells in vitro. In this study, primary goat trophoblast cells were purified by density gradient centrifugation and specific immuno-affinity purification. Then, the purified cells were immortalized through transfection of a plasmid containing the human telomerase reverse transcriptase (hTERT) gene. hTERT-transfected goat trophoblast cells (hTERT-GTCs) could steadily express hTERT gene and exhibit higher telomerase activity, and persistently proliferate without any signs of senescence up to 50 passages. The immortalized goat trophoblast cells still possessed the basic and key properties of normal primary goat trophoblast cells to express the specific intracellular marker cytokeratin 7 (CK-7) and secrete chorionic gonadotrophin β-subunit (CG-β) and placental lactogen (PL). Further studies showed that the immortalized goat trophoblast cells expressed vimentin and non-classical MHC class I antigen and exhibited invasive phenotype, suggesting that the immortalized goat trophoblasts resembled human extravillous trophoblasts. In addition, this cell line did not show neoplastic transformation either in vivo or in vitro. We concluded the immortalized goat trophoblast cells by hTERT transfection retained the basic and key characteristics of primary trophoblast cells and may provide a useful model to study the effects of some toxicological compounds on trophoblast cells.

Uptake of di(2-ethylhexyl) phthalate (DEHP) by the plant Benincasa hispida and its use for lowering DEHP content of intercropped vegetables

Uptake of di(2-ethylhexyl) phthalate (DEHP) by the plant Benincasa hispida and its use for topical phytoremediation were investigated by cultivation of plants in DEHP-contaminated environments. The results showed that major plant organs of B. hispida , including leaves, stems, and fruits, readily absorbed DEHP from the air. The amount of DEHP that accumulated in leaves, stems, and fruits was mainly dependent upon exposure time, and most DEHP accumulated in their inner tissues. A single plant of B. hispida with a gourd was able to absorb more than 700 mg of DEHP when it was exposed to DEHP-contaminated air for 6 week. B. hispida reduced air DEHP concentration by 65-76% as the air DEHP concentration ranged from 2351 to 3955 μg/m³ (high DEHP level) and 85-92% as the air DEHP concentration ranged from 35.1 to 65.3 μg/m³ (low DEHP level) in greenhouse experiments. When intercropping of B. hispida and Brassica chinensis or Brassica campestris , B. hispida reduced more than 87% of DEHP accumulation in the latter, which indicates that B. hispida has excellent use potential for lowering the DEHP content of intercropped vegetables.

Successful treatment of thalidomide for recurrent bleeding due to gastric angiodysplasia in hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder, which is uncommon anomaly to recurrent gastrointestinal bleeding. Although there are several forms of therapy ranging from local therapy to operations or drug therapy, there is a lack of more effective treatment for the disease. In this report, we presented a Chinese patient with recurrent melena due to gastric angiodysplasia in HHT treated successfully with thalidomide.