Partial trisomy 13 [46,XY,dup(13)(q14-31)]: a case report

We report a fetus with partial trisomy 13 [46,XY,dup(13)(q14-31)] which was found during an amniocentesis performed due to the age of the mother. This duplication segment (13q 14-31) has not been reported in literature. The clinical features of our patient included cleft lip/palate, low set ears, depressed nasal bridge, hypertelorism, and epicanthal fold. After termination of the pregnancy, the fetus was sent for an autopsy. The autopsy report was compatible with the gross findings and no other abnormalities, including central nervous, cardiac, and renal system, were found. The level of maternal alpha-fetoprotein, 2.67 MoM, was opposite with the common phenomenon in complete trisomy 13.

Population dynamics of the house dust mites Dermatophagoides farinae, D. pteronyssinus, and Euroglyphus maynei (Acari: Pyroglyphidae) at specific relative humidities

Experiments were conducted to determine the effects of relative humidity on the population dynamics of single and mixed species of Dermatophagoides farinae Hughes, D. pteronyssinus (Trouessart), and Euroglyphus maynei (Cooreman) at specific relative humidities maintained at 20 degrees C, with unlimited food. The population density of single and mixed species (D. farinae and D. pteronyssinus) increased exponentially when cultured at 65, 70, and 75% RH. The mean population growth rates were 17.3 +/- 4.4 SD and 32.5% +/- 4.7/wk for D. farinae and D. pteronyssinus, respectively. Mean population doubling times were 2.2 +/- 0.3 and 4.2 +/- 1.3 wk for D. pteronyssinus and D. farinae, respectively. Mixed species cultures, started with equal numbers of D. farinae and D. pteronyssinus, resulted in higher percentages of D. farinae than D. pteronyssinus. In cultures started with 75% of one species and 25% of the other, the more numerous species remained dominant and in similar ratios throughout the experiment. Both D. farinae and D. pteronyssinus population densities maintained at 85% RH declined over a 12-wk culture period because of mold growth. E. maynei were unable to survive at 65, 70, 75, and 85% RH, which indicated that their climatic requirements were different from those of D. farinae and D. pteronyssinus. Population densities of D. farinae and D. pteronyssinus cultures declined when held at 21-22 degrees C and relative humidities of < or = 50%; however, at 50% RH, significant proportions of the populations survived for 10 wk. Half-life for desiccation of D. farinae and D. pteronyssinus at 45% RH was 11.5 and 1.2 wk, respectively, but at 50% RH was 86.3 and 4.0 wk, respectively. The data indicated that a < or = 50% RH would have to be maintained for long periods to reduce both D. farinae and D. pteronyssinus by desiccation procedures. The results of this study show that D. farinae and D. pteronyssinus have high reproductive potentials and population growth rates, which indicate that mite reduction procedures must be thorough or mite densities will return to high levels quickly following remediation if adequate food and suitable microclimatic conditions exist.

Laser-induced thermal events in empty and pulp-filled dental pulp chambers

BACKGROUND AND OBJECTIVE

The purpose of this investigation was to evaluate: 1. thermal events during laser irradiation @2.1 microns of the pulp; 2. whether these effects are adequately modeled using an empty pulp chamber/root canal.

STUDY DESIGN/MATERIALS AND METHODS

In extracted human teeth, pulpal access was prepared and thermocouples placed 2, 3 mm apical to the center of the irradiation spot. Pulp-filled or empty pulp chambers were irradiated using a Ho:YAG laser: Spot Size: 1 mm; Power: 1, 2, 3.5, 4.5 W; PRR: 5, 12 Hz;

DURATION

10 sec. Thermal measurements were repeated 3x.

RESULTS

Thermal trends did not differ significantly and correlated positively with power (P < 0.01), PRR (P < 0.01), irradiation duration (P < 0.05). No significant difference was determined between temperatures in empty and pulp-filled chambers at all parameters at 5 Hz and at 1-2 W at 12 Hz (P < 0.05, 2-tailed Student's t-test). At 12 Hz and > 3.5 W, pulp chamber temperatures exceeded those in pulpal tissue (P < 0.05).

CONCLUSION

Pulp tissues must be present to ensure clinical relevance of thermal measurements.

Phenoloxidase activity of hemocytes derived from Penaeus monodon and Macrobrachium rosenbergii

The phenoloxidase (PO) activity of hemocyte lysate supernatant (HLS) from both tiger shrimp (Penaeus monodon) and giant freshwater prawn (Macro-branchium rosenbergii) was examined by treating HLS with various factors, such as an increase in temperatures from 25 to 70 degrees C, one of four elicitors (beta-1,3-1,6-glucan, zymosan, heat-killed Vibrio cells, and lipopolysaccharide), trypsin, one of three protease inhibitors (soybean trypsin inhibitor, p-nitrophenyl-p'-guanidinobenzoate, and benzamidine), and one of two divalent cations (Mg2+ and Ca2+). The strongest PO activity in both animals was induced at 37 degrees C, while enzyme activity varied according to the concentration of the elicitors or cations added to the HLS samples. The following optimum concentrations were recorded: lipopolysaccharides at 0.5 mg/ml, both beta-glucan and zymosan at 1 mg/ml, and Vibrio cells at 10(6) cells/ml. In addition, for giant freshwater prawn, PO activity increased when HLS was treated with trypsin and decreased when it was separately treated with three protease inhibitors. However, effects of either trypsin or protease inhibitors did not occur in tiger shrimp. Strongest PO activity occurred in HLS treated with 20 mM of either calcium ion or magnesium ion, and the addition of the two cations led to an increase in enzyme activity; a decrease was noted following the treatment with EDTA. Cytochemical analysis revealed that prophenoloxidase system exists in the granulocytes of both tiger shrimp and giant freshwater prawn.

Tissue-specific expression of herpes simplex virus thymidine kinase gene delivered by adeno-associated virus inhibits the growth of human hepatocellular carcinoma in athymic mice

About 70% of hepatocellular carcinomas are known to express alpha-fetoprotein, which is normally expressed in fetal but not in adult livers. To induce herpes simplex virus-thymidine kinase expression in these cancer cells, we constructed an adeno-associated viral vector containing the HSV-TK gene under the control of the alpha-fetoprotein enhancer and albumin promoter. We previously demonstrated in vitro that although this vector can transduce a variety of human cells, only transduced AFP and albumin-expressing hepatocellular carcinoma cell lines were sensitive to killing by ganciclovir (GCV). In the present study, we explored the effect of this vector on hepatocellular carcinoma cells in vivo. Subcutaneous tumors generated in nude mice by implanting hepatocellular carcinoma cells previously transduced with this vector shrank dramatically after treatment with GCV. Bystander effect was also observed on the tumors generated by mixing transduced and untransduced cells. To test whether the tumor cells can be transduced by the virus in vivo, we injected the recombinant adeno-associated virus into tumors generated by untransduced hepatocarcinoma cell line. Tumor growth were retarded after treatment with GCV. These experiments demonstrate the feasibility of in vivo transduction of tumor cell with rAAV.

Bilateral multicystic kidney dysplasia in a fetus with neonatal pulmonary hyaline membrane disease: a case report

Multicystic kidney disease is the most common cause of neonatal renal mass and either the most or second most common neonatal abdominal mass. This disease is a congenital dysplasia of the kidney characterized by large nonhomogeneous dilations of the collecting tubules. It may occur unilaterally or bilaterally, and the incidence is about 1 out of 5,000 to 10,000 births. Severe bilateral defects are lethal. Partial dysplastic involvement of both kidneys eventually leads to renal function impairment. This is a case of bilateral multicystic kidney dysplasia diagnosed prenatally at 34 weeks of gestation. Hyaline membrane disease was found in both lungs after delivery. The antenatal diagnostic criteria for multicystic kidney disease and treatment after diagnosis are also discussed.

Mesenteric and portal venous obstruction associated with primary antiphospholipid antibody syndrome

A 58-year-old Korean man who had a past history of appendicitis, superior mesenteric vein thrombosis and intestinal obstruction presented 7 years later suffering from colicky right upper quadrant pain, epigastric discomfort after fatty meals, nausea and vomiting. He was found to have thrombosis of the superior mesenteric and portal veins, portal hypertension with oesophageal varices, cholangitis, and a biliary stone. The serum anti-cardiolipin antibody (aCL) titres were 103 immunoglobulin (Ig)G antiphospholipid units (GPL) and 50 IgM antiphospholipid units (MPL) and the aCL-IgG titre was still high at 106 2 years after the initial diagnosis. No evidence of disease states known to be associated with antiphospholipid antibodies was found. We report a patient with mesenteric and portal venous obstruction associated with the primary antiphospholipid syndrome (APS).

A randomised trial of six versus twelve courses of chemotherapy in metastatic carcinoma of the breast

Chemotherapy given to patients with metastatic carcinoma of the breast is palliative in intent. Longer regimens would be justified if there was a proven prolongation of symptom response or survival. We conducted a randomised trial to assess the survival of patients receiving up to six extra courses of chemotherapy compared with our conventional regimen of six courses. The patients received either VAC, VEC (vincristine, doxorubicin or epirubicin and cyclophosphamide) or MMM (mitozantrone, methotrexate and mitomycin C) therapy. Patients who had stable disease or were responding after six courses of chemotherapy were randomised to either stop or continue treatment for another six courses. Those patients receiving maintenance therapy had a significantly longer duration of response (P < 0.02) and a significantly longer progression-free survival (P < 0.01). However, there was no survival difference between the two groups. Furthermore, treatment toxicity, which was similar in the two groups, persisted for longer in the maintenance group. These results indicate no clinical advantage for giving maintenance chemotherapy in order to prolong survival of patients with metastatic breast cancer.

Hemodynamic effect of inhaled nitric oxide in dilated cardiomyopathy patients on LVAD support

Recently it has been shown that inhaled nitric oxide (NO), which has been proven to contribute to improvement in critical pulmonary hypertension, may provide a favorable effect early after left ventricular assist device (LVAD) support. To improve right ventricular function, inhalation of NO was added to treatment with conventional catecholamines for four consecutive dilated cardiomyopathy (DCM) patients following institution of LVAD. In two patients 1 hr after inhalation of NO, central venous pressure (CVP), mean pulmonary arterial pressure (PAm), and pulmonary vascular resistance (PVR) were improved. These results led to better LVAD output and resulted in an adequate cardiac index. On the other hand, a right VAD (RVAD) was implemented in one patient whose high CVP, PAm, and PVR continued; he was weaned after 8 days of RVAD support. Another patient who had a high CVP but normal PAm and PVR before and after inhalation of NO had no improvement in his hemodynamic state. These data suggest that inhaled NO may improve systemic circulation by reducing right ventricular afterload and may become a promising and convenient therapy before placing RVAD in DCM patients under LVAD support. RVAD should be conducted in patients with right ventricular failure or when pulmonary hypertension is associated with impaired right ventricular reserve, even after inhalation of NO.

Genetic localization of the type I trimethoprim resistance gene and its dissemination in urinary tract isolates in Taiwan

In a total of 425 urinary isolates of E. coli, Enterobacter spp., and Klebsiella spp. selected, there were 169 (45.4%) isolates harbouring type I dihydrofolate reductase (DHFR) gene among 374 trimethoprim-resistant isolates. In these 169 isolates, only 17.2% hybridized with the Tn7 probe. According to another probe specific for the integrase gene of integron, 87.6% showed a positive reaction. Further analysis by restriction mapping proved that the type I DHFR gene was inserted into a integron-like structure. These results indicate that the type I DHFR gene that was initially observed in association with transposable element Tn7 is becoming associated with an integrase function similar to integrons in most instances. Further analysis of the distribution of Tn21-like integrase gene in clinical isolates indicated that the prevalence rates were 86.4%, 84.8%, and 76.7% respectively in E. coli, Enterobacter spp., and Klebsiella spp.. Furthermore, the integrase gene found in our clinical isolates proved to be mediated by a plasmid, demonstrated by Southern hybridization. Thus, the trimethoprim-resistant gene that developed under selective pressure from the double drug trimethoprim and sulphonamide was transmitted by insertion into integron-like structure and then mediated by plasmid transfer for dissemination.

Hepatic sinusoid endothelial dysfunction plays a role in hyperbilirubinemia in patients following implantation of an LVAD

To clarify the mechanism of hyperbilirubinemia in the setting of a left ventricular assist device (LVAD), the change in hepatocellular function, hepatic sinusoid endothelial microcirculation, and inflammatory response before and after LVAD implantation were evaluated. Eight consecutive patients underwent the placement of an LVAD, and serum levels of total bilirubin (TB), transaminases [alanine transaminase (ALT), aspartate transaminase (AST)], interleukin (IL-6, IL-8), and hyaluronic acid (HA), an indicator of hepatic sinusoidal circulation, were measured before and after LVAD implantation. The TB of all patients increased significantly in the first post operative week (p < 0.05 vs. pre-operatively). In five patients, the elevated TB (4.6 +/- 4.1 mg/dl) returned to pre-operative levels (2.7 +/- 2.0 mg/dl) by the 14th post operative day (Group R), but in the other three patients who died of multiple organ failure, the level of TB increased to 39.9 +/- 16.4 mg/dl (Group A). Levels of HA and IL-8 had good correlation with the level of TB (HA: r = 0.60, p < 0.05; IL-8: r = 0.55, p < 0.05). However, AST, ALT, and IL-6 were not related to changes in TB. These results suggest that hepatic sinusoid endothelial dysfunction and inflammatory reaction may play a significant role in hepatic failure in patients following implantation of an LVAD.

Antimicrobial susceptibility of flavobacteria as determined by agar dilution and disk diffusion methods

A total of 106 clinical isolates of flavobacteria, including 41 isolates of Flavobacterium meningosepticum, 59 of Flavobacterium indologenes, and 6 of Flavobacterium odoratum were collected from January 1992 to December 1995 from patients in Taiwan. The in vitro activities of antimicrobial agents were determined concomitantly by the standard agar dilution and disk diffusion methods. More than 90% of the flavobacterial isolates were resistant to cephalothin, cefotaxime, ceftriaxone, moxalactam, aztreonam, imipenem, aminoglycosides, erythromycin, and glycopeptides. The majority of F. meningosepticum isolates were susceptible to piperacillin and to minocycline but resistant to ceftazidime, with MICs at which 90% of the isolates are inhibited being 8, 4, and > 128 microg/ml, respectively. Approximately half of the F. indologenes isolates were susceptible to piperacillin, cefoperazone, ceftazidime, and minocycline, with MICs at which 50% of the isolates are inhibited being 4, 16, 8, and 4 microg/ml, respectively. The majority of F. odoratum isolates were resistant to all the antimicrobial agents tested except minocycline, to which five of six isolates were susceptible. With least-squares regression analysis and error rate-bounded analysis methods, the following resistant and susceptible zone diameter breakpoints were established: < or = 12 and > or = 17 mm, respectively, for piperacillin against F. meningosepticum and F. indologenes; < or = 13 and > or = 18 mm, respectively, for ceftazidime against F. meningosepticum and F. indologenes, < or = 17 and > or = 21 mm, respectively, for ofloxacin against F. indologenes; < or = 16 and > or = 20 mm, respectively, for ciprofloxacin against F. meningosepticum. Valid breakpoints for the disk diffusion method could not be established for cefoperazone and ofloxacin against F. meningosepticum and for minocycline against F. meningosepticum and F. indologenes due to a poor correlation coefficient for the regression line or for cefoperazone and ciprofloxacin against F. indologenes due to the presence of remarkable error rates.

Persistence of T-cell clones in psoriatic lesions

BACKGROUND

We previously demonstrated a clonal dominance in the V beta 13.1 messages isolated from the lesional CD8+ T cells of psoriasis vulgaris, which suggested an interaction of V beta 13.1+ CD8+ T cells with skin antigens.

OBJECTIVES

To determine whether the clonality observed accurately reflected a clonal population of infiltrating T cells or was skewed by an overabundance of messages from a small number of cells, and to extend our study of V beta gene usage by lesional CD8+ T cells to 9 new patients.

DESIGN

Case study.

SETTING

Patients were enrolled at the Psoriasis Research Institute in Palo Alto, Calif, and samples were analyzed at The Immune Response Corporation in Carlsbad, Calif.

MAIN OUTCOME MEASURES

For the 2 previous patients, skin samples were sorted directly for V beta 13.1+ T cells, for which the T-cell receptors were sequenced. For the 9 new patients, CD8+ T cells were sorted and their T-cell receptor V beta gene usage measured using semiquantitative polymerase chain reaction with V beta-specific primers.

RESULTS

The directly sorted V beta 13.1+ T cells exhibited clonal dominance in both patients. The dominant V beta 13.1 clone in each patient was the same as that found in the previous 2 biopsy specimens for which CD8+ T cells were sorted. Additionally, in 8 of the 9 new patients examined, we again found a preferential usage of V beta 3 and/or V beta 13.1 genes by the lesional CD8+ T cells.

CONCLUSIONS

The clonality, which was found in the V beta messages of the sorted CD8+ T cells, accurately reflects the dominance of these clones in the infiltrating T cells. Moreover, the persistence in the same patient of the same clone for as long as 15 months and the overrepresentation of V beta 3 and/or V beta 13.1 in lesional CD8+ T cells in the new patients examined support the pathogenic role of T cells bearing these V betas.

Flavimonas oryzihabitans bacteremia: clinical features and microbiological characteristics of isolates

Flavimonas oryzihabitans is rarely reported as a pathogen in humans. Twelve cases of F. oryzihabitans bacteremia were diagnosed at National Taiwan University Hospital over a 3-year period. The clinical features of these patients were analyzed, and antimicrobial susceptibilities and random amplified polymorphic DNA (RAPD) patterns of the 12 isolates were studied. Among these 12 patients, eight (67%) had underlying neoplastic diseases and all acquired F. oryzihabitans bacteremia while hospitalized. The clinical syndromes included primary bacteremia in 5 patients (42%), biliary tract infection in 3 (25%), and peritonitis, subdural empyema, infusion-related bacteremia, and pneumonia in 1 each. Polymicrobial bacteremia or concomitant fungemia was seen in three patients (25%). All the patients survived after antibiotic treatment. All isolates were susceptible to piperacillin, third-generation cephalosporins, aminoglycosides, and quinolones but resistant to cephalothin, cefuroxime, and trimethoprim. Susceptibility to aztreonam was variable (25%). The RAPD patterns differed among the isolates, indicating the epidemiological unrelatedness of these infections. F. oryzihabitans should be included as an etiology of severe nosocomial infection in patients with underlying debilitating diseases.

Family history of cancer and risk of lung cancer in lifetime non-smokers and long-term ex-smokers

BACKGROUND

Genetic factors appear to play a role in the aetiology of lung cancer.

METHODS

To examine the association between family history of cancer (all types) and risk of lung cancer among non-smokers, we conducted a case-control study. Cases (n = 618) were identified through the Missouri Cancer Registry for the period 1986 through 1991, and included 432 lifetime non-smokers and 186 ex-smokers who had stopped at least 15 years prior to diagnosis or had smoked for less than one pack-year. Controls (n = 1402) were selected through drivers licence and Medicare files.

RESULTS

The risk of lung cancer increased directly in relation to the number of family members affected with cancer. The odds ratio (OR) associated with five or more first-degree relatives with cancer was 2.7 (95% confidence interval [CI] 1.2-6.1), with a significant linear trend in risk according to the number of relatives affected (P = 0.03). Increased lung cancer risk was associated with two or more affected siblings (OR = 1.4; 95% CI: 1.0-1.9) and with two or more affected offspring (OR = 3.2: 95% CI: 1.3-8.1). Risk was slightly elevated for family history of lung cancer (OR = 1.3; 95% CI: 1.0-1.8).

CONCLUSIONS

Our study identified a slight increase in risk of lung cancer in relation to five or more relatives with cancer. Preventive implications of this increased risk are unclear because the attributable fraction is low in comparison to a variety of other factors.

Comparison of Etest and agar dilution method for antimicrobial susceptibility testing of Flavobacterium isolates

The Etest was evaluated as a possible alternative to the standard agar dilution method for susceptibility testing of nine antimicrobial agents against Flavobacterium species. In studies of 100 clinical isolates, the agreement between the MICs (+/-1 log2 dilution) obtained by the two methods was acceptable for cefotaxime, ceftazidime, amikacin, minocycline, ofloxacin, and ciprofloxacin (> 90%). Conversely, the agreement between the results obtained for piperacillin was limited (84%). The overall agreement was 92.5%.

NRF2, a member of the NFE2 family of transcription factors, is not essential for murine erythropoiesis, growth, and development

The locus control region of the beta-globin gene is composed of four erythroid-specific hypersensitive sites. Hypersensitive site 2 has been shown to be a powerful enhancer and contains a tandem repeat sequence for the transcription factors AP1 and NFE2 (activating protein 1 and nuclear factor erythroid 2, respectively). The human NRF2 (NFE2 related factor 2) has been isolated by bacterial expression screening using this core sequence as a probe. p45-NFE2, NRF1, and NRF2 belong to the CNC ("cap 'n' collar") subfamily of the basic region-leucine zipper transcription factors, which exhibits strong homology at specific regions such as the "CNC" and the DNA binding and leucine zipper domains. Although the erythroid-specific p45-NFE2 has been implicated in globin gene regulation, p45-NFE2 null mice succumb to bleedings due to lack of platelets and those that survive exhibit only a mild anemia. To determine the function of NRF2, which we found to be widely expressed in vivo, we have characterized the genomic structure of the mouse NRF2 gene, disrupted the Nrf2 gene by homologous recombination in mouse embryonic stem cells (ES cells), and generated NRF2-/- mice. Homozygous mutant mice developed normally, were not anemic, reached adulthood, and reproduced. Our studies indicate that NRF2 is dispensable for mouse development.

Postoperative thrombotic thrombocytopenic purpura following cardiovascular surgeries

Among 47 patients with thrombotic thrombocytopenic purpura (TTP), 8 patients were diagnosed to have postoperative-TTP. Two patients underwent vascular surgery, 5 patients coronary artery bypass grafts, and 1 patient resection of myocardial sarcoma. Prior to surgery, all patients except one had normal hemograms and platelet counts, and blood smears showed no schistocytes. Five to 19 days after surgery, all 8 patients developed postoperative TTP, which clinical feature was characterized by unexplained progressive encephalopathy, thrombocytopenia, and microangiopathic hemolytic anemia. In addition, in 3 patients, progressive gangrene of the toes also developed. Four patients achieved complete remission following exchange plasmapheresis and 1 patient spontaneous remission. Due to complicated surgical settings after surgery, recognition of TTP was often delayed and it contributed to death in 3 patients despite treatment with exchange plasmapheresis. In view of occurrence of postoperative TTP following cardiac and vascular surgeries, pathogenic mechanism for postoperative TTP may be explained on the basis of injury of diseased endothelial surface and release of a humoral factor(s) that results in platelet aggregation in the capillaries and arterioles. Our experience with these cases indicates that TTP may occur as a serious complication of cardiac and vascular surgeries, and early recognition of the diagnosis and institution of exchange plasmapheresis are of paramount importance for favorable outcome.