Mosaic trisomy 21/monosomy 21 in a living female infant

Many autosomal monosomies are presumed to end in arrested growth in the first few mitoses, prior even to the time of implantation, with possibly some proceeding to the stage of occult abortion. The single exception may be monosomy 21, although this has been questioned, with most earlier reports of monosomy 21 recently re-interpreted as being due to an unbalanced translocation involving chromosome 21. Here we report a female infant with a mosaic trisomy 21/monosomy 21 karyotype. While the karyotype 46,XX,i(21)(q10) is detected in all metaphases investigated in lymphocytes, mosaicism with the karyotype 46,XX,i(21)(q10)[31]/45,XX, -21[12] is seen in fibroblasts from a skin biopsy. Dysmorphic facial features and multiple malformations remarkably resemble cases of monosomy 21 that have been described in the literature. This suggests a dominant phenotypic effect of loss of one chromosome 21. Detailed clinical description, results of gene dosage studies, and cytogenetic analysis will be presented.

VEGF-A, VEGFR-1, VEGFR-2 and Tie2 levels in plasma of premature infants: relationship to retinopathy of prematurity

AIM

To study prospectively the plasma levels of vascular endothelial growth factor (VEGF-A), its soluble receptors sVEGFR-1, sVEGFR-2 and soluble Tie2 in premature infants. To identify their changes related to the onset of retinopathy of prematurity (ROP).

METHODS

Blood samples of 63 preterm infants born at a postmenstrual age (PMA) of 23-32 weeks were obtained between 5 days and 15 weeks after birth. 42 infants had no ROP, two had stage 1, nine stage 2 and 10 stage 3. Of these, four infants were treated with retinal photocoagulation. VEGF-A, sVEGFR-1, sVEGFR-2, and sTie2 were measured in the plasma with a sandwich enzyme immunoassay using factor-specific monoclonal mouse antibodies. The time course of concentrations plotted by kernel smoothing in infants with and without ROP were compared and a paired subgroup with analysis of variance was analysed.

RESULTS

ROP patients had raised plasma levels of sVEGFR-2 and sTie2 compared with premature infants without ROP. VEGF-A and sVEGFR-1 levels were similar in both groups. Analysis of a subgroup with pairs of measurements, one before 32 weeks and one after 36 weeks, showed a significant increase in sTie2 after 36 weeks of PMA independent of ROP (p = 0.03).

CONCLUSION

This is the first study to measure plasma levels of angiogenic factors in ROP. Similar VEGF-A plasma levels in infants with and without ROP suggest that pathogenic retinal angiogenesis in ROP is mainly driven by local VEGF-A synthesis. Elevated plasma levels in active ROP were observed for sVEGFR-2 and sTie2. These increases have yet to be confirmed as predictive values for ROP.

Follow-up of 11-16 years after modular fixed-bearing TKA

To present representative data of long-term survivorship and clinical outcome for the PFC total knee arthroplasty (PFC-TKA). A consecutive series of 141 TKA was followed for a mean of 13 years (range, 11-16 years). Sixty-five knees were evaluated, 30 of these clinically and radiographically. Twenty-eight knees could only be assessed with the use of a questionnaire. Six patients were living in nursing homes. Fifty-four patients (65 knees) had died. Eleven had undergone a revision. One patient was considered lost to follow-up. With re-operation for any reason as the endpoint, the 10-year survival rate was 92% (n = 91 patients at risk), and the 14-year survival rate was 91% (n = 12). With aseptic loosening of the implant as the endpoint, the 10- and 14-year survival rates were 97%. The mean Knee Society and function scores were 76 and 48 points, respectively. In this multi-surgeon series modular fixed-bearing TKA had good clinical and radiographic results with excellent long-term survivorship.

[Frequency of biceps tendon tenosynovitis from crutches: a sonographical observation]

A total of 138 patients using elbow crutches after endoprothetic joint replacement of the hip or knee were examined for effusion of the biceps tendon sheath using ultrasound sonography. A surprisingly high number of patients showed liquid effusion around the long biceps tendon area (69 patients, 50%). Tenosynovitis was associated with a liquid effusion of the glenohumeral joint in only 5 cases, whereas isolated tenovaginitis was seen in the large majority of the cases. This leads to the hypothesis that axial-mediated stress is the pathogenetic mechanism and causes a functional impingement as a result of high positioning of the caput humeri by the use of crutches. Further investigations are necessary to find out why the inflammation is limited to the anterior recessus region (Sulcus intertubercularis) of the glenohumeral joint.

Bestimmungen von CRP und Neopterin sowie antiendotoxischer Antikörper bei Pferden mit Fieber

Gegenstand: Feldstudie zum Fieber unbekannter Genese beim Pferd. Ziel: Die routinemäßigen Laborparameter wurden hinsichtlich ihrer Wertigkeit für eine ätiologische Diagnose analysiert. Das diagnostische Profil wurde durch die Parameter CRP und Neopterin sowie durch antiendotoxische Antikörper erweitert. Grundlage der Studie war die Hypothese, dass Endotoxine mit ihrem fieberauslösenden Potenzial eine ätiologische Bedeutung haben könnten. Material und Methoden: Über einen Zeitraum von drei Jahren wurden 383 Fieberfälle untersucht und entsprechend der klinischen Symptomatik in vier verschiedene Fiebertypen eingeteilt. Die Voraussetzung für die Einordnung in die Gruppe 1 (Fieber unbekannter Genese) war der Ausschluss einer anderen Fieberursache bei der Erst- und den Nachuntersuchungen. Die Blutprobe wurde am ersten Untersuchungstag entnommen. Die Bestimmungen von CRP und Neopterin sowie der antiendotoxischen Antikörper erfolgten jeweils mit einem ELISA. In die Auswertung dieser Messergebnisse wurde deren Korrelation zu weiteren klinisch-chemischen Parametern einbezogen. Ergebnisse: Bei 195 (50,9%) Patienten wurde Fieber unbekannter Genese registriert. Während der mittlere CRP-Wert (8,08 g/l) im Normbereich lag, war die Neopterinkonzentration (7,29 mmol/l) erhöht. Die Mittelwerte für die antiendotoxischen Antikörpertiter der Immunglobulinklasse M waren pathologisch erhöht (Anti-Lipid-A-IgM 1,18 OD, Anti-Endotoxin-IgM 1,5 OD). Klinische Relevanz: Das pyrogene Potenzial der Endotoxine ist bei Fällen von Fieber unbekannter Genese in die ätiologischen Betrachtungen mit einzubeziehen. Nach Ausschluss anderer Fieberursachen ist eine diesbezügliche Erweiterung des labordiagnostischen Profils sinnvoll. Neopterin und CRP stellen unspezifische Effektparameter dar, die im Zusammenhang mit weiteren Befunden auch beim Pferd für die Beurteilung des Gesundheitszustandes wertvoll sein können.

Transpapillary intraductal ultrasound in the evaluation of dominant bile duct stenoses in patients with primary sclerosing cholangitis

OBJECTIVE

Primary sclerosing cholangitis (PSC) is associated with the development of cholangiocarcinoma (CC) in approximately 9% of patients. Neither cholangiography nor endoscopic tissue sampling can reliably distinguish between CC and benign dominant bile duct stenosis. The aim of the present study was to assess the value of intraductal ultrasonography (IDUS) in distinguishing between benign and malignant dominant stenoses in PSC patients.

MATERIAL AND METHODS

Forty PSC patients with dominant bile duct stenoses were studied prospectively. Transpapillary IDUS and endoscopic tissue sampling were performed in addition to endoscopic retrograde cholangiography (ERC). Cholangiography and IDUS findings were classified as malignant or benign by the investigators. Final diagnosis of malignant stenosis was based on positive histology and/or cytology, whereas a benign character was assumed in cases of negative tissue sampling and uneventful extended clinical follow-up.

RESULTS

Eight PSC patients (20%) had dominant bile duct stenoses caused by CC, whereas 32 out of 40 patients (80%) had benign dominant bile duct stenoses. IDUS was significantly superior to ERC for detection of malignancy in terms of sensitivity (87.5% versus 62.5%, p=0.05), specificity (90.6% versus 53.1%, p<0.001), accuracy (90% versus 55%, p<0.001), positive predictive value (70% versus 25%, p<0.001), and negative predictive value (96.7% versus 85%, p=0.049).

CONCLUSIONS

Transpapillary IDUS significantly increases the ability to distinguish malignant from benign dominant bile duct stenoses in patients with PSC.

Inhibition of HCV subgenomic replicons by siRNAs derived from plasmids with opposing U6 and H1 promoters

Hepatitis C virus (HCV) is a main cause of chronic liver disease, which may lead to the development of liver cirrhosis and hepatocellular carcinoma. Therapeutic options are still limited in a significant proportion of patients. Small interfering RNAs (siRNAs) are an efficient tool to inhibit gene expression by RNA interference. As HCV RNA replicates in the cytoplasm of liver cells without integration into the genome, RNA-directed antiviral strategies are likely to successfully block its replication cycle. In this study, a panel of siRNAs was used to target various important regions of the HCV genome [5' untranslated region (UTR), NS3, NS4A, NS4B, NS5B, 3' UTR]. Convergent opposing human H1 and U6 polymerase III promoters were used to generate siRNAs. Target genes in sense and antisense orientation were attached to a luciferase reporter system to test the inhibitory efficiency of both siRNA strands. Our data revealed effective RNA interference against the HCV(+)-strand, the HCV(-)-strand or both strands simultaneously up to 65%. Subsequently, active siRNAs were tested in HCV subgenomic replicon cells and suppression of HCV RNA and NS5B protein levels up to 75% was confirmed. Interestingly, siRNAs that were effective against the sense as well as the antisense strand revealed the greatest inhibitory effects on HCV subgenomic replicons. Additionally, combinations of siRNAs induced a greater inhibition of HCV subgenomic replication of up to 90% proving the potential of this combined antiviral approach.

Removal of bacteria by filtration in planted and non-planted sand columns

In order to diminish hygienic hazards from pathogens, the elimination of pathogenic bacteria in a pre-treatment step is important for the use of domestic wastewater for irrigation purposes. Therefore, we analysed the removal of bacteria in laboratory-scale model sand filters simulating vertical flow systems of constructed wetlands (CW). Sand-filled glass columns were planted with Juncus effusus or Phragmites australis and non-planted columns were used as controls. Processes of bacteria removal such as adsorption, lysis, and the biotic effects caused by plants, protozoa, and Bdellovibrio were studied with E. coli as a model bacterium. E. coli suspensions (10(8) cellsml(-1)) were trickled on the columns by intermittent loading under non-water-saturated operation conditions. In non-planted and sterilized sand columns, an initial removal of cells was observed in the range as expected by the adsorption capacity of the sand columns. After loading of the sand with cells, an increasing reduction of the cell concentrations by 3-4 orders of magnitude in the effluent was registered up to volumetric loads of more than 548mll(-1) day(-1) (230mm day(-1)). In planted columns, no higher levels of removal were observed. Predation by protozoa, which were found in concentrations up to 10(4)ml(-1) in the effluent, is considered to be the main reason for the elimination. However, Bdellovibrio bacteriovorus was also found in plaque-forming units of about 10(4)g(-1) sand, suggesting that this bacteriovorous bacterium plays an additional role in the removal process. In a second series of experiments, domestic wastewater was applied and removal efficiencies up to four orders of magnitude of the cfu's of coliform bacteria, faecal streptococci, and salmonellae were observed. Considering the transpiration of the plants, higher removal efficiencies were found in the planted variants. Protozoa and Bdellovibrio were detected in the domestic wastewater in varying concentrations, suggesting that predation and lysis were the major removal mechanisms.