Follow up of patients with ocular scarring secondary to LOC syndrome treated by amniotic membrane transplantation

AIMS

To document and discuss the long term outcome of a new ophthalmic treatment for laryngo-onycho-cutaneous (LOC) syndrome.

METHODS

Two children were treated by excision of ocular granulation tissue and ocular surface rehabilitation with frozen amniotic membrane (AM). The clinical course of both patients was followed and documented at 2 years and 4 years following the surgery.

RESULTS

Patient 1 demonstrated limited recurrence of granulation tissue at 10 months. After 36 months, re-growth of granulation and scar tissue required a further three subsequent operations to the right eye in an attempt to keep the optical axis clear. 4 years postoperatively, neither eye has a clear visual axis. In contrast similar surgery for the right eye of patient 2 has been highly successful, with only very limited non-progressive recurrence after 2 years of follow up. The operation to the left eye has been similarly effective although the follow up is only 6 months.

CONCLUSIONS

Ocular surface rehabilitation with AM is the first partially effective treatment for the eye complications of LOC syndrome. The surprising benefit from AM may stem from the primary pathology of the condition. LOC syndrome is caused by a genetic defect resulting in an unusual N-terminal deletion of the alpha3a chain of the basement membrane protein laminin 5. One mechanism through which AM transplantation may act to reduce ocular scarring in this disease is to supplement the abnormal secreted laminin 5 with healthy transplanted laminin. Despite its initial efficacy one episode of AM treatment does not guarantee long term control of the scarring process and variations in AM graft efficacy may be related to other complicating factors such as limbal stem cell deficiency or severity of the initial scarring process.

Fungal endocarditis in neonates and children

Fungal endocarditis in the neonate and pediatric population is associated with a high degree of morbidity and mortality, with diagnosis in the majority of cases made postmortem. The aim of this article is to review published literature on fungal endocarditis in children and to discuss the incidence due to a wide range of fungi, primarily Aspergillus and Candida species, as well as its diagnosis, including the importance of molecular-based approaches and various treatment regimes.

Treatment and Survival from Colorectal Cancer: The Experience of Patients at South Australian Teaching Hospitals Between 1980 and 2002

AIMS

To evaluate trends in colorectal cancer survival and treatment at South Australian teaching hospitals and degree of adherence to treatment guidelines which recommend adjuvant chemotherapy for Dukes' C colon cancers and combined chemotherapy and radiotherapy for high-risk rectal cancers.

MATERIALS AND METHODS

Trends in disease specific survival and primary treatment were analysed, and comparisons drawn between diagnostic epochs, using cancer registry data from South Australian teaching hospitals. Statistical methods included univariate and multivariable disease specific survival analyses.

RESULTS

Five-year survival increased from 48% in 1980-1986 to 56% in 1995-2002. Largest gains were for stage C, where survivals were higher when chemotherapy was part of the primary treatment. By comparison, gains in 1-year survival were largest for stage D. Chemotherapy was provided for 4% of patients with colorectal cancers in 1980-1986, increasing to 32% in 1995-2002. Among stage C cases below 70 years at diagnosis, the proportion having chemotherapy increased to 83% in 1995-2002. The most common chemotherapy was fluorouracil (5FU) as a single agent in 1980-1986 and 5FU with leucovorin in 1995-2002. As expected, radiotherapy was used more frequently for rectal than colon cancers, and particularly for stage C. Among stage C rectal cases below 70 years, the proportion having radiotherapy increased from 10% in 1980-1986 to 57% in 1995-2002. Approximately 93% of colorectal cancers were treated surgically. Patients not treated surgically tended to be aged 80 years or more and to present with distant metastases.

CONCLUSIONS

Trends in chemotherapy and radiotherapy accord with evidence-based recommendations. There have been reassuring gains in survivals after adjusting for stage, grade and other prognostic indicators. The data show survival gains and treatment patterns that individual hospitals can use as benchmarks when evaluating their own experience.

Measurement of the D(s)+ lifetime

A high statistics measurement of the D(s)+ lifetime from the Fermilab fixed-target FOCUS photoproduction experiment is presented. We describe the analysis of the two decay modes, D(s)+ --> phi(1020)pi+ and D(s)+ -->K*(892)0K+, used for the measurement. The measured lifetime is 507.4 +/- 5.5(stat) +/- 5.1(syst) fs using 8961 +/- 105 D(s)+ --> phi(1020)pi+ and 4680 +/- 90 D(s)+ --> K*(892)0K+ decays. This is a significant improvement over the present world average.

Frequency and distribution of group I intron genotypes of Candida albicans colonising critically ill patients

A study is performed to examine the distribution and frequency of 25S rRNA intron genotypes of Candida albicans isolated from different anatomical sites of patients in an intensive care unit (ICU) setting. Germ-tube positive Candida isolates (n=65) from 65 patients are included and isolates are characterised by 25S intron genotyping, whereby all can be subdivided into four genotypes (A-D). Results demonstrated that there were no significant differences between the frequency and genotype distribution of the Candida isolates and the anatomical site of colonisation. Furthermore, analysis of the transposable intron region in the 25S rRNA gene demonstrated equal distribution, regardless of age and anatomical site of isolation (groin, throat, etc.). Therefore, there does not appear to be any selective pressure associated with any anatomical site, resulting in an ecological shift in the frequency of genotypes present. This suggests that C. albicans intron genotypes equally colonise those sites of the body examined in this study. Although such an ecological finding as this is interesting, it perpetuates the continued need to find a genotypic typing scheme that helps to identify the source (nosocomial or endogenous) and mode of entry of C. albicans into patients in the ICU setting, resulting in C. albicans bloodstream infection.

Central line-related bacteraemia due to Tsukamurella tyrosinosolvens in a haematology patient

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Occurrence of Burkholderia cepacia in the hospital environment

AIM

To determine the prevalence of Burkholderia cepacia from the environment in a regional adult cystic fibrosis (CF) care centre.

METHODS

Two hundred and eighty-five environmental samples were taken from inpatient and outpatient environments within the CF centre. Following a non-selective enrichment step, broths were plated onto a selective medium and B. cepacia isolates were confirmed by phenotypic tests and also genotypically by species specific 16S rRNA PCR.

RESULTS

B. cepacia was not detected from commonly shared items of equipment, staff hands, staff uniforms or toilets. In addition, the organism was not detected in toilet bowls, even in the B. cepacia unit. With regard to positive environments for B. cepacia, 4/10 (40%) of the outside surfaces and inner rims of patients' plastic disposable sputum collection containers and 4/17 (23.5%) of air from patients' rooms, following physiotherapy, were positive.

CONCLUSIONS

All positive samples originated in the B. cepacia segregation area of the inpatient wards and B. cepacia was not detected in the non-cepacia area of the CF centre. Consequently, these two positive sites should therefore be treated as high risk, where organisms may be potentially transmitted from environment to patient. As there is now evidence to suggest differences in the virulence and hence clinical outcome of certain of the genomovars of this organism, this study may be important in highlighting the areas that patients who are B. cepacia positive should avoid, to minimise the risk of transmission and acquisition of this organism within the CF cepacia population. These results indicate that effective infection control procedures are required in patients' rooms following physiotherapy, for prevention of B. cepacia transmission and to avoid the transmission of different genomovar types within CF patients, who are already colonised with this pathogen.

Phenotypic characterisation of flagellin and flagella of urease-positive thermophilic campylobacters

In this study, flagellin is purified biochemically from eight urease-positive thermophilic camplylobacters (UPTC) isolated from river water, sea water and mussels, and purified also from two isolates of Campylobacter jejuni and C. coli and fractionated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Results showed that no flagellin components were detected in the two Japanese UPTC isolates (CF89-12 and CF89-14) and the two UPTC NCTC strains (NCTC12893 and NCTC12894). Flagellin components, each consisting of a single peptide, with a heterogeneous molecular mass of approximately 52-63 kDa were demonstrated in the other four UPTC isolates (NCTC12892, NCTC12895, NCTC12896 and NI15F [from Northern Ireland]) and the two Japanese isolates of C. jejuni (JCM2013 and C. coli 27). The approximate molecular mass of flagellin from the flagellin-positive UPTC isolates was smaller than those of C. jejuni and C. coli. Flagella were not detected by electron microscopy in the four flagellin-negative UPTC isolates but they were detected in the four flagellin-positive UPTC isolates and the two isolates of C. jejuni and C. coli. Thus, significant phenotypic diversity for flagellin, which must be due to genotypic variations, was demonstrated among the UPTC isolates.

Entanglement entropy of random quantum critical points in one dimension

For quantum critical spin chains without disorder, it is known that the entanglement of a segment of N>>1 spins with the remainder is logarithmic in N with a prefactor fixed by the central charge of the associated conformal field theory. We show that for a class of strongly random quantum spin chains, the same logarithmic scaling holds for mean entanglement at criticality and defines a critical entropy equivalent to central charge in the pure case. This effective central charge is obtained for Heisenberg, XX, and quantum Ising chains using an analytic real-space renormalization-group approach believed to be asymptotically exact. For these random chains, the effective universal central charge is characteristic of a universality class and is consistent with a c-theorem.

Effects of supplementation on voluntary forage intake, diet digestibility, and animal performance

A data base was constructed to describe and estimate supplementation effects in nonlactating cattle consuming forage ad libitum. The data base included 66 publications on 126 forages (73 harvested and 53 grazed) and a total of 444 comparisons between a control, unsupplemented treatment and a supplemented treatment. Daily gains were reported for 301 comparisons and voluntary intake for 258. Direct measures of forage digestibility were reported for 202 comparisons, and total diet digestibility for 150. Supplements did not increase gain in all cases. Change in ADG due to supplement was not related closely to intake of supplemental TDN. Lowest increases in ADG were with native forages supplemented with molasses alone or with low intakes of molasses containing high levels of NPN. Greatest increases in gain were with improved forages, supplements with > 60% TDN, and supplemental CP intake > .05% of BW. Supplements decreased voluntary forage intake (VFI) when supplemental TDN intake was > .7% of BW, forage TDN:CP ratio was < 7 (adequate N), or VFI when fed alone was > 1.75% of BW. When supplements increased VFI, forage TDN: CP ratio was > 7 (N deficit), and VFI when fed alone was often low. There was little relationship between change in VFI and sources of supplemental CP and TDN. Supplements caused total diet TDN concentration to deviate from expected values by -10 to +5% of OM. When supplemental TDN intake was > .7% of BW, diet TDN concentration was always less than expected. There was little relationship between deviation from expected total diet TDN and type or composition of forages or supplements. Empirical multiple regression equations were developed to estimate effects of supplements on VFI and total diet TDN concentration. The most acceptable intake equation estimated VFI when fed with supplement (r2 = .84) That equation included VFI when fed alone, supplement intake, CP and TDN concentrations in forage and supplement, and classification codes describing forages and supplemental energy. The most acceptable equation for estimating total diet TDN concentration included only the expected total diet TDN concentration (r2 = .87). These equations may be used in nutritional models to account for associative effects.

Compliance matching stent placement in the carotid artery of the swine promotes optimal blood flow and attenuates restenosis

OBJECTIVES

We assessed the value of a gradient-compliant stent in an animal model.

METHODS

Bilateral carotid arteries were stented with nitinol stents having variable-oversizing, variable-stiffness, and with (CMS, 10 animals) and without (SMART, four animals) compliance-matching endings. Angiography, hemodynamic, scanning-electron-microscopic and histological analyses were performed at 3-month. The protocol was completed in 14 among 19 swines.

RESULTS

Transient (1-month) exaggerated recoil, attributable to stress-induced phasic inhibition of vasorelaxation, developed at CMS endings. At mid-term, all stents were endothelialized; CMS-stents, but not SMART-stents, were incorporated into walls (one-strut-thickness). Restenosis developed outside SMART-stents (cell migration+wall-compensatory enlargement) whereas CMS-stents elicited no or focalized cell-accumulations at endings that bulged vascular walls radially outward. SMART-stents were blood-flow neutral, whereas CMS-stents favored (higher-stiffness, higher-oversizing) or opposed (lower-stiffness, less-oversizing) carotid blood flow.

CONCLUSIONS

Direct carotid stenting with stents having compliance-matched endings and specific requirements of stiffness and oversizing can optimize blood flow to the brain and restrict local restenosis.

Occurrence of Campylobacter in retail foods in Ireland

A surveillance study was carried out to determine the prevalence of Campylobacter in a range of retail foods purchased in three Irish cities over a 20-month period between March 2001 and October 2002. In total 2391 food samples were analysed during this period. Campylobacter was isolated from 444 raw chicken (49.9%), 33 turkey (37.5%) and 11 duck samples (45.8%). Lower isolation rates of 7/221 (3.2%), 10/197 (5.1%) and 31/262 (11.8%) were observed for raw beef, pork and lamb, respectively. One sample of pork paté from 120 samples analysed (0.8%) was Campylobacter-positive. A total of three shellfish samples (oysters) from 129 raw specimens examined (2.3%) were found to contain Campylobacter. Low prevalences of the organism (0.9%) were also isolated from fresh mushrooms. Of 62 raw bulk tank milk samples analysed, Campylobacter was recovered in a single sample (1.6%). Campylobacter was not detected in any of the comminuted pork puddings, prepared vegetables and salads, retail sandwiches or cheeses made from unpasteurised milk. In total, 543 Campylobacter were isolated from all of the food samples analysed, of which 453 (83.4%) were confirmed as Campylobacter jejuni and the remaining 90 (16.6%) as Campylobacter coli.

Strong-weak coupling self-duality in the two-dimensional quantum phase transition of p + ip superconducting arrays

The 2D quantum phase transition that occurs in a square lattice of Josephson-coupled p +/- ip superconductors is an example of how four-body interactions in d = 2 reproduce nonperturbative effects caused by two-body interactions in d = 1. The ordered phase has an unconventional "bond order" of the local T-breaking variable. This problem can be analyzed using an exact self-duality; this duality in classical notation is the 3D generalization of the Kramers-Wannier duality of the 2D Ising model, and there are similar exact dualities in dimensions d > or = 3. We discuss the excitation spectrum and experimental signatures of the ordered and disordered phases, and the relationship between our model and previously studied behavior of 2D boson models with four-boson interactions.

Clinical outcome of Burkholderia cepacia complex infection in cystic fibrosis adults

BACKGROUND

The Burkholderia cepacia complex (BCC) is one of the most important groups of organisms infecting cystic fibrosis (CF) patients. The aim of the study was to examine how infection with BCC affects clinical outcome.

METHODS

Nineteen CF adults infected with BCC and 19 controls infected with Pseudomonas aeruginosa were studied over a 4-year period. The best forced expiratory volume in 1 s (FEV(1)) and body mass index (BMI) for each year were recorded and annual rate of decline calculated.

RESULTS

The BCC infected group displayed a significantly greater reduction of FEV(1) and BMI compared to the P. aeruginosa infected group (p=0.001 and p=0.009, respectively). Sixteen patients infected with a single Burkholderia cenocepacia strain had a significantly greater rate of FEV(1) decline compared to those infected with Burkholderia multivorans (n=3) or P. aeruginosa (p=0.01 and p<0.0001, respectively). The rate of BMI decline was significantly greater in patients infected with B. cenocepacia compared to those with P. aeruginosa (p=0.007), but not significantly different in those with B. multivorans (p=0.29).

CONCLUSION

BCC infection is associated with an accelerated decline in pulmonary function and BMI. Infection with a single B. cenocepacia strain was associated with a more rapid decline in lung function than those infected with either B. multivorans or P. aeruginosa.

Nucleotide sequence analysis of the recA gene and discrimination of the three isolates of urease-positive thermophilic Campylobacter (UPTC) isolated from seagulls (Larus spp.) in Northern Ireland

Nucleotide sequencing after TA cloning of the amplicon of the almost-full length recA gene from three strains of UPTC (A1, A2, and A3) isolated from seagulls in Northern Ireland, the phenotypical and genotypical characteristics of which have been demonstrated to be indistinguishable, clarified nucleotide differences at three nucleotide positions among the three strains. In conclusion, the nucleotide sequences of the recA gene were found to discriminate among the three strains of UPTC, A1, A2, and A3, which are indistinguishable phenotypically and genotypically. Thus, the present study strongly suggests that nucleotide sequence data of the amplicon of a suitable gene or region could aid in discriminating among isolates of the UPTC group, which are indistinguishable phenotypically and genotypically.

Current trends in the molecular diagnosis of infective endocarditis

The introduction of molecular methods into biomedical science, particularly nucleic acid amplification techniques including the polymerase chain reaction, has significantly improved the diagnosis of several diseases. Likewise, the adoption of such molecular techniques to aid in the detection and identification of causal organisms in patients with infective endocarditis (IE) has been particularly beneficial in cases of difficult, atypical or culture-negative IE. Several different molecular approaches have been suggested for the diagnosis of IE, including variations in the type of cardiological specimens examined, nucleic acid extraction, gene target and molecular platform, each presenting their own advantages and disadvantages. This review examines the molecular approach to the detection and identification of causal agents of IE and provides details and a discussion of the application of such methods, particularly those implemented over the last 7 years.

Endoscopic visualisation to aid deep anterior lamellar keratoplasty

AIMS

The aim of this study was to assess the value of endoscopy during deep anterior lamellar keratoplasty (DALK) by visualising the posterior cornea. This allows the surgeon to determine whether air injection had succeeded in stripping Descemet's membrane and endothelium from the posterior corneal stroma.

METHODS

Four whole globes for research were obtained from the Florida eye bank with consent. A 2 mm incision was placed at the limbus and the endoscope was introduced through this into the anterior chamber. A 26-gauge needle was introduced into the cornea with the bevel positioned as deep as possible and air injected into the corneal stroma. Air was injected until the whole cornea became opaque and repeated air injections were made even after an opaque cornea was noted. The endoscopic camera was used to visualise the posterior corneal surface during this procedure.

RESULTS

The view of the posterior corneal surface was clear and introduction of the probe did not interfere with the air dissection. In all four eyes, despite ease of air injection and diffuse corneal air infiltration, no large air bubble dissection of Descemet's membrane from adjacent stroma occurred. Instead multiple blistering of the posterior corneal surface could be seen.

CONCLUSIONS

Endoscopy provides an effective tool to visualise the posterior corneal surface during DALK, using air dissection. This technique may become a standard adjunctive procedure during DALK.

Detection of mycobacterial DNA from sputum of patients with cystic fibrosis

BACKGROUND

Patients with cystic fibrosis (CF) are at high risk from atypical mycobacterial infections. There have been few attempts to delineate the intensity of mycobacterial infection in CF patients in Ireland.

AIMS

To examine the incidence of mycobacterial DNA in an archived collection of genomic DNA extracted from the sputa of CF patients within the Northern Ireland population.

METHODS

One hundred and eighty-two CF patients (66 adults and 116 children) were examined for the presence of mycobacterial DNA in their sputum by a genus specific PCR assay based on 16S rRNA, followed by direct automated sequencing of the PCR amplicons.

RESULTS

One of 116 (0.9%) children and 2 of 66 adults were positive. Sequence identity revealed Mycobacterium xenopi in the paediatric patient and M. xenopi and M. chelonei in the two adult patients. False-positive results occurred in 11 patients (four adults), mainly due to Corynebacterium spp.

CONCLUSIONS

There was a low prevalence of Mycobacterium spp in the CF patient population. All PCR positive results should be confirmed by direct automated sequencing and an alternative specific assay employed. Enhanced molecular screening will contribute in understanding their role as opportunistic pathogens in patients with worsening lung function.

Haemophilus segnis: a rare cause of endocarditis

This report presents a case of endocarditis due to Haemophilus segnis, which represents a speciation difficulty for the routine laboratory. In this study, a molecular approach provided speciation, which was confirmed phenotypically by a reference laboratory. The use of molecular genotypic analysis is an additional strategy in the investigation of endocarditis. It has applications not only in isolate identification but also in primary detection of infection, particularly in patients whose blood is culture negative by conventional methodologies.