Immune complement and coagulation dysfunction in adverse outcomes of SARS-CoV-2 infection

Understanding the pathophysiology of SARS-CoV-2 infection is critical for therapeutic and public health strategies. Viral-host interactions can guide discovery of disease regulators, and protein structure function analysis points to several immune pathways, including complement and coagulation, as targets of coronaviruses. To determine whether conditions associated with dysregulated complement or coagulation systems impact disease, we performed a retrospective observational study and found that history of macular degeneration (a proxy for complement-activation disorders) and history of coagulation disorders (thrombocytopenia, thrombosis and hemorrhage) are risk factors for SARS-CoV-2-associated morbidity and mortality-effects that are independent of age, sex or history of smoking. Transcriptional profiling of nasopharyngeal swabs demonstrated that in addition to type-I interferon and interleukin-6-dependent inflammatory responses, infection results in robust engagement of the complement and coagulation pathways. Finally, in a candidate-driven genetic association study of severe SARS-CoV-2 disease, we identified putative complement and coagulation-associated loci including missense, eQTL and sQTL variants of critical complement and coagulation regulators. In addition to providing evidence that complement function modulates SARS-CoV-2 infection outcome, the data point to putative transcriptional genetic markers of susceptibility. The results highlight the value of using a multimodal analytical approach to reveal determinants and predictors of immunity, susceptibility and clinical outcome associated with infection.

Identification of Immune complement function as a determinant of adverse SARS-CoV-2 infection outcome

Understanding the pathophysiology of SARS-CoV-2 infection is critical for therapeutics and public health intervention strategies. Viral-host interactions can guide discovery of regulators of disease outcomes, and protein structure function analysis points to several immune pathways, including complement and coagulation, as targets of the coronavirus proteome. To determine if conditions associated with dysregulation of the complement or coagulation systems impact adverse clinical outcomes, we performed a retrospective observational study of 11,116 patients who presented with suspected SARS-CoV-2 infection. We found that history of macular degeneration (a proxy for complement activation disorders) and history of coagulation disorders (thrombocytopenia, thrombosis, and hemorrhage) are risk factors for morbidity and mortality in SARS-CoV-2 infected patients - effects that could not be explained by age, sex, or history of smoking. Further, transcriptional profiling of nasopharyngeal (NP) swabs from 650 control and SARS-CoV-2 infected patients demonstrated that in addition to innate Type-I interferon and IL-6 dependent inflammatory immune responses, infection results in robust engagement and activation of the complement and coagulation pathways. Finally, we conducted a candidate driven genetic association study of severe SARS-CoV-2 disease. Among the findings, our scan identified putative complement and coagulation associated loci including missense, eQTL and sQTL variants of critical regulators of the complement and coagulation cascades. In addition to providing evidence that complement function modulates SARS-CoV-2 infection outcome, the data point to putative transcriptional genetic markers of susceptibility. The results highlight the value of using a multi-modal analytical approach, combining molecular information from virus protein structure-function analysis with clinical informatics, transcriptomics, and genomics to reveal determinants and predictors of immunity, susceptibility, and clinical outcome associated with infection.

Episodes of particle ejection from the surface of the active asteroid (101955) Bennu

Active asteroids are those that show evidence of ongoing mass loss. We report repeated instances of particle ejection from the surface of (101955) Bennu, demonstrating that it is an active asteroid. The ejection events were imaged by the OSIRIS-REx (Origins, Spectral Interpretation, Resource Identification, and Security-Regolith Explorer) spacecraft. For the three largest observed events, we estimated the ejected particle velocities and sizes, event times, source regions, and energies. We also determined the trajectories and photometric properties of several gravitationally bound particles that orbited temporarily in the Bennu environment. We consider multiple hypotheses for the mechanisms that lead to particle ejection for the largest events, including rotational disruption, electrostatic lofting, ice sublimation, phyllosilicate dehydration, meteoroid impacts, thermal stress fracturing, and secondary impacts.

The financial burden of acute odontogenic infections: the South Australian experience

BACKGROUND

Acute odontogenic infections are a common surgical emergency managed by public hospitals in Australia which cause considerable patient morbidity and occasionally, mortality. Despite posing a significant public health burden, Australian data evaluating the cost of the management of these patients are lacking. This study assessed the patient and treatment variables associated with inpatient management of deep odontogenic infections, and their respective financial impact, at a statewide Oral & Maxillofacial service.

METHODS

A retrospective audit was carried out of patients with deep odontogenic infections at our institution, over a 7-year period. The primary outcome was the total cost of admission. Secondary outcomes included treatment received, operating room time, return-to-theatre, length of admission (LOS), and intensive care unit (ICU) use. Cost variables were assessed against the total LOS and ICU use to determine clinical predictors affecting outcome.

RESULTS

Four hundred and sixty two patients met the inclusion criteria. The average cost per patient was $12 228 Australian Dollars. After multivariate analysis, variables most significantly associated with increased cost of care and LOS were high-risk infections with airway compromise, high admission white cell count and age.

CONCLUSION

Hospital-based management of deep-space odontogenic infections engender significant costs compared to early primary care intervention such as a dental extraction ($181/extraction).

Timing of HPV16-E6 antibody seroconversion before OPSCC: findings from the HPVC3 consortium

BACKGROUND

Human papillomavirus type 16 (HPV16)-E6 antibodies are detectable in peripheral blood before diagnosis in the majority of HPV16-driven oropharyngeal squamous cell carcinoma (OPSCC), but the timing of seroconversion is unknown.

PATIENTS AND METHODS

We formed the HPV Cancer Cohort Consortium which comprises nine population cohorts from Europe, North America and Australia. In total, 743 incident OPSCC cases and 5814 controls provided at least one pre-diagnostic blood sample, including 111 cases with multiple samples. Median time between first blood collection and OPSCC diagnosis was 11.4 years (IQR = 6-11 years, range = 0-40 years). Antibodies against HPV16-E6 were measured by multiplex serology (GST fusion protein based Luminex assay).

RESULTS

HPV16-E6 seropositivity was present in 0.4% of controls (22/5814; 95% CI 0.2% to 0.6%) and 26.2% (195/743; 95% CI 23.1% to 29.6%) of OPSCC cases. HPV16-E6 seropositivity increased the odds of OPSCC 98.2-fold (95% CI 62.1-155.4) in whites and 17.2-fold (95% CI 1.7-170.5) in blacks. Seropositivity in cases was more frequent in recent calendar periods, ranging from 21.9% pre-1996 to 68.4% in 2005 onwards, in those with blood collection near diagnosis (lead time <5 years). HPV16-E6 seropositivity increased with lead time: 0.0%, 13.5%, 23.7%, and 38.9% with lead times of >30 years (N = 24), 20-30 years (N = 148), 10-20 years (N = 228), and <10 years (N = 301 cases) (p-trend < 0.001). Of the 47 HPV16-E6 seropositive cases with serially-collected blood samples, 17 cases seroconverted during follow-up, with timing ranging from 6 to 28 years before diagnosis. For the remaining 30 cases, robust seropositivity was observed up to 25 years before diagnosis.

CONCLUSIONS

The immune response to HPV16-driven tumorigenesis is most often detectable several decades before OPSCC diagnosis. HPV16-E6 seropositive individuals face increased risk of OPSCC over several decades.

The Drosophila Gene Sulfateless Modulates Autism-Like Behaviors

Major challenges to identifying genes that contribute to autism spectrum disorder (ASD) risk include the availability of large ASD cohorts, the contribution of many genes overall, and small effect sizes attributable to common gene variants. An alternative approach is to use a model organism to detect alleles that impact ASD-relevant behaviors and ask whether homologous human genes infer ASD risk. Here we utilized the Drosophila genetic reference panel (DGRP) as a tool to probe for perturbation in naturally occurring behaviors in Drosophila melanogaster that are analogous to three behavior domains: impaired social communication, social reciprocity and repetitive behaviors or restricted interests. Using 40 of the available DGRP lines, we identified single nucleotide polymorphisms (SNPs) in or near genes controlling these behavior domains, including ASD gene orthologs (neurexin 4 and neuroligin 2), an intellectual disability (ID) gene homolog (kirre), and a gene encoding a heparan sulfate (HS) modifying enzyme called sulfateless (sfl). SNPs in sfl were associated with all three ASD-like behaviors. Using RNAi knock-down of neuronal sfl expression, we observed significant changes in expressive and receptive communication during mating, decreased grooming behavior, and increased social spacing. These results suggest a role for HS proteoglycan synthesis and/or modification in normal social communication, repetitive behavior, and social interaction in flies. Finally, using the DGRP to directly identify genetic effects relevant to a neuropsychiatric disorder further demonstrates the utility of the Drosophila system in the discovery of genes relevant to human disease.

Abstract P1-08-11: The impact of existing comorbidities on survival disparities among women diagnosed with invasive breast cancer

Missouri is one of many states in the US burdened by high rates of mortality from female breast cancer (BC) as well as comorbidities such as Type-2 diabetes, cardiovascular disease (CVD), and hypertension. These comorbidity rates are higher among vulnerable populations including individuals in poverty and/or living in rural areas, African Americans, and the elderly. There is evidence that women with comorbidities at the time of BC diagnosis have a worse prognosis. We hypothesize that the co-existence of comorbidities is likely to impact survival and may contribute to survival disparities observed among women diagnosed with BC from these vulnerable populations.

Objective: To examine whether the number and/or type of comorbidity at BC diagnosis is associated with higher BC and all-cause mortality among women diagnosed with invasive BC in Missouri between 2004 and 2012.

Methods: Women age 18+ diagnosed with BC in Missouri during 2004–2012 were identified from the Missouri Cancer Registry. These data were then merged with hospital discharge data from the Missouri Patient Abstract System. Associations were evaluated in all women and by race, neighborhood poverty level, rural/urban residence, and age at diagnosis. A comorbidity score was constructed to account for the number of comorbidities (Type-2 diabetes, hypertension, and CVD) identified for each individual. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression models, adjusting for age at diagnosis, race, tumor hormone receptor status, stage, BC treatment, and rural/urban residence. Models were further stratified by race, poverty level, rural/urban residence, and age group.

Results: A total of 31,133 women with incident invasive BC and with comorbidity data at the time of BC diagnosis were included in the analysis. After a median follow-up time of 79 months, 9,912 deaths occurred, of which 4,900 deaths were due to BC. Increasing number of comorbidities was significantly associated with BC mortality (ptrend &lt; 0.001). BC mortality (HR, 1.33; 95% CI 1.19-1.49) and all-cause mortality (HR, 1.51; 90% CI 1.32-1.61) were significantly higher in women with ≥2 comorbidities. CVD accounted for the largest increase in BC mortality (HR, 1.36; 95% CI 1.19-1.55). In stratified analyses, we did not observe significant differences in associations by race, poverty, rural/urban residence, or age; however, there was a statistically significant interaction with age when modeled as a continuous measure, comorbidity score, and risk of mortality outcomes (p&lt; 0.001). White women with all 3 comorbidities had the highest risk of death (BC-specific: HR, 1.95; all-cause: HR, 2.28). Women in rural areas with ≥2 comorbidities were 1.78 times more likely to die of BC while women living in the metro with all 3 comorbidities were almost 2 times more likely to die of any cause.

Conclusion: Our results demonstrate the negative impact that comorbidities such as diabetes, CVD, and hypertension can have on BC and overall mortality in a diverse group of BC patients diagnosed and treated in Missouri. The data produced from this study can be utilized to identify and implement targeted preventive strategies to improve the quality of life and survival of BC patients.

Citation Format: Connor AE, May B, Schmaltz CL, Jackson-Thompson J, Visvanathan K. The impact of existing comorbidities on survival disparities among women diagnosed with invasive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-11.

Abstract P4-10-06: Factors impacting the accuracy of self-reported breast procedures among women with and without breast cancer

Background: Clinical/epidemiologic observational studies frequently rely on participants' recall for information about breast procedures. However, there is limited data on the accuracy of self-reported breast procedures. To address this knowledge gap and inform future study design and collection and interpretation of similar data, we investigated the impact of type, diagnosis, age, time, and other patient characteristics on the accuracy of self-report in a prospective cohort.

Methods: All benign breast biopsies, lumpectomies, and mastectomies for breast cancer treatment among women enrolled in the BOSS Cohort, a prospective study of women and men with a familial risk of breast/ovarian cancer, were identified. Study staff obtained pathology reports for 93% of women from self-reported breast procedure locations. For this analysis, we focused on 577 women who had at least one ascertained pathology report, and who self-reported at least one breast procedure at baseline. We estimated the percentage of self-reports (95% confidence interval (CI)) with matching pathology report within 6 months (+/- 6 months), and agreement between self-reported procedures and pathology-confirmed diagnoses (normal/benign vs. atypical hyperplasia vs. LCIS, and DCIS vs. invasive cancer) with the Kappa statistic. We also examined predictors of an accurate biopsy self-report, including age at baseline, personal and family history of breast cancer, educational attainment, and time between biopsy and baseline, using logistic regression models.

Results: At baseline, 158 women reported having at least one benign biopsy, 193 women reported having a lumpectomy for cancer treatment, and 174 women reported having a mastectomy for cancer treatment. The median time between biopsy, lumpectomy, mastectomy, and baseline was 9 years, 2 years, and 2 years, respectively. Fifty-seven percent (95% CI: 49-64.5%) of benign biopsy self-reports, 90.7% (95% CI: 85.6-94.1%) of lumpectomy self-reports, and 85.1% (95% CI: 78.9-89.7%) of mastectomy self-reports had a matching pathology report within 6 months. Further diagnostic agreement was moderate for biopsies, lumpectomies, and mastectomies with Kappa statistics of 0.65, 0.66, 0.65, respectively. Age at baseline (p-interaction =0.01) and time (p-interaction = 0.03) were independent and joint predictors of accurate biopsy self-reports. Women less than 49 years old had the largest reduction in odds of having an accurate self-report (26%) for every additional year between biopsy and baseline [adjusted odds ratio = 0.74 (95% CI: 0.63-0.88)]. Similarly, women with a biopsy within 4 years prior to baseline had a 10% reduction in the odds of having an accurate self-report with increasing age [adjusted odds ratio = 0.9 (95% CI: 0.84-0.97)].

Conclusions: In this highly-educated cohort, the overall accuracy of self-report of benign biopsies was only modest, and the accuracy of self-report of lumpectomies and mastectomies was lower than expected. This study suggests that age at baseline and time between procedure and baseline are important predictors of accuracy of self-report and should be considered when utilizing self-reported information. Furthermore, where possible, prospective collection of breast procedure data should be prioritized.

Citation Format: Schaeffer ML, May B, Cimino-Mathews A, Orellana M, McCullough M, Hogan B, Armstrong D, Visvanathan K. Factors impacting the accuracy of self-reported breast procedures among women with and without breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-06.

Core Biopsy and FNA: A Comparison of Diagnostic Yield in Lymph Nodes of Different Ultrasound Determined Malignant Potential

Background: The tissue diagnosis of lymphoma and metastases is commonly obtained from affected lymph nodes. The lymph nodes chosen for biopsy are often the consequence of their appearance on ultrasound, which determines their risk of malignancy. Two frequently used percutaneous sampling techniques are core biopsy and fine needle aspiration (FNA). While core biopsy obtains a larger tissue sample and provides a degree of architectural information, FNA is considered less invasive and has the advantage of immediate confirmation of adequacy by the attending cytologist. Anecdotally, core biopsy is more commonly used when a lymph node is suspected of harboring neoplasia, however a feature of malignancy is hypercellularity, which theoretically should increase the diagnostic yield of FNA. Aim: The aim of this project was to compare the diagnostic capability of FNA and core biopsy in lymph nodes of different malignant potential, as defined by ultrasound, and determine if the radiologic appearance can guide clinicians in their choice of sampling technique. The project also reviewed the role of clinical experience in both the choice of sampling technique and diagnostic yield. Methods: Retrospective study of percutaneous lymph node biopsies performed at a large tertiary hospital between July 2016 and March 2018. The associated ultrasounds were reviewed and the lymph nodes were classified as high or low risk of malignancy by their sonographic appearance. The end point for analysis was the capacity for FNA or core biopsy to provide a definitive diagnosis. The diagnostic yield was then separately assessed for lymph nodes of high and low malignant potential. The effect of clinical experience on diagnostic yield was also examined, by comparing the outcomes of radiology consultants and radiology trainees. Results: 296 lymph node biopsies were reviewed and statistical analysis was performed using logistic regression analysis. Core biopsy, in comparison with FNA, was used twice as often in lymph nodes of high malignant potential, supporting the aforementioned anecdotal evidence. Core biopsy demonstrated superior diagnostic yield in comparison with FNA, providing a diagnostic sample 45% ( P = 0.313) more often in low-risk lymph nodes and 209% ( P = < 0.05) more often in high-risk lymph nodes. Consultant radiologists used FNA 81% more often than core biopsy in lymph nodes of high malignant potential, while radiology trainees used core biopsy 104% more often than FNA in the same group. In high-risk lymph nodes, trainees were 117% ( P = 0.105) more likely to obtain a diagnostic sample than consultants. Conclusion: Core biopsy is superior to FNA in the tissue sampling of lymph nodes regardless of ultrasound determined risk of malignancy. Biopsies obtained by radiology trainees provided a diagnosis twice as often as those obtained by radiology consultants. This appeared to be the consequence of consultant preference for FNA over core biopsy.

Narrowing the wingless-2 mutation to a 227 kb candidate region on chicken chromosome 12

Wingless-2 (wg-2) is an autosomal recessive mutation in chicken that results in an embryonic lethal condition. Affected individuals exhibit a multisystem syndrome characterized by absent wings, truncated legs, and craniofacial, kidney, and feather malformations. Previously, work focused on phenotype description, establishing the autosomal recessive pattern of Mendelian inheritance and placing the mutation on an inbred genetic background to create the congenic line UCD Wingless-2.331. The research described in this paper employed the complementary tools of breeding, genetics, and genomics to map the chromosomal location of the mutation and successively narrow the size of the region for analysis of the causative element. Specifically, the wg-2 mutation was initially mapped to a 7 Mb region of chromosome 12 using an Illumina 3 K SNP array. Subsequent SNP genotyping and exon sequencing combined with analysis from improved genome assemblies narrowed the region of interest to a maximum size of 227 kb. Within this region, 3 validated and 3 predicted candidate genes are found, and these are described. The wg-2 mutation is a valuable resource to contribute to an improved understanding of the developmental pathways involved in chicken and avian limb development as well as serving as a model for human development, as the resulting syndrome shares features with human congenital disorders.

Antibiotic resistance in severe odontogenic infections of the South Australian population: a 9-year retrospective audit

BACKGROUND

The aims of this study were to evaluate the microbiological trends in severe odontogenic infections requiring hospital admission in the South Australian Oral and Maxillofacial Surgery Unit. Rates of antibiotic resistance to empirical antibiotic regimens were determined to quantify the clinical implications of antibiotic-resistant odontogenic infections.

METHODS

A retrospective case audit was performed on all odontogenic infections admitted to the Royal Adelaide Hospital over a 9-year period. Data was collected regarding demographics, microbiological culture and sensitivity results, and clinical outcome variables.

RESULTS

Of a total of 672 patients, microbiology data was available for 447 cases. Penicillin-resistant organisms were identified in 10.8% of patients, who required a significantly longer length of hospital admission (mean, 9.93 days) and higher rates of non-response to initial surgical therapy (40%).

CONCLUSIONS

There were moderate rates of antibiotic-resistant odontogenic infections within the South Australian population. Patients within this subgroup demonstrate markedly poorer clinical outcomes. Effective treatment of odontogenic infections involves early operative intervention, with adjunctive use of appropriate antibiotic therapy that involves close monitoring of response to removal of the cause and use of first-line antibiotic agents. Cases that fail to respond require urgent specialist review in order to reduce morbidity and mortality outcomes.

Switching adsorption and growth behavior of ultrathin [C2C1Im][OTf] films on Au(111) by Pd deposition

Combining in vacuo deposition of ultrathin ionic liquid (UTIL) films with angle-resolved X-ray photoelectron spectroscopy (ARXPS), we demonstrate that by deposition of submonolayer amounts of Pd onto Au(111) the initial growth mode of the ionic liquid (IL) 1-ethyl-3-methylimidazolium trifluoromethanesulfonate ([C₂C₁Im][OTf]) can be switched from three-dimensional (3D) to two-dimensional (2D) growth, that is, from non-wetting to wetting. On clean Au(111), pronounced 3D growth occurs on top of an initially formed 2D wetting layer with cations and anions next to each other in a checkerboard arrangement. After pre- or postdeposition of only 0.7 ML Pd, two-dimensional layer-by-layer growth is found, which is attributed to strong attractive interactions between [C₂C₁Im][OTf] and surface Pd. For Pd post deposition onto the IL, the ARXPS data revealed particularly strong interactions between the dialkylimidazolium cation and Pd atoms, which considerably reduce the regular surface alloying of Pd with the Au substrate stabilizing Pd at the metal surface. In the context of heterogeneous catalysis using the SCILL (solid catalyst coated with ionic liquid layer) concept, these results directly provide a possible explanation on the molecular level for the beneficial influence of the IL layer in case of heterogeneous metal alloy catalysts.

Developing major histocompatibility markers in a species of concern: the Sacramento perch Archoplites interruptus

Primers targeting two non-neutral major histocompatibility complex (mhc) II β genes were developed and assayed across several disjoint Sacramento perch Archoplites interruptus sampling locations. Variability at the two mhc loci among sampling stocks strongly correlated to previous estimates with neutral markers, suggesting that the effect of genetic drift was not limited to neutrally evolving regions of the genome. The novel mhc primers will help develop admixture schemes in A. interruptus captive breeding programmes and will increase the success of future reintroductions of this species of concern.

A major effect quantitative trait locus for whirling disease resistance identified in rainbow trout (Oncorhynchus mykiss)

Whirling disease, caused by the pathogen Myxobolus cerebralis, leads to skeletal deformation, neurological impairment and under certain conditions, mortality of juvenile salmonid fishes. The disease has impacted the propagation and survival of many salmonid species over six continents, with particularly negative consequences for rainbow trout. To assess the genetic basis of whirling disease resistance in rainbow trout, genome-wide mapping was initiated using a large outbred F(2) rainbow trout family (n=480) and results were confirmed in three additional outbred F(2) families (n=96 per family). A single quantitative trait locus (QTL) region on chromosome Omy9 was identified in the large mapping family and confirmed in all additional families. This region explains 50-86% of the phenotypic variance across families. Therefore, these data establish that a single QTL region is capable of explaining a large percentage of the phenotypic variance contributing to whirling disease resistance. This is the first genetic region discovered that contributes directly to the whirling disease phenotype and the finding moves the field closer to a mechanistic understanding of resistance to this important disease of salmonid fish.

Quantification of dissolved organic carbon at very low levels in natural ice samples by a UV-induced oxidation method

The study of chemical impurities trapped in solid precipitation and accumulated in polar ice sheets and high-elevation, midlatitude cold glaciers over the last several hundreds of years provides a unique way to reconstruct our changing atmosphere from the preindustrial era to the present day. Numerous ice core studies of inorganic species have already evaluated the effects of growing anthropogenic emissions of SO(2) or NO(x) on the chemical composition of the atmosphere in various regions of the world. While it was recently shown that organic species dominate the atmospheric aerosol mass, the contribution of anthropogenic emissions to their budget remains poorly understood. The study of organics in ice is at the infancy stage, and it still is difficult to draw a consistent picture of the organic content of polar ice from sparse available data. A UV oxidation method and IR quantification of CO(2) was optimized to obtain measurements of dissolved organic carbon content as low as a few ppbC. Stringent working conditions were defined to prevent contamination during the cleaning of ice. Measurements in various ice cores corresponding to preindustrial times revealed dissolved organic carbon content of less than 10 ppbC in Antarctica and up to 75 ppbC in alpine ice.

Single-Locus Inheritance in the Tetraploid Treefrog Hyla versicolor with an Analysis of Expected Progeny Ratios in Tetraploid Organisms

The recently evolved autotetraploid frog, Hyla versicolor , was examined electrophoretically for evidence of genomic restructuring leading to diploidization. Loci were tested against the progeny ratios expected if inheritance was disomic vs. tetrasomic. Two loci (Mpi and Sod-2) appeared to be inherited tetrasomically, one (Mdh-2) appeared to be inherited disomically, and one (Tpi) appeared to be inherited disomically in one family and tetrasomically in another family, when tested conventionally against 1:2:1 and 1:4:1 segregation ratios. The minimum number of progeny required for this type of analysis for codominant alleles is shown to be 92. Progeny resulting from double reduction were observed, and the occurrence of a null allele class at Mpi was noted. A reexamination of expected progeny ratios in tetraploid organisms reveals that tetrasomic inheritance patterns cannot be predicted without adequate knowledge of the amount of crossing-over, the proportion of tetravalents vs. random bivalents that are formed, and the ratio and types of centromere segregation (alternate and adjacent) that occur from tetravalents in the species being studied. However, disomic inheritance can be unambiguously confirmed only by the production of all heteroallelic gametes from homobivalent, symmetrically heterozygous individuals. In addition, a method is described for estimating genecentromere distances using the ratio of progeny genotypes in certain crosses in tetraploid species.

Endobronchial stent placement for the management of airway complications after lung transplantation

PURPOSE

To retrospectively evaluate the efficacy and complications of endobronchial stent placement for the management of airway complications following lung transplant.

MATERIALS AND METHODS

From 1992 to 2003, tracheobronchial stenting was performed on 25 lung transplant recipients (16 male and 9 female; mean age 51.6 years; range 21-65 years). A total of 27 lesions were treated and 27 stents were deployed (nine bronchomalacia, 12 bronchial stenosis, three bronchial stenosis and bronchomalacia both and three anastomotic dehiscence). The clinical and bronchoscopic follow-up ranged from 1 month to 69 months.

RESULTS

The technical success was 100%. Eighty-four percent of patients had immediate relief in dyspnea. The overall complication rate following stent placement was 0.049 per patient per month (23 complications/471 patient months). Stent migration and granulation tissue formation were the most frequent complications. The mean percentage change in FEV-1 was significantly greater than zero at 1 month and 6 months (P<.05) post-stent placement. The mean percentage change in FEV-1 was marginally greater than zero at 12 months (P=.07).The mean percentage change in FVC was marginally greater than zero at 1 month and 6 months (P=.08) post-stent. It was not significantly greater than zero at 12 months (P=1.00).

CONCLUSION

Tracheobronchial stent placement provides effective palliation of postoperative airway complications in lung transplant with morbidity that can be managed effectively by available treatment options. Airway stenting may be used as a primary management option for airway complications after lung transplantation as a large number of patients are not suitable candidates for repeat surgery.

Long-term response of primary biliary cirrhosis (stage I) to therapy with ursodeoxycholic acid

We report about a 56-year-old asymptomatic female patient, who was examined in April 1991 for an increase of biochemical parameters of the liver. Based on the biochemical and serological results (abnormal cholestatic liver function tests, positive antimitochondrial antibodies) as well as liver biopsy primary biliary cirrhosis stage I was diagnosed. Therapy with ursodeoxycholic acid (12mg/kg body-weight/die) was started. Follow-up examinations indicated that cholestatic parameters had normalized and antimitochondrial antibodies became negative. In a further biopsy of the liver nearly regular liver parenchyma was demonstrated. Thus, therapy with ursodeoxycholic acid was stopped. However, in November 1992 cholestatic parameters increased again and, antimitochondrial antibodies recurred (subtype anti-M9: positive) without any clinical symptoms. Ursodeoxycholic acid therapy was reintroduced again. Within 3 months cholestatic parameters returned to normal and antimitochondrial antibodies were eliminated again. Since then ursodeoxycholic acid has been given continuously and a long-term remission as defined by clinical, serological and histological criteria could be maintained until today. This case report indicates a serological remission and a marked histological improvement in a female patient with an early stage of primary biliary cirrhosis (stage I) during therapy under ursodeoxycholic acid. It has to be discussed whether certain early stages of primary biliary cirrhosis with benign antimitochondrial antibody-profile (anti-M9: positive) respond well to long-term treatment with ursodeoxycholic acid.

Genetic Evidence for Hybridization of Pallid and Shovelnose Sturgeon

To determine the genetic origin of individual sturgeon that are morphologically intermediate to pallid (Scaphirhynchus albus) and shovelnose (Scaphirhynchus platorhynchus) sturgeon, we combined previously published mitochondrial DNA (mtDNA) and microsatellite data with additional microsatellite data. Two sympatric populations of pallid and shovelnose sturgeon from the upper Missouri River and a sympatric population containing pallid, shovelnose, and putative pallid-shovelnose hybrids from the Atchafalaya River were analyzed using an index of hybridization and a principle components analysis of individual relatedness scores. The addition of new microsatellite data improved our ability to genetically differentiate individual pallid and shovelnose sturgeon collected in both areas. Our methods distinguished morphologically intermediate Atchafalaya River sturgeon, which appear to be genetically intermediate between pallid and shovelnose sturgeon. The results support a hybrid origin for morphologically intermediate individuals, although it is unclear whether they are all first-generation hybrids or if some are the result of subsequent backcrossing with the more common shovelnose sturgeon.

Differential Effects of Long-Term Treatment with Clozapine or Haloperidol on GABA Transporter Expression

BACKGROUND

Post-mortem studies with brain samples of schizophrenic patients led revealed altered GABA-ergic markers like reduced expression of the GABA transporter GAT-1. Whether this effect is due to the pathophysiology of schizophrenia or to antipsychotic treatment has not been investigated. We therefore established an animal trial of long-term antipsychotic treatment to address this question.

METHODS

A total of 33 adult male rats were investigated in three cohorts of 11 animals. One group received clozapine (45 mg/kg/ day), another group haloperidol (1.5 mg/kg/day), and the third one pH-adapted water over a period of 6 months. In situ hybridization with cRNA probes specific for GABA transporters VGAT, GAT-1 and GAT-3 were performed in comparison to control animals.

RESULTS

While GAT-1 was upregulated, VGAT expression declined in cortical and limbic brain regions, whereby haloperidol showed a greater effect than clozapine. GAT-3 expression was suppressed in parietal and temporal cortex.

CONCLUSIONS

We thus conclude that long-term antipsychotic treatment alters GABA transporter expression in rat. The upregulation of GAT-1 contrasts with the post-mortem finding of reduced GAT-1 expression in schizophrenic patients. Our results facilitate the distinction between disease dependent changes of GABAergic markers and medication effects.

Effects of chronic haloperidol and clozapine treatment on AMPA and kainate receptor binding in rat brain

BACKGROUND

Alterations in AMPA and kainate receptor binding have been revealed in post-mortem schizophrenic brains. As most patients had been treated with antipsychotics, medication effects cannot be excluded as a possible explanation for these results.

METHODS

Within the framework of this animal study, we investigated [3H]AMPA and [3H]kainate receptor binding in different rat brain regions following 6 months of oral treatment with either haloperidol (1.5 mg/kg/day) or clozapine (45 mg/kg/day).

RESULTS

AMPA receptor binding was increased after haloperidol treatment in the striatum, nucleus accumbens, cingulate cortex, and insular cortex. Clozapine showed increased AMPA receptor binding only in the anterior cingulate cortex. Kainate receptor binding was increased by both drugs in all hippocampal subfields.

CONCLUSIONS

This altered receptor binding may be related to beneficial neuroleptic effects and side effects. Furthermore, neuroleptic therapy may contribute to some of the post-mortem findings in the striatum in schizophrenia.

Die Wirkung von Antipsychotika auf glutamaterge Neurotransmission im Tiermodell

Post-mortem investigations have confirmed that glutamatergic NMDA, AMPA, and kainate receptors are involved in the pathophysiology of schizophrenia. It is still unclear, however, whether the altered number of receptors is caused by the disease itself or the medication. Therefore, animal models were investigated for effects of antipsychotic medication after treatment periods of up to 6 months, the results of which are summarized here. Generally, NMDA receptor binding was found to be increased in striatum and nucleus accumbens after therapy with haloperidol, whereas clozapine only increased the number of receptors in nucleus accumbens. While haloperidol led to an increase in AMPA receptors in the posterior cingulate gyrus, striatum, insular cortex, and n. accumbens, clozapine was found to elevate ligand binding in the anterior cingulate gyrus and infralimbic cortex. Although kainate receptor binding was increased in hippocampus by both antipsychotics, clozapine was significantly more effective. In conclusion, data reveal different effects from the typical neuroleptic haloperidol and the atypical antipsychotic clozapine. The results suggest that post-mortem findings in patients with schizophrenia may at least partially be explained by drug effects and plasticity changes induced by long-term medication with antipsychotics.

Tuberculous involvement of the oesophagus with oesophagobroncheal fistula

Tuberculous involvement of the oesophagus is a rare disease. Even if it is suspected, diagnosis is often difficult though dysphagia and chest pain are the most common symptoms without any other specific signs of tuberculosis. The diagnosis is based on oesophagography, oesophagoscopy, bronchoscopy, and computed tomographic scan. Suspected tuberculosis can be confirmed with histology, smear, and culture. The two most common differential diagnoses are Crohn's disease and carcinoma. The case is reported of a female patient with tuberculous involvement of the oesophagus, who developed an oesophagobroncheal fistula during steroid treatment started for suspicion of Crohn's disease. The patient was immunocompromised due to treatment with azathioprine that she was receiving for multiple sclerosis. The fistula was successfully treated by antituberculous chemotherapy alone.

Search for the scalar top quark in pp collisions at square root[s] = 1.8 TeV

We have performed a search for scalar top quark (stop) pair production in the inclusive electron-muon-missing transverse energy final state, using a sample of pp events corresponding to 108.3 pb(-1) of data collected with the D0 detector at Fermilab. The search is done in the framework of the minimal supersymmetric standard model assuming that the sneutrino is the lightest supersymmetric particle. For the dominant decays of the lightest stop, t-->b chi+1 and t-->blnu, no evidence for signal is found. We derive cross-section limits as a function of stop ( t ), chargino ( chi+1), and sneutrino ( nu) masses.

Direct search for charged higgs bosons in decays of top quarks

We present a search for charged Higgs bosons in decays of pair-produced top quarks in pp collisions at sqrt[s] = 1.8 TeV recorded by the D0 detector at the Fermilab Tevatron collider. With no evidence for signal, we exclude most regions of the ( M(H+/-),tan(beta)) parameter space where the decay t--> H(+)b has a branching fraction >0.36 and B(H+/--->tau(nu)(tau)) is large.