[Study on the mechanism of serotype conversion of historical isolates of Shigella flexneri]

Objective: The serotype screening of Shigella flexneri from 1934 to 1965 preserved by the National Center for Medical Culture Collections was carried out, and the molecular characteristics of the serotype conversion strains were studied. Methods: Serotyping of Shigella flexneri in this study was conducted by slide agglutination and multiplex PCR, respectively. The gtrⅡ gene sequence alignment and pulsed field gel electrophoresis typing were performed on the serotype conversion strains. Results: Among the 255 strains of Shigella flexneri preserved in CMCC (B) from 1934 to 1965, 79 were carrying gtrⅡ gene, of which 19 strains and 1 strain were agglutinated with the Y serotype and X serotype, respectively, and furthermore, the multiplex PCR assays results showed serotypes 2a and 2b, respectively, and the strains were considered to have serotype conversion. The 20 strains carrying the gtrⅡ gene showed multiple nucleotide mutations. Besides 3 strains of 3 amino acid mutations, the amino acid sequences of the other 17 strains showed a stop codon in advance, resulting in functional inactivation of gtrⅡ. PFGE analysis revealed that the similarity between the serotype Y strain carrying the gtrⅡ gene and the serotype 2a strain was 75.8%-100%, and the similarity between the serotype X strain carrying the gtrⅡ gene and the serotype 2b strain was 81.6%-100%. Conclusion: Mutations in the gtrⅡ gene are more complicated in serotype-transforming Shigella flexneri serotype Y or X strains. Molecular typing suggests that the serotype-transforming Shigella flexneri serotype Y or X strains may be derived from the Shigella flexneri serotype 2a or 2b, and advance the serotype conversion to 1949.

Arterial embolization of massive hepatocellular carcinoma with lipiodol and gelatin sponge

BACKGROUND

Transarterial chemoembolization (TACE) has been used to treat unresectable massive hepatocellular carcinoma (HCC). Lots of embolic agents have been applied in embolization because of it can decrease patient discomfort and side-effects.

AIM

The aim was to evaluate the clinical efficacy and safety of TACE with lipiodol and gelatin sponge.

MATERIALS AND METHODS

A total of 109 patients with massive HCC (the size of tumor >10 cm and unresectable) from January 2011 to August 2014 in our institution was divided into group A and group B based on the different embolitic agents. Before and about 1-month after each case of TACE, clinical and biological data such as tumor size, Child-Pugh stage, serum alpha-fetoprotein (AFP), complications, were recorded at the same time.

RESULTS

In group A, the diameter of the tumor reduced from 12.57 ± 1.26 cm to 9.04 ± 0.89 cm. No patient was complete response (CR), partial response (PR) 36, stable disease (SD) 7 and PD 6; in group B, the diameter of tumor decreased from 12.08 ± 1.42 cm to 8.43 ± 1.05 cm, CR 0, but PR 27, SD 18 and PD 15. RR in group A was significantly higher than in group B (P < 0.05).The change of Child-Pugh stage and AFP pre- and post-operative in group A can be found significantly better than in group B.

CONCLUSIONS

TACE with lipiodol and gelatin sponge is a highly effective for massive HCC.

Positive selection sites in tertiary structure of Leguminosae chalcone isomerase 1

Isoflavonoids and the related synthesis enzyme, chalcone isomerase 1 (CHI1), are unique in the Leguminosae, with diverse biological functions. Among the Leguminosae, the soybean is an important oil, protein crop, and model plant. In this study, we aimed to detect the generation pattern of Leguminosae CHI1. Genome-wide sequence analysis of CHI in 3 Leguminosae and 3 other closely related model plants was performed; the expression levels of soybean chalcone isomerases were also analyzed. By comparing positively selected sites and their protein structures, we retrieved the evolution patterns for Leguminosae CHI1. A total of 28 CHI and 7 FAP3 (CHI4) genes were identified and separated into 4 clades: CHI1, CHI2, CHI3, and FAP3. Soybean genes belonging to the same chalcone isomerase subfamily had similar expression patterns. CHI1, the unique chalcone isomerase subfamily in Leguminosae, showed signs of significant positive selection as well as special expression characteristics, indicating an accelerated evolution throughout its divergence. Eight sites were identified as undergoing positive selection with high confidence. When mapped onto the tertiary structure of CHI1, these 8 sites were observed surrounding the enzyme substrate only; some of them connected to the catalytic core of CHI. Thus, we inferred that the generation of Leguminosae CHI1 is dependent on the positively selected amino acids surrounding its catalytic substrate. In other words, the evolution of CHI1 was driven by specific selection or processing conditions within the substrate.

Complication prevalence following use of tutoplast-derived human acellular dermal matrix in prosthetic breast reconstruction: a retrospective review of 203 patients

Use of human acellular dermal matrix (ADM) during prosthetic breast reconstruction has increased. Several ADM products are available produced by differing manufacturing techniques. It is not known if outcomes vary with different products. This study reports the complication prevalence following use of a tutoplast-derived ADM (T-ADM) in prosthetic breast reconstruction. We performed a retrospective chart review of 203 patients (mean follow-up times 12.2 months) who underwent mastectomy and immediate prosthetic breast reconstruction utilizing T-ADM, recording demographic data, surgical indications and complication (infection, seroma, hematoma, wound healing exceeding three weeks and reconstruction failure). During a four-year period, 348 breast reconstructions were performed Complications occurred in 16.4% of reconstructed breasts. Infection occurred in 6.6% of breast reconstructions (3.7% - major infection, requiring intravenous antibiotics and 2.9% minor infection, requiring oral antibiotics only). Seromas occurred in 3.4% and reconstruction failure occurred in 0.6% of breast reconstructions. Analysis suggested that complication prevalence was significantly higher in patients with a BMI >30 (p = 0.03). The complication profile following T-ADM use is this series is comparable to that reported for with other ADM products. T-ADM appears to be a safe and acceptable option for use in ADM-assisted breast reconstruction.

Abstract P2-19-02: Do older women benefit from post-mastectomy breast reconstruction?

Purpose: Despite evidence that post-mastectomy breast reconstruction (PMBR) decreases psychological morbidity and improves body image, older women (aged 65 and above) receive it six times less often than younger women. It is unclear whether this difference represents a disparity or reflects informed patient choices since the outcomes of PMBR in older women have never been rigorously studied. We hypothesized that in older women, the use of PMBR is associated with greater psychosocial well-being and breast satisfaction than mastectomy alone.

Patients and Methods: The Dillman method was used to survey 299 older women with stage 0-III breast cancer who underwent a mastectomy from 2006-2011. The response rate was 75.3%. The survey incorporated demographic questions and measured satisfaction and health-related quality of life outcomes using the Duke health profile and the BREAST-Q mastectomy module. Patients who underwent PMBR were compared to those who did not (no-PMBR) to determine differences in patient characteristics, satisfaction, and quality-of-life outcomes between groups. Satisfaction and outcome results were risk adjusted using multivariable logistic regression to account for differences between PMBR and no-PMBR groups.

Results: The median age of respondents was 72. Of these, 77/214 (36%) elected to undergo PMBR. Marital status, education level, race, and tumor stage were similar in PMBR and no-PMBR groups. Those in the PMBR group were generally younger and more affluent than those in the no-PMBR group (p&lt;0.001 and p&lt;0.05, respectively). There were no significant differences in age-adjusted physical health, anxiety, or depression scores between PMBR and no-PMBR groups. Both groups reported high levels of decisional satisfaction. However, after adjusting for age and income, PMBR was associated with greater breast satisfaction (BREAST-Q score 69 vs. 57, p&lt;0.001) and greater psychosocial well-being (BREAST-Q score 83 vs. 76, p&lt;0.001). These differences in scores compared favorably to those seen in younger women.

Conclusions: This is the first study to compare psychosocial outcomes and breast satisfaction between older women who undergo PMBR and those who do not. These findings show that older women have the potential to benefit from PMBR at least as much as younger women do. PMBR can be performed in a significant proportion of older women with high levels of satisfaction. Older women who are appropriate candidates should be encouraged to consider breast reconstruction, and efforts should be made to narrow the disparity in the delivery of PMBR between older and younger women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-02.

ConfMatch: automating electron-density map interpretation by matching conformations

Building a protein model from the initial three-dimensional electron-density distribution (density map) is an important task in X-ray crystallography. This problem is computationally challenging because proteins are extremely flexible. The algorithm ConfMatch is a global real-space fitting procedure in torsion-angle space. It solves this 'map-interpretation' problem by matching a detailed conformation of the molecule to the density map (conformational matching). This 'best-match' structure is defined as one which maximizes the sum of the density at atom positions. ConfMatch is a practical systematic algorithm based on a branch-and-bound search. The most important idea of ConfMatch is an efficient method for computing accurate bounds. ConfMatch relaxes the conformational matching problem, a problem which can only be solved in exponential time, into one which can be solved in polynomial time. The solution to the relaxed problem is a guaranteed upper bound for the conformational matching problem. In most empirical cases, these bounds are accurate enough to prune the search space dramatically, enabling ConfMatch to solve structures with more than 100 free dihedral angles. Experiments have shown that ConfMatch may be able to automate the interpretation of density maps of small proteins.

Knowing and approaching hope as human experience: implications for the medical-surgical nurse

Hospitalized patients frequently share the mystery of their hopes and dreams. Through a deepened understanding and an alternative approach in practice, nurses can come to know patients' hopes and work with them in ways that enhance their quality of life.

Developing a concept of hope from a human science perspective

This article explores concept development from a human science perspective and uses concept inventing, a method described by Parse, for developing the concept of hope as inspired by the Taiwanese folk song "Mending a Torn Fish Net." The synthesized definition is hope is resolute picturing of the possibilities amid the restrictions-opportunities of communion-aloneness while creatively metamorphosing. This definition is explicitly connected to the three principles of Parse's theory of human becoming. Reflections on research and practice are provided.

Human cytomegalovirus infection of caco-2 cells occurs at the basolateral membrane and is differentiation state dependent

Epithelial cells are known to be a major target for human cytomegalovirus (HCMV) infection; however, the analysis of virus-cell interactions has been difficult to approach due to the lack of in vitro models. In this study, we established a polarized epithelial cell model using a colon epithelial cell-derived cell line (Caco-2) that is susceptible to HCMV infection at early stages of cellular differentiation. Infection of polarized cells was restricted to the basolateral surface whereas virus was released apically, which was consistent with the apical and not basolateral surface localization of two essential viral glycoproteins, gB and gH. HCMV infection resulted in the development of a cytopathology characteristic of HCMV infection of colon epithelium in vivo, and infection did not spread from cell to cell. The inability of HCMV to infect Caco-2 cells at late stages of differentiation was due to a restriction at the level of viral entry and was consistent with the sequestration of a cellular receptor for HCMV. These observations provide the first evidence that restriction of HCMV replication in epithelial cells is due to a receptor-mediated phenomenon.

Uncv (uncovered): a new mutation causing hairloss on mouse chromosome 11

A pair of mutant mice with a first sparse coat appeared spontaneously in the production stock of BALB/c mice with a normal coat. After being sib-mated, they produced three phenotypes in their progeny: mice with normal hair, mice with a first sparse coat and then a fuzzy coat, and uncovered mice. Genetic studies revealed the mutants had inherited an autosomal monogene that was semi-dominant. By using 11 biochemical loci--Idh, Car2, Mup1, Pgm1, Hbb, Es1, Es10, Gdc, Ce2, Mod1 and Es3--as genetic markers, two-point linkage tests were made. The results showed the gene was assigned to chromosome 11. The result of a three-point test with Es3 and D11Mit8 (microsatellite DNA) as markers showed that the mutation was linked to Es3 with the recombination fraction 7.89 +/- 2.19%, and linked to D11Mit8 with the recombination fraction 26.30 +/- 3.57%. The recombination fraction between Es3 and D11Mit8 was 32.90 +/- 3.81%. It is suggested that the mutation is a new genetic locus that affected the skin and hair structure of the mouse. The mutation was named uncovered, with the symbol Uncv. Further studies showed the mutation affected not only the histology of skin and hair but also the growth and reproductive performance of the mice. The molecular characterization of the Uncv locus needs to be further studied.

The role of CCR5 and CCR2 polymorphisms in HIV-1 transmission and disease progression

Entry of human immunodeficiency virus type 1 (HIV-1) into target cells requires both CD4 (ref. 1, 2) and one of a growing number of G-protein-coupled seven-transmembrane receptors. Viruses predominantly use one, or occasionally both, of the major co-receptors CCR5 or CXCR4, although other receptors, including CCR2B and CCR3, function as minor co-receptors. CCR3 appears critical in central nervous system infection. A 32-base pair inactivating deletion in CCR5 (delta 32) common to Northern European populations has been associated with reduced, but not absolute, HIV-1 transmission risk and delayed disease progression. A more commonly distributed transition causing a valine to isoleucine switch in transmembrane domain I of CCR2B (64I) with unknown functional consequences was recently shown to delay disease progression but not reduce infection risk. Although we confirm the lack of association of CCR2B 64I with transmission, we cannot confirm the association with delayed progression. Although subjects with CCR5 delta 32 defects had significantly reduced median viral load at study entry, providing a plausible explanation for the association with delayed progression, this association was not seen with CCR2B 64I. Further studies are needed to define the role of CCR2B64I in HIV pathogenesis.

The Pinwheel Model of Bereavement

The Pinwheel Model of Bereavement is a process-orientated model of grief which recognizes loss as a unique lived experience. The model and relevant nursing response are described using Margaret Newman's nursing theory of health as expanding consciousness. The model is based on research by Carter (1989) and clinical experience. The contextual theme for the model is "personal history." Six core themes are: being stopped, hurting, missing, holding, seeking, and valuing. Three meta themes are change, expectations, and inexpressibility. Capacities for "being with" the bereaved are identified for the practice of nursing.

Spontaneous rupture of the liver associated with pregnancy: a report of two cases

Spontaneous rupture of the liver associated with pregnancy is a rare and grave complication, usually occurring in preeclampsia or eclampsia. Two cases of ruptured subcapsular hematoma of the right liver during pregnancy are reported. The first case was a 19-year-old woman who had suffered from epigastralgia and absent fetal heart beat in the 32nd week of gestation. The second case was a 31-year-old female who complained of nausea and right upper quadrant pain in the 35th week of pregnancy. Both had preeclampsia, and developed shock with disseminated intravascular coagulation soon after admission. Both received surgery and were found to have ruptured hematoma over the right liver. Finally, the first patient died of renal failure, but the second survived because preoperative diagnosis had been exact. Greater suspicion, then awareness of diagnosis can lead to better timing of surgery and an improved prognosis for mother and child.

Structure and function of decay accelerating factor CD55

Studies of decay-accelerating factor (DAF) function and structure are reviewed. DAF was first recognized as a species restricting factor operating at the level of C3/C5 activation. Cloning of the gene indicates that DAF has four short consensus repeats of the type characteristic of the regulators of complement activation gene cluster family. The third short consensus repeat is responsible for DAF's complement regulatory activity and signaling. DAF, like other glycophosphatidylinositol (GPI) anchored proteins, is associated with tyrosine kinases, and these kinases are probably the signaling devices. The details of how DAF's GPI anchor in the outer leaflet of plasma membrane connects with the tyrosine kinases on the inner leaflet are not known. Although DAF does not have an essential role in controlling hemolysis of erythrocytes, it does have important role in regulating the deposition of C3 on nucleated cells. The therapeutic potential of DAF is discussed.