Multilabel hybridization probes for sequence-specific detection of sepsis-related drug resistance genes in plasmids

Emerging antimicrobial drug resistance is increasing the complexity involved in treating critical conditions such as bacterial induced sepsis. Methods for diagnosing specific drug resistance tend to be rapid or sensitive, but not both. Detection methods like sequence-specific single-molecule analysis could address this concern if they could be adapted to work on smaller targets similar to those produced in traditional clinical situations. In this work we demonstrate that a 120 bp double stranded polynucleotide with an overhanging single stranded 25 bp probe sequence can be created by immobilizing DNA with a biotin/streptavidin magnetic bead system, labeling with SYBR Gold, and rinsing the excess away while the probe retains multiple fluorophores. These probes with multiple fluorophores can then be used to label a bacterial plasmid target in a sequence-specific manner. These probes enabled the detection of 1 pM plasmid samples containing a portion of an antibiotic resistance gene sequence. This system shows the possibility of improving capture and fluorescence labeling of small nucleic acid fragments, generating lower limits of detection for clinically relevant samples while maintaining rapid processing times.

Rapid and simple pressure-sensitive adhesive microdevice fabrication for sequence-specific capture and fluorescence detection of sepsis-related bacterial plasmid gene sequences

Microbial resistance to currently available antibiotics poses a great threat in the global fight against infections. An important step in determining bacterial antibiotic resistance can be selective DNA sequence capture and fluorescence labeling. In this paper, we demonstrate the fabrication of simple, robust, inexpensive microfluidic devices for DNA capture and fluorescence detection of a model antibiotic resistance gene sequence. We laser micromachined polymethyl methacrylate microchannels and enclosed them using pressure-sensitive adhesive tapes. We then formed porous polymer monoliths with DNA capture probes in these microchannels and used them for sequence-specific capture, fluorescent labeling, and laser-induced fluorescence detection of picomolar (pM) concentrations of synthetic and plasmid antibiotic resistance gene targets. The relative fluorescence for the elution peaks increased with loaded target DNA concentration. We observed higher fluorescence signal and percent recovery for synthetic target DNA compared to plasmid DNA at the same loaded target concentration. A non-target gene was used for control experiments and produced < 3% capture relative to the same concentration of target. The full analysis process including device fabrication was completed in less than 90 min with a limit of detection of 30 pM. The simplicity of device fabrication and good DNA capture selectivity demonstrated herein have potential for application with processes for bacterial plasmid DNA extraction and single-particle counting to facilitate determination of antibiotic susceptibility. Graphical abstract.

Incidence of second primary malignancies (SPM) in men with castration-resistant prostate cancer (CRPC) in SEER-Medicare database

e13080

Background: A number of population-based epidemiological studies have been conducted to estimate incidence rates of SPM (newly detected malignancies) among cancer survivors, including those with prostate cancer. However, such data in patients with CRPC are limited. This study was conducted to estimate the incidence of SPM and overall survival (OS) in men with CRPC in the US. Methods: In the SEER-Medicare database, men aged > 65 years with prostate cancer diagnosed in 2000 through 2011 were eligible for the study if they had no other prior malignancy, had surgical or medical castration, and met the protocol-defined criteria for ascertaining castration resistance based on subsequent treatment with any of these therapies: abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, or sipuleucel-T. First SPM were identified in Medicare data as 1 inpatient claim, 2 outpatient claims, or 2 physician claims; or in SEER data as 1 diagnosis. Follow-up data ended in 2013. We estimated incidence of SPM as events per 100 person-years (py) with 95% confidence intervals (CI) and survival by the Kaplan-Meier method. Results: Among 2,234 men with CRPC (83.6% white; mean age, 76.6 years; 80.4% with bone metastases), we identified 172 with SPM, of which 20 (11.6%) were in SEER data. The incidence of all first SPM was 5.9 per 100 py (95% CI, 5.0-6.8). The most common of these were lung (n = 29), bladder (n = 22), colorectal (n = 21), other genitourinary cancers (n = 18), and non-colorectal gastrointestinal cancers (n = 17). Mean (SD) time from CRPC ascertainment to SPM was 1.0 (1.1) year. Median OS for the entire study population was 1.2 years (95% CI, 1.1-1.3) after CRPC ascertainment; estimated survival probabilities (95% CI) at 1, 3, and 5 years were 56% (54%-58%), 17% (15%-18%), and 9% (7%-11%), respectively. Conclusions: Most CRPC patients had claims for a diagnosis of bone metastasis when CRPC was ascertained. SPM were common among the study population and occurred relatively soon after CRPC. Most SPM were identified in Medicare rather than SEER data. These results provided context for the incidence of SPM in men with CRPC up to 2013.

The experience of accommodating privacy restrictions during implementation of a large-scale surveillance study of an osteoporosis medication

Purpose

To explore whether privacy restrictions developed to protect patients have complicated research within a 15‐year surveillance study conducted with US cancer registries.

Methods

Data from enrolling 27 cancer registries over a 10‐year period were examined to describe the amount of time needed to obtain study approval. We also analyzed the proportion of patients that completed a research interview out of the total reported by the registries and examined factors thought to influence this measure.

Results

The average length of the research review process from submission to approval of the research was 7 months (range, <1 to 24 months), and it took 6 months or more to obtain approval of the research at 41% of the cancer registries. Most registries (78%) required additional permission steps to gain access to patients for research. After adjustment for covariates, the interview response proportion was 110% greater (ratio of response proportion = 2.1; 95% confidence interval: 1.3, 3.3) when the least restrictive versus the most restrictive permission steps were required. An interview was more often completed for patients (or proxies) if patients were alive, within a year of being diagnosed, or identified earlier in the study.

Conclusions

Lengthy research review processes increased the time between diagnosis and provision of patient information to the researcher. Requiring physician permission for access to patients was associated with lower subject participation. A single national point of entry for use of cancer registry data in health research is worthy of consideration to make the research approval process efficient. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Curcumin (diferuloylmethane) alters the expression profiles of microRNAs in human pancreatic cancer cells

BACKGROUND

A major challenge in cancer chemotherapy has been developing safe and clinically efficacious chemotherapeutic agents. With its low toxicity profile, curcumin (diferuloylmethane), a naturally occurring flavinoid derived from the rhizome of Curcuma longa, has great promise. In vitro and in vivo preclinical studies have shown its inhibitory anticancer, antioxidant, anti-inflammatory, antiproliferative, and proapoptotic activities. The multiple mechanisms of the antitumor effect of curcumin putatively include down-regulating the expression of gene products such as nuclear factor-kappaB, growth suppression, inducing apoptosis, and modulating various signal transduction pathways and the expression of many oncogenes. The mechanisms underlying the antitumor activity of curcumin have not, however, been completely delineated.

METHODS

An oligonucleotide microarray chip was developed and used to profile microRNA (miRNA) expressions in pancreatic cells treated with curcumin. Transcripts with regulated expression patterns on the arrays were validated by real-time PCRs. Additionally, potential mRNA targets were analyzed bioinformatically and confirmed with flow cytometry experiments.

RESULTS

Curcumin alters miRNA expression in human pancreatic cells, up-regulating miRNA-22 and down-regulating miRNA-199a*, as confirmed by TaqMan real-time PCR. Upregulation of miRNA-22 expression by curcumin or by transfection with miRNA-22 mimetics in the PxBC-3 pancreatic cancer cell line suppressed expression of its target genes SP1 transcription factor (SP1) and estrogen receptor 1 (ESR1), while inhibiting miRNA-22 with antisense enhanced SP1 and ESR1 expression.

CONCLUSIONS

These observations suggest that modulation of miRNA expression may be an important mechanism underlying the biological effects of curcumin.

Stage of Breast Cancer Diagnosis Among Medically Underserved Women in California Receiving Mammography Through a State Screening Program

OBJECTIVE

This study describes breast cancer stage at diagnosis among California women receiving mammograms through a state-administered screening program in comparison to other California women.

METHOD

Linked data from California-administered screening programs and the California Cancer Registry were used to identify participants diagnosed with breast cancer between 1994 and 2000. Logistic regression was used to compare the adjusted likelihood of late stage disease among program participants (categorized into four subgroups based on the timing and frequency of mammograms) to non-participants in California diagnosed during the same time period.

RESULTS

Program participants were significantly more likely than non-participants to be diagnosed at late stage (adjusted OR 1.2; 95% CI 1.1, 1.3), with the highest risk occurring among those diagnosed 0-1 months after initial mammogram (adjusted OR 1.8; 95% CI 1.6, 2.1). The stage distribution among regularly screened participants was similar to non-participants (adjusted OR of late stage disease 0.9; 95% CI 0.7, 1.1).

CONCLUSIONS

Although program participants were more likely to be diagnosed at late stage than non-participants, their stage distribution was distinctly different according to their pattern of mammography utilization. This likely reflects differential utilization of program diagnostic and screening services, which should be taken into account in program evaluation.

Fertility in men with cystic fibrosis: an update on current surgical practices and outcomes

BACKGROUND

Men with cystic fibrosis (CF) have bilateral absence of the vas deferens causing an obstructive azoospermia that is not amenable to surgical correction. Advances in the field of reproductive medicine allow for the procurement of viable sperm and facilitate fertilization and pregnancy in couples where the man has CF.

OBJECTIVES

To describe patient anatomy and semen characteristics and to determine the pregnancy rates of couples in whom the male partner has CF and who have undergone microsurgical epididymal sperm aspiration coupled with in vitro technology, specifically intracytoplasmic sperm injection (ICSI).

DESIGN

Retrospective analysis.

SETTING

Clinical department of urology and two reproductive medicine units.

PATIENTS

Thirteen married men with CF who were referred for infertility.

INTERVENTIONS

History, physical examination, semen analysis, transrectal and renal ultrasonography, CF mutation analysis, and microsurgical sperm aspiration coupled with ICSI.

RESULTS

All 13 men had low-volume azoospermia, absent vasa, and aplasia/hypoplasia of the seminal vesicles. CF mutation analysis was carried out in 11 of 13 men, and 9 of 11 were DeltaF508 homozygous. Eight men underwent microsurgical sperm aspiration, and their partners underwent one or more cycles of ICSI. Five couples (62.5%) achieved a pregnancy, with four couples delivering (three sets of twins and one singleton).

CONCLUSIONS

CF in men is accompanied by bilateral vasal aplasia. The resultant obstructive azoospermia can be treated quite successfully with a combination of sperm aspiration and ICSI. It is important for physicians involved in the care of men with CF to convey the message that prospects for fatherhood are excellent with current technology.

Efficacy of intracytoplasmic sperm injection using intentionally cryopreserved epididymal spermatozoa

Microsurgical epididymal sperm aspiration was a great advance in the therapy of patients with non-reconstructable, obstructive azoospermia, most notably congenital bilateral absence of the vas deferens. Using conventional in-vitro fertilization, pregnancies were rarely achieved because the rate of oocyte fertilization was extremely poor. However, the use of retrieved spermatozoa in conjunction with intracytoplasmic sperm injection (ICSI) has dramatically increased the likelihood of embryo formation. Typically, sperm and oocyte harvesting are performed simultaneously. We have investigated whether frozen-thawed spermatozoa work as well as fresh spermatozoa. When we had concluded from our own population of patients (groups I and II) that they did, we adopted a policy of aspirating spermatozoa, primarily cryopreserving them and using them for ICSI at a later date. We found the fertilization rates of this latter cohort of patients (group III) to be excellent (37% per oocyte), and the ongoing pregnancy rate is quite satisfactory (40% per couple, 29% per cycle). We offer this approach as an alternative to the traditional scheme because it markedly eases the burden of partner scheduling on both the couple and the clinicians involved. In addition, assurance of the availability of male partner spermatozoa can be attained prior to beginning ovulation induction.

Sperm morphology and in vitro fertilization outcome: a direct comparison of World Health Organization and strict criteria methodologies

OBJECTIVE

To perform a direct comparison of two sperm morphology methodologies with regard to IVF outcome.

DESIGN

Blinded comparison of two methods of morphology assessment using the same morphology slides.

PATIENTS

Data were obtained from 132 couples in a consecutive series of patients undergoing IVF.

MAIN OUTCOME MEASURES

Two practical end points were selected for analysis for each couple: the presence of any fertilization and the number of fertilized eggs. Normal traditional morphology was defined as > or = 40% normal forms in a sample and normal strict criteria was defined as > or = 4%.

RESULTS

Traditional morphology demonstrated a higher sensitivity and negative predictive value than strict criteria (87% versus 61%, and 68% versus 36%, respectively). Positive predictive value and specificity were also numerically greater but did not reach statistical significance. Abnormal traditional morphology, but not strict criteria, was associated with reduced fertilization even among samples with normal sperm concentration and motility. Samples with normal morphology were associated with a greater number of fertilized eggs per couple than those with abnormal morphology: this difference was 3.2 fertilized eggs for traditional morphology and 1.6 for strict criteria. Overall, for samples with < 40% by traditional morphology only one case yielded more than two fertilized eggs. In contrast, up to five fertilized eggs were noted for the lowest strict criteria scores.

CONCLUSIONS

Comparison of traditional morphology and strict criteria with regard to IVF outcome favored traditional morphology in several areas. In particular, low scores were more predictive of poor IVF outcome.

Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis

Dialysis-induced hypovolemia occurs because the rate of extracorporeal ultrafiltration exceeds the rate of refilling of the blood compartment. The purpose of this study was to evaluate a method for calculating circulating blood volume (BV) during hemodialysis (HD) from changes in hematocrit (Hct) shortly (2 to 10 min) before and after ultrafiltration (UF) was abruptly stopped. Hct was monitored continuously during 93 HD treatment sessions in 16 patients by an optical technique and at selected times by centrifugation of blood samples. Total plasma protein and albumin concentrations were also measured at selected times. Continuously monitored Hct correlated with Hct determined by centrifugation (R = 0.89, N = 579). Relative changes in BV determined by continuously monitored Hct were not different from those determined by total plasma protein concentration (P = 0.05; N = 273). Calculated BV at the start of dialysis (4.1 +/- 1.3 L) was not different (P = 0.18, N = 12) from that derived anthropometrically from the patient's dry weight (4.6 +/- 0.8 L), and calculated BV when UF was stopped was 3.2 +/- 0.5 L (46 +/- 7 ml/kg body wt). These latter estimates of BV are consistent with those determined previously by dilution techniques in HD patients. It was concluded that (1) relative changes in BV assessed by continuously monitored Hct were unbiased and (2) BV can be determined noninvasively during HD by continuously monitoring Hct and temporarily stopping UF.

Hematocrit as an indicator of blood volume and a predictor of intradialytic morbid events

Hematocrit (H) levels can change during hemodialysis, and these changes in H are inversely related to changes in blood volume (BV). The objectives of this study were to determine whether mean arterial pressure (MAP) decreases with decreasing BV and rising H during hemodialysis, and to determine the relationship between dialysis induced intravascular volume depletion and intradialytic morbid events (IME), defined as hypotension, cramping, or lightheadedness that led to dialysis staff intervention. We monitored H continuously using a noninvasive optical technique in 93 hemodialysis sessions in 16 patients. IME occurred in 48 sessions. MAP decreased with increasing H in 10 of 16 patients (P < 0.05), but the relationship between MAP and H varied among the patients. The rate of BV change during sessions without morbidity (5.6 +/- 3.6 [SD] %/hr) was lower (P < 0.001) than that preceding IME in the other sessions (12.2 +/- 5.5 [SD] %/hr). Twelve of 16 patients who exhibited recurrent IME during this study experienced these events when H reached a patient specific threshold. It is concluded that MAP decreases with decreasing BV and increasing H in many patients on hemodialysis, and that a high rate of BV change often indicates that IME are forthcoming. It is further hypothesized that a patient specific H threshold is indicative of a critical BV level below which certain patients experience IME.

Comparative analysis of the sequence and structure of two Drosophila melanogaster genes encoding vitelline membrane proteins

Two Drosophila melanogaster vitelline membrane protein-encoding genes (VM), located at polytene band positions 26A and 34C, have been cloned and comparatively characterized at the nucleotide level. Sequence analysis of genomic and cDNA clones for the two genes, VM26A.1 and VM34C.1, indicates that both are similarly organized with a central highly conserved domain [Scherer et al., Dev. Biol. 130 (1988) 786-788] which is flanked by unrelated regions, and that both genes lack introns. Comparison of the upstream regions reveals that both VM genes contain a hepatmeric element identical to one associated with the D. melanogaster yolk protein-encoding genes (YP). This heptamer occurs in the specific 5' flanking region responsible for ovarian temporal- and tissue-specific control in both VM and YP genes. A putative chorion transcription factor 2 site is also associated with an upstream control element of VM26A.1, but not with any sequenced portion of VM34C.1.

Drosophila vitelline membrane genes contain a 114 base pair region of highly conserved coding sequence

Two Drosophila vitelline membrane (VM) genes located at polytene band positions 26A and 34C have been characterized at the nucleotide level. Sequence comparison of the two genes VM26A.1 and VM34C.1 has revealed a similar 114 base pair region centrally located in the coding regions of both genes. The conserved region has a 91% homology at the nucleic acid level and a 100% conservation at the amino acid level. This suggests a common evolutionary origin for these VM genes and indicates that a strong selective pressure exists to maintain a specific polypeptide sequence in a domain of the proteins.

Visual detection of driving while intoxicated

Visual cues were identified and procedures were developed to enhance on-the-road detection of driving while intoxicated (DWI) by police patrol officers. Related research was reviewed; police officers with demonstrated effectiveness in DWI detection were interviewed; DWI arrest reports were analyzed; and a study was conducted to determine the frequency of occurrence and relative discriminability of visual cues. Based on the results, a DWI detection guide was developed and verified in a field study involving a sample of 10 law enforcement agencies located throughout the United States. Use of the guide was accompanied by a statistically significant 12% overall increase in DWI arrest rate.

Acute hemorrhagic conjunctivitis: a mixed virus outbreak among Vietnamese refugees on Guam

In May 1975 the authors investigated an outbreak of acute hemorrhagic conjunctivitis that affected an estimated 29,000 refugees from South Vietnam who stayed on Guam while en route to the United States. Illness usually lasted6-10 days and was characterized by conjunctival injection (100%), lid edema (84%), eye irritation (81%) and subconjunctival hemorrhages (45%). Conjunctival swabs and paired serum specimens on a limited number of patients implicated enterovirus 70 as a major etiologic agent and adenovirus 11 as a less frequent agent. Adenovirus 8 and herpes simplex virus caused concurrent, sporadic cases of keratoconjunctivitis. Forty-three per cent of the refugees in a sample of 604 refugees were affected, and the attack rate was highest on evacuation vessels where crowding and poor sanitation facilitated person-to-person spread of infection. Because the outbreak subsided on Guam, and because infection was transmitted there to only 13 of about 1300 Americans in frequent contact with affected refugees, the risk of secondary outbreaks inthe United States appeared small.

Martian Relief and the Coming Opposition

In the report "Martian relief and the coming opposition" (3 Mar., p. 1100), D. H. Harris stated that, "... the reduced contrast with decreasing (terminator distance) just balances the increase in visibility due to shadow length." This is obviously erroneous. A more careful examination of the problem shows that for favorable values of the Aerocentric EarthSun Sun angle, visibility of relief increases toward the terminator, clouds not withstanding.

The impact of microelectronics on the utilization and training of maintenance personnel

Microelectronic functional equivalents were defined for two operational systems—a ship's inertial navigation system and a torpedo guidance system—and, by means of maintenance burden analyses, the maintenance personnel, training and organizational requirements of the microelectronic and existing configurations were compared. Microelectronics reduced the amount of maintenance required by the ship's inertial navigation system by 84 percent, and the amount required by the torpedo guidance system by 18 percent, under existing maintenance philosophies. Specific conclusions were provided with respect to the impact of microelectronics on maintenance personnel and training requirements, and on the organization of maintenance activities.

Martian Relief and the Coming Opposition

Ground-based observations of Martian relief may be possible when the Earth-Mars geometry is optimum and the observing conditions are near perfect. There is some evidence that detectable relief is present. Groundbased observations of Martian relief during the coming opposition will be optimum between 1 February and 1 March and between 1 June and 15 August 1967.