[Interpretation of the Implant Dentistry Core Outcome Set and Measurement international consensus report]

Selection and measurement of clinical outcome are key components of clinical research in implant dentistry. Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine took the lead and collaborated with multiple internationally renowned colleges of stomatology to develop an international consensus on the core outcome set and measurement in implant dentistry, which took two years and was published in May, 2023 in Journal of Clinical Periodontology and Clinical Oral Implants Research simultaneously. The consensus, aiming at identifying the full spectrum of benefits and harms of interventions, provides a comprehensive, agreed, and standardized set of outcomes that should be measured and reported as a minimum in clinical trials relating with implant dentistry, bone augmentation, and soft tissue augmentation. The present review describes the methodology and key elements of the consensus to help Chinese clinical researchers fully understand and appropriately apply the core outcome set and improve the overall quality of Chinese clinical research in implant dentistry.

Performance of neuroretinal rim thickness measurement by Cirrus high-definition optical coherence tomography in myopic eyes

Neuroretinal rim (NRR) measurement can aid the diagnosis of glaucoma. A few studies reported that Cirrus optical coherence tomography (OCT) had NRR segmentation errors. The current study investigated segmentation success of NRR in myopic eyes using the Cirrus built-in software and to determine the number of acquisitions required to identify NRR thinning. Right eye of 87 healthy adult myopes had an optic disc scanned using Cirrus HD-OCT for five successive acquisitions. A masked examiner evaluated 36 radial line images of each scan to screen for segmentation errors using the built-in software at the Bruch's membrane opening (BMO) and/or internal limiting membrane (ILM). Participants with three accurate NRR acquisitions had their average NRR thickness determined. This result was compared with average of the two acquisitions and the first acquisition. Among 435 OCT scans of the optic disc (87 eyes × 5 acquisitions), 129 (29.7%) scans had segmentation errors that occurred mainly at the ILM. The inferior-temporal and superior meridians had slightly more segmentation errors than other meridians, independent of axial length, amount of myopia, or presence of peripapillary atrophy. Sixty-five eyes (74.7%) had at least three accurate NRR measurements. The three acquisitions had high reliability in NRR thickness in the four quadrants (intraclass correlation coefficient > 0.990, coefficient of variation < 3.9%). NRR difference between the first acquisition and the average of three acquisitions was small (mean difference 2 ± 13 μm, 95% limits of agreement within ± 30 μm) among the four quadrants. Segmentation errors in NRR measurements appeared regardless of axial length, amount of myopia, or presence of peripapillary atrophy. Cirrus segmentation lines should be manually inspected when measuring NRR thickness.

Host Genetic Associations with Salivary Microbiome in Oral Cancer

Despite the growing recognition of a host genetic effect on shaping gut microbiota composition, the genetic determinants of oral microbiota remain largely unexplored, especially in the context of oral diseases. Here, we performed a microbiome genome-wide association study in 2 independent cohorts of patients with oral squamous cell carcinoma (OSCC, n = 144 and 67) and an additional group of noncancer individuals (n = 104). Besides oral bacterial dysbiosis and signatures observed in OSCC, associations of 3 loci with the abundance of genus-level taxa and 4 loci with β diversity measures were detected (q < 0.05) at the discovery stage. The most significant hit (rs10906082 with the genus Lachnoanaerobaculum, P = 3.55 × 10^-9 at discovery stage) was replicated in a second OSCC cohort. Moreover, the other 2 taxonomical associations, rs10973953 with the genus Kingella (P = 1.38 × 10^-9) and rs4721629 with the genus Parvimonas (P = 3.53 × 10^-8), were suggestive in the meta-analysis combining 2 OSCC cohorts. Further pathway analysis revealed that these loci were enriched for genes in regulation of oncogenic and angiogenic responses, implicating a genetic anchor to the oral microbiome in estimation of casual relationships with OSCC. Our findings delineate the role of host genotypes in influencing the structure of oral microbial communities.

A Comprehensive Study of the Epidemiology of Haematological Malignancies in North Queensland

BACKGROUND

There is an absence of clinically relevant epidemiological data in regional Australia pertaining to haematological malignancies.

AIM

To determine the incidence and geographical variation of haematological malignancies in North Queensland using a clinically appropriate disease classification.

METHODS

Retrospective, observational study of individual patient data records of all adults diagnosed with a haematological malignancy between 2005-2014 and residing within The Townsville Hospital Haematology catchment region. We report descriptive summaries, incidence rates and incidence-rate ratios of haematologic malignancies by geographic regions.

RESULTS

1581 haematological malignancies (69% lymphoid, 31% myeloid) were diagnosed over the 10-year study period. Descriptive data is presented for 58 major subtypes as per the WHO diagnostic classification of tumours of haematopoietic and lymphoid tissues. The overall median age at diagnosis was 66 years with a male predominance (60%). We demonstrate a temporal increase in the incidence of haematologic malignancies over the study period. We observed geographical variations in the age-standardised incidence rates per 100,000 ranging from 0.5 to 233.5. Our data suggests an increased incidence rate ratio for haematological malignancies in some postcodes within the Mackay area compared to other regions.

CONCLUSION

This study successfully reports on the incidence of haematological malignancies in regional Queensland using a clinically meaningful diagnostic classification system and identifies potential geographic hotspots. We advocate for such contemporary, comprehensive, and clinically meaningful epidemiological data reporting of blood cancer diagnoses in wider Australia. Such an approach will have significant implications toward developing appropriate data-driven management strategies and public health responses for haematological malignancies. This article is protected by copyright. All rights reserved.

P–522 Cervical secretion methylation profile is associated with the success of frozen-thawed embryo transfer - a proof-of-concept study

Study question

Is cervical secretion gene methylation profile different between receptive and non-receptive endometrium and associated with implantation outcome in frozen-embryo transfer (FET) cycle?

Summary answer

The combination of candidate genes methylation profiles obtained from cervical secretion showed significant associations with pregnancy outcomes.

What is known already

Implantation failure remains a black box in reproductive medicine, and the exact mechanism of how endometrial receptivity is regulated is still unknown. Epigenetic modifications play a role in the gene expression pattern and may alter the endometrial receptivity in the human endometrium. Cervical secretion containing various implantation-related cytokines, and the gene methylation change can be used as a non-invasive molecular source that reflects the endometrium condition.

Study design, size, duration

In this retrospective case-control study, sixty-two women who entered the FET cycle (30 pregnant and 32 non-pregnant women) were enrolled.

Participants/materials, setting, methods

Cervical secretion was collected before embryo transfer from women enrolled in multicenter university-affiliated reproductive units. The DNA methylation status of six candidate genes was measured using quantitative methylation-specific PCR (qMSP). The correlation between methylation change and the pregnancy outcome was analyzed.

Main results and the role of chance

The candidate genes were selected from that associated with implantation with literature review and the original genome-wide DNA methylation data from NCBI GEO DataSets (GSE90060) which processed using bioinformatics analysis. Six candidate genes whose CpG-level methylation analysis with β-value statistically higher in receptive endometrium than in a pre-receptive endometrium were selected. All six candidate genes showed different degrees of correlation with the pregnancy outcomes. Among them, PRKAG2 methylation changes showed the highest correlation with the pregnancy outcome. A logistic regression model was used to evaluate the performance of a single gene or a combination of genes for implantation prediction. The results showed a statistically significant association between the methylation status of a combination of genes (PRKAG2, KRS1, HAND2) and the pregnancy outcome (p = 0.008), resulting in an optimal AUC of 0.7 (95% CI: 0.57 - 0.81) for implantation prediction.

Limitations, reasons for caution

The results obtained from a relatively small cohort size. A larger study and further comprehensive methylome investigations are warranted.

Wider implications of the findings: This study is the first proof-of-concept study that cervical secretion methylation profile is associated with implantation outcome in a FET cycle, and showed potential as a non-invasive method for implantation prediction.

Trial registration number

non applicable

A randomized, open-label, phase 3 study of low-dose selinexor and lenalidomide (Len) versus len maintenance post autologous stem cell transplant (ASCT) for newly diagnosed multiple myeloma (NDMM): ALLG MM23, Sealand

TPS8055

Background: Len maintenance post ASCT is standard of care for patients (pts) with NDMM. Deep responses (CR or better) post ASCT correlates with better progression free survival (PFS). In a meta-analysis of len maintenance post ASCT (McCarthy PL et al. J Clin Oncol. 2017), only 10.7% of pts achieve CR post ASCT, and 72% of pts who discontinued len maintenance did so because of progressive disease (PD). Selinexor is a selective inhibitor of nuclear export that blocks exportin 1, thus retaining tumour suppressor proteins within the nucleus while blocking proto-oncoprotein translation. It is approved in combination with bortezomib and dexamethasone (dex) for pts with MM who have had at least 1 prior line of treatment, or with dex for pts with penta-refractory MM by the FDA. The oral bioavailability and weekly schedule of selinexor makes it suitable in combination with len for maintenance therapy. Given the encouraging activity (ORR 92%) and tolerability of selinexor, len and dex from the phase 1b/2 STOMP study, we hypothesise that combination low-dose selinexor and len (XR) will be well tolerated and effective, increasing CR and MRD negativity rate post ASCT, thus prolonging PFS compared to len. Methods: ALLG MM23 SeaLAND, is an ongoing randomised, multi-centre, phase 3 trial. Eligible pts ( > 17 years of age) have measurable disease, have undergone 3-6 cycles (C) of induction containing a proteasome inhibitor (PI) and/or immunomodulatory drug and recovered post melphalan-conditioned ASCT with adequate haematopoiesis, renal and liver function, and with ECOG performance status. Registration occurs prior to ASCT with screening between 75 to 115 days post ASCT. The study includes a lead-in safety phase of 20 patients with XR: Len 10mg daily days 1 to 21 and Selinexor 40mg weekly in a 28-day cycle. If well tolerated, Selinexor escalates to 60mg po weekly from C2 and Len to 15mg po daily from C4. Two safety reviews will occur after the 10th and 20th patients completes C2, respectively. Upon meeting safety criteria, a sample size of 290 pts will be randomised 1:1 to XR or lenalidomide (R). Therapy will continue until PD. The primary endpoint is PFS at 3 years post randomisation. Secondary endpoints include ORR and MRD-negativity rate (International Myeloma Working Group Response Criteria), PFS on next treatment line (PFS2), OS, safety and tolerability, quality of life, and cost effectiveness. Main analysis occurs after 232 patients complete 3-years of follow-up. Exploratory objective is to correlate immunological and molecular profiles to treatment response and resistance. ALLG MM23 SeaLAND is a multisite bi-national investigator-initiated trial lead by Australia and New Zealand’s national cooperative group, the Australasian Leukaemia & Lymphoma Group. Clinical trial registration: ACTRN12620000291987p. Clinical trial information: 12620000291987.

[Prevention and management of hardware and biological complications in implant dentistry]

Due to the highly predictable long-term clinical outcomes, modern implant dentistry has become one of the most preferred treatment modalities for restoring missing teeth. However, the complications of implant therapy compromise the long-term implant success and remain a great challenge to clinicians. Hardware complications include the mechanical complications which are related to the manufacturer-fabricated components of the prosthesis, such as abutment/screw loosening, fracture and implant fracture; and the technical complication which are related to laboratory-fabricated components of the prosthesis, such as veneer chipping. The biological complications mainly include peri-implant mucositis and peri-implantitis. It is crucial to figure out how to effectively avoid and manage the complications of implant therapy. This article reported the definitions, incidences, risk factors, prevention and treatment of both mechanical and biological complications of implant therapy.

A 14-year retrospective analysis of indications and outcomes of autologous haemopoietic stem cell transplantation in regional Queensland: a single-centre experience

BACKGROUND

The Townsville Hospital is a tertiary hospital in North Queensland with one of the largest regional transplant centres in Australia, performing primarily autologous haemopoietic stem cell transplants (HSCT) for various haematological malignancies.

AIMS

This single-centre, retrospective, observational study aims to describe the activity and outcomes of autologous HSCT at The Townsville Hospital between 2003 and 2017 to verify safety standards.

METHODS

Patient-level data were collected, including demographics, frequency and indication for transplant, conditioning, current clinical status and cause of death. Key outcomes included overall survival, non-relapse mortality, incidence of therapy-related neoplasm and causes of death. Progression-free survival in the multiple myeloma (MM) subgroup was also assessed.

RESULTS

There were 319 autologous HSCT in 286 patients, with a median age of 58 years (range 14-71 years); 62% of patients were male. Indications for transplantation were: MM 53.7%, non-Hodgkin lymphoma 29.4%, Hodgkin lymphoma 5.0% and other 11.9%. Causes of death were: disease progression/relapse (65.2%), second malignancy (17.0%), infection (9.8%) and other (8.0%). Non-relapse mortality was 1.2% (95% confidence interval 0.4-3.0) and 3.2% (1.7-5.7) at 100 days and 1 year, respectively, post-HSCT. Overall survival at 2 years was 81.0% (73.8-86.4) for MM and 69.6% (58.8-78.1) for non-Hodgkin lymphoma. The median progression-free survival in the MM cohort was 3.3 years.

CONCLUSION

The Townsville Hospital transplant centre provides an important transplant service in regional Queensland, with outcomes comparable to national data. We reported a relatively high rate of second malignancy as a cause of death.

Emerging Therapeutic Potential of Nanoparticles in Pancreatic Cancer: A Systematic Review of Clinical Trials

Pancreatic cancer is an aggressive disease with a five year survival rate of less than 5%, which is associated with late presentation. In recent years, research into nanomedicine and the use of nanoparticles as therapeutic agents for cancers has increased. This article describes the latest developments in the use of nanoparticles, and evaluates the risks and benefits of nanoparticles as an emerging therapy for pancreatic cancer. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses checklist was used. Studies were extracted by searching the Embase, MEDLINE, SCOPUS, Web of Science, and Cochrane Library databases from inception to 18 March 2016 with no language restrictions. Clinical trials involving the use of nanoparticles as a therapeutic or prognostic option in patients with pancreatic cancer were considered. Selected studies were evaluated using the Jadad score for randomised control trials and the Therapy CA Worksheet for intervention studies. Of the 210 articles found, 10 clinical trials including one randomised control trial and nine phase I/II clinical trials met the inclusion criteria and were analysed. These studies demonstrated that nanoparticles can be used in conjunction with chemotherapeutic agents increasing their efficacy whilst reducing their toxicity. Increased efficacy of treatment with nanoparticles may improve the clinical outcomes and quality of life in patients with pancreatic cancer, although the long-term side effects are yet to be defined. The study registration number is CRD42015020009.

Chemotherapy with low-dose bevacizumab and carboplatin in the treatment of a patient with recurrent cervical cancer

Management of patients with recurrent or advanced cervical cancer is a challenge. Concurrent chemotherapy has become the mainstay of treatment and platinum remains the most effective single agent. Combinations of other agents have not demonstrated significant advantages. The application of angiogenesis inhibitors such as bevacizumab, an antibody inhibiting vascular endothelial growth factor, in metastatic or advanced cervical cancer remains to be evaluated. We present the case of a patient with platinum-resistant recurrent cervical cancer treated with low-dose bevacizumab and carboplatin, with resultant improved disease progression and tolerable toxicity profiles.

Passively Q-switched Yb3+:YCa4O(BO3)3 laser with InGaAs quantum wells as saturable absorbers

A diode-pumped Yb:YCOB laser at 1086 nm is passively Q switched by using InGaAs quantum wells as saturable absorbers and utilizing the Bragg mirror structure as an output coupler. With an absorbed pump power of 9.2 W the laser produces pulses of 100 ms duration with average pulse energy of as much as 165 microJ at a pulse repetition rate of 7 kHz.

InGaAs quantum-well saturable absorbers for a diode-pumped passively Q-switched Nd:YAG laser at 1123 nm

A low-loss semiconductor saturable absorber based on InGaAs quantum wells was developed for highly efficient Q switching of a diode-pumped Nd:YAG laser operating at 1123 nm. With an incident pump power of 16 W, an average output power of 3.1 W with a Q-switched pulse width of 77 ns at a pulse repetition rate of 100 kHz was obtained.

Accuracy of various iron parameters in the prediction of iron deficiency in an acute care hospital

INTRODUCTION

Iron parameters like serum ferritin and iron saturation are routinely used in diagnosing iron deficiency. However, these tests are influenced by many factors. We aimed to review the accuracy of iron parameters among inpatients in an acute care hospital.

MATERIALS AND METHODS

From October 1997 to April 2002, bone marrow aspirate samples from patients on whom concurrent iron studies had been done were analysed. Accuracy of the various iron parameters was analysed using receiver operating characteristic curves.

RESULTS

Among 92 bone marrow aspirate samples, 58, 86 and 83 had a concurrent serum ferritin, serum iron and percentage iron saturation done respectively. Serum ferritin is the best marker for predicting the presence of iron deficiency. This is followed by percentage iron saturation and lastly by serum iron. At the most optimal, a serum ferritin of <60 ng/mL has a positive likelihood ratio of 24.35, sensitivity of 69.6%, specificity of 97.1% and positive predictive value of 94.1%. An iron saturation of <7% has a positive likelihood ratio of 21.62, sensitivity of 44.1%, specificity of 98.0% and positive predictive value of 93.8%. Seven out of 50 samples, which had concurrent measurements of iron saturation and serum ferritin, were discordant in indicating the presence of iron deficiency. In 6 cases, the iron saturation was the spurious result.

CONCLUSION

A serum ferritin of <60 ng/mL or a percentage iron saturation of <7% is highly predictive of iron deficiency among inpatients in an acute care hospital.

Haematological parameters in severe acute respiratory syndrome

Clinical presentation of severe acute respiratory syndrome (SARS) is non‐specific and isolation of all suspected patients is difficult because of the limited availability of isolation facilities. We studied changes in haematological parameters in SARS patients using median values analysed according to the day of symptom onset. White cell (WCC), absolute neutrophil, absolute lymphocyte (ALC) and platelet counts followed a v‐shaped trend with the nadir at day 6 or 7 after symptom onset except for ALC in the ICU group that had not reached the nadir by day 12. None of our patients had a platelet count < 80 × 10⁹/l and WCC < 2 × 10⁹/l in the first 5 days of symptoms and these parameters may allow early stratification of febrile patients into likely and unlikely SARS cases to allow effective utilization of isolation facilities. On multivariate analysis, age is the only independent predictor for ICU admission.

InAs/GaAs quantum-dot saturable absorber for a diode-pumped passively mode-locked Nd:YVO4 laser at 1342 nm

We report that InAs/GaAs quantum dots were developed to be saturable absorbers as well as output couplers in diode-pumped passively mode-locked Nd:YVO4 lasers at 1342 nm. With an incident pump power of 12.6 W, an average output power of 0.85 W with a mode-locked pulse width of 26 ps at a repetition rate of 152 MHz was obtained.

InAs/GaAs quantum-dot saturable absorbers for diode-pumped passively Q-switched Nd-doped 1.3-microm lasers

A low-loss semiconductor saturable absorber based on InAs/GaAs quantum dots was developed for Q switching of a diode-pumped Nd-doped laser operating at 1.3 microm. With an InAs/GaAs quantum-dot saturable absorber, a diode-pumped Nd:YVO4 laser at 1342 nm was achieved. With an incident pump power of 2.2 W, an average output power of 360 mW with a Q-switched pulse width of 90 ns at a pulse repetition rate of 770 kHz was obtained.

Identifying the combination of genetic factors that determine susceptibility to cervical cancer

Cervical cancer is common among women all over the world. Although infection with high-risk types of human papillomavirus (HPV) has been identified as the primary cause of cervical cancer, only some of those infected go on to develop cervical cancer. Obviously, the progression from HPV infection to cancer involves other environmental and host factors. Recent population-based twin and family studies have demonstrated the importance of the hereditary component of cervical cancer, associated with genetic susceptibility. Consequently, single-nucleotide polymorphism (SNP) markers and microsatellites should be considered genetic factors for determining what combinations of genetic factors are involved in precancerous changes to cervical cancer. This study employs a Bayesian network and four different decision tree algorithms, and compares the performance of these learning algorithms. The results of this study raise the possibility of investigations that could identify combinations of genetic factors, such as SNPs and microsatellites, that influence the risk associated with common complex multifactorial diseases, such as cervical cancer.

Rules of selection for spontaneous coherent states in mesoscopic systems: using the microcavity laser as an analog study

The selection rules for spontaneous coherent waves in mesoscopic systems are experimentally studied using the transverse patterns of a microcavity laser and theoretically analyzed using the theory of SU(2) coherent states. Comparison of the experimental results with the theoretical analyses reveals that an amplitude factor A should be included in the representation of the partially coherent states. The determination of the amplitude factor A is found to be associated with the constraint of minimum energy uncertainty.

Observation of vector vortex lattices in polarization states of an isotropic microcavity laser

We experimentally investigate the formation of a vector polarization pattern from an isotropic microcavity laser. It is found that the orthogonal components of the observed pattern are localized on the geometrical rays. The connection between eigenfunctions and geometrical rays is analytically constructed by using the SU(2) coherent states. With the analytical function form, the observed vector pattern is completely reconstructed and the vector vortex lattice is apparent.

Observation of the wave function of a quantum billiard from the transverse patterns of vertical cavity surface emitting lasers

We demonstrate experimentally that the near-field and far-field transverse patterns of a large aperture vertical cavity surface emitting laser (VCSEL) can be successfully interpreted as a two-dimensional (2D) billiard system. It is found that the near-field and far-field transverse patterns of a large aperture VCSEL evidently represent the coordinate-space and momentum-space wave functions of a 2D quantum billiard, respectively. The result of this paper suggests that large aperture VCSELs are potentially appropriate physical systems for the wave-function study in quantum problems.

Efficient identification of amino acid types for fast protein backbone assignments

We describe a procedure that allows for very efficient identification of amino acid types in proteins by selective 15N-labeling. The usefulness of selective incorporation of 15N-labeled amino acids into proteins for the backbone assignment has been recognized for several years. However, widespread use of this method has been hindered by the need to purify each selectively labeled sample and by the relatively high cost of labeling with 15N-labeled amino acids. Here we demonstrate that purification of the selectively 15N-labeled samples is not necessary and that background-free HSQC spectra containing only the peaks of the overexpressed heterologous protein can be obtained in crude lysates from as little as 100 ml cultures, thus saving time and money. This method can be used for fast and automated backbone assignment of proteins.

The significance of human papillomavirus viral load in prediction of histologic severity and size of squamous intraepithelial lesions of uterine cervix

OBJECTIVES

Persistence of high-risk types of human papillomavirus (HPV) in cervical scrapes is responsible for the development, maintenance, and progression of squamous intraepithelial lesions (SILs). Previous studies of viral load and histologic severity have ended with controversial results. This study evaluated the relationships of HPV viral load with size and histologic severity of cervical lesions, which has not been reported previously.

METHODS

By using Hybrid Capture II, DNA level of high-risk HPVs was determined in cervical scrapes and correlated with lesion size and histologic confirmation for 73 women referred for colposcopy. The lesion size was classified as nonvisible (n = 12), small (< or =2/5 of the 12x colposcopic visual filed, n = 36), and large (>2/5 of the 12x field, n = 25) lesions. The final disease status was categorized as high-grade SIL (HSIL)/squamous cell carcinoma (SCC) (designated HSIL+) (n = 32), low-grade SIL (LSIL) (n = 19), and no detectable SIL (n = 22).

RESULTS

A distinct upward trend of high-risk HPV DNA levels paralleled increasing size and histologic severity of cervical lesions (P = 0.003 and 0.001, respectively). With respect to relative risk, women who had high viral load of HPV were at significantly greater risk for large lesion size (odds ratio [OR] = 5.3, 95% confidence interval [CI] = 1.1-24.9) and HSIL+ (OR = 35.0, 95% CI = 4.2-294.5). Of particular note, the risk of developing large lesion size and HSIL+ significantly increased with increasing viral load of HPV (P values for trend test were 0.008 and 0.0004, respectively). In contrast, there were no significant associations of trend in viral load with risk in small lesion size and LSIL.

CONCLUSIONS

The present study revealed that the effect of HPV infection on SIL development is highly influenced by high viral load and highlighted a potential application of viral load testing in predicting the size and severity of lesions of the uterine cervix.

A reevaluation and discussion on the threshold limit for hemolysis in a turbulent shear flow

One major factor of red blood cell damage induced by artificial heart valves is the magnitude of turbulent shear stresses in the flow field. An often-cited threshold for hemolysis is 400 N/m(2) (Sallam and Hwang, Biorheology 21 (1984) 783). This value, however, was measured with a one-component laser Doppler anemometer and was not calculated from the major principal Reynolds shear stress, therefore underestimating the threshold. This study performed flow field measurements under similar conditions, using a two-component laser Doppler anemometer and determining major principal Reynolds shear stress, to reevaluate the hemolytic threshold as 800 N/m(2) with an exposure time of 1 ms. The Kolmogorov length scales, approximately 9 microm, are capable of inflicting direct damage to the red blood cells. These results will serve as a more accurate reference in future heart valve design and testing.

Association study of apolipoprotein E epsilon4 with clinical phenotype and clozapine response in schizophrenia

Schizophrenic patients with the apolipoprotein E (APOE = gene; apoE = protein) epsilon4 allele exhibited lower psychosis scores than patients without the epsilon4 allele in previous reports. The present study tested the hypothesis that the APOE epsilon4 allele confers association with the clinical manifestations of schizophrenia or clozapine response. A total of 95 schizophrenic patients who were treatment resistant were included in the study. The results demonstrated that the presence of the APOE epsilon4 allele did not influence the response to clozapine in schizophrenic patients, neither was the baseline psychopathology related to the APOE epsilon4 allele. Given the multiple functions of the apoE protein in the brain, further study of the influence of APOE on CNS medication response is needed.

The role of RsmA in the regulation of swarming motility in Serratia marcescens

Swarming motility is a multicellular phenomenon comprising population migration across surfaces by specially differentiated cells. In Serratia marcescens, a network exists in which the flhDC flagellar regulatory master operon, temperature, nutrient status, and quorum sensing all contribute to the regulation of swarming motility. In this study, the rsmA (repressor of secondary metabolites) gene (hereafter rsmA(Sm)) was cloned from S. marcescens. The presence of multicopy, plasmid-encoded rsmA(Sm) expressed from its native promoter in S. marcescens inhibits swarming. Synthesis of N-acylhomoserine lactones, presumably by the product of smaI (a luxI homolog isolated from S. marcescens), was also inhibited. Knockout of rsmA(Sm) on the S. marcescens chromosome shortens the time before swarming motility begins after inoculation to an agar surface. A single copy of the chromosomal PrsmA(Sm)::luxAB reporter of rsmA(Sm) transcription was constructed. Using this reporter, the roles of the flhDC flagellar regulatory master operon, temperature and autoregulation in the control of rsmA(Sm) expression were determined. Our findings indicate that RsmA(Sm) is a component of the complex regulatory network that controls swarming.

Early diagnosis of cystic fibrosis through neonatal screening prevents severe malnutrition and improves long-term growth. Wisconsin Cystic Fibrosis Neonatal Screening Study Group

OBJECTIVE

Despite its relative frequency among autosomal recessive diseases and the availability of the sweat test, cystic fibrosis (CF) has been difficult to diagnose in early childhood, and delays can lead to severe malnutrition, lung disease, or even death. The Wisconsin CF Neonatal Screening Project was designed as a randomized clinical trial to assess the benefits and risks of early diagnosis through screening. In addition, the incidence of CF was determined, and the validity of our randomization method assessed by comparing 16 demographic variables.

METHODOLOGY

Immunoreactive trypsinogen analysis was applied to dried newborn blood specimens for recognition of CF risk from 1985 to 1991 and was coupled to DNA-based detection of the DeltaF508 mutation from 1991 to 1994. Randomization of 650 341 newborns occurred when their blood specimens reached the Wisconsin screening laboratory. This created 2 groups-an early diagnosis, screened cohort and a standard diagnosis or control group. To avoid selection bias, we devised a unique unblinding method with a surveillance program to completely identify the control subjects. Because sequential analysis of nutritional outcome measures revealed significantly better growth in screened patients during 1996, we accelerated the unblinding and completely identified the control group by April 1998. Having each member of this cohort enrolled and evaluated for at least 1 year and having completed a comprehensive surveillance program, we performed another statistical analysis of anthropometric evaluated indices that includes all CF patients without meconium ileus.

RESULTS

The incidence of classical CF, ie, patients diagnosed in this trial with a sweat chloride of 60 mEq/L greater, was 1:4189. By incorporating other CF patients born during the randomization period, including 2 autopsy diagnosed patients and 8 probable patients, we calculate a maximum incidence of 1:3938 (95% confidence interval: 3402-4611). Although there were group differences in the proportion of patients with DeltaF508 genotypes and with pancreatic insufficiency, validity of the randomization plan was demonstrated by analyzing 16 demographic variables and finding no significant difference after adjustment for multiple comparisons. Focusing on patients without meconium ileus, we found a marked difference in the mean +/- standard deviation age of diagnosis for screened patients (13 +/- 37 weeks), compared with the standard diagnosis group (100 +/- 117). Anthropometric indices of nutritional status were significantly higher at diagnosis in the screened group, including length/height, weight, and head circumference. During 13 years of study, despite similar nutritional therapy and the inherently better pancreatic status of the control group, analysis of nutritional outcomes revealed significantly greater growth associated with early diagnosis. Most impressively, the screened group had a much lower proportion of patients with weight and height data below the 10th percentile throughout childhood.

CONCLUSIONS

Although the screened group had a higher proportion of patients with pancreatic insufficiency, their growth indices were significantly better than those of the control group during the 13-year follow-up evaluation and, therefore, this randomized clinical trial of early CF diagnosis must be interpreted as unequivocally positive. Our conclusions did not change when the height and weight data before 4 years of age for the controls detected by unblinding were included in the analysis. Also, comparison of growth outcomes after 4 years of age in all subjects showed persistence of the significant differences. Therefore, selection bias has been eliminated as a potential explanation. In addition, the results show that severe malnutrition persists after delayed diagnosis of CF and that catch-up may not be possible. We conclude that early diagnosis of CF through neonatal screening combined with aggressive nutritional therapy can result

Role of flhDC in the expression of the nuclease gene nucA, cell division and flagellar synthesis in Serratia marcescens

We investigated in Serratia marcescens the functions of the flhDC operon, which controls motility and cell division in enteric bacteria. Included in our evaluations were investigation of cell division, flagellar synthesis and regulation of the expression of nuclease (encoded by the nucA(Sm) gene, one of the virulence factors). Interruption of the chromosomal flhDC operon in S. marcescens CH-1 resulted in aberrant cell division and loss of nuclease and flagella. Expression of nucA(Sm) and other mutated phenotypes was restored in the flhDC mutant by the induction of overexpression of flhDC in a multicopy plasmid. Multicopied flhDC also induced the formation of differentiated cells (polyploid aseptate cells with oversynthesis of peritrichous flagella) in broth culture using minimal growth medium. Expression of the flhDC operon showed positive autoregulation, and was growth phase dependent (upregulated in early log phase). In addition, flhDC expression was inhibited when the temperature increased from 30 to 37 degrees C, and when osmolarity was increased, but was not influenced by glucose catabolite repression. These results show that FlhD/FlhC is a multifunctional transcriptional activator involved in the process of cell differentiation, swarming and virulence factor expression.

Association study of a functional serotonin transporter gene polymorphism with schizophrenia, psychopathology and clozapine response

Serotonin is implicated in the pathogenesis of schizophrenia. Following serotonin release, the serotonin transporter (5-HTT) is the major determinant of serotonin inactivation. The present study tested the hypothesis that a biallelic polymorphism in the 5' regulatory region of the 5-HTT gene (5-HTTLPR) confers susceptibility to schizophrenia, association with the clinical manifestations of schizophrenia or clozapine response. 90 treatment-resistant schizophrenic patients were assessed using the Brief Psychiatric Rating Scale before and after clozapine treatment. The results demonstrated that the 5-HTTLPR variants did not play a major role in the susceptibility, clinical manifestations or clozapine response in schizophrenia.

Apolipoprotein E genotype and schizophrenia

Schizophrenic disorders are complex genetic disorders and may involve multiple genes of small effect. The presence of apolipoprotein E (apoE) is associated with several neuropsychiatric disorders. Previous studies on apoE genotype distribution in schizophrenia have reported conflicting findings. We studied the genotype frequencies in a large group of schizophrenic patients. The genotype distribution was significantly different between the schizophrenic patients and the control subjects. Persons who were sigma3 carriers have an increased risk of schizophrenia. This result suggests that apoE isoforms may play a functional role in the pathogenesis of schizophrenic disorders. Some possible mechanisms regarding the effect of apoE on the development of schizophrenia are discussed.

Risk of persistent growth impairment after alternate-day prednisone treatment in children with cystic fibrosis

BACKGROUND

It is uncertain whether the growth impairment that occurs in children during long-term treatment with glucocorticoids persists after the medication is discontinued and ultimately affects adult height.

METHODS

We evaluated growth six to seven years after alternate-day treatment with prednisone had been discontinued in 224 children 6 to 14 years of age with cystic fibrosis who had participated in a multicenter trial of this therapy from 1986 through 1991. Of the children, 151 had been randomly assigned to receive prednisone (either 1 or 2 mg per kilogram of body weight) and 73 to receive placebo. We obtained data on growth up to 1997 from the Cystic Fibrosis Foundation Patient Registry and standardized the data to sex- and age-specific norms from the National Center for Health Statistics. We used z scores to compare growth patterns among treatment groups.

RESULTS

In 1997, 68 percent of the patients were 18 years of age or older. The z scores for height declined during prednisone therapy; catch-up growth began two years after treatment with prednisone was discontinued. Among the boys, the z scores for height in those treated with prednisone remained lower than the scores for those who received placebo (P=0.02). The mean heights for boys 18 years of age or older were 4 cm less in the prednisone groups than in the placebo group, an equivalent of 13 percentile points (P=0.03). Among the girls, differences in height between those who were treated with prednisone and those who received placebo were no longer present two to three years after prednisone therapy was discontinued.

CONCLUSIONS

Among children with cystic fibrosis who have received alternate-day treatment with prednisone, boys, but not girls, have persistent growth impairment after treatment is discontinued.

Nutritional status of patients with cystic fibrosis with meconium ileus: a comparison with patients without meconium ileus and diagnosed early through neonatal screening

OBJECTIVE

This study was pursued as an extension of a randomized clinical investigation of neonatal screening for cystic fibrosis (CF). The objective was to determine if CF patients with meconium ileus (MI) were more likely to be malnourished compared with those without MI who were diagnosed during early infancy through neonatal screening.

METHODOLOGY

Nutritional status was evaluated from early infancy to 13 years of age based on anthropometric, biochemical, and dietary assessments.

RESULTS

MI patients (n = 32) were smaller at birth (3117 g compared with 3413 g) and were shorter (22nd percentile compared with 48th percentile) and thinner (24th percentile compared with 49th percentile) compared with non-MI early diagnosed patients (n = 50) up to 13 years of age. Poor growth was particularly evident in 26 MI patients who required surgery for MI (height and weight at the 20th percentile), whereas those treated without surgery (n = 6) showed better height (45th percentile) and weight (37th percentile). Abnormal essential fatty acid profiles were significantly more prevalent in MI compared with non-MI early-diagnosed patients before 3 years of age. Daily intakes of calorie (130% compared with 111% recommended dietary allowances) and protein (339% compared with 279% recommended dietary allowances) were higher but the percentage of fat (37% compared with 38%) and linoleic acid (4.5% compared with 4.7%) in the diet were similar between the two groups.

CONCLUSIONS

These results demonstrated a clear association of MI with malnutrition in CF. The observed poor growth among our MI patients was not because of poor dietary intakes, but was related to surgical treatment for MI and poor essential fatty acid status. These findings present new challenges regarding the optimal medical treatment and nutritional intervention for CF patients with MI.

Favorable clinical outcome of cervical cancers infected with human papilloma virus type 58 and related types

To determine whether the status of human-papillomavirus (HPV) infection affects the clinical outcome of cervical carcinoma (CC), HPV genotype was prospectively determined in 94 consecutive CC cases subsequently followed for a median duration of 37.5 months. With a consensus PCR-RFLP method of HPV genotyping, 81 (86.2%) cancers were positive for HPV DNA. They were classified, according to the phylogenic similarities, into HPV-16-related (type 16, n = 45; type 31, n = 2), HPV-58-related (type 58, n = 17; type 33, n = 3; type 52, n = 2) and HPV-18-related (type 18, n = 8; type 68, n = 1) groups, and analyzed in relation to clinical outcome. The following results were observed: (i) Type-58-related HPVs were more prevalent in the old age (older than the median age of 52) group than in the young age group (41% vs. 14.6%, p = 0.045); (ii) 63% (5/8) of patients with advanced stages (III and IV) were HPV-negative, a figure much higher than that (9.3%, 8/84) of patients with early stages (stage I and II) (p = 0.002); (iii) the occurrence of adenocarcinoma or adenosquamous carcinoma was higher in the HPV-18-related group (50%) than in the HPV-16-related (33.3%) or the HPV-58-related (16.7%) groups (p = 0.024); (iv) the status of lymph-node metastasis and tumor grade did not correlate with HPV status; (v) 5-year survival rates were 90.2%, 80% and 74% for HPV-58-, HPV-16- and HPV-18-related groups, respectively (p = 0.03, after adjustment for tumor stage); (vi) in comparison with the HPV-16-related group, the relative risk of death in the HPV-58- and the HPV-18-related groups were 0.32 [95% CI, 0.07-1.49] and 1.87 [0.36-14.9] respectively. HPV genotype appears to affect the clinical behavior and outcome of cervical cancer. HPV-58-related types are prevalent in the older population, and appear to confer a favorable prognosis. Int. J. Cancer (Pred. Oncol.) 84:553-557, 1999.

Association analysis of the 5-HT(6) receptor polymorphism (C267T) in mood disorders

The serotonergic system is implicated in the etiology of mood disorders. Among those most recently discovered serotonin receptors, the relative abundance of serotonin type 6 receptor (5-HT(6)) in the limbic area and the high affinity of some antidepressants to 5-HT(6) receptors suggest that this receptor might be involved in the pathogenesis of mood disorders. In a population-based association study, we tested the hypothesis that the allelic variant (C267T) of the human 5-HT(6) gene confers susceptibility to mood disorders. We genotyped the 5-HT(6) receptor in 139 patients with mood disorders and 147 controls. The results demonstrated that there were no significant differences in genotype or allele frequencies between controls and all patients, or between controls and patients with bipolar disorders or major depression, separately. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:601-602, 1999.

Serotonin-2A receptor polymorphism (102T/C) in mood disorders

Serotonergic dysfunction has been implicated in mood disorders and suicidal behaviors. This study examined the association between a serotonin-2A (5HT2A) receptor gene polymorphism (102T/C) and mood disorders. The genotype and allele frequencies did not differ between patients with mood disorders and control subjects. Furthermore, the 102T/C polymorphism was not found to be associated with suicidal history in mood disorder patients. Our results suggest that this polymorphism is unlikely to play a role in the genetic susceptibility to mood disorders.

No association between an intronic presenilin-1 gene polymorphism and schizophrenia in a Chinese population

We investigated the association between schizophrenic psychosis and an intronic polymorphism of the presenilin-1 (PS1) gene in a Chinese population. Schizophrenic and control groups had similar PS1 genotype distributions and allele frequencies, indicating that this polymorphism may not be involved in the development of schizophrenia.

Alpha-1-antichymotrypsin polymorphism in schizophrenia: frequency, age at onset and cognitive function

A common polymorphism in the alpha1-antichymotrypsin (ACT) gene is associated with Alzheimer's disease. ACT is also a trophic factor in the hippocampal neurons. In order to examine if the ACT gene plays a role in the pathogenesis of schizophrenic disorders, patients (n = 175) and control subjects (n = 114) were genotyped for ACT. We also investigated the relationship between genotypes and patients' cognitive function as evaluated by the Clinical Dementia Rating Scale and the Mini-Mental State Examination. The results demonstrated no association between schizophrenia and/or cognitive deficit in schizophrenia and ACT polymorphism. The data suggest that the ACT gene is not of major importance for the genesis of schizophrenia. Further studies measuring ACT expression as messenger RNA or serum ACT level may help to exclude the role of ACT in the pathogenesis of schizophrenia.

The treatment of Pseudomonas keratoscleritis after pterygium excision

PURPOSE

To assess the effect of intensive topical and intravenous antibiotics plus oral prednisolone and surgical debridement in Pseudomonas keratoscleritis after pterygium excision.

METHODS

We describe three cases of P. aeruginosa-induced keratoscleritis occurring 10 days to 18 months after uncomplicated pterygium excision. Treatment included early conjunctival debridement, topical and intravenous antibiotics, and low-dosage oral prednisolone.

RESULTS

All three patients responded to the combined therapy. Microorganisms were eliminated, and ulcers were healed within 8 weeks. Treatment was not extended beyond that, and infection did not recur. No evisceration was required. The patients' best corrected visual acuities are 20/200, 20/400, and 20/120, respectively.

CONCLUSION

Early diagnosis and prompt, intensive medical and surgical treatment may save a patient's vision and forestall evisceration.

Fetal Doppler hemodynamic changes in spontaneous versus prostaglandin E1-induced active labor

BACKGROUND

To assess fetal hemodynamic changes before and during active labor, either spontaneous or prostaglandin E1 (PGE1)-induced labor.

MATERIALS AND METHODS

This is a prospective longitudinal study and a cohort of 49 healthy women at 37-41+ weeks gestation without signs of fetal distress was investigated until in labor. One group of 23 healthy women had spontaneous active labor, the second group of 26 women was in active labor induced by an intra-cervical administration of PGE1 for elective induction. Blood flow waveform indices (S/D ratio, RI, PI) were assessed by pulsed Doppler ultrasonography from the umbilical artery (UA) and fetal middle cerebral artery (MCA) before and in labor. Both groups were compared for the waveform indices and perinatal outcome including duration of labor, meconium stain, baby sex, birthweight, UA blood gas measurements at delivery, Apgar's scores, prolonged nursery stay (> or =5 days), and NICU admission.

RESULTS

Demographic data of the two groups were comparable. During spontaneous active labor, the S/D ratio and RI became significantly decreased in the UA (p<0.05) and the three wave-form indices were decreased more in the MCA (p<0.01, 0.005, 0.05, respectively) compared with those measured before labor. During PGE1-induced active labor, all the waveform indices were not significantly decreased in either the UA or the MCA. The occurrence of abnormal UA blood gas values was significantly more in the PGE1-induced group than in the spontaneous labor group (23.1% v.s. 4.3%; p<0.05). No other adverse perinatal outcomes were observed in either group.

CONCLUSIONS

Decreasing impedance in both the UA and MCA during spontaneous labor is a physiological fetal adaptation to labor to prevent fetal cerebral hypoxia by maintaining adequate brain blood flow during normal parturition. This fetal adaptation phenomenon was not observed in the group of PGE1-induced labor with the result of a high incidence of abnormal UA blood gas values.

Comparison of growth status of patients with cystic fibrosis between the United States and Canada

BACKGROUND

Differences in growth status of patients with cystic fibrosis (CF) between the United States and Canada were reported in the 1980s based on analysis of data from 2 regional CF centers.

OBJECTIVE

We evaluated the current growth status of the entire CF population in the United States and Canada in view of recent advances in the treatment of CF.

DESIGN

Growth data from the 1992-1994 CF Patient Registries were analyzed.

RESULTS

Mean height and weight were at approximately the 30th percentile for children with CF in the United States. Mean height and weight were 4-5 percentiles higher in children with CF in Canada than in those in the United States (P < 0.01), but percentages of ideal weight (104%) were similar in both populations. In adults with CF, mean height was similar at the 37th percentile; however, weight (26th compared with the 21st percentiles) and percentage of ideal weight (93% compared with 90%) were significantly higher in Canada than in the United States. Differences related to sex and age were similar in both countries for all indexes, which showed a high prevalence of underweight in infants and in older patients, but little sex discrepancy.

CONCLUSION

We observed substantially smaller differences in the growth indexes of CF patients between the United States and Canada compared with results from the 1980s. These findings reflect significant improvements in the nutritional status of US patients in recent years. However, caution is required in the direct comparison of mean percentiles from reports using different growth standards because there are systematic differences in growth standards, which affect, in particular, the comparison of growth in males and females.

Gastric digestion modifies absorption of butterfat into lymph chylomicrons in rats

Our objective was to characterize the time course of mesenteric lymph output, lipid composition and size of lymph chylomicrons in rats given gastric infusion of lipid emulsions containing defined fractions of butterfat, palm oil or corn oil. The concentrations of cholesterol, triacylglycerol (TAG) and phospholipid in lymph obtained before lipid infusion were 1.4-2.5-fold greater in rats chronically fed palm oil or solid butterfat compared with corn oil or liquid butterfat (P = 0.02). Total lymph chylomicron TAG output (mg/24 h) stimulated by gastric lipid infusion was 21% greater with corn oil compared with all saturated fats (P = 0.02). Total lymph chylomicron cholesterol output was 1.3-8.6-fold greater than the amount infused in all groups (P = 0.03) and was independent of the amount of cholesterol infused. The size distribution as well as the mean, median and modal diameters of lymph chylomicrons isolated during peak lymphatic TAG output were not significantly different among treatments. The fatty acid and TAG profiles of lymph chylomicrons obtained from rats infused with corn or palm oil did not differ significantly from that of the emulsion infused. In contrast, gastric lipolysis of butterfat significantly modified the lipid composition of lymph chylomicrons. We observed progressive disappearance of short- and medium-chain fatty acids in gastric contents and an absence of detectable short-chain fatty acids with concurrent proportionate increases in long-chain fatty acids and large TAG molecules in lymph chylomicrons compared with butterfat emulsions. These studies demonstrate that gastric digestion is an important modifier of lipid absorption.

Use of fluorescein labelled antibody and fluorescence activated cell sorter for rapid identification of Mycobacterium species

A fluorescein labelled antibody (Ab)/Fluorescence Activated Cell Sorter (FACS)-based assay was developed for detection of a wide range of mycobacterial species directly from bacterial culture and sputum specimens. The whole process could be completed within 3 hours and had a high specificity and sensitivity for cultured bacteria. The method was also shown to be applicable for direct identification from clinical specimens. This study showed that pretesting of clinical specimens for mycobacteria to the genus level with an antibody to Mycobacterium species offers the routine clinical laboratory a single convenient test for the detection of tuberculous and nontuberculous mycobacteria. Depending on the availability of species-specific antibody, the identification of Mycobacterium to the species level can be achieved.

Transition time to full nipple feeding for premature infants with a history of lung disease

OBJECTIVE

To (a) explore the contribution of infant, environmental, and historical factors to the number of days from initiation to achievement of full nipple feeding (transition time) for premature infants with a history of lung disease; (b) examine differences in the contribution of infant and environmental factors to transition time made by historical era, either earlier (in the 1980s) or later (in the 1990s); and (c) compare, within eras, the contribution to transition time of infant and environmental factors for infants with each lung diagnosis, respiratory distress syndrome (RDS) without bronchopulmonary dysplasia (BPD) or BPD.

DESIGN

Data were collected at two midwestern hospitals from the records of premature infants with a diagnosis of either RDS without BPD or BPD. The influence on transition time of infant, environmental and historical factors was assessed with the Cox proportional hazards model. This analytic model, a form of regression analysis, also was used to explore how era influenced the contribution to transition time of infant and environmental factors. Finally, the contribution to transition time of infant and environmental factors was examined within diagnostic group for each era.

SAMPLE

The hospital records audited were for infants who were 32 weeks gestational age or less with weight appropriate for gestational age. The number in each diagnostic group for each era was (a) BPD--Early, n = 35; (b) RDS--Early, n = 21; (c) BPD--Late, n = 21; and (d) RDS--Late, n = 15).

RESULTS

All three types of factors (infant, environmental, and historical) contributed significantly (p < .05) to shortening or lengthening transition time. A diagnosis of BPD lengthened transition time only in the early era. Across both eras, the number of days on tube feedings significantly lengthened transition time, and the older the infant in postconceptional age (PCA) at initiation of nipple feeding, the shorter the transition time.

CONCLUSION

The contribution of infant, environmental, and historical factors to transition time confirmed the basic structure of the theoretical model of transition time for premature infants with a history of lung disease. The influence of era on the contributions to transition time of infant and environmental factors suggests that care policy and practice have shortened the transition time. Although the current findings support the basic structure of the theoretical model for infants with either RDS or BPD, the marginally significant (p < .10) shortening effect of PCA on transition time for infants with BPD in both eras suggests that advancement to full nipple feeding may be limited by neurodevelopmental capacities, including respiratory control. How these capacities can be supported for advancement to full nipple feeding is a challenge for nursing practice and research.

Growth status in children with cystic fibrosis based on the National Cystic Fibrosis Patient Registry data: evaluation of various criteria used to identify malnutrition

OBJECTIVES

The objectives of this study were to determine growth status and to identify malnutrition with various anthropometric indicators in children with cystic fibrosis (CF) based on cross-sectional analysis of the 1993 National CF Patient Registry data.

METHODS

Heights and weights of 13,116 children with CF were evaluated with percentile, percent of reference median, Z-score, and percent ideal weight-for-height based on National Center for Health Statistics/Centers for Disease Control growth references. Malnutrition was defined by four criteria: (1) height-for-age <5th percentile ("stunting") or weight-for-age <5th percentile ("wasting") (2) height-for-age <90% of reference median or weight-for-age <80% of reference median, (3) height-for-age <5th percentile or percent ideal weight-for-height <85%, and (4) height-for-age <90% of reference median or weight-for-height <85% of reference median.

RESULTS

Mean and median height- and weight-for-age were found to be at the 30th and 20th percentiles in children with CF. Malnutrition (height- or weight-for-age <5th percentile) was particularly pronounced in infants (47%) and adolescents (34%) and patients with newly diagnosed CF (44%). A significant sex difference (p < 0.01) in the occurrence of stunting (height-for-age <5th percentile) was observed during adolescence: boys 11 to 14 years of age showed lower occurrence of stunting (19%) compared with girls (29%), whereas the opposite trend was observed at 15 to 18 years (34% in male patients vs 28% in female patients).

CONCLUSION

Twenty percent of all children in the 1993 National CF Patient Registry were <5th percentile for height- or weight-for-age. A significant discrepancy was found when different criteria were used to distinguish "stunting" versus "wasting" in malnourished children with CF.

Population cell differentiation of Serratia marcescens on agar surface and in broth culture

The bacterium Serratia marcescens shows population surface migration (swarming) phenomenum on an LB swarming plate, and differentiated cells can be observed at the swarming front. How the cell population differentiates during swarming on the agar surface is not known, neither is it clear whether cells with differentiated characteristics can be observed in broth culture. To monitor the population cell differentiation in a highly sensitive way without cell destruction, experiments were designed using bacterial luciferase genes luxAB as the reporter genes to allow direct monitoring of the differentiating cells through bioluminescence. An isogenic S. marcescens strain was constructed with luxAB under the control of the promoter of flagellin gene hag (phag::luxAB). Patterns of cell differentiation were monitored either by direct X-ray film exposure and/or by Autolumat luminometer detection. Results show that population cell differentiation on the agar surface occurs first in a temporal and then spatial way during colonial growth. It was also found that cells harvested from both the spreading agar plate and broth culture showed differentiation patterns similar to those from swarming cells, suggesting that the agar surface culture may not be essential for the formation of differentiated cells.