Genome skimming elucidates the evolutionary history of Octopoda

Phylogenies for Octopoda have, until now, been based on morphological characters or a few genes. Here we provide the complete mitogenomes and the nuclear 18S and 28S ribosomal genes of twenty Octopoda specimens, comprising 18 species of Cirrata and Incirrata, representing 13 genera and all five putative families of Cirrata (Cirroctopodidae, Cirroteuthidae, Grimpoteuthidae, Opisthoteuthidae and Stauroteuthidae) and six families of Incirrata (Amphitretidae, Argonautidae, Bathypolypodidae, Eledonidae, Enteroctopodidae, and Megaleledonidae) which were assembled using genome skimming. Phylogenetic trees were built using Maximum Likelihood and Bayesian Inference with several alignment matrices. All mitochondrial genomes had the 'typical' genome composition and gene order previously reported for octopodiforms, except Bathypolypus ergasticus, which appears to lack ND5, two tRNA genes that flank ND5 and two other tRNA genes. Argonautoidea was revealed as sister to Octopodidae by the mitochondrial protein-coding gene dataset, however, it was recovered as sister to all other incirrate octopods with strong support in an analysis using nuclear rRNA genes. Within Cirrata, our study supports two existing classifications suggesting neither is likely in conflict with the true evolutionary history of the suborder. Genome skimming is useful in the analysis of phylogenetic relationships within Octopoda; inclusion of both mitochondrial and nuclear data may be key.

The soft X-ray monochromator at the SASE3 beamline of the European XFEL: from design to operation

The SASE3 soft X-ray beamline at the European XFEL has been designed and built to provide experiments with a pink or monochromatic beam in the photon energy range 250-3000 eV. Here, the focus is monochromatic operation of the SASE3 beamline, and the design and performance of the SASE3 grating monochromator are reported. The unique capability of a free-electron laser source to produce short femtosecond pulses of a high degree of coherence challenges the monochromator design by demanding control of both photon energy and temporal resolution. The aim to transport close to transform-limited pulses poses very high demands on the optics quality, in particular on the grating. The current realization of the SASE3 monochromator is discussed in comparison with optimal design performance. At present, the monochromator operates with two gratings: the low-resolution grating is optimized for time-resolved experiments and allows for moderate resolving power of about 2000-5000 along with pulse stretching of a few to a few tens of femtoseconds RMS, and the high-resolution grating reaches a resolving power of 10 000 at the cost of larger pulse stretching.

B-esterases characterisation in the digestive tract of the common octopus and the European cuttlefish and their in vitro responses to contaminants of environmental concern

Cephalopods are a group of marine invertebrates that have received little attention as sentinel species in comparison to other molluscs, such as bivalves. Consequently, their physiological and biochemical xenobiotic metabolism responses are poorly understood. Here we undertake a comparative analysis of the enzymatic activities involved in detoxification reactions and neural transmission in the digestive tract of two commercial cephalopods: the Common octopus, Octopus vulgaris, and the European cuttlefish, Sepia officinalis. For methodological purposes, several common B-esterases (five carboxylesterase (CE) substrates and three cholinesterase (ChE) determinations) were assayed as a proxy of metabolic and neuronal activities, respectively. Four components of the digestive tract in each species were considered: salivary glands, the stomach, the digestive gland and the caecum. The in vitro responses of digestive gland homogenates to model chemicals and contaminants of environmental concern were contrasted between both cephalopod species. The baseline biochemical activities in the four digestive tract components were also determined. Moreover, in order to validate the protocol, purified proteins, recombinant human CE (CE1 and CE2) and purified eel acetylcholinesterase (AChE) were included in the analysis. Overall, carboxylesterase activities were higher in octopus than in cuttlefish, with the activity quantified in the digestive tract components in the following order: digestive gland ≈ caecum > stomach ≈ salivary glands, with higher hydrolysis rates reached with naphthyl-derived substrates. In contrast, cuttlefish hydrolysis rates with ChE substrates were higher than in octopus. This trend was also reflected in a higher sensitivity to CE inhibitors in octopus and to AChE inhibitors in cuttlefish. Given the detoxification character of CEs and its protective role preventing AChE inhibition, octopus could be regarded as more efficiently protected than cuttlefish from neurotoxic exposures. A full characterisation of B-esterases in the digestive tract of the two common cephalopods is also provided.

The SASE1 X-ray beam transport system

SASE1 is the first beamline of the European XFEL that became operational in 2017. It consists of the SASE1 undulator system, the beam transport system, and the two scientific experiment stations: Single Particles, Clusters, and Biomolecules and Serial Femtosecond Crystallography (SPB/SFX), and Femtosecond X-ray Experiments (FXE). The beam transport system comprises mirrors to offset and guide the beam to the instruments and a set of X-ray optical components to align, manipulate and diagnose the beam. The SASE1 beam transport system is described here in its initial configuration, and results and experiences from the first year of user operation are reported.

Abstract P5-15-09: Impact of oncotype dx genetic signature used in early breast cancer. Clinical and economic analisys of a 110 patient cohort treated in the Catalan Oncologic Institute (ICO), Spain

Introduction

Benefit from adjuvant chemotherapy (CT) is doubtful in a high percentage of patients with early breast cancer. The 21-gene recurrence-score (RS) assay (Oncotype DX, Genomic Health) is one gene-expression assay that provide prognostic and predictive information in hormone-receptor (RH) positive breast cancer. The results of the TAILORx study have confirmed that the majority of patients with tumors RH + and HER2 negative can avoid CT without increasing their risk of relapse. From 2012 to 2015 we used Mammaprint (MMP), in our institution and 60% of cases could avoided CT (communicated in SABCS 2015). Since 2017 we use RS for this purpose.

Primary Objective

To analyze the impact of using RS to change the indication of adjuvant CT.

Secondary Objectives

To analyze the association between different clinical pathological factors and the RS value, and calculate the difference between the cost of all RS test and the cost in direct expense of the treatment with CT of all patients who could avoid it thanks to the RS

Material and methods

We analyzed all RS test performed in the three ICO centers during 2017. We sent 112 tumor samples; in 2 samples adequated RNA for RS was not obtained. We compared the adjuvant treatment initially planned according to institutional treatment protocol with the treatment given after RS. We compared the direct economic costs of CT with the costs of the diagnostic test, and performed a logistic regression analysis of some pathological factors and RS value.

Results

The RS could be determined in 110 of 112 cases, in which there was indication of adjuvant CT. Only 14 patients received CT (12,72%) with the RS value, so CT was avoided in 96 patients (87,28%).

The clinical-pathological characteristics of the series are summarized in the table 1. Of the risk factors analyzed, only grade 3 (p 0.001) and PR <20% (p<0.002) showed a statistically significant relationship with a higher probability of RS> 25. No association was found between age, nodal status, tumor diameter, Ki67, Infiltrating Ductal Carcinoma vs neither Infiltrating Lobular Carcinoma nor Lympho-Vascular invasion.

The cost of the genetic studies was 180000€ (1636€ each). The cost of each CT schedule (EC x 4 followed by paclitaxel x 12) was 7214€ and the total cost of 96 cases 692590€. Direct costs savings estimated from the reduction in CT treatment were 512590€

Conclusion: Our series shows that RS avoided unnecessary CT in 87% of cases and was more cost-effective than a previous series with MMP. G3 and RP <20 were the only pathological factors associated with an increased risk of RS> 25.

Table 1.Patients characteristics and clinical-pathological details from the analyzed tumorsPatient characteristicsAge, mean (range)53,76 (19 – 75)≥50y72 (65.5%)<50y38 (34.5%)HistologyInfiltrating ductal carcinoma88 (80%)Infiltrating lobular carcinoma20 (18,2%)Others2 (1,8%)TNMTumor diameter (mm), mean (range)19,25 (1 – 160)pN058 (52,7%)pN1mic21 (19%)pN131 (28,3%)Hormone receptorsRE 2-100%110 (100%)RP <20%22 (20%)RP ≥20%88 (80%)Ki67 median, mean (range)20, 21 (2-75)Lymphovascular invasionyes9 (8%)no101 (92%)Adjuvant treatmentCT14 (12,72%)Hormonotherapy96 (87,28%)

Citation Format: Ferrer M, Dorcas J, Quiroga V, Margelí M, del Barco S, Stradella A, Petit A, Falo C, Viñas G, Romeo M, Villanueva R, Cirauqui B, Vázquez S, Fernández A, Recalde S, Vethencourt A, Soler T, Pérez-Martín X, Gil-Gil M. Impact of oncotype dx genetic signature used in early breast cancer. Clinical and economic analisys of a 110 patient cohort treated in the Catalan Oncologic Institute (ICO), Spain [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-09.

Abstract PD5-10: A first-in-human phase I study to evaluate the oral selective estrogen receptor degrader (SERD), GDC-0927, in postmenopausal women with estrogen receptor positive (ER+) HER2-negative metastatic breast cancer (BC)

Background: Modulation of estrogen activity and/or synthesis is the mainstay therapeutic strategy in the treatment of ER+ BC. However, despite the effectiveness of available endocrine therapies, many patients ultimately relapse or develop resistance to these agents via estrogen-dependent and estrogen-independent mechanisms, including mutations in ESR1 affecting the ER ligand binding domain that drive ER-dependent transcription and proliferation in the absence of estrogen. ER antagonists that are efficacious against ligand-dependent and ligand-independent, constitutively active ESR1 mutant tumors may be of substantial therapeutic benefit. GDC-0927 (formerly known as SRN-927) is a novel, potent, non-steroidal, orally bioavailable, selective ER antagonist/ER degrader (SERD) that induces tumor regression in ER+ BC patient-derived xenograft models.

Methods: A phase I dose escalation study with 3+3 design was conductedin postmenopausal women with ER+ (HER2-) metastatic BC (progressing ≥ 6 months on endocrine therapy and with ≤ 2 prior chemotherapies in the advanced or metastatic setting) to determine the safety, pharmacokinetics (PK) and the recommended Phase 2 dose (RP2D) of GDC-0927. Pharmacodynamic (PD) activity was assessed with [18F]-fluoroestradiol (FES)-PET scans. Plasma PK samples (after single dose and at steady state), CT scans, and when feasible, pre and on-study tumor biopsies were obtained

Results: From March 16, 2015 to March 17, 2017 patients (pts) with a median age of 53 years (range 44-69) and a median number of prior therapies for MBC 4 (range 1-7) were enrolled at 3 total daily dose levels (600, 1000, 1400 mg) once daily (QD) given orally with fasting (n = 12). Increases in GDC-0927 exposure were approximately dose proportional. Treatment related adverse events (AEs) were all grade 1 or 2. The most common treatment-related AEs were nausea (54%, n = 7), diarrhea (46%, n = 6), elevated aspartate aminotransferase (39%, n = 5) and anemia, constipation, (each 31%, n = 4). Treatment interruption was required for 2 pts due to nausea and vomiting. Of those pts with FES-PET avid disease at baseline (9 of 12), all post-therapy scans showed complete or near complete (> 90%) suppression of FES uptake to background levels, including pts with ESR1 mutations. Evidence of reduced ER levels and Ki67 staining was observed in on-treatment biopsies. Five of 12 pts (1 at 600 mg and 4 at 1400 mg) were on study ≥ 24 weeks (CBR = 41.6 %) with the best overall response of stable disease with 1 patient (ESR1 mt+ D538G) on study for over 490 days. There were no dose limiting toxicities and no SAEs related to study drug. R2PD was 1400 mg and was selected for single arm dose-expansion which is now complete with last patient enrolled on March 17, 2017. Updated results from dose-escalation and dose-expansion will be presented at the meeting (N = 43).

Conclusions: GDC-0927 appears well-tolerated to date with PK exposure supporting QD dosing, evidence of robust PD target engagement, and encouraging anti-tumor activity in heavily pretreated pts with advanced or metastatic ER+ BC, including pts with ESR1 mutations.

Citation Format: Dickler MN, Villanueva R, Perez Fidalgo JA, Mayer IA, Boni V, Winer EP, Hamilton EP, Bellet M, Urruticoechea A, Gonzalez-Martin A, Cortes J, Martin M, Giltnane J, Gates M, Cheeti S, Fredrickson J, Wang X, Friedman LS, Spoerke JM, Metcalfe C, Liu L, Li R, Morley R, McCurry U, Chan IT, Mueller L, Milan S, Lauchle J, Humke EW, Bardia A. A first-in-human phase I study to evaluate the oral selective estrogen receptor degrader (SERD), GDC-0927, in postmenopausal women with estrogen receptor positive (ER+) HER2-negative metastatic breast cancer (BC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD5-10.

Measuring the condylar unit in condylar hyperplasia: from the sigmoid notch or from the mandibular lingula?

The objective of this study was to determine, in patients with active unilateral condylar hyperplasia, which is the most reliable point to measure the length of the condylar unit: from the sigmoid notch or from the mandibular lingula to the condylar head. On cone beam computed tomography, an observational cross-sectional study was designed for 20 patients with active unilateral condylar hyperplasia. We measured and compared ramus length (affected and healthy sides) and condylar length (measured from the mandibular lingula and from the mandibular sigmoid notch) on both sides. The average of all the differences in ramus height (D.1) was 7.97mm; the average of all the differences in condylar heights measured from mandibular lingula (D.2) was 7.16mm, and measured from the sigmoid notch (D.3) was 4.89mm. No significant difference between D.1 and D.2 (P=0.818). There was a significant difference between D.1 and D.3 (P=0.005) and between D.2 and D.3 (P=0.0005). It can be concluded that the mandibular lingula is the lowest point of the condylar skeletal unit and is therefore a stable parameter to be used in patients with condylar hyperplasia. On the other hand, the sigmoidal notch is not a stable parameter in patients with asymmetry due to condylar hyperplasia.

Mindfulness effects on cognition: Preliminary results

Background

Mindfulness-based cognitive therapy (MBCT) is a psychotherapeutic intervention that has been shown effective in several clinical conditions. Nevertheless, research is still needed on its effectiveness on cognition.

Objective

To analyze possible effects on cognition of the addition of MBCT intervention versus a brief structured group psycho-education to the standard treatment of subsyndromal bipolar depression. Our hypothesis was that MBCT could improve some aspects of cognitive function to a higher degree than psycho-education and treatment as usual (TAU).

Methods/design

A randomized, multicenter, prospective, versus active comparator, evaluator-blinded clinical trial was conducted. Forty patients with BD and subclinical or mild depressive symptoms were randomly allocated to:

– MBCT added to psychopharmacological treatment (n = 16);

– a brief structured group psycho-educational intervention added to psychopharmacological treatment (n = 17);

– standard clinical management, including psychopharmacological treatment (n = 7).

Assessments were conducted at screening, baseline, post-intervention (8 weeks) and 4-month follow-up.

Results

Cognition results point to significant improvement in Stroop Color test as well as processing speed in TMT A test (P < 0.05) in the two psychological intervention groups versus TAU.

Conclusion

These preliminary findings suggest that the addition of MBCT or psycho-education to usual treatment could improve some cognitive dimensions in subsyndromal bipolar depressive patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P4-21-32: Treatment of early HER2-positive breast cancer in trastuzumab era in everyday clinical practice: An overview after 10 years of its approval

Introduction: The addition of Trastuzumab(T) to chemotherapy (CT) revolutionized HER2-positive breast cancer(BC) and changed its natural history. We reviewed the efficacy of T outside clinical trials in a cancer comprehensive center.

Methods: Ambiespective and descriptive study was conducted in Catalan Institute of Oncology (ICO-Barcelona). Estimates of progression-free survival (PFS) and overall survival (OS) were obtained with the Kaplan-Meier method and compared with LogRank test. The association of clinic-pathological variables and outcome was studied by χ2and Cox proportional hazard analysis.

Results: 430 consecutive early HER2-positive BC patients (pts) were treated with adjuvant/neoadjuvant T and CT from Jan 2005 to Dec 2012. Pt basal characteristics are reported in Table 1. Neoadjuvant treatment was administrated in 230pts (54%) and in 200 (46%) in adjuvancy. Pathological complete response (pCR) in breast and nodes (ypT0/isypN0) was achieved in 48% of pts, with higher rates in hormone receptor (HR)-negative pts (62 vs 37% p=0.0005). Median duration of T: 10.6 months (m). 28%pts treated with neoadjuvant T+CT who achieved a pCR did not receive adjuvant T. Treatment discontinuation: 38pts (8.8%): 27pts due to cardiac toxicity and 4 relapsed during adjuvant T. In 87%pts, neoadjuvant CT was based on anthracyclines(A) and taxanes. Adjuvant CT: A and taxanes in 57.4%; 14%pts FAC, 15.4% A-CMF and 12% TCH. At a median follow-up of 70m (3-135), 44pts (10.4%) had relapsed: 33pts with distant M1, 9pts with only loco-regional disease and 2pts contralateral HER2-positive BC. M1 location: 46% visceral, 34% bone/lymph nodes and 20% in central nervous system (CNS). PFS was 23.4m(0-88); median OS was not reached; estimated 10 years-OS was 86.5%. Pts treated with A and taxanes had a significantly better OS compared to those treated with other CT (113 vs 98m, p= 0.009). Kaplan-Meier curve showed numerically higher relapses at 10 years in HR-positive pts (83 vs 90% p=0.8). Pts with pCR had significantly better OS (113 vs 104m, p=0.006). Pts with CNS-metastases had a significantly worse OS (13 vs 26m,p=0,02) and those with HR-negative (49 vs 24m, p= 0.033).

Conclusion: In everyday clinical practice, recurrences after adjuvant/neoadjuvant trastuzumab in HER2-positive BC were less than described in the T-pivotals trials, with 10% of recurrences at a median of FU of 70m. In our series, estimated 10 years-OS was 86.5%. Pts treated with A and taxanes had a significantly better OS as well as those pts who achieved a pCR. On the contrary, pts with CNS M1 and those with HR-negative had worse prognosis.

Table 1Median age51.9y (27-83)Stage I/II/III106 (25%)/ 226 (52%)/ 97 (23%)HR Positive/ Negative249 (58%)/181 (42%)

Citation Format: Ortega A, Domenech M, Falo C, Gil M, Stradella A, Fernandez A, Morilla I, Villanueva R, Castany R, Vazquez S, Molina K, Bergamino M, Navarro V, Pernas S. Treatment of early HER2-positive breast cancer in trastuzumab era in everyday clinical practice: An overview after 10 years of its approval [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-32.

Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System: A systematic approach to decrease alerts

OBJECTIVE

We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts.

DESIGN

Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. MEASUREMENTRESULTS: Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors.

CONCLUSION

We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors.

Human gamma-aminobutyric acid A receptor alpha2 gene moderates the acute effects of alcohol and brain mRNA expression

Gamma-aminobutyric acid A (GABA(A)) receptors moderate several of the behavioral effects of alcohol. In fact, recent studies have shown an association between the gene for the alpha2-subunit of the GABA(A) receptor (GABRA2) and alcoholism. In the present study, we examined the functional relevance of the GABRA2 gene in alcohol dependence by assessing brain GABRA2 mRNA and GABA(A)alpha2-subunit protein levels in post-mortem prefrontal cortical tissue collected from control and alcohol-dependent individuals. In addition, using an endophenotype approach, we tested whether the GABRA2 gene moderates sensitivity to the acute effects of alcohol in two independent samples from distinct human alcohol challenge studies. Results indicated that GABRA2 mRNA levels significantly differed by GABRA2 genotype. GABRA2 single nucleotide polymorphisms (rs573400, rs279871 and rs279858) were significantly associated with sensitivity to the acute effects of alcohol. Specifically, there was a significant main effect of GABRA2 x breath alcohol concentration on several measures of subjective responses to alcohol, including the hedonic value of alcohol. Importantly, reanalysis of a previous intravenous alcohol administration study confirmed the results of the oral alcohol challenge study. In summary, these results extend previous findings and provide new insights into the putative biobehavioral mechanisms that may moderate the association between the GABRA2 gene, sensitivity to the acute effects of alcohol and ultimately alcohol dependence.

[In vitro activity of ertapenem against clinical bacterial isolates in 69 Spanish medical centers (E-test study)]

This study was conducted to assess the in vitro activity of ertapenem against clinical bacterial isolates from patients with community-acquired intra-abdominal and lower tract respiratory infections in Spain in 2003. As the study was conducted before the marketing of ertapenem, it was also useful to define a baseline susceptibility pattern for ertapenem in each of the participating hospitals for later surveillance studies. Each partipating site identified a variable number of aerobic and facultative bacteria isolated from patients with community-acquired intra-abdominal infection or pneumonia using standard procedures. E-test strips were used for determining the minimum inhibitory concentration (MIC) of ertapenem, while for other antimicrobials either quantitative dilution techniques or qualitative diffusion procedures were used according to each microbiology laboratory's routine practice. MIC breakpoints for categorization of susceptibility provided by the CLSI were used for interpreting MIC values. A total of 2,901 recent clinical isolates from patients with community-acquired intra-abdominal infection or pneumonia hospitalized in 69 Spanish medical centers were tested. These isolates included 2,039 Gram-negative bacteria (1,646 Enterobacteriaceae, 216 Haemophilus, 123 non-fermenting Gram-negative bacteria [NFGNB] and 54 others) and 862 Gram-positive bacteria (556 pneumococci, 159 staphylococci, 96 streptococci other than S. pneumoniae, 44 enterococci and 7 others). Ertapenem was very active in vitro against Enterobacteriaceae (99.8% susceptible), Haemophilus (96.3% susceptible), pneumococci (99.6% susceptible, of which 31% were penicillin non-susceptible strains), streptococci other than S. pneumoniae (99.0% susceptible) and methicillin-susceptible staphylococci (94.8% susceptible). For other Gram-positive and Gram-negative pathogens for which ertapenem susceptible breakpoints have not been defined, MIC(90) values were 0.38 and 0.064 mg/l, respectively. As expected, ertapenem had minimal activity in vitro against NFGNB, enterococci and methicillin-resistant staphylococci (MIC(90) of >32 mg/l for all three). Ertapenem was highly active in vitro against most bacteria isolated from patients with community-acquired intra-abdominal and lower respiratory tract infections.

Association of polymorphisms in myeloperoxidase and catalase genes with precancerous changes in the gastric mucosa of patients at inner-city hospitals in New York

Gastric carcinogenesis is a multistep process progressing from chronic gastritis, through glandular atrophy (GA), intestinal metaplasia (IM) and dysplasia. We have previously demonstrated that minority patients at New York City hospitals are infected with a relatively virulent strain of H. pylori (Hp) and that Hp infection is associated with an increased incidence of precancerous changes in the gastric mucosa. Nevertheless, precancerous changes are not observed in every Hp-infected individual, suggesting that environmental and genetic factors may also play a role in the formation and appearance of precancerous lesions. In the present study, the association between polymorphisms in the promoter regions of human myeloperoxidase (MPO -463G--> A) and catalase (CAT -262C-->T) genes and the appearance of precancerous changes in the gastric mucosa of our patient population were examined. Patients enrolled in this study were undergoing endoscopy for gastrointestinal complaints. Samples were collected from 126 patients at Kings County Hospital in Brooklyn and St. John's Episcopal Hospital in Queens. One antral biopsy was taken for genotyping, while additional biopsies were taken from the antrum and fundic region for histological analysis and were scored with respect to acute and chronic inflammation, GA, IM and Hp infestation according to the Sydney classification. MPO and CAT genotypes were determined by PCR and RFLP. CAT genotypes did not influence the incidence or severity of precancerous lesions in the fundic or antral regions of the stomach, whereas the MPO -463A allele was associated with an increase in intensity of gastric atrophy in the fundic mucosa. In Hp-infected individuals, the MPO -463G/G genotype was associated with an increase in the incidence of IM in the antrum, whereas the A allele was associated with an increase in IM in the fundic region. These paradoxical findings suggest that different MPO genotypes are associated with the appearance of IM in distinct anatomical regions of the stomach. However, since the majority of gastric cancer (GC) cases in our patient population occurred in the antrum, the MPO -463G/G genotype, which is associated with increased MPO expression and antral IM, may be considered a risk factor for GC.

Helicobacter pylori infection is associated with a high incidence of intestinal metaplasia in the gastric mucosa of patients at inner-city hospitals in New York

Gastric carcinogenesis is a multistep process progressing from chronic gastritis, through glandular atrophy (GA), intestinal metaplasia (IM) and dysplasia. Infection of the stomach with H. pylori increases the risk of developing gastric cancer. Few studies have examined the degree to which Hp-induced changes occur in specific populations. In the present study, we examined the association between Hp infection and histological changes in the gastric mucosa of patients at two inner-city hospitals in New York. Patients enrolled in this study were undergoing endoscopy for gastrointestinal complaints. One antral biopsy was taken for detecting and genotyping Hp by PCR. Additional biopsies were taken from the antrum and fundic region for histological analysis and were scored with respect to acute and chronic inflammation, GA, IM and Hp infestation according to the Sydney classification. Hp strains infecting these patients were genotyped with respect to the expression of Hp virulence factors including VacA, CagA, and BabA2. Samples were collected from 126 patients at Kings County Hospital in Brooklyn and St. John's Episcopal Hospital in Queens. Hp infection rates were highest in Blacks (41.6%) and Hispanics (29.4%) and lowest in Caucasians (18.8%). Scores for acute and chronic inflammation and IM were higher in Hp-infected individuals in both the antrum and fundic regions, whereas Hp infection did not affect the incidence or intensity of GA. In Hp-infected individuals, the incidence of IM was greater in the antrum (Hp-infected 37.8% vs. non-infected 9.2%, p < 0.05) and fundic region (Hp-infected 15.1% vs. noninfected 1.8%, p < 0.05). Genotyping of the Hp strains infecting these patients revealed that the predominant VacA allele was s1 bm 1 and that the CagA gene was present in 69.8% of Hp-infected samples. Interestingly, the BabA2 gene was detected in only four samples (9.3%). The incidence of IM in the antrum was higher in CagA + samples when compared with CagA- samples (52.2% vs. 15.4%, respectively). Our findings indicate that the virulent Hp strain infecting minority patients treated at inner-city hospitals in New York City is associated with a high incidence of IM and that these patients may be at greater risk for developing gastric cancer than the general population.

Clinical prognostic factors in metastatic gastrointestinal stromal tumors (GIST) patients treated with Imatinib

19500

Background: Imatinib (IMT) therapy is the main successful therapy for metastatic GIST. We analyze the results of the treatment according to the clinical factors and dose of IMT. Methods: 38 patients (pts) with metastatic GIST (C-KIT positive) were treated from June 2001 to June 2005 with IMT; 11 pts received 400 mg bid and 27 pts 400 mg daily. Evaluation of c-Kit mutation on exon 11 was analyzed in 23 pts. An analysis of the clinical factors was performed. Results: The average age was 60 y. (18–78); Gender: 26 male/12 female; Primary location in small bowel 24, gastric 12, esophagus 2. ECOG 0–1 in 87% of pts. 31 pts have had radical surgery at the primary (26 R0, 5 R1). Interval to metastatic/local relapse was 10 months (2–61). Hepatic metastases were presented in 26 pts (1–5 in 12, 6–10 in 5, >10 in 9 pts); peritoneal disease in 26 pts (1–5 in 10, 6–10 in 8, >10 in 7 pts); pulmonary metastases in 2, bone in 2 and nodal in 3 pts; local tumor in 6. With a median follow-up of the 56 m, response rate was 5 complete, 21 partial responders, 7 disease stabilization. Three pts died in the first month of treatment, two due to tumoral bleeding, one due to progressive disease. Median survival (MS) was 43 (0–54) months, not achieved for pts in 400 mg, 41 months for 400 mg bid pts (p=0.61). Progression free survival (PFS) was 21 months (21 for pts in 400 mg, 20 for pts in 400 mg bid). We don’t find statistical differences regarding the number of hepatic and peritoneal metastases, neither according to the size of metastases (<10 cm was 48 m., ≥10 cm was 41 m.). MS was not achieved in 18/23 patients with exon 11 mutation vs 9 months for non-mutation patients (p 0.00). No differences were found in survival for 4/18 pts with missense mutation. Conclusions: Mutational status may predict the outcome of GIST patients treated with IMT. Dose of IMT, mass size and number of metastases were not prognostic factors for survival. Special attention would be done to the risk of bleeding at the start of treatment with IMT.

No significant financial relationships to disclose.

Characterisation of the first CTX-M-10-producing isolate of Salmonella enterica serotype Virchow

Microbiological analysis of a urine sample from an outpatient with symptoms of urinary infection detected >10(5) CFU/mL urine of Salmonella enterica serotype Virchow with resistance to cefotaxime. Molecular analysis demonstrated the presence of the gene encoding CTX-M-10 beta-lactamase in this clinical isolate. This is the first report of this enzyme in Salmonella spp.

Evaluation of Group B Streptococcus Differential Agar for detection and isolation of Streptococcus agalactiae

In total, 320 vaginal or rectal swabs were cultured on Granada medium (GM) or Group B Streptococcus Differential Agar (GBSDA), and were also inoculated into LIM broth (Todd-Hewitt broth supplemented with selective antibiotics), for detection of group B Streptococcus (GBS). Overall, GBS isolates were detected on 53 of the 320 swabs; 47 of these isolates grew on both GM and GBSDA, five only on GBSDA, and one only following subculture from LIM broth. GBSDA appears to be a valid alternative to GM for the growth of GBS isolates from pregnant women.

Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection

Between October 2001 and August 2002, 30 hospital patients became infected or colonised by a multiresistant (including to carbapenems) epidemic strain of Acinetobacter baumannii (AbMR) in a hospital outbreak. This study analysed the risk-factors associated with acquisition of this epidemic strain and investigated the prognosis of patients infected by AbMR, with the aim of elucidating factors which lead to mortality. A case-control study of the acquisition of AbMR in patients infected or colonised in the hospital outbreak was performed. Independent risk-factors leading to death were studied by logistic regression analysis. Multivariate analysis of the risk-factors for colonisation/infection with AbMR revealed an independent association with the presence of an arterial catheter (OR, 1.13; 95% CI, 1.03-1.25) and administration of imipenem as monotherapy (OR, 11.12; 95% CI, 2.33-53.09). Multivariate analysis of the prognostic features leading to mortality revealed a significant association with hypotension or shock (OR, 24.63; 95% CI, 1.56-387.56) at the time of bacterial isolation.

Sibling recurrence risk in autoimmune thyroid disease

There is abundant evidence for a genetic influence on the development of autoimmune thyroid diseases (AITD). One measure of the magnitude of genetic contribution to the development of a disease is the sibling risk ratio (lambda(s)). Recent accurate prevalence data for hypothyroidism and hyperthyroidism in the United States reported from the National Health and Nutrition Examination Survey III (NHANES III) study have now allowed us to compute the sibling recurrence risk for AITD. Patients were recruited from our endocrine clinic on the basis of having AITD. The inclusion of patients in this study was unambiguously single ascertainment. We studied 155 patients (131 with Graves' disease [GD] and 24 with Hashimoto's thyroiditis [HT]) who had reliable information on the presence or absence of AITD in siblings. Nine probands had siblings with GD and 13 probands had siblings with HT. Using the prevalence rates from NHANES III for clinical hyperthyroidism and hypothyroidism, the calculated lambda(s) was 16.9 for AITD, 11.6 for GD, and 28.0 for HT. These results confirm the significant contribution of genetic factors to the development of AITD.

A new report of mesomelic camptomelia, polydactyly and Dandy-Walker complex in siblings

Two male siblings with several malformations are reported. The anomalies detected in both fetuses were mesomelic camptomelia, postaxial hexadactyly and Dandy-Walker complex. There was only one similar previous report in the literature. This combination could represent a specific pattern of malformation or a new syndrome, with different variants. The parents' consanguinity and the recurrence in a subsequent pregnancy suggest an autosomal recessive inheritance pattern.

Tensile strength of human dentin as a function of tubule orientation and density

PURPOSE

This study investigated the ultimate tensile strength (UTS) of human dentin as a function of tubule orientation and density.

MATERIALS AND METHODS

Slabs of dentin (ca 0.7 mm thick) were obtained from human third molars by either transversally or longitudinally sectioning the crowns with an Isomet saw. The slabs were gently trimmed to reduce the central area of the coronal dentin to a cross-sectional area of approximately 0.5 mm2. The longitudinally sectioned slabs were either trimmed from the mesial and distal sides or from the occlusal and pulpal aspects to permit the tensile load to be applied either parallel or perpendicular to the tubule orientation. The transversally sectioned specimens were obtained at several distances from the pulp and were used to evaluate the effects of tubule density. The trimmed specimens were tested in tension on a Kratos testing machine at 0.5 mm/min. After failure, the UTS of each was calculated and expressed in MPa. The fractured ends of the transversally sectioned specimens were viewed under SEM to calculate the number of tubules per mm2 at the site of fracture, and its relation with the UTS was investigated by regression analysis.

RESULTS

The UTS of dentin is higher when the load is applied perpendicular to the tubule orientation (80 +/- 13 MPa) than when applied parallel to tubule orientation (58 +/- 11 MPa, p < 0.05). There was a tendency for dentin to be weaker as the number of tubules at the site of fracture increased, although this relationship was not statistically significant (R2 = 0.051, p > 0.05).

CONCLUSION

The UTS of dentin is dependent on the tubule direction. Dentin tends to be weaker as the number of tubules per area increases.

Autoimmune thyroid disease susceptibility loci in a large Chinese family

OBJECTIVES

The autoimmune thyroid diseases (AITDs) comprising Graves' disease (GD) and Hashimoto's thyroiditis (HT) are complex genetic diseases, which result from an interaction between predisposing genes and environmental triggers. The aim of our study was to dissect the genetic predisposition to GD and HT in one large Chinese family with multiple members affected with AITD.

PATIENTS

We completed a whole genome screen of a large multiplex Chinese-American family. We enrolled 27 family members from three generations. Eight members were affected with AITD, six had GD and two had HT.

DESIGN

We determined the information limits of the family. Power calculations indicated that the maximum attainable LOD scores were 5.1 assuming dominant inheritance, and 3.4 assuming recessive inheritance. These estimates both assumed 100% penetrance and one gene. Whole genome screening was performed using 400 highly polymorphic and densely spaced microsatellite markers spanning the entire human genome (intermarker distance < 10 cM). Linkage analysis was performed using two-point and multipoint parametric and nonparametric methods.

RESULTS

Initial whole genome screening performed with 400 microsatellite markers identified two markers that showed evidence for linkage to AITD in this family, D11S4191 and D9S175, with two-point LOD scores of 2.31 and 2.05, respectively. Multipoint linkage analysis focusing on the regions containing these markers revealed a maximum multipoint LOD score (MLS) of 2.13 and a nonparametric linkage score (NPL) of 6.1 for D11S4191 and an MLS of 2.01 and NPL of 7.5 for D9S175.

CONCLUSIONS

These results showed that this Chinese family harboured susceptibility loci for AITD which were distinct from those previously found in the Caucasian population. This suggests that different susceptibility loci exist between different ethnic groups. Furthermore, even within a single family from a genetically homogenous population, more than one gene was involved in the genetic susceptibility to AITD, supporting the notion that AITDs are caused by multiple genes of varying influences.

The use of oxalate to reduce dentin permeability under adhesive restorations

PURPOSE

To test a novel approach to reducing dentin permeability that localizes occlusion of dentin tubules by calcium oxalate crystals to the subsurface without lowering resin bond strengths to oxalate-treated dentin surfaces.

MATERIALS AND METHODS

Flat dentin surfaces of extracted human third molars were etched with a mass fraction of 32% phosphoric acid (Bisco) for 15 s and rinsed. Half of the surface was treated with a potassium oxalate gel (mass fraction of 3% monopotassium monohydrogen oxalate) for 2 mins. The entire surface was then moist bonded with either One Step (OS) or Scotchbond Multi-Purpose (SB) adhesive systems. A resin-based composite (Z-100) buildup was made over the entire surface. After storage for 24 hrs in distilled water, the teeth were longitudinally sectioned to separate the oxalate-treated half from the untreated (control) half. Each half was serially sectioned into several 0.7 mm thick slabs which were then trimmed to an hour-glass shape to reduce the bonded area to approximately 0.8 mm2 and tested in tension. Pre- and post-treatment hydraulic conductance (Lp) of dentin was determined using dentin discs with a standard protocol. SEM images were obtained to examine the effects of treatment both on the dentin surface and along the tubules beneath the surface. The bonded interface was also examined by SEM.

RESULTS

Treating etched dentin discs with the oxalate gel caused significant reduction of the Lp of dentin (80% reduction, P < 0.05). There were no statistically significant differences between bond strengths of oxalate-treated and untreated surfaces for either adhesive system. OS resulted in a bond strength of 25.8 +/- 9.2 MPa to untreated and 27.8 +/- 8.9 MPa to oxalate treated surfaces (P > 0.05). SB showed bond strengths of 22.9 +/- 7.9 MPa and 22.9 +/- 9.6 MPa to untreated and treated surfaces, respectively (P > 0.05). SEM images showed that the application of potassium oxalate gel on etched dentin resulted in the formation of crystals inside the tubules rather than on the surface. Examination of the bonded interfaces demonstrated that the crystal formation inside the tubules did not compromise the formation of a typical hybrid layer on the top of dentin surfaces. Resin monomers penetrated into the tubules filling the spaces around the crystals forming resin tags with a jagged-like feature.

Evidence for association of polycystic ovary syndrome in caucasian women with a marker at the insulin receptor gene locus

The polycystic ovary syndrome (PCOS) is one of the commonest female endocrinopathies affecting 5-10% of women of reproductive age. The disorder, characterized by chronic anovulation and signs of hyperandrogenism, results from a complex interaction between genetic predisposing factors and environmental triggers. We have studied 85 Caucasian PCOS patients and 87 age-matched Caucasian control women for associations with four candidate genes: follistatin, CYP19 (aromatase), CYP17a, and the insulin receptor (INSR). These genes were analyzed using microsatellite markers located near or inside the genes. We found that only the insulin receptor gene marker D19S884 was significantly associated with PCOS (p=0.006 and even after a conservative correction p=0.042). The INSR gene region was then fine mapped with an additional panel of 9 markers but only marker D19S884, located 1 cM telomeric to the INSR gene, was again associated with PCOS. In conclusion, our results suggested that a susceptibility gene for PCOS was located on chromosome 19p13.3 in the insulin receptor gene region. It remains to be determined if this susceptibility gene is the insulin receptor gene itself or a closely located gene. Since insulin stimulates androgen secretion by the ovarian stroma it is likely that INSR function in the ovary is involved in the genetic susceptibility ot PCOS.

Comparative residual toxicities of pesticides to the predator Agistemus industani (Acari: Stigmaeidae) on citrus in Florida

Residual toxicities of registered and selected experimental pesticides used on citrus against Agistemus industani Gonzalez (Acari: Stigmaeidae) were compared. Pesticides considered highly toxic to A. industani were: abamectin 0.15 EC at 731 ml/ha + FC 435-66 petroleum oil at 46.8 l/ha, pyridaben 75 WP at 469 g/ha, ethion 4 EC at 7.01 l/ha + FC 435-66 petroleum oil at 46.8 l/ha, propargite 6.55 EC at 3.51 l/ha, chlorfenapyr 2 SC at 1.46 l/ha applied alone or in combination with FC 435-66 petroleum oil at 46.8 l/ha, sulphur 80 DF at 16.81 kg/ha. dicofol 4EC at 7.01 l/ha, fenbutatin oxide 50 WP at 2.24 kg/ha, benomyl 50 WP at 2.24 kg/ha, benomyl 50 WP at 1.68 kg/ha + ferbam 76 GF at 5.60 kg/ha, ferbam 76 GF at 11.21 kg/ha, neem oil 90 EC at 46.8 l/ha, and copper hydroxide DF (40% metallic copper) at 4.48 kg metallic copper/ha + FC 435-66 petroleum oil at 46.8 l/ha. Pesticides that were moderately to slightly toxic included: copper sulphate 98% at 4.48 kg metallic copper/ha + FC 435-66 petroleum oil at 46.8 l/ha, fenbuconazole 2 F at 280 ml/ha + FC 435-66 petroleum oil at 46.8 l/ha, FC 435-66 petroleum oil applied alone at 46.8 l/ha or 23.41/ha, and diflubenzuron 25 WP at 1.40 kg/ha. Pesticides that were non-toxic included: fenbuconazole 2 F at 585 ml/ha, malathion 57 EC at 5.85 l/ha, FC 435-66 petroleum oil at 46.8 l/ha, carbaryl 80 S at 3.36 kg/ha. chlorpyrifos 4 EC at 4.68 l/ha, and formetanate 92 SP at 1.12 kg/ha. Understanding the toxic effects of field weathered pesticides against key predacious mite species is important for effective IPM. The results of this study provide a comparison of direct and indirect toxic effects of various pesticides to A. industani under field conditions.

Limited genetic susceptibility to severe Graves' ophthalmopathy: no role for CTLA-4 but evidence for an environmental etiology

Graves' disease (GD) is an autoimmune thyroid disease (AITD) characterized by hyperthyroidism and by the occurrence of a distinctive ophthalmopathy (orbitopathy), which presents with varying degrees of severity. Graves' disease clusters in families but the importance of heredity in the pathogenesis of the associated ophthalmopathy is unclear. We have studied the family history of 114 consecutive, ethnically mixed patients with severe Graves' ophthalmopathy (GO). Patients were selected by unambiguous single ascertainment. Seventy-seven percent of patients were female and 59% smoked. The mean age at onset of their GD was 43 years (range 17-78 years). Forty-one patients (36%) had a family history of AITD, defined as a first- and/or a second-degree relative affected with either Graves' disease (GD) or Hashimoto's thyroiditis (HT). The segregation ratio for AITD in nuclear families in our ascertained Graves' ophthalmopathy families was 0.07 (0.12 in Caucasians only). Hence, the higher prevalence of AITD among relatives of Graves' ophthalmopathy patients agreed with the known genetic predisposition to AITD and this predisposition was stronger in women than in men. However, only 3 of the 114 patients had a family history of severe Graves' ophthalmopathy (all second-degree relatives) and the segregation ratio for GO was 0. These data did not support a major role for familial factors in the development of severe Graves' ophthalmopathy distinct from Graves' disease itself. In addition, we tested 4 candidate genes, human leukocyte antigen (HLA), tumor necrosis factor-beta (TNF-beta), CTLA-4 and the thyrotropin receptor (TSHR), for association with Graves' ophthalmopathy. These were negative except for the HLA and CTLA-4 genes, which were found to be weakly associated with GO giving similar relative risk (RR) as in GD patients without ophthalmopathy. These data suggested that environmental factors, rather than major genes, were likely to predispose certain individuals with AITD to severe Graves' ophthalmopathy. Smoking remains one example of such potential external insults.

Effect of peripheral perfusion on accuracy of pulse oximetry in children

STUDY OBJECTIVE

To examine the effect of perfusion on accuracy of two pulse oximeters in children and to determine thresholds of perfusion below which these pulse oximeters become inaccurate or cease to function.

DESIGN

Prospective, observational clinical study.

SETTING

Operating room of a large university hospital.

PATIENTS

19 children 10 years of age or less, who were scheduled for general anesthesia with placement of an intraarterial catheter.

INTERVENTIONS

A radial artery catheter, laser Doppler probe, skin temperature sensor, and band probes of two oximeters, Ohmeda 3700 (Boulder, CO) and Nellcor N200 (Hayward, CA), were attached to the same hand. Baseline pulse oximeter and Doppler readings were obtained with simultaneous hemoximetry (AVL Model 912 CO-Oxylite, Roswell, GA), skin and esophageal temperatures, total hemoglobin, and transduced arterial pressure. Readings of all parameters (n = 94) were obtained during periods of low perfusion or by occluding the upper arm to 70% to 100% of systolic pressure.

MEASUREMENTS AND MAIN RESULTS

Bias (SpO2-SaO2) of each oximeter is compared to each perfusion variable (age, weight, core and skin temperature, hemoglobin concentration, pulse pressure, and percent flow by laser Doppler) to determine effect on accuracy. Data were analyzed using backward multivariate linear regression, Pearson correlation coefficients, and independent paired t-test. p < 0.05 was considered significant. Less than 2% bias is seen with either oximeter (Nellcor 1.55 +/- 2.33, Ohmeda 0.78 +/- 2.25). Independent predictors of bias for each machine include weight (r = -0.376; p < 0.001) and pulse pressure (r = 0.250; p = 0.021) for the Nellcor, and weight (r = -0.390; p < 0.001), percent flow by Doppler (r = 0.220; p = 0.035), and core temperature (r = 0.307; p = 0.003) for the Ohmeda. However, using predetermined thresholds for each variable, only skin temperature below 30 degrees C is identified as a significant predictor of oximeter inaccuracy.

CONCLUSIONS

At the parameters explored in this study, the selected seven perfusion variables (age, weight, core and skin temperature, hemoglobin concentration, pulse pressure, and percent flow by laser Doppler) have little effect on accuracy of pulse oximetry in children.

[Petrous bone approach for the surgery of petroclival meningiomas]

Four patients, 3 woman and 1 man, with giant petroclival meningiomata are presented. In all cases the tumor size exceed 44 mm in its greater diametre. Main clinical symptoms were endocranial hypertension and cranial nerves deficit. A modified transcochlear approach in two stages was used. A total petrosectomy was performed, using the petrosygmoidal via for opening the dura. Transversus and sygmoid sinus were spared. Total removal was achieved in 2 cases, subtotal and partly in each of the other 2. No operative mortality occurred (hospital exitus) and neurologic morbility related to V-VI-VII and VIII cranial nerves and 1 hemyparesia was recorded. The AA. explain and comment the fundamentals of the followed procedure and compare, as well, the own outcomes with those reported by more classic alternatives. Finally, the conclusion is drawn out that retroclival meningiomata are conditions treatable, although always are difficulty approached and demand meticulous microsurgical techniques.

Adherence of mouse peritoneal macrophages following exposure to lead

Lead is a toxin widely used in industry. Recently, medical investigation into lead exposure has turned to testing organ systems, such as the immune system, that historically were not associated with lead poisoning. We evaluated the effects of doses of 13, 130 or 1,300 ppm of lead on the adherence of mouse peritoneal cells, and particularly on macrophages. Cellular adherence was measured according to the De la Fuente technique. Adherence of macrophages showed significant changes in the 1,300 ppm group, revealing a reduction to 55% of the control group. The macrophage adherence index showed 91% sensitivity and 96% specificity. These results indicate a considerable reduction in the adherence of peritoneal macrophages following exposure to certain levels of lead.

Hepatic and cardiac oxidative stress and other metabolic changes in broilers with the ascites syndrome

The objective of this study was to evaluate the gluconeogenic response of in vitro stimulated hepatocytes from control broilers and broilers with clinical manifestations of the ascites syndrome. The basal rate of glucose synthesis from lactate was found to be threefold greater in sick birds than in the control group and stimulation obtained with epinephrine was found to be quantitatively similar in both groups. Under basal conditions, the hepatocytes from the sick broilers exhibited 60% more ammonium than the control birds. In addition, the quantification of thiobarbituric acid reactive substances, as indicators of cellular lipoperoxidation, showed an increase of over 100% in heart and liver of sick broilers fowl. In conclusion, the complex integrated response of gluconeogenesis to epinephrine is maintained in broilers with ascites, although their hepatocytes present changes compatible with those observed in cases of oxidative stress. It is not known whether this stress is a cause or a consequence of the ascites syndrome.

Intestinal and extraintestinal cryptosporidiosis in AIDS patients

In a prospective study in AIDS patients with chronic diarrhea, the overall prevalence of intestinal cryptosporidiosis was 15.6% (43/275). The prevalence was higher in homosexual patients (33.3%) than in intravenous drug abusers (10.6%) (p < 0.001). Extraintestinal infection was present in 30% (13/43) of the patients with known intestinal cryptosporidiosis. Eight of the 13 (61.5%) patients with extraintestinal cryptosporidiosis had Cryptosporidium in the bile and 7 of 13 (16.28%) had it in the sputum. Of the seven patients with Cryptosporidium in the sputum, four had respiratory symptoms and an abnormal chest radiograph, although another pulmonary pathogen was isolated simultaneously. Two other patients from whom Cryptosporidium was the sole respiratory pathogen isolated had no respiratory symptoms and normal chest radiographs. The seventh patient had pulmonary symptoms, interstitial infiltrate on chest radiograph and excessive activity on a pulmonary Gallium scan; Cryptosporidium was the only organism detected in induced sputum and bronchoalveolar lavage specimens. The mean CD4+ lymphocyte count in patients with extraintestinal cryptosporidiosis was 55 cells/mm3.

[Perinatal transmission of the human immunodeficiency virus in the second trimester of pregnancy]

BACKGROUND

A prospective study was carried out in pregnant women seropositive for HIV-1 who wished to interrupt the pregnancy with the aim of detecting the specific sequences of DNA in fetal blood obtained by cordocentesis during the second trimester of pregnancy.

METHODS

The samples of fetal blood were obtained by cordocentesis with the Kleihauer's test being performed to discard contamination of maternal blood. In both maternal and fetal blood the HIV-1 antibodies, Western blot, p-24 antigen and hematologic parameters were determined. The DNA-HIV-1 sequences were determined by double PCR. Fifteen pregnant women were included in the study with one patient being excluded upon detection of contamination of fetal blood with maternal blood. In 8 cases the study could not be completed due to lack of material.

RESULTS

The specific sequences of DNA of HIV were detected in the six pregnant women and in three of the six fetuses studied. The anti-HIV-1 antibodies were present in all the samples of maternal and fetal blood with the bands of antibodies by Western blot being identical for each mother-fetus pair. No differences were observed in the mother-fetus pair. No differences were observed in the hematologic parameters or in the lymphocytic subpopulations among the fetuses with positive DNA sequences and those which demonstrated a negative result.

CONCLUSIONS

These preliminary results suggest that fetal infection by HIV-1 may be produced during pregnancy. Cordocentesis may be useful for determining the fetus which are infected in utero although this must be restricted to patients who wish to terminate the pregnancy due to the potential risk of infecting a previously healthy fetus.

Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study

OBJECTIVE

To evaluate the effect of a method of Selective Decontamination of the Digestive Tract (SDD) on colonization, nosocomial infection (NI), bacterial resistance, mortality and economic costs.

DESIGN

Randomized, double blind, placebo controlled study.

SETTING

Polyvalent intensive care unit (ICU) of a tertiary care hospital with 27 beds.

PATIENTS

101 patients with > 3 days of mechanical ventilation and > 5 days of stay, without infection at the start of the study. 47 belonged to the Treated Group (TG) and 54 to the Placebo Group (PG).

INTERVENTIONS

The TG was given Cefotaxime i.v. (6 g/day) for the first four days and an association of Polymyxin E, Tobramycin and Amphotericin B at the oropharyngeal and gastrointestinal level throughout the whole stay.

RESULTS

In the TG, colonization by gram-negative agents at oropharyngeal, tracheal and gastrointestinal level fell significantly. There was a significant drop in the overall, respiratory and urinary NI (26% vs 63%, p < 0.001; 15% vs 46%, p < 0.001; 9% vs 31%, p < 0.01). The overall mortality and NI related mortality was less in the TG (21% vs 44%, p < 0.05; 2% vs 20%, p < 0.01). The economic costs, mechanical ventilation time and length of stay were similar. The percentage of bacterial isolations resistant to Cefotaxime and Tobramycin was greater in the TG (38% vs 15% and 38% vs 9%, p < 0.001).

CONCLUSIONS

colonization by gram-negative bacilli, NI and the mortality related to it can be modified by SDD. Continuous bacteriological surveillance is necessary.

Enterotoxigenic Escherichia coli associated with infant diarrhoea in Galicia, north-western Spain

To assess the role of enterotoxigenic Escherichia coli (ETEC) in infantile diarrhoea, 482 children with diarrhoea and 103 healthy controls, from three localities of Galicia, north-western Spain, were investigated between 1985 and 1988. Rotavirus (37.3%) and Salmonella spp. (12.8%) were the most common causal agents, followed by ETEC (3.9%), Campylobacter jejuni (2.3%), Shigella spp. (0.9%) and Yersinia enterocolitica (0.5%). ETEC were significantly more frequently isolated from children with diarrhoea who were under 1 month of age (26.5%) than from older diarrhoeic children (2.2%) (p less than 0.001) or from healthy children who were under 1 month of age (0%) (p less than 0.05). Among children who harboured ETEC, five of the nine children under 1 month of age developed diarrhoea in hospital, whereas none of the 10 children over 1 month of age did so. Seventeen ETEC isolates produced heat-stable enterotoxin (STa) only, four produced only heat-labile enterotoxin (LT), and two produced both toxins. Colonisation factor antigens CFA/I and CFA/II were detected in 11 (55.0%) of the 20 ETEC isolates that remained enterotoxigenic after maintenance in the laboratory. Most ETEC isolates belonged to serotypes O153:K-:H45 (nine STa+ CFA/I+ isolates), O27:K-:H7 (three STa+ isolates) or O6:K15:H16 (two LT+ STa+ CFA/II+ isolates). Our results suggest that ETEC constitute an important cause of neonatal diarrhoea in this part of Spain.