Mortality on DOACs Versus on Vitamin K Antagonists in Atrial Fibrillation: Analysis of the Hungarian Health Insurance Fund Database

PURPOSE

Limited real-world data are available on the survival of patients treated with vitamin K antagonists (VKAs) versus with direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF). In this nationwide registry, we analyzed the mortality risk of patients with nonvalvular AF taking DOACs versus VKAs, with a special attention to the early treatment period.

METHODS

The Hungarian National Health Insurance Fund (NHIF) database was searched to identify patients treated with VKA or DOAC as a thromboembolic prophylaxis for nonvalvular AF between 2011 and 2016. The overall and the early (0-3, 4-6, and 7-12 months) mortality risks with the 2 types of anticoagulation were compared. A total of 144,394 patients with AF treated with either a VKA (n = 129,925) or a DOAC (n = 14,469) were enrolled.

FINDINGS

A 28% improvement in 3-year survival with DOAC treatment compared with VKA treatment was shown. Mortality reduction with DOACs was consistent across different subgroups. However, younger patients (30-59 years old) initiated on DOAC therapy had the greatest RRR (53%) in mortality. Furthermore, DOAC treatment also yielded a benefit of greater magnitude (HR = 0.55; 95% CI, 0.40-0.77, P = 0.001) in the lower (0-1) CHA₂DS₂-VASc score segment and in those with fewer (0-1) bleeding risk factors (HR = 0.50, CI 0.34-0.73, P = 0.001). The RRR in mortality with DOACs was 33% within the first 3 months, and 6% in the second year.

IMPLICATIONS

Thromboembolic prophylaxis with DOACs in this study yielded significantly lower mortality compared with VKA treatment in patients with nonvalvular AF. The largest benefit was shown in the early period after treatment initiation, as well as in younger patients, those with a lower CHA₂DS₂-VASc score, and those with fewer bleeding risk factors.

In vitro interactions of amantadine hydrochloride, R-(-)-deprenyl hydrochloride and valproic acid sodium salt with antifungal agents against filamentous fungal species causing central nervous system infection

The mortality rates of fungal infections that affect the central nervous system are high in consequence of the absence of effective antifungal drugs with good penetration across the blood-brain barrier and the blood-cerebrospinal fluid barrier. In the present work in vitro antifungal activities of three good penetrating non-antifungal drugs (amantadine hydrochloride, R-(-)-deprenyl hydrochloride, valproic acid sodium salt) and their combinations with three antifungal agents (amphotericin B, itraconazole, terbinafine) were tested with broth microdilution method against eight fungal isolates belonging to Zygomycetes (Lichtheimia corymbifera, Rhizomucor miehei, Rhizopus microsporus var. rhizopodiformis, Saksenaeavasiformis) and Aspergillus genus (A. flavus, A. fumigatus, A. nidulans, A. terreus). These are known to be possible agents of central nervous fungal infections (CNFI). When used alone, the investigated nonantifungal drugs exerted slight antifungal effects. In their combinations with antifungal agents they acted antagonistically, additively and synergistically against zygomyceteous isolates. Primarily antagonistic interactions were revealed between the investigated drugs in case of Aspergilli, but additive and synergistic interactions were also observed. The additive and synergistic combinations allowed the usage of reduced concentrations of antifungal agents to inhibit the fungal growth in our study. These combinations would be a basis of an effective, less toxic therapy for treatment of CNFI.

Antifungal activity of statins and their interaction with amphotericin B against clinically important Zygomycetes

The in vitro antifungal activity of different statins and the combinations of the two most effective ones (fluvastatin and rosuvastatin) with amphotericin B were investigated in this study on 6 fungal isolates representing 4 clinically important genera, namely Absidia, Rhizomucor, Rhizopus and Syncephalastrum . The antifungal effects of statins revealed substantial differences. The synthetic statins proved to be more effective than the fungal metabolites. All investigated strains proved to be sensitive to fluvastatin. Fluvastatin and rosuvastatin acted synergistically and additively with amphotericin B in inhibiting the fungal growth in clinically available concentration ranges. Results suggest that statins combined with amphotericin B have a therapeutic potential against fungal infections caused by Zygomycetes species.

Identification of acid- and thermotolerant extracellular beta-glucosidase activities in Zygomycetes fungi

Extracellular beta-glucosidase activity of 94 strains, representing 24 species of the genera Gilbertella, Mucor, Rhizomucor , and Rhizopus was evaluated in submerged culture and under solid state fermentation on wheat bran. Gilbertella persicaria G1 isolate showed the highest activity (70.9 U ml -1 ) followed by other Gilbertella (58.6-59.0 U ml -1 ) and Rhizomucor miehei isolates (29.2-42.0 U ml -1 ). Optimum temperature for enzyme production was 25 degrees C for Gilbertella and Mucor , and 30 degrees C for Rhizomucor and Rhizopus strains. Enzymes of R. miehei strains proved to be thermotolerant preserving up to 92.8% residual activity after heating to 75 degrees C in the presence of cellobiose substrate. Enzymes of Mucor racemosus f. chibinensis, R. miehei and Rhizopus microsporus var. oligosporus strains were activated at acidic condition (pH 4). Glucose was a strong inhibitor for each fungal beta-glucosidase tested but some of them showed ethanol tolerance up to 20% (v/v). Ethanol also activated the enzyme in these strains suggesting glycosyl transferase activity.

The necessity of recognizing all events in X-ray detection

In our work in studying properties of inner shell ionization, we are troubled that the experimental data used to determine the basic parameters of X-ray physics have a large and unexplainable scatter. As we looked into the problems we found that many of them contradict simple logic, elemental arithmetic, even parity and angular momentum conservation laws. We have identified that the main source of the problems, other than the human factor, is rooted in the signal processing electronics. To overcome these problems we have developed a fully digital signal processor, which not only has excellent resolution and line shape, but also allows proper accounting of all events. This is achieved by processing all events and separating them into two or more spectra (maximum 16), where the first spectrum is the accepted or good spectrum and the second spectrum is the spectrum of all rejected events. The availability of all the events allows one to see the other part of the spectrum. To our surprise the total information explains many of the shortcomings and contradictions of the X-ray database. The data processing methodology cannot be established on the partial and fractional information offered by other approaches. Comparing Monte Carlo detector modeling results with the partial spectra is ambiguous. It suggests that the metrology of calibration by radioactive sources as well as other X-ray measurements could be improved by the availability of the proper accounting of all events. It is not enough to know that an event was rejected and increment the input counter, it is necessary to know, what was rejected and why it happened, whether it was a noise or a disturbed event, a retarded event or a true event, or any pile up combination of these events. Such information is supplied by our processor reporting the events rejected by each discriminator in separate spectra. Several industrial applications of this quality assurance capable signal processor are presented.

Phylogeny and character evolution of the coprinoid mushroom genus Parasola as inferred from LSU and ITS nrDNA sequence data

Phylogenetic relationships, species concepts and morphological evolution of the coprinoid mushroom genus Parasola were studied. A combined dataset of nuclear ribosomal ITS and LSU sequences was used to infer phylogenetic relationships of Parasola species and several outgroup taxa. Clades recovered in the phylogenetic analyses corresponded well to morphologically discernable species, although in the case of P. leiocephala, P. lilatincta and P. plicatilis amended concepts proved necessary. Parasola galericuliformis and P. hemerobia are shown to be synonymous with P. leiocephala and P. plicatilis, respectively. By mapping morphological characters on the phylogeny, it is shown that the emergence of deliquescent Parasola taxa was accompanied by the development of pleurocystidia, brachybasidia and a plicate pileus. Spore shape and the position of the germ pore on the spores showed definite evolutionary trends within the group: from ellipsoid the former becomes more voluminous and heart-shaped, the latter evolves from central to eccentric in taxa referred to as 'crown' Parasola species. The results are discussed and compared to other Coprinus s.l. and Psathyrella taxa. Homoplasy and phylogenetic significance of various morphological characters, as well as indels in ITS and LSU sequences, are also evaluated.

High-affinity iron permease (FTR1) gene sequence-based molecular identification of clinically important Zygomycetes

The clinical importance of zygomycosis, an emerging and frequently fatal mycotic disease, has increased during recent years. This report describes an identification method based on PCR amplification and sequencing of the high-affinity iron permease 1 gene (FTR1). Primers and amplification protocols were established and tested for the identification of Rhizopus oryzae, Rhizopus microsporus var. rhizopodiformis, R. microsporus var. oligosporus, Rhizopus schipperae, Rhizopus niveus and Rhizopus stolonifer. Rhizomucor and Syncephalastrum could be identified at the genus level. PCR-restriction fragment length polymorphism analysis of the amplified gene fragment using AluI digestion distinguished three subgroups among the R. oryzae isolates.

Agrobacterium tumefaciens-mediated transformation ofMucor circinelloides

The Agrobacterium tumefaciens-mediated transformation of the zygomycetous fungus Mucor circinelloides is described. A method was also developed for the hygromycin B-based selection of Mucor transformants. Transformation with the hygromycin B phosphotransferase gene of Escherichia coli controlled by the heterologous Aspergillus nidulans trpC promoter resulted in hygromycin B-resistant clones. The presence of the hygromycin resistance gene in the genome of the transformants was verified by polymerase chain reaction and Southern hybridization: the latter analyses revealed integrations in the host genome at different sites in different transformants. The stability of transformants remained questionable during the latter analyses.

Quality assurance challenges in X-ray emission based analyses, the advantage of digital signal processing

There is a large scatter in the results of X-ray analysis with solid-state detectors suggesting methodological origin. In order to improve the methodology, detector response functions have been investigated by many researchers and analysts. This was necessary as the departure of the response function of some detector-signal processing electronics from the normally assumed Gaussian line shape can exceed 100% in area. Several detector models have been proposed to improve understanding and establish a firm basis for quantitative work. After reviewing some contradictory results, we describe a signal processor that offers quality assurance, by producing two spectra for each measurement. One is the normal spectrum of accepted events, while the second spectrum contains all of the rejected events. For each measurement, therefore, all X-ray events are recorded, enabling quality control. In addition to this improvement, the digital signal processor of Cambridge Scientific, Canada, delivers a high throughput rate, excellent resolution, decreased low energy tailing and a line shape justified by the physics of the detector. Comparative measurements are presented to demonstrate the improved rejection of background from gamma rays as well as a significant improvement in pile-up recognition. The rejected events spectrum gives insight into the origin of the response function, which suggests that the flat plateau of the frequently used Hypermet function, normally attributed to detector dead layers, originates from pile-up with the low energy noise events. A detailed analysis demonstrates how the relative intensities of the X-ray lines can change in a varying noise environment, thus potentially explaining the unacceptable large scatter in the experimental data currently found in the literature. The comparison of the accepted and rejected events adds the possibility of monitoring the electronic efficiency of signal recognition that has generally been ignored in this field.

Iron gathering of opportunistic pathogenic fungi. A mini review

Iron is an essential nutrient for most organisms because it serves as a catalytic cofactor in oxidation-reduction reactions. Iron is rather unavailable because it occurs in its insoluble ferric form in oxides and hydroxides, while in serum of mammalian hosts is highly bound to carrier proteins such as transferrin, so the free iron concentration is extremely low insufficient for microbial growth. Therefore, many organisms have developed different iron-scavenging systems for solubilizing ferric iron and transporting it into cells across the fungal membrane. There are three major mechanisms by which fungi can obtain iron from the host: (a) utilization of a high affinity iron permease to transport iron intracellularly, (b) production and secretion of low molecular weight iron-specific chelators (siderophores), (c) utilization of a hem oxygenase to acquire iron from hemin. Patients with elevated levels of available serum iron treated with iron chelator, deferoxamine to remedy iron overload conditions have an increased susceptibility of invasive zygomycosis. Presumably deferoxamine predisposes patients to Zygomycetes infections by acting as a siderophore]. The frequency of zygomycosis is increasing in recent years and these infections respond very poorly to currently available antifungal agents, so new approaches to develop strategies to prevent and treat zygomycosis are urgently needed. Siderophores and iron-transport proteins have been suggested to function as virulence factors because the acquisition of iron is a crucial pathogenetic event. Biosynthesis and uptake of siderophores represent possible targets for antifungal therapy.

Isolation of bovine adenovirus serotype 6 from a calf in the United Kingdom

Two viruses, designated 99-8130(C) and 99-8130(I), were isolated in calf testis cells from the colon and ileum, respectively, of a suckled beef calf which had developed dysentery and died. Electron microscopy indicated that the mean (sd) size of the viral particles, 83 (2.5) nm, and their morphology were consistent with their being members of the family Adenoviridae. They were confirmed as adenoviruses by PCR when products of the expected size (608 bp) were amplified from both isolates by using a primer pair specific for members of the genus Atadenovirus. A comparison of the sequence of a 567 bp segment of the 99-8130(C) amplicon with that of other prototype bovine adenovirus (BAdV) strains of atadenoviruses identified the isolate as BAdV serotype 6 (BAdV-6), which had 99.3 per cent and 100 per cent identities at the nucleotide and amino acid levels, respectively, with the prototype BAdV-6 strain 671130. A virus neutralisation test was developed and indicated a high prevalence of antibody to BAdV-6 in Northern Irish cattle. There was no evidence of adenoviral inclusions in tissues from the affected calf and no antigen was detected when the tissues were stained by an immunoperoxidase technique, using a homologous antiserum raised in rabbits. The two viruses were the third reported isolation of BAdV-6, and the first from a clinically ill bovine animal.

Phylogenetic relationship of the genus Gilbertella and related genera within the order Mucorales based on 5.8 S ribosomal DNA sequences

The complete ITS (internal transcribed spacer) region coding the ITS1, the ITS2 and the 5.8S rDNA was amplified by polymerase chain reaction from two strains of Gilbertella persicaria, six strains in the Mucoraceae (Mucor piriformis, M. rouxii, M. circinelloides, Rhizomucor miehei, R. pusillus and R. tauricus) and four strains representing three species of the Choanephoraceae (Blakeslea trispora, Choanephora infundibulifera and Poitrasia circinans). Sequences of the amplified DNA fragments were determined and analysed. G. persicaria belongs to the monogeneric family (Gilbertellaceae), however, originally it was described as Choanephora persicaria. The goal of this study was to reveal the phylogenetic relationship among fungi belonging to Gilbertellaceae, Choanephoraceae and Mucoraceae. Our results support that the "intermediate" position of this family is between Choanephoraceae and Mucoraceae.

Variation of isoenzyme and RAPD patterns in Candida albicans morphological mutants with altered colony ultrastructure

Molecular typing methods were applied to characterize four stable morphological mutants [1] isolated from a UV-induced unstable mutant colony of Candida albicans. The wild-type strain (ATCC 64385), the intermediate unstable mutant and its four morphologically altered derivatives revealed the same electrophoretic karyotypes. Of the five isoenzymes tested (catalase, malate dehydrogenase, glutamate dehydrogenase, acid phosphatase and 3-glucosidase), glutamate dehydrogenase displayed a different enzyme pattern (with an extra band of lower mobility) in the morphological mutants. In contrast, the random amplification DNA polymorphism patterns of the mutant strains differed in all cases from that of the parental strain. Different primers revealed various degrees of DNA polymorphism; one of them (OPC-8) proved to be useful for differentiation between all examined strains. Differences in genetic alterations between spontaneous and induced mutants, and the applicability of different molecular markers to analyse the consequences of induced mutagenesis in C. albicans are discussed.

Variability of isozyme and rapd markers among isolates of Mucor genevensis

Mucor genevensis is a dimorphic and homothallic fungal species (Zygomycetes). Ten M. genevensis strains, each strain of the recently described new homothallic species (M. meguroense and M. hachijyoensis) and strains of M. hiemalis and M. piriformis (as outgroups for numerical analysis) were investigated. Five different enzyme systems (CAT, GDH, G6D, MDH and SOD) and five 10-bp random primers were used in isoenzyme and random amplified polymorphic DNA analyses, respectively. The data from these studies were subjected to numerical analyses. Substantial intraspecific variability was detected in M. genevensis with both of the methods applied. Though both the M. meguroense strain and the M. hachijyoensis strain revealed characteristic differences, they grouped closer to the homothallic M. genevensis than to the heterothallic M. piriformis and M. hiemalis strains.

Genetic variability of the postharvest pathogen Gilbertella persicaria: identification of randomly amplified polymorphic DNA (RAPD) markers correlating with (+) and (-) mating types

Random amplified polymorphic DNA (RAPD) and isoenzyme polymorphisms among 16 isolates of the postharvest pathogen Gilbertella persicaria were examined. Six different 10-bp primers were used to determine the extent of intraspecific genetic variability. Nine composite amplification types were identified. RAPD markers were obtained which correlated with the mating types of the G. persicaria isolates. The variability of the isoenzyme patterns was very low and no correlation was found between the isoenzyme markers and the mating abilities. When 80 single carbon substrates were tested in utilization assays, most of them were utilized uniformly by the 16 G. persicaria strains. However, some compounds elicited differences between the isolates representing the two mating types. Beta-alanine (0.2%) has little effect on the germination of the sporangiospores of the (+) isolates, but inhibited the germination of (-) sporangiospores. Glycerol-1-monoacetate supported the growth of both mating types, but at concentrations higher than 4% this was accompanied with a compact (colonial) growth for plus mating type isolates only.

Mutational analysis of the PTEN/MMAC1 tumour suppressor gene in primary human malignant mesotheliomas

Eighteen primary human malignant mesotheliomas obtained from 18 patients were screened for point mutations and microdeletions/insertions in all exons of the tumour suppressor gene PTEN/MMAC1 by SSCP analysis. No mutation could be found. Our preliminary data indicate that disarrangements of PTEN/MMAC1 are at least not frequently involved in mesothelioma formation.

Presence of double-stranded RNA and virus-like particles in Rhizopus isolates

Fungal isolates belonging to four Rhizopus species were screened for the presence of double-stranded RNA (dsRNA) molecules. Five (two R. stolonifer, two R. microsporus, and one R. oryzae) of the 27 isolates examined harboured such genetic elements. Electrophoresis of the nucleic acids revealed five RNA patterns, with 1-5 discrete dsRNA bands. The molecular sizes corresponding to these bands were 2.2-14.8 kb. Gel electrophoresis of purified virus-like particles (VLPs) indicated only one capsid of similar size in all virus-harbouring strains; when investigated by electron microscopy, they were found to be polyhedral VLPs 40 nm in diameter. In one of the R. microsporus isolates an uncapsidated large dsRNA segment (14.8 kb) was observed. No phenotypic differences were observed between uninfected and virus-harbouring Rhizopus isolates.

Intraspecific variation in two species of Rhizomucor assessed by random amplified polymorphic DNA analysis

Twenty-three Rhizomucor isolates were characterized by random amplified polymorphic DNA-PCR (RAPD-PCR) with 10-bp oligonucleotide primers. These data were used for numerical analyses to obtain information on the intraspecific genetic polymorphism of Rhizomucor species. The genetic variability in Rhizomucor pusillus and Rhizomucor miehei isolates was found to differ; the latter revealed less intraspecific polymorphism. The different levels of genotypic diversity suggest a correlation with the different forms of mating behaviour of these species. Rhizomucor tauricus displayed amplification patterns similar to those of the investigated R. pusillus strains, reinforcing the assumption that R. tauricus does not represent a separate species. Characteristic RAPD markers allowing PCR-based species identification of Rhizomucor isolates were determined.

Mutational analysis of N-ras, p53, p16INK4a, p14ARF and CDK4 genes in primary human malignant mesotheliomas

Nineteen specimens from primary human malignant mesotheliomas obtained from 19 patients were screened for activating point mutations in the oncogenes N-ras and CDK4 by combined RFLP-PCR/SSCP analysis. In addition, all tumours were screened for deletions and point mutations in the tumour suppressor genes p53, p16INK4a (CDKN2A) and p14ARF (exon-1beta) by combined multiplex-PCR/SSCP analysis. No mutations were found in N-ras, p53 and CDK4. Three tumours displayed homozygous deletion (co-deletion of exons 1, 2 and 3) of p16INK4a. One of them displayed additional homozygous deletion of p14ARF (exon-1beta). Two silent point mutations and 2 polymorphisms were found in p16INK4a in 3 tumours. Our preliminary data indicate that disarrangement of the Rb1 pathway may be involved in mesothelioma formation.

Mutational analysis of the N-ras, p53, p16INK4a, CDK4, and MC1R genes in human congenital melanocytic naevi

Eighteen human congenital melanocytic naevi (CMN) from 17 patients were screened for activating point mutations in the oncogenes N-ras and CDK4 and for sequence variants in the MC1R gene by combined RFLP-PCR/SSCP analysis. In addition, all lesions were screened for deletions and point mutations in the tumour suppressor genes p53 and p16INK4a (CDKN2A) by combined multiplex PCR/SSCP analysis. Positive screening data were specified by sequencing of the corresponding PCR product. Activating point mutations in the N-ras gene (nine CAA (Gln) to AAA (Lys) transversions and one CAA (Gln) to CGA (Arg) transition at codon 61) were detected at high frequency (56%). Furthermore, three missense mutations (V92M) and two silent mutations (CGA (Arg) to CGG (Arg), codon 213, exon 6) were found in the MC1R and p53 genes, respectively. No mutations were found in p16 or CDK4. The activated N-ras oncogene, which is also found in human cutaneous melanomas, may constitute a potential risk factor for melanoma formation within CMN.

The mitochondrial genome of Mucor piriformis

DNA was purified from the isolated mitochondria of a Mucor piriformis wild-type strain (NRRL 26211). A circular restriction map of the mitochondrial DNA was established on the basis of single and double digests with several restriction endonucleases. The average mitochondrial DNA size calculated from these data was 33.53 kbp; this is in good agreement with the contour length size (33.62 kbp) of the open circular molecules detected by electron microscopy. Heterologous hybridizations with cloned Aspergillus nidulans mitochondrial genes were used to locate some coding regions on the map.

Differentiation of Rhizomucor species by carbon source utilization and isoenzyme analysis

Nineteen Rhizomucor miehei and Rhizomucor pusillus isolates were assayed for their ability to utilize 87 various substrates as a single carbon source. Besides a difference in sucrose utilization, distinctive differences were found in the utilization of glycine, phenylalanine, and beta-alanine. Five isoenzyme systems also proved useful for the determination of markers of distinctive value at a species level. Data were used to obtain information about the genetic polymorphism of these species: a high degree of variability was found among the R. pusillus isolates, whereas the group of R. miehei isolates was more homogeneous genetically.

Detection of double-stranded RNA molecules and virus-like particles in different Mucor species

The presence of double-stranded RNA elements was examined in 123 strains representing 18 Mucor species. These genetic elements were found to be present in 6 strains: 1 M. aligarensis, 1 M. hiemalis, 2 M. corticolus, 1 M. mucedo and 1 M. ramannianus. Electrophoretic separation of the nucleic acids revealed 4 different RNA patterns, with 1 to 5 discrete dsRNA bands. The molecular weights corresponding to these bands were 1.42-4.15 x 10(6) D. Using electronmicroscopy, for the first time the presence of virus like particles in Mucor species has been revealed.

Detection of hyperdiploidy and chromosome breakage affecting the 1 (1cen-q12) region in lentigo malignant melanoma (LMM), superficial spreading melanoma (SSM) and congenital nevus (CN) cells in vitro by the multicolor FISH technique

The centric/pericentric region of chromosome 1 (cen-q 2) of human melanoma cells of different stages of carcinogenicity (superficial spreading melanoma (SSM), lentigo malignant melanoma (LMM)) and premalignant precursor lesions (congenital nevus (CN)) were investigated by fluorescence in situ hybridization (FISH) with tandem DNA probes. The pericentric heterochromatin region 1(q12) is large and highly prone to breakage in contrast to the adjacent centromeric region which is much smaller and less prone to such events. All samples of melanoma cells were obtained from patients and cultivated in vitro. LMM cells showed the highest number of breakage events within the 1q12 region (90% of cells). The number of hyperdiploid cells was not increased in comparison to CN cells. In contrast to LMM cells, SSM cells showed a significant increased number of hyperdiploid cells which were mainly tetrasomic for chromosome 1 (P < or = 0.05). The number of chromosome breaks was not significantly increased in this type of melanoma cells. The spontaneous rates of chromosomal breakage and hyperdiploidy is relatively low in CN cells (1.5-2.5% and 3.2-5.8%, respectively) but these frequencies also differ between CN samples from different patients. These results show that the multicolor FISH technique represents a fast and reliable detection method, distinguishing structural and numerical chromosomal alterations in interphase nuclei. This technique is useful as a histological marker to differentiate between specific tumor subtypes and to investigate the relationship between genomic instability and clinopathological parameters (tumor grading and staging).

DNA amplification polymorphisms of Mucor piriformis

Mucor piriformis can cause postharvest decay in various fruits and vegetables stored at low temperatures. Thirty isolates of this fungus, collected from infected fruit, were subjected to random amplified polymorphic DNA (RAPD) analysis. Seven different 10-bp primers were used to determine the type and extent of intraspecific genetic polymorphisms. Nineteen composite amplification types were identified, indicating a higher degree of variability than found in previous isoenzyme studies. Numerical analysis with the UPGMA technique revealed three clusters, which correlated with the mating competency of the isolates or their place of origin. These results demonstrate that RAPD analysis can identify isolates and subspecific populations of M. piriformis.

Significant antenatal factors in the development of lumbar spinal stenosis

STUDY DESIGN

Adverse factors during pregnancy may permanently stunt the growth of the spinal canal. Subsequently, even in an optimal environment the canal cannot catch up in growth with the trunk and long bones because of its early maturation. The degree of retardation in canal size depends on the severity and timing of the adverse effect. The catch-up growth of the long bones mask the narrow canal, because the latter does not have growth potential, resulting in an adult of sufficient height and good proportions, but with a canal at risk for stenosis.

OBJECTIVES

To investigate the influence of the antenatal environment on the growth of the lumber spinal canal.

SUMMARY OF BACKGROUND DATA

To date, little is known about the effects of an adverse environment on the growth of the spinal canal, and no data have been reported on antenatal influencing factors.

METHODS

Lumbar magnetic resonance imaging scans from 58 patients were examined. Dimensions of the central spinal canals were measured by computerized image analysis and compared with the subjects' obstetric data from their mothers' pregnancies.

RESULTS

The L3 canal was found to be the most sensitive to the influence of the examined factors. Gestational age was the most significant factor; if short, it resulted in small adult canal. Small placental weight, greater maternal age, primiparity, low socioeconomic class, and low birth weight were also found to be significant in affecting the growth of the canal.

CONCLUSIONS

An adverse antenatal environment does have a permanent, retarding effect on the growth of the lumbar spinal canal.

An in vitro study of the biomechanical effects of flexible stabilization on the lumbar spine

STUDY DESIGN

Lumbar motion segments were tested in vitro to examine biomechanical changes after posterior fixation by a flexible device.

OBJECTIVES

To assess changes in load distribution and conformation of vertebral structures after a flexible stabilization. This should provide the foundations for a scientific understanding of the immediate effects of this surgical procedure.

METHODS

Hooks were placed over the proximal spinous process and the distal laminas of a motion segment and connected by a polyester braid. Tension applied to the braid then generated a compression of the posterior elements. The force between the articular facets, the displacement of the posterior anulus fibrosus of the intervertebral disc, and the change in the relative position of the adjacent vertebrae were measured as the applied tension was increased.

RESULTS

Facet joint force, disc bulge, and vertebral angulation increased with applied tension until a position of "locking" was achieved, apparently when the bony margin of the superior half of the facet joint contacted the inferior pars interarticularis. A tension of between 50 to 100 N in the braid was required for this. Facet joint force was less than 40% of this, and disc bulge was only 0.15 mm. The extension of the motion segment was between 2 degrees and 8 degrees.

CONCLUSIONS

The results suggest that if such a system is applied surgically, stabilization is produced by compaction of the bony margins of the facet joints. Only a relatively small proportion of the posteriorly applied load is carried by the facet joints themselves, and little angulatory change is expected with minimal disc bulge.

Lack of p53 mutations and loss of heterozygosity in non-cultured human melanocytic lesions

In this study we analysed snap-frozen surgical resections of 16 superficial spreading melanomas, 13 nodular malignant melanomas, 2 lentigo maligna melanomas, 1 dysplastic nevus, 1 congenital nevus and 5 normal nevi from 38 patients for point mutations in the human p53 gene at exons 5-8 by polymerase chain reaction/single-strand conformation polymorphism as well as for loss of heterozygosity of p53 by restriction-fragment-length polymorphism/polymerase chain reaction in order to determine whether p53 aberrations are associated with melanoma subtypes. In addition, we analysed six melanoma cell lines for point mutations in p53. Our results revealed the absence of point mutations and loss of heterozygosity in all fresh resected lesions. However, a TAC (Tyr) to TGC (Cys) transition at codon 163 in exon 5 was found in one cell line.

Trefoil configuration and developmental stenosis of the lumbar vertebral canal

The midsagittal and interpedicular diameters and the trefoil shape of lumbar vertebrae of known age at death were measured in skeletons from a population aged between 1 and 70 years. All the trefoil configurations were at L5 with the exception of one at L4. The overall prevalence was 25%, but this shape was not generally apparent until adulthood. The midsagittal diameter in the trefoil canals was found to be significantly smaller than that in the unaffected canals. This did not change significantly after six years of age indicating that the cause of the trefoil configuration is probably present early in life. The trefoil shape was no more common in the spines of the elderly subjects. Our findings indicate that the trefoil configuration of the lumbar vertebral canal has a developmental origin and is not a consequence of degenerative processes.

Mineral fibers induce apoptosis in Syrian hamster embryo fibroblasts

It is known that asbestos and other mineral fibers induce lung cancer and mesothelioma. However, the primary mechanisms of fiber-induced carcinogenesis still remain to be elucidated. Previous studies, including our own, have shown that asbestos causes specific mitotic disturbances, micronucleus formation and typical changes in chromatin structure resembling those of apoptosis. This effect has been considered as programmed cell death removing damaged or pre-cancerous cells. We investigated the induction of apoptosis by asbestos (amosite, crocidolite, chrysotile) and ceramic fibers. The typical ladder pattern of DNA fragments was identified by means of gel electrophoresis, the intracellular calcium concentration was measured and flow cytometry analyses were carried out to determine the percentage of apoptotic cells. The different fibers showed different potencies for the induction of apoptosis in Syrian hamster embryo (SHE) cells. Depending on the type of fiber applied 3-33% of cells underwent apoptosis. Chrysotile proved to be the most potent inducer of apoptosis compared to the other fibers. In addition, an increase intracellular calcium level was observed in apoptotic SHE cells. Chrysotile induced apoptosis after a considerably longer exposure time (66-72 h) than cisplatin (24 h). In view of these findings we hypothesize that chrysotile induces apoptosis resulting from long-term changes in intracellular regulation pathways.

Analysis of ras mutations in human melanocytic lesions: activation of the ras gene seems to be associated with the nodular type of human malignant melanoma

We have analyzed the Ha-ras, Ki-ras and N-ras gene for point mutations at codons 12, 13 and 61 via restriction fragment length polymorphism/polymerase chain reaction analysis and subsequent direct sequencing in non-cultured fresh-frozen tissues of 16 superficial spreading melanomas (SSM), 13 nodular malignant melanomas (NMM), 2 lentigo malignant melanomas (LMM), 1 dysplastic nevus, 1 congenital nevus and 5 normal nevi from 38 patients. Mutations were found in 4 melanoma samples, all belonging to the nodular malignant type. Three of them were mutated in N-ras and one in the Ha-ras gene. Mutation in N-ras was also detected in the congenital nevus. All mutations were exclusively located at the first two base pairs of codon 61. No Ki-ras mutation was detected in any lesion. No mutation could be found in SSM and LMM in addition to dysplastic and normal nevi. The frequency of ras mutation in NMM was 31%, whereas in SSM it was 0%. Our study suggests (a) an association between ras mutations (mainly N-ras) and the NMM as a subgroup of human melanoma; (b) that activation of Ki-ras is not involved in the pathogenesis of melanoma. The role of UV radiation in point mutations of ras genes in human melanoma is discussed.

The growth of the lumbar vertebral canal

STUDY DESIGN

This study examines the growth and development of the lumbar spinal canal with emphasis on early life.

OBJECTIVE

Changes in dimensions of the canal were investigated throughout life.

SUMMARY OF BACKGROUND DATA

Seven hundred and fifteen lumbar vertebrae were examined from the Spitalfield Collection of Skeletons at the Natural History Museum, London.

METHODS

Unmagnified silhouette pictures were taken of the canals with a specially designed photographic box. Computerized image analysis provided the accurate measurements.

RESULTS

Regarding the midsagittal diameter and the cross-sectional area, the cranial four lumbar vertebrae were already fully matured in infants. At L5 there was significant increase up to 4 years of age when the midsagittal diameter was even larger than in the adult. The interpedicular diameter significantly increased at L1 until 10 years of age, at the other levels until adulthood, as did the perimeter at L4 and L5 until 14 years of age. The shape of the canal was assessed by measuring the circularity, the 'trefoilness' and the situation of the centroid. The first measurement significantly decreased with age, the trefoilness increased until adulthood, and the centroid of the canal approached the vertebral body. In spines with spina bifida occulta, the lumbar canal was significantly larger proximal to the lesion than in the unaffected spines.

CONCLUSION

The lumbar spinal canal exhausts its growth potential by infancy as regards the midsagittal diameter and the cross-sectional area. Thus, in the case of delayed development, it is not capable of catch-up growth.

Changes of the lumbar spinal canal proximal to spina bifida occulta. An archaeologic study with clinical significance

STUDY DESIGN

This archaeologic study, based on four populations, examines the incidence of spina bifida occulta in the lumbar spine and the size of the vertebral canal proximal to the lesion.

OBJECTIVES

To ascertain any significant change in the dimensions of the lumbar spinal canal of skeletons with spina bifida occulta. The incidence of the lesion also was compared in the separate genetic groups.

METHODS

Central canals of 1760 lumbar vertebrae were examined. Silhouette, unmagnified pictures of the vertebral canals were measured by computerized image analysis.

RESULTS

The mid-sagittal diameter at L4 and L5 and the cross-sectional area at L5 were found to be significantly larger proximal to the lesion compared with the unaffected spines. The overall incidence was 18%.

CONCLUSIONS

The capacity of the lumbar canal is greater proximal to spina bifida occulta. Therefore, delayed closure of the neural arch at a single segment has morphologic significance to the more proximal spine.

Cytogenetic changes in primary, immortalized and malignant mammalian cells

Some chromosomes in transformed rat cells and somatic cell hybrids fail to display the presence of kinetochore proteins as detected by antikinetochore antibodies. Such chromosomes (K- chromosomes) may constitute a novel mechanism for the genesis of aneuploidy. We have analyzed primary, immortalized and malignant mammalian cells for the presence of kinetochore proteins and micronuclei. Our results suggest a correlation of the K- chromosome and micronucleus frequency with the variability in chromosome number. Upon in situ hybridization with the minor satellite and alpha satellite sequences some K- chromosomes showed a signal. This indicates that the observed lack of kinetochores is not necessarily due to a lack of centromeric DNA. We conclude that dislocated K- chromosomes may become incorporated into micronuclei which are prone to loss. Such events would be associated with the generation of aneuploidy.

Introducing foreign genes into fish eggs with electroporated sperm as a carrier

A new method has been developed for introduction of foreign genes into fish eggs. The procedure is based on the incubation of fish sperm cells suspended in dilute citrate solution with plasmid DNA, followed by application of high-field-strength electrical pulses (electroporation) to increase DNA binding., uptake, or both. Tissue homogenates and genomic DNA extracts of free swimming fry developed from eggs fertilized with treated sperm was tested to evaluate the efficiency of gene transfer. Dot blot hybridization and gene expression assay demonstrated the presence and expression of the reporter genes introduced in 2.6 to 4.2% of several hundreds of tested larvae of common carp (Cyprinus carpio L.), African catfish (Clarias gariepinus), and tilapia (Oreochromis niloticus). No transgene has been found in the fry resulting from parallel experiments without sperm electroporation. This is the first report on successful application of electroporated sperm cells for production of transgenic fish.