High prevalence of hepatitis A and B nonimmunity in pediatric liver transplant recipients

BACKGROUND

Pediatric liver transplant recipients are at increased risk of post-transplant infections. The purpose of this study was to quantify hepatitis A and B non-immunity based on antibody titers in liver transplant recipients.

METHODS

We conducted a retrospective chart review of 107 pediatric liver transplant recipients at a single medical center from 2000 to 2017. We compared hepatitis immune patients to non-immune patients and studied response to vaccination in patients immunized post-transplantation.

RESULTS

Eighty-one percent of patients had pre-transplant immunity to hepatitis A whereas 68% had pre-transplant immunity to hepatitis B. Post-transplant hepatitis B immunity decreased to 33% whereas post-transplant hepatitis A immunity remained high at 82%. Older age and time since transplantation were significantly associated with hepatitis B non-immunity. Most patients responded to doses post-transplantation with 78% seroconversion following hepatitis A re-immunization and 83% seroconversion following hepatitis B re-immunization.

CONCLUSIONS

Pediatric liver transplant recipients are at risk of hepatitis A and B non-immunity, particularly with respect to hepatitis B. Boosters post-transplant may improve immunity to hepatitis viruses.

Immunohistochemical ALK Expression in Granular Cell Atypical Fibroxanthoma: A Diagnostic Pitfall for ALK-Rearranged Non-neural Granular Cell Tumor

ABSTRACT

Atypical fibroxanthoma (AFX) is a neoplasm that most commonly occurs on sun-damaged skin of the head and neck in elderly patients and that usually exhibits indolent clinical behavior with complete excision. The granular cell variant of AFX demonstrates overlapping histopathologic features with dermal non-neural granular cell tumor (NNGCT), which typically arises on the extremities of young to middle aged adults with rare reports of regional metastasis. A subset of NNGCT harbors ALK rearrangements and expresses ALK by immunohistochemistry. Here, we present 2 cases of granular cell AFX occurring on the scalp of males aged 73 and 87 with ALK expression by immunohistochemistry and no evidence of an ALK rearrangement on fluorescence in situ hybridization, representing a diagnostic pitfall for NNGCT.

The Effect of Radium-223 Therapy in Agent Orange-Related Prostate Carcinoma

Background

Radium-223 (Ra-223) radioisotope has been reported to increase median survival in bone metastatic prostate carcinoma. The addition of Ra-223 to abiraterone was associated with an increased risk of bone fractures. There has been no comprehensive data for using Ra-223 in veterans who were exposed to Agent Orange (AO+).

Methods

We present a retrospective study of veterans with bone metastatic castration-resistant prostate cancer (CRPC) who received standard doses of Ra-223 and other sequential therapies at US Department of Veterans Affairs Pittsburgh Healthcare System in Pennsylvania from January 2014 to January 2019. Veterans were divided into 2 groups: those who were exposed to Agent Orange (AO+) and those who had no exposure (AO-). Time to study was calculated from the initiation of Ra-223. Time to skeletal-related events (SRE), progression of prostate specific antigen (PSA), bone metastasis, and alkaline phosphatase (ALP) were calculated in months using unpaired t test with 2-tailed P values. Median survival was calculated by Kaplan Meier R log-rank test.

Results

There were 34 veterans with bone metastatic CRPC: 17 veterans (50%) were AO+ and 17 veterans (50%) were AO-. The mean age of diagnosis of AO+ veterans was 62 years and 69 years (P = .005) for AO- veterans (the mean Gleason score 8.2 and 8.0, respectively [P = .71]). The median number of Ra-223 cycles was 6 (60%). Ten veterans received Ra-223 as first line (29%) and 24 veterans received Ra-223 later (71%). There were 12 SREs with median survival of 15 months. There was no difference in mean time to SRE between AO+ (8 veterans, 10.6 months) and AO- (4 veterans, 10.3 months) (P = .93). The mean time to PSA progression for AO+ was 5.4 months and AO- was 6.8 months (P = .28). Mean time to bone progression for AO+ was 7.6 months and AO- was 10.1 months (P = .16). Mean time to ALP progression for AO+ and AO- was 6.3 months and 8.7 months, respectively (P = .05). Twenty veterans (58%) had died. Median survival for Ra-223 first was 32 months and for Ra-223 later was 15 months (P = .14; hazard ratio [HR] 0.48; 95% CI, 0.17-1.3). Median survival for AO+ and AO- veterans was 12 months and 18 months, respectively (P = .15; HR, 2.0; 95% CI, 0.77-5.0).

Conclusions

There was no statistical difference between AO+ and AO- veterans in terms of time to SRE, PSA, bone and ALP progression, even though there was a trend of shorter duration in AO+ veterans. There was no median survival difference between Ra-223 first vs Ra-223 later as well as between AO+ and AO- but there is a trend of worse survival in AO+ veterans.

Evaluation of accuracy of the Finnish elbow dysplasia screening protocol in Labrador retrievers

OBJECTIVE

To determine whether the current Finnish screening method using a single flexed mediolateral view as scored by osteophyte is sufficient to diagnose mild elbow dysplasia in Labrador retrievers and to determine if an additional craniocaudal oblique projection would result in improvement in the screening protocol.

MATERIALS AND METHODS

Thirteen dogs with one mildly affected elbow joint and one elbow joint without radiological evidence of osteophytes were studied. Radiographic and computed tomography studies were performed and the results compared with each other.

RESULTS

Medial compartment disease was observed in 14 of 26 joints based on computed tomography. The sensitivity and specificity of the grading based mainly on osteoarthritis was 79 and 92%, respectively. A strong association existed between elbow dysplasia based on computed tomography and medial humeral epicondylar osteophytes on the craniocaudal projection.

CLINICAL SIGNIFICANCE

A single mediolateral flexed radiograph is reliable in diagnosing mild elbow dysplasia in Labrador retrievers. However, the craniocaudal oblique projection increases the specificity of the diagnosis, and it is proposed that it be included in the radiographic protocol in this breed.

Glycoprotein C of bovine herpesvirus 5 (BHV-5) confers a distinct heparin-binding phenotype to BHV-1

Bovine herpesvirus type 1 (BHV-1) causes respiratory and genital diseases in cattle, whereas the closely related BHV-5 can induce severe meningoencephalitis in calves. To characterize BHV-5 glycoprotein C (gC5) within the backbone of BHV-1, three consecutive recombinant viruses were constructed: A deletion mutant (rBHV-1delta gC blue) with gC replaced by the lacZ gene, an exchange mutant (rBHV-1gC5) with the lacZ of BHV-1delta gC blue exchanged by gC5, and a rescue mutant (rescue BHV-1) from rBHV-1gC5 with an additional XbaI site in gC1. The recombinant and wildtype viruses were characterized on MDBK cells. Although no significant differences were observed in growth behaviour and entry kinetics, rBHV-1gC5 showed a distinct phenotype in a heparin blocking assay. The gC5 was able to transfer the heparin binding phenotype of BHV-5 to BHV-1. This indicates that gC1 and gC5 differ in their receptor binding qualities, which might modulate the ability of the viruses to spread within the central nervous system.