Genetic confirmation of Octopus insularis (Leite and Haimovici, 2008) in South Florida, United States using physical features and de novo genome assembly

The distribution of octopuses within the Octopus vulgaris species complex remains inadequately understood. Species determination can be complex and involves characterizing a specimen's physical features and comparing its genetic makeup to other populations. In this study, we present the first genetic confirmation of Octopus insularis (Leite and Haimovici, 2008) inhabiting the coastal waters of the Florida Keys, United States. We employed visual observations to identify species-specific body patterns of three wild-caught octopuses and used de novo genome assembly to confirm their species. All three specimens exhibited a red/white reticulated pattern on their ventral arm surface. Two specimens displayed body pattern components of deimatic display (white eye encircled by a light ring, with darkening around the eye). All visual observations were consistent with distinguishing features of O. insularis. We then compared mitochondrial subunits COI, COIII, and 16S in these specimens across all available annotated octopod sequences, including Sepia apama (Hotaling et al., 2021) as a control outgroup taxon. For species exhibiting intraspecific genomic variation, we included multiple sequences from geographically distinct populations. Laboratory specimens consistently clustered into a single taxonomic node with O. insularis. These findings confirm O. insularis presence in South Florida and suggest a more extensive northern distribution than previously assumed. Whole genome Illumina sequencing of multiple specimens enabled taxonomic identification with well-established DNA barcodes while also generating the first de novo full assembly of O. insularis. Furthermore, constructing and comparing phylogenetic trees for multiple conserved genes is essential for confirming the presence and delineation of cryptic species in the Caribbean.

AB0965 Serial serology testing in patients with psoriatic arthritis- Should it be done?

Background

The diagnosis of psoriatic arthritis (PsA) is largely based on clinical phenotype due to the heterogeneity of the presenting features, which can include synovio-entheseal disease, dactylitis, skin and nail disease, uveitis and axial involvement. (1)

In contrast to rheumatoid arthritis (RA), PsA is a seronegative inflammatory arthropathy. Rheumatoid factor (RF) and Anti-CCP antibodies are usually absent in PsA, and if patients do have positive serological findings for RF or CCP, the titres tend to be low. (2)

Seronegativity for RF has a significantly high discriminant value in the Classification Criteria for Psoriatic arthritis (CASPAR), such that a negative RF forms one of the five possible criteria; thus serological testing is often done once at the initial diagnostic appointment. (3)

A previous study in the context of RA has shown that there is a tendency for repeated serological testing with as much as 70% of patients having RF tested more than once.(4) Repeated testing amounts to additional expense and is rarely needed in PsA.

The literature on the frequency of repeated serology testing in PsA patients is absent.

Objectives

To determine how often was serology for RF and anti-CCP antibodies repeated in a PsA cohort.

Methods

A cohort of consecutive patients attending the rheumatology clinic at our centre with a diagnosis of PsA were included.

We reviewed the laboratory results of individual patients to determine how many times each patient had been tested for RF and anti-CCP antibodies.

Results

118 patients with a diagnosis of PsA were included. 117 patients had RF antibody testing at least once and all 118 patients had a minimum of one anti-CCP antibody test.

59/117 (50.4%) patients had RF checked more than once and 28/117 (23.9%) had testing at least 3 times. 3 patients had an initial positive RF which was negative on subsequent testing.

Anti-CCP antibody was checked on all 118 patients. 41/118 (34.7%) patients had anti-CCP checked more than once and 13/118 (11.0%) patients had testing at least 2 times. One patient had an initial equivocal anti-CCP antibody titre which was subsequently negative on repeat testing.

Conclusion

As opposed to RA, PsA has not been associated with the presence of circulating antibodies. The presence or absence of RF in PsA patients has for long been a subject of debate. (3)

In cases of peripheral polyarticular PsA, which may be difficult to distinguish from RA, serological testing can be useful to identify RA. However, studies have found that RF can be present in 5-13% of PsA patients. (5)

In the context of RA, serological conversion from negative to positive is infrequent and repeat testing is not recommended. (6)

Over half of the patients in our PsA cohort had repeated RF testing. Certainly this is unlikely to be helpful or cost effective and serial serology measurements in PsA patients should be avoided.

References

[1]Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. The Lancet. 2018;391(10136):2273-84.

[2]Merola JF, Espinoza LR, Fleischmann R. Distinguishing rheumatoid arthritis from psoriatic arthritis. RMD Open. 2018;4(2):e000656.

[3]Veale DJ, Fearon U. What makes psoriatic and rheumatoid arthritis so different? RMD Open. 2015;1(1):e000025-e.

[4]Orr C, Young F, Veale DJ. AB0243 How Often Are Serology Tests Repeated in RA Patients, and What Are the Merits? Annals of the Rheumatic Diseases. 2015;74(Suppl 2):972.

[5]Punzi L, Podswiadek M, Oliviero F, Lonigro A, Modesti V, Ramonda R, et al. Laboratory findings in psoriatic arthritis. Reumatismo. 2007;59 Suppl 1:52-5.

[6]Reid AB, Wiese M, McWilliams L, Metcalf R, Hall C, Lee A, et al. Repeat serological testing for anti-citrullinated peptide antibody after commencement of therapy is not helpful in patients with seronegative rheumatoid arthritis. Internal Medicine Journal. 2020;50(7):818-22.

Disclosure of Interests

None declared

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

POS0477 HIGH DISEASE ACTIVITY AT BASELINE AND SEROPOSITIVITY ARE ASSOCIATED WITH TREATMENT RESPONSE AT ONE YEAR POST SYNOVIAL BIOPSY IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Despite recent therapeutic advances, our ability to predict prognosis and therapeutic response in RA remains imprecise.

Objectives:

To determine biomarkers predictive of outcome at one year following arthroscopy.

Methods:

RA patients were prospectively recruited and underwent knee arthroscopy performed under local anaesthetic. Each patient underwent a careful systematic assessment of demographic, clinical, and serologic factors on the day of arthroscopy and were reviewed at 2 weeks, 3, 6 and 12 months post arthroscopy. Erosive disease was defined based on plain-film radiographs of hands and feet. Disease activity at one year was used to define treatment response into responders (moderate/good EULAR Response) and non-responders.

Clinical characteristics, synovial tissue cell profiles and immunohistochemistry were analysed for T Cells (CD3), B Cells (CD20, CD138), macrophages (CD68) and vascularity (Factor VIII) to establish predictors of treatment response. All areas of each biopsy section were examined and the sub-lining layer independently scored by 2 observers using a well-validated semiquantitative scoring method, ranging from 0 to 4 (0=no staining, 1=<25%, 2=25–49%, 3=50–74%, and 4=75–100% staining). Factor 8 was scored by calculating the mean count of stained blood vessels per high-power field (at 20X magnification).

Results:

There were no significant differences between responders and non-responders regarding gender, age, disease duration, medications, erosive status, ESR, CRP or synovitis or vascularity at arthroscopy (Table 1). Interestingly, rates of RF and ACPA positivity, tender and swollen joint counts, DAS28 and DAS28CRP were all higher amongst treatment responders. Immunohistochemistry was a very poor predictor of treatment response. There were no significant differences between the two groups in CD3, CD20, CD138, CD68 or Factor 8 score.

Table 1.

Baseline Characteristics

Responder(n=30)Non-responder (n=18)p valueFemale20 (66.7%)14 (77.8%)NSAge51.5 (11.2)54.2 (10.9)NSDisease duration0.5 (0-16)0.5 (0-10)NSRF positive22 (73.3%)5 (27.8%)0.003ACPA positive22 (73.3%)8 (44.4%)0.045Erosions8 (26.7%)5 (27.8%)NSMedications No DMARD23 (76.7%)10 (55.6%)NS csDMARD only4 (13.3%)3 (16.7%)NS TNFi2 (6.7%)3 (16.7%)NS Other bDMARD1 (3.3%)2 (11.1%)NSPatient global health, VAS (mm)54.2 (10-100)51.5 (0-90)NSSJC (28 Joints)4.5 (0-16)1 (0-18)0.001TJC (28 Joints)7 (1-25)1 (0-15)0.001ESR, mm/hr23 (2-120)24 (2-81)NSCRP, mg/L5 (1-95)6.5 (1-64)NSDAS285.01 (1.95-7.36)3.93 (1.40-6.62)0.003DAS28CRP4.78 (2.82-7.13)3.39 (1.21-6.26)0.002Synovitis, VAS65 (10-100)70 (30-100)NSVascularity, VAS60 (10-90)70 (30-100)NS

Conclusion:

In this small study, seropositivity and disease activity were higher in responders. Baseline immunohistochemical staining was not a good discriminator of treatment respons

Disclosure of Interests:

Kieran Murray Grant/research support from: Bresnihan Molloy and Newman fellowships, Candice Low: None declared, Francis Young: None declared, Monika Bienicka: None declared, EImear Mylod: None declared, Ursula Fearon: None declared, Douglas Veale: None declared

POS0462 ALCOHOL AND INFLAMMATORY ARTHRITIS DISEASE ACTIVITY: PERSPECTIVES FROM A 979-PATIENT COHORT WITH SYSTEMATIC REVIEW AND META-ANALYSIS

Background:

The effect of alcohol on disease activity in inflammatory arthritis remains poorly understood. Studies of alcohol and the incidence or risk of inflammatory arthritis are conflicting [1,2]. Alcohol does downregulate pro-inflammatory cytokines and may therefore reduce immune-mediated disease activity.

Objectives:

This study investigates the relationship between alcohol consumption and disease activity in our inflammatory arthritis patient cohort and performs a systematic review with meta-analysis.

Methods:

Cohort Study Design and data analysis

Patients attending a rheumatology clinic between 2010-2020 were prospectively followed. Information on demographics, alcohol use, smoking habits, and disease outcome measures were collected. Statistical analysis included univariate and multivariate linear and binary logistic regressions, Mann Whitney-U tests, and one-way ANOVA with Tukey’s HSD.

Meta-analysis

EMBASE, Pubmed, the Cochrane library, and Web of Science were searched. Studies reporting on alcohol consumption and disease activity in a cohort of RA patients were included for further investigation. Forest plots were generated from 95% confidence intervals of extracted data using mean differences. Linear regression was used to determine correlations between alcohol and antibody status, gender, and smoking status.

Results:

Cohort Study

Of the 979 analysed patients, 62% had RA, 26.7% had PsA, and 11.2% had AS. Mean DAS28-CRP in RA and PsA at one year was 2.96 ± 1.39, and 64.2% of patients were in remission (DAS28-CRP ≤ 2.6 or BASDAI ≤ 4). Both male gender and risky drinking (>15 units of weekly alcohol) were both significantly associated with remission. Compared to women, men had an odds ratio of 1.78 [1.04, 2.52] (p=0.034) for any alcohol consumption and 6.9 [4.7, 9.1] (p=0.001) for drinking at least 15 weekly drinks. when adjusted for gender, there was no significant association between alcohol and disease activity. Yet, when adjusted for alcohol consumption, gender still influenced disease activity.

Meta-analysis

The search identified 4126 citations of which 14 were included. The pooled mean difference in DAS28 (95% CI) was 0.34 (0.24,0.44) (p<10-5) between non-drinkers and drinkers, 0.33 (0.05,0.62) (p=0.02) between non-drinkers and heavy drinkers, and 0 (-0.3,0.3) (p=0.98). between low- and high-risk drinkers. There was a significant difference in the mean difference of HAQ assessments between those who drink alcohol compared to those who do not (0.3 (0.18,0.41), p<10-5). There was no significant correlation between drinking and gender, smoking status, or antibody positivity.

Conclusion:

While it appears that alcohol is linked to remission in inflammatory arthritis, this association is lost when adjusted for gender. Men with inflammatory arthritis drink significantly more than women and men generally have less severe disease activity. However, the meta-analysis suggests alcohol consumption is associated with lower disease activity and self-reported health assessment in rheumatoid arthritis.

References:

[1]Bae S-C, Lee YH. Alcohol intake and risk of rheumatoid arthritis: a Mendelian randomization study. Z Rheumatol 2019;78:791–6. doi:10.1007/s00393-018-0537-z

[2]Scott IC, Tan R, Stahl D, et al. The protective effect of alcohol on developing rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2013;52:856–67. doi:10.1093/rheumatology/kes376

Figure 1.

Mean differences in DAS28 between drinking groups. A between non-drinkers and drinkers. B between non-drinkers and high-risk drinkers. C between low-risk and high-risk drinkers.

Disclosure of Interests:

None declared

POS0625 ASSOCIATIONS OF REMISSION AND PERSISTENCE OF BIOLOGICS AT 1 AND 12 YEARS

Background:

Biologic therapies have greatly improved outcomes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Yet, our ability to predict long-term remission and persistence or continuation of therapy remains limited.

Objectives:

To compare RA and PsA outcomes at 1 and 12 years after commencing biologic DMARDs and to identify predictors of remission and persistence of therapy.

Methods:

RA and PsA patients were prospectively recruited from a biologic clinic. Outcomes on commencing therapy, at 1 year and 12 years were reviewed. Demographics, medications, morning stiffness, patient global health score, tender and swollen joint counts, antibody status, CRP and HAQ were collected. Outcomes at 1 and 12 years are reported and predictors of EULAR-defined remission (DAS28-CRP < 2.6) and biologic persistence are examined with univariate and multivariate analysis.

Results:

A total of 403 patients (274 RA and 129 PsA) were analysed. PsA patients were more likely to be male, in full-time employment and have completed higher education. PsA had higher remission rates than RA at both 1 year (60.3% versus 34.5%, p < 0.001) and 12 years (91.3% versus 60.6%, p < 0.001). This difference persisted when patients were matched for baseline disease activity (p < 0.001). Biologic continuation rates were high for RA and PsA at 1 year (49.6% versus 58.9%) and 12 years (38.2% versus 52.3%). In PsA, patients starting on etanercept had lower CRP at 12 years (p = 0.041). Multivariate analysis showed 1-year continuation [OR 4.28 (1.28–14.38)] and 1-year low-disease activity [OR 3.90 (95% CI 1.05–14.53)] was predictive of a 12-year persistence. Persistence with initial biologic at 12 years [OR 4.98 (95% CI 1.83–13.56)] and male gender [OR 4.48 (95% CI 1.25–16.01)] predicted 12 year remission.

Conclusion:

This is the first real world data to show better response to biologic therapy in PsA compared to RA at 12 years. Long-term persistence with initial biologic agent was high and predicted by biologic persistence and low-disease activity at 1 year. Interestingly, PsA patients had higher levels of employment, educational attainment, and long-term remission rates compared to RA patients.

Disclosure of Interests:

Kieran Murray Grant/research support from: Bresnihan Molloy and Newman Fellowships, Matthew Turk: None declared, Yousef Alammari: None declared, Francis Young: None declared, Phil Gallagher: None declared, Tajvur Parveen Saber: None declared, Ursula Fearon: None declared, Douglas Veale: None declared

Telemedicine and the current opportunities for the management of oncological patients in Peru in the context of COVID-19 pandemic

COVID-19 pandemic is the more challenging public health emergency of the century, producing the collapse of health systems and unprecedented levels of morbidity and mortality around the world, especially in low resource settings. Patients with chronic diseases are the most affected, not only due to the high susceptibility to SARS-CoV-2 infection but also due to the decrease in opportunities for timely care. In this dark landscape, telemedicine, before limited to very specific scenarios, has become one of our main tools to manage cancer patients, particularly in Latin America where COVID-19 has had a strong impact on the public health. Telemedicine can provide rapid access to specialized cancer care in a scenario complicated, reducing the exposure of patients and healthcare personnel to the SARS-CoV-2. In this review, we would like to share our experience and our workflow using telemedicine at Oncosalud-AUNA, a private clinic in Peru.

Towards remote healthcare monitoring using accessible IoT technology: state-of-the-art, insights and experimental design

Healthcare studies are moving toward individualised measurement. There is need to move beyond supervised assessments in the laboratory/clinic. Longitudinal free-living assessment can provide a wealth of information on patient pathology and habitual behaviour, but cost and complexity of equipment have typically been a barrier. Lack of supervised conditions within free-living assessment means there is need to augment these studies with environmental analysis to provide context to individual measurements. This paper reviews low-cost and accessible Internet of Things (IoT) technologies with the aim of informing biomedical engineers of possibilities, workflows and limitations they present. In doing so, we evidence their use within healthcare research through literature and experimentation. As hardware becomes more affordable and feature rich, the cost of data magnifies. This can be limiting for biomedical engineers exploring low-cost solutions as data costs can make IoT approaches unscalable. IoT technologies can be exploited by biomedical engineers, but more research is needed before these technologies can become commonplace for clinicians and healthcare practitioners. It is hoped that the insights provided by this paper will better equip biomedical engineers to lead and monitor multi-disciplinary research investigations.

Seven Former FDA Commissioners: The FDA Should Be An Independent Federal Agency

Seven former commissioners of the Food and Drug Administration (FDA) from both sides of the political aisle recommend that the FDA be moved out of the Department of Health and Human Services and reconfigured as an independent federal agency. We believe that such a reengineering would promote reliance on consistent science-based regulation and ensure that the American public has access to the best that science and industry can offer.

Pathogen and Particle Associations in Wastewater: Significance and Implications for Treatment and Disinfection Processes

Disinfection guidelines exist for pathogen inactivation in potable water and recycled water, but wastewater with high numbers of particles can be more difficult to disinfect, making compliance with the guidelines problematic. Disinfection guidelines specify that drinking water with turbidity ≥1 Nephelometric Turbidity Units (NTU) is not suitable for disinfection and therefore not fit for purpose. Treated wastewater typically has higher concentrations of particles (1–10 NTU for secondary treated effluent). Two processes widely used for disinfecting wastewater are chlorination and ultraviolet radiation. In both cases, particles in wastewater can interfere with disinfection and can significantly increase treatment costs by increasing operational expenditure (chemical demand, power consumption) or infrastructure costs by requiring additional treatment processes to achieve the required levels of pathogen inactivation. Many microorganisms (viruses, bacteria, protozoans) associate with particles, which can allow them to survive disinfection processes and cause a health hazard. Improved understanding of this association will enable development of cost-effective treatment, which will become increasingly important as indirect and direct potable reuse of wastewater becomes more widespread in both developed and developing countries. This review provides an overview of wastewater and associated treatment processes, the pathogens in wastewater, the nature of particles in wastewater and how they interact with pathogens, and how particles can impact disinfection processes.

Life coaching following haematopoietic stem cell transplantation: a mixed-method investigation of feasibility and acceptability

Haematopoietic stem cell transplantation (HSCT) cures many haematological cancers. Recovery post-HSCT is physically and psychologically challenging, lasting several months. Beyond the first post-transplant year, a fifth report difficulties encompassing practical, social and emotional domains, including finance and employment. We investigated the feasibility, acceptability and impact of a life coaching intervention designed to address psychosocial 'survivor' concerns of HSCT recipients and facilitate transition to life post-treatment. A concurrent embedded experimental mixed-method design was employed. Pre- and post-intervention data collection comprised qualitative semi-structured telephone interviews and quantitative postal questionnaires. Seven purposively sampled HSCT recipients (<18 months) participated, reporting on one-to-one life coaching delivered by a professional life coach fortnightly over 8 weeks. Participants reported less anxiety, depression and fewer survivor concerns post-intervention, with a trend for lower social difficulties and increased functional well-being. Perceived self-efficacy was unchanged. Life coaching was feasible to deliver and acceptable to the participants who indicated it was a positive experience, with benefits described in diverse areas including work, lifestyle and hobbies. Life coaching within cancer services potentially offers the means to address psychosocial concerns and support transition to life after treatment, enabling patients to reach their potential, e.g. returning to employment and financial independence. Further investigation of this intervention in cancer survivors is warranted.

Pharyngeal angiosarcoma following multimodal treatment for oropharyngeal squamous cell carcinoma

It is well established that angiosarcoma can develop following radiotherapy. We present an unusual case of angiosarcoma of the pharynx that developed three years after treatment with surgery and adjuvant chemoradiotherapy for a T2N2bM0 squamous cell carcinoma of the oropharynx. The patient was tumour free until developing dysphagia, which was found to be caused by an angiosarcoma. The patient underwent surgery of the pharyngeal angiosarcoma by laryngopharyngectomy, tongue base resection, selective neck dissection and radial forearm microvascular free flap reconstruction. Angiosarcoma following head and neck malignancy is rare but must be considered as part of the differential diagnosis in patients with new symptoms after radiotherapy.

Torsades de pointes - a report of a case induced by caesium taken as a complementary medicine, and the literature review

WHAT IS KNOWN AND OBJECTIVE

Complementary medicines are commonly used by many patients. Caesium, a complementary therapy said to be of benefit for cancer treatment, has been associated with cardiac arrhythmias in the literature. We report a case of caesium-induced torsades de pointes and provide an evidence review.

CASE SUMMARY

A 46-year-old woman with syncope experienced torsades de pointes and cardiac arrest. Upon admission her QTc was 620 ms. The patient had taken caesium carbonate 10 g daily for 1 month prior to admission. The patient was successfully resuscitated and discharged home after 35 days in hospital.

WHAT IS NEW AND CONCLUSION

Ten cases of caesium-induced cardiac arrhythmias have previously been reported in the literature. Treatment strategies differed significantly among the cases. However, all patients recovered from the event. Complementary and alternative medicines should not be overlooked as a potential cause of serious adverse events.

Identification and management of ocular lipid deposition in association with hyperlipidaemia in captive moray eels, Gymnothorax funebris Ranzani, Gymnothorax moringa (Cuvier) and Muraena retifera Goode and Bean

Ocular lipid deposition and its surgical management and possible association with systemic hyperlipidaemia in captive moray eels are described. Ophthalmologic examinations, haematology and plasma biochemistry analyses were performed on an initial population of captive moray eels (n=10): green moray, Gymnothorax funebris Ranzani; spotted moray, Gymnothorax morninga (Cuvier) and reticulated moray, Muraena retifera Goode and Bean. Recently captured green moray eels comprised the control group (n=9). Clinical signs compatible with ocular lipid deposition were identified in six of ten captive eels (60%) vs. none of the controls. Green moray eels in the initial captive population (n=5) had significantly higher total protein, triglyceride, cholesterol and aspartate amino transferase values than the control eels. Dietary management was attempted in all captive eels, and surgical intervention was performed in three eels, including two from a separate population, with improved ocular clarity within 1month post-operatively. Histopathological evaluation of surgical specimens and two eyes from an additional affected eel that died suggested ocular lipid deposition. Eels in captivity have an apparent predisposition for hyperlipidaemia and ocular lipid deposition. Although limited in this study and complicated by exhibit restraints, dietary management was minimally effective, while surgery improved ocular clarity.

[Impact of splenectomy and/or distal pancreatectomy in the prognosis of the proximal gastric cancer]

OBJECTIVES

Identify prognostic factors associated to total or proximal gastrectomy with or without splenectomy and / or distal pancreatectomy in patient with proximal gastric cancer. Evaluate the frequency of lymph node metastasis to the hilum and splenic artery, postoperative morbidity and mortality and the impact of lymphadenectomy of group 10 and 11 on long term survival.

MATERIALS AND METHODS

We performed an observational, descriptive, longitudinal and retrospective study analyzing patients with diagnostic of proximal third gastric adenocarcinoma subjected to total or proximal gastrectomy with or without splenectomy or distal pancreatectomy in the service of Abdomen of the Instituto Nacional de Enfermedades Neoplásicas between 1990 and 2005. Overall survival for each of the groups was calculated using the Kaplan-Meier method, prognostic factors were evaluated using univariate and multivariate analysis.

RESULTS

We studied 219 patients with proximal third gastric adenocarcinoma (cardias and bottom), of wich, according to inclusion criteria, only qualify 129 (N=129): 22 (17.1%) were treated by gastrectomy alone, 79 (61.2%) gastrectomy associated witch splenectomy and 28 (21.7%) gastrectomy with distal pancreatosplenectomy, constituting three treatment groups. We compared the survival of each group and each factor analyzed, determining the following prognostic factors: lymph node metastasis (N2-N3), degree of differentiation, undifferentiated tumors and Borrmann III and IV tumors. Neither splenectomy or distal pancreatectosplenectomy improved survival compared to the gastrectomy alone. The morbidity and mortality was higher in patients with more aggressive but more aggressive surgery without significant value.

CONCLUSIONS

The number of nodes removed in patients who had pancreatosplenectomy and /or splenectomy was higher, however, had no impact on survival at 5 years.

[Gallstone disease post-radical gastrectomy for gastric adenocarcinoma at the National Institute of Neoplastic Diseases, January 1990 to December 2000]

SUBJECT

To determinate the frecuency and the time of development of the gallbladder stones in gastrectomy post-operated patients with stomach adenocarcinoma at The National Cancer Institute in Lima, Peru.

METHODS

In an observational, descriptive and retrospective case series design, 148 patiens' files who underwent gastrectomy for stomach adenocarcinoma in the National Cancer Institue of Lima during 1990 and 2000, have been reviewed looking for the development of gallbladder stones.

RESULTS

A total de 148 patients were involved in this study. 29 of them (19.6%) develop gallbladder stones during the (x years of) follow up vs 119 (80.9%) . The mean age ot the 29 patients with gallbladder stones were 59.9 years ans 18 of them were female and 11 male.\The mean time of develop gallbladder stones was 3.1 years.According to the type of surgery, 14 patient wiht gallbladder stones underwent to subtotal gastrectomy and 15 to total gastrectomy.

CONCLUSIONS

The frecuency of gallbladder stones post gastrectomy in this study was 19.6%. The mean time of the develop and diagnosis of litiasis was 3.1 years.To perform the colecistectomy at the same time of the gastrectomy could be an important decision in patients with high risk of gallstones and gallbladder cancer.We need furthermore studies to have conclusions about the risk factors.

Increased risk of tuberculosis disease in people with diabetes mellitus: record-linkage study in a UK population

BACKGROUND

The authors aimed to determine whether, and by how much, diabetes mellitus (DM) increases the risk of tuberculosis (TB) and conversely whether TB increases the risk of DM.

METHODS

Retrospective cohort analyses using data from two Oxford Record Linkage Study (ORLS) datasets, containing information on hospital admissions and day-case care between 1963 and 1998 (ORLS1) and between 1999 and 2005 (ORLS2), were carried out. The rate ratio (RR) for tuberculosis after admission to hospital with diabetes and for diabetes after hospital admission with tuberculosis was calculated.

RESULTS

In ORLS1, the RR for TB in people admitted to hospital with DM, comparing the latter with a reference cohort, was 1.83 (95% CI 1.26 to 2.60), and in ORLS2 the RR was 3.11 (1.17 to 7.03). RRs for pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) within ORLS1 were similar at, respectively, 1.80 (1.16 to 2.67) and 1.98 (0.88 to 3.92). In ORLS 2 the RR for PTB was 2.63 (0.91 to 6.30). In ORLS1, there was no indication that TB was a risk factor for DM (RR 1.12, 0.76 to 1.60). The ORLS2 dataset was too small to analyse whether TB led to DM.

DISCUSSION

DM was associated with a two- to threefold increased risk of TB within this predominantly white, English population. The authors found no evidence that TB increases the risk of DM. Our findings suggest that the risks of PTB and EPTB were both raised among individuals with DM. As DM prevalence rises, this association will become increasingly important for TB control and treatment.

[Surgical outcome of 801 patients with localized gastric cancer treated with d2 lymphadenectomy]

BACKGROUND

D2 gastrectomy has been regarded as an inconvenient procedure with high morbidity and no survival benefit in the West. Recent studies, however, have shown low mortality and a survival benefit of D2 gastrectomy. In the Instituto de Enfermedades Neoplasicas (INEN) of Lima Peru D2 gastrectomy is performed since 1990 after training of some of the authors in the NCC of Tokyo Japan. Distal Pancreatectomy was performed only if the pancreas was involved.The aim of this study was to evaluate the peri operative mortality and survival in a group of patients who had a standard D2 lymphadenectomy according to the rules of the Japanese Research Society for Gastric Cancer. Data were collected prospectively, and patients were followed for more than 7 years.

METHODS

Between 1990 and 1999, 938 patients with localized gastric cancer were registered at INEN. Of these, 801 patients underwent curative resection with extended lymphadenectomy (D2). Postoperative morbidity/mortality, type of gastrectomy, mean of lymph nodes removed, pTNM stages and Survival Time and were analyzed.

RESULTS

Sub total distal gastrectomy was performed in 511 patients and total gastrectomy in 290 patients. The mean number of lymph nodes removed was 46.48 per patient (54.91 nodes for total and 41.69 for sub total distal gastrectomy). Hospital mortality was 2.9%. 11% were Stage (TNM) IA, 9.4% stage IB, 19% stage II, 24.6% stage IIIA, 13.1% stage IIIB and 23% stage IV. Five-year actuarial survival was 47.5%. Five-year survival of patients with TNM stages IA, IB, II, IIIA, IIIB and IV were 85.8%, 79.4%, 60%, 46.7% 33% and 14.3% respectively.

CONCLUSIONS

Gastrectomy with D2 lymphadenectomy may be performed with low morbidity and mortality if the operation is performed in specialized centers with a strict quality control system, and without removing the pancreas during total gastrectomy unless it is suspected to be involved. This procedure could provide a good probability of long-term survival, even for patients with invaded regional lymph nodes.

[Laparoscopic distal gastrectomy for gastric cancer: initial experience]

OBJECTIVE

To report the initial experience with the laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer.

PATIENTS AND METHODS

Between May 2006 and May 2007, 29 consecutive GC patients with gastric cancer underwent LADG with D2 lymphadenectomy. The operation consisted in a laparoscopic time to perform lymphadenectomy and mobilization of the distal stomach, followed by a minilaparotomy for exteriorization of the specimen and construction of a hand sewn anastomosis.

RESULTS

Twenty-nine patients underwent LADG with D2 lymphadenectomy for gastric cancer. Mean age was 58.2 years. Mean operative time was 287.4 min. Mean number of lymph nodes resected was 42.6. Twelve patients were early gastric cancer, and seventeen were advanced gastric cancer. Mean proximal and distal resection margin were 5.8 cm and 3.5 cm, respectively. Resection margins were negative in all cases. Mean number of lymph nodes resected was 42.6. Thirty-day morbidity rate was 10.3 %. There were no postoperative deaths.CONCLUSION. The short-term results of our LADG with D2 lymphadenectomy for the treatment of gastric cancer shows that a radical surgery, in terms of resection margins and lymphadenectomy, can be done with low morbidity.

[Short and long-term results of liver resection for hepatocarcinoma in Peru: a Peruvian single center experience on 232 cases]

BACKGROUND

To evaluate the short and long term outcome of liver resections for hepatocellular carcinoma a retrospective analysis was performed on 232 consecutive patients with hepatocellular carcinoma resected between January 1990 and December 2006 at the Department of Abdomen of the Instituto de Enfermedades Neoplasicas of Lima Peru.

METHODS

Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan-Meier method, Prognostic factors were evaluated using univariate and multivariate analysis

RESULTS

The median age was 36 years. 44.2% were associated with hepatitis B, only 16.3% had cirrhosis. The median size of the tumors was 15 cm. The median value of AFP was 5,467 ng/ml. The majority of patients underwent a major hepatectomy (74.2 % had four or more segments resected)Overall morbidity and mortality were 13.7% and 5.3% respectively. After a median follow-up of 40 months, tumour recurrence appeared in 53.3% of the patients. The 1, 3, and 5 year overall survival rates were 66.5%, 38.7% and 26.7%respectively. The 1, 3, and 5 year disease-free survival rates were 53.7%, 27.6%, and 19.9%. On multivariate analysis, presence of multiple nodules (p<0.000), cirrhosis (p=0.001), and macroscopic vascular invasion (p=0.001) were found to be independent prognostic factors related to a worse long-term survival.

CONCLUSIONS

Surgical resection is the optimal therapy for large HCC and can be safely performed with a reasonable long-term survival.

A phase I pharmacokinetic and pharmacodynamic study of AMG 479, a fully human monoclonal antibody against insulin-like growth factor type 1 receptor (IGF-1R), in advanced solid tumors

3002

Background: Increased IGF-1 signaling mediates tumor proliferation, reduces apoptosis, and correlates with higher incidence and progression of common cancers. AMG 479, a fully human monoclonal antibody against IGF-1R, exhibited broad antitumor activity in xenograft models, both as a monotherapy and with chemotherapy. Methods: Patients (pts) entered escalating dose cohorts of AMG 479 (from 1 to 20 mg/kg administered intravenously [IV] every two weeks [Q2W]). Study objectives were to determine safety, maximum tolerated dose (MTD), pharmacokinetic (PK) parameters, pharmacodynamic (PD) parameters of tumor glucose metabolism (FDG PET/CT), human anti- AMG 479 antibody formation, IGF-1R occupancy in neutrophils, and tumor response (CT RECIST, and PET/CT criteria). Results: Sixteen pts with advanced malignancies were treated with doses from 1 to 20 mg/kg. The median number of cycles was 3 (range 1 to 16). Grade 3 thrombocytopenia was considered dose limiting in 1 pt at 20 mg/kg. Other grade 3/4 non-hematologic toxicities were observed in 2 pts; no hyperglycemia greater than grade 2 was observed. Anti-AMG 479 antibodies, but not neutralizing antibodies, were detected in 1 pt. One pt had an infusion reaction (grade 2 chills/rigors resolving in 15 minutes) but could be retreated following premedication. AMG 479 exhibited dose-linear PK in the dose range from 1 to 20 mg/kg, reaching steady state after 3 doses; mean terminal t1/2 ranged from 7 to 11 days; mean serum clearance ranged from 9 to 14 mL/day/kg; Css exceeded IC90 measured in preclinical models. PD results indicated a trend to dose-proportional occupancy of IGF-1R in neutrophils and increased levels of serum IGF-1 and IGF-BP3 (40% and 20% on day 3, respectively). By CT RECIST criteria, 1 pt with a neuroendocrine tumor had a confirmed partial response and 5 pts had durable stable disease. By FDG-PET/CT criteria, 1 pt with breast cancer had a mixed response. Conclusions: AMG 479 appears to be well tolerated at doses up to 20 mg/kg IV Q2W; dose escalation is complete. AMG 479 administration resulted in PK values adequate for activity in preclinical models, saturable binding of IGF-1R in neutrophils, and preliminary anti-tumor activity.

[Table: see text]

[Xanthogranulomatous cholecystitis: retrospective analysis of 6 cases]

Xanthogranulomatous cholecystitis (CX) is a rare kind of chronic cholecystitis, not yet reported in our media, characterized by the presence of chronic, inflammatory infiltration, formation of granulomas, with fibrosis and severe histiocytic reaction with macrophages rich in foam cells. The object of this study is to establish the clinical, radiological and histopathological pattern of CX, by means of the analysis of 6 cases identified in a retrospective check of 191 medical histories of cholecystectomized patients suffering from anatomopathological diagnosis of chronic cholecystitis, in the Department of Abdomen of the Institute of Neoplastic Diseases, from 1939 to 2004. The clinical presentation was characterized by the presence of a palpable mass on physical examination and weight loss. There were complications in two patients. The ultrasonigraph, tomograph and/or laparotomy scans of the vesicle were similar in appearance to a locally advanced vesicular cancer. In none of the specimens was the coexistence of a vesicular carcinoma identified. The vesicle was dried out in block with adjacent hepatic parenchyma in all cases. The CX can simulate a hepatobiliary malignant neoplasia and require suitable oncological surgical treatment. In cases of vesicular tumors, which can be considered inoperable there is the possibility of being faced with a xanthogranulomatous cholecystitis (CX), a benign condition treatable with surgery.

Integrated operational services: meeting continuously changing needs and expectations

This paper aims to provide a practitioner's view as to how property and facilities management professionals, and their colleagues in other operation support areas need to respond to changing customer needs and expectations. The views expressed are based on the author's extensive experience of property strategy, workplace innovation and service management, both as a consultant adviser and more recently in his current position as director of infrastructure operations for PricewaterhouseCoopers in the UK. While recognising the progress that has been made in improving the style, mix and efficiency of office environments, the author argues that these changes must be accompanied by improvements in service delivery. There are three aspects to this. First, closer engagement with the customer, based on a real understanding of business drivers and needs. Second, better integration with the whole operations community acting as one recognising the increasing impact of connectivity and flexible working on accommodation solutions. Third, creating an enhanced customer experience more akin to that of a good restaurant or hotel. This paper should be of interest to professionals who are involved in the planning or implementation of new accommodation or the introduction of new practices such as sharing or hotelling.

[Postoperative morbidity and in-hospital mortality of gastrectomy due to gastric adenocarcinoma: a report of 50 years]

OBJECTIVE

Determine the postoperative morbidity and in-hospital mortality of gastrectomy due to gastric cancer.

METHOD

The study involved the review of the clinical records of all patients with histologically confirmed diagnostic of gastric adenocarcinoma, which underwent a gastrectomy at the Peruvian Institute of Neoplastic Diseases between January 1950 and December 1999. During that period, 2,033 gastrectomies were performed, 503 of which were total gastrectomies and 1,447 were distal subtotal gastrectomies. Postoperative morbidity of total and distal subtotal gastrectomy dropped from 23.7% and 14.3% during the 1950 decade, to 19.8% and 7.4% during the 1990 decade, respectively, while the in-hospital mortality of total and subtotal gastrectomy dropped from 28.9% and 19.4% during the 50s to 4.4% and 2.2% during the 90's. The most common complications were the esophagojejunal, gastrojejunal and duodenal fistulas, respiratory infections, intra-abdominal abscesses, pancreatic fistula, early intestinal obstruction, hemorrhage from the anastomosis site and surgical site infection.

RESULTS

Multivariate logistics regression analysis showed that the risk factors for in-hospital mortality of total gastrectomy were hypoalbuminemia, intraoperative blood transfusion and re-resection (OR: 2.4, 5.9 and 1.7, respectively). For distal subtotal gastrectomy, the risk factors for in-hospital mortality were hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection (OR: 2.6, 2.46, 2.42 and 6.3, respectively).

CONCLUSIONS

Based on our results, the in-hospital mortality risk depends on the postoperative variables (hypoalbuminemia, intraoperative blood transfusion, splenectomy and re-resection) more than on the pre-operative variables, beyond the surgeon's control (age, sex, clinical stage, etc.).

Endogenous endothelin increases gallbladder tone and leads to acute cholecystitis in the Australian possum

Endothelins are bioactive peptides produced by gallbladder epithelial cells. We aimed to determine the role of endothelins in acute cholecystitis. Escherichia coli lipopolysaccharide vs saline (sham) was instilled into the gallbladder lumen of Australian possums. Some animals received the non-selective endothelin antagonist, tezosentan. At 4 or 24 h, plasma and gallbladder endothelins and white blood cell count (WBCC) were determined. Acute cholecystitis was assessed using a histopathology score. In other animals gallbladder tone was determined. At 4h, a dose-dependent 60-fold increase in gallbladder endothelin level occurred (P = 0.001) but other parameters remained comparable with sham animals. Epithelial cells were endothelin-immunoreactive. At 24 h, the WBCC rose (P < 0.007), and severe cholecystitis developed. Gallbladder but not plasma endothelin levels remained elevated. Tezosentan pre-treatment resulted in a histologically normal gallbladder, but the WBCC and gallbladder endothelin levels were elevated. Lipopolysaccharide or saline instillation also caused a time-dependent increase in gallbladder tone over 4 h (P < 0.001), but not in control animals. This increase was reduced by tezosentan treatment. Gallbladder endothelin production is an early event in acute cholecystitis, increases gallbladder tone and plays a crucial role in the inflammatory process.

Common stresses affecting activated sludge health and performance--what the four-assay set can tell us

Previously, we developed a novel biological early warning (BEW) system for directly monitoring the health and performance of activated sludge, the "four-assay set". In the present work, the four-assay set has been used to measure the effects of four common stresses on activated sludge biomass: high temperature; pH; anoxia; and starvation. The results demonstrate both the utility of the Paprican four-assay set as a biomass-evaluating and BEW tool, and the tolerances of a typical kraft mill activated sludge for these four stresses.

Field comparison of impingers and treated filters for sampling of total aliphatic isocyanates with the MAP reagent

Results of a comparative field study on the performance of 25-mm inhalable samplers (Institute of Occupational Medicine [IOM]) and midget impingers for the collection of total isocyanates in air using the 1-(9-anthracenylmethyl)piperazine (MAP) reagent are presented. Air sampling and analysis was performed according to the National Institute for Occupational Safety and Health MAP draft method 5525. Midget impingers filled with 15 mL of 1 x 10(-4) M MAP in butyl benzoate were operated at 1 L/min. IOM cassettes loaded with 25-mm quartz fiber filters impregnated with 500 microg MAP, were operated at 2 L/min. Filters were field extracted with 10 mL of 1 x 10(-4) M MAP in acetonitrile. Thirty-four impinger-IOM pairs were collected in three autobody shops during spray painting tasks. Regression analysis [Ln (IOM) = 1.0 Ln (impinger), R2 = 0.98] and a paired t-test (Pr > 0.9) demonstrated that impingers and IOMs perform equally in their collection efficiency for the monomer and total oligomeric hexamethylene diisocyanate (HDI). IOM performance did not deteriorate at longer sampling times compared with the impinger performance. Within-sampler variability was calculated from the individual coefficients of variation (CV) of the 17 pairs of like samplers. The mean of CVs (SD)% for the monomer and total oligomeric HDI was approximately 12 (12)% and 15 (13)% for the IOM and the impinger sampler, respectively. Poor correlation (Pearson correlation coefficient < 0.3) and statistically nonsignificant differences (P > 0.74 two-sided) were found for the between-sampler CVs. Factors that might have influenced the observed sampler agreement are also discussed. It is concluded that MAP impregnated filters can be successfully used for sampling of slow curing total aliphatic isocyanates in air.

A simple system to rapidly monitor activated sludge health and performance

A set of four assays designed to rapidly measure the health and biodegradative performance of pulp and paper mill activated sludges was developed. Three of the assays are specific oxygen uptake rates (SOURs) that measure the normal "working" aeration tank BOD (biochemical oxygen demand) removal rate (SOURAT), a near-maximum BOD removal rate (SOURNMAX), and a rate (SOURTOX) used in combination with the SOURNMAX to indicate the presence of toxic or inhibitory substances. The fourth assay is the specific adenosine triphosphate (SATP) content of the sludge, used as a measure of its viable cell content. Fresh biomass (sludge) samples from one laboratory reactor and four mill biotreatment systems were fed raw mill effluents and used to evaluate the four-assay set. The SOURAT values of all systems were 10-40% of their SOURNMAX values: thus the SOURAT:SOURNMAX ratios indicate that each system's free biodegradative capacity was far greater than its operating rate. It was demonstrated using phenol that the SOURNMAX:SOURTOX ratio can indicate the presence of substances toxic or inhibitory to the biomass. The results also indicated that the SOURNMAX is a much better indicator of improving or worsening sludge performance and capacity than the SOURAT. SATP was shown to be a useful monitor of the proportion of viable cells in an activated sludge and a toxicity indicator complementary to the SOURNMAX:SOURTOX ratio and similar in principle to the commercial Microtox toxicity test. This four-assay set was also applied to three practical situations: (a) at-mill monitoring of a biotreatment system; (b) effects of cold storage on biomass; and (c) effects of decreased BOD loading on biomass.

Individual differences in perceptual space for tactile textures: evidence from multidimensional scaling

Ratio scaling was used to obtain from 5 subjects estimates of the subjective dissimilarity between the members of all possible pairs of 17 tactile surfaces. The stimuli were a diverse array of everyday surfaces, such as corduroy, sandpaper, and synthetic fur. The results were analyzed using the multidimensional scaling (MDS) program ALSCAL. There was substantial, but not complete, agreement across subjects in the spatial arrangement of perceived textures. Scree plots and multivariate analysis suggested that, for some subjects, a two-dimensional space was the optimal MDS solution, whereas for other subjects, a three-dimensional space was indicated. Subsequent to their dissimilarity scaling, subjects rated each stimulus on each of five adjective scales. Consistent with earlier research, two of these (rough/smooth and soft/hard) were robustly related to the space for all subjects. A third scale, sticky/slippery, was more variably related to the dissimilarity data: regressed into three-dimensional MDS space, it was angled steeply into the third dimension only for subjects whose scree plots favored a nonplanar solution. We conclude that the sticky/slippery dimension is perceptually weighted less than the rough/smooth and soft/hard dimensions, materially contributing to the structure of perceptual space only in some individuals.

COL5A1 haploinsufficiency is a common molecular mechanism underlying the classical form of EDS

We have identified haploinsufficiency of the COL5A1 gene that encodes the proalpha1(V) chain of type V collagen in the classical form of the Ehlers-Danlos syndrome (EDS), a heritable connective-tissue disorder that severely alters the collagen-fibrillar structure of the dermis, joints, eyes, and blood vessels. Eight of 28 probands with classical EDS who were heterozygous for expressed polymorphisms in COL5A1 showed complete or nearly complete loss of expression of one COL5A1 allele. Reduced levels of proalpha1(V) mRNA relative to the levels of another type V collagen mRNA, proalpha2(V), were also observed in the cultured fibroblasts from EDS probands. Products of the two COL5A1 alleles were approximately equal after the addition of cycloheximide to the fibroblast cultures. After harvesting of mRNAs from cycloheximide-treated cultured fibroblasts, heteroduplex analysis of overlapping reverse transcriptase-PCR segments spanning the complete proalpha1(V) cDNA showed anomalies in four of the eight probands that led to identification of causative mutations, and, in the remaining four probands, targeting of CGA-->TGA mutations in genomic DNA revealed a premature stop at codon in one of them. We estimate that approximately one-third of individuals with classical EDS have mutations of COL5A1 that result in haploinsufficiency. These findings indicate that the normal formation of the heterotypic collagen fibrils that contain types I, III, and V collagen requires the expression of both COL5A1 alleles.

Gene content and organization of a 281-kbp contig from the genome of the extremely thermophilic archaeon, Sulfolobus solfataricus P2

The sequence of a 281-kbp contig from the crenarchaeote Sulfolobus solfataricus P2 was determined and analysed. Notable features in this region include 29 ribosomal protein genes, 12 tRNA genes (four of which contain archaeal-type introns), operons encoding enzymes of histidine biosynthesis, pyrimidine biosynthesis, and arginine biosynthesis, an ATPase operon, numerous genes for enzymes of lipopolysaccharide biosynthesis, and six insertion sequences. The content and organization of this contig are compared with sequences from crenarchaeotes, euryarchaeotes, bacteria, and eukaryotes.

Normal isotype switching in B cells lacking the I mu exon splice donor site: evidence for multiple I mu-like germline transcripts

Ig class switch recombination (CSR) in activated B cells is preceded by the generation of "switch" transcripts from the heavy chain constant region (CH) genes targeted for rearrangement. Switch transcripts include a sterile "I" exon spliced onto the first CH exon. Targeted mutations disrupting the expression or splicing of I exons severely hamper CSR to all tested CH loci, except mu. However, all mu switch transcript mutations tested so far have left the I mu exon splice donor site intact. To test the possibility that the residual CSR activity in I mu mutants could be due to splicing of a truncated I mu exon, we generated new mutants specifically lacking the I mu splice donor site. Surprisingly, normal CSR was observed in the I mu splice donor mutants even in the absence of detectable spliced I mu transcripts. In a search for potential alternative sources of switch-like transcripts in the mu locus, we identified two novel exons which map just upstream of the Smu region and splice onto the C mu 1 exon. Their expression is detectable from early B cell developmental stages, and, at least in hybridomas, it does not require the Emu enhancer. These studies highlight a unique structure for the mu locus I exon region, with multiple nested switch transcript-like exons mapping upstream of Smu. We propose that all of these transcripts directly contribute to mu class switching activity.

Papilloedema secondary to acute purulent sinusitis

Upper respiratory tract infections and sinusitis are common, but intracranial complications of sinusitis are rare in children and are often clinically unremarkable. Papilloedema secondary to purulent sinusitis is a complication previously not reported. We report two cases to highlight atypical manifestations of sinusitis in children.

Papilloedema secondary to acute purulent sinusitis

Upper respiratory tract infections and sinusitis are common, but intracranial complications of sinusitis are rare in children and are often clinically unremarkable. Papilloedema secondary to purulent sinusitis is a complication previously not reported. We report two cases to highlight atypical manifestations of sinusitis in children.

Deletion of the IgH intronic enhancer and associated matrix-attachment regions decreases, but does not abolish, class switching at the mu locus

The IgH locus intronic enhancer (Emu), located in the intron between the J(H) segments and the Cmu gene, and flanked by two matrix attachment regions (MAR), has been shown to be a major regulator of IgH gene transcription and VDJ recombination. To define the potential role of Emu plus MAR in class switch recombination (CSR), we generated IgG-expressing hybridomas from B cells heterozygous for mutations that delete all of these elements or replace them with a neo(r) gene and analyzed the switch status of the mutated IgH loci. Emu/MAR-deleted IgH loci displayed a highly significant, although not complete, decrease in CSR when compared to unmutated loci in normal hybridomas. Surprisingly, mutant loci with a pgk promoter-driven neo(r) gene replacing the Emu/MAR showed relatively normal switch frequency. These findings indicate that the Emu/MAR region plays a significant, but not necessary role in facilitating class switching at the mu locus. Potential mechanisms for these findings are discussed.

Safety review of adult clinical trial experience with lamotrigine

To date approximately 4000 adults > 12 years of age have been treated with lamotrigine in Glaxo Wellcome sponsored clinical trials. Review of the data from these trials shows lamotrigine to be effective and well tolerated in both add-on and monotherapy treatment. Safety of lamotrigine was comparable to that of other anticonvulsants in add-on controlled clinical trials. In addition, fewer than half the number of patients in monotherapy studies who were taking lamotrigine discontinued treatment because of adverse events compared to those taking carbamazepine and phenytoin. Most of the reported adverse events seen in lamotrigine treated patients in all studies were judged by the investigator to be mild or moderate in severity; few of the adverse events resulted in the withdrawal of patients from studies. Analysis of vital signs and clinical laboratory data have revealed no undesirable effect of lamotrigine on major systems of the body. The most concerning adverse event has been rash. In clinical trials, this has most often been limited to a simple morbilliform rash which is not associated with evidence of systemic involvement. The incidence of Stevens-Johnson syndrome (SJS) in clinical trials is approximately 1 in 1000. Rash associated with lamotrigine has typically occurred within the first 8 weeks of treatment. Data from clinical trials clearly point to exceeding currently recommended dosage guidelines of lamotrigine and co-administration of valproic acid (valproate sodium) as risk factors for rash. Early in 1997, Glaxo Wellcome strengthened existing warnings in the product label regarding the risk of rash and reinforced the importance of adherence to administration guidelines in an effort to reduce the incidence of rash.

Normative Scottish data on the CELF-RUK: a pilot study

There are relatively few standardised tests available for assessing language abilities in older children. A widely used test in Britain is the Clinical Evaluation of Language Fundamentals-Revised (CELF-R, Semel et al. 1987). One potential problem with its use in the UK is that the test has been standardised on American children. In this investigation, the CELF-RUK was administered to twenty Scottish language-normal children, aged 12;0-12;11 years. The results showed that the Scottish children's scores were significantly lower than the American standardisation sample scores for the expressive subtests but not significantly different for the receptive subtests. The results suggest that further research is needed before the test can be used confidently with Scottish children with language impairment.