Longevity of Crown Margin Repairs Using Glass Ionomer Cement: A Retrospective Study

OBJECTIVE

The objective of this study was to determine the survival time of crown margin repairs (CMRs) with glass ionomer and resin-modified glass ionomer cements on permanent teeth using electronic dental record (EDR) data.

METHODS

We queried a database of EDR (axiUm; Exan Group, Coquitlam, BC, Canada) in the Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA, for records of patients who underwent CMRs of permanent teeth at the Graduate Operative Dentistry Clinic. Two examiners developed guidelines for reviewing the records and manually reviewed the clinical notes of patient records to confirm for CMRs. Only records that were confirmed with the presence of CMRs were retained in the final dataset for survival analysis. Survival time was calculated by Kaplan-Meier statistics, and a Cox proportional hazards model was performed to assess the influence of age, gender, and tooth type on survival time (a<0.05).

RESULTS

A total of 214 teeth (115 patients) with CMR were evaluated. Patient average age was 69.4 ± 11.7 years old. Posterior teeth accounted for 78.5% (n=168) of teeth treated. CMRs using glass ionomer cements had a 5-year survival rate of 62.9% and an annual failure rate (AFR) of 8.9%. Cox proportional-hazards model revealed that none of the factors examined (age, gender, tooth type) affected time to failure.

CONCLUSION

The results indicate the potential of CMRs for extending the functional life of crowns with defective margins, thus reducing provider and patient burden of replacing an indirect restoration. We recommend future studies with a larger population who received CMR to extend the generalizability of our findings and to determine the influence of factors such as caries risk and severity of defects on survival time.

The Tendyne transcatheter mitral valve replacement system for the treatment of mitral regurgitation

Mitral valve regurgitation (MR) is the most prevalent valvular disorder among the growing elderly population, occurring in over 6% of those aged >65. Unfortunately, many individuals with severe MR (particularly those with systolic dysfunction or secondary MR) will not be candidates for surgical valve repair or replacement due to high or prohibitive operative risk. For such patients, transcatheter mitral valve replacement represents a viable option. The TendyneTM valve (Abbott Vascular, CA, USA) is one of the most well-studied system to date, with a good safety and efficacy profile.

Coronary Artery Disease and Transcatheter Aortic Valve Replacement: When to Intervene

"In patients with coronary artery disease undergoing transcatheter aortic valve replacement (TAVR), the decision of whether to revascularize, which lesions to revascularize, and the optimal timing of revascularization remains controversial. The sequence of revascularization should be made on a case-by-case basis. Pre-TAVR revascularization (staged or simultaneous with TAVR) is preferred due to unobstructed access to coronary ostia and is important to consider especially in cases in which long self-expanding valves are used. In patients who are hemodynamically compromised, the valve should be addressed first, as the most important cause of mortality is heart/multiorgan failure."

Optimizing hemodynamics of transcatheter aortic valve-in-valve implantation in 19-mm surgical aortic prostheses

OBJECTIVE

To demonstrate the feasibility of achieving good hemodynamic results with valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for degenerated 19 mm surgical bioprosthetic valves.

BACKGROUND

Considerable controversy exists regarding ViV TAVR within 19mm surgical prostheses due to concerns of elevated valve gradients and mortality.

METHODS

Among all patient undergoing ViV TAVR between 7/2016 and 4/2017 for symptomatic severe bioprosthetic aortic stenosis (AS), five had a 19 mm surgical valve in place and were included in this publication. None of the patients had patient-prosthesis mismatch. Aggressive post-dilation was performed in four out of five cases using a special technique we describe below.

RESULTS

In all cases, mean aortic valve (AV) gradients significantly improved post-ViV TAVR, particularly after post-dilation. Interestingly, high pressure post-dilation of the ViV resulted in an increase in the diameter of surgical valve stent frame dimensions in nearly all patients who underwent post-dilation.

CONCLUSIONS

Good hemodynamic outcome is possible with aggressive post-dilation in patients with 19 mm failed surgical bioprostheses. High-risk patients with 19 mm failed surgical prostheses who do not otherwise have viable surgical options should be considered for ViV TAVR.

Investigation of selective JAK1 inhibitor GSK2586184 for the treatment of psoriasis in a randomized placebo-controlled phase IIa study

BACKGROUND

GSK2586184 is a selective oral Janus kinase (JAK)1 inhibitor being evaluated as a treatment for moderate-to-severe plaque-type psoriasis.

OBJECTIVES

To assess the relationship between dose of GSK2586184 and clinical response, primarily by the Psoriasis Area Severity Index (PASI).

METHODS

Sixty patients with moderate-to-severe plaque psoriasis were randomized to cohort A: 100 mg, 200 mg or 400 mg GSK2586184 twice daily or placebo; and eight were randomized to open-label cohort B, a small exploratory cohort treated with 400 mg GSK2586184 twice daily, to explore differential gene expression.

RESULTS

At week 12, a 75% reduction in PASI (PASI 75) response rates in the intent-to-treat population were 0% in the placebo group compared with 13%, 25% and 57% in the 100 mg, 200 mg and 400 mg GSK2586184 twice-daily groups, respectively. Increases in the proportion of PASI 75 responses were seen across all dose levels by week 4. Improvement in itch and quality of life were observed at all doses relative to placebo with the greatest improvement seen in the 400-mg dose group. Overall, the incidence of adverse events (AEs) was similar across treatment groups, and no relationship between frequency of AE and GSK2586184 dose was identified. Differential gene expression was observed in involved and uninvolved skin at baseline and in involved skin after 2 weeks of treatment with GSK2586184.

CONCLUSIONS

Our study demonstrates that 12 weeks of treatment with GSK2586184 resulted in clinical improvement and was generally well tolerated in patients with moderate-to-severe plaque-type psoriasis.

Impact of intravascular ultrasound on the long-term clinical outcomes in the treatment of coronary ostial lesions

OBJECTIVES

To evaluate the long-term outcomes of patients with ostial lesions who underwent percutaneous coronary intervention (PCI) with and without the use of intravascular ultrasound (IVUS).

BACKGROUND

A higher rate of adverse cardiac events is associated with PCI of ostial lesions as compared with nonostial disease.

METHODS

From 7/2002 to 8/2010, 225 patients with 233 coronary ostial lesions underwent PCI with (n = 82) and without (n = 143) IVUS guidance. Ostial lesions included both native aorto-ostial or major coronary vessel (left anterior descending, left circumflex, and ramus intermedius) lesions. Clinical outcomes [cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR)] at a mean follow-up of 4.2 ± 2.5 years were compared between patients undergoing PCI of an ostial lesion with and without use of IVUS using univariate and propensity score adjusted analyses.

RESULTS

Aorto-ostial lesions (n = 109) comprised 47% of lesions, whereas the remaining lesions (53%) involved major coronary vessels. After propensity score adjustment, IVUS use was associated with lower rates of the composite of cardiovascular death, MI, or TLR (HR 0.54, 95% CI 0.29-0.99; P = 0.04), composite MI or TLR (HR 0.39, 95% CI 0.18-0.83; P = 0.01), and MI (HR 0.31, 95% CI 0.11-0.85; P = 0.02) as compared with no IVUS. The use of IVUS was also associated with a trend towards a lower rate of TLR (HR 0.42, 95% CI 0.17-1.02; P = 0.06).

CONCLUSIONS

PCI of coronary ostial lesions with the use of IVUS was associated with significantly lower rates of adverse cardiac events.

Association of Lower Fractional Flow Reserve Values With Higher Risk of Adverse Cardiac Events for Lesions Deferred Revascularization Among Patients With Acute Coronary Syndrome

Background

The safety of deferring revascularization based on fractional flow reserve (FFR) during acute coronary syndrome (ACS) is unclear. We evaluated the association of FFR and adverse cardiac events among patients with coronary lesions deferred revascularization based on FFR in the setting of ACS versus non-ACS.

Methods and Results

The study population (674 patients; 816 lesions) was divided into ACS (n=334) and non-ACS (n=340) groups based on the diagnosis when revascularization was deferred based on FFR values >0.80 between October 2002 and July 2010. The association and interaction between FFR and clinical outcomes was evaluated using Cox proportional hazards models within each group (mean follow-up of 4.5±2.1 years). Subsequent revascularization of a deferred lesion was classified as a deferred lesion intervention (DLI), whereas the composite of DLI or myocardial infarction (MI) attributed to a deferred lesion was designated as deferred lesion failure (DLF). In the non-ACS group, lower FFR values were not associated with any increase in adverse cardiac events. In the ACS group, every 0.01 decrease in FFR was associated with a significantly higher rate of cardiovascular death, MI, or DLI (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.03 to 1.12), MI or DLI (HR, 1.09; 95% CI: 1.04 to 1.14), DLF (HR, 1.12; 95% CI, 1.06 to 1.18), MI (HR, 1.07; 95% CI, 1.00 to 1.14), and DLI (HR, 1.12; 95% CI, 1.06 to 1.18).

Conclusion

Lower FFR values among ACS patients with coronary lesions deferred revascularization based on FFR are associated with a significantly higher rate of adverse cardiac events. This association was not observed in non-ACS patients.

Emerging antimicrobial resistance pattern of Helicobacter pylori in central Gujarat

BACKGROUND

Antimicrobial resistance is a growing problem in H. pylori treatment. The study was intended to evaluate the prevalence of resistance amongst 80 H.pylori isolates cultured from biopsy taken during routine endoscopies in 2008-2011.

MATERIALS AND METHODS

855 gastro duodenal biopsies were collected and cultured on H.pylori selective medium (containing Brucella agar and Columbia agar (Hi media), with Skirrow's supplement (antibiotic supplement) and 7% human blood cells). H.pylori was isolated from 80 specimens. The antimicrobial susceptibility of H.pylori isolates was carried out by the Kirby Bauer technique against metronidazole (5 µg), clarithromycin (15 µg), ciprofloxacin (5 µg), amoxicillin (10 µg), tetracycline (30 µg), erythromycin (15 µg), levofloxacin (5 µg), and furazolidone (50 µg) (Sigma- Aldrich, MO).

RESULTS

83.8% isolates were resistant to metronidazole, 58.8% were resistant to Clarithromycin 72.5% were resistant to Amoxicillin, 50% to Ciprofloxacin and 53.8% to tetracycline. furazolidone, erythromycin and Levofloxacin showed only 13.8% resistance to H.pylori. Multi drug resistance with metronidazole+clarithromycin+tetracycline was 85%. For all the drugs Antimicrobial resistance rate was found higher in males compare to females. Metronidazole and amoxicillin resistance was found noteworthy in patients with duodenal ulcer (p=0.018), gastritis (P=0.00), and in reflux esophagitis (P=0.00). clarithromycin and tetracycline resistance was suggestively linked with duodenitis (P=0.018), while furazolidone, erythromycin and levofloxacin showed excellent sensitivity in patients with duodenitis (P value--0.018), gastritis (P=0.00) and reflux esophagitis (P=0.00). Resistance with metronidazole (P=0.481), clarithromycin (P=0.261), amoxicillin (P=0.276), tetracycline (P=0.356), ciprofloxacin (P=0.164) was not correlated well with Age-group and Gender of the patients.

CONCLUSION

A very high percentage of patients were infected with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen.

Seasonal incidence of parasitic diseases in bovines of south western Gujarat (Junagadh), India

The current study was conducted to investigate the incidence of parasitic diseases in bovines which were sick and brought at veterinary hospital for treatment. A total of 366 samples were investigated from cattle (n = 175) and buffaloes (n = 191) presented at Teaching Veterinary Clinical Complex (TVCC), Veterinary College, Junagadh, Gujarat during January to December 2014. Examination of Giemsa-stained peripheral blood smears exhibited that 58.6 % of cattle and 41.2 % of buffaloes were infected with haemoparasites comprising Babesia bigemina, Theileria annulata, and Anaplasma marginale @ of 54.0, 3.4 and 1.1 in cattle and 38.8, 1.2 and 1.2 percent in buffaloes, respectively. The incidence of total haemoparasites and B. bigemina infections was significantly higher (p < 0.05) in cattle whereas, incidence of haemoparasites were recorded significantly higher in the month of July to November (i.e., rainy and autumn) in both cattle and buffaloes, respectively (p < 0.01 and p < 0.001). Coprological examination revealed that the overall incidence of gastrointestinal (GI) parasitic infection was 45.5 % in cattle and 43.4 % in buffaloes. The incidence of individual parasite was 11.4, 1.1, 2.3, 4.5, 1.1, 3.4, 2.3 and 19.3 in cattle and 4.7, 0.9, 0.0, 2.8, 0.9, 5.7, 0.0 and 28.3 % in buffaloes for Eimeria spp., Trichuris spp., Toxocara vitulorum, Strongyle, Fasciola spp., amphistomes, Schistosoma indicum and Buxtonella sulcata, respectively which differ insignificantly (p > 0.05). Seasonal prevalence of GI parasites was highest in summer in both cattle and buffaloes, the data being statistically non-significant (p > 0.05). However, the incidence of B. sulcata in both cattle (19.3 %) and buffaloes (28.3 %) was higher in comparisons to other GI parasites. The present investigation emphasized that B. bigemina and B. sulcata are the most important parasites of bovines of this region.

Clinical outcomes with use of erythropoiesis stimulating agents in patients with the HeartMate II left ventricular assist device

OBJECTIVES

This study evaluated clinical outcomes associated with erythropoiesis stimulating agent (ESA) use in left ventricular assist devices (LVAD)-supported patients.

BACKGROUND

Use of ESAs in patients with LVADs may minimize blood transfusions and decrease allosensitization. ESAs increase thrombotic events, which is concerning because LVADs are sensitive to pump thrombosis (PT).

METHODS

We retrospectively reviewed 221 patients at our center who received a HeartMate II (Thoratec Corp., Pleasanton, California) LVAD between January 1, 2009 and June 6, 2013. Patients were divided into those who received ESAs during index admission (n = 121) and those who did not (n = 100). Suspected PT was defined as evidence of thrombus in the LVAD or severe hemolysis (lactate dehydrogenase >1,000 mg/dl or plasma-free hemoglobin >40 mg/dl). Outcomes were compared between cohorts using inverse probability-weighted analyses.

RESULTS

During a mean follow-up of 14.2 ± 11.9 months, suspected PT occurred in 37 patients (ESA 23%, no ESA 12%; p =0.03). The ESA cohort received ESAs 13.9 ± 60.9 days after LVAD implantation. At 180 days, event-free rates for suspected PT were ESA 78.6% versus no ESA 94.5% (p < 0.001). ESA use had higher rates of suspected PT (hazard ratio [HR]: 2.35; 95% confidence interval [CI]: 1.38 to 4.00; p = 0.002). For every 100-unit increase in cumulative ESA dosage, the hazard of suspected PT increased by 10% (HR: 1.10; 95% CI: 1.04 to 1.16; p < 0.001). After inverse probability weighting, ESA use was associated with a significantly higher rate of all-cause mortality (HR: 1.62; 95% CI: 1.12 to 2.33; p = 0.01).

CONCLUSIONS

ESA use in LVAD patients is associated with higher rates of suspected PT.

Enantioselective α-Amination Enabled by a BINAM-Derived Phase-Transfer Catalyst

The enantioselective amination of carbonyl derivatives is achieved via phase-transfer of aryldiazonium salts by BINAM-derived phosphoric acids.

Chiral anion phase-transfer of aryldiazonium cations was utilized to achieve highly enantioselective α-amination of carbonyl compounds. A broad scope of indanone- and benzosuberone-derived substrates was amenable to this strategy. Critical to obtaining high levels of enantioselectivity was the use of BINAM-derived phosphoric acids. The utility of this transformation was demonstrated through facile conversion of diazene products to valuable α-amino acid derivatives.

First Report of Colletotrichum higginsianum Causing Anthracnose of Arugula (Eruca sativa) in Florida

Arugula (Eruca sativa) is grown in Florida and is an important component in packaged salad products. During spring 2013, leaf lesions on arugula caused significant economic losses in Miami-Dade County, Florida. Symptoms initially appeared as small water-soaked lesions that later became circular, sunken, and white in the center with a dark brown to black halo, up to 4 mm in diameter. Acervuli were found under a dissecting microscope on infected leaf lesions with black spines or setae. Occasionally, small, circular, often longitudinal dark brown spots appeared on leaf branches. Leaf tissues (5 × 5 mm) from lesion margins were surface sterilized in 0.9% sodium hypochlorite for 10 min, rinsed with sterile distilled water, and plated on potato dextrose agar (PDA). PDA plates were incubated at 21°C under 24-h fluorescent lights for 4 to 6 days. The fungus initially produced gray mycelium followed by orange conidial mass. Hyphae of the fungus were septate and hyaline. After 5 to 7 days, the fungus produced acervuli with dark brown to black setae (75 to 130 μm long) (n = 20). Conidia were found in the colonies, which were single celled, oblong, hyaline, and 12 to 25 × 4 to 6 μm (n = 20). The cultural and morphological characteristics of the conidia were similar to those for Colletotrichum higginsianum Sacc (1). To further confirm the species of the isolates, the sequence of the ITS region of rDNA, chitin synthase 1 (CHS1), and actin (ACT) was amplified from isolates 05131 and 05132 using primer pairs ITS 1 and ITS 4 (4), CHS-79F and CHS-354R, and ACT-512F and ACT-783R (3), respectively. The sequenced data of each locus were deposited in GenBank with accessions KF550281.1, KF550282.1, KJ159904, KJ159905, KJ159906, and KJ159907. The resulting sequence of ITS showed 100% identity with sequences of C. higginsianum in JQ005760.1, and sequence of ACT gene showed 100% identity with C. higginsianum in JQ005823.1. The sequence of ACT gene and ITS region had ≤99% identity with other closely related Colletotrichum spp. CHS1 gene had 100% identity with JQ005781.1 belonging to C. higginsianum, and one accession JQ005783.1 belonging to C. fuscum. However, ACT gene and ITS region does not share 100% identity with C. fuscum and therefore, sequence data from three loci proves that isolated pathogen is C. higginsianum. All the above mentioned accessions that shared 100% identity with sequences of isolates used in our study have been previously used to represent the species in the C. destructivum clade in a systematics study (2). To confirm its pathogenicity, a suspension of isolate 05132 at 5 × 10⁵ conidia/ml was sprayed on leaves of five arugula plants until runoff. The other five arugula plants sprayed with water served as non-inoculated controls. Both inoculated and non-inoculated plants were separately covered with a plastic bag to maintain high humidity for 24 h at 27 ± 5°C under natural day/night conditions in the greenhouse. Symptoms first appeared 3 to 4 days after inoculation as small water-soaked lesions, which became sunken with dark brown to black margins. Small circular and longitudinal dark brown spots were also seen on leaf branches as seen initially on naturally infected arugula. No symptoms developed on non-inoculated control plants. C. higginsianum was re-isolated from the lesions with the same morphological characteristics as described above, fulfilling Koch's postulates. To our knowledge, this is the first report of C. higginsianum causing anthracnose of arugula in Florida. This pathogen may potentially affect the salad industry in the United States. References: (1) A. J. Caesar et al. Plant Dis. 94:1166, 2010. (2) P. F. Cannon et al. Stud. Mycol. 73:181, 2012. (3) I. Carbone and L. M. Kohn. Mycologia 91:553, 1999. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Molecular characterization and detection of mutations associated with resistance to succinate dehydrogenase-inhibiting fungicides in Alternaria solani

Early blight, caused by Alternaria solani, is an economically important foliar disease of potato in several production areas of the United States. Few potato cultivars possess resistance to early blight; therefore, the application of fungicides is the primary means of achieving disease control. Previous work in our laboratory reported resistance to the succinate dehydrogenase-inhibiting (SDHI) fungicide boscalid in this plant pathogen with a concomitant loss of disease control. Two phenotypes were detected, one in which A. solani isolates were moderately resistant to boscalid, the other in which isolates were highly resistant to the fungicide. Resistance in other fungal plant pathogens to SDHI fungicides is known to occur due to amino acid exchanges in the soluble subunit succinate dehydrogenase B (SdhB), C (SdhC), and D (SdhD) proteins. In this study, the AsSdhB, AsSdhC, and AsSdhD genes were analyzed and compared in sensitive (50% effective concentration [EC50] < 5 μg ml(-1)), moderately resistant (EC50 = 5.1 to 20 μg ml(-1)), highly resistant (EC50 = 20.1 to 100 μg ml(-1)), and very highly resistant (EC50 > 100 μg ml(-1)) A. solani isolates. In total, five mutations were detected, two in each of the AsSdhB and AsSdhD genes and one in the AsSdhC gene. The sequencing of AsSdhB elucidated point mutations cytosine (C) to thymine (T) at nucleotide 990 and adenine (A) to guanine (G) at nucleotide 991, leading to an exchange from histidine to tyrosine (H278Y) or arginine (H278R), respectively, at codon 278. The H278R exchange was detected in 4 of 10 A. solani isolates moderately resistant to boscalid, exhibiting EC50 values of 6 to 8 μg ml(-1). Further genetic analysis also confirmed this mutation in isolates with high and very high EC50 values for boscalid of 28 to 500 μg ml(-1). Subsequent sequencing of AsSdhC and AsSdhD genes confirmed the presence of additional mutations from A to G at nucleotide position 490 in AsSdhC and at nucleotide position 398 in the AsSdhD, conferring H134R and H133R exchanges in AsSdhC and AsSdhD, respectively. The H134R exchange in AsSdhC was observed in A. solani isolates with sensitive, moderate, highly resistant, and very highly resistant boscalid phenotypes, and the AsSdhD H133R exchange was observed in isolates with both moderate and very high EC50 value boscalid phenotypes. Detection and differentiation of point mutations in AsSdhB resulting in H278R and H278Y exchanges in the AsSdhB subunit were facilitated by the development of a mismatch amplification mutation assay. Detection of these two mutations in boscalid-resistant isolates, in addition to mutations in AsSdhC and AsSdhD resulting in an H134R and H133R exchange, respectively, was achieved by the development of a multiplex polymerase chain reaction to detect and differentiate the sensitive and resistant isolates based on the single-nucleotide polymorphisms present in all three genes. A single A. solani isolate with resistance to boscalid did not contain any of the above-mentioned exchanges but did contain a substitution of aspartate to glutamic acid at amino acid position 123 (D123E) in the AsSdhD subunit. Among A. solani isolates possessing resistance to boscalid, point mutations in AsSdhB were more frequently detected than mutations in genes coding for any other subunit.

First Report of Elm Canker Caused by Pestalotiopsis mangiferae in the United States

Chinese elm (Ulmus parvifolia Jacq.) is native to China, Korea, and Japan and was introduced to the U.S. to replace the American elm, which is highly susceptible to Dutch elm disease. Cultivar Emmer II trademark Allee elm (or Allee elm) is preferred by nurseries for its rich green foliage and beauty of bark. In the summer of 2011, a new disease was observed on Allee elm at a tree farm in FL. Approximately 1% of elms in the same farm and in residential areas in central Florida had similar canker-like symptoms consisting of tan to orange patches of decomposed and loose bark. These symptoms were observed on the main trunks often extending into branches of affected trees. Cankered sections of the trunk were often several feet in length and penetrated the wood to a depth just under the bark into the phloem. To isolate the causal organism, cankers were gathered from 7 trees and tissues from the margin of 1 to 3 cankers per tree were surface sterilized in 1% sodium hypochlorite, plated on PDA, and incubated at 22°C under a 16-h/8-h light/dark cycle for 7 days. Colonies displayed white, fluffy mycelium with sporadic black acervuli containing aggregated conidia. Conidia were 5-celled with two or more apical appendages or hairs; the three central cells were dark brown and the two outer cells were hyaline (1). Based on conidial morphology, these isolates were putatively identified as Pestalotiopsis spp. To identify the species, the rDNA internal transcribed spacer (ITS) region was sequenced for two field isolates (GenBank Accessions JX999998 and JX999999). A BLASTn search in GenBank revealed 100% identity to Pestalotiopsis mangiferae ITS (JX305704.1). To test Koch's postulates, experiments were performed in the field and greenhouse. A mycelial plug of isolate 11-40 was grown on PDA, inoculated on wounded trunk of healthy 18-month-old Allee elms (n = 48) in the field and 7-month-old Allee elms (n = 12) in the greenhouse. Both experiments were set up as a randomized complete block design. The trunk of each tree was wounded with a scalpel to a depth of 5 mm, the wound was inoculated with a 5-mm² agar plug from a 7-day PDA culture, and the inoculated wound was wrapped with grafting tape. Plants that served as negative controls [n = 20 (field experiment) and n = 12 (greenhouse)] were mock-inoculated with a sterile PDA plug without mycelial growth. After 4 to 6 months, symptoms consisting of loose or fallen off bark developed on all pathogen-inoculated trees but not on control trees. Control wounds healed with no expansion beyond the original 5 mm inoculation zone, whereas Pestalotiopsis-inoculated cankers expanded to 3 to 8 cm in each direction in 6 months. Pestalotiopsis (confirmed by conidial morphology and ITS sequencing) was reisolated from pathogen-inoculated trees but not from control trees. These experiments were repeated with similar results at least three times, each consisting of 15 replications (greenhouse) and 12 replications (field) with additional Pestalotiopsis isolates. Many other Pestaliopsis spp. have been reported on other shade trees through the U.S. and the world. To our knowledge, this is the first report of P. mangiferae on an Ulmus species in the U.S. and the world. Since elm canker mainly affects the trunk, a featured characteristic of the Allee elm, it can potentially result in economic loss to the ornamental industry. References: (1) Y. Ko et al. Plant Dis. 91:1684, 2007. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, 1990.

Preparation, characterization and in vitro dissolution study of Nitrazepam: Cyclodextrin inclusion complex

The objectives of this research were to prepare and characterize inclusion complexes of Nitrazepam with Hydroxypropyl-β-cyclodextrin (HPβCD) and Sulfobutyl ether β-cyclodextrin (SBEβCD) to study the effect of complexation on the dissolution rate of Nitrazepam, a water-insoluble drug. The phase solubility profile of Nitrazepam with Hydroxypropyl- β-cyclodextrin and Sulfobutyl ether β-cyclodextrin was an AP-type, indicating the formation of 2:1 stoichiometric inclusion complexes. Gibbs free energy values were all negative, indicating the spontaneous nature Nitrazepam solubilization and their value decreased with increase in the cyclodextrin concentration, demonstrating that the reaction conditions became more favorable as the concentration of cyclodextrins increased. Complexes of Nitrazepam were prepared with cyclodextrin using various methods such as physical mixing, kneading, spray-drying and lyophilization. The complexes were characterized by Differential scanning calorimetry, Fourier-transform infrared, scanning electron microscopy and powder X-ray diffraction studies. These studies indicated that a complex prepared by lyophilization had successful inclusion of the Nitrazepam molecule into the cyclodextrin cavity. Complexation resulted in a marked improvement in the solubility and wettability of Nitrazepam. Among all the samples, a complex prepared with Sulfobutyl ether β-cyclodextrin by lyophilization had the greatest improvement in the in vitro rate of Nitrazepam dissolution. The mean dissolution time for Nitrazepam decreased significantly after preparing complexes. The similarity factor indicated a significant difference between the release profiles of Nitrazepam from complexes, physical mixtures and plain Nitrazepam. To conclude that, the tablets containing complexes prepared with Cyclodextrins had significant improvement in the release profile of Nitrazepam as compared to tablets containing Nitrazepam without cyclodextrin.

A fatal case of Kikuchi-Fujimoto disease

Kikuchi-Fujimoto disease is an extremely rare, benign, auto-immune, clinicopathological condition presenting with fever and lymphadenopathy. It has higher prevalance among Japanese and other Asiatic individuals. It is usually self-limiting with extremely rare mortality. A case of an adolescent girl who presented with fever and cervical lymphadenopathy, found to have Kikuchi's disease on histopathology of cervical lymph node is being reported. She eventually succumbed to the disease.

Body temperature around induced estrus in dairy cows

The overall objective of this study was to study the influence of induced estrus on body temperature, comparing 5 distinct intervals around induced estrus and to determine the diurnal pattern from 4 ± 1 d before to 4 ± 1 d after induced estrus. Sixteen estrous cycles of 9 postpartum dairy cows were synchronized with 2 injections of PGF(2α), 10 d apart. After the second PGF(2α) injection on d 10, temperature loggers were inserted into the vaginal cavity for a 12 ± 1-d period. Two days later, a third dose of PGF(2α) was injected to induce estrus. After confirmation of a corpus luteum, loggers were removed on d 5 ± 1. Observation of estrus, rectal palpation, and ultrasound scanning to determine ovulation were carried out every 4 ± 1h, beginning at 12h after the third PGF(2α) injection. Blood samples from the vena coccygea mediana were collected twice daily from d 11 to 12 and every 4 ± 1h after the third PGF(2α) injection until ovulation. Vaginal temperature was recorded every 5 min and averaged to hourly means for the following 5 periods: 1) 48 h preceding the third PGF(2α) injection, 2) from the third PGF(2α) injection to first signs of estrus, 3) estrus to ovulation, 4) a 4-h interval in which ovulation occurred, and 5) a 96-h post-ovulation period. High body temperatures (39.0 ± 0.5 °C) and low progesterone (P4) concentrations (<0.5 ng/mL) were observed during estrus, whereas low body temperatures were observed from PGF(2α) injection to estrus (38.6 ± 0.3 °C) and around ovulation (38.5 ± 0.2 °C), respectively. An association between body temperature and serum P4 concentrations did not exist. However, P4 concentrations on d 11 and 12 were high (5.0 ± 1.5 ng/mL) and decreased (0.9 ± 0.2 ng/mL) after ovulation. Diurnal temperature rhythms were similar before and after estrus. Vaginal temperature before estrus (d 11 and 12) was slightly (0.1 °C) higher compared with the post-ovulation period.

Role of transfusion in stem cell transplantation: a freedom-from-transfusion (FFT), cost and survival analysis

BACKGROUND

Transfusion of blood products is often necessary for patients undergoing stem cell transplantation (SCT). The need for red cell and platelet transfusion may vary significantly depending on the type of transplantation and underlying disease.

METHODS

In an attempt to evaluate the need and volume of transfusions in patients undergoing SCT at University of Kansas Medical Center, the authors retrospectively evaluated the transfusion data of all patients who received SCT between 2000 and 2005.

RESULTS

A total of 138 (90%) out of 154 patients undergoing autologous SCT and 24 (43%) out of 56 patients with allogeneic SCT exhibited total hematopoietic engraftment and freedom from transfusion (FFT). Time to achieve FFT (median; range) for RBC units for autologous SCT (12; 0-183) was significantly shorter compared with allogeneic SCT (16.5; 0-373). Number of RBC units (median; range) transfused were significantly less in patients undergoing autologous SCT (4; 0-26) compared to patients undergoing allogeneic SCT (6.5; 0-54). The median cost of transfusion was significantly higher in patients undergoing allogeneic SCT (red cell: $2,015; platelet: $4,480) compared to patients undergoing autologous SCT (red cell: $1,240; platelet: $2,520). The authors recognize that this was a retrospective single-center study and practice guidelines may vary from center to center.

CONCLUSION

Authors conclude that transfusion of blood products is an expensive but integral part of SCT, more so for allogeneic SCT than for patients undergoing autologous SCT. Total FFT is a desirable long-term goal of successful marrow transplantation.

Cerebral venous sinus thrombosis: a case series including thrombolysis

BACKGROUND

Cerebral venous sinus thrombosis (CVST) in children is associated with a high incidence of serious morbidity and mortality. The presenting features are variable. It can be diagnostically challenging and the optimal treatment is uncertain.

AIM

To describe the features of a series of children with CVST treated in a single paediatric neurology centre and to discuss the role of local thrombolysis.

METHODS

Electronic databases were searched using diagnostic labels and International Classification of Diseases (ICD) codes to identify children aged 1 month to under 17 years with CVST. Their records were reviewed.

RESULTS

21 children were identified over a period of 8.25 years with a median age of 7.1 years. The presenting symptoms included headache (15 children), vomiting (14 children) and visual disturbance (eight children). Signs found included papilloedema (16 children), fever (six children) and sixth nerve palsy (six children). The most common underlying condition was middle ear infection (13 children). All cases received unfractionated heparin and four severe cases received local pharmacological thrombolysis. 48% of cases had an adverse outcome (death, chronic intracranial hypertension, residual hemiparesis or sixth nerve palsy).

DISCUSSION

CVST has non-specific presenting features and a high risk of significant morbidity. CVST is typically found in association with a predisposing condition. Although heparin is the mainstay of treatment, thrombolysis may reverse deterioration as seen in three cases in this series. However, there is insufficient evidence to recommend the routine use of thrombolysis at present.

Arsenic accumulation by Pseudomonas stutzeri and its response to some thiol chelators

OBJECTIVE

The aim of this study is to examine arsenic accumulation by Pseudomonas stutzeri and its response to some thiol chelators, DMPS and MiADMSA.

METHODS

Determination of arsenic accumulation by Pseudomonas sp. was carried out using an atomic absorption spectrophotometer, a TEM and an EDAX. Arsenate reductase enzyme assay was carried out from a cell-free extract of Pseudomonas sp. The effect of chelating agents on arsenite accumulation was analyzed. Total cellular proteins were analyzed using 1-D SDS-PAGE.

RESULTS

Pseudomonas sp. exhibited a maximum accumulation of 4 mg As g(-1) (dry weight). TEM and EDAX analysis showed the presence of As-containing electron-dense particles inside the cells. Data on arsenate reductase enzyme kinetics yielded a K (m) of 0.40 mM for arsenate and a V (max) of 5,952 mumol arsenate reduced per minute per milligram of protein. The chelating agents MiADMSA and DMPS were found to reduce the arsenic accumulation by 60 and 35%, respectively, whereas the presence of both chelating agents in medium containing cells pretreated with arsenite reduced it by up to 90%. The total protein profile of the cellular extract, obtained by 1-D SDS-PAGE, indicated five upregulated proteins, and three of these proteins exhibited differential expression when the cells were grown with MiADMSA and DMPS.

CONCLUSION

This study shows a new approach towards arsenic detoxification. A combination treatment with MiADMSA and DMPS may be useful for removing intracellular arsenic. The proteins that were found to be induced in this study may play an important role in the extrusion of arsenic from the cells, and this requires further characterization.

Mechanism of vasorelaxant activity of a fraction of root extract of Sesamum indicum Linn

The petroleum ether soluble fraction (SIPE) of the root extract of S. indicum was evaluated for the vasorelaxant activity using isolated rat aorta. SIPE up to 180 microg/ml concentration significantly inhibited phenylephrine- and KCl-induced contraction to the extent of 98.13 +/- 6.37 and 70.19 +/- 3.43% respectively in isolated rat aorta in a concentration dependent manner. The vasorelaxant activity was not blocked by propranolol (10 microM), atropine (1 microM) indomethacin (10 microM) and glibenclamide (10 microM). Influence of SIPE on phenylephrine-induced contractions in aortic preparations in absence of functional endothelium and on pre-incubating the tissue with L-NAME (300 microM) or methylene blue (10 microM) was also studied. SIPE at 180 microg/ml concentration could elicit partial relaxation in presence of L-NAME or methylene blue to the extent of 34.26 +/- 6.13 and 25.66 +/- 10.95% respectively. However, in absence of functional endothelium, SIPE exhibited little relaxation to the extent of 6.70 +/- 4.87%. These studies revealed that the vasorelaxant activity of SIPE was chiefly mediated through endothelium-dependent pathway.

Behavior of the cholesteric liquid-crystal fabry-perot cavity in the bragg reflection band

In this Letter, we investigate the behavior of the cholesteric liquid-crystal Fabry-Perot cavity in the spectral range of the Bragg reflection band. We show that in this region the 2x2-Jones-matrix calculation gives a false predication. However, by the use of the 4x4-matrix method, interesting features are revealed in the resonance spectra. The resonance spectra split when lambda approximately &nmacr;P. Our experiments confirm this phenomenon. The experimental results show that the splitting occurs in a steplike fashion. This can be explained by the quantization of the pitch that occurs due to the fixed boundary conditions.

Behavior of cholesteric liquid crystals in a Fabry-Perot cavity

We investigate the behavior of cholesteric liquid crystals (CLC's) inside a Fabry-Perot (FP) cavity. Although FP cavities filled with various liquid crystals have been extensively studied, to our knowledge the behavior of CLC-based FP cavities has not been reported. In CLC the twisted structure can be changed because the pitch is a function of temperature. In a parallel-rubbed CLC FP cavity the balance between strong surface anchoring and elastic energy yield a steplike resonance spectrum. This corresponds to the quantized effective pitch that the system assumes when both surface alignments are fixed. Experiment results for parallel-rubbed samples are presented and explained theoretically by use of Jones matrix calculations.

Parameter optimization for a reflective bistable twisted nematic display by use of the Poincar sphereé method

Although reflective bistable twisted nematic (RBTN) displays have potential in low-power-consumption applications, to achieve the optimum conditions for both bistable states simultaneously remains a challenge. We use a geometrical method based on the Poincaré sphere representation to obtain the optimum conditions that can simultaneously satisfy both bistable states for a RBTN structure. With this method, the optimum conditions can be obtained analytically and the operation modes can be clearly visualized and better understood.

Distant and delayed mitomycin C extravasation

Mitomycin C is a vesicant chemotherapeutic agent used to treat solid tumors. Its ability to cause delayed and remote tissue injury after intravenous administration is reported in the literature. Two cases of delayed and distant mitomycin C extravasation injury occurred in our institution. In both patients, no evidence of acute extravasation was visible during or immediately after administration. Within 48 hours, one patient reported erythema, burning, and pain in the hand contralateral to the administration site. The second patient developed three distinct ulcerated lesions on her forearm within 6 weeks of receiving the agent. The lesions, located at sites of venipunctures, occurred 12-15 cm proximal to the site of mitomycin infusion. Because the drug has the potential to cause such unusual and unanticipated tissue injuries, health care professionals and patients should be aware of this hazard.

Polarization controller using nematic liquid crystals

In this Letter we demonstrate a polarization controller capable of changing any state of polarization of light from one arbitrary state to another. The controller consists of a stack of three homogeneous nematic liquid-crystal cells. The polarization state is controlled by proper adjustment of the voltages applied across each of the cells. The mathematical algorithm and principles of this polarization controller are developed in the framework of the Stokes parameters, allowing easy visualization by use of a Poincaré sphere representation. The transformation functions are given for conversion of an arbitrary input state to any output state. Experiments are carried out to demonstrate arbitrary polarization transformation.

Germline duplication of chromosome 2p and neuroblastoma

A child with a germline duplication of chromosome 2p, 46,XY,der(13)t(2;13)(p23;q34), who developed a fatal neuroblastoma confirmed at necropsy is reported. Fluorescent in situ hybridisation studies showed chromosome 2p (p23-pter) duplicated on chromosome 13 (q34). The clinical features of the present case shared many similarities to previous reports of trisomy 2p and there have been two cases described with neuroblastoma. Germline duplication of chromosome 2p including the N-myc proto-oncogene may have pre-disposed to the development of neuroblastoma in this case.

Focal dermal hypoplasia (Goltz syndrome) presenting as a severe fetal malformation syndrome

A fetal malformation syndrome comprising growth retardation, anophthalmia, bilateral diaphragmatic herniae, bifid lower leg, syndactyly of the fingers, malrotation of the colon, hypoplastic kidneys and total anomalous pulmonary venous drainage is described in a female fetus from a consanguineous relationship. Differential diagnosis is discussed and it is suggested that this case represents an unusually severe form of Goltz syndrome.

Spontaneous corneal rupture in Noonan syndrome. A case report

PURPOSE/METHODS

A variety of ocular and periocular manifestations have been described in Noonan syndrome. Collagen abnormalities have been described; however, to our knowledge spontaneous corneal rupture has not been reported. A forty-three-year-old female who presented with spontaneous corneal rupture was later diagnosed as having Noonan syndrome.

RESULTS/CONCLUSIONS

Collagen abnormalities have been described with Noonan syndrome and this is likely the cause of corneal rupture in this patient.

Use of a phosphorus-enriched dialysate to hemodialyze patients with ethylene glycol intoxication

A phosphorus-enriched dialysate was used to intensively hemodialyze two non-uremic and non-hyperphosphatemic patients poisoned with ethylene glycol. As a consequence of the use of such a dialysate, we were able to prevent a fall in plasma inorganic phosphorus levels in these patients in spite of the intensive dialytic therapy.

Removal of a corneal foreign body through a lamellar corneal pocket

A piece of glass was found in the posterior central cornea of a 43-year-old victim of a motor vehicle accident. The original entry of the foreign body had healed and epithelialized. This foreign body was removed through a peripheral corneal incision and corneal stromal pocket extended to the glass particle. This technique avoids creation of a corneal incision near the optical axis and prevents unwanted distortion of the corneal topography. The authors report this case to emphasize the importance of preserving corneal topography in corneal surgery.

Epikeratophakia to correct traumatic aphakia after penetrating keratoplasty

A 19-year-old man with keratoconus sustained ocular trauma and became aphakic in his operated left eye 2 months after penetrating keratoplasty. Original corneal wound repair was performed without intraocular lens implantation. Attempts to correct his aphakia with a contact lens failed when the patient became intolerant to its use. As an alternative, the patient had elective epikeratophakia. A standard 8.5 mm lenticule was placed over existing corneal graft. This operation resulted in +12.25 diopters of correction and a best corrected visual acuity of 20/25 at 30 months postoperatively. There was no sign of abnormalities at the host cornea or the transplanted lenticule. This case indicates that epikeratophakia may be successfully performed over existing corneal grafts.

Streptococcus pneumoniae invasive disease in the neonatal period: an increasing problem?

A series of 11 cases of invasive infection with Streptococcus pneumoniae, occurring over an 11-year period, is reported. Eight of the 11 cases occurred during the final 2 years of the study suggesting that the incidence of infection may be increasing. Infection carries a high mortality (3/11). Morbidity includes meningitis, convulsions and respiratory failure. In one case S. pneumoniae meningitis occurred in both mother and newborn. Most mothers who carried the organism were asymptomatic at the time of delivery.

CONCLUSION

S. pneumoniae should be specifically sought in swabs taken from the pregnant mother and newborn and if isolated, even in the absence of symptoms, antibiotic therapy against the organism should be strongly considered.

Bone mineralisation in type 1 glycogen storage disease

Radial bone mineral content (BMC) was measured using single photon absorptiometry in 11 prepubertal children, aged 3.4-12.6 years, with glycogen storage disease type 1 (GSD-1), 2 of whom were receiving granulocyte colony stimulating factor (G-CSF) therapy for chronic neutropenia. Patients were short (median height SD score -1.35, range -3.74 to -0.27), and had reduced BMC Z scores (median 1.79, range -6.35 to +0.27) and radial bone width Z scores (median -0.72, range -2.00 to +0.68). Those receiving G-CSF did not differ significantly from the rest of the group. Generally dietary calcium intake was low and urinary calcium excretion increased. Urinary lactate excretion was high but did not correlate with BMC Z scores. Factors regulating bone metabolism (parathyroid hormone and 25-hydroxy vitamin D concentrations) and markers of bone formation (osteocalcin and skeletal alkaline phosphatase) were not increased implying that there was no compensation for increased bone resorption.

CONCLUSION

Patients with GSD-1 may be at increased risk of fracture in later life and require close attention to metabolic control and calcium balance.

Programmable coherent source arrays generated by spatial light modulators

Programmable coherent source arrays are generated by using addressable liquid-crystal spatial light modulators and two-dimensional arrays of Fresnel lenses. The modulators used are an optically addressed liquid-crystal light valve, a matrix-addressed pixelated display, and two devices that have individually addressable elements with specially designed patterned electrodes. One such device has a transparent electrode patterned as a Fresnel zone plate array; the other is a gate array used in a hybrid implementation with a Fresnel lens array etched on a glass substrate. The operation of devices that use binary-amplitude and binary-phase Fresnel lenses is described, identifying programmable features, resolution limits, and applications.

Active-fiber star coupler that uses arrays of microlenses and liquid-crystal modulators

An active-fiber star coupler that uses arrays of N x N microlenses and liquid-crystal modulators is presented. A simplified implementation of this device uses an 8 x 8 array of Fresnel microlenses fan out an incident beam into 64 focused spots (an 18 dB fan-out loss); on-off capability (270:1 extinction ratio) at each element is provided by liquid-crystal spatial light modulators. A row of focused spots is coupled into an array of 1 x 8 multimode fibers with a measured excess loss of 12 dB along each path (with an estimated overall loss of 30 dB in an 8 x 8 device). A modification of this device that is capable of wavelength selection at individual output fibers is proposed for wavelength division multiplexing applications.

Electrically tunable ferroelectric liquid-crystal Fabry-Perot filter

An electrically operated device that can switch between two wavelengths is described. The device operates by using an electrically switchable optically anisotropic material such as a liquid crystal in a Fabry-Perot cavity. The anisotropy produces two distinct cavity resonances that determine the two wavelengths. The electric field interchanges the slow and the fast optical axes of the anisotropic ferroelectric liquid crystal and thus allows switching from one wavelength to the other. It is shown that this device structure can be used as a polarization-sensitive switch with an extinction ratio of better than 100:1. This is true only for a class of ferroelectric liquid-crystal material that has a title angle of 45 degrees .