Stereotactic Radiosurgery (SRS) for Large Brain Metastases: Dosimetric and Clinical Predictors of Local Progression and Radionecrosis

PURPOSE/OBJECTIVE(S)

Stereotactic radiosurgery (SRS) provides high rates of local control for small brain metastases with low rates of radionecrosis (RN). Larger targets are associated with increased risk of both local progression (LP) and RN. In this analysis, we hypothesized that dosimetric and clinical parameters predict for risk of LP and RN in SRS targets larger than two centimeters.

MATERIALS/METHODS

We retrospectively reviewed patients with one or more targets with either an intact versus post-operative cavity larger than 2.0 cm treated with LINAC-based SRS between 2017 and 2022 at one institution. We assessed for association between patient, treatment, and disease variables with LP and RN. Variables assessed included tumor resection status, PDL1 positivity, target volume, maximum and minimum target dose, EQD2 and BED (a/b = 2 for necrosis and a/b = 10 for tumor control), as well as receipt of steroids, bevacizumab, or systemic therapy before or after SRS. Radionecrosis was determined by characteristic radiographic changes. Analyses were performed for the entire cohort and within subsets including by resection status and dose fractionation.

RESULTS

A total of 178 lesions in 143 patients were included. Targets with volume diameters measuring at least 2 cm were used. Median follow-up was 2.3 years. Overall survival at 1 and 2 years was 56% and 32%, respectively. Most lesions (n = 119) were resected and treated with SRS post-operatively. The most common dose and fractionation schemes used were 30 Gy in 5 fractions (n = 89) and 27 Gy in 3 fractions (n = 63). For the entire cohort, the cumulative incidence of LP 1 and 2 years was 26% and 34%, respectively. The cumulative incidence of radiographic radionecrosis at 1 and 2 years was 12% and 17%, respectively. There was no difference in LP or RN between 27 Gy in 3 fractions versus 30 Gy in 5 fractions (p>0.5 for both). Median planning target volume (PTV) size was 18.5 cc for the 27 Gy in 3 fraction group compared to 21.9 cc in the 30 Gy in 5 fraction group. Minimum or maximum dose within the target was not associated with increased risk of LP or RN. Among patients receiving 27 Gy in 3 fractions, patients treated with resection followed by SRS had lower risk of LP compared to those treated with SRS alone (HR: 0.15, 95% CI: 0.03-0.64, p = 0.011). Among patients receiving 30 Gy in 5 fractions, patients who received corticosteroids prior to SRS had a lower risk of RN (HR: 0.14, 95% CI: 0.03-0.66, p = 0.013). For the entire cohort as well as within all subgroups, PD-L1≥1% was associated with increased risk of RN (p<0.001 for all).

CONCLUSION

Selecting the optimal SRS dose fractionation and planning parameters to minimize both LP and RN remains a challenge for large targets. In this analysis, 27 Gy in 3 fractions appeared to provide equivalent LP and RN compared to 30 Gy in 5 fractions, and may be more convenient for patients. Patients with PD-L1≥1% with large brain targets treated with SRS may be at increased risk of RN; corticosteroid prophylaxis may be considered in this population.

Big-data approaches lead to an increased understanding of the ecology of animal movement

Understanding animal movement is essential to elucidate how animals interact, survive, and thrive in a changing world. Recent technological advances in data collection and management have transformed our understanding of animal "movement ecology" (the integrated study of organismal movement), creating a big-data discipline that benefits from rapid, cost-effective generation of large amounts of data on movements of animals in the wild. These high-throughput wildlife tracking systems now allow more thorough investigation of variation among individuals and species across space and time, the nature of biological interactions, and behavioral responses to the environment. Movement ecology is rapidly expanding scientific frontiers through large interdisciplinary and collaborative frameworks, providing improved opportunities for conservation and insights into the movements of wild animals, and their causes and consequences.

Revisiting the challenge: perspectives on Canada’s freshwater fisheries policies three decades after the Pearse Report

A seminal report by Peter H. Pearse (1988; Rising to the Challenge: A New Policy for Canada’s Freshwater Fisheries, Canadian Wildlife Federation, Ottawa) outlined 62 policy recommendations focused on the management of Canada’s inland fisheries. Over three decades later, freshwater ecosystems and inland fisheries in Canada are still facing similar challenges with many emerging ones that could not have been foreseen. Here, we reflect on the contemporary relevance of the Pearse Report and propose recommendations that policy makers should consider. Broadly, our recommendations are: (1) manage fishes, fisheries, and habitat using a holistic co-management framework, with clearly defined fishery jurisdictions and partnerships with Indigenous governments; (2) engage in transparent, inclusive, and agile research to support decision-making; (3) facilitate knowledge co-production, involving interdisciplinary projects with diverse groups of actors and sectors including Indigenous Peoples, anglers, policy makers, scientists/researchers, governments, and the public; (4) embrace technological advances to support freshwater fisheries stock assessment and management; and (5) align policy and management activities in Canada with global initiatives related to increasing the sustainability of inland fisheries. We advocate for an updated comprehensive report such as the Pearse Report to ensure that we embrace robust, inclusive, and sustainable management strategies and policies for Canada’s inland fisheries for the next 30 years. It is time to again rise to the challenge.

Global COVID-19 lockdown highlights humans as both threats and custodians of the environment

The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus, initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness.

A role for lakes in revealing the nature of animal movement using high dimensional telemetry systems

Movement ecology is increasingly relying on experimental approaches and hypothesis testing to reveal how, when, where, why, and which animals move. Movement of megafauna is inherently interesting but many of the fundamental questions of movement ecology can be efficiently tested in study systems with high degrees of control. Lakes can be seen as microcosms for studying ecological processes and the use of high-resolution positioning systems to triangulate exact coordinates of fish, along with sensors that relay information about depth, temperature, acceleration, predation, and more, can be used to answer some of movement ecology's most pressing questions. We describe how key questions in animal movement have been approached and how experiments can be designed to gather information about movement processes to answer questions about the physiological, genetic, and environmental drivers of movement using lakes. We submit that whole lake telemetry studies have a key role to play not only in movement ecology but more broadly in biology as key scientific arenas for knowledge advancement. New hardware for tracking aquatic animals and statistical tools for understanding the processes underlying detection data will continue to advance the potential for revealing the paradigms that govern movement and biological phenomena not just within lakes but in other realms spanning lands and oceans.

Use of Fish Telemetry in Rehabilitation Planning, Management, and Monitoring in Areas of Concern in the Laurentian Great Lakes

Freshwater ecosystems provide many ecosystem services; however, they are often degraded as a result of human activity. To address ecosystem degradation in the Laurentian Great Lakes, Canada and the United States of America established the Great Lakes Water Quality Agreement (GLWQA). In 1987, 43 highly polluted and impacted areas were identified under the GLWQA as having one or more of 14 Beneficial Use Impairments (BUIs) to the physical and chemical habitat for fish, wildlife and humans, and were designated as Areas of Concern (AOC). Subnational jurisdictions combined with local stakeholders, with support from federal governments, developed plans to remediate and restore these sites. Biotelemetry (the tracking of animals using electronic tags) provides information on the spatial ecology of fish in the wild relevant to habitat management and stock assessment. Here, seven case studies are presented where biotelemetry data were directly incorporated within the AOC Remedial Action Plan (RAP) process. Specific applications include determining seasonal fish-habitat associations to inform habitat restoration plans, identifying the distribution of pollutant-indicator species to identify exposure risk to contamination sources, informing the development of fish passage facilities to enable fish to access fragmented upstream habitats, and assessing fish use of created or restored habitats. With growing capacity for fish biotelemetry research in the Great Lakes, we discuss the strengths and weaknesses of incorporating biotelemetry into AOC RAP processes to improve the science and practice of restoration and to facilitate the delisting of AOCs.

Using genetic inference to re-evaluate the minimum longevity of the lemon shark Negaprion brevirostris

A combination of mark-recapture and genetic sampling was used to extend the minimum longevity of an elasmobranch species and the life span estimate of the lemon shark Negaprion brevirostris was increased conservatively from 20·2 to 37 years. This increase in longevity means higher vulnerability and a longer recovery time from exploitation.

Dietary triggers in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a frequently occurring, benign functional gastrointestinal disorder with a complex poorly understood pathology which appears to be multifactorial in nature. There is no association with structural or biochemical abnormalities in the gastrointestinal tract. Functional variations in myoelectrical activity, visceral hypersensitivity and illness behaviours have all been observed in patients experimentally. In conjunction with environmental, psychological and alimentary factors, these mechanisms have been proposed as the major determinants of symptom genesis. Certainly, dietary factors are frequently perceived by sufferers as powerful symptom triggers, with many reporting multiple food intolerance. Physicians, however, remain divided upon the relevance of food to the disorder, with many eschewing a nutritional connection. This is unsurprising as, despite much experimental work to determine the clinical relevance of food intolerance and allergy to the aetiology of the disorder, the vast range of foodstuffs available for testing, inherent procedural problems with test foods, methodological insufficiencies and the continually evolving knowledge of the disorder, particularly the subgrouping of sufferers, have restricted the scientific validity of current findings. At the present time, it is difficult to make informed judgement upon the importance of food in IBS, and rigorously designed, large scale trials devised in the light of recent knowledge are required before conclusions can be drawn.

Psychogenic non-epileptic seizures--definition, etiology, treatment and prognostic issues: a critical review

In this review we systematically assess our currently available knowledge about psychogenic non-epileptic seizures (PNES) with an emphasis on the psychological mechanisms that underlie PNES, possibilities for psychological treatment as well as prognosis. Relevant studies were identified by searching the electronic databases. Case reports were not considered. 93 papers were identified; 65 of which were studies. An open non-randomized design, comparing patients with PNES to patients with epilepsy is the dominant design. A working definition for PNES is proposed. With respect to psychological etiology, a heterogeneous set of factors have been identified. Not all factors have a similar impact, though. On the basis of this review we propose a model with several factors that may interact in both the development and prolongation of PNES. These factors involve psychological etiology, vulnerability, shaping, as well as triggering and prolongation factors. A necessary first step of intervention in patients with PNES seems to be explaining the diagnosis with care. Although the evidence for the efficacy of additional treatment strategies is limited, variants of cognitive (behavioural) therapy showed to be the preferred type of treatment for most patients. The exact choice of treatment should be based on individual differences in the underlying factors. Outcome can be measured in terms of seizure occurrence (frequency, severity), but other measures might be of greater importance for the patient. Prognosis is unclear but studies consistently report that 1/3rd to 1/4th of the patients become chronic.

Treatments for non-epileptic attack disorder

BACKGROUND

Psychogenic non-epileptic seizures (NES) have the outward appearance of epilepsy in the absence of physiological or electroencephalographic correlates. Non-epileptic seizures can occur in isolation or in combination with epileptic seizures. The development and maintenance of non-epileptic seizures has been well documented and there is a growing literature on the treatment of NES which includes non-psychological (including anti-anxiety and antidepressant pharmacological treatment) and psychological therapies (including cognitive behavioural therapy (CBT), hypnotherapy and paradoxical therapy). Various treatment methodologies have been tried with variable success. The purpose of this Cochrane review was to establish the evidence base for the treatment of NES.

OBJECTIVES

To assess whether treatments for NES result in a reduction in frequency of seizures and/or improvement in quality of life, and whether any treatment is significantly more effective than others.

SEARCH STRATEGY

We searched the Cochrane Epilepsy Group's Specialised Register (September 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to July 2005), and PsycINFO (1806 to July 2005). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies

SELECTION CRITERIA

Randomised or quasi-randomised studies were included that assessed one or more types of psychological or non-psychological interventions for the treatment of NES. Studies of childhood NES were excluded from our review.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed the trials for inclusion and extracted data. Outcomes included reduction in seizure frequency and improvements in quality of life.

MAIN RESULTS

Three small studies met our inclusion criteria and were of poor methodological quality. Two assessed hypnosis and the other paradoxical therapy. There were no detailed reports of improved seizure frequency or quality of life outcomes, and these trials provide no reliable evidence of a beneficial effect of these interventions.

AUTHORS' CONCLUSIONS

In view of the methodological limitations and the small number of studies, we have no reliable evidence to support the use of any treatment including hypnosis or paradoxical injunction therapy in the treatment of NES. Randomised studies of these and other interventions are needed.

Dynamics of carriage of Neisseria meningitidis in a group of military recruits: subtype stability and specificity of the immune response following colonization

Meningococcal carriage and the immune response to colonization were studied in a group of military recruits undergoing basic training. Subtyping by determination of the class 1 protein sequence clearly differentiated between strains and demonstrated the dynamics of carriage and transmission. Expression of class 1 protein by each strain remained stable during prolonged carriage by different subjects. Following colonization, a marked increase in serum bactericidal response occurred, which was specific for the subtype of the acquired strain and was associated with an increase in reactivity by Western blot to the homologous class 1 protein. Subjects colonized by multiple strains showed evidence of a specific immune response to the class 1 protein of each strain acquired. The subtype specificity of the bactericidal response to meningococci and the stability of expression of the class 1 protein have important implications for the design of vaccines for prevention of serogroup B meningococcal disease.

Light-induced spectral changes in fully oxidized cytochrome c oxidase in the presence of oxygen

Illumination of oxidized cytochrome oxidase with low intensity (<2 mW) light below 300 nm in the presence of oxygen causes pH-dependent spectral changes in the Soret and visible regions. The light-induced difference spectra show a peak at 438 nm and a trough at 414 nm in the Soret region and a peak at 606 nm and a shoulder at approximately 577 nm in the visible region. The effect was inhibited by cyanide, suggesting the involvement of cytochrome a3. The pH dependence indicates two titratable groups with pKa values of 6.52 +/- 0.26 and 6.85 +/- 0.15. The spectral changes are analogous to those occurring upon addition of hydrogen peroxide to the fully oxidized enzyme, which results in a mixture of species with absorbance maxima at 607 and 580 nm when referenced against the oxidized enzyme. Catalase addition affected the initial onset of the spectral change and increased the rate at which the reverse reaction occurred upon termination of illumination. The data are consistent with a mechanism involving light-induced autoreduction of the binuclear center and subsequent O2 binding, followed by the release of hydrogen peroxide and the formation of a mixture of the 607 nm and 580 nm forms.

Sequence variation in class 1 outer membrane protein in Neisseria meningitidis isolated from patients with meningococcal infection and close household contacts

The meningococcal porA gene encodes the class 1 outer membrane protein which contains the VR1 and VR2 regions responsible for sero-subtype specificity. However, sequence variations may occur within these regions which are not recognised by the currently available subtype antibodies. Since this "silent" microheterogeneity represents a potential hidden source of information, in the current study we have used porA gene sequence analysis to study strains isolated from cases of meningococcal infection and close household contacts. With each of the three subtypes studied, the index cases could be differentiated from each other by sequence variations within at least one of the VR1, VR2 and SV1 regions. In addition, although isolates from close household contacts showed a high degree of homology significant differences could be detected within some family groups. These data demonstrate that it is possible to use sequence information to differentiate between potential sources of infection which appear identical using conventional serological methods.

Comparison of the class-1 outer membrane protein from B:15:P1.16 Neisseria meningitidis strains isolated from patients previously immunized with a serogroup B outer membrane protein vaccine in Norway

A previous report of a large, double blind, efficacy trial of an experimental Group B meningococcal outer membrane protein vaccine carried out in Norwegian Teenagers, showed a protection rate of 57%. Previous studies had demonstrated the occurrence of mutations in the class-1 outer membrane protein which alter its immunological properties. The occurrence of new mutations might compromise the efficacy of a vaccine and explain the occurrence of any vaccine failures. The porA gene, which encodes expression of the class 1 protein, was sequenced in all isolates from vaccine failures and compared to that of the vaccinating strain H44/76 (B:15:P1.7,16). The porA DNA and deduced amino acid sequences were all identical to that of the vaccinating strain except for that of one isolate which had a sequence identical to strains previously reported in Norway and England with a 'masked P1.7' epitope. The absence of new mutations in the trial was encouraging for the further development of outer membrane protein vaccines.

Experimental enzyme-linked amperometric immunosensors for the detection of salmonellas in foods

Two enzyme-linked amperometric immunosensors specific for salmonellas were developed as rapid methods for quantifying and detecting these organisms in pure cultures and foods. Both used alkaline phosphatase as the enzyme reporter molecule but one system used phenyl phosphate as the substrate followed by the electrochemical detection of phenol at a polarized platinum electrode. The other system incorporated an enzyme amplification step and relied on the electrochemical detection of a reduced mediator, ferrocyanide. Both assays were rapid (4 h) and specific and generated salmonella-dependent signals above 10(4) cfu/ml (phenyl phosphate system) or 10(5) cfu/ml (enzyme amplified system) in pure cultures and samples of several foods, although the results with beef samples showed considerable variation. Both systems were able to detect low (1-5 cfu/g or /ml) numbers of salmonellas in foods after non-selective (18 h) and selective (22 h) enrichment steps but four samples, out of 147, gave false positive results. False positive results were eliminated by reducing the enrichment steps to 6 h and 18 h respectively (90 samples).

Direct application to dairy foods of a Listeria-specific oligonucleotide probe to 16S rRNA

A potentially Listeria-specific 28 base oligonucleotide probe was designed from 16S rRNA sequence data. Using either 32P or non-radioactive (alkaline phosphatase) labels, the probe was shown to be highly specific as it hybridised to RNA extracted from all of the species of Listeria but not to any of the other bacteria tested. Both probe methods were highly sensitive and ca 10(2) cfu/ml Listeria could be detected in pure cultures. A rapid procedure for extracting RNA from milk, Camembert and cottage cheese was developed. This allowed the direct application of the probe to these foods and gave a rapid and specific method of detecting > 10(2) cfu/g or ml Listeria in these foods.

Use of the polymerase chain reaction and oligonucleotide probes for the rapid detection and identification of Carnobacterium species from meat

The polymerase chain reaction (PCR) was used selectively to amplify specific rDNA sequences of Carnobacterium divergens, C. mobile, C. piscicola and C. gallinarum in purified DNA extracts, crude cell lysates and food samples. The PCR products were visualized by agarose gel electrophoresis and identified, at species level, by hybridization reactions with three specific oligonucleotide probes for C. divergens, C. mobile and C. piscicola/C. gallinarum designed from 16S rRNA sequence data. The PCR was sufficiently sensitive to amplify DNA from a single bacterium to detectable levels after 30 cycles of amplification. Both radioactive (32P) and non-radioactive alkaline phosphatase labelled probes was able to detect the PCR products. Detection was highly specific and the probes did not hybridize with DNA samples from any other of the bacterial species tested. These methods enabled the rapid and specific detection and identification of carnobacteria from pure cultures and samples of meat.

The T cell receptor V alpha 11 gene family. Analysis of allelic sequence polymorphism and demonstration of J alpha region-dependent recognition by allele-specific antibodies

Allelic polymorphism in TCR loci may play an important role in shaping the T cell repertoire and in disease susceptibility. We have used a combination of antibody and sequence analysis to investigate polymorphism in the murine V alpha 11 family. Two different antibodies have been analyzed that recognize particular V alpha 11 family members of the V alpha b and V alpha d haplotypes. One antibody shows J alpha dependency, suggesting a conformational element to the epitope. Investigation of the anti-V alpha 11 staining pattern on different mouse strains indicates that there is a marked influence of MHC haplotype on V alpha 11 selection and that V alpha 11 is preferentially expressed on CD4+ cells. Sequence analysis of V alpha 11 genes from the V alpha a, V alpha b, and V alpha d haplotypes shows two potential regions for the haplotype-specific epitopes. The relatedness of the different V alpha 11 family members from different haplotypes suggests that the V alpha 11.1/11.2 gene duplication is relatively recent, but that V alpha 11.3 separated much earlier. Differences between V alpha 11.3 and V alpha 11.1/11.2 are concentrated in the putative complementarity determining regions (CDR), whereas differences between alleles are not clearly clustered. However, the V alpha 11.1a and V alpha 11.1d alleles differ from V alpha 11.1b and V alpha 11.2b in CDR1. A V alpha 11.2-expressing anti-cytochrome c T cell has the same V-J junction as a V alpha 11.1-bearing cell with a similar fine specificity, indicating that V alpha 11.1b and V alpha 11.2b do not contribute different Ag specificities.

The T cell receptor V alpha 11 gene family. Analysis of allelic sequence polymorphism and demonstration of J alpha region-dependent recognition by allele-specific antibodies

Allelic polymorphism in TCR loci may play an important role in shaping the T cell repertoire and in disease susceptibility. We have used a combination of antibody and sequence analysis to investigate polymorphism in the murine V alpha 11 family. Two different antibodies have been analyzed that recognize particular V alpha 11 family members of the V alpha b and V alpha d haplotypes. One antibody shows J alpha dependency, suggesting a conformational element to the epitope. Investigation of the anti-V alpha 11 staining pattern on different mouse strains indicates that there is a marked influence of MHC haplotype on V alpha 11 selection and that V alpha 11 is preferentially expressed on CD4+ cells. Sequence analysis of V alpha 11 genes from the V alpha a, V alpha b, and V alpha d haplotypes shows two potential regions for the haplotype-specific epitopes. The relatedness of the different V alpha 11 family members from different haplotypes suggests that the V alpha 11.1/11.2 gene duplication is relatively recent, but that V alpha 11.3 separated much earlier. Differences between V alpha 11.3 and V alpha 11.1/11.2 are concentrated in the putative complementarity determining regions (CDR), whereas differences between alleles are not clearly clustered. However, the V alpha 11.1a and V alpha 11.1d alleles differ from V alpha 11.1b and V alpha 11.2b in CDR1. A V alpha 11.2-expressing anti-cytochrome c T cell has the same V-J junction as a V alpha 11.1-bearing cell with a similar fine specificity, indicating that V alpha 11.1b and V alpha 11.2b do not contribute different Ag specificities.

Increased sensitivity of an enzyme-amplified colorimetric immunoassay for protein A-bearing Staphylococcus aureus in foods

A modification to the enzyme amplification system described by Self (1984), has been developed in which the addition of semicarbazide hydrochloride increased the sensitivity of detection of protein A-bearing Staphylococcus aureus in foods from 4-6 X 10(3) to 20 colony forming units (c.f.u.) g-1 or ml-1. This may be due to the removal of acetaldehyde produced as a by-product of the amplification cycle thereby permitting further cycling to proceed.

An improved amperometric immunosensor for the detection and enumeration of protein A-bearing Staphylococcus aureus

An amperometric immunosensor specific to the protein A of Staphylococcus aureus, was developed using the direct electrochemical detection of phenol produced by alkaline phosphatase from phenylphosphate. The immunosensor could detect protein A at 0.01 ng/ml and could reliably detect and quantify pure cultures of protein A-bearing Staph. aureus above 10(3) cfu/ml. A similar sensitivity of detection was obtained with samples of beef and milk.

A semi-homogeneous amperometric immunosensor for protein A-bearing Staphylococcus aureus in foods

A semi-homogeneous amperometric immunosensor specific to the protein A of Staphylococcus aureus was developed using direct electrochemical detection of phenol produced by alkaline phosphatase from phenyl phosphate. The immunosensor could reliably detect strains of protein A-bearing S. aureus in pure cultures at ca. 10(4) cfu/ml, and at ca. 10(5) cfu/g or ml in various food samples. Due to its semi-homogeneous nature, the system was very simple, easy to operate, and labour-saving. The good correlation between the amperometric current generated by the immunosensor and plate counts illustrated the potential usefulness of this simple system. It proved to be a reliable 24-h detection method for food samples containing very low numbers of protein A-bearing S. aureus after pre-enrichment, as it was able to detect cells that could not directly be enumerated by plate counts.

Sensitive enzyme-amplified electrical immunoassay for protein A-bearing Staphylococcus aureus in foods

An amperometric electrochemical immunoassay specific for protein A-bearing Staphylococcus aureus was developed. The method was based on a sandwich immunosorbent assay and incorporated an enzyme amplification step, using a NAD-specific redox cycle generating NADH (C. H. Stanley, A. Johannsson, and C. H. Self, J. Immunol. Methods 83:89-95, 1985). Reduction of the mediator, ferricyanide, was dependent on the initial concentration of antigen. The final potential was measured by using a Pt disk electrode polarized at +0.8 V to the Ag/AgCl reference electrode. The assay was rapid (4 h) and generated protein A- and cell (S. aureus)-dependent signals. The system was highly sensitive and could detect 10 pg of protein A ml-1 and less than 100 CFU of S. aureus ml-1. Similar sensitivities were observed with S. aureus cultures inoculated into beef and milk, but the sensitivity was reduced slightly (ca. 10(3) g-1) with samples of Cheddar cheese.

Development and performance of an enzyme-linked amperometric immunosensor for the detection of Staphylococcus aureus in foods

An amperometric enzyme-linked immunosensor was developed to detect and quantify levels of Staphylococcus aureus electrically in pure cultures and in foods. The assay was a modification of a 'sandwich' ELISA for the protein A of Staph. aureus, employing catalase-labelled anti-protein A antibody. On addition of hydrogen peroxide to the assay system the catalase released O2 which was monitored using an amperometric oxygen electrode. The rate of current increase was proportional to the antigen concentration (protein A or Staph. aureus). Protein A was detected reliably at 0.1 ng/ml representing a 20-fold increase in sensitivity over the conventional ELISA that used horseradish peroxidase. Pure cultures of Staph. aureus were detected at 10(-3)-10(-4) cfu/ml with the amperometric electrode (cf greater than 10(5)/ml for conventional ELISA). The same level of sensitivity was achieved for inoculated food samples. Low levels of contamination (1 cfu/g) of Staph. aureus were detected after incubation at 37 degrees C for 18 h, and the immunosensor could from the basis of a test for screening and identification of protein A-bearing Staph. aureus in 24 h, although natural variations in protein A content between different strains could make the system unreliable in accurate quantification of cell numbers.

Transluminal angioplasty versus surgical repair for stenosis of hemodialysis grafts. A randomized study

A randomized study of transluminal angioplasty versus surgical revision for stenosis at the venous end of hemodialysis grafts was carried out. Median patency for the surgical group was 12 months versus only 4 months for the transluminal angioplasty group. This difference was statistically significant (p less than 0.01). In addition, the average cost for surgical revision was slightly less than that for transluminal angioplasty. Therefore, for long-term patency, surgical treatment is the method of choice, although under special circumstances there may still be a role for transluminal angioplasty.

Fiber-optic interferometric sensor arrays with freedom from source phase-induced noise

We propose arrays of all-passive remote sensors with freedom from both source phase-induced intensity noise and cross talk between sensors. These arrays employ high-duty-cycle time-domain addressing, utilize laser diodes, and have downlead insensitivity. A synthetic heterodyne demodulation technique is used to prevent environmentally induced signal fading. An experimental all-fiber implementation of a single remote sensor yielded a measured sensitivity of below 40 microrad/ radicalHz at signal frequencies above 600 Hz.

Oxidase reactions of tomato anionic peroxidase

Tomato (Lycopersicon esculentum Mill) anionic peroxidase was found to catalyze oxidase reactions with NADH, glutathione, dithiothreitol, oxaloacetate, and hydroquinone as substrates with a mean activity 30% that of horseradish peroxidase; this is in contrast to the negligible activity of the tomato enzyme as compared to the horseradish enzyme in catalyzing an indoleacetic acid-oxidase reaction with only Mn(2+) and a phenol as cofactors. Substitution of Ce(3+) for Mn(2+) produced an 18-fold larger response with the tomato enzyme than with the horseradish enzyme, suggesting a significant difference in the autocatalytic indoleacetic acid-oxidase reactions with these two enzymes. In attempting to compare enzyme activities with 2,4-dichlorophenol as a cofactor, it was found that reaction rates increased exponentially with both increasing cofactor concentration and increasing enzyme concentration. While the former response may be analogous to allosteric control of enzyme activity, the latter response is contrary to the principle that reaction rate is proportional to enzyme concentration, and additionally makes any comparison of enzyme activity difficult.

Amebic colitis. Preventing morbidity and mortality from fulminant disease

Uncomplicated amebic colitis is readily treated and has a mortality rate of less than 0.5%. Complications necessitating surgical intervention develop in only 6% to 11% of patients with symptomatic disease. However, the mortality rate in these patients ranges from 40% to 100% and stems in part from delays in diagnosis and treatment. Patients with known amebic colitis who show signs of systemic toxicity or of localized or generalized peritonitis are at high risk for complications; surgical consultation should be obtained. Patients who are thought to have acute appendicitis, diverticulitis, or obstructive or perforative carcinoma but have a history of dysentery atypical of that in these conditions should also be evaluated for amebiasis. Such patients should be treated presumptively until the diagnosis of amebic colitis can be excluded.

Active polarization coupler for birefringent fiber

Static coupling between polarization modes achieved by periodically stressing birefringent fiber once per beat length was recently reported. The same scheme is now used to obtain coupling modulation at kilohertz-to-megahertz frequencies by applying pressure to the fiber with an oscillating piezoelectric ceramic. An amplitude of 30-50 V (peak to peak) was found to be necessary to modulate the polarization coupling from a minimum to a maximum. Polarization modulation is also achieved by applying stress along one fiber polarization axis between the two static couplers of a Mach-Zehnder interferometer.

Two-mode fiber modal coupler

When a single-mode fiber is used at a wavelength below the cutoff wavelength, the fiber guides second-order modes, which travel at different phase velocities from the fundamental mode. Periodically stressing this two-mode fiber once per beat length can cause coherent coupling between the modes. Such a modal coupler has been developed and is described here. Coupling to one of the second-order modes has been achieved, leaving less than -40-dB residual power in the fundamental mode. Two couplers have been mounted on a single strand of fiber to construct a Mach-Zehnder interferometer with better than a 30-dB on/off ratio. The coupler is polarization sensitive and can be used as an in-line polarizer. A 36-dB extinction ratio between polarizations has been observed.

Birefringent-fiber polarization coupler

Periodically stressing a birefringent fiber once per beat length can cause coherent coupling to occur between polarization modes. Such a birefringent-fiber polarization coupler is described here. More than 30 dB of power transfer between polarizations has been achieved. The device has been used as the output coupler of an in-line Mach-Zehnder interferometer, and better than 25-dB on/off extinction has been measured. The device is wavelength selective and can be used as a multiplexer or as a notch filter. A notch of 9-nm full width at half-maximum has been achieved with a 60-period comb structure.

Stimulation of peroxidase reactions by hydroxamates

Salicylhydroxamic acid, benzohydroxamic acid, and phenylacetohydroxamic acid were found to stimulate the oxidation of NADH, dithiothreitol, and ferrocyanide by horseradish peroxidase. The hydroxamates themselves served as substrates in peroxidase reactions, and the observed stimulations may involve hydroxamate free-radical formation.

Prognostic significance of hormone receptors in early recurrence of breast cancer

A retrospective analysis of 155 patients with primary infiltrating breast cancer was carried out to determine the prognostic significance of hormone receptor values and analyze the effect of adjuvant chemotherapy. Estrogen receptor-negative patients were found to have a significantly higher recurrence rate than estrogen receptor-positive patients (p less than 0.005). No difference was found based on the progesterone receptor value. The data strongly suggest a favorable response to adjuvant chemotherapy administered on the basis of the estrogen receptor value alone.

Hydrogen Peroxide-mediated Oxidation of Indole-3-acetic Acid by Tomato Peroxidase and Molecular Oxygen

The oxidation of indole-3-acetic acid by anionic tomato peroxidase was found to be negligible unless reaction mixtures were supplemented with H(2)O(2). The addition of H(2)O(2) to reaction mixtures initiated a period of rapid indole-3-acetic acid oxidation and O(2) uptake; this phase ended and O(2) uptake fell to a low level when the H(2)O(2) was exhausted. The stoichiometry of the reaction, which is highly dependent on enzyme concentration and pH, suggests that H(2)O(2) initiates a sequence of reactions in which indole-3-acetic acid is oxidized.

Tomato peroxidase: purification, characterization, and catalytic properties

A major peroxidase has been found in the tomato pericarp (Lycopersicon esculentum var. Tropic) of the ripe and green fruit. A purification scheme yielding this enzyme approximately 85% pure has been developed. The tomato enzyme resembles horseradish peroxidase (HRP) in a standard peroxidase assay and in its ability to be reduced to ferroperoxidase, to be converted to oxyferroperoxidase (compound III), and to form peroxidase complexes with hydrogen peroxide (compounds I and II). In contrast to the HRP, the tomato peroxidase fails to catalyze the aerobic oxidation of indole-3-acetic acid in the presence of 2,4-dichlorophenol and manganese. The tomato peroxidase can be resolved into two nonidentical subunits in the presence of dithiothreitol while HRP remains as a single polypeptide chain after such treatment. Dithiothreitol is oxidized in the presence of tomato or horseradish peroxidase with the enzymes accumulating in their oxyferroperoxidase forms during the oxidation reaction. Whereas HRP returns to its free ferric form at the end of the reaction, the tomato enzyme is converted into a form that absorbs at 442 nanometers.