Human cartilage repair with a photoreactive adhesive-hydrogel composite

Surgical options for cartilage resurfacing may be significantly improved by advances and application of biomaterials that direct tissue repair. A poly(ethylene glycol) diacrylate (PEGDA) hydrogel was designed to support cartilage matrix production, with easy surgical application. A model in vitro system demonstrated deposition of cartilage-specific extracellular matrix in the hydrogel biomaterial and stimulation of adjacent cartilage tissue development by mesenchymal stem cells. For translation to the joint environment, a chondroitin sulfate adhesive was applied to covalently bond and adhere the hydrogel to cartilage and bone tissue in articular defects. After preclinical testing in a caprine model, a pilot clinical study was initiated where the biomaterials system was combined with standard microfracture surgery in 15 patients with focal cartilage defects on the medial femoral condyle. Control patients were treated with microfracture alone. Magnetic resonance imaging showed that treated patients achieved significantly higher levels of tissue fill compared to controls. Magnetic resonance spin-spin relaxation times (T(2)) showed decreasing water content and increased tissue organization over time. Treated patients had less pain compared with controls, whereas knee function [International Knee Documentation Committee (IKDC)] scores increased to similar levels between the groups over the 6 months evaluated. No major adverse events were observed over the study period. With further clinical testing, this practical biomaterials strategy has the potential to improve the treatment of articular cartilage defects.

Erp61 is GRP58, a stress-inducible luminal endoplasmic reticulum protein, but is devoid of phosphatidylinositide-specific phospholipase C activity

Using antibody raised against putative Form I phosphatidylinositide-specific phospholipase C (PI-PLC) and direct amino acid sequencing of the protein recognized by this antibody, we have shown that the antibody reacts with luminal endoplasmic reticulum (ER) proteins, including ERp61. ERp61 possesses a COOH-terminal QEDL sequence that acts as an ER retention signal. Additional experiments have shown, however, that PI-PLC activity is separable from ERp61 and that rat or murine ERp61 expressed in COS cells failed to produce an increase in PI-PLC activity in the COS cells. Finally, we have identified ERp61 as GRP58, a 58-kDa protein inducible by glycosylation block and treatment with the Ca2+ ionophore, A23187.

Left ventricular function and mass after orthotopic heart transplantation: a comparison of cardiovascular magnetic resonance with echocardiography

OBJECTIVE

We compared the assessment of left ventricular function and mass by M-mode echocardiography (echo) with fast breath-hold cardiovascular magnetic resonance (CMR) in patients who received orthotopic heart transplantation. We also sought to establish the reproducibility of breath-hold CMR in this patient population.

METHODS

We prospectively acquired 51 sets of echo and CMR data in 21 patients who had undergone orthotopic heart transplantation. We examined the intraobserver and interobserver reproducibility of breath-hold CMR in this group and compared it with published data. We compared the left ventricular ejection fraction (EF) and mass determined by echo with the CMR data.

RESULTS

The average time between CMR and echo was 0 +/- 7 days (mean +/- SD), the time between each set of CMR-echo data acquisition was 5.1 +/- 4.1 months. Cardiovascular magnetic resonance showed good reproducibility in this population, with intraobserver percentage variability of 2.2% +/- 2.4% for EF and 3. 2% +/- 2.7% for mass, and interobserver percentage variability of 2. 4% +/- 1.9% for EF and 2.2% +/- 1.9% for mass. The Bland-Altman limits of agreement between echo and CMR were wide for both EF (-9. 6% to 15%) and mass, irrespective of the formula used (-61.3 to 198 g for the Bennett and Evans formula, -65.4 to 196.8 g for the American Society of Echocardiography (ASE) formula, -65.3 to 181 g for the Devereux formula, and -95.2 to 64.6 g for the Teichholz formula).

CONCLUSION

Fast-acquisition CMR is reproducible in recipients of transplanted hearts. We found poor agreement with the results of echo. The choice of technique will depend on local resources as well as the clinical importance of the result. Echo remains readily available and gives rapid assessment of volumes, EF, and mass. However, the good reproducibility of CMR may make it a more suitable technique for long-term follow-up of an individual or of a study population.

Distribution of neurons with high-affinity uptake sites for GABA in the myenteric plexus of the guniea-pig, rat and chicken

The occurrence of neurons possessing high-affinity uptake sites for GABA was studied in the myenteric plexus of the guinea-pig ileum, caecum, and proximal and distal colon, the rat proximal colon, and the chicken gizzard with the use of 3H-GABA and autoradiography. Experiments were carried out on plexuses that had been freshly isolated from the gut wall or on isolated plexuses that had been maintained as explant cultures for 7 to 14 days. Scattered neurons selectively labelled with 3H-GABA were found in the myenteric plexuses from all the areas examined. The results suggest that GABAergic neurons are widely distributed in the enteric nervous system.

Anaphylaxis in Israel: experience with 92 hospitalized children

Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.

Community-acquired Pseudomonas aeruginosa urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and treatment

BACKGROUND

The practice of antibiotic prophylaxis against recurrent urinary tract infection (UTI), with hospitalization reserved for severe or complicated cases, has led to changes in the nature and culprit uropathogens of community-acquired (CA), hospital-treated UTI. Characterization of subgroups that need special considerations is crucial.

OBJECTIVES

To elucidate the trends and characteristics of CA Pseudomonas UTI in hospitalized children; define the antibiotic susceptibility; determine the appropriateness of the empiric antibiotics used; compare to other causes of UTI in this population; and thereby define predictors for Pseudomonas UTI.

METHODS

A prospective clinical and laboratory study from 2001 through 2005. Children with P. aeruginosa UTI were characterized and compared with non-Pseudomonas UTI.

RESULTS

Of 351 episodes of culture-proven CA UTI, 28 (8%) were caused by Pseudomonas, representing a 2.8-fold increase from our previous study. Pseudomonas UTI was more common in children > 5 years (p < 0.01), with urinary abnormalities (p < 0.01) and with previous antibiotic use in the previous month (p < 0.001). Pseudomonas UTI was often resistant to antibiotics usually recommended for empiric therapy; 25% was initially treated with inappropriate IV antibiotics (4.6% in the non-Pseudomonas group, p < 0.001) with 1.3 days longer IV antibiotics. On multivariate analysis, risk factors for Pseudomonas UTI were previous antibiotic therapy and underlying urinary pathology.

CONCLUSIONS

Pseudomonas UTI seems to increase in CA, hospital-treated children and is often treated inappropriately according to current treatment protocols. Awareness of this trend and knowledge of the defined risk factors of Pseudomonas UTI might improve the empiric antibiotic therapy.

Target-Set and Response-Set Interaction: Implications for Models of Human Information Processing

In binary character-classification tasks, reaction time generally has been reported to increase substantially with the number of target elements. However, when the targets formed a familiar set and subjects were not required to make explicit "no" responses, reaction time did not increase significantly as the target set increased in size from one to three.

Tissue distribution of three members of the murine protein disulfide isomerase (PDI) family

The distribution of PDI, ERp61 and ERp72, members of the protein disulfide isomerase (PDI) family of endoplasmic reticulum (ER) proteins, was determined in various murine tissues. Relative amounts of mRNA were measured using a quantitative reverse transcription-polymerase chain reaction (RT-PCR) method. Protein levels were determined from Western blots. In most tissues, protein levels paralleled the amount of mRNA for each PDI family member. The tissue distribution of the PDI and ERp72 mRNAs was similar, although ERp72 was not as abundant as PDI in the tissues. The tissue distribution of the ERp61 mRNA was significantly different from the two other family members. To help define potential hormonal or maturational differences in the regulation of expression of PDI family members, mRNA was measured in the frontal cortex, liver, pituitary gland and uterus at timed intervals during postnatal maturation. Except in the pituitary gland, the mRNA levels at 10 days and 22 days after birth were essentially identical to those in the adult. The ERp61 and ERp72 mRNAs were present at 2- to 3-fold higher levels in the pituitary glands of the 10- and 22-day-old mice, than in the adult mice. In addition, the pituitary gland PDI mRNA was 2- to 3-fold higher in 10-day-old mice than in adults. In general, levels of PDI family members were higher in secretory tissues than in other tissues in both immature and adult mice.

Streptococcus acidominimus infection in a child causing Gradenigo syndrome

Gradenigo syndrome is a rare presentation of acute petrositis. The clinical triad of Gradenigo syndrome consists of acute suppurative otitis media, severe unilateral headache and abducens nerve palsy. We report the first case of Gradenigo syndrome caused by Streptococcus acidominimus, a Gram-positive coccus of the Streptococcus viridans group, which rarely causes deep-seated infection in humans.

CONCLUSION

Gradenigo syndrome may complicate acute otitis media and should be suspected in case of unilateral headache and abducens nerve palsy. Conservative medical treatment without surgery may be considered in some patients.

HLA compatibility assessment and management of highly sensitized patients under the new kidney allocation system (KAS): A 2016 status report from twelve HLA laboratories across the U.S

Twelve HLA laboratories were surveyed to assess the methods and operational issues involved to define highly sensitized patients and to assess HLA compatibility under the new kidney allocation system (KAS) in the U.S. All laboratories used single antigen bead assays both pre- and post-KAS to define both broad and allele-specific HLA antibodies. The methods and threshold used to list HLA unacceptable antigens in UNet for virtual crossmatch (vXM) and the criteria used for determining HLA compatibility varied among laboratories. Laboratories reported several limitations of the current assays including the accuracy of quantifiable antibody fluorescence values, inadequate coverage of common alleles on the bead panels, and challenges in calibrating the vXM. The new KAS has resulted in a significant surge of deceased donor organ offers requiring vXM evaluation under tight time constraints. In the post-KAS period, eight of twelve laboratories (67%) indicated that their center did not proceed to transplant based on vXM without a prospective lymphocyte crossmatch. In conclusion, HLA laboratories play a critical role in deceased donor allocation for highly sensitized patients under the new KAS. Significant opportunities exist to improve the methods used in the assessment of HLA compatibility to safely transplant highly sensitized patients.

Rapid increase in the prevalence of antimicrobial drug resistance among enterococcal blood isolates in southern Israel

A prospective surveillance was conducted to monitor the prevalence and dynamics of antimicrobial resistance among enterococci isolated from blood cultures in southern Israel. A total of 242 organisms isolated between 1993 and 1996 were studied. The prevalence of Enterococcus faecalis significantly decreased during the study period, whereas that of Enterococcus faecium doubled. Antimicrobial drug resistance increased steadily among Enterococcus faecium isolates: resistance to ampicillin increased from 19% in 1993-1994 to 53% in 1995, and to 67% in 1996 (p = 0.005); during the same period, resistance to vancomycin increased from 0% to 20%, and to 50% (p = 0.002), and combined resistance to ampicillin and vancomycin and high-level resistance to gentamicin from 0% to 20% and to 38% (p < 0.02).

NF-Y, a CCAAT box-binding protein, is one of the trans-acting factors necessary for the response of the murine ERp72 gene to protein traffic

The accumulation of incompletely assembled immunoglobulin mu heavy chain in transfected COS cells stimulates the cellular response to protein traffic that results in the increased transcription and elevated synthesis of several ER chaperones, including ERP72, a member of the protein disulfide isomerase family of molecular chaperones. The ERp72 promoter contains an 82 bp ER protein traffic response element (ERPTRE) that is sufficient to mediate this response. Previously, it had been shown that the alteration of a putative AP-2 site and a CCAAT and inverted CCAAT site within the ERPTRE significantly decreased the response of ERp72 promoter to mu chain accumulation. We have extended these findings by demonstrating a role for NF-Y and a potentially novel DNA-binding protein in the regulation of transcription from the ERp72 promoter. The fact that NF-Y binding to the ERPTRE is observed in extracts from both control cells and cells in which the response to protein traffic has been activated indicates that the binding of NF-Y, while necessary, is not sufficient to account for the response. Each of the two CCAAT sites in the ERPTRE can bind NF-Y independently, but both sites must be intact for full ERPTRE function. A second protein can bind to the ERPTRE independently of NF-Y and at a site overlapping or close to the 3' end of the reverse CCAAT site. It is possible that interactions between NF-Y, this protein and perhaps other factors are responsible for the regulation of the protein traffic response.

Transient hypoparathyroidism due to amphotericin B-induced hypomagnesemia in a patient with beta-thalassemia

OBJECTIVE

To report a case of transient hypoparathyroidism that developed in a beta-thalassemic patient due to amphotericin B-induced hypomagnesemia. CASE SIJMMARY: A 21-year-old man with beta-thalassemia was treated with amphotericin B for Candida albicans intravenous line sepsis. After five days of treatment (cumulative dose 160 mg), he developed hypomagnesemia, which caused hypoparathyroidism and hypocalcemia; all three abnormalities resolved after the drug was withdrawn.

DISCUSSION

Patients with beta-thalassemia may develop endocrinologic abnormalities due to excessive iron deposition. Some may have subclinical hypoparathyroidism that clinically emerges after even a mild homeostasis disturbance. Amphotericin B is associated with variable adverse effects including renal tubular insult, which may induce hypomagnesemia following relatively short treatment. The resolution of hypomagnesemia, hypocalcemia, and hypoparathyroidism in our patient after discontinuation of amphotericin B treatment suggests that the endocrine dysfunction was due to a drug-related adverse effect and not to parathyroid dysfunction caused by iron deposition.

CONCLUSIONS

This case demonstrates a known but rarely reported adverse effect of amphotericin B, namely hypomagnesemia, that may occur even at a low cumulative dose. It also emphasizes that patients with an underlying disease, such as thalassemia, may be more susceptible to hypoparathyroidism and hypocalcemia during treatment with amphotericin B.

Fluid-fluid levels in a simple bone cyst on magnetic resonance imaging

An unusual case is presented here of simple bone cyst (SBC) with fluid-fluid levels on MR and cementum-like substance on microscopy in an atypical location in the distal femur. Fluid-fluid levels are commonly described in the literature within aneurysmal bone cysts, giant cell tumour, chondroblastomas and telangiectatic osteosarcomas, but a literature review revealed only one reported case with multiple fluid levels occurring in a simple bone cyst on MRI. A cementum-like matrix is diagnostic of SBC and is seen in approximately 10% of cases.

Failure to diagnose pain of muscular origin leads to unnecessary surgery

Three patients who were scheduled for surgical procedures for a variety of diagnoses are presented. Each of the patients presented with pain that was interpreted as a result of an operable lesion. None of the patients was assessed for a possible muscular etiology of their pain prior to being evaluated at the author's pain center. In all three patients, muscles were identified that replicated their pain. Each patient received treatment to his or her pain-producing muscles. None of the contemplated surgeries was performed.

Identification of the HLA-Cw*0774 and DQB1*060105 alleles

Cw*0774 differs from Cw*070201 by one nucleotide within the coding sequence of exons 2-4. DQB1*060105 differs from DQB1*060101 by one nucleotide within the coding sequence of exons 2-3.

Social rehabilitation of addicts: a two-year evaluation

This paper points out the relationship that exists between treatment approaches with drug addicts and sociodemographic characteristics of the communities affected. It has been shown that while poor and middle class communities show good results with methadone maintenance approaches, in the area of secondary drug abuse they show marked dissimilarities. Also, the reasons for discharge are markedly different. It is speculated that the different attitudes existing at the two clinics studied provide contrasting environments that are selectively detrimental to program dropouts.

The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel

AIM

The aim was to evaluate the influence of a half day, hands-on, workshop on the detection and repair of obstetric anal sphincter injuries (OASIs).

METHOD

Starting in February 2011, hands-on workshops for the diagnosis and repair of OASIs were delivered by trained urogynaecologists in departments of tertiary medical centres in Israel. The structure of the hands-on workshop resembles the workshop organized at the International Urogynecological Association annual conferences. Participants included medical staff, midwives and surgical residents from each medical centre. We collected data regarding the rate of OASIs, 1 year before and 1 year following the workshop, in 11 medical centres. The study population was composed of parturients with the following inclusion criteria: singleton pregnancy, vertex presentation and vaginal delivery. Pre-viable preterm gestations (< 24 weeks), birth weight < 500 g, stillborn, and those with major congenital anomalies, multifoetal pregnancies, breech presentations and caesarean deliveries were excluded from the analysis.

RESULTS

In the reviewed centres, 70 663 (49.3%) women delivered prior to the workshop (pre-workshop group) and 72 616 (50.7%) women delivered following the workshop (post-workshop group). Third- or fourth-degree perineal tears occurred in 248 women (0.35%) before the workshop, and in 328 (0.45%) following the workshop, a significant increase of 28.7% (P = 0.002). The increase in diagnosis was significant also in women with third-degree tears alone, 226 women (0.32%) before the workshop and 298 (0.41%) following the workshop, an increase of 28.3% (P = 0.005).

CONCLUSION

The detection rate of OASIs has significantly increased following the hands-on workshop. The implementation of such programmes is crucial for increasing awareness and detection rates of OASI following vaginal deliveries.

Clinical applications of biofeedback: implications for psychiatry

The authors briefly describe biofeedback techniques such as EMG feedback, temperature feedback, and heart rate feedback, along with reports from the literature about their application to specific problems such as subvocalization while reading, Raynaud's disease, cardiac arrhythmias, and epilepsy. Many clinical applications of biofeedback are aimed at inducing relaxation, a state that has important psychotherapeutic potential. The authors suggest that biofeedback could be used to reduce a patient's general level of arousal or as an adjunct to behavior therapy or insight therapy. While there have been no reports in the literature of any harmful effects secondary to feedback training, the authors caution that some patients may respond negatively to an objectively measured state of relaxation.