891 EARLY EVOLUTION OF CARDIAC DAMAGE STAGING FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT: PREVALENCE, CLINICAL PATTERNS AND PROGNOSTIC SIGNIFICANCE

Background

The early evolution of extravalvular cardiac damage following transcatheter aortic valve replacement (TAVR) as assessed by a previous validated score system remains unstudied. We sought to assess the patterns of early cardiac damage change among patients with severe aortic stenosis (AS) undergoing TAVR and its prognostic implications.

Methods

The RECOVERY-TAVR is a multi-center, international retrospective registry including all consecutive patients undergoing TAVR in thirteen high-volume centers. All the enrolled patients with available paired echocardiography assessment pre- and post TAVR were included in this sub-analysis. Patients were categorized according to the extension of cardiac damage based on a previous published and validated classification (stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; and stage 4, right ventricular damage). The primary endpoint was a composite of all-cause mortality or first heart failure hospitalization at 1 year. The association of cardiac damage stage evaluated prior and following TAVR along with the staging evolution was assessed with multivariate Cox regression model (that include hemoglobin, NYHA class and max aortic valve gradient) for the primary outcome.

Results

Of 1331 Patients included in the RECOVERY-TAVR registry with a full echocardiographic pre-TAVR assessment, 892 patients with available paired echocardiography exams were finally included in this analysis (pre-TAVR assessment: median 8 days prior to TAVR; post-TAVR assessment: median 7 days post-TAVR). 63 (7.1%) had stage 0/1, 433 (48.2%) had stage 2, 235 (26.3%) had stage 3 and 161 (18%) had stage 4 myocardial damage. Pre-TAVR myocardial damage staging was associated with the primary outcome (Adj-HR for myocardial stage increase: HR 1.40, 95% CI 1.01–1.93). Following TAVR 274 (30.7%) patients experienced myocardial damage improvement and 161 (18.1%) myocardial damage worsening. Post-TAVR myocardial damage staging was more strongly associated with the primary outcome (HR 1.55, 95%CI 1.14–2.10) as compared to pre-TAVR assessment. Male Sex (p = 0.044) and post-procedural permanent pacemaker implantation (p = 0.044) was associated with myocardial damage worsening, while the use of a balloon-expandable valve (p = 0.011) was associated with myocardial damage improvement. Early myocardial damage worsening (HR 1.89, 95%CI 1.12–3.21), but not early myocardial damage improvement (HR 0.86, 95%CI 0.54–1.37) was associated with the primary outcome.

Conclusion

In patients undergoing TAVR, the extent of extravalvular cardiac damage prior to and early after TAVR has an independent prognostic value while early myocardial damage worsening following TAVR portends a poor prognosis. Whether strategies to improve procedural success and treatments addressing extravalvular myocardial damage early following TAVR may improve outcomes has to be prospectively assessed.

Belimumab restores Treg/Th17 balance in patients with refractory systemic lupus erythematosus

Belimumab, a specific inhibitor of the soluble B lymphocyte stimulator (BlyS), is the first biological drug approved by the United States Food and Drug Administration for the treatment of patients with active systemic lupus erythematosus (SLE) refractory to standard therapy. Given that an imbalance between regulatory T cells (Treg) and interleukin (IL)-17A-secreting T cells (Th17) has been reported in various autoimmune disorders, we assessed the frequency of both Treg and Th17 peripheral blood populations before and after belimumab administration in 20 patients with active SLE refractory to standard therapy. After six months of treatment, the mean SELENA-SLEDAI score as well as the mean anti-double-stranded DNA antibody titers were significantly decreased. In addition, we observed a significant increase in Treg percentages and a parallel, significant decrease in Th17 percentages, accompanied by significantly reduced serum levels of IL-21. In vitro studies showed that Treg purified from belimumab-treated patients were fully functional and displayed a suppressor function similar to that of Treg purified from healthy donors. Belimumab can restore Treg/Th17 balance in SLE patients with uncontrolled disease activity, and this results in decreased flare rate and reduced glucocorticoid dosage.

Use of a short-term whole blood intracellular staining assay to study the T-cell response in respiratory syncytial virus-infected pediatric patients

The aim of the present study was the development of a reliable method to evaluate the pattern of the ongoing T-cell response in young infants affected by respiratory infection. To this purpose, we enrolled 44 infants hospitalized with a diagnosis of respiratory syncytial virus bronchiolitis. After a short-term stimulation of whole blood samples, intracellular IFN-g and IL-4 cytokines were measured in CD4+ and CD8+ T-cell subsets by flow cytometry. A stringent staining and gating strategy was used in order to maximize the reduction of background noise and to exclude false positives. The frequencies of cytokine-producing T-cell subsets, albeit low, were easily quantifiable. Cytokine responses were higher in infants sampled > 7 days from the onset of symptoms. The use of a rigorous strategy for cell staining and gating, coupled with a short-term stimulation of whole blood and a careful evaluation of time elapsed from the onset of symptoms constitutes a convincing approach for future clinical studies.

Role of Viral Infection in the Aetiology-Pathogenesis of Bladder Tumor: A Reality or Chimera?

The possible role of human papillomavirus (HPV) in the aetiology of papillary tumor of the bladder has been evaluated and a review of the literature concerning this issue was made. A group of 17 patients affected by bladder papillary tumor was analysed. Surgical specimens were collected for virological and histological analysis. The DNA of the following viruses was searched by polymerase chain reaction (PCR): Adenovirus, Herpes simplex virus type 1 (HSV-1), Herpes simplex virus type 2 (HSV-2), Human Papillomaviruses (HPV), Polyomaviruses (BKV and JCV). The results showed that 15/17 (88 %) patients with papillary bladder tumor were found negative for each viral-searched DNA; only one sample was positive for HPV (6 %) genotype 6, which is considered to convey a low risk for cancer development and only one was positive for BKV (6 %). From the results obtained there seems to be no relationship between viral infection and the presence of bladder papillary tumor. Moreover, in the examined population the association bladder carcinoma-HPV, found by others, has not been confirmed. The homogeneity of the specimens studied was such that it would not be affected by the temporal factor, as were cases of more or less advanced cancers. Nonetheless specimens from patients with advanced cancers (G III) were negative to HPV infection. The data do not appear indicative for a correlation between viral DNA presence and histological parameters. Thus, in the light of the data emerging from this investigation, no causal relationship can be established between HPV infection and papillary bladder tumors.

Development and evaluation of a sublingual tablet based on recombinant Bet v 1 in birch pollen-allergic patients

BACKGROUND

Sublingual immunotherapy (SLIT) applied to type I respiratory allergies is commonly performed with natural allergen extracts. Herein, we developed a sublingual tablet made of pharmaceutical-grade recombinant Bet v 1.0101 (rBet v 1) and investigated its clinical safety and efficacy in birch pollen (BP)-allergic patients.

METHODS

Following expression in Escherichia coli and purification, rBet v 1 was characterized using chromatography, capillary electrophoresis, circular dichroism, mass spectrometry and crystallography. Safety and efficacy of rBet v 1 formulated as a sublingual tablet were assessed in a multicentre, double-blind, placebo-controlled study conducted in 483 patients with BP-induced rhinoconjunctivitis.

RESULTS

In-depth characterization confirmed the intact product structure and high purity of GMP-grade rBet v 1. The crystal structure resolved at 1.2 Å documented the natural conformation of the molecule. Native or oxidized forms of rBet v 1 did not induce the production of any proinflammatory cytokine by blood dendritic cells or mononuclear cells. Bet v 1 tablets were well tolerated by patients, consistent with the known safety profile of SLIT. The average adjusted symptom scores were significantly decreased relative to placebo in patients receiving once daily for 5 months rBet v 1 tablets, with a mean difference of 17.0-17.7% relative to the group treated with placebo (P < 0.025), without any influence of the dose in the range (12.5-50 μg) tested.

CONCLUSION

Recombinant Bet v 1 has been produced as a well-characterized pharmaceutical-grade biological drug. Sublingual administration of rBet v 1 tablets is safe and efficacious in patients with BP allergic rhinoconjunctivitis.

Hepatitis B virus mother-to-child transmission among HIV-infected women receiving lamivudine-containing antiretroviral regimens during pregnancy and breastfeeding

The study included 309 HIV-infected pregnant women receiving a lamivudine-containing antiretroviral regimen from week 25 of gestational age until 6 months postpartum, during breastfeeding. Twenty-seven of them (8.7%) were hepatitis B virus surface antigen (HBsAg) positive; at baseline, hepatitis B virus (HBV) DNA levels >3 log(10) IU/mL (with a median level of 6.2 log(10) IU/mL) were found in 10 women, who at one, three and six months postpartum had median levels of 5.2 log(10) IU/mL, 4.5 log(10) IU/mL and 2.8 log(10) IU/mL, respectively. Twenty-four of the 30 breast milk samples evaluated had undetectable HBV DNA and the other six had values between 15 and 155 IU/mL. Median lamivudine concentrations were 1070 ng/mL in serum and 684 ng/mL in breast milk. Among the 24 HBV-exposed children with available samples, 16 always tested negative, four had a transient infection, one had an undetermined status and three (12.5%) first tested positive at Month 12 or Month 24. Among the children born to the HBV-uninfected mothers of the same cohort, the rate of HBsAg positivity at 12-24 months was 2% (4/196). Our finding of the absence of significative levels of HBV DNA in the breast milk of co-infected mothers supports the present recommendations for breastfeeding in HBV-infected women. Horizontal transmission can be hypothesized for the infections detected in children at 12-24 months. Children born to HBV-positive mothers remained at higher risk of postnatal HBV acquisition compared to those born to HBV-negative women.

Molecular abnormalities of chromosome-19 in malignant gliomas - preferential involvement of the 19q13.2-q13.4 region

A deletion mapping analysis of chromosome 19 was performed on a series of 101 samples derived from malignant gliomas. A total of 35 tumors displayed different deletions for the loci studied (D19S21, D19S11, D19S74, D19S7, D19S8, CKM, and D19S22). In most instances, losses involving the long arm markers of chromosome 19 were observed, and only four samples were characterized by losses on the short arm. No tumor was found displaying loss of both short and long arm markers. The higher frequency of deletions was detected in tumors with a major oligodendroglial component: 76% of samples included in this group displayed losses at 19q. Among the astrocytic tumors, the frequency of 19q alterations varied as follows: 11% in pilocytic astrocytomas, 17% in astrocytomas grade II, 10% in anaplastic astrocytomas and 21% in glioblastoma multiforme. No ependymoma was found displaying allele loss on chromosome 19. The common region of overlap for the 19q deletions observed involves primarily the distal portion of the long arm, 19q13.2-q13.4. In agreement with previous reports, these data suggest the non-random involvement of a tumor suppressor gene located at 19q13 in the genesis or progression of malignant gliomas.

Transverse changes determined by rapid and slow maxillary expansion--a low-dose CT-based randomized controlled trial

OBJECTIVES

To compare transverse skeletal changes produced by rapid (RME) and slow (SME) maxillary expansion using low-dose computed tomography. The null hypothesis was that SME and RME are equally effective in producing skeletal maxillary expansion in patients with posterior crossbite.

SETTING AND SAMPLE POPULATION

This study was carried out at the Department of Oral Sciences, University of Naples Federico II, Italy. Twelve patients (seven males, five females, mean age ± SD: 10.3 ± 2.5 years) were allocated to the SME group and 14 patients (six males, eight females, mean age ± SD: 9.7 ± 1.5 years) to the RME group.

MATERIALS AND METHODS

All patients received a two-band palatal expander and were randomly allocated to either RME or SME. Low-dose computed tomography was used to identify skeletal and dental landmarks and to measure transverse maxillary changes with treatment.

RESULTS

A significant increase in skeletal transverse diameters was found in both SME and RME groups (anterior expansion = 2.2 ± 1.4 mm, posterior expansion = 2.2 ± 0.9 mm, pterygoid expansion = 0.9 ± 0.8 mm). No significant differences were found between groups at anterior (SME = 1.9 ± 1.3 mm; RME = 2.5 ± 1.5 mm) or posterior (SME = 1.9 ± 1.0 mm; RME = 2.4 ± 0.9 mm) locations, while a statistically significant difference was measured at the pterygoid processes (SME = 0.6 ± 0.6 mm; RME = 1.2 ± 0.9 mm, p = 0.04), which was not clinically relevant.

CONCLUSION

Rapid maxillary expansion is not more effective than SME in expanding the maxilla in patients with posterior crossbite.

Effects of a flexibility and relaxation programme, walking, and nordic walking on Parkinson's disease

Symptoms of Parkinson's disease (PD) progress despite optimized medical treatment. The present study investigated the effects of a flexibility and relaxation programme, walking, and Nordic walking (NW) on walking speed, stride length, stride length variability, Parkinson-specific disability (UPDRS), and health-related quality of life (PDQ 39). 90 PD patients were randomly allocated to the 3 treatment groups. Patients participated in a 6-month study with 3 exercise sessions per week, each lasting 70 min. Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved. Furthermore, walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS in addition. Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability. No significant injuries occurred during the training. All patients of the Nordic walking group continued Nordic walking after completing the study.

Direct sequencing and bidirectional allele specific polymerase chain reaction of the bovine beta-casein B variant

We have used the polymerase chain reaction (PCR) to amplify exon VII of the bovine beta-casein gene. The mutations responsible for the B variant were identified by direct sequencing of the amplification products. A bidirectional allele-specific PCR method (BAS-PCR) has been developed using oligonucleotides overlapping the mutation site at their 3' ends. This new procedure allows a rapid and reliable discrimination between the B and non-B alleles of beta-casein.

Primary effusion lymphoma cells undergoing human herpesvirus type 8 productive infection produce C-type retroviral particles

Primary effusion lymphomas (PELs) are invariably infected by the human herpesvirus 8 (HHV8)that is present in most PEL cells as latent virus but replicates in a subset of permissive cells to produce infectious progeny. Here we show that productively infected PEL cells release C-type retrovirus-like particles encoding an Mn++-dependent RT activity, which is typical of endogenous retroviruses. Strikingly, C-type particles are produced only in cells showing advanced HHV8 morphogenesis. Phorbol esters, which induce productive HHV8 replication and morphogenesis in PEL cells, increase RLP production. Phosphonoacetic acid, a blocker of HHV8 late gene expression, inhibits the production of C-type particles, whereas neutralizing anti-alphaIFN antibodies, which are known to increase HHV8 assembly, increases C-type particle production. These data suggest that factors expressed in advanced stages of HHV8 reactivation support endogenous C-type particle morphogenesis in PEL cells.

Angiopoietin 2 concentrations in infants developing bronchopulmonary dysplasia: attenuation by dexamethasone

OBJECTIVES

To study the association between angiopoietin 2 (Ang2) concentrations in tracheal aspirates (TAs) and adverse outcome (bronchopulmonary dysplasia (BPD)/death) in ventilated premature infants (VPIs) and modulation of Ang2 concentrations with dexamethasone (Dex) use.

STUDY DESIGN

Serial TA samples were collected on days 1, 3, 5 and 7, and Ang2 concentrations were measured. Ang2 TA concentrations were compared prior to and after 48 to 72 h of using Dex.

RESULT

A total of 151 TA samples were collected from 60 VPIs. BPD was defined as the oxygen requirement at 36 weeks postmenstrual age (PMA). Twelve infants (mean+/-s.d.) (gestational age (GA) 26.5+/-2.1 weeks, birth weight (BW) 913+/-230 g) had no BPD, 32 infants (GA 25.8+/-1.4 weeks, BW 768+/-157 g) developed BPD and 16 infants (GA 24.5+/-1.1 weeks, BW 710+/-143 g) died before 36 weeks PMA. Ang2 concentrations were significantly lower in infants with no BPD (median, 25th and 75th percentile) (157, 16 and 218 pg mg(-1)) compared with those who developed BPD (234, 138 and 338 pg mg(-1), P=0.03) or BPD and/or death (234, 157 and 347 pg mg(-1), P=0.017), in the first week of life. Twenty-six VPIs (BW 719+/-136 g, GA 25.1+/-1.3 weeks) received 27 courses of Dex. Ang2 concentrations before starting Dex were 202, 137 and 278 pg mg(-1) and significantly decreased to 144, 0 and 224 pg mg(-1) after therapy (P=0.007).

CONCLUSIONS

Higher Ang2 concentrations in TAs are associated with the development of BPD or death in VPIs. Dex use suppressed Ang2 concentrations.

Concordance of chlamydia trachomatis infections within sexual partnerships

OBJECTIVES

The enhanced sensitivity of nucleic acid amplification tests (NAAT) provides an opportunity for estimating the prevalence of untreated Chlamydia trachomatis infections. The transmissibility and public health significance of some NAAT-identified infections are, however, not known.

METHODS

Adults attending an urban emergency department provided specimens for C trachomatis screening using NAAT. Participants testing positive were offered follow-up including re-testing for C trachomatis using NAAT and traditional methods, eg culture and direct fluorescent antibody, and were treated. Partners were offered identical evaluation and treatment. Overall, 90 C trachomatis-positive participants had one or more sexual partners enrolled.

RESULTS

Evidence of transmission, as defined by infection concordance between partnerships, was observed among 75% of partners of index cases testing positive by both NAAT and traditional assay but only 45% of partners of index cases testing positive by NAAT only (prevalence ratio 1.7, 95% CI 1.1 to 2.5). Among index participants returning for follow-up, 17% had no evidence of C trachomatis infection by NAAT or traditional assay (median follow-up three weeks).

CONCLUSIONS

A substantial proportion of positive NAAT results for chlamydial infection may be of lower transmissibility and may not persist after a short follow-up. The long-term health effects of some positive NAAT are uncertain.

Rapid detection of three large novel deletions of the aspartoacylase gene in non-Jewish patients with Canavan disease

Canavan disease (CD), an autosomal recessive neurodegenerative disorder, is caused by mutations in the aspartoacylase (ASPA) gene. In the present study, the ASPA gene was analyzed in 24 non-Jewish patients with CD from 23 unrelated families. Within this cohort, we found three large novel deletions of approximate 92, 56, and 12.13 kb in length, using both self-ligation of restriction endonuclease-digested DNA fragments with long-distance inverse PCR and multiplex dosage quantitative PCR analysis of genomic DNA. The 92 kb large deletion results in complete absence of the ASPA gene in one homozygous and one compound heterozygous patient, respectively. The 56 kb large deletion causes absence of the majority of the ASPA gene except for exon 1 alone in a compound heterozygous patient. The 12.13 kb deletion involves deletion of the ASPA gene from intron 3 to intron 5 including exons 4 and 5 (I3 to E4E5I5) in a compound heterozygous patient. Patients with the three large deletions clinically manifested severe symptoms at birth, including seizures. Our study showed that the combined use of long-distance inverse PCR and multiplex dosage quantitative PCR analysis of genomic DNA is a helpful and rapid technique to search for large deletions, particularly for detection of large deletions in compound heterozygous patients.

Natural history of Canavan disease revealed by proton magnetic resonance spectroscopy (1H-MRS) and diffusion-weighted MRI

Canavan disease is a childhood leukodystrophy caused by mutations in the gene for human aspartoacylase ( ASPA), which leads to an abnormal accumulation of the substrate molecule N-acetyl-aspartate (NAA) in the brain. This study was designed to model the natural history of Canavan disease using MRI and proton magnetic resonance spectroscopy ( (1)H-MRS). NAA and various indices of brain structure (morphology, quantitative T1, fractional anisotropy, apparent diffusion coefficient) were measured in white and gray matter regions during the progression of Canavan disease. A mixed-effects statistical model was used to fit all outcome measures. Longitudinal data from 28 Canavan patients were directly compared in each brain region with reference data obtained from normal, age-matched pediatric subjects. The resultant model can be used to non-invasively monitor the natural history of Canavan disease or related leukodystrophies in future studies involving drug, gene therapy, or stem cell treatments.

Immune responses to AAV in a phase I study for Canavan disease

BACKGROUND

Canavan disease is a rare leukodystrophy with no current treatment. rAAV-ASPA has been developed for gene delivery to the central nervous system (CNS) for Canavan disease. This study represents the first use of a viral vector in an attempt to ameliorate a neurodegenerative disorder.

METHODS

Subjects received intracranial infusions via six cranial burr holes. Adeno-associated virus, serotype 2 (AAV2), mediated intraparenchymal delivery of the human aspartoacylase cDNA at a maximum dose of 1 x 10(12) vector genomes per subject. The immune response and safety profiles were monitored in the follow-up of ten subjects.

RESULTS

Following rAAV2 administration, we found no evidence of AAV2 neutralizing antibody titers in serum for the majority of subjects tested (7/10). In a subset (3/10) of subjects, low to moderately high levels of AAV2 neutralizing antibody with respect to baseline were detected. In all subjects, there were minimal systemic signs of inflammation or immune stimulation. In subjects with catheter access to the brain lateral ventricle, cerebrospinal fluid was examined and there was a complete absence of neutralizing antibody titers with no overt signs of brain inflammation.

CONCLUSIONS

rAAV2 vector administration to the human CNS appears well tolerated. The low levels of immune response to AAV2 detected in 3/10 subjects in this study suggest at this dose and with intraparenchymal administration this approach is relatively safe. Long-term monitoring of subjects and expansion to phase II/III will be necessary in order to make definitive statements on safety and efficacy.

Genetic analysis of metamorphic and premetamorphic Xenopus ciliary marginal zone

A major event affecting the eye during amphibian metamorphosis is an asymmetrical growth of the ventrotemporal portion of the retina compared with its dorsonasal counterpart. This event is due to an increased proliferation of the precursors of the ventral ciliary marginal zone (CMZ). Here, we analyze the expression patterns of several key homeobox genes implicated in eye development (Xrx1, Xvax2, Xsix3, Xpax6, Xchx10, Xotx2) to understand whether they are active at the time in which the metamorphic changes of the retina occur. We also analyze their expression patterns in the ventral and dorsal CMZ and compare them with bromodeoxyuridine incorporation in the CMZ. Our results suggest that the metamorphic CMZ maintains the functional subdivisions described during embryonic development. Moreover, we find that genes involved in proliferation and cell type determination of the embryonic retina are actively transcribed in the proliferating CMZ, thus indicating a potential regulatory role for these genes in the metamorphic retina.

Gamma knife radiosurgery in brain metastases from testicular tumors

To our knowledge, there are no published reports on the effectiveness of radiosurgery in the management of brain metastases from testicular nonseminomatous germ cell tumor. The authors evaluate the results of gamma knife (GK) treatment in three patients with these unusual intracranial lesions. Between April 1995 and July 2001, three patients with brain metastasis from testicular nonseminomatous germ cell tumor underwent adjuvant radiosurgery at our department. The primary tumor had been surgically removed in all cases. At diagnosis, one patient was stage IB and two were stage III poor risk. Chemotherapy and whole brain radiotherapy were administered before radiosurgery in all cases. Pre-GK radiotherapy was administered with a daily fraction dosage of 1.8-2.0 Gy. The indications for radiosurgery were tumor volume <20 cm3, microsurgery too risky, refusal of surgery. All the lesions were located in eloquent brain areas. Post-GK high-dose chemotherapy with autologous peripheral-blood stem-cell rescue was administered in two cases due to systemic recurrence of the disease. All patients are still alive with a median and mean follow-up period after radiosurgery of 63 and 68.3 mo, respectively. They had no neurological deficits at the latest examination. Neuroradiological follow-up invariably showed tumor growth control (complete response in two cases and partial response in one) with typically delayed post-radiosurgical imaging changes (transient in two cases and long-lasting in one). In conclusion, GK seems to be highly effective and safe in brain metastases from testicular nonseminomatous germ cell tumor. In cases with diffuse metastatic brain involvement, the whole brain radiotherapy preceding radiosurgery should be delivered with 1.8 Gy daily fraction to prevent the risk of long-lasting post-radiosurgical imaging changes.

Effects of AAV-2-mediated aspartoacylase gene transfer in the tremor rat model of Canavan disease

The tremor rat is a spontaneous epilepsy model with a seizure phenotype caused by a deletion in the aspartoacylase (ASPA) gene. The absence of ASPA expression in these animals results in undetectable levels of enzyme activity and the accumulation of the substrate N-acetyl-aspartate (NAA) in brain, leading to generalized myelin vacuolation and severe motor and cognitive impairment. In support of human gene therapy for CD, recombinant adeno-associated viral vector (AAV-2) expressing ASPA was stereotactically delivered to the tremor rat brain and effects on the mutant phenotype were measured. AAV-ASPA gene transfer resulted in elevated aspartoacylase bioactivity compared to untreated mutant animals and elicited a significant decrease in the pathologically elevated whole-brain NAA levels. Assessment of motor function via quantitative rotorod testing demonstrated that rats injected with AAV-ASPA significantly improved on tests of balance and coordinated locomotion compared to animals receiving control vectors. This study provides evidence that AAV-2-mediated aspartoacylase gene transfer to the brain improves biochemical and behavioral deficits in tremor rat mutants (tm/tm) and supports the rationale of human gene transfer for Canavan disease.

Substrate characterization for underwater gamma spectrometry: tank measurement results utilizing efficiencies calculated via Monte-Carlo code

In order to study the sediment contamination, underwater gamma-ray spectrometry measurements performed by the sub-marine detector Canberra HpGe with a relative efficiency of 80% were carried out in an equipped tank at the Ukrainian Hydrometeorological Institute of Kiev. Different substrates, certified sources and experiment geometrical set-up were arranged. Efficiencies were calculated by in situ object counting system (ISOCS) software. ISOCS performance tests using certified sources were carried out by comparing laboratory measurements, and measurement results for mineralogy and density performances are reported.

Selective Inhibition of Trypsins by Insect Peptides: Role of P6−P10 Loop

PMP-D2 and HI, two peptides from Locusta migratoria, were shown to belong to the family of tight-binding protease inhibitors. However, they interact weakly with bovine trypsin (K(i) around 100 nM) despite a trypsin-specific Arg at the primary specificity site P1. Here we demonstrate that they are potent inhibitors of midgut trypsins isolated from the same insect and of a fungal trypsin from Fusarium oxysporum (K(i) <or= 0.02 nM). Therefore, they display a selectivity not existing for the parent chymotrypsin inhibitor PMP-C. By NMR, we demonstrate that HI possesses a highly rigid structure similar to the crystal structure of a variant of PMP-D2 in complex with bovine alpha-chymotrypsin. The main difference with PMP-C is located in the region from residues 20 to 24 (positions P6-P10) that interacts with the loop containing Gly173 in chymotrypsin. The corresponding residue in mammalian trypsins is always a proline that may generate a steric clash with the inhibitor. The residues thought to confer selectivity were mutated with PMP-C as a model. The resulting analogue PMP-D2(K10W,P21A,W25A) loses some activity toward insect and fungal trypsins but is a more potent inhibitor of mammalian trypsins, corresponding to a decrease of selectivity. This work represents a first attempt in tuning the selectivity of natural peptidic serine protease inhibitors by mutating residues out of the reactive loop (P3-P'3).

Identification and characterization of novel mutations of the aspartoacylase gene in non-Jewish patients with Canavan disease

Canavan disease, an inherited leukodystrophy, is caused by mutations in the aspartoacylase (ASPA) gene. It is most common among children of Ashkenazi Jewish descent but has been diagnosed in many diverse ethnic groups. Two mutations comprise the majority of mutant alleles in Jewish patients, while mutations in the ASPA gene among non-Jewish patients are different and more diverse. In the present study, the ASPA gene was analysed in 22 unrelated non-Jewish patients with Canavan disease, and 24 different mutations were found. Of these, 14 are novel, including five missense mutations (E24G, D68A, D249V, C152W, H244R), two nonsense mutations (Q184X, E214X), three deletions (923delT, 33del13, 244delA), one insertion mutation (698insC), two sequence variations in one allele ([10T>G; 11insG]), an elimination of the stop codon (941A>G, TAG-->TGG, X314W), and one splice acceptor site mutation (IVS1 - 2A>T). The E24G mutation resulted in substitution of an invariable amino acid residue (Glu) in the first esterase catalytic domain consensus sequence. The IVS1 - 2A>T mutation caused the retention of 40 nucleotides of intron 1 upstream of exon 2. The results of transient expression of the mutant ASPA cDNA containing these mutations in COS-7 cells and assays for ASPA activity of patient fibroblasts indicated that these mutations were responsible for the enzyme deficiency. In addition, patients with the novel D249V mutation manifested clinically at birth and died early. Also, patients with certain other novel mutations, including C152W, E214X, X314W, and frame shift mutations in both alleles, developed clinical manifestations at an earlier age than in classical Canavan disease.

[Immunotherapy in the management of metastatic renal carcinoma]

BACKGROUND

Renal cell carcinoma (RCC) is a relatively rare tumor representing 2-3% of all neoplasias. Approximately 30% of patients diagnosed as having RCC present metastases: mean survival ranges between 6 and 10 months, whilst 10-20% present a 2-year survival rate. Treatment of patients with metastatic RCC is a difficult challenge. Hormones and chemotherapy, either alone or associated with surgical resection of the primary lesion have been used. In our experience, IL-2 + IFN-a has been shown to be an encouraging form of treatment.

METHODS

During the period between October 1997 and December 1999, 5 patients (3 males, 2 females), mean age 52.5 years, with metastatic RCC, came to our attention. TC revealed a circumscribed area the margins of which were not well defined, in a mid-renal localization, positive inter aorta caval and obturator lymph nodes, but no lung, brain or hepatic involvement. Patients were submitted to nephrectomy and lymphadenectomy followed later by immunotherapy with IFN-alpha (3 Mil twice a week) + low dose IL-2 (1 Mil/m2/12 h): treatment was given for 4 consecutive weeks and then repeated every 3 weeks for 1 year.

RESULTS

At 30 months' follow-up all patients showed regression of the disease (100% of cases) and in none of the cases there was evidence of metastases. Only one patient (20%) presented side-effects (nausea, vomiting, slight rise in temperature) all of which disappeared at the end of the first week of treatment.

CONCLUSIONS

These results, even if on a limited number of patients and for a limited follow-up period, show that in some patients with metastatic renal cell carcinoma, treatment with IL-2 and IFN-a following nephrectomy and lymphadenectomy should be considered the therapy of choice.

[Stenosis of the new bladder neck, a complication of radical prostatectomy: personal experience]

BACKGROUND

To describe personal experience on stenosis of the new bladder neck, a complication of radical prostatectomy. After a review of the literature, guidelines are proposed to avoid this complication, both from a prophylactic and treatment point of view.

METHODS

Between 1992 and 2000, 54 patients were submitted to radical prostatectomy, 18 of whom later presented stenosis in the new bladder neck. Mean age of patients was 65.6 years (range 55-76). According to TNM classification, 46 patients (85%) were stage pT2N0M0 and eight patients (15%) stage pT3N0M0, no significant correlation being found with PSA values. All patients were submitted to pre- and postmicturition retrograde cystourethrography, four weeks after surgery; patients presenting dysuric symptoms also underwent further retrograde cystourethrography and flowmeter examinations.

RESULTS

Of the 54 patients, 18 (33%) presented stenosis of the new bladder neck as a complication of radical prostatectomy. Of these 18 patients, 12 (22%) presented acute dysuria symptoms. In 14 cases, one-two cycles of urethral dilation were sufficient to improve flowmeter values. In the four remaining cases showing no improvement following urethral dilations, endoscopic resection was necessary in two and urethrotomy according to Sachse in the other two.

CONCLUSIONS

Stenosis of the anastomosis of the new bladder neck is a complication of radical prostatectomy occurring within six months of surgery, no correlation being found with tumour stage, recurrence, or duration of catheter in situ. Of the 18 patients presenting stenosis in the series described, in 78%, cycles of urethral dilation were sufficient to successfully resolve the complication thus avoiding further surgery, which, on the other hand, was necessary in four patients, two submitted to endoscopic resection of the stenosis and the other two to incision according to Sachse.

Adsorption of imidazolinone herbicides on smectite-humic acid and smectite-ferrihydrite associations

Adsorption of imazapyr (IMZ), imazethapyr (IMZT), and imazaquin (IMZQ) was studied on two smectite-humic acid and two smectite-ferrihydrite binary systems prepared by treating a Wyoming smectite with a humic acid extracted from soil (4 and 8% w/w of the smectite) and with just-precipitated synthetic ferrihydrite (8 and 16% w/w of the smectite). Adsorption of the three herbicides on the smectite was not measurable at pH >4.5, presumably because of negative charges on the surface of the smectite. Adsorption on the smectite-humic acid systems was also not measurable, presumably because of negative charges on the surface, despite the high affinity of the three herbicides for humic acid, the adsorption order of which was IMZ < IMZT << IMZQ. Adsorption decreased in the order IMZ < IMZT < IMZQ on the smectite-ferrihydrite systems and IMZQ < IMZT < IMZ on ferrihydrite, although here the differences were small. These results show that even though pure smectite cannot adsorb herbicides, it modifies the adsorption capacity of ferrihydrite. The mutual interaction of active phases such as humic acid, ferrihydrite, and smectite alters the characteristics of the resulting surface and hence the adsorption process. Investigations of herbicide adsorption have been seen to produce more reliable results if conducted on polyphasic systems rather than on single soil components.

[Postprostatectomy erectile dysfunction]

BACKGROUND

To evaluate the frequency of erectile dysfunction in patients submitted to radical prostatectomy due to prostate carcinoma and to the possibility, with appropriate treatment, of restoring adequate erections for a satisfactory sexual activity.

METHODS

Between 1996 and 2000, thirty-eight patients with prostate carcinoma have been submitted to radical prostatectomy. According to TNM classification upon diagnosis, thirty-three patients (87%) were stage pT2N0M0 and five patients (13%) stage pT3N0M0. Mean age of patients was 62.4 years (range 55-76). Mean follow-up was two years and seven months. Diagnosis of erectile dysfunction was made from personal history as well as that of the patient plus partner, and from nocturnal penile tumescence evaluation with Rigiscan.

RESULTS

Eighteen patients (47%) presented erectile dysfunction as a complication 16 (89%) of whom showed no nocturnal reaction at the Rigiscan test, while in the remaining two (1%), one-two nocturnal erections of less than five minutes were obtained. Of the eighteen patients, 14 (78%) showed a positive response to treatment with intracavernous drug infusion (papaverine+Phentolamine+Alprostadil), whilst only one patient benefited from treatment with oral Sildenafil.

CONCLUSIONS

This study showed the high frequency (47%) of erectile dysfunction in patients submitted to radical prostatectomy as well as the need to perform radical nerve-sparing surgery (particularly in the neoplastic forms not involving the prostate capsule) which is useful not only for preserving erectile function but also on account of better response to oral Sildenafil treatment following the use of this technique.

Viral-based gene transfer to the mammalian CNS for functional genomic studies

A fundamental problem in neuroscience has been the creation of suitable in vivo model systems to study basic neurological phenomena and pathology of the central nervous system (CNS). Somatic cell genetic engineering with viral vectors provides a versatile tool to model normal brain physiology and a variety of neurological diseases.

Clearance of human herpesvirus 8 from blood and regression of leukopenia-associated aggressive classic Kaposi's sarcoma during interferon-alpha therapy: a case report

A human immunodeficiency virus-negative woman with severe classic Kaposi's sarcoma, idiopathic leukopenia, and massive spread of human herpesvirus 8 (HHV-8) in circulating cells showed stable disease remission in response to systemic interferon-alpha treatment that was accompanied by increased CD3(+) and CD4(+) T cell numbers and complete clearance of HHV-8 from the circulation. These results suggest a direct relationship between HHV-8 clearance from blood and regression of Kaposi's sarcoma and are consistent with the in vitro inhibitory effects of interferon-alpha on HHV-8 infection.

Prevalence, incidence and correlates of HHV-8/KSHV infection and Kaposi's sarcoma in renal and liver transplant recipients

BACKGROUND

To determine whether the incidence of HHV-8/KSHV infection and the risk of developing KS among organ transplant recipients differ by type of organ transplanted, we calculated the rate of HHV-8/KSHV seroconversion and the risk of developing KS among renal and liver transplant recipients.

METHODS

The study population consisted of renal and liver transplant recipients recruited in two transplant centres in Rome, Italy. Both pre-transplant and post-transplant serum samples were available for all participants. The prevalence of HHV-8/KSHV infection before transplantation was calculated. To determine risk factors for infection, we calculated ORs and 95% CI. Seroconversion rates (i.e. attack rates) after transplantation were also calculated. Differences in attack rates were calculated using a binomial test for proportions.

RESULTS

Of the 130 participants, 21 (16.1%) were HHV-8/KSHV-positive before transplantation. Women were more likely to be infected than men, whereas no difference was observed by type of organ transplanted. Of the 109 initially negative individuals, 13 (11.9%) developed anti-HHV-8/KSHV antibodies after transplantation. The incidence of HHV-8/KSHV infection tended to be higher among liver transplant recipients. Four renal transplant recipients and none of the liver transplant recipients developed KS after transplantation. The risk of KS was higher among recipients who were already HHV-8/KSHV-positive before transplantation.

CONCLUSIONS

HHV-8/KSHV seroconversion rates appear to be higher among liver transplant recipients, compared to renal transplant recipients. However, renal transplant recipients tend to have a higher risk of KS. HHV-8/KSHV reactivation appears to play a greater role on the risk of KS than incident infections.

Activation of matrix-metalloproteinase-2 and membrane-type-1-matrix-metalloproteinase in endothelial cells and induction of vascular permeability in vivo by human immunodeficiency virus-1 Tat protein and basic fibroblast growth factor

Previous studies indicated that the Tat protein of human immunodeficiency virus type-1 (HIV-1) is a progression factor for Kaposi's sarcoma (KS). Specifically, extracellular Tat cooperates with basic fibroblast growth factor (bFGF) in promoting KS and endothelial cell growth and locomotion and in inducing KS-like lesions in vivo. Here we show that Tat and bFGF combined increase matrix-metalloproteinase-2 (MMP-2) secretion and activation in endothelial cells in an additive/synergistic manner. These effects are due to the activation of the membrane-type-1-matrix-metalloproteinase and to the induction of the membrane-bound tissue inhibitor of metalloproteinase-2 (TIMP-2) by Tat and bFGF combined, but also to Tat-mediated inhibition of both basal or bFGF-induced TIMP-1 and -2 secretion. Consistent with this, Tat and bFGF promote vascular permeability and edema in vivo that are blocked by a synthetic MMP inhibitor. Finally, high MMP-2 expression is detected in acquired immunodeficiency virus syndrome (AIDS)-KS lesions, and increased levels of MMP-2 are found in plasma from patients with AIDS-KS compared with HIV-uninfected individuals with classic KS, indicating that these mechanisms are operative in AIDS-KS. This suggests a novel pathway by which Tat can increase KS aggressiveness or induce vasculopathy in the setting of HIV-1 infection.

Quantitative comparison of expression with adeno-associated virus (AAV-2) brain-specific gene cassettes

This study compared a range of mammalian CNS expression cassettes in recombinant adeno-associated virus (AAV-2) vectors using strong endogenous promoter sequences, with or without a strong post-regulatory element and polyadenylation signal. Changes in these elements led to transgene expression varying by over three orders of magnitude. In experiments conducted in primary cell culture and in >100 stereotactically injected rats, we observed highly efficient and stable (>15 months) gene expression in neurons and limited expression in glia; the highest expression occurred with endogenous, nonviral promoters such as neuron-specific enolase and beta-actin. The packaging size of AAV-2 was maximized at 5.7 kb without impairing gene expression, as judged by direct comparison with a number of smaller AAV-2 constructs. The genomic insert size and titer were confirmed by Southern blot and quantitative PCR, and infectivity was tested by particle titer using ELISA with a conformation-dependent epitope that requires the full intact capsid. A packaging and purification protocol we describe allows for high-titer, high-capacity AAV-2 vectors that can transduce over 2 x 10(5) neurons in vivo per microliter of vector, using the strongest expression cassette.

Orthodontic finalization strategies in dysfunctional adult patients

Although orthodontic treatment for the finalization of temporomandibular dysfunction (TMD) patients is often advocated, it represents a risk of failure. Furthermore, in the literature there are few articles that illustrate appropriate orthodontic strategies for the finalization of these patients. In this article the authors suggest a step-by-step clinical procedure in order to: 1. verify the rationale for orthodontic finalization in TMD patients; 2. illustrate the guidelines for correct orthodontic treatment; and 3. suggest a strategy to stabilize the mandible during orthodontic treatment and to retain that stabilization after treatment. If splint therapy is successful in relieving the TMD symptoms, a fixed posterior bilateral stop is used for occlusal stability. After one or two months during which the bilateral stop is shown to be adequate in maintaining TMJ health without a splint, orthodontic finalization can be performed with minimal risk of failure. The essential sequences of Class I, Class II, and Class III treatment for the finalization of TMD patients are also presented. The difficult goal of a long term stability in cases that have been orthodontically finalized is reached by the conversion of the posterior bilateral stops (crown build-ups) into permanent vertical stops.

Vaccination with DNA containing tat coding sequences and unmethylated CpG motifs protects cynomolgus monkeys upon infection with simian/human immunodeficiency virus (SHIV89.6P)

Recent evidence suggests that a CD8-mediated cytotoxic T cell response against the Tat protein of human immunodeficiency virus (HIV)/simian immunodeficiency virus (SIV) controls primary infection after pathogenic virus challenge, and correlates with the status of long-term nonprogressor in humans. Due to the presence of unmethylated CpG sequences, DNA vaccination can boost the innate immunity driving more potent T cell-mediated immune responses. Therefore, cynomolgus monkeys were vaccinated with a tat-expressing vector containing defined unmethylated CpG sequences (pCV-tat). Here it is shown that the intramuscular inoculation of the pCV-tat contained primary infection with the highly pathogenic SHIV89.6P virus preventing the CD4(+) T cell decline in all the vaccinated monkeys. Undetectable virus replication and negative virus isolation correlated in all cases with the presence of anti-Tat CTLs. However, a CD8-mediated non cytolytic antiviral activity was also present in all protected animals. Of note, this activity was absent in the controls but was present in the monkey inoculated with the CpG-rich vector alone that was partially protected against viral challenge (i.e. no virus replication but positive virus isolation). These results suggest that a CTL response against Tat protects against primary infection by blocking virus replication at its early stage, in the absence of sterilizing immunity. Nevertheless, the boost of the innate immunity by CpG sequences can contribute to this protection both by driving more potent CTL responses and by inducing other CD8-mediated antiviral activities. Thus, the CpG-rich tat DNA vaccine may represent a promising candidate for preventive and therapeutic vaccination against AIDS.

Role of ferrihydrite in adsorption of three imidazolinone herbicides

Adsorption of the imidazolinone herbicides imazapyr, imazethapyr, and imazaquin on synthetic ferrihydrites, either freeze-dried or not-freeze-dried, has been studied. The synthetic ferrihydrites were characterized by X-ray diffraction, scanning electron micrographs, and specific area determination. On each ferrihydrite, adsorption was found to be strongly dependent on pH. The highest extent of adsorption took place at pH values close to the pK(a) of the carboxylic group of the herbicides. No adsorption was observed at pH > 8. The freeze-drying process reduced the adsorptive capacity of the ferrihydrite by formation of larger aggregates provoking a decrease of the surface area. The chemical differences between the herbicides did not strongly affect the adsorption process of the herbicides. However, imazaquin was more adsorbed than the other two herbicides, in particular at pH close to its pK(a).

Adsorption of imidazolinone herbicides on ferrihydrite-humic acid associations

Adsorption of the imidazolinone herbicides imazapyr, imazethapyr and imazaquin was studied on two binary systems (ferrihydrite-humic acid) prepared by treating ferrihydrite (Fh) immediately after its precipitation with a soil humic acid (HA) at different loadings (4% and 8% HA content), and on a blank ferrihydrite sample prepared in the same way, but without HA addition. Imidazolinone adsorption on pure Fh and on the 4% Fh-HA decreased with increasing of the herbicide hydrophobicity (imazaquin<imazethapyr<imazapyr), whereas on the 8% Fh-HA system the order of adsorption was nearly the same, indicating that higher amounts of HA on Fh increase the hydrophobicity of the surface and thus increases its affinity for the herbicides, specially for imazaquin. Adsorption was also enhanced by low pH values and slight changes in pH enhanced the contribution of each component in adsorption. Both the nature of the surface exposed and its ability to interact with herbicides are greatly altered by the mutual interaction of Fh and HA. The results show that albeit artificial polyphasic associations are more representative of the real situation than single model components and are thus better indicators of the behaviour of a given herbicide in the soil.

Single-dose gatifloxacin compared with ofloxacin for the treatment of uncomplicated gonorrhea: a randomized, double-blind, multicenter trial

BACKGROUND

Treatment of gonorrhea is complicated by widespread resistance of Neisseria gonorrhoeae to antimicrobial agents of choice, including decreased susceptibility to ciprofloxacin.

GOAL

To demonstrate the efficacy and safety of gatifloxacin, a novel 8-methoxy fluoroquinolone antibiotic, compared with ofloxacin in treating patients with uncomplicated gonococcal infection.

STUDY DESIGN

In a double-blind, randomized (2:2:1), controlled trial, 340 men and 388 women with uncomplicated gonorrhea who were 16 years or older received a single oral dose of gatifloxacin (400 mg or 600 mg) or ofloxacin (400 mg). Primary analysis of efficacy was based on bacteriologic eradication from sites of infection. Secondary analyses examined clinical response and adverse event profiles.

RESULTS

Bacteriologic eradication rates for gatifloxacin in evaluable men with urethral gonorrhea were 99% (400 mg) and 100% (600 mg) versus 100% for ofloxacin (n = 117, 122, and 55, respectively; P = ns). Eradication rates in evaluable women with endocervical gonorrhea were 99% for both 400 mg and 600 mg gatifloxacin versus 100% for ofloxacin (n = 101, 104, and 55, respectively; P = ns). Eradication rates were 100% for both rectal (n = 43) and pharyngeal (n = 31) infection across all treatment groups. All three drug regimens were well tolerated and exhibited similar clinical response profiles.

CONCLUSION

Gatifloxacin is safe and effective as a single 400-mg or 600-mg dose for the treatment of uncomplicated gonorrhea. Similar efficacy rates were observed with the 400-mg and 600-mg doses. A single 400-mg dose can be recommended for treatment of uncomplicated gonorrhea.

Lytic growth of human herpesvirus 8: morphological aspects

The human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus, is a gamma herpesvirus associated with AIDS-related body cavity-based lymphomas (BCBL), also called primary effusion lymphomas (PEL). These are a rare form of non-Hodgkin lymphomas in which HHV-8 is present, often associated with Epstein-Barr virus (EBV) infection. HHV-8 is also present in a latent state or in a state of low-level persistence in different primary effusion lymphoma-derived cell lines, such BCBL-1 cells, that lack EBV infection. This cell line was induced to produce mature virions by treatment with 12-O-tetradecanoyl phorbol-13-acetate (TPA) and the characteristic ultrastructural features of HHV-8 lytic replication were identified and compared to those of the other members of Herpesviridae family.