Topical hypertonic saline as a treatment for ocular and nasal hirudiniasis in a dog

This case report describes ocular and nasal leech infestation (hirudiniasis) in a dog. The patient presented for a suspected ocular foreign body. The patient was sedated to allow proper examination, which revealed a leech foreign body attached to the bulbar conjunctiva adjacent to the inferotemporal limbus of the left eye. A 3.5% hypertonic saline solution was applied topically to the eye in four sequential drops, until the leech detached itself and was removed with a cotton bud. The affected eye was found to have a small corneal ulcer, a small area of scleral haemorrhage, and prominent lymphoid follicles within the third eyelid. Approximately 5 min after the leech was removed, another leech emerged from the left nostril. The patient was sent home on chloramphenicol ointment for treatment of the corneal ulcer, was rechecked 4 days later by an American Board of Veterinary Ophthalmology resident (PM) and found to have a normal ocular exam. This case report highlights that topical hypertonic saline solution (3.5%) can be an effective and easily prepared treatment for ocular and nasal hirudiniasis in veterinary patients.

Evaluation of the BAX® System for Detection of Listeria monocytogenes in Foods: Collaborative Study

A multilaboratory study was conducted to compare the automated BAX® system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Improving diagnostic accuracy in clinically ambiguous paediatric appendicitis: a retrospective review of ultrasound and pathology findings with focus on the non-visualised appendix

OBJECTIVE

To compare pre-operative ultrasound to histopathological results and retrospectively assess the diagnostic accuracy of ultrasound in paediatric appendicitis.

METHODS

5 year review of all appendectomies performed in patients <16 years old in a tertiary referral university hospital. 983 patients had an appendicectomy over the time period while 189 patients had a preoperative ultrasound. We retrospectively reviewed all of the preoperative imaging in conjunction with the reports for the 189 patients; our aim was to determine the sensitivity of preoperative ultrasound for the diagnosis of acute appendicitis.

RESULTS

Of the 189 patients who had an ultrasound, 102 had histology positive for appendicitis and 87 had normal histology. Sensitivity overall was 72.55% [95% confidence interval (CI) 62.82 to 80.92] and specificity was 77.01% (95% CI 66.75 to 85.36). A suggested ultrasound diagnosis of appendicitis made positive pathology three times more likely and a normal ultrasound made positive pathology three times less likely [positive-predictive value 3.16 (95% CI 2.11 to 4.72) negative predictive value 0.36 (95% CI 0.25 to 0.50)]. 77% (67/87) of the patients whose pathology was ultimately normal had an ultrasound which was either normal or suggested an alternative diagnosis. However, in the 33 (17%) of patients with a non-visualised appendix, no secondary signs of inflammation or alternative diagnosis 16 (48%) had pathologically confirmed appendicitis.

CONCLUSION

Ultrasound has the potential to improve diagnostic accuracy in clinically ambiguous appendicitis.

ADVANCES IN KNOWLEDGE

This paper furthers the evidence on the efficacy of ultrasound as a diagnostic tool in acute appendicitis in children, especially when the diagnosis is clinically equivocal. It also sheds further light on the "non-visualized appendix" with almost half of these patients having pathologically confirmed appendicitis; meaning advanced imaging with CT or MR may be indicated in this cohort.

Anatomical integration and rich-club connectivity in euthymic bipolar disorder

BACKGROUND

Although repeatedly associated with white matter microstructural alterations, bipolar disorder (BD) has been relatively unexplored using complex network analysis. This method combines structural and diffusion magnetic resonance imaging (MRI) to model the brain as a network and evaluate its topological properties. A group of highly interconnected high-density structures, termed the 'rich-club', represents an important network for integration of brain functioning. This study aimed to assess structural and rich-club connectivity properties in BD through graph theory analyses.

METHOD

We obtained structural and diffusion MRI scans from 42 euthymic patients with BD type I and 43 age- and gender-matched healthy volunteers. Weighted fractional anisotropy connections mapped between cortical and subcortical structures defined the neuroanatomical networks. Next, we examined between-group differences in features of graph properties and sub-networks.

RESULTS

Patients exhibited significantly reduced clustering coefficient and global efficiency, compared with controls globally and regionally in frontal and occipital regions. Additionally, patients displayed weaker sub-network connectivity in distributed regions. Rich-club analysis revealed subtly reduced density in patients, which did not withstand multiple comparison correction. However, hub identification in most participants indicated differentially affected rich-club membership in the BD group, with two hubs absent when compared with controls, namely the superior frontal gyrus and thalamus.

CONCLUSIONS

This graph theory analysis presents a thorough investigation of topological features of connectivity in euthymic BD. Abnormalities of global and local measures and network components provide further neuroanatomically specific evidence for distributed dysconnectivity as a trait feature of BD.

Metabolic syndrome and cardiovascular disease following hematopoietic cell transplantation: screening and preventive practice recommendations from CIBMTR and EBMT

Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus and all cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with the estimated prevalence of MetS being 31-49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal of reviewing literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors.

New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG)

Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.

Active cervical range of motion recovery following the rugby off-season

AIM

It has been established that Rugby players have reduced active cervical function that further declines with increased number of playing years; noticeable even over a single season. Here we examine one possible reason, namely insufficient recovery during the off-season, which will only be exacerbated by the trend towards a decreasing off-season period.

METHODS

Twenty-six elite rugby players (12 Forwards 24.9±1.2 years; and 14 Backs 23.8±1.2 years) from two English Premiership rugby clubs had their Active Cervical Range of Motion (ACROM) measured at the end of one playing season and the beginning of the next. The ACROM was measured for flexion, extension, left and right side flexion, plus left and right rotation. Players engaged in active rehabilitation during the off- and pre-season.

RESULTS

Although, the results of paired T-test analysis showed no statistical difference in ACROM, nearly all calculated percentage changes were positive (range from -4.1% to 21%) suggesting a degree of recovery. Rugby Backs had significantly greater ACROM than the Forwards at both measurement points, but did not appear to show a greater percentage change.

CONCLUSION

Although these results indicate a degree of recovery, they reinforce the possibility that the off-season is not long enough to allow significant restoration in neck range of motion, alternatively, players do not undertake sufficient or appropriate neck related rehabilitation to aid their recovery.

Balance dysfunction in adults with haemophilia

The main focus of lower limb physical performance assessment in people with haemophilia (PWH) has usually been on function, muscle strength and joint flexibility. The impact of haemophilic arthropathy on balance and falls risk is relatively under-explored. The aim of this study was to evaluate balance and related performance in PWH compared with age and gender matched healthy controls. It involved a comprehensive suite of clinical and laboratory measures of static and dynamic balance, mobility, strength, physical activity and falls efficacy completed in 20 PWH (mean age 39.4, 100% male) and 20 controls. Fifty percent of PWH reported falls in the past 12 months. Moderate impairment of balance and related measures were identified in PWH compared with the controls, with an average 35% difference between groups. Significant differences were evident between groups on both clinical and laboratory measures, including measures of dynamic bilateral stance balance [limits of stability measures on the laboratory test, functional reach; (P < 0.001); dynamic single leg balance (Step Test, P < 0.001)], gait and mobility (gait speed, step width and turning measures on the laboratory test, timed up and go test; P < 0.001); muscle strength (timed sit to stand, P = 0.002; quadriceps strength, P < 0.001); and activity level and falls efficacy, (P < 0.004). The dynamic clinical and laboratory measures testing similar domains of balance, gait and mobility had moderate correlations (0.310 < r < 0.531, P < 0.01). Moderate impairments in balance, mobility and related measures were identified in PWH, compared with the control group. Clinicians should include assessments of balance and related measures when reviewing adults with haemophilia.

Alberta Aboriginal Head Start in Urban and Northern Communities: longitudinal study pilot phase

Aboriginal Head Start in Urban and Northern Communities (AHSUNC) is a federally funded, national, early childhood intervention strategy that addresses the needs of Aboriginal preschool children and their families. A pilot study, based on principles of community-based research, evaluated an Alberta Aboriginal Head Start (AHS) program offered off-reserve in Alberta. Overall, the results pertaining to children having followed an AHS program are positive. This phase 1 of a broader longitudinal evaluation study of all AHS sites in Alberta has led to the creation of several recommendations, which reinforce this type of evaluation and look to mitigate the limitations encountered in phase 1 (around available data, tools and context).

Pulmonary artery leiomyosarcoma: an unusual cause of shortness of breath

INTRODUCTION

Primary leiomyosarcomas of the pulmonary artery are very rare tumours with 30 cases reported in the English literature. Herein, we report the first case with evidence of a renal metastasis.

MATERIALS AND METHODS

The tumour was discovered at autopsy in a 61-year-old woman who had presented with shortness of breath and chest pain. It was located in the pulmonary trunk with extension into the adjacent pericardial cavity. Separate nodules were found in the pulmonary valve, the left pulmonary artery and the left kidney.

RESULTS

On microscopic examination, the tumour was composed of spindle cells with cigar-shaped nuclei immunoreactive for vimentin, desmin, CD68 and α-smooth muscle actin.

CONCLUSIONS

Primary pulmonary artery leiomyosarcoma is easily confused clinically with pulmonary thromboembolism and most cases are diagnosed post mortem. Most tumours arise in the pulmonary trunk and metastases are only rarely described. The management of patients with this rare tumour depends on early surgical resection and the prognosis is unfavourable.

Bicyclist fatalities in New York City: 1996-2005

OBJECTIVES

To describe bicyclist fatalities in a traffic-dense, urban environment.

METHODS

Multiple New York City (NYC) agencies provided information on bicyclist deaths. Fatality Analysis Reporting System (FARS) data were used to compare NYC's bicyclist fatality rate involving motor vehicles with rates in comparable urban centers.

RESULTS

Between 1996 and 2005, 225 bicyclists died in NYC. Most fatalities resulted from motor vehicle crashes (92%). Men in NYC had higher death rates than women, and no age group had higher risk. Most of NYC's bicyclist fatalities occurred at intersections (88%). Head injuries contributed to 77 percent of deaths; helmet use was rare (3%). Most fatal crashes (91%) involved motorist and bicyclist factors, such as inattention and unsafe speed. Alcohol was detected in 21 percent of bicyclists dying within 3 hours of a crash; motorist alcohol use was a contributing factor in 6 percent of crashes. Over half were on multi-lane roads (53%). Large vehicles were involved in 30 percent of crashes but comprise 5-17 percent of road vehicles. Bicyclist fatality rates involving motor vehicles in NYC were comparable to those of other cities.

CONCLUSION

Findings suggest the merits of multipronged efforts to prevent crashes and to improve bicyclist safety in NYC and in other dense, urban environments. Motorists and bicyclists should be made aware of the risks of alcohol use and the benefits of helmet-wearing. Road users should pay attention to traffic control measures and travel at safe speeds. Interventions that control traffic at intersections and on multilane streets, that dedicate and demarcate routes for motorists and cyclists, and that improve visibility, especially for large vehicles, warrant consideration.

Use of the Abbreviated Mental Test Score by junior doctors on patients with fractured neck of femur

INTRODUCTION

The mental state of patients with fractured neck of femur is important as a predictor of post-operative outcome. The Hodgkinson Abbreviated Mental Test Score (AMTS) is a validated and simple method of assessing the pre-operative mental state of patients with fractured neck of femur. This survey investigated whether or not orthopaedic junior doctors (SHOs) appreciated the importance of mental state assessment in patients with fractured neck of femur and whether they were able to recall the questions used in the AMTS.

METHOD

A total of 47 on-call orthopaedic and trauma SHOs from the UK were randomly contacted by telephone and agreed to answer questions from a standard questionnaire to assess awareness of the ten-question AMTS.

RESULTS

A total of 96% of SHOs claimed awareness of the importance of mental state assessment; 89% used the AMTS in their practice, of which 26% were aided by a pro forma. A mean of five (out of the ten) standard questions on the AMTS were correctly identified (95% CI = 0.68); 11% correctly identified all 10 questions. There was no correlation between use of a pro forma and correct identification of questions.

CONCLUSIONS

Patients with fractured neck of femur and low AMTS have higher morbidity and mortality. If the AMTS is to be used as an assessment tool in this setting, then SHOs need to be better informed and educated as to its use. Furthermore, the validity of data collection for research and audit purposes is potentially flawed; as data collected using such scoring systems may be inaccurate.

Nanoengineered analytical immobilized metal affinity chromatography stationary phase by atom transfer radical polymerization: separation of synthetic prion peptides

Atom transfer radical polymerization (ATRP) was employed to create isolated, metal-containing nanoparticles on the surface of nonporous polymeric beads with the goal of developing a new immobilized metal affinity chromatography (IMAC) stationary phase for separating prion peptides and proteins. Transmission electron microscopy was used to visualize nanoparticles on the substrate surface. Individual ferritin molecules were also visualized as ferritin-nanoparticle complexes. The column's resolving power was tested by synthesizing peptide analogs to the copper binding region of prion protein and injecting mixtures of these analogs onto the column. As expected, the column was capable of separating prion-related peptides differing in number of octapeptide repeat units (PHGGGWGQ), (PHGGGWGQ)(2), and (PHGGGWGQ)(4). Unexpectedly, the column could also resolve peptides containing the same number of repeats but differing only in the presence of a hydrophilic tail, Q-->A substitution, or amide nitrogen methylation.

Two cases of hepatic zygomycosis in allogeneic stem cell transplant recipients and review of literature

Gastrointestinal zygomycosis is a rare condition with a high mortality rate. We present 2 fatal cases of hepatic zygomycosis following allogeneic hematopoietic stem cell transplantation and review the literature.

The effect of lactose and inulin on intestinal morphology, selected microbial populations and volatile fatty acid concentrations in the gastro-intestinal tract of the weanling pig

Twenty piglets (21 days, 7·8 kg live weight (LW)) were used in a 2×2 factorial to investigate interactions between lactose and inulin on intestinal morphology, microbiology and volatile fatty acid (VFA) production of the weanling pig. The piglets were offered the following diets for 6 days and then sacrificed: (T1) 150 g/kg lactose, (T2) 150 g/kg lactose +15 g/kg inulin, ( T3) 330 g/kg lactose, and ( T4) 330 g/kg lactose +15 g/kg inulin. Tissue samples were taken from the duodenum, jejunum and ileum for morphological measurements. Digesta samples were taken from the ileum, caecum and colon. There was an interaction ( P<0·05) between lactose and inulin in villous height in the jejunum. The inclusion of inulin at 150 g/kg lactose increased villous height compared with 150 g/kg lactose without inulin. However, inulin had no effect on villous height at 330 g/kg lactose inclusion. There was a linear relationship between food intake and villous height in the duodenum (P<0·001, R2=0·45) and the jejunum (P< 0·01, R2=0·25). The inclusion of 330 g/kg lactose increased ( P<0·05) total VFA compared with 150 g/kg lactose in the caecum and the population of lactobacilli in the caecum and colon (P<0·1). There was an interaction (P<0·05) between lactose and inulin for total VFA concentration in the colon. The pigs receiving 330 g/kg lactose had a higher total VFA concentration compared with pigs on 150 g/kg lactose. However, there was no difference between 150 g/kg and 330 g/kg lactose when the diets were supplemented with inulin. In conclusion, the inclusion of high dietary concentrations of lactose resulted in increased lactobacilli and short-chain fatty acid concentrations. The inclusion of inulin with low dietary concentrations of lactose resulted in improved intestinal health through a reduction of intestinal pH and increases in villous height.

Dietary manipulation post weaning to improve piglet performance and gastro-intestinal health

Two experiments were conducted to investigate the use of dietary manipulation as a means of improving piglet post-weaning performance and gastro-intestinal health. In experiment 1, 144 piglets (24 days old) in a 3 × 2 factorial arrangement were offered diets containing 65, 170 and 280 g lactose per kg with or without lactic acid (16 g/kg) for 28 days. In experiment 2, 20 piglets (24 days old) (in a 2 × 2 factorial arrangement were offered the following diets for 7 days and then sacrificed: T1) basal diet; T2) basal diet + 15 g inulin per kg; T3) basal diet + 16 g lactic acid per kg and T4) basal diet + 15 g inulin per kg + 16 g lactic acid per kg. After slaughtering, tissue samples were taken from the duodenum, jejunum and ileum for morphological measurements. Digesta samples were taken from the ileum, caecum and colon for microbiology and volatile fatty acid analysis. In experiment 1, pigs offered diets containing lactic acid had improved daily gain (P< 0·01) and food efficiency (P< 0·05) from days 0 to 7 compared with pigs offered diets containing no lactic acid. There was a linear increase (P< 0·05) in average daily gain (ADG) from days 0 to 28 and a linear decrease in faecal pH (P< 0·01) with increasing lactose levels. There was a quadratic effect of lactose on food conversion ratio from days 0 to 28 (P< 0·05). In experiment 2, there was a significant interaction between inulin and lactic acid in villous height in the jejunum (P< 0·001) and the concentrations of lactobacilli (P< 0·1) andE. coli(P< 0·05) in the colon. The inclusion of inulin and lactic acid resulted in a significant increase in villous height compared with the inulin only diet (P< 0·001). However, lactic acid had no effect on villous height in pigs offered diets without inulin supplementation. The inclusion of lactic acid and inulin caused a significant increase in both lactobacilli andE. coliconcentrations compared with the inulin only diets (P< 0·05). However, neither inulin nor lactic acid had an effect on lactobacilli andE. colinumbers in isolation of the other. In conclusion, in experiment 1, lactic acid improved performance in the 1st week post weaning. There was a linear increase in ADG with increasing lactose levels. In experiment 2, the combination of lactic acid and inulin increased villous height in the jejunum and concentrations of lactobacilli andE. coliin the colon.

Performance of weanling pigs offered low or high lactose diets supplemented with avilamycin or inulin

One hundred and eighty piglets (24 days old, 6·0 kg live weight) were used to investigate interactions between lactose, avilamycin and inulin on growth performance and nutrient digestibility in weaned piglets. The piglets were blocked on the basis of live weight and within each block assigned to one of six dietary treatments (six replicates (pens) per treatment). The piglets were offered diets containing either a low (175 g/kg) or high (295 g/kg) lactose levels with one of the following food additives (1) 0 supplementation (2) avilamycin (60 mg/kg) or (3) inulin (15 g/kg) in a 2 × 3 factorial arrangement. The starter diets were offered for 21 days and all diets contained chromium III oxide at 150 p. p. m. There was an interaction (P< 0·05) between lactose level and both avilamycin and inulin on average daily gain (ADG) during the starter period (days 0 to 21). The pigs receiving 295 g/kg lactose level had a higher overall ADG than pigs receiving 175 g/kg lactose level. However, there was no difference between 295 g/kg lactose and 175 g/kg lactose in ADG when the diets were supplemented with avilamycin or inulin. There was an interaction between lactose level and inulin in the apparent digestibility of gross energy (GE) and nitrogen (N) (P< 0·05). The inclusion of inulin with 175 g/kg lactose increased GE digestibility compared with the 175 g/kg lactose only diet. However, the inclusion of inulin with 295 g/kg lactose had no effect on GE digestibility. The inclusion of inulin with 295 g/kg lactose reduced N digestibility compared with the inclusion of inulin at 175 g/kg lactose. However, there was no difference in N digestibility between 175 and 295 g/kg lactose only diets. In conclusion, there was no benefit in terms of pig growth rate to supplementing diets high in lactose with either inulin or avilamycin. However, the inclusion of inulin improved the energy digestibility of diets low in lactose.

Human leukocyte antigen (HLA) DR4 is not associated with differences in overall survival (OS), progression free survival (PFS), or graft-vs-host-disease (GVHD) following allogeneic hematopoietic stem cell transplantation (allo HSCT) for myeloid malignancies

6552

Background: HLA DR4 is associated with autoimmune disorders and with response to cyclosporine immunosuppression in T-cell Large Granular Lymphoproliferative Disorder (BJH 2003;123(3)). We have earlier reported association of DR 15 positivity with decreased acute GVHD (aGVHD) in patients undergoing allo HSCT for myeloid malignancies (Blood, 2005 Nov 10;Epub). Therefore we investigated the role of HLA DR4 on graft-versus-leukemia effect and GVHD in HLA-matched allo HSCT performed for myeloid malignancies. Methods: A retrospective review of 119 consecutive related and 48 consecutive unrelated allo HSCT patients (pts) treated between 1992 and 2003 at RPCI was performed to investigate the influence of HLA DR4 on OS, PFS and the incidence of grade 2–4 aGVHD and chronic GVHD (cGVHD). HLA DR B1 locus typing was determined by either molecular (n=108) or serologic (n=59) methods. The proportion of patients with one or two HLA DR4 antigens was 26% (43/167) which is similar to the range seen in general Caucasian population. Pt characteristics included: AML (n=84), CML (n=63), and MDS (n=20); median age 43 years (range 11–66); Male (n=104), Female (n=63); Caucasian (>95%); Total Body Irradiation (TBI) conditioning regimens (n=124); Busulfan (Bu)/Cyclophosphamide (Cy) (n=22), Bu/TBI (n=27), Cy/TBI (n=13), Etoposide/Cy/TBI (n=84), or other combinations (n=21). Results: There was no difference in OS and the PFS between the HLA DR4 positive vs negative groups in any disease or donor subgroups (p=0.4 and 0.6). GVHD prophylaxis was similar in the two groups but aGVHD and cGVHD incidence was not different in the two groups (p=0.8 and 0.9) Conclusions: HLA DR 4 is not associated with differences in GVHD or outcomes unlike the previous finding that HLA DR15 is associated with decreased acute GVHD in myeloid malignancies. These results suggest that there are differential effects of HLA DR antigens on the incidence of GVHD and outcomes in myeloid and lymphoid malignancies. Understanding these differences may facilitate the design of pt specific GVHD prophylaxis following allo HSCT.

No significant financial relationships to disclose.

Rituximab in Combination With Fludarabine Chemotherapy in Low-Grade or Follicular Lymphoma

Purpose

To evaluate the safety and efficacy of fludarabine plus rituximab in treatment-naïve or relapsed patients with low-grade and/or follicular non-Hodgkin's lymphoma.

Patients and Methods

This was an open-label, single-arm, single-center phase II study enrolling 40 patients. During the first week of the study, patients received two infusions of rituximab 375 mg/m2 administered 4 days apart. Seventy-two hours after the second infusion of rituximab, patients received the first of six cycles of fludarabine chemotherapy (25 mg/m2/d for 5 days on a 28-day cycle). Single infusions of rituximab were administered 72 hours before the second, fourth, and sixth cycles of fludarabine, and two infusions of rituximab were given 4 weeks after the last cycle of fludarabine. Treatment duration was 26 weeks.

Results

An overall response rate of 90% (80% complete response rate) was achieved in the intent-to-treat population. Similar response rates were seen in treatment-naïve and previously treated patients. The median duration of response has not been reached at 40+ months. The median follow-up time in this study is 44 months (range, 15 to 66 months). In patients positive for the 14;18 translocation in blood and/or marrow at enrollment, molecular remission was achieved in 88% of cases, with patients remaining negative for up to 4 years to date. Hematologic toxicity was manageable, and except for a 15% incidence of herpes simplex/zoster infections, infectious complications were rare. Nonhematologic toxicities were minimal.

Conclusion

Rituximab plus fludarabine was well tolerated and associated with an excellent complete response rate, including molecular remissions, in patients with low-grade or follicular lymphoma.

Evaluation of the BAX system for detection of Listeria monocytogenes in foods: collaborative study

A multilaboratory study was conducted to compare the automated BAX system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.

Angiogenesis in carotid atherosclerosis: the association with morphological features of plaque instability

Background

Intimal angiogenesis is a recognized feature of the atherosclerotic process. It has been described in the context of unstable coronary atherosclerotic lesions. The aims of this study were to assess the association between angiogenesis in atherosclerotic plaques and microscopic features of plaque instability, in particular intraplaque haemorrhage.

Methods

Consecutive patients undergoing carotid endarterectomy for carotid stenosis were included in the study. Endarterectomy specimens were examined and divided into their constituent atherosclerotic lesions. Histological sections were prepared and stained with haematoxylin and eosin, and immunohistochemically with an endothelial cell marker (CD34). Each lesion was classified according to the American Heart Association classification of atherosclerotic lesions. The size of plaque haemorrhage was measured in transverse histological sections using computerized image analysis. Haemorrhagic lesions were classified according to the size of haemorrhagic area (under 50 per cent of section area; over 50 per cent of section area). Microvessel counts were performed in CD34-stained sections at × 400 magnification and were verified with computerized image analysis. The Kruskal–Wallis test was used to study the differences in microvessel count in different atherosclerotic plaque types.

Results

A total of 239 atherosclerotic lesions from 73 patients was available for analysis, of which 73 were early lesions, 74 were raised fibroatheromas and 92 were unstable atherosclerotic plaques. One hundred and fifty lesions were not haemorrhagic; 89 exhibited intraplaque haemorrhage, of which 28 involved less than 50 per cent of the plaque section area. In 61 lesions the haemorrhage area was over 50 per cent of the section area. There were higher microvessel counts in plaques containing more than 50 per cent haemorrhage (median 277 (range 43–467)) compared with those containing less than 50 per cent (172 (57–372)) and non-haemorrhagic plaques (81 (7–389)) (P &lt; 0·0001). Higher microvessel counts were observed in unstable atherosclerotic lesions (median 252 (range 43–467)), compared with stable fibroatheromas (106 (14–302)) and early atherosclerotic lesions (55 (7–237)) (P &lt; 0·0001).

Conclusion

There are strong associations between plaque vascularity and presence and size of haemorrhage within atherosclerotic lesions, as well as features of plaque instability. This finding highlights the likely significance of these new blood vessels in the development of plaque instability and subsequent risk of stroke.