Detection of HIV-1 DNA in microglia/macrophages, astrocytes and neurons isolated from brain tissue with HIV-1 encephalitis by laser capture microdissection

In HIV-1 encephalitis, HIV-1 replicates predominantly in macrophages and microglia. Astrocytes also carry HIV-1, but the infection of oligodendrocytes and neurons is debated. In this study we examined the presence of HIV-1 DNA in different brain cell types in 6 paraffin embedded, archival post-mortem pediatric and adult brain tissues with HIV-1 encephalitis by Laser Capture Microdissection (LCM). Sections from frontal cortex and basal ganglia were stained by immunohistochemistry for CD68 (microglia), GFAP (astrocytes), MAP2 (neurons), and p24 (HIV-1 positive cells) and different cell types were microdissected by LCM. Individual cells or pools of same type of cells were lysed, the cell lysates were subjected to PCR using HIV-1 gag SK38/SK39 primers, and presence of HIV-1 DNA was confirmed by Southern blotting. HIV-1 gag DNA was consistently detected by this procedure in the frontal cortex and basal ganglia in 1 to 20 p24 HIV-1 capsid positive cells, and in pools of 50 to 100 microglia/macrophage cells, 100 to 200 astrocytes, and 100 to 200 neurons in HIV-1 positive cases but not in HIV-1 negative controls. These findings suggest that in addition to microglia, the infection of astrocytes and neurons by HIV-1 may contribute to the development of HIV-1 disease in the brain.

Septic arthritis following intra-articular steroid injection of the knee--a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee

Septic arthritis is a potential catastrophic complication of intra-articular steroid injection. There is lack of evidence regarding the precautions that should be taken to avoid such a complication, as well as how often it is encountered. The aim of this study was to evaluate the antiseptic precautions taken during intra-articular steroid injection of the knee in the United Kingdom (UK), and estimate how often septic arthritis is encountered by health professionals in the UK following steroid injection of the knee. A questionnaire was posted to 100 orthopaedic surgeons, 100 rheumatologists and 50 general practitioners (GPs), asking them about the cases of septic arthritis following intra-articular steroid injection of the knee that they encountered during their practice and the precautions they take when injecting knees. The response rate was 76.4%; 57.6% of the respondents used alcohol swabs to clean the skin, and the remaining 42.4% used chlorhexidine or Betadine. Only 16.3% used sterile towels to isolate the injection site. There were 32.5% of respondents who routinely used sterile gloves when injecting, and a total of 46.6% used either sterile or non-sterile gloves. Also, 91.1% changed needles between drawing the steroid and injecting it into the joint. Only 24 respondents (12.6%) had encountered septic arthritis after steroid injection of the knee (18 once, 3 twice, 2 three times, 1 several times). We concluded that septic arthritis post intra-articular steroid injection of the knee is probably rare. There is a wide variation in the precautions taken to avoid such a complication. However, the trend seems to be towards minimal use of antiseptic techniques. Further large prospective studies are needed to determine how frequently septic arthritis of the knee is encountered post steroid injection, and the exact precautions that should be taken to avoid it.

Late-onset idiopathic scoliosis in children six to fourteen years old. A cross-sectional prevalence study

We performed a point-prevalence survey of 15,799 children, six to fourteen years old, who formed part of a prospective longitudinal study. Our purpose was to detect the prevalence of scoliosis and to investigate associated factors. On the basis of the initial screening, 934 children (5.9 per cent) were referred for additional clinical and radiographic examinations; 896 children returned for this second evaluation. A lateral spinal curve with a Cobb angle of more than 5 degrees was seen in 431 children (2.7 per cent of the 15,799 children). Only seventy-six children (0.5 per cent) had a curve that met our definition of idiopathic scoliosis (a curve of more than 10 degrees with concordant apical rotation). The point-prevalence rate was higher in girls, and it increased with age. The rate was 0.1 per cent (four of 5246) in the age-group of six to eight years, 0.3 per cent (sixteen of 5831) in the age-group of nine to eleven years, and 1.2 per cent (fifty-six of 4722) in the age-group of twelve to fourteen years old. With allowance for the fact that different definitions of idiopathic scoliosis have been used in earlier studies, our results suggest that the natural history of idiopathic scoliosis may be becoming more benign spontaneously.

Use of intrathecal baclofen in the treatment of patients with dystonia

BACKGROUND

Continuous infusion of intrathecal (IT) baclofen is a highly effective standard therapy for severe spasticity of spinal origin. By contrast, there is limited clinical experience regarding the use of IT baclofen in treating patients with dystonia, and little is known regarding the indications for treatment, efficacy, and safety of IT baclofen in this disorder.

OBJECTIVE

To study retrospectively the effects of IT baclofen in treating 25 patients with severe segmental or generalized dystonia.

SETTING

Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY.

PATIENTS

Twenty-five patients with severe segmental or generalized dystonia that was refractory to oral medications underwent IT baclofen test dosing. In addition to dystonia, 17 patients had spasticity or painful spasms. Thirteen of 25 patients responded to the test doses of IT baclofen, according to unblinded neurological assessments that included the patient's subjective report; all 13 underwent implantation of a pump for continuous IT baclofen infusion.

RESULTS

In contrast to reports of patients with spasticity of spinal origin, those with dystonia in the present series had a lower response rate to bolus IT baclofen doses and a smaller degree of clinical improvement. For 10 of the 13 responders to the test doses of IT baclofen, dystonia rating scale scores of videotaped examinations by blinded observers detected no significant change (P < .07) in severity of dystonia. Retrospective data from 11 of 13 patients with implantable pumps, followed up for a mean interval of 21 months after pump insertion, showed continuing efficacy in 6 individuals (55%), based on a determination of patient satisfaction; however, only 3 patients (27%) reported a sustained improvement in functional capacity. Five (38%) of the 13 patients with implantable pumps experienced severe complications that required hospitalization.

CONCLUSIONS

Despite recent reports that have described the benefit in small numbers of patients with dystonia, we concluded that the role of IT baclofen in treating severe dystonia remains uncertain. Intrathecal baclofen may be more effective when dystonia is associated with spasticity or pain. In the present series, we detected no significant difference in the response to IT baclofen in patients with or without spasticity or pain, perhaps owing to the small sample size.

Joint Modeling of User Check-in Behaviors for Real-time Point-of-Interest Recommendation

Point-of-Interest (POI) recommendation has become an important means to help people discover attractive and interesting places, especially when users travel out of town. However, the extreme sparsity of a user-POI matrix creates a severe challenge. To cope with this challenge, we propose a unified probabilistic generative model, the Topic-Region Model (TRM) , to simultaneously discover the semantic, temporal, and spatial patterns of users’ check-in activities, and to model their joint effect on users’ decision making for selection of POIs to visit. To demonstrate the applicability and flexibility of TRM, we investigate how it supports two recommendation scenarios in a unified way, that is, hometown recommendation and out-of-town recommendation. TRM effectively overcomes data sparsity by the complementarity and mutual enhancement of the diverse information associated with users’ check-in activities (e.g., check-in content, time, and location) in the processes of discovering heterogeneous patterns and producing recommendations. To support real-time POI recommendations, we further extend the TRM model to an online learning model, TRM-Online, to track changing user interests and speed up the model training. In addition, based on the learned model, we propose a clustering-based branch and bound algorithm (CBB) to prune the POI search space and facilitate fast retrieval of the top- k recommendations.

We conduct extensive experiments to evaluate the performance of our proposals on two real-world datasets, including recommendation effectiveness, overcoming the cold-start problem, recommendation efficiency, and model-training efficiency. The experimental results demonstrate the superiority of our TRM models, especially TRM-Online, compared with state-of-the-art competitive methods, by making more effective and efficient mobile recommendations. In addition, we study the importance of each type of pattern in the two recommendation scenarios, respectively, and find that exploiting temporal patterns is most important for the hometown recommendation scenario, while the semantic patterns play a dominant role in improving the recommendation effectiveness for out-of-town users.

Potent small molecule inhibitors of spleen tyrosine kinase (Syk)

A series of oxindoles demonstrating inhibition of the phosphorylation of biotinylated substrates of Syk and IgE/Fc epsilon RI triggered basophil cell degranulation has been identified. A study of the SAR around sulfonamide 31 (IC(50)=5 nM, EC(50)=1400 nM) is discussed. The modest cellular activity representative of the sulfonamide series was overcome when the Polar Surface Area was lowered to <110 A(2), leading to the identification of amide 32 (IC(50)=145 nM, EC(50)=100 nM).

Thromboembolism complicating thrombin injection of femoral artery pseudoaneurysm: management with intraarterial thrombolysis

Ultrasound (US)-guided compression of pseudoaneurysms is being rapidly replaced by US-guided percutaneous treatment with thrombin injection because of the less intensive nature of this procedure. Thromboembolism after percutaneous treatment with thrombin injection is rare and has been described in brachial artery pseudoaneurysms. These were managed with intravenous administration of heparin and surgical thrombectomy. In this report, the authors describe thromboembolic complication of thrombin injection after treatment of a femoral artery pseudoaneurysm. This was managed by intraarterial thrombolysis with use of recombinant tissue plasminogen activator (rt-PA) with resolution of all major occlusive changes. A lower dose of thrombin injection and frequent postprocedural monitoring of distal pulses is recommended.

Mapping the kinase domain of Janus Kinase 3

The utilization and impact of parallel synthesis on lead exploration around initial hit oxindole (1) are described. The emergent SAR, analogue design and functional impact will also be detailed.

Proximal femoral osteotomy as the primary operation for young adults who have osteoarthrosis of the hip

We report the results of proximal femoral osteotomy that was performed to treat osteoarthrosis in twenty-three consecutive young adults (twenty-five hips) who had a mean age of thirty-eight years (range, eighteen to fifty-three years). The mean duration of follow-up was seven years (range, two to twelve years). With conversion to a total hip replacement as the end point, the rate of survival at twelve years was 67 per cent (95 per cent confidence interval, 37 to 88 per cent). Four hips (16 per cent) were converted to a total hip replacement at a mean of eight years after the osteotomy. For the patients who did not have conversion to a total hip replacement, the mean score for pain, according to the system of Merle d'Aubigné and Postel as modified by Charnley, improved from 3.4 points preoperatively to 5.1 points postoperatively, the mean score for walking ability improved from 3.9 to 4.7 points, and the mean score for range of motion improved from 3.2 to 4.2 points. These results compare favorably with those following other forms of operative treatment of osteoarthrosis of the hip in young adults. In addition, the osteotomy does not preclude subsequent replacement arthroplasty if one is necessary.

Elevation of CD5+ B lymphocytes in schizophrenia

BACKGROUND

A variety of immunologic alterations have been observed in patients with schizophrenia. These findings have lent support to theories that autoimmune mechanisms may be important in some patients with the illness. The CD5+ B lymphocyte, a B-cell subset associated with autoimmune disease, has been the subject of two previously published studies yielding disparate results.

METHODS

In this study, we used immunofluorescent flow cytometry to measure CD5+ B cells, total B and T cells, and CD4 and CD8 subsets in patients with schizophrenia and in normal control subjects.

RESULTS

A significantly higher percentage of patients with schizophrenia, relative to normal control subjects, exhibited an elevated level of CD5+ B cells (27.6% vs 6.7%). Antipsychotic withdrawal had no effect on CD5+ B-cell levels, suggesting that medication effects were not the cause of this difference. No other studied lymphocyte subsets differed between the two groups.

CONCLUSIONS

A subset of patients with schizophrenia have elevated levels of CD5+ B cells. This finding replicates an earlier study by another group and provides further evidence suggestive of autoimmune manifestations in schizophrenia.

Arterial pressure measurements using infrared photosensors: comparison with CW Doppler

We evaluated the accuracy of modern infrared photosensors (IPs) from a photoplethysmography (PPG) machine as flow detector in determining the systolic arterial pressures and ankle/brachial indices (ABIs) in comparison to the traditional continuous wave Doppler (Doppler) method. Pressures were obtained by placing an appropriate pneumatic cuff above the elbow and ankle. The Doppler probe was placed at brachial artery, posterior tibial artery and dorsalis pedis artery, and the IP was placed on the pad of the index finger and great toe. The two techniques were compared in 181 limbs in our non-invasive vascular laboratory, 133 limbs with normal and 48 limbs with abnormal ABIs. The accuracy of absolute ankle pressure measurements was also compared by both methods. We found that IPs from PPG machine have a good correlation (linear regression r=0.96 for normal and r=0.95 for abnormal ankle pressures) with the Doppler method. There was no significant difference (P< or =0.0001) in the ABIs calculated by two methods in either normal or abnormal subjects. The PPG method was easier, quicker and automated as compared with the cumbersome Doppler method. While PPG method does not differentiate between occlusive disease of posterior tibial and anterior tibial/dorsalis pedis arteries, it is better suited for non-compliant patients and is superior to Doppler method in advanced occlusive arterial disease. We recommend that it be used on a routine basis.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

ST-SAGE

With the rapid development of location-based social networks (LBSNs), spatial item recommendation has become an important mobile application, especially when users travel away from home. However, this type of recommendation is very challenging compared to traditional recommender systems. A user may visit only a limited number of spatial items, leading to a very sparse user-item matrix. This matrix becomes even sparser when the user travels to a distant place, as most of the items visited by a user are usually located within a short distance from the user’s home. Moreover, user interests and behavior patterns may vary dramatically across different time and geographical regions. In light of this, we propose ST-SAGE, a spatial-temporal sparse additive generative model for spatial item recommendation in this article. ST-SAGE considers both personal interests of the users and the preferences of the crowd in the target region at the given time by exploiting both the co-occurrence patterns and content of spatial items. To further alleviate the data-sparsity issue, ST-SAGE exploits the geographical correlation by smoothing the crowd’s preferences over a well-designed spatial index structure called the spatial pyramid . To speed up the training process of ST-SAGE, we implement a parallel version of the model inference algorithm on the GraphLab framework. We conduct extensive experiments; the experimental results clearly demonstrate that ST-SAGE outperforms the state-of-the-art recommender systems in terms of recommendation effectiveness, model training efficiency, and online recommendation efficiency.

A Spatial-Temporal Topic Model for the Semantic Annotation of POIs in LBSNs

Semantic tags of points of interest (POIs) are a crucial prerequisite for location search, recommendation services, and data cleaning. However, most POIs in location-based social networks (LBSNs) are either tag-missing or tag-incomplete. This article aims to develop semantic annotation techniques to automatically infer tags for POIs. We first analyze two LBSN datasets and observe that there are two types of tags, category-related ones and sentimental ones, which have unique characteristics. Category-related tags are hierarchical, whereas sentimental ones are category-aware. All existing related work has adopted classification methods to predict high-level category-related tags in the hierarchy, but they cannot apply to infer either low-level category tags or sentimental ones.

In light of this, we propose a latent-class probabilistic generative model, namely the spatial-temporal topic model (STM), to infer personal interests, the temporal and spatial patterns of topics/semantics embedded in users’ check-in activities, the interdependence between category-topic and sentiment-topic, and the correlation between sentimental tags and rating scores from users’ check-in and rating behaviors. Then, this learned knowledge is utilized to automatically annotate all POIs with both category-related and sentimental tags in a unified way. We conduct extensive experiments to evaluate the performance of the proposed STM on a real large-scale dataset. The experimental results show the superiority of our proposed STM, and we also observe that the real challenge of inferring category-related tags for POIs lies in the low-level ones of the hierarchy and that the challenge of predicting sentimental tags are those with neutral ratings.

Cerebello-pontine angle paraganglioma simulating an acoustic neurinoma

An unusual case of paraganglioma arising from the internal auditory meatus and growing into the cerebello-pontine angle is reported. Clinical features, pre-operative radiological appearances and intra-operative findings were indistinguishable from those of an acoustic neurinoma. However, the paraganglionic nature of the tumour was confirmed by the electron microscopic evidence of neurosecretory features.