Deletion analysis of four of eighteen late gene expression factor gene homologues of the baculovirus, BmNPV

Nucleotide sequence analysis of the genome of the baculovirus Bombyx mori nuclear polyhedrosis virus (BmNPV) identified 18 homologues of the Autographa californica NPV (AcNPV) lefs (late expression factor genes). These BmNPV lefs showed high (73-98%) amino acid sequence identities to AcNPV lefs and were localized to similar positions in the genome. One lef, p35, was previously characterized in AcNPV and BmNPV deletion experiments. Functional deletion of each of the BmNPV lef homologues was attempted here by insertion of a beta-galactosidase gene cassette into the coding region of each lef. Four of 18 BmNPV lef (39K, ie-2, lef-7, and p35) deletion mutants were successfully isolated, indicating that the other 14 BmNPV lefs were likely essential for viral replication in cell culture. Further analysis showed that deletion of lef-7, p35, and ie-2 resulted in lower levels of viral DNA replication, indicating that the BmNPV lef-7, p35, and ie-2 products have stimulating effects on DNA replication. Deletion of 39K resulted in a significantly lower level of late gene transcription and extremely low (over 10(2)-fold less at 48-80 hr p.i.) production of progeny budded virus in BmN cells. In contrast, the deletion did not affect viral DNA replication, indicating that BmNPV 39K is involved in late gene transcription. Reduced late gene expression presumably affected production and/or release of progeny budded virus particles. This was corroborated by transmission electron microscopy, which showed that virus replication was abnormal in BmN cells infected with a BmNPV mutant lacking 39K and virion production was low. Even though 39K deletion resulted in a loss of oral infectivity, the 39K deletion mutant replicated in silkworm larvae when injected into the body cavity, as did the ie-2, lef7, and p35 deletion mutants. In addition, a BmNPV homologue of the baculovirus very late expression factor gene (vif-1) found in AcNPV was essential, implying an essential function of the BmNPV vif-1 homologue at a step before the onset of very late gene expression.

A histologic evaluation of the accuracy of TMJ diagnostic arthroscopy

Sixty-seven temporomandibular joints with internal derangement were examined with arthroscopy, and synovial biopsies were taken for histologic evaluation. Histologically, in 10 cases, the synovium appeared to be normal in appearance, 24 cases had moderate to severe synovitis, 11 cases showed hyperplastic synovitis, 13 cases showed synovial fibrosis, and foreign body granuloma was found in 9 cases. Correlation between arthroscopic observation and histologic findings disclosed an 89.1% specificity and 100% sensitivity.

Analysis of desquamative gingivitis using direct immunofluorescence in conjunction with histology

Chronic desquamative gingivitis (DG) is a common condition often first recognized by periodontists. DG is characterized clinically by erythema with epithelial desquamation, ulceration, and/or the presence of vesiculobullous lesions of the free and attached gingiva. However, DG is actually a clinical manifestation of several different disease processes, particularly lichen planus and benign mucous membrane pemphigoid. Correct diagnosis in DG is critical since proper treatment and follow-up will depend on which disease is involved. However, the diseases that cause DG frequently present diagnostic problems because their lesions often resemble each other clinically and routine histological examination sometimes cannot differentiate between them. Thus, immunohistology, particularly immunofluorescence, is increasingly being used with routine histology to more accurately diagnose DG diseases. This article reviews our experience over the past 10 years in the diagnosis of 72 cases of DG using direct immunofluorescent (DIF) in conjunction with histology and clinical evaluation. Of the 72 DG cases in this study, 30 cases were diagnosed as erosive lichen planus or lichenoid mucositis; 29 cases were diagnosed as benign mucous membrane pemphigoid; 2 cases each of linear IgA disease and pemphigus vulgaris were diagnosed; there was 1 case of bullous pemphigoid; and 1 suspected case of paraneoplastic pemphigus. Even with DIF analysis, 7 cases could not be definitively assigned a particular cause. DIF analysis is not only proving very useful for differential diagnosis, but also adds insight into possible pathogenic mechanisms of DG.

Central hemangioma of the jaws

Fifteen cases of central hemangioma of the jaws in 14 patients are reported, and considerations in diagnosis and treatment are discussed. In the management of these tumors, diagnostic considerations are of paramount importance if associated risks are to be minimized while maximizing the chances for a successful outcome. A search of the literature suggests that surgery, either alone or in combination with embolization, remains the treatment of choice for these lesions. All cases in this report were treated surgically without incident and with good results. Of special interest were two cases in which the tumor was removed from the excised mandible, which was then sterilized and used in the immediate reconstruction of the surgical defect.

Histologic study of the fate of autogenous auricular cartilage grafts in the human temporomandibular joint

Biopsies of 30 autogenous auricular cartilage grafts previously placed in 21 patients with ankylosis and arthropathy of the temporomandibular joint were studied. These joints were reoperated because of persistent pain and limitation of motion. Histologically, all grafts showed viability of the cartilage. Eighteen cartilage grafts placed after Proplast (Vitek, Inc, Houston, TX) or Silastic (Dow Corning, Midland, MI) implants had been removed, all showed foreign-body granuloma with coexistent intact cartilage grafts. This indicated that the autogenous auricular cartilage was resistant to the foreign-body reaction. All cartilage grafts were encased by fibrous tissue. This overgrowth of fibrous tissue may be responsible for the ankylosis. Seven grafts showed cartilaginous proliferation grossly and all showed proliferation histologically. The cartilage proliferation also may contribute to the persistent symptoms and recurrent limitation of joint motion.

A regional approach to reconstruction of the upper lip

PURPOSE

This articles reviews the results obtained when cheek or lower lip flaps, or a combination of these flaps, are used for the reconstruction of defects of the upper lip.

PATIENTS AND METHODS

Twenty-four cases of either partial or total full-thickness defects of the upper lip were reconstructed. Four cases with lateral full-thickness partial defects were reconstructed by advancing a cheek flap using the Bernard-Burow method. In five cases, defects located at the junction of the upper lip and the cheek were reconstructed with an Estlander flap. Four patients with a tight upper lip were corrected with an Abbé flap. In two cases, a modified mucomuscular Abbé flap was used for reconstruction of a vermilion defect of the upper lip. Nine patients with subtotal or total full-thickness defects of the upper lip were reconstructed with a combination of bilateral or unilateral cheek flaps using either the Bernard-Burow or Dieffenback method and T-shaped or oblong Abbé flap.

RESULTS

All regional flaps healed uneventfully, and the function of reconstructed upper lips had recovered within 2 years postoperatively.

CONCLUSION

Use of regional flaps to reconstruct partial or total full-thickness defects of the upper lip can usually achieve satisfactory functional and esthetic results.

Multiple familial ossifying fibromas: relationship to other osseous lesions of the jaws

Multiple familial ossifying fibroma is a very rare jaw lesion. A 31-year-old white woman who had this heritable condition is reported. A differential diagnosis has been discussed to delineate an entity that has not appeared in the previous literature.

Expression of estrogen receptors in desquamative gingivitis

BACKGROUND

Most cases of chronic desquamative gingivitis (CDG) are shown by direct immunofluorescence (DIF) to be immune mediated diseases. Some patients present with similar clinical and microscopic findings as CDG but DIF staining is negative. It has been suggested that those cases of CDG may be hormone (estrogen) mediated and may be treated with estrogens with favorable results.

METHODS

Gingival tissue from 24 cases of CDG and one case of ordinary gingivitis were studied for estrogen receptor (ER) expression using immunohistochemical techniques. Twenty-four of the 25 cases were female. Using standard DIF analysis, 11 of the CDG cases were diagnosed as benign mucous membrane pemphigoid, 10 as lichen planus or lichenoid mucositis (LP), and one as pemphigus. The remaining 3 cases were not diagnostic for a specific disorder (idiopathic). Five of the females had a history of estrogen substitute therapy.

RESULTS

Twenty-two of 23 female CDG cases were positive for ER, although the degree of staining varied. A 32-year-old female with ordinary gingivitis, whose gingivitis varied with her menstrual cycle, did not stain for ER. A 50-year-old male and a 76-year-old female, both with gingival LP, also had negative staining for ER.

CONCLUSIONS

There appears to be no correlation between diagnosed diseases (immunological versus idiopathic) and expression of ER in CDG gingiva. ER expression in the gingiva is probably not related to the presence or absence of estrogen supplementation. The results of this study do not support the use of estrogen in the treatment of idiopathic CDG.

Secondary closure of oroantral and oronasal fistulas: a modification of existing techniques

Fifty-three patients, 25 with oroantral and 28 with oronasal fistulas, were treated using a modified technique of peripheral de-epithelialization and overlapping flaps. This technique was used with sliding buccal flaps, palatal rotation flaps, palatal island flaps, tongue flaps, and distant tubed pedicle flaps. The advantage of the flap is that it provides more tissue attachment, which promotes healing and resists the tendency of the flap to return to its original position. A high degree of success can be predicted. Only two failures were observed in 53 cases.

Infection of Gymnodinium sanguineum by the dinoflagellate Amoebophrya sp.: effect of nutrient environment on parasite generation time, reproduction, and infectivity

Preliminary attempts to culture Amoebophrya sp., a parasite of Gymnodinium sanguineum from Chesapeake Bay, indicated that success may be influenced by water quality. To explore that possibility, we determined development time, reproductive output, and infectivity of progeny (i.e. dinospores) for Amoebophyra sp. maintained on G. sanguineum grown in four different culture media. The duration of the parasite's intracellular growth phase showed no significant difference among treatments; however, the time required for completion of multiple parasite generations did, with elapsed time to the middle of the third generation being shorter in nutrient-replete media. Parasites of hosts grown in nutrient-replete medium also produced three to four times more dinospores than those infecting hosts under low-nutrient conditions, with mean values of 380 and 130 dinospores/host, respectively. Dinospore production relative to host biovolume also differed, with peak values of 7.4 per 1,000 microm3 host for nutrient-replete medium and 4.8 per 1,000 microm3 host for nutrient-limited medium. Furthermore, dinospores produced by "high-nutrient" parasites had a higher success rate than those formed by "low-nutrient" parasites. Results suggest that Amoebophrya sp. is well adapted to exploit G. sanguineum populations in nutrient-enriched environments.

A modified technique for obliteration of large bony defects after cystectomy

Thirteen cysts treated by enucleation followed by collapsing an osteoperiosteal flap to eliminate dead space are presented. Four of the cysts were dentigerous and nine were radicular. The bony defects ranged in size from 3 to 7 cm in greatest dimension. Healing by primary intention occurred in all cases. This method has been found to be successful in the obliteration of large bony defects after cystectomy.

Angiocentric T-cell lymphoma presenting as midface destructive lesion: case report and literature review

A case of angiocentric T-cell lymphoma presenting as a midface destructive lesion is reported. Angiocentric T-cell lymphoma typically manifests as an aggressive, progressively destructive, and necrotizing disorder, often with a fatal outcome. This case was characterized microscopically by the presence of an atypical lymphoid population that expressed a CD45+, CD3+ cytoplasmic, CD5+, and CD56- T-cell phenotype within a background of a polymorphous inflammatory infiltrate. Because of the rarity of the disorder, the differential diagnosis is discussed. Recent advances in clinical immunodiagnostics, the variations in therapeutic modalities, and the prognosis of the disease as reported in the recent literature are reviewed.

African Burkitt's lymphoma: case report and light and electron microscopic findings

An African Burkitt's lymphoma occurred in a 9-year-old American boy who had jaw tumors, proptosis, and abdominal masses. Histologically, the tumor consisted of a monotonous overgrowth of undifferentiated lymphocytes with a "starry sky" appearance. The differential diagnosis of African versus American form and Burkitt's lymphoma versus non-Burkitt's lymphoma is discussed.

Noma: report of a case resulting in bony ankylosis of the maxilla and mandible

Noma, or cancrum oris, has been described as a gangrenous infection of the soft and hard tissues of the oronasal region. Prior to the advent of antibiotics the disease was commonly fatal. Now many survive the acute phase of the disease and present the surgeon with formidable problems of repair. This is a report of a presumed case of noma that resulted in bony ankylosis of the maxilla and mandible. Three-dimensional shaded surface CT reconstruction images were especially useful in demonstrating the architecture of the abnormal bone.

Comparison of syndromic surveillance and a sentinel provider system in detecting an influenza outbreak--Denver, Colorado, 2003

INTRODUCTION

Syndromic surveillance systems can be useful in detecting naturally occurring illness.

OBJECTIVES

Syndromic surveillance performance was assessed to identify an early and severe influenza A outbreak in Denver in 2003.

METHODS

During October 1, 2003-January 31, 2004, syndromic surveillance signals generated for detecting clusters of influenza-like illness (ILI) were compared with ILI activity identified through a sentinel provider system and with reports of laboratory-confirmed influenza. The syndromic surveillance and sentinel provider systems identified ILI activity based on ambulatory-care visits to Kaiser Permanente Colorado. The syndromic surveillance system counted a visit as ILI if the provider recorded any in a list of 30 respiratory diagnoses plus fever. The sentinel provider system required the provider to select "influenza" or "ILI."

RESULTS

Laboratory-confirmed influenza cases, syndromic surveillance ILI episodes, and sentinel provider reports of patient visits for ILI all increased substantially during the week ending November 8, 2003. A greater absolute increase in syndromic surveillance episodes was observed than in sentinel provider reports, suggesting that sentinel clinicians failed to code certain cases of influenza. During the week ending December 6, when reports of laboratory-confirmed cases peaked, the number of sentinel provider reports exceeded the number of syndromic surveillance episodes, possibly because clinicians diagnosed influenza without documenting fever.

CONCLUSION

Syndromic surveillance performed as well as the sentinel provider system, particularly when clinicians were advised to be alert to influenza, suggesting that syndromic surveillance can be useful for detecting clusters of respiratory illness in various settings.

Clinico-pathological conference 2002

INTRODUCTION

Six cases are reported, each presented at the 11th Biennial Congress of the International Association of Oral Pathologists as an instructive case for differential diagnosis on the basis of clinical, imaging or histological features.

CLINICAL PICTURE

Case diagnoses included a large, possibly intraosseous, myofibroma presenting with an oral mass; Langerhans cell histiocytosis with facial skin lesions; an intraosseous vascular hamartoma of the maxilla with worrying radiological features; an unusual mixed radiolucency of the jaw caused by cemento-ossifying fibroma; an osteosarcoma of the posterior mandible causing a well-defined radiolucency and an intraoral squamous cell carcinoma in a child.

Connecting health departments and providers: syndromic surveillance's last mile

INTRODUCTION

A critical need exists for mechanisms to identify and report acute illness clusters to health departments. The Massachusetts Department of Public Health (MDPH) works with partner organizations to conduct syndromic surveillance. This effort is based on CDC's Health Alert Network program and includes automated generation and notification of signals and a mechanism to obtain detailed clinical information when needed.

METHODS

Syndromic surveillance partners collect emergency department and ambulatory care data. The principal communications platform between syndromic surveillance partners and MDPH is the Massachusetts Homeland and Health Alert Network (HHAN). This Internet-based application serves as a portal for communication and collaboration and alerts predefined groups of users involved in emergency response. Syndromic surveillance partners' systems report to HHAN by using Public Health Information Network Messaging System events that meet thresholds selected by MDPH. Cluster summaries are automatically posted into a document library. HHAN notifies users by electronic mail, alphanumeric pager, facsimile, or voice communications; users decide how they want to be notified for each level of alert. Discussion threads permit real-time communication among all parties.

RESULTS

This automated alert system became operational in July 2004. During July-December 2004, HHAN facilitated communication and streamlined investigation of 15 alerts.

CONCLUSION

The system allows rapid, efficient alerting and bidirectional communication among public health and private-sector partners and might be applicable to other public health agencies.