IgG rheumatoid factors isolated by the surface-displaying phage library technique

Our analysis of IgG rheumatoid factors (RFs) from three patients with rheumatoid arthritis (RA) revealed that most contained significant numbers of skewed mutations per V region, suggesting that these RFs arose from antigen-driven responses. To further study IgG RFs in RA, we used pComb3 vector to construct an IgG1,lambda combinatorial antibody library from a synovial fluid sample. After panning against human IgG, Fab fragments from 71/96 phage clones bound to Fc-coated wells. Sequence analysis of 20 randomly chosen Fc-binders showed that 17 (85%) clones had identical heavy (H) and light (L) chain V regions, represented by Humha311 and Humla211, respectively. Of the remaining three clones, two had the same Humla211 L chain, but each with a different H chain V region. All the putative germline V genes for these RFs also encode RF in RA patients. However, none of these RF V regions are similar to those of the two IgG RFs derived by the hybridoma technique from the same synovial fluid. The Humha311 H chain has two frameshifts: a one-base insertion upstream of the JH region and a four-base deletion near the end of the CH1 region, resulting in a mainly unconventional amino acid sequence in the CH1 region. In the future, it will be important to study the presence of IgG molecules with such unconventional CH1 amino acid sequences, and the effects of these amino acid sequences on the structures and immunological properties of the IgG molecules.

Occurrence and diagnosis of Mansonella streptocerca in Uganda

During filaria surveys Mansonella streptocerca was found for the first time in Uganda, in 12 widely scattered villages in the Bundibugyo district between the Ruwenzori mountains and the Ituri forest, an area not endemic for Onchocerca volvulus. The crude prevalence in 806 examined adult persons ranged from 5 to 89% with an average of 61%. In 148 children the prevalence was 36%. The geometric mean of microfilaria (mf) densities in adult mf carriers was 1.7 mf/mg skin and the community microfilarial loads ranged from 1.0 to 13.7 mf/skin snip. In 476 persons skin snips from the shoulder contained mf in 58% and those from the buttocks in 48%. Skin snips from 68 persons digested with collagenase showed that only 30-37% of the mf emerged during 24 h incubation at 30 degrees C in isotonic salt solution. An itching acute or more often chronic papular dermatitis, predominantly on the upper parts of the body, was the typical skin lesion observed in 24% of 177 M. streptocerca mf carriers.

Kawasaki disease: update on diagnosis, treatment, and a still controversial etiology

Diagnosis of Kawasaki syndrome still relies solely on clinical criteria because the etiology is unknown. However, the function and structure of different bacterial superantigens as potential pathogens are discussed. In this regard, the recent determination of the crystal structure of the toxic shock syndrome toxin-1 superantigen complexed with major histocompatibility complex class II suggests potential implications for the controversial findings concerning a role of those superantigens in Kawasaki disease. Although a specific therapy is not available, coronary complications can be significantly reduced with the help of intravenous immunoglobulin therapy combined with oral aspirin.

Calculation abilities in dementia of Alzheimer's type and in vascular dementia

Calculation abilities tested by 12 additive and 12 multiplicative tasks were investigated in 19 patients suffering from vascular dementia and in 23 patients suffering from dementia of Alzheimer's type as well as in 17 age-matched controls. Arithmetic impairment expressed by the number of correct results showed a significant correlation with the degree of dementia, measured by the Mini-Mental State Examination. An error type analysis was performed, but was of no help in the differential diagnosis of dementia. Calculation abilities are similarly impaired in both vascular dementia and dementia of Alzheimer's type.

A pharmacoeconomic evaluation of intravenous fosphenytoin (Cerebyx) versus intravenous phenytoin (Dilantin) in hospital emergency departments

The cost of emergency department services has become a major concern for patients, providers, and payers. Solid economic information is needed to provide a rationale for the selection of therapeutic options and the provision of care that is both clinically and financially prudent. To assess the full cost of care for patients with seizures who are treated in an acute care setting, a modified activity-based cost-accounting model was developed. The model was populated with data from a double-masked, parallel-group, single-dose, multicenter clinical trial designed to investigate the safety and tolerability of phenytoin (Dilantin) and fosphenytoin (Cerebyx) given intravenously in equivalent loading doses according to established recommendations. A total of 52 patients were enrolled in the trial; 13 were given phenytoin and 39 were given fosphenytoin. Salaries and benefits of emergency medical services personnel, drug acquisition costs, and direct and indirect overhead expenditures common to a large hospital emergency department comprised the total costs to treat enrolled patients and manage adverse events. The average cost to treat patients with fosphenytoin was lower than the cost to treat similar patients with phenytoin based on the frequency of adverse events associated with each comparator and the resources (human and material) consumed in the management of those events.

On the relationship between measles virus and Alzheimer neurofibrillary tangles in subacute sclerosing panencephalitis

We have studied the relationship between measles virus and the accumulation of abnormally phosphorylated tau (PHF-tau) in nine cases of subacute sclerosing panencephalitis (SSPE). By assessing the presence of viral intranuclear inclusions and neurofibrillary tangles (NFT) in each case, we found no correlation between presence and amount of measles virus and the numbers of neurons containing PHF-tau. Immunohistochemical double labeling in a case with long duration of disease and severe histopathologic change revealed no strict colocalization of measles virus antigen and PHF-tau throughout different brain regions. In areas containing both antigens, most neurons carrying measles virus did not have a tangle and vice versa, eventhough some colocalization beyond that expected by chance was observed in specific cortical areas. These results indicate that, although secondary to viral infection, NFT formation in SSPE is not restricted to cells carrying viral antigen. Conversely, measles virus infected cells do not necessarily accumulate PHF-tau. This lack of colocalization at the cellular level, throughout different brain areas and among different cases suggests that the formation of NFT in SSPE is not directly induced by the infectious agent. The formation of NFT in this disease appears to be elicited through a specific type of tissue damage and, thus, to be an epiphenomenon. This pathogenetic detail may be of interest for our understanding of the role of neurofibrillary degeneration in the pathogenesis of other more frequent neurodegenerative diseases with cytoskeletal pathology.

A Listeria monocytogenes pentapeptide is presented to cytolytic T lymphocytes by the H2-M3 MHC class Ib molecule

Polymorphism of MHC class Ia molecules severely constrains vaccine development against intracellular pathogens. Antigen presentation by MHC class Ib molecules, which are generally conserved between different individuals, may circumvent this obstacle. Herein, we use tandem mass spectrometry to identify a Listeria monocytogenes pentapeptide antigen that is presented to T lymphocytes by the H2-M3 MHC class Ib molecule. The peptide contains N-formyl methionine at the N terminus and exclusively hydrophobic amino acids. Mice of the H-2 d, H-2 b,and H-2 k haplotypes respond to this peptide upon infection with Listeria monocytogenes. Identification of antigens presented by MHC class Ib molecules is feasible and may provide opportunities for relatively unrestricted vaccine development.

Report on the progress of standardization of the G-banded canine (Canis familiaris) karyotype. Committee for the Standardized Karyotype of the Dog (Canis familiaris)

Karyotyping of dog chromosomes is a difficult task owing to the high diploid number of chromosomes (2n = 78) and the similar morphology of autosomes, all of which are acrocentrics. In this report 22 of the 39 G-banded chromosome pairs and their corresponding ideograms have been standardized. The ideogram comprises altogether 235 bands. The need for the introduction of molecular techniques such as chromosome painting and physical mapping of genetic markers for the identification of small acrocentrics is discussed.

Sensitivity of a polymerase chain reaction-based assay to detect Onchocerca volvulus DNA in skin biopsies

A polymerase chain reaction (PCR) of a 150-bp tandem repeat of Onchocerca volvulus (O-150) combined with Southern-blot hybridization to species-specific DNA probes was employed for DNA detection. O-150 was amplified from parasites originating from Uganda, Benin, Cameroon, Liberia, Ghana, Burkina Faso, Mali, and Zaire and was successfully hybridized to digoxigenin-labeled oligonucleotides. To investigate the sensitivity of the PCR, 2 skin biopsies were taken from each of 227 persons from Uganda with proven O. volvulus infections but with low microfilaria (mf) densities due to ivermectin treatment. One biopsy was tested by PCR and the other was digested using collagenase to assess the total number of mf. The PCR revealed 76.2% of the samples to be positive, and the collagenase method showed that 78.9% were positive, indicating similar sensitivity for the two methods. It is probable that for both techniques the biopsy must contain at least one live mf or fragments of a dead mf. In this study, no free or circulating O. volvulus DNA could be detected in skin biopsies by PCR.

Strain differentiation of Onchocerca volvulus from Uganda using DNA probes

Polymerase chain reaction (PCR) combined with non-radioactive DNA hybridization was applied for the detection and characterization of a 150 bp tandem repeat of Onchocerca volvulus. DNA of worms from western Uganda was amplified and then probed with a digoxygenin-labelled oligonucleotide, specific for the forest form of O. volvulus and compared to samples from various African countries. Hybridization was only observed with PCR products from the forest in Liberia, south-eastern Ghana, Benin and southern Cameroon, but not with worms from Uganda or the savannah in Burkina Faso and northern Ghana. A nested PCR using primers derived form the forest form-specific DNA sequence confirmed these results. Morphometric studies revealed length differences between the microfilariae of Ugandan O. volvulus to those of West Africa, especially to those of the savannah in Burkina Faso. It is concluded that the forest/savannah classification of O. volvulus from West Africa is not suitable for Simulium neavei-transmitted O. volvulus from Uganda.

[Magnetic resonance tomography and histopathologic findings after muscle denervation. A comparative animal experiment study during a two month follow-up]

Recently, MRI was described as a method in the diagnosis of changes of muscle after acute neurogenic muscle atrophy. This study was performed to compare MRI results with myopathological findings, to document the appearance of the MRI changes and to check the sensitivity of this method. We performed a segment resection of the suprascapular nerve resulting in a denervation of the supraspinatus and infraspinatus muscles on 18 Newzeeland white rabbits. MRI changes were followed and documented for two months in short periods of time. The results were compared with histological findings. In myopathology and MRI we found systematical changes: Apart from the reduction of the muscle diameter visual assessment revealed increased signal intensities on the 21st and 35th examination day after denervation. On the 2nd, 5th, 11th and 64th examination day signal intensities were normal. The changes were represented by calculated T2 times, too.

Annexin VII relocalization as a result of dystrophin deficiency

Annexin VII (synexin) is a member of the annexin family of proteins, which are characterized by Ca(2+)-dependent binding to phospholipids. In normal skeletal muscle annexin VII is located preferentially at the plasma membrane and the t-tubule system [Selbert et al. (1995) J. Cell. Sci. 108, 85-95]. Here we have analyzed the distribution of annexin VII in muscle disorders in which the Ca2+ regulation is affected. A remarkable difference was observed in muscle specimens from patients suffering from Duchenne muscular dystrophy and also in muscle from the MDX mouse where annexin VII was gradually released from the sarcolemmal membrane into the cytosol and into the extracellular space during progression of the disease. Hypercontracted muscle fibers positive in Ca2+ staining were devoid of cytosolic annexin VII. Annexins IV and VI were similarly released into the extracellular space. Whereas normal skeletal muscle showed specifically the 51-kDa annexin VII isoform, in dystrophic muscle different ratios of the 51-kDa and the muscle-atypic 47-kDa isoforms were observed. The potential of annexin VII to serve as a tool with which cellular Ca2+ levels can be studied and different muscular disorders classified is discussed.

The spectrum of depressive pseudo-dementia

Depressive disorder causes cognitive symptoms. In the case of severe cognitive symptoms or when psychometric procedures measure cognitive decline in the range of dementia, depressed patients may be diagnosed as Depressive Pseudo-Dementia (DPD). There is no data that depressive disorder can cause dementia without coexisting depressive symptoms. The latter symptoms are frequently overseen because cognitive symptoms are equated with organic brain disease. There are typical neuropsychological features of cognitive decline in depressive disorders, like psychomotor retardation and the slow-start phenomenon. Most patients referred to as DPD, suffer from depression-induced cognitive symptoms outside the range of dementia, but complain of memory disturbance and inability to think or concentrate. The diagnosis of DPD draws attention to a problem in the diagnosis of psychiatric disorders in the elderly: Old people suffering from depression are at particular risk of being labelled as demented. The most important step to diagnose depression causing dementia is the search for signs and symptoms of affective disorder even after having found cognitive symptoms.

Correlations between mental state and quantitative neuropathology in the Vienna Longitudinal Study on Dementia

Quantitative clinicopathological correlation studies are one way to address the question of the relevance of morphological abnormalities in Alzheimer's dementia (AD). This paper summarizes results of the Vienna Longitudinal Study on Dementia obtained during the past few years and presents a critical discussion on the relevance of clinicopathological correlation studies for the pathogenesis of AD. Plotting of psychometric test scores against the numbers of plaques, tangles and neuropil threads in various cortical areas shows that significant correlations are due primarily to very high lesion counts in severely demented patients. These data indicate that neocortical neurofibrillary pathology can be considered an end-stage marker in the pathology of AD. On the other hand, the topographical staging of neuritic Alzheimer changes proposed by Braak and Braak (1991) appears to be a better reflection of the progression of the degenerative process than numerical lesion counts; there is a linear correlation between the Braak stages and Mini-Mental State scores in 122 aged individuals. Significant correlations are further obtained between the severity of dementia and the levels of a number of synaptic proteins including synaptophysin and the chromogranins. Taken together, our data suggest that none of the classical AD lesions, plaques and tangles, play a central role in the pathogenesis of dementia, a fact that is supported by a molecular biological study showing that there is no close relationship between these lesions and the neurons undergoing degeneration in AD. Whereas neuritic pathology is a useful histopathological marker for the diagnosis and staging of AD, the major correlate of cognitive deficits is the loss of corticocortical and subcorticocortical connections reflected by a depletion of synapses. This pathology may be induced by a mismetabolism of the beta-amyloid precursor proteins or their interaction with cytoskeletal proteins related to neuronal degeneration.

Prevalence of Mansonella perstans in western Uganda and its detection using the QBC-fluorescence method

The prevalence of the apathogenic filaria Mansonella perstans was studied in four parishes in western Uganda as part of an onchocerciasis control programme to avoid futile treatment. Blood samples from 1543 persons aged over 14 years from 19 villages were examined for the presence of microfilariae using a modified Knott method. The prevalence of microfilaraemic persons ranged between the parishes from 39% (95% CI 35.9-42.0%) to 81% (95% CI 76.2-84.8%). With exception of single microfilariae of Onchocerca volvulus no other filaria species was detected. Onchocerciasis mass treatment campaigns did not reduce the prevalence of M. perstans infection, since 6-12 months after treatment with a single dose of 150 micrograms/kg ivermectin the prevalence in 124 persons was about the same as before treatment. The QBC-fluorescence technique was employed for the detection of microfilariae in samples from outpatients of the government hospital in Fort Portal: in 16% of 120 children and 24% of 369 adults microfilariae of M. perstans were detected.

Sex role conflict, social desirability, and eating-disorder attitudes and behaviors

The relationship of conflict between sex role ideology and sex role orientation with eating-disorder behaviors and attitudes was examined. American participants were 321 female college students who completed the Bem Sex Role Inventory (Bem, 1974), Sex Role Ideology Scale (Kalin & Tilby, 1978), and Eating Disorders Inventory (EDI; Garner, Olmsted, & Polivy, 1983). The results indicated that conflict between ideology and self-perception had little effect on responses to the Inventory. Instead, students with higher levels of self-rated social desirability and lower levels of masculinity reported higher prevalence of eating-disorder behaviors and attitudes. Analyses of sex role orientation data revealed that participants categorized as undifferentiated had the most pathological responses to the EDI. Overall, the results suggested that social desirability and masculinity, more than sex role orientation or conflict, are strongly related to eating-disorder behavior, perhaps because of a third mediating factor.