Anorexia Nervosa in vivo cytokine production: a systematic review

INTRODUCTION

The underlying psychobiology that contributes to Anorexia Nervosa (AN) onset and disease progression remains unclear. New research is emerging suggesting a possible link between inflammation and a variety of mental illnesses. Alterations of cytokines may play a role in the pathogenesis of AN. Some studies have found differences in the cytokine profile of those with AN compared to healthy controls, but results are heterogeneous. The aim of this work was to systematically review existing studies investigating in-vivo cytokine production in those with AN before and after weight restoration compared to controls.

METHODS

A comprehensive literature search of four electronic databases (PubMed, PsychInfo, EMBASE and CINAH) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify human in-vivo studies investigating the relationship between AN and cytokine production. Data extracted from included studies related to population characteristics (e.g. age, gender, mean mBMI/%IBW), cytokine measurement and relevant findings. Confounding factors (e.g. smoking status, co-morbid mental illness, menstruation status) were also collected.

RESULTS

36 studies were eligible for this systematic review of which the majority were conducted in Europe (77.8%) and involved female subjects (97.2%). Those with AN ranged in age from 13 to 47 years and had an illness duration of 3 months to 24 years. 15 candidate cytokines and 3 receptors were identified (TNF-alpha, IL-6, IL-1B, CRP, IL-2, IL-7, IL-10, IFN-γ, TNF-R2, IL-1 α, IL-15, TNF-R1, IL-17, IL-18, TGF-B1, IL-12, IL-6R and TGF-B2) exploring in-vivo levels in patients with AN and comparing to controls. TNF-alpha and IL-6 were the most extensively studied with IL-6 being significantly elevated in 4 out of 8 (50%) of longitudinal studies when comparing AN patients at baseline compared to post weight restoration. Following weight restoration, there was no difference in IL-6 levels when comparing to HC in 7 of 8 (87.5%) longitudinal studies examined.

CONCLUSIONS

The most promising cytokine potentially involved in the pathogenesis of AN appears to be IL-6, and possibly TNF-alpha pathways. The heterogeneity of clinical and methodology factors impedes the generalizability of results. Future studies may wish to address these methodological shortcomings as alterations in cytokine levels in AN could act as therapeutic targets assisting with weight restoration and psychopathology and may offer diagnostic potential.

Long-term follow-up of bilateral gracilis reconstruction following extra-levator abdominoperineal excision

INTRODUCTION

Colorectal operations such as an extra-levator abdominoperineal (elAPE) excision for locally advanced or recurrent cancer create a significant perineal tissue deficit. Options for perineal reconstruction include bilateral pedicled gracilis muscle flaps (BPGMF). Fashioning the gracili into a 'weave' creates a muscular sling that supports pelvic contents and is a novel technique. Our series reports the outcomes of the BPGMF in 50 patients undergoing surgery for pelvic cancer.

METHOD

This is a retrospective, single-centre study of patients undergoing reconstruction of perineal defects using BPGMF. All surgeries took place between January 2008 and February 2021. The primary outcome measured was perineal wound healing. The secondary outcomes measured were complications of surgical sites and length of hospital stay (short term), flap integrity on follow-up imaging and functional outcomes (long term).

RESULTS

Fifty patients underwent perineal reconstruction using BPGMF (26 males). The median age was 62 years. The 30-day mortality was 2% (n = 1). The average follow-up period was 2 years. Complete perineal wound healing was 86% (42/49) at outpatient follow-up. Complication rates for the donor site and reconstructed site were 14% and 22%, respectively. Complications included infection (2% donor site, 12% perineum), haematoma (4% donor site), dehiscence (2% donor site, 4% perineum) and seroma (3% donor site, 2% perineum).

CONCLUSION

BPGMF offers a reliable and technically simple muscle flap to reconstruct large perineal defects. The muscle flap integrity appears maintained on follow-up imaging despite a lack of flap monitoring tools. This cohort had minimal functional impairment following BPGMF.

The effect of financial support on depression among young adults during the COVID-19 pandemic

Background

To mitigate the adverse effects of the COVID-19 pandemic on financial resources, governments provided financial support (e.g., emergency aid funds) as well as family via personal assistance. This study aims to assess the moderating effect of financial support from the government or from family on the association between income loss and depression among young adults.

Methods

Two online cross-sectional surveys among young adults (18-29) living in Canada and France were conducted in October-December 2020 (n = 4511) and July-December 2021 (n = 3329). Depressive symptoms were measured using PHQ-9 score+10. Two logistic regression models were performed for each survey with an interaction term between income loss and financial support (government or family modeled separately), controlling for demographics (e.g., country, age, gender, income, living conditions).

Results

In the total sample, half reported depressive symptoms (2020/2021: 53%/46%), and over a third lost income (2020/2021: 10%/12% all income, 38%/22% some income). In 2020, 41% received government financial support (2021: 18%) while family/friends support was constant (12%). In both surveys, among those who received government support, income loss was associated with depression, whether participants lost all income (2020: AOR 1.75 [1.29-2.44]; 2021: AOR 2.17 [1.36-3.44]), or some income (2020: AOR 1.31 [1.17-1.81]; 2021: AOR 1.46 [0.99-2.16]). However, among those who received family support, income loss was no longer significantly associated with depression, whether participants lost all income (2020: AOR 1.37 [0.78-2.40]; 2021: AOR 1.51 [0.88-2.56]), or some income (2020: AOR 1.31 [0.86-1.99]; 2021: AOR 1.10 [0.67-1.81]).

Conclusions

Association between income loss and depression was moderated by receipt of family financial support but not by receipt of government support. Financial support may help to mitigate the negative effects of income loss on young adults mental health during public health crisis.

Key messages

• Financial support may help to minimize risk of depressive symptoms among youth who lost income related to the COVID-19 pandemic.

• Financial support through personal assistance (e.g., family, friends) appears to have a greater impact on youth mental health than COVID-specific government assistance funds.

Foxes (Vulpes vulpes) as sentinels for parasitic zoonoses, Toxoplasma gondii and Trichinella nativa, in the northeastern Canadian Arctic

Outbreaks of Toxoplasma gondii and Trichinella spp. have been recurring for decades among Inuit of Nunavik, northeastern Canada. Contact with wildlife has been identified as a risk factor for Inuit exposure to T. gondii, but reservoirs have yet to be confirmed based on direct detection of DNA or organism. Similarly, little is known about the occurrence of Trichinella spp. in wildlife species of Nunavik other than walrus (Odobenus rosmarus) and bears (Ursus americanus, Ursus maritimus). Foxes (Vulpes vulpes) were targeted as possible sentinels for T. gondii and Trichinella spp. because of their high trophic position within the Arctic food chain as carnivorous scavengers. A total of 39 red foxes were sampled from four communities in southern and western Nunavik between November 2015 and September 2016. For the first time in wildlife, a novel magnetic capture DNA extraction and real-time PCR technique was used to isolate and detect T. gondii DNA from the heart and brain of foxes. A double separatory funnel digestion method followed by multiplex PCR was used to recover and genotype larvae of Trichinella spp. from tongues of foxes. Seroprevalence based on detection of antibodies to T. gondii was 41% (95% CI: 27-57%) using a commercially available modified agglutination test (MAT). Detection of DNA of T. gondii and larvae of Trichinella nativa (T2) occurred in 44% (95% CI: 28-60%) and 36% (95% CI: 21-51%) of foxes, respectively. Coinfection with both T. nativa and T. gondii occurred among 23% (95%CI: 13-38%) of foxes which can be attributed to co-transmission from prey and scavenged species in their diet. There was only moderate agreement between T. gondii serology and direct detection of T. gondii DNA using the MC-PCR technique (Kappa test statistic: 0.321), suggesting that using both methods in tandem can increase the sensitivity of detection for this parasite. These findings show that foxes are good sentinels for circulation of parasitic zoonoses in terrestrial northern ecosystems since they are highly exposed, show measurable indicators of infection and do not serve as exposure sources for humans.

Canine parasitic zoonoses in India: status and issues

Dogs play valuable roles in human society. In addition to serving as pets and companions, dogs have also been important in hunting and, in recent times, as therapy animals. In India, the number of pet dogs is estimated to be around 5 million. The stray dog population in India is estimated to be 19 million and still increasing, due to ineffective control measures. Stray dogs pose substantial risks to public health due to injury and transmission of zoonoses such as rabies. Both pet and stray dogs may act as reservoirs of zoonotic parasites in India, which has a climate conducive to the environmental survival and transmission of many zoonotic parasites. At present, visceral larva migrans, cutaneous larva migrans and echinococcosis are the most important parasitic zoonoses in India. Leishmaniosis, dirofilariosis, Brugia malayi infection and giardiosis are potentially significant emerging parasitic zoonoses, and theleziosis, gnathostomiosis and dipylidiosis occur sporadically. Because of their biomedical and public health significance, and the lack of literature and compiled data on parasitic zoonoses of dogs in India, the authors provide a concise review on this topic along with potential control strategies.

Stabilizing Dog Populations and Improving Animal and Public Health Through a Participatory Approach in Indigenous Communities

Free-roaming dog populations are a global concern for animal and human health including transmission of infectious disease (e.g. rabies, distemper and parasites), dog bite injuries/mortalities, animal welfare and adverse effects on wildlife. In Saskatchewan (SK), Canada, veterinary care is difficult to access in the remote and sparsely inhabited northern half of the province, where the population is predominately Indigenous. Even where veterinary clinics are readily available, there are important barriers such as cost, lack of transportation, unique cultural perspectives on dog husbandry and perceived need for veterinary care. We report the effects of introducing a community action plan designed to improve animal and human health, increase animal health literacy and benefit community well-being in two Indigenous communities where a dog-related child fatality recently occurred. Initial door-to-door dog demographic surveys indicated that most dogs were sexually intact (92% of 382 dogs), and few had ever been vaccinated (6%) or dewormed (6%). Approximately three animal-related injuries requiring medical care were reported in the communities per 1000 persons per year (95% CL: 1.6-6.6), and approximately 86% of 145 environmentally collected dog faecal samples contained parasites, far above levels reported in other urban or rural settings in SK. Following two subsidized spay/neuter clinics and active rehoming of dogs, parasite levels in dog faeces decreased significantly (P < 0.001), and important changes were observed in the dog demographic profile. This project demonstrates the importance of engaging people using familiar, local resources and taking a community specific approach. As well, it highlights the value of integrated, cross-jurisdictional cooperation, utilizing the resources of university researchers, veterinary personnel, public health, environmental health and community-based advocates to work together to solve complex issues in One Health. On-going surveillance on dog bites, parasite levels and dog demographics are needed to measure the long-term sustainability of benefits to dog, human and wildlife health.

Perfusionist techniques of reducing acute kidney injury following cardiopulmonary bypass: an evidence-based review

Cardiac surgery utilizing cardiopulmonary bypass has come a long way since its introduction nearly 60 years ago. In the early days, end-organ damage was linked to contact of the blood with the extracorporeal circuit. One potential cardiac surgery complication known to result in significant morbidity and mortality is acute kidney injury (AKI). Causes of AKI are multifaceted, but most of them are associated with techniques that perfusionists employ during extracorporeal circuit management. These can cause patients to either go on dialysis or renal replacement therapy. Patients with AKI have longer lengths of stay and consume significant resources beyond those with normal kidney function. Few current evidence-based markers determine if the kidneys are adequately protected during surgery. Most relevant literature does not address perfusion-specific techniques that reduce the incidence of AKI. This paper reviews the pathophysiology of the kidney and focuses on perfusion techniques that may reduce the incidence of AKI.

Novel KDM6A (UTX) mutations and a clinical and molecular review of the X-linked Kabuki syndrome (KS2)

We describe seven patients with KDM6A (located on Xp11.3 and encodes UTX) mutations, a rare cause of Kabuki syndrome (KS2, MIM 300867) and report, for the first time, germ-line missense and splice-site mutations in the gene. We demonstrate that less than 5% cases of Kabuki syndrome are due to KDM6A mutations. Our work shows that similar to the commoner Type 1 Kabuki syndrome (KS1, MIM 147920) caused by KMT2D (previously called MLL2) mutations, KS2 patients are characterized by hypotonia and feeding difficulties during infancy and poor postnatal growth and short stature. Unlike KS1, developmental delay and learning disability are generally moderate-severe in boys but mild-moderate in girls with KS2. Some girls may have a normal developmental profile. Speech and cognition tend to be more severely affected than motor development. Increased susceptibility to infections, join laxity, heart, dental and ophthalmological anomalies are common. Hypoglycaemia is more common in KS2 than in KS1. Facial dysmorphism with KDM6A mutations is variable and diagnosis on facial gestalt alone may be difficult in some patients. Hypertrichosis, long halluces and large central incisors may be useful clues to an underlying KDM6A mutation in some patients.

Long-term use of the CentriMag® Ventricular Assist System as a right ventricular assist device: a case report

Right ventricular failure (RVF) following implantation of a left ventricular assist system (LVAS) is associated with high morbidity and mortality. 1 - 4 Numerous centers have reported short-term use of the CentriMag® Ventricular Assist System (CVAS) (Levitronix LLC, Waltham, MA) for treatment of cardiogenic shock, decompensated heart failure and right ventricular failure (RVF) following LVAS implantation. 5 - 9 The present report reviews the clinical course of a patient requiring long-term right ventricular support utilizing the CVAS, following a HeartMate® II LVAS (Thoratec Corp. Pleasanton, CA) implantation. Elevated cytotoxic antibody levels complicated the patient’s treatment plan by precluding orthotropic heart transplantation. The CVAS operated for 304 days without mechanical difficulty until replaced with the HeartWare® Ventricular Assist System (HeartWare Inc. Miramar, FL).

First American experience with the Terumo DuraHeart left ventricular assist system

Since the first implantation of a left ventricular assist system (LVAS) 45 years ago, LVAS therapy has emerged as a viable option for the treatment of advanced heart failure. The current generation of LVASs in clinical evaluation has design features enabling longer and more reliable support durations. We describe the operating characteristics of the DuraHeart LVAS (Terumo Heart, Inc., Ann Arbor, MI). The DuraHeart LVAS is a magnetically-levitated centrifugal pump that began a FDA-approved clinical trial for evaluation of bridge to transplant indication in July of 2008. Magnetic levitation of the spinning-pump impeller is hypothesized to improve long-term mechanical reliability and biological compatibility of the pump. Other design features make the DuraHeart LVAS particularly suited for implantation without cardiopulmonary bypass (CPB). A description of the implant procedure for the first six American implants of the DuraHeart LVAS both on-CPB and off-CPB, including CPB techniques employed, are discussed. While it is still very early in the DuraHeart LVAS experience, the initial outcomes of the first six patient implants would suggest that the device is a safe and effective LVAS.

Dementia of the Alzheimer's type and accelerated aging in Down syndrome

This case study, of a woman with Down syndrome and dementia of the Alzheimer's type (DAT), follows the course of her decline over an 11-year period until death at age 57. Detailed neuropathological findings are also presented. This case illustrates features of premature aging that are typically associated with Down syndrome, and the progressive changes in memory and cognition that are usually associated with DAT. Although the subject's cardiovascular condition and thyroid disorder were treated, they may have contributed to the decline of her memory. This case shows the difficulty in diagnosing dementia in an individual with mental retardation who suffered comorbid episodes of depression and psychosis.

Compelled to interact: forensic community mental health nurses' and service users' relationships

This is the first of two papers reporting community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Service user/nurse relationships and risk are addressed in this initial paper. A mixed method/approach was used. A piloted 15-item questionnaire sought quantitative and qualitative data from 122 nurses throughout England and Wales; 57 questionnaires were returned. Limitations applying to gaining qualitative data via written questionnaire are overtly acknowledged. Quantitative data were analysed using the SPSS program. Content analysis and reflexive appraisal of qualitative data led to production of critically appraised conclusions. Findings are illustrative of complexity. Increased understanding of relevant issues, rather than definitive conclusions, is claimed as an outcome. Reductionist approaches are insufficient in illustrating relevant complexities; nurses offer considered, contextualized responses; diametrically opposed opinions exist about the value of interpersonal relationships and balances between care, control and risk assessment.

The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes

OBJECTIVE

Alcohol is associated with acute hypoglycemia in patients with type 1 diabetes. After drinking alcohol in the evening, delayed hypoglycemia has also been described, although its cause is unknown. We performed a controlled study to investigate this phenomenon.

RESEARCH DESIGN AND METHODS

We admitted six men with type 1 diabetes (aged 19-51 years, HbA(1c) 7.0-10.3%) on two occasions, from 5:00 P.M. to 12:00 noon the following day. They received regular insulin injections before standardized meals, at 6:00 P.M. and 8:00 A.M., and a basal insulin infusion (0.15 mU x kg(-1) x min(-1)) from 11:00 P.M. They drank either dry white wine (0.75 g/kg alcohol) or mineral water at 9:00 P.M. over 90 min. Blood glucose, alcohol, insulin, cortisol, growth hormone, and glucagon levels were measured.

RESULTS

Blood ethanol reached a mean (SEM) peak of 19.1 (1.2) mmol/l and was undetectable by 8:00 A.M. There were no significant differences in evening or overnight blood glucose levels between the studies. In the morning, fasting and postprandial blood glucose levels were significantly lower after consumption of wine (postprandial peak 8.9 [1.7] vs. 15 [1.5] mmol/l, P < 0.01), and from 10:00 A.M., five subjects required treatment for hypoglycemia (nadir 1.9-2.9 mmol/l). None of the subjects had hypoglycemia after consumption of water. After consumption of wine, growth hormone secretion was significantly reduced between midnight and 4:00 A.M. (area under the curve 2.1 [1.1] vs. 6.5 [2.1] microg. l(-1) x h(-1), P = 0.04). There were no differences in insulin or other hormone levels.

CONCLUSIONS

In type 1 diabetes, moderate consumption of alcohol in the evening may predispose patients to hypoglycemia after breakfast the next morning. This is associated with reduced nocturnal growth hormone secretion. Patients should be informed of this risk and advised regarding appropriate preventative measures.

Testing the cosmic coincidence problem and the nature of dark energy

Dark energy models which alter the relative scaling behavior of dark energy and matter could provide a natural solution to the cosmic coincidence problem-why the densities of dark energy and dark matter are comparable today. A generalized class of dark energy models is introduced which allows noncanonical scaling of the ratio of dark matter and dark energy with the Robertson-Walker scale factor a(t). We show that determining whether there is a coincidence problem, and the extent of cosmic coincidence, can be addressed by several forthcoming experiments.

The cognitive and psychomotor effects of morphine in healthy subjects: a randomized controlled trial of repeated (four) oral doses of dextropropoxyphene, morphine, lorazepam and placebo

Ten healthy subjects (four male) of mean age 31 years (range 25-40) took part in a randomized double-blind four-way crossover study to examine the cognitive and psychomotor effects of repeated oral doses of dextropropoxyphene and morphine. Four treatments were compared: dextropropoxyphene napsylate 100 mg, morphine sulphate 10 mg, lorazepam 0.5 mg and placebo. Four doses of each drug were given at 4-h intervals to each subject on four separate study days at least 1 week apart. Cognitive function was assessed using choice reaction time, number vigilance, memory scanning, immediate and delayed word recall, word recognition, picture recognition, critical flicker fusion threshold (CFFT) and subjective measures of alertness, calmness and contentment. Lorazepam impaired the speed of responding on all tasks in which speed was recorded (except digit vigilance) and increased subjective ratings of calmness. Morphine had one major effect, which was to increase the accuracy of responding on the choice reaction time task, at every assessment. Morphine produced some sporadic effects in other tests and an increase in subjective calmness. Dextropropoxyphene impaired performance on choice reaction time and picture recognition. These data show that oral morphine may enhance performance in some measures of cognitive function, whereas dextropropoxyphene (in usual therapeutic doses) seems more likely to cause impairment. Neither opioid has substantial effects on cognition and psychomotor function compared with lorazepam.

The feasibility of PCR-based diagnosis of Prader-Willi and Angelman syndromes using restriction analysis after bisulfite modification of genomic DNA

We have developed a novel PCR-based method for studying DNA methylation in the proximal region of 15q, using restriction analysis after bisulfite treatment of genomic DNA. This protocol can be used for the diagnosis of Prader-Willi and Angelman syndromes. Unlike the recently reported methylation-specific PCR protocol, our method avoids the use of multiplex amplification, thus overcoming the need to adjust relative primer amounts and the risk of obtaining false-negative results.

Bacillus cereus infections among oncology patients at a children's hospital

BACKGROUND

Bacillus cereus can cause severe infections in immunocompromised persons.

METHODS

We report 3 cases of bacteremia/septicemia (1 fatal) among oncology patients in a children's hospital. Because all cases occurred during a 10-day period, a common source outbreak was suspected. An epidemiologic investigation was performed. Molecular comparison of patient and environmental isolates was performed by using pulsed-field gel electrophoresis.

RESULTS

After an extensive investigation, no common hospital source could be found. Pulsed-field gel electrophoresis proved that the isolates were not related.

CONCLUSION

Sporadic infections in immunocompromised persons do occur and can be associated with significant morbidity.

A critical approach to stress-related disorders in African Americans

This article outlines an integrative, dynamic approach to stress and is, in part, a response to emergent debates within social science research and practice that suggest that African Americans are currently experiencing the reverberating psychological effects of slavery and oppression. It is the product of the work of an African-American mental health think tank situated at the Community Mental Health Council, Chicago, Illinois. We suggest the need to attend to biopsychosocial, environmental, and cultural factors that inform both exposure and responses to stress. Finally, consideration is given to matters of resiliency.

Detection of vancomycin-resistant enterococci colonization in a children's hospital

BACKGROUND

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens in many hospitals. The true prevalence of VRE in pediatric hospitals is not known.

METHODS

A surveillance study was performed at a pediatric tertiary care medical center by using vancomycin-containing screening media.

RESULTS

Six children (of 112 screened) were found to be colonized with VRE. Colonized patients had a history of receiving broad-spectrum antimicrobial agents.

CONCLUSION

In the absence of VRE infections, surveillance studies can help determine the extent of VRE colonization and support infection control measures.

Developments in mental health nursing: a critical voice

This paper examines stances that are being adopted in relation to the current and future direction of mental health nursing practice. The argument is made that mental health nursing is being pushed into a direction that is essentially positivistic and narrow in its focus, stating that the current hegemony of thinking which dictates that our primary focus of concern should be with individuals suffering from severe or recurring mental illness, allied with the drive towards 'evidence based practice' is symptomatic of wider issues that should be of concern to all parties interested in the issue of mental health care. The authors examine the context and rationale for these developments from socio-political, philosophical and ethical viewpoints, highlighting that their logical outcome is the exclusion of individuals from the right to health care and question the motives underpinning what could be considered a fundamental shift in the provision of mental health services. The argument is then advanced that caution should be adopted by mental health nursing services before abandoning what Gournay (1994) described as 'redundant ideologies' and that a broader view of mental health nursing action should be accommodated. The validity of trying to account for mental nursing action in quantifiable and biomechanistic terms is questioned and an alternative paradigm of accounting for such action is suggested.

The cognitive, subjective, and physical effects of a ginkgo biloba/panax ginseng combination in healthy volunteers with neurasthenic complaints

We evaluated the effects of a Ginkgo biloba/ginseng combination on cognitive function in this 90-day, double-blind, placebo-controlled, parallel-group study. Sixty-four healthy volunteers (aged 40 to 65 years), selected on the basis of fulfilling the ICD-10 F48.0 criteria for neurasthenia, were assigned randomly to four equal dosing groups, receiving 80, 160, or 320 mg of the combination b.i.d. or placebo. Assessments were performed on the day before dosing, and again at Days 1, 30, and 90 at 1 hour after the morning dose and 1 hour after the afternoon dose. The assessments included the Cognitive Drug Research (CDR) computerized assessment system, the Vienna Determination Unit, cycle ergometry, and various questionnaires. The treatments were well tolerated by all volunteers. On Day 90 at 1 hour post morning dosing, dose-related improvements were seen on the CDR tests, the 320 mg dose being significantly superior to placebo. These effects, however, were reversed 1 hour after the afternoon dose, possibly suggesting that a longer inter-dosing interval would be preferable. The 80-mg dose produced a significant benefit on the ergometry assessment of heart rate at maximum load. There were also several supporting changes from other assessments, including an advantage of 320 mg over placebo on the global score from the Symptom Checklist-90-revised (SCL-90-R) at Day 90.

Meningitis due to Ochrobactrum anthropi: an emerging nosocomial pathogen. A report of 3 cases

We describe 3 cases of Ochrobactrum anthropi meningitis following the implantation of pericardial allograft tissue to cover dural defects following craniotomy. Following an extensive epidemiologic investigation, the tissue allograft was found to have been contaminated with this unusual organism during the harvesting and processing of the tissue in the tissue bank. This organism was only susceptible to imipenem, tetracycline, gentamicin, and ciprofloxacin. The clinical presentation of these patients was subacute. Two of the patients developed osteomyelitis of the bone flap; while another developed a relapse of infection along a former ventriculoperitoneal shunt track 6 months after the initial infection. Appropriate clinical outcome was only observed after removal of tissue allograft implants, debridement of devitalized tissue and bone, removal of shunt devices, and prolonged courses of antibiotics. No deaths were observed.

Human type I cytokeratin genes are a compact cluster

A YAC clone (211F11) containing approximately 0.5 Mb of human DNA was isolated from a human genomic library by PCR-based screening with cytokeratin (KRT) 13-specific primers. The YAC clone was mapped by FISH to the long arm of chromosome 17 (17q12-->q21), a region to which several other type I KRT genes had been mapped previously. We now show by Southern blot hybridization and PFGE analyses that KRT13, 14, 15, and 16 are all contained within YAC clone 211F11. Long-range restriction mapping analysis of clone 211F11 and of two smaller YAC clones that were also isolated with KRT13-specific primers, suggests that KRT13, 14, 15, 16 and their linked type I genes KRT17 and 19, are contained in less than 150 kb of genomic DNA. According to our reconstruction it then appears that at least six type I KRT genes are arranged in a highly compact cluster. The three YACs reported in this study represent a new tool to dissect the molecular structure of the locus of the human type I KRT genes.

Prevalence of spinal disc disease among interventional cardiologists

A suspected, but undocumented, excess of axial skeletal disease among interventional cardiologists (possibly a consequence of lead apron use) was investigated by comparing questionnaire responses from cardiologists, orthopedic surgeons, and rheumatologists (n = 714). Cardiologists reported more neck and back pain, more subsequent time lost from work, and a higher incidence of cervical disc herniations, as well as multiple level disc disease (all p <0.01): "interventionalist's disc disease" is a confirmed entity.

Spectrum of histological changes reactive to prosthetic breast implants: a clinopathological study of 84 patients

A wide range of host reactions can be produced in response to prosthetic breast implants. Although the spectrum of histological changes is well described in the literature, the chronology and relative occurrence of these changes are not well documented. Examination of 161 capsulectomy specimens from 84 women suggested the following chronological sequence of tissue response: fibrous scar tissue; histiocyte response; foreign body giant cell reaction to extruded or exposed material including polyurethane and Dacron patch; synovial-like metaplasia; and calcification. Fibrous scar tissue was seen in all implants. Histiocytic response was noted in 107/161 of the specimens and a foreign body giant cell reaction to polyurethane was seen only in the two Meme implants. Synovial-like metaplasia was less common than previously reported, occurring in 45/161 of specimens after a mean in situ duration of 11.7 years. This peculiar process was seen only in association with a prominent histiocytic response and was not associated with calcification. Dystrophic calcification, which has been reported as occurring rarely in implant capsules, was seen in 15/161 of our specimens after a mean in situ duration of 17.7 years.

Prenatal diagnosis and carrier screening for fragile X by PCR

During the past three years, we have conducted fragile X DNA studies for carrier screening and prenatal diagnosis using a previously described PCR protocol that accurately resolves normal FMR1 alleles and premutations and detects most full mutations [Brown et al., JAMA 270:1569-1575, 1996]. A total of 344 pregnant women with a family history of mental retardation of unknown cause were screened and 6 fragile X carriers were identified: two had full mutations, and four had premutations. The mentally retarded relatives of two other women were found to be fragile X positive although the women themselves were not carriers. In all, 6 carriers and 8 fragile X families were identified by this screening. We have also screened 40 pregnant women who were members of previously identified fragile X families, but whose carrier status was unknown. Ten were found to be carriers and were offered prenatal diagnosis. Prospective prenatal testing of 84 carrier women correctly detected 31 fetal samples (19 females, 12 males) with full mutations and 6 with premutations (2 females, 4 males). No false positives but one false negative occurred early on due to undetected maternal cell contamination. In addition, screening of 806 males with developmental delays of unknown cause gave positive results in 33 (4.1%). Potential problems and pitfalls of direct DNA testing are discussed. Because of the proven success of fragile X screening with direct molecular analysis, screening of all undiagnosed individuals with mental retardation and at risk pregnant women should now be considered. The identification of fragile X carriers and prenatal diagnosis of their pregnancies should significantly reduce the prevalence of this syndrome.

Normal ageing in adults with Down's syndrome: a longitudinal study

The ubiquitous presence of the neuropathology of Alzheimer disease (AD) in individuals with Down's syndrome (DS) over 40 years of age suggests that this group of people will exhibit a high prevalence of dementia of the Alzheimer type (DAT) as they age. The present study indicates that there is a clear discrepancy between the presumed presence of AD neuropathology and the clinical expression of DAT among older people with DS. In the first 6 years of a longitudinal study, the present authors compared 91 adults (31-63 years of age) with DS and mild or moderate mental retardation to 64 adults (31-76 years of age) with other forms of mental retardation (MR) on yearly measures of mental status, short- and long-term memory, speeded psychomotor function, and visuospatial organization. The results indicated that, over repeated testing on the verbal long-term memory test, younger participants with DS showed small increases in their scores, while older participants with DS showed very slight decreases. Overall performance scores on this test and a speeded psychomotor task were poorer for both diagnostic groups in individuals aged 50 years and older. The magnitude and type of these selective changes in performance were consistent with performance profiles observed in older healthy adults without mental retardation on tests measuring similar cognitive functions. Only four out of the 91 people with DS in the present sample showed changes in functioning that have led to a diagnosis of possible DAT, and in these individuals, alternative causes of performance declines were concurrently present (e.g. thyroid dysfunction). These findings indicate that some age-associated changes in functioning are related to "normal' but probably precocious ageing among adults with DS. Furthermore, these findings suggest that adults with DS and mild or moderate mental retardation may be at lower risk for dementia during their fourth and fifth decades of life than previous studies have suggested.

Ochrobactrum anthropi meningitis in pediatric pericardial allograft transplant recipients

An epidemiologic investigation was done after 3 patients contracted Ochrobactrum anthropi meningitis at one hospital in October 1994. Neurosurgical patients with pericardial tissue implants were at greater risk of infection than other neurosurgical patients (3/14 vs. 0/566; P<.001). Cultures of implants removed from 2 case-patients, an implant at implantation, a nonimplanted pericardial tissue, and an unwrapped but unopened bottle of Hank's balanced salt solution (HBSS) grew O. anthropi. Patient and tissue isolates had identical genotypes; the isolate from the HBSS bottle had a unique genotype. Culture samples from an unopened HBSS bottle and from pericardial tissue grew Pseudomonas stutzeri of the same genotype; however, no P. stutzeri infections were detected. The investigation documented intrinsic P. stutzeri contamination of HBSS. O. anthropi contamination of tissues occurred during processing, possibly due to extrinsic contamination of HBSS. Active surveillance is needed to detect infection in patients receiving transplanted tissues, and rigorous infection control practice are necessary during tissue harvesting and processing to ensure sterility.