Neutralization of SARS-CoV-2 variants by convalescent and BNT162b2 vaccinated serum

SARS-CoV-2 and its variants continue to infect hundreds of thousands every day despite the rollout of effective vaccines. Therefore, it is essential to understand the levels of protection that these vaccines provide in the face of emerging variants. Here, we report two demographically balanced cohorts of BNT162b2 vaccine recipients and COVID-19 patients, from which we evaluate neutralizing antibody titers against SARS-CoV-2 as well as the B.1.1.7 (alpha) and B.1.351 (beta) variants. We show that both B.1.1.7 and B.1.351 are less well neutralized by serum from vaccinated individuals, and that B.1.351, but not B.1.1.7, is less well neutralized by convalescent serum. We also find that the levels of variant-specific anti-spike antibodies are proportional to neutralizing activities. Together, our results demonstrate the escape of the emerging SARS-CoV-2 variants from neutralization by serum antibodies, which may lead to reduced protection from re-infection or increased risk of vaccine breakthrough.

Previously infected vaccinees broadly neutralize SARS-CoV-2 variants

We compared the serum neutralizing antibody titers before and after two doses of the BNT162b2 COVID-19 vaccine in ten individuals who recovered from SARS-CoV-2 infection prior to vaccination to 20 individuals with no history of infection, against clinical isolates of B.1.1.7, B.1.351, P.1, and the original SARS-CoV-2 virus. Vaccination boosted pre-existing levels of anti-SARS-CoV-2 spike antibodies 10-fold in previously infected individuals, but not to levels significantly higher than those of uninfected vaccinees. However, neutralizing antibody titers increased in previously infected vaccinees relative to uninfected vaccinees against every variant tested: 5.2-fold against B.1.1.7, 6.5-fold against B.1.351, 4.3-fold against P.1, and 3.4-fold against original SARS-CoV-2. Our study indicates that a first-generation COVID-19 vaccine provides broad protection from SARS-CoV-2 variants in individuals with previous infection.

Neutralization of SARS-CoV-2 variants by convalescent and vaccinated serum

We tested human sera from large, demographically balanced cohorts of BNT162b2 vaccine recipients (n=51) and COVID-19 patients (n=44) for neutralizing antibodies against SARS-CoV-2 variants B.1.1.7 and B.1.351. Although the effect is more pronounced in the vaccine cohort, both B.1.1.7 and B.1.351 show significantly reduced levels of neutralization by vaccinated and convalescent sera. Age is negatively correlated with neutralization in vaccinee, and levels of variant-specific RBD antibodies are proportional to neutralizing activities.

Vasomotor influences on glymphatic-lymphatic coupling and solute trafficking in the central nervous system

Despite the recent description of meningeal lymphatic vessels draining solutes from the brain interstitium and cerebrospinal fluid (CSF), the physiological factors governing cranial lymphatic efflux remain largely unexplored. In agreement with recent findings, cervical lymphatic drainage of 70 kD and 2000 kD fluorescent tracers injected into the adult mouse cortex was significantly impaired in the anesthetized compared to waking animals (tracer distribution across 2.1 ± 4.5% and 23.7 ± 15.8% of deep cervical lymph nodes, respectively); however, free-breathing anesthetized mice were markedly hypercapnic and acidemic (paCO₂ = 64 ± 8 mmHg; pH = 7.22 ± 0.05). Mechanical ventilation normalized arterial blood gases in anesthetized animals, and rescued lymphatic efflux of interstitial solutes in anesthetized mice. Experimental hypercapnia blocked cervical lymphatic efflux of intraparenchymal tracers. When tracers were injected into the subarachnoid CSF compartment, glymphatic influx into brain tissue was virtually abolished by hypercapnia, while lymphatic drainage was not appreciably altered. These findings demonstrate that cervical lymphatic drainage of interstitial solutes is, in part, regulated by upstream changes in glymphatic CSF-interstitial fluid exchange. Further, they suggest that maintaining physiological blood gas values in studies of glymphatic exchange and meningeal lymphatic drainage may be critical to defining the physiological regulation of these processes.

Structural and functional conservation of non-lumenized lymphatic endothelial cells in the mammalian leptomeninges

The vertebrate CNS is surrounded by the meninges, a protective barrier comprised of the outer dura mater and the inner leptomeninges, which includes the arachnoid and pial layers. While the dura mater contains lymphatic vessels, no conventional lymphatics have been found within the brain or leptomeninges. However, non-lumenized cells called Brain/Mural Lymphatic Endothelial Cells or Fluorescent Granule Perithelial cells (muLECs/BLECs/FGPs) that share a developmental program and gene expression with peripheral lymphatic vessels have been described in the meninges of zebrafish. Here we identify a structurally and functionally similar cell type in the mammalian leptomeninges that we name Leptomeningeal Lymphatic Endothelial Cells (LLEC). As in zebrafish, LLECs express multiple lymphatic markers, containing very large, spherical inclusions, and develop independently from the meningeal macrophage lineage. Mouse LLECs also internalize macromolecules from the cerebrospinal fluid, including Amyloid-β, the toxic driver of Alzheimer's disease progression. Finally, we identify morphologically similar cells co-expressing LLEC markers in human post-mortem leptomeninges. Given that LLECs share molecular, morphological, and functional characteristics with both lymphatics and macrophages, we propose they represent a novel, evolutionary conserved cell type with potential roles in homeostasis and immune organization of the meninges.

Concurrent Radiosurgery and Systemic Therapies for Melanoma Brain Metastases: A Systematic Review

Intracranial metastatic melanoma is a major challenge for neuro-oncological teams. Historically, treatment has focused on surgical or radiosurgical treatment of appropriate lesions, mostly for palliative purposes. Immunotherapies and other targeted therapies (BRAF/mitogen-activated protein kinase kinase inhibitors (BRAFi/MEKi)) are mainstays of advanced melanoma therapy, yet the optimal timing and synergistic properties of concurrent combinations of these systemic therapies and stereotactic radiosurgery (SRS) are poorly understood. We performed a systematic review of the MEDLINE and Scopus databases focused on outcomes after therapy using SRS and either immunotherapies or targeted therapies in an effort to define the optimal timing. We defined concurrent therapy as SRS within three months of treatment with any systemic therapy. End points included local control, distant control, overall survival, and toxicities. We identified five retrospective cohort studies from the literature. These studies found that concurrent SRS plus immunotherapy or BRAFi/MEKi is well tolerated by most patients and generally improved local control, distant control, and overall survival. Importantly, no significant increases in toxicities were noted with concurrent therapy. Combining concurrent SRS with immunotherapy or BRAFi/MEKi may offer important advances for patients with intracranial metastatic melanoma. To address interstudy heterogeneity, we propose reporting two major time intervals defining “concurrent treatment”: concurrent-SRS (≤4 weeks) and peri-SRS (≤3 months). Future large-scale, prospective trials considering truly concurrent SRS therapies with systemic therapies are desperately needed.

Characterization of dural sinus-associated lymphatic vasculature in human Alzheimer's dementia subjects

Recent reports describing lymphatic vasculature in the meninges have challenged the traditional understanding of interstitial solute clearance from the central nervous system, although the significance of this finding in human neurological disease remains unclear. To begin to define the role of meningeal lymphatic function in the clearance of interstitial amyloid beta (Aβ), and the contribution that its failure may make to the development of Alzheimer's disease (AD), we examined meningeal tissue from a case series including AD and control subjects by confocal microscopy. Our findings confirm the presence of lymphatic vasculature in the human meninges and indicate that, unlike perivascular efflux pathways in the brain parenchyma in subjects with AD, Aβ is not deposited in or around meningeal lymphatic vessels associated with dural sinuses. Our findings demonstrate that while the meningeal lymphatic vasculature may serve as an efflux route for Aβ from the brain and cerebrospinal fluid, Aβ does not deposit in the walls of meningeal lymphatic vessels in the setting of AD.

Cell fusion potentiates tumor heterogeneity and reveals circulating hybrid cells that correlate with stage and survival

High lethality rates associated with metastatic cancer highlight an urgent medical need for improved understanding of biologic mechanisms driving metastatic spread and identification of biomarkers predicting late-stage progression. Numerous neoplastic cell intrinsic and extrinsic mechanisms fuel tumor progression; however, mechanisms driving heterogeneity of neoplastic cells in solid tumors remain obscure. Increased mutational rates of neoplastic cells in stressed environments are implicated but cannot explain all aspects of tumor heterogeneity. We present evidence that fusion of neoplastic cells with leukocytes (for example, macrophages) contributes to tumor heterogeneity, resulting in cells exhibiting increased metastatic behavior. Fusion hybrids (cells harboring hematopoietic and epithelial properties) are readily detectible in cell culture and tumor-bearing mice. Further, hybrids enumerated in peripheral blood of human cancer patients correlate with disease stage and predict overall survival. This unique population of neoplastic cells provides a novel biomarker for tumor staging, as well as a potential therapeutic target for intervention.

Does the diurnal pattern of enteric methane emissions from dairy cows change over time?

Diet manipulation and genetic selection are two important mitigation strategies for reducing enteric methane (CH4) emissions from ruminant livestock. The aim of this study was to assess whether the diurnal pattern of CH4 emissions from individual dairy cows changes over time when cows are fed on diets varying in forage composition. Emissions of CH4 from 36 cows were measured during milking in an automatic (robotic) milking station in three consecutive feeding periods, for a total of 84 days. In Periods 1 and 2, the 36 cows were fed a high-forage partial mixed ration (PMR) containing 75% forage, with either a high grass silage or high maize silage content. In Period 3, cows were fed a commercial PMR containing 69% forage. Cows were offered PMR ad libitum plus concentrates during milking and CH4 emitted by individual cows was sampled during 8662 milkings. A linear mixed model was used to assess differences among cows, feeding periods and time of day. Considerable variation was observed among cows in daily mean and diurnal patterns of CH4 emissions. On average, cows produced less CH4 when fed on the commercial PMR in feeding Period 3 than when the same cows were fed on high-forage diets in feeding Periods 1 and 2. The average diurnal pattern for CH4 emissions did not significantly change between feeding periods and as lactation progressed. Emissions of CH4 were positively associated with dry matter (DM) intake and forage DM intake. It is concluded that if the management of feed allocation remains constant then the diurnal pattern of CH4 emissions from dairy cows will not necessarily alter over time. A change in diet composition may bring about an increase or decrease in absolute emissions over a 24-h period without significantly changing the diurnal pattern unless management of feed allocation changes. These findings are important for CH4 monitoring techniques that involve taking measurements over short periods within a day rather than complete 24-h observations.

Abstract WP411: Identification and Characterization of Human Meningeal Lymphatics

Late onset Alzheimer’s Disease (AD) is the most common form of dementia, affecting 40 million patients and countless families worldwide. AD is characterized by accumulation of amyloid beta (Aß) in the brain and central nervous system (CNS). A growing body of evidence indicates that while Aß production is unchanged, its clearance from the CNS is attenuated in late onset AD. Therefore, it is critical to determine how Aβ is cleared from the brain and if these processes differ in healthy and AD patients. Recently, two groups independently reported that a network of meningeal lymphatic vasculature participates in the clearance of solutes and macromolecules from the brain and cerebrospinal fluid of mice. However the presence of meningeal lymphatic vessels and their potential role in the clearance of Aß has not yet been defined in humans. Therefore, to determine if human meningeal lymphatic vessels absorb Aβ, we used immunofluorescence to examine superior sagittal sinus-associated dura mater tissue in a cohort of 21 patient samples including 6 subjects with no diagnosed dementia (control), 7 subjects with histopathologically confirmed AD, and 8 with diagnosis of mixed or other dementia. We found podoplanin (PDPN) positive, lumenized vessels in 19/21 patient samples, with 5/6 in control patients, 7/7 in AD patients and 7/8 in other or mixed dementia patients. These vessels were located in the dura mater, lateral to the superior sagittal sinus, and ranged from approximately 10 to 500 microns in diameter. Trace Aβ immunoreactivity was colocalized with podoplanin-positive vessels in 1/5 control, 1/7 AD, and 1/7 other or mixed dementia patients. Aß reactivity was found in meningeal blood vessels of 0/6 control, 1/7 AD, and 0/7 other or mixed dementia patients. To our knowledge, these data are the first to robustly support the existence of lymphatic vasculature in the human meninges. The data further suggest that Aß does not appear to widely deposit along wither these meningeal lymphatic or blood vessels, even among AD subjects.

Total Mercury and Methylmercury Response in Water, Sediment, and Biota to Destratification of the Great Salt Lake, Utah, United States

Measurements of chemical and physical parameters made before and after sealing of culverts in the railroad causeway spanning the Great Salt Lake in late 2013 documented dramatic alterations in the system in response to the elimination of flow between the Great Salt Lake's north and south arms. The flow of denser, more-saline water through the culverts from the north arm (Gunnison Bay) to the south arm (Gilbert Bay) previously drove the perennial stratification of the south arm and the existence of oxic shallow brine and anoxic deep brine layers. Closure of the causeway culverts occurred concurrently with a multiyear drought that resulted in a decrease in the lake elevation and a concomitant increase in top-down erosion of the upper surface of the deep brine layer by wind-forced mixing. The combination of these events resulted in the replacement of the formerly stratified water column in the south arm with one that was vertically homogeneous and oxic. Total mercury concentrations in the deep waters of the south arm decreased by approximately 81% and methylmercury concentrations in deep waters decreased by roughly 86% due to destratification. Methylmercury concentrations decreased by 77% in underlying surficial sediment, whereas there was no change observed in total mercury. The dramatic mercury loss from deep waters and methylmercury loss from underlying sediment in response to causeway sealing provides new understanding of the potential role of the deep brine layer in the accumulation and persistence of methylmercury in the Great Salt Lake. Additional mercury measurements in biota appear to contradict the previously implied connection between elevated methylmercury concentrations in the deep brine layer and elevated mercury in avian species reported prior to causeway sealing.

Aspirin and other NSAIDs as chemoprevention agents in melanoma

Melanoma incidence is increasing and, despite recent therapeutic advances, the prognosis for patients with metastatic disease remains poor. Thus, early detection and chemoprevention are promising strategies for improving patient outcomes. Aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAID) have demonstrated chemoprotective activity in several other cancers, and have been proposed as chemopreventive agents for melanoma. Throughout the last decade, however, a number of case-control, prospective, and interventional studies of NSAIDs and melanoma risk have yielded conflicting results. These inconsistent findings have led to uncertainty about the clinical utility of NSAIDs for melanoma chemoprevention. This mini-review highlights current knowledge of NSAID mechanisms of action and rationale for use in melanoma, provides a comparative review of outcomes and limitations of prior studies, and discusses the future challenges in demonstrating that these drugs are effective agents for mitigating melanoma risk.

Maternal transfer of inorganic mercury and methylmercury in aquatic and terrestrial arthropods

The transfer of mercury from females to their offspring plays an important role in mercury accumulation and toxicity during early development. To quantify the transfer of inorganic mercury and methylmercury from female arthropods to their eggs, the authors collected and analyzed brine shrimp (Artemia franciscana), wolf spiders (Alopecosa spp.), and their attached eggs from aquatic and terrestrial ecosystems at the Great Salt Lake, Utah, USA. Essentially all of the mercury in both the female brine shrimp and their eggs was methylmercury (94 ± 17% and 90 ± 21%, respectively). The brine shrimp eggs had methylmercury concentrations that were 84 ± 2% lower than in the females, reflecting the fact that females transferred 45 ± 4% of their total body mass but only 11 ± 3% of their methylmercury burden to their eggs. As a result of this sequestration, the concentration of methylmercury in the female brine shrimp increased by 62 ± 8% during egg formation. The percentage of the total mercury that was methylmercury in female wolf spiders (77 ± 21%) was similar to that in their egg masses (81 ± 19%), indicating similar maternal transfer efficiencies for inorganic mercury and methylmercury in these invertebrates. The concentration of inorganic mercury and methylmercury in the female spiders was the same as in their eggs. These arachnids transferred 48 ± 9% of their total body mass, 55 ± 13% of their inorganic mercury, and 50 ± 9% of their methylmercury to their egg masses. Thus, female wolf spiders do not have the ability to reduce the transfer of methylmercury to their eggs, nor does this process represent an important pathway for the depuration of mercury. The present study demonstrates that although some arthropods have mechanisms to minimize the transfer of methylmercury to their eggs and reduce the potential for mercury toxicity during early development, other arthropods do not.

Root resorption in retained deciduous canine and molar teeth without permanent successors in patients with severe hypodontia

AIMS

The ability to predict the morbidity of retained deciduous teeth with no permanent successors, a characteristic of hypodontia, would be of considerable value in treatment planning, but is hampered by lack of data.

METHODS

This problem was studied using 356 orthopantomogram radiographs (OPGs) from the records of 249 patients who had attended a specialist hypodontia clinic, and had retained deciduous teeth with no permanent successors. Due to their clinical importance, canine and molar teeth were chosen for examination. Resorption was assessed subjectively by three experienced clinicians.

RESULTS

Un-weighted Kappa values for reproducibility were > 0.8, and for interobserver error 0.60-0.83. Gender related differences were minimal. Regardless of gender or radiographic age, the lower canines appear to show the least amount of resorption and the upper first molars the most. The upper and lower second molars have particularly unpredictable life spans. Whilst the lower first molars have a predictable life span that is poor, the life span for the upper first molars is slightly worse.

CONCLUSIONS

Lower canines have a predictable life span that appears to be good, as do upper canines, but of lesser duration than lower canines. Molars have poorer and less predictable life spans.

Quantitation of the five forms of plasma high molecular weight angiotensinogen in women with pregnancy-induced hypertension

In the human pregnant state a high molecular weight form of angiotensinogen (HMrA) is present in significant quantities in addition to the usual low molecular weight angiotensinogen (LMrA). In a previous study involving a small number of white women, it was found that women who had developed pregnancy-induced hypertension (PIH) had significantly higher levels of plasma HMrA. It has been determined that there are five isoforms of HMrA. The objectives of this study were to expand the previous study with the inclusion of black women and to determine which isoform(s) of plasma HMrA are elevated in PIH. Plasma LMrA and HMrA were quantitated in 24 normotensive pregnant women and 65 women with PIH. The PIH group had higher levels of HMrA and somewhat lower levels of LMrA than the normotensive group. The HMrA/LMrA ratio was elevated in 47% of the PIH group. The five isoforms of HMrA were quantitated in plasma from 10 white women with PIH, 10 black women with PIH, and 6 normotensive pregnant white women. Half of both the white and black women with PIH had an elevated HMrA/LMrA ratio. The relative proportion of the HMrA isomers was similar in all groups. These studies show that half the women with PIH have a distinct abnormality in their renin angiotensin system. Both white and black women show this abnormality. In those women who have an elevated total HMrA, all five isoforms of HMrA are equally elevated.

Incontinentia pigmenti: seven cases with dental manifestations

Incontinentia Pigmenti (Bloch-Sulzberger syndrome) is an uncommon genodermatosis that usually affects female infants. The condition is characterized by four cutaneous stages and is frequently associated with dental, ocular, central nervous system and structural anomalies. A large case series of seven patients, all female, who presented to the Department of Paediatric Dentistry at the Eastman Dental Hospital over the last 16 years is reported. The dental features of these cases were typical and included missing teeth, microdontia and delayed eruption. In two of the seven cases, both maxillary canines were palatally impacted.

To reuse your circuit: the HME debate

Heat and moisture exchangers (HMEs) have been used for more than 30 years for heat and moisture retention during general anesthesia. Studies about bacteriostatic vs nonbacteriostatic HMEs (BHMEs/NHMEs) have been conducted to assess their role in preventing bacterial transmission to the anesthesia breathing circuit; none have been done on anesthetized patients in the operating room. The present study adds to existing knowledge about the HME's ability to prevent transmission of bacteria, with implications for cost reduction resulting from reuse of anesthesia breathing circuits among patients. The chi 2 test revealed no statistically significant differences between groups in transmission of bacteria from endotracheal tube (ETT) to anesthesia breathing circuit (P = .48). However, both groups showed statistically significant differences between presence of bacteria in ETTs and anesthesia breathing circuits: Group 1, BHME (P < .005) and group 2, NHME (P < .005). Neither HME prevented contamination of the machine side of the circuit. These results support not reusing breathing circuits. Of 53 participants in group 2, 28 had positive ETT cultures with 7 showing transmission to anesthesia breathing circuit. Of 46 participants in group 1, 28 had positive ETT cultures with 9 showing transmission to anesthesia breathing circuit.

Mycobacterium avium infection of gut mucosa in mice associated with late inflammatory response and intestinal cell necrosis

Mycobacterium avium is an intracellular pathogen that is associated with disseminated infection in acquired immunodeficiency syndrome (AIDS). Patients with AIDS appear to acquire M. avium mainly through the gastrointestinal tract. Previous studies have shown that healthy mice given M. avium orally develop disseminated infection after 2-4 weeks. The chief site of M. avium invasion of the intestinal mucosa is the terminal ileum. To learn more about the pathophysiology of M. avium infection of the intestinal mucosa, C57BL/6 bg+ bg+ mice were infected orally with M. avium strain 101 and groups of six mice were killed each week for 8 weeks. The terminal ileum was then prepared for histopathological studies and electron microscopy. A delayed inflammatory response was observed and influx of neutrophils in the Peyer's patches was the only abnormality seen at 1 week. A severe inflammatory response was seen from week 2 to week 5 and necrosis of intestinal villi was observed 6 weeks after infection. These results indicate that invasion and infection of the normal intestine by M. avium results in a severe inflammatory response with segmental necrosis of the intestinal mucosa.

Dental problems associated with hypophosphataemic vitamin D resistant rickets

OBJECTIVE

To review a series of cases of hypophosphataemic vitamin D resistant rickets. SUBJECTS INCLUDED: Seventeen cases, aged between 2 years 1 month and 15 years 9 months at first referral, and with an established diagnosis of vitamin D resistant rickets from twelve families were included in the review. Information was drawn from patient records for follow-up periods between 9 months and 20 years 4 months.

SETTING

All subjects had been referred to the Eastman Dental Hospital between 1973 and 1997.

FINDINGS

Abscessed non-carious primary and/or permanent teeth were a presenting feature in eleven of the seventeen cases. Although attrition and exposure of the abnormally formed dentine accounted for the route of infection in primary teeth, the route for microbial invasion of pulpal tissues in permanent teeth remained unexplained in a number of patients. The possible part played by infractures of the enamel as a portal of entry for infection is discussed. Enamel defects were observed in only six patients, in three of whom these changes were limited to the primary dentition. Taurodontism of permanent molar teeth was confirmed as a feature of the condition in the more severely affected male subjects.

Severe Infra-occlusion and failed eruption of deciduous molars associated with eruptive and developmental disturbances in the permanent dentition: a report of 28 selected cases

Retrospective analysis of 28 children suffering from severe infra-occlusion and/or primary failure of eruption of deciduous molars revealed an association with eruptive and developmental disturbances in the permanent dentition, including ectopically placed teeth and aplasia of teeth. Taurodont permanent molars were evident in 19 of the 28 selected cases which suggests a possible developmental relationship between these factors. Problems in relation to treatment of these cases are discussed.

Growth within macrophages increases the efficiency of Mycobacterium avium in invading other macrophages by a complement receptor-independent pathway

Infections caused by organisms of the Mycobacterium avium complex occur in approximately 50 to 60% of patients with AIDS. M. avium is an intracellular pathogen that survives and multiplies within mononuclear phagocytes. In this study, we investigated the uptake of M. avium grown within macrophages (intracellular growth M. avium [IG]) by a second macrophage compared with M. avium cultured in broth (extracellular growth M. avium [EG]). The results showed that IG was six- to eightfold more efficient than EG in entering macrophages. In addition, while an anti-CR3 antibody was able to inhibit approximately 60% of EG uptake by macrophages, it failed to inhibit the entry of IG. In contrast to EG, IG uptake into macrophages was significantly inhibited in the presence of anti-beta1-integrin and anti-transferrin receptor antibodies. Entry into macrophages by alternate receptors was associated with resistance to tumor necrosis factor alpha (TNF-alpha) stimulation. While stimulation with TNF-alpha resulted in inhibition of the growth of EG, it was not associated with inhibition of intracellular growth of IG. Investigation of the reason why M. avium is able to sense the changes in the intracellular environment triggering a change to the invasive phenotype suggests a direct relationship with macrophage apoptosis. These results suggest that intracellular growth is associated with novel mechanisms of M. avium uptake of macrophages and that those mechanisms appear to offer advantages to the bacteria in escaping the host defense.

Acquired toxoplasmosis of a submandibular lymph node in a 9-year-old boy diagnosed by fine-needle aspiration cytology

Toxoplasmosis is a parasitic infection which may be asymptomatic or produce lymphadenopathy, fever and malaise. In children the cervical lymph nodes are most commonly affected. This report describes a case of a 9-year-old boy who presented with submandibular lymphadenopathy associated with a non-vital primary tooth, which persisted following extraction of the tooth. A diagnosis of acquired toxoplasmosis was made on the findings of fine-needle aspiration cytology and subsequently confirmed by serological investigations, thus sparing the patient unnecessary hospitalization and surgery. The patient required amitryptyline as a nocturnal sedative and made a complete recovery within a few months without the need for further intervention.

Oral manifestations seen in association with a case of trisomy for the short arm of chromosome 9

A case of trisomy for the short arm of chromosome 9 in a 13-year-old boy is described. Particular emphasis is placed upon a number of abnormal dental findings, which include enamel hypoplasia, hypodontia, and severe dental crowding. The difficulties of providing comprehensive dental treatment in cases such as these is discussed.

Posttranslational modifications of brain and erythrocyte band 3 during aging and disease

Band 3 performs the same structural and functional activities in adult brain as it does in erythrocytes. It ages as cells and tissues age Our studies, to date, indicate that the anion transport ability of band 3 decreases in brains and lymphocytes from old mice. This decreased transport ability precedes obvious structural changes, such as band 3 degradation and generation of SCA and is the earliest change thus far detected in band 3. The following changes occur in lymphocytes, erythrocytes and brain band 3 with aging: 1) a decreased efficiency of anion transport (decreased Vmax) in spite of an increase in number of anion binding sites (increased K(m)), 2) a decreased glucose transport, 3) 32P labeling in vitro, 4) an increased degradation to smaller fragments as detected by quantitative binding of antibodies to band 3 breakdown products and residue 812-830, and 5) a binding of physiologic IgG autoantibodies in situ. The latter three findings indicate that posttranslational changes occur. In addition, the anion transporter, band 3, undergoes an as yet undefined change that results in binding of "980" antibodies to aged band 3. Posttranslational changes in AD include decreased brain and RBC phosphorylation of a M(r) = 135, 113 and 45 kDa band 3 polypeptides due to the phosphorylation site being already occupied, increased degradation of band 3, alterations in band 3 recognized by antibodies, and decreased anion and glucose transport by blood cells. Band 3 in erythrocytes of AD patients has a different immunological identity from normal band 3 as evidenced by the binding of antibodies described in this study. AD may be preferentially manifested in the brain because neurons accumulate damage throughout the lifetime as they do not regenerate or undergo cell division. We suspect, and our data indicate, that the same mechanism(s) of AD occurs in all cells, but that the manifestations differ due to different cell proteins and functions.

Hypodontia: 2. The management of severe hypodontia

The management of severe lack of teeth in the dental arch presents the clinician with a number of difficulties. In this paper, the second in a series on hypodontia, the problems are outlined and suggestions made as how best to overcome them.

Presenting complaints and findings in a group of patients attending a hypodontia clinic

A survey is presented of the complaints and findings in a group of 451 patients referred to a multidisciplinary clinic for the management of hypodontia. The most common complaints were missing teeth, spacing in the dental arches, and poor appearance. The majority of patients were referred by their dental practitioners, and more than half were over 12 years old when first seen. Delayed referral can have educational and social consequences. Changing attitudes to dental care and the maintenance of an intact dentition are resulting in hypodontia, particularly in its more severe forms, becoming of increasing concern to children and their parents. The management of this condition is best organised via multidisciplinary specialist clinics.

Distribution and function of multiple anion transporter proteins in brain tumor cell lines in relation to glucose transport

The anion transport, "band 3," family of proteins in mammalian brain performs the same functions as that of erythroid band 3. These functions are anion transport, ankyrin binding, and generation of senescent cell antigen, an aging antigen that terminates the life of cells. The presence of 5-7 band 3 related proteins in brain tissue was suggested by the reaction of antibodies to synthetic peptides of erythroid band 3 with a number of bands in immunoblots. Since there are a number of different cell types in brain, tissue cultures of neural cell types were examined to determine whether multiple band 3 related proteins are present in each cell type or whether several band 3 related proteins are present in each cell type. The tumor cell lines exhibit anion transport and are inhibited by the anion transport inhibitors 4,4'-diisothiocyano-2,2' disulfonic acid (DIDS), phenylglyoxal, and furosemide. Glucose transport is inhibited by cytochalasin B and the anion transport inhibitor, phenylglyoxal, in these cell lines, but not by 4,4'-diisothiocyano-2,2' disulfonic acid. Furosemide gave partial inhibition of most, but not all, cell lines. Since phenylglyoxal inhibits anion transport by binding to an arginine near the transport site, inhibition of glucose transport by phenylglyoxal suggests that an arginine lies in the substrate binding site. The number of cytochalasin B and DIDS binding sites was quantitated on cell lines as an approximation of the number of glucose transporter and anion transporter sites, respectively.

Osteopathia striata--a case report

Osteopathia striata is an unusual skeletal condition that can affect the bones of the skull quite markedly and result in dental problems that have rarely been discussed in the literature. The characteristic features exhibited by the patient in this case report were dense maxillary and mandibular bone, a high forehead with frontal bossing, a broad nasal bridge, prominent zygomatic arches and thickened angles of the mandible. The mouth opening was limited as a result of sclerosis of the mastoid process, and right lateral excursion of the mandible was reduced, probably because of a deformity of the left condyle.

Formocresol toxicity: is there a suitable alternative for pulpotomy of primary molars?

Some concern has been expressed in recent years about the use of formocresol for vital pulpotomy treatment of primary molars. This paper reviews the literature concerning the toxicity of formocresol and considers the evidence for the use of calcium hydroxide and glutaraldehyde. It is concluded that more work is required in this field before an alternative to formocresol can be recommended and that, in the meantime, a 1:5 dilution of the standard formocresol solution should be used but not included in the zinc oxide-eugenol sublining.

Pulsed nasal and transtracheal oxygen delivery

Oxygen conserving devices, the TTO catheters, electronic pulsed DODS and reservoir cannulas, increase efficacy of oxygen delivery; TTO also improves cosmetic appearance, comfort and compliance. We speculated that pulsing of oxygen transtracheally can increase efficiency of TTO. We modified the DODS to include settable delays and a rapid pre-inspiratory trigger. The first part of the study was performed with nasal oxygen on seven subjects and the second part, with TTO on 17 subjects. Nasal oxygen results indicate improved delivery efficiency with more rapid response. The TTO results indicate no significant change for each delay setting, but there was improvement in delivery efficiency when DODS was combined with TTO vs continuous flow TTO. Thus, early inspiratory delivery increases efficiency of oxygen therapy. Small delays in response time are critical in nasal delivery but not important in TTO. Pulsed TTO is more efficient than continuous flow TTO and merits long-term studies.

The use of the Magnetip double-J ureteral stent in urological practice

The Magnetip* double J type ureteral stent has been used in a wide variety of clinical urological settings. We reviewed the use of the stent in 50 patients. In 45 patients stents were placed in conjunction with extracorporeal shock wave lithotripsy, stone manipulation, obstruction due to pregnancy or malignancy, pyeloplasty and ureteroneocystostomy. In 83 per cent of the attempts the stent was placed successfully. Retrieval with the Magnetriever* was accomplished in 86 per cent of the cases (100 per cent in female and 76 per cent in male patients). Details of stent use are described.

Component failure in removable partial dentures for patients with severe hypodontia

Removable partial dentures (RPDs) are frequently used in the treatment of severe hypodontia. The failure rates and modes of failure of 138 such prostheses incorporating acrylic resin onlays were assessed in a retrospective survey. Failures primarily occurred either early or late in the life of the prostheses. Particular problems identified were the low wear resistance of acrylic resin onlays and poor fixation of resin components to metal bases, especially when space was limited.

A program for transtracheal oxygen delivery. Assessment of safety and efficacy

Over a 2-year period, the safety and efficacy of a program specifically designed for transtracheal oxygen therapy were evaluated in 100 patients with chronic hypoxemia. The four clinically defined phases of the program included patient orientation, evaluation, and selection (phase I); a new needle-wire guide-dilator transtracheal procedure and stent week (phase II); transtracheal oxygen delivery with an immature tract (phase III); and transtracheal oxygen delivery with a mature tract (phase IV). Sequelae and complications were minor, and patient acceptance was high. As compared with the nasal cannula, the transtracheal catheter was associated with a significant reduction in oxygen flow requirement during both rest and exercise. Adequate oxygenation was maintained over time, and erythrocythemia was alleviated with transtracheal delivery. We conclude that transtracheal oxygenation by this method has a low, acceptable morbidity; it is more efficient than nasal cannula delivery and may be more effective in some patients.

Antibiotic-associated interstitial nephritis and nephrotic syndrome

The combination of interstitial nephritis and minimal-change nephrotic syndrome has been well described in adults receiving nonsteroidal anti-inflammatory agents. The association of interstitial nephritis and minimal-change nephrotic syndrome has recently been described in 1 adult patient receiving ampicillin and in 1 patient receiving rifampin. We describe an 8-month-old child who developed reversible interstitial nephritis and minimal-change nephrotic syndrome while taking antibiotics.

How to cheat in morphology: the renal ultrafilter

It is easy to distort the "truth" in morphological reports in order to confirm a previously established dogma by selecting from a field of view only such details which are in accordance with the dogma and by ignoring parts contradictory to it. The renal corpuscle is used in this paper as an example and as a guide to the readers for future fraud.

Polypeptides immunologically related to band 3 are present in nucleated somatic cells

Band 3, the major transmembrane polypeptide of erythrocytes, mediates the exchange of anions (chloride and bicarbonate) across the membrane. We suspected that band 3 was present on nucleated somatic cells as well as erythrocytes because the senescent cell antigen that is immunologically related to band 3 is present on lymphocytes, platelets, adult liver cells, and embryonic kidney cells; and antibodies prepared against the senescent cell antigen isolated from leukocytes react with erythrocyte band 3. For this reason, we examined human fibroblasts, lung cells, neutrophils, mononuclear leukocytes, squamous epithelial (mouth) cells, lung squamous epithelial carcinoma, mouse neuroblastoma cells, and rat hepatocytes for immunoreactive forms of band 3 by using monospecific antibodies to erythrocyte band 3. The results demonstrated that polypeptides sharing common antigenic determinants with erythrocyte band 3 are present in nucleated somatic cells as determined by immunofluorescence, immunoelectron microscopy, and immunoautoradiography. Peptide mapping revealed substantial sequence homology between erythrocyte band 3 and the band 3-like protein of leukocytes. Immunofluorescence studies indicate that the band 3-like proteins in nucleated cells participate in antibody-induced cell surface capping.

Disparate effects of vitamin D treatment upon mitochondrial granulation in proximal and distal renal tubule

The distribution of calcium phosphate granules in mitochondria of proximal and distal renal tubules of nonuremic and uremic children was analyzed by electron microscopy of material obtained by percutaneous kidney biopsy. Although distal tubule had fewer granules/mitochondrion than proximal tubule, uremia induced a significant drop (50%) in both, related to an increase in mitochondria containing O granules and a decrease in mitochondria with 2+ granules. The decrease observed in uremic children was reproduced experimentally by partial nephrectomy in rats. Uremia resulted in a 58% decrease of calcium phosphate granules in rat proximal tubule while a smaller but significant decrease (36%) occurred in distal tubule. Vitamin D deficiency in rats was associated with greatly decreased granulation in proximal tubule (80%) whereas distal tubule was less severely affected (36%). Supplementation of vitamin D to uremic rats restored mitochondrial granulation to normal in proximal tubule in 24 hr, but had no effect in distal tubule since the number of granules/mitochondrion, 0.5 +/- 0.1, remained statistically similar to that of untreated animals. Granulation in both proximal and distal tubule of uremic rats was unaffected by parathyroid hormone administration. Since restoration of granulation occurred only in proximal tubule, the defect in uremia which can be overcome by vitamin D treatment appears localized at the level of the proximal tubular cell membrane, indicating an action of vitamin D on calcium and/or phosphorus translocation into the proximal tubule.

Glomerular basement membrane attenuation in familial nephritis and "benign" hematuria

Lamination of the basement membrane has been considered to be the lesion characteristic of familial nephritis and attenuation to be the lesion of "Benign" familial hematuria. Electron micrographs were reviewed of 57 children who had renal biopsies for persistent hematuria. Attenuation or lamination of the glomerular capillary basement membrane was found in each. Twenty of the 57 children had familial nephritis; 20 had familial hematuria; and 17 had no involved relatives. Follow-up data were available for 14 of 20 children with familial nephritis, 12 of 20 with familial hematuria, and 12 of 17 with sporadic hematuria for 13.6 +/- 6.3, 6.7 +/- 4.6, and 7.0 +/- 4.8 years, respectively, after discovery of hematuria. Five children developed end-stage renal disease: three with familial nephritis, one with familial hematuria, and one with sporadic hematuria. Only two no longer had hematuria. Attenuation of the glomerular capillary basement membrane was seen in every biopsy, whereas lamination was not. Because hematuria and ultrastructural abnormalities were findings shared by all the children, we suggest the possibility that familial nephritis, and familial or sporadic hematuria as defined in this study, may be variations in a spectrum of inherited abnormality or abnormalities in the formation of the glomerular capillary basement membrane.

Primary intestinal lymphangiectasia. Case report with radiological and ultrastructural study

A 16-year-old boy with primary intestinal lymphangiectasia presented with peripheral edema of 6 weeks duration. Laboratory and radiological studies included absolute lymphopenia, hypoalbuminemia, steatorrhea, abnormal stool 51Cr-albumin value, edema of small intestinal folds, dilated mesenteric lymphatics, as well as bilateral filling defects in external and common iliac lymph nodes. Abdominal CT scan revealed a possible periaortic mass. Small intestinal biopsies demonstrated normal villous architecture with dilated lacteals, and electron microscopy revealed enterocytes with normal as well as blunted microville, enlarged, dilated lacteals and intercellular vacuoles. An exploratory laparatomy was performed and revealed no masses but dilated serosal lymphatic vessels. Medical treatment, including marked restriction of long chain triglyceride intake, resulted in loss of peripheral edema, weight stabilization, and normal activity.