Oligopeptide-based molecular labelling of (bio)degradable polyester biomaterials

Nowadays, a very important motivation for the development of new functional materials for medical purposes is not only their performance but also whether they are environmentally friendly. In recent years, there has been a growing interest in the possibility of labelling (bio)degradable polymers, in particular those intended for specific applications, especially in the medical sector, and the potential of information storage in such polymers, making it possible, for example, to track the ultimate environmental fate of plastics. This article presents a straightforward green approach that combines both aspects using an oligopeptide, which is an integral part of polymer material, to store binary information in a physical mixture of polymer and oligopeptide. In the proposed procedure the year of production of polymer films made of poly(l-lactide) (PLLA) and a blend of poly(1,4-butylene adipate-co-1,4-butylene terephthalate) and polylactide (PBAT/PLA) were encoded as the sequence of the appropriate amino acids in the oligopeptide (PEP) added to these polymers. The decoding of the recorded information was carried out using mass spectrometry technique as a new method of decoding, which enabled the successful retrieval and reading of the stored information. Furthermore, the properties of labelled (bio)degradable polymer films and stability during biodegradation of PLLA/PEP film under industrial composting conditions have been investigated. The labelled films exhibited good oligopeptide stability, allowing the recorded information to be retrieved from a green polymer/oligopeptide system before and after biodegradation. The MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay) study of the PLLA and PLLA/PBAT using the MRC-5 mammalian fibroblasts was presented for the first time.

High-frequency ultrasound in anti-aging skin therapy monitoring

Over the last few decades, high-frequency ultrasound has found multiple applications in various diagnostic fields. The fast development of this imaging technique opens up new diagnostic paths in dermatology, allergology, cosmetology, and aesthetic medicine. In this paper, being the first in this area, we discuss the usability of HFUS in anti-aging skin therapy assessment. The fully automated algorithm combining high-quality image selection and entry echo layer segmentation steps followed by the dermal parameters estimation enables qualitative and quantitative evaluation of the effectiveness of anti-aging products. Considering the parameters of subcutaneous layers, the proposed framework provides a reliable tool for TCA-peel therapy assessment; however, it can be successfully applied to other skin-condition-related problems. In this randomized controlled clinical trial, forty-six postmenopausal women were randomly assigned to the experimental and control groups. Women were treated four times at one-week intervals and applied skin cream daily between visits. The three month follow-up study enables measurement of the long-term effect of the therapy. According to the results, the TCA-based therapy increased epidermal (entry echo layer) thickness, indicating that the thinning process has slowed down and the skin's condition has improved. An interesting outcome is the obtained growth in the intensity of the upper dermis in the experimental group, which might suggest a reduced photo-aging effect of TCA-peel and increased water content. The same conclusions connected with the anti-aging effect of TCA-peel can be drawn by observing the parameters describing the contribution of low and medium-intensity pixels in the upper dermis. The decreased share of low-intensity pixels and increased share of medium-intensity pixels in the upper dermis suggest a significant increase in local protein synthesis.

Tomographic reconstruction from planar thermal imaging using convolutional neural network

In this study, we investigate perspectives for thermal tomography based on planar infrared thermal images. Volumetric reconstruction of temperature distribution inside an object is hardly applicable in a way similar to ionizing-radiation-based modalities due to its non-penetrating character. Here, we aim at employing the autoencoder deep neural network to collect knowledge on the single-source heat transfer model. For that purpose, we prepare a series of synthetic 3D models of a cylindrical phantom with assumed thermal properties with various heat source locations, captured at different times. A set of planar thermal images taken around the model is subjected to initial backprojection reconstruction, then passed to the deep model. This paper reports the training and testing results in terms of five metrics assessing spatial similarity between volumetric models, signal-to-noise ratio, or heat source location accuracy. We also evaluate the assumptions of the synthetic model with an experiment involving thermal imaging of a real object (pork) and a single heat source. For validation, we investigate objects with multiple heat sources of a random location and temperature. Our results show the capability of a deep model to reconstruct the temperature distribution inside the object.

Chronic wounds multimodal image database

A multimodal wound image database was created to allow fast development of computer-aided approaches for wound healing monitoring. The developed system with parallel camera optical axes enables multimodal images: photo, thermal, stereo, and depth map of the wound area to be acquired. As a result of using this system a multimodal database of chronic wound images is introduced. It contains 188 image sets of photographs, thermal images, and 3D meshes of the surfaces of chronic wounds acquired during 79 patient visits. Manual wound outlines delineated by an expert are also included in the dataset. All images of each case are additionally coregistered, and both numerical registration parameters and the transformed images are covered in the database. The presented database is publicly available for the research community at https://chronicwounddatabase.eu. That is the first publicly available database for evaluation and comparison of new image-based algorithms in the wound healing monitoring process with coregistered photographs, thermal maps, and 3D models of the wound area. Easily available database of coregistered multimodal data with the raw data set allows faster development of algorithms devoted to wound healing analysis and monitoring.

Patient Specific Phantom in bimodal image navigation system

The paper presents the multistep methodology of bimodal Patient Specific Phantom (PSP) development. First, CT based abdominal digital model is designed. It serves as a source for designing organ moulds manufactured by means of a 3D-printer. The collagen based colloid fills the moulds yielding the organ casts. The PSP permits a bimodal navigation system to be developed that employs a realistic CT-based digital model and US imaging. Highly accurate results were achieved with mean Dice similarity coefficient value of 0.92 and Hausdorff distance 9.67 mm.

Quantitative scanning thermal microscopy based on determination of thermal probe dynamic resistance

Resistive thermal probes used in scanning thermal microscopy provide high spatial resolution of measurement accompanied with high sensitivity to temperature changes. At the same time their sensitivity to variations of thermal conductivity of a sample is relatively low. In typical dc operation mode the static resistance of the thermal probe is measured. It is shown both analytically and experimentally that the sensitivity of measurement can be improved by a factor of three by measuring the dynamic resistance of a dc biased probe superimposed with small ac current. The dynamic resistance can be treated as a complex value. Its amplitude represents the slope of the static voltage-current U-I characteristic for a given I while its phase describes the delay between the measured ac voltage and applied ac current component in the probe. The phase signal also reveals dependence on the sample thermal conductivity. Signal changes are relatively small but very repeatable. In contrast, the difference between dynamic and static resistance has higher sensitivity (the same maximum value as that of the 2nd and 3rd harmonics), and also much higher amplitude than higher harmonics. The proposed dc + ac excitation scheme combines the benefits of dc excitation (mechanical stability of probe-sample contact, average temperature control) with those of ac excitation (base-line stability, rejection of ambient temperature influence, high sensitivity, lock-in signal processing), when the experimental conditions prohibit large ac excitation.

Suitability of imaging methods (X-ray, CT, MRI) in the diagnostics of Ewing's sarcoma in children - analysis of own material

BACKGROUND

Ewing sarcoma is a malignant, small round cell bone tumor, presenting predominantly in children and adolescents. Ewing sarcoma may develop in every bone; diaphyses of long bones, ribs and flat bones are the main locations. Local and systemic clinical symptoms are nonspecific - pain, swelling, fever or ill-being. The aim of the study was to assess the role of radiography, computed tomography and magnetic resonance imaging in the analysis of bone lesions in children and young adults with Ewing sarcoma.

MATERIAL/METHODS

Twenty-seven patients, aged between 1 year and 10 months, and 17 years and 2 months, with histologically verified Ewing sarcoma of the bone, referred to the Radiological Department of University Hospital No 6., John Paul II Upper Silesian Centre for Child Health Katowice, in the period from 1996 to 2007, were included in the study.Plain radiography was performed in every child, CT in 20 and MRI in 12 individuals. Tumour location, extension of the tumour, soft tissue mass, and periosteal reaction were taken into consideration in the evaluation of the lesion. In some cases, pathological features of the MRI and CT were compared. The prevalence of some radiological features was compared to the literature data.

RESULTS

THE MOST COMMON SITE OF TUMOR WAS: ribs (6 children), femoral bone (6 children), pelvis (4 children) and tibia (3 children). In 2 children, a primary tumor was diagnosed in the spine (multifocal in 1 child). X-rays revealed: periosteal reaction in 17 children (63%), soft tissue involvement in 19 children (70%), permeative component in 16 children (59%), and sclerotic component in 5 children (19%). In 10 children (37%), periosteal reaction was not detected. The examination revealed: soft tissue calcifications in 7 cases (26%), a well-delineated focus of destruction within bones in 3 children (11%), cortical thickening in 4 children (15%), cortical destruction in 4 children (15%), saucerisation in 3 children (11%), bone expansion in 3 children (11%), pathological fracture in 2 children (7%), cystic component in 1 child (4%), and vertebra plana in 1 child (4%).Reaction of tumors after i.v. contrast administration, shown on CT, was visible in 16 children - it was useful for a better description of the tumor and extension of the mass within the soft tissue. All MRI examinations (12 children) showed a heterogenous mass with ill-defined borders and a violated cortex. Low signal intensity of the tumor in a T1-weighted image and high signal intensity in a T2-weighted image was shown as well. Heterogenous enhancement of signal intensity on T1-weighted images could be observed after i.v. contrast administration. MRI EXAMINATIONS SHOWED: tumor in an adjacent soft tissue in 11 children, and involvement of the epiphyseal plate or of the joint cavity in 6 children.

CONCLUSIONS

X-ray and MRI are essential in diagnostics. CT examination is more useful to estimate periosteal reactions and destruction of bone and marrow cavity, especially in flat bones. However, to recognise a malignancy, it is necessary to perform a histopathological examination. In doubtful cases, the examination has to be verified as well.

Opportunistic infections and other AIDS-defining illnesses in Poland in 2000-2002

BACKGROUND

The introduction of highly active antiretroviral therapy (HAART) led to a decreased incidence of the most severe opportunistic infections (OIs) in HIV-infected patients. In Poland, HAART became widely used in 1998.

MATERIALS AND METHODS

This study was based on data from medical records data collected in the years 2000-2002 from medical centers for HIV-infected patients in Poland. The aim of the study was to determine the incidence of opportunistic infections (OIs) and other AIDS defining illnesses (ADIs). The chi(2) test was used to determine any significant trends.

RESULTS

The incidence of ADIs was 6.8, 6.5 and 4.8/100 persons/year in 2000-2002, respectively. The most common diagnosed OIs were: fungal infections, tuberculosis, recurrent pneumonia, PCP and toxoplasmosis. In patients receiving HAART (HAART+) the incidence of ADIs was significantly lower than in non-ARV-treated as well as in all HIV+ (p < 0.02, p < 0.001, p < 0.001, respectively). A significant decrease in the incidence of ADIs in HAART+ patients between 2000 and 2002 (p < 0.0001) was observed. From 25% to 30% of ADIs among HAART+ patients were diagnosed within the first 3 months of antiretroviral therapy. In HAART+ patients the most common ADIs were fungal infections and tuberculosis. The diagnosis of ADIs resulted in the recognition of HIV status in 8.7-8.9% of patients.

CONCLUSIONS

Five years after the introduction of HAART the incidence of ADIs had declined. Fungal infections and tuberculosis were the most common OIs in HIV+ patients in Poland.

A correlation between the heterogeneity of hypervariable region 1 of E2 glycoprotein of Hepatitis C virus (HCV) and HCV antibody profile: a case study

A correlation between the heterogeneity of hypervariable region 1 (HVR1) of E2 glycoprotein (gp) and Hepatitis C virus (HCV) antibody profile was investigated. Of 6 patients studied two were in acute phase, two in chronic phase and two showed signs of long-time HCV infection, i.e. liver cirrhosis. All the patients exhibited a vigorous antibody response to viral proteins C, NS3, NS4 and NS5. An antibody response to HVR1 of E2 was found in one patient in acute phase and in one or two patients in chronic phase. Such a response was not found in the two patients with liver cirrhosis. Single-stranded conformation polymorphism (SSCP) and sequence analyses of HVR1 of E2 showed the lowest HVR1 heterogeneity in patients in acute phase and the highest one in those in chronic phase, while the long-time carriers of the virus showed an intermediate heterogeneity. This may reflect a specific interplay between the virus and immune system. The HVR1 heterogeneity may rise in the course of infection as a means of evading the immune pressure. Then, when an organism is unable to clear the virus, because the responses to HVR1 epitopes are weakened or exhausted, a population of less heterogeneous HVR1 variants may be established.

[Effectiveness of antiviral treatment of patients with chronic hepatitis C (a Polish multicenter study)]

Interferon alpha (INF) is routine treatment in patients with chronic hepatitis C. Many controlled investigations were evaluated to establish the optimal schedule of treatment with sustained virological and biochemical response. Recently, multicentre meta-analyses suggest that combination therapy (INF + Ribavirin) was more effective than treatment with interferon alone. The aim of this study was to compare the efficacy of four schedules of antiviral treatment in 445 patients with chronic hepatitis C. Combination therapy (INF + Ribavirin) given for 6 mo. and monotherapy (INF) for 18 mo. were more effective than interferon alone given for 6 mo. Treatment with INF alone for 6 mo. was demonstrated to be insufficient.

Distribution of 32 alelle of the CCR5 gene in the population of Poland

The chemokine receptor CCR5 constitutes a major co-receptor for the R5 strains of HIV-1, and a mutant allele of the CCR5 gene, especially in the homozygous form delta32/delta32, confers resistance against infection by the virus. The frequency of the delta32 allele was determined in blood donors from 16 provinces, covering the entire territory of Poland. Among 861 individuals 182 (21.1%) were carriers of the mutated allele: 7 of them (0.8 %) were homozygotes delta32/delta32, and 175 (20.3%) were heterozygotes +/delta32, resulting in a 10.9% frequency of the delta32 allele. The highest frequencies of the mutated allele were found in the eastern and western provinces, and the lowest frequencies of the delta32 allele were detected in the provinces in the center of the country. This pattern of distribution may reflect the migration of the population from the eastern territories of Poland to the western part of the country after World War II.

[Dilated cardiomyopathy in HIV infection]

The HIV-positive patient with dilated cardiomyopathy was described. Possible causes of heart failure in HIV infection was discussed. To achieve subclinical heart failure diagnosis authors suggest to perform echocardiography as a routine procedure in HIV-positive patients with low CD4 lymphocytes count and who have been infected for long time or when their disease becomes more advanced.

Clinical course and consequences of hepatitis B infection

Hepatitis B virus (HBV) is a small enveloped virus containing partially double-stranded DNA. The DNA and HBV-specific DNA polymerase are surrounded by the HBV core antigen (HBcAg), which in turn is surrounded by a lipoprotein envelope containing the HBV surface antigen (HBsAg). Serum of HBV-infected patients contains complete virus particles, as well as non-infectious spherical or filamentous HBsAg particles. Acute hepatitis is characterized by the appearance of serum HBV markers, including HBsAg and IgM anti-HBc, which then disappear during convalescence. Persistence of HBsAg for more than 6 months indicates a carrier state. Chronic hepatitis develops in 90% of newborns who become infected, compared with 29-40% of children infected and 5-10% of adults infected. The immune status of the infected person also influences the development of chronic hepatitis. Chronic HBV infection can be diagnosed by serology (identification of HBsAg and HBV DNA), biochemistry (elevated aminotransferase levels) and liver biopsy. The last is important to assess the severity of disease, its stage and prognosis, and to exclude other hepatic diseases. The outcome of chronic HBV infection varies between individuals, with estimated 5-year survivals of 97% for chronic persistent hepatitis, 86% for chronic active hepatitis, and 55% for chronic active hepatitis with cirrhosis. Treatment with interferon alpha is effective in up to 40% of cases, but in view of the very large number of infected people worldwide, vaccination to prevent spread of the disease is a more cost-effective option.

Anti-HCV RIBA/LiaTek reactivity and HCV genotype in EIA-negative patients with viremia

Individuals infected with hepatitis C virus (HCV) usually produce anti-HCV antibodies detectable by enzyme immunoassay (EIA); however, in certain viremic cases this antibody does not appear. To investigate whether anti-HCV in these cases is detectable by Western blot (WB), 38 HCV RNA positive/anti-HCV EIA-negative sera were tested by RIBA 3.0 or LiaTek III. The HCV genotypes (INNO-LiPA) were analyzed to determine whether the variance in these genotypes can be the reason for the late, weak antibody production or its absence. As the control group, 282 EIA-positive/HCV RNA-positive patients were examined. A single band reactivity of various intensities by RIBA or LiaTek was observed in 16/38 EIA negative sera. Positive results with NS3 were detected in 4 sera and weak positive (+/-) with core, NS3, and NS5 in 5, 6, and 1 sera, respectively. In 3 cases with anti-NS3, the seroreversion was observed in follow-up. The distribution of genotypes in anti-HCV-negative versus anti-HCV-positive groups was: 1b alone, 50.0% vs. 78.0%; 3a alone, 13.2% vs. 15.6%; and mixed (1b+3a), 36.8% vs. 5.0%, respectively. The follow-up studies showed that viremia was lost spontaneously in 12/35 patients. In some patients infected with two genotypes, the spontaneous loss of the 3a genotype was observed. The study showed that WB tests are useful for serological confirmation of HCV infection in some EIA negative/HCV RNA-positive patients but, because seroreversion may occur, sequential sera samples should be tested. No unusual HCV genotype was detected in anti-HCV-negative/HCV RNA-positive cases, but the frequency of mixed infection with the 1b+3a genotypes in this group was found to be higher than that in anti-HCV-positive hepatitis patients.

[Chylopericardium as a complication of mitral valve replacement]

We demonstrate the case of 47 year old woman with chylopericardium after mitral valve replacement. By reason of heart tamponade she underwent surgical treatment resulted in complete relief of the pericardial effusion.

[Cryptosporidiosis in HIV-positive patients]

Cryptosporidium parvum is a coccidian parasite that affects millions of people worldwide. Clinical outcome of human cryptosporidiosis differs between immunocompetent and immnunodeficient individuals. C. parvum is responsible for causing protracted and life-threatening diarrhea, biliary, and pulmonary infections in immunocompromised persons, especially in patients with AIDS. Though no effective treatment has been found so far, early diagnosis may be useful in controlling the infection. Thirty-eight stool specimens obtained from 35 HIV-positive patients admitted to the Clinic of Infectious Diseases in Poznań, Poland, were examined for the detection of oocysts, coproantigen and DNA of Cryptosporidium using standard microscopic, immunologic and molecular diagnostic methods. The presence of Cryptosporidium was detected in 10 HIV-positive patients. Oocysts, coproantigen and DNA of this parasite were identified solely in one specimen while Cryptosporidium DNA was detected in 8 specimens. Cryptosporidium coproantigen was found only in one sample. Although, the PCR was the most useful technique in the detection of Cryptosporidium in HIV-positive patients it should be noted that PCR has many pitfalls and needs to be carefully controlled to avoid both false positive and false negative results.

Reduced glutathione concentration in erythrocytes of patients with acute and chronic viral hepatitis

Reduced glutathione (GSH), the main intracellular mechanism that protects against oxidative stress, is the subject of considerable interest in viral hepatitis. In patients with chronic hepatitis C, results reported from different centres are controversial, demonstrating either a reduction or an elevation of GSH concentration. The aim of this study was to evaluate the glutathione concentration in erythrocytes (normal range 2.45 +/- 0.15 mmol l-1) in patients with acute and chronic viral hepatitis. In 52 patients with acute viral hepatitis (hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection) there was marked reduction of GSH at the beginning of the disease (0.79 +/- 0.43 mmol l-1, P < 0.001) with high alanine aminotransferase (ALT) activity (1549 +/- 772.9 IU l-1). In 37 patients with chronic HCV infection the mean value of GSH was below the normal range (1.92 +/- 0.62 mmol l-1, P < 0.001). In 60% of patients (n = 22), depletion of GSH was observed and 40% (n = 15) presented with a normal concentration of GSH. In 10 patients with chronic HBV infection the mean value of GSH was also below the normal range (1.93 +/- 0.32 mmol l-1, P < 0.001); in 80% of cases (n = 8) depletion of GSH was observed and 20% of patients (n = 2) had normal GSH concentrations. The ALT activity was not significantly different in patients with depleted and normal GSH concentrations (P > 0.05) in groups with chronic HBV and HCV infection.

[Spontaneous splenic rupture as a complication of infectious mononucleosis]

Spontaneous splenic rupture as a complication of infectious mononucleosis in 17-years old man was described. Clinical manifestations of infectious mononucleosis were typical without any sign of the splenic rupture. At the end of third week of the disease sonographic investigation revealed subcapsular hematoma of the spleen without overt rupture. The patient was observed. Five days later in the next sonographic investigation the second hematoma of the spleen appeared. Patient was treated underwent splenectomy and he remain alive and well. Authors suggest that in cases with subcapsular hematoma of the spleen splenectomy remains the treatment of choice. Mononucleosis patients with significant enlarged spleen should be observed very carefully. Authors propose control sonographic investigation in 3rd or 4th week of the disease in those cases.

Glycoforms of alpha 1-acid glycoprotein in sera of human immunodeficiency virus-infected persons

In acute infections thus far studied, there is a relative increase in plasma protein glycoforms rich in biantennary complex type N-glycans (type I), while in some diseases with chronic inflammatory changes, there is increase in glycoforms with more branched N-glycans (type II). In sera of 109 human immunodeficiency virus (HIV)-infected persons, 38 rheumatoid arthritis patients, and 44 healthy subjects, the composition of alpha 1-acid glycoprotein (AGP) glycoforms was studied using crossed immunoaffinity electrophoresis with concanavalin A as a ligand. In patients in CDC classifications I, II, and III, distribution of AGP glycoforms was analogous to that in normal subjects. Type I alterations were observed in patients in group IV who had no signs of arthritis. Type II changes, analogous to those found in rheumatoid arthritis, were seen in group IV patients who developed arthritis. Most significant type I changes were associated with Pneumocystis carinii pneumonia (specificity, 100%; sensitivity, 96%).

[Treatment of chronic hepatitis B with interferon alpha (Wellferon) with and without previous corticosteroid therapy -- results of a multicenter, double blind study]

The present study was aimed to test the efficacy and safety of interferon alpha (Wellferon-Wellcome Foundation Ltd.) either alone, or in combination with short-term corticosteroid pretreatment in the therapy of chronic hepatitis B. 44 patients with documented chronic hepatitis type B (12 women and 32 men; mean age 37.5 years, range 23-59 years) and satisfying the entry criteria were subjects of the study. 30 patients had chronic active hepatitis on liver biopsy, while 14 had chronic persistent hepatitis. Consecutive patients were given either placebo or prednisone in a double-blinded manner for 4 weeks (0.6 mg/kg/day in the first two weeks, 0.45 mg/kg/day in the third week and 0.25 mg/kg/day in the last week), and then, after a 2 week pause, therapy with interferon was instituted for a total of 12 weeks. Interferon was given by intramuscular injection in a single daily dose of 10 x 10(6) IU for 5 days and three times weekly thereafter. However, because of side effects, the dose of interferon was occasionally reduced to 5 x 10(6) IU in most patients. Interferon induced a sustained cessation of HBV replication as judged by loss of DNA-polymerase activity in 26 (59%) patients, 20 (45%) patients seroconverted to anti-HBe. Additionally, 6 (14%) cases lost HBsAg and seroconverted to anti-HBs. Prednisone pretreatment did not seem to improve the efficacy of interferon therapy. The outcome of the treatment was unrelated to gender and pretreatment activity of transaminases, however, patients with low activity of HBV replication were more likely to respond to therapy than patients with high HBV replication.

[Scintigraphy of "hot foci" in myocardial infarction while using technetium 99m labelled pyrophosphate and antimyosin antibodies labelled with radioactive indium 111]

Comparison of the scintigraphic diagnosis of the myocardial infarction with two radioactive substances is presented. Pyrophosphate labelled with radioactive 99mTc and anti-myosins labelled with radioactive 111In were used for this purpose.

[Myocarditis and dilated cardiomyopathy in scintigraphic evaluation using gallium-citrate 67 and antimyosin antibodies radiolabelled with indium 111]

Scintigraphic techniques of myocarditis diagnosis are presented. 67Ga-citrate and anti-myosins labelled with 111In-isotope have been used. Results were compared with those of heart biopsy.

[Evaluation of lipid metabolism in patients with chronic, active hepatitis (HBsAg positive)]

Selected parameters of the lipid metabolism were evaluated in patients with HBsAg-positive chronic, active hepatitis. A decrease in alpha-lipoproteins and an increase in plasma biliary acids level were found.

[Trace elements: zinc, copper and magnesium in patients with chronic persisting hepatitis--evaluation of changes during therapy]

Serum Zn2+, Cu2+, and Mg2+ were assayed in patients with chronic persisting hepatitis HBsAg-positive. Significantly decreased serum magnesium with increased serum copper levels were noted.