Polymeric immunoglobulin receptor (pIgR) in cancer

BACKGROUND

The polymeric immunoglobulin receptor (pIgR) is a transmembrane transporter of polymeric IgA through the intestinal epithelium. Its overexpression has been reported in several cancers, but its role as a diagnostic and prognostic biomarker of oncogenesis is currently unclear.

METHOD

A literature search was conducted to summarize the functions of pIgR, its expression levels, and its clinical implications.

RESULTS

pIgR expression has previously been investigated by proteomic analysis, RNA sequencing, and tissue microarray at the level of both RNA and protein in various cancers including pancreatic, esophageal, gastric, lung, and liver. However, studies have reported inconsistent results on how pIgR levels affect clinical outcomes such as survival rate and chemotherapy resistance. Possible explanations include pIgR mRNA levels being minimally correlated with the rate of downstream pIgR protein synthesis, and the diversity of antibodies used in immunohistochemistry studies further magnifying this ambiguity. In ovarian cancer cells, the transcytosis of IgA accompanied a series of transcriptional changes in intracellular inflammatory pathways that inhibit the progression of cancer, including the upregulation of IFN-gamma and downregulation of tumor-promoting ephrins. These findings suggest that both the levels of pIgR and secreted IgA from tumor-infiltrating B cells affect clinical outcomes.

CONCLUSION

Overall, no direct correlation was observed between the levels of pIgR inside tumor tissue and the clinical features in cancer patients. Measuring pIgR protein levels with a more specific and possibly chemically defined antibody, along with tumoral IgA, is a potential solution to better understand the pathways and consequences of pIgR overexpression in cancer cells.

Partial excision of schwannomatosis with fascicular invasion occurring in the ulnar nerve above the elbow: A 1-year follow-up study

Although not as common as solitary lesions, multiple schwannomas do occur, even in single nerve lesions. We report a rare case of a 47-year-old female patient who presented with multiple schwannomas with inter-fascicular invasion in the ulnar nerve above the cubital tunnel. Preoperative MRI revealed a 10-cm multilobulated tubular mass along the ulnar nerve above the elbow joint. During excision under 4.5° loupe magnification, we separated three ovoid yellow-colored neurogenic tumors of different sizes, but there were still remaining lesions as it was difficult to completely separate lesions from the ulnar nerve due to the risk of iatrogenic nerve ulnar nerve injury. The operative wound was closed. Postoperative biopsy confirmed the diagnosis of the three schwannomas. During the follow-up, the patient recovered without neurological symptom or limitations in range of motion, and there were no neurological abnormalities. At 1year after surgery, small lesions remained in the most proximal part. However, the patient had no clinical symptoms and was satisfied with the surgical results. Although a long-term follow-up is necessary for this patient, we were able to obtain good clinical and radiological results.

Specific ablation of PDGFRβ-overexpressing pericytes with antibody-drug conjugate potently inhibits pathologic ocular neovascularization in mouse models

BACKGROUND

Crosstalk between pericytes and endothelial cells is critical for ocular neovascularization. Endothelial cells secrete platelet-derived growth factor (PDGF)-BB and recruit PDGF receptor β (PDGFRβ)-overexpressing pericytes, which in turn cover and stabilize neovessels, independent of vascular endothelial growth factor (VEGF). Therapeutic agents inhibiting PDGF-BB/PDGFRβ signaling were tested in clinical trials but failed to provide additional benefits over anti-VEGF agents. We tested whether an antibody-drug conjugate (ADC) - an engineered monoclonal antibody linked to a cytotoxic agent - could selectively ablate pericytes and suppress retinal and choroidal neovascularization.

METHODS

Immunoblotting, flow cytometry, cell viability test, and confocal microscopy were conducted to assess the internalization and cytotoxic effect of ADC targeting mPDGFRβ in an in vitro setting. Immunofluorescence staining of whole-mount retinas and retinal pigment epithelium-choroid-scleral complexes, electroretinography, and OptoMotry test were used to evaluate the effect and safety of ADC targeting mPDGFRβ in the mouse models of pathologic ocular neovascularization.

RESULTS

ADC targeting mPDGFRβ is effectively internalized into mouse brain vascular pericytes and showed significant cytotoxicity compared with the control ADC. We also show that specific ablation of PDGFRβ-overexpressing pericytes using an ADC potently inhibits pathologic ocular neovascularization in mouse models of oxygen-induced retinopathy and laser-induced choroidal neovascularization, while not provoking generalized retinal toxicity.

CONCLUSION

Our results suggest that removing PDGFRβ-expressing pericytes by an ADC targeting PDGFRβ could be a potential therapeutic strategy for pathologic ocular neovascularization.

Machine Learning-Guided Prediction of Antigen-Reactive In Silico Clonotypes Based on Changes in Clonal Abundance through Bio-Panning

c-Met is a promising target in cancer therapy for its intrinsic oncogenic properties. However, there are currently no c-Met-specific inhibitors available in the clinic. Antibodies blocking the interaction with its only known ligand, hepatocyte growth factor, and/or inducing receptor internalization have been clinically tested. To explore other therapeutic antibody mechanisms like Fc-mediated effector function, bispecific T cell engagement, and chimeric antigen T cell receptors, a diverse panel of antibodies is essential. We prepared a chicken immune scFv library, performed four rounds of bio-panning, obtained 641 clones using a high-throughput clonal retrieval system (TrueRepertoireTM, TR), and found 149 antigen-reactive scFv clones. We also prepared phagemid DNA before the start of bio-panning (round 0) and, after each round of bio-panning (round 1-4), performed next-generation sequencing of these five sets of phagemid DNA, and identified 860,207 HCDR3 clonotypes and 443,292 LCDR3 clonotypes along with their clonal abundance data. We then established a TR data set consisting of antigen reactivity for scFv clones found in TR analysis and the clonal abundance of their HCDR3 and LCDR3 clonotypes in five sets of phagemid DNA. Using the TR data set, a random forest machine learning algorithm was trained to predict the binding properties of in silico HCDR3 and LCDR3 clonotypes. Subsequently, we synthesized 40 HCDR3 and 40 LCDR3 clonotypes predicted to be antigen reactive (AR) and constructed a phage-displayed scFv library called the AR library. In parallel, we also prepared an antigen non-reactive (NR) library using 10 HCDR3 and 10 LCDR3 clonotypes predicted to be NR. After a single round of bio-panning, we screened 96 randomly-selected phage clones from the AR library and found out 14 AR scFv clones consisting of 5 HCDR3 and 11 LCDR3 AR clonotypes. We also screened 96 randomly-selected phage clones from the NR library, but did not identify any AR clones. In summary, machine learning algorithms can provide a method for identifying AR antibodies, which allows for the characterization of diverse antibody libraries inaccessible by traditional methods.

Automatic matching of computed tomography and stereolithography data

BACKGROUND AND OBJECTIVE

Computed tomography (CT) is one of the most frequently used medical imaging methods. An important application area of CT is dental implants, which require precise inspection and analysis of oral structures. Since CT provides a precise 3D model of the teeth, bones and nerves, it can be used as a surgical guide for dental implants. Along with CT, optical 3D images called stereolithography (STL) have also been widely used. STL images obtained from optical 3D images can be used to show the 3D surfaces of oral structures. Since CT data and STL data deploy different technologies to obtain dental information, we can obtain more accurate dental implants by combining the two datasets. Since the two datasets are acquired by using different sensors, the datasets need to be registered.

METHODS

An automatic matching algorithm is proposed for CT and STL image registration, which is based on depth maps and maximum intensity projection. Then, fine tuning was performed based on volume matching.

RESULTS

When applied to real-world databases, the proposed method provided an average matching error of 2.7 mm for the upper jaw and 2.3 mm for the lower jaw with an average processing time of about 19 s.

CONCLUSIONS

The proposed method performs accurate registration of CT and STL.

Hydroxychloroquine treatment during pregnancy in lupus patients is associated with lower risk of preeclampsia

Background

Hydroxychloroquine (HCQ) is regarded as a mainstay in the treatment of systemic lupus erythematosus (SLE) because of its efficacy in preventing flares, achieving remission, and reducing overall mortality. However, the impact of HCQ on pregnancy outcomes remains controversial.

Objective

We aimed to investigate the effect of HCQ on pregnancy outcomes in patients with SLE.

Methods

We performed a retrospective cohort study of 151 pregnancies in 122 patients with SLE (80 pregnancies in the HCQ treatment group and 71 pregnancies in the HCQ nontreatment group). We reviewed baseline characteristics including maternal comorbidities such as antiphospholipid syndrome, lupus nephritis, and autoimmune hepatitis. Pregnancy outcomes (preeclampsia, preterm delivery, and fetal growth restriction) and neonatal outcomes (gestational age at delivery and birth weight) were compared between HCQ treatment and nontreatment groups.

Results

Preeclampsia was significantly less complicated (7.5% vs 19.7%, p = 0.032) and neonatal birth weight was significantly greater (2757.0 ± 583.5 g vs 2542.3 ± 908.3 g, p = 0.001) in the HCQ treatment group than in the HCQ nontreatment group. Multiple logistic analysis adjusting for body mass index (BMI), lupus nephritis, serum uric acid, and estimated glomerular filtration rate revealed HCQ treatment was associated with exceedingly lower risk of preeclampsia in SLE pregnancy (odds ratio (OR) 0.106 (confidence interval (CI) 0.017–0.671)). Other independent risk factors for preeclampsia were a high prepregnancy BMI (OR 1.575 (CI 1.114–2.227)) and low eGFR level (OR 0.931 (CI 0.886–0.979)) before pregnancy.

Conclusion

Our data showed pregnancy outcomes in SLE patients can be improved in the HCQ treatment group with about 90% reduction of preeclampsia.

Surface reconstruction and charge modulation in BaFe2As2 superconducting film

Whether or not epitaxially grown superconducting films have the same bulk-like superconducting properties is an important concern. We report the structure and the electronic properties of epitaxially grown Ba(Fe_1-x Co _x )₂As₂ films using scanning tunneling microscopy and scanning tunneling spectroscopy (STS). This film showed a different surface structure, [Formula: see text]R45° reconstruction, from those of as-cleaved surfaces from bulk crystals. The electronic structure of the grown film is different from that in bulk, and it is notable that the film exhibits the same superconducting transport properties. We found that the superconducting gap at the surface is screened at the Ba layer surface in STS measurements, and the charge density wave was observed at the surface in sample in the superconducting state.

Inflammatory Bowel Disease Patients' Participation, Attitude and Preferences Toward Exercise

The purpose of the study was to investigate the level of exercise participation in patients with inflammatory bowel disease (IBD) and to investigate their intention, attitude and preference toward exercise. The data of 158 IBD patients that participated in a self-administered survey at Severance Hospital between March 2013 and November 2013 were included in this cross sectional and descriptive analysis. Questionnaires included 3 sections to determine the IBD patient's current exercise participation, attitude toward exercise, and exercise preferences. This study investigated IBD patients both collectively, and according to their specific disease: Crohn's disease (CD) (n=62), Ulcerative colitis (UC) (n=73) and intestinal Behçet's disease (BD) (n=23). IBD patients currently participate in 103 min/week of exercise including mild, moderate and strenuous intensity, with BD patients being the least active, followed by CD, and UC being most active. The majority of IBD patients found exercise to be pleasant (57.7%), beneficial (80.5%), sensible (71.8%), uplifting (61%) and good (70.5%), and 44.4% found exercise to be enjoyable. This study shows the IBD patients' participation, attitude and preferences toward exercise and provides much needed information for the development of evidence based exercise programs that are specific to IBD.

Mid-infrared spectroscopy beyond the diffraction limit via direct measurement of the photothermal effect

An atomic force microscope equipped with temperature sensitive probes was used to measure locally the photothermal effect induced by IR light absorption. This novel instrument opens a pathway to correlated topographical, chemical composition, and thermal mapping with nanoscale resolution. Proof of principle demonstration is provided on polymers and plasmonic samples.

Early detection of hand movements from electroencephalograms for stroke therapy applications

Movement-assist devices such as neuromuscular stimulation systems can be used to generate movements in people with chronic hand paralysis due to stroke. If detectable, motor planning activity in the cortex could be used in real time to trigger a movement-assist device and restore a person's ability to perform many of the activities of daily living. Additionally, re-coupling motor planning in the cortex with assisted movement generation in the periphery may provide an even greater benefit-strengthening relevant synaptic connections over time to promote natural motor recovery. This study examined the potential for using electroencephalograms (EEGs) as a means of rapidly detecting the intent to open the hand during movement planning in individuals with moderate chronic hand paralysis following a subcortical ischemic stroke. On average, attempts to open the hand could be detected from EEGs approximately 100-500 ms prior to the first signs of movement onset. This earlier detection would minimize device activation delays and allow for tighter coupling between initial formation of the motor plan in the cortex and augmentation of that plan in the periphery by a movement-assist device. This tight temporal coupling may be important or even essential for strengthening synaptic connections and enhancing natural motor recovery.

Median nerve somatosensory evoked potentials and upper limb motor function in hemiparesis

The purpose of this study is to describe the relationship between median nerve somatosensory evoked potential (SEP) parameters and clinical measures of motor impairment and physical disability in the affected upper limb of patients with hemiparesis. SEP assessments were carried out in 28 long-term survivors of stroke. Stroke survivors with preserved SEPs over the affected hemisphere exhibited significantly lower motor impairment and physical disability than those with absent waveforms. Among those with preserved waveforms, SEP amplitude exhibited a weak correlation with degree of upper limb motor impairment. The correlation between SEP amplitude and physical disability was not statistically significant. Contrary to prior reports, median nerve SEP appears to have a weak correlational relationship with clinical measures of upper limb function in hemiparesis.

Intramuscular electromyographically controlled neuromuscular electrical stimulation for upper limb recovery in chronic hemiplegia

We report three cases of survivors of chronic stroke who were treated with active repetitive movement training of the paretic finger extensors mediated by intramuscular electromyographically controlled neuromuscular electrical stimulation for the purpose of motor relearning. These case reports demonstrate the feasibility of using intramuscular electromyographically controlled neuromuscular electrical stimulation for facilitating the upper limb motor recovery of chronic stroke survivors with mild to moderate hemiplegia.

[Recent advances in limb-girdle muscular dystrophy research]

In our laboratory, limb-girdle muscular dystrophy (LGMD) accounted for 20% of all patients with muscular dystrophy. To determine the incidence of various forms of LGMD phenotypes, we looked for mutations in the calpain 3 gene and, for deficiencies in dysferlin and sarcoglycan by immunohistochemical studies with specific antibodies on muscle biopsies from patients with probable autosomal recessive inheritance (LGMD2), which were mostly sporadic cases of LGMD. Fourteen of 276 (5%) patients examined had sarcoglycan complex deficiency (sarcoglycanopathy) and 21 of 80 (26%) had mutations in the calpain 3 gene. Although we have not performed gene analysis in all patients, 10 of 64 (15%) patients examined had no apparent immunoreactivity against the dysferlin antibody. Thus, approximately 46% of LGMD2 patients had the above 3 distinct disorders, but in 54% the causative defects remain unknown.

Intramuscular electromyographically controlled neuromuscular electrical stimulation for ankle dorsiflexion recovery in chronic hemiplegia

We report three cases of survivors of chronic stroke treated with active repetitive movement training of the paretic ankle dorsiflexors mediated by intramuscular electromyographically controlled neuromuscular electrical stimulation (NMES). These case reports demonstrate the feasibility of using intramuscular electromyographically controlled NMES for facilitating ankle dorsiflexion recovery among survivors chronic stroke with moderate hemiplegia. Relevant issues for clinical implementation and future investigations are reviewed.

Calpain 3 gene mutations: genetic and clinico-pathologic findings in limb-girdle muscular dystrophy

Mutations in the calpain 3 gene have been proven to be responsible for limb-girdle muscular dystrophy (LGMD) type 2A. To determine the incidence and genotypes of the calpain 3 (p94) gene mutations in Japanese LGMD patients, we sequenced the gene in 80 patients with clinical characteristics of autosomal recessive or sporadic LGMD. We identified 13 distinct pathogenic mutations in 21 patients (26%), including seven missense mutations, four splice-site mutations and two insertions in which six were novel mutations. Among the 21 patients, 15 (71%) had three types of the common missense (G233V, R461C, D707G) and one insertion (1795-1796insA) mutation. The patients had slowly progressive muscle weakness with age of onset of the disease varying from 6 to 52 years, averaging 20.9. The most striking pathologic findings were the presence of lobulated fibers in 14 patients, especially in the advanced stages. Differing from Duchenne and Becker muscular dystrophy, opaque (hypercontracted) fibers were very rarely seen. These findings may be helpful in establishing diagnostic screening strategies in Japanese LGMD patients.

Comparing stimulation-induced pain during percutaneous (intramuscular) and transcutaneous neuromuscular electric stimulation for treating shoulder subluxation in hemiplegia

OBJECTIVE

To determine whether percutaneous (intramuscular) neuromuscular electric stimulation (perc-NMES) is less painful than transcutaneous neuromuscular electric stimulation (trans-NMES) for treating shoulder subluxation in hemiplegia.

DESIGN

Double-blind, crossover trial.

SETTING

University-affiliated tertiary care hospital.

PARTICIPANTS

A convenience sample of 10 hemiplegic subjects with at least 1 fingerbreadth of glenohumeral subluxation.

INTERVENTIONS

All subjects received 3 randomly ordered pairs of perc-NMES and trans-NMES to the supraspinatus and posterior deltoid muscles of the subluxated shoulder. Both types of stimulation were optimized to provide full joint reduction with minimal discomfort.

MAIN OUTCOME MEASURES

Pain was assessed after each stimulation with a 10-cm visual analog scale (VAS) and the McGill Pain Questionnaire, using the Pain Rating Index (PRI) scoring method. Subjects were asked which type of stimulation they would prefer for 6 weeks of treatment. Wilcoxon's signed-rank test was used to compare median differences in VAS and PRI between perc-NMES and trans-NMES.

RESULTS

Median VAS scores for perc-NMES and trans-NMES were 1 and 5.7, respectively (p = .007). Median PRI scores for perc-NMES and trans-NMES were 7 and 19.5, respectively (p = .018). Nine of the 10 subjects preferred perc-NMES to trans-NMES for treatment.

CONCLUSION

Data suggest that perc-NMES is less painful than trans-NMES in the treatment of shoulder subluxation in hemiplegia.

Selectivity and sensitivity of intramuscular and transcutaneous electromyography electrodes

We evaluated the differences in selectivity and sensitivity of intramuscular fine-wire electrodes and transcutaneous electrodes in detecting dynamic electromyography (EMG) signals from extensor digitorum (EDC) and extensor carpi radialis (ECR) muscles during isolated EDC and ECR contractions in two able-bodied subjects. Intramuscular fine-wire electrodes differentiated EDC and ECR EMG activities better than transcutaneous electrodes, and intramuscular fine-wire electrodes recorded higher amplitude signals than transcutaneous electrodes. Data suggest that intramuscular fine-wire electrodes are more selective and sensitive than transcutaneous electrodes in detecting EMG signals from adjacent forearm muscles.

Percutaneous, intramuscular neuromuscular electrical stimulation for the treatment of shoulder subluxation and pain in chronic hemiplegia: a case report

This case report describes the first survivor with chronic stroke who was treated with percutaneous, intramuscular neuromuscular electrical stimulation (NMES) for shoulder subluxation and pain. The patient developed shoulder subluxation and pain within 2 mo of his stroke. After discharge from acute inpatient rehabilitation, he developed shoulder and hand pain, which was treated with subacromial bursa steroid injection and ibuprofen with eventual resolution. The patient remained clinically stable until approximately 15 mo after his stroke-when he developed severe shoulder pain associated with shoulder abduction, external rotation, and downward traction. The patient could not tolerate transcutaneous NMES because of the pain of stimulation. At approximately 17 mo post-stroke, the patient's posterior deltoid, middle deltoid, and supraspinatus muscles were percutaneously implanted with intramuscular electrodes. After 6 wk of percutaneous, intramuscular NMES treatment, marked improvements in shoulder subluxation and pain, and modest improvements in activities of daily living and motor function were noted. One year after the onset of treatment, the patient remained pain free, but subluxation had recurred. However, the patient was able to volitionally reduce the subluxation by abducting his shoulder. The patient remained pain free for up to 40 mo after the initiation of percutaneous, intramuscular NMES treatment. This case report demonstrates the feasibility of using percutaneous, intramuscular NMES for treating shoulder subluxation and pain in hemiplegia.

Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia: a pilot study

OBJECTIVE

To investigate the feasibility of percutaneous intramuscular neuromuscular electric stimulation (perc-NMES) for treating shoulder subluxation and pain in patients with chronic hemiplegia.

DESIGN

Before-after trial.

SETTING

University-affiliated tertiary care hospital.

PARTICIPANTS

A convenience sample of 8 neurologically stable subjects with chronic hemiplegia and shoulder subluxation.

INTERVENTION

Six weeks of perc-NMES to the subluxated shoulder.

MAIN OUTCOME MEASURES

Shoulder subluxation (radiograph), shoulder pain (Brief Pain Inventory), motor impairment (Fugl-Meyer score), shoulder pain-free external rotation (handheld goniometer), and disability (FIM instrument) were assessed before treatment (T1), after 6 weeks of neuromuscular stimulation (T2), and at 3-month follow-up (T3). A 1-way, repeated-measures analysis of variance using the generalized estimating equation approach was used to evaluate differences from T1 to T2 and from T1 to T3 for all outcome measures.

RESULTS

Subluxation (p =.0117), pain (p =.0115), shoulder pain-free external rotation (p <.0001), and disability (p =.0044) improved significantly from T1 to T2. Subluxation (p =.0066), pain (p =.0136), motor impairment (p <.0001), shoulder pain-free external rotation (p =.0234), and disability (p =.0152) improved significantly from T1 to T3.

CONCLUSIONS

Perc-NMES is feasible for treating shoulder dysfunction in hemiplegia and may reduce shoulder subluxation, reduce pain, improve range of motion, enhance motor recovery, and reduce disability in patients with chronic hemiplegia and shoulder subluxation. Further investigation is warranted.

A critical review of neuromuscular electrical stimulation for treatment of motor dysfunction in hemiplegia

The purpose of this review is to critically assess the clinical efficacy of neuromuscular electrical stimulation in treating motor dysfunction in hemiplegia. Three distinct applications are reviewed in the areas of motor relearning, shoulder dysfunction, and neuroprostheses. Assessment of clinical efficacy and recommendations on clinical implementation are based on the weight of published scientific evidence. With respect to motor relearning, evidence supports the use of neuromuscular electrical stimulation to facilitate recovery of muscle strength and coordination in hemiplegia. However, effects on physical disability are uncertain. With respect to shoulder dysfunction, neuromuscular electrical stimulation decreases shoulder subluxation, at least in the short term. However, effects on shoulder pain and disability are also uncertain. With respect to neuroprosthesis systems, clinically deployable upper extremity systems must await the development of more sophisticated control methods and greater fundamental understanding of motor dysfunction in hemiplegia. The evidence for clinical feasibility of lower extremity neuroprostheses is stronger, and investigations on clinical efficacy should be pursued. In summary, the application of neuromuscular electrical stimulation for motor relearning and shoulder dysfunction are ready for more rigorous scientific and clinical assessment via large, multicenter, randomized clinical trials. However, additional investigations are needed to demonstrate the clinical feasibility of neuroprostheses applications.

Molecular detection of an Ehrlichia-like agent in rainbow trout (Oncorhynchus mykiss) from Northern California

Ehrlichia DNA was identified by nested PCR in rainbow trout (Oncorhynchus mykiss) collected from a creek in northern California where Potomac horse fever is endemic. Ehrlichia DNA was found in tissues from several organs including the gills, heart, spleen, liver, kidneys and intestine of trout and from three different adult digenetic trematodes (Deropegus sp., Crepidostomum sp., Creptotrema sp.) parasitizing the gallbladder and/or the intestine of the trout. Sequencing of PCR-amplified DNA from the 16S rRNA gene indicated that the source organism was most closely related to the sequences of E. risticii (level of sequence similarity 96.0%), the SF agent (95.9%), E. sennetsu (95.8%), and Neorickettsia helminthoeca (95.3%). The data suggest that trout and parasitic trematodes may be involved in the epidemiology of an Ehrlichia-like agent belonging to the E. sennetsu genogroup. Whether the fish agent infects horses, dogs, or human beings, and whether it causes disease, remain to be determined.

Infection rate of Ehrlichia risticii, the agent of Potomac horse fever, in freshwater stream snails (Juga yrekaensis) from northern California

Juga yrekaensis freshwater snails were tested for trematode stages and for Ehrlichia risticii DNA using a nested PCR assay. Snails were collected monthly from two Potomac horse fever (PHF) endemic locations in northern California (Montague and Weed). The trematode infection rate varied between 40 and 93.3% in large snails (shell size >15mm) and between 0 and 13.3% in small snails (<15mm). The highest trematode infection rate for large and small snails was recorded in September and the lowest infection rate for large snails was recorded in June (Weed) and October (Montague). The E. risticii PCR infection rate among small snails from both sites was similar and varied monthly between 0 and 3.3%. The PCR infection rate for large snails from Weed was high in May (20.0%) and decreased progressively until November (10.0%). The PCR infection rate for large snails from Montague was 5.0% in May, 26.3% in August and 16. 7% in October. PCR-positive snails were always related to the microscopic detection of trematode stages (virgulate cercariae). This study provides evidence that J. yrekaensis are infected with trematode cercariae that harbor E. risticii. The number of snails harboring trematode stages and the number of PCR positive snails varied with the size of the snails, the month of collection, and the geographic origin.

Poor semen quality from patients with malignancies does not rule out sperm banking

Cancer therapy can further impair the already poor semen quality in cancer patients. This study evaluated the prefreeze and postthaw semen quality before treatment of patients with malignancies to examine the rationale for sperm banking for these men. Records of nine patients with different malignant tumors, who had been referred for sperm cryopreservation between 1982 and 1997, were reviewed and the results were compared with those of 50 normal healthy donors. Patients did not differ from donors in age, ejaculate volume, or duration of sexual abstinence. The total motile sperm count (median and interquartile range) was significantly different between patients and donors for prefreeze specimens (P = 0.026) and postthaw specimens (P = 0.008). Also, the percent motility was significantly lower in the patients as compared with the donors in prefreeze (P = 0.035) and postthaw specimens (P = 0.005). The percentage change in motility after thawing was also larger for patient samples (-54% versus -47%, P = 0.39). Other sperm motion characteristics did not significantly differ between the two groups except for postthaw curvilinear velocity (P = 0.01). This study concludes that fresh and frozen thawed semen from patients with malignant tumors is poor in quality but is still adequate for assisted reproductive techniques. As cancer therapy may further impair semen quality, patients should be offered the chance to bank sperm before undergoing cancer therapy.

The effects of cryopreservation on semen from men with sarcoma or carcinoma

PURPOSE

This study evaluated prefreeze and postthaw semen quality before treatment in patients with different types of sarcomas and carcinomas to determine whether cryopreservation would be of value for these patients.

METHODS

Semen specimens were obtained from 50 normal donors and from 21 patients with carcinoma and from 14 patients with sarcoma. The specimens were cryopreserved by a standard freezing procedure using TEST-Yolk buffer. Prefreeze and postthaw sperm motion characteristics were measured.

RESULTS

Prefreeze total motile sperm count was significantly higher in donors (median: 129.6 x 10(6)/ml) than in men with carcinoma (46.9 x 10(6)/ml, P < .001) or sarcoma (66.3 10(6)/ml, P = .04). The percent motility and percent linearity were significantly lower in patients with carcinoma. In postthaw specimens, total motile sperm count, curvilinear velocity, and linearity were significantly lower in patients with carcinoma.

CONCLUSIONS

The two patient groups in this study had poor semen quality when compared with healthy donors both before and after cryopreservation. Sarcoma patients had better semen quality than carcinoma patients. As cancer therapy in these men could significantly impair their reproductive potential, these men should be advised to preserve their semen before starting treatment.

Functional neuromuscular stimulation in spinal cord injury

With recent advances in clinical medicine and biomedical engineering, functional neuromuscular stimulation (FNS) can now be added to the psychiatric armamentarium to decrease the debilitating effects of traumatic spinal cord injury. In this article, the components of FNS systems and their evolution in design are presented. The clinical implications of FNS are discussed with respect to upper and lower extremities and bladder applications, and perspectives on future developments and directions are reviewed.

Comparison of Transient Network Brightenings and Explosive Events in the Solar Transition Region

The relation between transient network brightenings, known as blinkers, and explosive events is examined based on coordinated quiet Sun observations in the transition region line O v lambda630 recorded by the Coronal Diagnostic Spectrometer (CDS), in the transition region line Si iv lambda1402 recorded by the Solar Ultraviolet Measurements of Emitted Radiation (SUMER) instrument, and in photospheric magnetograms taken by the Big Bear Solar Observatory videomagnetograph. From these observations, we find that (1) explosive events, which are traditionally defined as features with very broad UV line profiles, tend to keep away from the centers of network brightenings and are mostly located at the edges of such brightenings, (2) CDS blinkers consist of many small-scale, short-lived SUMER "unit brightening events" with a size of a few arcseconds and a lifetime of a few minutes, and most importantly (3) each SUMER unit brightening event is characterized by a UV line profile that is not as broad as those of explosive events, but still has significantly enhanced wings. Our results imply that, like explosive events, individual unit brightening events involve high velocities, and, hence, blinkers may have the same physical origin as explosive events. It is likely that transient network brightenings and explosive events are both due to magnetic reconnection-but with different magnetic geometries.

The Drosophila tissue polarity gene starry night encodes a member of the protocadherin family

The tissue polarity genes control the polarity of hairs, bristles and ommatidia in the adult epidermis of Drosophila. We report here the identification of a new tissue polarity gene named starry night (stan). Mutations in this essential gene alter the polarity of cuticular structures in all regions of the adult body. The detailed polarity phenotype of stan on the wing suggested that it is most likely a component of the frizzled (fz) pathway. Consistent with this hypothesis, stan appears to be downstream of and required for fz function. We molecularly cloned stan and found that it encodes a huge protocadherin containing nine cadherin motifs, four EGF-like motifs, two laminin G motifs, and seven transmembrane domains. This suggests that Stan functions in signal reception, perhaps together with Fz.

Comparison of discomfort associated with surface and percutaneous intramuscular electrical stimulation for persons with chronic hemiplegia

Neuromuscular stimulation may facilitate motor recovery after stroke or brain injury, reduce shoulder pain associated with hemiplegia, and reduce cerebral spasticity. However, the discomfort of surface neuromuscular stimulation significantly limits the clinical implementation of this modality for persons with hemiplegia. The study contained herein tests the hypothesis that stroke and brain injury survivors with chronic hemiplegia (>6 mo) and intact sensation tolerate percutaneous intramuscular stimulation better than surface stimulation. Four stroke and two traumatic brain injury survivors participated in the study contained within this article. Each subject received three pairs of percutaneous and surface stimulations of the paretic finger extensors. The order of the type of stimulation within each pair was randomly assigned. The stimulation parameters for each type of stimulation were normalized to produce the same torque at the metacarpophalangeal joint. Subjects rated their perceived level of discomfort using a 10-cm visual analog scale and the McGill Pain Questionnaire. A blinded evaluator administered the pain measures. Percutaneous stimulation was associated with significantly lower discomfort as reflected by the visual analog scale (0.74 v 3.3; 95% confidence interval of difference, -3.84, -1.28). The McGill Pain Questionnaire produced similar results with percutaneous stimulation associated with a significantly fewer number of words chosen to describe the discomfort (0.87 v 3.30; 95% confidence interval of difference, -3.50, -1.30) and significantly lower Pain Rating Index (1.47 v 6.27; 95% confidence interval of difference, -7.77, -1.83). Data suggest that percutaneous intramuscular stimulation is significantly better tolerated than surface stimulation and that percutaneous stimulation may enhance patient compliance with neuromuscular stimulation treatments.

Functional status of cortical and subcortical nonhemorrhagic stroke survivors and the effect of lesion laterality

The purpose of this study is to examine the effects of cortical and subcortical infarcts and lesion laterality on the functional status of stroke survivors. Medical records of 72 stroke survivors admitted to an acute inpatient rehabilitation facility with a single nonhemorrhagic lesion were retrospectively reviewed. Multivariate analysis of variance was used to assess the effects of lesion level and hemisphere on admission and discharge Functional Independence Measure (FIM) and FIM gain. Admission FIM-Total and its subdimensions exhibited significant overall level (Wilk's lambda = 2.5; P = 0.03) and hemisphere-specific (Wilk's lambda = 2.3; P = 0.04) effects. Significant interaction between factors was noted only for the communication subdimension. Significant level and hemisphere-specific main effects were noted for admission FIM-Total (P < 0.01 and P = 0.02, respectively). There were significant level-specific main effects for self-care (P = 0.01) and mobility (P = 0.03) and hemisphere and level-specific main effects for communication (P < 0.01 and P < 0.01, respectively) and social cognition (P = 0.02 and P = 0.01, respectively). Discharge FIM-Total and its subdimensions exhibited significant overall level (Wilk's lambda = 2.5; P = 0.03) and hemisphere-specific (Wilk's lambda = 3.4; P = 0.01) effects. Discharge FIM subdimensions did not exhibit significant interaction between factors. Discharge FIM-Total was significant with respect to lesion level (P = 0.01) but not with respect to hemisphere (P = 0.08). There was a significant level-specific main effect for self-care (P = 0.01) and level and hemisphere-specific main effects for communication (P < 0.01 and P < 0.01, respectively) and social cognition (P = 0.01 and P = 0.01, respectively). FIM gain scores did not exhibit significant level (Wilk's lambda = 1.1; P = 0.36) or hemisphere-specific (Wilk's lambda = 1.4; P = 0.24) effects. The data suggest that the lesion level and hemisphere are important determinants of the function of nonhemorrhagic stroke survivors during inpatient rehabilitation.

Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia

BACKGROUND AND PURPOSE

The purpose of this study was to assess the efficacy of neuromuscular stimulation in enhancing the upper extremity motor and functional recovery of acute stroke survivors.

METHODS

Forty-six stroke survivors admitted to an inpatient rehabilitation unit were randomly assigned to receive either neuromuscular stimulation or placebo. Twenty-eight subjects completed the study. The treatment group received surface neuromuscular stimulation to produce wrist and finger extension exercises. The control group received placebo stimulation over the paretic forearm. All subjects were treated 1 hour per day, for a total of 15 sessions. Outcomes were assessed in a blinded manner with the upper extremity component of the Fugl-Meyer Motor Assessment and the self-care component of the Functional Independence Measure at pretreatment, after treatment, and at 4 and 12 weeks after treatment.

RESULTS

The treatment subjects and control subjects had comparable baseline characteristics. Parametric analyses revealed significantly greater gains in Fugl-Meyer scores for the treatment group after treatment (13.1 versus 6.5; P=0.05), at 4 weeks after treatment (17.9 versus 9.7; P=0.05), and at 12 weeks after treatment (20.6 versus 11.2; P=0.06). Functional Independence Measure scores were not different between groups at any of the time periods (P>0.10).

CONCLUSIONS

Data suggest that neuromuscular stimulation enhances the upper extremity motor recovery of acute stroke survivors. However, the sample size in this study was too small to detect any significant effect of neuromuscular stimulation on self-care function.

Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study

OBJECTIVE

To assess the efficacy of electromyogram (EMG)-triggered neuromuscular stimulation (EMG-stim) in enhancing upper extremity motor and functional recovery of acute stroke survivors.

DESIGN

A pilot randomized, single-blinded clinical trial.

SETTING

Freestanding inpatient rehabilitation facility.

PATIENTS

Nine subjects who were within 6 weeks of their first unifocal, nonhemorrhagic stroke were randomly assigned to either the EMG-stim (n = 4) or control (n = 5) group. All subjects had a detectable EMG signal (>5 microV) from the surface of the paretic extensor carpi radialis and voluntary wrist extension in synergy or in isolation with muscle grade of <3/5.

INTERVENTION

All subjects received two 30-minute sessions per day of wrist strengthening exercises with EMG-stim (experimental) or without (control) for the duration of their rehabilitation stay.

MAIN OUTCOME MEASURES

Upper extremity Fugl-Meyer motor assessment and the feeding, grooming, and upper body dressing items of the Functional Independence Measure (FIM) were assessed at study entry and at discharge.

RESULTS

Subjects treated with EMG-stim exhibited significantly greater gains in Fugl-Meyer (27.0 vs 10.4; p = .05), and FIM (6.0 vs 3.4; p = .02) scores compared with controls.

CONCLUSION

Data suggest that EMG-stim enhances the arm function of acute stroke survivors.

Nucleotide sequence heterogeneity in the small subunit ribosomal RNA gene variable (V4) region among and within geographic isolates of Theileria from cattle, elk and white-tailed deer

The phylogenetic relationships among fourteen isolates of benign Theileria spp. infecting cattle, elk and white-tailed deer were studied by nucleotide sequence comparisons of the variable (V4) region (200 nucleotides) of the small subunit ribosomal RNA gene. Included were six Korean bovine, one Japanese bovine, three North American bovine, and four North American cervine isolates. The SSU rRNA gene from each isolate was amplified, cloned, and the V4 region fragment sequenced. Seven different nucleotide sequence patterns were obtained and classified. Type A was identical to T. buffeli SSU rRNA gene sequence (GenBank Accession No. Z15106) and was found in Korean, Japanese, and North American bovine isolates. Type B was found in bovine isolates from Korea, Japan and North America. Type C was found only in the Korean bovine isolate from Chungnam. Type D was found in a Korean and in a North American bovine isolate. Type E was found in a bovine isolate from Cheju Island of Korea and a North American cervine (elk) isolate. Types F and G were found only in North American cervine isolates (both white-tailed deer and elk) and appear to represent a species separate from the bovine isolates. The presence of several sequence types observed in most of the bovine Theileria isolates may indicate mixed species (or subspecies) populations and/or multiple genotypes within a single species.

Functional outcome of hemorrhagic and nonhemorrhagic stroke patients after in-patient rehabilitation

Differences in functional prognosis for patients with hemorrhagic and nonhemorrhagic strokes are unclear. The purpose of this study is to compare the functional outcome of hemorrhagic and nonhemorrhagic stroke patients after inpatient stroke rehabilitation. By retrospective review, 25 hemorrhagic stroke patients were matched with 25 nonhemorrhagic stroke patients on the basis of age and onset to admission interval. Discharge Functional Independence Measure (FIM), FIM gain, FIM efficiency, length of stay (LOS), and discharge disposition were compared. Admission FIM, gender, and comorbidities were similar between the two groups. There were no differences in discharge FIM, FIM gain, and discharge to home rates between groups. However, the hemorrhagic group had a significantly shorter LOS (31.7 v 37.6 days; P = 0.05) with higher FIM-total efficiency (0.84 v 0.60; P = 0.02). The FIM-motor scale accounted for most of the gains in efficiency (0.71 v 0.53; P = 0.05) with no significant difference in FIM-cognition efficiency between groups. Post hoc analysis revealed that onset to admission interval was a strong predictor of LOS (r = 0.62; P < 0.0001). Hemorrhagic stroke patients appear to exhibit functional gains somewhat faster than nonhemorrhagic counterparts. Confirmation of these preliminary findings must await future studies.

Admission motor impairment as a predictor of physical disability after stroke rehabilitation

The purpose of this study is to investigate the Fugl-Meyer Motor Impairment Scale and physical disability as measured by the Functional Independence Measure (FIM) as predictors of physical independence after stroke inpatient rehabilitation. Forty-eight patients admitted to a rehabilitation hospital within 6 wk of their first unifocal stroke were prospectively studied. Upper and lower extremity Fugl-Meyer scores were obtained near rehabilitation admission. FIMs were obtained on admission and discharge. Discharge FIM self-care was predicted best by admission FIM total (rs = 0.75; P < 0.0001), although admission FIM self-care, other FIM components, and upper- and lower-extremity Fugl-Meyer scores were also good predictors. Discharge FIM mobility and locomotion correlated well with their admission counterparts (rs = 0.54 and 0.45; P < 0.001 and < 0.01, respectively) but were even more strongly related to admission Fugl-Meyer scores (rs = 0.63 and 0.74, respectively; P < 0.0001). As expected, cognitive and psychosocial components of the FIM at discharge correlated poorly with admission Fugl-Meyer. These data confirm the strong motor impairment basis for the physical disability subdimensions of the FIM and suggest that dependency in physical activities of daily living after stroke is primarily determined by degree of motor impairment.

Comparative studies of angioscopy and ultrasound for the evaluation of arterial disease

In this in vitro investigation, we studied the histopathological basis for intravascular ultrasound image interpretation and how this technique compares with fiberoptic angioscopy in assessing atherosclerosis. This article presents the sensitivity and specificity of these techniques in the recognition of arterial abnormalities. The relevance of these data in interventional therapeutic procedures and the clinical implications of intravascular imaging methods are also discussed.

Intravascular ultrasound cross-sectional arterial imaging

In this paper we review the current status of intravascular ultrasound. Data from qualitative and quantitative studies is presented. Our experimental findings and those of other investigators are reviewed. Intravascular ultrasound has been shown to delineate normal and abnormal arterial morphology as well as to identify and differentiate fibrous, lipid-rich, calcified plaques and complicated plaques. Quantitative studies show strong correlations between ultrasound and histology for lumen area, wall thickness, and plaque area. In vivo studies from our experimental work and clinical laboratory as well as the work of other researchers is presented. This data supports the potential of ultrasound imaging for guidance of intravascular intervention. The potential advantages and limitations of this new technology are discussed. This methodology shows promise for the assessment of the extent and severity of atherosclerosis, monitoring its progression and regression and guiding intravascular plaque ablation technologies.