Cyclosporiasis Epidemiologically Linked to Consumption of Green Onions: Houston Metropolitan Area, August 2017

ABSTRACT

During July 2017, Texas public health officials noted an increase in the number of reported cyclosporiasis cases. They detected a cluster in the Houston metropolitan area that involved four locations of a Mediterranean restaurant chain, restaurant A. A case-control study was conducted among patrons of restaurant A to identify a common food vehicle among items containing fresh produce. In matched case-control ingredient-level analyses that included both probable and confirmed cases, consumption of green onions, red onions, tomatoes, and cabbage was significantly associated with illness. A substantial percentage of case patients reported consumption of green onions, and only green onions remained statistically significantly associated with illness, whether probable and confirmed cases were included in analyses (matched odds ratio: 11.3; 95% confidence interval: 2.5 to 104.7), or only confirmed cases were included in analyses (matched odds ratio: 17.6; 95% confidence interval: 2.5 to 775.7). These results provide evidence that green onions were the likely vehicle of infection. It was not possible to trace the green onions to their source due to the need to redirect public health resources to Hurricane Harvey response efforts in Texas.

HIGHLIGHTS

Patterning the insect eye: From stochastic to deterministic mechanisms

While most processes in biology are highly deterministic, stochastic mechanisms are sometimes used to increase cellular diversity. In human and Drosophila eyes, photoreceptors sensitive to different wavelengths of light are distributed in stochastic patterns, and one such patterning system has been analyzed in detail in the Drosophila retina. Interestingly, some species in the dipteran family Dolichopodidae (the “long legged” flies, or “Doli”) instead exhibit highly orderly deterministic eye patterns. In these species, alternating columns of ommatidia (unit eyes) produce corneal lenses of different colors. Occasional perturbations in some individuals disrupt the regular columns in a way that suggests that patterning occurs via a posterior-to-anterior signaling relay during development, and that specification follows a local, cellular-automaton-like rule. We hypothesize that the regulatory mechanisms that pattern the eye are largely conserved among flies and that the difference between unordered Drosophila and ordered dolichopodid eyes can be explained in terms of relative strengths of signaling interactions rather than a rewiring of the regulatory network itself. We present a simple stochastic model that is capable of explaining both the stochastic Drosophila eye and the striped pattern of Dolichopodidae eyes and thereby characterize the least number of underlying developmental rules necessary to produce both stochastic and deterministic patterns. We show that only small changes to model parameters are needed to also reproduce intermediate, semi-random patterns observed in another Doli species, and quantification of ommatidial distributions in these eyes suggests that their patterning follows similar rules.

A simple model is able to account for a diversity of photoreceptor patterns in different fly species, ranging from highly deterministic to fully random.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors

BACKGROUND

Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non-Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non-Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes.

AIM

To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development.

METHOD

One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research.

RESULTS

Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non-verbal cognitive skills had vocabulary skills that remained below those with stronger non-verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age.

CONCLUSIONS

The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non-verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.

1% hydrocortisone ointment is an effective treatment of pruritus ani: a pilot randomized controlled crossover trial

BACKGROUND

Pruritus ani (PA) is a common condition which is difficult to treat in the absence of obvious predisposing factors. There is paucity of evidence-based guidelines on the treatment of this condition. We examined whether 1% hydrocortisone ointment is an effective treatment for PA.

MATERIALS AND METHODS

A pilot randomized, double-blind, placebo-controlled, crossover trial was carried out. Eleven patients consented to take part in the trial and ten completed the study. After a 2-week run-in period, patients with primary PA were randomly allocated to receive 1% hydrocortisone ointment or placebo for 2 weeks followed by the opposite treatment for a further 2-week period. There was a washout period of 2 weeks between treatments. The primary outcome measure was reduction in itch using a visual analogue score (VAS). The secondary outcome measures were improvement in quality of life measured using a validated questionnaire (Dermatology Life Quality Index, DLQI) and improvement in clinical appearance of the perianal skin using the Eczema Area and Severity Index (EASI) score.

RESULTS

Treatment with 1% hydrocortisone ointment resulted in a 68% reduction in VAS compared with placebo (P=0.019), a 75% reduction in DLQI score (P=0.067), and 81% reduction in EASI score (P=0.01).

CONCLUSION

A short course of mild steroid ointment is an effective treatment for PA.

Development of a microbial population within a hot-drinks vending machine and the microbial load of vended hot chocolate drink

In order to understand the development of the microbial population within a hot-drinks vending machine a new machine was placed in a staff area of a university campus vending only hot chocolate. The machine was cleaned weekly using a detergent based protocol. Samples from the mixing bowl, dispense area, and drink were taken over a 19-wk period and enumerated using plate count agar. Bacillus cereus was identified using biochemical methods. Vended drinks were sampled at 0, 3, 6, and 9 min after vending; the hot chocolate powder was also sampled. Over the 1st 8 wk, a significant increase in the microbial load of the machine components was observed. By the end of the study, levels within the vended drink had also increased significantly. Inactivation of the automatic flush over a subsequent 5-wk period led to a statistically but not operationally significant increase in the microbial load of the dispense area and vended drink. The simple weekly clean had a significant impact on the microbial load of the machine components and the vended drink. This study demonstrated that a weekly, detergent-based cleaning protocol was sufficient to maintain the microbial population of the mixing bowl and dispense point in a quasi-steady state below 3.5 log CFU/cm2 ensuring that the microbial load of the vended drinks was maintained below 3.4 log CFU/mL. The microbial load of the drinks showed no significant changes over 9 min after vending, suggesting only spores are present in the final product.

A novel case of linear syringomatous hamartoma

A 4-year-old girl presented with a linear, indurated area of dusky erythema and hyperpigmentation down the left leg, present since birth. Histology suggested syringomata. The clinical course and appearances suggest a novel entity for which we have coined the term 'linear syringomatous hamartoma'.

Transtibial amputation. Prosthetic use and functional outcome

Annually, roughly 80,000 to 100,000 amputations are performed with a total cost of greater than $50,000 per patient. Amputations in general and TTAs in particular are worthy of investigation to provide a cost-effective functional outcome that provides high patient satisfaction. The process of prosthetic selection, functional outcome, and avoidance of common complications begins with preoperative education of the patient and communication with the rehabilitation team. Determining an individual patient's perceptions of the process and his or her desired functional needs can help establish a baseline for prosthetic prescription and patient education. With the apparent difficulty in predicting who will be functional with a prosthesis, it seems prudent to initiate prosthetic training and fitting with all patients who have a moderate potential for use. Because many patients undergoing this operation have significant illness, as judged by the high mortality rate at follow-up, it is important to begin this process early to promote the highest recovery of functional independence. With the continual improvement in prosthetic components and postoperative management, it seems possible for the ill, elderly patient to regain near preoperative functional independence with the use of a prosthesis.

Persistence of clonal T-cell expansions following high-dose chemotherapy and autologous peripheral blood progenitor cell rescue

Analysing the regeneration of T lymphocytes after high-dose chemotherapy with autologous peripheral blood progenitor cell rescue (PBPCR) may help elucidate the mechanisms of immune recovery. The T-cell receptor variable beta chain (TCRBV) repertoire of adult patients undergoing high-dose chemotherapy was analysed by flow cytometry, before and after treatment. Four patients were found to have a stable expansion present (TCRBV3, 17, 21 and 22) ranging from 8% to 42% of the CD4(+) or CD8(+) repertoire. We demonstrated that, in these patients, following high-dose chemotherapy and autologous stem cell transplantation, the clonal expansions reappeared in peripheral blood and returned to pretransplant levels. Three expansions (CD3(+)CD8(+)TCRBV3(+), CD3(+)CD4(+)TCRBV21(+) and CD3(+)CD8(+)TCRBV22(+)) were further defined by sequence analysis of the complementarity-determining region (CDR)3 portion within the TCR rearrangements. These were shown to be predominantly clonal, with the same sequences being identified in peripheral blood before and after PBPCR, providing evidence that the overwhelming majority of T cells in these expansions arise from mature lymphocytes. This study demonstrated that patients undergoing autologous PBPCR for high-dose chemotherapy regenerate clonal expansions, consistent with pretreatment levels. They also regenerate T-cell repertoires with each TCRBV family represented to a similar level as that prior to high-dose chemotherapy.

Positive and negative selection to reduce tumour contamination in peripheral blood stem cell harvests

Peripheral blood progenitor cells used during high dose treatments for malignancy may be contaminated with tumour cells that could later contribute to recurrence. CD34+ selected harvests still contain tumour cells and an additional negative selection may be capable of reducing this contamination. We have assessed a two-stage technique in which a CD34+ selection is followed by a tumour specific depletion stage using a B cell or breast cancer specific antibody panel. Initial small-scale selections on 11 patients with NHL and breast cancer showed that cell loss was greatest following the CD34+ selection with a median yield of 38.8 per cent (range 17. 2-56.4 per cent). The addition of the depletion stage resulted in a minimal loss of CD34+ cells with a yield for this step of 94.2 per cent (range 77.5-99.3 per cent). Clinical scale selections were performed on seven patients with CLL and a median of 2.8x10(6)/kg CD34+ cells (range 1.5-6.1x10(6)/kg) were collected. Cell recovery was 53.3 per cent following CD34+ selection and 76.9 per cent following the tumour specific depletion stage, resulting in a final product containing a median of 1.0x10(6)/kg CD34+ cells (range 0. 55-2.0x10(6)/kg). All unmanipulated harvests were heavily contaminated with tumour cells (median contamination 10.2 per cent, range 2.0-83.1 per cent) as measured by flow cytometry and a median 4.7 log (range 3-5 log) tumour cell purge was produced following two-stage selection. Six of the patients have received cells manipulated in this way with median engraftment times of neutrophils>0.5x10(9)/l=16 days (range 13-20 days) and platelets>20x10(9)/l=16.5 days (range 11-42 days). At a median follow-up of 25 months, these transplanted patients remain well and in molecular complete remission.

Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy

OBJECTIVE

To determine the incidence of tracheal stenosis, voice and breathing changes, and stomal complications after percutaneous dilatational tracheostomy (PDT).

METHODS

From December 1992 through June 1999, 420 critically ill patients underwent 422 PDTs. There were 340 (81%) long-term survivors, 100 (29%) of whom were interviewed and offered further evaluation by fiberoptic laryngotracheoscopy (FOL) and tracheal computed tomography (CT). Tracheal stenosis was defined as more than 10% tracheal narrowing on transaxial sections or coronal and sagittal reconstruction views. Forty-eight patients agreed to CT evaluation; 38 patients also underwent FOL. CT and FOL evaluations occurred at 30 +/- 25 (mean +/- standard deviation) months after PDT.

RESULTS

Twenty-seven (27%) patients reported voice changes and 2 (2%) reported persistent severe hoarseness. Vocal cord abnormalities occurred in 4/38 (11%) patients, laryngeal granuloma in 1 (3%) patient, focal tracheal mucosal erythema in 2 (5%) patients, and severe tracheomalacia/stenosis in 1 (2.6%) patient. CT identified mild (11-25%) stenosis in 10 (21%) asymptomatic patients, moderate (26-50%) stenosis in 4 (8.3%) patients, 2 who were symptomatic, and severe (>50%) stenosis in 1 (2%) symptomatic patient. Ten patients (10%) reported persistent respiratory problems after tracheal decannulation, but only four agreed to be studied. Two patients had moderate stenosis, and one had severe stenosis. One patient's CT scan was normal. No long-term stomal complications were identified or reported.

CONCLUSIONS

Subjective voice changes and tracheal abnormalities are common after endotracheal intubation followed by PDT. Long-term follow-up of critically ill patients identified a 31% rate of more than 10% tracheal stenosis after PDT. Symptomatic stenosis manifested by subjective respiratory symptoms after decannulation was found in 3 of 48 (6%) patients.

A survey of injuries at five greyhound racing tracks

The number of orthopaedic injuries sustained by racing greyhounds from five greyhound tracks in the state of Wisconsin, USA, was obtained over a two-year period. Calculated injury rates were analysed to predict the probability that a given competitor would have an injury based on track design, temperature, bodyweight, grade of race, race distance, race number, injury location on track and type of trauma. One track had a significantly higher injury rate than the others, and this track was constructed with a decreased initial straightaway, a decreased turning radius in the second turn and an increased turn bank. Increased injury rates were also seen with successively higher grades of race, suggesting a possible correlation with speed. Race distance had a significant effect on racing greyhound injury rates as well. Races measuring 3/16 mile and 7/16 mile resulted in a higher incidence of injury as compared with races with lengths of 5/16 mile and 3/8 mile. Injuries were most likely to occur at the first turn of a race. Temperature, bodyweight, race number and type of trauma had no significant effect on injury rate. Speed, race distance and track design were significant factors that were found to influence the injury rate of the racing greyhound and should be areas to focus on for the prevention of injury.

Does long-term finasteride therapy affect the histologic features of benign prostatic tissue and prostate cancer on needle biopsy? PLESS Study Group. Proscar Long-Term Efficacy and Safety Study

OBJECTIVES

Finasteride, a common agent used to treat benign prostatic hyperplasia (BPH), inhibits 5-alpha-reductase. Testosterone is converted by 5-alpha-reductase to the more potent dihydrotestosterone, which is the primary androgen in the prostate. Leuprolide is a stronger antiandrogen that is used to downstage prostate cancer before radical prostatectomy. Leuprolide induces marked atrophy of prostate carcinoma cells, which sometimes makes pathologic diagnosis of cancer difficult, although evaluation at radical prostatectomy is easier than at biopsy. It is unknown whether finasteride produces similar changes, which would result in greater diagnostic difficulty because such changes would be seen on biopsy to rule out cancer in men with suspicious clinical findings treated for BPH. The current study investigated the histologic effects of finasteride therapy on human prostate cancer and benign prostatic tissue on needle biopsy.

METHODS

In blinded manner, we reviewed 53 needle biopsy specimens showing prostate carcinoma (35 treated with finasteride, 18 with placebo). Also reviewed in blinded manner were 50 benign needle biopsy specimens (25 treated with finasteride, 25 with placebo). The Gleason score, number of cores involved, percentage cancer involvement in a core, percentage of atrophic changes in cancer cells, presence of mitoses, blue-tinged mucinous secretions, prominent nucleoli, and high-grade prostatic intraepithelial neoplasia were documented for each case in the cancer group. The percentage of atrophy, basal cell hyperplasia, transitional metaplasia, chronic inflammation, and stromal proliferation was documented for each case in the benign group.

RESULTS

No significant histologic differences were present in either the benign or cancer group between cases treated with finasteride and placebo.

CONCLUSIONS

We conclude that finasteride treatment for BPH does not cause difficulty in the diagnosis of cancer in prostate needle specimens. It is possible that there are severely atrophic areas resulting from finasteride treatment that are undersampled. However, the conclusion that cancer seen on needle biopsy in men treated with finasteride is unaltered and readily identified as cancer remains valid.

Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial

Intrapleural analgesia (IPA) has been successfully used for the relief of chest wall pain. Previous studies investigating its use have yielded conflicting results and have often suffered from design defects. The theoretical lower incidence of respiratory and circulatory depression with IPA suggests significant advantages over epidural analgesia. Patients who had documented blunt chest wall trauma were entered into a prospective, randomized, double-blinded, crossover, placebo-controlled study within 16 hours of their injury. Patients who were intubated or had significant trauma outside of the chest wall were not entered. Intrapleural catheters were placed using a standardized technique. Each patient received either a placebo solution of normal saline or a combination of bupivacaine/lidocaine in a blinded, crossover fashion for two 24-hour periods. Data were obtained on the use of supplementary narcotics, transcutaneous pCO(2') pulse oximetry, pulmonary function tests, and both patient and nursing evaluations of pain based on a numeric analogue scale. A series of 16 patients from a Level I trauma center were identified over a 2-year period. The ratio of male to female was approximately 2:1, with an age range of 35-80 years. There were no complications related to catheter placement or anesthetic toxicity. Mean values for patient and nursing pain ratings revealed opposite trends. We found no significant difference in the mean values for supplemental narcotic use, pCO(2') p0(2') forced vital capacity, or forced expiratory volume between the placebo and the test solution. Although previous studies have suggested that IPA may be beneficial in the management of chest wall pain, this was not confirmed in our study for blunt chest injuries. The addition of IPA to the more traditional use of opioid analgesics was not more effective for management of blunt chest wall pain. Despite our small patient population (n = 16), the crossover design should have allowed clinically significant differences to become evident (alpha value = 0.95). A review of the literature and a historical basis for the evolution in the management of this type of pain is included.

Reduction mammaplasty: long-term efficacy, morbidity, and patient satisfaction

This retrospective study was designed to determine if reduction mammaplasty relieved preoperative symptoms in patients with macromastia. Seven-hundred and eighty women who had reduction mammaplasties between 1981 and 1992 were surveyed. Responses to questions concerning the preoperative and postoperative symptoms, breast size, complications, and satisfaction were elicited. Completed surveys were returned by 406 patients (52 percent) who had bilateral operations. The mean age at surgery was 38 years, with an average follow-up of 4.7 years. Preoperative complaints of shoulder grooving (94 percent), shoulder pains (93 percent), and back pains (81 percent) were significantly reduced following surgery (McNemar test, p < 0.0001). Cup size decreased an average of two sizes in 72 percent. There were 215 women (53 percent) with postoperative complications, and although most were minor, 20 (5 percent) required surgical correction. Self-esteem improved in 358 (88 percent), and most would have surgery again (93 percent) and would encourage others to have the same (94 percent). Reduction mammaplasty decreases breast size and significantly relieves preoperative symptoms associated with mammary hypertrophy. Relief of symptoms was the most common reason women gave for having the operation, and 87 percent were satisfied with the results despite frequent minor postoperative complications.

Effects of sampling context on the expressive language of children and adolescents with mental retardation

This study was designed to determine whether conversational samples of language should be supplemented with samples obtained in narrative, or storytelling, contexts when evaluating the expressive language skills of individuals with mental retardation. Language samples were elicited in both conversational and narrative contexts from 16 school-age individuals with mental retardation and 16 typically developing children matched to them on MA. An analysis of the samples demonstrated that both groups produced more syntactically complex language in narration than in conversation, whereas they were more talkative in conversation than in narration. These results suggest that conversational and narrative contexts should be used together when evaluating the expressive language performance of individuals with mental retardation.

Effect of removing impacted third molars on plaque and gingival indices

This study investigated the effect of removal of partially erupted mandibular third molars on the plaque and gingival indices. Sixty patients were studied and assigned to one of three groups: control, asymptomatic partially erupted third molars, and symptomatic partially erupted third molars. Plaque and gingival indices were scored for the second molar to the canine in all four quadrants preoperatively and again at 6 weeks after surgery. Results show that removing impacted teeth may provide some benefit in terms of improved gingival health.

Development of a theory of mind in individuals with mental retardation

The ability of adolescents with mental retardation to reason about other people's mental states was examined. Subjects were asked questions about the knowledge and beliefs of characters in stories that they heard and saw enacted with props. The adolescents with mental retardation performed worse than did children without mental retardation matched for MA. The adolescents with mental retardation did better on questions requiring first-order reasoning than on those involving second-order reasoning; this pattern is similar to that found previously for children without mental retardation.

Site-specific effects of intracerebral injections of three neurokinins (neurokinin A, neurokinin K, and neurokinin gamma) on the expression of male rat sexual behavior

Accumulating evidence indicates that neurokinins play a role in the neural regulation of male rat copulatory behavior. We have previously reported that injections of the neurokinin substance P into the medial preoptic nucleus facilitated male rat copulatory behavior. Recently, a number of other neurokinins, neurokinin K (neuropeptide K), neurokinin A (substance K), and neurokinin gamma (derived from the same gene as substance P), have been identified in the mammalian CNS. Therefore, in a series of experiments we examined the effects on male copulatory behavior following bilateral injections of different doses of neurokinin K (NkK), neurokinin A (NkA), or neurokinin gamma (Nk gamma) into the medial preoptic area (MPOA), bed nucleus of the stria terminalis (BnST), or the caudate/putamen. Bilateral injections of NkK into the MPOA or BnST inhibited the expression of male copulatory behavior. The most marked effect was seen following bilateral injections of 0.25 and 0.52 nmol of NkK into the MPOA and the BnST. These injections produced a dramatic suppression of copulatory behavior in previously sexually vigorous male rats when compared to control injections. In contrast, bilateral injections of three different doses of NkA into the MPOA failed to affect any parameter of male copulatory behavior. Bilateral injections of 0.431 nmol of Nk gamma into the MPOA failed to affect the expression of copulatory behavior, but significantly delayed its initiation when compared to controls. Bilateral injections of 0.251 nmol of NkK into the caudate/putamen had no significant effect on copulatory behavior in sexually vigorous male rats when compared to control injections. The results of the present study provide further support for a role of neurokinins in the regulation of copulatory behavior in male rat. Taken together, these results suggest that the effects of neurokinins upon the expression of male copulatory behavior are site specific for brain regions in the sexually dimorphic vomeronasal pathway which includes the MeA, BnST, and MPOA.