Phylodynamic approaches to studying avian influenza virus

Avian influenza viruses can cause severe disease in domestic and wild birds and are a pandemic threat. Phylodynamics is the study of how epidemiological, evolutionary, and immunological processes can interact to shape viral phylogenies. This review summarizes how phylodynamic methods have and could contribute to the study of avian influenza viruses. Specifically, we assess how phylodynamics can be used to examine viral spread within and between wild or domestic bird populations at various geographical scales, identify factors associated with virus dispersal, and determine the order and timing of virus lineage movement between geographic regions or poultry production systems. We discuss factors that can complicate the interpretation of phylodynamic results and identify how future methodological developments could contribute to improved control of the virus.

H9N2 avian influenza virus dispersal along Bangladeshi poultry trading networks

Avian influenza virus subtype H9N2 is endemic in Bangladesh's poultry population. The subtype affects poultry production and poses a potential zoonotic risk. Insufficient understanding of how the poultry trading network shapes the dissemination of avian influenza viruses has hindered the design of targeted interventions to reduce their spread. Here, we use phylodynamic analyses of haemagglutinin sequences to investigate the spatial spread and dispersal patterns of H9N2 viruses in Bangladesh's poultry population, focusing on its two largest cities (Dhaka and Chattogram) and their poultry production and distribution networks. Our analyses suggest that H9N2 subtype avian influenza virus lineage movement occurs relatively less frequently between Bangladesh's two largest cities than within each city. H9N2 viruses detected in single markets are often more closely related to viruses from other markets in the same city than to each other, consistent with close epidemiological connectivity between markets. Our analyses also suggest that H9N2 viruses may spread more frequently between chickens of the three most commonly sold types (sunali-a cross-bred of Fayoumi hen and Rhode Island Red cock, deshi-local indigenous, and exotic broiler) in Dhaka than in Chattogram. Overall, this study improves our understanding of how Bangladesh's poultry trading system impacts avian influenza virus spread and should contribute to the design of tailored surveillance that accommodates local heterogeneity in virus dispersal patterns.

Genomic and epidemiological monitoring of yellow fever virus transmission potential

The yellow fever virus (YFV) epidemic in Brazil is the largest in decades. The recent discovery of YFV in Brazilian Aedes species mosquitos highlights a need to monitor the risk of reestablishment of urban YFV transmission in the Americas. We use a suite of epidemiological, spatial, and genomic approaches to characterize YFV transmission. We show that the age and sex distribution of human cases is characteristic of sylvatic transmission. Analysis of YFV cases combined with genomes generated locally reveals an early phase of sylvatic YFV transmission and spatial expansion toward previously YFV-free areas, followed by a rise in viral spillover to humans in late 2016. Our results establish a framework for monitoring YFV transmission in real time that will contribute to a global strategy to eliminate future YFV epidemics.

Establishment and cryptic transmission of Zika virus in Brazil and the Americas

Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 2016) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 2016). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus.

Bacille Calmette-Guerin disease following Bacille Calmette-Guerin vaccination of an HIV-infected health-care worker

We present a case of Bacille Calmette-Guerin (BCG) lymphadenitis following immunization of a health-care worker with risk factors for HIV but undiagnosed infection. This case highlights the potential risks of BCG and clearly demonstrates the need to consider HIV testing in all patients prior to BCG vaccination.

Sexual health of transgender sex workers attending an inner-city genitourinary medicine clinic

Previous studies have reported high HIV prevalence among transgender sex workers (TSWs). We performed a retrospective case-note review of known TSWs attending our unit. In all, 16/24 (66.7%) of patients were diagnosed with at least one sexually transmitted infection (STI) and 7/24 (29.2%) reported intentional unprotected anal or vaginal intercourse, which may explain the high prevalence of HIV in our cohort (37.5%). TSWs disclosed high rates of substance misuse, violence and sexual assault, which may also contribute to the increased prevalence of STI in this group.

Is screening for pharyngeal Chlamydia trachomatis warranted in high-risk groups?

A recent survey reported that 36% of UK genitourinary medicine clinics offer testing for pharyngeal Chlamydia trachomatis (CT). Screening at this site is targeted at high-risk groups attending our centre, including female sex workers (FSWs) and male sex workers (MSWs). A total of 2406 patients were screened between November 2006 and October 2007. A retrospective case-note review was performed for positive cases. The prevalence of pharyngeal CT was 1.9% in both men and women. The mean number of sexual partners reported in the preceding three months was 168 and 56 for FSWs and MSWs, respectively. Lack of consistent condom use and high numbers of sexual partners identify this population as potential core transmitters of infection. While the British Association of Sexual Health and HIV (BASHH) guidelines do not recommend routine screening for pharyngeal CT, there may be a role in selected high-risk populations.

An audit on the management of lymphogranuloma venereum in a sexual health clinic in London, UK

We performed an audit on the management of lymphogranuloma venereum (LGV) against the British Association of Sexual Health and HIV (BASHH) guidelines. Sixty-three cases of LGV were diagnosed in 60 men who have sex with men (MSM). Fifty-six out of 63 (89%) episodes were treated in accordance with the guidelines. Although all eligible patients were offered an HIV test, 10% and 29% of patients were not offered syphilis or hepatitis C tests, respectively, at the time of LGV diagnosis. Partner notification was not possible in a third of cases. Several patients were re-infected with rectal Chlamydia trachomatis in the three months following LGV diagnosis, emphasizing the importance of rescreening to detect new infections as well as treatment failures in MSM at ongoing high risk of sexually transmitted infection acquisition.

Smoking in the home and children's health

OBJECTIVES

We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the United States.

METHODS

Health service use, healthcare expenditures and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potential confounding factors. The sample is 2759 children aged 0-4.

RESULTS

Smoking in the home is associated with an increase in the probability of emergency department visits for respiratory conditions by five percentage points and the probability of inpatient use for these conditions by three percentage points. There is no relation between indoor smoking by adults and either ambulatory visits or prescription drug expenditures. Overall, indoor smoking is associated with $117 in additional healthcare expenditures for respiratory conditions for each exposed child aged 0-4. Indoor smoking is also associated with an eight percentage point increase in the probability of having a bed day because of respiratory illness for children aged 1-4.

CONCLUSIONS

Despite the significant progress made in tobacco control, many children are still exposed to secondhand smoke in their home. Reducing exposure to smoking in the home would probably reduce healthcare expenditures for respiratory conditions and improve children's health.

The relation between skeletal maturation and adiposity in African American and Caucasian children

OBJECTIVE

African American children have earlier pubertal and skeletal maturation and a higher body mass index (BMI) than Caucasian children. We tested the hypothesis that advanced bone age in African American children is accounted for by their greater adiposity.

STUDY DESIGN

We studied 252 African American (n = 97) and Caucasian (n = 155) children aged 5 to 12 years. Skeletal age was determined by a radiologist blinded to clinical details. The difference between bone age (BA) and chronological age (CA) (noted as BA - CA) and the ratio of bone age to chronological age (BA/CA) were determined. Analysis of covariance was used to adjust skeletal maturation for the effects of adiposity, as measured by BMI, BMI standard deviation score (BMI SDS), and fat mass by dual energy x-ray absorptiometry (DXA).

RESULTS

African American children were significantly heavier than Caucasians (BMI SDS 2.7 +/- 3.4 vs 1.7 +/- 2.4, P <.05). Both BA - CA (0.75 +/- 1.46 vs 0.28 +/- 1.38, P <.05) and BA/CA (1.09 +/- 0.17 vs 1.03 +/- 0.16, P <.05) were significantly greater in African Americans than Caucasians. BA - CA and BA/CA were significantly correlated with lean body mass, BMI, BMI SDS, and DXA fat mass (all r > 0.46, P <.001). Neither BA - CA nor BA/CA of African Americans and Caucasians were significantly different after correction for lean body mass and measures of adiposity, including BMI, BMI SDS, or DXA fat mass.

CONCLUSION

Skeletal age is more advanced in African American than Caucasian children and is significantly related to body mass. In large measure, the advancement in skeletal maturation of prepubertal and early pubertal African American children can be accounted for by their greater adiposity.

Direct evidence that leukemic cells present HLA-associated immunogenic peptides derived from the BCR-ABL b3a2 fusion protein

The BCR-ABL oncogene is central in the pathogenesis of chronic myeloid leukemia (CML). Here, tandem nanospray mass spectrometry was used to demonstrate cell surface HLA-associated expression of the BCR-ABL peptide KQSSKALQR on class I-negative CML cells transfected with HLA-A*0301, and on primary CML cells from HLA-A3-positive patients. These patients mounted a cytotoxic T-lymphocyte response to KQSSKALQR that also killed autologous CML cells, and tetramer staining demonstrated the presence of circulating KQSSKALQR-specific T cells. The findings are the first demonstration that CML cells express HLA-associated leukemia-specific immunogenic peptides and provide a sound basis for immunization studies against BCR-ABL.

Scattering and Internal Fields of a Microsphere that Contains a Saturable Absorber: Finite-Difference Time-Domain Simulations

Illumination intensities that are used to induce scattering and fluorescence in aerosols can be large enough to cause variations in the refractive index. Methods used to calculate the scattering from homogeneous particles may not be valid for these systems. We use the finite-difference time-domain method and an iterative technique to model scattering by microspheres that contain a saturable absorber. We illustrate this technique by calculating the scattering from spheres that contain tryptophan. We show the Mueller scattering matrices along with the internal intensity distributions for different incident intensities. The backscattering increases as the illumination intensity becomes large enough to saturate the absorption in regions of the sphere.

Glucocorticoid excess during adolescence leads to a major persistent deficit in bone mass and an increase in central body fat

Endogenous Cushing's syndrome (CS) in children causes growth retardation, decreased bone mass, and increased total body fat. No prospective controlled studies have been performed in children to determine the long-term sequelae of CS on peak bone mass and body composition. A 15-year-old girl with Cushing disease (CD), and her healthy identical co-twin, were followed for 6 years after the CD was cured. At the 6-year follow-up both twins had areal bone mineral density (BMD) and body composition determined by dual-energy X-ray absorptiometry (DXA) and three-dimensional quantitative computed tomography (3DQCT). Z scores for height, weight, and body mass index (BMI) were -2.3, -0.8 and 0.2, and 1.2, 0.2, and -0.6, in the twin with CD and her co-twin, respectively. In the twin with CD, areal BMD and bone mineral apparent density (BMAD) at different sites varied from 0.7 to 3 SD below her co-twin. Volumetric lumbar spine bone density Z score was -0.75 and 1.0, and total body, abdominal visceral, and subcutaneous fat (%) was 42, 10, and 41 versus 26, 4, and 17 in the twin with CD and her co-twin, respectively. The relationship between total body fat and L2-L4 BMAD was inverse in the twin with CD (p < 0.05), which by contrast in her co-twin was opposite and direct (p < 0.001). In the twin with CD, despite cure, there was a persistent deficit in bone mass and increase in total and visceral body fat. These observations suggest that hypercortisolism (exogenous or endogenous) during adolescence may have persistent adverse effects on bone and fat mass.

Fluorescence from airborne microparticles: dependence on size, concentration of fluorophores, and illumination intensity

We measured fluorescence from spherical water droplets containing tryptophan and from aggregates of bacterial cells and compared these measurements with calculations of fluorescence of dielectric spheres. The measured dependence of fluorescence on size, from both droplets and dry-particle aggregates of bacteria, is proportional to the absorption cross section calculated for homogeneous spheres containing the appropriate percentage of tryptophan. However, as the tryptophan concentration of the water droplets is increased, the measured fluorescence from droplets increases less than predicted, probably because of concentration quenching. We model the dependence of the fluorescence on input intensity by assuming that the average time between fluorescence emission events is the sum of the fluorescence lifetime and the excitation lifetime (the average time it takes for an illuminated molecule to be excited), which we calculated assuming that the intensity inside the particle is uniform. Even though the intensity inside the particles spatially varies, this assumption of uniform intensity still leads to results consistent with the measured intensity dependence.

Sclerosing bone dysplasias: genetic and radioclinical features

Although knowledge of basic genetics in the field of sclerosing bone dysplasias is progressing, the radiologist still plays a pivotal role in the diagnosis of this relatively poorly understood group of disorders. Based on a target site approach, these anomalies are classified into three groups. Within each group, further differentiation can be made by distinctive clinical findings and by mode of inheritance: (a) dysplasias of endochondral bone formation: osteopetrosis (Albers-Schönberg disease), pycnodysostosis, enostosis, osteopoikilosis, osteopathia striata (Voorhoeve disease); (b) dysplasias of intramembranous bone formation: progressive diaphyseal dysplasia (Camurati-Engelmann disease) and variants, hyperostosis corticalis generalisata (Van Buchem disease) and variants; and (c) mixed sclerosing dysplasias: melorheostosis (Leri disease) and overlap syndromes.

Enhanced backward-directed multiphoton-excited fluorescence from dielectric microcavities

We demonstrate theoretically and experimentally that one-, two-, and three-photon excited fluorescence from dye molecules in spherical microcavities has an asymmetrical angular distribution and is enhanced in the backward direction. The enhancement ratios (of intensities at 180 degrees and 90 degrees ) are 9, 5, and 1.8 for three-, two-, and one-photon excitation, respectively. Even larger ratios are expected for microspheres with an index of refraction larger than that used in the experiments. Because of the reciprocity principle and concentration of the incident wave inside particles, the backward enhancement is expected to occur even with nonspherical particles.

Nano-electrospray and microbore liquid chromatography-ion trap mass spectrometry studies of copper complexation with MHC restricted peptides

The formation of copper/peptide complex ions by nano-electrospray and microbore HPLC-electrospray mass spectrometry has been investigated for major histocompatibility complex (MHC) class I and class II restricted peptides. Post-column addition of copper(II) acetate following microbore HPLC-MS separation was carried out using a mixing T-piece or via the sheath flow inlet of the electrospray source. Optimal analytical conditions for copper complex ion formation were determined by variation of copper concentration, pH, nebulization gas supply and spray voltage. Tandem mass spectrometry of copper/peptide complex ions provides peptide sequence information and insight into the peptide chelation sites. Copper associated y fragment ions dominate the product ion spectrum for non-histidine containing peptides, but both b and y copper complex ions were observed for the histidine containing MHC class I associated peptide gp70.

School-related violence among high school students in the United States, 1993-1995

Using logistic regression to calculate odds ratios and confidence intervals, this secondary analysis determined statistically significant predictors and prevalence rates for high school students in the United States who carried a weapon, were threatened or injured with a weapon, or were involved in physical fighting on school property from 1993-1995. Geographic region, grade in school, race/ethnicity, and gender were the independent variables. Data regarding school-related violence among adolescents were collected in 1993 and 1995 using the Youth Risk Behavior Survey developed and implemented by the Centers for Disease Control and Prevention. Results indicated gender, race, and grade in school were predictors of school-related violence for students in grades 9-12 from 1993 to 1995. Males were involved in violent acts more often than females. Minority students, especially Hispanics and Blacks, and students in lower grades at school participate in and are victims of violence more often than other students.

Fluorescence imaging of single molecules in polymer microspheres

We report on far-field fluorescence imaging of single molecules in spherical polymer microparticles produced from solution by using microdroplet techniques. The fluorescence photobleaching quantum yields of rhodamine 6G in a common water-soluble polymer (polyvinyl alcohol) are at least five times smaller, corresponding to proportionally larger average fluorescence signals, than those in ethanolic solvents. This allows for acquisition of multiple images from a single molecule on a time scale of several minutes. We also show that fluorescent images of single molecules in microspheres can be calculated from semiclassic electrodynamics, which may ultimately be useful in retrieving dynamical information from experimental images.

Localization of the gene for sclerosteosis to the van Buchem disease-gene region on chromosome 17q12-q21

Sclerosteosis is an uncommon, autosomal recessive, progressive, sclerosing, bone dysplasia characterized by generalized osteosclerosis and hyperostosis of the skeleton, affecting mainly the skull and mandible. In most patients this causes facial paralysis and hearing loss. Other features are gigantism and hand abnormalities. In the present study, linkage analysis in two consanguineous families with sclerosteosis resulted in the assignment of the sclerosteosis gene to chromosome 17q12-q21. This region was analyzed because of the recent assignment to this chromosomal region of the gene causing van Buchem disease, a rare autosomal recessive condition with a hyperostosis similar to sclerosteosis. Because of the clinical similarities between sclerosteosis and van Buchem disease, it has previously been suggested that both conditions might be caused by mutations in the same gene. Our study now provides genetic evidence for this hypothesis.

Hyper-IgE syndrome with recurrent infections--an autosomal dominant multisystem disorder

BACKGROUND

The hyper-IgE syndrome with recurrent infections is a rare immunodeficiency characterized by recurrent skin and pulmonary abscesses and extremely elevated levels of IgE in serum. Associated facial and skeletal features have been recognized, but their frequency is unknown, and the genetic basis of the hyper-IgE syndrome is poorly understood.

METHODS

We studied 30 patients with the hyper-IgE syndrome and 70 of their relatives. We took histories, reviewed records, performed physical and dental examinations, took anthropometric measurements, and conducted laboratory studies.

RESULTS

Nonimmunologic features of the hyper-IgE syndrome were present in all patients older than eight years. Seventy-two percent had the previously unrecognized feature of failure or delay of shedding of the primary teeth owing to lack of root resorption. Common findings among patients were recurrent fractures (in 57 percent of patients), hyperextensible joints (in 68 percent), and scoliosis (in 76 percent of patients 16 years of age or older). The classic triad of abscesses, pneumonia, and an elevated IgE level was identified in 77 percent of all patients and in 85 percent of those older than eight. In 6 of 23 adults (26 percent), IgE levels declined over time and came closer to or fell within the normal range. Autosomal dominant transmission of the hyper-IgE syndrome was found, but with variable expressivity. Of the 27 relatives at risk for inheriting the hyper-IgE syndrome, 10 were fully affected, 11 were unaffected, and 6 had combinations of mild immunologic, dental, and skeletal features of the hyper-IgE syndrome.

CONCLUSIONS

The hyper-IgE syndrome is a multisystem disorder that affects the dentition, the skeleton, connective tissue, and the immune system. It is inherited as a single-locus autosomal dominant trait with variable expressivity.

Single-shot fluorescence spectra of individual micrometer-sized bioaerosols illuminated by a 351- or a 266-nm ultraviolet laser

Reproducible fluorescence spectra of individual 2- to 5-microm -diameter biological aerosol particles excited with a single shot from a Q -switched laser (266 or 351 nm) have been obtained with highly improved signal-to-noise ratios. Critical to the advance are crossed diode-laser trigger beams, which precisely define the sample volume, and a reflecting objective, which minimizes chromatic aberration and has a large N.A. for collecting fluorescence. Several allergens (red oak, meadow oat pollen, paper mulberry pollen, and puffball spores) have different fluorescence spectra. Bacillus subtilis fluorescence spectrum deteriorates at high 266-nm incident intensity. Dry riboflavin particles illuminated with a 351-nm light exhibit a new 420-nm fluorescence peak that grows nonlinearly with laser pulse energy.

Six-year results of spironolactone and testolactone treatment of familial male-limited precocious puberty with addition of deslorelin after central puberty onset

Short term treatment with spironolactone, testolactone, and, after the onset of central puberty, deslorelin can normalize the rate of growth and bone maturation in boys with familial male-limited precocious puberty. To test the hypothesis that this treatment can achieve long term normalization of the growth and development of these children, we examined the growth rate, bone maturation rate (change in bone age/change in chronological age), and predicted adult height of 10 boys who were treated with spironolactone (5.7 mg/kg x day) and testolactone (40 mg/kg x day) for at least 6 yr. Deslorelin (4 microg/kg x day) treatment was initiated 2.6 +/- 1.3 yr after beginning spironolactone and testolactone treatment. The growth rate normalized within 1 yr of starting treatment and remained normal during the next 5 yr of treatment (P < 0.001). The rate of bone maturation normalized during the second year of treatment and remained normal thereafter (P < 0.001). Predicted height increased from 160.7 +/- 14.7 centimeters at baseline to 173.6 +/- 10.1 centimeters after 6 yr of treatment (P < 0.05 during the fourth through the sixth year of treatment compared to baseline). We conclude that long term treatment with spironolactone, testolactone, and, after central puberty, deslorelin normalizes the growth rate and bone maturation and improves the predicted height in boys with familial male-limited precocious puberty. The ultimate effect of this approach on adult height will require further study.

Two-dimensional angular optical scattering for the characterization of airborne microparticles

Two-dimensional angular optical scattering (TAOS) is recorded for several particle shapes and configurations. A lens is used to collect a large solid angle of the light and transform the angular profile into a planar distribution according to the Abbé sine condition. Qualitative agreement is found between experiment and theory for the TAOS from spheroids having the same aspect ratio but different sizes. A distinctive irregular island structure is observed in the TAOS from clusters of Bacillus subtilis spores and polystyrene latex spheres. The density per solid angle of these islands is found to increase with cluster diameter.

The consequences of paying Medicare managed care plans their costs

This study examines 1993 Medicare expenditures for enrollees in 63 managed care plans that were reimbursed on a cost basis. We find that government spending for enrollees in cost-reimbursed plans in 1993 was substantially greater than it would have been had these enrollees instead received care in traditional fee-for-service Medicare or in a Medicare risk plan. The increase was due entirely to the much higher expenditures for Part B services under cost reimbursement. The findings suggest that Medicare cost reimbursement of health plans should be eliminated or significantly modified.

Evaluation of the aortic root by MRI: insights from patients with homozygous familial hypercholesterolemia

BACKGROUND

In homozygous familial hypercholesterolemia (HFH), the aortic root is prone to develop atherosclerotic plaque at an early age. However, the aortic wall and plaque have not yet been assessed in this condition by MRI. We evaluated the aortic root by use of MRI in 17 HFH patients and 12 normal control subjects in a prospective, blinded, controlled study.

METHODS AND RESULTS

Morphological assessment of the aortic root was done with spin-echo and gradient-echo MRI scanning. Comparisons were made with a number of measures of disease severity, including cholesterol-year score, calcium score on electron-beam CT (EBCT), and size of Achilles tendon xanthomas. Atherosclerotic plaque, visible on fat-suppressed images but never on water-suppressed images, was present in 9 HFH patients (53%). Supravalvular aortic stenosis was present in 7 patients with HFH (41%). Maximum supravalvular aortic wall thickness was significantly greater and OD and lumen cross-sectional area (CSA) were smaller in patients than in control subjects (P=0.006, 0.0005, and 0.06, respectively). Maximum wall thickness was associated with a greater calcium score on electron-beam CT (P=0.02). Although the cumulative exposure of the aortic root to cholesterol (the cholesterol-year score) was significantly correlated with the Achilles tendon CSA and vascular calcification, this score did not correlate with the wall thickness or aortic CSA.

CONCLUSIONS

This study not only demonstrates the utility of MRI for detecting and characterizing aortic root atherosclerotic plaque and supravalvular aortic stenosis in HFH patients but also suggests that the LDL receptor plays a direct or indirect role in aortic mural development and vascular growth.

Spatial photoselection of single molecules on the surface of spherical microcavities

We show that ultrasensitive microdroplet-stream fluorescence techniques combined with surfactant forms of Rhodamine dyes can be used to probe single molecules on the surfaces of spherical microcavities. Individual octadecyl Rhodamine B molecules, shown previously by ensemble measurements to be localized and oriented at the surfaces of liquid microspheres, were spatially photoselected primarily along great circles lying perpendicular or parallel to the detection axis by use of polarized laser excitation. A polarization dependence is observed in the distribution of single-molecule fluorescence amplitudes that can be interpreted qualitatively in terms of position-dependent fluorescence-collection efficiencies.

Collection of emission from an oscillating dipole inside a sphere: analytical integration over a circular aperture

We describe a method for integrating analytically, over a circular aperture, the emission from an oscillating dipole inside a dielectric sphere. The model is useful for investigating fluorescence, Raman, or other emission from molecules inside of spherical particles or droplets. The analysis is performed for two cases: (a) the dipole emits from a fixed orientation, and (b) the dipole emits from all orientations and the collected energy is summed. This second case models the collection of emission from a molecule that is excited repeatedly; after each excitation it rotates to a random orientation before emitting. These results are applicable to single-molecule detection techniques employing microdroplets and to other techniques for characterizing microparticles with luminescence or inelastic scattering.

Sciatic nerve: paradoxic hypertrophy after amputation in young patients

PURPOSE

To evaluate the appearance of the sciatic nerve after leg amputation.

MATERIALS AND METHODS

Magnetic resonance (MR) images were obtained in seven patients (age at amputation, 11-19 years) who underwent above-knee amputation to treat osteogenic sarcoma. Images were evaluated for sciatic nerve enlargement. Findings were correlated with the time after amputation.

RESULTS

All seven patients were found to have a markedly enlarged sciatic nerve in the stump of the amputated leg. The enlargement extended proximally from the point of nerve transection to a level posterior to the femoral neck (8-27 cm) depending on the length of the stump. No evidence of sciatic nerve enlargement was found in the opposite leg or on preoperative MR images that were available in three of the patients. Moreover, in one patient with a sarcoma who underwent a leg-sparing procedure, no sciatic nerve enlargement was seen postoperatively. The thickness of the distal sciatic nerve was related to the time after amputation.

CONCLUSION

Hypertrophy of the sciatic nerve occurred after above-knee amputation in young patients. This finding differed from atrophy of the nerve that has been reported previously in older patients.

Real-time observation of single-molecule fluorescence in microdroplet streams

We report real-time observation of fluorescence bursts from individual Rhodamine 6G molecules in streams of microdroplets (peak signal-to-noise ratios, approximately 30) whose trajectories are constrained with a linear electric quadrupole. This approach offers a reasonable dynamic range in droplet size (3- 12-microm diameter) with <1% shot-to-shot size fluctuations and sensitivity comparable with that of droplet levitation techniques with at least 10(3) higher analysis rates. Applications to the study of single-molecule microcavity effects and stimulated emission are discussed.

Collection of fluorescence from single molecules in microspheres: effects of illumination geometry

The collection of fluorescence from a molecule inside a sphere illuminated with single or counterpropagating plane waves is modeled. The results are applicable to microdroplet-based single molecule detection techniques and to some microparticle characterization techniques using inelastic emission. The large position-dependent variations in the fluorescence collection rate are primarily attributable to variations in the excitation intensity. With plane-wave illumination the collection from shadow regions is low because the incident energy is refracted by the droplet surface away from these regions. The average collection rate from molecules in shadow regions can be increased by illuminating with counterpropagating beams.

Testing the HMO competitive strategy: an analysis of its impact on medical resources

Competitive approaches to health care reform, including managed competition, are hypothesized to reduce health care expenditures and the resources devoted to medical care. Empirical evidence has been limited. The short- and long-run effects of an experiment closely resembling managed competition are analyzed. We examine effects on hospitals, technology diffusion, physicians, and health insurance premiums. The strategy reduces capital in hospitals, has minor effects on physicians and technology, and has only initial effects on average premiums.

Radiographic findings in type 3b Gaucher disease

The purpose of this paper is to describe the radiographic findings in type 3 b Gaucher disease, a chronic neuronopathic form of the illness with severe systemic manifestations. Between 1980 and 1985 17 consecutive patients were evaluated with radiography of the chest, long bones and spine, CT of the head and chest, abdominal sonography, and MRI of the head, abdomen and spine. Clinical manifestations were severe, and led to death from hepatic, pulmonary or cardiac failure in nine patients. Type 3 b Gaucher disease shares the same spectrum of radiographic findings observed in type 1 disease, but the systemic manifestations are more severe. Pulmonary infiltrates, thoracic lymph node enlargement, vertebral compression fractures and osteonecrosis of the long bones occur much more frequently in patients with type 3 b disease.

Modeling fluorescence collection from single molecules in microspheres: effects of position, orientation, and frequency

We present calculations of fluorescence from single molecules (modeled as damped oscillating dipoles) inside a dielectric sphere. For an excited molecule at an arbitrary position within the sphere we calculate the fluorescence intensity collected by an objective in some well-defined detection geometry. We find that, for the cases we model, integration over the emission linewidth of the molecule is essential for obtaining representative results. Effects such as dipole position and orientation, numerical aperture of the collection objective, sphere size, emission wavelength, and linewidth are examined. These results are applicable to single-molecule detection techniques employing microdroplets.

Conditional-firing aerosol-fluorescence spectrum analyzer for individual airborne particles with pulsed 266-nm laser excitation

We report the operation of an aerosol-fluorescence spectrum analyzer capable of selectively measuring the fluorescence spectra of single micrometer-sized aerosol particles as they flow through the instrument. As the particle first traverses a cw 488-nm probe laser beam, the total fluorescence and elastic scattering are measured with photomultipliers. When the photomultiplier output levels meet preset logic conditions, a UV laser (at 266 nm) is fired and the particle fluorescence spectrum is recorded. Fluorescence spectra of biological airborne particles are presented. The ability of the analyzer to capture the fluorescence spectrum of one type of particle while ignoring others, based on the particle characteristics, is also demonstrated.

The effect of Cushing's disease on bone mineral density, body composition, growth, and puberty: a report of an identical adolescent twin pair

As endogenous Cushing's syndrome (CS) in children occurs during a critical developmental period, when the majority of peak bone mass is acquired, we hypothesized that children with CS might be at an increased risk of osteoporosis. To determine the effects of CS on bone density, bone metabolism, and growth, we studied a 15-yr-old female identical twin pair, one of whom had CS (twin A), and the other of whom was healthy (twin B). Before therapy for CS, twin A showed a severe loss of bone mineral density [BMD; -3.2SD at the lumbar spine (LS)] compared to twin B (-0.1 SD), which in twin A was associated with low serum osteocalcin levels and urinary pyridinium cross-link excretion. Cure of CS in twin A led to a marked increase in these bone markers, suggesting a state of active bone remodeling. After 27 months of follow-up, even though twin A's BMD improved significantly, it still remained abnormal [-1.9 SD at LS compared with that of twin B (0 SD)], suggesting that twin A continued to be at increased long term risk of osteoporosis. In addition, as a consequence of CS, twin A's final height was 21 cm less than that of her identical twin. We recommend that all children with CS should have BMD monitored after treatment to determine the long term risk of osteoporosis.

Conditional-sampling spectrograph detection system for fluorescence measurements of individual airborne biological particles

We report the design and operation of a prototype conditional-sampling spectrograph detection system that can record the fluorescence spectra of individual, micrometer-sized aerosols as they traverse an intense 488-nm intracavity laser beam. The instrument's image-intensified CCD detector is gated by elastic scattering or by undispersed fluorescence from particles that enter the spectrograph's field of view. It records spectra only from particles with preselected scattering-fluorescence levels (a fiber-optic-photomultiplier subsystem provides the gating signal). This conditional-sampling procedure reduces data-handling rates and increases the signal-to-noise ratio by restricting the system's exposures to brief periods when aerosols traverse the beam. We demonstrate these advantages by reliably capturing spectra from individual fluorescent microspheres dispersed in an airstream. The conditional-sampling procedure also permits some discrimination among different types of particles, so that spectra may be recorded from the few interesting particles present in a cloud of background aerosol. We demonstrate such discrimination by measuring spectra from selected fluorescent microspheres in a mixture of two types of microspheres, and from bacterial spores in a mixture of spores and nonfluorescent kaolin particles.

Aerosol-fluorescence spectrum analyzer: real-time measurement of emission spectra of airborne biological particles

We have assembled an aerosol-fluorescence spectrum analyzer (AFS), which can measure the fluorescence spectra and elastic scattering of airborne particles as they flow through a laser beam. The aerosols traverse a scattering cell where they are illuminated with intense (50 kW/cm(2)) light inside the cavity of an argon-ion laser operating at 488 nm. This AFS can obtain fluorescence spectra of individual dye-doped polystyrene microspheres as small as 0.5 µm in diameter. The spectra obtained from microspheres doped with pink and green-yellow dyes are clearly different. We have also detected the fluorescence spectra of airborne particles (although not single particles) made from various biological materials, e.g., Bacillus subtilis spores, B. anthrasis spores, riboflavin, and tree leaves. The AFS may be useful in detecting and characterizing airborne bacteria and other airborne particles of biological origin.

Enzyme replacement therapy for Gaucher disease: skeletal responses to macrophage-targeted glucocerebrosidase

OBJECTIVES

Reversal of the hematologic and visceral abnormalities characteristic of Gaucher disease, the most common lipid storage disorder, with biweekly infusions of macrophage-targeted glucocerebrosidase (glucosylceramidase) is well documented. The extent to which the skeleton responds to enzyme replacement therapy has not been systematically investigated.

METHODS

To assess the skeletal response to enzyme replacement therapy, we treated 12 patients with type 1 Gaucher disease, who had intact spleens, with macrophage-targeted glucocerebrosidase. The initial dose of enzyme was 60 U/kg body weight every 2 weeks for 24 months, followed by reduction in dosage to 30 and then 15 U/kg body weight every 2 weeks, each for 9 months.

RESULTS

The lipid composition of bone marrow, determined by direct chemical analysis, began to improve after 6 months of treatment at a time when noninvasive imaging studies showed no significant changes. By 42 months, improvement in marrow composition was demonstrable on all noninvasive, quantitative imaging modalities (magnetic resonance score, quantitative xenon scintigraphy, and quantitative chemical shift imaging) used in this study. Quantitative chemical shift imaging, the most sensitive technique, demonstrated a dramatic normalization of the marrow fat content in all patients. Net increases in either cortical or trabecular bone mass, as assessed by combined cortical thickness measurements and dual-energy quantitative computed tomography, respectively, occurred in 10 patients.

CONCLUSIONS

Prolonged treatment over 3 1/2 years with macrophage-targeted glucocerebrosidase produces objective reversal of disease in both the axial and appendicular skeleton in patients with Gaucher disease. Marked improvement occurs in marrow composition and bone mass in both children and adults.

Aerosol particle microphotography and glare-spot absorption spectroscopy

The relative intensities of glare spots in the image of an electrodynamically trapped aerosol droplet are measured experimentally with an aerosol particle microscope and calculated theoretically. The theoretical calculations are in good agreement with these experiments and indicate that the intensities of these spots are extremely sensitive to the imaginary part of the refractive index. Experimentally, we obtain the molecular absorption spectrum of an impurity within a droplet by recording the spectrum of an individual glare spot produced by broadband illumination.

Tc-99m sestamibi imaging of a hyperfunctioning parathyroid autograft with Doppler ultrasound and MRI correlation

The authors describe a case in which Tc-99m sestamibi demonstrated increased vascularity and uptake in a hyperfunctioning autograft in a patient with recurrent hyperparathyroidism and multiple endocrine neoplasia type 1. Findings were confirmed by differential parathyroid hormone levels in antecubital venous blood samples, ultrasound with color Doppler, MRI, and surgery.

Enzyme therapy in type 1 Gaucher disease: comparative efficacy of mannose-terminated glucocerebrosidase from natural and recombinant sources

OBJECTIVE

To compare the efficacy of mannose-terminated glucocerbrosidase prepared from natural (alglucerase; Ceredase, Genzyme Corp., Cambridge, Massachusetts) and recombinant (imiglucerase; Cerezyme, Genzyme Corp.) sources in treating type 1 Gaucher disease.

DESIGN

Double-blind, randomized, parallel trial.

SETTING

University medical center and clinical research hospital.

PATIENTS

15 patients (4 children and 11 adults) randomly assigned to receive Ceredase and 15 patients (3 children and 12 adults) assigned to receive Cerezyme.

INTERVENTION

Ceredase and Cerezyme were infused every 2 weeks for 9 months at a dose of 60 U/kg body weight.

OUTCOME MEASURES

Hemoglobin levels, platelet counts, and serum acid phosphatase and angiotensin-converting enzyme activities were monitored every 2 weeks during the trial. Hepatic and splenic volumes were assessed at the time of randomization and after 6 and 9 months of enzyme infusion. Formation of IgG antibodies to Ceredase or Cerezyme was monitored every 3 months by radioimmunoprecipitation assay.

RESULTS

No significant differences were found in the rate or extent of improvement in hemoglobin levels, platelet counts, serum acid phosphatase or angiotensin-converting enzyme activities, or hepatic or splenic volumes between either treatment group. The incidence of IgG antibody formation was greater in the Ceredase group (40%) than in the Cerezyme group (20%). No major immunologic adverse events occurred in either group.

CONCLUSIONS

Our study shows the therapeutic similarity of Ceredase and Cerezyme. Cerezyme has the advantage of being theoretically unlimited in supply and free of potential pathogenic contaminants.

Genetic diversity of human immunodeficiency virus type 2: evidence for distinct sequence subtypes with differences in virus biology

The virulence properties of human immunodeficiency virus type 2 (HIV-2) are known to vary significantly and to range from relative attenuation in certain individuals to high-level pathogenicity in others. These differences in clinical manifestations may, at least in part, be determined by genetic differences among infecting virus strains. Evaluation of the full spectrum of HIV-2 genetic diversity is thus a necessary first step towards understanding its molecular epidemiology, natural history of infection, and biological diversity. In this study, we have used nested PCR techniques to amplify viral sequences from the DNA of uncultured peripheral blood mononuclear cells from 12 patients with HIV-2 seroreactivity. Sequence analysis of four nonoverlapping genomic regions allowed a comprehensive analysis of HIV-2 phylogeny. The results revealed (i) the existence of five distinct and roughly equidistant evolutionary lineages of HIV-2 which, by analogy with HIV-1, have been termed sequence subtypes A to E; (ii) evidence for a mosaic HIV-2 genome, indicating that coinfection with genetically divergent strains and recombination can occur in HIV-2-infected individuals; and (iii) evidence supporting the conclusion that some of the HIV-2 subtypes may have arisen from independent introductions of genetically diverse sooty mangabey viruses into the human population. Importantly, only a subset of HIV-2 strains replicated in culture: all subtype A viruses grew to high titers, but attempts to isolate representatives of subtypes C, D, and E, as well as the majority of subtype B viruses, remained unsuccessful. Infection with all five viral subtypes was detectable by commercially available serological (Western immunoblot) assays, despite intersubtype sequence differences of up to 25% in the gag, pol, and env regions. These results indicate that the genetic and biological diversity of HIV-2 is far greater than previously appreciated and suggest that there may be subtype-specific differences in virus biology. Systematic natural history studies are needed to determine whether this heterogeneity has clinical relevance and whether the various HIV-2 subtypes differ in their in vivo pathogenicity.

Light scattering by a coated sphere illuminated with a Gaussian beam

<p>The intensity of light scattered by a coated sphere illuminated with an off-axis Gaussian beam is calculated. Results are shown for different beam positions with respect to the sphere. As the beam is shifted further away from the surface of the sphere, the higher-Q morphology-dependent resonances become increasingly important in the backscatter spectra, and the angular scattering intensity becomes smoother.</p> <p>The scattered intensity depends on the beam position, the refractive indices of the core and coat, the radius of the core, and the thickness of the coat. As the beam is moved further away from the sphere, the effect of the core on the scattering intensity decreases. When the incident Gaussian beam is focused outside of a particle with a relatively small core, the scattering spectra and angular scattering patterns become similar to those of a homogeneous sphere having the refractive index of the coat. These calculated results suggest that measurements of spectral scattering and angular scattering patterns for several Gaussian beam positions could be useful for the characterization of coated spheres.</p>