Multi-center evaluation of the Research Use Only NeuMoDx monkeypox virus (MPXV) fully automated real-time PCR assay

The mpox outbreak, caused by monkeypox virus (MPXV), accelerated the development of molecular diagnostics. In this study, we detail the evaluation of the Research Use Only (RUO) NeuMoDx MPXV assay by multiple European and US sites. The assay was designed and developed by Qiagen for the NeuMoDx Molecular Systems. Primers and probes were tested for specificity and inclusivity in silico. The analytical sensitivity of the assay was determined by testing dilutions of synthetic and genomic MPXV DNA. A total of 296 clinical samples were tested by three sites; the Johns Hopkins University (US), UZ Gent (Belgium, Europe), and Hospital Universitario San Cecilio (Spain, Europe). The analytical sensitivity of the assay was 50 copies/mL for both clades I and II. The assay showed 100% in silico identity for 80 clade I and 99.98% in silico identity for 5,162 clade II genomes. Clade II primers and probes showed 100% in silico specificity; however, identity of at least one of the two sets of clade I primers and probes with variola, cowpox, camelpox, and vaccinia viruses was noticed. The clinical validation showed sensitivity of 99.21% [95% confidence interval (CI): 95.66-99.98%] and specificity of 96.64% (95% CI: 91.62-99.08%) for lesion swab samples. The NeuMoDx MPXV Test shows acceptable analytical and clinical performance. The assay improves the laboratory's workflow as it consolidates nucleic acid extraction, PCR, data analysis, and interpretation and can be interfaced. The Test Strip can differentiate clades I and II, which has important laboratory safety implications.

IMPORTANCE

In this manuscript, we provide detailed in silico analysis and clinical evaluation of the assay using a large cohort of clinical samples across three academic centers in Europe and the United States. Because the assay differentiates MPXV clades I and II, this manuscript is timely due to the current need to rule out the regulated clade I by diagnostic clinical laboratories. In December 2023, and due to first report of cases of sexually transmitted clade I infections in the Democratic Republic of the Congo, when generic assays that do not differentiate the clades are used, samples are considered regulated. The assay meets the need of full automation and has a marked positive impact on the laboratory workflow.

[Current status and reflection on minimal access breast surgery]

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

[A retrospective cohort study of the postoperative prothesis-related complications of single-port endoscopic assisted versus open surgery on nipple sparing mastectomy and immediate prosthesis breast reconstruction]

Objective: To examine the postoperative prosthesis-related complications, short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction. Methods: This study was a retrospective cohort study. A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. They were divided into two groups according to the surgical approach. A total of 53 patients, aged (43.3±9.9) years (range: 25 to 66 years), underwent endoscopic nipple sparing mastectomy (E-NSM group) and immediate prothesis breast reconstruction. The other 51 patients aged (39.9±7.8) years (range: 25 to 54 years) underwent conventional open surgery (C-NSM group). Short-term surgical outcomes including operation time, postoperative hospital stay, postoperative blood loss, and postoperative drainage volume in 2 days were recorded. Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test. Postoperative prothesis-related complications were investigated to determine the experience to deal with them. Results: No postoperative prosthesis-related infection, prosthesis loss, or necrosis of the nipple-areola complex occurred in the E-NSM group, while 1 patient suffered from hematoma, whose wound was skinned with resuture after disinfection. Five patients in the C-NSM group had prosthesis-related infection, 2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent, another one underwent surgery for subcutaneous placement of the drain, as well as antimicrobial agent therapy, and the rest of them healed up only with antimicrobial agent therapy. All recovered well after treatment. One patient recovered from necrosis of the nipple-areola complex through periodic iodophor disinfection and dressing which ended in improvement of necrotic areas, another patient who had hematoma accepted the same treatment mentioned above and also healed. All the patients mentioned above are now in stable conditions. Patients in the E-NSM group had higher satisfaction with the cosmetic results of the breast prosthesis implant than those in the C-NSM group (Z=-4.511, P<0.01). Conclusions: Both surgical approaches were proven to be safe and effective with a low rate of postoperative prosthesis-related complications. Patients in the E-NSM group were more satisfied with the cosmetic results of breast reconstruction than those in the C-NSM group.

Host Genetic Associations with Salivary Microbiome in Oral Cancer

Despite the growing recognition of a host genetic effect on shaping gut microbiota composition, the genetic determinants of oral microbiota remain largely unexplored, especially in the context of oral diseases. Here, we performed a microbiome genome-wide association study in 2 independent cohorts of patients with oral squamous cell carcinoma (OSCC, n = 144 and 67) and an additional group of noncancer individuals (n = 104). Besides oral bacterial dysbiosis and signatures observed in OSCC, associations of 3 loci with the abundance of genus-level taxa and 4 loci with β diversity measures were detected (q < 0.05) at the discovery stage. The most significant hit (rs10906082 with the genus Lachnoanaerobaculum, P = 3.55 × 10^-9 at discovery stage) was replicated in a second OSCC cohort. Moreover, the other 2 taxonomical associations, rs10973953 with the genus Kingella (P = 1.38 × 10^-9) and rs4721629 with the genus Parvimonas (P = 3.53 × 10^-8), were suggestive in the meta-analysis combining 2 OSCC cohorts. Further pathway analysis revealed that these loci were enriched for genes in regulation of oncogenic and angiogenic responses, implicating a genetic anchor to the oral microbiome in estimation of casual relationships with OSCC. Our findings delineate the role of host genotypes in influencing the structure of oral microbial communities.

A Phase I Clinical Trial to Assess Safety and Tolerability of Injectable Collagenase in Women with Symptomatic Uterine Fibroids

Uterine fibroids feature excessive deposition of types I and III collagen. Previous ex vivo studies showed an FDA-approved collagenase (EN3835)-digested types I and III collagen fibers in fibroid tissues; however, collagenase had not been evaluated in vivo for effects on uterine fibroids. The objective was to assess the safety and tolerability of collagenase injection directly into uterine fibroids. This was a prospective, open label, dose escalation study. The study participants were fifteen women aged 35-50 years with symptomatic uterine fibroids planning to undergo hysterectomy. Three subjects received saline and methylene blue, three subjects received a fixed dose of EN3835, and 9 subjects received stepped, increasing dosages of EN3835, all by transvaginal, ultrasound-guided injections. Primary outcome measures were safety and tolerability of the injection and change in collagen content between treated and control tissues. There were no significant adverse events following injection of EN3835 into uterine fibroids. Masson's trichrome stains revealed a 39% reduction in collagen content in treated samples compared to controls (p <0.05). Second harmonic generation (SHG) analysis showed treated samples to have a 21% reduction in density of collagen compared to controls. Picrosirius-stained collagenase-treated fibroids showed collagen fibers to be shorter and less dense compared to controls. Subjects reported a decrease in fibroid-related pain on the McGill Pain Questionnaire after study drug injection in Group 2 at both 4-8 days and 60-90 days post-injection. The findings indicated that injection of collagenase was safe and well tolerated. These results support further clinical investigation of collagenase as a minimally invasive treatment of uterine fibroids. NCT0289848.

Single-step synthesis of polychromatic carbon quantum dots for macroscopic detection of Hg2

Two kinds of carbon quantum dots (CQDs), having luminous peaks at 480 and 525 nm, were obtained by a single-step hydrothermal method. The detection of Hg²⁺ by two kinds of carbon dots was further explored. In order to compensate for the weak luminescence of blue carbon dots (480 nm) and low sensitivity of green carbon dots (525 nm), mixed carbon dots were examined for Hg²⁺ detection. The mixed carbon dots showed a better detection of Hg²⁺ ions. Low detection limit of 0.05 μM was found to be in the range of 0-1.0 μM of Hg²⁺. Moreover, in this range, the change of fluorescence intensity can be clearly seen under the ultraviolet lamp, which will be conducive for the practical application of detecting mercury ions with carbon dots.

A-Kinase Anchoring Protein 13 (AKAP13) Augments Progesterone Signaling in Uterine Fibroid Cells

CONTEXT

Uterine leiomyomata (fibroids) are prevalent sex hormone‒dependent tumors with an altered response to mechanical stress. Ulipristal acetate, a selective progesterone receptor (PR) modulator, significantly reduces fibroid size in patients. However, PR signaling in fibroids and its relationship to mechanical signaling are incompletely understood.

OBJECTIVE

Our prior studies revealed that A-kinase anchoring protein 13 (AKAP13) was overexpressed in fibroids and contributed to altered mechanotransduction in fibroids. Because AKAP13 augmented nuclear receptor signaling in other tissues, we sought to determine whether AKAP13 might influence PR signaling in fibroids.

METHODS AND RESULTS

Fibroid samples from patients treated with ulipristal acetate or placebo were examined for AKAP13 expression by using immunohistochemistry. In immortalized uterine fibroid cell lines and COS-7 cells, we observed that AKAP13 increased ligand-dependent PR activation of luciferase reporters and endogenous progesterone-responsive genes for PR-B but not PR-A. Inhibition of ERK reduced activation of PR-dependent signaling by AKAP13, but inhibition of p38 MAPK had no effect. In addition, glutathione S-transferase‒binding assays revealed that AKAP13 was bound to PR-B through its carboxyl terminus.

CONCLUSION

These data suggest an intersection of mechanical signaling and PR signaling involving AKAP13 through ERK. Further elucidation of the integration of mechanical and hormonal signaling pathways in fibroids may provide insight into fibroid development and suggest new therapeutic strategies for treatment.

Mice deficient in AKAP13 (BRX) develop compulsive-like behavior and increased body weight

OBJECTIVE

Hormonal contributions to the sex-dependent development of both obsessive-compulsive disorder (OCD) and obesity have been described, but the underlying mechanisms are incompletely understood. A-kinase anchoring protein 13 (AKAP13) significantly augments ligand-dependent activation of estrogen receptors alpha and beta. The hypothalamus and pituitary gland are implicated in the development and exacerbation of OCD and obesity and have strong AKAP13 expression. The AKAP13 localization pattern observed in these key brain regions together with its effects on sex steroid action suggest a potential role for AKAP13 in compulsive-like behaviors. Here we tested the role of AKAP13 in compulsive-like behavior and body weight using an Akap13 haploinsufficient murine model.

MATERIALS AND METHODS

Targeted deletion of the Akap13 gene generated haploinsufficient (Akap13+/-) mice in a C57BL6/J genetic background. Established behavioral assays were conducted, video recorded, and scored blindly to assess compulsive-like behavior based on genotype and gender. Tests included: marble-burying, grooming, open- field and elevated plus-maze. Brain and body weights were also obtained. Mean levels of test outcomes were compared using multi-way ANOVA to test for genotype, sex, genotype*sex, and genotype*sex*age interaction effects with Bonferroni adjustment for multiple comparisons, to further explain any significant interactions.

RESULTS

The marble-burying and grooming assays revealed significant sex-dependent increases in perseverative, compulsive-like behaviors in female Akap13 haploinsufficient mice compared to female wild type (WT) mice by demonstrating increased marble-burying activity (p = .0025) and a trend towards increased grooming behavior (p = .06). Male Akap13 haploinsufficient mice exhibited no behavioral changes (p > 0.05). Elevated plus-maze and open-field test results showed no overt anxiety-like behavior in Akap13 haploinsufficient mice irrespective of sex (p > 0.05, both). No differences in brain weight were found in Akap13 haploinsufficient mice compared to WT mice (p > 0.05). However, female Akap13 haploinsufficient mice weighed more than female WT mice in the 4 to <7 months age range (p = .0051). Male Akap13 haploinsufficient mice showed no differences in weight compared to male WT mice (p = >0.05) at any age range examined.

CONCLUSION

Akap13 haploinsufficiency led to sex-dependent, compulsive-like behavioral changes in a murine model. Interestingly, Akap13 haploinsufficiency also led to a sex-dependent increase in body weight. These results revealed a requirement for AKAP13 in murine behavior, particularly in female mice, and is the first report of AKAP13 involvement in murine behavior. Future studies may examine the involvement of AKAP13 in the pathophysiology of OCD in female humans and may contribute to a better understanding of the role of AKAP13 and sex hormones in the development and exacerbation of OCD.

Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with malignancies

BACKGROUND

Malignancy is known to be associated with an increased mortality rate in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, risk factors contributing to the poor prognosis of patients with SJS/TEN with malignancies remain undefined.

OBJECTIVES

To explore the potential involvement of malignancy and its related factors contributing to the poor outcome of SJS/TEN, in a retrospective study.

METHODS

In total 517 patients with SJS/TEN were enrolled. Forty-seven who sustained various types of malignancies were analysed for numerous malignancy-related factors, including cancer types, clinical stages and chemotherapies given or not before the onset of SJS/TEN.

RESULTS

We found that the mortality rate of patients with SJS/TEN with malignancies was higher than that of patients without malignancies (32%, 15/47 vs. 8·5%, 40/470, respectively) (P < 0·001). The use of phenytoin was significantly higher in the malignancy group. The presence of hepatocellular carcinoma (80%, four of five; P < 0·001; odds ratio 43) and colorectal cancer (67%, two of three; P = 0·022; odds ratio 21·5) significantly increased the death rate of patients with SJS/TEN, whereas lung cancer and urothelial carcinoma did not. Patients who had received ongoing or recent chemotherapy showed higher mortality than those without chemotherapy (P = 0·022; odds ratio 4·95). Furthermore, among the 47 patients with SJS/TEN with malignancies, lower serum albumin, haemoglobin and platelet count were detected in the deceased patients than in the surviving patients before the onset of SJS/TEN.

CONCLUSIONS

Our results suggest that several factors related to malignancies, such as specific cancer types, chemotherapy and malnutrition, may contribute to poor prognosis in patients with malignancies developing SJS/TEN.

Celecoxib exerts protective effects on extracellular matrix metabolism of mandibular condylar chondrocytes under excessive mechanical stress

OBJECTIVE

Excessive mechanical stress is considered a major cause of temporomandibular joint osteoarthritis (TMJ-OA). High magnitude cyclic tensile strain (CTS) up-regulates pro-inflammatory cytokines and matrix metalloproteinases (MMPs) in chondrocytes, while selective cyclooxygenase (COX)-2 inhibition has been shown to be beneficial to cytokine-induced cartilage damage. However, the effect of selective COX-2 inhibitors on mechanically stimulated chondrocytes remains unclear. This study evaluated the effect of celecoxib, a selective COX-2 inhibitor, on extracellular matrix (ECM) metabolism of mandibular condylar chondrocytes under CTS.

METHODS

Porcine mandibular chondrocytes were subjected to CTS of 0.5 Hz, 10% elongation with celecoxib for 24 h. The gene expressions of COX-2, MMPs, aggrecanase (ADAMTS), type II collagen and aggrecan were examined by real-time PCR. Also, prostaglandin E2 (PGE2) concentrations were determined using enzyme immunoassay kit. The levels of MMP and transcription factor NF-κB were measured by western blot while MMP activity was determined by casein zymography.

RESULTS

The presence of celecoxib normalized the release of PGE2 and diminished the CTS-induced COX-2, MMP-1, MMP-3, MMP-9 and ADAMTS-5 gene expressions while recovered the downregulated type II collagen and aggrecan gene expressions. Concurrently, celecoxib showed inhibition of NF-κB and suppression of MMP production and activity.

CONCLUSIONS

Celecoxib exerts protective effects on mandibular condylar chondrocytes under CTS stimulation by diminishing degradation and restoring synthesis of ECM.

Directional single-mode emission from coupled whispering gallery resonators realized by using ZnS microbelts

Ring microcavities were formed by wrapping ZnS microbelts, which act as the waveguide and gain region of the microcavities on the surface of optical fibers. The ring microcavities with the formation of whispering gallery modes have lasing threshold lower (Q-factor higher) than that of the ZnS microbelts. The excitation of TM modes could also be suppressed by the ring geometries of ZnS microbelts. Furthermore, directional single-mode lasing was realized from a coupled asymmetric ring microcavity. The Vernier coupling effect and deformed geometry of the asymmetric ring microcavity were contributed to the stable single-mode operation and directional emission, respectively.

Long-term efficacy of miglustat in paediatric patients with Niemann-Pick disease type C

Niemann-Pick disease type C (NP-C) is a rare inherited neurovisceral disease characterized by progressive neurological manifestations. Oral miglustat was first approved for the treatment of children and adults with NP-C in Europe in 2009. There are still relatively few published data on the long-term efficacy and safety of miglustat in patients with NP-C in clinical practice. We report the effects of up to 6 years of treatment with miglustat 100 mg t.i.d. in five children. Overall, 3/5 patients displayed progressive dysphagia before starting miglustat, and 4/5 showed marked cognitive and/or motor impairment. The mean age at treatment start was 11.6 years, and the median (range) duration of therapy so far is 4 (4.1 to 6.1) years. No treatment dose alterations were required, but therapy was interrupted for 1-3 months at least once in all patients due to supply issues. Swallowing function was stabilised during miglustat therapy, with no significant increase in Han dysphagia scale or aspiration-penetration index scores among four evaluable patients (p > 0.05). Scores on the mini-mental state examination indicated an improvement in cognitive function during the first 3-6 months of miglustat therapy, followed by stabilisation up to 5 years. Ambulatory function remained stable for at least the first 2 years of treatment in most patients, but there was a trend towards deterioration thereafter, possibly related to treatment interruptions. The safety/tolerability profile of miglustat was similar to previous clinical studies, although reports of gastrointestinal disturbances were rare. Overall, miglustat appeared to stabilise key parameters of neurological disease progression.

First Report of Anthracnose Caused by Colletotrichum gloeosporioides on Pistachio (Pistacia vera) in China

In the 1990s, pistachio (Pistacia vera L. 'Kerman' and 'Peters') was introduced in China. They are found in many orchards in Beijing and Gansu and Hebei provinces, northern China. In 2009, a new disease was observed on leaves, stems, and fruits in pistachio orchards in Gansu Province. Disease incidence in 8- to 12-year-old orchards was 30%. Yield losses reached 25%. Symptoms began as discrete, sunken, black spots, approximately 10 mm in diameter, followed by circular lesions that eventually coalesced with tissue death recorded and orange fructifications developed on lesions. Pieces of diseased leaves, stems, and fruits were surfaced sterilized and placed on 2% potato dextrose agar (PDA) at 25°C. A fungus was consistently isolated. After 10 days, cultures on PDA showed aerial, white mycelium that turned gray to grayish black with a salmon-to-orange conidial mass at 25°C and a 12-h photoperiod. Brown, 80 to 120 μm long setae were observed in the acervulus. Conidia were hyaline, fusiform to nearly straight, and averaged 12 to 18 × 3 to 5 μm. On the basis of morphological characteristics, the fungus was identified as Colletotrichum gloeosporioides (Penz.) Sacc. (2). On PDA, 0.5 μg/ml of benomyl was applied for the sensitivity test (3). Benomyl completely inhibited the growth of the fungus. Mycelial DNA was extracted, PCR amplified using ITS1 and ITS4 primers for the ribosomal DNA internal transcribed spacers 1 and 2, and sequenced. The DNA sequence was recorded in GenBank as No. HQ631378. The DNA sequence was blasted showing 99% identity with Accession Nos. GQ144454 and GU004376, for C. gloeosporioides. Pathogenicity tests were conducted under greenhouse conditions at 25°C. Three replicates of 2-year-old 'Kerman' plants were inoculated with mycelial PDA plugs placed on 0.5-cm² stem wounds and then wrapped with Parafilm. Controls were inoculated with PDA plugs without the fungus. After 3 weeks, stem cankers were observed on inoculated plants. Control plants remained healthy. Pathogenicity was also tested on injured leaves and fruits. A 10-μl drop of a spore suspension of 10⁴ conidia/ml was applied on 'Kerman' and 'Peters' leaves and 'Kerman' fruits and placed on plates with a wet filter paper at 25°C. Small, black lesions were observed at 2 days after inoculation. At 7 days, necrotic lesions covered the entire surface. C. gloeosporioides was reisolated from necrotic lesions. Controls did not develop symptoms. C. acutatum has been reported on pistachio in Australia (1), but to our knowledge, this is the first report of anthracnose caused by C. gloeosporioides on pistachio. References: (1) G. J. Ash and V. M. Lanoiselet. Australas. Plant Pathol. 30:365, 2001. (2) J. Y. Lu. Plant Pathogenic Mycology. China Agricultural Press, Beijing, 2001. (3) N. A. R. Peres et al. Plant Dis. 86:620, 2002.

Optical properties of ZnMgO nanowalls grown by plasma-assisted molecular beam epitaxy

ZnMgO nanowalls were prepared by plasma-assisted molecular beam epitaxy without a catalyst on c-Al2O3 substrate. The obtained nanowalls have preferred orientation along c axis. The nanowalls are about 10 to 20 nm in thickness and about 50 nm in height. Only Zn, Mg, O and Al signals are detected in the nanowalls from the energy dispersive spectroscopy (EDS). The Mg content is about 3% in ZnMgO nanowalls. The room temperature photoluminescence (PL) spectra shows the emission peak of the ZnMgO nanowalls at 3.346 eV. The origin of the ultraviolet emission is discussed with the help of temperature-dependent PL spectra. The ultraviolet emission band is free exiton recombination observed in the low temperature PL spectra (at 81 K). We also observe the free-to-acceptor (FA) emission of the ZnMgO nanowalls. The acceptor binding energy obtained from photoluminescence studies is about 123 meV. The results show that Mg doping leads to an increase of the acceptor binding energy. The possible growth mechanism of the ZnMgO nanowall networks was discussed.

Survey of excited state neutron spectroscopic factors for Z=8-28 nuclei

We have extracted 565 neutron spectroscopic factors of sd and fp shell nuclei by systematically analyzing more than 2000 measured (d, p) angular distributions. We are able to compare 125 of the extracted spectroscopic factors to values predicted by large-basis shell-model calculations and evaluate the accuracies of spectroscopic factors predicted by different shell-model interactions in these regions. We find that the spectroscopic factors predicted for most excited states of sd-shell nuclei using the latest USDA or USDB interactions agree with the experimental values. For fp shell nuclei, the inability of the current models to account for the core excitation and fragmentation of the states leads to considerable discrepancies. In particular, the agreement between data and shell-model predictions for Ni isotopes is not better than a factor of 2 using either the GXPF1A or the XT interaction.

Pasteurella multocida bacteremia due to non-bite animal exposure in cirrhotic patients: report of two cases

Pasteurella species are very small gram-negative coccobacilli. They are normal flora found in the oral cavity and gastrointestinal tract of many animals, and can cause various infections including septicemia and pneumonia. Human infection with Pasteurella multocida occurs commonly as a localized cellulitis caused by animal bites. This report described 2 rare cases of P. multocida bacteremia in patients with liver cirrhosis and esophageal varices. Both patients had a history of contact with sick-appearing stray dogs, but neither had been bitten. P. multocida bacteremia should be included in the differential diagnosis of febrile cirrhotic patients with esophageal varices who have a history of non-bite animal exposure. Avoidance of animal contact by immunocompromised patients is the most important factor in preventing pasteurellosis.

Intellectual outcome of patients with congenital hypothyroidism detected by neonatal screening

BACKGROUND AND PURPOSE

Mental retardation is a major sequela of delayed treatment for congenital hypothyroidism; congenital hypothyroidism can be treated early if detected with neonatal screening. We evaluated the intellectual outcomes of 62 patients with congenital hypothyroidism detected by neonatal screening at a major teaching hospital in northern Taiwan. The effects of thyroid pathology, age at the initiation of treatment, socioeconomic status, and severity of hypothyroidism on intellectual outcome were also analyzed.

METHODS

All patients had euthyroid status at the time of intelligence testing. The Chinese Fourth Revision of the Binet-Simon Scales was used to evaluate the patients' intelligence between the ages of 3 and 6 years.

RESULTS

The mean intelligence quotient (IQ) score was 102 +/- 18. Only four of the 62 patients were mentally retarded. Patients with lower initial serum thyroxine concentrations (T4; < 2 micrograms/dL) at the time of diagnosis of congenital hypothyroidism had significantly lower IQs (95 +/- 19, n = 26) than those with higher initial T4 concentrations (106 +/- 16, n = 36; p < 0.05). Patients with fewer than three ossification centers had lower IQs (91 +/- 20, n = 12) than those with three or more (104 +/- 17, n = 36; p < 0.05). Significantly lower IQs were also found in patients with a smaller femoral epiphysis area (< 0.1 cm2) (92 +/- 20, n = 15) than in those with larger epiphyses (106 +/- 15, n = 21; p < 0.05). The type of pathology (ectopia, athyrosis, dyshormonogenesis), age at the start of treatment (before or after 30 days of age), and socioeconomic status did not significantly affect the intellectual outcome.

CONCLUSIONS

Our results indicate that intellectual outcome in Taiwanese patients with congenital hypothyroidism has been improved by neonatal screening and that the severity of hypothyroidism at diagnosis is the most important prognostic factor affecting intellectual outcome in these patients.

Determination of biogenic amines in fish implicated in food poisoning by micellar electrokinetic capillary chromatography

A micellar electrokinetic capillary chromatography (MECC) method for the simultaneous determination of seven biogenic amines in fish was developed. The peaks of all components were successfully separated within 11.5 min. MECC was performed with 0.06 M sodium deoxycholate in 0.02 M borate buffer (pH 9.2)-methanol (95:5, v/v) solvent. The average recoveries for all components ranged from 84.4 to 100.3%. The application of this method to detect amines in fried marlin fillet implicated in a food poisoning incident indicated that a high level (56.24 mg/100 g) of histamine was present in the sample. Another 10 fish samples collected from markets were also analyzed and did not contain detectable levels of histamine (<2.5 mg/100 g).

Loading conditions and cortical bone construction of an artiodactyl calcaneus

Customary nonuniform distributions of physiological bone strains are thought to evoke heterogeneous material adaptation in diaphyseal cortices of some limb bones. Recent studies of artiodactyl calcanei have suggested that the regional prevalence of specific mechanical strain features such as mode and magnitude correlate with specific variations in cortical bone ultrastructure, microstructure and mineralization. These data are also consistent with predictions of current algorithms of mechanically induced bone adaptation. However, detailed characterization of the customary functional strain environment of these bones is needed to understand better the mechanisms of these adaptations. An in vitro loading method and rosette strain gauges were used to record principal strains, maximum shear strains and principal strain angles at multiple locations on ten calcanei of adult male mule deer (Odocoileus hemionus hemionus). Each hind limb was fixed in an apparatus to mimic the mid-support phase of the gait and loaded via the Achilles tendon over a broad range of functional loads (0 to 2943 N). Strains were recorded on the craniolateral, craniomedial, caudal, medial and lateral cortices at mid-diaphysis. Loading variations included the progressive elimination of the ligament and tendon along the caudal calcaneus. The results showed that the cranial cortex experiences longitudinal compressive strains that are nearly equal to the principal minimum strains and that the caudal cortex receives longitudinal tensile strains that are nearly equal to the principal maximum strains. With a 981 N load, the mean principal compressive strain on the cranial cortex was −636+/−344 micro(ε) (mean +/− s.d., N=9) and the mean principal tensile strain on the caudal cortex was 1112+/−68 micro;(ε)x (N=9). In contrast to the cranial and caudal cortices, principal strains in the medial and lateral cortices displayed relatively large deviations from the longitudinal axis (medial, 24 degrees cranial; lateral, 27 degrees caudal). Although shear strains predominated at all gauge sites, variations in maximum shear strains showed no apparent regional pattern or consistent regional predominance. The plantar ligament and tendon of the superficial digital flexor muscle were shown to have important load-sharing functions. These results demonstrate that the functionally loaded artiodactyl calcaneus generally behaves like a cantilevered beam with longitudinal compression and tension strains predominating in opposing cranial and caudal cortices, respectively. Differences in osteon remodeling rates, osteon morphology and mineral content reported previously between the cranial and caudal cortices correlate, in part, with the magnitudes of the principal compressive and tensile strains, respectively. However, material differences that distinguish the medial and lateral cortices from the cranial and caudal cortices could not be primarily attributed to locally increased shear strains as previously suggested. Variations in osteon and/or collagen fiber orientation may correlate more strongly with principal strain direction.

Susceptibility testing and clinical effect of fusidic acid in oxacillin-resistant Staphylococcus aureus infections

One hundred and six oxacillin-resistant Staphylococcus aureus (ORSA) isolates collected from various clinical specimens at Mackay Memorial Hospital during the period from 1997 to 1998 were tested. The MICs of fusidic acid against ORSA isolates were in the range of 0.06 microgram/mL to 4 micrograms/mL. There was only one ORSA isolate (0.9%) resistant to fusidic acid in this study. Twenty-four patients with ORSA infection were enrolled into the study between July 1997 to June 1998. Four patients without the evidence of sepsis received oral fusidic acid only. The other 20 patients with sepsis received intravenous glycopeptide first, and then the oral fusidic acid for 7 to 10 days. Oral fusidic acid was used for mild ORSA infection and achieved satisfactory clinical outcome. In severe ORSA infection, it was found that sequential therapy with fusidic acid had relapsed in three patients. We concluded that oral fusidic acid achieved a satisfactory outcome in our patients with mild ORSA infection. In such cases, fusidic acid may provide an effective alternative treatment of choice. The rare side effect of granulocytopenia and jaundice was noted in our case series. The side effect may be not so rare as previously thought, if it had been carefully looked for.

Species identification and phylogenetic relationships based on partial HSP60 gene sequences within the genus Staphylococcus

The phylogenetic relationships among 36 validly described species or subspecies within the genus Staphylococcus were investigated by cloning and sequencing their 60 kDa heat-shock protein (HSP60) genes using a set of universal degenerate HSP60 PCR primers. The cloned partial HSP60 DNA sequences from nine Staphylococcus aureus strains were highly conserved (97-100% DNA sequence similarity; mean 98%), indicating that the HSP60 gene of multiple isolates within the same species have little microheterogeneity. At the subspecies level, DNA sequence similarity among members of S. aureus, Staphylococcus schleiferi, Staphylococcus cohnii and Staphylococcus capitis ranged from 91 to 98%. At the interspecies level, sequence similarity among 23 distinct species of staphylococci ranged from 74 to 93% (mean 82%). By comparison, the highest sequence similarity of Bacillus subtilis and Escherichia coli with members within the genus Staphylococcus was only 70 and 59%, respectively. Importantly, phylogenetic analysis based on the neighbour-joining distance method revealed remarkable concordance between the tree derived from partial HSP60 gene sequences and that based on genomic DNA-DNA hybridization, while 16S rRNA gene sequences correlated less well. The results demonstrate that DNA sequences from the highly conserved and ubiquitous HSP60 gene offer a convenient and accurate tool for species-specific identification and phylogenetic analysis of staphylococci.

Intellectual outcomes of patients with congenital hypothyroidism not detected by neonatal screening

Mental retardation is a major sequela of delayed treatment of congenital hypothyroidism. In this study, we investigated the intellectual outcomes of patients with congenital hypothyroidism diagnosed before a nationwide screening project started. Eighty-two patients had intelligence tests done while in the euthyroid state. Their mean intelligence quotient (IQ) was 78 +/- 21 (+/- SD) (n = 79). The mean verbal IQ was significantly higher than the mean full-scale IQ. The mean IQs of both ectopic thyroid (84 +/- 21, n = 28) and dyshormonogenic patients (85 +/- 14, n = 18) were significantly higher than that of patients with athyrosis (64 +/- 18, n = 19) (p < 0.05). Patients who were treated before 3 months of age had significantly higher mean IQs (90 +/- 16, n = 16) than those treated after 3 months (75 +/- 21, n = 63) (p < 0.01). Our results confirm that both patients with ectopic thyroids and those with dyshormonogenesis have better intellectual outcomes than athyrotic patients do, and that early treatment improves the intellectual outcome of patients with congenital hypothyroidism.

Psoas abscess: a 10 year review

Psoas muscle abscesses are rarely encountered yet, and pose diagnostic and therapeutic challenges because of nonspecific clinical presentations. We retrospectively reviewed the medical records of adults with a psoas muscle abscess who were admitted to our hospital from January, 1988 to May, 1998. Over this ten year period, psoas abscesses were found in 11 cases. Six cases were primary and Staphylococcus spp. was the most commonly isolated. Five cases were a secondary psoas abscess while urological problems were the most common underlying condition. Fever, chills, lower back or flank pain and a palpable mass were the most common manifestations. Only one patient presented the classic triad of fever, flank pain, and limitation of hip movement (a typical psoas sign). Leukocytosis was the most common laboratory finding. Two of 11 cases presented septic shock. Two patients were admitted to the hospital with the initial diagnosis of psoas abscesses. Computerized tomographic (CT) scans accurately confirmed the clinical diagnosis in 9 of 11 patients. Diagnosis was then established one each by ultrasound (US) and magnetic resonance imaging (MRI), respectively. Four of 11 patients had negative findings initially by US. All patients were managed with drainage and antibiotics, nine were drained surgically, and two were managed with percutaneous drainage under CT guidance. Two patients died. Because of the lack of the classic symptoms and signs in most cases, a high degree of suspicion is important for early diagnosis of psoas abscess. CT scan is the standard technique of diagnosis. The prognosis is generally good with appropriate antibiotic treatment and complete drainage.

Biomechanical implications of mineral content and microstructural variations in cortical bone of horse, elk, and sheep calcanei

BACKGROUND

Artiodactyl and perissodactyl calcanei have been recently introduced as models for examining bone for mechanically mediated adaptation. We have reported substantial regional variations in cortical bone microstructure and mineral content within the same cross-section of mule deer calcanei. In part, these variations may be adaptations accommodating the customary presence of predominantly tension, compression, and shear strain modes in mutually exclusive cortical locations. Calcanei from skeletally mature horses, elk, and sheep were examined in order to corroborate these previous findings.

METHODS

From each species, one calcaneus was obtained from each of 13 animals. Each bone was cut transversely near mid-shaft into two segments and examined for mineral (ash) content. From each species, an additional segment obtained from each of 7 of the original 13 bones was examined for microstructure using 50x backscattered electron images. Regions examined included the compression (cranial), tension (caudal), and medial and lateral (shear) cortices. Periosteal (P), middle (M), and endosteal (E) regions were also examined separately within the compression and tension cortices. Quantified microstructural parameters included: (1) secondary osteon population density (OPD), (2) fractional area of secondary bone (FASB), (3) porosity, (4) population density of new remodeling events (NRE = resorption spaces and newly forming secondary osteons), and (5) secondary osteon diameter and minimum-to-maximum chord ratio.

RESULTS

Results in each species showed variations that are considered to be mechanically important and are similar to those reported in mule deer calcanei. Mineral content data suggest that remodeling activity in the compression, medial, and lateral cortices was occurring at a slower rate than remodeling in the tension cortex. In comparison to the tension cortices, the compression cortices have approximately 6.0% higher mineral content (P < 0.007) and 35% higher OPD (P < 0.01). Additionally, the compression cortices have more nearly perfectly round osteons and lower FASB, porosity, NRE, and osteon diameter (P < 0.05; except for FASB in horse where P = 0.087 and NRE in sheep where P = 0.520). However, patterns of microstructural variations between intracortical regions (P, M, E) are inconsistent when compared to data reported in mule deer calcanei. Microstructural characteristics between the medial and lateral cortices were similar although some significant differences were identified. In general, the microstructure of the medial and lateral cortices differ from the neighboring compression and tension cortices.

CONCLUSIONS

Differences in mineral content and microstructure between opposing compression and tension cortices of these three species resemble differences previously reported in mule deer calcanei. The majority of the microstructural variations can be explained in the context of strain-magnitude-based rules of Frost's Mechanostat Theory of mechanically induced bone adaptation. These variations may also be strongly influenced by the strain mode predominating in each cortical location. The hypothesis that intracortical material adaptations are correlated with progressive transcortical strain magnitude variations is not supported by the inconsistent transcortical variations in material organization. These interpretations do not preclude the possibility that other specific strain features may contribute to a complex adaptive signal.

[Characterization of haemolysis of the Vibrio parahaemolyticus no.93]

Vibrio parahaemolyticus is a causative bacterium of food poisoning, and the haemolysin produced by this organism has been considered as one of the important virulence factors. In order to understand the pathogenic mechanism of this bacterium, the characteristics of haemolysin from Vibrio parahaemolyticus isolated from Taiwan were studied. One of the clinical strains, V. parahaemolyticus No.93, presents a weak hemolytic zone on 7% NaCl-Wagatsuma medium. The DNA hybridization results show that V. parahemolyticus has neither tdh nor trh gene. V. parahaemolyticus No.93 shows obviously hemolytic zone on 3%-NaCl Wagatsuma medium (human blood). The crude extracellular protein of V. parahaemolyticus No. 93 was evaluated for its heat tolerance and enzyme activities by media assay. The results show that this crude extracellular protein is thermolabile. The crude extracellular protein of V. parahaemolyticus No.93 was analyzed on 10% SDS-PAGE and an apparent band of 64 kDa protein was observed. Furthermore, the crude extracellular protein was analyzed by running gelatin-SDS-PAGE and hemoglobin-SDS-PAGE, and three clear zones on 62 kDa, 52 kDa and 41 kDa were observed on both SDS-PAGEs. Thus we propose that the crude extracellular protein of the V. parahaemolyticus No.93 can degrade gelatin as well as hemoglobin. Whether these protease being the virulence factors of Vibrio parahaemolyticus No.93 needs to be further studied.

Pelvic abscess caused by Salmonella: a case report

We report a case of a 28-year-old woman, with no history of sexual activity, who developed a cul-de-sac abscess and bilateral salpingitis caused by Salmonella group C1. This paper documents our limited experience with such an unusual event and suggests that gastrointestinal pathogens should be considered as potential etiologic organisms in patients presenting with pelvic infection and gastroenteritis.

Temperature variations in upright mechanical freezers

We examined temperature deviations from the set temperature in specific locations, between-freezer temperature variability, and the effect of defrosting on temperature deviation in a group of 15 upright mechanical freezers, part of a biological sample bank of a large prospective cohort study. By using an Omega Type T Thermocouple Microcomputer thermometer with the freezers set at -80 degrees C, the internal temperature (12 locations in each freezer) ranged from -90 degrees C to -43.5 degrees C. Overall, internal temperatures tended to be appreciably warmer in the upper and front sections of the freezers. Upright front-loading mechanical freezers, which are widely used in research laboratories throughout the world, may not be optimally suited to preserve human biological samples for long-term banking in epidemiology.

Molecular analysis of an extracellular protease gene from Vibrio parahaemolyticus

The structural gene prtVp encoding the extracellular protease of Vibrio parahaemolyticus strain 93 was cloned in Escherichia coli and sequenced. The cloned DNA fragment contained a 1761 bp ORF encoding a 587 amino acid protein. The deduced polypeptide is composed of a 25 amino acid signal peptide and a 562 amino acid extracellular polypeptide with a calculated molecular mass of 63,156 Da. Protease analysis using a gelatin-containing SDS-polyacrylamide gel detected the presence of a 62 kDa protease that was present in the culture supernatant fractions of the wild-type V. parahaemolyticus strain and of E. coli bearing a pUC119 recombinant with the prtVp DNA insert. The protease activity was inhibited by zinc- and metal-specific inhibitors such as EDTA and 1,10-phenanthroline, which suggested that it is a metalloprotease. The deduced amino acid sequence of PrtVp has 32% identity with that of the collagenase of Vibrio alginolyticus, but has no identity with those of the bacterial proteases. A conserved zinc-binding domain was also found in PrtVp from homology comparison with other metalloproteases. This PrtVp can cause weak haemolysis on blood agar.

[Comparison of the bactericidal effects of acid glutaraldehyde and alkaline glutaraldehyde]

Two glutaraldehydes, acid glutaraldehyde (sonacide) and alkaline glutaraldehyde (cidex) were evaluated for their bactericidal effect under different conditions. Two percent acid and alkaline glutaraldehyde could destroy vegetative bacteria and spores in twenty minutes. Less than 2.9 percent residual contamination rate could be achieved after immersing equipment in 0.1 percent acid glutaraldehyde or 0.5 percent alkaline glutaraldehyde for 30 minutes. Complete sterilization could be obtained by using two percent acid glutaraldehyde, while 0.5 percent residual contamination was noted after equipment had been immersed in two percent alkaline glutaraldehyde for one month. Acid glutaraldehyde could destroy bacteria completely in 30 minutes even after the solution had been standing for one month, but alkaline glutaraldehyde had an 11.4 to 26.9 percent residual rate. There were no deleterious effects on metal equipment after immersing for 14 days, but yellowish discoloration and hardening were observed on plastic and rubber equipment. It is concluded that both of these two glutaraldehydes are effective bactericides, but acid glutaraldehyde is more effective even after standing for one month or after dilution.

[Clinical observations of dengue fever among children]

From November 1987 to October 1988, seventy-seven cases diagnosed as dengue fever and confirmed by viral culture or serological examination in the Pediatric Department of Kaohsiung Medical College Hospital were studied. In nearly two thirds (64.9%) of the total cases, the ages were between 10 and 14 years old. No significant sexual difference could be found in this study. Two peaks of cases distribution occurred at November 1987 and October 1988. The major clinical manifestations of Dengue Fever were fever, headache, skin rash and cough. Nearly half of the total cases had nausea, vomiting, myalgia and skin itching. 29 cases (37.7%) had hemorrhagic complications during the course of disease. The most common features of hemorrhage was petechiae followed by epistaxis. Two cases were confirmed as hemorrhagic dengue fever and one was also dengue shock syndrome. Most (92.5%) of the cases had body temperatures over 38.5 degrees C at the onset of the disease. The mean duration of fever was 5.9 days. No fatality was found. It is concluded that eradication of vectors in the school environment might be one of the major points of disease control according to the age distribution of this study. The appearance of hemorrhagic dengue fever is a major problem and should be closely followed by clinicians and workers of public health in Taiwan.

High-performance ion-pair partition chromatography of sulfa drugs. Study and optimization of chemical parameters

High-performance ion-pair partition chromatography is shown to be a versatile, efficient method for separating sulfonamides. For a group of fourteen sulfa drugs varying widely in pKA and hydrophobicity, the effect of mobile phase composition, counterion composition, pH, and ionic strength on their ion-pair partition chromatographic separation using tetrabutylammonium as the counterion and n-butanol-n-heptane as the mobile phase is shown. Wide variation in k' and a is possible by changing these parameters. Silica columns coated with buffered aqueous solutions of tetrabutylammonium sulfate resulted in efficiencies of 4000-6000 theoretical plates per 25 cm. These columns are stable for long periods of time, and can be stripped and re-used in the adsorption mode with little or no loss in efficiency. Several chromatograms are presented in order to illustrate the performance of ion-pair partition chromatography.