Identification of novel translocation between short arm of chromosome 4 and long arm of chromosome 6 in an infertile man using Interphase Chromosome Profiling (ICP)

Conventional cytogenetics has always been a favourite to detect chromosomal aberrations. Carriers of chromosomal translocation are often phenotypically normal but are infertile. Couples are often advised to go for karyotyping, but culture failure or improper metaphase spread with poor banding often makes the analysis difficult. We report here a novel translocation between short arm of chromosome 4 and long arm of chromosome 6 in an infertile man using an advanced molecular cytogenetic technique of Interphase Chromosome Profiling (ICP).

Deterministic recurrences of sequential F-wave latencies

PURPOSE

Historically, F-waves have been classified by various linear descriptors like persistence, latency, duration, amplitude, chrono-dispersion and number of repeater waves. But because physiological signals are notoriously nonlinear in nature, the objective of this study was to apply modern nonlinear methodology to F-waves sequences to assess the presence of underlying deterministic structures. Subtle changes in these sensitive markers could give early warnings for neurological problems.

METHODS

F-waves were elicited in the left abductor pollicis breivs muscle by supra-maximally stimulating the median nerve percutaneously at the wrist. Approximately 200 stimuli were applied (0.5 Hz) to three subjects for at least four trials each. F-wave latencies were measured and assembled into sequences in proper order. Recurrence quantification analysis (RQA) was applied to these F-wave sequences from different dimensional perspectives. Controls were constructed by randomly shuffling the ordered sequences. RQA has a theoretical mathematical foundation and practical performance record on numerous other physiological systems.

RESULTS

Recurrence analysis showed that sequential F-waves form recurrent patterns with parallel trajectories with deterministic and laminated structures. These features could be destroyed by randomizing the sequential orders of F-waves, upholding the hypothesis that sequences of F-waves are deterministically formed from underlying physiological rules.

CONCLUSIONS

F-wave time series are fully amenable to recurrence analysis which provides a higher-dimensional perspective on the physiological dynamic. The recurrent patterns are complex, but not random, meaning that physiological rules dominate the sequence of F-waves. Disease processes within the central or peripheral nervous system may alter F-wave patterns. If so, RQA potentially may be a diagnostic tool to help discern subtleties between altered deterministic rules operating in disease.

Sensitivity and specificity of electrodiagnostic criteria for CIDP using ROC curves: comparison to patients with diabetic and MGUS associated neuropathies

INTRODUCTION

Electrodiagnostic testing plays a key role in the characterization of neuropathies. To this end, sets of electrodiagnostic criteria have been proposed to define chronic inflammatory demyelinating polyneuropathy (CIDP). These criteria sets differ because of the number of data points within the sets, the number of required abnormal measures within a criterion, and the cutoff value of each measure.

OBJECTIVE

To evaluate the sensitivity and specificity of the published criteria for defining CIDP in comparison to diabetic polyneuropathy (DMPN) and monoclonal gammopathy of undetermined significance associated neuropathies (MGUS-PN).

DESIGN/METHODS

Electrodiagnostic studies of 21 patients with biopsy proven CIDP, 35 patients with MGUS-PN, and 82 patients with DMPN were analyzed. Data were compared against 4 different published criteria sets. Receiver operator characteristic (ROC) curves were used to determine the ideal threshold values for individual electrodiagnostic parameters.

RESULTS/CONCLUSION

None of the currently published criteria sets could adequately separate CIDP from DMPN and MGUS-PN. Analysis of our data using ROC curves shows that the best discrimination was achieved using the following criteria: (1) FWL>145%ULN in one nerve or 110%ULN in two nerves in separate nerve roots. (2) Motor CV<90%LLN in four nerves with at least one nerve <70%LLN. Furthermore, proximal-to-distal amplitude ratio alone is not adequate to define conduction block. Although electrodiagnostic studies are important for evaluating CIDP, these studies by themselves cannot be used to define this neuropathy.

Percutaneous vertebroplasty: an experience of 31 procedures

A prospective study of 31 percutaneous vertebroplasty procedures (PVP) in 22 patients treated during January 2000 to December 2001 is presented. PVP was performed using polymethylmethacrylate (PMMA) to treat vertebral collapse due to osteoporosis and vertebral metastasis, to obtain analgesia and spinal stabilization. We analyze the efficacy and complications related to the procedure. PVP is a safe, effective and a daycare surgery. It can be performed under local anesthesia and has minimal and manageable complications.

Ex Vivo Cytokine Activation of Peripheral Blood Stem Cells: A Potential Role for Adoptive Cellular Immunotherapy

Ex vivo activation of peripheral blood stem cells (PBSC) using interleukin-2 (IL-2) results in cytotoxic effector cells that may possess beneficial in vivo effects. We proposed to evaluate ex vivo stimulation of PBSC using various cytokines alone or in combination to optimize their function. Cytokine-activated PBSC were analyzed for tumor-directed cytotoxicity and their ability to remove tumor cells from long-term clonogenic assays. Mononuclear cells were obtained from the apheresis products of normal donors and cultured with IL-2 (1000 U/ml), interferon-alpha (IFN-alpha) (1000 U/ml), or IL-12 (50 U/ml) either alone or in combinations at 37 degrees C and 5% CO(2) for 24 h. Colony-forming unit-tumor (CFUT) assays were initiated using cytokine-activated PBSC with varying concentrations of MCF-7 or SKBR-3 human breast cancer cells. Standard 4-h (51)Cr-release assays were performed with cytokine-activated PBSC using MCF-7 or SKBR-3 cells as targets. Activation of PBSC with IL-2, IFN-alpha, or IL-12 resulted in enhanced cytotoxicity against the two breast cancer cell lines when compared to controls. PBSC activated with IL-2 and IFN-alpha or IL-2 and IL-12 were more cytotoxic than PBSC activated with single cytokines (p = 0.0004 for MCF-7 cells and p < 0.001 for SKBR-3 cells). Using clonogenic assays, IL-2-activated PBSC reduced the number of CFU-T to a greater extent than did IL-12 or IFN-alpha-activated PBSC (p = 0.0006). However, PBSC activated with a combination of IL-2 and IFN-alpha or IL-2 and IL-12 demonstrated 95% and 90% reductions, respectively, compared to 79% reduction using IL-2-activated PBSC (p < 0.0001). The greatest reduction in cytotoxicity occurred in the cell populations depleted of CD56(+) cells (p = 0.016) and CD8(+) CD56(+) cells (p = 0.002), suggesting that the effector cell population includes a combination of cytotoxic CD8(+) T cells and CD56(+) natural killer cells. These results demonstrate that the ex vivo activation of PBSC with cytokines, either alone or in combination, enhances cytotoxicity against, and removal of two human breast cancer cells. The combinations of IL-2 with IFN-alpha or IL-12 are most beneficial in cytotoxicity and purging assays. These results could play an important role in designing adoptive cellular immunotherapy clinical trials in the autologous hematopoietic stem cell transplant setting.

Paclitaxel vs cyclophosphamide in peripheral blood stem cell mobilization: comparative studies in a murine model

Paclitaxel is a promising drug for the treatment of breast and ovarian cancer. It also may play a role in mobilization of peripheral blood stem cells (PBSC), as an alternative to cyclophosphamide (Cy). We investigated the PBSC-mobilizing potential of paclitaxel compared to Cy in a murine model. C57B1/6 mice were primed with intraperitoneal injections of Cy (200 mg/kg) or paclitaxel (60 mg/kg) and were sacrificed 4, 6, 8, or 10 days later. Spleens were harvested and processed to obtain low-density mononuclear cells that were used as PBSC. The number of hematopoietic progenitors (CFU-C) on day 4 was significantly higher in the paclitaxel group when compared to mice receiving Cy (72.0 +/- 1.8 vs 9.8 +/- 2.8, p < 0.001). By day 6, CFU-C became significantly higher in the Cy-treated group compared to the paclitaxel-treated group (195.6 +/- 31.9 vs 95.8 +/- 20.7, p < 0.05) and this trend was maintained. However, the total number of CFU-C recovered per spleen was greater in the paclitaxel-treated group (1.27 x 10(5) +/- 0.53 x 10(5) vs 1.06 x 10(5) +/- 0.36 x 10(5), NS). In contrast to paclitaxel, mobilization with Cy was associated with marked perturbation in the proportion of lymphoid cell subsets in the PBSC population along with functional impairment of lymphocytes. After 24 hours of in vitro IL-2 activation, the cytotoxic effector cell function of the Cy-mobilized PBSC population was lower than that of paclitaxel-mobilized cells when tested against three tumor cell lines (B16, melanoma; C1498, AML; and Yak-1, lymphoma). These results indicate that paclitaxel is an efficient mobilizer of PBSC, leading to early (day 4 to 6) mobilization of PBSC when compared to Cy (day 6 to 8). In addition, paclitaxel was associated with less perturbation of phenotypic and functional characteristics of cells contained within the mobilized PBSC population.

Induction of DNA damage, inhibition of DNA synthesis and suppression of c-myc expression by the anthracycline analog, idarubicin (4-demethoxy-daunorubicin) in the MCF-7 breast tumor cell line

PURPOSE

Studies were designed to elucidate the basis for the antiproliferative activity of the anthracycline antibiotic, idarubicin (4-demethoxy-daunorubicin) in MCF-7 breast tumor cells.

METHODS

Growth inhibition was evaluated using the MTT tetrazolium dye assay, induction of DNA strand breaks was determined by alkaline elution, inhibition of DNA synthesis was assessed by measuring the incorporation of labelled thymidine into DNA, modulation of the expression of the c-myc oncogene was determined by Northern blotting and the induction of apoptosis was evaluated by alkaline unwinding, static field gel electrophoresis, terminal end labelling and assessment of cell morphology.

RESULTS

MCF-7 cells were relatively sensitive to idarubicin, with an IC50 value for growth inhibition of approximately 0.01 microM. While DNA strand breakage was not evident below a concentration of 0.1 microM idarubicin, where growth inhibition exceeded 70%, both the inhibition of DNA synthesis and suppression of c-myc expression closely paralleled the profile of antiproliferative activity for idarubicin. Finally, while exposure to idarubicin resulted in a substantial loss of viable cells within 48-72 h, there was no morphological evidence of apoptotic body formation. The absence of apoptosis in cells exposed to idarubicin was supported by studies demonstrating the absence of DNA fragmentation using gel electrophoresis, alkaline elution and in situ DNA end-labelling assays.

CONCLUSIONS

The results of these studies extend previous results from this laboratory indicating an association between suppression of c-myc expression, inhibition of DNA synthesis and growth arrest by topoisomerase II inhibitors, as well as the lack of induction of apoptotic cell death by topoisomerase II inhibitors in MCF-7 breast tumor cells.

Virulence factors in Escherichia coli from urinary tract infections in patients with spinal injuries

A collection of 70 strains of Escherichia coli from urinary tract infections in spine-injured patients undergoing long-term bladder catheterization were tested for characteristics that have been associated with the ability to produce pyelonephritis. The incidence of the virulence factors were: mannose-resistant haemagglutinins (30%), P-fimbriae (17%), haemolysin (27%), K-antigens (28%) and aerobactin (by bioassay 33%, by gene probe 39%). Only 54% of the strains belonged to the O-serotypes usually associated with urinary tract infections. E. coli carrying the full complement of virulence factors were rare in the urinary tract of the spinal patients and were not associated with episodes of symptomatic pyelonephritis. It is clear that the neuropathic bladder and the presence of the catheter permits a wide variety of bacterial types to colonize the urinary tract and cause infection of the kidney. The identification of host markers rather than bacterial factors is suggested as a more fruitful approach to the early detection of cases likely to progress to pyelonephritis in this group of patients.

Scanning electron microscopy of bacterial biofilms on indwelling bladder catheters

Fifty Foley bladder catheters that had been indwelling for periods ranging from 3 to 83 days (mean 35 days) were examined for the presence of bacterial biofilm. Scanning electron microscopy on freeze-dried cross-sections and fixed, critical point-dried longitudinal sections revealed biofilm formation on the luminal surfaces of 44 of the catheters. Culture of urine samples and sonicates from catheters revealed that the prevalence of bacteriuria was less than that of catheter colonization. A wide range of nosocomial species were found colonizing the catheters, Escherichia coli being most often isolated. The bacterial composition of the biofilms ranged from single species to mixed communities containing up to four species. There was no relationship between the length of time that the catheter had been in situ and the extent of biofilm formation. The biofilms varied in thickness from 3 to 490 microns and were visible as layers of bacterial cells up to about 400 cells deep, embedded in a matrix.

The effect of intravesical Marcain instillation on hyperreflexic detrusor contractions

Thirty-six patients with suprasacral spinal injury were treated with intravesical local anaesthetic instillation. Eighteen of 32 patients (56%) were converted from an 'ice water positive' hyperreflexic state to an 'ice water negative' state by bupivacaine hydrochloride. Four patients treated with lignocaine hydrochloride showed no benefit. Intravesical local anaesthetic instillation is suggested as a possible treatment for selected cases of detrusor hyperreflexia in patients on intermittent catheterisation.

International infant mortality rankings: a look behind the numbers

The very unfavorable infant mortality ranking of the United States in international comparisons is often used to question the quality of health care there. Infant mortality rates, however, implicitly capture a complicated story, measuring much more than differences in health care across countries. This article examines reasons behind international infant mortality rate rankings, including variations in the measurement of vital events, and differences in risk factors across countries. Its goal is to offer a broader context for more informed debate on the meaning of international infant mortality statistics. These statistics offer opportunities to identify strategies for improving the U.S. health care system and learn from other countries that have been more successful.

Activity of some antiseptics against urinary tract pathogens growing as biofilms on silicone surfaces

The activity of chlorhexidine, mandelic acid and a mandelic/lactic mixture were tested against biofilms of four species of gram-negative nosocomial organisms that commonly infect the catheterized urinary tract. Cells growing on silicone discs were exposed to concentrations of agents used in bladder instillation. Citrobacter diversus biofilms proved to be sensitive to all three agents. Pseudomonas aeruginosa, Proteus mirabilis and Klebsiella pneumoniae all survived well in chlorhexidine but their viability was significantly reduced by the mandelic acid formulations. These results suggest that bladder instillations of mandelic acid or mandelic/lactic acids would be more effective than chlorhexidine in eliminating biofilms from catheter surfaces.

Significance of false-positive serologic tests for histoplasmosis and blastomycosis in an endemic area

False-positive serologic tests for histoplasmosis (H) and blastomycosis (B) are common in populations from endemic areas. In order to determine the significance of false-positive test results, we reviewed the final diagnoses of all patients whose sera were submitted to our laboratory for radioimmunoassay (RIA) and immunodiffusion (ID) during a 3-yr period. Of the 263 patients whose sera were examined, 29 (11%) had H or B; 41 (17.5%) of the remaining 234 patients had false-positive test results. Of these 41 patients, 31 were positive for H alone, and 10 had antibodies to both H and B. All three patients with false-positive ID tests for histoplasmosis also had positive titers (greater than or equal to 1:16) on RIA. No patient had a false-positive ID result for blastomycosis. The percentage of patients in each of five major diagnostic categories with and without false-positive serologic tests was similar (p greater than 0.05). The majority of patients had pulmonary infections, almost half of which were granulomatous infections other than H or B; this reflects the clinical indications for requesting fungal serologic tests. A positive fungal serology is not useful in suggesting the presence of a pulmonary disease other than H or B in patients from an endemic area suspected of having a pulmonary mycosis.

Activity of antiseptics against Escherichia coli growing as biofilms on silicone surfaces

The activity of chlorhexidine, acetic, lactic and mandelic acids were examined against biofilms of Escherichia coli established on silicone discs and against the test strain growing in suspension in urine. The results showed that the concentrations of chlorhexidine and acetic acid normally used for bladder instillations to control infections in patients with indwelling catheters failed to eliminate cells from the biofilm in exposure periods of up to 2 h. Lactic acid (1% v/v) had a bactericidal effect on planktonic cells but poor activity against cells in the biofilm. Mandelic acid (1% v/v), and mandelic (1% v/v) and lactic acid (1% v/v) mixtures eliminated organisms from both suspensions and biofilms. It is suggested that these solutions be considered as alternatives to acetic acid and chlorhexidine for the washing of catheterized bladders.

Dynamic urethral function in the assessment of spinal injury patients

Forty-two spinal injury patients underwent single or sequential urodynamic studies to assess the value of dynamic urethral pressure using transducer tipped catheters. Three groups of patients were identified: those with poor detrusor function, those with unsustained dyssynergia and those with sustained dyssynergia. All patients demonstrated some dyssynergia. Urethral needle EMG mirrored urethral pressure changes accurately. The addition of dynamic profilometry to fluoroscopy, detrusor pressure and urethral EMG has clarified our understanding of lower urinary tract behaviour after cord lesions.

Identification of semen in 500 patients seen because of rape

Of 500 patients seen because of rape, semen was identified in vaginal secretions by the identification of spermatozoa in 61%, by an acid phosphatase value of 50 units or more in 40%, and by the identification of a foreign blood group substance or a high titer of own blood group substance in 16%. The addition of the determination of the acid phosphatase to the search for spermatozoa identified semen in only 1.4% more patients, or a total of 62.4%. Identification and titers of blood group substance were confirmatory only, but further characterized the source of the semen in 25% of those patients with spermatozoa. Spermatozoa were identified for as long as 48 hours, and elevated acid phosphatase was not found after 18 hours. Acid phosphatase was elevated in only 62% of patients with spermatozoa.

EEG in brain abscess: its value in localization compared to other diagnostic tests

The EEG records of 13 cases of brain abscess were reviewed for their value in localization. Of the 11 cases of supratentorial abscesses localization was achieved in 10, and correct lateralization in the remaining 1 case. Two other cases were cerebellar abscesses; 1 of them showed a false cerebral localization; the other showed no focal abnormalities. The most consistent EEG localizing sign was focal arrhythmic delta waves. These were as slow as 0.5 c/sec in 6 of the 13 cases. Epileptiform discharges in the pre-operative EEG were seen in 4 of the 13 cases. Asymmetry of beta activity correctly lateralized the abscess in 7 of the 11 supratentorial abscesses. Generalized abnormalities when present correlated with depression of consciousness rather than with the duration of illness or the presence of raised intracranial pressure. Indium brain scans were done in 6 supratentorial abscesses and provided correct or approximate localization in 5. Carotid angiograms were also done in 7 cases and localized the abscess in 6. Our findings show that the EEG is comparable to brain scans and contrast radiological studies in localizing supratentorial abscesses. We feel that the combination of EEGs and brain scanslization in suspected brain abscess.