Severe anemia, panserositis, and cryptogenic hepatitis in an HIV patient infected with Bartonella henselae. Bartonella spp. constitute emerging pathogens of worldwide distribution. Bacillary angiomatosis is the most frequent skin manifestation of bartonelloses; nevertheless, B. henselae infection should always be considered systemic, especially in immunodeficient individuals. The authors report the case of an AIDS patient with bacillary angiomatosis, who had concurrent severe anemia, hepatitis, peritonitis, pleuritis, and pericarditis. Clinical manifestation, electronic microscopic examination of erythrocytes, and histopathology of a papule biopsy suggested a Bartonella sp. infection. Multiple genes were target by PCR and B. henselae DNA was amplified and sequenced (GenBank accession number EF196804) from the angiomatous papule. Treatment with clarithromycin resulted in resolution of the bacillary angiomatosis, fever, anemia, panserosites, and hepatitis.


Common tasks in microscopic and ultrastructural image analysis using ImageJ. Cooperation between research communities and software-development teams has led to the creation of novel software. The purpose of this paper is to show an alternative work method based on the usage of ImageJ (http://rsb.info.nih.gov/ij/), which can be effectively employed in solving common microscopic and ultrastructural image analysis tasks. As an open-source software, ImageJ provides the possibility to work in a free-development/sharing world. Its very "friendly" graphical user interface helps users to manage and edit biomedical images. The on-line material such as handbooks, wikis, and plugins leads users through various functions, giving clues about potential new applications. ImageJ is not only a morphometric analysis software, it is sufficiently flexible to be adapted to the numerous requirements tasked in the laboratories as routine as well as research demands. Examples include area measurements on selectively stained tissue components, cell count and area measurements at single cell level, immunohistochemical antigen quantification, and immunoelectron microscopy gold particle count.


Perforated appendicitis: urgency or interval surgery? The purpose of this study was to report how conservative treatment with interval appendectomy (IA) of ruptured appendicitis with localized abscess or phlegmon affects the outcome of patients. From January 2001 to December 2005, 121 patients with ruptured appendicitis with localized abscess or phlegmon were treated in our hospital. 104 patients underwent appendectomy (Group A); 17 patients underwent antibiotic treatment with interval appendectomy (Group B). The clinical characteristics (age and sex), laboratory data, mean time to surgery, operative time, complications, hospital days and cost of hospitalization were recorded. The sex, age, white blood cell count (WBC), body temperature, operation time, length of stay after surgery, first flatus, oral feeding, passage of stools, cost and overall complications (including wound infection, wound disruption, intra-abdominal abscess and enterocutaneous fistula) were not significantly different between the two groups. However, the length of stay after diagnosis established of group B was significantly longer in group B than in group A. Conservative treatment with IA is a safe and effective method to treat perforated appendicitis with localized abscess and phlegmon, but the recovery time may be longer and also the hospital stay (since diagnosis established). Thus this method is not cost-saving.


Checking concordance between findings and diagnoses in sonographic reports by a knowledge-based documentation system. Sonographic reports are examiner-dependent and may not always be reliable. We investigated concordance between documented findings and diagnostic conclusions--not the objective correctness of both--with the help of a knowledge-based documentation system. The knowledge-based documentation system SonoConsult (SC) is routinely used in the ultrasound unit of a gastroenterological clinic for more than four years. Physicians documented findings with goal directed questionnaires, and diagnostic conclusions with free text. The consistency of documented findings and diagnoses was checked with the help of SC in a two-step process: 1. the diagnoses inferred by SC based on the documented findings were compared to the diagnoses of the physicians stated as free text. 2. In case of discrepancies, a more thorough comparison was performed manually by the medical authors of this study. For judging the practical relevance of discrepancies, diagnostic codes were pre-classified as a) being presumably of higher and lower relevance for the clinician and b) requiring simple or complex inference rules from the findings. In a first series of 250 consecutive cases with 934 diagnoses (3.7 diagnoses per case), 71.1% showed agreement between diagnoses of the physicians and of SC and were judged as consistent compared to the documented findings. 24.4% of the diagnoses suggested by the documented findings, however, were not mentioned by the physicians (false negative) and 4.5% were mentioned by the physicians but not suggested by the documented findings (false positive). From the 24.4% missing diagnoses, 40% were pre-classified as being of higher relevance for the clinician. In a second series of 161 consecutive cases with 501 diagnoses (3.1 diagnoses per case), 61.1% were judged as consistent compared to the documented findings, 36.1% false negative and 2.8% false positive. In this study, we differentiated the missing diagnoses due to their inferential complexity: From the 152 complex diagnoses, 44% were missing, while from the 349 simple diagnoses, 32.7% were missing. As shown for a sonographic department of a clinic of internal medicine, in sonographic reports, one has to be aware of discrepancies between question-set-based documentations of findings and diagnostic conclusions of the examiners. While a detailed documentation of findings is the basis of quality control, consistency checks between documented findings and diagnostic conclusions, which might be done automatically in an electronic patient record, would considerably improve the quality of the reports.


Comparison of perfusion harmonic imaging and perfusion mr imaging for the assessment of microvascular characteristics in brain tumors. The purpose of this study was to evaluate the potential of perfusion harmonic imaging (pHI) for assessing microvascular characteristics of brain tumors and to compare this ultrasound technique to perfusion MRI (pMRI). Twenty-five patients with brain tumors underwent transtemporal pHI and fourteen of these patients underwent additional pMRI. Time-intensity curves of two different regions of interest (ROIs; (1) enhancing tumor; (2) healthy brain) were calculated off-line, and the following parameters were compared between the two ROIs and the two methodologies: time-to-peak intensity (TTP [sec]), the ratios of the peak intensities (PI ratio), the ratios of the positive slope gradient (PG ratio) and the ratios of the area under the curve (AUC ratio). p < 0.05 was considered statistically significant. Four of 25 patients were excluded due to bone window insufficiency or unfavorable tumor location. Focal abnormal echogenicity was detected in native B-mode in 86 % of the patients. Contrast agent administration led to remarkable echo enhancement in the tumor in all patients with corresponding time-intensity curves. Both pHI and pMRI showed significant differences with respect to the mean PI, PG and AUC (pHI: p < 0.001 / < 0.001 / < 0.001; pMRI: p < 0.05 / < 0.05 / < 0.001) when comparing tumor to healthy brain. The TTP was not significantly different in tumor and brain tissue. Comparison of pHI and pMRI data did not show any significant differences for three of four parameter ratios between both methodologies. PHI provides a new technique for assessing microvascular characteristics of brain tumors reflecting their abnormal perfusion. Overall comparison of this methodology to pMRI demonstrated encouraging results. Further studies should address the clinical potential of pHI especially in view of microvascular response to anti-angiogenic treatment.


Voiding ultrasonography: evaluation of the detection of vesicoureteral reflux based on the review of digital ultrasound clips. To evaluate the accuracy of voiding urosonography (VUS) compared to X-ray voiding cystoureterography (VCUG) for the detection and grading of vesicoureteral reflux (VUR) by standardised reading of digital clips obtained from VUS and digital images from VCUG. Approval by the ethics committee was obtained, and written, informed consent was given. 130 children (94 girls and 36 boys, mean age of 4.4 years) underwent VUS using Levovist (Schering, Germany) prior to VCUG. Digital VUS clips and digital VCUG images were reviewed by two groups of two radiologists. Results were mainly analysed in terms of reno-ureteral units (RUUs). Intra and interobserver reproducibility was estimated by calculation of kappa coefficient. Calculation of sensitivity and specificity of VUS was made in comparison with VCUG. Intraobserver reproducibility was good to moderate for the detection of VUR using VUS (kappa = 0.67 and 0.53 for each reviewer respectively) and good for the grading of reflux (kappa = 0.64 and 0.70). Interobserver reproducibility was excellent for the detection and grading of VUR using VCUG (kappa = 0.89 and 0.91) but good to moderate for VUS (kappa = 0.73 and 0.51). Compared to VCUG, sensitivity and specificity of VUS for the detection of VUR were 62.7 % and 83.4 %. Concordance for grading was moderate, with a higher grading using VUS. Real-time evaluation and diagnosis based on the review of VUS digital clips is achievable. However, there is a need for standardisation of digital records if a second reading by another radiologist or consideration by urologists is needed. Recent advances in US technology and the use of second-generation contrast agents would be promising to improve the feasibility, reproducibility and accuracy of the method.


Antenatal ovarian torsion: a "free-floating" cyst. This case report documents the unusual presentation of an antenatal ovarian torsion followed by auto-amputation of the ovarian tube complex, finally resulting in a free floating abdominal cyst. The differential diagnosis of antenatally diagnosed abdominal cysts is discussed and the surgical management outlined.


The effect of NQO1 polymorphism on the inflammatory response in cardiopulmonary bypass. Cardiopulmonary bypass (CPB) has been associated with systemic inflammatory response syndrome (SIRS). Endothelial dysfunction related to non-laminar flow during CPB is known to play a key role in this complex pathology. Antioxidant response element (ARE) dependent NAD(P)H:quinone oxidoreductase 1 (NQO1) promoter is a regulatory element involved in the anti-inflammatory mechanism in vasculature exposed to non-laminar flow. Mutation of the NQO1 could represent a novel anti-inflammatory effect in CPB. The goal of this study was to demonstrate whether genetic variants of NQO1 affect cytokine release after CPB. Eighteen patients who underwent standard coronary artery bypass grafting (CABG) operation were included in the study. Genotyping for NQO1 was performed. Serum Interleukin-6 (IL-6) levels were measured before induction, during CPB after declamping the aorta, and 24 h after operation. Clinical data were collected respectively. Seven patients were NQO1 T carriers and 11 patients were NQO1 T non-carriers. During CPB, IL-6 concentrations were increased in NQO1 T carriers compared to T non-carriers (p = 0.038). Although ventilation times and blood loss were higher in T carriers these were not statistically significant. Patients with NQO1 T carriers showed significantly higher IL-6 levels during CPB. Non-laminar flow during CPB may diminish the transcriptional activation of the NQO1 in T carriers. Preoperative determination of this novel anti-inflammatory mechanism could be useful to improve operative outcome in CPB.


Methylenetetrahydrofolate reductase gene polymorphisms in 13 Chinese ethnic populations. It has been shown that the polymorphisms of Methylenetetrahydrofolate reductase (MTHFR) gene are associated with susceptibility to several disorders including hyperhomocysteinemia, vascular disease, birth defect, and certain cancers, and exhibit great diversities among various populations. The aim of this study was to investigate the prevalence of two common non-synonymous single nucleotide polymorphisms (i.e., C677T and A1298C) at MTHFR gene in 13 Chinese populations. A total of 1015 healthy individuals from 13 populations distributed widely from north to south in China were studied. DNA samples were isolated from peripheral blood samples and genotyped using polymerase chain reaction-restriction fragment length polymorphism. For C677T polymorphism, the frequency in Chinese of CC homozygous was 42.4%; CT heterozygous was 49.8%; and TT homozygous was 7.9%. For A1298C, AA homozygous was 39.2%; AC heterozygous was 38.6%; and CC homozygous was 22.2%. The allelic frequency of 677T and 1298C was 32.8 and 41.5%, respectively, and each allele frequency had significant variance in 13 Chinese populations. The frequency of the 677T allele among southern populations was 30.7% compared to 38.0% among northeastern and 30.5% among northwestern populations. The difference was statistically significant (p < 0.01). The frequency of 1298C mutation in southerns was 58.9% whereas in northeasterns it was 24.0% and 37.6% in northwesterns. This was also statistically significant (p < 0.01). The MTHFR C677T and A1298C sites were in linkage disequilibrium in the Chinese population revealed by our data.


Content and mean polymerization degree of procyanidins in extracts obtained from clear and cloudy apple juices. The polyphenol profile of apples and that of technologically differently treated apple juices has already been studied thoroughly; nevertheless, the content of polymeric procyanidins has not received much attention up to date. Therefore, procyanidins in extracts made from six blended apple juices and two authentic clear as well as cloudy apple juices (Malus domestica cv. Bohnapfel and Bittenfelder) were investigated. Our determinations revealed significant differences in the total procyanidin content between apple juice extracts obtained from clear and the corresponding cloudy juices under study. Depending on the apple cultivars used average amounts of total procyanidin content determined in the extracts made from clear and cloudy juices ranged from 28.4 +/- 4.4% to 49.0 +/- 5.7% and from 48.3 +/- 0.3% to 60.6 +/- 0.3%, respectively. As the mean degree of polymerization (DPm) is supposed to have an influence on bioavailability and toxicity on different cells lines used in in vitro systems, the average degree of polymerization of the juices under examination were determined. Depending on the cultivar used and the technology of juice processing the DPm ranged between 3.0 and 13.4.


Hepatogenic differentiation of mesenchymal stem cells using microfluidic chips. Directional induction and differentiation of mesenchymal stem cells (MSCs) is very important to clinical therapy, but the mechanisms that govern differentiation are not well understood. However, traditional plate culture cannot precisely control cellular behavior because cells take up substances while secreting cytokines and wastes. Here, we used a microfluidic device to culture MSCs inside a microchamber. Hepatic differentiation medium was perfused to evaluate the ability of MSCs to differentiate toward hepatic cells on the chip. Parallel differentiation on 96-well plates was used to provide a detailed comparison of the differences between the two culturing methods. After treatment for 4 weeks, differentiated cells from both groups could express hepatocyte-specific markers, including alpha-fetoprotein, tyrosine aminotransferase, and albumin. The bioactivity assays revealed that these hepatocyte-like cells could uptake lipoprotein, but cells that differentiated on the chip showed more positive signals than the cells cultured on plates. Our results indicated that a microfluidic platform might be a potential tool for cost-effective and automated cell culture, and have potential applications in reliable cell-based screens and assays.


Direct enzymatic glucosylation of naringin in grapefruit juice by alpha-D-glucosidase from the marine mollusc Aplysia fasciata. The enzymatic glucosylations of naringin, performed using alpha-D-glucosidase, identified in the Mediterranean mollusc Aplysia fasciata is reported. The enzyme actively operates on maltose and has an interesting transglycosylation potential using this donor. We also investigated the use of this marine alpha-glucosidase for a food-compatible glucosylation of naringin to produce new enzymatically modified carbohydrate possessing naringin derivatives. The regioselective formations of the beta-gluco-C6 alpha-glucosyl derivative and of the corresponding isomaltosyl diglucoside of naringin were obtained in high yield and efficiency of reaction. Suspensions of naringin can be used up to approximately 90 mg/mL initial acceptor concentration. In different experiments it was demonstrated that the enzyme was still active after 48 h in presence of this high amount of acceptor and that one of the diasteromers of the naringin is preferred by the enzyme from A. fasciata during glucosylation/deglucosylation enzymatic steps. Finally, the feasibility of efficient naringin glucosylation in grapefruit juice was also demonstrated at optimal pH of the enzyme and low maltose concentrations.


Spontaneous NA+ transients in individual mitochondria of intact astrocytes. Mitochondria in intact cells maintain low Na(+) levels despite the large electrochemical gradient favoring cation influx into the matrix. In addition, they display individual spontaneous transient depolarizations. The authors report here that individual mitochondria in living astrocytes exhibit spontaneous increases in their Na(+) concentration (Na(mit)(+) spiking), as measured using the mitochondrial probe CoroNa Red. In a field of view with approximately 30 astrocytes, up to 1,400 transients per minute were typically detected under resting conditions. Na(mit)(+) spiking was also observed in neurons, but was scarce in two nonneural cell types tested. Astrocytic Na(mit)(+) spikes averaged 12.2 +/- 0.8 s in duration and 35.5 +/- 3.2 mM in amplitude and coincided with brief mitochondrial depolarizations; they were impaired by mitochondrial depolarization and ruthenium red pointing to the involvement of a cation uniporter. Na(mit)(+) spiking activity was significantly inhibited by mitochondrial Na(+)/H(+) exchanger inhibition and sensitive to cellular pH and Na(+) concentration. Ca(2+) played a permissive role on Na(mit)(+) spiking activity. Finally, the authors present evidence suggesting that Na(mit)(+) spiking frequency was correlated with cellular ATP levels. This study shows that, under physiological conditions, individual mitochondria in living astrocytes exhibit fast Na(+) exchange across their inner membrane, which reveals a new form of highly dynamic and localized functional regulation.


Characterization of Paracoccidioides brasiliensis PbDfg5p, a cell-wall protein implicated in filamentous growth. The dimorphic fungus Paracoccidioides brasiliensis is the causative agent of the most frequent systemic mycosis in Latin America. In humans, infection starts by inhalation of fungal propagules, which reach the pulmonary epithelium and differentiate into the yeast parasitic phase. Here we describe the characterization of a Dfg5p (defective for filamentous growth) homologue of P. brasiliensis, a predictable cell wall protein, first identified in Saccharomyces cerevisiae. The protein, the cDNA and genomic sequences were analysed. The cloned cDNA was expressed in Escherichia coli and the purified rPbDfg5p was used to obtain polyclonal antibodies. Immunoelectron microscopy and biochemical studies demonstrated the presence of PbDfg5p in the fungal cell wall. Enzymatic treatments identified PbDfg5p as a beta-glucan linked protein that undergoes N-glycosylation. The rPbDfg5p bound to extracellular matrix components, indicating that those interactions could be important for initial steps leading to P. brasiliensis attachment and colonization of host tissues.


In vitro study of axonal migration and myelination of motor neurons in a three-dimensional tissue-engineered model. Primary motor neurons are difficult to study in conventional culture systems because of their short-term survival without trophic support from glia. In addition, axonal migration on a two-dimensional Petri dish does not reflect the three-dimensional (3D) environment in vivo. A unique in vitro 3D model of motor nerve regeneration was developed to study motor neuron axonal migration and myelination. Mouse spinal cord motor neurons were seeded on a collagen sponge populated with Schwann cells and fibroblasts. This fibroblast-populated sponge was intended to mimic the connective tissue through which motor axons have to elongate in vivo. Addition of conventional neurotrophic supplements was not required for motor neuron survival but was necessary to promote deep neurite outgrowth, as assessed by immunostaining of neurofilament M. A vigorous neurite elongation was detected inside the sponge after only 14 days of neuron culture, reaching more than 850 microm. The model also allowed the maturation of motor fibers as one-third of them were positive for neurofilament H. Neurites growing in the sponge were subject to myelination when Schwann cells were present, as shown by myelin basic protein immunostaining and electron microscopy. We demonstrated in this model the spontaneous formation of numerous thick myelin sheaths surrounding motor fibers after long-term culture (28 days). Thus, this model might be a valuable tool to study the effect of various cells and/or attractive or repulsive molecules on motor neurite outgrowth in vitro and also for the study of myelination and pathogenesis of motor neuron diseases.


Capnocytophaga canimorsus infection with fulminant sepsis in an asplenic patient: diagnosis by review of peripheral blood smear.


The ectonucleotidase cd39/ENTPDase1 modulates purinergic-mediated microglial migration. Microglia is activated by brain injury. They migrate in response to ATP and although adenosine alone has no effect on wild type microglial migration, we show that inhibition of adenosine receptors impedes ATP triggered migration. CD39 is the dominant cellular ectonucleotidase that degrades nucleotides to nucleosides, including adenosine. Importantly, ATP fails to stimulate P2 receptor mediated migration in cd39(-/-) microglia. However, the effects of ATP on migration in cd39(-/-) microglia can be restored by co-stimulation with adenosine or by addition of a soluble ectonucleotidase. We also tested the impact of cd39-deletion in a model of ischemia, in an entorhinal cortex lesion and in the facial nucleus after facial nerve lesion. The accumulation of microglia at the pathological sites was markedly decreased in cd39(-/-) animals. We conclude that the co-stimulation of purinergic and adenosine receptors is a requirement for microglial migration and that the expression of cd39 controls the ATP/adenosine balance.


Musashi1 RNA-binding protein regulates oligodendrocyte lineage cell differentiation and survival. Expression of Musashi1 (Msi1), an evolutionarily conserved RNA-binding protein, in neural stem cells of the subventricular zone in the postnatal and adult CNS indicates a potential role in the generation of oligodendrocytes. We now show Msi1 expression in a subset of oligodendrocyte progenitor (OP) cells in white matter areas temporally and spatially associated with oligodendrogenesis in the postnatal CNS. Msi1 function was evaluated by infection of OP cells with retroviral transduction of Msi1 or knockdown of endogenous Msi1. Retroviral expression of Msi1 significantly reduced the proportion of mature oligodendrocytes generated from OP cells in vitro and in vivo during myelination. Msi1 transduction also promoted OP survival, particularly under conditions of challenge from oxidative stress, while Msi1 siRNA knockdown resulted in dramatic OP cell death. Furthermore, in experimental demyelination Msi1 expression was increased among cells associated with lesions, including OP cells, indicating a potential role in the generation of remyelinating oligodendrocytes.


Hepatitis B virus transmission pattern and vaccination efficiency in Uzbekistan. A national program of universal vaccination for the prevention of chronic hepatitis B virus (HBV) infection was launched in Uzbekistan since 1998. To evaluate the 6 years' outcome of the program, 567 children were enrolled in the study. Among those enrolled, 333 had immunized with adw2 type based Engerix-B (Glaxo Smith Kline Beechem, Rixensart, Belgium) and 48 with adr type based Hepavax-Gene (Green Cross Vaccine Corporation, Korea). A cohort of 186 children born before the immunization program, was also included in the study. When 45 vaccinated children were compared to age/sex-matched 45 unvaccinated children, the sero-prevalence of HBsAg was 0 versus 11% (P = 0.56), and of anti-HBc was 0% versus 44% (P < 0.0001), respectively. Loss of anti-HBs was observed in 18.4% after 5 years. Among 13 HBsAg carriers found in this study, genotype HBV/D was found in 69%, HBV/A in 23% (all in unvaccinated group) and HBV/C in 8% (in vaccinated group). No significant differences were observed in this study between groups which received different vaccine formulation. Phylogenetic analysis of the HBV isolates obtained from family members of the HBsAg-positive children, revealed evidence suggesting that transmission in the vaccinated group was exclusively perinatal, whereas in the unvaccinated group horizontal transmission pattern predominated. In conclusion, HBV universal vaccination is efficient in Uzbekistan irrespective of the vaccine formulation used, because the horizontal transmission pattern predominates currently in this endemic region.


Improved tracing of hepatitis B virus transmission chains by phylogenetic analysis based on C region sequences. An effective vaccine is available for the hepatitis B virus (HBV), which is a very contagious human pathogen. The prevalence of chronic HBV infection is very low in the Netherlands (<0.5%), and no universal vaccination is in place. Instead, a program of vaccination for targeted groups at high risk of HBV exposure has been implemented. Because transmission of HBV can occur by various routes, the effectiveness of this targeted vaccination strategy is difficult to assess. Molecular typing data for the surface protein encoding gene of HBV isolates, in combination with epidemiological data, provide some insight into the main transmission routes. Due to the low mutation rate of the HBV genome, many isolates have identical S region sequences, which hampers phylogenetic analysis and identification of transmission chains. The molecular epidemiological analysis of acute HBV isolates based on the surface and core protein encoding regions were compared. The nucleotide diversity found in the C region was statistically significant greater (1.5 times) than in the S region, and phylogenetic analysis based on the C region showed a higher resolution. C region analysis resulted in an almost 50% reduction of genotype A isolates with identical sequences. C region analysis also indicated that no long-chain transmission of genotype D strains is occurring in the Netherlands, as all genotype D isolates have unique C region sequences. Defining the goals of molecular typing of HBV isolates should precede the choice for phylogenetic analysis on the basis of either C or S region sequences.


Localization of CD8+ cells specific for hepatitis B virus surface protein in the liver of immunized mice. DNA plasmids are potent inducers of long-lasting antigen-specific CTL responses. Little is known about the distribution of antigen-specific CD8+ T cells in the lymphoid tissue and the non-lymphoid tissue after DNA immunization. HBsAg-specific CD8+ T cells in peripheral blood mononuclear cells, spleen, lymph nodes, and the liver of Balb/c mice have been quantified after injection with a DNA plasmid expressing the major S protein of hepatitis B virus (HBV). The kinetics of CD8+ T-cell responses in the circulation were measured after priming and boosting, showing that antigen-specific CD8+ T cells undergo first expansion and then decline to a sustainable level in the circulation, although the frequencies of HBsAg-specific CD8+ T cells in the circulation were lower than for the spleen. The greater frequencies of HBsAg-specific CD8+ T cells were found in the liver, whereas the largest numbers of antigen-specific CD8+ T cells were found in the spleen. By day 100 after priming, HBsAg-specific CD8+ T cells were still detected in the circulation, the spleen and the liver. After boosting with the same plasmid DNA immunogen, HBsAg-specific CD8+ T cells proliferated quickly and vigorously. By 150 days after boosting, HBsAg-specific memory CD8+ T cells were sustained at higher levels than those recorded after the first, primary injection, both in the spleen and the liver: anti-HBs antibody-secreting plasma cells persisted in the bone marrow and in the spleen, consistent with the detection of anti-HBs antibodies detected in the blood. These findings indicate that DNA immunization has considerable potential for inducing specific T cell responses in the liver and offers a strategy for the development of post-exposure immunotherapy against persistent hepatitis B infections.


Molecular epidemiology of a hepatitis C virus outbreak in a hemodialysis unit in Italy. Hemodialysis patients are at increased risk of hepatitis C virus (HCV) infection. The aim of this study was to investigate a HCV outbreak in a hemodialysis unit using epidemiological and molecular methods. Between April 2003 and October 2003, anti-HCV seronconversion was detected in four patients attending the unit. These cases were added to 10 patients already anti-HCV positive upon admission in the unit. All 14 anti-HCV patients were tested for HCV RNA and HCV genotype. NS5B and HVR1/ E2 genomic regions were amplified and sequenced in all HCV RNA positive patients and phylogenetic analysis was performed. Furthermore, clinical-epidemiological records obtained from all patients were examined. All four patients newly infected harbored genotype 2c. Genotype 2c was also detected in 2 of 10 patients already anti-HCV positive upon admission. Phylogenetic analysis showed that all newly HCV infected patients harbored very closely related viral isolates that clustered together with the 2c isolate found in one of the two 2c chronic infected patients. All HCV-2c infected patients had no other risk factors except hemodialysis. Three of four newly HCV-2c infected patients and the one HCV-2c chronically infected involved in the outbreak received dialysis on the same day and same shift but used different machines. The remaining HCV-2c newly infected patient and one of the above cited three received dialysis on the same day during different shifts but used the same machine. The outbreak was probably due to breaks of infection control procedures although a related-machine transmission cannot be excluded in one of the cases.


Epidemiological and clinical evaluation of hepatitis B, hepatitis C, and delta hepatitis viruses in Tajikistan. The implication of genotypes is recognized increasingly in the clinical course of hepatitis B virus (HBV) and in response to anti-viral drugs of hepatitis C virus (HCV). Genotypic prevalence of both etiological agents varies geographically and no data are available for Tajikistan. To investigate the epidemiology and clinical significance of HBV and HCV genotypes in chronic hepatitis (group 1) and liver cirrhosis/hepatocellular carcinoma (HCC) (group 2) patients in Tajikistan, 124 patients with chronic liver disease (group 1 = 84 and group 2 = 40) were enrolled. Genotypes of HBV, HCV, and delta hepatitis virus (HDV) were determined by sequencing. The overall prevalence of anti-HCV, HCV core antigen (HCVcAg) and HBsAg was 46% (57/124) and 41.1% (51/124), respectively. Coinfection of HCV/HBV, HBV/HDV, and HCV/HBV/HDV was found in 4.8% (6/124), 11.2% (12/124), and 0.8% (1/124) of cases, respectively. HDV genotype 1 was found in 19.6% (10/51) of HBsAg-positive patients. The HBV/HDV coinfection was relatively high in group 2 compared to group 1 (15% vs. 7.1%). HCV/1b detected in 84.6% (44/52) of HCV RNA-positive patients, followed by 3a (7.6%), 2a (5.7%), and 2c (1.9%). HBV/D was detected in 94.1% (48/51) of HBsAg-positive patients, followed by HBV/A [5.8% (3/51)]. T1762/A1764 double mutation was associated with liver cirrhosis/HCC in HBV-infected patients (P = 0.0004). This is the first study on the molecular epidemiology of hepatitis viruses among chronic liver diseases patients in Tajikistan. Among HBV-infected patients, the T1762/A1764 mutation was associated with liver cirrhosis/HCC.


Unexpectedly high incidence of indigenous acute hepatitis E within South Hampshire: time for routine testing? Hepatitis E indigenous to developed countries (hepatitis EIDC) is a form of hepatitis E in persons with no travel history to highly endemic areas. It has been recognized recently as an emerging clinical entity in a significant number of economically developed countries including UK. However, it is still perceived as a rare disease and routine laboratory testing for hepatitis E is not performed. A series of 13 cases of hepatitis EIDC, diagnosed in a 13-month period from June 2005 within a single center in South Hampshire, UK, is presented. These patients were identified after implementing a novel-screening algorithm that introduced routine hepatitis E serological investigations. Patients were middle aged or elderly and males were affected more commonly. Four patients (31%) required hospital admission. All reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed cases carried hepatitis E virus (HEV) genotype-3, which bore close sequence homology to HEV circulating in UK pigs. None of these patients recalled eating undercooked pork products or close contact with pigs during the 2 months preceding the onset of acute hepatitis. In comparison, during the same period, only two cases of hepatitis A and five cases of acute hepatitis B were diagnosed. These data illustrate the importance of introducing routine hepatitis E testing in all patients with unexplained acute liver disease and absence of relevant travel history. Routine testing can clarify hepatitis E epidemiology whilst improving the clinical management of patients with acute liver disease.


Quantitative temporal and spatial distribution of adenovirus type 2 correlates with disease manifestations and organ failure during disseminated infection. Disseminated adenovirus (HAdV) infections are serious complications in allogenic stem cell transplant (SCT) recipients. Quantitative HAdV DNA detection in blood samples demonstrated the association of high virus loads with disease and improved early diagnosis. However, the pathogenesis of disseminated HAdV disease, for example sources of HAdV DNA shedding in the blood stream and association of HAdV replication sites with disease manifestations, remained obscure. In this report, 24 bioptic and autoptic organ and tissue samples of an adult SCT recipient suffering from disseminated infection were quantitatively analyzed for HAdV DNA. Results indicate subsequent virus replication in the colon, bone marrow and liver as origin of HAdV DNAemia, which increased from 1.4 x 10(4) copies/ml to a peak of 2 x 10(9) copies/ml over a period of 84 days in spite of antiviral therapy. Symptoms as diarrhoea, bone marrow failure and hepatic failure were clearly linked to high HAdV DNA concentrations in affected organs. For example, the HAdV DNA level was 2.2 x 10(3) copies/cell in a colon biopsy when the patient suffered from diarrhoea whereas only 1.1 x 10(1) copies/cell were detected when symptoms had improved. Focal HAdV infection of the liver as demonstrated by laser microdissection was followed by fulminant virus replication with 1.3 x 10(5) copies of HAdV DNA/cell causing terminal hepatic failure. In conclusion, pathogenesis of disseminated HAdV disease was associated with virus replication in affected organs and not immune mediated as suggested recently by a fatal case of gene therapy with a non-replication competent HAdV-C5 vector.


Aberrant agouti-related protein system in the hypothalamus of the anx/anx mouse is associated with activation of microglia. Agouti-related protein (AgRP) is a key orexigenic neuropeptide expressed in the hypothalamic arcuate nucleus and a marker for neurons conveying hormonal signals of hunger to the brain. Mice homozygous for the anorexia (anx) mutation are characterized by decreased food intake, starvation, and death by 3-5 weeks of age. At this stage immunoreactivity for AgRP is increased in cell bodies but decreased in the nerve terminals. We studied when during early postnatal development the aberrant phenotype of the AgRP system becomes apparent in anx/anx mice and possible underlying mechanisms. AgRP and ionized calcium binding adapter molecule (Iba1), a marker for activated microglia, as well as Toll-like receptor 2 (TLR-2), were studied by immunohistochemistry at postnatal days P1, P5, P10, P12, P15 and P21 in anx/anx and wild-type mice. We found that the AgRP system in the anx/anx mouse develops similarly to the wild type until P12, when AgRP fibers in anx/anx mice cease to increase in density in the main projection areas. At P21, AgRP fiber density in anx/anx mice was significantly reduced vs. P15, in certain regions. At P21, many strongly AgRP-positive cell bodies were observed in the anx/anx arcuate nucleus vs. only few and weakly fluorescent ones in the wild type. The decrease in AgRP fiber density in anx/anx mice overlapped with an increase in Iba1 and TLR-2 immunoreactivities. Thus, the aberrant appearance of the AgRP system in the anx/anx mouse in the early postnatal development could involve a microglia-associated process and the innate immune system.


MicroRNA epigenetic alterations in human cancer: one step forward in diagnosis and treatment. MicroRNAs (miRNAs) are approximately 22 nt non-coding RNAs, which regulate gene expression in a sequence-specific manner via translational inhibition or messenger RNA (mRNA) degradation. Since the discovery of their fundamental mechanisms of action, the field of miRNAs has opened a new era in the understanding of small noncoding RNAs. By molecular cloning and bioinformatic approaches, miRNAs have been identified in viruses, plants and animals. miRNAs are predicted to negatively target up to one-third of human mRNAs. Cancer is a complex genetic disease caused by abnormalities in gene structure and expression. Previous studies have heavily focused on protein-coding genes; however, accumulating evidence is revealing an important role of miRNAs in cancer. Epigenetics is defined as mitotically and/or meiotically heritable changes in gene expression that are not accompanied by changes in DNA sequence. Given the critical roles of miRNAs and epigenetics in cancer, characterizing the epigenetic regulation of miRNAs will provide novel opportunities for the development of cancer biomarkers and/or the identification of new therapeutic targets in the foreseeable future.


MicroRNAs and cancer: profile, profile, profile. MicroRNAs (miRNAs) represent a new class of small noncoding RNAs (ncRNAs, RNAs that do not codify for proteins) that can regulate gene expression by targeting messenger RNAs of protein coding genes and other ncRNA transcripts. miRNAs were recently found to be involved in the pathophysiology of all types of analyzed human cancers mainly by aberrant gene expression. This is characterized by abnormal levels of expression for mature and/or precursor miRNA transcripts in comparison to the corresponding normal tissues. miRNA profiling has allowed the identification of signatures associated with diagnosis, prognosis and response to treatment of human tumors. Therefore, miRNAs fingerprinting represents a new addition to the tools to be used by medical oncologists.


Growth phenotypes and biosafety profiles in poliovirus-receptor transgenic mice of recombinant oncolytic polio/human rhinoviruses. The use of oncolytic recombinant polioviruses has an important therapeutic potential in the treatment of human gliomas. This study was carried out to assess parameters of the utility of the oncolytic poliovirus/human rhinovirus type 2 chimeras (PV/HRV2). The prototype PV/HRV2 chimera was constructed containing the complete genome of wild-type PV type 1 (Mahoney) [PV1(M)] in which the cognate IRES was replaced with that of HRV2 [called PV1(RIPO)]. A derivative of PV1(RIPO) is PV1(RIPOS) in which the capsid coding region (P1) was replaced with the capsid-coding region of the PV type 1 (Sabin) [PV1(S)] vaccine strain. In addition, a third PV/HRV2 chimera was constructed containing the complete genome of PV1(S) in which the cognate IRES was replaced with that of HRV2 [termed PVS(RIPO)]. To analyze the growth phenotypes of PV/HRV2 recombinants [PV1(RIPO), PV1(RIPOS), PVS(RIPO)], one-step growth experiments were performed in four human cell lines at three different temperatures. To address the safety profile, PVS(RIPO) was injected into the brain of CD155 tg mice at the dose 10(7) PFU. Then, clinical signs, persistence of the virus in the CNS and genetic stability of PVS(RIPO) replicating in the CNS were evaluated. The data obtained in the present study suggest (i) a correlation between temperature-sensitive (ts) phenotype in both neuronal and non-neuronal cell lines and neuroattenuation in experimental animals, (ii) that PVS (RIPO) is genetically stable on replication in the CNS of poliovirus-susceptible mice. These findings highlight the safety of intracerebral inoculation of PVS(RIPO) for the treatment of human glioma.


Clinical outcome of frequent exposure to Torque Teno virus (TTV) through blood transfusion in thalassemia patients with or without hepatitis C virus (HCV) infection. As a consequence of the high prevalence of TorqueTeno virus (TTV) in blood donors, thalassemia patients frequently acquire various genotypes of this virus through therapeutic blood transfusions. At present, the clinical consequences of TTV infection remain indeterminate for these patients. Here, several hundred thalassemia patients were tested for the presence of TTV and its genotypes using a combination of PCR and clone-based DNA sequencing. Approximately 10% (12/118) of the patients aged 2-20 years remained negative for TTV including eight genotypes of SENV. Ferritin, aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) levels were invariably lower in TTV-negative patients (P = 0.02, <0.01, and 0.06, respectively) than in TTV-positive patients. Patients with TTV-HCV co-infection showed elevated ferritin and ALT levels compared with patients with TTV infection alone (P < 0.02 and P < 0.01). AST and ALT levels were within the normal range for all TTV-negative patients, whereas abnormal levels of AST and ALT were seen in a significant proportion of TTV-positive patients (30.7% and 33.6%, respectively) and patients with TTV-HCV co-infections (70.0% and 56.6%, respectively). Only TTV-positive patients (28.0%) and patients with TTV-HCV co-infections (36.3%) had hyper-ferritin levels (> or =3,000 ng/ml). The genotype(s) of TTV responsible for the liver dysfunction could not be determined. However, high levels of AST and ALT were found to be correlated with detection of a higher number of TTV genotypes in the patients. The data suggests that frequent and persistent TTV infection through blood transfusion is associated with hepatic dysfunction and/or damage in transfusion dependent thalassemia patients.


Molecular epidemiology of HIV-1 subtypes and drug resistant strains in Taiwan. The Taiwanese government has provided free highly active antiretroviral therapy since April 1997. Previously, we have reported on the molecular epidemiology of HIV-1 in Taiwan from 1988 to 1998. In addition, an outbreak of circulating recombinant form (CRF) 07_BC among intravenous drug users was noted in 2004. Therefore, the purposes of this study were to elucidate the distribution of HIV-1 subtypes among different high-risk groups in Taiwan from 1999 to 2000 and to conduct surveillance on drug resistance among treatment naïve patients from 1997 to 2000. Blood samples from 239 HIV-1/AIDS patients and their subtypes were examined using DNA sequencing and phylogenetic analysis. The results showed that among 226 male patients, 213 (94.2%) had subtype B, 11 (4.9%) had CRF01_AE, 1 had unique recombinant strain related to both CRF07_BC and CRF08_BC (strain T12-99TW) and 1 had CRF08_BC (strain L9312-00TW). The patients infected with T12-99TW and L9312-00TW were intravenous drug users and had needle-sharing experiences in Yunnan Province, China. Of the 13 HIV-1-infected females, 7 (53.8%) had subtype B, 5 (38.5%) had CRF01_AE, and 1 (7.7%) had subtype C. Phylogenetic analysis demonstrated that the neither strain T12-99TW nor L9312-00TW clustered with CRF07_BC strains isolated from Taiwanese intravenous drug users in 2004. In addition, 126 treatment naïve patients were selected for genotypic DR analysis and the results showed that 4.3% (2/47) homosexual males had M184V mutations. This is the first report on the identification of CRF08_BC and a unique recombinant strain related to both CRF07_BC and CRF08_BC in Taiwan.


HIV-1 replication capacity and genotype changes in patients undergoing treatment interruption or lamivudine monotherapy. The objective of this study was to investigate the mechanisms underlying the virological and immunological changes occurring in failing HIV-1 infected patients undergoing treatment interruption or lamivudine monotherapy (the E-184V Study). Associations were sought between the de-selection of individual reverse transcriptase and protease resistance mutations and replication capacity recovery, HIV-RNA changes, and immunological changes. The replication capacity recovery was defined as the ratio between the replication capacity at weeks 24 or 48, and that measured at baseline. The replication capacity recovery, which was evaluable in 21 patients at week 24 and in 18 at week 48, was significantly higher in the treatment interruption than in the lamivudine group at week 24 (P = 0.002). Forty-eight week replication capacity recovery was greater when the 184V (P = 0.023), the 41L (P = 0.02), or the 215Y mutation (P = 0.037) were deselected at week 12. A greater reduction in the CD4+/CD8+ ratio at week 48 (P = 0.038) was observed as the 184V mutation was deselected and the de-selection of the 184V mutation at week 12 was the only independent predictor of the change of the CD4+/CD8+ ratio at week 48 from baseline at multivariable analysis (F-value = 6.72, P = 0.021). In conclusion, among patients undergoing treatment interruption or lamivudine monotherapy, the recovery of HIV-1 replication capacity was associated with the de-selection of reverse transcriptase mutations. The de-selection of the 184V mutation predicts independently a reduction in the CD4+/CD8+ ratio.


The increasing prevalence of hepatitis delta virus (HDV) infection in South London. On the basis of historical studies, hepatitis delta virus (HDV) infection is considered uncommon in the United Kingdom (UK) and mainly confined to intravenous drug users. In order to assess the current prevalence of HDV co-infection in patients with chronic hepatitis B (HBV), a retrospective analysis was performed of 962 consecutive HBV-infected adult patients referred to King's College Hospital between January 1st 2000 and March 31st 2006. The 82 subjects positive for HDV antibody (8.5%) had a similar age to those without HDV (median 36 years, interquartile range 30-47, vs. 35 years, 29-43). Excluding non-UK residents, the prevalence of HDV Antibody was 7.1%. Most HDV-infected subjects were born in regions where HDV is endemic, for example, Southern or Eastern Europe (28.1%), Africa (26.8%) or Middle-East (7.3%). Forty one (50%) were considered to have acquired HDV infection via intra-familial transmission but intravenous drug use was still a common route of transmission (24.4%). Comparing HBV/HDV co-infected to HBV mono-infected patients, a higher proportion were hepatitis C antibody positive (25.6% versus 3.8%; odds ratio 8.89, 95% confidence interval 4.4-17.9; P < 0.00001) and more had cirrhosis (26.8% vs. 12.9%; odds ratio 2.64, 95% confidence interval 1.55-4.49; P < 0.0001) but, despite this, the risk of hepatocellular carcinoma was similar (odds ratio 1.34, 95% confidence interval 0.62-2.91). Although HDV infection is reportedly declining in some endemic regions, our data demonstrate a high prevalence in South London. HDV co-infection is associated with increased morbidity and patients with HBV should be tested for HDV infection.


Characterization of a chemokine receptor CCR5-negative T cell line and its use in determining human immunodeficiency virus type 1 phenotype. A human CD4-positive T cell line from a donor homozygous negative for the chemokine receptor CCR5 was established, characterized, and used for determining the coreceptor usage of human immunodeficiency virus type 1 (HIV-1) isolates. Clones of this IL-2 dependent human T-cell lymphotropic virus type 1 (HTLV-I) immortalized cell line, named IsnoR5 clones 1 and 2, are susceptible to infection by HIV-1 isolates that use CXCR4 as a coreceptor but resistant to infection by CCR5 tropic HIV-1 viruses. HIV-1 isolates whose replication is inhibited in IsnoR5 cells in the presence of the bicyclam AMD 3100, a CXCR4 specific inhibitor, utilize a coreceptor distinct from CCR5 and CXCR4. Using a panel of primary HIV-1 isolates we have shown that a single T cell line is sufficient to discriminate between use of CCR5, CXCR4 or an alternative coreceptor. As IsnoR5 clone 1 cells revealed the existence of even minor populations of CXCR4-using virus variants, they could be useful for the early identification of changes in coreceptor usage in HIV infected individuals facilitating the timely introduction of appropriate clinical treatments.


Soluble urokinase plasminogen activator receptor is a marker of dysmetabolism in HIV-infected patients receiving highly active antiretroviral therapy. Circulating soluble urokinase plasminogen activator receptor (suPAR) reflects the immune and pro-inflammatory status of the HIV-infected patient. Highly active antiretroviral therapy (HAART) suppresses suPAR. Independent of the immune response to HAART, suPAR remains elevated in some HIV-infected patients, reflecting possibly a low-grade pro-inflammatory state. Low-grade inflammation has been implicated in insulin resistance and other features of dysmetabolism. Accordingly it is hypothesized that circulating suPAR is associated with the metabolic status of HIV-infected patients on HAART. Fasting plasma suPAR was determined in 36 normoglycaemic HIV-infected patients on HAART (n = 18 lipodystrophic, and n = 18 non-lipodystrophic) who had estimated insulin sensitivity (Rd) and non-oxidative glucose disposal (NOGM) by euglycaemic hyperinsulinaemic clamps, indirect calorimetry, and glucose tracer infusion. Five patients had circadian suPAR concentrations measured (24 hr, 20 min-intervals). suPAR and non-HDL-cholesterol were higher and Rd, NOGM, and limb fat were lower in lipodystrophic patients than in non-lipodystrophic patients (P < 0.05). suPAR correlated positively with non-HDL-cholesterol and inversely with Rd, NOGM and limb fat (P < 0.005, n = 36). suPAR also correlated positively with leukocyte count and TNF-alpha (P < 0.01, n = 36) but not with IL-6. In multiple regression analyses suPAR was a stronger predictor of dysmetabolism than TNF-alpha and IL-6. Circadian suPAR did not systematically fluctuate. In conclusion, suPAR may reflect the metabolic status of the HIV-infected patient on HAART, thus linking low-grade inflammation, immune constitution, lipid and glucose metabolism, and fat redistribution. Circadian suPAR concentration appeared stable, suggesting that sampling schedule does not affect measurement. Further studies addressing whether suPAR predicts lipodystrophy and dysmetabolism in HIV-infected patients are warranted.


Transmission of low-density hepatitis C viral particles during sexually transmitted acute resolving infection. Hepatitis C viruses in the blood of chronically infected patients are heterogeneous in density with the presence of lipoprotein associated viral particles of lower density than conventional virions. If low-density viral particles have been shown to be infectious in animal models it is currently not known whether these particles display the same infectivity for humans. In a case of sexually transmitted acute resolving infection, all isolated NS3 sequences from the acute-phase isolate clustered with a single sequence from the chronic carrier isolate, suggesting bottlenecking during transmission. To determine the density of the transmitted viruses, viral quasispecies from fractions with density below and above 1.055 g/ml were isolated and prepared from the plasma of the chronically infected sexual partner. Interestingly, the three closest sequences to the recipient consensus sequence were isolated from the low-density fraction. These data suggest that low-density viral particles are infectious for humans as they are for chimpanzees and that they can be transmitted during sexual intercourse.


Hepatitis C virus and the controversial role of the interferon sensitivity determining region in the response to interferon treatment. The degree of variability of the interferon sensitivity determining region (ISDR) in the hepatitis C virus (HCV) genome has been postulated to predict the response to interferon therapy, mainly in patients infected with subtype 1b, although this prediction has been the subject of a long controversy. This prediction has been tested by analyzing a cohort of 67 Spanish patients infected with HCV genotype 1, 23 of which were infected with subtype 1a and 44 with subtype 1b. A sample previous to therapy with alpha-interferon plus ribavirin was obtained and several clones (between 25 and 96) including the ISDR were sequenced from each patient. A significant correlation between mutations at the ISDR and response to treatment for subtype 1b patients, but not for those infected with subtype 1a, has been detected. Although the results suggest that the same relationship holds true for subtype 1a, lack of statistical power because of the small sample size of this subtype prevented firmer conclusions. However, identical ISDR sequences were found in responder and non-responder patients, suggesting that the stability of the ISDR sequence can occasionally help HCV to evade interferon therapy, although this is not a sufficient condition. More complex interactions, including the ISDR or not, are likely to exist and govern the HCV response to interferon treatment.


Clinical evaluation of the COBAS Ampliprep/COBAS TaqMan for HCV RNA quantitation in comparison with the branched-DNA assay. Diagnosis and monitoring of HCV infection relies on sensitive and accurate HCV RNA detection and quantitation. The performance of the COBAS AmpliPrep/COBAS TaqMan 48 (CAP/CTM) (Roche, Branchburg, NJ), a fully automated, real-time PCR HCV RNA quantitative test was assessed and compared with the branched-DNA (bDNA) assay. Clinical evaluation on 576 specimens obtained from patients with chronic hepatitis C showed a good correlation (r = 0.893) between the two test, but the CAP/CTM scored higher HCV RNA titers than the bDNA across all viral genotypes. The mean bDNA versus CAP/CTM log10 IU/ml differences were -0.49, -0.4, -0.54, -0.26 for genotype 1a, 1b, 2a/2c, 3a, and 4, respectively. These differences reached statistical significance for genotypes 1b, 2a/c, and 3a. The ability of the CAP/CTM to monitor patients undergoing antiviral therapy and correctly identify the weeks 4 and 12 rapid and early virological responses was confirmed. The broader dynamic range of the CAP/CTM compared with the bDNA allowed for a better definition of viral kinetics. In conclusion, the CAP/CTM appears as a reliable and user-friendly assay to monitor HCV viremia during treatment of patients with chronic hepatitis. Its high sensitivity and wide dynamic range may help a better definition of viral load changes during antiviral therapy.


Detection of a new mumps virus genotype during parotitis epidemic of 2006-2007 in the state of São Paulo, Brazil. Nucleotide sequence analyses of the SH gene of 18 mumps virus isolates collected in the 2006-2007 parotitis epidemic in the state of São Paulo identified a new genotype, designated genotype M. This new designation fulfills all the parameters required to define a new mumps virus genotype. The parameters were established by an expert panel in collaboration with the World Health Organization (WHO) in 2005. This information will enhance the mumps virus surveillance program both at the national and global levels.


A solid-state 53Cr NMR study of chromate and dichromate salts. Solid-state (53)Cr NMR spectra of a series of chromate (CrO4(2-)) and dichromate (Cr2O7(2-)) salts have been examined by employing the stepped-frequency quadrupolar Carr-Purcell Meiboom-Gill (QCPMG) experiment and high applied magnetic field strengths, 11.75 and 18.8 T. Cr-53 nuclear quadrupolar coupling constants, CQ(53Cr), ranging from 1.23 to 5.01 MHz for the Cr(4(2-) salts and 7.25 to 8.14 MHz for the Cr2O7(2-) salts have been measured. For the dichromate salts, this corresponds to central transition 53Cr NMR lineshapes of 200-250 kHz at 18.8 T. The use of hyperbolic secant (HS) pulses in combination with the Hahn-echo (HE) or QCPMG experiment results in significant sensitivity enhancements when acquiring 53Cr NMR spectra of magic-angle spinning (MAS) samples, provided the MAS rate is fast with respect to the second-order quadrupolar interaction. For the CrO4(2-) and Cr2O7(2-) salts, the anisotropic chromium magnetic shielding interaction is generally negligible compared to the second-order 53Cr nuclear quadrupolar interaction. No simple correlation between the structure of the CrO4(2-) and Cr2O7(2-) anions and the observed CQ(53Cr) values has been found.


Solid-state NMR studies and DFT calculations of flavonoids: baicalein, baicalin and wogonoside. Three flavonoids of pharmaceutical importance-baicalein, baicalin, and wogonoside-were isolated from a Chinese medicinal plant Scutellaria baicalensis Georgi and studied by 13C NMR in solution and solid state. Two-dimensional (2D) NMR spectroscopy in the liquid phase and dipolar dephasing (DD) experiments in magic-angle spinning (MAS) spectra enabled the assignment of 13C resonances. The cross-polarization (CP) time constants T(CH) and relaxation times T(H) (1rho) were obtained from the variable-contact time experiments. The principal elements of the 13C chemical shift tensor were determined in the spectra recorded under slow sample spinning (2 kHz) using phase-adjusted spinning sideband (PASS)-2D NMR technique, and were verified by density functional theory gauge-independent atomic orbital (DFT GIAO) calculations of shielding constants. Analysis of the 13C delta(ii) and comparison with shielding parameters calculated for different conformers of compounds 1-3 enabled the selection of the most reliable geometry in the solid phase. In all three compounds, an intramolecular hydrogen bond C5--OH...=C4 is formed; the existence of baicalein and baicalin with 'anticlockwise' orientation of OH groups is more probable.


An experimental study of decoupling sequences for multiple-quantum and high-resolution MAS experiments in solid-state NMR. Recently, a sequence for heteronuclear dipolar decoupling in solid-state NMR, namely SWf-TPPM, was introduced by us. Under magic-angle spinning (MAS), the decoupling efficiency of the sequence was unaffected over a range of values for various experimental parameters such as the pulse length, pulse phase, and 1H resonance offset. We here demonstrate its use in multiple-quantum (MQ) and high-resolution (HR) MAS experiments. This sequence further improves the MQMAS spectra compared to the earlier reported decoupling sequences with improved immunity to any missets of the pulse length, pulse phase and decoupler offset. In contrast, for HRMAS, the simple CW scheme is as efficient as any of the decoupling schemes that were studied.


Neutral zinc(II) O,O-di-alkyldithiopho- sphates-variable temperature 31P NMR and quantum chemical study of the ZDDP monomer-dimer equilibrium. A full line-shape analysis of the VT 31P NMR spectra was carried out for the monomer-dimer equilibrium of neutral ZDDP. The energy surface and the energetics of the monomer-dimer equilibrium (DeltaH degrees , DeltaG degrees , Ea, DeltaH(not equal), and DeltaG(not equal)) are reported for three variants wherein the alkyl groups in the ZDDP are 2-ethylhexyl, isopropyl, and isobutyl. We explored a reaction pathway between the monomer and dimer form by means of density functional theory (DFT). The linear combination of atomic orbitals (LCAO) code DMol3 was used together with a synchronous transient method to effectively locate transition states. Vibrational eigenmodes of all intermediates were computed to capture finite temperature effects. Methyl and ethyl were considered as alkyl groups. Two novel intermediates were located-a four-membered ring and a six-membered ring intermediate along the reaction coordinate. Comparison of the experimentally derived and computed energy surfaces was carried out.


Solid-state NMR analysis of the orientation and dynamics of epigallocatechin gallate, a green tea polyphenol, incorporated into lipid bilayers. Catechins are the principle polyphenolic compounds in green tea; the four major compounds identified are epicatechin (EC), epigallocatechin (EGC), epicatechin gallate (ECg) and epigallocatechin gallate (EGCg). Tea catechins tend to attach externally to their targets, such as viral envelopes, cell membranes, or the surface of low-density lipoproteins. In order to further our understanding of the molecular mobility of these compounds in cells, we examined the interaction of tea catechins with lipid membranes using solid-state NMR techniques. Our previous work indicated that the EGCg molecule is incorporated into lipid bilayers in a unique orientation. However, the detailed configuration, orientation, and dynamics of EGCg in lipid bilayers have not been well-characterized. Here, we investigated the orientation and dynamics of EGCg incorporated into multi-lamellar vesicles (MLVs) and bicelles using solid-state NMR spectroscopy.


Agreement of rubella IgG antibody measured in serum and dried blood spots using two commercial enzyme-linked immunosorbent assays. Cases of congenital rubella are now rare in the United Kingdom. However, in certain areas such as London, where a significant proportion of pregnant women has been born abroad and uptake of trivalent measles-mumps-rubella (MMR) vaccination is low, the risk of a rubella outbreak remains. Prior to carrying out a seroprevalence study using rubella IgG antibody in newborn dried blood spots as an indirect marker of maternal immunity, rubella IgG antibody concentrations in serum and dried blood spot samples were investigated. Anonymous paired serum-dried blood spot samples left over from occupational health screening were tested for rubella IgG antibody by two commercially available enzyme-linked immunosorbent assays (ELISAs) (Dade Behring, Marburg, Germany, and Diesse, Siena, Italy). Agreement between serum samples and dried blood spot samples was high for both assays. There were no significant differences in antibody concentrations in paired samples, as 67 of 73 samples tested with the Diesse ELISA (91.8%), and 76 out of 79 samples tested with the Dade Behring ELISA (96.2%) were within two standard deviations of the mean difference. Commercial ELISAs are an appropriate test for seroprevalence surveys based on rubella IgG in dried blood spot samples.


Acute gastroenteritis cases associated with noroviruses infection in the state of Rio de Janeiro. In March 2005, the Epidemiological Surveillance Service of Resende, municipality of the Middle Paraiba Valley, State of Rio de Janeiro, reported a sudden spontaneous occurrence of acute gastroenteritis cases in children in a public day care center. Further, between May and June 2005, gastroenteritis outbreaks or sporadic cases of gastroenteritis were reported in two other municipalities, Piraí and Rio Claro, also located in the Middle Paraiba Valley. From March to June 2005, 50 fecal samples were collected in this region and those samples were tested for the presence of bacteria and other parasites and were demonstrated to be negative. Polyacrylamide gel electrophoresis and an enzyme immunoassay were performed for adenovirus and rotavirus detection and reverse transcription-polymerase chain reaction was performed to investigate the presence of norovirus (NoV) and astrovirus. In addition, a quantitative TaqMan real time PCR for NoV was performed for quantification of viral DNA in order to compare the results with those obtained by conventional RT-PCR. NoV was detected in 33 out of 50 (66%) samples, and a 100% correlation between both methodologies was obtained. These results are demonstrating that NoV was the etiological agent responsible for those acute gastroenteritis cases. Partial nucleotide sequence analysis of the capsid gene revealed that the circulating strain was NoV GII/4 confirming the worldwide distribution of this genotype. The results highlight the role of NoV as a main viral agent responsible for gastroenteritis cases in children and adults both in outbreaks as well as in sporadic cases of acute gastroenteritis.


Two new phenylbutanoids from inner bark of Betula pendula. Two phenylbutanoids, 7-{3R-[(4-hydroxyphenyl)butyl] beta-glucopyranosid-O-6-yl} 4-O-beta-glucopyranosylvanillin and 3-beta-glucopyranosyloxy-1-(4-hydroxyphenyl)-butanone were isolated from an aqueous methanol extract of the inner bark of Betula pendula. Their structures were determined by NMR spectroscopy and mass spectrometry. The complete assignment of proton and carbon signals was achieved by 1D and 2D NMR experiments: selective 1D TOCSY, HSQC, HMBC and DQF-COSY.


Full NMR analysis of annomontine, methoxy- annomontine and N-hydroxyannomontine pyrimidine-beta-carboline alkaloids. Using modern NMR techniques, including 1H--13C and 1H--15N heteronuclear correlation experiments, the complete and unambiguous 1H, 13C, and 15N NMR chemical shift assignments of annomontine, methoxyannomontine, and N-hydroxyannomontine pyrimidine-beta-carboline alkaloids were performed. All 1H--1H scalar coupling constants and signal multiplicities were determined, and all nOe observations were also included.


High prevalence of anti-hepatitis E virus antibodies in blood donors from South West France. Cases of autochthonous acute hepatitis E occur in most industrialized countries and are frequent in the South West of France. The prevalence of anti-hepatitis E virus (HEV) IgG antibodies in blood donors in this area was determined. A total of 529 samples from rural and urban blood donors were tested. The overall prevalence was 16.6%, 19.1% of rural donors and 14.2% of urban donors had anti-HEV antibodies (P = 0.13). The antibodies were widely distributed among all age groups and the sex ratio of the anti-HEV positive blood donors was 1.12 (P = 0.57). Hunting was the only pastime or profession associated with a high prevalence of anti-HEV antibodies (P = 0.038). The frequency of anti-HEV antibodies in blood donors could reflect active autochthonous transmission in this area of France. As the risk factors for HEV infection in industrialized countries are still unknown, further studies are needed to clarify the epidemiology of HEV infection in the Midi-Pyrénées region.


Identification of human astrovirus infections among children with acute gastroenteritis in the Southern Part of Vietnam during 2005-2006. A molecular epidemiological study on common diarrheal viruses was conducted in a children's hospital in Ho Chi Minh City between December 2005 and November 2006. Fecal samples were collected from 502 pediatric patients with acute gastroenteritis, and were screened for eight types of viral agents. Human astroviruses (HAstVs), which were detected with a prevalence of 13.9%, became the second most frequent viral enteropathogen. Although detected in both dry and rainy seasons, the majority (92.8%) of HAstVs in this study were found in the rainy season. Patients aged between 6 and 23 months were found to be more infected from astrovirus when compared to other age groups. The ratio between boys and girls was 2.3:1. The overall mean severity score of astrovirus positive patients was 11.8 +/- 2.45. The mean severity score of the inpatients was statistically higher than that of the outpatients; however, there was no difference in severity scores between the age groups observed. The clinical manifestations of astrovirus infections among the Vietnamese children were diarrhea, vomiting, fever, coughing, and coryza. All of the detected astroviruses belonged to genotype 1. The phylogenetic tree clearly indicated that HAstVs-1 worldwide could be classified into four different lineages, in which, Vietnamese astroviruses and other recently isolated strains from other countries clustered into the distinct lineage, 1d. These results provide important information on astrovirus infections among Vietnamese children.


Complete 1H and 13C assignments of (21R) and (21S) diastereomers of argatroban. The complete 1H and 13C NMR assignments are reported for the antithrombotic (21R)- and (21S)-argatroban by 1D and 2D NMR experiments (HSQC, HMBC, NOESY and 1H--1H COSY). Some well-resolved signals could be used for an accurate measurement of the diastereomeric composition of argatroban.


Structural determination of salsolins A and B, new antioxidant polyoxygenated triterpenes from Salsola baryosma, by 1D and 2D NMR spectroscopy. Salsolins A (1) and B (2), the new triterpenes, have been isolated from the chloroform soluble fraction of Salsola baryosma along with 2alpha,3beta,23,24-tetrahydroxyurs-12-en-28-oic acid (3) reported for the first time from this species. Their structures have been assigned from 1H and 13C NMR spectra, DEPT and by 2D COSY, NOESY, HMQC and HMBC experiments. The compounds 1-3 showed significant antioxidant activity.


Genetic analysis of the hypervariable region of the human astrovirus nsP1a coding region: design of a new RFLP typing method. Human astroviruses (HAstV) are causative agents of viral gastroenteritis worldwide. A hypervariable region (HVR) is located close to the C-terminus of the nsP1a, and recent data support the involvement of the HVR-containing nonstructural protein in viral RNA replication processes, suggesting a correlation between variability in this region and pathogenic properties. The HVR of the C-terminal nsP1a coding region of 104 wild-type and reference isolates of HAstV was sequenced. A phylogenetic analysis was performed to identify different genotypes, and a restriction fragment length polymorphism (RFLP) method was designed. An extensive nucleotide and deduced amino acid sequence variability was observed, as well as many insertions and deletions that retained the reading frame. The resultant phylogenetic tree supported the subdivision of HAstV into the two previously described major genetic groups, genogroup A and B, and the identification of 12 genotypes (9 within genogroup A, and 3 within genogroup B), which could be identified by RFLP. A correlation analysis was performed between genotype information and viral load using information from 35 clinical samples. Significant differences were observed between the viral load in clinical samples and certain HAstV genotypes that belonged to the same serotype, confirming the influence of C-terminal nsP1a variability on the viral replication phenotype. The use of the new RFLP typing method based on the HVR of the C-terminal nsP1a coding region by diagnosticians would help to understand the relationship between different genotypes and the severity of the gastroenteritis.


Genetic and antigenic analysis of epidemic influenza viruses isolated during 2006-2007 season in Taiwan. Influenza viruses are some of the most active pathogens in Taiwan. The monitoring influenza activity has been coordinated by the Centers for Diseases Control, Taiwan, and the surveillance is based on integrated clinical and virological surveillance components. Data from sentinel physician networks and other sources, mainly hospitals were collected. During 2006-07 season, a total of 1724 cases of laboratory-confirmed influenza were reported by collaborating laboratories and sentinels, which was five fold higher than during the corresponding part of the 2005-06 season. Of the Taiwan isolates analyzed using post-infection ferret antisera, 1.5% were H1N1 (A/Hi), 21.5% H3N2 (A/H3), and 77.0% influenza B viruses. This reflects the predominance of influenza B viruses during 2006-07 season. In addition, continued antigenic drift was seen with the A/I-B viruses compared with the previous season's reference strains. However, an increasing number of recent A/H3 isolates characterized in our report were amantadine sensitive. Preparation for an influenza pandemic is presently a high priority in Taiwan. Laboratory-based surveillance systems must be timely in order to be effective. The data presented here highlights the need to characterize the circulating strains both antigenically and genetically during regular surveillance. Any contribution of individual genes or gene combinations to usual or unusual epidemic characteristics might thus be identified ensuring that virus strains can be selected for vaccine formulation that will most closely match the circulating viruses.


Genetic relatedness of noroviruses identified in sporadic gastroenteritis in children and gastroenteritis outbreaks in northern Alberta. We compared the proportion and genotype distribution of norovirus (NoV) identified in sporadic acute gastroenteritis in children younger than 7 years old with the NoV strains found in outbreaks from January 2003 through April 2004 in northern Alberta, Canada. Eight genogroup I (GI) and 133 GII NoV cases were detected in 1,166 cases of acute sporadic childhood gastroenteritis with a monthly detection rates varying from 6.0% to 20.4% and no sporadic gastroenteritis case in October 2003. Seventy-eight outbreaks (65%) tested positive for NoV during the study period with an obvious winter predominance and no NoV outbreaks in August, September, and October 2003. Three GI and 51 GII strains from the sporadic childhood gastroenteritis cases and seven GI and 37 GII strains from gastroenteritis outbreaks were sequenced and analyzed. Strains belonging to the GII.4 cluster predominated in outbreaks (68%) while the strains in sporadic childhood gastroenteritis demonstrated significant heterogeneity with the majority belonging to the GII.3 cluster (36%). Further analysis of NoV strains from 34 sporadic childhood gastroenteritis cases and 38 gastroenteritis outbreaks in chronologically and geographically related groups failed to demonstrate clear link between strains circulating in the setting of sporadic childhood gastroenteritis and those found in outbreaks.


1H, 13C and 77Se NMR study of tetraselenafulvalene derivatives supported by novel H(Se)C and H(C)Se triple-resonance experiments at natural abundance. A series of substituted tetraselenafulvalenes (TSeFs) was studied in solution using 1H, 13C and 77Se NMR spectroscopy. Chemical shifts and heteronuclear coupling constant values were determined and assigned. Novel two-dimensional H(Se)C and H(C)Se triple-resonance correlation experiments were applied at natural abundance in order to accomplish 13C and 77Se signal assignments. Using this approach, all the signals were unambiguously assigned and atom connectivity was established in the studied TSeF derivatives. These experiments, allowing signal assignments of quaternary carbons, may find wide application in the study of substituted TSeF and other organoselenium compounds. To the best of our knowledge, triple-resonance experiments with proton detection have been applied to organoselenium compounds for the first time.


Structural determination of two new sesquiterpenes biotransformed from germacrone by Mucor alternata. Eight transformed sesquiterpenes of germacrone by Mucor alternata were obtained. Their structures were characterized on the basis of spectral methods including 2D NMR. Among them, (1S, 4S, 5S, 10R)-isozedoarondiol (2) and (1R, 4S, 5S, 10R)-diepoxy-12-hydroxygermacrone (3) are new compounds.


Persistence of novel human parvovirus PARV4 in liver tissue of adults. Human parvovirus 4 (PARV4) is a recently identified virus whose biology, epidemiology and pathogenic potential have yet to be determined. Recently, it was reported that PARV4 DNA persists in tissues of some HIV-infected individuals, whilst PARV4 DNA was not detected in tissues of subjects not infected with HIV. In the present study, liver tissue from 87 individuals, none of who were infected with HIV, with the exception of a single subject, was analyzed for the presence of PARV4 DNA. Overall, PARV4 DNA was detected in 13 specimens (15%). In other tissues examined, PARV4 genotype 2 (also termed PARV5) DNA was detected in one of four paired bone marrow specimens. Tissue viral loads did not exceed 100 copies per microg of genomic DNA. In addition, serum samples from 40 of these individuals all tested negative for PARV4 DNA. In the subjects analyzed in this study, PARV4 genotype 2 appeared to be genetically more heterogeneous than PARV4 genotype 1. The results show that PARV4 DNA can be detected in liver, and that infection with PARV4 is not restricted to HIV-infected individuals. Previous studies showing the presence of PARV4 in plasma, suggest that during infection with PARV4, a viraemic stage occurs, allowing systemic spread to a variety of tissues.


1H NMR study of internal motions and quantum rotational tunneling in (CH3)4NGeCl3. (CH3)4NGeCl3 is prepared, characterized and studied using 1H NMR spin lattice relaxation time and second moment to understand the internal motions and quantum rotational tunneling. Proton second moment is measured at 7 MHz as function of temperature in the range 300-77 K and spin lattice relaxation time (T1) is measured at two Larmor frequencies, as a function of temperature in the range 270-17 K employing a homemade wide-line/pulsed NMR spectrometers. T1 data are analyzed in two temperature regions using relevant theoretical models. The relaxation in the higher temperatures (270-115 K) is attributed to the hindered reorientations of symmetric groups (CH3 and (CH3)4N). Broad asymmetric T1 minima observed below 115 K down to 17 K are attributed to quantum rotational tunneling of the inequivalent methyl groups.


Using indirect covariance spectra to identify artifact responses in unsymmetrical indirect covariance calculated spectra. Several groups of authors have reported studies in the areas of indirect and unsymmetrical indirect covariance NMR processing methods. Efforts have recently focused on the use of unsymmetrical indirect covariance processing methods to combine various discrete two-dimensional NMR spectra to afford the equivalent of the much less sensitive hyphenated 2D NMR experiments, for example indirect covariance (icv)-heteronuclear single quantum coherence (HSQC)-COSY and icv-HSQC-nuclear Overhauser effect spectroscopy (NOESY). Alternatively, unsymmetrical indirect covariance processing methods can be used to combine multiple heteronuclear 2D spectra to afford icv-13C-15N HSQC-HMBC correlation spectra. We now report the use of responses contained in indirect covariance processed HSQC spectra as a means for the identification of artifacts in both indirect covariance and unsymmetrical indirect covariance processed 2D NMR spectra.


A randomized trial comparing compression, Perclose Proglide and Angio-Seal VIP for arterial closure following percutaneous coronary intervention: the CAP trial. This prospective randomized trial compared the Angio-Seal VIP with Perclose Proglide and to manual compression with respect to time to hemostasis and ambulation, patient satisfaction, and vascular complications following percutaneous coronary intervention (PCI). The use of arterial closure devices for the reduction of vascular complications following PCI remains controversial. There have been no head to head trials comparing these most commonly used arterial closure devices following PCI. Two hundred patients undergoing PCI were randomized to manual compression, Perclose Proglide or Angio-Seal VIP. Ambulation was allowed 3 hr after Perclose Proglide or Angio-Seal VIP and 6 hr after compression. There were 10 failures to deploy Perclose Proglide and none for Angio-Sealt (P < 0.01). Time to hemostasis was significantly shorter with Angio-Seal VIP compared with Perclose Proglide (5.3 vs. 46.8 min, P < 0.01). Time to ambulation was shorter with Angio-Seal VIP than with Perclose Proglide (261 vs. 334 min, P < 0.05) and the time to ambulation, as expected, was longest with compression (943 min, P < 0.01 vs. Angio-Seal VIP and Perclose Proglide). Delay in ambulation was higher with Perclose Proglide than with Angio-Seal VIP (18 vs. 9, P < 0.01). There was no significant difference in major vascular complications between groups. Compared with compression, patient discomfort was significantly improved with Angio-Seal (1.5 vs. 2.0, P < 0.01), but not with Perclose Proglide. The Angio-Seal VIPtrade mark device has a high rate of deployment success, which is significantly better than that of Perclose Proglide. Angio-Seal VIP allows for earlier hemostasis and ambulation compared with both compression and Perclose Proglide and is associated with greater patient satisfaction compared with compression.


Insulin and solid-phase synthesis, 1964-1970. A chemical synthesis of insulin was undertaken by solid phase principles during the period 1964-70.


Belts, suspenders, and the world of vascular closure.


Effects of net charge and the number of positively charged residues on the biological activity of amphipathic alpha-helical cationic antimicrobial peptides. In our previous study, we utilized a 26-residue amphipathic alpha-helical antimicrobial peptide L-V13K (Chen et al., Antimicrob Agents Chemother 2007, 51, 1398-1406) as the framework to study the effects of peptide hydrophobicity on the mechanism of its antimicrobial action. In this study, we explored the effects of net charge and the number of positively charged residues on the hydrophilic/polar face of L-V13K on its biological activity (antimicrobial and hemolytic) and biophysical properties (hydrophobicity, amphipathicity, helicity, and peptide self-association). The net charge of V13K analogs at pH 7 varied between -5 and +10 and the number of positively charged residues varied from 1 to 10. The minimal inhibitory concentrations (MIC) against six strains of Pseudomonas aeruginosa as well as other gram-negative and gram-positive bacteria were determined along with the maximal peptide concentration that produces no hemolysis of human red blood cells (MHC). Our results show that the number of positively charged residues on the polar face and net charge are both important for both antimicrobial activity and hemolytic activity. The most dramatic observation is the sharp transition of hemolytic activity on increasing one positive charge on the polar face of V13K i.e., the change from +8 to +9 resulted in greater than 32-fold increase in hemolytic activity (250 microg/ml to <7.8 microg/ml, respectively).


CTO recanalization by intraocclusion injection of contrast: the microchannel technique. To assess the utilization of microinjection of contrast for the recanalization of chronic total occlusions (CTO). Microchannels in CTOs have been considered important conduits for CTO crossing, utilizing dedicated guidewires. We postulated that microinjection of contrast immediately distal to the proximal cap of the CTO could identify and enlarge these microvessels, creating a passage for crossing the CTO with a floppy guidewire. A total of 32 patients with a CTO were treated with this technique. Following few millimetres penetration of the proximal fibrous cap of the occlusion with a dedicated CTO guidewire, the over-the-wire balloon was advanced into the proximal portion of the occlusion, and 50-100 microg of nitroglycerine followed by 1 ml of contrast was gently injected into the occluded segment. Technical success of the microchannel technique was defined as the ability to visualize the distal true lumen with microinjection of contrast and thereafter cross the CTO with a floppy guidewire in the absence of any dissection. Overall, technical success of the microchannel technique was obtained in 20 (63%) with angiographic success in 19. In 12 (37%) cases there was a technical failure because of dissection, and we obtained recanalization of the artery in 7 of these 12 cases with another technique. There was only one case of periprocedural myocardial infarction in an unsuccessful procedure and no major adverse cardiac events or subacute stent thromboses were observed. Microinjection of contrast immediately distal to the proximal fibrous cap of a CTO may be an additional technique to facilitate recanalization of CTO.


Force spectroscopy of the fibrin(ogen)-fibrinogen interaction. Fibrin aggregation is of vital importance in many physiological and pathological processes, such as blood coagulation, wound healing, and thrombosis. In the present study, we investigated the forces involved in the initial steps of the fibrinogen fibrin aggregation by force spectroscopy using the atomic force microscope. Our data confirm the existence of strong specific interactions between fibrin and fibrin(ogen), with unbinding forces ranging from 290 to 375 pN and a logarithmic dependence on the loading rate between 0.8 and 23 nN/s.


Investigation of molecular structure of bombesin and its modified analogues nonadsorbed and adsorbed on electrochemically roughened silver surface. This work describes the molecular structure of bombesin (BN) and its analogs on the basis of the absorption infrared and Raman results described below. In these analogues is replaced one ([D-Phe12]BN, [Tyr4]BN, and [Lys3]BN) or two ([Tyr4,D-Phe12]BN, [D-Phe12,Leu14]BN, and [Leu13-(R)-Leu14]BN) amino acid residues within the peptide chain with a synthetic amino acid, creating antagonists to bombesin, which are useful in the treatment of cancer. It is also used surface enhanced Raman scattering (SERS) to study the differences and changes in the vibrational spectra of BN and its analogs, which were attached to an electrochemically roughened silver surface as these peptides interacted with target proteins. This work explores the use of SERS for molecules anchored to a macroscopic silver surface to interrogate the interaction of these peptides with protein receptors. The results presented here show that all peptides coordinate to the macroscopic silver surface through an indole ring and the methylene group of Trp8, the C==O fragment, and an amide bond; however, the orientation of these fragments on the electrochemically roughened silver surface and the strength of the interactions with this surface is slightly different for each peptide. For example, the interaction of --CH2-- of [D-Phe12]BN, [Tyr4,D-Phe12]BN, [D-Phe12,Leu14]BN, [Leu13-(R)-Leu14]BN, and [Lys3]BN with the silver surface perturbed the vertical orientation of the Trp8 indole ring on this surface. Hence, the indole ring adopted a close to perpendicular orientation on the silver surface for BN and [Tyr4]BN, only.


Intraplaque contrast injection for the recanalization of total occlusions: the drop that hollows out the stone?


Time-resolved fluorescence spectroscopy and molecular dynamics simulations point out the effects of pressure on the stability and dynamics of the porcine odorant-binding protein. The effects of hydrostatic pressure on the structure and stability of porcine odorant-binding protein (pOBP) in the presence and absence of the odorant molecule 2-isobutyl-3-methoxypyrazine (IBMP) were studied by steady-state and time-resolved fluorescence spectroscopy as well as by molecular dynamics simulation. The authors found that the application of moderate values of hydrostatic pressure to pOBP solutions perturbed the microenvironment of Trp(16) and disrupted its highly quenched complex with Met(39). In addition, compared with the protein in the absence of IBMP, the MD simulations experiments carried out at different pressures highlighted the role of this ligand in stabilizing the Trp(16)/Met(39) interaction even at 2000 bar. The obtained results will assist for the tailoring of this protein as specific sensing element in a new class of fluorescence-based biosensors for the detection of explosives.


A new method of three-dimensional coronary artery reconstruction from X-ray angiography: validation against a virtual phantom and multislice computed tomography. To develop and implement a method for three-dimensional (3D) reconstruction of coronary arteries from conventional monoplane angiograms. 3D reconstruction of conventional coronary angiograms is a promising imaging modality for both diagnostic and interventional purposes. Our method combines image enhancement, automatic edge detection, an iterative method to reconstruct the centerline of the artery and reconstruction of the diameter of the vessel by taking into consideration foreshortening effects. The X-Ray-based 3D coronary trees were compared against phantom data from a virtual arterial tree projected into two planes as well as computed tomography (CT)-based coronary artery reconstructions in patients subjected to coronary angiography. Comparison against the phantom arterial tree demonstrated perfect agreement with the developed algorithm. Visual comparison against the CT-based reconstruction was performed in the 3D space, in terms of the direction angle along the centerline length of the left anterior descending and circumflex arteries relative to the main stem, and location and take-off angle of sample bifurcation branches from the main coronary arteries. Only minimal differences were detected between the two methods. Inter- and intraobserver variability of our method was low (intra-class correlation coefficients > 0.8). The developed method for coronary artery reconstruction from conventional angiography images provides the geometry of coronary arteries in the 3D space.


First direct in vivo comparison of two commercially available three-dimensional quantitative coronary angiography systems. The in vivo comparison of the accuracy of two 3-dimensional quantitative coronary angiography (QCA) systems. Precision-drilled plexiglass phantoms with five different luminal diameters (0.5-1.9 mm) were percutaneously inserted into the coronary arteries of four Yorkshire pigs. Twenty-one angiographic images of these stenotic phantoms were acquired for in vivo validation testing. Quantitative assessments of the minimum, maximum, and mean luminal diameters together with the minimum luminal area were determined using two 3D QCA systems, the CardiOp-B and CAAS 5. The CardiOp-B system significantly underestimated the minimum luminal diameter MLD whilst both systems significantly overestimated the maximum luminal diameter at the minimal luminal area (MLA) over the phantom's true value. The CAAS 5 system had a greater degree of accuracy/mm (mean difference = 0.01 vs. 0.03) and precision/mm (SD = 0.09 vs. 0.23) than the CardiOp-B in assessing the minimal LD. An increased precision/mm (SD = 0.01 vs. 0.29) and accuracy/mm (mean difference = 0.03 vs. 0.11) in the mean LD was observed with the CAAS 5. In comparing the MLA/mm(2) the CAAS 5 was more precise/mm(2) (SD = 0.14 vs. 0.55) and accurate/mm(2) (mean difference = 0.12 vs. 0.02) to the true phantom MLA compared to the CardiOp-B system. In a 21 phantom study, the CAAS 5 3D QCA system had a greater degree of accuracy and precision in both the luminal and area measurements than the CardiOp-B 3D QCA system.


Novel paclitaxel-eluting, biodegradable polymer coated stent in the treatment of de novo coronary lesions: a prospective multicenter registry. The purpose of the present study was to evaluate the efficacy and safety of a biodegradable polymer coated, paclitaxel eluting stent (Luc-Chopin(2)) based on 9-months angiographic and 12-months clinical follow-up results. First-generation drug-eluting stents utilize nonbioabsorbable polymeric coatings, whose persistent presence in the arterial wall may negatively affect long-term outcomes. Bioabsorbable coatings with a degradation period matched to that of the drug elution may be a better alternative, clinically and economically. We conducted a prospective, multicenter first-in-man registry of a novel, locally developed, bioabsorbable-coated, paclitaxel-eluting coronary stent in 116 patients with single-lesion de novo coronary disease. Major adverse cardiac events occurred in 7.8% patients within 12 months. There were no late thrombotic events, death, stroke, or surgical revascularization in that period. There were two myocardial infarctions, one related to recent subacute stent thrombosis and another associated with restenosis. By 12 months, target vessel revascularization was performed in 7.8%; 2.9% were ischemia-driven and the rest were mandated at 9 months in accordance with a control angiography protocol. Core-lab assessed binary in-stent restenosis (> or =50% DS) was noted in 11.9% patients and mean late loss was 0.46 +/- 0.47 mm. This first-in-man experience obtained in a multicenter registry of real-world de novo lesions (almost half of lesions were class B2 or C by AHA classification) showed a favorable safety profile and acceptable efficacy through 12 months. Randomized comparison with a benchmark nonbioabsorbable polymer coated paclitaxel eluting stent should be undertaken to validate this initial positive experience.


Percutaneous intervention on the saphenous vein bypass grafts--long-term outcomes. In this era of drug eluting stents (DES), the long-term outcome of percutaneous intervention (PCI) on saphenous venous grafts (SVG) is unknown. The objective of the study was to compare the long-term outcomes of DES versus bare metal stent (BMS) in this population and to determine the predictors of outcomes. We reviewed the medical records of all patients who had PCI performed during January 2003 to February 2005 to obtain data cardiac risk factors, medications at discharge, angiographic details and outcomes. One hundred and nine patient had PCI to SVG; of these, 37 patients received DES and the remaining had BMS. Over a mean follow-up of 33 months, the PCI using DES was associated with 30% restenosis, 35% target vessel revascularization (TVR) and major adverse cardiac event (MACE) rate of 46% versus 35% restenosis, 38% TVR and 50% MACE rate with BMS. There was no significant difference in long-term outcome with DES as compared to BMS. There was no difference in the long-term outcomes of PCI on SVG irrespective of the type of stent used.


Surface modification and microstructure of single-walled carbon nanotubes for dental resin-based composites. In the present study, a novel process has been developed to improve the application of single-walled carbon nanotubes (SWCNTs) in dental resin-based composites (RBCs). Efforts have been made to deposit a thin shell of nano-SiO(2) onto the oxidized surface of SWCNTs by using a thin adlayer of 3-aminopropyltriethoxysilane; this was followed by modification of the nano-SiO(2) layer by using another organosilane with allyl-terminated functional groups to achieve well dispersion and integration in the matrix. Fourier transform infrared spectroscopy (FTIR) and transmission electron microscopy (TEM) are used to analyze the modified SWCNTs. The obtained shell has a sandwich-like structure, with an amino-modified silane layer on the inside, a nano-SiO(2) layer in the middle, and an allyl-terminated silane layer on the outside. Composite resin specimens with modified SWCNTs are prepared and examined using TEM. A three-point-bend test is performed using the MTS Synergie 100 testing machine. Statistical analysis reveals that the addition of modified SWCNTs improves the flexural strength (p < 0.05) of dental RBCs.


Anti-inflammatory effect of ibuprofen-loaded embolization beads in sheep uterus. Embolization of blood vessels may result in a variety of side effects which can include pain and inflammation. The objective of this study was to assess the release and effect of ibuprofen (IBU) from Bead Block microspheres (BB) loaded with IBU (IBU-BB) on the foreign body inflammatory reaction in a sheep uterine artery model. Both uterine arteries of 12 hormonally cycled ewes were embolized with 0.5 mL of 500-700 microm BB (n = 6) or IBU-BB (n = 6). Animals were sacrificed at 1 week (1W) or 3 weeks (3W) (n = 3 each group). The gross examination of the organs was performed and distribution of the beads in the tissue was assessed. Inflammation was estimated histologically by quantitative and semiquantitative classification of inflammatory cells on HES and MGG stains and use of videoanalysis after immunohistolabeling with CD-antibodies to a variety of inflammatory cells. At 1W, a significant decrease of inflammatory response was observed for IBU-BB relative to BB in terms of number of lymphocytes and of immunohistochemical staining for CD172a, MHC-II, CD3, and CD4. At 3W, the inflammatory response for IBU-BB was similar to that for BB at 1W in terms of cell populations and moderate intensity. There was no or low amounts of staining for CD8 and CD45RA and none for CD21 in all four groups. Immunohistochemical detection of IBU showed that some drug was still present in the beads at 1W but none was detectable at 3W suggesting it had all eluted. These results signify that the inflammatory response is dampened by the action of IBU eluted from the beads and that IBU-BB can delay postembolization inflammatory reaction.