Persistence of Epstein-Barr virus in salivary gland biopsies from healthy individuals and patients with Sjögren''s syndrome.

Salivary gland biopsies from 12 patients with primary Sjögren''s syndrome and 10 controls were examined for Epstein-Barr virus (EBV) DNA by in-situ hybridization and for EBV proteins by immunofluorescence and peroxidase techniques. Viral DNA was found in biopsies from two out of 12 patients with primary Sjögren''s syndrome and six out of the 10 controls. The DNA and early antigen were in epithelial cells lining the ducts and acini, early antigen expression being limited to the luminal side of the epithelium. In eight biopsies studied with other antibodies, membrane antigen was identified in both acini and ducts but viral capsid antigen and Epstein-Barr nuclear antigen were not detected. EBV was found in biopsies from five of the controls without inflammation or Class II expression. This suggests that, in health, persistence and replication occur without inducing an immune response, possibly due to the restricted expression of early antigen on the luminal of the epithelium, away from immune surveillance. The inflammation in Sjögren''s syndrome could be due to a breakdown of this unusual mechanism for viral persistence leading to a vigorous immune response to the virus. However our study provides no evidence to suggest that EBV infection load is increased in this disease.     

Adherence Patterns and Adherence-Related DNA Sequences in Escherichia coli Isolates from Children with and without Diarrhea in S?o Paulo City,Brazil

The correlation between various adherence patterns and adherence-related DNA sequences in Escherichia coli isolates from 1- to 4-year-old children with and without diarrhea in São Paulo, Brazil, was evaluated. A total of 1,801 isolates obtained from 200 patients and 200 age-matched controls were studied. The adherence patterns found were classified as diffuse, aggregative, aggregative in a 6-h assay, aggregative predominantly in coverslips, localized, localized-like, and noncharacteristic. In general, the DNA sequences used as probes showed excellent specificities (>93%), but their sensitivities varied. Thus, the results of bioassays and assays with DNA probes normally used to search for adherent E. coli did not correlate well, and the best method for the identification of these organisms in the clinical research setting remains controversial. Isolates presenting diffuse adherence or hybridizing with the related daaC probe, or both, were by far the most frequent in patients (31.5, 26.0, and 23.0%, respectively), followed by isolates presenting aggregative adherence or hybridizing with the related EAEC probe, or both (21.5, 13.0, and 10.5%, respectively). None of the different combinations of adherence patterns and adherence-related DNA sequences found were associated with acute diarrhea.The first step in the establishment of the diarrheal diseases caused by the various categories of diarrheagenic Escherichia coli is adherence to epithelial cells of the intestinal mucosa. In vitro assays with eukaryotic cell lines (HeLa and HEp-2 cells) have identified three distinct adherence patterns among fecal isolates of E. coli: localized, diffuse, and aggregative (37, 38, 41). Localized adherence (LA) is characterized by formation of bacterial microcolonies on a restricted area(s) of the cell surface, while diffuse adherence (DA) is the scattered attachment of bacteria over the whole surface of the cell (41). The pattern of aggregative adherence (AA) consists of bacterial attachment to the cells and the intervening cell growth surface in a stacked brick-like lattice (37).The LA pattern was first detected in strains classified as enteropathogenic E. coli (EPEC) among serogroups associated with outbreaks of infantile diarrhea (41). Although E. coli strains exhibiting DA (DAEC) have been isolated at similar frequencies from feces of infants and young children with acute diarrhea and nondiarrheic controls in some populations (3, 10, 11, 14, 18), they were significantly associated with diarrhea in other settings (1, 17, 24, 29, 33). E. coli strains showing AA, termed enteroaggregative E. coli (EAEC), have been linked to sporadic persistent diarrhea (3, 4, 7, 10, 13, 26, 27, 44) and to outbreaks of diarrhea in both developing and developed countries (8, 12, 28, 43). However, the role of EAEC in acute diarrhea is still controversial: some studies have shown a correlation (7, 23, 25, 27, 34, 37), but others (1, 3, 6, 10, 11, 13–15, 17, 18, 24, 26, 29, 33, 44) have not.DNA probes derived from adherence-related sequences have been constructed (2, 5, 16, 31, 36) and used in hybridization assays for the detection of the different established and putative categories of diarrheagenic E. coli in many epidemiological studies.We evaluated the relationship between the LA, DA, and AA patterns and hybridization with adherence-related DNA sequences and tested children 1 to 4 years old with and without acute diarrhea for the presence of adherent E. coli strains.     

Glycoproteins present in human follicular fluid that inhibit the zona- binding capacity of spermatozoa

Previous studies have suggested that human follicular fluid contains factors that reduce the zona-binding capacity of spermatozoa. The present study provides further evidence of the existence of such factors. Using the hemizona binding assay (HZA), we have shown that the inhibitory effect of human follicular fluid on the zona-binding capacity of spermatozoa is concentration-dependent, an inhibitory effect being detected when the concentration of human follicular fluid was > or = 10%. A 1% concentration of human follicular fluid did not possess this inhibitory activity. Heating human follicular fluid at 56 degrees C for 30 min did not affect its inhibitory properties; treatment with proteinase-K abolished such inhibition. Human follicular fluid was fractionated sequentially by concanavalin-A affinity chromatography, Mono Q ion-exchange chromatography and Superose-12 gel filtration. The zona binding inhibitory activity resided in the fraction which bound to the lectin and Mono Q column and contained molecules with native molecular weights of 32 and 192 kDa. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis analysis suggested that the 192 kDa glycoprotein was a tetramer, while the 32 kDa glycoprotein remained as a single molecular species under denaturing conditions. We conclude that two glycoproteins were responsible for the zona binding inhibitory activity of human follicular fluid. The physiological role of these factors remains unclear.      

Predicting hospital mortality for patients in the intensive care unit: a comparison of artificial neural networks with logistic regression models

OBJECTIVE: Logistic regression (LR), commonly used for hospital mortality prediction, has limitations. Artificial neural networks (ANNs) have been proposed as an alternative. We compared the performance of these approaches by using stepwise reductions in sample size. DESIGN: Prospective cohort study. SETTING: Seven intensive care units (ICU) at one tertiary care center. PATIENTS: Patients were 1,647 ICU admissions for whom first-day Acute Physiology and Chronic Health Evaluation III variables were collected. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We constructed LR and ANN models on a random set of 1,200 admissions (development set) and used the remaining 447 as the validation set. We repeated model construction on progressively smaller development sets (800, 400, and 200 admissions) and retested on the original validation set (n = 447). For each development set, we constructed models from two LR and two ANN architectures, organizing the independent variables differently. With the 1,200-admission development set, all models had good fit and discrimination on the validation set, where fit was assessed by the Hosmer-Lemeshow C statistic (range, 10.6-15.3; p > or = .05) and standardized mortality ratio (SMR) (range, 0.93 [95% confidence interval, 0.79-1.15] to 1.09 [95% confidence interval, 0.89-1.38]), and discrimination was assessed by the area under the receiver operating characteristic curve (range, 0.80-0.84). As development set sample size decreased, model performance on the validation set deteriorated rapidly, although the ANNs retained marginally better fit at 800 (best C statistic was 26.3 [p = .0009] and 13.1 [p = .11] for the LR and ANN models). Below 800, fit was poor with both approaches, with high C statistics (ranging from 22.8 [p <.004] to 633 [p <.0001]) and highly biased SMRs (seven of the eight models below 800 had SMRs of <0.85, with an upper confidence interval of <1). Discrimination ranged from 0.74 to 0.84 below 800. CONCLUSIONS: When sample size is adequate, LR and ANN models have similar performance. However, development sets of < or = 800 were generally inadequate. This is concerning, given typical sample sizes used for individual ICU mortality prediction.     

Current medical management of valvular heart disease

Drug therapy plays a key role in the management of valvular heart disease, though in many cases it does not alter its course or delay the need for surgery. The importance of drug therapy lies in stabilizing the patient's condition when the disease is due to abnormal valve structure, and in treating the underlying condition when the condition is due to a functional abnormality. Drug therapy also lowers the risk of bacterial endocarditis and rheumatic fever.     

Dependence of vibrotactile thresholds on the psychophysical measurement method

OBJECTIVES: To investigate the dependence of vibrotactile thresholds on the psychophysical method used in the diagnosis of neurological dysfunction caused by exposure to hand-transmitted vibration. To compare thresholds obtained with (a) 'continuously variable' versus intermittent 'staircase' stimulation using 'yes-no' responses, and (b) 'yes-no' and 'forced-choice' responses using intermittent staircase stimulation. METHODS: Vibrotactile thresholds were measured on 12 healthy men by three different psychophysical methods. All measurements were performed with the same vibrometer in which the vibratory stimulus was applied by a probe 6 mm in diameter that protruded through a hole of 10 mm diameter in a surround, controlling both the contact force and the push force. Four stimulus frequencies (16, 31.5, 63 and 125 Hz) were used to obtain responses from FAI and FAII mechanoreceptors. RESULTS: There was a 3 to 6 dB variation in threshold due to the psychophysical method: thresholds were lower with intermittent stimulation and thresholds obtained with the 'forced-choice' procedure were lower than those obtained with the 'yes-no' procedure. Alternative explanations of the findings were offered. CONCLUSIONS: The dependence of psychophysical measurement method on vibrotactile thresholds was partly due to influencing responses via mechanoreceptor systems. It was suggested that the psychophysical measurement method had a sufficiently large effect on vibrotactile thresholds for it to be taken into account when methods for the diagnosis of neurological disorders are standardised.     

An ecological risk assessment for triclosan in lotic systems following discharge from wastewater treatment plants in the United States

A modeling study was conducted to examine the distribution of concentrations of the antimicrobial triclosan (2,4,4'-trichloro-2'-hydroxydiphenyl ether) in rivers following discharge from wastewater treatment plants (WWTPs). Most uses of triclosan are disposed of down residential drains and ultimately reach WWTPs. A modeling analysis was conducted to simulate the discharge of triclosan in WWTP effluents to rivers and calculate the expected concentrations based on characteristics of the reach where the discharge occurred, the estimated concentration of triclosan in the WWTP effluent, and the physicochemical properties of triclosan. A probabilistic exposure assessment was conducted based on data on the characteristics of U.S. reaches receiving wastewater discharges and the physicochemical characteristics of triclosan. A risk assessment was conducted by comparing the estimated concentrations with toxicity endpoint concentrations for species representative of key ecological groups. For fish and invertebrates, neither acute nor chronic risks are of concern, and no concerns exist for vascular aquatic plants. However, certain types of algae are the most sensitive species to triclosan by more than an order of magnitude than other algal or aquatic plant species. For these algae, the potential exists for some risk from triclosan exposure near the WWTP discharge location during low-flow-rate periods for some WWTPs with small dilutions. The risks downstream are lower because of dissipation of triclosan.     

Bilateral longitudinal temporal bone fractures: A retrospective review of seventeen cases

The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10-year period from 1968 to 1978 are reviewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. Fifty-nine of these were temporal bone fractures and 17 of the 59 were bilateral. Of all the base of skull fractures, 10% were bilateral temporal bone fractures and 29% of all temporal bone fractures were bilateral. For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X-ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.     

Benefits of a lower hematocrit during extracorporeal membrane oxygenation?

OBJECTIVE--To determine the possible benefits of maintaining a lower hematocrit than that normally used (0.35 vs 0.45) in neonates treated with extracorporeal membrane oxygenation. DESIGN--Randomized cohort. SETTING--Neonatal and pediatric intensive care units at a university hospital. PARTICIPANTS--Twenty neonates who met criteria for receiving extracorporeal membrane oxygenation from May 1988 to March 1990. INTERVENTIONS--Hematocrits were maintained at 0.35 for neonates in group 1 and 0.45 for neonates in group 2. MEASUREMENTS/MAIN RESULTS--Hematocrits were measured every 4 hours. Visible clots in the major circuit components were recorded. Infants in group 1 received (mean +/- SD) 2.5 +/- 0.6 mL of packed red blood cells per hour of extracorporeal membrane oxygenation while infants in group 2 received 3.8 +/- 0.9 mL of packed red blood cells per hour of extracorporeal membrane oxygenation. In group 1, clots were noted in six of 10 oxygenators and five of 10 bladder reservoirs. In group 2, clots were found in all 10 oxygenators and bladder reservoirs. CONCLUSIONS--Neonates' hematocrits can be maintained safely at 0.35 during extracorporeal membrane oxygenation with significantly less exposure to packed red blood cells and less clotting in the circuit.