The recognition and characterisation of Finnish Clostridium difficile isolates resembling PCR-ribotype 027

Purpose

To characterise and compare twenty-eight Finnish Clostridium difficile RT027-like isolates, selected based on the presence of 18 bp deletion in the tcdC gene and toxin gene profile (A, B, binary), with eleven RT027 isolates from different Finnish geographical areas and time periods.

Type I iodothyronine 5'-deiodinase mRNA and activity is increased in adipose tissue of obese subjects

Differentiation and metabolism of adipose tissue are modulated by thyroid hormones (THs), but relatively little is known about the metabolism of THs in this tissue. Expression of the genes for type I iodothyronine 5'-deiodinase (D1), leptin (LEP) and stearoyl-CoA desaturase 1 (SCD-1) was evaluated in omental (OM) and subcutaneous (SC) fat using a cohort of 70 humans. Activities of iodothyronine deiodinases (D1, D2 and D3) were assessed in a randomly selected subpopulation of 19 subjects. D1 expression was upregulated in both OM (P=0.011) and SC (P=0.003) fat of obese subjects. Concomitantly, OM (P=0.002) and SC (P=0.028) LEP expression were increased in obesity, associated with both D1 mRNA (r=0.315, P=0.014) and activity (r=0.647, P=0.023) and inversely related to SCD-1 (r=-0.266, P=0.034) expression in SC fat. Also D1 (but not D2 and D3) activity was increased in OM (～fourfold, P=0.010) and SC (～eightfold, P=0.004) fat of obese when compared with non-obese subjects and correlated in both OM (r=0.528, P=0.036) and SC (r=0.749, P=0.005) fat with body mass index. Our results document increased D1 gene expression and activity in adipose tissue of obese humans and suggest a role of 3,5,3'-triiodo-L-thyronine formed by D1 in response to leptin in the modulation of adipose tissue metabolism.     

Effectiveness of radiosynoviorthesis in the treatment of chronic synovitis of small and middle-sized joints affected by rheumatoid arthritis

Our aim was to describe and evaluate our experience in the treatment of radiosynoviorthesis (RSO) of small and middle-sized joints in patients with rheumatoid arthritis (RA). Eighty six patients with RA enrolled in the study. The criterion for enrolment was destructive process of the joint detected by X-rays and classified as a stage II-III according to Larsen. Seventy-six middle-sized joints were treated each with 74MBq or rhenium-186 sulphate and other 80 small joints with 10-40MBq of erbium-169 citrate each. The effect of treatment was evaluated at 6 and 12 months following the RSO treatment. The obtained values were compared with those of the initial state. The inflammatory and structural changes in activity were assessed according to the results of ultrasound examination, regression of pain, swelling of the joint and the improvement in mobility. The data obtained were statistically processed with the Chi-square test. Our results showed that RSO significantly decreased pain of the affected joints, however the influence upon joint motion was minimal. The best treatment results were observed in shoulders and elbows, while the ankles were the worst to respond to the RSO treatment. The significant (P<0.05) beneficial effect of the RSO treatment on pain and swelling reduction were only transient started on 1 week to 1 month and declined over 12 months. In conclusion, our study showed that RSO is a suitable alternative in the treatment of chronic synovitis, with a low potential of adverse effects. However the beneficial effect on pain and swelling reduction was only transient and declined over 12 months.     

Ultrastructural characteristics and variability of vegetative reproduction in Fellomyces penicillatus

The yeast strains VKM Y‐2977 and VKM Y‐2978, derived from the isolate Pa‐202, were examined for their physiological properties and mycocin sensitivities and studied by light, phase‐contrast, fluorescence, transmission and scanning electron microscopy. The cells of the first strain produced long stalk‐like conidiophores, whereas the cells of the second one had the appearance of a typical budding yeast under the light microscope. Transmission and scanning electron microscopy showed the formation of stalk‐like conidiophores and long necks in VKM Y‐2977, similar in appearance to Fellomyces fuzhouensis. The actin cytoskeleton, microtubules and nuclei were similar as well, but due to presence of a capsule, they were not clearly visible. The second isolate, VKM Y‐2978, had very short stalk‐like conidiophores, and the neck, microtubules and actin cables were shorter as well. The actin patches, actin cables, and microtubules were similar in VKM Y‐2977 and VKM Y‐2978 and not clearly visible. The physiological characteristics and mycocin sensitivity patterns, together with the microscopic structures and ultrastructures, led us to conclude that both strains belong to Fellomyces penicillatus, even though they differ in the lengths of their stalk‐like conidiophores and necks. (© 2012 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

I-131 false positive uptake in a huge parapelvic renal cyst

A male patient had undergone total thyroidectomy for thyroid papillary carcinoma. He was administered thyroablation activity of radioiodine. Whole body imaging after diagnostic activity of 131-I demonstrated intense radioiodine uptake in the right side of the upper abdominal region. The serum thyroglobulin level was low. Ultrasonography demonstrated a large irregular anechoic structure in the centre of the right kidney--a cyst in the parapelvic region. Renal cysts can lead to erroneous interpretation of radioiodine scintigraphy.     

Salivary gland extract from engorged Ixodes ricinus (Acari: Ixodidae) stimulates in vitro growth of Borrelia burgdorferi sensu lato

In vitro effect of salivary gland extract from fed Ixodes ricinus, the competent vector of Lyme borreliosis in Europe, on the growth of Borrelia burgdorferi sensu lato (B. garinii, B. afzelii and B. burgdorferi sensu stricto) was examined in BSK‐H medium. Motility rate, concentration of motile spirochetes and their morphology were estimated at intervals of 0, 2, 4, 6 and 8 days using darkfield microscopy. Salivary gland extract derived from I. ricinus stimulated markedly the growth of three genomic species of borreliae. The results confirm a substantial role of salivary glands in the mechanism of pathogen transmission to vertebrate host. (© 2010 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Effect of tick saliva on mechanisms of innate immune response against Borrelia afzelii

The effect of salivary gland extract (SGE) and saliva from the tick Ixodes ricinus (L.) on the interaction of Borrelia afzelii spirochetes with mouse macrophages as well as on the borreli-acidal effect of calf serum was studied. SGE reduced both the number of phagocytosing cells and phagocytosed bacteria. An inhibitory effect of SGE on the killing of spirochetes by the alternative pathway of complement activation also was observed. Both SGE and saliva down-regulated production of proinflammatory cytokine tumor necrosis factor-alpha by macrophages stimulated with interferon-gamma and live B. afzelii spirochetes. The production of another macrophage cytokine, interleukin-6, remained unchanged. SGE and saliva exerted a different effect on the production of nitric oxide by stimulated macrophages. Whereas SGE up-regulated NO production, saliva decreased it. The significance of immunosuppressive effects of tick saliva for the transmission of Borrelia spirochetes is discussed.     

No evidence for linkage between the hereditary angiooedema clinical phenotype and the BDKR1, BDKR2, ACE or MBL2 gene

Hereditary angiooedema (HAE) is a life-threatening disease with poor clinical phenotype correlation with its causal mutation in the C1 inhibitor (SERPING1) gene. It is characterized by substantial symptom variability even in affected members of the same family. Therefore, it is likely that genetic factors outside the SERPING1 gene have an influence on disease manifestation. In this study, functional polymorphisms in genes with a possible disease-modifying effect, B1 and B2 bradykinin receptors (BDKR1, BDKR2), angiotensin-converting enzyme (ACE) and mannose-binding lectin (MBL2), were analysed in 36 unrelated HAE patients. The same analysis was carried out in 69 HAE patients regardless of their familial relationship. No significant influence of the studied polymorphisms in the BDKR1, BDKR2, ACE and MBL2 genes on overall disease severity, localization and severity of particular attacks, frequency of oedema episodes or age of disease onset was detected in either group of patients. Other genetic and/or environmental factors should be considered to be responsible for HAE clinical variability in Caucasians.     

Functional autonomies of thyroid and efficacy of radioiodine therapy

In this paper, the authors present their experience with the radioiodine therapy of thyroid functional autonomies. The aims of this study were to establish the efficacy and determine the adverse effects of radioiodine therapy of patients with thyroid functional autonomies. Over a period of 31 years (from 1974 to 2005) 868 patients (766 women, 102 men with the age from 33 to 86 years; average age, 58.5) with unifocal functional autonomy, multifocal functional autonomy, and disseminated functional autonomy, received at least one treatment of radioiodine in our Department of Nuclear Medicine. For diagnostics and the evaluation of the radioiodine therapeutic effect of functional autonomies, a thyroid scintigraphy is the basic and necessary procedure. We have also performed a thyroid ultrasonography, an assessment of a serum level of a total and free thyroxine, total tri-iodothyronine, thyroid-stimulating hormone (TSH), the radioiodine accumulation test, the estimation of the radioiodine effective half-life, and in some patients, thyrotrophin-releasing hormone (TRH)-TSH test. The follow-up examinations were done in all patients after 4-6 months, another examination after 1 year in 585 patients, and after 2 years in 284 patients. One therapeutic dose received 798 patients (91.9%) and it was sufficient for an elimination of functional autonomies. Some patients were retreated if there was the evidence of small or no treatment effect and no elimination of functional autonomies. Sixty-six (66) patients (7.6%) received two radioiodine treatments and 4 patients (0.5%) three treatments. Before radioiodine therapy, an average serum level of total thyroxine was 165.8 nmol/L, of free thyroxine 21.2 pmol/L, and of total triiodothyronine 3.3 nmol/L, and in all patients, TSH was suppressed. Before therapy, patient complaints were cardiovascular in 87%, neurological in 72%, hypermetabolic in 70%, and local in 31% of patients. After therapy, the average serum levels of total thyroxine were 110.9 nmol/L, free thyroxine 12.7 pmol/L, and total triiodothyronine 2.1 nmol/L with an improvement of symptoms in 91.5% of patients, no improvement in 8.2% and a worsening in 0.3% of patients. The suppression of TSH disappeared in 668 of treated patients (77%). An average volume reduction of thyroid of 40% was achieved in any type of functional autonomy after radioiodine treatment. Side-effects were minimal, and in some patients, presented as a transient neck pressure or pain and neck swelling. Postradiation hypothyroidism was diagnosed in 38 patients (4.4%). The results of this study show that the radioiodine therapy of the thyroid functional autonomies is safe, with a low incidence of adverse effects. It is effective, and for patients, is a nondemanding procedure.