Serological Diagnosis of North American Paragonimiasis by Western Blot Using Paragonimus kellicotti Adult Worm Antigen

We studied the value of an IgG Western blot (WB) with Paragonimus kellicotti (Pk) antigen for diagnosis of North American paragonimiasis. The test was evaluated with sera from patients with Pk and Paragonimus westermani infections, with control sera from patients with other helminth infections, and sera from healthy Americans. All 11 proven Pk infection sera and two samples from suspected cases that were negative by P. westermani WB at the Centers for Disease Control and Prevention (CDC) contained antibodies to antigens at 34 kDa and at 21/23 kDa. Seven of 7 P. westermani sera contained antibodies to the 34 kDa antigen, but only 2 recognized the 21/23 kDa doublet. No control samples were reactive with these antigens. Antibody reactivity declined after praziquantel treatment. Thus, the P. kellicotti WB appears to be superior to P. westermani WB for diagnosing Pk infections, and it may be useful for assessing responses to treatment.     

Diagnostic selective nerve root blocks: indications and usefulness

Diagnostic SNRIs are a useful tool in the diagnosis of radicular pain in atypical presentations. Diagnostic SNRI is indicated in the following circumstances: (1) for atypical extremity pain; (2) when imaging studies and clinical presentation do not correlate; (3) when electromyography and MRI are not corroborative or are equivocal; (4) for anomalous innervations, such [figure: see text] as conjoint nerve roots or furcal nerves [71]; (5) for failed back surgery syndrome with atypical extremity pain; and (6) for transitional vertebrae. Patients should have demonstrated a failure to improve with less invasive treatment. In these patients, a diagnostic SNRI may localize the pain to a specific spinal nerve. It must be emphasized that the diagnostic SNRI only determines if pain is emanating from a specific nerve root or spinal nerve. A diagnostic SNRI does not determine what has caused the nerve root or spinal nerve pain, nor does it provide prognostic information. The etiology of the nerve root pain, mechanism of injury, underlying anatomy, duration of symptoms, comorbidities, patient desire, physician skill, and a host of other factors determine the appropriate treatment and prognosis.     

Pre-registration education: learning communities

Changes in nurse education in the UK and the introduction of a new pre-registration nursing programme have led to developments in education methods. This article describes the creation of learning communities at Thames Valley University as a means of adapting to the new curriculum.     

Human trabecular meshwork cell responses induced by bimatoprost,travoprost, unoprostone,and other FP prostaglandin receptor agonist analogues

PURPOSE: To determine the functional agonist potencies of the intraocular pressure (IOP)-lowering prostaglandin F (FP)-class prostaglandin (PG) analogues (e.g., travoprost, latanoprost, bimatoprost, and unoprostone isopropyl ester) in human trabecular meshwork (h-TM) cells, by using phosphoinositide (PI) turnover and intracellular Ca(2+) ([Ca(2+)](i)) mobilization, and to confirm the FP nature of these receptors by using an FP receptor antagonist, 11beta-fluoro-15-epi-15-indanyl-PGF(2alpha) (AL-8810). METHODS: FP-receptor-mediated PI turnover and [Ca(2+)](i) mobilization were measured in h-TM cells by determining the accumulation of [(3)H]-inositol phosphates ([(3)H]-IPs) by anion-exchange chromatography and real-time fluorescence imaging, respectively. RESULTS: Various PG analogues concentration-dependently stimulated production of [(3)H]-IPs in h-TM cells with the following agonist potencies (median effective concentration; EC(50)): travoprost acid (EC(50) = 2.4 nM) > cloprostenol (EC(50) = 4.5 nM) > (+/-)-fluprostenol (EC(50) = 10.8 nM) > latanoprost acid (EC(50) = 34.7 nM) > bimatoprost acid (EC(50) = 112 nM) > PGF(2alpha) (EC(50) = 120 nM) > unoprostone (UF-021; EC(50) = 3280 nM) > S-1033 (EC(50) = 4570 nM; all n = 3-9). Prodrug derivatives of these compounds exhibited the following potencies: travoprost (isopropyl ester; EC(50) = 89.1 nM) > latanoprost (isopropyl ester; EC(50) = 778 nM) > bimatoprost (amide; EC(50) = 1410-6940 nM). Travoprost acid, PGF(2alpha,) unoprostone, and S-1033 were tested in addition for [Ca(2+)](i) mobilization and found to have rapid and dose-dependent effects. The FP receptor-selective antagonist AL-8810 antagonized the (+/-)-fluprostenol-induced PI turnover in these cells (K(i) = 2.56 +/- 0.62 micro M) as well as that induced by bimatoprost and acids of latanoprost and travoprost. The agonist and antagonist potencies of the PG analogues from the PI turnover assays in h-TM cells correlated well with PI turnover data obtained from the cloned human ciliary body FP receptor (r = 0.92; P < 0.0001). CONCLUSIONS: The pharmacology of the h-TM cell FP-receptor-mediated PI turnover and [Ca(2+)](i) mobilization was defined using numerous synthetic (FP-selective) PG agonist analogues and an FP receptor antagonist, AL-8810. Bimatoprost, travoprost, latanoprost, unoprostone isopropyl ester, and their respective free acids were shown to be FP agonists in the h-TM cells.     

Tensile bond strength of acrylic resin denture teeth to a microwave- or heat-processed denture base

STATEMENT OF PROBLEM: Fracture of acrylic resin prosthetic teeth from acrylic resin denture bases can be a problem for some patients. The optimal combination of acrylic resin denture tooth, denture base material, and processing method is not known. Purpose. The objective of this study was to compare the tensile bond strengths of heat- and microwave-polymerized acrylic resins among 4 types of acrylic resin denture teeth. MATERIAL AND METHODS: Heat-polymerized (Lucitone 199) and microwave-polymerized (Acron MC) acrylic resins were used. Four types of acrylic resin denture teeth (IPN, SLM, Vitapan, and SR-Orthotyp-PE) were milled to a fixed diameter according to ADA specification no. 15. Ten specimens of each tooth type were processed to each of the denture base materials according to the manufacturers' instructions. Ten additional resin control specimens without teeth also were fabricated. Specimens were thermocycled and tested for strength until fracture with a custom alignment device. Data were analyzed with analysis of variance and Duncan's multiple range test. A scanning electron microscope was used to identify adhesive and cohesive failures within debonded specimens. RESULTS: The mean force required to fracture the specimens ranged from 5.3 +/- 3.01 to 21.6 +/- 5.2 MPa for the microwave-polymerized base and 11.2 +/- 3.0 to 39.1 +/- 5.1 MPa for the heat-polymerized base. The most common failure was cohesive within the denture tooth. With each base material, Orthotyp and IPN teeth exhibited the highest bond strengths; SLM and Orthotyp bond strengths were similar. In general, heat-polymerized groups failed cohesively within the denture base resin or the tooth, and microwave-polymerized groups failed adhesively at either the ridge lap or occlusal surface of the denture tooth. CONCLUSION: Within the limitations of this study, the results suggest that the type of denture base material and denture tooth selected for use may influence the tensile bond strength of the tooth to the base. Selection of more compatible combinations of base and resin teeth may reduce the number of prosthesis fractures and resultant repairs.     

The role of hyperthermia in regional alkylating agent chemotherapy.

The role of hyperthermia during regional alkylating agent chemotherapy is controversial. The aim of this study was to determine the exact contribution of hyperthermia to tumor response during isolated limb infusion with l-phenylalanine mustard. Rats bearing rodent fibrosarcoma on the hindlimb underwent isolated limb infusion with saline, saline plus heat, l-phenylalanine mustard, l-phenylalanine mustard under conditions of normothermia, or l-phenylalanine mustard plus hyperthermia. Heat was administered locally using an in-line hot water circulation loop. Treatment with l-phenylalanine mustard at a concentration of 15 or 50 micrograms/mL was ineffective at producing tumor growth delay (P = 0.24 and 0.41, respectively). Furthermore, thermal enhancement of l-phenylalanine mustard activity was not seen at 15 micrograms/mL. However, administration of high-dose l-phenylalanine mustard, 50 micrograms/mL, with increasing amounts of heat yielded increasing tumor growth delay, increased regressions, and decreased proliferative index. Although l-phenylalanine mustard infusion under normothermia yielded a tumor growth delay of 7.1 days, combination l-phenylalanine mustard + hyperthermia treatment produced tumor growth delay of 27.0 days (P < 0.01; with two of five animals showing a complete response). Four hours after isolated limb infusion, 50.9% of cells in tumor treated with l-phenylalanine mustard + hyperthermia experienced apoptosis, whereas only 18.1, 16, and 4.4% of cells underwent apoptosis after treatment with l-phenylalanine mustard, saline + hyperthermia, or saline. The mean concentration of l-phenylalanine mustard within tumor relative to perfusate following isolated limb infusion was found to be similar among all groups at 0.023, 0.025, and 0.032 in animals undergoing isolated limb infusion with l-phenylalanine mustard, l-phenylalanine mustard + normothermia, and l-phenylalanine mustard + hyperthermia, respectively. These data indicate a synergistic cytotoxic effect of l-phenylalanine mustard + hyperthermia in isolated limb infusion, which is not attributable to enhanced tumor drug uptake.     

Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert panel

The Janus kinase 2 mutation, JAK2617V>F, is myeloid neoplasm-specific; its presence excludes secondary polycythemia, thrombocytosis, or bone marrow fibrosis from other causes. Furthermore, JAK2617V>F or a JAK2 exon 12 mutation is present in virtually all patients with polycythemia vera (PV), whereas JAK2617V>F also occurs in approximately half of patients with essential thrombocythemia (ET) or primary myelofibrosis (PMF). Therefore, JAK2 mutation screening holds the promise of a decisive diagnostic test in PV while being complementary to histology for the diagnosis of ET and PMF; the combination of molecular testing and histologic review should also facilitate diagnosis of ET associated with borderline thrombocytosis. Accordingly, revision of the current World Health Organization (WHO) diagnostic criteria for PV, ET, and PMF is warranted; JAK2 mutation analysis should be listed as a major criterion for PV diagnosis, and the platelet count threshold for ET diagnosis can be lowered from 600 to 450 x 10(9)/L. The current document was prepared by an international expert panel of pathologists and clinical investigators in myeloproliferative disorders; it was subsequently presented to members of the Clinical Advisory Committee for the revision of the WHO Classification of Myeloid Neoplasms, who endorsed the document and recommended its adoption by the WHO.     

Comparison of new and 3-month-old brush heads in the removal of plaque using a powered toothbrush

AIM: To compare the effectiveness of new and 3-month-old worn brush heads in plaque removal using a rotation-oscillation-powered toothbrush. MATERIAL AND METHODS: A single examiner blinded, randomized, cross-over study was conducted in which 34 adults attended the clinic on two occasions following 48-h periods of no oral hygiene. Following plaque scoring, subjects brushed for 2 min. with either a new brush or a brush they had used for 3 months and plaque was then re-scored. Bristle wear was assessed by measuring brushing surface areas on digital images. RESULTS: The mean plaque score percentage reductions with new brush heads were not significantly different from those achieved with 3-month-old heads for total surfaces (new=38.1%; worn=37.1%; p=0.83) and approximal surfaces (new=31.3%; worn=30.8%; p=0.9). Brushing surface area increases of the 3-month-old heads ranged from 0% to 135% (mean 26.9%). Compared with new brush heads, no significant differences were found for plaque score reductions for heads with minor, moderate or marked wear. CONCLUSION: Rotation-oscillation-powered toothbrushes with 3-month-old brush heads exhibiting various degrees of wear were as effective as new brush heads in plaque removal. Bristle age and wear on a powered toothbrush may not impede the effectiveness of plaque removal.     

Expression of platelet-derived growth factor and its receptors by two pre-B acute lymphocytic leukemia cell lines

Platelet-derived growth factors (PDGF) are potent regulators of cell proliferation. The three isoforms of PDGF AA, AB, and BB are encoded by two genes: PDGF A and PDGF B. The v-sis oncogene is homologous to the PDGF-B gene. v-sis can transform cells that express the appropriate PDGF receptors. Two different types of receptors, PDGF-alpha and PDGF- beta, also encoded by two genes, have been identified. We show that two cell lines. SMS-SB and NALM-6, both derived from pre-B-cell acute lymphocytic leukemias, express the PDGF-A chain gene, and one of them, SMS-SB, releases PDGF-A chains into the media. The SMS-SB cells also express the PDGF-beta receptor, whereas NALM-6 cells express the PDGF- alpha receptor and bind PDGF. This extends the possible targets for PDGF to the B-cell lineage lymphocytes.     

Detecting Malingering in Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice Symptom Validity Tests

Individual and joint malingering detection accuracy of the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) was examined in traumatic brain injury (TBI; 43 non-malingering, 27 malingering) and chronic pain (CP; 42 non-malingering, 58 malingering) using a known-groups design. At published cutoffs, the PDRT and TOMM were very specific but failed to detect about 50% of malingerers; the WMT was sensitive but prone to false positive errors. ROC analyses demonstrated comparable accuracy across all three tests. Joint classification accuracy was superior to that of the individual tests. Clinical and research implications are discussed.