Cross‐reactive adaptive immune response to oral commensal bacteria results in an induction of receptor activator of nuclear factor‐κB ligand (RANKL)‐dependent periodontal bone resorption in a mouse model

Introduction: The present study examined whether induction of an adaptive immune response to orally colonizing non‐pathogenic Pasteurella pneumotropica by immunization with the phylogenetically closely related bacterium, Actinobacillus actinomycetemcomitans, can result in periodontal bone loss in mice. Methods: BALB/c mice harboring P. pneumotropica (P. pneumotropica⁺ mice) in the oral cavity or control P. pneumotropica‐free mice were immunized with fixed A. actinomycetemcomitans. The animals were sacrificed on day 30, and the following measurements were carried out: (i) serum immunoglobulin G and gingival T‐cell responses to A. actinomycetemcomitans and P. pneumotropica; (ii) periodontal bone loss; and (iii) identification of receptor activator of nuclear factor‐κB ligand (RANKL) ‐positive T cells in gingival tissue. Results: Immunization with A. actinomycetemcomitans induced a significantly elevated serum immunoglobulin G response to the 29‐kDa A. actinomycetemcomitans outer membrane protein (Omp29), which showed strong cross‐reactivity with P. pneumotropica OmpA compared to results in the control non‐immunized mice. The A. actinomycetemcomitans‐immunized P. pneumotropica⁺ mice developed remarkable periodontal bone loss in a RANKL‐dependent manner, as determined by the abrogation of bone loss by treatment with osteoprotegerin‐Fc. The T cells isolated from the gingival tissue of A. actinomycetemcomitans‐immunized P. pneumotropica⁺ mice showed an in vitro proliferative response to both A. actinomycetemcomitans and P. pneumotropica antigen presentation, as well as production of soluble(s)RANKL in the culture supernatant. Double‐color confocal microscopy demonstrated that the frequency of RANKL⁺ T cells in the gingival tissue of A. actinomycetemcomitans‐immunized P. pneumotropica⁺ mice was remarkably elevated compared to control mice. Conclusion: The induction of an adaptive immune response to orally colonizing non‐pathogenic P. pneumotropica results in RANKL‐dependent periodontal bone loss in mice.     

The maternal plasma soluble vascular endothelial growth factor receptor-1 concentration is elevated in SGA and the magnitude of the increase relates to Doppler abnormalities in the maternal and fetal circulation

Objectives. The soluble form of vascular endothelial growth factor receptor-1 (sVEGFR-1), an antagonist to vascular endothelial growth factor and placental growth factor, has been implicated in the pathophysiology of preeclampsia. Preeclampsia and pregnancy complicated with small for gestational age (SGA) fetuses share some pathophysiologic derangements, such as failure of physiologic transformation of the spiral arteries, endothelial cell dysfunction, and leukocyte activation. The objectives of this study were to: (1) determine whether plasma concentrations of sVEGFR-1 in mothers with SGA fetuses without preeclampsia at the time of diagnosis are different from those in patients with preeclampsia or normal pregnant women, and (2) examine the relationship between plasma concentrations of sVEGFR-1 and Doppler velocimetry in uterine and umbilical arteries in patients with preeclampsia and those with SGA.

Study design. A cross-sectional study was conducted to determine the concentrations of the soluble form of VEGFR-1 in plasma obtained from normal pregnant women (n = 135), women with SGA fetuses (n = 53), and patients with preeclampsia (n = 112). Patients with SGA fetuses and those with preeclampsia were sub-classified according to the results of uterine and umbilical artery Doppler velocimetry examinations. Plasma concentrations of sVEGFR-1 were determined by an ELISA. Since these concentrations change with gestational age, differences among various subgroups were statistically estimated with the delta value, defined as the difference between the observed and expected plasma sVEGFR-1 concentration. The expected values were derived from regression analysis of plasma sVEGFR-1 concentrations in normal pregnancy. Regression analysis and univariate and multivariate analysis were employed.

Results. (1) Mothers with SGA fetuses had a mean plasma concentration of sVEGFR-1 higher than normal pregnant women (p < 0.001), but lower than patients with preeclampsia (p < 0.001). (2) Among patients with SGA fetuses, only those with abnormal uterine artery Doppler velocimetry had a mean plasma sVEGFR-1 concentration significantly higher than normal pregnant women (p < 0.001). (3) Among mothers with SGA fetuses in whom Doppler velocimetry was performed (n = 41), those with abnormalities in both the uterine and umbilical artery velocimetry had the highest mean delta of sVEGFR-1 plasma concentration (mean ± standard deviation (SD): 0.69 ± 0.29). Conversely, patients who had normal Doppler velocimetry in both uterine and umbilical arteries had the lowest mean delta (mean ± SD: 0.09 ± 0.29) of sVEGFR-1 plasma concentrations (ANOVA; p < 0.001). (4) Among patients with preeclampsia in whom Doppler velocimetry was performed (n = 69), those with abnormalities in both the uterine and umbilical artery velocimetry had the highest mean delta sVEGFR-1 plasma concentration (mean ± SD: 1.01 ± 0.22) among all groups classified (ANOVA; p < 0.001). (5) Among patients with SGA and those with preeclampsia, there was a relationship (Chi-square for trend p < 0.001 for both) between the severity of Doppler velocimetry abnormalities and the proportion of patients who had high delta sVEGFR-1 plasma concentrations (defined as a concentration two standard deviations (2SD) above the mean delta of normal pregnant women). (6) Multiple regression analysis suggested that the diagnostic category (e.g., SGA or preeclampsia), Doppler abnormalities, and gestational age at blood sampling were associated with an increase in plasma sVEGFR-1 concentrations (p < 0.001).

Conclusions. These observations provide support for the participation of the soluble receptor of vascular endothelial growth factor in the pathophysiology of SGA with abnormal uterine artery Doppler velocimetry and preeclampsia. An excess of sVEGFR-1 is released into the maternal circulation of patients with preeclampsia and those with SGA fetuses, as abnormalities of impedance to blood flow involve uterine and umbilical circulation.     

Effects of Colectomy on Gallbladder Motility in Patients with Ulcerative Colitis

In order to gain insight into the possiblemechanisms involved in gallstone formation incolectomized ulcerative colitis patients, we studiedgallbladder motility by means of ultrasonography inthree groups of subjects: controls (N = 40) and ulcerativecolitis patients without (N = 30) and with (N = 20)colectomy. Impaired gallbladder emptying after a liquidfatty meal stimulus was observed in ulcerative colitis patients with colectomy compared with thoseobtained in ulcerative colitis patients withoutcolectomy and controls (P = 0.001). The maximumpercentage of gallbladder emptying also, wassignificantly lower (59.8%) than those seen in ulcerative colitispatients without colectomy (74.5%) and controls (77.8%)(P = 0.001). Diminished gallbladder emptying withensuing stasis might be a contributory factor to the increased prevalence of gallstones incolectomized patients.     

Phase I dose-escalation study of the thioxanthone SR271425 administered intravenously once every 3 weeks in patients with advanced malignancies

This study was performed to determine the dose limiting toxicity (DLT), the recommended phase II dose and the pharmacokinetic profile for SR271425, given over 1 h every 3 weeks. The initial starting dose of SR271425 was 17 mg/m(2). Patient selection was based on common phase I criteria as well as additional cardiac criteria. Thirty-eight patients were accrued to 16 dose levels from 17 to 1,320 mg/m(2). Patient characteristics included 24 males and 14 females ages 35-78 with an Eastern Cooperative Oncology Group performance status of 0 (ten patients), 1 (27) and 2 (1). Tumor types were typical for a phase I study. The maximum administered dose was 1,320 mg/m(2) with two DLTs, both QTc grade 3 prolongation. No drug related hematological toxicity was noted. Grade 1 toxicities included rash, flushing, pruritus, weight loss, diarrhea, hypertension and fatigue. Grade 2 toxicities included yellow discoloration of the skin, nausea and vomiting. QTc prolongation and hyperbilirubinemia were the only grade 3 toxicities noted. No confirmed tumor response was observed; however, two patients had prolonged stable disease. Both C(end) and area under the plasma concentration-time curve increased in a dose related manner. Plasma drug concentrations declined in a biphasic manner with a mean terminal elimination half-life (t (1/2)) of 7.1 h (+/-1.3). There was no change in clearance or volume of distribution over the dose range studied. Due to cardiac toxicity occurring with both the parent compound, SR233377, as well as this analog, this series of agents was abandoned from further clinical development.     

Vitreous haemorrhage and other ocular complications of a persistent hyaloid artery

Purpose: To report ocular complications of a persistent hyaloid artery.Methods: We studied eight patients with persistent hyaloid artery.Results: Seven patients showed strabismus and very low visual acuity (≤0.12) of one eye. Despite correction of refractive errors, cataract surgery and occlusion therapy for amblyopia, visual acuity had not improved in these cases. Four patients showed nystagmus. Four had progression of unilateral cataract. In two cases, a 24-year-old woman and a 4-months-old boy, a vitreous haemorrhage had occurred due to rupture of a hyaloid artery, in the woman's case probably due to a spontaneous posterior vitreous detachment.Conclusion: A persistent hyaloid artery may be associated with strabismus, cataract, amblyopia and nystagmus. Despite amblyopia treatment, the prognosis of visual acuity of the involved eye is unfavourable. A persistent hyaloid artery may cause vitreous haemorrhage.     

Medical image rendering

Three-dimensional (3-D) visualization has recently become an established discipline in medicine. Although numerous visualization methods are currently available, a unified framework to describe and study them has been lacking. Often, the functionally independent operations in a method are integrated among themselves or with the method itself for computational efficiency. The two main aims of this article are (1) to review the methods in a unified way in a general setting so that it becomes possible to appreciate the interrelationship and interdependence of methods, and (2) to show how a variety of new methods emerge with potentially improved renditions in this unified treatment. To this end, we introduce an operator notation to describe concisely the basic 3-D imaging transforms commonly used in visualization and identify a comprehensive set of basic transforms. We describe several new basic transforms for filtering and interpolating structures and scenes, and for rendering surfaces and volumes. We show the power of the principle of treating 3-D imaging methodologies as comprising an appropriate combination of the basic operators. We show how such a treatment leads to a great variety of new rendering methods and how many such methods can lead to improved portrayal. We develop separate transform sequences to optimally render robust and frail structures (ie, structures represented in scenes with well-defined and ill-defined boundaries, respectively).