Mycobacterium bovis BCG vaccination as prophylaxis against Mycobacterium ulcerans osteomyelitis in Buruli ulcer disease

Mycobacterium ulcerans disease, or Buruli ulcer (BU), causes significant morbidity in West Africa. Clinically, the disease presents in the skin as either nonulcerative or ulcerative forms and often invades bones either subjacent to the skin lesion (contiguous osteomyelitis) or remote from the skin lesion (metastatic osteomyelitis). Osteomyelitis represents a severe form of the disease that often requires numerous surgical interventions, even amputations. Surgery is accepted as the present definitive treatment for BU. In the absence of an effective drug treatment, the need for the development of preventive and control strategies becomes paramount. No specific vaccine, however, is presently available for BU. Of 372 consecutive patients in Benin presenting with BU (confirmed by microbiological and histopathological analyses) whose Mycobacterium bovis BCG scar statuses were known, 196 children (<15 years old) and 108 adults had neonatal BCG vaccination scars. Of 196 children with BCG scars, 17 (8.7%) had osteomyelitis, while 7 of 28 children without BCG scars (25.0%) had osteomyelitis. Of 108 adults with BCG scars, 17 (15.7%) had osteomyelitis, while 14 of 40 adults without BCG scars (35.0%) had osteomyelitis. Our results show that effective BCG vaccination at birth provides significant protection against the development of M. ulcerans osteomyelitis in children and adults. Therefore, health authorities should give attention to the enhancement of neonatal BCG vaccination coverage in all countries of Africa where BU is endemic. Protection against severe forms of BU and childhood tuberculosis would likewise be improved by this intervention.     

Language processing from the perspective of electrical stimulation mapping

ABSTRACT

Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery.     

Bone marrow transplantation for diamond-blackfan anemia.

Patients with Diamond-Blackfan anemia (DBA) who are unresponsive to or intolerant of corticosteroids, experience treatment failure with other treatments, develop additional cytopenias or clonal disease, or opt for curative therapy are often treated with allogeneic bone marrow transplantation. We studied the transplantation outcomes of 61 DBA patients whose data were reported to the International Bone Marrow Transplant Registry between 1984 and 2000. The median age was 7 years (range, 1-32 years). Among 55 patients with available transfusion information, 35 (64%) had received > or =20 units of blood before transplantation. Most patients (67%) received their bone marrow grafts from an HLA-matched related donor. The median time to neutrophil recovery was 17 days (range, 10-119 days) and to platelet recovery was 23 days (range, 9-119 days). Five patients did not achieve neutrophil engraftment. The 100-day mortality was 18% (95% confidence interval, 10%-29%). Grade II to IV acute graft-versus-host disease occurred in 28% (range, 17%-39%) and chronic graft-versus-host disease in 26% (range, 15%-39%). The 3-year probability of overall survival was 64% (range, 50%-74%). In univariate analysis, a Karnofsky score > or =90 and transplantation from an HLA-identical sibling donor were associated with better survival. These data suggest that allogeneic bone marrow transplantation is effective for the treatment of DBA. Transplantation before deterioration of the performance status and from an HLA-identical sibling donor may improve survival.     

Notes on parasitism by Amblyomma humerale (Acari: Ixodidae) in the state of Rondônia,western Amazon,Brazil

The tick Amblyomma humerale Koch is endemic to South America. All host records refer to the adult stage parasitizing tortoises, mostly yellow-footed tortoise, Geochelone denticulata (L.), and red-footed tortoise, Geochelone carbonaria (Spix). The current study reports the presence of A. humerale in the state of Rond?nia, Brazil. A total of 215 adult ticks (201 males, 14 females) was collected from six G denticulata in an Indian reserve and nine Geochelone sp. in rural Monte Negro County, giving an overall mean infestation of 14.3 +/- 12.0 (range: 2-44) ticks per tortoise. Male ticks always outnumbered females on the host and nine tortoises had only male ticks. Male ticks were mostly attached in clusters on the ventral sides of the carapace near the anterior and posterior margins, and more rarely on the outer margin of the plastron. All females were found attached to the tortoise skin, at different sites such as head, neck, shoulders or legs. Male ticks were rarely observed attached to the body skin. Seven engorged nymphs collected on small vertebrates from Monte Negro County molted to adults of A. humerale. This included one nymph each on the seven-colored lizard, Plica plica (L), green tree climber, Plica umbra (L.), and wide-foraging lizard, Kentropyx calcarata Spix,three nymphs on the common opossum, Didelphis marsupialis L., and one nymph on the silky anteater, Cyclopes didactylus L. These constitute the first host records for the immature stages of the tick A. humerale.     

Translocation (11;11)(p13- p15;q23) in a child with therapy-related acute myeloid leukemia following chemotherapy with DNA-topoisomerase II inhibitors for Langerhans cell histiocytosis

We report a new case of therapy-related acute myeloid leukemia in a child with Langerhans cell histiocytosis. This patient was previously treated with a protocol of multidrug chemotherapy, containing a relatively low dose of etoposide (total dose of 900/m(2)). Twenty-six months after the end of the therapy, the patient returned to the hospital with fever and anemia. The white blood cell count was 53 x 10(9)/L. The bone marrow examination showed massive infiltration with French-American-British acute myeloid leukemia classification M4 blast cells. The patient did not respond to an intensive treatment with high dose ARA-C and idarubicin. He died 6 months later. The cytogenetic abnormality of the blast cells was a t(11;11)(p13 -15;q23), that has not been described before in a secondary leukemia case.     

Random coil dimensions of poly(1-hexadecene)

The characteristic ratios of three samples of poly(1-hexadecene) with different tacticities were evaluated from intrinsic viscosity and molecular weight data obtained with a size exclusion chromatograph with dual (concentration plus viscosity) detector. No significant differences were found for the characteristic ratio in the studied range of tacticities. Theoretical calculations for the unperturbed dimensions were also performed for these samples by using the rotational isomeric state model, and compared with the experimental results.     

Prediction of postoperative morbidity after lung resection using an artificial neural network ensemble

OBJECTIVE: To propose an ensemble model of artificial neural networks (ANNs) to predict cardio-respiratory morbidity after pulmonary resection for non-small cell lung cancer (NSCLC). METHODS: Prospective clinical study was based on 489 NSCLC operated cases. An artificial neural network ensemble was developed using a training set of 348 patients undergoing lung resection between 1994 and 1999. Predictive variables used were: sex of the patient, age, body mass index, ischemic heart disease, cardiac arrhythmia, diabetes mellitus, induction chemotherapy, extent of resection, chest wall resection, perioperative blood transfusion, tumour staging, forced expiratory volume in 1s percent (FEV(1)%), and predicted postoperative FEV(1)% (ppoFEV(1)%). The analysed outcome was the occurrence of postoperative cardio-respiratory complications prospectively recorded and codified. The artificial neural network ensemble consists of 100 backpropagation networks combined via a simple averaging method. The probabilities of complication calculated by ensemble model were obtained to the actual occurrence of complications in 141 cases operated on between January 2000 and December 2001 and a receiver operating characteristic (ROC) curve for this method was constructed. RESULTS: The prevalence of cardio-respiratory morbidity was 0.25 in the training and 0.30 in the validation series. The accuracy for morbidity prediction (area under the ROC curve) was 0.98 by the ensemble model. CONCLUSION: In this series an artificial neural network ensemble offered a high performance to predict postoperative cardio-respiratory morbidity.     

Levels of Expression and Immunogenicity of Attenuated Salmonella enterica Serovar Typhimurium Strains Expressing Escherichia coli Mutant Heat-Labile Enterotoxin

The effects of heterologous gene dosage as well as Salmonella typhimurium strain variability on immune response toward both the heterologous antigen, the nontoxic mutant of the Escherichia coli heat-labile enterotoxin LTK63, and the carrier Salmonella strain have been analyzed. Effects of a single integration into the host DNA and different-copy-number episomal vectors were compared in S. typhimurium Δcya Δcrp Δasd strains of two different serotypes, UK-1 and SR-11. Expression of the enterotoxin in the different Salmonella isolates in vitro was found to vary considerably and, for the episomal vectors, to correlate with the plasmid copy number. LTK63-specific serum immunoglobulin G (IgG) and mucosal immunoglobulin A (IgA) antibodies were highest in mice immunized with the high-level-expression strain. High anti-LTK63 IgG and IgA titers were found to correspond to higher anti-Salmonella immunity, suggesting that LTK63 exerts an adjuvant effect on response to the carrier. Statistically significant differences in anti-LTK63 immune response were observed between groups of mice immunized with the attenuated Δcya Δcrp UK-1 and SR-11 derivatives producing the antigen at the same rate. These data indicate that the same attenuation in S. typhimurium strains of different genetic backgrounds can influence significantly the immune response toward the heterologous antigen. Moreover, delivery of the LTK63 enterotoxin to the immune system by attenuated S. typhimurium strains is effective only when synthesis of the antigen is very high during the initial phase of invasion, while persistence of the S. typhimurium strain in deep tissues has only marginal influence.

Enterotoxigenic Escherichia coli strains produce a plasmid-encoded heat-labile enterotoxin (LT) (15, 34) related to cholera toxin (CT) (9, 35). LT is composed of two subunits, A and B, which are exported to the periplasmic space, where they assemble into an AB₅ multimeric complex (16). Several mutants of LT-A have been constructed, and in particular, a nontoxic mutant which contains a substitution of serine 63 with lysine (LTK63) has been shown to maintain the structural and immunogenic properties of wild-type LT (21, 27, 28). LTK63 has also been found to display the strong mucosal adjuvant activity pertaining to wild-type LT. Efficient induction of mucosal immune response, specifically in the mouse vagina, has been achieved via the intranasal route of immunization (10). For the development of oral vaccines, however, it would be desirable to exploit the properties of LTK63 for enhancing antigen-specific immune response in the intestinal mucosa by means of oral delivery of the potent mucosal adjuvant.Oral delivery of antigens by live vaccines is known to lead to a more effective production of antigen-specific antibodies in mucosal secretions than oral administration of the soluble antigen (36, 39). Several antigen delivery systems which use as carriers mutant intracellular pathogens that have lost the ability to persist and produce the disease while retaining limited growth in vivo have been developed. In particular, attenuated Salmonella mutants are suitable immunological carriers for virulence determinants from other enteric bacteria in that they can induce humoral immune response selectively at the site of colonization, the gut mucosa. Vaccine strains of Salmonella have been successfully attenuated by introducing different types of mutations (5, 8, 23, 26). Notably, Salmonella strains with a galactose epimerase (galE) mutation (18) or deletions in genes for the biosynthesis of aromatic compounds (aro mutants) (11, 12, 17, 19) or in the adenylate cyclase (cya) and cyclic AMP receptor protein (crp) genes (6) are the most extensively characterized.Delivery of the B subunit of the E. coli enterotoxin (LT-B) by a galE mutant of Salmonella typhimurium has been shown to elicit low levels of anti-LT-B serum and mucosal antibodies. Since the vector used for expression of LT-B was rapidly lost in vivo, i.e., in the absence of the antibiotic required for selection of the plasmid, the level of immune response could be correlated only with the amount of antigen expressed during the initial phase of invasion (3).Recently, direct comparison between the aroA aroD/pnirB and the Δcya Δcrp Δasd/asd⁺ delivery systems for the ability to induce humoral and cellular immunity after a single immunization showed that the former vaccine strain had greater potential as a carrier for antigen delivery (20). However, the balanced lethal asd system for in vivo selection of plasmids expressing heterologous antigens in the attenuated Δcya Δcrp Δasd strains is still very attractive in that asd⁺ plasmids do not require antibiotic resistance markers for selection while stably maintained in vivo (24). In addition, the Δcya Δcrp Δasd/asd⁺ delivery system has been reported to induce protective immunity against several pathogens (25, 29, 40). Most of these studies have restricted analysis of the immune response to antigens expressed from the same asd⁺ plasmid carried by Δcya Δcrp Δasd mutants usually of the same S. typhimurium serotype. In this work, we have analyzed the influence of heterologous gene dosage, and thus level of expression, as well as S. typhimurium strain variability on immune response toward both the heterologous antigen, a nontoxic mutant of E. coli LT, and the carrier Salmonella strain. Effects of a single integration into the host DNA and episomal vectors at different copy numbers were compared in S. typhimurium strains of two different Δcya Δcrp Δasd serotypes, UK-1 and SR-11.