Human Protoparvovirus DNA and IgG in Children and Adults with and without Respiratory or Gastrointestinal Infections

Three human protoparvoviruses, bufavirus (BuV), tusavirus (TuV) and cutavirus (CuV), have recently been discovered in diarrheal stool. BuV has been associated with diarrhea and CuV with cutaneous T-cell lymphoma, but there are hardly any data for TuV or CuV in stool or respiratory samples. Hence, using qPCR and IgG enzyme immunoassays, we analyzed 1072 stool, 316 respiratory and 445 serum or plasma samples from 1098 patients with and without gastroenteritis (GE) or respiratory-tract infections (RTI) from Finland, Latvia and Malawi. The overall CuV-DNA prevalences in stool samples ranged between 0–6.1% among our six patient cohorts. In Finland, CuV DNA was significantly more prevalent in GE patients above rather than below 60 years of age (5.1% vs 0.2%). CuV DNA was more prevalent in stools among Latvian and Malawian children compared with Finnish children. In 10/11 CuV DNA-positive adults and 4/6 CuV DNA-positive children with GE, no known causal pathogens were detected. Interestingly, for the first time, CuV DNA was observed in two nasopharyngeal aspirates from children with RTI and the rare TuV in diarrheal stools of two adults. Our results provide new insights on the occurrence of human protoparvoviruses in GE and RTI in different countries.     

Higher serum leptin level in women than in men with type 1 diabetes

Leptin is the protein product of the obese (ob) gene, a lipostatic hormone that contributes to body weight regulation through suppressing appetite and/or stimulating energy expenditure in humans and/or rodents. In humans, serum leptin concentrations are increased in relation to increased body fat content. Studies have shown a higher leptin level in women compared with men. However, the gender influence on serum leptin concentrations has never been evaluated in patients with type 1 diabetes. In this study, serum leptin levels and percentage body fat mass were measured in men and women with type 1 diabetes. Fasting serum leptin levels were higher in women (16.7 + 11.6 ng/mL) than in men (3.0 +/- 1.5 ng/mL; P < 0.05) and were independent of exogenous insulin intake and of glucose control. Percentage body fat and fat mass were significant determinants of leptin concentration, whereas age and duration of diabetes were not related to leptin concentration. Subgroups of men (n = 12) and women (n = 11) with total body fat between 20 and 30% were compared. Leptin levels were also higher in women compared with men (13.5 +/- 8.3 ng/mL versus 3.2 +/- 1.7 ng/mL; P < 0.05, respectively). In conclusion, our findings indicate that gender is an important determinant of serum leptin concentration in type 1 diabetics, this gender difference is partly explained by body fat distribution and that type 1 diabetic women may be more resistant than type 1 diabetic men to leptin's alleged lipostatic actions.     

The prognostic significance of serial exercise testing after myocardial infarction.

Serial treadmill exercise testing (mean 5.5 tests/patient) was used to evaluate the prognosis of 200 males (mean age 53 years) without clinical heart failure or unstable angina pectoris 3 weeks after acute myocardial infarction (MI). Exercise-induced ischemic ST-segment depression greater than or equal to 0.2 mV 3 weeks after MI was significantly more prevalent in patients with subsequent cardiac arrest (100%) or coronary artery bypass graft surgery (64%) than in patients without subsequent events within 2 years of infarction (35%) (p less than 0.05). Exercise-induced ventricular arrhythmia on multiple tests 5-52 weeks after MI was more prevalent in patients with recurrent myocardial infarction (90%) than in patients without subsequent events (47%) (p less than 0.001). By contrast, exercise-induced ventricular arrhythmia on a single test at 3 weeks was a less powerful predictor of subsequent cardiac events. Exercise-induced ischemia 3 weeks after MI predicted early fatal events, while ventricular arrhythmia on serial testing predicted later nonfatal events.     

Petrographic carbon in ancient sediments constrains Proterozoic Era atmospheric oxygen levels

Oxygen concentration defines the chemical structure of Earth''s ecosystems while it also fuels the metabolism of aerobic organisms. As different aerobes have different oxygen requirements, the evolution of oxygen levels through time has likely impacted both environmental chemistry and the history of life. Understanding the relationship between atmospheric oxygen levels, the chemical environment, and life, however, is hampered by uncertainties in the history of oxygen levels. We report over 5,700 Raman analyses of organic matter from nine geological formations spanning in time from 742 to 1,729 Ma. We find that organic matter was effectively oxidized during weathering and little was recycled into marine sediments. Indeed, during this time interval, organic matter was as efficiently oxidized during weathering as it is now. From these observations, we constrain minimum atmospheric oxygen levels to between 2 to 24% of present levels from the late Paleoproterozoic Era into the Neoproterozoic Era. Indeed, our results reveal that eukaryote evolution, including early animal evolution, was not likely hindered by oxygen through this time interval. Our results also show that due to efficient organic recycling during weathering, carbon cycle dynamics can be assessed directly from the sediment carbon record.

The history of life has been interwoven with levels of atmospheric oxygen through much of Earth’s history. For example, aerobic life could only prosper after the evolution of cyanobacteria, which introduced oxygen into the environment (1). Furthermore, the oxygen requirements of aerobic eukaryotes, representing most eukaryotes by far, scale positively with their size (2). For example, mammals could not have evolved into a low-oxygen environment that was sufficient for eukaryotic microbes. In this way, the history of atmospheric oxygen has both constrained and permitted evolutionary developments requiring specific oxygen levels (3). However, fully understanding how oxygen has impacted the history of life requires reconstructing the history of atmospheric oxygen.Direct measurements of atmospheric oxygen concentration over time can be made from air trapped in glacial ice, with a record extending over the past 800,000 y (4), or in evaporitic salt, extending the record to potentially over 1 billion years (5–8). The oxygen record from ice is continuous and precise, but young, while the salt record is infrequent and requires careful screening to ensure samples are appropriate for analysis (9). Otherwise, the history of atmospheric oxygen is estimated from oxygen-sensitive proxies. Oxygen impacts the chemical nature, isotopic composition, and/or concentrations of redox-sensitive substances in the oceans (like molybdenum, e.g., refs. 10 and 11, or cerium, e.g., refs. 12 and 13) and the chemical weathering of redox-sensitive substances on land (like chromium and iron, e.g., refs. 14–16). Oxygen is also directly incorporated into sulfate during redox transformation (17). None of the proxies deriving from these processes represent a direct oxygen barometer, and each requires interpretation through modeling with a variety of assumptions regarding reaction kinetics, isotopic behavior during redox transformations, and the activity level of the ancient biosphere. These approaches are also generally hindered by a limited geologic record.Furthermore, these approaches do not provide a consensus view as to the history of atmospheric oxygen. For example, some approaches suggest maximum Mesoproterozoic Era (1,600 to 1,000 Ma) oxygen levels of 0.1 to 1% times present levels (PAL) (15, 18), whereas other approaches suggest minimum oxygen levels of 1 to 4% PAL (19–21). Also, different approaches using the same proxy can yield dramatically different results. For example, a kinetic approach to modeling cerium anomalies suggests atmospheric oxygen levels of ≤0.1% PAL from the Mesoproterozoic Era (1,600 to 1,000 Ma) through the latest Neoproterozoic Era (1,000 to 541 Ma) (13), while thermodynamic modeling of the cerium anomaly suggests oxygen levels of 1 to 2% PAL through the same time window (12). Resolving such divergent views is critical, as the Mesoproterozoic Era was a time of emerging eukaryotic ecosystems (22) whose evolution could have been influenced by oxygen availability.The carbon cycle is also impacted by oxygen in which the weatherability of ancient “geologic” organic matter is a function of oxygen concentration (23). Indeed, existing carbon cycle models suggest that considerable unweathered organic matter should be recycled into marine sediments when oxygen concentrations fall below 10% PAL (24). Thus, the extent of organic matter recycling in the geologic past yields a potential oxygen barometer. Therefore, we have explored with Raman spectroscopy nine geologic formations of relatively low thermal maturity spanning 1 billion years of the Proterozoic Eon (Table 1). We find that recycled organic matter is rare and that organic matter was oxidized during weathering as efficiently then as now, placing rather firm lower limits on levels of atmospheric oxygen through this time.Table 1.Number of sampling points and estimates of petrographic carbon concentrations

Analysis of Potential Oral Cleft Risk Factors in the Kosovo Population

The aim of this study was to analyze the association of potential risk factors such as positive family cleft history, smoking, use of drugs during pregnancy, and parental age with oral clefts in offspring within the Kosovo population. We conducted a population-based case-control study of live births in Kosovo from 1996 to 2005. Using a logistic regression model, 244 oral cleft cases were compared with 488 controls. We have excluded all syndromic clefts. Heredity increases the risk of clefts in newborns [odds ratio (OR) = 8.25, 95% confidence interval (CI) 3.12–23.52]. Clefts were also associated with smoking (OR = 1.87, 95% CI 0.75–4.08), use of drugs during pregnancy (OR = 2.25, 95% CI 0.82–5.12), increasing maternal age (OR = 1.83, 95% CI 1.42–2.49), and increasing paternal age (OR = 1.3, 95% CI 1.2– 1.4). We found heredity to be the most important factor for cleft occurrence in Kosovar newborns. Another significant potential risk factor for occurrence of clefts is the parental age. We found the use of drugs and smoking during pregnancy to be less significant.Key words: Oral clefts, Cleft lip with or without cleft palate, Cleft palate only, Potential risk factors, Logistic regression model, Dummy variablesCleft lip with or without cleft palate and isolated cleft palate are the most common facial birth defects. The etiology involves complex interactions between genetic and environmental factors.¹ Genetic factors appear to create the most susceptibility for clefts. When environmental factors (i.e., triggers) interact with a genetically susceptible genotype, a cleft develops during an early stage of development.² The aim of this study was to analyze the association of potential risk factors such as positive family cleft history, smoking, use of drugs during pregnancy, and parental age with oral clefts in offspring in Kosovo. Risk factors vary among populations, and our ultimate goal was to provide data that may show new potential risk factors influencing the occurrence of clefts in Kosovo. With this new information, we hope to increase public awareness of such risks and thereby help reduce the incidence of cleft in Kosovo.     

Use of Stapling Devices for Safe Cholecystectomy in Acute Cholecystitis

Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred.Key words: Cholecystectomy, Endo-GIA, Acute cholecystitis, StaplerAfter the introduction of laparoscopic cholecystectomy (LC) in 1987,¹ LC replaced open cholecystectomy as the gold standard for the treatment of cholelithiasis in international guidelines.² LC was initially considered to be contraindicated for acute gallbladder inflammation, but it is currently a common procedure for acute cholecystitis.Some of the difficult situations a surgeon is likely to face during the performance of a laparoscopic cholecystectomy include anatomic anomalies such as a sessile gallbladder or short cystic duct and pathologic entities such as an empyema, Mirizzi syndrome, or a frozen Calot''s triangle secondary to infection and fibrosis.³It is suggested that laparoscopic surgery should be carried out within 72 hours from the onset of the symptoms because after that time there are higher rates of conversion to open procedures, increased risks of complications, and longer operative times.^4–6 The generally accepted procedure in patients whose symptoms started 72 hours before admission is to “cool down” the patient with appropriate medical therapy and to perform LC after a period of 6 to 12 weeks.^7,8 This approach aims to avoid a potentially more difficult cholecystectomy during an emergency admission and to avoid the difficulties of access to an emergency room.^9,10 However, more than 20% of patients may fail to respond to conservative treatment and require an urgent and rather more difficult cholecystectomy, and a further 25% of patients will require readmission with a severe acute complication of cholelithiasis while awaiting a cholecystectomy.^11,12 The scar formation, distortion, and organized adhesions around the gallbladder occurring secondary to the chronic inflammation in Calot''s triangle make the dissection difficult. The cystic duct (CD) is sometimes edematous, fibrous, or enlarged owing to inflammation and adhesions in acute cholecystitis and may be difficult to manage. Several methods were proposed for ligating the CD, including titanium or absorbable endoclip, endoloop, tie, ultrasonic or bipolar sealer, and the Endo-GIA stapler (Covidien, Mansfield, Massachusetts).^13–19This study proposes an effective, safe, and easy procedure for the stapling of dilated or difficult CD using the Endo-GIA.     

Development of the Arabic Version of Dysphagia Handicap Index (DHI)

The Dysphagia Handicap Index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool for measuring the handicapping effect of dysphagia on the physical, functional, and emotional aspects of people’s lives. The purposes of the present study were to develop an Arabic version of the DHI and to evaluate its validity, consistency, and reliability in the normal Arabic population with oropharyngeal dysphagia. This was a prospective study that was carried out at the Communication and Swallowing Disorders Unit, King Saud University. The generated Arabic DHI was administered to 94 patients with oropharyngeal dysphagia and 98 control subjects. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Arabic DHI showed excellent internal consistency (Cronbach’s α = 0.95). Also, good test–retest reliability was found for the total scores of the Arabic DHI (r = 0.9, p = 0.001). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (p < 0.001). This study demonstrated that the Arabic DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on the physical, functional, and emotional aspects of patients and can be used by Arabic language speakers.