Molecular typing of canine distemper virus strains reveals the presence of a new genetic variant in South America

Canine distemper virus (CDV, Paramyxoviridae, Morbillivirus) is the causative agent of a severe infectious disease affecting terrestrial and marine carnivores worldwide. Phylogenetic relationships and the genetic variability of the hemagglutinin (H) protein and the fusion protein signal-peptide (Fsp) allow for the classification of field strains into genetic lineages. Currently, there are nine CDV lineages worldwide, two of them co-circulating in South America. Using the Fsp-coding region, we analyzed the genetic variability of strains from Uruguay, Brazil, and Ecuador, and compared them with those described previously in South America and other geographical areas. The results revealed that the Brazilian and Uruguayan strains belong to the already described South America lineage (EU1/SA1), whereas the Ecuadorian strains cluster in a new clade, here named South America 3, which may represent the third CDV lineage described in South America.     

Maternal postpartum complications according to delivery mode in twin pregnancies

OBJECTIVE:

We aimed to examine maternal postpartum complications of twin deliveries according to mode of delivery and investigate the associated risk factors.

METHODS:

This was a retrospective cohort review of twin pregnancies with delivery after 26 weeks at a tertiary teaching hospital (1993-2008). The rates of maternal postpartum complications were compared among vaginal, elective cesarean and emergency cesarean deliveries. Significant predictors of complications were investigated with stepwise regression analysis and relative risks were calculated.

RESULTS:

A total of 90 complications were observed in 56/817 (6.9%) deliveries: 7/131 (5.3%) vaginal, 10/251 (4.0%) elective cesarean and 39/435 (9.0%) emergency cesarean deliveries. Significant predictors included high-risk pregnancy, gestational age at birth and delivery mode. The occurrence of complications was significantly increased in emergency compared to elective cesarean deliveries (RR = 2.34).

CONCLUSIONS:

Maternal postpartum complications in twin pregnancies are higher in emergency compared to elective cesarean deliveries and are also related to preexisting complications and earlier gestational age at delivery.     

Adipose Mesenchymal Stromal Cells Isolated From Type 2 Diabetic Patients Display Reduced Fibrinolytic Activity

Stem cells have been successfully used for the treatment of critical limb ischemia (CLI). We conducted a clinical trial to determine the feasibility of using autologous adipose-derived mesenchymal stromal cells (AdMSCs) for the treatment of CLI. Unexpectedly, two diabetic patients developed peripheral microthrombosis. This adverse effect, which contrasts with the reported antithrombotic properties of MSCs, may stem from the diabetic environment that alters the fibrinolytic activity of AdMSCs, thereby increasing the probability of developing thrombosis. Here, we confirm this premise by demonstrating that diabetic AdMSCs cultured in the presence of blood sera expressed and released higher levels of plasminogen activator inhibitor type 1, reduced levels of tissue plasminogen activator, and lower d-dimer formation compared with nondiabetic AdMSCs. Thus, to establish an appropriate cell therapy for diabetic patients, we recommend including new preclinical safety tests, such as the d-dimer and/or the tissue plasminogen activator-to-plasminogen activator inhibitor type 1 ratio tests, to assess fibrinolytic activity of cells before implantation.We evaluated the safety and feasibility of using autologous adipose-derived mesenchymal stromal cells (AdMSCs) for diabetic patients (ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT01257776","term_id":"NCT01257776"}}NCT01257776). Two diabetic patients developed distal microthrombosis (DMT) that was controlled with aggressive antithrombotic therapy. DMT was not detected when autologous AdMSCs isolated from nondiabetic patients were used (ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT01745744","term_id":"NCT01745744"}}NCT01745744) under identical conditions, as reported in ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT00872326","term_id":"NCT00872326"}}NCT00872326) (1). Development of AdMSCs-associated DMT has not been previously reported and is in sharp contrast to the described fibrinolytic and antithrombogenic properties of MSCs (2–4). This novel clinical observation raises the possibility that the diabetic milieu of patients may alter the functional properties of AdMSCs, thereby impairing secretion of factors involved in fibrinolysis. To validate this premise, we evaluated whether AdMSCs isolated from diabetic and nondiabetic patients and cultured in the presence of healthy, diabetic, or nondiabetic blood sera displayed differential expression levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1), which may result in impaired fibrinolytic activity of AdMSCs derived from diabetic patients.

TABLE 1

Clinical parameters and inclusion and exclusion criteria of diabetic and nondiabetic patients with CLIOpen in a separate window     

Numb chin syndrome with vagal and hypoglossal paralysis: an initial sign of an uncommon diagnosis

ABSTRACT:: In this study, the case of a 58-year-old man with a 2-month history of left chin paresthesia with difficulty swallowing and chewing, and dysphonia is reported. He had an absence of the gag reflex, unilateral palatal palsy and deviation of the tongue upon attempted protrusion with unilateral atrophy. Magnetic resonance imaging of the skull base revealed a tumoral infiltration of the left side of Meckel's cave, involvement of the clivus with extension into the cavernous sinus and signs of focal leptomeningeal infiltration. The patient was eventually diagnosed with generalized Burkitt's lymphoma. In this study, the authors suggest an initial diagnostic workup that includes a computed tomography scan of the mandible and a magnetic resonance imaging of the skull base searching for malignancy in patients with isolated numb chin syndrome, a rare disorder often associated with cancer, especially breast cancer and lymphoma, with mandibular metastases, leptomeningeal seeding and metastases of the base of the skull explaining the origin of the syndrome in most cases.     

Prognostic value of trisomy 8 as a single anomaly and the influence of additional cytogenetic aberrations in primary myelodysplastic syndromes

Trisomy 8 is the most common chromosomal gain in myelodysplastic syndromes (MDS), however, little is known about the features of MDS with isolated trisomy 8 and the influence of additional cytogenetic aberrations. We determined the characteristics and prognostic factors of 72 patients with trisomy 8 as a single anomaly and analysed also the impact of other aberrations added to trisomy 8 in another 62 patients. According to our study, MDS with isolated trisomy 8 was more frequent in men, with more than one cytopenia in most patients (62%) and having about 4% bone marrow blasts. The multivariate analysis demonstrated that platelet count and percentage bone marrow blasts had the strongest impact on overall survival (OS). The median OS for isolated trisomy 8, trisomy 8 plus one aberration (tr8 + 1), plus two (tr8 + 2) and plus three or more aberrations (tr8 + ≥3) was 34·3, 40, 23·4 and 5·8 months, respectively (P < 0·001). Trisomy 8 confers a poorer prognosis than a normal karyotype in MDS patients with ≥5% bone marrow blasts. This study supports the view that MDS with isolated trisomy 8 should be included in the intermediate cytogenetic risk group.