Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers

Aim To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas. Methods Forty-one patients (26 men, 15 women; age range 26–82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary stenosis in 21 patients, recurrent lesions in 15, and immature fistulas in 5. A PCB was used alone in 17 cases, but was followed by a larger standard balloon in 33 cases. Follow-up included ultrasound, flow analysis and urea reduction ratio, and ranged from 2 to 30 months (mean 14 months). Results The technical success rate was 98%. All procedures were relatively painless. Two PCBs burst and 4 leaked, but without causing any morbidity. Nineteen fistulas were still working at last follow-up. Primary patency rates at 6, 12, and 24 months using Kaplan-Meier analysis were 88%, 73%, and 34%, respectively, and the primary assisted patencies were 90%, 75%, and 50%, respectively. Conclusion PCB angioplasty has high technical success and low complication rates. The long-term patency rates are favorable for PCB angioplasty and compare favorably with other series.     

Resistance of Acanthamoeba Cysts to Disinfection in Multiple Contact Lens Solutions

Acanthamoebae are free-living amoebae found in the environment, including soil, freshwater, brackish water, seawater, hot tubs, and Jacuzzis. Acanthamoeba species can cause keratitis, a painful vision-threatening infection of the cornea, and fatal granulomatous encephalitis in humans. More than 20 species of Acanthamoeba belonging to morphological groups I, II, and III distributed in 15 genotypes have been described. Among these, Acanthamoeba castellanii, A. polyphaga, and A. hatchetti are frequently identified as causing Acanthamoeba keratitis (AK). Improper contact lens care and contact with nonsterile water while wearing contact lenses are known risk factors for AK. During a recent multistate outbreak, AK was found to be associated with the use of Advanced Medical Optics Complete MoisturePlus multipurpose contact lens solution, which was hypothesized to have had insufficient anti-Acanthamoeba activity. As part of the investigation of that outbreak, we compared the efficacies of 11 different contact lens solutions against cysts of A. castellanii, A. polyphaga, and A. hatchetti (the isolates of all species were genotype T4), which were isolated in 2007 from specimens obtained during the outbreak investigation. The data, generated with A. castellanii, A. polyphaga, and A. hatchetti cysts, suggest that the two contact lens solutions containing hydrogen peroxide were the only solutions that showed any disinfection ability, with 0% and 66% growth, respectively, being detected with A. castellanii and 0% and 33% growth, respectively, being detected with A. polyphaga. There was no statistically significant difference in disinfection efficacy between the 11 solutions for A. hatchetti.Acanthamoebae, which are free-living amoebae, occur worldwide in soil and water. It has been isolated from ponds, lakes, brackish water. and seawater; filters of heating, ventilating, and air-conditioning units; medical equipment, such as gastric wash tubing, dental irrigation units, contact lenses, and contact lens solutions; as well as vegetables, cell cultures, and even human and animal tissues (7, 23, 39). It has also been isolated from toxic waste dumpsites with high levels of pesticides, herbicides, pharmaceuticals, heavy metals, and polychlorinated biphenyls (35). Acanthamoeba species have two stages in their life cycle: a vegetative or trophozoite stage that reproduces by binary fission and that feeds voraciously on the bacteria and detritus present in the environment and a nondividing, cyst stage that is resistant to environmental stress. Acanthamoeba amoebae cause different types of human disease, including central nervous system infections (granulomatous amebic encephalitis, cutaneous infections) Acanthamoeba dermatitis, and ocular infections (Acanthamoeba keratitis [AK]). Granulomatous amebic encephalitis and cutaneous infections principally occur in immunocompromised individuals, including patients with human immunodeficiency virus infection or AIDS (17, 23, 37, 43). In contrast, AK principally occurs in immunocompetent individuals.AK is a painful vision-threatening infection, which, if it is not treated promptly, may lead to ulceration of the cornea, a loss of visual acuity, and, eventually, blindness (7, 15, 16). AK is associated with trauma to the cornea and with contact lens wear as a result of poor lens care and hygiene. When introduced into the eye by a contaminated contact lens, Acanthamoeba amoebae may adhere to the corneal surface and subsequently infiltrate the stoma and cause tissue damage (10). Both Acanthamoeba cysts and trophozoites can be isolated by culture from corneal scrapings or biopsy specimens and from contact lens paraphernalia (23, 43). Confocal microscopy has been used as an aid for the diagnosis of AK (29). Molecular techniques such as real-time PCR assays have been developed for the identification of Acanthamoeba species (32, 33). Sequencing analysis of the 18S rRNA gene has been used to identify as many as 15 genotypes of Acanthamoeba, of which the T4 genotype appears to be the most common in the environment and in patients with AK (2, 23).The first documented case of AK in the United States occurred in 1973 in a south Texas rancher following trauma to his right eye (15, 40, 42). Both trophozoite and cyst stages of Acanthamoeba polyphaga were demonstrated in corneal sections. Between October 1985 and August 1986, Stehr-Green et al. (41) conducted a case-control study to investigate an outbreak of AK in the United States. The majority of case patients wore contact lenses, and illness was most commonly associated with the use of homemade saline solutions and lens care practices, such as the disinfection of the lenses less frequently than recommended and swimming while wearing contact lenses (8, 41). Contact lens use is now considered an important risk factor for AK in the United States. AK cases have continued to be diagnosed since the 1986 outbreak, but because AK is not a reportable disease in the United States, the actual number of cases occurring each year is not known.A recent study indicated a dramatic increase in the number of AK cases in the Chicago, IL, area (16). An investigation conducted by the Centers for Disease Control and Prevention (CDC) revealed that this increase in the number of AK cases was occurring nationwide, starting in 2004 and continuing through 2007 (7). A subsequent investigation identified the use of Advanced Medical Optics (AMO) Complete MoisturePlus multipurpose contact lens solution as the primary risk factor, leading to an international recall of this product by the manufacturer (7, 16). We therefore decided to examine this and other frequently used major contact lens solutions for their efficacies against Acanthamoeba species isolated from clinical samples collected during the 2007 AK outbreak investigation.     

Rapid Variable-Number Tandem-Repeat Genotyping for Mycobacterium leprae Clinical Specimens

Mycobacterium leprae is the noncultivable pathogen of leprosy. Since the genome sequence of an isolate of M. leprae has become available, multiple-locus variable-number tandem-repeat (VNTR) analysis (MLVA) has been explored as a tool for strain typing and identification of chains of transmission of leprosy. In order to discover VNTRs and develop methods transferable to clinical samples, MLVA was applied to a global collection of M. leprae isolates derived from leprosy patients and propagated in armadillo hosts. PCR amplification, agarose gel electrophoresis, and sequencing methods were applied to DNA extracts from these infected armadillo tissues (n = 21). We identified polymorphisms in 15 out of 25 short-tandem-repeat (STR) loci previously selected by in silico analyses of the M. leprae genome. We then developed multiplex PCR for amplification of these 15 loci in four separate PCRs suitable for fluorescent fragment length analysis and demonstrated STR profiles highly concordant with those from the sequencing methods. Subsequently, we extended this method to DNA extracts from human clinical specimens, such as skin biopsy specimens (n = 30). With these techniques, mapping of multiple loci and differentiation of genotypes have been possible using total DNA extracts from limited amounts of clinical samples at a reduced cost and with less time. These practical methods are therefore available and applicable to answer focused epidemiological questions and to allow monitoring of the transmission of M. leprae in different countries where leprosy is endemic.The causative pathogen of leprosy is Mycobacterium leprae. A continued incidence, defying global campaigns to eliminate leprosy even after years of rigorous case finding and the availability of multidrug therapy regimens (28, 29, 30, 31), is attributed to subclinical human and environmental reservoirs of the pathogen (1, 8, 13). In recent years, molecular strain-typing methodologies have complemented conventional infectious disease epidemiology. With the publication in 2001 of the complete genome sequence of an isolate from Tamil Nadu, India, called the TN strain (4), selection of potential polymorphic genomic markers for strain typing was feasible. The first genetic markers that showed polymorphism were short tandem repeats (STRs) in the M. leprae genome. One was a 6-bp intragenic sequence in the rpoT gene, and the second, a trinucleotide (TTC) repeat element upstream of a pseudogene (17, 23). These sequences exhibit variable numbers of tandem repeats (VNTRs) when sequenced in different isolates. Based on these observations, we short-listed 44 loci (including the rpoT and TTC loci) by in silico analyses of the M. leprae genome and accomplished the screening of 11 STR loci, of which 9 were polymorphic when tested in a small panel of four human isolates derived from passage through armadillos (6). Five were minisatellites (6- to 50-bp repeat units), and four were microsatellites (1- to 5-bp repeat units). Since then, others have also shown that VNTR loci exist in M. leprae isolates (25, 33, 34). Three single-nucleotide polymorphisms have also been discovered by comparing sequences of a limited number of strains (20).The goal of our work has been to discover and apply DNA variation among M. leprae isolates to identify sources and chains of transmission of leprosy in regions of endemicity. There are, however, physiological and practical issues relevant to strain typing of M. leprae in the clinical setting, such as the long incubation period and low transmissibility of leprosy and the requirement for clinical specimens such as slit skin smears and skin biopsy specimens from leprosy patients due to the inability of M. leprae to grow in culture. During the course of the last 4 years, field studies in which STR mapping was implemented have been reported. Matsuoka et al. (16) applied the microsatellite locus (TTC)21 to type M. leprae strains obtained from nasal swabs and slit skin smears from patients grouped by village, dwelling, or household in Indonesia, while Young et al. (33) combined (AT)15, (GTA)9, and (TTC)21 VNTR loci for the identification of short- and long-range M. leprae transmission chains in areas within and surrounding the city of Hyderabad, India. Monot et al. mapped five M. leprae STR loci in patients from Mali, Africa (19). The results from those studies demonstrated heterogeneity in prevalent haplotypes, indicating that genotype mapping with a small panel of one to five microsatellite VNTR loci was insufficient to discern strain relatedness. However, within an intrafamilial case, three markers were congruent (33). The authors of those studies concluded that in these areas of endemicity, multiple rather than single dominant isolates are found and that additional genomic markers are necessary for strain typing.For these reasons, assays for the amplification and differentiation of multiple genomic loci are needed. When these requirements have been met, it becomes possible to undertake systematic strain-typing studies that include suitable sampling strategies and conventional epidemiology methods for monitoring transmission and detecting clusters of cases. In light of these laboratory, field, and clinical issues, we further explored multiple-locus VNTR analysis (MLVA) techniques. In this paper, we report the development and testing of multiplex-PCR methods for MLVA for reference armadillo-derived M. leprae isolates and clinical materials and address allelic properties of individual loci and the reproducibility and feasibility of the techniques. In a future paper, we will apply and extend these methods to the data from population-based studies in Cebu, the Philippines (R. M. Sakamuri, M. Kimura, W. Li, K. Madanahally, H.-C. Kim, H. Lee, M. Balagon, R. Gelber, W. C. Black, S.-N. Cho, P. J. Brennan, and V. Vissa, submitted for publication).     

Search of antimycobacterial activities in hybrid molecules with benzopyran skeleton

A series of hybrid molecules (7–9, 12, 13, and 14–18) consisting of chromans and pyrolidines or cyclic amines were prepared either by (3 + 2) cycloaddition of nitrostyrenes and azomethine ylide or by three component reactions of chromanyl aldehydes, acetylenes, and cyclic amines. All the synthesized compounds were evaluated against both avirulent (H37Ra) and virulent (H37Rv) strains of Mycobacterium tuberculosis. Out of all the compounds screened, compounds 16, 17, and 18 were found to be active against the virulent strain M. tubercolosis H37Rv displaying MIC in the range of 6.25–1.56 μg/ml against.     

The roles of hope and optimism on posttraumatic growth in oral cavity cancer patients

To investigate the association of the positive coping strategies, hope and optimism, on posttraumatic growth (PTG) in oral cavity (OC) cancer patients. A retrospective cross-sectional study was conducted and performed in the outpatient station of the Oral and Maxillofacial Surgery at the University of Hong Kong, Hong Kong SAR, PR China. Fifty patients successfully treated for OC cancer were recruited after their informed consents had been obtained during the review clinic. During their regular follow-up controls in the outpatient clinic, the patients compiled the posttraumatic growth inventory (PTGI) questionnaire, hope scale (HS) and the life orientation scale-revised (LOT-R). Hope and optimism correlated significantly positive with PTG and accounting together for a 25% variance of posttraumatic growth. Hope positively correlated with posttraumatic growth (r=.49, p<.001) as well as optimism (r=.31, p<.05). When compared to unmarried patients, married patients showed high levels of PTG and hope (married participants: mean=53.15, SD=11.04; unmarried participants: mean=41.00, SD=6.36; t (48)=2.403, p<.05). Hope and optimism represent important indicators for PTG in OC cancer patients. An intact dyad relationship seems to be important for hope and consecutive higher levels of PTG when compared to unmarried patients. Supportive psychological treatment strategies related to these two coping factors might be beneficial for OC cancer patients.     

Factors affecting acetabular bone loss during primary hip arthroplasty--a quantitative analysis using computer simulation

BACKGROUND: Although, various factors may affect the degree of acetabular bone loss during primary hip arthroplasty, they have not been quantified previously. METHODS: We assessed the influence of using various reamer diameters, designs and reaming depth on the amount of bone removed during acetabular preparation by simulated reaming in a three-dimensional pelvic model, using computer software. FINDINGS: The least amount of bone loss (6185 mm3) providing optimal bone contact with the acetabular articular surface occurred with a 165 degrees reamer design. Increase in reamer diameter, reaming depth and subtending angle of the reamer resulted in disproportionately large increase in the amount of bone resected compared to the relatively small increase in the reamer-bone contact area. INTERPRETATION: Surgeons must be aware of the relative influence of the reaming technique and the implant design on the amount of acetabular bone resection to optimize acetabular bone preservation during primary hip arthroplasty.     

A facile synthesis of alpha,alpha'-(EE)-bis(benzylidene)-cycloalkanones and their antitubercular evaluations

An economical and facile synthesis of alpha,alpha'-(EE)-bis(benzylidene)-cycloalkanones was achieved by the reaction of cycloalkanones with different aromatic aldehydes using ethanolic KOH in good yields. Few of the selected compounds were reduced with NaBH(4) to the respective alpha,alpha'-(EE)-bis(benzylidene)-cycloalkanols. All these compounds and our earlier synthesized cyclohexyl phenyl methanols were evaluated for their antitubercular, antifungal and antibacterial activities. Several compounds displayed moderate antitubercular activity with MIC=12.5-1.56 microg/mL. However, none of the compounds displayed any significant antifungal activity.     

Congenital bilateral coronary artery to pulmonary artery fistulas associated with left main trunk stenosis

A rare case of a 57-year-old patient who presented with an acute coronary syndrome with incidental discovery of bilateral coronary arteriovenous fistulas originating from both coronary arteries to the pulmonary artery trunk and coronary artery atherosclerosis.