CSF cytology of a patient with conversion of an acute lymphatic leukemia to an acute eosinophilic leukemia

The course of leukemic disease in a male adolescent with meningeal leukemia is described. The bone marrow aspirates showed a conversion from an acute lymphatic leukemia to an eosinophilic leukemia. Four weeks after the peripheral shift of phenotype two different cell clones were detected in one CSF smear. While under ultrahigh dose araC therapy the patient died 3 months after conversion. Possible explanation for the shift of phenotype and the peculiar leptomeningeal infiltration are discussed.     

The 49 K subunit of NADH: ubiquinone reductase (complex I) from Neurospora crassa mitochondria: primary structure of the gene and the protein

Summary The primary structure of the 49 K subunit of the respiratory chain NADH:ubiquinone reductase (complex I) from Neurospora crassa was determined by sequencing cDNA, genomic DNA and the N-terminus of the mature protein. The sequence lengths correlate to a molecular mass of 54002 daltons for the preprotein and 49239 daltons for the mature protein. The presequence consists of 42 amino acids of typical composition for sequences which target nuclear-encoded proteins into mitochondria. The mature protein consists of 436 amino acids and shows 64% similarity to a 49 K subunit of bovine heart NADH:ubiquinone reductase and 33% to a predicted translation product of an open reading frame in the chloroplast DNAs of Marchantia polymorpha and Nicotiana tabacum. Evidence for an iron-sulfur cluster in the subunit is discussed.     

SDF-1 enhances the expansion and maintenance of highly purified human hematopoietic progenitors

The stromal-derived factor-1 (SDF-1) chemokine and its putative receptor, CXCR4, have been implicated in hematopoiesis. Here we aim to characterize the effects of cytokine-induced CXCR4 expression and SDF-1 treatment on primitive human umbilical cord blood (CB) cells in vitro. Highly purified CD34+CD38-Lin-CXCR4- blood cells were capable of forming CD34+CXCR4+ cells during short-term liquid culture, but maintained distinct erythroid and myeloid progenitor composition, similar to the parent population prior to culture. In vitro, SDF-1 enhanced the expansion and differentiation of primitive CB cells in a manner that was dependent upon both the concentration of SDF-1 and the presence of specific cytokines. In the absence of cytokine addition, cultures seeded with CD34+CD38-Lin- cells demonstrated substantial cell death; however, the addition of SDF-1 alone preferentially increased progenitor cell frequency. Our study demonstrates that induction of CXCR4 expression does not alter the differentiative potential of human blood progenitors and suggests a role for SDF-1 as a growth factor required for human hematopoiesis.     

Mid-Adulthood Risk Factor Profiles for CKD

Early identification of CKD risk factors may allow risk factor modification and prevention of CKD progression. We investigated the hypothesis that risk factors are present ≥30 years before the diagnosis of CKD in a case-control study using data from the Framingham Offspring Study. Patients with incident CKD (eGFR≤60 ml/min per 1.73 m²) at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to patients without CKD at baseline (examination 5). CKD risk factors were measured at each examination cycle. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls. During follow-up, 441 new cases of CKD were identified and matched to 882 controls (mean age 69.2 years, 52.4% women). Those who ultimately developed CKD were more likely to have hypertension (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.23 to 2.51), obesity (OR, 1.71; 95% CI, 1.14 to 2.59), and higher triglyceride levels (OR, 1.43; 95% CI, 1.12 to 1.83) 30 years before CKD diagnosis, and were more likely to have hypertension (OR, 1.38; 95% CI, 1.07 to 1.79), higher triglyceride levels (OR, 1.35; 95% CI, 1.11 to 1.64), lower HDL_c (OR, 0.89; 95% CI, 0.81 to 0.97), and diabetes (OR, 2.90; 95% CI, 1.59 to 5.29) 20 years before CKD diagnosis. These findings demonstrate that risk factors for CKD are identifiable ≥30 years before diagnosis and suggest the importance of early risk factor identification in patients at risk for CKD.     

Laboratory tests for paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematological disorder that is often suspected in a patient presenting with non‐immune hemolytic anemia associated with pancytopenia or venous thrombosis. This disorder is a consequence of acquired somatic mutations in the phosphatidylinositol glycan class A (PIG‐A) gene in the hematopoietic stem cells (HSC) of patients. The presence of these mutations leads to production of blood cells with decreased glycosyl phosphatidylinositol‐anchored cell surface proteins, making red blood cells derived from the clone more sensitive to complement mediated hemolysis. The diagnosis of PNH may be difficult in some cases due a low proportion of PNH cells in the blood and occasionally due to difficulties in selecting the most appropriate diagnostic studies. The latest generation of tests allow for detection of very small populations of PNH cells, for following the natural course and response to therapy of the disease, and for helping to decide when to initiate therapy with monoclonal antibody targeting the terminal complement protein C5 (Eculizumab), anticoagulation, and in some cases allogeneic HSC transplant. In this article, we review the different diagnostic tests available to clinicians for PNH diagnosis. Am. J. Hematol. 89:339–341, 2014. © 2013 Wiley Periodicals, Inc.     

In vitro performance of zirconia and titanium implant/abutment systems for anterior application

Objectives

To investigate the type of failure and fracture resistance behaviour of different zirconia and titanium implant/abutment systems for anterior application.

Methods

Eight groups of implant–abutment combinations (n = 8/system) were restored with identical full-contour zirconia crowns. The systems represented one-piece and multi-piece zirconia (Z) or titanium (T) implants/abutments with different types of connection (screwed = S, bonded = B). The following combinations (implant–abutment-connection) were investigated: ZZS, ZZB, ZZZB (three-piece), ZTS, TTS, TTS reference, and Z (one-piece, 2×). To simulate clinical anterior loading situations the specimens were mounted into the chewing simulator at an angle of 135° and subjected to thermal cycling (2 × 3000 × 5°/55 °C) and mechanical loading (1.2 × 10⁶ × 50 N; 1.6 Hz). Fracture resistance and maximum bending stress were determined for all specimens that survived ageing. Data were statistically analyzed with the Kolmogorov–Smirnov-test and one-way ANOVA (α = 0.05). Survival performance was calculated with the Kaplan–Meier Log-Rank test.

Results

Independent of the material combinations screwed systems showed partly failures of the screws during simulation (ZZS: 3×, ZTS: 8×, TTS: 3×). Screw failures were combined with implant/abutment fractures of zirconia systems. Zirconia one-piece implants and the reference system did not show any failures, and only one specimen of the systems with a bonded connection (ZZZB) fractured. Mean (±standard deviation) fracture forces and maximum bending stresses differed significantly (p = 0.000) between 187.4 ± 42.0 N/250.0 ± 56.0 N/mm² (ZZZB) and 524.3 ± 43.1 N/753.0 ± 61.0 N/mm² (Z).

Conclusions

Both material (zirconia or titanium) and the type of connection influenced failure resistance during fatigue testing, fracture force, and maximum bending stress.

Clinical significance

Different material combinations for implants and abutments as well as different types of connection achieved acceptable or even good failure and fracture resistance that may be satisfactory for anterior clinical application.     

Correlation between indication for amniocentesis and the time of its performing

OBJECTIVES: Prenatal diagnosis of fetal disorders is a very wide range of noninvasive and invasive methods. We use ultrasound examination and biochemical tests as screening tools in the low risk pregnancies. In a high risk pregnancy we perform invasive procedures to obtain definitive diagnosis. Amniocentesis is carried out in the first or in the early second trimester of pregnancy to determine: fetal karyotype, monogenic disorders, metabolic errors, the level of alpha-fetoprotein and acetylocholinesterase. DESIGN: The aim of our study was to determine the impact of the indication to amniocentesis on the time of performing the procedure. MATERIALS AND METHODS: We have analysed all the 721 amniocenteses carried out in the Department of Obstetrics in Gdansk in 1996-2002. Amniocenteses were performed due to: advanced maternal age in 553 cases, fetal malformation in current pregnancy in 39 cases, inherited disease in previous pregnancies in 80 cases, maternal balanced translocation in 6 cases, psychological reasons in 15 cases, inherited diseases in the family in 8 cases and serious obstetric history in 9 cases, abnormal results of triple test in 11 cases. The T-Student test was used for statistical analysis with the significance level p=0.05. RESULTS: The amniocentesis was performed in the 15th (from the 12th to the 26th) week of gestation. Amniocentesis performed because of: advanced maternal age in the 15th (from the 12th to the 25th); foetal malformation in current pregnancy in the 16th (from the 12th to the 26th); inherited disease in previous pregnancies in the 14th (from the 12th to the 18th); maternal balanced translocation in the 13th (from the 13th to the 14th); psychological reasons in the 15th (from the 13th to the 18th); inherited diseases in the family in the 15th (from the 13th to the 22nd); serious obstetric history in the 16th (from the 15th to the 17th); abnormal results of triple test in the 16th (from the 14th to the 19th). There is a statistical difference between time of performing amniocentesis because of advanced maternal age, fetal malformation in current pregnancy, maternal balanced translocation and other indications. CONCLUSION: In pregnancies with serious obstetric history--balanced translocation, inherited disease in previous pregnancies--women decided to perform amniocentesis earlier than in cases when advanced maternal age was the only indication for this procedure.     

White paper on occupational regulation

There are many ways that occupations are regulated, with the degree of regulation usually depending on the amount of harm to the public that lack of regulation could bring. Strict regulations, such as mandatory licensure, are established through state law and maintained by a state board. Less strict regulations, such as voluntary credentialing, may be requirements by employers or third-party payers. This white paper reviews the possible approaches ASET could take toward regulation of the practice of electroneurodiagnostic technology: maintain position of neutrality, advocate for no statutory regulation of END, advocate for statutory regulation of END, or advocate for voluntary credentialing. The routes taken by other allied health fields are outlined, with exploration of the advantages and disadvantages of each option, as well as what would be required of ASET in terms of time and other resources to achieve each option. The appendix is a summary of entry requirements of several healthcare professions.     

Pregnancy, delivery and puerperium in patients after liver transplantation

We report two cases of successful pregnancies in women after liver transplantation for end-stage liver dysfunction caused in one case by Wilson disease and in the second one by lupoid hepatitis. For woman with the Wilson disease it was a second pregnancy and for woman with lupoid hepatitis it was the first pregnancy. Mothers continued immunosuppressive therapy during their pregnancies. Labours started spontaneously at 39th and 36th week's of gestation. As a result the healthy two female infants weighing 3600 g and 2420 g respectively were born. The first woman with her baby was discharged from hospital on the third day after delivery and the second one and her baby on the sixth day after delivery. Both were in good condition.