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The use of GFP to localize Rho GTPases in living cells.

The green fluorescent protein (GFP) of the jellyfish Aequorea victoria has revolutionized the study of protein localization and dynamics. GFP fusions permit analysis of proteins in living cells and offer distinct advantages over conventional immunofluorescence. Among these are lower background, higher resolution, robust dual color colocalization, and avoidance of fixation artifacts. In the case of Ras and Rho family proteins, GFP fusions have allowed breakthroughs in the understanding of how CAAX proteins are targeted to specific cell membranes and how signaling at different membranes can result in different cellular responses. GFP-tagged Rho proteins have also been informative in analyzing the interactions with the cytosolic chaperone, RhoGDI. The major disadvantages of studying GFP fusion proteins is that they are generally overexpressed relative to endogenous proteins, and the GFP tag can, in principle, affect protein function. Fortunately, in the case of Ras and Rho family proteins, a GFP tag at the N terminus seems to have little effect on protein targeting and function. Nevertheless, it is prudent to confirm GFP fusion protein data with the study of the endogenous protein. This chapter describes the tagging of Rho proteins with GFP and the analysis of GFP-Rho protein localization by epifluorescence and confocal microscopy. It further describes methods of analyzing endogenous Rho proteins as confirmation of data acquired using GFP-Rho fusion proteins. These techniques will be useful for anyone studying Rho protein function and are widely applicable to many cell types and signal transduction systems.

Amino Acid Sequence↗

MODFLOW/MT3DMS-based simulation of variable-density ground water flow and transport.

This paper presents an approach for coupling MODFLOW and MT3DMS for the simulation of variable-density ground water flow. MODFLOW routines were modified to solve a variable-density form of the ground water flow equation in which the density terms are calculated using an equation of state and the simulated MT3DMS solute concentrations. Changes to the MODFLOW and MT3DMS input files were kept to a minimum, and thus existing data files and data files created with most pre- and postprocessors can be used directly with the SEAWAT code. The approach was tested by simulating the Henry problem and two of the saltpool laboratory experiments (low- and high-density cases). For the Henry problem, the simulated results compared well with the steady-state semianalytic solution and also the transient isochlor movement as simulated by a finite-element model. For the saltpool problem, the simulated breakthrough curves compared better with the laboratory measurements for the low-density case than for the high-density case but showed good agreement with the measured salinity isosurfaces for both cases. Results from the test cases presented here indicate that the MODFLOW/MT3DMS approach provides accurate solutions for problems involving variable-density ground water flow and solute transport.

Finite Element Analysis↗

Breakthrough trichosporonosis in a bone marrow transplant recipient receiving caspofungin acetate.

We report a case of invasive trichosporonosis due to Trichosporon beigelii originating in the left wrist of a bone marrow transplant recipient who was receiving caspofungin acetate as prophylaxis against invasive Aspergillus infection. While the patient's neutrophil count was recovering, treatment with fluconazole and amphotericin B lipid complex resulted in a complete clinical response.

Adult↗

Cervical pregnancy: case reports and a current literature review.

The increasing number of reports of successful conservative treatment of cervical pregnancy, such as using the folinic acid antagonist methotrexate, constitutes a breakthrough in the management of this unusual but potentially life-threatening complication of pregnancy. We are reporting two cases of cervical pregnancy, both diagnosed in the first trimester of pregnancy. The first one was successfully treated by transvaginal ultrasound-guided administration of 2 mEq KCI intraamniotically in order to stop the fetal heart activity, followed by administration of 84 mg of methotrexate intraaminiotically (1 mg/kg); whereas in the second case, we encountered a technical failure of the above method. Both patients expressed desire to maintain their reproductive capability. These two cases gave us the opportunity to review the recent literature on cervical pregnancy.

Adult↗

Double-J stent insertion across vesicoureteral junction--is it a valuable initial approach in neonates and infants with severe primary nonrefluxing megaureter?

OBJECTIVES: To evaluate the role of double-J stent insertion in perinatally detected primary nonrefluxing megaureters as a method to temporize treatment in patients with impaired renal function or to prevent function loss in patients treated expectantly, but deemed at high risk of deterioration. METHODS: Two neonates and 8 infants with a ureter greater than 10 mm and an obstructive excretion pattern, including 3 cases with renal function less than 40%, were selected to undergo double-J stent insertion for a 6-month period. Patients underwent surgery if the ureter redilated and the excretion pattern was obstructive at reassessment 3 months after stent removal. RESULTS: Stents were placed at a median age of 3 months (range 1 to 6). Open insertion was necessary in 5 cases (50%). Seven patients (70%) developed stent-related complications (five breakthrough urinary infections) requiring early stent removal in 2 (20%). Five patients (50%) underwent surgery at a median age of 14 months (range 13 to 27), including the 3 patients with decreased renal function at presentation. None required ureteral tapering. None experienced any renal function loss with respect to the initial evaluation. CONCLUSIONS: Double-J stent insertion across the vesicoureteral junction allows for effective internal drainage of primary nonrefluxing megaureters, but at the cost of a 70% morbidity rate and various technical drawbacks. Therefore, stenting should be considered on a case-by-case basis. The procedure seems valuable to temporize surgery in patients with decreased renal function. However, given the associated morbidity, it seems impractical for patients with preserved function selected in accordance with currently available prognostic indicators.

Female↗

Infectious endocarditis due to non-typhi Salmonella in patients infected with human immunodeficiency virus: report of two cases and review.

Endocarditis is not usually considered a complication of AIDS. Because salmonellal bacteremia is common in HIV-infected patients and because salmonellae have a propensity to adhere to endothelial cells, these patients are at risk of endocarditis and endarteritis. We report two cases of endocarditis due to Salmonella enteritidis and review three previously reported cases. All five patients had underlying heart valve disease and developed fever, breakthrough or relapsing bacteremia, heart murmurs, and cardiac failure; four of five patients were older than 45 years. One patient died, but the other four were successfully treated with beta-lactam agents alone or in combination with aminoglycosides or with ofloxacin (valve replacement was not required). As AIDS patients get older, the number of cases of endocarditis or endarteritis due to Salmonella species may increase, particularly in geographic areas where Salmonella species are prevalent.

AIDS-Related Opportunistic Infections↗

Allegations of sexual abuse by nonverbal autistic people via facilitated communication: testing of validity.

OBJECTIVE: The aim of the paper is to offer a comprehensive approach to establishing the validity of allegations of sexual abuse by nonverbal autistic children and adults produced through facilitated communication (FC). This approach is offered as an alternative to existing methodology that relies exclusively on the "message passing" task, and has been used to advantage in the courts. METHOD: Three components to the battery are included: (a) specialized psychometric testing; (b) a variant of the message passing task; and (c) systematic analysis of the allegations themselves. Through the juxtaposition of the data from the different sources, conclusions can be reached as to the allegations' authorship. RESULTS: The results of a series of studies addressing the issue of validity of FC in general are briefly presented. Then a case presentation is offered to demonstrate how the technique can be employed to clarify allegations of sexual abuse. Elements of two other cases are also briefly discussed. CONCLUSIONS: Facilitated communication has been heralded as a breakthrough, allowing nonverbal people with autism to express themselves. It relies on manual guidance by a facilitator. Its proponents' resistance to allowing the technique's validation relying on the paradigm of normal science has resulted in its broad dissemination without support. In the case of sexual abuse allegations thus far the "message passing" task has been used to assess their verity. The present methodology is offered as a more comprehensive alternative to "message passing," with relevance to other populations of nonverbal individuals.

Adult↗

Clinical and genetic aspects of idiopathic epilepsies in childhood.

The identification of the first genes associated with idiopathic epilepsy has been an important breakthrough in the field of epilepsy research. In almost all cases these genes were found to encode components of voltage- or ligand-gated ion channels or functionally related structures. For many other idiopathic syndromes, there is linkage evidence to one or more chromosomes, but the genes have not yet been identified. Identification of the responsible genes and their gene products will further increase the knowledge of the pathogenic mechanisms involved in epilepsy, and will hopefully facilitate the development of drug targets for the effective treatment of epilepsy. This review gives an overview of the clinical characteristics and an update of genetic research of those idiopathic childhood epilepsies for which genes have been identified and the monogenic idiopathic childhood epilepsies for which mapping data are available.

Child↗

Effects of pore volume-transmissivity correlation on transport phenomena.

The relevant velocity that describes transport phenomena in a porous medium is the pore velocity. For this reason, one needs not only to describe the variability of transmissivity, which fully determines the Darcy velocity field for given source terms and boundary conditions, but also any variability of the pore volume. We demonstrate that hydraulically equivalent media with exactly the same transmissivity field can produce dramatic differences in the displacement of a solute if they have different pore volume distributions. In particular, we demonstrate that correlation between pore volume and transmissivity leads to a much smoother and more homogeneous solute distribution. This was observed in a laboratory experiment performed in artificial fractures made of two plexiglass plates into which a space-dependent aperture distribution was milled. Using visualization by a light transmission technique, we observe that the solute behaviour is much smoother and more regular after the fractures are filled with glass powder, which plays the role of a homogeneous fault gouge material. This is due to a perfect correlation between pore volume and transmissivity that causes pore velocity to be not directly dependent on the transmissivity, but only indirectly through the hydraulic gradient, which is a much smoother function due to the diffusive behaviour of the flow equation acting as a filter. This smoothing property of the pore volume-transmissivity correlation is also supported by numerical simulations of tracer tests in a dipole flow field. Three different conceptual models are used: an empty fracture, a rough-walled fracture filled with a homogeneous material and a parallel-plate fracture with a heterogeneous fault gouge. All three models are hydraulically equivalent, yet they have a different pore volume distribution. Even if piezometric heads and specific flow rates are exactly the same at any point of the domain, the transport process differs dramatically. These differences make it important to discriminate in situ among different conceptual models in order to simulate correctly the transport phenomena. For this reason, we study the solute breakthrough and recovery curves at the extraction wells. Our numerical case studies show that discrimination on the basis of such data might be impossible except under very favourable conditions, i.e. the integral scale of the transmissivity field has to be known and small compared to the dipole size. If the latter conditions are satisfied, discrimination between the rough-walled fracture filled with a homogeneous material and the other two models becomes possible, whereas the parallel-plate fracture with a heterogeneous fault gouge and the empty fracture still show identifiability problems. The latter may be solved by inspection of aperture and pressure testing.

Geological Phenomena↗

Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study.

BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 +/- 8 days after admission and retrieval at 50 +/- 61 days. Follow up after discharge (5.7 +/- 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.

Adult↗

[Neonatal care of premature infants].

Perinatal intensive centers deal with preterm infants of the region. Therefore, the rate of preterm deliveries at the Department of Obstetrics and Gynecology, Medical University of Pécs was high in 1997, about the double of the national rate (18.7%). Among prematures the rate of very low birth weight (VLBW) infants (less than 1500 g) was about 40%, moreover, the rate of extremely low birth weight infants (less than 1000 g) was 39% within the latter group. Related to the new regulation concerning preterm delivery the number of immature infants (weighing less than 750 g) with poor outcome increased. The most characteristic disease of preterm infants is the idiopathic respiratory distress syndrome (IRDS). This could be prevented by maternal steroid treatment, a therapy accepted worldwide, however, not so common in Hungary. Direct fetal steroid therapy may be applied also in selected cases. In the treatment of IRDS surfactant products made a breakthrough. Several factors (maternal tocolytic and fluid therapy, Cesarean section) influence the cardiopulmonary adaptation which may be monitored with impedance cardiography. Late hyponatremia and metabolic acidosis may develop in 1/3 of VLBW infants. Besides the fluid therapy the introduction of enteral feeding must be planned carefully and examination of gastric emptying with ultrasound is useful. The development of osteopenia may be prevented by passive exercise of the preterm infant. Anemia is common and human recombinant erythropoietin is available for treatment. Screening of vision, hearing, and neurodevelopmental follow up are integral parts of neonatal care. As a result of the above mentioned preventive and therapeutic interventions neonatal mortality has decreased significantly in Hungary in the past decades.

Female↗

[The low dosis gestagen therapy (author's transl)].

In young women aged 22-34 years the hormone profile under continuous therapy with 0.5 mg lynestrenol/day have been investigated. Estradiol, progesterone and FSH values have been determined in plasma by the RIA or protein-binding method, whereas LH excretion was daily measured in the urine starting on the 5th day of cycle. The low-dose-gestagen therapy shows all possible hormonal patterns ranging from the ovulatory to anovulatory one. The estradiol-17 B values in half of the patients were higher than in the cycle preceding treatment. In the first few treatment cycles all women showed markedly decreased progesterone values. However, this defect seems to recover and return to normal in later cycles. In order to be able to further explain the alterations occurring during the luteal phase under the treatment with 0.5 mg/day of lynestrenol, ovarian tissues wedge resection of women undergoing gynecological surgery has been examined macroscopically and microscopically. At the same time the hormonal profile has been determined in plasma. These investigations revealed that the morphological alterations in the ovary proceed in an unchanged way under the mentioned treatment. Histologically it could be demonstrated that ovulation is delayed by several days. The histological findings of tubal tissue (from patients who underwent sterilization) showed that the secretional activity of the tubal epithelium is considerably decreased and ciliogenesis increased. In our clinical study neither tablet nor patient failures occurred. With the exception of cycle- and tempo-disturbances no severe adverse reactions were reported. Breakthrough bleedings and spotting as well as amenorrhea in most cases manifested already in the first treatment cycles. It is important that the daily tablet is taken at midday because the maximum effect on the cervical mucus of the mini-pill therapy is most pronounced 4-6 hours after tablet intake. Especially in young patients it is recommended to get written reports on tablet intake. The strict following of these directions mainly guarantees a successful mini-pill therapy.

Adult↗

Breakthrough Candida infections in patients receiving voriconazole.

OBJECTIVE: To describe 2 instances of breakthrough Candida infection in 2 patients on treatment doses of voriconazole. CASE SUMMARIES: A 27-year-old woman with systemic lupus erythematosus was receiving high-dose voriconazole (400 mg twice daily) for central nervous system lesions of unknown origin and developed oral thrush. The patient was receiving concomitant therapy with phenytoin 400 mg/day. The voriconazole dose was increased to 400 mg 3 times daily, and the thrush resolved. A 50-year-old man with HIV infection was receiving enfuvirtide, lamivudine, tenofovir, and efavirenz 600 mg/day, as well as prophylactic trimethoprim/sulfamethoxazole and azithromycin. He was started on voriconazole 200 mg twice daily for pulmonary aspergillosis and developed esophageal candidiasis. The voriconazole dose was increased to 350 mg twice daily, and the thrush eventually resolved. DISCUSSION: Both reactions were probable according to the Naranjo probability scale. Significant drug interactions may have played a role in the development of breakthrough infections in these patients, specifically with phenytoin and efavirenz. Voriconazole is metabolized primarily by CYP2C19, as well as CYP2C9 and CYP3A4. Voriconazole is also known to inhibit these enzymes, and the manufacturer reports an extensive list of drugs that interact with voriconazole. CONCLUSIONS: Although requiring systematic evaluation, there may be a role for voriconazole serum concentration monitoring to ensure therapeutic efficacy when significant drug interactions are suspected.

Adult↗

Combined cataract surgery and vitrectomy for breakthrough vitreous hemorrhage from age-related macular degeneration.

PURPOSE: To report combined cataract extraction (CE), posterior chamber intraocular lens (PCIOL) implantation, and pars plana vitrectomy (PPV) for concurrent cataract and breakthrough vitreous hemorrhage from age-related macular degeneration (AMD). METHODS: Retrospective case series. RESULTS: Six eyes were included in the study. The postoperative follow-up interval ranged from 3 to 22 months (mean 8 months). Preoperative visual acuity (VA) ranged from 20/400 to hand motion. Postoperatively, 5/6 eyes had 2 or more lines of visual improvement. Three eyes were better than 20/200. CONCLUSIONS: Combined CE, PCIOL insertion, and PPV in selected patients with cataract and breakthrough vitreous hemorrhage from AMD was successful in improving VA in the majority of patients.

Aged↗

Candida lusitaniae: a cause of breakthrough fungemia in cancer patients.

Candida lusitaniae is an infrequent cause of fungemia. We identified 12 cases of C. lusitaniae fungemia that occurred at the University of Texas M. D. Anderson Cancer Center from 1988 to 1999. The mean age of patients was 48 years (range 20--70 years). Eight patients had hematologic malignancy or had received a bone marrow transplant, and 4 had a solid tumor. Most patients (75%) were neutropenic (<10(3)/mm(3)). Treatment with amphotericin B alone failed for 3 of 6 patients, irrespective of neutropenic status. Fluconazole was effective as a single agent in 3 patients with solid tumors. The combination of amphotericin B plus fluconazole was effective treatment for two-thirds of patients with hematologic malignancy, despite persistence of neutropenia. The mortality rate associated with C. lusitaniae infection was 25%. C. lusitaniae presents as breakthrough fungemia in immunocompromised patients and is associated with failure of amphotericin B therapy. Fluconazole may be a useful agent in the treatment of this infection.

Adult↗

Use of dimensionless residence time to study variations in breakthrough behaviour in expanded beds formed from varied particle size distributions.

This work demonstrates an experimental method for studying breakthrough behaviour in expanded beds. The behaviour of beds made with differently sized particles were studied at varying flowrates. The use of a dimensionless residence time measurement allowed a more valid comparison of breakthrough characteristics in expanded bed operation by compensating for the changes in bed volume that occur during expansion. We demonstrate that bed breakthrough behaviour can be compared directly even when the beds contain different-sized particles and hence have different expanded volumes. By utilising this concept we demonstrate that, in the case of the Alcohol Dehydrogenase (ADH) / STREAMLINE Phenyl system used here, there was little or no variation in ADH breakthrough behaviour between beds of differently sized particles operating at flowrates above 100 cm/h. This suggests that the higher specific surface area and hence binding capacity of smaller particles is negated in this case due to mass transfer limitations and the increase in system void volume even at normal operating flowrates of 200-300 cm/h.

Algorithms↗

[Therapy of male subfertility].

The possibilities of treating male subfertility are still limited. Approaches at medical therapy include stimulation of spermatogenesis at the testicular level, improvement of epididymal function (sperm maturation), influence on sperm transport and activation of sperm metabolism with improvement of sperm motility. Causal therapy has been most successful in patients with hormonal insufficiency and male adnexitis, while microsurgical reconstructive measures have yielded best results in cases of occlusion within the efferent seminal ducts. New therapeutic approaches include the use of mast cell blockers and alpha blockers as well as vitamin C/E as an antioxidative treatment to reduce reactive oxygen species. If medical or surgical therapy has failed, methods for improvement of sperm quality in vitro must be considered (swim-up technique, glass wool filtration, migration/sedimentation technique, density gradient centrifugation). In cases of severe male sterility factor, intracytoplasmic sperm injection (ICSI) has been a breakthrough in the therapy of childlessness. A further progress is the collection of spermatozoa from the epididymis (MESA = microsurgical epididymal sperm aspiration) or testis (TESE = testicular sperm extraction). Finally, pressure in terms of time and organization can now be avoided by the use of cryopreserved spermatozoa from the ejaculate, epididymis or testicular tissue so that microinjection may be planned independently of the partner. In any case, a close cooperation between gynecologist and andrologist is of utmost importance.

Epididymis↗

Results of buccal mucosal grafting for patients with medically controlled ocular cicatricial pemphigoid.

Eyelid surgery for patients with ocular cicatricial pemphigoid is risky when there is unchecked perioperative inflammation. The authors performed buccal mucosal grafts on 42 eyelids (23 eyes) of 17 patients with ocular cicatricial pemphigoid whose disease was controlled by systemic immunosuppression. Results were graded as: improved (12 cases, 16 eyes); satisfactory (2 cases, 2 eyes); or poor (5 patients, 5 eyes). Complications included breakthrough trichiasis, surface keratinization of the graft, blepharoptosis, phimosis, depressed eyelid blink, incomplete eyelid closure, submucosal abscess formation, and persistent nonhealing epithelial defects of the cornea. Technical errors at surgery accounted for two complications. Secondary corneal ulceration developed in two patients. The immunologic aspect of the disease flared or progressed in five patients in the postoperative period and necessitated an increase or change in systemic medication for immunosuppression. Buccal mucosal grafting shows promise in temporarily rehabilitating eyelids of some ocular cicatricial pemphigoid patients whose disease is controlled by immunosuppressive therapy.

Eyelid Diseases↗