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A family of human Y chromosomes has dispersed throughout northern Eurasia despite a 1.8-Mb deletion in the azoospermia factor c region.

The human Y chromosome is replete with amplicons-very large, nearly identical repeats-which render it susceptible to interstitial deletions that often cause spermatogenic failure. Here we describe a recurrent, 1.8-Mb deletion that removes half of the azoospermia factor c (AZFc) region, including 12 members of eight testis-specific gene families. We show that this "b2/b3" deletion arose at least four times in human history-likely on inverted variants of the AZFc region that we find exist as common polymorphisms. We observed the b2/b3 deletion primarily in one family of closely related Y chromosomes-branch N in the Y-chromosome genealogy-in which all chromosomes carried the deletion. This branch is known to be widely distributed in northern Eurasia, accounts for the majority of Y chromosomes in some populations, and appears to be several thousand years old. The population-genetic success of the b2/b3 deletion is surprising, (i) because it removes half of AZFc and (ii) because the gr/gr deletion, which removes a similar set of testis-specific genes, predisposes to spermatogenic failure. Our present findings suggest either that the b2/b3 deletion has at most a modest effect on fitness or that, within branch N, its effect has been counterbalanced by another genetic, possibly Y-linked, factor.

Asia↗

Histological evaluation of coronary plaque in patients with variant angina: relationship between vasospasm and neointimal hyperplasia in primary coronary lesions.

OBJECTIVES: This study was designed to determine whether coronary vasospasm in patients with variant angina pectoris (VAP) may produce focal organic lesions at the site of vasospasm that would contribute to disease progression. BACKGROUND: Recent clinical angiographic and experimental studies have demonstrated the potential role of vasospasm in the worsening of organic coronary stenosis. METHODS: We studied histologically the coronary plaques obtained at atherectomy in 202 patients with moderate to severe coronary stenosis. This population included 22 patients with VAP, 100 patients with chronic stable angina and 80 patients with restenosis following angioplasty or atherectomy. Diagnosis of VAP was based on both the clinical feature of angina at rest associated with ST elevation and a positive response to acetylcholine provocation test. RESULTS: The most common histological appearance in 92% of patients with stable angina was hypocellular fibroatheromatous plaques, whereas neointimal hyperplasia was the characteristic feature of the plaque observed in 90% of patients with restenosis. The coronary specimens at the site of spasm in 15 of the 22 patients (68%) with VAP demonstrated intimal injuries such as neointimal hyperplasia (15), thrombus formation (2), and intimal hemorrhage (3). Neointimal hyperplasia was significantly more common in the patients with VAP as compared with those with stable angina (68% vs. 8%; p < 0.0001). A rapid progression of organic stenosis within three years was angiographically found in 5 of the 22 patients with variant angina. In all five cases, neointimal hyperplasia was the main contributor to the worsening of the organic lesion at the site of spasm. These histological findings in patients with VAP extremely resembled those in restenosis. Except for vasospasm, no factors significantly predicted the presence of neointimal formations in primary coronary lesions. CONCLUSIONS: Coronary vasospasm may provoke vascular injury that leads to the formation of neointima in VAP patients similar to that seen with restenosis. Coronary spasm may thus play a key role in the rapid coronary stenosis progression in certain patients with VAP.

Adult↗

A case report of wegener granulomatosis treated only with corticosteroids for 30 years.

BACKGROUND: Wegener granulomatosis is a systemic vasculitis classically described as involving the upper and lower respiratory tracts together with glomerulonephritis. Its poor prognosis was marginally improved with the use of corticosteroids, and long-term remission was not achieved until the introduction of cytotoxic agents. Generalized or systemic Wegener granulomatosis has a worse prognosis than those limited to the respiratory tracts. OBJECTIVE: To report the case of an individual who we suspect has a 30-year history of Wegener granulomatosis treated only with prednisone. METHODS: A literature search was performed with PubMed using the keywords Wegener granulomatosis, survival, prognosis, and treatment. RESULTS: Our patient is alive 32 years after her initial symptoms of vasculitis. She has been taking daily prednisone only for the majority of this time. Our clinical diagnosis of Wegener granulomatosis is based on the history and very high antineutrophil cytoplasmic antibody with the cytoplasmic pattern. CONCLUSIONS: There may be variants of generalized Wegener granulomatosis that survive with less aggressive treatment.

Aged↗

Glomangiosarcoma of the hip: report of a highly aggressive tumour with widespread distant metastases.

Malignant glomus tumour is an extremely rare neoplasm, and only a few cases with local invasive or aggressive features have been described to date. We present a distinctive case of a malignant glomus tumor arising on the skin of the left hip of a 47-year-old woman. The primary tumour was small, with a maximum diameter of 1 cm, but 2 years after the tumour was excised, multiple lung and skin metastases appeared. Post-mortem examination also revealed widespread metastases in almost all of the visceral organs. Histological examination showed that the primary tumour was composed of a sheet-like proliferation of epithelioid round or short spindle cells surrounding small venules. In addition, there was a proliferation of long spindle cells with eosinophilic fibrillary cytoplasm, which mimicked a leiomyosarcoma. The tumour cells were intensely immunopositive for actin and vimentin but were negative for desmin. This is an exceptional case of malignant glomangiomyoma with widespread metastases, which represents a distinct variant of de novo glomangiosarcoma.

Fatal Outcome↗

An explicitly correlated second order Møller-Plesset theory using a frozen Gaussian geminal.

A variant of the MP2-R12 class of theories is introduced using an arbitrary geminal function in the place of r12. Integrals are derived for the case where the geminal is expanded in a basis of Gaussian functions in the interelectronic distance. Recurrence relations are derived that do not depend on the exponents of the Gaussian geminals, allowing much of the integration work to be performed after summations over the geminal expansion. Sample calculations at various levels of explicitly correlated MP2 theory are presented for He, Ne, and water.

Journal Article↗

Chronic lymphocytic leukaemia--the haematologic basis for diagnosis and treatment.

Clinically diagnosis may be incidental when absolute lymphocytosis is uncovered at routine medical examination. More usually there is a recurrent sinopulmonary infection reflecting a varying degree of humoral and cellular immune deficiency. Autoimmune phenomena may result in haemolytic anaemia or thrombocytopenia. Expanding tumour bulk underlies the lymphadenopathy which may be prominent. Diagnosis is confirmed on morphology of the smear where atypical variants need to be distinguished from other indolent lymphoproliferative disorders. Immunophenotyping is indispensable in classification. Prognosis is predicated by cytogenetics and markers of tumour biology that include beta-2 microglobulin and peripheral blood lymphocyte doubling time. Management is dictated by symptoms and signs of progression superimposed upon performance status that includes age. Disease that is asymptomatic and truly indolent, particularly in the elderly, qualifies for a careful watch-and-wait policy. In other circumstances stratification to therapy requires entry into peer-reviewed protocols if optimal outcome is to be achieved. Established regimens, of demonstrably equal efficacy, are pulsed single-agents exemplified by chlorambucil or combinations of cyclophosphamide with vincristine and prednisone. The purine analogues, particularly when administered with an alkylating agent and mitoxantrone, are emerging as superior options. In selected patients any properly accredited program will make provision for escalation in chemotherapy requiring haematopoietic stem cell transplantation on the one hand or use of serotherapy with CD52 antibodies on the other. Less commonly, but in a defined subgroup, immunoglobulins directed against membrane CD20 may be effective. Perspective for the generalist is anchored in recognising that the previous cavalier approach to drug medication, with or without radiotherapy, is unwise whereas integrated management is now the international standard of practice. The previous anachronism of dabbling by occasional therapists is to be deprecated since this will generally deny patients access to proper diagnosis and risk-adjusted multi-disciplinary treatment.

Antineoplastic Agents↗

Novel and de-novo truncating PAX6 mutations and ocular phenotypes in Thai aniridia patients.

PURPOSE: To describe the ophthalmic findings and mutation analyses of the PAX6 gene in Thai aniridia patients. METHODS: Ten patients from six unrelated families underwent a comprehensive ophthalmic examination. Mutations in the PAX6 gene were screened by single-strand conformational polymorphism (SSCP) and direct DNA sequencing of the SSCP variants. RESULTS: Seven patients developed cataracts and six developed glaucoma. Mutation analysis demonstrated four different truncating mutations, two of which were de novo. These included one novel insertion/deletion mutation (c.474del12insGA in exon 5) and three nonsense mutations. R203X and R240X are common recurrent mutations, while Q277X in exon 10 is novel. All mutations resulted in loss of function of the PAX6 protein. CONCLUSION: Our data confirm inter- and intrafamilial variable phenotypic manifestations of which the underlying mechanisms may be haploinsufficiency or dominant-negative mutation.

Adolescent↗

Inflammatory myofibroblastic tumor of the central nervous system: clinicopathologic analysis of 10 cases.

To verify the pathologic features, anaplastic lymphoma kinase (ALK) expression and biologic behavior of inflammatory myofibroblastic tumors (IMTs) of the central nervous system (CNS), we analyzed 10 cases of IMTs-CNS (8 cranial, 1 spinal, and 1 orbital). Our series of IMTs of the CNS showed a male predominance (male:female = 6:4) and a wide age range (10-60 years; mean age, 46.7 years). Lesion location also varied, but they were basically dura-based. Radiologically, they showed two patterns: isolated mass forming (n = 6) and an en plaque-like pattern (n = 4). Histopathologically, plasma cell granuloma (PCG)-like (n = 5) or fibrohistiocytic (FHC) variant (n = 5) was present. No correlation was found between the radiologic and histopathologic patterns. Spindle-shaped mesenchymal cells of IMTs expressed smooth muscle actin (SMA) in all cases. ALK expression was not found in our IMTs of the CNS. Late recurrence was found in 2 cases in different sites (20%). Pathologically, IMT-CNS could be subclassified into PCG-like and FHC. Immunostaining for SMA was found to helpfully discriminate myofibroblastic cells and to make a differential diagnosis. Although our cases did not show ALK immunoreactivity, some IMTs-CNS can recur, which suggests the neoplastic potential of these tumors. The rearrangement of the ALK gene in IMTs-CNS should be verified by an examination of more cases.

Actins↗

Prolonged lamivudine treatment in patients with chronic active anti-HBe-positive hepatitis.

The efficacy of lamivudine (LAM) at 100 mg/d for 1 year in normalizing serum ALT levels and suppressing HBV DNA has been demonstrated in many studies. However, frequent relapses make long-term results modest. In the present study, we evaluated the efficacy of LAM administered for 3 years in patients with chronic active anti-HBe-positive hepatitis. Thirty-four patients with chronic active anti-HBe-positive hepatitis were treated with LAM (100 mg) once daily for 3 years. Before treatment, all patients demonstrated serum ALT levels >2 times normal levels for >6 months and HBV DNA positivity >5 pg/mL as determined by the sandwich hybridization test for nucleic acid. Both ALT and HBV DNA were monitored during therapy. After 12 months of therapy, 24 of 34 patients (70.6%) showed evidence of HBV DNA clearance and normal ALT levels; 22 of 34 (64.7%) and 19 of 34 (55.8%) patients maintained a complete response after 2 and 3 years of therapy, respectively. The long-term LAM therapy (>1 year) was not associated with an increase in the response of intially nonresponder patients. The YMDD variant emerged in 17.6% of patients in the first year, in 35.2% during the second year, and 52.9% during the third year of treatment. LAM was well tolerated during the 3-year therapy in all patients. Patients with chronic active anti-HBe-positive hepatitis demonstrated that the LAM response rate tends to decrease over time due to the emergence of YMDD variants.

Adult↗

Variant Bernard-Soulier syndrome due to homozygous Asn45Ser mutation in the platelet glycoprotein (GP) IX in seven patients of five unrelated Finnish families.

Bernard-Soulier syndrome (BSS), a rare bleeding disorder with macrothrombocytopenia, is caused by a defect of the platelet glycoprotein (GP) Ib/IX/V complex. Here we report a variant form of BSS in eleven patients of five unrelated families who originate from a particular area of Finland. The differential diagnosis from idiopathic thrombocytopenic purpura was difficult. Bleeding symptoms were epistaxis and haematomas debuting in childhood, but no spontaneous, severe bleeding episodes were reported. The platelet count varied from 43 to 81x10(9)/l. Screening the entire GP Ibalpha, GP Ibbeta, GP IX and GP V genes revealed a recurrent homozygous Asn45Ser mutation in GP IX in all probands. Flow cytometry showed markedly reduced expression of GP Ib (<10%), and only moderately reduced expression of GP IX (24-36%) and GP V (38-49%). The expression of subunits seemed to vary independently from the normal polymorphisms. Heterozygotes did not differ significantly from controls by their GP Ib/IX/V expression. Since the Asn45Ser mutation has also been reported in three other kindreds of northern and central European origin, this study reveals that instead of being a mutation hot spot, it may be ancient and scattered in Europe. Moderate, chronic thrombocytopenia should be carefully studied to diagnose variant BSS correctly from treatment resistant idiopathic thrombocytopenia.

Amino Acid Substitution↗

Estimating true antimalarial efficacy by heteroduplex tracking assay in patients with complex Plasmodium falciparum infections.

Heteroduplex tracking assays (HTAs) of Plasmodium falciparum merozoite surface protein 1 block-2 were used to assess complexity of infection and treatment efficacy in a trial of three antimalarial treatments in 141 Malawian pregnant women. An elevated complexity of infection (COI) was associated with anemia, parasite burden, and human immunodeficiency virus infection but was not associated with age or gravidity. Comparisons of HTA patterns before and after treatment allowed the classification of 20 of 30 (66%) recurrent episodes as either definite treatment failures or reinfections. An elevated COI was strongly associated with treatment failure (P=0.003). An algorithm was developed to assign a probability of failure for the 10 indeterminate participants, some of whose infections shared a single variant of high prevalence (>10%). By summing these probabilities, treatment efficacy was estimated.

Animals↗

Abnormal chromosome 22 and recurrence of trisomy-22 syndrome.

Trisomy-22 was confirmed with both Q- and G-banding in two sibs. Growth and mental retardation plus various dysmorphic features of this syndrome are described and compared with previous reports. Cytogenetic studies reveal a morphologically atypical No. 22 in cells of the phenotypically normal mother (46,XX) and in both affected children. The variant G chromosome is identified as No. 22 by Q- and G-banding and is interpreted as a product of a pericentric inversion on the basis of general length, arm ratio (1.4), and anomalous satellite association frequency. Repeated nondisjunction for No. 22 is considered to have resulted from asynapsis caused by interference of an inversion loop configuration which, though short, comprised a major part of chromosome 22.

Abnormalities, Multiple↗

[Interrelations between genetically determined haptoglobin types and the course of the postoperative period in chronic forms of pulmonary tuberculosis].

Haptoglobin (Hp) phenotyping was performed in 346 patients with chronic tuberculosis of the lungs. 135 of them had been earlier subjected to operations which turned to be inefficient by various reasons. Among the patients with chronic destructive and complicated tuberculosis of the lung the number of the persons with Hp 2-1 lowered to 38.7 +/- 2.6 per cent (against 53.5 +/- 5.0 per cent in the reference group) while the number of the persons with Hp 2-2 increased (47.1 +/- 2.7 per cent). During the observation period 193 patients were operated. Within the immediate postoperative period various complications developed in 28.2 +/- 5.3 per cent of the patients with Hp 2-1, in 43.7 +/- 8.8 per cent of the patients with Hp 1-1 and in 47.8 +/- 5.3 per cent of the patients with Hp 2-2. The patients with Hp 1-1 by their histories and postoperative time courses were characterized by susceptibility to relapses and aggravation of the specific process during therapy. The therapy performed was insufficient beneficial for patients with Hp 2-2. It was concluded that homozygous variants of Hp were additional risk factors in phthisiosurgical patients.

Adult↗

Immunohistochemical characterization of the differentiation state of basal cell carcinomas with special interest for infiltrating relapsing tumors.

A retrospective histological and immunohistochemical study was performed on 66 basal cell carcinomas (BCC). To determine the differentiation stages of epithelial cells in these BCC, three monoclonal antibodies directed against cytokeratins K1, K2, K9 and K10-11 (EE21-06), to cytokeratins K1 to K19 (F12-19), and to corneodesmosin (G36-19) were used in indirect immunofluorescence on paraffin-embedded sections. Three histological groups of BCC with specific cytokeratin immunohistochemical features were distinguished: (1) superficial BCC were unlabelled, (2) nodular and variant (keratotic, adenoid) BCC showed an homogeneous labelling, and (3) infiltrative aggressive-type BCC showed a heterogeneous cell to cell labelling. Some nodular BCC cells presented characteristics of granular keratinocytes, i.e. they were labelled by the anticorneodesmosin antibody. All the clinically recurrent tumors were found to be of the infiltrative aggressive-type. If these aggressive forms of BCC were not identified by specific marker, their topographic patterns of labeling with antibodies directed to cytokeratins allowed them to be distinguished. We suggest that an immunohistochemical analysis with antibodies specific for different stages of keratinocyte differentiation is an efficient complement to histological diagnosis of BCC.

Aged↗

Solitary skin lesions with histopathologic features of early mycosis fungoides.

Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that usually begins with cutaneous patches that evolve into plaques and tumors. A few recent reports describe a solitary variant of MF distinct from localized pagetoid reticulosis, a disease in which solitary verrucous lesions occur on acral skin. Solitary skin lesions with some of the histopathologic features of MF rarely occur during treatment with several drugs, especially antidepressants or antihistamines. We analyzed the clinicopathologic features of 20 patients with solitary skin lesions showing histopathologic features of patch- or early plaque-stage MF. Eight men and 12 women (mean age 50.6, range 23-82, median 49) had solitary, small erythematous patches or plaques located on the trunk (16 cases, 6 of them on the breast), upper extremities (3 cases), and inguinal region (1 case). Ten patients were treated with one or more drugs; only two of them received antidepressants or antihistamines. Histopathologic examination revealed in all cases a band-like infiltrate in the upper dermis, frequently with epidermotropism of solitary lymphocytes. Atypical lymphocytes were present in a minority of cases. Immunohistology showed a predominance of CD3+ T lymphocytes, in most cases admixed with clusters of CD20+ B-cells. Only a small proportion of the infiltrate was CD8+. Molecular analysis of the rearrangement of the T-cell receptor genes was performed in 16 cases using the polymerase chain reaction (PCR) technique and revealed a monoclonal band in 8 of them. After surgical excision, 2/14 patients had a recurrence near the surgical scar. In 18 patients with complete follow-up data, no evidence of "classic" MF could be observed after a mean follow-up of 31.9 months. Solitary skin lesions with the histopathologic features of MF can be considered as a distinct clinicopathologic entity, probably representing a solitary variant of mycosis fungoides.

Adult↗

Endoscopic gastroduodenal polypectomy.

The authors performed a total of 288 successful endoscopic gastroduodenal polypectomy procedures in 129 patients. Drawing on literary data and the results of follow-up of their own patients, they regard endoscopic gastroduodenal polypectomy as a successful and relatively low-risk method for secondary prevention of gastric cancer. Recurrence of adenomas, with malignant degeneration in 6-75%, was noted, only in the first year after primary polypectomy, in 8% of patients. Four percent of patients after adenoma polypectomy developed gastric carcinoma. Removal of gastroduodenal adenomas by endoscopy represents a final therapeutic procedure significantly reducing the possibility of these originally benign variants transforming into malignant ones. Even polyps smaller than 10 mm in diameter may be adenomas possessing a rather high malignant potential. The authors regard endoscopic polypectomy of hyperplastic polyps as a justified procedure since the literary data compiled and their own experience suggest polyp susceptibility to development of dysplasia. While this tendency gets manifest only rarely, it would be medically wrong to dismiss it as negligible. In case of removal of an early polypoid gastric carcinoma, endoscopic polypectomy is a therapeutic procedure only in clearly defined and histologically well classified cases. In other cases involving prominence of the gastroduodenal mucosa, it is an invaluable diagnostic method whose benefit is that it removes an entire polyp for histologic examination.

Adult↗