A heroin addict with asymmetric septal hypertrophy and persistent fungemia with Candida parapsilosis was treated with amphotericin Band flucytosine tosine). The diagnosis of endocarditis was based on ...the subsequent development of a murmur of mitral tation and echocardiographic evidence of prolapse of the posterior leaflet of the mitral valve. Cure was effected with antifungal therapy alone. Thus, when the diagnosis of fungal endocarditis is made early in its course, open-heart surgery may not be needed. To investigate the relative frequency of isolation of parapsilosis from sites, a mycologic survey was conducted in our hospital Among the isolates of yeasts, C parapsilosis reprcsented 8.0, 17.1, and 26.7 percent of those from all cnll nre sites, from contaminated intravenous catheters, and from cultures of blood, respectively. Since this trend to in cases of fungemia was not seen with other yeasts.
Antibody responses after immunization with 23-valent pneumococcal polysaccharide and trivalent influenza virus vaccines were evaluated in 30 adults with hemophilia and in 17 healthy controls. The 30 ...patients with hemophilia included 13 who were human immunodeficiency virus (HIV) antibody positive with acquired immune deficiency syndrome (AIDS) or AIDS-related complex (group 1), 11 who were asymptomatic HIV antibody positive (group 2), and six who were asymptomatic HIV antibody negative (group 3). Sera were obtained before and 4 weeks after immunization, and levels of antibody were measured by enzyme-linked immunoassay or by hemagglutination inhibition assay. All three groups of patients with hemophilia showed significantly higher preimmunization geometric mean titers of antibodies (groups 1 and 2, fivefold, group 3, 2.8-fold higher), with little increase after pneumococcal vaccine, when compared with controls. Defective humoral responses were noted in groups 1 and 2, with depressed antibody responses after influenza vaccine, significantly elevated levels of IgG and IgM, and depressed blastogenic responsiveness to pokeweed mitogen. Group 3 demonstrated normal responses to pokeweed mitogen, normal antibody responses to influenza vaccine, and normal level of IgG and IgM, although levels of IgG and IgM were higher than those of controls. These data suggest that humoral immune abnormalities are found frequently in patients with hemophilia who are HIV antibody positive. Further, prolonged administration of blood products, regardless of the recipient's HIV status, appears to be associated with polyclonal activation of B cells for T-independent but not T-dependent antigens.
To study heterosexual transmission of the human immunodeficiency virus (HIV), 21 HIV antibody-positive hemophiliacs and their 21 spouses-sexual partners were evaluated. None belonged to other AIDS ...risk groups. HIV antibody was detected in four (19 percent) of the female partners. HIV was isolated from peripheral blood lymphocytes of one hemophiliac (4.8 percent), and one female partner (4.8) was antibody-positive. None of the couples engaged in anal intercourse. Compared with HIV antibody-negative female partners, HIV antibody-positive female partners were younger (P< .05), had younger hemophiliac partners (P< .05), and were likely (although not significantly so) to engage in oral sex (P = .08) and to have had more than one sexual partner in the previous 5 years (P = .08). Condoms were used all the time by only eight couples (40 percent), and pregnancy occurred in two other couples (9.5 percent), despite prior counseling. These data confirm the low frequency of heterosexual transmission of HIV from HIV antibody-positive hemophiliacs to their female sexual partners and suggest, moreover, that this may be due to the low rate of HIV infectivity in HIV seropositive hemophiliacs exposed to HIV. Further, these data document the need to design more effective educational programs to prevent heterosexual transmission of HIV.
Fires in waste facilities represent significant potential social, economic and environmental challenges. Although the awareness of fires in waste facilities and their consequences has increased in ...recent years, significant fire safety challenges remain. Fires in waste facilities in Norway and Sweden have been studied to make an overall fire safety assessment and propose measures for increased fire safety. Common ignition causes include self-heating, thermal runaway in batteries, friction, human activity, technical or electrical error and unfavourable combined storage. High-risk wastes include general, residual waste, batteries, electrical and electronics waste, and paper and cardboard. Frequent fires in outdoor storage, increasing indoor storage and new types of waste appear to result in an increased reluctance by insurance companies to work with waste facilities. Measures are suggested for fire safe facility design, operations, waste handling and storage, as well as actions to limit the consequences for the environment and the facility during and after a fire. These actions may prevent fires and minimise the impact of fires that do occur. Increased fire safety at waste facilities may foster a better dialogue between the industry and insurance providers by reducing the potential economic impacts, and limit potential social costs and environmental impacts.
•Qualitative survey of fire safety challenges in waste facilities.•Statistics on fires in waste facilities in Norway and Sweden.•Fire safety assessment, ranking waste fractions from high-risk to low-risk.•Safety measures to be taken before, during and after a fire are recommended.
Anisotropies that underlie organ morphogenesis have been quantified in 2D, taking advantage of a reference axis. However, morphogenesis is a 3D process and it remains a challenge to analyze cell ...polarities in 3D. Here, we have designed a novel procedure that integrates multidisciplinary tools, including image segmentation, statistical analyses, axial clustering and correlation analysis. The result is a sensitive and unbiased assessment of the significant alignment of cell orientations in 3D, compared with a random axial distribution. Taking the mouse heart as a model, we validate the procedure at the fetal stage, when cardiomyocytes are known to be aligned. At the embryonic stage, our study reveals that ventricular cells are already coordinated locally. The centrosome-nucleus axes and the cell division axes are biased in a plane parallel to the outer surface of the heart, with a minor transmural component. We show further alignment of these axes locally in the plane of the heart surface. Our method is generally applicable to other sets of vectors or axes in 3D tissues to map the regions where they show significant alignment.
•Subtle enhanced VWF clearance is present in 20% of patients with low VWF and is associated with an attenuated bleeding phenotype.•In patients with low VWF, there is poor correlation between ...desmopressin fall-off rates and steady-state VWFpp/VWF:Ag ratios.
Increased von Willebrand factor (VWF) clearance plays a key role in the pathogenesis of type 1 and type 2 von Willebrand disease (VWD). However, the pathological mechanisms involved in patients with mild to moderate reductions in plasma VWF:Ag (range, 30-50 IU/dL; low VWF) remain poorly understood. In this study, we investigated the hypothesis that enhanced VWF clearance may contribute to the pathobiology of low VWF. Patients with low VWF were recruited to the LoVIC study after ethics approval and receipt of informed consent. Desmopressin was administered IV in 75 patients, and blood samples were drawn at baseline and at the 1-hour and 4-hour time points. As defined by recent ASH/ISTH/NHF/WFH guidelines, 20% of our low-VWF cohort demonstrated significantly enhanced VWF clearance. Importantly, from a clinical perspective, this enhanced VWF clearance was seen after desmopressin infusion, but did not affect the steady-state VWF propeptide (VWFpp)-to-VWF antigen (VWF:Ag) ratio (VWFpp/VWF:Ag) in most cases. The discrepancy between the VWFpp/VWF:Ag ratio and desmopressin fall-off rates in patients with mild quantitative VWD may have reflected alteration in VWFpp clearance kinetics. Finally, bleeding scores were significantly lower in patients with low VWF with enhanced VWF clearance, compared with those in whom reduced VWF biosynthesis represented the principle pathogenic mechanism. This trial was registered at http://www.clinicaltrials.gov as #NCT03167320.
Confocal fluorescence microscopy has become a standard tool to image thick 3D tissue samples, permitting the observation of cell behaviour, such as cell division within developing organs. However, ...robust and automatic extraction of nuclear shape and mitotic orientation may be hindered by a highly cluttered environment as for example in mammalian tissues. We propose a fast and automated framework for the segmentation of nuclei from cluttered 3D images, allowing robust quantification of various parameters such as number of cells, number of mitoses and mitotic orientation. We have applied this framework to scans of the developing mouse heart, and manual validation on three independent experiments indicates a detection rate of 93% in all cases. Moreover, the proposed tool permits fast, real-time 3D rendering of the data set during the analysis, and can be easily adapted to other applications related to dense tissue analysis.
A 1986 survey of seven hemophilia treatment centers in Pennsylvania (PA) has revealed that 22 hemophiliacs residing in PA have developed the acquired immunodeficiency syndrome (AIDS), representing ...9.2% of the total 238 United States hemophiliac AIDS cases. These 22 included ten (45.5%) from western PA (W-PA), eleven (50.0%) from central PA (C-Pα), and one (0.5%) from eastern PA (E-PA). The HIV antibody prevalence for these three geographic groups is comparable, with 84 of 178 (47.2%) of hemophiliacs in W-PA seropositive, 102 of 182 (56.0%) in C-PA seropositive, and 105 of 177 (59.3%) in ϵ-PA seropositive. Blood product usage for these three areas is comparable: 47.8 × 103 (W-PA) v43.9 (C-Pα) ν 53.3 (ϵ-PA) units factor VIII concentrate per patient per year; 36.5 ν 24.5 ν 33.7 for factor IX concentrate; 8.4 ν 4.7 ν 7.7 for cryoprecipitate; and 1.3 ν 2.7 v 1.0 for fresh frozen plasma, respectively. These data demonstrate a geographic variation in hemophilia AIDS incidence in PA, with a tenfold higher incidence in W-PA and C-Pα than ϵ-PA, which is unrelated to differences in HIV antibody prevalence, patient blood product usage, or inaccuracies in AIDS case reporting. Because of the ≥5 year median latency between HIV infection and development of AIDS, the AIDS incidence will continue to change, but other factors appear to be operative in the development of AIDS in hemophiliacs.
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