ICF syndrome: high variability of the chromosomal phenotype and association with classical Hodgkin lymphoma.

We report on two sibs with ICF syndrome (immunodeficiency, centromeric heterochromatin instability, and facial anomalies) diagnosed in the elder brother based on the typical chromosomal abnormalities present in 56% of metaphases from cultured lymphocytes. In a previous cytogenetic analysis this diagnosis had been missed due to low manifestation of the ICF chromosomal phenotype. Hypomethylation of classical satellites 2 and 3, and of alpha-satellite DNA was shown in the lymphocytes of the younger sister. At 7 years of age the boy presented with hemiplegia due to tumerous invasion of the right brachial plexus. Histopathology revealed classical Hodgkin lymphoma, a neoplasia which might have been facilitated by the underlying genetic defect.

Distinct features of chronic rhinosinusitis with and without nasal polyps.

BACKGROUND: Based on the presence of nasal polyps on endoscopy, chronic rhinosinusitis (CRS) may be clinically divided in CRS with nasal polyps and CRS without nasal polyps. It is unclear, whether CRS with nasal polyps and CRS without nasal polyps represent different disease entities or just different stages of one single disease. In case of one disease, only minor histopathological differences between CRS with small early-stage polyps (CRSNP((+))) and CRS without nasal polyps (CRSNP(-)) were expected. METHODS: Patients with CRSNP((+)) confined to the infundibular region or CRSNP(-) were selected. Histochemical and immunohistochemical characterization of ethmoidal mucosa was performed on formalin-fixed and paraffin-embedded tissue specimens. Frequency and distribution of eosinophils, neutrophils, mast cells, IgE(+) cells, macrophages, B- and T-cell subsets, natural killer cells, plasma cells and goblet cells were assessed. In addition, the thickness of the basal membrane was evaluated. RESULTS: Nine CRS patients without detectable polyps, and 11 patients with small early-stage polyps confined to the infundibular region were selected. Despite adjacent polyp stage, the amount of round cell infiltration (P < 0.05), number of eosinophils (P < 0.05), and plasma cells (P < 0.01) significantly differed in the ethmoidal specimens from patients of the two groups. CONCLUSION: Substantial histopathological differences were observed in ethmoidal mucosa of CRSNP((+)) and CRSNP(-) patients. Thus, the results of this investigation support the concept that CRS with nasal polyps and CRS without nasal polyps are two different disease entities rather than different stages of one single disease, but may also be interpreted as a higher degree of inflammation.

Microfluorimetric analysis of a purinergic receptor (P2X7) in GH4C1 rat pituitary cells: effects of a bioactive substance produced by Pfiesteria piscicida.

Pfiesteria piscicida Steidinger & Burkholder is a toxic dinoflagellate that leads to fish and human toxicity. It produces a bioactive substance that leads to cytotoxicity of GH4C1 rat pituitary cells. Extracellular adenosine 5'-triphosphate (ATP) acting on P2X7 purinergic receptors induces the formation of a nonselective cation channel, causing elevation of the cytosolic free calcium followed by a characteristic permeabilization of the cell to progressively larger ions and subsequent cell lysis. We investigated whether GH4C1 rat pituitary cells express functional P2X7 receptors, and if so, are they activated by a bioactive substance isolated from toxic P. piscicida cultures. We tested the selective agonist 2'-3'-O-(benzoyl-4-benzoyl)-ATP (BzATP) and antagonists piridoxalphosphate-6-azophenyl-2'-4'-disulfonic acid (PPADS) and oxidized-ATP (oxATP) using elevated cytosolic free calcium in Fura-2 loaded cells, and induced permeability of these cells to the fluorescent dye YO-PRO-1 as end points. We demonstrated that in GH4C1 cells, BzATP induces both the elevation of cytosolic free calcium and the permeabilization of the cell membrane. ATP-induced membrane permeabilization was inhibited by PPADS reversibly and by oxATP irreversibly. The putative Pfiesteria toxin (pPfTx) also elevated cytosolic free calcium in Fura-2 in GH4C1 cells and increased the permeability to YO-PRO-1 in a manner inhibited fully by oxATP. This study indicates that GH4C1 cells express a purinoceptor with characteristics consistent with the P2X7 subtype, and that pPfTx mimics the kinetics of cell permeabilization by ATP.

Current progress in isolation and characterization of toxins isolated from Pfiesteria piscicida.

The isolation and partial purification of toxic substances derived from Pfiesteria piscicida Steidinger & Burkholder extracts is described. Four distinct bioassay systems were used to monitor bioactivity of the P. piscicida extracts, including a high throughput cell cytotoxicity assay and a reporter gene assay as well as assays using brine shrimp and fish. Using these bioassays to guide fractionation, we have isolated two distinct, active fractions from Pfiesteria culture medium and cell mass extracts on the basis of their solubility characteristics. We have identified and characterized a bioactive lipophilic substance from Pfiesteria-derived extracts as di(2-ethylhexyl)phthalate, a commonly used plasticizer. The source of this typically man-made substance has been identified as originating from Instant Ocean (Aquarium Systems, Mentor, OH, USA), a commercially available seawater salt mixture used to prepare our mass culture growth medium. We have developed chromatographic methodology to isolate a bioactive polar compound isolated from extracts of Pfiesteria culture and presently report the characterization of the activity of this substance. The molecular structural analysis of the polar active component(s) using mass spectrometry and nuclear magnetic resonance spectroscopy is currently under way.

Biomonitoring brevetoxin exposure in mammals using blood collection cards.

A method has been tested in laboratory mice to monitor for the presence of brevetoxins in blood after exposure. The use of blood collection cards is an adaptation of a method employed for routine diagnostic and genetic testing of newborns. Blood is collected and applied to a 0.5-inch diameter circle on a specially prepared blood collection card and allowed to dry. The blood spots are then extracted and the presence of toxin activity is first screened using a high throughput receptor binding assay. Positive samples are then examined for specific brevetoxin congeners by liquid chromatography-tandem mass spectrometry. Preliminary experiments tested the efficiency and linearity of toxin extraction from blood spiked with brevetoxin-3 (PbTx-3). Blood from treated mice was tested for the presence of brevetoxin at different times following exposure to a sublethal dose (180 microg/kg PbTx-3). Brevetoxin activity determined by receptor assay increased to 25 +/- 7.4 nM PbTx-3 equivalents within 4 hr after exposure and was still detectable in three of four animals 24 hr after exposure. Tandem mass spectrometry provided confirmation of PbTx-3, which also increased for the time points between 0.5 and 4.0 hr exposure. However, PbTx-3 was not detected at 24 hr, which suggested the formation of a biologically active metabolite. We anticipate that this approach will provide a method to biomonitor brevetoxins in living marine resources (e.g., finfish), protected species, and humans.

Identification of a P2X7 receptor in GH(4)C(1) rat pituitary cells: a potential target for a bioactive substance produced by Pfiesteria piscicida.

We examined the pharmacologic activity of a putative toxin (pPfTx) produced by Pfiesteria piscicida by characterizing the signaling pathways that induce the c-fos luciferase construct in GH(4)C(1) rat pituitary cells. Adenosine-5'-triphosphate (ATP) was determined to increase and, at higher concentrations, decrease luciferase activity in GH(4)C(1) rat pituitary cells that stably express c-fos luciferase. The inhibition of luciferase results from cytotoxicity, characteristic of the putative P. piscicida toxin (pPfTx). The actions of both pPfTx and ATP to induce c-fos luciferase were inhibited by the purinogenic receptor antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulfonic acid (PPADS). Further characterization of a P2X receptor on the GH(4)C(1) cell was determined by the analog selectivity of P2X agonists. The P2X1/P2X3 agonist alpha,beta-methylene ATP (alpha,beta-MeATP) failed to increase or decrease c-fos luciferase. However, the P2X7 agonist 2',3'-(4-benzoyl)benzoyl ATP (BzATP), which had a predominant cytotoxic effect, was more potent than ATP. Immunoblot analysis of GH(4)C(1) cell membranes confirmed the presence of a 70-kDa protein that was immunoreactive to an antibody directed against the carboxy-terminal domain unique to the P2X7 receptor. The P2X7 irreversible antagonist oxidized-ATP (oxATP) inhibited the action of ATP, BzATP, and pPfTx. These findings indicate that GH(4)C(1) cells express purinogenic receptors with selectivity consistent with the P2X7 subtype and that this receptor pathway mediates the induction of the c-fos luciferase reporter gene by ATP and the putative Pfiesteria toxin

Mortality of sea lions along the central California coast linked to a toxic diatom bloom.

Over 400 California sea lions (Zalophus californianus) died and many others displayed signs of neurological dysfunction along the central California coast during May and June 1998. A bloom of Pseudo-nitzschia australis (diatom) was observed in the Monterey Bay region during the same period. This bloom was associated with production of domoic acid (DA), a neurotoxin that was also detected in planktivorous fish, including the northern anchovy (Engraulis mordax), and in sea lion body fluids. These and other concurrent observations demonstrate the trophic transfer of DA resulting in marine mammal mortality. In contrast to fish, blue mussels (Mytilus edulus) collected during the DA outbreak contained no DA or only trace amounts. Such findings reveal that monitoring of mussel toxicity alone does not necessarily provide adequate warning of DA entering the food web at levels sufficient to harm marine wildlife and perhaps humans.

Reporter gene assay for fish-killing activity produced by Pfiesteria piscicida.

Collaborative studies were performed to develop a functional assay for fish-killing activity produced by Pfiesteria piscicida. Eight cell lines were used to screen organic fractions and residual water fraction by using a 3-[4, 5-dimethylthiazol-(2-4)]-diphenyltetrazolium bromide cytotoxicity assay. Diethyl ether and a residual water fraction were cytotoxic to several cell lines including rat pituitary (GH(4)C(1)) cells. Residual water as well as preextracted culture water containing P. piscicida cells induced c-fos-luciferase expressed in GH(4)C(1) cells with a rapid time course of induction and sensitive detection. The reporter gene assay detected activity in toxic isolates of P. piscicida from several North Carolina estuaries in 1997 and 1998 and may also be suitable for detecting toxic activity in human and animal serum.

Detection of domoic acid in northern anchovies and California sea lions associated with an unusual mortality event.

The occurrence of an unusual mortality event involving California sea lions (Zalophus californianus) along the central California coast in May 1998 was recently reported. The potent neurotoxin domoic acid (DA), produced naturally by the diatom Pseudo-nitzschia australis and transmitted to the sea lions via planktivorous northern anchovies (Engraulis mordax), was identified as the probable causative agent. Details of DA analyses for anchovy tissues and sea lion feces are described. Domoic acid levels were estimated in anchovy samples by HPLC-UV, and in sea lion feces using the same method as well as a microplate receptor binding assay, with absolute confirmation by tandem mass spectrometry. The highest DA concentrations in anchovies occurred in the viscera (223 +/- 5 microg DA g(-1)), exceeding values in the body tissues by seven-fold and suggesting minimal bioaccumulation of DA in anchovy tissue. HPLC values for DA in sea lion fecal material (ranging from 152 to 136.5 microg DA g(-1)) required correction for interference from an unidentified compound. Inter-laboratory comparisons of HPLC data showed close quantitative agreement. Fecal DA activity determined using the receptor binding assay corresponded with HPLC values to within a factor of two. Finally, our detection of P. australis frustules, via scanning electron microscopy, in both anchovy viscera and fecal material from sea lions exhibiting seizures provides corroborating evidence that this toxic algal species was involved in this unusual sea lion mortality event.

Okadaic acid production from the marine dinoflagellate Prorocentrum belizeanum Faust isolated from the Belizean coral reef ecosystem.

A species of epiphytic Prorocentrum (Dinophyta, Prorocentrales, collected from the macroalga Dictyota dichotoma, was brought into culture. Based on morphological characteristics, this isolate was identified as Prorocentrum belizeanum. Analysis of the culture extract using high-performance liquid chromatography and liquid chromatography-mass spectrometry indicated the production of okadaic acid, a toxic polyether linked with the human diseases, diarrhetic shellfish poisoning and ciguatera fish poisoning.

Neuroexcitatory actions of ciguatoxin on brain regions associated with thermoregulation.

We have investigated the action of ciguatoxin (CTX) in the mouse following i.p. administration. CTX (0.5 mouse units) induced a rapid (10-20 min) decrease in body temperature that persisted for several hours. This corresponded closely with a neuroexcitatory action of ciguatoxin on c-fos mRNA in the brain. We identified the neuronal pathways activated by CTX action in the mouse brain by immunostaining of c-fos translational product, a biomarker for neuroexcitability. c-fos-like immunoreactivity was prominent in the hypothalamus, including the medial preoptic and supraoptic nuclei. Immunostaining was also evident in certain regions of the brain stem, including the locus coeruleus, dorsolateral parabranchial nucleus, area postrema and the nucleus of the solitary tract. These studies indicate that CTX has neuroexcitatory actions on brain stem regions receiving vagal afferents and ascending pathways associated with visceral and thermoregulatory responses.

[Osteoradionecrosis. A review of the literature]. / L'ostéoradionécrose. Une revue de la littérature.

Osteoradionecrosis is a severe complication of radiotherapy characterized by the following sequence: radiation, trauma, bone exposure. The radiation reduces the vascularization potential of the tissues which leads to a hypoxic state that jeopardizes cellular activity and collagen formation. The diagnosis of osteoradionecrosis relies on the clinical examination of chronically exposed bone. Although this type of lesion is not limited to the jaws, the ratio between mandible and maxilla is 24:1. The severity of the lesion is a function of the radiation dosage. The main etiological factors of osteoradionecrosis are related to dental and periodontal pathology as well as to tooth extraction performed after, during or shortly before radiotherapy. Edentulous patients are less exposed to osteoradionecrosis than dentulous patients. Local treatment and antibiotic therapy are initially performed in mild cases. Surgical measures with hemiresection or block resection are indicated depending on the severity of the lesion. Some authors regard hyperbaric oxygen treatment as an efficient therapeutic and preventive technique. Prevention is of major concern. It requires a careful evaluation of soft and hard tissues of the oral cavity as well as the organization of an intensive prophylaxis program. Patient compliance is a prerequisite. This article is a literature review on osteoradionecrosis with its symptoms, incidence, pathogenesis, treatment and prevention.

Development of rapid and sensitive high throughput pharmacologic assays for marine phycotoxins.

The lack of rapid, high throughput assays is a major obstacle to many aspects of research on marine phycotoxins. Here we describe the application of microplate scintillation technology to develop high throughput assays for several classes of marine phycotoxin based on their differential pharmacologic actions. High throughput "drug discovery" format microplate receptor binding assays developed for brevetoxins/ciguatoxins and for domoic acid are described. Analysis for brevetoxins/ciguatoxins is carried out by binding competition with [3H] PbTx-3 for site 5 on the voltage dependent sodium channel in rat brain synaptosomes. Analysis of domoic acid is based on binding competition with [3H] kainic acid for the kainate/quisqualate glutamate receptor using frog brain synaptosomes. In addition, a high throughput microplate 45Ca flux assay for determination of maitotoxins is described. These microplate assays can be completed within 3 hours, have sensitivities of less than 1 ng, and can analyze dozens of samples simultaneously. The assays have been demonstrated to be useful for assessing algal toxicity and for assay-guided purification of toxins, and are applicable to the detection of biotoxins in seafood.

Mediastinal Clear Cell Lymphoma-A Distinct Entity of B-Cell Derived Lymphoma as Shown by Immunotyping and Analysis of Gene Rearrangements.

Mediastinal clear cell lymphoma (MCCL) is regarded as a distinct subtype of Non-Hodgkin's-lymphoma. We have analyzed gene rearrangements of eight cases of newly diagnosed MCCL in order to verify their alignment to the B-cell lineage as suggested by immunotyping. The lymphoma cells shared a common immunophenotype which consisted of CD10-, CD19+, CD20+, and CD21-. Rearrangements of the heavy chain of the immunoglobulin gene were found in all eight cases studied. In contrast, the beta chain of the T-cell antigen receptor gene was not rearranged. No rearrangements of the kappa light chain gene were detected. There was no evidence for a t(14;18) or a t(8;14). In conclusion, MCCL seems to be a B-cell derived tumor, which is distinct from other known lymphomas both by its immunophenotype and genotype.

Two toxic kaurene glycosides from the burrs of Xanthium pungens.

Two H2O-soluble toxic kaurene glycosides 3 and 4 responsible in part for the poisonous properties of the burr of Xanthium pungens have been isolated and identified. The structures of the compounds were elucidated using high resolution 2D nmr and mass spectral techniques.

Antifeedant activity againstSpodoptera litera larvae and [(13)C]NMR spectral assignments of the meliatoxins.

The tetranortriterpene, meliatoxin A2, induced a significant level of antifeedant activity inSpodoptera litura F. larvae, while meliatoxin B1, which lacks the ring D epoxide, was much less active. Complete [(13)C]NMR assignments for both compounds derived from homo- and heteronuclear short- and long-range couplings are given.

Fieldwork experience, Part I: Impact on practice preference.

Occupational therapy students and student supervisors in 65 fieldwork centers nationwide responded to a survey designed a) to appraise the relative value of the fieldwork experience in the occupational therapist's professional development and b) to identify the elements perceived as being essential to a good fieldwork experience. Three stages of professional development were examined: the preprofessional, the academic, and the fieldwork experience. Results suggest that the fieldwork experience stage has the greatest impact on the development of a therapist's preference for a specific area of clinical practice. This article discusses the primary influences in the three stages that contribute to this preference formation.

Fieldwork experience, Part II: The supervisor's dilemma.

This paper examines the distinguishing characteristics of the effective and the ineffective supervisor and the role, responsibilities, problems, and current needs of the occupational therapy student supervisor. Data were obtained through questionnaires received from 188 therapists and 127 students in 65 fieldwork centers nationwide. Responses indicate a perceived lack of adequate preparation of occupational therapists for the role of student supervisor and provide evidence that the profession needs to assume a more active role in providing formal, standardized training programs for the occupational therapy student supervisor. The results demonstrate a need for greater accountability for the quality of the fieldwork experience and the supervisory process guiding that experience.