A 16-year multi-institutional study of the role of age and EBV status on PTLD incidence among pediatric heart transplant recipients.

The objective was to determine the incidence and hazard for posttransplant lymphoproliferative disease (PTLD) in a study of 3170 pediatric primary heart transplants between 1993 and 2009 at 35 institutions in the Pediatric Heart Transplant Study. 147 of 151 reported malignancy events were classified as PTLD. Overall freedom from PTLD was 98.5% at 1 year, 94% at 5 years and 90% at 10 years. Freedom from PTLD was lowest in children (ages 1 to < 10 years) versus infants (<1 year) and adolescents (10 to < 18 years) with children at highest risk for PTLD with a relative risk of 2.4 compared to infants and 1.7 compared to adolescents. Positive donor EBV status was a strong risk factor for PTLD in the seronegative recipient, but risk magnitude was dependent on recipient age at the time of transplantation. Nearly 25% of EBV seronegative recipients of EBV+ donors at ages 4-7 at transplantation developed some form of PTLD. The overall risk for PTLD declined in the most recent transplant era (2001-2009, p = 0.003). These findings indicate that EBV status and the age of the recipient at the time of transplantation are important variables in the development of PTLD in the pediatric heart transplant recipient.

Increased incidence and mortality associated with skin cancers after cardiac transplant.

Skin cancer incidence has been shown to be increased in the context of transplant-associated immunosuppression. There is, however, limited information specifically about the incidence of skin cancer after cardiac transplantation in the United States. A 10-year retrospective cohort study of 6271 heart transplants at 32 US transplant centers revealed increased postprocedure incidence of nonmelanoma and melanoma skin cancers, especially cutaneous squamous cell carcinoma, for which the incidence increased from 4- to 30-fold compared to the age and gender equivalent general population. Incidence of skin cancer in this study was consistent with prior single-center data regarding cardiac transplant patients. Comparison of all-cause mortality statistics for patients with basal cell carcinoma, squamous cell carcinoma and melanoma, respectively, demonstrated increased mortality associated with melanoma. Skin cancer screening and prophylaxis may be of some utility in reducing morbidity and mortality in cardiac transplant patients.

Controlled synthesis of core-shell iron-silica nanoparticles and their magneto-dielectric properties in polymer composites.

Low loss core-shell iron-silica nanocomposites with improved magneto-dielectric properties at radio frequencies (1 MHz-1 GHz) were successfully fabricated. A new simple method was developed to synthesize metallic iron (Fe) nanoparticles with uniform size distribution in an aqueous environment at room temperature. Citric acid and oleic acid served as surface-capping agents to control the particle size of the synthesized Fe nanoparticles. Smaller Fe nanoparticles with narrower particle size distribution were obtained as the concentration ratio of iron ions to carboxylic acid groups decreased. The Fe nanoparticles were subsequently coated with silica (SiO(2)) layers to prevent the iron cores oxidizing. Polymer composites were prepared by incorporating Fe@SiO(2) nanoparticles with polydimethylsiloxane (PDMS) elastomers. Experimental results showed that the dielectric permittivity (ε) and magnetic permeability (µ) of the polymer composite increased with increasing amount of Fe@SiO(2) nanoparticle doping. The dielectric loss (tanδ) was near 0.020 at a frequency of 1 GHz.

Lyme disease in California: a novel enzootic transmission cycle of Borrelia burgdorferi.

Knowledge of zoonotic transmission cycles is essential for the development of effective strategies for disease prevention. The enzootiology of Lyme disease in California differs fundamentally from that reported from the eastern United States. Woodrats, not mice, serve as reservoir hosts, and Ixodes neotomae, a nonhuman-biting tick, maintains the agent of Lyme disease, Borrelia burgdorferi, in enzootic cycles. The western black-legged tick, Ixodes pacificus, is the primary vector to humans, but it appears to be an inefficient maintenance vector. Isolates of B. burgdorferi from California exhibit considerable antigenic heterogeneity, and some isolates differ strikingly from isolates recovered from this and other geographic regions.

Spatial analysis of the exposure of dogs in rural north-coastal California to vectorborne pathogens.

Between 0 and 50 per cent of the dogs in eight rural villages in far northern California with a high risk of tickborne diseases were seropositive for Anaplasma phagocytophilum and Bartonella vinsonii subspecies berkhoffii, and between 0 and 10 per cent were seropositive for Borrelia burgdorferi. The odds ratio for the co-exposure of individual dogs to B vinsonii berkhoffii and A phagocytophilum was 18.2. None of the diseases was associated with the sex of the dogs, whether they slept out of doors, or whether tick-preventive measures were taken. When the villages were assessed for landscape risk factors, a particularly high seroprevalence for B vinsonii berkhoffii and A phagocytophilum was observed in a village at a relatively high altitude and greater distance from the Pacific coast, and montane hardwood conifer woodland was most associated with a high seroprevalence for these two pathogens.

Sylvatic maintenance of Borrelia burgdorferi (Spirochaetales) in Northern California: untangling the web of transmission.

Lyme borreliosis is associated with several genospecies of Borrelia burgdorferi sensu lato (s.l.) (Spirochaetales), but human disease has been associated only with Borrelia burgdorferi sensu stricto (s.s.) Johnson, Schmid, Hyde, Steigerwalt & Brenner in the western United States. Restriction fragment length polymorphism (RFLP) analysis of rrf-rrl amplicons from 124 tick and mammalian isolates from various habitats yielded 13 RFLP patterns. Of these patterns, six were patterns previously associated either with Borrelia bissettii Postic, Marti Ras, Lane, Hendson & Baranton or Borrelia burgdorferi s.s., and the remaining seven patterns belonged to diverse and previously uncharacterized Borrelia spp. Uncharacterized Borrelia spp. were cultured most frequently from Ixodes spinipalpis Hadwen & Nuttall and California kangaroo rats, Dipodomys californicus Merriam, inhabiting grasslands, and B. bissettii from I. spinipalpis and dusky-footed woodrats, Neotoma fuscipes Baird, associated with oak woodlands or chaparral. B. burgdorferi s.s. typically was isolated from host-seeking Ixodes pacificus Cooley & Kohls collected in dense oak woodlands, woodland-grass, or redwood forests. Although some isolates of B. burgdorferi s.s. were cultured from woodrats, there was no clear association of this human pathogen with any vertebrate host. These findings, along with recent evidence indicating that the western gray squirrel, Sciurus griseus Ord, may be an important reservoir of B. burgdorferi s.s. in Californian oak woodlands, suggest that our earlier hypothesis implicating an enzootic cycle involving woodrats and I. spinipalpis is insufficient to account for observed patterns of infection in nature.

To induce or not to induce: do patients at greatest risk for fatal rejection benefit from cytolytic induction therapy?

BACKGROUND: Induction immunosuppression utilizing lymphocytolytic agents in the early peri-operative period has a number of theoretical and practical advantages and disadvantages. However, the efficacy of cytolytic agents as induction therapy remains unproven. METHODS: To assess the current impact of induction therapy in heart transplantation, we queried a multi-institutional database regarding the frequency of use, type of agent, duration of therapy and outcomes of 6,553 patients transplanted from 1990 to 2001. A study group of 5,897 patients were identified who survived the first 48 hours post-transplant and received either no induction therapy (n = 4,161) or induction with OKT3 or anti-thymocyte preparations (n = 1,736). RESULTS: By multivariate analysis, risk factors for rejection death were identified and then applied to a model of overall mortality. Among patients with a 1-year risk of rejection death at >5%, induction therapy provided a survival advantage, but survival with induction was decreased when the risk of rejection death was <2%. Specific patient sub-sets that received a survival benefit in the current era with induction included younger patients of black race with >/=4 HLA mismatches and long-term (>6 months) support on a ventricular assist device (VAD). CONCLUSIONS: Use and application of induction therapy continues to be controversial in heart transplantation. At present, this approach appears to be beneficial in selected patients who are at high risk for rejection death, but likely detrimental in patients who are at low risk for rejection death. Those with a combination of longer term VAD support, of black ethnicity, and having extensive HLA mismatching are most likely to benefit from cytolytic induction therapy.

Reservoir competence of four chaparral-dwelling rodents for Borrelia burgdorferi in California.

Aspects of the reservoir competence of four rodents for the Lyme disease spirochete, Borrelia burgdorferi, were evaluated in California. Rodents were live-trapped and ear-punch biopsies were cultured during each season. A second set of biopsies was cultured from representative individuals after 2-3 weeks of captivity and the results of culturing biopsies taken on both dates were compared with the results of feeding Ixodes pacificus larvae on hosts xenodiagnostically. The prevalence of infections did not differ significantly between dusky-footed woodrats (Neotoma fuscipes) and California kangaroo rats (Dipodomys californicus) nor among seasons. Combined results of the three tests showed that 85.7% of dusky-footed woodrats (n = 21) and 78.6% of California kangaroo rats (n = 14) were infected with B. burgdorferi. In contrast, only 22.2% of brush mice (Peromyscus boylii) (n = 14) and 7.1% of pinyon mice (P. truei) (n = 9) were infected. The sensitivity of culturing ear-punch biopsies as an assay for borrelial infection was significantly greater when biopsies were taken after a short period of captivity (0.89) rather than on the day of capture (0.52). Tick xenodiagnosis, in which I. pacificus was used as the vector, revealed borrelial infections in 90.3% of infected rodents. Spirochetes were observed in 37.7% of 239, 45.2% of 155, 60.0% of 10, and 7.1% of 14 cultures of nymphal I. pacificus fed as larvae on naturally infected woodrats, kangaroo rats, brush mice, and a pinyon mouse, respectively. The mean prevalence of infection in xenodiagnostic ticks varied significantly among host species with a greater proportion of ticks infected while feeding on woodrats and kangaroo rats than on mice. This study reconfirms previous reports that implicated woodrats and kangaroo rats as reservoirs of B. burgdorferi in California.

Considerations in selection and management of patients undergoing valve replacement with glutaraldehyde-fixed porcine bioprotheses.

From November, 1973, through June, 1978, 428 operations in 425 patients were performed for replacement of aortic, mitral, or aortic plus mitral valves, utilizing 277 Hancock and 180 Carpentier-Edwards bioprostheses. Actuarially determined survival at 36 months was similar for all three groups and compared favorably with our experience with the Björk-Shiley prosthesis. Certain patient-related variables influencing late survival were identified by multivariate analysis and included previous operation for congenital heart disease, coronary artery bypass grafting in nonaortic valve replacement, race (black), age at operation, and New York Heart Association Functional Class. A small but definite incidence of thromboembolism occurred in all three groups, again similar to our experience with the Björk-Shiley prosthesis. Multivariate analysis identified four factors influencing risk of thromboembolism: previous cardiac operation, age, double-valve replacement, and rhythm at discharge. Valve degeneraation occurred, primarily in children and young adults. Over the medium term, the porcine bioprosthesis compared favorably with mechanical prostheses in terms of survival, function, and thromboembolism. Certain patient-related variables affecting survival may be modified by earlier surgical intervention.

Dendritic growth of DAPI-accumulating amacrine cells in the retina of the goldfish.

The dendritic growth of amacrine cells was studied in the retina of the goldfish. Those cells that accumulated the intraocularly injected fluorescent dye 4,6-diamidino-2-phenylindole (DAPI) were compared in retinal wholemounts from small and large animals. Dendritic arbors were stained by intracellular injections of Lucifer yellow. Based upon their dendritic morphology, two types were identified, radiate and fusiform. The dendritic field areas and the number of dendritic terminals were quantitatively compared for cells in small retinas from young fish and large retinas from old fish in the region of the retina that grows by expansion. For both cell types the dendritic fields were significantly larger in the large retinas. The radiate cells had the same number of dendritic terminals in retinas of both sizes, where the fusiform cells in the large retinas had significantly more dendritic terminals than those in the small retinas. This resulted from the addition of new dendrites to the proximal arbor. These data show that with retinal expansion the pattern of dendritic growth by a amacrine cells is cell-type specific.

Wood rats and kangaroo rats: potential reservoirs of the Lyme disease spirochete in California.

The etiologic agent of Lyme disease, Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner, was isolated repeatedly from dusky-footed wood rats, Neotoma fuscipes Baird, and California kangaroo rats, Dipodomys californicus Merriam, in northern California. All animals were collected in a region endemic for Lyme disease but for which the natural reservoir of B. burgdorferi was unknown. Similar attempts to isolate spirochetes from lizards, other species of rodents, jack rabbits, and deer between 1987 and 1991 were unsuccessful. Spirochetes isolated from wood rats and kangaroo rats were antigenically similar to strains of B. burgdorferi that had been isolated previously from the western black-legged tick, Ixodes pacificus Cooley & Kohls, in California. Similar enzootic cycles involving wood rats or kangaroo rats should be sought in other regions of the United States where the reservoirs of this spirochete are unknown.

Vector competence of Ixodes pacificus and Dermacentor occidentalis (Acari: Ixodidae) for various isolates of Lyme disease spirochetes.

The vector competence of the western black-legged tick, Ixodes pacificus Cooley & Kohls, and the Pacific Coast tick, Dermacentor occidentalis Marx, for the Lyme disease spirochete (Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner) was compared. Rabbits, hamsters, and the deer mouse, Peromyscus maniculatus (Wagner), were injected with cultured spirochetes or infected tick-suspensions, or were fed upon by spirochete-infected ticks. Five of seven isolates used as inocula were reisolated from vertebrates with the ear-punch biopsy technique. Three isolates (CA4, 5, 7) that were infectious for both vertebrates and ticks possessed prominent low-molecular-weight protein bands that had relative mobilities of approximately 24-26 kd. The ability of ticks to acquire and maintain various inocula of B. burgdorferi was evaluated by feeding uninfected larvae xenodiagnostically on all three hosts 0-63 d postinjection. Low percentages (0-10.6%) of the I. pacificus and none of the D. occidentalis became infected. By contrast, 33% of I. pacificus and 40% of Ixodes scapularis Say (= I. dammini Spielman, Clifford, Piesman & Corwin) that fed on hamsters infected by tick-bite acquired and transstadially passed spirochetes; 10% of D. occidentalis fed on infected hamsters similarly acquired but did not maintain spirochetes. Ixodes pacificus nymphs efficiently transmitted B. burgdorferi to deer mice and a hamster. Feeding by one spirochete-infected nymph was sufficient to produce patent infections in each of five mice.

Ixodes (Ixodes) jellisoni and I. (I.) neotomae (Acari:Ixodidae): descriptions of the immature stages from California.

Nymphal and larval stages of Ixodes (Ixodes) jellisoni Cooley & Kohls and I. (I.) neotomae Cooley are described for the first time. These 2 tick species occur only in the western United States, predominantly in California. The primary host for I. jellisoni is the California kangaroo rat, Dipodomys californicus (Merriam); that for I. neotomae is the dusky-footed woodrat, Neotoma fuscipes Baird. The etiologic agent of Lyme disease Borrelia burgdorferi Johnson, Schmidt, Hyde, Steigerwalt & Brenner has recently been isolated from both tick species, and I. neotomae was proven a competent enzootic vector of the Lyme disease spirochete.

First isolation of Borrelia burgdorferi in southern California.

The Lyme disease spirochete, Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner, was isolated from the blood of a dusky-footed wood rat, Neotoma fuscipes Baird, in the San Bernardino Mountains of southern California. Antigenic, protein, and molecular analyses demonstrated that the isolate varied slightly from most isolates of B. burgdorferi from northern California and was clearly distinct from other species of Borrelia that are endemic to the state. This is the first reported isolate of B. burgdorferi from southern California and demonstrates that the Lyme disease spirochete is enzootic in mountains near the major human population center of the state.

Antigenic characterization of Psoroptes spp. (Acari: Psoroptidae) mites from different hosts.

Immunoblotting with defined antigens and antisera revealed extensive and nearly complete antigenic cross-reactivity between Psoroptes spp. mites from a bighorn sheep, a mule deer, a cow, and a rabbit. Antigenic differences were not detected between mites from the sympatric bighorn sheep and mule deer. However, minor antigenic differences between mites from the cow and rabbit suggested that these mites were distinct from each other, as well as from the mites from the bighorn sheep and mule deer. These results are consistent with earlier morphologic studies of these populations of mites and provide additional support for the hypothesis that putative populations and/or species of Psoroptes mites may not be reproductively or ecologically isolated, particularly when their hosts are sympatric.

Natural and experimental Borrelia burgdorferi infections in woodrats and deer mice from California.

Sequestration of spirochetes and concurrent histopathologic lesions were evaluated in tissues of Borrelia burgdorferi-infected dusky-footed woodrats (Neotoma fuscipes) and deer mice (Peromyscus maniculatus). Rodents were either wild-caught and naturally infected or were experimentally infected by tick bite, by intramuscular (i.m.) injection of cultured spirochetes, or by i.m. injection of tick suspensions. Samples of host tissues, including skin, blood, ear, brain, eye, heart, lung, liver, spleen, kidney, and urinary bladder, were removed from up to 21 woodrats and four deer mice and cultured in BSK II medium. Borreliae-positive cultures of ear punch biopsies were obtained from 10 of 11 woodrats and from all of four deer mice. Additionally, positive cultures were obtained from three of 36 skin biopsies of woodrats, and from one of 36 cultures of woodrat blood. In contrast, spirochetes were not observed in 505 cultures of internal organs or whole blood. Samples of tissues from seven naturally infected woodrats, four experimentally infected woodrats, and nine experimentally infected deer mice also were examined for histopathologic lesions. Nonsuppurative cellular infiltrates were recognized in samples from most tissue types from woodrats, but few lesions were observed in tissues from deer mice. Recognized lesions in woodrats that were consistent with infections of Lyme borreliosis in other species included synovitis, myositis, and myocarditis. Such lesions were more common in woodrats than in deer mice. Inflammatory lesions, especially synovitis, were more common in woodrats with long-term infections than in woodrats with relatively short-term infections. No clinical signs of disease were observed in either species of rodent.