Isolation and characterisation of the fungus Spiromastix asexualis sp. nov. from discospondylitis in a German Shepherd dog, and review of Spiromastix with the proposal of the new order Spiromastixales (Ascomycota).

The genus Spiromastix consists of several fungal species that have been isolated from soil and animal dung in various parts of the world. However, these species are considered to be of low pathogenic potential, as no cases of infections caused by these fungi have been reported. Here, we describe the clinical course of discospondylitis in a dog from which a fungus was cultured from a biopsy and identified as a Spiromastix species by morphologic characteristics and sequencing. Phylogenetic analysis determined this to be a new species, Spiromastix asexualis, which is described, and a new order, Spiromastixales, is proposed.

Isolation and characterization of a new fungal genus and species, Aphanoascella galapagosensis, from carapace keratitis of a Galapagos tortoise (Chelonoidis nigra microphyes).

A new fungal genus and species, Aphanoascella galapagosensis, recovered from carapace keratitis in a Galapagos tortoise residing in a south Texas zoological collection, is characterized and described. The presence of a pale peridium composed of textura epidermoidea surrounded by scarce Hülle cell-like chlamydospores, and the characteristic reticulate ascospores with an equatorial rim separates it from other genera within the Onygenales. The phylogenetic tree inferred from the analysis of D1/D2 sequences demonstrates that this fungus represents a new lineage within that order. As D1/D2 and ITS sequence data also shows a further separation of Aphanoascus spp. into two monophyletic groups, we propose to retain the generic name Keratinophyton for species whose ascospores are pitted and display a conspicuous equatorial rim, and thereby propose new combinations in this genus for four Aphanoascus species.

A randomized, double-blind, placebo-controlled study to evaluate the addition of methotrexate to etanercept in patients with moderate to severe plaque psoriasis.

BACKGROUND: Etanercept plus methotrexate combination therapy has not been adequately investigated in psoriasis. OBJECTIVES: To evaluate etanercept plus methotrexate vs. etanercept monotherapy in patients with moderate to severe plaque psoriasis who had not failed prior methotrexate or tumour necrosis factor-inhibitor therapy. METHODS: Patients received etanercept 50 mg twice weekly for 12 weeks followed by 50 mg once weekly for 12 weeks and were randomized 1 : 1 to receive methotrexate (7·5-15 mg weekly) or placebo. The primary endpoint was the proportion of patients achieving ≥75% improvement in Psoriasis Area and Severity Index (PASI 75) at week 24. RESULTS: In total, 239 patients were enrolled in each arm. PASI 75 was significantly higher at week 24 for the combination therapy group compared with the monotherapy group (77·3% vs. 60·3%; P < 0·0001). Other PASI improvement scores at week 12 [PASI 75, 70·2% vs. 54·3% (P = 0·01); PASI 50, 92·4% vs. 83·8% (P = 0·01); and PASI 90, 34·0% vs. 23·1% (P = 0·03)] showed similar results as did week 24 PASI 50 (91·6% vs. 84·6%; P = 0·01) and PASI 90 (53·8% vs. 34·2%; P = 0·01). Significantly more patients receiving combination therapy than monotherapy had static Physician's Global Assessment of clear/almost clear at week 12 (65·5% vs. 47·0%; P = 0·01) and week 24 (71·8% vs. 54·3%; P = 0·01). Adverse events (AEs) were reported in 74·9% and 59·8% of combination therapy and monotherapy groups, respectively; three serious AEs were reported in each arm. CONCLUSIONS: Combination therapy with etanercept plus methotrexate had acceptable tolerability and increased efficacy compared with etanercept monotherapy in patients with moderate to severe psoriasis.

Isolation and characterization of a new fungal species, Chrysosporium ophiodiicola, from a mycotic granuloma of a black rat snake (Elaphe obsoleta obsoleta).

Isolation and characterization of the new species Chrysosporium ophiodiicola from a mycotic granuloma of a black rat snake (Elaphe obsoleta obsoleta) are reported. Analysis of the sequences of different fragments of the ribosomal genes demonstrated that this species belongs to the Onygenales and that this species is genetically different from other morphologically similar species of Chrysosporium. This new species is unique in having both narrow and cylindrical-to-slightly clavate conidia and a strong, pungent odor.

Pulmonary Phialemonium curvatum phaeohyphomycosis in a Standard Poodle dog.

Phialemonium curvatum, frequently misidentified as an Acremonium species, is reported here as a new agent of pulmonary phaeohyphomycosis in a Standard Poodle dog, and added as a new species in the genus to cause mycoses in canines. In vitro susceptibility data, for both human and animal isolates, suggests resistance to amphotericin B and susceptibility to the triazole agents itraconazole, voriconazole, and posaconazole.

Identification and first report of Inonotus (Phellinus) tropicalis as an etiologic agent in a patient with chronic granulomatous disease.

Although isolates of filamentous basidiomycetes can usually be recognized in a clinical laboratory setting, identification is problematic, as they seldom exhibit diagnostic morphological features formed in nature. This paper is the first report of Inonotus (Phellinus) tropicalis inciting human disease and describes the methods used to support the identification.

Identification of Exophiala mesophila isolated from treated dental unit waterlines.

Members of the genus Exophiala are often difficult to identify to the species level because of their variable morphological appearances. This paper describes the methods used to identify Exophiala mesophila and provides salient differential features for distinguishing other mesophilic members of the genus.

Probing DNA polymerase fidelity mechanisms using time-resolved fluorescence anisotropy.

Prior to undergoing postsynthetic 3'-5' editing (proofreading), a defective DNA primer terminus must be transferred from the 5'-3' polymerase active site to a remote 3'-5' exonuclease site. To elucidate the mechanisms by which this occurs, we have used time-resolved fluorescence spectroscopy to study the interaction of dansyl-labeled DNA primer/templates with the Klenow fragment of Escherichia coli DNA polymerase I. The dansyl probe is positioned such that when the DNA substrate occupies the polymerase active site, the probe is solvent-exposed and possesses a short average fluorescence lifetime (4.7 ns) and extensive angular diffusion (42.5 degrees). Conversely, when the DNA substrate occupies the exonuclease active site, the probe becomes buried within the protein, resulting in an increase in the average lifetime (14.1 ns) and a decrease in the degree of angular diffusion (14.4 degrees ). If both polymerase and exonuclease binding modes are populated (lower limit approximately 5%), their markedly different fluorescence properties cause the anisotropy to decay with a characteristic "dip and rise" shape. Nonlinear least-squares analysis of these data recovers the ground-state mole fractions of exposed (x(e)) and buried (x(b)) probes, which are equivalent to the equilibrium proportions of the DNA substrate bound at the polymerase and exonuclease sites, respectively. The distribution between the polymerase and exonuclease binding modes is given by the equilibrium partitioning constant K(pe) (equal to x(b)/x(e)). The important determinants of the proofreading process can therefore be identified by changes made to either the protein or DNA that perturb the partitioning equilibrium and hence alter the magnitude of K(pe).

Blue-fluorescent antibodies.

The forte of catalytic antibodies has resided in the control of the ground-state reaction coordinate. A principle and method are now described in which antibodies can direct the outcome of photophysical and photochemical events that take place on excited-state potential energy surfaces. The key component is a chemically reactive optical sensor that provides a direct report of the dynamic interplay between protein and ligand at the active site. To illustrate the concept, we used a trans-stilbene hapten to elicit a panel of monoclonal antibodies that displayed a range of fluorescent spectral behavior when bound to a trans-stilbene substrate. Several antibodies yielded a blue fluorescence indicative of an excited-state complex or "exciplex" between trans-stilbene and the antibody. The antibodies controlled the isomerization coordinate of trans-stilbene and dynamically coupled this manifold with an active-site residue. A step was taken toward the use of antibody-based photochemical sensors for diagnostic and clinical applications.

Novel learning abilities after traumatic head injury in children.

The cognitive abilities of 69 children with traumatic head injury (THI) were evaluated with the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994), the Children's Category Test (CCT; Boll, 1993), and the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991). Compared to children with mild to moderate injuries, children with severe THI demonstrated statistically significant impairments on the CVLT-C Total T-score as well as the WISC-III Processing Speed index, but findings for the CCT were less robust. Longer length of coma and male gender were associated with relatively poorer performance on the CVLT-C. Children with severe THI demonstrated difficulties with both capacity and speed of information processing, which could not be accounted for by attentional or general verbal knowledge factors. It is concluded that the combination of the CVLT-C and the WISC-III is useful in the evaluation of cognitive sequelae of THI but that findings from the CCT must be considered with some caution in this population.

Disseminated zygomycosis due to Rhizopus schipperae after heatstroke.

A 21-year-old woman suffered heatstroke and developed diarrhea while trekking across south Texas. The heatstroke was complicated by seizures, rhabdomyolysis, pneumonia, renal failure, and disseminated intravascular coagulation. The patient's stool and blood cultures grew Campylobacter jejuni. The patient subsequently developed paranasal and gastrointestinal zygomycosis and required surgical debridement and a prolonged course of amphotericin B. The zygomycete cultured was Rhizopus schipperae. This is only the second isolate of R. schipperae that has been described. R. schipperae is characterized by the production of clusters of up to 10 sporangiophores arising from simple but well-developed rhizoids. These asexual reproductive propagules are produced on Czapek Dox agar but are absent on routine mycology media, where only chlamydospores are observed. Despite multiorgan failure, bacteremia, and disseminated zygomycosis, the patient survived and had a good neurological outcome. Heatstroke has not been previously described as a risk factor for the development of disseminated zygomycosis.

Deciphering the fluorescence signature of daunomycin and doxorubicin.

The fluorescence characteristics of daunomycin (DNM), doxorubicin (DXR), and other anthracycline drugs are often used to monitor localization of the drug within lipid bilayers and liposomal delivery systems and to assess interaction of the drug with DNA and other macromolecules. However, the binding of DNM and DXR to proteins and membrane systems has been observed to exhibit variable effects on the anthracycline's fluorescence. We have delineated the spectroscopic response of DXR and DNM to their surroundings in several systems, including solvents of differing dielectric constant, aqueous solutions of varying pH or fluorophore concentration, and the reverse micellar system of AOT/heptane/water with a range of doxorubicin concentrations. We have observed that the ratio of fluorescence intestinal at the two principal lambda max values shows a parabolic dependence on solvent dielectric constant, i.e. inverted solvatochromism. This behavior has been overlooked by previous investigators and, together with the appearance of a long-wavelength band near 630 nm in solvents of low dielectric strength (also previously not reported), is key to understanding the partitioning of anthracyclines in membrane systems as well as resolving the conflicting interpretation of data in the literature.

Social support and caregiving burden in family caregivers of frail elders.

This study assessed the relationships between six different types of social support and five measures of caregiving burden. Two questions were addressed: Are all types of social support equally associated with burden, and do the same types of support correlate with different types of burden? Family caregivers (N = 217) to frail elders composed the sample. Multiple regression analyses demonstrated that all types of social support for caregivers of frail elders are not equal. Engaging in social interaction for fun and recreation appears to be the most important in diminishing the burden of caregiving. These findings are instructive both theoretically and clinically. The theoretical import of greater social participation under a condition of chronic stress is discussed. Further, interventions that focus on caregivers regularly experiencing pleasant activity with friends and other family would seem to go a long way toward managing the burden of caregiving.

Variation in the self-concept of young adult chronic patients: chronicity reconsidered.

A group of 65 young adult chronic patients were asked to assess themselves and to describe a typical community resident and a typical mental patient; they used a semantic differential instrument consisting of adjective pairs arranged in a 7-point bipolar rating scale. The self-assessments of 96 percent of the patients corresponded to their descriptions of either the community resident or the mental patient. Compared with the two-thirds of the sample who described themselves as community residents, subjects who described themselves as patients were more likely to be older and single, to report psychological distress, and to rely on homogeneous support networks. They were also more likely to be taking medications and to be pessimistic about their prognoses, but less likely to have been hospitalized. Such perceptual patterns may lock some young adult patients into patienthood.

Effects of cell size and animal age on glucose metabolism in pig adipose tissue.

Adipose tissue slices were prepared from middle subcutaneous or perirenal adipose tissue excised from pigs of different ages (and obesity) and incubated with [U-14C]glucose. After incubation, the slices were fixed with osmium tetroxide and separated into diameter ranges of 20--63, 63--102, and 102--153 microgram, respectively. Following determination of cell size and number, the fixed adipocytes were decolorized with H2O2 prior to quantification of glucose conversion to total lipid, glyceride fatty acids, glycerideglycerol, and CO2. Glucose conversion to total lipid or CO2 was unaffected by the presence of purified porcine insulin (0, 10, 100, 1000, and 100,000 microM/ml). Within animals, adipocytes of different sizes were not different with regard to insulin sensitivity. Within a weight (age) group, conversion of glucose to total lipid (insulin present) or to glyceride fatty acids and glyceride-glycerol (insulin absent) per cell was significantly greater in large adipocytes compared to small adipocytes, regardless of the group examined. With increasing weight or age, there was a markedly decreased conversion of glucose to total lipid and glyceride fatty acids among adipocytes of similar size within a cell-size fraction. The diminution in glucose metabolism was greater (as a percentage) in 20--63 microgram adipocytes than for 63--102 or 102--153 microgram adipocytes. However, for all cell-size fractions there was a marked decrease in glucose conversion to fatty acids. Glyceride-glycerol synthesis was impaired in adipocytes from older pigs, but the decrease was less than observed for glyceride fatty acid synthesis.

Improved techniques for studies of adipocyte cellularity and metabolism.

Two methods are described for the study of adipose tissue cellularity and metabolism. In the first, 8 M urea was used to liberate osmium tetroxide-fixed adipocytes from the connective tissue matrix. In the smaller-sized cell ranges there was a significant reduction in apparent adipocyte number of rat, pig, and beef adipose tissue with 8 M urea treatment. This was attributed to solubilization of connective tissue debris that was counted as adipocytes in samples isolated without urea. There was no effect on the larger cell-size fractions with 8 M urea treatment. Eight molar urea had no effect on fixed adipocyte retention of radioactivity. The second method entailed the use of hydrogen peroxide to volatilize the black, osmium tetroxide-fatty acid complex of osmium tetroxide-fixed adipocytes, containing radioactivity, resulting in colorless lipid suitable for liquid scintillation counting. This latter technique permits incubation of unfixed adipose tissue slices with a radioactive substrate, followed by fixation with osmium tetroxide and subsequent separation of the adipocytes, by screening, into the desired size ranges. Adipocytes in various size fractions can then be counted, sized, and then decolorized with hydrogen peroxide in order to quantitate the amount of radioactivity within the adipocytes. There was no loss of radioactivity from the fixed cells with hydrogen peroxide treatment.