Persistence Pays: Diagnosing Tuberculous Meningitis after 11 Negative Polymerase Chain Reaction Evaluations.

Managing tuberculous meningitis (TBM) is challenging because of its poor prognosis and the difficulty in making an early diagnosis due to the low sensitivity of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) evaluations. A 75-year-old woman presented with fatigue and multiple enlarged lymph nodes and was initially suspected of having metastatic cancer of unknown primary origin. Differential diagnoses included carcinomatous meningitis, neurosarcoidosis, and TBM, as suggested by the presence of multiple enhancing cerebral nodules. Despite 11 negative PCR evaluations, including nested PCR of CSF and biopsied lymph nodes within the first 3 days of empirical anti-tubercular treatment, TBM was eventually confirmed by CSF cultures 32 days later. This case highlights the need for repeated sampling.

Inhibitory Activity of Hydroxytyrosol against Streptolysin O-Induced Hemolysis.

　Group A streptococcus is a bacterium that resides in the throat and skin and causes respiratory infection and occasionally glomerulonephritis and rheumatic fever. Streptolysin O (SLO) produced by Streptococcus pyogenes (S. pyogenes) binds to the cell membrane, particularly to that of white and red blood cells, and is toxic to the cells and tissue. In this study, we evaluated the inhibitory activity of water-soluble polyphenols in olives (Olea europaea) against SLO-induced hemolysis. Hydroxytyrosol inhibited SLO-induced hemolytic activity, and the amount required for 50% inhibition of hemolysis was 1.30 µg. These findings suggest that the water-soluble polyphenols contained in olives have inhibitory activity against SLO-induced hemolysis.

Rapid Discrimination between Methicillin-Sensitive and Methicillin-Resistant Staphylococcus aureus Using MALDI-TOF Mass Spectrometry.

　Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major pathogens responsible for nosocomial infections. The presence of MRSA in a hospital is detrimental to patients and to hospital management. Thus, rapid identification of MRSA is needed. Here, we report on a prospective method to rapidly discriminate of MSSA from MRSA using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and support vector machine (SVM) analysis in 160 clinical isolates of S. aureus. The predictive model was tested using 100 S. aureus isolates (50 MSSA and 50 MRSA). The identification rates were 90.0% for MSSA and 87.5% for MRSA in a 10-fold cross-validation SVM. In blind test sets, 60 S. aureus isolates (30 MSSA and 30 MRSA) were correctly classified, with identification rates of 93.3% for MSSA and 86.7% for MRSA. The method proposed in this study using the predictive model enables detection of one colony in 5 minutes, and thus is useful at clinical sites at which rapid discrimination of MRSA from MSSA is required.

Identification of a novel serum biomarker for pancreatic cancer, C4b-binding protein α-chain (C4BPA) by quantitative proteomic analysis using tandem mass tags.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) remains a devastating disease due to the lack of specific early diagnostic markers. To improve the outcomes, proteomic approaches are being developed for the discovery of novel biomarkers of PDAC. METHODS: Using tandem mass tag labelling and LC-MS/MS, we performed comparative analyses of pre- and postoperative sera from PDAC patients to identify specific serum biomarkers for PDAC. In validation studies, we evaluated the discriminatory power of candidate proteins. RESULTS: Among the 302 proteins analysed, 20 were identified as potential biomarkers, with C4b-binding protein α-chain (C4BPA) and polymeric immunoglobulin receptor (PIGR) being selected for further analysis. The sera levels of C4BPA and PIGR were significantly higher in the preoperative PDAC patients than in the postoperative ones (P<0.008, P<0.036, respectively). In addition, serum C4BPA levels, but not PIGR, in patients with PDAC were significantly higher than those in healthy controls as well as in patients with pancreatitis and other malignancies including biliary tract cancers (BTC) (P<0.001). The respective area under the receiver operator characteristics (ROC) curve (AUC) was 0.860 for C4BPA, 0.846 for CA19-9 and 0.930 for the combination of C4BPA and CA19-9 in PDAC vs non-cancer individuals. The respective AUC was 0.912 for C4BPA, 0.737 for CA19-9 in Stages I and II of PDAC, 0.854 for C4BPA and 0.264 for CA19-9 in PDAC vs BTC. CONCLUSIONS: We have demonstrated that C4BPA is a novel serum biomarker for detecting early stage PDAC, as well as for distinguishing PDAC from other gastroenterological cancers. Further analysis in large cohort studies will warrant C4BPA as a promising biomarker of PDAC in clinical use.

Evaluation of serum carbohydrate-deficient transferrin by HPLC and MALDI-TOF MS.

BACKGROUND: The percentage of carbohydrate-deficient transferrin (%CDT) in serum is a marker of habitual alcohol intake that can be determined by antibody detection of abnormal disialo sugar chains at D432 and D630. However, this approach lacks specificity for alcoholic liver disease. To decrease the false-positive rate in patients with non-alcoholic liver diseases, we developed a screening method using the disialo sugar chain at D630 alone. METHODS: Serum was obtained from 12 patients with alcoholic liver disease, 12 with type C chronic liver disease, 6 with non-alcoholic steatohepatitis (NASH), and 12 healthy non-alcohol drinkers. Transferrin with two sialic acids (disialotransferrin) was fractionated from serum using HPLC, digested with trypsin, and evaluated using MALDI-TOF MS. RESULTS: An abnormal sugar chain at D630 of transferrin was not detected in healthy subjects or in patients with chronic liver disease or NASH, but was detected in 9 patients (75%) with alcoholic liver disease. Positive results were found in 3 samples that were negative using an N-Latex CDT kit and in one sample negative for γ-glutamylaminotransferase and CDT. CONCLUSIONS: Detection of CDT by HPLC/MALDI-TOF MS based on an abnormal sugar chain at D630 may permit identification of habitual alcohol drinkers when used in combination with current markers.

Urinary albumin and transferrin as early diagnostic markers of chronic kidney disease.

Feline renal diseases are increasingly noted in veterinary practice. It is important to diagnose and identify the pathological basis of renal dysfunction accurately at an early stage, but there are only a few reports on this area in clinical veterinary medicine. We investigated the efficacy of measurement of urinary albumin (u-Alb) and urinary transferrin (u-Tf) for early diagnosis using 5-µl urine samples collected noninvasively by catheterization from normal (IRIS stage I) cats and cats with stage I chronic kidney disease (CKD). The u-Alb levels in normal and stage I CKD cats were 6.0 ± 4.5 and 11.2 ± 8.4 mg/dl, respectively, and the u-Tf levels were 0.09 ± 0.42 and 0.52 ± 0.79 mg/dl, respectively. Based on ROC curve analysis, the sensitivity and specificity of u-Alb and u-Tf were higher than those of the currently used biomarker, the plasma creatinine level. The sensitivity of u-Alb was higher than that of u-Tf, whereas the specificity of u-Tf was higher than that of u-Alb. The validity of the threshold albumin level (20 mg/dl) was confirmed by measurements using SDS-PAGE. Since leakage of u-Tf in urine precedes leakage of u-Alb, inclusion of u-Tf in biochemistry tests may be appropriate for IRIS staging as a diagnostic marker of early diagnosis of renal disorder in cats.

Marked changes in the ribonuclease activity of mature and immature gonads of sea urchins Hemicentrotus pulcherrimus and Anthocidaris crassispina.

It is generally impossible to sort male and female sea urchins before they reach maturity, i.e., while they are still in the immature stage. The ribonuclease (RNase) activity of the gonads of immature stage sea urchins consistently shows a constant activity level. Comparison of the RNase activity of the gonads of mature male and female Hemicentrotus pulcherrimus and Anthocidaris crassispina species at pH 5.0 showed that while its mean specific activity in the immature stage of female H. pulcherrimus increased rapidly from 7.35 to 62.79 units/mg, its activity in male H. pulcherrimus decreased from 7.35 to 1.90 units/mg. The same phenomenon was observed in A. crassispina. Based on its optimal pH, substrate specificity, and heat stability the RNase that exhibited these changes was determined to be an enzyme of the RNase T2 type. This enzyme is also thought to exert an influence on sex determination in sea urchins.

Novel conformation-sensitive antibodies specific to three- and four-repeat tau.

Two types of tau isoform, three- and four-repeat tau, are found in neurofibrillary tangles--a pathological hallmark of tauopathies. Which isoform is deposited in the affected tissues depends on the tauopathy. To study how and which tau isoforms contribute to neuronal degeneration, we have developed and characterized two novel conformation-sensitive antibodies, T3R and T4R. Two closely related synthetic peptides, PGGGKVQIVYK and PGGGSVQIVYK, respectively, were designed as antigens. The isoform-specific residues, (305)K in three-repeat tau or (305)S in four-repeat tau, and the PHF6 motif (VQIVYK) were identified as critical sequences. Despite the high similarity of the antigens, there was no cross-reactivity between T3R and T4R. Furthermore, T3R and T4R showed reduced binding to the thioflavin-positive beta-structural form of their target. These features may enable these antibodies to act as novel indicators that allow us to observe and evaluate conformational changes in each distinct isoform of tau.

Enzymatic properties of serine 93 mutants of RNase Rh from Rhizopus niveus. A trial to alter the base preference of RNase Rh.

In order to investigate the effects of mutation of Ser93, a component of base recognition site (B2 site) of a base non-specific RNase from Rhizopus niveus, we prepared 10 mutant enzymes at this position, S93A, S93V, S93F, S93T, S93G, S93D, S93N, S93E, S93Q and S93R, and their enzymatic activities towards RNA and 16 dinucleoside phosphates were measured. Enzymatic activities of the mutant enzymes towards RNA were between 3.5-75% of the native enzyme. From the rates of hydrolysis of 16 dinucleoside phosphates by the mutant enzymes, we estimated the base preference of B1 and B2 base recognition sites. The results indicated that mutation of Ser93 to Phe, Thr, Glu. Gln and Arg caused the B2 site of the enzymes to more cytosine base preference and Asp and Asn substitution caused more uracil base preference. The results suggested that we are able to construct an enzyme that preferentially cleaves internucleotidic linkage at the 5'-side of cytidine or uridine. The results seem able to convert a base non-specific RNase to a base specific one.