Progression of diabetic retinopathy after bariatric surgery.

AIM: To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes. METHOD: We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics. RESULTS: Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity. CONCLUSIONS: A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.

Kinetics of lung lesion development and pro-inflammatory cytokine response in pigs with vaccine-associated enhanced respiratory disease induced by challenge with pandemic (2009) A/H1N1 influenza virus.

The objective of this report was to characterize the enhanced clinical disease and lung lesions observed in pigs vaccinated with inactivated H1N2 swine δ-cluster influenza A virus and challenged with pandemic 2009 A/H1N1 human influenza virus. Eighty-four, 6-week-old, cross-bred pigs were randomly allocated into 3 groups of 28 pigs to represent vaccinated/challenged (V/C), non-vaccinated/challenged (NV/C), and non-vaccinated/non-challenged (NV/NC) control groups. Pigs were intratracheally inoculated with pH1N1 and euthanized at 1, 2, 5, and 21 days post inoculation (dpi). Macroscopically, V/C pigs demonstrated greater percentages of pneumonia compared to NV/C pigs. Histologically, V/C pigs demonstrated severe bronchointerstitial pneumonia with necrotizing bronchiolitis accompanied by interlobular and alveolar edema and hemorrhage at 1 and 2 dpi. The magnitude of peribronchiolar lymphocytic cuffing was greater in V/C pigs by 5 dpi. Microscopic lung lesion scores were significantly higher in the V/C pigs at 2 and 5 dpi compared to NV/C and NV/NC pigs. Elevated TNF-α, IL-1ß, IL-6, and IL-8 were detected in bronchoalveolar lavage fluid at all time points in V/C pigs compared to NV/C pigs. These data suggest H1 inactivated vaccines followed by heterologous challenge resulted in potentiated clinical signs and enhanced pulmonary lesions and correlated with an elevated proinflammatory cytokine response in the lung. The lung alterations and host immune response are consistent with the vaccine-associated enhanced respiratory disease (VAERD) clinical outcome observed reproducibly in this swine model.

In vitro susceptibility of macrophages to porcine reproductive and respiratory syndrome virus varies between genetically diverse lines of pigs.

Porcine reproductive and respiratory syndrome virus (PRRSV) continues to be responsible for financial losses in the swine industry worldwide. It remains undetermined whether genetic variability of the host in susceptibility to PRRSV exists and if this variability can be exploited to help control this important disease. The objective of this study was to determine if an in vitro flow cytometry (FACS) assay that detects the percentage of monocyte-derived macrophages (MDM) infected with PRRSV could be utilized to demonstrate genetic variability in the susceptibility between distinct lines of pigs. Over 400 growing pigs from six genetic lines maintained in a single commercial breeding herd were screened using an in vitro FACS assay. From this initial screening, two genetically diverse lines of pigs that were also divergent in their FACS results were selected for further study. An additional 264 pigs from these two lines were subsequently tested for in vitro susceptibility to PRRSV. As in the preliminary screening, the Large White line had significantly higher average percent positive MDM over the Duroc-Pietrain synthetic line. This report suggests a genetic component for susceptibility to PRRSV exists and that the in vitro assay may be useful in predicting the relative susceptibility to PRRSV in large groups of animals.

Lampyridae larva: a natural predator of schistosome vector snails in Liberia.

A lampyrid larva (Coleoptera) was found during snail collecting in Liberia, West Africa to be a natural predator of Biomphalaria pfeifferi and Bulinus globosus.

A survey of filariasis among refugees in south Florida.

Between January 1981 and March 1982, a filariasis survey was conducted among 668 Haitian immigrants and 155 Southeast Asian refugees residing in Florida, U.S.A. Microfilariae were detected only in Haitians, with 6.7% positive for Wuchereria bancrofti and 1.3% positive for Mansonella ozzardi. The majority of individuals with bancroftian filariasis came from five coastal urban areas including Port-au-Prince, Duvalierville, Gonaïves, Leógane and Cap-Haitien. No unequivocal signs of bancroftian filariasis or mansonellosis were seen. Membrane feeding of several species and strains of laboratory-reared mosquitoes on blood from a volunteer microfilaremic with W. bancrofti showed that Aedes aegypti and A. taeniorhynchus, but not Culex quinquefasciatus, were susceptible to infection with the Haitian strain of W. bancrofti. Culicoides furens, a known vector of M. ozzardi in Haiti and present in Florida, was not tested. Further studies are needed to determine the competence of Florida vectors for transmitting W. bancrofti and M. ozzardi to the indigenous human population.

Nondevelopment of Wuchereria bancrofti in nude (congenitally athymic) mice.

Infective larvae of Wuchereria bancrofti (Nematoda: Filarioidea) were harvested from Aedes aegypti mosquitoes fed in vitro on microfilaremic blood of Haitian volunteers. Larvae were inoculated either into the subcutaneous tissue (SC) or peritoneal cavity (IP) of congenitally athymic (nude) mice, C3H/HeN (nu/nu). Initially 15 male and two female mice received larval doses from 38-180, and necropsy was done between 11 and 75 days post-inoculation. No worms were found at necropsy. Four additional male mice given 75 larvae each were also injected daily with 0.3 ml of normal human serum, but again no worms were recovered at necropsy on days 13 through 17. Given the severe nature of the nude immunodeficiency, it seems unlikely that the total failure of W. bancrofti to develop in nude mice results from a T cell-dependent immune response. Perhaps either non-immune mechanisms actively destroy larvae or the mouse lacks a factor(s) essential for parasite development, but not found in human serum. In any case, the thymic independence of resistance to W. bancrofti is clearly unlike that shown to the related filaria, Brugia pahangi.

A molecular perspective on corneal dystrophies.

Corneal dystrophies refer to a group of corneal diseases and that are genetically determined. These have been traditionally classified with respect to the layer of cornea involved. We now know that this does not reflect the underlying pathobiology. Most of the corneal dystrophies are of Mendelian inheritance with some phenotype diversity and a variable degree of penetrance. The dystrophies involving enzymatic processes tend to be of autosomal recessive inheritance. In some cases, such as keratoconus, the inheritance pattern is not always clear and is considered complex. The age of onset of the disease, as in most inherited eye disorders, is variable and does not reflect the underlying pathogenic defect. Few cases are congenital. Our understanding of corneal dystrophies is undergoing somewhat of a revolution as over 12 chromosomes have been associated with corneal dystrophies with mutations identified in at least 14 genes if one includes anterior segment dysgenesis in this group of conditions. Several dystrophies remain without a gene or a genetic location (locus) and more familial studies are required. The new molecular information is challenging the traditional thinking about these conditions that was usually guided by the histopathological findings. As this new knowledge becomes more refined, the classification of this group of disorders will eventually be revisited to have a molecular basis. The elucidation of the underlying biochemical pathways may allow us to envisage the possibility of modulating these phenotypes in the future.

Generating mouse models of retinal disease using ENU mutagenesis.

We used the chemical mutagen, N-ethyl-N-nitrosourea, to induce random point mutations in the germline of the mouse strain C57BL/6 in order to generate models of retinal diseases. 1163 mutagenised first generation mice produced using this approach were examined for eye abnormalities. Approximately one-third (412) presented with some form of ocular abnormality. Most changes were unilateral and confined to the anterior segment of the eye. Less than 10% (44) of identified changes affected the posterior segment of the eye. 21 mice with varying ocular abnormalities, including 17 with retinal changes, were bred to produce second generation mice to confirm genetic inheritance. Genetic inheritance was confirmed in several of these lines including three with retinal changes.

Case report: anaerobic meningitis caused by Peptostreptococcus magnus after head and neck surgery.

Although anaerobic bacterial meningitis is uncommon, patients subjected to resection of head and neck malignancy appear at special risk. In this article, the authors report on a 72-year-old man in whom meningitis developed after extensive resection of the right sinuses for squamous cell carcinoma; initial treatment consisted of intravenous vancomycin and ceftazidime. Intravenous penicillin G was added after the fortuitous early finding of intracellular cocci in Wright-Giemsa stained cerebral spinal fluid submitted for cell count. Cerebral spinal fluid cultures then grew out a pure culture of Peptostreptococcus magnus. The patient had a complete recovery, without neurologic sequelae, recurrence of malignancy, or evidence of infection. Appropriate handling of cerebral spinal fluid specimens is crucial to ensure the correct diagnosis when anaerobic organisms are suspected.

The lymphatic pathology of Brugia pahangi in nude (athymic) and thymic mice C3H/HeN.

The nude (congenitally athymic) mouse, C3H/HeN is highly susceptible to infection with Brugia pahangi (Nematoda: Filarioidea). Normal, hairy mice show a strong thymus-dependent resistance and usually terminate the infection in the larval stages. The present study examined chronological histopathologic changes in the lumbar lymph nodes and adjacent lymphatic vessels of both hosts. In thymic mice, lymphangitis and perilymphangitis reached a maximum 14 to 17 days PI, about the time of disappearance of live worms. The infiltrate showed characteristics of both acute and chronic inflammation: eosinophils, neutrophils, eosinophilic precipitates, and sometimes necrotizing lymphangitis, as well as macrophages and plasma cells. The cellular infiltrate in nude mice was weaker and developed more slowly. Inflammatory responses to identifiable dead worms were seen in both types of hosts but appeared more frequently in thymic mice. Although variable in both models, the granulomas of thymic mice generally showed more tendency to cavitation, greater macrophage or epithelioid cell infiltration, more granulocytes, and appeared to be more destructive than the foreign body responses of nude mice. Whereas lymphangiectasis was generally progressive in nude mice, it was arrested before the end of the third week in thymic mice. In thymic mice, at maximum lumbar lymph node size (17 days), there were large areas of lymphocyte hyperplasia and heavy infiltration of plasma cells. Most nodes returned to normal mean size by the end of the second month. Little or no reactivity was seen in athymic mouse nodes. Our results suggest that some lesions of lymphatic filariasis are potentially thymus-independent: lymphatic fibrosis, lymphangiectasis, accumulations of macrophages and giant cells around disintegrating worms, calcification of worms, intralymphatic thrombosis, and moderate vascular infiltrates including eosinophils.

Ultrastructure of the rectum of infective-stage Wuchereria bancrofti (Nematoda: Filarioidea).

The authors have examined the ultrastructure of the rectum of infective-stage Wuchereria bancrofti by transmission electron microscopy. Our observations show that the rectum is divided into anterior and posterior segments. The cells of the anterior rectum appear to be derived from the microfilarial R (rectal) cells described by other authors. In both stages, these cells show voluminous nuclei, abundant mitochondria, and small cytoplasmic processes which contain fibrillar components. Amorphous material associated with these processes appears throughout the larval rectum and may protrude from the anus as the rectal plug. In the specimens examined, a patent lumen could not be traced completely through the anterior rectum. The posterior rectum has no counterpart in published accounts of microfilarial ultrastructure and probably arises during larval morphogenesis; it is lined with invaginated body cuticle, overlaid by a single layer of epithelial cells which may be of hypodermal origin.

Life cycle of Brugia pahangi (Nematoda) in nude mice, C3H/HeN (nu/nu).

The development of Brugia pahangi (Nematoda: Filarioidea) was studied in nude (congenitally athymic) mice C3H/HeN (nu/nu) and in their phenotypically normal littermates (nu/+). Nude mice were highly susceptible to this parasite. As in the natural host (the cat), the nematodes' third molt in nude mice occurred at 7 to 10 days. The final molt occurred at about 24 days for male worms and 33 days for female worms. Adult worms were smaller than those from other hosts, such as the cat. After inoculation of various numbers of infective larvae, recoveries of adult worms averaged about 15% of the inoculum. In long-term infections initiated with 100 larvae, about 75% of the worms localized in the heart or lungs. Patent infections were seen as early as day 50 PI. Microfilaremia developed in most nude mice given 100, 50, or 25 infective larvae, but was less frequent in those given only 10. Mean filaremias generally rose during the first 6 mo, but in individuals usually did not exceed 500-600/20 mm3 of blood. As in the Mongolian jird, intraperitoneal inoculations yielded large quantities of worms and microfilariae. Few worms could be recovered from normal mice after day 40, even when large (1,000 larvae) inocula were used. Microfilaremia was not detected in normal mice. Although recoveries of adult worms from some nude females were not as high as those from nude males, neither nude nor normal mice showed consistent evidence of a differential susceptibility based on sex. Given the strong, consistent dichotomy of response to B. pahangi between nude and normal mice, this system may be useful in studies of protective immune responses in filariasis.

Effect of immune reconstitution on resistance to Brugia pahangi in congenitally athymic nude mice.

The dichotomy of resistance to Brugia pahangi (Nematoda: Filarioidea) between nonsusceptible, euthymic C3H/HeN mice, heterozygotic for the "nu" gene (+/nu), and susceptible, congenitally-athymic "nude" (nu/nu) C3H/HeN mice, suggests that resistance is thymus-dependent. To test this hypothesis, the effect of syngeneic neonatal thymus grafts and neonatal thymus cell suspensions on recovery of worms at day 40 PI, and responses to Concanavalin A (Con A) were examined in reconstituted nudes. Nude recipients of a thymus graft 7 or 14 wk before subcutaneous inoculation with 50 infective larvae (L3) yielded no worms and responded strongly to Con A. Serum from these mice reacted in two lines of identity with serum from similarly-infected heterozygotes by double radial immunodiffusion against an adult worm saline extract. Nude recipients of a thymus 2 days or 3 wk before inoculation harbored an average of three or two worms, respectively. Intravenous injection of nude recipients with 10(7) or 10(8) neonatal thymus cells seven weeks before inoculation was less effective in conferring resistance to B. pahangi and responsiveness to Con A. Complete resistance to B. pahangi could be adoptively transferred to nude mice by 10(8) spleen cells obtained from infection-primed heterozygotes and injected intravenously on the day of larval inoculation. The same numbers of worms were significantly reduced. less effective when injected 3 wk before inoculation, although numbers of worms were significantly reduced. Passive transfer of primed heterozygote serum, containing high titers of antibodies to adult worm and larval antigens, failed to protect nude recipients against a larval inoculum in the absence of cellular reconstitution.(ABSTRACT TRUNCATED AT 250 WORDS)

The ultrastructure of adult Brugia malayi (Brug, 1927) (Nematoda: Filarioidea).

The ultrastruct of the adult subperiodic Brugia malayi (Brug, 1927) within pulmonary arteries of male jirds (Meriones unguiculatus) was studied by transmission electron microscopy. The cuticle consists of 10 sublayers (2 of which are prominently banded) and a typical outer unit membrane. Evidence is presented showing that the subcuticular region of the lateral chords comprises a functional complex of basal infoldings, multivesicular bodies, and associated mitochondria, which is probably engaged in the exchange of solutes across a permeable cuticle. Microbodies with paired, prominent cores, intracisternal A-particle viruslike bodies, nonstaining glycogen patches, and other structures are also present in the lateral chords. The platymyarian somatic musculature shares some coelomyarian characteristics, e.g., apparent neuromuscular connections and prominent glycogen deposits surrounded by mitochondria and other organelles. The alimentary tract has features typical of many nematodes. The luminal segments of the male and female reproductive tracts and their germinal products, excluding microfilariae, are described. Affinities with related species are discussed.

The lymphatic pathology of Brugia pahangi in the Mongolian jird.

We studied the sequence of histopathologic changes associated with Brugia pahangi (Nematoda: Filarioidea) infections in lymphatic vessels in the spermatic cord of the Mongolian jird (gerbil), Meriones unguiculatus. Intravascular granulomas caused mainly by disintegrating worms were seen in 67% of jirds necropsied on, or after, 35 days postinoculation, whereas none of 20 jirds examined before this day showed dying larvae. These granulomas usually evolved without vascular occlusion. Other granulomatous foci, often with a thrombuslike core, sometimes harbored microfilariae or microfilarialike materials. The perilymphatic cellular infiltrate consisted mostly of eosinophils, lymphocytes, and plasma cells. Large numbers of eosinophils were seen in the early weeks, but later declined, while lymphocytes increased to become the predominant cell in old infections. Irregular fibrosis of some valves and portions of the lymphatic walls were seen as early as the 2nd wk postinoculation. Lymphatic changes in the jird are similar to those described in other hosts infected with filariae, but remained moderate. Living worms appeared to be the stimulus for many observed changes. Most pathologic alterations were well established by 3 or 4 mo and showed little qualitative change during the remaining 4 mo of the study.

Ultrastructure of the anterior alimentary tract of infective-stage Wuchereria bancrofti (Nematoda: Filarioidea).

The anterior alimentary tract of infective-stage Wuchereria bancrofti is divided into the following segments: stoma or buccal capsule, muscular esophagus, glandular esophagus, esophageal-intestinal valve, and intestine. Invaginated external cuticle lines only the anterior stoma. External cuticle and esophageal lining are not continuous and are ultrastructurally distinct; the latter is compared morphologically to the amorphous component of elastin. The glandular esophagus is a composite structure of a stellate contractile epithelial core, surrounded by a sleeve of secretory epithelium. The glandular cytoplasm shows evidence of formation and release of dense secretory granules. At least 2 nerve cell bodies lie within the esophagus approximately 15 micrometer anterior to the esophageal-intestinal valve and their associated processes pass forward and backward through the contractile epithelium. Materials interpreted as ingested flight muscle mitochondria of the mosquito vector appear in various stages of degeneration within the intestinal lumen. It is suggested that, although simple by comparison to some other nematodes, the anterior alimentary tract of infective-stage W. bancrofti functions in the ingestion and breakdown of nutrient materials. The ultrastructure of the excretory cell likewise suggests a functional capability.

Filariasis and erisipela in Santo Domingo.

This study examined acute-convalescent changes in diagnostic anti-streptococcal antibodies by the anti-streptolysin O (ASO) and anti-DNAase B (ADAB) tests among patients (n 28) with lymphedema and recurrent erisipela of the lower limb, comparing them with endemic normal control residents (n=25). The study was based in Villa Francisca, an urban focus of Bancroftian filariasis in eastern Santo Domingo, capital of the Dominican Republic. The acute signs and symptoms of erisipela were consistent with a diagnosis of bacterial cellulitis. The ASO test was especially successful at demonstrating a rise in mean titer during convalescence, whereas the ADAB produced about the same frequency of significant increases (0.2 log titer) as did the ASO. When subjects were scored as responders if mounting a minimal titer increase by either test, patients were found more frequently positive than were controls (chi2=5.3, P=0.02). About half (54%) of all patients mounted at least a minimal antibody increase. Filaria-specific IgG4 antibodies were absent from all sera of 20 residents of a nonendemic Dominican mountain town but appeared in about two-thirds of the sampled residents of the endemic barrio. Notably however, levels did not change between the acute phase and convalescence. These findings are consistent with the hypothesis that recurrent streptococcal invasion of the lymphatics may be a significant factor triggering or amplifying lymphedema and elephantiasis in patients with chronic filariasis.

Simultaneous infection of pigs and people with triple-reassortant swine influenza virus H1N1 at a U.S. county fair.

Influenza-like illness was noted in people and pigs in attendance at an Ohio county fair in August 2007. The morbidity rate in swine approached 100% within 1-2 days of initial clinical signs being recognized, and approximately two dozen people developed influenza-like illness. Triple-reassortant swine H1N1 influenza viruses were identified in both pigs and people at the fair. The identified viruses (A/Sw/OH/511445/2007, A/Ohio/01/2007, and A/Ohio/02/2007) were similar to H1N1 swine influenza viruses currently found in the U.S. swine population. This case illustrates the possibility of transmission of swine influenza in settings where there is close human/swine interaction.

Leukogram abnormalities in gnotobiotic pigs infected with porcine circovirus type 2.

Porcine circovirus type 2 (PCV2) is a single-stranded circular DNA virus that is the causative agent of porcine circovirus associated disease (PCVAD), a disease complex affecting swine around the world. Although this virus is believed to negatively affect the host's immune system, the mechanism by which PCV2 induces disease is not completely understood. This report describes a series of PCV2 experiments using the gnotobiotic pig model in which a relationship was demonstrated between abnormal leukograms and development of clinical disease in PCV2-infected pigs. When compared to control pigs the leukogram was characterized by a decrease in lymphocytes within 14 days post inoculation (dpi) followed by an increase in neutrophils 7-14 days later. No significant changes in the circulating monocyte, basophil, and eosinophil cell populations were detected. The combination of an absolute neutrophilia and lymphopenia produced a neutrophil/lymphocyte ratio that was predictive of clinical disease and was inversely correlated with the presence of neutralizing antibodies. Based on previous reports, the lymphopenia may be attributed to a direct cytolytic effect of the virus and could negatively affect the pig's immune response. The role of the neutrophilia in the pathogenesis of PCVAD in gnotobiotic pigs is unknown.