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Abstract A significant minority of individuals develop trauma- and stressor-related disorders (TSRD) after surviving sepsis, a life-threatening immune response to infections. Accurate prediction of risk for TSRD can facilitate targeted early intervention strategies, but many existing models rely on research measures that are impractical to incorporate to standard emergency department workflows. To increase the feasibility of implementation, we developed models that predict TSRD in the year after survival from sepsis using only electronic health records from the hospitalization (n = 217,122 hospitalizations from 2012-2015). The optimal model was evaluated in a temporally independent prospective test sample (n = 128,783 hospitalizations from 2016-2017), where patients in the highest-risk decile accounted for nearly one-third of TSRD cases. Our approach demonstrates that risk for TSRD after sepsis can be stratified without additional assessment burden on clinicians and patients, which increases the likelihood of model implementation in hospital settings.

Objectives: To assess whether escalating to high-dose corticosteroids or anakinra compared with continuing low-dose corticosteroids reduced mortality in patients with severe COVID-19 whose respiratory function deteriorated while receiving dexamethasone 6 mg daily. Methods: We conducted a retrospective cohort study between March 1 to December 31, 2020, of hospitalized patients with confirmed COVID-19 pneumonia. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving anakinra, high-dose corticosteroid (dexamethasone >10 mg daily), or remaining on low-dose corticosteroids on the day of first respiratory deterioration. Results: We analyzed 6671 patients whose respiratory status deteriorated while receiving dexamethasone 6 mg daily for COVID-19 pneumonia, of whom 6265 stayed on low-dose corticosteroids, 232 were escalated to high-dose corticosteroids, and 174 to anakinra in addition to corticosteroids. The propensity score-adjusted odds of death were higher in the anakinra (odds ratio [OR] 1.76; 95% CI 1.13-2.72) and high-dose corticosteroid groups (OR 1.53; 95% CI 1.14-2.07) compared with those who continued low-dose corticosteroids on the day of respiratory deterioration. The odds of hospital-acquired infections were also higher in the anakinra (OR 2.00; 95% CI 1.28-3.11) and high-dose corticosteroid groups (OR 1.43; 95% CI 1.00-2.04) compared with low-dose corticosteroid group. Conclusion: Our findings do not support escalating patients with COVID-19 pneumonia who deteriorate on low-dose corticosteroids to high-dose corticosteroids or anakinra.

Objectives: To assess whether high- compared with low-dose corticosteroids started upon hospitalization reduce mortality in patients with severe COVID-19 pneumonia or in subgroups stratified by severity of respiratory impairment on admission. Methods: We conducted a retrospective cohort study of patients with confirmed SARS-CoV-2 infection who required oxygen supplementation upon hospitalization between March 1 and December 31, 2020. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving low- or high-dose corticosteroid (dexamethasone 6-10 mg daily or >10-20 mg daily or other corticosteroid equivalents). Results: We analyzed 13,366 patients who received low-dose and 948 who received high-dose corticosteroids, of whom 31.3% and 40.4% had severe respiratory impairment (>15 l/min of oxygen or mechanical ventilation) upon admission, respectively. There were no differences in the propensity score-adjusted odds of death (odds ratio 1.17, 95% CI 0.72-1.90) or infections (odds ratio 0.70, 95% CI 0.44-1.11) for patients who received high-dose compared with low-dose corticosteroids, beginning on the day of admission. No significant differences in subgroups stratified by severity of respiratory impairment were found. Conclusion: Initiating high-dose compared with low-dose corticosteroids among newly hospitalized patients with COVID-19 pneumonia did not improve survival. However, benefit of high-dose corticosteroids in specific subgroups cannot be excluded.

Abstract Background We reviewed the epidemiology, risk factors, pathophysiology, and clinical presentations of coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM), then discussed the importance of rapid diagnosis and treatment facilitated by multidisciplinary approach. Main body India has reported world’s highest number of CAM cases where Rhizopus arrhizus was the most predominant etiology. CAM caused by Rhizopus microsporus was the most common from the rest of the world. Multiple risk factors for CAM were identified including diabetes mellitus, inappropriate corticosteroid use, COVID-19-related hypoxia, and lung damage. Rhino-orbito-cerebral mucormycosis (ROCM) accounted for almost 90% of CAM in India while 64% of global cases were ROCM. Less than 10% of CAM from India were pulmonary while the rest of the world reported 21% of pulmonary CAM. CAM is diagnosed by confirmed SARS-CoV2 infection along with clinical, radiological, histopathological, and/or microbiological evidence of mucormycosis. In patients with risks of CAM and associated symptoms, CT or MRI are recommended. If ROCM is suspected, endoscopy and biopsy are recommended. If pulmonary CAM is suspected, tissue biopsies, nasal samples, or bronchoalveolar lavage is recommended with histopathological exams. Early diagnosis, surgical, and pharmaceutical interventions are key to treat mucormycosis. Upon diagnosis, antifungal therapy with liposomal amphotericin B (IV) is considered first-line of therapy. Alternatively, posaconazole (PO/IV) or isavuconazole (PO/IV) can be used. Conclusion Treating CAM requires a multidisciplinary approach for early diagnosis and prompt initiation of interventions to maximize patient’s chance of survival.

Improvements in soil moisture observations and modeling play a vital role in drought, water resources, flooding, and landslide management and forecasting. However, the lack of multisensor products that integrate different spatial scales (i.e., from 1 m2 to 102 km2) is a pressing need in the management and forecasting chain. Up to date, surface soil moisture estimates could be obtained through three primary approaches: (1) in situ measurements and their interpolations, (2) remote sensing observations, and (3) land surface model (LSM) outputs. Each source of soil moisture has its own spatiotemporal resolution, strengths, and weaknesses. Therefore, their correct interpretation and application require an in-depth understanding of their accuracy and appropriateness. In this study, we explore the utility of the triple collocation (TC) method for an independent assessment of three soil moisture products to characterize their uncertainty structures and make recommendations toward a potential product merge. The state of Oklahoma is an ideal domain to test the hypotheses of this work because of the presence of marked west-to-east gradients in climate, vegetation, and soils. The three target soil moisture products include (1) the remotely sensed microwave soil moisture active passive (SMAP) L3_SM_P_E (9 km, daily), (2) the physically based LSM estimates from NLDAS_NOAH0125_H (1/8°, hourly; Noah), and (3) the Oklahoma Mesonet ground sensor network (point, 30 min). The product assessment was conducted from April 2015 to July 2019. The results indicate that, in general, Mesonet and Noah are the most reliable products, although their performance varies geographically and by land cover type, reflecting the main spatiotemporal characteristics and scope of each product. Specifically, Mesonet provides the best estimates of volumetric soil moisture with a mean Pearson correlation coefficient of 0.805, followed by Noah with 0.747. However, Noah represents the true soil moisture variation better than the interpolated Mesonet product on the mesoscale, with an averaged RMSE of 0.026 m3⁄m3. Over different land cover types, Mesonet had the best performance in shrub/scrub, herbaceous, hay/pasture, and cultivated crops with an average correlation coefficient of 0.79, while Noah achieved the best performance in evergreen, mixed, and deciduous forests, with an average correlation coefficient of 0.74. The period-integrated TC intercomparison results over nine climate divisions indicated that Noah outperformed in the central, northeast, and east-central regions. TC provides not only a new perspective for comparatively assessing multisource soil moisture products but also a basis for objective data merging to capitalize on the strengths of multisensor, multiplatform soil moisture products.

The global pandemic of the novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented newfound challenges to the oncology community regarding management of disease progression in immunocompromised and cancer patients. Further, the large influx of COVID-19 patients has overwhelmed healthcare facilities, limited access to intensive care unit beds and ventilators, and canceled elective surgeries causing disruptions to the cancer care continuum and re-organization of oncological care. While it is known that the potential threat of infection is greatest in elderly patients (>60 years of age) and patients with underlying comorbidities, there is still insufficient data to determine the risk of COVID-19 in cancer patients. Given the immunosuppressive status in cancer patients arising from chemotherapy and other comorbidities, management of COVID-19 in this patient population carries a unique set of challenges. We report three cases of COVID-19 in immunocompromised cancer patients and discuss the challenges in preventing, diagnosing, and treating this vulnerable group.

Background: On March 11, 2020, the World Health Organization (WHO) declared Coronavirus Disease (COVID-19) a pandemic. Hospitals around the world began to implement infection prevention and control (IPC) measures to stop further spread and prevent infections within their facilities. Healthcare organizations were challenged to develop response plans, procure personal protective equipment (PPE) that was in limited supply while continuing to provide quality, safe care. Methods: As a comprehensive cancer center with immunocompromised patients, our efforts began immediately. Preventative measures were established and, as of September 2020, over 14,000 patients have been tested within the facility. From March 2020 through September 2020, only one case of hospital acquired (HA) COVID-19 was identified among our patients. Two cases of suspected community acquired (SCA) cases were also identified. Following the Centers for Disease Control (CDC) guidance, IPC measures were implemented within the facility as information science about the virus developed. This article addresses the IPC measures taken, such as enhancing isolation precautions, implementing screening protocols, disinfecting and reusing N95 respirators, by the center throughout the pandemic as well as the challenges that arouse with a new and emerging infectious disease. Conclusions: The infection control measures implemented at our comprehensive cancer center during the COVID-19 pandemic allowed our center to continue to provide world class cancer care with minimal COVID-19 infection transmission among patients and team members.

Objectives:. To characterize the signs and symptoms of sepsis, compare them with those from simple infection and other emergent conditions and evaluate their association with hospital outcomes. Design, Setting, Participants, and INTERVENTION:. A multicenter, retrospective cohort study of 408,377 patients hospitalized through the emergency department from 2012 to 2017 with sepsis, suspected infection, heart failure, or stroke. Infected patients were identified based on Sepsis-3 criteria, whereas noninfected patients were identified through diagnosis codes. MEASUREMENTS AND MAIN RESULTS:. Signs and symptoms were identified within physician clinical documentation in the first 24 hours of hospitalization using natural language processing. The time of sign and symptom onset prior to presentation was quantified, and sign and symptom prevalence was assessed. Using multivariable logistic regression, the association of each sign and symptom with four outcomes was evaluated: sepsis versus suspected infection diagnosis, hospital mortality, ICU admission, and time of first antibiotics (> 3 vs ≤ 3 hr from presentation). A total of 10,825 signs and symptoms were identified in 6,148,348 clinical documentation fragments. The most common symptoms overall were as follows: dyspnea (35.2%), weakness (27.2%), altered mental status (24.3%), pain (23.9%), cough (19.7%), edema (17.8%), nausea (16.9%), hypertension (15.6%), fever (13.9%), and chest pain (12.1%). Compared with predominant signs and symptoms in heart failure and stroke, those present in infection were heterogeneous. Signs and symptoms indicative of neurologic dysfunction, significant respiratory conditions, and hypotension were strongly associated with sepsis diagnosis, hospital mortality, and intensive care. Fever, present in only a minority of patients, was associated with improved mortality (odds ratio, 0.67, 95% CI, 0.64–0.70; p < 0.001). For common symptoms, the peak time of symptom onset before sepsis was 2 days, except for altered mental status, which peaked at 1 day prior to presentation. Conclusions:. The clinical presentation of sepsis was heterogeneous and occurred with rapid onset prior to hospital presentation. These findings have important implications for improving public education, clinical treatment, and quality measures of sepsis care.

Patients with prolonged neutropenia are at risk for a variety of complications and infections including the development of mucositis and oral ulcers. The changes in oral flora during chemotherapy and its effects on the development of infections of the oral cavity have been studied with inconsistent results. However, there is evidence that supports the colonization of gram negative rods in patients undergoing chemotherapy. In this report, we present two leukemic patients who developed oral ulcers secondary to multi-drug resistant Pseudomonas aeruginosa. It is important to suspect multi-drug resistant gram negative rods in patients with prolonged neutropenia who develop gum infections despite appropriate antibiotic coverage.

Bacillus cereus is a Gram-positive rod that is now recognized as a rare cause of frank disease in the neutropenic hematologic malignancy patient. Because this pathogen is rarely isolated in clinical specimens, no large studies exist to guide the management of these acutely ill patients. Individual case reports and case series exist in the literature describing various clinical manifestations of B. cereus in the neutropenic patient including bacteremia/septicemia, pneumonia, meningitis/encephalitis, hepatic abscesses, and gastritis. In this report, we describe a case of typhlitis caused by B. cereus in a 74-year-old female with recently diagnosed acute myelogenous leukemia (AML), and we summarize the available English language literature to draw tentative conclusions regarding the clinical manifestations of this organism.

Enteropathogenic Escherichia coli (EPEC) is a common cause of watery diarrhea in children in the developing world and an infrequent cause of significant diarrhea in adult patients. EPEC diarrhea, while not commonly seen in cancer patients, can cause significant distress to patients, and antimicrobial choice for this condition in this patient population is not clearly delineated in the literature. We report 3 cases of EPEC diarrhea in cancer patients and discuss the use of azithromycin for successful treatment of these patients. Positive outcomes were seen while using azithromycin in our first two patients and ciprofloxacin in our third patient.

This report describes a case of necrotizing fasciitis presenting with septic shock due to an Aeromonas infection. The patient cut his foot while mowing the lawn and then spent time in a pool with black mold. He began feeling ill and developed swelling and a quarter-sized black area on his right lower extremity. Despite being hemodynamically unstable with systolic blood pressure in the low 70s, the patient was transferred to our facility from outside hospital 100 miles away. Upon arriving to facility, the patient appeared to be septic and the infected area of skin had grown. Irrigation and debridement were performed and appropriate antibiotic therapy was given; however, the patient subsequently died on hospital day 8. On review of the literature, cases of necrotizing fasciitis due to Aeromonas infection have been treated successfully with the aforementioned therapy; however, there is high mortality associated with these infections, many times related to a delayed diagnosis. Our patient also had multiple poor prognostic factors including hepatic dysfunction and immunosuppression.

Vaccines containing live attenuated bacterial or viral organisms are currently being investigated as potential therapy for locally advanced or metastatic cancers. However, the use of such live organisms in an immunocompromised population, such as patients who recently or are currently receiving chemotherapy, raises the concern that these organisms can themselves disseminate and cause frank infection. We report a hereunto unreported phenomenon of anti-cancer vaccines (containing live attenuated organisms) leading to frank, disseminated infection. We submit that occurrence of this phenomenon must be watched for by all members of the interdisciplinary cancer treatment team. Keywords: Vaccine-induced disease, Anti-cancer vaccine, Listeria monocytogenes, Adenovirus

The first case of pulmonary talcosis or talc pneumoconiosis related to inhalation of talc during its extraction and processing in mines was described by Thorel in 1896. Pulmonary talcosis is most commonly seen secondary to occupational exposure or intravenous (IV) drug abuse and, occasionally, in excessive use of cosmetic talc. Based on literature review, there has been an increase in reported incidents of pulmonary talcosis due to various forms of exposure to the mineral. We report an 82-year-old man who is diagnosed with Philadelphia chromosome positive pre-B cell acute lymphoblastic leukemia (ALL) treated with palliative imatinib who presented with chronic hemoptysis and dyspnea shortly after his diagnosis. His symptoms were initially thought to be due to an infectious etiology due to his malignancy, immunocompromised state, and radiographic findings until high-resolution computerized tomographic (HRCT) findings showed a diffuse pulmonary fibrosis picture that prompted further questioning and a more thorough history inquiry on his exposure to causative agents of interstitial lung disease. Very often, patients do not recognize their exposure, especially in those whose exposure is unrelated to their occupation. Our case emphasizes the need for thorough and careful history taking of occupational and nonoccupational exposure to known causative agents of interstitial lung disease.

Invasive fungal infections are a significant cause of morbidity and mortality. Endogenous fungal endophthalmitis is a rare intraocular infection with potential vision threatening consequences. Our review of the literature revealed only one other case of Trichosporon endophthalmitis. Ocular fungal infections are difficult to eradicate because of the limited availability of systemic and intravitreal therapeutic agents and poor tissue penetration of current antifungals. Along with systemic antifungal agents, vitrectomy and intravitreal amphotericin B have been suggested as optimal treatments for fungal endophthalmitis. Other antifungals such as flucytosine and triazoles have recently received consideration. Although the current antifungal therapy is not highly successful, there remains a significant potential for more successful treatments in the future, based on the current studies. We report a case of endogenous trichosporon endophthalmitis that was successfully treated with micafungin and voriconazole. This combination has not been previously reported as a successful therapy in literature. More targeted research is required to uncover additional efficacious therapies to combat trichosporon.

Backgound Nutritionally variant Streptococci (NVS), Abiotrophia and Granulicatella are implicated in causing endocarditis and blood stream infections more frequently than other sites of infection. Neutropenia and mucositis are the most common predisposing factors for infection with other pathogens in cancer patients. In this study we investigated the clinical characteristics of NVS bacteremia in cancer patients and identified risk factors and outcomes associated with these infections. Materials and Methods We retrospectively reviewed all cases of NVS bacteremia occurring from June 1999 to April 2014 at H. Lee Moffitt Cancer Center and Research Institute. The computerized epidemiology report provided by the microbiology laboratory identified thirteen cancer patients with NVS bacteremia. We collected data regarding baseline demographics and clinical characteristics such as age, sex, underlying malignancy, neutropenic status, duration of neutropenia, treatment, and outcome. Results Thirteen patients were identified with positive NVS blood stream infection. Ten patients (77%) had hematologic malignancies, including chronic lymphocytic leukemia (CLL) (1), multiple myeloma (MM) (1), acute myelogenous leukemia (AML) (4), and non Hodgkin’s lymphoma (NHL) (4). The non-hematologic malignancies included esophageal cancer (2) and bladder cancer (1). Conclusion NVS should be considered as a possible agent of bacteremia in cancer patients with neutropenia and a breach in oral, gastrointestinal and genitourinary mucosa (gingivitis/mucositis).

Secondary syphilis has been known since the late 19th century as the great imitator; however, some experts now regard cutaneous lymphoma as the great imitator of skin disease. Either disease, at times an equally fastidious diagnosis, has reported to even mimic each other. It is thus vital to consider these possibilities when presented with a patient demonstrating peculiar skin lesions. No other manifestation of secondary syphilis may pose such quandary as a rare case of rupioid syphilis impersonating cutaneous lymphoma. We present such a case, of a 36-year-old HIV positive male, misdiagnosed with aggressive cutaneous lymphoma, actually exhibiting rupioid syphilis thought secondary to immune reconstitution inflammatory syndrome (IRIS).

Background Pneumonia carries significant morbidity and mortality in leukemic and bone marrow transplant patient. The development of pulmonary infiltrates in the setting of such immunocompromise raises concern for both infectious and non-infectious etiologies, some of which are potentially treatabl. Performing bronchoscopy provides several different options for sampling the lower respiratory tract. Among these, bronchoalveolar lavage (BAL) is especially effective at collecting samples from the alveoli and has been shown to be associated with less risk than transbonchial biops. We sought to examine the effect of antimicrobial treatment on BAL results in a large study population of leukemic and bone marrow transplant patients. Subjects and Methods This retrospective chart review was performed at a single academic cancer center. A power analysis was performed to determine the appropriate sample size. The patients were selected from those who had undergone an inpatient bronchoscopy in reverse chronological order until 300 patients with either a hematopoietic stem cell transplant or hematologic malignancy were identified. The exclusion criteria were age

NF- κB essential modulator (NEMO) is a kinase integral to the macrophage TNF-α pathway, which leads to the intracellular destruction of Mycobacteria species. Defects in the NEMO pathway lead to a spectrum of diseases, including but not limited to ectodermal dysplasia, Mendelian susceptibility to mycobacterial diseases, and incontinentia pigmenti. In addition, paucity of NEMO can lead to the inability to mount a proper immune response against opportunistic pyogenic and mycobacterial infections, leading to dissemination to various organ systems. This manuscript will discuss the numerous clinical manifestations of NEMO deficiency, the differential diagnosis for atypical mycobacterial infections in immunocompetent adults, and feature a case report of rare isolated susceptibility to disseminated atypical mycobacteria due to a mutation in the first exon of the NEMO gene.

Introduction During the last decades, gram-positive bacteremia has increased dramatically. Gram-positive cocci are the most frequent cause of nosocomial bloodstream infections. Among Gram-positive cocci, Viridans streptococci are a common cause of bacteremia in cancer patients with neutropenia, causing serious complications such as pneumonia, septic shock, and ARDS [1-6]. We present a series of cases of VGS bacteremia complicated with ARDS; early initiation of corticosteroids resulted in complete recovery. Materials and Methods A retrospective chart review of patients with hematologic malignancy diagnosed with VGS bacteremia admitted to the Moffitt Cancer Center in Tampa, Florida between 1/1/2001 and 4/1/2012 was completed. Data was collected about respiratory symptoms, diagnosis of adult respiratory syndrome, results of blood cultures, medications received and outcome. Results In this study, 70 cases of VGS bacteremia in neutropenic patients were reviewed. The most common adverse event of VGS bacteremia in this group of patients is the development of serious pulmonary complications such as ARDS. In our study, 7 patients developed ARDS. The most common identifies streptococcal species was Streptococcus mitis, isolated in 4 of 7 patients. All 7 patients received corticosteroids early with the onset of respiratory failure. The most commonly prescribed regimen was methylprednisolone 60 mg intravenously every 12 hour for an average of 3 days. All patients received comparable supportive care, appropriate antibiotics, ventilation and hemodynamic support. All patients (100 %) recovered from respiratory failure after receiving corticosteroids. There were no significant adverse events attributable to steroids use. Conclusion Streptococcus mitis is the species most frequently isolated from the patients who have developed ARDS from Streptococcus viridans bacteremia. Our data suggest that the early administration of corticosteroids to neutropenic patients who develop early signs of respiratory failure with VGS bacteremia can prevent the progression of ARDS and improve mortality. Moderate doses of steroids with short duration of administration were not associated with significant adverse events in our case series. While the use of corticosteroids in this setting has been described in the literature since the early 1990s, there remains a scarcity of data and our study help shed some light on this area. Moreover there is little recognition among clinicians of the association between ARDS and VGS bacteremia (particularly mitis species in neutropenic cancer patients) and thus this treatment modality is used late in the course of illness which may reduce benefit. Further studies are warranted to validate these findings and to further examine the utility of preemptive use of corticosteroids in cancer patients who develop VGS bacteremia, in regards to ARDS incidence reduction.

Abstract Background Escherichia coli (E. coli) is a pathogen of great concern in immunosuppressed patients. While antimicrobial prophylactic therapy has become the standard, the emergence of resistant pathogens has some questioning its use. This study describes our experience with E.coli as a pathogen in neutropenic patients with a hematologic malignancy, and addresses future directions of treatment for this patient population. Methods A retrospective chart review of 245 E.coli bacteremia patients at Moffitt Cancer Center from 05/18/02 – 05/15/12 was conducted. Patients were identified via microbiology laboratory computerized records. Results The included patients experienced clinically significant E.coli bacteremia resulting in a median hospital stay of 14.7 days. Several patients developed severe sepsis requiring the use of pressor and ventilator therapy. Conclusions E.coli is a major pathogen in these patient populations resulting in extended hospital stays and specialized treatment to overcome their E.coli bacteremia. The data supports the use of fluoroquinolone prophylactic therapy, however, earlier detection and treatment of neutropenic infection is needed.

The use of hematopoietic cell transplant (HCT) for the treatment of hematological malignancies has continued to grow over the last 10 years. . The development of new treatment strategies has minimized the severity and duration of immune suppression following transplantation. This article will review the management and challenges of the most common encountered infections after HCT.

Organisms that are not known to cause serious infection in the immunocompetent population can in fact cause devastating illness in immunosupressed neutropenic populations especially those who are undergoing hematopoietic stem cell transplantation (HSCT), and solid organ transplantation or a history of malignancy. One organism of interest isolated from immunosupressed patients at our institution was Bordetella bronchiseptica. B. bronchiseptica is a Gram-negative, rod shaped bacterium, primary respiratory tract organism known to cause respiratory tract disease in the animal population which include dogs, cats, and rabbits. This organism rarely causes serious infection in the immunocompetent population. However; in immunosupressed patients, it can cause serious pulmonary disease. We present three cases of B. bronchiseptica isolated from patients with a history of malignancy a serious pulmonary infection.

Tacrolimus is an immunosuppressive drug mainly used to lower the risk of transplant rejection in individuals who are post solid organ or hematopoietic transplantation. It is a macrolide which reduces peptidyl-propyl isomerase activity and inhibits calcineurin, thus inhibiting T-lymphocyte signal transduction and interleukin-2 (IL-2) transcription. It has been associated with Posterior Reversible Encephalopathy Syndrome (PRES), a disease of sudden onset that can present as a host of different symptoms, depending on the affected area of the brain. While infectious causes of encephalopathy must always be entertained, the differential diagnosis should also include PRES in the appropriate context. We report three cases of PRES in patients with acute myeloid leukemia (AML) placed on tacrolimus after receiving a bone marrow transplant (BMT). The focus of this review is to enhance clinical recognition of PRES as it is related to an adverse effect of Tacrolimus in the setting of hematopoietic transplantation.

We report the nucleotide sequence of human geranylgeranyl diphosphate (GGPP) synthase cDNA isolated from a fetal heart library. The 2.5 kb cDNA encodes a protein of 34 kDa. The protein contains six domains that have been identified previously in many other prenyltransferases. Recombinant, purified histidine-tagged protein exhibited the enzymatic properties associated with GGPP synthase, namely the synthesis of GGPP from farnesyl diphosphate and isopentenyl diphosphate. Transient transfection of mammalian cells with a plasmid encoding the putative GGPP synthase resulted in a 55-fold increase in GGPP synthase activity. Taken together, these results establish that the cDNA encodes the mammalian GGPP synthase protein. The mRNA for GGPP synthase was expressed ubiquitiously. Of the 16 human tissues examined, the highest expression of the mRNA was in testis. The mRNA levels in cultured HeLa cells were unaffected by alterations in cellular sterol levels and contrasted with the significant regulation of isopentenyl diphosphate synthase mRNA under these same conditions. Fluorescent in situ hybridization was used to map the single gene encoding human GGPP synthase to chromosome 1q43.—Ericsson, J., J. M. Greene, K. C. Carter, B. K. Shell, D. R. Duan, C. Florence, and P. A. Edwards. Human geranylgeranyl diphosphate synthase: isolation of the cDNA, chromosomal mapping, and tissue expression.

Family forest owners (FFOs) control a majority of private forestland in the United States and have widely diverse ownership and management objectives. Many FFOs manage their holdings for timber production and, thus, are concerned with issues such as reforestation incentives and tax treatment of timber revenues. Their actual knowledge of the tax aspects of timber management varies, with some owners even unaware of the federal income tax provisions that apply to timber. This research used econometric techniques to establish socioeconomic predictors of FFO awareness and use of federal income tax provisions. Socioeconomic factors (such as size of forest holding, ownership objective, education, age, and income) were evaluated in terms of association with awareness and use of income tax provisions. Data were obtained from a survey of 1350 South Carolina FFOs (472 useable responses). A two-step sample selection methodology revealed that membership in a landowner organization and size of forest holding positively influence landowner awareness of the seven tax provisions, while ownership objective and level of education exhibited varying degrees of influence. Overall, the findings suggest that size of forest holding is the key determinant that influences landowner use of the provisions. These tax incentives are one of the foundations of federal policies encouraging active forest management by FFOs and the effectiveness of the various incentives has crucial implications for forest policy analysis.