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Objective. Technical advances in deep brain stimulation (DBS) are crucial to improve therapeutic efficacy and battery life. We report the potentialities and pitfalls of one of the first commercially available devices capable of recording brain local field potentials (LFPs) from the implanted DBS leads, chronically and during stimulation. The aim was to provide clinicians with well-grounded tips on how to maximize the capabilities of this novel device, both in everyday practice and for research purposes. Approach. We collected clinical and neurophysiological data of the first 20 patients (14 with Parkinson’s disease (PD), five with dystonia, one with chronic pain) that received the Percept™ PC in our centres. We also performed tests in a saline bath to validate the recordings quality. Main results. The Percept PC reliably recorded the LFP of the implanted site, wirelessly and in real time. We recorded the most promising clinically useful biomarkers for PD and dystonia (beta and theta oscillations) with and without stimulation. Furthermore, we provide an open-source code to facilitate export and analysis of data. Critical aspects of the system are presently related to contact selection, artefact detection, data loss, and synchronization with other devices. Significance. New technologies will soon allow closed-loop neuromodulation therapies, capable of adapting stimulation based on real-time symptom-specific and task-dependent input signals. However, technical aspects need to be considered to ensure reliable recordings. The critical use by a growing number of DBS experts will alert new users about the currently observed shortcomings and inform on how to overcome them.

As the number of patients implanted with deep brain stimulation systems increases, coexistence with cardiac implantable electronic devices (CIEDs) poses questions about safety. We systematically reviewed the literature on coexisting DBS and CIED. Eighteen reports of 34 patients were included. Device-device interactions were reported in 6 patients. Sources of complications were extensively reviewed and cautious measures which could be considered as part of a standard checklist for careful consideration are suggested.

BackgroundTechnical advances in deep brain stimulation (DBS) are crucial to improve therapeutic efficacy and battery life. A prerogative of new devices is the recording and processing of a given input signal to instruct the delivery of stimulation.ObjectiveWe studied the advances and pitfalls of one of the first commercially available devices capable of recording brain local field potentials (LFP) from the implanted DBS leads, chronically and during stimulation.MethodsWe collected clinical and neurophysiological data of the first 20 patients (14 with Parkinson’s disease [PD], five with various types of dystonia, one with chronic pain) that received the Percept™ PC in our centers. We also performed tests in a saline bath to validate the recordings quality.ResultsThe Percept PC reliably recorded the LFP of the implanted site, wirelessly and in real time. We recorded the most promising clinically useful biomarkers for PD and dystonia (beta and theta oscillations) with and without stimulation. Critical aspects of the system are presently related to contact selection, artefact detection, data loss, and synchronization with other devices. Furthermore, we provide an open-source code to facilitate export and analysis of data.ConclusionNew technologies will soon allow closed-loop neuromodulation therapies, capable of adapting the stimulation based on real-time symptom-specific and task-dependent input signals. However, technical aspects need to be considered to ensure clean synchronized recordings. The critical use by a growing number of DBS experts will alert new users about the currently observed shortcomings and inform on how to overcome them.

Background: To systematically evaluate the effectiveness of deep brain stimulation of the globus pallidus internus (GPi-DBS) in dystonia on pre-operatively set functional priorities in daily living.\ud Methods: Fifteen pediatric and adult dystonia patients (8 male; median age 32y, range 8–65) receiving GPi-DBS were recruited. All patients underwent a multidisciplinary evaluation before and 1-year post DBS implantation. The Canadian Occupational Performance Measure (COPM) first identified and then measured changes in functional priorities. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate dystonia severity.\ud Results: Priorities in daily functioning substantially varied between patients but showed significant improvements on performance and satisfaction after DBS. Clinically significant COPM-score improvements were present in 7/8 motor responders, but also in 4/7 motor non-responders.\ud Discussion: The use of a patient-oriented approach to measure GPi-DBS effectiveness in dystonia provides an unique insight in patients’ priorities and demonstrates that tangible improvements can be achieved irrespective of motor response.\ud Highlights\ud • Functional priorities in life of dystonia patients and their caregivers vary greatly\ud • The effect of DBS on functional priorities did not correlate with motor outcome\ud • Half of the motor ‘non-responder’ patients reported important changes in their priorities\ud • The effect of DBS in dystonia should not be measured by motor outcome alone

BACKGROUND: Effects on non-motor symptoms, mainly cognitive and psychiatric side effects, could influence the decision for either globus pallidus pars interna (GPi) or subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with Parkinson's disease (PD).OBJECTIVE: 1) To compare cognitive and psychiatric outcomes 3 years after GPi DBS versus STN DBS, and 2) to report on occurrence of suicidal ideation, psychiatric diagnoses, social functioning, and marital satisfaction 3 years after DBS.METHODS: Patients were randomized to receive GPi DBS (n = 65) or STN DBS (n = 63). Standardized assessments were performed at baseline, 1 year, and 3 years. We used linear mixed model analyses to investigate between-group differences on the Mattis Dementia Rating Scale (MDRS), neuropsychological tests, and psychiatric questionnaires 3 years after DBS.RESULTS: Eighty-seven patients (68%) completed at least one neuropsychological test after 3 years. No significant between-group differences were found on the MDRS (p = 0.61), neuropsychological tests (p-values between 0.17 and 0.87), and psychiatric questionnaires (p-values between 0.23 and 0.88) 3 years after DBS. The Mini International Neuropsychiatric Interview did not indicate a substantial number of psychiatric diagnoses after 3 years. Social functioning and marital satisfaction were comparable in both groups.CONCLUSIONS: Three years after GPi DBS and STN DBS no pronounced between-group differences on measures of cognitive and psychiatric functioning could be demonstrated. Overall, cognitive and psychiatric outcome 3 years after DBS do not provide a clear direction for clinicians when considering which of these two surgical targets to choose.

Il progetto dello spazio aperto e collettivo delle citta termali si e alimentato, nel corso del XX secolo, di situazioni e occasioni ‘altre’ rispetto alle urgenze della crescita quantitativa della citta industriale. I materiali tradizionali dello spazio pubblico e collettivo sono stati declinati in tipologie e forme tese a realizzare spazi urbani di elevata qualita. Il progetto urbanistico e stato guidato da un’idea di benessere allargata all’intera organizzazione del sistema urbano. La riqualificazione degli spazi aperti centrali di Salsomaggiore Terme, tema oggetto di un Laboratorio di progettazione urbanistica per la qualita ambientale, nonche di una mostra e di un convegno di urbanistica partecipata condivisi con l’amministrazione comunale, e stata l’occasione per riflettere sul progetto dello spazio collettivo contemporaneo di questi luoghi ad elevata identita

Background This study set out to determine whether structural changes are present outside the thalamus after thalamotomy in patients with essential tremor (ET), specifically in the cerebellorubrothalamic tracts. We hypothesized that diffusion tensor imaging (DTI) would detect these changes. Methods We collected DTI scans and analyzed differences in Fractional Anisotropy (FA) and Mean Diffusivity (MD) between the left and right superior and middle cerebellar peduncle in ET patients that have undergone unilateral, left, thalamotomy and ET patients that did not undergo thalamotomy (control group). We used classical ROI-based statistics to determine whether changes are present. Results We found decreased FA and increased MD values in the right superior cerebellar peduncle leading to the left, lesioned thalamus, only in the thalamotomy group. Conclusions Our study suggests long-term structural changes in the cerebellorubrothalamic tract after thalamotomy. This contributes to further understanding of the biological mechanism following surgical lesions in the basal ganglia.

BACKGROUND: Displacement of deep brain stimulation (DBS) electrodes may occur after surgery, especially due to large subdural air collections, but other factors might contribute.OBJECTIVE: To investigate factors potentially contributing to postoperative electrode displacement, in particular, different lead-anchoring techniques.METHODS: We retrospectively analyzed 55 patients (106 electrodes) with Parkinson disease, dystonia, tremor, and obsessive-compulsive disorder in whom early postoperative and long-term follow-up computed tomography (CT) was performed. Electrodes were anchored with a titanium microplate or with a commercially available plastic cap system. Two independent examiners determined the stereotactic coordinates of the deepest DBS contact on early postoperative and long-term follow-up CT. The influence of age, surgery duration, subdural air volume, use of microrecordings, fixation method, follow-up time, and side operated on first was assessed.RESULTS: Subdural air collections measured on average 4.3 +/- 6.2 cm(3). Three-dimensional (3-D) electrode displacement and displacement in the X, Y, and Z axes significantly correlated only with the anchoring method, with larger displacement for microplate-anchored electrodes. The average 3-D displacement for microplate-anchored electrodes was 2.3 +/- 2.0 mm vs 1.5 +/- 0.6 mm for electrodes anchored with the plastic cap (P = .030). Fifty percent of the microplate-anchored electrodes showed 2-mm or greater (potentially relevant) 3-D displacement vs only 25% of the plastic cap-anchored electrodes (P CONCLUSION: The commercially available plastic cap system is more efficient in preventing postoperative DBS electrode displacement than titanium microplates. A reliability analysis of the electrode fixation is warranted when alternative anchoring methods are used.

Background: Patients with advanced Parkinson's disease often have rapid swings between mobility and immobility, and many respond unsatisfactorily to adjustments in pharmacological treatment. We assessed whether globus pallidus pars interna (GPi) deep brain stimulation (DBS) gives greater functional improvement than does subthalamic nucleus (STN) DBS.Methods: We recruited patients from five centres in the Netherlands who were aged 18 years or older, had idiopathic Parkinson's disease, and had, despite optimum pharmacological treatment, at least one of the following symptoms: severe response fluctuations, dyskinesias, painful dystonias, or bradykinesia. By use of a computer-generated randomisation sequence, we randomly assigned patients to receive either GPi DBS or STN DBS (1:1), applying a minimisation procedure according to drug use (levodopa equivalent dose Findings: Between Feb 1, 2007, and March 29, 2011, we enrolled 128 patients, assigning 65 to GPi DBS and 63 to STN DBS. We found no statistically significant difference in either of our primary outcomes: mean change in weighted ALDS (3·0 [SD 14·5] in the GPi group vs 7·7 [23·2] in the STN group; p=0·28) and the number of patients with cognitive, mood, and behavioural side-effects (36 [58%] of 62 patients in the GPi group vs 35 [56%] of 63 patients in the STN group; p=0·94). Secondary outcomes showed larger improvements in off-drug phase in the STN group compared with the GPi group in the mean change in unified Parkinson's disease rating scale motor examination scores (20·3 [16·3] vs 11·4 [16·1]; p=0·03), the mean change in ALDS scores (20·3 [27·1] vs 11·8 [18·9]; p=0·04), and medication (mean levodopa equivalent drug reduction: 546 [SD 561] vs 208 [521]; p=0·01). We recorded no difference in the occurrence of adverse events between the two groups. Other secondary endpoints showed no difference between the groups.Interpretation: Although there was no difference in our primary outcomes, our findings suggest that STN could be the preferred target for DBS in patients with advanced Parkinson's disease.Funding: Stichting Internationaal Parkinson Fonds, Prinses Beatrix Fonds, and Parkinson Vereniging.

BACKGROUND: Accurate electrode position is important for the efficacy of deep brain stimulation (DBS). Several reports revealed errors during stereotactic surgery due to cerebrospinal fluid (CSF) loss and subdural air invasion. Because subdural air resolves in the weeks after surgery and the brain returns to its original position, DBS electrodes may become displaced postoperatively. OBJECTIVE: To quantitatively assess postoperative DBS electrode displacement in relation to subdural air invasion. METHODS: We retrospectively analyzed 14 patients with advanced Parkinson disease and subthalamic nucleus DBS electrodes that underwent immediate postoperative frame-based stereotactic computer tomography (CT) and repeated CT after longer follow-up. We performed volumetric measurements of postoperative subdural air collections on both sides of the brain and determined stereotactic coordinates of the deepest DBS contact on the direct postoperative and follow-up CT. RESULTS: Subdural air collections measured on average 17 ± 24 cm 3 . Consequently, the frontal cortex shifted posteriorly. On follow-up imaging after 16 ± 8 months, air collections had resolved and the frontal cortex had returned to its original position, causing anterior curving of the electrodes. The electrodes moved on average 3.3 ± 2.5 mm upward along the trajectory. This displacement significantly correlated with the amount of post-operative subdural air. CONCLUSION: Considerable displacement of DBS electrodes may occur in the weeks following surgery, especially in cases with large postoperative subdural air volumes. Postoperative documentation of electrode localization should therefore be repeated after longer follow-up.

Papillary glioneuronal tumor is a recently described central nervous system neoplasm that almost always occurs adjacent to the lateral ventricle. We present a case of this rare entity, representing the 21st case of this lesion, which exhibits a mixed astrocytic and neuronal differentiation. This case was an incidental finding in a young woman who presented secondary to a traumatic injury to the left eye. Histologic evaluation after surgical removal showed a cystic tumor consisting of 2 distinct components: a unique pseudopapillary architecture admixed with foci of solid areas. The pseudopapillae were composed of thick hyalinized vessels enclosed by a single layer of glial fibrillary acid protein-positive astrocytes and variously sized synaptophysin-positive and chromogranin-negative neuronal cells in the interpapillary regions. Abundant Rosenthal fibers, foci of calcification, areas of hemosiderin deposition, gliosis, areas of vascular proliferation associated with piloid gliosis, and chronic inflammatory infiltrate were identified. The combination of cytologic benignity, lack of necrosis, and low proliferative index as evidenced by immunohistochemistry using antibody to Ki-67 confirmed the low malignant potential of this tumor. Knowledge and precise classification of this entity are important to avoid unnecessary use of chemo- and/or radiotherapy for treatment.

Cytologically, the distinction between bronchioalveolar carcinoma and reactive/reparative processes of respiratory epithelium can be difficult. Retrospectively, we have identified 11 consecutive cases of bronchioalveolar carcinoma from the cytology files of University Missouri-Kansas City/Truman Medical Center. On average, a combined 5.71 cytologic/histologic procedures were performed before reaching a definitive diagnosis for this group. An additional seven random cases of reactive/reparative respiratory cases of adult respiratory distress syndrome patients were used as a control. Cytomorphometric analysis was performed. The mean average nuclear diameter for the carcinoma group was 13.76 microns and for the reactive/reparative group was 13.29 microns. There was no statistical difference between the two groups (paired student t test, P > .05). It appears from our data that mean nuclear diameter is not a discriminator for the cytologic distinction between bronchioalveolar carcinoma and reactive/reparative respiratory epithelium and that the accepted cytologic parameters of for bronchioalveolar carcinoma are more valid.

Soil is an important factor in regional and global C budgets because it serves as a reservoir of large amounts of organic C. In our study, we compared six approaches of estimating soil organic C (kg C m -2 , not including the surface organic horizon, hereafter called soil C) and its spatial pattern in the mountainous, largely forested western Oregon region. The approaches were (i) USDA NRCS pedons, (ii) other pedons, (iii) the State Soil Geographic Data Base (STATSGO), (iv) the United Nations Soil Map of the World, (v) the National Soil Geographic Data Base (NATSGO), and (vi) an ecosystem-complex map. Agreement between approaches varied with scale. For the entire region (10 5 km 2 ), estimates of average soil C varied from 4.3 to 6.8 kg C m -2 for the 0- to 20-cm depth and from 12.1 to 16.9 kg C m -2 for the 0- to 100-cm depth. At the subregional scale (10 4 km 2 ), all approaches indicated higher soil C in the coastal area than in the inland southern area, but relative amounts in other subregions varied among the approaches. At the subsubregional scale (10 3 km 2 ), soil C was consistent between individual STATSGO map units and NRCS pedons within those map units, but there was less agreement with other pedons. Rigorous testing of soil-C maps requires data from pedons that are located by objective criteria, in contrast to the subjectively located pedons now available. The uncertainty associated with regional soil-C amounts and spatial patterns should be considered when soil-C maps are integrated into regional or global assessments of physical and biotic processes because simulation-model outputs may be sensitive to soil C.

Objective: The aim of this study was to investigate whether directional steering through a novel 32-contact electrode is safe and can modulate the thresholds for beneficial and side effects of stimulation. Methods: The study is a single-center, performance and safety study. Double-blind intraoperative evaluations of the thresholds for therapeutic benefit and for side effects were performed in 8 patients with Parkinson disease while stimulating in randomized order in spherical mode and in 4 different steering modes with the 32-contact electrode, and in monopolar mode with a commercial electrode. In addition, simultaneous recordings of local field potentials through all 32 contacts were performed. Results: There were no adverse events related to the experimental device. For 13 of 15 side effects (87%), the threshold could be increased by ≥1 mA while steering in at least one direction in comparison to conventional spherical stimulation, thereby increasing the therapeutic window by up to 1.5 mA. Recording local field potentials through all 32 electrode contacts yielded spatiotemporal information on pathologic neuronal activity. Conclusions: Controlled steering of current through the brain may improve the effectiveness of deep brain stimulation (DBS), allow for novel applications, and provide a tool to better explore pathophysiologic activity in the brain. Classification of evidence: This study provides Class IV evidence that for patients with Parkinson disease, steering DBS current is well tolerated, increases the threshold for side effects, and may improve the therapeutic window of subthalamic nucleus DBS as compared with current standard spherical stimulation.

Historically, fine-needle aspiration of the female breast has been accepted as a useful modality in the diagnosis of ductal as well as other types of breast carcinoma. However, cases of well differentiated small-cell duct carcinoma can be problematic. The differential diagnoses include fibrocystic disease, papillary neoplasia, fibroadenoma, and lobular carcinoma. Retrospectively, 16 cases of well differentiated small-cell duct carcinoma have been identified in the case files of Truman Medical Center/University of Missouri-Kansas City. Patient's ages ranged from 29-81 yr, with the mean being 56.2 yr. The overall cytologic features consisted predominantly of a hypercellular specimen with cohesive and rarely discohesive cells with no demonstrable nuclear atypia. For well differentiated small-cell duct carcinoma, the mean nuclear diameter was greater than that of a red cell (6-8 microns). For the well differentiated small-cell duct carcinoma group, the mean nuclear diameter was 9.86 microns; for fibrocystic disease, 12.86 microns; for papillomas, 8.28 microns; for fibroadenomas, 9.48 microns; and for lobular carcinoma, 11.88 microns. From our data, it appears that specific attention to the clinical presentation, cytologic pattern, and nuclear diameters are useful discriminators for well differentiated small-cell duct carcinoma.

Forests of the Pacific Northwest region of the U.S.A. are part of an ongoing political debate that focuses on the trade-offs between commodity and non-commodity values. A key issue in this debate is the location and extent of closed canopy mature and old-growth forest remaining in the region. Remote sensing can play a major part in locating mature and old-growth forests, but. several challenges must be overcome to do so with acceptable accuracy. Conifer forests of the region have high leaf area indices. Thus, most incident solar energy is absorbed, making these forests difficult targets for discrimination of classes. Additionally, spectral characteristics can be affected more by the effects of steep topography than condition of the closed canopy forest. Experimenting with a number of techniques, we estimated and mapped forest age and structure in 1988 over a 1 237 482 ha area on the west side of the Oregon Cascade Range with an overall accuracy of 82 per cent. Unsupervised classification enabled ...

The cytologic distinctions between artifactual atypia induced by endocervical brush collection, endocervical glandular repair, and endocervical glandular dysplasia or neoplasia are often difficult. This difficulty is amplified by the lack of accepted cytologic criteria for endocervical glandular dysplasia, and the fact that earlier studies defining the significant cytologic features of endocervical adenocarcinoma in situ and endocervical adenocarcinoma (endocervical neoplasia) utilized a swab for endocervical cell retrieval. With the almost universal adoption of the endocervical brush, it is important to redefine those cytologic characteristics that differentiate true endocervical glandular dysplasia or neoplasia from reactive or reparative processes and instrument artifact. From our data, it appears that the classically described cytologic discriminators between a negative smear and smears of endocervical dysplasia or neoplasia are basically unchanged with some minor modifications for endocervical brush-collected samples. Diagn Cytopathol 1994; 11:79–84. © 1994 Wiley-Liss, inc.

A case of multinodular goiter with multicentric papillary hyperplasia is presented with cytologic features suggestive of thyroid papillary carcinoma. While the cytologic criteria for papillary thyroid carcinoma is well defined, occasional diagnostic difficulties can arise. Cytologically, the presence of focal papillary aggregates, the presence of a psammoma body within a background of copious colloid and scattered follicular cells led to diagnostic confusion. Histologically, the presence of secondary follicles in the papillae and protrusion of the papillary structures into colloid lakes supported the diagnosis of goiter. It is our opinion that most, if not all, of these difficulties can be circumvented by the incorporation of all major and some minor cytologic criteria for papillary carcinoma in the analysis of such lesions. Single criteria for papillary carcinoma, either major or minor, is not sufficient.

A case of minor salivary gland clear cell adenocarcinoma of the palate with metastasis to the lungs in a 53-year-old female is presented. Histologically, the cells were characterized by glycogen rich clear cells arranged in solid nests, trabeculae, surrounded by hyalinized fibrous stroma. We believe this represents an aggressive form of this type of tumor.

Status dystonicus (SD) is a life threatening disorder that develops in patients with both primary and secondary dystonia, characterized by acute worsening of symptoms with generalized and severe muscle contractions. To date, no information is available on the best way to treat this disorder. We review the previously described cases of SD and two new cases are reported, one of which occurring in a child with static encephalopathy, and the other one in a patient with pantothenate kinase-associated neurodegeneration. Both patients were admitted to an intensive care unit and treated with midazolam and propofol. This approach proved to be useful in the former while the progressive nature of the dystonia of the second patient required the combination of intrathecal baclofen infusion and bilateral pallidal deep brain stimulation. We believe that a rapid and aggressive approach is justified to avoid the great morbidity and mortality which characterize SD. Our experience, combined with the data available in the literature, might permit to establish the best strategies in managing this rare and severe condition.

A 33-yr-old African-American male with known human immunodeficiency virus (HIV) positivity underwent CT guided fine-needle aspiration biopsy of an anterior mediastinal mass. The aspirate was composed of a dimorphic population of cells that included small mature lymphoid cells and scattered cohesive groups of large epithelial cells in equal numbers. The neoplasm stained strongly for low weight molecular cytokeratin, epithelial membrane antigen (EMA), leukocyte common antigen (LCA), and Leu-7 which was consistent with a diagnosis of thymoma. Subsequent biopsies determined the neoplasm to be a malignant (invasive) thymoma. This case emphasizes the efficacy of FNA biopsy for the evaluation of anterior mediastinal masses in HIV infected individuals. Additionally, the differential cytologic diagnoses for HIV infected individuals for this anatomic site are discussed.

We describe the phenotype of DYT13 primary torsion dystonia (PTD) in a family first examined in 1994. A complete neurological evaluation was performed on all available family members: 8 individuals were definitely affected by dystonia. The family was re-evaluated in March 2000: at that time, 3 more individuals had developed symptoms of dystonia. Inheritance of PTD was autosomal dominant, with affected individuals spanning three consecutive generations and male-to-male transmission. Age at onset ranged from 5 to 43 years. Onset occurred either in the craniocervical region or in upper limbs. Progression was mild, and the disease course was benign in most affected individuals; generalization occurred only in 2 cases. We did not find anticipation of age at onset or of disease severity through generations. Most subjects presented with jerky, myoclonic-like dystonic movements of the neck or shoulders. DYT13-PTD is an autosomal dominant disease, with incomplete penetrance (58%). Clinical presentation and age at onset were more variable than in DYT1-PTD, and the neck was involved in most of those affected. Moreover, the individuals with generalised dystonia were not severely disabled and were able to lead independent lives. To date, this is the only family with DYT13-PTD.

Autoantibodies directed against nucleic acid and protein complexes present in cell nuclei characterize autoimmune diseases and are employed in diagnosis. The mechanisms by which these autoantigens escape immunological tolerance are largely unknown, but a number of recent observations suggest that modified self-protein generated during apoptosis my play an important part in the development of autoimmunity. To investigate the possibility that autoantibodies in patients with Sjögren's syndrome are induced by apoptosis and presented on the surface of the cell, the internal distribution of autoantigens in apoptotic human salivary gland cells was studied in vitro. Salivary gland cells were treated with tumour necrosis factor-alpha, an apoptosis inducer. At increasing times after induction, cells were homogenized and cytoplasmic, cell surface membrane and nuclear compartments were fractionated using a sucrose density-gradient system. Autoantigens alpha-fodrin, SS-A (Ro), SS-B (La), and the enzyme poly(ADP-ribose) polymerase, were detected by conventional immunofluorescence and confirmed by Western immunoblotting. At increasing times after apoptosis, nuclear proteins SS-A (Ro) and SS-B (La), but not poly(ADP-ribose) polymerase were relocated from the cell nucleus to the cell surface membrane. Fodrin, a cytoplasmic protein, was also translocated to the cell membrane after cleavage of alpha-fodrin. These results show that autoantigens fodrin, SS-A (Ro) and SS-B (La) in human salivary gland cells undergo a striking redistribution during apoptosis and relocate to the cell membrane of apoptotic cells. The appearance of autoantigens on the surface of induced cells could form the basis of a mechanism for autoantigen presentation, processing and autoantibody induction.

Objective.—To determine the prevalence of diffuse infiltrative lymphocytosis syndrome (DILS) in the minor salivary glands of 30 African Cameroonian adults with the acquired immunodeficiency syndrome (AIDS).Design.—Salivary gland tissue was analyzed using a modified classification system that was developed to aid the diagnosis of Sjögren syndrome. The advantages and disadvantages of this approach are discussed.Materials and Methods.—Formalin-fixed, paraffin-embedded, hematoxylin-eosin–stained biopsy sections were prepared for 30 patients with AIDS, 26 healthy individuals who declined human immunodeficiency virus (HIV) testing, and 4 seronegative healthy controls. Tissues were immunostained for CD4/CD8+ lymphocytes and cytomegalovirus (CMV), and transmission electron microscopy was performed to locate viral particles. Patients were tested for HIV-1 and HIV-2 by the HIV/Chek System 3 or CAMSTIX-HIV-1 and HIV-2 assay.Results.—Severe salivary ductal atypia (96%) was the feature most strongly associated with AIDS, and the lymphocytic focus score was the second histologic feature most strongly correlated with AIDS. Forty-eight percent of patients with HIV-1 infection had more than 1 lymphocytic focus in a minor salivary gland. These lymphocytes were primarily CD8+. We report, to the best of our knowledge, the first case of multinucleated salivary duct epithelial cells in minor salivary glands also containing enveloped virus particles. All cases were negative for CMV.Conclusions.—The prevalence of DILS in West Africans with AIDS appears higher than the prevalence reported in whites from the United States and Europe and in blacks from the United States, a group that has been reported to have a greater incidence of DILS than whites. This discrepancy may be related to differences in patient selection criteria. The determination of lymphocytic focus score, as used in the diagnosis of Sjögren syndrome, with the adjunct of ductal atypia is useful for assessing DILS. The impact of patient selection, drug therapy, and parasites on salivary gland pathology is discussed.

Background . Management of recurrent spontaneous pneumothorax or symptomatic pleural effusion often uses thoracoscopic pleurodesis, about which many questions remain. Both effectiveness and toxicity of agents currently used for pleurodesis were evaluated in a rabbit model. Methods . Agents administered were autologous blood 1 mL/kg, talc slurry (70 mg · mL −1 · kg −1 ), and doxycycline 10 mg/mL, given through a chest tube to 30 rabbits. Controls had only chest tubes inserted. At 30 days surfaces were graded by gross observation and histologic examination. Blood and lung tissue from all animals were analyzed for enzymes and blood chemistries. Results . Gross observations showed mediastinal thickening and adhesions with doxycycline, and threadlike adhesions with talc. Autologous blood was only slightly more effective than a chest tube alone. Talc significantly increased angiotensin converting enzyme activity in serum, whereas doxycycline changed liver function enzymes and produced tissue toxicity. Conclusions . Doxycycline produced effective pleurodesis but yielded remarkably severe local effects. The distant sequelae of talc and doxycycline pleurodesis—histologic changes in the contralateral lung and serum enzyme elevations—suggests undesirable systemic effects for the commonly used agents, and autologous blood exhibited no significant pleurodesis, short-term. The search for the ideal agent for chemical pleurodesis continues.

Previous studies have shown the predominance of mycolic acid-containing filamentous actinomycetes (mycolata) in foam layers in activated sludge systems. Gordona (formerly Nocardia ) amarae often is considered the major representative of this group in activated sludge foam. In this study, small-subunit rRNA genes of four G. amarae strains were sequenced, and the resulting sequences were compared to the sequence of G. amarae type strain SE-6. Comparative sequence analysis showed that the five strains used represent two lines of evolutionary descent; group 1 consists of strains NM23 and ASAC1, and group 2 contains strains SE-6, SE-102, and ASF3. The following three oligonucleotide probes were designed: a species-specific probe for G. amarae , a probe specific for group 1, and a probe targeting group 2. The probes were characterized by dissociation temperature and specificity studies, and the species-specific probe was evaluated for use in fluorescent in situ hybridizations. By using the group-specific probes, it was possible to place additional G. amarae isolates in their respective groups. The probes were used along with previously designed probes in membrane hybridizations to determine the abundance of G. amarae , group 1, group 2, bacterial, mycolata, and Gordona rRNAs in samples obtained from foaming activated sludge systems in California, Illinois, and Wisconsin. The target groups were present in significantly greater concentrations in activated sludge foam than in mixed liquor and persisted in anaerobic digesters. Hybridization results indicated that the presence of certain G. amarae strains may be regional or treatment plant specific and that previously uncharacterized G. amarae strains may be present in some systems.