Search

Ricin is a highly toxic agent derived from the castor bean plant (Ricinus communis). Poisoning occurs commonly by oral ingestion of the beans. Injection of ricin is believed to be more lethal. Ricin is a large glycosylated protein difficult to detect in clinical samples. Instead, ricinine, a small alkaloid found in the same beans, is used as surrogate marker for ricin exposure. We describe a simple LC-MS/MS method for the detection of ricinine in serum, blood and urine, validated according to EMA guidelines and successfully applied to patient samples of a suicidal death after injection of a castor bean extract. A 26-year-old man self-presented to the emergency department with severe abdominal cramps and nausea after injection of a castor bean extract. Due to rapid deterioration of his hemodynamic function despite early aggressive fluid resuscitation, he was transferred to ICU. Abdominal cramps worsened and a fulminant diarrhea developed, resulting in hypovolemic shock and cardiorespiratory collapse. Despite full supportive therapy, the patient died approximately 10 hours after injection due to multiple organ failure. Ricinine was quantified by LC-MS/MS after LLE with diethyl ether using ricinine-D3 as internal standard. Six hours after injection, ricinine concentrations in serum and blood were 16.5 and 12.9 ng/mL, respectively, which decreased to 12.4 and 10.6 ng/mL, 4 hours later. The urinary concentration was 81.1 ng/mL 7 hours after injection, which amply exceeded the levels previously reported in similar cases with lethal outcome. Concentrations of ricinine, compatible with a lethal exposure to castor beans, were detected in serum, blood and urine. Ricinine was also found in bile and liver tissue.

Objectives Free light chain (FLC) measurement gained a lot of interest for diagnostic workup of monoclonal gammopathy. Methods We evaluated the performance of turbidimetric polyclonal Freelite (The Binding Site, Birmingham, UK) assays on Cobas 6000 (Roche Diagnostics, Rotkreuz, Switzerland) and nephelometric monoclonal N Latex (Siemens Healthcare Diagnostics, Marburg, Germany) assays on BN ProSpec (Dade Behring, Deerfield, IL) vs established nephelometric Freelite assays on BN ProSpec. Results Analytical performance was acceptable. Method comparison (n = 118) showed significant proportional FLC differences for N Latex assays. However, good correlation and clinical concordance were shown. Recovery study in the low concentration range demonstrated consistent over- and underrecovery for Freelite reagents, hampering future research on prognostic value of suppressed noninvolved FLC. Antigen excess detection was successful for κ FLC in three-fourths of cases with Freelite reagents and in all cases with N Latex reagents. However, the latter resulted in underestimated κ FLC concentrations. Conclusions FLC analysis requires continuous awareness of analytical limitations. Monitoring of disease response requires FLC analysis on the same platform using the same reagents.

The causes of high anion gap metabolic acidosis (HAGMA) are well described in the literature. However, sometimes more frequent causes of HAGMA cannot explain its occurrence.In the case of HAGMA and severe neurological depression in the absence of other causes of HAGMA, clinicians should consider an intoxication with gamma-hydroxybutyrate (GHB) as a possible cause.GHB is endogenous to the mammalian central nervous system (CNS). Synthetic GHB was initially used as an anesthetic but is now only licensed for medical use in a limited number of indications such as the treatment of narcolepsy. Because of its euphoric effects, it became popular for recreational use under the street names: Liquid Ecstasy, Georgia Home Boy, and Liquid G.We describe the clinical case of a patient who suffered from severe neurological depression and HAGMA.

Insertion sequences IS481 and IS1001 are targets for molecular detection of respectively Bordetella pertussis and Bordetella parapertussis. There is a raising concern about specificity of these targets due to sequence similarity with Bordetella holmesii and Bordetella bronchiseptica. The likelihood of false (para)pertussis diagnoses should be correlated with the prevalence of these organisms in the respiratory tract (RT). From October 2010 until September 2011, 2,207 RT samples were submitted to the Belgian reference laboratory for pertussis diagnosis. End-point IS481/IS 1001 PCR and culture were performed for B. pertussis and B. parapertussis. We developed a sensitive culture method followed by screening with matrix-assisted laser desorption/ionisation- time of flight mass spectrometry (MALDI-TOF MS) to look for B. holmesii and B. bronchiseptica in our samples,. Only one B. bronchiseptica and no B. holmesii were detected in RT samples from Belgian patients with pertussis-like symptoms.

Laboratory tests for pulmonary sarcoidosis (percentage lymphocytes and CD4/CD8 ratio in bronchoalveolar lavage fluid and serum angiotensin-converting enzyme activity) lack sensitivity and specificity. In a retrospective study of 153 subjects under suspicion of pulmonary sarcoidosis (36 cases and 117 patients with other diseases [control patients]), we defined likelihood ratios (LRs) for rationally selected result intervals of these tests, which improve clinical interpretation as compared with dichotomous interpretation based on a single cutoff value. By using logistic regression analysis, we further integrated the 3 individual tests into a unified algorithm that could rule out diagnosis in 57 (48.7%) of the 177 control subjects and confirm diagnosis in 12 (33%) of the 36 pulmonary sarcoidosis cases. We conclude that use of LRs improves interpretation of laboratory tests for pulmonary sarcoidosis. In addition, we present a prediction algorithm based on the combination of laboratory tests that helps clinicians confirm or exclude diagnosis in almost half of the study population.

Bryophyte metapopulations and the maintenance of bryophyte diversity heavily depend on species specific habitat and landscape characteristics. But the relationships between age structure of bryophyte populations, habitat characteristics and bryophyte diversity are not well known. We investigated the age structure of liverwort populations of Frullania dilatata, Metzgeria furcata and Radula complanata in relation to phorophyte preferences and epiphytic diversity of bryophytes and macrolichens. The results demonstrate that broad-leaved willow shrubs (primarily Salix caprea) are most preferred by these liverwort species and that these favorable phorophytes largely account for the cooccurrences of liverwort species in contrast to other phorophyte species. The liverworts show rather strongly aggregated distribution patterns. However, from ecotope level towards community level a change in association patterns occurs, suggesting that these species prefer similar habitats but occupy different microhabitats. The age distribution of the metapopulations is linked with the developmental stage of the habitats. The local frequency of the liverworts increases as the age of the population increases until the population is about 5-6 years. Also the suitability of habitats for these liverworts is temporally limited in the study area. After colonization of new habitats a lag phase of one year is hypothesized during which the species in general do not fully reproduce themselves.

We studied cryptogamic epiphytes in a river valley in northern Belgium in order to investigate the effects of potential environmental and ecological determinants on epiphyte diversity. The study was done on ecotope level. In practice different habitat types, historical variables (forest history, tree age) and ecological indicator values of the epiphytes were used as explaining variables. The environmental variables were linked with ecological indicator values by means of canonical correlation analysis. Thereby correlations between indicator values and epiphyte diversity were calculated in a qualitative as well as in a quantitative sense. Classification and regression trees were applied to study the importance of the different environmental variables for epiphyte diversity. Cryptogamic epiphyte diversity of old forests proved to be low, contradicting the ecological continuity hypothesis, while forests or shrubs with a high quantity of young trees were most suitable for epiphytes. These woodlands have a short forest history and are situated on alluvial soils in the centre of the valley, on former pastures. Main reasons for a high diversity in the young forests are elevated (air) humidity levels as well as the prominent presence of (several types of) wet broad-leaved forests, causing a high (micro)habitat diversity and diverse site conditions. As also structural aspects are important for the a-diversity of cryptogamic epiphytes, right actions should be implemented in management practices. � 2005 Elsevier Ltd. All rights reserved.

Detrended Correspondence Analysis (DCA) and logit regression were used to search for differences in species co-occurrence in the bryophyte layer of pinewoods. Plots where the invasive Lophocolea semiteres was already present have been compared to similar plots where it was not yet present.The first axis of the DCA ordination of 1 m2 subplots shows for both data-sets a similar floristic gradient with Plagiothecium curvifolium as a dominant at one side and Hypnum jutlandicum, Dicranum scoparium and Pleurozium schreberi as dominants at the other. More opportunistic mosses (e.g. Campylopus spp., Orthodontium lineare), Lophocolea heterophylla and L. bidentata occur in the central part of this gradient. When present, L. semite res occupies a dominant position in the central part of this gradient, whereas L. heterophylla is nearly absent and L. bidentata is strongly reduced. A DCA ordination was applied to the complete data set, but with the Lophocolea spp. made passive. Logit regression of the presence...

The World Health Organization introduced flow cytometry as an additional criterion for diagnosis of myelodysplastic syndromes (MDS). Aberrant antigen expression on bone marrow (BM) blasts may identify "low-grade MDS." This study aimed to examine differences in antigen expression on CD34+ BM cells between patients with MDS and those with secondary cytopenia. BM aspirates of 175 patients with cytopenia were classified as MDS or secondary cytopenia. Expression of stem cell antigens (CD34, CD133), myeloid antigens (CD13, CD33), B-cell antigens (CD19, CD10), growth factor receptors (CD117, CD123), and chemokine receptor (CD184) was examined. Thirty-two normal adults and 49 patients with CD34+ acute myeloid leukemia (AML) were also examined. High percentage of CD34+ cells, CD117 and CD123 overexpression, and abnormal CD45 expression on these cells are the best markers for MDS. These phenotypic aberrancies correlate with number of blasts and degree of dysplasia, and were similar to those in CD34+ AML, thus reflecting the relationship between these disorders.