Inactive Cases Research Articles

Clinical implications of hepatitis B surface antigen quantitation in the natural history of chronic hepatitis B virus infection

BackgroundHBsAg quantitation may be useful for managing patients with hepatitis B virus (HBV) infection. ObjectivesWe explored the clinical implications of HBsAg quantitation for patients with HBsAg levels >250IU/ml (Abbott Diagnostics). Study designTwo hundred and thirty-three HBV-infected patients comprising 29 immune tolerance cases, 49 treatment-naïve HBeAg-positive chronic hepatitis B (CHB) cases, 91 inactive HBV carrier cases, and 64 treatment-naïve HBeAg-negative CHB cases were analyzed. HBsAg was quantified by the Architect HBsAg assay (Abbott Diagnostics) after a 1:500 automated dilution. Results and conclusionsHBsAg (log10IU/ml) was established for immune tolerance (4.50±0.43), HBeAg-positive CHB (4.17±0.66), inactive HBV carrier (3.32±0.44), and HBeAg-negative CHB (3.23±0.40); (p=4.92×10−35). No significant difference was observed between inactive HBV carrier and HBeAg-negative CHB (p=0.247). The proportions of HBsAg <2000IU/ml for inactive HBV carrier and HBeAg-negative CHB were 51.6% and 59.3%, respectively (p=0.341). Positive correlations between HBsAg and HBV DNA were observed for immune tolerance (p=1.23×10−4) and HBeAg-positive CHB (p=0.003), but not for HBeAg-negative CHB (p=0.432). A negative correlation between HBsAg and age was observed for immune tolerance (p=0.030), HBeAg-positive CHB (p=0.016), and inactive HBV carrier (p=0.001), but not in HBeAg-negative CHB (p=0.249). No significant differences between HBsAg and ALT for HBeAg-positive (p=0.338) or HBeAg-negative CHB (p=0.564) were observed. For patients with HBsAg quantitation >250IU/ml, HBsAg may reflect HBV DNA replication for HBeAg-positive cases. HBsAg is not a suitable marker for evaluating hepatitis activity and distinguishing between cases of HBeAg-negative CHB and inactive HBV carrier state.

Oxidation and reduction of mercury by SCR DeNOx catalysts under flue gas conditions in coal fired power plants

The co-oxidation of elemental mercury (Hg) in SCR DeNOx reactors to water soluble oxidised species followed by co-removal in flue gas desulphurisation scrubbers is a promising way to reduce these emissions from fossil fuel fired power plants.This paper looks at the results of a series of lab experiments on the oxidation and reduction of Hg by commercial V2O5/WO3(MoO3)/TiO2 honeycomb and plate type DeNOx catalysts.It could be shown that at a given hydrogen halide content the oxidation of elemental Hg on DeNOx inactive material follows a first order reaction with respect to the Hg concentration. On the basis of mass concentration, HBr was ten times more effective than HCl in promoting the oxidation of elemental Hg under otherwise identical conditions. The oxidation of elemental Hg increased with increasing vanadium content in the catalysts. The Hg oxidation activities of several commercial SCR catalysts were determined for the DeNOx inactive case and compared with their DeNOx activities. In this way, it was possible to show that the velocities of Hg oxidation and DeNOx reaction are of the same order of magnitude.The DeNOx-active state of the catalysts had a strongly negative impact on the oxidation of elemental Hg that could not be explained solely by an inhibition effect of ammonia. Under these conditions, even reduction of oxidised Hg occurred on the catalyst. The same reduction occurred for SCR DeNOx catalysts when oxidising volatile organic hydrocarbons. This effect was called induced mercury reduction. The observed oxidation rate of Hg on DeNOx- and VOC-active catalysts is the net sum of an oxidation and a reduction reaction which take place in parallel. Our understanding of the control variables for Hg oxidation in SCR DeNOx plants has to be amended in light of these slowing effects and has to take the induced reduction into account.

THU0038 Abnormal Phenotypic T Cell Subsets in Peripheral Blood of Tunisian Patients with Behcet’s Disease

BackgroundBehçet’s disease (BD) is a chronic recurrent multisystemic inflammatory disorder of unknown origin. Immune-mediated mechanisms play a major role in the pathogenesis of the disease. BD is not considered to...

AB0017 Hla-g 3′utr 14bp polymorphism and shla-g levels in tunisian patients with behçet’s disease

BackgroundBehcet’s disease (BD) is a chronic relapsing multisystemic inflammatory disease. Although the actual etiology is still unclear, BD symptoms are considered to be the resultant of genetic intrinsic factors and...

Cost-effectiveness of Early Detection of Inactive and Treatment of Active Cases in a High Endemic Chronic Hepatitis B Region

Background: Persons with chronic hepatitis B (CHB) infection are at risk of developing cirrhosis and hepatocellular carcinoma (HCC). Early detection of active CHB through monitoring and treatment of eligible patients have the potential to prevent these diseases. Aims: We aimed to predict the disease progression in our baseline patient cohort by using risk prediction tools, and estimate the cost-effectiveness of a monitor and treat (M&T) strategy. Methods: The REVEAL-HBV study team has developed nomograms for predicting liver cirrhosis and HCC risk in patients with CHB. Baseline data such as gender, birth date, HBVDNA, ALT, HBeAg status, stage of liver disease, genotype, family history of HCC, and alcohol consumption were taken for 668 CHB patients. The cohort was divided into three subgroups according to the eligibility for treatment under the APASL guidelines; ineligible, borderline and eligible, and each were scored according to the REVEAL nomogram tools. Results: In the ineligible group, if inactive cases are being monitored and treated upon transition to active, the number of new cirrhotic and HCC cases will be reduced by 30% and 40%, respectively. For the borderline group, cirrhosis and HCC will be reduced by 63% and 72%, and for the eligible group, by 84% and 95%, respectively. If we were to implement the M&T strategy, the US$ per QALY gained, compared to do nothing strategy, for sub-groups eligible, borderline, and ineligible are $1,131, $500 and $97, respectively. Conclusions: To reduce the risk of cirrhosis and HCC, a monitor and treat strategy is cost-effective in allsubgroups.

Ocular Toxoplasmosis: A Case Report

Report a case of a male patient with a macular scar compatible with ocular toxoplasmosis (OT) in right eye (RE) and review the relevant literature on this disease. A patient, who attended for a routine contact lens follow up, presented with amblyopic exotropia without any ocular disease. Best-corrected visual acuity of the affected eye was 20/40 with constant and mono-fixation exotropia. Ophthalmoscopic assessment revealed a macular scar compatible with OT. OT is the leading cause of infection in the posterior segment. Inactive cases could be asymptomatic and diagnosis requires a complete eye examination, providing a correct diagnosis and patient management.

Epidemiologisch-klinische Charakteristika von Patienten mit zystischer Echinokokkose

Cystic echinococcosis (CE) is a widespread zoonosis. Difficulties in patient care were investigated in order to improve the clinical management of CE patients. 65 patients with CE attending our service between 1999 and 2011 were interviewed for their history. Previous diagnostic findings were taken into account. Diagnosis, staging and therapy relied on laboratory and imaging findings. 56 patients were immigrants and nine of German origin. 55 of 59 evaluable patients had been living in rural areas for many years. 34 of 35 patients recalled dog contacts. Symptoms had indicated CE in 21 of 59 (36 %) cases only, whereas CE was mostly detected accidentally. Diagnosis was hampered by false negative serological results (IHA false negative in 11 of 60 cases [18 %], EIA in 8 of 53 [15 %]), the low frequency of eosinophilia (15/61 [25 %]) and of IgE increase (27/57 [47 %]). Percutaneous treatment or surgery was performed in active CE of the liver; disseminated CE was treated non-surgically. Inactive CE cases were monitored without any intervention. Relapses occurred in 7 of 51 (14 %) patients with follow-up: one after surgery, six after conservative treatment. The diagnosis of CE is delayed by the paucity of characteristic symptoms and the inconsistency of serologic results. Assessment of cyst morphology and localisation are particularly important for diagnosis, staging and follow-up. CE requires an interdisciplinary management which should be coordinated by specialized infectious diseases centres.

Role of FDG PET-CT in Takayasu Arteritis: Sensitive Detection of Recurrences

The aim of this study was to investigate whether the maximum standardized uptake value (max SUV) of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) provides a quantitative indication of disease activity in Takayasu arteritis (TA) cases. The clinical value of FDG-PET for assessing TA has been investigated. Clinical evaluation of disease activity is often difficult, because most patients develop recurrent inflammation while receiving corticosteroid treatment. Thirty-nine TA patients underwent FDG-PET/CT at Tokyo Medical and Dental University from 2006 to 2010 (35 women and 4 men; median age, 30 years). Disease activity was defined according to National Institutes of Health criteria. Biomarkers including C-reactive protein and erythrocyte sedimentation rate were measured. Forty subjects without vasculitis served as control subjects. The max SUV was significantly higher in active than in inactive cases and control subjects (active [n = 27], median value, 2.7 vs. inactive [n = 12], 1.9; control [n = 40], 1.8; p < 0.001 each). Given a max SUV cutoff of 2.1, sensitivity for active-phase TA was 92.6%, specificity 91.7%, positive predictive value 96.2%, and negative predictive value 84.6%. In receiver-operating characteristic curves comparison, max SUV was superior to C-reactive protein (p < 0.05) and erythrocyte sedimentation rate (p < 0.05). Max SUV was significantly higher in relapsing on treatment cases (n = 17) than in stable on treatment cases (n = 12) (median value, 2.6 vs. 1.9; p < 0.001). FDG-PET/CT is useful for detection of active inflammation not only in patients with active TA before treatment but also in relapsing patients receiving immunosuppressive agents. The max SUV is useful for assessing subtle activity of TA with high sensitivity.

Expression of bone morphogenetic protein 2, 4, 5, and 7 correlates with histological activity of otosclerotic foci

Conclusion: This study is the first to establish that bone morphogenetic protein 5 (BMP5) plays a role in the pathogenesis of otosclerosis. These results confirm that elevated expression levels of BMPs, members of the transforming growth factor (TGF)-β superfamily, contribute to the pathologically increased bone turnover in early, active stages of otosclerosis. Objectives: Otosclerosis is a complex bone remodeling disorder of the otic capsule, which might be characterized by increased expression of different types of BMPs. TGF-β and BMP are both members of the TGF-β superfamily and play a critical role in bone resorption and new bone formation. It has been suggested that BMP and its receptors may be involved in the pathologically increased bone turnover observed in otosclerosis. Methods: Fifty-one otosclerotic and 16 non-otosclerotic ankylotic stapes footplates were histologically analyzed: conventional hematoxylin-eosin staining and BMP2, 4, 5, and 7specific immunofluorescent assays were performed. Cortical bone fragments (n = 35) and incus specimens (n = 6) were used as negative controls. Results: Active otosclerosis (n = 39) was characterized by increased expression of BMP2, 4, 5, and 7. Inactive cases of otosclerosis (n = 12) were characterized by negative immunoreaction for BMPs. Non-otosclerotic stapes specimens (n = 16) and negative controls (n = 41) showed negligible BMP expression. The BMP expression pattern showed a strong correlation with the histological activity of otosclerosis.

Changing pattern of neurocysticercosis in an urban endemic center (Guayaquil, Ecuador)

ObjectiveTo confirm recent evidence suggesting a change in the pattern of disease expression of neurocysticercosis, manifested by a decreasing number of severe and recent infections. MethodsRetrospective cohort of 246 neurocysticercosis patients residing in Guayaquil, evaluated over 20 years (1990 to 2009). Eighty-seven patients were seen from 1990 to 1994, 58 from 1995 to 1999, 57 from 2000 to 2004, and 44 from 2005 to 2009. Neurocysticercosis was classified as active or inactive according to neuroimaging findings. Patients with parenchymal, subarachnoid or ventricular cystic lesions were considered to have active disease, and those with calcifications and chronic arachnoiditis were classified as inactive. ResultsMean age was 36.6±20 years, and 61% were women. The relative prevalence of active and inactive cases varied according to the year of evaluation. Active neurocysticercosis was found in 63% of patients seen between 1990 and 1994, in 48% between 1995 and 1999, in 47% between 2000 and 2004, and in only 18% between 2005 and 2009 (p<0.0001). Together with reduction of active cases, there was an increased prevalence of asymptomatic infections over the years (from 17.2% between 1990 and 1994 to 54.5% between 2005 and 2009; p<0.0001). ConclusionIn this single-center cohort, the relative prevalence of active cases of neurocysticercosis reduced over the past years, suggesting a decreased incidence of new infections. Improved sanitation together with widespread use of cysticidal drugs were the most likely causes of these findings.

Botulinum Toxin Dosage Template for Frontal Wrinkle Effacement

There is no consensus in the literature about the ideal technique for precisely placing botulinum toxin in the frontal facial regions for the most natural posttreatment appearance. The authors describe a safe and effective dosage template for botulinum toxin injection (a "dose disc," which makes it possible to estimate the approximate area to which the action of the toxin dose will reach, thereby guiding the positioning of the injection in a very practical way) for frontal wrinkle effacement, preserving residual movement whenever possible. Fifty adult patients who presented to the authors' private clinic between January 2009 and May 2010 with aesthetic concerns about cutaneous expression wrinkles in the frontal region of their faces were selected for this study. Patients were sequentially divided into two groups: Group 1 included the first 15 patients, who underwent injections in the frontal region on the first visit and glabellar injections 15 days later; Group 2 included the subsequent 35 patients, who underwent frontal and glabellar treatment simultaneously. All pretreatment markings in both groups were made with the authors' "dose disc, which allows for overlap of the "halos" of effect. In the 50 patients included in the study, 317 injections were performed with the dose disc. Two treatment failures occurred (etiology unknown), and five patients presented with failure due to irregular technical positioning of the discs. The latter patients were treated at the beginning of the study and exhibited residual wrinkles. Only one case of complete toxin inactivity was observed. All patients with treatment failures underwent successful correction with additional injections. There was no evidence of palpebral ptosis, eyebrow ptosis, or any other serious diffusion or positioning side effects. A fixed dose disc template can be a useful tool for botulinum toxin injections in the frontal region of the face. Future studies assessing other disc models for different doses and different injection methods are needed, with the goal of establishing a longer duration of the effect and devising similar templates for other facial areas.

Osteoprotegerin expression and sensitivity in otosclerosis with different histological activity

Otosclerosis is a complex bone dystrophy of the human otic capsule leading to conductive and sensorineural hearing loss. Since otosclerosis may, at least in part, be considered as an autoimmune-inflammatory disease, disturbed balance of TNF-alpha and osteoprotegerin (OPG) expression has been implicated in the pathological bone remodeling. It has been supposed that active otosclerosis is characterized by decreased or missing local OPG production with invariable OPG sensitivity of the otosclerotic foci. Ankylotic stapes footplates (n = 41) removed by stapedectomy were processed to histological examination, OPG-specific RT-PCR, tissue culturing and alkaline-phosphatase (AP) activity assessment, respectively. OPG concentration of serum specimens (n = 41) was measured by ELISA. Cortical bone fragments harvested from the external ear canal were used as negative controls of otosclerosis. Among 41 ankylotic stapes footplates, 22 active and 19 inactive otosclerosis cases were histologically diagnosed. OPG expression was significantly lower (p < 0.001) in active otosclerosis compared to inactive cases. Osteoclast cultures originated from active otosclerotic foci showed a considerable susceptibility against external OPG dosage, which resulted in a significant decrease of AP activity (p < 0.001). In contrast, OPG serum levels were in the normal range (5-100 ng/ml) indicating a non-systemic bone resorption. In conclusion, secondary decreased local OPG production might play an important role in the pathogenesis of otosclerotic bone remodeling disorder. As to previous and current results, decreased OPG sensitivity of lesion-forming cells should be excluded. These observations may indicate the potential role of recombinant OPG treatment in early stages of otosclerosis.

High-Mobility Group Box-1 Protein (HMGB1) Is Increased in Antineutrophilic Cytoplasmatic Antibody (ANCA)-Associated Vasculitis with Renal Manifestations

High-mobility group box 1 (HMGB1) is a nuclear and cytosolic protein that is increasingly recognized as an important proinflammatory mediator actively secreted from monocytes and macrophages and passively released from necrotic cells. In antineutrophilic cytoplasmatic antibody (ANCA)-associated vasculitis (AAV), the kidneys are commonly affected vital organs, characterized by focal necrotizing and/or crescentic pauci-immune glomerulonephritis. The aim of the study was to determine whether HMGB1 serum levels are elevated in AAV with renal manifestations. A total of 30 AAV patients (16 female and 14 male; median age 59 years, range 17-82) with Wegener granulomatosis, microscopic polyangiitis and Churg-Strauss syndrome with available renal biopsies and serum samples were included. In seven cases, serum was also obtained at rebiopsy in remission. HMGB1 was analyzed with Western blot. Birmingham Vasculitis Activity Score (BVAS, version 2003), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), urinanalysis, creatinine, estimated glomerular filtration rate, sex and age were included in the analysis. Twenty-five episodes of biopsy-proven active disease with BVAS 17.9 ± 4.6 and 13 cases with inactive biopsies and BVAS 2.3 ± 3.7 (P = 0.0001) were identified. CRP, ESR, hematuria and proteinuria were significantly higher in active cases. HMGB1 was significantly elevated (P = 0.01) comparing active with inactive cases (120 ± 48 versus 78 ± 46 ng/mL) and significantly lower in the seven control patients (P = 0.03) at rebiopsy in remission. HMGB1 remained higher in inactive cases compared with historic healthy controls (10.9 ± 10.5 ng/mL). HMGB1 levels did not differ significantly between AAV subgroups. CRP and ESR did not correlate with HMGB1. HMGB1 is significantly increased in AAV with renal involvement. Residual HMGB1 elevation in remission could possibly reflect low-grade inflammatory activity or tissue damage. Future studies may further reveal whether HMGB1 is useful as a marker of disease activity and a predictor of outcome in AAV.

The role of serology in active ocular toxoplasmosis

Abstract Purpose Toxoplasmic serology in suspected toxoplasmic retinochoroiditis is mostly regarded as unnecessary. Our purpose was to examine toxoplasmic serology in relation with episodes of acute retinochoroiditis and evaluate its utility in appraisal of the patient. Methods Data of patients with active retinochoroiditis were retrospectively analyzed and compared to a group of uveitis cases in which toxoplasmosis as a diagnosis could be ruled out based on clinical appearance and to a group of patients with a quiescent toxoplasmic retinal scar. The mean values of enzymatic immunoassay (EIA) titers for toxoplasmic antibodies were compared in the three groups. Furthermore the proportion of cases under and above a predefined serology value fixed at four times the cut‐off value was compared in all groups. Results Between 1995 and 2009 97 out of 1276 (7.6%) new uveitis cases seen at Centre for Ophthalmic Specialized Care (COS), Lausanne, Switzerland were diagnosed as toxoplasmic retinochoroiditis. The mean EIA values were 147.75 ± 259.4 IU for patients with active disease, 18.93 ± 23.09 IU for inactive toxoplasmosis cases and 18.35 ± 20.82 IU for controls (p&lt;0.015). The proportion of cases under the designated limit value were respectively 2/51 (4%) in the retinitis group, 14/27 (52%) in the control group and 7/7 (100%) in the group with inactive toxoplasmic disease (p&lt;0.001). Conclusion Toxoplasmosis serology, in contrast to what is usually said, is useful to confirm active toxoplasmic retinochoroiditis; it is easy, cheap and backs‐up clinical diagnosis in up to 96% of cases. Serology is however absolutely essential in establishing the diagnosis in atypical cases where it should be performed.

Otosclerosis

Otosclerosis is an inflammatory bone remodeling disorder of the human otic capsule, which might be characterized by a disturbed balance between cell survival and apoptosis due to an increased expression of inflammatory cytokines, mainly tumor necrosis factor-[alpha] (TNF-[alpha]). Histologic features of otosclerosis have been well described; however, different histopathologic and clinical stages have not been attributed precisely to the molecular biology of the pathologically increased metabolism of bone-forming and bone-resorbing cells. Forty ankylotic stapes footplates (n = 40, males = 17, females = 23) removed by stapedectomy were histologically analyzed by conventional hematoxylin-eosin staining, and hCIAP1/2 (inhibitors of apoptosis) and granzyme-[beta] (apoptosis inducer) specific immunofluorescent assays were performed. Four normal stapes footplates obtained from cadavers with negative otologic history were used as negative controls. Active otosclerosis (n = 19) was featured by robust expression of apoptosis inhibitor proteins hCIAP1/2 and negligible expression of granzyme-[beta]. Inactive cases of otosclerosis (n = 8) were characterized by inverse reaction: granzyme-[beta] was highly expressed; however, hCIAP1/2 specific immunoreactions were absent. Nonotosclerotic and normal stapes specimens showed no considerable little granzyme-[beta] expression and moderate hCIAP1/2-specific immunoreactions. Expression pattern of apoptosis-associated proteins showed strong correlation with the histologic diagnosis and activity of otosclerosis (Yates-corrected [chi]2 test, p < 0.001). Detection of the inversely expressed apoptosis inhibitor and inducer proteins in active and inactive stages of otosclerosis demonstrates pathologic regulation of cell survival and apoptosis. These results may suggest active otosclerosis inactivation by TNF-[alpha] induced apoptosis. Anti-TNF-[alpha] biologics may serve as an option in the medical treatment of active otosclerosis.

Prevalence of HIV/HCV/HBV infections and drug-related risk behaviours amongst IDUs recruited through peer-driven sampling in Iran

Background The control of blood-borne infections including HIV and hepatitis C (HCV) amongst injecting drug users (IDUs) is a challenge for health authorities in Iran. Hence, more reliable estimates of the levels of blood-borne infections and their associated factors are critically needed. Methods Active IDUs were recruited using peer-driven sampling in a bio-behavioural survey in 2008. Over 8 weeks, data were collected from adults living in a city in Isfahan Province who had injected drugs in the past month. Participants provided a whole blood sample and answered questions on sexual and drug-related risk characteristics. Participants were provided post-test counselling and a non-monetary incentive for their participation. Excluding two inactive cases, the initial recruits resulted in 2–8 waves of recruitment. Results Overall, 118 IDUs including three females participated. The estimated population proportions of HIV, hepatitis B, and HCV infections were 0.7% (95% CI, 0.6–2.3), 0.7% (95% CI, 0.1–2.1), and 59.4% (95% CI, 47.4–68.7), respectively. Responses indicated that 31% (95% CI, 20–44.5) of the IDUs ever shared a needle/syringe for drug injection, and 77% (95% CI, 65–84) had ever injected an addictive solution marketed widely as Temgesic. Multivariate analyses revealed that the high prevalence of HCV infection amongst IDUs is associated with the lifetime duration of drug injection (AOR, 1.17; 95% CI, 1.01–1.34) and with having injected Temgesic (AOR, 4.73; 95% CI, 1.52–14.69). Conclusion Our experience in Iran indicates that IDUs can be recruited effectively in a bio-behavioural survey through peer-driven sampling and using only a single primary incentive. The high prevalence of HCV associated with injecting Temgesic is important evidence for harm-reduction policies in Iran.

Role of 3.0 T MR vessel wall imaging for identifying the activity of Takayasu arteritis

Objective To analyze and explore the value of 3 T high resolution magnetic resonance vessel wall imaging for identifying the activity of Takayasu arteritis. Methods Twenty-six consecutive patients with Takayasu arteritis underwent 3.0 T high resolution MR vessel wall imaging on supraortic vessels (according to the classification of Lupi-Herrea , type Ⅰ and Ⅲ were included). Sixteen patients were in active phase and 10 in inactive phase based on the Kerr criteria. The MR vessel wall imaging appearances of Takayasu arteritis were compared between the active phase and inactive phase cases. Results Wall thickening was demonstrated in all involved arteries. There were statistically significant differences between active phase and inactive phase cases in MR appearances including multi-ring thickening of vessel wall (75/80 and 18/50), arterial inner wail enhancement (50/80 and 19/50), obscurity of perivascular fat (55/80 and 18/50,X =50.39,7.41,13.40,P<0.01). There was also a statistically significant difference in the thickness of carotid artery wall between the two groups [ (3.8±0.2) mm vs (2.5±0.8) mm]. Conclusion 3 T high resolution MR vessel wall imaging is valuable for identifying the activity of Takayasu arteritis. Key words: Takayasu arteritis; Magnetic resonance imaging

TNF-α Receptor Expression Correlates With Histologic Activity of Otosclerosis

Otosclerosis is an inflammatory bone remodeling disorder of the human otic capsule, which might be characterized by variable levels and unique expression pattern of TNF-alpha receptors. Histologic characteristics of otosclerosis have been well described during the latest decades; however, the grading of different histopathologic and clinical stages has not been attributed precisely to the molecular biology of the pathologically increased metabolism of osteoclast-osteoblast axis. Forty otosclerotic- and 40 nonotosclerotic ankylotic stapes footplates (n = 80; men, 29; women, 51) were histologically analyzed: conventional hematoxylin-eosin staining and tumor necrosis factor-alpha receptor I and II (TNFRI/II)-specific immunofluorescent assay was performed. Active otosclerosis (Grades I-II; n = 24) was featured by increased expression of TNFRII and moderate expression of TNFRI; inactive cases (Grades III-IV) were characterized by permanent expression of TNFRI; however, TNFRII-specific immunoreaction was absent. Nonotosclerotic stapes specimens showed a negligible TNFR expression. Tumor necrosis factor receptor expression pattern showed a strong correlation with the histologic activity of otosclerosis (chi2 test; p < 0.001). Detection of elevated TNFR expression demonstrates activated osteoclast metabolism and inflammatory pathways in otosclerosis. Different etiopathogenesis of otosclerotic and nonotosclerotic stapes ankylosis should be distinguished. Administration of monoclonal anti-TNF-alpha antibody may be a reasonable option in the medical treatment of active stages of otosclerosis.

Persistence of Mycobacterium ulcerans Disease (Buruli Ulcer) in the Historical Focus of Kasongo Territory, the Democratic Republic of Congo

Fifty years after the last report of Mycobacterium ulcerans infections (Buruli ulcer [BU]) in Kasongo Territory, Maniema Province, Democratic Republic of Congo (DRC), we conducted a small-scale cross-sectional survey to assess if this historical BU focus was still active and if so to explore the disease epidemiology. Seventy-five active and inactive BU cases were identified on clinical grounds of which two of 28 BU active cases were laboratory confirmed. We used a modified BU02 form to reconstruct the local disease dynamics and we believe that the horrific conflict in eastern DRC and exceptional flooding were the most likely causes of the re-emergence of the disease. There is a need in the DRC to decentralize and integrate surveillance and control activities at local level to increase the effectiveness of patient management.

Peptide epitopes of the Taenia solium antigen Ts8B2 are immunodominant in human and porcine cysticercosis

Ts8B2 is a gene which encodes for a member of the Taenia solium metacestode 8kDa antigen family. Since the Ts8B2-GST recombinant protein compares very favourably with other diagnostic antigens, and in order to study the antigenic nature and structure of this molecule, the Ts8B2 was expressed in prokaryotic and eukaryotic systems. The diagnostic potential of the recombinant Ts8B2 proteins was evaluated by enzyme-linked immunosorbent assays (ELISA) using a collection of serum and cerebrospinal fluid (CSF) samples from patients with clinically defined neurocysticercosis (NCC), and also sera from T. solium infected pigs. Despite the predicted glycosylation of the Ts8B2-Bac recombinant protein, there was very little difference in assay sensitivity/specificity when the Ts8B2 reagent was expressed in either prokaryotic or eukaryotic systems, suggesting that peptidic Ts8B2 epitopes are immunodominant in porcine cysticercosis and human neurocysticercosis. Conveniently, production of recombinant Ts8B2 in Escherichia coli is economical and facile, making it a feasible and practical choice as a diagnostic reagent for use in endemic areas. The Ts8B2 ELISA is particularly useful for the diagnosis of active as opposed to inactive cases of NCC and conduct of the assay is also facilitated by the fact that assay sensitivity is significantly greater when serum as opposed to CSF samples are employed.