On-line polymerase chain reaction (PCR) monitoring

Outcomes management has received increased attention in the current health care environment, but nursing participation has been limited due to the lack of standardized data about the effects of nursing practice. The Nursing Outcomes Classification (NOC) provides a standardized language that can be used to measure the effects of nursing practice on patient outcomes. An overview of the classification and implementation methods is provided.     

Value of polymerase chain reaction (PCR) for diagnosis of tuberculoid meningitis

The prognosis of tuberculous meningitis (TBM) depends on early therapy based on rapid diagnosis. To study the clinical value of PCR in diagnosis of TBM, we investigated CSF specimens from 49 patients. After cell lysis and DNA preparation following a standard protocol, we performed a half-nested PCR with primers able to detect mycobacterial DNA. PCR results were evaluated according to clinical features, histopathological data, and bacteriological results. PCR detected four of five cases of confirmed TBM, corresponding to a sensitivity of 80%. Positive PCRs were also obtained in 25% CSF samples of non-TBM patients. Most of these false positive results were due to amplification of Mycobacteria fortuitum (M. fortuitum) as determined by direct sequencing analysis. To enhance specificity of our half nested protocol, the oligonucleotide primers that were specific for several mycobacterial subspecies were substituted by a primerpair, which allows selective amplification of DNA from Mycobacteria tuberculosis (M. tuberculosis). By using the altered PCR protocol, the screening of CSF samples revealed a much higher specificity (97%) and constant sensitivity (80%) in diagnosis of TBM. These findings indicate, that M. fortuitum, as an ubiquitous mycobacterial subtype of low pathogenicity, can potentially contaminate clinical specimens and account for false positive PCR results. Therefore, the clinical value of PCR in diagnosis of TBM strongly depends on appropriate oligonucleotide primers, that allow to differentiate between mycobacterial subtypes.     

Detection of Coxiella burnetii in cow's milk using the polymerase chain reaction (PCR)

A PCR approach (transposon PCR) with primers based on repetitive transposon-like sequences, which--depending on the isolate--were found at a minimum frequency of 19 on the C. burnetii genome, was established for the highly sensitive and specific detection of C. burnetii. This study describes the analytical detection of C. burnetii in milk, which requires a special preparation method prior to PCR. Because of the low level of C. burnetii particles in milk samples, template DNA was concentrated by a factor of 200, using cetyltrimethylammonium bromide as the precipitation reagent. Using this particular preparation method, even a single C. burnetii particle could be detected in 1 ml milk.     

Application of polymerase chain reaction (PCR) for diagnosis of equine herpes virus-1 (EHV-1)

Fifty aborted foetus samples were diagnosed for the presence of equine herpes virus-1 (EHV-1) by polymerase chain reaction (PCR) technique. Specific primer pair for amplification of a particular segment of EHV-1 DNA in gc region having 3 Hae III restriction endonuclease sites was used. A 409 base pair segment obtained as PCR amplification product in 9 samples was digested with Hae III to confirm the presence of EHV-1 as the infectious agent in aborted tissues. It was observed that PCR technique was more sensitive, specific and rapid than the conventional virological diagnostic methods.     

Use of the polymerase chain reaction (PCR) for the diagnosis of Helicobacter pylori infection in pediatric patients

BACKGROUND: Several direct or non direct methods may be used to detect H. pylori infection. A molecular method, PCR with ureA primers, was used in this study in 43 gastric biopsies obtained from paediatric patients with digestive symptomatology and the results were compared with those obtained by histology and culture. METHODS: Culture and histological stain were performed from gastric biopsies taken at routine endoscopy following standard methodology. A PCR with specific primers for the ureA gene was applied and the 411 pb fragment detected by agarose gel electrophoresis. RESULTS: From the 43 gastric biopsies, 21 were positive by culture (48.8%), 25 by histology (58.1%) and 29 by PCR (67.4%). In 30 biopsies (69.7%) PCR results were in good agreement with the reference method (histology and/or culture). In 7 biopsies the PCR was positive (16.3%), although the reference method was negative and in 6 (13.9%) the PCR was negative being positive the histology (5 samples) or histology and culture (1 sample). CONCLUSIONS: PCR shows the highest positive percentage among the methods used. The use of as many methods as possible in the H. pylori infection, increases the diagnosis of the infection.     

Diagnosis of Mycoplasma pneumoniae pneumonia in pediatric patients by polymerase chain reaction (PCR)

Polymerase chain reaction (PCR) testing was performed on respiratory tract specimens obtained by throat swab in 21 children admitted to the hospital with suspected Mycoplasma pneumoniae pneumonia. Of 13 patients with a clinical condition compatible with mycoplasma infection and an immunological response to M. pneumoniae, 11 were positive by PCR. Eight patients were negative by serology and/or had a clinical condition not compatible with mycoplasma infection, and all were negative by PCR. The antibody response to M. pneumoniae was delayed for a week or more in 3 (23%) of the 13 patients with documented mycoplasma infection. These results suggest that PCR performed on a respiratory tract specimen obtained by a throat swab may be useful in the initial evaluation of children with suspected M. pneumoniae pneumonia, especially in patients in whom the serological response is delayed.     

The frequent detection of a treponeme in bovine digital dermatitis by immunocytochemistry and polymerase chain reaction

A study was carried out to determine whether spirochaetes are frequently associated with digital dermatitis in United Kingdom (UK) dairy cattle. Histopathological examination of lesions using a silver stain showed a large number of unidentified spirochaete-like organisms present in digital dermatitis hoof skin tissue in all examined biopsies. Immunocytochemical staining demonstrated that spirochaetes in skin lesions were identified by polyclonal antisera to Borrelia burgdorferi, Treponema denticola and Treponema vincentii (again all biopsies were positively stained), whereas monoclonal antibodies to B. burgdorferi and any Treponema pallidum did not stain any organisms in all biopsies. A PCR of 16S rRNA, previously shown to be specific for a new treponeme, was employed and produced positive results from 82.4% of digital dermatitis tissues. It is concluded that this spirochaete (or related spirochaetes), which is similar to human oral treponemes, is frequently associated with, and may be responsible for, pathological changes in digital dermatitis.     

Authentication of the Chinese drug "ku-di-dan" (herba elephantopi) and its substitutes using random-primed polymerase chain reaction (PCR)

DNA fingerprinting and polymorphism among the Chinese drug "Ku-Di-Dan" and its substitutes were demonstrated with arbitrarily primed polymerase chain reaction (AP-PCR) and random amplified polymorphic DNA (RAPD). Distinctive, reproducible genomic fingerprints from DNA of the Chinese drug Ku-Di-Dan and 9 species of Compositae were generated with six long (18-24 mer) and one short (10 mer) random-chosen primers with PCR. Ku-Di-Dan samples can be distinguished according to the banding patterns of their amplified DNA on agarose gels. Results showed that AP-PCR and RAPD fingerprints of the commercial samples of Ku-Di-Dan retailed in Fujian, Taiwan, Hong Kong and Macau markets are identical with that of Elephantopus scaber L. The relatedness of Ku-Di-Dan among 9 plants may also be estimated by the Similarity Indexes values of the genomic DNA fingerprints.     

Sample suitability for the detection of minor white cell populations (microchimerism) by polymerase chain reaction

BACKGROUND: There is increasing use of highly sensitive testing with polymerase chain reaction (PCR) to study white cell microchimerism after transfusion and transplantation. This study investigated possible artifactual sources of allogeneic sample contamination before PCR testing. STUDY DESIGN AND METHODS: Quantitative Y-chromosome PCR was used to study microchimerism among transfused patients with sickle cell disease (SCD) and thalassemia by using residual specimens from the clinical laboratory. High levels of circulating male white cells among transfused patients with SCD but not thalassemia led to concern over the artifactual origin of male cells. To investigate, paired specimens were collected from 26 female SCD patients: one specimen underwent processing only for PCR, while the other underwent testing in the clinical laboratory before PCR as a process control. All laboratory instruments were also assessed for their ability to impart male allogeneic cells to aliquots of female blood. RESULTS: Thirty-three (31%) of 107 SCD samples, but 0 of 20 thalassemia samples, gave a high-level PCR signal. One of 26 paired samples that was not exposed to clinical laboratory equipment had low-level PCR positivity while 10 of the 26 became strongly positive after testing on a blood cell analyzer and a reticulocyte analyzer. Sixteen of 32 female samples became positive after reticulocyte analysis, while none became positive after blood cell analysis. Samples from thalassemia patients tested PCR-negative because reticulocyte counts had not been performed. CONCLUSION: Allogeneic cell contamination is common with clinical laboratory equipment. These samples may not be suitable for microchimerism studies. In addition to method controls, process controls should be employed where appropriate.     

Myoglobin as a polymerase chain reaction (PCR) inhibitor: a limitation for PCR from skeletal muscle tissue avoided by the use of Thermus thermophilus polymerase

Skeletal muscle tissue contains polymerase chain reaction (PCR) inhibitors that are coextracted by conventional nucleic acid extraction procedures. Myoglobin, a heme-containing molecule, was shown to act as a potent Thermus aquaticus DNA polymerase inhibitor and is likely to be involved in muscle tissue-associated PCR inhibition. The use of Thermus thermophilus DNA polymerase avoids muscle tissue-associated PCR inhibition, and should be used in case of small amounts or instability of the targeted nucleic acid.     

Rapid detection of aneuploidies by microsatellite and the quantitative fluorescent polymerase chain reaction

Several studies have been performed to assess the diagnostic value of using small tandem repeat (STR) markers and quantitative fluorescent polymerase chain reaction (QF-PCR) assays for the rapid detection of aneuploidies involving chromosomes 21, 18, 13 (Mansfield, 1993; Pertl et al., 1994, 1996; Adinolfi et al., 1995a). The results of these investigations have documented the diagnostic advantages of this approach to perform prenatal tests using amniotic and chorionic samples, or fetal nucleated cells retrieved from peripheral maternal blood or endocervical samples. The use of two or more STR markers for each autosome facilitates the diagnosis of aneuploidies, while avoiding the need to employ internal non-polymorphic markers. Multiplex quantitative fluorescent analyses can be performed in about six hours from the collection of the samples and, although targeted to specific abnormalities, they can exclude the presence of the most frequent chromosomal disorders. QF-PCR can be exploited to analyse DNA present in single or clumps of cells and thus to perform prenatal diagnoses on maternal peripheral blood or transcervical cell samples and on preimplantation embryos.     

Detection of bovine herpesvirus 1 (BHV-1) genomic sequences in bovine semen inoculated with BHV-1 by polymerase chain reaction

Polymerase chain reaction (PCR) technique was applied to detect BHV-1 in bovine semen inoculated with BHV-1. The technique was found to be 10(6) times more sensitive than a non-isotopic dot-blot hybridization method in detecting viral genomic DNA. Of the three primer pairs used, the one chosen from glycoprotein gC appeared to be most sensitive as it could detect up to 0.01 TCID50 of BHV-1 in the semen. The technique could be useful in screening breeding bulls or samples of frozen semen prior to use in artificial insemination.     

Effect of reference database on frequency estimates of polymerase chain reaction (PCR)-based DNA profiles

1. To assess the contribution of an aqueous extract of Ulmi radicis cortex (AEURC) in systemic anaphylaxis, compound 48/80 was used as a fatal anaphylaxis inducer in rats. 2. AEURC completely inhibited anaphylactic shock with a dose of 1.0 g/kg body weight (BW) 1 hr before injection of compound 48/80. 3. AEURC significantly inhibited serum histamine levels induced by compound 48/80. 4. AEURC (1.0 g/kg BW) also inhibited by 79.1% passive cutaneous anaphylaxis activated by anti-dinitrophenyl (DNP) IgE. 5. AEURC dose dependently inhibited the histamine release from the rat peritoneal mast cells (RPMCs) by compound 48/80. Moreover, AEURC had a significant inhibitory effect on anti-DNP IgE-induced histamine release and tumor necrosis factor-alpha production from RPMC. 6. The level of cAMP in RPMC, when AEURC was added, significantly increased compared with that of a normal control. 7. These results indicate that AEURC may possess strong antianaphylactic action.     

Sero-negative tsutsugamushi disease (scrub typhus) diagnosed by polymerase chain reaction

We report a case of sero-negative tsutsugamushi disease diagnosed by polymerase chain reaction (PCR). A 54-year-old man who worked in Nagano prefecture presented with flu-like symptoms that did not respond to cephalosporin therapy. On admission to another hospital, chest roentgenography revealed abnormal shadows; liver dysfunction was also present. Despite therapy, the patient's condition gradually worsened and he was transferred to our intensive care unit. Erythema on all extremities and scabs on the right medial femoral region and the dorsum of the left foot suggested a diagnosis of tsutsugamushi disease. We administered minocycline and gave percutaneous cardiopulmonary support for adult respiratory distress syndrome. Despite all efforts, the patient died. Although serologic tests were not positive, Karp strains of R. tsutsugamuschi were identified on PCR amplification. Autopsy revealed evidence of acute hemorrhagic pancreatitis, which has not been reported previously in tsutsugamushi disease. We conclude that PCR techniques may be useful in confirming a diagnosis of early tsutsugamushi disease.     

Polymerase chain reaction (PCR) and its possible applications in diagnosis of infection in ophthalmology

Fecal incontinence resulting from pudendal canal syndrome has been treated by pudendal canal decompression (PCD) with satisfactory results. Considering the possible difficulty in exposing the pudendal canal and nerve by the open method, laparoscopic PCD was practiced in 9 women aged between 37 and 52 years. They were complaining of fecal incontinence; urinary stress incontinence was an additional complaint in 4/9 women. Neurologic, manometric, and EMG studies confirmed the diagnosis of pudendal canal syndrome. For laparoscopic PCD a 1-cm incision lateral to the anal orifice was performed. A balloon dilator was introduced in the ischiorectal fossa (IRF) to create a working space, and CO2 was insufflated. Under the guidance of a laparoscope, the IRF was entered and the inferior rectal nerve identified and followed to the pudendal canal. The latter was split open, releasing the pudendal nerve into the IRF. Fecal control was achieved in 7/9 patients and urinary control in 2/4. Fecal and urinary control were associated with improvement in perianal sensation, rectal neck pressure, EMG of external anal sphincter and levator ani muscle as well as in pudendal nerve terminal motor latency. Two women showed no improvement. Failure is suggested to be due to an advanced pudendal neuropathy. In conclusion, laparoscopic PCD is a simple, easy, and safe procedure. It allows for better exposure of the contents of the IRF than the open procedure, thus avoiding injury of the pudendal nerve and its branches during the performance of the PCD.     

Use of the polymerase chain reaction in the diagnosis of leprosy

A case is described in which a pericardial branch of a nongrafted left internal mammary artery communicated directly with the distal left anterior descending artery, following saphenous vein bypass grafting. This type of collateralization following coronary artery bypass surgery seems to be very rare, and perhaps could protect the myocardium from severe ischemia.