Evidence for heterogeneity in facioscapulohumeral muscular dystrophy (FSHD)

Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive primary disease of muscle which is usually inherited as an autosomal dominant disorder. FSHD has been localized to the long arm of chromosome 4, specifically to the 4q3.5-qter region. Initially published linkage studies showed no evidence for heterogeneity in FSHD. In the present study we have examined individuals in seven FSHD families. Two-point lod scores show significant evidence for linkage for D4S163 (lod score 3.04 at recombination fraction .21) and D4S139 (lod score 3.84 at recombination fraction .20). D4S171 also gave a positive score (lod score 2.56 at recombination fraction .24). Significant evidence for heterogeneity was found for each of the three markers. Multipoint linkage analysis in this region resulted in a peak multipoint lod score of 6.47. The multipoint analysis supported the two-point studies with odds of 20:1 showing linkage and heterogeneity over linkage and homogeneity. Five of the seven families gave a posterior probability of > 95% of being of the linked type, while two families appeared unlinked to this region of 4q (P < .01%). Individuals in the two unlinked families met the clinical criteria for the diagnosis of FSHD, including facial weakness, clavicular flattening, scapula winging, proximal muscle weakness, and myopathic changes on muscle biopsies without inflammatory or mitochondrial pathology. This study demonstrates genetic heterogeneity in FSHD and has important implications for both genetic counseling and the elucidation of the etiology of FSHD.     

Osteomyelitis due to Pseudallescheria boydii

This report describes an unusual opportunistic fungal infection in an immunocompetent young man who had no cutaneous involvement and whose infection was diagnosed 6 years after an accident. The unusual clinical presentation and difficulties in making a correct diagnosis are discussed and prophylactic antifungal chemotherapy is suggested.     

T cell subpopulation phenotypes in filarial infections: CD27 negativity defines a population greatly enriched for Th2 cells

Three-color flow cytometric analysis was used to define surface markers which identify the Th2-type CD4+ cells responsible for the eosinophilia and elevated serum IgE typical of tissue invasive helminth infections. A group of six mAbs to well known cell surface markers were screened for differential expression on CD4+ CD45RO+ lymphocytes from normal individuals (NL; n = 6) and filaria-infected patients (PT; n = 10). The majority of markers were expressed equally by both groups, but the CD4+ CD45RO+ cells in the PTs showed significantly higher levels of expression of HLA-DR than those of NLs (P = 0.014). This CD4+ HLA-DR+ subpopulation was then studied further for its expression of an additional 10 activation and adhesion molecules. CD27 showed a trend for lower intensities of expression on PT CD4+ HLA-DR+ cells than on those of NLs. Analysis of the serum from both NLs and PTs revealed that PTs had significantly higher levels of soluble CD27 and CD25 (IL-2R) in the serum than NLs (P < 0.01 and P = 0.022 respectively) indicating a general state of immune activation and differentiation. Functional analysis of the CD4+ HLA-DR+ and the CD4+ CD27- subpopulations revealed that the CD4+ HLA-DR+ cells produced significantly higher levels of IL-5 than the CD4+ HLA-DR- cells (P = 0.04), and the CD4+ CD27- cells produced significantly higher levels of both IL-4 and IL-5 than the CD4+ CD27+ cells (P < 0.05 and P < 0.001 respectively). Thus, while the CD4+ CD27- and CD27+ subpopulations contain Th1 and Th0 cells, only the CD4+ CD27- population contains the Th2 cells (producing both IL-4 and IL-5).     

Improving the deflection of wire bonds in stacked chip scale package (CSP)

The deformation of gold wire bonds during transfer molding of stacked chip scale package (CSP) can seriously cause wire crossover and shorting. The major challenges of the stacked CSP development are to reduce the wire sweep (deflection), and make the sufficient space clearance between the wires of first to second die. In this paper, M shape wire looping program is developed to increase the wire sweep resistance in the stacked CSP. Both linear elastic finite element analysis and experiments based on wire bonding and molding process evaluation are conducted. It is found that M shape looping program is much better than conventional normal wire shape in terms of wire sweep resistance after molding. X-ray and scanning electronic microscopy (SEM) can verify the improvement of wire deflection after chemical de-capsulation. It is believed that using M shape looping program can efficiently overcome the risk of wire shorting and improve the yield of wire bonds in high volume production of stacked CSP.     

Erythropoietin production in rats with post-ischemic acute renal failure

To study the role of erythropoietin (Epo) in the pathogenesis of anemia in acute renal failure (ARF), organ Epo mRNA was measured by RNase protection assay in rats with ARF induced by a one hour-occlusion of the left renal artery. Hematocrit was significantly decreased two hours, 24 hours and one week after renal artery occlusion. A significant reduction in serum haptoglobin at two hours and an increase in serum LDH at 24 hours indicated that hemolysis was the likely cause of the initial fall in hematocrit. However, despite the reduced hematocrit, serum Epo concentrations were not significantly different from controls, suggesting that the anemia is maintained because of lack of an appropriate Epo response. Right renal Epo mRNA levels were not significantly different in all groups, but Epo mRNA levels in post-ischemic kidneys were 50 to 67% lower than in contralateral kidneys. However, Epo mRNA in the post-ischemic kidney was increased sixfold by acute hemorrhage, a rise comparable to the ninefold increase observed in contralateral kidneys. In ARF rats exposed to 7.5% O2 for four hours, right kidney Epo mRNA increased 200-fold over normoxic levels, to a value similar to sham-operated hypoxic controls. Epo mRNA in the post-ischemic kidney also increased 200-fold, to 50% of the level in the contralateral kidney. Hepatic Epo mRNA levels were elevated to comparable levels in both groups. In this ARF model, mild anemia is associated with relative Epo deficiency. In the post-ischemic kidney, a substantial capacity for Epo production is retained but the sensitivity of the Epo response to blood oxygen availability is significantly reduced.     

"Idiopathic" extracapillary glomerulonephritides without immune deposits are vascularitides: clinical and serologic analysis

To determine the spectrum of systemic diseases potentially associated with pauci-immune rapidly progressive glomerulonephritis (GN), most of which being considered as idiopathic, we have analyzed extra-renal manifestations, occurrence of extra-glomerular vasculitis and incidence and specificity of ANCAs in 40 patients selected only on histological criteria. Extra-renal symptoms were unexpectedly observed in all patients but one, and were suggestive of vasculitis in 24 of them. Extra-glomerular vasculitis was evidenced in 18 kidney biopsies and four biopsies from other organs. Among the 33 patients with suspected or established vasculitis, 13 had presumed or biopsy-proven Wegener's granulomatosis (WG), three had a macroscopic form of polyarteritis nodosa and 17 had a clinical presentation compatible with the so-called microscopic polyarteritis previously described in the british literature. An additional patient had clinical signs of WG without clinical and histological evidence of vasculitis. ANCAs were detected in 28/33 and 25/34 sera tested by IF and ELISA, respectively: 19 contained anti-myeloperoxidase (MPO) antibodies and 6 had anti-proteinase 3 (Pr3) activity. Anti-MPO and anti-Pr3 antibodies were present in all clinical subgroups but with various incidences: anti-MPO antibodies were surprisingly more often detected (6/12) than anti-Pr3 (4/12) in patients with suspected or histologically proven WG but anti-Pr3 antibodies were nonetheless 3- to 4-fold more frequent in WG than in non-WG systemic vasculitis (1/12) and necrotizing CGN without evidence of extra-renal vasculitis (1/10). These results strongly suggest that pauci-immune necrotizing CGNs belong to the broad spectrum of necrotizing vasculitides affecting glomerular capillaries. This hypothesis is also supported by the good response of patients to immunosuppressive treatments known for their efficacy in vasculitides, whereas these treatments are usually less successful in severe forms of extra-capillary GN with immune deposits.