Variability of the hepatitis B surface protein in HBV-infected liver transplant recipients

Variations in the major surface proteins (HBsAg) of hepatitis B virus (HBV) have been implicated in the high rate of reinfection in HBV-infected recipients of orthotopic liver transplantations (OLT). Sera from 6 OLT patients positive for HBsAg and from 3 recipients negative for it prior to transplantation were analyzed over several years, and 39 HBsAg sequences were compared. Despite anti-HBs immunoprophylaxis resulting in the disappearance of HBsAg, HBV DNA was detectable by a sensitive nested PCR in almost all sera. In 1 patient, a significant temporary shift in HBV subtypes was observed, indicating a mixed infection or the presence of multiple HBV populations in this patient; this was also true for other patients. Amino acid substitutions compared to wild-type HBV subtypes in 7 patients and variations within patients in 5 patients were detectable over time; the escape mutation at amino acid position 145 was detected in 2 patients. Our data suggest that the high rate of reinfection in OLT recipients seems not to be associated with specific sequence variations in the major HBs gene, but shows a remarkable inter- and intraindividual variability. Obviously, no correlation between heterogeneity in this gene and clinical outcome was present.The following investigators and institutions were members of the Liver Transplantation Group: U. Beuers, M. Bilzer, W. Caselmann, A. Gerbes, R. Hoffmann, C. Jung, G.R. Pape (Medical Department II), J. Briegel, J. Groh, M. Haller (Institute of Anesthesiology), H.J. Krämling, H. Rauh and M. Stangl (Department of Surgery).     

EMG muscle scanning: Stability of hand-held surface electrodes

Electromyographic (EMG) muscle scanning measures 2-second samples of integrated muscle action potentials from individual neck and back muscles using a hand-held scanner with post-style surface electrodes separated by a fixed distance. This scanning technique is widely used to expeditiously assess muscle activity in the diagnosis of musculoskeletal disorders. In order to determine if the 2-second sample is sufficiently representative of electrical activity at a specific muscle site, the stability of the signal received by the hand-held scanner was measured bilaterally at six neck and back muscle sites over 40 seconds (20 2-second integration periods) in five seated subjects. Taking the overall average EMG activity as the true value, the mean number of 2-second integration periods required to achieve <5% standard error was calculated to be 1.47 for the 60 muscles tested. Only three sites required more than five integration periods. The validity of EMG scanning as a diagnostic tool is enhanced by longer integration periods     

Mycotic infection and the pediatric surgeon

The incidence of major fungal infection in recent years has paralleled increasing use of immunosuppressive drugs, broad spectrum antibiotics and implantable catheters and prostheses. The pediatric surgeon encounters fungi as agents of perioperative infection and anatomic disease requiring surgical intervention. Clinical mycology is increasingly challenged by a wide spectrum of unfamiliar fungi, fungal infections and antimycotic drugs. An overview of the expanding role of surgical mycosis in children is presented.     

Locus-control-region-coupled betaS Antilles- and alpha2-hemoglobin genes select for high alpha2-hemoglobin expression in adult transgenic mice

Two transgenic lines of mice were produced which contained the ^S _Antilles- and ₂-hemoglobin genes trandemly coupled to the micro locus control region (LCR). The LCR^S _Antilles2-hemoglobin transgenic mice expressed high levels of ₂-hemoglobin while ^S _Antilles-hemoglobin expression was virtually undetectable. Abundant ₂-hemoglobin protein was observed in the blood of transgenic mice, while ^S _Antilles-hemoglobin chains could not be detected. Transgenic red blood cells had substantially decreased sensitivity to osmotic lysis. Attempts to produce homozygotes containing the transgene were unsuccessful. The phenotype of these mice closely resembles that of -thalassemic mice. The LCR^S _Antilles2 transgenic mice demonstrate that if the LCR is coupled to the ^S _Antilles- and ₂-hemoglobin genes in tandem, only the distal ₂-hemoglobin gene is selected for expression to significant levels in adult mice. These results support a reciprocally competitive model for LCR-hemoglobin developmental switching.