Protection of Penaeus monodon against white spot syndrome by continuous oral administration of a low concentration of Bacillus subtilis spores expressing the VP28 antigen.

In this study, Bacillus subtilis spores expressing a chimeric protein, CotB-VP28, were used as a probiotic vaccine to protect black tiger shrimps (Penaeus monodon) against white spot syndrome virus (WSSV) infection. Oral administration of pellets coated with CotB-VP28 spores (at ≥1 × 109  CFU per g pellet) to shrimps induced immune-relating phenoloxydase activity (PO) in shrimps after 14 days of feeding (prior challenge) and at day 3 post challenge (1·26 and 1·70 fold increase respectively). A 75% protection rate was obtained by continuous feeding of the spore-coated pellets at ≥1 × 109  CFU per g for 14 days prior to WSSV challenge and during all the postchallenge period. Even when the amount of CotB-VP28 spores in feed pellets was reduced down to ≥5 × 107  CFU per g and ≥1 × 106  CFU per g, relatively high protection rates of 70 and 67·5%, respectively, were still obtained. By contrast, feeding pellets without spores (untreated group) and with naked spores (PY79 group) at ≥1 × 109  CFU per g could not protect shrimps against WSSV. These data suggest that supplementation of CotB-VP28 spores at low dose of ≥1 × 106  CFU per g could be effective as a prophylactic treatment of WSS for black tiger shrimps. SIGNIFICANCE AND IMPACT OF THE STUDY: This study reports the protective efficacy of Bacillus subtilis CotB-VP28 spores on black tiger shrimps (Penaeus monodon) against white spot syndrome virus infection. Oral administration of pellets coated with CotB-VP28 spores (≥1 × 109  CFU per g) conferred 75% protection after white spot syndrome virus challenge. Even after reducing CotB-VP28 spores in feed pellets to ≥1 × 106  CFU per g, 67·5% protections was still obtained. These data indicate that supplementation of CotB-VP28 spores at a low dose of ≥1 × 106  CFU per g could be effective in prophylaxis against white spot syndrome in black tiger shrimps.

What Digital Imaging and Communication in Medicine (DICOM) could look like in common object request broker (CORBA) and extensible markup language (XML).

Common object request broker architecture (CORBA) is a method for invoking distributed objects across a network. There has been some activity in applying this software technology to Digital Imaging and Communications in Medicine (DICOM), but no documented demonstration of how this would actually work. We report a CORBA demonstration that is functionally equivalent and in some ways superior to the DICOM communication protocol. In addition, in and outside of medicine, there is great interest in the use of extensible markup language (XML) to provide interoperation between databases. An example implementation of the DICOM data structure in XML will also be demonstrated. Using Visibroker ORB from Inprise (Scotts Valley, CA), a test bed was developed to simulate the principle DICOM operations: store, query, and retrieve (SQR). SQR is the most common interaction between a modality device application entity (AE) such as a computed tomography (CT) scanner, and a storage component, as well as between a storage component and a workstation. The storage of a CT study by invoking one of several storage objects residing on a network was simulated and demonstrated. In addition, XML database descriptors were used to facilitate the transfer of DICOM header information between independent databases. CORBA is demonstrated to have great potential for the next version of DICOM. It can provide redundant protection against single points of failure. XML appears to be an excellent method of providing interaction between separate databases managing the DICOM information object model, and may therefore eliminate the common use of proprietary client-server databases in commercial implementations of picture archiving and communication systems (PACS).

Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction.

BACKGROUND AND STUDY OBJECTIVES: Noninvasive positive airway pressure may play a significant role in treating patients with congestive heart failure (CHF). We tested our hypothesis that noninvasive bilevel positive airway pressure improves left ventricular performance in patients with chronic CHF secondary to severe systolic dysfunction. OBJECTIVES: To determine the cardiac performance of patients using bilevel positive airway pressure, and to describe the hemodynamic effects of bilevel positive airway pressure and its use as a therapeutic adjunct in these patients. DESIGN: Prospective, cohort, nonrandomized study. SETTING: Outpatient medicine clinic. PATIENTS: Fourteen patients (9 men and 5 women) with stable chronic CHF with left ventricular ejection fraction < or =35%; mean age was 60.6 years (range, 43 to 87 years). INTERVENTIONS: Bilevel positive airway pressure via nasal mask at an inspiratory pressure of 5 cm H(2)O and an expiratory pressure of 3 cm H(2)O on spontaneous mode at room air for 1 h. MEASUREMENTS AND RESULTS: Myocardial performance and changes were measured using clinical and echocardiographic parameters. Baseline clinical and echocardiographic parameters were compared with the same parameters after 1 h of bilevel positive airway pressure. Statistically significant (p<0.05, Wilcoxon matched pair signed-rank test) decreases were noted in these mean values: systolic BP from 136.21 to 124.14 mm Hg (p = 0.008), heart rate from 85.07 to 74.71 beats/min (p = 0.002), respiratory rate from 23.07 to 15.43 breaths/min (p = 0.001), and systemic vascular resistance from 1671. 46 to 1236.27 dyne. s. cm(3) (p = 0.001). Statistically significant increases were noted in these mean values: cardiac output from 5.09 to 6.37 L/min (p = 0.004), ejection fraction from 28.71% to 34.36% (p = 0.001), and end-diastolic volume from 224.36 to 246.21 mL (p = 0.045). CONCLUSION: Bilevel positive airway pressure has excellent potential for improving left ventricular performance of patients with chronic CHF secondary to severe systolic dysfunction.

Cutaneous neuroblastoma. Peripheral neuroblastoma.

UNLABELLED: Cutaneous neuroblastoma (CN) is a rare tumor in adults. Histologically CN can be confused with other small, round cell tumors, especially with Merkel cell tumor. This is the second case that we have encountered in a 6-year period. A 46-year-old man with severe adult respiratory distress syndrome had a 2.5 x 2.0 x 2.0-cm, rapidly growing, fleshy nodule over his nose. The clinical impression was pyogenic granuloma (PG) or keratoacanthoma (KA). Histologically, the tumor showed undifferentiated cells with frequent Homer Wright rosettes and mitoses. Conventional special stains and a broad panel of immunohistochemical markers were applied that were positive only for neuron-specific enolase. Ultrastructurally the cells contained dense-core granules and immature desmosomes. The diagnosis of CN was made and an extensive radiologic and laboratory workup was initiated, but the results were negative for another primary tumor. The patient subsequently died and a thorough postmortem examination revealed multiple visceral metastatic lesions but no primary tumors in the adrenal glands, the sympathetic chain, or the central nervous system. CONCLUSIONS: (a) CN does occur in adults and can mimic other fast-growing tumors of the skin, for example, PG or KA; (b) the diagnosis of CN requires the combined use of immunohistochemistry and electron microscopy; and (c) the dermatologist should be aware of this rare, but important, tumor because its primary cutaneous manifestation may enable early recognition.

Pressure control inverse ratio ventilation as a method to reduce peak inspiratory pressure and provide adequate ventilation and oxygenation.

Nineteen patients with ARDS or pneumonia who were ventilated with PcIRV on the Siemens-Elema Servo 900 C were retrospectively reviewed. The PcIRV reduced peak airway pressure, PEEP, increased Paw, and improved ventilation and oxygenation in these patients. When these patients were compared with themselves on prior conventional IPPV, all had a decrease in PIP, an increase in Paw and most had a decrease in VE, with no change in PaCO2 and an increase in PaO2. The increase in Paw may have contributed to this improved arterial oxygenation. High levels of PIP and PEEP during IPPV have been identified as risk factors in the development of barotrauma and residual parenchymal pulmonary damage. We propose that PcIRV allows for adequate ventilation and oxygenation with decreases in PIP, extrinsically added PEEP and inspired O2 concentration. This mode of ventilation may decrease the morbidity associated with IPPV utilizing high PIP and PEEP.