BK polyomavirus (BKV) is highly prevalent in the human population, infecting children without obvious symptoms and persisting in the kidney in a latent state. In immunosuppressed patients, BKV is reactivated and excreted in urine. BKV isolates worldwide are classified into four serologically distinct subtypes, I-IV, with subtype I being the most frequently detected. Furthermore, subtype I is subdivided into subgroups based on genomic variations. In this study, the distribution patterns of the subtypes and subgroups of BKV were compared among four patient populations with various immunosuppressive states and of various ethnic backgrounds: (A) Finnish renal-transplant recipients; (B) Irish/English haematopoietic stem-cell transplant recipients with and without haemorrhagic cystitis; (C) Japanese renal-transplant recipients; and (D) Japanese bone-marrow transplant recipients. The typing sequences (287 bp) of BKV in population A were determined in this study; those in populations B-D have been reported previously. These sequences were subjected to phylogenetic and single nucleotide polymorphism analyses. Based on the results of these analyses, the BKV isolates in the four patient populations were classified into subtypes and subgroups. The incidence of subtype IV varied significantly among patient populations. Furthermore, the incidence of subgroup Ib-2 within subtype I was high in populations A and B, whereas that of Ic was high in populations C and D (P<0?01). These results suggest that subgroup Ib-2 is widespread among Europeans, whereas Ic is unique to north-east Asians. Furthermore, a phylogenetic analysis based on complete BKV DNA sequences supported the hypothesis that there is geographical separation of European and Asian BKV strains.

Nineteen patients were involved in an outbreak of infection caused by Yersinia pseudotuberculosis serotype 3. No epidemics attributable to this microorganism have been previously reported; the most extensive known cluster of cases involved four children in one family and their pet dog. The key finding in the outbreak described in the present study was the bacteriologic identification of serotype 3 in stool specimens from patients with clinically typical yersiniosis. Twelve cases were identified by isolation of Y pseudotuberculosis from stool specimens. An ELISA permitted serological diagnosis of the remaining seven cases. The antibody response was unusually slow in some patients. A noteworthy feature of the outbreak was the high incidence of postinfection complications, which developed in 10 of 19 patients. In spite of active screening of the respective families and environments of the patients, no transmitting factor was found, and the precise source of the infection remains unknown.

The interaction between fibronectin and Yersinia strains was studied. Wild-type Y. enterocolitica strains expressing the virulence-plasmid-encoded adhesion protein YadA adhered strongly to fibronectin-coated coverslips, while their plasmid-cured variants expressed weaker binding. The cloned yadA gene of Y. enterocolitica or Y. pseudotuberculosis conferred fibronectin-binding ability both to Escherichia coli and to Y. psuedotuberculosis strains lacking the YadA protein. The YadA protein did not mediate binding to isolated fragments of fibronectin or to soluble fibronectin.

The clinical manifestations of infection were analysed during an outbreak of 34 cases of Yersinia pseudotuberculosis serotype Ia infection. The diagnosis was based on the results of enzyme immunoassay and verified by stool culture in five cases. The first four patients were pupils from the same school, and information on any signs and symptoms of infection was obtained by questionnaire from pupils of the school. A blood sample was obtained from 101 children. Strong IgM and IgG antibody responses to Yersinia pseudotuberculosis Ia were found in 13 (25%) of the 52 pupils who reported signs and symptoms of infection and in 9 (18%) of the 49 with no manifestations of infection. The vigorous immune response also resulted in effective opsonization of the causative microorganism. The most common symptoms were fever and abdominal pain. Three children operated on because of suspected appendicitis were found to have mesenteric lymphadenitis. Only one patient developed reactive arthritis. Analysis showed that a remarkable proportion of Yersinia pseudotuberculosis infections may be subclinical, and that individual Yersinia pseudotuberculosis strains may have different capacities to cause postinfection complications.

Background: Pregnancy-associated plasma protein A (PAPP-A) has been suggested as a useful diagnostic and prognostic marker in acute coronary syndromes. Because low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are commonly used in these cases, we analyzed the effects of intravenous administration of these heparins on serum PAPP-A concentrations. Methods: Serum concentrations of total and free PAPP-A were analyzed in 14 patients on chronic hemodialysis and in 10 coronary angiography patients. Ten of the dialysis patients received standard LMWH anticoagulation at the start of dialysis, and 4 were treated with a heparin-free method. Two of the patients on heparin-free hemodialysis received a reduced LMWH bolus 2 h after the start of dialysis. All angiography patients received UFH at the start of the procedure, and 1 patient received 2 extra boluses of UFH. Serum PAPP-A concentrations were analyzed before and during the dialysis session and during the coronary angiography examination. Results: A rapid increase in total PAPP-A (median, 25-fold) was seen in all patients within 5 min of administration for both LMWH and UFH boluses. This response was due to an increase in free PAPP-A in the serum. PAPP-A did not increase significantly in the patients who underwent heparin-free hemodialysis. Repeated heparin boluses induced a new PAPP-A release. In vitro addition of heparins to samples of whole blood did not increase PAPP-A concentrations. Conclusions: Intravenous administration of heparin induces an intense and rapid increase in free PAPP-A in the serum. We recommend that this effect be considered when PAPP-A is assessed as a biomarker in acute coronary syndromes.

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Screening of the skeleton by plain radiography was compared to magnetic resonance imaging (MRI) of the lumbar spine in 41 patients with multiple myeloma. In the lumbar spine, myeloma lesions were detected in 15 patients with radiography and in 28 patients with MRI. Radiography of the lumbar spine was not positive in any of the 13 cases with negative MRI, but in two of them radiography was positive elsewhere in the skeleton. We suggest that plain radiography is the most suitable method for screening all bone areas in multiple myeloma, but MRI of the lumbar spine is needed to study patients with normal radiographs.

Coronary flow reserve was normal although baseline myocardial blood flow was increased in all CKD patients as compared to healthy controls. Peripheral endothelial dysfunction was detected in all patients. Our findings suggest that coronary perfusion and peripheral vascular function are disturbed by different mechanisms in patients with CKD.