Crouzon syndrome associated with acanthosis nigricans: prenatal 2D and 3D ultrasound findings and postnatal 3D CT findings

Crouzon syndrome with acanthosis nigricans (CAN) is a very rare condition with an approximate prevalence of 1 per 1 million newborns. We add the first report on prenatal 2D and 3D ultrasound findings in CAN. In addition we present the postnatal 3D CT findings. The diagnosis was confirmed by molecular testing.

Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity

BACKGROUND

Sympathetic block causes vasodilatation and increases in skin temperature (T(s)). However, the T(s) response after specific nerve blocking is unknown. In this study, we hypothesized that T(s) would increase after specific blocking of the nerve innervating that area.

METHODS

Forty-six patients undergoing hand surgery were included. We performed ultrasound-guided, specific nerve blocking of either the musculocutaneous, radial, ulnar, or median nerve in each patient and analysed T(s) in the forearm and hand at 2 min intervals in the following 22 min by the use of infrared thermography. Areas of interest corresponding to the cutaneous innervation area of each of the four nerves were defined and the mean T(s) in each area was analysed.

RESULTS

Specific blocking of the ulnar and median nerves caused a substantial increase in mean (sd) T(s) in the areas innervated by these nerves [5.2 (3.2)°C and 5.1 (2.5)°C, respectively; both P<0.0001]. The increase was even larger at the fingertips. Median nerve blocking also increased T(s) in the area of the hand innervated by the radial nerve (P<0.0001). However, T(s) did not increase in any area after either musculocutaneous or radial nerve blocking.

CONCLUSIONS

Specific blocking of the ulnar and median nerve causes substantial increases in T(s) in specific areas of the hand. In contrast, the specific blocking of the musculocutaneous or radial nerve does not increase T(s). Further studies are needed to clarify if these findings can be used to objectively evaluate brachial plexus block success.

Visceral leishmaniasis diagnosed in a patient with MALT lymphoma

We report a case of visceral leishmaniasis in a 66-year-old female with a history of MALT lymphoma in the gastrointestinal tract. The patient presented with major hemorrhage per rectum and perforation of the small intestine. Due to unexplained decreasing platelets, lymphoma bone marrow involvement was suspected and bone marrow examination was performed. Surprisingly, Leishman-Donovan bodies were detected. The low platelet count, caused by the combination of MALT lymphoma and visceral leishmaniasis, appears to have aggravated the symptoms of the intestinal lymphoma. Leishmaniasis should be suspected even among asymptomatic patients with immune compromising illnesses and a travel history to areas where leishmaniasis is endemic.

Ionized magnesium in gestational diabetes

A longitudinal prospective study was performed in order to describe variations in ionized magnesium in patients with gestational diabetes. Twenty-two gestational diabetic women and 24 healthy pregnant women were included consecutively. Blood samples were obtained in the second and third trimester and 2 days postpartum in both groups. The blood samples were analysed for serum ionized magnesium, serum ionized calcium and pH. None of the groups demonstrated any time-related changes in ionized magnesium. However, in the third trimester the level of ionized magnesium was statistically significantly elevated in patients with gestational diabetes compared to controls (0.57 +/- 0.05 mmol/l vs. 0.51 +/- 0.06 mmol/l; p < 0.01). The level of ionized calcium remained stable throughout the study period in both groups. In conclusion our findings suggest that gestational diabetes is associated with elevated levels of ionized magnesium.

The effect of subclinical hypocalcaemia induced by Na2EDTA on the feed intake and chewing activity of dairy cows

The effects of induced subclinical hypocalcaemia (SCHC) on feed intake and chewing activity during eating and rumination were studied in dairy cows. Two non-lactating and non-pregnant cows were subjected to three different treatments, with one test per day, such that the plasma free (ionized) calcium (FCa) concentration was maintained at the eucalcaemic level or at one of two constant SCHC levels. The cows and test days followed a 2 x 3 crossover design. SCHC was maintained for 7 h by repeatedly infusing 5% Na2EDTA so that constant FCa concentrations of 0.8 mmol/L or 0.6 mmol/L in plasma were achieved. Control conditions were achieved by infusing isotonic saline. Feed intake and the number of the rumination periods were recorded during test days. The proportion of feed eaten during each test meal (EatPro) was related to the mean plasma FCa. An almost linear decrease in EatPro was observed when the plasma FCa was 0.6-0.9 mmol/L. The cows showed no other clinical signs of hypocalcaemia during Na2EDTA-infusion. The time spent chewing during eating and rumination, and the number of rumination periods during a test day, decreased with a decline in plasma FCa concentration. It was concluded that induced SCHC depresses the feed intake and ruminative activity of dairy cows.

Increased post-exercise facilitation of motor evoked potentials in multiple sclerosis

OBJECTIVES

To study post-exercise facilitation following a non-fatigue exercise in a homogenous group of multiple sclerosis (MS) patients with complaints of muscle fatigue.

METHODS

In 15 MS patients and matched controls motor evoked potentials (MEP) were recorded from the biceps brachii muscle at time delays of 0.5-30s after an isometric contraction with a torque of 50% of maximal voluntary contraction (MVC) maintained for 2-6s. In addition, MEP was recorded after isometric torque of 25, 50, and 100% of MVC maintained for 6s.

RESULTS

Isometric non-fatigue contraction induced significant post-exercise increase in MEP amplitude in MS patients compared with controls being most pronounced after a contraction for 6s. The post-exercise increase in MEP lasted for longer than 30s in MS patients.

CONCLUSIONS

Post-exercise increase of MEP amplitude following a non-fatigue exercise was significant in MS patients with complaints of muscle fatigue compared with healthy subjects.

Mutation of yeast Eug1p CXXS active sites to CXXC results in a dramatic increase in protein disulphide isomerase activity

Protein disulphide isomerase (PDI) is an essential protein which is localized to the endoplasmic reticulum of eukaryotic cells. It catalyses the formation and isomerization of disulphide bonds during the folding of secretory proteins. PDI is composed of domains with structural homology to thioredoxin and with CXXC catalytic motifs. EUG1 encodes a yeast protein, Eug1p, that is highly homologous to PDI. However, Eug1p contains CXXS motifs instead of CXXC. In the current model for PDI function both cysteines in this motif are required for PDI-catalysed oxidase activity. To gain more insight into the biochemical properties of this unusual variant of PDI we have purified and characterized the protein. We have furthermore generated a number of mutant forms of Eug1p in which either or both of the active sites have been mutated to a CXXC sequence. To determine the catalytic capacity of the wild-type and mutant forms we assayed activity in oxidative refolding of reduced and denatured procarboxypeptidase Y as well as refolding of bovine pancreatic trypsin inhibitor. The wild-type protein showed very little activity, not only in oxidative refolding but also in assays where only isomerase activity was required. This was surprising, in particular since mutant forms of Eug1p containing a CXXC motif displayed activity close to that of genuine PDI. These results lead us to propose that general disulphide isomerization is not the main function of Eug1p in vivo.

[Uncomplicated gallstone disease and pregnancy]

Pregnancy is associated with an increased incidence of gallstones. However, most gallstones disappear spontaneously after pregnancy without having given any symptoms. New knowledge regarding the pathophysiology confirms changes in the motility of the gallbladder and the flow dynamics and lithogenicity of the bile. The studies have also shown, that these changes resolve completely after labour, which might explain the disappearance of most of the gallstones. These conditions support a conservative attitude towards treatment of gallstone disease during pregnancy. In case cholecystectomy is indicated, laparoscopic intervention seems safe during pregnancy and most optimal during the second trimester where the organogenesis of the fetus is completed and where the size of the uterus does not interfere with the operation technically. Laparoscopic cholecystectomy should under all circumstances be done in departments with routine in laparoscopic operations and with the possibility of gynaecological assistance, in case it is needed.

Salicylate-induced growth arrest is associated with inhibition of p70s6k and down-regulation of c-myc, cyclin D1, cyclin A, and proliferating cell nuclear antigen

Salicylate and its pro-drug form aspirin are widely used medicinally for their analgesic and anti-inflammatory properties, and more recently for their ability to protect against colon cancer and cardiovascular disease. Despite the wide use of salicylate, the mechanisms underlying its biological activities are largely unknown. Recent reports suggest that salicylate may produce some of its effects by modulating the activities of protein kinases. Since we have previously shown that the farnesyltransferase inhibitor l-744, 832 inhibits cell proliferation and p70(s6k) activity, and salicylate inhibits cell proliferation, we examined whether salicylate affects p70(s6k) activity. We find that salicylate potently inhibits p70(s6k) activation and phosphorylation in a p38 MAPK-independent manner. Interestingly, low salicylate concentrations (</=250 microm) inhibit p70(s6k) activation by phorbol myristate acetate, while higher salicylate concentrations (>/=5 mm) are required to block p70(s6k) activation by epidermal growth factor + insulin-like growth factor-1. These data suggest that salicylate may selectively inhibit p70(s6k) activation in response to specific stimuli. Inhibition of p70(s6k) by salicylate occurs within 5 min, is independent of the phosphatidylinositol 3-kinase pathway, and is associated with dephosphorylation of p70(s6k) on its major rapamycin-sensitive site, Thr(389). A rapamycin-resistant mutant of p70(s6k) is resistant to salicylate-induced Thr(389) dephosphorylation.

Optimised extraction of folic acid from multivitamin-mineral preparations for liquid chromatographic analysis

Degradation of folic acid may occur during extraction of multivitamin-mineral preparations. The degradation may be caused by presence of ions such as Fe3+ and Cu2+, however, the buffer composition may also be critical. This study presents an optimised extraction procedure tested on 24 different products of multivitamin-mineral tablets. The present method yielded mean recoveries of 97% (n = 20) for folic acid and prevented degradation of folic acid in at least 24 h in extracts from multivitamin-mineral tablets.

Post-exercise facilitation of compound muscle action potentials evoked by transcranial magnetic stimulation in healthy subjects

Post-exercise facilitation (PEF) of motor evoked potentials (MEPs) was studied by transcranial magnetic stimulation in 15 healthy subjects following standardized and controlled isometric contraction of the biceps brachii muscle. PEF was highly dependent on the time delay (TD) from muscle relaxation to delivery of the magnetic stimulus and only to a minor degree on the duration of the maintained muscular contraction of 2, 4, and 6 s. In addition, PEF was unaffected by the contraction levels of 25%, 50%, and 100% of maximal voluntary contraction (MVC). There was a linear relationship between the log amplitude of the post-exercise MEPs and the TD. The time point at which PEF had vanished was calculated to be 15.2 s. In order to challenge the question whether segmental and/or suprasegmental mechanisms are primarily responsible for PEF, MEPs and H-reflexes were recorded from the soleus muscle following a sustained plantar flexion at the ankle joint in three healthy subjects. PEF of MEPs was present at a TD of 1000 ms following a sustained contraction of 6 s at a level of 50% of MVC. It was accompanied by a pronounced decrease in the soleus H-reflex amplitude at a TD of 1000 ms.

Inactivation of the transforming growth factor beta type II receptor in human small cell lung cancer cell lines

Transforming growth factor beta (TGF-beta) exerts a growth inhibitory effect on many cell types through binding to two types of receptors, the type I and II receptors. Resistance to TGF-beta due to lack of type II receptor (RII) has been described in some cancer types including small cell lung cancer (SCLC). The purpose of this study was to examine the cause of absent RII expression in SCLC cell lines. Northern blot analysis showed that RII RNA expression was very weak in 16 of 21 cell lines. To investigate if the absence of RII transcript was due to mutations, we screened the poly-A tract for mutations, but no mutations were detected. Additional screening for mutations of the RII gene revealed a GG to TT base substitution in one cell line, which did not express RII. This mutation generates a stop codon resulting in predicted synthesis of a truncated RII of 219 amino acids. The nature of the mutation, which has not previously been observed in RII, has been linked to exposure to benzo[a]-pyrene, a component of cigarette smoke. Since RII has been mapped to chromosome 3p22 and nearby loci are often hypermethylated in SCLC, it was examined whether the lack of RII expression was due to hypermethylation. Southern blot analysis of the RII promoter did not show altered methylation patterns. The restriction endonuclease pattern of the RII gene was altered in two SCLC cell lines when digested with Smal. However, treatment with 5-aza-2'-deoxycytidine did not induce expression of RII mRNA. Our results indicate that in SCLC lack of RII mRNA is not commonly due to mutations and inactivation of RII transcription was not due to hypermethylation of the RII promoter or gene. Thus, these data show that in most cases of the SCLC cell lines, the RII gene and promoter is intact in spite of absent RII expression. However, the nature of the mutation found could suggest that it was caused by cigarette smoking.

Inhibition of DNA synthesis by a farnesyltransferase inhibitor involves inhibition of the p70(s6k) pathway

Previously, the protein farnesyltransferase inhibitor (FTI), L-744, 832, has been shown to inhibit the proliferation of a number of tumor cell lines in vitro in a manner that correlated with the inhibition of the mitogen-activated protein kinase cascade. Here we show that FTI inhibits p70(s6k) phosphorylation in mammary tumors in vivo in transgenic mice. Furthermore, in a mouse keratinocyte cell line, FTI inhibits p70(s6k) phosphorylation and activity and inhibits PHAS-1 phosphorylation in vitro in both rapidly growing cells and in growth factor-stimulated quiescent cells. Dominant-negative Ras expression inhibits p70(s6k) stimulation by epidermal growth factor, demonstrating a requirement for Ras activity during p70(s6k) activation. FTI does not inhibit protein kinase B phosphorylation on Ser473, indicating that FTI does not act by inhibiting phosphatidylinositol 3-kinase. FTI also inhibits DNA synthesis in keratinocytes, and inhibition of DNA synthesis correlates closely with p70(s6k) inhibition. Rapamycin, an inhibitor of p70(s6k) and PHAS-1 phosphorylation, causes a 30-45% reduction in DNA synthesis in keratinocytes, while FTI induces an 80-90% reduction in DNA synthesis. These observations suggest that alteration of p70(s6k) and PHAS-1 function by FTI are responsible for a substantial portion of the growth-inhibitory properties of FTI. Together, these data demonstrate that p70(s6k) and PHAS-1 are novel downstream targets of FTI and suggest that the anti-tumor properties of FTI are probably due to the inhibition of multiple mitogenic pathways.

Treatment with farnesyl-protein transferase inhibitor induces regression of mammary tumors in transforming growth factor (TGF) alpha and TGF alpha/neu transgenic mice by inhibition of mitogenic activity and induction of apoptosis

Mouse mammary tumor virus-transforming growth factor alpha (MMTV-TGF alpha) and MMTV-TGF alpha/neu transgenic mice develop mammary tumors after a long latency and therefore provide useful model systems for breast cancer with its recognized activation of receptor tyrosine kinase signaling. We used these mice to study the antitumor effect of L-744,832 (FTI), a potent and selective inhibitor of farnesyl-protein transferase, and hence of Ras function. A total of 55 mice were assigned randomly to treatment with FTI or vehicle, and one-half of the mice were crossed over after initial treatment to the opposite group. L-744,832 induced reversible regression of mammary tumors that was paralleled by a decrease in serum levels of TGF alpha secreted by the tumor cells. There was no difference in response to treatment with FTI between MMTV-TGF alpha mice, in which tumorigenesis was accelerated by multiparity or the chemical carcinogen 7,12-dimethylbenzanthracene, and MMTV-TGF alpha/neu mice. The tumor histological type had no impact on FTI sensitivity. For mechanistic analyses, tumor excision biopsies were obtained from 12 mice before and after treatment with L-744,832. In these samples, tumor regression was paralleled biochemically by inhibition of mitogen-activated protein kinase activity and biologically by an increase in G1-phase and decrease in S-phase fractions, as well as induction of apoptosis. These results suggest that the potential clinical use of FTI could be expanded to include cancers harboring activated receptor tyrosine kinases as well as those containing activated Ras.

Fibrolytic enzyme treatment of barley grain and source of forage in high-grain diets fed to growing cattle

We conducted a study to determine the effects of treating barley grain with a fibrolytic enzyme mixture on chewing activities, ruminal fermentation, and total tract digestibility in cattle. We also investigated the potential benefits of using barley straw rather than barley silage as a roughage source in high-grain diets for feedlot cattle. Steers were given ad libitum access to one of four diets that consisted of 95% barley-based concentrate and 5% forage (DM basis). The concentrate was either control or enzyme-treated, and the forage was either barley silage or barley straw. Applying the enzyme mixture onto the barley lowered the concentrations of dietary ADF and NDF. However, it is not certain when this fiber hydrolysis occurred relative to feed consumption because the fiber analyses were conducted after the study was completed. Enzyme treatment of barley increased total tract dietary ADF digestibility by 28% (P<.05). Acetate-to-propionate ratio tended to decrease, which suggests that enzymes may have increased ruminal starch digestion as a result of enhanced digestion of barley hulls. Replacing silage with straw increased ADF intake (P<.05) and resulted in 1-h/d increase in rumination time (P<.05). Even though there was no effect of diet on ruminal pH, replacing silage with straw increased ruminal acetate, as a percentage of total VFA, and total tract ADF digestion (P<.01). This study demonstrates that using a fibrolytic enzyme mixture in high-grain diets that contain mainly barley grain can improve fiber digestion and grain utilization, but the mode of action is unclear. Straw can be used rather than silage to increase the effective fiber content of a high-grain feedlot diet.

High value of the radiobiological parameter Dq correlates to expression of the transforming growth factor beta type II receptor in a panel of small cell lung cancer cell lines

Our panel of SCLC cell lines have previously been examined for their radiobiological characteristics and sensitivity to treatment with TGF beta 1. In this study we examined the possible correlations between radiobiological parameters and the expression of the TGF beta type II receptor (TGF beta-rII). We have, in other studies, shown that the presence of TGF beta-rII was mandatory for transmitting the growth inhibitory effect of TGF beta. The results showed a statistically significant difference in Dq, i.e. the shoulder width of the survival curve, between cell lines expressing TGF beta-rII and cell lines which did not express the receptor (P = 0.01). Cell lines expressing TGF beta-rII had a high Dq-value. TGF beta-rII expression did not correlate with any other radiobiological parameters. We suggest that an intact growth inhibitory pathway mediated by the TGF beta-rII may have a significant role for the repair of radiation induced DNA damage in SCLC.

Technical note: reversible re-entrant cannulation of the parotid duct in cattle using a new injection anesthesia regimen

A new method for reversible reentrant cannulation of the parotid duct in cattle by use of an injectable anesthetic regimen is described. Ruminal contents were removed before anesthesia instead of food deprivation. The parotid duct was dilated by means of a long hemostatic forceps: its jaws were encased in a piece of plastic tube, and the tip was extended by a piece of flexible wire. A polyethylene parotid catheter was inserted into the dilated duct and passed through the cheek. The saliva was re-directed back into the mouth via a silicone tube through another fistula in the cheek. The cannulations were maintained for 3 to 11 wk and two cows were recannulated three to five times in both parotid ducts without problems. No pathological changes of the mouth epithelium were found at slaughter. The rate of flow from the ducts during rest, ruminating, and eating were 5 to 20, 25 to 50, and 40 to 75 mL/min, respectively.