Perceptions of and risk factors for andropause

There has been some controversy about whether males undergo andropause (male equivalent of a menopause). This study seeks to describe how older males perceive and understand this entity. It also explores the possibility of an association between the age of onset of andropause and risk factors such as ethnic origin, smoking, alcohol, hypertension, and cerebrovascular disease. A nonexperimental, cross-sectional study was conducted at the outpatient clinic at a Veterans Affairs Medical Center. Subjects were interviewed by a single investigator and answered a questionnaire consisting of 22 items, including information on patient demographics, patient understanding of andropause, patient understanding of possible interventions with hormonal therapy, medical and drug history, and social habits such as smoking and drinking. Altogether 302 male patients were recruited: 71% of the survey population were above the age of 60 years, and 87% were white, 6% Hispanic, and 5% black. Patient knowledge of andropause was lacking, though the majority (70%) expressed an interest in getting further knowledge. The most frequent age for onset of symptoms related to andropause was 51-60 years, and patients reported symptoms such as impotence, weakness, and memory loss. The next most common age associated with onset was 61-70 years. Multivariate regression analysis revealed that smoking more than 10 cigarettes a day was independently associated with an earlier onset of andropause symptoms bringing down the age of onset to below 50 years (p = .01, OR = 2.5, CI = 1.2-5.3). We found no association with risk factors such as ethnicity or alcohol. Andropause is experienced by many older males but knowledge of the entity is nonuniform. Smokers are at risk for an earlier onset of andropause. This is the first study to look at risk factors for andropause and the results are consistent with studies in females on smoking and menopause.

Perceptions of and risk factors for andropause

There has been some controversy about whether males undergo an andropause (male equivalent of a menopause). This study seeks to describe how older males perceive and understand this entity and whether there is an association between the age of onset of andropause and risk factors such as ethnic origin, smoking, alcohol, hypertension, and cerebrovascular disease. A nonexperimental, cross-sectional study was conducted at the outpatient clinic at a Veterans Affairs Medical Center. Subjects were interviewed by a single investigator and administered a questionnaire consisting of 22 items, including information on patient demographics, patient understanding of the andropause, patient understanding of possible interventions with hormonal therapy, medical, and drug history, and social habits such as smoking and drinking. Altogether 302 male patients were recruited, 71% of which were above the age of 60 years, and 87% were white, 6% were Hispanic, and 5% were black. The knowledge of patients toward the entity of andropause was lacking, though the majority (70%) expressed an interest in getting further knowledge. The most frequent age of onset of symptoms related to andropause was 51-60 years, and patients reported symptoms such as impotence, weakness, and memory loss. The next most common age reported to he associated with age of onset was 61-70 years. Multivariate regression analysis reveals that smoking more than 10 cigarettes a day was independently associated with an earlier onset of symptoms of andropause, bringing down the age of onset to below 50 years (p = .01, OR = 2.5, CI = 1.2-5.3). We found no association with risk factors such as ethnicity and alcohol. Andropause is experienced by many older males but knowledge of the entity is nonuniform. Older males are at risk for an earlier onset of andropause if they were smokers. This is the first study looking at risk factors for andropause and the results are consistent with studies in females on smoking and menopause.

Altered immune response of interferon regulatory factor 1-deficient mice against Plasmodium berghei blood-stage malaria infection

Nitric oxide (NO) is a short-lived biological mediator which can be induced in various cell types and is able to cause many metabolic changes in target cells. Inhibition of tumor cell growth and antimicrobial activity has been attributed to the stimulation of NO production by transcriptional upregulation of inducible nitric oxide synthase. In the present study, we used mice devoid of functional interferon regulatory factor 1 by targeted gene disruption (IRF-1(-/-)) to investigate the role of NO in the host immune response against blood-stage Plasmodium berghei ANKA infection. IRF-1(-/-) mice survived longer with a later onset of and a lower peak parasitemia despite the inability to produce appreciable levels of NO. The administration of exogenous interleukin-12 (IL-12) was able to prolong survival in the wild-type mice with an upregulation in the expression of both gamma interferon (IFN-gamma) and NO. However, the administration of IL-12 did not improve the survival of IRF-1(-/-) mice. These studies indicate that while IL-12 is able to mediate protection via an IFN-gamma- and NO-dependent pathway in the wild-type mice, such a protective mechanism may not be functional in the IRF-1(-/-) mice. Our results suggest that NO may not be essential for host immunity to the parasite and that IRF-1(-/-) mice are able to induce an IFN-gamma- and NO-independent mechanism against P. berghei infection.

Goldberger's triad in dilated cardiomyopathy--can it predict the severity of left ventricular dysfunction?

Goldberger's triad is a specific, but relatively insensitive, electrocardiographic sign for dilated cardiomyopathy. To study the correlation between the presence of this sign and the severity of left ventricular dysfunction, the electrocardiograms and echocardiographically-determined left ventricular parameters of 17 patients (mean age 59.3 +/- 11.8 years) with dilated cardiomyopathy were examined. Five of the patients had Goldberger's triad. We found that the mean left atrial diameter, the mean left ventricular internal diameters (both end-systolic and end-diastolic) and the mean left ventricular ejection fraction of the group of patients with Goldberger's triad did not differ significantly from the group without. Coronary angiography revealed occult coronary artery disease in 5 of 12 patients. A larger, prospective study is required to verify our finding.

The Brugada syndrome in a Chinese population

Sudden cardiac death has been reported in patients with a unique electrocardiographic (ECG) abnormality showing right bundle branch block and ST segment elevation in the precordial leads. This syndrome was first described by Brugada and Brugada and has not been previously described in a Chinese population. We report here the first three cases in Singapore. The first patient was a 49-year-old man who presented with syncope, associated with generalized convulsions. The second patient was a 25-year-old man who complained of palpitations but no syncope. The third patient was a 77-year-old man who presented with recurrent episodes of syncope and collapsed with ventricular fibrillation. All patients had no past cardiac or drug history of note. The neurological examination and investigations were normal. All three patients showed a unique right bundle branch block pattern with ST segment elevation in leads V1-3. The echocardiogram and 24-h ambulatory ECG monitoring, were normal. Single vessel disease was present in the third patient. Electrophysiological studies performed in all three patients were able to induce ventricular fibrillation. The patient with resuscitated cardiac death underwent an implantable cardioverter defibrillator implantation. The importance of this syndrome is that the recognition of the unique ECG pattern enables early identification and treatment of these patients.

Testosterone replacement therapy. What is its potential in elderly men?

Currently, the use of testosterone replacement therapy in elderly men is not considered routine. However, the aging population makes it an increasingly important issue for primary care physicians, and therapy can be effectively managed in a primary care setting when indicated. Because of testosterone's potential side effects, therapy should be customized and patients must be carefully monitored. This treatment has tremendous potential, but further research is needed before routinely recommending it for hypogonadal elderly men.

Congestive heart failure in elderly patients. The treatment goal is improved quality, not quantity, of life

Primary care physicians who see elderly patients are likely to see cases of congestive heart failure, since this condition is typically the result of long-standing hypertension or coronary artery disease. Recognizing the condition in elderly patients may not be easy, though, because clinical signs can be distorted by accompanying symptoms. In this article, the authors discuss pathophysiologic, diagnostic, and pharmacokinetic issues. They also describe therapy with diuretics, angiotensin-converting enzyme inhibitors, and digoxin and outline special considerations in the elderly.

Regulation of IFN-alpha/beta genes: evidence for a dual function of the transcription factor complex ISGF3 in the production and action of IFN-alpha/beta

BACKGROUND

Efficient production of interferons (IFNs) in virally infected cells is an essential aspect of the host defence. The transcription factor complex ISGF3 (IFN-stimulated gene factor 3) was originally identified as a critical mediator of the IFN signal; it is formed upon IFN receptor (IFNR) stimulation and binds to ISREs (IFN-stimulated response elements) to activate IFN-inducible genes. It has recently been shown that the DNA binding component of ISGF3, p48 (ISGF3gamma) also binds to virus-inducible elements in the IFN-alpha/beta genes, suggesting a potential new role of p48 in IFN production.

RESULTS

Primary cells from mice with a targeted disruption of the p48 gene show severe defects in virus-induced IFN-alpha/beta gene expression. A similar defect was also observed in cells lacking type I IFNR or Stat1, further demonstrating the role of IFN signalling in the induction of these IFN genes. ISGF3 in fact binds to the virus-inducible elements within the IFN-alpha/beta promoters. We also provide evidence showing that these elements are additionally controlled by an unidentified factor(s) which presumably triggers the primary phase of IFN gene induction.

CONCLUSIONS

Our results demonstrate that the IFN signal transducing complex ISGF3 plays a crucial role in IFN production and suggest that ISGF3 may participate directly in the activation of IFN-alpha/beta promoters. This dual function of ISGF3 may insure the efficient operation of this cytokine system in the host defence.

Identification of the lysyl oxidase gene as target of the antioncogenic transcription factor, IRF-1, and its possible role in tumor suppression

The transcriptional activator IFN regulatory factor 1 (IRF-1) and its antagonistic repressor IRF-2 are regulators of the IFN system. IRF-1 also manifests tumor suppressive activity, and its inactivation could contribute to the development of human hematopoietic malignancies. Here, we report the identification of the lysyl oxidase gene as a target gene of IRF-1. An IRF response element was identified in the lysyl oxidase gene promoter. We also demonstrate that the transformed phenotype of ras-expressing embryonic fibroblasts with a null mutation in the IRF-1 allele could be suppressed by the expression of the lysyl oxidase cDNA, implicating its potential role in tumor suppression. Thus, the regulation of the lysyl oxidase gene by IRF-1 could contribute to the multistep process of malignant transformation.

Essential and non-redundant roles of p48 (ISGF3 gamma) and IRF-1 in both type I and type II interferon responses, as revealed by gene targeting studies

BACKGROUND

Interferons (IFNs) are a class of cytokines which confer cellular resistance against viral infections. Type I (IFN-alpha and -beta) and type II (IFN-gamma) IFNs utilize distinct receptors, the stimulation of which results in the induction of downstream target genes. These target genes usually contain within their promoter region an IFN responsive element, termed ISRE (IFN stimulated response element) which binds a heterotrimeric transcription factor, ISGF3 (IFN-stimulated gene factor 3) consisting of p48 (ISGF3 gamma), Stat1 (Signal transducers and activators of transcription-1; alpha or beta), and Stat2. The ISRE sequence overlaps with that of IRF-E which binds another IFN-inducible factor, IRF-1 (IFN regulatory factor-1).

RESULTS

We generated mice lacking p48 by gene targeting. We show that p48 plays an essential role in both type I and type II IFN responses; activation of IFN-inducible genes and establishment of the antiviral state by IFN-alpha or -gamma are both severely impaired, and ISRE-binding activities induced by both IFNs are absent in the p48-negative embryonic fibroblasts (EFs). Furthermore, we generated mice deficient for both p48 and IRF-1 and found that at least one IFN-inducible gene is dependent on both factors.

CONCLUSIONS

p48 and IRF-1 do not perform redundant functions in the cell, but rather complement one another in both type I and II IFN responses.

The effect of low dose lofepramine in depressed elderly patients in general medical wards

A double-blind randomised controlled trial of the effect of low dose lofepramine (70 mg once daily) against placebo was carried out on depressed elderly inpatients on general medical wards for the elderly, comparing measures of depression and side-effects between the randomised groups. Patients were identified for the study using the Geriatric Depression Scale (GDS) and the Brief Assessment Schedule Depression Cards (BASDEC). Sixty-three subjects were randomised: 46 patients completed the entire trial of 28 days treatment. BASDEC and GDS were administered on day 8 post-admission, and depressed patients were randomised double-blind to either low dose lofepramine (70 mg daily) (n = 23) or placebo (n = 23). Assessment of changes in depressive states were made using the Montgomery Asberg Depression Rating Scale (MADRS) on days 8, 18 and 36 post-admission. Both groups improved by a similar amount during the trial. Lofepramine tended to be more effective than placebo in those patients who were more depressed (GDS > or = 18). On the other hand, subjects who were less depressed (i.e. GDS < 18) improved more on placebo than lofepramine. Low dose lofepramine may prove useful in moderately or severely depressed patients treated for only 4 weeks. However, low dose lofepramine is not indicated for mild (GDS 15-18) depression.

Clinical and histological features of 'mechanic's hands' in a patient with antibodies to Jo-1--a case report

The clinical and histological features of 'mechanic's hands' are described in a patient with polymyositis characterized serologically by antibodies to histidyl tRNA synthetase (Jo-1). Although described in the past in association with polymyositis, these distinctive cutaneous lesions have only recently been associated with the 'anti-synthetase syndrome'. It is becoming apparent that recognition of subsets within the spectrum of polymyositis/dermatomyositis characterized by certain clinical and serological features not only have prognostic significance, but also may provide insights into mechanisms of disease.

Oral presentation of lymphoma: case report of T-cell lymphoma masquerading as oral Crohn's disease, and review of the literature

A 15-year-old male with labial swelling, mouth ulcers and mucosal tags is reported. While the features were clinically consistent with oral Crohn's disease the patient proved to have a fatal T-cell lymphocytic lymphoma.

Molecular analysis of hypoxanthine phosphoribosyl transferase mutants induced by glycidyl 1-naphthyl ether in mouse spleen cells in vivo

Treatment of C57BL/6J mice with an epoxide, glycidyl 1-naphthyl ether (GNE), resulted in an average of a 3.4-fold increase in frequency of 6-thioguanine-resistant mutants of mouse spleen T-lymphocytes. In similar experiments with the epoxide trichloropropylene oxide, no increase in mutant frequency was found. To determine the kind and location of mutations in the coding region of the hypoxanthine phosphoribosyl transferase (HPRT) gene, 26 GNE-induced mutants and 17 spontaneous mutants were analyzed by direct sequencing of polymerase chain reaction amplified cDNA. Among the GNE-induced mutants, HPRT cDNA was present in 22, while that from 4 could not be detected. Among the spontaneous mutants, HPRT cDNA was present in 15 and absent in 2. Among GNE-induced mutants, base substitution in HPRT occurred in 15 of 22 mutants analyzed. Nine of 15 base substitutions involved TA base pairs, primarily TA-->CG transitions. Base substitutions were found throughout exons 3-7 but 46% of substitutions were located in exon 3 and one frameshift mutation involving a GC base pair in exon 3 was also observed. Among the spontaneous mutants, base substitutions of HPRT occurred in 7 of 15 mutants analyzed with 6 of 7 base substitutions involving a TA base pair and another 2 of the 15 mutants showed a 4 base pair deletion. The base substitution spectrum in GNE-induced mutants was different from that of the spontaneous mutants.

Chromatographic purification and characterization of EBV DNase from chemically induced lymphoid cells

Epstein-Barr virus-associated deoxyribonuclease (EBV-DNase) was purified to homogeneity, as determined by silver staining, sequential column chromatography, and FPLC from Raji and P3HR-1 cells treated with 12-O-tetradecanoyl-phorbol-13-acetate and sodium butyrate. This viral protein was immunogenic and elicited high neutralization titer sera in rabbits. By silver staining of SDS-PAGE, Western immunoblot, and radioimmunoprecipitation using NPC patient sera and both polyclonal and monoclonal antibodies, the EBV DNase was identified as a 58K protein. The potential presence of two EBV DNases was also discussed.

Papular lesions and cutaneous lupus erythematosus: a comparative clinical and histological study using monoclonal antibodies

Skin biopsies from 13 patients with papular lesions thought to be cutaneous lupus erythematosus were analyzed by light microscopy, direct immunofluorescence and immunohistochemically and compared to 22 biopsies from patients with discoid lupus, subacute cutaneous lupus erythematosus and acute cutaneous lesions of SLE. Papular lesions demonstrated fewer florid dermal and epidermal changes but a similar marked mononuclear cell infiltrate which in all groups was composed predominantly of T lymphocytes (68.4 +2- 11.2 SD) with the mean helper: suppressor (corrected Leu 3a:T8) ratio 1.73 +/- 0.60 SD. HLA-DR expression on keratinocytes was present in 20 patients, including 4 with papular lesions, and was strongly associated with liquefactive degeneration (chi 2, p less than 0.001), the hallmark of dermoepidermal junctional damage.

Association of Epstein-Barr virus early antigen diffuse component and virus-specified DNA polymerase activity

The role of Epstein-Barr virus (EBV) early antigen diffuse component (EA-D) and its relationship with EBV DNA polymerase in EBV genome-carrying cells are unclear, EBV-specified DNA polymerase was purified in a sequential manner from Raji cells treated with phorbol-12,13-dibutyrate and n-butyrate by phosphocellulose, DEAE-cellulose, double-stranded DNA-cellulose, and blue Sepharose column chromatography. Four polypeptides with molecular masses of 110,000, 100,000, 55,000, and 49,000 daltons were found to be associated with EBV-specified DNA polymerase activity. A monoclonal antibody which could neutralize the EBV DNA polymerase activity was prepared and found to recognize 55,000- and 49,000-dalton polypeptides. An EA-D monoclonal antibody, R3 (G. R. Pearson, V. Vorman, B. Chase, T. Sculley, M. Hummel, and E. Kieff, J. Virol. 47:183-201, 1983), was also able to recognize these same two polypeptides associated with EBV DNA polymerase activity. It was concluded that EBV EA-D polypeptides, as identified by R3 monoclonal antibody, are critical components of EBV DNA polymerase.

Induction of virus enzymes by phorbol esters and n-butyrate in Epstein-Barr virus genome-carrying Raji cells

Phorbol esters and n-butyrate (SB) together could induce Epstein-Barr virus (EBV) DNA polymerase and DNase activities in Raji cells (virus nonproducer). Neither 12-O-tetradecanoylphorbol-13-acetate (TPA) nor SB alone could induce these EBV enzyme activities, transcription of the EcoRI C-region or other EBV proteins in Raji cells. The enzyme induction caused by exposure of Raji cells to TPA-SB was the result of the synthesis of virus-specified RNA, and the increase of linear EBV DNA content in Raji cells caused by TPA alone was not sufficient for induction of EBV-enzyme activities. Temporal characteristics of the TPA-SB induction process, but not the phorbol 12,13-dibutyrate-SB induction process, in Raji cells were observed; a critical phase (10-24 h) postphorbol ester treatment in phorbol 12,13-dibutyrate-SB-treated Raji cells which was responsible for the synthesis of virus RNA and enzymes was found. Phospholipase C, which increases intracellular diacylglycerols (and subsequently activates protein kinase C) was able to partially substitute for TPA in the TPA-SB induction for EBV polymerase and DNase activities. Sphingosine, a protein kinase C inhibitor, partially prevented the induction of virus enzyme activities in Raji cells treated with phorbol 12,13-dibutyrate and SB. No apparent changes in the methylation state of EBV DNA (EcoRI C region) were observed when Raji cells were treated with SB and TPA, alone or in combination. These results suggest that induction of EBV polymerase and DNase activities by TPA-SB may involve protein kinase C activation and another factor triggered by SB which together increase transcription of EBV DNA.

Pagetoid reticulosis, epidermotropic mycosis fungoides and mycosis fungoides: a disease spectrum

Using a standard technique involving monoclonal antibodies against T-cell subsets, we have shown that almost all the infiltrating T-cells in the epidermis of a patient with Pagetoid reticulosis (PR), one with epidermotropic mycosis fungoides (EMF) and one with poikiloderma atrophicans vasculare (PAV), were OKT8 positive (presumed cytotoxic/suppressor) T-cells. The infiltrating T-cells in the epidermis of a patient with limited plaque stage mycosis fungoides (MF), however, were almost exclusively Leu 3a-positive (presumed helper/inducer) T-cells as is usually found in this condition. The keratinocytes in the patients with PR, EMF and PAV were HLA-DR-positive whilst those in the patient with MF were HLA-DR-negative. We consider these four diseases to be part of the spectrum of mycosis fungoides, the first three conditions representing the early or benign end of the spectrum.

Demonstration of Epstein-Barr virus-specific DNA polymerase in chemically induced Raji cells and its antibody in serum from patients with nasopharyngeal carcinoma

Epstein-Barr virus (EBV) has been found to be associated with nasopharyngeal carcinoma (NPC), and antibodies with high frequency and titer to EBV proteins have been found in sera from NPC patients. Raji cells, an EBV genome-carrying nonproducer cell line, treated with 12-O-tetradecanoylphorbol-13-acetate and n-butyrate induced a unique EBV DNA polymerase which has properties similar to the EBV DNA polymerase induced by 12-O-tetradecanoylphorbol-13-acetate in P3HR-1 cells, an EBV producer cell line. The possible presence of antibodies to this EBV DNA polymerase in NPC patient serum was examined. The mean number of EBV DNA polymerase units neutralized was 380 +/- 168 units/ml serum (mean +/- SD) in 48 sera from patients with NPC, whereas that in the sera from 52 healthy donors was 62 +/- 56 units/ml (p less than 0.01). The EBV DNA polymerase antibody was found to be associated with the immunoglobulin G but not the immunoglobulin A fraction, and its titer was not correlated with the titers against EBV DNase or virus capsid antigen-immunoglobulin A. Whether the EBV DNA polymerase antibody is against the EBV DNA polymerase core protein or its stimulating protein is still being investigated. This study demonstrated the high frequency and high titer of antibody against EBV DNA polymerase in serum from NPC patients and suggested the potential of utilizing this antibody titer to complement other methods for the early diagnosis or prognosis of NPC.