Targeting of a phogrin-green fluorescent protein chimaera to insulin secretory granules of pancreatic beta-cells in transgenic mice

We have generated a transgenic mouse expressing a chimaeric phogrin-enhanced green fluorescent protein (EGFP) targeted to pancreatic beta-cells by the rat insulin II promoter. The transgenic animals appear healthy, have normal weight gain and normal glucose tolerance. Morphological analyses of adult transgenic mice revealed that the fluorescent reporter molecule was specifically expressed in beta-cells of the pancreatic islet and not in extra-pancreatic tissues. The distribution of phogrin-EGFP in beta-cells, however, was heterogeneous with three distinct populations distinguishable by FACS analysis and immunofluorescence microscopy. Superficially-localized islets in the whole pancreas were readily visualized in the animals as was the developing endocrine pancreas in undissected 15.5 day old mouse embryos. We envisage that the animal will be an important resource for future investigations of islet development, regeneration and the molecular cell biology of insulin secretion.

Male breast cancer. An analysis of four cases and review of the literature

We report the clinicopathological features and outcome of four cases of carcinoma of the male breast diagnosed at the University Hospital of the West Indies between 1988 and 1998. Male breast cancer is most commonly seen in men over age sixty years, and it exhibits the same prognosis, stage for stage, as the disease in females. However, some researchers report overall poorer survival in men, and explain this on the basis of advanced disease at presentation. Other researchers maintain that the majority of breast cancers in males present at early stages, and exhibit survival similar to that in females. The published literature concerning this uncommon malignancy is reviewed, and the data are compared with the features of our cases.

Gluteus minimus: observations on its insertion

In 17 adult and 3 full term fetuses the hip joints were dissected to expose the insertion of gluteus minimus. An attachment of the deep surface of the tendon as it passes over the hip joint capsule was found in every case. Histological examination of this insertion confirmed the presence of short intramuscular tendons firmly anchoring the tendon to the capsule. It is suggested that this attachment retracts the capsule during hip joint motion, thereby preventing capsular entrapment.

VPAC1 receptors and lung cancer

VIP/PACAP are autocrine growth factors for lung cancer. VIP and/or PACAP mRNA is present in most lung cancer cell lines examined. Although mRNA for VPAC2-R is not common, VPAC1-R and PAC1-R mRNA is present in many lung cancer cell lines. 125I-VIP binds with high affinity to lung cancer cells and specific 125I-VIP binding is inhibited with high affinity by (Lys15, Arg16, Leu27)VIP1-7 GRF8-27, the VPAC1-R specific agonist, but not by Ro25-1553(18), the VPAC2-R specific agonist. VIP elevates cAMP and increases c-fos gene expression. The increase in cAMP and c-fos mRNA caused by VIP is inhibited by SN(VH). (SH)VH inhibited the proliferation of NCIH1299 cells in the MTT assay, which is based on cytotoxicity. In a recent cell line screen, (SN)VH inhibited the growth of 51 of 56 cancer cell lines including leukemia, lung cancer, colon cancer, CNS cancer, melanoma, ovarian cancer, renal cancer, breast cancer, and prostate cancer (T. Moody, unpublished). It remains to be determined if (SN)VH will be useful for treatment of a wide variety of cancers.

Late arrhythmia in adults with the mustard procedure for transposition of great arteries: a surrogate marker for right ventricular dysfunction?

OBJECTIVE

To examine the relation between ventricular dysfunction and late clinical arrhythmia in adults who underwent the Mustard procedure for transposition of the great arteries.

DESIGN

Observational study based on periodic outpatient assessment of biventricular function.

SETTING

Tertiary referral centre.

INTERVENTIONS

Analysis of data from 12 lead ECGs, echocardiography, exercise radionuclide ventriculography, and magnetic resonance imaging.

MAIN OUTCOME MEASURES

Clinical outcome and late onset clinical arrhythmia during follow up. ECG and ventricular function indices obtained before arrhythmia onset were used for analysis.

RESULTS

51 patients (mean (SD) age 25.7 (5.0) years) fulfilled entry criteria at a mean of 23.4 (4.0) years after the Mustard procedure. Late arrhythmia occurred in 11 (22%): sustained atrial flutter/fibrillation in 10, ventricular tachycardia in one. Compared with patients who remained arrhythmia free, patients with arrhythmia had longer QRS (129 (26) v 112 (16) ms, p = 0.01), greater QT dispersion (107 (28) v 51 (24) ms, p < 0.001), and increased ratio of right to left ventricular end diastolic diameter (2.4 (0.9) v 1.7 (0.7), p = 0.02), but no difference in wall thickness. Systemic ejection fraction was also reduced in the arrhythmia subgroup (at rest: 34.1 (13)% v 47 (16)%, p = 0.04; during exercise: 37.8 (12)% v 52 (17)%, p = 0.03). QRS duration correlated with right ventricular end diastolic diameter (r = 0.59, p < 0.001), suggesting a possible mechano-electric relation after the Mustard procedure. QT dispersion was the only predictor of clinical arrhythmia in multivariate analysis.

CONCLUSIONS

Impaired ventricular function in adults with the Mustard procedure for transposition of the great arteries relates to clinical arrhythmia. Late atrial flutter/fibrillation may be a surrogate marker for ventricular dysfunction, and these patients may also be at risk of ventricular tachycardia.

The relationship between functional capacity, muscle size and strength in chronic ACL deficient and ACL reconstructed individuals

Aim: The aim of this study was to assess the relationship between the quadriceps muscle atrophy and strength deficits caused by chronic ACL deficiency, and to ascertain whether these deficits were rectified in subjects who had undergone ACL reconstruction.Methods: Thirteen ACL deficient subjects (ACLD) and eight subjects who had undergone ACL reconstruction (ACLR) participated in the study. Functional capacity, lean thigh volume (LTV), and isokinetic peak torque of the quadriceps and hamstrings muscles were assessed.Results: The ACLD group had a significantly lower score for episodes of giving way compared to the ACLR group (7.4 +/- 3.8 vs. 18.0 +/- 3.7; p < 0.01) and a lower score for inability to perform jumping/twisting activities (1.8 +/- 0.8 vs. 3.6 +/- 1.1; p <0.01; ACLD vs. ACLR) suggesting decreased functional capacity. However, there was no significant difference between the ACLD group and ACLR group for LTV differences (416.0 +/- 276.5 vs. 238.3 +/- 224.4 cc) and quadriceps eccentric peak torque differences (38.1 +/- 13.7 vs. 23.7 +/- 18.3 Nm) between involved and uninvolved limbs. The relationship between LTV and quadriceps isokinetic peak torque was r = 0.59 (p < 0.05) for the ACLD group and r = 0.50 (NS) for the ACLR group.Conclusion: Quadriceps strength deficits are present in ACL deficient subjects, particularly during eccentric contractions. ACL reconstruction improved subjective function and reduced the episodes of giving way, but did not prevent eccentric quadriceps muscle weakness. A low correlation exists between reported function and LTV and eccentric peak torque activity, and between LTV and eccentric peak torque in both ACLD and ACLR groups. These findings suggest that factors other than muscle atrophy are responsible for the functional changes described, in ACL deficient and. ACL reconstructed groups.

Inhaled short acting beta2-agonist use in asthma: regular vs as needed treatment

BACKGROUND

Inhaled beta2-adrenergic agonists delivered by inhalation are very widely used in asthma. There has been much controversy of the use and possible consequences of the use of these agents for regular, as opposed as-needed use in asthma.

OBJECTIVES

This review to assessed the clinical trial evidence to test whether using regular use of short-acting beta2-agonists reduced asthma control and pulmonary function; worsened symptoms, airway reactivity and quality of life; and increased the rate of exacerbations.

SEARCH STRATEGY

A search was carried out of the Cochrane Airways Group "Asthma and Wheez* RCT" register using the terms: regular AND [beta agonist OR bronchodilator OR salbutamol OR albuterol Or terbutaline OR isoproterenol OR reproterol OR fenoterol]. Bibliographies of existing trials were searched and primary trial authors and pharmaceutical companies were approached for additional trials.

SELECTION CRITERIA

Randomised controlled trials in which the short-acting beta2-agonist was given regularly in the experimental group, together with an inhaled bronchodilator for relief of symptoms ('rescue use'). The control group consisted of matching placebo inhaled regularly, with an inhaled bronchodilator for as-needed 'rescue use'.

DATA COLLECTION AND ANALYSIS

Data were extracted and quality assessments were made by both reviewers. Parallel group and cross-over trials were analysed separately. Where possible data were pooled using a fixed effects model.

MAIN RESULTS

Over 800 abstracts were identified, following a review, 60 papers were requested for full assessment by both reviewers. 34 trials from 30 papers met the entry criteria. Data from 31 outcomes were analyzable. There was little difference between the treatments for nearly all outcomes. In cross-over studies, evening peak flow was better with regular treatment, weighted mean difference (WMD) 13.1 l/min (95% confidence interval 24.3, 1.9). In contrast, the FEV1 was better with as-needed treatment (WMD 157 ml (95% CI: 123, 192). Bronchial hyper reactivity was slightly better in the as-needed group, standardised mean difference 0.23, 95% CI: 0.52, 1.12.

REVIEWER'S CONCLUSIONS

These results support current guidelines. There is little advantage in using short-acting beta2-agonists regularly, and potentially some small clinical disadvantage.

Alkaline conditions accelerate polymorphonuclear leukocyte apoptosis in vitro

Apoptosis was monitored in polymorphonuclear leukocytes (PMNs) cultured under mildly acidic, neutral, and alkaline conditions. Within 3 h, 9.0% of the PMNs underwent apoptosis at pH 6.7, as did 12% at pH 7.2, 38% at pH 7.7, and 60% at pH 8.2. Inhibitors of serine proteases, caspase-1, or caspase-3 significantly inhibited PMN apoptosis at pH 8.2, suggesting an involvement by these enzymes.

Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature

BACKGROUND

Human immunodeficiency virus (HIV)-associated pericardial effusion is common. We present its clinical features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital.

METHODS

A retrospective study was conducted of 122 patients with pericardial effusion (of which 40 were HIV associated) admitted to Queens Hospital Center from January 1988 to April 1997. A review of the literature is also presented.

RESULTS

Forty patients with HIV-associated pericardial effusion represent 33% of the 122 patients with pericardial effusion admitted during that period. The most common symptom of the 40 patients was dyspnea (75%). Echocardiogram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tamponade, in 15 of whom pericardiocentesis or pericardiostomy was performed. Causes of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcus pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma in 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tamponade in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's sarcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-up. Among the other 27, 11 (41%) were alive at 3 months and 5 (19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) were alive at 3 months and 3 (30%) at 1 year.

CONCLUSIONS

HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital. Causes are diverse. The development of pericardial effusion predicts a poor prognosis in HIV infection.