Human immunodeficiency virus-associated nephropathy in the Bronx: low prevalence in a predominantly Hispanic population

Reports of human immunodeficiency virus-associated nephropathy (HIVAN) occurring in Hispanics, females and heterosexuals are scarce. We reviewed 858 charts from our total HIV population to determine the prevalence and epidemiology of HIVAN at our center, and to evaluate the renal and patient survival among individual groups, according to race, sex and HIV risk factor. The prevalence of HIVAN was low (1.9%), relative to other centers (4-13%). Although Hispanics accounted for 56% of the HIV population, only 38% of HIVAN patients were Hispanic. The absolute risk of HIVAN in blacks was 3. 6%, and in Hispanics was 1.3%. The relative risk of blacks vs. Hispanics was 2.8% (p < 0.04). Women and men were represented equally in both the HIVAN and HIV populations. The mean (+/- SE) rate of decline in glomerular filtration rate was 3.7 +/- 0.9 ml/min/month, and patient survival following the onset of HIVAN was 23.6 +/- 4.8 months. We found no difference in renal or patient survival between individual groups. In summary, the risk of HIVAN in Hispanics is similar to that for whites. Male sex is not an independent risk factor. Both renal and patient survival are similar in blacks and Hispanics, and in men compared to women.

Hypertension in elderly persons: its prevalence and associated cardiovascular risk factors in Tainan City, southern Taiwan

BACKGROUND

Hypertension was the eighth leading cause of death in Taiwan in 1996, and the prevalence of hypertension has increased recently. The purpose of the study was to assess the prevalence of hypertension and its associated cardiovascular risk factors in elderly persons in Tainan City, southern Taiwan.

METHODS

The study was a cross-sectional, population-based study. We used the stratified cluster sampling method to enroll subjects aged 65 years and above, 1435 persons in total, into our study. Questionnaire interview, body weight, body height, and blood pressure measurement were completed for 876 participants (response rate of 70.2%) at each subject's home by home visit.

RESULTS

Hypertension was defined according to the criteria of the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The crude prevalence of hypertension was 60.4% (men 59.1%, women 61.9%); previously diagnosed hypertension was 31.1% (men 29.4%, women 33.1%); and newly diagnosed hypertension was 29.3% (men 29.7%, women 28.8%). The hypertensive group had a higher body mass index (BMI) than the normotensive group. There were no lifestyle differences such as smoking, drinking, eating a vegetarian diet, reading health information, and undergoing a health examination in the past year between the hypertensive and normotensive groups. However, the hypertensive group had a higher prevalence of regular exercise than did the normal blood pressure group on univariate analysis. Only BMI and family history of hypertension had a significantly positive association with hypertension on multiple logistic regression analysis.

CONCLUSIONS

The crude prevalence of hypertension was 60.4% in elderly persons in Tainan City. Subjects who had family history of hypertension and higher BMI had a higher risk of hypertension, so they should be screened for high blood pressure regularly.

In vitro and in vivo photosensitizing capabilities of 5-ALA versus photofrin in vascular endothelial cells

BACKGROUND AND OBJECTIVE

The objective of the present study was to evaluate the feasibility of photodynamic therapy (PDT) for complicated hemangiomas. The photosensitizing activities of 5-aminolevulinic acid (5-ALA) and Photofrin were evaluated in vitro with human dermal microvascular endothelial cells (MEC) and in vivo with the chicken cox comb.

STUDY DESIGN/MATERIALS AND METHODS

The in vitro absorption and photosensitizing activities of 5-ALA and Photofrin were examined in a MEC culture system. The percentages of MEC killed by different drug concentrations at a wavelength of 630 nm were measured by either live/dead or lactate dehydrogenase-released assays. Similarly, the in vivo biological activities of 5-ALA and Photofrin exposed to different total light dosages at 630 nm were studied by determining the amount of necrosis produced in chicken combs.

RESULTS

MEC incubated with 5-ALA at a concentration of 35 microg/ml and exposed to laser light at 630 nm at a power density of 100 mW/cm2 showed a 50% cell kill. MEC incubated with Photofrin at a concentration of 3.5 microg/ml and exposed to laser light at 630 nm at a power density of 100 mW/cm2 showed a 50% cell kill. Chicken combs that received 200 mg/kg of 5-ALA exposed to laser light at 630 nm at a power density of 100 mW/cm2 had an injury depth of 362.5+/-27.6 microm at histologic examination. Combs exposed to a power density of 100 or 120 mW/cm2 showed injury depths of 732.5+/-29.1 and 792.5+/-36.0 microm, respectively. Chicken combs that received 2.5 mg/kg of Photofrin exposed to laser light at 630 nm at a power density of 80 mW/cm2 had an injury depth of 535.6+/-22.3 microm at histologic examination. Combs exposed to a power density of 100 or 120 mW/cm2 showed injury depths of 795.8+/-32.5 and 805.2+/-49.1 microm, respectively.

CONCLUSION

Both 5-ALA and Photofrin have the capability to destroy MEC in vitro and vasculature in vivo. However, Photofrin achieved a higher degree of cell kill and tissue destruction at lower drug concentrations and at lower power densities.

Effect of glycoprotein IIb/IIIa inhibitors on the individual components of composite endpoints used in clinical trials of unstable angina and non-Q-wave myocardial infarction

Inhibitors of the platelet glycoprotein (GP) IIb/IIIa receptor complex have recently been approved for the treatment of patients with unstable angina and non-Q-wave myocardial infarction (MI). We performed a meta-analysis to ascertain the effect of these agents on the individual endpoints of death, myocardial infarction, refractory ischemia, and major bleeding after 30 days of follow-up. Five randomized, placebo-controlled trials involving 17,255 patients were identified. The odds ratios for each of the endpoints in each trial were calculated and combined using a fixed-effects model. There was no significant reduction in death (OR, 0.87; 95% CI, 0.73-1.03; P = 0.1), myocardial infarction (OR, 0.91; 95% CI, 0.82-1.004; P = 0.06), or refractory ischemia (OR, 0.92; 95% CI, 0.78-1.1; P = 0.36) in patients treated with GP IIb/IIIa inhibitors. There was a significant increase in major bleeding following treatment with GP IIb/IIIa inhibitors (OR, 1.2; 95% CI, 1.06-1.4; P = 0.005). When used to treat unstable angina and non-Q-wave MI, this new class of agents appears to be associated with minimal clinical benefit and an increase in major bleeding complications.

Ventricular tachycardia in a patient with primary hyperparathyroidism

We present a case of primary hyperparathyroidism with hypercalcemia in a patient who had spontaneous attacks of ventricular tachycardia. Right ventricular burst pacing reproducibly induced ventricular tachycardia in the electrophysiological laboratory after intravenous administration of calcium-gluconate, and verapamil could terminate the tachycardia. After resection of the parathyroid adenoma, the calcium level was restored to normal, and ventricular tachycardia did not occur again during the follow-up period.

Xanthene-bridged cofacial bisporphyrins

The synthesis and characterization of cofacial bisporphyrins juxtaposed by xanthene-bridged pillars are presented. The one-pot preparation of the xanthene dialdehyde avoids the lengthy bridge synthesis accompanying other cofacial porphyrin systems, thus allowing for the facile preparation of homobimetallic zinc (10), copper (11), and nickel (12) complexes. The cofacial orientation of the two porphyrin macrocycles was confirmed by X-ray crystallography. Structural data are provided for bisporphyrins 10-12: 10 (C79H82N8OZn2), triclinic, space group P1, a = 11.2671(2) A, b = 14.9809(2) A, c = 20.4852(2) A, alpha = 101.6680(10) degrees, beta = 100.8890(10) degrees, gamma = 101.8060(10) degrees, Z = 2; 11 (C79H82N8OCu2), triclinic, space group P1, a = 11.21410(10) A, b = 14.9539(5) A, c = 20.6915(7) A, alpha = 101.810(2) degrees, beta = 101.044(2) degrees, gamma = 101.722(2) degrees, Z = 2; 12 (C79H82N8ONi2), monoclinic, space group C2/c, a = 24.1671(4) A, b = 10.669 A, c = 50.5080(9) A, beta = 99.553(2) degrees, Z = 8. Exciton interactions between the porphyrin rings are apparent in electronic spectra, consistent with the cofacial superstructure. The combination of structural and spectroscopic data provides a basis for the design of additional metal derivatives for the activation of dioxygen and other small molecules.

Effects of atypical neuroleptics on sustained attention deficits in schizophrenia: a trial of risperidone versus haloperidol

To help determine whether sustained attention deficits as measured with the Continuous Performance Test (CPT) are stable vulnerability indicators of schizophrenia, we compared the CPT performance of schizophrenic patients before and after treatment with risperidone or haloperidol. In this double blind trial, 56 schizophrenic patients were randomly assigned to a 12-week regimen of either risperidone or haloperidol, after a 1-week washout period. The patients undertook two sessions of the CPT (undegraded and 25% degraded) twice, one at the end of the washout period and the other at the end of the study. Thirty-eight patients completed the study, 19 in each group. Both groups experienced significant improvements in clinical symptoms, and the risperidone group showed no change in the severity of extrapyramidal symptoms. Despite those improvements, the CPT performance indexes did not change significantly from the beginning to the end of the study. These findings indicate that sustained attention deficits might be stable vulnerability indicators of schizophrenia.

Nutritional requirements of Xylella fastidiosa, which causes Pierce's disease in grapes

A defined medium (XF-26) containing 3 inorganic salts, 2 tricarboxylic acids, 17 amino acids, potato starch, phenol red, and agar was used as the starting point for the study. Deletions of one or more ingredients were performed to prepare various media. A medium was considered able to support growth of Xylella fastidiosa strains responsible for Pierce's disease in grapes, only after 10 serial passages had been completed. Of 3 inorganic salts, K2HPO4 and MgSO4 x 7H2O were essential, and (NH4)2HPO4 was nonessential for growth. Of the Krebs cycle intermediates, all (citrate, alpha-ketoglutarate, succinate, fumarate, malate, and oxaloacetate) but isocitrate supported growth of cultivated strains, whereas only citrate alone or citrate plus succinate supported the primary isolation of PD bacterium. Of 17 amino acids, 6 uncharged polar R groups (asparagine, cysteine, glutamine, glycine, serine, and threonine) supported growth, whereas 8 nonpolar R groups (alanine, isoleucine, leucine, methionine, phenylalanine, proline, tryptophan, and valine) or 3 positively charged polar groups (arginine, histidine, and lysine) did not. Starch proved to be nonessential.

Hormone-independent activation of EGP during hypoglycemia is absent in type 1 diabetes mellitus

It has been suggested that insulin-induced suppression of endogenous glucose production (EGP) may be counteracted independently of increased epinephrine (Epi) or glucagon during moderate hypoglycemia. We examined EGP in nondiabetic (n = 12) and type 1 diabetic (DM1, n = 8) subjects while lowering plasma glucose (PG) from clamped euglycemia (5.6 mmol/l) to values just above the threshold for Epi and glucagon secretion (3.9 mmol/l). Individualized doses of insulin were infused to maintain euglycemia during pancreatic clamps by use of somatostatin (250 microg/h), glucagon (1.0 ng. kg(-1). min(-1)), and growth hormone (GH) (3.0 ng. kg(-1). min(-1)) infusions without need for exogenous glucose. Then, to achieve physiological hyperinsulinemia (HIns), insulin infusions were fixed at 20% above the rate previously determined for each subject. In nondiabetic subjects, PG was reduced from 5.4 +/- 0.1 mmol/l to 3.9 +/- 0.1 mmol/l in the experimental protocol, whereas it was held constant (5. 3 +/- 0.2 mmol/l and 5.5 mmol/l) in control studies. In the latter, EGP (estimated by [3-(3)H]glucose) fell to values 40% of basal (P < 0.01). In contrast, in the experimental protocol, at comparable HIns but with PG at 3.9 +/- 0.1 mmol/l, EGP was activated to values about twofold higher than in the euglycemic control (P < 0.01). In DM1 subjects, EGP failed to increase in the face of HIns and PG = 3.9 +/- 0.1 mmol/l. The decrease from basal EGP in DM1 subjects (4.4 +/- 1.0 micromol. kg(-1). min(-1)) was nearly twofold that in nondiabetics (2.5 +/- 0.8 micromol. kg(-1). min(-1), P < 0.02). When PG was lowered further to frank hypoglycemia ( approximately 3.1 mmol/l), the failure of EGP activation in DM1 subjects was even more profound but associated with a 50% lower plasma Epi response (P < 0. 02) compared with nondiabetics. We conclude that glucagon- or epinephrine-independent activation of EGP may accompany other counterregulatory mechanisms during mild hypoglycemia in humans and is impaired or absent in DM1.

The application of water drinking test on the evaluation of trabeculectomy patency

The water drinking test (WDT) was once frequently used as a diagnostic tool for glaucoma, but not so often nowadays. In this study, we investigated the potential use of the WDT on the evaluation of trabeculectomy patency. Twenty age-matched volunteers and thirty-six glaucoma patients who were to receive trabeculectomy procedure were enrolled in this study. The WDT was given to the volunteers once and to all glaucoma patients before undergoing trabeculectomy and at certain intervals after the procedure. The WDT was performed in a standard manner. We defined four parameters after performing the WDT: Initial Pressure [IP, intraocular pressure (IOP) level before the WDT]; Slope of Ascending Trend (SOAT, the slope between baseline IOP and the highest IOP level); Peak Pressure (PP, the highest IOP level during the WDT); and End Pressure (EP, the IOP level after the WDT). It was found that the results of the WDT and trabeculectomy patency were strongly correlated. The four parameters in success and failure cases were significantly different at the last follow up: IP: (15.2 +/- 3.6 vs. 25.3 +/- 6.4, p<0.01); SOAT: (0.9 +/- 0.3 vs. 1.8 +/- 1.2, p<0.01); PP: (19.2 +/- 6.4 vs. 39.5 +/- 12.2, p<0.01); EP: (15.5 +/- 4.8 vs. 29.4 +/- 8.2, p<0.01). Thus, it was observed in this study that WDT was not only easy and safe to perform, but also valuable in evaluating the patency of trabeculectomy.

Use of 16S rDNA sequences as signature characters to identify Xylella fastidiosa

The nucleotide sequences of 16S rDNAs (coding for the small subunit ribosomal RNAs) were used to identify Xylella fastidiosa, a nutritionally fastidious plant pathogenic bacterium. The near-complete 16S rDNAs from nine strains of Xyl. fastidiosa, including seven pathotypes and one strain of Xanthomonas campestris pv. campestris, were amplified through PCR with two conserved primers (forward primer 5'-AGA GTT TGA TCC TGG CTC AG-3' and reverse primer 5'-AAG GAG GTG ATC CAG CC-3') and sequenced. The 16S sequences were compared with all eukaryote and prokaryote DNA entries in GenBank database. A Xyl. fastidiosa 16S rDNA sequence, M26601, was determined to be the most similar to all the near-complete (1537 bp) and partial 5' end sequences from Xyl. fastidiosa, but not those from the Xanthomonas strain. A 20-bp oligonucleotide (5'-TTG GTA GTA ATA CCA TGG GT-3') was found to be highly characteristic of Xyl. fastidiosa. Since the 16S rDNA of Xyl. fastidiosa strains are highly homologous and characteristically different from other bacteria, including the most closely related Xanthomonas, 16S rDNA sequences can be used as signature characters to identify this bacterium.

Role of adenosine in insulin-stimulated release of leptin from isolated white adipocytes of Wistar rats

Leptin, the ob gene product that can decrease caloric intake and increase energy expenditure, is functionally released by insulin from adipose tissue. Adenosine is thought to be an important regulator of the action of insulin in adipose tissue. The present study investigated the role of adenosine in the release of leptin by insulin in isolated rat white adipocytes. Release of leptin, measured by radioimmunoassay, from insulin-stimulated samples was seen after 30 min. Adenosine deaminase, at concentrations sufficient to metabolize endogenous adenosine, decreased insulin-stimulated leptin release. Also, the insulin-stimulated leptin release was completely blocked by the adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX). Mediation of endogenous adenosine in this action of insulin was further supported by the assay of adenosine released into the medium from adipocytes stimulated with insulin. In addition, activation of adenosine A1 receptors by N6-cyclopentyladenosine (CPA) induced an increase in leptin release in a concentration-dependent manner that could be blocked by antagonists, either DPCPX or 8-(p-sulfophenyl)theophylline (8-SPT). In the presence of U73312, a specific inhibitor of phospholipase C (PLC), CPA-stimulated leptin secretion from adipocytes was reduced in a concentration-dependent manner, but it was not affected by U73343, the negative control for U73312. Moreover, chelerythrine and GF 109203X diminished the CPA-stimulated leptin secretion at concentrations sufficient to inhibit protein kinase C (PKC). These results suggest that, in isolated white adipocytes, the released adenosine acts as a helper and/or a positive regulator for insulin in the release of leptin via an activation of adenosine A1 receptors that involves the PLC-PKC pathway.

The impact of redefining affection status for alcoholism on affected-sib-pair analysis

The analysis of a complex disease such as alcohol dependence requires a more precise definition of affection status. Collaborative Study on the Genetics of Alcoholism (COGA) provided a variety of qualitative and quantitative measures as well as genotype information, in addition to two criteria of affection status. To identify two groups of phenotypically "more homogeneous" individuals among alcoholics (COGA criterion), we redefined affection status by using cluster analysis and classification and regression tree, incorporating some important covariates such as event related potentials, monoamine oxidase B activity, status of smoking, age of onset, three variables of personality assessed with the Tridimensional Personality Questionnaire and three latent class variables. With redefined affection status, we repeated nonparametric analysis by three sib pair analysis programs (SIBPAL, SIBPAIR, and BETA) using nine candidate DNA markers identified by Reich et al. [1998] and Long et al. [1998]. The goals of our analysis are 1) to confirm previous results for these nine markers with redefined affection status and 2) to compare the performance from these three programs.

Obstructive hypertrophic cardiomyopathy in Taiwanese adults

The purpose of this study was to analyze the clinical profiles, echocardiographic findings, and mortality among adult Taiwanese patients with obstructive hypertrophic cardiomyopathy (HCM) at Chang Gung Memorial Hospital, a university-affiliated tertiary referral center in suburban Taipei. We reviewed the medical records of all adult (> 15 years of age) patients referred to our laboratory for echocardiographic examinations of cardiac diseases from May 1990 through December 1996. The diagnosis of obstructive HCM required an outflow gradient of above 10 mm Hg and the presence of asymmetric septal hypertrophy of the left ventricle. Follow-up information on was obtained from hospital records, questionnaires, interviews, or the National Death Certificate Registry. Of the 6.798 adults who underwent echocardiographic examinations during the study period 122 (1.79%) had obstructive HCM. The mean +/- standard deviation age of the patients was 62.2 +/- 12.6 years, and females predominated (n = 76, 62.3%). During the mean follow-up period of 3.2 years, the annual all-cause mortality rate was 4.7%. Most deaths were due to concurrent medical conditions. The annual cardiac mortality rate was 0.99%. Logistic regression analysis identified medication with calcium channel blockers as the only negative predictor (relative risk = 0.26, 95% confidence interval = 0.07-0.96) of all-cause mortality, and left atrial size as the only positive predictor (relative risk = 1.18, 95% confidence interval = 1.02-1.37) of cardiac mortality. Cox regression analysis confirmed the former association, but not the latter. Thus, in our institution, obstructive HCM had a low prevalence among adult patients referred for echocardiographic examination. These patients were elderly and often had other associated medical conditions. The high all-cause mortality rate was largely due to non-cardiac causes. These findings suggest that obstructive HCM tends to have a benign clinical course. Large atrial size could be an independent predictor of cardiac mortality, but this possibility requires further confirmation.

Discriminating glucose tolerance status by regions of interest of dual-energy X-ray absorptiometry. Clinical implications of body fat distribution

OBJECTIVE

To determine whether measuring body fat distribution by dual-energy X-ray absorptiometry (DEXA) can be used to discriminate glucose tolerance status.

RESEARCH DESIGN AND METHODS

Using a 75-g oral glucose tolerance test, a total of 1,015 Chinese subjects (559 men and 456 women) were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes. Blood pressure and lipid profiles of these subjects were measured. Waist-to-hip ratio (WHR) and DEXA were used to evaluate the varying patterns of body fat distribution among the groups.

RESULTS

Body fat distribution, as reflected by WHR and the centrality index, showed significant partial correlation coefficients with glycosylated hemoglobin, blood pressure, and lipid profiles in all subjects. After adjusting for age and BMI, there were significant differences among the three glycemic groups for all the cardiovascular risk factors except for total cholesterol level. The diabetic group had a significantly higher WHR and centrality index, but lower femoral fat percentage than the NGT and IGT groups. The diabetic group also showed higher abdominal fat percentage than the NGT group. Moreover, the IGT group had a higher centrality index than the NGT group. However, no significant differences were found in the percentage of lean tissue mass among the three groups. Using multiple stepwise logistic regression models, the centrality index remained a significant factor for discriminating different glucose tolerance status independent of the percentage total body fat.

CONCLUSIONS

Central obesity has shown significant correlation with cardiovascular risk factors among the three different glycemic groups. Centrality index measured by DEXA appears to be the better predictor of glucose intolerance, compared with WHR, abdominal fat, and general obesity (reflected by percentage total body fat or BMI) in a large cohort of the Chinese population.

Gender differences in the presentation of adult obstructive hypertrophic cardiomyopathy with resting gradient: a study of 122 patients

The present study investigated gender differences among adult patients with obstructive hypertrophic cardiomyopathy (OHCM) and resting gradient. Using outflow gradients >10 mmHg and the presence of asymmetrical septal hypertrophy of the left ventricle as inclusion criteria, 122 patients were identified among patients referred for echocardiographic examinations between May 1990 and October 1996. Clinical, echocardiographical and follow-up data were compared between male and female patients. The female patients were significantly older than male patients (mean age +/-SD 66.7+/-10.5 vs 54.8+/-12.5 years). The female patients had a smaller interventricular septal wall thickness, less frequent systolic anterior movement of the mitral valve, more frequent association with hypertension, and less frequent association with ischemic heart disease (IHD) and giant T wave inversion. In this study population, adult female patients presented with OHCM 12 years later than males. Whether this represents female patients' reluctance to seek medical attention early, a different disease process that affects predominantly elderly females, or a gender-specific end organ response to aging, hypertension, IHD and other processes, or the protective effects of estrogen remains to be determined.

Cryogen spray cooling and higher fluence pulsed dye laser treatment improve port-wine stain clearance while minimizing epidermal damage

BACKGROUND

When a cryogen spurt is applied to the skin surface for an appropriately short period of time (on the order of tens of milliseconds), the cooling remains localized in the epidermis, while leaving the temperature of the deeper port-wine stain (PWS) blood vessels unchanged.

OBJECTIVE

The objective of this study was to compare the efficacy and safety of noncooled laser treatment (NC-LT), and cryogen spray cooled laser treatment (CSC-LT) of PWS birthmarks in a large series of patients.

METHODS

A retrospective review was conducted of 196 patients with head or neck PWS birthmarks treated with the pulsed dye laser (lambda = 585 nm; taup = 450 microseconds) over a 7-year period. Subjects' ages ranged between 2 months and 62 years; there were 109 females and 87 males, all of whom were Asian. Ninety-eight patients received NC-LT using light dosages of 5-7 J/cm2. Subsequently, 98 patients received CSC-LT using light dosages of 8-10 J/cm2. The primary efficacy measure was the quantitative assessment of the blanching response scores of NC-LT PWSs as compared, on a blinded basis, to CSC-LT PWSs.

RESULTS

Based on chi-squared analysis, there were clinical, and statistically significant, differences in the blanching response scores favoring PWS receiving CSC-LT as compared to the NC-LT group (P <.001). Permanent scarring was noted in 3.1% (n = 3) of the patients in the NC-LT group. Permanent scarring was not observed in the CSC-LT treatment group. Transient hyperpigmentation was noted in 57% (n = 56) and 48% (n = 47) of the patients in the NC-LT and CSC-LT groups, respectively. In both groups, the transient hyperpigmentation resolved in all patients within 1 year. Two patients in the NC-LT group developed delayed permanent hypopigmentation. Permanent hypopigmentation was not observed in the CSC-LT group.

CONCLUSION

CSC permitted the use of higher incident light dosages leading to improved PWS clearance without producing complications such as permanent scarring or dyspigmentation.

Novel protein kinase C inhibitors: synthesis and PKC inhibition of beta-substituted polythiophene derivatives

A series of beta-substituted polythiophene derivatives was synthesized through palladium-catalyzed coupling reaction. Their structure-protein kinase C (PKC) inhibitory activity relationship was studied. The carboxaldehyde and hydroxymethyl derivatives of alpha-terthiophene were potent PKC inhibitors (IC50 = 10(-7) M).

Hepatitis C virus infection among short-term intravenous drug users in southern Taiwan

The purpose of this study was to determine the correlation between the prevalence of hepatitis C virus (HCV) infection with duration of drug use and other risk factors among drug users. This survey covered 899 male drug users from Kaohsiung Narcotic Abstention Institute and Kaohsiung prison. The prevalence of positive anti-HCV was 67.2% among intravenous drug users (IVDU) and 14.7% among non-intravenous drug users (non-IVDU). Among intravenous (IV) drug users, age and duration of drug use were independently related to HCV seropositivity. Seroprevalence rate for HCV in the IVDU group increased with increasing duration of injection use within the first seven years of drug use. However, the steepest trajectory in seroprevalence of HCV infection occurred within the first four months. Due to the high rate of HCV infection among drug users, investigation of risk behaviors should be routine in such a group. A high frequency of HCV infection was also found among short-term injectors, which indicated that early risk reduction intervention was an important measure in moderating HCV infection.

Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes

BACKGROUND

Postural hypotension with a decline of 20 mm Hg or more in systolic blood pressure on standing is considered a potentially dangerous hypotensive response. Postural dizziness is often strongly associated with postural hypotension. However, there is conflicting evidence, and previous studies have been confined to the elderly, not specifically to patients with diabetes. Thus, we evaluated the association between postural hypotension and postural dizziness, and determined the factors most likely related to postural hypotension in patients with diabetes.

METHODS

The subjects were 204 consecutive noninsulin-dependent patients with diabetes and 408 age- and sex-matched control subjects. Postural hypotension was defined as a decline of 20 mm Hg or more in systolic blood pressure 1 minute after standing. Postural dizziness was any feelings of dizziness, lightheadedness, or faintness that occurred while standing during the examination.

RESULTS

The prevalence of postural hypotension and postural dizziness in patients with diabetes was higher than in control subjects. Those patients with both diabetes and postural hypotension were older and had higher supine systolic blood pressures and higher plasma glycosylated hemoglobin and fasting glucose levels. They had higher prevalence of postural dizziness, hypertension, and cerebrovascular disease, and lower standing systolic blood pressures than those without postural hypotension. They also were more often being treated with antihypertensive agents. Only 32.8% of patients with diabetes with postural hypotension suffered from postural dizziness. Postural dizziness, hypertension, cerebrovascular disease, and plasma glycosylated hemoglobin levels were independently associated with postural hypotension in patients with diabetes.

CONCLUSIONS

Postural dizziness, glycemic control, hypertension, and cerebrovascular disease were important determinants of postural hypotension in patients with diabetes. Postural hypotension was associated with postural dizziness, but it cannot be determined clinically just from the presence of postural dizziness because the sensitivity for diagnosis of postural hypotension is low.

In vitro and in vivo photosensitizing capabilities of 5-ALA in vascular endothelial cells

BACKGROUND

The object of our study is to evaluate the feasibility of photodynamic therapy for complicated hemangiomas. We studied the effect of the photosensitizing agent 5-aminolevulinic acid (5-ALA) in both in vitro and in vivo models.

METHODS

The in vitro photosensitizing activity of 5-ALA was examined in a microvascular endothelial cell (MEC) culture system. 5-ALA was added in various concentrations and the cells were illuminated at 630 nm. The percentage of MEC killed was measured by either a Live/Dead assay or an lactate dehydrogenase (LDH) assay. The effect of varying the light energy dose delivered at 630 nm after the administration of 5-ALA was studied by determining the amount of necrosis produced in chicken combs.

RESULTS

The combination of 5-ALA at a concentration of 35 micrograms/ml, and illumination by 100 mW/cm2 of laser light at 630 nm wavelength, caused 50% cell kill in the MEC culture system. Chicken combs of animals that received 200 mg/kg of 5-ALA and illumination at a power density of 80 mW/cm2 had a depth of injury of 362.5 +/- 27.6 microns upon histological examination. Those combs that received 100 or 120 mW/cm2 showed a depth of injury of 732.5 +/- 29.1 and 792.5 +/- 36.0 microns respectively.

CONCLUSION

5-ALA is effective in sensitizing human MEC to laser illumination. However, the degree of absorption and tissue destruction in different anatomical structures should be considered in future clinical studies.

Vulvovaginal reconstruction following radical tumor resection: report of 12 cases

BACKGROUND

The absence of the vulva and vagina is a distressful problem, especially for the sexual life of a woman. The potential benefit associated with the use of various vaginal reconstructive methods was studied.

METHODS

Between April 1987, and June 1997, 12 patients undergoing gynecologic carcinoma surgery were treated with simultaneous vulvovaginal reconstruction using local labia majora flaps (1), gracilis myocutaneous flaps (3), and innervated pudendal-thigh flaps (8).

RESULTS

The mean follow-up period was 32 months. There were no major surgical complications, with the exception of one patient who had a ureteroileal fistula after bilateral gracilis myocutaneous flap reconstruction and radiotherapy. One patient received pelvic radiation after bilateral gracilis myocutaneous flap reconstruction, and the complication of perineal bleeding occurred 90 days after the vaginal reconstruction. Another patient had introital stenosis of the neovagina after reconstruction using bilateral labia majora flaps. Seven patients had regular and satisfactory sexual lives. These patients were all treated by innervated pudendal-thigh flap reconstruction.

CONCLUSION

The innervated pudendal-thigh flap provides a sensitized flap for reconstruction of the vulva and vagina following vulvovaginal carcinoma surgery. For extended carcinoma with vulvovaginal involvement, the gracilis myocutaneous flap is would be better for reconstruction of a large defect.

Gender differences in HIV risk behaviors in an adult emergency department in New York City

BACKGROUND

The human immunodeficiency virus (HIV) epidemic in the US increasingly involves urban heterosexual adults, particularly women, belonging to ethnic minority groups. An understanding of gender-based differences in HIV risk behaviors within these groups would be of value in the ongoing struggle to limit HIV transmission in metropolitan centers.

METHODS

This was a prospective study of demographic and historical characteristics and HIV risk behaviors. The study utilized a structured interview format, which was administered to all patients treated by participating emergency department physicians.

RESULTS

On univariate analysis of data obtained from 1,460 patients who had neither a known HIV infection nor a chief complaint or final emergency department diagnosis associated with HIV risk behaviors, men were more likely to be older, homeless, to have ever injected drugs, used crack, engaged in same-gender sex, paid for sex, been incarcerated, or had syphilis or gonorrhea. Women were more likely to report prior chlamydia infection or to report that their sole sex partners had other partners within the past year. On multivariate analysis, variables independently associated with male gender included homelessness, injection drug use, crack use, any prior sexually transmitted disease (in subjects 35 years of age or older), and sex with prostitutes. In a separate analysis of patients admitting to drug use, the male predominance of other risk behaviors was not observed; the only significant differences between genders were a higher rate of prostitution among women and a higher rate of sexual contact with a prostitute among men.

CONCLUSIONS

In patients visiting an inner-city emergency department in the Bronx, HIV risk behaviors are generally more common in men, but rates of risk behaviors among male and female drug users are comparable.