Catatonic features: differential diagnosis and treatments at an emergency unit

During a 2-year period, 34 patients of catatonic features in Chinese ethnic background Taiwanese were brought to the emergency unit of Chang Gung Memorial Hospital at Linkou. The ratios of the causes of catatonic features by schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions were 26, 9, 24 and 41%, respectively. After the treatments of antipsychotics, benzodiazepam, or electroconvulsive therapy (ECT), 24 patients (70.6%) showed complete remission, seven patients (20.6%) showed partial remission, and three patients (8.8%) showed no response (two died). Additionally, a suggestive period is proposed in order to distinguish acute and insidious onset catatonic conditions to help clinicians in deciding on probability immediately. The patients were grouped into four diagnostic categories; namely, schizophrenic disorders, mood disorders, neuroleptic-induced disorders, and general medical conditions for comparison. One-way ANOVA and Duncan's multiple-range test were used for continuous variables, and the Chi-squared test was used for categorical variables. The mean duration of 'insidious onset catatonic condition' (including schizophrenic disorders and general medical conditions) before seeking medical help was longer than 3.33 weeks, while the mean duration of 'acute catatonic condition' (including mood disorders and neuroleptic-induced disorders) was shorter than 1.83 weeks. These findings suggest that 2-3 weeks would be a cut-off point for acute or insidious onsets of catatonic conditions.

Gene transfer via pollen-tube pathway for anti-fusarium wilt in watermelon

In order to obtain transgenic fusarium wilt resistant watermelon plants, squash DNA was introduced into the ovaries of watermelon plants via the pollen-tube pathway. The introduction of foreign genes into ovaries was accomplished using co-transformation with the CaMV35S-GUS as a marker. Transformed watermelon plants contained integrated copies of the GUS activity and the seeds of transformed progeny produced a blue color when stained with 5-bromo-4-chloro-3-indolyl glucuronide, whereas seeds from untransformed control plants did not. Of 200 transformed seedlings, ten were wilt resistant. The presence of the GUS activity in the genome of stable transgenic seedlings was confirmed by Southern blot analysis. Furthermore, the generation of random amplified polymorphic DNA (RAPD) fingerprints using primers with embedded restriction sites showed amplification products unique to these transgenic plants. Primers OPA-1 and OPA-9 gave distinct band patterns of genomic DNA using the polymerase chain reaction.

NMR spectroscopic studies of the hydrogenosomal [2Fe-2S] ferredoxin from Trichomonas vaginalis: hyperfine-shifted 1H resonances

The hyperfine-shifted 1H NMR resonances of oxidized and reduced Trichomonas vaginalis ferredoxin, a functionally unique [2Fe-2S] ferredoxin, have been studied. The oxidized protein spectrum displayed a pattern of six broad upfield-shifted resonances between 13 and 40 ppm with chemical shifts distinct from those of other [2Fe-2S] ferredoxins. All hyperfine 1H resonances of the oxidized ferredoxin displayed anti-Curie temperature dependences. Reduced T. vaginalis ferredoxin displayed hyperfine resonances both upfield and downfield of the diamagnetic region. These resonances showed Curie temperature dependences. Overall the hyperfine-shifted NMR spectrum of T. vaginalis ferredoxin, along with other spectroscopic properties, suggested different structural properties for the active center of oxidized hydrogenosomal ferredoxins from those of other [2Fe-2S] ferredoxins.

Selection at a P-glycoprotein gene in ivermectin- and moxidectin-selected strains of Haemonchus contortus

Resistance to anthelmintics that are used to control parasite populations in domestic animals has become a serious problem worldwide. The development of resistance is an evolutionary process that leads to genetic changes in parasite populations in response to drug exposure. The anthelmintic ivermectin is known to bind to the human membrane transport protein, P-glycoprotein, and P-glycoprotein-deficient mice treated with ivermectin have shown signs of neurotoxicity. P-glycoprotein is believed to be involved in the multidrug resistance phenotype seen in some human cancers and for drug resistance in some protists. We have examined the genetic variation of a P-glycoprotein homologue from the nematode Haemonchus contortus to see if an association exists between specific alleles of this gene and survival to exposure to ivermectin or moxidectin. Two parasite strains passaged without drug treatment and three strains, subjected to anthelmintic selection and derived from the unselected strains, were examined. Allelic variation in the unselected strains showed this locus to be highly polymorphic. chi 2 analyses of allele frequencies showed significant differences between the unselected and the drug-selected derived strains. In all three drug-selected strains, an apparent selection for the same allele was observed. These findings suggest that P-glycoprotein may be involved in resistance to both ivermectin and moxidectin in H. contortus.

Tomato chlorosis virus: a new whitefly-transmitted, Phloem-limited, bipartite closterovirus of tomato

ABSTRACT Tomato chlorosis virus (ToCV) is the second whitefly-transmitted, phloem-limited, bipartite closterovirus described infecting tomato. ToCV is distinct from tomato infectious chlorosis virus (TICV), based on lack of serological and nucleic acid cross-reactions and differences in vector specificity. TICV is transmitted only by the greenhouse whitefly (Trialeurodes vaporariorum), whereas ToCV is transmitted by the greenhouse whitefly, the banded-wing whitefly (T. abutilonea), and Bemisia tabaci biotypes A and B (B. argentifolii). Double-stranded (ds) RNA analyses of ToCV show two prominent dsRNAs of approximately 7,800 and 8,200 bp, with several small dsRNAs. Digoxigenin-11-UTP-labeled riboprobes derived from cDNA clones representing portions of RNAs 1 and 2 were used in Northern blot hybridizations to detect two large nonhomologous dsRNAs and a subset of smaller dsRNAs. These probes were used in dot blot hybridizations to detect ToCV in infected tomato. Inclusion bodies and cytoplasmic vesicles were consistently observed in phloem tissues of ToCV-infected Nicotiana clevelandii. Computer-assisted sequence analysis showed significant homology between ToCV clones that hybridize specifically with RNAs 1 and 2 and the lettuce infectious yellows virus methyltransferase of RNA 1 and the HSP70 heat shock protein homolog of RNA 2, respectively. Thus, ToCV is another member of the growing subgroup of bipartite closteroviruses transmitted by whiteflies.

Novel cytotoxic diterpenes, excavatolides A-E, isolated from the Formosan gorgonian Briareum excavatum

The chemistry of Briareum excavatum, a Formosan gorgonian coral, was investigated. This study has led to the isolation of five novel marine natural products, excavatolides A-E (1-5), together with brianolide (6). The structures of the above compounds were established by spectral and chemical methods. The relative configuration of excavatolide B (2) was further confirmed by a single-crystal X-ray structure analysis. Cytotoxicity of these compounds toward various cancer cell lines also is described.

Vacuum extraction delivery complicated with acute subdural hematoma and cerebral infarction: report of one case

We present a term, 2950 gm female neonate who was delivered by vacuum extraction and subsequently developed convulsions 23 hours after birth. Acute subduralhematoma was rapidly diagnosed by computed tomographic brain scan and successfully removed. The patient had a smooth postoperative recovery but cerebral infarction was found during follow up imaging studies. Magnetic resonance angiography revealed poor visualization of bilateral posterior cerebral arteries. After a follow-up period of 4 months, the infant had normal neurological development except for mild microcephalus. We report the occurrence of cerebral infarction in an infant following evacuation of a subdural hematoma. Onset of the late complication suggests the importance of serial neuroradiological and clinical evaluations.

The NOT proteins are part of the CCR4 transcriptional complex and affect gene expression both positively and negatively

The CCR4 transcriptional regulatory complex consisting of CCR4, CAF1, DBF2 and other unidentified factors is one of several groups of proteins that affect gene expression. Using mass spectrometry, we have identified the 195, 185 and 116 kDa species which are part of the CCR4 complex. The 195 and 185 kDa proteins were found to be NOT1 and the 116 kDa species was identical to NOT3. NOT1, 2, 3 and 4 proteins are part of a regulatory complex that negatively affects transcription. All four NOT proteins were found to co-immunoprecipitate with CCR4 and CAF1, and NOT1 co-purified with CCR4 and CAF1 through three chromatographic steps in a complex estimated to be 1.2x10(6) Da in size. Mutations in the NOT genes affected many of the same genes and processes that are affected by defects in the CCR4 complex components, including reduction in ADH2 derepression, defective cell wall integrity and increased sensitivity to monoand divalent ions. Similarly, ccr4, caf1 and dbf2 alleles negatively regulated FUS1-lacZ expression, as do defects in the NOT genes. These results indicate that the NOT proteins are physically and functionally part of the CCR4 complex which forms a unique and novel complex that affects transcription both positively and negatively.

DBF2, a cell cycle-regulated protein kinase, is physically and functionally associated with the CCR4 transcriptional regulatory complex

CCR4, a general transcriptional regulator affecting the expression of a number of genes in yeast, forms a multi-subunit complex in vivo. Using the yeast two-hybrid screen, we have identified DBF2, a cell cycle-regulated protein kinase, as a CCR4-associated protein. DBF2 is required for cell cycle progression at the telophase to G1 cell cycle transition. DBF2 co-immunoprecipitated with CCR4 and CAF1/POP2, a CCR4-associated factor, and co-purified with the CCR4 complex. Moreover, a dbf2 disruption resulted in phenotypes and transcriptional defects similar to those observed in strains deficient for CCR4 or CAF1. ccr4 and caf1 mutations, on the other hand, were found to affect cell cycle progression in a manner similar to that observed for dbf2 defects. These data indicate that DBF2 is involved in the control of gene expression and suggest that the CCR4 complex regulates transcription during the late mitotic part of the cell cycle.

Cardiovascular effects of nitric oxide in the brain stem nuclei of rats

Nitric oxide, synthesized from the semiessential amino acid L-arginine by nitric oxide synthase, is a remarkable regulatory molecule and plays an important role in physiological functions. However, the physiological role of nitric oxide in cardiovascular regulation by the central nervous system is not well understood. In this study we investigated the cardiovascular effects of nitric oxide in the lateral ventricle, nucleus tractus solitarii, area postrema, and rostral ventrolateral medulla in urethane-anesthetized male Sprague-Dawley rats. Microinjection of NG-monomethyl-L-arginine, a nitric oxide synthase inhibitor, into the cerebral ventricle of rats elicited a dose-dependent increase in blood pressure and heart rate. This suggests that nitric oxide may be involved in central cardiovascular regulation. Unilateral microinjection (60 nL) of L-arginine (1 to 100 nmol) into the nucleus tractus solitarii and rostral ventrolateral medulla produced prominent dose-related depressor and bradycardic effects and reduced renal sympathetic nerve activity. However, L-arginine had no significant cardiovascular effects in the area postrema. In addition, 4 to 6 hours after intravenous injection of bacterial endotoxin-lipopolysaccharide (10 mg/kg), there was a time-related potentiation of the L-arginine-induced depressor and bradycardic effects in the nucleus tractus solitarii. These results indicate that nitric oxide is involved in central cardiovascular regulation. The depressor effect of nitric oxide in the nucleus tractus solitarii and rostral ventrolateral medulla may be through inhibition of renal sympathetic nerve activity.

Predictive equations for basal metabolic rate in Chinese adults: a cross-validation study

OBJECTIVE

To develop predictive equations for basal metabolic rate (BMR) in healthy Chinese adults and to evaluate factors that may influence BMR.

DESIGN

Measuring the BMR of Chinese adults by indirect calorimetry. Selected subjects were randomly assigned to a validation sample and a cross-validation sample. The validation sample was used to develop predictive equations that were cross-validated using the other sample.

SUBJECTS

Two hundred twenty-three healthy Chinese adults (102 men and 121 women) participated in the study. Their ages ranged from 20 to 78 years old (mean = 43.8 +/- 14.3 years).

MEASURES

BMR was measured by indirect calorimetry. Body composition was assessed by skinfold fat thicknesses, bioelectrical impedance analysis, and urinary creatinine excretion.

STATISTICAL ANALYSES PERFORMED

Student's t test, Pearson correlation coefficients, linear regression analyses, and the best subset were used for statistical analyses.

RESULTS

The better-fitting equation for predicting BMR in Chinese adults is BMR = 13.88 x weight (kg) + 4.16 x height (cm) - 3.43 x age (years) - 112.40 x sex (men = 0; women = 1) +54.34. Men had higher BMR values than women because men had greater fat-free mass, body cell mass, and muscle mass. BMR correlated best with body composition, which correlated highly with anthropometric measurements. Therefore, accurate determination of body weight and body height are beneficial in predicting a person's BMR. All of the currently available predictive equations overestimated BMR (P = .0001) for healthy Chinese adults. The equations developed in this study predict BMR more accurately for Chinese adults.

APPLICATIONS

The equations developed in this study are recommended for clinical use in healthy Chinese adults who are within normal limits for body weight.

Identification of Leishmania species by a specific DNA probe that is conserved only in the maxicircle DNA of human-infective Leishmania parasites

An A + T-rich repeated DNA sequence cloned from maxicircle DNA of Leishmania mexicana amazonensis was found to be conserved in the maxicircles of human-infective Leishmania species but totally absent from non-human-infective ones. Differences in the pattern of distribution of this repeated sequence in the maxicircles of each human-infective Leishmania species potentially allow the development of a sensitive probe to differentiate among these species.

A non-invasive method for evaluating cirrhotic portal hypertension by administration of 99mTc-MIBI per rectum

A study was performed to evaluate radio-isotopic imaging using technetium-99m hexakis 2-methoxyisobutyl isonitrile administered per rectum to assess portal collateral circulation. The heart-liver ratios (H/L; mean +/- standard deviation) in 15 controls, 13 cases of histologically confirmed viral hepatitis and 57 cirrhosis patients were 0.27 +/- 0.11, 0.43 +/- 0.14 and 1.00 +/- 0.28, respectively (P < 0.001). Among the cirrhosis patients those with the Child-Pugh classification A, B and C had H/L of 0.56 +/- 0.14, 1.00 +/- 0.20 and 1.19 +/- 0.26, respectively (P < 0.001). A high value of H/L was associated with a high risk of hepatic encephalopathy (1.25 +/- 0.17, P < 0.01) and oesophageal varices (1.02 +/- 0.20, P < 0.01). There were associations between H/L and serum bilirubin (P < 0.01), albumin (P < 0.05) and prothrombin time (P < 0.05). The results also showed a good correlation between H/L and portal vein pressure measured during operation in 13 patients (P < 0.001, r = 0.87). The regression equation: y = 6.77 + 32.5 H/L, allowed portal vein pressure to be estimated. The prognostic value of the test was supported by the fact that good correlations were observed between the H/L ratio and widely accepted prognostic classification (Child-Pugh). It is suggested that this new method could be a reliable non-invasive way to give an indication of the degree of portasystemic shunting to evaluate the prognosis and to follow up the effects of medications for reducing portal hypertension in patients with cirrhotic portal hypertension.

Detection of tryptase TL2 and CD26 antigen in brain-derived cells non-permissive to T-cell line-tropic human immunodeficiency virus type 1

Tryptase TL2 purified from MOLT-4 human T cells binds to the envelope protein of human immunodeficiency virus type 1 (HIV-1). Tryptase TL2 and CD26 antigen are supposed to play roles in HIV-1 entry into cells. Although CD4 is a principal receptor for HIV-1, brain cells expressing the CD4 antigen are not permissive to HIV-1 strains infectious to monocyte or T-cell lines. We examined whether the non-permissiveness of the brain-derived cells to standard HIV-1 strains could be explained by a lack of tryptase TL2 or CD26. Western blots showed that the amounts of tryptase TL2 expressed in cell lysates prepared from the brain-derived cells were similar to those prepared from various cells susceptible to HIV-1 strains. Furthermore, flow cytometry revealed the presence of the CD26 antigen on the cell surface of many types of cells. The resistance of the brain-derived cells to standard HIV-1 strains is not due to a lack of tryptase TL2 or CD26.

The yeast CCR4 protein is neither regulated by nor associated with the SPT6 and SPT10 proteins and forms a functionally distinct complex from that of the SNF/SWI transcription factors

The CCR4 protein is specifically required for the increased transcription at the ADH2 locus resulting from mutations in the SPT10 (CRE1) and SPT6 (CRE2) genes and is also required for the expression of ADH2 and other genes under non-fermentative growth conditions. The mechanism by which mutations in CCR4 suppress defects in SPT10 and SPT6 was examined. The SPT10 and SPT6 genes were shown not to control CCR4 mRNA or protein expression nor did SPT10 and SPT6 proteins co-immuneprecipitate with CCR4. CCR4 association with two other proteins, 195 and 185 kDa in size, was unaffected by either spt10 or spt6 mutations. Also, the ability of CCR4 to activate transcription when fused to the LexA DNA binding domain was not specifically enhanced by defects in either SPT10 or SPT6. These results suggest that SPT10 and SPT6, in negatively regulating transcription at ADH2, act through a factor that requires CCR4 function, but do not regulate CCR4 expression, control its activity, physically interact with it, or affect its binding to other factors. The relationship of CCR4 to the group of general transcription factors, SNF2, SNF5, SNF6 and SWI1 and SWI3, which comprise a multisubunit complex required for ADH2 and other genes' expression, was also examined. CCR4 protein expression was not controlled by these factors nor did they co-immuneprecipitate or associate with CCR4. In addition, a ccr4 mutation had little effect on an ADH2 promoter alteration in contrast to the large effects displayed by mutations in SNF2 and SNF5. These data suggest that CCR4 acts by a separate mechanism from that used by the SNF/SWI general transcription factors in affecting gene expression.

Role of transesophageal echocardiography in pre- and post-percutaneous balloon mitral valvuloplasty

Transesophageal echocardiogram (TEE) was performed in 33 consecutive patients with both rheumatic mitral stenosis and chronic atrial fibrillation to evaluate the usefulness of this technique for the detection of left atrial thrombi, mitral regurgitation before percutaneous balloon mitral valvuloplasty and iatrogenic atrial septal defect after the procedure. TEE correctly identified thrombi in 10 (30%) patients and significant mitral regurgitation in 5 patients who underwent surgical intervention. The remaining 18 patients underwent percutaneous balloon mitral valvuloplasty without evidence of systemic embolic event and obtained adequate outcome. Transesophageal color doppler echocardiography demonstrated left-to-right shunting flow through atrial septum in 5 of 7(71%) patients 3 days after the procedure and repeated TEE in 2 of these 5 patients showed no shunting after 6 months. In conclusion, TEE plays a definite role in the selection of patients for balloon mitral valvuloplasty and assessment of iatrogenic atrial septal defect.

[Neuropsychiatric disturbances and neuro-electrophysiological examination in patients with arsenic poisoning]

Neuropsychiatric disturbances caused by arsenic poisoning in 28 patients were reported. The incidence was 32.2% of all the arsenic poisoning patients. The patients were classified into three types according to their clinical symptoms. The neurologic type constituted 46.4%, mental type 21.4% and mixed type 32.1% of the patient respectively. Various abnormalities were found in EEG, EMG, EP and EKG examination. EMG and EP were still abnormal in most of the patients after treatment for three months. The results showed that arsenic poisoning may cause neuropsychiatric disturbances. The symptoms in these patients are serious and the recovery is quite slow.

Specific A+T-rich repetitive DNA sequences in maxicircles from wildtype Leishmania mexicana amazonensis and variants with DNA amplification

To explain the low cross-hybridization between kinetoplast DNA maxicircles of Leishmania parasites that show DNA amplification and those of parasites without DNA amplification, we isolated and cloned two maxicircle fragments, one specific to each group of parasites. The cloned fragment from wildtype L. m. amazonensis (MbpW94) and that from an arsenite-resistant variant with DNA amplification (MpbA29) hybridized only to maxicircles from parasites of the group from which the fragment was originally derived. Both fragments were A+T-rich, tandemly repeated, and lacked long conserved open reading frames and transcriptional products. MpbW94 (685 bp) was harbored in a segment of roughly 12 kb in maxicircles of wildtype parasites and of an arsenite-resistant variant without DNA amplification, while MbpA29 (1121 bp) occupied a 6- to 7-kb segment of maxicircle DNA in arsenite- and tunicamycin-resistant variants with DNA amplification. These maxicircle DNA segments appear to resemble previously described maxicircle divergent regions of other kinetoplastids. The presence of these specific sequences allows differentiation between maxicircles of drug-resistant L. m. amazonensis with DNA amplification and those of parasites without DNA amplification and helps explain the low cross-hybridization between maxicircles of the two parasite groups. Furthermore, these sequences allow the study of the kinetics of the changeover of A+T-rich regions of maxicircles during the transition period from one maxicircle type to the other.

Clinical outcome and management of prenatally diagnosed primary megaureters

The objective of this study was to evaluate the clinical outcome of infants diagnosed perinatally with primary obstructive megaureter, and to determine which anatomical and physiological indexes best predict such outcome. A total of 67 megaureters thought to be due to primary vesicoureteral junction obstruction was detected in 53 newborns as a result of prenatally diagnosed hydronephrosis or hydroureteronephrosis. These patients were followed nonoperatively using periodic ultrasound and 99mtechnetium-diethylenetriaminepentaacetic acid (Tc-DTPA) renal scans. After a mean followup period of 3.1 years 23 dilated ureters (34%) spontaneously resolved while 33 (49%) persisted. Repair was performed on 11 megaureters (17%) because of breakthrough urinary infections in 3 and deteriorating renal function in 8. Postoperatively, all renal units showed improved drainage on 99mTc-DTPA renal scan, while half of those with decreased renal function regained the lost function. None had further deterioration in renal function. Of the clinical indexes studied ultrasonographic ureteral diameter (less than 6 mm. good, greater than 10 mm. poor prognosis) and drainage on 99mTc-DTPA renal scan correlated best with outcome. We conclude that the majority of primary megaureters detected in the perinatal period can be followed conservatively using periodic ultrasound and 99mTc-DTPA renal scans. Relatively few cases required surgical intervention and those at risk were identifiable by a diameter greater than 10 mm. and poor drainage on 99mTc-DTPA renal scan.

CCR4 is a glucose-regulated transcription factor whose leucine-rich repeat binds several proteins important for placing CCR4 in its proper promoter context

The yeast CCR4 protein is required for the expression of a number of genes involved in nonfermentative growth, including glucose-repressible ADH2, and is the only known suppressor of mutations in the SPT6 and SPT10 genes, two genes which are believed to be involved in chromatin maintenance. We show here that although CCR4 did not bind DNA under the conditions tested, it was able to activate transcription when fused to a heterologous DNA-binding domain. The transcriptional activation ability of CCR4, in contrast to that of many other activators, was glucose regulated. Two activation domains one of which was glucose responsive and encompassed a glutamine-proline-rich region similar to that found in other eukaryotic transcriptional factors were identified. The two transactivation regions, when separated from the leucine-rich repeat and the C terminus of CCR4, were unable to complement a defective ccr4 allele, suggesting that the leucine-rich repeat and the C terminus make contacts that link the activation regions to the proper gene context. Native immunoprecipitation of CCR4 revealed that CCR4 was complexed with at least four other proteins. The leucine-rich repeat of CCR4 was both necessary and sufficient for interaction with at least two of these factors. We propose that the leucine-rich repeat links CCR4 through its associated factors to its promoter context at ADH2 and other loci where it is required for proper transcriptional regulation.

[Chronological characteristics of retinoic acid-induced HL-60 cell differentiation]

HL-60 cells can be induced to differentiate into mature granulocytic cells in a continuous exposure to all-trans retinoic acid (RA) for at least 96 h. In this study, RA was removed after being exposed to HL-60 cells for 12-96h. Then the cells were reincubated in a fresh medium without drug for additional 48-144h and their differentiation markers such as NBT reduction, morphological changes and cytokinetic characteristics were studied. The results demonstrated that once exposed continuously to 1.0 mumol/L RA for at least 48h, the HL-60 cells would proceed to terminal differentiation: about 60-90 percent of the cells became NBT positive, 40-80 percent of cells exhibited decreased nucleus/cytoplasm ratio and marked reduction in the number of nucleoli and displayed matured granulocytic morphology. Cytokinetic studies demonstrated 48-85 percent of cells arrested in G1 phase, which is typical for differentiated cells. However, if the cells were exposed to RA for less than 48h, they would not show differentiation phenotype. These results indicate that 48h exposure is critical for HL-60 cell differentiation induced by RA, and the cell differentiation induced by RA is irreversible and RA-independent.

Selection for arsenite resistance causes reversible changes in minicircle composition and kinetoplast organization in Leishmania mexicana

Certain minor minicircle sequence classes in the kinetoplast DNA (kDNA) networks of arsenite- or tunicamycin-resistant Leishmania mexicana amazonensis variants whose nuclear DNA is amplified appear to be preferentially selected to replicate (S. T. Lee, C. Tarn, and K. P. Chang, Mol. Biochem. Parasitol. 58:187-204, 1993). These sequences replace the predominant wild-type minicircle sequences to become dominant species in the kDNA network. The switch from wild-type-specific to variant-specific minicircles takes place rapidly within the same network, the period of minicircle dominance changes being defined as the transition period. To investigate the structural organization of the kDNA networks during this transition period, we analyzed kDNA from whole arsenite-resistant Leishmania parasites by dot hybridization with sequence-specific DNA probes and by electron-microscopic examination of isolated kDNA networks in vitro. Both analyses concluded that during the switch of dominance the predominant wild-type minicircle class was rapidly lost and that selective replication of variant-specific minicircles subsequently filled the network step by step. There was a time during the transition when few wild-type- or variant-specific minicircles were present, leaving the network almost empty and exposing a species of thick, long, fibrous DNA which seemed to form a skeleton for the network. Both minicircles and maxicircles were found to attach to these long DNA fibrils. The nature of the long DNA fibrils is not clear, but they may be important in providing a framework for the network structure and a support for the replication of minicircles and maxicircles.

Cytosolic acetylation of sulfamethazine decreases hepatic release of ketone bodies in vivo in fasting rats

The effect of sulfamethazine (SMZ) on ketogenesis was studied in this report. SMZ, a sulfonamide metabolized by cytosolic acetylation in liver, was intraperitoneally injected (2 mmol/kg) to ketamine-anesthetized, overnight-fasted rats. Ketogenesis was measured by the Fick principle from the transhepatic (A-V) gradients of acetoacetate (AcAc) and D-beta-hydroxybutyrate (beta-OHB). Prior to SMZ injection, A-V gradient of ketone bodies (KB) (AcAc + beta-OHB) was -1.38 mM, indicating release from the liver. After SMZ injection, the release of KB decreased rapidly, maintaining at a level approximately 50% less than controls throughout the 2-h experimental period. Plasma concentrations of AcAc and beta-OHB also decreased. In contrast, plasma concentrations and trans-hepatic gradients of free fatty acids (FFA) were not significantly affected. Our results thus indicate that SMZ acetylation in liver mobilizes acetyl CoA from mitochondria. Decreased hepatic ketogenesis limits the availability of KB and may thus affect energy metabolism in the extrahepatic tissues. The incomplete inhibition on ketogenesis may indicate compartmentation of acetyl CoA in liver mitochondria.

Splenosis presenting as a left renal mass: a report of two cases

The development of splenosis is a recognized consequence of splenic trauma. We present 2 cases of splenosis that were initially diagnosed as left renal cell carcinomas. The diagnosis of splenosis was made by technetium sulfur colloid scans. The clinical presentation and diagnosis of these 2 cases of splenosis masquerading as renal cell carcinoma are reviewed.

Hemodynamic evaluation of bovine pericardial xenograft valves in the mitral position by stress Doppler echocardiography

The function of a bovine pericardial xenograft valve in the mitral position was studied in 18 patients by using stress Doppler echocardiography after submaximal supine exercise. In 10 patients with normally functioning tissue valve, peak and mean gradients increased from 9.3 +/- 1.3 and 2.7 +/- 0.7 mmHg, respectively at rest, to 14.7 +/- 0.9 and 4.1 +/- 1.0 mmHg at peak exercise. The tissue valve area assessed by the Doppler pressure half-time method increased from 2.69 +/- 0.38 cm2 at rest, to 3.15 +/- 0.38 cm2 at peak exercise (P < 0.05). In 6 patients with mitral regurgitation, peak and mean gradients increased from 17.3 +/- 5.3 and 7.0 +/- 1.8 mmHg, respectively at rest, to 24.3 +/- 5.0 and 9.0 +/- 2.6 mmHg at peak exercise, but there was no significant change in valve area at peak exercise. Patients with severe isolated mitral regurgitation had a Vmax of more than 2 m/s and elevated pressure gradients at peak exercise. But the pressure half-time was relatively unaffected, allowing their differentiation from patients with tissue valvular stenosis. Stress Doppler echocardiography is a simple, noninvasive and reliable method for the evaluation of the mitral tissue valve function which is recommendable for patients with suspected mitral tissue valve dysfunction.

Chemotherapy of head louse (Pediculus humanus capitis) infestation gamma benzene hexachloride (gamma-BHC) among school children in Szu-Hu District, Yunlin County, Central West Taiwan

In order to evaluate the effectiveness of 1% gamma-BHC emulsion against head louse infestation, 1,527 school children were examined using observation by ocular and combing methods were used and infested children were treated with three regimes of 1% gamma-BHC emulsion. An overall infestation rate of 40% was found. The infestation rate was highest in Tung-Kuang Primary School (59%) and lowest in Chien-Hua Primary Schools (7%). The rate was highest among school children grade 2 (45%) and lowest in grade 3 (35%). The rate of girls (65%) was much higher than that of boys (9%). A total of 443 lice were collected from 78 infested school girls: 56 males, 59 females, and 328 nymph. The average number of head lice in each infested girl was 5.7. Follow-up examination was conducted one week after treatment. The cure rates for dosages of 10.0 ml, 5.0 ml, and 2.5 ml 1% gamma-BHC emulsion were 96%, 88%, 68% for girls and 100%, 92%, and 33% for boys, respectively. Only mild and transient itching and burn sensation of scalp were reported by a few children. The overall infestation rate 5 months (April-September 1981) after treatment was 23% (286/1,245). The rate of girls decreased from 65% to 40% and that of boys from 9% to 3%. Results of the present study indicates that 1% gamma-BHC emulsion is an effective pediculicide at a dosage of 5 ml or 10 ml. However, the overall infestation rate remained high (23%) 5 months after treatment. These findings suggest that treatment of head louse infestation must be conducted continuously.

[Changes in parameters of hemorheology and circulation 6-keto-PGF1 alpha and TXB2 in dilated cardiomyopathy]

The changes in 12 parameters of hemorheology were observed and the levels of peripheral plasma 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane B2 (TXB2) measured in 35 cases of dilated cardiomyopathy (DCM), including 6 peripartum cardiomyopathy (PCM). We found that there is of hyperviscosity in DCM, the causes were decrease of erythrocyte deformability, increase of red blood cell aggregation, increase of plasma fibrinogen and TXA2 level and decrease of plasma 6-keto-PGF1 alpha level.

Risk factor analysis of an epidemic of hepatitis A in a factory in Shanghai

Investigation of an epidemic of hepatitis A which occurred in Shanghai in early 1988 was conducted at the Shanghai No. 2 Yarn Dyeing and Weaving Mill. In this factory the attack rate between January and April 1988 was 9%. The rate was highest among staff who ate raw clams (18%) and higher among those who ate cooked clams (7%) than among those who did not eat clams (2%). In addition, independent risk factors for infection were: age below 30 years (relative risk (RR) = 3.0, 95% Cl: 2.0, 4.5) shift work (RR = 3.3, 95% Cl: 1.9, 5.8) and eating out (RR = 4.7, 95% Cl: 2.3, 9.7). Consumption of clams contaminated with hepatitis A was the main risk factor in this episode. The study indicates that strengthening surveillance of shellfish hygiene is important in preventing future epidemics of hepatitis A.

Real-time, multiplanar computerized tomography: a new diagnostic modality used in the detection and endoscopic removal of a distal ureteral fibroepithelial polyp and adjacent calculus

Ureteral fibroepithelial polyps are rare benign mesodermal tumors that occur predominantly in the upper ureter. We report on a patient with a fibroepithelial polyp in the distal ureter that resulted in entrapment of a calculus and partial obstruction of the collecting system. Preoperatively, diagnosis by standard radiographic methods, such as excretory urogram, retrograde pyelogram and conventional computerized tomography with and without contrast enhancement, was not possible because of the close proximity of the fibroepithelial polyp, the ureteral calculus and calcifications in the adjacent internal iliac artery. The new diagnostic modality of real-time, multiplanar computerized tomography imaging using the Sun/Pixar computer system and the 2D/3D Orthotool software was used to make the correct preoperative assessment. Subsequently, the patient underwent ureteroscopic resection of the polyp and extraction of the calculus. A year later she was free of symptoms and there was no evidence of regrowth of the polyp. To our knowledge this is the first report to describe the use of real-time, multiplanar computerized tomography imaging as an effective diagnostic modality in the genitourinary tract. In addition, this is the first ureteral fibroepithelial polyp reported in the literature to be associated with a ureteral calculus and to be excised endoscopically with no recurrence on long-term followup.

[The significance and state of pre-S2 and antibodies to pre-S2 in 30 cases of acute viral hepatitis type B]

Determination of time sequence of pre-S2 and its antibody response during the symptomatic phase of acute viral hepatitis type B, as well as their relationship to the HBV-markers, was carried out in 30 subjects after the onset of liver damage by means of monoclone antibody-captured enzyme immunoassay were analysed. The results showed that anti-pre-S2 were positive in 80.3% of patients recovering from acute viral hepatitis type B, being higher than the percentage during maximal liver damage (P less than 0.001). Such antibodies were absent in cases showing chronic evolution and were found in less than 8% of chronic hepatitis B cases, with no relation to liver damage. Anti-pre-S2 were detected after the immune clearance of HBsAg and HBV-DNA, and thereafter the anti-HBs were present in 80% of patients after recovery (P less than 0.001). Our observations significantly suggest that anti-pre-S2 may be valuable as a marker of the favourable prognosis of acute viral hepatitis type B and of HBV clearance. They did not play any role in the pathogenesis of HBV-related liver damage. The continuous presence of pre-S2 with the absence of anti-pre-S2, on the contrary, is considered as a characteristic sign and a new information of chronic viral hepatitis type B.

Adult Hirschsprung's disease

This report presents a series of 17 patients with adult Hirschsprung's disease treated at the National Taiwan University Hospital and its affiliated hospitals from 1965 to 1988. Adults with Hirschsprung's disease may present with symptoms and operative findings different from those of children with Hirschsprung's disease. The symptoms, signs, criteria for diagnosis, operative findings, and operative procedures are presented.

[Use of baculovector for the expression of HBsAg gene in insect cells]

Based on the information of molecular biology of Autographa californica Nuclear Polyhedrosis virus (AcNPV), a recombinant transfer plasmid pAcMV was constructed by molecular procedures included using two synthetic localized probes, which provided an inserted position linked with BamHI sequences nearly at polyhedrin initiating ATG codon. Then an expression vector pAcMV-HBsAg was reconstructed, it contained HBsAg gene from subclone pYPSS-1 derived from adwserotype of HBV. The recombinant virus containing HBsAg gene was isolated and purified through 3 cycles plaques and hybridization experiment after cotransfection of Spodoptera frugiperda cells with DNA of pAcMV-HBsAg and AcNPV. The expression of HBsAg gene in S. frugiperda cells infected with recombinant virus AcRV-HBsAg was identified by ELISA as haemagglutination tests. The yield of HBsAg excreted from S. frugiperda cells (an appropriate density usually between 1-2 X 10(6) cells/ml) after 48-72 h infected with AcRV-HBsAg was 4-8 mg/L. HBsAg harvested from the infected culture medium was shown immunoelectromicroscopy to be composed of spherical particles of about 22 nm diameter. Using this purified HBsAg, Bal b/c mice was immunized, the titer of anti-HBsAg serum measured measured by RIA was similar to that of purified HBsAg from human blood. Stable recombinant virus was isolated and could be shown to replicate in corn borer (Ostrinia nubilalis) larvae. All of these results can be expected that this expression vector system will be commercially developed to its fullest potential for diagnosis and vaccine HBsAg.

An analysis of prognostic factors in cirrhosis

To develop a more comprehensive index for predicting the prognous of liver cirrhosis. 300 consecutive patients with cirrhosis were studied in terms of survival from 1975 to 1986. Median follow-up period was 5.3 years. A multivariable survival analysis (Cox's regression model) using clinical biochemical data obtained at admission disclosed eight factors of value in predicting prognosis: age, frequency of previous GI bleeding, ascites, hepatic encephalopathy, serum albumin, serum bilirubin, hemoglobin and prothrombin time. A prognostic index was constructed for the calculation of the estimated survival probability.

[Promoting effect of the Chinese medicinal herb, wikstroemia chamaedaphne and tung oil extracts on carcinoma of the uterine cervix induced by HSV-2 or methylcholanthrene (MCA) in mice]

The promoting effect of the Chinese medicinal herb, Wikstroemia chamaedaphne and Tung oil extracts (WC and HHPA) on carcinoma of uterine cervix induced by HSV-2 or MCA in mice was studied. The results showed that WC and HHPA extracts were not carcinogenic themselves. After carcinogen HSV-2 and MCA treatment, WC and HHPA were added separately. The inducing rates by HSV-2 increased from 7.4% to 21.1% and 26.3%, those by MCA increased from 56.5% to 82.8% and 84.4%. There was a significant difference between the combined groups and groups with HSV-2 or MCA only. The experimental results suggest that these two kinds of extracts play a promoting effect on carcinogenesis. The relation between the carcinogenesis of uterine cervix or nasopharynx and WC or HHPA extracts is discussed.