Plasma concentrations of leptin and selected minerals do not differ in Type 2 diabetic patients with or without sulfonylurea inefficacy

The oral hypoglycemic agent sulfonylurea (SU) can increase plasma leptin concentrations. Additionally, diabetic subjects frequently have an altered plasma status of selected minerals. However, whether these described plasma parameters are changed in Type 2 diabetic patients who exhibit SU inefficacy has not yet been evaluated. In this preliminary study, fasting blood samples were collected from 16 Type 2 diabetic patients with secondary SU failure. As controls, 16 sex-, age- and adiposity-matched diabetic patients, who had similar diabetic duration and optimal glycemic control by SU, were also recruited. The results show that plasma values of leptin, C-peptide, calcium, magnesium, copper, and zinc did not significantly differ in these diabetic patients with or without secondary SU failure. However, the gender effect on plasma leptin level and the correlations between leptin and adiposity and C-peptide were retained. This study indicates that there is no relation between SU inefficacy and the plasma status of leptin and selected minerals.

Effect of zinc on cellular levels of calmodulin and cyclic adenosine monophosphate in the adipocyte

A perturbation of zinc metabolism has been noted in subjects with obesity. Zinc may also participate in the intracellular signal cascade by affecting cellular calcium influx and a change in the calcium-calmodulin (CaM)-cyclic adenosine monophosphate (cAMP) pathway. The possible effects of zinc on cellular concentrations of CaM, a major cytosolic calcium-binding protein, in the adipocytes derived from obese (ob/ob) mice and their lean counterparts were studied. Adipocytes derived from both phenotypes of mice were treated either with 0.2 mM of zinc sulfate or without any additive for 1 h of incubation; the cellular levels of CaM and cAMP were then determined. The results showed that the obese mice had lower CaM and cAMP levels in their adipocytes compared to the lean mice. Zinc treatment reduced CaM and increased cAMP levels in all mice, although this effect was more pronounced in the lean mice. This study indicated that there was an inverse interaction between CaM and cAMP in their cellular levels in the mouse adipocytes and that might be affected by exogenous zinc addition.

Molecular diagnosis of fragile X syndrome and distribution of CGG repeats in the FMR-1 gene in Taiwanese

BACKGROUND AND PURPOSE

Fragile X syndrome, the most frequent form of inherited mental retardation, is caused by abnormal expansion of the CGG trinucleotide repeats in the 5' untranslated region of the FMR-1 gene. In this study, we describe the prenatal diagnosis of fragile X syndrome and the distribution of CGG repeat numbers in the FMR-1 gene, which has not been previously reported in Taiwanese.

METHODS

Using polymerase chain reaction (PCR), we determined the range of the CGG repeats in the FMR-1 gene in 316 normal individuals (350 X chromosomes) and 349 mentally retarded patients (429 X chromosomes). For prenatal diagnosis of fragile X syndrome, DNA extracted from amniotic fluid cells was used for PCR determination of CGG repeats.

RESULTS

Because there were no significant differences between the distribution of the (CGG)n alleles between the mentally retarded and normal subjects, the data were pooled. Among the 779 X chromosomes studied, 24 different alleles were identified with a low of 16 and a high of 45 CGG repeats. The 29 repeat allele was the most common, followed by the 30 and the 28 repeat alleles. We effectively amplified slightly expanded premutation alleles of up to about 90 CGG repeats. In the prenatally diagnosed fetus, a normal 29 repeat allele was found.

CONCLUSIONS

Determination of the distribution of the CGG repeats in the FMR-1 gene in Taiwanese is useful in genetic counseling regarding fragile X syndrome. Prenatal molecular diagnosis of the syndrome can be successfully performed using amniotic fluid cells.

Imaging in the diagnosis and follow-up evaluation of vertebral artery dissection

The purpose of this report is to discuss the value of ultrasonographic examination in the diagnosis and follow-up evaluation of vertebral artery dissection. We collected data on 8 patients with 11 pathologic vessels: 9 were affected intracranially and 6 were affected extracranially. Four vessels were affected in both intracranial and extracranial segments. Extracranial color-flow duplex sonography could detect abnormalities in every extracranial vertebral artery dissection. Most abnormal findings were non-specific, including severely reduced flow, absence of flow, and absence of diastolic flow. A specific finding (intramural hematoma) was noted in one artery. Abnormal transcranial color-coded sonographic findings included absence of flow, reduced velocity and reversed flow direction. Three intracranial dissecting arteries showed normal findings on transcranial color-coded sonography. Ultrasonographic follow-up study revealed evidence of improvement; this was noted almost exclusively in the extracranial segments of the vertebral artery but infrequently in the intracranial segment. Extracranial color-flow duplex sonography is sensitive in the detection of extracranial vertebral artery dissection, both in initial diagnosis and in follow-up evaluation.

Carotid and transcranial color-coded duplex sonography in different types of carotid-cavernous fistula

BACKGROUND AND PURPOSE

Patients with carotid-cavernous fistula (CCF) may undergo direct or indirect shunting. Ultrasonography has value that is complementary to angiography in the assessment and follow-up of these patients. The aim of this study was to characterize findings provided by carotid duplex sonography (CDS) and transcranial color-coded duplex sonography (TCCD) in patients with different types of CCF.

METHODS

CDS and TCCD were independently performed by technologists and neurologists. Digital subtraction or MR angiography was interpreted by a neuroradiologist. Ultrasonographic studies were categorized into 4 types: I, direct shunting only; II, direct shunting with a carotid aneurysm; III, indirect shunting only; and IV, mixed (direct and indirect) shunting. In addition to carotid and intracranial flow velocities, volume, and pulsatility, other direct and indirect ultrasound signs of shunting were evaluated. The direct sign of CCF was a mosaic flash detected by TCCD. Alteration of hemodynamic parameters on CDS and demonstration of draining veins with the use of TCCD were considered indirect signs.

RESULTS

Fifteen patients (8 men, 7 women) were included in the study. According to angiographic results, patients in ultrasonographic classification types I (n=7) and II (n=3) corresponded to type A of Barrow's classification. Patients with type III (n=8) were Barrow's type C. Type IV (n=1) had a combination of Barrow's types A and C. On ultrasound, both direct and indirect signs were seen in types I, II, and IV CCF. The presence of a 2-colored oval mass divided by a zone of separation without turbulence differentiated type I from type II CCF. All patients with type III CCF had indirect signs, and only 1 patient had direct signs on TCCD. Abnormal TCCD findings were most commonly seen through the transorbital window (100%), followed by the transtemporal window (63%) and transforaminal window (40%).

CONCLUSIONS

If only indirect ultrasonographic signs of CCF are present, TCCD can be used to predict an indirect CCF type on the basis of the origin of the fistula. With direct communication between carotid artery and cavernous sinus, both direct and indirect ultrasonographic signs can be found. The combination of CDS/TCCD may provide a noninvasive and reliable way to classify patients with CCF.

Leptin concentration and the Zn/Cu ratio in plasma in women with thyroid disorder

We investigated the possible correlation between the leptin concentration and the Zn/Cu ratio in the plasma of women with thyroid disorder. Forty women with hypothyroidism (n = 20) or hypothyroidism (n = 20) and 20 euthyroid controls were recruited. The results showed that the women with thyroid disorder (hypothyroidism or hyperthyroidism) had higher plasma leptin concentrations than the normal controls (p < 0.05). Moreover, the plasma leptin concentration had no correlation with plasma thyroid hormone levels in the separate groups, nor among all the participants considered together. A strong correlation (p < 0.005) between leptin and adiposity was only observed in euthyroid women. Plasma values of Zn and Cu and the Zn/Cu ratio were not markedly different among women with altered thyroid status. However, a weak correlation (r = 0.28, p = 0.032) between leptin and the Zn/Cu ratio was found from the pooled data of all participants and retained after adjustment for adiposity. We suggest that there may exist an interaction between the plasma leptin level and thyroid hormone-induced abnormality for selected minerals.

Aetiologies and prognosis of Chinese patients with deep vein thrombosis of the lower extremities

Deep vein thrombosis (DVT) of the lower extremities is not frequently encountered in Oriental patients. We investigated its aetiology and prognosis in 143 patients (65 males, 78 females), presenting to the National Taiwan University Hospital over 4.3 years, diagnosed by colour Doppler ultrasonography. Swelling and pain of the lower extremities were the most frequent presenting symptoms. The left femoropopliteal veins were more frequently involved than other parts of the lower extremities. In these patients, malignancy with or without intravenous catheterization was the most frequent cause (39 patients, 27%). Other common aetiologies included coagulopathy (29 patients, 20%), immobilization (24 patients, 17%) and catheter-related (13 patients, 9%). No definite aetiology could be determined in 37 patients (26%). During follow-up, 27 patients (19%) died, mostly with malignancy. Pulmonary embolism was noted in 16 patients and was not significantly directly related to death. Compared to similar studies in Caucasian patients, there were significant differences in the aetiology of DVT, with malignancy and coagulopathy more common in these Chinese patients.

Effects of zinc supplementation on the plasma glucose level and insulin activity in genetically obese (ob/ob) mice

The effects of zinc supplementation (20 mM ZnCl2 from the drinking water for eight weeks) on plasma glucose and insulin levels, as well as its in vitro effect on lipogenesis and lipolysis in adipocytes were studied in genetically obese (ob/ob) mice and their lean controls (+/?). Zinc supplementation reduced the fasting plasma glucose levels in both obese and lean mice by 21 and 25%, respectively (p < 0.05). Fasting plasma insulin levels were significantly decreased by 42% in obese mice after zinc treatment. In obese mice, zinc supplementation also attenuated the glycemic response by 34% after the glucose load. The insulin-like effect of zinc on lipogenesis in adipocytes was significantly increased by 80% in lean mice. However, the increment of 74% on lipogenesis in obese mice was observed only when the zinc plus insulin treatment was given. This study reveals that zinc supplementation alleviated the hyperglycemia of ob/ob mice, which may be related to its effect on the enhancement of insulin activity.

Zinc supplementation on serum levels and hepatic conversion of thyroid hormones in obese (ob/ob) mice

The supplemental effects of zinc on thyroid status in obese (ob/ob) mice were studied. Four-week-old obese mice and their lean controls were fed either a basal diet or a zinc-supplemented diet (200 mg/kg diet) for 8 wk. Following the 8-wk basal diet, obese mice had lower serum T4 values, as well as hepatic T4 and T3 values, than lean mice (p < 0.05). A significant decrease in hepatic 5'-deiodinase activity was also observed in obese mice. Dietary zinc supplementation significantly reduced serum T4 levels in both the obese and lean mice. However, the zinc-supplemented effects on diminishing hepatic T4 and T3 values, as well as on 5'-deiodinase activities, were found only in obese mice (p < 0.05). Furthermore, the 5'-deiodinase activities in hepatic microsomal pellets after incubation with various zinc concentrations (0.5, 1.0, and 2.5 mM) were also examined. The 5'-deiodinase activities, in hepatic samples from all mice, were significantly attenuated by zinc treatments. However, this effect was more predominant in obese mice following the addition of 0.5 mM zinc. This study suggests that a lower hepatic 5'-deiodinase activity, resulting from a higher zinc level, might be related to abnormal energy metabolism in the ob/ob mice.

[The lymphoepithelial lesion in salivary glands:report of 25 cases]

This paper reported the results of the clinical observation and long-term follow-up of twenty-five cases of lymphoepithelial lesion in salivary glands.It evaluated the name and character of this disease and investigated correlation between Mikulicz syndrome and Sjogren syndrome.Lymphoepithelial lesion were a course of the benign disease,and had character similar as tumors.It was liable to be diagnosed erroneously and should be treated according to principle of the tumor therapy in the salivary gland.

Dimerization of the N-terminal amphipathic alpha-helix domain of the fungal immunomodulatory protein from Ganoderma tsugae (Fip-gts) defined by a yeast two-hybrid system and site-directed mutagenesis

A fungal immunomodulatory protein (Fip-gts) was purified from Ganoderma tsugae. The DNA encoding Fip-gts was isolated from a cDNA library of G. tsugae by reverse transcriptase-polymerase chain reaction. The complete amino acid sequence of Fip-gts, deduced from the nucleotide sequence of the cDNA, was the same as LZ-8 isolated from Ganodermn lucidum. Recombinant Fip-gts was expressed as a glutathione S-transferase fusion protein in Escherichia coli with a yield of 20 mg/liter of culture. Recombinant Fip-gts, purified to homogeneity, had the same blast formation stimulatory activity to human peripheral blood lymphocytes as native Fip-gts. The yeast two-hybrid system and site-directed mutagenesis were used to determine whether dimerization of Fip-gts occurred. Deletion analysis of the N-terminal amphipathic alpha-helix domain of Fip-gts identified a sequence of about 10 amino acids responsible for inducing immunomodulatory activity. Non-functional Fip-gts deletion mutants did not form dimers, whereas wild type Fip-gts did as determined by gel filtration. A mutant with deletions at Leu-5, Phe-7, and Leu-9 lost the amphipathic characteristics of the N-terminal domain and the ability to form dimers as well as its immunomodulatory activity. Fusion of Fip-gts with the DNA binding and the transactivation domains of GAL4 resulted in the activation of the lacZ activator gene, indicating the interaction of Fip-gts with it itself. The dimerization domain was further defined by analyzing the ability of the N-terminal 13 amino acids or Leu-5, Phe-7, and Leu-9 deletion mutants of Fip-gts to interact with the wild type Fip-gts. These experiments confirmed the N-terminal amphipathic alpha-helix as the dimerization domain and suggest that the dimerization of Fip-gts may play an important role in Fip-gts immunomodulatory activity.

Zinc attenuation of GDP binding to brown adipocytes mitochondria in genetically obese (ob/ob) mice

In this study, we investigate the in vitro effect of zinc addition on guanosine diphosphate (GDP) binding to mitochondria in brown adipocytes of genetically obese (ob/ob) mice. Interscapular brown adipocytes of male mice (obese; lean) at 4 and 12 wk of age were incubated with 0, 50, 100, or 200 microM zinc sulfate. Mitochondria were then isolated and their GDP binding capacities were measured. The GDP-binding capacities of ob/ob mice were lower than lean mice, with or without zinc addition, in both age groups (p < 0.05). Zinc addition did not have any significant effect on GDP binding in lean mice. GDP binding decreased with increasing zinc addition in ob/ob mice, and this attenuation was more predominant in 12-wk old ob/ob mice. Moreover, we found that high magnesium addition (5 mM) increased GDP binding in lean mice, but this effect was not significant in ob/ob mice. This study reveals that brown adipose tissue thermogenesis in ob/ob mice could be greatly attenuated by zinc addition, suggesting that zinc may play a regulatory role in obesity.

A diether phosphonolipid surfactant analog, DEPN-8, is resistant to phospholipase-C cleavage

Increased activities of phospholipase A2 and C (PLC) have been observed in the bronchoalveolar lavages of patients with adult respiratory distress syndrome (ARDS). DL-alpha-Di-O-hexadecylphosphonocholine [(R)(S)-DEPN-8], a surfactant analog of superior surface activity to the major lung surfactant phospholipid, dipalmitoylphosphatidylcholine (DPPC), is not a substrate for phospholipases A1, A2 and D, but is a substrate for PLC. (R)(S)-DEPN-8 was found in vitro to undergo significantly less PLC-catalyzed degradation as compared to DPPC. The results suggest that (R)(S)-DEPN-8 and structurally related analogs may be useful as components of exogenous replacement surfactant formulations for the treatment of ARDS-related lung injuries.

Ultrasonographic study and long-term follow-up of Takayasu's arteritis

BACKGROUND AND PURPOSE

Takayasu's arteritis is an inflammatory vasculopathy involving the aorta and its major branches. Little information is available on the natural history and temporal profile of changes in the carotid vessels, the major vessels involved in Takayasu's arteritis. Duplex ultrasonography may provide a reliable and efficient tool for the characterization and follow-up of the brachiocephalic vascular changes in Takayasu's arteritis.

METHODS

Sixteen female patients fulfilling the clinical diagnostic criteria for Takayasu's arteritis were studied. Mean age at onset was 23.6 years (SD = 6.0), and mean duration of follow-up was 17.1 years (SD = 11.9). The clinical features were analyzed. Only one patient had had a stroke. They had undergone at least one duplex scanning examination to evaluate the brachiocephalic vessels, including the extracranial carotid, vertebral, and subclavian arteries. Six patients underwent sequential duplex examination and long-term clinical follow-up.

RESULTS

All the studied patients had subclavian artery involvement, and 11 (69%) had common carotid artery involvement. The percentage of bilateral concomitant involvement was 100% in the common carotid artery and 33% in the subclavian artery. Homogeneous circumferential intima-media thickening was commonly seen in stenotic common carotid arteries (89%). Four patients had internal carotid artery involvement (all on the left side). In the serial duplex follow-up study, 2 of 6 patients had progressive vascular stenosis with concentric thickening, rather than longitudinal spreading, in the bilateral common carotid arteries. Left-side lesions were more prominent. Most were clinically stationary, despite severe stenosis or occlusion of the common carotid arteries.

CONCLUSIONS

The characteristic vascular lesions and progression changes in Takayasu's arteritis detected by duplex ultrasonography are quite different from those seen in ordinary atherosclerosis. Homogeneous circumferential intima-media thickening of the common carotid arteries is a highly specific ultrasonographic finding in patients with Takayasu's arteritis, particularly young women. Sequential duplex scanning showed vascular progression to be unpredictable and unrelated to medication in our patients. Further clinical investigations of vascular progression are warranted, and duplex scanning may provide a simple, safe, and accurate long-term means of follow-up.

Prenatal diagnosis in a Chinese family with type Ia glycogen storage disease by PCR-based genetic analysis

Type Ia glycogen storage disease (GSD), an autosomal recessive metabolic disorder, is caused by a deficiency in glucose-6-phosphatase (G6Pase). We had previously identified the nature of the causative mutations in a Chinese family whose first two children were affected with type Ia GSD. Two different point mutations in the G6Pase gene, a guanine to adenine substitution at base position 327 in exon 2 and a thymine to adenine substitution at base position 1101 in exon 5, change the restriction sites for the enzymes Fok I and Hinc II. Family study revealed that both parents were heterozygous carriers: the father with a mutant G6Pase allele at exon 2 and the mother with another mutant G6Pase allele at exon 5. This paper deals with a prenatal diagnosis on the fetus of this family who is at risk of type Ia GSD. Genomic DNA was extracted from a chorionic villus biopsy sampled at the tenth week of gestation. Exons 2 and 5 of the G6Pase gene were amplified by the polymerase chain reaction (PCR) followed by restriction enzyme digestion and direct sequence analysis. DNA analysis indicated that the fetus was a heterozygous carrier of type Ia GSD with a mutant G6Pase allele at exon 2 and a normal G6Pase allele at exon 5. The diagnosis was further confirmed by the same method with cultured amniocytes and with a blood sample after the baby was born. This is the first report of prenatal carrier detection of type Ia GSD at the gene level.

Neoplastic response in Japanese medaka and channel catfish exposed to N-methyl-N'-nitro-N-nitrosoguanidine

Japanese medaka (Oryzias latipes) and channel catfish (Ictalurus punctatus) were investigated for carcinogenic response following a 28-day, 3 x/wk pulse exposure to N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). Five-wk-old medaka were exposed at concentrations of 0, 0.5, and 1.0 mg/L, and 5-mo-old catfish at concentrations of 0, 0.1, and 0.5 mg/L. In medaka, a total of 19 tumors including 2 branchioblastomas, 6 thyroid follicular adenomas and 1 adenocarcinoma, and 11 subcutaneous fibrosarcomas were observed in 16 of 96 MNNG-exposed fish. In catfish, a total of 37 tumors including 4 squamous cell carcinomas and 16 papillomas, 3 lipomas, 1 fibroma, 1 osteosarcoma, 4 branchioblastomas, 6 thymic epithelial tumors, and 2 generalized lymphosarcomas were observed in 34 of 172 MNNG-exposed fish. The induction of neoplasms in medaka was primarily in the gill, thyroid, and subcutis of the cervical and trunk regions, whereas in catfish skin, thymus, oro-pharynx, and hemopoietic tissues were also commonly affected. In both species, the neoplastic response was considered to be related to direct exposure of the tissues to MNNG. Some of these tumors have not been reported in the literature in either natural or experimental fish. The results also suggest species-specific differences in carcinogenic response following MNNG exposure.

Genetic analysis of the glucose-6-phosphatase mutation of type 1a glycogen storage disease in a Chinese family

Type 1a glycogen storage disease (GSD) is an autosomal recessive metabolic disorder caused by a deficiency in glucose-6-phosphatase (G6Pase). Polymerase chain reaction (PCR) and nucleotide sequence analysis were used to identify the location and nature of mutations at the G6Pase locus in two siblings affected with type 1a GSD. Both patients are compound heterozygotes with two different single nucleotide substitutions in the two G6Pase alleles. A guanine to adenine transition was identified at base position 327 in the exon 2, converting an arginine to a histidine at codon 83. The second substitution was a thymine to adenine transversion at base position 1101 in the exon 5, converting an isoleucine to an asparagine at codon 341. Family study reveals that both parents are heterozygous carriers: the father with a mutant G6Pase allele at exon 2, the mother with another mutant G6Pase allele at exon 5. This is the first family study in Taiwan on type 1a GSD identified by molecular analysis. The mutations identified herein are novel substitutions in the G6Pase gene. In addition, an adenine to guanine substitution was observed at base position 653 in the exon 5 of G6Pase gene in both sibling patients and their parents, as well as in 15 normal Chinese subjects and three normal Caucasian subjects.

Reverse jugular flow in a case of thrombosis of the brachiocephalic vein with an artificial arteriovenous fistula

Thrombosis of the thoracic inlet veins following placement of a central venous catheter is a well-known complication, and several findings have been reported by color Doppler sonography. However, reverse jugular flow resulting from this complication is rarely mentioned and should be differentiated from another complication of iatrogenic arteriovenous fistula between neck vessels. The authors here describe a uremic patient with an artificial arteriovenous fistula in the forearm complicated with thrombosis of the ipsilateral brachiocephalic vein. Factors permitting the differential diagnosis by coloer Doppler sonography and clinical conditions are proposed.