Intralesional photocoagulation of vascular anomalies of the tongue

Vascular anomalies remain a challenge for patients and reconstructive surgeons. Recently, promising results have been reported using intralesional photocoagulation (ILP) to treat large, deep vascular lesions. We report our experience in treating 12 patients with vascular anomalies of the tongue (10 venous malformations and two haemangiomas) using intralesional photocoagulation. All patients were treated with a Nd:YAG (neodymium:yttrium-aluminium-garnet) (1064 nm) laser (Sharplan, Inc., NJ, USA) delivered with a 600 microns optical fibre. Laser power was set at 7 or 10 W, delivered with a pulse duration of 10 s. Laser energy was delivered to all areas of the vascular lesion. Heat, visible shrinkage and firmness of the lesion signalled the end-point of treatment. The mean follow-up period was 9.5 months (range 3-20 months). All patients demonstrated improvement as judged by a clinical assessment of the reduction in lesion size (mean reduction = 87%, range 60-100%). Three patients (25%) had complications attributed to photocoagulation. Energy delivered too superficially resulted in ulceration or scarring. These complications should be avoidable if this potential for harm is kept in mind.

Microvascular vastus lateralis muscle flap for chronic empyema associated with a large cavity

Thoracic empyema can be disabling and may need microvascular free flaps in some intractable cases. After repeated failure of conventional thoracic surgical procedures, 2 patients with empyema were treated with microvascular free vastus lateralis muscle flaps for obliteration of the large empyema cavity. The reconstruction was successful in wound closure and eradication of infection. The donor site morbidity was minimal, and the patients resumed normal daily activities. Microvascular vastus lateralis muscle flap is the best option if free flaps are required for reconstruction of empyema.

Double-stranded linear duck hepatitis B virus (DHBV) stably integrates at a higher frequency than wild-type DHBV in LMH chicken hepatoma cells

Integration of hepadnavirus DNAs into host chromosomes can have oncogenic consequences. Analysis of host-viral DNA junctions of DHBV identified the terminally duplicated r region of the viral genome as a hotspot for integration. Since the r region is present on the 5' and 3' ends of double-stranded linear (DSL) hepadnavirus DNAs, these molecules have been implicated as integration precursors. We have produced a LMH chicken hepatoma cell line (LMH 66-1 DSL) which replicates exclusively DSL duck hepatitis B virus (DHBV) DNA. To test whether linear DHBV DNAs integrate more frequently than the wild type open circular DHBV DNAs, we have characterized the integration frequency in LMH 66-1 DSL cells by using a subcloning approach. This approach revealed that 83% of the LMH 66-1 DSL subclones contained new integrations, compared to only 16% of subclones from LMH-D2 cells replicating wild-type open circular DHBV DNA. Also, a higher percentage of the LMH 66-1 DSL subclones contained two or more new integrations. Mathematical analysis suggests that the DSL DHBV DNAs integrated stably once every three generations during subcloning whereas wild-type DHBV integrated only once every four to five generations. Cloning and sequencing of new integrations confirmed the r region as a preferred integration site for linear DHBV DNA molecules. One DHBV integrant was associated with a small deletion of chromosomal DNA, and another DHBV integrant occurred in a telomeric repeat sequence.

Intralesional photocoagulation of periorbital hemangiomas

The purpose of this study was to examine the effects of intralesional bare fiber photocoagulation with the KTP and Nd:YAG lasers on periorbital hemangiomas of infancy. Initial reports by Apfelberg and Gregory suggest that intralesional laser therapy may have a role in the treatment of hemangiomas. Intralesional photocoagulation may be preferred to superficial laser treatment for several reasons. It may decrease cutaneous skin damage and more effectively reduce bulky, deep lesions. Twenty-three patients with periorbital hemangiomas were treated (KTP, n = 7; Nd:YAG, n = 16). An 18-g Angiocath was placed into the lesion to pass the fiber through. Laser energy was delivered by means of a 0.6-mm bare fiber at 10 to 15 J (KTP) or 7 J (Nd:YAG). Treatments were done under general anesthesia. Patients were followed closely for 1 month and then monthly to assess results and complications. Results are as follows: 61 percent demonstrated 50-percent or more reduction at 3 months; 22 percent demonstrated 50-percent or more reduction in 3 to 8 months, i.e., 83 percent of patients had 50-percent or more reduction within 8 months. To achieve these results, two patients required two treatments. The remaining 17 percent had 10- to 14-percent reduction at 1 to 3 months. Two of these patients had two treatments. A subgroup of patients had a very dramatic response. Thirty-five percent (8 of 23) had 50- to 90-percent reduction in 1 month. It is unclear why these patients responded so dramatically. We expected some ulceration during the healing phase. Seventeen percent developed ulceration. Complications were limited (4 percent) to one wound infection. Intralesional photocoagulation treatment with the KTP and Nd:YAG lasers is effective and safe for the treatment of periorbital hemangiomas in the majority of patients with minimal complications. Further study is necessary to identify factors that result in dramatic or limited responses.

The effect of cotinine or cigarette smoke co-administration on the formation of O6-methylguanine adducts in the lung and liver of A/J mice treated with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)

4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), a tobacco-specific nitrosamine, induces lung adenomas in A/J mice, following a single intraperitoneal (i.p.) injection. However, inhalation of tobacco smoke has not induced or promoted tumors in these mice. NNK-induced lung tumorigenesis is thought to involve O6-methylguanine (O6MeG) formation, leading to GC-->AT transitional mispairing and an activation of the K-ras proto-oncogene in the A/J mouse. NNK can be metabolized by several different cytochromes P450, resulting in a number of metabolites. Formation of the promutagenic DNA adduct O6MeG is believed to require metabolic activation of NNK by cytochrome P450-mediated alpha-hydroxylation of the methylene group adjacent to the N-nitroso nitrogen to yield the unstable intermediate, methanediazohydroxide. Nicotine, cotinine (the major metabolite of nicotine), and aqueous cigarette tar extract (ACTE) have all been shown to effectively inhibit metabolic activation of NNK to its mutagenic form, most likely due to competitive inhibition of the cytochrome P450 enzymes involved in alpha-hydroxylation of NNK. The objective of the current study was to monitor the effects of cotinine and cigarette smoke (CS) on the formation of O6MeG in target tissues of mice during the acute phase of NNK treatment. To test the effect of cotinine, mature female A/J mice received a single intraperitoneal injection of NNK (0, 2.5, 5, 7.5, or 10 mumole/mouse) with cotinine administered at a total dose of 50 mumole/mouse in 3 separate i.p. injections, administered 30 min before, immediately after, and 30 min after NNK treatment. To test the effect of whole smoke exposure on NNK-related O6MeG formation, mice were exposed to smoke generated from Kentucky 1R4F reference cigarettes at 0, 0.4, 0.6, or 0.8 mg wet total particulate matter/liter (WTPM/L) for 2 h, with a single i.p. injection of NNK (0, 3.75, or 7.5 mumole/mouse) midway through the exposure. Cigarette smoke alone failed to yield detectable levels of O6MeG. The number of O6MeG adducts following i.p. injection of NNK was significantly (p < 0.05) reduced in both lung and liver by cotinine and by cigarette smoke exposure. Our results demonstrate that NNK-induced O6MeG DNA adducts in A/J mice are significantly reduced when NNK is administered together with either cotinine, the major metabolite of nicotine, or the parental complex mixture, cigarette smoke.

Isolation of Spiroplasma citri from Flowers and Seeds Collected from Infected Periwinkles

Isolations were attempted from flowers, stems, and seeds from six Spiroplasma citri-infected periwinkles and from flowers and stems from two healthy plants. Each flower was separated into four parts: petals, sepals, pistils, and corolla tubes. A total of 140 seeds from infected plants were germinated, with a germination rate of 59%. Two and three months after germination, 25 plants from seeds were sampled for the isolation of S. citri. The average spiroplasma cells g^-1 of diseased pistils, sepals, petals, corolla tubes, or stems was 1.87 × 10⁸, 1.9 × 10⁷, 1.89 × 10⁶, 3.7 × 10⁶, or 2.35 × 10⁶, respectively. The number of cells isolated from pistils was significantly higher than that from stems, whereas the numbers from sepals, corolla tubes, and petals were comparable to those from stems. No spiroplasma was isolated from flower parts of two healthy plants, from seeds, or from samples collected from 25 plants grown from seeds. Results indicated that flowers were good sources for the isolation of S. citri and confirmed that there is no seed transmission of the S. citri infection in periwinkles.

Sympathetic hyperactivity in Wistar rats with insulin-resistance

In an attempt to know the effect of sustained hyperinsulinemia on sympathetic function, plasma norepinephrine (NE) and glucose levels were measured in Wistar rats with insulin resistance. Both the basal plasma glucose and the plasma NE levels in insulin-resistant rats were markedly higher than that obtained in normal or streptozotocin (STZ)-induced diabetic rats. Treatment with guanethidine and prazosin reversed these sympathetic hyperactive responses in insulin-resistant rats. Moreover, increase of plasma insulin in rats receiving an intraperitoneal glucose challenge test confirmed the mediation of endogenous insulin in this sympathetic hyperactivity. These results suggest an increase of sympathetic activity in insulin-resistant state that may be related to the hypertension-prone associated with diabetes mellitus in clinics.

A prospective study of tuberculosis and HIV disease progression

OBJECTIVE

To determine whether active tuberculosis alters the rate of progression of HIV infection in dually infected patients.

METHODS

HIV-seropositive patients at two Bronx, New York hospitals with tuberculosis confirmed by culture from July 1992 to February 1995, who survived the initial hospitalization for tuberculosis, were matched on gender, age, CD4+ percentage, and calendar time with HIV-seropositive patients without tuberculosis participating in a study of the natural history of HIV infection. Patients received follow-up observation prospectively until May 23, 1995 to determine survival rates and development of AIDS-defining opportunistic infections (OIs).

RESULTS

70 patients had tuberculosis; 120 did not. Mean CD4+ percentages were 12.4% and 12.5%, respectively. At study entry, 27% of those with tuberculosis had prior AIDS-defining OIs other than tuberculosis, compared with 10% of those without tuberculosis (p = .004). In multivariate survival analysis, controlling for CD4+ level, tuberculosis was not an independent predictor of increased other causes of AIDS-related mortality. However, in a logistic regression model, independent predictors of subsequent OIs included tuberculosis (hazard ratio, 4.1; 95% confidence intervals [CI], 1.9, 8.7), CD4+ count <100/mm3 (hazard ratio, 2.4; 95% CI, 1.1, 5.0) and prior OIs (hazard ration, 3.3; 95% CI, 1.3, 8.3).

CONCLUSIONS

Tuberculosis was not an independent predictor of increased non-tuberculosis-related mortality in HIV-seropositive patients but was associated with increased risk of development of OIs.

Seroepidemiology of hepatitis C virus infection among drug abusers in southern Taiwan

The purpose of this study was to determine the risk factors for hepatitis C virus (HCV) infection among drug abusers in southern Taiwan. This survey included 935 drug abusers from Kaohsiung Narcotic Abstention Institute and Kaohsiung prison. The prevalence of anti-HCV antibody was 29.1% among male drug abusers and 19.4% among female drug abusers. The seroprevalence of anti-HCV antibody was 66.4% among intravenous drug abusers and 14.4% among nonintravenous drug abusers. Intravenous drug use, a history of hepatitis, having tattoos, and age were independently related to HCV seropositivity among drug abusers. The prevalence of anti-HCV antibody concentrations significantly increased (10.8-fold) with intravenous drug abuse and with having tattoos (1.7-fold). These findings suggest that hepatitis C virus is mainly transmitted by the parenteral route among drug abusers in southern Taiwan. Due to the high rate of HCV infection among drug abusers, investigation of high-risk behavior should be routine in this group. To prevent HCV infection, emphasis on the use of sterile needles and aseptic procedures in tattooing is important in Taiwan.

The Gln-Arg 191 polymorphism of the human paraoxonase gene is not associated with the risk of coronary artery disease among Chinese in Taiwan

Paraoxonase (PON1) is a high density lipoprotein-associated enzyme capable of hydrolyzing lipid peroxides, and thus, might protect lipoproteins from oxidation. A common polymorphism due to an amino acid substitution (Gln-Arg) at codon 191 is considered to be a major determinant of variation in serum PON1 activity. Recent studies have suggested that the PON1-191 polymorphism is an independent risk factor for coronary atherosclerosis in patients with or without diabetes mellitus. The association of PON1-191 polymorphism genotypes and coronary artery disease (CAD) among Chinese subjects in Taiwan was examined. The genotype of 218 angiographically documented CAD patients and the same number of age- and sex-matched control subjects was determined. Genotypes AA, AB and BB were present in 25 (11%), 102 (47%) and 91 (42%) of control subjects, respectively, and in 30 (14%), 96 (44%) and 92 (42%) of CAD patients, respectively (chi2 = 0.57, P = 0.75 between groups). The frequency of the A allele was 0.36 for the control group and 0.35 for CAD patients (P = 0.94). No significant differences in the PON1-191 genotype frequencies could be found between groups when multivariate logistic regression analysis was performed, or different subgroups of age, sex or risk factors were analyzed. Among control subjects, there was also no significant difference between genotypes of the PON1-191 polymorphism and various clinical and lipid variables. In conclusion, our data suggest that there is no association between the Gln-Arg 191 polymorphism of the human PON1 gene and CAD among Chinese subjects in Taiwan.

Pathogenicity of Aster Yellows Phytoplasma and Spiroplasma citri on Periwinkle

ABSTRACT Using Murashige and Skoog (MS) as a basal medium, the effects of varying levels and combinations of plant growth regulators required for shoot tip and root proliferation in healthy and aster yellows phytoplasma (AYP)- and Spiroplasma citri-infected periwinkle (Catharanthus roseus) shoots were studied. Number of shoots and fresh and dry mass of healthy and AYP-infected shoots increased when benzyladenine (BA) concentrations were increased from 0.5 to 4 mg/liter. The maximum number of shoots for both healthy and AYP-infected plants was obtained when grown in MS medium supplemented with BA at 4 mg/liter and indole-3-acetic acid (IAA) at 0.5 mg/liter. S. citri-infected shoots proliferated the most when grown in MS medium containing BA at 2 mg/liter and IAA at 0.5 mg/liter. The best medium for root production in healthy periwinkle shoots contained alpha-naphthaleneacetic acid (NAA) at 0.5 mg/liter, whereas the best medium for AYP-infected shoots contained indole-3-butyric acid (IBA) at 2.5 mg/liter, both in combination with kinetin at 0.1 mg/liter. S. citri-infected shoots had the best root growth when grown in medium supplemented with IBA at 5.0 mg/liter and kinetin at 0.1 mg/liter. The concentration of cytokinin and auxin needed for maximum shoot proliferation differed between AYP- and S. citri-infected shoot tips, strongly indicating that the two mollicutes may cause different changes in endogenous cytokinin and auxin levels. The concentrations of NAA and IBA needed for root growth of S. citri-infected shoots were two- to fivefold higher than the concentrations needed for healthy and AYP-infected shoots, clearly demonstrating that S. citri infection caused a shortage of auxins that resulted in retardation of secondary root growth. Chlorophyll content was markedly reduced in periwinkles infected with AYP or S. citri compared with chlorophyll in healthy periwinkles. AYP caused a decrease in carotenoid in leaves 6 weeks after graft-inoculation, but carotenoid content was unchanged in S. citri-infected leaves throughout the test period. Anthocyanin content in periwinkles infected with AYP decreased significantly by 4 weeks postinoculation, whereas anthocyanin content in periwinkles infected with S. citri increased. Anthocyanin content in leaf tissues, however, was reduced as a result of AYP and S. citri infection. Pigment changes induced by AYP and S. citri, whether similar or different compared with those of healthy periwinkle shoots, provide important information for interpreting pathogenesis when linked with plant growth regulators.

Evaluation in a mouse model of a thyroid-blocking protocol for 131I antibody therapy (short communication)

PURPOSE

We describe a murine model to evaluate variations of a published multicenter thyroid blocking protocol described for 131I antibody therapy, using doses of blocking agents proportional to those used in man. Variables include duration of super-saturated potassium iodide (SSKI) pretreatment and use of supplemental KClO4.

MATERIALS AND METHODS

Whole-body activity measurements were performed 0, 24, 48 and 72 hours following 131I-NaI administration in control and thyroid-blocked mice. Retained whole-body activity was calculated as a percentage of the injected dose (%ID), primarily reflecting radioiodine sequestered in the thyroid gland. In blocked groups, SSKI was begun one or 7 days preceding 131I-NaI therapy, and was supplemented in one half of the cases with KClO4 from time of therapy.

RESULTS

In control mice, %ID was 11.23 +/- 1.47%, 10.15 +/- 1.11% and 9.29 +/- 1.50% at 24, 48 and 72 hrs respectively. %IDs of blocked groups were markedly lower than controls (p = .0001). In the one day SSKI pretreatment group, %ID was reduced from 1.73 +/- 0.58, 1.42 +/- 0.45 and 1.20 +/- 0.38 at 24, 48 and 72 hours to 0.49 +/- 0.08, 0.50 +/- 0.07 and 0.44 +/- 0.06 with addition of supplemental KClO4. In the 7 day SSKI pretreatment group, %ID was reduced from 1.87 +/- 0.73, 1.48 +/- 0.49 and 1.36 +/- 0.57 at 24, 48 and 72 hours to 0.60 +/- 0.36, 0.45 +/- 0.13 and 0.41 +/- 0.14 with addition of supplemental KClO4. %IDs in the 7 day pretreatment animals were not statistically different from those in the one day pretreatment groups (all p >> 0.05).

CONCLUSION

SSKI reduces retention of radioiodide approximately six-fold whereas supplemental KClO4 enhances thyroid blocking an additional three-fold. Seven day SSKI pretreatment appears no more effective than one day pretreatment.

Electroacupuncture decreases c-fos expression in the spinal cord induced by noxious stimulation of the rat bladder

PURPOSE

The present study investigated the effects of noxious stimulation of the lower urinary tract on neuronal fos protein expression in the spinal micturition center of rats and also examined the effects of electroacupuncture (EA) on fos expression induced by noxious stimulation of the lower urinary tract.

MATERIALS AND METHODS

Experiments were conducted on 21 female Sprague-Dawley rats divided into four groups. Group 1 rats (n = 5) served as normal controls. Group 2 rats (n = 5) received EA at the Sanyinjiao acupoint. Group 3 animals (n = 6) were catheterized through the urethra and instilled with 1% acetic acid, and group 4 (n = 5) animals received EA 1 hour before 1% acetic acid instillation. All animals underwent arterial perfusion, laminectomy, and spinal cord removal. Spinal cords were sectioned and processed for immunohistochemical staining for fos protein.

RESULTS

No fos protein was detected in any spinal neurons in normal control animals, and either none or few (0 to 4 cells/section) fos-immunoreactive (fos-IR) cells were seen in animals treated with EA. Noxious stimulation of the lower urinary tract with 1% acetic acid drastically increased the number of fos-IR neurons (30 to 127 cells/L6 section, mean 76.17+/-13.98; 28 to 77, cells/S1 section, mean 59+/-8.30; 7 to 35 cells/S2 section, mean 19.83+/-4.10). However, EA administered 1 hour before 1% acetic acid instillation significantly decreased the number of fos-IR neurons resulting from chemical irritation (0 to 50 cells/L6 section, mean 19.8+/-9.33; 0 to 47 cells/S1 section, mean 13.2+/-9.12; 0 to 37 cells/S2 section, mean 13.6+/-7.31).

CONCLUSIONS

Our study demonstrates that bladder instillation with 1% acetic acid induces fos protein expression in the spinal micturition center of the rat and that electroacupuncture can reduce this expression. These results suggest a link between electroacupuncture and reduction in spinal neuronal cell activity.

Flow-cytometric DNA content analysis of oesophageal carcinoma. Comparison between tumour and sequential non-tumour mucosae

The DNA content in oesophageal carcinoma and in sequential non-tumour mucosa was evaluated in 35 patients with oesophageal carcinoma, to explore the hypotheses that DNA distribution pattern and S-phase fraction can reflect malignant potential and that DNA aneuploidy can provide an early-warning signal of developing cancer. DNA flow cytometry was performed on 129 specimens from the tumours and on 119 specimens from non-tumour mucosa. Control specimens from gastric fundus had normal diploid DNA content and low S-phase fraction. Aneuploidy was found in 94.3% of the carcinoma specimens and intratumoral heterogeneity in 54.3%. Of the non-tumour specimens, 43.7% showed aneuploidy and none multiple aneuploidy. Pattern III distribution was present in 8.6% of the tumour specimens but not in non-tumour mucosa, where the incidence of aneuploidy rose with closeness to the tumour (p < 0.001). S-phase fraction was smaller in non-tumour than in tumour specimens (p < 0.0001). The study indicated that histologically tumour-free oesophageal mucosa may have a high malignant potential in patients with oesophageal carcinoma. The relative instability of such mucosa, with aneuploid cells and low S-phase fraction, may facilitate transition to abnormally proliferating cells in response to environmental signals. Cigarette smoking and alcohol may increase the risk of multicentric cancer development.

Intraosseous schwannoma of the fourth lumbar vertebra: case report

OBJECTIVE AND IMPORTANCE

Intraosseous schwannomas (neurilemomas) are rare neoplasms. In one large series, schwannomas accounted for less than 0.2% of all primary bone tumors. These schwannomas most commonly arise in the mandible and have also been observed, very rarely, in the vertebra. We present a patient with an unusual intraosseous schwannoma in the lumbar vertebra.

CLINICAL PRESENTATION

A 58-year-old man who was admitted to Cathay General Hospital had complained of numbness and pain in his lower extremities for approximately 1 year. At the time of admission, a neurological examination revealed mild motor weakness and sensory numbness bilaterally in his lower legs. Magnetic resonance images showed a neoplastic lesion occupying the entire L4 body and the superior part of the L5 body, with marked perivertebral protrusion and compression of the thecal sac and bilateral neuroforamina.

INTERVENTION

The patient underwent a computed tomography-guided needle biopsy and a two-stage operation. During the initial surgical procedure, the tumor mass was totally removed via an anterolateral approach. Fixation and fusion of the third to fifth lumbar vertebral bodies was accomplished using a full-thickness iliac bone graft with an anterior locking plate and screws. During the second operation, posterior fusion of L2, L3, L4, L5, and S1 with Luque wires and a Hartshill rectangle rod was performed to increase the spinal stability.

CONCLUSION

Intraosseous schwannomas are rare neoplasms that are not commonly observed in the lumbar vertebral bodies. Schwannomas in the lumbar spine commonly originate from the nerve passing through the neural foramina. We report a rare case of L4 intraosseous schwannoma, the magnetic resonance imaging, computed tomographic, and histological findings, and the surgical procedures.

Temporal trends in the progression of human immunodeficiency virus disease in a cohort of drug users

We evaluated changes over time in rates of progression to AIDS, mortality, and distribution of AIDS-defining illnesses in 524 human immunodeficiency virus (HIV)-seropositive injection drug users enrolled between 1986 and 1995 in a prospective study of HIV infection in the Bronx, NY. At enrollment, participants attended a hospital-affiliated methadone maintenance program with on-site primary care. Using the 1993 clinical definition of AIDS, we found that the hazard ratio (HR) of progression to AIDS declined for enrollees over time in comparison with the referent group of persons enrolled in 1986-1987. For program enrollees in 1988-1989, the HR was 1.0 [95% confidence interval (CI) = 0.6-1.6]; for enrollees in 1990-1991, the HR was 0.3 (95% CI = 0.1-0.9); for enrollees in 1992-1993, the HR was 0.5 (95% CI = 0.3-0.9); and for enrollees in 1994-1995, the HR was 0.2 (95% CI = 0.1-0.7), after controlling on initial CD4+ cell counts and age. Nevertheless, the greater AIDS-free time of later study entrants was not associated with reduced mortality. The study provides evidence that drug users with access to primary care likely benefited from improved management of HIV disease in prolonging AIDS-free time but, through 1996, did not experience greater survival.

Fasting plasma glucose in screening for diabetes in the Taiwanese population

OBJECTIVE

To reveal the relationship between fasting and 2-h postload plasma glucose and to examine the appropriate fasting glucose cutoff as the primary screening test for diabetes.

RESEARCH DESIGN AND METHODS

We recruited 5,303 subjects from preventive services of the National Cheng Kung University Hospital. Exclusion criteria were age <20 years, pregnancy, known diabetes, and a history of recent surgery, trauma, or illness. All subjects received the 75-g oral glucose tolerance test. The relationship between fasting and 2-h glucose was examined. Sensitivities, specificities, efficiency, and predictive values were assessed at different cutoffs of fasting glucose for prediction of diabetes.

RESULTS

The best fit model for the relationship between fasting and 2-h glucose was fasting glucose = 4.914-0.060 x (2-h glucose) + 0.0144 x (2-h glucose)2. From this model, the fasting glucose was 6.0 mmol/l when 2-h glucose was 11.1 mmol/l. A fasting glucose with 6.25 mmol/l gave the same diabetes prevalence as the World Health Organization 2-h glucose criterion. When 7.8 mmol/l was the fasting glucose cutoff, the sensitivity was 28.5%. Lowering the cutoff from 7.8 to 7.0 mmol/l increased the sensitivity by 11.2% and slightly reduced the specificity and positive predictive value. If the cutoffs were 6.25 and 6.0 mmol/l, the sensitivity increased and the specificity and the positive predictive value decreased accordingly.

CONCLUSIONS

Our results suggest that fasting glucose as a screening criterion for diabetes could be revised downward to 7.0 mmol/l, because the slight reduction of positive predictive value was more than balanced by an apparent increase of sensitivity and insignificant change of specificity.

Novel protein kinase C inhibitors: alpha-terthiophene derivatives

A series of alpha-terthiophene derivatives were prepared and their protein kinase C inhibitory activity were evaluated. The aldehyde derivatives were most potent inhibitors (IC50 < 1 microM). alpha-Terthiophene monoaldehyde was inactive in the inhibitions of protein kinase A, mitogen activated protein kinase and protein tyrosine kinase.

Osteochondritis dissecans of the talar dome in a collegiate swimmer: a case report

OBJECTIVE

To present the case of an intercollegiate swimmer with a stage IV lateral talar dome injury and associated bony fragments.

BACKGROUND

Lack of distinct diagnostic symptoms, low index of clinical suspicion, and the difficulty of visualizing the early stages of this injury on standard x-rays cause frequent misdiagnosis of talar dome lesions.

DIFFERENTIAL DIAGNOSIS

Ganglion cyst, with inflammatory synovitis secondary to rupture of cyst; loose bodies from previous occult fracture; osteochondral fracture.

TREATMENT

Initial treatment with nonsteroidal antiinflammatory drugs and a posterior splint for comfort, followed by arthroscopic excision of loose bodies with abrasion and drilling arthroplasty.

UNIQUENESS

Patient presented to the team physician for care of acute left medial ankle pain after the athletic trainer had attempted to rupture a ganglion cyst on the anterolateral aspect of the patient's ankle.

CONCLUSIONS

Increased clinical suspicion is necessary to correctly diagnose osteochondral lesions, particularly in the early stages. Aggressive treatment of talar dome lesions has a good success rate and may be an attractive option for competitive athletes.

Coactivator TIF1beta interacts with transcription factor C/EBPbeta and glucocorticoid receptor to induce alpha1-acid glycoprotein gene expression

The transcription of the alpha1-acid glycoprotein gene is induced by inflammatory cytokines and glucocorticoids. C/EBPbeta is a major transcription factor involved in the induction of the agp gene by some cytokines. In this report, we have identified a novel transcriptional intermediary factor, TIF1beta, which could enhance the transcription of the agp gene by the glucocorticoid receptor (GR) and C/EBPbeta. TIF1beta belongs to a subgroup of RING (really interesting new gene) finger proteins that contain a RING finger preceding two B box-type fingers and a putative coiled-coil domain (RBCC domain). Immunoprecipitation experiments showed that the interaction between GR and TIF1beta is ligand independent. The overexpression of the TIF1beta gene enhances GR-regulated expression in a ligand- and glucocorticoid-responsive element (GRE)-dependent manner. TIF1beta can also augment C/EBPbeta-mediated activity on wild-type and GRE-mutated agp genes, but this augmentation is diminished when all three C/EBPbeta-binding elements are mutated. Functional and biochemical characterizations indicated that the bZIP domain of C/EBPbeta and the RBCC domain, plant homeodomain finger, and bromodomain of TIF1beta are crucial for the interactions of these proteins. Taken together, these results suggest that TIF1beta serves as a converging mediator of signal transduction pathways of glucocorticoids and some inflammatory cytokines.

Electron microscopic studies of microvasculature and sympathetic nerve fibers in dilated cardiomyopathy

OBJECTIVE

To investigate the ultrastructural pathological alterations of the microvasculature and nerve fibers in the endomyocardial biopsied specimens of the left ventricular myocardium obtained from patients with idiopathic dilated cardiomyopathy and chronic heart failure.

METHODS

Transmission electron microscopic observations of endomyocardial biopsied specimens of the left ventricular myocardium were carried out in 10 patients with idiopathic dilated cardiomyopathy and chronic heart failure.

RESULTS

Various degrees of ultrastructural pathological alterations in the microvessels and sympathetic nerves in the diseased myocardium were consistently demonstrated in idiopathic dilated cardiomyopathy. In addition, abnormal accumulation of collagen tissue and edematous fluid were often seen in the interspace between myocardial cells and nerve endings and capillaries.

CONCLUSIONS

Based on the ultrastructural pathological findings in this study, we consider that all the structures forming the muscle cells and the tissues around them, namely the microvessels and nerves may participate in the pathological process in the course of dilated cardiomyopathy. The damage of microvasculature and sympathetic nerves resulting from the underlying disease processes are considered to be an important pathogenetic mechanism responsible for progressive development of myocardial degeneration and dysfunction throughout the course of the disease. It is hoped that our data may provide some insights into the understanding of the role of microcirculation and sympathetic nerves in the etiopathogenesis of dilated cardiomyopathy.

Characterization of the hrpC and hrpRS operons of Pseudomonas syringae pathovars syringae, tomato, and glycinea and analysis of the ability of hrpF, hrpG, hrcC, hrpT, and hrpV mutants to elicit the hypersensitive response and disease in plants

The species Pseudomonas syringae encompasses plant pathogens with differing host specificities and corresponding pathovar designations. P. syringae requires the Hrp (type III protein secretion) system, encoded by a 25-kb cluster of hrp and hrc genes, in order to elicit the hypersensitive response (HR) in nonhosts or to be pathogenic in hosts. DNA sequence analysis of the hrpC and hrpRS operons of P. syringae pv. syringae 61 (brown spot of beans), P. syringae pv. glycinea U1 (bacterial blight of soybeans), and P. syringae pv. tomato DC3000 (bacterial speck of tomatos) revealed that the 13 genes comprising the right half of the hrp cluster (including those in the previously sequenced hrpZ operon) are conserved and identically arranged. The hrpC operon is comprised of hrpF, hrpG, hrcC, hrpT, and hrpV. hrcC encodes a putative outer membrane protein that is conserved in all type III secretion systems. The other four genes appear to be characteristic of group I Hrp systems, such as those possessed by P. syringae and Erwinia amylovora. The predicted products of these four genes in P. syringae pv. syringae 61 are HrpF (8 kDa), HrpG (15.4 kDa), HrpT (7.5 kDa), and HrpV (13.4 kDa). HrpT is a putative outer membrane lipoprotein. HrpF, HrpG, and HrpV are all hydrophilic proteins lacking N-terminal signal peptides. The HrpG, HrcC, HrpT, and HrpV proteins of P. syringae pathovars syringae and tomato (the two most divergent pathovars) had at least 76% amino acid identity with each other, whereas the HrpF proteins of these two pathovars had only 36% amino acid identity. The HrpF proteins of P. syringae pathovars syringae and glycinea also showed significant similarity to the HrpA pilin protein of P. syringae pathovar tomato. Functionally nonpolar mutations were introduced into each of the genes in the hrpC operon of P. syringae pv. syringae 61 by insertion of an nptII cartridge lacking a transcription terminator. The mutants were assayed for their ability to elicit the HR in nonhost tobacco leaves or to multiply and cause disease in host bean leaves. Mutations in hrpF, hrcC, and hrpT abolished or greatly reduced the ability of P. syringae pv. syringae 61 to elicit the HR in tobacco. The hrpG mutant had only weakly reduced HR activity, and the activity of the hrpV mutant was indistinguishable from that of the wild type. Each of the mutations could be complemented, but surprisingly, the hrpV subclone caused a reduction in the HR elicitation ability of the DeltahrpV::nptII mutant. The hrpF and hrcC mutants caused no disease in beans, whereas the hrpG, hrpT, and hrpV mutants had reduced virulence. Similarly, the hrcC mutant grew little in beans, whereas the other mutants grew to intermediate levels in comparison with the wild type. These results indicate that HrpC and HrpF have essential functions in the Hrp system, that HrpG and HrpT contribute quantitatively but are not essential, and that HrpV is a candidate negative regulator of the Hrp system.

Sustained attention deficit and schizotypal personality features in nonpsychotic relatives of schizophrenic patients

OBJECTIVE

The authors investigated whether nonpsychotic relatives of schizophrenic probands have an elevated risk of deficits in sustained attention as measured by the Continuous Performance Test (CPT), whether such deficits are associated with specific factors of schizotypy, and whether poor CPT performance by probands predicts poor performance by their relatives. In addition, the heritability of CPT performance in the families of schizophrenic probands was estimated.

METHOD

The study subjects were 60 schizophrenic probands, 148 of their first-degree relatives, 20 normal comparison probands, and 42 of the comparison probands' first-degree relatives. Subjects completed undegraded and 25% degraded sessions of the CPT and were interviewed with use of the Chinese version of the Diagnostic Interview for Genetic Studies. Subjects' CPT sensitivity indexes, d', were standardized against those of a community sample of 345 subjects, with adjustment for age, sex, and level of education.

RESULTS

On average, the d' values of the relatives of schizophrenic probands were lower than those of the relatives of comparison probands but higher than those of schizophrenic probands. Lower sensitivity indexes among the relatives of schizophrenic patients were associated with the interpersonal dysfunction and disorganization factors of schizotypy but not the cognitive/perceptual factor. When schizophrenic probands were divided into two subgroups by a cutoff of -3.0 for adjusted z score on the CPT, the d' values of relatives of probands with CPT deficits were lower than those of relatives of probands without deficits. The estimated heritability of performance on the CPT ranged from 0.48 to 0.62.

CONCLUSIONS

Sustained attention deficit may be a genetic vulnerability marker for schizophrenia, and it may be more useful in linkage analysis than traditional phenotype definitions of schizophrenia.

Chimeric human-mouse IgG antibodies with shuffled constant region exons demonstrate that multiple domains contribute to in vivo half-life

Structural features that determine the differing rates of immunoglobulin catabolism are of great relevance to the engineering of immunologically active reagents. Sequences in the CH2 and CH3 region of IgG have been shown to regulate the rate of clearance through their interaction with FcRn. In an attempt to probe additional structural features that regulate antibody half-life, we have investigated two families of chimeric antibodies, composed of identical murine heavy and light antidansyl variable regions joined to human kappa light-chains and wild-type or shuffled human IgG heavy-chain constant regions. These antibodies were iodinated, and their clearance was studied in severe combined immunodeficient mice hosts by whole-body radioactivity measurements. Clearances of the wild-type and recombinant antibodies were biphasic. In a panel of immunoglobulins derived from IgG2 and IgG3, as successive domains were varied from gamma2 to gamma3, beta-phase half-life gradually decreased from 337.0 h to 70.6 h. Statistical analysis suggested that the composition of each of the three domains affected half-life, and no single region of the molecule by itself determined the rate of clearance. In the second panel of immunoglobulins derived from IgG1 and IgG4, the construct with the amino terminus portion of the molecule derived from IgG4, joined within the CH2 domain to the COOH terminus portion of IgG1, had a half-life paradoxically greater than either IgG1, or IgG4 (P < 0.012). All four IgG1/IgG4 constructs demonstrated presence of the concentration catabolism phenomenon, which is a unique hallmark of immunoglobulin catabolism. The contribution of all three constant region domains to immunoglobulin half-life may be due to distant conformational effects in addition to direct binding to protective receptors, and emphasizes the importance of distant sequences on the rate of immunoglobulin catabolism. Interesting possibilities regarding mechanisms controlling immunoglobulin metabolism are raised by the hybrid gamma4/gamma1 molecule with a half-life greater than either parental immunoglobulin. Understanding the relationships between the structure of these molecules and their clearance rate will further our ability to produce immunoglobulins with improved pharmacokinetic properties.

Cryogen spray cooling for spatially selective photocoagulation of hemangiomas: a new methodology with preliminary clinical reports

Spatially selective photocoagulation of subsurface-targeted blood vessels by repetitive application of a short cryogen spurt during continuous Nd:YAG laser irradiation has been demonstrated in two human cases. This procedure may be effective for the treatment of thick hemangiomas that require photocoagulation of subsurface blood vessels while protecting the epidermis.