[Evaluation of prosthetic valvular regurgitation by color Doppler echocardiography]

Prosthetic valvular regurgitation was evaluated by color Doppler echocardiography in 107 patients with prostheses. Regurgitant jets were detected in 37 (35%) prostheses, 76% of them were transvalvular and 24% of them were perivalvular. The ratio of bioprostheses with increased intensity and transvalvular regurgitant jets increased parallel to the duration after replacement. Of those bioprostheses replaced more than 6 years, 23% developed regurgitation with a higher degree. Transvalvular regurgitation was detected in 25% of St. Jude Medical prostheses recently replaced, but the degree was low.

Modulation of bullous pemphigoid antigens by gamma interferon in cultured human keratinocytes

We report the effects of human recombinant gamma interferon (gamma-IFN) on the expression of bullous pemphigoid (BP) antigens by human cultured keratinocytes. Secondary epidermal cell cultures were grown on 3T3 mouse fibroblasts; when confluent, some cultures were maintained in control medium while others were exposed to various concentrations of gamma-IFN (100, 200, 400 U/ml) for 14 days. The expression of BP antigens was analyzed by indirect immunofluorescence on epithelial sheets and immunoblotting of Tris, SDS, beta-mercaptoethanol culture extracts using different BP sera. Our results show that gamma-IFN alters the expression of BP antigens in a way varying according to the skin donor: we observed results ranging from complete loss and decreased expression to unchanged reactivity patterns. Thus, gamma-IFN modifies BP antigen expression; this behavior has been previously shown for other adhesion molecules such as fibronectin and thrombospondin. However, the observed variability of the expression of BP antigens according to the skin donor suggests an unexpected variability in keratinocyte sensitivity to gamma interferon, which remains to be explored both in vitro and in vivo.

Comparative expression of bullous pemphigoid antigens in normal human epidermis and cultured keratinocytes

A heterogeneity of the bullous pemphigoid (BP) antigen initially described as a 220- to 240-kDa polypeptide doublet expressed in normal human skin was recently demonstrated. The aim of our study was to compare the heterogeneity of BP antigen by the immunoblotting technique in extracts of both human epidermis and keratinocyte cultures. Extracts of epidermal tissues obtained from plastic surgery skin samples and secondary keratinocyte cultures were analyzed for their immunologic content defined by 30 BP sera. Twenty-six out of 30 tested sera showed similar binding reactivities with one or several polypeptide bands in both extracts. These sera defined seven antigens of molecular weights ranging from 240 to 97 kDa. Three groups of sera reacting with three, two, or only one antigen could be distinguished in which 180, 200, and 220 kDa polypeptides represented the major BP antigens both in vivo and in vitro. The binding reactivity of most immunofluorescent negative sera demonstrated the sensitivity of the immunoblotting technique to evidence the heterogeneity of BP antigens and antibodies. Keratinocyte cultures represent a reproducible substrate for such analysis and offer a standardization attempt in comparative investigations in BP.

Immunohistochemical study of normal skin of HIV-1-infected patients shows no evidence of infection of epidermal Langerhans cells by HIV

Langerhans cells (LC) are dendritic epidermal antigen-presenting cells expressing the surface molecule CD4, which renders them theoretical cellular targets for direct infection by the human immunodeficiency virus (HIV). To date, somewhat conflicting results have been reported concerning the in vivo infection of LC by HIV as well as the numerical alteration of these cells in the course of HIV infection. In the present work we studied clinically normal skin of a group of 44 HIV-1-seropositive patients classified according to the Centers for Disease Control (CDC) stages II (n = 14), III (n = 9), and IV (n = 21). Monoclonal antibodies (MAb) to HIV p18, p24, and gp120 and to HLA-DR and CD1a antigens (specific for LC) were applied on frozen skin sections using an amplification biotin-streptavidin-fluorescein technique. The MAb to HIV p18 cross-reacted with a cytoplasmic antigen of epidermal basal keratinocytes also present on HIV-seronegative skin specimens. No other reactivity was observed with any of the three anti-HIV MAb. The quantitative study showed that no significant correlations could be established between the number of LC (evaluated independently by HLA-DR and CD1a antigens) and the number of peripheral blood CD4+ve lymphocytes or the CDC disease stage. These results cast some doubt on the previously reported in vivo infection and numerical decrease in LC in HIV infection. The precise involvement of LC in HIV infection awaits further investigation.

Distribution of an estrogen receptor-related protein (P29) in normal skin and in cultured human keratinocytes

A monoclonal antibody, ERD5, which recognizes a 29Kd phosphoprotein associated with human estrogen receptor of myometrium was used to study the expression of this protein in normal skin and in cultured human keratinocytes. By indirect immunofluorescence, both in vivo and in vitro keratinocytes showed a variable cytoplasmic staining which increased with cell differentiation. SDS gel electrophoresis of soluble extracts of cultured keratinocytes and normal epidermis showed that P29 was a minor protein. Immunoblot analysis demonstrated that ERD5 strongly reacted only with a 29Kd polypeptide band without any cross-reactivity. These data suggest that keratinocytes might be estrogen sensitive like other cells in which P29 has already been located. The exact role of this protein in the keratinocyte differentiation process and its relationship with estrogen receptors remain to be elucidated.

Bullous pemphigoid and cicatricial pemphigoid: immunoblotting detection of involved autoantigens

Bullous pemphigoid (BP) and cicatricial pemphigoid (CP) are subepidermal bullous autoimmune diseases which have distinct clinical features but identical immunological status. In order to determine whether these diseases could be dissociated on the basis of qualitative differences in serum antibodies to basement membrane zone (BMZ) antigens, the reactivity of sera from 7 CP and 29 BP patients with proteins extracted from normal human epidermal sheets (containing most of the lamina lucida components) was analysed using immunoblotting and compared to that of 10 normal sera. 20 out of the 29 BP sera contained antibodies recognizing one or several protein(s) of 240, 200, 180 and 165 kD molecular weight (MW). Antibodies in 4 out 7 CP sera specifically reacted with one or two polypeptides of 240 and 120 kD MW. These data confirm the heterogeneity of BP antigens and show the presence in CP of a novel 120 kD MW polypeptide which is found only in CP but not in BP. Taken together these findings demonstrate that in BP and CP, autoantibodies are directed to both common and specific BMZ antigens, their physiopathological significance need to be understood.

A comparison of the distributions of eight peptides in spinal cord from normal controls and cases of motor neurone disease with special reference to Onuf's nucleus

The distributions of 8 peptides were studied in the 4 major segmental levels (cervical, thoracic, lumbar, sacral) of the spinal cord in 52 neurologically normal cases. Similar regions from 36 cases of motor neurone disease (MND) were compared using the same procedures to determine possible changes in the distribution of peptides in areas associated with sensory, motor and autonomic function. In normal spinal cords, calcitonin gene-related peptide (CGRP)-, the C-flanking peptide of neuropeptide Y (CPON)-, enkephalin-, galanin-, neurokinin-like-, somatostatin- and vasoactive intestinal polypeptide (VIP)-immunoreactive fibres were abundant in the dorsal horn. Numerous somatostatin-immunoreactive cell bodies were also present. In the ventral horn, immunoreactive fibres were less abundant. Most motoneurones were closely apposed by fibres immunoreactive for enkephalin, neurokinin, somatostatin and thyrotrophin-releasing hormone (TRH). A subpopulation of motoneurones, most notable in lumbar segments, displayed CGRP immunoreactivity. In common with autonomic nuclei, Onuf's nucleus, which is thought to innervate perineal striated muscle and external urethral and anal sphincters, was densely innervated with CPON-, enkephalin-, and in particular somatostatin-immunoreactive fibres, thus suggesting Onuf's nucleus may have an autonomic component. In the diseased cords, there was a reduction in the area of the ventral horn and numbers of motoneurones as revealed by conventional histological staining and immunostaining of neurofilament triplet proteins. No changes in the distribution of peptides was noted in the dorsal horn or autonomic nuclei. By contrast, in the ventral horn, neurokinin-, enkephalin-, somatostatin- and TRH-immunoreactive fibres, which are normally found associated with motoneurones, were absent. Therefore, not only are motoneurones lost in MND, but also the fibres which innervate them. CGRP-immunoreactive motoneurones were not observed, a finding consistent with the proposed role of this peptide as a muscle-trophic factor. In contrast to the large motoneurone groups in the ventral horn, the neuronal integrity of Onuf's nucleus and the peptides associated with it were spared. These data further imply that Onuf's nucleus is not a typical motor nucleus and it is not purely somatic. The coincident loss of peptide immunoreactivity and motoneurones from the large motor nuclei and sparing of Onuf's nucleus and its peptide-containing constituents in the diseased state suggests that peptides contribute to maintenance of neural integrity.

Differential effect of trypsin on infectivity of Chlamydia trachomatis: loss of infectivity requires cleavage of major outer membrane protein variable domains II and IV

The initial interaction of chlamydiae with host cells is not well understood. Chlamydial cell surface components that function in attachment are key virulence factors, and their identification is critical for understanding the pathogenic strategies of this very successful parasite. We used trypsin proteolysis of chlamydiae to define surface components that function in chlamydia-host cell interactions. We found that trypsin had a differential effect on the infectivity of Chlamydia trachomatis serovars B and L2 for HeLa 229 cells. Trypsin treatment resulted in a significant loss of attachment and infectivity of serovar B but had no effect on the infectivity of serovar L2. Fluorograms of chlamydiae metabolically labeled with 14C-amino acids and treated with trypsin showed that the major outer membrane protein (MOMP) of both serovars was cleaved. Evidence for two trypsin cleavage sites was found for the serovar B MOMP. One cleavage site was located between lysine 145 and valine 146 in variable domain (VD) II of the protein. The second site was located between lysine 309 and threonine 310 in VD IV. In contrast, the serovar L2 MOMP was cleaved only at lysine 309 in VD IV. These results suggest a functional role for MOMP in chlamydial attachment and implicate VDs II and IV of MOMP in this interaction.

Mapping antigenic domains expressed by Chlamydia trachomatis major outer membrane protein genes

Chlamydia trachomatis is an obligate prokaryotic intracellular pathogen of humans that infects mucosal epithelial cells. Exposed domains of its major outer membrane protein (MOMP) are both serotyping and protective antigenic determinants. To identify these domains, we have cloned and epitope-mapped the genes of serovars A, C (C serogroup) and L2, B (B serogroup) with a panel of monoclonal antibodies (mAbs). Predominantly conserved regions of the genes of both serogroups are interspersed with four short variable domains (I-IV). Recombinant phage clones expressing specific MOMP antigenic determinants revealed that protective serotype-specific recognized epitopes in variable domains I and II. Protective subspecies and serogroup-specific mAbs recognized overlapping determinants in variable domain IV near the C terminus. A nonprotective species-specific mAb mapped to an invariant peptide of nine residues contained within variable domain IV. In the intact chlamydial organism of serovar B, variable domains II and IV were susceptible to proteolytic digestion, whereas both N and C termini were protected. These results suggest an arrangement of MOMP in the outer membrane in which three of the four variable domains are exposed to the outside and in which both N and C termini are presumably oriented toward the periplasmic space. This molecular analysis of MOMP antigenic determinants and their surface topology on intact chlamydiae will be useful toward the development of a recombinant subunit or synthetic chlamydial vaccine.

Retrograde tracing shows that CGRP-immunoreactive nerves of rat trachea and lung originate from vagal and dorsal root ganglia

The origins of sensory innervation of the lower respiratory tract are thought to be principally the nodose and jugular ganglia of the vagus nerve. It has been suggested and partially demonstrated that there is also a component arising from dorsal root ganglia, but the segmental levels involved are not known precisely. We have therefore investigated the origins of sensory nerves within the rat respiratory tract, particularly those containing calcitonin gene-related peptide (CGRP), using the technique of retrograde axonal tracing combined with immunohistochemistry. Injections of True blue were made into extra-thoracic trachea (n = 4 rats) and percutaneously into the right and left lung (n = 4 each). Retrogradely labelled neuronal perikarya were detected in vagal and dorsal root ganglia, and sympathetic chain ganglia. CGRP-immunoreactive cells were seen only in vagal and dorsal root ganglia. Tracheal innervation arose bilaterally in the vagal sensory ganglia but those on the right side represented the principal source; the majority of CGRP-containing neurons occurred in the jugular ganglion. A very small component of labelling occurred in spinal ganglia at levels C2-C6. The sensory innervation of the lungs was seen to arise predominantly from the ipsilateral dorsal root ganglia (45% of cells CGRP-immunoreactive) at levels T1-T6. In contrast to the trachea, the contribution of vagal sensory neurones to the lungs appeared to be less than that of the spinal ganglia. These results show that the sensory innervation of the rat lungs has a major origin in the dorsal root ganglia, in which almost half of the involved neurons contain CGRP, and confirm that most CGRP-immunoreactive nerves in the trachea arise in the right jugular ganglion.

Transplantation of anastomosed vascular allomentum and split thickness autogenous skin grafting for repair of deep electrical burns of the wrist

The use of allomentum to replace automentum or skin flaps in treating 3 patients with severe electrical burns of the wrist is discussed, as are the specific advantages and disadvantages, and the prospects for clinical use of the technique.

High tension electrical burns of upper arms treated by segmental excision of necrosed humerus. An introduction of a new surgical method

This paper describes treating high-tension electrical burns of the upper arms by segmental excision of the necrosed humerus. This is a new surgical method of treating local electrical burns. The authors use modification of traditional surgical method, shorten the course of treatment, and preserve the injured limb. However, this surgical method should not be used to treat all high-tension electrical burns of the upper arm, and should be used only under certain conditions. Therefore, it is important to grasp the operative indications.

Studies on the ultrastructure of envelope of elementary bodies of Chlamydia trachomatis

Electron microscopy of purified Chlamydia trachomatis treated by various physical and chemical means shows that the envelope of the elementary bodies (EB) consists of the outer cell wall layer, the inner cell wall layer, and the inner membrane. The outer cell wall layer is mainly made up of granular subunits arranged in a hexagonal pattern and may be called the "mural structural protein layer". It forms together with the inner cell wall layer the rigid cell wall. The inner or protoplasmic membrane is not easily shown in the young EB. In the negatively stained specimen, a frail and easily removable superficial layer is seen adhering to the "mural structural protein layer". But in ultra-thin sections this superficial layer is not shown separately. There are fold-like grooves which are special structures probably related to reproduction. There are seen some EB's in binary fission, and a number of bodies very big in size yet having morphological characteristics of the EB's, which are in various processes of multiplication, such as binary fission, budding, and "multicentered germination". These observations give a challenge to the current opinion that only the initial bodies have the power of reproduction.