Hyperfractionated Cyclophosphamide and Dexamethasone Alone or in Combination with Daratumumab and/or Carfilzomib for the Treatment of Relapsed or Refractory Multiple Myeloma: A Single-Center Retrospective Analysis

BACKGROUND

Hyperfractionated cyclophosphamide and dexamethasone (HyperCd) alone, or with carfilzomib(K) and/or daratumumab(D), represents a potential treatment option when rapid disease control is needed for patients with aggressive presentations of relapsed/refractory multiple myeloma (RRMM).

PATIENTS AND METHODS

This is a single-center, retrospective analysis of adult patients with RRMM who received HyperCd with or without K and/or D between May 1, 2016 and August 1, 2019 at the University of Texas MD Anderson Cancer Center. We here report treatment response and safety outcomes.

RESULTS

Data from 97 patients, 12 with plasma cell leukemia (PCL), were reviewed in this analysis. Patients had had a median of 5 prior lines of therapy and received a median of 1 consecutive cycle of hyperCd-based therapy. The overall response rate (ORR) of all patients was 71.8% (HyperCd 75%, HyperCdK 64.3%, D-HyperCd 73.3%, and D-HyperCdK 76.9%). Median progression-free survival and overall survival among all patients was 4.3 months (HyperCd 3.1 months, HyperCdK 4.5 months, D-HyperCd 3.3 months, and D-HyperCdK 6 months) and 9.0 months (HyperCd 7.4 months, HyperCdK 9.0 months, D-HyperCd 7.5 months, and D-HyperCdK 15.2 months), respectively. Grade 3/4 hematologic toxicities were common, thrombocytopenia being the most frequent at 76%. Notably, 29-41% of patients per treatment group had existing grade 3/4 cytopenias at initiation of hyperCd-based therapy.

CONCLUSION

HyperCd-based regimens provided rapid disease control among MM patients, even when heavily pre-treated and with few remaining treatment options. Grade 3/4 hematologic toxicities were frequent, but manageable with aggressive supportive care.

Establishing the Maximum Collectivity in Highly Deformed N=Z Nuclei

The lifetimes of the first excited 2^{+} states in the N=Z nuclei ^{80}Zr, ^{78}Y, and ^{76}Sr have been measured using the γ-ray line shape method following population via nucleon-knockout reactions from intermediate-energy rare-isotope beams. The extracted reduced electromagnetic transition strengths yield new information on where the collectivity is maximized and provide evidence for a significant, and as yet unexplained, odd-odd vs even-even staggering in the observed values. The experimental results are analyzed in the context of state-of-the-art nuclear density-functional model calculations.

Evolution of collectivity in 72Kr: evidence for rapid shape transition

The transition rates from the yrast 2+ and 4+ states in the self-conjugate 72Kr nucleus were studied via lifetime measurements employing the GRETINA array with a novel application of the recoil-distance method. The large collectivity observed for the 4+→2+ transition suggests a prolate character of the excited states. The reduced collectivity previously reported for the 2+→0+ transition was confirmed. The irregular behavior of collectivity points to the occurrence of a rapid oblate-prolate shape transition in 72Kr, providing stringent tests for advanced theories to describe the shape coexistence and its evolution.

Nuclear structure towards N = 40 60Ca: in-beam γ-ray spectroscopy of 58,60Ti

Excited states in the neutron-rich N = 38, 36 nuclei (60)Ti and (58)Ti were populated in nucleon-removal reactions from (61)V projectiles at 90 MeV/nucleon. The γ-ray transitions from such states in these Ti isotopes were detected with the advanced γ-ray tracking array GRETINA and were corrected event by event for large Doppler shifts (v/c ∼ 0.4) using the γ-ray interaction points deduced from online signal decomposition. The new data indicate that a steep decrease in quadrupole collectivity occurs when moving from neutron-rich N = 36, 38 Fe and Cr toward the Ti and Ca isotones. In fact, (58,60)Ti provide some of the most neutron-rich benchmarks accessible today for calculations attempting to determine the structure of the potentially doubly magic nucleus (60)Ca.

Quadrupole collectivity in neutron-rich Fe and Cr isotopes

Intermediate-energy Coulomb excitation measurements are performed on the N ≥ 40 neutron-rich nuclei (66,68)Fe and (64)Cr. The reduced transition matrix elements providing a direct measure of the quadrupole collectivity B(E2;2(1)(+) → 0(1)(+)) are determined for the first time in (68)Fe(42) and (64)Cr(40) and confirm a previous recoil distance method lifetime measurement in (66)Fe(40). The results are compared to state-of-the-art large-scale shell-model calculations within the full fpgd neutron orbital model space using the Lenzi-Nowacki-Poves-Sieja effective interaction and confirm the results of the calculations that show these nuclei are well deformed.

Lifetime measurement of the 2(1)+ state in 20C

Establishing how and when large N/Z values require modified or new theoretical tools is a major quest in nuclear physics. Here we report the first measurement of the lifetime of the 2(1)+ state in the near-dripline nucleus 20C. The deduced value of τ(2(1)+)=9.8±2.8(stat)(-1.1)(+0.5)(syst)  ps gives a reduced transition probability of B(E2; 2(1)+→0(g.s.)+)=7.5(-1.7)(+3.0)(stat)(-0.4)(+1.0)(syst)  e2  fm4 in good agreement with a shell model calculation using isospin-dependent effective charges.

New superheavy element isotopes: ²⁴²Pu(⁴⁸Ca,5n) ²⁸⁵114

The new, neutron-deficient, superheavy element isotope ²⁸⁵114 was produced in ⁴⁸Ca irradiations of ²⁴²Pu targets at a center-of-target beam energy of 256 MeV (E*=50  MeV). The α decay of ²⁸⁵114was followed by the sequential α decay of four daughter nuclides, 281Cn, 277Ds, 273Hs, and 269Sg. 265Rf was observed to decay by spontaneous fission. The measured α-decay Q values were compared with those from a macroscopic-microscopic nuclear mass model to give insight into superheavy element shell effects. The²⁴²Pu (⁴⁸Ca,5n²)²⁸⁵114 cross section was 0.6(-0.5)+0.9  pb.

Molecular evidence for tick-borne encephalitis virus in ticks in South Korea

To investigate whether tick-borne encephalitis viruses (TBEVs) are present in South Korea, Korean ixodid ticks were tested for TBEV RNA. Ticks (n = 2460) were collected from wild and domestic animals or by flagging at forest and grassland in 12 regions of five provinces in 2005-06. Four species in two genera were identified, yielding 197 sample pools (1-20 ticks per pool); from these, 12 envelope protein gene fragments of TBEV were amplified by reverse transcriptase-nested polymerase chain reaction (RT-nested PCR). Ten of the 2104 adult ticks (0.4%) and two of the 356 nymph ticks (0.2%) were positive for the envelope (E) gene of TBEV. Twelve TBEV RNA-positive samples were detected in Gyeonggi and Gangwon provinces. Phylogenetic analysis showed that the E genes of the TBEV isolates were clustered with the Western European subtype (98% identity). This study suggests that TBEVs may exist in Korea.

Return of collective rotation in 157Er and 158Er at ultrahigh spin

A new frontier of discrete-line gamma-ray spectroscopy at ultrahigh spin has been opened in the rare-earth nuclei (157,158) Er. Four rotational structures, displaying high moments of inertia, have been identified, which extend up to spin approximately 65 variant Planck's over 2pi and bypass the band-terminating states in these nuclei which occur at approximately 45 variant Planck's over 2pi. Cranked Nilsson-Strutinsky calculations suggest that these structures arise from well-deformed triaxial configurations that lie in a valley of favored shell energy which also includes the triaxial strongly deformed bands in (161-167) Lu.

SHENG MAI SAN, A CHINESE HERBAL MEDICINE, PROTECTS AGAINST RENAL ISCHAEMIC INJURY DURING HEAT STROKE IN THE RAT

1. There is evidence that the induction of inducible nitric oxide synthase (iNOS) and peroxynitrite by ischaemia/reperfusion may lead to renal cell injury. Herein, we investigated whether Sheng mai san (SMS), a Chinese herbal medicine, protects against renal ischaemic injury during heat stroke by reducing iNOS-dependent nitric oxide (NO) and peroxynitrite formation. 2. Urethane-anaesthetized rats were exposed to heat stress (ambient temperature 43 degrees C) to induce heat stroke. Control rats were exposed to 24 degrees C. Mean arterial pressure and renal blood flow after the onset of heat stroke were significantly lower in heat stroke rats than in control rats. However, both colonic temperature and renal damage score were greater in heat stroke rats compared with control rats. Similarly, plasma NO, creatinine and blood urea nitrogen (BUN), as well as the renal immunoreactivity of iNOS and peroxynitrite, were significantly higher in heat stroke rats compared with their normothermic controls. 3. Pretreatment with SMS (1.2 g/day per rat for 7 consecutive days before the initiation of heat stress) significantly attenuated the heat stroke-induced arterial hypotension, hyperthermia, renal ischaemia and damage, the increased renal immunoreactivity of iNOS and peroxynitrite and the increased plasma levels of NO, creatinine and BUN. Pretreatment with SMS resulted in a prolongation of survival time in heat stroke. 4. The results of the present study suggest that SMS protects against renal ischaemic damage by reducing iNOS-dependent NO and peroxynitrite production during heat stroke.

Order-to-chaos transition in rotational nuclei

We have developed a new method to study the order-to-chaos transition in rotational nuclei. Correlations between successive gamma rays are used to determine the average complexity of the intermediate levels and thereby the ratio of the interaction potential between levels to the level spacing. The measured ratios, 0.15 to 1.5, span the range from nearly fully ordered to nearly fully chaotic.

High-spin structure beyond band termination in 157Er

The angular-momentum induced transition from a deformed state of collective rotation to a noncollective configuration has been studied. In 157Er this transition manifests itself as favored band termination near I=45 Planck's. The feeding of these band terminating states has been investigated for the first time using the Gammasphere spectrometer. Many weakly populated states lying at high excitation energy that decay into these special states have been discovered. Cranked Nilsson-Strutinsky calculations suggest that these states arise from weakly collective "core-breaking" configurations.

Quality of marital life in Korean patients with spondyloarthropathy

The objectives of this study were to assess the quality of marital life (QML) in patients with spondyloarthropathy (SpA) in Korea and to identify possible gender differences in QML in patients with SpA. This was a case-control study at the outpatient unit of a tertiary care medical centre. Subjects were the patient group, composed of 47 married patients with SpA, and a comparison group composed of 47 healthy married adults with similar demographic characteristics. QML was measured using the Marital Satisfaction Inventory, Revised. As a result, QML was similar for both the male patients and the healthy men. However, the female patients had higher scores on the global distress scale (59.8 +/- 6.3 vs. 53.8 +/- 5.6, P=0.021) and the aggression scale (50.5 +/- 7.9 vs. 44.3 +/- 5.4, P=0.016) than the female comparison group. At the same time, the female patients demonstrated higher scores on the global distress scale (59.8 +/- 6.3 vs. 54.7 +/- 7.2, P=0.035) than the male patients. In conclusion, QML in Korean males with SpA was not greatly different from that of the male comparison group. However, QML in the female patients was characterised by higher global distress and a higher probability of aggression from their partner, but no significant sexual dissatisfaction.

Chiral degeneracy in triaxial 104Rh

Chiral doublet bands based on the pi g(9/2) multiply sign in circle nu h(11/2) configuration that achieve degeneracy at spin I=17 in the odd-odd triaxial 104Rh nucleus have been observed. Experimental verification of the interpretation has been tested against specific fingerprints of chirality in the intrinsic system.

Evidence for a new type of shears mechanism in 106Cd

Lifetimes of states in the lowest lying positive parity band in 106Cd have been measured using the Doppler shift attenuation method. The deduced B(E2) transition rates show a marked decrease with increasing spin. Cranking and semiclassical model calculations suggest that the structure has the character of a shears-type band resulting from the coupling of g(9/2) proton holes to aligned pairs of h(11/2) and g(7/2) neutron particles. This is the first clear evidence for the phenomenon of "antimagnetic" rotation in nuclei.

Competitive adsorption for binary mixture of 4-nitrophenol and phenol on RSTA using GAC

Adsorption characteristics of a reverse stratified tapered adsorber (RSTA) system and competitive adsorption for phenol and 4-nitrophenol were investigated. In this study, a novel technology, RSTA, was introduced and compared with a conventional cylindrical adsorber (CA). The optimum study of RSTA in a single-solute system with phenol for size distribution, mean velocity and optimum angle was conducted to satisfy environmental criteria and reduce granular activated carbon (GAC) treatment costs. The competitive adsorption efficiency of RSTA and CA was also compared in a binary solute system with phenol and 4-nitrophenol. In the results of single-solute experiment, breakthrough time of RSTA was increased by 30-50% over conventional CA. The mean bed velocity was 19.10 cm/min and the optimum angle of RSTA was decided to 3 degrees. Adsorption efficiency was increased with increasing GAC dose and the number of GAC layers. The affinity of competitive adsorption was significantly increased with decreasing GAC dose and increasing adsorbate concentration. The RSTA can be considered to provide an increase in breakthrough time with decreasing flow rate and increasing the number of layers. Water and wastewater plants processing large volumes of water can realize significant savings in capital and operation costs by utilizing this type of operation.

Significance of low compliance bladder in cauda equina injury

STUDY DESIGN

Prospective investigation using serial urodynamic studies.

OBJECTIVE

To evaluate type of neurogenic bladder and to observe changes of autonomous detrusor contraction (ADC) after the normalization of the compliance and capacity of the bladder in cauda equina injury.

SETTING

Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea.

METHODS

Urodynamic studies were performed in 50 patients with complete cauda equina injury from trauma with an infusion ratio of 30 ml/min. Findings of urodynamic studies and clinical features of patients with low compliance were compared with those of the normal compliant patients. Fourteen patients with low compliance received oral administration of oxybutynin and propiverine and intravesical instillation of oxybutynin to increase the compliance and capacity of the bladder, and follow-up urodynamic studies to monitor the change were undertaken.

RESULTS

Bladder compliance was decreased in 14 (28%) patients and normal in 36 (72%) patients. There was a significantly long time interval between the onset of injury and the initiation of rehabilitative treatment in the neurogenic bladder group with low compliance when compared to those of the normal compliance group (P < 0.05). Clean intermittent catheterization was used as the voiding method, significantly less than the normal compliance group (P < 0.05). ADC was observed in six out of fourteen patients with low compliance neurogenic bladder, but none in the normal compliance group. Upon the completion of conservative treatment, ADC disappeared in four patients whose compliance and capacity of the bladder were normalized on follow-up urodynamic studies.

CONCLUSION

ADC was only observed in the low compliant bladder and as ADC disappeared when compliance and capacity of the bladder was normalized; low compliance appeared to be the main cause of ADC. In addition, this study supports that the maintenance of compliance of the bladder may be the most important factor in the management of neurogenic bladder.

Rotational damping in ytterbium nuclei

We have made the first clear measurements of rotational damping widths in nuclei. In a mixture of three Yb nuclei, these widths are 300 +/- 60 keV between 1.2 and 1.5 MeV gamma-ray energy [approximately (37-57)Planck's constant]. Compound damping and motional narrowing are discussed in connection with these results.

Monoclonal antibodies to recombinant Der f 2 and development of a two-site ELISA sensitive to major Der f 2 isoallergen in Korea

BACKGROUND

Der f 2 is a major sensitizing allergen in patients allergic to house dust mites worldwide. Isoforms of Der f 2 have been reported and are known to have different antigenicities. The aim of this study was to facilitate antigenic analysis and to develop an improved method for the detection of Der f 2 isoallergen, which is prevalent in Korea.

METHODS

A two-site ELISA was developed with monoclonal antibodies (mAbs) which were produced against recombinant Der f 2 (rDer f 2) and applied to assess Der f 2 in bedding samples.

RESULTS

A major isoform of Der f 2, found in Korea, was found to have amino acid variations especially at position 100 from lysine to glutamic acid, which is known to reduce significantly the binding affinity of mAbs when used to assess group 2 allergens. The detection limit of the developed two-site ELISA was determined to be about 8 ng/ml with rDer f 2 and 1 microg/ml with Derntatophagoides farinae crude extract. The average amount of Der f 2 in dust obtained from bedding samples from 89 homes in Seoul was estimated to be 25.61+/-10.70 microg/g dust.

CONCLUSIONS

Assays using mAbs for rDer f 2 could be useful for the assessment of environmental allergen exposure and mAbs could be used to further characterize the isoallergens of Der f 2.

Very extended shapes in the A--110 region

High-angular-momentum states in 108Cd were populated via the (64)Ni((48)Ca,4n) reaction at a beam energy of 207 MeV. Gamma rays were detected using the Gammasphere array. A rotational band has been observed with a dynamic moment of inertia and deduced lower limit of the quadrupole moment suggesting a major-to-minor axis ratio larger than 1.8:1, placing it among the most deformed structures identified in any nucleus, to date.

Determination and geographical distribution of Orientia tsutsugamushi serotypes in Korea by nested polymerase chain reaction

Field rodents and chigger mites were collected at 30 locations in Korea in October and November 1997-1999 to determine the serotypes of Orientia tsutsugamushi and their geographical distribution. A nested polymerase chain reaction was performed with the spleen tissues from 546 field-striped mice (Apodemus agrarius) and 104 pools of chigger mites. The positivity rate of O. tsutsugamushi was 45.6% in A. agrarius and 39.4% in the chigger mite pools. Two serotypes, Boryong and Karp, were found in these samples; the former was predominant (78.3% in the mice and 82.9% in the chigger mite pools), with wide distribution throughout the country, including Cheju-do. The latter was confined to the middle of the Korean peninsula, with positivity rates of 15.7% in the mice and 12.2% in the chigger mite pools. The double infection of Karp and Boryong serotypes was found in 15 (6.0%) A. agrarius mice. Gilliam serotype was not detected at any of the study locations. The Boryong and Kuroki serotypes were identical in amino acid sequence of the 56-kDa protein, although they differed in virulence to BALB/c mice.

Restriction fragment length dimorphism-PCR method for the detection of extended-spectrum beta-lactamases unrelated to TEM- and SHV-types

The diagnostic ability of the restriction fragment length dimorphism-polymerase chain reaction (RFLD-PCR) method was evaluated. Seven primer pairs, newly designed from 44 beta-lactamase genes encoding extended-spectrum beta-lactamases not related to TEM- and SHV-types, were used to differentiate OXA-2, FOX-3, CMY-3, IMP-1, and IMI-1 beta-lactamases. The RFLD-PCR was carried out successfully, and these genes were differentiated by the sizes of their PCR products and by the difference in restriction fragment length when each amplicon was digested with a unique restriction enzyme. This discriminatory detection of the genes was confirmed by sequencing the PCR products.

Histopathology of polytetrafluoroethylene (Gore-tex) as a scleral buckle in humans

Several materials have been used for scleral buckling implants in retinal detachment surgery. Of these, polytetrafluoroethylene (PTFE, Gore-tex) has the relative advantage of decreasing infection and extrusion when it is used as a scleral buckle material. In this report, we present the clinical and histopathologic finding of a case where Gore-tex was used as an encircling buckle material for retinal detachment operation.

Comparison of allergenic components between German cockroach whole body and fecal extracts

BACKGROUND

Cockroaches have been demonstrated to be an etiologic factor in allergic diseases. Further, sensitivity to cockroach places patients with asthma at risk for exacerbations that require emergency medical care.

OBJECTIVE

This study compared the differences in allergenic components between German cockroach whole body and German cockroach fecal extracts (GWBE and GFE).

METHODS

Patients with asthma and/or allergic rhinitis were skin prick tested with German cockroach extract (Bayer Corporation, West Haven, CT). Serum specimens from these patients, 25 with positive skin tests and 8 with negative tests, were used for the ELISA and immunoblot experiments.

RESULTS

By ELISA, 72% (18 of 25) and 60% (15 of 25) of positive responders' sera showed IgE antibodies to GWBE and GFE, respectively, and the IgE levels to GWBE were highly correlated with those to GFE (r = .84, P < .01). In inhibition ELISA experiments, extensive cross-reactivity was observed between GWBE and GFE, slight cross-reactivity between GWBE and Dermatophagoides farinae, and no cross-reactivity between GFE and D. farinae. The two-site monoclonal antibody ELISA detected more of the German cockroach major allergens in GFE compared with GWBE; 6.2 times (2420 vs 390 U/mL) for Bla g 1 and 3 times (15.32 vs 5.07 microg/mL) for Bla g 2. In the immunoblot comparison of patients' sera, the IgE antibodies binding to GWBE were apparently different from those binding to GFE in all the positive responders' sera; eg, 50% or more of the 25 positive responders' sera reacted to 43- to 67-kDa proteins in GWBE and to 28- to 30-kDa proteins in GFE, respectively. No IgE antibodies bound to components in GWBE and GFE in the 8 negative responders' sera.

CONCLUSIONS

There are major differences between the allergenic components of GWBE and GFE. Based on the amounts of major allergens (Bla g 1, Bla g 2), German cockroach feces are a more important source of allergen than the whole body in respiratory allergic diseases.

Conversion of gamma-butyrobetaine to L-carnitine by Achromobacter cycloclast

L-Carnitine is an ubiquitous substance that plays a major role in the transportation of long-chain fatty acids. We investigated crucial factors that influence microbial conversion of gamma-butyrobetaine to L-carnitine using an Achromobacter cycloclast strain. Two-stage culture results showed that gamma-butyrobetaine induced enzymes essential for the conversion, which suggests that the precursor should be present in the initial cell growth stage. The addition of yeast extract enhanced L-carnitine production whereas inorganic nitrogen sources inhibited it. Under nitrogen-limiting conditions, the cells accumulated poly-beta-hydroxybutyrate instead of L-carnitine. Among the trace elements tested, nickel addition enhanced L-carnitine production by almost twice that of the control and copper strongly inhibited the conversion. L-Carnitine production was reduced when the medium contained inorganic salts of sodium, potassium, and calcium at a concentration greater than 2 g l(-1). A higher L-carnitine yield was achieved when cells were incubated in a lower culture volume. The optimal pH for L-carnitine production was 5 to 5.5, whereas that of growth was 7.0, indicating that a pH shift was required. Under optimal conditions, L-carnitine concentrations as high as 15 g l(-1) were obtained in 62 h with a 45% molar conversion yield.

A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel

STUDY DESIGN

A face-to-face interview survey.

OBJECTIVE

To compare bowel care patterns in spinal cord injury (SCI) patients based on type of neurogenic bowel.

SETTING

Department of Physical Medicine and Rehabilitation of a tertiary university hospital in Suwon, Korea.

METHODS

Among chronic SCI patients, 22 patients with upper motor neuron bowel (UMNB) and 20 patients with lower motor neuron bowel (LMNB) participated in an interview survey for the evaluation of bowel care patterns.

RESULTS

The patients with LMNB demonstrated increased frequency of defecation, increased frequency of fecal incontinence, increased use of oral medications for bowel care, increased required time for defecation and more diet modification than those with UMNB (P < 0.05). However, there was no significant difference in the subjective difficulty of bowel care. Among several available bowel care methods, suppositories were used most frequently by the UMNB group, whereas the Valsalva maneuver was the most frequently used method by the LMNB group.

CONCLUSIONS

Patients with LMNB tend to suffer more difficulties in management of their neurogenic bowel than those with UMNB. Therefore, more intensive and aggressive bowel care programs should be provided for SCI patients with LMNB.

Daily survival and human blood index of Anopheles sinensis, the vector species of malaria in Korea

To evaluate the vector efficiency of Anopheles sinensis in transmitting vivax malaria in the northern part of Gyonggi-do, South Korea, daily survival and feeding host preferences were studied during the period of June-October 1999. Ovaries of unfed and freshly fed An. sinensis females were dissected and parity or nulliparity were observed. The parous rates were 75.2% in July, 56.5% in August, 78.5% in September, and 60.0% in October at Gusan-dong, Goyang-si, Gyonggi-do. The average probability of daily survival was 0.890. To determine the host feeding patterns of An. sinensis, outdoor-resting bloodfed mosquitoes were collected, and the sources of the blood meals were analyzed by enzyme-linked immunosorbent assay, using 6 different animal immunoglobulin G antibodies. Out of 305 blood meals tested, 0.7% were positive from humans, 89.8% from bovines, 3.3% from swine, 0.7% from dogs, 1.6% from chickens, and 0.7% from bovines and swine mixed. No blood meals were positive from mice. Though the vector efficiency of An. sinensis was poor because of a low human blood index and a moderate rate of daily survival, vectorial capacity would be high because of high density of the population.

Frequency doubling technology perimetry in retinal diseases--preliminary report

The role of frequency doubling technology perimetry (FDT) in glaucoma has been promising in speed and simplicity as well as in its high sensitivity and specificity compared to conventional automatic perimetry. In this study, we evaluate the role of frequency doubling technology perimetry (FDT) in a variety of retinal diseases. FDT using full-threshold C-20 mode was performed in thirty-three patients with a variety of retinal diseases [16 cases of rhegmatogenous retinal detachment (RRD), nine cases of age-related maculopathy (AMD) and eight cases of central serous chorioretinopathy (CSCR)]. The fundus was scored by the extent of disease on each quadrant and macular area (central five degree visual angle). Then the retinal scores were compared with the points depressed to 2% on total deviation plots in FDT C-20 full-threshold mode using Spearman's rank correlation method. The correlation was statistically significant in the group of RRD (R = 0.57, P = 0.01), whereas the correlation was not significant in the group of macular diseases (AMD & CSCR, R = 0.47 & 0.32, P = 0.12 & 0.20). In conclusion, our results suggest that FDT might be a useful and simple technique for functional evaluation in RRD, but not in the macular disease group under this scoring system.

Superdeformation in the N = Z nucleus 36Ar: experimental, deformed mean field, and spherical shell model descriptions

A superdeformed rotational band has been identified in 36Ar, linked to known low-spin states, and observed to its high-spin termination at Ipi = 16(+). Cranked Nilsson-Strutinsky and spherical shell model calculations assign the band to a configuration in which four pf-shell orbitals are occupied, leading to a low-spin deformation beta(2) approximately 0.45. Two major shells are active for both protons and neutrons, yet the valence space remains small enough to be confronted with the shell model. This band thus provides an ideal case to study the microscopic structure of collective rotational motion.

Enterobius vermicularis egg positive rate in a primary school in Chungchongnam-do (province) in Korea

The egg positive rate of Enterobius vermicularis was investigated among students of a primary school and a kindergarten located in the rural area of Tangjin-gun, Chungchongnam-do in December, 1998. Of the 189 examinees, 28 (14.8%) were found to be infected with E. vermicularis by the adhesive cellotape anal swab method. The infection rates ranged from 4.2% to 26.1% among school children, and the highest rate was observed in children attending kindergarten. Three months after treatment with albendazole, four (14.3%) out of 28 infected children still remained infected with E. vermicularis. Through this survey, we were able to determine that E. vermicularis infection is still prevalent among children in rural areas of Korea.

Localization of a major allergen, Der p 2, in the gut and faecal pellets of Dermatophagoides pteronyssinus

BACKGROUND

The house dust mite Dermatophagoides ptronyssinus is one of the most significant indoor sensitizing agents of allergy. Allergen localization may indicate the importance of secreted materials, faeces, and nonexcreted mite body components as allergen sources.

OBJECTIVE

This study attempted to localize the sites and concentrations of Der p 2 in the cryostat sections of D. pteronyssinus using antirecombinant Der p 2 monoclonal antibody.

METHODS

Male and female mites and mite faeces collected separately from both sexes were used. Live mites were embedded and serial cryostat sections for light microscopy were performed. Anti-recombinant Der p 2 monoclonal antibody previously produced by the authors was used. For immunoprobing, mite cryostat sections were incubated in the following antibody-containing solutions: monoclonal antibody against Der p 2 was initially applied to the sections and fluorescent isothiocyanate conjugated antimouse immunoglobulin G was reacted as the secondary antibody. The faecal pellets were treated the same as described above.

RESULTS

Immunofluorescent probing of cryostat sections with the monoclonal antibody showed labelling of the gut lining, gut contents and defecated faecal pellets. No other internal organs were identified as positively labelled.

CONCLUSION

This study suggested that a major allergen, Der p 2, found in the house dust mite D. pteronyssinus is derived from the digestive tract and concentrated in the faeces.

Characterization of Vibrio parahaemolyticus isolates obtained from foodborne illness outbreaks during 1992 through 1995 in Taiwan

Vibrio parahaemolyticus is an important foodborne pathogen in Taiwan and many other Asian countries. A total of 371 isolates of V. parahaemolyticus collected from patients involved in foodborne illness outbreaks in Taiwan from 1992 to 1995 were characterized. These isolates had typical biochemical characteristics and only 4% were urease positive. The most frequently isolated serovars were O5:K15 (18.5%), O4:K8 (16.2%), O3:K29 (12.5%), O1:K56 (8.3%), O2:K3 (6.5%), and O4:K12 (6.0%). Most of the isolates were susceptible to nalidixic acid, tetracycline, tobramycin, cephalothin, and gentamicin. About 10% of the isolates were resistant to seven or more antibiotics. Approximately 92.4% of these V. parahaemolyticus showed beta-hemolysis on Wagatsuma blood agar plate and approximately 62.1% of these isolates exhibited detectable amounts of thermostable direct hemolysin. Most of the isolates examined exhibited two copies of tdh genes on the 1.3- and 2.5-kb HindIII-digested chromosome fragments with several variations on other fragments. A pulsed-field gel electrophoresis (PFGE) subspecies typing scheme was used to analyze these domestic isolates and the O3:K6 strains from Japan, Korea, and Taiwan. Fifty seven patterns were differentiated with A, B, C, E, and H being the major domestic types (cumulatively 76% of isolates), while O3:K6 strains (PFGE type I), abruptly occurring since 1996, were genetically distant from the major domestic types.

The effects of hydrocolloid dressing and gentian violet on radiation-induced moist desquamation wound healing

The aim of the study was to compare the effect of a gentian violet topical application with that of a moist dressing (hydrocolloid) on the rate and efficacy of radiotherapy-induced moist desquamation wound healing and the patients' satisfaction level with each method. This prospective randomized clinical trial used a stratified sampling design. A sample of 39 patients with 60 wounds had their wounds assessed on alternate days in terms of several wound-healing parameters including wound size, wound pain, incidence of infection, and time required for healing. Patient satisfaction with each treatment was evaluated at the completion of the study. Gentian violet significantly decreased wound size and reduced wound pain. However, this treatment received significantly lower ratings for dressing comfort and dressing aesthetic acceptance. Nevertheless, the time required for healing was not statistically different in the two groups. These findings suggest that the lower score of dressing satisfaction level in the gentian violet group may result from the skin discoloration and drying effects of the treatment, which renders patients unable to move or stretch their skin. Although the aim is to have complete wound healing, this may not be realistic for many lesions such as radiotherapy-induced moist desquamation wounds. The best evidence on which to make decisions about individual care can now be based on patients' own perception of quality.

A qualitative analysis of brain SPECT for prognostication of gross motor development in children with cerebral palsy

PURPOSE

In this report, the authors assessed the clinical significance of decreased regional cerebral blood flow (rCBF) in the thalamus or cerebellar hemispheres in relation to gross motor performance in the children with cerebral palsy.

MATERIALS AND METHODS

Thirty-six children with bilateral spastic cerebral palsy (BSCP) underwent brain SPECT. Visual analysis was used for the brain SPECT interpretation. The rCBF in the thalamus or cerebellum was graded as normal, mildly decreased, or severely decreased. A marked decrease or near absence of rCBF in the thalamus or cerebellum was considered as severely decreased.

RESULTS

All 36 children with BSCP had hypoperfusion in the thalamus or cerebellar hemispheres. Eight of 20 children (40%) with mildly decreased rCBF on brain SPECT had mild developmental delays. On the other hand, only 1 of 16 children (6.3%) with severe hypoperfusion in the thalamus or cerebellum had a mild developmental delay, and the remaining 15 of 16 children (93.8%) had severe developmental delays. There was good correlation between the degree of developmental delay and the severity of hypoperfusion in the thalamus or cerebellum (P = 0.023).

CONCLUSION

The measurement of rCBF by Tc-99m ethyl cysteinate dimer brain SPECT appears to be valuable in prognostication of gross motor development in children with BSCP.

Needs of families with a relative in a critical care unit in Hong Kong

The aim of this study is to explore family members' perceptions of their immediate needs following admission of a relative to a critical care unit in Hong Kong. A convenience sample of 30 family members was drawn from those available during the first 96 hours of hospitalization of their relative. Self-reported questionnaires, consisting of a demographic data sheet, a modified Chinese version of the 45-item Critical Care Family Needs Inventory (CCFNI) and semistructured interviews, are the instruments used to examine family members' perceptions of need importance and to ascertain whether or not these needs are met. Doctors and nurses are identified as the most suitable people to meet most immediate family needs. Conclusions are drawn as to the best focus of nursing interventions in order to provide quality care to patients and families.

Ataxia in prion protein (PrP)-deficient mice is associated with upregulation of the novel PrP-like protein doppel

The novel locus Prnd is 16 kb downstream of the mouse prion protein (PrP) gene Prnp and encodes a 179 residue PrP-like protein designated doppel (Dpl). Prnd generates major transcripts of 1.7 and 2.7 kb as well as some unusual chimeric transcripts generated by intergenic splicing with Prnp. Like PrP, Dpl mRNA is expressed during embryogenesis but, in contrast to PrP, it is expressed minimally in the CNS. Unexpectedly, Dpl is upregulated in the CNS of two PrP-deficient (Prnp(0/0)) lines of mice, both of which develop late-onset ataxia, suggesting that Dpl may provoke neurodegeneration. Dpl is the first PrP-like protein to be described in mammals, and since Dpl seems to cause neurodegeneration similar to PrP, the linked expression of the Prnp and Prnd genes may play a previously unrecognized role in the pathogenesis of prion diseases or other illnesses.

Identification of Chironomus kiiensis allergens, a dominant species of non-biting midges in Korea

Non-biting midges are known to contain potent inhalant allergens. IgE antibody responses to the crude extract of Chironomus kiiensis adults, a dominant chironomid species in Korea, were examined. With the IgE-ELISA or passive cutaneous anaphylaxis reactions, increased levels of chironomid-specific IgE were detected in the skin test positive human sera, or immunized BALB/c mouse sera with the crude extract adsorbed to alum. IgE-immunoblot analysis showed major IgE-reacting protein band patterns, which reacted with more than 50% of the skin test positive human sera, at 110, 80, 73, 46, 40, 37, 34, and 31 kDa. The reactive band patterns were largely similar between skin test positive humans and immune BALB/c mice. However, the bands of 55, 31, 27, 26, 24, and 23 kDa were found only in sensitized humans, but not in immunized mice.

Monoclonal antibodies to recombinant Der p 2, a major house dust mite allergen: specificity, epitope analysis and development of two-site capture ELISA

House dust mite allergens have been well established as sensitizing agents that are important in the induction of allergic diseases. In order to analyze epitopes of the allergen and to develop a quantitative method of the allergen exposure, monoclonal antibodies against a recombinant Der p 2 (rDer p 2), one of the major allergens of Dermatophagoides pteronyssinus, were produced. Four monoclonal antibodies produced were species-specific and did not cross-react to the D. farinae crude extract. Two of the monoclonal antibodies were found to be IgG1 and the others were IgM. For the analysis of epitopes, a Der p 2 cDNA encoding 126 amino acids (aa) was dissected into three fragments with several overlapping peptides. A (aa residues 1-49), B (44-93), and C fragment (84-126). Three monoclonal antibodies showed reactivities to the recombinant B fragment and to the full-length rDer p 2, but one monoclonal antibody reacted only with the full-length rDer p 2. Two-site capture ELISA was developed using two different monoclonal antibodies for quantitating Der p 2 in house dust. The sensitivity limit was 4 ng/ml with rDer p 2 and 8 micrograms/ml with the D. pteronyssinus crude extract. The result suggested that the assay using monoclonal antibodies against rDer p 2 could be useful for the environmental studies and for the standardization of mite allergen extracts.

Clinical characteristics of children with mental retardation of unknown etiology in Korea

The purpose of this study was to investigate the clinical characteristics of children with mental retardation (MR) of unknown etiology for early recognition and intervention. In this study, we defined children with MR of unknown etiology as those without clear etiologies for MR despite extensive evaluation and were not associated with pathological behavioral problems such as pervasive developmental disorders and attention-deficit/hyperactivity disorder. The clinical characteristics of children with MR of unknown etiology were as follows. 1) MR of unknown etiology was 48.8% of all MR. 2) MR of unknown etiology was more common in males. 3) Delayed language development was a leading factor that made the parents of children with MR of unknown etiology seek help from physicians. However, most of the children with MR of unknown etiology showed a relatively uniform delay in several areas of development. 4) Most children with MR of unknown etiology were delayed walkers. 5) Most children with MR of unknown etiology were mild cases.

Higher intracellular levels of uridinemonophosphate under nitrogen-limited conditions enhance metabolic flux of curdlan synthesis in Agrobacterium species

Changes of intracellular nucleotide levels and their stimulatory effects on curdlan synthesis in Agrobacterium species were investigated under different culture conditions. Under nitrogen-limited conditions where curdlan synthesis was stimulated, intracellular levels of UMP were as high as 87 and those of AMP were 78 nmol/mg of cellular protein, while those under nitrogen-sufficient conditions were lower than 45 nmol/mg-protein. The levels of other nucleotides such as UDP, UTP, UDP-glucose, ADP, ATP, and ADP-glucose were lower than 30 nmol/mg-protein under both nitrogen-limited and sufficient conditions. The time profiles of curdlan synthesis and cellular nucleotide levels showed that curdlan synthesis had a positive relationship with intracellular levels of UMP and AMP. After the ammonium concentration in the medium fell below 0.1 g/L, intracellular levels of UMP and AMP increased, followed by curdlan synthesis. However, no significant changes in the specific activities of UMP kinase, UDP kinase, and UDP-glucose pyrophosphorylase were observed during cultivation. In vitro enzyme reactions for the synthesis of UDP-glucose, which serve as a precursor for curdlan synthesis, demonstrated that the synthesis of UDP-glucose increased with the increase of UMP concentration. In contrast, AMP had no effect on UDP-glucose synthesis at all. Addition of UMP in the medium increased the curdlan synthesis, whereas curdlan synthesis was inhibited in the presence of AMP. From these results, we concluded that only the higher intracellular UMP levels caused by nitrogen limitation in the medium enhance the metabolic flux of curdlan synthesis by promoting cellular UDP-glucose synthesis.

Enzyme histochemical study of germanium dioxide-induced mitochondrial myopathy in rats

The purpose of this study were 1) to determine the earliest pathological changes of germanium dioxide (GeO2)-induced myopathy; 2) to determine the pathomechanism of GeO2-induced myopathy; and 3) to determine the minimal dose of GeO2 to induce myopathy in rats. One hundred and twenty five male and female Sprague-Dawley rats, each weighing about 150 gm, were divided into seven groups according to daily doses of GeO2. Within each group, histopathological studies were done at 4, 8, 16, and 24 weeks of GeO2 administration. Characteristic mitochondrial myopathy was induced in the groups treated daily with 10 mg/kg of GeO2 or more. In conclusion, the results were as follows: 1) The earliest pathological change on electron microscope was the abnormalities of mitochondrial shape, size and increased number of mitochondria; 2) The earliest pathological change on light microscope was the presence of ragged red fibers which showed enhanced subsarcolemmal succinate dehydrogenase and cytochrome c oxidase reactivity; 3) GeO2 seemed to affect the mitochondrial oxidative metabolism of muscle fibers; 4) GeO2 could induce mitochondrial myopathy with 10 mg/kg of GeO2 for 4 weeks or less duration in rats.

Quality of marital life in Korean spinal cord injured patients

The purposes of this study were to assess the quality of marital life and to investigate the most serious problem in the marital relationships of Korean spinal cord injured patients. 30 spinal cord injured (SCI) couples (SCI husbands and their non-disabled wives) who were married prior to injury and 30 able-bodied (AB) couples participated in a questionnaire study. The quality of marital life was measured with three parameters: marital stability, marital adjustment, and marital satisfaction. The results were as follows: (1) The marriage of chronic SCI couples was not noticeably unstable when compared with that of AB couples; (2) There was no significant difference in dyadic adjustment and marital satisfaction between SCI couples and AB couples; (3) There was no significant difference in marital stability, marital adjustment, and marital satisfaction between SCI husbands and their wives; (4) SCI couples had more cohesive marital relationships and SCI husbands expressed less affection to their wives than AB husbands and (5) Sex was the most serious problem in marriages of SCI couples.

IN CONCLUSION

(1) the quality of marital life in chronic SCI couples is not highly different from that of AB couples; (2) There is no significant difference in the quality of marital life between chronic SCI husbands and their non-disabled wives; and (3) It is considered necessary that rehabilitation program for SCI patients should include information on the altered physiology of sexual function of SCI patients and subsequent mutual adaptation to changed sexual function.

Complete genomic sequence and analysis of the prion protein gene region from three mammalian species

The prion protein (PrP), first identified in scrapie-infected rodents, is encoded by a single exon of a single-copy chromosomal gene. In addition to the protein-coding exon, PrP genes in mammals contain one or two 5'-noncoding exons. To learn more about the genomic organization of regions surrounding the PrP exons, we sequenced 10(5) bp of DNA from clones containing human, sheep, and mouse PrP genes isolated in cosmids or lambda phage. Our findings are as follows: (1) Although the human PrP transcript does not include the untranslated exon 2 found in its mouse and sheep counterparts, the large intron of the human PrP gene contains an exon 2-like sequence flanked by consensus splice acceptor and donor sites. (2) The mouse Prnpa but not the Prnpb allele found in 44 inbred lines contains a 6593 nucleotide retroviral genome inserted into the anticoding strand of intron 2. This intracisternal A-particle element is flanked by duplications of an AAGGCT nucleotide motif. (3) We found that the PrP gene regions contain from 40% to 57% genome-wide repetitive elements that independently increased the size of the locus in all three species by numerous mutations. The unusually long sheep PrP 3'-untranslated region contains a "fossil" 1.2-kb mariner transposable element. (4) We identified sequences in noncoding DNA that are conserved between the three species and may represent biologically functional sites.

Effects of distal cement voids on cement stress in total hip arthroplasty

The purpose of this study was to determine whether voids in the distal cement mantle created during total hip arthroplasty increase cement stress at the distal tip of the femoral component. Using a three-dimensional finite element model of an idealized, cylindrical femoral shaft with implanted prosthesis, peak von Mises stress in the cement mantle was evaluated for five different air-bubble configurations and two cement mantle thicknesses, 2 mm and 5 mm. Results indicated that voids in the cement mantle increased peak cement stress at the medial tip of the prosthesis by 2% to 57%, with greater increases in stress being evident with larger bubble sizes. On the average, peak stresses were 53% greater in the models with the thinner cement mantle. Clinicians are encouraged to use a thicker cement mantle and to avoid bubble formation during total hip arthroplasty.

Fracture originated at the tip of heterotopic ossification of femur by minor external force: report of two cases

Fracture of femur without evidence of severe osteoporosis rarely occurs as a result of minor external force such as a gentle passive or an active range of motion exercises. We report two cases of femoral shaft fracture occurred at the tip of heterotopic ossification of femur by a minor external force, in which the involved femur shows no evidence of remarkable osteoporosis. The possible mechanism inferred by authors is as follows: 1) heterotopic ossification limits range of motion of the hip joint; 2) a new lever arm is formed at the tip of heterotopic ossification where energy can be concentrated; 3) therefore, fractures develop even by a minor external force. Search for similar cases and further discussions on possible mechanisms and prevention of femoral fractures in patients with heterotopic ossification will be necessary.