Green conversion of waste alkaline battery material to zeolitic imidazolate framework-8 and its iodine capture mechanism

Zeolitic imidazolate framework-8 (ZIF-8) exhibits excellent performance in capturing iodine. However, the solvent-based procedures and raw materials for ZIF-8 synthesis often lead to secondary pollution. We developed a solvent-minimizing method for preparing ZIF-8 via ball milling of raw material obtained from spent alkaline batteries, and studied its iodine-capture performance and structural changes. Exposure of the ZIF-8 to iodine vapor for 60 min demonstrated that it exhibited industrially competitive iodine-capture performance (the adsorbed amount reaches to 1123 mg g-1 within 60 min). Spectroscopic studies showed that ZIF-8 underwent a structural transformation upon iodine loading. Iodine molecules were adsorbed onto the surface of ZIF-8 and also formed C-I bond with the methyl groups on the imidazole rings, reducing iodine release. This work represents a comprehensive revelation of long-range order and short-range order evolution of ZIF-8 during iodine vapor adsorption over time. Moreover, this green synthesis of ZIF-8 is of lower cost and generates fewer harmful by-products than existing methods, and the produced ZIF-8 effectively entraps toxic iodine vapor. Thus, this synthesis enables a sustainable and circular material flow for beneficial utilization of waste materials.

Self-consumed strategy to reuse cathode residue for Zn stabilization in spent batteries: Structural properties and metal stabilization effect

Due to ecotoxicity, zinc (Zn) as a heavy metal from electronic waste (e-waste) has been a source of pollution to soil and water for several decades. This study proposes a solution to this serious environmental problem via a self-consumed strategy to stabilize Zn in anode residues. This unique method uses cathode residues from spent zinc-manganese oxide (Zn-Mn) batteries as a stabilized matrix via thermal treatment. More specifically, the strategy incorporates zinc metal into a chemically durable matrix comprised of a lattice of AB2O4 compounds. Results demonstrate that 5-20 wt% of anode residue were fully incorporated into the cathode residue to form a Mn3-xZnxO4 solid solution after sintering at 1300 ℃ for 3 h. The lattice parameters of the Mn3-xZnxO4 solid solution reveal an approximately linear decreasing evolution with the addition of anode residue. To determine the occupancy of Zn in the crystal structure of the products, we used Raman and Rietveld refinement processes; the results reveal that Mn2+ in the 4a site was gradually replaced by Zn2+. We then used a prolonged toxicity leaching procedure to evaluate the Zn stabilization effect after phase transformation; this showed that the Zn leachability of sintered anode-doped cathode sample was over 40 folds lower than that of untreated anode residue. Therefore, this study presents an economical and effective strategy for mitigating the presence of heavy metal pollutants derived from e-waste.

UiO66-Derived Catalyst for Low Temperature Catalytic Reduction of NO with NH3

Diesel exhaust emissions are major outdoor air pollutants. Reducing the emission of NOx by diesel commercial vehicles and related machineries is at present a great challenge. In this study, we synthesize a catalyst for low-temperature catalytic reduction of NO using calcinated UiO-66(Zr) as a host for the doping of cerium, manganese, and titanium by the incipient wetness impregnation, followed by the dispersion of 1.0 wt % platinum. A solid solution of Ce_0.15Zr_0.54Mn_0.11Ti_0.20O₂/1.0Pt (CZMTO/Pt) is synthesized as evident by the structural characterizations. The catalyst demonstrates significant NO reduction in the laboratory due to the synergistic effect of various elements, with NO conversion above 80% at 160 °C.

Prevalence of abnormal Papanicolaou smears in female sex workers in Hong Kong

OBJECTIVE. To investigate the prevalence of pre-cancerous uterine cervix lesions as detected in Papanicolaou (Pap) smears from female sex workers in Hong Kong. DESIGN. Retrospective analysis of laboratory records. SETTING. Private anatomical pathology laboratory, Hong Kong. PATIENTS. Female sex workers undergoing Pap smear examinations at two non-governmental organisations between 2006 and 2012. MAIN OUTCOME MEASURES. Detection of pre-cancerous uterine cervical conditions and their management. RESULTS. A total of 2697 satisfactory Pap smears from female sex workers were performed during the study period from 2006 to 2012. In these subjects, the point prevalence of low-grade squamous intraepithelial lesion and atypical squamous cells of unknown significance was 10.12% (compared with 3.92% for the general population during the same period), whereas that of high-grade squamous intraepithelial lesions and atypical squamous cells of unknown significance with or without high-grade intraepithelial lesions was 2.22% (compared with 0.54% in the general population). For both categories of lesions, the higher prevalence among female sex workers than in the general population was statistically significant. Most patients who had abnormal Pap smears received proper referrals and follow-up management according to recommended guidelines. CONCLUSIONS. Female sex workers in Hong Kong as a group had a significantly higher prevalence of abnormal Pap smears than the general population. Non-governmental organisations providing free-of-charge screening services to these women helped early detection and proper follow-up for those who had abnormal Pap smears, whilst also increasing their awareness of women's health issues.

Angioplasty and stenting for intracranial atherosclerotic stenosis: position statement of the Hong Kong Society of Interventional and Therapeutic Neuroradiology

As a means of preventing secondary ischaemic stroke, angioplasty and stenting are considered potentially beneficial for patients with severe intracranial atherosclerotic stenosis. However, the role of stenting has been challenged since the publication of the first randomised controlled trial on Stenting versus Aggressive Medical Management for Preventing Recurrent stroke in Intracranial arterial Stenosis (SAMMPRIS). This indicated that aggressive medical management was superior to stenting using Wingspan to prevent recurrent stroke, because stenting has a high peri-procedural stroke and death rate. In this paper, we review the management of intracranial atherosclerosis, revisit the skepticism on stenting, and state our position on the topic in the form of recommendations. These are based on the prevalence of the disease in Hong Kong, the high risk of recurrent stroke despite medical therapy in the presence of haemodynamic intracranial stenosis without sufficient collaterals, an analysis of the weak points of SAMMPRIS, and results of clinical studies in Hong Kong.

Intracranial aneurysms: midterm outcome of pipeline embolization device--a prospective study in 143 patients with 178 aneurysms

PURPOSE

To evaluate the midterm clinical and angiographic outcomes after pipeline embolization device (PED) placement for treatment of intracranial aneurysms.

MATERIALS AND METHODS

This prospective nonrandomized multicenter study was approved by the review boards of all involved centers; informed consent was obtained. Patients (143 patients, 178 aneurysms) with unruptured saccular or fusiform aneurysms or recurrent aneurysms after previous treatment were included and observed angiographically for up to 18 months and clinically for up to 3 years. Study endpoints included complete aneurysm occlusion; neurologic complications within 30 days and up to 3 years; clinical outcome of cranial nerve palsy after PED placement; angiographic evidence of occlusion or stenosis of parent artery and that of occlusion of covered side branches at 6, 12, and 18 months; and clinical and computed tomographic evidence of perforator infarction.

RESULTS

There were five (3.5%) cases of periprocedural death or major stroke (modified Rankin Scale [mRS] > 3) (95% confidence interval [CI]: 1.3%, 8.4%), including two posttreatment delayed ruptures, two intracerebral hemorrhages, and one thromboembolism. Five (3.5%) patients had minor neurologic complications within 30 days (mRS = 1) (95% CI: 1.3%, 8.4%), including transient ischemic attack (n = 2), small cerebral infarction (n = 2), and cranial nerve palsy (n = 1). Beyond 30 days, there was one fatal intracerebral hemorrhage and one transient ischemic attack. Ten of 13 patients (95% CI: 46%, 93.8%) completely recovered from symptoms of cranial nerve palsy within a median of 3.5 months. Angiographic results at 18 months revealed a complete aneurysm occlusion rate of 84% (49 of 58; 95% CI: 72.1%, 92.2%), with no cases of parent artery occlusion, parent artery stenosis (<50%) in three patients, and occlusion of a covered side branch in two cases (posterior communicating arteries). Perforator infarction did not occur.

CONCLUSION

PED placement is a reasonably safe and effective treatment for intracranial aneurysms. The treatment is promising for aneurysms of unfavorable morphologic features, such as wide neck, large size, fusiform morphology, incorporation of side branches, and posttreatment recanalization, and should be considered a first choice for treating unruptured aneurysms and recurrent aneurysms after previous treatments.

SUPPLEMENTAL MATERIAL

http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120422/-/DC1.

Surgical recanalisation of thrombosed M2 trunk after coil embolisation of a ruptured middle cerebral artery aneurysm

Thromboembolic events are known complications of endovascular coiling of intracerebral aneurysms. We report a case of a 50-year-old patient whose ruptured middle cerebral artery aneurysm was treated with endovascular coiling, which was complicated by occlusion of the inferior M2 trunk during the procedure. An emergency craniotomy was performed to enable coil retrieval, evacuation of the thrombus and clipping of the aneurysm. All the middle cerebral artery branches were recanalised and the patient recovered with no neurological deficits. Our experience suggests that an emergency salvage operation for thrombosis after endovascular coiling is a treatment option offering a good clinical outcome.

Community-based intervention to optimise falls risk management: a randomised controlled trial

BACKGROUND

falls are the leading causes of accidental death and fragility fractures in older adults. Interventions that assess and reduce falls risk are underutilised.

OBJECTIVE

to evaluate the impact of a multifaceted community-based programme aimed at optimising evidence-based management of patients at risk for fall-related fractures.

DESIGN

this was a randomised trial performed from 2003 to 2006.

SETTING

community-based intervention in Ontario, Canada.

PARTICIPANTS

eligible patients were community-dwelling, aged > or =55 years and identified to be at risk for fall-related fractures. A total of 201 patients were allocated to the intervention group or to usual care.

INTERVENTION

components of the intervention included assessment of falls risk, functional status and home environment, and patient education.

MEASUREMENTS

primary outcome was the implementation of appropriate falls risk assessment at 6 months. Secondary outcomes included falls and fractures at 6 and 12 months.

RESULTS

the mean age of participants was 72 years, and 41% had fallen with injury in the previous year. Compared to usual care, the intervention increased the number of referrals made to physiotherapy [21% (21/101) vs 6.0% (6/100); relative risk (RR) 3.47, 95% confidence interval (CI) 1.46-8.22] and occupational therapy [15% (15/101) vs 0%; RR 30.7, 95% CI 1.86 to >500]. At 12 months, the number of falls in the intervention group was greater than in the usual care group [23% (23/101) vs 11% (11/100); RR 2.07, 95% CI 1.07-4.02].

CONCLUSIONS

compared to usual care, a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls. Similar falls reduction interventions cannot be recommended based on the results of this study.

Community-based randomised controlled trial evaluating falls and osteoporosis risk management strategies

Background

Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis, as well as prevention of fractures and falls, are substantially underutilized. This paper outlines the protocol for a pragmatic randomised trial of a multifaceted community-based care program aimed at optimizing the evidence-based management of falls and fractures in patients at risk.

Design

6-month randomised controlled study.

Methods

This population-based study was completed in the Algoma District of Ontario, Canada a geographically vast area with Sault Ste Marie (population 78 000) as its main city. Eligible patients were allocated to an immediate intervention protocol (IP) group, or a delayed intervention protocol (DP) group. The DP group received usual care for 6 months and then was crossed over to receive the interventions. Components of the intervention were directed at the physicians and their patients and included patient-specific recommendations for osteoporosis therapy as outlined by the clinical practice guidelines developed by Osteoporosis Canada, and falls risk assessment and treatment. Two primary outcomes were measured including implementation of appropriate osteoporosis and falls risk management. Secondary outcomes included quality of life and the number of falls, fractures, and hospital admissions over a twelve-month period. The patient is the unit of allocation and analysis. Analyses will be performed on an intention to treat basis.

Discussion

This paper outlines the protocol for a pragmatic randomised trial of a multi-faceted, community-based intervention to optimize the implementation of evidence based management for patients at risk for falls and osteoporosis.

Trial Registration

This trial has been registered with clinicaltrials.gov (ID: NCT00465387)

Development of human single-chain antibodies against SARS-associated coronavirus

The outbreak of severe acute respiratory syndrome (SARS), caused by a distinct coronavirus, in 2003 greatly threatened public health in China, Southeast Asia as well as North America. Over 1,000 patients died of the SARS virus, representing 10% of infected people. Like other coronaviruses, the SARS virus also utilizes a surface glycoprotein, namely the spike protein, to infect host cells. The spike protein of SARS virus consists of 1,255 amino acid residues and can be divided into two sub-domains, S1 and S2. The S1 domain mediates the binding of the virus to its receptor angiotensin-converting enzyme 2, which is abundantly distributed on the surface of human lung cells. The S2 domain mediates membrane fusion between the virus and the host cell. Hence two strategies can be used to block the infection of the SARS virus, either by interfering with the binding of the S1 domain to the receptor or by blocking the fusion of the virus with the cell membrane mediated by the S2 domain. Several antibodies against the S1 domain have been generated and all of them are able to neutralize the virus in vitro and in vivo using animal models. Unfortunately, point mutations have been identified in the S1 domain, so that the virus isolated in the future may not be recognized by these antibodies. As no mutation has been found in the S2 domain indicating that this region is more conserved than the S1 domain, it may be a better target for antibody binding. After predicting the immunogenicity of the epitopes of the S2 domain, we chemically synthesized two peptides and also expressed one of them using a recombinant DNA method. We screened a phage displaying library of human single-chain antibodies (ScFv) against the predicted epitopes and obtained a human ScFv which can recognize the SARS virus in vitro.

Characteristics of false-negative ThinPrep cervical smears in women with high-grade squamous intraepithelial lesions

OBJECTIVE

To examine the cellular characteristics and other possible factors affecting the correct prediction of ThinPrep cervical smears from patients with high-grade squamous intraepithelial lesions.

DESIGN

Retrospective study.

SETTING

Private anatomical pathology service, Hong Kong.

PATIENTS

Patients (n=98) with biopsy-confirmed high-grade squamous intraepithelial lesion of the uterine cervix encountered between 2004 and 2006.

MAIN OUTCOME MEASURES

Correct prediction of the cervical ThinPrep Papanicolaou tests.

RESULTS

There were no significant differences in age, hormonal status, degree of inflammation, and the presence or absence of endocervical/metaplastic cells between the true-positive and false-negative groups. There was a significant difference in the number of abnormal cells present and the screening time between the two groups. Approximately 79% (34/43) false-negative smears had 100 or less abnormal cells, while only 11% (5/45) true-positive smears had 100 or less abnormal cells (P<0.001). The true-positive smears were also more likely to contain koilocytic cells and abnormal cells with hyperchromatic nuclei.

CONCLUSIONS

The number of abnormal cells present, the presence or absence of koilocytic cells, and the presence or absence of abnormal cells with nuclear hyperchromasia appeared to be independent factors affecting the correct prediction of smears from patients with high-grade squamous intraepithelial lesions.

Enhanced light output from a nitride-based power chip of green light-emitting diodes with nano-rough surface using nanoimprint lithography

Enhanced light extraction from a GaN-based power chip (PC) of green light-emitting diodes (LEDs) with a rough p-GaN surface using nanoimprint lithography is presented. At a driving current of 350 mA and with a chip size of 1 mm × 1 mm packaged on transistor outline (TO)-cans, the light output power of the green PC LEDs with nano-rough p-GaN surface is enhanced by 48% when compared with the same device without a rough p-GaN surface. In addition, by examining the radiation patterns, the green PC LED with nano-rough p-GaN surface shows stronger light extraction with a wider view angle. These results offer promising potential to enhance the light output powers of commercial light-emitting devices by using the technique of nanoimprint lithography under suitable nanopattern design.

Breast pathology in complications associated with polyacrylamide hydrogel (PAAG) mammoplasty

OBJECTIVE

To study the tissue pathology of breast lesions associated with hydrophilic polyacrylamide gel injection augmentation mammoplasty.

DESIGN

Retrospective study.

SETTING

Private anatomical pathology practice, Hong Kong.

PATIENTS

Eight patients who underwent lumpectomy of the breast due to complications of hydrophilic polyacrylamide gel injection for augmentation mammoplasty.

MAIN OUTCOME MEASURES

Identification of hydrophilic polyacrylamide gel in breast tissue and associated pathological changes.

RESULTS

We reviewed the pathological changes in breast tissue associated with hydrophilic polyacrylamide gel injection in eight cases retrieved from our archive. Microscopically, the hydrophilic polyacrylamide gel appeared as pools of pale violet gelatinous material of variable size, between the interstices of connective tissue and fat cells. The larger pools were often surrounded by cellular reactions consisting of histiocytic cells and foreign body-type multinucleated giant cells. Inflammatory reaction featuring infiltration by lymphocytes and plasma cells in the adjacent breast tissue was observed in samples from four patients, and a sample from another patient showed acute inflammation with abscess formation. There was no evidence of abnormal cellular proliferation, atypia or malignant change in the stromal connective tissue or ductal-acinic epithelial components of the breast tissue.

CONCLUSIONS

Hydrophilic polyacrylamide gel injection for augmentation mammoplasty can give rise to a breast lump and inflammation. Pathologically, this complication is associated with fibrosis, foreign body reaction, and inflammation.

Clinical relevance of intra-operative sentinel lymph node examination in breast cancer management

OBJECTIVES

To determine the sensitivity, accuracy, and clinical relevance of intra-operative examination of sentinel lymph nodes in breast cancer management.

DESIGN

Retrospective study.

SETTING

Private anatomical pathology practice.

PARTICIPANTS

Three hundred breast cancer patients who underwent axillary sentinel lymph node biopsies for intra-operative assessment between January 2004 and March 2006.

MAIN OUTCOME MEASURES

Correct identification of metastatic carcinoma in sentinel lymph nodes during intra-operative examination, sparing patient a second surgery.

RESULTS

The intra-operative diagnosis of sentinel lymph node biopsies from 300 consecutive patients were compared with the final pathological diagnoses. The final pathology results showed metastatic carcinoma in 74 patients, of whom 63 (85%) were correctly diagnosed during frozen section examination. There was no false-positive case (positive predictive value 100%). The sensitivity for detecting macro- and micro-metastases were 95% and 50%, respectively (P<0.01). The sensitivity for detecting metastases in T1 and T2/above tumours were 72% and 90%, respectively (P<0.05).

CONCLUSIONS

Intra-operative examination is a reliable and sensitive method for the detection of sentinel lymph node metastasis. Eighty-five percent of the patients with metastatic disease were correctly diagnosed and spared a second operation for axillary dissection. The disadvantage of missing a positive lymph node is by far outweighed by the advantage of a single stage operation in case of a positive diagnosis. The benefit of intra-operative examination was slightly less in patients with smaller tumours.

Inhibitors of inducible nitric oxide (NO) synthase are more effective than an NO donor in reducing carbon-tetrachloride induced acute liver injury

The exact functional role of nitric oxide (NO) in liver injury is currently a source of controversy. NO is enzymatically synthesized by nitric oxide synthase (NOS). In this study, we assessed the role of inducible NOS (iNOS) in carbon tetrachloride (CCl4)-induced acute liver injury using inhibitors of iNOS, and an NO donor. Adult ICR mice were injected with CCl4 with or without the iNOS inhibitors (5-methylisothiourea hemisulfate [SMT] and l-N6-(1-iminoethyl)-lysine [L-NIL]) and an NO donor (Sodium Nitroprusside [SNP]). Blood and liver tissues were collected for analysis. Immunohistochemistry (IHC), serum alanine aminotransferase (ALT), serum total 8-isoprostane analysis, RT-PCR, Western Blotting (WB) and EMSA were done. Our results showed increased levels of ALT, necrosis, total 8-isoprostane and nitrotyrosine after CCl4 administration. iNOS inhibitors and SNP abrogated these effects but the effect was more pronounced with SMT and L-NIL. RT-PCR, WB and IHC in CCl4-treated mice demonstrated upregulation of TNF-alpha, iNOS, and COX-2. The administration of iNOS inhibitors with CCl4 diminished the expression of these proinflammatory mediators. NF-kappaB was also upregulated in CCl4-treated mice and was reversed in mice pretreated with iNOS inhibitors. SNP pretreated mice also showed a lower expression of COX-2 when compared with CCl4 treated mice but TNF-alpha, iNOS and NF-kappaB activity were unaffected. We propose that a high level of nitric oxide is associated with CCl4-induced acute liver injury and the liver injury can be ameliorated by decreasing the NO level with iNOS inhibitors and an NO donor with the former more effective in reducing CCl4-induced liver injury.

Overexpression of iNOS and down-regulation of BMPs-2, 4 and 7 in retinoic acid induced cleft palate formation

The present work studied the induction of cleft palate formation in embryos developed from pregnant BALB/c mice treated orally with retinoic acid (RA). Previous studies on mature somatic cell types showed that RA exerted inhibitory effects on inducible nitric oxide synthase (iNOS) production. For the first time, our study has shown that RA actually stimulates significant expression of iNOS at specific zones of the affected embryonic palatal tissues at three consecutive stages, from gestation day 13 (GD13) to day 16 (GD16). Enzymatically, iNOS facilitates intracellular nitric oxide (NO) synthesis from L-arginine. When NO reacts with reactive superoxides it may result in irreparable cell injury. NO was also reported to induce apoptosis in some mammalian cell systems. Based on our findings, we propose that such an increase in NO production might be associated with apoptosis in the embryonic palatal tissues in the RA-treated mice. The detrimental effects of NO resulted in a reduction in proliferating palatal cells and therefore disturbed the normal plasticity of the palatal shelves. With iNOS overexpression, our findings also showed that there was significant concomitant down-regulation in the expressions of Bone Morphogenetic Proteins (BMPs) -2, 4, and 7 with regional variations particularly in the palatal mesenchymal cells for those embryos developing cleft palate. Since specific spatial and temporal expressions of BMPs -2, 4, and 7 are critical during normal palatal morphogenesis, any deficiency in the epithelial-mesenchymal interaction may result in retarding growth at the embryonic palatal shelves. Taken together, our study has demonstrated cleft palate formation in the BALB/c embryos involved overexpression of iNOS and down-regulation of BMPs-2, 4 and 7.

Expression of phosphacan and neurocan during early development of mouse retinofugal pathway

We have investigated whether the two major brain chondroitin sulfate (CS) proteoglycans (PGs), phosphacan and neurocan, are expressed in patterns that correlate to the axon order changes in the mouse retinofugal pathway. Expression of these proteoglycans was examined by polyclonal antibodies against phosphacan and N- and C-terminal fragments of neurocan. In E13-E15 mouse embryos, when most optic axons grow in the chiasm and the optic tract, phosphacan and neurocan were observed in the inner regions of the retina. In the chiasm and the tract, phosphacan but not neurocan was expressed prominently at the midline and in the deep parts of the tract. Both proteoglycans were observed on the chiasmatic neurons, which have been shown to regulate axon divergence at the chiasmatic midline and the chronotopic fiber ordering in the tract, but phosphacan appeared to be the predominant form that persists to later developmental stages. Intense staining of both proteoglycans was also observed in a strip of glial-like elements in lateral regions of the chiasm, partitioning axons in the stalk from those in the tract. We conclude that phosphacan but not neurocan is likely the major carrier of the CS glycosaminoglycans that play crucial functions in axon divergence and age-related axon ordering in the mouse optic pathway. Furthermore, localization of these carrier proteins in the optic pathway raises a possibility that these two proteoglycans regulate axon growth and patterning not only through the sulfated sugars but also by interactions of the protein parts with guidance molecules on the optic axons.

HAb18G/CD147-mediated calcium mobilization and hepatoma metastasis require both C-terminal and N-terminal domains

HAb18G/CD147 is a heavily glycosylated protein containing two immunoglobulin superfamily domains. Our previous studies have indicated that overexpression of HAb18G/CD147 enhances metastatic potentials in human hepatoma cells by disrupting the regulation of store-operated Ca2+ entry by nitric oxide (NO)/cGMP. In the present study, we investigated the structure-function of HAb18G/CD147 by transfecting truncated HAb18G/CD147 fragments into human 7721 hepatoma cells. The inhibitory effect of HAb18G/CD147 on 8-bromo-cGMP-regulated thapsigargin-induced Ca2+ entry was reversed by the expression of either C or N terminus truncated HAb18G/CD147 in T7721deltaC and T7721deltaN cells, respectively. The potential effect of HAb18G/CD147 on metastatic potentials, both adhesion and invasion capacities, of hepatoma cells was abolished in T7721deltaC cells, but not affected in T7721deltaN cells. Release and activation of matrix metalloproteinases (MMPs), MMP-2 and MMP-9, were found to be enhanced by the expression of HAb18G/CD147, and this effect was abolished by both truncations. Thapsigargin significantly enhanced release and activation of MMPs (MMP-2 and MMP-9) in non-transfected 7721 cells, and this effect was negatively regulated by SNAP. However, no effects of thapsigargin or SNAP were observed in T7721 cells, and expression of HAb18G/CD147 enhanced secretion and activation of MMPs at a stable and high level. Taken together, these results suggest that both ectodomain and intracellular domains of HAb18G/CD147 are required to mediate the effect of HAb18G/CD147 on the secretion and activation of MMPs and metastasis-related processes in human hepatoma cells by disrupting the regulation of NO/cGMP-sensitive intracellular Ca2+ mobilization although each domain may play different roles.

Diffuse axonal injury: detection of changes in anisotropy of water diffusion by diffusion-weighted imaging

Myelinated axons of white matter demonstrate prominent directional differences in water diffusion. We performed diffusion-weighted imaging on ten patients with head injury to explore the feasibility of using water diffusion anisotropy for quantitating diffuse axonal injury. We showed significant decrease in diffusion anisotropy indices in areas with or without signal abnormality on T2 and T2*-weighted images. We conclude that the water diffusion anisotropy index a potentially useful, sensitive and quantitative way of diagnosing and assessing patients with diffuse axonal injury.

Expression, immunolocalization, and functional activity of Na+/H+ exchanger isoforms in mouse endometrial epithelium

The luminal fluid microenvironment of the uterus is important for sperm capacitation and embryo development. In an attempt to understand the possible role of Na(+)/H(+) exchangers (NHEs) in uterine function, the mRNAs of different NHE isoforms as well as their subcellular localization (apical versus basolateral) and functional activity were investigated in mouse endometrial epithelial cells using reverse transcriptase-polymerase chain reaction (RT-PCR), immunohistochemistry, and intracellular pH (pH(i)) measurement techniques. The presence of NHE1, NHE2, and NHE4, but not NHE3 mRNAs were revealed by RT-PCR. Immunostaining showed that NHE1, NHE2, and NHE4 were present in both apical and basolateral membranes. The pH(i) recovery from intracellular acidification was Na(+)-dependent; however, the rate of pH(i) recovery depending on basolateral Na(+) was 12.4 times faster than that depending on apical Na(+). The Na(+)-dependent rate of pH(i) recovery was also inhibited by amiloride, indicating H(+) extrusion through NHEs; however, the amiloride sensitivity of the apical membrane was less than that of the basolateral membrane, suggesting the involvement of different types of NHEs in the two membranes. The results indicate that the basolaterally located NHE1, NHE2, and NHE4, in addition to participating in the homeostatic control of intracellular pH, may play a role in H(+) extrusion in order to achieve transepithelial HCO(3)(-) secretion. The apically located NHEs may be involved in mediating Na(+) absorption as alternatives of or complementary to epithelial Na(+) channels.

Organochlorine hydrocarbons in human breast milk collected in Hong Kong and Guangzhou

In southern China, the awareness of persistent organic pollutant contamination has been increasing as a considerable number of past studies in Hong Kong had reported their trail in the coastal sediments, green-lipped mussels, muscle and viscera of pond fish, and foodstuffs. Hence there is an urgent need to assess their existence, contamination profiles, and potential impact on the public. In the present study, a survey was conducted to examine p,p'-DDT, p,p'-DDE, beta-HCH, and PCB concentrations in human breast milk, one of the most reliable bioaccumulation indicators. Milk samples (115 from Hong Kong and 54 from Guangzhou), in the lactation period from 3-5 weeks were analyzed. The results demonstrated that the mean levels of p,p'-DDT (Hong Kong: 0.39; Guangzhou: 0.70 microg/g of fat), p,p'-DDE (2.48; 2.85), and beta-HCH (0.95; 1.11) were 2-15-fold higher when compared with studies conducted elsewhere ( i.e., United Kingdom, Germany, Sweden, Spain, and Canada), and in contrast the concentration of PCBs (0.035; 0.031) was about 10 times lower. When compared to a similar study conducted 10 years ago in Hong Kong ( p,p'-DDT 2.17 microg/g of fat, p,p'-DDE 11.67, beta-HCH 15.96, and PCB 0.64), a considerable reduction in the levels of their contaminations was observed. The drastic reduction in body burdens in 10 years' time is presumably the result of effective regulatory actions. It is worth noting that body burden correlated positively with maternal age (total DDT, r = 0.93; beta-HCH, r = 0.91; PCBs, r = 0.77) and with historical record of seafood consumption (total DDT, r = 0.89; beta-HCH, r = 0.98; PCBs, r = 0.91) (p < 0.001) and potential uptake of the POPs by breastfed infants may pose adverse health hazards.

Involvement of Na+-HCO3- cotransporter in mediating cyclic adenosine 3',5'-monophosphate-dependent HCO3- secretion by mouse endometrial epithelium

The present study investigated the involvement of Na+-HCO3- cotransporter in mediating cAMP-stimulated HCO3- secretion across the cultured mouse endometrial epithelium using the short-circuit current (I(SC)) technique and intracellular pH measurement. Forskolin stimulated a rise in the I(SC), 55.6% and 52.1% of which could be reduced by the removal of extracellular Cl- or by eliminating the contribution of Cl- secretion by bumetanide, an inhibitor of Na+-K+-2Cl- cotransporter, respectively. More than 80% reduction in the forskolin-induced I(SC) was obtained when both Cl- and HCO3- in the bath were removed or in HCO3--free solution with bumetanide, indicating that the I(SC) depended on both Cl- and HCO3-. The presence of the Na+ channel-blocker amiloride in the apical solution did not reduce the forskolin-induced I(SC); however, the I(SC) could be abolished by removing Na+ from the bathing solution, suggesting that the Cl-- and HCO3--dependent I(SC) was also dependent on basolateral Na+. The forskolin-stimulated I(SC) could be reduced 43.6% by removal of HCO3- and 47.9% by a Na+-HCO3--cotransporter inhibitor, dihydrogen-4,4'-didsothiocyanostilbene-2,2'-disulfonic acid (H2DIDS). The inhibitory effect of H2DIDS was observed in Cl--free solution, but not when HCO3- was removed, thus confirming its effect on HCO3--dependent transport. Intracellular pH measurements demonstrated that the recovery from cellular acidification depended on the presence of both basolateral Na+ and HCO3-, further indicating the involvement of Na+-HCO3- cotransporter. Reverse transcription-polymerase chain reaction experiments confirmed the expression of Na+-HCO3- cotransporter in the mouse endometrium. The results suggest that basolaterally located Na+-HCO3- cotransporter is involved in mediating cAMP-stimulated HCO3- secretion across the mouse endometrial epithelium.

Can saltwater toxicity be predicted from freshwater data?

The regulation of substances discharged to estuarine and coastal environments relies upon data derived from ecotoxicity tests. Most such data are generated for freshwater rather than saltwater species. If freshwater toxicity data are related to saltwater toxic effects in a systematic and predictable way, the former can be used to predict the latter. This would have economic advantages due to a reduction in toxicity testing of saltwater species. If toxicity data are plotted as species sensitivity distributions, four theoretical relationships between freshwater and saltwater can be envisaged. Examples show that each one of these relationships is supported by empirical data. These examples show that although there is considerable potential for freshwater to saltwater prediction, species parity and representativeness need to be examined for each chemical substance to avoid bias.

Survival, growth, metallothionein and glycogen levels of Nucella lapillus (L.) exposed to subchronic cadmium stress: the influence of nutritional state and prey type

Dogwhelks Nucella lapillus feed mainly on mussels and barnacles, and may experience periods of starvation. We report effects of nutritional state and prey type on the survival, growth, cadmium (Cd) accumulation, metallothionein (MT) induction and glycogen stores in N. lapillus exposed to Cd in water. Adult dogwhelks, with similar shell length (30.0+/-1.5 mm), were either starved or fed to satiation with barnacles Semibalanus balanoides, mussels Mytilus edulis or Cd-dosed M. edulis, and kept in filtered natural seawater (< 0.01 microg Cd 1(-1)) or Cd-contaminated (400 microg Cd 1(-1)) seawater for 80 days. Mortality and individual growth rate were determined. Cd, MT and glycogen were measured in different tissues. Prolonged starvation and exposure to Cd significantly reduced the survivorship of N. lapillus, but feeding could help dogwhelks to combat Cd toxicity and minimise mortality. Extended starvation also caused tissue wastage, leading to higher concentrations of Cd and MT in tissues, whereas fed animals increased in weight and had lower Cd and MT concentrations because of the tissue dilution effect. Prey type significantly affected growth rate of dogwhelks and indirectly influenced Cd accumulation, MT induction and glycogen stores. Eating mussels promoted better growth and higher glycogen reserves than eating barnacles. Individual growth rate decreased with increasing Cd accumulation. Cd-exposed survivors grew faster and consumed more than control animals, implying that these survivors may have better fitness and greater tolerance to Cd toxicity. The use of growth, condition index, MT and glycogen as biomarkers of environmental pollution are discussed. These results indicate a need to incorporate biological data including growth (or at least condition index) and prey type into biomonitoring programmes to allow sound interpretation.

Heparan sulfate proteoglycan expression in the optic chiasm of mouse embryos

Previous studies have demonstrated that heparan sulfate (HS) proteoglycans (PGs) regulate neurite outgrowth through binding to a variety of cell surface molecules, extracellular matrix proteins, and growth factors. The present study investigated the possible involvement of HS-PGs in retinal axon growth by examining its expression in the retinofugal pathway of mouse embryos by using a monoclonal antibody against the HS epitope. Immunoreactive HS was first detected in all regions of the retina at embryonic day (E) 11. The staining was gradually lost in the central regions and restricted to the retinal periphery at later developmental stages (E12--E16). Prominent staining for HS was consistently found in the retinal fiber layer and at the optic disk, indicating a possible supportive role of HS-PGs in axon growth in the retina. At the ventral diencephalon, immunostaining for HS was first detected at E12, before arrival of any retinal axons. The staining matched closely the neurons that are immunopositive for the stage-specific embryonic antigen 1 (SSEA-1). At E13 to E16, when axons are actively exploring their paths across the chiasm, immunoreactivity for HS was particularly intense at the midline. This characteristic expression pattern suggests a role for HS-PGs in defining the path of early axons in the chiasm and in regulating development of axon divergence at the midline. Furthermore, HS immunoreactivity is substantially reduced at regions flanking both sides of the midline, which coincides spatially to the position of actin-rich growth cones from subpial surface to the deep regions of the optic axon layer at the chiasm. Moreover, at the threshold of the optic tract, immunoreactive HS was localized to deep parts of the fiber layer. These findings indicate that changes in age-related fiber order in the optic chiasm and optic tract of mouse embryos are possibly regulated by a spatially restricted expression of HS-PGs.

Metallothionein induction and condition index of dogwhelks Nucella lapillus (L.) exposed to cadmium and hydrogen peroxide

It has been suggested that metallothionein (MT) not only can regulate essential metals and detoxify toxic metals, but that MT can also play a significant role as an antioxidant and can be induced by oxidative stresses other than metals. This study is aimed at investigating the effect of hydrogen peroxide (H2O2), and the combined effect of H2O2 and cadmium (Cd) on MT induction and condition index (CI) in dogwhelks Nucella lapillus. Adult male dogwhelks (27 +/- 1 mm in shell length) were exposed for 20 days to (1) control (filtered natural seawater only); (2), 0.50 ppm Cd; (3) 2.0 ppm H2O2 + 0.50 ppm Cd; (4) 1.0 ppm H2O2 + 0.25 ppm Cd; (5) 2.0 ppm H2O2; (6) 1000 ppm H2O2 or (7) 1000 ppm H2O2 + 0.50 ppm Cd. The concentration of MT in the Leiblein gland of N. lapillus was quantified using the silver saturation method. MT or MT-like proteins in the animals were induced by Cd (0.5 ppm), H2O2 (2.0 ppm) or Cd + H2O2, indicating that MT in this gastropod species can be induced by either metal or oxidative stresses. Exposure to high H2O2 (1000 ppm) alone or combined with Cd, and exposure to Cd (0.50 ppm) or H2O2 (2.0 ppm), resulted in significant weight loss, indicated by a reduction of CI. However, CIs of groups (3) and (4) were similar to that of the control suggesting that Cd antagonistically reduces toxicity caused by H2O2 since Cd-induced MT may have a protective function against hydroxyl radicals.

Overexpression of BMP-2/4, -5 and BMPR-IA associated with malignancy of oral epithelium

The aim of the present study was to determine the relationships between bone morphogenetic proteins (BMPs), BMP receptor type IA and carcinogenesis of oral epithelium. A retrospective study was performed on material obtained from oral mucosa, including nine cases of normal mucosa (NB), eight cases of nonspecific chronic inflammation (NCI), seven cases of hyperkeratosis (HK), five cases of squamous cell papilloma (SCP), 29 cases of squamous cell carcinoma (SCC) with various grades of differentiation and 10 cases of epithelium adjacent to carcinoma (EAC). Six cases of NB from hard palate (NHP) were chosen as a control group. The benign groups consisted of NCI, HK and SCP. The antibodies against BMP-2/4, -5, receptor BMPR-IA and purified bovine BMP (bBMP-McAb) were utilised using an immunocytochemical method. The results demonstrated that the immunostaining of BMP-2/4, BMP-5, BMPR-IA and bBMP-McAb was weak and not consistent in normal and benign groups. The immunoreactivity level was independent of the clinical and pathological grading of SCC. All cases of SCC showed positive staining for BMP-2/4, BMP-5, BMPR-IA and bBMP-McAb except for three cases and one case of SCC which negatively stained for BMP-2/4 and BMP-5, respectively. The staining intensity and proportion of the positively stained cells were markedly increased in SCC when compared with that of the normal and benign groups except for EAC. The metastatic carcinoma cells in lymph nodes were strongly and positively stained for BMP-2/4 and BMP-5 when compared with the primary lesions. Our results indicate that there was an overexpression of BMP-2/4, BMP-5, bBMP-McAb and BMPR-IA in the high-risk premalignant and malignant lesions of oral epithelium. Our findings suggest that BMP-2/4 and BMP-5 but not BMPR-IA might be involved in the metastasis of oral carcinoma cells.

International study of emergency department care for pediatric traumatic brain injury and the role of CT scanning

OBJECTS

Our objective was to investigate the use of CT and its relationship to head injury severity and age.

METHOD

The multi-center group International Study of Head Injury Project (ISHIP) serves as the administrative body for research design, data collection and analysis. This is a nonrandomized prospective study of longitudinal outcomes following examination and care in emergency department in five different countries. The subjects of our study were 4,690 children from birth to 15 years of age, all of whom were systematically evaluated. Each child was medically evaluated and categorized as to injury severity, mechanism of injury and findings on X-ray and CT scan. Follow-up interview and assessment was completed for comparison with the presenting clinical state.

RESULTS

CT scans were performed for 674 (14.3%) of the children: 438 scans were normal and 236 were abnormal (P<0.001). Of the children with abnormal CT scans, 23.3% had mild head injuries, 42.7% had moderate injuries, and 33.8% had severe injuries, as determined by the GCS. By age, 10.5% of the positive CTs were in children aged 0-2 years, 56.3% in 3- to 9-year-olds, and 33% in 10- to 15-year-olds; only in 2% of cases were both CT and X-ray positive.

CONCLUSIONS

The majority of children did not need significant medical intervention. Physicians ordered X-ray investigations more frequently than CT scanning. The use of X-ray to decide whether or not CT is necessary is not warranted. The implications of positive CTs in mild or moderate injuries were most noteworthy, as were age-related interactions with positive CT findings.

A possible role of p73 on the modulation of p53 level through MDM2

MDM2, one of the transcriptional targets of p53, can target p53 for degradation in a negative feedback loop. The p53-related protein p73, however, can bind to MDM2 but is not consequently down-regulated. Here we demonstrate that p73 could transactivate the MDM2 promoter in p53-null cell lines. In p53-null cell lines, the level of MDM2 was increased by p73 due to increases in transcription and protein stability of MDM2. In transient transfection assays, inhibition of the transcriptional activity of p73 required a higher amount of MDM2 than that of p53. This is probably due to the fact that MDM2 can target p53, but not p73, for degradation. We demonstrated further that the level of p53 could be altered by a cooperation between MDM2 and p73, but not by transcriptional inactive mutants of p73. Expression of p73 resulted in a reduction of the ectopically expressed p53 in transient transfections or of the endogenous p53 induced by Adriamycin- or UV-mediated damage. These reductions of p53 were likely to be due to an increase in MDM2-mediated proteolysis. These results suggest the possibility that different levels of p73 in the cell may act as a mechanism to modulate p53 responses after DNA damage and other stresses and that an increase rather than a decrease in p73 may play a role in tumorigenesis.

Outcomes of a population-based asthma management program: quality of life, absenteeism, and utilization

BACKGROUND

Despite the availability of the National Asthma Education Program (NAEP) guidelines since 1991, asthma remains inadequately managed. To improve quality of life, functional status, and self-management behavior of asthma patients, a large health maintenance organization (HMO) in California implemented an asthma management program in 1996.

OBJECTIVE

To evaluate the effectiveness of an asthma management program in an HMO setting.

DESIGN AND SETTING

Prospective study. Survey data from members who participated in the intervention program and data from members who received usual care were analyzed using propensity score technique.

RESULTS

A total of 1,043 asthma patients who responded both baseline and follow-up survey were included in the analysis. From baseline to followup, participants in the in-home intervention program reported significant improvement in functional status (improvements range from 0.2 to 7.2), daily use of steroid inhaler (+4.1%), daily peak flow meter use (+6.4%), self-reported knowledge of what to do for an asthma attack (+12.4%), and feeling that their asthma was under control (+10.8%). Absenteeism (-11.8%) and hospitalization due to asthma (-3.5%) were significantly reduced from baseline to follow-up. Participants did not report significant changes in overuse of beta2-agonists and emergency room visits due to asthma. In comparison with the asthmatic patients who received usual care (non-participants), participants had significantly greater improvement on daily use of steroid inhaler (+4.0% versus -6.0%), daily use of home peak flow meter (+6.4% versus 1.9%) and self-reported knowledge on what to do for an asthma attack (+12.4% versus +5.4%).

CONCLUSION

These findings suggest that population-based programs can improve functional status, increase self-monitoring and knowledge about asthma, and decrease absenteeism and hospitalization for asthma by directly providing asthmatic patients with educational materials and self-monitoring tools. Such "direct-to-consumer" outreach programs may help bridge the gap between NAEPs 1991 practice guidelines and the reality of current asthma management.

Studies on thallium toxicity, its tissue distribution and histopathological effects in rats

The distribution of thallium (Tl) in the body and its toxic effect on the histology and function of the liver and kidney of rats after Tl administration were investigated using biochemical and histopathological assays. Male albino rats exhibited a markedly dose-dependent increase in the serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at 16 h after an intraperitoneal injection of 30, 60 or 120 mg/kg Tl. The serum level of creatinine in the rats injected with 30 mg/kg Tl, elevated significantly after 4 days of administration. The distribution of Tl in the tissues of intoxicated rats was uneven. The content of Tl was found to be highest in the kidney, followed by ileum, stomach and liver. Histological examination demonstrated frequent occurrence of hepatocyte necrosis and vacuolation in the liver and pathological changes of renal tubules in the treated rats.

Induction of apoptosis by hexamethylene bisacetamide is p53-dependent associated with telomerase activity but not with terminal differentiation

The present study investigated the relationships amongst apoptosis, terminal differentiation and telomerase activity in human colon carcinoma cells. We found that hexamethylene bisacetamide (HMBA) induced apoptosis in human colon carcinoma LoVo cells harbouring wild-type p53 but not in SW1116 cells harbouring mutant p53. HMBA reduced telomerase activity in both colon carcinoma cells but it did not induce differentiation in the colon carcinoma cells. Taken together, our results suggest that HMBA can induce apoptosis via a p53-dependent pathway, but apoptosis and terminal differentiation may be separately regulated in LoVo cells. Inhibition of telomerase activity may activate apoptosis through a p53-dependent mechanism.

Disenrollment from an HMO and its relationship with the characteristics of Medicare beneficiaries

To examine the relationship between Medicare beneficiaries' characteristics and disenrollment, a longitudinal study was conducted in an HMO in California. Approximately 10 percent of the Medicare beneficiaries disenrolled within the first year of enrollment. There was no difference between those who continuously enrolled and those who disenrolled in terms of age, gender, mental and physical health status, previous utilization, and anticipated utilization in the coming year. However, people with limited social activities and people not living in a single-family house were more likely to disenroll. The authors also examined the disenrollment rates among physicians groups. The rates were significantly different.

Trucut needle biopsy through superior orbital fissure for the diagnosis of rabies

Necropsy diagnosis of rabies can be done by taking a brain biopsy specimen with a trucut needle inserted through the superior orbital fissure into the cranial cavity. This technique reduces the number of personnel who require post-exposure prophylaxis and avoids full necropsy if the deceased's relatives are opposed.

Diabetes and disenrollment in a health maintenance organization setting: a 4-year longitudinal study with a matched cohort

OBJECTIVE

The increasing enrollment of Medicare beneficiaries in health maintenance organizations (HMOs) in recent years has caused concern about whether HMOs and their providers have created an unfavorable environment for members who are chronically ill. This study was designed to examine whether there are any differences in disenrollment rates among enrollees with diabetes and enrollees without diabetes.

RESEARCH DESIGN AND METHODS

This was a 4-year longitudinal follow-up study with a matched cohort. Medicare beneficiaries (aged > or =65 years) with diabetes identified through pharmacy records in 1994 were matched with a comparison group according to age, sex, comorbidities, and type of provider groups in an HMO in California.

RESULTS

The overall distribution of the characteristics of members in the diabetic and matched nondiabetic group is almost identical. The matched-pair chi2 tests indicated that there were no statistical differences in disenrollment rates between diabetic and nondiabetic members during all three follow-up periods (P = 0.16-0.85).

CONCLUSIONS

We found that the HMO members with diabetes did not disenroll from the HMO at a higher rate than those without diabetes. The findings should alleviate some of the concern that HMOs and their contracted providers have created an unattractive environment for members who have chronic diseases such as diabetes.

International Multicenter Study of Head Injury in Children. ISHIP Group

With the object of evaluating different epidemiological factors in the acute phase of head injury (HI) in the pediatric age group in five countries (Argentina, Brazil, France, Hong-Kong and Spain), we carried out a prospective and descriptive study, in which we analyzed the clinical and radiological risk factors versus management and outcome 7-30 days after trauma. We included all children seen in the emergency department and hospitalized who were aged between 0 and 15 years and had sustained HI. Data were compiled from the clinical records and analyzed for neurological evaluation with the Glasgow Coma Scale (GCS) and the Glasgow Paediatric Coma Score (GPCS), and also by means of dynamics, symptoms, skull X-rays, CT scans. The total of 2478 patients enrolled in the study was made up of 60.9% boys and 39.1 % girls. Age distribution was as follows: 55.2% aged 0-4 years; 28.3% aged 5-9 years, and 16.4% aged 10-15 years. Most (75.3%, or 1768) of these patients completed follow-up. The total sample included 1058 children (42.7%) who required hospitalization. Skull fractures were identified in 11.8% (298) of the cases, and 6.4% (158) of CT scans were pathologic. Minor HI accounted for 56.4% of these children, moderate HI for 38.9%, and severe HI for the remaining 4.7%. The lethality rate was 1.6%. Our preliminary data reveal that it is very important for new guidelines on the treatment of minor HI to be prepared, because patients with minor HI had undergone the most skull X-rays and also most frequently been admitted to hospital for unnecessarily long periods of time, though the incidence of brain damage (1.6%) was lowest in this group of the study population. We intend to carry out a full analysis of the various risk factors at the end of the study.

Induction of metallothionein in dogwhelk Nucella lapillus during and after exposure to cadmium

Induction of metallothionein (MT) was investigated in a common biomonitor, the dogwhelk Nucella lapillus (shell length: 27.7+/-1.4 mm; wet tissue weight: 667+/-196 mg), during and after exposure to cadmium (Cd) under controlled laboratory conditions (10+/-1 degrees C and 34+/-1 per thousand salinity). The dogwhelks were exposed to 500 microg Cd l-1 (2.2% of 96 h LC50) for 60 days and then placed into clean seawater for 110 days. MT concentration in whole animal increased during the exposure period, peaked at Day 70, and then declined gradually. Half-life of MT was ca. 40 days. MT concentration increased very significantly with increasing Cd concentration (r=0.74, n=24, P<0.001). Nevertheless, Cd concentration increased throughout the period of exposure and while in clean seawater, leveling off only after Day 120, indicating that Cd concentration could not be regulated by N. lapillus. Throughout the study, MT and Cd concentrations in gills, Leiblein gland, kidney, digestive gland, and gonad tissues increased gradually. Highest concentrations of MT and Cd were found in the Leiblein gland. Measurement of MT induction in the Leiblein gland of N. lapillus may therefore prove useful as a sublethal biological response to Cd contamination.

Compliance with US asthma management guidelines and specialty care: a regional variation or national concern?

The objective of this study was to examine the compliance with the National Asthma Education Program (NAEP) guidelines among asthmatic members of eight health plans (regions) in seven states, as well as the factors related to the compliance. Information was gathered by means of a cross-sectional survey in a managed care environment. The participants were 6703 respondents (ages 14-65) with moderate or severe asthma. The main outcome measures were compliance with the NAEP guidelines on the use of inhaled steroids, inhaled beta2-agonists, peak flow measurement, and allergy evaluations. Among the results of this survey we found that although these health plans are located from the West Coast to the East Coast and the socioeconomic status of their members varied greatly, compliance with the NAEP guidelines was low among asthmatic members across all geographical regions. The major areas of low compliance identified were inappropriate pharmacological therapy, lack of objective measurement of lung function through peak flow meter, and insufficient environmental trigger control. The regression analyses indicated that the effect of the health plan explained little of the variation in compliance across these regions (only 0.3% at maximum). Low compliance was associated with young age, smoking, moderate asthma, being asthmatic for a few years, currently working, and being treated by a generalist rather than a specialist. In conclusion, this study showed that the compliance with the national guidelines for asthma care was consistently low across different geographical regions in the nation. Improvement in care for asthmatics will require greater commitment and involvement by all stakeholders including physicians, patients, health plans, and employers. We suggest a need for a national strategy to disseminate clinical guidelines not only to the medical community but also to patients themselves.

Effect of multiple patient reminders in improving diabetic retinopathy screening. A randomized trial

OBJECTIVE

To determine whether multiple mailed patient reminders can produce an increase in the rate of diabetic retinal examinations (DRE) over that seen with a single reminder.

RESEARCH DESIGN AND METHODS

All diabetic members > or = 18 years who were enrolled in a large network-based health maintenance organization (HMO) in California from August 1996 to July 1997 were identified using claims and pharmacy databases. Members who had no record of DRE in the HMO's claims database were then randomized into two groups. Both groups received mailed educational materials and a reminder to obtain the examination. Their physician groups also received a letter explaining the program, current guidelines for DRE, and a list of their diabetes patients with their DRE status. The single intervention group received no additional reminders. The multiple intervention group received additional reminders at 3, 6, and 9 months after baseline if they continued with no record of service, as determined from the claims database.

RESULTS

The study cohort comprised 19,523 diabetic members, which were randomized into single (n = 9,614) and multiple (n = 9,909) intervention groups. There was an increase in monthly DRE rates after the intervention in August 1996 for both intervention groups. After the second reminder was sent to the multiple intervention group, the percentage of diabetic members receiving DRE was higher than the single intervention group. Rates before and after the third intervention were not significantly different, nor were monthly differences found. There was a significant difference in overall annual DRE rates between the groups (P = 0.023).

CONCLUSIONS

Multiple patient reminders are more effective than single reminders in improving DRE rates in a managed care setting. However, the improvement noted was clinically small and appeared only after the second reminder; no incremental improvement was seen with additional reminders. Resources used for multiple reminders aimed at diabetic retinopathy might better be spent on other approaches to reducing complications of diabetes.

Expression of risk factors for breast cancer in women younger than 49

The definition of women younger than 49 who are at increased risk for breast cancer would enable intensified efforts in surveillance and use of preventive measures for this group. In this survey of 32,123 members of Health Net, an increased risk for breast cancer was related to age, breast cancer in the immediate family (mother, sister), and previous biopsies for cystic lesions of the breast. No increased risk was related to menarche, nulliparity, first pregnancy after age 30, or breast feeding.

Patients with newly diagnosed carcinoma of the breast: validation of a claim-based identification algorithm

The objectives of this study were to validate a claims-based algorithm for identification of patients with newly diagnosed carcinoma of the breast and to optimize the algorithm. Claims data from all females aged 21 years or older who enrolled in a large California health maintenance organization during the study period from October 1, 1994 through March 31, 1996 were analyzed. Medical records of the patients identified through the claims-based algorithm were reviewed to determine whether the patients were correctly identified. The initial algorithm had a positive predictive value of 84% which was similar to the previous study. The percentages of correct identification significantly increased with the patient's age at diagnosis. Other patient demographic characteristics and facility characteristics were not related to the accuracy of the identification. Using a classification tree procedure and additional information from the false-positive cases, the initial algorithm was modified for improvement. The best-modified algorithm had a positive predictive value of 92% while only 0.5% (4/837) of the true-positive cases were excluded. The results once again demonstrated that patients with newly diagnosed carcinomas of the breast can be identified using claims data. These databases provide an efficient and effective tool for performing health services studies on large patient populations.

Mercury and organochlorine exposure from fish consumption in Hong Kong

The average person in Hong Kong consumes fish or shellfish four or more times a week averaging about 60 Kg of fish per year. Even though the mean mercury level in store-bought Hong Kong fish was only 0.12 mg/kg, corroborating evidence is presented from numerous studies to support the view that mercury bioaccumulates. By the time a typical Hong Kong male reaches 30 years of age he will have accumulated approximately 4 mg/kg mercury in his hair. By age 60, his hair mercury levels will have increased to about 7.5 mg/kg. Hair is a useful indicator of mercury exposure. In the U.S. over a million hair samples have been examined for mercury (mean, 1.5 mg/kg). The mean hair mercury concentration for over 200 Hong Kong residents was 3.3 mg/kg which is more than double the U.S. mean (well over one standard deviation above the U.S. mean). Two lines of evidence support the hypothesis that fish is the major source of methyl mercury in the diet of Hong Kong residents. 1. Individuals consuming 4 or more meals of fish per week had a hair mercury of 4.07 mg/kg dry weight of hair while those consuming fish less frequently had significantly lower levels (2.56 mg/kg). 2. Hong Kong residents that consume no fish had only 0.38 mg/kg hair mercury. The World Health Organization has adopted the U.S. EPA levels for mercury and recommends that food with mercury concentrations of 0.5 mg/kg or more should not be sold for human consumption. Data presented in this paper are consistent with the notion that adoption of a 0.3 mg/kg mercury guideline would benefit residents in countries where rates of fish consumption are significantly higher than in the U.S. Japan, for example, has already adopted a 0.3 mg/kg mercury guideline. In Hong Kong there is a significant correlation (p < 0.05) between male subfertility and the level of mercury in the hair of males between the ages of 25 and 75. Our study of individuals who have been eating mercury contaminated fish steadily for many years suggests that a daily mercury intake of only 0.3 to 0.7 mg/kg body weight may be sufficient to inhibit spermatogenesis in some Hong Kong males. Male subfertility has been correlated with both elevated mercury and the presence of various organochlorines in the diet. To determine whether fish sold in Hong Kong with elevated levels of mercury also had elevated levels of organochlorines we analyzed fish for both mercury and organochlorine content of their dorsal muscle tissue. Because analysis of fish tissue for lipids and a wide range of organochlorines is both very time consuming and expensive, only 15 different species of fish were tested. Organochlorine concentrations were low and there was no correlation between mercury and organochlorine in the 15 fish tested for both organochlorines and mercury. As a result of these tests we concluded that mercury could not be ruled out as the principal causal factor associated with the lack of fertility in Hong Kong males.

Early prognostic indicators in primary perinatal human immunodeficiency virus type 1 infection: importance of viral RNA and the timing of transmission on long-term outcome

The time of perinatal human immunodeficiency virus type 1 (HIV-1) transmission and the pattern of early plasma viremia as predictors of disease progression were evaluated in infected infants followed from birth. Cox proportional hazards modeling demonstrated that a 1-log higher HIV-1 RNA copy number at birth was associated with a 40% increase in the relative hazard (RH) of developing CDC class A or B symptoms (P = .004), a 60% increase in developing AIDS (P = .01), and an 80% increase in the of risk death (P = .023) over the follow-up period of up to 8 years. The peak HIV-1 RNA copy number for infants during primary viremia was also predictive of progression to AIDS (RH, 9.9; 95% confidence interval [95% CI], 1.8-54.1; P = .008) and death (RH, 6.9; 95% CI, 1.1-43.8; P = .04). The results indicate that high levels of HIV-1 RNA at birth and during primary viremia are associated with early onset of symptoms and rapid disease progression to AIDS and death in perinatally infected children.

Highly stable differential phase optical interferometer using rotating Ronchi gratings

We describe a dual-beam differential phase interferometer that performs direct phase measurement by using a rotating Ronchi grating filter. Two laser beams derived from a single source are focused onto the sample surface. The reflected light will retrace the same path and intersect at the back focus of the objective lens. Interference between the reflected rays will therefore produce intensity fringes with their spatial location governed primarily by the differential optical phase of the probes. When the fringes are projected onto a rotating grating filter with identical periodicity, the transmitted optical signal becomes an oscillating signal from which the optical phase can be measured by standard phase-sensitive techniques. This approach has the advantages of simple system configuration, effective isolation from environmental disturbance, and low-frequency operation, which permit the use of high impedance electronics with shot-noise-limited performance at low laser power.

Axillary node dissection in ductal carcinoma in situ

Intraductal carcinoma of the breast has become a well-defined entity that has been more frequently diagnosed since the introduction of mammography. For many years, the usual treatment has been mastectomy, often with axillary lymph node dissection. Concurrent with documentation that breast conservation treatment has been effective for many invasive breast cancers, such treatment has been introduced for noninvasive breast cancers (ductal carcinoma in situ and lobular cancer in situ). However, there is no basis for axillary dissection because tumor cells are contained by the basement membrane and should not metastasize. In this study, 107 axillary dissections were carried out, with an average of 20 nodes identified, and a single metastasis was identified.

Compliance with national asthma management guidelines and specialty care: a health maintenance organization experience

BACKGROUND

To improve asthma disease management, the National Asthma Education Program (NAEP) Expert Panel published Guidelines for the Diagnosis and Management of Asthma in 1991.

OBJECTIVES

To compare the current status of asthma disease management among patients in a large health maintenance organization with the NAEP guidelines and to identify the factors that may be associated with medical care (eg, emergency department visits and hospital admissions) and adherence to the guidelines.

METHODS

Analyses of 1996 survey data from 5580 members with asthma (age range, 14 to 65 years) covered by a major health maintenance organization in California (Health Net).

RESULTS

In general, adherence to NAEP guidelines was poor. Seventy-two percent of respondents with severe asthma reported having a steroid inhaler, and of those, only 54% used it daily. Only 26% of respondents reported having a peak flowmeter, and of those, only 16% used it daily. Age (older), duration of asthma (longer), increasing current severity of disease, and treatment by an asthma specialist correlated with daily use of inhaled steroids. Ethnicity (African American and Hispanic) correlated negatively with inhaled steroid use but positively with emergency department visits and hospital admissions for asthma. Increasing age and treatment by an asthma specialist were also identified as common factors significantly related to the daily use of a peak flowmeter and, interestingly, to overuse of beta2-agonist metered-dose inhalers.

CONCLUSIONS

Although the NAEP guidelines were published 7 years ago, compliance with the guidelines was low. It was especially poor for use of preventive medication and routine peak-flow measurement. Furthermore, the results showed that asthma specialists provided more thorough care than did primary care physicians in treating patients with asthma. Combining the results of the regression analyses revealed that some of the variation in rates of emergency department visits and hospitalizations among some subpopulations can be explained by the underuse of preventive medication. This study serves the goal of documenting the quality of care and services currently provided to patients with asthma through a large health maintenance organization and provides baseline information that can be used to design and assess effective population-based asthma disease management intervention programs.