Assessing oral health and the minimally important differences in oral health-related quality of life of non-diabetic and diabetic patients: a cross-sectional study

BACKGROUND

Non-diabetics and diabetics might have different oral health problems and impacts on their oral health-related quality of life (OHRQoL). Comparison of oral health status and coping strategies between these patients, and evaluation of factors associated with OHRQoL might facilitate better treatment planning for improved patient-centred outcome.

METHODS

One hundred and eleven non-diabetics and 107 diabetics attending a public hospital were clinically examined and evaluated for coping strategies (abbreviated coping orientation to problems experienced) and OHRQoL [short-form oral health impact profile (OHIP-14S)]. Factors associated with OHRQoL were analysed through correlation/partial correlation. Minimally important differences (MID) of OHIP-14S were calculated to confirm associations between attachment loss, caries, and tooth loss with OHRQoL.

RESULTS

Non-diabetics had worse periodontal status. Diabetics had more missing teeth. Non-diabetics and diabetics employed maladaptive coping to manage oral health problems. Overall, non-diabetics reported worse OHRQoL. Determination of MID showed that non-diabetics with high-severe attachment loss and <20 teeth experienced poorer OHRQoL. Diabetics with caries, high-severe attachment loss, and <25 teeth experienced poorer OHRQoL.

CONCLUSION

Different factors were associated with OHRQoL of non-diabetics and diabetics. Delivery of treatment aimed at maintaining teeth in a periodontally healthy and caries free state, and provision of more chewing units might help improve OHRQoL of diabetics. © 2024 Australian Dental Association.

Validation of the Chinese Version of Dementia Quality of Life Measure - Proxy in Care Home Residents with Dementia

OBJECTIVE

To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy).

METHODS

Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. The original DEMQoL-Proxy was translated into Chinese (Cantonese) by a trained translator. The forward-translated version was reviewed by an expert panel of six experienced healthcare professionals. Revisions were made based on comments. The instrument was back-translated to English to check whether further changes were necessary. Demographic data (age, sex, type and severity of dementia, and Mini-Mental State Examination [MMSE] score) were collected from medical records of participants with dementia. Caregivers were interviewed by an occupational therapist or personnel supervised by the occupational therapist using the C-DEMQoL-Proxy and the Chinese version of Quality of Life-Alzheimer's Disease-Proxy (C-QoL-AD-Proxy). Acceptability, reliability, and validity of the C-DEMQoL-Proxy were evaluated using standard psychometric methods.

RESULTS

90 individuals (82.2% women) with dementia aged 72 to 102 years were included. Their diagnosis included Alzheimer's disease (23.3%), vascular dementia (15.6%), mixed and other types of dementias (51.1%), and missing (10%). Severity was mild in 12.2%, moderate in 62.2%, and severe in 25.6%. The mean MMSE score was 12.0 ± 4.9. 20% of the caregivers were family members and the rest were professional carers. The C-DEMQoL-Proxy had good acceptability, with no floor or ceiling effects or missing data. It had good internal consistency (Cronbach alpha = 0.91) and test-retest reliability (intraclass correlation coefficients = 0.83). It was mildly correlated with C-QoL-AD-Proxy (r = 0.29, p < 0.01). Age and sex were not correlated with C-DEMQoL-Proxy scores. C-DEMQoL-Proxy scores were not significantly different between dementia types, severity levels, or between those with higher or lower MMSE scores.

CONCLUSION

The C-DEMQoL-Proxy is a valid and reliable instrument to assess health-related quality of life in individuals with dementia.

[An athletic man with a swollen arm]

A 28-year-old male was referred to our emergency department with a swollen left arm after intensive exercise. Physical examination revealed distension of the superficial veins of his left arm and chest. Duplex ultrasound confirmed the diagnosis of Paget-Schroetter syndrome. He was successfully treated with thrombolysis and first rib resection.

Effect of soft segment crystallization and hard segment physical crosslink on shape memory function in antibacterial segmented polyurethane ionomers

Shape memory polyurethane (SMPU) ionomers containing constant 75 wt.% soft segment content were synthesized using poly(epsilon-caprolactone)diol, 4,4'-diphenylmethane diisocyanate, 1,4-butanediol and/or N,N-bis(2-hydroxyethyl)-isonicotinamide. To introduce substrate bonding antibacterial activity, pyridinium was prepared through a neutralization reaction using 1-iodooctane as neutralization agent. For the SMPU ionomer film obtained, tensile testing at 70 degrees C and dynamic mechanical analysis suggests that, at temperatures>T(ms) (the melting point of soft segments), 6.72 and 29.55 mol.% pyridinium within hard segments significantly decreased the mechanical properties such as the stress at 100% elongation (70 degrees C), the initial modulus (70 degrees C) and the elastic modulus (75-110 degrees C). Cyclic tensile investigation demonstrated that the two factors, soft segment crystallization and hard segment physical crosslink, play a very important role in shape memory function in SMPU ionomers. For the each individual specimen, the fixity ratio increased, and the recovery ratio decreased with the extension of cooling time. After sufficient cooling time, the fixity ratio of all specimens can reach a high value (approximately 95%). Owing to the disrupted physical crosslink in the sample containing 29.55 mol.% pyridinium, the crystallization rate of soft segments has less effect on shape fixity. Therefore, a high fixity ratio (93.8%) can be achieved in a short cooling time (30 s). In the control sample, the fixity ratio is only 73.7% after 30 s cooling. In addition, the admirable substrate bonding antibacterial activity of prepared SMPU ionomers was verified using standards AACTT 147 and ASTM E2149 in comparison with the control sample. The antibacterial activity of SMPU ionomers on Gram-positive bacteria (Staphylococcus aureus) is significant, and the rate of reduction of bacteria is 100%; the antibacterial activity on Gram-negative bacteria (Klebsiella pneumoniae) increases from 83.6% to 90.7% with increase in pyridinium content from 6.72 to 29.55 mol.%.

Primary ion fluence dependence in time-of-flight SIMS of a self-assembled monolayer of octadecylphosphonic acid molecules on mica discussion of static limit

By using a self-assembled monolayer of octadecylphosphonic acid molecules, CH3(CH2)17PO(OH)2, on mica as a model of the “soft” materials, such as self-assembled monolayers (SAMs) and multilayers in many biological systems as well as artificially engineered molecular electronic systems, we have examined the effects of primary ion fluence on time-of-flight secondary ion mass spectrometry (TOF-SIMS) of the technologically important model. Our measurements clearly show that although the intensity per unit primary ion fluence of most atomic ions and many small fragment ions do not vary by more than 10% for the fluence range of 1010–1013 cm–2, the intensity of the parent molecular ion can drop by two orders of magnitude in this fluence range. While the changes are different for the primary ion beams of Bi3+ (25 keV, 45°), Bi+ (25 keV, 45°), and Ar+ (8 keV, 45°), they are all substantial, with the damage cross section induced by the Bi3+ beam being the largest (6 000 Å2). Since different secondary ions have quite different intensity changes, the analytical results derived from TOF-SIMS can vary significantly by the time and duration of the measurements in the TOF-SIMS experiment. Therefore, our results suggest that for TOF-SIMS of molecular layers such as SAMs, the primary ion fluence condition should be recorded and reported. In general, the validity of the static condition becomes questionable when the cumulative primary ion fluence exceeds 1 × 1011 cm–2.Key words: SIMS, static SIMS, TOF-SIMS, soft materials, self-assembled monolayer, bilayer, surface of biological materials.

Use of at-line spectrophotometry for the rapid definition of pilot-scale flocculation processes

Traditionally most downstream bioprocesses have been operated without real-time knowledge of product and key contaminants, yielding little confidence in their operation and the impact on subsequent operations. A rapid UV-vis spectral prediction technique has been successfully demonstrated for the at-line characterization of a large scale continuous flocculation process in terms of RNA, key protein contaminants, and cell debris. A comparison was made between the spectral predictions and retrospective wet chemical assays, and a highly linear correlation was obtained. The spectral analysis technique allowed for real-time system information, which was applied to control the flocculation process to maintain satisfactory process performance, even when subjected to given possible process disturbances.

Induction of apoptosis in 9-nitrocamptothecin-treated DU145 human prostate carcinoma cells correlates with de novo synthesis of CD95 and CD95 ligand and down-regulation of c-FLIP(short)

Stimulation of CD95 leads to oligomerization of this receptor and the recruitment of the Fas-associated death domain (FADD) and procaspase-8 to form the death-inducing signaling complex (DISC). Subsequent proteolytic activation of caspase-8 at the DISC leads to the activation of downstream caspases and execution of apoptosis. The anticancer drug 9-nitrocamptothecin (9NC) inhibits the nuclear enzyme topoisomerase I (Top1), an event followed by apoptosis of cancer cells. We investigated whether other mechanisms downstream of the DNA-Top1-9NC complexing step regulate the apoptotic ability of 9NC in DU145 cells. We demonstrate that induction of apoptosis in DU145 cells, upon exposure to 9NC, is associated with de novo expression of CD95 and CD95L, suggesting that 9NC-induced apoptosis is mediated by the CD95 system. In this line, we observed early activation of procaspase-3, -7, and -8, but not -1, -9, and -10. Moreover, 9NC treatment resulted in the dramatic down-regulation of c-FLIP(short) expression, but not that of c-FLIP(long) or FADD. Furthermore, incubation of DU145 cells with a neutralizing antibody (NOK-1) to CD95L or transient transfection of a c-FLIP(short) expression vector into DU145 cells partially abrogated 9NC-triggered apoptosis. We propose that 9NC triggers apoptosis by driving DU145 cells from a nonapoptotic status (c-FLIP(short)(high), CD95(low), CD95L(low)) toward a proapoptotic status (c-FLIP(short)(low), CD95(high), CD95L(high)). These findings indicate that in addition to a Top1-mediated effect, 9NC can additionally activate a CD95/CD95L-dependent apoptotic pathway.

Mechanism of suppression of the Raf/MEK/extracellular signal-regulated kinase pathway by the raf kinase inhibitor protein

We have recently identified the Raf kinase inhibitor protein (RKIP) as a physiological endogenous inhibitor of the Raf-1/MEK/extracellular signal-regulated kinase (ERK) pathway. RKIP interfered with MEK phosphorylation and activation by Raf-1, resulting in the suppression of both Raf-1-induced transformation and AP-1-dependent transcription. Here we report the molecular mechanism of RKIP's inhibitory function. RKIP can form ternary complexes with Raf-1, MEK, and ERK. However, whereas MEK and ERK can simultaneously associate with RKIP, Raf-1 binding to RKIP and that of MEK are mutually exclusive. RKIP is able to dissociate a Raf-1-MEK complex and behaves as a competitive inhibitor of MEK phosphorylation. Mapping of the binding domains showed that MEK and Raf-1 bind to overlapping sites in RKIP, whereas MEK and RKIP associate with different domains in Raf-1, and Raf-1 and RKIP bind to different sites in MEK. Both the Raf-1 and the MEK binding sites in RKIP need to be destroyed in order to relieve RKIP-mediated suppression of the Raf-1/MEK/ERK pathway, indicating that binding of either Raf-1 or MEK is sufficient for inhibition. The properties of RKIP reveal the specific sequestration of interacting components as a novel motif in the cell's repertoire for the regulation of signaling pathways.

Effect of aftermarket automobile window tinting films on driver vision

This study was conducted to determine the level of automobile window tint that causes a significant reduction of vision for automobile drivers. Contrast sensitivity was measured on 20 participants, of whom 10 were age 20 to 29 years and 10 were age 60 to 69 years, through a stock automobile window (control) and two windows darkened with plastic film. For the younger drivers, a car window with 37% transmittance did not significantly reduce contrast sensitivity, but a darker tint of 18% transmittance reduced contrast sensitivity at higher spatial frequencies. For the older drivers, a tint of 37% transmittance significantly reduced mid-to- high spatial frequency contrast sensitivity. The typical state standard (no tint with less than 35% transmittance) would thus seem to be appropriate for younger drivers; however, further examination of the standard may be necessary in regard to older drivers. Actual or potential applications of this research include guidelines and regulations regarding tinting of automobile windows.

Suppression of Raf-1 kinase activity and MAP kinase signalling by RKIP

Raf-1 phosphorylates and activates MEK-1, a kinase that activates the extracellular signal regulated kinases (ERK). This kinase cascade controls the proliferation and differentiation of different cell types. Here we describe a Raf-1-interacting protein, isolated using a yeast two-hybrid screen. This protein inhibits the phosphorylation and activation of MEK by Raf-1 and is designated RKIP (Raf kinase inhibitor protein). In vitro, RKIP binds to Raf-1, MEK and ERK, but not to Ras. RKIP co-immunoprecipitates with Raf-1 and MEK from cell lysates and colocalizes with Raf-1 when examined by confocal microscopy. RKIP is not a substrate for Raf-1 or MEK, but competitively disrupts the interaction between these kinases. RKIP overexpression interferes with the activation of MEK and ERK, induction of AP-1-dependent reporter genes and transformation elicited by an oncogenically activated Raf-1 kinase. Downregulation of endogenous RKIP by expression of antisense RNA or antibody microinjection induces the activation of MEK-, ERK- and AP-1-dependent transcription. RKIP represents a new class of protein-kinase-inhibitor protein that regulates the activity of the Raf/MEK/ERK module.

A PCR assay for discriminating Neisseria gonorrhoeaebeta-lactamase-producing plasmids

Oligonucleotide primers were developed for use in polymerase chain reaction (PCR) assays to differentiate three related, epidemic beta-lactamase-producing plasmids of Neisseria gonorrhoeae-the Asia-(7426 bp), Africa-(5599 bp) and Toronto-(5154 bp) type plasmids. One-hundred and two N. gonorrhoeae isolates with different plasmid profiles were tested-16 isolates carried the Asia plasmid, 41 isolates contained the Africa plasmid, 16 isolates contained the Toronto plasmid and 29 isolates contained no beta-lactamase-producing plasmids. Most (101/102) isolates also carried the gonococcal cryptic plasmid, while 27/102 and 44/102 isolates carried either the transfer plasmid or the tet M-containing plasmids, respectively. The assay was 100% sensitive and specific for identifying the correct plasmid type. This assay is useful for rapidly detecting the presence of gonococcal beta-lactamase-producing plasmids in clinical samples and discriminating them for epidemiological typing.

CT appearance of ectopic pancreas: a case report

The appearance of ectopic pancreas on computed tomography (CT) is described in a 47-year-old man with bowel obstruction. The enhancement pattern of ectopic pancreas after intravenous iodine contrast administration is the same as that of leiomyoma or carcinoid. This CT finding has not been reported previously to our knowledge.

The reliability and validity of an obstacle course as a measure of gait and balance in older adults

The use of an obstacle course to quantify gait, balance and functional mobility in elderly persons, particularly to assess objectively changes following exercise and rehabilitation interventions, has not been extensively developed or tested. In this study, we describe an 18-item obstacle course developed as an outcome measure for an exercise intervention among fall-prone elderly men. Reliability and validity of the obstacle course was tested in a group of 58 community-living elderly men (mean age = 75 years). Each subject's performance was videotaped and timed. The videotapes were scored by a physical therapist and a physician. Inter-rater reliability between the raters was high (Kappa = 0.96, p < 0.0001). Both the obstacle course score and time correlated significantly with gait velocity, a 6-minute walk test, and a performance-oriented instrument of gait and balance. Obstacle course scores showed significant improvement among the most impaired subjects, but not among higher functioning subjects following a 3-month exercise intervention. These results suggest that an obstacle course may be a useful and valid method for measuring outcomes related to mobility tasks in selected elderly populations. Further work is needed to determine in which populations, and for which outcomes, an obstacle course is better than simpler performance-based measures.

Functional dissection of a human Dr1-DRAP1 repressor complex

The heterotetrameric Dr1-DRAP1 transcriptional repressor complex was functionally dissected. Dr1 was found to contain two domains required for repression of transcription. The tethering domain interacts with the TATA box binding protein and directs the repressor complex to the promoter. This tethering domain can be replaced by a domain conferring sequence-specific recognition to the repressor complex. In the absence of the tethering domain, Dr1 interacts with its corepressor DRAP1, but this interaction is not functional. The enhancement of Dr1-mediated repression of transcription by DRAP1 requires the tethering domain. The second domain of Dr1 is the repression domain, which is glutamine-alanine rich. A 65-amino-acid polypeptide containing the repression domain fused to the Ga14 DNA binding domain repressed transcription when directed to TATA-containing and TATA-less promoters. This repression domain was also found to functionally and directly interact with the TATA box binding protein.

Requirement of a corepressor for Dr1-mediated repression of transcription

A Dr1-associated polypeptide (DRAP1) was isolated from HeLa cells and found to function as a corepressor of transcription. Corepressor function requires an interaction between DRAP1 and Dr1. Heterodimer formation was dependent on a histone fold motif present at the amino terminus of both polypeptides. Association of DRAP1 with Dr1 results in higher stability of the Dr1-TBP-TATA motif complex and precluded the entry of TFIIA and/or TFIIB to preinitiation complexes. DRAP1 was found to be expressed in all tissues analyzed with higher levels in tissues with a low mitotic index. Analysis of DRAP1 in the developing brain of rat demonstrated undetectable levels of DRAP1 in actively dividing cells but high levels of DRAP1 expression in differentiated non dividing cells. Dr1 was immunodetected in all cells analyzed. A model for DRAP1-dependent, Dr1-mediated repression of transcription is proposed.

Clinical experience with piggyback contact lens systems on keratoconic eyes

BACKGROUND

A piggyback contact lens system (PBCLS) is used when traditional lenses do not provide optimal vision or tolerance. This study assessed the use of PBCLS in keratoconic patients.

METHODS

The charts of 205 keratoconic patients were retrospectively reviewed and 16 patients wearing PBCLS were identified. Visual acuity, average wearing time, and ocular complication data with PBCLS were analyzed.

RESULTS

Vision and average lens wearing time were stable, if not improved, for the 16 patients when the data was compared to the patients' wear of rigid gas permeable contact lenses. Although two patients developed neovascularization and one patient developed giant papillary conjunctivitis, all pre-existing corneal complications resolved with PBCLS wear. Average Dk/L through the center and mid-periphery of the PBCLS were 8.4 +/- 1.2 x 10(-9) (mean +/- standard deviation) and 4.5 +/- 1.8 x 10(-9) cm2ml O2/sec ml mmHg (mean +/- standard deviation) respectively. No gross corneal edema was noted upon slit lamp observation.

CONCLUSIONS

PBCLS can be beneficial in the management of keratoconus.

Angiosarcoma following treatment of testicular seminoma: case report and literature review

We report a case of paravertebral angiosarcoma 10 years after treatment for testicular seminoma. The patient underwent irradiation treatment to areas including the mediastinum. Tumor induction by therapeutic irradiation remains the most likely etiology. Other possibilities include a natural association between seminoma and angiosarcoma, and perhaps the use of chemotherapy.

Reconstitution of human TFIIA activity from recombinant polypeptides: a role in TFIID-mediated transcription

Human TFIIA activity is composed of three subunits (alpha, beta, gamma). Here we report the isolation of a human cDNA clone encoding the gamma-subunit and the reconstitution of TFIIA activity from recombinant polypeptides (holo-TFIIA). Protein-protein interaction analysis established that the beta and gamma subunits of TFIIA interact with the TBP component of TFIID. The alpha-subunit is recruited into the complex by association with the gamma-subunit. Functional studies indicate that recombinant TFIIA stimulates basal TFIID-dependent transcription but is without effect on TBP-dependent transcription. Our studies indicate that TFIIA not only functions by physically removing negative components present in TFIID (antirepression), as demonstrated previously, but that it can stimulate basal transcription through components of the TFIID complex. Holo-TFIIA also stimulated activation of transcription in vitro as well as in vivo in transfected HeLa cells.

Interaction of the Dr1 inhibitory factor with the TATA binding protein is disrupted by adenovirus E1A

Past experiments have shown that the adenovirus E1A12S product activates the hsp70 promoter, dependent on the TATA element and dependent on N-terminal E1A sequences. Other experiments have identified a factor termed Dr1 that interacts with and inhibits the transcriptional activity of the TATA-binding protein (TBP). We now find that the E1A12S protein can disrupt the interaction of the Dr1 factor with the TATA-specific TBP factor, allowing the productive interaction of TBP with TFIIA. This E1A-mediated disruption is dependent on N-terminal sequences that are also essential for the TATA-dependent trans-activation of the hsp70 promoter. Moreover, we also find that Dr1 expression in transfected cells can inhibit transcription from the hsp70 promoter and that this can be overcome by coexpression of the wild-type E1A protein, dependent on N-terminal sequences. We conclude that the activation of hsp70 through the TATA element may be mechanistically similar to the activation of the E2 promoter via E2F, in each case involving a release of a transcription factor from an inactive complex.

Simultaneous development of diffuse immunoblastic lymphoma in recipients of renal transplants from a single cadaver donor: transmission of Epstein-Barr virus and triggering by OKT3

Rapidly progressive diffuse immunoblastic lymphoma is an uncommon but devastating complication of organ transplantation that typically occurs early in the postoperative period. The fulminant course is characterized by progressive encephalopathy and coagulopathy, with malignant B-cell infiltration in the graft and other sites. Both de novo infection with Epstein-Barr virus (EBV) and treatment with the monoclonal antibody OKT3 have been implicated in the development of this disorder. We report two patients who received renal transplants from the same cadaver donor, with transmission of EBV from the same source, in whom treatment with OKT3 for acute rejection triggered the simultaneous development of fulminant and fatal B-cell immunoblastic lymphoma. We suggest that antilymphocyte agents be used with caution in EBV-seronegative graft recipients who receive a transplant from an EBV-seropositive donor to minimize the risk of this lethal complication.

Phase I combined modality clinical trial of alpha-2-interferon and radiotherapy

Sixteen patients were enrolled in a Phase I study of the combined use of recombinant DNA alpha-2-interferon (IFN) and radiation therapy, conducted at the Georgetown University Hospital (GUH) from February 1, 1984 to September 20, 1985. Escalating IFN doses ranging from 2.0 X 10(6) IU/m2 to 5 X 10(6) IU/m2 were administered to groups of six patients per IFN dose level. Three patients at each dose level were treated on a 5-day-a-week schedule and three patients were treated on a 3-day-a-week schedule. Significant toxicity including dehydration, infection, deep vein thrombosis, and myocardial infarction was noted throughout in patients receiving IFN five times per week, with eight of nine requiring hospitalization during the treatment course. There was one treatment-related death. In the five-times-per-week group, only 22% of patients tolerated the full initially planned IFN dosage and 44% tolerated the full initially planned radiation dosage, compared to 100 and 86%, respectively, in the three-times-per-week group. A tolerance dose and schedule of 5.0 X 10(6) IU/m2 of alpha-2-interferon administered subcutaneously three-times-per-week in conjunction with standard radiotherapy has been identified for use in future combined modality trials.

Kinetics of gallium nitrate, a new anticancer agent

Pharmacokinetic studies were conducted in 8 patients with disseminated neoplasms refractory to conventional chemotherapy, who received gallium nitrate at doses of 300 to 600 mg/m2 intravenously in a phase I clinical trial. Gallium concentrations in biological fluids were determined colorimetrically. In patients with normal renal function, gallium showed a biphasic plasma disappearance with an initial half-life (t1/2) of 0.5 to 1.8 hr (mean 1.0) and a terminal t1/2 of 10.5 to 50.4 hr (mean 25.1). Gallium was distributed in total body water and often localized in some body compartment as evidenced by a volume of distribution ranging from 0.25 to 2.53 L/kg (mean 1.19). The total drug clearance from the plasma was 0.13 to 1.00 ml/kg/min (mean 0.65) in patients with normal renal function. Cumulative urinary excretion of gallium was 15% to 72% (mean 35%) of the administered dose in 24 hr (it fell to 23% in 8 days in a patient with acute oliguric renal failure). Gallium kinetics are altered in patients with acute renal dysfunction and in patients who have received multiple doses of gallium or other metal chemotherapy.

Idiopathic acquired sideroblastic anemia terminating in acute myelofibrosis: case report and review of leterature

Acute myelofibrosis is a rare but distinct accelerated variant of agnogenic myeloid metaplasia that is characterized by marked anemia, peripheral blood myeloblastosis and normoblastosis, a lack of teardrop poikilocytosis, and prominent myelofibrosis. There is usually no palpable hepatosplenomegaly or lymph node enlargement. The clinical course is remarkable short. We describe a 63-year-old man who presented with idiopathic acquired sideroblastic anemia and subsequently developed acute myelofibrosis. Intensive polychemotherapy with vincristine, cytosine arabinoside, and prednisone and a later trial of oxymetholone therapy were ineffective. He died 134 days after the diagnosis of acute myelofibrosis was established. The 11 previously reported cases of acute myelofibrosis are reviewed, and the relationships of acute myelofibrosis to other myeloproliferative disorders and to idiopathic acquired sideroblastic anemia are discussed.