[Analysis of clinical characteristics and treatment status of atopic dermatitis in a children's hospital in Beijing from 2015 to 2019]

To analyze the clinical characteristics and treatment status of atopic dermatitis (AD) in children in the outpatient department of a children's hospital in Beijing from 2015 to 2019. This study used a cross-sectional study method to retrospectively analyze the data of AD patients who visited the Dermatology outpatient department of Beijing Children's Hospital, Capital Medical University, from April 2015 to April 2019. A total of 1 926 AD patients aged 0-17.5 years old living in Beijing and its surrounding areas were included, and the general situation, severity and distribution of AD disease, clinical characteristics and severity of AD, relevant influencing factors of AD onset, AD disease prognosis and treatment status were recorded. SAS 9.4, SPSS19.0, and R software were used for data processing, and descriptive statistical analysis, Chi-square test, Analysis of Variance, and correspondence analysis were used for statistical analysis. The results showed that the male to female ratio of AD patients in children included in this study was 1.4∶1; 79.0% (1 522/1 926), 86.1%(1 658/1 926), 91.3%(1 758/1 926), and 97.3%(1 907/1 926) of AD onset at the age of 6 months, 1 year, 2 years, and 5 years, respectively; mild of AD patients accounted for 13.2% (255/1 926)(SCORAD score 0-24), moderate of AD patients accounted for 50.1%(965/1 926) (SCORAD score 25-50), and severe of AD patients accounted for 36.7% (706/1 926)(SCORAD score>50).The age of severe AD patients were younger than mild and moderate AD patients. The face, head, trunk, and lower limbs were common areas of onset for moderate to severe AD, while the hands, feet, and ears were common areas of onset for severe AD patients. Temperature changes, hot water factors, mental and emotional states, and spring and winter were the main aggravation factors of AD;35.2% (678/1 926) aggravated and 61.8% (1 191/1 926) persistent. The more frequent bathing, the less severity of AD disease (χ2=29.791,P<0.001); 28.0% (520/1 856) of AD patients have no moisturizing habits, which were correlated with the severity of AD disease (χ2=15.908, P<0.05); the proportion of combined treatment medications in children with moderate to severe AD was significantly higher than mild AD patients. In conclusion, the patients with AD who went to specialist clinics were mainly moderate to severe patients and developed disease before the age of 5 years from 2015 to 2019.The severity of AD were mainly moderate to severe, and most of these patients had poor disease control. Traditional treatment plans had limitations. Identifying the clinical characteristics and treatment status of childhood AD would help us to carry out more targeted prevention and management work.

Application of combined multimodal neuroimaging and video-electroencephalography in intractable epilepsy patients for improved post-surgical outcome prediction

AIM

To investigate the ability of a multidisciplinary approach that combines multimodal neuroimaging with video-electroencephalography (v-EEG) to predict post-surgical outcomes in patients with intractable epilepsy, and explore prognostic predictors for these patients.

MATERIALS AND METHODS

Fifty-eight patients with intractable epilepsy who underwent surgery between March 2016 and October 2019 were reviewed retrospectively. Demographic, clinical, v-EEG, neuroimaging, surgical, and regular follow-up seizure outcome data were collected. Forty-six patients with a follow-up of at least 12 months were graded by Engel scores. Univariate and multivariate analyses were applied to explore prognostic factors that could predict post-surgical seizure outcomes.

RESULTS

Of the 58 patients, 28 were males. The median age was 27 years, the median age at first seizure was 11 years, and the median duration of seizures was 10 years. The Kaplan-Meier log-rank test showed that regardless of whether the follow-up duration was considered, epilepsy type, v-EEG, PET/CT, image post-processing methods, and a multidisciplinary approach that combined multimodal imaging with v-EEG were all correlated with seizure outcomes. Multivariate analysis found that the multidisciplinary approach was an independent predictor of post-surgical outcomes in patients with intractable epilepsy (hazard ratio = 11.400, 95% confidence interval = 2.249-57.787, p=0.003).

CONCLUSIONS

The present study showed that the multidisciplinary approach could provide independent prognostic information for patients with intractable epilepsy undergoing surgery. This approach has strong potential for the easier selection of patients to undergo surgical treatment and accurate prognostication.

The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study

BACKGROUND

Dupilumab is an antibody against interleukin 4 receptor α, used in treating atopic dermatitis (AD).

OBJECTIVES

To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD.

METHODS

In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both Investigator's Global Assessment (IGA) score of 0-1 and a reduction from baseline of ≥2 points at week 16.

RESULTS

Overall, 165 patients (mean age: 30.6 years; 71.5% male) were randomized: 82 to dupilumab and 83 to placebo. At week 16, 26.8% of patients in the dupilumab group and 4.8% of patients in the placebo group achieved the primary endpoint (difference, 22.0%; 95% confidence interval [CI], 11.37-32.65%; p<0.0001). Compared with placebo, higher proportions of patients in the dupilumab group achieved ≥75% reduction in the Eczema Area and Severity Index score (57.3% vs 14.5%; difference, 42.9%; 95% CI, 29.75-55.97%; p<0.0001) and had ≥3-point (52.4% vs 9.6%; difference, 42.8%; 95% CI, 30.26-55.34%; p<0.0001) and ≥4-point (39.0% vs 4.8%; difference, 34.2%; 95% CI, 22.69-45.72%; p<0.0001) reductions in weekly average daily peak daily pruritus numerical rating scale scores. The incidence of TEAEs during the treatment period was similar in the two groups. The incidence of conjunctivitis, allergic conjunctivitis, and injection site reaction was higher in the dupilumab group than in the placebo group.

CONCLUSIONS

In adult Chinese patients, dupilumab was effective in improving the signs and symptoms of AD and demonstrated a favorable safety profile.

Prolonged recombinant pregnancy hormone use in BRCA1 and BRCA2 mutation carriers

BACKGROUND

An early first full-time pregnancy substantially reduces the risk of developing breast cancer later in life. Extensive studies indicate that this protective effect is mediated by the pregnancy hormone human chorionic gonadotrophin (hCG).

METHODS

In this proof-of-concept study 33 women with a BRCA mutation received recombinant-hCG (r-hCG). A 4-mm breast biopsy was obtained before (T1) and after 12 weeks of r-hCG injections (T2), as well as 6 months later (T3). The tissue was examined using RNA-sequencing methodology to determine if the 'high-risk' transcriptomic signature was converted to a 'low-risk' signature as in an early first full-time pregnancy. A stringent clinical safety monitoring was performed.

RESULTS

The r-hCG administration was well tolerated in all participants. No clinically relevant changes were observed. In 25 women, the RNA quality was good for RNA sequencing in all three breast tissue biopsies. In response to the r-hCG, we observed 1907 differentially expressed genes (DEGs) (1032 up, 875 down) at T2 vs. T1 and 1065 DEGs (897 up, 168 down) at T3 vs. T1 in the group of women (n = 11) not using any hormonal contraceptives during the study. There was no response at T2 vs. T1 and a small number of DEGs, 260 (214 up, 46 down) at T3 vs. T1 in the group of 14 women using contraceptives.

CONCLUSIONS

In summary, r-hCG has a remarkable effect on the gene expression profile of breast tissues from BRCA1/2 carriers who did not use any contraception. This opens an opportunity for a novel preventive strategy to reduce the incidence of breast cancer.

MRzero - Automated discovery of MRI sequences using supervised learning

PURPOSE

A supervised learning framework is proposed to automatically generate MR sequences and corresponding reconstruction based on the target contrast of interest. Combined with a flexible, task-driven cost function this allows for an efficient exploration of novel MR sequence strategies.

METHODS

The scanning and reconstruction process is simulated end-to-end in terms of RF events, gradient moment events in x and y, and delay times, acting on the input model spin system given in terms of proton density, T 1 and T 2 , and Δ B 0 . As a proof of concept, we use both conventional MR images and T 1 maps as targets and optimize from scratch using the loss defined by data fidelity, SAR penalty, and scan time.

RESULTS

In a first attempt, MRzero learns gradient and RF events from zero, and is able to generate a target image produced by a conventional gradient echo sequence. Using a neural network within the reconstruction module allows arbitrary targets to be learned successfully. Experiments could be translated to image acquisition at the real system (3T Siemens, PRISMA) and could be verified in the measurements of phantoms and a human brain in vivo.

CONCLUSIONS

Automated MR sequence generation is possible based on differentiable Bloch equation simulations and a supervised learning approach.

Polyurethane/polycaprolactone membrane grafted with conjugated linoleic acid for artificial vascular graft application

Constructing satisfied small-diameter vascular graft (diameter less than 6 mm) remains an unsolvable challenge in vascular tissue engineering. This study described the fabrication of electrospun polyurethane/polycaprolactone (PU/PCL) membranes chemically grafted with various densities of conjugated linoleic acid (CLA) - an antithrombotic fatty acid - for making small-diameter blood vessel. Differences in mechanical, antithrombotic properties and biocompatibility of the membranes resulting from the CLA-grafting procedure were the focus of the study. Investigation of mechanical properties relevant to vascular graft application revealed that these properties of the membranes remained unaffected and satisfied clinical criteria following the CLA graft. Blood-membrane interaction assays showed that the CLA-grafted membranes mitigated the adhesion of blood cells, as well as preventing blood coagulation. These effects were also commensurate with increasing density of CLA, suggesting an effective approach to improve antithromboticity. Cellular tests suggested that CLA has an optimal density at which it promoted cell proliferation on the surface of the membranes; however, excessive presence of CLA might cause undesirable inhibition on cells. In conclusion, PU/PCL membrane grafted with CLA could be a prospective material for vascular tissue engineering with further development and investigation.

GLP-1-Exendin-4/IgG4 (Fc) fusion protein as a novel drug for diabetes treatment

In this paper, we aimed to look for a potent long acting GLP-1 receptor agonist for diabetes treatment. In this work, we constructed the eukaryotic expression vector of GLP-1-Exendin-4/IgG4 (Fc)-pOptiVEC™-TOPO(®) and then transfected it into Chinese hamster ovary DG44 (CHO/DG44) cells using liposome method. Then the beta-cell line INS-1 cells were treated with purified GLP-1-Exendin-4/IgG4 (Fc) fusion protein (0.01, 0.1, 1.0 mM respectively) and randomly assigned to 2 groups, each group were then grown in KRB buffer in the presence of 2.8 mM or 16.8 mM glucose for 2 h separately. In addition, single dose of fusion protein was intraperitoneally injected into male CD1 mice for pharmacokinetic study. Besides, multiple low doses of streptozotozin (STZ) induced diabetes mice were used to evaluate the effect of fusion protein for anti-diabetes in male CD1 mice. GLP-1-Exendin-4/IgG4 (Fc) had stimulatory effect on insulin secretion glucose-dependently from INS-1 cells in a dose-dependent manner. Pharmacokinetic studies showed that the GLP-1 level increased significantly after injecting fusion protein and maintained a higher level for 200 h. Besides, multiple-low-dose STZ-induced diabetes mice which received intraperitoneal injections of fusion protein did not show sign of diabetes. Our results indicated that GLP-1-Exendin-4/IgG4 (Fc) fusion protein retained native GLP-1 activities and had effect on long-term glucose regulation. All the results suggest that this fusion protein may serve as a potent long acting GLP-1 receptor agonist.

Effects of statins on proinflammatory/prothrombotic biomarkers and on disease activity scores in SLE patients: data from LUMINA (LXXVI), a multi-ethnic US cohort

OBJECTIVES

We sought to determine the effect of statin therapy on the levels of proinflammatory/prothrombotic markers and disease activity scores in patients with SLE in a multi-ethnic, multi-centre cohort (LUMINA).

METHODS

Plasma/serum samples from SLE patients placed on statins (n=21) therapy taken before and after at least 6 months of treatment were tested. Disease activity was assessed using SLAM-R scores. Interleukin (IL)-1β, IL-6, IL-8, tumour necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF) and soluble CD40 ligand (sCD40L) levels were determined by a multiplex immunoassay. Soluble intercellular cell adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and anticardiolipin (aCL) antibodies were evaluated using ELISA assays while high sensitivity C-reactive protein (hsCRP) was assessed by nephelometry. Plasma/serum samples from frequency- matched healthy donors were used as controls.

RESULTS

Levels of IL-6, VEGF, sCD40L and TNF-α were significantly elevated in SLE patients versus controls. Statin therapy resulted in a significant decrease in SLAM-R scores (p=0.0199) but no significant changes in biomarker levels were observed. There was no significant association of biomarkers with SLAM-R scores.

CONCLUSIONS

Statin therapy resulted in significant clinical improvement in SLE patients, underscoring the use of statins in the treatment of SLE.

Comparative evaluation of two flowcytometric analysers as diagnostic tools for the automated detection of malaria

GOALS

Automated flowcytometric analysers are used to analyse complete blood count (CBC) in most patients. They differentiate WBC depending on their size, internal granularity, and nuclear content by producing various scattergrams. In malaria, haemozoin pigment-containing cells (parasitized RBC and phagocytic cells) are able to depolarize the laser beam and therefore exhibit abnormal scattergram.

PROCEDURE

A study was conducted to evaluate the diagnostic utility and to determine the sensitivity and specificity of flowcytometric haematology analysers [Sysmex XE-2100 (System 1) and Cell-Dyn 3700 (System 2)] in comparison with the conventional microscopy (QBC, AO, Giemsa) and ICT (Immunochromatographic test) for detection of the malaria parasite.

RESULTS

Fifty-eight of 320 samples were found to be positive for malaria by conventional methods. Considering atypical scattergram, System 1 showed the sensitivity and specificity of 68.9% and 90.6%, respectively; whereas System 2 showed a sensitivity of 100% and specificity of 98.8%.

CONCLUSION

System 2 (Cell-Dyn 3700) was found to be a highly sensitive and specific tool compared to System 1 and conventional methods. Hence, it may be preferred for automated detection of malaria in the blood samples of patients with a differential diagnosis of malaria and those who are subjected to CBC analysis.

Downregulation of Stat3 in melanoma: reprogramming the immune microenvironment as an anticancer therapeutic strategy

Persistent activation of the transcription factor, signal transducer and activator of transcription 3 (Stat3) has been shown to mediate several oncogenic features in many types of cancers, including melanoma. In this study, we investigated whether lentiviral (LV) delivery of Stat3-targeting short hairpin RNA (shRNA; LV-shStat3) to K1735-C4 melanoma cells modulates antitumor immunity. Three shStat3 sequences, starting at the position 446, 830 and 1412, were cloned into a mir30 cassette. A shRNA with scrambled sequence served as a control. Transduction with LV-shStat3 resulted in downregulation of Stat3 in vitro. The latter coincided with low cell viability, a reduced expression of survivin and matrix metalloproteinase (MMP)-2. A single injection of LV-shStat3 in K1735-C4 tumors efficiently downregulated Stat3 in vivo and resulted in reduction of both vascular endothelial growth factor secretion and in myeloid-derived suppressor cell (MDSC) numbers. In contrast, we observed an increase in interleukin-6 and interferon-γ secretion, mature dendritic cells (DCs) and CD8(+) T cells. Both DCs and CD8(+) T cells displayed enhanced activity, whereas granulocytic MDSCs lost their suppressive capacity upon Stat3 downregulation. Importantly, a single injection of LV-shStat3 was sufficient to reduce tumor growth, hence prolong survival of tumor-bearing mice. These data demonstrate that Stat3 downregulation in melanoma reinvigorates existing antitumor immunity.

Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA (LXXV), a multiethnic US cohort

OBJECTIVE

We sought to determine the effect of hydroxychloroquine therapy on the levels proinflammatory/prothrombotic markers and disease activity scores in patients with systemic lupus erythematosus (SLE) in a multiethnic, multi-center cohort (LUMINA).

METHODS

Plasma/serum samples from SLE patients (n = 35) were evaluated at baseline and after hydroxychloroquine treatment. Disease activity was assessed using SLAM-R scores. Interferon (IFN)-α2, interleukin (IL)-1β, IL-6, IL-8, inducible protein (IP)-10, monocyte chemotactic protein-1, tumor necrosis factor (TNF)-α and soluble CD40 ligand (sCD40L) levels were determined by a multiplex immunoassay. Anticardiolipin antibodies were evaluated using ELISA assays. Thirty-two frequency-matched plasma/serum samples from healthy donors were used as controls.

RESULTS

Levels of IL-6, IP-10, sCD40L, IFN-α and TNF-α were significantly elevated in SLE patients versus controls. There was a positive but moderate correlation between SLAM-R scores at baseline and levels of IFN-α (p = 0.0546). Hydroxychloroquine therapy resulted in a significant decrease in SLAM-R scores (p = 0.0157), and the decrease in SLAM-R after hydroxychloroquine therapy strongly correlated with decreases in IFN-α (p = 0.0087).

CONCLUSIONS

Hydroxychloroquine therapy resulted in significant clinical improvement in SLE patients, which strongly correlated with reductions in IFN-α levels. This indicates an important role for the inhibition of endogenous TLR activation in the action of hydroxychloroquine in SLE and provides additional evidence for the importance of type I interferons in the pathogenesis of SLE. This study underscores the use of hydroxychloroquine in the treatment of SLE.

Hodgkin's disease in patients infected with human immunodeficiency virus: frequency, presentation and clinical outcome

We report the frequency, presenting characteristics, progression-free survival, event-free survival, overall survival and AIDS-free survival of patients with previously untreated Hodgkin's disease (HD) in the setting of infection by human immunodeficiency virus (HIV). To accomplish this we retrospectively reviewed all untreated patients presenting to the University of Texas M.D. Anderson Cancer Center between July 1985 and August 1999 with HD and HIV infection. All available records were reviewed to determine presentation, clinical characteristics, treatment outcome, progression-free survival and overall survival. We identified 887 patients with HD and 3,500 with Non-Hodgkin's Lymphoma (NHL). The ratio of NHL to HD in HIV-negative versus HIV-positive patients was 3.9 versus 6.9, respectively. There were 14 HIV-positive patients with HD and 97 with NHL. The median age of the HIV-positive HD patients was 33 years, and 13 were male. Three patients had Acquired Immune Deficiency syndrome (AIDS) at the time of HD diagnosis, and seven had B-symptoms. Ann Arbor stage was I in one, II in three, III in four and IV in six patients. Mixed cellularity histology was seen in eight, bone marrow involvement in five and extranodal disease in seven patients. Four patients had elevated serum lactate dehydrogenase, three low serum albumin, and nine elevated serum beta2-microglobulin, The median CD4 count was 160/microl. Eleven patients received ABVD or equivalent regimens, followed by radiotherapy in five. One patient was treated with COPP and radiotherapy, one with NOVP and radiotherapy and one only with radiotherapy. All patients received some antiretroviral therapy, but it was variable over the years. With a median follow-up of 64 months for survivors, the projected 5-year progression-free survival was 64%, event-free survival 45%, overall survival 54% and AIDS-free survival 45%. Six patients died of complications arising from HIV infection, including one patient who had preexisting AIDS at HD presentation. Two patients died of HD, without developing other conditions diagnostic of AIDS. We conclude that in our referral patient population HIV infection is associated with preferential development of NHL rather than HD, which appears curable with standard treatment regimens. Since HIV-related deaths exceed those caused by HD, future investigation should focus on integration of chemotherapy and highly active antiretroviral therapy.

Infectious complications of pentostatin therapy

Managing the infectious complications associated with pentostatin (Nipent), used alone or in combination with other agents in patients with low-grade lymphomas, poses a significant problem for clinicians. Since there is limited experience with these therapies, definitive treatment recommendations concerning prophylaxis cannot be made. The panel members discussed the use of valacyclovir (Valtrex) to provide prophylaxis for herpes zoster, trimethoprim/sulfamethoxazole for Pneumocystis, and acyclovir (Zovirax) for varicella zoster. They also considered combinations of pentostatin with agents such as interferon, rituximab (Rituxan), and chlorambucil (Leukeran) and their effect on the immune system. The biology of B and T cells was discussed, with an emphasis on clinical application.

Recognition of shared melanoma antigens in association with major HLA-A alleles by tumor infiltrating T lymphocytes from 123 patients with melanoma

A total of 123 tumor-infiltrating T lymphocyte (TIL) cultures established from patients with HLA-A1, -A2, -A3, -A24, or -A31 metastatic melanoma in the Surgery Branch, National Cancer Institute, were screened for recognition of shared melanoma antigens including five melanosomal proteins (tyrosinase, MART-1/melan-A, gp100, TRP1, TRP2) as well as peptides derived from MAGE-1 and MAGE-3. Examination of the specificity of these T cells indicated that 16% of HLA-A1 TIL, 57% of HLA-A2 TIL, 7% of HLA-A3 TIL, 13% of HLA-A24 TIL, and 27% of HLA-A31 TIL recognized shared melanoma antigens restricted by major histocompatibility complex class I. Melanosomal proteins were frequently recognized by these TIL, and MART-1(27-35), gp100(154-162), gp100(209-217), and gp100(280-288) represent highly immunogenic epitopes that were recognized by a high percentage of HLA-A2 restricted melanoma reactive TIL. Recognition of gp100 by HLA-A2 restricted TIL significantly correlated with clinical response to adoptive immunotherapy with TIL in 21 HLA-A2 melanoma patients (p = 0.024). Four HLA-A1, two HLA-A2, two HLA-A3, one HLA-A24, and two HLA-A31 restricted shared antigen-specific TIL did not recognize the previously identified antigens tested in this study, and may be useful for the identification of new melanoma antigens. The observation that TILs isolated from patients with metastatic melanoma recognized melanosomal proteins in the context of predominant HLA-A alleles implies that it may be possible to develop immunotherapies for patients with melanoma expressing diverse HLA types.

Pulmonary metastasectomy for head and neck cancers

BACKGROUND

Distant metastases from carcinomas that arise from the head and neck region are infrequent. The most common site is the lung. To evaluate the results of resection of pulmonary metastases for head and neck cancers, we reviewed our own cases of these metastases.

METHODS

Between November 1966 and March 1995, 83 patients with pulmonary metastases from head and neck cancers underwent 94 thoracic operations. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Kaplan-Meier and Cox regression models were used to analyze the prognostic factors for survival after metastasectomy.

RESULTS

Median age was 53 years (range, 17-77). Fifty-nine were male and 24 were female. Forty-one patients had squamous cell cancers, and 36 had glandular tumors that consisted mostly of thyroid and adenoid cystic carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Sixty-eight (82%) patients had complete resection. Overall operative mortality rate was 2%. Overall actuarial survival rate after metastasectomy was 50% at 5 years. Patients with glandular tumors had a 5-year survival rate of 64% compared with 34% for patients with squamous cell cancers. When the patients with glandular tumors were analyzed according to their histology, patients with adenoid cystic carcinomas had an 84% 5-year survival, but none remained disease-free. Patients with thyroid cancers fared similarly whether they were treated medically or surgically. On multivariate analysis, the adverse prognostic factors for patients with squamous cell cancers were incomplete resection, age greater than 50 years, and disease-free interval less than or equal to 2 years.

CONCLUSIONS

Approximately 30% of patients with pulmonary metastases from squamous cell cancers of the head and neck who underwent complete resection of all their metastases can expect to achieve long-term survival. The role of pulmonary resection for patients with glandular tumors is unclear.

Apical bridging in association with regular root formation following single-visit apexification: a case report

A case report is presented in which continuing root formation occurred in a carious nonvital and immature mandibular second premolar after single-visit calcium hydroxide apexification treatment. An apical hard tissue barrier was formed, accompanied by a separate, mesioapically growing root, 7 months posttreatment. Treatment was concluded with gutta-percha root canal restoration. The success of this single-visit apexification treatment supports the contention that frequent changing of the calcium hydroxide dressing is not always required to induce apical closure.

A PET study of human auditory spatial processing

To learn more about human auditory spatial processing, we used positron emission tomography (PET) to measure regional cerebral blood flow in human volunteers engaged in sound localization tasks. Spectral and binaural cues of localized sound were reproduced by a sound system and delivered via headphones. During localization tasks, subjects activated inferior parietal lobules (IPL) bilaterally. In a second experiment, matched in design to the first, subjects made non-spatial auditory discriminations based on frequency, activating the IPL bilaterally with left hemispheric predominance. A between-study comparison revealed that the right IPL was significantly more activated during the sound localization task compared with the feature discrimination task, suggesting a preferential role for the right IPL in auditory spatial processing.

Crouzon disease--a case report

The present case of a ten year old boy with craniofacial dysostosis with the features of midfacial hypoplasia is a disease known as Crouzon disease. This disease is characterised by cranial deformities, facial malformation, eye changes and occasional other associated abnormalities. The aim of this case is to discuss the clinical, radiographic features and management of the problems.

Transgenic mice over-expressing the C-99 fragment of betaPP with an alpha-secretase site mutation develop a myopathy similar to human inclusion body myositis

Inclusion body myositis (IBM) is the most common muscle disease in the elderly. Amyloid-beta protein (A beta) has been shown to accumulate abnormally in the vacuolated fibers and to localize to amyloid-like fibrils in muscles from IBM patients. We studied the skeletal muscles from a line of transgenic mice over-expressing the carboxyl-terminal 99 amino acids (C99) of the beta-amyloid precursor protein (betaPP) with a substitution of lysine-612 to valine (K612V), intended to abolish alpha-secretase recognition and to preserve the A beta domain of C99. The majority (87%) of the 24-month-old transgenic mice showed myopathic changes, and approximately one-third of them had degenerating fibers with sarcoplasmic vacuoles and thioflavin-S-positive deposits. Ultrastructurally, the inclusions were aggregates of short thin amyloid-like fibrils, 6 to 8 nm in diameter. These features are similar to those of human IBM. Immunocytochemistry using an antibody against A beta showed membranous staining in most muscle fibers of transgenic mice, as well as granular or vacuolar cytoplasmic staining in the atrophic fibers. Western blots showed a high level of accumulation of carboxyl-terminal fragments of betaPP in the muscles of the transgenic mice with the most severe IBM-like lesions. The expression of IBM-like lesions was age dependent. These transgenic mice provide a model for the study of IBM and for the peripheral expression of a key element in the pathogenesis of Alzheimer disease.

Incoordination in pianists with overuse syndrome

To investigate claims that painful musculoligamentous overuse in the arms and hands of pianists is accompanied by loss of motor control, we studied 18 pianists with overuse syndrome of one or both arms and hands and 22 skill-matched pianists with no history of overuse. All of the pianists performed continuous repetitions of a five-finger exercise on a piano keyboard at metronome-paced tempos. The main outcome measures were quantitative analysis of four measurements of performance (duration of key presses, interval between key presses, velocity of key presses [loudness], and time off the metronome beat [difference between actual and expected time of key press]); comparison of the errors in the two groups; and comparison of the performances by a listening panel. The two groups had significant differences in performance, and a classification tree had a sensitivity of 0.886 and a specificity of 0.862 in identifying the affected hands. The pianists with overuse syndrome made more skill-based errors. The listening panel could distinguish between the affected and unaffected hands. We conclude that pianists with overuse syndrome have a coordination disturbance.

Suture splint: an alternative for luxation injuries of teeth in pediatric patients--a case report

Stabilization of replanted tooth "splinting" is done to prevent further damage to the pulp and periodontal structure during the healing period. Suture and bonded resin splint is passive, semirigid and functional splint. It is easy to fabricate directly in mouth without lengthy laboratory procedures. A case is presented in which suture and bonded resin splint was performed on laterally luxated maxillary central incisor and avulsed lateral incisor. The splint was removed after one week and sufficient periodontal and gingival healing was observed.

Management of teeth with open apices and necrotic pulps with single visit apexification: 3 representative cases

Apexification is the most widely accepted procedure for the treatment of nonvital immature teeth. Single visit apexification is less time consuming, more economical and an easily acceptable technique with the aim of inducing the formation of a hard tissue barrier, thus allowing proper condensation of gutta percha in the root canal. Factors considered during this procedure are: i. Debridement of root canal minimizing the infection and filling the root canal space with resorbable calcification inducing material i.e. Ca(OH)2. ii. Minimal mechanical intervention to maintain the integrity and vascularity of apical region. Once filled, Ca(OH)2 was not changed again and the treated tooth was examined only radiographically till the desired apical closure was achieved. Three representative cases treated with this single visit apexification technique are discussed here. In all the cases successful apical closure of different types was achieved. Treatment was then concluded with gutta percha obturation in all the cases with successful follow up.

Implicit and explicit learning in an auditory serial reaction time task

OBJECTIVE

To explore the role of the motor cortex during implicit and explicit learning.

MATERIALS AND METHODS

EEG signals were recorded from 30 channels by measuring task-related desynchronization (TRD) when 10 right-handed naive volunteers performed a variation of the serial reaction task. Stimuli, consisting of 4 pure tones of 500, 1000, 1500, and 2000 HZ, lasting 200 ms, were presented binaurally through a pair of tubephones at 60 dB with a 2-s constant interstimulus interval. A series of 10 repetitive tones represented the test sequence; the random sequence was the control.

RESULTS

All subjects developed implicit and explicit knowledge reflected by decreased response time, increased accuracy, and the ability to generate the sequence. Six of 10 subjects demonstrated implicit learning without explicit learning during the first 3 blocks. When subjects acquired full explicit learning, 10 Hz TRD at C3 reached a peak amplitude, declining thereafter.

CONCLUSIONS

Properties of the sensorimotor cortex change during learning and these changes are independent of stimulus modality.

Effects of designs of Class 2 preparations on resistance of teeth to fracture

This study was designed to evaluate the effect of isthmus width on the strength of the remaining tooth structure in maxillary first premolars restored with class 2 silver amalgam restorations. One hundred ten sound maxillary first premolars freshly extracted as a part of orthodontic treatment were collected. The teeth were then divided into 10 groups of 11 teeth each. Ideal class 2 mesio-occlusal, disto-occlusal and mesio-occlusodistal cavities with different isthmus widths i.e. one half the intercuspal distance, one third the intercuspal distance and one fourth the intercuspal distance and one fourth the intercuspal distance were prepared. Compressive forces were applied using a Universal Testing Machine and load to the point of fracture was determined. Intact teeth produced the best tooth fracture resistance i.e. 105.4 MPa, followed by preparations with isthmus width of one fourth, one third and one half intercuspal distance in the order.

Sport practice and osteoarthritis of the limbs

Participation in sports has evolved as a cause of osteoarthritis (OA), especially in hip and knee joints. OA often occurs at a relatively early age in adult life, in certain sports (soccer, rugby, racket sports and other track and field sports) and under certain conditions (high level of practice). We review preclinical considerations and published epidemiological studies. Joint overuse even without notable trauma is likely the main mechanism of OA both in these sports and in certain occupational activities (relative risk ranges from 1.5 to more than 5 depending chiefly on the category of sport and on the level and duration of practice). Irregular or sudden impacts, heavy load application on the dominant weight-bearing lower limb and the pre-existing state of the joint including dysplasia, dystrophy or previous trauma are risk factors for OA. However, recreational sport activities at a reasonable level are not likely to be harmful for most individuals, in most sport activities.

Expression of apolipoprotein E inhibits aggregation of the C-terminal fragments of beta-amyloid precursor protein

An important role of apolipoprotein E in the amyloidogenesis of Alzheimer's disease is suggested by an accumulation of apolipoprotein E in beta-amyloid plaques and a genetic association between Alzheimer's disease and one of the allelic variants (APOE4) of apolipoprotein E. Overexpression of a C-terminal region of beta-amyloid precursor protein brings about aggregation of the C-terminal fragments in COS cells. This COS cell culture system was used to study effects of apolipoprotein E on aggregation of the C-terminal fragments. When both apolipoprotein E and the C-terminal fragments were overexpressed in COS cells, Western blot analyses revealed significant inhibition of aggregation of the C-terminal fragments. No significant differences between apolipoprotein E3 and E4 in the inhibitory activities were found by this method. Apolipoprotein E may inhibit formation of amyloid fibrils.

Overexpressions of cDNAs for beta-amyloid precursor proteins 695, 751, and 770 enhance the secretion of beta-amyloid precursor protein derivatives and the survival of P19-derived neurons

P19 is a C3H mouse-derived line of multipotent embryonic carcinoma cells that differentiate into neural cells. P19 cell clones overexpressing the three major forms of beta-amyloid precursor protein from their cDNA constructs were established. Unlike a previous study in which P19-derived neurons had a limited alpha-secretase activity, all of these clones produced significant amounts of secreted beta-amyloid precursor protein. When treated with retinoic acid, these transformed lines differentiated into neurons and survived better than did nontransformed parental P19 cells. Furthermore, P19-derived neurons survived better in medium conditioned by the transformed P19 line, and survival was reduced by immunoabsorption with an antibody to beta-amyloid precursor protein. These results suggest neurotrophic effects of secreted beta-amyloid precursor protein and contrast with a previous report in which overexpression of a full-length cDNA for beta-amyloid precursor protein led to degeneration of P19-derived neurons. Western blot analysis suggested that this difference might result from different levels of expression of putative neurotoxic C-terminal fragments of beta-amyloid precursor protein; moreover, P19-derived neurons differ from P19 stem cells in the processing of these C-terminal fragments.

Activity assays of nine heterogeneous promoters in neural and other cultured cells

To express high levels of proteins encoded by transfected DNA constructs in a variety of cultured cells, including neuronal cells, the activities of nine different promoters were evaluated using Escherichia coli beta-galactosidase (beta-gal) (LacZ) as a reporter gene. These nine promoters were categorized into three distinct groups (high, intermediate, and low expresser), in terms of the levels of beta-gal expression. An expression vector containing the cytomegalovirus enhancer and the chick beta-actin promoter (high expresser) showed the highest levels of expression, followed by vectors containing the cytomegalovirus promoter/enhancer and the SV40 promoter/enhancer (intermediate expresser). The rest of the promoters (thymidine kinase, adenovirus, murine proliferative sarcoma virus, nerve growth factor receptor, Rous sarcoma and mouse mammary tumor virus, and beta-amyloid precursor protein) expressed low levels of beta-gal. These results were consistent for eight different cell types. A particularly attractive model is the stem cell, P19; cultures differentiating into progeny consisting predominantly of cholinergic neurons could be readily transfected with expression vectors using liposomes and expressed beta-gal without significant morphologic changes of the differentiated neurons. The systems should be useful for the study of promoters and various expressed proteins, including those involved in axonal transport.

Selective neurotoxicity of COOH-terminal fragments of the beta-amyloid precursor protein

The primary component of amyloid deposits found in the brains of patients with Alzheimer's disease is the beta-amyloid protein, a derivative of a much larger precursor protein (beta PP). We have previously reported that overexpression of carboxyl (COOH)-terminal fragments of beta PP from an integrated DNA construct leads to degeneration of neuronally differentiating mouse embryonic stem cells and that the neuronal degeneration is related to approximately 14- and 15-kDa COOH-terminal fragments of the precursor protein. We here demonstrate that these putative cytotoxic fragments contain intact beta-amyloid protein. When such transformed cell lines are treated with dimethyl sulfoxide to induce differentiation into muscle cells, however, the resulting muscle cells remain viable (as do control non-transformed cells), despite the production of comparable amounts of the 14- and 15-kDa fragments. These results are consistent with the hypothesis that particular COOH-terminal fragments of beta PP are amyloidogenic and neurotoxic.

Polymyositis associated with ulcerative colitis

An elderly woman with chronic ulcerative colitis who developed proximal muscle weakness, increased serum creatine phosphokinase activity, and histological and electromyographic abnormalities characteristic of polymyositis is described. Treatment with corticosteroids and 5-acetylsalicylic acid was followed by a remission in bowel symptoms, improvement in muscle power, and reversal of electromyographic changes. An autoimmune link between the two disorders seems likely.

The N30 component of somatosensory evoked potentials in patients with dystonia

We recorded short-latency median nerve somatosensory evoked potentials (SEPs) in 10 patients with dystonia (6 with focal dystonia, 3 with generalized dystonia, and 1 with segmental dystonia) and compared them with those of 10 normal controls. The EEG was recorded from 29 sites on the scalp with linked earlobe electrodes for reference. Latencies and amplitudes of P15, postcentral N20 and P45, and frontal N30 were evaluated. The latencies of all potentials were the same in patients and controls. The amplitudes of P15, N20 and P45 were also the same in both groups, but the N30 amplitude of the patients was larger than of the controls. The amplitude of N30 did not vary from the affected side to the unaffected side. Previous work has shown decreased N30 amplitude in patients with Parkinson's disease. Changes in N30 amplitude may be indicative of abnormal excitatory effects on cortex resulting from disorders of the basal ganglia.

No evidence of hearing loss in humans due to transcranial magnetic stimulation

Prompted by the description of hearing loss in rabbits exposed to the acoustic artifact of magnetic stimulation, we compared the results of audiologic studies before and after exposure to transcranial magnetic stimulation in humans. We found no evidence of temporary or permanent threshold shifts in any of the subjects, even in those exposed to transcranial magnetic stimulation repeatedly for several years. Risk of hearing loss from the acoustic artifact of magnetic stimulation, as evaluated by audiograms, tympanograms, acoustic reflexes, and auditory evoked potentials, seems to be small in humans.

Physiological analysis of motor reorganization following lower limb amputation

It is now known that amputation results in reorganization of central motor pathways, but the mechanism for the changes is unclear. One possibility is alteration of the excitability of the alpha motoneurons. We studied motor reorganization and excitability of alpha motoneurons to Ia input in 6 subjects with unilateral lower limb amputation. A Cadwell MES-10 stimulator was used to deliver transcranial magnetic stimuli through a circular coil centered on the sagittal axis 4 cm anterior to Cz and through an 8-shaped coil positioned over scalp locations 1 cm apart along the coronal axis. Surface EMG was recorded bilaterally from quadriceps femoris, the first muscle immediately proximal to the site of amputation. Excitability of the spinal alpha motoneuron pool to Ia afferents was assessed by determining the ratio of the maximal H reflex to the maximal M response (H/M ratio) elicited in the quadriceps femoris. Stimuli of equal intensity delivered to optimal scalp positions recruited a larger percentage of the alpha motoneuron pool in muscles ipsilateral to the stump than in those contralateral to the stump (P less than 0.01). Mean onset latencies of motor evoked potentials were shorter in ipsilateral muscles than in contralateral muscles (P less than 0.01). Muscles ipsilateral to the stump showed a trend toward activation from a larger number of scalp positions than those contralateral to the stump (P = 0.06). There was no difference in the quadriceps H/M ratios (7.2% ipsilateral vs. 10.9% contralateral). The absence of changes in the excitability of the alpha motoneuron pool in the presence of motor reorganization targeting muscles proximal to the stump suggests that reorganization occurs proximal to the alpha motoneuron level.

[Conflict between psoas and total hip prosthesis]

This conflict leads to a chronic irritation of the psoas by the antero-medial part of the cup, but it has been poorly described in the past. A study of six patients suffering from this trauma, and who were re-operated revealed that the muscle was worn thin in front of the prominent cup. In the case of 4 of the 6 patients pain had started to occur shortly after total hip replacement. The following symptoms were noted among all 6 patients: pain was suffered during flexion--extension movements--walking up stairs--arising from a chair. Pressure on the medial part of the groin was painful, especially during active elevation of the lower limb. Passive mobility was normal and painless. Psoas bursitis was observed in three cases. The main cause of this conflict is the protrusion of the cup beyond the antero-medial edge of the acetabulum; this protrusion may be either due to a bone graft or a bit of cement, but most often an acetabular insufficiency (congenital dysplasia) favors the formation of this anterior overhang. The spiral cup screwed into the bone can be especially aggressive when it protrudes. Treatment includes the resection of the overhang, but post-operative results will be uncertain unless the resection is really complete. In the case of 4 patients the results of such an intervention were only mild to poor. This problem can be avoided by proper care and preventive measures in the original replacement avoiding all projections beyond the anterior edge of the acetabulum--cup, bone graft, cement, especially if dysplasic.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of chemotherapy on cell counts in peripheral blood & bronchoalveolar lavage of patients with pulmonary tuberculosis

Cell counts in peripheral blood and bronchoalveolar lavage fluid were estimated in 38 patients with active tuberculosis; 12 patients with tuberculosis who had successfully completed more than 9 months of chemotherapy with isoniazid, rifampicin, and ethambutol; 10 Mantoux negative bronchitic subjects; and 6 control subjects. There were 50 males and 16 females aged 16-50 yr. Age, haemoglobin, total and differential serum proteins, were comparable in the various groups. Patients with active tuberculosis had higher ESR and significantly raised absolute (2.24 +/- 0.13 x 10(3); P less than 0.05), B (0.56 +/- 0.03 x 10(3); P less than 0.01) and Null lymphocyte counts (0.56 +/- 0.05 x 10(3); P less than 0.01) in blood. After chemotherapy there was no significant change in lymphocyte counts (2.43 +/- 0.21; P greater than 0.05). In bronchoalveolar lavage (BAL) total cell counts were increased five fold in patients with active disease (40.8 +/- 5.79 x 10(4)/ml) and although these showed considerable reduction after therapy they were higher (18.33 +/- 4.73 x 10(4)/ml) than those in controls (8.3 +/- 1.2 x 10(4)/ml; P greater than 0.05). In bronchitic subjects, total cell counts and macrophage counts in BAL fluid were elevated (P less than 0.01; less than 0.05 respectively) but lymphocyte counts were comparable to controls (3.4 +/- 1.35 x 10(4)/ml vs 1.09 +/- 0.19 x 10(4)/ml; P greater than 0.05). Lymphocytosis in the bronchoalveolar lavage fluid of patients with pulmonary tuberculosis persisted even after adequate treatment.

Monocyte/macrophage functions & humoral response in blood & bronchoalveolar lavage fluid of pulmonary tuberculosis patients

Subsegmental bronchoalveolar lavage (BAL) was performed in 33 patients with active pulmonary tuberculosis and five control subjects. Phagocytosis by monocytes and alveolar macrophages was studied, and in addition serum and BAL immunoglobulin and complement levels were also determined. The phagocytic activity of blood monocytes was depressed in pulmonary tuberculosis patients as compared to controls, 37.8 +/- 2.3 per cent; 50.7 +/- 4.2 per cent and 32.9 +/- 3.6 per cent for sheep RBC's, latex and Staphylococcus aureus respectively compared to 66.7 +/- 6, 54.8 +/- 2.2 and 68.3 +/- 3.5 per cent respectively in controls; the differences being significant for sheep RBC's (P less than 0.05) and Staph. aureus (P less than 0.001). However, phagocytosis was not impaired in BAL macrophages (P greater than 0.05). In patients no significant alteration in serum immunoglobulin and complement levels was observed except that levels of C4 component of complement were increased in patients with far advanced lesions (98.5 +/- 33.7 mg/dl compared to 78.7 +/- 7.9 mg/dl; P less than 0.05). While IgM and C4 component of complement could not be detected in BAL fluid the levels of IgA were significantly increased in pulmonary tuberculosis patients (65.5 +/- 50.5 mg/dl compared to 39.9 +/- 13.3 mg/dl in control; P less than 0.05). Since IgA secreted in the BAL fluid is mostly synthesised locally, increased levels of this immunoglobulin could be of value in determining activity of the disease.