Critical impacts of pyrolysis conditions and activation methods on application-oriented production of wood waste-derived biochar

Wood waste-derived biochar with tunable carbon structure and surface functionality has a great potential for various environmental applications and circular economy; however, a holistic understanding on the application-oriented production of high-efficacy biochar is lacking. Thus, the co-impacts of different pyrolysis conditions (temperature and duration) and activation methods (steam, CO₂, and acid pretreatment) on the biochar properties were first investigated. A temperature of 650 ℃ was effective in forming carbonized structure in biochar, while 750 ℃ was critical for the porous structure development. A longer pyrolysis duration (>60 min) enhanced the pore volume without compromising the yield. The activated biochar exhibited a larger pore volume (2.1- to 2.9-fold of pristine biochar) for potential high-end emerging applications. The acid pretreatment effectively removed dissolved organic carbon and most metals from the biochar. This study provides an essential guidance on the fit-for-purpose designs of biochar production conditions for sustainable wood waste management.

Childhood Adversity, Resilience, and Mental Health: A Sequential Mixed-Methods Study of Chinese Young Adults

Resilience is a key health protective factor for those with adverse childhood experiences (ACEs), but little research has explored how it manifests in early adulthood or across cultures. The purpose of this study was to generate a fuller understanding of resilience and its contribution to the relationships between mental health problems and ACEs among Chinese young adults in Hong Kong. Using a sequential explanatory mixed-methods design, 433 Chinese young adults aged 18 to 24 years were surveyed online to examine the relationships between ACEs, resilience, and mental health problems (depression, anxiety, maladjustment, and posttraumatic stress symptoms). Among them, 34 participants with ACEs were purposively selected and interviewed to explore cultural factors that influenced their resilience. Quantitative data were analyzed using multiple hierarchical regression analyses; qualitative data were analyzed using a qualitative descriptive approach. Higher cumulative ACE exposure was associated with higher severity of adjustment disorder and odds for screening positive for posttraumatic stress disorders, but not for symptoms of depression or anxiety. Resilience significantly contributed to explaining variances across all mental health outcomes over and beyond ACEs and in a protective fashion. Four themes emerged from qualitative interviews: (a) Privacy, emotional restraint, and "saving face"; (b) Conforming to preserve harmony; (c) A will to excel; and (d) Viewing adversity as a matter of luck. These findings suggest Chinese young adults' resilience was influenced by cultural norms of restraint, conformity, competition, and superstition. The present study provides a model for future studies using a mixed-methods design to deeply examine resilience among younger people exposed to early adversities within sociocultural, historical, or geographical contexts.

Relationship between coronary artery calcium score and myocardial blood flow reserve in patients with suspected coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Background

Both the Coronary Artery Calcium Score (CACS), a non-invasive surrogate for atherosclerotic burden, and reduced myocardial blood flow reserve (MBFR) with normal perfusion, a non-invasive surrogate for coronary vasomotor dysfunction, independently predict future cardiovascular events. The relationship between CACS and MBFR, and potential clinical factors affecting it, is not well understood.

Methods

Among 9467 consecutive patients without known history of CAD who had normal perfusion on 82Rb PET-CT and a concomitantly measured CACS between 01/2010 - 06/2020 within our health system, we assessed the relationship between CACS and MBFR. Multiple linear regression was used to predict MBFR using CACS, adjusted for age, sex, BMI, risk factors, symptoms, resting LVEF and vital signs. Interactions of age, sex, diabetes, and symptoms with CACS were assessed to evaluate if they modified the relationship of CACS with MBFR.

Results

Mean age (SD) of the study cohort was 66.4 (12.6) years, 64% were women, 64% had chest pain and 47% had dyspnea. Reduced MBFR (<2) was present in 44% and CAC >0 in 74% of patients.  There was a modest inverse correlation between MBFR and CACS, r= - 0.18, p = < 0.0001 (Figure). In adjusted analyses, CACS (β for CAC per 100 = -0.013 [95% CI: -0.015, -0.010]) was weakly associated with MBFR, and age, sex, diabetes, or symptoms did not modify this relationship (all interaction p-values >0.1). Older age, female sex, presence of hypertension, diabetes, dyspnea, lower LVEF, higher baseline HR and higher CACS independently predicted reduced MBFR, but explained only 20% of the variance in MBFR (R2 =0.20).

Conclusion

There is a weak relationship between CACS and MBFR, which is not modified by age, sex, symptoms, or other CV risk factors. Coronary calcium burden does not completely reflect the overall disease activity within the coronary circulation, and measures of coronary vasomotor function such as MBFR may offer complementary information on CAD risk to that provided by the total burden of calcified atherosclerosis.

Safety, tolerability and clinical implementation of 'ready-to-use' 68gallium-DOTA0-Tyr3-octreotide (68Ga-DOTATOC) (SomaKIT TOC) for injection in patients diagnosed with gastroenteropancreatic neuroendocrine tumours (GEP-NETs)

BACKGROUND

⁶⁸Ga-DOTA0-Tyr3-octreotide (⁶⁸Ga-DOTATOC) positron emission tomography-CT (PET-CT) has superior diagnostic performance compared to the licensed tracer OctreoScan single photon emission CT-CT in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs). A new preparation of ⁶⁸Ga-DOTATOC using a new 'ready-to-use' ⁶⁸Ga-DOTATOC formulation for injection has been developed (⁶⁸Ga-DOTATOC (SomaKIT TOC)).

OBJECTIVES

This study aimed to assess the safety and tolerability of ⁶⁸Ga-DOTATOC (SomaKIT TOC) and evaluate the feasibility and robustness of implementing it in a NET clinical imaging service.

METHODS

A first-in-human phase I/II multicentre, open-label study of a single dose of ⁶⁸Ga-DOTATOC (SomaKIT TOC) 2 MBq/kg±10% (range 100-200 MBq) in patients with biopsy-proven grade 1-2 GEP-NETs. PET-CT was performed post injection. Patients were followed up for 28 days. We next implemented this new synthesis methodology in a clinical service assessed over 11 months.

RESULTS

Twenty consenting patients were recruited; 14 males, 6 females; mean (SD) age 58 years (12); NET grade 1 (70%), grade 2 (30%); and 75% with stage IV disease. Twelve patients experienced at least one adverse event (AE) during the study with no grade 3-4 toxicities. Only four AEs were classified as possibly (headache (n=1; 4%), nausea (1; 4%)) or probably (dysgeusia (1; 4%), paraesthesia (1; 4%)) related to the study preparation. One hundred thirteen vials of ⁶⁸Ga-DOTATOC (SomaKIT TOC) were synthesised with the 'kit' over a period of 11 months for clinical utility. Only 2/113 vials (1.77%) were rejected.

CONCLUSIONS

The new ready-to-use preparation of ⁶⁸Ga-DOTATOC (SomaKIT TOC) for injection was safe and well tolerated. This has led to the world's first (EMA) licensed ⁶⁸Ga-DOTATOC (SomaKIT TOC) radiopharmaceutical for the utility of PET imaging in patients with NETs. This preparation can be robustly implemented into routine clinical practice.

Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields

BACKGROUND

Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.

METHODS

A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.

RESULTS

The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.

CONCLUSION

The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

Use of 18F FDG PET and the short temporal response of Hodgkin's disease to RIT

Radioimmunotherapy (RIT) has been available for some time to treat patients with non-Hodgkin's lymphoma, but its use in Hodgkin's lymphoma has been less available, partly because of the need to find an appropriate antibody. A new radioiodinated chimeric antibody directed against the CD25 epitope (¹³¹I basiliximab) seems promising, but assessment of response has been difficult. ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG-PET) has become a standard method by which the response of Hodgkin's disease to chemotherapy is both predicted and assessed with well-understood criteria of response. The aim of this study is to determine ¹⁸F-FDG-PET can be used to assess response to RIT. Pre- and post-treatment ¹⁸F-FDG-PET imaging was performed in a series of 13 patients with advanced Hodgkin's disease who had failed conventional therapy and had been enrolled on a compassionate use program for treatment with ¹³¹I basiliximab. The ¹³¹I basiliximab was given at an activity of 1200MBq/m² with one patient receiving 2 cycles and the rest a single cycle. The ¹⁸F-FDG-PET studies were compared using the “Deauville” criteria and by comparing the maximum standardized uptake value (SUVmax) of target tumors before and 4 and 8 weeks after treatment. All patients survived long enough for their initial ¹⁸F-FDG-PET-computed tomography scan at 4 weeks after their ¹³¹I basiliximab therapy. One out of ten patients with “Deauville” Grade 4 or 5 response died during the 6-month follow-up period. Two out of three patients with a “Deauville” Grade 2 or 3 response died in the follow-up period. The mean SUVmax pretreatment was 11.9 (±4.7); at 4-week posttreatment, the mean SUVmax was significantly lower at 6.5 (±5.8) (P = 0.02). At 8 weeks, the mean SUVmax was 8.8 (±7.0), which was not significantly different from the pretreatment level. ¹⁸F-FDG-PET imaging is able to predict the short-term response to treatment of Hodgkin's disease by RIT, and an initial poor response appears to predict poor outcome. Early changes in ¹⁸F-FDG-PET uptake did not predict sustained response and by 8 weeks all but one patient had recurrent disease.

Social stress alters expression of large conductance calcium-activated potassium channel subunits in mouse adrenal medulla and pituitary glands

Large conductance calcium-activated potassium (BK) channels are very prominently expressed in adrenal chromaffin and many anterior pituitary cells, where they shape intrinsic excitability complexly. Stress- and sex-steroids regulate alternative splicing of Slo-alpha, the pore-forming subunit of BK channels, and chronic behavioural stress has been shown to alter Slo splicing in tree shrew adrenals. In the present study, we focus on mice, measuring the effects of chronic behavioural stress on total mRNA expression of the Slo-alpha gene, two key BK channel beta subunit genes (beta2 and beta4), and the 'STREX' splice variant of Slo-alpha. As a chronic stressor, males of the relatively aggressive SJL strain were housed with a different unfamiliar SJL male every 24 h for 19 days. This 'social-instability' paradigm stressed all individuals, as demonstrated by reduced weight gain and elevated corticosterone levels. Five quantitative reverse transcriptase-polymerase chain assays were performed in parallel, including beta-actin, each calibrated against a dilution series of its corresponding cDNA template. Stress-related changes in BK expression were larger in mice tested at 6 weeks than 9 weeks. In younger animals, Slo-alpha mRNA levels were elevated 44% and 116% in the adrenal medulla and pituitary, respectively, compared to individually-housed controls. beta2 and beta4 mRNAs were elevated 162% and 194% in the pituitary, but slightly reduced in the adrenals of stressed animals. In the pituitary, dominance scores of stressed animals correlated negatively with alpha and beta subunit expression, with more subordinate individuals exhibiting levels that were three- to four-fold higher than controls or dominant individuals. STREX variant representation was lower in the subordinate subset. Thus, the combination of subunits responding to stress differs markedly between adrenal and pituitary glands. These data suggest that early stress will differentially affect neuroendocrine cell excitability, and call for detailed analysis of functional consequences.

Dynamic gain-tilt compensation using electronic variable optical attenuators and a thin film filter spectral tilt monitor

An all-optical dynamic gain tilt compensator (DGTC) is proposed and experimentally demonstrated. A single wide-band thin film filter and a pair of photodetector allow the DGTC to distinguish band add/drop position. Power fluctuations from EDFA gain tilt were reduced with fast electronic variable optical attenuators.

Immuno-prophylaxis of babies borne to hepatitis B carrier mothers

OBJECTIVES

To examine the efficacy of current hepatitis B immuno-prophylaxis and estimate the prevalence of S-mutant infections among local newborn babies.

DESIGN

Prospective study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

A total of 137 newborn babies delivered between the period of November 2000 and 30 June 2001 inclusive, whose mothers were chronic hepatitis B surface antigen carriers.

RESULTS

Of the 121 infants who were followed up for 12 months, three were found to be chronic hepatitis B virus carriers, giving a vertical transmission rate of 2.5%. One (0.8%) was suspected to be infected by the S-mutant. All the three hepatitis B virus carrier babies were born to mothers with hepatitis B e antigen, but none to the eight mothers suspected to have S-mutants. Of 119 (98.3%) infants who developed hepatitis B surface antibody upon follow-up at 12 months, 35 were found to have hepatitis B e antigen at birth. All were born to hepatitis B e antigen-positive mothers. Only three of the 35 babies were found to be hepatitis B virus carriers. Most babies lost the hepatitis B e antigen by 6 months of age; only the infected babies had the antigen persisting at 1 year of age. The non-infected infants' hepatitis B e antigen is likely transplacental.

CONCLUSIONS

Our hepatitis B virus prophylaxis programme was effective at preventing perinatal infection and the non-infected infants' hepatitis B e antigen was likely transplacental.

Effect of Prepartum Dietary Calcium on Intake and Serum and Urinary Mineral Concentrations of Cows

Nine multiparous and 12 primiparous cows were fed diets containing an anionic salt supplement and moderate Ca (0.99%) or high Ca (1.50%) concentrations for 21 d prepartum to determine the effects of dietary Ca concentration on serum and urine electrolytes and on postpartum intake and milk yield. Blood samples were collected during 21 to 1 d prepartum, 0 to 2 d postpartum, and 3 to 21 d postpartum. Dietary cation-anion difference (DCAD) for prepartum diets was approximately -6 mEq/100 g of dry matter (Na + K - Cl - S). Immediately postpartum, cows were fed diets with positive DCAD with greater than 1.00% Ca concentration. Mean serum Ca concentrations 21 to 1 d prepartum, 0 to 2 d postpartum, and 3 to 21 d postpartum were 9.62, 8.41, and 9.38 mg/dL. There were no treatment effects on serum Ca concentration. Mean serum Ca concentration was higher for primiparous than multiparous cows (9.34 vs. 8.93 mg/dL) for the trial and at calving (8.77 vs. 8.13 mg/dL). Mean serum HCO(3)(-) and urinary pH, respectively, were 20.32 mEq/L and 5.67 prepartum, 25.82 mEq/L and 7.62 at calving, and 26.08 mEq/L and 8.25 postpartum. No differences due to treatment were observed for serum and urinary concentrations of HCO(3)(-), pH, Mg, Na, K, and Cl. Milk yield was similar for 0.99 and 1.50% Ca treatments (22.8 and 20.7 kg/d). Diets containing 0.99 or 1.5% Ca maintained serum Ca at adequate levels around parturition and resulted in similar dry matter intake and postpartum milk yield.

Effects of Dietary Cation-Anion Difference on Intake, Milk Yield, and Blood Components of the Early Lactation Cow

Early lactation Holsteins cows (15 primiparous and 18 multiparous) were offered rations with dietary cation-anion difference, calculated as mEq (Na + K - Cl - S)/100 g of feed dry matter (DCAD:S), of 20, 35, or 50 mEq from d 0 (calving) to 42 d postpartum (August 20, 2000 to January 9, 2001) to determine the effects of increasing DCAD:S on dry matter intake (DMI), milk yield, and blood metabolites. For DCAD:S of 20, 35, and 50, DMI was 3.30, 3.38, 2.96 kg/100 kg of body weight (BW); milk yield was 25.5, 24.2, and 22.4 kg/d, respectively. No differences were observed for concentration or yield of milk fat or milk protein. Serum Ca, P, Mg, Na, K, Cl, cation-anion difference, insulin, and glucose did not differ with DCAD. Serum HCO3- was 26.07, 25.88, and 27.64 mEq/L for 20, 35, and 50 DCAD:S. Serum Ca, Mg, Na, and K concentrations were greater for primiparous cows (9.52 mg/dL, 2.35 mg/dL, 140.03 mEq/L, 4.66 mEq/L, respectively) than for multiparous cows (9.27 mg/dL, 2.12 mg/dL, 137.63 mEq/L, 4.46 mEq/ L, respectively). A DCAD:S between 23 and 33 mEq/100 g of dry matter (DM) appears to be adequate during cool weather for the milk yield that occurred in the present study based on DMI (kg/100 kg of BW), whereas DCAD:S of 50 mEq/100 g of DM may be excessive and could be too alkaline or unpalatable, resulting in decreased DMI (kg/100 kg of BW).

Gene expression profile of mechanically impacted bovine articular cartilage explants

Traumatic injury to a joint can initiate cartilage degradation. Blunt trauma increases matrix damage and decreases proteoglycan synthesis in in vitro models. Few studies have investigated gene expression of articular cartilage (AC) following mechanical loading. Recent advances in microarray technology allow analysis of a number of genes, and may elucidate pathways of AC degradation. In the present study, we used a bovine cDNA microarray to determine how acute trauma of cartilage explants in the absence of underlying bone alters gene expression. Results indicate that at least 19 genes were differentially expressed at 3 h after trauma. Fourteen genes were up-regulated and five genes were down-regulated relative to control explants. The up-regulated genes included cytokine and chemokine receptors, enzymes, and molecules involved in signal transduction. Genes of adhesion molecules and apoptosis were down-regulated. The results of this study highlight the potential benefits of using a bovine cDNA microarray to study cartilage metabolism.

17-year follow-up of a randomized prospective controlled trial of adjuvant intravesical doxorubicin in the treatment of superficial bladder cancer

PURPOSE

To evaluate the efficacy of adjuvant intravesical doxorubicin in superficial transitional cell carcinoma of the urinary bladder on long-term follow-up.

MATERIALS AND METHODS

Between July 1986 and November 1991, all patients harboring superficial bladder cancers (Ta or T1) with one or more of these criteria (stage>a, grade>1, size>1 cm, multiple or recurrent tumors) were randomized to receive either 50 mg doxorubicin or no adjuvant therapy. Patients with recurrences were allowed to receive doxorubicin or other intravesical agents. Recurrence, progression and survival were analyzed.

RESULTS

There were 82 patients included (64 males and 18 females). The mean age was 64 years. Forty-six patients were randomized to the doxorubicin group and 36 to the control group. Final analysis was made at median follow-up of 45, 128 and 131.5 months for recurrence, progression and survival, respectively. Recurrence free, progression free and disease specific survival did not differ significantly between groups. The 10-year Kaplan-Meier estimates for recurrence free, progression free and disease specific survival were 67%, 84% and 92%, respectively for the doxorubicin group, and were 50%, 89% and 97%, respectively for the control group. Tumor size predicted recurrence (p=0.013) and grade predicted progression (p=0.004) with multivariate analysis.

CONCLUSIONS

Adjuvant intravesical doxorubicin could not be shown to improve recurrence, progression and survival of superficial bladder cancer, compared with control on long-term follow-up. Tumor size and grade were shown to be prognostic factors for recurrence and progression, respectively.

Glucosamine and chondroitin sulfate regulate gene expression and synthesis of nitric oxide and prostaglandin E(2) in articular cartilage explants

OBJECTIVE

Glucosamine (GLN) and chondroitin sulfate (CS) are widely used to alleviate symptoms of osteoarthritis (OA). However, the mechanism(s) of action of these nutraceuticals remains unresolved. In the present study, we determined the effect of physiologically relevant concentrations of GLN and CS on gene expression and synthesis of nitric oxide (NO) and prostaglandin E(2) (PGE(2)) in cytokine-stimulated articular cartilage explants.

METHODS

Using bovine articular cartilage explants in culture stimulated with IL-1, the effects of physiologically relevant concentrations of GLN and CS on gene expression of inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), cyclooxygenase-2 (COX-2) and microsomal prostaglandin E synthase-1 (mPGEs1) were assessed with quantitative real-time polymerase chain reaction (Q-RT-PCR). The production of NO and PGE(2) was also quantified.

RESULTS

CS and the GLN and CS combination at concentrations attainable in the blood down-regulated IL-1 induced mRNA expression of iNOS at 24 and 48 h post-culture. Up-regulated iNOS expression at 24h by IL-1 was also suppressed by GLN. GLN and CS transiently repressed the cytokine-stimulated mPGEs1 transcript. Synthesis of NO was reduced with CS alone and the combination after 24h of culture. Repression of COX-2 transcripts by GLN and CS was accompanied by concomitant reduction in PGE(2).

CONCLUSION

Our results indicate that physiologically relevant concentrations of GLN and CS can regulate gene expression and synthesis of NO and PGE(2), providing a plausible explanation for their purported anti-inflammatory properties.

Detection of mRNA expression of gonadotropin-releasing hormone and its receptor in normal and neoplastic rat prostates

Hypothalamic gonadotropin-releasing hormone (GnRH) plays a central role in the regulation of the mammalian reproductive systems as a releasing hormone of pituitary gonadotropins. However, a number of studies have shown that GnRH or its receptor are also expressed in some reproductive organs including prostate gland, mammary gland, ovary and placenta, tumors and tumor cell lines derived from these organs, suggesting that this peptide hormone may have other extrapituitary functions in addition to its role as a gonadotropin-releasing hormone. Moreover, it has been demonstrated that GnRH analogs exert some direct inhibitory effects on the proliferation of human and rat prostate cancer cells, probably mediated by its own specific receptors expressed in these tumor cells. In the present study, we investigated the mRNA expression of GnRH and its receptor in normal Noble rat prostate gland, and in three rat models of prostate cancer including the sex hormone-induced Noble rat model, an androgen-independent Noble rat prostatic tumor (AIT) and Dunning rat prostatic adenocarcinomas by RT-PCR and Southern blot analyses. The results showed that GnRH mRNA was expressed in the normal, hormone-treated and neoplastic rat prostates, in addition to its positive control expression in the hypothalamus, whereas its receptor was only detected in the androgen-dependent Dunning R3327H tumor. The detection of both GnRH and its receptor in the androgen-dependent Dunning R3327H tumor tissue suggests that this peptide hormone may have some autocrine and paracrine regulatory functions in this tumor. However, the gene expression of GnRH receptor was not detected in two androgen-independent Dunning tumor sublines and the Noble rat prostatic tumor, AIT, suggesting that the expression of GnRH receptor is lost or down-regulated in the prostatic tumors during the progression to a hormone-independent phenotype.

Altered expression of extracellular matrix and proteinases in Noble rat prostate gland after long-term treatment with sex steroids

BACKGROUND

Interactions between the epithelial cells and stromal tissues, which include the epithelial basement membrane, extracellular matrix, inducible factors, and various cell types, are believed to play a significant role in prostate gland carcinogenesis. Remodeling of extracellular matrix and degradation of basement membrane are the prerequisites for tumor cell invasion, and these changes are correlated with the expression of various proteinases.

METHODS

The present study examined the alterations of epithelial basement membrane, extracellular matrix, and proteinase activities in the Noble rat prostate gland after long-term treatments with androgen and estrogen (T+DES or T+E(2) for 4-12 months) by histochemistry, immunohistochemistry, electron microscopy, and gelatin-gel zymography.

RESULTS

After hormonal treatments, defects of epithelial basement membranes, such as focal disruption, diffuse staining and multilayering, were observed by histochemistry and immunohistochemistry in the dysplastic and neoplastic lesions induced in the lateral (LP) and ventral prostates (VP) but not in dorsal prostate (DP). An increase in the amount of extracellular matrix components, including hyaluronan (HA), chondroitin sulfate proteoglycan (CSPG) and tenascin, in the stroma of hormone-treated LP and VP was revealed by histochemistry and immunohistochemistry. Positive immunolabeling of matrix metalloproteinases 2 (MMP-2) and 9 (MMP-9) was detected in the fibromuscular layer surrounding the adenoma and adenocarcinoma induced in LP and VP after treatments with steroids for over 9-12 months. Zymography also detected an increase in activities of proteinases of apparent MW 120, 90, 86 and 68 kDa in the hormone-treated LP and VP, and these proteinases were characterized as metalloproteinases. In addition, two serine proteinases of MW 100 and 30 kDa were identified as being overexpressed in the hormone-treated LP and VP. Compared to LP and VP, there was no significant change in the proteinase activities in the hormone-treated DP.

CONCLUSIONS

The present study demonstrated that the epithelial basement membrane and stromal extracellular matrix were altered in dysplastic and neoplastic Noble rat prostates. Since HA and CSPG (or their complexes) are highly anionic molecules, their increased accumulation in the altered prostatic stroma would tend to hydrate this tissue. This would create an environment more favorable for tumor growth and invasion. These morphological changes were also correlated with the concurrent increase in gelatinolytic proteinase activities induced in these prostates. The results suggest that the remodeling of the stromal tissue might play a role in the early stage of prostate carcinogenesis as shown in the Noble rat model.

SPARC (secreted protein acidic and rich in cysteine) induces apoptosis in ovarian cancer cells

Secreted protein acidic and rich in cysteine (SPARC) is an extracellular Ca(2+)-binding matricellular glycoprotein that associates with cell populations undergoing migration, morphogenesis, and differentiation. Studies on endothelial cells have established that its principal functions in vitro are counteradhesion and antiproliferation. The mechanism(s) underlying these antitumor effects is unknown. In this study, we showed that SPARC expression in ovarian cancer cells is inversely correlated with the degree of malignancy. The immunohistochemical data presented here confirmed the importance of diminished SPARC expression in ovarian cancer development. Treating human ovarian surface epithelial cells and ovarian cancer cells with SPARC revealed that as SPARC inhibits the proliferation of both normal and cancer cells, it induces apoptosis only in cancer cells. This observation indicates that down-regulation of SPARC is essential for ovarian carcinogenesis as cancer cells become sensitized to the apoptotic activity of SPARC during malignant transformation. We also showed here the first direct evidence that putative SPARC receptors are present on ovarian epithelial cells. Their levels are higher in human ovarian surface epithelial cells than cancer cells. Binding of SPARC to its receptor is likely to trigger tissue-specific signaling pathways that mediate its tumor suppressing functions. Decrease in ligand-receptor interaction by the down-regulation of SPARC and/or its receptor is essential for ovarian carcinogenesis.

The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions

This study investigates the effect of experience of the interpreter on the ability of magnetic resonance imaging (MRI) to identify the presence and anatomic location of a triangular fibrocartilage complex (TFCC) lesion. Fifty-one patients who underwent wrist arthroscopy with preoperative MRI studies were reviewed retrospectively. Two radiologists with different levels of training and experience evaluated the MRI scans in a blinded manner. The sensitivity rates of the 2 observers for detection of TFCC lesions were 86% and 80%. The specificity rates were 96% and 80%. The accuracy rates for prediction of a TFCC tear were 83% and 61% for the 2 observers. The correct location of a TFCC lesion was predicted by the more experienced observer for 12 of 19 central, 3 of 4 radial, and 6 of 12 peripheral lesions. The less experienced observer correctly identified 8 of 19 central, 2 of 4 radial, and 2 of 12 peripheral tears. The overall accuracy rates for prediction of a TFCC lesion and its location were 69% and 37%. Our data indicate that the published accuracy rates for prediction of TFCC lesion location may be reproducible only in very specialized centers.

I1307K Mutation Detection by Allele-Specific PCR in Familial Colorectal Cancer

Familial colorectal cancer (FCC) is a hereditary form of colorectal cancer that accounts for 15-50% of all colorectal cancers (1,2). FCC patients generally have one or two family members affected with colon polyps or cancer. A mutation (I1307K) in the APC gene has been associated with colorectal cancer in Ashkenazi Jews (3). This specific mutation is detected in approx 6% of the Ashkenazic Jewish population. The frequency increases to about 28% in Ashkenazim with a family history of colorectal cancer. A person carrying this mutation will have a twofold increased risk, over the general Ashkenazic Jewish population, of developing colorectal cancer in his or her lifetime (3). This risk is estimated to be approx 18-30% (3). Screening for this mutation is therefore important preventative care in this high-risk population.

A comparative study of hormonal regulation of three secretory proteins (prostatic secretory protein-PSP94, probasin, and seminal vesicle secretion II) in rat lateral prostate

The rat dorsolateral prostate secretes several major known proteins, although their physiological and reproductive functions are largely undefined. In the present study we examined and compared the in vivo hormonal regulation of the messenger RNA (mRNA) expression of three major secretory proteins, including prostatic secretory protein of 94 amino acids (PSP94 or beta-microseminoprotein), probasin, and seminal vesicle secretion II (SVSII), in long-term castrated lateral prostates (LP) by in situ hybridization and semiquantitative RT-PCR. The protein levels of PSP94 in the castrated LPs were also examined by Western blotting. PSP94 is a small protein newly isolated from the rat prostate gland and demonstrates highly specific expression in the LP. The results of in situ hybridization showed that PSP94, probasin, and SVSII were highly expressed in the intact LP. The hybridization signals of probasin and PSP94 disappeared in the 60-day postcastrated LPs, whereas the signals of SVSII dropped sharply in the 14-day postcastrated LPs. Similar patterns of decreasing mRNA levels of the three proteins in the castrated LPs were observed by RT-PCR analysis. Their mRNA transcripts were restored to normal levels after replacement with testosterone. The results indicate that these secretory proteins are all under androgen regulation in the rat LP. Interestingly, we also observed that their degrees of sensitivity or responsiveness to androgen withdrawal are different. Their mRNA levels dropped in response to duration of castration in the following decreasing order: SVSII, PSP94, and probasin. Besides androgen [dihydrotestosterone (DHT)], we also examined the effects of glucocorticoid [dexamethasone (DEX)], progestin [medroxyprogesterone acetate (MPA)], and zinc on their gene expressions in castrated LPs. We observed that the mRNA transcripts of both PSP94 and probasin were increased after treatments with DHT, DEX, and MPA, suggesting that these two proteins could also be regulated by glucocorticoid and progestin. In contrast with probasin, PSP94 and SVSII were not induced by ZnSO4 treatment. On the other hand, SVSII expression was only increased significantly by DHT and moderately by MPA, but not by DEX, suggesting that SVSII is under strict control by androgen.

Induction of apoptosis in prostate cancer cell lines by a flavonoid, baicalin

The flavonoid baicalin (baicalein 7-D-beta-glucuronate), isolated from the dried root of Scutellaria baicalensis Georgi (Huang Qin), is widely used in the traditional Chinese herbal medicine for its anti-inflammatory, anti-pyretic and anti-hypersensitivity effects. In the present study, we investigated the in vitro effects of baicalin on the growth, viability, and induction of apoptosis in several human prostate cancer cell lines, including DU145, PC-3, LNCaP and CA-HPV-10. The cell viability after treating with baicalin for 2-4 days was quantified by a colorimetric 3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-s ulfophenyl)- 2H-tetrazolium (MTS) assay. The results showed that baicalin could inhibit the proliferation of prostate cancer cells. The responses to baicalin were different among different cell lines, with DU145 cells being the most sensitive and LNCaP cells the most resistant. Baicalin caused a 50% inhibition of DU145 cells at concentrations of 150 microM or above. The inhibition of proliferation of prostate cancer cells after a short period of exposure to baicalin was associated with induction by apoptosis, as evidenced by the typical nuclear fragmentation using Hoechst 33258 staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) labeling, DNA fragmentation, activation of caspase-3 and cleavage of poly-ADP-ribose polymerase (PARP). The results indicate that baicalin has direct anti-tumor effects on human prostate cancer cells.

The synthesis and vasopressin (AVP) antagonist activity of a novel series of N-aroyl-2,4,5,6-tetrahydropyrazolo[3,4-d]thieno[3,2-b]azepines

Synthesis and SAR of N-[4-[(4,5-dihydropyrazolo[3,4-d]thieno[3,2-b]azepin-6(2H)-y l)carbonyl]phenyl]benzamides as arginine vasopressin (AVP) receptor antagonists are discussed. Potent orally active AVP receptor antagonists are produced when the benzamide moiety contains a phenyl group at the 2-position. Similar analogues of 4,6,7,8-tetrahydro-5H-thieno[3,2-b]azepine and VPA-985 are reported.

The design, synthesis and physical chemical properties of novel human vasopressin V2-receptor antagonists optimized for parenteral delivery

Ionizable groups were introduced onto the 10,11-dihydro-5H-pyrrolo[2,1-c][1,4]benzodiazepine scaffold of the vasopressin V2-antagonist WAY-VPA-985 in the search for molecules optimized for parenteral formulation. The synthesis and structure activity relationships (SAR) are presented together with solubility data in a model parenteral system. The amine, WAY-140288 (4f), was chosen for further development. p6

PSP94 (or beta-microseminoprotein) is a secretory protein specifically expressed and synthesized in the lateral lobe of the rat prostate

BACKGROUND

Prostatic secretory protein of 94 amino acids (PSP94), also called beta-microseminoprotein, is a small, nonglycosylated protein, rich in cysteine residues. It was first isolated as a major protein from human seminal plasma. Subsequently, its homologous proteins were identified, and their cDNAs or genes have been cloned in primates, pigs, and rodents.

METHODS

The present study investigated the expression pattern of PSP94 in the normal Noble rat prostate gland by nonradioactive in situ hybridization, Northern blotting, RT-PCR, Western blotting, and immunohistochemistry. Its expression in the mouse prostate gland was also examined by in situ hybridization.

RESULTS

The results of in situ hybridization, and Northern and Western blot analyses, showed that the expression of rat PSP94 was prostate-specific. It was highly expressed in the lateral prostatic lobe, moderate in the dorsal lobe, weak in the coagulating gland, and negative in the ventral lobe and seminal vesicle. Its specific expression in the rat prostate gland was further confirmed by RT-PCR analysis of prostatic and nonprostatic organ tissues. Its mRNA transcripts were not detected in the urinary, digestive, and respiratory tracts, male and female reproductive organs, muscles, brain, and kidney. Its molecular mass was estimated to be 14.5 kDa by Western blotting. Similar prostate-specific expression of PSP94 was also observed by in situ hybridization in the lateral lobe, but not in the dorsal and ventral lobe, of the mouse prostate gland.

CONCLUSIONS

Rat PSP94 is a major secretory protein highly expressed and synthesized by the lateral lobe of both rat and mouse prostate glands, and moderately expressed in the dorsal lobe of the rat prostate gland.

Optimal position for the one-bone forearm. An analysis using a hinged brace in normal subjects

The purpose of the present study was to determine whether there is an optimal position for fixation of the one-bone forearm. Eight normal individuals were fitted with a hinged brace which fixed the position of pronation and supination and underwent functional hand testing using the tests of Jebsen et al. Our results indicate that a one-bone forearm in a position of 30 degrees of pronation will provide the best function for writing and working with small objects using the dominant arm.

In situ hybridization study of PSP94 (prostatic secretory protein of 94 amino acids) expression in human prostates

BACKGROUND

The prostatic secretory protein of 94 amino acids (PSP94), also named beta-microseminoprotein, is one of the major proteins secreted by the human prostate. However, its value as a prognostic marker for prostate cancers is still under debate. The aim of the present study was to examine the expression pattern of this protein in fetal, pubertal, and aged human prostates.

METHODS

Nonisotopic in situ hybridization using a digoxigenin-labeled riboprobe for PSP94 and immunohistochemistry were used to demonstrate the expression of PSP94 in different regions or zones of fetal, pubertal, and adult human prostates. Its localization pattern was also compared with those of two other major secretory proteins, prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), by immunohistochemistry.

RESULTS

PSP94 mRNA and its protein were localized to the secretory epithelium of normal pubertal and adult human prostates. No hybridization signal and immunoreactivity of PSP94 were seen in fetal prostates at 6-7 months of gestation, whereas some glandular cells were positive to PSA and PAP immunostainings. In the adult prostates, PSP94 expression was intense in the acini in the peripheral zone, less intense in the transition zone, and variable in the central zone. Such a zonal expression pattern was more apparent in the pubertal prostates. However, no obvious differential expression pattern was observed in the immunohistochemistry of PAP and PSA, which showed a uniform staining of the secretory epithelia of the acini in all anatomic zones. The hybridization signals and immunoreactivity of PSP94 became reduced or lost in premalignant prostatic intraepithelial neoplastic lesions and different grades of prostatic carcinomas.

CONCLUSIONS

Fetal prostates at 6-7 months of gestation already synthesize PSA and PAP but not PSP94. The delayed expression of PSP94 appears to correlate with the development of the prostate gland. A differential expression pattern of PSP94 is demonstrated in different anatomical zones, showing that this protein is more expressed and synthesized in the acini in the peripheral zone than in the central and transition zones. However, such a zonal pattern is not seen in the immunohistochemistry of PSA and PAP. The present study also shows that PSP94 is downregulated in different grades of prostate cancers.

5-fluoro-2-methyl-N-[5-(5H-pyrrolo[2,1-c][1,4]benzodiazepine-10(11H)-yl carbonyl)-2-pyridinyl]benzamide (CL-385004) and analogs as orally active arginine vasopressin receptor antagonists

Synthesis and structure-activity relationships (SAR) of orally active arginine vasopressin (AVP) receptor antagonists are discussed. Potent and orally active AVP receptor antagonists are produced when ring A of VPA-985 (1) is replaced with a 3-pyridinyl unit (2b).

4,10-dihydro-5H-thieno[3,2-c][1]benzazepine derivatives and 9,10-dihydro-4H-thieno[2,3-c][1]benzazepine derivatives as orally active arginine vasopressin receptor antagonists

Synthesis and structure-activity relationships (SAR) of arginine vasopressin receptor (AVP) antagonists are described. Potent and orally active compounds are prepared when tricyclic 10,11-dihydro-5H-pyrrolo[2,1-c][1,4]benzodiazepine moiety in VPA-985 1 is replaced with a compound 7 or 12.

Computed tomographic scanning of cervical spine fractures: does it influence treatment?

OBJECTIVE

To determine whether the superior sensitivity of computed tomography (CT) results in changes in treatment plans for cervical spine fractures that have been diagnosed on plain films alone.

DESIGN

Retrospective review of radiographic studies for cervical spine trauma.

SETTING/PARTICIPANTS

An orthopaedic spine surgeon (SS), an orthopaedic traumatologist (OT), an orthopaedic spine fellow (SF), and an orthopaedic chief resident (CR) were independently presented thirty-nine cases of cervical spine trauma imaged with adequate plain radiographs and with CT.

MAIN OUTCOME MEASURES

Agreement was measured by calculation of kappa coefficients.

RESULTS

The detection rate of total fractures on plain radiographs alone ranged from 47 percent to 71 percent, and the diagnosis changed an average 53 percent of cases. Change in treatment plans ranged from 10 percent (SS) to 46 percent (CR) of cases. Of these changes, undertreatment occurred as follows: SS =3 percent, OT =8 percent, SF =36 percent, and CR = 46 percent. The mean kappa coefficient for intraobserver agreement of treatment plans was 0.69. The experienced observers demonstrated "excellent" agreement with an average kappa coefficient of 0.85, whereas the mean coefficient for inexperienced observers was 0.54 or "moderate" agreement. Complete diagnostic agreement occurred between the experienced observers after review of both the plain films and CT scans. The interobserver agreement of treatment plans for the experienced observers increased from 0.79 to 0.88.

CONCLUSIONS

CT scanning afforded additional information for all observers. Experienced observers can reliably determine treatment plans for cervical spine trauma diagnosed on plain films alone, whereas inexperienced observers are less reliable. For the experienced observers, interobserver agreement on treatment plans increased after the addition of CT.

Consequences of knuckle cracking: a report of two acute injuries

A question commonly asked of physicians focuses on the possible deleterious effects of knuckle cracking. Patients are usually concerned that the risk of arthritis is increased by the habit; however, reports addressing the potential long-term consequence are controversial. We present two cases in which acute injuries were suffered while the patients were attempting to crack their knuckles. Both injuries responded well to conservative treatment. Our investigation shows that acute injuries can result from the forceful manipulation needed to achieve the audible pop of cracking knuckles and that patients should be counseled accordingly.

Addition of opioids alters the density and spread of intrathecal local anesthetics? An in vitro study

PURPOSE

To determine whether the addition of opioids alters the density and spread of intrathecal local anesthetics in vitro.

METHODS

In Part I, the densities of hyperbaric bupivacaine 0.75% (HB), hyperbaric lidocaine 5% (HL) and isobaric bupivacaine 0.5% (IB) with and without morphine (M), and fentanyl (F) were measured at 22 degrees C. In Part II a model was constructed utilizing a column containing a solution similar in composition to cerebrospinal fluid (CSF) at 37 degrees C. The various local anesthetic-opioid solutions, coloured with crystalline methylene blue dye, were injected at 22 degrees C into the column at a controlled rate through a spinal needle. The direction and extent of spread of the injectates were compared.

RESULTS

The relative densities of the five solutions were: HB = HL > IB > M > F. The addition of fentanyl to IB reduced the density of the final solution (P < 0.05). In the model, IB alone and IB with morphine showed mainly downward spread, with the addition of fentanyl to IB resulting in upward movement (P = 0.004). The hyperbaric local anesthetics moved downward with or without opioids.

CONCLUSION

The addition of fentanyl reduces the density of IB in vitro and alters its movement in simulated CSF. This may prove to be important in predicting the level of spinal block in clinical practice.

Identification of the vascular and avascular zones of the human meniscus using magnetic resonance imaging: correlation with histology

Since the initial employment of magnetic resonance imaging (MRI) to diagnose meniscal tears, a characteristic low-signal intensity, triangular-shaped structure has been interpreted as representing the entire meniscus. The difficulty in diagnosing meniscocapsular separations with MRI has brought attention to our lack of understanding of the appearance on MRI of the outer third of the meniscus and the meniscocapsular junction. We correlated MRIs of the meniscus in cadaver knees with histological sections and found that the low-signal, wedge-shaped structure corresponds only to the avascular (white) zone of the meniscus, whereas the high-signal zone peripheral to it corresponds to the vascularized (red) zone.

The significance of the three volar spaces in forearm compartment syndrome: a clinical and cadaveric correlation

The goal of this study was to assess the importance of the 3 volar spaces in forearm compartment syndrome in a prospective manner. A cadaveric model was developed to correlate with our clinical experience. All but 1 of 21 volar compartments (superficial volar, deep volar, and pronator quadratus spaces) in 7 patients in our clinical series decompressed adequately after release of the superficial volar fascia. One patient needed further release of the pronator quadratus compartment; he had suffered a combined crush and vascular injury. All volar compartments in our cadaveric model decompressed with superficial fasciotomy. Prefasciotomy and postfasciotomy pressures should be obtained from all 3 compartments of the volar forearm. Superficial fasciotomy usually adequately decompresses the entire volar forearm; however, in the event that deep compartment pressures remain high after superficial fasciotomy, release of the affected space is indicated.

Psychosocial and psychiatric morbidity in patients on CAPD

Continuous ambulatory peritoneal dialysis (CAPD) is an important mode of therapy for patients with end-stage renal disease. Although techniques and patient survival rates have improved, the psychosocial rehabilitation of Asian CAPD patients has not been studied. The aim of this study is to measure the extent of psychosocial and psychiatric morbidity in a sample of Asian CAPD patients. Patients from the outpatient CAPD facility affiliated with a tertiary care hospital were randomly selected and enrolled in the study. Demographic and clinical data were collected. Psychosocial and psychiatric assessments using the Hospital Anxiety and Depression Scale and coping style questionnaires were performed by a trained psychiatrist. The patients' most bother-some symptoms and specific worries were noted. Thirty of 105 stable CAPD patients (mean age 54.2 +/- 14.1 years, M:F 1:2, mean duration on CAPD 22.3 +/- 8.3 months) were studied. Twenty-one patients were married. Twenty-two patients were uneducated, 19 were unemployed, and 9 were homemakers. Based on the Hospital Anxiety and Depression scales, 50% of the patients were identified as cases of anxiety and 13% as depression. Although 93% of the patients accepted their illness, 46% of the patients were in a state of despair and hopelessness. Pruritus was the most frequent complaint (40%), followed by dietary restrictions (23%). The main worries were financial in 83% of patients, sexual dysfunction in 73%, and unemployment in 67%. In conclusion, Asian CAPD patients have a high degree of undetected psychosocial and psychiatric morbidity. These issues need to be addressed to provide adequate psychosocial rehabilitation.

Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures

OBJECTIVE

To evaluate the interobserver and intraobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain films alone and with computed tomography (CT) scans.

DESIGN

Prospective study to assess the impact of an advanced radiologic study on the agreement of treatment plan and fracture classification of tibial plateau fractures.

SETTING/PARTICIPANTS

Two orthopaedic traumatologists, two orthopaedic residents, and two skeletal radiologists were presented with twenty-one cases of tibial plateau fractures imaged with plain films and with CT scans.

MAIN OUTCOME MEASURES

Agreement was measured using kappa coefficients.

RESULTS

Using plain films alone, the mean interobserver kappa coefficient for classification was 0.62, which decreased to 0.61 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.58, which increased to 0.71 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain films was 0.70, which increased to 0.80 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain films alone was 0.62, which increased to 0.82 after addition of CT scans. Class was changed in an average of 12 percent of cases after addition of CT scans. Treatment plan was changed an average of 26 percent of the time after addition of CT scans.

CONCLUSION

Addition of CT scans to plain roentgenograms increases the interobserver and intraobserver agreement on treatment plan.

Supracondylar femur fracture above a mature knee fusion treated with a long locked intramedullary rod

Fracture around a mature knee fusion has been reported in the orthopedic literature, but little has been written regarding treatment options. Closed long anterograde rodding with interlocking screws offers distinct advantages over other methods of reduction and fixation. The closed nature of the procedure avoids excessive soft-tissue stripping. In comparison with a short unlocked rod or plate, the long locked rod imparts more stability and prevents shortening and rotation. We present a case of a supracondylar femur fracture above a mature knee fusion treated in this manner. The literature on this injury is also reviewed.

Treatment of considerations in patients with compartment syndrome and an inherited bleeding disorder

In addition to consultation with an experienced hematologist, the following are recommendations regarding compartment syndrome in a patient with an inherited bleeding disorder. Von Willebrand's Disease. Humate-P (rich in von Willebrand factor) is the replacement therapy of choice for surgical procedures in patients with von Willebrand's disease. In general, in the perioperative period, factor VIII levels between 50% and 100% are ideal with a gradual tapering to maintain levels at 50% for approximately 2 weeks. Adjuncts to therapy are DDAVP and EACA. Hemophilia A. During the initial evaluation and with measurement of compartment pressures, factor VIII replacement to levels in the range of 40% to 60% of normal is appropriate replacement therapy. For fasciotomy, however, factor VIII levels greater than 50% to 100% are required. In patients who have developed antibodies to factor VIII, a number of options are available. With low titers of factor VIII inhibitor, higher doses of factor VIII may be successful in overriding the inhibitor. In patients with higher titers of inhibitor, activated factor VII or porcine factor VIII is recommended. Hemophilia B. Highly purified factor IX replacement aimed at keeping factor levels between 50% and 100% in the perioperative period, followed by maintenance at 50% for approximately 2 weeks, is optimal management. Treatment Algorithm: The Figure outlines an algorithm to aid in the diagnosis and treatment of compartment syndrome in the patient with an inherited bleeding disorder. In a suspected case of compartment syndrome due to a soft-tissue hemorrhage or injury, factor replacement as outlined above should be initiated. Unequivocal clinical findings in the normal patient usually would be an indication to proceed to fasciotomy without obtaining compartment pressures. In the patient with an inherited bleeding disorder, however, factor replacement and subsequent normalization of the clotting cascade may help lowe compartment pressures. Therefore, we advocate obtaining initial pressures even with clinical findings of an acute compartment syndrome. At our institution, we advocate using an automated handheld pressure monitor (Stryker, Ontario, Canada) or the needle injection technique as described by Whitesides et al. In interpreting the obtained pressures, we choose to use the guidelines as described by Heppenstall et al. Briefly, Heppenstall et al determined that the pressure threshold at which cellular damage occurred was related more closely to the difference between the mean arterial blood pressure and compartment pressure than with the absolute compartment pressure alone; this measurement is called delta P. If delta P is > 30 mm Hg, then one should continue factor replacements and perform serial clinical and pressure examinations. Pressures should be taken every hour for 2 hours total. If the patient worsens in either respect, then the physician should enter the other limb of the algorithm for delta P < 30 mm Hg. For the patient with a delta P < 30 mm Hg, the amount of time since onset of symptoms must be considered. Since the patient may improve with adequate factor replacement, a delta P < 30 mm Hg mercury does not dictate automatic fasciotomy. An adequate time trial of replacement therapy may be attempted. In patients whose pressures do not begin normalizing, we advocate proceeding to fasciotomy. Patients who begin to normalize pressures during a 2-hour trial can be followed with serial clinical and pressure examinations. Any worsening in either scenario is an indication for fasciotomy; otherwise, observation and factor replacement may be continued. After initial decompression, staples may be placed in both wound edges with an elastic vascular loop woven between the two edges in a "shoelace" pattern. Then while waiting for closure, the loops can be gradually tightened at the bedside. Definitive closure should be attempted around the fifth postoperative day. All closure techniques should be pre

Lignans and isoflavonoids in plasma and prostatic fluid in men: samples from Portugal, Hong Kong, and the United Kingdom

BACKGROUND

Chinese men have lower incidences of prostate cancer compared to men from Europe and North America. Asians consume large quantities of soya, a rich source of isoflavanoids phyto-oestrogens and have high plasma and urinary levels of these compounds. The mammalian lignans, enterolactone and enterodiol, are another group of weak plant oestrogens and are derived from seeds, cereals and grains. Vegetarians have high plasma and urinary concentrations of lignans.

METHODS

The concentrations lignans and isoflavonic phyto-oestrogens were determined by gas chromatography-mass spectrometry (GC-MS) in plasma and prostatic fluid from Portuguese, Chinese and British men consuming their traditional diets.

RESULTS

In prostatic fluid the mean concentrations of enterolactone were 31, 162 and 20.3 ng/ml for Hong Kong, Portugal and Britain respectively. Very high levels of enterolactone (> 600 ng/ml) were observed in the prostatic fluid of some of the men from Portugal. High concentrations of equol (3270 ng/ml) and daidzein (532 ng/ml) were found in a sample of prostatic fluid from Hong Kong. Higher mean levels of daidzein were observed in prostatic fluid from Hong Kong at 70 ng/ml, compared to 4.6 and 11.3 ng/ml in samples from Portugal and Britain respectively. Mean levels of daidzein were higher in the plasma samples from Hong Kong (31.3 ng/ml) compared to those from Portugal (1.3 ng/ml) and Britain (8.2 ng/ml). In general, the mean plasma concentrations of enterolactone from the three centres were similar, at 6.2, 3.9 and 3.9 ng/ml in samples from Hong Kong Portugal and Britain respectively.

CONCLUSIONS

Higher concentrations of the isoflavanoid phyto-oestrogens, daidzein and equol, were found in the plasma and prostatic fluid of men from Hong Kong compared to those from Britain and Portugal. However, the levels of the lignan, enterolactone, were very much higher in prostatic fluid of Portuguese men. Isoflavanoids and lignans have many interesting properties and may, in part, be responsible for lower incidences of prostate cancer in men from Asia and also some Mediterranean countries. The isoflavanoids from soya, which are present in high concentrations in the prostatic fluid of Asian men, may be protective against prostate disease.

Compartment syndrome after isolated perfusion of the leg: a case report

The authors present a case of a lower leg compartment syndrome that developed after a regional chemotherapy technique was used for recurrent melanoma of the foot in a 74-year-old woman. The diagnosis was based on the results of physical examination, with confirmation by intracompartmental pressures. Prompt consultation of orthopedic surgeons and fasciotomy helped avoid potentially crippling sequelae.

Measurement and metabolism of isoflavonoids and lignans in the human male

Asian men, who consume a low fat/high fibre soya-based diet, have very much lower incidence of prostate cancer than men from North America and Europe. The soya bean is a rich source of the isoflavonic phyto-oestrogens, daidzein, genistein and equol, compounds which may be cancer-protective in Asian populations. The lignans, enterolactone and enterodiol, plant oestrogens derived from cereals and vegetables, may act in a similar manner in vegetarian men. We report here on the measurement of isoflavonoids and lignans, by gas chromatography-mass spectrometry, in prostatic fluid of men from Asia and Europe and also on the metabolism of these compounds in Western men following dietary supplementation.

Inpatient group psychotherapy in Chinese patients

OBJECTIVE

Inpatient group psychotherapy in acute psychiatric units has been a much maligned treatment modality with doubts cast upon its therapeutic value. However, local Chinese patients value and benefit from its inclusion in the therapeutic package after some adjustments to its structure and content.

DESIGN

Groups of 8 inpatients met weekly with a regular therapist and co-therapist. Feedback forms were filled by consenting patients at the end of each session to rate the value of each treatment modality in the ward package and to ascertain if therapeutic factors had been achieved.

SETTING AND PATIENTS

All were voluntary patients on an acute psychiatric ward based in a general hospital, who had consented to attend group therapy and were able to sit through a 45-minute session. Excluded were those with dementia, organic brain syndrome or those who were too disturbed. Thirty-nine patients completed the questionnaire legibly.

RESULTS

In order of preference, patients rated individual attention from doctors first, followed by medication, relaxation therapy, then group therapy. Among the therapeutic factors, the ones achieved most were acceptance, altruism and self-awareness. Patients wanted instruction and advice on mental health. Twenty-eight of thirty-nine patients wanted to continue attending group therapy.

CONCLUSION

In this study, group therapy ranked 4th in the therapy package on an inpatient unit. Patients were able to experience some therapeutic factors but they valued factors which were different from those described in Western literature. Increased educational input from therapists was the preferred agenda.

Aggressive fibromatosis of the spermatic cord. A typical lesion in a "new" location

The authors describe a 31-year-old man with a 7 cm aggressive fibromatosis (desmoid tumor) of the spermatic cord presenting as a swelling in the left inguinal area that was excised along with the testis and cord. The desmoid tumor is histologically typical, but such tumors arising primarily from the paratesticular structures have apparently not been previously reported and the diagnosis would not be questioned if it not for the unusual site. This tumor is histologically and immunohistochemically indistinguishable from abdominal wall desmoid tumor, with or without Gardner's syndrome. Desmoid tumors at this location should be distinguished from reactive processes, such as pseudosarcomatous myofibroblastic proliferation (so-called "proliferative funiculitis") and inflammatory fibrous pseudotumor, all of which exhibit fibroblastic/myofibroblastic differentiation. Paratesticular fibrosarcoma and leiomyosarcoma should also be differentiated from desmoid tumor that does not have the metastatic potential of sarcomas. Thirty-four months post-operatively, an 8 cm local recurrence in the remaining portion of the left vas deferens causing left hydroureter and hydronephrosis was detected.

An ATP-activated cation conductance in human epididymal cells

An outwardly rectifying conductance was observed in primary cultured human epididymal cells under the patch-clamp whole-cell configuration in KCl pipette and bath solutions. Removal of Cl- from intracellular and extracellular solutions did not affect this conductance, but substitution of K+ with N-methyl-D-glucamine in both solutions completely blocked the current. The current magnitude was also found to be affected by intracellular but not extracellular K+ concentrations. The conductance could be inhibited by the cation channel blockers, barium and tetraethylammonium chloride. Single-channel recordings from the same cell population also revealed the presence of a conductance of about 150 pS with voltage dependence and blocker sensitivity similar to those observed for the whole-cell current. This cation conductance was not affected by changes in solution osmolarity but could be activated by extracellular ATP. ATP activation of the conductance could be mimicked by ionomycin and inhibited by BAPTA-AM, an agent that suppresses intracellular free Ca2+. This ATP-regulated cation conductance may be responsible for secreting K+ across the epididymal epithelium, resulting in an observed K+ concentration much higher in the lumen of the epididymis than in the blood.

Regional differences in bioelectrical properties and anion secretion in cultured epithelia from rat and human male excurrent ducts

Bioelectrical properties and anion secretion in cultured epithelia from different regions of rat and human male excurrent ducts were studied by measuring the short-circuit currents (ISC). In all regions of the rat excurrent duct, Cl- secretion accounts for over 90% of the basal ISC, although the magnitude varied in different regions. Cl- secretion was found to be mediated by a Cl-/HCO3- exchanger, an Na+/H+ exchanger, and an Na+/K+/2Cl- symport located on the basolateral side of the epithelial cells. Forskolin, an activator of adenylate cyclase, and ionomycin, a Ca2+ ionophore, were used to investigate the relative importance of cAMP and Ca2+ as intracellular messengers regulating Cl- secretion in different regions. It was found that in both species, the forskolin-evoked ISC response was larger in the proximal end (efferent duct/caput epididymidis [rat/human, respectively]) than in the distal end (cauda/corpus epididymidis). The response to ionomycin in the rat cauda epididymidis (distal end) was larger than that in the efferent duct (proximal end); on the other hand, no significant difference in the ionomycin-induced ISC was observed in the caput and the corpus regions from the human epididymis. Our results indicate that while the cAMP- and Ca(2+)-dependent pathways are both involved in regulating Cl- secretion in all regions along the male excurrent ducts in both species, a regional difference exists with respect to the relative importance of the two regulatory pathways involved in Cl- secretion along the male reproductive tract.