Pleiotropic Nanostructures Built from l-Histidine Show Biologically Relevant Multicatalytic Activities

The essential amino acid histidine plays a central role in the manifestation of several metabolic processes, including protein synthesis, enzyme-catalysis, and key biomolecular interactions. However, excess accumulation of histidine causes histidinemia, which shows brain-related medical complications, and the molecular mechanism of such histidine-linked complications is largely unknown. Here, we show that histidine undergoes a self-assembly process, leading to the formation of amyloid-like cytotoxic and catalytically active nanofibers. The kinetics of histidine self-assembly was favored in the presence of Mg(II) and Co(II) ions. Molecular dynamics data showed that preferential noncovalent interactions dominated by H-bonds between histidine molecules facilitate the formation of histidine nanofibers. The histidine nanofibers induced amyloid cross-seeding reactions in several proteins and peptides including pathogenic Aβ1-42 and brain extract components. Further, the histidine nanofibers exhibited oxidase activity and enhanced the oxidation of neurotransmitters. Cell-based studies confirmed the cellular internalization of histidine nanofibers in SH-SY5Y cells and subsequent cytotoxic effects through necrosis and apoptosis-mediated cell death. Since several complications including behavioral abnormality, developmental delay, and neurological disabilities are directly linked to abnormal accumulation of histidine, our findings provide a foundational understanding of the mechanism of histidine-related complications. Further, the ability of histidine nanofibers to catalyze amyloid seeding and oxidation reactions is equally important for both biological and materials science research.

Vaginal Atresia with Cervical Agenesis, a Rare Congenital Malformation

Congenital vaginal atresia and cervical agenesis is a rare congenital abnormality of the female genital tract. Here we report a case of 15-year old girl with primary amenorrhea with hematometra, presented with lower abdominal mass. She was symptomatic since 5 months and visited local hospital after 4 months of onset of her symptoms when it became severe, where diagnostic laparotomy was performed for suspected Adnexal mass. Intraoperatively adnexal mass was adhered with and extended up to the uterus with 16 weeks size of uterus. Abdomen was closed without any further intervention and was referred to higher center for needful. When she presented to Kathmandu Model Hospital, she was asymptomatic on her 5th post-operative day of laparotomy. We planned for surgical intervention after examination and investigation. Drainage with vaginoplasty with amnion graft with placement of mould was done.

COVID-19 Pandemic: An Experience of OBGYN Residents at Kathmandu Model Hospital

COVID-19, a novel corona virus has affected the life of each and every individual worldwide. Nepal being the neighborhood country of china, though, we had a late case detection. But, since the month of July this virus has spread in an alarming manner in Nepal. Nepal being one of the developing countries, we lack in equipments, manpower resources and also in treatment centers. Looking into the devastating scenario of Covid 19 in China, Italy, New York, Brazil and our neighboring countries like India, Pakistan and Bangladesh is scary. We wondered how we were going to handle this pandemic if similar circumstances happened in our country too. At the same time being OBGYN residents, we all know pregnancy is very crucial and our patients have faced much difficulties to receive the maternal health services. In this manuscript, we have shared our experience regarding preparedness for COVID-19, management of positive cases and its effect in OBGYN trainee.

Misleading Diagnosis of Dysgerminoma in a Young Asymptomatic Patient

Dysgerminomas account for approximately one third of all malignant ovarian germ cell tumors (tumors arising from ovarian germinal elements) and are the most common ovarian malignancy detected during pregnancy. They are the only germ cell malignancy with a significant rate of bilateral ovarian involvement that is 15-20 percent. They have a variable gross appearance, but in general are solid, pink to tan to cream colored lobulated masses. They have the best prognosis of all malignant ovarian germ cell tumor variants. Two thirds are stage I at diagnosis, and prognosis is excellent even for those with advanced disease due to exquisite tumor chemosensitivity. The 5 year disease specific survival rate approximates 99 percent. This is a case report of a huge ovarian dysgerminoma in a young unmarried lady that was quite asymptomatic. She underwent laparotomy with right ovarian cystectomy.

Pregnancy Complicated by Acute Pancreatitis with Ascariasis

Ascariasis lumbricoides infections are common in tropical and sub-tropical countries. As it is one of the common causes for common bile duct obstruction. But in pregnancy is a rare entity. It may present with complications like acute pancreatitis. Here we present a case of 24 year female gravida 2 para 1 at 34 weeks of pregnancy presented with chief complain of pain over epigastric region radiating to back and associated with two episodes of vomiting, non bilious, not mixed with blood. Ultrasonography showed long tubular hyperechoic structure in gallbladder lumen most likely ascariasis and then she was diagnosed as a case of acute pancreatitis with alive ascariasis.

Growth and nutritional status of Bengali adolescent girls

OBJECTIVE

Assessment of the growth and nutritional status among healthy Bengali adolescent schoolgirls at peri-urban area.

METHODS

In this cross sectional study, sample consists of 527 school going adolescent girls, aged 10 to 18 years. The sample of the present study was collected from a peri-urban area (Duttapukur) of north 24 parganas district of West Bengal, India. Standard anthropometric measurements including linear, curvilinear and skinfold thickness were collected from each subject. Percentile curves and nutritional indices were used to determine the growth and nutritional status respectively.

RESULTS

The nature of distance curves and percentile curves of the body measurements showed a high rate of increase in 10-11 years of age group corresponding to an earlier adolescent growth spurt than average Indian girls. The adolescent girls in the current study were found to be significantly (p<0.0001) taller than Indian girls and heavier than both Indian and urban Bengali girls but slightly shorter than urban Bengali girls. They are significantly (p<0.0001) shorter and lighter than American girls, which also corresponded to 50(th) percentile curves. Age specific nutritional assessment shows different grades of malnutrition among them. Gomez's classification indicates about 60 % to 70 % adolescent girls show either moderate to mild malnutrition during their growth period. Both the indices of Waterlow's classification show least percentage of least malnutrition among the girls.

CONCLUSION

The growth pattern and nutritional status observed among adolescent girls in peri-urban situation show heterogeneity with respect to some anthropometric traits and in conformity with the growth pattern and nutritional status of urban girls.

Prevalence and causes of chronic energy deficiency and obesity in Indian women

We investigate the nutritional status of women in India and its relation to the prevalence of chronic energy deficiency (CED) and obesity. To do this, we have used the data from the Indian National Family Health Survey, 1998-1999, on body mass index (BMI) of ever-married women, ages 15-49 years, along with several socioeconomic factors, such as level of education, religion or caste, occupational status, and standard of living index. The study was based on 81,712 women from 26 states and 6 zones, which were grouped according to geographic proximity of the states of India. A multiple linear regression analysis was done to see the relation between nutritional status of women and different socioeconomic factors. The data reveal that the prevalences of CED, overweight, and obesity in India are 31.2%, 9.4%, and 2.6%, respectively. The incidences of CED and obesity are negatively related. The prevalence of CED is the lowest in Arunachal Pradesh and highest in Orissa. Punjab has the highest prevalence of obesity, and Bihar has the lowest. For the zonewise distribution the Northeast zone has the lowest degree of prevalence of CED and the East zone is at the bottom of the list with the highest degree of malnutrition. We also found that the nutritional status of women goes together with the enhancement of their educational status, standard of living, and so on. There are also significant differences between rural and urban sectors and among castes, religions, and occupations. Furthermore, regression analysis shows that all the socioeconomic variables considered here significantly affect BMI in Indian women.

Body mass index and chronic energy deficiency of adult males of Central Indian populations

Data on body weight, height, and sitting height from 11,496 adult males, age 18-62 years, belonging to 38 different populations of five major social groups (scheduled tribes, scheduled castes, "other backward castes," general castes, and Muslims) of Central India were taken for our analysis to assess the nutritional status of these groups. Cormic index and body mass index (BMI) were computed, and an analysis of variance (ANOVA) was carried out among different populations as well as among social groups separately on Cormic index and BMI. Shape, size, and generalized distances among the different social groups were computed and dendrograms were drawn. The level of malnutrition is the lowest among the general castes. The opposite is the case with the scheduled castes and scheduled tribes. Comparison of the coefficient of variation shows that there is variation in weight and BMI but that there is no marked variation in the other anthropometric variables. The ANOVA on Cormic index and BMI suggests that the people within a population are more homogeneous than the people between populations. There is a positive but statistically insignificant correlation between Cormic index and BMI. The five social groups differ more in size distance than in shape distance. According to the dendrogram of generalized distance values, the Muslims and the general castes can be grouped into one cluster and the scheduled castes, scheduled tribes, and other backward castes can be grouped into another cluster.

Spatial patterns of anthropometric variation in India with reference to geographic, climatic, ethnic and linguistic backgrounds

BACKGROUND

Anthropometric variation can be fruitfully utilized to investigate microevolutionary processes. Anthropometric variations in the Indian subcontinent based on stature and three indices (Cephalic Index, Nasal Index, and Total Facial Index) are highly variable and discriminative among populations across geographical regions.

AIMS

Anthropometric variation in stature, Cephalic Index (CI), Nasal Index (NI) and Total Facial Index (TFI) were investigated with respect to ethnic, linguistic, geographical and climatic affiliation, across the Indian subcontinent.

SUBJECTS AND METHODS

Published data on anthropometric variations of 531 populations from the Indian subcontinent were analysed using discriminant analysis and spatial autocorrelation analysis.

RESULTS

Discriminant analysis of the four anthropometric variables shows that stature and NI are good discriminators for populations of different languages. Stature, NI and CI discriminate well among populations of diverse ethnic origin and climatic conditions in different regions. TFI is not a good discriminator for populations of diverse ethnic, linguistic and climatic attributes. Spatial autocorrelation analysis showed significant departure from randomness, suggesting geographic structuring. The Moran's I estimate is positive and statistically significant for the four variables at low distances but exhibits significant negative association at higher values.

CONCLUSION

The results suggest geographical clines for the four anthropometric variables and indicate the influence of population structure on the studied variables.

Patterns of ethnic, linguistic, and geographic heterogeneity of palmar interdigital ridge counts in the Indian subcontinent

Published data on palmar interdigital ridge counts (a-b, b-c, and c-d) among 57 populations from the Indian subcontinent were analyzed with reference to ethnic, socioeconomic, linguistic, and geographic affiliations of the studied populations. The spatial autocorrelation analysis suggests significant correlation between dermatoglyphic and geographic distances. The congruence with the ethnic semblance of the groups is also apparent in the data, and, in fact, the multiresponse permutation procedure did suggest highly significant within-group homogeneity, confirming the biological validity of the social and ethnic criteria used in the analysis. The plots of populations on the first two principal components, accounting for 92% of the total variance, complement and support the results based on the other analyses, which show certain ethnic and geographic patterns. These findings can serve as baseline information for future studies on population variation in India, particularly studies based on molecular genetic markers, a trend that has already gained momentum.

Effect of socio-economic and biological variables on birth weight in Madhya Pradesh

A study on a few selected socio-biological and demographic determinants of birth weight was conducted at a hospital in Sagar town, Madhya Pradesh. Records of 2,680 single live births over a period of one year (1st January to 31st December 2000) were analysed. It was found that male infants were 124 g heavier than female infants. Tabular representation of data showed that maternal age, education, ethnicity, father's income and occupation, infant's sex and parity were strongly associated with birth weight of infants. Regression analysis gave a comprehensive picture of such associations and confirmed the above findings. The study showed that the socio-economic and biological variables considered in the analysis have significant effect on birth weight.

Pattern of adolescent growth among the Brahmin girls--rural-urban variation

A cross-sectional study of adolescent growth was undertaken among the Brahmin girls residing in rural and urban areas of Sagar districts, Madhya Pradesh to evaluate the urban-rural differences. Six anthropometric measurements, such as weight, stature, sitting height, head circumference, upper arm circumference and chest girth are taken into consideration. Though the urban girls show consistently higher values of weight, stature, sitting height and chest girth than the rural girls, but in case of head circumference and upper arm circumference they show consistently lower values. The maximum increment occurs between the ages 13 and 14 years in all the six measurements in both rural and urban girls.

Climate and head form in India

The relationship between head form and climatic variation was investigated in different tribal and caste populations of India. The magnitude of the cephalic index varies significantly in different zones. In tropical zones, head form is longer (dolicocephalic), but in temperate zones, head form is more round (mesocephalic or brachycephalic), especially among Scheduled Tribes (ST) and Scheduled Castes (SC) than among other castes. These trends possibly support a climatic adaptation model in head form differences among ST and SC in India.

His electrogram alternans reveal dual-wavefront inputs into and longitudinal dissociation within the bundle of His

BACKGROUND

His electrogram (HE) amplitude and morphology changes were observed in our previous studies during transition from "fast" to "slow" atrioventricular nodal (AVN) conduction. This phenomenon and its significance for the dual-AVN electrophysiology are not well recognized and have not been studied.

METHODS AND RESULTS

Experiments were performed on 17 healthy rabbit atrial-AVN preparations during standard programmed electrical pacing. HEs were mapped along the His bundle with roving surface electrodes, along with recording of cellular action potentials (APs). HEs recorded from the superior margin of the His bundle were of greater amplitude during basic beats and decreased substantially, by 42+/-19% (P<0.01), when premature A(1)A(2) shortened to 178+/-20 ms. In contrast, the HEs from the inferior margin increased dramatically, 2.9+/-1.7 times (P<0.01), during short A(1)A(2) and remained high until AVN block occurred. In addition, during long A(1)A(2), the superior HEs consistently preceded the inferior by 1.9+/-0.7 ms. In contrast, at short A(1)A(2), the superior HEs occurred 2.7+/-0.8 ms after the inferior. Cellular AP recordings demonstrated clearly the presence of and the transition between early (fast) and late (slow) excitation wavefronts that accompanied HE alternans.

CONCLUSIONS

The morphological-electrophysiological evidence from the AV junction suggests that fast and slow wavefronts reach the His bundle differently, producing functional longitudinal dissociation into 2 domains. The characteristic HE alternans recorded from these domains are a new sensitive tool to determine the presence of distinctly different wavefronts and their participation in the conduction during reentrant or other arrhythmias. These findings provide further understanding of the mechanisms of dual-AVN electrophysiology.

The ablation of atrial fibrillation with the loop catheter design: what we have learned from the animal model

Ablation of chronic atrial fibrillation (AF) with the use of transcutaneous catheter ablation is yet to become a clinical tool. This article summarizes the development of the technology and the technique for the ablation of AF that was tested on the rapidly paced AF dog model. The current ablation technology using the standard ablation technique used in humans is not suitable for the creation of transmural contiguous linear lesions, and such technology is subjecting the patient to the prolonged procedures with considerable risk of complication. The use of the loop catheter design or other designs of ablation technology, which is specifically targeted for the creation of linear lesions, should be developed if the catheter approach for the ablation of AF is to succeed. This article describes the data available for the loop catheter design that is currently undergoing human feasibility studies.

Repair of chromosomal abasic sites in vivo involves at least three different repair pathways

We introduced multiple abasic sites (AP sites) in the chromosome of repair-deficient mutants of Escherichia coli, in vivo, by expressing engineered variants of uracil-DNA glycosylase that remove either thymine or cytosine. After introduction of AP sites, deficiencies in base excision repair (BER) or recombination were associated with strongly enhanced cytotoxicity and elevated mutation frequencies, selected as base substitutions giving rifampicin resistance. In these strains, increased fractions of transversions and untargeted mutations were observed. In a recA mutant, deficient in both recombination and translesion DNA synthesis (TLS), multiple AP sites resulted in rapid cell death. Preferential incorporation of dAMP opposite a chromosomal AP site ('A rule') required UmuC. Furthermore, we observed an 'A rule-like' pattern of spontaneous mutations that was also UmuC dependent. The mutation patterns indicate that UmuC is involved in untargeted mutations as well. In a UmuC-deficient background, a preference for dGMP was observed. Spontaneous mutation spectra were generally strongly dependent upon the repair background. In conclusion, BER, recombination and TLS all contribute to the handling of chromosomal AP sites in E.coli in vivo.

A cross between truncus arteriosus communis and aortopulmonary septal defect: a hitherto undescribed entity

Case history and necropsy findings of a 5-month-old infant with a unique heart defect with features of truncus arteriosus communis and aortopulmonary defect in combination with severe tricuspid stenosis are presented. There is a wide spectrum of remarkable heart defects between truncus arteriosus communis and aortopulmonary septal defect.

Accessory atrioventricular node with properties of a typical accessory pathway: anatomic-electrophysiologic correlation

We report an accessory AV node producing ventricular preexcitation and comprising the retrograde limb of AV reentrant tachycardia (AVRT). A 66-year-old man presented with an anteroseptal myocardial infarction and thereafter developed recurrent, drug-refractory AVRT requiring multiple cardioversions. Electrophysiologic findings were typical for a concealed anteroseptal accessory pathway 0.5 cm anterior to the His bundle. The patient died of intractable heart failure after endocardial resection for a left ventricular aneurysm and coronary bypass grafting. Pathologic examination revealed a para-Hisian accessory AV node connecting the right atrium to ventricular myocardium immediately anterior to the His bundle at a depth of 4 mm from the endocardium. No typical AV accessory pathway was found. This is the first report of an accessory AV node that participated in AVRT. It was deeper than typical radiofrequency catheter ablation lesions.

Living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. A Consensus Statement from the Cardiac Nomenclature Study Group, Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE

Current nomenclature for the atrioventricular (AV) junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with antero-posterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, although the mouth of the coronary sinus is shown as being posterior. Although this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and atrioventricular nodal reentry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. It proposes a new anatomically sound nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value for description of the AV junctions, establishing the principles of this new nomenclature.

Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping. A Consensus Statement from the Cardiac Nomenclature Study Group, Working Group of Arrythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE. North American Society of Pacing and Electrophysiology

Current nomenclature for atrioventricular junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with antero-posterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, while the mouth of the coronary sinus is shown as being posterior. While this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and atrioventricular nodal re-entry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology, and the North American Society of Pacing and Electrophysiology. It proposes a new, anatomically sound, nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value as regards the description of the atrioventricular junctions, establishing the principles of this new nomenclature.

ESCWGA/NASPE/P experts consensus statement: living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. Working Group of Arrhythmias of the European Society of Cardiology. North American Society of Pacing and Electrophysiology

Current nomenclature for the AV junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with anteroposterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, whereas the mouth of the coronary sinus is shown as being posterior. Although this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and AV nodal reentry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology and from the North American Society of Pacing and Electrophysiology. It proposes a new, anatomically sound, nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value for description of the AV junctions and establish the principles of this new nomenclature.

Human mitochondrial uracil-DNA glycosylase preform (UNG1) is processed to two forms one of which is resistant to inhibition by AP sites

The preform of human mitochondrial uracil-DNA glycosylase (UNG1) contains 35 N-terminal residues required for mitochondrial targeting. We have examined processing of human UNG1 expressed in insect cells and processing in vitro by human mitochondrial extracts . In insect cells we detected a major processed form lacking 29 of the 35 unique N-terminal residues (UNG1Delta29, 31 kDa) and two minor forms lacking the 75 and 77 N-terminal residues, respectively (UNG1Delta75 and UNG1Delta77, 26 kDa). Purified UNG1Delta29 was effectively cleaved in vitro to a fully active 26 kDa form by human mitochondrial extracts. Furthermore, endogenous forms of 31 and 26 kDa were also observed in HeLa mitochondrial extracts. The sequences at the cleavage sites, as identified by peptide sequencing, were compatible with the known specificity of mitochondrial processing peptidase (MPP). However, in vitro cleavage of UNG1Delta29 by mitochondrial extracts did not require divalent cations and was stimulated by EDTA, indicating the involvement of a processing peptidase distinct from MPP at the second site. Interestingly, while UNG1Delta29 generally has the typical properties reported for other uracil-DNA glycosylases, it is not inhibited by apurinic/apyrimidinic sites. Our results indicate that the preform of human mitochondrial uracil-DNA glycosylase is processed to distinctly different forms lacking 29 or 75/77 N-terminal residues, respectively.

Base excision repair initiation revealed by crystal structures and binding kinetics of human uracil-DNA glycosylase with DNA

Three high-resolution crystal structures of DNA complexes with wild-type and mutant human uracil-DNA glycosylase (UDG), coupled kinetic characterizations and comparisons with the refined unbound UDG structure help resolve fundamental issues in the initiation of DNA base excision repair (BER): damage detection, nucleotide flipping versus extrahelical nucleotide capture, avoidance of apurinic/apyrimidinic (AP) site toxicity and coupling of damage-specific and damage-general BER steps. Structural and kinetic results suggest that UDG binds, kinks and compresses the DNA backbone with a 'Ser-Pro pinch' and scans the minor groove for damage. Concerted shifts in UDG simultaneously form the catalytically competent active site and induce further compression and kinking of the double-stranded DNA backbone only at uracil and AP sites, where these nucleotides can flip at the phosphate-sugar junction into a complementary specificity pocket. Unexpectedly, UDG binds to AP sites more tightly and more rapidly than to uracil-containing DNA, and thus may protect cells sterically from AP site toxicity. Furthermore, AP-endonuclease, which catalyzes the first damage-general step of BER, enhances UDG activity, most likely by inducing UDG release via shared minor groove contacts and flipped AP site binding. Thus, AP site binding may couple damage-specific and damage-general steps of BER without requiring direct protein-protein interactions.

An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis)

BACKGROUND

The syndrome of sudden death due to low-energy trauma to the chest wall (commotio cordis) has been described in young sports participants, but the mechanism is unknown.

METHODS

We developed a swine model of commotio cordis in which a low-energy impact to the chest wall was produced by a wooden object the size and weight of a regulation baseball. This projectile was thrust at a velocity of 30 miles per hour and was timed to the cardiac cycle.

RESULTS

We first studied 18 young pigs, 6 subjected to multiple chest impacts and 12 to single impacts. Of the 10 impacts occurring within the window from 30 to 15 msec before the peak of the T wave on the electrocardiogram, 9 produced ventricular fibrillation. Ventricular fibrillation was not produced by impacts at any other time during the cardiac cycle. Of the 10 impacts sustained during the QRS complex, 4 resulted in transient complete heart block. We also studied whether the use of safety baseballs, which are softer than standard ones, would reduce the risk of arrhythmia. A total of 48 additional animals sustained up to three impacts during the T-wave window of vulnerability to ventricular fibrillation with a regulation baseball and safety baseballs of three degrees of hardness. We found that the likelihood of ventricular fibrillation was proportional to the hardness of the ball, with the softest balls associated with the lowest risk (two instances of ventricular fibrillation after 26 impacts, as compared with eight instances after 23 impacts with regulation baseballs).

CONCLUSIONS

This experimental model of commotio cordis closely resembles the clinical profile of this catastrophic event. Whether ventricular fibrillation occurred depended on the precise timing of the impact. Safety baseballs, as compared with regulation balls, may reduce the risk of commotio cordis.

Relationship between menarcheal age and nutritional anthropometry in urban girls of the Howrah District, West Bengal, India

The present paper deals with the menarche and nutritional anthropometry among Bengali girls aged 9 to 16 years (n = 645) living in the city of Howrah (West Bengal, India). The result show that within the same socioeconomic group early menarche girls were heavier and taller than the late menarche girls. There is a significant difference between not attained menarche (NAM) and attained menarche (AM) girls aged 12 and 13 years for height and for 12 to 14 years in case of weight.

Complete AV block following mediastinal radiation therapy: electrocardiographic and pathologic correlation and review of the world literature

The clinical, features, serial electrocardiograms, and autopsy findings of a patient with symptomatic complete AV block, who had received mediastinal radiation therapy 8 1/2 years previously, are presented. The cardiac histopathology disclosed immense fibrosis of the conduction system and of the atria and ventricles. The enormous amount of fibrosis was similar in location and intensity to that observed in our previously reported patient (Cohen et al., Arch Intern Med 1981; 141:676-679) who had undergone mediastinal radiation. We conclude that the severe fibrosis was primarily due to radiation, rather than secondary to atherosclerotic coronary artery disease, which also has been described as a consequence of mediastinal radiotherapy. This patient's serial electrocardiograms disclosed evidence of complete block both in the AV nodal area and infra His system, which correlated well with the histopathology. The characteristic clinical features of patients with symptomatic complete AV block post mediastinal radiation therapy are presented, along with a review of the world literature.

Prominent venous valves in hypoplastic right hearts

To investigate the hypothesis that embryologic abnormalities in the venous valves may be associated with abnormal cardiac development, we examined the right atrial morphologic characteristics in 20 hearts with underdevelopment of the right heart and 17 normal hearts. In the study group, 16 (80%) of the patients had significantly enlarged eustachian valves, one (5%) was slightly enlarged, and three (15%) were smaller than expected. Five (25%) had cor triatriatum dexter. In comparison, eustachian valves in the control specimens were prominent in only one (6%), normal in five (29%), and almost absent in eight (47%). The thebesian valve was also more prominent in the study cohort when compared with controls (p < 0.05). No other morphologic features of the right atrium analyzed in this study differed from those found in normal specimens. We speculate that failure of the venous valves to regress appropriately may create abnormalities in fetal circulation that predispose the fetus to maldevelopment of the right heart structures.

A sequence in the N-terminal region of human uracil-DNA glycosylase with homology to XPA interacts with the C-terminal part of the 34-kDa subunit of replication protein A

Uracil-DNA glycosylase releases free uracil from DNA and initiates base excision repair for removal of this potentially mutagenic DNA lesion. Using the yeast two-hybrid system, human uracil-DNA glycosylase encoded by the UNG gene (UNG) was found to interact with the C-terminal part of the 34-kDa subunit of replication protein A (RPA2). No interaction with RPA4 (a homolog of RPA2), RPA1, or RPA3 was observed. A sandwich enzyme-linked immunosorbent assay with trimeric RPA and the two-hybrid system both demonstrated that the interaction depends on a region in UNG localized between amino acids 28 and 79 in the open reading frame. In this part of UNG a 23-amino acid sequence has a significant homology to the RPA2-binding region of XPA, a protein involved in damage recognition in nucleotide excision repair. Trimeric RPA did not enhance the activity of UNG in vitro on single- or double-stranded DNA. A part of the N-terminal region of UNG corresponding in size to the complete presequence was efficiently removed by proteinase K, leaving the proteinase K-resistant compact catalytic domain intact and fully active. These results indicate that the N-terminal part constitutes a separate structural domain required for RPA binding and suggest a possible function for RPA in base excision repair.

The conduction system in sudden death in Alaskan sled dogs during the Iditarod race and/or during training

Using serial section examination, we studied the conduction system in five Alaskan sled dogs that died suddenly; four during the Iditarod race and one during training. We compared our findings with the conduction system of three sled dogs of similar age that died of natural causes unrelated to the cardiovascular system. The conduction system of sudden death dogs revealed marked fibrosis of the sinoatrial (SA) node and/or its approaches and narrowing of the SA nodal artery in 3 dogs, fibrosis and marked fatty infiltration in and around the AV node in all 5, total isolation and/or tenuous connection of the AV node with its approaches in 4, fat and fibrosis in the AV bundle and bundle branches to a varying degree in all, and focal fibrotic scars in the left ventricle with fat and/or some disarray in 3. The control group revealed mild fibro-fatty changes in the conduction system without fibrotic scar areas in the heart. These findings are similar to the pathological findings in and around the conduction system in cases of sudden death in humans, especially trained athletes. These changes may form an anatomical substrate for an arrhythmic event in susceptible dogs during an altered physiological state.

Pathologic findings following sudden death in an infant with hypertrophic cardiomyopathy and supraventricular tachycardia

The cardiac conduction system from infants suddenly dying with hypertrophic cardiomyopathy has not been described. We studied by serial section examination the conduction system from a 13-month old infant also known to have had supraventricular tachycardia. At autopsy, there was cardiomegaly with asymmetric septal hypertrophy. Microscopic examination revealed myofiber disarray around an abnormally formed central fibrous body, numerous nodoventricular fibers to both sides of the ventricular septum, and fibrosis of the left bundle branch. We postulate that supraventricular tachycardia utilized a concealed pathway or the malformed AV junction. Death may have resulted from deranged hemodynamics secondary to supraventricular tachycardia.

Intermittent preexcitation and mesothelioma of the atrioventricular node: a hitherto undescribed entity

This is the first documented case of spontaneous intermittent preexcitation associated with mesothelioma of the atrioventricular (AV) node. A 66-year-old male with recurrent atrial arrhythmias, palpitations, heart failure, and marked intra-atrial conduction defect that required a pacemaker died during sleep. Electrophysiologic study revealed left free-wall bypass tract with marked intra-atrial conduction defect and prolonged conduction across the bypass tract. With atrial pacing, high degrees of block were noted in the bypass tract. Serial section of the conduction system and both AV rims revealed two left posterior and lateral bypass pathways with patchy areas of fibrosis. A large mesothelioma (benign AV nodal tumor) almost completely replaced the AV node. In addition, there was marked fatty infiltration of the atria. In summary: (1) the intermittent preexcitation with prolonged conduction across the bypass tract and block with atrial pacing were probably related to the incomplete patchy degenerative changes in the bypass tract, and/or almost complete replacement of the AV node by the tumor; (2) the intra-atrial conduction defect was probably related to the replacement of the AV node by mesothelioma and/or the fatty infiltration of the atria; and (3) the paroxysmal atrial arrhythmias probably reflect the marked atrial pathology.

Hypoplasia of the eustachian valve and abnormal orientation of the limbus of the foramen ovale in hypoplastic left heart syndrome

We examined the eustachian valve and the limbus of the foramen ovale in 42 hearts with hypoplastic left heart syndrome (HLHS) and in 16 normal hearts. In HLHS, only 4.8% of the eustachian valves were moderately to well developed, whereas the remaining 95.2% were abnormal (p < 0.001): 92.9% of the eustachian valves were absent or markedly hypoplastic, and 2.4% had an abnormally redundant and enlarged eustachian valve. The eustachian valve was well developed in 87.5% of normal hearts. In addition, the lesser development of the eustachian valve seemed to correlate with lesser development of the left side of the heart. The limbus was well developed in 100% of the normal hearts and moderately to well developed in only 33.3% of the HLHS group (p < 0.001). Most hearts in the HLHS group had marked hypoplasia of the limbus, which was rotated and deviated so as to be close to the superior vena caval entrance.

Alternatives in biventricular repair of double-outlet left ventricle

Wide variation in morphology of double-outlet left ventricle allows numerous surgical alternatives that require sorting out to develop a more organized approach. There is a high association between tricuspid abnormalities and right ventricular hypoplasia with double-outlet left ventricle that calls for either Fontan-type procedure or biventricular repair. With pulmonic stenosis, biventricular repair has been accomplished using right-sided conduits. When pulmonic stenosis is mild or absent, repair techniques without conduits depend on the commitment of the ventricular septal defect (VSD). With subaortic VSD and mild pulmonic valvar stenosis, we successfully performed translocation of the main pulmonary artery and valve to the right ventricle on 2 patients (ages 32 and 8 months). Both patients are doing well 2 years and 1 year postoperatively. Others have successfully connected the right ventricle to the pulmonary artery with intraventricular baffle by enlarging a subaortic VSD or when the VSD is either subpulmonic or doubly committed. With subaortic VSD, although it has not been reported, biventricular repair can also be accomplished using a right ventricle-to-aorta baffle combined by either atrial or arterial switch. We believe that a simplified management plan can be formed in double outlet left ventricle based on the size of the right ventricle, presence of pulmonic stenosis, and commitment of the VSD. Whenever possible, translocation of the main pulmonary artery and valve or intraventricular repair should be accomplished in double-outlet right ventricle minimizing the use of right-sided conduits and reoperation.

Congenital polyvalvular cardiac disease without chromosomal abnormalities

Congenital polyvalvular cardiac disease has been reported in association with trisomies 18, 13, and 15. Ninety-three percent of trisomy 18 patients have polyvalvular disease, and 34% have all four valves involved. Four cases of polyvalvular disease without chromosomal abnormalities were studied and compared to polyvalvular disease with trisomy. In these four cases, all four valves were markedly abnormal with nodularity and reductant tissue; one aortic and two pulmonary valves were bicuspid; and one aortic, two tricuspid, and three mitral valves were unicuspid. The chordae tendineae were generally abbreviated and papillary muscles were hypoplastic. Microscopically, the valves had spongiosis, vacuolar degeneration, and a decrease in elastic fibers. Multiple other cardiac anomalies were present in each case. Three of the four cases also had significant extracardiac anomalies, which were lethal in two cases. The fourth case with no other anomalies had a history of maternal tobacco, alcohol, and cocaine abuse, with the latter being detected in fetal urine after birth. There does not appear to be a significant difference between polyvalvular disease with and without trisomy. Polyvalvular disease is usually not an isolated disorder but is associated with other intra- and extracardiac anomalies.

Cardiac conduction system involvement in sudden death of obese young people

Involvement of the conduction system in the sudden death of obese young people has not been documented in the literature. We therefore studied the conduction system by serial section examination in 7 subjects, 5 obese and 2 mild to moderately obese, who died suddenly at ages 6, 11, 14, 16, 20, 30, and 32 years of age (5 males, 4 black and 1 white; two females, 1 black and 1 white). Three had a history of sleep apnea. The heart was hypertrophied and enlarged in 6; all 6 had a distinct ventricular septal bulge and epicardial coronary arteries were normal. All had focal mononuclear cells in and around the sinoatrial node and/or its approaches, with marked fat throughout the conduction system in 3, fibrosis of the atrioventricular (AV) bundle and/or the left bundle branch in 5, and the branching bundle sandwiched between the bulbar muscle and the summit of the ventricular septum in 5 (2 with left-sided bundle, 1 with loop formation, and 1 with a markedly fragmented bundle). The AV node was partly within the central fibrous body and/or the atrial septum in 6 patients; focal mononuclear cells were present to a varying degree, with focal fibrosis of the ventricular septum in 6 patients, arteriolosclerosis in 4, and myocardial disarray in 3. The mild to moderately obese patients demonstrated lesser amounts of fat with more fibrosis when compared with the markedly obese. In summary, there are significant pathologic findings in the conduction system in the sudden death of obese young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Properties of a recombinant human uracil-DNA glycosylase from the UNG gene and evidence that UNG encodes the major uracil-DNA glycosylase

We have expressed a human recombinant uracil-DNA glycosylase (UNG delta 84) closely resembling the mature form of the human enzyme (UNG, from the UNG gene) in Escherichia coli and purified the protein to apparent homogeneity. This form, which lacks the first seven nonconserved amino acids at the amino terminus, has properties similar to a 50% homogeneous UDG purified from human placenta except for a lower salt optimum and a slightly lower specific activity. The recombinant enzyme removed U from ssDNA approximately 3-fold more rapidly than from dsDNA. In the presence of 10 mM NaCl, Km values were 0.45 and 1.6 microM with ssDNA and dsDNA, respectively, but Km values increased significantly with higher NaCl concentrations. The pH optimum for UNG delta 84 was 7.7-8.0; the activation energy, 50.6 kJ/mol; and the pI between 10.4 and 10.8. The enzyme displays a striking sequence specificity in removal of U from UA base pairs in M13 dsDNA. The sequence specificity for removal of U from UG mismatches (simulating the situation after deamination of C) was essentially similar to removal from UA matches when examined in oligonucleotides. However, removal of U from UG mismatches was in general slightly faster, and in some cases significantly faster, than removal from UA base pairs. Immunofluorescence studies using polyclonal antibodies against UNG delta 84 demonstrated that the major fraction of UNG was located in the nucleus. Furthermore, > 98% of the total uracil-DNA glycosylase activity from HeLa cell extracts was inhibited by the antibodies, indicating that the UNG protein represents the major uracil-DNA glycosylase in the cells.

Microwave ablation of the atrioventricular junction in open-chest dogs

The use of microwave energy for ablation of the atrioventricular (AV) junction was examined in open-chest dogs. Using a specially designed microwave catheter and a 2450 MHz generator, microwave energy was delivered to the AV junction according to one of two protocols. In protocol 1, increasing amounts of energy were delivered until irreversible AV block occurred. In protocol 2, only two applications of energy were used, one at low energy and the other at an energy found to be high enough to cause irreversible AV block. Each dog received between one and six applications of microwave energy. The amount of energy delivered per application ranged from 25.6 to 311.4 J. No AV block was seen at 59.4 +/- 28.3 J. Reversible AV block was seen with an energy of 120.6 +/- 58 J. Irreversible AV block was seen at 188.1 +/- 75.9 J. Irreversible AV block could be achieved in each animal. There was no difference in the energy required to cause irreversible AV block between the two protocols. The tissue temperature measured near the tip of the microwave catheter was correlated with both the amount of energy delivered and the extent of AV block caused. Histologic examination demonstrated coagulation necrosis of the conduction system. Microwave energy is a feasible alternative energy source for myocardial ablation. Since tissue damage is due exclusively to heating and the resulting rise in temperature can be measured, microwave energy may have advantages over currently existing energy sources in terms of both titrating delivered energy and monitoring the extent of tissue destruction.