Evaluation of Burden and Anxiety in Caregivers of Patients with Pediatric Celiac Disease in the COVID-19 Pandemic

Background Anxiety and caregiver burden increase among caregivers for individuals with chronic disease. The purpose of this study was to compare the anxiety levels and caregiver burden among caregivers for cases with pediatric celiac disease (CD) before and during the COVID-19 pandemic.

Materials The Zarit Burden Interview (ZBI) and the Beck Anxiety Inventory (BAI) were applied to 29 parents caring for pediatric CD patients in January 2020, when COVID-19 cases had not yet been seen in Turkey. The study was designed prospectively. The scales were also reapplied to the same study group online during the COVID-19 pandemic (May 2020). The results were then compared.

Results Parents caring for 29 cases of pediatric CD; 21 mothers (72.4%), six fathers (20.7%), and two aunts (6.9%) took part in the study. Mean ZBI scores before and during the COVID-19 pandemic were 27.51 ± 14.12 (8–73) and 38.68 ± 10.95 (21–57), respectively ( p < 0.01). Mean BAI scores before and during the COVID-19 pandemic were 13.27 ± 7.65 (1–27) and 23.48 ± 12.40 (2–48), respectively ( p < 0.01).

Conclusion Increased anxiety and caregiver burden among caregivers of pediatric CD cases during the COVID-19 pandemic were identified for the first time in the literature in this study.

Temporal Trends in the Epidemiology of HIV in Turkey

OBJECTIVE

The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016.

METHODS

Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes.

RESULTS

A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy.

CONCLUSION

The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.

The effect of knowledge levels of individuals receiving basic first aid training in Turkey on the applications of first aid

Objectives

To evaluate the knowledge level of individuals who attended a first aid training update program, and to determine the factors affecting their approaches in such cases.

Methods

This is a descriptive cross-sectional study. The sample of the research consists of 747 individuals (laypersons) who applied to the first aid training update organized in an institution in Istanbul providing health education between 01.02.2018 and 01.08.2018, and who agreed to participate in the research. These first aid trainings are provided by healthcare professionals who have first aid certificate of authority within the scope of first aid regulation. Data were collected using the "Participant Information Form" and the "Basic First Aid Knowledge Level Evaluation Form".

Results

The participants administered first aid within the three years of time following their basic first aid training course (24.6%). They administered first aid primarily in emergency cases of fainting (29.6%) and the majority of them (95.7%) did not perform cardiopulmonary resuscitation during their basic first aid effort. Of the participants, 73.9% answered incorrectly the question: "The letter 'A' in the abbreviation ABC of basic life support administration stands for airway". In our study, it was also found that there was a significant relationship between the total knowledge score and the number of trainings update and first aid intervention in the last three years (P < 0.05, P < 0.001, respectively).

Conclusions

It was determined that individuals had a high level of knowledge about basic first aid and one-quarter of the participants had administered first aid in the last three years. In order for individuals not to lose their knowledge and skills gained through first aid training; updating training and providing first aid training programs to individuals in society can be a guide for bystanders who provide faster and sufficient first aid in cases of emergency.

Three-dimensional shaping technique for coil placement using the steam-shaped microcatheter for ruptured blood blister-like aneurysm

Treatment of blood blister-like aneurysm (BBA) is a challenge due to its unfavourable morphology, small size and the friable neck of BBA. In the management of ruptured BBA, coil placement can be achieved by stent-assisted coil embolisation. We propose to incorporate a new technique using a steam-shaped microcatheter to improve safety. A 59-year-old woman was transferred to our hospital and diagnosed with subarachnoid haemorrhage (SAH) due to a ruptured BBA of the left internal carotid artery (ICA) at the C2 portion. For coil embolisation, we selected the aneurysm sac using a three-dimensional shaping technique and the jailing method. Post-embolisation angiography revealed complete occlusion of the aneurysmal sac. For safe treatment and stability of BBA, the shape of the catheter tip and the distal portion of the microcatheter are two important factors to consider. The proposed technique could help resolve the problem of catheter shaping in the treatment of BBA.

Mutation analysis of the NRXN1 gene in autism spectrum disorders

The aim of this study was to identify the sequence mutations in the Neurexin 1 (NRXN1) gene that has been considered as one of the strong candidate genes. A total of 30 children and adolescents (aged 3-18) with non syndromic autism were enrolled this study. Sequencing of the coding exons and the exon-intron boundaries of the NRXN1 gene was performed. Two known mutations were described in two different cases. Heterozygous S14L was determined in one patient and heterozygous L748I was determined in another patient. The S14L and L748I mutations have been described in the patients with autism before. Both of these mutations were inherited from their father. In this study, two of 30 (6.7%) autism spectrum disorder (ASD) patients carrying NRXN1 gene mutations were detected. It indicates that variants in the NRXN1 gene might confer a risk of developing nonsyndromic ASD. However, due to the reduced penetrance in the gene, the causal role of the NRXN1 gene mutations must be evaluated carefully in all cases.

Role of inflammation in sensory neuropathy in prediabetes or diabetes

OBJECTIVES

Prediabetes includes individuals with impaired glucose metabolism, and it has been associated with various complications of diabetes mellitus (DM), including peripheral neuropathy. We aimed to investigate the associations between pro-inflammatory (TNF-α) and anti-inflammatory (IL-10) cytokines and neuropathy of very distal sensory nerves in patients with prediabetes or type 2 DM.

MATERIALS AND METHODS

We included 50 patients with prediabetes, 50 patients with type 2 DM, and 44 controls in the study. Plasma levels of HbA1c, TNF-α, and IL-10 were analyzed. Electrodiagnostic testing was performed on dorsal sural and medial plantar sensory nerves, which are the very distal sensory nerves of the feet.

RESULTS

Abnormalities in nerve conduction studies (NCS) of the dorsal sural and medial plantar sensory nerves were substantially higher in patients with prediabetes or type 2 DM. In addition, plasma levels of TNF-α were significantly higher in patients with type 2 DM than in controls, whereas IL-10 levels were significantly lower in patients with both prediabetes and diabetes. However, we found no correlation between the levels of HbA1c, TNF-α, IL-10, and abnormalities in NCS of the dorsal sural or medial plantar sensory nerves in either patient group.

CONCLUSIONS

To our knowledge, this is the first study to assess the relationships between TNF-α, IL-10, and NCS of the most distal sensory nerves in patients with prediabetes or type 2 DM. The mechanisms involved in the pathogenesis of DM and diabetic peripheral neuropathy are complex. The pro-inflammatory stage and the high incidence of neuropathy in patients with prediabetes may suggest a possible causative effect; however, the potential role of inflammation in the pathogenesis of peripheral neuropathy needs further clarification.

Managing atypical and typical herpetic central nervous system infections: results of a multinational study

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

Molecular mechanism by which acyclic retinoid induces nuclear localization of transglutaminase 2 in human hepatocellular carcinoma cells

Nuclear accumulation of transglutaminase 2 (TG2) is an important step in TG2-dependent cell death. However, the underlying molecular mechanisms for nuclear translocation of TG2 are still poorly understood. In this study, we demonstrated that acyclic retinoid (ACR) induced nuclear accumulation of TG2 in JHH-7 cells, a hepatocellular carcinoma (HCC) leading to their apoptosis. We further demonstrated molecular mechanism in nuclear-cytoplasmic trafficking of TG2 and an effect of ACR on it. We identified a novel 14-amino acid nuclear localization signal (NLS) (466)AEKEETGMAMRIRV(479) in the 'C' domain and a leucine-rich nuclear export signal (NES) (657)LHMGLHKL(664) in the 'D' domain that allowed TG2 to shuttle between the nuclear and cytosolic milieu. Increased nuclear import of GAPDH myc-HIS fused with the identified NLS was observed, confirming its nuclear import ability. Leptomycin B, an inhibitor of exportin-1 as well as point mutation of all leucine residues to glutamine residues in the NES of TG2 demolished its nuclear export. TG2 formed a trimeric complex with importin-α and importin-β independently from transamidase activity which strongly suggested the involvement of a NLS-based translocation of TG2 to the nucleus. ACR accelerated the formation of the trimeric complex and that may be at least in part responsible for enhanced nuclear localization of TG2 in HCC cells treated with ACR.

Fungal peritonitis in peritoneal dialysis: a 10 year retrospective analysis in a single center

INTRODUCTION

Fungal peritonitis (FP) is a rare but serious complication in patients undergoing peritoneal dialysis (PD), and is associated with higher morbidity, mortality. We aimed to analyze the predisposing factors, etiological agents, outcome and treatment of FP in patients with PD.

METHODOLOGY

We evaluated retrospectively all PD patients PD center between 2001 and 2011. Sixteen patients with FP were included into the study.

RESULTS

The clinical records of 16 patients with FP among 355 patients were reviewed for the clinical and laboratory data. Among 506 episodes of PD-related peritonitis in 10 years, we identified 16 episodes of FP. Median PD duration was 36.7±22.2 months. In 87.5% of patients had one or more previous episode of bacterial peritonitis that were treated with multiple broad-spectrum antibiotics. FP was primary infection in five patients, whereas eleven patients experienced FP during the course of treatment of bacterial peritonitis. Six patients died due to the fungal infection whereas others were transferred to haemodialysis.

CONCLUSIONS

Treatment of bacterial peritonitis with broad spectrum antibiotics was an important risk factor predisposing to the development of FP. The catheter removal and initiation of antifungal therapy as soon as possible are obligatory in episode of FP because it is responsible from high mortality rate.

Fear of blood/injection in healthy and unhealthy adults admitted to a teaching hospital

Blood/injury phobia is one of the specific phobias. The aim of this study was to determine the fear of injection and blood in patients and healthy people. This study was carried out at Tepecik Hospital, Clinical Biochemistry Laboratory and Blood Center. Data were collected from 1500 adults who agreed to participate in the study (237 patients with chronic diseases and 1263 healthy people) during the period from January 2003 to February 2005. All participants completed two self-administered questionnaires (17-item Symptom Questionnaire and 20-item Blood/Injection Fear Scale) after giving blood samples by blood donation. 30.1% of the patients and 19.5% of the healthy adults reported that they had fear of blood/injection. Symptoms related to having blood drawn or injection were more frequently reported among women than men. Patients' educational level was also associated with the Symptom Questionnaire and fear of blood/injection scores. Fear of blood/injection was significantly higher in patients with chronic diseases. Fear of blood/injection should be considered by healthcare professionals as it is important for assessing the treatment-seeking individuals.

Brugada-like electrocardiographic changes induced by fever

As "time is myocardium" in the settings of acute myocardial infarction, it is important to make the diagnosis as quickly as possible, and a high clinical suspicion is needed to avoid missing the diagnosis, resulting in unwarranted interventions. The electrocardiogram is a crucial tool in the identification of acute chest pain, enabling a detailed analysis of patterns of ST-segment elevation. We describe the case of a 22-year-old man who presented with fever, with dynamic electrocardiographic changes similar to the Brugada syndrome. These electrocardiographic anomalies disappeared when the temperature returned to normal.

Spironolactone does not prevent restenosis after coronary stenting in humans

INTRODUCTION

In animal studies, aldosterone enhanced neointimal proliferation by increasing extracellular accumulation of collagen and potentiating the effects of angiotensin II. Spironolactone, an aldosterone antagonist, is a potent inhibitor of neointimal proliferation. We conducted a placebo-controlled, double-blind, randomised study to assess the effect of spironolactone on angiographic 6-month in-stent restenosis.

MATERIALS AND METHODS

Of the 310 randomised patients with significant coronary artery disease, 258 patients were available for analysis: 128 constituted the placebo group and 130 were assigned to receive spironolactone. Eligible patients were randomly assigned to receive a dose of 50 mg spironolactone or placebo orally twice a day for 6 months. The primary endpoint was the angiographic restenosis (>50% stenosis) rate at follow-up angiography.

RESULTS

At 6-month follow-up angiography after stenting, there was no difference between the 2 groups in minimal lumen diameter, percent diameter stenosis, late loss, and net gain. Angiographic restenosis occurred in 46 (35.4%) of 130 patients receiving spironolactone and 50 (39.0%) of 128 in the placebo group with an odds ratio (OR) of 0.85 with a 95% confidence interval (CI) of 0.49 to 1.46 (P = 0.62). Restenosis rate was found in 60 (32.9%) of 182 lesions in the spironolactone group, and 61 (35.5%) of 172 lesions in the placebo group with an OR of 0.89 with a 95% CI of 0.56 to 1.42 (P = 0.89).

CONCLUSIONS

Spironolactone did not reduce the incidence of in-stent restenosis as compared with placebo in human, contrary to the fact that reduction of neointimal formation in animal models has been observed upon administration of spironolactone.

Transforming growth factor-beta induces nuclear import of Smad3 in an importin-beta1 and Ran-dependent manner

Smad proteins are cytoplasmic signaling effectors of transforming growth factor-beta (TGF-beta) family cytokines and regulate gene transcription in the nucleus. Receptor-activated Smads (R-Smads) become phosphorylated by the TGF-beta type I receptor. Rapid and precise transport of R-Smads to the nucleus is of crucial importance for signal transduction. By focusing on the R-Smad Smad3 we demonstrate that 1) only activated Smad3 efficiently enters the nucleus of permeabilized cells in an energy- and cytosol-dependent manner. 2) Smad3, via its N-terminal domain, interacts specifically with importin-beta1 and only after activation by receptor. In contrast, the unique insert of exon3 in the N-terminal domain of Smad2 prevents its association with importin-beta1. 3) Nuclear import of Smad3 in vivo requires the action of the Ran GTPase, which mediates release of Smad3 from the complex with importin-beta1. 4) Importin-beta1, Ran, and p10/NTF2 are sufficient to mediate import of activated Smad3. The data describe a pathway whereby Smad3 phosphorylation by the TGF-beta receptor leads to enhanced interaction with importin-beta1 and Ran-dependent import and release into the nucleus. The import mechanism of Smad3 shows distinct features from that of the related Smad2 and the structural basis for this difference maps to the divergent sequences of their N-terminal domains.

The adoption of a twisted structure of importin-beta is essential for the protein-protein interaction required for nuclear transport

Importin-beta is a nuclear transport factor which mediates the nuclear import of various nuclear proteins. The N-terminal 1-449 residue fragment of mouse importin-beta (impbeta449) possesses the ability to bidirectionally translocate through the nuclear pore complex (NPC), and to bind RanGTP. The structure of the uncomplexed form of impbeta449 has been solved at a 2.6 A resolution by X-ray crystallography. It consists of ten copies of the tandemly arrayed HEAT repeat and exhibits conformational flexibility which is involved in protein-protein interaction for nuclear transport. The overall conformation of the HEAT repeats shows that a twisted motion produces a significantly varied superhelical architecture from the previously reported structure of RanGTP-bound importin-beta. These conformational changes appear to be the sum of small conformational changes throughout the polypeptide. Such a flexibility, which resides in the stacked HEAT repeats, is essential for interaction with RanGTP or with NPCs. Furthermore, it was found that impbeta449 has a structural similarity with another nuclear migrating protein, namely beta-catenin, which is composed of another type of helix-repeated structure of ARM repeat. Interestingly, the essential regions for NPC translocation for both importin-beta and beta-catenin are spatially well overlapped with one another. This strongly indicates the importance of helix stacking of the HEAT or ARM repeats for NPC-passage.

Recycling of importin alpha from the nucleus is suppressed by loss of RCC1 function in living mammalian cells

We previously reported that the nuclear import of substrates containing SV40 T antigen nuclear localization signal (NLS) was suppressed in a temperature-sensitive RCC1 mutant cell line, tsBN2, at nonpermissive temperature. Moreover, it was shown that import into wild type BHK21 cell-derived nuclei gradually decreased in heterokaryons between the tsBN2 and BHK21 cells, although the BHK21 nuclei retained wild type RCC1 and should contain RanGTP (Tachibana et al., 1994). In this study, it was found that in the heterokaryons cultured at non-permissive temperature, endogenous importin alpha was not detected immunocytochemically in the cytoplasm or BHK21 nuclei but only in the tsBN2 nuclei, suggesting that importin alpha cannot be exported from the RCC1-depleted nuclei. In fact, importin alpha microinjected into the nucleus of tsBN2 cells at non-permissive temperature remained in the nucleus. These results strongly support the hypothesis that the recycling of importin alpha from the nucleus requires nuclear RanGTP. Moreover, it was found that cytoplasmic injection of importin alpha restored the import of SV40 T-NLS substrates in the BHK21 nuclei but not the tsBN2 nuclei in the heterokaryons. This indicates that the decrease of importin alpha from the cytoplasm in the heterokaryons leads to a suppression of the efficiency of nuclear import of the T-NLS substrate and provides support for the view that nuclear RanGTP is essential for the nuclear entry of the substrates.

Distinct energy requirement for nuclear import and export of importin beta in living cells

Importin beta can shuttle between the nucleus and cytoplasm through the nuclear pore complex (NPC). This study deals with the issue of how the energy is utilized during the NPC passage of importin beta. In chilled or ATP-depleted cells, importin beta was transported into the nucleus, while the nuclear export of importin beta was inhibited. Further, it was found that the nuclear export inhibition of importin beta is not due to nuclear retention via binding to nucleoporins or nuclear importin alpha. These data show that the nuclear export of importin beta involves energy-requiring step(s) in living cells.

Clinical evidence for dystrophin dysfunction as a cause of hearing loss in locus DFN4

OBJECTIVE

Locus DFN4 is an X-linked nonsyndromic hearing loss locus originally mapped to Xp21.2. Recently, we have mapped deafness in a second family from Turkey to the same region, refining the location to within the Duchenne muscular dystrophy (DMD) locus. The objective of this study was to characterize the clinical phenotype of the Turkish family with comprehensive audiovestibular testing and high-resolution temporal bone computerized tomography.

METHODS

Fourteen members of a three-generation family were studied in detail including two deaf affected males. Members of the family underwent general physical and otologic examination, vestibular testing, pure-tone audiometry, otoacoustic emissions, and immitance testing. An affected male underwent high-resolution computerized tomography of the temporal bone, electroretinogram (ERG), electromyography, electroneurography, and determination of serum creatinine phosphokinase level.

RESULTS

Affected males were congenitally deaf with normal vestibular function. Carrier females showed a mild sensorineural hearing loss affecting all frequencies and absent otoacoustic emissions. Otoacoustic emissions in a younger, 3-year-old carrier girl were normal. In an affected male, ERG demonstrated subnormal scotopic b-wave typically seen in DMD. Computerized tomography of the temporal bone was normal. With the exception of the ERG finding, there was no clinical or laboratory evidence of DMD or Becker muscular dystrophy (BMD).

CONCLUSION

The abnormal ERG in the Turkish family in conjunction with mapping of the DFN4 locus to within DMD strongly suggests that a defect in dystrophin is responsible for the hearing loss in this family. Patients with DMD and BMD should be screened systematically for sensorineural hearing loss. This family provides additional evidence for the critical role of cytoskeletal proteins in normal hearing.

A monoclonal antibody to the COOH-terminal acidic portion of Ran inhibits both the recycling of Ran and nuclear protein import in living cells

A small GTPase Ran is a key regulator for active nuclear transport. In immunoblotting analysis, a monoclonal antibody against recombinant human Ran, designated ARAN1, was found to recognize an epitope in the COOH-terminal domain of Ran. In a solution binding assay, ARAN1 recognized Ran when complexed with importin beta, transportin, and CAS, but not the Ran-GTP or the Ran-GDP alone, indicating that the COOH-terminal domain of Ran is exposed via its interaction with importin beta-related proteins. In addition, ARAN1 suppressed the binding of RanBP1 to the Ran-importin beta complex. When injected into the nucleus of BHK cells, ARAN1 was rapidly exported to the cytoplasm, indicating that the Ran-importin beta-related protein complex is exported as a complex from the nucleus to the cytoplasm in living cells. Moreover, ARAN1, when injected into the cultured cells induces the accumulation of endogenous Ran in the cytoplasm and prevents the nuclear import of SV-40 T-antigen nuclear localization signal substrates. From these findings, we propose that the binding of RanBP1 to the Ran-importin beta complex is required for the dissociation of the complex in the cytoplasm and that the released Ran is recycled to the nucleus, which is essential for the nuclear protein transport.

beta-subunit of nuclear pore-targeting complex (importin-beta) can be exported from the nucleus in a Ran-independent manner

The nuclear export of importin-alpha is mediated by CAS, which is related to importin-beta, whereas the mechanism for the export of importin-beta remains unclear. In this study, we demonstrate that the nuclear export of importin-beta is mediated by the nuclear pore complex-binding domain of this molecule. Insensitivity to leptomycin B indicates that its export is not mediated by a leucine-rich nuclear export signal-specific receptor, CRM1. Furthermore, the nuclear export of importin-beta was not inhibited by co-injection with a GTPase-deficient Ran mutant (G19V). The cell line tsBN2 contains a temperature-sensitive point mutation in the RCC1 gene, which encodes a guanine nucleotide exchange factor of Ran. At the nonpermissive temperature, importin-beta was exported from the nucleus of these cells, even when RanGAP1, a GTPase-activating protein for Ran, was co-injected. These results not only provide support for the view that Ran-dependent GTP hydrolysis is not required for the nuclear export of importin-beta but also indicate that nuclear RanGTP is not essential for its export. As a result, we propose that importin-beta can be recycled from the nucleus alone in a Ran-independent manner.

Simultaneous operation for coexisting lung and liver hydatid cysts: a treatment modality

BACKGROUND/AIMS

Hydatid disease is very common in our region. Whether or not coexisting cysts of lung and liver should be operated on simultaneously is a challenging question.

METHODOLOGY

Of 127 patients operated on for hydatid cysts of the lung between 1990 and 1995, 23 (18%) had coexisting hydatid cysts of the right lung and liver. There were 12 male and 11 female patients with an average age of 34 years.

RESULTS

All patients had simultaneous operations for both organs via right thoracotomy with an incision in the diaphragm (phrenotomy). In the lung, cystotomy and capitonnage were performed in 21 patients and wedge resection in 2; in the liver, cystotomy and capitonnage were performed in all 23 patients. No hospital mortality occurred.

CONCLUSION

Coexisting hydatid cysts of the right lung and liver should be surgically treated simultaneously.

From barrier-free to universal design: an international perspective

What is universal design? And where lies the difference between barrier-free design and universal design? One can answer this question from different viewpoints. This paper attempts to answer the question from the Far East, where the idea came later than in the United States or Europe.

Ran-unassisted nuclear migration of a 97-kD component of nuclear pore-targeting complex

A 97-kD component of nuclear pore-targeting complex (the beta-subunit of nuclear pore-targeting complex [PTAC]/importin/karyopherin) mediates the import of nuclear localization signal (NLS)-containing proteins by anchoring the NLS receptor protein (the alpha-subunit of PTAC/importin/karyopherin) to the nuclear pore complex (NPC). The import requires a small GTPase Ran, which interacts directly with the beta-subunit. The present study describes an examination of the behavior of the beta-subunit in living cells and in digitonin-permeabilized cells. In living cells, cytoplasmically injected beta-subunit rapidly migrates into the nucleus. The use of deletion mutants reveals that nuclear migration of the beta-subunit requires neither Ran- nor alpha-subunit-binding but only the NPC-binding domain of this molecule, which is also involved in NLS-mediated import. Furthermore, unlike NLS-mediated import, a dominant-negative Ran, defective in GTP-hydrolysis, did not inhibit nuclear migration of the beta-subunit. In the digitonin-permeabilized cell-free import assay, the beta-subunit transits rapidly through the NPC into the nucleus in a saturating manner in the absence of exogenous addition of soluble factors. These results show that the beta-subunit undergoes translocation at the NPC in a Ran-unassisted manner when it does not carry alpha-subunit/NLS substrate. Therefore, a requirement for Ran arises only when the beta-subunit undergoes a translocation reaction together with the alpha-subunit/NLS substrate. The results provide an insight to the yet unsolved question regarding the mechanism by which proteins are directionally transported through the NPC, and the role of Ran in this process.

Possibilities for change toward universal design: Japanese housing policy for seniors at the crossroads

Japanese government policies for seniors have long assumed that informal care by their families exists for them. The rapid aging of Japan is eroding the basis for this assumption. It is now necessary to include barrier-free design concepts in the basic requirements for dwellings to be used by everyone, not just seniors, to support independent living. Essential requirements in proposed guidelines are already in effect in the design and construction of publicly operated rental housing. But at this time, only the schemes of the Housing Loan Corporation of Japan for additional loans are being used, in cases where some design requirements for senior users are being met. The Housing Loan Corporation's loan system has long been seen as a policy on the part of government to boost the economy, particularly during recessions, but assistance for construction of higher quality dwellings has been lacking. This article discusses the basic philosophy of design guidelines and practical ideas to be considered in dwelling design and the merit of model dwellings constructed by housing manufacturers in Japan. It also discusses potential strategies to implement the basic ideas of design guidelines. It then proposes some possible methods to realize life-span dwellings, or dwellings designed for everybody.

In vivo evidence for involvement of a 58 kDa component of nuclear pore-targeting complex in nuclear protein import

We recently showed that a nuclear location signal (NLS)-containing karyophile forms a stable complex with cytoplasmic components for nuclear pore-targeting The complex, termed nuclear pore-targeting complex (PTAC), contained two essential proteins of 54 and 90 kDa, respectively, as estimated by electrophoresis. In this study, we found that the 54 kDa component of PTAC is the mouse homologue of Xenopus importin (m-importin). Cytoplasmic injection of the antibodies raised against recombinant m-importin showed an inhibitory effect on nuclear import of a karyophile in living mammalian cells. A portion of cytoplasmically injected antibodies migrated rapidly into the nucleus, indicating dynamic movement of this protein across the nuclear envelope. Moreover, the injected antibodies co-precipitated the karyophile, in an NLS-dependent manner, with endogenous m-importin in the cytoplasm. These results provide in vivo evidence that m-importin is involved in nuclear protein import through association with a NLS in the cytoplasm before nuclear pore binding.

The nuclear pore-targeting complex binds to nuclear pores after association with a karyophile

We recently showed that a karyophilic protein forms a stable complex, termed nuclear pore-targeting complex (PTAC), with cytoplasmic components prior to nuclear pore-binding. In this study, we cloned a cDNA encoding a 97 kDa of PTAC (PTAC97). Recombinant PTAC97 completely reconstitutes the nuclear binding-step in conjunction with a 58 kDa component of PTAC (PTAC58) in the semi-intact cell-free transport assay. Biochemical analysis reveals that PTAC58 binds to a karyophilic protein, and PTAC97 is associated with PTAC58 in a 1:1 molar ratio. A complex of PTAC97 and PTAC58 targets nuclear pores, depending on the presence of a karyophile. These in vitro results suggest that the first step in nuclear import occurs through the targeting-complex formation of a karyophile with PTAC58 bound to PTAC97.

[Effect of steroids on intracranial pressure and pressure-volume index in patients with hydrocephalus]

It is well-established that steroids (glucocorticoids) have a beneficial clinical effects on patients with increased intracranial pressure, but there is still a controversy on the mode of action of steroids. The purpose of this study is to investigate the effects of steroids on continuous intracranial pressure and on intracranial compliance using pressure-volume index (PVI). Thirteen hydrocephalic patients, ranging from 9 to 70 years old, without intracranial mass lesion nor brain edema were studied. The patients were divided into two groups. Group I: Five patients were monitored the continuous intracranial pressure for 24 hours again following the administration of steroids on continuous intracranial pressure. The method of the administration of steroids was that betamethasone 8 mg for initial dose was administered intravenously and followed by 4 mg intramuscularly every 6 hours. There was little change in the baseline pressure and the amplitude on continuous intracranial pressure monitoring before and after the administration of steroids. But the maximum pressure and the maximum amplitude significantly decreased after the administration of steroids. The % time B-wave and the maximum continuous time of B-wave also decreased significantly. Group II: Eight patients were studied in order to investigate the effects of steroids on the intracranial compliance. PVI was measured according to Marmarou's method before and after the intravenous administration of steroids (beta-methasone 0.5 mg/kg). PVI increased in 7 out of 8 cases after the administration of steroids, which was statistically significant. It can be concluded that steroids increase the intracranial compliance and inhibit the rise of intracranial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Three cases of acute interhemispheric subdural hematoma]

Traumatic acute subdural hematomas over the convexity of the cerebral hemispheres are often encountered, but acute interhemispheric subdural hematomas are rare. Fourty-eight cases of acute subdural hematomas was admitted to our hospital between 1977 and 1986, and three cases of them (6%) were located in the interhemispheric subdural space. In this paper, these three cases are reported with 20 documented cases. Case 1: an 81-year-old female was admitted to our hospital because of headache, nausea and vomiting. She hit her occiput a week ago. CT scan demonstrated contusion in the right frontal lobe and a high density in the interhemispheric space of the right frontal region. Her complaints disappeared gradually by conservative therapy and she returned to her social life. Case 2: a 50-year-old male fell downstairs and hit his vertex. As he lost consciousness, he was admitted to our hospital. He was stuporous and had left-hemiparesis. Skull X-ray film showed fracture line extending from the right temporal bone to the left parietal bone across the midline. CT scan revealed intracerebral hematoma in both frontal lobe and right parietal lobe and subarachnoid hemorrhage in the basal cistern and Sylvian fissure of the right side. And interhemispheric subdural hematoma in the right parietal region was visualized. Angiography demonstrated a lateral displacement of the right callosomarginal artery and an avascular area between the falx and the callosomarginal artery. After admission his consciousness recovered and convulsion was controlled by drug. Left-hemiparesis was improved by conservative therapy and he was discharged on foot.(ABSTRACT TRUNCATED AT 250 WORDS)

[Continuous intracranial pressure monitoring in normal pressure hydrocephalus--with special reference to clinical significance of B wave and prognostic criteria for CSF shunting]

The authors investigated the hydrodynamics in normal pressure hydrocephalus (NPH) and suggested surgical indication for identifying cases suitable for shunt operation. 48 patients with presumed NPH who underwent CT scanning, CT cisternography, and continuous monitoring of intracranial pressure for 24 hours were studied for assessing the correlation of incidence of B wave with clinicopathological features of the normal pressure hydrocephalus syndromes. The causes of NPH consisted of idiopathic of primary origin in 24 patients, subarachnoid hemorrhage in 9, head injury in 8, cerebrovascular occlusion in 3, meningitis in 2, intracerebral hematoma in one and craniotomy in one. The incidence of B waves in term of percentage of time with B waves did not correlate with the age of the patients and presence or absence of CT evidence of brain atrophy. There was a good correlation between incidence of B waves and the degree of ventriculomegaly, the presence of periventricular lucency on CT, and the grade of CSF circulation disturbance as evaluated by CT cisternography. The pathogenesis of B waves may be related to increased malabsorption of CSF in the major pathways and episodic pressure response promoting CSF absorption in the lesser pathways. Those patients who exhibit the type IV or type V on CT cisternography and B waves for more than 20% of the time monitored on continuous monitoring of intracranial pressure (ICP) responded to shunting in more than 90%. Patients showing type III-b on CT cisternography and B waves for more than 5% on ICP monitoring benefited from a shunt in about 70%. On the other hand, patients with type III-a on CTC and B waves for less than 5% of the time monitored could not be expected to respond to shunting. Incidence of B waves on continuous ICP monitoring correlated closely with response to CSF shunting. Therefore continuous ICP monitoring, combined with CT cisternography, provide a reliable indication of the potential of a patient with NPH to recover after shunting.