Psychiatrists' Attitude and Use of Second-generation Antipsychotics for the Treatment of Schizophrenia in Taiwan

OBJECTIVES

This survey aimed to understand the attitude of psychiatrists and their use of commonly prescribed second-generation antipsychotics (SGAs) for the treatment of schizophrenia in Taiwan. It also attempted to identify the factors that might influence their preference for selecting SGAs.

METHODS

Psychiatrists were interviewed face-to-face using a structured questionnaire. The questionnaire addressed various issues involved in the treatment of patients with schizophrenia, including the reasons for selecting SGAs, psychiatrists' level of satisfaction with commonly prescribed SGAs, and their current use of SGAs in clinical practice.

RESULTS

Gender and age of the psychiatrists, and practice setting were not related to SGA selection. The selection of a SGA might be influenced by characteristics of the psychiatrist, properties of the drugs, and the healthcare insurance system. Most psychiatrists agreed that the performance of brand-name drugs was superior to that of generic drugs. Better symptom control, improvement in cognition, and higher tolerability were among the major factors considered by psychiatrists in Taiwan when prescribing antipsychotics.

CONCLUSION

Selection of a SGA in Taiwan is potentially influenced by the characteristics of the psychiatrist, properties of the drug, and the healthcare insurance system. Efficacy and tolerability were among the major determining factors when prescribing antipsychotics for the treatment of patients with schizophrenia.

Preparation and identification of an antiserum against recombinant UL31 protein of pseudorabies virus

Pseudorabies virus (PRV) early protein UL31 is a homologue of herpes simplex virus 1 (HSV-1) UL31, which is a multifunctional protein important for HSV-1 infection. However, the precise roles of PRV UL31 in virus life cycle are still poorly understood. A relatively crucial tool for uncovering the function of UL31 is an antiserum that specifically detects UL31 in the PRV-infected cells. For this purpose, a recombinant UL31 protein consisting of N-terminal 27 aa of UL31 fused to EYFP and His-tag was expressed, purified and used for the preparation of antiserum in BALB/c mice. Our results show that Western blot analysis and immunofluorescence assay showed that this antiserum could specifically detect the purified recombinant UL31 as well as full-length UL31 in the PRV infected cells. These results demonstrate that the prepared antiserum could serve as a valuable tool for further studies of UL31 functions in PRV infection.

A genome-wide association study of growth trait-related single nucleotide polymorphisms in Chinese Yancheng chickens

Chicken (Gallus gallus) growth traits are important economic traits, and many studies have been conducted on genetic selection for body weight. However, most of these studies have detected functional chromosome mutations or regions by conventional molecular markers or gene chips. In this study, we performed a new genome-wide association study using specific-locus amplified fragment sequencing (SLAF-seq) technology in purebred Yancheng chickens. Single nucleotide polymorphisms (SNPs) that were significantly associated with phenotypic traits were identified by GAPIT-compressed mixed linear models. Eighteen SNP markers reached 5% Bonferroni genome-wide significance. A region spanning 72.3 to 82.1 Mb on GGA4 had a strong influence on growth traits. Four genes (FAM184B, KCNIP4, MIR15A, and GLI3) were closely associated with body weight. Some SNPs were coincident with previously reported quantitative trait locus regions. Our results would promote the researches of Chinese chickens and accelerate the utilization of Chinese chicken, specially Yancheng chicken.

Development and Impact of De Novo Anti-HLA Antibodies in Pediatric Heart Transplant Recipients

There is increasing evidence that de novo anti-HLA antibodies, more specifically de novo donor-specific antibodies (DSA) following solid organ transplantation may be associated with negative outcomes including rejection in the first year and graft loss. Limited data are available in pediatric heart transplant recipients. We sought to prospectively determine the incidence, class and early impact of de novo anti-HLA antibodies in a cohort of pediatric heart transplant recipients. Serial panel reactive antibody testing posttransplant was performed in 25 patients (14 males) transplanted between January 2008 and June 2010. Five patients were sensitized pretransplant; all patients had negative direct crossmatch. Seventy-two percent developed de novo anti-HLA antibodies at a median of 2.6 weeks (IQR 1.2 weeks to 6.2 months) posttransplant; 67% of these were DSA. The majority of recipients in our cohort developed de novo anti-HLA antibodies within the first year posttransplant, with two-thirds being donor-specific. Acute cellular rejection, though frequent, was not different in patients with antibody development regardless of class or specificity, and there was no antibody-mediated rejection, graft loss or early cardiac allograft vasculopathy.

Effects of spiked metals on the MSW anaerobic digestion

This study aimed to investigate the effects of eight metals on the anaerobic digestion of the organic fraction of municipal solid waste (OFMSW) in bioreactors. Anaerobic bioreactors containing 200 mL MSW mixed completely with 200 m L sludge seeding. Ca and K (0, 1000, 2000 and 6,000 mg L(-1)) and Cr, Ni, Zn, Co, Mo and W (0, 5, 50 and 100 mg  L(-1)) of various dose were added to anaerobic bioreactors to examine their anaerobic digestion performance. Results showed that except K and Zn, Ca (~728 to ~1,461 mg  L(-1)), Cr (~0.0022 to ~0.0212 mg  L(-1)), Ni (~0.801 to ~5.362 mg  L(-1)), Co (~0.148 to ~0.580 mg  L(-1)), Mo (~0.044 to ~52.94 mg  L(-1)) and W (~0.658 to ~40.39 mg  L(-1)) had the potential to enhance the biogas production. On the other hand, except Mo and W, inhibitory concentrations IC(50) of Ca, K, Cr, Ni, Zn and Co were found to be ~3252, ~2097, ~0.124, ~7.239, ~0.482, ~8.625 mg  L(-1), respectively. Eight spiked metals showed that they were adsorbed by MSW to a different extent resulting in different liquid metals levels and potential stimulation and inhibition on MSW anaerobic digestion. These results were discussed and compared to results from literature.

Model-based segmentation of flexor tendons from magnetic resonance images of finger joints

Trigger finger is a common hand disease, causing swelling, painful popping and clicking in moving the affected finger joint. To better evaluate patients with trigger finger, segmentation of flexor tendons from magnetic resonance (MR) images of finger joints, which can offer detailed structural information of tendons to clinicians, is essential. This paper presents a novel model-based method with three stages for automatically segmenting the flexor tendons. In the first stage, a set of tendon contour models (TCMs) is initialized from the most proximal cross-sectional image via two-step ellipse estimation. Each of the TCMs is then propagated to its distally adjacent image by affine registration. The propagation is sequentially performed along the proximal-distal direction until the most distal image is reached, as the second stage of segmentation. The TCMs on each cross-sectional image are refined in the last stage with the snake deformation. MR volumes of three subjects were used to validate the segmentation accuracy. Compared with the manual results, our method showed good accuracy with small average margins of errors (within 0.5 mm) and large overlapping ratio (dice similarity coefficient above 0.8). Overall, the proposed method has great potential for morphological change assessment of flexor tendons and pulley-tendon system modeling for image guided surgery.

Modeling biogas production from organic fraction of MSW co-digested with MSWI ashes in anaerobic bioreactors

This study aims at investigating the effects of MSW incinerator fly ash (FA) and bottom ash (BA) on the anaerobic co-digestion of OFMSW with FA or BA. It also simulates the biogas production from various dosed and control bioreactors. Results showed that suitable ashes addition (FA/MSW 10 and 20 g L(-1) and BA/MSW 100 g L(-1)) could improve the MSW anaerobic digestion and enhance the biogas production rates. FA/MSW 20 g L(-1) bioreactor had the higher biogas production and rate implying the potential option for MSW anaerobic co-digestion. Modeling studies showed that exponential plot simulated better for FA/MSW 10 g L(-1) and control bioreactors while Gaussian plot was applicable for FA/MSW 20 g L(-1) one. Linear and exponential plot of descending limb both simulated better for BA/MSW 100 g L(-1) bioreactor. Modified Gompertz plot showed higher correlation of biogas accumulation than exponential rise to maximum plot for all bioreactors.

A rare cutaneous fungal infection complicating bacterial necrotising fasciitis

We report a case of bacterial necrotising fasciitis complicated by the rare fungus Absidia corymbifera. Although this fungal infection is rare, the prognosis is poor and it therefore requires attention. Only 30 cases have been reported since 1874, and we are the first group to report this clinical scenario in our locality. Using a comprehensive journal review, we discuss the expected clinical course and optimal management.

Sternocleoidomastoid muscle length predicts depth of central venous catheter insertion

BACKGROUND

Correct central venous catheter (CVC) insertion avoids serious complications, especially fatal intracardiac impalement. There are only few methods which discussed the depth of CVC insertion previously. Predicting the depth of CVC by body surface landmark is an easy and quick way, which is applied most wildly. Chest X-ray is a standard procedure to examine the depth of CVC. However, chest X-ray is not routinely availale, especially in emergency situations. Recent publications demonstrated that the determination of accurate placement by chest X-ray can be substituted by ECG guidance. We would like to find the correlation between surface anatomic landmarks and the depth of CVC insertion, and a method that could be applied easily and quickly to predict the depth of CVC insertion through ECG guidance.

METHODS

Thirty patients receiving orthopedic, neurologic and gastrointestinal operations under general anesthesia were chosen for the study of CVC insertion via the right internal jugular vein puncture. The puncture site is at the mid-point of sternocleidomastoid (SCM) muscle, and direction of puncture is 30-45 degrees, pointing to nipple. ECG guidance is applied for the depth of CVC measurement. Body height, sitting height, length of sternum and SCM muscle were measured for reference.

RESULTS

Both the length of SCM muscle and body height have statistically meaning for predicting the depth of CVC insertion (P < 0.001 vs. P = 0.012). In point of accuracy, SCM muscle length might be more significant in view of yielding a smaller P-value. And, the depth of CVC is equal to half of the length of SCM muscle plus 6.5 cm in adults aged 18 to 78 yrs.

Dissociation dynamics of positive-ion and negative-ion fragments of gaseous and condensed Si(CH(3))(2)Cl(2) via Si 2p, Cl 2p, and Cl 1s core-level excitations

The state-selective positive-ion and negative-ion dissociation pathways of gaseous and condensed Si(CH(3))(2)Cl(2) following Cl 2p, Cl 1s, and Si 2p core-level excitations have been characterized. The excitations to a specific antibonding state (15a(1) (*) state) of gaseous Si(CH(3))(2)Cl(2) at the Cl 2p, Cl 1s, and Si 2p edges produce significant enhancement of fragment ions. This ion enhancement at specific core-excited states correlates closely with the ion kinetic energy distribution. The results deduced from ion kinetic energy distribution are consistent with results of quantum-chemical calculations on Si(CH(3))(2)Cl(2) using the ADF package. The Cl(-) desorption yields for Si(CH(3))(2)Cl(2)Si(100) at approximately 90 K are notably enhanced at the 15a(1) (*) resonance at both Cl 2p and Si 2p edges. The resonant enhancement of Cl(-) yield occurs through the formation of highly excited states of the adsorbed molecules. These results provide insight into the state-selective ionic fragmentation of molecules via core-level excitation.

The lead content of currently available new residential paint in several Asian countries

Worldwide prohibitions on lead gasoline additives were a major international public health accomplishment, the results of which are still being documented in parts of the world. Although the need to remove lead from paints has been recognized for over a century, evidence reported in this article indicates that lead-based paints for household use, some containing more than 10% lead, are readily available for purchase in some of the largest countries in the world. Sixty-six percent of new paint samples from China, India, and Malaysia were found to contain 5000 ppm (0.5%) or more of lead, the US definition of lead-based paint in existing housing, and 78% contained 600 ppm (0.06%) or more, the limit for new paints. In contrast, the comparable levels in a nearby developed country, Singapore, were 0% and 9%. In examining lead levels in paints of the same brands purchased in different countries, it was found that some brands had lead-based paints in one of the countries and paints meeting US limits in another; another had lead-free paint available in all countries where samples were obtained. Lead-based paints have already poisoned millions of children and likely will cause similar damage in the future as paint use increases as countries in Asia and elsewhere continue their rapid development. The ready availability of lead-based paints documented in this article provides stark evidence of the urgent need for efforts to accomplish an effective worldwide ban on the use of lead in paint.

The vertebrate phototransduction cascade: amplification and termination mechanisms

The biochemical cascade which transduces light into a neuronal signal in retinal photoreceptors is a heterotrimeric GTP-binding protein (G protein) signaling pathway called phototransduction. Works from psychophysicists, electrophysiologists, biochemists, and geneticists over several decades have come together to shape our understanding of how photon absorption leads to photoreceptor membrane hyperpolarization. The insights of phototransduction provide the foundation for a mechanistic account of signaling from many other G protein-coupled receptors (GPCR) found throughout nature. The application of reverse genetic techniques has strengthened many historic findings and helped to describe this pathway at greater molecular details. However, many important questions remain to be answered.

Implications of the changing pattern of bacterial infections following total joint replacements

PURPOSE

To retrospectively review the causative organisms isolated from infected hip and knee replacements requiring revision.

METHODS

We reviewed a consecutive series of 36 patients who underwent revision hip or knee arthroplasties due to bacterial infection at Pamela Youde Nethersole Eastern Hospital in Hong Kong between 1995 and 2003. The male to female ratio was 1:2, and the mean age of patients was 70 years (range, 54-82 years). The mean duration of follow-up was 3.8 years (range, 1.1-8.3 years). No patient was lost to follow-up. All 14 revision knee patients had previously undergone cemented and patella-resurfacing total knee arthroplasties. Of the 22 revision hip patients, 9 had cementless, 6 had cemented, and 7 had hybrid total hip arthroplasties previously.

RESULTS

None of the bacteria isolated from 1995 to 1996 were multiple-drug resistant. Subsequently, however, most of the isolates were multiple-drug resistant, with methicillin-resistant Staphylococcus aureus (MRSA) being the most common. Half of the isolates of Staphylococcus epidermidis and Escherichia coli demonstrated multiple-drug resistance. The incidence of positive culture in revision hip patients was 59%, 46% of which were MRSA. All 13 revision hips with positive cultures showed chronic sepsis: 4 occurred within one year and 10 occurred 2 or more years after the index arthroplasty. The incidence of positive culture in revision knee patients was 57%, 46% of which were MRSA. All 8 revision knees with positive cultures showed chronic sepsis: 3 occurred within one year, 5 occurred 2 or more years after the index arthroplasty. Only one patient, who was infected with gram-negative bacilli, required a second revision for residual sepsis. Harris hip scores for the revision hip patients improved from a mean of 65 (range, 55-75) to 85 (range, 75-90). Knee Society knee scores of the revision knee patients improved from a mean of 68 (range, 55-75) to 80 (range, 70-85). There were no radiological signs suggestive of loosening in the 2 groups at the latest follow-up.

CONCLUSION

This study found a definite increase in multiple-drug-resistant bacteria isolated from periprosthetic infections around total hip and knee prostheses.

Raising and controlling study of dissolved oxygen concentration in closed-type aeration tank

This study investigated the promotion and control of dissolved oxygen (DO) concentration of the closed-type aeration tank via practical experiments in the wastewater treatment system of a 5-star hotel in Taipei. As with limited and treasured space in Taiwan, before the completion of the sewer system construction in cities, to utilize the mat foundation under large buildings as the space of sewage treatment plant still has been one of the alternatives of those sewage treatments. However, aeration tanks constructed in the mat foundation of buildings have smaller effective water depth, which will cause a lower total transfer amount of DO. Controlling the total exhaust gas flow rate can increase the pressure on such closed-type aeration tanks. The DO concentration thus may increase according to Henry's Law. Furthermore, it may enable operators to adjust the DO concentration of the aeration tank more precisely and thus sustain optimal operating conditions in these treatment facilities. Practical experiments indicated that the DO concentration of aeration tank maintains an average of 3.8 mg l(-1), obtaining the optimum operating conditions. The efficiency of the biological treatment facilities in the mat foundation could be markedly improved.

Usefulness of intraoperative transesophageal echocardiography in the assessment of surgical repair of pediatric ventricular septal defects with video-assisted endoscopic techniques in children

BACKGROUND

Mini cardiac operative procedures with video-assisted endoscopic techniques for closure of ventricular septal defects (VSDs) in pediatric patients have become quite popular for cardiac surgery. A precise diagnosis is very important for determining the surgical approach, and evaluation by intraoperative transesophageal echocardiography (TEE) plays a major role in confirmation of the preoperative diagnosis, residual defects, and the need to return to the bypass after repair.

METHODS

Sixty-five patients (30 boys and 35 girls; aged 8.7 +/- 5.3 years) who were undergoing minimally invasive closure of VSDs were monitored with a Hewlett-Packard color Doppler pediatric TEE throughout the procedure.

RESULTS

Closure of the defect was successfully performed in all patients. Sixty-two patients showed neither residual shunt nor aortic regurgitation after the repair. Residual leaks were detected intraoperatively in 3 patients after the repair. One patient required a return to the bypass with an immediate reoperation due to a residual color jet diameter of > 3 mm. One patient was changed from video-assisted endoscopic techniques to a surgical approach for closure of the VSD from a conventional median sternotomy after identification by TEE of an outlet-type perimembranous VSD with 2 additional muscular VSDs.

CONCLUSIONS

Our study showed that, with refinement of surgical closure of VSD via video-assisted endoscopic techniques, intraoperative TEE provides valuable and accurate information for decision-making in surgical management, provides immediate assessment of surgical repairs, and prevents reintervention and the morbidity associated with residual flow.

Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis

BACKGROUND

The long-term use of methamphetamine (MAMP) can result in psychosis but it is not clear why some individuals develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We set out to characterize MAMP users and to examine the relationship of pre-morbid personality, pre-morbid social function and other psychiatric disorders to MAMP psychosis.

METHOD

Four hundred and forty-five amphetamine users were recruited from a psychiatric hospital and a detention centre in Taipei, and were assessed with the Diagnostic Interview for Genetic Studies (DIGS). Their parents were interviewed with the Premorbid Schizoid and Schizotypal Traits (PSST) and the Premorbid Social Adjustment (PSA) schedules. Pre-morbid characteristics and psychiatric co-morbidity were compared between the MAMP users with a lifetime diagnosis of MAMP psychosis and those without.

RESULTS

The MAMP users with psychosis presented a clinical picture which mimicked the positive symptoms of schizophrenia: 85% had auditory hallucinations; 71% persecutory delusions; 63% delusions of reference. Compared with their non-psychotic counterparts, these MAMP users were younger at first MAMP use, used larger amounts of MAMP, had a significantly higher mean PSST score, and higher rates of major depressive disorder, alcohol dependence and antisocial personality disorder.

CONCLUSIONS

Earlier and larger use of MAMP was associated with increased risk of psychosis. Our data are also compatible with the view that pre-morbid schizoid/schizotypal personality predisposes MAMP users to develop psychosis, and that the greater the personality vulnerability, the longer the psychosis will persist.

Treatment of slaughterhouse wastewater using an activated sludge/contact aeration process

This study combines a two-phase biological treatment system of activated sludge/contact aeration process by adding biological contact filters into the rear sector of the activated sludge aeration tank of the slaughterhouse wastewater treatment plant. This system keeps the advantages of complete mixing of substrates and microorganisms and flexible operation of the activated sludge process, and increased biological phase, less sludge, process stability and good settleability of sludge of the contact aeration process. This system could avoid the defects of sludge bulking, increased sludge production and difficult operation of the activated sludge process, and system clogging and rigid operation of the contact aeration process. Because suspended microorganisms are flowing into the contact aeration system, which then degrade or suspend within the biological contact filters after being adsorbed by the fixed biological film, on which partial bio-solids will act as seeding microorganisms. Suspended microorganisms and the dropped biological film will settled in the secondary settling tank, then reflux into the activated sludge aeration tank. The partial dropped biological film will decompose in the activated sludge aeration tank to achieve the function of decreasing sludge. Large specific gravity and good settling ability of biofilm sludge will provide better effluent quality. It has been proven through a practical experiment at a slaughterhouse wastewater treatment plant in Taiwan, that the activated sludge process effluent COD value of 150-200 mg/L and SS value of 80-100 mg/L were decreased to around 40 mg/L and 22 mg/L, respectively, after changing its system to the two-phase biological treatment system of activated sludge/contact aeration process.

Anti-HBc IgG subclasses in different populations by comparing a variety of ELISA plates

The number of IgG subclasses for hepatitis B virus (HBV) core antigen (anti-HBc), demonstrated for HBV-infected individuals, was measured by enzyme-linked immunosorbent assay (ELISA). Four commercially available hepatitis B core antigen (HBcAg) plates and one prepared plate were tested for ELISA sensitivity by the detection of 14 serum samples drawn from HBV chronic carriers, cured patients, vaccinees, and non-infected individuals. Differences in optical density (OD) values were obtained by comparing data gathered from the five plate types, suggesting that different plates may have different binding capabilities for each anti-HBc IgG subclass and, thus, contribute to the different ELISA sensitivities. Of these plates, the GB plate showed the most obvious absorbance changes for anti-HBc subclasses in different populations. These data also indicated different patterns for IgG-specific subclasses for various populations. For HBsAg+ carriers, the OD for IgG1 was greater than for IgG3. By contrast, the OD for IgG3 was higher than that for IgG1 in those subjects who were negative for HBsAg.

Characterization of human GRK7 as a potential cone opsin kinase

PURPOSE

Homozygous inactivation of the mouse gene for GRK1 (G protein-coupled receptor kinase 1, or rhodopsin kinase) causes severe defects in the recovery of cone phototransduction. However, electroretinographic (ERG) analyses of human oguchi patients with defective GRK1 alleles showed normal or slightly abnormal photopic responses. It remains unclear why the loss of GRK1 yields such different phenotypes in the recovery of mouse and human cones. We examined the localization and enzyme activity of GRK7, the human ortholog of the seventh member of the GRK family, in an attempt to understand its potential role in photopic vision.

METHODS

Bioinformatic approaches were used to identify the human GRK7 gene. Human and bovine GRK7 cDNAs were isolated by RT-PCR. Recombinant GRK7, expressed in insect cells, was used to phosphorylate activated rhodopsin. Antibodies raised against GRK7 peptides were used to examine the retina specific expression of GRK7 by immunoblotting and its subcellular localization by immunocytochemistry.

RESULTS

The human GRK7 gene is located on chromosome 3q21, spans at least 10 Kb and consists of 4 exons. In human, GRK7 is expressed exclusively in the retina and is found in all retinal neurons, and specifically, in cone outer segments. Recombinant human GRK7 catalyzes rhodopsin phosphorylation in a light dependent manner. We provide evidence that GRK1 and GRK7 are co-expressed in human cones. In contrast, mouse GRK7 is expressed in many tissues including retina where photoreceptors apparently do not express GRK7.

CONCLUSIONS

The presence of GRK7 in human, but not in mouse, cone outer segments suggests that GRK7 may function to provide the normal photopic vision reported by oguchi patients with a defective GRK1 gene. The absence of GRK7 expression in cone outer segments of mice is consistent with the notion that mouse cones rely solely on GRK1 to shutoff cone visual pigments.

Gene expression profiles of light-induced apoptosis in arrestin/rhodopsin kinase-deficient mouse retinas

To examine the molecular processes that lead to light-induced retinal degeneration, mutant mice deficient in arrestin and rhodopsin kinase were raised in the dark and then subjected to relatively low doses of white light. The kinetics of the subsequent induction of apoptosis, change in mRNA transcript level, and photoreceptor cell death were monitored. Analysis of transcript profiles identified clusters of genes that responded differently to illumination, including a cluster of photoreceptor-specific genes that showed marked decreases in levels long before morphological damage could be readily ascertained. The behaviors of other gene clusters demonstrate the coordinate induction of stress gene responses early in the course of irradiation. There was little, if any, change in transcript levels corresponding to genes associated with the initiation of apoptosis or antiapoptotic effects. Transcript analysis provides insight into the patterns of gene expression that are associated with the different stages of retinal degeneration in this model system.

Long-lived immune response to early secretory antigenic target 6 in individuals who had recovered from tuberculosis

We sought to understand the persistence and relevance of the long-lived immune response to early secretory antigenic target (ESAT-6) of Mycobacterium tuberculosis in humans. ESAT-6 is recognized by memory cells involved in protection of animals against tuberculosis (TB). Recent reports also showed that ESAT-6 response can be recovered in patients with TB and in those soon after anti-TB therapy. We chose 18 individuals who had recovered from pulmonary TB (some in remission for >5 years), and 14 bacille Calmette-Guérin-vaccinated healthy individuals for this study. The results showed that peripheral blood mononuclear cells of 10 (55.6%) of 18 patients with TB remission responded to ESAT-6 with stimulation indices >3.0, whereas none of the healthy controls responded. Functional analysis showed that 13 (72.2%) of 18 patients with TB remission produced significant amounts of IFN-gamma in response to ESAT-6, whereas only 1 (7.1%) of the 14 healthy control subjects did so. It appears that responses to ESAT-6 can persist in individuals who had recovered from pulmonary TB.

Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study

OBJECTIVES

To evaluate the electromyographic activities of vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles in open and closed kinetic chain exercises in subjects with patellofemoral pain syndrome (PFPS).

DESIGN

Case-controlled study.

SETTING

Rehabilitation science center in a tertiary medical center.

PARTICIPANTS

Ten patients with bilateral knee pain diagnosed with PFPS and 10 healthy volunteers.

INTERVENTIONS

Subjects performed open kinetic chain exercise on an isokinetic dynamometer and closed kinetic chain exercise by squat-to-stand and stand-to-squat tasks. Surface electromyography was done for the VMO and VL muscles.

MAIN OUTCOME MEASURES

VMO/VL ratios were calculated after normalization of muscle activities.

RESULTS

The VMO/VL ratios of PFPS subjects were significantly lower than were those of unimpaired subjects during knee isokinetic closed kinetic chain exercises (p = .047). However, there was no statistical difference in VMO/VL ratio between subjects with and without PFPS during closed kinetic chain exercises (p = .623). Maximum VMO/VL ratio was obtained at 60 degrees knee flexion in closed kinetic chain exercise.

CONCLUSION

In closed kinetic chain exercises, more selective VMO activation can be obtained at 60 degrees knee flexion. Maximal VMO/VL ratio was observed at this knee flexion angle, and muscle contraction intensity was also greatest.

Lipoma arborescens of the knee: a case report

Lipoma arborescens is a rare intraarticular lesion of unknown etiology. We describe the radiographic, computerized tomographic, and magnetic resonance (MR) imaging characteristics of lipoma arborescens in a 17-year-old boy presenting with chronic painful swollen knee. Histologic examination after surgical synovectomy confirmed the diagnosis of lipoma arborescens. The fatty nature and frond-like appearance of this lesion can be demonstrated on imaging studies, especially MR imaging. Open synovectomy is curative in most cases. Although lipoma arborescens is rare, it is important to recognize and differentiate it from other synovial lesions by MR imaging.

Chemical constituents from Drypetes littoralis

Chemical investigation of Drypetes littoralis yielded three new tricyclic diterpenes, drypetenones A, B, and C (1--3), and one new xanthone (4). Spectral analyses and chemical correlations established the structures as 10S-12-hydroxy-11-methoxy-13-methylpodocarpa-1,5,8,11,13-pentaene-3,7-dione, (1), 10S-12-hydroxy-11-methoxy-13-methylpodocarpa-5,8,11,13-tetraene-3,7-dione (2), 10S-12-hydroxy-6,11-dimethoxy-13-methylpodocarpa-1,5,8,11,13-pentaene-3,7-dione (3), and 1-hydroxy-7-hydroxymethyl-6-methoxyxanthone (4). Complete (13)C NMR assignment of boehmenan D (5) is also made.

Functional evolution of the Myb oncogene family

Three Myb-related genes (A-Myb, B-Myb, and c- Myb) have been found in all vertebrates examined thus far including mammals, birds, and amphibians. Two invertebrates, the sea urchin and the fruit fly, have only one Myb-related gene. Our laboratory has used Drosophila as a model system to explore the function of its sole Myb gene. We have also reintroduced the three different vertebrate Myb genes into Drosophila in order to begin to understand how their different functions may have arisen following gene duplication during evolution.

Modules in the photoreceptor RGS9-1.Gbeta 5L GTPase-accelerating protein complex control effector coupling, GTPase acceleration, protein folding, and stability

RGS (regulators of G protein signaling) proteins regulate G protein signaling by accelerating GTP hydrolysis, but little is known about regulation of GTPase-accelerating protein (GAP) activities or roles of domains and subunits outside the catalytic cores. RGS9-1 is the GAP required for rapid recovery of light responses in vertebrate photoreceptors and the only mammalian RGS protein with a defined physiological function. It belongs to an RGS subfamily whose members have multiple domains, including G(gamma)-like domains that bind G(beta)(5) proteins. Members of this subfamily play important roles in neuronal signaling. Within the GAP complex organized around the RGS domain of RGS9-1, we have identified a functional role for the G(gamma)-like-G(beta)(5L) complex in regulation of GAP activity by an effector subunit, cGMP phosphodiesterase gamma and in protein folding and stability of RGS9-1. The C-terminal domain of RGS9-1 also plays a major role in conferring effector stimulation. The sequence of the RGS domain determines whether the sign of the effector effect will be positive or negative. These roles were observed in vitro using full-length proteins or fragments for RGS9-1, RGS7, G(beta)(5S), and G(beta)(5L). The dependence of RGS9-1 on G(beta)(5) co-expression for folding, stability, and function has been confirmed in vivo using transgenic Xenopus laevis. These results reveal how multiple domains and regulatory polypeptides work together to fine tune G(talpha) inactivation.

Determination of bisbenzylisoquinoline alkaloids by high-performance liquid chromatography (II)

After the earlier analysis of nine bisbenzylisoquinoline alkaloids with ion pair chromatography, seven other bisbenzylisoquinoline alkaloids were analyzed using gradient elution with an acetonitrile-phosphate buffer (pH 8.0) mixture, and UV detection. Four alkaloids were detected in the stem woods of a Lauraceous plant, Dehaasia triandra Merr. and their contents determined. LC-MS suggested that a major unknown compound in the plant was also a bisbenzylisoquinoline alkaloid.

Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients

OBJECTIVE

The objective of this study is to describe the CT and MR imaging findings of gouty tophi in the wrist and present this entity as a cause of carpal tunnel syndrome.

MATERIALS AND METHODS

Retrospective review of the CT (n = 18) and MR imaging (n = 20) studies of the wrist in patients with a documented diagnosis of gout who presented with gout-related carpal tunnel syndrome was performed; images of 24 wrists were collected over a 5-year period. Patient population included 20 men, who ranged in age from 35 to 76 years. All images were reviewed by two musculoskeletal radiologists who reached a consensus opinion. Surgical correlation was available in 12 patients.

RESULTS

Tophi were found in the floor of the carpal tunnel (n = 18), carpal bones (n = 17), radiocarpal joint (n = 17), and extensor tendons or tendon sheaths (n = 16) of the wrist. All tophi showed similar signal characteristics (from low to intermediate signal intensity on T1-weighted images with heterogeneous signal intensity on T2-weighted images) with the exception of tophi in the floor of the carpal tunnel (low signal intensity on T2-weighted images). Varying degrees of calcification were noted on CT and MR imaging studies. Gadolinium-enhanced MR studies showed heterogeneous enhancement.

CONCLUSION

Gouty tophi should be entertained as a cause of carpal tunnel syndrome in the appropriate patient population. Familiarity with this entity and its imaging characteristics may prove helpful in diagnosis and preoperative planning.

Association analysis of the GABA(A) receptor subunit genes cluster on 5q33-34 and alcohol dependence in a Japanese population

Recent investigations suggest that genetic susceptibility to alcohol dependence may be conferred by GABA(A) receptor subunit genes. In this study, three RFLPs at the GABA(A)beta2, GABAAalpha6, GABA(A)alpha1 and two at the GABA(A)gamma2 receptor subunit genes, were examined for association with alcohol dependence in 189 subjects meeting DSM-III-R criteria for this disorder and 152 unrelated controls from a Japanese population. The results demonstrated no association between the AlwNI RFLP at the GABA(A)alpha6 receptor subunit gene and alcohol dependence (P = 0.059). However, the NciI RFLP at the GABA(A)gamma2 receptor subunit gene was associated with alcohol dependence comorbid with antisocial personality disorder (P = 0.021). This supports a recent finding reporting an association between the GABA(A)gamma2 receptor subunit gene and alcohol dependence with criminal record in a Finnish population. Taking into account the effects of multiple comparisons, this result should be interpreted with caution pending replication.

Examination of trisomy 13, 18 and 21 foetal tissues at different gestational ages using FISH

In man high levels of aneuploidy are seen in spontaneous abortions. Very few autosomal trisomies survive to birth, the three most common being those for chromosome 13, 18 and 21 giving rise to the syndromes named Patau, Edwards and Down respectively. Since the majority of these spontaneously abort, what makes the survivors different from the aborters? Could it be that they have tissue specific mosaicism with the additional normal cell line supporting survival? In this study fluorescence in situ hybridisation was used as a convenient way to detect trisomy in interphase cells. To study the level of mosaicism across gestation, different tissues from 21 trisomic foetuses were analysed using probes for chromosome 13, 18, 21, X and Y. Two trisomy 18 foetuses exhibited mosaicism. Two others, one trisomy 13 and one trisomy 18 had mosaic placentas. There was no clear association between the limited mosaicism seen and severity of the phenotype. We conclude that at least for this sample set, tissue-specific mosaicism was not likely to be responsible for potential survival to birth.

Small hepatocellular carcinoma: safety and efficacy of single high-dose percutaneous acetic acid injection for treatment

PURPOSE

To evaluate the safety and efficacy of single high-dose percutaneous acetic acid injection (PAI) for treatment of small (<3-cm-diameter) hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Eighteen patients with HCC (22 nodules; diameter range, 1.5-3.0 cm) underwent single PAI. With ultrasonographic or computed tomographic (CT) guidance, 4-11 mL of 50% acetic acid was slowly injected into the center of the nodule through a skinny multiple-side-hole needle. Follow-up was performed with helical contrast material-enhanced CT. Complications of high-dose PAI were recorded.

RESULTS

Seventeen nodules showed no local recurrence (follow-up, 6-29 months) after single PAI. At a mean follow-up of 15.6 months, mean tumor diameter was 2.1 cm and mean injected volume was 6.4 mL. Four nodules showed residual tumor (mean tumor diameter, 2.6 cm; mean injected volume, 5.8 mL). The mean ratio of injected to estimated volume of acetic acid was 1.21 in cases of successful single PAI and 0.72 in cases of local recurrence (P < .001). One patient with preexistent right portal venous thrombosis died of hepatic failure 37 days after PAI. Other complications included severe pain (11%), high fever (4%), and segmental wedge infarction (4%).

CONCLUSION

Single high-dose PAI is safe and effective for treatment of small HCC.

Co-expression of Gbeta5 enhances the function of two Ggamma subunit-like domain-containing regulators of G protein signaling proteins

Regulators of G protein signaling (RGS) stimulate the GTPase activity of G protein Galpha subunits and probably play additional roles. Some RGS proteins contain a Ggamma subunit-like (GGL) domain, which mediates a specific interaction with Gbeta5. The role of such interactions in RGS function is unclear. RGS proteins can accelerate the kinetics of coupling of G protein-coupled receptors to G-protein-gated inwardly rectifying K(+) (GIRK) channels. Therefore, we coupled m2-muscarinic acetylcholine receptors to GIRK channels in Xenopus oocytes to evaluate the effect of Gbeta5 on RGS function. Co-expression of either RGS7 or RGS9 modestly accelerated GIRK channel kinetics. When Gbeta5 was co-expressed with either RGS7 or RGS9, the acceleration of GIRK channel kinetics was strongly increased over that produced by RGS7 or RGS9 alone. RGS function was not enhanced by co-expression of Gbeta1, and co-expression of Gbeta5 alone had no effect on GIRK channel kinetics. Gbeta5 did not modulate the function either of RGS4, an RGS protein that lacks a GGL domain, or of a functional RGS7 construct in which the GGL domain was omitted. Enhancement of RGS7 function by Gbeta5 was not a consequence of an increase in the amount of plasma membrane or cytosolic RGS7 protein.

Slowed recovery of rod photoresponse in mice lacking the GTPase accelerating protein RGS9-1

Timely deactivation of the alpha-subunit of the rod G-protein transducin (Galphat) is essential for the temporal resolution of rod vision. Regulators of G-protein signalling (RGS) proteins accelerate hydrolysis of GTP by the alpha-subunits of heterotrimeric G proteins in vitro. Several retinal RGS proteins can act in vitro as GTPase accelerating proteins (GAP) for Galphat. Recent reconstitution experiments indicate that one of these, RGS9-1, may account for much of the Galphat GAP activity in rod outer segments (ROS). Here we report that ROS membranes from mice lacking RGS9-1 hydrolyse GTP more slowly than ROS membranes from control mice. The Gbeta5-L protein that forms a complex with RGS9-1 was absent from RGS9-/- retinas, although Gbeta5-L messenger RNA was still present. The flash responses of RGS9-/- rods rose normally, but recovered much more slowly than normal. We conclude that RGS9-1, probably in a complex with Gbeta5-L, is essential for acceleration of hydrolysis of GTP by Galphat and for normal recovery of the photoresponse.

Fatal hyperkalemia during rapid and massive blood transfusion in a child undergoing hip surgery--a case report

We report a girl who developed severe and fatal hyperkalemia following rapid and massive blood transfusion during surgery. She was 7-year-old, 20-kg in weight, and received wide resection of the femoral bone with custom prosthesis implant because of malignant femoral osteosarcoma. During the procedure, bleeding was active and profuse and amounted to about 3,000 mL in 4 h, eventuating in shock. Despite rapid transfusion with 15 units of packed red blood cells (RBC) still she remained hypotensive and hypovolemic. When we switched to give her whole blood, actually 100 mL having been given, widening of QRS complex followed immediately by cardiac arrest developed. Cardiopulmonary resuscitation although started at once was unsuccessful. At this juncture, arterial blood gas analysis showed acidosis and severe hyperkalemia (10.3 mmol/L), possibly resulting from transfusion of blood of older storage. The case reminded us once again the importance and necessity of the use of potassium-low blood component (fresh, saline-washed RBCs) in case of massive and rapid blood transfusion especially in pediatric patients with hypovolemia and low cardiac output.

Imaging diagnosis of insufficiency fracture of the sacrum

BACKGROUND

Insufficiency fracture of the sacrum has been recognized as a major cause of lower back pain, especially in elderly osteoporotic patients with or without underlying malignancy and/or prior pelvic radiotherapy. Its diagnosis cannot be readily made from its nonspecific clinical features. Consequently some cases may be mistaken for bone metastases, causing patients to receive inappropriate diagnostic measures and management. Recognition of the spectrum of imaging features is the basis of correct diagnosis and treatment.

METHODS

The imaging studies of 14 cases (12 women and 2 men; age range, 60-84 years; mean age, 70 years) of sacral insufficiency fracture were reviewed retrospectively. These included 14 radiographs, six bone scintigraphs, eight computerized tomography (CT) scans and 12 magnetic resonance (MR) imaging studies. Six patients had a history of malignancy. Diagnosis was made by characteristic imaging findings, and clinical and radiographic follow-up for one to 3.5 years.

RESULTS

Five cases of sacral insufficiency fracture were suspected based on radiographic findings of fracture lines (2 cases) and focal sclerosis (3 cases). Seven cases were diagnosed by CT findings of linear fractures (7 cases) and focal sclerosis (2 cases). Nine MR examinations demonstrated characteristic vertical bands of marrow edema. A hypointense fracture line was identified in eight cases. The remaining two MR imaging studies disclosed nonspecific focal marrow edema. An early case, which appeared normal on CT scan, showed marrow edema on MR imaging. The positive and diagnostic rates were both 36% for plain radiographs, 88% for CT scans, and 100% and 83%, respectively, for MR images.

CONCLUSIONS

Plain radiographs are often unrewarding. Although MR imaging is the most sensitive tool, fracture lines are best demonstrated and diagnosed using CT. Due to the better diagnostic rate, popularity and cost effectiveness, CT is recommended as the definitive modality for confirming diagnosis of insufficiency fracture of the sacrum.

Regulators of G-protein signalling: a novel protein family involved in timely deactivation and desensitization of signalling via heterotrimeric G proteins

In a variety of signalling pathways heterotrimeric guanine-nucleotide-binding proteins (G proteins) trigger physiological responses elicited by hormones, neurotransmitters and sensory stimuli. Receptor-induced GDP/GTP exchange activates G proteins by dissociating G-protein alpha-subunits from the betagamma-dimers. Both alpha-subunits and betagamma-dimers are involved in effector regulation. The deactivation of these active forms is controlled by the hydrolysis of GTP bound to alpha-subunits, allowing the inactive heterotrimer to reform. Termination of G-protein-mediated signalling in vivo is 10- to 100-fold faster than the in vitro rate of GTP hydrolysis by alpha-subunits, suggesting that in analogy to the GTPases of the Ras-superfamily, GTPase-activating proteins (GAPs) are required to achieve timely deactivation. Recently, members of a novel protein superfamily, known as "regulators of G-protein signalling" (RGS), were identified as potent GAPs for at least one subset of heterotrimeric G-protein alpha-subunits. In this review, we intend to discuss the proposed mechanism by which RGS proteins exert GAP activity for G-protein alpha-subunits as well as their specificities. The role of RGS proteins in desensitization and temporal resolution in certain signalling pathways will also be addressed.

Amino-terminal cysteine residues of RGS16 are required for palmitoylation and modulation of Gi- and Gq-mediated signaling

RGS proteins (Regulators of G protein Signaling) are a recently discovered family of proteins that accelerate the GTPase activity of heterotrimeric G protein alpha subunits of the i, q, and 12 classes. The proteins share a homologous core domain but have divergent amino-terminal sequences that are the site of palmitoylation for RGS-GAIP and RGS4. We investigated the function of palmitoylation for RGS16, which shares conserved amino-terminal cysteines with RGS4 and RGS5. Mutation of cysteine residues at residues 2 and 12 blocked the incorporation of [3H]palmitate into RGS16 in metabolic labeling studies of transfected cells or into purified RGS proteins in a cell-free palmitoylation assay. The purified RGS16 proteins with the cysteine mutations were still able to act as GTPase-activating protein for Gialpha. Inhibition or a decrease in palmitoylation did not significantly change the amount of protein that was membrane-associated. However, palmitoylation-defective RGS16 mutants demonstrated impaired ability to inhibit both Gi- and Gq-linked signaling pathways when expressed in HEK293T cells. These findings suggest that the amino-terminal region of RGS16 may affect the affinity of these proteins for Galpha subunits in vivo or that palmitoylation localizes the RGS protein in close proximity to Galpha subunits on cellular membranes.

Characteristics of hospitalized heroin smokers and heroin injectors in Taiwan

BACKGROUND

Heroin usage in Taiwan has been under-investigated. Use of the same drug by different routes provides an opportunity for examination of drug behavior and complications related to the drug itself and to the different routes of administration.

METHODS

A sample of 245 hospitalized heroin users received semi-structured interviews, drug screen urine tests, serological screens for hepatitis B infection, and liver function tests. The sample was divided into a smokers group and an injectors group for comparison.

RESULTS

The heroin injectors had lower educational status, spent less money on day-to-day heroin usage, but had longer drug-using careers than the heroin smokers. There was a trend for injectors to have a higher rate of abnormal liver function than the smokers although there was no significant difference in the prevalence of hepatitis B infection.

CONCLUSION

Major differences exist between heroin smokers and heroin injectors. Therefore harm reduction intervention for heroin users should take account of the different routes of administration. A comprehensive survey of risk factors relating to hepatic dysfunction in heroin addicts in Taiwan is indicated.

Negative regulation of atonal in proneural cluster formation of Drosophila R8 photoreceptors

atonal (ato) encodes a basic helix-loop-helix protein and is required for the specification of R8 photoreceptor cells in Drosophila. In the eye imaginal discs, expression of Ato protein is initially in a dorsoventral stripe of cells anterior to the morphogenetic furrow (MF). In the MF, this stripe expression is resolved into regularly spaced clusters of Ato-positive cells, the proneural clusters, which are intervened with Ato-negative cells. Another basic helix-loop-helix protein, Daughterless (Da), dimerizes with Ato and is expressed at an enhanced level in Ato-expressing cells. Here we show that during the late stages of proneural clusters, the mitogen-activated protein kinase (MAPK) is activated in proneural clusters. Normal ato or da activity is required for maintenance of MAPK activation. Furthermore, in ato or da mutants, Ato expression is expanded to all cells in the MF, suggesting that ato and da are required for Ato repression in cells between proneural clusters. By changing the MAPK activity in proneural clusters, we show that MAPK activation mediates Ato repression nonautonomously. Consistently, hyperactivation of the MAPK in a stripe of cells posterior to or overlapping the Ato stripe eliminates the formation of proneural clusters. Taken together, these results suggest that a negative regulatory loop involving MAPK activation and Ato repression is required for the generation of evenly spaced proneural clusters.

Abnormal photoresponses and light-induced apoptosis in rods lacking rhodopsin kinase

Phosphorylation is thought to be an essential first step in the prompt deactivation of photoexcited rhodopsin. In vitro, the phosphorylation can be catalyzed either by rhodopsin kinase (RK) or by protein kinase C (PKC). To investigate the specific role of RK, we inactivated both alleles of the RK gene in mice. This eliminated the light-dependent phosphorylation of rhodopsin and caused the single-photon response to become larger and longer lasting than normal. These results demonstrate that RK is required for normal rhodopsin deactivation. When the photon responses of RK-/- rods did finally turn off, they did so abruptly and stochastically, revealing a first-order backup mechanism for rhodopsin deactivation. The rod outer segments of RK-/- mice raised in 12-hr cyclic illumination were 50% shorter than those of normal (RK+/+) rods or rods from RK-/- mice raised in constant darkness. One day of constant light caused the rods in the RK-/- mouse retina to undergo apoptotic degeneration. Mice lacking RK provide a valuable model for the study of Oguchi disease, a human RK deficiency that causes congenital stationary night blindness.

Effect of acetate on molecular and physiological aspects of Clostridium beijerinckii NCIMB 8052 solvent production and strain degeneration

The addition of sodium acetate to chemically defined MP2 medium was found to increase and stabilize solvent production and also increase glucose utilization by Clostridium beijerinckii NCIMB 8052. RNA and enzyme analyses indicated that coenzyme A (CoA) transferase was highly expressed and has higher activity in C. beijerinckii NCIMB 8052 grown in MP2 medium containing added sodium acetate than in the microorganism grown without sodium acetate. RNA analysis suggested the existence of a sol operon and confirmed the presence of a ptb-buk operon in C. beijerinckii NCIMB 8052. In addition to CoA transferase, C. beijerinckii NCIMB 8052 grown in MP2 medium containing added acetate demonstrated higher acetate kinase- and butyrate kinase-specific activity than when the culture was grown in MP2 medium containing no added acetate. Southern blot analysis with chromosomal DNA isolated from solventogenic and degenerated C. beijerinckii NCIMB 8052 indicated that C. beijerinckii NCIMB 8052 strain degeneration does not involve loss of the CoA transferase genes. The addition of acetate to MP2 medium may induce the expression of the sol operon, which ensures solvent production and prevents strain degeneration in C. beijerinckii NCIMB 8052.

Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients

OBJECTIVE

To define the imaging characteristics of intra-articular tophi of the knee.

DESIGN AND PATIENTS

Twelve patients with intra-articular tophi in the knee were studied with routine MR imaging, gadolinium (Gd)-enhanced MR imaging, and CT over a 4-year period. There were 11 men and one woman, 25-82 years of age (mean age 48 years). Four patients did not have a documented history of gout at the time of the MR examination. The diagnosis of intra-articular tophi was provided by arthroscopy and histological examination (5 patients), by microscopic study of joint fluid (5 patients), or by characteristic clinical, laboratory and imaging findings (2 patients).

RESULTS

In 15 MR examinations the tophi were located purely intra-articularly in 10 knees. In the remaining five MR studies, periarticular soft tissues or bone, or both, were involved. All the intra-articular tophi manifested low to intermediate signal intensity on both T1- and T2-weighted images. All five Gd-enhanced MR examinations demonstrated a heterogeneous peripheral enhancement. All 10 CT scans showed varying degrees of stippled calcifications within the tophi. The nature of the calcifications was confirmed on histological examination in three patients.

CONCLUSION

Presenting clinical manifestations of gout may relate to intra-articular tophaceous deposits. Such deposits present as masses on MR images with low to intermediate signal intensity on both T1- and T2-weighted images and a characteristic enhancement pattern following intravenous Gd administration. These features relate primarily to internal calcifications, which are most evident on CT images. MR evaluation (including Gd administration) supplemented, in some cases, with CT scanning allows accurate diagnosis of intra-articular tophaceous deposits.