Autoantibodies against the amino terminal of alpha-enolase are a useful diagnostic marker of Hashimoto's encephalopathy

We investigated autoantibodies and their epitope(s) in Hashimoto's encephalopathy associated with Hashimoto's thyroiditis. In a proteomic analysis, they proved to recognize alpha-enolase. We further searched the epitope region in alpha-enolase using different regions of recombinant proteins expressed in cultured human cells. The amino terminal region was recognized by autobodies from a much higher proportion of patients with Hashimoto's encephalopathy (83.3%; 5/6) than from patients with Hashimoto's thyroiditis (11.8%; 2/17), and not at all by sera from controls (25 healthy individuals and 25 controls with other neurological disorders) (0%; 0/50). Neither the carboxyl terminal nor the mid-region of alpha-enolase showed specificity for Hashimoto's encephalopathy. Autoantibodies against the amino terminal of alpha-enolase are a useful diagnostic marker for Hashimoto's encephalopathy.

Molecular epidemiology of Neisseria gonorrhoeae exhibiting decreased susceptibility and resistance to ciprofloxacin in Hawaii, 1991-1999

BACKGROUND

Clinically significant resistance to Centers for Disease Control and Prevention (CDC)-recommended doses of fluoroquinolones (ciprofloxacin and ofloxacin) has been reported for Neisseria gonorrhoeae. In Hawaii, fluoroquinolone-resistant gonococcal isolates were first identified in 1991.

GOAL

To assess the diversity, based on phenotypic and genotypic characterization, of gonococcal isolates exhibiting decreased susceptibility (CipI; MICs = 0.125-0.5 microg/ml) or clinically significant resistance (CipR; MICs > or = 1 microg/ml) to ciprofloxacin in Hawaii from 1991 through 1999.

STUDY DESIGN

Antimicrobial susceptibilities, auxotype/serovar (A/S) class, GyrA/ParC alteration patterns, and plasmid profiles were determined for gonococci isolated in Honolulu from 1991 through 1999 that exhibited intermediate or clinically significant resistance to ciprofloxacin. Strain phenotypes were defined by A/S class, GyrA/ParC alteration pattern, and penicillin-tetracycline resistance phenotype supplemented with plasmid profiles for beta-lactamase-producing isolates.

RESULTS

Altogether, 68 isolates exhibiting intermediate or clinically significant resistance to ciprofloxacin belonged to 23 and 19 strain phenotypes, respectively. Among the CipI and CipR isolates, 4 and 13 GyrA/ParC alterations patterns were identified, respectively. The 91,95/Asp-86 alteration pattern occurred most frequently among CipR isolates. Forty-four strain phenotypes were represented by only one isolate. In addition, seven pairs and two clusters of isolates were identified.

CONCLUSIONS

From 1991 through 1997, few gonococcal strains exhibiting intermediate or clinically significant resistance to CDC-recommended doses of fluoroquinolones were identified from Hawaii. Isolates belonged to a large number of phenotypic and genotypic types, suggesting that most cases were imported, with only a few instances in which isolate pairs indicated that secondary transmission of infections had occurred in Hawaii. Beginning in 1998, the number of CipR isolates increased markedly, and more isolates belonged to fewer phenotypic and genotypic types, suggesting either more frequent importation of fewer strain types or the possibility that the endemic spread of a few strains is beginning to occur.

Evidence for widespread infection of wild rats with hepatitis E virus in the United States

Hepatitis E is an important medical pathogen in many developing countries but is rarely reported from the United States, although antibody to hepatitis E virus (anti-HEV) is found in > 1% of U.S. citizens. Zoonotic spread of the virus is suspected. Sera obtained from 239 wild rats trapped in widely separated regions of the United States were tested for anti-HEV. Seventy-seven percent of rats from Maryland, 90% from Hawaii, and 44% from Louisiana were seropositive for anti-HEV. Rats from urban as well as rural areas were seropositive and the prevalence of anti-HEV IgG increased in parallel with the estimated age of the rats, leading to speculation that they might be involved in the puzzling high prevalence of anti-HEV among some U.S. city dwellers. The discovery of a in rats in the United States and the recently reported discovery that HEV is endemic in U.S. swine raise many questions about transmission, reservoirs, and strains of HEV in developed countries.

Multiple Photorefractive Keratectomy Retreatments for Myopia

PURPOSE

To examine the outcome of multiple photorefractive keratectomy retreatments by the excimer laser on eyes treated for myopia and myopic astigmatism.

METHODS

We present 980 of 1218 (80%) consecutive eyes treated with a VISX 20/20 excimer laser that were available for follow-up. Thirteen eyes of 13 individuals were retreated twice using the same VISX excimer laser because of refractive regression. Epithelium was mechanically removed in the initial treatment and subsequent retreatment of all the eyes. No increased difficulty was noted upon removing the epithelium on subsequent retreatments. The aim in both the initial and subsequent treatments was to correct 100% of the refractive error.

RESULTS

Eyes with higher amounts of myopia and astigmatism were more likely to require multiple retreatments. Seven eyes (54%) attained a spectacle-corrected visual acuity of 20/20 or better. Twelve eyes (92%) attained a spectacle-corrected visual acuity of 20/40 or greater following the second retreatment. The amount of astigmatism corrected was improved in 10 of the 13 eyes with an average improvement of 1.90 D of cylinder. Only one patient experienced a haze score of 3 or more following retreatment.

CONCLUSION

There is a subgroup of patients who require multiple PRK retreatments for myopic regression. A good visual outcome may be obtained with minimal haze.

Predictability of excimer laser treatment of myopia and astigmatism by the VISX Twenty-Twenty. Melbourne Excimer Laser Group

BACKGROUND

To determine the predictability of excimer laser photorefractive keratectomy (PRK) to correct myopia, astigmatism, or both between -1.00 and -19.00 diopters (D).

SETTING

Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.

METHODS

This study comprised 1218 consecutive eyes treated with a VISX Twenty-Twenty excimer laser and followed prospectively for 12 months. Low myopia was treated with one ablation zone (6.0 mm), high myopia with two ablation zones (5.0 and 6.0 mm), and extreme myopia with three ablation zones (4.5, 5.0, and 6.0 mm). Maximum spherical treatment was 15.00 D at the corneal plane. Data were analyzed to determine the predictability of the postoperative outcomes by preoperative refraction.

RESULTS

Nine hundred eighty eyes (80.5%) were available for the 12 month follow-up. The predictability of refraction and uncorrected and best corrected visual acuities progressively decreased with increasing myopia, although a comparable percentage of spherical correction was achieved at each diopter of myopia. The likelihood of losing lines of best corrected visual acuity and corneal haze increased with increasing myopia.

CONCLUSION

These data can be used to counsel patients of likely outcomes of excimer laser PRK to correct myopia.

A new type of hereditary motor and sensory neuropathy linked to chromosome 3

We report the clinical, pathological, and genetic findings of 23 patients in 8 families with hereditary motor and sensory neuropathy (proximal dominant form) (HMSN-P) in Okinawa, Japan. The clinical features were unique with respect to autosomal dominant inheritance, Kennedy-Alter-Sung syndrome-like proximal dominant neurogenic atrophy, obvious sensory involvement, painful muscle cramp, fasciculations, areflexia, and high incidences of elevated creatine kinase levels, hyperlipidemia, and diabetes mellitus. Electrophysiological and pathological studies revealed typical motor and sensory axonal neuropathy, and decreased numbers of anterior born and dorsal ganglion cells, which suggested the presence of neuronopathy in HMSN-P. Genetic linkage studies showed a lod score of 4.04 (two-point analysis) in DNA marker D3S1284. Haplotype analysis showed that the gene locus of the disease was mapped to 3p14.1-q13 bracketed by D3S1285 and D3S1281. In this region, the patients' chromosomes showed an obvious increase in the allele frequency of five markers. One allele in D3S1591 was identical in all patients but had a low frequency in the control population. This finding suggested the presence of linkage disequilibrium and a common origin of this allele in all patients with HMSN-P. The HMSN-P described here is a new clinical entity characterized by unique clinical manifestations and a new gene locus.

Diversity of isolates of penicillinase-producing Neisseria gonorrhoeae (PPNG) in Honolulu, Hawaii: 1982-1991

BACKGROUND AND OBJECTIVES

Gonococcal infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates have increased in geographic distribution and prevalence. It was postulated that PPNG strains would become endemic in Honolulu and that, in turn, this city would serve as a reservoir for the introduction of PPNG strains into the continental United States.

GOAL OF THIS STUDY

To assess the role of Honolulu as a reservoir for PPNG strains by assessing the diversity and persistence of PPNG strains between 1982 and 1991.

STUDY DESIGN

A total of 432 PPNG strains were characterized by auxotype/serovar (A/S) class and plasmid content, and their distribution during the 10-year period was studied.

RESULTS

Of 432 isolates, 373 (86.4%) possessed a 4.4-Mdal beta-lactamase plasmid; 39 (9.0%) possessed a 3.2-Mdal beta-lactamase plasmid; and 20 (4.6%) possessed a 3.05-Mdal beta-lactamase plasmid. A total of 53 A/S classes were identified. Asian, African, and Toronto PPNG strains belonged to 49 (92.5%), 15 (28.3%), and 11 (20.7%) A/S classes, respectively. Though all Toronto PPNG strains possessed a 24.5-Mdal conjugative plasmid, these plasmids could not be transferred by conjugation. Although some apparent microepidemics of PPNG strains were identified, most strains were isolated sporadically.

CONCLUSIONS

A large number of different strains have been associated with PPNG infections in Honolulu, but there was no evidence that any strain persisted endemically during the study period. These observations have important implications for the design and assessment of community gonorrhea control strategies.

Emerging in vitro resistance to quinolones in penicillinase-producing Neisseria gonorrhoeae strains in Hawaii

The susceptibilities of 37 penicillinase-producing strains of Neisseria gonorrhoeae (PPNG), isolated in Hawaii from December 1991 through January 1994, were determined to ciprofloxacin and ofloxacin, fluoroquinolone agents currently recommended by the Centers for Disease Control and Prevention as alternative regimens for the treatment of uncomplicated gonorrhea. Nine isolates (24.3%) exhibited decreased susceptibilities (MICs, > or = 0.06 microgram/ml) to ciprofloxacin and ofloxacin. Ciprofloxacin MICs for three isolates (8.1%) were 2.0 micrograms/ml; these isolates belonged to the auxotype/serovar class Pro/IB-7 and possessed the 3.2-MDa beta-lactamase and the 24.5-MDa conjugative plasmids. Six strains for which ciprofloxacin MICs were 0.06 to 0.125 microgram/ml belonged to a variety of gonococcal phenotypes. Strains for which ciprofloxacin MICs were 2.0 micrograms/ml were isolated from persons who had traveled to, or were sexual contacts of persons who had recently traveled to, Southeast Asia. Persons infected with these isolates had been treated with ceftriaxone (250 mg intramuscularly, single dose); therefore, none of these cases were associated with clinical failure following the use of fluoroquinolone therapy. Further studies are needed to confirm the clinical and public health significance of increased in vitro resistance to ciprofloxacin and ofloxacin in N. gonorrhoeae.

Age of menopause in Japanese women: trends and recent changes

The age of menopause was investigated in a survey conducted in 1987 in 13,996 Japanese women aged 22-86 years, the findings being as follows: (1) The percentage of post-menopausal women showed a sharp linear increase between the ages of 49 and 53 years, the figure being 42.7% at age 50. The rate of increase was slightly lower after 50 years of age. (2) Among the 6477 post-menopausal women, the age at which the peak number had undergone menopause was 50 years (17.7%), followed by 49, 52 and 48 years. The crude mean age of menopause was 49.33 years in post-menopausal subjects aged over 40. The mean age of menopause in urban and rural women was not significantly different. (3) The crude mean age of menopause, calculated by classifying those aged 50 (born in or before 1937) into groups corresponding to 5-year age intervals, was highest in the 1928-32 birth-year group, followed, in descending order, by the 1923-27, 1918-22, 1917 or earlier and 1933-37 groups in all post-menopausal and in urban subjects, while in rural subjects it was highest in the 1918-22 group. However, overall, the adjusted mean age of menopause was highest (50.2 +/- 3.24 years) in the 1928-32 birth-year group, followed by the 1923-27 and 1933-37 groups.

[Effects of catecholestrogen and catecholestrogen 2-monomethyl ether on serum lipids and lipoproteins in rats]

To clarify the mechanism of action of catecholestrogen and catecholestrogen 2-monomethylether on lipid metabolism, the effects of 2-OHE1, 2-MeoE1, 2-MeoE3 and E2-17 beta on serum total cholesterol, HDL-cholesterol, triglyceride levels, beta/alpha lipoprotein ratio, body weights and uterine weights were investigated in five serial experimental systems using normochoesterolemic and dietary hypercholesterolemic female rats those were previously oophorectomized. The results obtained were as follows: 1) In a short term hormone administration experiment using normocholesterolemic rats, 2-OHE1, 2-MeoE1, and 2-MeoE3 showed a serum triglyceride reducing effect as strong as that of E2-17 beta. 2) To integrate the results of the short term hormone administration experiment in normocholesterolemic rats and the results of short term and long term hormone administration experiments in dietary hypercholesterolemic rats, the serum cholesterol reducing activity was in the following sequences; 2-MeoE3 not equal to E2-17 beta greater than 2-MeoE1 greater than 2-OHE1. Hypocholesterolemic activity of 2-MeoE3 was almost equivalent or slightly stronger than that of E2-17 beta, and 2-MeoE1 showed approximately a half of that of E2-17 beta. 3) According to the results of the short term hormone administration experiment, and the long term hormone administration experiment in dietary hypercholesterolemic rats, the serum HDL-cholesterol increasing effect was in the following relation; E2-17 beta greater than 2-MeoE3 greater than 2-MeoE1. Dose dependency was not observed in the serum HDL-cholesterol increasing effect. 4) From the results of the short term hormone administration experiment, 2-MeoE3 had an equal or stronger activity than that of E2-17 beta in serum beta/alpha lipoprotein ratio decreasing effect. 5) In experiment 4 which 2-MeoE3 and E2-17 beta were administered singly or combined with Tamoxifen to the dietary hypercholesterolemic rats, the hypocholesterolemic effect of neither hormone was inhibited by Tamoxifen. On the other hand, the uterotrophic activity of E2-17 beta was slightly, but not significantly inhibited by Tamoxifen. 6) Although E2-17 beta, 2-MeoE1 exhibited a remarkable uterotrophic activity and a slight reducing effect on body weight, neither 2-OHE1 nor 2-MeoE3 had an effect on uterine weight or body weight. Given these results, it was strongly suggested that the effects of catecholestrogen and catecholestrogen 2-monomethyl ether on serum lipids were not mediated by the estrogen receptor system but by other mechanisms of action.

[Hypocholesterolemic effect of catechol estrogen 2-monomethyl ether]

The hypocholesterolemic effect of 2-methoxyestrone (2-MeOE1), 2-methoxyestriol (2-MeOE3) and estradiol-17 beta (E2-17 beta) was investigated in two experimental systems of normocholesterolemic and dietary hypercholesterolemic rats that had undergone oophorectomy. Each compound was subcutaneously administered for 6 consecutive days at a dose of 10 micrograms per day in the former systems and at 300 micrograms per day in the latter system, respectively. The hypocholesterolemic effect was in the following relation: 2-MeOE3 = E2 - 17 beta greater than 2-MeOE1. In the latter system, the serum total cholesterol level of individual rats in both 2-MeOE3- and E2-17 beta-administered groups returned to normal. No uterotrophic activity was exhibited by either 2-MeOE1 or 2-MeOE3, while E2-17 beta exhibited an anomalous activity. The effect of 2-MeOE1 and 2-MeOE3 on body weight was not exhibited, while E2-17 beta reduced it slightly. The results suggest that catechol estrogen 2-monomethyl ether plays an important role in lipid metabolism through estrogen receptor independent mechanisms and has a pharmacologically important effect on hyperlipidemia and atherosclerosis.

The specificity of viral and bacterial sialidases for alpha(2-3)- and alpha(2-6)-linked sialic acids in glycoproteins

The anomeric specificity of six sialidases (Vibrio cholerae, Arthrobacter ureafaciens, Clostridium perfringens, Newcastle disease virus, fowl plague virus and influenza A2 virus sialidases) was assessed with sialylated antifreeze glycoprotein, ovine submandibular gland glycoprotein and alpha 1-acid glycoprotein, resialylated specifically in alpha(2-3) or alpha(2-6) linkage with N-acetylneuraminic acid or N-glycolylneuraminic acid using highly purified sialyltransferases. The rate of release of sialic acid from these substrates was found to correlate well with the specificity observed earlier with the same sialidases using small oligosaccharide substrates, i.e., alpha(2-3) glycosidic linkages are hydrolyzed faster than alpha(2-6) linkages, with the exception of the enzyme from A. ureafaciens. Sialidase activity was higher with N-acetylneuraminic acid when compared with N-glycolylneuraminic acid. The studies also showed that the core oligosaccharide and protein structure in glycoproteins may influence the rate of release for different glycosidic linkages.

gamma-Aminobutyric acid system in isolated dorsal and ventral horn neurons from bovine spinal cord

In order to search for the relationship between the structure and the function of the nervous system, the spinal cord provides suitable material. We devised a procedure for isolation of large ventral and small dorsal horn neurons. Then we examined the gamma-aminobutyric acid (GABA) system in both neurons isolated using our procedure. Glutamic decarboxylase (GAD) activity in dorsal horn neurons was much higher than that in ventral horn neurons. Further, GABA uptake activity by the dorsal horn neurons was also somewhat higher than that by the ventral horn neurons, although some properties of GABA uptake were found to be almost the same in both neuronal fractions. However, we could not find any difference of GABA-alpha-ketoglutarate transaminase (GABA-T) activity between the dorsal and ventral horn neurons. These results suggest that GAD and GABA uptake may be indicators for cell specificity to some extent.

Vibrio alginolyticus infections in Hawaii

Clinical and bacteriological features of eight cases of Vibrio alginolyticus infections in Hawaii are presented. These isolates occurred in superficial sites, primarily related to infections caused by swimming.