Physician values in alopecia areata treatment decision-making: A qualitative assessment

Background

Alopecia areata (AA) is a disease of hair loss with multiple treatment options. Physicians play an important role in guiding patients during the decision-making process.

Objective

Assess physicians' values and attitudes when helping patients choose an AA treatment.

Methods

Semi-structured qualitative interviews were conducted with dermatologists of varying practice type and location. Each interview was coded independently twice using inductive thematic analysis. Interrater reliability and code frequencies were determined.

Results

Fourteen participants were interviewed. Interrater reliability was κ = 0.85 to 0.97. Dermatologists wanted patients to consider various treatment factors (ie, efficacy, safety, convenience of use, accessibility) and also assessed patients' AA clinical severity and personality traits. Participants often encountered various barriers to effective communication with patients, which may be mitigated by shared decision-making. Shared decision-making tools were perceived to potentially improve patient care and communication, although physicians expressed concern about lack of individualization, limitations of time, and the appropriateness of information.

Conclusion

AA treatment decision-making is a complex process that often utilizes the expertise of a dermatologist, during which shared decision-making tools may be of value to both patients and physicians.

[Enterostomy based on abdominal wall tension and fascial locking: a theory of preventing stoma complications and parahernia]

No consensus on standardized technique of enterostomy creation has been made meanwhile high heterogeneity of surgical procedure exists in 'stoma creation' chapters of textbooks or atlases of colorectal surgery. The present article reviews the anatomy of tendinous aponeurotic fibers which is crucial for abdominal wall tension and integrity. Through empirical practice we hypothesize a procedure of enterostomy creation basied on abdominal wall tension plus anchor suture for fascia fixation which could theoretically decrease short-term stoma complication rates and long-term parastomal hernia rates. Surgical techniques are as followed: (1) preoperative stoma site mark for de-functioning ileostomy should be positioned at the lateral border of rectus abdominis muscle (RAM) to decrease the difficulty of stoma reversal and for permanent colostomy should be placed overlying the RAM to promote adhesion; (2)Optimal circular removal or lineal opening of skin, and avoid dissection of subcutaneous tissue; (3) Lineal dissection of natural strong fascia (rectus sheath) at stoma site and blunt separation of muscular fibers. The tunnel of the fascia should be made with appropriate size without undue tension. To prevent the formation of dead space, additional suturing at fascia layer is unnecessary. (4) Anchor suture for fascia fixation at two ends of fascia opening could be considered to avoid delayed fascia disruption and parastomal hernia. (5) After pull-through of ileum or colon loop, 4-8 interrupted seromuscular sutures could be placed to attach loop to skin. For ileostomy, self-eversion of mucosa can be successful in vast majority of cases and a Brooke ileostomy is not necessary. The efficacy and safety of this procedure should be tested in future trials.

Factors influencing alopecia areata treatment decisions: A qualitative assessment

Background

Alopecia areata (AA) is a disease of hair loss in which patients may benefit from comprehensive understanding of AA's disease process and therapeutic options during treatment decision-making.

Objective

Determine factors influencing patients' AA treatment decision-making.

Methods

Qualitative interviews were conducted using semi-structured interview guides. Interviews were coded using inductive thematic analysis.

Results

Twenty-one participants with AA were interviewed. Coding interrater reliability was κ = 0.87-0.91, indicating strong-almost perfect agreement. Participants faced multiple barriers, including lack of access to health care (n = 10, 47.6%) and lack of transparency about their condition and treatment options (n = 9, 42.9%). Information about AA was sought from primarily the internet (n = 15, 71.4%) and physician recommendation (n = 15, 71.4%). When choosing AA treatments, patients often considered treatment efficacy (n = 21, 100%), safety (n = 21, 100%), and convenience of use (n = 20, 95.2%).

Limitations

Referral and regional biases may be present and limit generalizability.

Conclusions

Patients with AA face various challenges including medical uncertainty and lack of information. Patients need trustworthy and accessible sources of information regarding their treatment that also take into consideration their preferences and values.

Shared Decision-Making, Therapeutic Choice, and Decisional Regret in Patients With Alopecia Areata

Importance

Alopecia areata (AA) is an autoimmune disorder of hair loss with a complex and evolving treatment landscape, making it an ideal setting for shared decision-making (SDM) between patients and physicians. Given the varying efficacy, experience, and risks of treatments for AA, we sought to evaluate patient preferences for SDM and the association of SDM with decisional regret.

Objective

To evaluate patient preferences for SDM and the association of SDM with decisional regret.

Design, Setting, and Participants

A cross-sectional online survey using the validated SDMQ9 scale for shared decision-making and Decisional Regret Scale (DRS) was distributed using the National Alopecia Areata Foundation (NAAF) with the aim of assessing (1) patient preferences in SDM when making treatment decisions, (2) how patients perceived the last decision to have been made, (3) which components of SDM were incorporated into the last decision, and (4) decisional regret related to their last treatment decision. The survey was distributed from July 12, 2021, to August 2, 2021, and data analysis occurred from October 2021 to March 2022.

Main Outcomes and Measures

Primary outcomes included (1) patient preferences in incorporation of SDM, (2) how patients made their most recent treatment decision, (3) which components of SDM were incorporated into their most recent treatment decision measured with the validated SDMQ9, and (4) an assessment of decisional regret in relation to SDM components and the most recent treatment modality used by the patient as measured by the validated DRS.

Results

Of 1387 individuals who initiated the survey, 1074 completed it and were included in the analysis (77.4% completion rate). Overall, 917 respondents were women (85.4%). There were 5 American Indian or Alaska Native respondents (0.5%), 33 were Asian (3.1%), 112 Black or African American (10.4%), 836 White (77.8%), and 36 were multiracial (3.4%) or other (36 [3.4%]). The mean age (SD) was 49.3 (15.4) years. Most respondents preferred making the final treatment decision themselves after considering their physician's opinion (503 [46.8%]). Of those who preferred to make treatment decisions using SDM, most made the last AA treatment decision with their physician (596 [55%]; 95% CI, 53%-58%; P < .001). The components of SDM implemented by the patients' dermatologists most identified were the physician "explained the advantages and disadvantages of treatment options" (472 [44%]), and the physician "asked me which treatment option I prefer" (494 [45.9%]). Incorporation of SDM by physicians was generally associated with decreased decisional regret (all ORs with 95% CIs greater than 1.1; P < .01). The treatments associated with the lowest decisional regret were Janus kinase (JAK) inhibitors, followed by biologics, and deciding not to treat; whereas, the highest decisional regret was reported with anthralin and minoxidil.

Conclusions and Relevance

The findings of this cross-sectional survey study suggest that patients with AA prefer to make treatment decisions with their dermatologist using SDM. When SDM is used, patients report less decisional regret, indicating that SDM may help improve the patient-reported quality of treatment decisions. Newer, more efficacious therapies such as JAK inhibitors may be related to lower decisional regret. Future studies should seek to devise solutions to implement SDM as the AA treatment landscape continues to evolve.

Crowdfunding for Gender-Affirming Mastectomy: Balancing Fundraising With Loss of Privacy

INTRODUCTION

Limitations in insurance coverage may cause patients to turn to crowdfunding to raise money for gender-affirming procedures. In this study, we analyze the impact of Medicaid insurance coverage on gender-affirming mastectomy campaigns posted on GoFundMe.com.

METHODS

Between March 1 and 12, 2021, we accessed GoFundMe.com to analyze available campaigns requesting monetary contributions for gender-affirming mastectomy. Campaigns were identified using the search term "top surgery" followed by the state's name. Duplicate campaigns, campaigns whose primary goal was not gender-affirming mastectomy, and ongoing campaigns were excluded. Campaigns were then categorized according to their state's coverage of gender-affirming surgery: explicit exclusion (EE), explicit inclusion (EI), or no explicit statement of gender-affirming care. We collected data on the number of donors and shares, the fundraising goal, and the total amount raised for each campaign. Common themes within campaign narratives were identified and assessed by each reviewer. Finally, we collected data on the photographs posted by campaign creators.

RESULTS

Our search yielded 790 campaigns, with an overall mean of 58 ± 99 donors and 212 ± 288 shares. The mean fundraising goal and amount raised among all campaigns were $6811 ± $5027 and $2579 ± $3072, respectively. Fundraising goals were most likely to be met in an EI state than an EE state (26.3% vs 8.1%; P < 0.001). The mean amount sought was highest in EE states and lowest in EI states, whereas the mean amount raised was lowest in EE states and highest in EI states. Of the campaigns, 97.1% mentioned personal or situational characteristics in the narrative section; 16.2% of all campaigns expressed negative feelings about posting on GoFundMe.com to raise money for their surgeries.

CONCLUSION

Disparities in health care coverage of gender-affirming surgeries were seen between state categories, with a decreased need for crowdfunding in states explicitly including coverage of gender-affirming surgery. Many transgender patients used crowdfunding to pay for transition-related health care costs, relying on the kindness of strangers and their social network at the expense of their personal privacy. Expansion of legislative coverage of gender-affirming surgeries may alleviate some of this financial burden and reduce transgender patients' reliance on crowdfunding campaigns.

Sinusitis as a cause of insidious headache in a pregnant woman: A case report

Background

The incidence of headaches during pregnancy is 35%. Although ruling out pre-eclampsia as a possible cause for headache is important in the pregnant population, acute sinusitis should remain on the differential as it occurs six times more frequently in pregnant women. Untreated disease can lead to rare intracranial complications such as a subdural empyema.Case presentation: 21-year-old female with recurring headaches at 33 weeks of gestation was diagnosed with pre-eclampsia with severe features requiring emergent caesarean section. The woman continued to have altered mental status and focal neurologic deficits after delivery. Computerized tomography head imaging demonstrated a subdural collection discovered to be an empyema due to unilateral acute sinusitis of odontogenic origin.

Conclusion

Maintaining a clinical suspicion for acute sinusitis as a cause of headache in a pregnant woman is important for prompt diagnosis and treatment before it develops into a rare intracranial complication.

Physician Perspectives on the Effect of Topical Steroid Costs on Patients and Proposed Solutions

Importance

Rising costs of topical steroids have increased overall health care and patient out-of-pocket costs while increasing administrative burden on dermatologists and office staff.

Objective

To explore factors affecting the decision-making process for dermatologists around topical steroid prescriptions, determine the association of insurance coverage and cost, and assess willingness to implement solutions to decrease out-of-pocket topical steroid costs for patients.

Design, Setting, and Participants

This qualitative study was conducted from June to November 2020 and used semistructured interviews of 16 dermatologists who reflected a mix of physicians in academic, nonacademic, and private practice until thematic saturation was reached. Each interview was independently coded by 2 researchers. Code frequency and interrater reliability were determined using NVIVO software. Data analysis was conducted from November 2020 to March 2021.

Main Outcomes and Measures

Factors influencing dermatologist decision-making around topical steroid selection, outcomes of unaffordable medications on patients, solution recommendations, and perspectives on a system to automatically substitute topical steroid for cheaper alternatives of the same class and vehicle.

Results

Of the 16 dermatologists, 8 (50.0%) were women, 8 (50.0%) were men, 1 (6.3%) was Asian, 2 (12.5%) were Latinx, and 12 (75.0%) were White. The interrater reliability ranged from κ = 0.86 to κ = 0.98, indicating excellent agreement. Most physicians (13 [81%]) thought about costs regularly when making choices about topical steroids. All physicians identified a scenario in which patients could not obtain medication based on cost. In these cases, 15 (94%) reported that they try to find an alternative medication by calling the pharmacist or insurance company. Despite a desire to consider cost at the time of prescribing, physicians reported not knowing medication costs before prescribing because of the variability of insurance coverage (15 [94%]), lack of transparency (12 [75%]), and fluctuating drug prices (12 [75%]). In addition to affecting patients, 14 physicians (88%) reported that a patient's inability to afford medications increases administrative burden. Physicians suggested that they were open to solutions that focused on increased cost transparency (10 [63%]) and improved electronic health record technologies. Furthermore, 14 (88%) were willing to use a system to allow the substitution of one topical steroid for another of the same class and vehicle.

Conclusions and Relevance

The results of this qualitative study suggest that opacity around drug costs reduces access for patients and is followed by administrative stress for physicians and staff. Dermatologists are receptive to systems that provide greater transparency for drug costs or automate substitution of equivalent cheaper drugs for patients.

[Proximal incisal edge length and recent clinical observation of Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma]

Objective: To investigate the clinical effect of the radical resection with a proximal incisal edge length of 20-25 mm and 30-35 mm in Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma, to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm. Methods: A retrospective cohort study method was used. The clinical data of 166 patients with Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma who underwent total gastrectomy from January 2017 to August 2020 in the Department of Gastrointestinal Surgery, Heji Hospital Affiliated to Changzhi Medical College were retrospectively collected. According to the proximal incisal edge length, the patients were divided into two groups: the proximal incisal edge length of 20-25 mm group (69 cases) and 30-35 mm group (97 cases). The perioperative conditions and the 6-month follow-up after the operation were compared between the two groups. Results: There was no statistically significant difference in baseline information between the patients in the two groups (P>0.05). The operations of both groups were completed. The intraoperative operation time of the proximal incisal edge length of 20-25 mm group was shorter than that in the proximal incisal edge length of 30-35 mm group ((172±24)and(206±27)min, P<0.001). There were no significant differences in the amount of intraoperative blood loss, the treatment of the diaphragm during the operation and the positive rate of intraoperative freezing of the upper incisal edge between the patients in the two groups (all P>0.05). And there was no significant differences in the first exhaust time, gastric tube removal time, first feeding time and hospital stay after the operation of the two groups (all P>0.05). There was no significant differences in the incidence of anastomotic leakage, anastomotic stenosis, reflux esophagitis and intestinal obstruction after the operation between the patients in the two groups (all P>0.05). And there was no anastomotic leakage case among the 69 cases in the proximal incisal edge length of 20-25 mm group. Postoperative pathological treatment showed no significant differences in the vascular tumor thrombus and nerve infiltration between the two groups (both P>0.05). During the 6-month follow-up, there was no death or tumor recurrence in the two groups, and there was no significant difference in body weight loss at 6 months after the operation between the two groups (P=0.178). Conclusion: When radical resection of Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma is performed, it is feasible to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm under the premise of ensuring R0 resection. The operation time is shortened. Due to the shortening the incisal edge distance, the anastomotic tension is decreased, and the incidence of postoperative anastomotic leakage is also reduced.

New Acne Therapies and Updates on Use of Spironolactone and Isotretinoin: A Narrative Review

Acne vulgaris is a chronic inflammatory skin disease with a multifactorial pathogenesis. Although a variety of acne treatments are available, limitations of current therapies include tolerability, antimicrobial resistance, and costs and patient burden associated with monitoring. This narrative review focuses on emerging treatments and updates on the management of acne. Clascoterone, sarecycline, trifarotene, and novel lotion formulations of tretinoin and tazarotene have been evaluated in clinical trials and provide new options for treatment. Emerging data on the safety and efficacy of spironolactone and isotretinoin challenge current conventions and suggest a need to reconsider drug monitoring guidelines and risk prevention systems. Additional head-to-head data are needed to confirm these novel treatments' utility in treating acne.

[Research advances in the adverse effects of azo dyes]

China is the world's largest producer and user of dyes. The mass production and widespread use of disperse azo dyes led to environmental pollutions and potential human health risks. Azo dyes in environmental media (i.e., water, soil, air, and dust), food and clothing can enter the human body through multiple exposure routes, and some of them can be metabolized to produce more toxic metabolites, which can trigger toxic effects such as allergic reactions, tumor formation, and endocrine disruptions. This study systematically reviewed the production and use of azo dyes, environmental concentrations, human exposures, toxic effects and their underlying mechanisms, and regulations and standards. Meanwhile, the research trends of azo dyes were also discussed.

Inpatient Dermatology Best Practice Strategies for Educating and Relaying Findings to Colleagues

Purpose of Review

This review examines the role of education and relaying findings to non-dermatologist colleagues when performing inpatient dermatology consults. We highlight best practices for communication and education.

Recent Findings

Non-dermatologists receive minimal training on the diagnosis and the management of skin conditions. Efforts to teach dermatology in the inpatient setting via traditional didactics have been met with limited success, and hospitalists have indicated a desire to learn from specialists. Incorporating education into standard consultation practices including the note, one-on-one communication, and bedside rounds can efficiently improve teaching and patient care.

Summary

Our key principles of consultation emphasize communication, use of pre-existing components of a consultation to teach, and close follow-up. Inpatient dermatologists can implement these simple but effective measures to encourage education and communication with primary teams for both in-person and telehealth consults.

Abnormal correlation between phase transformation and cooling rate for pure metals

This work aims to achieve deep insight into the phenomenon of phase transformation upon rapid cooling in metal systems and reveal the physical meaning of scatter in the time taken to reach crystallization. The total number of pure metals considered in this work accounts for 14. Taking pure copper as an example, the correlation between phase selection of crystal or glass and cooling rate was investigated using molecular dynamic simulations. The obtained results demonstrate that there exists a cooling rate region of 6.3 × 10¹¹–16.6 × 10¹¹ K/s, in which crystalline fractions largely fluctuate along with cooling rates. Glass transformation in this cooling rate region is determined by atomic structure fluctuation, which is controlled by thermodynamic factors. According to the feature of bond-orientation order at different cooling rates, we propose two mechanisms of glass formation: (i) kinetic retardation of atom rearrangement or structural relaxation at a high cooling rate; and (ii) competition of icosahedral order against crystal order near the critical cooling rate.

Regulation of the pentose phosphate pathway by an androgen receptor-mTOR-mediated mechanism and its role in prostate cancer cell growth

Cancer cells display an increased demand for glucose. Therefore, identifying the specific aspects of glucose metabolism that are involved in the pathogenesis of cancer may uncover novel therapeutic nodes. Recently, there has been a renewed interest in the role of the pentose phosphate pathway in cancer. This metabolic pathway is advantageous for rapidly growing cells because it provides nucleotide precursors and helps regenerate the reducing agent NADPH, which can contribute to reactive oxygen species (ROS) scavenging. Correspondingly, clinical data suggest glucose-6-phosphate dehydrogenase (G6PD), the rate-limiting enzyme of the pentose phosphate pathway, is upregulated in prostate cancer. We hypothesized that androgen receptor (AR) signaling, which plays an essential role in the disease, mediated prostate cancer cell growth in part by increasing flux through the pentose phosphate pathway. Here, we determined that G6PD, NADPH and ribose synthesis were all increased by AR signaling. Further, this process was necessary to modulate ROS levels. Pharmacological or molecular inhibition of G6PD abolished these effects and blocked androgen-mediated cell growth. Mechanistically, regulation of G6PD via AR in both hormone-sensitive and castration-resistant models of prostate cancer was abolished following rapamycin treatment, indicating that AR increased flux through the pentose phosphate pathway by the mammalian target of rapamycin (mTOR)-mediated upregulation of G6PD. Accordingly, in two separate mouse models of Pten deletion/elevated mTOR signaling, Pb-Cre;Pten(f/f) and K8-CreER(T2);Pten(f/f), G6PD levels correlated with prostate cancer progression in vivo. Importantly, G6PD levels remained high during progression to castration-resistant prostate cancer. Taken together, our data suggest that AR signaling can promote prostate cancer through the upregulation of G6PD and therefore, the flux of sugars through the pentose phosphate pathway. Hence, these findings support a vital role for other metabolic pathways (that is, not glycolysis) in prostate cancer cell growth and maintenance.

Androgens regulate prostate cancer cell growth via an AMPK-PGC-1α-mediated metabolic switch

Prostate cancer is the most commonly diagnosed malignancy among men in industrialized countries, accounting for the second leading cause of cancer-related deaths. Although we now know that the androgen receptor (AR) is important for progression to the deadly advanced stages of the disease, it is poorly understood what AR-regulated processes drive this pathology. Here we demonstrate that AR regulates prostate cancer cell growth via the metabolic sensor 5'-AMP-activated protein kinase (AMPK), a kinase that classically regulates cellular energy homeostasis. In patients, activation of AMPK correlated with prostate cancer progression. Using a combination of radiolabeled assays and emerging metabolomic approaches, we also show that prostate cancer cells respond to androgen treatment by increasing not only rates of glycolysis, as is commonly seen in many cancers, but also glucose and fatty acid oxidation. Importantly, this effect was dependent on androgen-mediated AMPK activity. Our results further indicate that the AMPK-mediated metabolic changes increased intracellular ATP levels and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α)-mediated mitochondrial biogenesis, affording distinct growth advantages to the prostate cancer cells. Correspondingly, we used outlier analysis to determine that PGC-1α is overexpressed in a subpopulation of clinical cancer samples. This was in contrast to what was observed in immortalized benign human prostate cells and a testosterone-induced rat model of benign prostatic hyperplasia. Taken together, our findings converge to demonstrate that androgens can co-opt the AMPK-PGC-1α signaling cascade, a known homeostatic mechanism, to increase prostate cancer cell growth. The current study points to the potential utility of developing metabolic-targeted therapies directed toward the AMPK-PGC-1α signaling axis for the treatment of prostate cancer.

Epigenetic mechanisms of protein tyrosine phosphatase 6 suppression in diffuse large B-cell lymphoma: implications for epigenetic therapy

Protein tyrosine phosphatases such as PTPN6 can be downregulated in various neoplasms. PTPN6 expression by immunohistochemistry in 40 diffuse large B-cell lymphoma (DLBCL) tumors was lost or suppressed in 53% (21/40). To elucidate the molecular mechanisms of PTPN6 suppression, we performed a comprehensive epigenetic analysis of PTPN6 promoter 2 (P2). None of the DLBCL primary tumors (0/37) had PTPN6 hypermethylation on the CpG1 island using methylation-specific PCR, pyrosequencing, and high-resolution melting assays. However, hypermethylation in 57% (21/37) of cases was found in a novel CpG island (CpG2) in P2. PTPN6 gene suppression was reversed by 5-aza-deoxycytidine (5-Aza), a DNA methyltransferase inhibitor, and the histone deacetylase inhibitor (HDACi) LBH589. LBH589 and 5-Aza in combination inhibited DLBCL survival and PTPN6 hypermethylation at CpG2. The role of histone modifications was investigated with a chromatin-immunoprecipitation assay demonstrating that PTPN6 P2 is associated with silencing histone marks H3K27me3 and H3K9me3 in DLBCL cells but not normal B cells. 3-Deazaneplanocin A, a histone methyltransferase inhibitor, decreased the H3K27me3 mark, whereas HDACi LBH589 increased the H3K9Ac mark within P2 resulting in re-expression of PTPN6. These studies have uncovered novel epigenetic mechanisms of PTPN6 suppression and suggest that PTPN6 may be a potential target of epigenetic therapy in DLBCL.

First-principles calculation of structural, mechanical, magnetic and thermodynamic properties for γ-M23C6 (M = Fe, Cr) compounds

We report the results of our first-principles calculations of structural stability, mechanical, magnetic, and thermodynamic properties for γ-M(23)C(6) (M = Fe, Cr) compounds with each of the four metal Wyckoff sites being occupied in turn by Fe. The thermodynamic properties and the temperature dependence of the mechanical behavior of γ-M(23)C(6) compounds are investigated based on the quasi-harmonic Debye model. The results show that the thermodynamic properties of γ-M(23)C(6) (M = Fe, Cr) compounds are more dependent on the position of Fe atoms than the amount of Fe.

Regulation of STAT3 by histone deacetylase-3 in diffuse large B-cell lymphoma: implications for therapy

Diffuse large B-cell lymphoma (DLBCL) with an activated B-cell (ABC) gene-expression profile has been shown to have a poorer prognosis compared with tumors with a germinal center B-cell type. ABC cell lines have constitutive activation of STAT3; however, the mechanisms regulating STAT3 signaling in lymphoma are unknown. In studies of class-I histone deacetylase (HDAC) expression, we found overexpression of HDAC3 in phospho STAT3-positive DLBCL and the HDAC3 was found to be complexed with STAT3. Inhibition of HDAC activity by panobinostat (LBH589) increased p300-mediated STAT3(Lys685) acetylation with increased nuclear export of STAT3 to the cytoplasm. HDAC inhibition abolished STAT3(Tyr705) phosphorylation with minimal effect on STAT3(Ser727) and JAK2 tyrosine activity. pSTAT3(Tyr705)-positive DLBCLs were more sensitive to HDAC inhibition with LBH589 compared with pSTAT3(Tyr705)-negative DLBCLs. This cytotoxicity was associated with downregulation of the direct STAT3 target Mcl-1. HDAC3 knockdown upregulated STAT3(Lys685) acetylation but prevented STAT3(Tyr705) phosphorylation and inhibited survival of pSTAT3-positive DLBCL cells. These studies provide the rationale for targeting STAT3-positive DLBCL tumors with HDAC inhibitors.

Elevated plasma surfactant protein D (SP-D) levels and a direct correlation with anti-severe acute respiratory syndrome coronavirus-specific IgG antibody in SARS patients

Pulmonary SP‐D is a defence lectin promoting clearance of viral infections. SP‐D is recognized to bind the S protein of SARS‐CoV and enhance phagocytosis. Moreover, systemic SP‐D is widely used as a biomarker of alveolar integrity. We investigated the relation between plasma SP‐D, SARS‐type pneumonia and the SARS‐specific IgG response. Sixteen patients with SARS, 19 patients with community‐acquired pneumonia (CAP) (Streptococcus pneumonia) and 16 healthy control subjects were enrolled in the study. Plasma SP‐D and anti‐SARS‐CoV N protein IgG were measured using ELISA. SP‐D was significantly elevated in SARS‐type pneumonia [median (95% CI), 453 (379–963) ng/ml versus controls 218 (160–362) ng/ml, P < 0.05] like in patients with CAP. SP‐D significantly correlated with anti‐SARS‐CoV N protein IgG (r² = 0.5995, P = 0.02). The possible re‐emergence of SARS or SARS‐like infections suggests a need for minimal traumatic techniques for following the alveolar compartment, e.g. during testing of antivirals. We suggest that monitoring systemic SP‐D may be useful in monitoring the alveolar integrity in SARS‐type pneumonia. The significant correlation between plasma SP‐D and anti‐SARS‐CoV‐specific antibodies support the role for SP‐D in interlinking innate and adaptive immune pathways.

Albumin versus normal saline for dehydrated term infants with metabolic acidosis due to acute diarrhea

To compare the efficacy of albumin to normal saline (NS) for initial hydration therapy for dehydrated term infants with severe metabolic acidosis due to acute diarrhea.

STUDY DESIGN

We randomized 33 infants presenting with moderate-to-severe dehydration and metabolic acidosis (pH <7.25 or base excess (BE) <-15) into two groups, an albumin group (n=15) and a NS group (n=18). For initial hydration treatment, the albumin group received 5% albumin (10 ml kg(-1)), whereas the NS group received NS (10 ml kg(-1)).

RESULT

After 3 h of treatment, both groups improved. However, the magnitude of improvement in the pH, BE and HCO(3)(-) levels were not different in comparisons between these two groups. In addition, there were no differences either in the body weight and weight gain 4 days after treatment or in the length of hospital stay.

CONCLUSION

Albumin was not more effective than NS for initial hydration treatment of dehydrated term infants with metabolic acidosis due to acute diarrhea.

Right ventricular outflow patch reconstruction for repair of double-outlet left ventricle

Double-outlet left ventricle (DOLV) is conventionally repaired with an extracardiac conduit when pulmonary stenosis is present. We report a case of surgical repair for DOLV with severe pulmonary stenosis where the right ventricular outflow tract was established using a vascular graft patch anteriorly after constructing the posterior wall with autologous tissue. This approach provides excellent hemodynamic repair without the use of an extracardiac conduit and has the major advantage of growth potential.

Plasma Surfactant Protein D Levels and the Relation to Body Mass Index in a Chinese Population

Surfactant protein D (SP-D) is a member of the collectin family and is an important component of the pulmonary innate host defence. The protein has a widespread distribution in the human body and is present in multiple epithelia, in endothelium and in blood. Various studies have looked at the relationship between serum SP-D levels and pulmonary inflammatory diseases. The SP-D distribution has been most thoroughly described in European populations and appears with a broad range of serum values highly influenced by genetic factors. In the present study, we investigated the plasma SP-D distribution in a Chinese population from the Tai An region comprising 268 individuals. We found that (i) plasma SP-D in the Chinese population was distributed with a median value of 380.2 ng/ml (324.9; 418.7) and a range from 79.4 to 3965.3 ng/ml, (ii) significantly higher plasma SP-D in men than in women, and no significant effect of age, and (iii) a significant inverse association between serum SP-D and body mass index (BMI) (P = 0.012). The data indicate that racial differences in SP-D expression exist as the median plasma SP-D in the Chinese population was approximately two times lower than the median serum SP-D previously measured in a Danish population using the same immuno-assay. The inverse association between serum SP-D and BMI found in the Chinese population indicates that serum SP-D is related to obesity in similar ways in Chinese and Danes.

Fine needle aspiration cytology of solitary fibrous tumours of the pleura

OBJECTIVE

To analyse fine needle aspirates from solitary fibrous tumour (SFT) of the pleura and to elucidate the cytological features unique to these tumours and differential diagnostic findings of benign and malignant SFTs.

METHODS

Fine needle aspiration (FNA) cytology slides from eight cases of SFT of the pleura, including six benign and two malignant SFTs, were reviewed. The subsequent histological slides were also examined.

RESULTS

Cytological diagnoses from six histologically proven cases of benign SFTs were low-grade sarcoma (one), non-small cell carcinoma (one), malignant tumour (1) and benign (three). Two cases of malignant SFTs were cytologically diagnosed as malignancy. The aspirates showed a varying degree of cellularity. Most smears were composed of single, scattered fusiform cells, and irregular loose aggregates of oval to spindle cells intimately admixed with dense collagenous stroma. Two malignant SFTs had a greater number of cells in clusters, and displayed mitotic activity, without significant cytological atypia.

CONCLUSIONS

The diagnosis of SFT may be suggested by a combination of cytological and radiological findings. The precise determination of malignancy for SFT, however, is not usually straightforward on the basis of cytological features alone. The findings of highly cellular clusters and mitotic activity in the FNA cytological smear can help differentiate malignant from benign SFTs.

Expression of HMGI(Y) associated with malignant phenotype of human gastric tissue

AIMS

We evaluated the association between HMGI(Y) expression and the detection of malignant cells by simple reverse transcriptase-polymerase chain reaction (RT-PCR) and correlated the level of HMGI(Y) expression and the clinicopathological data in gastric cancer.

METHODS AND RESULTS

We analysed HMGI(Y) expression in 62 gastric cancer tissues and 28 normal gastric tissues by RT-PCR and immunohistochemical study. HMGI(Y) expression evidenced by RT-PCR was observed in 42 (67.7%) of 62 gastric cancer samples, whereas eight (28.6%) of 28 normal gastric tissues were positive (P = 0.001). In immunohistochemical staining for HMGI(Y), 48 (77.4%) of 62 gastric cancers were positive for HMGI(Y), whereas four (6.5%) of 62 normal gastric mucosae around the tumour were weakly positive, particularly in cells of some hyperplastic glands (P < 0.001). There was no significant correlation between the levels of HMGI(Y) expression and stage, tumour size, histological grade, invasion depth, or lymph node metastasis.

CONCLUSIONS

Our results suggest that HMGI(Y) expression could be associated with malignant phenotype in human gastric tissue, and that HMGI(Y) may contribute to gastric tumorigenesis.

Analysis of factors influencing the blood levels and activities of tissue-type plasminogen activator (t-PA)

This study aimed to correlate plasmatic tissue-type plasminogen activator (t-PA) levels and activity with parameters of artery blood flow and vessel walls, nail fold microcirculation, hemorheology, serum glucose, and lipids. Thirty healthy volunteers (female/male 12/18) aged 40-60 (average 46) were included in the study. In citrate venous blood, the following parameters were determined: carotid mean velocity, carotid intimal-medial-thickness (IMT), capillary circulation parameters, hemorheology index, serum glucose, and lipids. Analysis of data showed that t-PA concentration was positively and significantly correlated with total cholesterol, triglycerides, and serum glucose (P<0.05, P<0.05, and P<0.01), but t-PA activity showed no correlation with them; among the hemorheology factors investigated, t-PA concentration showed the strongest positive correlation with both whole blood viscosity and reduced blood viscosity at high and low shear rate separately (P<0.01), t-PA activity showed no correlation with any hemorheology factors; t-PA concentration showed no correlation with any investigated nail fold capillary parameters, whereas t-PA activity was significantly and negatively associated with capillary loop number (P<0.05); t-PA concentration and activity was not associated with values of carotid maximum intimal-medial-thickness (mIMT) and mean velocity or systolic, diastolic blood pressure (P>0.05). But subjects with mIMT 1.0 mm showed higher t-PA levels compared with those with mIMT < 1.0 mm (P<0.05) and decreased carotid mean velocity (P<0.01). These findings suggest that multiple vascular disease risk factors would influence the t-PA level; t-PA concentration does not parallelize with t-PA activity.

Conjugated linoleic acid depresses the delta9 desaturase index and stearoyl coenzyme A desaturase enzyme activity in porcine subcutaneous adipose tissue

Conjugated linoleic acid (CLA) has been shown to have an effect on subcutaneous fatty acid composition and has been reported to decrease stearoyl coenzyme A desaturase (SCD) activity by decreasing mRNA expression and(or) catalytic activity in rodents and rodent cell lines. This investigation was designed to study the effects of CLA, corn oil, or beef tallow supplementation on s.c. adipose tissue fatty acid composition, adiposity, SCD enzyme activity, and the delta9 desaturase index in piglets. Eighteen crossbred barrows 16 to 18 d of age were adapted to diet for 1 wk and then assigned randomly to one of three treatments: 1.5% added CLA, 1.5% added corn oil, or 1.5% added beef tallow. Barrows were penned individually and fed the supplemental oils for 35 d (to 25.6 +/- 0.6 kg BW). Subcutaneous adipose tissue samples were obtained after slaughter. Fatty acid composition of the s.c. adipose tissue differed for each fatty acid measured due to diet with the exception of 18:3. The concentrations of CLA trans-10, cis-12 and cis-9, trans-11 were elevated from nondetectable to 1.62 and 2.52 g/100 g lipid, respectively (P < 0.001 for both isomers). Conjugated linoleic acid decreased the delta9 desaturase index (P < 0.01) and SCD enzyme activity, expressed as nanomoles of palmitate converted to palmitoleate/(7 min x g of tissue) (P = 0.075) and nanomoles of palmitate converted to palmitoleate/(7 min 105 cells) (P= 0.056). Tallow-fed pigs had a greater proportion of large adipocytes (> 700 pL) and the greatest SCD activity. These data provide the first direct evidence that dietary CLA depresses SCD enzyme activity in porcine adipose tissue, which may in part be responsible for the depression of adiposity by CLA observed by others in market weight pigs.

Lymph nodes in gastric B-cell lymphoma: pattern of involvement and early histological changes

AIMS

This study aims to analyse the histological pattern of nodal involvement in gastric B-cell lymphoma and to detect early involvement of the lymph nodes.

METHODS AND RESULTS

Histological findings of 37 resected primary gastric lymphomas with 1313 regional lymph nodes were analysed. The primary tumour was classified into four groups: MALT lymphoma, MALT lymphoma with a minor large B-cell lymphoma (<20%), large B-cell lymphoma with MALT lymphoma, and large B-cell lymphoma without MALT lymphoma. Histological patterns of nodal involvement were divided into sinusoidal, subsinusoidal/marginal, follicular, and diffuse patterns. Semi-nested polymerase chain reaction (PCR) analysis for IgH gene rearrangement was performed. Nodal involvement was found in 2/13 (15%) MALT lymphomas, 5/6 (83%) MALT lymphomas with a minor large B-cell lymphoma, 9/12 (75%) large B-cell lymphomas with MALT lymphoma, and 6/6 (100%) large B-cell lymphomas without MALT lymphoma. The MALT lymphoma and MALT lymphoma with a minor large B-cell lymphoma showed a predominantly sinusoidal and subsinusoidal pattern, whereas diffuse pattern predominated in large B-cell lymphomas without MALT lymphoma and large B-cell lymphomas with MALT lymphoma. The follicular pattern was least common, being observed in 10.2% of large B-cell lymphomas without MALT lymphoma and large B-cell lymphomas with MALT lymphoma. Sinusoidal obliteration with permeation of small monocytoid cells into subsinusoidal zone is a characteristic finding suggesting early nodal involvement of MALT lymphoma.

CONCLUSIONS

Histological patterns of nodal involvement in gastric B-cell lymphoma vary according to the histological grade. Immunostaining for CD20 with or without PCR analysis for IgH gene rearrangement would be a useful ancillary method to confirm lymphomatous involvement.

Classification and treatment of prominent mandibular angle

In Oriental culture, the contour of the mandibular angle is important for feminine facial shape because a woman who has a wide and square face is thought to have had an unhappy life. A prominent mandibular angle, which does not coincide with the natural look, produces a characteristic quadrangle, coarse, and muscular appearance. So Oriental women who have a prominent mandibular angle want to have an ovoid, reduced, and slender face by aesthetic mandibular angle resection. Many satisfactory corrections of a prominent mandibular angle by various operative techniques have been reported. But reasonable morphologic classification and treatment were not reported. So we classified prominent mandibular angles into four groups by morphology and operated on the patients according to their classification with different modalities: no square shape but only a reduced gonial angle in the profile view-class I, mild form; severe mandibular angle protrusion with lateral protrusion-class II, moderate form; a definite square-shaped angle (class II) with masseteric hypertrophy-class III, severe form; and combined prominent mandibular angle and chin deformity-class IV, complex form. We use angle ostectomy through the intraoral route alone or with an additional external stab incision for class I. An external stab incision to set up the reciprocating saw is sometimes helpful in class I cases because there is no lateral protrusion of the angle. For class II cases, we use conventional intraoral angle ostectomy only or angle splitting ostectomy with contouring. For class III cases, we use angle splitting ostectomy and contouring with partial masseteric myectomy. In class IV, we use angle ostectomy and additional genioplasty. During 7 years, we have performed 46 cases of mandibular angle resection. Of the mandibular angle resection cases, 19 were class I, 15 were class II, 9 were class III, and 3 were class IV. A total of 42 patients were satisfied with the postoperative results. For reasonable and satisfactory final results, classification according to the mandibular angle shape and suitable treatment according to the classification are essential.

An epidemiological investigation of congenital Schistosoma japonicum transmission in Hubei Province, PR China

A cohort study was conducted in Hubei Province, China, following serious flooding of the Yangtze River in the autumn of 1998 to investigate the possibility of congenital transmission of Schistosoma japonicum in humans. The cohort investigated was comprised of 205 women and their 208 infants born between 1 September and 30 December 1998. Blood and fecal samples from all the women and their infants were collected and examined for S. japonicum infection. Positive specific antibody titers were found in 14 (6.8%) of the mothers, but no fecal egg excretion was observed. All infants had negative specific antibody titers and no S. japonicum eggs were found in their feces. Hence, the present study coud not confirm congenital S. japonicum transmission in humans. Further studies are highly wanted to study the impact of prenatal exposure of S. japonicum on the offspring.

A vascular ring: right aortic arch and descending aorta with left ductus arteriosus

A case is presented of vascular ring caused by right aortic arch with mirror-image branching and left ductus arteriosus. In this case, the descending aorta was located right of the tracheoesophagus and the left ductus arteriosus connected to the descending aorta far below the arch, producing compression of the esophagus only. Through median sternotomy, the ligation and division of the ductus was performed with concomitant repair of ventricular septal defect.

Correlation between ICAM-1 and functional recovery of piglet myocardium with leukocyte-depleted reperfusion

BACKGROUND

Reperfusion injury involves leukocyte-endothelial interaction mediated by cell adhesion molecules. This study was designed to determine the time course of intercellular adhesion molecule-1 (ICAM-1) expression and the functional recovery of myocardium when reperfused with leukocyte depleted whole blood.

METHODS

Sixteen neonatal piglet hearts were harvested and stored with 4 degrees C cold University of Wisconsin Solution (UWS) for 12 hours. An ex vivo model consisting of an isolated working heart perfusion circuit, roller pumps, and a membrane oxygenator, was used for reperfusion. Atrial tissues were taken for staining ICAM-1. The stroke work index (SWI) was calculated during 4 hours of reperfusion. Two groups (group 1: reperfused with whole blood, group 2: with leukocyte depleted blood) were compared.

RESULTS

The differences of ICAM-1 expression between group 1 and 2 were significant at 3 and 4 hours of reperfusion (p < 0.05). The differences of the mean stroke work indices were significant at 2, 3, and 4 hours after reperfusion (p < 0.05).

CONCLUSIONS

Leukocyte-depleted reperfusion attenuates the expression of ICAM-1 and reduces the time-dependent functional deterioration of the myocardium. These results suggest that adhesion molecule like ICAM-1 plays a major role in deteriorating myocardial function during the reperfusion, possibly by leukocyte-mediated inflammatory process.

Effects of intraoperative blood flow on the early patency of radiocephalic fistulas

The purpose of this study was to find the correlation between intraoperative blood flow and early patency of the radiocephalic fistula. Between March 1998 and March 1999, 50 radiocephalic arteriovenous fistulas were constructed in 41 patients. Intraoperative blood flow measurements were made 10 min after completion of the vascular anastomoses with 3-4 mm handheld flow probes. Patients were followed until failure of fistula or 3 months after the first hemodialysis with these fistulas. Intraoperative blood flow as well as age, gender, presence of diabetes, size of cephalic vein, thrill on the fistula, and flow of radial artery were correlated with early patency. The mean intraoperative blood flow was 174.7 +/- 13.2 mL/min and ranged from 50 to 500 mL/min; it was the only significant parameter that determined early patency of the radiocephalic fistula. Fistulas with flow <160 mL/min (10 of 25) had a higher failure rate than those with flow >160 mL/min (4 of 25), which was statistically significant (p < 0.01). All of the patients with flow <70 mL/min (5 of 5) failed to maintain patency within a month. However, the other variables were not correlated with early patency. We conclude that intraoperative blood flow is a reliable parameter that determines the early patency of radiocephalic fistulas.

Enhancement of both reaction yield and rate of synthesis of structured triacylglycerol containing eicosapentaenoic acid under vacuum with water activity control

Production of structured triacylglycerols (sTAG) containing eicosapentaenoic acid (EPA) at the sn-1 (or 3) position using Lipozyme in a solvent-free system was studied. Optimal water activity (a(w)) for the synthesis of the sTAG was investigated. Vacuum was applied to shift reaction equilibrium toward the synthesis reaction by removing by-products. During vacuum application, the water level of the reaction system was controlled at the optimal level by addition of a suitable amount of water at a predetermined interval. Intermittent periodic addition of a suitable amount of water into the reaction mixture made the reaction rate faster than that without adding water. A molar yield of 89.7% of the targeted sTAG was obtained after 16 h reaction with a(w) control during the vacuum application as compared with the yield of 87.0% after 24 h of reaction without a(w) control during the vacuum application.

Transgene expression in the guinea pig cochlea mediated by a lentivirus-derived gene transfer vector

The utility of lentivirus as a gene delivery vector in the cochlea was evaluated in vitro and in vivo. Lentivirus transduction was assessed through expression analysis of a reporter gene, green fluorescent protein (GFP), integrated within the viral genome. In vitro characterization of lentivirus-GFP was assessed by infection of explants from cochleas of neonatal rat. The lentiviral vector transduced both spiral ganglion neurons (SGNs) and glial cells. In vivo characterization of lentivirus-GFP was assessed by directly infusing the vector into the guinea pig cochlea via an osmotic minipump. Sections of lentivirus-infused cochlea revealed a highly restricted fluorescence pattern limited to the periphery of the perilymphatic space. Transduction of SGNs and glial cells by lentivirus in vitro but not in vivo suggests limited dissemination of the viral vector from the perilymphatic space. The cellular and tissue architecture of the lentivirus-infused cochlea was intact and free of inflammation. Restricted transduction of cell types confined to the periphery of the perilymphatic space by the lentivirus is ideal for stable production of gene products secreted into the perilymph.

Cationic liposome mediated transgene expression in the guinea pig cochlea

Sensorineural hearing loss affects nearly 10% of the American population that is refractory to conventional therapy. Gene therapy represents an intervention with potential therapeutic efficacy. We studied the feasibility of cationic liposome mediated gene transfer within the guinea pig cochlea in vivo following direct microinjection into the cochlea. Transgene expression was persistent up to 14 days in the neurosensory epithelia and surrounding tissue without toxicity and inflammation in the target organ. This study represents the first successful use of cationic liposomes for cochlear gene transfer thus providing a safe and rapid alternative to the use of recombinant viral vectors in gene therapy for inner ear disorders.

Aflatoxin B1-induced suppression of nitric oxide production in murine peritoneal macrophages

Aflatoxin B1 (AFB1), a potent hepatocarcinogen, is known to impair specific and non-specific immune responses. AFB1 mainly decreases lymphocyte functions and may also affect macrophages assisting lymphocyte functions. Macrophages play an important role in a host defense against tumors and bacteria. Furthermore, some macrophage products, including nitric oxide (NO), may be involved in cytotoxicity. The effect of aflatoxin B1 (AFB1) was investigated on NO production from murine peritoneal macrophages. Macrophages were pretreated with AFB1 for 24 h and then stimulated with lipopolysaccharide (LPS) for 24 h. AFB1 at 10 or 50 microM reduced the production of NO. Compared to vehicle control, there was a greater reduction of NO production with increased AFB1 pretreatment and LPS stimulation. AFB1 at 10 or 50 microM decreased inducible nitric oxide synthase (iNOS) activity about 24% and 28%, respectively, after stimulation with 1 microg/ml LPS and about 12% and 24%, respectively, after stimulation with 10 microg/ml LPS. AFB1 pretreatment also decreased the synthesis of iNOS protein and the mRNA of macrophages. Taken together, these results suggest that AFB1 pretreatment reduces NO production from murine peritoneal macrophages stimulated by LPS, which is mediated by the reduction of iNOS activity, mRNA, and protein.

Autobiographical memory in Korean, Chinese, and American children

Autobiographical memory and story recall were examined in Korean, Chinese, and American children (N = 158). In each culture, 4- and 6-year-olds (half boys) participated, with interviews conducted in the country-language of origin. On Day 1, children were given identical free-narrative interviews about life events and were shown a narrated story. On Day 2, children were interviewed about the story. Day 1 results indicate that in comparison with Asians, Americans provided more references to specific past events, more descriptives, more references to internal states, such as evaluations, and more mentions of themselves relative to others. Age differences were observed in Asia and sex differences in the United States. Objective story memory performance was equally accurate across cultures, although memory content differed.

Autobiographical memory in Korean, Chinese, and American children

Autobiographical memory and story recall were examined in Korean, Chinese, and American children (N = 158). In each culture, 4- and 6-year-olds (half boys) participated, with interviews conducted in the country-language of origin. On Day 1, children were given identical free-narrative interviews about life events and were shown a narrated story. On Day 2, children were interviewed about the story. Day 1 results indicate that in comparison with Asians, Americans provided more references to specific past events, more descriptives, more references to internal states, such as evaluations, and more mentions of themselves relative to others. Age differences were observed in Asia and sex differences in the United States. Objective story memory performance was equally accurate across cultures, although memory content differed.

Effect of salt hydrate pair on lipase-catalyzed regioselective monoacylation of sucrose

Sucrose monoesters of a fatty acid were synthesized by using lipase in a solvent-free system. When lipase from Mucor miehei was used as a catalyst with capric acid as the donor and sugar as the acceptor, sucrose 6-monocaprate was predominantly produced in a yield of 25.3%. The yield of product was significantly increased by the direct addition of a suitable pair of solid salt hydrates to the reaction mixture to control the water activity (aw). Among the salt hydrate pairs investigated, the barium hydroxide, 8/1H2O pair resulted in the highest yield of the product. This salt addition method was also successfully employed for acylation of primary hydroxyl groups in various unprotected mono- and disaccharides such as glucose, galactose, fructose, trehalose, mannose, maltose, and lactose.

Green fluorescent protein as a reporter for gene transfer studies in the cochlea

This study examined the 'humanized, red-shifted' version of the jellyfish Aequorea victoria green fluorescent protein (hrGFP) as a novel reporter for in vivo gene transfer studies in the cochlea using adeno-associated virus (AAV) vectors. Approximately 10(5) AAV vectors containing the hrGFP reporter gene were infused over 2 days or 1 week into the cochlea of the guinea pig via an osmotic minipump. Saline infused, non-infused, as well as AAV-beta-galactosidase infused guinea pigs served as the negative controls. The hrGFP transgene expression was detected as moderate intensity fluorescence easily distinguished from the background. Increased fluorescence was seen in the spiral ganglion, spiral ligament, spiral limbus, organ of Corti, and Reissner's membrane of the AAV-hrGFP infused animals. Control animals showed minimal fluorescence throughout the cochlea. Comparison of the 2 day and 1 week AAV-hrGFP infused animals showed qualitatively increased fluorescence in the 2 day animals. Background autofluorescence in the stria vascularis was noted in both the experimental and the control animals. In addition, fluorescence was detected in the contralateral cochlea of the AAV-hrGFP infused animals. Subsequent PCR analysis confirmed the presence of viral particles in the AAV-hrGFP infused cochlea as well as in the brain and the contralateral cochlea. This finding has important implications for the eventual implementation of cochlear gene therapy. The results not only reinforce the need to assess the introduction and expression of foreign genes in the target cochlea but also consider issues of viral spread, safety, and modes of gene delivery. This study establishes hrGFP as an effective reporter of gene transfer and transgene expression in the cochlea. GFP's small gene size, stability, ease of detection, and potential for diverse biological applications will be invaluable for a variety of future gene transfer and expression studies in the cochlea.