A protocol for manual segmentation of medial temporal lobe subregions in 7 Tesla MRI

Recent advances in MRI and increasing knowledge on the characterization and anatomical variability of medial temporal lobe (MTL) anatomy have paved the way for more specific subdivisions of the MTL in humans. In addition, recent studies suggest that early changes in many neurodegenerative and neuropsychiatric diseases are better detected in smaller subregions of the MTL rather than with whole structure analyses. Here, we developed a new protocol using 7 Tesla (T) MRI incorporating novel anatomical findings for the manual segmentation of entorhinal cortex (ErC), perirhinal cortex (PrC; divided into area 35 and 36), parahippocampal cortex (PhC), and hippocampus; which includes the subfields subiculum (Sub), CA1, CA2, as well as CA3 and dentate gyrus (DG) which are separated by the endfolial pathway covering most of the long axis of the hippocampus. We provide detailed instructions alongside slice-by-slice segmentations to ease learning for the untrained but also more experienced raters. Twenty-two subjects were scanned (19-32 yrs, mean age = 26 years, 12 females) with a turbo spin echo (TSE) T2-weighted MRI sequence with high-resolution oblique coronal slices oriented orthogonal to the long axis of the hippocampus (in-plane resolution 0.44 × 0.44 mm2) and 1.0 mm slice thickness. The scans were manually delineated by two experienced raters, to assess intra- and inter-rater reliability. The Dice Similarity Index (DSI) was above 0.78 for all regions and the Intraclass Correlation Coefficients (ICC) were between 0.76 to 0.99 both for intra- and inter-rater reliability. In conclusion, this study presents a fine-grained and comprehensive segmentation protocol for MTL structures at 7 T MRI that closely follows recent knowledge from anatomical studies. More specific subdivisions (e.g. area 35 and 36 in PrC, and the separation of DG and CA3) may pave the way for more precise delineations thereby enabling the detection of early volumetric changes in dementia and neuropsychiatric diseases.

First Report of Boll Rot of Cotton Caused by Pantoea agglomerans in China

Since the summer of 2006, bacterial boll rot of cotton has been observed on fruits of 'Xinluzao 31' (Xinluzao 6 × Acala) in Xinjiang Province. It resulted in as much as 20% yield loss in several fields. Symptoms do not appear on the outer carpel. In the infected cotton bolls, fibers do not mature completely and seed tissue exhibits brown necrotic coloration. Lint and seeds from 24 surface-disinfested cotton bolls were triturated and plated onto King's medium B (KB). Plates were incubated at 28°C for 48 h. Forty eight strains with yellow pigmentation on KB were characterized. All were nonfluorescent on KB, gram negative, facultatively anaerobic, unable to produce indole from tryptophan, able to reduce nitrate to nitrite, and produce acid from glucose, cellobiose, lactose, melibiose, and melonate. In addition, 16S rDNA in seven strains was amplified with universal primers (1). The PCR products were cloned into pGEM-T easy vector and sequenced. A BLAST search of the seven sequences against the GenBank nucleotide library indicated 100% identity with the 16S rDNA sequence of Enterobacter agglomerans strain A80. Then an additional primer pair, pagF and pagR (3), was used for more specific amplification of Pantoea agglomerans 16S rDNA, which resulted in single highly specific fragments of approximately 1 kb. On the basis of morphological, physiological, biochemical characteristics, and 16S rRNA gene sequence analysis, we identified the bacterium to be P. agglomerans. To confirm pathogenicity, cell suspensions (1 × 10⁸ CFU/ml) of eight representative strains were used to inoculate cotton at peak bolling stage in the field. Cell suspensions, or water as the control, were applied to stigma scars, wall sutures, and scratch wounds on bracts, calyxes, and bolls. Alternatively, a needle was used to puncture through a drop of suspension placed on the boll wall suture and bracts. At least 20 bolls or flowers were inoculated with each bacterial strain per inoculation method. Infection occurred only when bacterial injections breached the endocarp of the boll either through the carpel wall or a suture between carpel sections. Disease symptoms developed 1 week postinoculation. The inoculated organism was reisolated from the diseased tissues. P. agglomerans is generally regarded to be a soil saprophyte or leaf epiphyte, but strains can opportunistically infect plants triggering gall formations or human wounds causing septic arthritis. The disease symptoms and pathogen characteristics observed in this study are identical to those reported in the United States (2). To our knowledge, this is the first report of P. agglomerans causing boll rot of cotton in China. References: (1) S. Manulisi and I. Barash. Mol. Plant Pathol. 4:307, 2003. (2) E. G. Medrano et al. J. Appl. Microbiol. 103:436, 2007. (3) S. Vorwerk et al. Agric. For. Entomol. 9:57, 2007.

Abnormality of the DNA double-strand-break checkpoint/repair genes, ATM, BRCA1 and TP53, in breast cancer is related to tumour grade

The role of the DNA double-strand-break (DSB) checkpoint/repair genes, ATM, BRCA1 and TP53, in sporadic breast cancer requires clarification, since ATM and BRCA1 mutations are rare in sporadic tumours. In an attempt to explain this phenomenon, we postulated that (i) in addition to genetic deletion, abnormal expression of DSB checkpoint/repair proteins might abolish the function of these genes and (ii) there might be a combined effect of individual defective genes during breast cancer pathogenesis. Using a largely homogenous group of 74 specimens of early-onset (⩽35 years of age) infiltrating ductal carcinomas, we examined associations between pathological grade and genetic deletion and/or abnormal protein expression of ATM, BRCA1 and TP53. The results showed that high-grade tumours displayed a high frequency of loss of heterozygosity (LOH) at, and/or abnormal expression of, ATM, BRCA1 and TP53. Multigenetic analysis showed abnormalities in BRCA1 to be independently associated with high-grade tumours. ATM and TP53 appeared to play an assistant role, abnormalities in these genes significantly increasing the possibility of poor differentiation in tumours with abnormalities in BRCA1. Furthermore, a higher number of abnormalities (LOH or abnormal expression) in these three genes correlated with poor tumour differentiation. Thus, this study suggests that combined changes in several DSB checkpoint/repair genes belonging to a common functional pathway are associated with breast cancer pathogenesis.

Modular organization of the monkey presubiculum

There have been previous reports of somatostatin- and acetylcholinesterase (AChE)-positive patches in the superficial layers of the presubiculum in monkeys. In this study, we show additional instances of patches in the presubiculum, as demonstrated by cytochrome oxidase (CO), by myelin and Nissl stains, and by the calcium-binding proteins calbindin (CB), calretinin (CR), and parvalbumin (PV). Markers are differentially expressed along the lateral and longitudinal axes. Comparisons of adjacent sections reacted for different markers suggest that the CB+ and CR+ patches, and CO+ and AChE+ patches generally correspond, but not the CB+ and CO+ patches. In cross section, patches are about 100-300 microm in width. Sections cut tangentially through the superficial layers indicate that the pattern of CO and AChE labeling is in fact patchlike in layer I, but that the apparent patches in layer II (CB and CR) form a reticular or lattice-like network. As patches are restricted to the presubiculum, these labeling patterns provide a convenient marker for the boundary between the presubiculum and the adjoining posteroventral retrosplenial cortex. More work is necessary to determine how this modularity may relate to the functional organization of the presubiculum.

Postnatal development of biotinylated dextran amine-labeled corpus callosum axons projecting from the visual and auditory cortices to the visual cortex of the rat

The distribution and morphology of developing corpus callosum (CC) axons in rat visual cortex was studied by unilateral application of the in vivo anterograde tracer biotinylated dextran amine (BDA) to the visual or auditory cortex of newborns through adults. Changes in the distribution and morphology of CC axons during development were observed. Following BDA placement only in visual cortex, nearly all CC projections were to visual cortex (homotopic CC projections). At postnatal day (PND) 5-8, labeled CC axons were found throughout the contralateral visual cortex, including area 17; these CC axons could be followed from the white matter to layer I. By PND 13, few CC axons were found in medial area 17, indicating the existence of transitory CC axons in area 17 at younger ages. Morphological changes were investigated at the area 17/18a border and showed that CC axon collaterals were not formed until PND 8, and terminal arbors were not visible until PND 13; by PND 17, the adult CC-axon terminal pattern was present. At all ages, only a few heterotopic CC projections from visual to auditory cortex were found in the gray matter, although many labeled CC axons extended laterally into the white matter underlying the auditory cortex. Following BDA placement only in auditory cortex, CC projections to both auditory (homotopic CC projections) and visual (heterotopic CC projections) cortex were observed. At all ages, the homotopic CC projections were present throughout the auditory cortex, but were not distributed homogeneously; densely labeled CC axons showed a distinct columnar organization. The heterotopic CC projections were present in all visual cortical areas, including medial area 17, in significant numbers until PND 24, but were mostly eliminated by PND 28, at which time a labeling pattern similar to the adult was found. Thus, most of the heterotopic CC projections were transitory. The present study confirms the existence of transitory CC axons projecting through all layers of the visual cortex, as revealed by DiI, and extends the DiI results by showing that these transitory CC axons arise from both homotopic and heterotopic origins. Furthermore, different sources of transitory CC axons have different timetables for elimination.

Neuropeptide Y- and somatostatin-immunoreactive axons in the corpus callosum during postnatal development of the rat

Corpus callosum (CC) projections in adult mammals were generally thought to be excitatory and to use excitatory amino acids as their transmitters. Little information has been available about the electrical properties and neurochemical status of developing CC connections. The present study investigated the chemical status of rat CC axons during postnatal development by using antibodies to neuropeptide Y (NPY) and to somatostatin (SOM). Both NPY-immunoreactive (ir) and SOM-ir axons were found in the CC of the rat from newborn through adult; however, the number of SOM-ir CC axons is less than that of NPY-ir CC axons at corresponding ages. The density of both NPY-ir and SOM-ir CC axons initially increased, then peaked, and finally decreased to the mature level. In the adult, only a few NPY-ir and SOM-ir CC axons were found in the CC. These results indicate that many NPY-ir and SOM-ir CC axons are transitory during early postnatal development. The results also suggest that the functions of CC connections in adult mammals may be different from that of developing ones. The present results as well as the previous results demonstrate that both developing and mature CC connections are chemically heterogeneous.

Anti-idiotype antibody directly interferes with glomerular IgA immune complex deposition

Data from both animal and clinical studies suggest that anti-idiotype antibodies deposited in glomeruli may be involved in the pathogenesis of glomerulonephritis. This study was conducted to examine the role of a hybridoma-AB1-2-derived IgG anti-T15 idiotype (IgG anti-T15) in the immunopathogenesis of a short-term experimental IgA nephropathy. BALB/c mice (12/group) were administered intravenously with: (1) an equal mass (1 mg) of T15-hybridoma-derived IgA antiphosphorylcholine (PC) and PC-conjugated bovine serum albumin (BSA-PC) antigen; (2) 1 mg of IgA anti-PC, 1 mg of BSA-PC antigen, and 3 mg of IgG anti-T15, or (3) 1 mg of BSA-PC antigen alone. The mice were sacrificed 6 h after the injection. A 6-hour clearance study was performed. The initial phase of elimination of BSA-PC antigen in mice receiving IgA anti-PC/BSA-PC/IgG anti-T15 or those receiving the antigen alone was significantly faster than that in those receiving IgA anti-PC/BSA-PC (p < 0.001). There was no significant difference in the elimination rate of BSA-PC antigen between mice receiving IgA anti-PC/BSA-PC/IgG anti-T15 and those receiving BSA-PC antigen alone. The late phases of elimination of the BSA-PC antigen in mice receiving IgA anti-PC/BSA-PC/IgG anti-T15 showed somewhat similar to those of BSA-PC antigen in mice receiving IgA anti-PC/BSA-PC. Moreover, mice injected with IgA anti-PC/BSA-PC/IgG anti-T15 showed a significantly less glomerular BSA-PC antigen deposition than those injected with IgA anti-PC/BSA-PC (positive control), as demonstrated by light microscopy, autoradiography, and immunohistochemistry (each p < 0.001). It is inferred that the injected IgG anti-T15 could react with the IgA anti-PC in vivo, directly interfering with immune complex formation by the IgA anti-PC and BSA-PC antigen, thereby resulting in diminished glomerular deposition of the BSA-PC antigen. These findings suggest that an anti-idiotype antibody may be protective in the immunopathogenesis of IgA nephropathy, because of its inhibitory effect on glomerular trapping of an antigen.

Inferior parietal lobule projections to the presubiculum and neighboring ventromedial temporal cortical areas

The entorhinal and perirhinal cortices have long been accorded a special role in the communications between neocortical areas and the hippocampal formation. Less attention has been paid to the presubiculum, which, however, is also a component of the parahippocampal gyrus, receives dense inputs from several cortical areas, and itself is a major source of connections to the entorhinal cortex (EC). In part of a closer investigation of corticohippocampal systems, the authors applied single-axon analysis to the connections from the inferior parietal lobule (IPL) to the presubiculum. One major result from this approach was the finding that many of these axons (at least 10 of 14) branch beyond the presubiculum. For 4 axons, branches were followed to area TF and to the border between the perirhinal and entorhinal cortices, raising the suggestion that these areas, which sometimes are viewed as serial stages, are tightly interconnected. In addition, the current data identify several features of presubicular organization that may be relevant to its functional role in visuospatial or memory processes: 1) Terminations from the IPL, as previously reported for prefrontal connections (Goldman-Rakic et al. [1984] Neuroscience 12:719-743), form two to four patches in the superficial layers. These align in stripes, but only for short distances ( approximately 1.5 mm). This pattern suggests a strong compartmentalization in layers I and II that is also indicated by cytochrome oxidase and other markers. 2) Connections tend to be bistratified, terminating in layers I-II and deeper in layer III. 3) Single axons terminate in layer I alone or in different combinations of layers. This may imply some heterogeneity of subtypes. 4) Individual axons, both ipsilateral projecting (n = 14 axons) and contralateral projecting (n = 6 axons), tend to have large arbors (0.3-0.8 mm across). Finally, the authors observe that projections from the IPL, except for its anteriormost portion, converge at the perirhinal-entorhinal border around the posterior tip of the rhinal sulcus. These projections partially overlap with projections from ventromedial areas TE and TF, and this convergence may contribute to the severe deficits in visual recognition memory resulting from ablations of rhinal cortex.

Parvalbumin immunoreactive Cajal-Retzius and non-Cajal-Retzius neurons in layer I of different cortical regions of human newborn

Neurons of layer I play an important role in the development of the basic structural and functional organization of the mammalian cerebral cortex. Basic data, however, concerning the spatial and temporal distribution of the neuron populations in layer I are still limited, especially for human material. The present study investigates the distribution of Cajal-Retzius (CR) and non Cajal-Retzius (NCR) neurons in thirteen cortical areas in the newborn human in terms of their relative density and possible subtypes. Neuronal populations were identified by immunohistochemistry for parvalbumin. Three main results are reported. First, parvalbumin-immunoreactive (Parv-ir) CR cells were observed in all of the neocortical areas examined. These areas also had a Parv-ir horizontal fiber plexus in deep layer I, confirming to the horizontal plexus classically associated with CR neurons. Second, many Parv-ir CR cells showed clear signs of degeneration. Third, in addition to the large CR cells, smaller Parv-ir NCR neurons occurred in many of the neocortical areas examined. These were morphologically heterogeneous and may represent several subtypes. By sampling across several areas, we were able to establish that these NCR cells occurred at higher density in primary sensory areas 3, 1, 17, and 41. Because of this variability in density of Parv-ir NCR cells, the ratio of Parv-ir CR to Parv-ir NCR cells is selectively lower in primary sensory areas. Recent investigations in somatosensory cortex of early postnatal rat report complex spatiotemporal patterns of correlated spontaneous activity among neurons in layer I (Schwartz et al. 1998). An interesting possibility is that regional variability in this activity may play a major role in the organization of cortical circuitry in different areas.

Monomeric immunoglobulin A protects glomerulus against polymeric immunoglobulin A immune complex in experimental immunoglobulin A nephropathy

Polymeric (p) IgA constitutes 13% of total serum IgA, whereas monomeric (m) IgA represents the other 87%. pIgA tends to form complexes in the circulation that eventually localize in the glomerulus. mIgA is a nonprecipitable antibody. When complexed with an antigen in vivo, the circulating mIgA immune complex (IC) thus formed does not deposit in the glomerulus. The purpose of the present study was to evaluate the influence of mIgA on the formation of pIgA-lC and subsequent glomerular deposition of the IC in an experimental model of IgA nephropathy. The influence of mIgA anti-dinitrophenyl (DNP) on pIgA anti-DNP/DNP-conjugated BSA (BSA-DNP) IC formation was assessed by double diffusion test and competition PAGE in combination with autoradiography. Only the BSA-DNP, a model antigen of relatively low molecular mass, was radiolabeled and monitored throughout the latter experiment. An analysis of clearance kinetics (1 and 6 hours) of the antigen using 4-week-old female BALB/c mice, and a series of renal studies were performed after intravenous injection with a single dose of combined pIgA anti-DNP, BSA-DNP, and mIgA anti-DNP. As demonstrated by the double diffusion test, addition of mIgA anti-DNP resulted in suppression of the precipitating reaction of pIgA anti-DNP and BSA-DNP. This effect was confirmed by PAGE for size determination of the BSA-DNP which had been complexed with either pIgA anti-DNP or a mixture of pIgA anti-DNP and mIgA anti-DNP. The clearance kinetics studies showed that the elimination of BSA-DNP injected with pIgA anti-DNP was prolonged in the presence of mIgA anti-DNP in a partially dose-dependent manner. The experimental mice receiving pIgA anti-DNP, BSA-DNP, and mIgA anti-DNP showed less hematuria (p < 0.005) than mice receiving pIgA anti-DNP and BSA-DNP (positive control) when examined 1 hour after injection. Immunofluorescence study of the renal tissue of mice receiving pIgA anti-DNP, BSA-DNP, and mIgA anti-DNP showed a suppressed glomerular localization of IgA and third component of complement, as compared with those injected with pIgA anti-DNP and BSA-DNP alone. Similarly, a significant decrease of glomerular BSA-DNP deposits was observed in mice receiving pIgA anti-DNP, BSA-DNP, and mIgA anti-DNP compared with those receiving pIgA anti-DNP and BSA-DNP alone, as demonstrated by light microscopic autoradiography. These findings indicate that a high dose of specific mIgA was capable of modulating glomerular deposition of the pIgA-IC in this animal model of IgAN.

A modification of biotinylated dextran amine histochemistry for labeling the developing mammalian brain

Biotinylated dextran amine (BDA) has proven to be an excellent anterograde tracer in adult mammalian brains, having some advantages over other anterograde tracers such as Phaseolus vulgaris-leucoagglutinin (PHA-L) and biocytin. However, results are inferior when BDA is used in neonatal mammals. To improve the sensitivity and quality of BDA labeling in neonatal mammalian brains, the tetramethylbenzidine-sodium tungstate (TMB-ST) method for horseradish peroxidase (HRP) histochemistry was modified and used in BDA histochemistry. After BDA application to the visual cortex of neonatal rat and cat, contralateral and ipsilateral cortical and subcortical regions were examined for BDA-labeled exons and terminals. The modified BDA histochemistry produced corpus callosum (CC) axons in neonatal rat and cat that were heavily and continuously labeled. The distribution, trajectories, branching and termination of individual CC axons, and even possible axon-axon contracts, were clearly identified in exquisite detail, even at low magnification. The quality of BDA labeling in the ipsilateral lateral geniculate nucleus and superior colliculus was similar to that of the CC axonal labeling. These results indicate that the modified BDA histochemistry provides a very sensitive and reliable approach to revealing the detailed distribution and morphology of projecting axons and terminals in the developing mammalian nervous system.

Induction of proteinuria by adriamycin or bovine serum albumin in the mouse

To establish models of proteinuria in the mouse, BALB/c mice were injected with puromycin aminonucleoside (PAN, 1.5 or 4.5 mg/10 g body weight), adriamycin (AD, 0.2 mg/10 g body weight) intravenously or bovine serum albumin (BSA, 100 mg/10 g body weight) intraperitoneally. Proteinuria was measured as the ratio of urinary albumin (micrograms/ml) to creatinine (mg/dl) and further characterized by isotyping the immunoglobulin. Although not obtained with PAN (followed for 4 weeks), proteinuria was readily attained in the mouse after treatment with AD or BSA. Most AD-treated mice (5/7) developed an abrupt increase of proteinuria at day 2 after injection, with the ratio of urinary albumin to creatinine in the range 0.28-0.45. The degree of proteinuria increased with time and all mice tested (7/7) showed overt proteinuria at day 4. These mice became anuric at day 5 and died at days 6 and 7. For BSA, 4 h after administration, four of seven mice showed enhanced proteinuria, lasting 8 h with urinary albumin and creatinine in a ratio < 0.05. Isotyping of urine samples collected at the time of heavy proteinuria (ratio of urinary albumin to creatinine: > 0.40 for AD-treated mice, > 0.15 for BSA-treated mice) showed that all of the mice (7/7) with AD-induced proteinuria (ADp) and three of four mice with BSA-induced proteinuria (BSAp) revealed urinary IgG2b and IgA, while only one of seven control mice showed IgG2b alone in urine. The mice were sacrificed at the time they presented with heavy proteinura for pathologic and anionic studies on renal tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Confirmation of the existence of transitory corpus callosum axons in area 17 of neonatal cat: an anterograde tracing study using biotinylated dextran amine

Corpus callosum (CC) axons in visual cortex were labeled anterogradely by in vivo biotinylated dextran amine (BDA) in neonatal cat at postnatal day (PND) 6, 10 and 15. Labeled CC axons were distributed throughout the visual cortex including medial area 17. The number of CC axons in medial area 17 increased from PND 6 to PND 10, and then decreased from PND 10 to PND 15. At PND 15, few CC axons could be followed into the grey matter in medial area 17. Thus, BDA labels transitory CC axons that extend through all cortical layers in medial area 17, confirming the results revealed by in vitro DiI labeling.

Neuropeptide Y immunoreactive axons in the corpus callosum of the cat during postnatal development

Many immunocytochemical studies have identified different types of neurotransmitters localized in the corpus callosum (CC) axons in the adult mammal. Few studies have looked at the development of different neurochemically identified CC systems. Previous studies on the development of cat CC axons have indicated that a large number of transitory CC axons project to the cortex during early postnatal development. The present study focuses on the development of one neurochemically identified group of CC axons in the cat, labeled with an antibody against neuropeptide Y (NPY), to determine if this group participates in transitory CC axonal growth. Cats at specified ages from birth to adulthood were studied with a routine method of immunocytochemistry for antiserum to NPY. NPY-immunoreactive (ir) CC axons were detected at all stages examined, from newborn to adult; the peak density occurred during postnatal weeks (PNW) 3-4. During PNW 1-2, the density of NPY-ir CC axons increased gradually; some NPY-ir axons at this age had growth cones located within the CC bundle between the cerebral hemispheres. The density of the NPY-ir CC axons decreased gradually during PNW 5-7, and from PNW 8 to maturity only a few NPY-ir CC axons were observed. These results indicate that at least two types of NPY-ir CC axons (i.e., transitory and permanent) exist during development, and that most of these axons are eliminated or only express NPY-ir for a short period during development. The results also indicate that neurochemical subsets of CC axons participate in the extensive transitory growth observed by means of the membrane tracer DiI but they may follow unique developmental timetables.

[Epidemiologic analysis of 845 cases of pedestrian traffic injuries]

BACKGROUND

Pedestrian-vehicle collision is a serious public health problem today in Taiwan, but this issue of pedestrian safety has received relatively little attention. The purpose of this study was to evaluate the characteristics of pedestrian injury after involvement in a collision.

METHODS

An epidemiologic study on 845 traffic accident consecutive victims, managed at Tri-Service General Hospital in 1990, was performed. They were interviewed with a brief questionnaire about demographic data and types of accident including injured site, Injury Severity Score (ISS) and outcome; the latter was obtained by review of medical records and by a telephone survey performed four months after discharge.

RESULTS

Results showed a common distribution of injuries for all age groups. Of the 845 patients, 487 were male and 358 were female (sex ratio = 1.4:1). The majority of injuries (84.8%) occurred for pedestrians who were walking on the side of, or crossing, the road. Four hundred and ninety-six victims (58.7%) were treated in the Emergency Department only, while 342 patients (40.5%) were further admitted as inpatients; the remaining 34 patients (4.0%) died in the Emergency Department (0.8%), or as inpatients (3.2%). The study showed fatality rates according to age as follows: 0.5% age 1 to 19, 1.8% age 20 to 39, 4.6% age 40 to 59, 7.5% age 60 or older, with the elderly having the highest pedestrian death rate. Elder pedestrians who were struck by motor vehicles also had the highest fatality rate of all pedestrian injury victims. The percentage of pedestrian injuries is fairly constant from month to month. For time of day, 12 noon and 3 to 5 pm were associated with the most injuries for age 0-19 youths; 4 pm and 10 pm for age 20-59 adults; 8 am and 7 pm for age 60 or older. There was a significant difference of mean ISS between the nonsurvivors (27.8) and the survivors (4.6) (p < 0.01). When nonsurvivors were compared with survivors, among the aged (> 60), high Abbreviated Injury Scale (AIS) of head, and high ISS were most common among nonsurvivors (p < 0.01).

CONCLUSIONS

That pedestrians are the least protected participants in traffic. Situations is reflected by a considerable fatality rate among pedestrians. Data from this study should be useful for designing, implementing, and evaluating a targeted pedestrian safety program in Taiwan.

Experimental IgA nephropathy. Enhanced deposition of glomerular IgA immune complex in proteinuric states

BACKGROUND

IgA nephropathy is induced by the IgA-immune complex (IC). IgA nephropathy associated with heavy proteinuria is considered a more progressive form of the disease. To elucidate the mechanism by which the latter condition occurs, we investigated the effect of proteinuria on the glomerular deposition of IgA-IC.

EXPERIMENTAL DESIGN

BALB/c female mice that had been made proteinuric by adriamycin or bovine serum albumin (BSA) were injected with TEPC-15 hybridoma-derived IgA anti-phosphorylcholine (PC) and individual specific antigens. The 6-hour clearance kinetics of IgA were measured, and the accumulation of IgA deposits and the third complement component (C3) in the glomerulus were analyzed.

RESULTS

The clearance kinetics of 125I-IgA injected together with a specific antigen, PC-conjugated BSA (BSA-PC), showed only a minimal distinction between the experimental (proteinuric) and the control (nonproteinuric) groups of mice. However, analysis of renal tissue by immunofluorescence and light microscopic autoradiography revealed markedly enhanced mesangial IgA-IC deposition in the proteinuric mice receiving IgA and one of three specific antigens, BSA-PC, PC-conjugated cytochrome-c, and a pneumococcal C-polysaccharide. Immunofluorescence also showed augmented mesangial C3 deposition in proteinuric mice that received IgA/PC-conjugated cytochrome-c or IgA/pneumococcal C-polysaccharide. In addition, adriamycin or BSA per se did not influence glomerular IgA-IC localization.

CONCLUSIONS

Glomerular localization of nephritogenic IgA-IC was comparably enhanced in mice with proteinuria induced by various methods. Thus, a vicious cycle for the progression of IgA nephropathy might ensue in proteinuric states.

[Reactive histiocytosis variant of tuberculous lymphadenitis]

Paraffin blocks from 38 cases with superficial lymph nodes exhibiting reactive histiocytosis with debris-like necrosis and neutrophil infiltration were studied by means of polymerase chain reaction for amplifying the repetitive DNA sequence (123pb fragment) specific for mycobacterium tuberculosis (M.TB-PCR), BCG immunohistochemistry (BCG-IHC) as well as acid fast stain (AF) for M.TB/MOTT (mycobacterium other than tuberculosis). The comprehensive positive rate of the three methods was 52.6% (20/38 cases) and the separate positive rates for M.TB-PCR, BCG-IHC and AF being 50%, 26% and 0.8% respectively. The results prove that (1) half of the reactive histiocytosis of lymph nodes selected in this paper are related to tuberculosis infection, i.e., some tuberculous lymphadenitis may appear as a variant of reactive histiocytosis; and (2) PCR technique is a very valuable method for making the etiologic diagnosis of tuberculous lymphadenitis.

[Head injuries in traffic accidents with emphasis on the comparisons between motorcycle-helmet users and non-users]

Motor-vehicle incidents in Taiwan are a major cause of head injuries. Our objective was to analyze the characteristics of head injuries caused by motor vehicle accidents in terms of the injured person's demographic characteristics, time and types of crash, injury severity on the abbreviated injury scale (AIS), medical cost and benefits of helmet protection. For this purpose we conducted an epidemiologic survey of 2451 consecutive victims of traffic accidents, coming to, or managed at, the emergency care department of a large Taipei metropolitan hospital in 1990. The results showed that the most common cause of head injury in traffic accidents was a motorcycle incident. Motorcycle accident injured patients were generally young males, laborers or students. Most head injuries occurred between 16:00 and 23:00, and peaking at 21:00 in a day. Forty-three points four percent of patients were admitted, major head injury fatalities occurred within one week of the collision. The elderly or patients with high AIS comprised most nonsurvivors. According to our data, helmet usage was about 14% overall. Helmetless young riders were numerous among the total victims. A significant difference was noted in the severity of injury of helmeted users of motorcycles, compared with those who wore no helmet. As expected, patients who did not wear a helmet had a greater AIS average and higher rate of fatality. Forty-one of the 42 fatalities were patients who had been riding on motorcycles without helmets. Helmets provide adequate protection and reduce severity of injury, and medical cost for motorcycle collisions.

Gycomoside I: a new dammarane saponin from Gynostemma compressum

A new dammarane saponin, gycomoside I, was isolated from the aerial part of Gynostemma compressum X.X. Chen et D.R.Liang. The structure was elucidated on the basis of spectral and chemical evidences as [see text].

[Estimation of case fatality rate and incidence rate of traffic injury in Taiwan--analysis of 4,329 victims at a medical center]

Accidents remain the third leading cause of mortality in Taiwan, of which traffic injuries constitute the major part. In order to characterize traffic injuries and to estimate the annual traffic injury rate in Taiwan, we conducted an epidemiologic study of 4,329 consecutive traffic accident victims, managed at the Tri-Service General Hospital from January to December of 1990. Victims were interviewed for demographic data and types of accident using a brief questionnaire. The questions included injury site and Injury Severity Score (ISS); final diagnosis and outcome were obtained by review of medical records and by a telephone survey performed 4 months after discharge. The sex- and age-specific case fatality rates calculated from the data obtained in this study were used to divide the annual incidence of traffic mortality abstracted from the vital statistics of Taiwan (1990) and, thus, to obtain an annual frequency of traffic injury cases under certain assumptions. The results showed that more men than women were injured in all age groups. The highest frequency of traffic injuries was noted in patients ranging in age from 20 to 39 years. Up to 58.9% of the victims were motorcycle users, followed by pedestrians (19.5%) and automobile-users (16.0%). The case fatality rate was 2.5% for males and 1.7% for females. The estimated annual traffic incidence was about 330,000, and the total annual rate of traffic injuries in Taiwan was 1,627/100,000 (2,188/100,000 for men and 1,114/100,000 for women).(ABSTRACT TRUNCATED AT 250 WORDS)

Glomerular localization of nephritogenic protein complexes on a nonimmunologic basis

BACKGROUND

In a preliminary study, we have found that a group of charge-distinct protein molecules can react with each other to form protein complexes in vitro. The present study was conducted to determine the nephritogenic effect and the mode of action of these proteins in vivo.

EXPERIMENTAL DESIGN

To demonstrate the precipitating interactions, a phosphorylcholine (PC)-conjugated, cationized bovine serum albumin (BSA(+)-PC) was applied to react with dinitrophenyl (DNP)-protein conjugates by double diffusion test. The types of forces involved in binding actions were determined. The experimental groups of CDF1 mice were injected simultaneously with BSA(+)-PC and individual DNP-protein conjugates through the tail vein. Both clearance kinetics and renal tissue studies were performed.

RESULTS

BSA(+)-PC was able to form precipitin lines with respective DNP-protein conjugates in the agarose gel without any antigen-antibody interactions. These precipitating reactions were partially prevented by the presence of either NaCl, urea, or trifluoroacetate, suggesting that electrostatic force, hydrogen bond, and/or hydrophobic force are involved in the precipitation of these modified protein molecules. The clearance kinetics of BSA(+)-PC/BSA-DNP, and BSA(+)-PC/DNP-apoferritin showed a significant acceleration of the rapid phase of elimination. All of the experimental mice had hematuria and systemic thrombotic microangiopathic changes 1 hour later. By immunofluorescence, both the BSA(+)-PC and the DNP-protein conjugate injected were present in the renal glomerular tufts of experimental groups, although these protein molecules failed to deposit in the glomerulus when injected alone. Concomitant fibrinogen deposition was noted in almost all of the glomeruli affected. Moreover, 10 to 50% of the glomeruli examined 4 hours after injection had deposition of the third component of complement (C3).

CONCLUSIONS

These data strongly support a hypothesis that nondeposited nephritogenic protein molecules in a fashion of heterogeneous complexes can localize in the glomerulus, thereby initiating renal injury, with the lack of antibody involvement.

[A clinical study on 268 patients with cervical carcinoma]

Cancer is the leading cause of death in Taiwan with cervical carcinoma having the highest incidence rate (29.65 per 100,000) of all cancers among women. In the present study, we collected 268 consecutive cases of cervical carcinoma, seen in Tri-Service General Hospital from January 1983 to December 1984. The evaluation included a review of the case data including demographic features, symptoms, stage of cancer, reproductive history, pathology, and survival time (product limit method for survival). Results showed that in situ cervical carcinoma was diagnosed in 31 (11.5%) patients with a mean age of 47.7 years. Two hundred and thirty-seven patients (88.5%) with a mean age of 55.6 years were noted to have invasive carcinoma, showing stage I 22.4%, stage II 46.6%, stage III 10.1% and stage IV 9.3%. The ratio of invasive carcinoma to carcinoma in situ was 7.7:1. Ninety-two percent of patients were symptomatic on admission with vaginal bleeding (78%), vaginal discharge (16%) and abdominal pain (16%) being the most common, and the majority of these patients were symptomatic before cervical carcinoma was pathologically proved. Survival analysis showed five-year survival rates of 100%, 84.6%, 63.2%, 54.1% and 13.2% for stages O, I, II, III and IV, respectively. Low cervical carcinoma survival rates seemed clearly related to progression of the disease the presence of more extensive disease. The average age at the time of diagnosis was older and the clinical stage of disease was more advanced when compared with most developed countries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Non-Hodgkin's lymphoma in adults: a clinico-pathologic study of 169 cases]

From 1983 to 1988, non-Hodgkin's lymphoma was diagnosed in 169 patients ranging from 19 to 89 years of age (mean 49). They were investigated using both unifactorial and multivariate regression (Cox model) analyses to determine the relationship of survival rate and prognostic factors including age, sex, histology, B symptom and clinical stage. All cases were histologically classified according to the criteria of the working formulation and were staged according to the Ann Arbor classification. Non-Hodgkin's lymphoma occurred roughly 9 times as frequently as Hodgkin's disease. The lymph nodes of the neck and inguinal regions were noted to be the most common sites of involvement. However, extranodal lymphomas originated most frequently from the stomach. For the patients with non-Hodgkin's lymphoma, the proportions of low grade, intermediate grade, and high grade were 10.7%, 59.1% and 20.7%, respectively. The remaining 9.5% of cases were unclassified (7.7%) and true histiocytic (1.8%). The most common subtype was diffuse large cell (33.7%). Lymphoblastic lymphoma was found to have a predilection for young male adults. Follicular lymphomas occurred mainly in mid-adult life. The patients with high grade lymphoma almost always presented the advanced stage. The median survival time (MST) of our series was 20 months, the 3-year survival rate was 43.3% and the 5-year survival rate was 30.40%. Statistical studies of both unifactorial (p less than 0.01) and multivariate regression (p less than 0.05) analyses showed that patients with an age greater than 60 years old, having B symptom, clinically advanced stage, or both histologically intermediate and high grade experienced a much poorer prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Small cell lung cancer: survival analysis of 96 cases]

Existing records of 96 patients with small cell lung cancer (SCLC) at TSGH from 1983 to 1987 were analyzed to determine the relationship of survival rate and prognostic factors including age, sex stage, symptomatic history, liver metastasis, bone metastasis, albumin level, hemoglobin value, and choice of treatment. For the SCLC patients the median survival time (MST) is only 7.2 month, the 1-year survival rate is 25.1%, and the 2-year survival rate is 5.1%. The prognosis for patients with liver or bone metastasis was poor. Sixteen prognostic variables were evaluated in a Cox proportional hazard regression model analysis to assess their prognostic value. It is suggested that improving survival rate for patients with SCLS can be obtained by using selective combined therapy.

[Mode of action of intrauterine devices]

The intrauterine foreign bodies (IUFB) used in a series of the authors' experiments were made of stainless steel, plastics, copper wire, and silicone rubber. The experiments were done as follows: Firstly, the implantive influence of IUFB was examined. It was found (1) that the embryo might be implanted above or below the position of the foreign body but not at the position of the foreign body and (2) that the existing 5 different kinds of foreign bodies possessed the same antifertility effect. Secondly, the washing fluid of uterine cavities with foreign bodies was examined for studying biochemical component, immunologic reaction in respect of blood coagulating factors and white cell counts and its differential counts. The results of these experiments did not give any significant statistical meaning except in so far as the protein nitrogen and white cell counts were concerned. The authors have investigated the results of the contrast group by statistical methods, which showed no significant change, but it was found that the polymorphonuclear leukocyte counts are proportional to the amount of protein nitrogen contained. In the experiments, the authors did not observe any relationship existing between the uterine foreign bodies and the increase of macrophages. Thirdly, the morphology of the endometrium in contact with intrauterine foreign bodies was examined by light, scanning, and transmission electron microscopy. The results of these observations showed that the phenomenon of the endometrium can be divided into 3 conditions: (1) the accumulated mucus formed a thin or thick layer like a screen covering the surface of the endometrium; (2) the erosions and ulcers appeared on the surface of the endometrium with some white cell infiltration; and (3) sometimes, necrosis of the endometrium and bleeding ensued, 1 or another of these phenomena might happen in all the samples but one. The authors, therefore, conclude that the antifertility effect of an interauterine foreign body must prevent the embryo from implantation. This effect may be caused by the pressure and stimulation of the foreign bodies, which induce unspecialized reaction with moderate exudation and necrosis in the tissue.