Plakoglobin regulates adipocyte differentiation independently of the Wnt/β-catenin signaling pathway

The scaffold protein 14-3-3ζ is an established regulator of adipogenesis and postnatal adiposity. We and others have demonstrated the 14-3-3ζ interactome to be diverse and dynamic, and it can be examined to identify novel regulators of physiological processes, including adipogenesis. In the present study, we sought to determine if factors that influence adipogenesis during the development of obesity could be identified in the 14-3-3ζ interactome found in white adipose tissue of lean or obese TAP-tagged-14-3-3ζ overexpressing mice. Using mass spectrometry, differences in the abundance of novel, as well as established, adipogenic factors within the 14-3-3ζ interactome could be detected in adipose tissues. One novel candidate was revealed to be plakoglobin, the homolog of the known adipogenic inhibitor, β-catenin, and herein, we report that plakoglobin is involved in adipocyte differentiation. Plakoglobin is expressed in murine 3T3-L1 cells and is primarily localized to the nucleus, where its abundance decreases during adipogenesis. Depletion of plakoglobin by siRNA inhibited adipogenesis and reduced PPARγ2 expression, and similarly, plakoglobin depletion in human adipose-derived stem cells also impaired adipogenesis and reduced lipid accumulation post-differentiation. Transcriptional assays indicated that plakoglobin does not participate in Wnt/β-catenin signaling, as its depletion did not affect Wnt3a-mediated transcriptional activity. Taken together, our results establish plakoglobin as a novel regulator of adipogenesis in vitro and highlights the ability of using the 14-3-3ζ interactome to identify potential pro-obesogenic factors.

A Dyadic Cooking-Based Intervention for Improving Subjective Health and Well-Being of Older Adults with Subjective Cognitive Decline and Their Caregivers: A Randomized Controlled Trial

OBJECTIVES

Evidence on the effectiveness of cooking activities as a well-being promotion intervention for older adults with subjective cognitive decline (SCD) and their caregivers is scarce. In view of this, a randomized controlled trial was conducted to examine whether a dyadic cooking-based intervention can improve the subjective health and well-being of older adults with SCD and their caregivers, as well as the cooking competence of the former group.

DESIGN

Randomized controlled trial.

SETTING

Community.

PARTICIPANTS

Sixty pairs of community-dwelling older adults aged 60 years or above with SCD (mean age = 78.4 years) and their caregivers (mean age = 65.3 years) were randomly assigned to the intervention group (N = 30 pairs) and the wait-list control group (N = 30 pairs).

INTERVENTION

The intervention was an innovative 5-week (two hours per week) dyadic cooking-based intervention employing procedural learning methods specifically adapted for older adults with SCD.

MEASUREMENTS

The outcome measures included 1) a well-being index composed by four indicators: life satisfaction, feeling of happiness, sense of purpose and meaning in life, and perceived health, and 2) cooking competence.

RESULTS

For both older adults with SCD and their caregivers, the increases in the well-being index were significantly greater in the intervention group than in the control group (β = 0.508, 95% CI [0.036, 0.980]). For older adults with SCD, the increases in the cooking competence score were significantly greater in the intervention group than in the control group (β = 1.629, 95% CI [0.165, 3.071]).

CONCLUSION

The dyadic cooking-based intervention resulted in improvements in the cooking competence and well-being of older adults with SCD, as well as the well-being of caregivers.

The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma

Background:

For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL.

Patients and methods:

ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group.

Results:

A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP.

Conclusions:

In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.

Dermatology services: The new normal post COVID-19

The article discusses the impact of COVID‐19 on the future of dermatology services. It will explore the changes dermatology services may need to follow to minimise disease transmission. This will include an integration of teledermatology into everyday practice, a shift in dermatology training, and change in dermoscopy technique.

High-Performance Host-Device Scheduling and Data-Transfer Minimization Techniques for Visualization of 3D Agent-Based Wound Healing Applications

High-fidelity numerical simulations produce massive amounts of data. Analyzing these numerical data sets as they are being generated provides useful insights into the processes underlying the modeled phenomenon. However, developing real-time in-situ visualization techniques to process large amounts of data can be challenging since the data does not fit on the GPU, thus requiring expensive CPU-GPU data copies. In this work, we present a scheduling scheme that achieve real-time simulation and interactivity through GPU hyper-tasking. Furthermore, the CPU-GPU communications were minimized using an activity-aware technique to reduce redundant copies. Our simulation platform is capable of visualizing 1.7 billion protein data points in situ, with an average frame rate of 42.8 fps. This performance allows users to explore large data sets on remote server with real-time interactivity as they are performing their simulations.

A comparison of measured and predicted diffusion coefficients applied to sand and silt sized acid mine drainage materials

Determining the rate at which Acid Mine Drainage (AMD) sulfide oxidation occurs in mining waste products is a central requirement for safe and sustainable long term design of storages, including tails storage facilities, ore stockpiles and waste rock dumps. Inappropriate design can result in AMD acidification, mobilisation of heavy metals and pollution of ground and surface waters. The use of soil gas (oxygen) transport modelling to model AMD based sulfide oxidation and potential acidity loads is widespread, but diffusion coefficients used for modelling are based on existing diffusion coefficient models derived for natural and agricultural soils. Mining wastes are often well sorted due to mineral processing, and differences in soil structure and porosity can impact on diffusion coefficient behaviour compared to natural soils. This study compares a variety of approaches to estimate the diffusion coefficient and compare these results to measured values for comparison and analysis. A diffusion column apparatus is used to compare diffusion coefficient models from the literature with test results from the laboratory in several mining derived AMD materials. The results of the comparison indicate that laboratory testing of diffusion provides more accurate estimation of soil gas diffusion coefficients in mine materials. The use of diffusion coefficient safety factor approaches are explored as possible alternatives, if measurement of mine material matrix soil gas diffusion coefficient is not possible.

Post-traumatic rapidly enlarging mucinous carcinoma of the breast with intratumoural haemorrhage: MRI appearances with pathological correlation

Pure mucinous carcinoma of the breast is a histological type of invasive carcinoma and generally shows a slow growth pattern. Rapid growth and intratumoural haemorrhage are rare and there have been no reports presenting such a clinical course and associated radiographic findings. We report a case with atypical rapidly enlarging mucinous carcinoma of the breast after trauma, in which MRI closely reflected the histopathological background and was thought to be useful for differential diagnosis from other highly malignant breast tumours.

Investigator-initiated clinical trials in Malaysia and the role of the Clinical Research Centre of the Ministry of Health

The objective of this review is to better understand the concept of investigator-initiated trials and its benefits. While investigator-initiated trials can be an invaluable tool, there are several challenges in its initiation and management. However, it is for these reasons that Clinical Research Centre (CRC) had developed the Investigator Initiated Trial (IIT) Programme where financial support and technical assistance are provided to local investigators embarking on their own clinical trials. In the course of preparing the review, we found that the inclination of investigator-initiated trials has yet to be well established in Ministry of Health, Malaysia. Given the potential and impact of such trials, clinicians should be aware of their ability as well as the availability of a supportive network in mobilising their concerted research efforts. Greater research collaboration among investigators could foster more innovative, insightful and constructive research.

MR imaging of ventral thalamic nuclei

BACKGROUND AND PURPOSE

The Vim and VPL are important target regions of the thalamus for DBS. Our aim was to clarify the anatomic locations of the ventral thalamic nuclei, including the Vim and VPL, on MR imaging.

MATERIALS AND METHODS

Ten healthy adult volunteers underwent MR imaging by using a 1.5T whole-body scanner. The subjects included 5 men and 5 women, ranging in age from 23 to 38 years, with a mean age of 28 years. The subjects were imaged with STIR sequences (TR/TE/TI = 3200 ms/15 ms/120 ms) and DTI with a single-shot echo-planar imaging technique (TR/TE = 6000 ms/88 ms, b-value = 2000 s/mm(2)). Tractography of the CTC and spinothalamic pathway was used to identify the thalamic nuclei. Tractography of the PT was used as a reference, and the results were superimposed on the STIR image, FA map, and color-coded vector map.

RESULTS

The Vim, VPL, and PT were all in close contact at the level through the ventral thalamus. The Vim was bounded laterally by the PT and medially by the IML. The VPL was bounded anteriorly by the Vim, laterally by the internal capsule, and medially by the IML. The posterior boundary of the VPL was defined by a band of low FA that divided the VPL from the pulvinar.

CONCLUSIONS

The ventral thalamic nuclei can be identified on MR imaging by using reference structures such as the PT and the IML.

Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up

BACKGROUND

Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status.

METHODS

A review of 42 RYGB patients with T2DM and >or=3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved.

RESULTS

T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P <or=.0001; and 85% versus 15%; P = .0006, respectively).

CONCLUSION

Our results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.

Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer

BACKGROUND

The role of positron emission tomography with the glucose analogue [18F] fluoro-2-deoxy-D-glucose (FDG-PET) in the initial staging of disease in patients with primary colorectal cancer (CRC) has not been adequately assessed.

AIMS

To evaluate the additional value of FDG-PET as a staging modality, complementary to routine multidetector row computed tomography (MDCT) in patients with CRC.

METHODS

Forty four patients with CRC underwent preoperative MDCT and FDG-PET. The accuracy of intraoperative macroscopic staging was also investigated compared with histopathological diagnosis. All FDG-PET images were evaluated with respect to detectability of the primary tumour, lymph node involvement, and distant metastases. Both MDCT and FDG-PET diagnoses and treatment plan were compared with surgical and histopathological results.

RESULTS

Thirty seven patients underwent surgery. Tumour detection rate was 95% (42/44) for MDCT, 100% (44/44) for FDG-PET, and 100% (37/37) for intraoperative macroscopic diagnosis. Pathological diagnosis of T factor was T1 in five, T2 in four, T3 in 24, and T4 in four cases. Concordance rate with pathological findings of T factor was 57% (21/37) for MDCT and 62% (23/37) for macroscopic diagnosis. Lymph node involvement was pathologically positive in 19 cases. Regarding N factor, overall accuracy was 62% (23/37) for MDCT, 59% (22/37) for FDG-PET, and 70% (26/37) for macroscopic diagnosis. For all 44 patients, FDG-PET findings resulted in treatment changes in only one (2%) patient.

CONCLUSION

FDG-PET is not superior to routine MDCT in the initial staging of primary CRC.

Functional categories of TP53 mutation in colorectal cancer: results of an International Collaborative Study

BACKGROUND

Loss of TP53 function through gene mutation is a critical event in the development and progression of many tumour types including colorectal cancer (CRC). In vitro studies have found considerable heterogeneity amongst different TP53 mutants in terms of their transactivating abilities. The aim of this work was to evaluate whether TP53 mutations classified as functionally inactive (< or=20% of wildtype transactivation ability) had different prognostic and predictive values in CRC compared with mutations that retained significant activity.

MATERIALS AND METHODS

TP53 mutations within a large, international database of CRC (n = 3583) were classified according to functional status for transactivation.

RESULTS

Inactive TP53 mutations were found in 29% of all CRCs and were more frequent in rectal (32%) than proximal colon (22%) tumours (P < 0.001). Higher frequencies of inactive TP53 mutations were also seen in advanced stage tumours (P = 0.0003) and in tumours with the poor prognostic features of vascular (P = 0.006) and lymphatic invasion (P = 0.002). Inactive TP53 mutations were associated with significantly worse outcome only in patients with Dukes' stage D tumours (RR = 1.71, 95%CI 1.25-2.33, P < 0.001). Patients with Dukes' C stage tumours appeared to gain a survival benefit from 5-fluorouracil-based chemotherapy regardless of TP53 functional status for transactivation ability.

CONCLUSIONS

Mutations that inactivate the transactivational ability of TP53 are more frequent in advanced CRC and are associated with worse prognosis in this stage of disease.

How do paediatricians communicate with children and parents?

AIM

The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor-parent-child communication in the outpatient setting.

METHODS

Fifty-one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions.

RESULTS

Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%).

CONTROL

Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor.

CONCLUSION

Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient-centred approach.

CT-based evaluation of axillary sentinel lymph node status in breast cancer: value of added contrast-enhanced study

PURPOSE

To evaluate the diagnostic reliability of CT-based sentinel lymph node (SLN) size criteria for selecting the candidates for direct axillary dissection without SLN biopsy and to determine the value of added contrast-enhanced study.

MATERIAL AND METHODS

Breast cancer patients (n = 107) underwent triple phasic (1-min, 3-min, 8-min) contrast-enhanced 5 mm-computed tomography (CT) of the breasts and axillae. In the CT image, the most inferior lymph node in the axilla was designated the SLN. Axillary status was judged based on SLN size criteria. CT density, enhancement rate, and peak enhancement time of each SLN were correlated with histopathological results.

RESULTS

SLN size criteria demonstrated a sensitivity of 76% and a positive predictive value of 95% in predicting SLN metastasis. The density values at each scanning time-point were significantly different for metastatic and non-metastatic SLN. However, their enhancement rates differed significantly only at 1 min. Their peak enhancement occurred primarily at 1 min. The use of contrast-enhancement criteria improved the predictive sensitivity, but failed to decrease the false-positive rate of the SLN size criteria.

CONCLUSION

The enhancement rate at 1 min proved to be the most useful parameter in contrast-enhanced CT studies; however, it failed in improving the accuracy of the SLN size criteria.

Wallerian degeneration of the inferior cerebellar peduncle depicted by diffusion weighted imaging

Wallerian degeneration of the inferior cerebellar peduncle has never been demonstrated on imaging studies. We describe a case in which it was depicted by thin slice diffusion weighted imaging. Location to the inferior cerebellar peduncle was confirmed by a fibre tracking method.

Evaluation of axillary status in breast cancer. CT-based determination of sentinel lymph node size

PURPOSE

To determine whether the location and size of sentinel lymph nodes (SLN) on CT are predictive of the axillary lymph node status in patients with breast cancer.

MATERIAL AND METHODS

Forty patients with confirmed breast cancer underwent 5-mm CT of both breasts and axillae and the most inferior lymph node in the affected axilla was designated the SLN. Based on CT assessment of the axillary lymph node status, 22 (55%) patients then underwent dye- and gamma probe (DGP)-guided SLN biopsy followed by axillary dissection; 18 (45%) underwent dissection without prior SLN biopsy. The localization and status of the SLN determined on CT and by DGP-guided biopsy were compared. Biopsied and excised nodes were subjected to histopathologic examinations.

RESULTS

All SLN identified on CT were close to the lateral thoracic artery and their localization corresponded well with SLN identified by the DGP-guided method. The positive predictive value of CT diagnosis was 100%. Histopathologic examination of excised nodes confirmed that none of the SLN biopsies was false-negative.

CONCLUSION

Our CT criteria were highly accurate for identification and diagnostic assessment of SLN and useful for evaluating the axillary status in patients with breast cancer.

Evaluation of axillary status in breast cancer. CT-based determination of sentinel lymph node size

PURPOSE

To determine whether the location and size of sentinel lymph nodes (SLN) on CT are predictive of the axillary lymph node status in patients with breast cancer.

MATERIAL AND METHODS

Forty patients with confirmed breast cancer underwent 5-mm CT of both breasts and axillae and the most inferior lymph node in the affected axilla was designated the SLN. Based on CT assessment of the axillary lymph node status, 22 (55%) patients then underwent dye- and gamma probe (DGP)-guided SLN biopsy followed by axillary dissection; 18 (45%) underwent dissection without prior SLN biopsy. The localization and status of the SLN determined on CT and by DGP-guided biopsy were compared. Biopsied and excised nodes were subjected to histopathologic examinations.

RESULTS

All SLN identified on CT were close to the lateral thoracic artery and their localization corresponded well with SLN identified by the DGP-guided method. The positive predictive value of CT diagnosis was 100%. Histopathologic examination of excised nodes confirmed that none of the SLN biopsies was false-negative.

CONCLUSION

Our CT criteria were highly accurate for identification and diagnostic assessment of SLN and useful for evaluating the axillary status in patients with breast cancer.

[The expression of DNA mismatch repair genes and detection of DNA ploidy in young patients with colorectal carcinoma]

OBJECTIVE

To investigate the clinicopathologic characters and carcinogentic pathways of young (age < 36) colorectal carcinomas (CRCs) in Guangzhou, China.

METHODS

Immunohistochemistry and flow cytometry methods were used to detect the expression of hMSH(2) and hMLH(1), status of DNA ploidy in 63 cases of young CRCs from Guangzhou, China, and analyze their correlations with patient's clinicopathological characters.

RESULTS

Of the 63 young CRCs studied, forty-four (69.8%) tumors were non-mucinous carcinomas, thirty-nine (61.9%) patients were in Dukes' C or D stage. Of the 59 CRCs which were successfully detected by immunohistochemistry and flow cytometry, ten (16.9%) CRCs lost either hMSH(2) or hMLH(1) and showed DNA diploid or near-diploid, while twenty-six (44.1%) had aneuploid DNA content and all with the normal expression of hMSH(2) and hMLH(1). In addition, there existed a significant percentage (23/59, 39%) of young CRCs showing no loss of either of these two mismatch repair proteins and having a diploid or near diploid DNA content.

CONCLUSION

The overall percentage of young CRCs in Guangzhou is significantly higher than those in Caucasian predominant countries and about seventy percent of young CRCs in Guangzhou are conventional carcinomas. 39% of young CRCs in Guangzhou showed no evidence of either chromosomal instability or microsatellite instability carcinogentic pathway, indicating that there must be at least a third pathway which triggers the CRCs in these special subgroups of young patients in Guangzhou, China.

Combination therapy with lamivudine and famciclovir for chronic hepatitis B-infected Chinese patients: a viral dynamics study

In vitro studies have shown that lamivudine and penciclovir (the active metabolite of famciclovir) act synergistically to inhibit hepatitis B virus (HBV) replication. We compared the effectiveness of HBV viral suppression by lamivudine monotherapy versus lamivudine plus famciclovir combination therapy in Chinese patients with chronic HBV infection. Twenty-one Chinese hepatitis B e antigen (HBeAg)-positive patients, with detectable HBV DNA (Digene Hybrid Capture II), were randomized to receive either lamivudine 150 mg/d orally (group 1, 9 patients) or lamivudine 150 mg/d plus famciclovir 500 mg 3 times a day orally (group 2, 12 patients) for 12 weeks, with a follow-up period of at least 16 weeks. Serial serum HBV-DNA levels were determined and a mathematical model with provision for incomplete inhibition of virus production during therapy was applied to analyze the dynamics of viral clearance. The mean antiviral efficacy was significantly greater in group 2 than in group 1 (0.988 +/- 0.012 vs. 0.94 +/- 0.03, P =.0012). HBV DNA returned to pretreatment level within 16 weeks after the end of initial treatment in 4 patients (66.7%) in group 1 and none in group 2 (P =.08), who remained HBeAg positive and received no further treatment after week 12. Hence, in Chinese chronic HBeAg-positive patients, combination therapy using lamivudine and famciclovir was superior to lamivudine monotherapy in inhibiting HBV replication. Further studies of longer duration are needed to define whether combination therapy will increase the HBeAg seroconversion rate and decrease the rate of emergence of lamivudine-resistant variants.

An evaluation of whole blood testing for Helicobacter pylori infection in the Chinese population

BACKGROUND

Near patient tests for Helicobacter pylori were developed to assist in the management of dyspepsia patients in general practice. Most studies were performed in western populations.

AIM

To evaluate the rapid whole blood test (Flexpack HP) for H. pylori in the Chinese population.

METHODS

Consecutive dyspeptic patients referred for upper endoscopy were recruited. During upper endoscopy, biopsies were taken from the antrum and corpus for rapid urease test (CLO test) and histological examination. After endoscopy, the whole blood test (FlexPack HP) was performed according to the manufacturer's instruction. Patients then received a 13C-urea breath test. Results of the whole blood test were compared with the gold standard (CLO test, histology and 13C-urea breath test).

RESULTS

A total of 294 consecutive patients gave a valid Flexpack HP result for interpretation. The mean age of patients was 47.7 (range 15-85) years. Analysis showed a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 58%, 92%, 91%, 63% and 73% respectively.

CONCLUSION

The FlexPack HP whole blood test showed good specificity but lacked sensitivity. It is not sensitive enough to be used in a general practice setting for the test-and-treat approach in the Chinese population.

Germline hMSH2 and differential somatic mutations in patients with Turcot's syndrome. Genes Chromosomes Cancer 25:75-81, 1999

Chan TL, Yuen ST, Chung LP, Ho JWC, Kwan K, Fan YW, Chan ASY, Leung SY. 1999. Germline hMSH2 and differential somatic mutations in patients with Turcot's syndrome. Genes Chromosomes Cancer 25:75-81, 1999. It has come to our attention that the three patients described in the article above, were also included in a report by Leung et al., American Journal of Pathology, 153:1181-1189, 1998. Reference to the American Journal of Pathology article was inadvertently omitted

Patient-initiated prevention discussions. Two interventions to stimulate patients to initiate prevention discussions

BACKGROUND

When patients are active participants in discussions, comprehension and compliance are likely to improve. This study examines the use of two interventions to aid patients in initiating such discussions in the area of health maintenance.

METHODS

The study was a randomized controlled trial of adult patients. The first intervention used two cards that listed seven core health maintenance concerns. The second intervention used a brief session with a nurse to help patients identify their health risks and develop a plan for seeking any desired information about these risks. An exit questionnaire and a telephone interview 4 to 6 weeks later assessed the extent to which (1) information seeking by patients was stimulated; (2) patients recalled the information obtained; (3) patients used the information to effect lifestyle changes; and (4) patients felt they participated in the decision to discuss health maintenance.

RESULTS

Both interventions stimulated patients to request health maintenance information (both P < .05); the second intervention significantly increased patient recall (P = .018). Neither intervention, however, had a significant impact on lifestyle change or sense of participation in the decision to initiate discussion. Analysis of the second intervention did show that both increasing patients' recall of information (P = .008) and sense of involvement in the decision to discuss health maintenance (P = .003) significantly increases the likelihood of lifestyle change.

CONCLUSIONS

Two interventions have been developed that are relatively simple and inexpensive methods to stimulate patients to seek health maintenance, and quite probably other health-related information. The blunted impact of these two interventions, however, raises the question of whether such simple and relatively inexpensive interventions are strong enough to stimulate patients to use this information to initiate change when one seeks to address a wide range of risks.

Experimental reproduction of severe hypoglycemia and spiking mortality syndrome using field-derived and embryo-passaged preparations

The clinical signs, enteritis, weight depression, and hypoglycemia of spiking mortality syndrome were experimentally reproduced in broiler breeders and broiler chicks. Inocula included 1) virus-like particles from intestines of chicks with spiking mortality syndrome that had been banded in a discontinuous Renograffin gradient, 2) homogenized darkling beetles collected from litter of farms where spiking mortality syndrome had occurred repeatedly, and 3) homogenized embryos which had been inoculated with the Renograffin-banded material. Arkansas variant infectious bronchitis virus and arenavirus-like particles were identified in the inocula. Serology on samples from surviving chicks suggested the presence of an avian encephalomyelitis virus in one of the inocula. One-day-old (n = 172) and 2.5-day-old (n = 30) chicks were inoculated orally, and some were also injected intraperitoneally or subcutaneously, with 0.5 ml of the inocula. Twelve to fourteen days postinoculation, chicks were fasted for 4-6 hours, then briefly stressed with a cool water spray. Within 1.5 hours, inoculated chicks began dying with severe hypoglycemia and clinical signs of spiking mortality syndrome. Body weights were significantly depressed. Uninoculated controls (n = 130) from the same hatches, also fasted and stressed, were unaffected clinically and were not hypoglycemic. One group (n = 52) of inoculated chicks exposed to a controlled lighting program was unaffected clinically, had significantly higher mean plasma glucose levels, and had significantly less body weight depression than chicks exposed to continuous lighting. We concluded that exposure to controlled amounts of light/darkness can ameliorate much of the hypoglycemia, mortality, and runting-stunting associated with spiking mortality syndrome of chickens. The significance of the viruses and virus-like particles detected in the inocula is currently under investigation.

A modified reaction cartridge for direct protein sequencing on polymeric membranes

A newly designed reaction vessel implements a vertical cross-flow type reactor with the Applied Biosystems multi-mode reaction cartridge design. This cartridge is designed for sequencing samples on polyvinylidine difluoride-type membranes. The benefits of this design include a reduced reaction chamber volume that results in lower rates of chemical consumption and less risk of sample loss or contamination during sequencing. Visualization of the membrane in the reaction chamber during sequencing facilitates optimization of drying, washing, extraction and transfer times. The cycle modifications described in this report are designed to optimize post-coupling extraction, cleavage and post-cleavage extraction steps during "flow across" conditions for polymeric membranes. Also, efficient washing and drying of membranes allows for a fast cycle time of 30 minutes when using Pulsed Liquid chemistry. Examples of Blott cartridge utility for sequencing polyvinylidine difluoride-bound proteins in the low picomole range are shown by analyzing samples prepared by a two-dimensional purification scheme using the 230A HPEC and sodium dodecyl sulfate polyacrylamide gel electrophoresis.

Isolation and sequence determination of a cDNA clone for rat peroxisomal urate oxidase: liver-specific expression in the rat

Urate oxidase (UOxase; urate:oxygen oxidoreductase, EC 1.7.3.3), which catalyzes the oxidation of uric acid to allantoin, is present in most mammals but is absent in humans and certain primates. A cDNA clone for UOxase containing an insert of 1.3 kilobases (kb) was isolated from a lambda gt11 cDNA library prepared from rat liver mRNA. This recombinant clone with a 1283-nucleotide insert has sequence for 97% of the coding region together with 401 nucleotides of the 3'-untranslated region of the mRNA. The identity of UOxase cDNA clone was verified by analyzing the fusion protein, immunocytochemical localization with epitope-selected antibody, and hybrid-select translation analysis and by comparing sequences of four CNBr-cleaved peptides of the protein. Blot analysis revealed that the probe hybridizes to a single 1.5-kb mRNA species in the rat liver and a transplantable hepatocellular carcinoma. No UOxase mRNA was detected in 11 nonhepatic tissues of rat, suggesting tissue specificity of expression of this UOxase gene. Blot analysis of RNA from livers of rats treated with a peroxisome proliferator showed 2- to 3-fold increase in UOxase mRNA content, whereas the fatty acyl-CoA oxidase mRNA increased over 30-fold. Southern blot analysis of restriction enzyme digests of rat DNA suggests that there is a single copy of UOxase gene. Analysis of human genomic DNA revealed restriction fragments that are homologous to rat UOxase cDNA, although no UOxase mRNA was detected in human liver.

Applications of tandem microbore liquid chromatography and sodium dodecyl sulfate-polyacrylamide gel electrophoresis/electroblotting in microsequence analysis

Protein isolation by microbore HPLC is compared with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)/electroblotting methods for several major proteins from rabbit muscle. Although single-mode HPLC or SDS-PAGE/electroblotting provides excellent speed and sensitivity for submicrogram-level protein purification, neither one alone has adequate resolution for separating such a complex protein mixture. Tandem procedures, utilizing two different modes of HPLC in separate steps or a combination of single HPLC separation and SDS-PAGE/electroblotting, offer the necessary versatility. One of the major concerns in this investigation was to evaluate electroblotting techniques for microsequencing. The Aebersold et al. procedure (R.H. Aebersold, D.B. Teplow, L.E. Hood, and S.B.H. Kent (1986) J. Biol. Chem. 261, 4229-4238) was substantially modified and improved; the details of this work will be published elsewhere. These changes significantly improve repetitive yields at the low microgram level without producing high backgrounds. At lower levels the recovery of sequenceable protein currently limits our ability to obtain useful results. Starting with 250-750 micrograms of rabbit muscle crude extract, several proteins (15-70 kDa) were isolated by tandem microbore LC and PAGE/electroblotting for amino-terminal sequence analysis. It appears that the combination of electroblotting and microbore LC represents a powerful approach for microsample preparation.

Ectopic eruption of the maxillary permanent first molar: the effect of increased mesial angulation on arch length

Fifty-four cases of ectopically erupted maxillary permanent first molars were studied with a method using the measurements obtained from photographs of the study casts. The amount of relative loss of anteroposterior arch length of the right and left sides was shown to correlate with the increased mesial angulation of the maxillary permanent first molar. The bilateral ectopic group has a significantly larger mesial angulation of the permanent first molar on a maxilla with shorter anteroposterior arch length. The relative loss of arch length with ectopic eruption of the permanent first molar limits the use of unilateral appliances for treatment. The use of an appliance with bilateral arch support seems preferable.

Thin-layer chromatographic screening procedure for undeclared synthetic drugs in Chinese herbal preparations

A simple and rapid thin-layer chromatographic procedure was developed for the detection and presumptive identification of seventeen synthetic drugs previously reported as adulterants of Chinese herbal preparations. Depending on its complexity, the sample may be directly extracted into aqueous ethanol, or stepwise fractionated into acidic, basic, and neutral components. Extracts are analyzed on silica gel layers containing a fluorescent indicator with the aid of two solvent systems. Spots are visualized under short and long wavelength ultraviolet lights. The procedure was successfully tested on synthetic and commercial samples.

The flushing response to alcohol use among Koreans and Taiwanese

Alcohol use, the existence of a flushing response to alcohol and the amount of alcohol required to evoke flushing were studied by questionnaire in 87 homeland Korean and 101 Taiwan Chinese families. SFs (slow flushers--flush after two or more drinks) and FFs (fast flushers--flush after one drink or less) were compared. Despite the similarity in the proportions of subjects who reported flushing, Koreans reported very heavy and Taiwanese very light alcohol use. The two groups differed substantially in the proportions of SFs and FFs. Five ethnic groups in Hawaii were compared with the Koreans and Taiwanese. It appears that fast flushing, but not slow flushing, leads to substantial decreases in alcohol use among all seven groups. The association of flushing type with the extent and duration of flushing and with the frequency of other alcohol-related symptoms may be dose-dependent. For both Koreans and Taiwanese, family resemblances in flushing are substantial but not supportive of the belief that flushing is dominant and results from the influence of a single autosomal gene pair. Of the large groups of subjects from whom data were obtained (Caucasians, Chinese, Filipinos, Hawaiians or part Hawaiians, and Japanese in Hawaii; homeland Koreans; and Taiwan Chinese), the Koreans and Taiwanese differ the most from one another in alcohol consumption. In summary, there is substantial diversity among groups frequently lumped together as "Mongoloid."

Unerupted maxillary anterior supernumerary teeth: report of 204 cases

Two hundred and four cases of unerupted maxillary anterior supernumerary teeth were found among Hong Kong school children between the ages of six to 9.5 years. The anomaly was prominent in the male with a sex ratio of 5.4:1. There was no significant difference in the distribution of unilateral and bilateral supernumerary teeth, between the two sexes. Most of the supernumeraries were located within the central incisor region. The inverted type was found to be associated with bodily displacement, median diastema and torsiversion, while the normally oriented ones were related to delayed eruption. The association of maxillary anterior supernumeraries with clinical symptoms was compared with studies on Caucasian populations, and guidelines were described for their early diagnosis.