Role of serum eosinophil cationic protein in distinct endotypes of chronic rhinosinusitis

BACKGROUND

Serum eosinophil cationic protein (ECP) levels affect the surgical outcome of chronic rhinosinusitis (CRS) with nasal polyps. Primary CRS can be classified into type 2 (T2) and non-T2. We aimed to differentiate the role of serum ECP levels in surgical outcomes between the distinct endotypes of primary CRS.

METHODS

We prospectively enrolled patients with bilateral primary CRS who underwent surgical treatment with postoperative follow-up for at least 12 months. Endotyping and serum parameter measurements were completed within 1 week before surgery.

RESULTS

In total, 113 patients were enrolled, including 65 with T2 CRS and 48 with non-T2 CRS. Patients in the T2 CRS group with uncontrolled CRS had significantly higher serum ECP levels than those in patients in the non-T2 CRS group. An optimal cut-off value was obtained at 17.0 μg/L using the receiver operating characteristic curve, attaining a sensitivity of 91.7% and specificity of 56.6%. Multivariate logistic regression analysis showed that a higher serum ECP level was an independent factor for postoperative uncontrolled disease. The hazard ratio was 11.3 for the T2 group, with serum ECP levels over 17.0 μg/L. In the non-T2 group, no parameters were significantly correlated with postoperative uncontrolled CRS.

CONCLUSIONS

Serum ECP levels appear to be a feasible predictor of postoperative uncontrolled disease in patients with T2 CRS as preoperative serum ECP levels >17.0 μg/L in these patients have an approximately 16.7-fold increased risk of postoperative uncontrolled disease and should be closely monitored.

Identifying a sphenoid sinus fungus ball using a nomogram model

Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.

Left ventricle geometry, atrial strain, ventricle strain, and hemodynamics across aortic valve before and after transcatheter aortic valve replacements

INTRODUCTION

Transcatheter aortic valve replacements (TAVRs) has become widespread throughout the world. To date, there are no echocardiographic studies of TAVR patients from Southeast Asia (SEA). We sought to evaluate (1) changes in echocardiographic and strain values pre- and post-TAVR (2) relationship between aortic stenosis (AS) severity and strain values, (3) left ventricle geometry in severe AS, (4) relationship of flow rate to dimensionless index (DVI) and acceleration time (AT), and (5) effect of strains on the outcome.

MATERIALS AND METHODS

Retrospective study of 112 TAVR patients in our centre from 2009 to 2020. The echocardiographic and strain images pre (within 1 month), post (day after), and 6 months post-TAVR were analyzed by expert echocardiographer.

RESULTS

The ejection fraction (EF) increased at 6 months (53.02 ± 12.12% to 56.35 ± 9.00%) (p=0.044). Interventricular septal thickness in diastole (IVSd) decreased (1.27 ± 0.21 cm to 1.21 ± 0.23 cm) (p=0.038) and left ventricle internal dimension in diastole (LVIDd) decreased from 4.77 ± 0.64 cm to 4.49 ± 0.65 cm (p=0.001). No changes in stroke volume index (SVI pre vs 6 months p=0.187), but the flow rate increases (217.80 ± 57.61 mls/s to 251.94 ± 69.59 mls/s, p<0.001). Global longitudinal strain (GLS) improved from -11.44 ± 4.23% to -13.94 ± 3.72% (p<0.001), left atrial reservoir strain (Lar-S) increased from 17.44 ± 9.16% to 19.60 ± 8.77% (p=0.033). Eight patients (7.5%) had IVSd < 1.0 cm, and 4 patients (3.7%) had normal left ventricle (LV) geometry. There was linear relationship between IVSd and mean PG (r=0.208, p=0.031), between GLS to aortic valve area (AVA) and aortic valve area index (AVAi) (r = - 0.305, p=0.001 and r= - 0.316, p= 0.001). There was also relationship between AT (r=-0.20, p=0.04) and DVI (r=0.35, p<0.001) with flow rate. Patients who died late (after 6 months) had lower GLS at 6 months. (Alive; -13.94 ± 3.72% vs Died; -12.43 ± 4.19%, p=0.001).

CONCLUSION

At 6 months, TAVR cause reverse remodelling of the LV with the reduction in IVSd, LVIDd, and improvement in GLS and LAr-S. There is a linear relationship between GLS and AVA and between IVSd and AVA.

Synchronised neural signature of creative mental imagery in reality and augmented reality

Creativity, transforming imaginative thinking into reality, is a mental imagery simulation in essence. It can be incorporeal, concerns sophisticated and/or substantial thinking, and involves objects. In the present study, a mental imagery task consisting of creating a scene using familiar (FA) or abstract (AB) physical or virtual objects in real (RMI) and augmented reality (VMI) environments, and an execution task involving effectively creating a scene in augmented reality (VE), were utilised. The beta and gamma neural oscillations of healthy participants were recorded via a 32 channel wireless 10/20 international EGG system. In real and augmented environments and for both the mental imagery and execution tasks, the participants displayed a similar cortico-cortical neural signature essentially based on synchronous vs asynchronous beta and gamma oscillatory activities between anterior (i.e. frontal) and posterior (i.e. parietal, occipito-parietal and occipito-temporal) areas bilaterally. The findings revealed a transient synchronised neural architecture that appears to be consistent with the hypothesis according to which, creativity, because of its inherent complexity, cannot be confined to a single brain area but engages various interconnected networks.

Association between fetal fraction on cell-free DNA testing and first-trimester markers for pre-eclampsia

OBJECTIVES

To evaluate the association between fetal fraction on cell-free DNA (cfDNA) testing and first-trimester markers for pre-eclampsia, and to investigate the possible association of low fetal fraction with increased risks for pre-eclampsia (PE) and fetal growth restriction (FGR).

METHODS

This was a retrospective cohort study including all women with a singleton pregnancy who had risk calculation for PE and FGR between 11 + 0 and 13 + 6 weeks' gestation and who also had cfDNA as a primary or secondary screening test for chromosomal abnormalities at any gestational age at two fetal medicine clinics in Sydney and Melbourne, Australia, between March 2013 and May 2017. Logarithmically transformed fetal fraction results were adjusted for gestational age and maternal characteristics. Associations with mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), and risks for PE < 34 weeks, PE < 37 weeks and FGR < 37 weeks were analyzed using correlation analysis and univariable and multivariable linear regressions.

RESULTS

In total, 4317 singleton pregnancies that underwent cfDNA testing with fetal fraction reported were included. Significant prediction of fetal fraction was provided by gestational age, conception by in-vitro fertilization, maternal age, body mass index, chronic hypertension, diabetes mellitus, South Asian ethnicity and being parous without history of PE or FGR. Fetal fraction was associated inversely with MAP and UtA-PI and associated positively with PAPP-A and PlGF. The lower the fetal fraction, the higher were the risks for PE < 34 weeks, PE < 37 weeks and FGR < 37 weeks (P < 0.001 for all).

CONCLUSIONS

There is a significant association between fetal fraction result and first-trimester markers for adverse pregnancy outcome. Low fetal fraction is associated with an increased risk for pregnancy complication, but its capacity to act an as independent first-trimester marker in an algorithm for screening for PE and FGR requires further research. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Clinical analysis of submucosal Medpor implantation for empty nose syndrome

BACKGROUND

Empty nose syndrome (ENS) describes symptomatology and radiographic findings after surgeries on turbinates.The treatment of ENS is still debatable.

PURPOSE

To analyse clinical outcomes of submucosal Medpor® implantation for ENS.

METHODS

A total of 18 patients underwent submucosal Medpor® implantation from 2006 to 2011. We applied SNOT-22 (SinoNasalOutcome Test) for statistical survey of the patients' symptoms before and after surgery.

RESULTS

Two patients were lost to follow up after the surgery. Most of the patients developed ENS-related symptoms gradually within 2 years to 16 years after the previous nasal surgery or treatment. The sites of submucosal implantation are mainly septum and nasal floor, unilaterally or bilaterally. There is a significant improvement of SNOT-22 pre-operatively to one year post-operatively.

CONCLUSIONS

The symptomatolgy remains the most important point when dealing with patients with ENS. Submucosal implantation of Medpor® is a feasible surgical treatment to ENS. A positive cotton test is suggested for the surgical indication and planning.

LSD1 demethylates HIF1α to inhibit hydroxylation and ubiquitin-mediated degradation in tumor angiogenesis

Lysine-specific demethylase 1 (LSD1), which has been considered as a potential therapeutic target in human cancer, has been known to regulate many biological functions through its non-histone substrates. Although LSD1-induced hypoxia-inducible factor alpha (HIF1α) demethylation has recently been proposed, the effect of LSD1 on the relationship between HIF1α post-translational modifications (PTMs) and HIF1α-induced tumor angiogenesis remains to be elucidated. Here, we identify a new methylation site of the HIF1α protein antagonized by LSD1 and the interplay between HIF1α protein methylation and other PTMs in regulating tumor angiogenesis. LSD1 demethylates HIF1α at lysine (K) 391, which protects HIF1α against ubiquitin-mediated protein degradation. LSD1 also directly suppresses PHD2-induced HIF1α hydroxylation, which has a mutually dependent interplay with Set9-mediated HIF1α methylation. Moreover, the HIF1α acetylation that occurs in a HIF1α methylation-dependent manner is inhibited by the LSD1/NuRD complex. HIF1α stabilized by LSD1 cooperates with CBP and MTA1 to enhance vascular endothelial growth factor (VEGF)-induced tumor angiogenesis. Thus, LSD1 is a key regulator of HIF1α/VEGF-mediated tumor angiogenesis by antagonizing the crosstalk between PTMs involving HIF1α protein degradation.

Lymphangioma Arising From the Ovary

Primary lymphangioma arising from the ovary is a rare tumor, with only 24 cases reported to date. As it is often accompanied by ascites or recurrence, similar to a malignant tumor, an aggressive treatment approach is used for disease control. In this report, we describe a 75-year-old woman with a left ovarian lymphangioma that increased in size during the menopause period. Microscopic examination of the tumor showed thin-walled multilocular cystic spaces and immunoreactivity for D2-40, a specific marker for lymphatic endothelium, lining the cystic spaces. The patient has been doing well for 5 years postoperatively. Ovarian cystic lymphangioma should be included in the differential diagnosis of an ovarian cyst and long-term follow-up is recommended to exclude malignant behavior. We also summarize a total of 25 cases, including the case presented here.

An isolated intracranial mucocoele herniated from the frontal sinus

Mucocoeles are chronic mucosa-lined retention cysts that occur due to sinus ostium obstruction and expand along the path of least resistance, most commonly involving the frontal sinus. A frontal mucocoele typically appears as a smooth and rounded expansile enlargement of a completely opacified frontal sinus, with or without thinning of the bony wall of the sinus. Here we report a rare case of isolated intracranial mucocoele that presented with posterior herniation to the anterior cranial fossa through a small bony defect on the posterior table of the frontal sinus. The findings upon imaging could easily be confused with intracranial abscess, potentially leading to craniotomy drainage. In the present case of mucocoele, the frontal intracranial lesion was completely resolved following endoscopic frontal sinusotomy.

Response of a ZnO single crystal rod-based chemical sensor for hydrogen sulfide

A zinc oxide single crystal rod was grown by a thermal evaporation method for application as a chemical gas-sensing material in this study. Zinc acetate (20 wt%) impregnated over activated carbon was used as the precursor for the epitaxial growth of ZnO single crystal rods. The response tests were carried out across a range of sensing temperatures (100, 150 and 200 °C) and the hydrogen sulfide content (10.2-51.0 ppmv) was balanced with nitrogen gas. The response of the ZnO single crystal rods grown on the gas sensors varied with the H2S content and the sensing temperature. A high response for H2S was obtained at 150 and 200 °C due to the high reactivity between H2S and ZnO at high temperature. Since H2S absorption rate and ZnS oxidation rate over ZnO single crystal rods at 100 °C lower than that at 150 and 200 °C, the changing rate of electric resistance decreased with the decrease of temperature. Meanwhile, a different response, which is the changing rate of electric resistance for H2S absorption and ZnS oxidation over ZnO single crystal rods at 100 °C, was observed with changing amount of H2S in feed gas. Therefore, it was concluded that the ZnO single crystal rods based gas sensor is operated above 200 °C for the shortly response time.

Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea

OBJECTIVE

To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea.

METHOD

Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression.

RESULTS

The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.

Application of ZnO single-crystal wire grown by the thermal evaporation method as a chemical gas sensor for hydrogen sulfide

A zinc oxide single-crystal wire was synthesized for application as a gas-sensing material for hydrogen sulfide, and its gas-sensing properties were investigated in this study. The gas sensor consisted of a ZnO thin film as the buffer layer and a ZnO single-crystal wire. The ZnO thin film was deposited over a patterning silicon substrate with a gold electrode by the CFR method. The ZnO single-crystal wire was synthesized over the ZnO thin film using zinc and activated carbon as the precursor for the thermal evaporation method at 800 degrees C. The electrical properties of the gas sensors that were prepared for the growth of ZnO single-crystal wire varied with the amount of zinc contained in the precursor. The charged current on the gas sensors increased with the increasing amount of zinc in the precursor. It was concluded that the charged current on the gas sensors was related to ZnO single-crystal wire growth on the silicon substrate area between the two electrodes. The charged current on the gas sensor was enhanced when the ZnO single-crystal wire was exposed to a H2S stream. The experimental results obtained in this study confirmed that a ZnO single-crystal wire can be used as a gas sensor for H2S.

Internally displaced human resources for health: villager health worker partnerships to scale up a malaria control programme in active conflict areas of eastern Burma

Approaches to expand malaria control interventions in areas of active conflict are urgently needed. Despite international agreement regarding the imperative to control malaria in eastern Burma, there are currently no large-scale international malaria programmes operating in areas of active conflict. A local ethnic health department demonstrated that village health workers are capable of implementing malaria control interventions among internally displaced persons (IDPs). This paper describes how these internally displaced villagers facilitated rapid expansion of the programme. Clinic health workers received training in malaria diagnosis and treatment, vector control and education at training sites along the border. After returning to programme areas inside Burma, they trained villagers to perform an increasingly comprehensive set of interventions. This iterative training strategy to increase human resources for health permitted the programme to expand from 3000 IDPs in 2003 to nearly 40,000 in 2008. It was concluded that IDPs are capable of delivering essential malaria control interventions in areas of active conflict in eastern Burma. In addition, health workers in this area have the capacity to train community members to take on implementation of such interventions. This iterative strategy may provide a model to improve access to care in this population and in other conflict settings.

Multi-level partnerships to promote health services among internally displaced in eastern Burma

Ethnic populations in eastern Burma are the target of military policies that result in forced labour, destruction of food supplies, and massive forced displacement. Despite international assistance to Burmese refugees along the Thai-Burma border, traditional humanitarian models have failed to reach these internally displaced persons (IDPs) within Burma. Nevertheless, through the cultivation of a model (cross border local-global partnerships) 300,000 IDPs in eastern Burma now receive critical health services where, otherwise, there would be none. We describe key elements of the partnership model's genesis in eastern Burma. The role of the local partner, Backpack Health Worker Team (BPHWT), is highlighted for its indigenous access to the IDP populations and its maintenance of programmatic autonomy. These local elements are potentiated by international support for technical assistance, training, resources, and advocacy. International policy and investment should prioritize support of locally-driven health initiatives that utilize local-global partnerships to reach not only IDPs but also other war-torn or traditionally inaccessible populations worldwide.

MR imaging evaluation of disorders of the chest wall

Chest wall lesions constitute a diverse group of thoracic diseases, including those of soft tissue and osseous origin. MR imaging, with its superior tissue-resolving capability and multiplanar image acquisition, is an important tool for assessing chest wall lesions. In this article, the authors review common and uncommon diseases of the chest wall, with an emphasis on the MR imaging characteristics of these diseases. Among the diseases they discuss are diseases of the soft tissue including lipoma, hibernoma, liposarcoma, hemangioma, and lymphoma. They also examine diseases of the osseous thorax, including benign osseous tumors, fibrous dysplasia, and aneurysmal bone cyst. In addition, they discuss such malignant osseous tumors as osteosarcoma and Ewing's sarcoma.

Elevated anti-alpha-enolase antibody levels in Kawasaki disease

OBJECTIVE

By functioning as a heat-shock protein (HSP), alpha-enolase has an important role in the pathophysiology of multivariant vasculitis. Kawasaki disease (KD) is a type of vasculitis occurring primarily in children. The role of alpha-enolase in KD was assessed by measuring anti-alpha-enolase antibody (Ab) titres in patients with KD and the usefulness of anti-alpha-enolase Ab as a diagnostic tool in atypical KD patients was evaluated.

METHODS

Anti-alpha-enolase Ab titres were measured by using an enzyme-linked immunosorbent assay (ELISA) in seven normal control patients, nine febrile control patients and 14 KD patients (10 typical KD, four atypical KD). A standard deviation (SD) of 3 above the mean of the normal control group was considered to be positive reactivity. Western blotting using recombinant human alpha-enolase was performed in four KD patients and three normal controls.

RESULTS

With the positive reactivity limited to +3 SD over the mean (>0.6), 10 out of 14 patients (71%) were positive at the acute onset and 12 out of 14 patients (85.7%) were positive before discharge. In total, 12 out of 14 patients (85.7%) were positive either at acute onset or before discharge. All four atypical KD patients showed positive reactivity. Specific positive bands against recombinant human alpha-enolase were detected by western blotting in all four KD patients, but no reactivity was seen in three patients with normal controls.

CONCLUSION

This is the first study to demonstrate that autoantibodies against the alpha-enolase are present in the sera of KD patients. We suggest that anti-alpha-enolase Ab should be a good candidate for a diagnostic tool in atypical KD.

Detailed analysis of the radiographic presentation of Mycobacterium kansasii lung disease in patients with HIV infection

BACKGROUND

Published criteria for the diagnosis of Mycobacterium kansasii lung disease require the presence of clinical symptoms, positive microbiologic results, and radiographic abnormalities. In patients with HIV infection, the radiographic findings of M kansasii lung disease are not well described.

METHODS

Medical records and chest radiographs of all patients with HIV infection and at least one respiratory specimen culture positive for M kansasii at San Francisco General Hospital between December 1989 and July 2002 were reviewed.

RESULTS

Chest radiographic results were abnormal in 75 of 83 patients (90%) included in the study. Radiographic abnormalities were diverse, with consolidation (66%) and nodules (42%) as the most frequent findings. The mid or lower lung zones were involved in 89% of patients. The pattern of radiographic abnormalities did not differ based on acid-fast bacilli smear status, the presence or absence of coexisting pulmonary infections, or CD4+ T-lymphocyte count. In multivariate Cox regression analysis, cavitation was the only radiographic abnormality independently associated with mortality (hazard ratio, 4.8; 95% confidence interval, 1.2 to 19.6).

CONCLUSION

Patients with HIV infection and M kansasii lung disease present with diverse radiographic patterns, most commonly consolidation and nodules predominantly located in the mid and lower lung zones. This finding is in contrast to the upper-lobe cavitary presentation described in patients without HIV infection. Although rare, the presence of cavitary disease in patients with HIV infection and M kansasii independently predicts worse outcome. The diversity in the radiographic presentation of M kansasii lung disease implies that clinicians should obtain sputum mycobacterial culture samples from any patient with HIV infection and an abnormal chest radiograph finding.

Increased serum levels of macrophage migration inhibitory factor in patients with Kawasaki disease

OBJECTIVE

To determine whether serum levels of macrophage migration inhibitory factor (MIF) increase in patients with Kawasaki disease (KD) and also correlate with other inflammatory indices.

METHODS

Serum samples from 10 patients with KD, 15 normal healthy subjects, and seven febrile control subjects were assayed for MIF by enzyme-linked immunosorbent assay (ELISA).

RESULTS

There was a significant increase in the serum levels of MIF in the acute stage of KD [113.06 (range 20.6-157.36) ng/mL] compared with those in the subacute stage [28.11 (8.57-143.48) ng/mL, p<0.01], normal controls [12.95 (8.40-18.67) ng/mL, p<0.001], and febrile controls [36.58 (21.31-59.67) ng/mL, p = 0.01]. The increase in MIF correlated with an increase in interleukin-6 (IL-6) (r = 0.52, p = 0.047).

CONCLUSION

MIF may be a useful marker in the acute stage of KD and may provide important clues to the pathogenesis of this disease.

Depression in vascular dementia is quantitatively and qualitatively different from depression in Alzheimer's disease

BACKGROUND/AIMS

To compare the prevalence and characteristics of depression in vascular dementia (VaD) and Alzheimer's disease (AD) after adjusting for dementia severity and gender.

METHODS

One hundred and eight pairs of VaD and AD patients matched for dementia severity and gender were assessed.

RESULTS

Major depressive disorder (MDD) was more prevalent in the VaD group than in the AD group (20.4% in VaD, 10.2% in AD, p = 0.04, Cochran-Mantel-Haenszel, CMH, test) regardless of the dementia severity and gender. The odds ratio for developing MDD in the VaD group versus the AD group was estimated to be 2.20 (95% confidence interval = 1.02-4.74). Neurovegetative symptoms such as 'felt tired and weak all the time' (30.6% in VaD, 13.9% in AD, p = 0.003, CMH test) and 'changed weight without trying' (16.7% in VaD, 6.5% in AD, p = 0.02, CMH test) were more prevalent in the VaD group than in the AD group.

CONCLUSION

Depression in VaD was quantitatively and qualitatively different from that in AD regardless of the severity of dementia and gender; depression was more prevalent, severer and more retarded and vegetative in VaD than in AD.

Comparison of esophageal acid exposure at 1 cm and 6 cm above the squamocolumnar junction using the Bravo pH monitoring system

The aim of this study was to assess the quantitative differences of acid exposure at 1 cm and 6 cm above the squamocolumnar junction (SCJ) using two radiotelemetry pH capsules affixed to the esophageal mucosa. Ten normal subjects and 10 endoscopy-negative gastroesophageal reflux disease (GERD) patients without hiatus hernia (ages 20-54, 12 male) were studied for a 24-h period using the Bravo pH monitoring system. pH capsules were placed 1 cm and 6 cm above the SCJ. Interpretable data for at least 14 h was obtained in 18 of the 20 subjects (9 normal, 9 GERD). Two failures occurred secondary to early capsule dislodgement. Median esophageal acid exposure was significantly increased at 1 cm above the SCJ compared to 6 cm above the SCJ during the total, upright and postprandial time periods in both normal and GERD subjects. During a 2 h postprandial period the esophageal acid exposure was 8-fold greater in GERD subjects and 5-fold greater in normal subjects 1 cm above the SCJ compared to 6 cm above the SCJ. Confident measurement of esophageal acid exposure at a fixed position 1 cm above the SCJ is feasible with the Bravo system. Acid exposure was significantly higher 1 cm above the SCJ compared to 6 cm above the SCJ in both GERD patients and controls. These findings suggest that measurement of acid exposure 1 cm above the SCJ may improve accuracy of pH monitoring by detecting acid reflux events confined to the distal esophagus.

Factors influencing cardiac auscultation proficiency in physician trainees

INTRODUCTION

We assessed the accuracy of physician trainees in identifying different cardiac sounds and examined the factors influencing their cardiac auscultation proficiency.

METHODS

A total of 106 physicians in the Family Medicine Training Programme were asked to identify 10 cardiac sounds played sequentially on the Littmann electronic stethoscope, which functioned as a surrogate patient. Their auscultation accuracy was scored numerically out of a maximum of 10. Demographical data of the physicians was collected prospectively.

RESULTS

The mean (+/-SD) auscultation proficiency score of the study population was 4.0 +/- 1.7. Physicians who graduated in 1994 or earlier fared significantly poorer than those who obtained their Bachelor of Medicine and Bachelor of Surgery degrees between 1995 and 2000 (p-value equals 0.02). Auscultation proficiency was not related to current practice, previous years of primary care, cardiology, internal medicine or paediatric medicine postings, or cumulative years of postings. Normal heart sounds were most accurately identified. Prosthetic cardiac sounds were better identified than other extra-cardiac sounds while systolic murmurs were more accurately identified than diastolic murmurs. Tachycardia had the lowest identification rate.

CONCLUSION

Our data suggest that cardiac auscultation skill declined with time, being significantly impaired eight years after graduation. We suggest that there is a need for retraining in the form of continuing medical education to address not only new knowledge and skills, but also basic skill competency.

Systematic review: Is there excessive use of proton pump inhibitors in gastro-oesophageal reflux disease?

BACKGROUND

Proton-pump inhibitors are often recommended for continuous use in gastro-oesophageal reflux disease, but this may not be necessary in all patients.

AIM

To ascertain the level of evidence for alternative strategies for proton-pump inhibitor treatment in gastro-oesophageal reflux disease.

METHODS

We searched for observational or interventional studies examining alternatives to continuous proton-pump inhibitor treatment in gastro-oesophageal reflux disease.

RESULTS

Non-randomized studies suggest that some patients with gastro-oesophageal reflux disease, including some with erosive oesophagitis, may be adequately maintained on proton-pump inhibitor therapy given less frequently than once daily. However, the results may not be generalizable. Four high quality randomized-controlled trials compared 'on-demand' proton-pump inhibitor and placebo treatment in endoscopy-negative reflux disease; all found this effective for most patients. One high quality randomized-controlled trial found intermittent courses of a proton-pump inhibitor or H2-receptor antagonist in erosive oesophagitis or endoscopy-negative reflux disease adequate for almost half of the patients studied. Up to 80% of patients on continuous high-dose proton-pump inhibitor treatment for gastro-oesophageal reflux disease can be 'stepped down' to less intensive therapy.

CONCLUSIONS

On-demand proton-pump inhibitor treatment may be appropriate in endoscopy-negative reflux disease. In gastro-oesophageal reflux disease, patients taking more than once daily or high-dose proton-pump inhibitor treatment, a step down to once daily or standard dose therapy should be attempted.

Synthesis and characterization of high-quality double-walled carbon nanotubes by catalytic decomposition of alcohol

We report the synthesis of high-quality double-walled carbon nanotubes without defects by catalytic decomposition of alcohol over an Fe-Mo/Al2O3 catalyst; the synthesized DWNTs have outer diameters in the range of 1.52-3.54 nm and an average interlayer distance of 0.38 nm between graphene layers.

Safety and feasibility of a CT protocol for acute stroke: combined CT, CT angiography, and CT perfusion imaging in 53 consecutive patients

By combining non-contrast-enhanced CT imaging, CT perfusion imaging, and cranial-to-chest CT angiography (CTA), the entire cerebrovascular axis can be imaged during acute stroke. To our knowledge, the safety and feasibility of this technique have not been previously reported. In a consecutive series of 53 patients with suspected acute stroke, renal failure was not observed. Median imaging time was 27 minutes (range, 9-67 minutes). Image quality was degraded by motion in 1.3% of vessels studied. Dynamic CT perfusion data were successfully obtained in 52 patients (98% of patients). High-speed, multisection, helical CT scanners allow rapid, safe imaging of the entire neurovascular axis in patients with acute stroke by use of combined CT imaging, CT perfusion imaging, and CTA.

Synthesis of high-quality single-walled carbon nanotubes by catalytic decomposition of C2H2

High-quality single-walled carbon nanotubes free of defects and amorphous carbon coating have been produced by catalytic decomposition of C2H2 over Fe-Mo/Al2O3 catalyst.

Microbial community structures of activated sludges dominated with polyphosphate-accumulating bacteria and glycogen-accumulating bacteria

The microbial community structures of anaerobic-aerobic activated sludges, which are dominated with polyphosphate-accumulating bacteria (PABs) and glycogen-accumulating bacteria (GABs), were investigated by quinone profile method and dual staining DAPI (4',6-diamidino-2-phenylindol dihydrochloride) with fluorescent in situ hybridization (FISH). For both activated sludges, the predominant bacterial groups were the beta subclass of the Proteobacteria that contained mainly Q-8 as analyzed by the quinone profile method and gram-positive bacteria with a high DNA G+C content based on FISH. A 16S rRNA-targeted oligonucleotide probe (MP2) specific for M. phosphovorus, a known polyphosphate-accumulating bacterium, was also applied to PABs and GABs-enriched activated sludge to evaluate their possible role in the enhanced biological phosphorus removal (EBPR) process. Interestingly, the bacteria that hybridized with the probe specific to M. phosphovorus in the sludge dominated with PABs represent about 6.9% of the total microorganisms. In the sludge dominated with GABs, these bacteria were about 1.9%. These results suggest its possible involvement in the EBPR process.

A novel strategy for cyanobacterial bloom control by ultrasonic irradiation

The application of ultrasonic irradiation to control cyanobacterial blooms was evaluated in actual eutrophic lake water. Ten prototype units of the Ultrasonic Irradiation System (USIS) were installed in the 32 ha Lake Senba, and the water and sediment quality were monitored for 2 years. By incorporating the ultrasonication process with the on-going strategy, particularly flushing with induction water, cyanobacterial blooms can be controlled effectively. In addition, a significant improvement in the conditions of the lake in terms of chlorophyll-a, COD and T-P was attained. Moreover, the feasibility of ultrasonic irradiation and bacterial assisted control of cyanobacterial blooms was also evaluated in laboratory conditions. The destruction of gas vacuoles brought about by ultrasonic irradiation promoted close contact between cyanobacteria and their lysing Myxobacter leading to immediate and accelerated destruction of the cells.

In situ algal bloom control by the integration of ultrasonic radiation and jet circulation to flushing

A novel strategy for in situ water bloom control was applied and evaluated in Lake Senba. The proposed strategy was to integrate ultrasonic radiation and water jet circulation to an existing flushing process for reducing the growth rate of cyanobacteria and to support the flushing process by providing efficient mixing. Ten units of the system, each consisting of an ultrasonication module and a water jet circulator module, were strategically situated on the lake, and the performance was monitored for 2 years. Water bloom occurrence reflected as chlorophyll a, SS, and transparency were controlled to lower levels when the integrated system was coupled with sufficient inflow water supply to achieve the target flushing rate. Also, an improvement in the water quality such as COD and phosphorus were observed. Based on linear regression analysis, relationships between water quality parameters and inflow water volume were discussed to evaluate the proposed strategy. Of the three major water quality parameters associated with water bloom, the integrated system contributed mainly to the reduction in SS and transparency compared to chlorophyll a reduction. Improved chlorophyll a reduction may be achieved by strategies that augment effective washout of cyanobacteria during flushing.

Inhibition of nitric oxide synthase inhibitors and lipopolysaccharide induced inducible NOS and cyclooxygenase-2 gene expressions by rutin, quercetin, and quercetin pentaacetate in RAW 264.7 macrophages

Several natural flavonoids have been demonstrated to perform some beneficial biological activities, however, higher-effective concentrations and poor-absorptive efficacy in body of flavonoids blocked their practical applications. In the present study, we provided evidences to demonstrate that flavonoids rutin, quercetin, and its acetylated product quercetin pentaacetate were able to be used with nitric oxide synthase (NOS) inhibitors (N-nitro-L-arginine (NLA) or N-nitro-L-arginine methyl ester (L-NAME)) in treatment of lipopolysaccharide (LPS) induced nitric oxide (NO) and prostaglandin E2 (PGE2) productions, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) gene expressions in a mouse macrophage cell line (RAW 264.7). The results showed that rutin, quercetin, and quercetin pentaacetate-inhibited LPS-induced NO production in a concentration-dependent manner without obvious cytotoxic effect on cells by MTT assay using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide as an indicator. Decrease of NO production by flavonoids was consistent with the inhibition on LPS-induced iNOS gene expression by western blotting. However, these compounds were unable to block iNOS enzyme activity by direct and indirect measurement on iNOS enzyme activity. Quercetin pentaacetate showed the obvious inhibition on LPS-induced PGE2 production and COX-2 gene expression and the inhibition was not result of suppression on COX-2 enzyme activity. Previous study demonstrated that decrease of NO production by L-arginine analogs effectively stimulated LPS-induced iNOS gene expression, and proposed that stimulatory effects on iNOS protein by NOS inhibitors might be harmful in treating sepsis. In this study, NLA or L-NAME treatment stimulated significantly on LPS-induced iNOS (but not COX-2) protein in RAW 264.7 cells which was inhibited by these three compounds. Quercetin pentaacetate, but not quercetin and rutin, showed the strong inhibitory activity on PGE2 production and COX-2 protein expression in NLA/LPS or L-NAME/LPS co-treated RAW 264.7 cells. These results indicated that combinatorial treatment of L-arginine analogs and flavonoid derivates, such as quercetin pentaacetate, effectively inhibited LPS-induced NO and PGE2 productions, at the same time, inhibited enhanced expressions of iNOS and COX-2 genes.

Streptococcal brain abscess: analysis of clinical features in 20 patients

BACKGROUND

To assess the clinical features and therapeutic outcomes of brain abscess caused by streptococci.

METHODS

Twenty patients, 18 males and 2 females, aged 3 to 76 years, collected over a 14-year period, have been identified at Kaohsiung Chang Gung Memorial Hospital.

RESULTS

Among these 20 patients, 13 had viridans streptococci infection alone, one had non-A, non-B, and non-D streptococci infection alone, and the other 6 had mixed infections each including streptococci. The locations of all of the abscesses were supratentorial. Among these patients, 18 had a single abscess and 2 had multiple abscesses. Underlying conditions were common in our patients, including head trauma, heart disease, otopharyngeal infection, and medical procedures. Nineteen patients were treated surgically and 1 was treated with antibiotics alone. Nineteen survived and 1 died, with an overall mortality rate of 5%.

CONCLUSION

The clinical presentations and underlying conditions varied according to the different streptococcal species. Streptococcal brain abscesses accounted for 17% of our cases with brain abscesses, and 30% of our streptococcal infections had polymicrobial infections. Although streptococcal brain abscesses were commonly associated with otopharyngeal infections or infectious endocarditis, they also appeared to be often related to neurosurgical events or medical procedures in recent years. Based on our study, prognosis is favorable with early diagnosis and prompt treatment.

Sleep duration, subjective sleep disturbances and associated factors among university students in Korea

Objective of this study was to look into sleep patterns of university students in association with their lifestyle, specifically to examine mean sleep duration, prevalence of sleep disturbances and their correlates. This study also aimed to examine a possible association of sleep patterns of young adults with new media like computers and videos, which were supposed to have a great influence on their lifestyle. Self-reported sleep data were derived from questionnaires administered to a total of 1,414 students of one university located in Chullabuk-do, Korea. Statistical methods such as t-test, analyses of variance, chi-square test and multivariate logistic regression were used for analysis. The mean sleep duration of the respondents was 6.7+/-1.3 hr. Of the respondents, 30.2% reported having insufficient sleep. About one third of them pointed to visual media including computers as the primary reason. The proportion of those having some types of sleep disturbances was 36.2%. The risk of subjective sleep disturbances was significantly lower among those perceiving themselves healthy than among those perceiving themselves unhealthy (OR=0.44; 95% CI: 0.34-0.57).

Presynaptic alpha7-nicotinic acetylcholine receptors mediate nicotine-induced nitric oxidergic neurogenic vasodilation in porcine basilar arteries

We previously reported that nicotine-induced nitric oxide (NO)-mediated neurogenic vasodilation in the porcine basilar artery was dependent on intact sympathetic innervation. We further demonstrated in this artery that nicotine acted on nicotinic acetylcholine receptors (nAChRs) on presynaptic sympathetic nerve terminals to release norepinephrine (NE), which then acted on beta2-adrenoceptors located on the neighboring NOergic nerve terminals to release NO, resulting in vasodilation. The nature of the nAChRs has not been determined. The nAChR subtype mediating nicotine-induced dilation in isolated porcine basilar arterial rings denuded of endothelium was therefore examined pharmacologically and immunohistochemically. Results from using an in vitro tissue bath technique indicated that relaxation induced by nicotine (100 microM) was blocked by preferential alpha7-nAChR antagonists (methyllycaconitine and alpha-bungarotoxin) and nonspecific nAChR antagonist (mecamylamine) in a concentration-dependent manner, but was not affected by dihydro-beta-erythroidine (a preferential alpha4-nAChR antagonist). These nAChR antagonists did not affect relaxation elicited by transmural nerve stimulation (8 Hz) or that by sodium nitroprusside and NE. Results from double-labeling immunohistochemical studies in whole-mount porcine basilar and middle cerebral arteries and in cultured porcine superior cervical ganglia (SCG) indicated that alpha7-nAChR- and tyrosine hydroxylase immunoreactivities were colocalized in same nerve fibers. These results suggest the presence of functional alpha7-nAChRs on postganglionic sympathetic adrenergic nerve terminals of SCG origin, which mediate nicotine-induced neurogenic NOergic vasodilation. These findings are consistent with our hypothesis that nicotine acts on nAChRs on presynaptic sympathetic nerve terminals to release NE, which then acts on presynaptic beta2-adrenoceptors located on the neighboring NOergic nerve terminals, resulting in release of NO and dilation of porcine basilar arteries.

A case of cutaneous low-grade myofibroblastic sarcoma

A 28-year-old woman presented with a recurrent nodule on the lower margin of her left nostril after laser surgery. Histologically, the nodule had an indistinct margin and was composed of interlacing fascicles of plump, spindled or stellate tumor cells with mild cytologic atypia. The tumor cells were revealed to be myofibroblasts by positivity to smooth muscle actin and negativity to desmin. A diagnosis of low grade myofibroblastic sarcoma (LGMS) was made.

Wogonin, baicalin, and baicalein inhibition of inducible nitric oxide synthase and cyclooxygenase-2 gene expressions induced by nitric oxide synthase inhibitors and lipopolysaccharide

We previously reported that oroxylin A, a polyphenolic compound, was a potent inhibitor of lipopolysaccharide (LPS)-induced expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). In the present study, three oroxylin A structurally related polyphenols isolated from the Chinese herb Huang Qui, namely baicalin, baicalein, and wogonin, were examined for their effects on LPS-induced nitric oxide (NO) production and iNOS and COX-2 gene expressions in RAW 264.7 macrophages. The results indicated that these three polyphenolic compounds inhibited LPS-induced NO production in a concentration-dependent manner without a notable cytotoxic effect on these cells. The decrease in NO production was in parallel with the inhibition by these polyphenolic compounds of LPS-induced iNOS gene expression. However, these three compounds did not directly affect iNOS enzyme activity. In addition, wogonin, but not baicalin or baicalein, inhibited LPS-induced prostaglandin E2 (PGE2) production and COX-2 gene expression without affecting COX-2 enzyme activity. Furthermore, N-nitro-L-arginine (NLA) and N-nitro-L-arginine methyl ester (L-NAME) pretreatment enhanced LPS-induced iNOS (but not COX-2) protein expression, which was inhibited by these three polyphenolic compounds. Wogonin, but not baicalin or baicalein, similarly inhibited PGE2 production and COX-2 protein expression in NLA/LPS or L-NAME/LPS-co-treated RAW 264.7 cells. These results indicated that co-treatment with NOS inhibitors and polyphenolic compounds such as wogonin effectively blocks acute production of NO and, at the same time, inhibits expression of iNOS and COX-2 genes.

Craniopharyngioma involving supfrasellar region and sphenoid sinus: case report

Craniopharyngiomas are benign, epithelial, slow-growing neoplasms that generally develop either in the suprasellar region or in both the suprasellar and intrasellar regions. They rarely occurs in the infrasellar region. Based on embryologic development of adenohypophysis, the tumor can arise along the path of the craniopharyngeal duct. We report on an 8- year-old boy who presented to us with headache and anorexia for several weeks during May 1999. Brain MRI revealed a huge sphenoid tumor. The tumor was completely excised by functional endoscopic sinus surgery on 12th August 1999. The postoperative course was smooth and no evidence of tumor recurrence was found on his latest follow-up visit in February, 2000. From the clinical experience with this case, functional endoscopic sinus surgery is an alternative and a less-harmful surgical procedure for this kind of benign sphenoid tumor. Moreover, embryology development, epidemiology, clinical presentation, diagnostic method and treatment of craniopharyngioma are discussed.

Multisection dynamic CT perfusion for acute cerebral ischemia: the "toggling-table" technique

A new CT perfusion technique providing extended anatomic coverage was evaluated in 12 patients with suspected acute middle cerebral artery ischemia. With a multidetector CT scanner, scans were obtained in an alternating fashion at two distinct "toggling" table positions (two 1-cm sections each) during a 40-mL contrast agent bolus (approximately 5 seconds per image), and perfusion parameter maps were created. The CT perfusion results were compared with follow-up images. Nine patients showed focal perfusion abnormalities in at least one section, most commonly on mean transit time maps. Using a single table location would have underestimated or missed the involved tissue in most cases. In three of 12 patients, perfusion maps failed to delineate any abnormality. In two patients, perfusion and diffusion MR imaging confirmed the absence of perfusion abnormality and tissue injury, respectively. In one case, a small ischemic injury was revealed by diffusion MR imaging. By using the toggling-table approach, perfusion images can be obtained over an extended anatomic area and, thus, reveal the presence and the extent of presumed tissue injury.

Origin and Co-localization of nitric oxide synthase, CGRP, PACAP, and VIP in the cerebral circulation of the rat

The origin of perivascular nerve fibres storing nitric oxide synthase (NOS) and co-localisation with perivascular neuropeptides were examined in the rat middle cerebral artery (MCA) by retrograde tracing with True Blue (TB) in combination with immunocytochemistry. Application of TB to the proximal part of the middle cerebral artery labelled nerve cell bodies ipsilaterally in the trigeminal, sphenopalatine, otic, and superior cervical ganglia. A few labelled cell bodies were seen contralaterally, suggesting bilateral innervation. In the parasympathetic sphenopalatine and otic ganglia, numerous TB-labelled cell bodies contained neuronal NOS (C- and N-terminal), vasoactive intestinal peptide (VIP), and pituitary adenylate cyclase activating peptide (PACAP). In the trigeminal ganglion, almost all TB-labelled cell bodies contained calcitonin gene-related peptide (CGRP) but only a few cells contained NOS. In the superior cervical ganglion, the majority of the TB-labelled nerve cells contained neuropeptide Y (NPY) but none of them contained NOS. Removal of the ipsilateral sphenopalatine ganglion caused a slight reduction in the number of perivascular VIP-, PACAP-, and NOS-containing fibres after 3 days in the MCA while there was no difference at 2 and 4 weeks after the denervation as compared to control. This indicates that the parasympathetic VIP-, PACAP-, and NOS-immunoreactive nerve fibres in the rat MCA originate from several sources.

Cholinergic-nitrergic transmitter mechanisms in the cerebral circulation

Cerebral blood vessels from several species are innervated by vasodilator nerves. Acetylcholine (ACh) released from parasympathetic cholinergic nerves was first suggested to be the transmitter for vasodilation. Results from pharmacological studies in isolated cerebral arterial ring preparations, however, have demonstrated that nitric oxide (NO) but not ACh mediates the major component of neurogenic vasodilation. More recently, ACh and NO have been shown to co-release from the same cholinergic-nitrergic nerves, and that ACh acts as a presynaptic transmitter in modulating NO release. In this communication, evidence for the neuronal origin of NO and possible role of ACh in modulating NO release in large cerebral arteries at the base of the brain will be discussed.

Ultrasonic irradiation for blue-green algae bloom control

A novel application of ultrasonic irradiation for rapid control of blue-green algae (BGA) bloom was investigated. Potassium iodide (KI) experiments demonstrated that frequency and input power are the major factors that affect the ultrasonic irradiation intensity. Short exposure (3 s) to ultrasonic irradiation (120 W input power, 28 kHz) effectively settled naturally growing BGA suspension. Electron microscopy reconfirmed that sedimentation was caused by the disruption and collapse of gas vacuoles after ultrasonic exposure. Moreover, even after 5 min of exposure to ultrasonic irradiation (1200 W input power, 28 kHz) the microcystin concentration in BGA suspensions did not increase. For the same input power (120 W), a lower frequency (28 kHz) was found to be more effective in decreasing the photosynthetic activity of BGA than a higher frequency (100 kHz). The sonicated cells did not proliferate when they were cultured in conditions that simulated the bottom of water bodies (i.e. with limited light (400 lx) or no light and non-aerated or aerated (1 l min-1)). Furthermore, ultrasonic irradiation did not only collapse gas vacuoles and precipitate BGA, but may have also inflicted damage on the photosynthetic system of the BGA.

Electronic spectra and ionization potentials of a stable class of closed shell polycyclic aromatic hydrocarbon cations

Due to their stability, closed shell polycyclic aromatic hydrocarbon (PAH) cations are possible candidates as carriers for some of the diffuse interstellar bands (DIBs). The electronic absorption spectra and ionization potentials of several closed shell PAH cations are determined in this study. We use density functional theory (DFT) at the BLYP/6-31G* level to determine the ionization potentials and thus confirm the stability of the PAH cations of interest. We use time-dependent density functional theory (TDDFT), again at the BLYP/6-31G* level, to calculate the vertical excitation energies and oscillator strengths of the PAH cations. We observe dominant single absorptions within the DIB spectral region of interest in all of the PAH cation spectra except for the smallest member of the series.

Muellerianosis of the urinary bladder, endocervicosis type: a case report

This case reports muellerianosis of the urinary bladder, showing glandular lesions made up of endocervical type glands, in a 36-yr-old woman. The patient presented with lower abdominal discomfort and pain on voiding. The patient had undergone two Cesarean sections 5 yr and 3 yr earlier. On a pelvic ultrasonography, a well-circumscribed mass, 2.2x0.8 cm in dimension, was found with luminal polypoid projection in the posterior wall of the urinary bladder. The patient had a transurethral resection of the bladder mass. Histologically, the tumor was composed of irregularly shaped glands lined by endocervical mucous epithelium in the muscularis propria of the urinary bladder. Some glands exhibited cystic dilatation and contained mucinous secretions. The glands elicited no desmoplastic tissue reaction. The intraluminal mucin often contained polymorphonuclear leukocytes. The glands were mostly lined by tall columnar and bland looking mucous cells with mucin secretion. The ciliated cells were rarely observed. No endometrial component is noted. It would be appropriate to designate this lesion as "Muellerianosis of the urinary bladder, endocervicosis type". Awareness of the lesion and attention to its typical histologic features should facilitate its crucial distinction from adenocarcinoma.

Correlation of VEGF with contrast enhancement on dual-phase dynamic helical CT in liver tumors: preliminary study

The purpose of this preliminary study is to elucidate that vascular endothelial growth factor (VEGF) influences contrast enhancement of hepatic tumors on computed tomography (CT). Fourteen patients with hepatic tumors (11 hepatocellular carcinomas; 3 metastatic cancers) underwent a dual-phase dynamic helical CT or computed tomographic hepatic arteriography. The attenuation of each mass was determined as hyperattenuation, isoattenuation or hypoattenuation with respect to the adjacent nontumorous parenchyma. Gun-needle biopsy was done for each tumor, and paraffin sections were immunostained with anti- VEGF antibody by the avidin-biotin-peroxidase complex method. The pathologic grade was made by intensity (1 +, 2+, 3+) and area (+/-, 1 +, 2+). The tumor ranged 2.0-14.0 cm in size (mean, 5.8 cm). In arterial phase, the intensity was not correlated with the degree of enhancement (p=0.086). However, the correlation between the attenuation value of hepatic arterial phase and the area of positive tumor cells was statistically significant (p=0.002). VEGF may be the factor that enhances the hepatic mass with water-soluble iodinated contrast agent in CT.

Effect of drug substance particle size on the characteristics of granulation manufactured in a high-shear mixer

DPC 963 is a non-nucleoside reverse transcriptase inhibitor with low aqueous solubility. The effect of DPC 963 drug substance particle size on the characteristics of granules manufactured by high-shear wet granulation was evaluated. The wet granulation process was used to manufacture a DPC 963 formulation with high drug loading. The formulation was manufactured using drug substance lots with different particle size distributions. Granulation particle size distribution, porosity, and compressibility were determined. A uniaxial compression test was also performed on moist compacts of the formulation prepared with different particle size distributions. Particle agglomeration behavior was affected by drug substance particle size. Granulation geometric mean diameter and fraction with particle size greater than 250 microm was inversely proportional to the drug substance particle size. Mercury intrusion porosimetry revealed higher pore volumes for the granules manufactured using the drug substance with the smaller particle size, suggesting lower tendency for granule densification than for that manufactured with the larger drug substance particle size. Granulation compressibility was also sensitive to changes in drug substance particle size. A decreased drug substance particle size led to increased granulation compressibility. Results from the uniaxial compression experiments suggested that the effect of particle size on granulation growth is the result of increased densification propensity, which in turn results from increased drug substance particle size.

Abrogation of the p16-Rb pathway in Korean hepatocellular carcinomas

BACKGROUND/AIMS

The tumor suppressor gene p16 on human chromosome 9p21 encodes a specific inhibitor of the cyclin D-CDK4 complex which inactivates the Rb protein by hyperphosphorylation. Many reports show that p16 is inactivated in a variety of human cancers. We investigated whether abnormalities involving p16 and Rb are associated with hepatocellular carcinomas in Korea.

METHODOLOGY

We performed loss of heterozygosity analysis on 9 primary hepatocellular carcinomas using 7 microsatellite markers spanning human chromosome 9p. Reverse transcriptase-PCR, ribonuclease protection assay, and immunoblotting were used to examine the expression of p16 and Rb in 8 hepatocellular carcinoma cell lines, including 5 from Korean patients. Exons 1 and 2 of the p16 gene were sequenced.

RESULTS

We found a 33% loss of heterozygosity at the D9S171 locus (9p21 region) in the primary hepatocellular carcinomas. The p16 protein was not found in 4 out of 5 (80%) of the Korean cell lines. Among them, 2 cell lines lacked p16 protein and had the following point mutations in p16 exon 2: Asp125 to Asn and Arg58 to Ter. Two of the Korean cell lines and the SK-Hep-1 cells contained deletions in the p16 gene. All cell lines examined, except Hep 3B, expressed Rb protein, which in all cases was dominantly hyperphosphorylated (inactivated).

CONCLUSIONS

Our results suggest that p16 and Rb abnormalities are associated with hepatocellular carcinomas in the Korean population.

Influence of the sequence variations of the HLA-DR promoters derived from human melanoma cell lines on nuclear protein binding and promoter activity

In previous studies we reported that the expression of HLA-DR on melanoma cell lines was differentially modulated by IFN- gamma and that the transcription rate was responsible for this differential modulation. We have also reported the nucleotide sequence variations in the promoter region of HLA-DR genes, and proposed that differences in the promoter activity by the sequence variations of the HLA-DR promoters might contribute to such a differential transcriptional regulation at the promoter level. In this study, in order to assess whether the sequence variations of the HLA-DR promoters affect the factor binding and exert influence on the promoter activity, nuclear factor binding to our previous six HLA-DRA and fourteen HLA-DRB promoter clones was evaluated with the nuclear protein extracted from a B-lymphoblastoid cell line (BLCL), BH, together with the chloramphenicol acetyltransferase (CAT) reporter assay. In the HLA-DRA promoters, clone #35 containing one bp nucleotide sequence variation at the octamer binding site (OCT) (GATTTGC to GATCTGC) showed relatively weak factor binding. In the HLA-DRB promoters, clusters I, III, and IV of our previous HLA-DRB promoter homologues, containing one bp nucleotide sequence variation (GATTCG) in their Y boxes exhibited weak factor binding and CAT activity compared to other clusters (GATTGG) that showed strong factor binding and CAT activity. This data suggests chat the binding patterns of transcription factors influenced by the nucleotide sequence variations of the HLA-DR promoter could affect the promoter activity and the DNA sequence elements in the HLA-DR promoter could mediate transcriptional regulation.