How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

Immunologic Heterogeneity in 2 Cartilage-Hair Hypoplasia Patients With a Distinct Clinical Course

BACKGROUND AND OBJECTIVE

Cartilage-hair hypoplasia (CHH) syndrome is a rare autosomal recessive syndrome associated with skeletal dysplasia, varying degrees of combined immunodeficiency (CID), short stature, hair hypoplasia, macrocytic anemia, increased risk of malignancies, and Hirschsprung disease. To provide clinical and immunological insights obtained from 2 unrelated patients who displayed clinical characteristics of CHH.

METHODS

Two patients with suspected CHH syndrome due to skeletal dysplasia and immunodeficiency underwent an immunological and genetic work-up using flow cytometry, next-generation sequencing (NGS) of the immune repertoire, and Sanger sequencing to identify the underlying defects.

RESULTS

Patient 1 presented with low birth weight and skeletal dysplasia. Newborn screening was suggestive of T-cell immunodeficiency, as T-cell receptor excision circle levels were undetectable. Both the T-cell receptor (TCR) Vß and TCR-g (TRG) repertoires were restricted, with evidence of clonal expansion. Genetic analysis identified compound heterozygous RMRP variants inherited from both parents. Patient 2 presented with recurrent lung and gastrointestinal infections, skeletal dysplasia, failure to thrive, and hepatomegaly. The polyclonal pattern of the TCRß repertoire was normal, with only slight overexpression of TCR-ßV20 and restricted expression of Vßs. TRG expressed a normal diverse repertoire, similar to that of the healthy control sample. Genetic analysis identified biallelic novel regulatory variants in RMRP. Both parents are carriers of this mutation.

CONCLUSION

Our findings demonstrate how the immunological work-up, supported by genetic findings, can dramatically change treatment and future outcome in patients with the same clinical syndrome.

How experienced wound care nurses conceptualize what to do in pressure injury management

BACKGROUND

Conceptual understanding of the perceptions that wound care nurses use to determine how to manage pressure injuries may provide information for improving their pressure injury care competency. The aim of this study is to explore and describe the way wound care nurses experience and perceive pressure injury management.

METHODS

A qualitative, phenomenographic approach, a method designed to explore the different ways in which people comprehend a phenomenon and develop a practical knowledge-based framework, was used in this study. Semi-structured interviews were used for data collection with twenty wound care nurses. All participants were female with a mean age of 38.0, mean total clinical experience of 15.2 years and mean clinical experience as wound care nurse of 7.7 years. The eight steps of qualitative data analysis for a phenomenographic study were employed to develop an understanding of participants' experience of pressure injury management.

RESULTS

The analysis resulted in an assessment domain and an intervention domain, each containing three descriptive categories based on five identified conceptions. The categories were as follows: "comparison", "consideration", and "monitoring" in assessment, and "creation", "conversation" and "judgement" in intervention.

CONCLUSIONS

This study has created a framework for understanding pressure injury management based on practical knowledge. This framework of the nurses' pressure injury care reflected the need for an awareness of a harmonious approach to patients and wounds. There is a pattern of transcending a reliance on only theoretical knowledge, and this key factor in the framework should be considered when developing education programs and tools for improving nurse pressure injury care competency and patient safety.

An e-Problem-Based Learning Program for Infection Control in Nursing Homes: A Quasi-Experimental Study

Infection is a significant factor adversely affecting the health of nursing home (NH) residents, potentially even leading to death. Therefore, educating NH staff to think critically is necessary to prevent and control infection. In this study, we developed an electronic problem-based learning (e-PBL) program using the Network-Based Instructional System Design model to enhance South Korean NH staff's critical thinking competencies; subsequently, its effectiveness was evaluated. This study utilized a quasi-experimental nonequivalent pretest-post-test design. The participants (n = 54) were randomly allocated into an experimental group (n = 28) and a control group (n = 26). The results indicate that the e-PBL program significantly improved the critical thinking disposition in the experimental group compared with in the control group.

AD-9308 ameliorates the impacts of 4-HNE on the progress of pulmonary arterial hypertension in aldehyde dehydrogenase 2*1*2 knock-in mice

 

Endothelial dysfunctions play a critical role on the development of pulmonary arterial hypertension (PAH). It has been reported that the one-year mortality rate is still up to 15% even with PAH-targeted therapy, implying that there may be untargeted pathways. 4-hydroxynenonal (4-HNE), an unsaturated aldehyde, is highly induced in the lungs of PAH animals and its serum levels were also reported to be higher in PAH patients. 4-HNE is metabolized by mitochondrial aldehyde dehydrogenase (ALDH2), which is dysfunctional in near 40% of East Asian people. Currently, the impacts of 4-HNE on endothelial dysfunctions in the development of PAH are unclear. In terms of translational medicine, we proposed that modulation of 4-HNE level may alleviate the progress of PAH patients with ALDH2 deficiency.

We found that 4-HNE alone was not sufficient to induce pulmonary artery endothelial cell (PAEC) functional changes, including proliferation, migration and tube formation, whereas their effects emerge from the depletion of ALDH2. We further mimicked human ALDH2 functional deficiency by using daidzin (DZN), an inhibitor which is able to block the substrate binding site of ALDH2. ALDH2 functional inhibition alone did not induce any PAEC functional change, while an add-on of 4-HNE impaired PAEC functions. In addition, 4-HNE significantly reduced eNOS activity with combined DZN treatment. Consistent with the mechanism of ALDH2 activity-mediated angiogensis, ALDH2 enhancers Alda-1 and AD-5591 completely reverse the anti-angiogenic effects of 4-HNE in the presence of DZN. To further confirm whether ALDH2 functional deficiency impact on PAH development in mammals, heterozygous ALDH2*1/*2 transgenic and wild-type mice were subjected to chronic hypoxia to induce PAH. ALDH2*1/*2 transgenic mice had similar right ventricular systolic pressure (RVSP) as wild-type mice. However, after exposure to chronic hypoxia, ALDH2*1/*2 transgenic mice indeed developed a significantly higher RVSP than that in wild-type mice. Furthermore, we demonstrated that 4-HNE expression was profoundly enhanced in ALDH2*1/*2 transgenic mice by chronic hypoxia-induced PAH with pulmonary artery smooth muscle cell hyperplasia. More importantly, we found that AD-9308, an enhancer of ALDH2 significantly decreased hypoxia-induced RVSP elevation in heterozygous ALDH2*1/*2 transgenic mice.

Taken together, our data demonstrate that 4-HNE and ALDH2 functional deficiency potentially contribute to PAH development and worsening, and that ALDH2 enhancers may be promising as a PAH adjunct therapy, particularly for patients with ALDH2 nonfunctional alleles.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Taiwan

How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?

Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.

For the interprofessional management of the discomfort of long-term care facility residents with dementia

Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.

How do wound care nurses structure the subjective frame on palliative wound care? A Q-methodology approach

Background

Palliative wound care is important for stability in terminal care. It addresses both the physical and psychological needs of patients and facilitates other aspects of terminal care. Appropriate competencies of nurses regarding palliative wound care can improve patient outcomes and raise their quality of life. The purpose of this study was to identify how wound care nurses structure the subjective frames regarding palliative wound care.

Method

This study utilized Q-methodology to analyze their subjective viewpoints. Forty nurses experienced in palliative wound care were asked to completely classify 35 Q-statements into a normal distribution shape. The PQ-Method program was used to conduct principal factor analysis and varimax rotation for data analysis.

Results

This study revealed 4 Q-factors of palliative wound care: “Focusing on care within the boundary of current patient demands,” “Comparing continuously the priorities on wound healing and disease care,” “Preparing and preventing from worsening via tracking care in advance,” and “Moving forward with a clear direction by confronting the declining condition.”

Conclusion

We hope that the results of this study are used in the development of nursing education that reflects professional perspectives of palliative wound care, thus helping to improve nursing competencies in palliative care.

Bridging the Knowledge Gap for Pressure Injury Management in Nursing Homes

BACKGROUND

Pressure injuries in nursing homes remain a consistent problem. Unfortunately, despite the variety of pressure injury education offered in nursing homes, the knowledge learned cannot be applied in practice, and as a result, the prevalence and incidence of such injuries are consistently high. This study aimed to address those gaps by analyzing the nursing competency for pressure injury management and implementing pressure injury education programs in nursing homes.

METHODS

Two phases were conducted based on the action cycle in the knowledge to action model. During the first phase, a framework was constructed by analyzing nursing experience. The second phase consisted of the implementation and monitoring of the program to evaluate the effects of the framework.

RESULTS

The main results for nursing competencies for pressure injury management in nursing homes are integrated thinking, understanding in an environmental context, interpersonal relationships for efficient decision making, and meeting any challenges to professional development. The results concerning the program's effects showed significant differences in the participants' knowledge, attitude, stage discrimination ability, and clinical management judgment ability.

CONCLUSION

The educational framework and program derived from this study are expected to improve nurses' pressure injury management competency in nursing homes and to contribute to effective pressure injury management and quality of life for residents in nursing homes.

Association between Consumption of Sugar-Sweetened Beverages and Risk of Cardiovascular Disease in Korean Men: Analysis Based on the Korea National Health and Nutrition Examination Survey 2014-2016

Background

This study aimed to evaluate the association between the high risk of cardiovascular disease (CVD) and the consumption of sugar-sweetened beverages (SSBs) in Korean men.

Methods

This cross-sectional study analyzed the data of 3,705 men (age 30–64 years) who participated in the 2014–2016 Korea National Health and Nutrition Examination Survey (KNHANES). SSB intake was defined as the sum of the intakes of carbonated beverages and fruit juices. Participants were categorized into study groups depending on their intake of SSBs: ≤2, 3–4, or ≥5 times per week. High CVD risk was defined as a 10-year risk of more than 10%, based on the Framingham Heart Study 10-year CVD Risk Calculator. The association between high CVD risk and SSB intake was evaluated using a multivariable-adjusted logistic regression model.

Results

Korean men who consumed SSBs 3–4 and ≥5 times a week showed a multivariate-adjusted odds ratio of 1.49 (95% confidence interval [CI], 1.05–2.11) and 1.61 (95% CI, 0.97–2.67) for high CVD risk, respectively, compared with those who consumed SSBs ≤2 times per week. Additionally, the risk of CVD increased with the increase in the intake of SSBs (P-trend=0.01). In subgroup analysis, no association was observed between SSB intake and high CVD risk in the group with regular physical activity (P for interaction=0.01).

Conclusion

In Korean men, except those with regular physical activity, SSB intake ≥3 times a week is associated with a high risk for CVD (10-year CVD risk ≥10%).

Measuring the Resilience of Patients on Hemodialysis: Development of a Patient on Hemodialysis Resilience Scale

The aim of this study was to develop a patient on hemodialysis resilience scale and to verify validity and reliability. This patient on hemodialysis resilience scale (PHRS) was developed according to the scale development process by DeVellis (2017). Thirty-one publications on the subject were reviewed, and in-depth interviews with seven patients on hemodialysis were conducted. Items comprising the scale were reviewed and modified through evaluation by a panel of experts and face validity. For verification of validity, a content validity index for the items, exploratory factor analysis, and confirmatory factor analysis were performed. In the exploratory factor analysis, the PHRS was categorized into three factors: 'pursuing a positive meaning in life,' 'accepting hemodialysis as a part of daily life,' and 'building a willingness to live through meaningful relationships.'

How Do Patients on Hemodialysis Perceive and Overcome Hemodialysis?: Concept Development of the Resilience of Patients on Hemodialysis

This study was conducted to clarify and conceptualize the phenomenon of the resilience of patients on hemodialysis. Three phases of a hybrid model were applied. In the theoretical phase, a working definition of the resilience of patients on hemodialysis was developed via literature review. In the fieldwork phase, in-depth interviews were conducted with 10 patients. Qualitative data from the interviews were analyzed to find attributes of resilience for patients on hemodialysis. The final analytical phase interpreted and compared findings of the theoretical and fieldwork phases. The concept of the resilience of patients on hemodialysis was as a complex phenomenon possessing several dimensions and attributes, delineating how patients on hemodialysis perceive and overcome hemodialysis. This conceptualization could lead to demonstrating a theoretical construct of resilience of patients on hemodialysis.

Influence of Peripheral Neuropathy and Microangiopathy on Skin Hydration in the Feet of Patients With Diabetes Mellitus

INTRODUCTION

Maintaining adequate skin hydration is crucial in the feet of patients with diabetes because xerotic skin may crack and develop fissures, thereby increasing vulnerability to ulceration and infection. The nervous system is considered the powerhouse for maintaining adequate skin hydration; however, no clinical study has assessed the effect of the nervous system on skin hydration. In addition, it is hypothesized that microcirculation may play an important role in maintaining adequate hydration in patients with diabetes.

OBJECTIVE

This study aims to evaluate the influence of peripheral nerve function and microvascularity on skin hydration in the feet of patients with diabetes mellitus and compare the effects of these 2 functions on skin hydration.

MATERIALS AND METHODS

This study included 266 patients with diabetic foot disease. Skin hydration was evaluated using corneometry and microvascularity by measuring the transcutaneous oximetry (TcpO₂) of the foot. The Semmes-Weinstein 5.07/10-g monofilament test, electromyography, and nerve conduction velocity test were conducted to evaluate peripheral neuropathy. Patient data were divided into 3 subgroups according to test values, and statistical comparisons were performed using the linear-by-linear association trend and Pearson's chi-square tests.

RESULTS

There was a significant correlation between skin hydration and TcpO₂. However, there was no significant correlation between skin hydration and peripheral nerve function (P = .338).

CONCLUSIONS

The results of this study demonstrated that skin hydration in the feet of patients with diabetes mellitus mainly is influenced by microcirculation rather than peripheral nerve function.

Translation and validation of the Korean version of the Diabetic Foot Ulcer Scale-Short Form

The purpose of this study was to translate the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) into Korean and evaluate its psychometric performance in patients with diabetic foot ulcers (DFUs). The DFS-SF was translated into Korean using translation guidelines from the World Health Organization. The Korean version of DFS-SF (DFS-SF-K) went through the full linguistic validation process and was evaluated in 320 Korean patients with DFU. For this study, Cronbach's alpha was used to evaluate the reliability of the DFS-SF-K. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and known-group validity were conducted to examine construct validity. Correlation of the DFS-SF-K with SF-36 was used to test concurrent validity of the DFS-SF-K. Cronbach's alpha was >0.70 for all scales. Factor loadings of the 29 items on the six subscales ranged from 0.82 to 0.95. The six-subscale model was validated by CFA (x² /df = 4.55, P < 0.001, RMR = 0.06, GFI = 0.73, NFI = 0.90, TLI = 0.91, CFI = 0.92, RMSEA = 0.10). Spearman's correlations and known-groups comparisons supported construct validity. The newly translated DFS-SF-K may be used to assess the impact of QoL with DFUs in Korean patients.

Altered T cell receptor beta repertoire patterns in pediatric ulcerative colitis

The antigenic specificity of T cells occurs via generation and rearrangement of different gene segments producing a functional T cell receptor (TCR). High-throughput sequencing (HTS) allows in-depth assessment of TCR repertoire patterns. There are limited data concerning whether TCR repertoires are altered in inflammatory bowel disease. We hypothesized that pediatric ulcerative colitis (UC) patients possess unique TCR repertoires, resulting from clonotypical expansions in the gut. Paired blood and rectal samples were collected from nine newly diagnosed treatment-naive pediatric UC patients and four healthy controls. DNA was isolated to determine the TCR-β repertoire by HTS. Significant clonal expansion was demonstrated in UC patients, with inverse correlation between clinical disease severity and repertoire diversity in the gut. Using different repertoire variables in rectal biopsies, a clear segregation was observed between patients with severe UC, those with mild-moderate disease and healthy controls. Moreover, the overlap between autologous blood-rectal samples in UC patients was significantly higher compared with overlap among controls. Finally, we identified several clonotypes that were shared in either all or the majority of UC patients in the colon. Clonal expansion of TCR-β-expressing T cells among UC patients correlates with disease severity and highlights their involvement in mediating intestinal inflammation.

Comparison of perfusion values after percutaneous transluminal angioplasty according to the severity of ischaemia in the diabetic foot

Percutaneous transluminal angioplasty (PTA) is now more frequently used to improve tissue perfusion in ischemic diabetic feet. However, there are concerns about its feasibility and effectiveness in severely ischaemic feet. This study aimed to compare the perfusion values after PTA according to the ischaemic degree of diabetic feet. This study included 133 ischaemic diabetic feet. The foot transcutaneous oxygen pressure (TcPO₂ ) and toe pressure were measured before the procedure and every second postoperative week for 6 weeks. The patients were divided into three groups according to ischaemic severity on the basis of TcPO₂ and toe pressures. In the "severely ischaemic" group, the TcPO₂ increased from 7.5 ± 4.9 to 40.3 ± 11.3 mm Hg (5.4-fold) 6 weeks after the PTA (P < 0.001). The toe pressure increased from 8.5 ± 8.8 to 42.2 ± 19.3 mm Hg (5.0-fold, P < 0.001). In the "mild" group, the TcPO₂ increased from 35.4 ± 2.5 to 41.8 ± 12.4 mm Hg (1.2-fold, P = 0.003), and the toe pressure increased from 45.7 ± 12.3 to 54.3 ± 31.3 mm Hg (1.2-fold, P > 0.05). Results of the "intermediate" group were in between. The most severely ischaemic group had the most dramatic increase of tissue perfusion after PTA. As such, PTA can be an effective method for increasing tissue perfusion even in the severely ischaemic diabetic feet.

Exploring Subjective Frames of Patients on Hemodialysis on Acquiring Resilience: A Q Methodology Study

This study explored subjectivity frames of reference of resilience of patients on hemodialysis by using Q methodology. Participants included 35 patients on hemodialysis. Data were obtained from October to December 2016 and were analyzed by the PQ method. Five factors were identified: 1) finding the value of life by focusing on the meaning of a new life through hemodialysis, 2) compromising actively with the situation of hemodialysis, 3) internalizing sadness and emphasizing the meaning of life itself, 4) finding a support system to help overcome hemodialysis, and 5) building the will to live by getting strength from family. The common theme of the five factors was overcoming hemodialysis and moving forward with their lives. This study can help nurses understand the resilience of patients on hemodialysis and presents strategies that can be used to develop an intervention program to improve the resilience of patients on hemodialysis.

Identification of amino acids related to catalytic function of Sulfolobus solfataricus P1 carboxylesterase by site-directed mutagenesis and molecular modeling

The archaeon Sulfolobus solfataricus P1 carboxylesterase is a thermostable enzyme with a molecular mass of 33.5 kDa belonging to the mammalian hormone-sensitive lipase (HSL) family. In our previous study, we purified the enzyme and suggested the expected amino acids related to its catalysis by chemical modification and a sequence homology search. For further validating these amino acids in this study, we modified them using site-directed mutagenesis and examined the activity of the mutant enzymes using spectrophotometric analysis and then estimated by homology modeling and fluorescence analysis. As a result, it was identified that Ser151, Asp244, and His274 consist of a catalytic triad, and Gly80, Gly81, and Ala152 compose an oxyanion hole of the enzyme. In addition, it was also determined that the cysteine residues are located near the active site or at the positions inducing any conformational changes of the enzyme by their replacement with serine residues. [BMB Reports 2016; 49(6): 349-354]

Direct peroral cholangioscopy using an ultraslim upper endoscope for management of residual stones after mechanical lithotripsy for retained common bile duct stones

BACKGROUND AND STUDY AIMS

The incidence of residual stones after mechanical lithotripsy for retained common bile duct (CBD) stones is relatively high. Peroral cholangioscopy using a mother-baby system may be useful for confirming complete extraction of stones, but has several limitations regarding routine use. We evaluated the role of direct peroral cholangioscopy (DPOC) using an ultraslim upper endoscope for the evaluation and removal of residual CBD stones after mechanical lithotripsy.

PATIENTS AND METHODS

From August 2006 to November 2010, 48 patients who had undergone mechanical lithotripsy for retained CBD stones with no evidence of filling defects in balloon cholangiography were recruited. The bile duct was inspected by DPOC after balloon cholangiography. Detected residual CBD stones were directly retrieved with a basket or balloon catheter under DPOC. The incidence of residual stones detected by DPOC, and the success rate of residual stone retrieval under DPOC were investigated.

RESULTS

DPOC was successfully performed in 46 of the 48 patients (95.8%). Of these, 13 patients (28.3%) had residual CBD stones (mean number 1.4, range 1-3; mean diameter 4.5 mm, range 2.3-9.6). The residual stones were removed directly under DPOC in 11 of these patients (84.6%). There were no complications associated with DPOC or stone removal.

CONCLUSION

DPOC using an ultraslim upper endoscope is a useful endoscopic procedure for the evaluation and extraction of residual stones after mechanical lithotripsy for retained CBD stones.

Anti-influenza virus activity of green tea by-products in vitro and efficacy against influenza virus infection in chickens

Polyphenolic compounds present in green tea, particularly catechins, are known to have strong anti-influenza activity. The goal of this study was to determine whether green tea by-products could function as an alternative to common antivirals in animals compared to original green tea. Inhibition of viral cytopathic effects ascertained by neutral red dye uptake was examined with 50% effective (virus-inhibitory) concentrations (EC₅₀)determined. Against the H1N1 virus A/NWS/33, we found the anti-influenza activity of green tea by-products (EC₅₀ = 6.36 µg/mL) to be equivalent to that of original green tea (EC₅₀= 6.72 µg/mL). The anti-influenza activity of green tea by-products was further examined in mouse and chicken influenza infection models. In mice, oral administration of green tea by-products reduced viral titers in the lungs in the early phase of infection, but they could not protect these animals from disease and death. In contrast, therapeutic administration of green tea by-products via feed or water supplement resulted in a dose-dependent significant antiviral effect in chickens, with a dose of 10 g/kg of feed being the most effective (P < 0.001). We also demonstrated that unidentified hexane-soluble fractions of green tea by-products possessed strong anti-influenza activity, in addition to ethyl acetate-soluble fractions, including catechins. This study revealed green tea by-product extracts to be a promising novel antiviral resource for animals.

Short-term temporal variation in PM2.5 mass and chemical composition during the Atlanta Supersite Experiment, 1999

Measurements in urban Atlanta of transient aerosol events in which PM2.5 mass concentrations rapidly rise and fall over a period of 3-6 hr are reported. The data are based on new measurement techniques demonstrated at the U.S. Environmental Protection Agency (EPA) Atlanta Supersite Experiment in August 1999. These independent instruments for aerosol chemical speciation of NO3-, SO4(2-), NH4+, and organic and elemental carbon (OC and EC), reconstructed the observed hourly dry PM2.5 mass to within 20% or better. Data from the experiment indicated that transient PM2.5 events were ubiquitous in Atlanta and were typically characterized by a sudden increase of EC (soot) and OC in the early morning or SO4(2-) in the late afternoon. The frequent temporal decoupling of these events provides insights into their origins, suggesting mobile sources in metro Atlanta as the main contributor to early morning PM2.5 and more regionally located point SO2 sources for afternoon PM2.5 events. The transient events may also have health implications. New data suggest that short-term PM2.5 exposures may lead to adverse health effects. Standard integrated filter-based techniques used in PM2.5 compliance monitoring networks and in most past PM2.5 epidemiologic studies collect samples over 24-hr periods and thus are unable to capture these transient events. Moreover, health-effects studies that focus on daily PM2.5 mass alone cannot evaluate the health implications of the unique and variable chemical properties of these episodes.

Heterogeneity of myocardial sleeve morphology and gap junctions in canine superior vena cava

BACKGROUND

The myocardial sleeve of the superior vena cava (SVC) has been identified as a potential initiating focus in atrial fibrillation, but information on cell-to-cell linkage at this site is lacking.

METHODS AND RESULTS

We examined the SVC in 8 dogs by immunoconfocal and electron microscopy. Cardiomyocytes outlined with vinculin and bearing striations positive for alpha-actinin are found in the proximal segment of the SVC. These cells, grouped in bundles of various orientations according to location, extend cephalically as far as 3 cm from the right atrium (RA)-SVC junction. Comparison between the junctional level and the level 2 cm distal shows that the myocardial layer in the latter is thinner and not as compact and is composed of longer cells (87.3+/-15.7 versus 71.6+/-14.4 micrometer, P<0.01). Gap junctions made of connexin43 (Cx43), Cx40, and Cx45 are aggregated mainly at the intercalated disks, and colocalization of connexins is a common feature throughout the myocardial sleeve. Areas of atypical expression exist, however, characterized by a center of abundant Cx43 labels surrounded by a periphery of scattered tiny Cx40-labeled spots. Although in the ventral subluminal compact myocardial layer, individual cells at both levels are surrounded by similar numbers of cells, the number of aggregation of labeled gap junctions at the distal level is less (2.3+/-0.6 versus 3.7+/-0.9, P<0.01). In addition, electron-microscopic examination demonstrates that the gap junctions at the distal level are smaller in size (0.37+/-0.30 versus 0.55+/-0.34 micrometer, P<0.01).

CONCLUSIONS

The myocardial sleeve in the canine SVC is a heterogeneous structure, which could potentially form a substrate for heterogeneity of electrical coupling.

Identification of a role for the sialomucin CD164 in myogenic differentiation by signal sequence trapping in yeast

Determination and differentiation of skeletal muscle precursors requires cell-cell contact, but the full range of cell surface proteins that mediate this requirement and the mechanisms by which they work are not known. To identify participants in cell contact-mediated regulation of myogenesis, genes that encode secreted proteins specifically upregulated during differentiation of C2C12 myoblasts were identified by the yeast signal sequence trap method (K. A. Jacobs, L. A. Collins-Racie, M. Colbert, M. Duckett, M. Golden-Fleet, K. Kelleher, R. Kriz, E. R. La Vallie, D. Merberg, V. Spaulding, J. Stover, M. J. Williamson, and J. M. McCoy, Gene 198:289-296, 1997), followed by RNA expression analysis. We report here the identification of CD164 as a gene expressed in proliferating C2C12 cells that is upregulated during differentiation. CD164 encodes a widely expressed cell surface sialomucin that has been implicated in regulation of cell proliferation and adhesion during hematopoiesis. Stable overexpression of CD164 in C2C12 and F3 myoblasts enhanced their differentiation, as assessed by both morphological and biochemical criteria. Furthermore, expression of antisense CD164 or soluble extracellular regions of CD164 inhibited myogenic differentiation. Treatment of C2C12 cells with sialidase or O-sialoglycoprotease, two enzymes previously reported to destroy functional epitopes on CD164, also inhibited differentiation. These data indicate that (i) CD164 may play a rate-limiting role in differentiation of cultured myoblasts, (ii) sialomucins represent a class of potential effectors of cell contact-mediated regulation of myogenesis, and (iii) carbohydrate-based cell recognition may play a role in mediating this phenomenon.

Structure-activity relationship studies of isoquinolinone type anticancer agent

Substituted isoquinolin-1-ones (1) were synthesized to test their in vitro anticancer activity. 3-Biphenyl-N-methylisoquinolin-1-one (7) showed the most potent anticancer activity against five different human cancer cell lines.

Mode of antiviral activity of water soluble components isolated from Elfvingia applanata on vesicular stomatitis virus

A preparation of water soluble components (EA) was made from carpophores of Elfvingia applanata (Pers.) Karst and its in vitro antiviral activity on vesicular stomatitis virus [(Indiana serotype, VSV(IND)] was investigated by plaque reduction assay. EA exhibited potent antiviral activity on VSV(IND) growth and negligible cytotoxicity on Vero cells, 50% effective concentration (EC50) of 104 microg/ml and 50% cytotoxic concentration (CC50) of 3,793 microg/ml, respectively. Selectivity index (SI, CC50/EC50) of EA on Vero cell and VSV(IND) was about 36.5. EA did not display either a direct virucidal effect on VSV(IND) or induction of antiviral substance by Vero cells upon its treatment. Thus, the mode of antiviral activity of EA was studied at steps of viral adsorption onto cell. When both EA and virus were added to cell monolayers, titer of cell-free virus in culture supernatant increased in ca. 30-40% compared with that of control group and titer of cell-associated virus was 60-100% higher than that of control group. These results suggested that antiviral activity of EA on VSV(IND) might be due to the hindrance of viral entry to cells at either endocytosis or loss of envelope.

Virtual reality for relearning daily living skills

The explosive increase in the power of computers has enabled the creation of fast, interactive 3D environments, sometimes called virtual reality (VR). This technology, often associated with arcade games, is increasingly being used for more serious applications. This paper describes research showing transfer of skills from a virtual environment to the real world. We then describe our VR authoring tool and an application to help cognitively impaired individuals relearn important daily living skills. Additionally we describe the development of a prototype networked system to enable a doctor to monitor remotely the rehabilitation of a group of patients.

Biochemical characterization of extracellular cAMP-dependent protein kinase as a tumor marker

In a recent report (Cho et al., Proc. Natl. Acad. Sci. USA 97, 835-840, 2000), we showed that cancer cells of various cell types secrete cAMP-dependent protein kinase (PKA) into the conditioned medium and that in the serum of cancer patients this extracellular PKA (ECPKA) is upregulated 10-fold as compared with normal serum. Here, we characterized the enzymatic properties of ECPKA that is present in the conditioned medium of PC3M prostate cancer cells and in the serum of cancer patients, and we compared ECPKA with PKA found in the cell extracts of PC3M cells. ECPKA present in the conditioned medium and human serum was not activated by cAMP addition, but intracellular PKA activity was totally dependent on the addition of cAMP. This indicates that the ECPKA is present in active, free C subunit form, whereas intracellular PKA is present in inactive holoenzyme form. ECPKA activity increased in a substrate concentration- and time-dependent manner, as did intracellular PKA. Both ECPKA and intracellular PKA activities were specifically inhibited by the PKA inhibitor protein, PKI. However, ECPKA activity was more temperature-sensitive than intracellular PKA; after two cycles of freezing/thawing, only 20% of initial ECPKA activity was detected compared with over 40% of intracellular PKA activity. Western blot analysis revealed the presence of a 40 kDa C(alpha) subunit of PKA in both conditioned medium and in the serum of cancer patients. These results suggest that ECPKA, out of the context of cAMP regulation, may function as a growth factor promoting cell growth and transformation; thus, it may serve as a tumor biomarker.

Age-related alteration of gap junction distribution and connexin expression in rat aortic endothelium

We investigated endothelial gap junctions and their three component connexins, connexin37 (Cx37), Cx40, and Cx43, during growth and senescence in rat aorta by en face immunoconfocal microscopy and electron microscopy. Gap junction spots labeled by specific antisera against Cx37, Cx40, and Cx43 were quantified at 1 day, 7 days, 28 days, 16 months, and > or =20 months of age, and the relationship between the connexins was examined by co-localization analysis. At birth, all three connexins were abundantly expressed; the number and total area of connexin spots then declined within 1 week (p<0.05 for each connexin). From 1 week, each connexin showed a distinct temporal expression pattern. Whereas Cx43 signal decreased progressively, Cx37 signal fluctuated in a downward trend. By contrast, Cx40 maintained an abundant level until > or =20 months of age (> or =20 months vs. 28 days, p<0.05 for number and total connexin signal area). These patterns were associated with changes in endothelial cell morphology. Double-label analysis showed that the extent of co-localization of connexins to the same gap junctional spot was age-dependent [>70% at birth and 28 days old; <70% at later stages (p<0.05)]. We conclude that expression of the three connexins in aortic endothelium is age-related, implying specific intercellular communication requirements during different stages after birth.

Compensatory stabilization of RIIbeta protein, cell cycle deregulation, and growth arrest in colon and prostate carcinoma cells by antisense-directed down-regulation of protein kinase A RIalpha protein

The cyclic AMP-dependent protein kinase (PKA) exists in two isoforms, PKA-I (type I) and PKA-II (type II), that contain an identical catalytic (C) subunit but distinct regulatory (R) subunits, RI and RII, respectively. Increased expression of RIalpha/PKA-I has been shown in human cancer cell lines, in primary tumors, in cells after transformation, and in cells upon stimulation of growth. We have shown previously that a single-injection RI, antisense treatment results in a reduction in RIalpha and PKA-I expression and sustained inhibition of human colon carcinoma growth in athymic mice (M. Nesterova and Y. S. Cho-Chung, Nat. Med., 1: 528-533, 1995). Growth inhibition accompanied reduction in RIalpha/PKA-I expression and compensatory increases in RIIbeta protein and PKA-IIbeta, the RIIbeta-containing holoenzyme. Here, we report that these in vivo findings are consistent with observations made in cancer cells in culture. We demonstrate that the antisense depletion of RIalpha in cancer cells results in increased RIIbeta protein without increasing the rate of RIIbeta synthesis or RIIbeta mRNA levels. Pulse-chase experiments revealed a 3-6-fold increase in the half-life of RIIbeta protein in antisense-treated colon and prostate carcinoma cells with little or no change in the half-lives of RIalpha, RIIalpha, and Calpha proteins. Compensation by RIIbeta stabilization may represent a novel biochemical adaptation mechanism of the cell in response to sequence-specific loss of RIalpha expression, which leads to sustained down-regulation of PKA-I activity and inhibition of tumor growth.

CRE-decoy oligonucleotide-inhibition of gene expression and tumor growth

Nucleic acid molecules with high affinities for a target transcription factor can be introduced into cells as decoy cis-elements to bind these factors and alter gene expression. This review discusses a synthetic single-stranded palindromic oligonucleotide, which self-hybridizes to form a duplex/hairpin and competes with cAMP response element (CRE) enhancers for binding transcription factors. This oligonucleotide inhibits CRE- and Ap-1-directed gene transcription and promotes growth inhibition in vitro and in vivo in a broad spectrum of cancer cells, without adversely affecting normal cell growth. Evidence presented here suggests that the CRE-decoy oligonucleotide can provide a powerful new means of combating cancers, viral diseases, and other pathological conditions by regulating the expression of cAMP-responsive genes.

CRE-transcription factor decoy oligonucleotide inhibition of MCF-7 breast cancer cells: cross-talk with p53 signaling pathway

The CRE, 5'-TGACGTCA-3', has been described as the consensus sequence for the cis-element that directs cAMP-regulated gene expression. Many transcription factors bind to this element and regulate the expression of a wide variety of cellular and viral genes. We have shown that CRE-transcription factor decoy oligonucleotide restrains the growth of cancer cells in vitro and in vivo [Park, Y. G., Nesterova, M., Agrawal, S., and Cho-Chung, Y. S. (1999) J. Biol. Chem. 274, 1573-1580]. The growth inhibition was accompanied by changes in cell morphology and apoptosis. To elucidate the molecular mechanism(s) of the growth inhibition by the CRE-decoy oligonucleotide, we investigated the p53 signaling pathway. Herein, we report that CRE-decoy oligonucleotide treatment results in an increase in the p53 protein level in MCF-7 human breast cancer cells that express wild-type p53. The p21WAF1/Cip1 protein levels were also increased in the CRE-decoy oligonucleotide treated cells accompanying a reduction in Cdk2- and cyclin E-dependent kinase activity and pRb phosphorylation. Pulse-chase experiments reveal that the p53 upregulation was due to increased stability of the protein. The decoy oligonucleotide treatment also enhanced the p53 promotor-directed transcription in vivo along with the increase in p53-CBP (CREB-binding protein) complex formation. Thus, the stabilization and activation of p53 may have contributed to the growth inhibition induced by CRE-transcription factor decoy oligonucleotide in MCF-7 breast cancer cells. This decoy oligonucleotide approach offers great promise as a tool for defining cellular regulatory processes and treating cancer and other diseases.

Production of two different catalase-peroxidases by Deinococcus radiophilus

The production of two kinds of catalase-peroxidase, viz. catalase-2 and catalase-3 of Deinococcus radiophilus varied depending upon growth phases and oxidative stress. A gradual increase in total catalase activity occurred during exponential and stationary phase. Electrophoretic resolution of these catalases in Deinococcal cell extracts revealed the uniform occurrence of catalase-2 and the appearance of catalase-3 only during the late exponential and stationary phase. A substantial increase in total catalase was observed in either hydrogen peroxide- or UV-treated cells. Monitoring of D. radiophilus catalase activity in the oxidative stressed and non-treated cells by gel electrophoresis followed by densitometry revealed the several-fold increase in catalase-3, which is above the constant level of catalase-2. The occurrence of catalase-3 and catalase-2 revealed by fractionation of sucrose-shocked cells suggests that catalase-3 is a cytosolic inducible enzyme whereas catalase-2 is the membrane-associated constitutive enzyme.

Extracellular protein kinase A as a cancer biomarker: its expression by tumor cells and reversal by a myristate-lacking Calpha and RIIbeta subunit overexpression

Overexpression of cAMP-dependent protein kinase (PKA) type I isozyme is associated with cell proliferation and neoplastic transformation. The presence of PKA on the external surface of LS-174T human colon carcinoma cells has been shown. Here, we show that cancer cells of various cell types excrete PKA into the conditioned medium. This extracellular PKA (ECPKA) is present in active, free catalytic subunit (C subunit) form, and its activity is specifically inhibited by PKA inhibitory protein, PKI. Overexpression of the Calpha or RIalpha subunit gene of PKA in an expression vector, which up-regulates intracellular PKA type I, markedly up-regulates ECPKA expression. In contrast, overexpression of the RIIbeta subunit, which eliminates PKA type I, up-regulates PKA type II, and reverts the transformed phenotype, down-regulates ECPKA. A mutation in the Calpha gene that prevents myristylation allows the intracellular PKA up-regulation but blocks the ECPKA increase, suggesting that the NH(2)-terminal myristyl group of Calpha is required for the ECPKA expression. In serum of cancer patients, the ECPKA expression is up-regulated 10-fold as compared with normal serum. These results indicate that the ECPKA expression is an ordered cellular response of a living cell to actively exclude excess intracellular PKA molecules from the cell. This phenomenon is up-regulated in tumor cells and has an inverse relationship with the hormone dependency of breast cancer. Thus, the extracellular PKA may serve as a potential diagnostic and prognostic marker for cancer.

Antisense DNA-targeting protein kinase A-RIA subunit: a novel approach to cancer treatment

Enhanced expression of the RIa subunit of cAMP-dependent protein kinase type I (PKA-I) has been shown during carcinogenesis, in human cancer cell lines and in primary tumors. We demonstrate that the sequence-specific inhibition of RIa gene expression by antisense oligonucleotides results in the differentiation of leukemia cells and growth arrest of cancer cells of epithelial origin and tumors in mice. The loss of RI by the antisense results in rapid increase in the half-life of the competitor molecule, RII protein, via its stabilization in a holoenzyme complex (PKA-II) that insures depletion of PKA-I and sustained inhibition of tumor growth. RI antisense, which restrains tumor cell growth by turning on the signals for blockade of tumor cell survival, namely blockade of the tyrosine kinase signaling, cell cycle deregulation and apoptosis, provides a single gene-targeting approach to treatment of cancer.

Suppression of microphthalmia transcriptional activity by its association with protein kinase C-interacting protein 1 in mast cells

Microphthalmia (mi) is a transcription factor that plays a major role in the regulation of growth and function in mast cells and melanocytes. Association of mi with other proteins is a critical step in the regulation of mi-mediated transcriptional activation. We found protein kinase C-interacting protein 1 (PKCI) specifically associated with mi in yeast two-hybrid screening. Immunoprecipitation of mi from quiescent rat basophilic leukemic cells or mouse melanocytes resulted in the specific co-immunoprecipitation of PKCI. This association was significantly reduced on engagement of the surface FcepsilonRI of mast cells or engagement of the Kit receptor on melanocytes. Hence, cell activation caused disengagement of mi from PKCI. Microphthalmia was previously shown to activate the mouse mast cell protease 6 (mMCP-6) promoter. Cotransfection of mi with PKCI in NIH 3T3 fibroblasts containing an mMCP-6 promoter-luciferase reporter demonstrated an up to 94% inhibition of mi-mediated transcriptional activation. PKCI by itself, although localized in the cytosol and nucleus of the cells, has no known physiological function and did not demonstrate transcriptional activity. Its ability to suppres mi transcriptional activity in the transient transfected fibroblast system suggests that it can function in vivo as a negative regulator of mi-induced transcriptional activation.

Oligonucleotides as transcription factor decoys

Cellular and molecular research has been focused to develop a means to regulate gene expression in an effort to treat and cure a variety of diseases and abnormal physiological conditions. A successful oligonucleotide-based approach has been the use of synthetic oligonucleotides containing an enhancer element that can penetrate cells, bind sequence-specific DNA-binding proteins and interfere with transcription in vivo. This review describes such decoy oligonucleotides that exhibit high affinity for a target transcription factor and successfully interfere with transcription in vivo. Evidence presented here shows that the decoy oligonucleotide technology offers great promise as a tool for defining cellular regulatory processes and for treating cancer, viral diseases and other pathological conditions.

Involvement of glucocorticoid receptor in the induction of differentiation by ginsenosides in F9 teratocarcinoma cells

We have previously reported that ginsenosides Rh1 and Rh2 induced the differentiation of F9 teratocarcinoma stem cells [Lee, Y. N., Lee, H. Y., Chung, H. Y., Kim, S. I., Lee, S. K., Park, B. C. and Kim, K. W., In vitro induction of differentiation by ginsenosides in F9 teratocarcinoma cells. Eur. J. Cancer 1996, 32, 1420-1428.]. Since the chemical structure of Rh1 and Rh2 is very similar to that of dexamethasone, a synthetic glucocorticoid, we investigated whether Rh1 and Rh2 act through the glucocorticoid receptor (GR). Immunocytochemistry showed that Rh1 or Rh2 increased the nuclear translocation of GR in the same manner of dexamethasone. In the gel shift assay, glucocorticoid response element (GRE) binding protein in F9 cells was increased by Rh1 or Rh2. To confirm whether the increased binding protein is GR, we performed the competition assay with unlabeled GRE as a specific competitor. Moreover, supershift assay with the GR antibody showed that the binding proteins are GR. In addition, to confirm the Rh1 or Rh2-induced transactivation of GRE promoter, we cotransfected GR expression vector and GRE-luciferase vector. In the luciferase assay, Rh1 or Rh2 potently induced luciferase activity and this induction was blocked by RU486, a potent GR antagonist. Taken together, we suggest that ginsenosides Rh1 and Rh2 may induce the differentiation of F9 cells by stimulating the nuclear translocation of GR.

The RIIbeta regulatory subunit of protein kinase A binds to cAMP response element: an alternative cAMP signaling pathway

cAMP, through the activation of cAMP-dependent protein kinase (PKA), is involved in transcriptional regulation. In eukaryotic cells, cAMP is not considered to alter the binding affinity of CREB/ATF to cAMP-responsive element (CRE) but to induce serine phosphorylation and consequent increase in transcriptional activity. In contrast, in prokaryotic cells, cAMP enhances the DNA binding of the catabolite repressor protein to regulate the transcription of several operons. The structural similarity of the cAMP binding sites in catabolite repressor protein and regulatory subunit of PKA type II (RII) suggested the possibility of a similar role for RII in eukaryotic gene regulation. Herein we report that RIIbeta subunit of PKA is a transcription factor capable of interacting physically and functionally with a CRE. In contrast to CREB/ATF, the binding of RIIbeta to a CRE was enhanced by cAMP, and in addition, RIIbeta exhibited transcriptional activity as a Gal4-RIIbeta fusion protein. These experiments identify RIIbeta as a component of an alternative pathway for regulation of CRE-directed transcription in eukaryotic cells.

Cloning and characterization of two catA genes in Acinetobacter lwoffii K24

Two novel type I catechol 1,2-dioxygenases inducible on aniline media were isolated from Acinetobacter lwoffii K24. Although the two purified enzymes, CD I1 and CD I2, had similar intradiol cleavage activities, they showed different substrate specificities for catechol analogs, physicochemical properties, and amino acid sequences. Two catA genes, catA1 and catA2, encoding by CD I1 and CD I2, respectively, were isolated from the A. lwoffii K24 genomic library by using colony hybridization and PCR. Two DNA fragments containing the catA1 and catA2 genes were located on separate regions of the chromosome. They contained open reading frames encoding 33.4- and 30.4-kDa proteins. The amino acid sequences of the two proteins matched well with previously determined sequences. Interestingly, further analysis of the two DNA fragments revealed the locations of the catB and catC genes as well. Moreover, the DNA fragment containing catA1 had a cluster of genes in the order catB1-catC1-catA1 while the catB2-catA2-catC2 arrangement was found in the catA2 DNA fragment. These results may provide an explanation of the different substrate specificities and physicochemical properties of CD I1 and CD I2.

In vitro induction of differentiation by ginsenoides in F9 teratocarcinoma cells

The aim of this study was to determine the ability of the ginsenosides, extracts of Panax ginseng C.A. Meyer, to cause differentiation of F9 teratocarcinoma stem cells as a model system. F9 stem cells cultured in the presence of the ginsenosides together with dibutyryl cyclic AMP (dbcAMP) became parietal endoderm-like cells. Moreover, the expression of differentiation marker genes, such as laminin B1 and type IV collagen, was increased after treatment with the ginsenosides. Among the various purified ginsenosides, Rh1 and Rh2 were the most effective at causing differentiation of F9 cells. Since ginsenosides and glucocorticoid hormone have similar chemical structures, we examined the possibility of the involvement of a glucocorticoid receptor (GR) in the differentiation process induced by the ginsenosides. According to Southwestern blot analysis, a 94 kDa protein regarded as a GR was detected in F9 cells cultured in the medium containing the ginsenosides Rh1 or Rh2. In addition, F9 stem cells treated with the ginsenosides Rh1 or Rh2 and with RU486, a glucocorticoid antagonist with a high affinity for the GR, did not differentiate into endoderm cells morphologically, and the expression of laminin B1 gene was not induced in these cells. In a gel mobility shift assay, protein factors capable of binding to the glucocorticoid responsive element (GRE) specifically were detected in nuclear extracts of the ginsenoside-treated F9 cells. Moreover, overexpression of GR by cotransfection of GR expression vector and GRE-luciferase vector enhanced the transactivation activity of GRE promoter in the presence of ginsenosides Rh1 or Rh2 and was further augmented by dbcAMP. In addition, ginsenosides Rh1 and Rh2 bound to a GR assessed by whole-cell binding assay, even though the specific binding affinity was weaker compared to dexamethasone. Based on these data, we suggest that the ginsenosides Rh1 and Rh2 cause the differentiation of F9 cells and the effects of ginsenosides might be exerted via binding with a GR or its analogous nuclear receptor.

Taurine intake of Korean breast-fed infants during lactation

i. Taurine concentrations of human milk of nonvegetarians and lacto-ovovegetarians decreased significantly during the course of lactation. Taurine concentrations in lacto-ovovegetarians after 90 days postpartum were lower than those of nonvegetarians. Taurine concentrations of human milk by 150 days postpartum were: nonvegetarian 248-434 nmol/ml (31.0-54.4 mg/L); lacto-ovovegetarian 153-418 nmol/ml (19.1-52.3 mg/L). ii. Taurine intakes in infants of lacto-ovovegetarians decreased significantly during lactation, unlike from the pattern in infants of nonvegetarians. Taurine intakes in infants of lacto-ovovegetarians at 90, 120 and 150 days postpartum were lower, compared with those in nonvegetarians. Taurine intakes in infants by 150 days postpartum were: Infants of nonvegetarians 169-229 mumol/day (21.1-28.6 mg/day); Infants of lacto-ovovegetarians 106-210 mumol/day (21.1-28.6 mg/day). iii. This study showed that the taurine concentration in human milk and the taurine intake of infants were different during lactation between nonvegetarians and lacto-ovovegetarians, and that the intake per kg body weight decreased during lactation. Results suggest that the differences observed might be due to the effect of consumption of different types of food.

Prevalence of hepatitis C antibody in patients with chronic liver disease and hepatocellular carcinoma in Korea

To investigate the contribution of hepatitis C virus (HCV) to chronic liver disease and hepatocellular carcinoma (HCC) in Korea, antibodies to HCV (anti-HCV) were tested by enzyme immunoassay in 1759 patients with chronic liver disease and HCC, and in 808 healthy adults. The prevalence of anti-HCV was 1.6% in 808 controls. Anti-HCV was present in 32 (7.7%) of 418 hepatitis B surface antigen (HBsAg)-positive and 128 (53.1%) of 241 HBsAg-negative patients with chronic hepatitis, 16 (6.0%) of 265 HBsAg-positive and 90 (30.5%) of 295 HBsAg-negative patients with liver cirrhosis, and 16 (4.8%) of 330 HBsAg-positive and 61 (29.0%) of 210 HBsAg-negative patients with HCC. Antibodies to hepatitis B core antigen (anti-HBc) were present in 80-88% of patients who were seropositive for anti-HCV and seronegative for HBsAg. Among the sera from 114 patients with HBsAg-negative and anti-HCV-positive chronic liver diseases, HBV DNA and HCV RNA were detected by polymerase chain reaction (PCR) in 54 (47.4%) and 61 (53.3%), respectively. Both HBV DNA and HCV RNA were detected in 4 (4.4%) samples. The mean age of the patients with both HBsAg and anti-HCV was not different from that of patients who were seropositive for HBsAg alone. These findings indicate that current and/or past HBV infection is still the main cause of chronic liver disease in Korea.(ABSTRACT TRUNCATED AT 250 WORDS)

Leiomyosarcoma of the broad ligament--report of two cases

Leiomyosarcoma of the broad ligament (LBL) is a very rare tumor. Up to 1989, there had been only 7 cases reported in the English literature. During recent 12 years, we have had 15 cases of leiomyosarcoma in our department. Among them, there were two cases of LBL. The others were leiomyosarcoma of the uterine corpus. The first patient was 36 years old. She received total abdominal hysterectomy, bilateral salpingo-oophorectomy and paraaortic lymph node sampling followed by chemotherapy with adriamycin. Intra-abdominal recurrence with hepatic metastasis occurred 18 months after operation and she received palliative radiotherapy. The second patient was 65 years old and received subtotal hysterectomy, bilateral salpingo-oophorectomy, omental biopsy and suprapubic cystostomy followed also by chemotherapy with adriamycin. She received segmental resection of ileum and ileostomy due to intestinal obstruction caused by metastasis 5 months after her initial operation. Both patients were still alive when reported with 33 and 26 months of survival, respectively. The nature and management for LBL are scarcely reported, accumulation of cases and clinical experiences are needed.

Amniotic fluid index measurement with the four-quadrant technique during pregnancy

Eleven hundred thirty-four pregnant women with reliable dates underwent ultrasound evaluation for amniotic fluid index (AFI) measurement with the modified four-quadrant technique. We found that from 13 weeks' gestation the AFI rose progressively until 26 weeks. From then to 38 weeks the AFI measurements demonstrated little variation. After 38 weeks the AFI appeared to decline gradually. In the third trimester the mean AFI was 16.0 +/- 4.8 cm; 5% of cases had an AFI less than or equal to 8 cm, and 5% had an AFI greater than or equal to 24 cm. These results confirm the reproducibility of the semiquantitative technique and suggest that in estimating amniotic fluid volume, AFI measurement may be a more appropriate means than measurement of the single largest pocket or subjective assessment. Serial AFI measurement would be an effective way of assessing fetal status throughout pregnancy.

Malignant mixed müllerian tumor of fallopian tube. Report of a case and review of literature

This is a case of malignant mixed Müllerian tumor arising primarily from the fallopian tube. The tumor was distant metastasis to the omentum and the serosa of the sigmoid colon. Literatures published in the last two decades are reviewed and discussed.

Meigs' syndrome--a case report

Bilateral ovarian fibromas combined with as and hydrothorax is a rare disorder. A case of bilateral ovarian fibromas combined with ascites and hyrothorax is presented. The ascites and hydrothorax disappeared spontaneously after removal of the ovarian tumors.