Discharge planning in a community hospital--a multidisciplinary approach

The population of Singapore is ageing rapidly. Acute hospitals in Singapore are also experiencing an acute bed shortage. However, many elderly admitted to acute hospitals require a longer period of convalescence before they are able to go home. Community hospitals are most suitable to provide such care for the elderly patient. Patients could be discharged to the community hospitals to continue rehabilitation and convalescence. In addition this would also free the beds in the acute hospitals. However, there is a risk that without adequate discharge planning, the community hospitals would in turn also reach full capacity and no longer be able to accept patients. A discharge planning programme has been set up in a community hospital to address the following needs: 1) caring for a rapidly ageing population with increasing degrees of disability; 2) the shortage of beds in the acute hospitals; (3) the provision of holistic care and care-giver education, and 4) to prevent long term institutionalisation of the elderly as much as possible.

Phosphoinositide-3-OH kinase-dependent regulation of glycogen synthase kinase 3 and protein kinase B/AKT by the integrin-linked kinase

Integrin-linked kinase (ILK) is an ankyrin-repeat containing serine-threonine protein kinase capable of interacting with the cytoplasmic domains of integrin beta1, beta2, and beta3 subunits. Overexpression of ILK in epithelial cells disrupts cell-extracellular matrix as well as cell-cell interactions, suppresses suspension-induced apoptosis (also called Anoikis), and stimulates anchorage-independent cell cycle progression. In addition, ILK induces nuclear translocation of beta-catenin, where the latter associates with a T cell factor/lymphocyte enhancer-binding factor 1 (TCF/LEF-1) to form an activated transcription factor. We now demonstrate that ILK activity is rapidly, but transiently, stimulated upon attachment of cells to fibronectin, as well as by insulin, in a phosphoinositide-3-OH kinase [Pi(3)K]-dependent manner. Furthermore, phosphatidylinositol(3,4,5)trisphosphate specifically stimulates the activity of ILK in vitro, and in addition, membrane targetted constitutively active Pi(3)K activates ILK in vivo. We also demonstrate here that ILK is an upstream effector of the Pi(3)K-dependent regulation of both protein kinase B (PKB/AKT) and glycogen synthase kinase 3 (GSK-3). Specifically, ILK can directly phosphorylate GSK-3 in vitro and when stably, or transiently, overexpressed in cells can inhibit GSK-3 activity, whereas the overexpression of kinase-deficient ILK enhances GSK-3 activity. In addition, kinase-active ILK can phosphorylate PKB/AKT on serine-473, whereas kinase-deficient ILK severely inhibits endogenous phosphorylation of PKB/AKT on serine-473, demonstrating that ILK is involved in agonist stimulated, Pi(3)K-dependent, PKB/AKT activation. ILK is thus a receptor-proximal effector for the Pi(3)K-dependent, extracellular matrix and growth factor mediated, activation of PKB/AKT, and inhibition of GSK-3.

[The experimental research of inner ear metabolism and electrical physiology of autoimmune sensorineural hearing loss]

Inquire into the mechanism of inner ear pathological physiology in autoimmune sensorineural hearing loss (ASHL). With the auditory electric-physiological techniques and enzyme-histochemical method, the change of inner ear hearing function and enzyme activity were observed. These animals, which threshold of auditory nerve compound active potential (CAP) and cochlear microphonic potential(CM) heightening evidently, showed that the amplitude of endolymphatic potential(EP) (include-EP) bring down in various degrees, which was related to the change of the active of Na(+)-K(+)-ATPase and SDH in vascularis stria and endolymphatic sac. The abnormality of enzymes metabolism in inner ear tissues, which following autoimmune inflammation damage, is the pathological foundation of hearing dysfunction.

Antigen-dependent CD28 signaling selectively enhances survival and proliferation in genetically modified activated human primary T lymphocytes

Most tumor cells function poorly as antigen-presenting cells in part because they do not express costimulatory molecules. To provide costimulation to T lymphocytes that recognize tumor cells, we constructed a CD28-like receptor specific for GD2, a ganglioside overexpressed on the surface of neuroblastoma, small-cell lung carcinoma, melanoma, and other human tumors. Recognition of GD2 was provided by a single-chain antibody derived from the GD2-specific monoclonal antibody 3G6. We demonstrate that the chimeric receptor 3G6-CD28 provides CD28 signaling upon specific recognition of the GD2 antigen on tumor cells. Human primary T lymphocytes retrovirally transduced with 3G6-CD28 secrete interleukin 2, survive proapoptotic culture conditions, and selectively undergo clonal expansion in the presence of an antiidiotypic antibody specific for 3G6-CD28. Polyclonal CD8(+) lymphocytes expressing 3G6-CD28 are selectively expanded when cultured with cells expressing allogeneic major histocompatibility complex class I together with GD2. Primary T cells given such an antigen-dependent survival advantage should be very useful to augment immune responses against tumor cells.

[Cochlear and retrocochlear deafness induced by immunity with different inner ear tissue antigens]

OBJECTIVES

To inquire into whether the different inner ear tissue antigens could cause different kind of hearing loss, and to find out the disorder positions of auditory system.

METHODS

The basilar membrane (BM), spiral ligament (SL), and spiral ganglion (SG) of guinea pigs were removed for making antigens, respectively. Then, we used these antigens to immune guinea pigs. The special humour and cellular immune reaction, hearing function, and inner ear histopathological changes were observed.

RESULTS

In BM-antigen and SL-antigen immune group, the various degrees of cochlear microphonic potential disturbance, recruitment, and immune pathological inflammation in cochlear duct and stria vascularis were found. In SG-antigen immune group, auditory nerve compound action potential changes were prominent, and the inner ear pathological damage mainly existed in cochlear axis vessels or surround areas, and SG.

CONCLUSIONS

It was confirmed that the inner ear antigens come from different part of auditory system, which could cause cochlear or retrocochlear autoimmune disease.

Frizzled-8 is expressed in the Spemann organizer and plays a role in early morphogenesis

Wnts are secreted signaling molecules implicated in a large number of developmental processes. Frizzled proteins have been identified as likely receptors for Wnt ligands in vertebrates and invertebrates, but a functional role for vertebrate frizzleds has not yet been defined. To assess the endogenous role of frizzled proteins during vertebrate development, we have identified and characterized a Xenopus frizzled gene (xfz8). It is highly expressed in the deep cells of the Spemann organizer prior to dorsal lip formation and in the early involuting marginal zone. Ectopic expression of xfz8 in ventral cells leads to complete secondary axis formation and can synergize with Xwnt-8 while an inhibitory form of xfz8 (Nxfz8) blocks axis duplication by Xwnt-8, consistent with a role for xfz8 in Wnt signal transduction. Expression of Nxfz8 in dorsal cells has profound effects on morphogenesis during gastrulation and neurulation that result in dramatic shortening of the anterior-posterior axis. Our results suggest a role for xfz8 in morphogenesis during the gastrula stage of embryogenesis.

Effect of nickel chloride on mouse T-lymphocyte subsets

The study was carried out to observe the effect of nickel chloride (NiCl2) on T-lymphocyte subsets, CD4, CD8 and CD4/CD8 ratios in vivo. BALB/C mice were injected i.p. with NiCl2 every other day for 2 w. The NiCl2 doses were 1, 3, 6, 9 or 12 mg/kg. Lymphocytes were obtained from mouse spleen and cultured in the presence of monoclonal antibody FITC conjugated, anti-CD4 or anti-CD8. Samples were determined with a flow cytometer. A suppressive effect on CD4-positive cells was found in the 6 mg/kg group, but this subset was restored to the control level in the 9 and 12 mg/kg groups, suggesting that there was an "immune tolerance" effect. No significant changes were found in CD8-positive cells and CD4/CD8 ratios. The results suggested the NiCl2 had a deleterious effect on mouse T-lymphocytes in short-term in vivo exposure, but the effects may depend on the dose and cell subset.

[The clinical study of immune factors relative to Menière's disease]

It was investigated that the clinical unspecialized immunological factors and special immune reaction against to inner ear antigens relate with the cause of Meniere's disease. Every of the relative immune tests and special humoral and cellular immune reaction tests were proceeded in the breaking out and intermittent period of Meniere's disease patients, and the normal controls. The levels of IgG and C3 in serum and unspecialized lymphocyte blastogenesis increased, and positive of circular immune compound and antibody against cellular nucleus, and special humoral and cellular immune reaction against inner ear antigens during the breaking out period of the patients. The element of inner ear autoimmune could play an important role in the pathogenical mechanism of some patients with Meniere's disease.

Covalent binding of carbamazepine reactive metabolites to P450 isoforms present in the skin

Carbamazepine is an anticonvulsant associated with a high risk for severe cutaneous reactions. Upon metabolism by cytochrome P450, carbamazepine may produce reactive metabolites. We evaluated in vitro the covalent binding of carbamazepine reactive metabolites on human P450s and then the presence of these P450s in human epidermis. Carbamazepine reactive metabolites covalent binding to human liver microsomes involved P450 subfamilies 1A, 2C and 3A. Specific covalent binding to yeasts expressing different P450s showed that carbamazepine reactive metabolites bound specifically to P450 1A2 and 3A4. We confirmed the constitutive presence of P450 3A in human epidermis and after induction with coaltar of P450 1A. Consequently, the production in epidermis of carbamazepine reactive metabolites is theoretically possible with formation of P450 adduct metabolites.

Structuring a safer donor-replacement program

BACKGROUND

Replacement donors are more likely than volunteer donors to have positive or abnormal tests for transfusion-transmissible disease. In an effort to increase the donor pool, workers sought to identify a safer replacement-donor subgroup that may be acceptable for routine donations.

STUDY DESIGN AND METHODS

In a retrospective review and cohort study, the replacement-donor effect was separated from the new-donor effect. The relative effect the replacement donor has on the risk of transfusion-transmissible diseases, donor retention, and frequency of returning donations was then quantified by comparison against the effect of repeat volunteer donors.

RESULTS

The replacement donor had 3.1 times the risk and 0.72 times the donor retention rate and made 0.81 times as many returning donations as the repeat volunteer donor. The figures for the new-donor effect were similar. The two risks were additive, making a new replacement donor particularly hazardous. If replacement donations only from repeat replacement donors were considered, the donor risk and the number of donations per returning donor were made comparable to those for the general (combined) volunteer donor.

CONCLUSION

The negative effect of the replacement donor is similar in magnitude to that of the new volunteer donor. A replacement-donation program targeting repeat replacement donors has an acceptable risk profile and may be a valuable adjunct to the collection of blood from general volunteer donors.

Unusual features of the Drosophila melanogaster telomere transposable element HeT-A are conserved in Drosophila yakuba telomere elements

HeT-A was the first transposable element shown to have a bona fide role in chromosome structure, maintenance of telomeres in Drosophila melanogaster. HeT-A has hallmarks of non-long-terminal-repeat (non-LTR) retrotransposable elements but also has several unique features. We have now isolated HeT-A elements from Drosophila yakuba, showing that the retrotransposon mechanism of telomere maintenance predates the separation of D. melanogaster and D. yakuba (5-15 million years ago). HeT-A elements from the two species show significant sequence divergence, yet unusual features seen in HeT-Amel are conserved in HeT-Ayak. In both species, HeT-A elements are found in head-to-tail tandem arrays in telomeric heterochromatin. In both species, nearly half of the HeT-A sequence is noncoding and shows a distinctive imperfect repeat pattern of A-rich segments. Neither element encodes reverse transcriptase. The HeT-Amel promoter appears to be intermediate between the promoters of non-LTR and of LTR retrotransposons. The HeT-Ayak promoter shows similar features. HeT-Amel has a frameshift within the coding region. HeT-Ayak does not require a frameshift but shows conservation of the polypeptide sequence of the frameshifted product of D. melanogaster.

[Development of an electrode for atrial epicardial mapping]

Procedure of a electrode for atrial epicardial mapping (template electrode) is introduced in this paper. It is easy to made, we can get sharp and clear waveforms and a constant baseline while mapping. If the electrode is connected with computer, it is able to be used for epicardial mapping of atrial arrhythmias, especially atrial fibrillation in real time.

The internal ribosomal entry site of the encephalomyocarditis virus enables reliable coexpression of two transgenes in human primary T lymphocytes

It is essential for the improvement of adoptive cell therapies to generate efficiently large populations of human primary T cells that reliably express a suicide gene conferring drug sensitivity, such as herpes simplex virus thymidine kinase (HSVtk). We show here that an optimized dicistronic vector containing the encephalomyocarditis virus (EMCV) internal ribosomal entry site (IRES) is functional in human primary. T lymphocytes that bear on average one integrated vector copy per cell. We demonstrate reliable coexpression of the marker NTP, an inactive mutant of the human low-affinity nerve growth factor receptor and HSVtk. In the dicistronic vector NIT, NTP is expressed as a cap-dependent marker and HSVtk as a nonselectable IRES-dependent gene. Cell-surface expression of NTP is sufficient to allow for the efficient and rapid enrichment of the transduced cells to high purity. Of these purified lymphocytes, 97 +/- 4% and 92 +/- 6% are selectively eliminated when cultured in the presence of 1.0 or 0.1 microM ganciclovic respectively, establishing that the EMCV IRES ensures efficient and sufficient expression of two genes in human primary T cells.

Recombinant retroviruses pseudotyped with the vesicular stomatitis virus G glycoprotein mediate both stable gene transfer and pseudotransduction in human peripheral blood lymphocytes

It is essential for the study of T-cell function and the improvement of adoptive cell therapies to efficiently generate large populations of human primary T cells that reliably express foreign genes. This goal is achieved by using recombinant retroviruses pseudotyped with either the gibbon ape leukemia virus (GaLV) envelope or the vesicular stomatitis virus G (VSV-G) glycoprotein. We show here that both retroviral particles mediate stable gene transfer in CD4+ and in CD8+ peripheral blood lymphocytes cultured under optimized conditions. However, VSV-G-pseudotyped virions may cause transduction artifacts that must be carefully excluded. The VSV-G virions require 10- to 100-fold higher concentrations of infectious particles to achieve levels of gene transfer comparable to GaLV-virions. Nonetheless, the physical stability of VSV-G-coated particles enables the concentration of viral stocks to 10(9) infectious particles per milliliter or more.

Molecular cloning and characterization of a new receptor for galanin

Galanin (GAL) is a widely distributed neuropeptide with diverse biological effects including modulation of hormone release, antinociception and modification of feeding behavior. Its effects are mediated through G-protein-coupled receptors (GPCR) for which only a single type has been cloned, GAL receptor 1 (GALR1). We describe the cloning of a second galanin receptor type, GALR2, from rat hypothalamus. The GALR2 amino acid sequence is 38% identical to GALR1 and is pharmacologically similar to GALR1 when expressed in COS-7 cells. GALR2 is encoded by a single gene containing at least one intron and expressed in a diverse range of tissues.

[Kaposi's sarcoma associated with HIV in otorhinolaryngology: report of 21 cases]

Twenty one cases of kaposi's sarcoma (KS) with manifestation in the field of otolaryngology are reported. The incidence of KS is increasing following epidemic of AIDS all over the world. Epistaxis, nasal obstruction, sore-throat, dry of foreign body filling in throat and nodal mass are most frequent manifestation. The relationship of KS with HIV, it's pathology and diagnosis are discussed.

[CT for diagnosis of parathyroid adenoma]

We analyzed Ct findings of 10 cases with parathyroid adenoma which had been verified by surgery and pathologic section. The correct localization of 9 adenomas was made by CT preoperatively. The method of CT scanning of parathyroid adenoma were elucidated. The results showed that most adenomas were located in the groove between trachea and esophagus. The contour of tumors was oval, the edge was smooth and regular. Enhancement CT images were helpful for differentiating the tumor from blood vessel. It is indicated that CT scanning is a good method for localizing the parathyroid adenoma.

Trabeculectomy--success rates in a Singapore hospital

Previously published papers on the success of trabeculectomy as a treatment for glaucoma show success rates between 67% and 84%. The success rate of trabeculectomy in Afro-Carribean patients was observed to be lower than in Caucasian patients. It has been commonly believed that the success rate of trabeculectomy in Oriental/Asian eyes would lie somewhere between these. We reviewed the records of 51 consecutive trabeculectomies performed in the National University Hospital, Singapore and found that our success rate was lower-43.1% overall and 48.7% for primary glaucomas.

Growth and final height after treatment for childhood Hodgkin disease

PURPOSE

To evaluate in children the impact of contemporary treatment for Hodgkin disease on the pattern of growth and final height.

PATIENTS AND METHODS

We studied 80 patients (54 males) aged <14 years at diagnosis, with newly diagnosed, pathologically confirmed Hodgkin disease, treated at a single institution. Forty six patients received chemotherapy (CT) + radiotherapy (RT), 23 patients received RT alone, and 11 patients received CT alone. Heights were obtained at diagnosis, at the end of treatment, 1, 2, and 3 years after the end of treatment and at attainment of final height. Heights were converted to age- and sex-adjusted SD scores (SDS).

RESULTS

There was a significant change in height SDS at the end of treatment compared to height SDS at diagnosis for all three groups (CT + RT: -0.33, p<0.001; RT: +0.09, p=0.027; CT: -0.24, p=0.012). Over the 3 years following treatment, the rate of change of height SDS was not statistically different between the three treatment groups. Final height SDS was decreased for patients receiving RT + CT (-0.41 SDS, p=0.02; n=31). The change in final height SDS for patients receiving RT or CT only was -0.36 (n=14) and +0.42 (n=4), respectively. Loss of final height SDS correlated with younger age at diagnosis (p=0.005). Patients receiving higher RT doses tended to fare worse (p=0.08).

CONCLUSIONS

Pediatric patients treated for Hodgkin disease with the combination of RT and CT suffer a small but significant decrease in their final height SDS. Younger patients and those treated with higher RT doses appear to experience the greatest loss of height potential.

412-positive mesodermal cells and the gonadal mesoderm are separate from the fat-cell lineage

The Drosophila retrotransposon, 412, is expressed in a cell-specific manner during embryogenesis. At stage 11, 412 transcripts are present in bilateral clusters of cells within the mesoderm. The posterior clusters of 412-positive cells become associated with the gonads at stage 13; however, the fate of the cells in the remaining clusters is unknown. We have tested by in situ hybridization to whole-mount embryos the possible identity of these cells with known precursor cell types present in bilateral clusters. We simultaneously located the 412-positive cells and the precursor cells to visceral muscle or the fat body. We have determined that the 412-positive cells do not correspond to these precursor cells and that the development of the visceral muscle or fat body does not affect the expression of 412 during embryogenesis.

Mechanism and structure based inhibitors of phospholipase C enzymes

PI-specific PLC enzymes are a key component of phosphatidylinositol-mediated signaling pathways since the hydrophobic product, diacylglycerol, activates protein kinase C and the water-soluble product, inositol trisphosphate, is involved in Ca2+ mobilization. Nonspecific, or PC-PLC, enzymes can generate diacylglycerol without Ca2+ mobilization. A series of inhibitors, both lipophilic and water-soluble, have been synthesized to target each of these two classes of PLC enzymes. Design of the inhibitors was based on proposed enzyme mechanisms and available crystal structures. The solution conformations of the lipophilic phospholipid analogs, (diheptanoylphosphatidyl(2-O-methyl)inositol for PI-PLC and a dihexanoyl-sn-(3-N-benzylaminoglycero)phosphoramidocholine for PC-PLC, have been determined using NMR methodology and the interaction of these compounds with bacterial enzymes has been examined. Water-soluble inhibitors include strained cyclic phosphonates for PI-PLC and vanadate for PC-PLC. An eventual goal of this work is to generate compounds that specifically target each type of intracellular PLC activity.