Using buffy coat for reverse transcriptase-polymerase chain reaction in the diagnosis of dengue virus infection: preliminary study

Using reverse transcriptase-polymerase chain reaction (RT-PCR) to detect and type from viremic human serum samples for dengue virus infection is widely used today. However, a few false-negative results were reported due to very low titers of the virus particle in serum samples. As mononuclear cells, macrophages or monocytes are target cells for dengue virus infection, and the replication of virions can be observed in peripheral leukocytes frequently, the amount of virus particle in buffy coat should be higher than those in serum samples. Here, we describe a procedure in which RNA extraction from the buffy coat of a patient with a false-negative serum sample yielded specific viral RNA amplifiable by RT-PCR, thereby providing an alternative choice for the accurate diagnosis of dengue infection.

Preparation and evaluation of an imidazole-coated capillary column for the electrophoretic separation of aromatic acids

An imidazole-coated capillary column for electrophoresis has been prepared by means of organosilanization. With mesityl oxide as neutral marker, the results indicated that the electroosmotic flow of the bonded phase displays a dramatic difference in pH dependence in comparison with that of the bare fused-silica column. The presence of positive charges on the coating surface and the anionic exchange property, due to the cationic property of the imidazole group at pH values below 6, allows the separation of geometric isomers that are very similar in ionic mobility. Separation parameters including buffer composition and concentration, pH, applied voltage, and the influence of other additives were investigated. By using acetate buffer (100 mM, pH 5.2) and an applied voltage of -15 kV with UV detection at 212 nm, the separation of 11 aromatic acids including mono-, di-, tri- and tetra-carboxylic acids could be achieved in less than 14 min. The average plate number was 3 x 10(5)/m. With acetate buffer (25 mM, pH 5.5) and an applied voltage of -25 kV, the addition of silver nitrate or beta-cyclodextrin significantly improved the resolution of some more highly charged carboxylic acids.

[The vagus nerve coordinates the motion of gallbladder and sphincter of Oddi in the interdigestive period in rabbits]

AIM

To investigate the effect of vagus nerve on coordinating the motion of gallbladder (GB) and sphincter of Oddi (SO) in the interdigestive period in rabbits.

METHODS

Fasted for 15 h-18 h, but allowed to drink water, the rabbib were anesthetized with urethane (1.0 mg/kg, i.v.). In order to measure GB pressure, a frog bladder filled with normal saline was put into GB and connected to a transducer (TP-200T). Myoelectric signals of SO was recorded by a pair of copper electrodes.

RESULTS

In the interdigestive period, phasic contractions of GB (PCGB) and clusters of spike potentials of SO (CSPSO) was 1:1 correlated (Y = 0.962X + 0.587, r = 0.982, P < 0.01). That is, every PCGB was accompanied by one CSPSO. Microinjection of thyrotropin-releasing hormone (TRH, 0.8 nmol, 1 microliter) or monosodium glutamate (MSG, 2 mumol, 1 microliter) into dorsal vagal complex (DVC) enhanced the motility of GB and SO, and the 1:1 temporal relation between PCGB and CSPSO still existed. Vagotomy or intravenous injection of atropine inhibited the PCGB and the spike potentials of SO, and the 1:1 correlation between PCGB and CSPSO disappeared. The spike bursts of SO did not respond to the artificial rise of gallbladder pressure.

CONCLUSION

In the interdigestive period in rabbits, gallbladder and SO contract and relax rhythmically and simultaneously. This eoordinated motion between GB and SO is controlled by DVC via vagus nerve and peripheral M receptors.

Analysis of sharp-edged medical-object injuries at a medical center in Taiwan

A total of 733 incidents by sharp-edged objects occurred among healthcare workers between 1995 and 1998. Injuries occurred most frequently among interns. The workplace location with the highest incidence of injury was the patient ward, and the object that most frequently inflicted injury was a needle. The most frequent work practice was recapping of syringes. One healthcare worker demonstrated seroconversion for hepatitis C.

Klebsiella pneumoniae renal abscess

BACKGROUND

The clinical characteristics of renal abscess caused by Klebsiella pneumoniae have not been previously reported in case-series studies. The purpose of this study is to demonstrate the clinical characteristics of K pneumoniae renal abscess for early diagnosis and to identify the clinical risk factors associating with poor prognosis.

METHODS

We retrospectively reviewed the medical records of 24 patients with K pneumoniae renal abscess, from April, 1982 through February, 1998. The clinical presentations, including the demographic characteristics, predisposing disorders, initial signs and symptoms, laboratory test results, diagnostic radiology studies, therapeutic modalities and risk factors associated with mortality were studied.

RESULTS

The mean age was 58.7 years and the male to female ratio was 10:14. The most common predisposing factors were diabetes mellitus (58%), urolithiasis (25%) and immunosuppression (17%). Fever, chills and flank pain were the most common symptoms and signs, whereas pyuria, elevation of leukocyte count, glucose, blood urea nitrogen and creatinine were the common laboratory features. The distinct complications of K pneumoniae renal abscess were bacteremia in 13 (54%), emphysematous pyelonephritis in five (21%), and metastatic septic infection in three (12.5%). The cure rate was 52% (11/21) in patients treated with a combination of antibiotics and percutaneous drainage; however, six (35%) patients who survived required another surgical procedure for complete recovery. The overall mortality rate was 25%. The clinical factors of elderly age (>65 years) at presentation, lethargy, elevation of serum blood urea nitrogen and pulmonary complications were associated with poor prognoses.

CONCLUSIONS

Focusing on the early diagnosis of K pneumoniae renal abscess and recognition of the prognostic factors for a poor prognosis, we highlight the specific clinical characteristics that include elderly age, lethargy, impairment of renal function, metastatic septic lesions and pulmonary complications. All patients with K pneumoniae renal abscesses should receive empiric antibiotics and percutaneous drainage or aspiration, and surgical intervention as necessary for patients with intractable disease.

An Update on Laparoscopic Hysterectomy and Pelvic Floor Reconstruction

Laparoscopic hysterectomy and pelvic floor reconstruction have recently undergone some degree of evolution. New instrumentation has appeared, such as the vaginal delineator, but overall most of the instruments used have remained basically unchanged. This is related mostly to the need of keeping costs down by limiting the use of disposable instrumentation. For pelvic reconstruction, the laparoscopic approach is now usually considered the optimal approach, as it allows the surgeon to visualize structures that the vaginal surgeon could in the past only palpate.

Intra- and extracellular measurement of reactive oxygen species produced during heat stress in diaphragm muscle

Skeletal muscles are exposed to increased temperatures during intense exercise, particularly in high environmental temperatures. We hypothesized that heat may directly stimulate the reactive oxygen species (ROS) formation in diaphragm (one kind of skeletal muscle) and thus potentially play a role in contractile and metabolic activity. Laser scan confocal microscopy was used to study the conversion of hydroethidine (a probe for intracellular ROS) to ethidium (ET) in mouse diaphragm. During a 30-min period, heat (42 degrees C) increased ET fluorescence by 24 +/- 4%, whereas in control (37 degrees C), fluorescence decreased by 8 +/- 1% compared with baseline (P < 0.001). The superoxide scavenger Tiron (10 mM) abolished the rise in intracellular fluorescence, whereas extracellular superoxide dismutase (SOD; 5,000 U/ml) had no significant effect. Reduction of oxidized cytochrome c was used to detect extracellular ROS in rat diaphragm. After 45 min, 53 +/- 7 nmol cytochrome c. g dry wt(-1). ml(-1) were reduced in heat compared with 22 +/- 13 nmol. g(-1). ml(-1) in controls (P < 0.001). SOD decreased cytochrome c reduction in heat to control levels. The results suggest that heat stress stimulates intracellular and extracellular superoxide production, which may contribute to the physiological responses to severe exercise or the pathology of heat shock.

An analysis of the interaction between mouse apolipoprotein B100 and apolipoprotein(a)

The assembly of lipoprotein(a) (Lp(a)) involves an initial noncovalent interaction between apolipoprotein (apo) B100 and apo(a), followed by the formation of a disulfide bond between apoB100 cysteine 4326 and apo(a) cysteine 4057. The structural features of apoB100 that are required for its noncovalent interaction with apo(a) have not been fully defined. To analyze that initial interaction, we tested whether apo(a) could bind noncovalently to two apoB proteins that lack cysteine 4326: mouse apoB100 and human apoB100-C4326G. Our experiments demonstrated that both mouse apoB and the human apoB100-C4326G bind noncovalently to apo(a). We next sought to gain insights into the apoB amino acid sequences required for the interaction between apoB100 and apo(a). Previous studies of truncated human apoB proteins indicated that the carboxyl terminus of human apoB100 (amino acids 4330-4397) is important for Lp(a) assembly. To determine whether the carboxyl terminus of mouse apoB100 can interact with apo(a), transgenic mice were produced with a mutant human apoB gene construct in which human apoB100 amino acids 4279-4536 were replaced with the corresponding mouse apoB100 sequences and tyrosine 4326 was changed to a cysteine. The mutant apoB100 bound to apo(a) and formed bona fide disulfide-linked Lp(a), but Lp(a) assembly was less efficient than with wild-type human apoB100. The fact that Lp(a) assembly was less efficient with the mouse apoB sequences provides additional support for the notion that sequences in the carboxyl terminus of apoB100 are important for Lp(a) assembly.

The induction of congenital spinal deformities in mice by maternal carbon monoxide exposure

Carbon monoxide (CO) has been shown to be teratogenic in mice. High altitude hypoxia has also been shown to induce congenital vertebral anomalies in mice. The purpose of this study was to investigate the effect of maternal hypoxia owing to CO exposure and the production of congenital spinal deformities in the offspring. Sixty DBA-1J mice were bred using polygamous timed breeding methods. Pregnant females were exposed to 200, 400, or 600 ppm CO using a custom-designed gas blender system. Seven-hour exposures were performed on day 8.5, 9.5, or 10.5 of the 21-day gestation cycle. The neonates were euthanized at birth; the specimens were fixed, eviscerated, and radiographed. Congenital spinal deformities were observed (wedge, hemi, fused, and missing vertebrae; fused ribs) and were located in all regions of the spine. There was a statistically significant difference in the number of spinal deformities between all groups, with no defects in the controls and a 77% incidence at 600 ppm (p < 0.0001). There was no apparent correlation between the time of exposure and defect location. The most sensitive time of gestation was 9.5 days. We identified an animal model of congenital spinal deformities that compares favorably with the evidence of human congenital spinal deformities in cases of maternal exposure to CO and other gas and chemical fumes.

Ligand-independent dimerization activates the stress response kinases IRE1 and PERK in the lumen of the endoplasmic reticulum

IRE1 and PERK are type I transmembrane serine/threonine protein kinases that are activated by unfolded proteins in the endoplasmic reticulum (ER) to signal adaptive responses. IRE1 is present in all eukaryotic cells and signals the unfolded protein response through its kinase and endoribonuclease activities. PERK signals phosphorylation of a translation initiation factor to inhibit protein synthesis in higher eukaryotic cells but is absent in the Saccharomyces cerevisiae genome. The amino acid sequences of the amino-terminal ER luminal domains (NLDs) from IRE1 and PERK display limited homology and have diverged among species. In this study, we have demonstrated that the NLD of yeast Ire1p is required for signaling. However, the NLDs from human IRE1alpha and murine IRE1beta and the Caenorhabditis elegans IRE1 and PERK function as replacements for the S. cerevisiae Ire1p-NLD to signal the unfolded protein response. Replacement of the Ire1p-NLD with a functional leucine zipper dimerization motif yielded a constitutively active kinase that surprisingly was further activated by ER stress. These results demonstrate that ER stress-induced dimerization of the NLD is sufficient for IRE1 and PERK activation and is conserved through evolution. We propose that ligand-independent activation of IRE1 and PERK permits homodimerization upon accumulation of unfolded proteins in the lumen of the ER.

[Molecular clonging of the human dimethyglycine dehydrogenase-like gene (DMGDHL1) from the sarcosinemia critical region at 9q34]

Through the analysis of EST database, we obtained one human EST (GenBank: H28856) which showed significant similarity with the partial coding sequence of rat dimethylglycine dehydrogenase gene. This EST was mapped to 9q34 due to 95.6% identity with one genomic sequence (GenBank: AC002295). A pair of primers (HRP-1/HRP-2) designed on the sequence of the EST were coupled with the primers (lambda gt10-5/lambda gt10-3) on the vector flanking cloning site respectively to amplify the 5' and 3' cDNA beyond the EST. New primers designed based on novel cDNA sequence overlapped with the sequence within EST H28856 were used for amplification with lambda gt10-5 and lambda gt10-3 by the similar way as above untill a complete ORF was obtained. Finally, a 1,970 bp sequence (termed as dimethylglycine dehydrogenase like gene isoform I, DMGDHL1a) containing a 1,428 bp complete coding sequence from the live cDNA library and 1,475 bp sequence (isoform II, termed as DMGDHL1b) containing a 1,296 bp complete coding sequence from the fetas live cDNA library were obtained. Fourteen exons were identified in isoform I and the first nine exons of isoform II which shared with isoform I could be determined too. The last 105 bp cDNA sequence of isoform II could not be found in the public database, indicating a very large intron (> 123 kb) existed between exon 9 and exon 10 of isoform II. DMGDHL1 showed highly homology on both cDNA and amino acid level with rat dimethylglycine dehydrogenase (60% identity in 135 bp and 35% identity in 436 residues respectively). It was reported that human sarcosinemia gene was mapped at 9q34. Therefore it could be a good candidate gene for the sarcosinemia.

Erythromycin inhibits beta2-integrins (CD11b/CD18) expression, interleukin-8 release and intracellular oxidative metabolism in neutrophils

Macrolides have therapeutic benefits on chronic inflammatory airway diseases. Thus, macrolides are supposed to have variable biological effects apart from antimicrobial activity. Neutrophil adherence and influx with oxidants and cytokines production implicates involvement in airway inflammation. To investigate whether erythromycin (EM) affects neutrophil activity in vitro, lipopolysaccharide (LPS)-treated neutrophils were continuously incubated for 4 h in the absence or presence of increasing doses of EM from 1 microg ml(-1) to 100 microg ml(-1) in the last 2 h. Leukocyte adhesion molecules Mac-1 and intracellular H2O2(DCFH) were determined by flowcytometric assay. IL-8 and TNFalpha in supernatant was measured by ELISA method. The expression of Mac-1 and mean intracellular DCF fluorescence intensity (DCFH) of neutrophils significantly increased after stimulation with LPS. Pretreatment with EM significantly decreased LPS induced Mac-1 expression on neutrophils compared with LPS stimulation only. EM alone (100 microg ml(-1)) also decreased Mac-1 expression on neutrophils. EM significantly reduced the LPS-increased DCFH. EM alone (100 microg ml(-1)) also caused a decrease in DCFH. Increasing doses of EM also significantly decreased the IL-8 released by LPS-stimulated neutrophils. In conclusion, EM exerts a direct effect on the neutrophils by downregulating the expression of beta2-integrin on neutrophils, thus leading to a decrease in the intracellular H2O2, as well as the production of IL-8. Our conclusion provides an explanation for the clinical efficacy of erythromycin in neutrophil-mediated airway inflammation.

Safety of MRI-guided endovascular guidewire applications

Magnetic radiofrequency (RF) fields applied during magnetic resonance imaging (MRI) may induce heating in devices made from conductive materials. The present paper reports on theoretical and experimental studies on the RF heating resonance phenomenon of an endovascular guidewire. A nitinol-based guidewire was inserted into a vessel phantom and imaged at 1.5 and 0.2 T with continuous temperature monitoring at the guidewire tip. The heating effects due to different experimental settings were examined. A model is developed for the resonant current and the associated electric field produced by the guidewire acting as an antenna. Temperature increases of up to 17 degrees C were measured while imaging the guidewire at an off-center position in the 1.5 T MR system. Power absorption produced by the resonating wire decreased as the repetition time was increased. No temperature rise was measured at 0.2 T. Considering the potential utility of low-field, open MR systems for MRI-guided endovascular interventions, it is important to be aware of the safety of such applications.

Perceptual alternation in obsessive compulsive disorder--implications for a role of the cortico-striatal circuitry in mediating awareness

Mounting evidence suggests that obsessive compulsive disorder (OCD) results from functional aberrations of the fronto-striatal circuitry. However, empirical studies of the behavioral manifestations of OCD have been relatively lacking. The present study employs a behavioral task that allows a quantitative measure of how alternative percepts are formed from one moment to another, a process mimicking the brain state in which different thoughts and imageries compete for access to awareness. Eighteen patients with OCD, 12 with generalized anxiety disorder, and 18 normal subjects participated in the experiment, in which they viewed one of the three Schröder staircases and responded by pressing a key to each perceptual reversal. The results demonstrate that the patients with OCD have a higher perceptual alternation rate than the normal controls. Moreover, the frequency of perceptual alternation is significantly correlated with the Yale-Brown obsessive compulsive and the Hamilton anxiety scores. The increase in the frequency of perceptual reversals cannot easily be accounted for by learning or by different patterns of eye fixations on the task. These results provide further evidence that an impairment of the inhibitory function of the cortico-striatal circuitry might underlie the etiology of OCD. The implications of the results for a general role of the cortico-striatal circuitry in mediating awareness are discussed.

Effects of estrogen on cognition, mood, and cerebral blood flow in AD: a controlled study

OBJECTIVE

To examine the effects of estrogen therapy on cognition, mood, and cerebral blood flow in patients with AD.

BACKGROUND

Some studies have suggested estrogen may be effective in the treatment of AD. However, most of these studies were not controlled adequately.

METHODS

Fifty female AD patients were recruited in a randomized, double-blind, placebo-controlled 12-week trial. Each member of the estrogen-treated group received conjugated estrogen (Premarin) 1.25 mg/day. The primary outcome measures were the Cognitive Ability Screening Instrument (CASI), Clinical Dementia Rating (CDR), and Clinician Interview-Based Impression of Change (CIBIC-plus). The secondary outcome measures were Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD), Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), and 99mTc hexamethylpropylene amine oxime SPECT of the brain.

RESULTS

No meaningful differences were found between the outcome measures (CASI, CDR, CIBIC-plus, BEHAVE-AD, HARS, HDRS, and cerebral blood flow) taken from the estrogen-treated group and those from the control group.

CONCLUSION

A 1.25-mg/day dose of Premarin administered for 12 consecutive weeks does not produce a meaningful effect on cognitive performance, dementia severity, behavior, mood, and cerebral perfusion in female AD patients. Because estrogen therapy has been suspected of yielding adverse effects, and its therapeutic effectiveness is in doubt, additional evaluation of its role in AD treatment ought to be conducted.

In vitro activity of quinupristin/dalfopristin against gram-positive bacteria Haemophilus influenzae and Branhamella catarrhalis in Taiwan

BACKGROUND

Over the past decade, resistance of Gram-positive cocci to common antibiotics has steadily increased. New antibacterial agents that are active against multidrug-resistant pathogens are urgently needed for the treatment of these pathogens. We conducted an in vitro study on the activity of quinupristin/dalfopristin and other antibiotics against common clinical isolates of the gram-positive cocci, Haemophilus influenzae and Branhamella catarrhalis.

METHODS

The agar dilution method described by the National Committee for Clinical Laboratory Standards was used to determine the minimum inhibitory concentrations (MICs) of bacterial isolates from clinical specimens obtained from patients in a medical center.

RESULTS

All Staphylococcus aureus isolates were inhibited by quinupristin/dalfopristin (< or = 2 micrograms/ml). The MIC90s were 1 mg/ml for both methicillin-sensitive and -resistant S aureus. Quinupristin/dalfopristin inhibited streptococci at a concentration of 1 microgram/ml or less. The MIC90s were 1 microgram/ml for Streptococcus pneumoniae, S pyogenes and viridans streptococci. Ampicillin-resistant Enterococcus faecium was inhibited by quinupristin/dalfopristin at 0.5 to 4 micrograms/ml, with an MIC90 of 1 microgram/ml. H influenzae was inhibited by quinupristin/dalfopristin at 0.25 to 8 micrograms/ml, with an MIC90 of 4 micrograms/ml. B catarrhalis was inhibited by quinupristin/dalfopristin at 0.25 to 1 microgram/ml, with an MIC90 of 1 microgram/ml.

CONCLUSIONS

We found that quinupristin/dalfopristin showed good in vitro activity against staphylococci, streptococci and B catarrhalis but less in vitro activity against H influenzae.

A 5-year study of the seroepidemiology of Klebsiella pneumoniae: high prevalence of capsular serotype K1 in Taiwan and implication for vaccine efficacy

Seroepidemiology of Klebsiella pneumoniae was determined for 1000 nonrepetitive K. pneumoniae isolates collected by a medical center in Taiwan during 1993-1997. Of these, 630 isolates (63%) were from community-acquired infections; the rest were from hospital-acquired infections. The isolates were serotyped according to capsular antigen by countercurrent immunoelectrophoresis. About 77% were typeable. Serotypes K1 and K2 accounted for 21.7% and 9.3% of the isolates, respectively, followed by K57 (5.1%), K54 (4.2%), K21 (3. 3%), and K16 (3%). The frequency of serotype K1 among bacteremic isolates (30.8%) far exceeded that reported by other investigators worldwide. Molecular typing of random K1 isolates by pulsed-field gel electrophoresis revealed several different pulsotypes, suggesting a nonclonal spread. This study indicates that a Klebsiella vaccine developed in Europe is not optimal for use in Taiwan because it does not contain the most predominant serotypes-K1, K54, and K57.

Using conjunctival swab with polymerase chain reaction to aid diagnosis of cytomegalovirus retinitis in AIDS patients

Conjunctival swabs were used in combination with polymerase chain reactions (PCR) or virus culture to aid to confirm the diagnosis of cytomegalovirus (CMV) retinitis in AIDS patients. Based on ophthalmoscopic findings, 13 AIDS patients were diagnosed as having CMV retinitis and treated with systemic ganciclovir from January 1997 to December 1998. Nine of 13 AIDS patients with CMV retinitis were found to be positive for CMV DNA by using a conjunctival swab with PCR (CS-PCR). CMV was also isolated from the conjunctival swab culture in 2 AIDS patients with CMV retinitis. Following 1 month of systemic ganciclovir treatment, except for 1 patient who had disease progression and remained positive for CMV DNA by using CS-PCR, 12 patients were negative for CMV with a concordant lesion regression. Results of this study also indicate that this CS-PCR method is valuable for confirming the diagnosis of CMV retinitis and monitoring the ganciclovir effect on the treatment of CMV retinitis in AIDS patients.

Meropenem versus imipenem/cilastatin in the treatment of sepsis in Chinese patients

BACKGROUND

Meropenem and imipenem are beta-lactam antibiotics of the carbapenem group. Carbapenems have bactericidal activity against a broad spectrum of bacteria, including most gram-positive cocci, gram-negative bacilli and anaerobes. Experience in using meropenem in Chinese patients has not been previously reported.

METHODS

Meropenem (2 g daily) and imipenem/cilastatin (2 g daily) were compared in an open, randomized, prospective study on the treatment of hospitalized Chinese septic patients. All participants (male or female) were hospitalized with a diagnosis of sepsis. All patients were randomly allocated to one of the two treatment groups: the meropenem group or the imipenem/cilastatin group. Clinical status was evaluated daily during treatment and at the end of therapy or when treatment was withdrawn. Patients were checked every day for potential side-effects, according to subjective and objective symptoms.

RESULTS

Fifty-three patients were enrolled in the study; 50 were evaluated for clinical efficacy and 27 patients were evaluated for bacteriologic efficacy. The most frequent clinical diagnoses were pneumonia and urinary tract infection. The predominant pathogens were Pseudomonas aeruginosa, Escherichia coli and Enterobacter cloacae. There were 31 pathogens isolated from 27 patients. A single pathogen was identified in 23 patients, and two pathogens were isolated from four patients. Satisfactory clinical outcome (excellent and good) was 84% in the meropenem group and 76% in the imipenem/cilastatin group. Satisfactory bacteriologic response was 80% in the meropenem group and 75% in the imipenem/cilastatin group. Transiently elevated liver enzymes were the most common side-effect. One patient treated with imipenem/cilastatin experienced a seizure during the study, while another patient treated with meropenem withdrew due to urticaria.

CONCLUSIONS

The efficacy and safety data presented in this report indicate that meropenem was well tolerated and appeared to be as effective as standard monotherapy with imipenem in bacteremic patients. Meropenem and imipenem/cilastatin were highly effective for the treatment of bacteremia in Chinese patients and only mild or negligible side-effects were noted.

Hypodense alveolar macrophages in patients with diabetes mellitus and active pulmonary tuberculosis

SETTING

Alveolar macrophages (AM), a heterogeneous cell population, play a critical role in eliminating mycobacterial infections in collaboration with lymphocytes. Patients with diabetes mellitus (DM) show increased susceptibility to pulmonary tuberculosis (TB) infection. It is still uncertain whether there is a defect in T cell or AM activation in patients with DM against TB infection.

OBJECTIVE

To study the difference in activation status of AM and T cells between patients with TB + DM and TB alone.

METHOD

The heterogeneity of AM from 14 patients with TB + DM, 9 with TB alone, 10 normal subjects and 8 DM alone patients, was studied using Percoll density fractionation. The intracellular H2O2 production of AM before and after stimulation with phorbol myristate acetate (PMA) or F-Met-Leu-Phen (FMLP) was assayed by loading cells with 2',7'-dichlorofluorescin (DCFH) and analyzed by flow cytometry. Lymphocytes subsets (CD3, CD4, CD8) and their activation status (CD25) in bronchoalveolar lavage were also measured.

RESULTS

The proportion of the least dense AM (< 1,030 g/ml) and the magnitude of DCFH oxidation of AM was higher in TB patients than in normal subjects, regardless of DM. Patients with TB + DM had a significantly lower proportion of the least density AM fraction than TB alone patients, regardless of disease extent. Among TB patients, the proportion of the least dense AM was inversely correlated with the bacterial load on sputum and the disease extent on chest radiograph. Stimulation of AM with PMA or FMLP induced an increase in the hypodense AM subpopulations and enhanced intracellular H2O2 generation in patients with TB + DM and to a similar extent in normal subjects, but not in patients with TB alone. There was no significant difference in CD3 numbers, CD4/CD8 ratio, and CD25+ cells between patients with TB alone and TB + DM. The activation status of AM or T lymphocytes from DM alone patients was not significantly different from those from normal subjects.

CONCLUSION

Hypodense subpopulations of AM increase in active TB patients and are related to the disease severity as well as activation status of AM. AM in TB patients complicated with DM was less activated, and may be contributory to the susceptibility to mycobacterial infection.

TT virus infection among hemodialysis patients at a medical center in Taiwan

Although the association between TT virus (TTV) infection and hepatitis is controversial, the high prevalence of TTV infection in healthy blood donors and even higher rate among frequently transfused patients poses a potential threat to public health and clinical care. In addition, there is a lack of data concerning the prevalence and mode of transmission of TTV infection in different subpopulations in Taiwan. In the present study, we investigated the prevalence of TTV infection in 111 uremic patients receiving regular hemodialysis in a single hospital in Taiwan. Blood samples were collected and analyzed using a seminested polymerase chain reaction (PCR) designed to amplify a 271 base-pair DNA fragment. The results show that the overall TTV positive rate in uremic patients in our hospital was 61% (68/111), which was much higher than the reported TTV prevalence rate among the normal population (ranging from 1%-12%). The results of analysis of the demographic and clinical characteristics of the patients indicate that blood transfusion may play an important role in TTV transmission (p < 0.05). In addition, the hepatitis B positive rate was significantly lower in TTV positive patients. However, liver function tests were not significantly different between TTV positive and TTV negative patients. The results of the present study suggest that blood transfusion plays an important role in TTV transmission in uremic patients.

Subjective memory complaint in relation to cognitive performance and depression: a longitudinal study of a rural Chinese population

OBJECTIVES

To examine the associations of subjective memory complaint (SMC) in old age with (a) objective test performance, (b) past and subsequent cognitive decline, and (c) depression.

DESIGN

A group of community residents were examined twice during a 3-year period.

SETTING

Two townships on a rural Chinese islet.

PARTICIPANTS

A total of 543 men and women aged 65 years and older.

MEASUREMENTS

During each examination, neurologists interviewed and examined all participants for dementia and asked the question, "Do you have trouble with your memory?" In addition, research assistants administered (a) the Cognitive Abilities Screening Instrument (CASI) to assess cognitive abilities, including long-term memory (LTM) and short-term memory (STM), and (b) the Geriatric Depression Scale-Short Version (GDS-S) to assess symptoms of depression.

RESULTS

At each examination, almost half of the subjects acknowledged having trouble with their memory (the SMC+ group). At both examinations, the SMC+ group scored significantly lower on the CASI and significantly higher on the GDS-S than the SMC- group. However, the presence of SMC was not associated with faster cognitive decline over the past or subsequent 3 years. There were no consistent associations between SMC and the demographic variables of age, gender, and education at the two examinations. Logistic regression analysis showed that SMC was associated with poorer memory test scores after controlling for gender, age, education, and depression.

CONCLUSIONS

SMC was associated with poorer objective memory performance even after controlling the effect of depression and demographic data, but SMC did not predict faster cognitive decline or dementia over 3 years.

Ophthalmic findings in patients with acquired immunodeficiency syndrome

Ocular manifestations have been reported in up to 60% of individuals infected with human immunodeficiency virus (HIV) in the United States, and it is becoming increasing apparent that these ocular manifestations almost invariably reflect extent of progression of the disease. The prevalence of ocular abnormalities among acquired immunodeficiency syndrome (AIDS) patients in Taiwan has not been reported. In the present study, we examined and followed up the ophthalmic conditions of a total of 274 HIV-infected patients during the period from March 1993 to May 1999. The results show that cotton-wool spots was the most common ocular finding in this series of patients with AIDS, occurring in 22 (32.8%) of 67 AIDS patients. Cytomegalovirus (CMV) retinitis was the most commonly seen opportunistic ocular infection, occurring in 14 (20.8%) of 67 AIDS patients. These findings suggest that AIDS patients should be closely followed for signs of opportunistic ocular disease which may initially be asymptomatic. Close co-operation between the ophthalmologist and the internist is essential to ensure timely therapeutic intervention, which can decrease the risk of further complications including visual impairment and blindness.

Self-destructive acts occurring during medical general hospitalization

Although several articles about suicide in general hospitals have been published, the rates of self-destructive individuals among various diseases and departments have not been reported previously. Moreover, self-destructive acts in Chinese general hospital inpatients have been neglected. We retrospectively investigated self-destructive incidents among medical general inpatients. A total of 75 self-destructive incidents, including 15 fatalities, were identified during the 10-year study period. The self-destructive rate was 8.7 per 100,000, and the fatality rate was 1.8 per 100,000 admissions. The highest self-destructive rate occurred in patients admitted to the rehabilitation ward (33.4 per 100,000) followed by the neurology ward (29.9 per 100,000). The highest fatality rate occurred among patients in the neurology ward (6.7 per 100,000). The majority of self-destructive patients suffered from a chronic or terminal illness with the most frequent types of illnesses being malignant neoplasm (31.1%), neurological disease (20.3%), and chronic obstructive pulmonary disease (COPD, 10.8%). COPD patients had the highest rate of self-destructive behavior (64.0 per 100,000) and the highest fatality rate (16.0 per 100,000) due to these incidents. The most common self-destructive incident was knife-cutting. More than one-half (53.4%) of the self-destructive incidents occurred within the first 2 weeks of admission, and nearly one-half (46.7%) occurred during the night shift. Moreover, the majority of severe or fatal incidents also occurred during the night shift. The results suggest that close supervision of high-risk patients should be mandatory within the first 2 weeks following admission, especially during the night shift.

[Molecular cloning of one splicing form of human M6b cDNA]

X-linked, early onset Pelizaeus-Merzbacher disease (PMD) and part of X-linked spastic paraplegia are caused by mutation of proteolipid protein. M6b (U45955) partially cloned by Olinsky was considered as a member of PLP gene family. One novel fragment about 300 bp partially overlapped but differed in 5'part with U45955 was obtained by nested PCR. Assembly of the novel sequence with U45955 make a 1.642kb cDNA sequence with an open reading frame encoding 265 amino acids, which was verified by sequence of PCR products from brain cDNA library. The cDNA (termed M6ba) and its deduced peptide sequence showed significant similarity to murine M6b gene and protein (91.2% and 93.4% respectively). Northern blot, PCR amplification in cDNA library and EST analysis indicated that human M6b gene has at least three splicing forms. M6ba also showed significant similarity to PLP gene, they encode strongly hydrophobic protein and all their hydrophobic region are highly conserved. Gene structure analysis showed that the coding region of M6ba was composed of seven exons.