A simple, artificial-membrane feeding method for the radio-isotope labelling of Aedes aegypti polypeptides in vivo

An artificial feeding unit has been designed and constructed to feed laboratory-bred Aedes aegypti with a radio-isotope (35S), so that the mosquitoes' polypeptides can be labelled in vivo. In the unit, a piece of Parafilm M barrier film is stretched over the bottom, outer surface of a polystyrene Petri dish, to create a small gap in which the mixture of blood and radio-isotope is placed. Warm water is placed in the dish, to keep the blood at about 37 degrees C. When such units were placed on net-covered rearing cages, almost all (80%-90%) of the female mosquitoes in the cages took bloodmeals from them. When checked by polyacrylamide-gel electrophoresis and autoradiography 1 h after feeding had begun, the blood-fed mosquitoes were found to have radio-labelled polypeptides. The unit is simple, easy to handle, disposable and can be used to offer small blood samples (>or=50 microl) to Ae. aegypti and, presumably, other mosquito species.

A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men

OBJECTIVE

To assess the prevalence of chronic post-vasectomy testicular pain (CPTP) compared to the prevalence of chronic testicular pain in a control population of non-vasectomised men.

METHODS

A retrospective postal study of 198 men who had a vasectomy more than 3 years previously at the Palatine Centre to determine the incidence of CPTP, of whom 101 (51%) replied (mean age 40.4 years, range 29-54 years, mean time since vasectomy 46.5 months). A control group of 102 men (mean age 40.2 years, range 28-55 years) who had not had a vasectomy were obtained via patients attending the community family planning clinics or associated general practitioner (GP) services in the same geographical area.

RESULTS

Occasional non-troublesome discomfort was reported by 37/101 of the post-vasectomy men compared to 21/102 of the control group. Occasional discomfort which was a nuisance was felt by 10/101 of the post-vasectomy group compared with 3/102 of the control group, and 6/101 in the post-vasectomy group reported pain severe enough to seek medical advice compared to only 2/102 controls. None of the post-vasectomy men regretted having had the operation.

CONCLUSIONS

Only 6% of cases (compared to 2% of controls) experienced pain severe enough to seek medical advice in the 3-4-year post-operative period. However, there was a significant difference in the prevalence of occasional testicular discomfort between post-vasectomy men and controls. Mostly these pains were not regarded as troublesome, however men attending for vasectomy counselling should be informed of the possibility of this morbidity.

Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS)

AIMS

We tested the hypothesis that enhanced care for diabetes, tailored to the needs of the South Asian community with Type 2 diabetes, would improve risk factors for diabetic vascular complications and ultimately reduce morbidity and mortality.

PATIENTS AND METHODS

The study was a cluster randomized controlled trial (RCT) with general practice the unit of randomization. Six West Midlands general practices with a high proportion of South Asian patients were randomized to 'enhanced care' using Asian link workers and extra community diabetes specialist nurse sessions (intervention) or continued standard practice care (control).

RESULTS

Of 401 patients recruited to the study, 361 (90%), comprising 178 from Coventry and 183 from Birmingham were eligible and included in the analyses. The mean age at baseline (standard deviation, SD) was 58.9 (11.7 years) with median (interquartile range; IQR) duration of diabetes 6.5 (3-11) years. At one year follow-up there was a significant difference in reduction of systolic (4.6 mmHg, P = 0.035) and diastolic blood pressure (3.4 mmHg, P = 0.003) and total cholesterol (0.4 mmol/l, P = 0.005), comparing the intervention and control groups. After adjusting for baseline measurement and age, only differential reduction in diastolic blood pressure remained significant. There was no significant change in HbA(1c) and no difference between the groups.

CONCLUSIONS

Using link workers and extra community diabetes specialist nurse input together with treatment protocols in primary care might prove a useful strategy in working towards NSF targets for diabetes management. In this study, small reductions in blood pressure and cholesterol were achieved. Improvement in glycaemic control may require longer and possibly different strategies. Further research is required to evaluate fully the effectiveness, including the costs and longer term sustainability of culturally sensitive initiatives.

Randomized control trial of quinine and artesunate in complicated malaria

OBJECTIVE

To study the comparative efficacy of the quinine and artesunate in complicated malaria in children.

METHODS

All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P. falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests.

RESULTS

80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 +/- 31.49 hrs; 43.55 +/- 20.12 hrs, and 41.67 +/- 16.78 hrs respectively) as compared to the quinine group (70.15 +/- 17.56 hrs, 62.23 +/- 16.99 hrs, and 52.24 +/- 12.69 hrs respectively) ( p<0.05) No side effects were observed in the artesunate treated group.

CONCLUSION

Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution, fever clearance, parasite clearance and better tolerability.

A randomized controlled trial to evaluate the slow-acting symptom modifying effects of a regimen containing colchicine in a subset of patients with osteoarthritis of the knee

OBJECTIVE

As crystals may contribute to inflammation in osteoarthritis (OA), it is hypothesized that colchicine may have symptom/disease modifying effects in OA. The objective of this study was to evaluate the symptomatic benefit of addition of colchicine to a regimen of intraarticular steroids and piroxicam in patients with knee OA with inflammation.

DESIGN

39 patients with OA of the knee with persisting inflammation, despite at least 2 weeks of piroxicam, were subjected to intraarticular steroid injection and randomly assigned to receive colchicine 0.5 mg twice daily or placebo in a randomized, double blind, placebo-controlled trial over 5 months.

RESULTS

VAS for index knee pain (VAS-pain) and total KGMC score (a modified WOMAC index) at 16 and 20 weeks were significantly better in the colchicine group than the corresponding scores in controls. The benefit persisted on multivariate analysis at 16 weeks (Hotellings T(2)=18.6, F(5,33)=3.3154, P=0.015). The proportion of patients who had 30% or greater response at 16 weeks was significantly higher in the colchicine group in VAS-pain (69% vs 15%) and total KGMC scores (74% vs 45%) and the significance persisted on combined analysis using Mantel-Haenszel test (M-H Risk=5.9, 95% C.I.: 2.08 to 16.73). At 20 weeks, benefit of colchicine therapy was seen on pooled analysis only (M-H risk=3.71, 95% C.I.: 1.07=8.02).

CONCLUSION

The addition of colchicine produced significantly greater symptomatic benefit at 16 and 20 weeks than intraarticular steroid and piroxicam alone in patients with knee OA with inflammation.

Bone marrow necrosis in paediatric patients

Necrosis of bone marrow is a very rare condition with a prevalence ranging from 0.15 to 7 percent. It is mostly not compatible with life. We diagnosed four cases of necrotic marrow out of 830 bone marrow aspirations done in last five years of time. All were paediatric patients having peripheral pancytopenia. Three out of four patients expired within one month of diagnosis.

Congenital spinal lipomas--tumor versus hamartoma

Congenital spinal lipomas as a form of dysraphism are frequently reported in literature. A few studies have highlighted their histologic features and found them different from lipomas in other parts of the body. In a review of eight cases of spinal lipomas, we found heterotopic tissue in seven. Neural tissue, muscle, bone and cartilage were frequently encountered. The presence of meningothelial cells in one case was an unusual finding. These findings support the concept of their hamartomatous origin. Malignancy, occurring later in life in one of the heterotopic elements is known, though uncommon, and is one of the reasons, besides neurologic deficit, for long term follow-up.

Yeast Ku protein plays a direct role in telomeric silencing and counteracts inhibition by rif proteins

Yku70p/Yku80p, the yeast Ku protein homologue, is a DNA end-binding heterodimer involved in non-homologous end joining. It also binds to telomeres, where it plays an important role in the maintenance of telomeric DNA structure [1] [2] [3] [4] [5]. Ku protein, together with Rap1p, a telomeric DNA (TG(1-3) repeat)-binding protein, is also required to initiate transcriptional silencing, or telomere-position effect (TPE). Here, we provide evidence for a direct role of Ku in TPE, which is most likely to be in either the recruitment or activation of Sir4 protein at the telomere. Surprisingly, however, the essential role of Ku in TPE is to overcome the inhibitory effect of two Rap1p-interacting proteins, Rif1p and Rif2p, both of which also play an important role in telomere length regulation [6] [7]. Previous studies showed that Rif and Sir proteins compete for binding to the carboxyl terminus of Rap1p [7] [8] [9]. In the absence of this competition, for example, when RIF genes are mutated, Ku is no longer necessary for TPE, whereas the Rap1p carboxyl terminus is still absolutely required. We show that Rif1p is localized to telomeres, indicating that its inhibitory effect on TPE is direct. Our data implicate a role for Ku in the competition between Sir and Rif proteins for access to the telomeric array of Rap1p molecules, which results in a balance between telomeric silencing and telomere length control.

Do all grade I lesions on colposcopy need to be biopsied?

The present study intends to correlate grade I atypical transformation zone (ATZ) on colposcopy with cytology & histology in 51 patients by retrospective data analysis. Indications of colposcopy were inflammatory smears with unhealthy cervix (37/51). Atypical squamous cells of unknown etiology (2/51) & squamous intraepithelial lesions on cytology (12/51). All the patients exhibited grade I lesions on colposcopy & underwent directed biopsy. On histology chronic cervicitis was the commonest finding 70.6% (36/51) & CIN was found in 19.6% (10/51), out of which CIN II-III occurred only in 3.92% (2/51). Overcall rate of colposcopy for grade I lesions was 80.39%. Age, parity, the postcoital or contact bleeding did not correlate with the histological positivity of the lesions. Grade I ATZ with inflammatory smears revealed CIN II-III only in 2.7% (1/37) while with low grade SIL cytology there was no moderate or severe dysplasia. However Grade I lesions in association with high grade SIL exhibited CIN II-III lesions in 16.6% (1/6). Therefore grade I lesions in presence of inflammatory or low grade SIL smears can be observed & biopsied only if the changes persist. However association of high grade SIL with grade I ATZ calls for immediate biopsy.

Precursor lesions of Wilms' tumor in Indian children: a multiinstitutional study

BACKGROUND

Studies regarding different ethnic populations of children with Wilms' tumor (WT) in the U. S. have shown differences between age and gender incidence and the type of its precursor lesions (nephrogenic rests). To the authors' knowledge there are few reports in the literature regarding nephrogenic rests in a large number of cases from other parts of the world.

METHODS

In this study, histopathology sections from 127 WTs were pooled from the archives of 4 institutions in northern India and studied for the incidence of nephrogenic rests. Their incidence also was cross-correlated with patient age gender, and tumor morphology.

RESULTS

Significantly, the complete absence of perilobar nephrogenic rests was observed in all cases. Intralobar rests were associated with 45.3% of WTs and were observed predominantly with a triphasic histologic pattern and a relatively lower incidence of anaplasia compared with reports in the Western literature (1.5% vs. 4.5%). A lower median age of 2.5 years with a peak in the first 2 years of life was consistent with reported studies in Asian children. The male gender preponderance was in contrast to the equal male to female ratio reported in Western cases.

CONCLUSIONS

The type of nephrogenic rests present in Indian children was noted to be different from that in children reported in the Western literature. Differences also existed with regard to the age and gender incidence of children with WT and its morphologic pattern, possibly due to the different genetic nature of the tumor. However, this theory requires confirmation by large epidemiologic and genetic studies.

Fine needle aspiration cytology of malignant chondroid syringoma: a case report

BACKGROUND

Chondroid syringoma, a tumor of the eccrine glands, was previously called mixed tumor of skin as it has both mesenchymal and epithelial elements. Malignancy in this tumor is extremely rare. Although there are a few reports describing the cytomorphologic features of chondroid syringoma, the cytologic findings of its malignant counterpart have not been described.

CASE

A 40-year-old female presented with a recurrent swelling on the scalp of one year's duration. Fine needle aspiration yielded blood-mixed gelatinous material. May-Grünwald-Giemsastained smears showed epithelial cells arranged in cordlike structures and ill-formed glands against a myxomatous background. The epithelial cells had scanty cytoplasm and markedly pleomorphic nuclei with prominent nucleoli. A few cells in the stroma had a halo around them and a resemblance to cartilage cells. A preoperative diagnosis of malignant chondroid syringoma was made. The tumor was excised, and the cytologic diagnosis was confirmed on histopathology.

CONCLUSION

Cytomorphologic features of a rare case of malignant chondroid syringoma are reported for the first time. The presence of malignant epithelial cells against a myxoid background with a few chondroid foci helped in making a correct preoperative diagnosis.

Malignant chondroid syringoma

Malignant chondroid syringoma (MCS) is a rare tumor, of the sweat gland; only a few hundred such cases are reported in literature. A female presented with a subcutaneous swelling on the scalp with repeated recurrence and positive regional lymph nodes. Adequate planning for the treatment of this case was possible as preoperative diagnosis of MCS was documented by fine needle aspiration cytology (FNAC). The case was successfully managed with a multimodal approach, which included radical surgery and subsequent radiotherapy. The patient is symptom free after 25 months. The possibility of this type tumor should be entertained when multiple recurrences occur following adequate excision. FNAC has a definitive role in planning rational therapy.

Leopard syndrome: a tropical rarity

This is a case report of a classical presentation of the Leopard syndrome from the Indian subcontinent. The male patient had progressively increasing generalised multiple lentiginosis, ocular hypertelorism, pulmonary stenosis, short stature, cryptorchidism, and pectus excavatum. The case is documented for its rarity in this part of the world and typical clinical presentation.

Rat lactase-phlorizin hydrolase/human growth hormone transgene is expressed on small intestinal villi in transgenic mice

BACKGROUND & AIMS

Lactase-phlorizin hydrolase (LPH) is an absorptive enterocyte-specific gene that is expressed in a well-characterized pattern along the cryptvillus (vertical), proximal-distal (horizontal), and developmental (temporal) gradients. The aim of this study was to characterize the capacity of regulatory elements within the rat LPH gene to direct appropriate cell lineage and topographical patterns of expression in vivo in transgenic mice.

METHODS

Transgenic mouse lines were established using a construction containing bases -2038 to +15 of the rat LPH gene fused to a human growth hormone reporter gene.

RESULTS

In one line, the transgene was expressed only in small intestine and was localized to absorptive enterocytes on villi. The transgene was not expressed in goblet or enteroendocrine cells or in crypts. Transgene expression along horizontal and developmental gradients was different from that of the native mouse LPH gene.

CONCLUSIONS

The results suggest that the region from -2038 to +15 of the rat LPH gene contains regulatory elements that direct correct tissue, cell, and vertical expression but may not contain all the elements necessary for appropriate horizontal and temporal control. This investigation provides further insight into the complexities of the molecular control of intestinal gene expression.

Focal versus diffuse anaplasia in Wilms tumor--new definitions with prognostic significance: a report from the National Wilms Tumor Study Group

Anaplasia, defined by the presence of extreme nuclear and mitotic atypia, is a potent marker of adverse prognosis in Wilms tumor (WT). Anaplastic WT cells apparently have increased resistance to therapy rather than increased aggressiveness. The distribution of anaplasia should therefore have critical prognostic relevance. The original definitions for focal anaplasia (FA) and diffuse anaplasia (DA) were based on quantitative rather than topographical criteria and lacked prognostic significance. A new definition was developed based on the distribution of anaplastic changes within the tumor: FA applies only to tumors with anaplasia confined to one or a few discrete loci within the primary tumor, with no anaplasia or marked nuclear atypia elsewhere. This revised definition was evaluated in 165 cases with anaplastic WT entered on the third and fourth National Wilms Tumor Study. Only three relapses and one death occurred among 39 cases with FA, regardless of tumor stage, a result comparable to that for nonanaplastic WT. Eight children with metastases at diagnosis and FA in the primary tumor were alive and free of relapse; 22 of 23 children with stage IV DA WT died of tumor. This new definition reinforces the importance of carefully documenting the exact site from which each tumor section is obtained.

Further characterization of the 5'-flanking region of the rat lactase-phlorizin hydrolase gene

The lactase-phlorizin hydrolase gene is widely used as a marker of intestinal differentiation. Recent evidence demonstrating that transcription plays a major role in the regulation of this gene suggests that study of the 5'-flanking region will allow an understanding of how the expression of this gene is controlled. However, sequence, restriction, and primer extension analysis of a rat genomic clone has revealed that previously published data are incomplete. In the present study, we used a directed sequencing strategy to carefully analyze this region. Our expanded analysis of the 5'-flanking region of the lactase-phlorizin hydrolase gene should facilitate future studies of its structure and function.

Essential role of protein phosphorylation in nuclear transport

We have investigated a possible role for protein phosphorylation in nuclear transport in semi-intact cells, prepared by digitonin permeabilization of rat F-111 fibroblasts. Treatment of semi-intact cells with alkaline phosphatase abolished the import of nuclear transport substrates, namely, signal peptide-albumin conjugates, as well as their signal-dependent binding at the nuclear pores, but did not affect the morphology of the cells, in particular their cytoskeletal network. Authentic transport and functional binding of the karyophilic protein at the nuclear envelope could be restored by incubation of phosphatase-treated cells with cytosol enriched in protein kinase C or with purified protein kinase A (catalytic subunit). Restoration of transport was blocked by specific inhibitors of these kinases. Since the protein phosphorylation required for nuclear transport appeared to be a reasonably stable modification, characterization of the phosphorylated proteins was attempted in kinase reactions with radiolabeled ATP. Two proteins of 60-62 kDa were the predominant substrates phosphorylated by both protein kinase C and protein kinase A under conditions wherein nuclear transport was restored. Our results suggest a requirement for phosphorylation of one or more proteins for binding of a karyophilic protein at the nuclear envelope.

Developmentally regulated Gb3 galactosyltransferase and alpha-galactosidase determine Shiga toxin receptors in intestine

The receptor for Shiga toxin on rabbit intestinal microvillus membranes (MVMs) has been identified as a developmentally regulated glycolipid, globotriaosylceramide [galactose alpha 1-4 galactose beta 1-4 glucose beta 1-1 ceramide (Gb3)]. MVM Gb3 levels increase markedly in the third week of life, concomitant with fluid secretory responses to the toxin. To study mechanisms controlling developmental regulation of MVM Gb3, we measured the specific synthetic Gb3 galactosyltransferase and degradative alpha-galactosidase activities and subcellular distribution of Gb3 at various ages. Quantitative high-performance liquid chromatography demonstrated a similar developmental pattern in both microsomal and MVM Gb3, indicating that late expression of MVM Gb3 is not due to delayed migration of Gb3 from the microsomal to the MVM. The specific Gb3 galactosyltransferase activity increased with age, with a sharp increase seen at 18 days of age, whereas alpha-galactosidase activity followed an inverse pattern. Thus, regulation of both synthetic and degradative pathways for Gb3 appears to explain the observed changes in Gb3 levels with age. The nature of the signals for developmental regulation of Gb3 levels is unknown, as are the physiological consequences of altered MVM glycolipid composition other than mediating response to Shiga toxin.