Endoscopy in acquired immunodeficiency syndrome patients with diarrhea and negative stool studies

BACKGROUND

Diarrhea is a frequent gastrointestinal symptom in patients with acquired immuno-deficiency syndrome (AIDS) and is a major source of morbidity and mortality. A stepwise diagnostic approach is often recommended to search for treatable causes. However, whether the stepwise diagnostic approach is adequate for planning treatment and whether specific treatment for infectious etiologies will affect the survival of patients with AIDS remain unknown.

METHODS

From March 1996 to September 1997, endoscopy was performed in AIDS patients with diarrhea, the etiology of which was not identified by noninvasive methods. Specific treatment was given according to the identified etiologies and symptomatic treatment was given for those without definite diagnosis. The clinical symptoms, signs, and duration of follow-up were recorded and survival patterns were analyzed.

RESULTS

Etiologic diagnoses were made in 26 of 40 patients (65%) who underwent endoscopic studies. Amebic colitis and cytomegalovirus colitis were the 2 leading causes of prolonged diarrhea in patients with AIDS. Thirty-five patients (87.5%) recovered after treatment. The difference in survival time after diarrhea between patients whose symptoms resolved after treatment and those who continued to have diarrhea was statistically significant (p < 0.001).

CONCLUSIONS

Endoscopic studies were helpful for the diagnosis of prolonged diarrhea in AIDS patients who had negative stool studies and did not respond to 2 weeks of empiric treatment. Specific treatment according to the results of endoscopy may improve survival in these patients.

Contribution of inflammation to reperfusion injury

Interrupting the flow of blood to an organ for even a relatively brief period disrupts multiple essential vascular homeostatic mechanisms. This results in the cardinal manifestations of reperfusion injury, which, at the tissue level, are comprised of leukocyte infiltration, thrombosis, edema, and vasoconstriction. Molecular mechanisms that are particularly relevant to postischemic inflammation and reperfusion injury include induction of adhesion receptor expression at the endothelial surface, alterations in the procoagulant/anticoagulant balance to promote accumulation of intravascular thrombus, oxidant stress that directly injures cells and indirectly promotes inflammatory upregulation, loss of protective second messenger cyclic nucleotide systems, and activation of the complement cascade that causes vascular injury as well as collateral damage to innocent bystander cells with the reperfused tissue. Understanding the inflammatory mechanisms that participate in reperfusion injury may lead to reperfusion therapies designed to improve postischemic organ function.

Conditional-cumulant-of-exposure method in logistic missing covariate regression

We consider estimation in logistic regression where some covariate variables may be missing at random. Satten and Kupper (1993, Journal of the American Statistical Association 88, 200-208) proposed estimating odds ratio parameters using methods based on the probability of exposure. By approximating a partial likelihood, we extend their idea and propose a method that estimates the cumulant-generating function of the missing covariate given observed covariates and surrogates in the controls. Our proposed method first estimates some lower order cumulants of the conditional distribution of the unobserved data and then solves a resulting estimating equation for the logistic regression parameter. A simple version of the proposed method is to replace a missing covariate by the summation of its conditional mean and conditional variance given observed data in the controls. We note that one important property of the proposed method is that, when the validation is only on controls, a class of inverse selection probability weighted semiparametric estimators cannot be applied because selection probabilities on cases are zeroes. The proposed estimator performs well unless the relative risk parameters are large, even though it is technically inconsistent. Small-sample simulations are conducted. We illustrate the method by an example of real data analysis.

Weighted normality-based estimator in correcting correlation coefficient estimation between incomplete nutrient measurements

Consider the problem of estimating the correlation between two nutrient measurements, such as the percent energy from fat obtained from a food frequency questionnaire (FFQ) and that from repeated food records or 24-hour recalls. Under a classical additive model for repeated food records, it is known that there is an attenuation effect on the correlation estimation if the sample average of repeated food records for each subject is used to estimate the underlying long-term average. This paper considers the case in which the selection probability of a subject for participation in the calibration study, in which repeated food records are measured, depends on the corresponding FFQ value, and the repeated longitudinal measurement errors have an autoregressive structure. This paper investigates a normality-based estimator and compares it with a simple method of moments. Both methods are consistent if the first two moments of nutrient measurements exist. Furthermore, joint estimating equations are applied to estimate the correlation coefficient and related nuisance parameters simultaneously. This approach provides a simple sandwich formula for the covariance estimation of the estimator. Finite sample performance is examined via a simulation study, and the proposed weighted normality-based estimator performs well under various distributional assumptions. The methods are applied to real data from a dietary assessment study.

Akt suppresses apoptosis by stimulating the transactivation potential of the RelA/p65 subunit of NF-kappaB

It is well established that cell survival signals stimulated by growth factors, cytokines, and oncoproteins are initiated by phosphoinositide 3-kinase (PI3K)- and Akt-dependent signal transduction pathways. Oncogenic Ras, an upstream activator of Akt, requires NF-kappaB to initiate transformation, at least partially through the ability of NF-kappaB to suppress transformation-associated apoptosis. In this study, we show that oncogenic H-Ras requires PI3K and Akt to stimulate the transcriptional activity of NF-kappaB. Activated forms of H-Ras and MEKK stimulate signals that result in nuclear translocation and DNA binding of NF-kappaB as well as stimulation of the NF-kappaB transactivation potential. In contrast, activated PI3K or Akt stimulates NF-kappaB-dependent transcription by stimulating transactivation domain 1 of the p65 subunit rather than inducing NF-kappaB nuclear translocation via IkappaB degradation. Inhibition of IkappaB kinase (IKK), using an IKKbeta dominant negative protein, demonstrated that activated Akt requires IKK to efficiently stimulate the transactivation domain of the p65 subunit of NF-kappaB. Inhibition of endogenous Akt activity sensitized cells to H-Ras(V12)-induced apoptosis, which was associated with a loss of NF-kappaB transcriptional activity. Finally, Akt-transformed cells were shown to require NF-kappaB to suppress the ability of etoposide to induce apoptosis. Our work demonstrates that, unlike activated Ras, which can stimulate parallel pathways to activate both DNA binding and the transcriptional activity of NF-kappaB, Akt stimulates NF-kappaB predominantly by upregulating of the transactivation potential of p65.

An Sp1 binding site involves the transcription of the Fas ligand gene induced by PMA and ionomycin in Jurkat cells

The transcriptional regulation of the Fas ligand (FasL) gene in Jurkat cells was investigated. We demonstrated that an Sp1 binding site, located between -280 and -275 bp relative to the translational start site (+1) of the FasL gene, was important for the transcription of the FasL gene by deletion and mutation analysis in Jurkat cells after phorbol 12-myristate 13-acetate (PMA) and ionomycin treatment. Nuclear extract of Jurkat cells formed complexes with the oligonucleotides bearing the Sp1 site within -280 to -275 of the FasL promoter. Apart from the constitutive complexes, a new complex was observed after PMA and ionomycin stimulation. Plasmid containing the Sp1 site sequence with site-directed mutation reduced the FasL promoter activity in driving the expression of reporter luciferase gene expression in transfected Jurkat cells after PMA and ionomycin stimulation. The binding of activated Jurkat cell nuclear extract to the mutated Sp1 binding site of the FasL promoter was ablated. In addition, the oligomer containing the Sp1 site of the FasL promoter could compete with oligomer with conserved Sp1 binding sequence in nuclear protein binding of activated Jurkat cells. The data presented in this study suggest that the transactivation of the FasL promoter via the Sp1 binding sequence (-280 to -275) involves the PMA- and ionomycin-induced expression of the FasL gene.

Comparison of antileukemic immunity against U937 cells in atopic asthmatics versus healthy controls

To assess the antitumor effects in atopic asthmatics versus healthy adults, we designed this study using in vitro mononuclear cells (MNC) culture as an immunity model with human leukemic U937 cells as the target. MNCs were collected from asthmatic subjects and healthy controls. Conditioned media from the MNC cultures (MNC-CM) were collected after stimulation with various concentrations of phytohemagglutinin (PHA). We treated U937 cells with these MNC-CMs, then assayed their proliferation and differentiation after 5 days of culture. At lower PHA doses (1.25 microg/ml), as well as in absence of PHA, the asthmatic MNC-CMs inhibited U937 cells growth to a slightly greater extent than did the MNC-CMs from controls. In contrast, when higher doses of PHA were used (5, 10 microg/ml), this growth-inhibiting effect was dramatically reversed. The dual effect of MNC-CM in these two groups was also shown in U937 cell differentiation assay, assessed as follows: morphological change by Liu's staining, functional change by NBT reduction test and CD 14 expression by flow cytometric detection. We suggest that the antileukemic effects of MNCs from asthmatic patients result from a slightly immunopotentiated status. This immunity may be dramatically reversed, however, after marked activation of MNCs.

Antisense intercellular adhesion molecule-1 (ICAM-1) oligodeoxyribonucleotide delivered during organ preservation inhibits posttransplant ICAM-1 expression and reduces primary lung isograft failure

Transiently increased expression of leukocyte adhesion receptors after lung preservation contributes to early graft demise by recruiting leukocytes, activating complement, and causing microcirculatory stasis. We hypothesized that inhibiting intercellular adhesion molecule-1 (ICAM-1) expression even briefly may significantly improve lung graft function and that the preservation period might provide a unique window to deliver a therapeutic pulse of antisense oligonucleotide ICAM-1 to inhibit ICAM-1 expression after transplantation. Interleukin-1beta-treated rat pulmonary endothelial cells given a 20-mer phosphorothioate oligonucleotide comprising an antisense span targeted to the 3'-untranslated region of rat ICAM-1 demonstrated an oligonucleotide dose-dependent reduction in ICAM-1 expression. Using a cationic liposomal carrier, this same antisense oligonucleotide (but not the sense control) instilled into the pulmonary vasculature at the time of preservation reduced subsequent graft ICAM-1 expression and graft leukostasis and markedly improved oxygenation, pulmonary blood flow, and graft survival. These experiments demonstrate that the preservation period presents a window during which to target an anti-ICAM-1 expression strategy to inhibit early adhesion receptor expression and improve functional outcome after lung transplantation.

Methyl jasmonate reduces chilling injury and maintains postharvest quality of mango fruit

Exposure of mango (Mangifera indica cv. Tommy Atkins) fruit to methyl jasmonate (MJ) vapors (10(-)(4) M) for 24 h at 25 degrees C reduced chilling injury during subsequent storage for 21 days at 7 degrees C and after 5 days of shelf life at 20 degrees C. The chilling tolerance induced by MJ was positively correlated with the reduction in the percent ion leakage of mango tissue. The overall quality of MJ-treated fruit was also better than that of control fruit. MJ treatment increased the total soluble solids but did not affect titratable acidity or pH. MJ also did not change the normal climacteric rise in respiration, water loss, and softening rates. The efficacy of MJ to reduce chilling injury and decay of mango could be related to the tolerance induced at low temperature. It was concluded that MJ treatment may prevent chilling injury symptoms of mango without altering the ripening process.

Nasopharyngeal carcinoma with leptomeningeal dissemination: case report

Nasopharyngeal carcinoma (NPC) is a highly prevalent malignancy in southeast China, Hong Kong, and Taiwan. Spread of this tumor is known to occur via three main routes, i.e., local invasion of adjacent structures, regional metastasis to neck nodes, and hematogenous metastasis to distant organs. In this report, we describe a rare case of NPC disseminated via the leptomeninges, so called meningeal carcinomatosis (MC). The patient was a 62 year-old man who presented with multiple cranial nerve palsies and a headache, and was diagnosed with NPC in August 1988. The primary tumor regressed completely after induction chemotherapy and radiation therapy. Computerized tomography (CT) 17 months after radiation therapy showed multiple enhanced nodules scattered along the temporal meninges. The nodules increased in number and size in the subsequent CT scan 4 months later. The patient declined further invasive procedures and oncologic treatments, and he expired at home 9 months after the development of MC. It is speculated that perineural invasion and access to the subarachnoid space was the major cause of MC in this case. The case, although rare, possibly highlights a rare route of tumor dissemination in NPC.

Alfentanil for intubation under halothane anaesthesia in children

Intubating conditions under halothane anaesthesia aided with alfentanil 20 micrograms.kg-1 were compared with suxamethonium 2 mg.kg-1 in 40 children presenting for day dental procedures. The condition of vocal cords, jaw relaxation and presence of movement and coughing were scored to give the overall intubating conditions. Successful intubation was achieved in 100% of the suxamethonium group and 94.7% of the alfentanil group. The cardiovascular response to intubation was attenuated in the alfentanil group. Some 43.7% of those receiving suxamethonium developed myalgia the day after surgery compared with 0% in the alfentanil group (P < 0.01).

Preparation of Shell-Core Cu(2)O-Cu Nanocomposite Particles and Cu Nanoparticles in a New Microemulsion System

Shell-core Cu(2)O-Cu nanocomposite particles and metal Cu nanoparticles are synthesized in a new microemulsion system which consists of saturated Cu(2+) salt aqueous solution dispersed in isopropanol and stabilized by polyvinylalcohol (PVA). The size of the composite particles and the thickness of the Cu(2)O shell layer can be controlled by the volume ratio of isopropanol to H(2)O (the ratio is defined as R). When R >/= 1000, it is available to obtain metal Cu nanoparticles. Copyright 1999 Academic Press.

Autofluorescence spectroscopic differentiation between normal and cancerous colorectal tissues by means of a two-peak ratio algorithm

We conducted an ex vivo study with light-induced autofluorescence spectroscopy to distinguish between normal and cancerous colorectal tissues. A total of 20 normal and 20 cancerous tissue samples were obtained from 20 patients undergoing oncologic surgery of the colon and rectum. The tissue diagnosis was confirmed histologically. After excitation, the autofluorescence spectra of each sample were measured and recorded. To determine the most appropriate excitation wavelength, we analyzed the autofluorescence spectra at excitation wavelengths of 280 to 400 nm, in 10-nm increments. To distinguish between normal and cancerous tissues, we first calculated the "two-peak ratio" (the ratio of the integrated intensity of the first peak +/- 6 nm to the integrated intensity of the second peak +/- 6 nm) of the autofluorescence spectra. By applying receiver operating characteristic (ROC) curves and calculating the areas under the ROC curves (AUC), we found 330 and 340 nm to be the most appropriate excitation wavelengths to distinguish between cancerous and normal colorectal tissue. When approximate thresholds were selected, autofluorescence spectroscopy with 330 nm excitation yielded a sensitivity of 85%, a specificity of 90%, and a positive predictive value of 89% for detection of cancerous tissue. The ex vivo autofluorescence study and two-peak ratio algorithm developed herein may be very useful for developing an algorithm for in vivo diagnosis of colorectal cancer.

Genotoxic effects of heterocyclic aromatic amines in human derived hepatoma (HepG2) cells

In order to study the mutagenic effects of heterocyclic aromatic amines (HAAs) in cells of human origin, five compounds, namely 2-amino-3-methyl-imidazo[4,5-f]quinoline (IQ), 2-amino-3, 4-dimethyl-imidazo[4,5-f]quinoline (MeIQ), 2-amino-3, 8-dimethyl-imidazo[4,5-f]quinoxaline (MeIQx), the pyridoimidazo derivative 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and 3-amino-1,4-dimethyl-5H-pyrido[4,3-b]indole (Trp-P-1), were tested in micronucleus (MN) assays with a human derived hepatoma (HepG2) cell line. All HAAs caused significant, dose-dependent effects. The activities of IQ, MeIQ, MeIQx and PhIP were similar (lowest effective concentrations 25-50 microM), whereas Trp-P-1 was effective at a dose of >/=2.1 microM. In addition, the HAAs were tested in MN assays with Chinese hamster ovary (CHO) cells and in Salmonella strain YG1024 using HepG2 cell homogenates as an activation mix. In the CHO experiments, positive results were obtained with Trp-P-1 and PhIP, whereas the other compounds were devoid of activity under all experimental conditions. The discrepancy in the responsivity of the two cell lines is probably due to differences in their acetylation capacity: enzyme measurements with 2-aminofluorene as a substrate revealed that the cytosolic acetyltransferase activity in the HepG2 cells is approximately 40-fold higher than that of the CHO cells. In the bacterial assays all five HAAs gave positive results but the ranking order was completely different from that seen in the HepG2/MN experiments (IQ > MeIQ > Trp-P-1 >/= MeIQx >> PhIP) and the mutagenic potencies of the various compounds varied over several orders of magnitude. The order obtained in bacterial tests with rat liver S9 mix was more or less identical to that seen in the tests with HepG2 cell homogenates but the concentrations of the amines required to give positive results were in general substantially lower (10(-5)-10(-1) microM). Overall, the results of the present study indicate that MN/HepG2 tests might reflect the mutagenic effects of HAAs more adequately than other in vitro mammalian cell systems due to the presence of enzymes involved in the metabolic conversion of the amines.

Expression and alternative splicing of the mouse autoimmune regulator gene (Aire)

AIRE, the gene responsible for the autoimmune polyglandular syndrome type 1 (APS1) or APECED, may act as a transcription factor according to its predicated protein structure. Here we demonstrate the low expression level of the mouse Aire gene as it is undetectable by Northern blot analyses. However, RT-PCR analyses revealed expression of Aire in mouse thymus, ovary, lung, testis, kidney and adrenal gland. Barely detectable level of RT-PCR product was also found in thyroid gland and heart but no amplification was detected in pancreas, spleen and liver. Competitive RT-PCR assays demonstrated highest expression level of Aire mRNA in thymus. In addition to the complete cDNA (Aire or Aire-1a), we identified 11 alternative splicing forms (designated as Aire-1b, Aire-1c, Aire-1d, Aire-2a, Aire-2b, Aire-2c, Aire-2d, Aire-3a, Aire-3b, Aire-3c and Aire-3d). These forms result from combinations of four alternative splicing units (exon 10, exon 11, 12 bp in exon 6 and 3 bp in exon 8). The relative abundance of these splicing forms was also determined.

Removal of cardiac beat artifact in oesophageal pressure measurement by frequency analysis

Oesophageal pressure (Pes) measurements are important in medical research and useful in clinical diagnosis. Measurements, however, are contaminated heavily by cardiac artifacts. The spectrum and waveform of the Pes signal is obtained from the oesophageal balloon. Adaptive finite impulse response (AFIR) filter and modified adaptive noise cancellation (MANC) methods are adopted to filter out cardiac beat interference. These results are compared. In the frequency domain, frequency variations and spectral overlap between the Pes components and cardiac beat signal components impact on the performance of the filter. From our experimental results on power strength, the fourth or higher harmonics did not have any significant effect on the filter performance. However, the second harmonics of these signals had a significant effect on the filtering result. Thus, in the design of AFIR filters, attention is needed to minimise these effects. In frequency analysis, these harmonics or overlapping frequencies do not affect MANC. MANC was the better method for eliminating cardiac beat artifact in Pes measurement. The dynamic compliance (Cdyn) was also used to evaluate the performance of MANC and AFIR. The standard deviation of Cdyn was less than 0.15 using MANC, compared with standard deviations as high as 0.57 for AFIR. We conclude that MANC performs better than AFIR.

Evaluation of a selective screening for colorectal carcinoma: the Taiwan Multicenter Cancer Screening (TAMCAS) project

BACKGROUND

Although the efficacy of mass screening for colorectal carcinoma (CRC) with a fecal occult blood test has been demonstrated in several randomized trials, a mass screening approach used in countries with intermediate or low incidence of CRC might be costly. Screening high risk people may be an alternative approach, to aid in the prevention of death from CRC. However, the efficacy of CRC screening for high risk people in such countries is uncertain.

METHODS

For this study, a multicenter design was devised to identify high risk groups without clinical symptoms related to CRC; these subjects were identified through the study of index cases of CRC in Taiwan. Colonoscopy, in combination with a fecal occult blood test or double-contrast barium enema, was used to screen high risk groups. A total of 8909 subjects were invited to attend screening. Of 8909, 81 with asymptomatic CRC were detected in one-shot screening. Markov models, in conjunction with a simulated approach, were proposed to estimate relevant parameters in relation to disease progression and to assess the effect of the interval between screenings on the efficacy of CRC screening for these high risk groups.

RESULTS

The estimated preclinical incidence rate was 0. 00396 (95% confidence interval [CI], 0.002944-0.004985), which was 21 times that reported from a cancer registry in 1994. The simultaneous estimations of mean sojourn time (the average duration between the preclinical screen-detectable phase and the clinical phase) and sensitivity were 2.8 years (95% CI, 2.15-4.30) and 95.0% (95% CI, 24.4-99.9%), respectively. Predictions of mortality reduction for people who received annual, biennial, and triennial screening regimes compared with controls were 26% (95% CI, 0-50%), 23% (95% CI, 0-48%), and 21% (95% CI, 0-47%), respectively.

CONCLUSIONS

The efficacy of selective colorectal carcinoma screening has been demonstrated in this study. A high preclinical CRC incidence rate also suggests that such a screening strategy might be cost-effective for countries with intermediate or low incidence of CRC. Methods proposed in this study can be used to evaluate the efficacy of CRC screening in similar screening trials.

Transposition of the endogenous insertion sequence element IS1126 modulates gingipain expression in Porphyromonas gingivalis

We have previously reported on a Tn4351-generated mutant of Porphyromonas gingivalis (MSM-3) which expresses enhanced arginine-specific proteinase activity and does not utilize hemin or hemoglobin for growth (C. A. Genco et al., Infect. Immun. 63:2459-2466, 1995). In the process of characterizing the genetic lesion in P. gingivalis MSM-3, we have determined that the endogenous P. gingivalis insertion sequence element IS1126 is capable of transposition within P. gingivalis. We have also determined that IS1126 transposition modulates the transcription of the genes encoding the lysine-specific proteinase, gingipain K (kgp) and the arginine-specific proteinase, gingipain R2 (rgpB). Sequence analysis of P. gingivalis MSM-3 revealed that Tn4351 had inserted 60 bp upstream of the P. gingivalis endogenous IS element IS1126. Furthermore, P. gingivalis MSM-3 exhibited two additional copies of IS1126 compared to the parental strain A7436. Examination of the first additional IS1126 element, IS1126(1), indicated that it has inserted into the putative promoter region of the P. gingivalis kgp gene. Analysis of total RNA extracted from P. gingivalis MSM-3 demonstrated no detectable kgp transcript; likewise, P. gingivalis MSM-3 was devoid of lysine-specific proteinase activity. The increased arginine-specific proteinase activity exhibited by P. gingivalis MSM-3 was demonstrated to correlate with an increase in the rgpA and rgpB transcripts. The second additional IS1126 element, IS1126(2), was found to have inserted upstream of a newly identified gene, hmuR, which exhibits homology to a number of TonB-dependent genes involved in hemin and iron acquisition. Analysis of total RNA from P. gingivalis MSM-3 demonstrated that hmuR is transcribed, indicating that the insertion of IS1126 had not produced a polar effect on hmuR transcription. The hemin-hemoglobin defect in P. gingivalis MSM-3 is proposed to result from the inactivation of Kgp, which has recently been demonstrated to function in hemoglobin binding. Taken together, the results presented here demonstrate that the introduction of Tn4351 into the P. gingivalis chromosome has resulted in two previously undocumented phenomena in P. gingivalis: (i) the transposition of the endogenous insertion sequence element IS1126 and (ii) the modulation of gingipain transcription and translation as a result of IS1126 transposition.

Membranous glomerulonephritis induced in the pig by antibody to angiotensin-converting enzyme: considerations on its relevance to the pathogenesis of human idiopathic membranous glomerulonephritis

In the course of studies on the humoral consequences of swine to primate xenotransplantation, the investigators induced formation of glomerular subepithelial immune deposits and tubular lesions in pigs injected with heterologous antibody to angiotensin-converting enzyme. This study describes the morphology of the lesions, discusses their mechanism, explains their relevance for understanding the pathogenesis of human idiopathic membranous glomerulonephritis, and proposes future directions for investigations.

NF-kappaB induces expression of the Bcl-2 homologue A1/Bfl-1 to preferentially suppress chemotherapy-induced apoptosis

Recent evidence indicates that the transcription factor NF-kappaB is a major effector of inducible antiapoptotic mechanisms. For example, it was shown that NF-kappaB activation suppresses the activation of caspase 8, the apical caspase in tumor necrosis factor (TNF) receptor family signaling cascades, through the transcriptional regulation of certain TRAF and IAP proteins. However, it was unknown whether NF-kappaB controls other key regulatory mechanisms in apoptosis. Here we show that NF-kappaB activation suppresses mitochondrial release of cytochrome c through the activation of the Bcl-2 family member A1/Bfl-1. The restoration of A1 in NF-kappaB null cells diminished TNF-induced apoptosis by reducing the release of proapoptotic cytochrome c from mitochondria. In addition, A1 potently inhibited etoposide-induced apoptosis by inhibiting the release of cytochrome c and by blocking caspase 3 activation. Our findings demonstrate that A1 is an important antiapoptotic gene controlled by NF-kappaB and establish that the prosurvival function of NF-kappaB can be manifested at multiple levels.

Development of a community-based diabetes management program for Pacific Islanders

PURPOSE

This study examined the perception of diabetes among a sample of Pacific Islanders in Honolulu, Hawaii. All 23 participants were diagnosed with type 2 diabetes, ranged in age from 21 to 70 years, and had glycosylated hemoglobin levels of 5.8% to 13.9%.

METHODS

Four focus groups were held in English and audiotaped. Outreach workers served as translators and comoderators. The content of transcripts was analyzed with Ethnograph software by investigators. The priority issues were confirmed by the comoderators and participants.

RESULTS

Participants perceived diabetes as full of complications, emotions, symptoms, and behavior changes. Responses to hyperglycemia were fear, frustration, and uncertainty. Barriers to staying on the prescribed diet were habit, cultural ritual, ideal body image, and limited budget.

CONCLUSIONS

Participants suggested that helpful activities would include walking/support group, cooking class, community healthy food store, translated material, and family participation. A community-based diabetes program has been developing as a result of the focus group findings.

Estimation of the correlation between nutrient intake measures under restricted sampling

Food frequency questionnaires (FFQs) are commonly used to assess dietary intake in epidemiologic research. To evaluate the FFQ reliability, the commonly used approach is to estimate the correlation coefficient between the data given in FFQ and those in food records (for example, 4-day food records [4DFR]) for nutrients of interest. However, in a dietary intervention study, a criterion for eligibility may be to select participants who have baseline FFQ-measured dietary intake of percent energy from fat above a prespecified quantity. Other instruments, such as the 4DFR, may be subsequently administrated only to eligible participants. Under these circumstances, analysis without adjusting for the restricted population will usually lead to biased estimation of correlation coefficients and other parameters of interest. In this paper, we apply likelihood-based and multiple imputation (MI) methods to accommodate such incomplete data obtained as a result of the study design. A simulation study is conducted to examine finite sample performance of various estimators. We note that both the MI estimate and the maximum likelihood (ML) estimate based on a bivariate-normal model are not sensitive to departures from this normality assumption. This led us to investigate robustness properties of the ML estimator analytically. We present some data analyses from a dietary assessment study from the Women's Health Initiative to illustrate the methods.

Responsiveness of human prostate carcinoma bone tumors to interleukin-2 therapy in a mouse xenograft tumor model

We have tested an immunotherapy approach for the treatment of metastatic prostate carcinoma using a bone tumor model. Human PC-3 prostate carcinoma tumor cells were heterotransplanted into the femur cavity of athymic Balb/c nude mice. Tumor cells replaced marrow cells in the bone cavity, invaded adjacent bone and muscle tissues, and formed a palpable tumor at the hip joint. PC-3/IF cell lines, generated from bone tumors by serial in vivo passages, grew with faster kinetics in the femur and metastasized to inguinal lymph nodes. Established tumors were treated with systemic interleukin-2 (IL-2) injections. IL-2 significantly inhibited the formation of palpable tumors and prolonged mouse survival at nontoxic low doses. Histologically IL-2 caused vascular damage and infiltration of polymorphonuclear cells and lymphocytes in the tumor as well as necrotic areas with apoptotic cells. These findings suggest destruction of tumor cells by systemic IL-2 therapy and IL-2 responsiveness of prostate carcinoma bone tumors.

Reduction of retrosternal and pericardial adhesions with rapidly resorbable polymer films

BACKGROUND

The formation of postoperative cardiac adhesions makes a repeat sternotomy time consuming and dangerous. Many attempts have been made to solve this problem by using either drugs to inhibit fibrinolytic activity or different types of pericardial substitutes. The results have not been satisfactory.

METHODS

The efficacy of bioresorbable film prototypes made of polyethylene glycol (EO) and polylactic acid (LA) (EO/LA = 1.5, 2.5, and 3.0) in the prevention of adhesions after cardiac operations in canine models was tested. After desiccation and abrasion of the epicardium, a transparent bioresorbable film was placed over the heart. The pericardium was closed to allow intrapericardial adhesions (n = 32) or left open and attached to the chest wall to induce retrosternal adhesions (n = 17). Postoperative recovery was similar among the groups. Retrosternal and pericardial adhesions were evaluated at necropsy 3 weeks later by assessing area, tenacity, and density of the adhesions.

RESULTS

In the control dogs, tenacious, dense adhesions were observed. In contrast, adhesion formation was reduced at all sites covered by the films. The bioresorbable films were efficacious in the reduction of adhesion formation between epicardium and pericardium or between epicardium and sternum after cardiac operation. The EO/LA 1.5 film most effectively prevented the early adhesions.

CONCLUSIONS

The bioresorbable films (EO/LA = 1.5, 2.5, and 3.0) significantly reduced adhesion formation, with EO/LA = 1.5 (Repel CV) being optimal. As the barrier was rapidly resorbed, the capsule formation induced by permanent barriers was avoided.

Epithelial proliferation and expression of the aromatic amine activation enzyme N-acetyltransferase in the prostate of postnatal rat

Male ACI/seg rats of different postnatal ages were injected, i.p., with 150 mg/kg bromodeoxyuridine one hour before being sacrificed. The incorporation of this compound into the DNA of prostate epithelium was detected immunohistochemically. The labeling indices in prostate epithelium were 16.8, 26.5 and 13.7%, in 3, 11 and 17 days old rats, respectively. It decreased gradually thereafter to 1.8% in 60 days old rats. The mRNA of N-acetyltransferase 1 was detected by a non-isotopic in situ hybridization method using a mixture of specific digoxigenin-11-dUTP-labeled oligodeoxynucleotide probes. The mRNA of N-acetyltransferase 1 was detected during the entire postnatal period. It was not detected in the stromal or endothelial cells. The coincidence of N-acetyltransferase expression in actively proliferating prostate epithelial cells during the postnatal period suggest that the prostate tissue may be particularly sensitive during this period to the carcinogenesis by aromatic and heterocyclic amines.