Endoscope-assisted parotidectomy for benign parotid tumors

Sixteen cases of parotidectomy of benign tumors were performed by means of a short incision with the assistance of endoscopic surgery. The average length of the preauricular and retromandibular incision was 6.9 cm (range, 6.0-8.1 cm). This incision provided safe dissection of the facial nerve trunk and exposed a major part of the gland to direct vision. Identification and separation of the facial nerve branches in peripheral glandular tissue was performed by means of endoscopic surgery instead of wide exposure with a long incision. Because endoscopic surgery provided good illumination and magnification on the monitor, the operation could proceed clearly and sharply in a bloodless field. Therefore, the incidence of facial nerve injury and perioperative morbidity was minimized. In this series, tumors were removed completely, without injury to the facial nerve. Patients were also satisfied with the short and inconspicuous postoperative scars.

Electrophilic substitution of (diamine)tetrahydroxoplatinum(IV) with carboxylic anhydrides. Synthesis and characterization of (diamine)platinum(IV) complexes of mixed carboxylates

A novel series of (diamine)platinum(IV) complexes of mixed carboxylates have been synthesized by electrophilic substitution of the tetrahydroxoplatinum(IV) complex (dach)Pt(OH)4 (dach = trans-(+/-)-1,2-diaminocyclohexane) with three different carboxylic anhydrides, pivalic, acetic, and trifluoroacetic anhydrides. Consecutive two-step acylations with two different carboxylic anhydrides in acetone or dichloromethane gave the mixed carboxylate complexes (dach)Pt(O2CR)x(O2CR')4 - x (R = C(CH3)3 or CF3, R' = CH3, x = 1-4) including all the possible stereoisomers, which could be separated and identified by means of HPLC, column chromatography, 1H NMR, and X-ray crystallography. From analysis of the reaction products we have found that the positions of electrophilic substitution of (dach)Pt(OH)4 were influenced by the kinds of carboxylic anhydrides exhibiting different electrophilicity or steric effects. The initial substitution by the first reactant occurs more favorably on axial OH, but in the case of pivalic anhydride, equatorial substitution is favored probably because of the bulkiness of the pivalate group. Such a result seems to be related to their stereochemical factors rather than to differences in electrophilicity. The lipophilicity of the title complexes was affected not only by the carbon numbers of substituents but also by the conformation of the resulting compound.

Glassy cell carcinoma of the uterine cervix. Cytologic features and expression of estrogen and progesterone receptors

OBJECTIVE

To identify the cytomorphologic features and investigate the expression of estrogen receptor (ER) and progesterone receptor (PR) in glassy cell carcinoma (GCC) of the uterine cervix.

STUDY DESIGN

A retrospective analysis of nine GCCs encountered at Korea Cancer Center Hospital between January 1990 and April 1999 was undertaken. The cervical smears were obtained prior to histologic diagnosis of GCC. The cytomorphologic and clinical features were reviewed, and the expression of ER and PR was investigated immunohistochemically on histologic sections.

RESULTS

Smears of GCC were hypercellular and remarkably cohesive. The tumor cells were large and characterized by abundant granular cytoplasm, distinct cell membranes and round to polygonal, large nuclei with prominent nucleoli. In the background tumor diathesis and numerous inflammatory cells containing eosinophils were present. The inflammatory cells (mainly eosinophils) were intimately associated with tumor cells to form "granuloepithelial complex." Immunohistochemically, ER was identified in two of the nine cases and PR in one of them.

CONCLUSION

Cytology of GCC has characteristic features that differ from those of other carcinomas or atypical reparative cells. Although there are deceptive mimics of GCC, the characteristic cytologic findings should prompt a diagnosis of GCC. ER and PR positivity was found in two cases (22%) and one case (11%), respectively, of GCC, suggesting that this tumor might be hormonally responsive.

Successful treatment of azoospermia secondary to ejaculatory duct cyst

Ejaculatory duct obstruction is considered a rare cause of infertility. Two cases are reported of an ejaculatory duct cyst with azoospermia preoperatively diagnosed by transrectal ultrasonography. The diagnosis of ejaculatory duct obstruction in one patient was confirmed by vasography with a combined iodinated contrast medium and methylene blue solution for radiological and direct visualization. Transrectal puncture and contrast filling of the cyst under the transrectal ultrasonographic guidance diagnosed the other patient. On the basis of these findings transurethral unroofing of the cyst was performed successfully. Transrectal ultrasonography facilitates evaluation and treatment of azoospermia caused by ejaculatory duct obstruction and may minimize the need for more invasive studies in such cases.

Giant hydronephrosis of a duplex system associated with ureteral ectopia: a cause of retrograde ejaculation

Retrograde ejaculation is an extremely rare complication of the ectopic ureter or ectopic ureterocele. In the literature, only two cases have been reported worldwide. In this article the authors describe a patient who has a completely duplicated collecting system with massive dilatation of the upper pole system, which has manifested as a huge abdominal and retroperitoneal mass, complicated by retrograde ejaculation.

Growth, adipose, brain, and skin alterations resulting from targeted disruption of the mouse peroxisome proliferator-activated receptor beta(delta)

To determine the physiological roles of peroxisome proliferator-activated receptor beta (PPARbeta), null mice were constructed by targeted disruption of the ligand binding domain of the murine PPARbeta gene. Homozygous PPARbeta-null term fetuses were smaller than controls, and this phenotype persisted postnatally. Gonadal adipose stores were smaller, and constitutive mRNA levels of CD36 were higher, in PPARbeta-null mice than in controls. In the brain, myelination of the corpus callosum was altered in PPARbeta-null mice. PPARbeta was not required for induction of mRNAs involved in epidermal differentiation induced by O-tetradecanoylphorbol-13-acetate (TPA). The hyperplastic response observed in the epidermis after TPA application was significantly greater in the PPARbeta-null mice than in controls. Inflammation induced by TPA in the skin was lower in wild-type mice fed sulindac than in similarly treated PPARbeta-null mice. These results are the first to provide in vivo evidence of significant roles for PPARbeta in development, myelination of the corpus callosum, lipid metabolism, and epidermal cell proliferation.

A comparison of different lead biomarkers in their associations with lead-related symptoms

OBJECTIVES

To evaluate whether dimercaptosuccinic acid (DMSA) -chelatable lead, an estimate of current bioavailable lead stores, is a better predictor of lead-related symptoms than are other commonly used lead biomarkers.

METHODS

A total of 95 male lead workers from three lead industries (one secondary lead smelting facility, one polyvinyl chloridestabilizer manufacturing plant, and one lead-acid storage battery factory), and 13 workers without occupational lead exposure recruited from an occupational health institute, were studied. Blood lead, blood zinc protoporphyrin (ZPP), 4 h DMSA-chelatable lead (after oral administration of 10 mg/kg DMSA), urine lead, and urinary delta-aminolevulinic acid levels were evaluated as predictors of 15 lead-related symptoms, assessed by self-administered questionnaire, with linear and logistic regression controlling for covariates. Total symptoms and symptoms in three categories (gastrointestinal, neuromuscular, and general) were evaluated.

RESULTS

The mean (SD) 4 h DMSA-chelatable lead level was 288.7 (167.7) microg, with a range from 32.4 to 789 microg in the 95 lead workers. The mean (SD) in the non-exposed subjects was 23.7 (11.5) microg with a range from 10.5 to 43.5 microg. Blood lead, blood ZPP, and spot urine lead levels ranged from 21.4 to 78.4 microg/dl, 40 to 331 microg/l, and 7.5 to 153.0 micro/l, respectively, in the lead workers, and from 4.0 to 7.2 micro/dl, 27 to 52 microg/l, and 2.9 to 15.5 microg/l in the non-exposed controls, respectively. The overall mean symptom score (SD), derived as the sum of 0 or 1 point for absence or presence of 15 symptoms, of the lead workers was 3.7 (2.0), compared to 1.2 (1.5) for the non-exposed workers. DMSA-chelatable lead was the best predictor of symptom scores in both crude and adjusted analyses, compared with the other biomarkers. Lead workers with DMSA-chelatable lead values greater than the median (260.5 microg) were 6.2 times more likely to have frequent tingling or numbness of the arms or legs and 3.3 times more likely to have muscle pain than subjects with lower chelatable lead values. Three symptoms (tingling or numbness of arm or leg, muscle pain, and feeling irritation at the slightest disturbance) evidenced a dose-dependent relationship with DMSA-chelatable lead levels.

CONCLUSIONS

DMSA-chelatable lead was found to be the best predictor of lead-related symptoms, particularly of both total symptom scores and neuromuscular symptoms, than were the other other lead biomarkers.

Treatment options in patients with chronic hepatitis C

Hepatitis C is a major health care problem plagued by the lack of a truly effective therapy. To date, the combination of interferon and ribavirin has provided the best chance of viral eradication. However, this therapy is expensive, has multiple side effects and works in less than half of patients. New strategies need to be developed to deal with the increasing burden of hepatitis C-related disease, and we anxiously await the arrival of new drugs such as helicase and protease inhibitors.

Cirrhotic cardiomyopathy and liver transplantation

Myocardial contractility in cirrhosis is impaired, particularly under stressful situations, in a phenomenon termed cirrhotic cardiomyopathy. Impairment of the cardiac beta-adrenergic receptor and its signaling function appears to be involved in the pathogenesis of this disorder. Additional mechanisms that may have a role include alterations in the physicochemical properties of the cardiomyocyte plasma membrane and abnormalities in circulating humoral factors, such as nitric oxide, carbon monoxide, and catecholamines. The widespread use of orthotopic liver transplantation (OLT) and its associated stresses on the cardiovascular system have highlighted this condition. Cardiac failure has emerged as an important cause of morbidity and mortality in the liver transplant recipient. Unfortunately, pre-OLT recognition of cirrhotic cardiomyopathy is suboptimal because of a lack of sensitive, noninvasive diagnostic tests. Similarly, the management of cirrhotic cardiomyopathy is largely empirical because of a paucity of existing literature. Although evidence suggests that cirrhotic cardiomyopathy may be reversible after OLT, the natural history of this condition warrants further investigation.

Conformational transition and mass transfer in extraction of proteins by AOT--alcohol--isooctane reverse micellar systems

We examined quantitatively the effect of alcohols on protein and reverse micellar structure. We used circular dichroism (CD) to compare the effects of various alcohols on the protein structure, and percolation phenomena to evaluate the effects of various alcohols on reverse micellar structure. Upon the addition of alcohols to the bulk aqueous phase, proteins were denatured significantly, depending on the alcohol species and concentration, suggesting that use of alcohol directly to the stripping solution is not effective in back-extraction processes of proteins. In the present study, a new method, a small amount of alcohol is added to the surfactant-organic solution to improve the back-extraction behaviors of proteins. Practically, in the back-extraction process, the alcohols suppressing the cluster formation of reverse micelles (high value of beta1), remarkably improved the back-extraction behavior of proteins. In addition, the same alcohol molecules showed a positive effect on the rate and fraction of protein back-extraction. From a result of the CD measurement of the back-extracted proteins, it was known that the alcohols added to reverse micellar solution allowed the proteins to back-extract safely without causing structural changes. These results show that the values of beta(t), defined by the variation of percolation processes, and the back-extraction behaviors of proteins have a good relationship, suggesting that the back-extraction processes were controlled by the micellar-micellar and protein-micellar interactions.

CD40 engagement on synovial fibroblast up-regulates production of vascular endothelial growth factor

We tested the impact of CD40 engagement on the production of vascular endothelial growth factor (VEGF) from rheumatoid synovial fibroblasts. Fibroblast-like synovial cells (FLS) were prepared from the synovial tissues of rheumatoid arthritis patients and cultured in the presence of CD40 ligand-transfected (CD40L+) L cells. VEGF levels were determined in the culture supernatants by ELISA. Stimulation of FLS by CD40L+ L cells increased the production of VEGF by 4.1-fold over the constitutive levels of unstimulated FLS. The CD40L on activated T cells from rheumatoid synovial fluid also up-regulated VEGF production from FLS. Neither indomethacin nor Abs to IL-1beta, TNF-alpha, and TGF-beta did affect CD40L-induced VEGF production. Stimulation of FLS with TNF-alpha, IL-1beta, and TGF-beta increased VEGF production by 1.6-, 2.0-, and 5.2-fold, respectively, and displayed an additive effect on the production of VEGF by CD40L. VEGF mRNA expression was also up-regulated by the stimulation of FLS with membranes from the CD40L+ L cells. Dexamethasone completely abrogated CD40L-induced VEGF production. In addition, pyrrolidine dithiocarbamate partially down-regulated CD40L-induced VEGF production, showing that the NF-kappaB pathway was partly involved in the signaling of CD40L leading to VEGF production. Collectively, these results suggest that the interaction between CD40 on synovial fibroblasts and CD40L expressed on activated T lymphocytes may be directly involved in the neovascularization in rheumatoid synovitis by enhancing the production of VEGF.

Contribution of nitric oxide to the pathogenesis of cirrhotic cardiomyopathy in bile duct-ligated rats

BACKGROUND & AIMS

Decreased cardiac contractility and beta-adrenergic responsiveness have been observed in cirrhosis, but the etiology remains unclear. We aimed to test the role of nitric oxide (NO), a negative inotropic agent, in the pathogenesis of cirrhotic cardiomyopathy in a rat model.

METHODS

Cirrhosis was induced by bile duct ligation. Four weeks after ligation or sham operation, cardiac levels of tumor necrosis factor (TNF)-alpha, guanosine 3,5'-cyclic monophosphate (cGMP), inducible NOS (NOS2), and endothelial constitutive NOS (NOS3) messenger RNA (mRNA) and protein were determined. Serum nitrite/nitrate level was measured. Cardiac contractile function was evaluated in isolated left ventricular papillary muscles in the absence and presence of the NOS inhibitor nitro-L-arginine methyl ester (L-NAME).

RESULTS

Cardiac TNF-alpha, NOS2 mRNA and protein, cGMP, and serum interleukin (IL)-1beta and nitrite/nitrate levels were significantly higher in cirrhotic rats than sham controls. No significant differences in NOS3 mRNA or protein were found between cirrhotic and sham control rats. Baseline isoproterenol-stimulated papillary muscle contractile force was significantly lower in the cirrhotic group; with L-NAME incubation, contractile force increased significantly in cirrhotic rats but was unaffected in the controls. In normal papillary muscles, IL-1beta attenuated the contractility, but coincubation with L-NAME again reversed this attenuation. Incubation with the exogenous NO donor S-nitroso-N-acetyl-penicillamine also blunted papillary muscle contractility.

CONCLUSIONS

These results suggest that cytokine-induced stimulation of NOS2 plays a significant role in the pathogenesis of cirrhotic cardiomyopathy.

Study of the gastrointestinal protective effects of polysaccharides from Angelica sinensis in rats

We studied the protective effects of polysaccharides isolated from the root of Angelica sinensis (Oliv.) (Danggui) on gastrointestinal damage induced by ethanol or indomethacin in rats. Oral administration of ethanol provoked a marked hemorrhagic damage in the glandular mucosa, which was accompanied with a significant increase of myeloperoxidase (MPO) activity, a marker enzyme for inflammation and neutrophil infiltration. An extract from Angelica, which mainly consisted of polysaccharides (95%) (AP), dose-dependently prevented gastric mucosal damage. This ulcer protective effect could last at least 12 h after administration. Prostaglandin E2 produced a similar anti-lesion effect. AP and prostaglandin E2 also reduced mucosal MPO activity. Indomethacin-induced gastrointestinal damage, another neutrophil-dependent lesion model in the gastrointestinal tract, was also prevented by AP pretreatment. The present findings suggest that polysaccharides from Angelica possess an anti-inflammatory action, perhaps through the inhibitory action on neutrophil infiltration in the gastrointestinal mucosa. AP could potentially be useful to prevent any neutrophil-dependent mucosal injury in the gastrointestinal tract.

Non-tuberculous cold abscess of the psoas muscle--an unusual manifestation of colocutaneous fistula

We report here a case of colocutaneous fistula drained from the retroperitoneal space mimicking a cold abscess of the psoas muscle. A 60-year-old diabetic woman with a 6-year history of a chronic draining sinus over her right thigh had been treated intermittently with antibiotics. At presentation, she had no systemic toxic signs nor other constitutional symptoms. The patient was inadequately managed by curettage at first under the tentative diagnosis of tuberculous cold abscess. After the correct diagnosis of colocutaneous fistula, right nephrectomy and right hemicolectomy with ileotransverse colostomy were done. The patient was well 5 years later without recurrence. This is an atypical presentation of enterocutaneous fistula in an immunodeficient patient that should be emphasized to facilitate the correct diagnosis and early treatment.

Synthesis and oral antitumor activity of tetrakis(carboxylato)platinum(IV) complexes

A novel class of tetrakis(carboxylato)platinum(IV) complexes, [Pt(O(2)CR)(4)(dach)] (dach = trans-(+/-)-1,2-diaminocyclohexane; R = C(n)H(2n+1), n = 1 approximately 5), was synthesized and studied for physicochemical properties and oral antitumor activity. Lipophilicity and aqueous solubility of the title complexes were greatly dependent on the alkyl chain length of the carboxylate ligand, and their partition coefficient and solubility changed by 4 or 5 orders of magnitude from acetate to hexanoate complexes. On the other hand, the range of their cathodic reduction potential (-546 approximately -403 mV) depending on the chain length of the carboxylate ligand was relatively small. Among the title complexes, the tetrakis(propionato)platinum(IV) complex, [Pt(O(2)CC(2)H(5))(4)(dach)], with appropriate lipophilicity (log P = 0.18) and aqueous solubility (14.6 mg/mL) was found to exhibit better oral antitumor activity than JM216 against the human ovarian tumor xenograft SKOV3 in nude mice.

Basaloid squamous carcinoma of the oesophagus: a distinct neoplasm with multipotential differentiation

AIMS

Basaloid squamous carcinoma (BSC) is an uncommon variant of squamous cell carcinoma, with its prevalent sites being the hypopharynx, tongue base and larynx. In the oesophagus, BSC is rarer than in the head and neck region. This study was aimed to document the clinicopathological features of BSCs of the oesophagus, and to present their relative incidence and immunohistochemical findings.

METHODS AND RESULTS

Eighteen cases of BSC of the oesophagus, comprising 3.6% of 502 oesophageal carcinomas, were reviewed for their pathological and clinical features, and examined for the immunohistochemical expression of neuroendocrine markers, cytokeratins, p53, pRb and bcl-2. Oesophageal basaloid squamous carcinomas tended to be biphasic or multiphasic carcinomas, most commonly with basaloid and squamous components (eight cases), or with additional adenocarcinoma (three cases) or with small cell carcinoma (two cases). Each component was microscopically clearly distinguishable from the others, and metastasized separately, chiefly the basaloid component. The remaining five cases were apparently pure basaloid carcinomas, being characterized by lobules and nests of monotonous round undifferentiated cells with frequent comedo necrosis. They resembled, but were differentiated from, the small cell carcinoma on the basis of neuroendocrine markers and cytokeratin expression. p53, pRb and bcl-2 oncoprotein, which are known to normally present in the basal/parabasal cells of the oesophageal epithelium, were detected in 40-50% of cases, with a heterogeneous expression pattern. The patients were all male, with the age ranging 47-74 years (median 57) and presented at variable stages. The plotted 3 years survival rate was 51%, and the immunohistochemical expression of p53, pRb and bcl-2 was not related to the survival of the patients.

CONCLUSION

Basaloid squamous carcinoma of the oesophagus is a peculiar neoplasm with a capacity of multidirectional differentiation, often with heterogeneous oncogene expression, probably reflecting the pluripotential stem cell origin.

Correction of scar contracture deformities of the big toe with a multiplanar distraction device

A multiplanar distraction device was used in a 65-year-old woman for correction of multiplanar deformities of her right big toe. These deformities were caused by long-standing scar contracture after a crushing injury to the right foot. Without the necessity of other complicated procedures, the dorsal contracture and lateral deviation were corrected from 43 deg to 0 deg and from 22 deg to 0 deg respectively 3 weeks postoperatively. Kirschner wires were inserted temporarily for prevention of recurrence after removal of the frame, and were removed 6 weeks later. In follow-up after 8 months, the position of the big toe was stable and without recurrence of contracture. Application of the multiplanar distraction device simplified the surgical procedure to achieve this correction.

Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union

OBJECTIVES

To investigate the success of exchange reamed femoral nailing in the treatment of femoral nonunion after intramedullary (IM) nailing, and to analyze factors that may contribute to failure of exchange reamed femoral nailing.

DESIGN

Retrospective consecutive clinical series.

SETTING

Level I trauma center and tertiary university hospital.

PATIENTS

Twenty-three patients were identified whose radiographs failed to show progression of healing for four months after treatment with a reamed IM femoral nail. Nineteen patients had undergone primary IM nailing of an acute femoral shaft fracture, one patient had been converted to an IM nail after initially being treated in an external fixator, and three patients had previously undergone an unsuccessful exchange reamed nailing.

INTERVENTION

All patients were treated by exchange reamed femoral nailing. The diameter of the new nail was one to three millimeters larger than that of the previous nail (the majority were two millimeters larger). The intramedullary canal was overreamed by one millimeter more than the diameter of the nail. Most of the nails were statically locked, and care was taken to avoid distraction of the nonunion site by reverse impaction after distal interlocking was performed or by applying compression with a femoral distractor.

MAIN OUTCOME MEASUREMENTS

Radiographic evaluation of union was determined by the presence of healing on at least three of four cortices. Factors reviewed included the patient's age, smoking history, mechanism of injury, associated injuries, whether the initial fracture was open or closed, the pattern and location of the fracture, the type of nonunion, the increase in nail diameter, whether the nail was dynamically or statically locked, and the results of any intraoperative cultures.

RESULTS

Tobacco use was found to have a detrimental impact on the success of exchange reamed nailing. All eight of the nonsmokers healed after exchange reamed nailing, whereas only ten of the fifteen smokers (66.7 percent) healed after exchange reamed nailing. Overall, exchange reamed femoral nailing was successful in eighteen cases (78.3 percent). Three patients achieved union with additional procedures. Intramedullary cultures were positive in five cases; all of these achieved successful union.

CONCLUSIONS

Exchange reamed nailing remains the treatment of choice for most femoral diaphyseal nonunions. Exchange reamed IM nailing has low morbidity, may obviate the need for additional bone grafting, and allows full weight-bearing and active rehabilitation. Tobacco use appears to have an adverse effect on nonunion healing after exchange reamed femoral nailing.

Endoscope-assisted correction of primary varicose veins

The purpose of this study is to evaluate the possibilities and results of application of endoscopic surgery in the operation of primary varicose veins. With good illumination and magnified viewing, the varicosities, incompetent perforating veins, and healthy veins were clearly visualized. The incompetent perforating veins were clipped and divided securely. The varicose veins and tributaries were dissected and removed completely after being clipped and divided. The healthy veins were preserved if possible. Primary varicose veins in 43 limbs of 37 patients were operated. The operation was conducted through one access incision in 31 limbs (72%), two incisions in 11 limbs (25%), and three incisions in 1 limb. The mean number of incisions was 1.3 in each limb. Hematoma formation occurred in 1 patient due to the slipping of one clip on the third postoperative day. The other patients had uneventful postoperative courses. All 37 patients were reviewed 4 to 30 months postoperatively. Only one limb had recurrent varices at a new site. Ninety-seven percent of limbs (42 of 43) had no recurrence of varicose veins. Seventy-eight percent of patients (29 of 37) were extremely pleased with this operation. Although the other 22% of patients (8 of 37) appreciated this operation, they were not completely satisfied because some preoperative complaints persisted. In this series, the recurrent rate of varicose veins was low (1 in 43 limbs) and postoperative scarring was minimized, in addition to the advantages of endoscopic surgery. These results demonstrate that endoscopic surgery is a worthy alternative procedure for correcting primary varicose veins.

IgG antibodies to type II collagen reflect inflammatory activity in patients with rheumatoid arthritis

OBJECTIVE

To determine the clinical significance of IgG antibodies to type II collagen (CII) and to define any correlation of antibodies to CII with the inflammatory response in patients with rheumatoid arthritis (RA).

METHODS

IgG antibodies to native human type II collagen (IgG anti-CII) were measured in sera and synovial fluid (SF) from patients with RA, patients with osteoarthritis (OA), and healthy controls by an improved ELISA. Demographic, clinical, and laboratory data including tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6) levels were also obtained at the time of sampling in patients with RA.

RESULTS

The median level and positivity for circulating IgG anti-CII were higher in patients with RA (n = 297) than patients with OA (n = 34) and healthy controls (n = 50) (p < 0.001). The titers of IgG anti-CII in SF were also higher in RA (n = 45) than in OA (n = 16) (p < 0.001). In paired samples, the levels of IgG anti-CII were significantly higher in SF compared to the sera in patients with RA (n = 45) (p < 0.001), but levels were not different in patients with OA (n = 16). Circulating IgG anti-CII converted from positive to negative in 13 patients (10.7%) and from negative to positive in 18 patients (14.8%) among 122 patients with RA in whom IgG anti-CII were monitored sequentially at a mean interval of 12.2 months. IgG anti-CII positive patients (n = 98) had shorter disease duration (p = 0.04) and less frequent deformity (p = 0.013), and higher median erythrocyte sedimentation rate (ESR) (p = 0.001) and C-reactive protein (CRP) (p < 0.001) than IgG anti-CII negative patients (n = 120). The levels of IgG anti-CII correlated with CRP (r = 0.270) and ESR (r = 0.253). CRP decreased significantly in patients (n = 13) who converted from IgG anti-CII positive to negative (p = 0.013). IgG anti-CII positive patients (n = 40) had higher levels of TNF-alpha and IL-6 than negative patients (n = 40) (p < 0.001). Levels of IgG anti-CII correlated well with TNF-alpha (r = 0.617) and IL-6 (r = 0.347).

CONCLUSION

Increased IgG anti-CII in sera and SF in RA correlated directly with acute phase reactants and the proinflammatory cytokines TNF-alpha and IL-6. Our data suggest that IgG anti-CII could reflect inflammatory activity with a potential to destroy cartilage in the early stages of RA.

Pre-operative teaching: how does a group of nurses do it?

Studies have revealed that adequate pre-operative instructions alleviate anxiety, increase patient participation in their care and minimize the development of post-operative complications. However, other researches have found that there are discrepancies between nurses' perceptions of patient's pre-operative needs and patients' actual needs. The aim of this study is to gain insight into how a group of surgical ward nurses organize and implement their pre-operative teaching, and the difficulties they have encountered. It explores how a group of surgical ward nurses conduct pre-operative teaching to their patients. It has found that their training, rote learning, and the timing of patient admissions have all affected how participating nurses organize and implement their pre-operative teaching to their patients. This case study acts as an exemplar to other nurses, to stimulate reflection on their own practice.

Origin of rate-acceleration in ester hydrolysis with metalloprotease mimics

Mimics of carboxypeptidase A, a prototypical metalloprotease, were synthesized by linking macrocyclicpolyamines to the primary side of beta-cyclodextrin followed by complexing with Zn(II). These enzyme mimics exhibit saturation kinetics in hydrolysis of p-nitrophenyl acetate (PNPA) and enhance the rate of hydrolysis reaction by almost 300-fold. The effective molarities (EM) of the mimics range from 0.2 to 1.9 M. Origin of the rate acceleration was examined: the reactivity of Zn(II) complexes of [12]aneN3 [12]aneN4, and [14]aneN4 for hydrolyzing PNPA increases with increase in basicity of the zinc bound hydroxides [Zn(II)-OH], yielding a linear Brönsted plot. Free hydroxide fits well on this plot. A similar plot was obtained with the enzyme mimics. The Brönsted relationships indicate that the Zn(II)-OH in the catalytic systems hydrolyzes the ester by direct nucleophilic attack on the ester carbonyl of cyclodextrin-bound but not Zn(II)-coordinated PNPA.

Isolation and characterization of polymorphic cDNAs partially encoding ADP-glucose pyrophosphorylase (AGPase) large subunit from sweet potato

cDNA clones encoding sweet potato AGPase large subunit (iAGPLI) from the cDNA library constructed from the tuberous root were isolated. Two clones were characterized and named iAGPLI-a and iAGPLI-b. They were 1,661 bp and 1,277 bp in length and contained partial open reading frames of 450 and 306 amino acids, respectively. Both nucleic acid and amino acid sequence identities between iAGPLI-a and iAGPLI-b were 83.8% and 97.3%, respectively. Based on the amino acid sequence analysis, iAGPLI-a and iAGPLI-b share the highest sequence identity (81%) with potato AGPase large subunit. The iAGPLI-a and iAGPLI-b genes were expressed predominantly in the stem and weakly in the tuberous root, and no transcript was expressed in other tissues. The sweet potato genome contains several copies of the iAGPLI gene.

Observation of disorder-induced 2D mott-hubbard states of the alkali-earth metal (Mg,Ba)-adsorbed Si(111) surface

We report evidence of a disorder-driven Mott-Hubbard-type localization on the alkali-earth metal (AEM) (Mg,Ba)-adsorbed Si(111)-(7x7) surface. The clean metallic Si(111) surface is found to undergo a two-dimensional (2D) metal-insulator transition as randomly distributed AEM adsorbates cause disorder on the surface. A well-defined electron-energy-loss peak unique to the insulating phase is attributed to an interband excitation between the split Hubbard bands originated from a metallic surface band at Fermi energy. A quantitative analysis of the loss peak reveals that the AEM-induced insulating surfaces are of a Mott-Hubbard type driven essentially by disorder.