Effect of heparin on phosphorylation site specificity of neuronal Cdc2-like kinase

Neuronal Cdc2-like kinase (Nclk) can be stimulated by heparin in a substrate-dependent manner. While phosphorylation of tau is markedly enhanced by heparin, phosphorylation of histone H1 by Nclk is essentially unaffected. A histone H1 peptide, HS(9-18): PKTPKKAKKL, and its substitution analogues were used to examine the basis of the differential heparin effect. In the presence of heparin, the phosphorylation site specificity of Nclk is altered and only proline immediately following the phosphorylation site is still an essential substrate determinant. This change in the site specificity may adequately account for the differential heparin effect on histone H1 and tau phosphorylation.

Endogenous cryptococcal endophthalmitis

BACKGROUND

Occurrence of cryptococcal endophthalmitis is rare and commonly is associated with widespread disseminated diseases. The authors report here a well-documented case of endogenous cryptococcal endophthalmitis without the preceding meningeal infection.

METHODS

A 45-year-old female with a history of long-term use of systemic corticosteroid and cytotoxic drugs for systemic lupus erythematosus suffered from progressive visual loss in her left eye over 1 month. Large exudative retinal detachment and severe vitreous infiltration were observed.

RESULTS

Histopathologic study of the retinal biopsy specimen established the diagnosis of cryptococcal endophthalmitis. Subsequent positive histopathologic study of the aspiration vitreous smear and epiretinal membrane confirmed the recurrence and persistence of the disease over 4 months after the initial presentation. Systemic amphotericin B-fluconazole and two doses of intravitreous amphotericin B injection eliminated the infection successfully.

CONCLUSION

The authors report here a well-documented case of cryptococcal endophthalmitis and present the serial clinical and histopathologic pictures. The importance of retinal biopsy in diagnosis and the combined form of antifungal treatment also are shown.

Association of neurofilament proteins with neuronal Cdk5 activator

Cdk5 exists in brain extracts in multiple forms, one of which is a macromolecular protein complex comprising Cdk5, neuron-specific Cdk5 activator p35nck5a and other protein components (Lee, K.-Y., Rosales, J. L., Tang, D., and Wang, J.H. (1996) J. Biol. Chem. 271, 1538-1543). The yeast two-hybrid system was employed to identify p35nck5a-interacting proteins from a human brain cDNA library. One of the isolated clones encodes a fragment of glial fibrillary acidic protein, which is a glial-specific protein. Sequence alignment revealed significant homology between the p35nck5a-binding fragment of glial fibrillary acidic protein and corresponding regions in neurofilaments. The association between p35nck5a and neurofilament medium molecular weight subunit (NF-M) was confirmed by both the yeast two-hybrid assay and direct binding of the bacteria-expressed proteins. The p35nck5a binding site on NF-M was mapped to a carboxyl-terminal region of the rod domain, in close proximity to the putative Cdk5 phosphorylation sites in NF-M. A region immediately amino-terminal to the kinase-activating domain in p35nck5a is required for its binding with NF-M. In in vitro binding assays, NF-M binds both monomeric p35nck5a and the Cdk5/p35nck5a complex. The binding of NF-M has no effect on the kinase activity of Cdk5/p35nck5a.

Surveillance of noise-induced hearing loss in Taiwan, ROC: a report of the PRESS-NHL results

BACKGROUND

To understand the extent of noise-induced hearing loss (NIHL) among noise-exposed workers, an ongoing public health surveillance system (Program to Reduce Exposure by Surveillance System or PRESS-NIHL) was established in Taiwan in 1995 to monitor the prevalence of NIHL.

METHODS

A total of 9,535 noise-exposed (> 85 dBA) workers were recruited into PRESS-NIHL from January to June 1995. Each received a periodic annual audiometric examination at 1 of 73 well-qualified audiometric examination rooms in accredited hospitals. Among those examined, 9,463 audiograms were acceptable for evaluation to determine the severity of NIHL at 4K Hz.

RESULTS

The mean hearing threshold at 4K Hz was 36.8 dB among male workers and 29.7 dB among female workers. The mean hearing loss at 4K Hz of male workers was higher than that of female workers. Among both men and women, hearing ability was found to decrease with increasing age. A total of 3,216 (34.0%) workers were found to have NIHL, with a hearing threshold higher than 40 dB (NIHL) in either one or both ears. Among these workers, 1,886 (19.9%) had mild NIHL (hearing threshold between 40 and 55 dB) and 1,330 (14.1%) had severe NIHL (hearing threshold above 55 dB) in either one or both ears. The proportion of severe NIHL was higher in certain industries, including construction (38.6%), ship building/repairing (19.2%), and weapon manufacturing (13.6%).

CONCLUSION

This surveillance system for NIHL is on of the first surveillance systems in the world established to monitor and control NIHL in the setting of industrial hygiene and occupational disease prevention. Our finding of a high prevalence of NIHL in certain industries will trigger immediate actions to control noise hazard, which in turn will provide better protection for noise-exposed workers.

Assignment of three Chinese xeroderma pigmentosum patients to complementation group C and one to group E

Four Chinese patients with xeroderma pigmentosum (XP), who had different degrees of skin symptoms, were tested for their genetic complementation groups. Skin fibroblasts obtained from the patients were used for complementation analysis done by a cell-fusion technique. Three of the patients belonged to group C and one, who had the mildest cutaneous manifestations, to group E. This is the first report of a group E XP patient in China. Our present findings together with previous reports suggest that group C XP is more common in China, similar to the distribution among Caucasian XP patients but markedly different from the Japanese distribution.

An ecological theory of expertise effects in memory recall

Previous research has shown a significant correlation between domain expertise and memory recall performance after a very brief exposure time. Despite the large number of such studies, several findings in the literature have no satisfactory theoretical explanation. A novel theory based on an ecological approach is proposed to explain these results. This constraint attunement hypothesis provides a framework for identifying and representing the various levels of goal-relevant constraint in a domain. The theory predicts that there will be a memory expertise advantage in cases in which experts are attuned to the goal-relevant constraints in the material to be recalled and that the more constraint available, the greater the expertise advantage can be. The theory explains a number of diverse empirical findings in the literature in a coherent, unique, and parsimonious fashion and suggests a number of promising issues for future research.

Macrodactyly of the feet and hands

We reviewed the records of 16 patients with true macrodactyly and analyzed the typical clinical features and methods of treatment. Fourteen feet were involved in 13 patients (one was bilaterally affected). Three hands were involved in three patients. Clinically, all lesions in the hands and lesions in 11 of 14 feet involved the preaxial side. There was multiple digit involvement in two hands and 11 feet. Progressive macrodactyly (10 feet and two hands) was more common than the static type (four feet and one hand). Proximal involvement of the sole or palm occurred in seven feet and one hand; all cases were of progressive macrodactyly. Enlargement of the metatarsals or the metacarpals was frequent (11 feet and two hands). The growth behavior and extent of bony involvement were similar in patients with hand involvement and those with foot involvement. Fourteen patients had additional clinodactyly, either medial or lateral. The toes of eight feet had angular deformities in the sagittal plane; most were angulated dorsally. Nine patients underwent surgery and two had repeated surgery. The reduction procedures included debulking, ray resection, toe resection, phalangeal resection, and phalangeal epiphysiodesis; the corrective procedures included wedge osteotomy, interdigitalization, and split thickness skin graft. Of the nine patients surgically treated, five had good results and four had fair results. Of the seven patients without surgical repair, three had fair results and four had poor results. Surgical debulking, phalangeal resection, ray resection, and phalangeal epiphysiodesis produced significant improvement in macrodactyly of the feet and hands. Toe resection was not as beneficial.

Attenuation of paired-pulse facilitation associated with synaptic potentiation mediated by postsynaptic mechanisms

Attenuation of paired-pulse facilitation associated with synaptic potentiation mediated by postsynaptic mechanisms. J. Neurophysiol. 78: 2707-2716, 1997. The relationship between paired-pulse facilitation (PPF) and synaptic potentiation induced by various protocols and their cellular and molecular mechanisms were examined by extracellular field potential and current- or voltage-clamp recordings at CA1 synapses in rat hippocampal slices. Microelectrodes were used for both intracellular recordings and injections of modulators of calcium (Ca2+) and Ca2+/calmodulin (CaM) signaling pathways into postsynaptic neurons. Basal synaptic transmission was not accompanied by changes in PPF. Tetanic stimulation induced long-term potentiation (LTP) of synaptic transmission and attenuated PPF. Experiments stimulating two independent Schaffer collateral/commisural(S/C) pathways showed that PPF attenuation and tetanus-LTP were pathway specific. Postsynaptic injections of pseudosubstrate inhibitors of CaM-dependent protein kinase II and protein kinase C (CaM-KII/PKC), [Ala286]CaMKII286-302 plus PKC19-31, almost completely attenuated tetanus-LTP and reversed PPF attenuation but did not affect synaptic transmission and PPF under basal conditions. Postsynaptic injections of heparin and dantrolene (inhibitors of IP3 and ryanodine receptors at intracellular Ca2+ stores) prevented tetanus-LTP induction and PPF attenuation. Postsynaptic injections of calcineurin (CaN) inhibitors, CaN autoinhibitory peptide (CaN-AIP) or FK-506, enhanced synaptic transmission and decreased PPF. CaN-inhibited synaptic potentiation and PPF attenuation were unaffected by (-)-a-Amino-5-phosphonopentanoic, but blocked by coinjecting 1, 2-bis(2-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid, heparin plus dantrolene, calmodulin-binding peptide, or [Ala286]CaMKII281-302 plus PKC19-31. PPF attenuation associated with tetanus-LTP or CaN-inhibited synaptic potentiation resulted from smaller increases in the potentiation of the second synaptic responses (R2) compared with the potentiation of the first responses (R1). Our results indicate that PPF attenuation is associated with synaptic potentiation mediated by postsynaptic mechanisms, and postsynaptic Ca2+/CaM signaling pathways play a dual role in synaptic plasticity. CaN activity limits synaptic transmission under basal conditions, whereas the activation of Ca2+-dependent protein kinases enhances synaptic transmission and attenuates PPF at central synapses.

Intercellular adhesion molecule-1 (ICAM-1) is expressed on human neutrophils and is essential for neutrophil adherence and aggregation

This study investigated the expression and regulation of intercellular adhesion molecule-1 (ICAM-1) on human polymorphonuclear neutrophils (PMNs), and its potential role in PMN-PMN adherence and aggregation as observed during systemic inflammatory response syndrome. Normal human PMNs were found to express ICAM-1 with 90% positive population, and this expression was augmented by endotoxin (lipopolysaccharide, LPS) and tumor necrosis factor-alpha (TNF-alpha) stimulation. The presence of ICAM-1 mRNA in human PMNs was further detected by reverse transcription-polymerase chain reaction before and after LPS and TNF-alpha treatment. Furthermore, incubation of PMNs with LPS and TNF-alpha resulted in significant increases in PMN-PMN adherence and aggregation, while addition of either anti ICAM-1 mAb or anti CD11b/CD18 mAb significantly inhibited LPS and TNF-alpha-mediated PMN-PMN adherence and aggregation. These novel findings demonstrate that ICAM-1 is expressed on human PMNs and responsible for PMN aggregation, and suggest that the interaction between ICAM-1 and CD11b/CD18 may be the molecular basis for PMN aggregation and clumping in the microcirculation during systemic inflammatory response syndrome.

Incidence of hepatitis C infection in a hepatitis C endemic township in southern Taiwan

To realize the incidence of hepatitis C virus (HCV) infection in an HCV endemic township, Tzukuan, in Taiwan, we conducted a follow-up community-based survey. A total of 173 adults, 82 males and 91 females, with mean age of 55.5 +/- 9.9 years received initial and follow-up anti-HCV tests with one-year interval. One (1.2%, 95% CI: 0%-5.5%) of 84 anti-HCV-positive subjects was negative-seroconversion, and 4 (4.5%, 95% CI: 0.2%-8.8%) of 89 anti-HCV-negative subjects were positive-seroconversion. The results indicated that hepatitis C might be still spreading in the HCV-endemic area now.

Differentiation of substrate-binding sites in pyruvate kinase by selective photoaffinity labeling

The four substrate-binding sites in porcine liver pyruvate kinase have been labeled with the photoaffinity reagent 8-azido-2'-O-dansyl-[alpha-32P]ATP (AD-ATP) under different experimental conditions. In the dark, the native pyruvate kinase was reversibly and competitively inhibited by AD-ATP, with KI = 2.8 microM and KADP = 0.18 mM. Under UV-irradiation, the enzyme was covalently labeled in the presence of Mg2+ by AD-ATP and inactivated irreversibly. Measurement of this photoinactivation process in the presence of various concentrations of ADP gave KI = 4.0 microM and KADP = 0.2 mM. A linear plot of the relative specific activity of the partially photolabeled enzyme after gel-filtration vs. the number of label per pyruvate kinase molecule introduced in the presence of Mg2+ shows that each covalent label completely inactivates a tetrameric pyruvate kinase molecule. In the strict absence of Mg2+, up to three substrate-binding sites in each pyruvate kinase molecule can be labeled by AD-ATP without decreasing enzyme activity. Subsequent addition of Mg2+ enables AD-ATP to label the remaining site and inactivate the enzyme. These observations show that there are one catalytic and three non-catalytic substrate-binding sites in each pyruvate kinase molecule. A probable structural reason for possible functional differentiation of intrinsically identical substrate-binding sites in all tetrameric enzymes is suggested.

The role of Src kinase in the potentiation by ethanol of cytokine- and endotoxin-mediated nitric oxide synthase expression in rat hepatocytes

This study demonstrates that exposure of primary rat hepatocytes or mouse BNL Cl.2 liver cell line to ethanol causes potentiation of tumor necrosis factor-alpha (TNF-alpha)- and lipopolysaccharide (LPS)-stimulated nitrite accumulation. The potentiating effect of ethanol (0.02-2 mM) appears to be time and concentration dependent. Consistent with nitrite production, the amount of inducible nitric oxide synthase (iNOS) mRNA and protein is initially detected at 4 hr after treatment with TNF-alpha/LPS/ethanol. Furthermore, the capability of these agents to induce iNOS expression is primarily determined by the age of the animals. Interestingly, antioxidants such as N-acetylcysteine (NAC), ascorbic acid, or alpha-tocopherol fail to inhibit TNF-alpha/LPS/ethanol-induced increase in iNOS protein. In addition, several kinase inhibitors, including staurosporine, genistein, curcumin, and herbimycin A, were used to examine their effects on this induction. Among them, only herbimycin A potently inhibits the accumulation of nitrite and iNOS expression. In vitro kinase assay verifies that Src tyrosine kinase is rapidly activated with a peak at 1 hr after treatment with TNF-alpha/LPS/ethanol but is not activated by these agents singly or doubly. As expected, herbimycin A can block Src kinase activity under circumstances in which iNOS expression is also inhibited. However, our results do not indicate that the mitogen-activated protein kinase is activated after treatment with these agents. The study results suggest that Src tyrosine kinase plays a prominent role in transducing the signal to induce iNOS expression in hepatocytes treated with TNF-alpha/LPS/ethanol.

Role of benzathine penicillin G in prophylaxis for recurrent streptococcal cellulitis of the lower legs

Cellulitis of the lower leg is an infection caused by streptococci or, less commonly, Staphylococcus aureus and other gram-negative rods. Recurrence of cellulitis is a common problem. In the present study, we evaluated the use of monthly intramuscular injections of benzathine penicillin G to prevent recurrences of cellulitis. A total of 115 patients with definite or presumptive cases of streptococcal cellulitis were enrolled in this study. Eighty-four of these patients who declined follow-up or received incomplete prophylaxis were considered controls. Recurrence occurred in four (12.9%) of 31 cases who received prophylaxis and 16 (19%) of the 84 cases who did not receive prophylaxis. The difference was not statistically significant. Predisposing factors for cellulitis were found in 57 (49.6%) of the 115 enrolled cases and were mostly related to the impairment of local circulation. Administration of prophylaxis successfully reduced the recurrence rate to zero among patients without predisposing factors but failed to prevent recurrence in those with predisposing factors (20%). We conclude that monthly benzathine penicillin G prophylaxis benefits only patients without predisposing factors for cellulitis.

Reduced protein adsorption on plastics via direct plasma deposition of triethylene glycol monoallyl ether

The direct plasma-induced deposition of tri(ethylene glycol) monoallyl ether is reported. RF plasma polymerization of this monomer was carried out under both continuous wave (CW) and pulsed plasma operation. The major focus of this work was optimization of the degree of retention of the C-O-C bonds of the starting monomer during the deposition process. This successfully was accomplished using low RF power during the CW runs and low RF duty cycles during the pulsed plasma experiments. Spectroscopic analysis of the plasma films revealed a strong dependence of film composition on the RF power and duty cycles employed. In particular, an unusually high level of film chemistry compositional control was demonstrated for the pulsed plasma studies, with film composition varying in a steady, progressive fashion with sequential changes in the ratios of plasma on to plasma off times. This film chemistry controllability is demonstrated despite the relatively low volatility of the starting monomer. The utility of this plasma deposition approach in introducing polyethylene oxide (PEO) structures on solid substrates was evaluated via protein adsorption studies. Radiolabeled bovine albumin adsorption was studied on plasma-modified poly(ethylene teraphthalate) (PET) substrates. Dramatic reductions in both initial adsorption and retention of this protein were observed on PET samples having maximal PEO content relative to its adsorption on untreated PET surfaces. Good stability and adhesion of the plasma films to the underlying PET substrates were observed, as evidenced from prolonged immersion of plasma-treated surfaces in aqueous solution. Overall, the results obtained from the present work provide additional support for the utility of one-step plasma process to reduce biological fouling of surfaces via deposition of PEO surface units.

Mechanisms of inhibition of calmodulin-stimulated cyclic nucleotide phosphodiesterase by dihydropyridine calcium antagonists

Calmodulin-dependent cyclic nucleotide phosphodiesterase (CaMPDE) is one of the key enzymes involved in the complex interaction between the cyclic nucleotide and Ca2+ second-messenger systems. CaMPDE exists as tissue-specific isozymes, and initially these isozymes were designated according to their respective subunit molecular mass. A variety of pharmacological agents have been used to inhibit CaMPDE, and this inhibition occurs mostly via Ca2+-dependent association with the proteins. We have examined the effect of dihydropyridine Ca2+-channel blockers felodipine and nicardipine on CaMPDE. The results suggest that the 63-kDa (PDE 1B1) and 60-kDa (PDE 1A2) CaMPDE isozymes are inhibited by felodipine and nicardipine by partial competitive inhibition and that these two Ca2+ antagonists appear to counteract each other. This study further demonstrates the existence of a specific site, distinct from the active site on CaMPDE, that exhibits high-affinity binding of these drugs. Felodipine and nicardipine have similar affinities for 60-kDa CaMPDE isozymes but bring about different levels of enzyme inhibition, suggesting the possibility of designing specific drugs that can protect the enzyme from inhibition by dihydropyridine Ca2+-channel blockers.

Serum concentrations of myoglobin vs human heart-type cytoplasmic fatty acid-binding protein in early detection of acute myocardial infarction

We compared the diagnostic utility of serum concentrations of human heart-type cytoplasmic fatty acid-binding protein (H-FABPc), myoglobin, and their ratio for the early diagnosis of acute myocardial infarction (AMI) in 104 healthy volunteers and 165 patients at admission within 6 h of the onset of chest pain. The ROC curves of the H-FABPc [0.946, 95% confidence interval (CI) = 0.913-0.979] and myoglobin (0.895, 95% CI = 0.846-0.944) between patients with AMI and healthy volunteers were significantly greater than the area under the ratio of myoglobin to H-FABPc (0.823, 95% CI = 0.765-0.881). In 165 patients, the sensitivity (81.8%, 95% CI = 74.2-89.4%), specificity (86.4%, 95% CI = 78.1-94.6%), and predictive accuracy (83.6%, 95% CI = 78.0-89.3%) of H-FABPc > 12 micrograms/L in diagnosing AMI were significantly higher than those of myoglobin, and were similar to those of the combination of H-FABPc > 12 micrograms/L and the ratio < or = 14. We conclude that H-FABPc is a more sensitive and specific marker than myoglobin for the early diagnosis of AMI, and that their ratio cannot give a clear advantage over the measurement of H-FABPc alone.

Skin and soft-tissue manifestations of Shewanella putrefaciens infection

Shewanella putrefaciens, a saprophytic gram-negative rod, is infrequently recovered from clinical specimens. Although a number of clinical syndromes have been attributed to S. putrefaciens, the pathogenic role of this agent remains largely undefined. We report 16 cases of S. putrefaciens infection that occurred at the Veterans General Hospital-Kaohsiung in Taiwan between 1990 and 1995. S. putrefaciens infection was associated with a wide clinical spectrum including bacteremia/septicemia, skin and soft-tissue infection, biliary tract infection, peritonitis, and empyema. Five of our patients had skin and soft-tissue manifestations, including fulminant periorbitofacial cellulitis, dacryocystitis, perineal abscess, finger abscess, and postcholecystectomy wound infection. These clinical features deviated from the chronic ulcers or infected burns of the lower extremities that have been described in previous reports. Seven (44%) of our 16 patients had bacteremia/septicemia, and all seven had underlying hepatobiliary diseases. S. putrefaciens was isolated in mixed cultures of specimens from 14 patients; Escherichia coli was the most common coisolate. Hepatobiliary diseases and malignancy were the major predisposing factors for S. putrefaciens infection of the biliary tract and S. putrefaciens bacteremia/septicemia.

Chylothorax: a complication of internal jugular vein catheterization

Thoracic duct injury is a potential problem from central venous catheter insertion that has rarely been reported. A case in which a left chylothorax developed 2 days after internal jugular vein catheterization is presented here. This complication was managed successfully by continuous drainage of the pleural space, oral administration of a low-fat, high-carbohydrate and high-protein diet, and application of positive end-expiratory pressure. The etiology, pathogenesis, clinical presentation and recommended management of such iatrogenic chylothorax are discussed on the basis of this clinical report and of a review of the literature.

Neuronal Cdc2-like kinases: neuron-specific forms of Cdk5

Neuronal Cdc2-like kinase, Nclk, is a heterodimer of a Cdk5 catalytic subunit and a 25 kDa regulatory subunit derived proteolytically from a neuron- and central nervous system-specific 35 kDa protein. The regulatory subunit is mandatory for kinase activity, hence it is designated the neuronal Cdk5 activator, p25/p35nck5a. Nclk has been suggested to play a regulatory role in neuro-cytoskeleton dynamics and in neuronal differentiation. In addition to the activation by Nck5a, Cdk5 is regulated by other mechanisms including additional activator proteins and inhibition by phosphorylation of specific amino acid residues. While Nclk shares common catalytic and regulatory properties with other members of the cdc2-like kinase family, it also displays unique characteristics that may be important for its neuronal functions.

Tuberculosis of the prostate: MR appearance

Tuberculosis of the prostate is uncommon. Here we present a case of tuberculosis of the prostate with its MR findings.

Hyperbaric oxygen as an adjunctive treatment for descending necrotizing mediastinitis: a case report

Descending necrotizing mediastinitis is a rare but serious complication of oropharyngeal and deep neck infection which spreads down to the mediastinum via the cervical-facial planes. Its mortality rate remains high even with aggressive surgical drainage and appropriate antibiotics. Here, a case of descending necrotizing mediastinitis secondary to peritonsillar abscess is reported. It was successfully treated with hyperbaric oxygen and antibiotics followed by surgical drainage. Based on this report, hyperbaric oxygen therapy might be of great value as an adjunctive management to control this fatal infection.

Cellular and molecular bases of memory: synaptic and neuronal plasticity

Discoveries made during the past decade have greatly improved our understanding of how the nervous system functions. This review article examines the relation between memory and the cellular mechanisms of neuronal and synaptic plasticity in the central nervous system. Evidence indicating that activity-dependent short- and long-term changes in strength of synaptic transmission are important for memory processes is examined. Focus is placed on one model of synaptic plasticity called long-term potentiation, and its similarities with memory processes are illustrated. Recent studies show that the regulation of synaptic strength is bidirectional (e.g., synaptic potentiation or depression). Mechanisms involving intracellular signaling pathways that regulate synaptic strength are described, and the specific roles of calcium, protein kinases, protein phosphatases, and retrograde messengers are emphasized. Evidence suggests that changes in synaptic ultrastructure, dendritic ultrastructure, and neuronal gene expression may also contribute to mechanisms of synaptic plasticity. Also discussed are recent findings about postsynaptic mechanisms that regulate short-term synaptic facilitation and neuronal burst-pattern activity, as well as evidence about the subcellular location (presynaptic or postsynaptic) of mechanisms involved in long-term synaptic plasticity.

Different viral aetiology of hepatocellular carcinoma between two hepatitis B and C endemic townships in Taiwan

In Taiwan, we found two hepatitis B virus (HBV)- and hepatitis C virus (HCV)-endemic townships, Paisha and Tzukuan, with an anti-HCV prevalence of 19 and 37% in men, and 26 and 38% in women, respectively. The hepatitis B surface antigen (HBsAg)-positive rates were 25 and 18%, for men and women in Paisha, and 25 and 22% in Tzukuan, respectively. According to the national death certification database (1982 to 1991), the annual age-adjusted mortality rates per 100,000 population for liver cancer among men and women were 83.0 and 13.8, respectively, in Paisha, and 55.9 and 17.0 in Tzukuan compared with 30.9 and 9.1 in Taiwan as a whole. The male-to-female ratios were 6.0 in Paisha and 3.3 in Tzukuan. Aetiology of 11 cases of hepatocellular carcinoma (HCC) from Paisha and 14 cases from Tzukuan were analysed. All HCC cases from Paisha were HBsAg positive, while 13/14 HCC cases from Tzukuan were anti-HCV positive. The endemic duration of HCV in Tzukuan seemed long enough to induce HCC, but the HCV appeared to be a newly introduced infection in Paisha.

Early detection of successful coronary reperfusion based on serum concentration of human heart-type cytoplasmic fatty acid-binding protein

Both human heart-type cytoplasmic fatty acid-binding protein (H-FABPc) and myoglobin are low molecular weight proteins that are abundant in the cytoplasm of myocardial cells. Unlike myoglobin, H-FABPc content in the skeletal muscle is less than in cardiac muscle. To investigate the usefulness of the serum concentration of H-FABPc in the early detection of successful coronary reperfusion, we measured serum concentrations of H-FABPc and myoglobin in 45 patients with acute myocardial infarction treated with intracoronary thrombolysis or direct percutaneous transluminal coronary angioplasty. Coronary angiography was performed every 5 min for reperfusion therapy to identify the onset of reperfusion. Reperfusion, defined as a TIMI grade 2 or 3, was achieved within 60 min of the initiation of reperfusion therapy in 30 patients (the reperfused group), but was not achieved in 15 patients (the non-reperfused group). Blood samples were obtained before initiation of treatment and 15, 30 and 60 min after initiation of treatment in the non-reperfused group. In the reperfused group, samples were obtained before reperfusion and 15, 30 and 60 min after reperfusion. The H-FABPc ratio (the ratio of value after to value before the initiation of treatment or reperfusion) increased sharply after the onset of reperfusion, peaking at 41 +/- 18 min, and decreased rapidly thereafter. The predictive accuracy of an H-FABPc ratio of > 1.8 for the detection of reperfusion within 60 min of the initiation of treatment was 93% at 15 min after reperfusion, 98% at 30 min, and 100% at 60 min. Similar rates of predictive accuracy were observed for a myoglobin ratio > 2.4. The H-FABPc ratio detected successful reperfusion as early as 15 min after the onset of reperfusion and was highly accurate in detecting reperfusion within 60 min of the onset of reperfusion. The predictive accuracy of the H-FABPc ratio was similar to that of the myoglobin ratio for the early detection of successful coronary reperfusion.