Expression of stereotyped behaviour requires stimulation of nigral D1 dopamine receptors

Dopamine receptors in the pars reticulata of the substantia nigra were inactivated following bilateral injections of N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ). Loss of D1, but not D2, receptors was associated with a significant decrease in the incidence of stereotyped head-down sniffing elicited by the mixed D1/D2 receptor agonist, apomorphine. The results support the hypothesis that D1 receptors in the substantia nigra are necessary for the expression of dopamine mediated stereotyped behaviour.

Human tumour necrosis factor-alpha inhibits glucose transport in cultured Ehrlich ascites tumour cells

Human recombinant tumour necrosis factor-alpha (rhTNF-alpha) arrested the growth of Ehrlich ascites tumour (EAT) cells in vitro. It suppressed cellular glucose uptake and decreased the membrane density of glucose transporters as measured by glucose-reversible cytochalasin B binding. The glucose transporters' affinity for substrate was also reduced. However, rhTNF-alpha treatment exerted no effect on the phosphoribosyl pyrophosphate level in EAT cells. The role of rhTNF-alpha on the inhibition of glucose transport of tumour cells is discussed.

Long-term efficacy of recombinant hepatitis B vaccine and risk of natural infection in infants born to mothers with hepatitis B e antigen

To evaluate the long-term protection afforded by the vaccine, recombinant hepatitis B (HB) vaccine was given to 171 infants born to hepatitis B e antigen-positive carrier mothers. Group A (53 infants) and group B (57 infants) received four doses of HB vaccine at birth and at 1, 2, and 12 months of age, with a dose of 20 micrograms in group A and 10 micrograms in group B. Group C (61 infants) received three 20 micrograms doses of HB vaccine at birth and at 1 and 6 months of age. These children were followed up annually up to 5 years of age. Six children (4%) became HB carriers before 1 year of age, and the carrier state persisted to the end of follow-up. The overall seropositive rate of HB surface antibody (anti-HBs) dropped from 99% at 1 year of age to 83% at 5 years of age. Among 548 serum pairs taken at 1-year intervals from children negative for HB surface antigen (HBsAg), a fourfold rise of anti-HBs titer was noted in 58 (11%) and a 10-fold rise of anti-HBs was noted in 17 (3%). Maternal HB core antibody disappeared in most children (151/152, 99%) before 2 years of age. Natural infections, as judged by persistence or reappearance of HB core antibody, occurred in 19 of 163 (12%) HBsAg-negative children. None of these episodes was associated with HBsAg positivity. We conclude that the long-term protection afforded by recombinant HB vaccine is satisfactory and that a further booster dose before 5 years of age is not necessary.

Sequence of a cloned pR72H fragment and its use for detection of Vibrio parahaemolyticus in shellfish with the PCR

The nucleotide sequence of pR72H cloned from Vibrio parahaemolyticus 93 was determined. We examined all V. parahaemolyticus gene sequences published in the GenBank-EMBL databases for homology and found that no other DNA sequence of V. parahaemolyticus was highly homologous to the sequence reported in this study. A pair of primers, VP33-VP32, derived from a pR72H fragment were selected to detect V. parahaemolyticus. The sensitivity of PCR detection for a pure culture of V. parahaemolyticus was 10 cells from crude bacterial lysates. Furthermore, a detection level of 2.6 fg, equivalent to 1 cell, was obtained by using purified chromosomal DNA as the template. The expected PCR products were obtained from all V. parahaemolyticus strains tested (n = 124), while no PCR amplicons were found in other vibrios or related genera (n = 50). High levels (10(6) to 10(10) CFU/ml) of Escherichia coli cells did not affect the PCR assay sensitivity. The presence of 10(8) V. parahaemolyticus cells or 10(9) E. coli cells in the PCR mixtures completely inhibited the PCR. When oyster samples were inoculated with V. parahaemolyticus 93 and cultured in tryptic soy broth containing 3% NaCl for 3 h at 35 degrees C, an initial sample inoculum level of 9.3 CFU/g was detected in a PCR assay with crude bacterial lysates. The PCR assay with enrichment culturing in salt polymyxin broth was compared with the conventional method for naturally contaminated shellfish and fish samples. We conclude that this PCR assay with enrichment culturing is a good alternative method for the detection of V. parahaemolyticus.

Precore mutant of hepatitis B virus in childhood fulminant hepatitis B: an infrequent association

Serum HBV DNA from infants and children with fulminant hepatitis B (FHB) or acute self-limiting hepatitis B (AHB) and patients believed to be contamination sources was amplified by polymerase chain reaction (PCR) followed by direct sequencing of the precore region. A precore mutation from G to A at nucleotide 1896 was found in 5 of 14 FHB patients and in 3 of 10 AHB patients. Among the 10 infants who developed hepatitis during the first 6 months of age, the precore mutation was detected in only 2 of 7 with FHB and in 1 of 3 with AHB. In 1 infant with FHB, a shift from wild type to precore mutant predominance occurred in the serum virus population during the incubation period. Thus, the precore mutation is neither necessary nor sufficient to cause FHB in childhood, although its contributory role cannot be excluded. Factors other than precore mutations may be important in the pathogenesis of FHB.

Characterization of a cloned pR72H probe for Vibrio parahaemolyticus detection and development of a nonisotopic colony hybridization assay

Vibrio parahaemolyticus is a halophilic bacterium often found in shellfish and is an important causative agent of food poisoning in Taiwan. A rapid and efficient detection method is required to identify this foodborne pathogen. A 0.76-Kb HindIII DNA fragment was cloned from the chromosomal DNA of V. parahaemolyticus strain no. 93, designated as pR72H fragment, was used as a polynucleotide probe. It was labeled with digoxigenin-11-dUTP (DIG) by the random primer-labeling method. The sensitivity and specificity of the digoxigenin-labeled 0.76-Kb DNA probe was determined by colony hybridization assay. Under stringent hybridization conditions, 122 of 124 isolates of V. parahaemolyticus showed positive hybridization reaction with DIG-0.76-Kb DNA probe; the negative strains were attributed to slow growth. The DIG-0.76-Kb probe did not hybridize with 86 isolates of other vibrios and a number of other enterics as well as nonenteric microorganisms. The sensitivity and specificity of this DIG probe are 98% and 100%, respectively. This nonisotopic colony hybridization assay can be very useful for routine monitoring of V. parahaemolyticus in the food industry, environmental analysis and clinical laboratories.

Effects of waglerin-I on neuromuscular transmission of mouse nerve-muscle preparations

The effects of waglerin-I, a toxin from Trimeresurus wagleri, on neuromuscular (NM) transmission were studied on the phrenic nerve-diaphragm preparation and triangularis sterni nerve-muscle preparation of mice. The toxin (1.2-4.0 microM) reversibly inhibited the indirectly elicited twitch tension of the diaphragm and decreased the ACh-elicited muscle contracture of chronically denervated diaphragm, while the directly elicited twitch tension was not affected. The toxin reversibly decreased the amplitude of miniature endplate potential (MEPP) at 0.52 microM and endplate potential (EPP) at 1.2-4 nM. The toxin (120 nM-0.4 microM) also decreased the quantal content of EPP. The perineural waveforms were recorded with an extracellular electrode placed into the perineural sheaths of motor nerves of M. triangularis sterni. The toxin (4 microM) did not alter the amplitudes of waveforms related to sodium and potassium currents of the nerve terminal action potential, while the waveform related to calcium current was decreased. It is concluded that the toxin acts on both presynaptic and postsynaptic sites of the mouse motor endplate, and that the presynaptic effect is apparently more potent than the postsynaptic effect.

Oviposition site preference of Aedes albopictus in the laboratory

Several parameters on the oviposition site preference of Aedes albopictus were studied, including color, container type, salinity, and water type. Dark-colored glass jars, especially black, blue, and red ones were preferred over light-colored jars. The black-colored ovitrap with a paper strip performed better than other types of containers. Seasoned tap water had the highest egg count when compared with a saline water series. In addition, water that had previously been used for the culture of Ae. albopictus was the most preferred for oviposition. The significance of this study in conjunction with the present Aedes mosquito surveillance and monitoring program is discussed.

Multiple sclerosis in children: clinical, neuroimaging, and neurophysiological correlations

Four female children with clinically-definite diagnoses of multiple sclerosis (MS) were studied with multimodal evoked potentials (EPs), electroencephalogram (EEG), cerebrospinal fluid (CSF) analysis, computed tomography (CT) and magnetic resonance imaging (MRI). Correlations among the clinical features, neuroimaging and neurophysiological studies were also evaluated. Their ages of the onset ranged from 5 to 11 years. The clinical evolution in the all four MS cases was relapsing-remitting form. MRI studies in three cases showed abnormal demyelinating plaques in the brainstem, cerebellum and white matter of the cerebrum. CT examination, performed in the other MS case, did not reveal hypodensic lesion. Despite that MRI failed to document optical nerve lesions, three cases had abnormal visual evoked potentials (VEPs). Somatosensory evoked potentials (SSEPs) were abnormal in three cases. Brainstem auditory evoked potentials (BAEPs) were abnormal in two cases presenting with signs of brainstem dysfunction. The conclusion was that paraclinical evidences obtained from MRI and multimodal evoked potential studies are of value as an aid in localizing involved areas and detecting silent lesions in children with MS.

Gastrin and the growth of the gastrointestinal tract

While the proliferative effects of gastrin in the gastric fundus are well established, there is a considerable degree of confusion regarding the role of gastrin on the growth of the small intestine and colon. The hypothesis that gastrin is trophic throughout the gut was tested by giving three doses of pentagastrin and one of gastrin 17 to rats maintained by total parenteral nutrition (TPN). The rats were fed intravenously for one week, with the various peptides added to the TPN diet. The number of vincristine arrested metaphases per gland or crypt was then scored to determine the proliferative state. Both gastrin 17 and pentagastrin were found to be trophic in the gastric fundus, but not to the gastric antrum. A proliferative response was also seen in the duodenum, but with little evidence of a dose response element. No effect on small bowel weight was seen, and no proliferative effect was noted in the mid small bowel, thus the duodenal effect could be attributed to a local action of increased acid output on the duodenum, not a general role throughout the small intestine. No proliferative effects of pentagastrin or gastrin were seen in the colon. It is therefore concluded that the trophic role of gastrin is restricted to the gastric fundus and the proximal duodenum.

Immunomodulation treatment for childhood virus-associated haemophagocytic lymphohistiocytosis

The Epstein-Barr virus (EBV), or human herpesvirus-6 (HHV-6) associated haemophagocytic lymphohistiocytosis, has been found prevalent in Taiwan; it affects previously healthy children and is always fatal when treated only supportively. Recognition of the underlying pathogenesis for this disease prompted adoption of an immunomodulatory regimen of intravenous immunoglobulin (IVIG) and/or etoposide on 17 such patients treated between 1990 and 1993. Remarkable improvement in patients' prognoses was demonstrated. Eight patients are still alive with a median follow-up of 1 year and 2 months post-treatment. Both IVIG and etoposide had positive immunomodulation effects such as alleviation of fever and normalization of haematological and hepatic parameters. Sustained complete response was obtained in two of nine cases of EBV-associated diseases treated with IVIG only. EBV transcripts became undetectable after etoposide and/or IVIG treatment without antiviral agents. Etoposide given by split-doses schedule appeared to be superior to conventional three-consecutive-days schedule for both remission induction and disease-free survival. Our preliminary trial apparently provides a promising improvement in the treatment of this previously fatal disease. IVIG or etoposide is effective in reversing the process of lymphohistiocytic dysregulation resulting from virus infection of immune cells in this syndrome and probably helps hosts to control active virus replication in certain cases, through immunomodulation.

A major portion of the 150-kilodalton insulin-like growth factor-binding protein (IGFBP) complex in adult rat serum contains unoccupied, proteolytically nicked IGFBP-3 that binds IGF-II preferentially

Insulin-like growth factor-II (IGF-II) binds to 150-kilodalton (kDa) protein complexes in adult rat serum that have higher affinity for IGF-II than IGF-I. We now examine the nature of these IGF-II-preferring complexes. A 150-kDa pool, isolated after neutral Sephadex G-200 gel filtration of adult rat serum, bound IGF-II with approximately 80-fold greater affinity than IGF-I, but did not contain immunoprecipitable IGF-II/mannose-6-phosphate receptors, which bind IGF-II with the same preferential affinity. Exogenous IGF-II bound to the 150-kDa complex without displacing endogenous IGF-I, indicating that it bound to sites that were previously unoccupied. IGF-I affinity chromatography was used to separate unoccupied 150-kDa complexes that bound to the column and were eluted with acid from complexes that contained endogenous IGF-I, did not bind to the column, and appeared in the flow-through. In competitive binding assays, IGF-binding proteins (IGFBPs) in the acid eluate bound IGF-II with higher affinity than IGF-I, whereas IGFBPs in the flow-through, after acid stripping, bound IGF-I and IGF-II with similar affinity. The acid eluate and the acid-stripped flow-through predominantly formed 50-kDa complexes with [125I]IGF-II when affinity-cross-linked and examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis; these complexes were precipitated by antibodies to rat IGFBP-3. Larger complexes (> 95 kDa) present in the nonacidified 150-kDa pool were not observed, consistent with the IGFBP-3 molecules in the flow-through and eluate having been complexed to an acid-labile subunit (ALS). By contrast, when these preparations were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis without affinity cross-linking, the flow-through contained intact IGFBP-3 (40-43 kDa), whereas the eluate contained only truncated 30-kDa IGFBP-3. We conclude that the 150-kDa fraction of adult rat serum includes 1) ternary complexes of intact IGFBP-3 (which binds IGF-I and IGF-II with similar affinity), endogenous IGF-I, and the ALS; and 2) binary complexes of proteolytically nicked IGFBP-3 and ALS that bind IGF-II preferentially. The nicked IGF-II-preferring complex is present in native serum before acidification or exposure to denaturants.

Outbreak of aseptic meningitis in Taipei in spring 1993

An outbreak of aseptic meningitis in the Taipei area occurred from January to August 1993. A total of 114 cases were identified by cerebrospinal fluid (CSF) examination at National Taiwan University Hospital. Most of the cases were found from February to May 1993. The peak of age distribution was 3 to 11 years. The male-to-female ratio was 2.1 to 1. Most patients had fever, headache, and vomiting and nausea. On initial CSF examination, protein concentrations > 400 mg/L were noted in 38 of 93 CSF samples, while 19 of 70 initial samples had hypoglycorrhachia (CSF/serum glucose ratio < 0.5). CSF white cell counts of the initial lumbar puncture were 0-9 x 10(6) cells/L in 4 patients, 10-99 x 10(6) cells/L in 42 patients, 100-199 x 10(6) cells/L in 27 patients, 200-499 x 10(6) cells/L in 24 patients, 500-999 x 10(6) cells/L in 12 patients and > or = 1,000 x 10(6) cells/L in 5 patients. Polymorphonuclear cells predominated in 73 of 114 cases. Viral cultures from CSF, throat swabs and rectal swabs were done with a majority yielding enteroviruses. Enterovirus as a definite etiology was found in 58 of 114 cases and was the presumptive etiology in 15 of 114 cases. The serotypes of the enteroviruses isolated were mostly echovirus type 30. All patients recovered without obvious sequelae.

A study on the cause of death due to waglerin-I, a toxin from Trimeresurus wagleri

Waglerin-I, a lethal toxin isolated from the venom of Trimeresurus wagleri, consists of 22 amino acid residues with a proline-rich sequence. In the present study, we investigated the cause of death and the possible site of action of this toxin. In anesthetized mice, i.v. administration of waglerin-I at 0.5 microgram/g produced respiratory failure within 5 min. The blood pressure could be maintained by the application of artificial respiration immediately after respiratory arrest. Waglerin-I at 4 microM reversibly blocked the indirect twitch of the mouse phrenic nerve-hemidiaphragm preparation, but had no effect on the direct twitch. It is concluded that respiratory failure, resulting from neuromuscular block, is the primary cause of death due to waglerin-I in mice. In contrast to the results obtained in mice, in anesthetized rats no toxic effects on respiration and blood pressure were observed except for a transient hypotension up to 10 micrograms/g (i.v.). In accordance with the in vivo experiments, waglerin-I at concentrations up to 40 microM did not block the indirect twitch of the rat diaphragm. It thus appears that rats are resistant to the toxic effects of waglerin-I.

Formation of 150-kDa binary complexes of insulin-like growth factor binding protein-3 and the acid-labile subunit in vitro and in vivo

Adult rat serum contains two types of 150-kDa IGFBP complexes: ternary complexes containing bound IGF-I, intact IGFBP-3 and the acid-labile subunit (ALS), and binary complexes that contain ALS and proteolytically-nicked IGFBP-3 but which lack bound IGF. We present evidence that the binary complexes containing proteolytically-nicked IGFBP-3 can be formed in two ways: by direct association of IGFBP-3 with ALS in the absence of IGF, and by proteolysis of IGFBP-3 within 150-kDa ternary complexes, resulting in increased dissociation of IGF-I. The relative contributions of the two mechanisms is unknown. Preliminary results indicate that binary complexes also can form in vivo. Proteolysis of IGFBP-3 in the 150-kDa ternary complex provides a regulatable mechanism by which IGF-I may be mobilized from the circulating reservoir of 150-kDa complexes to the tissues.

Binding of the anti-human sperm monoclonal antibody HS-11 to bull spermatozoa is correlated with fertility in vitro

The present study aimed to determine if there is bull to bull variation in the binding of the anti-human sperm monoclonal antibody (MAb) HS-11 to bull spermatozoa, and to investigate if there is any correlation between HS-11 binding to spermatozoa and in vitro fertility of the bulls tested. Semen samples of a single collection (split frozen in 0.5-ml straws) from 8 dairy bulls were used. Swim-up separated motile spermatozoa were incubated in 90-microl drops of capacitation medium (TALP+10 microg/ml heparin) at 39 degrees C, 5% CO2, 95% air. At 0, 2, 4 and 6 h of incubation HS-11 was added (1:1000 final concentration), and the MAb binding was assessed by indirect immunofluorescence assay (IIFA). The HS-11 binding was indicated by a bright green fluorescence of the sperm acrosome region. In vitro-matured, good quality bovine oocytes were randomly allocated to spermatozoa of each bull for in vitro fertilization. Sperm samples of 2 to 3 bulls were used in each trial until 4 replicates per bull were attained for IVF (n approximately 100 oocytes/bull) and IIFA experiments. Sperm capacitation status was assessed simultaneously using an egg yolk lysophosphatidylcholine- (LC) induced acrosome reaction assay. The binding of HS-11 to spermatozoa was maximum at 4 h of incubation in most (6/8) of the bull semen samples. Significant (P < 0.01) differences were observed between bulls in the binding of HS-11 to their spermatozoa (range 22 +/- 8 to 52 +/- 5%) at 4 h, but not within replicates. Similarly, variations (P < 0.05) in the cleavage rate were also seen (range 22 +/- 9 to 58 +/- 7%) between bulls. The HS-11 binding and cleavage were significantly correlated (r = 0.43; n = 32; P < 0.05). The highest percentage of spermatozoa underwent acrosome reaction in response to LC treatment at the 4-h incubation period. This and the linear relationship between HS-11 binding and the cleavage rate observed in the present study together strengthen our earlier suggestion that the binding of the monoclonal antibody HS-11 to bull spermatozoa on a time-dependent manner, may indicate capacitation changes. We conclude that 1) between-bull differences exist in HS-11 binding to spermatozoa, and in the cleavage rate, and 2) HS-11 binding to spermatozoa is correlated with fertility, as determined by the cleavage of bovine oocytes matured and fertilized in vitro.

Growth Characteristics of Aciduric Sporeforming Bacilli Isolated from Fruit Juices

Two aciduric, aerobic, sporeforming bacteria were isolated from pasteurized juices. The gram-positive, catalase-positive rods produced spores that were located subterminally in a swollen sporangium. The cultures had an optimal pH of 3.5-4.0 for growth and preferred potato dextrose agar over many of the rich media usually used for cultivating sporeforming bacteria. Spore inocula grew well in apple juice and white grape juice. Red grape juice was inhibitory, perhaps because of the concentrations of certain phenolic compounds. The spores were sufficiently heat resistant (D₉₀ values of 16 to 23 min and z-values of 7.2 to 7.7°C) to survive commercial pasteurization processes.

Occurrence of plasmids and tetracycline resistance among Campylobacter jejuni and Campylobacter coli isolated from whole market chickens and clinical samples

Twenty whole market chickens, purchased from 10 different stores in the Taipei Metropolitan area, were examined for the presence of Campylobacter jejuni and Campylobacter coli. The microorganisms were recovered from 95% of the chickens. A survey of different sites on--breast, thigh and tail--showed that contamination was equally common on all these sites. One hundred and sixty-seven chicken isolates and the 41 clinical isolates of Campylobacter jejuni were examined for the occurrence of plasmid DNA in association with tetracycline resistance. A high plasmid occurrence rate of 91% and 44% was observed for C. jejuni from chickens and clinical isolates, respectively. Plasmids ranged in size from 16 to 208 Kb. A 61 Kb plasmid and a 50 Kb plasmid were common to the chicken isolates and clinical isolates, respectively. All chicken isolates and 78% of clinical isolates were tetracycline-resistant. The high rate of tetracycline resistance in chicken isolates probably related to use of tetracycline as a growth promoter for poultry. A tetO DNA Probe, highly specific for the detection of tetracycline resistance in C. jejuni and C. coli, was used to find the location of tetracycline resistance. Of 157 chicken isolates, 98% of isolates were positive with the tetO probe, 87% (137/157) on plasmids and 11% (17/157) on the chromosome; only three isolates did not hybridize with the tetO probe. Of 32 clinical isolates, 88% isolates hybridized with the tetO probe, 47% (15/32) on plasmids and 41% (13/32) on the chromosome; four isolates did not hybridize with the tetO probe.

Dengue vector control: present status and future prospects

Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) have been the most common urban diseases in Southeast Asia since the 1950s. More recently, the diseases have spread to Central and South America and are now considered as worldwide diseases. Both Aedes aegypti and Aedes albopictus are involved in the transmission of DF/DHF in Southeast Asian region. The paper discusses the present status and future prospects of Aedes control with reference to the Malaysian experience. Vector control approaches which include source reduction and environmental management, larviciding with the use of chemicals (synthetic insecticides and insect growth regulators and microbial insecticide), and adulticiding which include personal protection measures (household insecticide products and repellents) for long-term control and space spray (both thermal fogging and ultra low volume sprays) as short-term epidemic measures are discussed. The potential incorporation of IGRs and Bacillus thuringiensis-14 (Bti) as larvicides in addition to insecticides (temephos) is discussed. The advantages of using water-based spray over the oil-based (diesel) spray and the use of spray formulation which provide both larvicidal and adulticidal effects that would consequently have greater impact on the overall vector and disease control in DF/DHF are highlighted.

Isolation and characterization of a cDNA that codes for a LIM-containing protein which is developmentally regulated in heart

During our human heart cDNA sequencing project, we have obtained a novel cDNA clone which is very similar in DNA and amino acid sequences to a rat/mouse cysteine-rich intestinal protein (1). Sequence analysis has shown that this human cysteine-rich heart protein (hCRHP) is a protein of 77 amino acids and possesses a LIM motif which is considered to be able to bind zinc. Northern blot analyses have shown that its mRNA level in rat heart is regulated developmentally. We have expressed hCRHP in E. coli using pAED4 as the vector and the cDNA was engineered so that the authentic protein is produced. The protein was partially purified and was shown to be a basic protein.

Acute outcome of percutaneous Inoue-balloon mitral commissurotomy

This study examines the acute results and the potential impact, if any, of 16 clinical, echocardiographic, hemodynamic and balloon-related variables on the acute outcomes of Inoue-balloon percutaneous transvenous mitral commissurotomy (PTMC). Of 107 patients, PTMC was successfully completed in 105 (98%) without cardioembolism or death, and resulted in an increase in mitral valve area from 0.8 +/- 0.2 cm2 to 1.7 +/- 0.4 cm2 (p = 0.0001) as assessed echocardiographically. Optimal results defined as a valve area improvement of > or = 50% and/or a final valve area of > or = 1.5 cm2 without significant mitral regurgitation (> or = 2 grade increase in mitral regurgitation or a final regurgitation > or = 3+) was obtained in 96 patients (91%). Significant mitral regurgitation was observed in six patients. On univariate analysis, patients with suboptimal results were older (52 +/- 7 vs. 44 +/- 10 years, p = 0.037) and were likely to have the procedure performed during the learning phase (first 33 vs.. subsequent 72 patients, p = 0.007) than those with optimal results, and patients with resultant significant mitral regurgitation had more severe pre-existing mitral regurgitation compared with those without (1.4 +/- 0.5 vs. 0.7 +/- 0.7, p = 0.0098). However, there were no independent predictors of either acute outcome identified in multivariate analysis. We therefore conclude that although Inoue-balloon PTMC is a safe and highly effective procedure with a low risk of creating severe mitral regurgitation, the acute outcomes cannot be accurately predicted.