Short-term treatment of obesity with fluoxetine as a supplement to a low calorie diet

BACKGROUND

Inhibitors of serotonin re-uptake including fluoxetine have generally been successful in inducing modest but statistically significant weight reductions in clinical trials. However, there are few published trials with serotonin re-uptake inhibitors in obesity therapy on Asians. This study aimed to assess the effect of fluoxetine as an adjunct therapy to a low calorie diet in the obese Taiwanese population.

METHODS

Sixty healthy obese subjects [body weight > 130% of ideal body weight (IBW)] were instructed to follow a low calorie diet. All subjects were randomized to receive fluoxetine 60 mg once daily with diet or diet only for 12 weeks.

RESULTS

The mean total body weight reduction at the end of the study was significantly greater in the fluoxetine group than in the diet group (mean +/- S.E., -5.75 +/- 0.69 vs. -3.06 +/- 0.59 kg, p = 0.008). The body weight reduction in the first 4 weeks and second 4 weeks were greater in the fluoxetine group and they were statistically significant (mean +/- S.E., 1st 4 weeks: -2.57 +/- 0.34 vs. -1.24 +/- 0.22 kg, p = 0.0033; 2nd 4 weeks: -1.90 +/- 0.25 vs. -0.9 +/- 0.35 kg, p = 0.0226). In the third 4 weeks, the weight reduction in the fluoxetine group was still greater, but it was not statistically significantly (mean +/- S.E., third 4 weeks: -1.21 +/- 0.34 vs. -0.73 +/- 0.25 kg, p = 0.299). More symptoms of anorexia and nausea were noted in the fluoxetine group. The other side effects noted in the fluoxetine group were usually mild and tolerable.

CONCLUSION

Fluoxetine is effective, well tolerated and relatively safe in the short-term treatment of obesity in the Taiwanese population when added to a low calorie diet.

Space-variant interconnections based on diffractive optical elements for neural networks: architectures and cross-talk reduction

Optical architectures for fully connected and limited-fan-out space-variant weighted interconnections based on diffractive optical elements for fixed-connection multilayer neural networks are investigated and compared in terms of propagation lengths, system volumes, connection densities, and interconnection cross talk. For a small overall system volume the limited-fan-out architecture can accommodate a much larger number of input and output nodes. However, the interconnection cross talk of the limited-fan-out space-variant architecture is relatively high owing to noise from the diffractive-optical-element reconstructions. Therefore a cross-talk reduction technique based on a modified design procedure for diffractive optical elements is proposed. It rearranges the reconstruction pattern of the diffractive optical elements such that less noise lands on each detector region. This technique is verified by the simulation of one layer of an interconnection system with 128 x 128 input nodes, 128 x 128 output nodes, and weighted connections that fan out from each input node to the nearest 5 x 5 array of output nodes. In addition to a significant cross-talk reduction, this technique can reduce the propagation length and system volume.

Inhibition of Na+, K+-ATPase activates swelling-induced taurine efflux in a human neuroblastoma cell line

The Na+ pump (Na+, K+-ATPase) has been implicated in the regulation of many cellular functions, including cell volume regulation. The effects of inhibiting Na+ pump activity on cell volume and taurine efflux were evaluated in the human neuroblastoma cell line CHP-100. Cell volume changes monitored with the Coulter Multisizer technique and confocal microscopy showed that neuroblastoma cells exposed to ouabain swelled by 22 +/- 4% (n = 5). The rapid cell swelling was followed by regulatory volume decrease (RVD). In cells treated with ouabain, 14C-taurine efflux increased by 183 +/- 11% compared with controls. However, cells exposed simultaneously to ouabain and hypoosmotic solution resulted in a 14C-taurine efflux of 207 +/- 18%. Western blot and immunofluorescence microscopy with specific monoclonal antibodies for the catalytic alpha isoforms of Na+, K+-ATPase demonstrated high levels of the ubiquitously expressed alpha1 and the neuronal-specific alpha3. Ouabain-binding data showed that CHP-100 cells express approximately 3 x 10(5) pump units/cell. The present data indicate that efflux of taurine may be involved during volume recovery subsequent to blockade of Na+, K+-ATPase in CHP-100 cells.

Arterial oxygenation is unchanged during hemodialysis in patients mechanically ventilated in assist-control mode

Dialysis-induced hypoxemia can occur in spontaneously breathing renal failure patients but whether it occurs during bicarbonate hemodialysis in critically ill patients receiving mechanical ventilation in assist-control mode is not clear. Twenty-one patients admitted to the medical intensive care unit who required mechanical ventilation and hemodialysis with the use of a cuprammonium dialyzer were enrolled and 25 sessions of hemodialysis were performed. Arterial blood gas, white blood cell count, minute ventilation, respiratory rate, and blood pressure were measured before dialysis (time 0) and at 15, 30, 60, 120, 180, and 240 minutes thereafter. The white blood cell count dropped immediately and reached the nadir 15 minutes after hemodialysis began. Thereafter, it recovered and overshot the predialysis value at the end of dialysis. The serum HCO3- concentration increased progressively after dialysis began and resulted in significant metabolic alkalosis. The P (A-a)O2 was not aggravated and minute ventilation was not depressed by rapid metabolic alkalosis under mechanical ventilatory support. The PaO2 remained stable throughout hemodialysis. No significant hypoxemia occurred in groups of varying predialysis cardiopulmonary dysfunction. These findings suggest that in renal failure patients ventilated in assist-control mode, l) hypoventilation and accompanying hypoxemia did not occur during bicarbonate (35 mEq/L) dialysis, despite significant metabolic alkalosis; and 2) patients with higher Acute Physiologic and Chronic Health Evaluation (APACHE) III scores and P(A-a)O2 levels were not more prone to dialysis-induced hypoxemia.

Lipoblastomatosis combined with intestinal neuronal dysplasia

We report the case of a male infant with multifocal lipoblastomatosis and intestinal pseudo-obstruction for whom the pathologic findings of rectal biopsy were consistent with intestinal neuronal dysplasia. Lipoblastomatosis is a benign neoplasm of human fetal white adipose tissue that mainly occurs in infants and children. Intestinal neuronal dysplasia is a disorder that clinically mimics Hirschsprung's disease and that is pathologically characterized by parasympathetic hyperganglionosis of the enteric nervous system. To our knowledge, the combination of lipoblastomatosis and intestinal neuronal dysplasia has never been documented, and the gene mutations involved are completely different. In this case, therefore, we postulate that intestinal neuronal dysplasia may be secondary to either compression of the nerve tract or inhibition of bowel movement due to lipoblastomatosis.

Effects of an educational program on parents with febrile convulsive children

The purpose of this study was to characterize the effects of an educational program on knowledge, attitude, concern, and first-aid measures among parents with febrile convulsive children. All parents completed a pretest questionnaire 3 weeks before the meeting. The parents were assigned randomly into experimental (n = 65) and control (n = 64) groups on the day they attended the program. The control group completed the identical questionnaire (posttest) before the program, whereas the experimental group completed the same posttest after the program. In pretest, most parents considered electroencephalogram or computed tomography necessary in evaluating their children, suggested that immunization be postponed, and rated the risk of subsequent epilepsy as high for their children. Most of them favored frequent body temperature measurement, were very anxious about further febrile convulsion episodes during the night, and were fever phobic. After education, although only a slight change in fever anxiety was found, the experimental group showed significant improvement in knowledge, attitude, concerns, and anticipatory practice of febrile convulsion compared with the control group. In conclusion the parents' poor knowledge, negative attitudes, anxiety, and inadequate first-aid measures toward febrile convulsion can be effectively improved by an educational intervention program.

The lips. Excision and repair

Dermatologists commonly encounter lesions arising on the lips that require excision either for biopsy or treatment. Several surgical techniques used for excision and repair of the lip in the treatment of these conditions are reviewed. Topics covered include the importance of the lip, lip anatomy as it pertains to cutaneous surgery, techniques for obtaining lip anesthesia, partial-thickness and full-thickness lip excision and repair, surgical vermilionectomy, and carbon dioxide laser vermilionectomy. Emphasis will be placed on those surgical techniques that might commonly be used in a general dermatology practice.

The role of acetic acid in the prevention of salt-induced aggregation of snake venom cardiotoxins

Snake venom cardiotoxins (CTXs) exhibit a strong tendency to aggregate upon desalting and hence it is extremely difficult to prepare salt-free cardiotoxin(s). In the present study, we describe a new method for preparation of salt-free CTX based on dialysis against acetic acid. Based on experimental observation and the three dimensional solution structure of cardiotoxin analogue III from the Taiwan cobra (Naja naja atra), a molecular mechanism for the prevention of aggregation of cardiotoxins by acetic acid is discussed. In our opinion, the results obtained in the present study would pave way for elucidating the structural basis for the broad spectrum of biological activities exhibited by snake venom cardiotoxins.

Glomerular transforming growth factor-beta1 mRNA as a marker of glomerulosclerosis-application in renal biopsies

As transforming growth factor-beta1 (TGF-beta1) is implicated in the pathogenesis of glomerulosclerosis, the aim of the study was to demonstrate if levels of glomerular TGF-beta1 mRNA in renal biopsies correlated with glomerulosclerosis. Glomeruli were collected by microdissection from renal biopsies in patients with membranous nephropathy, lupus nephritis, diabetic nephropathy, minimal change disease and IgA nephropathy presented by proteinuria when serum creatinine was <3 mg%. Glomerular mRNAs were reverse transcribed and TGF-beta1, alpha2(IV) collagen, beta-actin cDNA quantitated by competitive polymerase chain reaction (PCR). By semiquantitative electron microscopy, a 3.5-fold increase of glomerular TGF-beta1/beta-actin mRNA ratio in the moderate sclerotic group (n = 23, p < 0.01) and a 1.5-fold increase in the mild sclerotic group (n = 22, p < 0.05) were observed when compared to the minimal sclerotic group (n = 12). A concordant increase of glomerular alpha2(IV) collagen mRNA was found with 2.2- and 1.3-fold in moderate and mild sclerotic groups, respectively. The TGF-beta1/beta-actin mRNA ratios were highest in membranous nephropathy (466.4 +/- 133.4, n = 11), followed by lupus nephritis (394.9 +/- 94.8, n = 12) and diabetic nephropathy (333.2 +/- 97.6, n = 10). Patients with minimal change disease(233.1 +/- 54.1, n = 15)and IgA nephropathy(185.3 +/- 39.6, n = 9) had low levels. The degree of glomerulosclerosis in each group followed the TGF-beta1/beta-actin mRNA ratios indicating that the level is the major determinant ofglomerulosclerosis but not the disease entities. Glomerular TGF-beta1/beta-actin mRNA ratio did not correlate with clinical parameters such as the urinary protein excretion and creatinine clearance. These results suggest that glomerular TGF-beta1/beta-actin mRNA ratio may be used as a marker of glomerulosclerosis in renal biopsy to reflect the local sclerotic process.

Malakoplakia of the prostate: a case report

Malakoplakia is an unusual chronic inflammatory disease that was first discovered in the urinary bladder but has subsequently been described in other sites. Characteristic gross and microscopic features of the lesions have been well described. The diagnosis of this tumor-like lesion can only be established by pathologic examination of the involved tissue. A case of prostatic malakoplakia with characteristic gross and microscopic features is reported in a 59-year-old man who presented with urinary frequency and a diminished urinary stream. Clinically the condition mimicked carcinoma of the prostate gland and the patient underwent a radical retropubic prostatectomy. Postoperative recovery was uneventful. The clinical and pathological findings, differential diagnosis and pertinent literature are reviewed. Preoperative needle biopsy or intraoperative frozen section for tissue diagnosis is recommended to avoid unnecessary radical surgery for this type of tumor-like lesion.

Differential screening of a subtracted cDNA library: a method to search for genes preferentially expressed in multiple tissues

We have developed a new strategy for differential screening of genes that are expressed in two or more tissues, and have used it to identify genes that are preferentially expressed in both testis and ovary. In this approach, testis-specific cDNAs were first generated using the suppression subtractive hybridization technique, cloned and arrayed in microplates. The inserts from the subtracted testis-specific library were amplified by PCR and spotted on filters. The dot blots were screened by hybridization using either testis- or ovary-specific subtracted cDNA mixtures as probes. By screening about 2000 putative clones from the subtracted testis-specific library, we identified 14 candidate genes that hybridized to both cDNA probes. Northern blot analysis showed that 12 clones were preferentially or exclusively expressed in testis and ovary. Nucleotide sequence analysis indicated that three of the identified clones represented cDNAs from novel genes.

Leptospirosis: an ignored cause of acute renal failure in Taiwan

Leptospirosis, caused by a spirochete, is the most common zoonosis in domestic or wild animals. Animals excrete infected urine in soil or water and may cause human infections through abrased wound, mucosa, conjunctiva, or by swallowing contaminated water. Clinical presentations of leptospirosis are mostly subclinical. Five to ten percent of leptospirosis are fatal, causing fever, hemorrhage, jaundice, and acute renal failure (Weil's syndrome). Leptospirosis has been ignored as a cause of acute renal failure in Taiwan. We report two patients with leptospirosis who presented with high fever, abdominal pain, jaundice, and acute renal failure. Patient 1 died on day 12 of admission of multiple organ failure associated with pancytopenia, hypogammaglobulinemia, and reactive hemophagocytosis. Leptospirosis was recognized after death. Patient 2 was admitted with similar presentations 2 weeks later. Penicillin and doxycycline were given early in the course, and azotemia, jaundice, respiratory failure, and aseptic meningitis gradually improved. Renal biopsy showed interstitial nephritis. Several tubular clearance tests showed proximal tubular defect with severe bicarbonate wasting (FeHCO3- 20.9%) and incomplete type II renal tubular acidosis without affecting the distal nephron. After 80 days of treatment, this patient was discharged with recovery of conscious level and renal function. This is the first leptospirosis patient with detailed tubular functional and morphological studies of the kidney. Diagnosis of leptospirosis was made by microscopic agglutination test (MAT) for antibody to leptospira and by polymerase chain reaction (PCR) for leptospira DNA in blood and urine (interrogans serogroup australis in case 1 and Leptospira borgpetersenii serogroup ballum in case 2). Because active surveillance has resulted in 13 cases diagnosed as leptospirosis islandwide thereafter, underestimation and ignorance of leptospirosis as a cause of acute renal failure may occur in Taiwan. Therefore, an area with a low leptospirosis incidence may actually have a very high incidence. Leptospirosis should be suspected in febrile patients with jaundice and renal failure when pathogens cannot be identified by traditional culture for microorganisms.

Deletions of the Aequorea victoria green fluorescent protein define the minimal domain required for fluorescence

The Green Fluorescent Protein (GFP) from the jellyfish Aequorea victoria is a widely used marker for gene expression and protein localization studies. Dissection of the structure of the protein would be expected to shed light on its potential applications to other fields such as the detection of protease activity. Using deletion analysis, we have defined the minimal domain in GFP required for fluorescence to amino acids 7-229. This domain starts at the middle of the first small alpha helix at the N terminus of GFP and ends immediately following the last beta sheet. Studies of the amino acids at both termini of the minimal domain revealed that positions 6 and 7 at the N terminus are Glu-specific. Change of the Glu residues to other amino acids results in reduction of GFP fluorescence. Position 229 at the C terminus of GFP, however, is nonspecific: the Ile can be replaced with other amino acids with no measurable loss of fluorescence. A total of only 15 terminal amino acids can be deleted from GFP without disrupting fluorescence, consistent with findings of a previous study of GFP crystal structure (Ormo, M., Cubitt, A. B., Kallio, K., Gross, L. A., Tsien, R. Y., Remington, S. J. (1996) Science 273, 1392-1395 and Yang, F., Moss, L. G., and Phillips, G. N., Jr. (1996) Nat. Biotechnol. 14, 1246-1251) that a tightly packed structure exists in the protein. We also generated internal deletions within the loop regions of GFP according to its crystal structure and found that all such deletions eliminated GFP fluorescence.

A multidisciplinary pulmonary rehabilitation program for patients with moderately severe chronic obstructive pulmonary disease

A multidisciplinary pulmonary rehabilitation program was conducted for 13 outpatients (mean age 66 +/- 6.7 yr) with moderately severe chronic obstructive pulmonary disease. Changes in pulmonary function and blood gas data were not significant. Exercise capability, including 6-minute walking distance (WkD6), maximal work load (WkLmax), endurance time, and maximum heart rate, improved significantly (p < 0.05), as did subjective symptoms and quality of life. Of the observed changes, only baseline PaO2 and oxygen saturation were positively correlated with changes in maximum heart rate. The initial maximum heart rate was inversely related to both the absolute and percentage improvement. There were no significant relationships between improvement in WkD6 and age, initial arterial blood gas, or pulmonary function, but a significant relationship was found between baseline forced expired volume in the first second (FEV1) and percentage change in WkLmax. Our results indicate that patients with moderately severe chronic obstructive pulmonary disease can improve their exercise capacity, subjective symptoms, and quality of life through a pulmonary rehabilitation program. All patients can increase their endurance, regardless of their initial exercise performance. Maximum heart rate and FEV1 are predictors of exercise capability improvement.

Assessment of dialysis adequacy using the dialysate urea monitor: preliminary experience of the dialysate urea monitor

Numerous studies have identified a strong linkage between the delivered dialysis dose (Kt/V) and the survival of hemodialysis (HD) patients. However, the current method used to calculate Kt/V requires multiple blood samples and the process is complex and time consuming. We evaluate the performance of a recently developed on-line monitor (Biostat 1000 dialysate urea monitor, Baxter) that measures the urea concentration in the effluent dialysate and displays Kt/V and nPCR immediately after hemodialysis. To verify the performance of the urea monitor, we selected 21 hemodialysis patients, calculated their Kt/V and nPCR values from blood samples obtained during each hemodialysis, and compared the results with data obtained using the urea monitor. The Kt/V and nPCR values calculated by the urea monitor were both significantly correlated with those obtained using blood samples (R = 0.804, p < 0.001 in Kt/V and R = 0.749, p < 0.001 in nPCR). Our results suggest that the urea monitor may be used for on-line assessment of dialysis adequacy and obviates the need for blood sampling.

Demographic characteristics and medical aspects of menopausal women in Taiwan

This report describes the medical and demographic characteristics of menopausal women in Taiwan in order to provide information for consideration during future healthcare planning. The medical and demographic data analyzed were taken from officially published materials of the Government of the Republic of China on Taiwan, our own studies, and those of other researchers. In 1994, the average lifespan of men in Taiwan was 71.8 years and that of women was 77.7 years. The age of menarche was 13.6 years and the age of menopause was 49.5 years. Women aged 50 and over accounted for 18.3% of the total female population and 8.9% of the total population in Taiwan. In 1994, 68.9% of women in Taiwan aged 50 and over were married. The most frequently occurring menopausal symptoms in Taiwanese women were lumbago or low backpain (68%), fatigue (59%), impairment of memory (55%), vaginal dryness (50%), and hot flushes and sweating (49%). The spinal bone mineral density of women decreased markedly after the age of 50 years. The prevalence of vertebral fracture in women 65 years and over was 19.8%, which was higher than the 12.5% in men of the same age group. The prevalence of hypertension and coronary heart disease in women 50 years or older was also higher than in men. The most frequent sites of cancer in women in 1992 were the cervix uteri, breast, sigmoid colon and rectum, lungs, liver, stomach, thyroid, ovaries, hemopoietic and reticuloendothelial systems, and skin. There were 14,298 newly reported cases of malignant neoplasms in women in 1992. About 60% of these occurred in women aged 50 years or more. The median age of occurrence of cervix uteri, breast, and ovarian cancers was 48 to 49 years, which is very close to the menopause age. About 30% of menopausal women in Taiwan are currently living without a husband. Although 18.3% of women in Taiwan were at least 50 years old, approximately 60% of all malignant neoplasms in the female population occurred in this group. There is an urgent need for menopausal women in Taiwan to receive psychologic support and comprehensive medical care.

Respiratory drive and pulmonary mechanics during haemodialysis with ultrafiltration in ventilated patients

The improvements of respiratory drive and pulmonary mechanics which follow haemodialysis with ultrafiltration in mechanically ventilated renal failure patients seem predictable but have not been studied before. In this study, 14 renal failure patients with stable haemodynamics mechanically ventilated with pressure support ventilation (PSV) were enrolled. Respiratory drive (represented as P0.1), pulmonary mechanics, breathing pattern, arterial blood gas and haemodynamics were measured according to the time schedule: pre-dialysis (Time 0), and at 60, 120, 180, 240 minutes thereafter. Following the removal of excess lung water during haemodialysis, auto-PEEP and patient's work of breathing (WOBp) decreased gradually. P0.1 lessened progressively along with the improvement in pulmonary mechanics. The changes in auto-PEEP and WOBp correlated closely to the pre- and post-dialysis decline of P0.1 (delta P0.1). There was a negative, moderately significant correlation between the amount of fluid ultrafiltrated during dialysis (delta UF) and the delta P0.1 (R = -0.54). The breathing pattern remained stable during dialysis. No hypoventilation or hypoxaemia occurred despite the development of metabolic alkalosis induced by bicarbonate dialysate. We have shown that respiratory drive decreases gradually during bicarbonate haemodialysis. The improvements of pulmonary mechanics, rather than the rapid alkalization of body fluids, responds to the decrease of P0.1 in renal failure patients ventilated with PSV.

Automated on-line sample pretreatment system for the determination of trace metals in biological samples by inductively coupled plasma mass spectrometry

A fully automated on-line sample pretreatment system combining microwave digestion with sample preconcentration/matrix separation for the determination of trace metals (Fe, Ni, Cu, Zn, and Pb) in blood and serum samples by inductively coupled plasma mass spectrometry (ICPMS) was designed and evaluated. The samples were mixed with an appropriate reagent and digested in a flow-through, focused microwave-heated oven. After digestion, the sample solution was transferred on-line to a column packed with iminodiacetate-based resin for separation of matrix elements like Na, K, Ca, Mg, Cl, P, and S that might interfere with the measurement by ICPMS. The analytes chelated on the resin were subsequently eluted and led to ICPMS for multielement determination. The whole sample pretreatment process was automatically controlled by a self-designed expert system. The analytical reliability of data from this on-line system was confirmed to be good with the analysis of SRM samples (Seronorm Whole Blood and NIST SRM 1598 Bovine Serum), and the limits of detection (3 sigma) for Fe, Ni, Cu, Zn, and Pb were 68, 0.34, 3.5, 13.4, and 0.22 microgram/L, respectively. With this fully automated on-line system, the determination of analytes in biological fluid samples down to micrograms-per-liter levels has been proven to be feasible, and the sample throughput can achieve up to 6 samples/h.

Nitric oxide signalling is required for the generation of anoxia-induced long-term potentiation in the hippocampus

The involvement of nitric oxide in anoxia-induced long-term potentiation (anoxic LTP) of synaptic transmission was investigated in CA1 neurons of rat hippocampal slices using intracellular recording techniques in vitro. In response to superfusion of an anoxic artificial cerebral spinal fluid saturated with 95% N2-5% CO2, the excitatory postsynaptic potential (EPSP) generated in hippocampal CA1 neurons by stimulation of the Schaffer collateral/commissural afferent pathway was completely abolished within 10 min of anoxia. On return to reoxygenated medium, the EPSP returned to the control value within 10 min and was subsequently and progressively potentiated to reach a plateau 15-20 min after return to oxygen. This anoxia-induced persistent increase in synaptic transmission lasted for more than 1 h. Application of the nitric oxide synthase inhibitors 7-nitroindazole (7-NI) or L-N(G)-nitroarginine (NOARG) produced no effects on the baseline EPSP amplitude, but effectively attenuated the anoxic LTP. The inhibitory effects of both 7-NI and NOARG on the anoxic LTP were blocked by L-arginine, a substrate for nitric oxide synthase. These results suggest that nitric oxide is required for the generation of anoxia-induced LTP of glutamatergic synaptic transmission in the CA1 region of the rat hippocampus.

Level of transforming growth factor beta 1 is elevated in cerebrospinal fluid of children with acute bacterial meningitis

We investigated the levels of transforming growth factor beta 1 (TGF-beta 1) in cerebrospinal fluid (CSF) in children with meningitis, with a view to prognostic relevance. CSF TGF-beta 1 levels on admission were measured by a sandwich enzyme immunoassay in children with bacterial meningitis (n = 16), aseptic meningitis (n = 12), and control subjects without evidence of central nervous system (CNS) infection (n = 16). Patients were followed up for a mean duration of 13 months, and neurodevelopmental sequelae was determined for those with bacterial meningitis. On admission, CSF TGF-beta 1 levels were significantly higher in children with bacterial meningitis (mean, standard error, 32.92, 2.36 pg/ml) as opposed to those with aseptic meningitis (25.26, 1.72 pg/ml) (P = 0.0155), or control subjects (20.53, 1.05 pg/ml) (P < 0.0001). The CSF TGF-beta 1 levels in children with aseptic meningitis were higher than those in the control group, but without significance (P = 0.02). No apparent correlation existed between CSF TGF-beta 1 levels and CSF protein or cell counts in patients with bacterial meningitis. No significant difference in CSF TGF-beta 1 levels was found between patients with or without major sequelae following bacterial meningitis.

Poor pre-dialysis glycaemic control is a predictor of mortality in type II diabetic patients on maintenance haemodialysis

BACKGROUND

In type II diabetic patients, a better glycaemic control has been reported to slow down the progression of nephropathy. The effect of pre-dialysis glycaemic control on the long term prognosis in type II diabetics on haemodialysis is still uncertain. The purpose of this study is to evaluate the effect of glycaemic control before starting maintenance haemodialysis on the clinical outcome in type II diabetic haemodialysis patients.

METHODS

One hundred and thirty-seven type II diabetics receiving regular haemodialysis in a single university hospital were enrolled. The patients were classified as either good or poor glycaemic control group according to their glycaemic control within 6 months before starting haemodialysis. Serum albumin, haematocrit, cholesterol, triglyceride, residual renal function, diabetic complications, and patient survival were analysed in both groups.

RESULTS

There was no significant difference in age, gender, predialysis albumin level, cholesterol level, triglyceride level, and residual renal function between the two groups. The 1-year (94.5% vs 80.0%), 3-year (82.9% vs 58.1%), and 5-year (75.8% vs 21.8%) cumulative survival rates were lower in the poor glycaemic control group than in the good glycaemic control group (P < 0.001). The poor glycaemic control group also had more cardiovascular morbidity during the period of dialysis (P < 0.001). The increase in cardiovascular complications also accounted for the increased mortality during the course of haemodialysis.

CONCLUSIONS

We conclude that poor glycaemic control before starting dialysis is a strong predictor of cardiovascular morbidity and survival for type II diabetics on haemodialysis. These results imply that better glycaemic control before dialysis might be important in improving the long-term prognosis in type II diabetics on haemodialysis.

Micropatterning gradients and controlling surface densities of photoactivatable biomolecules on self-assembled monolayers of oligo(ethylene glycol) alkanethiolates

BACKGROUND

Bioactive molecules that are covalently immobilized in patterns on surfaces have previously been used to control or study cell behavior such as adhesion, spreading, movement or differentiation. Photoimmobilization techniques can be used, however, to control not only the spatial pattern of molecular immobilization, termed the micropattern, but also the surface density of the molecules--a characteristic that has not been previously exploited.

RESULTS

Oligopeptides containing the bioactive Arg-Gly-Asp cell-adhesion sequence were immobilized upon self-assembled monolayers of an oligo(ethylene glycol) alkanethiolate in patterns that were visualized and quantified by autoradiography. The amount and pattern of immobilized peptide were controlled by manipulating the exposure of the sample to a UV lamp or a laser beam. Patterns of peptides, including a density gradient, were used to control the location and number of adherent cells and also the cell shape.

CONCLUSIONS

A photoimmobilization technique for decorating surfaces with micropatterns that consist of variable densities of bioactive molecules is described. The efficacy of the patterns for controlling cell adhesion and shape has been demonstrated. This technique is useful for the study of cell behavior on micropatterns.