Apoptotic proteins. p53 and c-myc related pathways

c-Myc and p53 are two proteins that have critical roles in the regulation of apoptosis and the cell cycle. The authors review how these two proteins are thought to control the opposing events of proliferation and apoptosis and examine whether their well-documented biological roles in tumorigenesis can be applied to the vascular system.

Single-mode operation of a broad-area semiconductor laser with an anamorphic external cavity: experimental and numerical results

The emission of high-power broad-area semiconductor lasers inherently contains many lateral modes that increase the beam divergence and reduce the spatial coherence. Elimination of higher-order lateral modes from the output beams of commercially available broad-area lasers will be beneficial in many applications of these lasers. Experimental results obtained with a broad-area laser coupled to an anamorphic external cavity are presented and are compared with the predictions from our numerical model. We have predicted and observed with the anamorphic external cavity a greatly improved discrimination against high-order lateral modes. The measurement of the spectrally resolved near-field intensity patterns provides much more comprehensive information on their longitudinal- and lateral-mode content than do observations of near-field and far-field beam intensity profiles. With a broad-area laser of 100-mW nominal power, it has been possible to extract 40% of the maximal power in a stable single-lateral and single-longitudinal mode regime.

Sensitivity of a three-mirror cavity to thermal and nonlinear lensing: Gaussian-beam analysis

We consider a compact three-mirror cavity consisting of a flat output coupler, a curved folding mirror, and an active medium with one facet cut at the Brewster angle and the other facet coated for unit reflectivity. We examine the sensitivity to thermal lensing and to self-focusing in the active medium of the Gaussian beam that is circulating in that cavity. We use a simple thin-lens model; the astigmatism of the beam that is circulating in the cavity and the nonlinear coupling between the field distributions along the two orthogonal axes are taken into account. We find configurations in which beam ellipticity is compensated for at either end of the cavity in the presence of thermal lensing. We have derived an analytical criterion that predicts the sensitivity of the beam size to nonlinear lensing. The ability of the cavity to favor self-mode locking is found to be sensitive to the strength of thermal lensing. In the absence of thermal lensing, cavities operated as telescopic systems (C = 0) or self-imaging systems (B = 0) are most appropriate for achieving self-mode locking, with nonlinear mode selection accomplished through saturation of the spatially varying laser gain. We identify conditions for which self-mode locking can be produced by variable-reflectivity output couplers with either maximum or minimum reflectivity at the center of the coupler. We use our model to estimate the nonlinear gain produced in laser cavities equipped with such output couplers. We identify a cavity configuration for which nonlinear lensing can simultaneously produce mode locking and correction of beam ellipticity at the output coupler.

Diagnosis and management of subdural haematoma complicating bone marrow transplantation

Subdural haematoma (SDH) is a known complication of bone marrow transplantation (BMT). A retrospective review of 657 consecutive patients undergoing allogeneic or autologous bone marrow/stem cell transplantation at the Royal Brisbane Hospital between January 1991 and December 1998 is reported. Seventeen cases of subdural haematoma/hygroma were identified (2.6%). Eleven of these (65%) were bilateral. Four required surgical drainage, with two developing re-accumulation of SDH. All cases presented with a headache and eight of these had associated neurological complications. Diagnosis was made predominately by CT scan: however in 25% of cases definitive diagnosis could only be made in MRI studies. An association with intrathecal methorexate-containing conditioning therapy, post lumbar puncture headache, prolonged thrombocytopenia and coagulopathy was noted. In our experience, conservative management with platelet support and correction of coagulopathy achieved resolution of subdural haematoma in most cases, with surgical intervention being reserved for neurological deterioration. Bone Marrow Transplantation (2000) 25, 549-552.

An international outbreak of Vero cytotoxin-producing Escherichia coli O157 infection amongst tourists; a challenge for the European infectious disease surveillance network

In March 1997, an outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC) infection occurred amongst holidaymakers returning from Fuerteventura, Canary Islands. For the investigation, a confirmed case was an individual staying in Fuerteventura during March 1997, with either E. coli O157 VTEC isolated in stool, HUS or serological evidence of recent infection; a probable case was an individual with bloody diarrhoea without laboratory confirmation. Local and Europe-wide active case finding was undertaken through national centres, Salm-Net and the European Programme of Intervention Epidemiology, followed by a case-control study. Fourteen confirmed and one probable case were identified from England (7), Finland (5), Wales (1), Sweden (1) and Denmark (1) staying in four hotels. Three of the four hotels were supplied with water from a private well which appeared to be the probable vehicle of transmission. The case-control study showed illness was associated with consumption of raw vegetables (OR 8.4, 95% CI 1-5-48.2) which may have been washed in well water. This investigation shows the importance of international collaboration in the detection and investigation of clusters of enteric infection.

Case-case comparisons to study causation of common infectious diseases

BACKGROUND

Analytical studies of reportable infectious diseases often use the small minority of cases detected through surveillance systems. For many diseases, notification of cases represents a non-random selection process. Apparent differences in exposure histories may be due to biases involved in the surveillance system selection of cases compared to randomly selected controls. In addition, differential recall between cases and controls may occur. One way to avoid these problems is to compare cases with another group of cases with a different disorder selected by a similar surveillance system, although this can introduce new biases.

METHODS

In infectious diseases cases with the same disease can be divided into aetiologically meaningful subgroups by subtyping the pathogen. Exposure history can then be compared between these subgroups.

RESULTS

Several biases are removed. The control group composed of other cases does not represent the exposure history of the study base but differs from it in a predictable and useful way. People considered as controls will have a higher incidence of general predisposing factors than the general population. Analysis is limited to factors associated with exposure to the infecting agent.

CONCLUSIONS

Case-case comparison is a development of case-control methodology made possible by laboratory typing techniques. These comparisons allow a more restricted but more refined analysis of the association of some exposures with infection. Determination of how exposure to the infectious agent occurred is more efficient and unbiased than in standard case-control studies but general factors determining whether disease occurs after an infectious exposure can not be studied.

Continuous subcutaneous infusion of morphine vs. hydromorphone: a controlled trial

Seventy-four patients were included in a double-blind, randomized, controlled trial comparing the analgesic efficacy and adverse effects of hydromorphone and morphine delivered by continuous subcutaneous infusion. Patients completed the Memorial Pain Assessment Card and a checklist of opioid-related adverse effects immediately before commencing subcutaneous infusion and 24, 48, and 72 hours later. An assessment tool was developed for the 60 patients who were too ill to complete their own questionnaire. The tool demonstrated excellent inter-rater reliability. Thirty-four percent of patients in the hydromorphone group and 27% of those in the morphine group died before completion of the study (P = 0.66). The hydromorphone group required more analgesia for breakthrough pain in the first 24 hours of the study (P = 0.03) and had a greater improvement in the behavior of frowning on movement and the comfort visual analogue scale (P = 0.08) over the course of the study. Adverse effects were rare and similar in both groups. This study found hydromorphone to be at least as effective as morphine when delivered by continuous subcutaneous infusion.

Analgesic infiltration at the site of bone marrow harvest significantly reduces donor morbidity

Little information has been published concerning the severity of pain experienced by bone marrow donors or the use of local analgesia following bone marrow harvesting procedures. The aims of this study were to assess duration and severity of pain experienced by bone marrow donors and the effectiveness of bupivacaine as a local analgesic agent following bone marrow harvest. During a single blinded randomised study of 24 bone marrow donors, 10 ml of 0.5% bupivacaine was infiltrated either into the right or left posterior iliac crest of the donor immediately following bone marrow harvest. Donors were requested to record the level of pain experienced at the right and left harvest sites on a pain rating score sheet (0-10) at time intervals of 4, 8, 12, 24, 48 and 72 h following harvest. A significant reduction in pain was experienced at the harvest site infiltrated with bupivacaine when compared with the control site during the first 3 days post-harvest. It is recommended that bupivacaine be infiltrated routinely into the harvest sites of all bone marrow donors to reduce the pain experienced in the 3 days following harvest.

The risk of Guillain-Barré syndrome following infection with Campylobacter jejuni

To estimate the incidence of Guillain-Barré syndrome (GBS) following Campylobacter jejuni infection (CI) we studied three populations where outbreaks of CI had occurred involving an estimated 8000 cases. No case of GBS was detected in the 6 months following the outbreaks in the local populations. The point estimate for the risk of GBS following CI estimated in this study was 0 in 8000 (95% confidence interval 0-3).

Apodizing holographic gratings for dual-wavelength operation of broad-area semiconductor lasers

Apodizing holographic gratings are designed to have a Gaussian reflectivity profile in the -1 order and a complementary reflectivity profile in the specular (0) order. They are obtained by the interference of two Gaussian beams on a glass plate covered with a photoresist. These gratings are intended to be used as the coupler of the external cavity of a broad-area semiconductor laser. When the grating is oriented to get the -1 order counterpropagating with respect to the incident beam, single-longitudinal- and single-lateral-mode operation is obtained. We report on the fabrication technique of an apodizing holographic grating designed to allow lasing on two wavelengths simultaneously, with a preselected wavelength separation. The results obtained with a commercial broad-area laser are presented.

Epidemiological explanation of an outbreak of gastro-enteritis in Sweden in the absence of detailed microbiological information

Waterborne gastroenteritis outbreaks have often gone undetected or been incompletely defined in terms of source and extent. Methods which allow detection or clarification of such events are therefore useful. We describe the methods used to detect and investigate such an outbreak. In autumn 1996 high school absence rates and the rate of parents absent from work to care for sick children suggested a health problem in a Swedish town which had a history of unexplained outbreaks of gastrointestinal disease. A systematic sample of 300 households was surveyed by post. Respondents represented 10% of the total population of the town. Questions concerning symptoms and exposures were included. The same questionnaire was used in a nearby town as a control. Sixty four percent of respondents reported an acute gastrointestinal illness during a two month period. Diarrhoea (90%) and abdominal pain (88%) were the most frequent symptoms among the sick. Two percent of those sick sought medical care. Exposures associated with disease were being a member of a large household, young age, and consumption of water from the community water supply. Attack rate showed a dose response relationship with increasing frequency of water consumption. The peak incidence of gastrointestinal illness occurred shortly after raw water quality control data had shown a rise in indicator bacteria. Further analysis, dividing those infected into groups according to when they became ill and whether they were the first member of their household to fall ill, supported the hypothesis of primary cases being infected from the water supply with some secondary person to person spread.

Noise reduction in a mode-locked semiconductor laser by coherent photon seeding

We have used coherent photon seeding to reduce the noise in an actively mode-locked extended-cavity semiconductor laser. Feedback is provided by an auxiliary cavity terminated either by a wedge plate or by a phase-conjugate mirror. Both conventional and phase-conjugate feedback can reduce the low-frequency noise components (0-5 MHz) by as much as 36 dB, hence drastically reducing the pulse fluctuations. A noise reduction of as much as 18 dB is also observed in the 0.01-3.0-GHz frequency range. We obtained these results while preserving the pulse duration (26 ps) and improving the time-bandwidth product.

Apodizing holographic gratings for the modal control of semiconductor lasers

We first present the fabrication technique of apodizing holographic gratings. Gratings with a spatially variable reflectivity profile were obtained by the interference of two Gaussian beams on a glass plate covered with a photoresist. When the exposure time was short enough to avoid saturation of the photoresist, gratings with a quasi-Gaussian reflectivity profile for the beam reflected in the -1 order were produced; the reflectivity at the center could be as high as 71%, and the half-width of the reflectivity profile at the e(-1) position could be as small as 180 mum. Apodizing gratings were used as the end mirror of the external cavity of a broad-area semiconductor laser. Single longitudinal- and lateral-mode operation was observed over the full range of allowed injection currents.

DAMAGE TO THE SUPERIOR GLUTEAL NERVE AFTER THE HARDINGE APPROACH TO THE HIP

We studied prospectively 81 consecutive patients undergoing hip surgery using the Hardinge (1982) approach. The abductor muscles of the hip in these patients were assessed electrophysiologically and clinically by the modified Trendelenburg test. Power was measured using a force plate. We performed assessment at two weeks, and at three and nine months after operation.

At two weeks we found that 19 patients (23%) showed evidence of damage to the superior gluteal nerve. By three months, five of these had recovered. The nine patients with complete denervation at three months showed no signs of recovery when reassessed at nine months. Persistent damage to the nerve was associated with a positive Trendelenburg test.

Damage to the superior gluteal nerve after the Hardinge approach to the hip

We studied prospectively 81 consecutive patients undergoing hip surgery using the Hardinge (1982) approach. The abductor muscles of the hip in these patients were assessed electrophysiologically and clinically by the modified Trendelenburg test. Power was measured using a force plate. We performed assessment at two weeks, and at three and nine months after operation. At two weeks we found that 19 patients (23%) showed evidence of damage to the superior gluteal nerve. By three months, five of these had recovered. The nine patients with complete denervation at three months showed no signs of recovery when reassessed at nine months. Persistent damage to the nerve was associated with a positive Trendelenburg test.

Improvement of the lateral-mode discrimination of broad-area diode lasers with a profiled reflectivity output facet

The emission of a broad-area laser always contains several lateral modes (along the junction plane) even at low drive levels. To increase the discrimination against high-order lateral modes, we developed simple techniques for depositing a profiled thin layer of SiO on the output facet of a broad-area laser that has a 75-μm-wide injection current stripe. The profiled coating provided a nearly Gaussian reflectivity in the lateral direction (parallel to the junction plane). The resolved near-field spectra of the uncoated and coated lasers have been compared. The maximum output power in the single-lateral-mode regime was pushed to 25 mW with the profiled coating, compared with a corresponding power of less than 1 mW before deposition. Experimental results have confirmed the behavior predicted by our numerical simulations. This method is scalable to higher-power lasers.

Antiepithelial cell antibodies do not impair paediatric renal allograft survival but appear to be associated with acute viral infections

There is a reported association between antiepithelial cell (AEC) antibodies and increased renal allograft loss in paediatric recipients. Our unit experienced a dramatic fall in 1-year graft survival so we undertook a study to determine if AEC antibodies could account for such losses. We also studied healthy children and adults as well as a group of individuals with serologically proven viral infection in an attempt to determine the prevalence and possible aetiology of these antibodies. Sera were screened for AEC antibodies in a microcytotoxicity test using a lung epithelial cell line (A549) as target. The prevalence of these antibodies in our paediatric recipients was similar to that reported elsewhere but we found no correlation between the presence of AEC antibody and allograft loss. Within the control populations, we found the antibody was more prevalent in children than in adults (p < 0.0001). We also found a strong age banding pattern, with antibody being present in 50% of children under 10 years and declining with increasing age, so that by the age of 16 years the seroprevalence was similar to that found in our adults. However, AEC antibody had a significantly higher prevalence in individuals with active viral infection than in our healthy control groups (p = 0.00003). A positive association was noted between rubella and respiratory syncytial virus and AEC antibody presence and a negative association with varicella zoster. We conclude that AEC antibodies do not correlate with increased paediatric renal allograft loss but appear to be linked to certain viral infections.

Biochemistry of cell death

Apoptosis is a common feature of the nervous system, occurring physiologically during development and pathologically in several diseases. In view of the latter, pathways that regulate apoptosis in neurones are of particular interest, and recent advances in this field implicate several signalling pathways in the induction of apoptosis, after withdrawal of nerve growth factor. Recent information drawn from both mammalian and invertebrate models enables us to assign components of the apoptotic pathway as either regulators or effectors.

Sixth nerve palsy: an unusual manifestation of preeclampsia

BACKGROUND

Neurologic abnormalities may occur in pregnancy as a manifestation of neurologic or systemic disease. We present an unusual case of preeclampsia presenting with a sixth nerve lesion.

CASE

A 33-year-old woman, gravida 2, presented at 38 weeks' gestation with sixth nerve palsy. She was hypertensive and proteinuric, with plasma urea of 24 mg/dL. Labor was induced and hypertension escalated in the early puerperium, with concomitant worsening diplopia. Blood pressure control and resolution of preeclampsia were followed by resolution of the sixth nerve lesion. There was no evidence of other pathology on extensive investigations.

CONCLUSION

Sixth nerve palsy is an unusual manifestation of preeclampsia.

Peptide glyoxals: a novel class of inhibitor for serine and cysteine proteinases

A series of novel synthetic dipeptides, containing a C-terminal glyoxal grouping (-COCHO), have been tested as inhibitors against typical members of the serine- and cysteine-proteinase families. For example, the sequences benzyloxycarbonyl (Cbz)-Pro-Phe-CHO (I) and Cbz-Phe-Ala-CHO (II), which fulfil the known primary and secondary specificity requirements of chymotrypsin and cathepsin B respectively, have been found to be potent reversible inhibitors of their respective target proteinase. Thus I was found to inhibit chymotrypsin with a Ki of approximately 0.8 microM, whereas II exhibits a Ki of approximately 80 nm against cathepsin B. These Ki values are some 10-fold and 3-fold lower than those reported for the corresponding peptide-aldehyde inhibitors of chymotrypsin and cathepsin B upon which the peptidyl-glyoxals were fashioned. Unexpectedly, the sequence Cbz-Pro-Ala-CHO, which was designed to inhibit elastase-like proteinases, exhibited no inhibitory activity towards porcine pancreatic elastase, even when used at concentrations as high as 200 microM.

Noise reduction in an argon laser with a phase-conjugating external cavity

The reinjection of a small fraction of the output beam back into the laser cavity is shown to improve the signal-to- noise ratio of a cw multilongitudinal mode Ar(+) laser efficiently. The argon laser is coupled to an external cavity terminated by a phase-conjugate mirror in order to obtain a self-aligned coupled cavity. With the external cavity, the signal-to-noise ratio has been significantly improved. The low-frequency noise components are reduced by up to 15 dB, and the frequency components of the spectrum of the longitudinal-mode beating are attenuated by factors reaching 46 dB.

High-order transverse modes of misaligned laser resonators with Gaussian reflectivity mirrors

Analytical expressions of high-order transverse modes of misaligned laser resonators with Gaussian reflectivity mirrors are presented. We found that modal discrimination is independent of the mirror tilt angle. The propagation laws of the beam parameters are also discussed.

Oxygen saturation during transfer from operating room to recovery after anaesthesia

Transcutaneous oxygen saturation of haemoglobin was measured in 101 patients en route from the operating room to the recovery room. Twenty-nine became significantly hypoxaemic during the journey. The incidence of hypoxaemia was not found to relate to age, weight, duration or type of surgery, type of anaesthesia or pre-existing disease. Duration of the interval between cessation of oxygen in the operating room and arrival in recovery room was the only significant finding in patients who became hypoxaemic.

Parainfluenza virus bronchiolitis. Epidemiology and pathogenesis

An investigation of the epidemiology and pathogenesis of bronchiolitis due to parainfluenza virus (PV) was carried out. Bronchiolitis due to PV occurred most commonly in non-Caucasian males. Breast-fed infants exhibited a reduced risk of developing bronchiolitis. Once an episode of PV bronchiolitis occurred, both exposure to cigarette smoke and bottle feeding were associated with an increased frequency of recurrent wheezing, and subsequent infection with respiratory virus almost uniformly resulted in wheezing. Cell-mediated immune responses to PV antigen and titers of PV-specific IgE were greater among patients with bronchiolitis than among patients with upper respiratory tract infection. The epidemiology and pathogenesis of bronchiolitis due to PV is similar to that of respiratory syncytial virus. Lower respiratory tract infection may predispose to episodes of bronchoconstriction on subsequent exposure to cigarette smoke or other viral infections.

Large-size Gaussian mode in unstable resonators using Gaussian mirrors

Gaussian modes with large sections have been experimentally produced in Cassegrain resonators using Gaussian reflectivity convex couplers. The far field of the beam, which was coupled through a Gaussian coupler, was found to be free from secondary rings.

Hypercalcemia: long-term follow-up with matched controls

Using laboratory tests and the presence of complaints thought to be associated with hyperparathyroidism, we retrospectively studied 160 patients found to have hypercalcemia on a routine multiphasic examination in two different calendar years. Each case was compared to a matched control, and mean follow-up was 8.5 yr. The diagnosis of presumptive hyperparathyroidism was made by attempting to eliminate any confounding causes of hypercalcemia and by performing parathyroid hormone assays in 41 unoperated patients. Fifteen patients had a parathyroid adenoma removed (12 during and 3 after the duration of the study). Except for an increase in the incidence of hypertension in black male patients, we noted no significant differences in symptomatology or renal function between patients and matched controls. We conclude that most patients with mild persistent (presumptive) hyperparathyroidism may be left untreated under surveillance for long periods of time without the development of significant complications.

Role of parainfluenza virus-specific IgE in pathogenesis of croup and wheezing subsequent to infection

In order to determine the role of parainfluenza virus-specific IgE antibody production and release of histamine in the pathogenesis of lower respiratory disease caused by parainfluenza virus infection, we studied 84 infants and children at the time of parainfluenza virus infection. Parainfluenza virus-IgE antibody was detected in samples of nasopharyngeal secretions by means of an enzyme-linked immunosorbent assay, and histamine content of nasopharyngeal secretions was determined by a fluorometric technique. Virus-specific IgE responses appeared earlier and were of greater magnitude in patients with croup, wheezing, and croup with wheezing caused by parainfluenza virus infection than in patients with parainfluenza virus-induced upper respiratory illness. Histamine was detectable in nasopharyngeal secretions of patients with parainfluenza virus-related croup significantly more often than in patients with upper respiratory illness caused by parainfluenza virus. These observations suggest a role for immunologic mechanisms in the pathogenesis of severe forms of respiratory illness caused by parainfluenza virus infection.

Reserpine and breast cancer

After a series of studies on the linkage of reserpine with breast cancer, both evidence and interpretation appeared to be in conflict. Our case-control survey of long-term, comprehensive records from the Kaiser Foundation Medical Care Program, on 108 hypertensive breast cancer cases and 324 hypertensive controls, matched by year of birth and by race, produces a significant positive association between reserpine use and breast cancer. However, the association vanishes upon further matching with respect to the year of the first hypertension diagnosis and the subsequent length of follow-up. We thus fail to support suspicions of causality.