The conditional survival statistics for survivors with primary supratentorial astrocytic tumors

BACKGROUND

Relative survival rates can offer a general description of tumor outcome and, traditionally, are used for surveillance and comparison purposes. However, they are not informative for individual tumor survivors. Conditional survival estimates can calculate the probability of surviving next some years given survival to a specific period of time after craniotomy for individual tumor survivors. However, clinically, they have not been used for predicting the tumor outcome.

METHODS

We calculated conditional probabilities of survival within 6 years after craniotomy in 112 patients with primary supratentorial astrocytic tumors and evaluated factors affecting the survival time more than 2 years after craniotomy.

RESULTS

Our data showed that the conditional probability of survival can predict yearly survival rate when patients survive for a specific period of time. The conditional survival rates within 6 years after craniotomy were always higher than those evaluated by relative survival rates. Overall, the longer the patients survived, the higher the conditional probabilities of surviving sixth year postoperatively were.

CONCLUSION

Our study demonstrates the conditional probabilities of survival have good availability and are important estimates for individual tumor survivors.

Kinetics of reductive denitrification by nanoscale zero-valent iron

Zero-valent iron powder (Fe0) has been determined to be potentially useful for the removal of nitrate in the water environment. This research is aimed at subjecting the kinetics of denitrification by nanoscale Fe0 to an analysis of factors affecting the chemical denitrification of nitrate. Nanoscale iron particles with a diameter in the range of 1-100 nm, which are characterized by the large BET specific surface area to mass ratio (31.4 m2/g), removed mostly 50, 100, 200, and 400 mg/l of nitrate within a period of 30 min with little intermediates. Compared with microscale (75-150 microm) Fe0, end product is not ammonia but N2 gas. Kinetics analysis from batch studies revealed that the denitrification reaction with nanoscale Fe0 appeared to be a pseudo first-order with respect to substrate and the observed reaction rate constant (k(obs)) varied with iron content at a relatively low degree of application. The effects of mixing intensity (rpm) on the denitrification rate suggest that the denitrification appears to be coupled with oxidative dissolution of iron through a largely mass transport-limited surface reaction (<40 rpm).

Norms for the Wisconsin Card Sorting Test in 6- to 11-year-old children in Taiwan

The main aims of this study were to develop norms for the Wisconsin Card Sorting Test in 6- to 11-year-old children in Taiwan; to explore the effect of sex, age, birth order, number of siblings, and parental education on WCST performance in 6- to 11-year-old children; and to make a comparison of WCST performance between children in Taiwan and the USA. The results of this comparison of developmental norms of school children in Taiwan and the United States may facilitate the WCST as a clinical or research instrument in combination with other test procedures to assess aspects of cognitive and neuropsychological functioning of school children.

Metabolic instability of Escherichia coli cyclopropane fatty acid synthase is due to RpoH-dependent proteolysis

Cyclopropane fatty acids (CFAs) are generally synthesized as bacterial cultures enter stationary phase. In Escherichia coli, the onset of CFA synthesis results from increased transcription of cfa, the gene encoding CFA synthase. However, the increased level of CFA synthase activity is transient; the activity quickly declines to the basal level. We report that the loss of CFA activity is due to proteolytic degradation dependent on expression of the heat shock regulon. CFA synthase degradation is unaffected by mutations in the lon, clpP, and groEL genes or by depletion of the intracellular ATP pools. It seems likely that CFA synthase is the target of an unidentified energy-independent heat shock regulon protease. This seems to be the first example of heat shock-dependent degradation of a normal biosynthetic enzyme.

Familial breast cancer in southern Taiwan

The purpose of this study is to evaluate whether there are pathobiologic differences and differences in overall rates survival between familial and non-familial breast cancer patients in Taiwan. A retrospective study was performed evaluating 76 familial breast cancer patients in 69 families, which included two BRCA1 related cases and six BRCA2 related cases. Patients were compared with 425 non-familial sporadic cases. Familial breast cancer patients had similar ages and stages as non-familial patients (mean, 46.6 years vs 48.9 years, p = 0.306). However, the familial breast cancer patients with BRCA1 and BRCA2 related cases presented at lower stages (p = 0.034) and younger ages than non-familial patients (mean, 45.1 years vs 48.9 years P = 0.042). The occurrence of infiltrating ductal carcinoma and lobular carcinoma in situ was not significantly different in the two groups. Mucinous carcinoma was represented with 6.7% (4/76) and 1.3% (1/76) medullary carcinoma. The overall grade of familial breast cancer, including BRCA1 and BRCA2 related cases in 8 infiltrating ductal carcinoma, was significantly higher than that of controls. The mean follow up was 4.5 years for familial breast cancers. Five- and 10-year overall survival rates were 69% and 61% for those with a family history, compared with 86% and 64% for those in the control group (p = 0.644). There were no statistically significant differences in disease-free survival rates between the two groups at 5 or 10 years (69% vs 78% in 5 years; 48% vs 58% in 10 years) (p = 0.862). Despite the younger ages and earlier stages at presentation in familial breast cancer patients with BRCA1 and BRCA2 related cases, the familial breast cancer patients had higher grade patholobiologic characteristics, but similar prognoses when compared with sporadic breast cancer patients. Owing to the limited number of familial cases in this study, more cases and longer follow up are needed.

The mental health in mothers with autistic children: a case-control study in southern Taiwan

The aim of this study was to investigate the impact of autistic children on the mental health of their mothers. Autism is a complicated neuropsychiatric disorder. Evidence shows that mothers with autistic children experience greater stress than those having children with other chronic diseases. In this study we have 1) assessed the mental health of mothers with autistic children; 2) determined their prevalence of minor psychiatric morbidity (MPM); 3) classified their MPM; and 4) determined factors related to their mental health. A case-controlled design was used to compare the mental status among mothers having children with either autistic (n = 30), or Down syndrome (n = 11) and with normal children (n = 56). The mean score of the Chinese Health Questionnaire (CHQ) showed no differences between those mothers of case and control groups. Using a 9-point criterion to screen for MPM in the CHQ, more mothers (37%) in the case group had scores > or = 9 compared with the control group (18%). Mothers of the case group had significantly higher for MPM using logistic regression analysis. The educational level was inversely related to the CHQ scores. Mothers with a CHQ score > or = 9, were later diagnosed with either depression (36%) and anxiety (46%); or anxiety and depression (9%). A primary care model for mothers with autistic children should therefore be developed to prevent them from developing mental disorders.

Suspended rice particles for cultivation of Monascus purpureus in a tower-type bioreactor

Cultivation of Monascus purpureus (CCRC 31615) for the production of natural pigments was investigated. Traditionally, Monascus species were grown on rice by solid-state culture. For large-scale cultivation, solid-state cultures were associated with some problems such as contamination and scale-up. By using submerged cultures with rice particles, a stirred-tank fermentor was not suitable for submerged cultures as the impeller tended to break the particles into small pieces. A conventional bubble column was also unsuitable as its mixing capability was poor. In the present study, a modified bubble column with wire-mesh draft tubes was employed for the cultivation of M. purpureus. The proposed column had a shorter mixing time and a higher oxygen transfer rate relative to the conventional bubble column. The production of pigments using the proposed column was up to 80% higher than that achieved using the conventional bubble column.

Invasion of the brain and chronic central nervous system infection after systemic Mycobacterium avium complex infection in mice

Central nervous system (CNS) infections caused by nontuberculous mycobacteria have been described previously, especially in patients with AIDS. To investigate specific aspects of the pathogenesis of this entity, C57BL bg(+)/bg(-) mice were infected intravenously with Mycobacterium avium, and cultures of blood and brain as well as histopathology examination of brain tissue were carried out at several time points up to 6 months after infection. Low-grade inflammatory changes with small aggregates of lymphocytes and macrophages as well as perivascular cuffing were seen early in the infection. A small number of bacteria could be observed in the parenchyma of the choroid plexus. Six months after infection, numerous bacteria were present within the foamy macrophage of the granulomatous lesions along the ventricle and meninges. None of the mice developed clinical signs of meningitis or encephalitis or even died spontaneously during the period of observation. Use of CD18(-/-) knockout mice indicated that transport of the bacterium within neutrophils or monocytes into the brain is unlikely. Mild chronic CNS infection developed in the mice during sustained systemic M. avium infection, similar to what has been reported in most human cases.

Transtentorial cerebellar c-jun expression after focal cerebral cortical injury in mice

Delayed and remote effect of focal cerebral cortical lesion on cerebellum remains unclear. The c-Jun, an inducible transcription factor of cellular immediate early gene, is the predominant transcription factor and consistent marker for neurons that respond to stress or injury. We use a mouse cryogenic injury model to study the spatial and temporal changes of c-jun in the cerebellum after focal neocortical lesion. A transient and moderate expression of c-jun mRNA was found in the cerebellum with central dominance since 3 day postinjury and gradually subsided within 2 weeks. A distinct increment of c-Jun protein expression in Purkinje cells of the bilateral cerebellar hemispheres with focal connotation in the vermis was detected since 1 week postinjury. These findings suggest that the delayed and remote c-jun expression of the cerebellum, functionally connected with the cerebral cortex, indicate transneuronal gene activation.

An abnormal cholesterol profile in young adults with normocholesterolemic cerebral ischemia

An abnormal cholesterol fraction can still be able to provoke cascades of lipidic atherogenesis even when the serum TC level is within normal range (< 200 mg%). However, there is a shortage of convincing data concerning cerebral atherogenesis in young Asians who have a different diet habit and living style from those in western countries. In this study, we examined the lipoprotein-cholesterol profile in young Taiwanese patients with noncardiac cerebral ischemia (NCCI) whose serum TC level was < 200 mg% and 200-250 mg%. The results showed a decrease of HDLC and an increase of VLDLC in patients with TC < 200 mg%, but only a decrease of HDLC in patients with TC = 200-250 mg%. The cholesterol fraction metabolism is obviously perplexed in NCCI subjects. These findings were not related to their associated risk factors. Accordingly, a derangement of cholesterol fraction with normal serum TC level can also incite lipidic cerebral atherogenesis in young Taiwanese adults. Therefore, a detailed evaluation of cholesterol profile should be born in mind in young eastern NCCI patients despite of a normal serum TC level. Tailored measure of diet and living should be modified to prevent lipidic atherogenesis in our society in future.

A study of the professional commitment changes from nursing students to registered nurses

The purposes of this longitudinal study were to understand the professional commitment changes from nursing students to registered nurses. A total of 890 subjects completed the questionnaires of the nursing professional commitment and personality test before their graduation, and nursing professional commitment one year after their graduation, respectively. The data were analyzed by mean, correlation, t-test and repeated measures ANOVA. The results showed that: (1) the nurses exhibited a medium-high degree of professional commitment--the average score was 2.99 before graduation and 2.85 after graduation; (2) there was a highly significant correlation between professional commitments for nursing students and registered nurses; (3) The scores of overall commitment and four factors of professional commitment decreased from nursing students to registered nurses significantly; (4) personality traits were positively correlated with professional commitment for nursing students and registered nurses; and (5) there was no significant relationship between nurses' work backgrounds and the changes of professional commitment from nursing students to registered nurses. Implications for nursing education and for hospital management are suggested.

Neuroprotective effects of an antioxidant in cortical cerebral ischemia: prevention of early reduction of the apurinic/apyrimidinic endonuclease DNA repair enzyme

We examined the effects of the free radical scavenger, 21-aminosteroid, on apurinic/apyrimidinic endonuclease (APE/Ref-1) protein expression and subsequent infarction volume after photothrombotic cortical cerebral ischemia in mice. Immunohistochemistry and Western blot analysis showed a significant reduction in APE/Ref-1 expression 6 and 24 h after ischemia in untreated animals, whereas in drug-treated animals the reduction was much less at the same time points. The administration of 21-aminosteroid significantly decreased subsequent infarction volume 3 days after ischemia. These data suggest that 21-aminosteroid prevents the early decrease of APE/Ref-1 expression, thereby reducing cortical infarction after photothrombotic cerebral ischemia.

D-Allose catabolism of Escherichia coli: involvement of alsI and regulation of als regulon expression by allose and ribose

Genes involved in allose utilization of Escherichia coli K-12 are organized in at least two operons, alsRBACE and alsI, located next to each other on the chromosome but divergently transcribed. Mutants defective in alsI (allose 6-phosphate isomerase gene) and alsE (allulose 6-phosphate epimerase gene) were Als(-). Transcription of the two allose operons, measured as beta-galactosidase activity specified by alsI-lacZ(+) or alsE-lacZ(+) operon fusions, was induced by allose. Ribose also caused derepression of expression of the regulon under conditions in which ribose phosphate catabolism was impaired.

Organization of HIV-1 pol is critical for Pol polyprotein processing

The HIV pol sequentially encodes protease (PR), reverse transcriptase (RT), and integrase (IN) from the 5'-3' direction. We explored the significance of this gene arrangement. All six possible gene dispositions were examined. In two situations where PR was removed from the leading place and no two genes were in their original location, viral polyprotein processing was abolished. Processing of the polyprotein did not occur when IN was translocated to the front of PR-RT. However, in the following two arrangements, the polyprotein was processed but only at specific sites. First, PR remained in the leading position while the locations of RT and IN were exchanged; viral polyprotein was processed at a site between the upstream transframe peptide (TF) and PR. Second, PR was placed after RT-IN and located at the distal end of Pol. Processing occurred only at the created junction between TF and RT. These results indicated that cleavage after TF occurred autocatalytically but did not proceed to a second site, which needed an extraneous PR for trans-action. Therefore, arranging Pol in the order of PR-RT-IN warrants the streamline processing of the polyprotein once the autocleavage is initiated.

Influence of polymorphism at p53, CYP1A1 and GSTM1 loci on p53 mutation and association of p53 mutation with prognosis in lung cancer

BACKGROUND

We previously found that the majority (9/11) of p53 tumor suppressor gene mutations in 60 lung cancer patients in Taiwan were small intragenic deletions and nonsense mutations. To gain insights into the possible etiologic factors involved in these mutations and the prognostic significance of p53 gene mutations in lung cancer in Taiwan, we investigated the influence of polymorphism at p53, cytochrome p450 1A1 (CYP1A1) and glutathione S-transferase M1 (GSTM1) loci on p53 gene mutation, and the association of p53 gene mutation with prognosis in these lung cancer patients.

METHODS

The polymorphism of these genes was determined by polymerase chain reaction followed by restriction enzyme digestion. The Pearson chi 2 test was used to compare allelic distributions between lung cancer patients and controls. The log-rank test was used to assess the significance of the survival differences between patients with and without p53 mutations.

RESULTS

There was no significant difference with respect to the genotype distribution of p53, CYP1A1 and GSTM1 polymorphisms between patients with and without p53 mutations, although a tendency toward increasing frequency of the wild-type homozygote genotype of p53 polymorphism was noted in lung cancer patients containing p53 mutations. We further analyzed the association of p53 mutation with prognoses in lung cancer patients for whom postoperative survival data were available. The estimated median survival times for patients with and without p53 mutation were 25 and 28 months, respectively. There was no significant correlation between p53 mutation and survival.

CONCLUSIONS

Our data suggest that p53 gene mutation may not be associated with polymorphisms of p53, CYP1A1 and GSTM1 genes, and it may have no significant effect on the prognosis of lung cancer patients in Taiwan.

Membrane cyclopropane fatty acid content is a major factor in acid resistance of Escherichia coli

Cyclopropane fatty acid (CFA) formation is a post-synthetic modification of the lipid bilayer that occurs as cultures of Escherichia coli and many other bacteria enter stationary phase. We report the first distinct phenotype for this membrane modification; early stationary phase cultures of strains lacking CFA (as a result of a null mutation in the cfa gene) are abnormally sensitive to killing by a rapid shift from neutral pH to pH 3. This sensitivity to acid shock is dependent on CFA itself because resistance to acid shock is restored to cfa mutant strains by incorporation of CFAs from the growth medium or by introduction of a functional cfa gene on a plasmid. The synthesis of CFA depends in part on the RpoS sigma factor, but the role of RpoS in resistance to acid shock involves additional factors because strains with null mutations in both cfa and rpoS are more sensitive to acid shock than either single mutant strain. Exponential phase cultures of E. coli are much more sensitive to acid shock than stationary phase cultures, but survival is greatly increased if the exponential phase cultures are exposed to moderately acid conditions (pH 5) before shift to pH 3. We show that exposure to moderately acid conditions gives a marked increase in cfa transcription. The efficiency of the survival of acid shock is extremely strain dependent, even among putative wild-type strains. Much, but not all, of this variability can be explained by the partially or totally defective RpoS alleles carried by many strains.

Prognostic significance of p53 codon 72 polymorphism in lung carcinomas

Lung cancer is the leading cause of cancer death in Taiwan. Potential molecular markers associated with cancer susceptibility and prognosis are the genes involved in tumorigenesis. Therefore, we investigated the association of p53 codon 72 polymorphism with prognosis in 114 lung cancer patients. The estimated median survival times for patients with proline (Pro)/Pro, arginine (Arg)/Arg, and Arg/Pro genotypes were 25, 26 and 36 months, respectively. We also found that patients with the Pro/Pro genotype had a worse prognosis compared with those with Arg/Pro genotypes, especially for patients with squamous cell lung cancer (P = 0.013), male patients (P = 0.028) and those aged 60-69 years (P = 0.052). In patients with early stage lung cancer, patients with Pro/Pro and Arg/Arg genotypes had a tendency for a worse prognosis than those with the Arg/Pro genotype (P = 0.057). Our data suggest that p53 codon 72 polymorphism may be a potential prognostic factor in certain sub groups of lung cancer patients in Taiwan.

Effect of ppGpp on Escherichia coli cyclopropane fatty acid synthesis is mediated through the RpoS sigma factor (sigmaS)

Strains of Escherichia coli carrying mutations at the relA locus are deficient in cyclopropane fatty acid (CFA) synthesis, a phospholipid modification that occurs as cultures enter stationary phase. RelA protein catalyzes the synthesis of guanosine-3',5'-bisdiphosphate (ppGpp); therefore, ppGpp was a putative direct regulator of CFA synthesis. The nucleotide could act by increasing either the activity or the amount of CFA synthase, the enzyme catalyzing the lipid modification. We report that the effect of RelA on CFA synthesis is indirect. In vitro and in vivo experiments show no direct interaction between ppGpp and CFA synthase activity. The relA effect is due to ppGpp-engendered stimulation of the synthesis of the alternative sigma factor, RpoS, which is required for function of one of the two promoters responsible for expression of CFA synthase.

p53 codon 72 polymorphism in Taiwanese lung cancer patients: association with lung cancer susceptibility and prognosis

An association between the BstUI (Pro/Pro) genotype of the p53 codon 72 polymorphism and lung cancer has been reported previously (X. Jin et al., Carcinogenesis (Lond.), 16: 2205-2208, 1995). However, the genotype distribution of p53 codon 72 polymorphism as well as the association of this polymorphism with lung cancer risk and prognosis remain undefined in the Taiwanese population. Therefore, we investigated the genotype distribution of p53 codon 72 polymorphism in 194 lung cancer patients and 152 noncancer controls. The genotype frequencies in Taiwanese noncancer controls were 0.56 (Arg) and 0.44 (Pro). Chi2 analysis indicated significant differences in genotype distribution of p53 from other reports in Swedish (P < 0.001), Spanish (P < 0.001), Caucasians in the United States (P = 0.002), and African-Americans (P = 0.027). In addition, our data suggest that the Pro allele of the p53 codon 72 polymorphism increased the risk of lung cancer among female Taiwanese. The female patients with genotype Pro/Pro showed a significantly increased odds ratio (3.14; confidence interval, 1.48-6.64; P = 0.003) of having lung adenocarcinoma, compared with normal controls with the other genotypes. Patients with the Pro/Pro genotype had an odds ratio of 2.63 (confidence interval, 1.22-5.68; P = 0.01) higher than those with the other genotypes to be diagnosed with lung cancer at the early ages. We further investigated the association of p53 codon 72 polymorphism with prognosis in 133 lung cancer patients. Patients with the Pro/Pro genotype tended to have poorer prognosis than those with the Arg/Pro genotype (P = 0.05, by the log-rank test). Our data suggested that p53 codon 72 polymorphism may play a role in cancer susceptibility and prognosis in specific classes of lung cancer patients in Taiwan.

Modulation of MAP kinase signaling and growth characteristics by the overexpression of protein kinase C in NIH3T3 cells

This study was performed to examine effects of the overexpression of protein kinase C (PKC) isoforms (i.e., beta I, beta II, gamma, delta, eta, and zeta) on mitogen-activated protein (MAP) kinase (Erk-1 and -2) signaling and growth characteristics of NIH3T3 cells. Phorbol ester (PMA) activated endogenous and ectopically expressed PKC alpha, beta I, beta II, gamma, delta, epsilon, and eta. Overexpression of the examined PKC isoforms enhanced PMA-induced MAP kinase activation. Potentiation of MAP kinase activation was also observed upon stimulation of cells with platelet-derived growth factor (PDGF) although there was no indication for the activation PKC isoforms by PDGF. Inhibition of PKC blocked PMA- but not PDGF-induced MAP kinase activation. Thus, potentiation of PDGF-induced MAP kinase activation appears to be independent to PKC activity, while PMA-induced MAP kinase activation requires PKC activity. The ability of PKC isoforms to potentiate MAP kinase activation is not related to the growth characteristics of cells because individual PKC isoforms differentially regulated maximum density and proliferation of cells.

Bilateral cheiro-oral syndrome

Eight cases of pure bilateral cheiro-oral syndrome (COS) are reported. The location and etiology of lesion were well defined in six cases, including pontine infarct in three, and brainstem hemorrhage, unilateral thalamic infarct and bilateral subdural hematoma in one patient each respectively. Neuroimaging and neurophysiological studies were normal in another two patients. Taken together with the previous five reported cases of bilateral COS, pons is the most frequent site for presentation even in the absence of associated brainstem signs.

Antiplatelet drugs induce apoptosis in cultured cancer cells

In order to understand if antiplatelet drugs possess direct antineoplastic property, we tested the apoptotic effect of 5 popularly marketed antiplatelet drugs in Taiwan in 6 cultured cancer cell lines (Hep 3B hepatocarcinoma, U87-MG malignant glioma, PC-3 prostate adenocarcinoma, HeLa cervical adenocarcinoma, HL-60 preleukemia and K-562 chronic myelogenous leukemia). While acetylsalicylate and flunarizine exerted no effect on these cancer cells, pentoxifyline (PTX), dipyridamole (DYA) and ticlopidine hydrochloride (T. HCl) displayed a time and dose-dependent apoptotic effect on them except for HL-60 and K-562 cells. PTX induced apoptosis in U87-MG, Hep 3B and HeLa cells, DYA in HeLa cells, while T. HCl in U87-MG, Hep 3B, PC-3 and HeLa cells. Adriamycin also provoked apoptotic effect in all 6 cell lines but neither PTX, DYA nor T. HCl acted synergy with adriamycin to HeLa cells, implicating that they may share a similar pathway for inducing apoptosis. Therefore, our results show that the antiplatelet drugs do possess antineoplastic property in vitro. A co-administration of antiplatelet drugs is noteworthy for an alternative adjunctive therapy in cancer patients.

Sulfhydryl chemistry detects three conformations of the lipid binding region of Escherichia coli pyruvate oxidase

Site-specific disulfide cross-linking experiments detected a conformational change within the C-terminal segment of Escherichia coli pyruvate oxidase (PoxB), a lipid-activated homotetrameric enzyme, upon substrate binding [Chang, Y.-Y., & Cronan, J. E., Jr. (1995) J. Biol. Chem. 270, 7896-7901]. The C-terminal lipid binding regions were cross-linked only in the presence of the substrate, pyruvate, and the thiamine pyrophosphate cofactor, indicating close proximity of a pair of C termini. We have now systematically substituted cysteine at 18 additional amino acid positions within the C-terminal region to obtain a panel of 21 proteins each having a single residue changed to cysteine. These proteins have been studied by disulfide cross-linking and by accessibility of the cysteine side chain to a variety of sulfhydryl agents. In the absence of pyruvate, the cysteine residues of the modified PoxB proteins failed to form disulfide bonds, generally failed to react with a large and rigid hydrophilic sulfhydryl reagent, 4-acetamido-4'-[(iodoacetyl)amino]stilbene-2,2'-disulfonic acid (IASD), and in some cases reacted weakly with a smaller more hydrophobic reagent, N-ethylmaleimide. Therefore, in this conformation, the C termini appear fixed in a rigid environment having limited exposure to solvent. In the presence of pyruvate, all of the C-terminal cysteine residues (except the two most distal from the C terminus) reacted with both sulfhydryl reagents and readily formed disulfide cross-linked species, indicating conversion to a structure having a high degree of conformational freedom. In the presence of lipid activators, Triton X-100 or dipalmitoylphosphatidylglycerol, a subset of the cysteine-substituted proteins no longer reacted with the membrane-impermeable IASD reagent, indicating penetration of these protein segments into the lipid micelles. For most of the proteins, similar extents of disulfide formation were seen upon addition of an oxidizing agent in the presence or absence of lipid activators. An exception was PoxB D560C which was much more readily cross-linked in the presence of lipid. Moreover, a subset of PoxB proteins that cross-linked to lower extents in the presence of lipids was found. The behavior of these proteins provides strong support for the model in which two C termini associate to form the functional lipid binding domain. These data are discussed in terms of three distinct PoxB conformers and the known crystal structure of a highly related protein.

Phorbol ester effects in atypical protein kinase C zeta overexpressing NIH3T3 cells: possible evidence for crosstalk between protein kinase C isoforms

To examine whether multiple protein kinase C (PKC) isoforms could interact or crosstalk, phorbol ester-insensitive atypical PKC (aPKC) zeta isoform was overexpressed in NIH3T3 cells, and the cells were stimulated with phorbol ester to activate diacylglycerol-dependent conventional (cPKC) and novel PKC (nPKC) isoforms. Treatment of cells with phorbol ester which activates PKCalpha, gamma, delta, and epsilon isoforms in NIH3T3 cells significantly reduced proliferation of cells. Overexpression of aPKCzeta and subsequent phorbol ester treatment abolished phorbol ester-induced reduction in cell proliferation. Overexpression of aPKCzeta also potentiated phorbol ester-induced mitogen-activated protein (MAP) kinase activation in a PKC-dependent manner. The effects of PKCzeta overexpression on proliferation and MAP kinase activation were proportional to the levels of aPKCzeta expression. Since aPKCzeta cannot be activated by phorbol ester, modulation of cell proliferation and MAP kinase activation by phorbol ester in aPKCzeta overexpressing cells might be due to the activation of cPKCs and/or nPKCs by phorbol ester. Thus, the results provide possible evidence for either direct or indirect crosstalk between PKC isoforms.

Prediction of total cholesterol: high-density-lipoprotein-cholesterol ratio in young adults

Abnormal cholesterol fraction is an essential risk factor for atherosclerosis of large cerebral arteries in young Asians. In order to reduce the medical cost and social resource for cholesterol electrophoresis, especially in undeveloped and developing Asian countries, we evaluated the validity of Nanji's GUT score for predicting TC: HDLC ratio in this population. Results showed that GUT score only predicted 71% of them. We also tested the predictive power of CUT index, and predicting rate was 81%. Therefore, Nanji's GUT score is not an ideal surrogate for cholesterol electrophoresis. We recommend CUT index to screen for high-risk subjects till a new method can satisfy the economic pattern in Asian countries.

The clinical experience of gaseous retroperitoneoscopic and gasless retroperitoneoscopy-assisted unroofing of renal cyst

BACKGROUND

The aim of this study is to compare the application of gaseous retroperitoneoscopic (GR) and gasless retroperitoneoscopy-assisted (GLRA) unroofing of renal cysts.

METHODS

Fourteen patients with symptomatic simple renal cysts had undergone unroofing of the cyst with GR in seven cases and GLRA in seven others. Three trocars (10 mm, 10 mm and 5 mm) were inserted in the GR procedure. A 3 cm flank muscle-split incision was made and retroperitoneoscopy was performed through the same incision in the GLRA procedure. Then, the cyst was unroofed.

RESULTS

The mean operative time was 104.3 minutes in the GR group and 52.1 minutes in the GLRA group, respectively (p = 0.001). The mean requirement of postoperative meperidine hydrochloride injection was 21.4 mg in the GR group and 71.4 mg in the GLRA group, respectively (p = 0.017). In the GR group, the mean postoperative stay was 3.7 days, and the time needed for return to normal activity was 7 days. In the GLRA group, the mean postoperative stay was 4.6 days, and the time needed for return to normal activity was 8 days.

CONCLUSIONS

GR and GLRA techniques for unroofing of renal cysts are safe, effective and minimally invasive. GLRA is easy to perform and a more time-saving procedure when compared to GR, however, the patients of GLRA suffered more postoperative pain than after GR. GLRA is recommended in patients who had received retroperitoneal surgery or who have multiple renal cysts.

Transient global amnesia and thalamic hemorrhage

A left rostral thalamic hematoma was found in a 52-year-old hypertensive man who suffered from a 10-h episode of transient global amnesia (TGA). A neuropsychological study revealed no cognitive impairment in a follow-up period for 5 years. The left rostral part of the thalamus appears to be responsible for his TGA, due probably to an interference of the mamillothalamic tract, ventroamygdalofugal pathway or dorsal noradrenergic bundle.

The effect of child-birth class on first-time fathers' psychological responses

The purpose of this study was to examine fathers' psychological responses to labor/delivery over time and to evaluate the effect of child-birth class on the father. A quasi-experimental and exploratory study was conducted with data collected at the 36th and the 39th weeks of pregnancy, and the first day of the postpartum period. 100 married, first-time expectant fathers in both the experimental and control groups were drawn from one medical center in southern Taiwan as a convenient sample. Three two-hour sessions of childbirth class, each lasting for one day, were conducted consecutively following the first data point for the experimental group. The "Chinese Health Questionnaire" and Zung's Self-rating Anxiety and Self-rating Depression Scales were used to obtain the first-time fathers' health status, anxiety, and depression scores at each data point. The two-way ANOVA with repeated measures was used to compare the means of psychological responses between experimental and control groups at each point in time. The main effect of classes on paternal health status, anxiety, and depression of the experimental group was not found and the limitations of the study were discussed.

The lipoprotein profile of young adults with cerebral atherosclerosis

In order to elucidate the relationship between the lipoprotein profile and large cerebral artery atherosclerosis in the young adults living in developing Asian countries, the serum lipoprotein profile and the luminal diameter of large cerebral arteries (internal carotid, middle/anterior cerebral and vertebrobasilar arteries) were measured and correlated in 67 young Taiwanese with non-embolic cerebral infarct (CI). Totally 23 (21.9%) patients had atherosclerotic stenosis. A significant elevation of the serum total cholesterol (TC), triglyceride, total lipids, beta-lipoprotein (beta-LP) and pre-beta-LP level was found in atherosclerotic CI patients. But multiple regression analysis showed only the serum beta-LP (p = 0.0041) and TC (p = 0.0324) level to be the independent risk factors for atherosclerosis. Secondary dyslipoproteinemia is the main cause for hyperlipoproteinemia in our atherosclerotic patients. Therefore, an abnormal lipoprotein profile is linked to large cerebral artery atherosclerosis in young Asians regardless of ethnic group. A tailored program is recommended to modify the life style and dietary habit, as well as to gain access to secondary control for large cerebral atherosclerosis prevention in developing countries.

Prognostic factors of primary aldosteronism

BACKGROUND

Primary aldosteronism (PA) is a rare but potentially curable cause of hypertension. Between October 1982 and November 1994, 30 patients of PA received unilateral adrenalectomy with a long-term follow up (mean:60.3 months). Nineteen (63.3%) cases were cured (Group 1); 11(36.7%) cases were improved (Group 2). The purpose of this study was to determine prognostic factors after surgery in patients with PA.

METHODS

A retrospective analysis was performed regarding age and sex of the patients, duration of hypertension, family history of hypertension, preoperative blood pressure, plasma aldosterone concentration (PAC), plasma renin activity (PRA) and efficacy of spironolactone on blood pressure between both groups. End-organs (including kidney, heart, retina and brain) involvement was evaluated and compared. Adrenalectomy and renal biopsy specimen for pathology were similarly evaluated.

RESULTS

The duration of hypertension was longer in Group 2 than in Group 1 (8.18 +/- 4.94 vs 5.21 +/- 4.24 years). The efficacy of spironolactone on blood pressure (BP) was positive in 81.8% of Group 1 and 16.7% of Group 2. Adrenal cortical adenoma in 24 cases with a cure rate of 70.8% (17/24) and adrenal cortical macronodular hyperplasia in 6 cases with a cure rate of 33.3% (2/6) were noted. Group 2 had more end-organs involvement than Group 1. The severity of histopathological change of the renal biopsy was similar.

CONCLUSIONS

This study suggests that preoperative response of blood pressure to spironolactone administration predicts the postoperative prognosis of hypertension in patient with PA. Long duration of hypertension and involvement of two or more end-organs were poor prognostic factors. Excellent results can be achieved by unilateral adrenalectomy in adrenal cortical adenoma and fair results, in adrenal cortical macronodular hyperplasia.

Delayed transhemispheric c-fos gene expression after focal cerebral ischemia-reperfusion in rats

Using a unilateral, focal, cortical, ischemia-reperfusion rat model, c-fos mRNA and Fos immunoreactivity in the brain were investigated. The study was divided into a series of reperfusion intervals which were carried out for a period of up to 7 days. The c-fos mRNA peaked in the ischemic cortex (about 15-fold) after 30 minutes of ischemia followed by 1 hour of reperfusion and dropped to baseline level after 1 day of reperfusion. Increased expression switched to the bilateral retrosplenial and frontal cortex, as well as the left (nonischemic) parietal cortex, at 3- or 5-days of reperfusion (about three- to fourfold). Fos immunohistochemical staining correlated positively with the surge of c-fos mRNA. Nuclear run-off transcription assays further indicated that the increase in c-fos mRNA was regulated at the transcriptional level not only in the ischemic cortex (30 min of ischemia, followed by 1 h of reperfusion) but also in the contralateral counterpart (30 min of ischemia, followed by 3 d of reperfusion). A link between altered gene expression and diaschisis is suggested. The distant/delayed c-fos expression is probably caused by loss of inhibition from the ischemic cortex through a polysynaptic transneural pathway.

Fibromuscular dysplasia associated with intracranial giant aneurysm: report of a case

Although the correlation between fibromuscular dysplasia (FMD) and intracranial aneurysm is well established, the combination of FMD with a giant aneurysm is rare. This paper reports a patient with extracranial FMD associated with a giant intracavernous aneurysm compromising the trigeminal and abducens nerve. A review of the literature uncovered only four documented cases of FMD with concurrent giant intracranial aneurysms. The present case adds further weight to the argument for including FMD in the differential diagnosis list when confronted with a patient with a giant intracranial aneurysm. Absence of adequate collaterals in this patient eliminated ligation as a treatment strategy for the aneurysm.

An investigation of junior high students' attitudes toward amphetamine use and related forms of behavior

The purpose of the present study was to investigate the attitudes toward amphetamine use and some forms of behavior related to it. Two different kinds of junior high schools from southern Taiwan participated in this study. Five hundred and sixty-nine students supplied urine samples and filled in questionnaires. The results indicated that the prevalence rate of amphetamine use was 4.0% and the subjects had a fair level of cognition and very negative beliefs toward amphetamine use. Discriminant analyses indicated that access to amphetamine and the unlikelihood of being caught when using amphetamine were the two most important and meaningful variables in the distinction of previous using experience. School, grades, opinions about amphetamine use, the ease with which amphetamine could be obtained, and the severity of misbehavior were the most important variables in the prediction of the probable intention to use it, if amphetamine were available. However, because of the limited number of amphetamine users found in the study, any conclusions based on the results should be used cautiously. Strategies of prevention are suggested.

Correlations among height, leg length and arm span in growing Korean children

A cross-sectional study was performed to find out if any specific correlations exist among height, leg length and arm span in growing Korean children. Height, leg length and arm span were measured in 10,322 healthy children (4740 males and 5582 females). Computed ratios of leg length to height, leg length to arm span and arm span to height for the 3rd, 25th, 50th, 75th and 97th percentiles were made. It was found that the ratios of leg length to height, leg length to arm span, and arm span to height were bigger in taller children in the same age group than the shorter ones in both sexes. All the ratios were bigger in older children in the same percentile than the younger ones in both sexes, showing that the growth rates of leg length and arm span were bigger than that of height in general. However, growth of leg length is faster in shorter children than in taller children until the onset of puberty, after which growth of leg length in taller children is faster than in shorter children. The first and most rapid growth of leg length is seen from birth to 2 years, the second growth spurt is seen during the pubertal period. An exceptional increment in leg length between ages from 10 to 15 is also noted in taller children. After puberty, arm span grows faster than height until 17 years of age in the tallest male child, and taller children have longer arm span than height, while arm span in the shortest children never exceeds height.

Amphotericin B-induced leukoencephalopathy in a patient with cryptococcal meningitis

A 43-year-old male was diagnosed as having cryptococcal meningitis based on his clinical condition, cerebrospinal fluid (CSF) profile and high titer CSF cryptococcal antigen. The patient received intravenous amphotericin B at a total dose of 91 mg over 5 days. The therapy was then abandoned due to acute hepatorenal failure. The patient's neurologic status remained stable for 2 months, after which he began experiencing somnolence, confusion and a personality change. Cranial computed tomography revealed multifocal white matter lesions, and a brain biopsy showed a demyelination change with concurrent IgM and C1q deposition. A clinical diagnosis of amphotericin B-induced leukoencephalopathy was made. The patient's clinical condition was partially reversed after low-dose steroid therapy.

Posterior urethral valves: a report of five cases

From 1985 to 1993, five male patients with posterior urethral valves were treated at our hospital; they included three newborns, a 32-month-old and a 10-year-old child. On initial examination, all patients showed severe bilateral hydronephrosis and hydroureter on sonographic findings, dilatation of the prostate urethra and trabeculation of the bladder wall in the voiding cystourethrogram; only one patient showed vesicoureteral reflux. Type I urethral valves were present in all patients. Retrograde transurethral ablation of the valves was performed in four patients with good preoperative renal function. The postoperative courses were smooth except for vesicoureteral reflux in one patient and systemic fungus infection in another. Reimplantation of the ureter was done for the vesicoureteral reflux, and the fungus infection was treated by amphotericin B. Cutaneous vesicostomy was performed for a newborn since the urethral orifice was small. He presented with poor renal function and ascites. Delayed antegrade ablation of the valves per vesicostomy and closure of the vesicostomy were done three months later after restoration of the renal function. Renal function returned to normal after operation in all patients, but the function of the upper urinary tract and bladder continence need long-term follow-up.

Bilateral cheiro-oral syndrome and traumatic subdural hematoma

Typical bilateral cheiro-oral syndrome was encountered in a 74-year-old man who had bilateral subdural hematoma after a minor head injury. The delayed grave neurologic deficits occurred 1 month later without expansion of the hematoma. Removal of the lesions reversed both cheiro-oral syndrome and his late-onset neurological disabilities.

Detection by site-specific disulfide cross-linking of a conformational change in binding of Escherichia coli pyruvate oxidase to lipid bilayers

Escherichia coli pyruvate oxidase, a peripheral membrane homotetrameric flavoprotein, exposes its C-terminal lipid binding site in the presence of substrate pyruvate and co-factor thiamine pyrophosphate Mg2+ and binds tightly to phospholipid bilayers during catalysis. Using site-specific disulfide cross-linking, we demonstrate that disulfide cross-links are formed between C termini of D560C pyruvate oxidase and that the degree of cross-linking is greatly increased by the presence of substrate and co-factors indicating a conformational change that results in juxtaposition of two subunit C termini. The cross-linked oxidase is enzymatically active and remains able to associate with lipid micelles. These results argue strongly that lipid bilayer binding of pyruvate oxidase involves pairing of the C termini of two subunits.

Isolated vertiginous dysequilibrium due to bilateral caudal cerebellar infarction

We present a 74-year-old woman who developed a sudden onset of vertigo, vomiting, and axial retropulsion without limb ataxia. A clinical diagnosis of acute peripheral labyrinthine lesion was made initially. However, magnetic resonance imaging demonstrated a small infarct area involving the caudal part of the cerebellar vermis and medial cerebellar hemispheres on both sides. We emphasize that a cautious attitude should be taken in managing patients with isolated vestibular dysfunction, especially in aged person or those associated with stroke risk factor.

Asymptomatic sacral arachnoid cyst in a patient with ankylosing spondylitis

A sacral arachnoid cyst was found incidentally in a patient with ankylosing spondylitis. The clinical manifestations were perithecal bony erosions and thecal sac displacement while no associated neurological deficit was detected. This peculiar situation is of special interest as cauda equina syndrome invariably presented in such clinical complex. The pathogenesis of the arachnoid cyst remains unclear. And surgical intervention is only indicated in patients with evidence of nerve root compression.

A case of Graves' diseases associated with intracranial moyamoya vessels and tubular stenosis of extracranial internal carotid arteries

A 28-year-old woman presented with a clinical picture of hyperthyroidism, goiter, ophthalmopathy, and an ensuing ischemic stroke. Cerebral angiography demonstrated moyamoya vessels around the Willis's circle and tubular stenosis of the bilateral extracranial internal carotid arteries. The combination of the above angiographic abnormalities occurring in a patient with Graves' disease is extremely rare. A pathogenic link between Graves' disease and certain specific vascular disorders is suspected.

Intractable hiccup due to multiple sclerosis: MR imaging of medullary plaque

We describe a 31-year-old man with clinically definite multiple sclerosis who presented with intractable hiccup for one month prior to admission. The responsible lesion was confirmed by magnetic resonance imaging to be a plaque in the ventral paramedian portion of the medulla oblongata.

Unilateral cheiro-oral syndrome in a patient with bilateral subdural hematomas

We report a 49-year-old man with acute intermittent perioral and distal hand sensory dysfunction on the left side (cheiro-oral syndrome). The responsible lesion was confirmed by magnetic resonance imaging to be bilateral subdural hematomas with the larger side compressing the middle and lower thirds of the right postcentral gyrus. We emphasize that subdural hematoma should be considered in the differential diagnosis of cheiro-oral syndrome.

Expression of Escherichia coli pyruvate oxidase (PoxB) depends on the sigma factor encoded by the rpoS(katF) gene

The activity of Escherichia coli pyruvate oxidase (PoxB) was shown to be growth-phase dependent; the enzyme activity reaches a maximum at early stationary phase. We report that PoxB activity is dependent on a functional rpoS(katF) gene which encodes a sigma factor required to transcribe a number of stationary-phase-induced genes. PoxB activity as well as the beta-galactosidase encoded by a poxB::lacZ protein fusion was completely abolished in a strain containing a defective rpoS gene. Northern and primer extension analyses showed that poxB expression was regulated at the transcriptional level and was transcribed from a single promoter; the 5' end of the mRNA being located 27 bp upstream of the translational initiation codon of poxB. The poxB gene was expressed at decreased levels under anaerobiosis; however, the anaerobic regulatory genes arcA, arcB or fnr were not involved in anaerobic poxB gene expression. Expression of the rpoS(katF) gene has been reported to be affected by acetate, the product of PoxB reaction. However, we found that poxB null mutations had no effect on rpoS(katF) expression. Inactivation of two genes involved in acetate metabolism, ackA and pta, had no effect on either poxB or rpoS(katF) expression.

Low dose propranolol-induced delirium: 3 cases report and a review of literature

Delirium in 3 elderly patients with recent cerebral infarction and pre-existing brain dysfunction receiving low dose propranolol is described. The dose ranged from 30 to 60 mg/day and the interval between delirium onset and drug initiation was 3-7 days. One patient exhibited ictal mydriasis and sinus tachycardia. Hypoalbuminemia was found in 1 patient. Discontinuation of propranolol abolished their delirious pictures 2-5 days later. Their delirium may be attributed to central beta blockade or anticholinergic effect. Preexisting brain damage, old age and hypoalbuminemia may predispose such patients to neuropharmacotoxicity of low dose propranolol.

Removal of renal cell carcinoma extending into the right atrium using cardiopulmonary bypass, profound hypothermia and circulatory arrest

A 65-year-old man presented with renal cell carcinoma of the right kidney with a tumor thrombus extending up the vena cava to the right atrium. Cardiopulmonary bypass, profound hypothermia and total circulatory arrest were used to create a bloodless field for excision of the renal cell carcinoma and its tumor thrombus. Acute respiratory failure and deep jaundice developed after the operation and the patient was transferred to the intensive care unit for critical care. After respiratory therapy and nutritional support, the liver function was restored. The endotracheal tube was weaned one month later. The patient has had total resolution of all symptoms and there is no evidence of tumor recurrence of distant metastases after 6 months follow-up.

Babinski-Nageotte syndrome: a case report

A 68-year-old man developed a sudden onset of the left Wallenberg's syndrome with additional left hypoglossal nerve palsy and contralateral hemiparesis sparing the face. The clinical constellation, known as Babinski-Nageotte syndrome, is regarded as a combination of the medial and lateral medullary syndrome. Magnetic resonance imaging showed potential of in vivo confirmation of the underlying vascular insult, which clearly demonstrated an infarct area in the left half of the medulla oblongata.

Intractable hiccup caused by medulla oblongata lesions

Intractable hiccup is a rare manifestation of a brainstem lesion. We present five cases of intractable hiccups associated with medulla oblongata lesions: three of these had brainstem infarction compatible with Wallenberg's lateral medullary syndrome; one, clinically probable multiple sclerosis with a medullary lesion; and one, choroid plexus papilloma of the fourth ventricle with medullary compression. Using magnetic resonance imaging, it was demonstrated that the lesions affecting the dorsal and/or lateral medulla oblongata were responsible for the intractable hiccups.

Two independent intracranial arteriovenous malformations: a case report

Two independent intracranial arteriovenous malformations occurring to a single patient is rarely seen. A 23-year-old female suffered from a sudden onset weakness of the left side extremities and a generalized tonic-clonic seizure. A cranial CT revealed an intracranial hemorrhage in the right posterior temporal region and a highly enhanced mass in the left frontal lobe. On MR images, combination of subacute hematoma and serpentine vascular shadows in the right temporal area as well as clusters of vessels in the left frontal lobe were seen. Cerebral angiography confirmed one AVM in the right posterior temporal and the other the left frontal cortex.