Myocardial protection by Salvia miltiorrhiza Injection in streptozotocin-induced diabetic rats through attenuation of expression of thrombospondin-1 and transforming growth factor-β1

OBJECTIVES

To investigate the myocardially protective effects of Salvia miltiorrhiza injection in streptozotocin-induced diabetic rats and the possible mechanisms involved.

METHODS

Adult male Sprague-Dawley rats were randomized into three groups (n = 10 per group): diabetes, no treatment (Sm-); diabetes, S. miltiorrhiza injection (Sm+); control (no diabetes; saline treatment). After model induction and 4 weeks' treatment, heart function of five rats from each group was tested by Langendorff isolated in vivo heart perfusion. In the remaining rats, pathological changes of the myocardium were observed by haematoxylin and eosin staining, and protein levels of thrombospondin-1 (TSP-1) and transforming growth factor-β1 (TGF-β1) were assessed by immunohistochemistry.

RESULTS

Left ventricular systolic end pressure and left ventricular developed pressure were significantly improved in the Sm+ group compared with the Sm- group. Pathological changes were ameliorated through significantly reduced TSP-1 and TGF-β1 protein levels.

CONCLUSIONS

S. miltiorrhiza injection may improve the heart function of diabetic rats and protect against cardiomyopathy by downregulating TSP-1 and TGF-β1 in myocardial tissue.

Critical modeling parameters identified for 3D CFD modeling of rectangular final settling tanks for New York City wastewater treatment plants

New York City Environmental Protection is in the process of incorporating biological nitrogen removal (BNR) in its wastewater treatment plants (WWTPs) which entails operating the aeration tanks with higher levels of mixed liquor suspended solids (MLSS) than a conventional activated sludge process. The objective of this paper is to discuss two of the important parameters introduced in the 3D CFD model that has been developed by the City College of New York (CCNY) group: (a) the development of the 'discrete particle' measurement technique to carry out the fractionation of the solids in the final settling tank (FST) which has critical implications in the prediction of the effluent quality; and (b) the modification of the floc aggregation (K(A)) and floc break-up (K(B)) coefficients that are found in Parker's flocculation equation (Parker et al. 1970, 1971) used in the CFD model. The dependence of these parameters on the predictions of the CFD model will be illustrated with simulation results on one of the FSTs at the 26th Ward WWTP in Brooklyn, NY.

Development of a flocculation sub-model for a 3-D CFD model based on rectangular settling tanks

To assess performance and evaluate alternatives to improve the efficiency of rectangular Gould II type final settling tanks (FSTs), New York City Department of Environmental Protection and City College of NY developed a 3D computer model depicting the actual structural configuration of the tanks and the current and proposed hydraulic and solids loading rates. Fluent 6.3.26™ was the base platform for the computational fluid dynamics (CFD) model, for which sub-models of the SS settling characteristics, turbulence, flocculation and rheology were incorporated. This was supplemented by field and bench scale experiments to quantify the coefficients integral to the sub-models. The 3D model developed can be used to consider different baffle arrangements, sludge withdrawal mechanisms and loading alternatives to the FSTs. Flocculation in the front half of the rectangular tank especially in the region before and after the inlet baffle is one of the vital parameters that influences the capture efficiency of SS. Flocculation could be further improved by capturing medium and small size particles by creating an additional zone with an in-tank baffle. This was one of the methods that was adopted in optimizing the performance of the tank where the CCNY 3D CFD model was used to locate the in-tank baffle position. This paper describes the development of the flocculation sub-model and the relationship of the flocculation coefficients in the known Parker equation to the initial mixed liquor suspended solids (MLSS) concentration X0. A new modified equation is proposed removing the dependency of the breakup coefficient to the initial value of X0 based on preliminary data using normal and low concentration mixed liquor suspended solids values in flocculation experiments performed.

Association of the ADIPOQ rs17360539 and rs266729 polymorphisms with type 2 diabetes: a meta-analysis

Published data on the association between ADIPOQ polymorphisms and type 2 diabetes are inconsistent. The present meta-analysis was performed to clarify the role of polymorphisms in proximal promoter region of ADIPOQ (rs17360539 and rs266729) in type 2 diabetes. The MEDLINE, EMBASE and Science Citation Index Expanded database were searched for eligible studies. Odd ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association. The pooled ORs were performed for per-allele model (A/a) and others genetic models. A total of 10267 T2DM patients and 12837 controls was included in the meta-analysis. Overall the -11377G allele had an 8% elevated risk of T2DM compared to -11377C allele in all subjects (P=0.034, OR=1.08, 95% CI 1.01-1.15). The -11391A allele showed no significant effect on T2DM risk in all subjects (P=0.240, OR=1.10, 95% CI 0.94-1.29) compared to -11391G allele. In the subgroup analyses by ethnicity, -11391A allele increased T2DM risk in European population (P=0.046, OR=1.09, 95% CI 1.00-1.09). In conclusion, the accumulated evidence suggested that the ADIPOQ -11377G allele is a low-penetrant risk factor for developing type 2 diabetes, but -11391A is a risk factor only in European Caucasians.

Upregulation of caspase-3 expression in esophageal cancer correlates with favorable prognosis: an immunohistochemical study from a high incidence area in northern China

Caspase-3 plays an important role as the key effector during apoptosis, but there are very few studies of caspase-3 in esophageal squamous cell carcinoma (ESCC). The purpose of this study was to investigate the expression and prognostic significance of caspase-3 in ESCC from Linzhou City, a high incidence area in northern China. All 64 patients underwent esophagectomy for ESCC between January 2002 and December were enrolled in this study. Caspase-3 expression was assessed by immunohistochemistry (IHC) in primary ESCC and paired normal esophageal epithelium. The positive rate of caspase-3 expression was higher in ESCC than in normal esophageal epithelium (79.7% vs. 50.0%, Chi-square = 12.372, P= 0.001). Caspase-3 expression was correlated with tumor cell differentiation (Phi = 0.717, P < 0.001), tumor infiltration depth (Phi =-0.334, P= 0.008), and pathologic TNM (pTNM) staging (rs =-0.268, P= 0.032). Patients in caspase-3 positive group had a significantly better 5-year overall survival than those in the negative group (77.4% vs. 35.9%, chi(2)= 7.344, P= 0.007). Our results showed that caspase-3 expression was upregulated in ESCC compared with normal esophageal epithelium in population of Chinese high incidence area, and patients with caspase-3 positive expression had better prognosis. Therefore, caspase-3 immunostaining could be a simple and useful tool for predicting survival in ESCC patients.

Giant panda habitat networks and conservation: is this species adequately protected?

Context. Giant pandas (Ailuropoda melanoleuca) are restricted to six mountain ranges at the edge of the Tibetan Plateau. One of these ranges, the Qinling Mountains, contains the highest density of giant pandas and is home to ~20% of those remaining in the wild. Commercial logging and other developments have resulted in habitat fragmentation, and an efficient and powerful conservation network is now needed for the species in this area. Aims. This study sought to assess giant panda habitat and estimate the carrying capacity of this reserve network. Our goal was to improve the function and carrying capacity of the reserve network and facilitate population growth and gene flow among subpopulations of giant pandas. Methods. We use habitat suitability models to assess the efficacy of conservation networks. With estimation of carrying capacity by home range, we can reveal issues facing reserves and populations of endangered species they contain. Here, we define key habitat, linkages, corridors and overall connectivity and then use habitat network modelling and spatial analyses to design a conservation landscape for giant pandas across their Qinling Mountains stronghold. Key results. We found that 91% of giant panda sightings were in suitable or marginally suitable habitat. The total area of giant panda habitat present in the Qinling Mountains is ~1600 km2 fragmented across four key habitat blocks by national roads or other human activity. The current nature reserve network encompasses 71% of available suitable habitat and 62% of available marginal habitat, meaning a significant proportion of panda habitat remains outside the current conservation network. We found that giant panda reserves across this region are not equal in their carrying capacity; some reserves contain an overabundance of giant pandas and the wellbeing of these populations are in doubt. Conclusions. Our results highlight the potential risk of high densities and bamboo flowering events to the safety of giant pandas. With poor population size and heavy isolation, small populations will not persist without translocation. Implication. Redrawing the reserve network to correct localised problems may improve the function of the giant panda protection system, build capacity in the reserve network, and decrease human–wildlife conflict. We propose a new reserve and adjustment of the borders and region for three reserves.

Micropapillary urothelial carcinoma of the urinary bladder: Early surgery or neoadjuvant chemotherapy?

e16007

Background: Micropapillary bladder carcinoma is a rare variant of urothelial carcinoma (UC) of the urinary bladder. As a particularly aggressive variant, patients are often urged to undergo up-front radical cystectomy. Though data is scarce on the treatment outcomes of patients with this entity, we present the case for neoadjuvant chemotherapy as opposed to early cystectomy in the setting of clinically localized micropapillary UC. Methods: A review of records of all patients evaluated at our institution for UC was conducted to identify micropapillary UC of the bladder over the period from 2000–2007. A total of 24 cases were found, and were evaluated for preoperative pathology and clinical stage, treatment course, pathological stage and cancer specific survival. Results: Mean patient age was 67.9 years with 19 males and 5 females. Twenty-one (87.5%) patients had clinically organ confined micropapillary UC at the time of diagnosis, three had minimally enlarged lymph nodes on pelvic CAT scans. Half of our patients had BCG refractory high grade non-muscle invasive UC. Twenty-two patients (91.67%) were offered radical cystectomy as first line management. Extended lymph node dissection was performed in eleven patients (45.83%). Final pathologic examination diagnosed metastatic lymph node involvement in 20 patients (83.33%), with 4 patients (20%) having positive LN outside the standard (pelvic) template of dissection. A stage upgrade was noticed in 95.23% of cases. Median cancer specific survival was 13 months. Survival at one year was 44% and 50% at 2years, with only one patient alive at 5 years. Conclusions: Our results suggest that clinically localized micropapillary UC is often metastatic to LN at the time of presentation. This setting of frequent systemic disease should encourage standard neoadjuvant chemotherapy rather than early surgical management for these patients. Extended LN dissection is warranted in these cases due to the high incidence of nodal involvement outside the standard template.

No significant financial relationships to disclose.

Effects of two different hydroxyethyl starch solutions (HES200/0.5 vs. HES130/0.4) on the expression of platelet membrane glycoprotein

BACKGROUND

There are various hydroxyethyl starch (HES) solutions with different degrees of hydroxylation and different molecular weights. HES200/0.5 solution is most commonly used. HES130/0.4 is a new HES solution and is the 'state-of-the-art' in volume substitution. However, the mechanism of the observed anticoagulation action of HES has not been fully delineated. The objective of this study was to further investigate the effect of HES200/0.5 and HES130/0.4 on platelet coagulation.

METHODS

Sixty ASA I-II patients undergoing elective minor surgery were randomly allocated to receive an intravenous infusion (20 ml/kg) of lactated Ringer's solution (group L), HES200/0.5 (group H) or HES130/0.4 (group V) after the induction of anesthesia. The expression of CD42b, CD41/61 and CD62p in vivo was assessed on non-stimulated platelets and adenosine diphosphate (ADP) agonist-activated platelets using flow cytometry.

RESULTS

Resting glycoprotein expression of the non-stimulated platelets was observed. HES200/0.5 and HES130/0.4 reduced the CD42b, CD41/61 and CD62p expression of ADP-agonist-activated platelets at 15 min after intravenous infusion. At 6 h after intravenous infusion, the trend of decreasing expression of activated CD42b, CD41/61 and CD62p was maintained in group H. However, CD42b, CD41/61 and CD62p expression returned to the pre-operative level in group V.

CONCLUSION

This study showed that both HES200/0.5 and HES130/0.4 can inhibit platelet coagulation. Platelet dysfunction experienced a faster recovery after the infusion of HES130/0.4 than after HES200/0.5. Liquid resuscitation with HES130/0.4 may decrease the risk of hemorrhage in the operative period.

Enhanced vascular contractility and diminished coronary artery flow in rats made hypertensive from diet-induced obesity

OBJECTIVE

To determine whether obesity-induced hypertension was associated with alterations in vascular contractility and/or cardiac function.

DESIGN

Male Sprague-Dawley rats were fed either a low fat (LF; 11% kcal as fat) or a moderately high fat (MHF; 32% kcal as fat) diet for 11 weeks.

MEASUREMENTS

Body weight; mean arterial pressure; angiotensin peptides; mesenteric contractile response to phenylephrine (PE), potassium chloride (KCl), serotonin, angiotensin II (AngII), calcium chloride; baseline and isoproterenol-induced cardiac contractility; baseline and isoproterenol-induced coronary artery blood flow.

RESULTS

Rats fed the MHF diet segregated into obesity-prone (OP) and obesity-resistant (OR) groups. OP rats exhibited elevations in mean arterial pressure (MAP) and elevations in systemic concentrations of angiotensin peptides. Mesenteric arteries from OP rats exhibited a greater contractile response to PE, KCl and serotonin (5-HT). Heightened responses to PE persisted in arteries from OP rats even after normalization of the response to KCl. In contrast, the response of permeabilized mesenteric arteries to a maximal concentration of calcium was similar in rats from each group. Isolated perfused hearts exhibited similar baseline and isoproterenol-induced contractility in rats from each group. However, isoproterenol was unable to increase coronary artery blood flow in hearts from OP rats.

CONCLUSION

Enhanced vascular reactivity may contribute to obesity-induced hypertension, while reductions in coronary artery relaxation would impair the ability of the heart to respond to increased myocardial demand.

Low energy electron irradiation induced deep level defects in 6H-SiC: the implication for the microstructure of the deep levels E1/E2

N-type 6H-SiC samples irradiated with electrons having energies of E(e)=0.2, 0.3, 0.5, and 1.7 were studied by deep level transient technique. No deep level was detected at below 0.2 MeV irradiation energy while for E(e)>/=0.3 MeV, deep levels ED1, E(1)/E(2), and E(i) appeared. By considering the minimum energy required to displace the C atom or the Si atom in the SiC lattice, it is concluded that generation of the deep levels E(1)/E(2), as well as ED1 and E(i), involves the displacement of the C atom in the SiC lattice.

A unique folate hydrolase, prostate-specific membrane antigen (PSMA): a target for immunotherapy?

Prostate-specific membrane antigen (PSMA) is a potential target in prostate cancer patients because it is very highly expressed and because it has been reported to be upregulated by androgen deprivation. This review discusses the historical background, biochemical characteristics, gene regulation, potential for targeting, tissue localization, and a novel T-body strategy.

A model of self-regulation for control of chronic disease

Chronic disease poses increasing threat to individual and community health. The day-to-day manager of disease is the patient who undertakes actions with the guidance of a clinician. The ability of the patient to control the illness through an effective therapeutic plan is significantly influenced by social and behavioral factors. This article presents a model of patient management of chronic disease that accounts for intrapersonal and extemal influences on management and emphasizes the central role of self-regulatory processes in disease control. Asthma serves as a case for exploration of the model. Findings from a 5-year study of 637 children with asthma and their care-taking parents supported that the self-regulation elements of the model were reasonably stable over time and baseline values were predictive of important disease management outcomes.

"Malgun" (clear) cell change of gastric epithelium in chronic Helicobacter pylori gastritis

To characterize the Helicobacter pylori gastritis-associated epithelial change, we analyzed 251 randomly selected gastric biopsies. The "malgun" (clear) cell change of the gastric epithelium was noted in 229 biopsies (91.2%). Malgun cells were characterized by large, pale nuclei with a euchromatin pattern, enlarged nucleoli, and clear cytoplasm. In the proliferative zone, individual malgun cells and small clusters were often in close contact with infiltrating neutrophils, suggesting that they had developed individually in the background of acute foveolitis. Mitotic figures of malgun cells were not infrequent, including atypical ones. In the surface epithelium, most malgun cells were in clusters that were often large enough to occupy wide epithelial segments. With Warthin-Starry triple staining, they were distinguished by the absence of silver impregnation, while other cells showed staining of the heterochromatin. They displayed prominent immunostaining for low molecular weight cytokeratin (No. 8). Most malgun cells were PCNA-positive in both surface and proliferative zones, whereas Ki67-positive cells were found only in the proliferative zone. It was suggested that a population of malgun cells, which were positive for PCNA only, were in the process of active DNA repair. The malgun cell change may represent a "cellular pattern of activation" in a population which had significant DNA damage, but somehow escaped the detection by the apoptosis system. The notion of "damage at the genetic level" was supported by the observation that these cells remained at least for 8 weeks after eradication of the H. pylori infection.

[Does simple posterior dislocation of the elbow necessitate strict immobilization?]

OBJECTIVE

To research for the ideal treatment of isolated posterior dislocation with the elbow after reduction.

METHODS

36 patients of isolated posterior dislocation of the elbow after closed reduction (male 26, female 10; left 14, right 22; dominant extremity 21, undominant extremity 15; average age 22) were examined by varus and valgus stress test and push-draw test. Satisfactory stability from 30 degrees to 130 degrees flexion of the elbow was found in all patients. For the 30 patients below 35 years old, long-arm posterior splint was applied to immobilize the elbow joint at 90 degrees flexion and pronation for one week. For 6 patients over 35 years old, we only immobilized the elbow joint for 3 to 5 days with a neck-wrist sling. Prompt active motion begin after the swelling and pain reduced slightly, but the last 30 extension was not allowed for the first 1 to 2 weeks. Forceful passive motion and stretching of the elbow joint were avoided in all patients.

RESULTS

The average follow-up time was 9 months (3 - 15 months). Range of motion and muscle power were regained within 3 - 4 months. 32 patients rehabilitated completely and 4 of the 6 patients decreased extension for 5 degrees - 10 degrees. No unstable symptoms and signs or recurrent dislocation were found. No ectopic calcification or post-traumatic arthritic changes were found on X-ray follow-up.

CONCLUSIONS

The ulna-humeral joint is one of the most highly constrained joints in the body with intrinsic stability. Bony structure is stable enough to allow for capsular and ligamental structure healing, even during active motion. For isolated posterior dislocation of the elbow joint, short-term immobilization and early functional exercise are desirable. Elbow instability and recurrent dislocation are rare and do not necessitate long-term strict immobilization.

Long-term effects of asthma education for physicians on patient satisfaction and use of health services

This randomized clinical trial evaluated the long-term impact of an interactive seminar for physicians based on principles of self-regulation on clinician behaviour, children's use of health services for asthma, and parent's views of physician performance. Seventy-four general practice paediatricians, and 637 of their asthma patients aged 1-12 yrs, were randomized to treatment or control. Children and parents were blind to physicians' participation. Data were collected at baseline and follow-up through self-administered surveys (paediatricians), telephone interviews (parents) and medical records. The seminar focused on development of communication and teaching skills and use of therapeutic medical regimens for asthma as outlined in the National Asthma Education and Prevention Program guidelines. Approximately 2 yrs postintervention, treatment group physicians were more likely than control physicians to: use protocols for delivering asthma education (odds ratio (OR) 4.9, p=0.2), write down for patients how to adjust medicines when symptoms change (OR 5.7, p=0.05), and provide more guidelines for modifying therapy (OR 3.8, p=0.06). Parents scored treatment group physicians higher than control physicians on five specific positive communication behaviours. Children seen by treatment group physicians had fewer hospitalizations (p=0.03) and those with higher levels of emergency department (ED) use at baseline had fewer subsequent ED visits (p=0.03). No differences regarding the number of office visits were noted. There were no significant differences found between treatment and control group physicians in the amount of time spent with patients during office visits (26 versus 29 min) or in the number of patients treated with anti-inflammatory medicine. It is concluded that interactive asthma seminars for paediatricians had significant long-term benefits for their asthma care.

[Therapeutic effect of blood activating polypeptide on the treatment of chronic severe viral hepatitis]

OBJECTIVE

To study the therapeutic effect of blood activating polypeptide on chronic severe viral hepatitis (CSH) and the method used.

METHODS

The treated group included 50 CSH patients (male 82, female 8, age 39 +/- 9). Based on routine treatments, they were intravenously injected with 15 ml blood activating polypeptide dissolved in 250 ml of 10% glucose, qd x 4 wks. The control group contained 50 CSH patients (male 3, female 7, age 38+/-12). They were only treated with routine treatments for liver protection, jaundice regression, health maintenance, anti-infection and diuresis.

RESULTS

The SB and ALT in treated patients decreased obviously (P < 0.01) after treatment, the prominent efficacy was 52%, the total efficacy was 86%, all were superior to the control group.

CONCLUSIONS

Blood activating polypeptide is safe, reliable and effective in the treatment of CSH.

[A study on the chemical components of essential oil of oak moss concrete by gas chromatography/mass spectrometry]

The essential oil of oak moss concrete was extracted by volatile oil content equipment. The chemical compositions and their relative contents were analyzed by GC and GC/MS. A Supelco-5 fused silica capillary column (30 m x 0.32 mm i.d.; 0.25 micron thickness) and a flame ionization detector (FID) were employed in GC analysis. The temperature program included temperature increase of 4 degrees C/min from 50 degrees C to 250 degrees C, and a 10 min isothermal period at 250 degrees C. Mass spectra were obtained by electron impact at 70 eV and a source temperature of 170 degrees C. Twenty-four volatile compounds of oak mass concrete were identified, which comprised more than 83% of volatile fraction. The major components were diethyl phthalate, alpha-terpineol, cedrane and linalool.

Noncollinear-pumped KTP optical parametric oscillator

A theoretical analysis and an experimental study are presented on the phase-matching condition of noncollinearly pumped optical parametric oscillators (OPO's) based on a noncritical phase-matching potassium titanyl phosphate (KTP) OPO. It is shown that noncollinearly pumped, double-pass, singly resonant optical parametric oscillators maintain the advantage of round-trip parametric gain in a collinear pump, since in this case the two generated signal waves are coherent, which results in high conversion efficiency and low pump threshold. With this KTP OPO we achieved 31% energy conversion efficiency from a 1064-nm pump wave to 1572-nm eye-safe output. In addition, because the incident pump beam is not perpendicular to the OPO cavity mirrors and consequently no reflected beam flows back into the pump source, we can avoid employing optical isolators.

Surgical challenge of massive bilateral staghorn renal calculi in a spinal cord injury patient

We report a rare case of massive bilateral staghorn calculi in a spinal cord injury patient with significant renal compromise. The patient was successfully treated with percutaneous nephrolithotomy to achieve a stone-free status. The various options of treatment are discussed with special attention to the technical aspects necessary to achieve complete eradication of the stone burden during percutaneous nephrolithotomy. Furthermore, the importance of treating bladder dysfunction and urinary metabolic abnormalities is emphasized.

Isolation and characterization of genomic sequences involved in the regulation of the human reduced folate carrier gene (RFC1)

Decreased reduced folate carrier (RFC) activity has been associated with MTX resistance in experimental models of transport-mediated MTX resistance, and has been attributed to changes in the expression of RFC1, the gene that encodes a protein with this activity. RNA transcripts of RFC1 may contain any one of four distinct 5' untranslated regions (UTRs). We cloned a human genomic DNA fragment upstream from the RFC1 translation start site and determined the nucleotide sequence of a 4.8kb region that contained the exons corresponding to each of the reported UTRs. To identify regulatory elements that may be involved in RFC1 transcription, we first developed a semi-quantitative RT-PCR assay using primers specific for each of the 5' UTRs to amplify RNA transcripts containing each of the RFC1 5' exons, and found evidence for differential transcription of RFC1 non-coding exons in tissues, during development, and in MTX-resistant, transport-deficient cells. We also found that RFC1 RNA levels are cell cycle regulated and peak at the G1 to S transition. Then, using a series of RFC1 promoter-reporter fusion constructs, we identified genomic sequences that may be involved in the regulation of expression of exons 1b and 1c of the RFC1 gene. These studies therefore identify regulatory regions of RFC1 promoters and potential models of regulation in which these regions may exert control.

[Therapeutic effect of recombinant interferon alpha-2b on hemorrhagic fever with renal syndrome]

To study the therapeutic effect of recombinant interferon alpha-2b(rIFN alpha-2b) on cases of hemorrhagic fever with renal syndrome(HFRS) in early stage, 146 cases of HFRS in feverish stage and within five days of onset were randomly divided into two groups: the treatment and the control, each group included 73 cases. The control group was given the traditional combined therapy with a predominance of balanced solution, the treatment group was given rIFN alpha-2b 1 x 10(6)U per day, i.m., for three days. The treatment group showed much better effects in improving the viremia, the clinical conditions, skipping phases, restoring kidney function and platelet account, decreasing complications than the control group (P < 0.05). All the patients of the treatment group recovered, and four patients of the control group died, accounting for 5.47%. No side-effect resulting from rIFN alpha-2b was found. Administration of rIFN alpha-2b to patients with HFRS within five days of onset could lighten the organ lesions, shorten the course of disease and raise the curative rate.

[Nontypical limited resection of the lung]

OBJECTIVE

To evaluate the role of limited resection in the treatment of lung disease.

METHOD

From 1989 to 1996, 46 limited resections were performed on 35 patients with lung diseases. All patients were followed up for 0.5 to 7 years (mean 29.3 months).

RESULT

There were no operative deaths and operative complications. In 16 patients with benign lung diseases, no recurrences and late complications were found. In 5 patients with primary lung cancers, 2 died 1.5 and 2 years after operation, respectively, and 3 are still living well for 2.5, 4 and 5 years postoperatively. In 14 patients with metastatic lung diseases (10 with bilateral multiple metastases), 216 metastatic lesions were excised. 1-, 3-, and 5-year survival rates were 78.5%, 50% and 21.4% respectively.

CONCLUSION

Limited lung resection could be an additional option and a surgical alternative to conventional lung resection for some compromised patients.

Differential selection of cells with proviral c-myc and c-erbB integrations after avian leukosis virus infection

Avian leukosis virus (ALV) infection induces bursal lymphomas in chickens after proviral integration within the c-myc proto-oncogene and induces erythroblastosis after integration within the c-erbB proto-oncogene. A nested PCR assay was used to analyze the appearance of these integrations at an early stage of tumor induction after infection of embryos. Five to eight distinct proviral c-myc integration events were amplified from bursas of infected 35-day-old birds, in good agreement with the number of transformed bursal follicles arising with these integrations. Cells containing these integrations are remarkably common, with an estimated 1 in 350 bursal cells having proviral c-myc integrations. These integrations were clustered within the 3' half of c-myc intron 1, in a pattern similar to that observed in bursal lymphomas. Bone marrow and spleen showed a similar number and pattern of integrations clustered within 3' c-myc intron 1, indicating that this region is a common integration target whether or not that tissue undergoes tumor induction. While all tissues showed equivalent levels of viral infection, cells with c-myc integrations were much more abundant in the bursa than in other tissues, indicating that cells with proviral c-myc integrations are preferentially expanded within the bursal environment. Proviral integration within the c-erbB gene was also analyzed, to detect clustered c-erbB intron 14 integrations associated with erythroblastosis. Proviral c-erbB integrations were equally abundant in the bone marrow, spleen, and bursa. These integrations were randomly situated upstream of c-erbB exon 15, indicating that cells carrying 3' intron 14 integrations must be selected during induction of erythroblastosis.

Mapping of ORF121, a factor that activates baculovirus early gene expression

The protein product of the 39k gene of Autographa californica nuclear polyhedrosis virus is thought to be important for viral replication because of its association with the virogenic stroma and its role in activation of late gene expression Transient expression assays showed that addition of a DNA fragment encoding a 58-amino-acid polypeptide increased expression of a 39k reporter plasmid. This stimulation was dependent on cotransfection of a plasmid encoding IE1. Cotransfection of this gene, orf121, also stimulated ie1 expression, and the activation of ie1 was even more dramatic in the presence of IE1. These data suggested that ORF-121 stimulated 39k expression by upregulation of IE1 expression. Activation of 39k by ORF121 and the viral transcription factor IE2 was additive, while activation by ORF-121 and the apoptotic suppressor P35 was synergistic. Cotransfection of p39cat and pIE1 with plasmids encoding ORF121, IE2, and P35 stimulated 39cat expression more than 100-fold compared to cells transfected with only p39cat and pIE1. These data suggest that IE2 and ORF121 work by similar mechanisms and indirectly activate p39cat by increasing IE1 expression, while P35 increases 39cat expression by a different mechanism.

Impact of education for physicians on patient outcomes

OBJECTIVES

This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1) the treatment practices and communications and education behavior of physicians, 2) the health status and medical care utilization of their pediatric patients with asthma, and 3) the satisfaction with care of the subjects' parents.

METHODS

A total of 74 general practice pediatricians were assigned to either a program or a control group in a randomized controlled study. Data were collected from physicians at baseline, and 69 (93%) provided follow-up data 5 months after the program. Data were also collected from 637 of their patients at baseline, and in a 22-month window after the intervention, 472 (74%) of this number provided follow-up data.

RESULTS

After the seminar, physicians in the program group were more likely than were control group physicians to address patients' fears about medicines, review written instructions, provide a sequence of educational messages, write down how to adjust the medicines at home when symptoms change, and report that they spent less time with their patients. Parents of the children treated by program physicians were significantly more likely than were control group parents to report that the physician had been reassuring, described as a goal that the child be fully active, and gave information to relieve specific worries. After a visit with the physician, these parents were also more likely to report that they knew how to make management decisions at home. After the intervention compared to controls, patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler. After the intervention, children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms; however, there were no differences in emergency department visits and hospitalizations. Among children who were placed on inhaled corticosteroids during this study, however, children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits, nonemergency physician office visits, emergency department visits, and hospitalizations.

CONCLUSIONS

The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.

Molecular mechanism of antifolate transport-deficiency in a methotrexate-resistant MOLT-3 human leukemia cell line

Ohnuma et al reported a series of methotrexate-resistant MOLT-3 human T-cell acute lymphoblastic leukemia cell lines that showed decreasing methotrexate (MTX) uptake as the sublines acquired increasing MTX resistance (Cancer Res 45:1815, 1985). The alteration of MTX uptake kinetics in these cells, the intermediately resistant MOLT-3/MTX200 and the highly resistant MOLT-3/MTX10,000 cell lines, was attributed to a change in Vmax for methotrexate transport, without an apparent change in affinity of the transporter for MTX. We studied these cell lines to determine whether alteration of transcription or translation of the recently isolated reduced folate carrier gene (RFC1) was the cause of MTX transport deficiency in these cell lines. Reconstitution of RFC activity in MOLT-3/MTX10,000 cells by transduction with a murine RFC retroviral vector reversed MTX resistance and trimetrexate sensitivity. Although RFC1 RNA levels were unchanged in the resistant cell lines, FACS analysis using a polyclonal anti-RFC1 antibody showed no detectable RFC1 protein in the MOLT-3/MTX10,000 cells. Determination of the nucleotide sequence of RFC1 genes from MOLT-3/MTX10,000 cells revealed that this cell line contained 3 RFC1 alleles: a wild-type allele, an allele containing the premature stop codon at codon 40 and a third allele containing another mutation, which resulted in a premature stop codon at codon 25. We examined the relative expression of these alleles by determining the nucleotide sequence of 24 RFC1 cDNA subclones from MOLT-3/MTX10,000 cells and found that only one-third of these clones contained the wild-type sequence. Determination of the genomic sequence of RFC1 in MOLT-3/ MTX200 cells demonstrated that these cells were heterozygous for a mutation at codon 40, but were homozygous for the wild-type sequence at codon 25. Thus, the acquisition of MTX transport-deficiency in MOLT-3/MTX10,000 cells results from inactivating mutations of RFC1 gene alleles.

A scale for Assessing Health Care Providers' Teaching and Communication Behavior regarding asthma

Partnership between health care providers and patients is important for controlling illness. A limited number of studies show how to assess health professionals' communication and partnering behavior. The relationship between these aspects of professional behavior and enhanced management of disease by patients has received little empirical study. The research reported here developed a Health Care Providers' Teaching and Communication Behavior (TCB) scale for assessing the teaching and communication behavior of clinicians treating patients with asthma. Such a tool is needed for research related to provider-patient relationships and for evaluation of professionals' performance.

Multimodality treatment of squamous cell carcinoma complicating pilonidal disease

Malignant degeneration is an unusual complication of chronic primary or recurrent pilonidal disease. To date, only 43 cases have been reported, the great majority being squamous cell type. Historically, these cases were treated with primary excision. Recurrence following such treatment was high and prognosis poor compared with nonmelanoma skin cancer. We describe a patient with squamous cell carcinoma arising in chronic pilonidal disease, who is disease-free 3 years after adjuvant radiation therapy following radical excision. This communication describes the clinicopathologic features of 38 cases of squamous cell carcinoma arising in pilonidal disease and suggests treatment modalities.

Testicular torsion with contralateral vanishing testis

An infant with a left hydrocele and nonpalpable right testis had an antenatal ultrasonogram showing a left hydrocele and normal right testis. When left inguinal hydrocelectomy was performed, extravaginal torsion of the spermatic cord and a normal testis was discovered. The right spermatic cord ended in a testicular remnant. We propose that this was a case of bilateral antenatal torsion that would have resulted in bilateral vanishing testis syndrome had the left hydrocele not prevented vascular compromise when antenatal testicular torsion occurred. This case gives visible support to the theory that testicular remnants are the result of antenatal torsion.

A unique perineal herniation of large bladder diverticulum: successful surgical repair through posterior sagittal approach

We report a case of symptomatic perineal herniation of a massive posterior bladder diverticulum following abdominoperineal resection in a 75-year-old man with Crohn's disease and renal failure. Presentation, evaluation, and management issues are discussed.

Effect of head positioning in panoramic radiography on vertical measurements: an in vitro study

OBJECTIVE

To assess whether it is possible to make accurate vertical measurements of the jaws from panoramic radiographs.

METHODS

Five dry skulls were shifted 5 mm forwards and backwards and tilted 5 degrees up and down in the sagittal plane. Panoramic radiographs of each skull were obtained in nine different positions. In the maxilla, three reference lines were used and vertical measurements were made at the distal surfaces of the first premolar and first molar and in the midline. In the mandible, measurements were made at the distal surfaces of the first premolar and first molar, and at the mental foramen on both sides, and in the midline. The points and lines were marked manually and the radiographs were digitized, magnified and measured.

RESULTS

Sagittal shifting and tilting had only a slight effect on measurements in the mandible. Sagittal tilting of the head had the greatest effect on all the measurements made from the line between the articular eminences to the alveolar crest, as well as measurements in the maxillary midline.

CONCLUSIONS

The line between the articular eminences is unsuitable as a reference line for measurements of the tooth-bearing areas. A slight misalignment of the head does not significantly affect the vertical measurements in the mandible or of the posterior maxilla if the reference lines are in the same vertical plane as the teeth.

[The study of BL21(DE3)/PET-11 as an expression system of human IL-2]

The coding region of hIL-2 cDNA is specifically amplified by PCR. A Nde I site is introduced into its 5'-end and its 3'-non coding region is partly deleted. After filling-in by Klenow enzyme, the DNA fragment is cloned into Sma I site of PUC18. Eight white colonies are screened and one (C1) contains Nde I site. DNA sequencing shows that non-specific mutation has not been found in its coding region. The DNA fragment digested by BamH I, Nde I of C1 plasmid is recovered and subcloned into PET-11 and transfered into BL21 (DE3). After IPTG induction, the Bacteria lysate is run directly on SDS-PAGE. Western blot test shows a specific rhIL-2 McAb binding band. The molecular weight is about 17000. Laser scanning indicates that the absorption area of IL-2 is about 5% of the total area.

Isolation of a gene encoding a human reduced folate carrier (RFC1) and analysis of its expression in transport-deficient, methotrexate-resistant human breast cancer cells

Our laboratory has previously reported the isolation of a murine cDNA which restores reduced folate carrier (RFC) activity and methotrexate (MTX) sensitivity to a MTX-resistant, transport-deficient human breast cancer cell line (MTXR ZR-75-1) (K. H. Dixon et al., J. Biol. Chem., 269: 17-20, 1994). Using this murine cDNA as a probe, we have isolated two homologous overlapping partial cDNAs from a human testis cDNA library. In addition, using human cDNA as a probe, we have isolated a 20-kb human genomic fragment which contains RFC coding regions. Analysis of the nucleotide sequence of these clones revealed that the human RFC gene, RFC1, is approximately 65% homologous to the murine and hamster genes. Using a human genomic P1 plasmid clone containing RFC1, we mapped the location of RFC1 by fluorescence in situ hybridization to the end of the long arm of chromosome 21 (21q22.2-q22.3). Fluorescence in situ hybridization analysis also showed that two copies of RFC1 were present in MTXR ZR-75-1 cells, and showed no evidence of rearrangement of this gene. Northern blot analysis of MTXR ZR-75-1 cells demonstrated a marked decrease in the level of the 3-kb RFC1 transcript relative to the parental cell line, and Western blot analysis using a polyclonal antibody raised against a peptide generated from the RFC1 sequence showed decreased expression of an approximately M(r) 56,000 protein in MTXR ZR-75-1 cells. Finally, MTXR ZR-75-1 cells transfected with an RFC1 gene showed increased MTX uptake, which was more sensitive to competition by folinic acid than by folic acid. Therefore, decreased RFC1 expression appears to be the molecular mechanism of decreased MTX uptake in this MTX-resistant cell line.

Insight into mechanism of neodymium: yttrium-aluminum-garnet laser prostatectomy utilizing the high-power contact-free beam technique

OBJECTIVES

The objective of this study was to define the actual mechanism of neodymium: yttrium-aluminum-garnet (Nd:YAG) laser prostatectomy achieved with the previously described contact-free beam technique using the Ultraline delivery system at high-power settings.

METHODS

Transurethral Nd:YAG laser application was performed with the Ultraline side-firing laser fiber in canine and human prostates. Total or radical prostatectomy was performed after laser treatment to examine and measure laser tissue effects produced using the contact-free beam technique.

RESULTS

Minimal actual tissue evaporation or vaporization was noted in either the canine or human prostate using this technique. The extent of tissue vaporization achieved was probably insufficient to produce clinically significant voiding outcomes acutely or chronically. However, this technique, using the Nd:YAG laser, produced excellent tissue coagulation and necrosis, similar to other laser delivery systems and reports dealing with laser coagulation prostatectomy.

CONCLUSIONS

The primary mechanism accounting for therapeutic efficacy of the contact-free beam technique for Nd:YAG laser prostatectomy utilizing the Ultraline delivery system at high-power settings appears to be tissue coagulation with subsequent necrosis and slough, rather than tissue vaporization. This is consistent with the known tissue effects of the Nd:YAG laser wavelength in other systems.