Mediation of the cytotoxicity of lanostanoids and steroids of Ganoderma tsugae through apoptosis and cell cycle

A new lanostanoid ester glucoside, 3 alpha-acetoxy-5 alpha-lanosta-8,24-dien-21-oic acid ester beta-d-glucoside (1), and a known steroid, 2 beta,3 alpha,9 alpha-trihydroxy-5 alpha-ergosta-7,22-diene (2), were isolated from the fruit bodies of Ganoderma tsugae and their structures determined by spectroscopic methods. To study the cytotoxicity of 1 and 2, the changes of DNA content in human hepatocytes (Hep 3B) were studied. A sub-G1 cell stage was drastically increased after 24-h incubation with 1 (24 micrograms/mL). Compound 2 (100 micrograms/mL) inhibited the cell cycle progression of Hep 3B cells at the G2/M phase with an IC50 value of about 87.1 micrograms/mL. These results indicate that 1 causes cell death by apoptosis and 2 may possess the activity of cell cycle inhibition.

The hepatoprotective and therapeutic effects of propolis ethanol extract on chronic alcohol-induced liver injuries

Propolis designates a mixture of gums, resins and balms, of viscous consistency, which are gathered on certain parts (buds and bark, mainly) of vegetables (especially coniferous trees) by honeybees. They bring this back to the hive, where it is modified and mixed with other substances (essentially their own wax and salivary secretions). In this study, the hepatoprotective and therapeutic effects of propolis ethanol extract on chronic alcohol-induced liver injuries were investigated in rats. 3.125 ml of 99.5% alcohol was added to animal's daily diet for four weeks to induce chronic alcohol liver injuries. After sacrifice, serum transaminases (GOT, GPT), triacylglyceride and hepatic triacylglyceride (HTG) concentration were assayed to observe liver injuries induced by chronic alcohol abuse. In addition, the phenomenon of alcohol induced fatty liver were also observed by histopathological changes. Different doses of propolis ethanol extract were p.o. administered three times per day for three days, after four weeks' alcohol administration. It was found that 10 mg/kg of propolis ethanol extract significantly decreased the elevations of serum GOT, GPT, TG and HTG. In histopathological examination, 30 mg/kg of propolis ethanol extract also remarkably decreased the hepatocellular fatty degeneration, apparent as vacuolization, induced by chronic alcohol abuse.

Water Resource Protection in Taiwan: An Evaluation of the Taipei Water Management Commission

/ This study evaluates the institutional capacity and performance of the Taipei Water Management Commission. The commission, which manages the Taipei Water Special Area-one of 95 such areas in Taiwan and the only one managed by a supervisory agency-has established a record of water conservation that suggests its utility as a model for managing other protected water resources areas in Taiwan. However, its present institutional structure limits its ability deliver on its mandate. The study identifies a number of problems related to the commission's current institutional structure that need to be addressed if the commission is to serve as a viable model for managing other protected water resource areas in Taiwan.KEY WORDS: Water resources management; Commissions; Institutional capacity; Taiwan

Age differences in remote pointing performance

The purpose of this study was to investigate age differences in remote pointing movements. The subjects were recruited from three age groups (ages 18-22 yr., 40-50 yr., and 60-70 yr., with 9 men and 9 women in each group). They were required to perform cursor-positioning tasks using a remote pointing device, in which the dependent measures were the time taken to reposition the cursor and the accuracy of subjects' movement trajectories. The movement time was further separated into two components, First Submovement duration and Adjustment Submovement duration. Analysis indicated that age groups showed reduced performance on remote pointing. Moreover, remote positioning movement for the young-adult group was mostly completed in their First Submovement phase, while the elderly subjects spent most of their movement time on the Adjustment Submovement phase. These results support the proposition that different age groups exhibit different kinds of movement patterns.

Human liver CYP2B6-catalyzed hydroxylation of RP 73401

RP 73401 is a potent inhibitor of cyclic nucleotide phosphodiesterase type IV. RP 73401 is metabolized by human liver microsomes almost exclusively by transhydroxylation of the cyclopentyl group to RPR 113406. Liquid chromatography/mass spectrometry/mass spectrometry analysis of plasma from patients given RP 73401 also revealed a molecular ion and fragmentation consistent with RPR 113406. Thus, the objective was to determine the oxidative enzyme(s) responsible for RP 73401 hydroxylation. Kinetic constants of RP 113406 formation ranged from 8 to 26 MM and 0.83 to 5.99 nmol/min/mg protein for K(m) and V(max), respectively (n = 3). Enzyme activity varied 23-fold among 15 human liver microsome samples and correlated with CYP2A6-catalyzed coumarin hydroxylase (r2 = 0.85, P < .01) and CYP2B6-catalyzed 7-ethoxytrifluoromethylcoumarin O-deethylase (r2 = 0.82, P < .01) activities. Chemical inhibition studies showed a 63% decrease in RP 73401 hydroxylation by 500 microM orphenadrine. Coumarin (10 microM), however, did not inhibit RP 73401 hydroxylation. Also, anti-CYP2B1 IgG produced 85% inhibition of RP 73401 hydroxylation, but only a negligible decline in coumarin hydroxylase activity. Of the 10 expressed P450 forms studied, only CYP2B6 catalyzed RP 73401 hydroxylation. Finally, expressed CYP2B6 showed a high affinity (K(m) = 22.5 microM) for RP 73401 hydroxylation, similar to the human liver microsome studies.

The effects of ursodeoxycholic acid in patients with severe obstructive jaundice after drainage procedure

BACKGROUND

The aim of this study is to evaluate the therapeutic effect of ursodeoxycholic acid (UDCA) for patients with severe obstructive jaundice after drainage procedure.

METHODS

From September 1993 to December 1994, patients admitted with severe obstructive jaundice (serum bilirubin > 15 mg/dl) and successful drainage were enrolled into our study. They were randomly divided into two groups to receive UDCA 600 mg per day (UDCA group) or a placebo (placebo group) until operation or discharge. Bile drainage amount, clinical symptoms and signs and adverse effects of drugs were recorded daily. Biochemical tests, including albumin, total bilirubin, cholesterol, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase and prothrombin time, were checked first, on the third and seventh days, and then two weeks after drainage.

RESULTS

Thirty-eight patients (M/F = 36/ 2, mean age 66.6 +/- 6.4 years) completed the study, 18 in the UDCA group and 20 in the placebo group. There were no differences in age, sex, causes of obstructive jaundice or methods of drainage procedure between the UDCA and placebo groups. Improvement in biochemical test results were noted in both groups. However, bile drainage amount and changes in liver biochemical test, especially the decrement of serum bilirubin, were not significantly different between both groups.

CONCLUSIONS

UDCA seemed not to benefit patients with severe obstructive jaundice after successful drainage.

Novel and frequent mutations of hepatitis B virus coincide with a major histocompatibility complex class I-restricted T-cell epitope of the surface antigen

We examined the full-length hepatitis B virus (HBV) envelope (surface antigen or HBV small surface antigen [HBsAg]) sequences of 12 different liver samples from 10 different hepatoma-containing chronic carriers. Surprisingly, novel and frequent mutations occurred predominantly at amino acids 40 and 47 of HBsAg, in addition to within a known protective B-cell epitope (so-called group a determinant of HBsAg 124-148). Approximately 58% of chronic carriers contain mutations at the group a determinant. The mutation frequency at the hotspot codons 40 and 47 is approximately 83%, 1 order of magnitude higher than at the known polymorphic sites of subtype-specific determinants at codons 122 and 160, which is approximately 4%. This new mutational domain is found to coincide with a major histocompatibility complex class I-restricted T-cell epitope. The potential biological significance of this novel mutation in the immunopathogenesis of HBV chronic carriers is discussed.

Vitamin D stores of urban women in Taipei: effect on bone density and bone turnover, and seasonal variation

This study was performed to survey the vitamin D nutritional status of urban Chinese women, and to define its role in determining bone metabolic rate and bone mineral density (BMD). We measured serum 25-hydroxyvitamin D (25-OHD), the major storage form of vitamin D, and BMD, at the spine, hip, and total body skeleton, of 262 healthy Chinese women aged from 40 to 72 years, residing in Taipei city. Bone turnover markers, including serum osteocalcin, bone alkaline phosphatase isozyme, and C-terminal propeptide of type I procollagen, and a urinary bone resorption marker, N-terminal crosslinked fragment of type I collagen, were also measured. We found generally adequate vitamin D nutritional stores. The mean concentration of serum 25-OHD was 30.7 (SD = 8.2) ng/mL for all 262 subjects and there were no significant age-related changes. Those who had serum sampled during the summer showed higher serum 25-OHD levels (N = 138; mean +/- SD: 32.7 +/- 7.6 ng/mL) than those who had serum sampled during winter (N = 124; mean +/- SD: 28.5 +/- 8.3 ng/mL; Student's t-test, p < 0.001), but these two groups showed similar BMD and bone marker values. Those with serum 25-OHD concentration in the lowest or highest tertile did not show different BMD or bone marker values than those in the other tertiles. Multiple regression demonstrated no correlation between 25-OHD and any bone marker or BMD at any site. Thus, in this free-living urban Chinese population, in a subtropical region, we could not demonstrate a role of vitamin D stores in determining bone turnover rate or BMD in women aged 40-70 years.

Solamargine purified from Solanum incanum Chinese herb triggers gene expression of human TNFR I which may lead to cell apoptosis

Solamargine possessed a potent cytotoxicity to human hepatocyte (Hep3B) and normal skin fibroblast. The inhibition curves of solamargine to the both cells were essentially overlapped, suggesting a parallel effect for the cell death. To define mechanism of cytotoxicity of solamargine, the changes of morphology and DNA content in cells were studied. A sub-G1 cell stage was drastically increased after 3-h incubation with solamargine. The results evidence that solamargine arises cell death by apoptosis. In addition, the gene expression of TNFR I were up-regulated within 30 min of solamargine treatment. Since TNF Receptor I has been involved in apoptosis, the overexpression of TNF receptor I may be related with the mechanism of cytotoxicity of solamargine. This communication is the first report that a component of Chinese herbs triggers gene expression of human TNFR I which may lead to cell apoptosis.

Sexual differences in bone markers and bone mineral density of normal Chinese

We measured bone mineral density (BMD) at lumbar (L2-L4) vertebrae and proximal femurs of 385 healthy Chinese women aged 40-70 years and 156 healthy Chinese men aged 20-85, and four markers-bone alkaline phosphatase isozyme (BAP), procollagen-I C terminal propeptide (PICP), osteocalcin (BGP) in serum, and a bone resorption marker, urinary cross-linked N-telopeptide of type I collagen (NTX), of these subjects. The results indicate that in postmenopausal women, levels of all the markers increased with age. In men, serum BAP, PICP, and urinary NTX decreased significantly, and serum BGP decreased with borderline significance (P = 0.08). With increasing age, bone density decreased at both sites in postmenopausal women and at the proximal femur in men. The lumbar bone density showed no significant age-related changes in men. In premenopausal women, BMD at either site showed no significant change with increasing age. Despite the different trends between men and women of age-related changes in BMD and bone markers, bone density of both proximal femur and spine in both sexes correlated inversely with levels of the bone markers in a manner independent of age or body weight. The meaning of opposite age effects on bone markers in men and women needs further investigation. In addition, higher bone marker levels, implying faster bone turnover rate, are associated with lower BMD in both sexes.

Bone mineral density and bone markers in relation to vitamin D receptor gene polymorphisms in Chinese men and women

Whether vitamin D receptor gene (VDRG) polymorphism can be used as a predictor for bone turnover rate or bone mass remains controversial. Its role within various ethnic populations are also unsettled. We examined VDRG polymorphism using restrictive enzymes Bsm-I, Apa-I, and Taq-I in 155 men aged 22-88 and 113 premenopausal women aged 40-53. The bone mineral density (BMD) of the vertebrae (L2-4), proximal femur, and total body bone mineral content (tb-BMC) (women only), as well as urinary N-terminal crosslinked fragment of type I collagen (NTX), serum osteocalcin, bone isozyme of alkaline phosphatase, and caboxyterminal propeptide of type I procollagen levels were measured. Chinese men and women exhibited a low prevalence for B (absence of Bsm-I restriction site) phenotypes than white and Japanese. Within the tested samples there were 0.4% BB homozygotes, 6.7% Bb heterozygotes, and 93% bb homozygotes. The distributions of Apa-I polymorphism (9.0% AA, 42.5% Aa, and 48.5% aa) also differed from those reported for the white populations. Most of the Chinese men and women were TT homozygous (96.6%). A comparison of actual values and values adjusted for age and weight of tb-BMC and BMD at the lumbar spine, Trochanter, Ward's triangle, and femoral neck showed no significant difference among three subgroups in each of the three sets of polymorphism. Furthermore, the actual values and adjusted values (adjusted for age) of the four bone markers, respectively, showed no significant differences. We conclude that given the very low prevalence of the suspected high risk genotypes (B, A, and t), and the lack of difference among the polymorphic subgroups, VDRG polymorphism may not be an important determinant of the bone turnover rate and bone mass of Chinese men and women.

Role of viscoelasticity in the tube model of airway reopening. II. Non-Newtonian gels and airway simulation

The influence of viscoelastic gels as lining fluids on the pressure-velocity relationships in an airway tube model (Gaver et al. J. Appl. Physiol. 69: 74-85, 1990) was examined. A flow instability was observed due to the occurrence of a sol-gel transition in the viscoelastic properties under flow conditions. We further report measurements of the viscoelastic properties of airway secretions. Airway secretions are gels under small strains and have a yield stress of 4-7 dyn/cm2. Secretions from the pharyngeal airway show lower elasticity than secretions from the trachea. The airway reopening process is simulated using a Weibel lung geometry by incorporating the constitutive equations from the model gel studies and utilizing the rheological data on airway secretions. In these simulations, a "popping-open" phenomenon arises from a flow instability in airway generations 8-14 when the rheological properties of the lining fluids are assumed to be similar to those of pharyngeal secretions. On the basis of these studies, the elasticity of airway secretions plays an important role in airway reopening.

The liver biochemical tests and serological markers of hepatitis B virus in the very old-aged population in Taiwan

BACKGROUND

Human liver alters with aging. Lower serum albumin with elevation in serum cholesterol and alkaline phosphatase (ALP) has been reported in the elders, but there was no further report on the very old people (i.e., >75 Y/O). We evaluated changes of liver biochemical tests and hepatitis B virus (HBV) serological markers in the very old-aged population.

METHODS

From October 1993 to June 1994, 2,549 subjects attended our hospital for physical check-up. Of them 1,742 were healthy subjects (M/F = 1,058/648) and were enrolled for analysis of the normal range of liver biochemical tests in different age groups. They were divided into four groups; young-aged group (age between 18 and 40, n = 231), middle-aged group (age between 41 and 64, n = 991), old-aged group (age between 65 and 75, n = 424), and very old-aged group (age > or = 76, n = 96). The items of liver biochemical tests included albumin, total bilirubin, cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALP and gamma-glutamyl transpeptidase (GGT). The whole population, totally 2,549 subjects, were used for the analysis of the prevalence of HBV serological markers in different age groups.

RESULTS

Serum albumin was the only biochemical parameter that persisted to decline after the age of 75 (p <0.05). Cholesterol began to elevate in the middle-age but decreased after 75 Y/O. The old-aged and very old-aged subjects had higher levels of serum bilirubin, AST, ALP, and GGT levels than the other two groups (p <0.05), however, the changes of ALT levels among these groups were not so remarkable. The HBV carrier rates in the young-aged, middle-aged, old-aged and the very old-aged groups were 16.8%, 12.3%, 6.8% and 7.0%, respectively (p <0.001). Furthermore, the very old-aged group had a significantly higher prevalence of negativity in both HBsAg and anti-HBs (p <0.001).

CONCLUSIONS

Serum albumin is the only biochemical parameter that persists to decline after the age of 75. In contrast, elevation of cholesterol tends to reverse after that age. All the aging-related changes in biochemical tests are clinically nonsignificant though some of them are significant in statistical analysis. In addition, a low HBV carrier rate and a high prevalence of negativity in both HBsAg and anti-HBs are noted in the very old-aged people, possibly due to the progressive loss of HBV markers in the elders.

Analysis of a vinyl pyrrolidone/poly(propylene fumarate) resorbable bone cement

A resorbable bone cement was formulated from N-vinyl-2-pyrrolidinone (VP), the unsaturated polyester poly(propylene fumarate) (PPF), and the inorganic filler tribasic calcium phosphate (hydroxy apatite). Cure, initiated by benzoyl peroxide and accelerated by N,N-dimethyl-p-toluidine, resulted in the formation of VP crosslinks between polyester chains. During cure the cement hardened from a viscous moldable putty to a rigid structure with a shore D hardness of 50-60. The purpose of this study was to determine the fractions of PPF and VP incorporated into the crosslinked structure. Dissolution of the cured cement in water followed by extraction of the residue in tetrahydrofuran indicated that over 90% of the PPF was crosslinked over the range of PPF/VP ratios explored, but that the fraction of VP used in formation of crosslinks depended linearly on the PPF/VP ratio. Kinetic analysis of these data suggests that k'pp/kpf (the reactivity ratio) was approximately 2.0 where k'pp is the rate constant for the addition of VP radical to VP monomer leading to formation of poly(vinyl pyrrolidone), and kpf is for the addition of VP radical to PPF unsaturation.

Pharmacoeconomics of propofol versus thiopental for induction of anaesthesia in short procedures

This study compared the costs and benefits of using propofol/fentanyl versus thiopental/fentanyl for induction of anaesthesia in short procedures. A prospective, cohort trial was conducted in conjunction with a patient survey. The study population included a consecutive sample of American Society of Anaesthesiologists. Class I or II patients who underwent short operative procedures and who were given one of the studied anaesthetic regimens. Insoflurane/N2O was used for maintenance of anaesthesia in all cases. Propofol patients showed a significantly shorter time to eye opening (p = 0.0025); orientation to date of birth, place, and day of week (p = 0.0002); time to consciousness (p = 0.0019); and time in recovery room (p = 0.013); but not time to tolerating 50 mL of oral fluid (p = 0.06). Nausea and vomiting occurred in 41% of thiopental patients and 19% of propofol patients (difference 22%; 95% C.I., -1% to 44%). Based on survey results, propofol patients subjectively reported fewer side effects upon returning home and were able to resume daily activities earlier than thiopental patients. With the current staffing and patient load at our institution, an estimated 4.8 hours of nursing time per day would be made available if propofol were used in place of thiopental for induction of anaesthesia in these procedures. If propofol were used for all daycare surgery patients in our institution, the annual acquisition cost is projected to be $60,331.28 versus $8,079.68 for thiopental.(ABSTRACT TRUNCATED AT 250 WORDS)

The psychophysical lifting capacities of Chinese subjects

The psychophysical lifting capacity (MAWL) of twelve subjects was determined in this study. The subjects were all young Chinese males who performed lifting tasks in three lifting ranges (floor to knuckle, floor to shoulder, and knuckle to shoulder) and four lifting frequencies (one-time maximum, 1 lift/min, 4 lifts/min, and 6 lifts/min). The oxygen uptake (1/min) and heart rate (beats/min) were recorded while subjects were lifting. Upon completion of each lifting task, the subjects were required to rate their perceived exertion levels. The statistical analyses results indicated the following. Chinese subjects have smaller body size and MAWLs compared with past studies using the US population. The MAWLs decreased with an increase in lifting frequencies. The decrements of MAWL due to lifting frequencies were in agreement with the results of past studies. However, there were larger decreases due to lifting ranges. The MAWLs of the floor to knuckle height lift were the largest, followed by the MAWLs of the floor to shoulder height lift, and the MAWLs of the knuckle to shoulder height lift. The measured physiological responses were considered similar to those obtained in past studies. Subjects' perceived stress levels increased with the lifting frequency and the upper extremities received the most stress for the total range of lifting tasks. The comparisons of the Chinese MAWLs with the NIOSH lifting guidelines for limits (AL and MPL) indicated that the vertical discounting factor in the guidelines should be modified before the NIOSH limits can be applied to non-Western populations.

Role of viscoelasticity in tube model of airway reopening. I. Nonnewtonian sols

This investigation used a previously described bench-top device (Gaver et al., J. Appl. Physiol. 69: 74-85, 1990) to examine the role of nonnewtonian and viscoelastic fluids on events at reopening of a closed flexible tube. Aqueous sodium alginate solutions with and without calcium chloride and sodium dodecyl sulfate in desired concentrations provided fluids with a wide range of surface tensions, storage and loss moduli, and nonnewtonian steady shear viscosity. Dimensionless analysis, using the shear rate-dependent viscosities, was applied to reduce reopening pressure-meniscus velocity data to a master curve. With regard to fluid properties, we found that 1) fluid elasticity strongly changes the pressure-velocity relationship, causing flow instability at higher meniscus velocities; 2) decreasing surface tension gives rise to a smaller yield pressure for reopening; and 3) whereas larger tubes are easier to open, smaller tubes produce additional shear thinning of the lining fluid. These results suggest that, for both the upper (large) and lower (small) airways, nonnewtonian and viscoelastic properties of the mucosal fluid modify the time of closure and rate of reopening.

Functional expression and site-directed mutagenesis of a synthetic gene for alpha-bungarotoxin

In order to explore the structure-function relationships of the curare mimetic alpha-neurotoxins we have constructed and cloned a synthetic gene for Bungarus multicinctus alpha-bungarotoxin which is expressed in Escherichia coli. The recombinant alpha-bungarotoxin is expressed as a fusion protein with alpha-bungarotoxin linked to the COOH-terminal end of the T7 Gene 9-encoded coat protein. After treatment of the fusion protein with Factor Xa protease, a recombinant alpha-bungarotoxin is released that co-migrates with authentic alpha-bungarotoxin upon reverse-phase high performance liquid chromatography and ion-exchange chromatography. Final yields of active recombinant alpha-bungarotoxin were about 0.4 mg/liter of starting bacterial culture. The recombinant alpha-bungarotoxin contains 10 additional residues linked to the NH2-terminal Ile of the alpha-bungarotoxin sequence due apparently to the inaccessibility of the engineered cleavage site to Factor Xa. Nevertheless, the recombinant alpha-bungarotoxin is capable of binding to the nicotinic acetylcholine receptor with an apparent affinity that is only decreased approximately 1.7-fold from that of authentic alpha-bungarotoxin. Alanine substitution of a residue, Asp30, highly conserved among alpha-neurotoxins and previously suggested to play a key role in receptor recognition, resulted in a recombinant alpha-bungarotoxin whose receptor binding activity is indistinguishable from authentic alpha-bungarotoxin.

Psychophysical modelling of lifting capacity of Chinese males using strength variables

This study used the psychophysical approach to determine the maximum acceptable weight of lift (MAWL) for 12 young Chinese male subjects, and used strength variables as predictors to develop prediction models. Each subject performed 12 different lifting tasks involving three lifting heights and four lifting frequencies. The results showed that both the dynamic and static models developed in this study could predict the MAWL with a reasonable degree of accuracy. However, a comparison of the models revealed that the use of the dynamic model resulted in less PRESS (PRediction Error Sum of Squares) statistics and higher [Formula: see text] values than the static model. Isoinertial 1.83 m maximum strength (T1) and the isoinertial elbow-height strength, tested on an incremental weightlifting machine, were found to be the best screening test. This was different from a previous study that recommended T1 as the most promising single screening test for Occidentals.

Analysis of a large kindred with Blau syndrome for HLA, autoimmunity, and sarcoidosis

OBJECTIVE

To determine whether HLA and autoimmunity contribute to the pathogenesis of Blau syndrome (familial granulomatous arthritis, uveitis, and rash) and evaluate whether this condition is related to sarcoidosis.

DESIGN

Large family survey.

SETTING

General community, Green Bay, Wis, and two tertiary care medical centers in Philadelphia, Pa.

PARTICIPANTS

Thirty-six family members and spouses from a large kindred with Blau syndrome.

SELECTION PROCEDURES

Volunteer and convenience sample.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Ten affected and many unaffected subjects were personally examined. Medical records and previous biopsy reports and specimens, when available, were reviewed. Two affected subjects had skin biopsies performed and three affected adult subjects were tested with Kveim skin-test reagent. Serologic and genomic class I and class II HLA typing was performed on 27 affected and unaffected subjects. All 13 living affected subjects and the one obligate carrier had the following assays performed; antinuclear antibody titer, rheumatoid factor, serum angiotensin converting enzyme level, quantitative immunoglobulins of the IgG, IgM, and IgA classes, and clinical chemistry profiles. Several had complete blood cell counts and erythrocyte sedimentation rates performed. Four affected subjects, one possibly affected subject, and one obligate carrier were newly identified. Flexion contractures of the fingers and toes (camptodactyly) were found, for the first time, to be a phenotype characteristic. Earlier onset and worsening of symptoms in succeeding generations (anticipation) were observed. Sixteen HLA haplotypes were identified. No conclusive evidence for linkage between these haplotypes and phenotype expression could be demonstrated. All 13 affected subjects, however, carried the DR2 (DR beta 1*1501) and/or DR4 (DR beta 1*0401) allele. There was no evidence of hypercalcemia, hypergammaglobulinemia M, rheumatoid factor production, or abnormal blood cell counts. Two affected subjects had low-titer antinuclear antibody screening tests, five had mild to moderately elevated IgG and/or IgA levels, two had raised serum angiotensin converting enzyme levels, and three had mild elevation of the erythrocyte sedimentation rate. All three subjects tested with Kveim skin-test reagent showed no reactivity by visual inspection. Both subjects who had had skin biopsies performed had evidence of granulomatous inflammation.

CONCLUSIONS

This family's illness is distinct from both classic and early-onset sarcoidosis. There is minimal evidence for autoimmunity and systemic inflammation. Camptodactyly should be added to the list of syndrome-defining characteristics. Although HLA haplotypes do not appear to segregate with affected subjects, HLA-DR2 and HLA-DR4 subtypes may play a permissive role in phenotype expression. This family represents a unique opportunity to define the molecular mechanisms involved in the initiation of arthritis and uveitis in humans. Genetic linkage studies to determine the chromosomal location of the Blau syndrome gene are in progress.

Reappraisal of skeletal tuberculosis: role of radiological imaging

Skeletal tuberculosis (TB) can present with a broad spectrum of variable clinical manifestations which may cause diagnostic difficulties. To further elucidate these possible diagnostic pitfalls, 14 cases of bacteriologically or histologically proven skeletal TB, which were initially diagnosed otherwise, are reviewed. In five cases with lumbar or midthoracic spinal involvement, concomitant traumatic history and degenerative radiological changes were the main reasons for not suspecting the possibility of skeletal TB. A differential diagnosis between TB and metastatic lesions can be difficult in the very early stage when X-ray images usually have a low contrast and are not sharp. In nine cases with bone and joint involvement, a long-lasting discharging sinus led the clinician to an initial impression of septic arthritis; sometimes concomitant gouty arthritis can mask the clinical manifestations of skeletal TB. In five cases, minor erosive lesions over the peripheral margin of the involved bone were the earliest findings on the plain X-ray films and were overlooked. To facilitate the early diagnosis of skeletal TB and to avoid the possibility of complications in the management of patients, medical practitioners should be familiar with the usual forms of the condition and the wide variety of clinical manifestations.

Demonstration of passenger leukocytes in a case of Epstein-Barr virus posttransplant lymphoproliferative disorder using restriction fragment length polymorphism analysis

Lymphocytic populations of the posttransplant lymphoproliferative disorder in a completely matched renal allograft and a recipient's regional lymph node were examined, using restriction fragment length polymorphism analysis with probe YNH24 to the variable number tandem repeat D2S44. The donor's DNA was found in lymphocytes extracted from both the grafted kidney and the recipient's lymph node 26 days after engraftment. In both these organs, the results of in situ hybridization with a terminally biotin-labeled oligonucleotide probe to the Not I tandem repeat region of the Epstein-Barr virus (EBV) genome, as well as those of Southern blot hybridization to the EBV nuclear antigen region of the EBV genome, were positive. These findings confirmed the presence of the donor's lymphocytes ("passenger leukocytes") in the host nodal tissue in human renal transplantation and implicated EBV as playing a role in the development of posttransplant lymphoproliferative disorder. It is speculated that the EBV proliferative stimulus contributed to the recipient and the donor lymphocyte expansions. Alternatively, the proliferation of both lymphocyte populations could result from a mutual stimulation by minor histocompatibility or other antigens.