Epidemiology of schistosomiasis in the People's Republic of China, 2004

Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People's Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6-65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.

Strategy formulation for schistosomiasis japonica control in different environmental settings supported by spatial analysis: a case study from China

With the aim of exploring the usefulness of spatial analysis in the formulation of a strategy for schistosomiasis japonica control in different environmental settings, a population-based database was established in Dangtu county, China. This database, containing the human prevalence of schistosomiasis at the village level from 2001 to 2004, was analyzed by directional trend analysis supported with ArcGIS 9.0 to select the optimum predictive approach. Based on the approach selected, different strata of prevalence were classified and the spatial distribution of human infection with Schistosoma japonicum was estimated. The second-order ordinary kriging approach of spatial analysis was found to be optimal for prediction of human prevalence of S. japonicum infection. The mean prediction error was close to 0 and the root-mean-square standardised error was close to 1. Starting with the different environmental settings for each stratum of transmission, four areas were classified according to human prevalence, and different strategies to control transmission of schistosomiasis were put forward. We conclude that the approach to use spatial analysis as a tool to predict the spatial distribution of human prevalence of S. japonicum infection improves the formulation of strategies for schistosomiasis control in different environmental settings at the county level.

[Observation on the change of anti-S. japonicum antibody level in population migrated from outside embankment to new town]

OBJECTIVE

To detect the change of the anti-S. japonicum antibody level after people migrated from outside embankment to newly established town.

METHODS

Three pilot spots were established for the investigation: one spot that both inhabitancy and cultivation disuse (A), one spot that only inhabitancy disuse but farming continued (B) and the third one served as control (C). DIGFA and ELISA were used to detect the antibody level in the populations from 2002 to 2005.

RESULTS

The positive rate of anti-S. japonicum antibody declined significantly from 6.63% to 3.52% by DIGFA and from 7.26% to 3.71% by ELISA at spot A (chi2=5.2625, P<0.05; chi2=6.3296, P<0.05, respectively). There was no significant difference on the positive rate of antibody in spots B and C. The average A450 value of ELISA in the three spots was statistically analyzed by One-Way ANOVA. It was only in spot B that the average A450 value declined from 0.182 in 2003 to 0.147 in 2005 (P<0.01).

CONCLUSION

The anti-S. japonicum antibody level in human population has decreased at certain degree after they migrated from outside embankment to new town.

Does multiple hosts mean multiple parasites? Population genetic structure of Schistosoma japonicum between definitive host species

Multi-host parasites, those capable of infecting more than one species of host, are responsible for the majority of all zoonotic, emerging or persistent human and animal diseases and are considered one of the major challenges for the biomedical sciences in the 21st century. We characterized the population structure of the multi-host parasite Schistosoma japonicum in relation to its definitive host species by genotyping miracidia collected from humans and domestic animals across five villages around the Yangtze River in Anhui Province, mainland China, using microsatellite markers. High levels of polymorphisms were observed and two main genetic clusters were identified which separated water buffalo, cattle and humans from goats, pigs, dogs and cats. We thereby believe that we present the first evidence of definitive host-based genetic variation in Schistosoma japonicum which has important epidemiological, evolutionary, medical and veterinary implications.

Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China

BACKGROUND

Many people with epilepsy need not experience further seizures if the diagnosis and treatment are correct. Most epilepsy patients have convulsions, which are usually fairly easy to diagnose. This study tested a model for treatment of people with convulsive forms of epilepsy at primary health-care level in rural areas of China.

METHODS

Patients with convulsive epilepsy were identified at primary care level and provided with phenobarbital monotherapy. Local physicians, who were provided with special training, carried out screening, treatment, and follow-up. A local neurologist confirmed the diagnoses. Efficacy was assessed from the percentage reduction in seizure frequency from baseline and the retention of patients on treatment.

FINDINGS

The study enrolled 2455 patients. In 68% of patients who completed 12 months' treatment, seizure frequency was decreased by at least 50%, and a third of patients were seizure free. 72% of patients who completed 24 months' treatment had reduction of seizure frequency of at least 50% and a quarter of patients remained seizure free. Probability of retention was 0.84 at 1 year, and 0.76 at 2 years. Medication was well tolerated and reported adverse events were mild; only 32 patients (1%) discontinued medication because of side-effects.

INTERPRETATION

This pragmatic study confirmed that this simple protocol was suitable for the treatment of convulsive forms of epilepsy in rural areas of China. Physicians with basic training could treat epilepsy patients with phenobarbital, with beneficial effects for most patients with convulsive seizures. Few cognitive or behavioural adverse events were noted, but formal psychometric testing was not done.

Transmission of Schistosoma japonicum by humans and domestic animals in the Yangtze River valley, Anhui province, China

The aim of the present work was to assess the relative contribution to transmission of Schistosoma japonicum by humans and domestic animals in two villages in the Yangtze River valley in Anhui province, China. A cross-sectional survey was conducted to determine the prevalence and intensity of S. japonicum in humans, cattle, water buffaloes, horses, pigs, goats, dogs and cats. Additionally, for each host species the number of individuals and the mean faecal excretion per day was determined. Results showed that both prevalence and intensity of infection varied significantly between species and between the two villages and neither of the variables gave an adequate picture of the potential transmission. Total daily egg excretion was significantly higher in Chenqiao village compared with Guanghui village. Whereas humans were the main contributors to transmission of schistosomiasis in Guanghui village (80.4%), water buffaloes accounted for nearly 90% and goats for more than 5% of the transmission in Chenqiao village. Hence, the present study suggests that schistosomiasis transmission might vary significantly within Chinese farm districts and successful control should rely on prior transmission index determinations on major potential contributors rather than routine data of prevalence and intensity of infection. Further studies should determine the value of adding other transmission variables like egg hatchability and faecal deposition habits.

An economic evaluation of the national schistosomiasis control programme in China from 1992 to 2000

The World Bank Loan Project, by far the largest effort in China for schistosomiasis control since control activities were initiated in the mid 1950s, was carried out for a 9-year period commencing in 1992 in the 8 provinces where Schistosoma japonicum remained endemic when the project started. To evaluate its impact, a retrospective economic evaluation was done in 2001. Six representative counties, i.e. Huarong in Hunan province, Qianjiang in Hubei province, Yugan in Jiangxi province, Tongling in Anhui province, Xichang in Sichuan province and Dali in Yunnan province, were selected for the study. The total financial input in these counties from 1992 to 2000 was RMB Yuan 90.334 million with the World Bank loan accounting for 40.9%. Control efforts resulted in reduction of human prevalence rates in the six counties from 0.7-9.0% in 1992 to 0.1-2.7% in 2000. With regard to S. japonicum infection in bovines, a high reduction was observed in Qianjiang, and smaller decreases were noted in four counties, while there was an increase in Dali. In general, the areas infested by the intermediate host snail fluctuated around the initial level. The net benefit-cost ratio was 6.20, which means that this project gained US$ 6.20 for every dollar spent. The correlation coefficients of the net benefit-cost ratio to the human and bovine infection rates at the beginning of the project were 0.55 and 0.66, respectively. It is conceivable that further progress in schistosomiasis control is an important feature for sustained growth of the local economy, particularly in areas where control of the disease has been most challenging.

Population genetics of multi-host parasites – the case for molecular epidemiological studies of Schistosoma japonicum using larval stages from naturally infected hosts

Population genetics of multi-host pathogens offers great potential for the understanding of their complex epidemiology but care must be taken to ensure that the sampling procedure does not bias estimates of population indices. The transfer of material to laboratory passage, in particular, runs the risk of bottlenecking and imposing non-random host-induced selection pressures according to the hosts used in passage. We present a novel technique allowing single-locus microsatellite genotyping of the naturally sampled larval stages, enabling unbiased population genetic studies of the multi-host zoonotic parasite Schistosoma japonicum. The utility of these larval genotyping methods for molecular epidemiological studies are illustrated in results from 3 separate data sets. In the first data set, potential loss of alleles based on the definitive host species used for laboratory maintenance was identified by comparing adult worm populations derived from mice and rabbits infected with cercarial populations originating from the same set of snails. In the second data set, bottlenecking was demonstrated by the loss of alleles in adult worms derived within a single generation of laboratory maintenance compared to their parent field-collected cercarial samples. In the final data set, comparison of miracidia and adult worms recovered from naturally infected animals demonstrated that larval analyses can provide stage-specific epidemiological information and that population genetics of schistosomes can be well described by analysis of larval stages. Our results thus advocate the use of natural life-cycle stages to obtain an accurate and ethical representation of the population genetic structure of S. japonicum and other multi-host pathogens.

[Ecological surveillance on breeding ground for Oncomelania hupensis snails in the areas prevalent with islet-type schistosomiasis using remote sensing technology]

OBJECTIVE

To probe rational indices suitable for ecological surveillance on breeding ground for Oncomelania hupensis snails in areas prevalent with islet-type schisitosomiasis using remote sensing technology.

METHODS

Three adjacent islets, prevalent with islet-type schistosomiasis, along the Yangtze River within the boundaries of Dongzhi County, Anhui Province were selected as study field for remote sensing analysis. Multi-spectral data were composed and non-supervisedly classified in computer with Idisi software for remote sensing analysis. Values of the normalized difference vegetation index (NDVI), green vegetation index (GVI), bright index (BI), which reflect the greenness and brightness of landscape, were also calculated. Finally, all the results were comprehensively analyzed, combined with data from the field investigation.

RESULTS

NDVI, GVI and BI could depict characteristics of the landscape quantitatively. Values of NDVI, BI and GVI were varied in different types of landscapes, and 95% confidence interval of these values suitable for breeding of snails was 0.0522 approximately 0.3566, 2.4162 approximately 28.2672 and 29.3404 approximately 40.3135, respectively. Classification of NDVI showed that type 5 anf type 6 were main breeding ground for snails, and type 4 with values of NDVI from 0 to 0.1 was potential areas for snail propagation. Classification of GVI showed that types 5, 6 and 7 were main breeding ground for snails, and also type 4 with values of GVI from 2 to 10 was potential areas for snail propagation. Both NDVI and GVI showed type 2 and type 3 were temporarily not suitable for snail breeding.

CONCLUSION

Index figures of NDVI and GVI re-formed by reasonable classification could reflect not only breeding ground for snails and range of the areas for snail propagation in islets, but also their evolving rules, i.e., status of new marshland formation and vegetation growth.

The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study

The authors carried out a door-to-door survey to determine the prevalence of epilepsy among 55,000 people in China. The lifetime prevalence was 7.0/1000, and 41% of all persons had never received appropriate treatment. The prevalence of active epilepsy was 4.6/1000, and 63% of people with active epilepsy had not received antiepileptic treatment in the week before the survey. Figures for the prevalence and the treatment gap were significantly higher than previous estimates.

Studies of impact on physical fitness and working capacity of patients with advanced Schistosomiasis japonica in Susong County, Anhui Province

To assess the impact level on physical fitness and working capacity in patients with advanced Schistosomiasis japonica, a field study was carried out. According to the records of patients with advanced schistosomiasis in Susong County, Anhui Province, 48 advanced cases without other serious chronic diseases from endemic areas in two townships and 56 healthy individuals from non-endemic area, served as control group with matched ages between 40 and 70 years and matched sex were investigated with questionnaire, anthropometric measure and hemoglobin level. The impairment level of the liver was measured by ultrasonography and physical fitness was measured by the Step test in the case and control groups. All situations including lifestyle, working, socio-economic status and residing environment was similar in the case and control groups. Average height and weight was significantly lower in the case group than in the control group (height = 156.29 and 159.41 cm; weight = 50.72 and 53.92 kg; respectively, all P < 0.05). Thirteen individuals (28.3%) in the case group had moderate reduction of working capacity or even unable to work, but only seven (12.7%) individuals in the control group had moderate reduction of working capacity and all in the control group were able to work (P < 0.01). In the past 1 year, the average working days lost was 4.11 days in the case group and 0.86 day in the control group (P < 0.01). Both groups differed significantly in symptoms of abdominal pain, diarrhea and weakness (all P < 0.05). Twenty-one cases (43.8%) had grade II impairment of the liver and eight cases (16.7%) had grade III impairment of the liver in the case group, whereas seven individuals (12.7%) had grade II impairment of the liver in the control group (P < 0.01), as assessed by ultrasound. The hemoglobin levels and the power of gripping in the case group were significantly lower than those in the control group (Hb = 111.06 and 122.27 g/l; grip = 303.83 and 344.20 N, respectively, all P < 0.01). Physical fitness scores showed the control group (score: 71.84) was significantly fitter than the case group (score: 61.09, P < 0.01). Compared with the control group, the physical fitness of the case group reduced by 15%. The results showed that physical fitness and working capacity were reduced in advanced cases. Although most of the cases were treated and had reached a status of 'clinical cure', the impact on physical fitness and working capacity still existed.

Improvement of signal-to-noise and contrast-to-noise ratios in dual-screen computed radiography

A dual-screen computed radiography (CR) technique has been developed to improve and optimize the overall image signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). With this technique, two CR screens are exposed together and separately scanned to form a front and a back image. These two images are then superimposed to form an image of improved SNR and CNR. A mathematical model has been derived to describe the improvement and optimization of the SNR and CNR. Based on this model, the front and back images should be weighted in proportion to their SNR squared to optimize the SNR of the composite image. Imaging experiments have been conducted to verify the theoretical model under mammographic and chest imaging conditions. The results largely agree with the theoretical predictions. It has also been found that optimization of the SNR results in nearly optimal CNR and vice versa. For mammographic imaging, a 14%-22% improvement in the SNR and a 13%-19% improvement in the CNR have been demonstrated. For chest imaging, a 31%-36% improvement in the SNR and a 28%-30% improvement in the CNR has been demonstrated.

Simultaneous existence of two types of ribosome-inactivating proteins in the seeds of Cinnamonum camphora--characterization of the enzymatic activities of these cytotoxic proteins

Two types of ribosome-inactivating proteins (RIPs), camphorin and cinnamomin, have been purified from the seeds of Cinnamomum camphora. Camphorin is a type I RIP with a molecular mass of 23 kDa. Cinnamomin is a type II RIP having three isoforms, its molecular mass is around 61 kDa. The A- and B-chain derived from cinnamomin isoforms have similar mobilities in SDS-polyacrylamide gel. Camphorin and cinnamomin are both glycoproteins. In phylogenesis, it is particularly significant to find the simultaneous existence of type I and type II RIP as well as three isoforms of the latter in the same organ of a higher plant. The molecular mechanism of action of these two RIPs on mammalian ribosomes was demonstrated to be the specific RNA N-glycosidase activity. They modify 28S RNA among the four species of ribosomal RNAs. The cleavage site is the adenosine at position 4324 (rat liver 28S rRNA) embedded in the highly conserved 'R/S domain'. It is the first report that an intact type II RIP (cinnamomin) exhibits RNA N-glycosidase activity. Additionally, camphorin and cinnamomin can cleave supercoiled double-stranded DNA into nicked and linear forms (Ling et al. (1994) FEBS Lett. 345, 143-146).

Operational techniques and combination treatment for the recurrent sacro-coccygeal tumor

This article presents 6 cases of recurrent sacro-coccygeal tumor with analysis of the causes of recurrence, operational technique for second-time operation and concomitant treatment. It is suggested that combined abdominal and sacro-coccygeal approaches be used to excise maximal mass of the tumor, surrounding affected tissues be curetted out and the space be filled up with adriamycin-bone-cement to destroy remaining tumor cells and to strengthen the stability of pelvis. Besides, the patients should be subject to supersegregation radiotherapy in order to minimize the possibility of recurrence.

Cleavage of supercoiled double-stranded DNA by several ribosome-inactivating proteins in vitro

Several ribosome-inactivating proteins (RIPs), such as ricin (including its A-chain), luffin, cinnamomin and camphorin, were found to express enzymatic activity to cleave supercoiled double-stranded DNA. In particular, alpha-sarcin, a RIP with a novel ribonuclease activity, was first proved to have this activity. They convert supercoiled DNA into a nicked circular conformation at low concentrations and further into a linear form at high concentrations: they have no effect on linear DNA. Although intact type II RIPs exhibited no RNA N-glucosidase activity, they were detected to cleave supercoiled DNA. Even if ricin A-chain was treated by boiling, its activity on supercoiled DNA was largely retained.

A clinical application of artery-including silicone tubing to peripheral nerve defect

7 cases of 11 peripheral nerve defects (5 median nerves, 5 ulnar nerves, and 1 radial nerve) were repaired through artery-including silicone tubing. The nerves have gaps within 3 cm in 9, and 3 to 5 cm in 2. Repairing the defect's location, 4 of them were below the axilla; 1 at the upper 1/3 part of the forearm and 6 at the lower part of the forearm. The duration of injuries was from 4 to 7 months, except one case lasting over a year. Six patients with 9 nerves involved had adequate follow-up of 6 to 9 months. One patient with 2 nerves was lost to follow-up. The results were excellent in 5 nerves (M4S3), good in 2 (M3S3), and poor in 2 (M1S1).

[Relation between left ventricular mass indexes and cardiac function in hypertensive patients: an approach with Doppler echocardiography]

73 age-matched hypertensive patients, 46 men and 27 women, were divided into the four groups according to left ventricular mass indexes (LVMI) and normal control groups were established correspondingly. Doppler and M-mode echocardiography were used to assess the systolic and diastolic functions of left ventricle (LV) and the alterations of heart construction. It was shown that when the LVMI increased slightly, the internal dimension and systolic function of LV had no significant change, but the diastolic function became abnormal and the left atrium enlarged. When the LVMI increased significantly, both the left atrium and left ventricle enlarged and the systolic and diastolic functions of LV were impaired. It is concluded that increase of LV mass may be present in the early stage of hypertension and left atrial enlargement is an early sign of left ventricular diastolic dysfunction, which occurs before systolic dysfunction in the patients with essential hypertension.

Psoralens cleave pBR322 DNA under ultraviolet radiation

Supercoiled (SC) pBR322 was used to probe the recent claim that 5-geranoxylpsoralen (5-GOP) did not photoreact with DNA. Contrary to expectations, 5-GOP was found to damage DNA in the presence of UV-A through two competing pathways: (a) single strand breaks, identified by the conversion of supercoiled into open circular and linear DNA, and (b) cross-linking, revealed by the fluence-dependent decrease in the extent of denaturation of the double stranded supercoiled DNA to single stranded circular DNA. In addition, a fluence-dependent modification reduced the ability of the restriction enzyme EcoR I to linearize the photosensitized DNA, and alkali-labile lesions were generated. Psoralen, 5-methoxypsoralen, and 8-methoxypsoralen, which are well-known to undergo cycloaddition to DNA, had a more pronounced effect on supercoiled DNA. Single strand breaks occurred more readily than with 5-GOP, and the surviving SC form remaining had reduced electrophoretic mobility in agarose gels. In all cases, the DNA damage was more prominent when oxygen was absent.

Merocyanine 540-sensitized photoinactivation of enveloped viruses in blood products: site and mechanism of phototoxicity

The amphipathic dye, merocyanine 540 (MC540), which preferentially photosensitizes enveloped viruses and virus-infected cells, is currently being evaluated in preclinical models as a blood sterilizing agent. In this communication, we report on an initial analysis of the site and nature of MC540-mediated photodynamic damages to human herpes simplex virus type 1 and human cytomegalovirus. The comigration of dye molecules and virions on a gel filtration column, the red-shift of the fluorescence emission spectrum of virus-containing fractions, and the distribution of MC540-treated virions in an aqueous two-phase partition system were indicative of MC540 binding to the enveloped viruses and localizing in a lipophilic environment (most likely the viral envelope). Fluorescence quenching and fluorescence resonance energy transfer experiments suggested that both dye monomers and dimers were capable of partitioning into the lipid bilayer of the viral envelope. Adsorption and penetration assays and immunohistochemical analyses of viral antigen expression showed that MC540-sensitized irradiation interfered with early phases of the infectious process, the adhesion to the host cell, the penetration of the host cell, and the translocation of the virus into the nucleus of the host cell. The inactivation of viruses was inhibited if oxygen in the medium was displaced by argon, enhanced if air was displaced by pure oxygen or if water was replaced by deuterium oxide. This suggested that the MC540-sensitized photoinactivation of enveloped viruses is an oxygen-dependent process and that singlet oxygen is one but not necessarily the only mediator of the antiviral effects of MC540.

Photosensitization by 2-chloro-3,11-tridecadiene-5,7,9-triyn-1-ol: damage to erythrocyte membranes, Escherichia coli, and DNA

The natural product 2-chloro-3,11-tridecadiene-5,7,9-triyn-1-ol (1) photosensitized the inactivation of Escherichia coli in the presence of near-ultraviolet light (320-400 nm; NUV) under both aerobic and anaerobic conditions. A series of E. coli strains differing in DNA repair capabilities and catalase proficiency exhibited indistinguishable inactivation kinetics following treatment with the chemical plus NUV. The presence of carotenoids did afford some protection to E. coli against inactivation under aerobic conditions, consistent with the involvement of singlet oxygen. The photosensitized hemolysis of human erythrocytes occurred more rapidly in the absence than in the presence of oxygen. Aerobically, the onset of hemolysis was partially inhibited by NaN3 and by 2,6-di-t-butyl-4-methylphenol (BHT) but not by superoxide dismutase (SOD). The aerobic lipid peroxidation observed in the membranes of erythrocyte ghosts was completely inhibited by BHT, and partially by NaN3, but not by SOD. These results suggest that either lipid peroxidation of the membrane is not the main cause of photohemolysis or that BHT has insufficient access to intact erythrocyte lipids to protect them. Aerobically, crosslinking of membrane proteins was also observed; it was not affected by SOD, but was partially inhibited by BHT and NaN3. The anaerobic photosensitized hemolysis of erythrocytes was more rapid; a radical mechanism was suggested since BHT inhibited the hemolysis to a greater extent than under aerobic conditions. Neither lipid peroxidation nor protein crosslinking was observed under conditions believed to be anaerobic. A light-dependent electron transfer to cytochrome c was obtained under argon but not under oxygen. Although induced mutations were not observed in the experiments with E. coli, 1 was capable of damaging both supercoiled pBR322 and Haemophilus influenzae transforming DNA in a manner that seemed to be equivalent under aerobic and anaerobic conditions. In conclusion, 1 can behave as typical photodynamic molecule under aerobic conditions but, in contrast to most photodynamic molecules, it is also phototoxic under anaerobic conditions. The extent to which the radical reactions detected under anaerobic reactions compete with the photodynamic processes when oxygen is present is not known.

alpha-Terthienyl photosensitizes damage to pBR322 DNA

alpha-Terthienyl photosensitizes single strand breaks in pBR322 DNA. Almost identical results were observed under oxygen and under argon. In the presence of oxygen, this DNA nicking was enhanced by histidine and was not affected by superoxide dismutase, catalase, or the antioxidant BHT. Although chemical damage to DNA treated with alpha-terthienyl plus near-UV was clearly demonstrated in vitro, transformation in E. coli with this damaged pBR322 DNA still took place. Likewise, Haemophilus influenzae DNA transforming activity was not significantly decreased by photosensitization with alpha-terthienyl.

Classification of plasma cortisol patterns in normal subjects and in Cushing's syndrome

The 24-h pattern of half-hourly sampled plasma cortisol in normal human subjects shows a 24-h (circadian) period, which may be variably distorted in patients who suffer from autonomous hypercortisolism (Cushing's syndrome). We have developed a pattern recognition system for computer classification of cortisol time series into the normal class and subclasses of Cushing's syndrome with different etiology ("pituitary" designating pituitary tumor, "adrenal" designating adrenal tumor, and "ectopic" designating tumor elsewhere). Discriminatory features were extracted from Fourier analysis and Karhunen-Loeve expansion coefficients of cortisol time series. Decision functions were trained by the LMSE algorithm and tested by the jack-knife test procedure on a data-base of 90 normal and patient patterns. The classification accuracy for normal, "pituitary," "adrenal," and "ectopic" classes was 100, 98.1, 98.3, and 100%, respectively. Hence this pattern recognition system may be useful as an aid in the differential diagnosis of Cushing's syndrome.

Light-dependent cytotoxic reactions of anthracene

Anthracene is a photodynamic compound in vitro. In the presence of oxygen, it is known to generate singlet oxygen and participate in Type II reactions. In aqueous solution, it also participates in Type I reactions, such as in the photoreduction of cytochrome c, which can be suppressed by superoxide dismutase. In argon, direct photoreduction of cytochrome c also takes place. Anthracene induces the photodynamic hemolysis of human erythrocytes and inactivates Escherichia coli cells photodynamically. By using a series of E. coli strains differing in DNA repair capabilities and catalase proficiency, sensitivity to inactivation by anthracene plus NUV was correlated with catalase deficiency rather than with particular repair deficiencies. The fact that carotenoid genes cloned and expressed in E. coli offered partial protection suggests that the membrane may be one possible target for inactivation by anthracene plus NUV. Anthracene plus NUV inactivated Haemophilus influenzae transforming DNA and led to nicking of supercoiled pBR322 DNA in vitro. In vivo, therefore, anthracene is a phototoxic molecule whose cytotoxicity could be the result of damage to more than one target.

The hemolysis of erythrocytes by singlet oxygen generated in the gas phase

Many sensitizers cause photodynamic hemolysis of erythrocytes. As these sensitizers usually participate in Type I as well as Type II processes, the determination of the mechanism(s) of photosensitized hemolysis is always ambiguous. Here, human erythrocytes were proved to hemolyze upon treatment with singlet oxygen (1 delta g) generated with fluoranthene in the gas phase. These conditions rigorously exclude the participation of superoxide anion. The standard diagnostic tests for singlet oxygen (enhanced effect in D2O and protection by NaN3) gave the anticipated results when the erythrocytes were treated with 1O2 generated in the gas phase. When the erythrocytes were irradiated in a buffer solution containing fluoranthene, the results of the diagnostic tests depended on the sensitizer concentration.

Microsurgical treatment of disorders of leg and foot--a report of 40 cases

Since 1979, the authors have performed five types of microsurgical flap (including myocutaneous flap) graft to treat 40 patients with disorders of leg and foot. In the treatment of inflammatory diseases, good results were obtained owing to the following important points: 1) the operation was performed with inflammation well controlled or localized, particularly in chronic osteomyelitis; 2) indication for each type of microsurgical flap was made carefully; 3) isolation of flap was carried out gently, bleedings were thoroughly stopped by ligation.

Clinical application of the forearm island skin and fascia flap with posterior interosseous artery pedicle--report of 15 cases

The present paper reported 15 cases, in which skin and fascia forearm island flap with posterior interosseous artery pedicle was applied. It was found that this flap has the advantages of stable vessels, abundance in blood supply and good circulation, without sacrificing the main arteries of the forearm. As a result, it is an ideal method for repair and reconstruction of the hand and forearm.

A simple and rapid solid-phase RNA sequencing method

A simple and rapid solid-phase RNA sequencing method has been developed based on Peattie's direct chemical method. 3'-Terminally labeled RNA was immobilized on DEAE-cellulose sheets and followed by specific modification with dimethyl sulfate, diethylpyrocarbonate, hydroxylamine (at pH 10 for the uridine and pH 5.5 for the cytidine reaction), and cleavage reaction with aniline. RNA fragments were washed from the DEAE-cellulose sheets using salt solutions, precipitated with ethanol, and separated by 15% polyacrylamide gel electrophoresis. Due to the complete removal of the impurities normally present in the solution method, the higher resolution of the sequencing bands and lower background on the autoradiograph make this solid-phase technique more efficient. This solid-phase technique is much faster and more convenient than the original method.

Determination of plasma fentanyl by GC-mass spectrometry and pharmacokinetic analysis

GC-mass spectrometry was used to measure extremely low levels of fentanyl in dog plasma. Deuterated fentanyl was synthesized for use as an internal standard. Fentanyl was hydrolyzed to despropionyl fentanyl by 20% DCl in in deuterium oxide. Mass spectrometric analysis of the product revealed that the molecular ion was three mass units higher than that of the authentic despropionyl fentanyl, indicating that the deuterium exchange reactions occurred at this stage. Deuterated despropionyl fentanyl was reesterified by propionyl chloride to fentanyl-d3. The drug was assayed in biological fluids by extraction into ethyl acetate followed by analysis with GC-chemical-ionization mass spectrometry. The lowest measurable plasma fentanyl level is 500 pg/ml. The method is highly selective and is suitable for monitoring the time course of plasma drug levels. Evaluation of pharmacokinetic data from experiments using nine dogs revealed a triphasic phenomenon. No measurable amounts of the major metabolites, depropionyl fentanyl and norfentanyl, were detected.

Correlation between neurotoxicity and chlordecone (Kepone) levels in brain and plasma in the mouse

The brain and plasma levels of chlordecone were monitored after daily oral administration of chlordecone at 10 to 50 mg/kg/day. At a low dose, the plasma level of chlordecone increased steadily and the brain level showed a steady increase and then a plateau. However, at the higher dose the brain and plasma concentrations of chlordecone decayed biphasically. The data also revealed that chlordecone-induced neurotoxicity correlated closely with both brain and plasma concentration of chlordecone. Brain and plasma concentrations required for low and high dose for induction of the loss of motor coordination were estimated to be 10 to 65 ug/g and 10 to 25 microgram/ml, respectively. In addition, the chlordecone levels in the brain at time of death were 0.10 and 0.41 mg/g in groups receiving 10 and 50 mg/kg/day, respectively. However, the cumulative lethal dose of chlordecone in animals treated with different doses was about the same. This study established the threshold levels of chlordecone in plasma and brain for motor incoordination and mortality in the mouse.

Quantitation of plasma azathioprine and 6-mercaptopurine levels in renal transplant patients

The plasma of renal transplant patients was analyzed by high performance liquid chromatography (HPLC) for the presence of azathioprine and its primary metabolite, 6-mercaptopurine, after either oral or i.v. administration of azathioprine. Azathioprine was demonstrated in plasma at peak concentrations of 0.6 microgram/ml 15 min after i.v. injections of 100 to 200 mg. Within 90 min of injection, the azathioprine level fell to 10 ng/ml. Azathioprine was not detected in plasma at any time after an oral dose of 100 mg, indicating that the plasma concentration is less than 0.5 ng/ml, which is the sensitivity limit of this assay. 6-Mercaptopurine appeared in the plasma after either oral or i.v. azathioprine administration. Furthermore, decreased renal graft function has no effect on the rate of disappearance of azathioprine from plasma. These results demonstrate that high performance liquid chromatography can be used to determine azathioprine and 6-mercaptopurine levels in man, and that alteration in renal function does not influence early stages of azathioprine degradation.

Influence of cerebral embolism on brain monoamines

In baboons the right cerebral hemisphere was embolised by a shower of microemboli, immediately followed by one large embolus designed to occlude the middle cerebral artery (MCA). One hour after embolism a significant, though small, reduction in blood flow and oxygen consumption of the embolised hemisphere was recorded, at which time the animals were killed and brain monoamines measured. Dopamine was reduced in the ipsilateral caudate nucleus, the reported site of maximal ischaemic damage in this model. Dopamine levels were increased in frontal and occipital grey matter sampled from areas surrounding the occluded MCA territory and in similar brain areas of the opposite non-embolised hemisphere. Noradrenaline was increased in grey matter from both cerebral hemispheres, as well as subcortical structures bilaterally. Brain 5-hydroxytryptamine levels were unaltered, but increased 5-hydroxyindoleacetic acid in cisternal cerebrospinal fluid suggested transient alteration in 5-hydroxytryptamine metabolism after embolism. The effects of cerebral embolism on brain monoamine metabolism appear to be different from the effects of permanent surgical occlusion of major cerebral vessels. The bilaterality of effects after unilateral hemispheric embolism might be related to diaschisis. The mechanisms of the observed changes, as well as their relevance to the progression of cerebral ischaemia and the complications associated with cerebral embolism, still require to be established.

Ischemia-induced seizures and cortical monoamine levels

Seizure activity as a component of the ischemic process possibly responsible for monoamine changes described in the gerbil stroke model was the subject of this study. Abnormal motor activity suggestive of seizures developed one to three hours after unilateral ligation of the common carotid artery in approximately 50% of gerbils that exhibited signs of stroke. Reduction of cortical levels of dopamine and norepinephrine was observed only when seizures occurred in association with stroke. The levels of 5-hydroxytryptamine were reduced bilaterally in animals with and without signs of stroke and were reduced further in animals with stroke plus seizures. Further study is needed to establish whether the catecholamine changes associated with ischemia-induced seizures are primary and causative or secondary to seizure activity itself. In the ischemic brain, 5-hydroxytryptamine metabolism appears disordered independent of seizure activity. Seizure activity must be taken into account when the mechanisms of disordered monoamine metabolism are being examined in the gerbil stroke model.