Response of human dendritic cells to different immunomodulatory polysaccharides derived from mushroom and barley

Polysaccharides derived from fungi and plants have been increasingly used as dietary supplement with therapeutic intention for cancer. However, whether these polysaccharides from different sources and structures can elicit similar immunological effects remain unknown. This study aims to investigate and compare the effects of selected groups of purified and crude polysaccharides on human dendritic cells (DCs), the most potent antigen-presenting cells. The selected polysaccharides were from Ganoderma lucidum [(GL) Lingzhi, Reishi], a medicinal mushroom commonly used by oriental; and barley glucan, a purified polysaccharide with known in vivo immunomodulating effect. We found that purified polysaccharides from GL mycelium could induce human PBMC proliferation and phenotypic and functional maturation of DCs with significant IL-12 and IL-10 production. Polysaccharides of GL spore and barley were both rather weak immunostimulator in vitro. In general, all these polysaccharides did not polarize T cells into either T(h)1 or T(h)2 or regulatory T cells, except for crude spore polysaccharides-treated DCs which could suppress T cell proliferation with IL-10 production. This study revealed the polysaccharides of different sources have different immune potency and effect on human immune cells including DCs. Our study also provides a reproducible biological platform for comparing the potential therapeutic effects of different herbal-derived polysaccharides in the future.

A case of mixed adult Wilms' tumour and angiosarcoma responsive to carboplatin, etoposide and vincristine (CEO)

Here we report an unusual case of mixed Wilms' tumour and angiosarcoma in a 38-year-old female patient who presented with haematuria and right lower back pain. A computed tomographic (CT) scan confirmed a massive renal tumour associated with extensive retroperitoneal lymph node involvement, bony metastases and a right hip fracture. She was initially managed with palliative nephrectomy, which was followed by rapid postoperative deterioration. Histopathology revealed differentiated adult Wilms' tumour with renal angiosarcoma, whereas the pathology of the para-aortic lymph node and bone metastasis revealed angiosarcoma only. In view of her cachexia and cytopaenia, emergency chemotherapy was initiated using a modified regimen of carboplatin, etoposide and vincristine (CEO) in preference to the more traditional but less well-tolerated VAC (vincristine, actinomycin D, cyclophosphamide). Four cycles of this protocol yielded a dramatic response on re-staging CT scan. This case suggests that highly angiogenic tumours such as angiosarcoma may be effectively palliated using agents usually reserved for refractory Wilms' tumour, and supports the view that adult Wilms' tumour is more sensitive to such agents.

Profiling of HIV clinic patients to determine the prevalence and characteristics of recent infections

Patients newly attending the government HIV clinic in Hong Kong were studied for the prevalence and characteristics of recent HIV infection, which was defined as having a negative HIV antibody test and/or seroconversion illness within one year of a first positive antibody result. Fifty-nine (12.0%) of 492 HIV-positive patients first seen from 2001 to 2004 were determined to be recently infected. This likely represented the lower bound of the real situation. Compared with non-recent infections on univariate analysis, recent cases were more likely to be men who have sex with men (OR 2.23; 95%CI, 1.23-4.05), never married (OR 1.96; 95%CI, 1.03-3.89), had tertiary or above education (OR 3.93; 95%CI, 1.65-10.09) and with a baseline CD4>=500 cells/ul (OR 3.65; 95%CI, 1.87-6.93). Upon multivariate analysis, tertiary or above education (adjusted OR 4.23; 95%CI, 1.76-10.16) and CD4>=500 cells/ul at diagnosis (adjusted OR 3.58; 95%CI, 1.88-6.84) remained independent variables. HIV clinics are feasible settings for collecting epidemiological information of on-going infection. Differences in the profile between recent and non-recent cases may shed light on targeting efforts to prevent new HIV infections.

Mechanical characterization of cellulosic thecal plates in dinoflagellates by nanoindentation

Dinoflagellates constitute an important group of microorganisms. Symbiotic dinoflagellates are responsible for the primary production of coral reef ecosystems and the phenomenon of their demise is known as "coral bleaching." Blooming of the planktonic dinoflagellates is the major cause of "red tides." Many dinoflagellates have prominent membrane-bound thecal plates at their cell cortices. These thecal plates have high cellulose content and are biologically fabricated into various shapes. However, the mechanical properties of theca have not previously been characterized; understanding these properties, including hardness and elastic modulus, will give insights into the ecological significance and biotechnological potential of bio-fabricated structures. A series of nanoindentation tests were performed on various locations of cellulosic thecal plates isolated from the dinoflagellates Alexandrium catenella and Lingulodinium polyedrum. Despite having transparent properties, thecal plates possess mechanical properties comparable to softwood cell walls, implicating their role as a protective cell covering. Consistent measurements were obtained when indentation was performed at various locations, which contrasts with the high variability of cellulose microfibers from plant sources. The present study demonstrated the novel properties of this potential new source of cellulose.

Metal Phthalocyanine Nanoribbons and Nanowires

Nanoribbons and nanowires of different metal phthalocyanines (copper, nickel, iron, cobalt, and zinc), as well as copper hexadecafluorophthalocyanine (F(16)CuPc), have been grown by organic vapor-phase deposition. Their properties, as a function of substrate type, source-to-substrate distance, and substrate temperature, were studied by scanning electron microscopy, transmission electron microscopy, X-ray diffraction, and absorption measurements. The size and morphology of the nanostructures were found to be mainly determined by the substrate temperature. The crystal structure was dependent on the substrate temperature as well. At substrate temperatures below 200 degrees C, in addition to straight nanoribbons, twisted nanoribbons were found for all investigated materials except F(16)CuPc, which formed helical nanoribbons upon exposure to an electron beam. The formation of different nanostructures (nanoribbons, twisted nanoribbons, and helical nanoribbons) is discussed.

Tailoring and modifications of a ZnO nanostructure surface by the layer-by-layer deposition technique

Different ZnO nanostructures have been modified using the layer-by-layer polyelectrolyte deposition process. The polymer multilayers were deposited on free standing ZnO tetrapods, ZnO tetrapods on a substrate and ZnO nanorod arrays. In addition, attachment of metallic (Au) nanoparticles to the ZnO nanostructure surface using layer-by-layer deposition was demonstrated. The properties of the ZnO nanostructures with modified surfaces were investigated by electron microscopy, absorption and photoluminescence measurements. A linear increase in polymer thickness with the number of polymer multilayers was confirmed by absorption and transmission electron microscopy. The technique can be readily extended to different nanoparticles and different morphologies of ZnO.

Management of hypertension by private doctors in Hong Kong

OBJECTIVE

To investigate the management of hypertension by private doctors in Hong Kong.

DESIGN

Self-administered questionnaire survey.

SETTING

Hong Kong.

PARTICIPANTS

Private doctors from all districts in Hong Kong selected by simple random sampling from the website of "The Hong Kong Doctors Homepage" from March to June 2005.

MAIN OUTCOME MEASURES

Practice of blood pressure measurement and the treatment prescribed to hypertensive patients.

RESULTS

A total of 225 (46%) completed questionnaires were analysed. Only 24.4% of the respondents measured blood pressure in all new patients aged above 18 years. A total of 28.0% of doctors reported that hypertensive status was unknown in over 30% of their patients prior to their first clinic visit when it was consequently diagnosed. Calcium channel blockers (31%), angiotensin-converting enzyme inhibitors (28.5%), diuretics (27.5%), and beta-blockers (21.2%) were the most commonly prescribed antihypertensive medication. Drug efficacy was the reason cited by more than half (56.9%) of doctors for selecting a given drug. Public education about hypertension was considered insufficient by 66.2% of doctors and 32% believed that self-medication would have a very significant effect on drug compliance.

CONCLUSIONS

In private clinics, blood pressure measurement should become a routine procedure. There is a need to raise public awareness of hypertension.

Ganoderma lucidumMycelium and Spore Extracts as Natural Adjuvants for Immunotherapy

OBJECTIVES

Ganoderma lucidum (GL) is one of the most commonly used Chinese herbs in the oriental community, with more than 30% of pediatric cancer patients taking GL. The immunomodulating and anticancer effects exerted by GL extracts have been demonstrated by in vitro and in vivo studies. There was, however, no comparison between the immunomodulating effects of GL mycelium extract (GL-M) and spore extracts on human immune cells. Dendritic cells (DCs) are professional antigen-presenting cells and their role in DC-based tumor vaccine has been well defined. The possibility of GL as natural adjuvant for human DCs remains unknown.

DESIGN

This study explored the differential effect of GL-M and GL spore extract (GL-S) on proliferation and Th1/Th2 cytokine mRNA expression of human peripheral blood mononuclear cells (PBMCs) and monocytes. Their effects on the phenotypic and functional maturation of human monocyte-derived DCs were also investigated.

RESULTS

GL-M induced the proliferation of PBMCs and monocytes, whereas GL-S showed a mild suppressive effect. Both extracts could stimulate Th1 and Th2 cytokine mRNA expression, but GL-M was a relatively stronger Th1 stimulator. Different from GL-S, GL-M enhanced maturation of DCs in terms of upregulation of CD40, CD80, and CD86, and also reduced fluorescein isothiocyanate-dextran endocytosis. Interestingly, GLM- treated DCs only modestly enhanced lymphocyte proliferation in allogenic mixed lymphocyte culture with mild enhancement in Th development.

CONCLUSION

These findings provide evidences that GL-M has immunomodulating effects on human immune cells and therefore can be used as a natural adjuvant for cancer immunotherapy with DCs.

Barriers to participation in a phase II cardiac rehabilitation programme

OBJECTIVES

To identify barriers to participation in a phase II cardiac rehabilitation programme and measures that may enhance participation.

DESIGN

Prospective study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

Cardiac patients recruited for a phase I cardiac rehabilitation programme from July 2002 to January 2003.

MAIN OUTCOME MEASURES

Reasons for not participating in a phase II cardiac rehabilitation programme.

RESULTS

Of the 193 patients recruited for a phase I cardiac rehabilitation programme, 152 (79%) patients, with a mean age of 70.3 years (standard deviation, 11.9 years), did not proceed to phase II programme. Eleven (7%) deaths occurred before commencement of phase II and 74 (49%) patients were considered physically unfit. Reasons for the latter included fractures, pain, or degenerative changes in the lower limbs (24%), and co-morbidities such as cerebrovascular accident (19%), chronic renal failure (11%), congestive heart failure (9%), and unstable angina (8%). Phase II rehabilitation was postponed until after completion of scheduled cardiac interventions in 13% of patients. Failure of physicians to arrange the pre-phase II exercise stress test as per protocol was reported in 7% of patients. Other reasons were reported: work or time conflicts (16%), non-compliance with cardiac treatment (5%), financial constraints (4%), self-exercise (3%), fear after exercise stress testing (3%), and patients returning to their original cardiologists for treatment (3%).

CONCLUSIONS

A significant (79%) proportion of patients did not proceed to a phase II cardiac rehabilitation programme for a variety of reasons. These included physical unfitness, work or time conflicts, and need to attend scheduled cardiac interventions. Further studies are required to determine how to overcome obstacles to cardiac rehabilitation.

Clopidogrel-induced hepatotoxicity after percutaneous coronary stenting

Clopidogrel, an adenosine diphosphate receptor blocker, is widely used as an adjunctive antiplatelet therapy in acute coronary syndrome and percutaneous coronary stenting. The occurrence of hepatotoxicity is rare. We describe the occurrence of symptomatic liver disease in a 74-year-old man 5 weeks following commencement of therapy with clopidogrel. The reported cases of clopidogrel-induced hepatotoxicity are reviewed and the clinical significance of this event are discussed.

Vertebroplasty by use of a strontium-containing bioactive bone cement

STUDY DESIGN

A review of the laboratory and clinical data for a new strontium-containing hydroxyapatite bioactive bone cement.

OBJECTIVES

To compare the properties of the strontium-containing bioactive bone cement with those of polymethyl methacrylate (PMMA) and hydroxyapatite (HA) bone cements.

SUMMARY OF BACKGROUND DATA

Vertebroplasty and kyphoplasty using conventional PMMA bone cements have been effectively used to treat osteoporotic spine fractures with good short- and medium-term results. However, PMMA has some undesirable properties, including its high setting temperature, lack of osseointegration, and large stiffness mismatch with osteoporotic bone. These properties are responsible for some postoperative complications.

METHODS

Strontium-containing hydroxyapatite (Sr-HA) bioactive bone cement consists of a filler blend of strontium-containing hydroxyapatite, fumed silica and benzoyl peroxide; and a resin blend of bisphenol A diglycidylether methacrylate, triethylene glycol dimethacrylate, poly(ethylene glycol) methacrylate, and N, N-dimethyl-p-toluidine. Its properties, including mechanical strength, setting temperature, biocompatibility, and osseoinduction, were compared with other cements in vitro and in vivo. Early clinical results are presented.

RESULTS

The Sr-HA cement has a setting time of 15 to 18 minutes, a maximum setting temperature of 58 degrees C, a compressive strength of 40.9 MPa, bending strength of 31.3 MPa, and a bending modulus of 1,408 MPa. The bending strength and modulus are closer to human cancellous bone. Sr-HA cement promotes osteoblast attachment and mineralization in vitro and bone growth and osseointegration in vivo. In a pilot study, 23 cases of osteoporotic fractures treated with this cement with a mean follow-up of 18 months suggest that it is as effective as PMMA in relieving pain.

DISCUSSIONS

Oral strontium has been shown to induce new bone formation and is effective in reducing fracture risk in osteoporosis. Our data suggest that strontium delivered locally has the same effect; thus, the combination of strontium with HA in a cement with a low setting temperature, adequate stiffness, and low viscosity makes this a good bioactive cement for vertebroplasty and kyphoplasty.

Chromosomal abnormalities and FMR1 gene premutation in Chinese women with premature menopause

OBJECTIVE

To study the prevalence of chromosomal abnormalities and FMR1 gene premutation in Chinese women with premature menopause in Hong Kong.

DESIGN

Retrospective study.

SETTING

Clinical Genetic Service, Hong Kong.

PARTICIPANTS

Chinese women with premature menopause referred for cytogenetic study from January 1983 to November 2003.

MAIN OUTCOME MEASURES

Chromosomal abnormalities, FMR1 gene premutation.

RESULTS

Chromosomal abnormalities were present in 15.6% of Chinese women who suffered premature menopause. X-chromosome abnormality was involved in over 80% of cases. FMR1 gene premutation was present in 0.86% of 116 cases screened for this abnormality. The predominance of X-chromosome abnormality accounted for the shorter stature, younger menopausal age, and higher prevalence of dysmorphic features among the cytogenetically abnormal patients. However, on logistic regression, no clinical feature was significantly correlated with cytogenetic abnormality.

CONCLUSIONS

The prevalence of chromosomal abnormalities among Hong Kong Chinese women who suffer premature menopause was comparable with that of Caucasian and Chinese populations elsewhere. Because clinical features are poor predictors of cytogenetic abnormality, a pragmatic approach to screening is advocated. The carrier rate of fragile X premutation in these women appeared lower than that of Caucasians. Nevertheless, a search for FMR1 gene premutation, in addition to conventional chromosomal study, has important implication for prenatal diagnosis and fertility management for the extended family.

In vivo cancellous bone remodeling on a strontium-containing hydroxyapatite (sr-HA) bioactive cement

The purpose of this study was to investigate the in vivo bone response to the strontium-containing hydroxyapatite (Sr-HA) bioactive bone cement injected into the cancellous bone. Sr-HA cement was injected into the iliac crest of rabbits for 1, 3, and 6 months. Active bone formation and remodeling were observed after 1 month. Newly formed bone was observed to grow onto the bone cement after 3 months. Thick osteoid layer with osteoblasts formed along the bone and guided over the bone cement surface reflected the stimulating effect of Sr-HA. From scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analysis, high calcium and phosphorus levels were detected at the interface with a thick layer of 70 microm in width, and fusion of Sr-HA with the bone was observed. Blood vessels were found developing in remodeling sites. The affinity of bone on Sr-HA cement was increased from 73.55 +/- 3.50% after 3 months up to 85.15 +/- 2.74% after 6 months (p < 0.01). In contrast to Sr-HA cement, poly(methyl methacrylate) (PMMA) bone cement was neither osteoconductive nor bioresorbable. Results show that the Sr-HA cement is biocompatible and osteoconductive, which is suitable for use in treating osteoporotic vertebral fractures.

Clinical profile and genetic basis of Brugada syndrome in the Chinese population

OBJECTIVE

To study the clinical profile and genetic basis of Brugada syndrome in Chinese patients.

DESIGN

Prospective observational study.

SETTING

Seven regional public hospitals, Hong Kong.

MAIN OUTCOME MEASURES

The clinical and follow-up data of 50 patients (47 men, 3 women; mean age, 53 years) were collected, and genetic data of 36 probands and eight family members of three genotyped probands were analysed.

RESULTS

Eight patients survived sudden cardiac death (group A), 12 had syncope of unknown origin but no sudden death (group B), and 30 were asymptomatic before recognition of Brugada syndrome (group C). Programmed electrical stimulation induced sustained ventricular arrhythmias in 88% (7/8), 82% (9/11), and 27% (3/11) of patients in group A, group B, and group C, respectively. New arrhythmic events occurred in 50% (4/8) of patients in group A and 17% (2/12) of patients in group B after a mean follow-up period of 30 (standard deviation, 13) months and 25 (7) months, respectively. All group C patients remained asymptomatic during a mean follow-up period of 25 (standard deviation, 11) months. Five of 36 probands and three of eight family members who underwent genetic testing were found to have a mutation in their SCN5A gene.

CONCLUSIONS

Chinese patients with Brugada syndrome who are symptomatic have a high likelihood of arrhythmia recurrence, whereas asymptomatic patients enjoy a good short-term prognosis. The prevalence of SCN5A mutation among probands is 14%. Thus, Chinese patients with Brugada syndrome share with their western counterparts similar clinical and genetic heterogeneity.

Ultrastructural study of mineralization of a strontium-containing hydroxyapatite (Sr-HA) cementin vivo

The purpose of this study was to investigate the mineralization leading to osseointegration of strontium-containing hydroxyapatite (Sr-HA) bioactive bone cement injected into cancellous bone in vivo. Sr-HA cement was injected into the ilium of rabbits for 1, 3, and 6 months. The bone mineralization area was found to be largest at 3 months, then at 1 month, and smallest at 6 months (p < 0.01) measured with tetracycline labeling. Osseointegration of Sr-HA cement was achieved at 3 months as observed by scanning electron microscopy. A high calcium and phosphorus area was observed at the interface of bone-Sr-HA cement determined by energy-dispersive X-ray analysis. Transmission electron microscopy gave evidence of the mechanism of bone formation. Dissolution of Sr-HA into debris by the bone remodeling process was thought to increase the concentration of calcium and phosphorus at the interface of bone-Sr-HA cement and stimulate bone formation. Crystalline Sr-HA formed an amorphous layer and dissolved into the surrounding solution, then apatite crystallites were precipitated and formed new bone at 3 months. This young bone then becomes mature bone, which bonds tightly to the Sr-HA cement with collagen fibers inserted perpendicularly after 6 months.

Numerical investigation of the effect of blade geometry on blood trauma in a centrifugal blood pump

Fluid dynamic forces in centrifugal blood pump impellers are of key importance in destruction of red blood cells (RBCs) because high rotational speed leads to strong interaction between the impeller and the RBCs. In this paper, three-dimensional models of five different blade geometries are investigated numerically using the commercial software CFX-TASCflow, and the streaklines of RBCs are obtained using the Lagrangian particle tracking method. In reality, RBCs pass through the pump along complicated paths resulting in a highly irregular loading condition for each RBC. In order to enable the prediction of blood damage under the action of these complex-loading conditions, a cumulative damage model for RBCs was adopted in this paper. The numerically simulated percent hemoglobin (%HB) released as RBCs traversed the impeller and volute was examined. It was observed that the residence time of particles in the blade passage is a critical factor in determining hemolytic effects. This, in turn, is a function of the blade geometry. In addition, it was observed that the volute profile is an important influence on the computed HB% released.

A computational study of the effects of inlet guide vanes on the performance of a centrifugal blood pump

This article presents computational studies on the effects of inlet guide vanes (IGVs) on the flow pattern and shear stress in a centrifugal blood pump. The effect of IGVs is to introduce a pre-swirl to fluid particles entering the impeller with the intention that the fluid particles will travel along the blade profile. Currently, most commercial centrifugal blood pumps employ straight radial impeller blades that are not hydrodynamically ideal for a good flow pattern within the blade passage. Flow separation and formation of vortices within the blade passage are believed to increase the degree of hemolysis and thrombosis. These are causes for blood clotting that will lead to malfunctioning of ventricular assist devices. Four IGVs of different geometrical profiles have been numerically investigated using a commercial software program CFX-Tascflow. The pump is operated at 2,000 rpm, and the results revealed that the relative flow patterns in the blade passage have been dramatically altered. The size of the vortices was reduced, and the pressure contours indicated a gradual rise from the impeller leading edge to the trailing edge. However, inclusion of IGV causes a drop in the pressure head generated. Higher frictional losses are incurred as fluid particles passed through the IGV. In addition, the IGV modifies the inlet velocity triangles, and this also contributes to a drop in the pressure head generated that is consistent with Euler's pump theory. The change in the flow patterns and the gradual variation of the pressure contours have led to lower shear stress within the blade passages as compared to the case without IGVs.

The role of ruthenium and rhenium diimine complexes in conjugated polymers that exhibit interesting opto-electronic properties

This paper reports the synthesis and opto-electronic properties of different conjugated polymers that contain the diimine complexes of ruthenium or rhenium. Conjugated poly(phenylene vinylene)s that contain aromatic 1,3,4-oxadiazole and 2,2'-bipyridine units on the main chain were synthesized by the palladium catalyzed olefinic coupling reaction. Other types of polymers based on 1,10-phenanthroline bis(2,2-bipyridyl) ruthenium(II) or chlorotricarbonyl rhenium(I) complexes were also synthesized by the same reaction. In general, these polymers exhibit two absorption bands due to the pi - pi transition of the conjugated main chain and the d-pi* metal-to-ligand charge-transfer transition of the metal complex. As a result, the photosensitivity of the polymers beyond 500 nm was enhanced. Charge-carrier mobility measurements showed that the presence of metal complexes could facilitate the charge-transport process, and the enhancement in carrier mobility was dependent on the metal content in the polymer. In addition, we have also demonstrated that the ruthenium complex could act as both photosensitizer and light emitter. Photovoltaic cells were constructed, and they were subjected to irradiation with a xenon arc lamp. Under illumination, the short circuit current and the open circuit voltage were measured to be 0.05 mAcm(-2) and 0.35 V, respectively. The polymers were fabricated into single-layer emitting devices, and light emission was observed when the device was subjected to forward bias. The maximum luminance was determined to be 300 cdm(-2), and the external quantum efficiency was approximately 0.05 to 0.2%. Although the efficiency was relatively low when compared with other devices based on organic materials, we have demonstrated the first examples of using transition metal complexes for both photovoltaic and light-emitting applications.

Therapeutic use of Bausch & Lomb PureVision contact lenses

PURPOSE

To evaluate the Bausch & Lomb PureVision contact lens as a continuous wear contact lens for therapeutic indications in a prospective open-ended non-randomized clinical trial.

METHODS

Patients with a variety of corneal and ocular surface disease conditions presenting at the Singapore National Eye Centre who required therapeutic continuous contact lens wear were enrolled. Therapeutic indications included pain relief, corneal protection, and enhancement of corneal wound healing. Success or failure of specific treatment indications was assessed in all cases, with evaluation of lens performance and fit characteristics, and the presence of ocular complications or lens-related complications was noted.

RESULTS

There were 54 patients (54 eyes), and the mean duration of continuous contact lens wear was 1.1 months. Conditions treated included post-surgical indications (n = 36) (post-keratoplasty or ocular surface transplantation, post-LASIK or PRK surgery) bullous keratopathy (n = 7), chemical burns (n = 3), epithelial abrasions or recurrent corneal erosion syndromes (n = 3), corneal perforations (n = 3), neurotrophic ulcer (n = 1), and corneal laceration (n = 1). For the indication of corneal healing (40 eyes), improved healing was noted in 38 eyes (96%), with full healing occurring in 33 eyes (83%). For pain relief (28 eyes), 27 patients (96%) had considerable or complete pain relief, and the remaining patient reported partial pain relief. For corneal protection (21 eyes), lens wear was fully protective in all cases. The lens performance and fitting characteristics surpassed any previous therapeutic lenses used by the investigators. Complications related to contact lens wear were limited to one case of a culture-negative corneal infiltrate requiring cessation of therapeutic lens wear and one case of a loosely fit lens.

CONCLUSIONS

Our results show that the PureVision contact lens exhibits good safety and efficacy when utilized as a continuous wear therapeutic lens. With the theoretical advantage of increased oxygen transmissibility reducing the risk of hypoxia-related complications, this new lens may be one step closer to the ideal therapeutic contact lens. The PureVision contact lens is now our primary bandage lens of choice in our corneal, external disease, and refractive surgery services.

Ontogeny of alpha-amylase gene expression in sea bass larvae (Lates calcarifer)

The enzymatic activities of alpha-amylase and its corresponding messenger RNA levels in developing sea bass (Lates calcarifer) larvae were studied from hatching until 27 days post hatching (dph). An increasing activity of amylase enzyme was measured until 5 dph, and the activity gradually decreased thereafter and reached a constant level by 12 dph. To achieve a better understanding of the molecular mechanisms underlying amylase expression, we have cloned and sequenced a 318-bp fragment of alpha-amylase complementary DNA. Based on this sequence, a real-time reverse transcriptase polymerase chain reaction technique to monitor the changes in the mRNA levels in the larvae was developed. A correlation between enzymatic activity and mRNA level of alpha-amylase could be demonstrated during the early development of sea bass larvae. This suggests that the changes in alpha-amylase are controlled at least at the transcriptional level during early larval development of sea bass.

Phase II trial of systemic recombinant interleukin-2 in the treatment of refractory nasopharyngeal carcinoma

BACKGROUND

Interleukin-2 (IL-2) is a cytokine produced by activated T cells, which has shown powerful immunostimulatory and antineoplastic properties. Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus-associated cancer with abundant lymphocyte infiltration histologically. The activity of IL-2 in the treatment of NPC patients is currently unknown. A phase II study was, therefore, initiated to evaluate the efficacy, toxicity and immunological consequences of intravenous bolus IL-2 in patients with recurrent/metastatic NPC.

METHODS

Between November 1996 and April 1997, 14 patients with recurrent/metastatic NPC were entered into the study. Recombinant IL-2 (Proleukin, Chiron) was injected by intravenous bolus every 8 h at 72,000 IU/kg for a maximum of 15 doses. After 7 days, patients were retreated with a second identical cycle of therapy. Those patients who were stable or responding to treatment 5-6 weeks later went on to receive another course (two cycles) of therapy. All patients received prophylactic antibiotics and antipyretic medicine. Response and toxicities were evaluated. Serial plasma level of TNF-alpha, IL-6, soluble IL-2 receptor, IL-10 and soluble CD8 were determined.

RESULTS

Fourteen patients received a total of 34 cycles of therapy. No response was observed. Fifty percent had stable disease, 50% had progressive disease after a median of two cycles of therapy. There was one treatment-related death from acute myocardial infarction. Body weight increase (>5%) occurred in 80% of cycles, and hypotension (BP <80 mm Hg systolic) occurred in 53%. Serum creatinine increase (>2 mg%) occurred in 24% of cycles, and SGOT/SGPT increase (>3x) in 10% of cycles. Symptoms of somnolence, general malaise, nausea and vomiting, pruritus, xerostomia, desquamation were generally mild to moderate but rapidly reversible.

CONCLUSION

The single modality of intravenous bolus IL-2 at the dose level of 72,000 IU/kg is clinically ineffective in NPC patients. Potential mechanisms of the ineffectiveness of IL-2 therapy on NPC patients are discussed.

Neurofilaments consist of distinct populations that can be distinguished by C-terminal phosphorylation, bundling, and axonal transport rate in growing axonal neurites

We examined the steady-state distribution and axonal transport of neurofilament (NF) subunits within growing axonal neurites of NB2a/d1 cells. Ultrastructural analyses demonstrated a longitudinally oriented "bundle" of closely apposed NFs that was surrounded by more widely spaced individual NFs. NF bundles were recovered during fractionation and could be isolated from individual NFs by sedimentation through sucrose. Immunoreactivity toward the restrictive C-terminal phospho-dependent antibody RT97 was significantly more prominent on bundled than on individual NFs. Microinjected biotinylated NF subunits, GFP-tagged NF subunits expressed after transfection, and radiolabeled endogenous subunits all associated with individual NFs before they associated with bundled NFs. Biotinylated and GFP-tagged NF subunits did not accumulate uniformly along bundled NFs; they initially appeared within the proximal portion of the NF bundle and only subsequently were observed along the entire length of bundled NFs. These findings demonstrate that axonal NFs are not homogeneous but, rather, consist of distinct populations. One of these is characterized by less extensive C-terminal phosphorylation and a relative lack of NF-NF interactions. The other is characterized by more extensive C-terminal NF phosphorylation and increased NF-NF interactions and either undergoes markedly slower axonal transport or does not transport and undergoes turnover via subunit and/or filament exchange with individual NFs. Inhibition of phosphatase activities increased NF-NF interactions within living cells. These findings collectively suggest that C-terminal phosphorylation and NF-NF interactions are responsible for slowing NF axonal transport.

Inverse design and CFD investigation of blood pump impeller

In this paper, a three-dimensional inverse design method using mean swirl specification is applied to the design of centrifugal blood pump impeller blades. CFD investigation of the passage flows is carried out to analyze the flow field and pressure generated across the blade. The results show that the possibility of blood cells' damage may not be increased when the pressure developed is increased. This technique can provide designers valuable insight on the development of efficient blood pump with reduced risk of blood traumatization.

Experimental and computational studies of the relative flow field in a centrifugal blood pump

The relative flow field within the impeller passage of a centrifugal blood pump had been examined using flow visualization technique and computational fluid dynamics. It was found that for a seven-blade radial impeller design, the required flow rate and static pressure rise across the pump could be achieved but the flow field within the blades was highly undesirable. Two vortices were observed near the suction side and these could lead to thrombus formation. Preliminary results presented in this article are part of our overall effort to minimize undesirable flow patterns such flow separation and high shear stress regions within the centrifugal blood pump. This will facilitate the future progress in developing a long-term clinically effective blood pump.

The predominant form in which neurofilament subunits undergo axonal transport varies during axonal initiation, elongation, and maturation

The forms in which neurofilament (NF) subunits undergo axonal transport is controversial. Recent studies from have provided real-time visualization of the slow axonal transport of NF subunits by transfecting neuronal cultures with constructs encoding green fluorescent protein (GFP)-conjugated NF-M subunits. In our studies in differentiated NB2a/d1 cells, the majority NF subunits underwent transport in the form of punctate NF precursors, while studies in cultured neurons have demonstrated transport of NF subunits in predominantly filamentous form. Although different constructs were used in these studies, transfection of the same cultured neurons with our construct yielded the filamentous pattern observed by others, while transfection of our cultures with their construct generated punctate structures, confirming that the observed differences did not reflect variances in assembly-competence among the constructs. Manipulation of intracellular kinase, phosphatase, and protease activities shifted the predominant form of GFP-conjugated subunits between punctate and filamentous, confirming, as shown previously for vimentin, that punctate structures represent precursors for intermediate filament formation. Since these prior studies were conducted at markedly differing neuronal differentiation states, we tested the alternate hypothesis that these differing results reflected developmental alterations in NF dynamics that accompany various stages of neuritogenesis. We conducted time-course analyses of transfected NB2a/d1 cells, including monitoring of transfected cells over several days, as well as transfecting cells at varying intervals prior to and following induction of differentiation and axonal neurite outgrowth. GFP-conjugated subunits were predominantly filamentous during the period of most robust axonal outgrowth and NF accumulation, and presented a mixed profile of punctate and filamentous forms prior to neuritogenesis and following the developmental slowing of neurite outgrowth. These analyses demonstrate that NF subunits are capable of undergoing axonal transport in multiple forms, and that the predominant form in which NF subunits undergo axonal transport varies in accord with the rate of axonal elongation and accumulation of NFs within developing axons.

Resveratrol, a red wine constituent, is a mechanism-based inactivator of cytochrome P450 3A4

Resveratrol, a phytoalexin found in red wine, has been shown to possess antioxidant and antimutagenic properties. Incubation of resveratrol with Sf9 insect microsomes containing baculovirus-derived human cytochrome P450 3A4 (CYP3A4) and NADPH-cytochrome P450 reductase showed that resveratrol inactivated CYP3A4 in a time- and NADPH-dependent manner. Resveratrol, erythromycin and troleandomycin inactivated CYP3A4 at a similar rate (as reflected by k(inact)) whereas the binding affinity to CYP3A4 (as reflected by K(I)) was in the order of: troleandomycin > erythromycin > resveratrol. (K(I) and k(inact) for CYP3A4 inactivation by resveratrol, erythromycin and troleandomycin are 20 microM and 0.20 min(-1), 5.3 microM and 0.12 min(-1) and 0.18 microM and 0.15 min(-1), respectively.) Fractionation studies of red wine showed that fractions that did not contain resveratrol inactivated CYP3A4 significantly. In addition, the resveratrol content in red wine used in the study was too low to account for the degree of CYP3A4 inactivation observed after red wine treatment. Inactivation studies using a variety of red wine types showed that the CYP3A4 inactivation did not correlate to their resveratrol content. In summary, data here showed that resveratrol is an effective mechanism-based inactivator of CYP3A4; however, it is not one of the main red wine constituents that are responsible for CYP3A4 inactivation by red wine. Nevertheless, inactivation of CYP3A4 by resveratrol may cause clinically relevant drug interactions with CYP3A4 substrates.

Analytical investigation of leakage flow in disk clearance of a magnetically suspended centrifugal impeller

Leakage flow through the disk clearance of a magnetically suspended centrifugal blood pump is essential for a good washout. An analytical approach, based on the theory of lubrication, is used to predict the leakage volume flow rate, nondimensional radial velocity, nondimensional mean pressure distribution, and comparative shear stress distribution for different disk clearance geometry under varying rotational speeds. The results showed that nondimensional mean pressure distribution and nondimensional radial velocity distribution along the clearance are independent of rotational speed. The flow through the gap depends on a nondimensional parameter S that denotes the ratio of centrifugal forces to the head generating capability of the impeller. It was found that an impeller having a lower S has less possibility of flow reversals in the gap, and gap with maximum height at the outside radius also is more susceptible to flow reversals at the impeller surface. The comparative shear stress within the gap reveals that, in general, the scalar stress is below 500 N/m2.

Haemophagocytic syndrome and histiocytic necrotising lymphadenitis (Kikuchi's disease)

A young boy presented with a rash, fever, and cervical lymphadenopathy, originally thought to be caused by tuberculosis. A lymph node biopsy showed the features of Kikuchi's disease, with necrosis and histiocytic infiltration without neutrophils. No evidence of tuberculosis was found on staining, culture, or the polymerase chain reaction. Bone marrow biopsy revealed prominent haemophagocytosis, and a diagnosis of haemophagocytic syndrome was reached. The aetiology of haemophagocytic syndrome, and its association with Kikuchi's lymphadenitis, is discussed.

The flow patterns within the impeller passages of a centrifugal blood pump model

The effects of impeller geometry on the performance of a centrifugal blood pump model [the MSCBP design of Akamatsu and Tsukiya (The Seventh Asian Congress of Fluid Mechanics (1997), 7-10) at a 1:1 scale] have been investigated both experimentally and computationally. Four impeller designs were tested for pump hydraulic performance at the operating point (i.e. 2000 rpm), using blood analog as the working fluid. Each impeller has seven blades with different configurations including the radial straight blade and backward swept blade designs. The results show that both designs can achieve a stable head of about 100 mm Hg at the operating point. Subsequent investigations involved the visualization of the relative flow field within the impeller passages via the image de-rotation system coupled with a 2.5 W argon ion laser. Flow structures in all sectors of each impeller were examined and discussed. To further quantify the possible effects of blade geometry to thrombus formation and hemolysis, computational fluid dynamics (CFD) was used to simulate a simplified two-dimensional blade-to-blade flow analysis so as to estimate the shear stress levels. The results indicate that the stress levels found within the blade passages are generally below the threshold level of 150 N/m(2) for extensive erythrocyte damage to occur. There are some localized regions near the leading edge of the blades where the stress levels are 60% above the threshold level. However, given such a short residence time for the fluid particles to go through these high shear stress regions, their effects appear to be insignificant.

Is automatic mode switching effective for atrial arrhythmias occurring at different rates? A study of the efficacy of automatic mode and rate switching to simulated atrial arrhythmias by chest wall stimulation

Automatic mode switching (AMS) is a useful means to avoid rapid ventricular response during atrial fibrillation (AF), but AMS cannot occur if the detected atrial rate during AF is below the mode switching criteria. This may be the result of antiarrhythmic medications, or when the atrial events fall within the atrial blanking period, or if the atrial amplitudes during AF are too small to be sensed. We hypothesize that the addition of an automatic rate switching (ARS) algorithm may complement AMS response during AF with different detected atrial rates. We studied the Marathon DDDR pacemaker (Model 294-09, Intermedics Inc.) with the AMS and ARS algorithms that are independently programmable but can also operate in combination. AF sensed above the AMS rate (160 beats/min) will lead to VDIR pacing, whereas AF below AMS rate will be tracked at an interim rate as dictate by the ARS, at a ventricular response that is 20 beats/min above the sensor indicated rate. Atrial tachyarrhythmias were simulated by chest wall stimulation (CWS). CWS was applied to 33 patients (16 men, 17 women, mean age 69 +/- 11 years) with a Marathon DDDR pacemaker using an external pacer to simulate AF occurring at two rate levels: above the AMS rate (programmed at 160 beats/min) at 180 beats/min and below the AMS rate at 120 beats/min. The maximum, minimum, and mean ventricular rates during CWS in DDDR mode with AMS alone, ARS alone, and their combination were compared. During CWS at 120 beats/min, the AMS plus ARS setting showed a mean ventricular rate of 79 +/- 3 beats/min and 124 +/- 14 beats/min in the AMS setting alone (P < 0.01). With CWS at 180 beats/min, the mean ventricular rate in the AMS plus ARS setting compared to the AMS setting alone was not significantly different. However, the variation in ventricular pacing rate was 7 +/- 14 beats/min in the AMS plus ARS setting and 40 +/- 42 beats/min in the AMS setting (P < 0.05). In conclusion, AMS is effective for simulated atrial tachyarrhythmias sensed above the AMS rate. Combined AMS with ARS is useful to handle simulated atrial tachyarrhythmia at a slower rate and to avoid rate fluctuation during AMS. There is also a possibility that this can be applied to the naturally occurring atrial tachyarrhythmias.

Phospho-dependent association of neurofilament proteins with kinesin in situ

Recent studies demonstrate co-localization of kinesin with neurofilament (NF) subunits in culture and suggest that kinesin participates in NF subunit distribution. We sought to determine whether kinesin was also associated with NF subunits in situ. Axonal transport of NF subunits in mouse optic nerve was perturbed by the microtubule (MT)-depolymerizing drug vinblastine, indicating that NF transport was dependent upon MT dynamics. Kinesin co-precipitated during immunoprecipitation of NF subunits from optic nerve. The association of NFs and kinesin was regulated by NF phosphorylation, since (1) NF subunits bearing developmentally delayed phospho-epitopes did not co-purify in a microtubule motor preparation from CNS while less phosphorylated forms did; (2) subunits bearing these phospho-epitopes were selectively not co-precipitated with kinesin; and (3) phosphorylation under cell-free conditions diminished the association of NF subunits with kinesin. The nature and extent of this association was further examined by intravitreal injection of (35)S-methionine and monitoring NF subunit transport along optic axons. As previously described by several laboratories, the wave of NF subunits underwent a progressive broadening during continued transport. The front, but not the trail, of this broadening wave of NF subunits was co-precipitated with kinesin, indicating that (1) the fastest-moving NFs were associated with kinesin, and (2) that dissociation from kinesin may foster trailing of NF subunits during continued transport. These data suggest that kinesin participates in NF axonal transport either by directly translocating NFs and/or by linking NFs to transporting MTs. Both Triton-soluble as well as cytoskeleton-associated NF subunits were co-precipitated with kinesin; these data are considered in terms of the form(s) in which NF subunits undergo axonal transport.

A case of episcleral neurofibroma

PURPOSE

To report a rare case of episcleral neurofibroma and discuss the possible differential diagnoses.

METHODS

Case report of a 36-year-old man who presented with a painless epibulbar mass of the left eye. We describe the clinical and histopathologic features of the tumour and compare it with other tumours which may have a similar clinical presentation.

RESULTS

An excisional biopsy of the tumour was performed. Histopathologic examination revealed the tumour to be an isolated episcleral neurofibroma.

CONCLUSION

It is often difficult to clinically differentiate this tumour from other conditions. Because of the slow growth of neurofibromas and its slow risk of malignant transformation, these lesions may be observed periodically for progression. Surgical excision may be performed if the lesion is found to be progressively enlarging in size.

Developmental expression of a novel Ftz-F1 homologue, ff1b (NR5A4), in the zebrafish Danio rerio

The Ftz-F1 genes encode orphan receptors of the nuclear receptor superfamily. The mammalian Ftz-F1 homologue, SF-1, has been found to be essential for the proper development of the adrenal-gonadal axis and it also plays a critical role in mammalian sex-determination. We report here the isolation and characterisation of a novel zebrafish Ftz-F1 gene, ff1b. Whole-mount in situ hybridization revealed onset of expression in the developing rostral diencephalon at 22 h post-fertilization (h.p.f.). Later, at 30 h.p.f., transcripts could be detected in the anterior regions of the pancreatic anlagen. Expression in both locations peaks at 36 h.p.f. and disappears at around 48 h.p.f.

Temporal expression and T3 induction of thyroid hormone receptors alpha1 and beta1 during early embryonic and larval development in zebrafish, Danio rerio

The effects of thyroid hormones on metabolism and development are mediated by thyroid hormone receptors (TRs). We report the cloning and characterization of a TR beta1 cDNA from zebrafish. Southern blot analysis revealed that there is a single genomic locus for the TR beta gene, while the TR alpha gene potentially has two loci. Multiple TR alpha and TR beta transcripts were detected in adult tissues. Using a semiquantitative RT-PCR assay, zygotic expression of TR alpha1 and TR beta1 were shown to occur before the midblastula transition stage. In transiently transfected HeLa cells, TR alpha1 displayed constitutive transactivation in the absence of ligands, which was slightly enhanced by triiodothyronine (T3). The transactivating activity of TR beta1 was strictly ligand-dependent and repressed in the absence of T3. Finally, the T3 induction of TR alpha1 and TR beta1 mRNAs was demonstrated in zebrafish embryos and larvae. The auto-induction of TR alpha1 and TR beta1 may serve a regulatory role during the embryonic and larval development of zebrafish.

Troponin-I, myoglobin, and mass concentration of creatine kinase-MB in acute myocardial infarction

Myoglobin, creatine kinase-MB (CKMB) mass concentration and troponin-I are newer biochemical markers for the diagnosis of acute myocardial infarction (AMI). We conducted a prospective study to formulate a model for the collective interpretation of these three markers in the diagnosis of AMI. Eighty-seven patients with AMI had serial serum samples taken to establish the time-frame sensitivity of individual markers. None of the markers had a good sensitivity within the first 4 h of infarction. Myoglobin and CKMB (mass) had sensitivities of 92.3% and 96.2%, respectively, at 4-8 h post infarct. CKMB (mass) and troponin-I had sensitivities >92% at 8-24 h. Troponin-I maintained sensitivity >93% until 72 h. A guideline was formulated based on the results. Our data suggest that troponin-I, myoglobin and CKMB (mass) yield satisfactory diagnostic sensitivity when used with reference to specific time frames. The combined use of these markers can provide valuable information for clinicians in managing AMI patients.

Excimer laser phototherapeutic keratectomy for recurrent corneal erosions

The purpose of this paper was to review the Singapore National Eye Centre's (SNEC) experience with excimer laser phototherapeutic keratectomy (PTK) for treating recurrent corneal erosions (RCE). Thirty-five eyes of 32 patients who had PTK between 1992 and 1997 in SNEC were studied retrospectively. There was a history of previous ocular trauma in 15 eyes. Sixteen eyes had anterior corneal dystrophy. All had received conventional therapy without improvement in symptoms. The mean duration of symptoms prior to PTK was 19 months (range 1 to 71 months). PTK was performed with one of two 193 nm excimer lasers (Summit UV200LA, Summit Technology, Waltham, USA or Visx 20/20B, Visx Corp, Santa Clara, USA). An average of 30 laser pulses were delivered to Bowman's membrane after debridement of the corneal epithelium. The mean follow-up time was 12 months (range 0 to 56 months). Among those with adequate length of follow-up, 26/27 eyes (96%) were symptom-free for 3 months, 19/22 eyes (86%) were symptom-free for 6 months and 9/13 eyes (69%) were symptom-free for 1 year. Three eyes had repeat PTK. Mild corneal haze was seen in 3 eyes. No visually threatening complications were encountered. PTK is a safe and effective procedure for RCE refractory to conventional treatment.

A numerical investigation on the steady and pulsatile flow characteristics in axi-symmetric abdominal aortic aneurysm models with some experimental evaluation

Steady and pulsatile flow characteristics in rigid abdominal aortic aneurysm (AAA) models were investigated computationally (using Fluent v. 4.3) over a range of Reynolds number (from 200 to 1600) and Womersley number (from 17 to 22). Some comparisons with measurements obtained by particle image velocimetry under the pulsatile flow conditions are also included. A sinusoidal inlet flow waveform 1 + sin omega t with thin inlet boundary layers was used to produce the required pulsatile flow conditions. The bulk features of the mean flow as well as some detailed features, such as wall shear stress distributions, are the foci of the present investigation. Recirculating vortices appeared at different phases of a flow cycle causing significant spatial and temporal variations in wall shear stresses and static pressure distributions. A high level of shear stresses usually appeared at the upstream and downstream ends of the bulge. Effects of pressure rise caused by the increase in cross-sectional area were transmitted into the downstream tube. Further simulation studies were conducted using simulated physiological waveforms under resting and exercise conditions so as to determine the possible implication of vortex dynamics inside the AAA model.

The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study

Grapefruit juice is an inhibitor of cytochrome P-450 3A4 (CYP3A4). This study was designed to assess the in vitro and in vivo effects of grapefruit juice on sertraline metabolism. The in vitro assay involved analysis of sertraline metabolism by CYP3A4 using CYP3A4-expressed human beta-lymphoblast microsomes. The in vivo study involved high-performance liquid chromatographic analysis of serum trough levels of sertraline and desmethylsertraline in 5 patients who had been taking their usual dose of sertraline for > or =6 weeks, followed by concurrent use of sertraline with grapefruit juice for 1 week. The in vitro assay demonstrated that grapefruit juice inhibited the formation of desmethylsertraline in a dose-dependent manner. In the in vivo study, mean serum sertraline levels were determined in 5 patients with a history of depression (4 males and 1 female). The mean age of the patients was 68.6 years, their mean weight was 69.6 kg, and their mean sertraline dosage was 55 mg/d. The results of the in vivo study appeared to be consistent with the in vitro findings, in that mean (+/- SD) serum sertraline trough levels increased significantly from 13.7+/-4.9 microg/L before to 20.2+/-4.4 microg/L (P = 0.047) after administration of grapefruit juice. Thus the in vitro study demonstrated that grapefruit juice can inhibit the metabolism of sertraline. A larger study is warranted to substantiate the clinical significance of the in vivo findings.

Transport, metabolism and elimination mechanisms of anti-HIV agents

Currently available anti-HIV drugs can be classified into three categories: nucleoside analogue reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. Knowledge of these anti-HIV drugs in various physiological or pharmacokinetic compartments is essential for design and development of drug delivery systems for the treatment of HIV infection. The input and output of anti-HIV drugs in the biological systems are described by their transport and metabolism/elimination in this review. Transport mechanisms of anti-HIV agents across various biological barriers, i.e., gastrointestinal wall, skin, mucosa, blood cerebrospinal barrier, blood-brain barrier, placenta, and cellular membranes, are discussed. Their fates during and after systemic absorption and their metabolism-related drug interactions are reviewed. Many anti-HIV drugs presently marketed in the US bear some significant drawbacks such as relatively short half-life, low bioavailability, poor penetration into the central nervous system, and undesirable side effects. Efforts have been made to design drug delivery systems for the anti-HIV agents to: (1) reduce the dosing frequency; (2) increase the bioavailability and decrease the degradation/metabolism in the gastrointestinal tract; (3) improve the CNS penetration and inhibit the CNS efflux; and (4) deliver them to target cells selectively with minimal side effects. We hope to stimulate further interests in the area of controlled delivery of anti-HIV agents by providing current status of transport and metabolism/elimination of these agents.

HPV testing in primary screening of older women

Certain types of the human papilloma virus (HPV) are well established as the primary cause of cervical cancer. Several studies have shown that HPV testing can improve the detection rate of high-grade cervical intraepithelial neoplasia (CIN), but these have been carried out primarily in younger women. In this study we evaluated the role of HPV testing as an adjunct to cytology in women aged 35 or over. An additional aim was to evaluate commercially available kits for HPV testing. A total of 2988 eligible women aged 34 or more attending for a routine smear in 40 general practitioner practices received HPV testing in addition to routine cytology, after having given written informed consent. Samples were assayed by polymerase chain reaction (PCR) and two versions of the Hybrid Capture test for HPV, and women were invited for colposcopy if there was any cytological abnormality (including borderline smears) or the PCR test was positive. Any apparent abnormality was biopsied and loop-excision was performed as necessary. CIN was judged by histology; 42 women had high-grade CIN, of which six were cytology negative (86% sensitivity for borderline or worse) and three had a borderline smear (79% sensitivity for mild dyskaryosis or worse). The positive predictive value of a borderline smear was only 3.1%. Eleven high-grade lesions were negative by the PCR HPV test (sensitivity 74%). The first generation Hybrid Capture II test had a similar sensitivity but an unacceptably high false positive rate (18.3%), while the newer Hybrid Capture II microtitre kit had a 95% sensitivity and a 2.3% positivity rate in normal women when used at a 2 pg ml(-1) cut-off (positive predictive value 27%). Cytology performed very well in this older cohort of women. The newer Hybrid Capture II microtitre test may be a useful adjunct, especially if the results reported here are reproducible in other studies. A combined screening test offers the possibility of greater protection and/or longer screening intervals, which could reduce the overall cost of the screening programme.

Ten-year cardiovascular risk in a Hong Kong population

BACKGROUND

Cardiovascular disease is a major health issue in Hong Kong. We conducted a screening program to assess the 10-year risk for the population and to assess the potential benefit of large-scale screening in Hong Kong.

METHOD

A local screening program for cardiovascular risk was carried out in a health service network with a total of 17,716 participants. Retrospective data analysis for the prevalence and distribution of the various risk factors was performed. The data were then applied to calculate the 10-year risk of each individual, according to the European Task Force coronary risk chart.

RESULTS

Of the participants, 54.2% had total cholesterol levels > 5.2 mmol/l; 28.7% had body mass index > 25 kg/m2; 18.5% were hypertensive; 15.1% were smokers; and 3.7% had diabetes mellitus. There were 35.5% of the screened population who had at least two risk factors and 10.9% had at least three risk factors. A total of 9049 individuals satisfied the criteria for the European Task Force guidelines and were selected for 10-year cardiovascular risk analysis. We calculated that 68.0% of the male population had at least 10% risk and 41.5% had at least 20% risk of developing a coronary heart event within 10 years. Among women, 48.2% of the population carried at least 10% risk and 2.8% carried at least 20% risk.

CONCLUSION

The calculated 10-year risk of the population, particularly for men, is significant. Our study demonstrated that mass screening is feasible, and has the benefit of early identification of high-risk individuals, which could be a reasonable strategy for cost-effective medicine.

Cross-talk between the aryl hydrocarbon receptor and hypoxia inducible factor signaling pathways. Demonstration of competition and compensation

The aryl hydrocarbon receptor (AHR) and the alpha-class hypoxia inducible factors (HIF1alpha, HIF2alpha, and HIF3alpha) are basic helix-loop-helix PAS (bHLH-PAS) proteins that heterodimerize with ARNT. In response to 2,3,7,8-tetrachlorodibenzo-p-dioxin, the AHR. ARNT complex binds to "dioxin responsive enhancers" (DREs) and activates genes involved in the metabolism of xenobiotics, e.g. cytochrome P4501A1 (Cyp1a1). The HIF1alpha.ARNT complex binds to "hypoxia responsive enhancers" and activates the transcription of genes that regulate adaptation to low oxygen, e.g. erythropoietin (Epo). We postulated that activation of one pathway would inhibit the other due to competition for ARNT or other limiting cellular factors. Using pathway specific reporters in transient transfection assays, we observed that DRE driven transcription was markedly inhibited by hypoxia and that hypoxia responsive enhancer driven transcription was inhibited by AHR agonists. When we attempted to support this cross-talk model using endogenous loci, we observed that activation of the hypoxia pathway inhibited Cyp1a1 up-regulation, but that activation of the AHR actually enhanced the induction of Epo by hypoxia. To explain this unexpected additivity, we examined the Epo gene and found that its promoter harbors DREs immediately upstream of its transcriptional start site. These experiments outline conditions where inhibitory and additive cross-talk occur between the hypoxia and dioxin signal transduction pathways and identify Epo as an AHR-regulated gene.

Excimer laser photorefractive keratectomy for the correction of myopia

AIM OF STUDY

To ascertain the efficacy, predictability, safety and stability of photorefractive keratectomy (PRK) for the correction of myopia.

METHODS

Nine-hundred and seventy-one eyes of 628 patients had PRK performed for the correction of myopia. The mean pre-operative myopia was -5.7 D +/- 2.21 D (range -1.0 D to -15.25 D). The mean attempted correction was -5.0 D +/- 1.9 D (range -1.0 D to -9.90 D).

RESULTS

Four-hundred and sixty-seven eyes had a follow-up of 6 months or more. Ninety-three percent of low myopic eyes (pre-operative myopia of less than or equal to 6.0 D) and 75% of high myopic eyes (pre-operative myopia of more than 6.0 D) attained an unaided visual acuity of 6/12 or better. Seventy-four percent of low myopic and 50% of high myopic eyes were within 1 D of the intended correction. The mean post-operative refraction at 6 months was 0.60 D +/- 1.46 D. Eight eyes in the high myopia group and 1 eye in the low myope group lost 2 or more lines or best-corrected visual acuity.

CONCLUSION

PRK was safer and produced better results for low myopes.

Important role of cardiac spect imaging in patients undergoing percutaneous transluminal coronary angioplasty

OBJECTIVE

To examine the utilization and contribution of cardiac perfusion scans to patients undergoing percutaneous transluminal coronary angioplasty.

METHODS

From July 1996 to January 1998, 34 patients underwent percutaneous transluminal coronary angioplasty and cardiac SPECT imaging was studied. Twenty-five patients had pre-procedure SPECT scans. The agreement between angioplasty strategies and SPECT findings of ischemia and hypokinesia was examined.

RESULTS

When radionuclide imaging was performed before revascularization procedures, 84% of the patients had intervention strategies guided by scan findings. Perfusion scan findings including extent and severity of ischemia, degree of hypokinesia directed the selection of target vessel for angioplasty in the patient subgroup with multi-vessel disease. Post-angioplasty radionuclide cardiac scans were performed only on symptomatic patients, demonstrating ischemia and hypokinesia in most of them, conceivably reflected the selection bias.

CONCLUSION

We recommend routine pre- and post-angioplasty radionuclide imaging with multigated scans for wall motion assessment for all patients receiving coronary intervention.

Novel cytokine release inhibitors. Part IV: analogs of podocarpic acid

Podocarpic acid derivatives as cytokine (IL-1beta) release inhibitors are discussed.

Novel cytokine release inhibitors. Part III: Truncated analogs of tripterine

Truncated analogs of tripterine as cytokine (IL-1 alpha, IL-1 beta, TNF-alpha, IL-6, and IL-8) release inhibitors are discussed.