Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in Ankylosing Spondylitis Working Group

An international working group was formed to select core sets to be used as endpoints in clinical trials in ankylosing spondylitis (AS). The results of the first steps of the selection of these core sets are described. The definition of the settings for which the core set will be intended are defined. The methods used to select the core sets were a combination of literature search, nominal group discussions, and plenary discussions. The following settings were defined: disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD)/physical therapy, and clinical record keeping. Over 110 variables used as endpoints in AS were found in the literature. The preliminary core set for DC-ART consists of physical function, pain, spinal mobility, patient global assessment, peripheral joints/entheses, x-ray spine. The selected core set for SMARD/physical therapy includes physical function, pain, spinal mobility, spinal stiffness, and patient global assessment. The core set for clinical record keeping includes all measures of the SMARD/physical therapy core set completed by peripheral joints/entheses, and acute phase reactants. Three preliminary core sets for AS have been defined. Further research will be performed to select specific measures for all domains.

Open fractures caused by high velocity missiles: the outcome of treatment of 39 fractures followed for 1-3 years

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority (33 out of 39) were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well as the inherent limitations of the external fixator. Revision of the external fixator with internal fixation after healing of the soft tissues seems to be the direction of the future.

Glucocorticoids stimulate growth of human papillomavirus type 16 (HPV16)-immortalized human keratinocytes and support HPV16-mediated immortalization without affecting the levels of HPV16 E6/E7 mRNA

We investigated the effects of the glucocorticoids hydrocortisone and dexamethasone on human papillomavirus type 16 (HPV16)-mediated human cell carcinogenesis using normal human keratinocytes (HKc) and HKc immortalized by transfection with HPV16 DNA (HKc/HPV16). Normal HKc did not require glucocorticoids for proliferation. In contrast, growth of early passage HKc/HPV16 strictly required these hormones, although glucocorticoid dependence became less stringent during in vitro progression. Glucocorticoid dependence was acquired by HKc early after immortalization with HPV16 DNA, and glucocorticoids were required for efficient HKc immortalization. However, treatment of HKc/HPV16 with hydrocortisone or dexamethasone did not increase the steady-state levels of HPV16 E6/E7 mRNA or protein. Firefly luciferase activity expressed under the control of the HPV16 upstream regulatory region and P97 promoter increased by about fourfold following dexamethasone treatment of HeLa, but only twofold in HKc/HPV16, and less than twofold in SiHa. However, all of these cell lines expressed sufficient endogenous glucocorticoid receptors to allow for a dexamethasone response of the mouse mammary tumor virus promoter. These results indicate that mechanisms other than a direct influence by glucocorticoids on HPV16 early gene expression may contribute to the striking biological effects of these steroids on HPV16-mediated human cell carcinogenesis.

High performance liquid chromatographic determination of folic acid and its photodegradation products in the presence of riboflavin

A high performance liquid chromatographic procedure was developed to determine folic acid and its photodegradation products, p-aminobenzoic acid, pterine-6-carboxylic acid, p-aminobenzoyl-L-glutamic acid, and pteroic acid in the presence of riboflavin. The method involves reversed phase, paired-ion chromatography on mu-BondaPak C18 column using a UV detector (254 nm), and isocratic solvent system (at ambient temperature) comprising 0.017 M monobasic potassium phosphate, tetrabutyl ammonium hydroxide solution (20%, aqueous) and methanol (870:15:250, v/v). The range of quantitation for the individual compounds was found to be: p-aminobenzoic acid, 0.01 - 1.25 x 10(-5) M; pterine-6-carboxylic acid, 0.01-2.0 x 10(-5) M; p-aminobenzoyl-L-glutamic acid, 0.02-2.0 x 10(-5) M; pteroic acid, 0.02-2.5 x 10(-5) M; folic acid, 1.0-5.0 x 10(-5) M; riboflavin, 1.0-5.0 x 10(-5) M. Linear regression analysis of the data demonstrates adequate performance of the method in terms of accuracy and precision (R. S. D. 3%). The method is specific, rapid and convenient and has been applied to photodegradation studies of folic acid in the presence and absence of riboflavin.

Pasteurella multocida infectious arthritis with acute gout after a cat bite

A 74-year-old man with chronic lymphocytic leukemia, immune purpura, and gout presented with a painful, swollen ankle after a cat bite to his leg. On aspiration of the ankle, gram negative pleomorphic rods and monosodium urate crystals were seen and Pasteurella multocida was cultured. He was treated with ampicillin/sulbactam, joint aspiration, and intraarticular steroids, with resolution of infection and return of joint function. The syndromes of Pasteurella arthritis and crystal arthropathy with septic arthritis are reviewed.

Mutation analysis of the transforming growth factor-beta type II receptor in human cell lines resistant to growth inhibition by transforming growth factor-beta

The transforming growth factor-beta (TGF-beta) binds the type II TGF-beta growth factor receptor (RII) to inhibit the growth of most epithelial tissues. Most human colon and gastric cancers with microsatellite instability (MI) have frameshift mutations in polynucleotide repeats within the RII coding region; these mutations truncate the receptor protein and disable the serine/threonine kinase to produce TGF-beta resistance. To further investigate the type, frequency and tissue distribution of RII mutations, we selected 24 human cancer cell lines from various tissues which were previously reported to be resistant to the inhibitory effects of TGF-beta. We developed protocols for non-isotopic SSCP analysis of PCR products from genomic DNA samples, and we tested them for microsatellite instability. PCR-SSCP analysis followed by DNA sequencing identified deletion mutations in the exon 3 poly-adenine tract in three colon tumor cell lines: LS174T and SW48 had a single base deletion and LS411 had a two base deletion. Among the 24 previously unreported cell lines, only these three demonstrated microsatellite instability. These and other recent data indicate that RII mutations are essentially confined to colon and gastric cancers with microsatellite instability. The narrow spectrum of tissues containing RII mutations illustrates the complexity of genetic checkpoints in human carcinogenesis.

Differential effects of p53 mutants on the growth of human bronchial epithelial cells

We investigated the effects of five different p53 mutants on the growth of primary cultures of normal human bronchial epithelial (NHBE) cells. The five defective viral pZIP-Neo constructs contained the following mutations at mutational hot-spots found in human cancers: codons 143ala, 175his, 248trp, 249ser, and 273his. NHBE cells were infected with the p53 mutants, wild-type p53, or the pZIP-Neo vector control. The 143ala, 248trp, and 273his mutants, as well as wild-type p53, decreased the colony-forming efficiency and inhibited the growth of NHBE cells. The 175his mutant did not significantly change the growth rates. In NHBE cells from three donors, the 249ser mutant conferred a substantial growth advantage to the NHBE cells in a colony-forming-efficiency assay. In NHBE cells isolated from one donor, the 249ser mutant also produced a significant life span extension. These cells grew rapidly through 80 population doublings and entered an apparent "crisis" in passage 14. Karyotypic analyses of one culture at multiple passages revealed aneuploid populations with alterations of chromosomes 5, 11, and 13; quantitative DNA analysis detected aneuploidy in late passages from that culture and two other primary cultures. These data demonstrated that the codon 249ser mutation could provide a growth advantage to bronchial epithelial cells and suggest that this mutant protein can induce genomic instability.

Quantitative Relationship Between Leaf Rust and Wheat Yield in Mississippi

Yield losses in wheat (Triticum aestivum) caused by leaf rust were evaluated in cultivar trials at five locations in Mississippi over a 4-year period from 1986 through 1989. Different levels of disease developed in the various trials over the 4-year period. There was no significant interaction between location and cultivar when yield data were collected from sites in the north and central areas of the state. A model derived from data for eight cultivars at two locations showed a negative linear relationship between yield and leaf rust. Total grain yield was reduced by 1% for each 1% increase in rust when the percentage flag leaf area covered by pustules was assessed visually at Feekes stage 11.1. Using this model, and rust ratings from three additional locations, predicted yields were statistically similar to recorded yields.

Intranasal meningoencephalocele and the use of fibrin glue

Meningoencephaloceles are rarely seen in adults. This case report illustrates the management of a large intranasal meningoencephalocele in an adult man. Excision of this lesion resulted in a defect in the cribriform plate which was closed using tissue and fibrin glue.

Nutritional evaluation of some commercial baby foods consumed in Saudi Arabia

The nutritive value of six baby foods based on milk (Nido, Wadi Fatima and Gain) and milk-cereal blends (Cerelac with wheat, Cerelac with rice and Milupa 2) commonly used in the Kingdom of Saudia Arabia was evaluated chemically including fatty acids analysis and biologically in growing rats. The milk based products vs milk-cereal blends provided (per 100 kcal) protein (3.8-5.0 g vs 3.7-3.8 g), fat (5.2-5.7 g vs 2.0-4.8 g), available carbohydrates (7.3-9.5 g vs 10.5-16.6 g), Ca (159-189 mg vs 101-145 mg), Mg (15-18 mg vs 14-20 mg), Na (32-39 mg vs 42-51 mg), K (160-180 mg vs 122-144 mg), Fe (1.4-1.8 mg vs 1.5-1.9 mg), Cu (0.04-0.09 mg vs 0.09-0.1 mg), Zn (0.8-1.2 mg vs 0.8-1.1 mg), and linoleic acid (208-1343 mg vs 518-639 mg). Metabolizable energy (ME) values in milk based products (487-495 kcal/100 g) were higher than milk-cereal blends (404-473 kcal/100 g). The true protein digestibility (TD) varied from (93-95%) in milk based foods to (94-95%) in milk-cereal blends. The net protein utilization (NPU) ranged between (0.74-0.78) in milk based products and (0.68-0.74) in milk-cereal blends. The net dietary protein calorie percent (NDP cal%) was higher in milk based foods (11.7-15.0%) than milk-cereal blends (10.2-11.1%). An imbalance of calories and nutrients in some baby foods was noticed. However, the protein quality was satisfactory and could meet the protein requirements of infants and toddlers as indicated by NDP cal% values.

Cytotoxicity of copper complexes of 2-furaldehyde oxime derivatives in murine and human tissue cultured cell lines

The copper complexes of furan oxime derivatives were found to be potent cytotoxic agents in both murine and human tissue cultured cell lines which were either suspended or solid tumors. The ED50 values were frequently improved over the clinically useful antineoplastic agents. These copper complexes of 2-furaldehyde oximes were effective inhibitors of L1210 lymphoid leukemia DNA synthesis followed by RNA synthesis. Purine synthesis regulatory enzyme activities were markedly reduced by the compounds with marginal inhibition of t-RNA polymerase, and nucleoside kinases activities. L1210 DNA topoisomerase II activity was markedly reduced with IC50 values better than the standard VP-16, etoposide. Yet, the copper complexes caused no further protein linked breaks than VP-16 did, but did block phosphorylation activation of the topoisomerase II enzyme.

Effect of laser treatment on the root canal of human teeth

The purpose of this study was to examine the morphological and temperature changes of the apical portion of human extracted teeth treated by Nd: YAG, CO2 and Argon-lasers. Seventy-two single-rooted human teeth were studied. The root canals were prepared conventionally. Laser treatment of the apical portion of the canal was carried out by means of an optic fiber or metal tip. Temperatures were recorded thermographically. Two-thirds of the specimens were stained with black India ink and 36% silver ammonium fluoride solution. All specimens were irradiated by the three types of lasers at several intensities and the temperatures were recorded. Half of the specimens were prepared for the telescopic light microscope and for scanning electron microscopic observation, and the rest for histopathological examination by light microscope. The scanning electron microscopic evaluation showed that the laser energy vaporized the deposited debris, producing a glaze-like surface. The histopathological investigation revealed a tapered, enlarged apical lased area. All three laser devices were capable of vaporizing the debris in this way but the degree of morphological change was highly dependent on energy level and duration. The Argon-laser produced the highest temperatures.

HLA antigen pattern of Kashmiri patients with rheumatic heart disease

The distribution of HLA class-I (A, B and C), and class II (DR and DQ) antigens was studied in 50 randomly selected Kashmiri Muslim patients with established rheumatic heart disease and compared with that of 50 controls of similar ethnicity. A significant increase in the frequency of HLA-DR4 (P < 0.005, RR 3.27) and a significant decrease in the frequency of HLA-B5 (P < 0.001, RR 0.19) were found in the patient group. Though HLA-DQ3 showed a significant increase (P < 0.005, RR 2.52) and HLA-DR7 a significant decrease (P < 0.05, RR 0.42) in the patient group, the corrected P value was not significant. The findings suggest that susceptibility to RHD in the studied population is HLA-related, with HLA-DR4 influencing its occurrence and HLA-B5 conferring protection against the same.

FHIT mutations in human primary gastric cancer

Allelic deletion of multiple regions on the short arm of chromosome 3 (3p) implies the presence of multiple important tumor suppressor genes in human carcinogenesis. The FHIT gene, identified recently in chromosome 3p14.2, shows frequent allelic deletion and aberrant transcripts in gastrointestinal tumors. After determining the intron sequences flanking each of the coding exons of the FHIT gene and designing intron primers to facilitate mutation analysis of genomic DNA samples, we analyzed the complete coding sequences in matched cancer and normal tissues from 40 cases with primary gastric cancer using intron primers, PCR-single-strand conformation polymorphism analysis, and direct sequencing. A somatic missense mutation in exon 6, codon 61, ACG (threonine) --> ATG (methionine) was found in a signet ring cell adenocarcinoma. We also evaluated allelic deletion in these tumors by PCR-based microsatellite analysis; allelic deletion occurred in 42.1% (16 of 38) of evaluable cases. This is the first report of a somatic missense mutation of the FHIT gene in a primary tumor. Presence of a point mutation and frequent allelic deletions are consistent with the hypothesis that FHIT gene alterations are involved in the development of primary gastric cancers.

Lung cancer response following inhaled radon in the A/J and C57BL/6J mouse

A/J and C57BL/6J mice, strains which differ in susceptibility to chemical-induced lung tumours, were examined for differential sensitivity to radon-induced lung cancer. Sixty weeks after exposure to 952 WLM radon (3.34 J h1 m-3), no lung tumours were found in the control, sham- (one dust-) exposed, or radon-exposed C57BL/6J mice. In contrast, each of the A/J groups had a substantial number of tumours. Although there were no differences in overall lung tumour incidence or multiplicity associated with radon and ore dust exposure in A/J mice, distinct differences in tumour size and histopathological appearance were noted. The ratio of lung adenoma-to-carcinoma found in control A/J mice was 10:1, whereas the ratio in one dust-exposed animals was 10:8 and that in radon-exposed animals was 8:6. Based on these data, particulates appear to modify the promotion-progression of lung cancer in this strain. In addition, the appearance of two very large carcinomas histologically resembling Clara-cell-derived tumours only in the radon-exposed A/J mice and the possibility of alpha-particle-induced killing of target cells in the radon-exposed animals suggests that A/J but not the C57BL/6J, mice may have genes that modify susceptibility to radon-induced lung cancer.

Evaluation of oral poliovirus vaccine delivery during the 1994 national immunization days in Pakistan

Pakistan conducted national immunization days (NIDs) for the first time in 1994. To estimate coverage, to evaluate risk factors for failure to be immunized, and to determine the effectiveness of mass media, parents of 1288 children in 714 households in four districts were surveyed after the first NID round. In each district, a high proportion of children (93%-96%) received oral poliovirus vaccine (OPV) during the NID. In three districts, unimmunized or partially immunized children were less likely to receive NID OPV than were fully immunized children (Kohistan, P < .001; Quetta, P < .001; and Sibi, P = .05). Although a high proportion of children in each age cohort received NID OPV, in three districts children 0-11 months of age were less likely to receive NID OPV than were older children. Television and radio reached a high proportion of survey households, but other mass media were less effectively utilized. Risk factor and media effectiveness surveys provide important information that is useful for planning future NIDs.

Comparative evaluation of the severity of gastric ulceration by solid dispersions and coprecipitates of indomethacin

The ulcerogenic activity of indomethacin was studied in rats following single and chronic doses of indomethacin in the form of pure drug, solid dispersions and coprecipitates. Each formulation was administrated as a suspension in a 2% methylcellulose solution. Gastrointestinal ulceration was assessed, four hours after a single dose and 24 hours following the last dose of a chronic four day dosing regimen, by counting the number of lesions and ulcers present. A rating scale was employed to evaluate the severity index. The coprecipitate formulation produced less severe ulceration than the solid dispersion and pure drug. This suggests that the severity of ulceration than the solid dispersion and pure drug. This suggests that the severity of ulceration may be related to the preparation methodology and drug release kinetics.

Nonatomic games on Loeb spaces

In the setting of noncooperative game theory, strategic negligibility of individual agents, or diffuseness of information, has been modeled as a nonatomic measure space, typically the unit interval endowed with Lebesgue measure. However, recent work has shown that with uncountable action sets, for example the unit interval, there do not exist pure-strategy Nash equilibria in such nonatomic games. In this brief announcement, we show that there is a perfectly satisfactory existence theory for nonatomic games provided this nonatomicity is formulated on the basis of a particular class of measure spaces, hyperfinite Loeb spaces. We also emphasize other desirable properties of games on hyperfinite Loeb spaces, and present a synthetic treatment, embracing both large games as well as those with incomplete information.

Dexamethasone and bacterial meningitis in Pakistan

The objective of this study was to assess, in a developing country setting, the effect of dexamethasone therapy on bacterial meningitis outcomes. A prospective double blind placebo controlled trial was conducted in 89 children aged from 2 months to 12 years suffering from bacterial meningitis. Neurological, developmental, and hearing assessments were conducted at one, four, and 12 months after discharge. Forty eight patients received dexamethasone and 41 placebo. Initial antimicrobial drugs used were ampicillin and chloramphenicol. For all patients at the time of admission the mean duration of illness was 5.7 days; 47% had had seizures and 56% had impaired consciousness. Seventeen of 89 (19%) patients died. The mortality for the dexamethasone group was 25% as compared with 12% in the group receiving placebo. Presentation to the hospital after four days of symptoms and with impaired conscious state were independent predictors of death. Of the dexamethasone group survivors, 26.5% had neurological sequelae and 42.3% had hearing impairment, whereas in the placebo group it was 24% and 30% respectively. Altered state of consciousness was a predictor of neurological sequelae. The presence of neurological sequelae and high cerebrospinal fluid protein independently predicted hearing loss. No beneficial effect of dexamethasone was observed on morbidity or mortality of this group of patients with bacterial meningitis. Dexamethasone is therefore not useful in developing countries as adjunctive treatment in patients seriously ill with bacterial meningitis, who present late for treatment and have been partially treated.