Depletion of cutaneous peptidergic innervation in HIV-associated xerosis

Severe xerosis occurs in approximately 20% of human immunodeficiency virus seropositive patients. Changes in cutaneous innervation have been found in various inflammatory skin diseases and in xerotic skin in familial amyloid. We have therefore carried out a quantitative examination of the cutaneous peptidergic innervation in human immunodeficiency virus-associated xerosis. Immunohistochemistry and image analysis quantitation were used to compare total cutaneous innervation (protein gene product 9.5), calcitonin gene-related peptide, substance P, and vasoactive intestinal peptide peptidergic fibers, at two sites in the skin of human immunodeficiency virus-associated xerosis patients (upper arm, n = 12; upper leg, n = 11) and site-matched seronegative controls (upper arm, n = 10; upper leg, n = 10). Measurement of lengths of fibers of each type was carried out for each subject in the epidermis and papillary dermis, and around the sweat glands. Immunostained mast cells in these areas were counted. Epidermal integrity and maturation were assessed by immunostaining for involucrin. There were significant (Mann-Whitney U test; p < 0.02) decreases in total lengths of protein gene product 9.5 fibers in both epidermis/papillary dermis and sweat gland fields; of calcitonin gene-related peptide innervation in the epidermis/papillary dermis; and of substance P innervation of the sweat glands. There were no differences in the distribution of mast cells, or in the epidermal expression of involucrin. Depletion of the calcitonin gene-related peptide innervation may affect the nutrient blood supply of the upper dermis, and the integrity and function of basal epidermis and Langerhans cells. Diminished substance P innervation of the sweat glands may affect their secretory activity. Both of these changes may be implicated in the development of xerosis.

3D coronary artery imaging with phase reordering for improved scan efficiency

Three-dimensional (3D) coronary imaging has the potential to overcome problems resulting from vessel tortuosity and to reduce partial volume effects. With these techniques, however, acquisition times are long and respiratory motion artifacts problematical. This work describes the development of a method that applies phase encode reordering to 3D acquisitions, allowing larger navigator acceptance windows to be used, with a consequent reduction in acquisition time. This method is compared with navigator acceptance window methods (the acceptance-rejection algorithm and the diminishing variance algorithm) and the retrospective respiratory gating technique, both in vitro and in vivo. The use of phase reordering with a 10 mm acceptance window provided a significant increase in scan efficiency over a non-reordered 5 mm method (P<0.001) with no significant change in image quality, and a significant increase in image quality compared with a non-reordered image acquired in the same time (P<0.05). A significant improvement in both image quality and scan efficiency was demonstrated over the retrospective respiratory gating method (P<0.05).

Spectre at the feast

The government's vision, reflected in both the white paper The New NHS: Modern, Dependable (Department of Health, 1997) and circulars since is of GPs and community nurses working together in primary care groups to shape services for patients. But the short history of PCGs has seen nurses having to fight for representation. There is also cynicism about the outcome, nurses having a maximum of two members, GPs seven. Is an equal working relationship really possible? This snapshot survey examines professionalism and collaborative working in primary care. The results suggest that without changes in structure, understanding and attitudes by both doctors and nurses a relationship of equality is not likely.

Interleukin-4 and the interleukin-4 receptor in allergic contact dermatitis

Cutaneous immune responses involving T helper (TH) type 1 (TH1) and type 2 (TH2) T cells, characterised by secretion of interferon-gamma (Ifn-gamma) and interleukin-4 (IL-4), respectively, have both been reported in allergic contact dermatitis (ACD). We used immunohistochemistry to localize expression of IL-4 in ACD lesions and unaffected skin. Atopic dermatitis (AD) and psoriasis biopsies provided positive and negative IL-4 immunoreactivity controls. To investigate the role of IL-4 in ACD, we investigated expression of IL-4 receptors in ACD, AD and psoriatic skin. IL-4 immunoreactivity was found in cells in the dermal infiltrate in 3 out of 7 ACD lesions, but not in unaffected skin from these patients. IL-4 immunoreactivity was found in the dermal infiltrate of all lesional and unaffected AD biopsies, but in none of the psoriatic biopsies. IL-4 receptor alpha chain immunoreactivity, associated with dermal mast cells, was found in all patients. Local expression of IL-4 in ACD indicates either TH2 or TH0 immunoregulation in some allergic contact dermatitis lesions. Our findings do not support exclusive TH1 or TH2 cutaneous immune responses in ACD. Expression of IL-4 receptors by cutaneous mast cells provides a route through which local effects of IL-4 might be mediated.

[Cholesterol in beef, pork, chicken and their products commercialized in Maringá, Paraná, Brazil]

A rapid method developed by Al-Hasani et al. with modifications for cholesterol determination was applied in samples of beef, pork, chicken and meat products. Analyses of cholesterol were performed by capillary gas chromatography. The obtained results showed that chicken presented higher concentration (126.96 to 188.29 mg/100 g) of cholesterol in comparison to beef and pork and similar to meat products, except bovine liver that presented 265.03 mg/100 g. Cholesterol values of beef and pork samples were considered low due to the absence of superficial fat in meat samples.

Endoscopic management of pancreatic pseudocysts

Pancreatic pseudocyst is a major complication of acute and chronic pancreatitis. Surgical drainage, the mainstay of therapy for this condition, is associated with 5% mortality, 25% morbidity, and 10% recurrence rates. Efforts to improve these figures and reduce the typically long hospitalizations have brought about percutaneous and endoscopic drainages. This article describes the endoscopic techniques and attempts to summarize their results based on a literature review. Before endoscopic drainage is carried out, other cystic lesions must be excluded with clinical history, computed tomography findings, and perhaps cyst fluid CEA content and cytology. Endoscopic techniques include wide transmural incision, transmural puncture and stenting, and transpapillary stenting. Either transgastric or transduodenal drainages can be carried out depending on the proximity of the pseudocyst to the gastrointestinal lumen. Endosonography has become an integral part of the transmural procedure because it can help diagnose cystic neoplasms, localize pseudocysts, detect submucosal vessels, and measure the cyst to mucosal distance for transmural punctures. Temporary nasocystic drains are often used to complement stenting during the initial treatment phase. Overall, the endoscopic experience in expert hands is associated with 94% initial technical success, 90% cyst resolution, and 16% recurrence rates. Additional nonendoscopic interventions, mostly surgical, are necessary in 17% of patients. Complication rate is 20%, with < 1% mortality. These data suggest that endoscopic drainage should become an accepted modality in the treatment of pseudocysts. Because of significant technical difficulty and potential risks, endoscopic drainages should only be carried out by experienced endoscopists and at well-equipped facilities.

Retinoid X receptors

Retinoids are metabolites of retinol (vitamin A), which act as signalling molecules in embryogenesis and as stimulators of cellular differentiation. The potency of retinoids as differentiating agents has led to their successful use in treating skin diseases and some forms of cancer. The retinoid X receptors (RXRs) are receptors for the vitamin A metabolite 9-cis retinoic acid, and they are members of the steroid/thyroid hormone receptor superfamily of DNA binding nuclear hormone receptor. The RXRs are also cofactors required for transcription activated by some other members of the steroid/thyroid hormone receptor superfamily, including the all-trans retinoic acid, thyroid hormone, vitamin D and peroxisome proliferator-activated receptors. The biological importance of the RXRs has been demonstrated in recent genetic studies which have shown that some RXR null mutations in mice have phenotypic effects similar to vitamin A deficiency.

Constitutive endothelial and inducible nitric oxide synthase in inflammatory dermatoses

We have used immunohistochemistry to localize the expression of the constitutive endothelial and inducible forms of the enzyme nitric oxide synthase (NOS) in skin from involved and uninvolved sites in patients with atopic dermatitis (AD) and allergic contact dermatitis (CD). Endothelial NOS (eNOS) immunoreactivity was localized to vascular endothelium in the dermis of both involved and uninvolved skin from all patients. Inducible NOS (iNOS) immunoreactivity was found to be closely associated with the upper dermal microvasculature in all the involved AD biopsies, but only in two of 10 uninvolved AD biopsies. CD biopsies were taken from 10 positive skin patch test sites and iNOS immunoreactivity was detected in all of these. iNOS immunoreactivity was detected in only one of the negative patch test biopsies. Both the extent and intensity of iNOS immunoreactivity was lower in CD than in AD skin lesions. The presence of eNOS in the skin is necessary for constitutive NO-mediated dilatation of the dermal vasculature. Induction of iNOS in the dermal endothelium and in perivascular inflammatory cells may be significant with respect to the roles of NO in both the vasodilatory component of the inflammatory response and in the modulation of immune responses in the skin.

Investigations into the molecular size and shape of tomato extensin

The molecular characteristics of soluble extensin from tomato have been investigated. An apparent molecular mass greater than 240 kDa has been previously observed with the shape-dependent method of gel-filtration chromatography [Brownleader and Dey (1993) Planta (Berlin) 191, 457-469]. Tomato extensin is a heavily glycosylated protein that does not migrate into SDS/polyacrylamide gels. This shape-dependent behaviour raises doubts about agreement between the observed apparent mass and the absolute value. The molecular mass measured with matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) was 72.3 kDa, with no evidence of any other species except a doubly charged ion. The sample was therefore considered to be monodisperse under the conditions used. Electron microscopy of soluble extensin showed the presence of particles 40-50 nm in length and 2.0-2.5 nm in width. A minority of these particles showed a central 'kink'. A number of smaller and generally wider particles (20 nm x 2-4 nm) were considered to be folded monomers and larger particles were thought to be dimers. Sedimentation analysis showed that extensin exists in a rapid monomer-dimer equilibrium in the concentration range and buffer used. Sedimentation equilibrium data gave a Kd of 8.5 microM and sedimentation velocity data generated a Kd between 1 and 10 microM. The concentration dependence of the measured sedimentation coefficient was used, together with hydrodynamic bead modelling, to define plausible shapes for monomer and dimer. This suggests that monomeric extensin is an elongated rod of length 40 nm and width 2 nm, which forms staggered dimers of average length 50 nm and width 3 nm. Extensin is an integral component of the primary cell wall. The physical characteristics (size, shape and form) of the rod-like extensin have been evaluated in this paper so that the role that extensin plays in primary cell wall architecture and during plant disease resistance can be more fully understood.

Role of mutations G-480 and C-6203 in the attenuation phenotype of Sabin type 1 poliovirus

Of the 55 point mutations which distinguish the type 1 poliovirus vaccine strain (Sabin 1) from its neurovirulent progenitor (P1/Mahoney), two have been strongly implicated by previous studies as determinants of the attenuation phenotype. A change of an A to a G at position 480, located within the 5' noncoding region, has been suggested to be the major attenuating mutation, analogous to the mutations at positions 481 and 472 in poliovirus types 2 and 3, respectively. In addition, the change of a U to a C at position 6203, resulting in an amino acid change in the polymerase protein 3D, has also been implicated as a determinant of attenuation, albeit to a lesser extent. To assess the contributions of these mutations to attenuation and temperature sensitivity, reciprocal changes were generated at these positions in infectious cDNA clones of Sabin 1 and P1/Mahoney. Assays in tissue culture and primates indicated that the two mutations make some contribution to the temperature sensitivity of the Sabin 1 strain but that neither is a strong determinant of attenuation.

Expression of the chicken retinoid X receptor-gamma gene in migrating cranial neural crest cells

We have used in situ hybridisation to whole chick embryos with digoxygenin-labelled probes to investigate the distribution of RXR-gamma transcripts during neural crest cell migration in the developing head and the anterior of the trunk (the vagal region), where neural crest cells make a substantial contribution. We have found that RXR-gamma transcripts are a good marker for migrating neural crest cells in the chick embryo. RXR-gamma transcripts were first detected in cells that had recently emerged from the neural crest, providing an earlier marker for neural crest cells than the HNK-1 epitope. The pattern of RXR-gamma transcript distribution is dynamic in the developing chick head, and changes in a pattern which is coincident with the migration of cells containing RXR-gamma transcripts and the gradual restriction of RXR-gamma transcripts to specific differentiating neural crest derivatives. Transcripts appeared to be present initially in migrating neural crest cells thoughout the developing head, but gradually became restricted to some crest-derived populations and absent from others. By stage 15, RXR-gamma transcripts were not detectable in neural-crest-derived ectomesenchymal cells, although they were still found in cells contributing to the cranial ganglia and their roots.

Plasmodium falciparum rosetting is associated with malaria severity in Kenya

Rosette formation in 154 fresh Plasmodium falciparum isolates from Kenyan children with mild (n = 54), moderate (n = 64), or severe (n = 36) malaria was studied to determine whether the ability to form rosettes in vitro is correlated with malaria severity. There was a wide distribution of rosette frequencies within each clinical category; however, a clear trend towards higher rosette frequency with increasing severity of disease was seen, with the median rosette frequency of the mild-malaria group (1%; range, 0 to 82%) being significantly lower than those of the moderate-malaria group (5%; range, 0 to 45%; Mann-Whitney U test, P < 0.02) and the severe-malaria group (7%; range, 0 to 97%; Mann-Whitney U test, P < 0.003). Within the severe-malaria category there was no difference in rosetting among isolates from cerebral malaria patients or those with other forms of severe malaria. We also examined the ABO blood groups of the patients from whom isolates were obtained and found that isolates from group O patients (median rosette frequency, 2%; range 0 to 45%) rosetted less well than those from group A (median, 7%; range 0 to 82%; Mann-Whitney U test, P < 0.01) or group AB (median, 11%; range 0 to 94%; Mann-Whitney U test, P < 0.03). We therefore confirm that rosetting is associated with severe malaria and provide further evidence that rosetting is influenced by ABO blood group type. Whether rosetting itself plays a direct role in the pathogenesis of severe malaria or is a marker for some other causal factor remains unknown.

Diversity management: practical application in a health care organization

Lee Gardenswartz and Anita Rowe extend our lead author's contributions to diversity management by suggesting a framework for organizational development that can create an "inclusive" environment for enhancing the productivity and service quality of its staff. The framework includes attention to (1) individual attitudes and beliefs, (2) organizational values and policies, and (3) management skills and practices. The common ground among these three aspects is change. Gardenswartz and Rowe posit that substantial change is necessary to realize maximum value from diversity, and therefore barriers to organizational, attitudinal and managerial behavioral change must be acknowledged and overcome.

Plasmodium falciparum: a family of sulphated glycoconjugates disrupts erythrocyte rosettes

The ability of Plasmodium falciparum-infected erythrocytes to form spontaneous rosettes with uninfected red cells is a parasite adhesion property which has been associated with severe malaria. The mechanism of rosetting remains unknown, but the ability of heparin to disrupt rosettes has been recognised previously. In this paper we show that a group of sulphated glycoconjugates including sulphatide, dextran sulphate, and fucoidan are more effective rosette reversing agents than heparin and are active against both laboratory strains and wild isolates. Other related anionic glycosaminoglycans such as the chondroitin sulphates A, B, and C and hyaluronic acid have no effect on rosette formation. This family of sulphated glycoconjugates which are active against rosettes is also known to inhibit sporozoite invasion of hepatocytes and merozoite reinvasion of erythrocytes, suggesting that sulphated glycoconjugate interaction may be an important process in cell adhesion at different stages in the plasmodial life cycle.

Effect of parathyroid hormone-related peptide supplementation of soy protein formulas in the neonatal pig model

PTH-related peptide (PTHrP) is found in all milks, including human and pig. To define a role for PTHrP in milk, 2-day-old piglets were randomized to receive soy formula devoid of PTHrP or supplemented with 1 nM synthetic PTHrP(1-86) (n = 8 per group). The number of serum samples with detectable PTHrP by immunoassay (Incstar) and radiometric assay (Nichols) was 9 of 33 and 3 of 13 in PTHrP- and 8 of 27 and 3 of 15 in PTHrP+ formula-fed piglets and 8 of 14 and 7 of 12 in naturally suckling piglets, respectively. Serum and urine concentrations of calcium and magnesium and total and bone alkaline phosphatase were similar in both groups at 3, 6, 10, and 17 days of age. No differences were seen in bone mineral content of the tibia measured by single-photon absorptiometry (BMC 0.22 +/- 0.06 and 0.22 +/- 0.10) or dual x-ray absorption (BMC 1.43 +/- 0.36 and 1.31 +/- 0.78) either in vivo or on excised bone or by measurement of Ca, Mg, or P content or total bone ash (1.26 +/- 0.26 and 1.38 +/- 0.28 mg). Intestinal histology, serum intestinal alkaline phosphatase, and net absorption and retention of Ca, Mg, and P in balances from age 11-17 days were all similar. As in humans, however, a developmental pattern was seen for phosphorus regulation in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular mechanisms of sequestration in malaria

Cell surface molecules have received intense attention in recent years because of the central roles they play at the interface between the external environment and the cellular interior. Their functions include adhesion to other cells or extracellular matrices, protection against hostile physical, chemical and biological agents and the transport of metabolites into and out of the cell. In addition, cell surface molecules transduce signals across the cell membrane, relaying information inwards and presenting altered characteristics to the exterior as the environment changes.