Lindane (gamma-hexachlorocyclohexane) induces internal Ca2+ release and capacitative Ca2+ entry in Madin-Darby canine kidney cells

The effect of lindane (gamma-hexachlorocyclohexane), an organochlorine pesticide, on Ca2+ mobilization in Madin-Darby canine kidney cells was examined by fluorimetry using fura-2 as a Ca2+ indicator. Lindane (5-200 microM) increased [Ca2+]i concentration-dependently. The [Ca2+]i signal comprised an immediate initial rise followed by a persistent phase. Ca2+ removal inhibited the [Ca2+]i signal by reducing both the initial rise and the sustained phase. This implies lindane-triggered Ca2+ influx and Ca2+ release. In Ca2+ -free medium, 0.15 mM lindane increased [Ca2+]i after pretreatment with carbonylcyanide m-chlorophenylhydrazone (CCCP, 2 microM), a mitochondrial uncoupler, and two endoplasmic reticulum Ca2+ pump inhibitors, thapsigargin and cyclopiazonic acid. Conversely, pretreatment with lindane abolished CCCP- and thapsigargin-induced Ca2+ release. This suggests that 0.15 mM lindane released Ca2+ from the endoplasmic reticulum, mitochondria and other stores. La3+ (1 mM) partly inhibited 0.1 mM lindane-induced [Ca2+]i increase, confirming that lindane induced Ca2+ influx. Addition of 3 mM Ca2+ increased [Ca2+]i after pretreatment with 0.15 mM lindane for 750 sec. in Ca2+ -free medium, which indicates lindane-induced capacitative Ca2+ entry. Lindane (0.15 mM)-induced Ca2+ release was not reduced by inhibiting phospholipase C with 2 microM U73122, but was inhibited by 70% by the phospholipase A2 inhibitor aristolochic acid (40 microM).

Ca(2+) mobilization induced by W-7 in MG63 human osteosarcoma cells

The effect of N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide hydrochloride (W-7), a widely used calmodulin inhibitor, on intracellular free Ca(2+)levels ([Ca(2+)](i)) in MG63 human osteosarcoma cells was explored using fura-2 as a Ca(2+)probe. W-7 (20-1000 micro m) induced an increase in [Ca(2+)](i)in a dose-dependent manner, with an EC(50)of 100 microm. The [Ca(2+)](i)signal comprised an initial rise and a sustained plateau without significant decay within 5 min. External Ca(2+)removal decreased the Ca(2+)signals by reducing the peak and sustained phase, indicating W-7-activated intracellular Ca(2+)release and extracellular Ca(2+)influx. W-7 (500 microm) failed to induce a [Ca(2+)](i)increase in a Ca(2+)-free medium after pre-treatment with thapsigargin (1 microm), an endoplasmic reticulum Ca(2+)pump inhibitor. Conversely, W-7 pre-treatment abolished the Ca(2+)release induced by thapsigargin. This suggests that W-7 (500 microm ) released internal Ca(2+)mainly from the endoplasmic reticulum. The addition of 3 mm Ca(2+)increased [Ca(2+)](i)dose-dependently after preincubation with 20-1000 microm W-7 in a Ca(2+)-free medium, implying that W-7 induced capacitative Ca(2+)entry. W-7-induced Ca(2+)release was not altered by inhibiting phospholipase C with 2 microm 1-(6-((17 beta - 3-methoxyestra-1,3, 5(10)-trien-17-yl)amino)hexyl)-1H-pyrrole-2,5-dione) (U73122). Tryphan blue assay demonstrated that W-7 (200 microm) caused gradual cell death within 30 min of the initial drug exposure. Together, it was found that W-7 induced [Ca(2+)](i)increases in human osteosarcoma cells by releasing internal Ca(2+)from the endoplasmic reticulum, and also by triggering Ca(2+)influx. W-7 may be cytotoxic to osteosarcoma cells.

Adults with meningitis caused by oxacillin-resistant Staphylococcus aureus

Since 1995, 11 adult patients with oxacillin-resistant Staphylococcus aureus (ORSA) meningitis have been identified at Chang Gung Memorial Hospital-Kaohsiung, in Kaohsiung, Taiwan. The 11 patients were 8 men and 3 women, aged 17-78 years. A postneurosurgical state was an underlying condition for all, and fever and disturbances in consciousness were the most common clinical manifestations. Infection with S. aureus only was found in 8 patients, and mixed infection was found in the other 3. The 8 patients with meningitis caused by S. aureus only were mainly treated with intravenous vancomycin, 2-4 g/day; 4 of these patients died. Although ORSA meningitis is uncommon among adults with culture-proven bacterial meningitis, its incidence has been increasing in recent years. The diagnosis of adult ORSA meningitis can be confirmed only with a positive culture of cerebrospinal fluid, and the choice of initial empirical antibiotics must be guided by the accumulated data concerning the relative frequency of the implicated pathogens found at each institution. Despite the high rate of mortality associated with ORSA meningitis, intravenous vancomycin therapy seems to be one of the best choices for management of this condition in adults.

Transrectal ultrasonographic findings in patients with hemospermia

BACKGROUND

Hemospermia causes anxiety in many men. Its etiology includes inflammatory disorders, vascular lesions, malignancies and congenital anomalies. With the advent of modern transrectal ultrasonography (TRUS) and magnetic resonance imaging technology, we can now visualize the internal structures of the seminal vesicles and prostate, and identify a more accurate etiology for hemospermia. This study was performed to assess the efficacy of TRUS in the evaluation of hemospermia.

METHODS

TRUS was used to evaluate 40 patients with hemospermia. Patients' ages ranged from 20 to 72 years, with an average age of 41 years. The duration of symptoms was 3 days to 10 years, (average age 12.4 months). Apart from three patients with hepatitis, there was no major illness found in the medical histories. TRUS was performed with a B & K, type 3535 transrectal transducer device, with an 1850 multiplane probe.

RESULTS

TRUS revealed abnormalities in 33 (83%) of 40 patients, which included ejaculatory duct cysts, müllerian duct cysts, asymmetric seminal vesicle dilatation, preprostatic vein engorgement and prostatic enlargement. There were stones in the ejaculatory ducts, ejaculatory duct cysts, müllerian duct cysts or prostate. Nine patients with prostatic stones were under 40 years-of-age. Other than the development of stones, there were no significant differences between patients less than 40 years-of-age and those more than 40 years old.

CONCLUSIONS

The results suggest that TRUS is an effective method for examining the seminal vesicles, ejaculatory duct and prostate complex. Sonoguided aspiration, injection of contrast medium or biopsy can further help to differentiate the nature of hemospermia.

Ultrastructure of white spot syndrome virus development in primary lymphoid organ cell cultures

Primary cell cultures from the lymphoid organ of Penaeus monodon were used to investigate in vitro propagation and morphogenesis of white spot syndrome virus (WSSV). Double-strength Leibovitz's L15 supplemented with 20% fetal bovine serum, pH 7.5, with a final osmolarity of 530 +/- 5 mOsm kg-1 was identified as the most suitable culture medium. In this medium, the lymphoid cells remained viable for more than 1 wk. Migrating cells were inoculated with WSSV, and the consequent cytopathic effects documented by light and electron microscopy. WSSV appears capable of following 2 alternative assembly sequences, one similar to the morphogenesis of the Oryctes rhinocerus virus and another which is more typical of baculoviral assembly. Possible relationships between WSSV, Oryctes virus, and baculoviruses are discussed.

The level of DLDB/CHIP controls the activity of the LIM homeodomain protein apterous: evidence for a functional tetramer complex in vivo

The LIM homeodomain (LIM-HD) protein Apterous (Ap) and its cofactor DLDB/CHIP control dorso- ventral (D/V) patterning and growth of Drosophila wing. To investigate the molecular mechanisms of Ap/CHIP function we altered their relative levels of expression and generated mutants in the LIM1, LIM2 and HD domains of Ap, as well as in the LIM-interacting and self-association domains of CHIP. Using in vitro and in vivo assays we found that: (i) the levels of CHIP relative to Ap control D/V patterning; (ii) the LIM1 and LIM2 domains differ in their contributions to Ap function; (iii) Ap HD mutations cause weak dominant negative effects; (iv) overexpression of ChipDeltaSAD mutants mimics Ap lack-of-function, and this dominant negative phenotype is caused by titration of Ap because it can be rescued by adding extra Ap; and (v) overexpression of ChipDeltaLID mutants also causes an Ap lack-of-function phenotype, but it cannot be rescued by extra Ap. These results support the model that the Ap-CHIP active complex in vivo is a tetramer.

Mixed infection in adult bacterial meningitis

12 adult patients suffering from bacterial meningitis caused by mixed infection were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 13 years (1986-1998), and they accounted for 6.5% (12/184) of our culture-proven adult bacterial meningitis. The 12 cases included seven males and five females, aged 17-74 years. Six of the 12 cases had community-acquired infections and the other six had nosocomially-acquired infections. Ten of the 12 cases had associated underlying diseases, with head trauma and/or neurosurgical procedure being the most frequent. Both gram-negative and gram-positive pathogens were identified in these 12 cases with gram-negative pathogens outnumbering the gram-positive ones. The implicated pathogens, starting with the most frequent, included Enterobacter species (Enterobacter cloacae, Enterobacter aerogenes), Klebsiella species (Klebsiella pneumoniae, Klebsiella oxytoca), Escherichia coli, Staphylococcus species (Staphylococcus aureus, Staphylococcus haemolyticus), Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus, Serratia marcescens, Citrobacter diversus, Proteus mirabilis, Streptococcus viridans and Neisseria meningitidis. Six of the 12 cases were found to have multi-antibiotic-resistant strains, which included E. cloacae in one, A. baumannii in one, K. pneumoniae in one and S. aureus in three. The management of these 12 cases included appropriate antibiotics and neurosurgical procedures including shunt revision. Despite the complexity of implicated pathogens and the high incidence of emergence of resistant strains, the overall mortality rate (8.3%, 1/12) was not higher than that in adult bacterial meningitis. However, complete recuperation was difficult in adult patients with mixed bacterial meningitis.

Adult Citrobacter freundii meningitis: case report

Citrobacter is a distinct group of Gram-negative bacilli belonging to the Enterobacteriaceae family. Central nervous system (CNS) infections due to Citrobacter are uncommon, though they occur more frequently in neonates and young children. In adults, Citrobacter meningitis is extremely unusual with only 6 cases reported in the literature before 1998. This rare CNS infection has been seen in patients with head trauma, following neurosurgical procedures, and in those who are immunocompromised. Of the patients in the 6 reported cases, only one developed multi-antibiotic resistant Citrobacter CNS infection. Adding to this small number of reported cases, we report an adult case of post-neurosurgical meningitis and subdural empyema caused by multi-antibiotic resistant Citrobacter freundii and also review the literature related to this infection. Antimicrobial therapy with imipenem and third-generation cephalosporins failed to result in cerebrospinal fluid sterilization in our patient. Because of the use of broad-spectrum antibiotics, multi-antibiotic resistant Citrobacter species have developed in this nosocomial CNS infection and now present a therapeutic challenge. Therefore, further clinical studies are needed to determine updated therapeutic modalities for treating this life-threatening infection.

Gram-negative bacillary meningitis in adult post-neurosurgical patients

BACKGROUND

To assess the clinical features and therapeutic outcomes of gram-negative bacillary meningitis (GNBM) in adult postneurosurgical patients.

METHODS

Thirty adult patients with GNBM were included in this study. Their clinical features, laboratory data, prognostic factors, and therapeutic outcome were analyzed. The patients were 22 males and 8 females, aged 17-72 years. Seven had community-acquired infections and 23 had nosocomial infections. Two patients were associated with brain abscess.

RESULTS

The pathogens found in the 30 GNBM patients were Pseudomonas aeruginosa, Klebsiella species, Escherichia coli, Acinetobacter baumannii, and some rare pathogens including Citrobacter freundii, Serratia marcescens, Enterobacter cloacae, and Proteus mirabilis. Among these 30 patients, 8 patients with third-generation cephalosporin-resistant GNBM were identified since 1994; all infections were nosocomially acquired. Appropriate antibiotics were given to 22 patients. Eight patients did not receive appropriate antibiotic therapy. All eight died. The mortality rate in those treated with appropriate antibiotics was 14%.

CONCLUSIONS

There has been an increase of GNBM in postneurosurgical patients in recent years. In addition, the emergence of strains resistant to third-generation cephalosporins in this specific group of patients has also been noted in recent years, and has become a great therapeutic challenge. We noted many prognostic factors in postneurosurgical patients in this study; however, appropriate antibiotic therapy and initial consciousness level are the most significant ones. Therefore, in cases of postneurosurgical patients with nosocomially acquired GNBM, the possibility of third-generation cephalosporin resistance should be strongly suspected. Early initiation of appropriate antibiotic therapy is needed in this potentially fatal disease.

Transmyocardial holmium-YAG laser channels in an animal model: a preliminary morphologic and histologic study

BACKGROUND

Laser transmyocardial revascularization (TMR) appears to improve symptoms in patients with refractory angina. However, it remains a controversial treatment modality for relieving ischemia. We conducted our study in dogs and evaluated the changes in morphology and histology of the myocardium after laser TMR.

METHODS

The hearts of 10 mongrel dogs (20-30 kg each) were treated with a holmiumyttrium aluminum garnet (YAG) laser in vivo. After opening the pericardium, the 1-mm fiberoptic device was used to create an average of 30 transmyocardial channels per heart at approximate intervals of 0.5 to 1 cm through normal left ventricular myocardium. All dogs tested survived the procedure. The dogs were sacrificed on the first and 60th postoperative days.

RESULTS

In the day-1 postoperative group (n = 4), the transmyocardial channels were obliterated at both epicardial and endocardial ends. The channels were totally occupied by necrotic myocytes and did not appear patent under the microscope. In the day-60 postoperative group (n = 6), the epicardial and endocardial scars were identified at each original laser application site. On cross-section, the channels were invaded by fibrous tissue bands extending from the endocardium to the epicardium, without a prominent central passage. Trichrome stained specimens showed that the channels were replaced by collagen fibers, fat tissue and numerous well-developed capillaries or sinusoids in which plenty of red blood cells were found.

CONCLUSIONS

We concluded that laser TMR offers no help for acute myocardial ischemia, but results in neovascularization inside the channels by the 60th postoperative day. Angiogenesis induced by laser TMR could possibly play a role in relieving chronic ischemia.

Mutation analysis of pertussis toxin promoter

The improving of the expression efficiency of a pertussis toxin (PT) promoter was believed to be a critical issue for the production of PT in acellular vaccine development. In this study, we have isolated a PT promoter region from the genome of a pertussis strain ATCC 9340. Based on the promoter sequence, a series of mutant PT promoters have been generated and subjected to in vitro gel shift analysis and in vivo reporter beta-galactosidase activity study. As compared with the wild type promoter, the mutation of the ribosome binding sequence or -10 element, to the respective consensus sequence derived from strong bacterial promoters, resulted in an enhancement of its interaction with two cellular proteins, and a slightly higher beta-galactosidase activity (1.3 fold). Whereas, the change of either upstream inverse repeats or 20-bp direct repeats to a certain complete repeat significantly promoted the formation of another DNA-protein-complex, and exhibited an 1.8 fold beta-galactosidase activity. These findings would have provided a mutation target for making a more efficient PT-production pertussis strain.

The prognostic factors of cryptococcal meningitis in HIV-negative patients

Seventy-one patients with cryptococcal meningitis, 46 males and 25 females, aged 15-83 years, were included in this study. Their initial clinical manifestations, cerebrospinal fluid (CSF) features, and therapeutic results were analysed. Patients were treated with three different regimens: amphotericin B, fluconazole, and combination therapy. Based on the therapeutic results, the 71 patients were also divided into cured, improved, and failed groups. For statistical comparison, the clinical manifestations and CSF features, were compared according to therapeutic outcome. There was no statistical difference in outcome among the three different antifungal regimens. However, patients treated with fluconazole required 36% fewer days of hospitalization compared with those receiving amphotericin B. Significant prognostic factors, included low CSF glucose, high CSF lactate, high CSF cryptococcal antigen titre (> or = 1:1024), initial level of consciousness, the presence of seizure, hydrocephalus, and central nervous system vasculitis. Multiple logistic regression analysis showed that only initial level of consciousness, and CSF antigen titre were strongly associated with therapeutic failure after other potentially confounding factors were adjusted for. Because some of the prognostic factors in cryptococcal meningitis can be corrected, early diagnosis, early use of appropriate antifungal treatment, and the correction of the underlying metabolic derangements are important in management.

Resistance to third-generation cephalosporins in adult gram-negative bacillary meningitis

Ninety-three patients with gram-negative bacillary meningitis (GNBM) were identified at Kaohsiung Chang Gung Memorial Hospital, over a period of 12 years. Among them, eight showed resistance to third-generation cephalosporins, accounting for 9% of the total GNBM cases and 29% of the postneurosurgical GNBM cases. The resistant pathogens included Acinetobacter baumannii, Klebsiella pneumoniae, Citrobacter freundii and Morganella morganii. These eight patients, six males and two females aged 18-61 years, all had nosocomially acquired meningitis associated with head trauma and/or postneurosurgical states. Six patients received imipenem/cilastatin treatment; five survived and one died. The other two expired because they did not receive appropriate antibiotic treatment. Although third-generation cephalosporin-resistant GNBM is rare, its incidence has been increasing over the past 5 years. In patients with nosocomially-acquired postneurosurgical GNBM, the presence of third-generation cephalosporin resistance should therefore be highly suspected. The appropriate choice of antibiotic is essential for their survival.

Pseudomonas aeruginosa central nervous system infections: analysis of clinical features of 16 adult patients

BACKGROUND

The purpose of this study was to analyze the clinical features and therapeutic outcome of 16 adult patients with Pseudomonas aeruginosa central nervous system (CNS) infection. We also attempted to identify the factors that significantly influence the prognosis of this potentially fatal CNS infection.

METHODS

Sixteen adult patients with P aeruginosa CNS infection, nine men and seven women, aged from 18 to 86 years, were included in this retrospective study. The clinical features and the laboratory data of these patients were analyzed. Potential prognostic factors were compared by means of Fisher's exact test and the relative risks were estimated by odds ratio.

RESULTS

Of the 16 patients, 13 had meningitis and three had focal suppuration (two with brain abscess and one with spinal epidural abscess). The 13 meningitis patients with nosocomial or community-acquired infections were classified into two forms: the spontaneous form and the neurosurgical form. The overall mortality rate was 37.5% (6/16). In the meningitis group, the patients with the neurosurgical form had a lower mortality rate (11.1%; 1/9) than the patients with the spontaneous form (100%; 4/4), and those with community-acquired meningitis had a higher mortality rate (80%; 4/5) than those with nosocomial infections (12.5%; 1/8). All the meningitis patients who did not receive appropriate antibiotic treatment expired. The statistically significant prognostic factors included the acquisition of infection, form of infection, bacteremia, initial level of consciousness and the use of appropriate antibiotics.

CONCLUSIONS

Vigilance for P aeruginosa is particularly important in patients with predisposing factors such as head injury, neurosurgical procedures and long-term debilitating diseases. Early appropriate antibiotic therapy and neurosurgical intervention for patients with suppurative infections can bring about improved therapeutic results.

Conservation of the expression and function of apterous orthologs in Drosophila and mammals

The Drosophila apterous (ap) gene encodes a protein of the LIM-homeodomain family. Many transcription factors of this class have been conserved during evolution; however, the functional significance of their structural conservation is generally not known. ap is best known for its fundamental role as a dorsal selector gene required for patterning and growth of the wing, but it also has other important functions required for neuronal fasciculation, fertility, and normal viability. We isolated mouse (mLhx2) and human (hLhx2) ap orthologs, and we used transgenic animals and rescue assays to investigate the conservation of the Ap protein during evolution. We found that the human protein LHX2 is able to regulate correctly ap target genes in the fly, causes the same phenotypes as Ap when ectopically produced, and most importantly rescues ap mutant phenotypes as efficiently as the fly protein. In addition, we found striking similarities in the expression patterns of the Drosophila and murine genes. Both mLhx2 and ap are expressed in the respective nerve cords, eyes, olfactory organs, brain, and limbs. These results demonstrate the conservation of Ap protein function across phyla and argue that aspects of its expression pattern have also been conserved from a common ancestor of insects and vertebrates.

Endoscopic hydrogen peroxide spray may facilitate localization of the bleeding site in acute upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS

A major problem encountered in the emergency endoscopic management of acute upper gastrointestinal (UGI) bleeding is poor localization of the bleeding site, which can be obscured by blood or clots. Traditional attempts to overcome this problem have been by physical methods, which have usually proved unsatisfactory. The aim of this prospective study was to show that hydrogen peroxide can be used as a dissolution agent, resulting in an alteration of the characteristics of blood clots and allowing a clearer visual field.

PATIENTS AND METHODS

Twenty patients with acute UGI bleeding (13 male, seven female) were included in the study. The suspected site of bleeding was initially sprayed with 200 ml of saline and then with 25-175 ml of 3 % H2O2. Pictures of the visual field were taken before and after irrigation with both saline and H2O2. These pictures were evaluated by three gastroenterologists and scored using the following visual clearance scoring system: -3, marked worsening of visual field; -2, moderate worsening; -1, slight worsening; 0, no change; +1, slight improvement; +2, moderate improvement; + 3, marked improvement. In cases of active oozing or spurting, after initial hemostasis was achieved the bleeding point was injected with pure ethanol or cauterized with a heater probe. In order to assess the safety of 3 % H2O2 endoscopic biopsies of the antrum and the duodenal bulb were performed before and 30 minutes after its use and examined by a pathologist.

RESULTS

There was a significant improvement in the mean visual clearance score after irrigation with H2O2 compared to irrigation with saline alone (2.13 vs. 0.43, P<0.001). During endoscopic examination there were 19 patients with active oozing from the ulcer base covered by an adherent blood clot; 12 of these (63.1%) achieved initial hemostasis after H2O2 spraying. Eleven of 18 (61.1 %) patients complained of a mild epigastric burning sensation during H2O2 irrigation. There was no clinically significant change in the histology of the antrum and the duodenal bulb after H2O2 therapy.

CONCLUSIONS

We concluded that H2O2 is a safe and effective way to clear the visual field, facilitating the localization of the bleeding site during emergency endoscopy for acute UGI bleeding, with only mild side effects. In some cases H2O2 therapy can also induce temporary hemostasis. We recommended the use of hydrogen peroxide to improve endoscopic visualization, especially in cases where an adherent blood clot covers the suspected bleeding site.

Acinetobacter meningitis: four nosocomial cases

We report the clinical features and therapeutic outcomes of four patients with multiantibiotic-resistant Acinetobacter meningitis. There were three males and one female, aged from 17 to 49 years. Three of them had suffered from head injuries with skull fractures, and the other suffered from an intracerebral hemorrhage and underwent a craniotomy. All four patients acquired nosocomial Acinetobacter meningitis, and multiantibiotic resistance developed. After treatment with imipenem/cilastatin, three of the four patients survived; one died of multiorgan failure. Because the clinical manifestations of Acinetobacter meningitis are similar to those of other gram-negative bacillary meningitis, the diagnosis can only be confirmed by bacterial culture. Resistance to multiple antibiotics, including third-generation cephalosporins, is frequently seen in patients with nosocomial Acinetobacter meningitis, and imipenem/cilastatin seems to be the antibiotic of choice for this potentially fatal central nervous system infection.

Processing irrelevant location information: practice and transfer effects in choice-reaction tasks

Left or right keypresses to a relevant stimulus dimension are faster when the stimulus location, although irrelevant, corresponds with that of the response than when it does not. This phenomenon, called the Simon effect, persisted across 1,800 trials of practice, although its magnitude was reduced. Practice with the relevant stimulus dimension presented at a centered location had little influence on the magnitude of the Simon effect when irrelevant location was varied subsequently, and practice with location irrelevant prior to performing with location relevant slowed responses. After practice responding to stimulus location with an incompatible spatial mapping, the Simon effect was reversed (i.e., responses were slower when stimulus location corresponded with response location) when location was made irrelevant. When the response keys were labeled according to the relevant stimulus dimension (the Hedge and Marsh [1975] task variation), this reversal from practice with a spatially incompatible mapping was found for both the congruent and the incongruent relevant stimulus-response mappings. Thus, task-defined associations between stimulus location and response location affect performance when location is changed from relevant to irrelevant, apparently through producing automatic activation of the previously associated response.

The relative expression amounts of apterous and its co-factor dLdb/Chip are critical for dorso-ventral compartmentalization in the Drosophila wing

Dorso-ventral axis formation in the Drosophila wing requires the localized accumulation of the Apterous LIM/homeodomain protein (Ap) in dorsal cells. Here we report that dLdb/Chip encodes a LIM-binding cofactor that controls Ap activity. Both lack and excess of dLdb/Chip function cause the same phenotype as apterous (ap) lack of function; i.e. dorsal to ventral transformations, generation of new wing margins, and wing outgrowths. These results indicate that the normal function of Ap in dorso-ventral compartmentalization requires the correct amount of the DLDB/CHIP co-factor, and suggest that the Ap and DLDB/CHIP proteins form a multimeric functional complex. In support of this model, we show that the dLdb/Chip excess-of-function phenotypes can be rescued by ap overexpression.

The prognostic factors of adult gram-negative bacillary meningitis

Seventy-seven patients with Gram-negative bacillary meningitis (GNBM), 57 males and 20 females, aged 17-86 years, were identified at Kaohsiung Chang Gung Memorial Hospital, over an 11-year period. Fifty-four infections were community-acquired, and 23 were nosocomial; 49 were spontaneous and 28 occurred after head surgery or neurosurgery. The organisms most frequently involved were Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter. Rarer pathogens included Citrobacter species, Serratia marcescens, Enterobacter cloacae, and Proteus mirabilis. All patients who did not receive appropriate antibiotic therapy died. The mortality in those treated with appropriate antibiotics was 28%. Other statistically significant prognostic factors included septic shock, initial level of consciousness, hyperosmolar hyperglycemic nonketotic coma, disseminated intravascular coagulation, high cerebrospinal fluid lactate levels and leucocytosis. In the multiple logistic regression analysis, only appropriate antimicrobial therapy and septic shock were strongly associated with mortality even after adjusting for other potentially confounding factors. Despite the high mortality, management can be improved by early diagnosis, early use of appropriate antibiotics, and correction of underlying and associated medical derangement.

Depressive disorders among the Chinese elderly in a suburban community

A community survey of depression among the Chinese > or = 65 years in age was performed in a suburban setting. One hundred and eighty-seven individuals comprised the survey group. Among them, 65 (34.8%) were scored > or = 11 on the Chinese version of the Geriatric Depression Scale. Compared with nondepressed individuals, those with depressive disorders were more likely to be older and with poor family support. Forward stepwise logistic regression analysis identified only age as significantly correlating with geriatric depression scores.

Correlations between scores on Chinese versions of long and short forms of the Geriatric Depression Scale among elderly Chinese

A total of 187 elderly Chinese from the community were interviewed with the Chinese versions of the Geriatric Depression Scale-the long form and the short form. The scores on a proposed new version of the short form were also calculated. Cronbach alpha for the Geriatric Depression Scale-long form was .86. The correlations were significant between scores on the long and short forms (r = .94, p < .05) and between these on the long and new short forms (r = .91, p < .05). Cronbach coefficient alpha for the short form was .77 and for the new short form .81. Results of our study indicated that responding by these elderly persons on both short forms is acceptably internally consistent in comparison with those on the original Geriatric Depression Scale.