Development of the stable isotope tracer approach for studies of copper turnover in the rat and mouse

The stable isotope tracer approach was explored for long-term investigations of copper turnover in the adult rat and mouse, with inductively coupled plasma mass spectrometry for isotope measurements. The isotopic measurement method permitted precision and accuracy of <1.0%, with an overall sample blank of <0.05 microg copper. Rats were fed a copper-deficient diet and deionized water with (+Cu) or without (-Cu) copper (20 microg/ml). Both groups underwent a single-day replacement of drinking water with 20 microg/ml of (65)Cu. Compared with the baseline isotope ratio ((65)Cu/(63)Cu) of 0.462 +/- 0.002, blood plasma ratios for the +Cu group on days 2, 7, and 14 postdosing were 0.702 +/- 0.021, 0.557 +/- 0.004, and 0.474 +/- 0.001, respectively. The corresponding data for liver were 1.652 +/- 0.018, 0.560 +/- 0.005, and 0.482 +/- 0.001, respectively. For the -Cu group, respective plasma ratios were 1.580 +/- 0.04. 0.917 +/- 0.02, and 0.664 +/- 0.01 for days 2, 7, and 14 postdosing, and the ratios for liver were 0.987 +/- 0.02, 0.876 +/- 0.04, and 0.739 +/- 0.03. Mice previously made copper deficient to varying degrees were given a single-day replacement with the label. When the 24-hour postdosing isotope ratios in the livers of these mice were correlated with the activity of plasma ceruloplasmin, a negative correlation (r = -0.85) was observed. Isotope enrichment in both rats and mice was greater in the copper-deficient animals compared with the controls.

Dopamine receptor D4 (DRD4) gene in Han Chinese children with attention-deficit/hyperactivity disorder (ADHD): increased prevalence of the 2-repeat allele

There is an increased prevalence of the 7-repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention-deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate-responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2-repeat (2R) allele in this clinical sample (33%) compared to ethnically-matched controls (20%) (chi(2)(1d.f.) = 5.90, P = 0.015). This approximately 1.65-fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European-ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European-ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non-4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated.

Cardiovascular fitness and exercise as determinants of insulin resistance in postpubertal adolescent females

In obese adolescents, body mass index (BMI) is a poor predictor of insulin resistance, and the potential role of diminished physical activity has not been quantitated. We measured possible determinants of sensitivity to insulin in 53 adolescent females with a BMI between the 10th and the 95th percentile. We hypothesized that across weight and fitness spectra, relative fat mass, rather than BMI, and cardiovascular fitness would be predictors of insulin resistance. We measured body composition by total-body dual x-ray absorptiometry. Self-reported weekly frequency of aerobic exercise for 1 h (RDE) was recorded, and maximal oxygen consumption (VO(2)max) was measured. Insulin sensitivity was estimated by homeostasis model assessment index (HOMA(IR)) derived from fasting glucose and insulin concentrations. BMI was not related to HOMA(IR) (P = 0.20), RDE showed a marginal relationship (P = 0.049), whereas percent body fat and VO(2)max were significantly related to HOMA(IR) (P = 0.01 and 0.0008, respectively). In a multiple regression model, VO(2)max was a more critical determinant of insulin resistance than percent body fat (P = 0.03 vs. P = 0.67) or RDE (P = 0.01 vs. 0.51). For prevention strategies in youth, physical inactivity may represent a greater metabolic risk than obesity alone.

Usefulness of 99mTc ethyl cysteinate dimer brain SPECT to detect abnormal regional cerebral blood flow in patients with acute carbon monoxide poisoning

99mTc ethyl cysteinate dimer (99mTc-ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in patients with acute carbon monoxide (CO) poisoning. Ten patients with acute CO poisoning and no past histories of psychoneurological disorders were enrolled in this study. After oxygen treatment, all of the 10 patients were investigated using 99mTc-ECD brain SPECT and brain computed tomography (CT) scan. Brain CT scan findings were normal in all of the 10 patients. 99mTc-ECD brain SPECT showed the hypoperfusion lesions of the basal ganglia and brain cortex in five and seven patients, respectively. Only three of the 10 patients had normal 99mTc-ECD brain SPECT findings. This study suggests that, in comparison with brain CT scan, 99mTc-ECD brain SPECT is a better tool for the early detection of hypoperfusion brain lesions in acute CO poisoning in patients with normal brain CT findings.

A comparison of maternal age, sex ratio and associated anomalies among numerically aneuploid, structurally aneuploid and euploid holoprosencephaly

During the period January 1987-July 2003, 59 cases of perinatally detected holoprosencephaly (HPE) with cytogenetic results were identified among 97,306 deliveries at Mackay Memorial Hospital. Among these 59 cases with HPE, 25 had euploidy, 27 had numerical aneuploidy, and 7 had structural aneuploidy. In the euploid cases, the male:female sex ratio was 0.39:1, whereas in the aneuploid cases, the ratio was 1:1. The mean (+/-SD) maternal ages for numerical aneuploidy, structural aneuploidy, and euploidy were 33.0 +/- 5.1 years, 27.9 +/- 2.1 years, and 27.8 +/- 5.0 years, respectively. The frequencies of associated major structural anomalies other than craniofacial defects in the cases with numerical aneuploidy, structural aneuploidy, and euploidy were 85.7%, 0%, and 16%, respectively. The present study of HPE suggests that a female excess appears only in the euploid cases, and advanced maternal age and structural anomalies are more commonly associated with the numerically aneuploid cases than the structurally aneuploid and euploid cases.

Two novel mutations of the glycine receptor gene in a Taiwanese hyperekplexia family

The authors report a Taiwanese family with autosomal recessive hyperekplexia. Two novel mutations, W96C (from the paternal allele) and R344X (from the maternal allele), which are located in exon 4 and exon 7 of the GLRA1 gene, were identified in this family. A series of electrophysiologic investigations were conducted in one of the probands, and the results suggest that the "startle center" is located subcortically.

Severe acute respiratory syndrome and pulmonary tuberculosis

In Singapore, of 236 patients with probable severe acute respiratory syndrome (SARS), 2 were coinfected with tuberculosis, a phenomenon not previously reported. The patients' tuberculosis episodes only came to light after full recovery from SARS, when they presented with persistent respiratory symptoms and/or worsening chest radiography findings.

Overexpression of sprouty 2 inhibits HGF/SF-mediated cell growth, invasion, migration, and cytokinesis

A strict regulation of hepatocyte growth factor/scatter factor (HGF/SF)-Met signaling is essential for its appropriate function. Several negative regulators of Met signaling have been identified. Here we report that human Spry2 is induced by HGF/SF and negatively regulates HGF/SF-Met signaling. We show that overexpression of Spry2 inhibits cell proliferation, anchorage-independent cell growth, and migration in wound-healing and in vitro invasion assays. Measured in an electric cell-substrate impedance sensing biosensor, cell movement is restricted, because Spry2 dramatically facilitates cell attachment and spreading by enhancing focal adhesions and increasing stress fibers. An analysis of cell cycle distribution shows, unexpectedly, that Spry2-GFP cells are polyploid. Thus, as with FGF and EGF receptors, Spry2-GFP tempers downstream Met signaling in addition to its pronounced effect on cell adhesion, and it has properties suitable to be considered a tumor-suppressor protein.

Serum PCDD/F concentration distribution in residents living in the vicinity of an incinerator and its association with predicted ambient dioxin exposure

The aim of this study was to evaluate the serum polychlorinated dibenzo-p-dioxin (PCDD) and dibenzofuran (PCDF) concentration distribution in residents living in the vicinity of an incinerator and its association with annual ambient dioxin exposure predicted by an atmospheric dispersion model. A municipal waste incinerator in Northern Taiwan was chosen for this study. This incinerator had been in operation for 6 years at the time of this study. Using the incinerator site as the center, based on the simulated ambient annual average PCDD/F concentrations. Ninety-five volunteers, all live within a radius of 5 km from the incinerator for at least 5 years, who had no occupational exposure potential, were selected based on the population distribution in each district. The average serum PCDD/F concentration for these subjects living within four zones was about 14 pg I-TEQ/g lipid. The serum distribution levels of people of the four study zones, however, were not consistent with the predicted ambient levels. Results also suggest that ambient exposure might not be the most important contributor to serum concentrations when compared to other exposure sources, such as dietary intake.

Simultaneously evaluating the effects of one-week fluticasone propionate inhalation therapy on lung ventilation and permeability in children with asthma

This study evaluated the effects of fluticasone propionate inhalation therapy on lung ventilation and alveolar permeability by quantitative Tc-99m DTPA radioaerosol inhalation lung scintigraphy in 15 children with asthma. Lung ventilation was evaluated as the distribution percentage (D%) of Tc-99m DTPA radioaerosols in the central, intermediate and peripheral regions of the right lung. Alveolar permeability was measured by the rate of Tc-99m DTPA radioaerosol clearance curve from the peripheral alveoli of the right lung and represented as slope. The D% and slopes were calculated before and after one-week inhalation therapy (100 microg fluticasone propionate two times daily for one-week) to evaluate the effects of inhalation therapy on lung ventilation and alveolar permeability. The preliminary results revealed statistically significantly improved lung ventilation but no significant change of alveolar permeability in the right lung after one-week fluticasone propionate inhalation therapy in children with asthma. We suggest that the widely available and noninvasive Tc-99m DTPA radioaerosol inhalation lung scintigraphy can simultaneously evaluate lung ventilation and alveolar permeability in one study and should contribute to any disorder involving both alveoli and airways.

Removal of odorous sulphur-containing gases by a new isolate from activated sludge

Biological treatment of odorous sulphur-containing compounds is attracting attention due to its benign eco-friendliness, energy-savings and low operating costs. As the biological treatment efficiency of dimethylsulphide (DMS) reported was often low and variable, selection of useful DMS-degrading microorganisms is of importance for the enhancement of the biological deodorizing process. This paper reports the successful isolation of a DMS-degrading bacterium from activated sludge, using the enrichment isolation technique. The isolate was identified by 16S rRNA gene sequencing, and found to belong to the alpha group of Proteobacteria, with an identity of 99.4% and 99.1% to the 16S rRNA gene sequences of Afipia felis and Pseudomonas carboxydohydrogena, respectively. The isolate was able to metabolize DMS as well as hydrogen sulphide (H2S). A batch experiment was performed to assess the removal characteristics of DMS by the isolate. The results showed that over half of DMS could be removed by the isolate in 3 hours when the initial DMS amount was approximately 10 micromol and 25 micromol. Removal of H2S by the isolate was evaluated by a continuous test in a 2-L gas-bubbling bottle. Although part of the H2S removal by the mineral medium itself was observed in the control test, the majority of H2S removal was believed to be attributed to the metabolic activity of the isolate. In conclusion, the isolate might be potentially useful for the enhancement of the biological deodorizing processes.

Tonotopic and heterotopic projection systems in physiologically defined auditory cortex

Combined physiological and connectional studies show significant non-topographic extrinsic projections to frequency-specific domains in the cat auditory cortex. These frequency-mismatched loci in the thalamus, ipsilateral cortex, and commissural system complement the predicted topographic and tonotopic projections. Two tonotopic areas, the primary auditory cortex (AI) and the anterior auditory field (AAF), were electrophysiologically characterized by their frequency organization. Next, either cholera toxin beta subunit or cholera toxin beta subunit gold conjugate was injected into frequency-matched locations in each area to reveal the projection pattern from the thalamus and cortex. Most retrograde labeling was found at tonotopically appropriate locations within a 1 mm-wide strip in the thalamus and a 2-3 mm-wide expanse of cortex (approximately 85%). However, approximately 13-30% of the neurons originated from frequency-mismatched locations far from their predicted positions in thalamic nuclei and cortical areas, respectively. We propose that these heterotopic projections satisfy at least three criteria that may be necessary to support the magnitude and character of plastic changes in physiological studies. First, they are found in the thalamus, ipsilateral and commissural cortex; since this reorganization could arise from any of these routes and may involve each, such projections ought to occur in them. Second, they originate from nuclei and areas with or without tonotopy; it is likely that plasticity is not exclusively shaped by spectral influences and not limited to cochleotopic regions. Finally, the projections are appropriate in magnitude and sign to plausibly support such rearrangements; given the rapidity of some aspects of plastic changes, they should be mediated by substantial existing connections. Alternative roles for these heterotopic projections are also considered.

Discrepancy between the fetus and extra-embryonic tissues in prenatally detected mosaic distal 5p deletion

Discrepancy between the fetus and extra-embryonic tissues in prenatally detected mosaic distal 5p deletion: We present clinical and cytogenetic data on a second-trimester fetus with mosaic del(5)(p15.1) and the extra-embryonic tissues with a normal karyotype. A 34-year-old woman, gravida 2, para 0, underwent genetic amniocentesis at 20 weeks' gestation because of advanced maternal age. Cytogenetic analysis of the cultured amniocytes revealed mosaicism for a distal 5p deletion, mos 46,XY,del(5)(p15.1)[4]/46,XY[26]. The pregnancy was terminated subsequently. Postnatally, the fetus displayed a triangular face, hypertelorism, epicanthal folds, low-set ears, and micrognathia. A karyotype of mos 46,XY,del(5)(pl 5.1)/46,XY was found in the liver, lungs, skin, and cord blood, whereas, the placenta, amnion, and umbilical cord had a karyotype of 46,XY. Our observation of fetoplacental, fetoamniotic, and fetoumbilical discrepancies shows a limitation of using placenta, amnion, and umbilical cord as confirmatory tools for prenatally detected mosaic distal 5p deletion. Our case also reinforces the notion that amniocentesis offers a more reliable diagnosis, compared to chorionic villus sampling.

De novo satellited 21q associated with corpus callosum dysgenesis, colpocephaly, a concealed penis, congenital heart defects, and developmental delay

De novo satellited 21q associated with corpus callosum dysgenesis, colpocephaly, a concealed penis, congenital heart defects, and developmental delay: We present clinical and cytogenetic data on an infant with de novo satellited 21 q. A 3-month-old boy was found to have microcephaly, developmental delay, hypertelorism, down-slanting palpebral fissures, large low-set ears, a prominent nose, a broad philtrum, a concealed penis, interventricular septal defects, corpus callosum dysgenesis, colpocephaly, ventriculomegaly, and a de novo karyotype of 46,XY,21qs. Standard Ag-NOR staining and FISH studies confirmed a satellite and a deletion on the long arm of a chromosome 21. Quantitative-fluorescent polymerase chain reaction using the polymorphic small tandem repeat markers specific for chromosome 21 determined a maternal origin of the deletion and the breakpoint between D21S156 (21q22.1) (present) and D21S53 (21q22.3) (absent), centromeric to the known minimal holoprosencephaly critical region, D21S13-21qter. The present case provides evidence of the correlation of a distal region of chromosome 21 to the phenotypic effects of monosomy 21.

Coupled reduction of chlorinated hydrocarbons and heavy metals by zerovalent silicon

The feasibility of using zerovalent silicon (Si0) as a novel reductant to remove chlorinated compounds and heavy metals in contaminated sites was investigated. The kinetics and degradation mechanism of carbon tetrachloride (CT) by Si0 were also examined. Results showed that zerovalent silicon could effectively dechlorinate the chlorinated compounds. A nearly complete dechlorination of CT by Si0 was obtained within 14 h. The produced concentrations of chloroform (CF) accounted for 71-88% loss of CT, showing that reductive dechlorination is the major degradation pathway for the degradation of chlorinated hydrocarbons by Si0. The degradation followed pseudo first-order kinetics and the normalized surface reaction rate constant (k(sa)) for CT dechlorination ranged between 0.0342 and 0.0454 L m(-2) h(-1) when CT concentrations were in the range of 3-20 microM. A linear relationship between the k(sa) and pH value was also established. In addition, zerovalent silicon has a high capability in the removal of heavy metals. 83% of Cr(VI) was removed by 0.5g Si0 within 5 h, which is higher than that by Fe0. The removal efficiency of divalent metal ions by Si0 followed the order of Cu(II) > Pb(II) > Ni(II). This indicates that zerovalent silicon is an alternative reductant and can undergo coupled reduction of heavy metals and chlorinated hydrocarbons in contaminated groundwater.

Deregulation and mislocalization of the cytokinesis regulator ECT2 activate the Rho signaling pathways leading to malignant transformation

The human ECT2 protooncogene encodes a guanine nucleotide exchange factor for the Rho GTPases and regulates cytokinesis. Although the oncogenic form of ECT2 contains an N-terminal truncation, it is not clear how the structural abnormality of ECT2 causes malignant transformation. Here we show that both the removal of the negative regulatory domain and alteration of subcellular localization are required to induce the oncogenic activity of ECT2. The transforming activity of oncogenic ECT2 was strongly inhibited by dominant negative Rho GTPases, suggesting the involvement of Rho GTPases in ECT2 transformation. Although deletion of the N-terminal cell cycle regulator-related domain (N) of ECT2 did not activate its transforming activity, removal of the small central domain (S), which contains two nuclear localization signals (NLSs), significantly induced the activity. The ECT2 N domain interacted with the catalytic domain and significantly inhibited the focus formation by oncogenic ECT2. Interestingly, the introduction of the NLS mutations in the S domain of N-terminally truncated ECT2 dramatically induced the transforming activity of this otherwise non-oncogenic derivative. Among the known Rho GTPases expressed in NIH 3T3 cells, RhoA was predominantly activated by oncogenic ECT2 in vivo. Therefore, the mislocalization of structurally altered ECT2 might cause the untimely activation of cytoplasmic Rho GTPases leading to the malignant transformation.

The effects of one-week fluticasone propionate inhalation therapy for Tc-99m DTPA radioaerosol distribution in asthma of children: a preliminary report

This study evaluated the effects of fluticasone propionate inhalation therapy for the distribution pattern of Tc-99m DTPA radioaerosols in 10 children with asthma. The homogeneous degree of depositing Tc-99m DTPA radioaerosol was evaluated using a modified standard score system over the bilateral lungs. The baseline scores were calculated from Tc-99m DTPA radioaerosol inhalation lung scintigraphy before inhalation therapy (100 microg fluticasone propionate two times daily for one week), and the scores were recalculated after inhalation therapy to evaluate the effects of one-week of fluticasone propionate inhalation therapy for Tc-99m DTPA radioaerosol distribution patterns. After one week of fluticasone propionate inhalation therapy, the scores were decreased in all of the 10 children, which may mean that the bronchial constriction degree due to asthma is decreased. In addition, there was a significantly statistical difference in the scores before and after one-week fluticasone propionate inhalation therapy (p < 0.05). In conclusion, one-week fluticasone propionate inhalation therapy could significantly improve the bronchial constriction due to asthma in children based on the evidence of Tc-99m DTPA radioaerosol inhalation lung scintigraphic findings.

Use of a Fluidized Bed Hammer Mill for Size Reduction and Classification: Effects of Process Variables and Starting Materials on the Particle Size Distribution of Milled Lactose Batches

The process capability of a fluidized bed hammer mill was investigated with respect to four process variables, namely, rotational speeds of beater system and classifier wheel, airflow rates and length of grinding zones, as well as the particle size and flow property of the starting materials. The size distributions of all the milled lactose batches could be fitted to the Rosin Rammler distribution (RRD) function. The characteristic particle size (De) and uniform coefficient (n), which were derived from the RRD function, complemented the size at the 99th percentile of the cumulative undersize distribution (D99) to characterize the lactose batches. Lower De and D99 values indicate a finer powder while a higher n value indicates a narrower size distribution. The beater speed played a critical role. Increasing the beater speed from 12000 to 21000 rpm generally resulted in an increase in n and a decrease in D99 values due to the greater amount of milling energy supplied. The particle size and flow property of the starting material also played an important role at beater speed of 12000 rpm, where the lowest amount of milling energy was supplied. When a higher amount of milling energy was provided, the effect of particle size of the starting material was less significant. The other process variables exerted varying effects. Increasing the classifier wheel speed from 5000 to 15000 rpm decreased the De and D99 and increased the n values of the milled lactose batches, provided sufficient milling energy was supplied to the lactose particles. Changing airflow rates from 80 to 90 m3/h generally resulted in larger De and D99 values and lower n values as the higher airflow rate provided greater airflow-induced kinetic energy that facilitated the passage of lactose through the classifier wheel. However, changing the long grinding zone to a short one did not significantly affect the De, D99 and n values of the milled lactose batches produced. Small lactose particles of narrow size distribution could be obtained using the fluidized bed hammer mill upon gaining a better understanding of the milling process.

Comparing thallium-201 spect mammoscintigraphy and ultrasonography to detect breast cancer in mammographical dense breasts

The aim of our study was to compare the usefulness of thallium-201 (Tl-201) single photon emission computed tomography (SPECT) mammoscintigraphy and ultrasonography to detect breast cancer in mammographical dense breasts. This study included 32 Taiwanese female patients with indeterminate mammographic probability of malignancy due to mammographical dense breasts. Both Tl-201 SPECT mammoscintigraphy and ultrasonography were performed for each patient. Then, all of the 32 breast masses undervent biopsies or operations to obtain finally pathological diagnoses. Based on the finally pathological diagnoses, 24 masses were breast cancer and 8 masses were benign breast tumors among the 32 patients. Twenty-two cancers and one benign tumor had positive Tl-201 SPECT mammoscintigraphic findings. The sensitivity, specificity, and accuracy were 92%, 88%, and 91%. Twenty-two cancers and 5 benign tumors had positive ultrasonographic findings. The sensitivity, specificity, and accuracy were 92%, 38%, and 78%, respectively. To detect breast cancer in patients with non-diagnostic mammogram because of mammographically dense breasts, Tl-201 SPECT mammoscintigraphy and ultrasonography have the same sensitivity to screen breast masses. However, due to its higher specificity, Tl-201 SPECT mammoscintigraphy should be useful to confirm the ultrasonographic findings.

Usefulness of technetium-99m methoxyisobutylisonitrile liver single photon emission computed tomography to detect hepatocellular carcinoma

Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) has been shown to be useful in identifying several types of tumors, such as breast, lung and thyroid cancers. The usefulness of Tc-99m MIBI liver imaging in detecting hepatocellular carcinoma (HCC) is still controversial. In this study, 22 patients with HCC performed Tc-99m MIBI liver single photon emission computed tomography (SPECT). Twenty of 22 patients (90.9%) showed negative liver SPECT findings without significant Tc-99m MIBI uptake in HCC, and only 2 patients (9.1%) showed positive liver SPECT findings with significant Tc-99m MIBI uptake in HCC. In addition, no significant correlation between liver SPECT findings with sex, age, alpha feto-protein serum level, HCC differentiation, and virus hepatitis status was found. We concluded that Tc-99m MIBI liver SPECT is not a sensitive tool to detect HCC.

Detecting abnormal regional cerebral blood flow in patients with primary Sjögren's syndrome by technetium-99m ethyl cysteinate dimer single photon emission computed tomography of the brain--a preliminary report

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in 32 female patients with primary Sjögren's syndrome (PSS) showing definite neuropsychiatric symptoms/signs and normal brain magnetic resonance imaging (MRI) findings. It demonstrated hypoperfusion brain lesions in 18 (56.3%) of the patients, most frequently in the parietal lobes, and appears to be a sensitive tool for this clinical application.

Usefulness of quantitative Tc-99m HMPAO and Ga-67 citrate lung scans in detecting pulmonary vascular endothelium damage and lung inflammation in patients with systemic lupus erythematosus: a preliminary report

Pulmonary vascular endothelium damage in 34 patients with systemic lupus erythematosus (SLE) was measured by technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan. The degree of damage was represented as lung/liver uptake (L/L) ratio. The patients were divided into two subgroups according to the following criteria: (a) clinical features, separated as stable or flare stage and (b) chest X-ray findings separated as positive or negative results. Meanwhile, quantitative gallium-67 citrate (Ga-67) lung scan was performed as Ga-67 uptake index (GUI) to evaluate the severity of inflammation in the SLE lungs. The results show (a) no significant statistical differences in the degree of pulmonary vascular endothelium damage (the L/L ratio on Tc-99m HMPAO lung scan) between the two subgroups according to clinical features or chest X-ray findings and (b) no good correlation between the degree of pulmonary vascular endothelium damage and lung inflammation (GUI on Ga-67 lung scan). In conclusion, the change in pulmonary vascular endothelium damage in SLE may be unrelated to the clinical presentation or chest X-ray findings, and its degree is not related to the severity of pulmonary inflammation.

Treatment of toxic epidermal necrolysis in AIDS with intravenous immunoglobulins

Individuals with AIDS are at higher risk of developing severe cutaneous adverse drug reactions. We report two AIDS patients with drug-induced toxic epidermal necrolysis (TEN). The suspected drugs were discontinued. Both patients were treated with intravenous human immunoglobulins at a dose of 1 g/kg body weight per day for two consecutive days and both experienced a good outcome. Intravenous immunoglobulin potentially lowers the morbidity and mortality of TEN and shortens the duration of the patient's hospitalization.

Usefulness of mammoscintigraphy with thallium-201 single photon emission computed tomography to differentiate palpable breast masses of young Taiwanese women when comparing with mammography

Sixty young Taiwanese women with palpable breast masses detected by mammography and/or physical examinations underwent mammoscintigraphy with thallium-201 (Tl-201) single photon emission computed tomography (SPECT) to assess its value for differentiating breast masses. The results showed that 42 of the 45 cases of breast carcinoma were detected by Tl-201 SPECT mammoscintigraphy. Fourteen of the 15 of benign breast lesions were differentiated by Tl-201 SPECT mammoscintigraphy. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tl-201 SPECT mammoscintigraphy were 93%, 93%, 98%, 82%, and 93%, respectively. Thirty-eight of the 45 cases of breast carcinoma were detected by mammography. Twelve of the 15 of benign breast lesions were differentiated by mammography. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mammography were 84%, 80%, 93%, 63%, and 83%, respectively. We concluded that Tl-201 SPECT mammoscintigraphy significantly improves the accuracy when comparing with mammography for the differentiating breast cancer in Taiwanese women.

Impaired gallbladder function in spinal cord injury on quantitative Tc-99m DISIDA cholescintigraphy

BACKGROUND

Patients with spinal cord injury (SCI) have increased prevalences of gallstones and acute acalculous cholecystitis. A possible explanation for the increased prevalence of gallstone disease in SCI patients is decreased gallbladder motility causing gallbladder stasis, a known risk factor for gallstone disease. We investigated gallbladder function in SCI.

METHODS

Twenty-five normal control subjects and 50 SCI patients were included in this study. Gallbladder function was measured by technium 99m-labeled imino-diacetic acid analogue (Tc-99m DISIDA) cholescintigraphy and represented by the filling fraction (FF) and the ejection fraction (EF). The SCI patients were assigned to subgroups: old versus young, female versus male, high- versus low-level injury, and long versus short injury duration.

RESULTS

Forty-two percent of SCI patients had abnormal FFs and 54% of SCI patients had abnormal EFs. Significantly decreased FF and EF values were found in SCI patients, especially in those who were female and had high-level injuries.

CONCLUSION

With the use of quantitative Tc-99m DISIDA cholescintigraphy, we found that SCI can significantly impair gallbladder function.

First human ventral mesencephalon and striatum cografting in a Parkinson patient

Fetal ventral mesencephalon (VM) transplantation has been reported to improve parkinsonian symptoms. Animal studies show that cografting of striatal tissue increases the survival of dopamine neurons. Whether or not VM and striatum cografting could ameliorate motor dysfunction in a Parkinson's disease (PD) patient was explored in this study. The patient was a 53-year-old male who had presented with symptoms of tremor, rigidity and bradykinesia for 11 years. He had been treated with L-dopa and had progressive deterioration of symptoms even with the daily dosage of L-dopa increased to 900 mg per day. Before transplantation, his PD symptoms were scored with Unified Parkinson's Disease Rating Scale (UPDRS) and video recordings. The influx constant (ki) of the [18F] 6-fluoro-L-dopa uptake in the striatum was measured by positron emission tomography (PET) imaging. The fetal VM and the lateral part of the lateral ganglionic eminence (LGE) were cografted into the right putamen and, one week later, fetal VM alone was transplanted into the left putamen. After the transplantation, the patient's UPDRS score improved from 128 to 62 at 6 months and to 24 at 22 months during the "off" phase. The score of daily living disability improved from 35 to 18 at 6 months and to 10 at 22 months post transplantation. Twenty-two months after grafting, "off" phases were almost absent, and the freezing had totally disappeared. The [18F] 6-fluoro-L-dopa PET studies were performed 1 month before and 21 months after transplantation. The ki for [18F] 6-fluoro-L-dopa was decreased by 15% in the right caudate and 5% in the left caudate, both of which did not have any ventral mesencephalic grafts. However, the ki was increased by 35%, in the left non-cografted putamen, and by 58% in the right cografted putamen. In conclusion, cografting the fetal VM and the LGE in the putamen may improve the motor function of PD patients.

Left ventricular cavity-to-myocardium count ratio in exercise and resting technetium-99m-tetrofosmin SPECT: correlation with left ventricular function

The aim of this study was to assess the value of the cavity-to-myocardium count ratio (C/M ratio) calculated in exercise and resting technetium-99m (Tc-99m) tetrofosmin single photon emission computed tomography (SPECT) images to identify patients with depressed exercise and resting left ventricular ejection fraction (LVEF). We studied 60 patients with recent coronary artery diseases (CAD) undergoing first-pass ventriculography to calculate LVEF and myocardial perfusion SPECT imaging to calculate left ventricular C/M ratios. The group A of 30 CAD patients with higher LVEF (> or = 40%) had significant higher C/M ratios than the group B of 30 CAD patients with abnormal LVEF (< 40%) during exercise and rest. However, C/M ratios between exercise and rest did not differ significantly in the both groups A and B. There is significant correlation between exercise/rest LVEF and exercise/rest C/M ratios. Tc-99m tetrofosmin C/M ratios calculated SPECT perfusion images are useful parameters in identifying patients with depressed LVEF in CAD patients.

Hydrops foetalis caused by anti-Mur in first pregnancy--a case report

Anti-'Mia' is the most common alloantibody of potential clinical significance in the Taiwanese population. The Mi.III phenotype is rare among Caucasians but has a high incidence in various Oriental populations. We describe a nulliparous woman with no history of transfusions, who had hydrops foetalis at 28 weeks gestation. Foetal haemoglobin was 4.4 g dL-1, and a positive direct antiglobulin test was positive in the foetal blood. Intrauterine intravascular transfusion was given, and the baby was discharged healthy. Anti-'Mia' was identified in the maternal serum, the cord blood serum and the eluate from red cells of the cord blood. Anti-'Mia' in the maternal serum was confirmed to be anti-Mur. The polymerase chain reaction-restriction fragment length polymorphism method confirmed that both the baby and her father had the Mi.III gene. Therefore, our report documents that anti-Mur has the potential to cause hydrops foetalis.

Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients with renal cell carcinomas - a preliminary report

PURPOSE

Conventional technetium-99m methylene diphosphate whole body bone scan (bone scan) has a high sensitivity but a poor specificity to detect bone metastases. However, positron emission tomography with 18F-2-deoxyglucose (FDG-PET) can offer superior spatial resolution and improved specificity. We have attempted to evaluate the usefulness of FDG-PET for detecting bone metastases in renal cell carcinomas (RCC) and to compare FDG-PET results with bone scan findings.

METHODS

Eighteen patients were selected for this study with biopsy-proven RCC. They were suspected of having bone metastases and were undergoing bone scan and FDG-PET to detect bone metastases. The final diagnoses of bone metastases were established by operative, histopathological findings or clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/bone scan findings showing progressive and extensive widespread bone lesions.

RESULTS

A total of 52 bone lesions including 40 metastatic and 12 benign bone lesions found on either FDG-PET or bone scan were evaluated. FDG-PET could accurately diagnose all 40 metastatic and 12 benign bone lesions. Bone scan could accurately diagnose only 31 metastatic bone lesions. Diagnostic sensitivity and accuracy of FDG-PET were 100% and 100%, respectively,and bone scan were 77.5% and 59.6%, respectively.

CONCLUSIONS

Our data suggest that FDG-PET has a higher sensitivity and a better accuracy than that of bone scan to detect bone metastases in patients with RCC.

Ultrafine grinding using a fluidized bed opposed jet mill: effects of feed load and rotational speed of classifier wheel on particle shape

Circularity, aspect ratio, modelx, and pellips were employed to study the effects of process parameters, namely varying feed loads and rotational speeds of the classifier wheel, of the fluidized bed opposed jet mill on the shape of the micronized particles produced. The Shapiro-Wilk statistical test showed that 80.0% of the shape distributions of the four descriptors were not normal. Therefore, the Kruskal-Wallis test, which is a nonparametric statistical test, was employed to analyze the data. Micronized particles were more spherical and less elongated, as indicated respectively by higher median circularity and lower median modelx values when compared to unmilled lactose. These descriptors were able to indicate that the particles had been micronized. When feed loads of 250 and 350 g were used, increasing the rotational speed of the classifier wheel was found to bring about a decrease in span values of all the shape descriptors, indicating that the micronized particles were more uniform in shape. Micronized particles produced had lower median aspect ratio values than the unmilled lactose, whereas a higher feed load of 450 g resulted in the production of micronized particles that were less uniform in shape and more elliptical in nature, as reflected by the lower median pellips values. A higher feed load of 450 g caused a high level of impingement of particles on to the rotating classifier wheel, causing decreased classifier wheel efficiency, and this resulted in a less well-controlled micronization process. Thus, aspect ratio and pellips were sensitive to the changes in performance of the classifier wheel. The four shape descriptors were proposed to be used collectively as indicators for the monitoring of the micronization process.

Objective evidence of abnormal regional cerebral blood flow in patients with systemic lupus erythematosus on Tc-99m ECD brain SPECT

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in 78 SLE patients with neuropsychiatric manifestations. These patients were separated into two subgroups: group 1 including 48 cases with definite neuropsychiatric symptoms/signs and group 2 with 30 cases having no neuropsychiatric symptoms/signs. Tc-99m ECD brain SPECT demonstrated hypoperfusion brain lesions in 90% and 20% of patients in groups 1 and 2, respectively. In both groups, parietal lobe and cerebellum are the most and least common areas with hypoperfusion lesions, respectively. This study suggests that Tc-99m ECD brain SPECT may provide objective information for detection of hypoperfusion brain lesions in SLE patients.

Comparing whole body (18)F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphonate bone scan to detect bone metastases in patients with breast cancer

PURPOSE

At present, bone metastases are usually assessed using conventional technetium-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with (18)F-2-deoxyglucose (FDG-PET) can offer superior spatial resolution and improved specificity. We attempted to evaluate the usefulness of FDG-PET for detecting bone metastases in breast cancer and to compare FDG-PET results with bone scan findings.

PATIENTS

The study group comprised 48 patients with biopsy-proven breast cancer and suspected of having bone metastases who underwent bone scan and FDG-PET to detect the bone metastases. The final diagnosis of bone metastases was established by operative, histopathological findings or during a clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/bone scan findings showing progressive widespread bone lesions.

RESULTS

A total of 127 bone lesions including 105 metastatic and 22 benign bone lesions found by either FDG-PET or bone scan were evaluated. Using FDG-PET, 100 metastatic and 20 benign bone lesions were accurately diagnosed, and using bone scan 98 metastatic and 2 benign bone lesions were accurately diagnosed. The diagnostic sensitivity and accuracy of FDG-PET were 95.2% and 94.5%, and of bone scan were 93.3% and 78.7%, respectively.

CONCLUSIONS

Our findings suggest that FDG-PET shows a similar sensitivity and a better accuracy than bone scan for detecting bone metastases in patients with breast cancer.

Detection of recurrent nasopharyngeal carcinomas with positron emission tomography using 18-fluoro-2-deoxyglucose in patients with indeterminate magnetic resonance imaging findings after radiotherapy

PURPOSE

The aim of this study was to evaluate the effectiveness of positron emission tomography (PET) using 18-fluoro-2-deoxyglucose (FDG) to detect recurrent nasopharyngeal carcinomas (NPC) when magnetic resonance imaging (MRI) findings are indeterminate.

PATIENTS AND METHODS

After radiotherapy, 28 NPC patients with indeterminate MRI findings were included. MRI, FDG-PET, and biopsy were performed at least 4 months after radiotherapy and within 1 week. The final results were based on histopathologic findings and a clinical follow-up of at least 6 months.

RESULTS

For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity and accuracy of FDG-PET were 100.0%, 92.9% and 96.4%, respectively.

CONCLUSIONS

Based on these results, we can recommend FDG-PET for detecting recurrent NPC when MRI findings are indeterminate.

Met protein expression level correlates with survival in patients with late-stage nasopharyngeal carcinoma

Met tyrosine kinase, the receptor for HGF/SF, is important in various cellular functions, including proliferation, mitogenesis, formation of branching tubules, angiogenesis, and tumor cell invasion and metastasis. However, the role of Met/HGF signaling pathway in nasopharyngeal carcinoma (NPC) has not been evaluated. In this study, we determined the expression profile and clinical correlation of Met/HGF in 66 cases of advanced NPC and the activation mechanisms of Met receptor in five NPC cell lines. Immunofluorescent staining and quantitative image analysis showed that the Met protein was expressed throughout the tumors and normal nasopharyngeal epithelia. Compared with NPC, the Met expression level was higher in columnar nasopharyngeal epithelium but lower in squamous nasopharyngeal epithelium. The normal interstitial stromal tissue expressed the lowest level of Met protein. HGF was detected mainly in the normal interstitial tissue surrounding the tumor. Met protein expression level was inversely correlated with patients' survival time; the correlation coefficient was -0.319 (P = 0.009). The mean survival time was 118 months in low Met expression group versus 52 months in high expression group (P = 0.0004). The cumulative 5-year survival rate was 77.68% in low expression group versus 38.24% in high expression group. The clinical stage was also significantly more advanced in high Met expression group. In the multivariate analysis, both clinical stage and Met protein expression level were independent prognostic indicators for patient survival. All of the five NPC cell lines tested did not express hgf mRNA but expressed met mRNA, and tyrosine phosphorylation of Met protein was mainly induced by exogenous HGF stimulation in these cells. No mutation was found in the tyrosine kinase and the juxtamembrane domains of Met receptor in the five NPC cell lines tested. These results indicate that: (a) high Met protein expression level correlates with poorer survival in late-stage NPC and serves as an independent prognostic indicator; and (b) the Met receptor in NPC is activated by its paracrine ligand HGF from the interstitial tissues rather than by an autocrine loop or its activating mutation.

Cerebral melioidosis in Singapore: a review of five cases

A variety of neurological manifestations of infection with Burkholderia pseudomallei have been described including cerebral abscesses, which are a well-recognized form of neurological melioidosis. The optimal antibiotic therapy for this condition has not been defined; however, combinations of intravenous antibiotics are frequently used in the early stages. Five cases of melioidosis involving brain abscesses are described which presented in Singapore over the past 3 years (1997-2000), 4 of which cases had evidence of disseminated infection. Despite profound neurological deficits and low Glasgow Coma Scale scores at presentation in 3 of these cases, all survived after surgical drainage and prolonged courses of intravenous ceftazidime or imipenem, and only 2 of whom had residual neurological impairment. One incidental finding on computed tomography (CT) or magnetic resonance imaging (MRI) scans not described before as an association with cerebral melioidosis was sinusitis in 4 out of the 5 cases.

Effect of rice--glycerol complex medium on the production of Lovastatin by Monascus ruber

Response surface methodology (RSM) was employed to study the effect of the composition of the rice-glycerol complex medium on the production of lovastatin (Lvs) by the ascomycete Monascus ruber in mixed solid-liquid (or submerged) cultures at 25 degrees C. Four components (rice powder, peptone, glycerol, glucose) were studied to evaluate the approximate polynomial for all dependent variables, explaining their effects on the production of Lvs. The best composition derived from RSM regression was (in g/L) rice powder 34.4, peptone 10.8,, glucose 129, KNO3 8.0, MgSO4.7H2O 4.0 and glycerol 36.4 mL/L. With this composition, the Lvs production was 157 mg/L after 10 d of cultivation. In comparison with glycerol and glucose, the rice powder becomes a more suitable carbon source and represents a great potential for the production of Lvs.

Mutation screening of the FSH receptor gene in infertile men

Follicle stimulating hormone (FSH) is important for controlling spermatogenesis through binding with its receptor. However, little information is available on mutations of the FSH and its receptor gene in infertile men. To study the genetic defects, which caused problems in spermatogenesis, we screened the point mutations of the FSH receptor gene in infertile men with high serum FSH concentrations. Seventy male infertile patients with high FHS levels (> 12 mIU/ml) were screened for mutations in each of the 10 exons of the FSH receptor gene, using genomic DNA PCR and a single-strand conformation polymorphism (SSCP) analysis. From this study, three shifted bands were detected by SSCP. The first shifted band was found in the PCR product of exon 4, including the exon-intron boundary sequence in only one patient. The sequence analysis revealed a nucleotide A to T substitution in intron 3 (IVS3-4A-->T). The second shifted band was detected in exon 10 with high frequency (33%). A nucleotide A to G substitution was found at the position of the 994th nucleotide, predicting a Thr to Ala substitution at the position of the 307th amino acid (Thr307Ala). The third shifted band in the 3' region of exon 10 was detected frequently in infertile patient and normal groups. It was tightly linked to the Thr307Ala variant. Thus, all of the abnormalities represent neutral polymorphisms, and not pathological mutations of the FSH receptor gene. In conclusion, we did not confirm that the genomic mutation of the FSH receptor is a major genetic cause in Korean infertile patients with high FSH levels.

Cloning and characterization of two cellulase genes from Lentinula edodes

Lentinula edodes has traditionally been grown on fallen logs. It produces a wide array of enzymes to digest the lignocellulolytic substrate for nutrients. Thus, this organism represents a rich source of potentially potent lignocellulolytic enzymes that can be harnessed for conversion of biomass to simple sugars. These sugars can then be used as feedstock for ethanol production or other chemical syntheses. We have cloned two cellulase genes from L. edodes grown on a wood substrate without the use of genomic or cDNA libraries by using a PCR-based strategy employing degenerate primers directed at the cellulose-binding domain. cel7A encoded a 516-amino acid protein that belonged to glycosyl hydrolase family 7 and had sequence similarities to cbhI genes from other fungi. cel6B encoded a 444-amino acid protein that belonged to glycosyl hydrolase family 6 and had sequence similarities to cbhII genes from other fungi. We demonstrated that cel7A and cel6B transcript levels were positively correlated to L. edodes growth in the presence of crystalline cellulose.

Beam coupling in nanotube-doped liquid-crystal films

Diffraction gratings written in films of nematic liquid crystals doped with multiwall carbon nanotubes were investigated by measurements of exponential beam-coupling coefficients. These phase gratings were induced by the interference modulation of two coherent optical beams, in conjunction with an externally applied dc field. Systematic and consistent results of the gain properties indicate that the bserved coherent-beam amplification depends strongly on the pump-to-probe intensity ratio.

Increased expression of alpha 1A Ca2+ channel currents arising from expanded trinucleotide repeats in spinocerebellar ataxia type 6

The expansion of polyglutamine tracts encoded by CAG trinucleotide repeats is a common mutational mechanism in inherited neurodegenerative diseases. Spinocerebellar ataxia type 6 (SCA6), an autosomal dominant, progressive disease, arises from trinucleotide repeat expansions present in the coding region of CACNA1A (chromosome 19p13). This gene encodes alpha(1A), the principal subunit of P/Q-type Ca(2+) channels, which are abundant in the CNS, particularly in cerebellar Purkinje and granule neurons. We assayed ion channel function by introduction of human alpha(1A) cDNAs in human embryonic kidney 293 cells that stably coexpressed beta(1) and alpha(2)delta subunits. Immunocytochemical analysis showed a rise in intracellular and surface expression of alpha(1A) protein when CAG repeat lengths reached or exceeded the pathogenic range for SCA6. This gain at the protein level was not a consequence of changes in RNA stability, as indicated by Northern blot analysis. The electrophysiological behavior of alpha(1A) subunits containing expanded (EXP) numbers of CAG repeats (23, 27, and 72) was compared against that of wild-type subunits (WT) (4 and 11 repeats) using standard whole-cell patch-clamp recording conditions. The EXP alpha(1A) subunits yielded functional ion channels that supported inward Ca(2+) channel currents, with a sharp increase in P/Q Ca(2+) channel current density relative to WT. Our results showed that Ca(2+) channels from SCA6 patients display near-normal biophysical properties but increased current density attributable to elevated protein expression at the cell surface.

Mutation analysis of a family with hereditary hemorrhagic telangiectasia associated with hepatic arteriovenous malformation

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by multisystemic vascular dysplasia. Two related genes, endoglin and activin receptor-like kinase (ALK-1), have been mapped to chromosomes 9q34 and 12q13, respectively. We describe a Taiwanese HHT family with hepatic arteriovenous malformation. Clinical and molecular evaluations were performed in eight members of this family, and HHT symptoms were found in three adults. Short tandem repeat markers were used to perform linkage analysis, and this family was classified as HHT type 2 (ALK-1 gene). The exons of ALK-1 were amplified using the polymerase chain reaction and subjected to direct DNA sequencing. The mutation causing the disease was located at ALK-1 codon 411, causing an arginine to glutamine substitution. Five members of this family carried the mutated ALK-1 gene. This investigation successfully used linkage and sequencing techniques to perform molecular diagnosis of HHT.

Epidemiological, clinical and laboratory characteristics of 19 serologically confirmed rickettsial disease in Singapore

AIM

To identify epidemiological, clinical and laboratory features of serologically-proven typhus in the local setting.

METHOD & RESULTS

Retrospective study looking at rickettsial serologies done over a six-month period and collection of the epidemological, clinical, laboratory and treatment response data from the case notes of the patients with an ordered rickettsial serology. Twenty of the 35 cases had a positive serology. Of these 20 patients, 18 were already clinically diagnosed as having murine typhus. All except one were males and all were migrant workers. Majority of the patients were construction workers staying in containers where rats abound. The most consistent clinical features were high fever (100%) for a median period of seven days, headache (94%) and cough (47%). The white cell count was usually normal (74%) but thrombocytopenia was common (68%). Transaminitis was also common (90%) with the AST component higher than the ALT in half of the cases. Response to doxycycline therapy was rapid and most (88%) were afebrile by 72 hours.

CONCLUSION

Typhus (notably murine type) can be confidently diagnosed from consistent clinical features supported by epidemiological and laboratory clues. Early recognition with the prompt treatment response will result in shorter hospital stay with decreased cost. Serological testing may only prove useful in difficult situations when the clinical diagnosis is less clear.

Correlation between P-glycoprotein (P-gp) expression in parathyroid and Tc-99m MIBI parathyroid image findings

The major factor to influence localization of parathyroid adenomas is tumor size. P-glycoprotein (P-gp) expression in parathyroid adenomas has been considered to be an another possible factor to influence localization of parathyroid adenomas because false-negative studies have been reported with large tumors and true-positives reported with very small tumors in previous studies. The aim of this study was to characterize Tc-99m MIBI uptake and retention by parathyroid adenomas and to correlate this with cell surface expression of P-gp. Sixteen patients with parathyroid adenoma (larger than 1.5 gm) underwent dual-phase (10min and 2hr) Tc-99m MIBI parathyroid image immediately before parathyroid exploration. Tissues were obtained from normal and abnormal parathyroid glands and from the thyroid gland. Immunohistochemistry (IHC) was obtained with monoclonal antibodies to identify P-gp expression in all tissues. All of the 16 parathyroid adenomas and 32 normal control specimens (16 normal parathyroid and 16 normal thyroid specimens) were submitted for P-gp detection by IHC. The dual-phase Tc-99m MIBI parathyroid image accurately localized 14 parathyroid adenomas, but not the remaining 2 adenomas. The 14 parathyroid adenomas with significant Tc-99m MIBI uptake in delayed 2hr images revealed negative P-gp expression, but the 2 adenomas without significant Tc-99m MIBI uptake, as well as normal parathyroid and normal thyroid specimens, revealed positive P-gp expression when evaluated by IHC. Not only the size of parathyroid adenomas, but also significant P-gp expression limited the sensitivity of dual-phase Tc-99m MIBI parathyroid image to localize parathyroid adenomas before operation.

Oral manifestations of human immunodeficiency virus (HIV)-infected patients in Singapore

INTRODUCTION

Oral lesions have been recognised as prominent features of acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection since the beginning of the epidemic.

OBJECTIVE

This descriptive study was conducted to study the types of oral lesions among HIV-infected patients in Singapore.

MATERIALS AND METHODS

Oral examination was done on 81 randomly selected HIV-infected patients attending the specialist outpatient clinic at the Communicable Disease Centre.

RESULTS

A total of 9 different lesions were observed in 45 (56%) patients. The lesions observed were oral candidosis (35%), periodontal disease (16%), aphthous-like ulcers (5%), oral hairy leukoplakia (5%) and lymphoma (1%).

CONCLUSION

The oral manifestations of HIV-infected patients in Singapore appear to be less frequent in comparison with those patients from Africa and Europe. Similarities in oral findings among the HIV-infected patients in Asia are evident with a notable lack of oral Kaposi's sarcoma (KS) and a low prevalence of non-Hodgkin's lymphoma and oral hairy leukoplakia.

Technetium-99m methoxyisobutylisonitrile chest imaging for small-cell lung cancer. Relationship to chemotherapy response (six courses of combination of cisplatin and etoposide) and p-glycoprotein or multidrug resistance related protein expression

AIMS

This is a retrospective and adaptive randomization study. The purpose of this study was to evaluate the relationship between technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) chest-imaging results, chemotherapy response and P-glycoprotein (Pgp) or multidrug resistance related protein (MRP) expression in small-cell lung cancer (SCLC).

PATIENTS AND METHODS

Before chemotherapy, 30 patients (11 females, 19 males, ages: 52-69 years) with SCLC, including 14 extensive diseases without localized problems and 16 limited diseases in excess of solitary pulmonary nodule, underwent early chest imaging, including visual interpretation and quantitative analyses of tumor uptake ratio (TUR), 10 minutes after intravenous injection of Tc-99m MIBI. Immunohistochemical analyses were performed, using multiple nonconsecutive sections of the biopsy specimens, to detect Pgp and MRP expressions. Chemotherapy response was evaluated in the third month after completion of treatment by clinical and radiological methods.

RESULTS

All 15 (100%) of the SCLC patients with complete or partial response had positive Tc-99m MIBI chest SPECT results, but negative ones for both Pgp and MRP expression. Twelve of the 15 (80%) SCLC patients with no response or progressive disease had negative Tc-99m MIBI chest SPECT results and were positive for either Pgp or MRP expression (P < 0.05). Negative Tc-99m MIBI chest SPECT results predicted complete or partial response. The TUR of patients with complete or partial response (1.91 +/- 0.29 with a 95% confidence interval (95% CI): 1.75-2.07) was significantly higher than that of patients with no response or progressive disease (1.19 +/- 0.28 with a 95% CI: 1.04-1.35).

CONCLUSION

Tc-99m MIBI chest images are a potential tool for understanding Pgp and MRP expressions in SCLC and for predicting patient chemotherapy response.

Time course of cerebral infarction in the middle cerebral arterial territory: deep watershed versus territorial subtypes on diffusion-weighted MR images

PURPOSE

To examine possible differences between the evolution of cerebral watershed infarction (WI) and that of territorial thromboembolic infarction (TI) by using diffusion-weighted (DW) and T2-weighted magnetic resonance (MR) images and apparent diffusion coefficient (ADC) maps.

MATERIALS AND METHODS

Fourteen patients with TI and nine with WI underwent MR imaging from the acute to chronic infarction stages. ADC maps were derived from DW images. Lesion-to-normal tissue signal intensity ratios on ADC maps (rADC), echo-planar T2-weighted images, and DW images were calculated. Lesion volumes at acute or early subacute infarction stages were measured on DW images, and final lesion volumes were estimated on fluid-attenuated inversion-recovery images.

RESULTS

Analysis of variance revealed a significant difference in temporal evolution patterns of rADC between WI and TI (P <.001). rADC pseudonormalization following TI began about 10 days after symptom onset, but that following WI did not occur until about 1 month after symptom onset. The Pearson correlation coefficient between final and initial infarct volumes was 0.9899 for both infarction subtypes, indicating that the initial ischemic injury volume measured at the acute or early subacute stage predicted the final lesion volume fairly well.

CONCLUSION

The evolution time of ADC is faster for TI than for WI. This difference, which likely originates from the different pathophysiologic and hemodynamic features of the two infarction types, might account for the relatively large range of ADC values reported for the time course of ischemic strokes.

The C terminus of the Ca channel alpha1B subunit mediates selective inhibition by G-protein-coupled receptors

Inhibition of calcium channels by G-protein-coupled receptors depends on the nature of the Galpha subunit, although the Gbetagamma complex is thought to be responsible for channel inhibition. Ca currents in hypothalamic neurons and N-type calcium channels expressed in HEK-293 cells showed robust inhibition by G(i)/G(o)-coupled galanin receptors (GalR1), but not by Gq-coupled galanin receptors (GalR2). However, deletions in the C terminus of alpha(1B-1) produced Ca channels that were inhibited after activation of both GalR1 and GalR2. Inhibition of protein kinase C (PKC) also revealed Ca current modulation by GalR2. Imaging studies using green fluorescent protein fusions of the C terminus of alpha(1B) demonstrated that activation of the GalR2 receptor caused translocation of the C terminus of alpha(1B-1) to the membrane and co-localization with Galphaq and PKC. Similar translocation was not seen with a C-terminal truncated splice variant, alpha(1B-2). Immunoprecipitation experiments demonstrated that Galphaq interacts directly with the C terminus of the alpha(1B) subunit. These results are consistent with a model in which local activation of PKC by channel-associated Galphaq blocks modulation of the channel by Gbetagamma released by Gq-coupled receptors.