Non-resonant and resonant x-ray scattering studies on multiferroic TbMn2O5

Comprehensive x-ray scattering studies, including resonant scattering at Mn L, Tb L, and M edges, were performed on single crystals of TbMn2O5 for crystallographic data to elucidate the nature of its commensurate and incommensurate phases. The scattering results provide direct evidence of symmetry lowering to the ferroelectric phase driven by magnetically induced lattice modulations and show the presence of multiple magnetic orders. The competing orders under spin-frustrated geometry are believed to cause discommensuration and result in the commensurate-to-incommensurate phase transition around 24 K. It is proposed that the low temperature incommensurate phase consists of commensurate domains separated by antiphase domain walls which change both signs of spontaneous polarizations and x-ray scattering amplitudes for forbidden reflections.

Resonant X-ray scattering study of quadrupole-strain coupling in DyB4

X-ray and neutron scattering studies were performed on DyB4 which exhibits both a quadrupolar ordering and a macroscopic lattice distortion. A forbidden reflection at 7.792 keV near the Dy L3 absorption edge is identified as a quadrupolar ordering peak, and the quadrupolar order and a monoclinic structural distortion develop concomitantly below 12.3 K as second-order-type phase transitions. Coupling between the quadrupolar order and the strain in DyB4 is directly demonstrated by observing that both order parameters are proportional to each other.

Endoscopic resection of large colonic lipomas assisted by a prototype single-use Endoloop device

Colonic lipomas are benign adipose tumors that occasionally cause symptoms. Endoscopic resection of large lipomas may be associated with the risk of hemorrhage or perforation. Experience with endoscopic resection of colonic lipomas with the assistance of a prototype single-use ligating Endoloop device, with a detachable snare unit, has not been previously reported. Three patients with a total of four large symptomatic colonic lipomas successfully underwent endoscopic resection with the aid of this device. One patient had self-limiting minor rectal bleeding which settled without consequence. All patients were well on follow-up, with resolution of their symptoms. This novel endoscopic technique should be considered during resection of large lipomas (> 10 mm diameter) to reduce the potential risk of bleeding.

Modern modified 'ultra' Goeckerman therapy: a PASI assessment of a very effective therapy for psoriasis resistant to both prebiologic and biologic therapies

BACKGROUND

Compared with the original Goeckerman therapy devised by Dr Goeckerman in the 1930s, modern modified Goeckerman therapy in the second millennium shows significantly enhanced efficacy by improvements in technology (e.g. narrowband UVB) and the possibility of adding other relatively safe therapeutic options for more resistant cases to enhance efficacy without compromising the basic safety profile.

METHODS

For approximately 6 months, psoriasis patients undergoing Goeckerman therapy at the UCSF Psoriasis Center were followed from admission to discharge. A total of 25 consecutive psoriasis patients were treated with the Goeckerman regimen until (near-) clearance or for a maximum period of 3 months, and their weekly improvements in terms of PASI (psoriasis area and severity index) were recorded.

RESULTS

In all, 100% reached PASI 75 by 12 weeks of treatment. In fact, by 8 weeks, 95% reached PASI 75 and most of the patients were discharged within 2 months.

CONCLUSIONS

The onset of treatment effect was rapid. Goeckerman therapy is still a valuable and important part of the psoriatic armamentarium.

Characterization of bone metastases in patients with renal cell cancer

OBJECTIVE

To characterize the clinical features of bone metastases in patients with renal cell carcinoma (RCC) treated with interleukin-2 therapy. Bone lesions contribute to significant morbidity and mortality, and although present in up to half of patients with RCC, their behaviour and response to therapy have not been well characterized.

PATIENTS AND METHODS

We evaluated skeletal metastases in 19 patients with bone lesions who received either moderate- or high-dose interleukin-2 therapy. Data on bone disease, including location and number of bone lesions, need for bone-specific therapies and use of pain medications, were noted. The response of bone lesions to interleukin-2 was compared with the response of other systemic metastatic sites.

RESULTS

Skeletal metastases resulted in significant morbidity by causing pain (75%) and other complications requiring surgical and/or radiotherapeutic intervention (94%) before beginning interleukin-2 therapy. In most patients the response of bone lesions to interleukin-2 was similar to that in their other systemic sites. Treatment with interleukin-2 had no significant effect on the requirement for pain medication for bone pain. However, it may have prevented skeletal complications requiring surgery or radiotherapy. None of the patients had hypercalcaemia; there was no significant association between bone metastases and elevated alkaline phosphatase levels.

CONCLUSIONS

Skeletal metastases are a significant contributor to morbidity among patients with RCC. Bone lesions respond similarly to interleukin-2 therapy as other systemic sites. Bisphosphonates appear promising for these predominantly osteolytic lesions.

Interference of magnetic and anisotropic tensor susceptibility reflections in resonant X-ray scattering of GdB4

Resonant x-ray scattering experiments at the Gd L3 edge show interference between magnetic and anisotropic tensor susceptibility (ATS) reflections in GdB4. Energy profiles obtained from the magnetic and ATS resonances exhibited approximately 10 eV separation between the maximum resonance energies. The findings show that the Gd 5d band experienced hybridization giving rise to a significant split into isotropic lower energy band and distorted upper band states that account for the magnetic and ATS scattering, respectively.

Delusions of parasitosis. A dermatologist's guide to diagnosis and treatment

Delusions of parasitosis is a rare psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites. Even though it is a psychiatric disorder, these patients usually present to a dermatologist because they are convinced that they have a dermatological problem. Patients with delusions of parasitosis generally reject psychiatric referral. The diagnosis of delusions of parasitosis can often be made on the basis of the history alone, but it is important to make sure that the patient does not have a organic skin disorder, and the delusion is not secondary to another mental or physical illness. The current treatment of choice is the antipsychotic medication pimozide. The principal difficulty in management is convincing patients to take the drug. This results from the obvious discrepancy between the patients' belief system and the clinician's understanding of the situation. The most common adverse effects of pimozide are extrapyramidal symptoms such as stiffness and, less frequently, a special inner sense of restlessness called akathisia. Effective treatment of such extrapyramidal reactions includes benztropine 1 to 2 mg up to 4 times daily as needed, or diphenhydramine 25 mg 3 times daily as needed. Pimozide can have cardiotoxic effects at high dosages. Traditionally, it has been recommended to check pretreatment and post-treatment electrocardiograms even for patients who have no history or cardiac conduction abnormalities or arrhythmia. However, a more recent publication questions the need for this if the patient takes < 10 mg/day, is not elderly, and has no history of cardiac arrhythmia. Effective dosages of pimozide for delusions of parasitosis have ranged from 1 to 10 mg/day. The lowest effective dosage of pimozide should be used for the shortest possible duration to minimize the risk of tardive dyskinesia developing in these patients. Significant improvements in quality of life have been achieved with successful treatment with pimozide. Atypical antipsychotics such as risperidone with a much safer adverse effect profile may prove to be effective for the treatment of delusions of parasitosis in the future.

Psycho dermatology: the mind and skin connection

A psychodermatologic disorder is a condition that involves an interaction between the mind and the skin. Psychodermatologic disorders fall into three categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychophysiologic disorders (e.g., psoriasis and eczema) are associated with skin problems that are not directly connected to the mind but that react to emotional states, such as stress. Primary psychiatric disorders involve psychiatric conditions that result in self-induced cutaneous manifestations, such as trichotillomania and delusions of parasitosis. Secondary psychiatric disorders are associated with disfiguring skin disorders. The disfigurement results in psychologic problems, such as decreased self-esteem, depression or social phobia. Most psychodermatologic disorders can be treated with anxiety-decreasing techniques or, in extreme cases, psychotropic medications.

Cancer screening in public health clinics: the importance of clinic utilization

OBJECTIVES

To determine how screening for breast and cervical cancer in public health clinics was associated with overall clinic utilization.

METHODS

Evidence of screening and clinic visits between June 1989 and May 1992 was obtained by medical record audit for a random sample of 1825 women aged 40 to 75 attending eight public health clinics in the San Francisco Bay Area.

RESULTS

With an average number of visits (4 per year), women who did not receive a physical examination were much less likely than those who did to obtain a clinical breast examination (OR = 0.03), mammography referral (OR = 0.1), or a mammogram (OR = 0.4) within 2 years, or a Papanicolaou smear (OR = 0.1) within 3 years. Without a physical examination, the odds of screening or referral increased with the first visit (OR = 1.2 for referral, breast examination, and Pap; 1.3 for mammography), but with a decreasing marginal effect of each additional visit (ratio of successive one-visit OR values = 0.992 for referral and breast examination; 0.995 for Pap; 0.98 for mammography). With a physical exam, visits were associated with mammography only (first visit OR = 1.2; OR ratio = 0.992).

CONCLUSIONS

In public health clinics, screening is associated either with receipt of routine care or repeated visits for treatment. Women who fall through the cracks are those who come to the clinic with a medical problem but otherwise receive few services. Interventions in public health clinics need to facilitate the provider's ability to use medically related visits as opportunities to increase adherence to screening recommendations.

Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis

Although adjunctive treatment with retinoids in concert with either psoralen-ultraviolet A (PUVA) or ultraviolet B (UVB) phototherapy has been a treatment option for chronic, moderate to severe plaque psoriasis for nearly two decades, acitretin-UV therapy is an underutilized therapeutic modality. According to a recent member survey by the National Psoriasis Foundation, many psoriasis patients are frustrated with available treatment options, which they perceive as ineffective, inconvenient, and/or excessively conservative. Treatment of psoriasis with acitretin in concert with UVB or PUVA is emerging as a viable clinical strategy. Compared with either acitretin or UV light monotherapy alone, the combination regimen enhances efficacy and limits treatment frequency, duration, and cumulative doses. These effects translate into care that is more effective, better tolerated, more convenient, less costly, and, perhaps, safer during long-term treatment than phototherapy alone. Drawing from an extensive literature search and the expertise of its participants, this consensus conference advances clinical recommendations as well as "clinical pearls" for health providers who treat patients with chronic, moderate to severe plaque psoriasis and suggests avenues for future research.

Phytoestrogen consumption and breast cancer risk in a multiethnic population: the Bay Area Breast Cancer Study

Research on the relation between phytoestrogens and breast cancer risk has been limited in scope. Most epidemiologic studies have involved Asian women and have examined the effects of traditional soy foods (e.g., tofu), soy protein, or urinary excretion of phytoestrogens. The present study extends this research by examining the effects of a spectrum of phytoestrogenic compounds on breast cancer risk in non-Asian US women. African-American, Latina, and White women aged 35-79 years, who were diagnosed with breast cancer between 1995 and 1998, were compared with women selected from the general population via random digit dialing. Interviews were conducted with 1,326 cases and 1,657 controls. Usual intake of specific phytoestrogenic compounds was assessed via a food frequency questionnaire and a newly developed nutrient database. Phytoestrogen intake was not associated with breast cancer risk (odds ratio = 1.0, 95% confidence interval: 0.80, 1.3 for the highest vs. lowest quartile). Results were similar for pre- and postmenopausal women, for women in each ethnic group, and for all seven phytoestrogenic compounds studied. Phytoestrogens appear to have little effect on breast cancer risk at the levels commonly consumed by non-Asian US women: an average intake equivalent to less than one serving of tofu per week.

Antacid increases survival of Vibrio vulnificus and Vibrio vulnificus phage in a gastrointestinal model

Viable counts of three strains of Vibrio vulnificus and its phage were determined during exposure to a mechanical gastrointestinal model with or without antacid for 9 h at 37 degrees C. V. vulnificus was eliminated (>4-log reduction) within 30 min in the gastric compartment (pH decline from 5.0 to 3.5). Viable V. vulnificus cells delivered from the gastric compartment during the first 30 min of exposure reached 10(6) to 10(8) CFU/ml in the intestinal compartment after 9 h (pH 7.0). Phages were eliminated within 45 min in the gastric compartment (pH decline from 5.1 to 2.5). Less than a 2-log reduction of phage was observed in the intestinal compartment after 9 h (pH 7.0). When the gastric compartment contained antacid V. vulnificus counts decreased slightly (<2 log) during 2 h of exposure (pH decline from 7.7 to 6.0), while counts in the intestinal compartment (pH 7.5) reached 10(7) to 10(9) CFU/ml. Phage numbers decreased 1 log after 2 h in the gastric compartment (pH decline from 7.7 to 5.7) containing antacid and decreased 1 log in the intestinal compartment (pH 7.6) after 9 h. Presence of antacid in the gastric compartment of the model greatly increased the ability of both V. vulnificus and its phage to survive simulated gastrointestinal transit and may be a factor involved with oyster-associated illness.

Clinical spectrum of reversible posterior leukoencephalopathy syndrome

Reversible posterior leukoencephalopathy syndrome is a recently recognized disorder with characteristic radiologic findings that mainly involve the white/gray matter of the parieto-occipital lobes. This complex syndrome is associated with cyclosporine A therapy or a variety of other conditions in which blood pressure rises acutely. Twelve patients from a variety of conditions who met the diagnostic criteria for this syndrome were studied. Interestingly, three of these patients had intra-abdominal neurogenic tumors, which have rarely been reported. Initial cranial magnetic resonance imaging scans revealed fairly symmetric areas of increased T(2) signal involving both white and gray matter of parieto-occipital lobes in the majority of the patients. However, the lesions were often located outside the parieto-occipital regions. Four patients had occipital region magnetic resonance spectroscopy during the acute phase, which revealed high lactate peak and normal N-acetyl aspartate/creatine and choline peaks. With appropriate treatment, most patients recovered from this syndrome and experienced almost complete resolution of brain lesions on follow-up magnetic resonance imaging. One patient, however, continued to have small residual hemosiderin deposits on a follow-up magnetic resonance imaging with neurologic sequellae. In conclusion, a better understanding of this complex syndrome may obviate unnecessary investigations and allow management of the associated problems in prompt and appropriate ways.

The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey

BACKGROUND

Psoriasis can have a profound impact on a patient's quality of life.

OBJECTIVES

To assess patients' perspectives on the impact of psoriasis on their lifestyle and emotional well-being and the social ramifications of living with the disease; to determine the range of therapies available; and to ascertain patients' satisfaction with the management of their disease.

DESIGN

A 4-page, self-administered questionnaire was mailed on July 13 and 14, 1998, to the entire membership of the National Psoriasis Foundation (N = 40 350), and followed by a telephone survey of responders with severe psoriasis.

MAIN OUTCOME MEASURES

Patients' perspectives on the psychosocial impact of psoriasis and the effectiveness of the management of their disease.

RESULTS

Of the 40 350 questionnaires mailed out, a response rate of 43% was realized. The most frequent symptoms experienced by the mail-survey respondents were scaling (94%), itching (79%), and skin redness (71%); 39% reported that psoriasis covered 10% or more of their bodies. A total of 6194 patients with severe psoriasis were entered into the database for the telephone survey. Of these, 79% reported that psoriasis had a negative impact on their lives, 40% felt frustrated with the ineffectiveness of their current therapies, and 32% reported that treatment was not aggressive enough.

CONCLUSIONS

The unprecedented response to the survey provides compelling evidence that individuals with psoriasis believe that the disease has a profound emotional and social as well as physical impact on their quality of life. Many patients with psoriasis, particularly those with severe disease, are frustrated with the management of their disease and by the perceived ineffectiveness of their therapies. Physicians may need to improve communication with their patients and should reevaluate their management of psoriasis.

Effects of nicotine on APP secretion and Abeta- or CT(105)-induced toxicity

Several lines of evidence indicated that overexpression or aberrant processing of amyloid precursor protein (APP) is causally related to Alzheimer's disease (AD). Amyloid precursor protein is principally cleaved within the amyloid beta protein domain to release a large soluble ectodomain (APPs), known to have a wide range of trophic functions. The central hypothesis guiding this review is that nicotine may play an important role in APP secretion and protection against toxicity induced by APP metabolic fragments (beta-amyloid [Abeta], carboxyl terminal [CT]). Findings from our experiments have shown that nicotine enhances the release of APPs, which has neurotrophic and neuroprotective activities in concentration-dependent (>50 micromol/L) and time-dependent (>2 hours) manners. In addition, pretreatment of nicotine (>10 micromol/L for 24 hours) partially prevented Abeta or CT(105)-induced cytotoxicity in primary cultured neuron cells, and the effects of nicotine-induced protection were inhibited by the pretreatment with a nicotine alpha-bungarotoxin. Nicotine (>10 micromol/L for 24 hours) partially inhibited CT(105)-induced cytotoxicity when PC12 cells was transfected with CT(105). From these results, we proposed that nicotine or nicotinic receptor agonist treatment might improve the cognitive functions not only by supplementation of cholinergic neurotransmission, but also by protecting Abeta- or CT(105)-induced neurotoxicity probably through the increased release of APPs and the activation of nicotinic receptors.

Regulation of mucin gene expression in human tracheobronchial epithelial cells by thyroid hormone

We reported previously that the expression of the gene encoding MUC5AC mucin in human airway epithelial cells is controlled by retinoic acid via the retinoic acid receptor (RAR)-alpha and that 3,3',5-tri-iodothyronine (T(3)) inhibits the expression of MUC5AC. The purpose of the present study was to identify mechanisms mediating the effect of T(3). T(3) has been shown to inhibit gene expression via several mechanisms, either by enhancing or repressing the transcription of target genes or by the regulation of post-transcriptional events. Results showed that T(3) strongly inhibited MUC5AC-driven luciferase activity in normal human tracheobronchial epithelial cells that had been transiently transfected with a MUC5AC-luciferase reporter construct; however, it did not affect MUC5AC mRNA stability. These results indicate that T(3) suppresses MUC5AC expression at the transcriptional level. An analysis of deletion constructs showed that deletion of the region downstream of 3 kb resulted in markedly decreased levels of MUC5AC transcription in the absence of T(3) (i.e. under control conditions) as well as a loss of responsiveness to the inhibitory effects of T(3). This suggests that this region might contain elements important for the activation as well as the repression of MUC5AC transcription. To determine whether T(3) modulates retinoic-acid-dependent MUC5AC transcription via an alteration in the abundance of retinoid receptor proteins, we examined the type and abundance of these receptors in nuclear extracts of airway epithelial cells grown in the presence or absence of T(3). Western blots showed that T(3) markedly decreased several types of retinoid receptor while not affecting T(3) receptor proteins. Consistent with this finding were gel-shift assays revealing a decrease in RAR-retinoic acid response element complexes obtained from T(3)-treated cells. We propose that T(3) might inhibit retinoid-dependent MUC5AC expression by decreasing retinoid receptor levels and thereby decreasing the transcriptional activation of this gene for mucins.

Effect of simulated gastric fluid and bile on survival of Vibrio vulnificus and Vibrio vulnificus phage

Bacteria and phages may be exposed to acid conditions in the stomach and to bile in the intestine. Survival of three strains of Vibrio vulnificus and three strains of its phages was examined at 37 degrees C after exposure to simulated gastric fluid at pH 3 to 4 or to 0, 1, and 2% bile in broth or buffer. Mean D-values (decimal reduction times) at pH 4 and 3 were 3.3 and 1.3 min for V. vulnificus and 97.8 and 0.7 min for its phages. No V. vulnificus survivors were found at pH 2.0. There were few survival differences among strains of V. vulnificus or its phages. Numbers of V. vulnificus increased 1 log in tryptic soy broth containing 1 or 2% bile after 3 h. Numbers of V. vulnificus and its phages remained constant in phosphate-buffered saline regardless of bile concentrations up to 3 h. Those V. vulnificus bacteria and phages that survive stomach acidity may proliferate in the small intestine, since they are resistant to bile.