Cancer screening practices among primary care physicians serving Chinese Americans in San Francisco

Previous research has reported a lack of regular cancer screening among Chinese Americans. The overall objectives of this study were to use a mail survey of primary care physicians who served Chinese Americans in San Francisco to investigate: a) the attitudes, beliefs, and practices regarding breast, cervical, and colon cancer screening and b) factors influencing the use of these cancer screening tests. The sampling frame for our mail survey consisted of: a) primary care physicians affiliated with the Chinese Community Health Plan and b) primary care physicians with a Chinese surname listed in the Yellow Pages of the 1995 San Francisco Telephone Directory. A 5-minute, self-administered questionnaire was developed and mailed to 80 physicians, and 51 primary care physicians completed the survey. A majority reported performing regular clinical breast examinations (84%) and teaching their patients to do self-breast examinations (84%). However, the rate of performing Pap smears was only 61% and the rate of ordering annual mammograms for patients aged 50 and older was 63%. The rates of ordering annual fecal occult blood testing and sigmoidoscopy at regular intervals of three to five years among patients aged 50 and older were 69% and 20%, respectively. Barriers (patient-specific, provider-specific, and practice logistics) to using cancer screening tests were identified. The data presented in this study provide a basis for developing interventions to increase performance of regular cancer screening among primary care physicians serving Chinese Americans. Cancer screening rates may be improved by targeting the barriers to screening identified among these physicians. Strategies to help physicians overcome these barriers are discussed.

Estimation of left ventricular end-diastolic pressure with the difference in pulmonary venous and mitral A durations is limited when mitral E and A waves are overlapped

Previous studies showed that difference in pulmonary venous and mitral A-wave durations can be used for the estimation of left ventricular end-diastolic pressure, which is based on the assumption that the pulmonary venous A wave and mitral A wave start with the beginning of left atrial contraction. It is also assumed that the mitral A wave ends with the end of left atrial contraction. These assumptions may not be correct if left atrial contraction occurs before the early left ventricular filling is completed. Adequate Doppler mitral inflow and pulmonary venous flow signals were obtained simultaneously with left ventricular pressures at the cardiac catheterization laboratory in 50 patients who showed separated E and A waves in mitral inflow. After heart rate was increased by right atrial pacing to make the mitral E and A waves overlap, Doppler and hemodynamic measurements were repeated. When E and A waves are separated, pulmonary A-wave duration exceeding mitral A-wave duration has a sensitivity of 67% and specificity of 85% in the prediction of elevated left ventricular end-diastolic pressure (>/=20 mm Hg), whereas the pulmonary A wave ending later than mitral A wave has a sensitivity of 83% and a specificity of 45%. When the mitral E and A waves are overlapped, the pulmonary A wave ending later than mitral A wave is better for the prediction of elevated left ventricular end-diastolic pressure (sensitivity 55%, specificity 75%) than pulmonary A-wave duration exceeding mitral A-wave duration (sensitivity 9%, specificity 96%). However, overall, both methods are limited for clinical use.

Laboratory assay reproducibility of serum estrogens in umbilical cord blood samples

We evaluated the reproducibility of laboratory assays for umbilical cord blood estrogen levels and its implications on sample size estimation. Specifically, we examined correlation between duplicate measurements of the same blood samples and estimated the relative contribution of variability due to study subject and assay batch to the overall variation in measured hormone levels. Cord blood was collected from a total of 25 female babies (15 Caucasian and 10 Chinese-American) from full-term deliveries at two study sites between March and December 1997. Two serum aliquots per blood sample were assayed, either at the same time or 4 months apart, for estrone, total estradiol, weakly bound estradiol, and sex hormone-binding globulin (SHBG). Correlation coefficients (Pearson's r) between duplicate measurements were calculated. We also estimated the components of variance for each hormone or protein associated with variation among subjects and variation between assay batches. Pearson's correlation coefficients were >0.90 for all of the compounds except for total estradiol when all of the subjects were included. The intraclass correlation coefficient, defined as a proportion of the total variance due to between-subject variation, for estrone, total estradiol, weakly bound estradiol, and SHBG were 92, 80, 85, and 97%, respectively. The magnitude of measurement error found in this study would increase the sample size required for detecting a difference between two populations for total estradiol and SHBG by 25 and 3%, respectively.

Expression of green fluorescent protein in oligodendrocytes in a time- and level-controllable fashion with a tetracycline-regulated system

Developments in transgenic technology have greatly enhanced our ability to understand the functions of various genes in animal models and relevant human diseases. The tetracycline (tet)-regulated transactivation system for inducing gene expression allowed us to control the expression of exogenous genes in a temporal and quantitative way. The ability to manipulate a cell-specific promoter enabled us to express one particular protein in a single type of cell. The combination of a tetracycline system and a tissue-specific promoter has led us to the development of an innovative gene expression system, which is able to express genes in a cell type-specific and time- and level-controllable fashion. An oligodendrocyte-specific myelin basic protein (MBP) gene promoter controls the reversed tet-inducible transactivator. The green fluorescent protein (GFP) gene was placed under the control of the human cytomegalovirus (CMV) basic promoter in tandem with seven tet-responsive elements (TRE), binding sites for the activated transactivator. Upon the addition of doxycycline (DOX, a tetracycline derivative), tet transactivators became activated and bound to one or more TRE, leading to the activation of the CMV promoter and the expression of GFP in oligodendrocytes. We have successfully expressed GFP and luciferase at high levels in oligodendrocytes in a time- and dose-dependent fashion. In the absence of DOX, there was almost no GFP expression in oligodendroglial cultures. Graded levels of GFP expression were observed after induction with DOX (0.5 to 12.5 microg/ml). Our data indicate that this inducible gene expression system is useful for the study of gene function in vivo and for the development of transgenic animal models relevant to human diseases such as multiple sclerosis.

Social factors affecting interest in participating in a prostate cancer chemoprevention trial

PURPOSE

A sample survey was conducted to assess the feasibility of recruiting participants, specifically African Americans, and to determine social factors influencing participation in a prostate cancer chemoprevention trial.

METHODS

A convenience sample of adults visiting a hospital was identified and asked to participate in the survey. The survey included brief background information about prostate cancer and questions concerning four independent (age, marital status, race, insurance status) and three dependent (willingness to join a trial, involvement in long-term drug intake, interest in receiving more information) variables.

RESULTS

The study analyzed 165 responses. Of the 165 respondents, 67% were African American. Marital status was a significant predictor of general willingness to participate (p = 0.047) for male respondents. No significant predictor was found for female respondents. Furthermore, for men, ethnicity/race showed a significant difference (30% white men vs 70% of minority men) for willingness to take the pills.

CONCLUSION

The results suggest that African Americans are receptive to participating in chemopreventive trials. Thus, future studies exploring chemoprevention trials as an effective tool for reaching African Americans are warranted.

Restoration of atrial mechanical function after maze operation in patients with structural heart disease

BACKGROUND

The maze operation is effective for the restoration of sinus rhythm; however, restoration of atrial mechanical function has not been demonstrated in all patients.

METHODS

Maze operations were performed in 32 patients (13 men, 19 women; mean age 47.1 +/- 9.0 years) combined with valvular surgery (n = 25), coronary artery bypass graft (CABG) (n = 3), and others (n = 4). At 1 week, 3 months, 6 months, and 1 year after the operation, prospective serial Doppler echocardiographic examination was carried out to determine the presence of atrial mechanical function.

RESULTS

Sinus rhythm was restored and maintained during the follow-up period in 26 (81%) patients; in 22 patients this was due solely to the operation, whereas in four patients an antiarrhythmic agent was needed to maintain sinus rhythm. Another four patients showed paroxysmal atrial fibrillation (AF) despite treatment with an antiarrhythmic agent. Right atrial mechanical function was restored in all 30 patients with sinus rhythm or paroxysmal AF; in 19 (63%) of these, left atrial mechanical function was restored. In patients with restored left atrial mechanical function, peak A velocity (A) and A/E ratio (A/E) of mitral inflow were significantly lower than in the 16 postoperative control patients (A: 0.46 +/- 0.14 m/sec vs 0. 75 +/- 0.29 m/sec, p < 0.01; A/E: 0.40 vs 0.80, p < 0.01). In patients with left atrial mechanical function, the duration of AF was significantly shorter than in patients without left atrial mechanical function (1.9 +/- 2.9 years vs 7.1 +/- 3.0 years, p < 0. 01), but there were no significant differences in left atrial size and volume.

CONCLUSIONS

The maze operation could be safely added to standard open heart surgery for the correction of underlying structural heart disease. The rate of conversion to sinus rhythm resulting solely from the operation might be lower than the rates previously reported with only the duration of AF adversely affecting the restoration of left atrial mechanical function. Considering the fact that not all patients converted to sinus rhythm show atrial mechanical function, the role of the maze operation in the prevention of systemic embolism, with subsequent improvement in survival, requires further study.

Case-control study of diet and prostate cancer in China

INTRODUCTION

A higher incidence of prostate cancer is observed in the Western world than in Asian countries. Although it is relatively rare in China, an increased incidence has been reported in recent years. Studies in high-risk populations have suggested that dietary fat may play a role in enhancing the risk of developing prostate cancer. However, limited epidemiologic study has never examined the role of diet in low risk populations.

METHODS

A case-control study was conducted in 12 cities in China to evaluate the relationship between dietary factors and prostate cancer risk. We conducted personal interviews with 133 histopathologically confirmed prostate cancer cases diagnosed between 1989 to 1992 and 265 neighborhood controls of similar age.

RESULTS

Cases were more likely than controls to consume food with high fat and from animal sources (p < 0.01). The daily fat intake and the percentage of energy from fat were statistically significantly higher among cases than among controls (p < 0.01). The adjusted odds ratio for total fat between lowest quartiles and highest quartiles was OR = 3.6 (95 percent C.I. 1.8-7.2); for saturated fat, OR = 2.9 (95 percent C.I. 1.5-5.7); and for unsaturated fat, OR = 3.3 (95 percent C.I. 1.7-6.3).

DISCUSSION

The data suggest that dietary fat, both saturated and unsaturated, are associated with an increased risk for prostate cancer in a low risk population.

Percutaneous transluminal coronary angioplasty in a child with Kawasaki disease

A successful attempt at percutaneous transluminanl coronary angioplasty (PTCA) to relieve stenosis of the mid-portion of the left anterior descending artery was achieved in a 6-year 9-month old boy who had multiple coronary aneurysms and stenosis due to Kawasaki disease. Despite the progression of coronary stenosis he had been well except for the perfusion defect of the anterior wall of myocardium on 99mTc-MIBI SPECT with dipyridamole infusion until PTCA was carried out after 4-year 4-months of the onset of illness. The area of stenosis was 70% before PTCA and 20% after PTCA. No restenosis at the site of PTCA was observed on follow-up angiography at 26 months after PTCA. This successful attempt may indicate that this procedure should be considered early in subclinical stenosis to prevent ischemic cardiac damage.

Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension

The objective of this study is to evaluate the changes of diurnal blood pressure pattern after 8 weeks of red ginseng medication (4.5 g/day) by 24 hour ambulatory blood pressure monitoring. In 26 subjects with essential hypertension, 24 hour mean systolic blood pressure decreased significantly (p = 0.03) while diastolic blood pressure only showed a tendency of decline (p = 0.17). The decrease in pressures were observed at daytime (8 A.M.-6 P.M.) and dawn (5 A.M.-7 A.M.). In 8 subjects with white coat hypertension, no significant blood pressure change was observed. We suggest that red ginseng might be useful as a relatively safe medication adjuvant to current antihypertensive medications.

Magnolol protects cortical neuronal cells from chemical hypoxia in rats

The protective effect of magnolol, a component of Magnolia officinalis, against hypoxia-induced cell injury in cortical neuron-astrocyte mixed cultures was examined. Exposure of the cells to chemical hypoxia (0.5 mM KCN) produced morphological changes in neurons but not in astrocytes. KCN induced dose- and time-dependent increases in release of LDH and decreases in viable cell number. Treatment with magnolol (10 and 100 microM) significantly reduced the KCN-induced LDH release in a concentration-dependent manner. A higher concentration (750 microM) magnolol was toxic. Nuclear condensation was not observed in KCN-treated cells, suggesting that chemical hypoxia-induced cell death was via necrosis, rather than via apoptosis. This is the first report demonstrating that magnolol protects neurons against chemical hypoxic damage or necrotic cell death in cortical neuron-astrocyte mixed cultures.

Birthplace and yield of nipple aspirate fluid in Chinese women

The different rates of breast cancer found between Chinese women in Asia compared with Chinese-born women in the United States suggest that dietary and environmental factors may be of etiological significance. We evaluated the proportion of 480 premenopausal Chinese women who yielded nipple aspirate fluid (NAF) by birthplace in Asia versus the United States and by reproductive and other risk factors. Birthplace was used as a surrogate for presumed differences in exposures during gestation, childhood, and adolescence that might influence yield of NAF in premenopausal women. In United States-born Chinese women compared with Asia-born Chinese women, the proportion yielding NAF was 44 of 95 (46.3%) versus 120 of 385 (31.2%), respectively. The relative risk of yield of NAF in United States-born women compared with Asia-born women was odds ratio = 2.37 (95% confidence interval, 1.26-4.47). Independent positive associations of NAF yield were also found with history of parity and breast feeding, cerumen phenotype, and a negative association with ever use of oral contraceptives. These findings support the hypothesis that early environmental exposures may have long-lasting physiological effects discernible in the breast glands of adult women.

New one-week, low-dose triple therapy for the treatment of duodenal ulcer with Helicobacter pylori infection

BACKGROUND

Antimicrobial therapy is the recommended treatment for duodenal ulcer associated with Helicobacter pylori infection. The eradication of bismuth-based triple therapy with bismuth subcitrate, metronidazole and amoxicillin is limited by low compliance, drug resistance and side-effects. Two-week proton pump inhibitor (PPI)-based triple therapy has a higher eradication rate but is costly. This study was designed to compare the efficacy, patient compliance and cost of short-term PPI-based triple therapy with those of bismuth-based triple therapy.

METHODS

Ninety patients with active duodenal ulcer disease and H pylori infection, proven with the 13C-urea breath test and CLO test (Campylobacter-like organism test) were treated randomly in three therapeutic groups: Group A, DeNol 120 mg, amoxicillin 500 mg and metronidazole 250 mg four times a day orally for 14 days; Group B, omeprazole 20 mg plus clarithromycin 500 mg twice a day and amoxicillin 500 mg four times a day for 14 days; Group C, omeprazole 20 mg, clarithromycin 250 mg and metronidazole 500 mg twice a day for seven days. Nizatidine 150 mg twice a day was given continuously following the end of anti-H pylori therapy for each group. Two months later, endoscopy, the CLO test and 13C-urea breath test were repeated to assess the eradication rate of H pylori and the ulcer-healing rate. Drug tolerance was evaluated by patients themselves by daily recording of any side-effects.

RESULTS

Eighty-four patients completed the entire course of therapy and evaluation for H pylori infection. The H pylori eradication rates in Groups A, B and C were 75% (21/28), 93% (26/28) and 89% (25/28), respectively (p = 0.466). The ulcer healing rate was 86% (24/28) in Group A and 89% (25/28) in Groups B and C (p = 0.764). A total of 74 patients (88%) were free from symptoms at the end of the triple therapy. Symptom relief was faster in patients with PPI-based triple therapy (Groups B and C) (days 3 and 4) than for patients with bismuth-based triple therapy (day 5). The cost of Group C therapy was lower than that for Groups A and B. There were no major side-effects in any of the patients.

CONCLUSIONS

One-week triple therapy with omeprazole, clarithromycin and metronidazole is highly effected for the eradication of H pylori. A therapeutic regime of one week's duration with lower cost, good compliance and mild side-effects may offer a good choice for treatment of duodenal ulcer associated with H pylori infection in clinical practice.

Biotic and abiotic stress-related expression of 1-aminocyclopropane-1-carboxylate oxidase gene family in Nicotiana glutinosa L

Three full length 1-aminocyclopropane-1-carboxylate (ACC) oxidase cDNA clones (pNG-ACO1, 1,254 bp; pNG-ACO2, 1,198 bp; and pNG-ACO3, 1,053 bp) were isolated from the TMV-treated leaf cDNA library of Nicotiana glutinosa plant. They share a high degree of sequence identity (78-81%) throughout the coding regions but are divergent within the 3'-untranslated regions. The gene-specific probes were prepared using these regions to investigate the differential expression of the ACC oxidase gene family in various organs and in response to a multitude of biotic and abiotic stresses in N. glutinosa plants. All three genes were transcriptionally active displaying unique patterns of expression. Both the pNG-ACO1 and pNG-ACO3 transcripts highly accumulated during the senescence of leaves, while the pNG-ACO2 mRNA was constitutively present. In addition, the NG-ACO1 and NG-ACO3 transcripts were predominantly found in roots whereas the NG-ACO2 mRNA was mainly in stems. Upon TMV infection, both NG-ACO1 and NG-ACO3 were markedly induced, but in mock treatment which has an effect of mild wounding, only the NG-ACO3 gene was induced. Furthermore, salicylic acid and CuSO4 treatments of leaves increased the level of NG-ACO1 and NG-ACO3 transcripts, while they did not affect the NG-ACO2 gene expression. Results showed that both the NG-ACO1 and NG-ACO3 genes were highly inducible by ethylene and methyl jasmonate treatments, with NG-ACO3 being more responsive. By contrast, NG-ACO2 did not respond to these growth regulators. Thus, it appears that there are two groups of ACC oxidase transcripts expressed in leaf tissue of N. glutinosa, either stress-induced or constitutive. The possible molecular mechanism of differential regulation of ACC oxidase gene expression and its physiological significance are discussed.

Reciprocal change in angiotensinogen mRNA expression in rat myocardium and liver after myocardial infarction

The aim of this study was to analyze sequential change of angiotensinogen (Ao) mRNA expression in rat liver and noninfarcted myocardium after myocardial infarction (MI). Female sprague-Dawley rats were subjected either to left coronary artery occlusion or sham operation. Three weeks after MI, coronary artery ligation resulted in comparable infarct sizes. A hypokinetic thin anterior wall and remarkable dilatation of the left ventricle, as well as decreased contractility (left ventricular end-systolic dimension = 6.0+/-0.4, 3.3+/-0.2, LV end-diastolic dimension = 7.9+/-0.3, 5.9+/-0.2 mm, and fractional shortening = 25.3+/-3.1%, 45.1+/-3.3%) were shown in the MI and sham group, respectively, by echocardiography (P < 0.01). Experimental MI caused a significant fall in systolic blood pressure (MI 90+/-5.0, vs sham 130+/-7.5 mmHg; P< 0.01) and significantly higher left ventricular end-diastolic pressure (MI 21+/-1.5, vs sham 11+/-1.0 mmHg: P < 0.01). At 4, 18, and 24h after MI, liver Ao mRNA levels, as shown by Northern blot analysis, had increased by up to four times (Ao/glyceraldehyde-3-phosphate dehydrogenase (GAPDH) = 1.4+/-0.1 and 6.0+/-0.2 at baseline and 4h after MI, respectively (P < 0.01). After sham surgery, however, the corresponding increase was slight (maximal 1.5-fold). Three days after MI, liver mRNA had returned to the baseline level. In contrast, ATG mRNA expression in noninfarcted myocardium, as shown by reverse transcription-polymerase chain reaction and Southern blotting, decreased transiently during the acute phase. It returned to its baseline level within 3 days, and then increased further (Ao/ GAPDH = 2.9+/-0.6, 0.3+/-0.1, 3.2+/-0.8, and 3.7+/-0.8 at baseline, 24h, 3 days, and 3 weeks after MI, respectively). In conclusion, it can be stated that after MI, the Ao gene contributes, acutely in the liver and chronically in the myocardium, to the maintenance of hemodynamic homeostasis during the acute phase and ventricular remodeling during the chronic phase.

Characterization of a highly conserved gene (OS4) amplified with CDK4 in human sarcomas

Amplification and overexpression of genes involved in cellular growth control occur frequently in human cancers. Here, we report characterization of the full length OS4 cDNA derived from 12q13-q15 (Su et al., Proc. Natl. Acad. Sci. USA, 91: 9121-9125, 1994), a region frequently amplified in sarcomas and brain tumors. This cDNA consists of 4833 base pairs (bp) encoding an open reading frame (ORF) of 283 amino acids. The ORF predicts a water-soluble acidic (pI 5.50) polypeptide with a molecular weight of 31759. Database searches revealed highly significant similarity between OS4 and eight proteins predicted from genomic sequences of Caenorhabditis elegans, Schizosaccaharomyces pombe, and Saccharomyces cerevisiae. Thus, OS4 defines a novel evolutionarily conserved gene superfamily. Northern and database analyses revealed OS4 transcripts in numerous human tissues demonstrating its ubiquitous expression. We also observed overexpression of OS4 in three cancer cell lines with amplification of this gene. Furthermore, we detected OS4 amplification in 5/5 primary sarcomas with known amplification of the closely linked marker CDK4. These results demonstrate that the highly conserved OS4 gene is frequently included in the 12q13-q15 amplicon and may contribute to the development of a subset of sarcomas.

Angiotensin I converting enzyme gene polymorphism and insulin resistance in patients with hypertension

BACKGROUND

The homozygote deletion (DD) genotype of the angiotensin I converting enzyme (ACE) gene has been shown to be associated with an increased risk of coronary heart disease independent of other risk factors.

OBJECTIVE

To investigate the possible association of the insertion/deletion (I/D) polymorphism of the ACE gene with insulin resistance in a Chinese population with and without hypertension.

SUBJECTS AND METHODS

The I/D polymorphism of the ACE gene was determined for 361 Chinese including 148 women and 96 men with normal blood pressures and 64 male and 53 female patients with mild-to-moderate hypertension. Insulin resistance was estimated by the insulin suppression test and glucose intolerance evaluated with an oral glucose-tolerance test for all of the subjects.

RESULTS

Three hypertensive subgroups with DD, DI and II genotypes having similar ages and body mass indexes presented insignificantly different degrees of glucose intolerance and insulin resistance both among men and among women. Similar results were found for normotensive subjects. In addition, ACE genotypes were not significant predictors of insulin resistance and glucose intolerance either among men or among women after adjustment for age, body mass index, and hypertension.

CONCLUSION

The present data indicated that the I/D polymorphism of the ACE gene was not related to insulin resistance for Chinese hypertensive and normotensive subjects. The increased risk of coronary heart disease associated with the DD genotype need not be mediated through the mechanism of insulin resistance and glucose intolerance for Chinese patients with hypertension.

Gemfibrozil treatment of hypertriglyceridemia: improvement on fibrinolysis without change of insulin resistance

The fibrinolytic and metabolic changes associated with gemfibrozil treatment of hypertriglyceridemia were evaluated in 16 patients with type IV hyperlipidemia by criteria of triglyceride levels > 250 mg/dl and total cholesterol levels < 220 mg/dl. The plasma triglyceride level was significantly lower (323 +/- 71 vs 189 +/- 57 mg/dl; p = 0.000) and high-density lipoprotein cholesterol level significantly higher (33.5 +/- 4.6 vs 38.0 +/- 6.7 mg/dl; p = 0.005) after 3 to 4 months of gemfibrozil treatment. However, the glucose and insulin metabolism measured by oral glucose challenge and insulin suppression tests showed no significant changes after gemfibrozil therapy. In contrast, plasma plasminogen activator inhibitor-1 antigen (36.9 +/- 12.4 vs 27.3 +/- 11.4 ng/ml; p = 0.008) and activity (15.5 +/- 5.5 vs 11.8 +/- 3.0 IU/ml; p = 0.009) and tissue plasminogen activator antigen (13.2 +/- 4.0 vs 10.4 +/- 3.7 ng/ml; p = 0.007) were significantly depressed, and tissue plasimogen activator activity (0.57 +/- 0.31 vs 0.69 +/- 0.38 IU/ml; p = 0.015) was significantly elevated by gemfibrozil. The data indicate that lowering plasma triglyceride and raising high-density lipoprotein cholesterol levels by gemfibrozil treatment also improved the fibrinolytic system without changes of insulin resistance and glucose intolerance in patients with isolated hypertriglyceridemia.

Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function

OBJECTIVES

This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function.

BACKGROUND

Mitral inflow velocity recorded by Doppler echocardiography has been widely used to evaluate left ventricular diastolic function but is affected by other factors. The mitral annulus velocity profile during diastole may provide additional information about left ventricular diastolic function.

METHODS

Mitral annulus velocity during diastole was measured by Doppler tissue imaging (DTI) 1) in 59 normal volunteers (group 1); 2) in 20 patients with a relaxation abnormality as assessed by Doppler mitral inflow variables (group 2) at baseline and after saline loading; 3) in 11 patients (group 3) with normal diastolic function before and after intravenous nitroglycerin infusion; and 4) in 38 consecutive patients (group 4) undergoing cardiac catheterization in whom mitral inflow velocity and tau as well as mitral annulus velocity were measured simultaneously.

RESULTS

In group 1, mean +/- SD peak early and late diastolic mitral annulus velocity was 10.0 +/- 1.3 and 9.5 +/- 1.5 cm/s, respectively. In group 2, mitral inflow velocity profile changed toward the pseudonormalization pattern with saline loading (deceleration time 311 +/- 84 ms before to 216 +/- 40 ms after intervention, p < 0.001), whereas peak early diastolic mitral annulus velocity did not change significantly (5.3 +/- 1.2 cm/s to 5.7 +/- 1.4 cm/s, p = NS). In group 3, despite a significant change in mitral inflow velocity profile after nitroglycerin, peak early diastolic mitral annulus velocity did not change significantly (9.5 +/- 2.2 cm/s to 9.2 +/- 1.7 cm/s, p = NS). In group 4, peak early diastolic mitral annulus velocity (r = -0.56, p < 0.01) and the early/late ratio (r = -0.46, p < 0.01) correlated with tau. When the combination of normal mitral inflow variables with prolonged tau (> or = 50 ms) was classified as pseudonormalization, peak early diastolic mitral annulus velocity < 8.5 cm/s and the early/late ratio < 1 could identify the pseudonormalization with a sensitivity of 88% and specificity of 67%.

CONCLUSIONS

Mitral annulus velocity determined by DTI is a relatively preload-independent variable in evaluating diastolic function.

In vivo determination of surface tension in the horse trachea and in vitro model studies

We measured the surface tension in the trachea of the non-anaesthetised horse from the spreading behaviour of fluid drops, using videotracheoscopy. To do this, we placed small oil drops onto the tracheal wall with a thin Teflon tubing inserted into a videocolonoscope used in humans. Either 5 ml of saline (control) or 5 ml of bovine lipid extract surfactant (BLES) at 4 mg/ml were administered. Tracheal surface tension was 31.9 +/- 0.54 mN/m (Mean +/- SEM, n = 30) in the control experiments and 24.5 +/- 0.51 mN/m (Mean +/- SEM, n = 21) in the entire trachea after the administration of BLES. These values were determined from calibration curves relating film surface tension to the relative diameter of test fluid droplets. In the calibration experiments, the test fluid droplets were placed onto a surfactant film at various surface tensions in either a modified Langmuir-Wilhelmy balance or a captive bubble surfactometer. The spreading behaviour of a given test fluid droplet in the model studies did not only depend on the film surface tension but also on the thickness of the aqueous layer below the surfactant film. Hence, the computed surface tensions in the trachea depend on the choice of which in vitro model is applied.

Characterization and expression of two members of the S-adenosylmethionine decarboxylase gene family in carnation flower

S-adenosylmethionine decarboxylase (SAMDC; EC 4.1.4.50) is one of the key enzymes in polyamine biosynthesis, and the product of its catalytic reaction, decarboxylated S-adenosylmethionine (dcSAM), serves as an aminopropyl donor in the biosynthesis of spermidine and spermine. In order to provide information on the structure and regulation of SAMDC, we have isolated and sequenced two different SAMDC cDNA clones from carnation petals. The nucleotide sequences of CSDC9 and CSDC16 show 78.3% identity, and the deduced amino acid sequences show 81.7% identity and 86.5% similarity [12]. There are several regions with highly conserved sequences among SAMDC cDNAs of potato, spinach, periwinkle, man and yeast. These conserved regions include a cleavage site for the processing of SAMDC proenzyme and a putative PEST sequence that may be relevant to the rapid degradation of SAMDC protein. Carnation SAMDC cDNAs have long transcript leaders of 472 bp and 502 bp for CSDC9 and CSDC16, respectively. Both sequences contain short upstream open reading frames (uORFs) in their 5'-untranslated regions. The CSDC9 uORF is 54 amino acids from 152 to 317 while the corresponding sequence in CSDC16 is 52 amino acids located from 156 to 314 in each 5'-untranslated region. The nucleotide sequences of uORFs in CSDC9 and CSDC16 were 89.9% identical. In vitro transcription/translation experiments showed: (1) each proenzyme of both cDNAs of SAMDC was converted to two polypeptides consisting of a large subunit (calculated as 31,544 Da and 32,537 Da, respectively) and a small subunit (calculated as 9704 and 9041 Da, respectively) after 20 min of translation; (2) the processing occurs rapidly during the translation of protein. But once the translation process is stopped accumulation of the subunits slows and never reaches completion even after 300 min. The processing of carnation SAMDC enzyme is not stimulated by putrescine in in vitro transcription/translation reaction.

Temperature-guided radiofrequency catheter ablation of accessory pathway

OBJECTIVES

This study was performed to evaluate the usefulness of temperature-guided radiofrequency catheter ablation for the elimination of accessory pathway conduction in patients with Wolff-Parkinson-White syndrome.

METHODS

Temperature-guided radiofrequency catheter ablation was attempted in 138 patients with 144 accessory pathways (88 pathways along the left free wall, 5 in the anteroseptal region, 2 in the midseptal region, 19 in the posteroseptal region and 30 along the right free wall). The energy source was a HAT 200S which regulated the power automatically to the set temperature of 70 degrees C. Radiofrequency current was delivered through a thermocatheter to the atrial or ventricular side of mitral or tricuspid annulus.

RESULTS

Accessory pathway conduction was eliminated in 130 of 144 pathways (90.3%). The mean power outputs of the successful ablations at the atrial side of the annulus were higher than those at the ventricular side (34.0 +/- 8.9W versus 20.0 +/- 7.6W, p < 0.01), but the maximum temperatures were lower at the atrial side of the annulus than those at the ventricular side (66.4 +/- 14.0 degrees C versus 77.2 +/- 6.4 degrees C, p < 0.01). There were 3 non-fatal complications (2.1%), 2 patients with hemopericardium and 1 with femoral artery thrombus, during or after ablation procedures. Recurrences of AV re-entrant tachycardia or delta wave on the electrocardiogram occurred in 4 patients (2.8%) who had successful second procedures. There were no late complications during a mean follow-up period of 41 +/- 25 months (range, 3 to 55).

CONCLUSION

We conclude that 1) temperature-guided radiofrequency catheter ablation can be performed reliably and safely in eliminating accessory pathway conduction in patients with WPW syndrome, and 2) temperature monitoring and adjustment of the power to the set temperature during ablation would be useful for the avoidance of impedance rises and coagulum formation.

Measurements of serum müllerian inhibiting substance in the evaluation of children with nonpalpable gonads

BACKGROUND

Müllerian inhibiting substance, produced constitutively by the prepubertal testes, promotes involution of the müllerian ducts during normal male sexual differentiation. In children with virilization and nonpalpable gonads, only those with testicular tissue should have detectable serum concentrations of müllerian inhibiting substance.

METHODS

We measured serum mullerian inhibiting substance in 65 children with virilization at birth and nonpalpable gonads (age at diagnosis, 2 days to 11 years) and serum testosterone in 54 of them either after the administration of human chorionic gonadotropin or during the physiologic rise in testosterone that occurs in normal infants.

RESULTS

The mean (+/-SD) serum mullerian inhibiting substance concentration in the 17 children with no testicular tissue was 0.7+/-0.5 ng per milliliter, as compared with 37.5+/-39.6 ng per milliliter in the 48 children with testes (P<0.001). In the latter group, the mean values in the 14 children with abnormal testes and the 34 with normal testes were 11.5+/-11.8 and 48.2+/-42.1 ng per milliliter, respectively (P< 0.001). The sensitivity and specificity of the serum müllerian inhibiting substance assay for detecting the absence of testicular tissue were 92 percent and 98 percent, respectively, as compared with 69 percent and 83 percent for the measurement of serum testosterone. Furthermore, measurement of serum mullerian inhibiting substance was more sensitive than serum testosterone measurement for the identification of children with abnormal testes (67 percent vs. 25 percent), whereas the specificity of the two tests was similar.

CONCLUSIONS

Measurements of serum mullerian inhibiting substance can be used to determine testicular status in prepubertal children with nonpalpable gonads, thus differentiating anorchia from undescended testes in boys with bilateral cryptorchidism and serving as a measure of testicular integrity in children with intersexual anomalies.

Practical considerations in acquiring biological signals from confocal microscope. II. Laser-induced rise of fluorescence and effect of agonist droplet application

Confocal laser scanning microscopy (CLSM) is extensively used in the study of cellular activities through monitoring the temporal and spatial changes of biologically active molecules such as cAMP and Ca2+ which have been rendered visible by fluorescent labels. During our work with fluo-3 and Ca2+, we noticed two potential sources of artifacts which can make interpretation of the experimental observations difficult. Firstly, the excitation laser light generates heat that enhances the conversion of residual non-fluorescent acetoxymethyl (AM)-esterified indicator to the fluorescent form, thus giving rise to erroneous signals. Secondly, addition of reagents onto the coverslips alters the position of the focal plane, again causing error. In this paper, we present the phenomena and suggest ways to control and eliminate false images.

Premorbid personality and behavioral symptoms in Alzheimer disease. Some cautions

OBJECTIVE

To evaluate the extent to which the previously reported relationship between premorbid personality and psychopathological symptoms after the onset of Alzheimer disease (AD) is due to the use of a single informant for both personality and symptom information.

DESIGN

Premorbid personality descriptions of patients with AD were obtained from 2 sources, primary caregivers and secondary informants, using the Personality Assessment Schedule and NEO-PI-R Neuroticism Scale, respectively. All information regarding depression and anxiety since the onset of AD was obtained from primary caregivers using clinical interviews and the Cornell Scale for Depression in Dementia.

RESULTS

When data were obtained from the same informant, significant relationships were found between premorbid personality and both presence of depression and the severity of anxiety symptoms. When data were obtained from 2 different informants, the only significant relationship was between premorbid neuroticism and anxiety severity.

CONCLUSION

As in a previous report, there was a relationship between premorbid personality and depressive symptoms in AD, but only when personality and symptom information was obtained from the same informant. On the other hand, there was a relationship between premorbid personality and severity of anxiety symptoms both when personality and symptom information came from different informants as well as from the same informant. These data suggest that retrospective bias contributes to the apparent consistency between premorbid personality and some aspects of psychiatric symptoms in AD, specifically depression.

Airway surfactant, a primary defense barrier: mechanical and immunological aspects

Epidemiologic studies have shown strong associations between mortality and morbidity from respiratory and cardiac causes and exposure to fine (PM10), but not coarse, particulates. A plausible mechanistic explanation for these associations is lacking. It has been shown that particles may be retained for an extended period of time in the airways, and that their clearance is inversely proportional to particle size. Such particles are localized in close association with the airway epithelium, and if they consist of low surface energy material, will be coated with an osmiophilic layer, consistent with surfactant. Particles are displaced into this position by surface and line tension forces exerted by the surfactant film at the air-aqueous interface. Particle displacement due to line tension is much greater for smaller particles in the micrometer range. The surface forces acting on the particles leave deep indentations on the epithelial cells. During the displacement process they may come into contact with airway macrophages in the mucous layer and/or dendritic cells situated in the airway epithelium. The smallest particles may even penetrate the mucosa to enter the interstitial compartment. In addition to altering the physical properties of particles, surfactant coatings reduce particle toxicity and enhance phagocytosis by opsonization. We speculate that surfactant acts as a primary defense barrier and plays a role in antigen presentation and elimination at the air-mucus interface of the airways.