Effect of Pseudomonas fluorescens on beef discoloration and oxymyoglobin oxidation in vitro

The relationship between bacterial growth and oxymyoglobin oxidation in vitro and in meat was studied. In the in vitro study, oxymyoglobin was combined with Pseudomonas fluorescens or sterile nutrient broth (control) in an airtight vessel. P. fluorescens samples showed greater metmyoglobin formation and oxygen consumption than controls. The P. fluorescens population in the reaction vessels was correlated with metmyoglobin formation (r = 0.85, P < 0.05) and oxygen consumption (r = 0.91, P < 0.05). When P. fluorescens and oxymyoglobin were combined in an airtight vessel, reducing the headspace from 13 ml and 9 ml to 3 ml resulted in greater metmyoglobin formation (P < 0.05). In the meat study, beef cores prepared from longissimus lumborum were inoculated with P. fluorescens (10(7) CFU/cm2) or sterile peptone water (control), packaged under 1% O2 (+99% N2), air, or 100% O2 and stored at 4 degrees C. Inoculated beef cores showed higher bacterial loads and metmyoglobin formation than their respective controls during 10 h storage in 1% O2, 3 days in air, and 7 days in 100% O2 (P < 0.05). This finding indicated that P. fluorescens could accelerate beef discoloration. Overall, studies demonstrated that oxygen consumption concomitant with P. fluorescens growth decreased partial oxygen pressure, which accelerated oxymyoglobin oxidation.

OphthWeb---cost-effective telemedicine for ophthalmology

'OphthWeb' is an ophthalmic electronic medical record that can be accessed locally and globally via the Internet. OphthWeb can provide secure multimedia patient data to doctors, patients, and health care providers at any time and in any place. Patients have secured access to their own records in the convenience of their homes or during any emergency at any time or place around the world. OphthWeb provides interactive educational information and answers frequently asked questions by way of multimedia images on the Worldwide Web. A data transmission trial was conducted between the Xiamen Eye Centre in the Fujian province in southern China and Singapore. Clinical records, voice messages, and fundus and slit-lamp images were transmitted from Xiamen, and an off-line dialogue by e-mail and Internet-relay chat was conducted. The time delay from transmission to receipt was 30 minutes, which would be adequate to respond to most ophthalmic emergencies. This pilot project will promote computer literacy among doctors, and inter-institutional interaction in the health care profession. OphthWeb can provide telemedicine and electronic medical records at a low cost and great convenience.

Novel cytokine release inhibitors. Part I: Triterpenes

Tripterine and closely related triterpenoid derivatives as IL-1 beta release inhibitors are discussed.

Phase II and pharmacokinetic study of paclitaxel therapy for unresectable hepatocellular carcinoma patients

Hepatocellular carcinoma (HCC) is a common lethal disease in Asia and there is no effective chemotherapy. Identification of new effective drugs in the treatment of inoperable HCC is urgently need. This is a phase II clinical study to investigate the efficacy, toxicity and pharmacokinetics of paclitaxel in HCC patients. Twenty patients with measurable, unresectable HCC, normal serum bilirubin, normal bone marrow and renal functions were studied. Paclitaxel 175 mg m(-2) was given intravenously over 3 h every 3 weeks. No complete or partial responses were observed. Five patients had stable disease. Major treatment toxicities (grade 3-4) were neutropenia (25%), thrombocytopenia (15%), infection (10%) and allergy (10%). Treatment-related deaths occurred in two patients. The median survival was 12 weeks (range 1-36). Paclitaxel is metabolized by the liver and the pharmacokinetics of paclitaxel in cancer patients with liver involvement or impairment may be important clinically. Pharmacokinetic study was completed in 13 HCC patients. The paclitaxel area under the curve was significantly increased (P < 0.02), clearance decreased (P < 0.02) and treatment-related deaths increased (P = 0.03) in patients with hepatic impairment. In conclusion, paclitaxel in this dose and schedule has no significant anti-cancer effect in HCC patients. Paclitaxel should be used with caution in cancer patients with liver impairment.

Undiagnosed acute myocardial infarction in the accident and emergency department: reasons and implications

Because acute myocardial infarction causes significant morbidity and mortality, a correct diagnosis in the accident and emergency department is important so that early treatment including thrombolytic therapy can be given. The aim of this study was to evaluate the reasons for missed diagnosis of acute myocardial infarction in the accident and emergency department, and the implications. All patients admitted to our coronary care unit in 1995 with the confirmed diagnosis of acute myocardial infarction were analysed retrospectively. The demographic data, clinical profiles, diagnosis made at the accident and emergency department and feasibility of thrombolytic therapy were assessed. Analysis of the electrocardiography by the accident and emergency department doctor and the coronary care unit doctor were also compared. Forty-three out of 159 patients (27.0%) with acute myocardial infarction were missed in the accident and emergency department. The diagnoses made were mostly angina or chest pain. Absence of chest pain (25.6%) [vs. 10.2% in correct diagnosis group, p < 0.05] and lack of ST elevation in electrocardiograph (62.8%) [vs. 18.1% in correct diagnosis group, p < 0.0001] were the main predisposing factors for missed diagnosis. Because of missed diagnosis, only 25.6% (vs. 67.2% in correct diagnosis group, p < 0.01) of patients were admitted to the coronary care unit. About one-third (34.9%) of missed diagnosis patients (vs. 6.0% in correct diagnosis, p < 0.01) did not receive thrombolytic therapy because of delayed diagnosis. In the missed diagnosis group, 34.8% of them might be avoidable, if electrocardiogram interpretation was more accurate. More education and training of the involved medical personnel might improve the overall situation.

Weekly etoposide, epirubicin, cisplatin, 5-fluorouracil and leucovorin: an effective chemotherapy in advanced gastric cancer

In order to optimize the therapeutic index of combining etoposide, epirubicin, cisplatin, 5-fluorouracil (5-FU), leucovorin (EEPFL) chemotherapy in the treatment of advanced gastric cancer, a trial of a novel schedule of weekly administration was conducted. Weekly EEPFL treatment consisted of a concomitant boost of etoposide 40 mg m(-2) i.v. over 30 min, epirubicin 10 mg m(-2) i.v. over 5 min to a backbone regimen, weekly PFL chemotherapy with cisplatin 25 mg m(-2), 5-FU 2200 mg m(-2), leucovorin 120 mg m(-2) given simultaneously by 24-h i.v. infusion. Response, survival and toxicity were evaluated. Forty-two patients were studied. Median age was 69 (range 31-84) years. Twenty-six per cent of patients showed complete response and 45% partial response. The overall response rate was 71% (95% confidence interval 58-84%). For a total of 507 weekly EEPFL cycles delivered, the incidence of grade 4 leucopenia was 1% of cycles. One patient died of neutropenia septicaemia. There was no other grade 4 toxicity. Grade 3 and 2 leucopenia occurred in 7% and 14% of cycles. The incidence of grade 3 and 2 mucositis was 1% and 3% of cycles. Grade 3 and 2 diarrhoea occurred in 0.4% and 1.6% of cycles. Overall median survival was 10 months (range 3-41+ months). Weekly EEPFL chemotherapy is an effective regimen with tolerable toxicities in the treatment of advanced gastric cancer. A randomized controlled clinical trial to formally assess the efficacy and benefit of EEPFL chemotherapy is under way.

Effects of alpha-tocopherol on metmyoglobin formation and reduction in beef from cattle fed soybean or cottonseed meal diets

Hereford-Angus crossbred heifers were fed a cottonseed meal-based diet containing gossypol (14 mg free gossypol x kg body wt(-1) x d(-1); CSM), a soybean meal-based diet (SBM), or alpha-tocopherol-supplemented diets (4,036 IU vitamin E x heifer(-1) x d(-1) for 90 d; CSM+E and SBM+E). The effects of diet on color stability and aerobic metmyoglobin reducing ability of beef longissimus lumborum (LL) and psoas major (PM) were evaluated. The CSM containing gossypol did not affect alpha-tocopherol concentration, a* value, or hue angle value of beef muscles obtained from control or vitamin E-supplemented cattle compared to their SBM counterparts. Vitamin E supplementation increased endogenous alpha-tocopherol concentrations and color stability in LL and PM muscles compared with controls from either diet (P < .05). In the aerobic metmyoglobin reducing ability study, LL and PM muscles were stored in 1% O2:99% N2 (a pigment-oxidizing atmosphere) for 48 h and subsequently stored aerobically for an additional 48 h. Within the LL, alpha-tocopherol supplementation delayed metmyoglobin formation in LL exposed to 1% O2 (P < .05). Within the PM, no differences in metmyoglobin formation were found between controls and vitamin E treatments in SBM or CSM diets. Relative aerobic metmyoglobin reduction was the same (P > .05) in LL and PM muscles within SBM or CSM diets for control and vitamin E treatments. Alpha-tocopherol did not seem to affect metmyoglobin aerobic reducing ability in LL and PM muscles.

Beef color update: the role for vitamin E

Dietary supplementation of livestock with vitamin E results in improved quality of meat subsequently obtained from these animals. The effect is especially noteworthy in cattle, in which the primary effects are delayed discoloration and lipid oxidation. A threshold level of alpha-tocopherol in muscle ensures a detectable effect; dietary strategies for attaining this threshold must consider tocopherol status of cattle arriving at the feedyard and duration and level of supplementation. The alpha-tocopherol concentration in muscle must be determined before proper interpretation of experimental results can be made. Muscles vary in their color stability, and this relative difference is not changed by vitamin E supplementation. Several in vitro models have been used to characterize the interaction between alpha-tocopherol, lipid oxidation, and oxymyoglobin oxidation. Alpha-tocopherol seems to exert its color-stabilizing effect by indirectly delaying oxymyoglobin oxidation via direct inhibition of lipid oxidation. However, recent results demonstrating a protective effect of alpha-tocopherol toward oxymyoglobin in low-oxygen atmospheres indicate that additional mechanisms may exist. A better understanding of the fundamental bases for protection of water-soluble myoglobin by lipid-soluble alpha-tocopherol is needed to optimize this beneficial effect.

Starting thrombolytic therapy for patients with acute myocardial infarction in Accident and Emergency Department: from implementation to evaluation

OBJECTIVE

To evaluate the effectiveness of initiating thrombolysis for patients with acute myocardial infarction (AMI) in the Accident and Emergency Department.

METHODS

From January 1993 to December 1995, all AMI patients who were admitted to the United Christian Hospital and given thrombolytic therapy were studied. The patients' demographic data, time and mode of presentation, site of myocardial infarction, treatment modality and timing, and complications related to AMI or treatment were recorded prospectively in our AMI database. The frequency of thrombolysis administered in Accident and Emergency Department and Coronary Care Unit, as well as the median door-to-needle time (time interval between hospital arrival to initiation of thrombolytic therapy) were compared. Cases of inappropriate thrombolysis and complication were also analyzed.

RESULTS

Over these 3 years, 257 patients received thrombolysis in the United Christian Hospital. The percentage of patients receiving thrombolysis in Accident and Emergency Department increased from 3.2% in 1993 to 12.3% in 1994, and to 39.4% in 1995. The median time interval between arrival to hospital and thrombolysis (door-to-needle time) was 25 minutes, compared with 81 minutes in the Coronary Care Unit. The door-to-needle time also improved over these 3 years: from 95 minutes in 1993 to 75 minutes in 1995 in Coronary Care Unit group, and from 35 minutes in 1993 to 20 minutes in 1995 in the Accident and Emergency Department group. Over these 3 years, 2 cases of inappropriate thrombolysis were reported but these did not result in any mortality. Four complications from thrombolytic therapy were reported, and these were managed appropriately by the staff in Accident and Emergency Department and did not result in mortality.

CONCLUSIONS

Starting thrombolytic therapy in Accident and Emergency Department is safe and effectively decreases the door-to-needle time.

Catalase prevents estradiol-induced chondrocyte cytotoxicity

Osteoarthritis is a common geriatric disease and estrogen may play an important role in this disease. Estradiol may cause chondrocyte damage as suggested by in vitro and in vivo data. One of the possible mechanisms of estradiol-induced chondrocyte damage was thought to be related to free radicals. Whether catalase, a known free radical scavenger, can prevent estradiol-induced chondrocyte damage was tested using a chondrocyte culture system. The results of this study suggest that catalase can significantly reduce the estradiol-induced damage to chondrocytes. Apparently, catalase alters the molecular structure of estradiol as indicated by the absorption spectrum of estradiol with time. The modified estradiol may decrease its toxicity to the chondrocytes. However, the contents of free radicals in the treated chondrocytes have no significant difference from the untreated control cells. Studies to further investigate the mechanism or prevention of estradiol-induced chondrocyte damage in osteoarthritis are warranted.

Mechanism-based inactivation of human cytochrome P450 3A4 by grapefruit juice and red wine

Grapefruit juice is well documented to cause clinically significant increases in the plasma concentrations of many therapeutic agents. These interactions are believed to be mediated via inhibition of intestinal cytochrome P-450 3A4 (CYP3A4) by flavonoids and/or other chemicals in grapefruit juice, although the mechanism of that inhibition has not been fully characterized. Like grapefruit juice, red wine contains large amounts of flavonoids and other xenobiotics which could also mediate CYP3A4 inhibition. In this study, we investigated the mechanism of inhibition of CYP3A4 by grapefruit juice and also examined the ability of red wine to inhibit this enzyme. Both red wine and grapefruit juice potently inhibited CYP3A4 activity in a concentration-dependent manner. At 8% of natural strength, enzyme activity was inhibited almost 90 and 84%, respectively, by grapefruit juice and red wine. In contrast, white wine did not appreciably inhibit CYP3A4 activity. Grapefruit juice irreversibly inactivated CYP3A4 in a time- and NADPH-dependent manner. The rate of inactivation mediated by grapefruit juice was similar to that mediated by troleandomycin, a potent mechanism-based inhibitor of CYP3A4. Red wine also inactivated CYP3A4 but at a rate approximately 16% that of grapefruit juice. Inhibition of CYP3A4 by red wine is primarily reversible in nature. The clinical implications of this research are discussed.

Emergency defibrillation performed by coronary nursing staff: A pilot report

The time taken to initiate defibrillation is a key factor in determining survival after cardiac arrest; all first-responding medical or paramedical personnel are thus recommended to receive training in defibrillation skills. We have recently established a working programme that allows trained coronary care nurses to defibrillate in emergencies. Prospective data collected from 1 October 1996 to 31 January 1997 showed that a total of 11 witnessed episodes of ventricular fibrillation or pulseless ventricular tachycardia occurred in nine patients, and were defibrillated by nurses. All the defibrillations were started within 1 minute of cardiac arrest. In five patients, defibrillation was commenced before the arrival of the crash team of doctors; three of the five patients survived. There were no violations of the resuscitation protocol or complications relating to defibrillation. Through programmed training in advanced cardiac life-support, coronary care nurses are capable of providing safe and prompt defibrillation. The importance of training and re-certification is also stressed.

Proliferation and cell death in oligodendrogliomas

The rates of cell proliferation and of cell loss influence the growth rate of a tumour and reflect genetic changes. We studied proliferation and apoptosis in oligodendrogliomas and their relationship to progression of the tumours. Thirty-two cases of oligodendroglioma were retrieved spanning a 10-year period. The diagnosis and grade were reviewed and follow-up data obtained. Mitotic index (MI) and apoptotic index (AI) were determined from haematoxylin and eosin (H & E) stained sections. A labelling index (LI) of proliferating cells was obtained using the MIB1 antibody to the Ki-67 antigen. A further index of apoptosis was obtained using in situ end-labelling of DNA strand breaks (TUNEL index, TI). Fourteen cases were graded as II, 18 as III (1993 WHO). LI was significantly higher in grade III than in grade II tumours (P < 0.01) but the difference in apoptotic indices between grades was not significant. There was a significant (P = 0.036) positive correlation between the logarithms of TI and LI. Construction of survival curves demonstrated a significant difference in survival according to histological grade (P < 0.05). Stratification of cases by LI alone did not predict significantly different survival outcomes, and apoptotic indices did not demonstrate a relationship to survival. A positive relationship was demonstrated between proliferation and apoptosis in oligodendrogliomas. The levels of apoptosis observed indicate that this phenomenon may have an important influence on the overall rate of tumour growth.

Injection sclerotherapy in the treatment of rectal prolapse in infants and children

PURPOSE

The aim of this study was to examine the efficacy of injection sclerotherapy as treatment for persistent rectal prolapse.

METHODS

The records of 28 patients with rectal prolapse treated with injection sclerotherapy over a 16-year period were reviewed. Initial management included assessment and correction of predisposing factors. If rectal prolapse persisted or if the prolapse required repeat emergency or operating room reduction, injection sclerotherapy was performed. The sclerosing agent included D50W in 21 patients (sole agent in 15, combined with ethanolamine oleate in four, and with phenol 5% in two). Phenol 5% alone was used in six patients, and 25% saline was used in one patient. Number of injections, recurrences, and complications were reviewed.

RESULTS

Two patients were lost to follow-up, and one patient was cured once a polyp was recognized and removed. Of the remaining 25 patients, 21 were cured. Sixteen required one injection, three required two injections, and two required three injections (64% cure rate after one injection, 84% cure rate after three injections). There were 4 of 25 failures: two went on to low anterior resection after having failed two injections each; one patient was treated with Thiersch cerclage and injection after two failed injections; and one patient did not respond after three injections but had less severe prolapses. Of those injected with D50W alone, 13 of 14 were cured with injection sclerotherapy. Nine received one injection, two received two injections, and two received three injections (64% cure rate after one injection, 93% cure rate after three injections). The only complication was excessive oozing at the injection site in one patient. He was simply observed in hospital overnight. Follow-up averaged 33 months. The only significant underlying abnormality in our patient population was spina bifida in one patient. This patient was cured with injection therapy. Cystic fibrosis was ruled out by clinical examination and sweat chloride test in all patients. Constipation was the most common condition identified with the onset of rectal prolapse (15 of 28).

CONCLUSIONS

Injection sclerotherapy is simple and should be considered as the first line treatment of recurrent rectal prolapse after failure of conservative measures. D50W is effective, easily available, inexpensive, and associated with few complications.

The cloning, expression and characterization of a cellobiase gene encoding a secretory enzyme from Cellulomonas biazotea

A 4.7-kb DNA insert encoding a secretory cellobiase (Cba) was cloned from Cellulomonas biazotea in Escherichia coli using an excretion vector, pM. Host cells transformed with the recombinant construct, designated pBZ4.7, were able to utilize cellobiose as the sole carbon source. Part of the Cba activity encoded by pBZ4.7 could be detected in the periplasm and even in the culture supernatant. The Cba protein was purified from the culture supernatant and analyzed by SDS-PAGE to have an apparent M(r) of 86,000. The insert consisted of two PstI fragments with lengths of 0.75 and 3.95 kb, both of which were found to be crucial for expressing the Cba activity. Sequencing of the first 3.95 kb of the insert revealed that the coding sequence for Cba, designated the cba gene, was 2484 bp long. Comparison of the deduced Cba sequence with those of published beta-glucosidases revealed a potential active site located at the N-terminal portion of the former. The cba gene has a high G + C content of 76.4% and is flanked by a putative ribosome-binding site and potential transcriptional termination signals upstream and downstream from its coding sequence, respectively.

The prediction of surgically induced refractive change from corneal topography

PURPOSE

To develop a method to predict the refractive power of the cornea from corneal topography.

METHODS

We reviewed preoperative and postoperative cycloplegic refraction, keratometry, and corneal topography in 40 eyes of 40 patients who had undergone photorefractive keratectomy, radial keratotomy, myopic keratomileusis in situ, or hyperopic lamellar keratoplasty. For each axial dioptric power map, we calculated the aspheric ellipsoid that best fit that map. Central corneal points were weighted more heavily than peripheral points, based on the Stiles-Crawford effect. The equation of the best-fit ellipsoid yielded the spherical and astigmatic power and axis for each cornea preoperatively and postoperatively.

RESULTS

The preoperative corneal spherical and astigmatic powers measured by the best-fit method were consistent with the spherical and astigmatic powers measured by keratometry and simulated keratometry. The change in corneal spherical power predicted by the best-fit method was significantly (P < .05) more accurate at predicting the change in spherical equivalent refraction than change either in spherical equivalent keratometry or in spherical equivalent simulated keratometry. The prediction of the astigmatic change was less precise than that of the spherical, but the best-fit method was the most accurate.

CONCLUSIONS

The best-fit method is more accurate than simulated keratometry and standard keratometry are in evaluating corneal refractive power after refractive surgery. An improved method of calculating corneal refractive power may facilitate subjective refraction after refractive surgery, improve the accuracy of intraocular lens power calculation for eyes that have had previous refractive surgery, and improve ablation profiles for excimer laser refractive surgery.

Mandibular odontogenic fibrosarcoma. Case report

A rare case of mandibular odontogenic fibroma is presented which transformed to a stage 1A odontogenic fibrosarcoma with a local recurrence after surgical resection and unusually delayed pulmonary metastases eight years later. Prolonged follow-up of these patients after complete surgical resection, including regular chest X-rays, is recommended.

Central diabetes insipidus in a newborn with deletion of chromosome 7q

We report an infant with midline craniofacial defects and holoprosencephaly due to chromosome 46, XY, del (7) (pter-->q34) who presented at 1 week of age with central diabetes insipidus. The importance of hypothalamic-pituitary endocrine investigation in patients with this syndrome, and more generally, in patients with midline craniofacial malformation or holoprosencephaly is emphasized. As infants with chromosome 7q deletion bear close phenotypic resemblance to infants of Trisomy 13, chromosomal confirmation and karyotype banding is mandatory to establish an accurate diagnosis and for genetic counselling of their parents.

Photorefractive keratectomy for the treatment of compound myopic astigmatism using the ablatable mask

Eight eyes of 8 patients with compound myopic astigmatism were treated with excimer laser photorefractive keratectomy (PRK) using a hand-held ablatable mask in conjunction with the Summit excimer laser. The attempted correction ranged from -1.25 to -400 dioptres (D) of astigmatism and 0 to -8.00 D of myopia. All eyes had attained at least 6 months of postoperative follow-up. Five of the 8 eyes achieved an unaided visual acuity of 6/12 or better. Postoperative refractions ranged from -0.50 to -3.50 D of refractive cylinder and from +0.50 to -3.75 D of spherical error. Decentration of the ablation zone was encountered in 3 eyes due to shifts in patients' fixation. Technical difficulty with the use of the hand-held ablatable mask limited the widespread application of this procedure and it has now been superseded by newer excimer laser systems which can correct astigmatism without having to employ a mask. Despite this, because of the theoretical ability of the mask to correct any form of refractive error, the concept of the mask shape transfer process will remain as a potential alternative in refractive surgery, especially for correction of hyperopia and hyperopic astigmatism.

Efficient gene transfer into zebrafish skeletal muscle by intramuscular injection of plasmid DNA

The ability of zebrafish skeletal muscles to internalize and express plasmid DNA was demonstrated using pCMVCAT1, a chloramphenicol acetyltransferase (CAT) construct driven by the human cytomegalovirus immediate early (CMV-IE) promoter. We found that CAT activity was correlated to the amount of plasmid DNA injected, with maximal expression at 5 micrograms of pCMVCAT1. CAT activity was also shown to increase steadily over the first seven days after injection, with high levels of CAT expression persisting up to one year. Intramuscular injection of CAT constructs driven by other viral promoters also resulted in high levels of CAT activity. Histochemical localization using a CMV beta-galactosidase construct confirmed that only myofibers at the site of injection expressed beta-galactosidase enzyme. The persistence and strong expression of injected plasmid constructs suggest that zebrafish may be a simple and readily accessible system for direct muscle injection studies.

Harvesting a lamellar graft from a corneoscleral button: a new technique

PURPOSE

To describe a new technique for harvesting a lamellar graft from a corneoscleral button in the absence of an artificial anterior chamber.

METHODS

Two layers of sterile fine-weave fabric were wrapped tightly around a glass orbital implant. The corneoscleral button was sutured firmly at its scleral rim onto the fabric. The lamellar graft then was dissected in the regular fashion.

RESULTS

The lamellar graft was successfully obtained. During the dissection, the donor cornea and its supporting fabric-covered glass ball were easily handled, and there was minimal risk of perforation of the posterior lamella of the donor cornea.

CONCLUSION

This simple technique allows a lamellar graft to be easily obtained from a corneoscleral button without specialized and expensive equipment.

A phase II study of carboplatin in nasopharyngeal carcinoma

This is a phase II study to evaluate the efficacy and toxicity of short-course carboplatin in advanced-stage nasopharyngeal carcinoma (NPC). Thirty-three previously untreated stage III-IV NPC patients were studied. Carboplatin was given as a rapid intravenous injection every 3 weeks. The dose of carboplatin was calculated according to the individual patient's creatinine clearance and desired platelet nadir of 75,000/microliter according to the Egorin formula. Response and toxicity were evaluated. Thirty-two patients were evaluated for response. The median age was 54 years, range 30-70 years. Twenty-four patients had local regional disease and 8 patients had metastatic disease. The median dose of carboplatin given was 415 mg/m2 (range 91-791 mg/m2). Fourteen (44%) patients had a partial response with a 95% confidence interval of 26-62%. Fifteen (47%) patients had stable disease and 3 (9%) progressive disease. The overall median survival rate was not reached at 43 months. Overall toxicity was tolerable. Grade III-IV myelosuppression occurred in 4 (12%) patients. There were no other major toxicity- or treatment-related deaths. We conclude that carboplatin has a significant anticancer effect in advanced NPC. Thus carboplatin combination chemotherapy for the treatment of NPC is worthy of future clinical investigations.

Phase II study of megestrol acetate in the treatment of hepatocellular carcinoma

This is a report of a phase II study of megestrol acetate (160 mg/day, orally) in the treatment of hepatocellular carcinoma (HCC). Forty-six patients with advanced HCC were studied and tumour response, changes in appetite, bodyweight, a feeling of well-being, survival and toxicity were evaluated. Thirty-two patients were able to be evaluated for response; there were no complete responders or partial responders. Twelve patients (38%) had stable disease and seven of these patients had a minor response with a median size reduction in the tumour of 18%. Twenty patients (62%) had progressive disease. Five of 24 (21%) patients had a median reduction in alpha-fetoprotein levels of 59 ng/mL. The overall median survival was 4 months (range 1 week to 27 months). Twenty of 32 (62%) patients had an increased appetite and feeling of well-being. Fourteen of 22 (64%) patients had a median lean bodyweight gain of 5 kg (range 1-14 kg). Toxicities were minimal. Tests for glucocorticoid receptors were performed in 10 patients. Four of five patients who were positive for glucocorticoid receptors in the tumour had a stable disease and all five patients who were negative for glucocorticoid receptors had progressive disease. Megestrol acetate had no significant effect on the tumour in HCC patients. However, megestrol acetate is useful in the palliative management of HCC patients, with improvements in appetite, bodyweight and a feeling of well-being with minimal side effects. Some patients had stable disease, a minor reduction of tumour size and a prolonged survival after megestrol acetate treatment and this response may be related to the presence of glucocorticoid receptors in the HCC tumour.

Characterization of a subset of the basic-helix-loop-helix-PAS superfamily that interacts with components of the dioxin signaling pathway

In an effort to better understand the mechanism of toxicity of 2,3,7, 8-tetrachlorodibenzo-p-dioxin, we employed an iterative search of human expressed sequence tags to identify novel basic-helix-loop-helix-PAS (bHLH-PAS) proteins that interact with either the Ah receptor (AHR) or the Ah receptor nuclear translocator (ARNT). We characterized five new "members of the PAS superfamily," or MOPs 1-5, that are similar in size and structural organization to the AHR and ARNT. MOPs 1-4 have N-terminal bHLH and PAS domains and C-terminal variable regions. MOP5 contained the characteristic PAS domain and a variable C terminus; it is possible that the cDNA contains a bHLH domain, but the entire open reading frame has yet to be completed. Coimmunoprecipitation studies, yeast two-hybrid analysis, and transient transfection experiments demonstrated that MOP1 and MOP2 dimerize with ARNT and that these complexes are transcriptionally active at defined DNA enhancer sequences in vivo. MOP3 was found to associate with the AHR in vitro but not in vivo. This observation, coupled with the fact that MOP3 formed tighter associations with the 90-kDa heat shock protein than the human AHR, suggests that MOP3 may be a conditionally active bHLH-PAS protein that requires activation by an unknown ligand. The expression profiles of the AHR, MOP1, and MOP2 mRNAs, coupled with the observation that they all share ARNT as a common dimeric partner, suggests that the cellular pathways mediated by MOP1 and MOP2 may influence or respond to the dioxin signaling pathway.

Penetrating keratoplasty for keratoconus

Keratoconus is a common corneal dystrophy in which penetrating keratoplasty is an effective form of treatment. A retrospective study on patients with keratoconus who underwent penetrating keratoplasty in the Singapore National Eye Centre between 1991 and 1995 was undertaken to describe and characterise the patient population and the success of this procedure. Thirty-two penetrating keratoplasties for keratoconus in 32 eyes of 29 patients were identified. Twenty eyes of 20 patients had a postoperative follow-up period of at least 12 months (range 12 to 44 months). These eyes were specifically examined for success rate and complications. Of the 32 eyes in the study, 18 (56%) belonged to Indians patients and 23 (72%) belonged to male patients. In those eyes with 12 months or more of postoperative follow-up, the visual acuity of 16 (80%) eyes improved postoperatively, with 14 (70%) eyes having a best corrected visual acuity of 6/12 or better. There were no graft failures. Nine eyes (45%) had complications postoperatively. Five eyes underwent refractive surgery for correction of astigmatism. Useful vision of 6/60 or better was achieved within 1 week postoperatively in 8 (40%) of the eyes. The authors conclude that penetrating keratoplasty is a successful procedure in keratoconic eyes not correctable by conservative therapy. The incidence of postoperative complications were however not uncommon. Although the majority of these complications were treated successfully, severe complications such as retinal detachment and glaucoma were the main causes of poor visual outcome after penetrating keratoplasty for keratoconus.

Problems of refraction after photorefractive keratectomy

BACKGROUND

Excimer laser photorefractive keratectomy (PRK) is a refractive procedure to correct myopia that is gaining worldwide acceptance. PRK has been performed as an open-ended clinical trial since January 1992, and specific problems have been encountered in refracting PRK patients.

METHODS

A review of all cases of PRK performed with at least 1-year follow-up was conducted. Nine hundred and seventy-one eyes with myopia ranging from -2.00 to -15.00 diopters had preoperative manifest and cycloplegic refraction, and postoperative refraction at 3 months after treatment.

RESULTS

Refractive difficulty due to degradation of the retinoscopic reflex was encountered in patients who developed moderate to severe haze (seven eyes). Small ablation zones (5 mm) and decentered ablations also contributed to confusion in interpretation of the retinoscopic reflex. In addition, excessive accommodation, profound early myopic and hypermetropic shifts, postoperative irregular astigmatism and inaccurate autorefractometer readings contributed to difficulty in refraction.

CONCLUSIONS

Laser ablation of the central cornea produces alterations in optical homogeneity of the cornea that may cause significant refractive difficulties. Refracting PRK patients requires careful and consistent refraction by an experienced refractionist, both before and after laser treatment.

Fusarium keratitis following the use of topical antibiotic-corticosteroid therapy in traumatised eyes

Keratomycosis is a rare sight-threatening infection of the cornea. Important predisposing factors in its pathogenesis include corneal trauma and use of topical corticosteroid or antibiotic-corticosteroid therapy. Some family physicians are unaware of the dangers of unmonitored topical corticosteroid therapy for traumatised eyes. Three cases of Fusarium keratitis following the use of topical antibiotic-corticosteroid therapy in traumatised eyes are reported. Despite aggressive anti-fungal therapy, one eye required a therapeutic penetrating keratoplasty for impending corneal perforation, another eye progressed to corneal perforation and required evisceration while the third eye developed endophthalmitis which also required evisceration. The potential danger of fungal infections of the cornea following the unmonitored use of topical antibiotic-corticosteroids in traumatised eyes is highlighted.

Structure-activity relationships study of two series of leukotriene B4 antagonists: novel indolyl and naphthyl compounds substituted with a 2-[methyl(2-phenethyl)amino]-2-oxoethyl side chain

N-Methyl-N-phenethylphenylacetamide has been reported to be a key binding domain to LTB4 receptors. Here we describe the synthesis and structure-activity relationship (SAR) studies of two new series of LTB4 receptor antagonists in which the phenyl ring of this receptor binding domain is replaced with indole and naphthalene, respectively. Results of these studies indicate that, in addition to the 2-[methyl(2-phenethyl)amino]-2-oxoethyl moiety, the presence of an acid group and a lipophilic side chain, as well as the spatial relationship of these three functions, is crucial for high binding affinity with LTB4 receptors. Our SAR studies also reveal that an arenecarboxylic acid, or an enoic acid in which the carboxyl group is conjugated with the central ring, is the preferred polar group. The lipophilic side chain of the naphthyl series was found to tolerate minor variations, ranging from a phenylmethoxy group to phenyl and alkyloxy groups. The most active compounds are 2-ethyl-3-[1-[2-[methyl(2-phenethyl) amino]-2-oxoethyl]-5-(phenylmethoxy)indol-3-yl]propenoic+ ++ acid (4g) of the indolyl series and 4-[2-[methyl(2-phenethyl)amino]-2-oxoethyl]-8-(phenylmethoxy )-2-naphthalenecarboxylic acid (2a) or the naphthyl series, with IC50 of 8 and 4.7 nM respectively, in the receptor binding assay using intact human neutrophils.

A novel series of [2-[methyl(2-phenethyl)amino]-2-oxoethyl] benzene-containing leukotriene B4 antagonists: initial structure-activity relationships

This report describes the synthesis of a new class of LTB4 receptor antagonists containing [2-[methyl(2-phenethyl)amino]-2-oxoethyl]benzene as a key binding domain for interaction with high-affinity LTB4 receptors. In addition to this binding domain, two other structural features, an acid function and a lipophilic group, are also required by these compounds for high binding affinity. Our studies indicate that maximal binding affinity in this series is controlled by the spatial relationship of these groups relative to one another. The structure-activity relationships are discussed. The most potent compound in this chemical series, (E)-5-[2-[methyl(2-phenethyl)-amino]-2-oxoethyl]-2-(benzyloxy)cinn amic acid (32), has an IC50 of 2 nM in a guinea pig spleen cell membrane assay. In the whole-cell human neutrophils binding assay, (Z)-5-[2-[methyl-(2-phenethyl)amino]-2-oxoethyl]-2-(benzyloxy)cinn amic acid (30) was the most potent compound with an IC50 of 50 nM.

A pharmacokinetic study with the high-dose anticancer agent menadione in rabbits

The aim of this investigation was to assess the pharmacokinetic properties of high-dose menadione (VK3), as an anticancer agent, in plasma and red blood cells (RBCs) in rabbits. An extremely high dose of 75 mg menadiol sodium diphosphate (Synkayvite) was intravenously injected. HPLC analysis was applied to measure the major metabolite, menadione, VK3. The kinetic properties of VK3 in both plasma and red blood cells showed a short elimination half-life, high clearance, and large volume of distribution in plasma and RBCs. The mean elimination t1/2 values of menadione in plasma and in RBCs were 27.17 +/- 10.49 min and 35.22 +/- 11.82 min, respectively. The plasma clearance (CL/F) of VK3 was 0.822 +/- 0.254 L min-1. The systemic clearance in RBCs was 0.407 +/- 0.152 L min-1. The apparent volume of distribution (Vd/F) in plasma was 30.833 +/- 12.835 L and that in RBCs 20.488 +/- 9.401 L. The plasma AUC was 32.453 +/- 9.785 micrograms min mL-1 and that of RBCs 67.219 +/- 24.449 micrograms min mL-1. Menadiol was rapidly biotransformed to menadione in blood. The formation rate constant (kf) of menadione in plasma was 0.589 +/- 0.246 min-1, and that of RBCs 1.520 +/- 1.345 min-1. Through this study the estimated menadione dosage needed to maintain a plasma level of 1 microgram mL-1 for anticancer purposes was 19.7 mg kg-1 every hour.

Case reports and mini review of bee stings of the cornea

Bee stings of the eye are not uncommon. Quite a few clinical case reports have documented the various ocular reactions to the venom of the bee stings, which may range from mild conjunctivitis to sudden loss of vision. This report presents 2 patients who suffered bee stings to the cornea and their different outcomes. The properties of bee venom as well as the treatment of various possible complications are also discussed.

Phase II study of flutamide in the treatment of hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is a male predominant disease and may be an androgen-dependent or androgen-responsive tumor. This Phase 11 study was designed to investigate the clinical activity and toxicity of flutamide in the treatment of patients with advanced HCC.

METHODS

Thirty-two patients with measurable advanced HCC were studied. Flutamide, 750 mg per day, was administered orally for 8 weeks. Ten patients died before repeat tumor measurements could be performed.

RESULTS

Twenty-two patients were evaluable for response and toxicities. There were no complete responses nor partial responses. Nine of 22 patients (41%) had stable disease and 13 patients (59%) had progressive disease. Serum alpha-fetoprotein was reduced in three patients. The median survival was 10 weeks (range, one to 35 weeks). Toxicities were minimal and tolerable.

CONCLUSIONS

Flutamide is not effective in the treatment of advanced HCC. Clinically, HCC may not be an androgen-responsive tumor. Other new methods of treatment of HCC warrants future clinical investigations.

Autologous Keratophakia for the Correction of Consecutive Hyperopia After Automated Lamellar Keratoplasty for Myopia

PURPOSE

Consecutive hyperopia occurs if too much corneal tissue is resected during automated lamellar keratoplasty for myopia. We report what are, to our knowledge, the first two cases of consecutive hyperopia after automated lamellar keratoplasty that were treated by keratophakia with autologous corneal tissue.

METHODS

The patient in case 1 had a spherical equivalent refraction of +3.38 diopters (D) and the patient in case 2 a refraction of +3.63 D in each eye after automated lamellar keratoplasty for myopia. Corneal tissue from the contralateral eye of each patient was obtained with an automated microkeratome and transferred to the overcorrected eye in an autologous keratophakia procedure.

RESULTS

The patient in case 1 had an unaided visual acuity of 20/20, with a spherical equivalent refraction of +0.63 D 4 months after the autologous keratophakia. The patient in case 2 had an unaided visual acuity of 20/60, with a spherical equivalent refraction of -2.25 D 2.5 months postoperatively.

CONCLUSION

These two cases illustrate the use of simultaneous contralateral myopic automated lamellar keratoplasty with autologous keratophakia to treat eyes overcorrected following previous automated lamellar keratoplasty for myopia.

Corneal pannus associated with contact lens wear

PURPOSE

To determine whether contact lens, related corneal pannus regressed when eyes were refitted with rigid gas-permeable contact lenses and to investigate the role of hypoxia as the putative origin of this complication.

METHODS

Twenty-three eyes of 14 patients with corneal pannus were identified retrospectively from a referral practice population and were separated into two subgroups. One subgroup accepted refitting with rigid gas-permeable contact lenses or discontinued contact lens wear, and the other elected to continue wearing hydrogel or polymethylmethacrylate contact lenses. The response of pannus was observed by slit-lamp biomicroscopy and photographs and was compared between the two subgroups. One eye of each of six patients identified with bilateral corneal pannus secondary to daily wear of hydrogel contact lenses was selected at random. Duplicates of the hydrogel contact lenses worn by these eyes were obtained, and their peripheral oxygen transmissibility (Dk/Lp) values were compared with those of a control group of hydrogel contact lenses identical to those worn by another group of patients, matched by age, gender, and laterality to the study group, but who did not have corneal vascularization.

RESULTS

Vascularization regressed in 14 eyes of nine patients refitted with rigid gas-permeable contact lenses and also in both eyes of one patient who discontinued contact lens wear. All seven eyes of five patients who declined refitting showed persistence or increase of pannus. The mean Dk/Lp of the hydrogel contact lenses for six eyes with pannus was 3.8 X 10(-9) cm ml O2/s ml mm Hg; mean Dk/Lp was 8.6 X 10(-9) cm ml O2/s ml mm Hg for the lens of the control eyes. This difference was found to be statistically significant (P = .028).

CONCLUSION

Peripheral, contact lens-induced hypoxia is a risk factor for corneal pannus, and conversion from hydrogel or polymethylmethacrylate contact lenses to daily wear rigid gas-permeable contact lenses in these eyes successfully reversed this complication.

Corneal scarring after photorefractive keratectomy in a penetrating keratoplasty

PURPOSE

To report severe scarring in a corneal graft after excimer laser photorefractive keratectomy.

METHODS

A 35-year-old man underwent photorefractive keratectomy twice for severe compound myopic astigmatism and anisometropia after penetrating keratoplasty.

RESULTS

Corneal opacity corresponded to areas of irregular epithelial thickness, focal absence of the basement membrane, loss of Bowman's layer, and stromal scarring in the ablation zone.

CONCLUSION

There may be an increased risk of severe corneal stromal scarring from photorefractive keratectomy in eyes that have had previous penetrating keratoplasty.

Notational analysis on game strategy used by the world's top male squash players in international competition

The purpose of this study was to provide a profile of the competition strategy used by the world's top squash players at the international level and provide recommendations for other players to improve their playing strategy. A total of 10 matches including three in round one, the four quarter finals, the two semi-finals, and the final of the 1993 Hong Kong Squash Open were filmed using a 3-CDD video camera. The tournament was played under the North American scoring system. Notational analysis which is based on frame by frame video analysis was used to categorize a player's motion. The frequency of each stroke, and the success or failure rate of each stroke were recorded. Shots were classified as "effective", "ineffective", "winning" and "losing" shots and the analysis demonstrated that 70.28% were "effective", 19.86% were "ineffective", 5.37% were "winning" and 4.48% were "losing" shots. The mean number of shots per game was 252.09. The order of priority using different kinds of strokes in matches were as follows: drive (length) (60.79%), drop (17.91%), volley (11.79%), boast (4.80%), and lob (4.72%). The results of this study show that the "pressure and attack game" was the most important strategy for the world's top squash players in producing winning performances. Also identified are the strokes and the strategies which should be practiced to improve performance. This method of notational analysis can be utilized to evaluate the strengths and weaknesses of players at all levels of competition.

Elimination of dose limiting toxicities of cisplatin, 5-fluorouracil, and leucovorin using a weekly 24-hour infusion schedule for the treatment of patients with nasopharyngeal carcinoma

BACKGROUND

Cisplatin, 5-flourouracil (5-FU), and leucovorin (PFL) chemotherapy has been reported to be effective in the treatment of cancers but severe mucositis or neutropenia are dose limiting toxicities. This Phase II study evaluated the anticancer effect and the toxicities of a new weekly 24-hour infusional PFL chemotherapy in patients with nasopharyngeal carcinoma (NPC).

METHODS

Forty-two patients with stage IV NPC were studied. Cisplatin 25 mg/m2/d, 5-FU 2200 mg/m2/d, and leucovorin 120 mg/m2/d were adminstered weekly by 24-hour intravenous continuous infusion in an outpatient setting. Clinical response and toxicity were evaluated weekly.

RESULTS

The complete response rate (CR) was 30% and the partial response (PR) rate 60% in the localized previously untreated group. The CR rate was 22.7% and PR rate 45.5% in local recurrent/metastatic group. The overall response rate was 79%. Eighty-one percent of patients who had no previous chemotherapy and 67% of patients who had previous chemotherapy responded to weekly PFL. There were no dose limiting toxicities. No patient had grade 3 or 4 mucositis or neutropenia. Thirty-two patients (76%) had no oral mucositis. Seven patients (17%) had grade 1 mucositis and 3 patients (7%) had grade 2 mucositis.

CONCLUSIONS

Elimination of dose limiting toxicities is possible using a weekly 24-hour infusion schedule of PFL chemotherapy while retaining significant anticancer activity as demonstrated in these patients with advanced NPC. To discover whether this schedule is superior to cisplatin and 5-FU or other PFL chemotherapy regimens requires further investigation.

DNA binding specificities and pairing rules of the Ah receptor, ARNT, and SIM proteins

The Ah receptor (AHR), the Ah receptor nuclear translocator protein (ARNT), and single-minded protein (SIM) are members of the basic helix-loop-helix-PAS (bHLH-PAS) family of regulatory proteins. In this study, we examine the DNA half-site recognition and pairing rules for these proteins using oligonucleotide selection-amplification and coprecipitation protocols. Oligonucleotide selection-amplification revealed that a variety of bHLH-PAS protein combinations could interact, with each generating a unique DNA binding specificity. To validate the selection-amplification protocol, we demonstrated the preference of the AHR.ARNT complex for the sequence commonly found in dioxin-responsive enhancers in vivo (TNGCGTG). We then demonstrated that the ARNT protein is capable of forming a homodimer with a binding preference for the palindromic E-box sequence, CACGTG. Further examination indicated that ARNT may have a relaxed partner specificity, since it was also capable of forming a heterodimer with SIM and recognizing the sequence GT(G/A)CGTG. Coprecipitation experiments using various PAS proteins and ARNT were consistent with the idea that the ARNT protein has a broad range of interactions among the bHLH-PAS proteins, while the other members appear more restricted in their interactions. Comparison of this in vitro data with sites known to be bound in vivo suggests that the high affinity half-site recognition sequences for the AHR, SIM, and ARNT are T(C/T)GC, GT(G/A)C (5'-half-sites), and GTG (3'-half-sites), respectively.

Nonischemic ventricular tachycardia: surgical or medical treatment?

Fifty-two consecutive patients with nonischemic ventricular tachycardia (VT) were seen between 1985 and 1991. Twenty-two patients underwent surgery, while in the remaining 30, the VT was well controlled on medication. In the surgical group, arrhythmogenic right ventricular dysplasia (ARVD) was the cause of VT in 12 patients, cardiomyopathy (CM) in 6, posttetralogy of Fallot repair in 2, myocarditis in 1, and myocardial hamartoma in 1. The mean number of drugs tried and found ineffective was 5.5. There were three early deaths; 13 patients are symptom-free without taking any medication. In the medical group, the pathology associated with the VT was myocarditis in 2 patients, CM in 11, and ARVD in 2. In ten patients, VT appeared idiopathic, 1 was exercise-induced, 3 were catecholamine sensitive, and 1 presented with long QT syndrome. Beta blockers controlled the symptoms in 43% of the patients, amiodarone in 20%, and flecainide in 17%. The mortality was higher in the surgical group, but 95% of them are VT-free, compared with those on medical treatment (55%) over the last 8 years' follow-up. In conclusion, the nonischemic VT is a serious condition. Medical therapy is usually effective, but if it fails, VT surgery should be considered.

Nuclear and cytoplasmic bcl-2 expression in endometrial hyperplasia and adenocarcinoma

The bcl-2 proto-oncogene, which inhibits programmed cell death (apoptosis), has recently been found to be cyclically expressed in human endometrium. In order to investigate its role in endometrial hyperplasia and neoplasia, bcl-2 expression was studied in 25 cases of endometrial carcinoma and 20 cases of endometrial hyperplasia (eight simple, two complex, and ten atypical hyperplasias). Uniform intense cytoplasmic bcl-2 expression was found in all cases of non-atypical hyperplasia, and less strong positivity in eight out of ten cases of atypical hyperplasia. In well-differentiated carcinomas, nine out of ten showed weak to moderate bcl-2 expression, whereas six out of seven poorly differentiated carcinomas were bcl-2-negative. Moderately differentiated tumours were an intermediate group, with six out of eight being positive. Widespread localization of bcl-2 protein to the chromosomes of dividing cells was also demonstrated, regardless of cytoplasmic bcl-2 expression, with rare staining of interphase nuclei. Our findings suggest a role for bcl-2 in the natural history of endometrial neoplasia and studies are needed to determine its usefulness as a prognostic marker. The finding of bcl-2 localization to chromosomes has important implications for its mode and site of action.

Effect of granulocyte-macrophage colony-stimulating factor on oral mucositis in head and neck cancer patients after cisplatin, fluorouracil, and leucovorin chemotherapy

PURPOSE

To evaluate prospectively the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) in the reduction of chemotherapy-induced oral mucositis.

PATIENTS AND METHODS

Twenty patients with stage IV squamous cell carcinoma of head and neck were studied. Two-cycles (periods) of identical doses of cisplatin, fluorouracil (5-FU), and leucovorin (PFL) chemotherapy with cisplatin 20 mg/m2/d, 5-FU 800 mg/m2/d, leucovorin 90 mg/m2/d by 96-hour continuous intravenous infusion every 3 weeks were given to each patient. After PFL chemotherapy, GM-CSF 4 micrograms/kg subcutaneously from days 5 to 14 or no therapy was given by a randomized self-controlled crossover study design. Oral mucositis was graded with modified Radiation Therapy Oncology Group criteria.

RESULTS

In the first cycle of PFL chemotherapy, GM-CSF significantly reduced the incidence, mean duration, and mean area under the curve (AUC) of severe oral gross mucositis (grade > or = 3) compared with no therapy. These beneficial effects continued into the second cycle of PFL chemotherapy after crossover to no GM-CSF. The incidence of severe mucositis was reduced when GM-CSF was given in the second cycle of PFL. Analysis of variance indicated significant direct GM-CSF treatment effects on the mean AUC of gross/functional scores and duration of moderate gross mucositis (grade > or = 2) over both periods. There was a significant period effect in favor of giving GM-CSF in the first cycle of chemotherapy.

CONCLUSION

GM-CSF can significantly reduce the severity and duration of chemotherapy-induced oral mucositis after PFL chemotherapy.

Inheritance of RAPD markers in the guppy fish, Poecilia reticulata

Random Amplified Polymorphic DNA (RAPD) fingerprinting offers a rapid and efficient method for generating a new series of DNA markers in fishes. Three oligonucleotide primers (two 10-mers and one 9-mer) and their paired combinations were found to generate different but reproducible RAPD fingerprints in the guppy. Of these, a 10-mer primer (designated S3D2) was used to detect DNA polymorphisms in two guppy varieties, Green Snakeskin (GSS) and 3/4Black (3/4B). High Genetic Similarity (SI) was found among individuals of the GSS and 3/4B varieties indicating low intra-variety genetic variability. The average SI values for the Green Snakeskin and 3/4Black varieties were 0.78 +/- 0.104 and 0.81 +/- 0.083, respectively. The average SI value between individuals of the GSS and 3/4B varieties was 0.66 +/- 0.066, indicating higher genetic variability between the two varieties. To study the inheritance of RAPD markers, single-pair crosses were set up between males of the GSS variety and females of the 3/4B variety. The S3D2 primer was used to generate RAPD fingerprints of the parents and their F1 offsprings. A total of 14 RAPD markers were scored from these crosses. Of these markers, eight (60.0%) of them were polymorphic. The RAPD markers were shown by the F1 to exhibit dominant Mendelian inheritance and could thus be used for subsequent genetic linkage mapping of the guppy.

A multicenter trial of photorefractive keratectomy for residual myopia after previous ocular surgery. Summit Therapeutic Refractive Study Group

PURPOSE

The Summit Therapeutic Refractive Clinical Trial is a nine-center prospective, nonrandomized, self-controlled trial to assess the efficacy, stability, and safety of using a standardized technique of excimer laser photorefractive keratectomy (PRK) to correct residual myopia in eyes with previous refractive surgery or cataract surgery.

PATIENTS AND METHODS

Eligible eyes with a mean residual myopia of -3.7 +/- 1.8 diopters (D) (range, -0.63 to -11.00 D) underwent PRK with a 193-nm excimer laser for myopic corrections between -1.50 and -7.50 D. Standardized settings were used for the ablation zone, ablation rate, repetition rate, and fluence. One hundred seven of the first 114 treated eyes were examined 1 year after PRK, with 98% of eyes having had refractive keratotomy and 2% having had cataract surgery.

RESULTS

One year postoperatively, the mean manifest spherical equivalent refraction was -0.6 +/- 1.4 D (range, -6.50 to 2.50 D); 63% of eyes were within +/-1.00 D of the attempted correction; and uncorrected visual acuity was 20/40 or better in 74% of eyes. Twenty-nine percent of eyes lost two or more Snellen lines of best-corrected visual acuity, and central corneal haze was moderate or severe in 8% of eyes.

CONCLUSIONS

Excimer laser PRK is effective in reducing residual myopia after previous refractive and cataract surgery. However, it is less accurate than PRK in eyes that did not undergo surgery and is more likely to cause a loss of best-corrected visual acuity 1 year after treatment.

Inhaled nitric oxide improves oxygenation in piglets with meconium aspiration

We hypothesized that nitric oxide (NO) inhalation in a model of meconium aspiration in newborn piglets would decrease pulmonary vascular resistance. Seven neonatal piglets were obtained at less than 48 hr of age and instrumented under fentanyl anesthesia. Inhaled NO (40 parts per million) was administered during normoxia and again after hypoxia was induced by reducing FiO2 to 0.13. During normoxia NO inhalation caused a fall in pulmonary artery pressure from a mean of 3.15 (SD 0.8) kPa to 2.84 (SD 0.7) kPa (P < 0.01). Hypoxia (mean arterial O2 saturation 35%) increased PA pressures to a mean of 5.4 (SD 1.6) kPa and NO administration during hypoxia decreased PA pressures to 3.6 (SD 1.2) kPa (P < 0.001). In order to determine the effects of NO in a model of meconium aspiration, 6 to 7 mL/kg of 20% human meconium in normal saline was instilled into the trachea. This procedure induced hypoxemia (mean SaO2 43.4%, SD 19), respiratory acidosis, (mean PaCO2 12.1 kPa, SD 0.5; mean pH 7.04, SD 0.03), and pulmonary arterial hypertension (mean pulmonary artery pressure 6.0 kPa, SD 1.3) despite ventilation with 90% oxygen. Inhaled NO was then administered in concentrations of 5, 10, 20, 30, 40, 60, and 80 parts per million in random order according to a Latin square design.(ABSTRACT TRUNCATED AT 250 WORDS)

Photorefractive Keratectomy for Myopia of 6 to 12 Diopters

To conduct a prospective, nonrandomized clinical trial to assess the efficacy, stability and safety of the use of excimer laser photorefractive keratectomy (PRK) to correct myopia of greater than -6.00 diopters (D) in Singapore. Two hundred thirty-three eyes of 176 patients with a mean preoperative spherical equivalent refraction of -8.70 +/- 2.3 D (range, -5.75 D to -18.13 D) underwent PRK with a 193nm ArF excimer laser (ExciMed, Summit) for myopic corrections of between -6.20 D and -11.90 D. The first 66 of 233 eyes that reached at least 1 year of postoperative follow up are reported. One year postoperatively, the mean manifest spherical equivalent refraction was -1.50 D +/- 1.90 D (range -6.25 D to +3.25 D); 34% of eyes were within +/- 1.00 D of attempted correction; uncorrected visual acuity was 20/40 or better in 75% of eyes. No eyes lost two or more Snellen lines of spectacle corrected visual acuity. Central corneal haze was mild in 20% of eyes and moderate in 3% of eyes. Five eyes developed ocular hypertension that subsequently resolved with treatment. Excimer laser PRK is reasonably effective and safe in the treatment of -6.00 D to -12.00 D of myopia. However, it is less accurate than PRK in eyes with low to moderate myopia and is more likely to result in significant corneal haze.

Determination of anticancer drug vitamin K3 in plasma by high-performance liquid chromatography

Synthetic vitamin K3 (VK3, 2-methyl-1,4-naphthoquinone, or menadione) has been found to exhibit antitumor activity against various human cancer cells at relative high dose. Parallel to our study on the mechanism of VK3 action and for future clinical trials in Taiwan, we developed a simple, sensitive and accurate high-performance liquid chromatographic method for the determination of VK3 in biological fluids. VK3 was extracted from the plasma samples with n-hexane. The chromatographic separation employed an ODS analytical column (5 microns, 250 x 4.6 mm I.D.) with a mobile phase of methanol-water (70:30, v/v) and UV detection at 265 nm. On completely drying of the extraction solution, n-hexane, by a stream of nitrogen, menadione was lost to a great extent. Methanol (70%, 200 microliters) was added to the extraction solvent after extraction and centrifugation to prevent the loss of menadione. The absolute recovery was 82.4 +/- 7.69% (n = 7). The within-day and between-day calibration curves of VK3 in plasma in the ranges of interest (0.01-10.00 micrograms/ml; 0.01-5.00 micrograms/ml) showed good linearity (r > 0.999) and acceptable precision. The limit of quantitation of VK3 was 10 ng/ml in plasma. This method has been successfully applied to a pilot pharmacokinetic study of VK3 in rabbits receiving an intravenous high-dose bolus injection of 75 mg menadiol sodium diphosphate (Synkayvite). The pharmacokinetic properties of menadione could be described adequately by an open two-compartment model. The mean half-life of menadiol (transformation to menadione) was 2.60 +/- 0.12 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipiodol uptake and retention by human hepatoma cells

Lipodol has important diagnostic and therapeutic uses in hepatoma. However, the mechanisms of its selective, prolonged retention in hepatoma cells is not well understood. Therefore, using oil-red O, light and electron microscopy and neutron activation analysis we have determined that HepG2 cells are characterized by lipiodol deposition and emulsification on the cell surface, action uptake of lipodol by endocytosis, and prolonged intracellular retention. These findings may have major clinical significance in the development of a new treatment for hepatoma patients.

A blind, randomized comparison of the circulatory effects of dopamine and epinephrine infusions in the newborn piglet during normoxia and hypoxia

OBJECTIVE

To determine the hemodynamic responses to dopamine and epinephrine infusions in newborn piglets during normoxia and hypoxia.

DESIGN

Prospective, randomized, blind cross-over study.

SUBJECTS

Newborn piglets (n = 7).

INTERVENTIONS

Animals were acutely instrumented for measurements of cardiac output, pulmonary and systemic pressures, carotid and coronary artery blood flow, and coronary artery oxygen consumption. Dopamine at infusion rates of 2 to 16 micrograms/kg/min and epinephrine 0.2 to 1.6 micrograms/kg/min were administered during normoxia. Six piglets were similarly prepared and were then made hypoxic to an arterial O2 saturation of 45% to 50%. Epinephrine at infusion rates of 0.2 to 3.2 micrograms/kg/min and dopamine at rates of 2 to 32 micrograms/kg/min were administered in random order during hypoxia.

MEASUREMENTS AND MAIN RESULTS

During normoxia, cardiac output increased similarly with both drugs and was significantly increased by > or = 0.2 micrograms/kg/min of epinephrine and significantly increased by 8 or 16 micrograms/kg/min of dopamine. Mean arterial blood pressure was not affected by dopamine but was significantly increased by epinephrine at a rate of 1.6 micrograms/kg/min. The relative effects of the drugs on pulmonary and systemic vascular resistance differed, the pulmonary/systemic vascular resistance ratio was reduced at the higher doses of epinephrine (i.e., 0.8 and 1.6 micrograms/kg/min) and was unaffected by dopamine. Coronary artery oxygen consumption and coronary blood flow increased significantly with both medications at rates > 0.4 and 4 micrograms/kg/min, respectively. Increases of both variables were greater with epinephrine than with dopamine. Myocardial extraction ratio was unaffected by dopamine and reduced at 0.2 and 1.6 micrograms/kg/min of epinephrine. Hypoxia caused significant increases in cardiac index, systemic blood pressure, pulmonary arterial pressure, carotid artery blood flow, coronary artery blood flow, coronary oxygen consumption, coronary oxygen extraction ratio, and the pulmonary/systemic vascular resistance ratio. Mean systemic arterial blood pressure increased significantly with 1.6 and 3.2 micrograms/kg/min of epinephrine, but was not significantly affected by dopamine at any infusion rate. Cardiac index was not affected significantly by either of the medications. Thus, there was a significant increase in the calculated systemic vascular resistance index with the highest dose of epinephrine, in contrast to the slight, statistically significant, decrease in calculated systemic vascular resistance index with the highest dose of dopamine. Epinephrine significantly reduced pulmonary arterial pressures at 0.2, 0.4, and 0.8 microgram/kg/min. Dopamine had no effect on this variable. The pulmonary/systemic vascular resistance ratio was significantly reduced by epinephrine at doses of 0.2 and 3.2 micrograms/kg/min, whereas the highest dose of dopamine caused a significant increase in the pulmonary/systemic vascular resistance ratio.

CONCLUSIONS

Epinephrine infusion during normoxia increases systemic pressure more than pulmonary arterial pressure at doses > or = 8 micrograms/kg/min, and furthermore, produces a more appropriate hemodynamic profile in the presence of hypoxic pulmonary hypertension than dopamine infusion, in the acutely operated anesthetized piglet.