Factors influencing the successful treatment of infectious pulmonary tuberculosis

SETTING

Achieving successful treatment of infectious pulmonary tuberculosis (PTB) could reduce the spread of tuberculosis (TB) and the emergence of multidrug resistance.

OBJECTIVE

To explore factors associated with successful treatment for sputum-positive PTB.

DESIGN

This study used a population-based retrospective cohort design. All PTB patients residing in southern Taiwan recorded in the tuberculosis registry from 1 January to 30 June 2003 were identified. Each patient's medical record was requested from treating hospitals and retrospectively reviewed for 15 months after the date PTB was confirmed.

RESULTS

There were 399 PTB patients included in the study. Factors significantly associated with successful treatment included treatment by pulmonologists (OR 1.93), receiving directly observed therapy (DOT) (OR 1.76) and receiving treatment at the chest hospital (OR 5.41). Patients of advanced age were less likely to achieve treatment success (OR 0.97). Among patients treated by pulmonologists, those treated at the chest hospital had a significantly higher treatment success rate than those treated at other institutions (94.1% vs. 69.9%).

CONCLUSIONS

Patients treated with DOT and by pulmonologists, especially at the chest hospital, had a higher treatment success rate. DOT and training of care professionals and institutions are therefore important factors that affect the successful treatment of TB.

The Impact of Arteriovenous Malformation Radiosurgery on the Brain: From Morphology and Perfusion to Neurocognition

The therapeutic aims of brain arteriovenous malformation (AVM) radiosurgery are multiple. Protecting patients from rebleeding is the prime goal. Among the others, hemodynamics, perfusion and neurocognition recovery are interesting and important. Anatomically AVM contains an abnormal cluster of vascular networks (nidus) between arteries and veins. Hemodynamically the nidus contains a low resistance and causes high-flow transnidal shunts between both sides of the nidus. The shunts cause hypotension in the neighboring arteries and diversion of blood from the adjacent brain tissues. The diversion disturbs brain hemodynamics. Radiosurgery, by eliminating the nidus, reconstitutes normal brain hemodynamics. From the early stage after radiosurgery, the abnormal transnidal flows gradually decrease, and the adjacent hemodynamics recovers toward normal. For nonhemorrhagic AVM, improvement of seizure control and stable or improved neurological status are observed clinically. The radiosurgical effects are also reflected in the recovery of metabolism in the adjacent brain and neurocognitive function paralleling the hemodynamic normalization. Morphological cure of AVM and the associated recovery of brain hemodynamics, metabolism and neurocognitive function form the therapeutic rationale of AVM radiosurgery.

CPS1, a homolog of the Streptococcus pneumoniae type 3 polysaccharide synthase gene, is important for the pathobiology of Cryptococcus neoformans

The polysaccharide capsule is known to be the major factor required for the virulence of Cryptococcus neoformans. We have cloned and characterized a gene, designated CPS1, that encodes a protein containing a glycosyltransferase moiety and shares similarity with the type 3 polysaccharide synthase encoded by the cap3B gene of Streptococcus pneumoniae. Cps1p also shares similarity with hyaluronan synthase of higher eukaryotes. Deletion of the CPS1 gene from a serotype D strain of C. neoformans resulted in a slight reduction of the capsule size as observed by using an India ink preparation. The growth at 37 degrees C was impaired, and the ability to associate with human brain endothelial cells in vitro was also significantly reduced by the deletion of CPS1. Using site-specific mutagenesis, we showed that the conserved glycosyltransferase domains are critical for the ability of the strain to grow at elevated temperatures. A hyaluronan enzyme-linked immunosorbent assay method demonstrated that CPS1 is important for the synthesis of hyaluronan or its related polysaccharides in C. neoformans. Comparisons between the wild-type and the cps1Delta strains, using three different transmission electron microscopic methods, indicated that the CPS1 gene product is involved in the composition or maintenance of an electron-dense layer between the outer cell wall and the capsule. These and the virulence studies in a mouse model suggested that the CPS1 gene is important in the pathobiology of C. neoformans.

Similarities and differences for light-induced surface plasmons in one- and two-dimensional symmetrical metallic nanostructures

Two types of double-sided nanostructure, one possessing a slit aperture with parallel grooves and the other possessing a circular aperture with concentric grooves, were fabricated to examine the similarities and differences of their diffraction behavior in one-dimensional (1-D) and two-dimensional (2-D) nanostructures. Based on the projection-slice theory, we conjecture that the surface plasmons in these two different nano-scale grooves possess similar modes. A localized surface plasmon (LSP) was used to examine the transmission characteristics induced by the apertures. The transmission characteristics of the slitted nanostructure and the circular nanostructure aperture were then measured. We coupled the transmission spectra measured from these two apertures with a 1-D parallel groove transmission curve simulated by a 1-D rigorous coupled wave analysis. Measured spectra results show reasonable agreement with the simulated data. We propose that the apparent blueshift observed in the peak frequency of a 2-D nanostructure is due to the difference in the shape of the aperture and the spot transmission characteristics of 1-D and 2-D systems as induced by a LSP.

Systemic Herpes Simplex Virus Infection Following Cadaveric Renal Transplantation: A Case Report

Herpes simplex virus (HSV) infection usually occurs in immunocompromised or severely debilitated patients. It is not so common in patients with renal transplants. The diagnosis can only be made histologically. It usually occurs during or shortly after treatment of graft rejection with high-dose steroids. We have recently experienced a case of HSV esophagitis and nephropathy in the renal allograft biopsy, which was identified by histology, immunostaining, and electron microscopy. A 43-year-old woman underwent cadaveric renal transplantation with cyclosporine and prednisolone treatment. Twelve months later, she developed renal insufficiency and proteinuria. Allograft renal biopsy showed some evidence of acute rejection. She was treated with 3 successive days of methylprednisolone (1.0 g/d) intravenously and continued tapering of steroids. Three weeks after steroid pulse therapy, she had throat pain, oral cavity ulcer, dysphagia, and febrile sensation. Esophagoscopy revealed multiple confluent ulcers in the whole esophagus, and biopsy showed enlarged epithelial cells with prominent nuclei. Immunohistochemically, the epithelial cells were positive with a monoclonal antibody to HSV type 1. She was started on acyclovir intravenously, which was continued for a week. After a week, her symptoms began to improve and repeat endoscopy showed no residual esophagitis. A renal allograft infection with HSV can persist in heavily immunosuppressed patients with recurrent rejection episodes. HSV mainly affects tubular cells causing necrosis, a major reason for functional deterioration. A biopsy is required for diagnosis.

On-Line HPLC-UV/Nano-TiO2-ICPMS System for the Determination of Inorganic Selenium Species

We have developed an UV/nano-TiO2 vapor generation (VG) device that when coupled between a chromatographic column and an ICP mass spectrometer provides a simple and sensitive hyphenated method for the determination of Se(IV) and Se(VI) without the need to use conventional chemical VG techniques. Because our proposed VG device allows both Se(IV) and Se(VI) species in the column effluent to be converted on-line into volatile Se products, which are then measured directly by the ICPMS, the safety risks and the probability of contamination arising from the use of additional chemicals are both low. To achieve the maximum signal intensity, we optimized a number of the operating parameters of the UV/nano-TiO2 VG device, including the acidity, the amounts of TiO2 and formic acid, and the length of the reaction coil, with respect to their effects on the reduction efficiency of the analyte species. This hyphenated method achieves excellent detection limits-0.06 and 0.03 ng mL(-1) for Se(IV) and Se(VI), respectively-because of the high efficiencies of the conversions of Se(IV) and Se(VI) to their respective volatile products and the lower blank level achieved, relative to those of other traditional systems. In addition, because the conversion efficiency of the analyte selenium species reached its maximum level within 36 s of irradiation, the working time (approximately 12 min) was limited primarily by time required for the chromatographic separation. A series of validation experiments-analysis of the 1643e Standard Reference Material and natural water samples-indicated that our proposed methods can be applied satisfactorily to the determination of inorganic selenium species in water samples.

Strategic analysis for sustainable urban river aquatic environment using the system dynamic approach

A sustainable aquatic environment, which relates to the issues of pollution mitigation and ecological restoration, is one of the important indicators of the vitality and prosperity of a city. Traditionally, resort to engineering efforts is always the first priority in dealing with such problems. Nevertheless, treated as an integrated system, the nature of the problem should involve many aspects including economic, ecological, environmental, and engineering factors. Meanwhile, the special feature of the time-dependent state has also made such a system a dynamic and complex problem. The current research has employed the concepts of integrated assessment trying to aggregate related studies and tackling the problem as a complete system. With the aid of the system dynamic modeling tool, which is capable of dealing with dynamic and complex problems, the simulation model was formulated following the macrostructure of system behavior. Various strategies for improving the sustainability of the aquatic environment in Love River, Kaohsiung, Taiwan have been evaluated. The decision makers are therefore allowed to choose more effective strategies based on the integrated perspectives.

Transcription factor decoy for AP-1 reduces mesangial cell proliferation and extracellular matrix production in vitro and in vivo

Diabetic nephropathy is characterized by an expansion of glomerular mesangium, caused by mesangial cell proliferation and excessive accumulation of extracellular matrix (ECM) proteins, which eventually leads to glomerulosclerosis and renal failure. Activator protein-1 (AP-1), a transcription factor, is implicated in the transcriptional regulation of a wide range of genes participating in cell proliferation and ECM production. This investigation was undertaken to test the hypothesis that AP-1 plays an important role in ECM gene expression, and to develop a molecular therapeutic strategy based on decoy oligodeoxynucleotides (ODN). In this report, we show that transfection with AP-1 decoy ODN strongly inhibits high glucose- and angiotensin II-induced cell proliferation and expression of ECM genes in cultured mesangial cells in vitro. Administration of AP-1 decoy ODN into streptozotocin-induced diabetic rat kidney in vivo using the hemagglutinating virus of Japan (HVJ)-liposome method virtually abolished TGF-beta1 and plasminogen activator inhibitor-1 expression. Our results collectively indicate that AP-1 activation is crucial for mesangial cell proliferation and ECM production in response to high glucose and angiotensin II. Moreover, use of stable AP-1 decoy ODN combined with the highly effective HVJ-liposome method provides a novel potential molecular therapeutic strategy for the prevention of diabetic nephropathy.

Haploid fruiting in Cryptococcus neoformans is not mating type alpha-specific

Under appropriate conditions, haploid Cryptococcus neoformans cells can undergo a morphological switch from a budding yeast form to develop hyphae and viable basidiospores, which resemble those produced by mating. This process, known as haploid fruiting, was previously thought to occur only in MATalpha strains. We identified two new strains of C. neoformans var. neoformans serotype D that are MATa type and are able to haploid fruit. Further, a MATa reference strain, B-3502, also produced hyphae and fruited after prolonged incubation on filament agar. Over-expression of STE12a dramatically enhanced the ability of all MATa strains tested to filament. Segregation analysis of haploid fruiting ability confirmed that haploid fruiting is not MATalpha-specific. Our results indicate that MATa cells are intrinsically able to haploid fruit and previous observations that they do not were probably biased by the examination of a small number of genetically related isolates that have been maintained in the laboratory for many years.

Striatal formation of 6-hydroxydopamine in mice treated with pargyline, pyrogallol and methamphetamine

Formation of 6-hydroxydopamine (6-OHDA) has been posited in the striatum following methamphetamine treatment and plays a critical role in methamphetamine-induced nigrostriatal dopaminergic toxicity. We used high performance liquid chromatography electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS) to determine the formation of 6-OHDA by the treatments of methamphetamine combined with pargyline, a monoamine oxidase inhibitor, and pyrogallol, a catechol-O-methyl-transferase inhibitor, in female C57BL/6J mouse striatum. A substantial amount of 6-OHDA (9.9 +/- 0.7 pg/mg wet tissue) was detected in mice treated with pargyline (100 mg/kg) and pyrogallol (25 mg/kg) in combination. Greater striatal 6-OHDA levels were observed in mice treated with combined pargyline, pyrogallol and methamphetamine (50 mg/kg) as compared to mice treated with combined pargyline and pyrogallol. However, mice treated with pargyline and pyragollol in combination followed by one and two doses of methamphetamine exhibited comparable striatal 6-OHDA levels (23.2 +/- 4.3, 27.3 +/- 1.3 pg/mg wet tissue) in our protocol. We conclude that blockade of the primary metabolic pathways of dopamine by inhibiting both monoamine oxidase and catechol-O-methyl-transferase activities is sufficient to induce 6-OHDA formation in the striatum. Acute 6-OHDA accumulation in the striatum can be potentiated by methamphetamine, a potent dopamine releaser, administration following such metabolic inhibitions.

Adaptive phase field simulation of dendritic growth in a forced flow at various supercoolings

An efficient finite volume method is developed for the phase-field simulation of two-dimensional dendritic growth in a forced flow at various supercoolings. The adaptive nature of the method allows the dendrite in a large domain to evolve secondary structures, even at low supercoolings. In addition to good agreement with previous calculations on the tip shape and speed, the effects of forced flow at various supercoolings are investigated and compared with the Oseen-Ivantsov solution and good agreement is found. The steady dendrite shape in all cases continues to have a self-affine nature and the invariant scaling parameters are in good agreement with the estimation.

The design of a web-based decision support system for the sustainable management of an urban river system

The effects of urbanization on the aquatic environment, and solutions to the deterioration of water quality and stream ecology in the Love River have long been the main focus of environmental management in southern Taiwan. Apart from choosing the regular strategies of installing an intercept and sewer system, coastal wastewater treatment plant, and ocean outfall pipe, a new opportunity for improving the overall managerial efficiency is to design and implement a web-based Decision Support System (DSS). This DSS must be capable of managing storm water impacts when overflow is inevitable, river water quality variations loading to influences on the ecosystem, and changing land use programs along river corridors and adjacent urban areas simultaneously. This paper presents a new design framework for building such a DSS. By using the advanced information technology in the "Internet" environment, the proposed DSS may perform normal queries and statistical analyses in a web-enabled database, spatial analysis via the use of a Geographic Information System (GIS) in the Internet environment, and essential data warehousing/data mining. Possible linkage with various analytical models is anticipated. Such a DSS must be helpful for achieving the rehabilitation of the estuarine ecosystem and satisfying the goals for sustainable management in a regional sense.

The relationship between FTL and NA, DMV or CVLM in central cardiovascular control

The aim of the present study was to examine the relationship between the lateral tegmental field (FTL), a cardioinhibitory area, with other cardioinhibitory areas, i.e., the ambiguus nucleus (NA) and the dorsal motor nucleus of vagus (DMV) and the caudal ventrolateral medulla (CVLM), a vasopressor inhibitory area. In 55 cats anesthetized with chloralose (40 mg/kg) and urethane (400 mg/kg), the cardiovascular responses of heart rate (HR), systemic arterial blood pressure (SAP) and vertebral nerve activity (VNA) were recorded. The FTL, NA, DMV and CVLM were identified first by stimulation (rectangular pulses in 80 Hz, 0.5 ms, 50-100 microA) and then confirmed by microinjection of sodium glutamate (Glu, 0.25M, 70 nl). In studying the influence of NA, DMV, or CVLM lesion on the Gluinduced responses in FTL, kainic acid (KA, 24 mM, 100 nl) was microinjected into the NA, DMV or CVLM. FTL stimulation produced an average decrease of HR by 55%. After KA lesioning of the ipsilateral NA or the DMV, the decreased HR induced by FTL was significantly diminished. After subsequent lesion of the contralateral DMV or NA, the bradycardia of FTL was abolished. The reduction of resting HR was more intense after lesioning the NA than DMV and with the left side more than that of the right side. These studies suggest that the cardioinhibitory responses of FTL are mediated through both NA and DMV with predominance of the former, while the hypotensive effect of FTL is mediated through CVLM. The precise pathway responsible for the FTL-induced bradycardia and hypotension is to be determined.

Antimicrobial activity of four root canal sealers against endodontic pathogens

The antibacterial effects of various types of widely used endodontic sealers have not been compared systematically on facultative or obligate anaerobic endodontic pathogens. The aim of this study was to evaluate the antimicrobial properties of four commonly used endodontic sealers: two epoxy-resin-based sealers (AH26, AH plus), one zinc-oxide eugenol-based sealer (N2), and one calcium hydroxide-based sealer (Sealapex). The testing microbes were four facultative anaerobic species (Streptococcus mutans, Streptococcus sanguis, Escherichia coli, and Staphylococcus aureus) and four obligate anaerobic species (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, and Prevotella intermedia). The freshly mixed sealers were placed into the prepared wells of agar plates inoculated with the test microorganisms. After varying periods of incubation (2 days for facultative anaerobic species and 7 days for obligate anaerobic species), the zones of growth inhibition were observed and measured. All the sealers were distinctly different from each other in their antimicrobial activity. The sealers showed different inhibitory effects depending on the types and bacterial strains. N2 containing formaldehyde and eugenol proved to be the most effective against the microorganisms. The extreme antimicrobial potency of this root canal sealer must be weighted against its pronounced tissue toxic effect.

Identifying an interfering factor on chemical oxygen demand (COD) determination in piggery wastewater and eliminating the factor by an indigenous Pseudomonas stutzeri strain

AIMS

This study attempted to demonstrate nitrite interference on chemical oxygen demand (COD) determination in piggery wastewater, and the capability of aerobic denitrification of the SU2 strain which is capable of promoting the efficiency of nitrogen and COD removal from piggery wastewater.

METHODS AND RESULTS

This study was performed in a 17-litre reactor with a 30% packing ratio, with a ratio of immobilized SU2 cells to sludge of 100:1. The ratio of aeration to nonaeration was 4 : 1.5. Removal efficiency of COD was 86.8%. Removal efficiency of BOD and SS was higher than 90%, and removal efficiency of NH4+-N and TKN was almost 100%.

CONCLUSIONS

NO2- -N interference is significant when its concentration in piggery wastewater exceeds 100 mg l-1. COD in piggery wastewater can be indirectly reduced following nitrite reduction by SU2 strain.

SIGNIFICANCE AND IMPACT OF THE STUDY

Utilizing immobilized SU2 cells in coordination with an SBR system simultaneously reduces nitrite and COD concentrations.

[Cloning and characterization of syap1, a down regulated gene in human hepatocellular carcinoma]

Using a different fragment DE6 obtained from DD-PCR as probe, a full-length cDNA has been cloned from human liver cDNA library and named as syap1 (Synapse-associated protein 1) because its deduced amino acid sequence is homologous to SAP47 of D. melanogaster. Northern blot analysis reveals that two transcripts of syap1 mRNA are expressed in cultured human liver L-02 cells. Moreover, the syap1 mRNA was also detected in most of adult human tissues by RT-PCR analysis. Down-regulated expression of syap1 mRNA was confirmed by semi-quantitative RT-PCR assay in 5 of 10 (50%) cases of human hepatocellular carcinoma (HCC).

Quantitative pathology of cutaneous nerve terminal degeneration in the human skin

Pathological diagnosis of neuropathy has traditionally depended on ultrastructural examinations of nerve biopsy specimens, particularly for sensory neuropathies affecting unmyelinated and small-myelinated nociceptive nerves. These sensory nerves terminate in the epidermis of the skin, and the pathology of neuropathy usually begins from nerve terminals. We investigated the feasibility of diagnosing small-fiber sensory neuropathy by evaluating cutaneous innervation. Skin biopsy specimens of 3-mm in diameter were obtained from the distal leg and the distal forearm of 55 healthy controls and 35 patients with sensory neuropathy. In the healthy controls, conventional intraepidermal nerve fiber densities (IENF densities) as measured using the image analysis system in the distal forearm and in the distal leg were correlated (r=0.55, P<0.0001), with significantly higher values in the distal forearm than in the distal leg (17.07+/-6.51 vs 12.92+/-5.33 fibers/mm, P<0.001). Compared to IENF densities of healthy controls, these values of neuropathic patients were significantly reduced in the distal forearm (5.82+/-6.50 fibers/mm, P<0.01) and in the distal leg (2.40+/-2.30, P<0.001). We further explored the possibility of quantifying skin innervation by counting "ocular intraepidermal nerve fiber density" (ocular nerve fiber density) with no aid of an image analysis system. This was based on the fact that the epidermal length on specifically defined sections was very close to the predicted epidermal length of 3 mm, the diameter of skin punches (P=0.14). Ocular nerve fiber densities were significantly correlated with IENF densities as measured by the image analysis system (r=0.99, P<0.0001). Dermal nerve fibers of neuropathic patients either disappeared or became degenerated. These findings were consistent with the notion of early terminal degeneration in neuropathy, and will facilitate quantitative interpretation of epidermal innervation in human neuropathy.