Zamorano-Dujovny multipurpose neurosurgical image-guided localizing unit: experience in 866 consecutive cases of 'open stereotaxis'

We describe the Zamorano-Dujovny localizing unit which consists of a ring-shaped headholder held on the patient's head by three or four variably placed fixation pins, thereby avoiding interference with the flap sites or craniotomy. The base ring is mounted intraoperatively on a special adapter that allows any patient positioning including supine, lateral prone, 3/4 prone, sitting, etc. Imaging studies, such as computed tomography, magnetic resonance imaging, x-ray, digital angiography, and digital subtraction angiography can be performed with the headholder anchored in place for multimodality image localization. Surgical draping can be done over the ring to provide a completely sterile field. An arc/quadrant localizing device can be mounted on any four alternative positions according to the neurosurgeon's preference. PC-compatible software gives the setting for any possible mounting. Intraoperatively the localizing unit can be used in a 'fixed' permanent setting or as a 'nonfixed' system to provide intraoperative three-dimensional orientation. Different types of instruments compatible with the unit extend its capabilities, such as 'bayonet'-type brain retractors (cylinders and speculum) that keeps the surgical corridor unobstructed from the arc. As an alternative, in the nonfixed setting, self-retaining arms are fixed to the base ring and brain retractors and conventional microsurgical techniques can be used without any mechanical obstruction.

Cytolysin gene expression in the islets of diabetic BioBreeding/Worcester rats

Diabetes prone (DP) BB/Wor rats develop spontaneous autoimmune diabetes mellitus caused by a T cell-dependent process that destroys pancreatic beta cells. Neither the inciting immune system defect nor the mechanism by which beta cells are destroyed is known with certainty. DP rats are severely deficient in certain T cell subsets including CD8+ cytotoxic T cells (Tc) and RT6+ T cells. Diabetes-resistant (DR) BB/Wor rats can be rendered diabetic if depleted of RT6+ T cells. To investigate the mechanisms of beta cell destruction in BB rat diabetes, we determined: 1) the relative abundance of Tc and NK cells in the islets of acutely diabetic DP and RT6-depleted DR rats and 2) expression of mRNA encoding cytolysin, a cytolytic pore-forming protein produced by both Tc and NK cells. We found that in the islets of acutely diabetic DP rats NK cells were about three times more abundant than in diabetic RT6-depleted DR rats. Conversely, in the islets of diabetic DR rats, Tc were three times more abundant than NK cells. In addition, cytolysin gene expression was detected in about 60% of the islets of both DP and DR rats. These data suggest that cytolysin may be a mechanism by which Tc and NK cells damage B cells in vivo.

Cytolysin gene expression in the islets of diabetic BioBreeding/Worcester rats

Diabetes prone (DP) BB/Wor rats develop spontaneous autoimmune diabetes mellitus caused by a T cell-dependent process that destroys pancreatic beta cells. Neither the inciting immune system defect nor the mechanism by which beta cells are destroyed is known with certainty. DP rats are severely deficient in certain T cell subsets including CD8+ cytotoxic T cells (Tc) and RT6+ T cells. Diabetes-resistant (DR) BB/Wor rats can be rendered diabetic if depleted of RT6+ T cells. To investigate the mechanisms of beta cell destruction in BB rat diabetes, we determined: 1) the relative abundance of Tc and NK cells in the islets of acutely diabetic DP and RT6-depleted DR rats and 2) expression of mRNA encoding cytolysin, a cytolytic pore-forming protein produced by both Tc and NK cells. We found that in the islets of acutely diabetic DP rats NK cells were about three times more abundant than in diabetic RT6-depleted DR rats. Conversely, in the islets of diabetic DR rats, Tc were three times more abundant than NK cells. In addition, cytolysin gene expression was detected in about 60% of the islets of both DP and DR rats. These data suggest that cytolysin may be a mechanism by which Tc and NK cells damage B cells in vivo.

Dynamic 13C NMR analysis of oxidative metabolism in the in vivo canine myocardium

Oxidative metabolism in the in vivo canine myocardium was studied noninvasively using 13C-enriched acetate and non-steady state 13C NMR techniques. Under low workload conditions, the myocardium oxidized the infused [2-13C]acetate and incorporated the labeled carbon into the glutamate pool as expected. This conclusion stems from the rapid enrichment of the C-2, C-3, and C-4 carbons of glutamic acid both under in vivo conditions and in extracts. Surprisingly, [2-13C]acetate uptake was not observed at high workloads as reflected by an absence of glutamate pool enrichment at these rate pressure products. Rather, the myocardium selected its substrate from an endogenous pool. Since free acetate can directly cross the inner mitochondrial membrane and be converted to acetyl-CoA through acetyl-CoA synthetase, these results support workload-dependent regulation of substrate access to the mitochondrial CoASH pool. As such, we advance the hypothesis that the selection of substrate for condensation with CoASH and subsequent oxidation in the tricarboxylic acid cycle is regulated kinetically through the Km values of the appropriate condensation enzymes and through the absolute levels of free CoASH in the mitochondria.

Functional ecdysone receptor is the product of EcR and Ultraspiracle genes

Although the biological activity of the insect moulting hormone ecdysone, is manifested through a hormonally regulated transcriptional cascade associated with chromosomal puffing, a direct association of the receptor with the puff has yet to be established. The cloned ecdysone receptor (EcR) is by itself incapable of high-affinity DNA binding or transcriptional activation. Rather, these activities are dependent on heterodimer formation with Ultraspiracle (USP) the insect homologue of vertebrate retinoid X receptor. Here we report that native EcR and USP are co-localized on ecdysone-responsive loci of polytene chromosomes. Moreover, we show that natural ecdysones selectively promote physical association between EcR and USP, and conversely, that high-affinity hormone binding requires both EcR and USP. Replacement of USP with retinoid X receptor produces heterodimers with distinct pharmacological and functional properties. These results redefine the ecdysone receptor as a dynamic complex whose activity may be altered by combinatorial interactions among subunits and ligand.

Consumption of n-3 polyunsaturated fatty acid-enriched eggs and changes in plasma lipids of human subjects

The cholesterolemic effect of chicken eggs enriched with n-3 polyunsaturated fatty acids (PUFA) was investigated in healthy volunteers. Twenty-three male university students consumed two regular or n-3 PUFA-enriched eggs per day with their habitual diet for 18 days. Plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were raised in subjects who consumed regular eggs but were maintained virtually unchanged in those who consumed n-3 PUFA-enriched eggs. Intake of two regular eggs a day did not affect plasma high-density lipoprotein cholesterol (HDL-C) and plasma triglyceride (TG) levels, but intake of two n-3 PUFA-enriched eggs a day resulted in a significant elevation in HDL-C (p < 0.05) and a reduction in plasma TG (p < 0.01). Consuming regular eggs tended to decrease both HDL-C/TC and HDL-C/LDL-C ratios, whereas consuming n-3-enriched eggs tended to increase them. The n-3 PUFA contents in plasma lipids of subjects who consumed n-3 PUFA-enriched eggs were also found to be elevated. These results demonstrate that the cholesterolemic property of chicken eggs can be modified by altering the fatty acid composition of yolk lipids.

Interactive intraoperative localization using an infrared-based system

We discuss new methods of localizing and treating brain lesions for both the conventional method of a base-ring fixed to the patient's skull (referred to as frame-based procedures) and the new method of frameless procedures (no base ring). Frame-based procedures are used for finding a precise instrument position during neurosurgical procedures, such as stereotactic biopsy of deep-seated lesions, placing electrodes for functional stereotaxis or catheters with radioactive seeds for brachytherapy, or even the placement of a stereotactic retractor or endoscope for removal or internal decompression of lesions. In such procedures, the intraoperative image localization of instruments becomes useful as it tracks instruments as they travel through the preplanned trajectory. Additional intraoperative digitization of surgical instruments, e.g., bipolar suction, biopsy forceps, microscope, ultrasound probe, etc, can be achieved during the stereotactic resection of eloquent areas or deep intracranial lesions by adding an infrared-based system. Frameless procedures broaden the range of surgical approaches, image guidance planning, and operative procedures, since no ring is attached to the patient's head which might interfere with the surgical approach, and offers logistic advantages in scheduling diagnostic studies. Frameless diagnostic studies employ anatomical markers and/or surface matching techniques for data registration in the computer software surgical preplanning program. This simplifies scheduling of the procedures since the image study does not need to be acquired the same day as surgery. Frameless diagnostic studies allow for the use of more than one type of imaging data for planning and optimization of surgical procedures, and greatly improve patient tolerance and comfort during these procedures and during surgery, as compared with frame-based procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

A graphical user interface to facilitate patient-specific drug dosing

This paper describes the development of a graphical user-interface (GUI) designed to facilitate the process of generating patient-specific drug doses using bayesian modelling software. The graphical user interface was developed in Visual Basic (Microsoft, Inc.) and runs under the Windows 3.1 (Microsoft, Inc.) operating system. Patient demographic data are stored in a relational database (Access, Microsoft, Inc.). The GUI and the database communicate via dynamic data exchange links. The largely object-oriented nature of the language allowed us to change the entire look and feel of the system with a few simple changes to the underlying code. Use of the relational database to store patient demographic information allows greater flexibility in searching for and displaying patient specific information. The GUI reduces the time required to enter data. The prototype has allowed us to experiment with different presentation methods, greatly improving the clinical acceptance of the dosing programs.

[Development of hybridomas secreting monoclonal anti-idiotypic antibodies that bear the internal image of the terminal trisaccharide of PGL-I]

Two hybridomas designated as F7B7 and F7B9 secreting monoclonal anti-idiotypic antibodies against terminal trisaccharide of PGL-I were developed by fusion of SP2/0 cells and spleen cells of BALB/c mouse immunized with mouse monoclonal anti-trisaccharide of PGL-I (MAb1-E10F1). To characterize the F7B7, the following results were obtained. First, F7B7 reacted with MAb1-E10F1 specifically. Secondly, the cross ELISA neutralizing tests gave positive results. The binding of anti-trisaccharide positive serum with trisaccharide (contained in semi-synthetic antigen, NT-O-BSA) was inhibited F7B7 and the degree of inhibition showed dose-dependent manner. The binding of anti-trisaccharide positive serum with F7B7 was inhibited by NT-O-BSA and the degree of inhibition also showed dose-dependent manner. It was concluded that the hybridoma F7B7 is able to secrete monoclonal anti-idiotypic antibodies that bear the internal image of trisaccharide of PGL-I. The potentials and advantages of monoclonal anti-idiotypic antibody F7B7 as surrogate antigen in the serodiagnosis of leprosy have been discussed.

[The antioxidant action of AH-9]

AH-9 is a compound with hypoglycemic action. AH-9 was also found to have antioxidant activity. The hemolysis, hemoglobin oxidation and lipid peroxidation of erythrocytes induced by hydrogen peroxide and Fe(++)-induced MDA formation of liver microsomes were inhibited by AH-9, and the activity of SOD and catalase were shown to be increased in normal and alloxan-diabetic mice after treatment with AH-9. The above results indicate that AH-9 might act as a scavenger of superoxide and might be useful for improving the pathophysiological state in diabetes mellitus and its complications.

[The hypoglycemic effect of AH-9]

AH-9 is an acylhydrazine compound with hypoglycemic effects in normal mice, alloxan-induced diabetic mice and spontaneously diabetic KK mice. In terms of equi-molar doses (0.3 mmol/kg po), AH-9 was found to be more potent than phenfornin and glicalazide (diamicron) in normal mice. Insulin resistance was shown to be improved in spontaneously diabetic KK mice and hydrocortisone-induced insulin resistant mice after treatment with AH-9. The LD 50 of AH-9 given orally to mice was found to be 956 mg/kg (about 18 times its effective dose). Studies on the hypoglycemic mechanism of AH-9 (insulin release, insulin receptor and post-receptor) showed that AH-9 did not influence serum insulin levels in mice. But, in in vivo experiments, AH-9 appeared to promote the capacity and affinity of insulin receptors in mouse liver plasma membranes. AH-9 was also found to antagonize the elevation of blood glucose level and liver glycogen content caused by alanine injection. AH-9 was shown to enhance the conversion of U-14C-glucose to 14CO2 in mouse epididymal fat tissue in vitro. According to the above results, the hypoglycemic action of AH-9 might be due to: 1) increasing the capacity and affinity of insulin receptors; 2) directly enhancing glucose aerobic oxidation; and 3) inhibiting gluconeogenesis.

Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China

In northern China, annual epidemics of acute-onset flaccid paralysis diagnosed clinically as Guillain-Barré syndrome have been recognized for at least 20 years. On the basis of an historical analysis of more than 3,200 patients, distinctive features include most cases occurring during the summer months among children and young adults, most of whom reside in rural areas. Of 90 patients with acute flaccid paralysis, 88 had a distinctive pattern that shares clinical and cerebrospinal fluid findings with demyelinating Guillain-Barré syndrome, but that differs from Guillain-Barré syndrome physiologically and pathologically. The clinical course is marked by rapidly progressive ascending tetraparesis, often with respiratory failure, but without fever, systemic illness, or sensory involvement. Cerebrospinal fluid is acellular, and elevations of protein content occur in the second or third week of illness. Electrodiagnostic studies show normal motor distal latencies and limb conduction velocities, but reduced compound muscle action potential amplitudes. Sensory nerve action potentials and, when elicitable, F waves are within the range of normal. Recovery is usually good. Autopsy studies have shown Wallerian-like degeneration of motor fibers. These studies establish that this is a distinctive syndrome, distinguishable from poliomyelitis and demyelinating Guillain-Barré syndrome.

Is atrial pacing needed for determination of coronary flow reserve by parametric imaging?

Heart rate changes during determination of coronary flow by parametric imaging may influence the flow measurement. Thus, the question is whether atrial pacing is mandatory for determination of coronary flow reserve (CFR) by this technique. CFR was calculated by digital subtraction angiography (parametric imaging) in 10 patients (8 with coronary artery disease and 2 control subjects) during sinus rhythm and during atrial pacing. Flow measurements were determined in the perfusion region of the left anterior descending and circumflex coronary artery, both at rest and after maximal coronary vasodilation with 10 mg intracoronary papaverine. CFR was defined as coronary flow during hyperemia divided by coronary flow at rest. Spontaneous heart rate was 71 +/- 15 min-1 at baseline, 73 +/- 15 min-1 after papaverine injection and 85 +/- 10 min-1 during atrial pacing. Heart rate variations during coronary arteriography were 4 +/- 3 min-1 at baseline and 5 +/- 4 min-1 after papaverine administration. CFR was 2.61 +/- 1.01 during sinus rhythm and 2.67 +/- 1.05 during atrial pacing. Mean absolute difference in CFR between sinus rhythm and atrial pacing was 0.31 +/- 0.31 (12 +/- 10% of CFR during pacing). Spontaneous heart rate variations during coronary arteriography are not associated with significant changes in CFR. Thus, atrial pacing is not mandatory for the determination of CFR by parametric imaging.

Schizophrenic delusions among Koreans, Korean-Chinese and Chinese: a transcultural study

In this transcultural study of schizophrenic delusions among Koreans, Korean-Chinese and Chinese, many delusions were shown to be different among the three groups in their frequency and content and the differences could be explained by sociocultural and political factors. Delusional themes sensitive to influence by sociocultural or political situations and changes seem to be 'family', 'love affairs', 'religious matters', 'economic matters', 'specific physical damage' and 'political themes.' Delusions about 'family', 'love affair', 'being raped', 'religious matters' and 'economic and business matters' were most frequent in Koreans. Delusions of 'blood-relatedness', 'longevity' and 'political themes' were most frequent in Korean-Chinese. Delusions of 'bloodsucking and brain or viscera extracted' and 'poison or being pricked by poisoned needle' were most prominent in Chinese.

New calcium-sensitive ligand for nuclear magnetic resonance spectroscopy

Fluorinated calcium-sensitive indicators such as 5,5'-difluoro-1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (difluoro-BAPTA) will often be less sensitive under in vivo conditions than gyromagnetic ratio considerations alone would have predicted. This is due to the very broad line widths displayed by these molecules within the living cell. In order to provide a spectroscopic alternative to these molecules, we have synthesized 13C-enriched 1-(2-aminophenoxy)-2-(2-aminoethoxy)ethane-N,N,N',N'-tetraac etic acid or AATA. The rationale for the design of this molecule was the increased signal to noise ratio available by selective detection of 13C-attached protons in AATA using proton-observe carbon-edited spectroscopy or multiple-quantum coherence. AATA has the advantage of increased number of detectable nuclei and narrow line widths. As such, it should provide a 6-10-fold improvement in the signal to noise ratio over existing fluorinated indicators. As a hybrid between EGTA and BAPTA, AATA should display intermediate pKa's, exchange rates, and KD values. We have measured pKa values of 5.94 +/- 0.05 and 9.03 +/- 0.05 for AATA. KD values of 350 +/- 80 nM and 6.6 +/- 2.0 mM were obtained for the AATA-Ca2+ and AATA-Mg2+ interactions, respectively, at 37 degrees C in 0.1 M KCl. As such, this new ligand displays the expected selectivity for Ca2+ over Mg2+. This new approach to detection of intracellular probes with NMR can be readily extended to other probes for intracellular ions, pH, and membrane potential. In addition, the move toward carbon-selected proton spectroscopy should also permit more flexibility in synthetic approaches since the strong electronegativity of fluorine often hampers synthetic design.

[The kinetic observation of serum ketone body levels in surgical patients receiving MCT or LCT emulsions]

The changes of serum beta-hydroxybutyrate concentrations in patients after receiving medium chain triglycerides (MCT) or long chain triglycerides (LCT) were studied. The patients were divided into two groups: in Group 1, the dose of fat was 0.14 g/kg.h for fat emulsion clearance test: and in Group 2, the dose was 0.06 g/kg.h for total parenteral nutrition (TPN) support. The beta-hydroxybutyrate concentrations were estimated by an enzymatic method using Sigma's beta-hydroxybutyrate kit (Sigma Diagnostics, MO 63178, USA). The normal range of beta-hydroxybutyrate concentration in 30 healthy Chinese subjects was 1.04 +/- 1.42 mg/dl (range 0-3.88 mg/dl). In Group 1, we found that the concentrations of beta-hydroxybutyrate rose steadily after fat emulsion infusion. The concentrations in the medium chain triglyceride group were higher than those in long chain triglyceride group. The elevated concentrations of beta-hydroxybutyrate gradually returned to normal levels when the emulsion infusion was stopped. In Group 2, the concentrations of beta-hydroxybutyrate in the patients were within the normal range.

Transforming growth factor beta 1 and adrenocorticotropin differentially regulate the synthesis of adrenocortical cell heparan sulfate proteoglycans and their binding of basic fibroblast growth factor

Adrenocortical differentiated functions are under the control of both endocrine hormones such as ACTH and local factors such as transforming growth factor beta (TGF beta) or basic fibroblast growth factor (bFGF). Besides their regulatory actions on the synthesis of corticosteroids, these two classes of factors also exert some important effects on the cellular environment. We have examined here the regulation by ACTH and TGF beta of adrenocortical cell proteoglycan synthesis and secretion. Under basal conditions, adrenocortical cells synthesized and secreted several species of sulfated proteoglycans, 80% of them being recovered in solution in the culture medium. When analyzed by ion exchange chromatography, the cell extracts and the media from cells metabolically labeled with 35S-sulfate were found to contain two and three species of radioactive sulfated proteoglycans, respectively. All species were proteoheparan-sulfates. Treatment of adrenocortical cells with TGF beta 1 or ACTH resulted in a significant increase of the incorporation of 35S into both secreted and cell-associated proteoglycans. ACTH stimulated more than three times the amount of secreted proteoglycans eluting from DEAE-Trisacryl as peak B, whereas TGF beta preferentially increased the amount of peak C. No important modification of the size of the synthesized proteoglycans was observed. The subpopulation of heparan sulfate proteoglycans capable to bind bFGF was also largely increased after ACTH or TGF beta treatment and paralleled the variation in overall proteoheparan sulfate synthesis. Thus those effects of TGF beta and ACTH on proteoglycan synthesis may participate in an increased ability of adrenocortical cells to bind and respond to bFGF.

Monitoring of serum markers for fibrosis during CCl4-induced liver damage. Effects of anti-fibrotic agents

Liver fibrosis was induced in rats by repeated peritoneal injections of carbon tetrachloride (CCl4) over a period of 2-11 weeks. Serum procollagen III peptide (SPIIINP), prolidase (SP) and alanine aminotransferase (SALT) levels were monitored during the period of induction. The extent of fibrosis was semi-quantitatively estimated after collagen staining, and the anti-fibrotic effects of 16,16-dimethyl prostaglandin E2 (DMPGE2), colchicine, and zinc sulphate were studied. SPIIINP and SP were increased the first 2 weeks after CCl4 administration and peaked at 6 weeks. Alterations in SPIIINP and SP correlated well to the semi-quantitative histological score of liver sections during the first 6 weeks, and SP was positively related to SPIIINP throughout the whole induction period. DMPGE2 decreased SPIIINP, SP and SALT significantly in addition to a markedly decreased formation of liver collagens. Colchicine had a similar but less dramatic effect, whereas zinc sulphate only reduced SPIIINP without influencing liver damage. In conclusion SPIIINP seems to be a valuable indicator of liver fibrogenesis, and SP may play a limited role in indicating accelerated collagen metabolism in the liver. DMPGE2 obviously inhibited the production of collagens induced by CCl4. Colchicine also had an apparent effect on liver fibrosis, whereas zinc sulphate merely seemed to postpone it.

[Reduction mammaplasty]

Twenty-eight breasts of 15 patients with macromastia underwent reduction mammaplasty from 1982 to 1989. We followed up these patients postoperatively for 6 months to 7 years. The follow-up time for 8 patients was over 1 year, and 4 patients over 5 years. And 3 patients labored and lactated. These 15 patients were satisfied with this operative results. The operative technology was based on Pitange's method. This method improved the site of the nipple, transposition of nipple-areola complex, and design of dermal pedicle, so that it had better effects in the breast shape, breast fixation and incision scar concealed. We suggest that the purpose of macromastia treated in reducing volume, improving breast shape, preserving lactating function. This paper also discusses the methods for nipple site, nipple-areola complex transposition, breast resection and mastopexy.

Ion-exchange chromatography (IC) in the determination of serum transition metals and its clinical application

The reproducibility of ion-exchange chromatography (IC) (Dionex Bio-LC) in measuring the serum transition metals Cu and Zn was found to be fairly good (CV = +/- 2.1% and +/- 2.7% within runs, and +/- 2.5% and +/- 4.3% among runs for Cu and Zn, respectively). For clinical application, sera from 20 normal volunteers and 20 patients with cancers of the digestive tract (10 early and 10 late stage cases) were analyzed. The means of serum Cu (15.54 +/- 0.31 mumol/L) and serum Zn (14.84 +/- 0.31 mumol/L) in normal volunteers were very close to the values previously determined by atomic absorption spectrophotometry in our laboratory. In the group of late stage cancer patients, the means of serum Cu (24.18 +/- 0.63 mumol/L) and the Cu/Zn ratio (1.97 +/- 0.07) were significantly elevated (P < 0.01), while serum Zn (13.01 +/- 0.61 mumol/L) was remarkably decreased (P < 0.05). There were no significant changes of serum Cu, Zn and Cu/Zn ratio in early stage cancer patients. It is concluded that the IC method is rapid, accurate, sensitive, relatively simple and could be useful in diagnosing late stage cancers of the digestive tract.