Expressed genes in interleukin-4 treated B cells identified by cDNA representational difference analysis

Interleukin-4 (IL-4) stimulates B cell growth and differentiation, such as inducing mature B cells to switch to IgG1 and IgE production. To further characterize IL-4 effects on B cells, we used a sensitive PCR-based subtraction approach to isolate genes expressed in IL-4 treated cells. Our approach combined an adaptation of the genomic representational difference analysis (RDA) method to cDNA analysis with a physical separation method (magnetic bead depletion). This cDNA RDA technique allowed us to perform subtraction on the relatively small number of highly, characterized, purified B cells that can be conveniently prepared. In the hopes of removing genes responsible for general cell growth, we subtracted cDNA made from lipopolysaccharide (LPS)-stimulated B cells from cDNA from LPS+IL-4 stimulated B cells. Two rounds of subtraction resulted in greater than 100-fold enhancement of expected IL-4-induced Cgamma1 cDNA. At that point, we cloned this subtraction library and analysed 154 randomly picked clones for sequence similarities. From these clones, 37 individual genes were obtained. Most of these genes (30) could be functionally identified by sequence similarity. These included genes encoding Cgamma1 (1), cytoskeletal components (4) and products involved in DNA replication (3), metabolism (5), signal transduction (4), transcription (4), translation (6) and transport (3). Only 7 genes had no similarity to known sequences in the GenBank, EMBL or Swiss Prot databases. One unknown gene (designated Fig1 for IL-Four Induced Gene 1) and one gene with homology to the human transcription factor E4BP4 were confirmed by Northern blot analysis to be induced 10-20-fold by IL-4 treatment. This list of expressed genes in LPS + IL-4 treated B cells may shed further insight on the action and mechanism of IL-4 stimulation of cells.

Isoorientin-6"-O-glucoside, a water-soluble antioxidant isolated from Gentiana arisanensis

The antioxidant activities of isoorientin-6"-O-glucoside were studied using various models. Isoorientin-6"-O-glucoside was more potent than Trolox, probucol and butylated hydroxytoluene (BHT) in reducing the stable free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH). It also scavenged superoxide anion, peroxyl and hydroxyl radicals that were generated by xanthine/xanthine oxidase, 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH) and Fe3+-ascorbate-EDTA-H2O2 system, respectively. The IC50 value, stoichiometry factor and second-order rate constant were 9.0+/-0.8 microM, 1.8+/-0.1 and 2.6 X 10(10) M(-1) s(-1) for superoxide generation, peroxyl and hydroxyl radicals. However, isoorientin-6"-O-glucoside did not inhibit xanthine oxidase activity or scavenge hydrogen peroxide (H2O2), carbon radical or 2,2'-azobis(2,4-dimethyl-valeronitrile) (AMVN)-derived peroxyl radical in hexane. Isoorientin-6"-O-glucoside inhibited Cu2+-induced oxidation of human low-density lipoprotein (LDL) as measured by fluorescence intensity, thiobarbituric acid-reactive substance formation and electrophoretic mobility. Since isoorientin-6"-O-glucoside did not possess pro-oxidant activity, it may be an effective water-soluble antioxidant that can prevent LDL against oxidation.

Fiber-matrix interface studies on bioabsorbable composite materials for internal fixation of bone fractures. II. A new method using laser scanning confocal microscopy

In this study, a new visual characterization method was developed using laser scanning confocal microscopy (LSCM) to study morphologic properties, particularly at the fiber-matrix interface, by optical sectioning of bioabsorbable single-fiber composites. The interface gap width (IGW) between the fiber and matrix, and the changes in IGW after in vitro hydrolysis, named the gap rate (Rg), were measured from images obtained using the LSCM. Higher values for IGW and Rg showed faster degradation of the fiber-matrix interface. These parameters were used to investigate the effects of strain, wicking, different reinforcing fibers, and gamma-irradiation on the fiber-matrix interface morphology. The component materials used were nonbioabsorbable AS4 carbon (C) fibers, bioabsorbable calcium phosphate (CaP), poly(glycolic acid) (PGA), and chitin fibers, and bioabsorbable poly(L-lactic acid) (PLLA) matrix. The application of strain on CaP/PLLA composites increased the IGW up to about 15%, after which there was no change up to 25%. The Rg for CaP/PLLA composites with the fiber ends exposed in vitro (permitting wicking) was greater than for CaP/PLLA with the fiber ends embedded completely within the matrix (preventing wicking). Open-end C/PLLA composites had the slowest rate of interface degradation in vitro, followed by chitin/PLLA, PGA/PLLA, and CaP/PLLA. The exposure of closed-end CaP/PLLA composites to 4 Mrad of gamma-irradiation, in air at room temperature or in vaccuum at 77K, accelerated the rate of interface degradation in vitro. In conclusion, an effective new visual characterization method was developed using LSCM, and it was used to show that (a) moderate strain could accelerate the degradation of the interface, (b) fiber-matrix interface wicking could accelerate the rate of degradation of the interface, (c) the rate of interface degradation depends on the type of fiber used, and (d) gamma-irradiation could accelerate the rate of interface degradation. Furthermore, the results of LSCM analysis of different reinforcing fibers with a PLLA matrix agree with measurements of interfacial shear strength (IFSS) and single-fiber tensile strength reported in Part I of this study.

Fiber-matrix interface studies on bioabsorbable composite materials for internal fixation of bone fractures. I. Raw material evaluation and measurement of fiber-matrix interfacial adhesion

The objective of this study was to characterize and evaluate the performance of various fiber-matrix composite systems by studying the mechanical, thermal, and physical properties of the fiber and matrix components, and by studying the fiber-matrix interface adhesion strength using both microbond and fragmentation methods. The composites studies were poly(L-lactic acid) (PLLA) matrix reinforced with continuous fibers of either nonabsorbable AS4 carbon (C), absorbable calcium phosphate (CaP), poly(glycolic acid) (PGA), or chitin. Carbon and CaP single fibers had high Young's moduli and failed in a brittle manner. PGA and chitin single fibers had relatively lower Young's moduli and relatively higher ductility. Upon in vitro hydrolysis, CaP fibers retained 17% of their tensile strength and 39% of their Young's modulus after 12 h, PCA fibers retained 10% of their tensile strength and 52% of their Young's modulus after 16 days, and chitin fibers retained 87% of their tensile strength and 130% of their Young's modulus after 25 days. PLLA films had much lower strength and Young's moduli, but much higher ductility relative to the single fibers. Using the microbond method, the initial fiber-matrix interfacial shear strength (IFSS) of C/PLLA and CaP/PLLA microcomposites was 33.9 and 12.6 MPa, respectively. Upon in vitro hydrolysis, C/PLLA retained 49% of IFSS after 15 days and CaP/PLLA retained 46% of IFSS after 6 h. Using a fiber fragmentation method, the initial IFSS of C/PLLA, CaP/PLLA, and chitin/ PLLA was 22.2, 15.6, and 28.3 MPa, respectively. The performance of carbon fibers and C/PLLA composites was superior to the other fibers and fiber/PLLA systems, but the carbon fiber was nonabsorbable. CaP had the most suitable modulus of the absorbable fibers for fixing cortical bone fracture, but its rapid deterioration of mechanical properties and loss of IFSS limits its use. PGA and chitin fibers had suitable mechanical properties and their retention for fixing cancellous bone fractures, but likely had insufficient stiffness for applications such as bone plates for fixing cortical bone fractures.

Cerebral sparganosis: increased uptake of technetium-99m-HMPAO

Cerebral sparganosis is an extremely rare intracranial parasitic infectious disease. We report findings of 99mTc-HMPAO cerebral perfusion SPECT in a case with cerebral sparganosis. SPECT revealed an irregularly shaped area with markedly increased 99mTc-HMPAO uptake in the parasitic infectious region of the cerebrum. Both white and gray matter was involved, the white matter involved predominantly. Decreased perfusion to the right cerebellum, suggesting cross cerebellar diaschisis, was also demonstrated. This article illustrates that cerebral sparganosis is one of the causes of increased 99mTc-HMPAO uptake in the cerebrum and should be considered clinically if present.

Exaggerated luminal loss a few minutes after successful percutaneous transluminal coronary angioplasty in patients with recent myocardial infarction compared with stable angina: an intracoronary ultrasound study

This study investigates the mechanisms of exaggerated acute luminal loss after successful coronary angioplasty in patients with recent myocardial infarction compared with stable angina by angiography and intracoronary ultrasound (ICUS). We studied 15 consecutive patients (group 1) who, after a successful thrombolysis for myocardial infarction, underwent delayed (8 +/- 2 days after the myocardial infarction) successful balloon coronary angioplasty. Group 1 patients were individually matched with 15 stable angina patients (group 2). The percentage of stenosis and acute luminal loss were measured by quantitative coronary analysis. The ultrasound characteristics of lumen pathology were described as soft, hard, calcified, eccentric, concentric, thrombotic, and dissection lesions. Matching by stenosis location, reference diameter, sex, and age resulted in 2 comparable groups of 15 lesions with identical baseline characteristics. Immediately after percutaneous transluminal coronary angioplasty (PTCA), the minimal luminal diameter increased from 0.5 +/- 0.3 mm to 2.4 +/- 0.3 mm and from 0.5 +/- 0.2 mm to 2.4 +/- 0.3 mm in groups 1 and 2, respectively. Similar balloon sizes were used in both groups. The acute luminal loss (the difference between the maximal dilated balloon diameter and the minimal luminal diameter) immediately after PTCA was 0.4 +/- 0.2 mm and 0.3 +/- 0.3 mm (14 +/- 8% and 10 +/- 11% of balloon size) (P = not significant [NS]) in groups 1 and 2, respectively. After ICUS (mean 24 min after the last balloon deflation), the acute luminal loss was 0.9 +/- 0.3 mm and 0.5 +/- 0.4 mm (29 +/- 11% and 17 +/- 8% of balloon size) (P = 0.01) in groups 1 and 2, respectively. There was a significantly higher prevalence of intracoronary thrombus formation as detected by ICUS in group 1 compared with group 2 (80% vs. 20%; P < 0.001). In matched groups of successfully treated coronary angioplasty, patients with recent myocardial infarction had a similar magnitude of acute gained luminal loss immediately after the procedure. However, an exaggerated luminal loss a few minutes after the last balloon deflation in patients with recent myocardial infarction was noted because of mural thrombus formation compared with patients with stable angina.

Fig1, an interleukin 4-induced mouse B cell gene isolated by cDNA representational difference analysis

Interleukin 4 (IL-4) is a cytokine that regulates growth and differentiation of lymphoid and nonlymphoid cells. To study the molecular basis of IL-4 function, we used a cDNA subtraction approach based on the representational difference analysis method. This subtractive amplification technique allowed us to use small amounts of RNA from lipopolysaccharide +/- IL-4-stimulated normal B cells to obtain IL-4-induced genes from these cells. We report here on one such gene, Fig1 (interleukin-four induced gene 1), the first characterized immediate-early IL-4 inducible gene from B cells. Fig1 expression is strikingly limited to the lymphoid compartment. B cells, but not T cells or mast cells, express Fig1 in response to IL-4 within 2 hr in a cycloheximide resistant manner. IL-2, IL-5, and I1-6 do not induce Fig1 in culture. Fig1 maps between Klk1 and Ldh3 on mouse chromosome 7, near two loci involved with murine lupus, Sle3 and Lbw5. The Fig1 cDNA sequence encodes a predicted 70-kDa flavoprotein with best homology to the monoamine oxidases, particularly in domains responsible for FAD binding.

Carotid floating plaques associated with multiple cerebral embolic strokes. Case reports

The authors describe 2 patients with multiple cerebral infarcts and hemorrhagic transformation caused by artery-to-artery emboli. Ulcerated plaques with free-floating thrombus adherent to the plaque were detected at the carotid bifurcation by duplex sonography. No other embolic source could be found. One patient developed an occipital infarction due to carotid emboli passing through a fetal-type posterior communicating artery. Both patients recovered well without recurrence of stroke or transient ischemic attack with antiplatelet treatment only. Follow-up carotid duplex sonography showed disappearance of floating thrombus in 1 patient and consolidation of the lesion in the other.

The lost endotracheal tube--a rare complication of accidental esophageal intubation

Endotracheal intubation is a discreet skill for the management of compromised airway. Various complications associated with this procedure have been described. Here, we would like to present a pediatric patient suffering from cerebellar atrophy, who was intubated in a local clinic due to seizure with cyanosis and loss of consciousness. Unfortunately, due to inadvertent esophageal intubation and bad management, the patient swallowed the endotracheal tube together with two detached loose teeth. This irrational and iatrogenic medical misconduct as exemplified in this accident calls forth the need of educating and disciplining the nonanesthetic physicians for acute management of airway, particularly of those who would likely come across difficult airway problems.

The autonomic-related cortex: pathology in Alzheimer's disease

Alzheimer's disease (AD) causes progressive deterioration of cognition and behavior. Memory dysfunction is the hallmark, but there are also changes in behavior, emotion and autonomic functions, which cannot be explained simply as a consequence of memory impairment. These observations suggest that the natural disease process of AD involves not only memory-related neural structures, but also specific neural systems related to other behaviors, emotion and autonomic functions. Since recent evidence has indicated a primary role for ventromedial frontal (VMF) cortex in such functions, we examined laminar distribution of neurofibrillary tangles and Alz 50 immunoreactive neurons in subdivisions of VMF cortex in 20 AD patients and seven age-matched controls. The densities of pathological changes were: (i) highest in the posteromedial mesocortical regions, particularly Brodmann's area 25 (A25), posterior orbitofrontal cortex (POF) and anterior insula (AI); (ii) of comparable severity between posteromedial mesocortical regions and most temporal cortices, excluding only the entorhinal cortex and temporal pole; and (iii) located predominantly in layer III and especially layer V. Further analysis demonstrated selective pathology in layer V of A25, POF and AI that would disrupt direct cortico-autonomic projections. This is the first study to detail severe AD pathology in these autonomic-related cortices, which could contribute to the behavioral changes, emotional disturbance and autonomic dysregulation that often accompany AD.

Peripheral neuropathy in mitochondrial encephalomyopathies

Seven patients with mitochondrial encephalomyopathies were studied for peripheral neuropathy by clinical, electrophysiological and pathological examinations. The clinical manifestation of neuropathy varied from asymptomatic to mild and moderate sensorimotor symptoms with painful paresthesia. Five patients (2 with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes, and 3 with myoclonic epilepsy and ragged-red fibers, MERRF) had clinical symptoms and signs of polyneuropathy associated mainly with decreased amplitudes of the compound muscle or nerve action potentials in an electrophysiological study indicating axonal degeneration. Sural nerve biopsy from 1 MERRF patient, also confirmed an axonal degeneration with reduction of large myelinated fibers. Mitochondrial DNA analysis of the sural nerve from this patient showed a point mutation from A to G transition at the nucleotide position 8344 with 80% mtDNA mutation. The results of this study suggest that peripheral neuropathy is not uncommon in mitochondrial encephalomyopathies and is predominantly due to axonal degeneration.

Intravenous immunoglobulin therapy in POEMS syndrome: a case report

One course of intravenous immunoglobulin was tried on a patient with the syndrome of polyneuropathy, organomegaly, endocrinopathy, M-protein and skin lesions and Castleman's disease. No effect was noted.

Inguinal hernia in children: US versus exploratory surgery and intraoperative contralateral laparoscopy

PURPOSE

To analyze the value of ultrasound (US) in the preoperative recognition of clinically apparent and inapparent inguinal hernias (or patent processus vaginalis).

MATERIALS AND METHODS

Two hundred sixty children (197 boys, 63 girls), in whom a clinical diagnosis of inguinal hernia (226 unilateral hernias, 34 bilateral hernias) had been made, underwent US examination with a 7.0-MHz linear-array transducer. The contralateral internal inguinal ring was evaluated by means of intraoperative laparoscopy in 141 patients. The 197 boys were grouped together by age (< 12 months, 12-24 months, 24-48 months, 48-72 months, and > 72 months).

RESULTS

In the 260 patients who underwent inguinal herniorrhaphy, 246 hernias (95%) were correctly diagnosed at US based on criteria of an internal inguinal ring width greater than 4 mm in diameter or the presence of fluid or organs in the inguinal canal at rest or during straining. A total of 473 hernias were confirmed surgically and 459 (97%) hernias were correctly detected at US. A statistically significant difference in the mean width of the internal inguinal ring of the five age groups was found between patients at rest and during straining (P < .05) in US measurement of the 197 surgically proved cases in boys.

CONCLUSION

US is a noninvasive, readily available, and highly accurate (95%) method for evaluating the presence of inguinal hernia in children at risk, especially when the clinical findings are equivocal or normal. US can provide an objective measure in determining the advisability of exploratory inguinal surgery in such cases.

Carbon disulfide induced polyneuropathy: sural nerve pathology, electrophysiology, and clinical correlation

We report the clinical features, electrophysiological studies, sural nerve pathology and recovery course of carbon disulfide-(CS2) induced polyneuropathy in a 48-year-old man who worked in a viscose rayon plant. Sural nerve biopsy 2 years later still showed degeneration of both axon and myelin with a predominant loss of large myelinated fibers and remyelination. Electrophysiologic studies revealed mixed axonal and demyelinating polyneuropathy. To our knowledge, this is the first human report of sural nerve pathology in the recovery stage due to CS2 intoxication. After diagnosis, the patient was removed from the toxic environment. In the following three years, he showed part recovery predominantly in motor function compatible with the serial nerve conduction studies. We conclude that CS2 polyneuropathy may partly recover years after cessation of exposure.

H-protein of the glycine cleavage system in Flaveria: alternative splicing of the pre-mRNA occurs exclusively in advanced C4 species of the genus

A recent paper reports on the occurrence of alternative splicing of H-protein pre-mRNA in the C4 species, Flaveria trinervia, that is organ-specifically regulated. The analysis of 11 other species of the genus, F. cronquistii and F. pringlei (C3), F. anomala, F. chloraefolia, F. floridana, F. linearis and F. pubescens (C3-C4 intermediate), F. brownii (C4-like), F. palmeri, F. bidentis and F. australasica (C4), revealed that this post-transcriptional effect is not specific for F. trinervia. It occurs in all the examined C4 species of the genus Flaveria except the less advanced C4-like species, F. brownii. Both the position and the direct effect of alternative splicing, the addition of two alanine residues near to the N-terminus of the derived mature H-protein, are invariant. A quantification of the relative amounts of both transcripts revealed that, as in F. trinervia, the alternative mRNA strongly dominates in leaves. In sharp contrast, none of the C3, C3-C4 intermediate, or C4-like species showed alternative splicing. By Western analysis both H-isoproteins have been detected in F. trinervia and their ratio approximately corresponds to the measured transcript levels. It is concluded that alternative splicing leads to the synthesis of two different H-proteins of the glycine cleavage system in all advanced Flaveria C4 species.

Case report: Pontine haemorrhage following iohexol lumbar myelography

A case of pontine haemorrhage following lumbar myelography using iohexol is described. Stress, inducing transient hypertension during the procedure, with superimposed neurotoxicity from contrast medium (iohexol) is suggested as a possible mechanism. No brain stem lesion was seen on the initial brain CT scan, possibly because of the high attenuation of the contrast medium in the subarachnoid space. A delayed CT brain scan demonstrated the pontine haemorrhage and was necessary to confirm the diagnosis.

Low-dose intravenous immunoglobulin therapy in myasthenia gravis: a case report

The maintenance effect of low dose, short duration intravenous immunoglobulin (IVIg) therapy (0.3gm/kg/day for one day) is reported in a patient with myasthenia gravis. The patient had had a progressive course of diplopia, generalized muscle weakness and bulbar symptoms in spite of anticholinesterase agents and steroid therapy for two years. She received a course of high-dose IVIg infusion (0.5 gm/kg/day) for five days, and the symptoms disappeared in few days. However, they recurred 13 months later. Because of the high cost of high-dose IVIg, a trial with 0.3 gm/kg/day IVIg for 1 day was initiated. The clinical neurological manifestations improved within a few hours, and this made natural fluctuation unlikely. She received 4 courses of 1 day, low-dose IVIg therapy during the follow-up period of two years. The beneficial effects usually maintained for two to six months. She was symptom free and had no side effects. The report suggests that low-dose IVIg can be an alternative way, at least in some patients when there is consideration of economic benefit and convenience, compared with high-dose IVIg in the treatment of myasthenia gravis.

Epididymo-orchitis in an infant resulting from Escherichia coli urinary tract infection

Epididymo-orchitis (EO) is said to be extremely rare in infants and children. It is usually diagnosed after scrotal exploration for symptoms which mimic manifestations between EO and torsion of the cord and its appendage. The pathophysiologic mechanisms for the development of EO are not well known. Although some causative agents of EO have been reported, in most cases there was no clear etiology. We report a 3-month-old male infant who had been well until the day prior to admission when irritability, left testicular swelling, scrotal erythema with a hot sensation were noted by his mother. He was treated medically after excluding the possibility of an emergent surgical condition (such as torsion of the cord and its appendage, or incarcerated hernia) by means of physical examinations, abdominal and inguino-scrotal sonography, laboratory studies, and testicular radionuclide scintigraphy. A catheterized sample of urine for culture yielded Escherichia coli. There was the possibility that the EO was caused by hematogenous rather than local spread from an infection of the urinary tract. He was treated with a 10-day course of intravenous cefazolin and amikacin. Following this, he improved clinically and a repeat catheterized urine sample remained sterile on culture. In addition, a bilateral inguinal hernia and hydrocele were detected by inguino-scrotal sonography and were operated on the 11th hospital day. He was discharged on the 16th day of hospitalization and remained well 11 months after discharge.

Recurrent hypokalemic muscle weakness as an initial manifestation of Wilson's disease

A 24-year-old man had several episodes of hypokalemic muscle weakness of undetermined etiology since the age of 13 years. Wilson's disease (WD) was not diagnosed until the age of 18 when wing-beating tremor in the left upper limb was noted. Renal function study revealed incomplete proximal renal tubular acidosis. The hypokalemic muscle weakness and wing-beating tremor had subsided after long-term penicillamine therapy. The present case indicates that recurrent hypokalemic paralysis due to renal tubular acidosis is a rare initial presentation of WD and may respond to penicillamine therapy.